Effects of rational-emotive therapy on family function among patients with heterosexual transmission of HIV

目的 探讨理性情绪疗法对经异性性途径感染艾滋病患者家庭功能的影响.方法 采用整群随机抽样方法抽取湖南省3个艾滋病治疗点39例经异性性途径感染艾滋病患者及其配偶作为研究对象,随机分为干预组(19例)和对照组(20例).干预组给予为期6周的基于理性情绪疗法的干预,对照组接受常规治疗和护理.采用家庭关怀度指数问卷进行效果评价.结果 两组家庭功能总分及适应度、合作度、情感度干预主效应有统计学意义(均P＜0.01)；干预后干预组家庭功能障碍程度显著轻于对照组(P＜0.05).结论 理性情绪疗法是改善经异性性途径感染艾滋病患者家庭功能的有效方法.     

理性情绪疗法对产后抑郁的作用观察

目的探讨对产后抑郁患者辅以理性情绪疗法，纠正患者的不良认知，提高治疗效果。方法应用理性情绪疗法，改变错误认知，转变思维模式，养成用理性方式进行思维的习惯。结果观察组51例效果满意。结论理性情绪疗法对产后抑郁有积极的治疗作用。     

高效抗逆转录病毒治疗对艾滋病患者机体代谢的影响

目的探讨高效抗逆转录病毒治疗（HAART）后艾滋病患者代谢状态的临床及流行病学特征。方法选择本院收治的HAART后的高脂血症艾滋病患者42例与未经HAART治疗的艾滋病患者41例,就基线血脂水平、高脂血症类型、心血管事件的风险、非酒精性脂肪肝、高血压、高血糖、代谢综合征以及心脏结构和功能进行横断面研究,对两组患者的上述指标进行比较。结果在艾滋病患者未进行HAART治疗组中,血脂异常以高密度脂蛋白（HDL）降低为主（24.32%）,14.63%（6/41）患者评估为心血管病事件低危组;在HAART治疗组中,临床分型以混合性高脂血症为主,其中高TG＋高TC血症者占42.86%,高TG＋高TC＋低HDL血症者占11.90%,高TG＋低HDL血症者占23.81%,35.71%的患者评估为心血管病事件低危组,中危和高危组患者各占11.90%。HAART治疗组与未治疗组患者中,非酒精性脂肪肝（NAFLD）比例分别为78.58%和4.88%;分别有1例（2.44%）和16例（38.10%）患者诊断为代谢综合征;分别有19.05%和21.95%的患者出现心脏舒张功能减退。结论在未治疗的艾滋病患者中,血脂异常以低HDL血症为主,部分患者出现非酒精性脂肪肝、高血压、糖尿病、代谢综合征和心脏舒张功能不全等的临床表现;随着HAART的应用,血脂异常向混合高脂血症转化,且心血管事件的危险性明显增加,代谢综合征的临床特征表现得更加明显。本研究结果提示,艾滋病患者在HAART治疗前后应检测引起代谢综合征和心血管事件的危险因素,以便早期进行干预治疗。     

4例恶性肿瘤合并HIV感染患者化疗的护理

对4例恶性肿瘤合并HIV感染患者进行抗感染、抗HIV病毒、护肝、提高机体免疫力等治疗的同时给予化疗。结果3例好转，1例死亡。由于护理到位，未发生职业暴露及交叉感染。提出在护理恶性肿瘤合并HIV感染化疗患者时护理人员要具备丰富的专业理论知识和娴熟的操作技能，加强职业防护，防止医源性感染和交叉感染。     

4例恶性肿瘤合并HIV感染患者化疗的护理

对4例恶性肿瘤合并HIV感染患者进行抗感染、抗HIV病毒、护肝、提高机体免疫力等治疗的同时给予化疗.结果 3例好转,1例死亡.由于护理到位,未发生职业暴露及交又感染.提出在护理恶性肿瘤合并HIV感染化疗患者时护理人员要具备丰富的专业理论知识和娴熟的操作技能,加强职业防护,防止医源性感染和交叉感染.     

理性情绪教育对护生情绪的影响

目的探讨理性情绪教育对护生的情绪影响。方法随机选取二年级2个自然班护生116人．实验班和对照班各58人。对照班常规开设《护理心理学》课程；实验班增设自行设计的理性情绪教育（REE）课程。结果实验班情绪稳定性、情绪表达性与情绪调节能力与课前比较．差异有显著性意义（P〈0．05。P〈0．01）；与对照班课后比较．除疑病因子外，其余各因子差异均有显著性意义（P〈0．05．P〈0．01）。对照班课前、课后各因子比较．情绪稳定性中强迫症、疑病症因子比较．差异有显著性意义（P〈0．05，P〈0．01）。其余各因子差异无显著性意义（均P〉0．05）。结论理性情绪教育对护生的情绪稳定性、情绪表达能力和情绪调节能力的改善具有重要的作用。     

