抑郁症患者照顾者负担与需求的相关性分析

目的分析我院抑郁症患者照顾者的照顾负担、需求状况及两者之间的相关性。为减轻照顾者负担,研究有效的干预措施提供依据。方法采用自编的问卷调查表、照顾负担量表（CBI）和家庭照顾者需求问卷对105名精神类疾病患者照顾者进行调查。结果精神类疾病患者照顾者照顾负担CBI总分为（55.94±16.97）。5个指标的得分率为41.29%~88.31%;照顾需求总分为（266.75±22.08）分。照顾者照顾负担与需求呈正相关（r=0.695,P〈0.05）。结论精神类疾病患者照顾者承受着较重的负担,满足照顾者的相关需要,有针对性地提供社会支持,可减轻照顾者的负担,提高照顾者生存质量。     

帕金森病患者家庭照顾者负担及相关影响因素分析

目的 调查帕金森病(PD)患者家庭照顾者的负担及生活质量,分析其主要影响因素.方法 采用照顾者负担问卷(CBI)评估115例PD患者主要照顾者的负担,同时应用统一PD评分量表(UPDRS)、Hoehn-Yahr分级(H-Y分级)、日常生活能力量表(ADL)、PD生活质量量表(PDQ-39)、Hamilton抑郁量表(HAMD)、Hamilton焦虑量表(HAMA)、蒙特利尔认知评估量表(MoCA)、简易智能量表(MMSE)等评分,对115例原发性PD患者的疾病严重度、情绪、认知功能及生活质量等进行评估.采用Spearman相关分析及多元逐步同归分析方法分析影响照顾者负担的主要因素.结果 CBI的主要影响因素为患者ADL(β=-0.813,t=-6.26:5,P=0.000)、PDQ-39(β=0.285,t=4.256,P=0.000)及照顾者年龄(β3=0.327,t=3.107,P=0.002).结论 PD患者家庭照顾者负担受多方面因素影响,应引起社会各界的关注,给予针对性干预措施.     

照顾者的照顾负担、应对方式与焦虑抑郁情绪 相关性分析

摘要:目的　探讨肠癌化疗病人主要照顾者焦虑抑郁情绪、照顾负担、应对方式现况及其相关性。方法　采用自编的一般资料问卷、医院焦虑抑郁量表（HAD）、照顾负担量表（ZBI）、简易应对方式量表（SCSQ）对319例肠癌化疗主要照顾者进行问卷调查。结果　有焦虑情绪者138例（43.3%）,有抑郁情绪者86例（27.3%）,66例（20.7%）处于焦虑抑郁共存状态;照顾负担总分为（28.7±11.3）分,83例（26.0%）处于轻度负担,182例（57.1%）处于中度负担,54例（17.54％）处于重度负担;消极应对维度均分为（1.22±0.58）分,低于国内常模,差异有统计学意义（P＜0.01）;照顾负担得分、消极应对方式得分与照顾者焦虑得分呈正相关（r＝0.50,0.19）;照顾负担得分、消极应对方式得分与照顾者抑郁得分呈正相关（r＝0.41,0.16）;积极应对方式得分与照顾者抑郁得分呈负相关（r＝-0.24）。结论　肠癌化疗病人主要照顾者存在不同程度的焦虑抑郁情绪,照顾负担以中度为主,应对方式良好,三者之间存在一定的相关性。     

高血压合并冠心病患者家属照顾者社会支持、压力及应对方式研究

目的分析社区高血压合并冠心病患者家属照顾者社会支持情况及其与压力、应对方式的相关性,为制定具体可行的压力应对干预模式提供参考依据。方法对福州市25个社区196例中有压力的高血压合并冠心病患者家属照顾者66例进行社会支持、压力及应对方式的测量。结果66例家属照顾者社会支持总分为（36．50±5．67）分,国内常模为（34．56±3．73）分,差异有统计学意义（t=2．782,P=0．007）,且60．6％的家属照顾者表示社会支持度一般。Spearman相关分析结果显示,社会支持水平、客观支持、主观支持、社会支持利用度与家属照顾者ZBI压力总分及ZBI等级、个人负担、角色负担均呈负相关（P〈0．01）;积极应对方式与家属照顾者社会支持总分、社会支持水平、客观支持、社会支持利用度呈正相关（P〈0．05或〈0．01）;积极应对方式与家属照顾者ZBI压力总分及ZBI等级、个人负担、角色负担呈负相关（P〈0．05）。结论高血压合并冠心病患者家属照顾者社会支持情况有待提高,且其社会支持、压力及应对方式存在一定的相关性。     

