慢性病患者病耻感的研究现状

近年来,人体各系统慢性病的发生率呈不断上升趋势,且已成为世界范围内影响人体健康的公共卫生问题。病耻感(stigma)是指“被剥夺全部社会认可资格的个人情况”,其本质是把一个整体或正常的人贴上标签、做上标记,标志着他们是不同的,导致他们在别人眼中贬值,被诋毁,是一种广泛的、消极的、刻板的社会现象[1],主要包括感知病耻感、实际病耻感和内在病耻感三个方面[2]:感知病耻感是指患者预期所能感觉的贬低歧视感;实际病耻感是指已经或正在经历的被歧视;内在病耻感是指患者对各种消极态度所做出的个人反应,内化为羞耻、低自尊等。     

Nutritional Supplementation Increases Rifampin Exposure among Tuberculosis Patients Coinfected with HIV

Nutritional supplementation to tuberculosis (TB) patients has been associated with increased weight and reduced mortality, but its effect on the pharmacokinetics of first-line anti-TB drugs is unknown. A cohort of 100 TB patients (58 men; median age, 35 [interquartile range {IQR}, 29 to 40] years, and median body mass index [BMI], 18.8 [17.3 to 19.9] kg/m²) were randomized to receive nutritional supplementation during the intensive phase of TB treatment. Rifampin plasma concentrations were determined after 1 week and 2 months of treatment. The effects of nutritional supplementation, HIV, time on treatment, body weight, and SLCO1B1 rs4149032 genotype were examined using a population pharmacokinetic model. The model adjusted for body size via allometric scaling, accounted for clearance autoinduction, and detected an increase in bioavailability (+14%) for the patients in the continuation phase. HIV coinfection in patients not receiving the supplementation was found to decrease bioavailability by 21.8%, with a median maximum concentration of drug in serum (C_max) and area under the concentration-time curve from 0 to 24 h (AUC_0–24) of 5.6 μg/ml and 28.6 μg · h/ml, respectively. HIV-coinfected patients on nutritional supplementation achieved higher C_max and AUC_0–24 values of 6.4 μg/ml and 31.6 μg · h/ml, respectively, and only 13.3% bioavailability reduction. No effect of the SLCO1B1 rs4149032 genotype was observed. In conclusion, nutritional supplementation during the first 2 months of TB treatment reduces the decrease in rifampin exposure observed in HIV-coinfected patients but does not affect exposure in HIV-uninfected patients. If confirmed in other studies, the use of defined nutritional supplementation in HIV-coinfected TB patients should be considered in TB control programs. (This study has the controlled trial registration number ISRCTN 16552219.)     

肺结核患者疾病污名感受的质性研究

目的 透过对肺结核患者真实故事的诠释,深入理解肺结核患者疾病污名感受及其病耻感产生的原因和影响,为将来实施干预提供初步的理论依据.方法 采用深度访谈法收集14例肺结核患者的资料,应用诠释学方法进行分析.资料收集时间为2010年6-8月.结果 肺结核患者疾病污名感受是一个动态的主、客体相互作用的过程,可以从2个主题进行诠注:疏离与回避.结论 肺结核患者存在强烈的疾病污名感受,临床工作者应将帮助他们减轻疾病污名感受作为缓解症状之外的一项重要服务目标.     

我国肺结核患者污名感受的现状及其影响因素

目的探讨我国肺结核患者污名感受的现状及其影响因素。方法采用结核病污名感受量表(tuberculosis-related stigma scale,TSS)、自尊量表(rosenberg self-esteem scale,SES)、医学应对问卷(medical coping modes questionnaire,MCMQ)、社会支持量表(social support rating scal,SSRS)对方便抽样的330名肺结核患者进行测评。结果共302名(91.5%)结核病患者完成调查。单因素分析显示:不同性别、文化程度、家庭收入、治疗情况、有无咯血的患者在TSS得分上的差异有统计学意义(P<0.05或P<0.01)。相关分析显示,TSS评分与SES、MCMQ及SSRS评分中的多个因子相关。多元回归分析示,咯血、自尊水平、社会支持-利用度、应对方式-面对、应对方式-回避5个变量进入多元逐步回归模型,可解释TSS得分总变异量的38.3%。结论肺结核患者污名感受与多个因素有关,其中咯血的预测作用最强。在设计和实施消除结核病相关污名感受的干预时,应充分考量这些因素。     

