不同群体的应激、应对与心理健康

目的：探讨不同受教育程度、性别、年龄群体的应激、应对与心理健康水平。方法：用自编社会应激事件调查量表、简易应对量表、SCL-90症状自评量表对某集团4745名员工进行问卷调查。结果：低等受教育程度群体的社会应激、积极应对、消极应对、SCL-90总分均最低，高等受教育程度群体的社会应激、积极应对、消极应对得分最高；男性的社会应激、积极应对、消极应对得分高于女性，SCL-90总分低于女性；年轻群体的社会应激和SCL-90总分得分高于年龄较大的群体。结论：后期的教育培训可能会改善心理健康水平。     

应激情景中焦虑和健康状况心理控制源的实证研究

目的 探讨应激情景中，特质焦虑的稳定性变化、状态焦虑的唤醒及健康状况的归因。方法 在真实存在的、自然发生的应激情景(SARS)中，用《状态—特质焦虑问卷(STAI)》和《多维度健康状况心理控制源量表(MHLC)》对568名大学生进行问卷调查。结果 在非应激情景中，被试的特质焦虑高于状态焦虑，应激情景下，状态焦虑高于特质焦虑且特质焦虑的稳定性受到明显影响。同时，不同基础特质焦虑水平的被试，其状态焦虑的变化过程及应激情景中的健康状况心理控制源亦不相同。结论 应激事件的刺激使特质焦虑失去原有的稳定性，不同基础特质焦虑水平的个体在应激事件中状态焦虑唤醒水平的相似性(倾同性)，但其健康状况归因不同。     

应激对鼠脾NK细胞穿孔素及颗粒酶的mRNA表达的影响

目的：阐明躯体性应激和心理性应激降低NK细胞杀伤活性的机制及异同。方法：应用Communication box系统分别使小鼠连续负荷躯体性应激和心理性应激后，以放免法检测鼠血浆类固醇激素水平：以^51Cr释放法检测鼠脾NK细胞杀伤活性；以流式细胞术检测鼠脾NK细胞数量；以RT-PCR技术检测鼠脾细胞中杀伤效应介质——穿孔素、颗粒酶A及B的mRNA表达水平。结果：负荷躯体性应激和心理性应激后，小鼠血浆类固醇激素水平升高，分别于第3天和第5天达高峰后，逐渐下降；两者均可导致鼠脾NK细胞数量减少，杀伤活性降低（P〈0．05，P〈0．01）；两者均可导致穿孔素的mRNA表达下降；但躯体性应激降低颗粒酶A的mRNA表达，而颗粒酶B的mRNA表达反而升高；心理性应激可降低颗粒酶B的mRNA表达，虽然也降低颗粒酶A的mRNA表达，但无显著性差异。结论：躯体性应激和心理性应激均可降低脾NK细胞数量及其杀伤活性，但对杀伤效应介质——穿孔素、颗粒酶A及B的mRNA表达的影响不同，提示躯体性应激和心理性应激对NK细胞功能影响的机制不同。     

情绪反应、个性特征与月经失调的关系

目的：了解月经失调在女学生中的发生情况，探讨月经失调与情绪状态、个性特征等心理社会因素之间的关系。方法：本研究采用分层整群抽样的调查法和心理测验法，对521名调查对象实施了月经健康问卷、状态特质焦虑问卷、流调中心用抑郁量表、艾森克个性问卷调查。结果：月经失调占总调查人数的44．7％；应激时的焦虑、抑郁评分均值显著高于平时；女生月经失调发生率有随年龄、考试应激时焦虑、抑郁反应强度以及特质焦虑水平增加而增加的趋势。结论：情绪状态、个性特征等心理社会因素对女生月经失调的发病起重要作用,临床应重视相应心理干预对策的运用。     

