The efficacy of biobehavioral and compliance interventions in the adjunctive treatment of mild pregnancy-induced hypertension

This investigation assessed the efficacy of a biobehavioral intervention in the adjunctive treatment of mild pregnancy-induced hypertension (PIH), a potentially serious complication of pregnancy in which normotensive women develop hypertension, proteinuria, and edema of unknown etiology late in gestation. Forty-five women with symptoms of PIH were randomly assigned to one of three treatment conditions: bed rest alone (the most common obstetrical treatment), bed rest with individualized compliance enhancement training, or a four-session biobehavioral treatment consisting of bed rest, compliance enhancement training, and individualized thermal biofeedback-assisted relaxation training. Results indicated that while blood pressure for the bed rest and compliance enhancement groups continued to rise and pose an increasing health risk to maternal and fetal well-being, subjects in the biobehavioral group maintained their blood pressure at a significantly lower, and presumably safer, level. The biobehavioral treatment is hypothesized to affect blood pressure levels in subjects with mild PIH through the mediation of the sympathetic nervous system, decreasing peripheral vascular resistance and cardiac output. The results of this investigation suggest that the biobehavioral intervention may be an effective adjunct to bed rest in the treatment of mild PIH remote from term.     

Ethical obligation and legal requirements: On informed consent practices in Bangladesh

Informed consent to medical intervention is fundamental in both ethics and law. But in practice it is often not taken seriously in developing countries. This paper provides an appraisal of informed consent practices in Bangladesh. Following a review of the ethical and legal principles of informed consent, it assesses the degree to which doctors adhere to it in Bangladesh. Based on findings of non-compliance, it then investigates the reasons for such non-compliance through an appraisal of informed consent practices in Bangladesh and provides recommendations aimed at improving such practices. The significance of this paper lies in unveiling the interdependence between the ethical and legal traits of informed consent and their ramifications on strengthening the patient-oriented approach of duty to care.     

Utilidad y seguridad de los ingresos directos a una unidad hospitalaria de agudos de un servicio de geriatría valorados por atención geriátrica en residencias

Background and objectiveMore than half of institutionalized older people need a emergency department visit annually, with high resources consumption and higher risk of adverse events, due to high complexity. Direct admission to Acute Geriatric Unit (AGU), after geriatric consultant and nursing home medical team assessment, could be a safety and effective alternative to emergency department (ED) admission.MethodsRetrospective observational study of AGU patients admitted by Nursing Home Geriatric Team between January, 1st and December, 31st, 2021. Planned admissions and SARS-CoV-2 positive patients were excluded. Medical (sociodemographic, clinical, functional and cognitive) records and outcomes data (inpatient mortality, hospital and ED lenght of stay, transfer to ED and delirium within 48 h after admission, hospital discharge location) were collected.ResultsTwo hundred and six patients directly admitted, 101 through ED (N 307). 62.5% with Barthel index <40, 65% with dementia, 56.4% with Charlson index ≥3. Inpatient mortality was 14.6% in direct admission, 20.8% in ED referral group, p = 0.14. Hospital lenght of stay was 9.61 ± 6.01 days in direct admission, 11.22 ± 5.36 days in ED group, p = 0.02. 27.7% of patients with delirium in direct admission and 36.6% in ED group; only one patient was transferred to ED, within 48 h after admission.ConclusionsDirect admission is a safety and effective alternative to ED referral in institutionalized older people after geriatric assessment, due to no increased mortality, shorter length of stay and hospital cost reduction.     

