华盛顿健康科学转化研究中心

华盛顿健康科学转化研究中心是全美60个临床和转化科学中心之一。本文对该中心的组成、管理、提供支持的项目、开放基金的申请及转化医学研究的分期等方面进行简要的介绍。当面临复杂的医疗卫生问题时,转化医学的研究和应用需要一个由科学家、临床医生和社区人员组成的跨学科的团队进行合作。     

军队数字化卫勤建设系列讲座（36） 区域一体化军人健康管理平台的构建与应用

根据上级试点实施方案,我院承担了军队＂区域一体化卫勤保障模式改革试点＂任务,对区域一体化军人健康管理平台的构建进行了探索。通过建立与完善军人电子健康档案,构建健康管理体系,深入开展健康教育,开展纵横区域一体化健康管理,提高了部队官兵健康水平。     

社区老年高血压病的健康教育体会

目的：通过对社区老年高血压病人的健康教育，提高辖区老年人对高血压病的自我防护能力。方法：针对老年人的特点通过面对面的重复教育、个别教育，指导老年人有效地控制血压，保持血压稳定。结果：有效的健康教育减少并延缓了并发症的发生，提高了老年人的生存质量和生活质量。结论：健康教育对社区老年高血压病起着重要的作用。     

老年透析患者的健康教育

随着血液净化技术的提高和普及,老年透析患者依赖血液透析维持生命这一特殊群体所占的比例越来越高,在这一漫长过程中,老年患者在精神上承受了很大压力,加之,器官功能老化,并发症多,生活自理能力差,认知和理解力减退,老年血液透析患者的健康教育越来越受到重视,自2010年1月~12月对30例老年血液透析患者进行了健康教育,取得了良好效果,现将报告如下:     

老年消化性溃疡的健康教育

目的：探讨系统的、全程的健康教育对老年消化性溃疡患者的方法及实施效果.方法：将2007-01～2009-12期间消化科所收治的243例老年消化性溃疡的患者开展用药宣教、心理宣教、特殊检查宣教、饮食宣教、出院指导等健康教育,1个月后进行治愈率比较,3个月后进行临床症状等比较,并对生活质量进行评估.结果：患者出院时对健康教育知识的掌握程度比以前提高21%、对医疗护理满意度比以前提高38%,复发率降低了6%,症状缓解明显,生活质量明显提高.结论：对老年消化性溃疡患者进行系统的、全程的健康教育,可以明显改变患者的不良生活习惯,促进建立健康生活方式.     

老年透析患者的健康教育

随着血液净化技术的提高和普及,老年透析患者依赖血液透析维持生命这一特殊群体所占的比例越来越高,在这一漫长过程中,老年患者在精神上承受了很大压力,加之,器官功能老化,并发症多,生活自理能力差,认知和理解力减退,老年血液透析患者的健康教育越来越受到重视,自2010年1月～12月对30例老年血液透析患者进行了健康教育,取得了良好效果,现将报告如下:     

老年患者149例健康教育

我科从 1997年 7月开始实行整体护理 ,在对患者进行健康教育的过程中 ,经过不断探索、改进、完善 ,取得良好效果 ,现报告如下。1　资料和方法1 1　临床资料　将 1998年 1月～ 1999年 1月收治的 149例老年患者中随机分组。Ａ组为观察组 78例 ,男 70例 ,女 8例 ,年龄 48～ 81岁 ,平均年龄 6 9岁 ;Ｂ组为对照组 71例 ,男6 4例 ,女 7例 ,年龄 5 0～ 79岁 ,平均年龄 71岁。 2组患者年龄、智力和文化程度无明显差异 (Ｐ >0 0 5 )。1 2　方法　对照组采用普通宣教法 ,包括入院介绍、讲解其疾病特点及症状、治疗情况和预防保健 ,宣教从入院开始。观…     

高原地区健康儿童脑电图分析

目的：探讨高原地区健康儿童脑电图的特点。方法：用三瑞LQWY～N3数字化脑电图、脑电地形图仪对海拔3700m高原地区180例各年龄组健康儿童进行脑电图检查。结果：高原地区健康儿童脑电图异常率达38．88％。结论：高原地区低氧、高寒环境对健康儿童脑功能有一定影响。     

