GI-Ⅱ型渗透陶瓷底层冠适合性及轴面聚合度对适合性的影响研究

目的　研究GI-Ⅱ型渗透陶瓷底层冠的适合性以及牙体预备时轴面聚合度对适合性的影响。方法分别为 1 5个具有三种不同聚合度 (5 、1 0 、1 5 )的上前磨牙制备GI -Ⅱ型渗透陶瓷底层冠 ,粘结后测定底冠适合性。结果　 5 、1 0 、1 5 聚合度牙体预备底层冠绝对边缘间隙量分别为 1 0 5μm、66 .2 0 μm、69.37μm。聚合度从 5 增加到 1 0 时适合性显著提高 ,1 0 以上则提高不显著。结论　GI -Ⅱ型渗透陶瓷底层冠具有良好的适合性 ,牙体预备时聚合度对GI -Ⅱ型渗透陶瓷底层冠适合性有显著影响     

保留乳头乳晕的改良根治术联合假体置入术对乳腺癌早期患者的影响观察

目的探讨保留乳头乳晕的改良根治术联合假体置入术对乳腺癌早期患者应对方式及美观效果的影响。 方法选取2017年3月至2019年3月长安医院收治的乳腺癌早期患者140例,根据手术方案分为研究组与对照组,各70例。研究组采取保留乳头乳晕的改良根治术联合假体置入术,对照组采取乳腺癌改良根治术。统计两组手术情况（手术时间、淋巴结清扫数目、术后引流量、住院时间）、并发症（皮下气肿、感染、皮肤坏死、皮下积液、上肢水肿）、美观效果,对比手术前后免疫功能（CD3⁺、CD4⁺、CD4⁺/CD8⁺）、应对方式。 结果研究组术后引流量少于对照组,住院时间短于对照组（t=13.584、8.423,P<0.001、<0.001）。术后1 d研究组CD3⁺、CD4⁺、CD4⁺/CD8⁺高于对照组（t=6.612、7.057、5.170,均P<0.001）。术后1个月研究组依靠自我、姑息、宿命、逃避评分低于对照组,情感宣泄、寻求支持、乐观、面对评分高于对照组（t=10.821、11.010、7.854、5.952、8.563、9.657、9.223、11.596,均P<0.001）。研究组并发症发生率（5.72%）低于对照组（20.00%）（χ²=6.375,P=0.012）,美观效果优良率（92.86%）高于对照组（81.43%）（χ²=4.080,P=0.043）。 结论保留乳头乳晕的改良根治术联合假体置入术治疗乳腺癌早期患者,可减少并发症,改善应对方式,提高美观效果,且对免疫功能影响较小。     

肾移植受者应对方式对服药依从性及自我管理的影响

目的探讨肾移植受者疾病应对方式、服药依从性及其自我管理的特点,并分析应对方式对服药依从性和自我管理依从性的影响。 方法采用便利抽样选取2019年3月至5月广州医科大学附属第三医院器官移植随访门诊就诊的肾移植受者作为研究对象。采用一般情况调查表、医学应对问卷、免疫抑制剂依从性Basel评估量表(BAASIS)及肾移植受者自我管理调查量表作为调查工具。所有问卷调查均在肾移植受者门诊随访时进行。采用成组t检验比较肾移植组和慢病常模组面对、回避和屈服因子得分。应用分层回归方程分析肾移植受者应对方式对服药依从性和自我管理的影响。P<0.05为差异有统计学意义。 结果肾移植受者面对因子得分[(19.8±2.9)分]最高。肾移植组和慢病常模组回避因子得分分别为(15.1±2.7)和(14.4±3.0)分,差异有统计学意义(t＝-2.320,P<0.05)。肾移植受者BAASIS得分平均为(22.2±2.6)分,125例受者中53例(42.4%)受者服药依从性好。36例(28.8%)曾在过去1个月中至少漏服1次免疫抑制剂;19例(15.2%)在过去1个月中曾出现至少1次连续漏服状况;63例(50.4%)曾在过去1个月中提前或推迟2 h服药;9例(7.2%)曾不按医嘱剂量服药。肾移植受者自我管理总得分为(91±8)分,其中68例(54.4%)自我管理水平良好,57例(45.6%)自我管理处于中等水平。受者饮食、治疗、躯体活动和社会心理管理得分分别为(29.5±3.0)、(33.4±3.4)、(15.7±2.1)和(12.4±1.6)分。面对、回避和屈服3个变量分别解释服药依从性总变异的8.6%,治疗管理总变异的13.7%,躯体活动管理总变异的7.0%,社会心理管理总变异的25.0%,整体自我管理总变异的15.0%。服药依从性的预测因子为屈服(β＝-0.252,P<0.01),饮食管理的预测因子为面对(β＝0.212,P<0.05),治疗管理的预测因子为面对(β＝0.348,P<0.01),躯体活动管理的预测因子为面对(β＝0.255,P<0.01),社会心理管理的预测因子为面对和屈服(β＝0.394和-0.271,P均<0.01),整体自我管理的预测因子为面对(β＝0.365,P<0.01)。 结论肾移植受者应对方式是服药依从性和自我管理的重要影响因素,应重视其对待疾病的态度和方式,及时转换其消极的应对策略,以提高其服药依从性和自我管理水平。     

