主动脉夹层术后患者心理状况及躯体症状对生活质量的影响

目的 探讨主动脉夹层术后患者心理状况、躯体症状对其生活质量的影响及作用机制，为制订干预计划提供参考。方法 采用广泛性焦虑障碍量表、患者健康问卷抑郁量表、躯体症状量表、12项简明健康状况调查表对327例主动脉夹层术后患者进行调查，根据相关性分析结果提出假设，应用AMOS软件进行结构方程模型分析。结果 主动脉夹层术后患者生活质量得分（81.56±7.36）分，焦虑得分2.00(0, 3.00)分，抑郁得分2.00(0, 3.00)分，躯体症状得分5.00(2.00, 8.00)分；焦虑、抑郁、躯体症状对生活质量有直接影响，焦虑、抑郁通过躯体症状对生活质量有间接影响（均P<0.05）。结论 主动脉夹层术后患者生活质量处于中等偏上水平，应早期对主动脉夹层术后患者的心理状况与躯体症状进行动态评估与监测，及时进行心理干预和症状管理，以改善其生活质量。     

Advanced Cancer Patients' Prognostic Awareness and Its Association With Anxiety,Depression and Spiritual Well-Being: A Multi-Country Study in Asia

AimsThe associations between prognostic awareness, acceptance of illness and psychological outcomes (anxiety, depression and spiritual well-being) remain unclear. This study examined the associations between prognostic awareness and various psychological outcomes and how they can be moderated by patient acceptance of illness (cancer).Materials and methodsIn total, 1184 patients with stage IV solid cancer were recruited at major public hospitals across four Asian countries (China, India, Sri Lanka, Vietnam). Prognostic awareness and acceptance of illness were assessed through self-reported understanding of treatment intent and acceptance of illness, respectively. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale, whereas spiritual well-being was measured using the Functional Assessment of Chronic Illness Therapy – Spiritual Well-Being Scale. Multivariate regressions were used to estimate the associations while controlling for patient characteristics.ResultsCompared with being unaware of their prognosis (i.e. believing that their cancer is curable), being aware or unsure of their prognosis was associated with higher anxiety and depressive symptoms, and lower spiritual well-being scores. Acceptance of illness moderated these relationships and improved the psychological outcomes.ConclusionsThe results suggest that disclosure of prognostic information should be provided in conjunction with psychological interventions that focus on acceptance of illness.     

Salir Adelante: Social capital and resilience during the Covid-19 pandemic in Argentina

The Covid-19 pandemic has stimulated new appraisals of how social cohesion, including neighborhood-level social capital, fosters resilience in the face of crisis. Several studies suggest better health outcomes in neighborhoods with higher level of social capital, in general and during the pandemic. Building on a growing body of research which suggests that those who live in close-knit neighborhoods have fared better during the pandemic, this article analyzes how social capital influences individual and collective perceptions and attitudes about the experiences of the Covid-19 pandemic in Tucumán, Argentina. To assess this question, we used a mixed-methods approach, combining focus groups, semi-structured interviews, and an online survey (n = 701 respondents) conducted in September 2021. We find widespread experiences of resilience in response to the Covid-19 pandemic, in spite of difficult socioeconomic conditions and perceived poor government performance. Results from logistic regression analysis indicate that perceptions of high neighborhood social capital are associated with more positive outcomes in many dimensions, including personal resilience, ability to cope with uncertainty, perceptions of community solidarity, and reported compliance with public health measures. We further argue that conceptualizations of social cohesion need to be adjusted to local or national-level cultural norms to accurately capture the experience of countries of the Global South.     

