领悟社会支持对农村不孕不育症女性患者自我接纳的影响研究

目的探讨广西农村不孕不育症女性患者领悟社会支持和自我接纳的关系。方法以205例农村不孕不育症女性患者为研究对象,采用领悟社会支持量表和自我接纳问卷进行调查。结果领悟社会支持总分及其各维度与自我接纳呈显著正相关,家庭内支持和家庭外支持是农村不孕不育症女性患者自我接纳的正向预测因子。结论社会支持是广西农村不孕不育症女性患者自我接纳的重要影响因素。     

六步癌症告知模型在前列腺癌患者病情告知中的应用

目的评价六步癌症告知模型在前列腺癌穿刺活检阳性患者告知中的应用效果。方法将98例前列腺癌穿刺活检阳性患者随机分为干预组和对照组各49例,对照组采用常规病情告知方式,干预组采用六步癌症告知模型进行病情告知。结果病情告知后干预组自我接纳总分显著高于对照组,患者负性情绪及死亡焦虑总分显著低于对照组(均P0.01)。结论将六步癌症告知模型应用于前列腺癌穿刺活检阳性患者,可提高患者的自我接纳水平,降低其负性情绪和死亡焦虑,对患者而言具有正性意义。     

初产妇母亲功能状态与自我效能感和主观幸福感的相关性分析

目的 调查初产妇母亲功能状态，分析与自我效能感、主观幸福感的相关性，为制订针对性干预措施提供参考。方法 便利选取297名初产妇，于产后42 d复查时，采用一般资料调查问卷、中文版Barkin母亲功能状态量表、一般自我效能感量表及总体幸福感量表进行调查。结果 初产妇母亲功能状态总分为(61.70±7.36)分，自我效能感评分为(25.16±4.09)分，主观幸福感评分为(67.62±7.88)分。Pearson相关性分析结果显示，初产妇自我效能感、主观幸福感与母亲功能状态总分及各维度评分呈正相关(均P<0.05)。分层回归分析结果显示，自我效能感与主观幸福感能够独立解释母亲功能状态18.4%的变异(均P<0.05)。结论 初产妇母亲功能状态处于中等偏上水平，与自我效能感、主观幸福感密切相关。医护人员对初产妇进行产后护理保健时，应给予足够的信息支持与情感支持，以提高其自我效能感、主观幸福感，进而促进母亲功能执行。     

对乳腺癌手术患者实施有氧运动联合正念减压疗法的效果评价

目的探讨有氧运动联合正念减压疗法对乳腺癌手术患者负性情绪、希望水平、主观幸福感及生活质量的影响。方法将乳腺癌手术患者90例按随机数字表法分为对照组与观察组各45例。对照组进行常规护理干预,观察组在常规护理干预基础上实施有氧运动联合正念减压疗法。结果干预后观察组压力知觉、焦虑、抑郁评分显著低于对照组,希望、主观幸福感评分显著高于对照组,生活质量总分及各维度得分显著高于对照组(均P0.01)。结论对乳腺癌手术患者实施正念减压疗法结合有氧运动,可使患者正视、认知和调控不良情绪,降低其压力、焦虑、抑郁水平,从而提高患者术后希望水平和生活质量。     

归因训练对乳腺癌根治术患者主观幸福感及归因方式的影响

目的探讨归因训练对乳腺癌根治术患者主观幸福感及归因方式的影响。方法将在衡水市某三甲医院住院的206例乳腺癌根治术患者按随机数字表法分为观察组103例、对照组103例。对照组予常规护理和健康教育;观察组在常规护理的基础上,辅以归因训练。于患者入院时和出院后6个月应用归因方式问卷(ASQ)、单项目自陈主观幸福感量表进行测评。结果干预后观察组正性事件、人际事件、成就事件、内外维度、普遍维度、持续维度及自我形象适应度、配偶理解度和主观幸福感评分显著高于对照组;负性事件、无望感、宿命维度得分显著低于对照组(P<0.05,P<0.01)。结论对乳腺癌患者实施归因训练,可引导患者形成积极的归因倾向,有助于患者健康心态的建立,提升其主观幸福感,促进康复。     

