共患强迫障碍的Tourette综合征儿童的家庭环境及父母养育方式

目的：探讨共患强迫障碍（OCD）的Tourette综合征（TS）儿童的父母养育方式及家庭环境特点。方法：以33例共患OCD的TS儿童、40例单纯TS儿童和40例正常儿童为研究对象,采用家庭环境量表中文版及父母养育方式问卷中文版对所有受试者的家庭环境及其父母的养育方式进行评定。结果：共患OCD的TS儿童家庭的亲密度和情感表达因子分低于单纯TS组和正常对照组（5.7±1.4/7.1±1.4,7.6±1.2,P〈0.05）,矛盾性和控制性得分则高于单纯TS组和对照组（4.3±1.2/2.8±1.04,1.4±1.0,P〈0.05;4.8±1.7/4.1±1.4,3.5±1.2,P〈0.05）,共患病儿童组父亲的惩罚严厉和过分干涉（19.9±4.3,21.9±3.3）、过度保护分量表得分（12.8±2.4）高于单纯TS组（17.1±4.2,20.1±3.2,11.4±3.0）和正常儿童组（16.2±5.2,18.7±3.9,10.1±2.6）,情感温暖分量表得分低于正常儿童组（43.2±7.3/49.2±8.9,F=5.81,P=0.004）,拒绝否认得分高于正常儿童组（10.4±2.5/8.3±2.4,F=6.21,P=0.003）,但与单纯TS组差异无显著性。共患OCD的TS儿童组母亲的过分干涉保护和拒绝否认两个分量表得分高于其他两组（F=8.12、10.22、P=0.001,0.000）,其惩罚严厉分量表得分高于正常儿童组（F=3.37,P=0.038）,而两病例组间无差异。结论：共患OCD的TS儿童生活的家庭环境欠佳,其父母的养育方式存在问题。     

暴力犯罪者人格障碍研究

目的：研究暴力犯罪者的人格障碍。方法：随机抽取在重庆市女子监狱服刑的女性暴力罪犯204名，在重庆市监狱服刑的男性暴力罪犯294名，用人格诊断问卷（PDQ-R）、艾森克个性问卷（EPQ）进行测查。结果：男性在反社会型因子上得分高于女性（2±4／0±0，P=0．008）；女性在偏执型、分裂样、回避型因子上得分均高于男性（4±2／3±2、3±2／2±2、3±3／3±2，P=0．044、0．041、0．047）。结论：暴力犯罪者存在不同类型、不同程度的人格障碍。     

197名大学生的时间管理倾向与父母教养方式的关系

目的：探讨父母教养方式对大学生时间管理倾向的影响。方法：运用时间管理倾向量表和父母教养方式问卷对197名大学生施测,半年后进行追踪调查。结果：（1）197名大学生的时间价值感、时间监控观和时间效能感的性别差异不显著。大一学生的时间价值感和时间效能感均高于大二、大三和大四学生（3.9±0.5/3.3±0.6、3.2±0.6、3.4±0.6,P〈0.001;3.5±0.4/3.3±0.5、3.1±0.4、3.3±0.4,P=0.010,0.000,0.004）。（2）权威型教养方式下大学生的时间价值感、时间监控观与时间效能感得分均高于专制型和忽视型（3.6±0.6/3.3±0.6、3.3±0.6,P=0.015,0.018;3.2±0.4/3.1±0.3、3.0±0.4,P=0.026,0.000;3.4±0.5/3.2±0.4、3.2±0.5,P=0.022,0.005）。（3）父母教养方式的接受-参与性对时间价值感、时间监控观和时间效能感具有正向预测作用（β=0.32、0.33、0.36）,严厉-监督性对时间监控观和时间效能感有正向预测作用（β=0.22、0.14）。（4）专制型教养大学生的时间监控观和忽视型教养大学生的时间效能感得分在半年里均显著降低（3.3±0.3/3.1±0.3、3.5±0.5/3.2±0.4,P=0.007,0.001）。结论：接受-参与性和严厉-监督性对大学生时间管理的水平与稳定性有积极影响,前者的作用相对较大。权威型教养的大学生时间管理优于专制型和忽视型。     

