脊髓损伤患者主要照顾者积极体验的质性研究

目的从积极心理学角度了解脊髓损伤患者照顾者的照顾感受,为采取措施有效提高照顾者积极体验提供参考。方法对8名脊髓损伤患者主要照顾者进行深入访谈,采用Colaizzi分析法对资料进行分析、整理、并提炼主题。结果提炼出4个主题,即经历明显的心路历程变化以适应照顾生活,同伴交流以减轻照顾压力,相互扶持,规划未来新生活。结论尽管脊髓损伤患者照顾者照顾负担十分沉重,但在长期的照顾过程中,他们开始适应照顾生活,逐渐从重大的创伤事件所带来的影响中走出并获得成长。     

养老机构老年人家庭参与的研究进展

介绍家庭参与的概念和发展,阐明家庭参与对机构老年人身心健康发挥积极作用,简述老年人机构养老后家庭成员角色的变化,深入探讨养老机构老年人家庭参与的具体内容,全方面分析家庭参与的影响因素,旨在明析养老机构老年人家庭参与机制和内涵,以提高机构老年人的晚年生活质量。     

自杀未遂青少年自杀污名体验的质性研究

目的 深入了解自杀未遂青少年患者的污名化体验,为帮助自杀未遂青少年患者心身康复提供参考。方法 采用解释性现象学研究方法,选取2022年3～12月有自杀未遂经历的15例青少年患者进行半结构式访谈,使用Colaizzi 7步分析法提炼主题。结果 共提炼出3个主题和9个亚主题,即自我污名负性情绪体验(羞耻与自责,绝望与愤怒),公众污名负性体验(家人不理解加深羞耻和愤怒,老师、同学反应和期待有落差,网友言语冲击感受失落),负性体验后的消极应对(自我表露意愿低,产生再自杀想法,回避专业帮助,回避正常人际交往)。结论 自杀未遂青少年有强烈的自我污名负性情绪和公众污名负性情绪,由此产生消极应对。因此,应积极调整自杀未遂青少年对污名的片面认知,改善其应对污名的方式,促进自杀未遂青少年身心的康复,防止再自杀的发生。     

社区老年人社会隔离及抑郁孤独与生活质量的关系

目的探讨社区老年人社会隔离、抑郁孤独负性情绪与生活质量的关系,并分析抑郁孤独负性情绪在社会隔离与生活质量间的中介作用。方法采用Lubben社会网络量表-6、老年抑郁量表、孤独感量表及简明健康状况量表对592名社区老年人进行调查。结果社区老年人社会隔离、抑郁、孤独及生活质量得分依次为(14.95±4.58)、(5.19±3.13)、(42.06±8.53)和(113.02±10.56)分。社会隔离得分与抑郁和孤独呈负相关,与生活质量呈正相关;抑郁和孤独与生活质量呈负相关(均P0.01)。社会隔离可直接影响生活质量(β=0.558),还可通过抑郁、孤独的部分中介作用间接影响生活质量(β=0.367);抑郁和孤独的中介效应分别占总效应的24.86%和14.81%。结论社区老年人社会隔离风险较高。社会隔离可直接影响或通过抑郁、孤独负性情绪间接影响老年人生活质量,应促进老年人积极融入社会,从而改善其负性情绪,提高生活质量。     

基于健康生态学理论的干预对空巢失能老年人身心健康的影响

目的探讨基于健康生态学理论的干预模式对空巢失能老年人身心健康的干预效果,为改善老年人身心健康提供依据。方法选取唐山市两个社区,采用抽签法分为观察组(50人)和对照组(49人)。观察组采用基于健康生态学理论构建的干预模式从家庭、社区、社会3个层面进行干预,对照组给予社区常规干预。于干预前及干预6个月后使用健康促进生活方式量表、孤独量表、衰弱量表、ADL量表、家庭及社会支持量表对老年人进行评测。结果干预6个月后,观察组健康促进生活方式、孤独感、衰弱、日常生活能力、家庭支持及社会支持得分较对照组显著改善,差异有统计学意义(均P0.01)。结论基于健康生态学理论构建的干预模式可以有效改善空巢失能老年人的身心健康状况。     

家庭参与老年人机构养老的干预研究进展

老年人入住养老机构后,家庭成员的参与对改善老年人身心健康、提升其养老生活质量发挥着不可替代的作用。本文对家庭参与老年人机构养老的内容及其干预进行综述,旨在为实施家庭参与老年人机构养老的干预提供参考。     

