Revista clinica espanola最新文献_第9页

Asociación entre la velocidad estimada de onda de pulso y la muerte por todas las causas en pacientes con insuficiencia cardiaca 心力衰竭患者估计脉搏波速度与全因死亡之间的关系

IF 2.9 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-01-01 DOI: 10.1016/j.rce.2023.11.009

X. Yuan , C. Chen , J. Mao , W. Bao , C. Chen , T. Xu

Background

Arteriosclerosis has been proven to be a risk factor for the development of heart failure and readmission. ePWV is a novel non-invasive and simple indicator of arterial stiffness, and this study aims to investigate its relationship with all-cause mortality rate in patients with heart failure.

Methods

This study is a cohort study that included 1272 patients with heart failure from NHANES data from 1999 to 2018. The ePWV was divided into three groups, and the cumulative mortality rate of heart failure patients was calculated using KM survival curves. The relationship between ePWV and all-cause mortality rate in heart failure patients was represented by a smoothed curve fitting. COX regression analysis was used to assess the association between ePWV and all-cause mortality rate in heart failure patients.

Results

The average age of the study population was 67.8 ± 12.6 years, with 862 males and 650 females. During the 12-month follow-up period, there were 790 cases of all-cause mortality. Cox regression analysis was used to validate the relationship between ePWV and all-cause mortality rate in patients with heart failure. Patients with higher levels of ePWV tended to have a higher all-cause mortality rate. After adjustment for multiple factors, an increase in ePWV was positively associated with all-cause mortality rate (HR = 1.17, 95% confidence interval [CI]: 1.12-1.22). Compared to the lowest tertile, the multivariable-adjusted HR and 95% CI for the highest tertile of ePWV were 1.81 (95% CI: 1.45-2.27). Additionally, a smoothed curve fitting was used to observe the relationship between ePWV and mortality rate, where the curve demonstrated a positive correlation between ePWV and all-cause mortality rate. Furthermore, KM survival curves indicated that all-cause mortality rate increased with the increase in ePWV. Subgroup analysis suggested a correlation between ePWV and mortality rate.

Conclusion

Our study shows that ePWV is positively associated with all-cause mortality in patients with heart failure.

背景动脉硬化已被证实是心力衰竭发病和再入院的风险因素。ePWV是一种新型的无创、简单的动脉僵化指标，本研究旨在探讨其与心力衰竭患者全因死亡率的关系。方法本研究是一项队列研究，纳入了1999年至2018年NHANES数据中的1272名心力衰竭患者。将 ePWV 分成三组，利用 KM 生存曲线计算心衰患者的累积死亡率。心衰患者 ePWV 与全因死亡率之间的关系用平滑曲线拟合表示。结果研究对象的平均年龄为（67.8 ± 12.6）岁，其中男性 862 人，女性 650 人。在12个月的随访期间，全因死亡率为790例。研究人员采用 Cox 回归分析验证了心衰患者 ePWV 与全因死亡率之间的关系。ePWV 水平越高的患者全因死亡率越高。在对多种因素进行调整后，ePWV 的增加与全因死亡率呈正相关（HR = 1.17，95% 置信区间 [CI]：1.12-1.22）。与最低三分位数相比，最高三分位数 ePWV 的多变量调整 HR 和 95% CI 分别为 1.81（95% CI：1.45-2.27）。此外，还使用平滑曲线拟合来观察 ePWV 与死亡率之间的关系，曲线显示 ePWV 与全因死亡率呈正相关。此外，KM 生存曲线表明，全因死亡率随着 ePWV 的增加而增加。结论我们的研究表明，ePWV 与心衰患者的全因死亡率呈正相关。

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引用次数: 0

Impacto de las medidas de aislamiento estricto, actividad quirúrgica y uso de antibióticos en la infección por Clostridioides difficile durante la COVID-19 COVID-19 期间严格隔离措施、手术活动和抗生素使用对艰难梭菌感染的影响

IF 2.9 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-01-01 DOI: 10.1016/j.rce.2023.09.007

