成人和婴儿麻疹临床特点和治疗

麻疹是一种急性呼吸道传染病,常见于6月～5岁儿童。近年来婴儿和成人麻疹患者在总患者数中所占比率表现出上升的趋势,容易造成误诊、漏诊。作为临床工作者,我们认为临床医生应充分认识到麻疹发病人群及年龄的改变,在临床工作中减少误诊,并为患者提供及时有效的治疗,对高危人群的有计划干预对于减低成人麻疹发病率有着重要作用。本文针对婴儿和成人麻疹的诊断和治疗进行了综述,试图提供参考。     

Exposure and response prevention of morbid ruminations and compulsive avoidance

Two patients with morbid ruminations and compulsive avoidance behavior were independently treated by the authors with exposure and response prevention strategies. The patients were quite different with respect to age (23 vs 58), occupational status (student vs civil servant) and length of disorder (2 vs 40 years), although their disorders were quite similar. The present report describes the patients and treatment procedures and reports on dramatic behavioral changes that occurred within brief time periods.     

Working memory and attention are still impaired after three years in patients with stress‐related exhaustion

Cognitive impairment is one of the most pronounced symptoms reported by patients with stress‐related mental health problems. Impairments related to executive function and to some extent speed and attention are therefore common in patients with stress‐related burnout/exhaustion. In this paper we present a follow‐up of cognitive performance in patients with stress‐related exhaustion several years after they initially sought medical care. Thirty patients and 27 healthy controls, mean age 49 years (SD 6.5) and 55 years (SD 6.7) respectively, were included, all of whom had undergone baseline measurements of neuropsychological functioning. The mean follow‐up time was three years. Half of the patients still reported mental health problems at follow‐up and over time no major changes in cognitive performance were noted. The patients still performed significantly poorer than controls with regard to cognitive functions, mainly related to speed, attention and memory function. Long‐lasting impairment of cognitive functions related to speed, attention and memory function noted in patients with stress‐related exhaustion should be acknowledged and taken into consideration during treatment and when discussing a return to work. Follow‐up periods longer than three years are needed to explore the persistence of the cognitive impairment.     

高龄老年高血压患者的降压治疗策略

80岁以上高龄老年高血压患者的降压治疗随着人口老龄化而越来越受关注。评估高龄高血压患者降压治疗的获益与风险,在循证医学基础上进行个体化治疗,依据全身情况和耐受程度调整血压控制水平,慎重选择药物,平稳缓慢降压,将使高龄高血压患者最大程度受益。     

Longitudinal Intellectual Assessment of Children With HIV Infection

The objective of this paper was to describe the intellectual development of 39 children with HIV infection. The children received serial evaluations over a 10-year period. Thirty-nine children were assessed with age-appropriate intellectual measures at regular intervals as part of their treatment in the HIV Program of a children's hospital. Children showed an 24-point drop in mean Bayley Mental scores over the first 2 years of life. McCarthy scores remained in the low average range from ages 3–5 years. IQ scores were stable by age 6 in the low average range, and unchanged through age 12. Significant changes in memory, vocabulary, and performance subtests were noted. Children with HIV infection demonstrated a significant decline in mental functioning over the first 2 years of life, fell into the low average range by age 3, and remained in the low average range, with subtle changes in some areas.     

Severity of injuries due to accidental fall across the life span: a retrospective hospital-based study

This retrospective study investigated injuries due to accidental fall across the life span for which 19,593 patients were admitted to the Emergency Unit of the Groningen University Hospital during the period 1990 through 1997. 64% of the accidental falls were found for those in the age range between 10 years and 59 years; however, the proportion of accidental falls with regard to other causes of injuries by age group were the highest in youngsters (infants up to 9 years old) and in elderly persons (over 60 years old), 43% or more of these patients having falls with injuries. The clinically treated patients had on the average a statistically greater Injury Severity Score (7.2) than the outpatients (2.4). The highest percentages of medically treated inpatients were the patients of 60 years and over. Their mean ISS score was about the same for elderly inpatients, but the percentage of clinical treatment increased with age as well as the mortality. 30% of the injuries were found in the lower extremities and 30% in the upper extremities. Bone fracture was statistically significantly the major (36%) injury followed by contusion (20%). 34% of the accidental falls occurred at home, and statistically significantly more females, 50 years of age and older, were injured than males.     

