心理自助教育对乳腺癌术后患者焦虑和抑郁情绪的影响

目的 探讨心理自助教育对乳腺癌术后患者焦虑和抑郁情绪的干预效果。方法将147例行乳腺癌改良根治术后的患者分为试验组（76例）和对照组（71例）。分别于术后l周和术后1个月采用zun礁虑自评量表（SAS）和zung抑郁自评量表（SDS）测评其心理状态。对照组采用常规护理和健康教育,试验组在此基础上统一由经过培训的心理专科护士进行心理自助教育,包括每周1次的集体心理辅导和心理调试技巧教育,并发放有关的健康教育手册和音像制品。比较两组患者干预前后焦虑和抑郁情绪的变化。结果干预后试验组焦虑和抑郁评分均低于干预前;干预后试验组焦虑和抑郁评分低于对照组;干预后对照组的焦虑和抑郁评分高于干预前,差异均有统计学意义（P〈0．05）。结论心理自助教育可以缓解乳腺癌术后患者焦虑和抑郁情绪。     

The impact of the COVID-19 pandemic on wellness among vascular surgeons

The coronavirus disease 2019 (COVID-19) pandemic has placed significant strain on the health and welfare of all health care professionals, including vascular surgeons. This review summarizes the implications of the pandemic on the health and wellness of surgeons and trainees, with a particular focus on those in vascular surgery (VS). A literature review was completed using common resource databases. We provide a brief history of burnout in VS and explore burnout and wellness in VS during this unprecedented pandemic. We then offer recommendations to address mental health needs by the VS workforce and highlight opportunities to address the gaps in the literature. The impact of COVID-19 on the professional and personal lives of surgeons and trainees in VS is notable. More than half of vascular surgeons reported some degree of anxiety. Factors associated with anxiety and burnout include COVID-19 exposure, moral injury, practice changes, and financial impacts. Trainees appeared to have more active coping strategies with dampened rates of anxiety compared to those in practice. Women appear to be disproportionately affected by the pandemic, with higher rates of anxiety and burnout. Groups underrepresented in medicine seemed to have more resilience when it came to burnout, but struggled with other inequities in the health care environment, such as structural racism and isolation. Strategies for addressing burnout include mindfulness practices, exercise, and peer and institutional support. The COVID-19 pandemic has had a substantial mental health impact on the VS workforce globally, as shifts were made in patient care, surgical practice, and work–home life concerns.     

More than the loss of a parent: potentially traumatic events among orphaned and abandoned children

This study examines rates of potentially traumatic events and associated anxiety and emotional/behavioral difficulties among 1,258 orphaned and abandoned children in 5 low- and middle-income countries. The study quantifies the types of events the children experienced and demonstrates that anxiety and emotional/behavioral difficulties increase with additional exposure. As policies for orphaned and abandoned children are being implemented, this study helps policy makers and care providers recognize that (a) children and caregivers are willing to report experiences of potentially traumatic events, (b) those who report such events are at higher risk for experiencing additional events, (c) resulting symptomatology indicates a need for appropriate mental health services, and (d) boys are as vulnerable as girls, indicating an equal need for protection.     

三级管理体系对住院儿童术后感染的预防

目的研究三级管理体系对住院手术儿童感染的预防效果。 方法选取2013年1月至2014年12月于本院进行手术的2 000例住院儿童为研究对象,其中2013年1～12月收治的1 000例儿童为对照组,2014年1～12月收治的1 000例儿童为观察组。对照组患儿采用常规管理体系,观察组则采用三级管理体系,比较两组医护人员感染知识知晓度、预防态度合格率以及两组住院手术儿童院内感染率,并对感染多重耐药菌进行分析。 结果观察组医护人员感染知识知晓度为84.55%,预防态度合格率为90.00%,均显著高于对照组,差异具有统计学意义（χ² = 8.561、11.269,P = 0.019、0.008）;观察组患儿院内感染率为5.40%,显著低于对照组（14.60%）（χ² = 6.148、P = 0.026）;共分离出124株病原菌,其中68株凝固酶阴性葡萄球菌构成比最高（占54.84%）,其次是链球菌和气球菌等。 结论三级管理体系可以有效预防住院手术儿童发生院内感染,提高医护人员的感染知识知晓度和预防态度合格率。     

