久治不愈的老年阴囊湿疹应注意啥

问：我今年72岁，患阴囊湿疹已有9年，阴囊和腹股沟处的皮肤不但潮红、湿润还微痒，抹了许多药膏，吃了不少中药，都不见好，而且越来越严重，请问有什么好办法？

老年社会工作机构服务绩效评估指标体系研究

服务老年群体的社会工作(以下简称"社工")机构面临绩效评估体系不健全的挑战。本文采用德尔菲法研究了如何评价老年社工机构服务绩效问题。首先,通过查询相关文献、实地访谈建立初步备选指标体系。其次,邀请了34名学校科研机构、一线社会工作机构专家,进行了三轮专家咨询。三轮咨询的专家积极性系数分别为97.06%、94.12%和73.53%;变异系数小于25%,满足建议标准。基于此,建构出一套老年社工机构服务绩效评估指标体系。指标体系包括服务投入、服务过程、服务质量、服务效果和服务产出等5个维度,共65项指标。该指标体系具有良好应用前景。

两种标准评价老年住院患者的潜在不适当用药结果及影响因素分析

目的:采用2019年版B e e r s标准(以下简称B e e r s标准)和2017年版《中国老年人潜在不适当用药判断标准》(简称中国标准)分析我院老年住院患者潜在不适当用药(P I M)的情况。方法:选取2021年6月—12月宜宾市第一人民医院收治的年龄≥65岁的4635例住院患者。收集患者的年龄、性别、诊断、医嘱、住院天数、药品费用、总医疗费用等基本信息,分别采用Beers标准和中国标准审查老年住院患者PIM情况,并应用二元Logistic回归分析PIM发生的相关危险因素。结果:Beers标准筛选出PIM占比为62.55%(2899例);中国标准筛选出PIM占比为67.62%(3134例),两组差异显著(P<0.05)。L o g i s t i c结果显示,诊断种数、用药种类是P I M发生的危险因素(P<0.05)。结论:多重用药和PIM在老年患者发生率很高,多重药物是PIM发生最相关的独立危险因素。药师应协助临床促进老年患者的合理用药,降低PIM的发生率。

联合国确定的十年纪念活动和国际年

20世纪90年代:第三个裁军十年;1990至1999年:国际减少自然灾害十年;1990至1999年:联合国国际法十年;1991至2000年:联合国禁止毒品泛滥十年;1991至2000年:非洲第二个运输与交通十年;1993至2002年:非洲第二个工业发展十年;1993至2002年:非洲与太平洋地区残疾人十年;

中共黑龙江省引嫩工程管理处委员会《关于授予献身引嫩工作二十五年以上的离退休人员及在职人员荣誉纪念牌的决定》

在举国欢庆新中国五十华诞之际,全处千名职工欣逢第一个国际老年人年和我国第12个老年节。为了进一步弘扬中华民族尊老敬老爱老的传统美德,缅怀和继承老领导、老引嫩的艰苦创业精神,激励青年同志继往开来,以旺盛的斗志和良好的精神风貌迎接新世纪的到来,处党委决定,对献身引嫩事业25年以上的离退休人员和在职人员授予荣誉纪念牌。 从1973年建立北引工程管理处到1999年,20多年来,北引工程做为全国较大的无坝引水工程,产生了良好的社会效益和生态环境效益。在几届处党委的领导下,在引嫩全战线几代干部职工的共同努力下,引嫩事业取得了众人瞩目的成绩,获得了国家、省、厅级一系列荣誉。截止1998年末,我处固定资产已达4.76亿元,年收入水费达6 495万元。

Geriatric nursing competence of clinical nursing staff at different hospital levels in Chongqing,China:A cross-sectional study