J. Ena , C. Martinez-Peinado , V. Valls

引用次数: 0

Detección incidental de niveles de vitamina B12 elevados y su relación con neoplasias 意外发现维生素 B12 水平升高及其与恶性肿瘤的关系

IF 2.9 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-01-01 DOI: 10.1016/j.rce.2023.11.003

J. Pardo Lledias , M. Martín Millán , J.A. Mazariegos Cano , C. Aibar Marco , N. Arias Martínez , B. San Pedro Careaga , E. Urizar Ursua , M.C. Insua García , B.A. Lavin Gómez , J.L. Hernández Hernández

Background and objective

Elevated serum levels of vitamin B12 have been associated with oncohematological diseases. However, the relevance of its incidental detection in subjects without a previous diagnosis of cancer is unknown. The aim of this study was to evaluate the relationship between incidental hypercobalaminemia (vitamin B12 > 1000 pg/mL) and the diagnosis of a tumor process in patients without a diagnosis and to establish the risk factors.

Material and methods

Retrospective observational study of a cohort of patients with hypercobalaminemia. The incidence of neoplasms was compared with a cohort of patients with vitamin B12 levels < 1000 pg/mL.

Results

Vitamin B12 determinations of 4800 subjects were selected. Of them, 345 (7.1%) had levels > 1000 pg/ml; 68 (28.4%) were excluded due to exogenous administration, 12 (5%) due to insufficient data, and 15 (3%) due to having an active neoplasia, selecting 250 patients, with a median follow-up of 22 (IQR: 12-39) months. Structural liver disease was detected in 59 (23.6%). 18.2% (44 patients) had solid organ cancer and 17 (7.1%) had malignant hemopathy. The average time from the detection of hypercobalaminemia to the diagnosis of cancer was about 10 months. The median until the diagnosis of neoplasia was higher in the high vitamin B12 group (13 vs 51 months; P < .001). Hypercobalaminemia (HR: 11.8; 95% CI: 2.8-49.6; P = .001) and smoking (HR: 4.0; 95% CI: 2.15-7.59; P < .001) were independent predictors of neoplasia in the multivariate analysis.

Conclusions

Incidental detection of serum vitamin B12 levels > 1000 pg/ml is high in the population. The diagnosis of solid organ and hematological neoplasia is frequent during the following year of follow-up, with hypercobalaminemia and smoking being predictors of a higher risk of cancer.

背景和目的血清中维生素 B12 水平的升高与肿瘤血液病有关。然而，在既往未确诊癌症的受试者中偶然检测出维生素 B12 与癌症的相关性尚不清楚。本研究的目的是评估未确诊患者偶然出现的高钴胺血症（维生素 B12 1000 pg/mL）与肿瘤诊断之间的关系，并确定风险因素。结果选取了 4800 名维生素 B12 测定对象。其中，345 人（7.1%）的维生素 B12 含量为 1000 pg/ml；68 人（28.4%）因外源性用药而被排除，12 人（5%）因数据不足而被排除，15 人（3%）因患有活动性肿瘤而被排除，共选出 250 名患者，中位随访时间为 22 个月（IQR：12-39 个月）。59例（23.6%）患者发现结构性肝病。18.2%（44 例患者）患有实体器官癌症，17 例（7.1%）患有恶性血病。从发现高钴胺血症到确诊癌症的平均时间约为 10 个月。高维生素 B12 组患者确诊肿瘤前的中位时间更长（13 个月 vs 51 个月；P < .001）。在多变量分析中，高钴胺血症（HR：11.8；95% CI：2.8-49.6；P = .001）和吸烟（HR：4.0；95% CI：2.15-7.59；P <；.001）是肿瘤的独立预测因素。高钴胺血症和吸烟是癌症风险较高的预测因素。

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引用次数: 0

Factores relacionados con la no adherencia a la rehabilitación cardiaca en pacientes con insuficiencia cardiaca 心力衰竭患者不坚持心脏康复治疗的相关因素

IF 2.9 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-01-01 DOI: 10.1016/j.rce.2023.11.006

J. Betancourt-Peña , I. Portela-Pino , M. Amaral-Figueroa

Introduction

In heart failure, cardiac rehabilitation has been recommended as an intervention strategy that improves functional capacity, health-related quality of life and survival. However, adherence to these programs is low. The objective was to determine the factors related to non-adherence to cardiac rehabilitation in patients with heart failure in Colombia.