家庭环境对儿童探究行为及同伴交往的影响

目的：考察儿童探究行为及同伴交往类型与家庭环境的关系。方法：由父母填写家庭环境量表，测量儿童的家庭环境；然后在实验室及自由活动时间录像观察并编码，分析56名儿童的探究行为和同伴交往类型，考察两者间的关系。结果：男孩单独被动活动及探索性行为的频率得分均高于女孩[（18．5±3．7）vs．（13．2±3．8），（5．4±2．0）vs．（3．9±1．5）；P=0．003，0．006]，而互动活动和探究行为的持续时间得分均低于女孩[（9．4±2．7）vs．（12．6±3．1），（2．1±0．9）vs．（3．3±1．2）；P=0．041，0．032]；家庭亲密度与同伴交往中的抑制行为、单独被动活动负相关（r=-0．26、-0．24，P〈0．01），而与平行活动、单独主动活动、互动活动正相关（r=0．14、0．28、0．38，P〈0．05或0．01）；儿童探究行为与家庭的独立性、知识性、乐观因子呈正相关（r=0．46、0．33、0．38，P〈0．05或0．01），与控制性、矛盾性、悲观因子呈负相关（r=-0．41、-0．38、-0．33，P〈0．05或0．01）。多元逐步回归分析显示，对于不同家庭环境中有6个因子是对儿童同伴交往的预测变量（联合解释变异量为0．437），5个因子是对儿童探索性的预测变量（联合解释变异量为0．362）。结论：家庭环境与儿童的探究行为及同伴交往类型密切相关。     

父母教养行为在儿童2岁和7岁时的差异及与儿童抑制性的关系

目的：考察父母教养行为在儿童2岁和7岁时的差异及其与儿童抑制性的关系。方法：采用实验室观察法对56名儿童2岁时的抑制性进行评价,用问卷法对父母在儿童2岁和7岁时的教养行为分别进行测量。结果：（1）儿童2岁时母亲的情感表达控制和惩罚评分都低于父亲（2.9±0.7/3.4±0.8,t=-4.47,P=0.000;2.8±0.6/3.1±0.8,t=-2.31,P=0.020）,7岁时母亲的惩罚高于父亲（3.3±0.6/3.0±0.8,t=2.17,P=0.030）。（2）7岁时测量得到的母亲的担忧（3.7±0.8/4.4±0.7）、接纳（4.7±0.5/4.9±0.5）评分较2岁下降,惩罚评分增加（3.3±0.6/2.8±0.6）且有统计学意义（F（1,53）=10.98,F（1,53）=6.89,F（1,53）=20.58,P〈0.01）,7岁时父亲的担忧评分较2岁时也下降（3.7±0.8/3.9±0.6,F=5.63（1,53）,P〈0.01）。（3）两次测量中,母亲对三种抑制类型儿童情感表达的控制都存在显著差异（F（2,53）=2.96,P=0.050）。（4）测量与抑制性对母亲的拒绝和排除限制的鼓励独立存在交互作用（F（2,53）=3.39,F（2,53）=4.20,P〈0.05）。结论：父亲的教养行为比较稳定,母亲的教养行为变化较多且母亲的拒绝和鼓励独立方面与儿童的抑制性有更多的关联,母亲对抑制型儿童的教养表现出较多消极的行为和行为的变化。     

小学生同伴接纳、教师接纳、学业成绩与心理健康的关系

目的：探讨同伴接纳、教师接纳、学业成绩与小学生心理健康的关系。方法：采用分层随机抽样的方法从福州市三所小学二、四、五年级的2200名学生中抽取445名学生，通过社会测量法和儿童行为量表来测量小学生心理健康状况，结合方差、相关等统计分析方法探讨这四者的关系。结果：小学男生Achebach儿童行为量表评分位于前3位的依次为：攻击性（8．45±6．05）、多动（4．82±3．51）、强迫性（4．56±4．18）。小学女生评分位于前3位的依次为：攻击性（7．79±6．03）、抑郁（5．05±4．20）、多动（4．69±3．67）；心理健康和同伴接纳、教师接纳、学业成绩之间呈负相关（r=-0．22、-0．26、-0．17，均P〈0．01）；不同同伴接纳、教师接纳和学业成绩水平小学生的心理健康存在显著的差异（F=11．610、11．34、6．147，P〈0．01）。进一步两两比较发现：高同伴接纳组的Achebach儿童行为量表总分低于中等接纳组和低接纳组[（25．3±17．2）vs．（30．7±21．7）、（42．4±22．2），P〈0．001]，中等接纳组得分低于低接纳组（P〈0．001）；低教师接纳组的Achebach儿童行为量表总分高于高接纳组和中等接纳组[（46．6±24．9）vs．（25．7±25．4）、（30．7±21．7），P〈0．001]，中等接纳组得分高于高接纳组（P〈0．001）；高成绩组的Achebach儿童行为量表总分低于中等成绩组和低成绩组[（25．3±17．9）vs．（31．1±21．9）、（38．4±22．0），P〈0．001]，中等成绩组低于低成绩组（P〈0．05）。结论：教师接纳程度低的学生心理健康水平也低。学业成绩好的学生同伴接纳水平和教师接纳水平也高。同伴接纳、教师接纳和学业成绩对小学生的心理健康会产生一定的影响。     

