产后抑郁心理的诱发因素及心理保健服务效果

目的:探讨产后抑郁心理的诱发因素及心理保健服务的临床疗效。方法:对符合入选标准的525例分娩产妇进行一般资料问卷调查,同时采用社会支持量表(SSRS)评价社会支持情况及采用爱丁堡产后抑郁量表(EPDS)对研究对象心理状态进行评估,并筛选出产后抑郁患者(EPDS评分≥13分),将其分为观察组(n=48)和对照组(n=48),对照组给予常规护理,观察组在对照组基础上给予心理保健服务,干预3个月后观察比较抑郁组和正常组患者一般资料,并对两组患者中单因素进行多因素Logistic回归性分析,同时观察对照组和观察组患者干预前后EPDS评分。结果:抑郁组和正常组在年龄、文化程度、夫妻关系、是否计划内怀孕、孕产期保健知识知晓、孕期抑郁情绪、产后负性事件发生、丈夫期盼生男孩程度、社会支持总分比较差异显著(χ~2=8.878,11.648,5.745,5.886,14.523,7.075,9.696,8.122,t=2.203;P0.05),经多因素Logistic回归分析显示,产妇文化程度、孕期抑郁情绪、产后负性事件和丈夫期盼生男孩程度是产妇产后抑郁发生的独立危险因素(OR=3.773,12.840,0.171,2.811;P0.05),而社会支持是产妇产后抑郁的保护性因素(OR=0.350,P0.01)。两组患者干预后EPDS评分较干预前显著降低(t=8.498,4.347;P0.01),且观察组患者EPDS评分较对照组显著降低,差异具有统计学意义(t=5.410,P0.001)。结论:产妇文化程度、孕期抑郁情绪、产后负性事件和丈夫期盼生男孩程度是产妇产后抑郁发生的独立危险因素,心理保健服务能够显著改善产妇抑郁症状。     

产后抑郁发病因素的综合研究

目的:研究产后抑郁可能的心理社会因素,为提高围产保健水平提供一些理论与实践的依据.方法:自拟一般资料调查表等4种表格收集有关的心理、社会、环境因素及产科因素;用Edinburgh(EPDS)抑郁量表分≥10分为界,筛查产后抑郁,共298例完成了产后第3天评定,127例完成了产后第42天的评定.测定38名产妇临产前与产后72小时的雌二醇、孕酮及催乳素水平.结果:产后抑郁的发病率为23.15%,家庭支持等社会心理因素以及雌二醇的变化幅度和产后抑郁密切相关.结论:产后抑郁的发生具有一定的心理、社会与生物学因素,妊娠、分娩与产褥期良好的社会、家庭支持是减少产后抑郁障碍的有力措施.     

上海市孕产妇焦虑、抑郁症状发生率及相关危险因素

目的：了解孕产妇焦虑、抑郁症状的发生情况及其相关危险因素。方法：自编不同孕期和产后焦虑／抑郁危险因素问卷。采用综合性医院所用焦虑抑郁量表（HAD）和爱丁堡产后抑郁量表（EPDS），对600例孕妇在孕24、38周，产后7、42天和3个月进行随访评估。HAD的焦影抑郁症状以9分为界，EPDS抑郁以13分为界。结果：1）五个时点HAD的焦虑发生率为5．0％、6．6％、4．4％、4．1％和2．2％：抑郁发生率为：5．0％、7．6％、7．4％、5．9％和3．0％。2）产后EPDS评估三个时点的抑郁发生率为：8．0％、10．7％和9．6％。3）35岁以上高龄孕妇在孕24周时抑郁症状的比例（21．1％：4．4％，P〈0．02）和产后7天焦虑症状的比例明显高于35岁以下的产妇（21．1％：4．6％，P〈0．02）。4）孕24周时有焦虑的孕妇产后7天抑郁的比例25．9％（7／27），产后3月的比例33．3％（4／12）；孕38周时有焦虑／抑郁的孕妇产后7天抑郁的比例分别为32．4％（11／34）和28．6％（10／35）；与同期非焦虑、抑郁孕妇相比差异有显著性（P〈0．05）。5）孕期与焦虑／抑郁症状相关的主要危险因素为担忧产后婴儿健康（OR=7．09，5．72-8．46）、婆媳关系（OR=38．46，35．61-41．31）和夫妻关系（OR=41．66，38．72-44．62）。6）产后抑郁的主要危险因素为产前抑郁（OR=8．13，6．55-9．71）、产前焦虑（OR=8．54，7．02-10．37）。有无烦恼事件（OR=9．34，8．15-10．53）和每天睡眠时间（OR=10．66，9．27-12．07）。结论：孕期和产后都有一定比例的焦虑和抑郁症状。孕期焦虑和抑郁对产后抑郁的发生有明显影响。高龄产妇的焦虑／抑郁症状的比例明显升高。孕期和产后焦虑／抑郁症状相关的危险因素不同。     

