WONCA研究论文摘要汇编——学校欺负行为及其他儿童期风险因素为成年对亲密伴侣暴虐的预测因子

目的评估儿童期欺负同学与成年对亲密伴侣暴虐的相关性,基于临床成年男性研究。学校欺负行为及亲密伴侣暴虐主要源于渴望强势和控制他人的观念。设计2005年1月—2006年12月横断层面研究。场所麻萨诸塞州波士顿3个城市社区卫生中心。参试者在参试社区卫生中心寻求服务的18～35岁男性(n=1 491)。主要暴露学校欺负不良行为。结果测量过去一年对女性伴侣施躯体或性暴虐(亲密伴侣暴虐,intimate-partner violence,IPV)。结果 2/5的男性报告儿童期存在着欺负行为(n=610;40.9%)。在学校少有欺负行为的男性有IPV行为的风险是无欺负行为男性的1.53倍〔95%CI(1.02,2.29)〕;频繁欺负同学的男性,发生不良行为的风险升至3.82倍,更可能出现IPV行为。结论研究表明,儿童期在学校欺负同学,尤其频繁出现欺负行为的男性,与其成年后IPV行为风险增加相关。对欺负及IPV行为的常见重要风险因素控制后,这种作用依然保持着强势。需进一步研究以辨别辱骂行为机制及潜在的根本原因。     

亲密伴侣暴力的临床后果及识别与处理技巧

亲密伴侣暴力（IPV）是最常见的一种家庭暴力，不仅危害受害人的身心健康和生命安全，还会影响其婚姻家庭和子女成长。IPV广泛存在于各种社会经济、宗教和文化群体中。中国约有1/4的女性曾遭受过配偶不同形式的IPV。绝大多数患者不会以IPV为主诉就诊，所以在各种非特异的症状和体征中快速识别出可能的IPV是临床医生工作的重点和难点。目前，我国尚没有官方指南指导IPV的诊疗，IPV相关研究也较少。本文通过对IPV研究相关英文文献进行证据综述，重点总结了IPV的临床后果及识别与处理技巧，并讨论了如何将这些证据应用于中国。     

家庭暴力严重影响健康

世界卫生组织2005年11月24日发布的关于家庭暴力的第一次研究报告揭示，亲密伴侣暴力是妇女生活中最常见的暴力形式。研究报告了丈夫和伴侣的身体和性暴力对全世界妇女的健康和幸福造成的巨大损失以及伴侣暴力在很大程度上仍然隐蔽的程度。     

扑朔迷离的性幻想

当过于熟悉的身体局限了“性”福的疆界,当亲密越来越成为单调乏味的重复,性幻想就会乘机而入,有趣的是幻想中的性伴侣往往不是正在交合的伴侣,很可能是一位理想中的意中人或远远超越现行伴侣的现实中人。     

骨科住院老年患者衰弱评估工具的范围综述

背景随着我国人口老龄化加剧，骨科围术期老年患者人数呈逐年递增趋势，衰弱在接受骨科手术的老年患者中越来越常见且日益引起关注，术前尽早评估老年人的衰弱状态，早期进行干预，对于改善患者预后和减少并发症的发生具有重要意义。目的 对骨科住院老年患者使用的衰弱评估工具进行范围综述，为骨科住院老年患者衰弱评估工具的选择提供参考依据。方法 计算机检索PubMed、CINAHL、PsycINFO、Scopus、Embase、中国知网、万方数据知识服务平台共7个数据库，检索时间为2006—2021年。由2名研究者独立筛选文献并提取文献的基本特征（第一作者、发表时间、国家、基本信息、研究工具和结局指标）及涉及的衰弱评估工具基本特点（名称、研究国家、研究类型、量表维度、量表条目、评估截点值、评估时间等）。结果 共检索出1 733篇文献，最终纳入25项研究共12种衰弱评估工具。分析结果表明，目前评估工具种类繁多，不同的研究使用了不同的衰弱评估工具，Fried’s衰弱表型（FP）标准和衰弱指数（FI）是常用的两种衰弱评估工具，运用准确有效的工具进行衰弱的筛查对加强术前风险分层和改善术后预后至关重要，患者自我报告埃...     