Disclosure challenges among people living with HIV in Thailand

One of the main challenges facing people living with HIV (PLH) in Thailand is HIV disclosure. The goal of this study was to examine HIV disclosure barriers and motivators in Northeastern Thailand. Focus groups were conducted with 40 PLH to explore the barriers and motivators. To confirm the themes identified in the focus groups, face‐face interviews were conducted with 50 PLH. Focus group findings revealed barriers to HIV disclosure in three domains: perceived stigma, shame and fear of rejection. Motivators to HIV disclosure consisted of the following: coping with illness, seeking help and common experiences. Findings from the face‐to‐face interviews included the following barriers: fear of privacy breach, fear of rejection and communication difficulties. The motivators to HIV disclosure included seeking supportive relationship, duty to inform and catharsis. Based on these findings, we are currently developing family‐focused HIV disclosure intervention in Northeastern Thailand.     

肺结核患者健康知识调查分析与健康教育对策

采用自行设计的调查表对本科135例出院后肺结核患进行健康知识调查,结果表明46％的患不了解不遵医嘱服药所产生的后果,其中36人未按要求完成服药计划;而健康知识认知途径来源于护士的仅占50％。针对上述问题,作提出增强护士健康教育意识．提高健康教育水平,建立分阶段健康教育的对策。     

Stigma and Spiritual Well-being among People Living with HIV/AIDS in Southern Appalachia

The Appalachian South is disproportionately affected by HIV/AIDS. Partly due to the negative connotation that this disease carries in religiously conservative areas, HIV-related stigma remains a critical barrier to HIV care in the South. However, spirituality is a well-documented, effective coping mechanism among persons living with HIV/AIDS (PLWH). The purpose of this study was to examine the relationship between HIV-related stigma and spiritual well-being among a sample of PLWH (n = 216) in Appalachian counties of Tennessee and Alabama using the HIV Stigma Scale and the Spiritual Well-being Scale. Overall, disclosure of HIV status was the most highly reported stigma concern. Women reported higher levels of stigma and religious well-being than men. While existential well-being was negatively correlated with stigma, no significant overall correlation was found between religious well-being and stigma. Our findings reveal the importance of defining theology and differentiating between cultural religious conditioning and internalized beliefs.     

稳定期精神分裂症患者病耻感影响因素分析

目的 了解稳定期精神分裂症患者的病耻感水平,并分析其相关因素.方法 采用一般情况调查表、精神疾病内在病耻感量表,对广州市某三级甲等专科医院272例稳定期精神分裂症患者进行问卷调查.采用Logistic回归分析探讨病耻感的影响因素.结果 213例(78.3%)患者存在病耻感,其中91例(33.5%)为中、重度.Logistic回归分析显示:患者的学历(OR=0.369,P<0.001)、工作状况(OR=0.393,P=0.030)、家庭收入(OR=0.636,P=0.010)、住院次数(OR=4.430,P<0.001)及病程(OR=5.392,P<0.001)是病耻感的影响因素.结论 稳定期精神分裂症患者普遍存在病耻感,尤其是低学历、无业、家庭收入低、反复多次住院及病程长的患者更加突出;医护人员应重视这个问题,通过健康教育等方法减轻患者的病耻感.     

Cavitary Penetration of Levofloxacin among Patients with Multidrug-Resistant Tuberculosis