Method

Observational and retrospective study. Patients with heart failure were linked in a clinic in Colombia, adherence to cardiac rehabilitation was measured with ≥ 80% of scheduled sessions. Sociodemographic and clinical variables, functional aerobic capacity (Sit to Stand and 6-minute walk test), Duke Activity Status Index (DASI), quality of life Minnesota Living with Heart Failure Questionnaire (MLFHQ) and depression Patient health questionnaire 9 (PHQ-9) were taken into account.

Results

300 patients were linked with heart failure with age 63.16 ± 12.87; men 194 (64.7%). Adherence to cardiac rehabilitation was 66.67%, there were statistically significant differences between the groups in arterial hypertension, LVEF, cholesterol, LDL, triglycerides, SBP, DBP, distance traveled, VO₂e, METs, DASI and PHQ-9 P ≤ .05. The logistic regression model adjusted for sex and age showed OR for non-adherence to CR arterial hypertension 2.23 [1.22-4.07], LDL outside of goals 2.15 [1.20-3.88], triglycerides outside goals 2.34 [1.35-4.07], DASI < 4METs 2.38 [1.04-5.45] and PHQ-9 1.06 [1.00-1.12].

Conclusion

High blood pressure, LDL, triglycerides, DASI and depression with the PHQ-9 questionnaire are related factors for not having adherence to cardiac rehabilitation in patients with heart failure.

导言：在心力衰竭患者中，心脏康复已被推荐为一种干预策略，可提高功能能力、与健康相关的生活质量和生存率。然而，这些计划的坚持率却很低。本研究旨在确定哥伦比亚心力衰竭患者不坚持心脏康复治疗的相关因素。在哥伦比亚的一家诊所对心力衰竭患者进行了追踪调查，并对心脏康复计划的坚持率进行了测量，结果显示坚持率≥80%。研究还考虑了社会人口学和临床变量、有氧功能能力（从坐到站和6分钟步行测试）、杜克活动状态指数（DASI）、生活质量明尼苏达心衰患者问卷（MLFHQ）和抑郁症患者健康问卷9（PHQ-9）。各组间在动脉高血压、LVEF、胆固醇、低密度脂蛋白、甘油三酯、SBP、DBP、行走距离、VO2e、METs、DASI 和 PHQ-9 方面的差异均有统计学意义（P≤0.05）。根据性别和年龄调整后的逻辑回归模型显示，未坚持 CR 的动脉高血压 OR 值为 2.23 [1.22-4.07]，目标之外的低密度脂蛋白 OR 值为 2.15 [1.20-3.88]，目标之外的甘油三酯 OR 值为 2.34 [1.35-4.07]，DASI < 4METs OR 值为 2.38 [1.结论高血压、低密度脂蛋白、甘油三酯、DASI和PHQ-9问卷调查显示的抑郁是心力衰竭患者不坚持心脏康复的相关因素。

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引用次数: 0

Fumadores y riesgo de muerte hospitalaria por COVID calculado con el procesamiento de lenguaje natural de SAVANA en el ámbito de Castilla-La Mancha 在卡斯蒂利亚-拉曼恰地区，通过 COVID 和 SAVANA 自然语言处理计算吸烟者和住院死亡风险。

IF 2.9 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-01-01 DOI: 10.1016/j.rce.2023.11.007

R. Godoy Mayoral , M. Benavent Núñez , J. Cruz Ruiz , G. López Yepes , A. Parralejo Jiménez , F.J. Callejas González , J.L. Izquierdo Alonso

Introduction

During the COVID pandemic, it was speculated that patients with the virus who were smoking-related might have a lower likelihood of disease exacerbation or death. To assess whether there is an association between smoking and risk of in-hospital mortality, SAVANA's big data and natural language processing (NLP) technology is used.

Method

A retrospective, observational, non-interventional cohort study was conducted based on real-life data extracted from medical records throughout Castilla-La Mancha using natural language processing and artificial intelligence techniques developed by SAVANA. The study covered the entire population of this region with Electronic Medical Records in SESCAM presenting with a diagnosis of COVID from March 1, 2020 to February 28, 2021.