本人知情同意与家属知情同意情况下患者术前心理状况的比较

目的：探讨知情同意对常规手术患者的心理影响。方法：根据术前知情同意实施现状,将新入院待手术的患者分为患者知情组（N=29）、家属知情组（N=31）,采用焦虑自评量表、抑郁自评量表和症状自评量表,结合访谈的方法对两组知情同意前、后的心理状况进行了评估和比较。结果：（1）在两组间一般资料构成比比较中,患者知情组的男性比例和受教育程度高于家属知情组（19/10：6/25,χ^2=13.14,P〈0.001;7/12/10：14/14/3,z=-2.33,P〈0.05）;在年龄上,患者知情组平均年龄47±14岁,家属知情组平均年龄52±13岁,在科室构成上,肝胆外科、肿瘤外科、骨一科患者知情组与家属知情组的构成分别为9/12/8和19/8/4,以上两组间未达到统计学差异（P〉0.05）。（2）知情同意前及知情同意后两组焦虑、抑郁和心身症状的测评结果无明显差别,如患者知情组焦虑得分两次分别为33.9±7.0和32.5±7.4,家属知情组分别为33.8±6.6和33.6±7.5;抑郁得分患者知情组两次分别为33.0±7.4和31.7±8.0,家属知情组分别为34.1±6.5和33.6±6.6。以上断面比较经统计学检验均P〉0.05。（3）在知情同意前、后比较中,患者知情组症状自评量表总分下降,由113.5±21.9下降到107.4±18.0（t=2.93,P〈0.05）,家属知情组变化不明显（114.7±33.8到113.7±39.0,P〉0.05）。结论：采取自愿方式及适宜的告知方法由患者本人知情同意,患者的心理状况与选择家属知情同意的患者无明显区别。     

汉、藏、彝族青少年负面身体自我评价比较

目的：探讨汉、藏、彝族青少年负面身体自我评价的特点。方法：采用青少年负面身体自我量表测量汉、藏、彝族990名中学生身体自我满意度的状况,并进行不同层面的分析。结果：汉、藏、彝族青少年负面身体自我量表评分为1.34±0.37。民族和性别对青少年负面身体自我量表评分影响没有交互作用。在总体负面身体自我和相貌、瘦维度上,彝族青少年得分（1.42±0.03、1.58±0.06、1.05±0.05）分别高于汉族、藏族青少年（汉族：1.26±0.02、1.23±0.04、0.89±0.03,藏族：1.26±0.03、1.15±0.05、0.88±0.04,P〈0.05或0.01）;在整体特征维度上,藏族青少年得分（2.23±0.03）分别高于汉族、彝族（2.09±0.03、2.12±0.04）;在胖维度上,藏族、彝族青少年得分（1.01±0.05、1.14±0.05）均显著高于汉族（0.88±0.04,P〈0.05）。女生的相貌特征、胖维度和总体负面身体自我评分均高于男生（1.41±0.04/1.23±0.04,1.24±0.04/0.78±0.04,1.36±0.02/1.26±0.02,P=0.001）,瘦和整体特征维度评分低于男生（0.85±0.04/1.03±0.03,2.11±0.03/2.19±0.03,P=0.001）。结论：青少年负面身体自我存在民族差异和性别差异,在教育干预上应区分对待。     

男性更年期综合征的心身特点

目的：探讨男性更年期综合征的临床特征。方法：以主动到心理咨询门诊的男性更年期综合征患者60例为研究组（A组）,以女性更年期综合征患者148例为女性对照组（B组）,另有来自大学和医院的男性职工62人为正常对照组（C组）。采用一般资料、Locke-wallace婚姻调适测定、生命质量评定量表（TDL）、生活事件评定量表（LES）、应激量表（WSP）、社会支持量表（SSRS）、艾森克人格问卷（EPQ）等,从心身角度对A、B两组进行多方面的对照,且对A组与C组进行了性激素测定对照,对A组血清睾酮、雌激素水平与更年期症状（Kupperman评分）进行了相关分析。结果：①A组不良生活方式、伴发躯体慢性疾病比例及婚姻质量评分高于B组（32/60、28/148;19/60、26/148;107.2±11.0、70.6±22.7,χ^2=24.64、5.01、t=11.89,P〈0.01）,而B组神经质性人格比例高于A组（66/148、12/60,χ2=11.02,P〈0.01）。②A组LES、SSRS分值高于B组（70.1±23.2/62.2±15.5,53.3±5.0/20.8±7.0,t=2.88、32.93,P〈0.01）,B组WSP分值高于A组（35.5±2.8/30.0±5.9,t=9.08,P〈0.01）。A、B两组Kup-perman总分比较差异无显著性,但因子分差异有显著性。③A组雌激素水平显示高于C组（40.8±9.2/35.7±10.3,t=2.86,P〈0.05）。④A组血清睾酮与Kupperman总分无相关（r=0.03,P〉0.05）,但雌激素与Kupperman总分呈正相关（r=0.57,P〈0.01）。结论：男性更年期综合征的临床特征有别于女性,血清雌激素水平可能与男性更年期症状的产生有关。     

