血液透析患者的心理状态及其相关因素分析

目的研究长期维持性血透患者的心理状态及其相关因素。方法采用HAD情绪自评表,对我科1995～1999年100例维持性血透患者进行问卷调查,并研究心理问题与躯体及社会因素之间的关系。结果39%的血透患者存在抑郁状态,25%的血透患者存在焦虑状态。血管痛、头痛、疲劳、不良反应频繁以及朋友减少、经济负担加重、住院日延长患者的抑郁发生率显著升高（P<0.01）。女性焦虑发生率高于男性（P<0.05）,不良反应频繁、不安腿综合征及朋友减少患者其焦虑发生率高（P<0.01）。结论对长期维持性血透治疗的患者,应充分重视抑郁和焦虑的护理。     

脑梗死患者心理状态及其相关因素分析

背景：脑梗死不仅可直接导致患者产生抑郁症状，还可以间接影响患者心理状态，从而对脑梗死患者的治疗过程产生不同程度的负面影响。 目的：分析脑梗死患者住院期间的心理状态及其相关因素。 设计：横断面观察。 单位：梅州人民医院神经内科。 对象：选取梅州人民医院2000～2002年住院的脑梗死患者91例，经CT明确诊断，神志清楚、病情相对稳定，能独立完成问卷填写。 方法：①采用焦虑白评量表和抑郁白评量表对91例脑梗死患者进行独立问卷调查，测试前由统一医务人员进行讲解指导。焦虑自评量表与抑郁自评量表均包含7个问题，两表累积评分均为0～21分，〉9分者为焦虑或抑郁。②从躯体因素、社会因素两方面来评定脑梗死患者产生抑郁及焦虑的情况。躯体因素包括头晕、头痛、失眠、肢体活动障碍（指肌力在4级以下，无法自主行走者）、不良反应（指肺部感染、泌尿系感染、压疮和消化道出血、发热等）；社会因素包括年龄、性别、婚姻、教育、家人关心程度、经济状况（状况好指能支付所有住院费用，状况差指不能支付）以及住院时间延长（〉1个月）。调查结果采用Binary分析，相对危险度估计值表达为Exp（B），B为偏回归系数。 主要观察指标：抑郁、焦虑与脑梗死患者躯体因素及社会因素的相关性。 结果：实验选取脑梗死患者91例，全部进入结果分析。①抑郁与脑梗死患者躯体因素及社会因素的相关性：91例患者中，抑郁患者38例（41.8％），抑郁与脑梗死患者的躯体因素及社会因素均密切相关。躯体因素方面，存在头痛、头晕、肢体活动障碍及不良反应者的抑郁发生率明显高于无这些症状者（P〈0．01）；社会因素方面，住院期间家人不够关心、住院时间延长的抑郁发生率明显增高（P〈0．01）。抑郁发生与患者的年龄、性别、婚否、受教育程度、经济状况及睡眠状况无关（P〉0．05）。②焦虑与脑梗死患者躯体因素及社会因素的相关性：焦虑患者28例（30．8％），焦虑与住院期间患者的躯体因素及社会因素均密切相关。在躯体因素方面，存在不良反应、瘫痪肢体功能恢复慢者的焦虑发生率明显高于无不良反应、肢体功能恢复良好者（P〈0．05）；社会因素方面，女性、受教育程度高、家人关心不够、经济状况差者的焦虑发生率较高（P〈0．05）。焦虑发生与患者的年龄、婚否、住院时间、头痛、头晕以及失眠症状无关（P〉0．05）。 结论：焦虑与抑郁是脑梗死患者住院期间常见的心理障碍，与躯体因素及社会因素均密切相关，提示对脑梗死住院患者应加强心理治疗及护理。     