理性情绪疗法联合正念减压法对腋臭患者术后身心状态及自我效能的影响

目的 探讨理性情绪疗法联合正念减压法对腋臭患者术后身心状态及自我效能的影响。方法 选 取我院2022年1月-2023年12月收治的70例腋臭患者为研究对象,采用随机数字表法分为对照组与研究组, 各35例,对照组术后给予常规术后护理,研究组术后给予理性情绪疗法联合正念减压法干预,比较两 组心理状态、自我效能、自我感受负担及生活质量。结果 研究组干预后SAS、SDS评分均低于对照组 （P ＜0.05）;研究组干预后躯体功能、疼痛管理、症状应对评分及总分均高于对照组（P ＜0.05）;研究 组干预后情感、经济、身体评分均低于对照组（P ＜0.05）;研究组干预后DLQI各维度评分均低于对照组 （P＜0.05）。结论 对腋臭患者术后开展理性情绪疗法联合正念减压法有助于改善患者心理状态,提高其 自我效能,缓解心理负担,对提高患者生活质量具有促进作用。     

艾滋病患者行冠脉介入治疗的职业防护

艾滋病,即获得性免疫缺陷综合征（acquired immune deficiency syndrome,AIDS）是因人类免疫缺陷病毒（human immunodeficiency virus,HIV）感染所导致的机体免疫功能部分或完全丧失,从而继发各种机会性感染或机会性肿瘤[1]。心脏介入诊疗是用来诊断和治疗心血管疾病的一种手段,冠状动脉造影术是判断冠状动脉病变范围和严重程度最准确的方法。经皮冠状动脉介入治疗（percutaneous coronary intervention,PCI）,是目前治疗冠心病、心肌梗死主要有效的治疗方法。目前,我国AIDS的传播速度逐渐加快,流行区域不断扩大,报告感染人数呈上升趋势,流行形势十分严峻[2]。因此, AIDS合并冠心病的患者也相应增多,HIV感染者中有44.1%会出现心脏受累[3]。     

理性情绪教育对护生情绪的影响

目的探讨理性情绪教育对护生的情绪影响。方法随机选取二年级2个自然班护生116人,实验班和对照班各58人。对照班常规开设《护理心理学》课程;实验班增设自行设计的理性情绪教育(REE)课程。结果实验班情绪稳定性、情绪表达性与情绪调节能力与课前比较,差异有显著性意义(P<0.05,P<0.01);与对照班课后比较,除疑病因子外,其余各因子差异均有显著性意义(P<0.05,P<0.01)。对照班课前、课后各因子比较,情绪稳定性中强迫症、疑病症因子比较,差异有显著性意义(P<0.05,P<0.01),其余各因子差异无显著性意义(均P>0.05)。结论理性情绪教育对护生的情绪稳定性、情绪表达能力和情绪调节能力的改善具有重要的作用。     

艾滋病抗病毒治疗患者的症状管理

就艾滋病抗病毒治疗患者症状管理的意义,实施相关理论、方法与注意事项进行综述.提出高效抗逆转录病毒疗法可有效延缓艾滋病患者疾病进程,但是每种抗逆转录病毒药物都具有短期或长期不良反应,各种不适症状的出现会降低患者服药依从性,影响患者生活质量.而有效的症状管理能帮助患者积极应对各种不适反应,提高服药依从性,改善生活质量.     

哈尔滨市艾滋病流行趋势分析及抗病毒治疗的疗效观察

目的了解哈尔滨市艾滋病的流行现状及趋势,分析艾滋病患者高效抗病毒治疗（HAART）的治疗效果,为艾滋病的防治提供策略和依据。方法回顾性研究在哈尔滨某综合医院接受艾滋病免费抗病毒治疗的80例患者,采用SPSS 16.0软件进行描述性统计分析。结果80例病例中有72例（90%）处于随访中,男女比例为5.15︰1,平均年龄41岁;已婚和同居者占48.75%（39/80）,未婚者占32.5%（26/80）,同性性传播占全部例数的56.25%（45/80）,其次为异性传播,占21.25%（17/80）,有2例女性系通过丈夫而感染。治疗前CD4＜200个/μl高达73.75%（59/80）,其中＜50个/μl者24例（30%）;16.25%（13/80）患者近1年曾有过结核感染史;治疗后,患者相应临床症状显著改善,CD4水平在治疗3、6、12个月均有显著提升,86.67%患者病毒载量低于检测下限,治疗有效率达81.67%（49/60）。结论哈尔滨市艾滋病目前处于低流行区,但在特殊人群中处于高流行态势;艾滋病患者抗病毒治疗效果明显;各级防控人员必须加强该人群的干预和检测;鼓励符合治疗要求的患者接受治疗。     

Trends of CD4 cell count levels at the initiation of antiretroviral therapy over time and factors associated with late initiation of antiretroviral therapy among Asian HIV-positive patients

Introduction

Although antiretroviral therapy (ART) has been rapidly scaled up in Asia, most HIV-positive patients in the region still present with late-stage HIV disease. We aimed to determine trends of pre-ART CD4 levels over time in Asian HIV-positive patients and to determine factors associated with late ART initiation.

