不孕症妇女心理状态分析

[目的]探讨心理因素与不孕症之间的关系。[方法]采用抑郁自评量表和焦虑自评量表评定68例不孕症妇女心理状态,同时选择正常生育妇女50例作为对照。按既往有无妊娠史,分原发不孕与继发不孕;按不孕病程长短分A组(不孕2~年)、B组(不孕3~年)、C组(不孕4年及以上),比较分析心理因素与不孕之间的关系。[结果]68例不孕妇女抑郁发生率为47.06%,焦虑发生率为66.18%,明显高于对照组的6.00%和4.00%。不孕症妇女的抑郁与焦虑评分明显高于正常生育妇女(P<0.005),原发不孕组的抑郁焦虑评分明显高于继发不孕组(P<0.005)。随着不孕病程的延长,抑郁与焦虑评分也增高。[结论]心理因素可能是引起不孕症的原因之一,其在减轻或加剧不孕症的病程方面有很重要的意义。社会和家人应给予不孕妇女更多的关爱和支持,以避免或减少她们不良心理状态的产生。     

不孕症女性心理状态调查

目的:了解不孕症女性患者的心理健康状况。方法:运用汉密顿抑郁量表、汉密顿焦虑量表、生活事件量表等心理问卷,对105例不孕症患者和110例正常育龄妇女心理状态、生活事件进行调查。结果:①不孕症妇女抑郁评分、焦虑评分、负性事件值比正常育龄妇女均明显增高(P<0.001);②原发不孕组和继发不孕组在抑郁评分、负性事件值两方面存在显著差异(P<0.05),焦虑评分和生活事件总值无显著差异;③随着不孕症患者病程的延长、年龄的增大抑郁评分、焦虑评分、负性事件值日趋升高。结论:①女性不孕症患者的心理健康水平显著低于正常人,抑郁和焦虑是不孕症患者心理应激最常见的反应,社会生活事件可作为社会心理因素对不孕症患者产生影响;②抑郁和焦虑的心理状态和不良的负性生活事件是引起不孕症的危险因素;③心理因素与不孕常同时存在,提示在临床诊治不孕症的过程中应充分重视心理因素在本病中的重要作用。     

不孕症妇女焦虑抑郁心理状态调查

目的:分析不孕症妇女焦虑/抑郁心理状态,为其提供更为有益的治疗措施。方法:用综合医院焦虑/抑郁情绪测定表(HADS)对213例不孕症妇女问卷调查,并选择健康育龄妇女180例作为对照,探讨焦虑/抑郁评分与不孕病程、教育程度、经济状况及患者年龄的相关性。结果:不孕症妇女焦虑评分为6.02±3.47,抑郁评分为5.27±3.37,显著高于对照组(P<0.05);随不孕病程延长,焦虑/抑郁评分升高,但无统计学意义(P>0.05);焦虑与教育程度呈负相关,与患者年龄和经济状况相关性无统计学意义;抑郁与教育程度、经济状况呈负相关,与患者年龄无显著相关性。结论:不孕症妇女焦虑/抑郁水平高于对照组,提示该人群需心理帮助或支持。     

深圳市高龄不孕女性焦虑和抑郁症状及相关因素分析

目的:了解深圳地区高龄不孕女性人群焦虑和抑郁情况,探索影响焦虑和抑郁症状的相关因素。方法:2016年1月—12月对深圳市人民医院不孕不育门诊就诊的年龄35~45岁女性不孕症患者210例开展横断面研究,通过医院焦虑抑郁量表调查研究对象焦虑和抑郁症状,并用SPSS软件分析相关的影响因素。结果:调查对象中有焦虑症状81例(38.6%),抑郁症状83例(39.5%)。多因素分析显示,已有子女(OR=0.67,95%CI0.53~0.93),家庭月收入8000元(OR=0.72,95%CI0.58~0.94)是焦虑的保护因素;对于抑郁的形成,原发性不孕(OR=1.89,95%CI1.19~2.72)是危险因素,高中及以上文化程度(OR=0.54,95%CI0.32~0.91)、家庭的支持(OR=0.42,95%CI0.29~0.61)是保护性因素。结论:深圳市35岁以上不孕女性焦虑和抑郁症状发生率较高,应该引起关注,对于不孕女性应进行常规心理健康问题的筛查,早期给予社会支持和心理关怀。     