某三甲综合医院心内科门诊患者焦虑抑郁症状及相关因素

目的:调查某三甲综合医院心血管内科门诊患者焦虑抑郁症状发生率及其影响因素。方法:随机抽样法选取2010年6月至12月该院心内科门诊患者1597例,应用焦虑自评量表(SAS)、抑郁自评量表(SDS)和自制人口社会学一般资料调查表进行调查。结果:受检者焦虑抑郁症状发生率为42.5%,其中单纯焦虑症状8.7%;单纯抑郁症状6.5%;焦虑抑郁症状共存27.3%。现患心血管疾病患者焦虑抑郁症状发生率为45.7%;无心血管疾病患者发生率为35.6%,两者比较有显著性差异(P<0.05)。现患高血压病、冠心病、心律失常和高血压病和冠心病并发患者焦虑抑郁症状发生率分别为39.7%、43.2%、40%、53.7%。多因素分析显示性别、A型人格、病程、就诊次数、服药种类、现患心血管疾病、工作压力和对目前家庭收入满意度为焦虑抑郁发生独立影响因素。结论:三甲综合医院心内科门诊患者焦虑抑郁症状总发生率高达42.5%;现患心血管疾病患者并发焦虑抑郁症状发生率显著高于无心血管疾病者。影响焦虑抑郁症状发生的主要因素涉及心理、生理、社会多方面。     

孕妇产前抑郁焦虑的危险因素

目的:探讨孕妇产前抑郁、焦虑的相关危险因素,为产前抑郁、焦虑的早期筛查及临床干预提供理论支持。方法:选取昆明市妇幼保健院产前检查的孕妇2112人,采用爱丁堡产后抑郁量表(EPDS)、焦虑自评量表(SAS)于孕28周对其进行问卷调查。采用非条件logistic回归分析探讨产前抑郁、焦虑症状的相关危险因素。结果:孕28周抑郁症状检出率为25.4%,焦虑症状检出率为6.6%。Logistic回归分析显示,抑郁症状的危险因素为低年龄(OR=0.80,95%CI:0.68~0.94)、孕期非坚持工作(OR=1.18,95%CI:1.02~1.36)、对居住环境不满意(OR=1.50,95%CI:1.23~1.83)、期望生男孩(OR=0.86,95%CI:0.77~0.96)、非独子(OR=1.37,95%CI:1.06~1.76)、非计划内怀孕(OR=1.38,95%CI:1.10~1.72);焦虑症状的危险因素为不满意居住环境(OR=1.64,95%CI:1.19~2.26)、与丈夫关系不融洽(OR=2.01,95%CI:1.20~3.37)、非计划内怀孕(OR=1.50,95%CI:1.05~2.14)。结论:本研究提示,年龄越小、孕期未坚持工作、对居住环境不满意、期望生男孩、孕妇非独子、非计划内怀孕的孕妇,越易患产前抑郁症;对居住环境不满意、与丈夫关系不融洽、非计划内怀孕的孕妇,越易患产前焦虑症。     

意外妊娠终止女性创伤后心理应激反应状况

目的:了解意外妊娠终止女性创伤后心理应激反应现状及相关因素。方法:选取福建省2所三级甲等医院的意外妊娠终止女性388例,采用事件影响量表修订版(IES-R)、医院焦虑抑郁量表(HADS)、心理弹性量表(CD-RISC)、围产期悲伤量表(PGS)进行调查。IES-R总分≥35分为创伤后应激障碍筛查阳性。结果:IES-R总分为(20.6±12.4)分,创伤后应激障碍筛查阳性率16.5%。多元线性回归分析结果显示,认为怀孕时机合适者IES-R总分高于认为怀孕时机错误者(β=0.13)、终止妊娠过程中中度疼痛者IES-R总分低于重度疼痛者(β=-0.09);IES-R总分与孕周、HADS孕期抑郁得分和PGS现存悲伤得分正向关联(β=0.18、0.27、0.16),与CD-RISC乐观得分负向关联(β=-0.12)。结论:意外妊娠终止女性的创伤后心理应激反应处于中等水平,认为怀孕时机合适、终止妊娠过程中重度疼痛、孕周大、孕期抑郁水平高、终止妊娠后现存悲伤水平高者易发生创伤后心理应激反应。     