污名对感染新冠病毒医护人员心理应激的影响：心理弹性、睡眠质量及社会支持的序列中介效应

目的：探讨新冠病毒感染后医护人员污名与心理应激的关系，以及心理弹性、睡眠质量和社会支持在其中的中介作用。方法：采用方便取样法，通过网络问卷平台对某医院的1032名医护人员进行在线调查。使用应激感受量表-10、社会影响量表、社会支持评定量表、成人心理弹性量表、匹兹堡睡眠质量指数对其进行调查，并对污名进行潜类别分析，比较不同类别的心理应激差异。结果：污名可分为社会排斥型，社会隔离型及内在羞耻型三种类别，其中社会排斥型的心理应激程度最高。且污名对心理应激有正向预测作用。心理弹性、睡眠质量及社会支持在污名对心理应激的作用中起多重序列中介作用，即污名分别通过心理弹性、睡眠质量、社会支持、心理弹性→睡眠质量、心理弹性→社会支持、社会支持→睡眠质量及心理弹性→社会支持→睡眠质量对心理应激起显著间接作用。结论：污名可以直接影响感染新冠病毒医护人员的心理应激，也可以通过心理弹性、睡眠质量及社会支持的多重序列中介作用间接影响其心理应激。     

地震重灾区民警灾后3个月的应激特点

目的及时了解地震重灾区民警在灾后3个月的应激特点以及变化规律，以此制定相应的计划和对策。方法使用自编的民警灾后应激调查问卷．对重灾区125名一线民警进行调查。结果重灾区民警在灾后3个月的心理应激依然突出，并存在显著差异（P〈0．01），其中北川民警的心理应激突出；对北川、安县、江油进行纵向对比，除北川在生理应激上有显著改善（P〈0．01）之外，北川的其他因子、其他地区的所有因子均无显著改善。结论①灾后3个月，地震重灾区民警心理应激和行为应激比较突出；②地震重灾区民警比较突出的是心理应激，受灾越严重，心理应激越严重，以北川为甚，而其他因子在地区上则无显著性差异；③地震重灾区民警的应激反应与灾后10天相比无大的改善，部分民警的应激特点符合创伤后应激障碍的症状和诊断标准。     

应激对大鼠血清皮质醇及白细胞介素2、6、8水平的影响

目的：探讨心理应激时，大鼠血清皮质醇及IL－2、IL－6、IL－8水平的改变。方法：雄性SD大鼠18只，随机分为对照组8只，实验组10只；制造心理社会应激动物模型，于应激后1h取大鼠血清，用放射免疫法检测血清IL－2、IL－6、IL－8及皮质醇水平。结果：应激后1h，皮质醇水平显著升高（P＜0．01）；IL－2、IL－6和IL－8水平皆显著降低（P＜0．05），结论：心理应激后，大鼠免疫功能受到抑制。     

潜艇艇员心理应激与个性特征、应对方式及社会支持的关系研究

目的探讨潜艇艇员心理应激与个性特征、应对方式及社会支持的关系。方法对460名游艇艇员进行量表测评，包括心理社会应激调查表（PSSG）、卡特尔16种人格因素问卷（16PF）、特质应对问卷（TCSQ）和领悟社会支持量表（PSSS），数据采用SPSS15．0和Amos7．0进行统计分析。结果①潜艇艇员不同衔级组间心理应激水平存在高度显著性差异（F=12．12，P〈0．01），其中高级士官及军官组（51．46±25．19）心理应激水平最高，而义务兵组（35．63士16．94）最低；②潜艇艇员心理应激水平与适应与焦虑型（0．68）和消极应对（0．63）等呈高度显著性正相关，与内向与外向型（-0．41）、社会支持（-0．33）、积极应对（-0．32）和感情与安详型（-0．30）等呈高度显著性负相关；③多元逐步回归分析标准回归系数排在前3位的变量依次为：适应与焦虑型、消极应对、社会支持（标准回归系数依次为0．441、0．300、-0．107）；④路径分析显示适应与焦虑型对潜艇艇员心理应激既有直接效应又有间接效应，且以直接效应为主（总效应0．682，直接效应0．441）；消极应对和社会支持对心理应激具有直接效应（分别为0．300和-0．107）；积极应对和内向与外向型对心理应激具有间接效应（分别为-0．027和-0．005）。结论潜艇艇员心理应激水平受个性特征、应对方式及社会支持的影响。     

心理控制源、社会支持对大学生积极心理的影响

目的探讨心理控制源、社会支持对大学生积极心理的影响。方法对284名大学生施测心理控制源量表（I-E）、社会支持评定量表（SSRS）、一般健康问卷（GHQ-20）。结果①大学生不同的控制倾向所得的社会支持及对支持的利用度都有明显的差异；②大学生心理控制原、社会支持与心理健康有显著的相关；③大学生心理控制源与社会支持对心理健康的预测作用显著。结论社会支持是影响大学生积极心理的是中介变量，探讨三者之间的关系对于研究大学生心理健康状况具有重要意义。     

