Depressive Symptoms and Associated Clinical Characteristics in Outpatients Seeking Community-Based Treatment for Alcohol and Drug Problems

Background: Comorbid psychiatric and substance use disorders are common and associated with poorer treatment engagement, retention, and outcomes. This study examines the presence of depressive symptoms and the demographic and clinical correlates in a diverse sample of substance abuse treatment seekers to better characterize patients with co-occurring depressive symptoms and substance use disorders and understand potential treatment needs. Methods: Baseline data from a randomized clinical effectiveness trial of a computer-assisted, Web-delivered psychosocial intervention were analyzed. Participants (N = 507) were recruited from 10 geographically diverse outpatient drug treatment programs. Assessments included the self-report Patient Health Questionnaire, and measures of coping strategies, social functioning, physical health status, and substance use. Results: One fifth (21%; n = 106) of the sample screened positive for depression; those screening positive for depression were significantly more likely to screen positive for anxiety (66.9%) and posttraumatic stress disorder (PTSD; 42.9%). After controlling for anxiety and PTSD symptoms, presence of depressive symptoms remained significantly associated with fewer coping strategies (P = .001), greater impairment in social adjustment (P < .001), and poorer health status (P < .001), but not to days of drug use in the last 90 days (P = .14). Conclusions: Depression is a clinically significant problem among substance abusers, and, in this study, patients who screened positive for depression were more likely to have co-occurring symptoms of anxiety and PTSD. Additionally, the presence of depressive symptoms was associated with fewer coping strategies and poorer social adjustment. Coping skills are a significant predictor of addiction outcomes, and it may be especially important to screen for and enhance coping among depressed patients. Evidence-based interventions that target coping skills and global functioning among substance abusers with depressive symptoms may be important adjuncts to usual treatment.     

儿童青少年拒绝上学现象的认识、预防与应对策略

拒绝上学行为对儿童青少年影响重大。该文综合国内外相关研究,浅谈对于儿童拒绝入学现象的认识,从影响因素方面入手提出早期预防措施及应对策略,希望对于拒绝上学行为的早预防早发现早干预有所裨益。     

H5N1 vaccines in humans

The spread of highly pathogenic avian H5N1 influenza viruses since 1997 and their virulence for poultry and humans has raised concerns about their potential to cause an influenza pandemic. Vaccines offer the most viable means to combat a pandemic threat. However, it will be a challenge to produce, distribute and implement a new vaccine if a pandemic spreads rapidly. Therefore, efforts are being undertaken to develop pandemic vaccines that use less antigen and induce cross-protective and long-lasting responses, that can be administered as soon as a pandemic is declared or possibly even before, in order to prime the population and allow for a rapid and protective antibody response. In the last few years, several vaccine manufacturers have developed candidate pandemic and pre-pandemic vaccines, based on reverse genetics and have improved the immunogenicity by formulating these vaccines with different adjuvants. Some of the important and consistent observations from clinical studies with H5N1 vaccines are as follows: two doses of inactivated vaccine are generally necessary to elicit the level of immunity required to meet licensure criteria, less antigen can be used if an oil-in-water adjuvant is included, in general antibody titers decline rapidly but can be boosted with additional doses of vaccine and if high titers of antibody are elicited, cross-reactivity against other clades is observed. Prime-boost strategies elicit a more robust immune response. In this review, we discuss data from clinical trials with a variety of H5N1 influenza vaccines. We also describe studies conducted in animal models to explore the possibility of reassortment between pandemic live attenuated vaccine candidates and seasonal influenza viruses, since this is an important consideration for the use of live vaccines in a pandemic setting.     

Coping with Sleep Disturbances Among Young Adults: A Survey of First-Year College Students in Taiwan

Abstract

Sleep problems are highly prevalent among young adults and affect different aspects of their quality of life. In this study, the authors aimed to investigate the young adults' coping strategies for these sleep disturbances and the effectiveness of the coping strategies upon sleep quality and daytime sleepiness. The subjects included 1,922 first-year college students, 44% of whom reported experiencing sleep problems, with insufficient sleep being the most common complaint (23.9%). Taking naps and adjusting sleep schedules were the coping strategies associated with better sleep quality. On the other hand, subjects who reported attempting a sleep-promoting activity, ignoring their sleep problems altogether, or trying unsuccessfully to find a way of coping with their sleep problems reported a poorer sleep quality. Although some coping strategies were associated with better sleep quality than others, the levels of daytime sleepiness were equally impaired in all coping groups to a degree that is equivalent to the sleepiness in patients with a moderate sleep-related breathing disorder.     