Associations of collective self-help activity,health literacy and quality of life in patients with tinnitus

Objective

About 800 of the 13,000 members of the German Tinnitus Association (DTL) are active in self-help groups (SHGs). This study analyzes whether SHG-participation is associated with tinnitus-related Health Literacy (HLit) and Quality of Life (QoL).

社交恐惧症患者防御方式的研究

目的　了解社交恐惧症患者的防御方式以及父母教养方式和个性特征 ,以期在今后的临床工作中能够对社交恐惧症患者更好地实施心理干预措施。方法　采用防御方式问卷 (DSQ)、父母养育方式评价量表 (EMBU)及艾森克个性问卷 (EPQ)对4 8例社交恐惧症患者进行问卷调查 ,并与 4 8例正常受试者加以比较。结果　同正常对照组相比 ,社交恐惧症组中间型和不成熟防御方式因子分较高 ,而成熟防御方式因子分较低 (P <0 .0 5 ) ;其父母的情感温暖因子分低 ,而父母的惩罚、拒绝因子分及父亲的过度保护和母亲的偏爱被试因子分高 (P <0 .0 1或P <0 .0 5 ) ;另外 ,社交恐惧症组EPQ的神经质 (N)因子分较高 ,而内外倾向 (E)因子分则较低 (P <0 .0 1 )。结论　社交恐惧症患者的防御方式、父母教养方式及个性特征与正常人有着明显的不同 ,为今后开展分析性心理治疗 ,实施心理干预措施提供了依据     

Predictors of psychosocial adaptation among people with spinal cord injury or disorder

OBJECTIVE: To examine the influence of disability-related medical and psychologic variables on psychosocial adaptation to spinal cord injury or disorder (SCI/D). DESIGN: A structural equation modeling design linking 3 sets of predictive variables to an outcome measure of adaptation. SETTING: Two outpatient SCI clinics (1 veteran, 1 civilian) in Texas. PARTICIPANTS: Veterans (n=181) and civilians (n=132) with SCI/D. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The adaptation outcome was measured by 2 subscales (acknowledgment, adjustment) of the Reactions to Impairment and Disability Inventory (RIDI) and by the Quality of Life Scale. The predictive variables were measured by a demographic questionnaire, 3 subscales (intrusion, re-experiencing, hyperarousal) of the Purdue Posttraumatic Stress Disorder-Revised scale, the McMordie-Templer Death Anxiety Scale, and 3 subscales (anxiety, depression, denial) of the RIDI. RESULTS: Goodness-of-fit indices suggested that a revised model of adaptation was a moderately good fit to the data. The revised model of adaptation indicated that there were medium total effects (direct plus indirect) on psychosocial adaptation by 2 latent variables (disability severity and impact, negative affectivity) and small total effects on psychosocial adaptation by disengagement coping. The latent factor of disengagement coping had the strongest direct effect on adaptation (although not statistically significant). Disability severity and impact had medium indirect effects and negative affectivity had small indirect effects on psychosocial adaptation. All of the aforementioned effects had a negative coefficient. CONCLUSIONS: Negative emotional responses (eg, depression, anxiety) to SCI/D, disengagement-type coping (eg, disability denial, avoidance), and the severity and impact of disability were related to lower levels of adaptation to SCI/D.     