ICU患者身体约束评估工具的研究进展

随着对重症监护病房(intensive care unit,ICU)患者身体约束研究的不断深入,越来越多的证据表明身体约束对患者造成诸多的负性影响.各国都相继发布身体约束指南,强调通过对患者进行合理评估降低身体约束使用率.本文通过总结目前国内外现有的适宜重症患者身体约束评估的工具及其应用情况,为开发具有我国ICU特色的评估工具提供参考依据.     

痴呆患者抗拒护理评估工具的研究进展

抗拒护理（RTC）是在照护痴呆患者过程中发现的一种常见的异常行为表现，对患者及其照顾者可造成较严重的负面影响。国外对痴呆患者RTC评估工具的研究起步较早，研究内容更加深入和全面，自1999年阿尔茨海默病抗拒护理量表（RTC-DAT）被开发以来，国外研究者对其进行了多次评价内容和方法上的修订，打造出适用于不同护理情境且各具特色的痴呆患者RTC评估工具。本文对国外开发的痴呆患者RTC评估工具进行综述，着重探讨不同评估工具在评价内容和方法上的差异，分析其特点、优势和不足，旨在为我国开发或引入适合国情的痴呆患者RTC评估工具提供借鉴。当前，国外学者在开展痴呆患者RTC相关研究时，多由研究人员基于RTC-DAT使用观察法评估痴呆患者RTC行为发生情况，而这种方法在实际推广应用的过程中面临诸多挑战。2022年被开发的抗拒护理信息提供者量表（RoCIS）允许研究人员使用在其他领域常见的咨询照顾者的方法评价痴呆患者RTC行为发生情况，这为国内引入或开发适用于我国痴呆患者RTC行为评估的工具提供了新的借鉴。医务人员应在综合考虑不同类型评估工具适用性的基础上选择适宜工具评估痴呆患者RTC行为发生情况。     

失智症老年人综合评估工具的研究进展

国内外评估失智症患者的工具种类繁多，但采用单个维度量表的评估常具有局限性，且目前缺乏专门针对失智症患者综合评估工具的相关报道。基于此，本文对国内外失智症老年人综合评估工具进行综述，归纳了从需求和功能两个角度对失智症老年人进行评估的8个评估工具，并对各工具的内容、信效度、应用情况等方面进行了讨论，以期为我国失智症老年人评估工具的使用与开发提供借鉴。     

慢性阻塞性肺疾病患者吞咽障碍评估工具的研究进展

吞咽障碍是慢性阻塞性肺疾病（COPD）的常见并发症之一，并且是COPD急性加重的危险因素之一，对患者预后造成不良影响。对COPD患者吞咽障碍的发生及严重程度进行准确的评估，是进行科学管理的首要前提。本文对COPD吞咽障碍评估工具的基本特点、应用现状及发展现状进行综述，为临床医务人员选择评估工具提供借鉴。     

全科门诊接诊家庭暴力受害者的技巧分析

家庭暴力受害者可同时遭受身体安全威胁和心理创伤折磨,导致受害者会因多种多样的生理和/或心理问题咨询全科医生。全科医生在面对家庭暴力受害者时,需要及时识别患者,充分评估和正确处理。但在临床实践中,全科医生遇到此类患者存在着手困难、缺乏问诊技巧、无恰当处理方式等诸多问题,因而多选择无视或简单转诊。本文通过对家庭暴力案例的接诊分析,讨论应用“以患者为中心”的方法和“生物-社会-心理医学模式”进行诊疗活动的技巧,充分体现全科医生价值所在,延伸以家庭为单位的治疗理念。     

