抚触对婴幼儿健康成长的影响

抚触源于英语Touch,在美国等发达国家对婴幼儿抚触的概念．已被广泛接受并得到了积极推广。在中国．婴儿抚触这一全新的婴儿护理概念也于1995年首次被引入,作为一种科学育婴的新方法,其对婴儿的生理及心理上的影响已经受到医护界、社会和家庭的广泛重视。近10年来对婴幼儿抚触开展了一系列临床研究表明．抚触对婴幼儿的健康成长有很大的影响,现概述如下。     

新生儿抚触及其临床意义

目的：探讨抚触对新生儿发育的影响。方法：将180例新生儿随机分为抚触组91例和对照组89例。分别测量、观察新生儿摄入奶量与体重、胎便转黄时间、生理性黄疸开始消退时间、完全消退时间及睡眠时间。结果：抚触组新生儿的摄入奶量与体重均增加,胎便转黄时间、生理性黄疸开始消退时间、完全消退时间均减少,睡眠时间延长,两组新生儿在摄入奶量、体重、胎便初排时间及胎便转黄时间、新生儿生理性黄疸开始消退和完全消退时间、睡眠时间均有明显差异（P〈0.05）。结论：抚触对促进新生儿身心的健康发育有明显效果。     

对80例新生儿抚触的临床观察

抚触就是我们常说的按摩，源于英语“Touch”。新生儿抚触就是经过科学的指导，有技巧的对新生儿全身按摩，让大量温和的良好的刺激，通过皮肤的感受器传到中枢神经系统。使新生儿得到感触的满足和情感的安慰，产生良好的心理和生理效应。操作者为母亲，也是建立亲子关系的最好方式。我院妇产科于2001年5月份开展新生儿抚触这项新技术，为了解新生儿抚触的作用，     

弥散加权成像及1H磁共振波谱在新生儿缺氧缺血性脑病中的诊断价值

目的:探讨弥散加权成像、1H磁共振波谱诊断新生儿缺氧缺血性脑病的应用价值。方法:以本院收治的缺氧缺血性脑病新生儿37例为研究组,另选择健康新生儿40例作为对照组,两组新生儿均接受弥散加权成像及1H磁共振波谱检查,观察研究组新生儿普通MRI与弥散加权成像检查结果,对比研究组和对照组新生儿的脑代谢化合物相对浓度。结果:与普通MRI检出率相比,研究组患儿的弥散加权成像信号明显升高,差异存在统计学意义(P0.05)。研究组NAA/Cr比值低于对照组,Cho/Cr、MI/Cr、Glu-Gln/Cr、Lac/Cr比值高于对照组,差异存在统计学意义(P0.05)。结论:临床上诊断新生儿缺氧缺血性脑病时,弥散加权成像与1H磁共振波谱的联合应用可提升诊断准确率,通过对代谢物浓度的分析有利于评价缺氧缺血导致脑组织损害的严重程度。     

探讨分层级管理对医院护理管理的作用和意义

目的:随着生活水平的提升,人们对健康水平也越来越重视,对相关医疗水平的要求随之提升。针对护理工作中存在的问题,采取积极的应对措施是目前临床护理管理工作的重点。本文通过观察分层级管理用于医院护理管理的效果,探讨并分析该方法对医院护理管理的作用和意义。方法:2011年1月-2012年12月期间在我院呼吸科、消化科、骨科等7个主要病区,按照护理人员的技能水平、职业资历等进行分层级管理。根据不同层级的护理要求进行培训并定期考核。观察并比较实施分层级护理管理前后的临床效果,调查并分析患者对分层级护理的反馈情况及护理人员自身对其工作的满意度。结果:实施分层级管理后,护士的基本护理工作落实率、危重护理工作落实率、健康教育落实率、环境管理落实率均显著提高,差异具有统计学意义(P0.05);患者和护士自身对护理工作的满意率明显提高,差异具有统计学意义(P0.05);意外发生率和护理差错发生率均明显降低,差异具有统计学意义(P0.05)。结论:在医院护理管理工作中开展分层级管理,有助于促进护理工作的顺利进行,提升医院整体护理水平,有助于患者的身体恢复及精神健康,提高患者的满意度。     