中学生对立违抗性障碍的父母养育方式和家庭环境特征的初步研究

目的：了解单纯对立违抗性障碍（ODD）儿童的父母养育方式及家庭功能。方法：应用向制儿童行为调查表、家庭环境量表中文版（FES～CV）、父母养育方式量表（EMBU），对115例单纯ODD儿童（研究组）和115名非ODD正常儿童（对照组）进行评定和病例对照分析，结果：ODD组儿童家庭矛盾性得分较对照组高（P〈0．01），ODD组父母双亲的“情感温暖．理解”得分均明显比对照组得分低（父亲P〈0．01，母亲P〈0.05）．而其“惩罚，严厉”和“拒绝，否认”二因子得分则明显比对照组高（P〈0．01）；ODD组母亲的“过分干涉，过度保护”，因子得分也明显高于对照组（P〈0．01）。结论：ODD中学生的家庭存在高度的矛盾性．他们的父母养育方式不良，应引起重视。     

Pain and Effusion and Quadriceps Activation and Strength

Context:

Quadriceps dysfunction is a common consequence of knee joint injury and disease, yet its causes remain elusive.

Objective:

To determine the effects of pain on quadriceps strength and activation and to learn if simultaneous pain and knee joint effusion affect the magnitude of quadriceps dysfunction.

Design:

Crossover study.

Setting:

University research laboratory.

Patients or Other Participants:

Fourteen (8 men, 6 women; age = 23.6 ± 4.8 years, height = 170.3 ± 9.16 cm, mass = 72.9 ± 11.84 kg) healthy volunteers.

Intervention(s):

All participants were tested under 4 randomized conditions: normal knee, effused knee, painful knee, and effused and painful knee.

Main Outcome Measure(s):

Quadriceps strength (Nm/kg) and activation (central activation ratio) were assessed after each condition was induced.

Results:

Quadriceps strength and activation were highest under the normal knee condition and differed from the 3 experimental knee conditions (P < .05). No differences were noted among the 3 experimental knee conditions for either variable (P > .05).

Conclusions:

Both pain and effusion led to quadriceps dysfunction, but the interaction of the 2 stimuli did not increase the magnitude of the strength or activation deficits. Therefore, pain and effusion can be considered equally potent in eliciting quadriceps inhibition. Given that pain and effusion accompany numerous knee conditions, the prevalence of quadriceps dysfunction is likely high.Key Words: arthrogenic muscle inhibition, central activation failure, voluntary activation, muscles

Key Points

• Knee pain and effusion resulted in arthrogenic muscle inhibition and weakness of the quadriceps.
• The simultaneous presence of pain and effusion did not increase the magnitude of quadriceps dysfunction.
• To reduce arthrogenic muscle inhibition and improve muscle strength, clinicians should employ interventions that target removing both pain and effusion.