Objectives:This study aimed to survey the geriatric nursing competencies of clinical nursing staff in Chongqing City,China,and provide suggestions to enhance these competencies.Methods:This study was conducted in 204 hospitals in Southwest China from December 24,2022 to January 7,2023.The“Geriatric Nursing Competence of Clinical Nurse Investigation Tool”was used to explore factors that influence geriatric nurses’competencies via stratified sampling.The survey was conducted by distributing and collecting questionnaires through the online platform Wenjuanxing.Results:A total of 10,692 nurses answered the questionnaires.Of these questionnaires,9,442 were valid.The total geriatric nursing competence score of the clinical nursing staff was 2.29±0.81,the secondary hospital score was 2.23±0.78,and the tertiary hospital’s overall mean score was 2.33±0.83.The factors that influenced secondary hospitals included the department of medicine,age of nurses and total length of career(P<0.05).The factors that influenced tertiary hospitals included the department of medicine,age of nurses,nurses’professional title,and geriatric practical advanced nurses’certification(P<0.05).Conclusions:Geriatric nursing competence among clinical nursing staff is imbalanced at a lower-middle level and is influenced by various factors.Thefindings highlight the need for further clinical training in geriatric nursing.The training of geriatric nurses should focus on necessary clinical skills and on preparing them to adequately manage comprehensive geriatric syndromes.

Decreased contrast sensitivity of visual cortical cells to visual stimuli accompanies a reduction of intracortical inhibition in old cats

Psychophysical experiments on human and animal subjects have proven that aged individuals show significantly reduced visual contrast sensitivity compared with young adults.To uncover the possible neural mechanisms,we used extracellular single-unit recording techniques to examine the response of V1（primary visual cortex） neurons as a function of visual stimulus contrast in both old and young adult cats（Felis catus）.The mean contrast sensitivity of V1 neurons to visual stimuli in old cats decreased significantly relative to young adult cats,consistent with findings reported in old primates.These results indicate that aging can affect contrast sensitivity of visual cortical cells in both primate and non-primate mammalian animals,and might contribute to the reduction of perceptual visual contrast sensitivity in aged individuals.Further,V1 cells of old cats exhibited increased responsiveness,decreased signal-to-noise ratio,and enlarged receptive field（RF） size compared with that of young adult cats,which indicated that decreased contrast sensitivity of V1 neurons accompanied a reduction of intracortical inhibition during senescence.

社区老年糖尿病眼病患者综合干预效果研究

防止糖尿病患者视力减退和盲已成为防盲治盲工作的重要课题。我院眼科从2006年1月至2008年12月与社区卫生服务中心合作，对社区内300例老年糖尿病患者实施为期3年的综合防治干预，收到了明显的成效，现报道如下。

Effects of urethane on the response properties of visual cortical neurons in young adult and old cats

Previous studies have shown that visual cortical neurons in old mammals exhibit higher spontaneous activity,higher responsiveness to visual stimuli,and lower selectivity for stimulus orientations and motion directions than did neurons in young adult counterparts.However,whether the responsive difference in cortical neurons between young and old animals resulted from different effects induced by anesthetics has remained unclear.To clarify this issue,we recorded the response properties of individual neurons in the primary visual cortex of old and young adult cats while systematically varying the anesthesia level of urethane,a widely used anesthetic in physiology experiments.Our results showed that cumulatively administrating 50 mg and 100 mg of urethane upon the minimal level of urethane required to anesthetize an old or young adult cat did not significantly alter the degree of neuronal response selectivity for stimulus orientations and motion directions nor significantly change the visually-driven response and spontaneous activity of neurons in old and young adult cats.Cumulatively administrating 150 mg of urethane decreased neuronal responsiveness similarly in both age groups.Therefore,urethane appears to exert similar effects on neuronal response properties of old and young adult animals.

Development and course of heart failure after a myocardial infarction in younger and older people

Background Acute myocardial infarction （AMI） is a common cause of heart failure （HF）, which can develop soon after AMI and may persist or resolve or develop late. HF after an MI is a major source of mortality. The cumulative incidence, prevalence and resolution of HF after MI in different age groups are poorly described. This study describes the natural history of HF after AMI according to age. Methods Patients with AMI during 1998 were identified from hospital records. HF was defined as treatment of symptoms and signs of HF with loop diuretics and was considered to have resolved if loop diuretic therapy could be stopped without recurrence of symptoms. Patients were cate- gorised into those aged 〈 65 years, 65-75 years, and 〉 75 years. Results Of 896 patients, 311,297 and 288 were aged 〈 65, 65-75 and 〉75 years and of whom 24%, 57% and 82% had died respectively by December 2005. Of these deaths, 24 （8%）, 68 （23%） and 107 （37%） oc- curred during the index admission, many associated with acute HF. A further 37 （12%）, 63 （21%） and 82 （29%） developed HF that persisted until discharge, of whom 15, 44 and 62 subsequently died. After discharge, 53 （24%）, 55 （40%） and 37 （47%） patients developed I-IF for the first time, of whom 26%, 62% and 76% subsequently died. Death was preceded by the development of HF in 35 （70%）, 93 （91%） and 107 （85%） in aged 〈 65 years, 65-75 years and 〉75 years, respectively. Conclusions The risk of developing HF and of dying after an MI in- creases progressively with age. Regardless of age, most deaths after a MI are preceded by the development of HF.