不孕女性诊疗过程中疾病获益感的定性研究

目的了解不孕女性如何在负性事件中寻求积极意义,总结有效积极心理体验。方法对16位不孕女性进行一对一半结构深入访谈并录音,在转录为文档后,借助Nvivo 11.0定性分析软件,以Colaizzi 7步法对访谈内容进行整理分析。结果在不孕不育的诊疗过程,不孕女性的疾病获益感可归纳为5个主题(以及相关的9个亚主题):健康行为改善(主动获取保健知识、保健行为的调整);精神成长(感恩、共情、忍耐力);认知适应(对未来生活规划的接纳、对辅助生殖治疗的接纳);利他行为;群体归属感。不孕女性在主观上可从感受精神成长、获得认知适应和获取群体归属感3方面获益;在客观方面,不孕女性的利他行为有助于社会关系的改善,而促进健康行为的生活方式则有助于提高不孕女性的身心健康。结论医务人员应当具备相关心理学知识,通过识别不孕女性疾病获益感的表现,帮助患者调适心理状态,促进患者体验到更多积极情绪,从而提高治疗依从性并改善其身心状况。     

养老机构生活自理老年人负性情绪的质性研究

目的了解养老机构生活能够自理的老年人存在的心理健康问题,从而为老年人提供更专业的人性化服务。方法采用社会支持评定量表筛选出社会支持度低于常模的8位老年人进行质性访谈,并对访谈内容整理、记录、编码、分析。结果养老机构生活自理老年人存在的主要负性情绪有孤独、无奈。结论养老机构老年人存在较多的负性情绪,需要增加情感和社会支持,强化家庭照护,推进医养结合,完善机构管理,改善机构养老老年人负性情绪。     

中重度尊严缺失晚期癌症患者尊严维护需求的质性研究

目的了解中重度尊严缺失晚期癌症患者尊严维护需求,为更好地维护其尊严提供参考。方法对10例中重度尊严缺失晚期癌症患者进行半结构式深度访谈,采用现象学研究方法进行资料分析、提炼主题。结果共提炼出3个主题及10项下属内容:疾病相关尊严维护需求(维持独立水平,免受生理症状困扰,维护知情及自主权),家庭社会支持需求(家庭支持,病友沟通,医疗支持),心理灵性关怀需求(角色维护,保持自我价值,活在当下,传承奉献)。结论晚期癌症患者尊严维护需求呈现症状控制、相对独立与陪伴、知情参与及安宁需求等特征,医护人员应根据需求实施针对性个体化的尊严维护与实现。     

肺移植家庭照顾者负担体验和需求的质性研究

目的 深入了解肺移植家庭照顾者在照护过程中的真实负担体验及需求,为提高肺移植家庭照顾者的身心健康水平和照护能力提供参考.方法 采用 目的抽样法,选取11名肺移植受者的家庭照顾者,进行面对面半结构式深度访谈.运用Colaizzi七步分析法提炼主题.结果 最终提炼4个主题:照顾者的负担体验;肺移植术后疾病管理需求;照顾者心理疏导的需求;照顾者多元化支持的需求.结论 肺移植家庭照顾者的负担重,需求明显,医护人员应强化健康教育、重视心理疏导、加强社会支持,以减轻照顾者身心负担.     

农村居家失能老年人健康管理需求评估问卷的编制及信效度检验

目的编制农村居家失能老年人健康管理需求评估问卷,并检验其信效度。方法以奥马哈问题分类系统为理论框架,综合文献回顾形成问卷条目池,对18名专家进行2轮Delphi专家函询形成预试问卷。对河南省213名农村居家失能老年人进行调查,检验问卷的信效度。结果探索性因子分析共提取6个公因子29个条目,包括健康档案、身体评估、心理健康、医疗环境、健康知识、智慧养老,累积方差贡献率为72.992%;条目内容效度指数为0.889～1.000,平均内容效度为0.975。问卷Cronbach′sα系数为0.897,折半信度为0.876,重测信度为0.902。结论农村居家失能老年人健康管理需求评估问卷具有良好的信度及效度,可作为评价农村居家失能老年人健康管理需求的有效工具。     

Racism,stress and health in Asian Americans: A structural equation analysis of mediation and social support group differences

The buffering effect of social support on the negative effects of racism exposure on health outcomes has been mixed in prior studies regarding Asian Americans. Based on the stress-coping framework and using structural equation modelling (SEM) methods, we tested a theoretical model portraying simultaneous mediational paths from racism exposure to general physical and mental health through racism-related stress. Bootstrap analysis was used to test the indirect effects present in the model. Additionally, multi-group SEM analysis was conducted to investigate the moderation effect of social support from family and friends on the paths in the model. The sample consisted of 310 Asian American adults who completed an online survey. The results from the two-step SEM analysis and bootstrap analysis supported the theoretical model—racism exposure can simultaneously have a negative indirect effect on Asian Americans' physical and mental health via racism-related stress. Multi-group SEM analysis showed that there were no differences in model path coefficients based on having varying levels of social support from friends or family.     