女性不孕症患者抑郁现状及影响因素分析

目的 调查分析女性不孕症患者抑郁现状及其影响因素,为其获取更为有益的治疗措施提供依据.方法 选择2012年12月至2013年12月确诊的182例女性不孕症患者为研究对象（不孕组）,另选择174例女性健康体检者为对照组,对所有入选者采用自评抑郁量表（SDS）及汉密尔顿抑郁量表（HAMD）评定后进行比较分析.结果 HAMD评定结果：不孕组轻度、中度、重度抑郁发生率均高于对照组[13.7％（25/182）比4.6％（8/174）,14.8％ （27/182）比4.0％ （7/174）,16.5％（30/182）比2.9％（5/174）],差异有统计学意义（P＜0.01）.SDS评定结果：不孕组轻度、中度、重度抑郁发生率均高于对照组[13.2％（24/182）比4.0％ （7/174）,15.4％ （28/182）比4.6％ （8/174）,17.0％（31/182）比2.9％（5/174）],差异有统计学意义（P＜0.01）;相关性分析显示,患者年龄（r=0.18,P=0.012）与抑郁的发生呈正相关,教育程度（r=-0.26,P=0.000）、经济状况（r=-0.20,P=0.004）与抑郁的发生呈负相关.结论 女性不孕症患者抑郁的发生率高于正常人群,提示需对女性不孕症患者提供心理支持.     

不孕症夫妇心理状况及相关因素分析

[目的]调查不孕症夫妇心理健康状况以及进行相关因素分析,探讨不孕症"生物-心理-社会"的医学模式. [方法]采用90项症状自评量表(SCL-90)及问卷方法对不孕症夫妇进行调查.SCL-90每个项目按1～5分的五级评分,参照全国成人常模标准.数据采用SPSS15.0软件进行统计处理. [结果]调查不孕症夫妇69对(138人),SCL-90总分>160分者占13.8%,抑郁因子均分>2分31.9%,焦虑因子均分>2分者16.7%;白评总分、总均分、阳性项目数、抑郁、焦虑、人际关系敏感、敌对、躯体化等因子分均高于全国常模(P<0.05);不孕症夫妇之间,女方总分、总均分、阳性项目数均高于男方(P<0.01);不孕症夫妇年龄越大、结婚年限越长、治疗时间越长,因子得分相应也高;夫妇双方在总分、总均分、抑郁和焦虑因子得分均呈高度相关性(r>0.7,P<0.01);文化程度越低、个人收入越少,因子得分越高;城乡户籍也是影响因子得分的因素,乡村不孕症夫妇承受的心理压力及心理紊乱的发生率明显高于城镇夫妇. [结论]不孕症对夫妇心理健康影响较大,以抑郁、焦虑、人际关系敏感等负性情绪为主要表现;不孕妇女心理压力高于丈夫,并且夫妇之间负性情感相互影响;年龄、结婚年限、治疗时间、文化程度和收入等因素能够影响心理紊乱的发生和严重程度.     

不孕症妇女心理状况及心理干预效果

[目的]了解不孕症妇女抑郁、焦虑状况,探讨心理干预对不孕症妇女排卵的影响. [方法]应用焦虑自评量表(SAS)和抑郁自身量表(SDS)对40名排卵障碍的不孕症妇女进行心理评估;对其中20例在促排卵时及排卵期进行心理干预即支持性心理干预、家庭疗法、小组治疗和放松训练,对照组不采用心理干预措施.观察两组治疗前后抑郁、焦虑情绪变化的异同,并进行3个月促排卵周期的排卵率的比较. [结果]不孕症妇女均存在不同程度抑郁、焦虑(48.2±9.4,47.9±10.3),心理干预能明显改善其不良情绪(40.8±10.0,36.9±10.0),差异有统计学意义(t=4.2,t=5.9,P＜0.01),干预组与对照组比较3个促排卵周期排卵率高于对照组(分别为89%,67%),差异有统计学意义(X2=7.82,P＜0.01). [结论]妇科医生应重视不孕妇女的心理,并进行必要的心理干预,改善其不良情绪,提高排卵率,增加妊娠机会.     