Enigma of primary aortoduodenal fistula

A diagnosis of primary aortoenteric fistula is difficult to make despite a high level of clinical suspicion. It should be considered in any elderly patient who presents with upper gastrointestinal bleeding in the context of a known abdominal aortic aneurysm. We present the case of young man with no history of abdominal aortic aneurysm who presented with massive upper gastrointestinal bleeding. Initial misdiagnosis led to a delay in treatment and the patient succumbing to the illness. This case is unique in that the fistula formed as a result of complex atherosclerotic disease of the abdominal aorta, and not from an aneurysm.

Semantic Region Estimation of Assistant Robot for the Elderly Long-Term Operation in Indoor Environment

In this work, in order to improve spatial recognition abilities for the long-term operation tasks of the assistant robot for the elderly, a novel approach of semantic region estimation is proposed. We define a novel graphbased semantic region descriptions, which are estimated in a dynamically fashion. We propose a two-level update algorithm, namely, Symbols update level and Regions update level. The algorithm firstly adopts particle filter to update weights of the symbols, and then use the Viterbi algorithm to estimate the region the robot stays in based on those weights, optimally. Experimental results demonstrate that our proposed approach can solve problems of the long-term operation and kidnapped robot problem.

Peptic ulcer and childhood adversities experienced by working-aged people

AIM: To study the association between self-reported peptic ulcer and childhood adversities.METHODS: The Health and Social Support Study (HeS-Sup) population consisted of a stratif ied random sample drawn from the Finnish Population Register in four age groups: 20-24, 30-34, 40-44 and 50-54. The survey was carried out by postal questionnaire during 1998, with a response rate of 40.0%. A follow-up questionnaire was sent during 2003 to all those who responded to the f irst. Altogether 19 626 individuals returned the follow-up questionnaire; a response rate of 75.8%. The subjects were asked whether a doctor had told them that they have or have had peptic ulcer. The analyses covered those who responded aff irmatively to both the baseline and the follow-up enquiries (n = 718). Those not re-porting a peptic ulcer in either of the two questionnaires (n = 17 677) were taken as controls. The subjects were further requested (through six questions) to think about their childhood adversities.RESULTS: The most common adversities mentioned were long-lasting financial difficulties in the family, serious conflicts in the family, and a family member seriously or chronically ill. All the adversities reported, except parental divorce, were more common among peptic ulcer patients than among controls (P values varied between < 0.001 and 0.003). Age- and sex-adjusted odds ratios (OR) of childhood adversities in the multivariate logistic analysis for self-reported pep-tic ulcer varied between 1.45 and 2.01. Adjusting for smoking, heavy drinking, stress and nonsteroidal anti-inflammatory drug use had no further influence (ORs between 1.22 and 1.73).CONCLUSION: Our findings suggest that childhood adversities maintain a connection with and have a predictive role in the development of peptic ulcer.

Use of antiarrhythmic drugs in elderly patients

Human aging is a global issue with important implications for current and future incidence and prevalence of health conditions and disability. Cardiac arrhythmias, including atrial fibrillation, sudden cardiac death, and bradycardia requiring pacemaker placement, all increase exponentially after the age of 60. It is important to distinguish between the normal, physiological consequences of aging on cardiac electrophysiology and the abnormal, pathological alterations. The age-related cardiac changes include ventricular hypertrophy, senile amyloidosis, cardiac valvular degenerative changes and annular calcification, fibrous infiltration of the conduction system, and loss of natural pacemaker cells and these changes could have a profound effect on the development of arrhythmias. The age-related cardiac electrophysiological changes include up- and down-regulation of specific ion channel expression and intmcellular Ca2＋ overload which promote the development of cardiac arrhythmias. As ion channels are the substrates of antiarrhythmic drugs, it follows that the pharmacokinetics and pharmacodynamics of these drugs will also change with age. Aging alters the absorption, distribution, metabolism, and elimination of antiarrhythmic drugs, so liver and kidney function must be monitored to avoid potential adverse drug effects, and antiarrhythmic dosing may need to be adjusted for age. Elderly patients are also more susceptible to the side effects of many antiarrhytbanics, including bradycardia, orthostatic hypotension, urinary retention, and falls. Moreover, the choice of antiarrhythmic drugs in the elderly patient is frequently complicated by the presence of co-morbid conditions and by polypharmacy, and the astute physician must pay careful attention to potential drug-drug interactions. Finally, it is important to remember that the use of antiarrhythmic drugs in elderly patients must be individualized and tailored to each patient＇s physiology, disease processes, and medication regimen.