产后抑郁症的心理因素分析及预防对策研究

目的分析产后抑郁症发病的心理因素,并探讨相应的对策。方法对820例孕妇于妊娠36~38周施测艾森克个性量表(EPQ)及焦虑、抑郁情绪测定量表(HAD),在产后4~6周施测爱丁堡产后抑郁量表(EPDS)。结果产后抑郁症患者在EPQ的N量表和P量表上的评分均显著高于无产后抑郁症产妇,在L量表上的评分则显著低于后者,两者在E量表上的评分无显著差异。孕期有焦虑、抑郁情绪的产妇产后抑郁症的发病率显著高于孕期无焦虑、抑郁情绪的产妇(2χ=21.43,26.39,P<0.005)。结论产妇产后抑郁症的发生既有其心理根源,也与其孕期的焦虑抑郁情绪有密切的关系。加强孕期保健、采取及时筛查与干预措施是预防产后抑郁症的关键。     

1008例孕晚期妊娠妇女焦虑、抑郁情绪调查

目的了解孕晚期妊娠妇女焦虑、抑郁情绪的发生情况。方法采用状态-特质焦虑量表(STAI)、自评抑郁量表(SDS)以及自制的孕妇基本情况调查表,对1008名孕妇在孕32～34周时进行测试,并对结果进行分析。结果 1008名孕妇状态焦虑情绪发生率为20.3%,特质焦虑情绪发生率为5.9%,状态焦虑情绪评分明显高于国内正常人群(t=5.12,P<0.01);抑郁情绪发生率为23.7%,其中轻度抑郁发生率为18.5%,中度抑郁发生率为4.8%,重度抑郁发生率为0.5%。孕期状态焦虑、特质焦虑和抑郁情绪的发生率均以户籍孕妇最低,流动孕妇最高(χ2=15.65,7.07,28.19;P<0.01或<0.05)。结论孕期焦虑、抑郁情绪普遍存在。     

社区老年人抑郁症状及影响因素

目的:了解社区老年人抑郁症状的发生情况及影响因素。方法:采用分层随机抽样方法,应用自编一般情况问卷、饮食情况调查表及老年抑郁量表(GDS)对济宁市某社区165名老年人进行问卷调查。结果:老年人抑郁症状的发生率为7.3%。单因素分析表明,居住在城市(χ~2=10.110,P=0.003)、家庭和睦(χ~2=9.587,P=0.019)、经常吃水果(χ~2=6.976,P=0.013)、豆制品(χ~2=7.373,P=0.012)的老年人抑郁症状的发生率比较低,差别有统计学意义;Logistic回归分析,家庭和睦老年人抑郁症状发生率比较低(OR=8.190,P=0.022),差异有统计学意义。结论:家庭和睦情况是影响老年抑郁症状发生的因素,饮食因素对抑郁症状的发生有一定的影响。     

产后抑郁症的社区调查分析

目的探讨产后抑郁症的发生情况和相关影响因素。方法采用自行设计的一般资料调查表、爱丁堡产后抑郁量表（EPDS）、艾森克个性问卷（EPQ）对503例产妇在产后7～28天进行调查，对所有资料进行卫生统计学及流行病学分析。结果①503例产妇产后抑郁发生率为5．51％（28／503）；②EPQ中的N量表分和P量表分抑郁症组均高于非抑郁症组，L量表分抑郁症组低于非抑郁症组；③非条件Logistic回归分析显示：新生儿疾病等6项因素为产后抑郁的危险因素，母乳喂养等2项因素为保护因素。结论产后抑郁症是多种因素综合作用的结果，针对各种危险因素积极干预非常重要。     

Development in in vitro toxicology

There are three principal pressures driving the development of in vitro toxicology: (1) the need for more efficient testing systems to cope with the large number of xenobiotics currently being developed; (2) public pressure to reduce animal experimentation; and (3) a need for a better understanding of the mechanisms of toxicity. Within this, in vitro toxicology is focused on local, systemic, and target-organ toxicity. It is becoming increasingly apparent that a step or decision-tree approach using input of a variety of experimental data (physicochemical properties, biokinetics, cytotoxicity) provides the most efficient system for predicting toxicity. Examples of the use of in vitro toxicity systems for prediction of systemic toxicity and target-organ (liver) toxicity are presented.Originally presented at ECCP 93.     

