江苏地区1260名精神科女护士主观幸福感的调查研究

目的 了解江苏地区精神专科医院临床女护士主观幸福感的现状及影响因素,为提高精神专科医院的管理水平提供参考依据。方法 采用中文版的“总体幸福感量表”和自制的“一般情况调查表”对江苏省不同地区的6所精神专科医院1260名女护士进行调查。 结果 被调查对象主观幸福感前18项总分为(67.89±14.09)分,处于中等幸福感49～72分之间,但显著低于全国女性常模(71.00±18.00)分,两者比较,t =-2.768,差异有统计学意义(P<0.01)；经回归分析,其主要影响因素有对职业伤害的担心程度、家庭的支持程度、收入状况、医院支持系统的满意度,差异均有统计学意义(P<0.01或P<0.05)。结论 江苏地区的精神科女护士主观幸福感总体处于中等水平但显著低于全国女性常模,提高其主观幸福感可以从减少精神科护士的职业伤害、关注家庭方面影响、建立合理的薪酬体系和高效的医院支持系统4个方面努力。     

Exercise Improves Self-Reported Sexual Function Among Physically Active Adults

BackgroundSexual dysfunction is common among adults and takes a toll on quality of life for both men and women.AimTo determine whether higher levels of weekly cardiovascular exercise are protective against self-reported sexual dysfunction among men and women.MethodsWe conducted an international online, cross-sectional survey of physically active men and women between April and December 2016, assessing exercise activity categorized into sextiles of weekly metabolic equivalent-hours. Odds ratios (ORs) of sexual dysfunction for each activity sextile compared with the lowest sextile were calculated using multivariable logistic regression, controlling for age, body mass index, diabetes mellitus, tobacco/alcohol use, sport, and marital status.Main Outcome MeasuresFemale sexual dysfunction was defined as a score ≤26.55 on the Female Sexual Function Inventory and erectile dysfunction (ED) was defined as a score ≤21 on the Sexual Health Inventory for Men.Results3,906 men and 2,264 women (median age 41–45 and 31–35 years, respectively) met the inclusion criteria for the study. Men in sextiles 2–6 had reduced odds of ED compared with the reference sextile in adjusted analysis (P_trend = .03), with an OR of 0.77 (95% CI = 0.61–0.97) for sextile 4 and 0.78 (95% CI = 0.62–0.99) for sextile 6, both statistically significant. Women in higher sextiles had a reduced adjusted OR of female sexual dysfunction (P_trend = .02), which was significant in sextile 4 (OR = 0.70; 95% CI = 0.51–0.96). A similar pattern held true for orgasm dissatisfaction (P_trend < .01) and arousal difficulty (P_trend < .01) among women, with sextiles 4–6 reaching statistical significance in both.Clinical ImplicationsMen and women at risk for sexual dysfunction regardless of physical activity level may benefit by exercising more rigorously.Strengths & LimitationsStrengths include using a large international sample of participants with a wide range of physical activity levels. Limitations include the cross-sectional design, and results should be interpreted in context of the study population of physically active adults.ConclusionHigher cardiovascular exercise levels in physically active adults are inversely associated with ED by self-report in men and protective against female sexual dysfunction in women.Fergus KB, Gaither TW, Baradaran N, et al. Exercise Improves Self-Reported Sexual Function Among Physically Active Adults. J Sex Med 2019;16:1236–1245.     

高频超声对女性肛门括约肌完整性评估的可行性研究

目的 利用高频超声对女性肛门括约肌进行显像与评价,验证高频超声运用于女性肛门括约肌完整性评估的可行性。方法 2020年1月-2021年3月期间行盆底超声检查的110例女性受检者,通过高频线阵探头分别从横断面及矢状面对其肛门括约肌进行连续性扫查,而后两位经验不同的研究人员在互盲情况下独立对肛门括约肌的影像进行完整性评价,记录肛门括约肌损伤情况并进行统计分析。结果 在全部受检者中,高频超声均可从横断面及矢状面清晰地显示各水平肛管特征性的解剖结构,从而当出现异常的超声表现时,可以实现对肛门括约肌损伤的检出。通过Kappa一致性检验可得高频超声对肛门括约肌的完整性评价在不同经验的研究人员间也具有较强的一致性(Kappa=0.888,P<0.05)。结论 高频超声通过对各水平肛管的清晰成像,可以实现对肛门括约肌的完整性评价,为肛门括约肌的评估提供一种新的影像学手段。     

从肝脾论治成年女性特应性皮炎

目的:特应性皮炎的发病及治疗存在很大的异质性,在治疗方面特别强调个体化治疗,本文主要总结成年女性特应性皮炎的治疗思路和方法。方法:基于肝脾两脏的生理、病理及成年女性特应性皮炎的临床表现,深入分析其病因病机及治疗方法。结果:女性成年特应性皮炎患者常肝脾同病,肝郁脾虚湿蕴和肝郁脾虚血弱是成年女性特应性皮炎的常见证型,临床可采用疏肝健脾祛湿法和疏肝健脾养血法进行治疗。典型病例中采用肝脾同调法不但可以改善患者的皮疹,也可有效缓解瘙痒和不良情绪。结论:肝脾同调法是治疗成年女性特应性皮炎的有效方法。     