Emotional intelligence as a mediator between attachment security and empathy in pre-clinical medical students: A multi-center cross-sectional study

ObjectiveTo explore the association of emotional intelligence (EI) and attachment security (AS) with empathy dimensions in medical students by examining the mediating role of EI.MethodsIn a cross-sectional design, the Interpersonal Reactivity Index (IRI), the Emotional Quotient Inventory (EQ-i), the Attachment Style Questionnaire (ASQ), and demographic questions were administrated to second-year medical students of two medical schools in Northern Italy.Results253 medical students (56.13% female), aged 19–29, participated in this study. AS positively correlated to Empathic Concern (r = 0.17, p = 0.008) and Perspective Taking (r = 0.24, p < 0.001), and negatively to Personal Distress (r = ?0.33, p < 0.001). Individuals with the same level of AS and a higher score on EQ-i had a higher score (β = 0.072, p = 0.033) on empathy latent factor (at the basis of Empathic Concern and Perspective Taking) and a lower score (β = ?0.290, p < 0.001) on Personal Distress than those with a lower EQ-i score.ConclusionThis study shows that EI completely mediated the relationship between AS and empathy dimensions among medical students.Practice implicationsEI training and workshop should be considered when designing educational interventions and programs to enhance empathy and decrease interpersonal distress in medical students.     

“Eh – What type of cells are these – flourishing in the liver?” Cancer patients’ disclosure of existential concerns in routine hospital consultations

ObjectiveAdvanced cancer poses a threat to all aspects of being, potentially causing existential suffering. We explore what kind of existential concerns patients with advanced cancer disclose during a routine hospital consultation, and how they communicate such concerns.MethodsWe analyzed thirteen video-recorded hospital consultations involving adult patients with advanced cancer. The study has a qualitative and exploratory design, using procedures from microanalysis of face-to-face-dialogue.ResultsNearly all patients disclosed how the illness experience included losses and threats of loss that are strongly associated with existential suffering, displaying uncertainty about future and insecurity about self and coping. Patients usually disclosed existential concerns uninvited, but they did so indirectly and subtly, typically hiding concerns in biomedical terms or conveying them with hesitation and very little emotion.ConclusionsPatients may have existential concerns they want to address, but they may be uncertain whether these are issues they can discuss with the physician.Practice implicationsHealth professionals should be attentive to underlying existential messages embedded in the patient’s questions and concerns. Acknowledging these existential concerns provides an opportunity to briefly explore the patient’s needs and may direct how the physician tailors information and support to promote coping, autonomy, and existential health.     

Assessing learning styles: practical tips for patient education

Nurses must facilitate and support patient and family decision-making and improvement in health outcomes using instructional skills. Complex patient needs and nursing responsibilities necessitate thoughtful consideration for maximizing the effectiveness of patient teaching encounters. This article reviews assessment of patient learning styles in combination with context for an individualized approach, as well as motivation for adult learners as a framework for organization of patient teaching. Methods and modes of patient teaching are discussed as well as tips for overcoming barriers to planning and implementing patient teaching.     

Cortical responses to pain in healthy individuals depends on pain catastrophizing

The personal experience of pain is complex and depends on physiological and psychological factors. From this latter category, pain catastrophizing plays an important role in pain behavior and response. We aimed to determine the effect of pain catastrophizing on central nociceptive processing in healthy individuals. Functional MRI was performed during two pain intensity levels evoked by electrical median nerve stimulation in 22 healthy individuals. Pain catastrophizing scores were determined for all subjects. Pain catastrophizing was not related to activity in regions associated with sensory-discriminative aspects of pain, such as the primary or secondary somatosensory cortex. Instead, during mild pain, there was a relationship between catastrophizing and activity in cortical regions associated with affective, attention, and motor aspects of pain, including dorsolateral prefrontal, insula, rostral anterior cingulate, premotor, and parietal cortices. During more intense pain, prefrontal cortical regions implicated in the top-down modulation of pain were negatively correlated with catastrophizing. These findings can be viewed from the framework of an attention model of pain catastrophizing, whereby a cortical vigilance network is engaged during mild pain, but diminished prefrontal cortical modulation impedes disengaging from and suppressing pain during more intense pain. These findings may also implicate catastrophizing in the progression to or persistence of chronic pain.