不同性别人群的冠心病主要危险因素分析

目的分析冠心病(CHD)主要危险因素年龄、高血压、高脂血症、糖尿病在男性和女性人群中的差别。方法经冠状动脉造影检查确诊的冠心病患者608例,其中合并高血压350例,高血脂158例,糖尿病222例。分析男女冠心病发病的年龄及危险因素在不同年龄段的分布。结果冠心病发病平均年龄男性组(55.2±9.9)岁与女性组(64.5±10.1)岁比较有差异(P=0.04),在<50岁亚组中,男性较女性发病率高(P<0.05)。女性组危险因素中高血压病、糖尿病、高脂血症的发生率均明显高于男性组(均P<0.05)。女性高血压在70~79岁亚组较60~69岁亚组下降;糖尿病在男性和女性70~79岁亚组较60~69岁亚组都下降;高脂血症在男性70~79岁亚组构成比下降。冠心病人高血压和糖尿病在男性和女性各年龄亚组构成比差异有统计学意义(P<0.01);高血脂年龄构成比差异无统计学意义(P=0.134)。结论年龄、高血压、高脂血症、糖尿病在男性和女性冠心病患者中有差别。     

我院剖官产率上升原因的调查分析

目的 探讨引起剖宫产率上升的相关因素,提出降低剖宫产率的可行性措施.方法 对2000年1月至2009年12月我院剖宫产病例进行回顾性分析.结果 剖宫产率逐年升高,2000年为32.0%,2001年为34.5%,2002年为35.0%,2003年为32.3%,2004年为37.1%,2005年为37.9%,2006年为40.2%,2007年为41.7%,2008年为43.6%,2009年为46.1%.结论 应采取有效措施,降低剖宫产率.

Abstract：

Objective To discuss the related factors about the rising cesarean section rates, and to propose feasible measures to reduce cesarean section rates. Methods Cesarean section cases in our hospital from January, 2000 to December, 2009 were retrospectively analyzed. Results The cesarean section rate increased year by year,32.0% in 2000,34.5% in 2001,35.0% in 2002,32.3% in 2003,37.1% in 2004,37.9% in 2005,40.2% in 2006,41.7% in 2007,43.6% in 2008,46.1% in 2009. Conclusions Effective measures should be taken to reduce the cesarean section rate.     

Factors strengthening and weakening vaccination competence

The purpose of this study was to describe factors strengthening and weakening vaccination competence. The data were collected by focus group and individual interviews with 40 participants, consisting of health-care professionals, students and clients, and were then analysed by content analysis. The results could be classified into four categories: vaccinator professional conduct, education, client conduct and the vaccination environment. Successful client encounters, comprehensive knowledge of vaccinating, adequate education, clients' positive attitude, suitable physical environment and centralization of vaccinations were considered strengthening factors, whereas their opposites weakened vaccination competence. The two most important factors were vaccinator professional conduct and education, and therefore these factors should be considered the most in education, clinical practice and administration. Further research is necessary to determine how well current education, clinical practice and administration support factors strengthening, and help alleviate factors weakening vaccination competence.     

护士评判性思维能力的调查及其相关因素分析

Objective To investigate and analyze the nurses' critical thinking abilities and its related factors, and provide basic data for developing nurses' critical thinking. Methods 210 nurses accepted CTDICV and EPQ questionnaire investigation in a top hospital in Nantong. Results The total score of nurses' critical thinking was (276.41 ± 26. 107); Single factor analysis results revealed that the critical thinking scores of nurses were significant in different education background(266.5 ± 22.200,277.03 ± 25. 750,292.92 ± 24.841;F = 19. 168, P ＜ 0. 01 ), professional title, length of nursing working and different departments; The length of nursing service and the E scores were positively correlated with the scores of critical thinking; The P, N scores ( r =0. 292,0. 221 ,P ＜0. 01 ) were negatively correlated with the score of critical thinking( r = -. 0142, -0. 196,P ＜0. 05 or P ＜0. 01 ); Multivariate analysis showed that nurses' critical thinking abilities were correlated with the nurse education background, length of service, different departments and the E scores ( P ＜ 0. 01 or P ＜0. 05 ). Conclusions Nursing managers should pay attention on improvement nurses' critical thinking abilities.Nurses critical thinking abilities may be developed by individualized training according to their specific circumstances.     