A better understanding of second-line drug (SLD) pharmacokinetics, including cavitary penetration, may help optimize SLD dosing. Patients with pulmonary multidrug-resistant tuberculosis (MDR-TB) undergoing adjunctive surgery were enrolled in Tbilisi, Georgia. Serum was obtained at 0, 1, 4, and 8 h and at the time of cavitary removal to measure levofloxacin concentrations. After surgery, microdialysis was performed using the ex vivo cavity, and levofloxacin concentrations in the collected dialysate fluid were measured. Noncompartmental analysis was performed, and a cavitary-to-serum levofloxacin concentration ratio was calculated. Twelve patients received levofloxacin for a median of 373 days before surgery (median dose, 11.8 mg/kg). The median levofloxacin concentration in serum (C_max) was 6.5 μg/ml, and it was <2 μg/ml in 3 (25%) patients. Among 11 patients with complete data, the median cavitary concentration of levofloxacin was 4.36 μg/ml (range, 0.46 to 8.82). The median cavitary/serum levofloxacin ratio was 1.33 (range, 0.63 to 2.36), and 7 patients (64%) had a ratio of >1. There was a significant correlation between serum and cavitary concentrations (r = 0.71; P = 0.01). Levofloxacin had excellent penetration into chronic cavitary TB lesions, and there was a good correlation between serum and cavitary concentrations. Optimizing serum concentrations will help ensure optimal cavitary concentrations of levofloxacin, which may enhance treatment outcomes.     

Antiretroviral therapy adherence among patients living with HIV/AIDS in Thailand

The importance of antiretroviral therapy adherence for patients living with HIV/AIDS has been well documented. Despite this critical need, many do not follow prescribed regimens. To examine the barriers that lead to non‐adherence, we used cross‐sectional survey data from a randomized controlled intervention trial in northern and north‐eastern Thailand. Of the 507 patients that were enrolled in the trial, we analyzed 386 patients on antiretroviral therapy in order to examine the barriers to adherence. In addition to demographic characteristics, depressive symptoms, physical health, access to care, social support, and internalized shame, HIV disclosure and family communication were examined. The correlation analysis revealed that adherence is significantly associated with internalized shame, access to care, depressive symptoms, and family communication. Based on the multiple logistic regression analysis, depressive symptoms, access to care, HIV disclosure, and family communication were significant predictors of adherence. Having depressive symptoms remains a significant barrier to adherence, while access to care, HIV disclosure, and family communication play important positive roles. Our findings underscore the critical importance of addressing these various challenges that can influence adherence to antiretroviral therapy.     

精神分裂症患者孤独感与病耻感的调查分析

目的：分析精神分裂症患者孤独感与病耻感现状,探讨两者的相关性。方法选取广州市脑科医院住院的精神分裂症患者110例,采用一般资料调查表、孤独感量表和贬低-歧视感知量表进行调查。结果110例精神分裂症患者孤独感总分为（43.27±9.98）分,其中40～59分轻度孤独有68例,占61.8%;60～79分中度孤独有8例,占7.3%。病耻感条目均分为（2.44±0.52）,与量表中位2.50分比较差异无统计学意义（P>0.05）。精神分裂症患者孤独感与病耻感呈正相关（r=0.486,P=0.003）。结论精神分裂症患者普遍存在孤独感与病耻感,病耻感较强,其孤独感较严重。医护人员需积极建立良好的护患关系,帮助患者改善精神症状的同时,关注患者的心理健康,帮助患者与周围成员建立良好的人际关系,降低其病耻感与孤独感。     

AIDS合并皮肤疾病患者185例的护理

目的探讨艾滋病(acquired immunodeficiency syndrome,AIDS)合并皮肤疾病患者的护理方法。方法回顾性分析2004年10月至2011年10月广西龙潭医院收治的185例AIDS合并皮肤疾病患者的临床资料,总结其护理要点。结果经治疗,患者中皮疹消退173例,病死12例。皮疹消退的173例患者经高效抗反转录病毒治疗,免疫重建效果良好。结论 AIDS合并皮肤疾病患者的临床表现多种多样,应根据其实际情况,采取相应的护理措施以提高治疗成功率。     

离休老年血液病患者社会支持的调查与分析

目的调查离休老年血液病患者社会支持的现状，为提高老年血液病患者生活质量提供参考依据。方法使用社会支持评定量表（social support rating scale，SSRS）对60例离休老年血液病患者进行闻卷调查，分析其社会支持现状和原因。结果离休老年血液病患者获得的社会支持处于较高水平，高于国内常模，比较有统计学意义（P〈0．01）；但支持利用度相对不足。结论离休老年血液病患者的社会支持利用度较低，应对此采取针对性措施，提高此类患者的社会支持利用度，以提高生活质量。     