农村丧亲个体应对策略的定性研究:以江西省上饶县某农村为例

目的:初步研究中国农村丧亲个体的哀伤应对策略.方法:选取9名江西东北部某农村丧亲个体进行深入访谈,将访谈资料逐字转录,使用Nvivo 7.0管理资料,采用主题分析法对资料进行分析.结果:丧亲后的个体会经历强烈的哀伤,他们采用的应对策略包括葬礼仪式、处理遗物、归因、背鬼、压抑、回避、投身事物、社会交往、葬礼后仪式和保持联结.这些应对策略又可以归入到丽个更高级别——丧失指向的应对和恢复指向的应对——的分类中.每个丧亲者均会使用不同形式的丧失指向的应对和恢复指向的应对,随着时间的变化,丧失指向的应对变少,恢复指向的应对增多.丧亲者在两种应对之间有良好的摆动.结论:农村个体的哀伤应对策略有其独特性,对哀伤平复有良好的作用.仪式对哀伤平复有非常重要的作用.     

A Theoretical Model of Transition to Practice for Athletic Trainers

ContextThe transition to practice of newly credentialed athletic trainers (ATs) has become an area of focus in the athletic training literature. However, no theoretical model has been developed to describe the phenomenon and drive investigation.ObjectiveTo better understand the lived experience of the transition to practice and develop a theoretical model of transition to practice for ATs.DesignQualitative study.SettingTelephone interviews.Patients or Other ParticipantsFourteen professional master''s athletic training students (7 men, 7 women, age = 25.6 ± 3.7 years, from 9 higher education institutions) in the first year of clinical practice as newly credentialed ATs.Data Collection and AnalysisParticipants completed semistructured phone interviews at 3 timepoints over 12 to 15 months. The first interview was conducted just before graduation, the second 4 to 6 months later, and the third at 10 to 12 months. The interviews were transcribed and analyzed using a grounded theory approach.ResultsWe developed a theoretical model to explain the causal conditions that triggered transition, how the causal conditions were experienced, the coping strategies used to persist through the first year of practice, and the consequences of those strategies.ConclusionsThe model provides a framework for new athletic training clinicians, educators, and employers to better understand the transition process in order to help new clinicians respond by accepting or adapting to their environment or their behaviors.     

ICU机械通气病人获得性肌无力危险因素分析及其护理对策

目的:探讨重症监护室(ICU)机械通气病人获得性肌无力的危险因素及其护理对策。方法:选择2017年8月—2019年8月医院ICU收治的机械通气病人120例,回顾性分析病人的临床资料,通过单因素、多因素Logistic回归分析筛选获得性肌无力的危险因素,探究其护理对策。结果:120例ICU机械通气病人中38例发生了获得性肌无力,发生率为31.67%;单因素、多因素Logistic回归分析结果显示,年龄≥60岁、急性生理与慢性健康评分Ⅱ(APACHEⅡ)评分>20分、制动时间>48 h、CRRT治疗、血乳酸水平升高、合并脓毒症、机械通气时间>7 d、ICU入住时长>14 d是ICU机械通气病人获得性肌无力发生的危险因素(P<0.05)。结论:ICU机械通气病人发生获得性肌无力的危险因素复杂,需根据以上危险因素制定针对性的护理干预措施,加强护理干预。     

Dissemination,Implementation, and Improvement Science Research in Population Health: Opportunities for Public Health and CTSAs

Importance

The complex, dynamic nature of health systems requires dissemination, implementation, and improvement (DII) sciences to effectively translate emerging knowledge into practice. Although they hold great promise for informing multisector policies and system‐level changes, these methods are often not strategically used by public health.

Objectives and Methods

More than 120 stakeholders from Southern California, including the community, federal and local government, university, and health services were convened to identify key priorities and opportunities for public health departments and Clinical and Translational Science Awards programs (CTSAs) to advance DII sciences in population health.

Main Outcomes

Participants identified challenges (mismatch of practice realities with narrowly focused research questions; lack of iterative learning) and solutions (using methods that fit the dynamic nature of the real world; aligning theories of change across sectors) for applying DII science research to public health problems. Pragmatic steps that public health and CTSAs can take to facilitate DII science research include: employing appropriate study designs; training scientists and practicing professionals in these methods; securing resources to advance this work; and supporting team science to solve complex‐systems issues.

Conclusions

Public health and CTSAs represent a unique model of practice for advancing DII research in population health. The partnership can inform policy and program development in local communities.     

ALK抑制剂在NSCLC中的耐药机制及逆转策略的研究进展

间变性淋巴瘤激酶（ALK）抑制剂是目前治疗NSCLC伴ALK阳性的有效药物,然而,耐药性的产生严重限制了其临床应用。本文对ALK抑制剂耐药产生的主要机制如二次基因突变、基因扩增、旁路通路激活等进行了简要介绍,并对联合用药、开发新型PROTAC降解剂等逆转耐药策略进行了综述,以期为ALK抑制剂药物的未来发展提供参考。