社会及躯体因素对血液透析患者心理问题的影响及其意义

目的研究血液透析患者的心理问题极其意义，分析探讨社会及躯体因素对心理问题的影响，以期指导临床治疗。方法用问卷形式调查1999年1月-2003年12月在我院血液净化中心进行血液透析的患者的各种症状，进行综合分析，根据其有无神经官能症、易于烦乱或易激、焦虑、抑郁等心理问题分为有症状组和无症状组，然后以心理问题为变量，以社会及躯体因素为不变量，分析社会及躯体因素在每个心理问题两组间的分布极其相关性。躯体因素包括血管痛、痛性痉挛、瘙痒、腿不宁、关节痛、腰痛等。社会因素包括进入血液透析的年龄、透龄、性别、婚姻状况、家庭结构、职业、受教育水平、对肾衰原因的了解及对治疗的渴望等。结果经卡方检验，神经官能症、焦虑与躯体因素的相关性较与社会因素的相关性更大，而易于烦乱或易激与社会因素的相关性更大，抑郁与社会因素和躯体因素都有关。抑郁与患者对肾衰的了解呈负相关，即患者对肾衰知识越缺乏，越易患抑郁。经逐步多无回归分析，腿不宁与各种心理问题都有关。结论本研究结果揭示了社会及躯体因素对血液透析患者心理问题的影响，有助于临床医护人员及患者家属针对产生这些心理问题的原因治疗心理障碍。但心理问题与某些社会因素及躯体因素相互影响，互为因果，有待于进一步研究。     

Relative contribution of intrapersonal and partner factors to contraceptive behavior among taiwanese female adolescents.

PURPOSE: To explore the relative contribution of intrapersonal factors (demographic data, sexual history, and self-efficacy for contraception) and partner factors (perceptions of support from sexual partners for contraception, and relationship power) to contraceptive behaviors among sexually active female adolescents in Taiwan. DESIGN: A cross-sectional design. Female adolescents who have had a steady male sexual partner in the past 3 months (N=375) were recruited as participants. METHODS: Questionnaires including demographic data, sexual history, contraceptive behavior, self-efficacy for contraception, perceptions of support from sexual partner for contraception, and perceptions of relationship power were submitted anonymously for this study. FINDINGS: Participants who had their first sexual experience at less than 14 years of age and were from one-parent families had the least comprehensive contraceptive behavior than did other participants. Number of steady sexual partners was significantly negatively correlated with contraceptive behavior. Self-efficacy, perceptions of support from sexual partner for contraception, and relationship power all were positively correlated with contraceptive behavior. The important explanatory variables of contraceptive behavior were self-efficacy, age of first sexual intercourse, intervals between sexual intercourse, and perceptions of support from sexual partner for contraception. These accounted for 39.1% of variance in contraceptive behavior. CONCLUSIONS: Intrapersonal factors (self-efficacy, age of first sexual intercourse, and intervals between sexual intercourse) were more important than were partner factors (perceptions of support from sexual partners for contraception and relationship power) in influencing contraceptive behavior among sexually active female adolescents in Taiwan. CLINICAL RELEVANCE: Intervention to increase contraceptive behavior among female adolescents should be focused more on intrapersonal factors than on partner factors.     