社会关系质量在乳腺癌幸存者病耻感与社交回避及苦恼间的中介效应

目的 探讨乳腺癌幸存者社会关系质量在病耻感与社交回避及苦恼间的中介效应。方法 采用便利抽样法,选取于2019年5—9月在山东第一医科大学附属肿瘤医院、山东中医药大学附属医院乳腺外科门诊及病房复诊的228例乳腺癌幸存者作为研究对象,采用一般情况调查表、社会影响量表、社会关系质量量表和社交回避及苦恼量表对其进行调查,采用结构方程模型检验社会关系质量在病耻感与社交回避及苦恼间的中介效应。结果 乳腺癌幸存者病耻感、社会关系质量、社交回避及苦恼总分分别为（56.63±9.68）分、（50.53±6.08）分、（9.39±6.63）分;社会关系质量与病耻感、社交回避及苦恼总分均呈负相关（r=-0.463,-0.552;P<0.01）,病耻感与社交回避及苦恼总分呈正相关（r=0.532,P<0.01）;结构方程模型结果显示,病耻感对社交回避及苦恼有直接（正向）效应（β=0.421,P<0.01）,社会关系质量对社交回避及苦恼有直接（负向）效应（β=-0.404,P<0.01）,社会关系质量在病耻感与社交回避及苦恼之间起部分中介效应（β=0.211,P<0.01）。结论 乳腺癌幸存者社交回避及苦恼处于中等水平,社会关系质量在病耻感与社交回避及苦恼间起部分中介效应。建议在改善乳腺癌幸存者社交状况的干预工作中应重视社会关系质量的影响,以增强该人群的社会关系质量为依托,减轻病耻感,促进其社会交往。     

精神分裂症患者病耻感的研究进展

精神分裂症是一种慢性且严重的精神疾患,患者的精神症状可以通过药物治疗得到有效控制。Seeman等[1]调查表明,公众对精神疾病普遍存在歧视和偏见;而精神分裂症的耻辱感水平明显高于其他类型的精神疾病[2]。Gerlinger等[3]的系统综述结果表明,有1/3?1/2的精神分裂症患者因患此疾病而感到羞耻,并且在疾病的缓解期病耻感也持续存在。     

Pleural Tuberculosis in Patients with Early HIV Infection Is Associated with Increased TNF-Alpha Expression and Necrosis in Granulomas

Although granulomas may be an essential host response against persistent antigens, they are also associated with immunopathology. We investigated whether HIV co-infection affects histopathological appearance and cytokine profiles of pleural granulomas in patients with active pleural tuberculosis (TB). Granulomas were investigated in pleural biopsies from HIV positive and negative TB pleuritis patients. Granulomas were characterised as necrotic or non-necrotic, graded histologically and investigated for the mRNA expression of IL-12, IFN-γ, TNF-α and IL-4 by in situ hybridisation. In all TB patients a mixed Th1/Th2 profile was noted. Necrotic granulomas were more evident in HIV positive patients with a clear association between TNF-α and necrosis. This study demonstrates immune dysregulation which may include TNF-α-mediated immunopathology at the site of disease in HIV infected pleural TB patients.     

社区慢性病患者和高危人群知己健康管理效果评价

目的 探讨知己健康管理在社区慢性病患者及高危人群中实施的效果.方法 应用知己能量监测仪和生活方式疾病综合防治软件,对2006年6月-2010年12月北京德胜社区卫生服务中心和所属6个社区站1 227例慢性病患者及高危人群进行饮食、运动量化管理,纠正不良习惯,进行心理问题疏导和健康教育.结果 入选对象健康意识提高,建立了平衡膳食的观念,总运动量特别是有效运动量提高,逐步采取健康生活方式.管理后体质量指数、腰围、血糖、血压、血脂等改善均有统计学意义(P＜0.01).结论 知己健康管理行为干预模式具有科学化、个性化、数字化特点,患者易掌握可执行,监测方便,是社区卫生服务中控制慢性病发生发展的有效手段.