Results

Smokers had a significantly higher percentage of cardiovascular risk factors (hypertension, dyslipidemia and diabetes), COPD, asthma, IDP, IC, CVD, PTE, cancer in general and lung cancer in particular, bronchiectasis, heart failure and a history of pneumonia (P < .0001). Former smokers, current smokers and non-smokers have a significant age difference. As for in-hospital deaths, they were more frequent in the case of ex-smokers, followed by smokers and then non-smokers (P < .0001).

Conclusion

There is an increased risk of dying in hospital in SARS-CoV-2-infected patients who are active smokers or have smoked in the past.

导言在COVID大流行期间，有人推测与吸烟有关的病毒感染者病情恶化或死亡的可能性较低。为了评估吸烟与院内死亡风险之间是否存在关联，我们使用了 SAVANA 的大数据和自然语言处理（NLP）技术。方法我们使用 SAVANA 开发的自然语言处理和人工智能技术，基于从整个卡斯蒂利亚-拉曼恰（Castilla-La Mancha）地区医疗记录中提取的真实数据，开展了一项回顾性、观察性、非干预性队列研究。结果吸烟者的心血管风险因素（高血压、血脂异常和糖尿病）、慢性阻塞性肺病、哮喘、IDP、IC、心血管疾病、PTE、癌症（尤其是肺癌）、支气管扩张、心力衰竭和肺炎病史的比例明显更高（P <.0001）。曾经吸烟者、目前吸烟者和不吸烟者的年龄差异显著。结论：SARS-CoV-2 感染者中吸烟者或过去曾吸烟者死于医院的风险增加。

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引用次数: 0

Fortalezas sistémicas y necesidades en atención paliativa domiciliaria: explorando la complejidad 居家姑息关怀的系统优势和需求：探索复杂性

IF 2.9 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-01-01 DOI: 10.1016/j.rce.2023.11.004

X. Busquet-Duran , B.M. Carralero , J. Bielsa-Pascual , L. Milian-Adriazola , N. Salamero-Tura , P. Torán-Monserrat

Objective

We aimed to investigate the relationship between systemic strengths and complexity in home care of end-of-life patients.

Methods

Quantitative descriptive longitudinal study of patients cared for at home by a palliative care team. Place of death was analyzed in relation to complexity, as determined by the HexCom complexity model after the initial home assessment. We used Pearson's chi-square test to analyze the comparison of proportions.

Results

Forty-six hundred patients (74.4% oncologic) with a mean age of 76.2 years (SD 13.2) participated. Fifty-three percent had complete or severe functional dependence, 30.8% were already bedridden in the first assessment, and 59.7% died at home. Strengths influenced place of death, specifically exosystem (team) strength (OR: 4.07 [1.92-8.63]), microsystem (both patient 0.51 [0.28-0.94]) and caregiver (OR: 3.90 [1.48-10.25]), and chronosystem, related to prediction of progressive course (OR: 2.22 [1.37-3.60]).

Conclusions

To improve care for end-of-life patients and their families, a systemic view of dying and death that includes both needs and strengths is necessary. In this sense, the systemic framework proposed by Bonfrenbrenner can be useful for clinical practice.

方法对姑息治疗团队在家护理的患者进行定量描述性纵向研究。研究分析了死亡地点与复杂性的关系，复杂性是在初次家庭评估后根据 HexCom 复杂性模型确定的。我们使用皮尔逊卡方检验来分析比例比较。53%的患者有完全或严重的功能依赖，30.8%的患者在首次评估时已卧床不起，59.7%的患者死于家中。优势会影响死亡地点，特别是外在系统（团队）优势（OR：4.07 [1.92-8.63]）、微观系统（患者 0.51 [0.28-0.94]）和照护者（OR：3.90 [1.48-10.25]），以及与预测进展过程相关的时间系统（OR：2.22 [1.37-3.60]）。从这个意义上讲，Bonfrenbrenner 提出的系统框架对临床实践很有帮助。