我国转化医学模式的循证评价

目的系统评价我国转化医学模式的现状,总结模式的领域范围、特点和流程,为我国转化医学的发展提供思路。方法计算机检索PubMed、EMBASE、Cochrane Library、中国生物医学文献数据库、中国期刊全文数据库、中文科技期刊全文数据库和万方数据库,检索时间为建库至2017年6月,纳入评价我国转化医学模式的研究,对结果进行描述性分析。结果共纳入16篇文献,转化医学研究领域中,25.00%(4/16)为科研管理,12.50%(2/16)为中医药领域,6.25%(1/16)为学科服务模式,6.25%(1/16)为儿科领域,6.25%(1/16)为创伤医学领域,6.25%(1/16)为病理生理学实验平台,6.25%(1/16)为疾病标志物的挖掘,6.25%(1/16)为创建妇科临床基地,25.00%(4/16)未限制研究领域。针对转化医学模式的构建方法,87.50%(14/16)采用文献综述方法,仅12.50%(2/16)研究采用定性和定量相结合的方法。纳入研究中构建了不同的转化医学模式,比如转化医学科研管理创新模式、学科服务模式、全维式交叉协同转化医学科研组织模式、多维立体的中医药转化医学模式等,各模式领域范围、特点和流程存在较大差异。结论我国转化医学正处于快速发展阶段,尚无科学的转化医学模式和实现转化医学的评价体系,建议以循证方法构建我国转化医学模式及评价体系,为实现基础研究到临床应用提供更多的参考和依据。     

烧伤病房实施循证护理的对比分析

目的：探讨循证护理应用于大面积烧伤病人的实施效果。方法：选取我院烧伤病房2005年-2006年开展循证护理前后收治的大面积烧伤患者344例，分别实施烧伤常规护理和循证护理，将两组护理效果进行对比。结果：284例实施循证护理患者的治疗护理配合程度和病人满意率明显提高（P〈0．05），差异有统计学意义；实施循证护理组病人并发症发生率降低，平均住院日减少（P〈0．05）．差异有统计学意义。结论：对大面积烧伤病人实施循证护理，提高了烧伤护理质量和服务水平。     

Aging effect on step adjustments and stability control in visually perturbed gait initiation

Gait adaptability is essential for fall avoidance during locomotion. It requires the ability to rapidly inhibit original motor planning, select and execute alternative motor commands, while also maintaining the stability of locomotion. This study investigated the aging effect on gait adaptability and dynamic stability control during a visually perturbed gait initiation task. A novel approach was used such that the anticipatory postural adjustment (APA) during gait initiation were used to trigger the unpredictable relocation of a foot-size stepping target. Participants (10 young adults and 10 older adults) completed visually perturbed gait initiation in three adjustment timing conditions (early, intermediate, late; all extracted from the stereotypical APA pattern) and two adjustment direction conditions (medial, lateral). Stepping accuracy, foot rotation at landing, and Margin of Dynamic Stability (MDS) were analyzed and compared across test conditions and groups using a linear mixed model. Stepping accuracy decreased as a function of adjustment timing as well as stepping direction, with older subjects exhibited a significantly greater undershoot in foot placement to late lateral stepping. Late adjustment also elicited a reaching-like movement (i.e. foot rotation prior to landing in order to step on the target), regardless of stepping direction. MDS measures in the medial-lateral and anterior-posterior direction revealed both young and older adults exhibited reduced stability in the adjustment step and subsequent steps. However, young adults returned to stable gait faster than older adults. These findings could be useful for future study of screening deficits in gait adaptability and preventing falls.     