冠心病患者躯体化症状 焦虑和抑郁及其影响因素

目的 探讨冠心病患者躯体症状、焦虑、抑郁及其影响因素。方法 对500例冠心病患者采用躯体化症状自评量表、抑郁症筛查量表、广泛性焦虑自评量表评估患者躯体化症状、抑郁、焦虑症状,并分析躯体化症状与抑郁、焦虑的相关性;采用多元Logistic回归模型探讨其影响因素。结果 500例冠心病患者存在躯体化症状80例(16.00%),躯体化症状越严重,抑郁症筛查量表、广泛性焦虑自评量表评分越高(P<0.01)。Pearson相关分析显示,有躯体化症状冠心病患者躯体化症状自评量表评分与抑郁症筛查量表、广泛性焦虑自评量表评分存在显著正相关(P<0.01)。单因素分析显示,有无躯体化症状冠心病患者在性别、年龄、吸烟史、高血压、焦虑以及抑郁方面比较有显著性差异(P<0.05)。多元Logistic回归分析结果显示：性别、年龄、吸烟、焦虑、抑郁与冠心病躯体化症状相关联(P<0.01)。结论 冠心病患者躯体症状以非特异性全身不适症状为主,且与抑郁、焦虑存在明显相关性。冠心病躯体症状影响因素包括性别、年龄、吸烟史、焦虑以及抑郁等,应对其予以有针对性的干预,改善其健康状况。     

脑梗死患者心理状态及其相关因素分析

背景:脑梗死不仅可直接导致患者产生抑郁症状,还可以间接影响患者心理状态,从而对脑梗死患者的治疗过程产生不同程度的负面影响。目的:分析脑梗死患者住院期间的心理状态及其相关因素。设计:横断面观察。单位:梅州人民医院神经内科。对象:选取梅州人民医院2000～2002年住院的脑梗死患者91例,经CT明确诊断,神志清楚、病情相对稳定,能独立完成问卷填写。方法:①采用焦虑自评量表和抑郁自评量表对91例脑梗死患者进行独立问卷调查,测试前由统一医务人员进行讲解指导。焦虑自评量表与抑郁自评量表均包含7个问题,两表累积评分均为0～21分,>9分者为焦虑或抑郁。②从躯体因素、社会因素两方面来评定脑梗死患者产生抑郁及焦虑的情况。躯体因素包括头晕、头痛、失眠、肢体活动障碍(指肌力在4级以下,无法自主行走者)、不良反应(指肺部感染、泌尿系感染、压疮和消化道出血、发热等);社会因素包括年龄、性别、婚姻、教育、家人关心程度、经济状况(状况好指能支付所有住院费用,状况差指不能支付)以及住院时间延长(>1个月)。调查结果采用Binary分析,相对危险度估计值表达为Exp穴B雪,B为偏回归系数。主要观察指标:抑郁、焦虑与脑梗死患者躯体因素及社会因素的相关性。结果:实验选取脑梗死患者91例,全部进入结果分析。①抑郁与脑梗死患者躯体因素及社会因素的相关性:91例患者中,抑郁患者38例(41.8%),抑郁与脑梗死患者的躯体因素及社会因素均密切相关。躯体因素方面,存在头痛、头晕、肢体活动障碍及不良反应者的抑郁发生率明显高于无这些症状者(P<0.01);社会因素方面,住院期间家人不够关心、住院时间延长的抑郁发生率明显增高(P<0.01)。抑郁发生与患者的年龄、性别、婚否、受教育程度、经济状况及睡眠状况无关(P>0.05)。②焦虑与脑梗死患者躯体因素及社会因素的相关性:焦虑患者28例(30.8%),焦虑与住院期间患者的躯体因素及社会因素均密切相关。在躯体因素方面,存在不良反应、瘫痪肢体功能恢复慢者的焦虑发生率明显高于无不良反应、肢体功能恢复良好者(P<0.05);社会因素方面,女性、受教育程度高、家人关心不够、经济状况差者的焦虑发生率较高(P<0.05)。焦虑发生与患者的年龄、婚否、住院时间、头痛、头晕以及失眠症状无关(P>0.05)。结论:焦虑与抑郁是脑梗死患者住院期间常见的心理障碍,与躯体因素及社会因素均密切相关,提示对脑梗死住院患者应加强心理治疗及护理。     