Development and Open Trial of a Psychosocial Intervention for Young Children With Chronic Tics: The CBIT-JR Study

The Comprehensive Behavioral Intervention for Tic Disorders (CBIT) has demonstrated efficacy in large randomized controlled trials for children (≥9 yrs), adolescents and adults with Tourette Syndrome and Chronic Tic Disorders. Given the early age of onset for tic disorders, a large portion of affected individuals with chronic tic disorders are less than 9 years of age and appropriate developmental adaptations of behavioral treatment have not yet been tested. The goal of this study was to adapt and evaluate the acceptability and utility of a family-based adaptation of CBIT for children under 9 years of age. Children 5–8 years of age (N = 15) with chronic tics were recruited from three study sites. CBIT was adapted for use with young children and included habit reversal strategies introduced in a developmentally appropriate game format and function-based interventions to reduce family accommodation of and attention to tic symptoms.Children and parents described high level of treatment satisfaction and study retention rate was 100%. Treatment response rate was 54% (CGI-I = 1 or 2) with a significant decrease in the YGTSS total score (Cohen’s d = 0.73) that was largely maintained at 3-month and 1-year follow-up assessments. Treatment was associated with reduction of some symptoms of tic-related comorbid syndromes and with changes in parental accommodation and attention to tics.Future research should determine if parental attention to tics and symptom accommodation are important mediators of treatment outcome, or if participating in this intervention at a younger age may prevent the chronic course of tic symptoms.     

Individuelle Therapiezielerreichung nach Gruppentherapie „SAVE“

Background

Adolescents with attention deficit hyperactivity disorder (ADHD) are severely impaired in routine daily activities in the same way as adults. Therapy programs focus on improving everyday behavior. Goal attainment scaling (GAS) has already proven to be a suitable instrument for assessing treatment success with adult ADHD patients.

Material and methods

Goal attainment scaling was used in addition to standardized self-evaluation of core symptoms of ADHD in 49 adolescents aged 12-18 years old with a mean age of 14.14 years (standard deviation SD±1.59 years) with ADHD to operationalize treatment success of the cognitive behavior group therapy program SAVE. Behavior-oriented aims and criteria for target achievement were set. To examine treatment success changes were assessed at different time points (10 weeks before treatment, process evaluation during treatment and after treatment).

Results

The adolescents in this study were able to define relevant goals together with the therapists. They focused on goals concerning organization of everyday life, attention, distraction and power of endurance. Goals were reached from the beginning of the study to post-evaluation, even before SAVE started, with great effects (d?=?1.85). Adolescents evaluated changes in symptoms during the course of the SAVE program in general (d?=?0.47) and attention deficits (d?=?0.45) as having significant effects. The reduction in symptoms (attention) was only moderately correlated with the target achievement.

Conclusion

The GAS method has been proven to be a practical instrument to assess treatment success for adolescents with ADHD. Further studies in a controlled design should focus on assessment of the influence of GAS as an intervention method.     

Mortality of geriatric and younger patients with schizophrenia in the community

Little is known about the differences in mortality among non-institutionalized geriatric and younger patients with schizophrenia. In this study long-term mortality and suicidal behavior of all the geriatric (age > or = 65 years), middle-age (age 41-64 years), and young (age 15-40 years) subjects with schizophrenia living in a Chinese rural community were compared. A 10 year follow-up investigation among a 1994 cohort (n = 510) of patients with schizophrenia was conducted in Xinjin County, Chengdu, China. Compared with young subjects, geriatric subjects with schizophrenia were more likely to be female, have more previous physical illness, never accepted treatment, and practice religious (p < or = 0.01). There were no significant differences of suicide attempts among the three groups. Young subjects had a higher rate of suicide (1,033.8 per 100,000 person-years), and geriatric subjects had a higher rate of deaths due to other causes (accident and natural causes) (4,314.2 per 100,000 person-years). Standardized mortality ratios for both suicide and deaths due to other causes were highest in young subjects and the lowest in geriatric subjects. Patients with schizophrenia in all age groups had a marked increase in mortality and suicide. Specific intervention strategies for decreasing mortality and suicide should be developed for patients with schizophrenia in different age groups.     

Effect of age at the time of illness, tumor grade and Karnofsky value on the therapy result in patients with glioma of the cerebral cortex treated with combined therapy

49 patients with gliomas were investigated by means of life table analysis with regard to the influence of age, grade of the tumor and Karnofsky-score on the result of the treatment. The grade of the tumor and the age are factors of high prognostic value. They significantly influence the survival time of patients with gliomas treated by a combination treatment (operation, radiation, polychemotherapy; median survival times: grade 2: 50.4 months; grade 3: 28.5 months; grade 4: 18.9 months; group younger than 40 years: 49.2 months; older than 40 years: 21.9 months). Patients with different Karnofsky-scores show no differences concerning their median survival times (Karnofsky-score 50-70: 34.2 months; 80-100: 31.8 months).     