Comparison of presentation and impact on quality of life of gastroesophageal reflux disease between young and old adults in a Chinese population

AIM:To compare the presentation and impact on qual-ity of life of gastroesophageal reflux disease(GERD)in old and young age groups.METHODS:Data from adult patients with GERD di-agnosed by endoscopic and symptomic characteristics were collected between January and November 2009.Exclusion criteria included combined peptic ulcers,ma-lignancy,prior surgery,antacid medication for more than 2 mo,and pregnancy.Enrolled patients were assigned to the elderly group if they were 65 years or older,or the younger group if they were under 65 years.They had completed the GERD impact scale,the Chinese GERD questionnaire,and the SF-36 question-naire.Data from other cases without endoscopic f ind-ings or symptoms were collected and these subjects comprised the control group in our study.RESULTS:There were 111 patients with GERD and 44 normal cases:78(70.3%)and 33 patients(29.7%)were in the younger and elderly groups,respectively.There were more female patients(60.3%)in the younger group,and more males(72.7%)in the elderly group.The younger cases had more severe and fre-quent typical symptoms than the elderly patients.Sig-nif icantly more impairment of daily activities was noted in the younger patients compared with the elderly group,except for physical functioning.CONCLUSION:Elderly patients with GERD were pre-dominantly male with rare presentation of typical symp-toms,and had less impaired quality of life compared with younger patients in a Chinese population.

The pooled analysis of single gemcitabine for non-small cell lung cancer patients with elderly age

Objective:Gemcitabine,used as single agent for elderly patients with non-small cell lung cancer (NSCLC),was demonstrated effective in this population based on phase II studies.The aim of this study was to summarize all those phase II studies with the hope to get a comprehensive understanding of gemcitabine efficacy.Methods:The PubMed database was used to search all the papers on NSCLC associated with gemcitabine used as single agent in the first line setting till to March 31st,2010.And the medians and their 95% CI of overall response rate (ORR),disease control rate (DCR),progression free survival (PFS),and overall survival (OS) were calculated.Results:1.There were 7 papers including 410 patients with performance status (PS) ≤ 2 and advanced stage collected.2.The dose-intensities of gemcitabine were 843.75 mg/m 2 /week-1125 mg/m 2 /week in the 4-week schedule,and 666.7 mg/m 2 /week in the 3-week schedule.3.The median age was 73.8 (95% CI was 72.44,75.16) years old;36.1% (95% CI:31.4%,40.7%) of patients with stage IIIB and 60.5% (95% CI:55.8%,65.2%) of patients with stage IV;35.9% (95% CI:31.2%,40.5%) patients were adenocarcinomas and 43.7% (95% CI:38.9%,48.5%) patients were squamous cell carcinomas (SCCs).4.The ORR,DCR,PFS/TTP,and OS were 22.3% (95% CI:18.2%,26.5%),58.4% (95% CI:53.5%,63.4%),3.6 (95% CI:2.9,5.15) months and 6.68 (95% CI:5.4,8.11) months,respectively.Conclusion:Gemcitabine as single agent applied in this special population was effective and can be well tolerated under different doses and usage.

