“心境-促进协作医疗”模式对精神分裂症患者生活质量和复发的影响

[目的]探讨\     

“心境-促进协作医疗”模式对社区老年抑郁症的疗效评价

[目的]探讨"心境-促进协作医疗"(IMPACT)管理模式对社区老年抑郁症患者疗效的影响。[方法]在上海市浦东新区精神卫生网络系统中,抽取符合病例要求的60例社区老年抑郁症患者,分为干预组和对照组,每组30例,干预组实施为期18个月的IMPACT管理治疗,对照组为常规的社区精神病康复管理。使用汉密尔顿抑郁量表(HAMD)、抑郁自评量表(SDS)和自知力与治疗态度问卷(ITAQ)评价两组干预前与干预后第6、12、18个月时的抑郁症状及服药依从性得分变化情况,比较两组患者在干预期间的复发住院率。使用生活质量表(SF-36)评价干预前、后(第18个月)两组患者的生存质量得分变化情况。[结果]在干预后第6、12、18个月,干预组患者的HAMD和SDS得分改善情况优于对照组(P均0.05),ITAQ得分提升高于对照组(P0.05)。SF-36评价中,干预组患者的躯体疼痛、一般健康状况、精力、社会功能、精神健康及健康变化得分提升均优于对照组,两组差异有统计学意义(P均0.05)。干预组无1例复发住院,对照组有6例复发住院,复发住院率为20%(χ2=6.67,P0.05)。[结论]IMPACT管理模式能有效减轻社区老年抑郁症患者的抑郁症状,降低复发住院率,改善老年抑郁症患者的生活质量。     

“心境促进协作医疗”模式对社区老年抑郁症生活质量影响及初步卫生经济学评价

目的探讨＂心境-促进协作医疗＂（IMPACT）管理模式对社区老年抑郁症患者生活质量影响及卫生经济学价值。方法对30名社区老年抑郁症患者实施为期2年的IMPACT管理治疗,按1：1配对另30例作为对照组,对其实施常规的社区精神病康复管理。在干预第一年末及第二年末使用汉密尔顿量表（HAMD）、家庭负担表（FIS）、生活满意度（LSR）进行评定并观察费用成本。结果在实施干预的第一年末和第二年末,干预组患者的HAMD和FIS得分较对照组显著降低、干预组患者LSR得分较对照组显著升高（列联表卡方检验结果中,χ^2均大于5.9,P值均〈0.05）。2年内干预组患者总费用低于对照组,表现在门诊费用、住院费用、社区防治费用和家属误工费用等方面干预者患者的支出要明显少于对照组患者（t检验结果中,P值均〈0.05）;同时,两者患者在药物费用支出方面无显著差异。结论 IMPACT管理模式能有效减轻社区老年抑郁症患者的抑郁症状,并显著降低患者因疾病产生的各项费用成本。     

鼻咽癌患者术前焦虑、抑郁心境表现调查

本文调查了41例鼻咽癌患者手术前焦虑、抑郁心境表现，并与同期在我科做鼻、声带息肉手术患者做比较，现报道如下：     

冥想与放松训练对精神分裂症患者焦虑抑郁情绪的影响

目的探讨冥想与放松训练对精神分裂症患者焦虑抑郁情绪的影响。方法将80例合并焦虑抑郁情绪的精神分裂症患者随机分为对照组和研究组各40例,两组均给予口服利培酮药物维持治疗和常规护理,而研究组在常规护理的基础上给予冥想与放松训练,共4周,两组患者分别于干预前、干预4周后采用焦虑自评量表(SAS)及抑郁自评量表(SDS)进行评定,比较两组焦虑、抑郁情绪的变化。结果训练前研究组与对照组SAS、SDS评分比较无统计学差异(P>0.05),训练4周后研究组SAS、SDS评分显著低于对照组,差异有显著统计学意义(P<0.01)。结论冥想与放松训练可改善精神分裂症患者焦虑抑郁的情绪,使患者配合治疗,促进患者的康复,有利于患者回归社会。     

