绝经妇女激素替代治疗的回顾与思考

随着人们平均寿命的延长,对生活质量要求的不断提高,绝经后的问题也日益受到全社会的广泛关注,绝经后骨质疏松和冠心病、阿尔茨海默病等的增加引起人们对激素替代治疗(HRT)的兴趣,其旨在改善妇女生活质量.但随着研究的深入,其所引发的问题也不断涌现.HRT对绝经后妇女的生活质量究竟是否有总体益处已成为目前关注的焦点.自从1963年Wilson倡导HRT以来,HRT的发展走过了一段曲折之路,对HRT的认识,经历了几十年反复的过程,体现了辩证唯物主义认识论和矛盾论的观点.     

雌激素替代疗法的利与弊

随着妇女社会地位的提高,以及人们对健康与生活质量要求的提高,绝经后雌激素替代疗法(HRT)日益成为人们关注的话题,越来越多的妇女选择在进入围绝经期后开始接受HRT,以改善因内源性雌激素分泌不足而引起的种种不适,确实提高了生活质量。但是,这种方法有增加子宫内膜癌、乳腺癌等其他疾病发病率的潜在危险,于是我们在临床应用时应该用辨证的眼光去看待它,试图抓住其主要矛盾,尽可能扬其利,避其害,以达到安全而有效地提高广大中老年妇女生活质量的目的。     

雌激素替代疗法的利与弊

随着妇女社会地位的提高,以及人们对健康与生活质量要求的提高,绝经后雌激素替代疗法(HRT)日益成为人们关注的话题,越来越多的妇女选择在进入围绝经期后开始接受HRT,以改善因内源性雌激素分泌不足而引起的种种不适,确实提高了生活质量.但是,这种方法有增加子宫内膜癌、乳腺癌等其他疾病发病率的潜在危险,于是我们在临床应用时应该用辨证的眼光去看待它,试图抓住其主要矛盾,尽可能扬其利,避其害,以达到安全而有效地提高广大中老年妇女生活质量的目的.     

重新认识激素替代治疗的利与弊

随着老龄化社会的到来和女性对生活质量改善需求的增加 ,越来越多的妇女在进入更年期或因病行卵巢切除后开始接受激素替代治疗 (HormoneReplacementTreatment,HRT)以改善因体内性激素水平下降所引起的种种不适。经过临床观察 ,HRT自使用以来 ,确实大大提高了妇女的生存质量。但随着使用人数的增多 ,加之国外的一些大样本、系统的深入研究的开展 ,其弊端逐渐显现出来 ,可以说HRT是一把双刃剑 ,所以临床医生在对病人使用HRT时 ,需要重新权衡其利与弊 ,这是势在必行的。1　是否能延缓老年性痴呆老年性痴呆 (Alzheirmer’sdisease,AD)是…     

激素替代治疗对绝经妇女心脏保护效应的重新认识

激素替代疗法（HRT）已有数十年历史,但是否具有心脏保护效应一直存在争议。早期研究提示HRT可维持血管正常功能,但大样本随机对照研究却发现服用雌激素和孕激素妇女的心血管疾病较安慰剂组增加22％,这导致了HRT应用的急剧减少。而2007年妇女健康启动计划——冠状动脉钙化研究（WHI—CACS）却证实HRT能显著降低冠状动脉钙化,再次提起了人们对HRT心脏保护效应的关注。     

HRT的诞生与完善

由于寿命延长 ,女性一生中有 1/ 3的时间是在绝经后度过的 (妇女平均绝经年龄为 4 6 - 5 2岁 ) ,为了提高老年妇女的健康水平和生活质量 ,应用激素替代疗法 (ＨＲＴ)已越来越成为不可缺少的保健和治疗手段 ,因此 ,对ＨＲＴ的安全性 ,医患双方都极为关注 ,特别是ＨＲＴ后引起恶性肿瘤的风险性一直是研究的热点。那么到底用激素替代是利大还是弊大 ?是否ＨＲＴ适合于每一位绝经妇女 ?治疗期应以多长为宜 ?随着ＨＲＴ逐步建立、推广、规范化应用、监测、管理 ,在获得治疗经验的同时 ,对ＨＲＴ的认识也有了较大的变化 ,结合这些观念的改变 ,我们…     

从系统角度重新评价子宫的生理作用

1　问题的提出过去,人们一致认为子宫仅仅是卵巢激素作用的靶器官,其主要生理功能是孕育胎儿。但进入90年代后,这一传统认识受到了挑战。挑战来自临床上的这样一个发现:绝经前妇女单纯切除子宫而卵巢完好的病人,大多数在术后半年开始出现更年期症状,提早出现骨质疏松、冠?..     

