职业病患者心理健康状况及干预效果研究

目的 分析职业病患者心理健康状况,探讨应用心理干预措施的效果.方法 以整群随机抽样方法抽取本省5家职业病专科医院共526名住院职业病患者为研究对象,在实施心理干预前后采用症状自评量表(SCL-90)、医院焦虑抑郁量表(HAD)进行评定式问卷调查,与国内常模比较,分析职业病患者的心理健康状况和心理干预效果.结果 实施心理干预前,职业病患者SCL-90总分(162.34±54.21)高于全国常模(P＜0.05),其中,躯体化(1.89±0.78)、焦虑(1.78±0.46)、抑郁(1.92±0.68)、敌对(1.92±0.57)、偏执(1.51 ±0.87)等5个因子分均高于全国常模(P＜0.05或P＜0.01);而HAD焦虑维度评分(10.82±2.32)接近阳性(≥11分)水平.实施心理干预后,职业病患者SCL-90总分(135.35±40.32)和躯体化(1.67±0.53)、强迫症状(1.56±0.49)、焦虑(1.51±0.35)、抑郁(1.67±0.62)、敌对(1.59±0.49)、恐怖(1.19±0.54)、偏执(1.38±0.62)、精神病性(1.22±0.39)等8个因子分均较实施前下降(P＜0.05);SCL-90总分、总均分、阳性项目数、阳性项目均分与躯体化、焦虑、抑郁等3个因子分仍高于全国常模(P＜0.05或P＜0.01).HAD的焦虑(7.38±2.27)、抑郁(3.51±1.86)评分均低于实施前水平(P＜0.05),焦虑、抑郁维度阳性率均较实施前下降(P ＜0.001).结论 职业病患者普遍存在心理卫生问题,职业病治疗过程中给予心理干预措施有助于改善负性情绪和心理障碍,促进患者的治疗和康复.     

心理行为干预对溃疡性结肠炎伴抑郁焦虑患者的影响

目的 评估溃疡性结肠炎患者的抑郁焦虑心理状况,探讨心理行为干预对UC伴抑郁焦虑患者的影响.方法 对2010年1月-2013年12月在浙江省丽水市中心医院消化内科住院治疗的UC伴抑郁焦虑患者56例,分别在干预前后应用SDS量表和SAS量表,以及相关知识问卷进行调查,评估期心理情况.结果 干预前UC患者的抑郁和焦虑分值分别为（60.85±7.83）分和（53.73±6.47）分,均高于中国常模水平（P＜0.05）.干预后,UC患者抑郁和焦虑得分分别为（51.28 ±6.35）分和（49.14±7.54）分,均低于干预前（P＜0.05）.干预后,UC患者疾病的病因及诱因（73.21％）、服药知识（76.79％）、饮食知识（78.57％）、情绪对疾病的影响（85.71％）、何时需要就诊（76.79％）知晓率均高于对照组（P＜0.05）.结论 对UC伴抑郁焦虑患者开展心理行为干预十分有必要,可有效改善抑郁、焦虑情绪,提高临床治疗效果.     

创伤骨折住院患者心理健康状态调查及其心理护理干预研究

目的 创伤骨折住院患者心理健康状态调查及其心理护理干预.方法 将2010年8月--2012年8月入住我院的600例创伤性骨折患者按照抽签法随机地均分为对照组与观察组,各为300例.对照组给予常规护理方法,观察组在此基础上给予心理护理.采用焦虑自评量表(SAS)与抑郁自评量表(SDS)对两组患者护理干预前后心理状况进行评分.结果 对照组护理干预前SAS评分与SDS评分分别为(47.25±11.39)分、(49.33±12.97)分,护理干预后二者得分分别为(42.31±10.22)分、(44.56±11.00)分,本组护理干预前后SAS与SDS评分差异无统计学意义(P＞0.05);观察组护理干预前SAS评分与SDS评分分别为(47.29±11.44)分、(49.55±12.34)分,护理干预后二者得分分别为(35.66±8.38)分、(36.17±9.02)分,本组护理干预前后SAS得分与SDS得分差异具有显著的统计学意义(P＜0.01),且较对照组护理后差异具有统计学意义(P＜0.05).结论 创伤骨折患者有抑郁、焦虑等不良心理,应给予必要的心理护理干预,能够明显改善患者的心理状况.     