正念对护士职业倦怠与主观幸福感的中介及调节作用

目的探讨正念在护士职业倦怠与主观幸福感之间的作用机制。方法采用正念注意觉知量表、主观幸福感指数量表、护士职业倦怠量表对471名护士进行调查。结果正念与职业倦怠呈负相关,与主观幸福感呈正相关(均P0.01);职业倦怠总分与主观幸福感总分及2个分量表得分呈负相关(均P0.01);正念在护士职业倦怠与主观幸福感之间有部分中介作用,中介效应为-0.096,占总效应比例为34.2%;正念对护士职业倦怠与主观幸福感关系有调节作用(△R2=0.033,P0.01)。结论职业倦怠既可以直接又可通过正念间接影响护士的主观幸福感,正念能够缓冲职业倦怠对主观幸福感的负面影响,是护士主观幸福感的保护因素。     

康复期精神分裂症患者自尊水平与主观幸福感及自我和谐状况的调查

目的探讨康复期精神分裂症患者的自尊水平、主观幸福感及自我和谐状况.方法采用自尊量表(SES)、主观幸福感量表(GWB)及自我和谐量表(SCCS)对100例康复期精神分裂症患者(精分组)及100例健康自愿者(对照组)进行调查,并将调查结果加以比较.结果精分组的SES及GWB评分显著低于对照组(均P<0.01);不和谐及刻板性评分显著高于对照组(均P<0.01);灵活性评分显著低于对照组(P<0.01).结论康复期精神分裂症患者的自尊水平及主观幸福感较低,自我和谐性差,应予心理支持和干预指导.     

优势使用对护士主观幸福感的影响：基本心理需要满足的中介作用

目的考察优势使用对护士主观幸福感的影响,以及基本心理需要满足在其中的中介作用。方法采用优势使用量表、生活满意度量表、积极情感与消极情感体验量表和基本心理需要满足量表对湖北省武汉市、仙桃市、天门市、潜江市8所医院的475名护士进行调查。结果护士主观幸福感、生活满意度、积极情绪、消极情绪、优势使用、基本心理需要满足条目均分分别为(5.09±1.97)、(4.13±1.22)、(3.40±0.65)、(2.44±0.62)、(4.67±1.05)、(4.65±0.68)。优势使用与主观幸福感、基本心理需要满足呈显著正相关(均P0.01);基本心理需要与主观幸福感呈显著正相关(P0.01)。回归分析显示基本心理需要满足在优势使用与护士主观幸福感之间的中介作用显著,中介效应占总效应的41.61%。结论护士主观幸福感处于中等水平。护士可以通过使用自身优势来提升主观幸福感,也可以通过满足基本心理需要提升主观幸福感水平。     

青年淋巴瘤患者主观幸福感的质性研究

目的 了解青年淋巴瘤患者主观幸福感。方法 采用扎根理论研究方法,选取住院治疗的15例青年淋巴瘤患者,对其进行半结构式深入访谈,采用Nvivo11.0软件对访谈资料进行分析、归纳和提炼主题。结果 通过对访谈资料的编码分析,得出6个选择性编码,分别是继续实现自我价值、积极健康的生活状态、心理和情感状态、社会融入状态、家庭和社会情感关怀、影响主观幸福感的因素。结论 本研究深入了解 青年淋巴瘤患者主观幸福感,可为进一步探索青年淋巴瘤患者主观幸福感的干预性研究提供依据。     

太原市三甲医院临床护士主观幸福感与自我概念的相关性研究

目的探讨三甲综合性医院临床护士总体幸福感与自我概念之间的相关性。方法采用总体主观幸福感量表(GWB)和田纳西自我概念量表(TSCS)对太原市2所三甲综合性医院193名临床护士进行随机抽样调查。结果三甲综合性医院临床护士主观幸福感评分为(106.33±13.49)分,自我概念总分为(252.59±20.01)分,两者呈显著正相关(P<0.01);自我概念是临床护士主观幸福感的主要预测因素(P<0.01)。结论自我概念是影响临床护士主观幸福感的重要因素,可以通过增强临床护士的自我概念而提高临床护士的主观幸福感,进而促进临床护士的身心健康,利于提高临床护理工作质量。     

Mental health correlates of valid perception of nasal deformity in female applicants for aesthetic rhinoplasty

Thirty-four female applicants for rhinoplasty were assessed prior to undergoing surgery by means of a measuring scale for objective evaluation of the nasal shape. This scale yields an objective nasal deformity score as well as a measure of validity of subjective perception of nasal shape (nose image) and deformity. Subjects were assessed also for identity integration by a short measure of Eriksonian identity, and for psychological well-being and self-acceptance by means of the appropriate California Psychological Inventory (CPI) scales.Degree of nasal objective deformity was found to correlate with various aspects of positive mental health, namely, identity integration, psychological well-being, and self-acceptance. Validity of nose image was also correlated with identity integration. Findings are in accord with former investigations and call attention to the need for careful selection and management of patients for rhinoplasty, especially when deformity is mild.     