Editorial Commentary: Mental Health Comorbidities Are Associated With Increased Cost,Opioid Use,and Inferior Outcomes After Shoulder Rotator Cuff Repair

In patients undergoing rotator cuff repair (RCR), patient comorbidities including mental health diagnoses of anxiety and depression are very common and are known to adversely affect surgical outcomes. This study highlights the complex interplay of mental health with other important considerations in outcomes following RCR, namely opioid use and health care costs. The extent to which we can mitigate opioid use and health care costs in patients with comorbid mental health disorders undergoing RCR remains unclear but worthy of concerted efforts to improve patient outcomes. Improving recognition of the role of mental health comorbidities in outcomes of RCR will be critical in future efforts to improve preoperative counseling and optimize perioperative management of patients electing RCR.     

The risk of mental health disorders among U.S. military personnel infected with human immunodeficiency virus, active component, U.S. Armed Forces, 2000-2011

Mental disorders account for significant morbidity, health care utilization, disability, and attrition from military service; the health care burden associated with mental disorders has increased over the last several years. During the years 2000 through 2011, 936,283 active component service members were diagnosed with at least one mental disorder. Annual counts and rates of incident diagnoses of mental disorders have increased by approximately 65 percent over the last twelve years; this overall increase is largely attributable to diagnoses of adjustment disorders, depressive and anxiety disorders, and post-traumatic stress disorder. Rates of incident mental disorder diagnoses were higher in females than males and in service members under 30 years of age. These findings reinforce previous reports that have documented a rise in demand for mental health services in the active component force and suggest that continued focus on detection and treatment for mental health issues is warranted.     

Some aspects of vaccination coverage in the Gelukspan health ward

In 1985 and 1986, 210 mothers of children aged 1-2 years were selected from the total population of the Gelukspan health ward. Sampling followed a multistage random procedure. The women and their children were studied in relation to several aspects of primary health care. In this article we report on the vaccination component of the study. The response rate was 100%. By the age of 9 months 30% of the children had completed the basic vaccination schedule and by the age of 12 months this had increased to 65%. Only 4% of the children had all the required immunisations within the time schedule defined by official policy. Completion of the vaccination schedule on time depends mostly on the frequency of contact between children and health workers in under-5 clinics. It is concluded that the main thrust of any vaccination policy should be directed at increasing the frequency of contact between the health services and children during their first 9 months of life.     

Mental health outcomes in pediatric trauma patients: A 10 year real world analysis using a large database approach

IntroductionTraumatic injury is the leading cause of morbidity and mortality among children in the United States. Single institution studies suggest an increased risk of poor mental health outcomes among these patients, but there are few population-based studies assessing this risk.MethodsThe IBM^? MarketScan^? private insurance claims database was used to identify children (6–17yo) with traumatic injuries between 2007 and 2016. Time-to-event analysis was performed to compare rates of PTSD, depression, anxiety, and adjustment disorder among children admitted to the hospital compared to children treated in the emergency department (ED), urgent care (UC), or in the outpatient setting, and to children admitted with uncomplicated appendicitis.ResultsAmong children admitted for traumatic injury, 3.3% developed a subsequent mental health diagnosis, and 1.6% developed PTSD. Children admitted for traumatic injury were at increased risk of developing a mental health condition (HR 1.34, p < 0.001) compared to those admitted for appendicitis. Children treated in the ED or UC for traumatic injury and those treated in the outpatient setting were also at increased risk (HR 1.20 and 1.18, p = 0.006 and p = 0.012, respectively). Among those admitted to the hospital, the risk of subsequent mental health diagnosis increased by 1.5% per day; in the first 31 days of hospitalization, the risk of PTSD diagnosis increased by 13% per day.ConclusionChildren who sustain a traumatic injury are at increased risk of developing a mental health condition. PTSD rates found in our real world analysis are lower than those found in prospective studies, raising the possibility of under-recognition of PTSD in this population.Level of evidenceLevel II     