Prevalence of Low Sexual Desire With Associated Distress Across the Adult Life Span: An Australian Cross-Sectional Study

BackgroundAlthough hypoactive sexual desire dysfunction (HSDD; low sexual desire with personal distress) negatively impacts well-being, contemporary life-course prevalence data for HSDD are lacking.AimTo document, in an epidemiologic study, the prevalence of low sexual desire with associated distress (epidemiological HSDD [eHSDD]), and associated psychosocial factors in Australian women.MethodsA cross-sectional study of 10,554 women, aged 18–79 years, recruited from the community was performed.Main Outcome MeasuresLow desire was determined by corresponding questions in the Profile of Female Sexual Function and Female Sexual Function Index. HSDD was defined as having a low desire and Female Sexual Distress Scale-Revised score of ≥11.Clinical TranslationClinicians need to be aware that young women often experience sexually related distress whereas low desire with associated distress is most common in women at midlife.ResultsThe majority of the participants were partnered (66.5%) and 38.9% were recently sexually inactive. Low desire prevalence increased from age 18–24 years to 75–79 years (27.4%, 95% CI 25.5–29.3 vs 91.6%, 95% CI 88.3–94.1, P < .001). Just over half of all participants aged 25–39 years had sexually related personal distress, after which the prevalence declined with age (P < .001). 10,259 participants provided sufficient information for eHSDD classification. eHSDD increased from age 18–24 years (12.2%, 95% CI 10.8–13.7) to 40–44 years (33.4%, 95% CI 28.5–38.8), remained constant until 60–64 years (33.1%, 95% CI 28.3–38.4), and progressively declined to 7.3% (95% CI 4.8–10.9) by 75–79 years. HSDD was significantly, positively associated with being partnered (P < .001), sexually inactive (P < .001), more educated (P = .001), and psychotropic medication use (P < .001), and negatively with Asian ethnicity (P < .001).Strengths & LimitationsThis study involved the assessment of desire using a single question derived from the Profile of Female Sexual Function or the Female Sexual Function Index.ConclusioneHSDD is most prevalent at midlife. Furthermore, the likelihood of eHSDD is greater for women who are partnered, sexually inactive, more educated, or taking psychotropic medications. Taken together these findings should aid health professionals in identifying women most at risk of eHSDD.Zheng J, Islam RM, Bell RJ, et al. Prevalence of Low Sexual Desire With Associated Distress Across the Adult Life Span: An Australian Cross-Sectional Study. J Sex Med 2020;17:1885–1895.     

Birth Order and Sibling Sex Ratio in Androphilic Males and Gynephilic Females Diagnosed With Gender Dysphoria From Iran

BackgroundThis study investigated the effect of older brothers on sexual orientation in male adults diagnosed with gender dysphoria and the effect of older sisters on sexual orientation in female adults diagnosed with gender dysphoria from Iran.AimTo assess for the presence of a fraternal birth order effect in transgender androphilic males and a sororal birth order effect in transgender gynephilic females.MethodsThe subjects were 92 transgender males and 107 transgender females (all of whom met the DSM-5 criteria for gender dysphoria), together with 72 male and 78 female clinical controls. All the transgender males were androphilic, all the transgender females were gynephilic (preferentially attracted to members of their own biological sex), and all of the clinical controls were heterosexual (none were transgender or had a diagnosis of gender dysphoria).OutcomesIn relation to the probands, we analyzed the sibship composition of our groups with regard to birth order and sibling sex ratio (brothers to sisters).ResultsThe results for the transgender males confirmed the findings of 2 recent meta-analyses that older brothers increase the odds of androphilia in later-born males. The results for the transgender females did not clearly confirm one previous finding that older sisters increase the odds of gynephilia in later-born females—a finding obtained in a relatively large study that included gynephilic cisgender girls as well as girls diagnosed with gender dysphoria who will probably be predominantly gynephilic.Clinical ImplicationsThe fraternal (later-born) birth order effect that we found for the transgender androphilic males, similar to that found in gay men, suggests a common underlying causal mechanism.Strengths and LimitationsOur study on Iranian patients diagnosed with gender dysphoria provides further generalizability for the study of birth order and sibling sex ratio that has, more often than not, been restricted to Western samples of adults diagnosed with gender dysphoria. It would be important to study these variables in Iranian gay men and lesbian women (without gender dysphoria) to further examine evidence for cross-cultural similarities when compared to Western samples.ConclusionsIn contrast to the well-established fraternal birth order effect for males, the possible sororal birth order effect for females needs to be examined with additional samples.Khorashad BS, Zucker KJ, Talaei A. Birth Order and Sibling Sex Ratio in Androphilic Males and Gynephilic Females Diagnosed With Gender Dysphoria from Iran. J Sex Med 2020;17:1195–1202.