Population prevalence of antiretroviral therapy sharing and its association with HIV viremia in rural Uganda: a cross-sectional population-based study

Introduction

Antiretroviral treatment (ART) sharing has been reported among fishermen and sex workers in Uganda and South Africa. However, no population-based studies have documented ART diversion prevalence (including sharing [giving/receiving], buying and selling) or its relationship with viremia among men and women living with HIV in Africa.

Methods

In 2018–2020, we surveyed people living with HIV aged 15–49 years in 41 communities in the Rakai Community Cohort Study, a population-based cohort in south-central Uganda. We assessed the prevalence and correlates of self-reported lifetime and past-year ART diversion, stratifying by age and gender and documenting sources of diverted drugs. We used log-binomial regression to quantify the relationship between diversion patterns and viremia (viral load >40 copies/ml), reported as unadjusted and adjusted prevalence ratios (aPR) with 95% confidence intervals (CI).

Results

Of 2852 people living with HIV and self-reporting current ART use, 266 (9.3%) reported lifetime ART diversion. Giving/receiving drugs were most common; few participants reported buying, and none reported selling. Men (12.9%) were more likely to report lifetime diversion than women (7.4%), with men aged 25–34 reporting high levels of sharing (18.9%). Friends were the most common sources of shared drugs, followed by spouses/sexual partners. Patterns of lifetime and past-year diversion were similar. Among participants with viral load results, 8.6% were viraemic. In adjusted analyses, people who reported only giving ART were nearly twice as likely to be viraemic than those who reported no diversion (aPR: 1.94, 95% CI: 1.10−3.44), and those reporting only receiving ART were less likely to exhibit viremia (aPR: 0.46, 95% CI: 0.12−1.79), although the latter was not statistically significant. Reporting both giving and receiving ART was not associated with viremia (aPR: 0.79, 95% CI: 0.43−1.46). Reporting buying ART, though rare, was also correlated with higher rates of viremia, but this relationship was not statistically significant (aPR: 1.98, 95% CI: 0.72−5.45).

Conclusions

ART sharing is common among persons reporting ART use in rural Uganda, particularly among men. Sharing ART was associated with viremia, and receiving ART may facilitate viral suppression. HIV programmes may benefit from considering ART sharing in counselling messages.     

Concomitant contraceptive implant and efavirenz use in women living with HIV: perspectives on current evidence and policy implications for family planning and HIV treatment guidelines

Introduction : Preventing unintended pregnancies is important among all women, including those living with HIV. Increasing numbers of women, including HIV‐positive women, choose progestin‐containing subdermal implants, which are one of the most effective forms of contraception. However, drug–drug interactions between contraceptive hormones and efavirenz‐based antiretroviral therapy (ART) may reduce implant effectiveness. We present four inter‐related perspectives on this issue. Discussion : First, as a case study, we discuss how limited data prompted country‐level guidance against the use of implants among women concomitantly using efavirenz in South Africa and its subsequent negative effects on the use of implants in general. Second, we discuss the existing clinical data on this topic, including the observational study from Kenya showing women using implants plus efavirenz‐based ART had three‐fold higher rates of pregnancy than women using implants plus nevirapine‐based ART. However, the higher rates of pregnancy in the implant plus efavirenz group were still lower than the pregnancy rates among women using common alternative contraceptive methods, such as injectables. Third, we discuss the four pharmacokinetic studies that show 50–70% reductions in plasma progestin concentrations in women concurrently using efavirenz‐based ART as compared to women not on any ART. These pharmacokinetic studies provide the biologic basis for the clinical findings. Fourth, we discuss how data on this topic have marked implications for both family planning and HIV programmes and policies globally. Conclusion : This controversy underlines the importance of integrating family planning services into routine HIV care, counselling women appropriately on increased risk of pregnancy with concomitant implant and efavirenz use, and expanding contraceptive method mix for all women. As global access to ART expands, greater research is needed to explore implant effectiveness when used concomitantly with newer ART regimens. Data on how HIV‐positive women and their partners choose contraceptives, as well as information from providers on how they present and counsel patients on contraceptive options are needed to help guide policy and service delivery. Lastly, greater collaboration between HIV and reproductive health experts at all levels are needed to develop successful strategies to ensure the best HIV and reproductive health outcomes for women living with HIV.     