基于罗森塔尔效应的护理干预对脑出血后遗症病人的心理状况和生活质量的影响

目的:探讨基于罗森塔尔效应的护理干预对脑出血后遗症病人的心理状况和生活质量的影响。方法:按照随机数字表法将2019年1月—2021年1月收治的98例脑出血后遗症病人分为对照组和观察组各49例,对照组实施常规护理,观察组在常规护理基础上给予基于罗森塔尔效应的护理干预。干预前后采用卒中量表(NIHSS)、功能独立性评定量表(FIM)、生活活动功能测量量表Barthel指数(BADL)评定两组病人康复情况,采用非精神病性焦虑量表(HADS-A)、非精神病性抑郁量表(HADS-D)、自我效能量表(GSES)评定两组病人心理状态,采用生活质量简明调查表(SF-36)评定两组病人生活质量。结果:观察组病人干预后NIHSS评分低于对照组,FIM和BADL评分高于对照组(P<0.05);观察组病人干预后HADS-A和HADS-D评分低于对照组,GSES评分高于对照组(P<0.05);观察组病人干预后生活质量各维度(躯体功能、躯体角色、肌体疼痛、总体健康、活力、社会功能、情绪角色、心理卫生)评分均明显高于对照组(P<0.05)。结论:基于罗森塔尔效应的护理干预应用于脑出血后遗症病人能有效促进病人康复,改善病人心理状态,提高病人生活质量。     

基于奥马哈理论的围手术期全程康复管理对TAVR患者心理应激、6 min步行距离及并发症的影响

目的 探讨基于奥马哈理论的围手术期全程康复管理对经导管主动脉瓣置换术（transcatheter aortic valve replacement，TAVR）患者心理应激、6 min步行距离及并发症的影响。 方法 选取我院74例TAVR患者，采用随机数字表法分为2组，各37例。对照组采取传统围术期护理，在对照组基础上，观察组采取基于奥马哈理论的围手术期全程康复管理。统计2组并发症、护理满意度及护理前后心理应激、心功能指标、健康行为（health promotionlifestyleprofile-Ⅱ，HPLP-Ⅱ）、6 min步行距离及生活质量。 结果 观察组干预后左心室舒张末期内径、跨瓣压差较对照组低，主动脉瓣面积、左心室射血分数高于对照组（P＜0.05）；观察组干预后特质焦虑（Trait Anxiety Inventory，T~AI）、状态焦虑（State Anxiety Inventory，S~AI）评分低于对照组（P＜0.05）；观察组干预后HPLP-Ⅱ量表6个维度评分高于对照组（P＜0.05）；观察组术后3个月、6个月生活质量及6 min步行距离高于对照组（P＜0.05）；2组并发症比较差异无统计学意义（P＞0.05）。 结论 基于奥马哈理论的围手术期全程康复管理应用于TAVR患者，可减轻其心理应激，提高患者健康促进生活方式水平，预防并发症发生，在改善患者心功能、运动耐力和提高患者护理满意度方面具有积极意义。     

562名医务人员子女心理行为状况调查

目的 了解儿童心理行为状况,为改善儿童心理行为问题提供依据。方法 针对本院医务人员子女采用整群随机抽样的方法,通过手机端发放长处和困难问卷(Strengths and Difficulties Questionnaire,SDQ)电子版进行调查,收集儿童心理行为健康相关信息。结果 本研究纳入观察病例共562份,年龄均值(8.06±3.251)岁。其中,男275名(48.9%),女287名(51.1%);学龄期儿童311名(55.3%),学龄前期儿童251名(44.7%)。SDQ困难总分评定异常者12.9%,边缘状态者18.1%,正常者69%。情绪问题 、品行问题 、同伴关系问题 、多动问题 、困难总分、亲社会行为各因子异常检出率分别为9.6%、9.8%、19.2%、18.1%、12.9%、7.8%。不同性别儿童SDQ困难总分、情绪症状、亲社会行为、品行问题差异无统计学意义(P>0.05)。男生多动问题、同伴关系问题评分分别为(3.87±1.471)分、(4.53±1.542)分,分别高于女生的(3.65±1.415)分、(4.31±1.554)分,差异有统计学意义(t=0.96、7.65,P<0.05)。学龄前期儿童与学龄期儿童情绪症状、品行问题、亲社会行为差异无统计学意义(P>0.05)。学龄期儿童同伴关系问题、多动问题、困难总分评分分别为(4.53±1.507)分、(3.85±1.298)分、(12.15±3.613)分,分别高于学龄前期儿童的(4.26±1.652)分、(3.54±1.402)分、(11.45±4.39)分,差异有统计学意义(t=5.36、6.57、14.32,P<0.05)。结论 调查发现,本院医务人员子女心理行为问题发生率较高。应进一步核实诊断,根据不同的心理特征及年龄分类,及早给予心理支持和干预,并由心理医生对这一群体进行长期随访。