Methods

Data from two regional cohort observational databases were analyzed for trends in median CD4 cell counts at ART initiation and the proportion of late ART initiation (CD4 cell counts <200 cells/mm³ or prior AIDS diagnosis). Predictors for late ART initiation and mortality were determined.

Results

A total of 2737 HIV-positive ART-naïve patients from 22 sites in 13 Asian countries and territories were eligible. The overall median (IQR) CD4 cell count at ART initiation was 150 (46–241) cells/mm³. Median CD4 cell counts at ART initiation increased over time, from a low point of 115 cells/mm³ in 2008 to a peak of 302 cells/mm³ after 2011 (p for trend 0.002). The proportion of patients with late ART initiation significantly decreased over time from 79.1% before 2007 to 36.3% after 2011 (p for trend <0.001). Factors associated with late ART initiation were year of ART initiation (e.g. 2010 vs. before 2007; OR 0.40, 95% CI 0.27–0.59; p<0.001), sex (male vs. female; OR 1.51, 95% CI 1.18–1.93; p=0.001) and HIV exposure risk (heterosexual vs. homosexual; OR 1.66, 95% CI 1.24–2.23; p=0.001 and intravenous drug use vs. homosexual; OR 3.03, 95% CI 1.77–5.21; p<0.001). Factors associated with mortality after ART initiation were late ART initiation (HR 2.13, 95% CI 1.19–3.79; p=0.010), sex (male vs. female; HR 2.12, 95% CI 1.31–3.43; p=0.002), age (≥51 vs. ≤30 years; HR 3.91, 95% CI 2.18–7.04; p<0.001) and hepatitis C serostatus (positive vs. negative; HR 2.48, 95% CI 1.−4.36; p=0.035).

Conclusions

Median CD4 cell count at ART initiation among Asian patients significantly increases over time but the proportion of patients with late ART initiation is still significant. ART initiation at higher CD4 cell counts remains a challenge. Strategic interventions to increase earlier diagnosis of HIV infection and prompt more rapid linkage to ART must be implemented.     

心理护理干预对艾滋病患者免疫功能的影响

目的 探讨心理护理干预对艾滋病患者免疫功能的影响.方法 将50例抗病毒治疗艾滋病患者随机分为干预组和对照组各25例.对照组采用常规护理方法,干预组实施为期6个月的个性化心理护理干预.结果 干预组干预1个月、3个月、6个月HAMA、HAMD评分显著低于对照组,干预3个月、6个月CD4+T淋巴细胞计数显著高于对照组(均P＜0.05).结论 心理护理干预能减轻艾滋病抗病毒治疗患者的负性情绪,提高患者免疫功能,且随着干预时间的增加,其效果也越好.     

Lesotho's Minimum PMTCT Package: lessons learned for combating vertical HIV transmission using co-packaged medicines

Introduction

Mother-to-child transmission of HIV can be reduced to<5% with appropriate antiretroviral medications. Such reductions depend on multiple health system encounters during antenatal care (ANC), delivery and breastfeeding; in countries with limited access to care, transmission remains high. In Lesotho, where 28% of women attending ANC are HIV positive but where geographic and other factors limit access to ANC and facility deliveries, a Minimum PMTCT Package was launched in 2007 as an alternative to the existing facility-based approach. Distributed at the first ANC visit, it packaged together all necessary pregnancy, delivery and early postnatal antiretroviral medications for mother and infant.

Methods

To examine the availability, feasibility, acceptability and possible negative consequences of the Minimum PMTCT Package, data from a 2009 qualitative and quantitative study and a 2010 facility assessment were used. To examine the effects on ANC and facility-based delivery rates, a difference-in-differences analytic approach was applied to 2009 Demographic and Health Survey data for HIV-tested women who gave birth before and after Minimum PMTCT Package implementation.

Results

The Minimum PMTCT Package was feasible and acceptable to providers and clients. Problems with test kit and medicine stock-outs occurred, and 46% of women did not receive the Minimum PMTCT Package until at least their second ANC visit. Providing adequate instruction on the use of multiple medications represented a challenge. The proportion of HIV-positive women delivering in facilities declined after Minimum PMTCT Package implementation, although it increased among HIV-negative women (difference-in-differences=14.5%, p=0.05). The mean number of ANC visits declined more among HIV-positive women than among HIV-negative women after implementation, though the difference was not statistically significant (p=0.09). Changes in the percentage of women receiving≥4 ANC visits did not differ between the two groups.