男性不育伴精索静脉曲张患者的心理状况调查

目的:探索男性不育伴精索静脉曲张患者的精神心理症状的发生情况及其与不育的关系。方法:采用14项症状的医院焦虑抑郁量表(HAD量表)对110例不育伴精索静脉曲张患者进行精神心理因素的评估,分析各相关因素与患者精神心理因素的相关性,筛选鉴别男性不育伴精索静脉曲张患者发生焦虑抑郁症状的危险因素,并与61例已婚生育健康男性作为对照组进行比较分析。对106例不育伴精索静脉曲张患者的精神心理症状进行多因素分析。结果:男性不育伴精索静脉曲张患者和已经生育的健康对照者焦虑症状发生率分别为61.32%和13.79%,抑郁症状发生率分别为37.73%和6.90%,不育伴精索静脉曲张组的焦虑和抑郁症状发生率显著高于已育健康对照组(P<0.05)。Logistic回归分析结果显示,不育患者发生焦虑抑郁的主要危险因素是就诊次数和睾丸病变程度。结论:男性不育伴精索静脉曲张患者合并有明显精神心理症状,值得关注。患者中多次就诊及睾丸病变程度严重者更容易发生焦虑抑郁。     

Impact of Trauma System Preparedness on the Outcomes of Severe Injuries Among Child Populations

Severe child trauma poses a heavy burden upon the public’s health and the nations’ economies, in terms of mortality, morbidity, and disability. The burden varies by the maturity level of the adopted trauma system. This work aimed to identify the impact of trauma system maturity on the outcomes of care of severely injured children. Discharge data for the hospitalized trauma children in Florida (mature trauma system) and Indiana (immature trauma system) were retrospectively analyzed. All severely injured children, 1–15 years of age with an injury severity score ≥25 during 1999–2000 were included. Assessment involved the differences in specified treatment procedures, survival rates, hospital length of stay, and the need for post-hospital institutional care. Analysis revealed that Indiana children significantly stay longer in hospital, and that no differences in the rates of patient mortality, discharge-home, and selected procedures were found. Trauma system maturity impacts the volume and complexity of interventions, as well as the mortality, morbidity, and disability associated with severe children and adolescent trauma. The cost of such burden could be directed to improving the quality of the state’s injury management services.     

Mental health status of human rights workers,Kosovo, June 2000

Human rights workers in humanitarian relief settings may be exposed to traumatic events that put them at risk for psychiatric morbidity. We conducted a cross-sectional survey in June 2000 to study the prevalence of psychiatric morbidity among 70 expatriate and Kosovar Albanian staff collecting human rights data in Kosovo. Among those surveyed, elevated levels of anxiety, depression, and posttraumatic stress disorder symptoms were found in 17.1, 8.6, and 7.1% respectively. Multiple regression analysis revealed that human rights workers at risk for elevated anxiety symptoms were those who had worked with their organization longer than 6 months, those who had experienced an armed attack, and those who experienced local hostility. Our study indicates that human rights organizations should consider mental health assessment, care, and prevention programs for their staff.     

基于问卷调查的孕妇孕期护肤美容知识认知需求情况分析

通过对我院产科门诊产检及住院的孕妇孕期护肤美容知识掌握情况进行调查，为提高 育龄期妇女孕期护肤美容保健知识提供借鉴。方法 使用预先设计好的自填式问卷，对2023年2月-7月 我院产科门诊及产科病房的200例妊娠期女性进行问卷调查。结果 本研究显示孕妇关于孕期护肤美容 知识知晓率低，孕期存在容貌焦虑的孕妇比例极高，认为护肤品对母儿健康可能存在影响的有169例 （84.50%），认为化妆品对母儿健康有可能存在影响的有191例（95.50%），158例孕妇（79.00%）在孕 期将护肤品更换成孕期可用的护肤品，101例孕妇（50.50%）表示孕期不使用化妆品，有166例孕妇表示 对孕期美容知识有需求，这些孕妇最希望得到以科普视频和文章的形式指导。结论 育龄期女性的孕期 护肤知识知晓程度有待提高，应加强对相关知识的宣传，首选的科普途径是互联网媒体，有助于积极缓 解孕期焦虑，加强孕期心理保健。     

Stress,Mental Health,and Burnout in National Humanitarian Aid Workers in Gulu,Northern Uganda