You are not alone – adolescents’ experiences of participation in a structured skills training group for ADHD

Little is known about how adolescents with attention deficit/hyperactivity disorder (ADHD) experience participating in group therapy, an important factor to consider when developing treatment methods for this age group. This study aimed to explore how adolescents with ADHD experience participating in a structured skills training group program based on dialectical behavioral therapy. Semi-structured interviews were conducted with 20 adolescents (15–18 years of age) with ADHD after participating in a structured skills training group. The interviews were transcribed verbatim and qualitative content analysis were used to analyze the text. The participants emphasized the value of meeting other adolescents with ADHD and the opportunity to exchange experiences, strategies and tips. Participating in the group treatment made the adolescents realize that they were not alone, and feelings of togetherness and an increased acceptance of themselves were described. The participants associated the treatment with elevated knowledge and understanding, for example, about ADHD, their own functioning and helpful strategies. They also described emotional and behavioral changes, such as higher self-esteem, fewer inter-personal conflicts and improved concentration. Activating and experiential exercises were considered important elements of the treatment, and the participants expressed a need for a variation of exercises, as well as more time for practicing skills, discussions and breaks. The results indicate that the group format add an extra value to the treatment and that the use of an active approach throughout the treatment is of importance for this group of patients.     

The framing heuristic influences judgements about younger and older adults' decision to refuse medical treatment

Three-hundred and one young adults evaluated medical dilemmas in which a patient (1) was portrayed as either 40 or 70 years old, (2) decided to either refuse or consent to a risky treatment for a serious medical disorder, and (3) received either positively or negatively framed information about the potential effectiveness of a proposed medical treatment. Participants' evaluations of the patients' decisions reflected the implementation of a framing heuristic and an age heuristic. The framing heuristic influenced participants' judgements of patients who refused the proposed treatment. Specifically, information which was positively framed resulted in risk-avoiding judgements, while information which was negatively framed resulted in risk-taking judgements. The age heuristic predisposed participants to recommend that 40 year old patients, more so than 70-year-old patients, opt for high-risk medical treatments that could potentially add a large number of years to their lives.     

Diagnosespezifische Strukturdefizite

Central to this work are the axes structure and treatment requirements of the Operationalized Psychodynamic Diagnostic in Childhood and Adolescence (OPD-CA), which were studied on a sample of n?=?195 inpatient child and adolescent psychiatric patients [mean age (M)?=?12.9 years, SD±10.1 years] in Austria. The study shows the overall poorer structure of male patients in all structural dimensions and the better treatment requirements of older compared to younger patients. Structural deficits not only affect the capacity for insight and motivation for treatment and the working alliance, but also the possible presence of morbid gain. In the diagnosis-specific analysis it was shown that patients diagnosed as F6 were understructured in emotional control, while patients with a diagnosis F9 have more structural deficits in the self-object differentiation. Patients with F3 and F4 diagnosis have better structural capacities for treatment, but their higher degree of insight and motivation for treatment is counterbalanced by an equally high gain of illness. The implications of these findings for treatment planning are discussed.     

The changing nature of diagnosis in an inpatient service over 20 years

This study examined factors related to mental illness in children and adolescents. A survey of all 362 files of child and adolescent patients discharged from a single residential treatment facility in 1961-1962, 1971-1972, and 1978 revealed several major diagnostic trends. The proportion of cases diagnosed as schizophrenic decreased by one-third, those diagnosed as neurotic increased over ten-fold, and significant increases occurred in the proportion of children diagnosed as autistic, personality disorder, and behavior disorder of childhood and adolescence. There was a decrease in cases between 6 and 12 years of age and a significant increase in 13- to 18-year-olds. The relative importance of symptoms appeared to be interpreted differently at various times. Significant changes were also found In treatment length, in medications used, and in a number of factors related to the characteristics of the family.     

Pre-morbid personality traits and responsiveness to flooding in obsessive-compulsive patients

Clinical and psychophysiological assessments were carried out before and after completion of flooding treatment in two groups of obsessive-compulsive patients, matched for age and duration of the illness but differing in pre-morbid obsessional personality traits.

Patients with such traits appear to demonstrate a specific autonomic sensitivity to flooding, probably related to either the reduction of anxiety after treatment or to certain qualities of the treatment itself. Significant changes after treatment regarding neutral stimuli and attitude ratings of untreated obsessional manifestations suggest a more global response to flooding in such patients.