心理干预对鼻咽癌患者心理健康状况及生活质量的影响

目的 探讨心理干预对鼻咽癌患者心理健康状况及生活质量的影响.方法 将78例鼻咽癌患者随机分为研究组和对照组各39例.两组均予以肿瘤内科常规治疗,研究组在此基础上联合心理干预.观察6周.于心理干预前及干预2、4和6周末采用症状自评量表评定心理健康状况,焦虑自评量表、抑郁自评量表评定焦虑、抑郁情绪;于心理干预前后采用生活质量综合评定问卷评定生活质量.结果 心理干预6周末,研究组症状自评量表、焦虑自评量表、抑郁自评量表评分均较干预前有显著下降(P ＜0.05或P＜0.01),并显著低于对照组(P＜0.05或0.01),对照组干预前后则均无显著变化(P＞0.05).干预6周末,研究组GQOLI-74总分、躯体健康、心理健康、社会功能维度分较治疗前有显著提高(P＜0.01),并显著高于对照组(P＜0.01),对照组干预前后则无显著变化(P＞0.05).结论 心理干预能有效缓解鼻咽癌患者的焦虑、抑郁情绪,对提高患者的生活质量具有重要意义.     

胃癌术后患者生存质量影响因素分析

目的 了解胃癌术后患者生存质量的影响因素,为采取干预措施提供参考依据.方法对2008年1月- 2009年1月在福建省肿瘤医院和福建省协和医院收治的231例胃癌根治术后患者进行问卷调查.结果231例胃癌根治术后患者生存质量平均得分为(62.61±13.18)分;不同主癌位置、侵润深度、分化程度和淋巴结有无转移术后患者生存质量差异均无统计学意义(P＞0.05);无抑郁、轻度抑郁、中度抑郁和重度抑郁术后患者生存质量平均得分分别为(55.42±9.32),(66.76±12.58),(75.00±8.28)和(80.60±12.13)分,差异有统计学意义(F=44.857,P＜0.05);低、中、高社会支持术后患者生存质量平均得分分别为(65.34±13.75),(61.81±13.37)和(56.32±10.05)分,差异有统计学意义(F=6.353,P＜0.05);多元线性逐步回归分析结果表明,抑郁状态是胃癌术后患者生存质量的危险因素;男性和社会支持是胃癌术后患者生存质量的保护因素.结论缓解患者的抑郁状态和增加患者的社会支持有助于提高胃癌术后患者的生存质量.     

心理护理对宫颈癌患者负性情绪及生存质量的影响

目的:探讨心理护理对宫颈癌患者抑郁、焦虑情绪及生存质量的影响.方法:选择宫颈癌患者97例并随机分为对照组和干预组,对照组给予常规护理,干预组增加心理护理,对两组患者干预前、术后1周及1个月(复查时)的抑郁、焦虑和生存质量进行比较,并对比两组患者对护理服务的满意度.结果:术后7天及术后1个月,干预组的整体功能、角色功能、情绪功能、认知功能4个评分高于对照组,SDS、SAS标准分低于对照组,差异均有统计学意义(P＜0.05).干预组患者对护理服务的满意率为95.9％,高于对照组(81.2％),差异有统计学意义(P＜0.05).结论:心理护理能有效改善宫颈癌患者抑郁、焦虑情绪,提高其生存质量.     

团体心理治疗对乳腺癌患者生存质量的影响

目的 探讨团体心理治疗对乳腺癌患者生存质量和情绪的影响.方法 将本院96例乳腺癌患者按随机数字表法分为两组,每组48例.观察组采用常规治疗及团体心理治疗,对照组只采用常规治疗.两组治疗前后采用焦虑自评量表(SAS)、抑郁自评表(SDS)及生命质量测定量表(FACT-B)评分,比较两组乳腺癌患者焦虑、抑郁发生率及生存质量的差异.结果 干预前两组患者焦虑自评量表(SAS)、抑郁自评表(SDS)及生命质量测定量表(FACT-B)评分比较差异均无统计学意义(P＞0.05),观察组患者干预后焦虑及抑郁评分均低于干预前(P＜0.01),而对照组干预后焦虑及抑郁评分与干预前比较无明显变化(P＞0.05),观察组患者干预后焦虑及抑郁评分均低于对照组(P＜0.01);观察组患者干预后生存质量总分及各领域得分均高于干预前(P＜0.01),对照组干预后生存质量总分及各领域得分与干预前比较无明显变化(P＞0.05),观察组患者干预后生存质量总分及各领域得分均高于对照组,其差异均有统计学意义(P＜0.01).结论 乳腺癌患者术后实施团体心理治疗,能减少其负性情绪,降低其焦虑、抑郁发生率,并改善生存质量,可作为乳腺癌辅助治疗的方法.     