This study examined the mental health of national humanitarian aid workers in northern Uganda and contextual and organizational factors predicting well‐being. A cross‐sectional survey was conducted among 376 national staff working for 21 humanitarian aid agencies. Over 50% of workers experienced 5 or more categories of traumatic events. Although, in the absence of clinical interviews, no clinical diagnoses were able to be confirmed, 68%, 53%, and 26% of respondents reported symptom levels associated with high risk for depression, anxiety disorders, and posttraumatic stress disorder (PTSD), respectively. Between one quarter and one half of respondents reported symptom levels associated with high risk regarding measured dimensions of burnout. Female workers reported significantly more symptoms of anxiety, depression, PTSD, and emotional exhaustion than males. Workers with the United Nations and related agencies reported fewest symptoms. Higher levels of social support, stronger team cohesion, and reduced exposure to chronic stressors were associated with improved mental health. National humanitarian staff members in Gulu have high exposure to chronic and traumatic stress and high risk of a range of poor mental health outcomes. Given that work‐related factors appear to influence the relationship between the two strategies are suggested to support the well‐being of national staff working in such contexts.     

Stepped early psychological intervention for posttraumatic stress disorder, other anxiety disorders, and depression following serious injury

The best approach for implementing early psychological intervention for anxiety and depressive disorders after a traumatic event has not been established. This study aimed to test the effectiveness of a stepped model of early psychological intervention following traumatic injury. A sample of 683 consecutively admitted injury patients were screened during hospitalization. High-risk patients were followed up at 4-weeks postinjury and assessed for anxiety and depression symptom levels. Patients with elevated symptoms were randomly assigned to receive 4-10 sessions of cognitive-behavioral therapy (n = 24) or usual care (n = 22). Screening in the hospital identified 89% of those who went on to develop any anxiety or affective disorder at 12 months. Relative to usual care, patients receiving early intervention had significantly improved mental health at 12 months. A stepped model can effectively identify and treat injury patients with high psychiatric symptoms within 3 months of the initial trauma.     

Staff/bed and staff/patient ratios in South African public sector mental health services.

OBJECTIVES: To document staff/bed and staff/patient ratios in public sector mental health services in South Africa. DESIGN: Cross-sectional survey. METHOD: A questionnaire was distributed to provincial mental health co-ordinators requesting numbers of full-time equivalent (FTE) staff who provide mental health care at all service levels; numbers of psychiatric beds; and numbers of patients who attend outpatient departments, clinics and community health centres. The information was supplemented by consultations with mental health co-ordinators in each of the nine provinces. RESULTS: The staff/bed ratio for the country as a whole was 0.3 staff per bed. For the provinces, the staff/bed ratios were as follows: Eastern Cape 0.30, Free State 0.50, Gauteng 0.22, KwaZulu-Natal 0.34, Mpumalanga 0.89, North-West 0.27, Northern Cape 0.26, Northern Province 0.26, and Western Cape 0.59. For the country as a whole, the staff/bed ratios for each category of staff were as follows: total nursing staff 0.25, occupational therapists 0.01, occupational therapy assistants 0.01, social workers 0.01, community health workers 0.00, psychologists 0.00, intern psychologists 0.00, psychiatrists 0.00, psychiatric registrars 0.01, and medical officers 0.00. The ratio of ambulatory psychiatric service staff to daily patient visits (DPV) for the country as a whole was 0.6. CONCLUSIONS: Staff/bed ratios in South African mental health care are low relative to developed countries. Staff/DPV ratios highlight both the need to develop ambulatory care personnel for mental health care, and problems associated with monitoring the delivery and utilisation of mental health services within an integrated health system at primary level.     

Stress,anxiety, emotion regulation and social support in parent-child dyads prior to and during the onset of the COVID-19 pandemic

In March 2020, and in order to assess the impact of the COVID-19 pandemic on stress and mental health in parent-child dyads using pre-pandemic measures, we recontacted participants from a 2019 study. A total of 136 dyads of Canadian parents (77% mothers, mean age = 44.48 years/old) and children (63% girls, 77% aged 10–12 years/old and 23% aged 15–17 years/old) completed self-report measures of perceived stress, anxiety (state/sensitivity) and emotion regulation strategies (cognitive reappraisal/expressive suppression). Children additionally completed measures of co-rumination and perceived social support from friends, parents, and teachers. Results revealed a significant increase in parents' stress and state anxiety during the pandemic compared to before, but not in their children. Dyads' anxiety sensitivity remained unchanged, as well as parents' use of cognitive reappraisal and expressive suppression. Children showed similar use of cognitive reappraisal, but less expressive suppression and co-rumination during the pandemic compared to before. Children reported similar perceived social support from all sources over time. Finally, parental and children scores were not significantly correlated at either time. These results suggest that during the onset of the COVID-19 pandemic, parents and children responded differently in terms of stress, anxiety, and emotion regulation strategies.     