心脏瓣膜置换术后患者主要照顾者的照顾负荷现状及影响因素分析

目的：探索心脏瓣膜置换术后患者的主要照顾者的照顾负荷现状及影响因素，为改善主要照顾者的照顾负荷，促进患者平稳过渡到居家照顾提供帮助。方法：采用一般资料调查表、照顾者照顾负荷调查表（CBI）、照顾者的照顾能力量表、患者出院准备度量表对139例心脏瓣膜置换术后患者及主要照顾者于出院当天进行调查。结果：心脏瓣膜置换术后患者的主要照顾者照顾负荷总分为（55.50±6.53）分，照顾能力总分为（61.37±10.87）分。多元线性回归分析结果显示，患者因素（术后并发症、住院天数）、主要照顾者因素（文化程度、照顾者照顾能力）是瓣膜置换术后患者主要照顾者照顾负荷的主要影响因素。结论：心脏瓣膜置换术后患者主要照顾者的照顾负荷处于中等偏上水平，医务人员在治病的同时也需不断降低照顾者的照顾负荷，努力提升照顾者的居家照顾技能，帮助照顾者所承担的角色由辅到主的转变，从而提升患者院外康复效果。     

肺癌患者照顾者的生命意义水平及其影响因素

目的 探讨肺癌患者的照顾者生命意义水平及其影响因素。方法 选取2021年11月-2022年5月在北京市某三级综合医院住院的肺癌患者的照顾者300例为调查对象。采用生命意义感量表（C-MLQ）,Zarit照顾者负担量表（ZBI），领悟社会支持量表（PSSS）对患者及照顾者进行调查，通过单因素及多因素线性回归分析，筛选肺癌患者照顾者生命意义水平的影响因素。结果 肺癌患者照顾者生命意义总分为33.57±4.50分，处于低水平，多因素分析结果显示，子女数、疾病分期、对您工作生活的影响程度、与患者关系、是否有人共同照顾、照顾时长、照顾负担、领悟社会支持为影响肺癌患者的照顾者生命意义的影响因素（P<0.05）。中介效应分析结果表明，社会支持在照顾者负担和生命意义之间存在部分中介效应（P<0.05）。结论 肺癌患者的照顾者生命意义处于低水平，子女数少、疾病分期高、对工作生活的影响程度大、与患者关系密切、无人共同照顾、照顾时间长、照顾负担大、领悟社会支持低的照顾者生命意义总分偏低。     

乳腺癌患者照顾者生活质量影响因素分析

目的乳腺癌患者照顾者生活质量整体处于相对较低水平。本研究分析乳腺癌患者照顾者生活质量影响因素,为今后护理工作提供参考依据。方法选取我院乳腺外科2017-01-01-2017-12-31收治的100名乳腺癌患者照顾者作为研究样本。采用问卷调查法对100名照顾者进行基本信息调查,并采用生活质量核心量表(quality of life core scale,QLQ-C30)进行生活质量调查。分析影响乳腺癌患者照顾者生活质量的主要因素。结果 100名照顾者总体健康水平得分为(75.21±5.94)分,低于国内常模水平的(86.26±4.29)分,差异有统计学意义,t=15.081,P0.001。单因素分析结果显示,病情(χ~2=24.054,P0.001)、病程(χ~2=27.352,P0.001)、家庭收入状况(χ~2=23.556,P0.001)和有无医保(χ~2=17.504,P0.001)是乳腺癌患者照顾者生活质量影响因素。多因素分析结果显示,病情(OR=17.285,95%CI为3.045～98.110,P=0.001)、病程(OR=16.631,95%CI为3.040～90.985,P=0.001)、家庭收入状况(OR=0.063,95%CI为0.013～0.304,P=0.001)和有无医保(OR=9.743,95%CI为2.258～42.044,P=0.002)是乳腺癌患者照顾者生活质量影响因素。结论影响乳腺癌患者照顾者生活质量的因素包括患者病程、病情及家庭月收入和有无医保,在护理中应加强相关影响因素的针对性护理干预,以改善照顾者生活质量。     