Association of cardiovascular system medications with cognitive function and dementia in older adults living in nursing homes in Australia

Objective To examine associations between cardiovascular system medication use with cognition function and diagnosis of dementia in older adults living in nursing homes in Australia. Methods As part of a cross-sectional study of 17 Australian nursing homes examining quality of life and resource use, we examined the association between cognitive impairment and cardiovascular medication use （identified using the Anatomical Therapeutic Classification System） using general linear regression and logistic regression models. People who were receiving end of life care were excluded. Results Participants included 541 residents with a mean age of 85.5 years （± 8.5）, a mean Psychogeriatric Assessment Scale–Cognitive Impairment （PAS-Cog） score of 13.3 （± 7.7）, a prevalence of cardiovascular diseases of 44% and of hypertension of 47%. Sixty-four percent of participants had been diagnosed with dementia and 72% had received cardiovascular system medications within the previous 12 months. Regression models demonstrated the use of cardiovascular medications was associated with lower （better） PAS-Cog scores [Coefficient （β） = -3.7; 95% CI： -5.2 to -2.2; P 〈 0.0001] and a lower probability of a dementia diagnosis （OR = 0.44; 95% CI： 0.26 to 0.75, P = 0.0022）. Analysis by subgroups of medications showed cardiac therapy medications （C01）, beta blocking agents （C07）, and renin-angiotensin system agents （C09） were associated with lower PAS-Cog scores （better cognition） and lower dementia diagnosis probability. Conclusions This analysis has demonstrated an association between greater cardiovascular system medication use and better cognitive status among older adults living in nursing homes. In this population, there may be differential access to health care and treatment of cardiovascular risk factors. This association warrants further investigation in large cohort studies.

Therapeutic effect of interventional therapy for unprotected left main coronary artery lesions in aged patients

Objective To assesse the therapeutic effect of interventional therapy in aged patients with unprotected left main coronary artery （UPLM） lesions. Methods A total of 61 patients who were over 60 years and accepted interventional therapy of UPLM from January 2012 to November 2013 in our hospital were followed up for average 14.6 months by telephone call or outpatient visits. We analyzed the clinical features data of the interventional therapy and assessed the factors that likely influenced the clinical prognosis. Results The average age of the 61 patients was 73.9 years. The average left ventricular ejection fraction （LVEF） was 47.7%. The median of the estimated glomerular filtration rate （eGFR） was 52 mL/min per 1.73 mmz. The average SYNTAX score was 27.4 and the median of stent length was 36 mm. The cumulative incidence of cardiac death at 30 days and major adverse cardiac events （MACE） after one year was 6.6% and 32.5% estimated by Kaplan-Meier plots respectively. No severe hemorrhagic complications were observed during follow-up period. On multivariate regression analysis with a COX proportional hazards model, LVEF was an independent predictor of cardiac death at 30 days [Hazard ratio （HR）： 0.7, P = 0.01]. As for MACE after one year, LVEF and eGFR were both independent predictors （HR： 0.91, P = 0.06 for LVEF, HR： 0.03, P = 0.097 for eGFR）. Conclusions The interventional therapy for UPLM was effective and safe in aged patients. LVEF was the only predictor of cardiac death at 30 days, while LVEF and eGFR were both independent predictors of MACE after one year.

TREATMENT OF 50 CASES OF SENILE DEMENTIA BY ACUPUNCTURE COMBINED WITH INHALATION OF HERBAL DRUGS AND OXYGEN

Clinical DataCase selection: 100 cases who met thediagnostic criteria of senile dementiaformulated by American Association ofPsychiatry in Handbook of Diagnosis andStatistics (DSM-Ⅲ-R, 3rd revised edition)

Gemcitabine in elderly patients with advanced pancreatic cancer

AIM： TO assess feasibility, tolerability and efficacy of gemcitabine-based chemotherapy in patients ≥ 75 years old with advanced pancreatic cancer. METHODS： All consecutive patients ≥ 75 years old with advanced pancreatic adenocarcinoma were included in this retrospective study. Necessary criteria to receive chemotherapy were： performance status 0-2, adequate biological parameters and no serious comorbidities. Other patients received best supportive care （BSC）. RESULTS： Thirty-eight patients （53% women, median age 78 years, range 75-84） with pancreatic cancer （metastatic： n = 20, locally advanced： n = 18） were studied. Among them, 30 （79%） were able to receive chemotherapy [median number： 9 infusions （1-45）]. Six patients （23%） had at least one episode of grade 3 neutropenia and one patient developed a grade 3 hemolytic-uremic syndrome. No toxic death occurred. Three patients （11%） had a partial tumor response, 13 （46%） had a stable disease and 12 （43%） had a tumor progression. Median survival was 9.1 mo （metastatic： 6.9 too, locally advanced： 11.4 too）. CONCLUSION： Tolerance and efficacy of gemcitabinebased chemotherapy is acceptable in elderly patients in good condition, with similar results to younger patients.