社区卫生护理的未来趋势和展望

社区护理是护理人员立足于社区,面向家庭,以社区内居民的健康为中心,以老年人、妇女、儿童和残疾人为重点服务对象,为其提供集预防、医疗护理、康复护理、保健、健康教育和计划生育技术服务为一体的综合性和连续性的健康护理。社区护理是社区卫生服务事业的重要组成部分,随着社会经济水平的提高和老年人口的快速增加,人们在追求健康和生活质量的同时,对预防保健知识的需求日益增加。社区护理作为21世纪护理发展的主要方向和新的热点,正越来越受到重视。发展社区卫生护理是顺应国际卫生发展的趋势和潮流,是实现“人人享有卫生保健”的途径。它有利于改进卫生护理服务方式,满足群众日益增长的卫生护理需求。选择合适的社区护理服务地段,确立服务对象,建立社区健康评估资料库,与社区、家庭签定社区护理合同,并进行健康护理诊断、健康教育计划、执行护理计划、健康评估。它正在改变生病了只有上医院、等病人上门护理的传统护理模式,真正实现向现代整体护理模式的转换[1,2]。     

社区卫生护理的未来趋势和展望

社区护理是护理人员立足于社区,面向家庭,以社区内居民的健康为中心,以老年人、妇女、儿童和残疾人为重点服务对象,为其提供集预防、医疗护理、康复护理、保健、健康教育和计划生育技术服务为一体的综合性和连续性的健康护理。社区护理是社区卫生服务事业的重要组成部分,随着社会经济水平的提高和老年人口的快速增加。人们在追求健康和生活质量的同时,对预防保健知识的需求日益增加。社区护理作为21世纪护理发展的主要方向和新的热点,正越来越受到重视。发展社区卫生护理是顺应国际卫生发展的趋势和潮流,是实现“人人享有卫生保健”的途径。它有利于改进卫生护理服务方式。满足群众日益增长的卫生护理需求。选择合适的社区护理服务地段,确立服务对象,建立社区健康评估资料库,与社区、家庭签定社区护理合同,并进行健康护理诊断、健康教育计划、执行护理计划、健康评估。它正在改变生病了只有上医院、等病人上门护理的传统护理模式。真正实现向现代整体护理模式的转换。     

广西新生儿专科护士的现况调查

目的了解并分析广西新生儿专科护士的现况,为广西新生儿专科护士的培训提供客观依据。方法通过查阅文献,结合广西新生儿专科护士培训方案及培训计划,采用自制调查表及自评式问卷对3期共163名广西新生儿专科护士进行培训技能需求调查,并对培训前、培训后的专科技能掌握现况进行自评。结果基本技能需求构成比为80.98%,重症护理需求构成比为93.25,外科护理需求构成比为51.53%,科研指导需求构成比为41.72%。培训前后新生儿专科基本技能和科研能力掌握评分比较,差异有统计学意义(P<0.05);新生儿重症护理技术和新生儿外科护理技术培训前后的评分比较,差异无统计学意义(P>0.05)。结论广西新生儿专科护士在重症护理技术和外科护理技术能力较低,系统、全面、规范的人才培养及培训有助于提高专科护士的专业技术水平。     

长沙地区县级医院中年慢性病患者健康商数及其影响因素的研究

目的:探讨长沙地区县级医院中年慢性病患者健康商数指数及其影响因素,帮助中年人群提升健康自我管理能力.方法:采用随机抽样的方法对长沙地区4所县级医院的808名中年慢性疾病患者进行一般情况和健商问卷调查,所有资料均采用SPSS13.0统计软件进行分析.结果:(1)健康商数状况调查结果中各维度得分均较低,在相应临界值水平左右,其中自我保健、生活方式、精神状态维度未低于相应,临界值,精神状态维度得分相对较高,为24.73±5.49;健康知识维度的得分较低,为21.47±5.89,甚至低于安全健康商数维度的临界值.(2)不同年龄段、不同家庭住址、不同文化程度、不同体检频度患者在健康商数四个维度的得分均具有统计学意义(P<0.05);不同体质指数的患者在健康知识和精神状态维度的得分有统计学意义(P<0.05).结论:(1)长沙地区县级医院中年慢性病患者健康商数状况总体不容乐观,尤其是健康知识维度较为薄弱,提示此类患者应成为护理工作针对性健康教育的重点对象,而健康知识普及应成为健康教育的重点内容.(2)年龄段、家庭住址、文化程度和体检频度是住院中年慢性病患者健康商数的重要影响因素,据此可为护理工作中开展个体化的干预策略提供参考依据.     