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引用次数: 0

Asociación del colesterol remanente con el grado de control glucémico y la presencia de complicaciones microvasculares en personas con diabetes mellitus tipo 1 剩余胆固醇与 1 型糖尿病患者血糖控制程度和微血管并发症的关系。

IF 2.9 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-01-01 DOI: 10.1016/j.rce.2023.11.002

J.J. Raposo-López, M.S. Tapia-Sanchiz, V. Navas-Moreno, J.A. Arranz Martín, M. Marazuela, F. Sebastián-Valles

Introduction

This study examines the relationship between remnant cholesterol, glucose metrics, and chronic complications of type 1 diabetes in users of glucose monitoring systems.

Material and methods

Clinical variables and glucose metrics were collected from individuals using glucose sensors. Statistical models were employed to investigate the association of remnant cholesterol with glucose metrics, diabetic retinopathy, and diabetic nephropathy.

Results

A total of 383 individuals, aged 48.3 ± 16.2 years, with 54.1% women, and a remnant cholesterol level of 16 ± 10 mg/dL, were included. The results demonstrated that remnant cholesterol was associated with less time within the target range (P=.015) and more time above the target range (P=.003). Diabetic nephropathy was the only complication associated with remnant cholesterol levels exceeding 30 mg/dL; OR: 8.93; 95% CI: 2.99-26.62, P<.001.

Conclusion

Remnant cholesterol is independently associated with hyperglycemia and diabetic nephropathy in individuals with type 1 diabetes.

导言本研究探讨了血糖监测系统使用者体内残余胆固醇、血糖指标与 1 型糖尿病慢性并发症之间的关系。结果共纳入 383 人，年龄为 48.3 ± 16.2 岁，女性占 54.1%，残余胆固醇水平为 16 ± 10 mg/dL。结果表明，残余胆固醇与在目标范围内的时间较少（P=.015）和超过目标范围的时间较多（P=.003）有关。糖尿病肾病是唯一与残余胆固醇水平超过 30 mg/dL 相关的并发症；OR：8.93；95% CI：2.99-26.62，P<.001。

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引用次数: 0

Comentario al artículo «Trombosis venosa cerebral en adultos: cohorte de 35 casos de un hospital terciario» 评论文章 "成人脑静脉血栓：一家三甲医院的 35 个病例"。

IF 2.9 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-01-01 DOI: 10.1016/j.rce.2023.09.006

A. Gil-Díaz

引用次数: 0

Resumen ejecutivo del documento de consenso para la formación y el desarrollo de la ecografía clínica en Medicina Interna: recomendaciones desde el Grupo de Trabajo de Ecografía Clínica de la Sociedad Española de Medicina Interna (GTECO-SEMI) 内科临床超声培训与发展共识文件执行摘要：西班牙内科医学会临床超声工作组（GTECO-SEMI）的建议。

IF 2.9 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-01-01 DOI: 10.1016/j.rce.2023.11.005

Y. Tung-Chen , G. García de Casasola Sánchez , S. García Rubio , L. Beltrán Romero , M. Bernabéu Wittel , L.S. Briongos Figuero , J. Canora Lebrato , D. García Gil , S. López Palmero , D. Luordo Tedesco , P. Martín Rico , M. Mateos González , M. Méndez Bailón , J.M. Porcel , G. Serralta , M. Torres Arrese , J. Oteiza Olaso , P. Varela García , J. Torres Macho

Introduction

Given the increasing adoption of clinical ultrasound in medicine, it is essential to standardize its application, training, and research.

Objectives and methods

The purpose of this document is to provide consensus recommendations to address questions about the practice and operation of clinical ultrasound units. Nineteen experts and leaders from advanced clinical ultrasound units participated. A modified Delphi consensus method was used.

Results

A total of 137 consensus statements, based on evidence and expert opinion, were considered. The statements were distributed across 10 areas, and 99 recommendations achieved consensus.

Conclusions

This consensus defines the most important aspects of clinical ultrasound in the field of internal medicine, with the aim of standardizing and promoting this healthcare advancement in its various aspects. The document has been prepared by the Clinical Ultrasound Working Group and endorsed by the Spanish Society of Internal Medicine.