Physical and mental health in young adults operated on for idiopathic scoliosis

In this study, physical and mental health were investigated in 30 young adults who were operated on for idiopathic scoliosis, 2–3 years after surgery, and the results compared to an age- and sex-matched control group of 40 individuals. We used the short form of the 36 health survey (SF-36 version 1.2), which is a 36-item questionnaire measuring health functioning on eight scales: physical functioning, role limitations due to physical functioning, bodily pain, general health perceptions, vitality, social functioning, emotional role limitation, and general mental health. The patient scores indicated lower than the controls in physical health but higher in mental health. Otherwise, there were no significant differences between the two groups. Overall, this study showed that young adults operated on for idiopathic scoliosis were satisfied, and that their mental health was even better than the normal group, but their physical health was somewhat poorer. Thus, the surgical procedure was well tolerated and had not traumatized the patient.     

Investigating the work–family conflict and health link: Repetitive thought as a mechanism

Research is needed to investigate mechanisms linking work–family conflict to poor health in working adults. We took a novel approach to build on extant studies by testing a potential mechanism in these associations – repetitive thought. Data came from a sample of 203 partnered working adults. There were significant direct effects of work–family conflict with lower life satisfaction, positive affect, and perceived health as well as greater fatigue. As for total effects, work–family conflict was significantly associated with all health outcomes – life satisfaction, positive affect, negative affect, fatigue, perceived health, and chronic health conditions – in the expected directions through repetitive thought. This study provides support that repetitive thought is one potential mechanism of how work–family conflict can take a toll on psychological and physical health. Findings are discussed in relation to improving workplace policies to improve the health of working adults managing work–family conflict.     

Patient characteristics can predict improvement in functional health after elective coronary artery bypass grafting

BACKGROUND: Despite many patients undergoing coronary artery bypass grafting (CABG) to improve their functional status, literature in this area is limited. The purpose of this study is to determine the effect of CABG on the functional health of an elective population and to identify preoperative patient characteristics associated with improved functional health after surgery. METHODS: Physical and mental functional health was assessed before and 6 months after surgery with the Short-Form Health Survey (SF-36) in 1,061 consecutive patients undergoing elective, isolated CABG. Survey data were complete in 529 patients (49.9%). Preoperative information on patient demographics, severity of cardiovascular illness, and disease comorbidities was also prospectively collected. RESULTS: Six months post-CABG the mean summary score for physical function improved by 31.9% over baseline (45.1 versus 34.2, p < 0.0001). The mean summary score for mental function improved by 7.3% over baseline (51.3 versus 47.8, p < 0.0001). Overall 73.2% of patients showed improvement in physical function and 41.6% showed improvement in mental function. Multivariate logistic regression identified certain preoperative characteristics as negative correlates of a significant improvement in physical functioning: body mass index 35 kg/m2 or greater, diabetes with sequelae, chronic obstructive pulmonary disease, peripheral vascular disease, and baseline physical function. Baseline mental function and chronic obstructive pulmonary disease were identified as negative correlates and older age as a positive correlate of significant improvement in mental functioning. CONCLUSIONS: Patient characteristics exist that impact functional health after elective CABG. Knowledge of these characteristics may be helpful when counseling patients about expected improvement in functional health with CABG.     

Health care utilization and outcomes in older adults after Traumatic Brain Injury: A CENTER-TBI study

IntroductionThe incidence of Traumatic Brain Injury (TBI) is increasingly common in older adults aged ≥65 years, forming a growing public health problem. However, older adults are underrepresented in TBI research. Therefore, we aimed to provide an overview of health-care utilization, and of six-month outcomes after TBI and their determinants in older adults who sustained a TBI.MethodsWe used data from the prospective multi-center Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. In-hospital and post-hospital health care utilization and outcomes were described for patients aged ≥65 years. Ordinal and linear regression analyses were performed to identify determinants of the Glasgow Outcome Scale Extended (GOSE), health-related quality of life (HRQoL), and mental health symptoms six-months post-injury.ResultsOf 1254 older patients, 45% were admitted to an ICU with a mean length of stay of 9 days. Nearly 30% of the patients received inpatient rehabilitation. In total, 554/1254 older patients completed the six-month follow-up questionnaires. The mortality rate was 9% after mild and 60% after moderate/severe TBI, and full recovery based on GOSE was reported for 44% of patients after mild and 6% after moderate/severe TBI. Higher age and increased injury severity were primarily associated with functional impairment, while pre-injury systemic disease, psychiatric conditions and lower educational level were associated with functional impairment, lower generic and disease-specific HRQoL and mental health symptoms.ConclusionThe rate of impairment and disability following TBI in older adults is substantial, and poorer outcomes across domains are associated with worse preinjury health. Nonetheless, a considerable number of patients fully or partially returns to their preinjury functioning. There should not be pessimism about outcomes in older adults who survive.     