基于优质护理服务的“病房管理年”活动实践及体会

从大庆油田总医院开展“病房管理年”活动的实施背景、对优质护理服务的重要性、具体实施方法以及活动取得的成效和体会等多个方面对开展活动的情况进行了阐述和分析，提出了开展“病房管理年”活动，能够促进医院各项工作的协调发展，为优质护理服务在医院的健康开展提供更大程度的保障和支持的观点，为推进优质护理服务在医院的持续深入开展提供参考。     

Seeing Touches Early in Life

The sense of touch provides fundamental information about the surrounding world, and feedback about our own actions. Although touch is very important during the earliest stages of life, to date no study has investigated infants’ abilities to process visual stimuli implying touch. This study explores the developmental origins of the ability to visually recognize touching gestures involving others. Looking times and orienting responses were measured in a visual preference task, in which participants were simultaneously presented with two videos depicting a touching and a no-touching gesture involving human body parts (face, hand) and/or an object (spoon). In Experiment 1, 2-day-old newborns and 3-month-old infants viewed two videos: in one video a moving hand touched a static face, in the other the moving hand stopped before touching it. Results showed that only 3-month-olds, but not newborns, differentiated the touching from the no-touching gesture, displaying a preference for the former over the latter. To test whether newborns could manifest a preferential visual response when the touched body part is different from the face, in Experiment 2 newborns were presented with touching/no-touching gestures in which a hand or an inanimate object—i.e., a spoon- moved towards a static hand. Newborns were able to discriminate a hand-to-hand touching gesture, but they did not manifest any preference for the object-to-hand touch. The present findings speak in favour of an early ability to visually recognize touching gestures involving the interaction between human body parts.     

The influence of plasma lipoproteins on steroidogenesis of cultured ovine fetal and neonatal adrenal cells

The present study examined the effects of serum and lipoproteins on the function of cultured adrenal cells from 115-127-day-old ovine fetuses and from newborn lambs. On day 1 of culture, corticosteroid output was similar in medium containing 2% horse serum or in serum-free medium, both for fetal and neonatal cells. However, on day 5, cells cultured in the absence of serum produced smaller amounts of these steroids than cells maintained in medium containing serum; the difference was more marked under ACTH1-24 stimulation. Conversely, cAMP production was never lower in the absence than in the presence of serum. When stimulated by ACTH1-24 on day 2 of culture, fetal or neonatal adrenal cells incubated in the presence of a saturating concentration of ovine LDL produced more corticosteroids than cells incubated in serum-free medium; HDL also enhanced ACTH1-24-induced steroidogenesis, but to a lesser extent. VLDL was effective only with neonatal cells. In fetal and neonatal cells cultured for 6 days in ACTH-free medium, VLDL and LDL increased ACTH-induced steroidogenesis, but HDL did not. On the other hand, when cells were cultured in the presence of ACTH1-24, LDL and HDL were equipotent in supporting ACTH1-24-induced steroid output. Three major lipoprotein fractions were observed in serum of fetal and newborn lambs. The concentration of cholesterol was very low in the VLDL fraction of fetuses, but it was similar to that of newborns in LDL. Conversely, 4 times more cholesterol was present in HDL of newborns than in HDL of fetuses. These results suggest that: (i) after several days of cell culture, cholesterol availability is an important limiting factor for the steroidogenesis of cells maintained under serum-free conditions; (ii) both an "LDL pathway" and an "HDL pathway" are operating in adrenal cells from fetal as well as newborn sheep; (iii) LDL and HDL are important physiological sources of cholesterol to support steroidogenesis by fetal and neonatal adrenal cells.     

Parental Reports on Touch Screen Use in Early Childhood

Touch screens are increasingly prevalent, and anecdotal evidence suggests that young children are very drawn towards them. Yet there is little data regarding how young children use them. A brief online questionnaire queried over 450 French parents of infants between the ages of 5 and 40 months on their young child’s use of touch-screen technology. Parents estimated frequency of use, and further completed several checklists. Results suggest that, among respondent families, the use of touch screens is widespread in early childhood, meaning that most children have some exposure to touch screens. Among child users, certain activities are more frequently reported to be liked than others, findings that we discuss in light of current concern for children’s employment of time and the cognitive effects of passive media exposure. Additionally, these parental reports point to clear developmental trends for certain types of interactive gestures. These results contribute to the investigation of touch screen use on early development and suggest a number of considerations that should help improve the design of applications geared towards toddlers, particularly for scientific purposes.     

Bodily illusions modulate tactile perception

Touch differs from other exteroceptive senses in that the body itself forms part of the tactile percept. Interactions between proprioception and touch provide a powerful way to investigate the implicit body representation underlying touch. Here, we demonstrate that an intrinsic primary quality of a tactile object, for example its size, is directly affected by the perceived size of the body part touching it. We elicited proprioceptive illusions that the left index finger was either elongating or shrinking by vibrating the biceps or triceps tendon of the right arm while subjects grasped the tip of their left index finger. Subjects estimated the distance between two simultaneous tactile contacts on the left finger during tendon vibration. We found that tactile distances feel bigger when the touched body part feels elongated. Control tests showed that the modulation of touch was linked to the perceived index-finger size induced by tendon vibration. Vibrations that did not produce proprioceptive illusion had no effect on touch. Our results show that the perception of tactile objects is referenced to an implicit body representation and that proprioception contributes to this body representation. We also provide, for the first time, a quantitative, implicit measure of distortions of body size.     