Inter-relation of coagulation factors and d-dimer levels in healthy individuals

Summary.  Recently, high levels of coagulation factor (F)VIII, FIX and FXI have been associated with an increased risk of venous thrombosis. For several coagulation factors a substantial hereditary component was found. If regulatory genes are located outside the clotting factor genes, they may regulate the levels of several proteins in the coagulation system. Thus levels would then cluster in individuals. The aim of the present study was to assess the inter-relation among levels of the pro- and anticoagulant proteins in the coagulation cascade. We also investigated the relation between the coagulation factors and d -dimer levels (marker of coagulation activity). All analyses were performed in healthy subjects, the control population of the Leiden Thrombophilia Study (LETS), to eliminate the influence of a prior thrombosis on the interpretation of the results ( n  = 466). Using principal-components analysis, a method intended to explain relationships among several correlated variables, we found a clustering between the vitamin K-dependent factors (prothrombin, VII, IX, X) and FXI and FXII. FV and FVIII clustered with fibrinogen and d -dimer. FXIII remained relatively independent of the other factors. Adding the anticoagulant factors to the analysis resulted in minor changes in the clustering pattern. The anticoagulant factors clustered together. We found relatively independent clusters within the group of pro- and anticoagulant factors, which may suggest that the genetic basis for high or low levels of factors in the coagulation system may, at least partly, lie outside the genes coding for these factors.     

The Relative Utility of Fixed and Variable Risk Factors in Discriminating Sexual Recidivists and Nonrecidivists

This study compared the relative utility of fixed and variable risk factors in discriminating between recidivist and nonrecidivist sexual offenders. Subjects were 95 adult male offenders released from the Canadian federal correctional system between 1988 and 1992. Risk factors from the Sexual Violence Risk—20 (SVR-20; D. P. Boer, S. D. Hart, P. R. Kropp, & C. D. Webster, 1997) were coded from prerelease institutional records; sexual and nonsexual violent recidivism was coded from postrelease police and correctional records. SVR-20 risk factors were categorized as fixed (static) or variable (dynamic) markers according to the criteria of H. C. Kraemer et al. (1997); the fixed risk markers were further divided into offense history and psychosocial factors. Hierarchical Cox regression survival analyses were conducted to compare the relative contribution of fixed offense history, fixed psychosocial, and variable psychosocial risk markers in accounting for any violent recidivism and sexually violent recidivism. Analyses indicated that fixed psychosocial factors added little to the models comprised fixed offense history factors alone. There was some evidence that variable psychosocial factors had incremental validity when added to predictions made on the basis of fixed factors, particularly in the prediction of sexual violence. The individual factors that were included in the final models are consistent with previous findings, and support the use of sexual deviance and antisocial lifestyle variables in the prediction of recidivism among sexual offenders.     

Precipitating and Aggravating Factors of Migraine Versus Tension-type Headache

OBJECTIVE: We conducted the present study to determine whether there are headache precipitating and aggravating factors that differentiate migraine from tension-type headache and headache precipitating and aggravating factors that differentiate tension-type headache from migraine. METHODS: We interviewed 38 patients with migraine and 17 patients with tension-type headache (diagnosed using International Headache Society criteria) by telephone, using a questionnaire. The questionnaire inquired about the following precipitating and aggravating headache factors: (1) physical activity, (2) straining, (3) bending over, (4) stress/tension, (5) coughing/sneezing, (6) fatigue, (7) reading, (8) driving, (9) lack of sleep, (10) specific foods/drinks, (11) alcohol, (12) not eating on time, (13) smoke, (14) smell, (15) light, (16) noise, (17) menstruation, and (18) weather. RESULTS: The most common precipitating factors acknowledged by both groups of patients were stress/tension, not eating on time, fatigue, and lack of sleep. Weather, smell, smoke, and light were the precipitating factors that differentiated migraine from tension-type headache. Excluding those factors that are part of the International Headache Society migraine diagnosis, the aggravating factors were straining, bending over, and smell. We found no precipitating or aggravating factors differentiating tension-type headache from migraine. CONCLUSION: Apparently there are precipitating and aggravating factors differentiating migraine from tension-type headache but not vice versa. It is interesting that three of the migraine-specific precipitating factors (ie, weather, smell, and smoke) involve the nose/sinus system, suggesting a greater significance of this system in headache than is generally considered.     