伴焦虑抑郁症状的精神分裂症临床分析

为了解伴焦虑抑郁症状的精神分裂症的临床特点，作对92例伴发焦虑抑郁症状的精神分裂症患与84例不伴发进行临床对比分析。结果显示：焦虑抑郁症状在精神分裂症的发生率为52．27％，发生于分裂症各期；女性发生率显高于男性；伴焦虑抑郁症状病前性格多为内向不稳定、起病多较急且有一定诱因，家族史阳性率多较高，从随着其它精神症状的缓解而改善，多见于偏执型和青春型而单纯型和紧张型较少伴有焦虑抑郁情绪。提示女性、内向不稳定性格、急性起病且有刺激诱因、家族史阳性的偏执型或青春型病人较易伴发焦虑抑郁症状。     

结构式团体心理健康治疗对精神分裂症住院患者抑郁、焦虑情绪的影响分析

目的 探讨住院精神分裂症患者经结构式团体心理健康治疗干预后抑郁、焦虑情绪的变化。方法入组120例慢性精神分裂症住院患者并随机分入研究组(60例)和对照组(60例),分别接受结构式团体心理健康治疗(研究组)及进行自然观察(对照组),随访12周。应用焦虑自评量表(SAS)、抑郁自评量表(SDS)分别在基线、治疗6周末、12周末进行评估。结果 (1)采用重复测量方差分析,主效应分析：干预后SDS量表分、SAS量表分的时间主效应、组间主效应、交互作用差异均有统计学意义(P均<0.01)。简单效应分析：研究组在6周末、治疗后SDS、SAS量表分均低于对照组(P均<0.01),研究组、对照组治疗前后不同时间点的SDS、SAS量表分差异均有统计学意义(P均<0.01)。(2)干预后,研究组SDS量表分差值与性别、职业经历呈低度正相关(r=0.415、0.432;P均<0.01);SAS量表分差值与性别呈低度正相关(r=0.393,P<0.01),与总病程呈微弱负相关(r=-0.272,P<0.05)。(3)研究组男性患者SDS、SAS量表分差值均小于女性患者(P均...     

社会心理干预对精神分裂症患者家属焦虑及抑郁情绪影响的效果评价

目的：观察社会心理干预措施对精神分裂症患者家属焦虑抑郁情绪的影响.方法：选择符合标准的患者84例,随机分为观察组（42例）和对照组（42例）,对照组给于常规精神分裂症患者家属宣教,观察组在常规宣教基础上进行社会心理干预.包括支持性心理治疗;对家属进行健康教育;调动家属心理、社会支持交流;肌肉放松训练.临床干预时间为4周治疗.治疗前后分别评定焦虑自评量表和抑郁自评量表.结果：观察组患者家属焦虑、抑郁明显好转,评分比较,两组患者家属经宣教后观察组SPS、SAS评分明显低于对照组（P〈0.05）.结论：社会心理干预有可能缓解精神分裂症患者家属的焦虑抑郁情绪.     

药物联合经络导平对精神分裂症患者抑郁、焦虑的影响

目的 探讨经络导平疗法对女性精神分裂症患者抑郁、焦虑症状的疗效。方法选取2020年1月—2021年12月在某三级甲等精神疾病专科医院住院的女性精神分裂症患者64例,用随机数字表法分为对照组和干预组各32例。对照组予常规抗精神病药物治疗,干预组在对照组基础采用经络导平疗法治疗4周,观察两组患者汉密顿抑郁量表（Hamilton depressionsale,HAMD）评分及HAMD量表中焦虑/躯体化和睡眠障碍因子分、汉密顿焦虑量表（Hamiltonanxiety sale,HAMA）评分及临床疗效。结果两组患者治疗后组间HAMD评分及HAMD量表中焦虑/躯体化、HAMA评分、HAMA的显效率比较差异有统计学意义（P <0.05）;HAMD量表睡眠障碍因子分和HAMD的显效率比较差异无统计学意义（P> 0.05）。结论 经络导平法能改善精神分裂症女性患者的抑郁、焦虑症状,对焦虑症状的改善更显著。     

健康教育对子宫切除患者抑郁和焦虑的影响

目的 了解子宫切除术后患者的情感障碍，探讨健康教育对子宫切除术后患者抑郁和焦虑的影响。方法 采用实验性研究方法．进行随机取样，研究组和对照组各230例子宫切除患者，对研究组施用健康教育护理程序，对照组施用常规妇科护理，研究工具采用焦虑自评量表（SAS），抑郁自评量表（SDS），研究者分别于入院后1d、手术后7d填写问卷。结果 研究组焦虑、抑郁评分明显低于对照组，在统计学上差异有显著性（P〈0.01）。结论宫切除术对患者的情感会造成一定的影响，实施健康教育护理程序优于常规护理．对降低抑郁和焦虑的发生有明显效果。     