Associations among stress,gender, sources of social support,and health in emerging adults

This study aimed to examine how sources of social support intersect with stress and health by testing two theoretical models. Three relationship‐specific sources of social support (family, friends, and romantic partners) and two health indicators (self‐rated physical health and depressive symptoms) were investigated. The sample consisted of 636 emerging adults attending college (age range: 18–25). Results suggest that only support from family was a stress‐buffer, in that it buffered the adverse association between stress and depressive symptoms. Holding stress constant, only support from family was related to self‐rated physical health and only support from friends or romantic partners was associated with depressive symptoms. There were no gender differences in the mean levels of self‐rated physical health and depressive symptoms. However, gender moderations were found, in that the positive relationship between friends support and physical health was observed only in women, that the association between friends support and depressive symptoms was greater in men than in women, and that family support buffered the negative relationship between stress and physical health only in men. Findings of this study suggest that the associations among stress, social support, and health vary by the sources of support, the health outcome, and gender.     

直腿抬高试验阴性的腰椎间盘突出症

目的 探讨腰4-5、腰5骶1椎间盘突出症中直腿抬高试验阴性的原因。方法 通过物理检查、影像学表现、手术所见对直腿抬高试验阴性的椎间盘突出症做了直观性的分析。结果 神经根变性、个体致痛性不敏感、突出物位置、病理环境下的神经根病态平衡、患病间隙的椎管容积大、腰背肌的保护性脊柱固定、职业因素等是造成腰椎间盘突出症中直腿抬高试验阴性的主要原因。结论 仔细的分析临床症状，参照影像学的客观性，排除直腿抬高试验阴性的原因是避免腰椎间盘突出症漏诊的重要方法。     

Factors influencing exercise participation by older adults requiring chronic hemodialysis: a qualitative study

Despite the recognized health and psychosocial benefits of exercise for older adults with end-stage renal disease (ESRD), exercise participation remains poor. Previous research has attributed low levels of exercise to patient-related factors such as lack of motivation and fear of adverse consequences. This qualitative study involving focus group discussions with hemodialysis patients, nephrology nurses, and family care providers explored specific motivators and barriers to exercise participation in older adults requiring hemodialysis. Nurse participants were chosen for the health care provider focus groups because their prolonged and sustained contact with hemodialysis patients during the dialysis treatment sessions positions them well to encourage and promote exercise. Motivators to exercise included patient aspirations to exercise and their experiences of improvements from exercising, as well as the formal incorporation of exercise into the overall dialysis treatment plan. Barriers to exercise included nurses’ lack of encouragement to exercise, transportation issues, and the use of exercise equipment that precludes participation by patients who recline during dialysis and inhibits exercise encouragement by nurses due to concerns of equipment-related injury. These findings support the need for a broader recognition of the systemic factors that may impede exercise participation by older adults requiring hemodialysis. A shift is required in the culture of ESRD treatment programs towards a wellness perspective that includes expectations of exercise encouragement by the health care team and participation by patients.     

Prospective Changes in the Distribution of Movement Behaviors Are Associated With Bone Health in the Elderly According to Variations in their Frailty Levels

Frailty is associated with poor bone health and osteoporosis, and physical activity (PA) is one of the best treatments for both pathologies in older adults. Nonetheless, because daily time is limited, how the time is distributed during the waking hours is critical. The waking hours are spent according to different movement behaviors: sedentary behaviors (SB), light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA). The aim of this study was to use compositional data analyses to examine the effects of the change in movement behaviors on bone health during aging in older people, related to the changes in their frailty levels. We analyzed 227 older people aged 65 to 94 (125 women and 102 men) over a 4-year period. Movement behaviors were assessed using accelerometry. Both bone mineral density (BMD) and bone mineral content (BMC) were determined using bone densitometry. The Frailty Trait Scale was used to divide the sample by frailty level evolution during aging. The R statistical system was used for the compositional data analysis and, in addition, all models were adjusted for several covariates. The changes in the distribution of all movement behaviors within a waking hour period were significantly associated with spine and femoral neck BMD changes in the subgroup with a positive change in frailty level and spine BMC in the subgroup with no change in frailty level (p ≤ .05). Likewise, MVPA relative to the change in other movement behaviors was also associated in both subgroups with higher BMD and BMC, respectively, in the same body areas (p ≤ .05). No significant associations were found in the negative change in frailty level subgroup. Older people who achieved a positive change in frailty level during a 4-year period showed higher BMD changes compared to those with no changes or increases in their frailty level. Therefore, increasing MVPA relative to the change in the other movement behaviors during a 4-year period could perhaps produce bone health improvements in the elderly that do not worsen their frailty level. © 2020 American Society for Bone and Mineral Research.