四种不同职业女性心理健康状况调查

目的 了解不同职业女性对家庭与职业的满意度、心理健康水平，以及家庭和职业生活支其心理健康状况的影响。方法 使用自制职业与家庭生活满意度调查问卷、症状自评量表（ＳＣＬ－９０）、社交苦恼与回避量表（ＳＡＤ）、感情与社交孤独量表（ＳＨＬ），调查４５５例。结果 四组心理健康水平优于一般人群；医护人员组与教师组心理障碍明显多于干部组与服务组，社交苦恼与回避、感情与社交孤独等负性体验，均教师组多于其余三组。ＳＣＬ－９０反映的心理健康水平，主要与受调查者人际关系及职业成就感密切相关，而家庭生活项目无关，ＳＡＤ、ＳＥＬ反映的心理健康水平，主要与受调查者家庭生活项目密切相关，而与职业度项目无关。结论 不同职业女性心理健康状况有差异，心理健康的不同层次具有不同的相关因子。     

Can medical school admission committee members predict which applicants will choose primary care careers?

PURPOSE: To determine the accuracy of admission committee members' predictions regarding which applicants are likely to become generalists, and to determine which applicant characteristics are used and should be used in making these predictions. METHOD: Thirteen characteristics of each applicant who entered medical school in 1990-1993 and graduated in 1994-1997 were obtained from their applications. Committee members reviewed these characteristics and assigned a probability of each applicant's choosing a generalist career. Just before their graduation, the students were surveyed to ascertain their career plans. The relationships between the characteristics and career predictions were analyzed using regression models. A secondary analysis examined the relationship between the students' stated career preferences at matriculation and career plans at graduation. RESULTS: The accuracy of the committee members' predictions was low. Predictions of generalist careers were significantly related to seven applicant characteristics: rural legal residence, gender (women), lower science grades, lower MCAT science scores, lower levels of parents' education, no reported research activity, and higher levels of community service. In contrast, the students' actual generalist career plans at graduation were significantly related only to gender (women) and higher levels of community service. In the secondary analysis, applicants' stated career preferences at matriculation were the strongest predictor of their having generalist career plans at graduation. CONCLUSIONS: Admission committee members often made inaccurate predictions about applicants' career plans. This may be because they based their judgments on applicants' characteristics that were not significantly related to the students' career plans at graduation.     

Obstacles to promotion? Values of women faculty about career success and recognition. Committee on the Status of Women and Minorities, Virginia Commonwealth University, Medical College of Virginia Campus.

PURPOSE: To assess attitudes of female faculty about career progress, resources for career development, and values related to academic success and recognition. METHOD: In 1997, the authors surveyed all faculty at Virginia Commonwealth University School of Medicine and its associated Veterans Affairs Medical Center. RESULTS: Of 918 faculty, 567 (62%) responded to the survey; 33% of the respondents were women. Compared with men, women faculty were less likely to be tenured or at the level of professor, spent more time in clinical activities, had less time for scholarly activity, and reported slower career progress. Women were more likely to report that promotion and tenure criteria had not been reviewed with them. Significant differences were found between female physicians and non-physician faculty; female physicians reported the least time for scholarly activities and poorest understanding of promotion and tenure criteria. When the authors asked faculty how they valued certain indicators of career success, women were less likely to value leadership than were men. Female physicians were less likely to value scholarship and national recognition as indicators of their career success. CONCLUSION: This survey found important differences in career progress of male and female faculty, with women reporting less time for career development. In addition, there were differences in values related to career success and recognition, which were most pronounced for female physicians. These differences may have an important impact on promotion for women in general and particularly for female physicians.     

The career outcomes for doctors completing general practice vocational training 1990-1995.