Trends in the incidence of treated end-stage kidney disease among Indigenous Australians and access to treatment

OBJECTIVE: To determine temporal trends of incidence of treated end-stage kidney disease in Indigenous Australians and the extent to which these patients had to move from their home community to access renal replacement therapy. METHODS: Data for 1993-2001, regarding place of residence before starting renal replacement therapy, were analysed to give accurate incidence for 1,194 Indigenous treated end-stage kidney disease patients. We calculated indirectly standardised incidence ratios of treated end-stage kidney disease by State and Territory. We surveyed treating renal units about which Indigenous patients relocated to access therapy from 1999 to 2001. RESULTS: The incidence of treated end-stage kidney disease among Indigenous Australians is high and rising; however, the rate of increase is lower than has been previously reported. The Northern Territory (NT) and Queensland have the most new Indigenous treated end-stage kidney disease cases. The highest standardised incidence ratio was in the NT (17.0), followed by Western Australia (WA) (11.9). From 1999 to 2001, half of the 476 Indigenous patients starting therapy had to relocate to access treatment. CONCLUSIONS: The incidence of end-stage kidney disease among Indigenous Australians continues to rise. However, significant gaps in knowledge remain about the burden of early chronic kidney disease and whether many Indigenous patients with end-stage kidney disease still choose not to receive renal replacement therapy. The need to relocate to access treatment has a strong negative impact on individuals, families and entire communities.     

The association between primary source of ambulatory care and access to and outcomes of treatment among AIDS patients.

OBJECTIVES: To examine the relationship between having a primary source of ambulatory care (PSAC), access to AIDS treatment and prophylaxis for opportunistic infection, and hospital and mortality outcomes among heterosexual men and women with AIDS. METHODS: Using a linked AIDS Registry-Medicaid database, 366 adults were identified (1989-1991) with at least 1 year of continuous Medicaid enrollment before AIDS diagnosis, who survived 2 weeks after diagnosis, and with no antiretroviral use or Pneumocystis carinii pneumonia (PCP) prophylaxis during the pre-diagnosis year. Outcomes included times to zidovudine treatment, PCP prophylaxis, hospitalization and death following diagnosis. Multivariate proportional hazards models were used to estimate the effects of patients' PSAC status in the 12-month post-diagnosis period on outcomes, controlling for demographic and case-mix variables. RESULTS: Study criteria preferentially included females, non-whites and enrollees eligible on the basis of aid to families with dependent children. A total of 49% of the patients had no PSAC. Patients with a PSAC were more likely to have received zidovudine [relative risk (RR) = 1.75, 95% confidence interval (CI) = 1.2, 2.2] or PCP prophylaxis (RR = 2.22, 95% CI = 1.5, 3.3). Regression models simultaneously examining association of the propensity to use zidovudine and PCP prophylaxis agents with death indicated that zidovudine-treated and PCP-prophylaxed patients were 64% and 51% less likely to die, respectively (RRdeath,zidovudine = (.36, 95% CI = 0.2, 0.4; RRdeath, PCP prophylaxis = 0.49, 95% CI = 0.3, 0.8). CONCLUSIONS: Patients' underuse of zidovudine and PCP prophylaxis was systematically associated with not having a PSAC. Lack of PSAC, in turn, predicted shorter survival but not increased hospitalization. Female gender, injecting drug use, non-white race and earlier diagnosis year also predicted poorer outcomes.     