Management of acute adult sexual assault

An estimated 13% of women and 3% of men worldwide report sexual assault in their lifetime. Although managing sexual assault may appear daunting, some victims want medical care only. After disclosure, discuss forensic assessment. If a complaint to the police is possible, give the first dose of emergency contraception if required, and refer for forensic assessment. If medical care only is desired, determine the timing and type of assault and current contraception, manage general and genital injuries and perform relevant tests. After unprotected vaginal rape, offer emergency contraception, chlamydia prophylaxis and vaccination against hepatitis B virus. Counselling is important for all victims of sexual assault, as psychosocial consequences are more common than physical injuries. Management by a sympathetic, non-judgmental health practitioner helps the victim to regain control.     

A survey of cutlass ("Collins") injuries seen in the emergency department of the Queen Elizabeth Hospital in Barbados

For the period March to November 1998 inclusive, a prospective survey was conducted of all patients who sustained injuries with a cutlass or machete and were admitted to the Accident and Emergency Department of the Queen Elizabeth Hospital. Of the 77 patient admissions, 81% (62/77) were male. The average age was 28.8 years (range 8 to 73 years; standard deviation 13.1). Twenty-two per cent of the patients were less than 20 years old. The most common locations of the lacerations were upper extremity (59 lacerations) and scalp (16 lacerations). Thirty-four per cent of the patients (26/77) sustained lacerations to two or more anatomical locations. There were 23 fractures in 21 patients; skull fractures were the most common fractures (11). Of the 63 patients who responded to the question on whether they knew the identity of their assailants, 51 reported that they were attacked by someone known to them; eight were assaulted by a spouse or known family member. Eighty-six per cent of patients (66/77) were treated in the emergency room and discharged. Of the 11 patients admitted, eight required treatment in the operating theatre. The average length of stay was 3.6 days. There were no amputations or deaths. One patient sustained loss of vision in one eye. In Barbados, most victims of cutlass injuries are males who know their assailants and the morbidity is most often related to head injuries and to short-term physical disability due especially to lacerations of the hand and forearm.     

西部农村地区家庭暴力发生情况及对妇女精神健康的影响

目的:了解西部农村针对妇女的家庭暴力发生情况及对妇女精神健康的影响。方法:使用夫妻冲突量表(the revised Conflict Tactics Scale,CTS2)及自编问卷对宁夏某县1 577名妇女进行调查。结果:24.6%的妇女报告过去1年遭受过精神暴力,轻度和重度精神暴力的发生率分别为23.9%和7.0%;5.5%的妇女过去1年遭受过躯体暴力,轻度和重度躯体暴力的发生率分别为4.4%和4.1%;1.1%的妇女报告过去1年曾受过性暴力。有2.2%的妇女报告在过去1年中曾因家庭暴力受到躯体伤害,轻度和重度躯体伤害的发生率分别为2.1%和1.0%。妇女过去任何时候曾经遭受家庭暴力的比例分别为精神暴力30%,躯体暴力16.3%,性暴力1.8%,躯体伤害6.4%。妇女精神健康分别用过去1个月精神症状出现的种类、过去1年是否有过自杀意念和过去1年心理精神健康状况的自我评价3个指标来描述,多元线性回归和Logistic回归显示,在同时考虑年龄、家庭收入、丈夫是否外出打工这3个因素时,家庭暴力持续显示为影响妇女精神健康的重要因素,遭受精神暴力或躯体暴力的妇女表述过去1个月内出现更多种类的精神症状;过去1年遭受过精神暴力的妇女,其过去1年出现自杀意念的风险是未遭受过精神暴力者的3.98倍,其自我评价过去1年心理精神健康状况差的风险是未遭受过精神暴力者的1.67倍;过去1年遭受过躯体暴力的妇女,其过去1年出现自杀意念的风险是未遭受过躯体暴力者的4.72倍,其自我评价过去1年心理精神健康状况差的风险是未遭受过躯体暴力者的4.57倍。研究还显示,老年妇女和家庭收入极低的妇女为精神健康的危险人群。结论:针对农村妇女的家庭暴力发生情况不容乐观,家庭暴力对妇女的身心健康造成极大威胁,今后应采取有效措施,降低类似农村地区家庭暴力的发生,保护妇女,提高其生活质量。     