老年住院患者心理状态分析

目的 探讨老年住院患者抑郁症状、焦虑症状及躯体化症状的特点及相关因素.方法 随机抽取住院治疗的80例老年患者,选取SCL-90量表中的躯体化症状组、焦虑症状组及抑郁症状组等3个因子共35个项目进行测评.结果 住院老年患者焦虑、抑郁的发生率明显高于国内研究报道的结果 .结论 老年患者中存在较严重心理问题且与多因素有关.     

综合治疗非便秘型肠易激综合征临床研究

目的探讨精神因素对非便秘型肠易激综合征的影响及心身综合治疗的疗效。方法采用症状自评量表对109例非便秘肠易激综合征患者与92名正常健康者进行评定分析,将症状自评量表评定总分>170分,阳性项>43.3,抑郁因子>1.71分的69名患者随机分为甲、乙两组治疗。甲组口服马来酸曲美布汀300mg·d-1·Tid,促均生2.25g·d-1·Tid;乙组在甲组治疗的基础上,联用抗抑郁剂 心理治疗。结果非便秘肠易激综合征患者与健康对照组比较,存在有较严重的抑郁、焦虑、恐怖状态及躯体化等多种情绪障碍(P<0.05或0.01)。治疗8w末,甲组躯体化、恐怖因子改善显著(P<0.05),乙组除偏执因子无显著改善外,其它各因子均有极显著性改善(P<0.01),两组间同期评分差异有显著性(P<0.05)。结论非便秘肠易激综合征发病与社会心理因素具有相关性,常规治疗联合抗抑郁剂 心理治疗可明显改善患者的临床症状。     

大学生肠易激综合征患者心理社会因素调查

目的 了解大学生肠易激综合征(IBS)患者的心理社会因素。方法 对54例大学生肠易激综合征患者(观察组)和50名正常大学生(对照组)采用(1)大学生生活事件量表(LESU)，计算1a内生活事件总刺激量。(2)社会支持量表(SSS)，计算社会支持总分。(3)90项症状核查清单(SCL-90)10个因子分及总症状指数。(4)简易应对方式问卷(SCS)。(5)简式个性问卷(SPQ)，反映内外向及神经质倾向。5项量表均由患者自评。所有数据用SPSS10.0软件包进行统计处理。结果 观察组总体心身健康水平及躯体化、焦虑、抑郁、敌意、恐怖、附加因子等评分较对照组高。生活事件较多而社会支持少。且较多地采用消极应对方式，个性倾向内向、神经质。结论 应注意大学生肠易激综合征的心理问题。     

老年住院患者心理状态分析

目的探讨老年住院患者抑郁症状、焦虑症状及躯体化症状的特点及相关因素。方法随机抽取住院治疗的80例老年患者,选取SCL-90量表中的躯体化症状组、焦虑症状组及抑郁症状组等3个因子共35个项目进行测评。结果住院老年患者焦虑、抑郁的发生率明显高于国内研究报道的结果。结论老年患者中存在较严重心理问题且与多因素有关。     

血液透析患者焦虑抑郁情绪与生活质量的相关性分析

目的探讨血液透析患者焦虑抑郁情绪与生活质量的相关性。方法对进行血液透析的80例患者应用焦虑自评量表（SAS）、抑郁自评量表（SDS）、生命质量量表（SF-36）进行调查,分析焦虑抑郁情绪与生活质量相关性。结果本组患者SAS评分（57．24±6．18）分,SDS评分（63．29±7．12）分。其中无焦虑或抑郁23．75％,单纯焦虑28．75％,单纯抑郁33．75％,焦虑合并抑郁13．75％。无焦虑抑郁患者总体健康、精力、社会功能、情绪角色功能、心理健康、躯体疼痛评分均高于有焦虑抑郁患者（均P〈0．05）。结论焦虑抑郁情绪在一定程度上影响了患者的生活质量,应当多角度采取护理措施减轻患者的焦虑抑郁情绪,提高患者的生活质量。     