Age-related changes in polyamines in memory-associated brain structures in rats

Polyamines putrescine, spermidine and spermine are positively charged aliphatic amines and have important roles in maintaining normal cellular function, regulating neurotransmitter receptors and modulating learning and memory. Recent evidence suggests a role of putrescine in hippocampal neurogenesis, that is significantly impaired during aging. The present study measured the polyamine levels in memory-related brain structures in 24- (aged), 12- (middle-aged) and 4- (young) month-old rats using liquid chromatography/mass spectrometry and high performance liquid chromatography. In the hippocampus, the putrescine levels were significantly decreased in the CA1 and dentate gyrus, and increased in the CA2/3 with age. Significant age-related increases in the spermidine levels were found in the CA1 and CA2/3. There was no difference between groups in spermine in any sub-regions examined. In the parahippocampal region, increased putrescine level with age was observed in the entorhinal cortex, and age did not alter the spermidine levels. The spermine level was significantly decreased in the perirhinal cortex and increased in the postrhinal cortex with age. In the prefrontal cortex, there was age-related decrease in putrescine, and the spermidine and spermine levels were significantly increased with age. This study, for the first time, demonstrates age-related region-specific changes in polyamines in memory-associated structures, suggesting that polyamine system dysfunction may potentially contribute to aged-related impairments in hippocampal neurogenesis and learning and memory.     

Seasonal variations in acute toxoplasmosis in pregnant women in Slovenia

Between December 1999 and December 2004, 40 081 pregnant women were examined for toxoplasmosis with Toxo-IgG, Toxo-IgM enzyme immunoassay. Women with positive results were then retested with the Toxo-IgG avidity assay for recent toxoplasmosis. Recent acute toxoplasmosis in pregnant women was found to be significantly more frequent (p < 0.01) during winter than summer. The incidence of acute toxoplasmosis during winter-spring was also significantly more frequent (p < 0.025) than summer-autumn. This phenomenon should be taken into account when formulating preventive measures for toxoplasmosis, especially for pregnant women.     

休克过程中肾上腺髓质素变化的研究进展

Adrenomedullin (AM) is a new peptidergic regulator of vascular function. AM serves as a hormone, which has many biological properties, plays an important role in the many pathophysiological processes, especially shock. This review will highlight the structure, biological properties of AM and the relationship between AM and shock.     

Secular change in menarche in women in Madrid

The age at menarche was estimated by recollection in 1617 women between the ages of 18 and 60 in Madrid and a nearby suburb, Pinto. The population of Pinto is working-class and the Madrid group, taken from residential neighbourhoods , belongs to the upper middle class. In both groups we found a diminution in average age at menarche, from 14.04 to 13.02 years in Madrid and from 14.55 to 13.16 years from about 1935 to about 1965 in Pinto. These changes have been more intense in the group which is less well-off economically, where living conditions have varied much more drastically.     

Uteroglobin in the developing rabbit conceptus in vivo and in vitro

Summary Uteroglobin (UGL) was measured in day- 4 to day-10 rabbit conceptuses by a competitive ELISA. Levels in blastocyst fluid, tissues, coverings and in the early fetus were determined separately. The total amount of UGL increased from 18.4 ng to 6.8 g per conceptus. The UGL content of individual day-6 blastocysts was studied in vitro. Culturing was carried out up to 60 h in Ham's F10 medium with polyvinylpyrrolidone as macromolecular component, with and without progesterone, and with progesterone plus estradiol. UGL was determined in the blastocyst fluids, tissues with coverings and in the culture media. After labelling with [³⁵S]-methionine, protein patterns of total blastocysts and of culture media were analysed by two-dimensional gel electrophoresis and fluorography. The morphology of cultured blastocysts was examined by electron microscopy. During 60 h of culture, the blastocysts expanded in diameter by 84%, and released 19% of their initial UGL content into the medium, independent of the hormonal substitution. Neither de novo synthesis, nor degradation of UGL was found: the protein remained unlabelled in fluorography, and its total quantity was not significantly different from that of non-cultured controls. Trophoblast, endoderm and embryoblast cells showed well preserved cell organelles and intercellular junctions, while the morphological differentiation of the germ layer was inhibited.