生活质量问题研究

进入 2 0世纪以后 ,人们的健康观发生了改变 ,传统的生物医学模式愈来愈不能适应现代医学的要求 ,而必然转向生物—心理—社会医学模式。随着社会生活条件的改善和人民生活水平的不断提高及社会科技的进步和医疗技术的提高 ,人们愈来愈重视通过干预得到较好的生活质量 ,医学界也就产生了生活质量 (ＱｕａｌｉｔｙｏｆＬｉｆｅ ,ＱＯＬ)的概念。1　生活质量的概念尽管生活质量问题一直是人类社会共同关注的问题之一 ,但有关人类的生活质量问题的广泛深入研究还是近几年才开始。何谓生活质量 ,不同的研究人员从各自的专业和研究目的出发去理解…     

关于室内环境艺术设计的人性化设计分析

随着国内各项建设的逐步开展,人们的生活水平也有了明显的改善。在满足了温饱的基本需求后,人们的关注点逐渐转移到住房上,希望能提高自己的生活质量。在这种社会需求下,室内环境艺术设计开始真正走人人们的生活中。而基于人们对室内环境艺术设计的最基本要求,室内环境设计的人性化设计是人们关注的重点。为了能更好地满足人们的需求,展开对室内环境艺术设计的人性化设计的各方面展开探讨。     

房屋建筑工程防渗漏施工技术分析

随着经济的快速发展,人们的生活水平有很大程度的改善和提高,人们对生活住房的质量要求也有所提高。针对房屋建筑工程渗漏问题的原因进一步分析,并对如何防渗漏的施工技术措施进一步探究分析,有利于给人们的生活住房提供良好的保障。     

The Long-Term Effects of Group-Based Psychological Interventions for Children With Tourette Syndrome: A Randomized Controlled Trial

This randomized controlled trial examined the long-term effects of group-based psychological interventions on measures of tic severity, self-reported quality of life (QOL), and school attendance. Children (n = 28) with Tourette syndrome (TS) were assessed 12 months after completing a course of either group-based Habit Reversal Training (HRT) or Education.Both groups demonstrated long-term improvement in tic severity and QOL, which included significant continued improvement during the follow-up (FU) period. Both groups also showed significant posttreatment improvement in school attendance. Further research is required to explore potential therapeutic mechanisms, independent or mutual, which may underlie long-term symptom improvements.     

Impact of low-level expression dermatological diseases on the quality of life as a function of its level of specificity

The impact of dermatological diseases on the quality of life is relatively well established, although some results do not support this relationship. Whereas a few studies indicate a decrease in various indicators of quality of life in conditions of disease, in other studies, this effect has not been observed. These differences can be explained by the use of different concepts of quality of life and/or the comparison of different severity levels of the diseases. The purpose of this paper is to analyze the impact of low-level expression dermatological diseases on various concepts of quality of life. Two hundred-ninety-nine participants completed a questionnaire about symptoms, psychological and psychosocial impact, and general and specific satisfaction. Results show that minor dermatological diseases affect health-related quality of life, but not quality of life considered as well-being.     

Health Related Quality of Life in Children with Congenital Heart Disease

Health-related quality of life in children with congenital heart disease (CHD) was compared to that of healthy children. Furthermore, agreement between child and parent reports was examined. In addition, differences in quality of life related to the severity of CHD were evaluated. One hundred children with CHD aged between 8-18 years and their parents answered a health-related quality of life-questionnaire during their visit to the paediatric cardiology outpatient department. CHD children reported reduced motor functioning and autonomy compared to healthy children. Parents of children with CHD reported their children to have a reduced quality of life in the domains of: motor functioning, autonomy and cognitive functioning. Agreement between child and parent reports was moderate. Children systematically reported lower health related quality of life on the domain of positive emotions than did parents. Health related quality of life in children with CHD appeared not to be influenced by severity of the disease. In conclusion, regardless of the severity of the disease, children with CHD reported their health related quality of life on several domains to be lower than that of healthy children. This means that on several domains, the emotional impact of problems in health status is greater for children with CHD than for healthy children. When CHD patients visit the clinic, it is important that physicians actively ask patients as well as parents about the child's motor functioning, autonomy and cognitive functioning. Children with problems in these domains can then be identified, and psychological interventions can take place at an early stage.     