护理干预对成人癫痫患者生活质量及焦虑抑郁状况的影响

目的探讨护理干预对成人癫痫患者生活质量及焦虑抑郁状况的影响。方法回顾性分析本院2011年8月-2013年5月收治的86例癫痫患者的临床资料,所有患者均给予护理干预,比较干预前、干预1个月、干预3个月时患者的焦虑、抑郁的发生率及生活质量评分。结果护理干预3个月后86例患者的焦虑、抑郁的发生率均明显降低与干预前比较,差异有统计学意义（P〈0．05）。干预前、干预1个月、干预3个月时患者的QOLIE-31评分差异有统计学意义（F=23．598,P〈0．05）。结论护理干预可降低癫痫患者焦虑、抑郁的发生率,提高患者的生活质量。     

新冠肺炎疫情期间乳腺癌患者就医延迟与焦虑抑郁的现况调查

目的 了解新型冠状病毒肺炎疫情期间乳腺癌患者就医延迟与焦虑抑郁的发生情况,并分析焦虑抑郁的影响因素。方法 采用问卷调查在我院接受治疗的乳腺癌患者的就医延迟及抑郁焦虑情况,采用SPSS进行数据分析。结果 共收集316份有效问卷。就医延迟方面,化疗与复诊延迟的患者人数较多,患者多倾向于到原医院进行治疗,希望能采取网上就诊,邮寄药品的方式解决就医延迟。有39例（12.3%）患者存在焦虑症状,60例（19.0%）患者存在抑郁症状,其中农村地区（OR = 3.05, 95%CI: 1.51～6.15）、身体状况差（OR = 1.86, 95%CI: 1.06～3.26）、治疗阶段靠前（OR = 0.54, 95%CI: 0.33～0.91）显著提高患者的焦虑水平,收入低（OR = 0.59, 95%CI: 0.39～0.91）、身体状况差（OR = 1.71, 95%CI: 1.05～2.79）、对延迟治疗越担忧（OR = 1.53, 95%CI: 1.16～2.02）显著提高患者的抑郁水平。结论 新冠肺炎疫情期间乳腺癌患者出现了不同类别的就医延迟,患者表现出了不同程度的焦虑、抑郁心理反应,提示应根据影响因素合理分配医疗资源并提供心理干预。     

Impact of private funding on access to elective hospital treatment in the regions of England and Wales. National records survey.

BACKGROUND: The UK National Health Service aims to match access to health care to the level of need and to reduce inequalities in the health of sub-populations. One in ten persons have private medical insurance (PMI). This study describes the impact of private purchasing on access to hospital care in regions according to health need. METHOD: Details of admissions to NHS hospitals in one year and waiting times were obtained from the government's Hospital Episodes Statistics, and of patients in independent hospitals through weighted time samples of records. Data were combined into two groups, state funded and privately funded patients. The prevalence of limiting longstanding illness and the proportions of individuals covered by PMI in Wales and the eight English health regions were obtained from the General Household Survey. Correlation coefficients were calculated for inter-regional relationships between measures of need, provision of resources and levels of activity. RESULTS: Limiting, longstanding illness was significantly associated with NHS resource levels, NHS hospital activity, and total hospital activity, however funded; and inversely with PMI coverage, waiting times for NHS admission and levels of privately funded activity. Waiting times for admission were positively correlated with PMI coverage. CONCLUSIONS: Regionally, NHS resources and activity match need. Private hospital use complements lower levels of NHS service. Private consumption does not distort access according to need but in regions with lower levels of NHS activity those least deprived may make relatively more use of NHS hospitals, thus widening the health gap. Small area studies should explore this.     

The heterogeneous causal effects of neonatal care: a model of endogenous demand for multiple treatment options based on geographical access to care

Neonatal units in the UK are organised into three levels, from highest Neonatal Intensive Care Unit (NICU), to Local Neonatal Unit (LNU) to lowest Special Care Unit (SCU). We model the endogenous treatment selection of neonatal care unit of birth to estimate the average and marginal treatment effects of different neonatal designations on infant mortality, length of stay and hospital costs. We use prognostic factors, survival and hospital care use data on all preterm births in England for 2014–2015, supplemented by national reimbursement tariffs and instrumental variables of travel time from a geographic information system. The data were consistent with a model of demand for preterm birth care driven by physical access. In‐hospital mortality of infants born before 32 weeks was 8.5% overall, and 1.2 (95% CI: ?0.7, 3.2) percentage points lower for live births in hospitals with NICU or SCU compared to those with an LNU according to instrumental variable estimates. We find imprecise differences in average total hospital costs by unit designation, with positive unobserved selection of those with higher unexplained absolute and incremental costs into NICU. Our results suggest a limited scope for improvement in infant mortality by increasing in‐utero transfers based on unit designation alone.