Some suggestions for further research are presented.     

Correlates of changes in voluntary physical activity associated with the Youth Fit For Life intervention during after-school care

Overweight in youth is increasing and physical inactivity has been implicated as a causal factor. An after-school care intervention, Youth Fit For Life, has been associated with significant improvements in physiological factors and frequency of moderate-to-vigorous physical activity voluntarily completed outside of structured settings. Correlates of the observed changes in physical activity amounts were, however, unknown. A multiple regression equation with simultaneous entry of sex, age, race, initial Body Mass Index, and initial frequency of voluntary physical activity as predictor variables for changes in physical activity was calculated on Euro-American and African-American participants ages 8 to 12 years (N=217). A statistically significant 16% of the variance in changes in frequency of voluntary physical activity over 12 wk. was accounted for, with only voluntary physical activity at baseline and age making significant, unique contributions. For participants either overweight or at risk for overweight (n=72), the changes in physical activity significantly correlated with changes in Body Mass Index. Implications of findings to maximize treatment effects on voluntary physical activity were suggested.     

幽门螺杆菌相关性胃炎的时空特征研究

研究幽门螺杆菌导致胃黏膜病理损伤表现的多样性与年龄的关系。进行胃镜检查的患者,排除其它脏器疾病,测定尿素酶表达程度,观察黏膜损伤情况并取病理。结果是不同程度尿素酶表达的幽门螺杆菌感染性胃炎表现不同的病理特征;年龄、幽门螺杆菌感染时间及生活事件是相互作用的原因。幽门螺杆菌特征性慢性感染过程及其致病方式使胃黏膜的病理变化有了多样性,高尿素酶表达的幽门螺杆菌引起的增生性病灶乃至隆起性病变的机会随年龄增加及胃黏膜的病理变化而增长。     

重复异位妊娠的临床处理策略

为了探讨重复异位妊娠适宜的临床治疗方案,对2006年1月至2006年12月我科收治的251例异位妊娠中42例重复异位妊娠患者的资料进行回顾性分析,资料显示:重复异位妊娠的发病率为16.7%(42/251),平均发病年龄30.7岁,42例患者中异位妊娠部位与上次发生在同侧输卵管12例,对侧输卵管30例,两次异位妊娠发生间隔的时间最短为2个月,最长为9年,平均3.2年。其中10例为第3次异位妊娠。此次患病手术治疗25例,包括切除输卵管13例,保守性手术12例。因盆腔炎症和保守性手术是重复异位妊娠的危险因素,预防和彻底治疗盆腔炎症是降低重复异位妊娠发生的重要手段,采取保守性治疗或保守性手术时应慎重考虑其对患者将来生育和心理的影响。     

广西肝恶性肿瘤患者住院费用的研究

为探讨肝恶性肿瘤患者住院总费用情况,对广西2010年～2012年间肝恶性肿瘤患者的住院费用资料进行统计学分析,比较肝恶性肿瘤患者3年住院总费用的变化情况,并采用多重线性回归分析方法,分析肝恶性肿瘤患者住院总费用的影响因素.结果显示广西肝恶性肿瘤住院患者逐年增多,住院费用逐年增高;住院天数、有无手术、有无合并症、有无院内感染、性别、年龄6个因素是住院总费用的影响因素.我们应加大预防控制肝恶性肿瘤的力度,建立单病种诊疗规范和费用控制标准,推进临床路径管理,以减轻患者的经济负担.     

Changes in Anxiety Control Beliefs Following a Brief CBT Treatment and Their Association With Anxiety Symptom Reduction

Anxiety control beliefs (i.e., beliefs regarding one’s ability to cope with external, fear-inducing threats and internal reactions to those perceived threats) have been found to negatively predict anxiety symptoms in children and adults and to be modifiable by cognitive-behavioral therapy for anxiety disorders. The current study examines whether changes in anxiety control beliefs were seen following a brief, intensive treatment for specific phobias, and whether those changes were associated with improvements in the targeted phobia and comorbid anxiety disorder symptoms. Participants were 135 children and adolescents (M age = 9.01 years, 49% male) who received one-session treatment (OST) with or without parental involvement for their primary specific phobia. Results indicated that self-reported anxiety control beliefs significantly increased following treatment and that these increases significantly predicted reductions in specific phobia severity and symptoms of comorbid anxiety disorders 6 months and 1 year following treatment. Findings illustrate that involvement in a single 3-hour OST was associated with changes in anxiety control beliefs and demonstrate the potential importance of targeting control beliefs in pediatric anxiety treatment.