接受供精人工授精夫妇生育压力和生活质量研究

目的：调查接受供精人工授精（AID）夫妇的生育压力与生活质量，了解生育压力和生活质量的关系，为这些夫妇进行心理和生活质量干预时提供理论依据。方法：采用患者夫妇一般情况调查表、生育压力量表（FPI量表）和生活质量量表（FertiQoL量表）对北京大学第三医院2018年5—9月生殖中心门诊就诊的129对准备接受AID助孕的夫妇进行横断面调查，比较夫妇双方生育压力和生活质量的差异，分析生育压力和生活质量之间的关系。结果：接受AID的女性患者FPI总分为（159.00±17.52）分，FertiQoL总分为（62.27±9.26）分；男性配偶FPI总得分为（153.91±19.96）分，男性配偶FertiQoL总分为（65.12±11.62）分。女性FPI总分高于男性（t=2.436，P=0.016），女性无子女压力维度得分高于男性（t=3.145，P=0.002）。男性FertiQol总分高于女性（t=-2.881，P=0.005），女性情感反应维度得分高于男性（t=3.681，P=0.000），男性身心关系维度得分高于女性（t=-11.401，P=0.000）。Pearson 相关分析结果显示，接受AID助孕的女性FPI总分及性压力、夫妻关系、父母角色需求压力三个维度与其生活质量呈负相关（P＜0.05），接受AID男性配偶FPI总分和社会压力、性压力、夫妻关系维度、父母角色需求压力这4个维度与其生活质量呈负相关（P＜0.05）。多重线性回归显示，生育压力、居住地、文化程度是影响接受AID助孕女性患者生活质量的重要影响因素（F=3.485，R2=0.168，P＜0.05），生育压力、文化程度、家庭月收入是影响接受AID助孕男性配偶生活质量的重要影响因素（F=4.390，R2=0.203，P＜0.01）。结论：接受AID女性患者生育压力高于男性配偶，生活质量低于男性配偶；生育压力是影响AID夫妇生活质量的重要因素，夫妇双方生育压力越大，生活质量越低。     

社会支持和应对方式对Housebound老年人家庭照顾者照顾负担的影响

目的:了解社会支持和应对方式对Housebound老年人家庭照顾者照顾负担影响,为改善其照顾负担提供依据。方法:于2017年12月〜2018年1月,对唐山市社区Housebound老年人家庭照顾者应用一般情况调查表、社会支持量表、特质应对方式量表和Zarit照顾者负担量表进行调查。结果:Housebound老年人家庭照顾者照顾负担总分为(32.60±20.94)分,处于中等水平;积极应对与照顾负担总分呈负相关(P<0.05),消极应对与家庭照顾者照顾负担总分呈正相关(P<0.05),社会支持与照顾分担总分呈负相关(P<0.05);多因素回归分析显示:性别、年龄、老年人关系、婚姻、文化程度、月收入、工作情况、照顾老年人时间、与社会支持、应对方式是家庭照顾者照顾负担的影响因素。结论:Hoiiseboimd老年人家庭照顾者感知的照顾负担呈中等水平,社区工作之中应引导其采取积极的应对方式,加强社会支持,使其照顾负担感知降低。     