Influence of the type of anaesthesia on post-operative subjective physical well-being and mental function in elderly patients

Standardized behavioural observations were used to establish the influence of the type of anaesthesia on the mental function and the subjective physical well-being in 60 patients, all men, following urological surgery. The patients were randomized to two groups, receiving spinal or general anaesthesia. For evaluation of the influence of pre-operative physical condition on post-operative mental function, a supplementary group of 34 patients with pre-existing cardiovascular and/or pulmonary disorders was included in the study. These patients all received spinal anaesthesia. The patients were observed from the day before surgery until 4 weeks after. In all patients a short-lasting temporary decline in mental function was observed. The outcome was not influenced by the type of anaesthesia. In the two groups receiving spinal anaesthesia the decline in post-operative mental function and subjective sense of well-being was most pronounced in patients with a compromised physical condition pre-operatively. Four weeks after surgery, no signs of mental deterioration were present; however, the subjective sense of physical well-being had not fully returned.     

Changes in Bone Mineral Density,Body Composition,Vitamin D Status,and Mineral Metabolism in Urban HIV‐Positive South African Women Over 12 Months

Human immunodeficiency virus (HIV) infection and antiretroviral therapy (ART) are associated with bone loss and poor vitamin D status in white populations, though their relative roles are not known. No previous studies have examined longitudinal changes in areal bone mineral density (aBMD), measured by dual‐energy X‐ray absorptiometry (DXA), or in vitamin D status in HIV‐positive African women. Of 247 premenopausal, urban, black African women from Soweto, South Africa, initially recruited, 187 underwent anthropometry, DXA scanning and blood and urine collections at both baseline and 12 months. Of these, 67 were HIV‐negative throughout (Nref), 60 were HIV‐positive with preserved CD4 counts at baseline (Ppres), and 60 were HIV‐positive with low CD4 counts at baseline, eligible for ART by South African standards of care at the time (Plow). No participant had been exposed to ART at baseline. By 12 months, 51 Plow women had initiated ART, >85% of whom took combined tenofovir disoproxil fumarate (TDF), lamivudine, and efavirenz. By 12 months, Plow and Nref, but not Ppres, increased in body weight and fat mass (group‐by‐timepoint p ≤ 0.001, p = 0.002, respectively). Plow had significant decreases in aBMD of 2% to 3%, before and after size adjustment, at the femoral neck (p ≤ 0.002) and lumbar spine (p ≤ 0.001), despite significant weight gain. These decreases were associated with increased bone turnover but there were no significant differences or changes over time in vitamin D status, serum phosphate concentrations, or renal phosphate handling. Excluding data from nine Plow women unexposed to ART and 11 Ppres women who had initiated ART accentuated these findings, suggesting the bone loss in Plow was related to ART exposure. This is the first study describing DXA‐defined bone loss in HIV‐positive Sub‐Saharan African women in association with ART. Further work is required to establish if bone loss continues with ongoing ART and, if so, whether this results in increased fracture rates. © 2017 American Society for Bone and Mineral Research.     

健康教育及工娱疗法对恢复期精神病病人负性情绪的调适作用

目的探讨健康教育和工娱疗法对恢复期精神病人负性情绪的改善作用。方法对 4 0例恢复期精神病人 ,应用健康教育、行为干预和工娱活动等措施 ,在回归社会前 1个月进行心理调适和社会适应能力的训练 ;采用焦虑自评量表 (SAS)、抑郁自评量表 (SDS)、护士用住院病人观察量表 (NOSIE)对病人训练前后进行比较。结果训练后病人的焦虑和抑郁等负性情绪较训练前有了明显改善 (P <0 .0 1) ;NOSIE各因子分与训练前比较 ,其社会兴趣、个人整洁及社会适应能力有明显提高 ;激惹、精神病表现、抑郁及退缩有明显降低 (P <0 .0 5或P <0 .0 1)。结论健康教育及工娱活动训练 ,可改善恢复期精神病人的负性情绪 ,巩固治疗效果 ,对病人健康地回归社会具有积极作用。     

Subjective well-being and quality of life following traumatic brain injury in adults: a long-term population-based follow-up

Primary objective: To assess subjective well-being and quality-of-life in nationally representative samples of patients at long intervals following traumatic brain injuries.