维持性血液透析患者及其家属的情感障碍临床观察

目的：探讨维持性血液透析患者及其家属中产生情感障碍的发生率情况，并探讨相关的影响因素。方法：以汉密尔顿抑郁量表（HAMD）和汉密尔顿焦虑量表（HAMA）作为抑郁、焦虑评价指标，对情感障碍产生的相关影响因子进行统计分析。结果：以HAMD及HAMA评分为观察指标，患者组与正常人群组之间比较、患者家属组与正常人群家属组相比较，差异均有统计学意义（P〈0．01）。结论：维持性血液透析患者因自身需要长期接受治疗且病情反复而造成的心理问题应引起关注，与正常人群相比不仅接受维持性血液透析的患者本身存在严重心理问题，而且其家属中抑郁、焦虑障碍的发生率也明显增高，均应及时采取针对性疏导。     

不同性别人群的冠心病主要危险因素分析

目的分析冠心病(CHD)主要危险因素年龄、高血压、高脂血症、糖尿病在男性和女性人群中的差别。方法经冠状动脉造影检查确诊的冠心病患者608例,其中合并高血压350例,高血脂158例,糖尿病222例。分析男女冠心病发病的年龄及危险因素在不同年龄段的分布。结果冠心病发病平均年龄男性组(55.2±9.9)岁与女性组(64.5±10.1)岁比较有差异(P=0.04),在<50岁亚组中,男性较女性发病率高(P<0.05)。女性组危险因素中高血压病、糖尿病、高脂血症的发生率均明显高于男性组(均P<0.05)。女性高血压在70~79岁亚组较60~69岁亚组下降;糖尿病在男性和女性70~79岁亚组较60~69岁亚组都下降;高脂血症在男性70~79岁亚组构成比下降。冠心病人高血压和糖尿病在男性和女性各年龄亚组构成比差异有统计学意义(P<0.01);高血脂年龄构成比差异无统计学意义(P=0.134)。结论年龄、高血压、高脂血症、糖尿病在男性和女性冠心病患者中有差别。     

我院剖官产率上升原因的调查分析

目的 探讨引起剖宫产率上升的相关因素,提出降低剖宫产率的可行性措施.方法 对2000年1月至2009年12月我院剖宫产病例进行回顾性分析.结果 剖宫产率逐年升高,2000年为32.0%,2001年为34.5%,2002年为35.0%,2003年为32.3%,2004年为37.1%,2005年为37.9%,2006年为40.2%,2007年为41.7%,2008年为43.6%,2009年为46.1%.结论 应采取有效措施,降低剖宫产率.

Abstract：

Objective To discuss the related factors about the rising cesarean section rates, and to propose feasible measures to reduce cesarean section rates. Methods Cesarean section cases in our hospital from January, 2000 to December, 2009 were retrospectively analyzed. Results The cesarean section rate increased year by year,32.0% in 2000,34.5% in 2001,35.0% in 2002,32.3% in 2003,37.1% in 2004,37.9% in 2005,40.2% in 2006,41.7% in 2007,43.6% in 2008,46.1% in 2009. Conclusions Effective measures should be taken to reduce the cesarean section rate.     