照顾者反应对髋关节置换术后康复治疗患者自我感受负担的影响

目的：探讨照顾者反应对髋关节置换术后康复治疗患者自我感受负担（SPB）的影响。方法：采用SPB量表和中文版照顾者反应评估量表对320例髋关节置换术后康复治疗患者及其主要照顾者进行问卷调查,比较不同程度SPB的患者照顾者反应的差别,采用Pearson相关分析法和分层回归分析法探讨照顾者反应对髋关节置换术后康复治疗患者SPB的影响。结果：1髋关节置换术术后康复治疗患者SPB平均为（33.73±4.48）分,275例（85.94%）存在SPB;2不同程度SPB组的健康问题、时间安排受打扰、经济问题、家庭支持缺乏评分比较,差异均有统计学意义（均P〈0.01）;3Pearson相关分析显示,髋关节置换术术后康复治疗患者SPB评分与照顾者反应中的健康问题（r=0.371,P=0.007）、时间安排受打扰（r=0.356,P=0.025）、经济问题（r=0.334,P=0.018）、家庭支持缺乏（r=0.396,P=0.002）均显著正相关;与自尊显著负相关（r=-0.381,P=0.029）;4分层回归分析显示,家庭收入、主要照顾者与患者关系及照顾者反应中的家庭支持缺乏、健康问题、时间安排受打扰和经济问题是髋关节置换术术后康复治疗患者SPB的影响因素。结论：髋关节置换术术后康复治疗患者SPB发生率较高,照顾者反应是重要影响因素。     

Predictors of the Extent of Agreement for Quality of Life Assessments Between Terminally Ill Cancer Patients and their Primary Family Caregivers in Taiwan

The use of family caregivers to report patients’ dying experiences has been suggested as a way of resolving the problem of non-response bias and missing data in end-of-life research. There is a dearth of information in the literature about the predictors of the extent of agreement for quality of life (QOL) assessments between patients and family informants outside of Western countries. In addition, to date there has been little progress made in deciphering meaningful influencing factors on the levels of agreement between patient and family QOL assessments. The purpose of this study was to identify the impact of the demographics and disease characteristics of patients and families, relationships of the patient to family caregiver, and caregiving burden on the extent of agreement for QOL assessments between Taiwanese terminally ill cancer patients and their family caregivers. Results from assessments by 114 dyads of Taiwanese terminally ill cancer patients and their family caregivers indicated that the extent of agreement between patient and family assessments of patient QOL was negatively influenced by the caregiving burden (amount of care needed and the impact of caregiving on caregiver’s health), positively influenced by the patient’s poorer health status, and there were a mixed effect of the demographics and the relationship between the patient and the family. Providing clinical care tailored at empowering families and aimed at reducing their unmet caregiving needs may improve family caregivers’ abilities to assess patient QOL sensitively.     

新疆牧业地区失能老年人居家非正式照护质量的影响因素分析

目的 分析新疆牧业地区失能老年人居家非正式照护质量的影响因素。方法 运用家庭照护质量量表（FCCI）对335例新疆牧业地区哈萨克族失能老年人居家非正式照护者进行现场调研,采用多重线性回归法对照护质量的影响因素进行分析。 结果 居家非正式照护质量平均得分为44分;被照护老年人的失能程度、与照护者关系、被照护时间、照护者就业情况、年龄及社会支持是影响居家照护质量的主要因素,上述6个变量解释失能老年人居家照护质量总变异量的32.3%。其中,被照护老人的失能程度重（Beta = - 0.475）、配偶照护者(Beta = - 0.171)、被照护时间长(Beta = - 0.180)、照护者就业状况差(Beta = - 0.134)、照护者年龄大(Beta = - 0.116)为其危险因素,高社会支持(Beta = 0.110)为保护因素。结论 新疆政府相关部门在解决失能老年人的长期照护问题中,应优先考虑牧业地区失能程度重、照护时间长及年龄较大的照护者,减轻其照护负担,提高居家非正式照护质量。     

新疆牧业地区失能老年人居家照护时间影响因素分析

目的 探讨新疆牧业地区失能老年人居家照护时间及影响因素。方法 对335例新疆牧业地区哈萨克族失能老年人居家照护时间影响因素进行分析。结果 居家照护总时间为（5.72±2.108） h/d,其中以日常家务活动照护时间（IADLT）最高,为（4.19±0.857） h/d。多重线性回归分析显示:老年人失能程度、居家照护者性别、年龄、照护能力、照护者健康状况、照护者的子女是否需要照护、社会支持以及照护负担会影响照护时间。结论 居家照护时间的影响因素涉及失能老年人、居家照护者及家庭内外部相关因素,应优先针对不同影响因素导致居家照护时间较长的照护者进行相应的照护费用补偿及政策支持。     

Family Caregivers in Rural Uganda: The Hidden Reality

We conducted 16 in-depth interviews with family caregivers of AIDS patients in three rural districts in western Uganda. They were selected from a client visitation list of the home-based care program for AIDS patients, based on volunteer participation. Family caregivers reported huge problems associated with providing the necessary psychological, social, and economic care. They also said that the physical and emotional demands of caregiving are overwhelming daily challenges. Most support to AIDS patients provided by family, friends, and the churches. The study highlights the great burden of caregivers, in sub-Saharan Africa who most often are elderly women and young girls.