Mechanical signalling,calcium and plant form

Calcium is a dynamic signalling molecule which acts to transduce numerous signals in plant tissues. The basis of calcium signalling is outlined and the necessity for measuring and imaging of calcium indicated. Using plants genetically transformed with a cDNA for the calcium-sensitive luminescent protein, aequorin, we have shown touch and wind signals to immediately increase cytosol calcium. Touch and wind signal plant cells mechanically, through tension and compression of appropiate cells. Many plant tissues and cells are very sensitive to mechanical stimulation and the obvious examples of climbing plants, insectivorous species as well as other less well-known examples are described. Touch sensing in these plants may be a simple evolutionary modification of sensitive mechanosensing system present in every plant. The possibility that gravitropism may be a specific adaptation of touch sensing is discussed. There is a growing appreciation that plant form may have a mechanical basis. A simple mechanical mechanism specifying spherical, cylindrical and flat-bladed structures is suggested. The limited morphological variety of plant tissues may also reflect mechanical specification. The article concludes with a discussion of the mechanisms of mechanical sensing, identifying integrin-like molecules as one important component, and considers the specific role of calcium.     

Animal-Assisted Therapy Enhances Resident Social Interaction and Initiation in Long-Term Care Facilities

ABSTRACT

Social stimulation is a valuable aspect of therapeutic activities at long-term care facilities, designed to decrease social isolation, maintain or stimulate mental abilities, and increase awareness of the external environment. A study was undertaken at two such facilities to compare the effectiveness of Animal-Assisted Therapy (AAT) with Non-Animal Therapy (NAT) at providing social stimulation, that is, at providing opportunities for patients to engage in social interaction and to initiate social behaviors. While studies have indicated that AAT can improve resident outlook or affect, few have directly studied the social behaviors that might lead to such improvements, or the role the animals themselves might play. We observed 33 patients, both alert and semi- to non-alert, during regular recreational therapy sessions. Most patients were women (29 vs. four men), and geriatric (in their 70's and 80's). Non-Animal Therapies included Arts and Crafts and Snack Bingo, while AAT involved animals from local animal shelters being brought by volunteers to group sessions. Social behaviors naturally divided into Brief Conversations, Long Conversations, and Touch. We determined frequencies and rates of the behaviors, who initiated the behaviors and whether the behaviors were directed at other people or at the animals.

Overall, during AAT residents were involved in as much or more conversation with others, including the animals, as residents in Non-Animal Therapy, and were more likely to initiate and participate in longer conversations. The finding that different kinds of therapies seem to encourage different kinds of conversation might be an important consideration when investigating health benefits. The most dramatic differences between therapy types were found in rates of touch: touching the animals during AAT added significantly to resident engagement in, and initiation of, this behavior. Since touch is considered an important part of social stimulation and therapy, the enhancement of this social behavior by the animals is an important, and perhaps undervalued, effect.     

Differential Reliance on Autophagy for Protection from HSV Encephalitis between Newborns and Adults

Newborns are more susceptible to severe disease from infection than adults, with maturation of immune responses implicated as a major factor. The type I interferon response delays mortality and limits viral replication in adult mice in a model of herpes simplex virus (HSV) encephalitis. We found that intact type I interferon signaling did not control HSV disease in the neonatal brain. However, the multifunctional HSV protein γ34.5 involved in countering type I interferon responses was important for virulence in the brain in both age groups. To investigate this observation further, we studied a specific function of γ34.5 which contributes to HSV pathogenesis in the adult brain, inhibition of the cellular process of autophagy. Surprisingly, we found that the beclin binding domain of γ34.5 responsible for inhibiting autophagy was dispensable for HSV disease in the neonatal brain, as infection of newborns with the deletion mutant decreased time to mortality compared to the rescue virus. Additionally, a functional beclin binding domain in HSV γ34.5 did not effectively inhibit autophagy in the neonate, unlike in the adult. Type I IFN responses promote autophagy in adult, a finding we confirmed in the adult brain after HSV infection; however, in the newborn brain we observed that autophagy was activated through a type I IFN-independent mechanism. Furthermore, autophagy in the wild-type neonatal mouse was associated with increased apoptosis in infected regions of the brain. Observations in the mouse model were consistent with those in a human case of neonatal HSV encephalitis. Our findings reveal age-dependent differences in autophagy for protection from HSV encephalitis, indicating developmental differences in induction and regulation of this innate defense mechanism after HSV infection in the neonatal brain.     