Factors strengthening and weakening vaccination competence

The purpose of this study was to describe factors strengthening and weakening vaccination competence. The data were collected by focus group and individual interviews with 40 participants, consisting of health-care professionals, students and clients, and were then analysed by content analysis. The results could be classified into four categories: vaccinator professional conduct, education, client conduct and the vaccination environment. Successful client encounters, comprehensive knowledge of vaccinating, adequate education, clients' positive attitude, suitable physical environment and centralization of vaccinations were considered strengthening factors, whereas their opposites weakened vaccination competence. The two most important factors were vaccinator professional conduct and education, and therefore these factors should be considered the most in education, clinical practice and administration. Further research is necessary to determine how well current education, clinical practice and administration support factors strengthening, and help alleviate factors weakening vaccination competence.     

护士评判性思维能力的调查及其相关因素分析

Objective To investigate and analyze the nurses' critical thinking abilities and its related factors, and provide basic data for developing nurses' critical thinking. Methods 210 nurses accepted CTDICV and EPQ questionnaire investigation in a top hospital in Nantong. Results The total score of nurses' critical thinking was (276.41 ± 26. 107); Single factor analysis results revealed that the critical thinking scores of nurses were significant in different education background(266.5 ± 22.200,277.03 ± 25. 750,292.92 ± 24.841;F = 19. 168, P ＜ 0. 01 ), professional title, length of nursing working and different departments; The length of nursing service and the E scores were positively correlated with the scores of critical thinking; The P, N scores ( r =0. 292,0. 221 ,P ＜0. 01 ) were negatively correlated with the score of critical thinking( r = -. 0142, -0. 196,P ＜0. 05 or P ＜0. 01 ); Multivariate analysis showed that nurses' critical thinking abilities were correlated with the nurse education background, length of service, different departments and the E scores ( P ＜ 0. 01 or P ＜0. 05 ). Conclusions Nursing managers should pay attention on improvement nurses' critical thinking abilities.Nurses critical thinking abilities may be developed by individualized training according to their specific circumstances.     

Relative contribution of intrapersonal and partner factors to contraceptive behavior among taiwanese female adolescents.

PURPOSE: To explore the relative contribution of intrapersonal factors (demographic data, sexual history, and self-efficacy for contraception) and partner factors (perceptions of support from sexual partners for contraception, and relationship power) to contraceptive behaviors among sexually active female adolescents in Taiwan. DESIGN: A cross-sectional design. Female adolescents who have had a steady male sexual partner in the past 3 months (N=375) were recruited as participants. METHODS: Questionnaires including demographic data, sexual history, contraceptive behavior, self-efficacy for contraception, perceptions of support from sexual partner for contraception, and perceptions of relationship power were submitted anonymously for this study. FINDINGS: Participants who had their first sexual experience at less than 14 years of age and were from one-parent families had the least comprehensive contraceptive behavior than did other participants. Number of steady sexual partners was significantly negatively correlated with contraceptive behavior. Self-efficacy, perceptions of support from sexual partner for contraception, and relationship power all were positively correlated with contraceptive behavior. The important explanatory variables of contraceptive behavior were self-efficacy, age of first sexual intercourse, intervals between sexual intercourse, and perceptions of support from sexual partner for contraception. These accounted for 39.1% of variance in contraceptive behavior. CONCLUSIONS: Intrapersonal factors (self-efficacy, age of first sexual intercourse, and intervals between sexual intercourse) were more important than were partner factors (perceptions of support from sexual partners for contraception and relationship power) in influencing contraceptive behavior among sexually active female adolescents in Taiwan. CLINICAL RELEVANCE: Intervention to increase contraceptive behavior among female adolescents should be focused more on intrapersonal factors than on partner factors.     