继发性不孕症妇女心理状态调查

目的：探讨继发性不孕症妇女的心理状态及相关影响因素,为继发性不孕症的针对性治疗与护理提供有价值的信息。方法对2012年6月一2013年6月在本中心行IVF-ET的290例女性因素继发性不孕症进行调查,分析继发性不孕症患者常见心理问题。结果患者焦虑心理、抑郁心理、仇恨心理、感到悲观、内疚感、孤独感和无所谓者分别占70.7％、55.5％、45.9％、33.5％、32.1％、24.8％和8.6％;不同年限、家庭关系、性伴侣数目对患者SDS和SAS有影响。结论对继发性不孕症妇女针对心理特征有的放矢行个性化心理干预,可减轻患者焦虑、抑郁情绪,增加受孕机会。     

接受辅助生殖技术治疗的不孕女性的心理特点及相关因素分析

目的探讨接受辅助生殖技术(ART)治疗的不孕症女性的心理特点及其影响因素。方法选取2014年1月—2017年1月在本院接受ART治疗的女性不孕症患者279例作为研究对象,按照年龄进行1:1匹配,选取同时期在本院体检的已婚女性279例作为对照组。分别采用自制一般问卷、症状自评量表(SCL-90)、焦虑自评量表(SAS)及抑郁自评量表(SDS)对研究对象的一般情况、症状及焦虑抑郁发生情况进行调查,分析影响不孕症女性焦虑、抑郁的相关因素。结果 SCL-90评分结果显示,接受ART治疗的不孕症女性的抑郁、焦虑、敌对、精神病性及人际关系敏感性5个因子的得分均明显高于同年龄段已婚女性;进一步采用SAS、SDS量表对患者进行评定,结果显示,32.2%的不孕症患者存在焦虑症状,24.4%的不育症女性存在抑郁症状。单因素分析结果显示,焦虑症状的发生在年龄、不孕时间、经济收入、既往治疗费用、传统生育观念及对ART治疗了解程度方面的差异均有统计学意义,抑郁症状的发生在教育程度、不孕时间、夫妻关系、既往治疗费用、传统生育观念、社会交往方面的差异有统计学意义。多因素Logistic回归分析结果显示,年龄、不孕时间、经济收入、既往治疗费用及对ART治疗相关知识了解程度是焦虑症状的主要影响因素,文化程度、不孕时间、夫妻关系、社会交往是抑郁症状的主要影响因素。结论接受ART治疗的不孕症女性焦虑、抑郁症状的发生风险较高,临床上应加以重视,并根据其高危因素采取相应干预措施,提高患者心理健康水平。     

高龄不孕妇女辅助生殖助孕前心理状态调查

目的:调查高龄不孕妇女辅助生殖(ART)助孕前心理状态及影响因素。方法:选取接受ART助孕的高育龄不孕妇女203例作为不孕组,按照年龄以1:1匹配选取同期接受健康体检的已婚女性203例作为对照组。向两组发放调查问卷,了解其一般情况及心理状态,对比调查结果并分析影响ART助孕妇女心理状态的相关影响因素。结果:不孕组SAS(45.05±8.74分)、SDS(45.62±10.03分)评分均高于对照组(39.87±9.07分、38.05±9.96分)(P0.05),焦虑、抑郁检出率分别为36.0%和33.0%。不孕组有焦虑症状患者年龄≥40岁、不孕年限4年、家庭年收入≤5万元、既往治疗费用5万元占比高于无焦虑症状患者,夫妻关系融洽、了解ART助孕相关知识、初次失败后愿意再次辅助生殖者占比低于无焦虑症状患者(P0.05);有抑郁症状患者年龄≥40岁、不孕年限4年、家庭年收入≤5万元、既往治疗费用5万元者占比高于无抑郁症状患者,夫妻关系融洽、了解ART助孕相关知识、初次失败后愿意再次辅助生殖者占比低于无抑郁症状患者(P0.05)。多因素分析显示,年龄≥40岁、不孕年限4年、既往治疗费用5万元、未生育是患者焦虑的危险因素,年龄≥40岁、不孕年限4年、既往治疗费用5万元是患者抑郁的危险因素。结论:接受ART助孕的高龄不孕妇女助孕前普遍有明显的焦虑、抑郁症状,临床应关注高龄不孕妇女ART助孕前心理健康状况,有针对性干预,提高治疗效果。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.