Conclusions

If supply issues can be resolved and adequate client educational materials provided, take-away co-packages have the potential to increase access to PMTCT commodities in countries where women have limited access to health services. However, efforts must be made to carefully monitor potential changes in ANC visits and facility deliveries, and further evaluation of adherence, safety and effectiveness are needed.     

Sexual risk behaviour among people living with HIV according to the biomedical risk of transmission: results from the ANRS-VESPA2 survey

Introduction

People living with HIV (PLHIV) on antiretroviral therapy (ART), with sustained undetectable viral load (sUVL) and no history of sexually transmitted infections for at least six months, are considered to have a low risk of HIV transmission (LRT). We aimed to characterize, in a representative sample of French PLHIV, the sexual behaviour of LRT PLHIV compared with non-LRT PLHIV.

Methods

The cross-sectional ANRS-VESPA2 survey was conducted on adult PLHIV attending French hospitals in 2011. The LRT PLHIV group included participants with sUVL and no sexually transmitted infection for at least 12 months. Socio-behavioural and medical data were collected. Chi-square tests helped compare sexual risk indicators between LRT and non-LRT PLHIV. The survey''s retrospective nature allowed us to perform complementary category-based analyses of LRT PLHIV according to whether they had sUVL for at least 18, 24 or 36 months in three socio-epidemiological groups: men who have sex with men (MSM), other men and women.

Results

Analysis included 2638 PLHIV diagnosed >12 months with available viral load data. The proportion of LRT PLHIV varied from 58% (≥12 months sUVL) to 38% (≥36 months sUVL). Irrespective of sUVL duration, we found the following: 1) LRT men (MSM and other men) were more likely to report having no sexual partner than their non-LRT counterparts. Among men having sexual partners in the previous 12 months, no significant difference was seen between LRT and non-LRT men in the number of sexual partners. LRT women were less likely to report having more than one sexual partner than non-LRT women; 2) LRT MSM were more likely to report being in sexually inactive couples than their non-LRT counterparts; 3) among sexually active participants, no difference was observed between LRT and non-LRT PLHIV concerning condom use with their serodiscordant steady partner or with their most recent casual sexual partners.

Conclusions

LRT PLHIV with sUVL ≥12 months did not report more sexual risk behaviours than their non-LRT counterparts. Because the same result was obtained for those having a sUVL ≥36 months, the hypothesis of increased sexual risk behaviour over time in PLHIV meeting non-transmission biomedical criteria is not supported.     

腹腔镜手术对HIV感染者免疫功能的影响

目的:检测HIV(+)者腹腔镜手术前后主要细胞和体液免疫指标的变化并与HIV(-)者对照,探讨微创手术对HIV感染者主要免疫功能的影响。方法:将42例胆囊疾病患者分为2组:观察组(HIV+)22例,对照组(HIV-)20例。用同样方法施行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)。于术前1d,术后3、7d(POD3,7)检测血常规、白蛋白,CD3、CD4、CD8及其百分比和CD4/CD8;IgG、IgM、IgA,补体C3和C4,CRP。HIV(+)者检测HIV-RNA。常规统计学方法处理所得数据。结果:白细胞总数HIV(-)组>HIV(+)组(POD3,7)(P<0.05)。淋巴和中性粒细胞无显著变化(P>0.05)。白蛋白2组手术前后>35g/L。IgA手术前后HIV(+)>HIV(-)(P<0.05)。IgG、IgGM、C3和C42组手术前后均无显著变化,均在正常范围。CD4HIV(+)者术前1天至术后1月<50copy/ml。组间比较:CD4手术前后HIV(+)0.05)。CD4/CD8手术前后HIV(+)0.05)。CRPHIV(+)组术前>POD3,7(P<0.05)。CRP HIV(-)组术前相似文献   

乳腺癌患者内分泌治疗期感知认知功能现况调查

目的了解乳腺癌患者内分泌治疗期感知认知功能现状,并分析其影响因素。方法应用患者一般资料调查表、癌症患者功能评估-认知功能量表、匹兹堡睡眠质量指数、国际体力活动问卷、医院焦虑抑郁量表、慢性病治疗功能评估-疲乏量表对366例乳腺癌患者进行调查。结果乳腺癌内分泌治疗期患者感知认知功能总分108.46±16.20。多元线性回归分析结果显示,年龄、既往激素替代治疗、静坐时间、疲乏、焦虑与日间功能障碍是影响患者认知功能的主要因素(均P<0.01)。结论医护人员应重视患者内分泌治疗期间认知功能的变化,通过改善疲乏与焦虑、缩短静坐时间、减轻日间功能障碍方面制定干预策略,改善患者感知认知功能水平。