BACKGROUND: While much has been published about the career outcomes of doctors who completed general practice vocational training prior to 1990, no evidence is currently available about those who have qualified since that time. AIM: To obtain information about the career paths of doctors who had completed general practice vocational training since 1990, and to compare the results with previously published data. METHOD: Postal questionnaire survey of all doctors completing vocational training during the period 1990-1995 in three regions of the United Kingdom. The study examined current work status, career path since completion of training, desire for and experience of part-time training, degree of difficulty in choosing and following a career, and the degree to which certain factors impeded career choice. RESULTS: The overall response rate was 64.8%, although there was a significant difference between the response rates for men and women. While virtually all responders were employed, with the majority working in general practice, women were significantly less likely than men to be working as principals in general practice, for all cohorts. These results were very similar to those cohorts described in earlier studies. The career paths of doctors only became stable after about four years. Of those working in general practice, about 20% found it difficult to choose their career, and about 10% found it difficult to follow their career. Out-of-hours work was the major factor impeding career choice. CONCLUSION: Although they are taking longer to reach, the final career destinations of doctors completing vocational training since 1990 are no different from those of earlier cohorts.     

Employment status passages and psychosocial well-being

Medical students entering the labor market were studied to find out whether the improvement of psychosocial well-being depends on characteristics of their careers. Psychosocial well-being was described on the basis of psychosomatic stress symptoms, psychological distress (General Health Questionnaire), and strain resistance resources (Sense of Coherence). The 3-year follow-up showed that among women the improvement of strain resistance resources was delayed in the group with several entries into work. Among men the findings suggested associations between stress symptoms and career characteristics. Most of the results, however, did not support the hypothesis about the division of the participants into those with a stable career and improving well-being and those with a fragmented career and low well-being.     

Gender and medical careers

The concerns about physicians’ career advancement tend to be raised in gender terms, because women presently constitute close to and will soon form a majority of the medical students in most western societies. The question is to what extent female and male medical students and residents today make similar or different career and lifestyle choices? Two major mechanisms have been referred to as the reason for gender differences in career paths for physicians. The major theoretical framework tends to be the socialization or sex-role theory and later versions of this explanatory framework. The other mechanism referred to is structural and points to the barriers or the concrete support that women and men experience in making their career decisions. Studies of medical students in the UK and US have shown that women students expected family demands to hamper career plans, while male students were less influenced by family concerns. The importance of role models and mentors in setting the career goals of medical students and residents has recently confirmed early studies of the topic. A number of studies have documented that early negative experiences or lack of encouragement in medical school deter women from choosing surgery as a career. Recent studies suggest that lifestyle choices rather than merely career advancement influence both female and male surgeons’ career plans.     

Women in academic general surgery.

PURPOSE: To portray the professional experiences of men and women in academic general surgery with specific attention to factors associated with differing academic productivity and with leaving academia. METHOD: A 131-question survey was mailed to all female (1,076) and a random 2:1 sample of male (2,152) members of the American College of Surgeons in three mailings between September 1998 and March 1999. Detailed questions regarding academic rank, career aspirations, publication rate, grant funding, workload, harassment, income, marriage and parenthood were asked. A five-point Likert scale measured influences on career satisfaction. Responses from strictly academic and tenure-track surgeons were analyzed and interpreted by gender, age, and rank. RESULTS: Overall, 317 surgeons in academic practice (168 men, 149 women) responded, of which 150 were in tenure-track positions (86 men, 64 women). Men and women differed in academic rank, tenure status, career aspirations, and income. Women surgeons had published a median of ten articles compared with 25 articles for men (p <.001). Marriage or parenthood did not influence numbers of publications for women. Overall career satisfaction was high, but women reported feeling career advancement opportunities were not equally available to them as to their male colleagues and feeling isolation from surgical peers. Ten percent to 20% of surgeons considered leaving academia, with women assistant professors (29%) contemplating this most commonly. CONCLUSION: Addressing the differences between men and women academic general surgeons is critical in fostering career development and in recruiting competitive candidates of both sexes to general surgery.     