This study examine, the burden and related health issues of family caregivers, primarily women, for AIDS patients in Uganda. It was part of a broad research project using qualitative methods on family caregiving in the home environment in sub-Saharan Africa. As the requirements for family care giving are often overwhelming for women under the conditions as they exist in Uganda and in other developing countries, it constitutes a gender issue of great importance that has not been appreciated fully in the international literature. Family caregiving is also of international relevance, as HIV/AIDS is a global pandemic of previously unknown proportions. In many poor countries, family caregiving is the most common and often the only care that AIDS patients receive, because clinic-based care often is not available close to home or is not affordable. Therefore, family caregiver support programs to alleviate this burden are essential for all those countries where HIV/AIDS is prevalent. Family caregiver burden encompasses medical, social, and economic issues at the household level, which requires an interdisciplinary approach in order to fully understand and appreciate the different dimensions of the family caregiver burden and its negative impact on the lives of so many women in so many countries.     

广州市老年痴呆症患者家庭照顾者负担及卫生服务现状分析

目的 了解广州市老年痴呆症门诊患者家庭照顾者负担现状及其影响因素,分析其卫生服务需求与利用情况。方法 选取2017年3—9月在广州市某医院门诊确诊、符合纳入排除标准且照顾者知情同意的全部老年痴呆症患者及其家庭照顾者,采用照顾者负担评估量表（CBI）评估照顾者负担情况,收集一般资料及卫生服务需求与利用。采用t检验、方差分析、多元线性回归分析照顾者负担的影响因素。结果 本研究中老年痴呆症患者及其照顾者97对,照顾者平均年龄为（55 ± 12）岁。照顾者CBI总分为（40.43 ± 20.05）分,时间依赖性维度的负担最重,主要影响因素为主观感觉的经济负担（标准系数：0.24、0.43）、每周照顾时长≥61 h（标准系数：0.22）和承担除照顾外的家务（标准系数：0.21）。照顾者认为患者最需要的卫生服务分别为护理院照顾、特别看护和上门治疗,而实际利用的卫生服务则以体格检查与门诊医疗为主。结论 影响照顾者负担的主要因素是经济状况和照顾时长。广州市老年痴呆症患者卫生服务需求与利用不平衡。建议增设老年痴呆护理机构和老人活动中心等。     

Societal costs of home and hospital end‐of‐life care for palliative care patients in Ontario,Canada

In Canada, health system restructuring has led to a greater focus on home‐based palliative care as an alternative to institutionalised palliative care. However, little is known about the effect of this change on end‐of‐life care costs and the extent to which the financial burden of care has shifted from the acute care public sector to families. The purpose of this study was to assess the societal costs of end‐of‐life care associated with two places of death (hospital and home) using a prospective cohort design in a home‐based palliative care programme. Societal cost includes all costs incurred during the course of palliative care irrespective of payer (e.g. health system, out‐of‐pocket, informal care‐giving costs, etc.). Primary caregivers of terminal cancer patients were recruited from the Temmy Latner Centre for Palliative Care in Toronto, Canada. Demographic, service utilisation, care‐giving time, health and functional status, and death data were collected by telephone interviews with primary caregivers over the course of patients' palliative trajectory. Logistic regression was conducted to model an individual's propensity for home death. Total societal costs of end‐of‐life care and component costs were compared between home and hospital death using propensity score stratification. Costs were presented in 2012 Canadian dollars ($1.00CDN = $1.00USD). The estimated total societal cost of end‐of‐life care was $34,197.73 per patient over the entire palliative trajectory (4 months on average). Results showed no significant difference (P > 0.05) in total societal costs between home and hospital death patients. Higher hospitalisation costs for hospital death patients were replaced by higher unpaid caregiver time and outpatient service costs for home death patients. Thus, from a societal cost perspective, alternative sites of death, while not associated with a significant change in total societal cost of end‐of‐life care, resulted in changes in the distribution of costs borne by different stakeholders.     