Quadriceps weakness is a common consequence of traumatic knee joint injury^1,2 and chronic degenerative knee joint conditions.^3,4 Arthrogenic muscle inhibition (AMI), a neurologic decline in muscle activation, results in quadriceps weakness and hinders rehabilitation by preventing gains in strength.⁵ The inability to reverse AMI and restore muscle function can lead to decreased physical abilities,⁶ biomechanical deficits,⁷ and possibly reinjury.⁵ Furthermore, researchers^8,9 have suggested that quadriceps weakness resulting from AMI may place patients at risk for developing osteoarthritis in the knee. In light of the substantial influence of quadriceps AMI on these clinically relevant outcomes, we need to improve our understanding of the factors that contribute to this neurologic decline in muscle activity so efforts to target and reverse it can be implemented and gains in strength can be achieved more easily.Joint injury and disease are accompanied by numerous sequelae (ie, pain, swelling, tissue damage, inflammation), so ascertaining which one ultimately leads to neurologic muscle dysfunction is difficult. Whereas a joint effusion can result in AMI,^10–12 the effects of pain are less understood despite many clinicians attributing AMI to pain. Using techniques that introduce knee pain without accompanying injury may provide insights into the role of pain in eliciting AMI.The degree of knee joint damage may play a role in the quantity of AMI that manifests. Hurley et al^13,14 demonstrated that quadriceps AMI, measured using an interpolated-twitch technique, was greater in patients with extensive traumatic knee injury (eg, fractured tibial plateau, ruptured medial collateral ligament, and medial meniscectomy) than patients with isolated joint trauma (ie, isolated anterior cruciate ligament [ACL] rupture). Similarly, patients with more knee joint symptoms (ie, greater number of symptoms and increased severity of symptoms) may present with greater magnitudes of quadriceps inhibition. Recently, investigators¹⁵ have suggested that patients with more pain display less quadriceps strength, supporting this tenet. Given that effusion and pain often present simultaneously with joint injuries and diseases, such as ACL injury and osteoarthritis, examining both the isolated and cumulative effects of these sequelae appears warranted to determine if they influence the magnitude of muscle inhibition.Experimental joint-effusion and pain models are safe and effective experimental methods that allow for the isolated examination of their effects on muscle function. The effusion model, whereby sterile saline is injected directly into the knee joint capsule,⁷ produces a clinically relevant magnitude of the joint effusion that may be present with traumatic injury. Effusion is thought to activate group II afferents responding to stretch or pressure,^16–18 which in turn may facilitate group Ib interneurons and result in quadriceps AMI.⁵ The pain model involves injecting hypertonic saline into the infrapatellar fat pad to produce anteromedial knee pain similar to that described in patients with patellofemoral pain syndrome.¹⁹ Pain is considered to initiate AMI through activation of group III and IV afferents that act as nocioceptors to signal damage or potential damage to joint structures.^16–18 The firing of these afferents then may lead to facilitation of group Ib interneurons, the flexion reflex, or the gamma loop, ultimately resulting in quadriceps inhibition.²⁰ Thus, these models allow us to create symptoms that are associated with knee injury and have the added benefit of providing a way to examine their effects in isolation.Therefore, the purpose of our study was to determine the effects of pain on quadriceps strength and activation and to learn if simultaneous pain and knee joint effusion would affect the magnitude of quadriceps dysfunction. We hypothesized that pain alone would result in quadriceps inhibition and that the magnitude of inhibition would be greater when effusion and pain were present simultaneously.     

即早基因c-fos与脑血管病及学习记忆

即早基因c-fos是广泛存在于原核细胞和真核细胞的高度保守基因.在正常情况下,c-fos基因参与细胞生长、分化、信息传递、学习和记忆等生理过程,而在病理情况下c-fos基因表达及调控变化与多种疾病的发生和发展有关.C-fos在中枢神经系统的某些部位可有基础水平的表达,但表达很低,当受到如脑缺血、脑出血、痫性发作、应激等刺激后,其在数十分钟内做出反应,在对外界刺激-转录耦联的信忠传递过程中起着核内第三信使的重要作用.     

Opportunities and challenges in the prevention and control of cancer and other chronic diseases: children's diet and nutrition and weight and physical activity

OBJECTIVE: The purpose of this article is to review the role of behavioral research in disease prevention and control, with a particular emphasis on lifestyle- and behavior-related cancer and chronic disease risk factors--specifically, relationships among diet and nutrition and weight and physical activity with adult cancer, and tracking developmental origins of these health-promoting and health-compromising behaviors from childhood into adulthood. METHOD: After reviewing the background of the field of cancer prevention and control and establishing plausibility for the role of child health behavior in adult cancer risk, studies selected from the pediatric published literature are reviewed. Articles were retrieved, selected, and summarized to illustrate that results from separate but related fields of study are combinable to yield insights into the prevention and control of cancer and other chronic diseases in adulthood through the conduct of nonintervention and intervention research with children in clinical, public health, and other contexts. RESULTS: As illustrated by the evidence presented in this review, there are numerous reasons (biological, psychological, and social), opportunities (school and community, health care, and family settings), and approaches (nonintervention and intervention) to understand and impact behavior change in children's diet and nutrition and weight and physical activity. CONCLUSIONS: Further development and evaluation of behavioral science intervention protocols conducted with children are necessary to understand the efficacy of these approaches and their public health impact on proximal and distal cancer, cancer-related, and chronic disease outcomes before diffusion. It is clear that more attention should be paid to early life and early developmental phases in cancer prevention.