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Objective:To understand the current situation of care needs for disabled elderly people, analyze the impact of the family environment and community services on the care needs and care pathways of older people with disabilities and to formulate effective interventions.Methods:A cross-sectional survey was conducted from August 2022 to March 2023 in five tertiary-level hospitals in Tangshan city. The survey included 332 elderly people who were disabled before hospitalization and their primary caregivers, who were selected using a convenience sampling method. The survey investigated their general information, degree of disability, family members′ support, children′s filial piety and old age ethical level, family relationships, and the care needs of the elderly people who were disabled. SPSS 22.0 was used for one-way and correlation analyses as well as multiple linear regression analyses, and AMOS 22.0 was used for the development of structural equations for path analysis.Results:Among 332 disabled elderly individuals, there were 166 males and 166 females each. The care needs score for elderly people with disabilities was 101.54 ± 16.38. The care needs of this population can be influenced by several factors, including the level of disability, number of chronic conditions, presence of chronic pain, filial piety and old age ethical level of caregivers, family relationships, and the availability of care services in the community or village. These factors had direct effects of 0.468, 0.155, -0.083, -0.350, -0.094, and 0.104, respectively.Chronic diseases and chronic pain indirectly affected the demand for care through the degree of incapacity (with respective indirect effect values of 0.065 and 0.049). Additionally, the demand for care was indirectly influenced by the level of filial piety and ethics of the caregiver through the degree of incapacity and the family relationships (an indirect effect value of -0.162).Conclusions:The care needs of the disabled elderly are high, and the personal physiology, family environment and community support of the disabled elderly will directly or indirectly affect their care needs. Therefore, many factors should be considered comprehensively considered to improve the quality of care of the disabled elderly.
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Objective:To analyze the independent risk factors for the occurrence of post-traumatic cognitive dysfunction, construct a prediction model for the risk factors of post-traumatic cognitive dysfunction, and verify the effectiveness of the risk prediction model, so as to provide a clinical tool for early prediction of the risk of post-traumatic cognitive impairment.Methods:Part I: patients with brain trauma (training set with 556 subjects) who were hospitalized in 21 tertiary and secondary hospitals from Tangshan, Cangzhou and Chengde cities of Hebei province were retrospectively collected from February to May 2021 for Montreal cognitive assessment, and 33 influencing factors (general data, symptoms and signs, laboratory and imaging parameters) were obtained obtained through literature research.The patients were divided into case group and control group according to whether they had cognitive impairment or not, and univariate and multivariate analysis were used to screen independent risk factors.Part Ⅱ: a binary Logistic regression equation was used to construct a cognitive impairment prediction model, the visualization model of line graph is presented.Part Ⅲ: brain trauma patients (260 subjects of the validation set) hospitalized in the aforementioned 21 hospitals from August to October 2021 were collected as a prospective validation population for the prediction model of cognitive impairment, and the grouping basis of case group and control group was the same as before.And the risk factors between the two groups were compared.The receiver operating characteristic curve(ROC), calibration curve and clinical applicability of the model were drawn to evaluate the effectiveness of the model for internal and external verification of the model.Results:Binary Logistic regression analysis showed that the risk factors for post-traumatic cognitive dysfunction were basal ganglia injury, severe injury, amnesia experience after injury, frequent headache after injury, upper limb dysfunction after injury, age ≥ 60 years, and education level of elementary school or below.Visual nomograms showed that the experience of amnesia after injury, frequent headache after injury, upper limb dysfunction, and degree of injury among the symptom factors were the factors that contributed greatly to the risk of traumatic brain injury cognitive impairment in this model.Predictive model discrimination using area under curve(AUC) values of the area under the ROC curve showed that internal validation and external validation were 0.868 and 0.885 for R language analysis and 0.868 and 0.901 for SPSS analysis, respectively.The curve after model calibration almost coincided with the reference line, Hosmer-Lemeshow test P>0.05.The two decision curve analysis (DCA) curves drawn by the clinical applicability of the model were higher than the two extreme curves, predicting that traumatic brain injury patients with cognitive impairment could benefit from the predictive model, and there was a net benefit rate in the range of Pt about 0.1-0.8, when Pt reached about 0.1 until the approximate 1.0 composite evaluation model. Conclusion:Risk factors such as experience of amnesia after injury, frequent headache after injury, upper limb dysfunction, and degree of injury are predicting factors contributed to the risk of cognitive impairment in traumatic brain injury, and their prediction models have good predictive effect, high predictive accuracy and good clinical applicability, which can be applied in clinical diagnosis.
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@#Objective To investigate the risk factors of cognitive dysfunction in patients with traumatic brain injury. Methods From March to September, 2021, 556 hospitalized patients with traumatic brain injury were selected from a multicenter study. A 1∶1 sex-matched case-control study design was used. After assessment by Montreal Cognitive Assessment (MoCA), those with cognitive impairment were as case group and those without cognitive impairment were as control group. They were collected general data and assessed with Social Support Rating Scale (SSRS) and Hospital Anxiety and Depression Scale (HADS). Results Logistic regression analysis showed that college education or above (OR = 0.040) and high level of social support (OR = 0.118) were protective factors for cognitive impairment (P < 0.05). Aged 60 to 88 years (OR = 9.996), severe brain injury (OR = 7.345), headache after injury (OR = 2.159), frequent waking at night or multiple dreams ≥ three times per week (OR = 3.705), severe upper limb dysfunction caused by brain injury (OR = 6.072), depression (OR = 5.202) were risk factors for cognitive impairment (P < 0.05). Conclusion The related factors for cognitive impairment in patients with traumatic brain injury include general factors, disease factors, sleep, psychological and social support and other factors. It is suggested that in addition to the treatment of disease, it is necessary to improve sleep, psychology and social support, to reduce the incidence of cognitive impairment and promote the recovery of disease.