Foot and ankle biomechanics during walking in older adults: A systematic review and meta-analysis of observational studies

BackgroundThe foot and ankle complex undergoes significant structural and functional changes with advancing age.Research questionThe objective of this systematic review and meta-analysis was to synthesize and critique the research literature pertaining to foot and ankle biomechanics while walking in young and older adults.MethodsElectronic databases (Web of Science, PubMed, Scopus and Embase) were searched from inception to April 2019 for cross-sectional studies which compared kinematics, kinetics and plantar pressure differences between young and older adults. Screening and data extraction were performed by two independent assessors, with disagreements resolved by consensus.ResultsA total of 39 articles underwent full-text screening, and 19 articles met the inclusion criteria and were included. Meta-analysis showed that older adults had less ankle joint plantar flexion (5 studies; weighted mean difference [WMD]: −5.15; 95 %CI: −6.47 to −3.83; P < 0.001) and less ankle joint power generation (6 studies; standardized mean difference [SMD]: −0.62; 95 %CI: −0.82 to −0.41; P < 0.001) during propulsion compared to young adults. These differences persisted in subgroup analyses comparing different walking speeds. Plantar pressure findings were highly variable due to differences in data collection protocols and meta-analysis was not possible.SignificanceOlder adults have unique foot and ankle kinematics and kinetics during walking characterized by reduced ankle joint plantarflexion and power generation during propulsion.     

The effects of object height and visual information on the control of obstacle crossing during locomotion in healthy older adults

In order to safely avoid obstacles, humans must rely on visual information regarding the position and shape of the object obtained in advance. The present study aimed to reveal the duration of obstacle visibility necessary for appropriate visuomotor control during obstacle avoidance in healthy older adults. Participants included 13 healthy young women (mean age: 21.5 ± 1.4 years) and 15 healthy older women (mean age: 68.5 ± 3.5 years) who were instructed to cross over an obstacle along a pressure-sensitive pathway at a self-selected pace while wearing liquid crystal shutter goggles. Participants were evaluated during three visual occlusion conditions: (i) full visibility, (ii) occlusion at T-1 step (T: time of obstacle crossing), and (iii) occlusion at T-2 steps. Toe clearances of both the lead and trail limb (LTC and TTC) were calculated. LTC in the occlusion at T-2 steps condition was significantly greater than that in other conditions. Furthermore, a significant correlation was observed between LTC and TTC in both groups, regardless of the condition or obstacle height. In the older adult group alone, step width in the occlusion at T-2 steps condition increased relative to that in full visibility conditions. The results of the present study suggest that there is no difference in the characteristics of visuomotor control for appropriate obstacle crossing based on age. However, older adults may exhibit increased dependence on visual information for postural stability; they may also need an increased step width when lacking information regarding their positional relationship to obstacles.     

The effect of a dual task on gait speed in community dwelling older adults: A systematic review and meta-analysis

Background and purposeReduced walking speed in older adults is associated with adverse health outcomes. This review aims to examine the effect of a cognitive dual-task on the gait speed of community-dwelling older adults with no significant pathology affecting gait.Data sources and study selectionElectronic database searches were performed in, Web of Science, PubMed, SCOPUS, Embase and psychINFO. Eligibility and methodological quality was assessed by two independent reviewers. The effect size on gait speed was measured as the raw mean difference (95% confidence interval) between single and dual-task performance. Pooled estimates of the overall effect were computed using a random effects method and forest plots generated.Data extraction and data synthesis22 studies (27 data sets) with a population of 3728 were reviewed and pooled for meta-analysis. The mean walking speed of participants included in all studies was >1.0 m/s and all studies reported the effect of a cognitive dual-task on gait speed. Sub-analysis examined the effect of type of cognitive task (mental-tracking vs. verbal-fluency). Mean single-task gait speed was 1.21 (0.13) m/s, the addition of a dual-task reduced speed by 0.19 m/s to 1.02 (0.16) m/s (p < 0.00001), both mental-tracking and verbal-fluency tasks resulted in significant reduction in gait speed.Limitations and conclusionThe cross-sectional design of the studies made quality assessment difficult. Despite efforts, high heterogeneity remained, possibly due to participant characteristics and testing protocols. This meta-analysis shows that in community-dwelling older adults, the addition of a dual-task significantly reduces gait speed and may indicate the value of including dual-task walking as part of the standard clinical assessment of older people.     