小鼠骨骼肌损伤修复过程中肌再生调节因子和血管再生因子的表达规律研究

目的:观察骨骼肌损伤修复过程中肌再生调节因子和血管再生因子表达规律,探讨肌再生调节因子和血管再生因子在骨骼肌损伤修复过程中可能发挥的作用。方法:40只雄性C57小鼠随机分为对照组(C组,n=8)和损伤组(S组,n=32)。骨骼肌钝挫伤后0d,1d,3d,7d,14d取右侧腓肠肌用于HE染色,左侧腓肠肌进行荧光定量PCR检测肌再生调节因子(Myo D,myogenin,IGF-1,MGF,HGF,u PA,Myostain,GDF11,LIF)和血管再生因子(HIF-1α,Angpt-1,VEGF)mRNA表达变化。结果:(1)骨骼肌钝挫伤后第3天有少量再生肌纤维,第7天显著增加,第14天基本恢复正常。(2)与对照组相比,生肌调节因子(Myo D,myogenin,IGF-1,MGF,HGF,u PA,GDF11,LIF)mRNA在损伤后表达显著增加(P0.05或P0.01),Myostain mRNA在损伤后表达显著降低(P0.01)。(3)血管再生因子(HIF-1α,Angpt1)m RNA在损伤后表达显著增加(P0.05或P0.01)而VEGF mRNA在损伤后表达显著降低(P0.05)。结论:骨骼肌钝挫伤后多种肌再生调节因子表达上调,可能促进骨骼肌再生。血管再生因子(HIF-1α和Angpt1)表达上调,可能参与了骨骼肌损伤后血管再生以及骨骼肌再生。     

我国预立医疗照护计划阻碍与促进因素的研究进展

预立医疗照护计划的实施是在充分尊重患者医疗自主权的基础上帮助临终者实现符合本人意愿的治疗和护理,从而提高患者疾病终末期的生活质量。本文对预立医疗照护计划的影响因素进行分析总结,从阻碍和促进的角度指出其存在的问题和未来研究的方向,旨在进一步为我国预立医疗照护计划研究与实践提供参考。     

新疆地区不同民族人群心房颤动与血清尿酸水平的相关性研究

目的探讨新疆地区维吾尔族、汉族心房颤动(AF)患者心房颤动的发生与血清尿酸水平的关系。方法以维吾尔族、汉族心房颤动患者各100例作为病例组,以维吾尔族、汉族非心房颤动患者各100例作为对照组,记录各组患者的年龄、性别、尿酸水平,用药情况等。采用Logistic回归分析心房颤动发生的危险因素。结果维吾尔族、汉族病例组与对照组比较,年龄、低密度脂蛋白、总胆固醇、尿酸水平差异有统计学意义(P0.05),心房颤动组年龄、低密度脂蛋白、总胆固醇和尿酸均显著高于非心房颤动组。多因素Logistic回归分析结果发现,年龄(OR=1.114,95%CI=1.080~1.149,P0.01)、总胆固醇(OR=1.902,95%CI=1.434~2.522,P0.01)和尿酸(OR=1.023,95%CI=1.017~1.029,P0.01)是心房颤动的独立危险因素。结论在新疆地区维吾尔族和汉族人群中,血清尿酸可能是心房颤动的危险因素。     

个人和社会因素对糖尿病病人血糖的影响

[目的 ]探讨个人及社会因素对糖尿病病人血糖的影响。 [方法 ]对随诊的糖尿病病人进行问卷调查和血糖测定 ,分别比较 8种个人及社会因素中各水平组的血糖浓度。[结果 ]配合治疗、文化程度高、坚持体育锻炼、有自信心、作息有规律、一般干部、家人关心及人际关系良好的各水平组的血糖值明显低于其对照组。 [结论 ] 8种个人及社会因素对糖尿病病人血糖具有明显影响。     