The intestinal microflora during the first weeks of life

Bacterial colonization of the neonatal gastrointestinal tract begins during birth when the neonate comes into contact with the maternal cervical and vaginal flora. In infants delivered by Caesarean section, bacteria colonizing the neonate gastrointestinal tract are provided by the environment. The first bacteria encountered in the majority of healthy infants, are facultative anaerobes, which remain predominant during the first 2 weeks of life. Among them, Staphylococcus, Enterobacteriaceae and Streptococcus were the genera most commonly isolated from the newborn faecal flora at birth. Facultative anaerobic bacteria are followed closely by Bifidobacterium sp. Clostridium perfringens is present within 2 days with an increase incidence in newborns delivered by a Caesarean section. Clostridium perfringens seems to be the precursor for installation of other anaerobic putrefactive bacteria, as Bacteroides and other Clostridium sp. The impact of Caesarean section and the period and quality of hospitalization are mainly implicated in changes of the normal newborn flora. Feeding seems to modulate the colonization pattern. In humans, breast milk plays a role in passive immunization of the neonatal intestine, and contains factors that promote the growth of Bifidobacterium bifidum in the intestinal flora. Formula feeding seems to promote implantation and persistence of Clostridium perfringens, and clearly enhances intestinal colonization of C. difficile in newborns.     

Alloparental Responsiveness to Newborns by Nonreproductive,Adult Male,Common Marmosets (Callithrix jacchus)

Parental care in mammals is influenced by sensory stimuli from infants, and by changes in the hormone levels of caretakers. To determine the responsiveness to infant cues in nonreproductive adult male common marmosets (Callithrix jacchus) with and without previous experience in caretaking, we exposed 12 males to newborn marmosets and assessed their cortisol plasma levels and behavioral response. Newborn marmosets housed in transparent enclosures were placed inside the cages of the adult male subjects. Males were exposed four times to two different experimental conditions: (a) newborn enclosures remained closed during the observation period and (b) newborn enclosures were opened during the observation period to allow direct social interaction by the adult males. Blood samples from adult males were collected after each behavioral observation trial to measure the levels of cortisol. The behavioral responses of adult males exposed to the closed and open newborn enclosures showed a significant difference only with respect to the frequency of displacements, where males moved among the quadrants of their own cages with greater frequency when the newborn enclosure was sealed. Experienced males approached newborn enclosures more frequently, spent more time in close proximity, and carried and recovered newborns more quickly than inexperienced males. The successive exposure to newborns increased the responsiveness in inexperienced males. The highest levels of plasma cortisol in adult males were recorded following periods of exposure to the sealed newborn enclosures. This suggests that successive exposure to newborns and previous alloparental caregiving experience while living in family groups influences the responsiveness of male marmosets to the sensory cues of newborns. Am. J. Primatol. 75:145‐152, 2013. © 2012 Wiley Periodicals, Inc.     

Prevention and Management of Neonatal Hypothermia in Rural Zambia

Background

Neonatal hypothermia is increasingly recognized as a risk factor for newborn survival. The World Health Organization recommends maintaining a warm chain and skin-to-skin care for thermoprotection of newborn children. Since little is known about practices related to newborn hypothermia in rural Africa, this study''s goal was to characterize relevant practices, attitudes, and beliefs in rural Zambia.

Methods and Findings

We conducted 14 focus group discussions with mothers and grandmothers and 31 in-depth interviews with community leaders and health officers in Lufwanyama District, a rural area in the Copperbelt Province, Zambia, enrolling a total of 171 participants. We analyzed data using domain analysis. In rural Lufwanyama, community members were aware of the danger of neonatal hypothermia. Caregivers'' and health workers'' knowledge of thermoprotective practices included birthplace warming, drying and wrapping of the newborn, delayed bathing, and immediate and exclusive breastfeeding. However, this warm chain was not consistently maintained in the first hours postpartum, when newborns are at greatest risk. Skin-to-skin care was not practiced in the study area. Having to assume household and agricultural labor responsibilities in the immediate postnatal period was a challenge for mothers to provide continuous thermal care to their newborns.

Conclusions

Understanding and addressing community-based practices on hypothermia prevention and management might help improve newborn survival in resource-limited settings. Possible interventions include the implementation of skin-to-skin care in rural areas and the use of appropriate, low-cost newborn warmers to prevent hypothermia and support families in their provision of newborn thermal protection. Training family members to support mothers in the provision of thermoprotection for their newborns could facilitate these practices.