The burden of brain diseases in Europe.

The burden [as defined by the World Health Organisation (WHO)] of brain diseases (neurological, neurosurgical and psychiatric diseases together) is very high and yet resources spent on these diseases are not necessarily commensurate with the extent of this burden. However, hard data on the burden of brain diseases in Europe have not previously been easily accessible. The Global Burden of Disease (GBD) 1990 study conducted jointly by the WHO, Harvard University and the World Bank provided new measures that are now becoming universally accepted and have been used also in a repeat study: The GBD 2000. The key parameter of the study is disability adjusted life years (DALY), which is the sum of years of life lost (YLL) caused by premature death and years of life lived with disability (YLD). In the present report, data from the GBD 2000 study and from the World Health Report 2001 on brain diseases is extracted for the territory of Europe. This territory corresponds roughly to the membership countries of the European Federation of Neurological Societies. The WHO's Report has a category called neuropsychiatric diseases, which comprises the majority but not all the brain diseases. In order to gather all brain diseases, stroke, meningitis, half of the burden of injuries and half of the burden of congenital abnormalities are added. Throughout Europe, 23% of the years of healthy life is lost and 50% of YLD are caused by brain diseases. Regarding the key summary measure of lost health, DALY, 35% are because of brain diseases. The fact that approximately one-third of all burden of disease is caused by brain diseases should have an impact on resource allocation to teaching, reasearch, health care and prevention. Although other factors are also of importance, it seems reasonable that one-third of the curriculum at medical school should deal with the brain and that one-third of life science funding should go to basic and clinical neuroscience. In addition, resource allocation to prevention, diagnosis and treatment of brain diseases should be increased to approach, at least, one-third of health care expenditure. With the present data on hand, neurologists, neurosurgeons, psychiatrists, patient organizations and basic neuroscientists have a better possibility to increase the focus on the brain.     

脑卒中后抑郁及其对神经功能康复的影响

目的:观察脑卒中后抑郁(Post-Stroke Depression,PSD)的发生率和相关因素;探讨选择性5-HT抑制剂对脑卒中后抑郁神经功能康复的影响.方法:选取急性脑脑卒中患者132例(脑梗死78例,脑出血54例),分别在病程2周、1,3,6,12月时给每一位入组患者行PSD诊断、神经功能缺损评分、日常生活能力评分(Activity of Daily Living Scale,ADL)、汉密尔顿抑郁量表(Hamilton Depression Scale,HAMD)评分;同时完成Zung's抑郁自评量表(Self-Rating Depression Scale,SDS)和焦虑自评量表(Self-Rating Anxiety Scale,SAS).结果:①脑卒中患者中约44.70%出现抑郁症状;②脑卒中类型和性别与PSD发生率无相关性(P＞0.05);③PSD的发生率和严重程度与神经功能缺损和日常生活能力下降程度有关.④PSD与病变部位、病灶大小、病灶单侧性均无明显相关(P＞0.05);⑤氟西汀抗抑郁治疗能明显改善病程3、6个月时的神经功能缺损,病程12月时不仅抑郁症状减轻,日常生活能力改善,神经功能缺损减轻尤为显著.结论:脑卒中后抑郁是急性脑血管病患者常见的长期并发症,并可影响患者功能康复的速度和程度.抗抑郁剂治疗能在抑郁症状明显改善的同时,促进患者日常生活能力和神经功能的恢复.     

Alcohol and obesity: A new look at high blood pressure and stroke

Summary An investigation of the staff of a car assembly plant (3,351 persons) revealed a similarity between the change in relative body weight and diastolic blood pressure with age. There is a good temporal correlation between the course of alcohol consumption during life and the change of the relative body weight. German women had significantly less blood pressure for the same relative body weight than German men, and foreign employees had lower blood pressure than Germans In both cases the main cause is the difference in alcohol consumption. Besides obesity and hereditary factors, alcohol is the main cause of essential hypertension today. Epidemiological and experimental data indicate that there are two ways from alcohol to high blood pressure, a more direct one and an indirect one via obesity. Alcohol causes obesity via a change in metabolism (hyperinsulinism) rather than by higher caloric intake. In both ways alcohol is an important cause of stroke. To reduce body weight and blood pressure, a reduction of alcohol consumption should be recommended in addition to reduced caloric intake and increased physical activity as means of preventive neurology.     