La qualité de vie d'enfants asthmatiques participant à un programme d'éducation à la maladie

Our purpose is here to study the quality of life of asthmatic children involved in a program of education. Regarding this, we used the “OK. ado” of Manificat and Dazord, the Trait-Anxiety inventory for children of Spielberger, the questionnaires of educative diagnostic “Ce que tu sais” and “À toi de jouer” and our observations during the different sessions of the program of education. The analysis of the results we obtained for the questionnaires of educative diagnostic, and for the Trait-Anxiety inventory, combined with our observations confirmed the elements of the literature: asthma badly affects quality of life among children. It also shows the importance not to neglect the experience of asthmatic children in their treatment. Nevertheless, results obtained for the quality of life questionnaire (“OK. ado”) doesn't reveal the same dissatisfaction of children regarding their quality of life. This contradiction leads us to wonder about the influence of a group into the educational program and about the opposition between assessment of the quality of life and experience of the disease.     

膀胱过度活动症诊治的思考

随着老年人口的增多,膀胱过度活动症的发病率也会逐年升高,但其确切病因不清楚,临床症状不典型,很多患者对这种疾病认识不够,严重影响着患者的生活质量,给患者带来了极大的生理和心理上的困扰。因此,临床工作中应注意发现膀胱过度活动症相关的临床症状,结合完整全面的病史,进行体格检查和相关的辅助检查,及早诊断并给予合理的治疗,提高患者的生活质量。     

Illness perceptions in dialysis patients and their association with quality of life

The present study explored illness perceptions of end stage renal disease (ESRD) patients on both haemodialysis (HD) and peritoneal dialysis (PD) treatment, and their associations with quality of life. Leventhal's self-regulation model (SRM) was used as a theoretical framework. Illness perceptions and quality of life were assessed with the IPQ-R and the SF-36 in 91 HD and 42 PD patients participating in the NECOSAD-study. Compared to HD patients, PD patients experienced more personal control and had a better understanding of the illness. Illness perceptions explained from 17 to 51% of the variance in quality of life scores. Perception of more symptoms, more consequences and lower personal control were associated with lower well-being. The concept of illness perceptions is useful in understanding the impact of ESRD and of dialysis treatment on quality of life. Interventions aimed at providing more knowledge about ESRD and dialysis, and provision of skills to coping with the illness and its consequences may improve quality of life in dialysis patients.     

对保乳手术及预防性乳腺切除术的思考

鉴于对乳腺癌是全身性疾病的认识,为提高术后生存质量,目前乳腺癌治疗中保乳手术日益受到重视.而为了阻断高危险性的乳腺向乳腺癌发展,预防性乳房切除术也正在被患者接受.保留乳腺与预防性切除乳腺的医学实践反映了目前人们对乳腺癌的深层认识,值得深入思考.     

Sickle cell disease as a neurodevelopmental disorder

Sickle cell disease (SCD) is a blood disorder; however, the central nervous system (CNS) is one of the organs frequently affected by the disease. Brain disease can begin early in life and often leads to neurocognitive dysfunction. Approximately one-fourth to one-third of children with SCD have some form of CNS effects from the disease, which typically manifest as deficits in specific cognitive domains and academic difficulties. We discuss SCD as a neurodevelopmental disorder by reviewing the mechanisms of neurological morbidity in SCD, the timing of these mechanisms, the types of cognitive and behavioral morbidity that is typical, and the interaction of social-environmental context with disease processes. The impact of the disease on families shares many features similar to other neurodevelopmental disorders; however, social-environmental factors related to low socioeconomic status, worry and concerns about social stigma, and recurrent, unpredictable medical complications can be sources of relatively higher stress in SCD. Greater public awareness of the neurocognitive effects of SCD and their impact on child outcomes is a critical step toward improved treatment, adaptation to illness, and quality of life.