Prevalence of intimate partner violence and its associated risk factors among Saudi female patients attending the primary healthcare centers in Western Saudi Arabia

Objectives:

To estimate the prevalence of intimate partner violence (IPV) among female patients, age 18-60 years, attending primary health care centers (PHCCs) and to measure its determinants, and reporting behavior.

Methods:

A cross-sectional study design using validated, translated, and self-administered questionnaire among 497 Saudi female patients attending PHCCs in Taif, Kingdom of Saudi Arabia (KSA) from January to February 2015 was employed. A 2-stage probability sampling was adopted for selection of PHCCs in the first stage, and then participants in the second stage.

Results:

The estimated prevalence of IPV during the last year was 11.9%. Predictors of IPV related to abused women included divorced status and divorced parents; while those related to abusers (husbands) included widowed parents, exposure to violence in childhood, and alcohol or drugs addiction. Most of the abused wives (56%) talked regarding their IPV to their families, their husbands’ families (15.2%), or their friends (11.8%); while only a minority (3.3%) complained to the police or to a judge, and no one reported this to a family physician, or to women protection agency.

Conclusion:

One out of 10 women is a victim of IPV in Taif, KSA. Intimate partner violence is significantly associated with a number of victim and abuser-related psychosocial factors, the detection of which might help screening for individuals at risk.Intimate partner violence (IPV) is defined as any behavior within an intimate relationship that causes physical, sexual, or psychological harm. The present study examines IPV within the context of marriage,1 and focuses only on physical and psychological violence. Sexual violence, which is an important type of IPV was not assessed due to the sensitivity of the issue, and the expectation that there would be few instances to be reported. Intimate partner violence has major short- and long-term social, mental, and physical wellness effects.2 Nationwide surveys in Canada and the United Kingdom found that approximately 25% of women experienced IPV.3 In some Arab countries, IPV is still not properly investigated despite its relatively high prevalence.4 It is difficult to calculate the financial burden of IPV on the health system,5 but some studies estimate the cost to be from 1.7 - 10 billion US$ per year in the US,6 and approximately 400 million Swiss Francs in Switzerland.7 Many risk factors are associated with IPV, such as young age, low socioeconomic status, marital conflicts, a past history of violence in childhood, alcohol and drug addictions,1,6 disempowerment of women, stress, and jealousy.1 Intimate partner violence is a significant public health issue that is associated with serious health outcomes, including depression, suicide attempts, and death.1 Eldoseri8 conducted a cross-sectional study in Jeddah, Kingdom of Saudi Arabia (KSA) and interviewed women attending the primary health care centers (PHCCs), found that the prevalence of physical IPV was 45.5% that was significantly associated with husbands having alcohol or drug addictions, exposure to violence during childhood, and unemployment status. Al-Faris et al9 conducted a study in Riyadh, KSA on 222 women at a teaching hospital and found that 12.2% of them experienced lifetime physical abuse, which was significantly associated with unemployment, past exposure to violence, and living in rented houses. In Iraq, Al-Atrushi et al10 conducted a cross-sectional study at 2 community hospitals and found 58% of visiting women experienced lifetime IPV with physical violence accounting for 38.9%, and sexual violence accounting for 21.1% of the IPV. Due to the discrepancy in the prevalence rate of IPV across the country, a common simple measure is needed to assess and compare IPV in future studies. Therefore, the current study was conducted to measure IPV and its associated risk factors among female patients attending PHCCs in Taif, KSA, and to assess wives’ reporting behavior.     