失效模式与效应分析法在神经内科ICU医院感染控制中的应用

目的探讨失效模式与效应分析法(failure mode and effects analysis,FMEA)在神经内科ICU医院感染控制中的应用,发现高风险因素,为院感防控提供参考依据。方法根据神经内科ICU临床实际情况,通过FMEA风险评估法对34项医院感染风险事件进行风险评估,按照"二八法则"筛选出风险优先级事件。结果根据每一项风险因素的平均RPN值进行风险排序,按照"二八法则"筛选出风险优先级前6位的事件分别是:本科室医护人员手卫生依从性不到位(平均RPN值=5.6)、导尿管日常维护不到位(平均RPN值=4.17)、多耐患者未有效执行接触隔离措施(平均RPN值=3.80)、物表清洁消毒未有效执行(平均RPN值=3.73)、未严格掌握留置导尿指征(平均RPN值=3.70)、未保持尿液引流系统的密闭性(平均RPN值=3.53)。结论FMEA风险评估法可以发现神经内科ICU医院感染防控中的薄弱环节,为精准化感控措施的制订提供依据。     

宣武医院神经内科门诊用药分析

目的：了解神经内科疾病用药变化趋势，指导临床合理用药。方法：采用回顾性调查方法，以宣武医院2001年12月每天上午神经内科门诊处方，进行记录和统计，并与1999年同期的神经内科统计资料做对比，进行分析。结果：2001年自配制剂健脑Ⅱ号和劳拉西泮较1999年有所上升，在用药排序中分别在第1位和第2位，但在价格排序中却未进入前16位。脑血管病药物仍然占神经内科用药之首且价格较高,5 羟色胺再摄取抑制药为治疗抑郁症的首选药。结论：脑血管病应选择作用明确，较经济的药物，对患有焦虑症、抑郁症的患者用药应坚持镇静催眠药交替使用，保证患者的合理用药。     

神经内科护理中对脑卒中康复护理的临床研究

目的探讨神经内科护理中脑卒中康复护理的临床效果。方法选取本院2011年10月～2012年10月神经内科脑卒中患者92例,随机分为两组,41例患者实施常规护理为对照组,另外41例患者实施康复护理为观察组,比较两组患者患侧上肢运动功能及日常生活能力评分、临床疗效、继发性功能障碍。结果护理后,两组患者患侧上肢运动功能评分、日常生活能力评分均显著提高,且观察组相关评分均明显高于对照组;观察组总有效率（97.6%）明显高于对照组（85.4%）,观察组继发性功能障碍发生率（17.1%）明显低于对照组（46.3%）,差异均有统计学意义（P〈0.05）。结论康复护理可明显改善脑卒中患者的临床症状,促进神经功能恢复,提高患侧上肢运动功能和日常生活能力,临床疗效显著,且继发性功能障碍发生率较低。     

案例教学法在神经病学教学中应用的体会

通过以急性炎症性脱髓鞘性多发性神经病为案例进行分析,在本科生神经病学授课中开展案例教学。结果发现案例教学可以激发学生的学习热情,变被动学习为主动学习;培养学生的临床思维能力,显著提高教学质量和教学效果,值得在临床神经病学教学中广泛推广。     

'Neurophobia'– attitudes of medical students and doctors in Ireland to neurological teaching

(i) To determine whether neurology is the medical specialty with which Irish students and doctors have most difficulty, (ii) appraise attitudes towards how neurology is taught, and (iii) suggest ways teaching might be improved. A questionnaire on medical teaching was given to 457 medical students and junior doctors in Ireland. Perceived difficulties with neurology compared with seven other medical specialties were analysed. Other aspects of teaching were assessed including why neurology is perceived as difficult and ways teaching could be improved. Neurology was perceived as the most difficult of the eight medical specialties assessed. Participants felt they learned most at bedside tutorials with surprisingly few learning online. Neurology was perceived as difficult because of insufficient exposure to the subject, lack of teaching, and perceived complexity. Neurology teaching could be improved by increasing the number of bedside tutorials and by greater exposure to neurological patients for the students in clinical training. Medical students and doctors find neurology difficult. The teaching of neurology is reported as moderate to poor. The reasons for this are wide ranging but an emphasis on increased numbers of tutorials and greater integration of pre-clinical neurology to clinical years would improve teaching.