Early agonistic experience and rank acquisition among free-ranging infant rhesus monkeys

Several aspects of agonistic experience are described for freeranging infant rhesus monkeys (Macaca mulatta)on Cayo Santiago. Even before infants are fully integrated with peers in rank dominance based on maternal ranks,infants of highranking mothers tend to be threatened less frequently by other members of the group and are less likely to be threatened by unfamiliar individuals than are infants of lowranking mothers. There is no evidence that fearful interactions between pairs of infants are related to their mother’s ranks before 22 weeks of age. However, an imperfect hierarchy can be constructed for infants between 27 and 30 weeks of age. At this age,infants of higherranking mothers are also more likely to receive protection when threatened than are infants of lowerranking mothers. When protected, their protectors are less likely to emit fearful gestures to the infants’ threatener. Close female relatives appear to play a large role in the protection of infants and may be more directly responsible for the differences described above than the mother, other relatives, or other highranking members of the group. It is suggested that more than one mechanism, including intervention by the mother and by close female relatives,may be important in rank acquisition among peers.     

早产儿语言发展的影响因素及其干预对策

早产儿的语言发展受到多种因素的影响,可能导致他们在词汇、语法、语音等方面出现发展滞后或障碍。本文首先简述了影响早产儿语言发展的生物学和环境因素的研究进展,其中生物学因素包括早产程度、体重和性别、新生儿发病率和疾病严重程度等,环境因素则包括新生儿重症监护室的环境、家庭中的语言环境和社会因素等。在明确这些影响因素的基础上,本文强调了早期评估和早期干预是优化早产儿语言发育效果的关键步骤,并分析了具体的干预对策,例如生理和神经干预、优化新生儿重症监护室（NICU）环境、增强家庭语言互动、多学科合作和社会支持等。此综述旨在探讨影响早产儿语言发展的各种因素,并总结出有效的早期干预措施,为其提供更为全面的语言发展支持。     

低分子肝素与普通肝素在介入手术中安全性与疗效的比较

肝素已经普遍用于冠状动脉介入术中,但是由于在应用过程中抗凝效果个体差异大、出血风险相对较高、并发症等问题的日益显现,已经引起了医生们的注意。相对而言,低分子肝素具有抗凝作用强、出血风险低、并发症发生率相对较低、无需实验室监测等优点,进而越来越广泛的在冠状动脉介入术中担当重要角色。普通肝素与低分子肝素在冠状动脉介入术中的有效性与安全性的比较是值得我们去探讨的,知道普通肝素与低分子肝素的优缺点后,可使我们在冠状动脉介入术中更好的选择抗凝药物,使手术的成功率大大提高,降低术后并发症的发生,减轻患者的痛苦。本文结合普通肝素与低分子肝素的药理作用及相关临床研究的结果,分析比较了普通肝素与低分子肝素在冠状动脉介入术中的有效性与安全性。     

干预措施对噪声污染大鼠脑组织基因表达及去甲肾上腺素水平的影响

为了探索干预措施对噪声污染大鼠脑组织基因表达水平的影响, 将50只SPF级Wistar大鼠随机分为空白对照组、噪声污染组(分为30、60、80 dB三个组)、干预组(利血平+80 dB), 每组10只动物。每天刺激1次, 每次刺激30 min, 连续刺激15 d。第16天解剖出脑组织用酶联免疫吸附法(ELISA)检测基因表达水平。结果发现, 噪声污染组大脑前额叶皮质(PFC)和海马(Hipp)组织中去甲肾上腺素(noradrenaline,NA)水平比对照组分别升高了22.87%、50.35%、94.65%和 12.00%、31.76%、61.83%; 干预组NA水平比对照组分别降低了33.66%和52.06%; 去甲肾上腺素转运蛋白(noradrenaline transporter, NAt)水平比对照组分别升高了22.87%、50.35%、94.65%和12.00%、31.76%、61.83%, 干预组NAt水平比对照组分别降低了33.66%和52.06%; 脑源性神经营养因子(brain derived neurotrophic factor, BDNF)水平比对照组分别升高了24.87%、39.27%、67.41%和44.97%、80.81%、95.84%, 干预组BDNF水平比对照组分别升高了16.36%和14.34%, 升高程度明显低于噪声污染组; 酪氨酸激酶受体B(Tyrosine kinase B, TrkB)水平比对照组分别升高了32.64%、59.95%、82.64%和31.02%、57.31%、80.23%, 干预组TrkB水平比对照组分别升高了4.75%和10.52%, 升高程度明显低于噪声污染组。结果显示, 噪声污染使动物体内去甲肾上腺素等水平升高, 去甲肾上腺素是噪声污染引起组织器官损伤的主要因素, 脑源性神经营养因子和酪氨酸激酶受体B防止神经元受损死亡, 改善神经元的病理状态, 利血平使去甲肾上腺素耗竭, 保护组织器官免受噪声污染的损伤。     