Inter-relation of coagulation factors and d-dimer levels in healthy individuals

Summary.  Recently, high levels of coagulation factor (F)VIII, FIX and FXI have been associated with an increased risk of venous thrombosis. For several coagulation factors a substantial hereditary component was found. If regulatory genes are located outside the clotting factor genes, they may regulate the levels of several proteins in the coagulation system. Thus levels would then cluster in individuals. The aim of the present study was to assess the inter-relation among levels of the pro- and anticoagulant proteins in the coagulation cascade. We also investigated the relation between the coagulation factors and d -dimer levels (marker of coagulation activity). All analyses were performed in healthy subjects, the control population of the Leiden Thrombophilia Study (LETS), to eliminate the influence of a prior thrombosis on the interpretation of the results ( n  = 466). Using principal-components analysis, a method intended to explain relationships among several correlated variables, we found a clustering between the vitamin K-dependent factors (prothrombin, VII, IX, X) and FXI and FXII. FV and FVIII clustered with fibrinogen and d -dimer. FXIII remained relatively independent of the other factors. Adding the anticoagulant factors to the analysis resulted in minor changes in the clustering pattern. The anticoagulant factors clustered together. We found relatively independent clusters within the group of pro- and anticoagulant factors, which may suggest that the genetic basis for high or low levels of factors in the coagulation system may, at least partly, lie outside the genes coding for these factors.     

The Relative Utility of Fixed and Variable Risk Factors in Discriminating Sexual Recidivists and Nonrecidivists

This study compared the relative utility of fixed and variable risk factors in discriminating between recidivist and nonrecidivist sexual offenders. Subjects were 95 adult male offenders released from the Canadian federal correctional system between 1988 and 1992. Risk factors from the Sexual Violence Risk—20 (SVR-20; D. P. Boer, S. D. Hart, P. R. Kropp, & C. D. Webster, 1997) were coded from prerelease institutional records; sexual and nonsexual violent recidivism was coded from postrelease police and correctional records. SVR-20 risk factors were categorized as fixed (static) or variable (dynamic) markers according to the criteria of H. C. Kraemer et al. (1997); the fixed risk markers were further divided into offense history and psychosocial factors. Hierarchical Cox regression survival analyses were conducted to compare the relative contribution of fixed offense history, fixed psychosocial, and variable psychosocial risk markers in accounting for any violent recidivism and sexually violent recidivism. Analyses indicated that fixed psychosocial factors added little to the models comprised fixed offense history factors alone. There was some evidence that variable psychosocial factors had incremental validity when added to predictions made on the basis of fixed factors, particularly in the prediction of sexual violence. The individual factors that were included in the final models are consistent with previous findings, and support the use of sexual deviance and antisocial lifestyle variables in the prediction of recidivism among sexual offenders.     

Precipitating and Aggravating Factors of Migraine Versus Tension-type Headache

OBJECTIVE: We conducted the present study to determine whether there are headache precipitating and aggravating factors that differentiate migraine from tension-type headache and headache precipitating and aggravating factors that differentiate tension-type headache from migraine. METHODS: We interviewed 38 patients with migraine and 17 patients with tension-type headache (diagnosed using International Headache Society criteria) by telephone, using a questionnaire. The questionnaire inquired about the following precipitating and aggravating headache factors: (1) physical activity, (2) straining, (3) bending over, (4) stress/tension, (5) coughing/sneezing, (6) fatigue, (7) reading, (8) driving, (9) lack of sleep, (10) specific foods/drinks, (11) alcohol, (12) not eating on time, (13) smoke, (14) smell, (15) light, (16) noise, (17) menstruation, and (18) weather. RESULTS: The most common precipitating factors acknowledged by both groups of patients were stress/tension, not eating on time, fatigue, and lack of sleep. Weather, smell, smoke, and light were the precipitating factors that differentiated migraine from tension-type headache. Excluding those factors that are part of the International Headache Society migraine diagnosis, the aggravating factors were straining, bending over, and smell. We found no precipitating or aggravating factors differentiating tension-type headache from migraine. CONCLUSION: Apparently there are precipitating and aggravating factors differentiating migraine from tension-type headache but not vice versa. It is interesting that three of the migraine-specific precipitating factors (ie, weather, smell, and smoke) involve the nose/sinus system, suggesting a greater significance of this system in headache than is generally considered.