姑息关怀服务模式对癌症晚期患者生命质量的影响研究

目的 评估姑息关怀服务对癌症晚期患者生命质量的影响并提出管理建议。方法 采用问卷调查的方式对H医院接受姑息关怀治疗和常规抗癌治疗的248名癌症晚期住院患者的生命质量进行调查。选取中国癌症患者生命质量量表对癌症晚期患者的生命质量进行评估,然后通过统计分析探讨不同治疗方式下患者生命质量的差异。结果 癌症晚期患者生命质量普遍较差(36.38±4.82),其中躯体症状得分最低,依次是精神心理和社会关系。接受姑息关怀后患者生命质量及各指标得分均有显著提高。治疗前生命质量更差、疼痛程度更高的姑息关怀组患者,其治疗后的生命质量评分与常规抗癌组患者相比无显著差异,疼痛程度更是低于常规抗癌组。两组治疗方式下患者生命质量治疗前后的差值对比(6.82±2.71 vs 2.53±2.95),姑息关怀组的改善效果更明显(t=11.908,P<0.05)。结论 姑息关怀治疗相对于常规抗癌治疗,对癌症晚期患者生命质量的改善效果更为显著,应加强对以价值为核心的姑息关怀服务模式的宣传和推广。     

乳腺癌术后化疗患者生命质量现状及影响因素的研究

目的 了解乳腺癌术后化疗患者生命质量状况及其影响因素。方法 采用乳腺癌患者生命质量测定量表(Functional Assessment of Cancer Therapy-Breast,FACT-B),对徐州市153名乳腺癌术后化疗患者进行问卷调查,采用t检验、方差分析和多元线性回归分析方法探讨乳腺癌患者生命质量的影响因素。结果 乳腺癌术后化疗患者生命质量总分为(83.30±15.53)分。经单因素分析,不同年龄、体质指数(Body Mass Index,BMI)、化疗次数以及癌瘤是否有远处转移患者的生命质量比较,差异有统计学意义(P均＜0.05)。多重线性回归分析显示,癌瘤是否有远处转移、BMI、化疗次数对乳腺癌术后化疗患者生命质量影响最大。结论 乳腺癌术后化疗患者的生命质量较低,其影响因素是多方面的,应从临床干预、家庭关怀、社会支持等多方面提高患者的生命质量。     

Family caregiving in advanced chronic organ failure

ObjectivesTo assess caregiver burden as well as positive aspects of family caregiving in advanced chronic obstructive pulmonary disease (COPD), chronic heart failure (CHF), and chronic renal failure (CRF).DesignCross-sectional observational study.SettingPatients recruited at the outpatient clinics of academic and general hospitals in the Netherlands.ParticipantsPatients with advanced COPD (n = 73), CHF (n = 45), and CRF (n = 41) and their family caregivers.MeasurementsCaregiver burden and positive aspects of caregiving were assessed using the Family Appraisal of Caregiving Questionnaire for Palliative Care and were compared among family caregivers of patients with COPD, CHF, or CRF using linear regression analysis while controlling for characteristics of patients and family caregivers.ResultsMost family caregivers were female partners of participating patients. Caregiver distress and caregiver strain scores were relatively low, whereas scores for positive caregiving appraisals and family well-being were relatively positive. Caregiver strain, positive caregiving appraisals, and family well-being were comparable for family caregivers of patients with COPD, CHF, or CRF. Caregiver distress was higher for family caregivers of patients with COPD than CHF. The experience of caregiving was influenced by being the patient's spouse, patient's psychological symptoms, and the presence of comorbidities.ConclusionsFamily caregiving for patients with COPD, CHF, or CRF should not only be seen as a burden, but also as a positive experience. To support family caregivers, attention should be paid to caregiver burden and the positive aspects of family caregiving.