Immediate medical consequences of nuclear accidents. Lessons from Chernobyl

The immediate medical response to the nuclear accident at the Chernobyl nuclear power station involved containment of the radioactivity and evacuation of the nearby population. The next step consisted of assessment of the radiation dose received by individuals, based on biological dosimetry, and treatment of those exposed. Medical care involved treatment of skin burns; measures to support bone marrow failure, gastrointestinal tract injury, and other organ damage (ie, infection prophylaxis and transfusions) for those with lower radiation dose exposure; and bone marrow transplantation for those exposed to a high dose of radiation. At Chernobyl, two victims died immediately and 29 died of radiation or thermal injuries in the next three months. The remaining victims of the accident are currently well. A nuclear accident anywhere is a nuclear accident everywhere. Prevention and cooperation in response to these accidents are essential goals.     

Pattern of injury in fatal road traffic accidents in a rural area of western Maharashtra,India

Background

Fatal road traffic accidents (RTA) are a major cause of concern all over the world. The outcome of injuries sustained in an RTA depends on various factors including but not limited to: the location of the event, type of vehicle involved, nature of the roads, the time of accident, etc.

Aims

This study aims to investigate and evaluate prospectively the socio-demographic profile and pattern of injuries in victims of RTA in the rural area of the Ahmedanagar district of Maharashtra state.

Method

This prospective study included all victims of RTA that presented to our emergency room from 1 June 2007 to 31 May 2009 and were either found dead on arrival or died during treatment. All the victims were autopsied at the post-mortem centre of Rural Medical College, Loni.

Results

Ninety-eight RTA victims were studied during the period. The most commonly affected age group was 20-39 years. Men died in RTA more than women. Fatal RTA were more prevalent on the secondary road system (47.97 per cent) and especially involved pedestrian and two wheeler vehicle users. Large numbers (n=63, 64.28%) of victims either died on the scene or during transportation. Numbers of skeletal injuries (199) and internal organ injuries (202) exceeded the total number of victims (98) clearly indicating the multiplicity of injuries. The majority of RTA victims (n=46, 46.93%) died due to head injury. The study showed that most deaths in RTA, brought to a tertiary care rural hospital, took place either on the spot or within 24 hours of injury which is very alarming and highlights the need to take urgent steps to establish good pre-hospital care and provision of trauma services at site.

Conclusion

A computerised trauma registry is urgently needed to highlight risk factors, circumstances and chains of events leading to accidents. This would be extremely helpful in policy making and health management in India.     

2007—2016年陕西省渭南市某区193例命案的法医学分析

 目的 回顾性分析既往的命案现场，总结法医学鉴定的要点。方法 收集渭南市某区2007—2016年193例命案资料并进行归纳分析。结果 被害人及犯罪嫌疑人均以男性、本区户籍、21～40岁、农民、小学文化程度为主；作案动机以侵权居多(52.8%)；致伤工具以锐器伤为主(63.8%)；损伤部位以多部位损伤为主(32.1%)；死亡原因主要为机械性损伤(87.0%)造成的失血性休克及颅脑损伤。结论 渭南市某区的命案在犯罪嫌疑人的人口学特征、作案动机、致伤工具、损伤部位、死亡原因等方面均有相似的特点，为今后命案侦破提供了线索及借鉴。     

老年人口腔衰弱的研究进展

口腔衰弱作为一个新概念在衰弱领域被提出,指伴随认知及身体功能衰退的口腔功能低下,与衰弱、肌少症、残疾及死亡等诸多老年人不良事件有关。本文回顾分析了口腔衰弱的定义、临床特征及诊断标准,对口腔衰弱的研究现状、评估工具及相关影响因素进行归纳总结,提出老年人口腔衰弱未来的研究方向可结合我国实际情况从开发适合我国老年人口腔衰弱的评估工具、开展口腔衰弱的调查性研究、丰富研究设计内容和方法以及加强干预研究四方面开展。