The influence of age on the thresholds of compensatory stepping and dynamic stability maintenance

The purpose of this study was to investigate the effects of age on compensatory-stepping thresholds and dynamic stability maintenance in response to postural disturbances. It was hypothesized that, with older age, anterior but not posterior stepping thresholds would be reduced. Thirteen young adults (31.1 ± 0.8 years), 11 middle-aged adults (57.6 ± 2.5 years), and 11 older adults (73.8 ± 5.3 years) participated in this study. Surface translations were delivered as subjects stood on a microprocessor-controlled treadmill. Subjects were instructed to “try not to step”. Stepping thresholds were defined as the largest displacement at a given peak treadmill-belt velocity for which a subject could prevent stepping. The margin of stability was calculated to estimate the minimum dynamic stability at the stepping thresholds. Age-related declines in the ability to prevent forward steps were apparent. Anterior stepping thresholds were reduced with age. The minimum margin of stability associated with anterior stepping thresholds was not influenced by age. Therefore, smaller disturbance displacements caused middle-aged and older subjects to become dynamically unstable to the point of stepping. Posterior stepping thresholds were not influenced by age. It is concluded that an age-related decline in anterior, but not posterior, stepping thresholds was due to an impaired ability to maintain dynamic stability after a disturbance.     

Cognitive tasks promote automatization of postural control in young and older adults

Researchers looking at the effects of performing a concurrent cognitive task on postural control in young and older adults using traditional center-of-pressure measures and complexity measures found discordant results. Results of experiments showing improvements of stability have suggested the use of strategies such as automatization of postural control or stiffening strategy. This experiment aimed to confirm in healthy young and older adults that performing a cognitive task while standing leads to improvements that are due to automaticity of sway by using sample entropy. Twenty-one young adults and twenty-five older adults were asked to stand on a force platform while performing a cognitive task. There were four cognitive tasks: simple reaction time, go/no-go reaction time, equation and occurrence of a digit in a number sequence. Results demonstrated decreased sway area and variability as well as increased sample entropy for both groups when performing a cognitive task. Results suggest that performing a concurrent cognitive task promotes the adoption of an automatic postural control in young and older adults as evidenced by an increased postural stability and postural sway complexity.     

中医药维护和促进人民健康的作用发微

中医药是中华民族的伟大创造,凝聚着中华民族几千年的健康养生理念及实践经验,是中华文明的瑰宝,也是中国给世界的珍贵礼物。中医药具有"简、便、效、廉"和"注重治未病"等特点,几千年来在疾病预防、治疗、康复中发挥着独特优势,为维护和促进人民健康作出了重要贡献。本文将从中医药"抗疫""治未病""中医药与现代医学融合"等方面所做的贡献进行阐述,以期更深入了解中医药的作用和优势,为建设健康中国贡献力量。     

Rate of torque development and the risk of falls among community dwelling older adults in Japan

BackgroundRate of torque development (RTD) is defined as the slope of the torque-time curve obtained during an isometric contraction. Several studies have shown that RTD is lower in fallers than in nonfallers. However, these studies had small sample size and was not adjusted confounding factors.Research question: Is RTD associated with falls history in healthy community dwelling older adults.MethodsThis was cross-sectional study. In total, 122 participants aged ≥65 (mean, 71.3 ± 4.4) years were recruited for this study. We assessed RTD, muscle strength, functional capacity, and physical activity. We assessed RTD over the first 200 ms of the maximal isometric contraction, whereby the onset of contraction was deemed as the point at which torque had risen 4 Nm above the baseline. Differences between the 3 groups (no fall group, single fall group and multiple falls group) were examined using one-way analysis of variance or Kruskal-Wallis test. A post-hoc Bonferroni or Games-Howell test was used to assess the differences between the individual groups. A multivariate multinomial logistic model was built using the factors associated with the fall category.ResultsRTD was significantly different between the no fall group and multiple falls group (P = 0.047). Similarly, RTD was significantly different between the single fall group and multiple falls group (P = 0.016). RTD was associated with both the no fall group and single fall group (odds ratio = 2.05, 95% confidence interval: 1.06–3.97, odds ratio = 2.45, 95% confidence interval: 1.20–4.98, respectively) in multinomial logistic regression.SignificanceThis is the first study to investigate the relationship between RTD and falls history in community-dwelling older adults in multivariate analysis. RTD is more strongly associated with falls history than other performance measures in community-dwelling elderly.