Methods and procedures: Patients with either cranial fractures or cerebral lesions were identified in a national computer-based register of hospital admissions and random samples were selected among those who had suffered the injury at 5, 10 or 15 years prior to the follow-up. Postal questionnaires were sent to them covering quality of life, e.g. return to employment, family relations and current subjective well-being in terms of symptomatology, e.g. somatic complaints, cognitive dysfunction. A response rate of 76% was obtained, comprising 114 patients with cranial fracture and 126 with cerebral lesions.

Main outcomes and results: The group with cerebral lesions had markedly poorer quality of life and subjective well-being than the group with cranial fractures and this did not vary across time. In both groups, the most common symptoms concerned cognition. Among the cerebral lesion group, quality of life outcome was fairly well predicted by severity of injury, but subjective well-being was less well predicted.

Conclusions: The negative consequences of traumatic cerebral lesions are marked and do not vary at long periods following injury.     

老年糖调节受损者应对方式与主观幸福感状况调查

目的探讨老年糖调节受损(IGR)者的应对方式和主观幸福感状况及其相互关系,为心理护理提供理论依据.方法用主观幸福感量表和特质应对方式问卷对220例老年IGR者的应对方式和主观幸福感状况进行调查,并对应对方式与主观幸福感的关系进行相关性分析.结果老年IGR者积极应对和消极应对得分分别为34.23±7.02和19.92±5.65,积极应对得分高于国内常模(P＜0.01),有27.73%～78.64%采用不同形式的积极应对方式,4.09%～18.18%采取消极应对方式;主观幸福感总分为36.60±8.21;积极应对方式与主观幸福感呈正相关(r=0.39,P<0.01),消极应对方式与主观幸福感呈负相关(r=-0.40,P<0.01).结论老年IGR者中大部分人采取积极应对方式,幸福感较强.应重视采取消极应对方式的少部分人,帮助其改变应对方式,以提高主观幸福感.     

子宫内膜异位症不育患者腹腔镜术后不同治疗方法预后比较

目的 回顾性比较分析子宫内膜异位症（内异症）不育患者腹腔镜术后不同治疗方法的预后.方法 1997年7月至2007年12月在江苏省人民医院因不育经腹腔镜检查证实为内异症的患者179例,男方精液异常者不包括在内.轻型Ⅰ、Ⅱ期患者分为A组62例辅助生育治疗（ART组）,其中行宫腔内人工授精（IUI）治疗17例、体外受精（IVF）45例,B组35例期待治疗（NART组）两组;重症型 Ⅲ、Ⅳ期患者分为C组55例ART组,其中IUI17例、IVF38例,D组27例NART组两组.根据输卵管通畅情况、患者年龄、不孕年限、内异症分期及评分将双侧通畅组、单侧通畅组分别行NART、ART治疗的患者进行配对比较,进行随访,随访时间截止2008年4月,将随访结果进行统计分析.结果 A、B、C、D 组累计妊娠率分别为56.5%、45.7%、45.5%、44.4%,各组之间累计妊娠率无明显差异.术后妊娠88例,其中术后1年内妊娠者84例;1年后妊娠者仅为4例（P〈0.001）.术后各组的复发率分别为4.8%、11.4%、29.1%和33.3%,A与B组间、C与D组间复发率无明显差异,但C、D组较A、B组复发率明显升高（P〈0.05）.双侧输卵管通畅分别行NART、ART的配对组的比较中,轻症内异症行ART或期待疗法的妊娠率无明显差异,而重症内异症行ART较期待治疗妊娠率明显升高（P〈0.05）.结论 对于轻症内异症,术后采取ART与NART妊娠率无明显差异,但重症内异症术后行ART是一种更积极的获得妊娠的方法.内异症术后复发率与手术的分期密切相关,重症内异症复发率更高.