Distress during the induction of anesthesia and postoperative behavioral outcomes.

We determined whether children who are extremely anxious during the induction of anesthesia are more at risk of developing postoperative negative behavioral changes compared with children who appear calm during the induction process. Children (n = 91) aged 1-7 yr scheduled for general anesthesia and elective outpatient surgery were recruited. Using validated measures of preoperative anxiety and postoperative behaviors, children were evaluated during the induction of general anesthesia and on Postoperative Days 1, 2, 3, 7, and 14. Using a multivariate logistic regression model, in which the dependent variable was the presence or absence of postoperative negative behavioral changes and the independent variables included several potential predictors, we demonstrated that anxiety of the child, time after surgery, and type of surgical procedure were predictors for postoperative maladaptive behavior. The frequency of negative postoperative behavioral changes decreased with time after surgery, and the frequency of negative postoperative behavioral changes increased when the child exhibited increased anxiety during the induction of anesthesia. Finally, we found a significant correlation (r) of 0.42 (P = 0.004) between the anxiety of the child during induction and the excitement score on arrival to the postanesthesia care unit. We conclude that children who are anxious during the induction of anesthesia have an increased likelihood of developing postoperative negative behavioral changes. We recommend that anesthesiologists advise parents of children who are anxious during the induction of anesthesia of the increased likelihood that their children will develop postoperative negative behavioral changes such as nightmares, separation anxiety, and aggression toward authority. IMPLICATIONS: Anesthesiologists who care for children who are anxious during the induction of anesthesia should inform parents that these children have an increased likelihood of developing postoperative negative behavioral changes.     

Parental presence during anaesthesia induction for outpatient surgery of the infant

We conducted a randomized controlled trial of parental presence during anaesthesia induction for outpatient surgery in 73 infants (aged 1-12 months). Effects of parental presence on infant and parental outcomes, including anxiety, health care attitudes and satisfaction with the anaesthesia and surgery experience were evaluated. Results demonstrated that parental presence had no impact on infant behavioural distress during induction. In addition, parents who were present demonstrated comparable anxiety levels and health care attitudes before and after surgery, as well as comparable levels of satisfaction with the surgical experience compared to parents who were absent during induction. We discuss reasons for the lack of treatment effects from parental presence, and new directions for future research to identify subgroups of children who may most benefit from the opportunity to have parents involved in the perioperative period.     

Laughter and Humor Therapy in Dialysis

Laughter and humor therapy have been used in health care to achieve physiological and psychological health‐related benefits. The application of these therapies to the dialysis context remains unclear. This paper reviews the evidence related to laughter and humor therapy as a medical therapy relevant to the dialysis patient population. Studies from other groups such as children, the elderly, and persons with mental health, cancer, and other chronic conditions are included to inform potential applications of laughter therapy to the dialysis population. Therapeutic interventions could range from humorous videos, stories, laughter clowns through to raucous simulated laughter and Laughter Yoga. The effect of laughter and humor on depression, anxiety, pain, immunity, fatigue, sleep quality, respiratory function and blood glucose may have applications to the dialysis context and require further research.     

妊娠晚期胎死宫内对孕妇心理状态的影响

目的探讨妊娠晚期胎死宫内对孕妇心理状态的影响,为制定临床护理措施提供依据。方法应用抑郁自评量表(SDS)、焦虑自评量表(SAS)采用观察和交谈的方式对18例妊娠晚期胎死宫内孕妇的心理状态进行评估。结果18例孕妇中抑郁症状发生率83.33%,其中SDS评分>60分占40.00%;焦虑症状发生率94.44%,SAS评分>60分占41.18%;不同年龄、学历、家人关心程度的患者其抑郁、焦虑状态比较,差异有显著性意义(均P<0.05)。结论医护人员应重视妊娠晚期胎死宫内孕妇这一特殊人群的心理问题,有针对性地制定护理对策,加强心理护理。