自然流产妇女血清氧化应激状态分析

目的通过对自然流产女妇血清氧化应激指标———超氧化物歧化酶(SOD)、丙二醛(MDA)及维生素E(VE)的测定,分析其氧化应激状态。方法用化学比色法对20例正常未孕妇女、20例正常孕早期妇女及20例自然流产妇女血清中SOD、MDA及VE进行测定。结果与未孕妇女相比,正常孕早期妇女血清MDA升高(P<0.05),SOD和VE也显著升高(P<0.05;P<0.05);与正常孕早期妇女相比。自然流产妇女血清MDA水平升高(P<0.05),SOD、VE水平却下降(P<0.05;P<0.05)。结论自然流产妇女处于氧化应澈状态中。     

Responses to laboratory psychosocial stress in postpartum women

OBJECTIVE: Lactation has been associated with attenuated hormonal responses to exercise stress in humans. This study was designed to determine the effect of lactation on hypothalamic-pituitary-adrenal axis, autonomic nervous system, and anxiety responses to psychological stress. METHOD: The Trier Social Stress Test was administered to 24 lactating women, 13 postpartum nonlactating women, and 14 healthy control women in the early follicular phase of the menstrual cycle. Lactating women were stressed at least 40 minutes after last feeding their infant. RESULTS: ACTH, cortisol, heart rate, diastolic blood pressure, systolic blood pressure, and subjective anxiety ratings were all significantly increased in response to the psychological stress (all p <.0001). There were no differences among the three groups in any of these responses to the stress. However, postpartum nonlactating women did have a persistently higher systolic blood pressure and lower cardiac vagal tone than the lactating women and control subjects. In addition, the typical negative correlation between cardiac vagal tone and heart rate was consistently higher in lactating women than nonlactating postpartum women and controls, which suggests stronger vagal control of heart rate in lactating women. In addition, there was no change in oxytocin or allopregnanolone in response to the stress, and baseline oxytocin and allopregnanolone levels did not differ among the three groups. CONCLUSIONS: These results indicate that physiological and subjective responses to social stress are not attenuated in lactating women tested at least one hour after feeding their infant. However, enhanced vagal control of cardiac reactivity was observed in lactating women. In addition, postpartum women who did not lactate showed evidence of increased sympathetic and decreased parasympathetic nervous system tone.     

The impact of U.S. medical students' debt on their choice of primary care careers: an analysis of data from the 2002 medical school graduation questionnaire.

PURPOSE: To examine the hypothesis that medical students' rising total educational debt is one of the factors that explains the recent decline in students' interest in family medicine and primary care. METHOD: The authors used results from questions on the Association of American Medical Colleges' 2002 Medical School Graduation Questionnaire that focused on students' debt and career choices. Logistic regression was used to determine the independent association of students' debt with career choices, while controlling for students' demographic characteristics. RESULTS: In 2002, 83.5% of graduating students were in debt, and the average student owed US $86,870. Minority students had higher levels of debt. Students reported that higher levels of debt influenced their future career choices, and there was an inverse relationship between the level of total educational debt and the intention to enter primary care, with the most marked effect noted for students owing more than $150,000 at graduation. Total debt was associated with a lower likelihood of choosing a primary care career, but factors such as gender and race appeared to have more explanatory power. Female students were much more interested in primary care-and especially pediatrics-than were male students; African American students were more interested in inner-city practice than was any other identified racial or ethnic group. CONCLUSION: In 2002, students' debt levels were high and increasing. Although students with higher debt levels were less likely than were their counterparts to pursue a career in primary care, the effect was modest when demographic characteristics were taken into consideration.     

High NK cell activity in recurrent miscarriage: what are we really measuring?

BACKGROUND: Several studies have shown that women with unexplained recurrent miscarriage (RM) have increased numbers and activity of peripheral blood NK cells and that elevated levels of these cells predict subsequent miscarriages in women with RM. Because catecholamines rapidly mobilize NK cells into the circulation, such increases may not reflect a steady state of overactive immunity but may result from a transient increase in the number of NK cells because of the stress associated with blood withdrawal. METHODS: Blood was drawn from 22 controls and 38 RM patients immediately after vein cannulation, and again 20 min later. The percentage of NK cells within lymphocytes, their concentration per microlitre of blood and their activity were assessed. RESULTS: All three indices of NK cells did not change in the controls across the two samples. However, women with RM had elevated levels in all three NK indices in the first blood sample, but these levels declined to values similar to those seen in the controls. This decline was mainly observed in primary aborters whose NK activity was highest in the first blood withdrawal. Accordingly, there was a high correlation between the magnitude of the decline and the initial NK cell indices in women with RM. The change in activity highly correlated with the change in the concentration of NK cells. CONCLUSION: The increased NK number and activity previously observed in RM patients may result from a transient stress response at the time of blood withdrawal. Patients with primary RM may be characterized by exaggerated acute stress responses in other circumstances.