心理行为干预对头颈部肿瘤患者心理康复的影响

目的探讨心理行为干预对头颈部肿瘤患者心理康复的影响,探索有效的心理行为干预方法。方法选择92例头颈部肿瘤住院治疗患者,随机将患者分为两组,实验组实施心理行为干预,对照组给予常规治疗护理,应用汉密抑郁表(HAMD,17项)和焦虑量表(HAMA)及GLQI生存质量量表为研究工具,调查两组患者入院时及治疗后出院时的心理和行为状况,并进行统计学处理分析。结果实验组患者生存总评分及诸因子分增分均较对照组明显增多(P<0.05)。结论心理行为干预对头颈部肿瘤患者心理康复有重要作用。     

心理护理对冠心病患者焦虑、抑郁的干预作用

目的 探讨心理护理对社区冠心病患者焦虑、抑郁情绪的干预作用.方法 在心理干预前后采用汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)对86例社区冠心病患者进行焦虑水平利抑郁水平的调查,并将其随机分为干预组(44例)及对照组(42例),干预组在进行常规冠心病治疗的同时给予心理干预,比较两组疗效,以及干预前后的疗效.结果 在心理护理干预后,心理干预组患者的焦虑得分显著下降(P＜0.01),抑郁得分显著下降(P＜0.01);心理干预后,心理干预组焦虑得分显著低于对照组(P＜0.05),抑郁得分显著低于对照组(P＜0.05).结论 冠心病患者常常伴有焦虑、抑郁等情绪障碍,有效的心理护理干预能显著缓解其情绪障碍,帮助改善症状.     

心理干预对产妇焦虑和分娩质量的影响

目的 探讨心理干预对产妇焦虑和分娩质量的影响.方法 将Zung氏焦虑自评量表评分阳性的待产妇100例随机分为焦虑-心理干预组(n=50)和焦虑-常规护理组(n=50),评分阴性者设为对照组(n=50),观察3组产妇产前、产后焦虑评分及分娩质量.结果 3组产妇产前评分对照组(45.4±3.2)最低(t=3.588,P＜0.05),而焦虑-心理干预组(55.8±4.2)、焦虑-常规护理组(54.9±3.7)评分差异无统计学意义(t=1.633,P＞0.05);经不同干预方式后,3组产妇产后评分焦虑-常规护理组(52.7±4.6)评分最高(t=4.508,P＜0.05),而焦虑-心理干预组(43.7±5.2)和对照组(44.8±4.5)评分差异无统计学意义(t=1.695,P＞0.05);3组中,焦虑-常规护理组剖宫产率(χ2=15.442,P＜0.05)、产程延长发生率(χ2=7.008,P＜0.05)和产时出血量最高(t=5.736,P＜0.05),而母乳喂养率最低(χ2=10.053,P＜0.05),焦虑-心理干预组和对照组差异无统计学意义(P＞0.05).结论 心理干预可降低产妇焦虑,改善分娩质量,缩短产程,减少产时出血量,促进母乳喂养,有效的心理干预可使焦虑的产妇达到和正常产妇相同的分娩质量.     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Fatigue and health in a seafaring population

Background Occupational fatigue is relatively common withinthe general population and has been linked to reduced performance,injury and longer term ill-health. Despite growing acknowledgementof this problem in the maritime sector, little research hasbeen conducted into the risk factors, prevalence and consequencesof seafarers' fatigue. Aims To examine the prevalence of fatigue among seafarers, identifypotential risk factors and assess possible links with poor performanceand ill-health. Methods Cross-sectional questionnaire survey of seafarers workingin the offshore oil support, short-sea and deep-sea shippingindustries. A number of tools were used including the fatiguesubscale of the profile of fatigue-related symptoms, the CognitiveFailures Questionnaire, the General Health Questionnaire andthe SF36 General Health scale. Results In all, 1855 questionnaires were completed giving anoverall response rate of 20%. Fatigue symptoms were associatedwith a range of occupational and environmental factors, manyunique to seafaring. Reporting a greater number of risk factorswas associated with greater fatigue [e.g. OR = 2.53 (1.90–3.35)for those with three or four risk factors and OR = 9.54 (6.95–13.09)for those with five or more risk factors]. There was also astrong link between fatigue and poorer cognitive and healthoutcomes, with fatigue the most important of a number of riskfactors, accounting for 10–14% of the variance. Conclusions Seafarers' fatigue could impact on safety withinthe industry and may be linked to longer term individual ill-health.It can only be addressed by considering how multiple factorscombine to contribute to fatigue.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.