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Objective To evaluate the effect of motor guided imagery to improve the sleep quality and the emotional state in patients with stroke.Methods Totally 100 patients were randomly divided into experimental group(n=50) and control group(n=42).The control group received the routine medicine treatment and nursing measures in neurology,while the experimental group received motor guided imagery training therapy.The Pittsburgh sleep quality index scale (PSQI)were used to evaluate sleep quality,the Hospital Anxiety and Depression Scale (HADS) were used to evaluate emotional state and the Stroke Specific Quality of Life (SS-QOL) were used to evaluate quality of life before and after intervention.Results After one-or five-week intervention,the total score of PSQI and the scores of HADS in the experimental group ((4.95 ±1.94),(3.91± 1.63),(12.92±2.58),(7.26±4.49))were lower than those in the control group ((10.81±3.23),(7.93±3.20),(18.45±3.03),(12.07±5.48)),and the differences were statistically significant (P＜0.05).Intergroup effect,time effect and interaction effect of PSQI score and HADS score showed significant in two groups(P＜0.05).Mter one-or five-week intervention,the total score of SS-QOL in the experimental group((194.12 ± 18.98),(213.66 ± 17.95)) were higher than those in the control group ((156.81 ±18.39),(194.12± 25.41)),and the differences were statistically significant (P＜ 0.05).The inter-group effect,time effect and interaction effect of SS-QOL score in both groups were significant(P＜0.05).Conclusion The motor guided imagery training can effectively improve the sleep quality,the emotional state and quality of life in stroke patients.
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Objective To understand the loneliness of elderly people,and to analyze the correlation between frailty,family social support and loneliness.Methods The elderly people aged 75 and over from 10 community health service centers in Tangshan were selected and evaluated with the CFAI comprehensive e-valuation tool and the loneliness scale.Results The frailty rate was 100% in 3 448 elderly people.The score of the frailty of elderly was(47.27±0.77),and the degree of frailty was increased with the increase of age. The social support level of general and below accounted for 95.92%.The total average score of social support for the elderly was(32.72±6.21);and the medium or above loneliness accounted for 68.94%.The total aver-age score of loneliness in the elderly was(40.24± 10.23).The most needed caregiver was the children and their daughters. Multivariate analysis showed that the degree of education,the degree of frailty,family support (the relationship with children,with the children who do not support the elderly,communicating with chil-dren,taking the views of the elderly,importance of being at home and the visiting frequency of the children), community support(received the services provided by the neighborhood committee,often keep up with rela-tives and friends,the frequency of neighborhood interaction,have received community psychological counse-ling and have received volunteer service)and social support entered the regression equation.The regression coefficient were -0.084,1.167,1.016,1.212,0.914,1.029,1.025,1.264,1.400,0.889,1.053,1.307,1.466, 1.332,-0.405,respectively.Conclusion Frailty,family function and community social support are important factors of loneliness among the elderly.The support system construction should be strengthened to reduce the loneliness of the elderly,and improve the quality of life.
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Objective To develop the Chinese version of mini-Balance Evaluation Systems Test (mini-BESTest) and evaluate its reliabil-ity. Methods Chinese version of mini-BESTest was developed following the process of translation, reverse translation, cultural adaptation and pre-experiment. 61 Chinese patients with stroke were tested with it by 2 testers, and 30 patients in them were tested again in 48 h. The inter-class coefficient (ICC) of testers and test-retest, and the Cronbach'sαamong the total score and 4 factors scores were calculated. Re-sults The ICC of testers of 4 factors were 0.856-0.978 (P<0.01), ICC of test-retest were 0.795-0.951 (P<0.01). The Cronbach's α were 0.794-0.905 (P<0.01). Conclusion The Chinese version of mini-BEStest is reliable for patients with stroke.
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@#Objective To develop the Chinese version of mini-Balance Evaluation Systems Test (mini-BESTest) and evaluate its reliability. Methods Chinese version of mini-BESTest was developed following the process of translation, reverse translation, cultural adaptation and pre-experiment. 61 Chinese patients with stroke were tested with it by 2 testers, and 30 patients in them were tested again in 48 h. The inter-class coefficient (ICC) of testers and test-retest, and the Cronbach's α among the total score and 4 factors scores were calculated. Results The ICC of testers of 4 factors were 0.856- 0.978 (P<0.01), ICC of test- retest were 0.795- 0.951 (P<0.01). The Cronbach's α were 0.794-0.905 (P<0.01). Conclusion The Chinese version of mini-BEStest is reliable for patients with stroke.
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@# Objective To investigate the effect of somatic sense interactive game Kinect on executive dysfunction for patients with stroke. Methods 78 inpatients with first stroke were divided into intervention group and control group, and 35 cases in the intervention group and 36 cases in the control group finished the study. The control group accepted conventional rehabilitation, and the intervention group played the game of Sailing for Gold Coins and Golf of the Kinect in addition. They were assessed with Behavioral Assessment of Dysexecutive Syndrome (BADS) before and 4 weeks after intervention. Results The difference of scores of all the sub-scales and total of BADS before and after intervention were more in the intervention group than in the control group (P<0.05). Conclusion The somatic sense interactive game Kinect can be used to improve the executive function of the patients with stroke.