引言鉴于临床超声在医学中的应用日益广泛，对其应用、培训和研究进行标准化是至关重要的。目的和方法本文件旨在提供共识建议，以解决临床超声科室的实践和操作问题。来自先进临床超声科室的 19 位专家和领导参加了此次会议。结果根据证据和专家意见，共审议了 137 项共识声明。结论本共识界定了内科临床超声领域最重要的方面，旨在规范和促进这一医疗保健进步的各个方面。本文件由临床超声工作组编写，并得到了西班牙内科学会的认可。

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引用次数: 0

Admisiones en los servicios de urgencias y costes económicos relacionados con procesos susceptibles de atención ambulatoria en adultos mayores que viven en centros residenciales 住院的老年人在急诊室的入院情况和与门诊护理相关的经济费用

IF 2.9 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2023-12-01 DOI: 10.1016/j.rce.2023.09.004

F.J. Afonso-Argilés , M. Comas-Serrano , X. Castells-Oliveres , I. Cirera-Lorenzo , D. García-Pérez , T. Pujadas-Lafarga , X. Ichart-Tomás , M. Puig-Campmany , A.B. Vena-Martínez , A. Renom-Guiteras , en nombre del Grupo Caregency que se indica a continuación

Objectives

To assess the frequency of emergency department admissions (EDAs) for ambulatory care sensitive conditions (ACSC) and non-ACSC among older adults living in care homes (CH), to describe and compare their demographic and clinical characteristics, the outcomes of the hospitalization process and the associated costs.

Method

This multicenter, retrospective and observational study evaluated 2444 EDAs of older adults ≥65 years old living in care homes in five emergency departments in Catalonia (Spain) by ACSC and non-ACSC, in 2017. Sociodemographic variables, prior functional and cognitive status, and information on diagnosis and hospitalization were collected. Additionally, the costs related with the EDAs were calculated, as well as a sensitivity analysis using different assumptions of decreased admissions due to ACSC.

Results

A total of 2444 ED admissions were analyzed. The patients’ mean (SD) age was 85.9 (7.2) years. The frequency of ACSC-EDA and non-ACSC-EDA was 56.6% and 43.4%, respectively. Severe dependency and cognitive impairment were present in 56.6% and 78%, respectively, with no differences between the two groups. The three most frequent ACSC were falls/trauma (13.8%), chronic obstructive pulmonary disease/asthma (11.4%) and urinary tract infection (7.4%). The average cost per ACSC-EDA was €1408.24. Assuming a 60% reduction of ACSC-EDA, the estimated cost savings would be €1.2 million.

Conclusions

Emergency admissions for ACSC from care homes have a significant impact on both frequency and costs. Reducing these conditions through targeted interventions could redirect the avoided costs toward improving care support in residential settings.

目的评估在养老院(CH)生活的老年人因门诊敏感状况(ACSC)和非ACSC而急诊入院(EDAs)的频率，描述并比较他们的人口学和临床特征、住院过程的结果和相关费用。该多中心、回顾性和观察性研究评估了2017年加泰罗尼亚(西班牙)5个急诊科生活在养老院的2444名≥65岁老年人的ACSC和非ACSC。收集了社会人口学变量、先前的功能和认知状态以及诊断和住院信息。此外，还计算了与EDAs相关的成本，并使用ACSC导致入学率下降的不同假设进行了敏感性分析。结果共分析急诊入院2444例。患者平均(SD)年龄为85.9(7.2)岁。ACSC-EDA和非ACSC-EDA的发生率分别为56.6%和43.4%。严重依赖和认知障碍分别占56.6%和78%，两组间无差异。最常见的三个ACSC是跌倒/创伤(13.8%)、慢性阻塞性肺疾病/哮喘(11.4%)和尿路感染(7.4%)。ACSC-EDA的平均成本为1408.24欧元。假设ACSC-EDA减少60%，预计将节省120万欧元的成本。结论养老院的ACSC急诊入院对频率和费用都有显著影响。通过有针对性的干预措施减少这些情况，可以将避免的成本转向改善住宅环境中的护理支持。

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引用次数: 0