不同干扰模式对受害马尾松人工纯林林分结构的影响

在浙江安吉选择松材线虫病危害的马尾松人工纯林,分别进行暂不采伐直至10年后统一伐除受害木的集中干扰、采伐受害松木的适度干扰、采伐受害松木与周边松木及生长势弱松木的强度干扰,探讨不同干扰模式使受害马尾松林恢复健康的可能性.16年后的试验结果表明: 3种模式下受害林分马尾松的重要值为集中干扰>适度干扰>强度干扰,阔叶树的重要值则正好相反;与集中干扰相比,适度和强度干扰后的马尾松、阔叶树的平均胸径分别提高1.2、1.7倍和1.3、1.9倍,平均树高分别提高了1.5、2.0倍和1.2、1.8倍,林分每公顷蓄积量分别是集中干扰样地的5.2和3.8倍;适度和强度干扰的各径阶株数均远高于集中干扰样地,胸径结构近似于反J型曲线,也形成了复层林,物种丰富度和多样性指数均显著高于集中干扰样地,林木个体差异及林分复杂性指数均表现为适度干扰>强度干扰>集中干扰.适度和强度干扰下单层马尾松同龄纯林均演替为复层马尾松-阔叶树混交异龄林.3种模式均是正向阔叶化演替,演替速度为强度干扰>适度干扰>集中干扰.表明适度干扰更有利于病害马尾松林分恢复,间伐马尾松纯林能加快阔叶混交化进程以抵御松材线虫病的入侵.     

家庭干预对喉癌患者术后生活质量的影响

目的:探讨家庭干预对喉癌术后患者生活质量的影响。方法:将66例喉癌术后患者随机分为干预组和时照组,两组病人均进行常规治疗和护理,干预组在此基础上对患者实施针对性家庭干预。采用Terrell生活质量调查表分别在实施干预前及实施干预后进行评估。结果:干预组患者干预后对健康知识掌握率显著高于对照组(P<0.05),生活质量明显高于对照组(P<0.05)。结论:对喉癌术后病人实施针对性家庭干预,可以提高喉癌术后病人生活质量。     

基于奥马哈理论的护理模式 对慢性阻塞性肺疾病患者肺功能及细菌感染率的影响

目的探讨基于奥马哈理论的护理模式对慢性阻塞性肺疾病(COPD)患者肺功能、症状控制、细菌感染率及生活质量的影响。方法选取2018年1月至2019年1月我院收治的134例COPD患者,采用随机数字表法将研究对象分为观察组(n=69)与对照组(n=65),对两组患者住院期间肺功能、症状控制情况、细菌感染率、睡眠情况以及生活质量进行评估和分析。结果观察组患者肺功能情况优于入院时(P0.05)。两组患者泌尿系统感染发生率最高,其次为褥疮创面感染和口腔感染。观察组患者泌尿系感染的发生率低于对照组(P0.05)。两组患者干预后PSQI量表评分和CAT评分均低于入院前,且观察组患者总分低于对照组(均P0.05)。干预后观察组患者SF-36评分均高于对照组(均P0.05)。结论在基于奥马哈理论的护理模式下,COPD患者的肺功能得到加强,继发感染的发生减少,生活质量得到提高。