氯吡格雷对不稳定型心绞痛患者血浆炎症因子及血小板活化因子水平的影响

目的研究氯吡格雷对于不稳定型心绞痛（UA）患者的血浆炎症因子以及血小板活化因子水平的影响。方法入组患者随机分为2组,对照组给予UA常规治疗方案,研究组在此基础上给予氯吡格雷治疗,观察2组患者的临床疗效及不良反应。结果 2组治疗后与治疗前相比血浆炎症因子水平以及血小板活化因子水平均明显降低,研究组与对照组相比下降更为明显,且2组均未出现明显不良反应。结论氯吡格雷可以有效抑制血管内斑块的炎症反应及血小板的活化,对于UA患者的治疗和预防存在重要意义。     

离心跑台运动对小鼠骨骼肌炎性因子、肌再生因子及血管再生因子表达的影响

目的:观察小鼠离心运动后骨骼肌炎性因子、肌再生因子以及血管再生因子的表达变化,探讨其在离心运动骨骼肌损伤修复中可能发挥的作用。方法:32只雄性C57BL/6小鼠随机分为对照组(C组,n=8)和离心运动组(D组,n=24)。根据取材时间,离心运动组又分为3个小组(运动后1d,3d和7d组)。离心运动后不同时间点取双侧腓肠肌。HE染色观察骨骼肌形态学变化,比色法检测血浆肌酸激酶(CK)和乳酸脱氢酶(LDH)活性,荧光定量PCR检测炎性因子、肌再生因子及血管再生因子基因表达的变化。结果:小鼠下坡跑后骨骼肌纤维结构无明显破坏,无显著炎性细胞浸润。与对照相比,血浆CK和LDH活性在运动后各时间点均无显著变化(P0.05)。从基因层面看,炎性细胞标志物(MPO—嗜中性粒细胞标志物;F4/80—巨噬细胞标志物)在下坡跑后显著上升。部分炎症因子(如肿瘤坏死因子-α、白介素-1β、白介素-6)在下坡跑后显著上调。而肌再生调节因子中,只有机械生长因子和白血病抑制因子在运动后出现显著上调。而肌再生关键细胞——肌卫星细胞的特异性标记分子(分子标志—Pax7,增殖标记—Myo D,分化标记—myogenin)在离心运动后未出现显著变化(P0.05)。此外,其他与肌肉和血管再生密切相关的再生因子(如:胰岛素样生长因子1、肝细胞生长因子、尿激酶型纤溶酶原激活物、环氧合酶2、低氧诱导因子-1α、血管内皮生长因子、血管生成素1等)在离心运动后均未见显著变化(P0.05)。结论:从形态学表现、血清指标和基因表达综合来看,离心跑台运动并非小鼠骨骼肌损伤建模的理想方式。     

Varicose veins of the legs among nurses: Occupational and demographic characteristics

This study aims to determine the relationship between occupational and demographic hazards that characterize varicose veins (VV) in the legs and their intensity among nurses.A cross‐sectional study was carried out among 203 nurses from three general hospitals in Amol, Iran. The required subjects' information was collected through a self‐filled questionnaire and the physical examination of the VV intensity was based on the Clinical finding using the Etiology, Anatomic finding, Pathophysiological standards. The prevalence of VV, with different degrees, was 72.4% (95% CI 65.7–78.4), with women having a higher prevalence compared with men (77.9% vs. 56.9%, P = 0.004). The other non‐interventional risk variable was having longer years of service. Interventional variables were long‐standing hours, overtime work and body mass index status. This study had determined the occupational risk variables on VV which could be interventional in improving the working nurses' environment and quality of life for their long‐term career.