社会支持和自我老化态度在老年人日常生活活动能力与抑郁中的链式中介作用

目的探讨社会支持和自我老化态度在日常生活活动能力与抑郁关系中的链式中介效应,为老年人抑郁研究和干预提供参考。方法从中国老年社会追踪调查(CLASS)数据集中采集6843名老年人填写的日常生活活动能力量表、社会网络量表、老化态度问卷和流调中心抑郁量表的数据,构建结构方程模型分析老年人日常生活活动能力、社会支持、自我老化态度与抑郁之间的关系。结果老年人日常生活活动能力得分与抑郁得分、自我老化态度得分呈正相关,与社会支持得分呈负相关;社会支持得分与自我老化态度得分呈负相关;自我老化态度得分与抑郁得分呈正相关(均P<0.01)。构建链式中介模型,老年人日常生活活动能力可以直接正向预测抑郁,也可以通过自我老化态度正向预测抑郁,还可以通过社会支持和自我老化态度的多重中介正向预测抑郁,总效应值0.369,间接效应值0.231,占总效应的62.60%。结论社会支持和自我老化态度在日常生活活动能力与抑郁关系中发挥链式中介作用。     

脑卒中患者口腔健康素养现状及其影响因素分析

目的 调查脑卒中患者口腔健康素养现状并分析其影响因素,为制订个体化干预方案提供参考.方法 采用人口学资料及相关影响因素调查表、脑卒中患者口腔健康素养量表、口腔生活质量影响程度量表、汉密尔顿抑郁量表对199例脑卒中患者进行调查.结果 脑卒中患者口腔健康素养总分为(82.24±5.90)分;脑卒中患者口腔健康素养与口腔生活质量影响程度及抑郁呈负相关(均P＜0.01).文化程度、居住地、领悟社会支持、营养状态、婚姻状态、医疗支付方式、经济来源、吞咽功能、患慢性病种数、自觉经济压力、神经系统功能、自我感受负担、主要陪护者是脑卒中患者口腔健康素养的影响因素(P＜0.05,P＜0.01).结论 脑卒中患者口腔健康素养有待提高,其影响因素较多.医护人员应采取针对性措施提高患者的口腔健康素养.     

慢性心力衰竭患者健康素养对健康行为及结局的影响

目的 探索老年慢性心力衰竭患者的健康素养对其出院后健康行为和结局的影响。方法 对231例住院慢性心力衰竭患者于出院前进行人口学变量、疾病相关资料和健康素养资料收集,于患者出院后30 d收集其社会支持、服药依从性、心理困扰、健康相关生活质量、非计划再入院资料。进行相关影响与中介作用分析。结果 健康素养可直接影响服药依从性和健康相关生活质量(直接效应分别为0.281、-0.290),也可通过社会支持和心理困扰间接影响两者。出院后30 d非计划再入院率为14.29%;健康素养对非计划再入院有保护作用(直接效应为-0.304),可通过社会支持(间接效应为-0.128)和心理困扰(间接效应为-0.115)间接影响非计划再入院。结论 健康素养是慢性心力衰竭患者健康行为和结局的保护因素,医护人员可采取有效方案提高患者健康素养,从而提高健康行为和避免非计划再入院。     

自我管理和护理依赖在A型主动脉夹层术后患者健康 素养与出院准备度间的链式中介作用

目的 探讨自我管理和护理依赖在A型主动脉夹层术后患者健康素养与出院准备度间的链式中介作用,为制定相关干预方案提供参考。方法 采用便利抽样法,选取251例A型主动脉夹层术后拟出院患者为调查对象,使用健康素养问卷、主动脉夹层患者术后自我管理测评量表、护理依赖量表、出院准备度量表进行调查。结果 A型主动脉夹层术后患者出院准备度得分为（138.61±12.03）分,出院准备度、健康素养、自我管理、护理依赖之间具有相关性（均P<0.05）。中介模型显示,患者健康素养对出院准备度的直接效应显著,健康素养还通过自我管理（β=0.083,P<0.05）、护理依赖（β=0.040,P<0.05）间接影响出院准备度。自我管理与护理依赖在健康素养与出院准备度间起链式中介作用（β=0.038,P<0.05）,总间接效应占总效应的43.63%。结论 A型主动脉夹层术后患者出院准备度处于中等水平。自我管理和护理依赖在A型主动脉夹层术后患者健康素养与出院准备度间发挥中介作用。医护人员应重视对患者进行健康素养教育及疾病知识普及,通过改善患者术后自我管理能力,降低护理依赖,进而提高患者出院准备度。     

基于结构方程模型的冠心病患者生活质量影响因素分析

目的探讨冠心病患者健康素养、自我效能、自我管理、社会支持对生活质量的影响,为其健康管理提供参考。方法采用便利抽样法,对280例冠心病住院患者采用一般情况调查表、冠心病健康素养调查问卷、冠心病自我管理量表、慢性病自我效能量表、社会支持评定量表、欧洲五维度量表进行调查,采用结构方程模型分析各影响因素之间的关系。结果影响冠心病患者生活质量的因素依次为自我管理、健康素养、自我效能、社会支持、文化程度、年龄、个人月收入、合并症种数。自我管理和社会支持对生活质量的直接效应系数分别为0.644和0.355。健康素养通过自我效能、自我管理、社会支持对生活质量产生间接影响,总效应系数为0.479;自我效能通过自我管理间接作用生活质量,总效应系数为0.414;文化程度、年龄、个人月收入、合并症种数对生活质量的总效应系数分别为0.167、-0.126、0.091、-0.058。结论冠心病患者的生活质量影响因素多而复杂,应加强针对性干预,以提高患者健康素养水平,增强自我效能感,从而提高自我管理能力,改善生活质量。     

社区老年人社会隔离及抑郁孤独与生活质量的关系

目的探讨社区老年人社会隔离、抑郁孤独负性情绪与生活质量的关系,并分析抑郁孤独负性情绪在社会隔离与生活质量间的中介作用。方法采用Lubben社会网络量表-6、老年抑郁量表、孤独感量表及简明健康状况量表对592名社区老年人进行调查。结果社区老年人社会隔离、抑郁、孤独及生活质量得分依次为(14.95±4.58)、(5.19±3.13)、(42.06±8.53)和(113.02±10.56)分。社会隔离得分与抑郁和孤独呈负相关,与生活质量呈正相关;抑郁和孤独与生活质量呈负相关(均P0.01)。社会隔离可直接影响生活质量(β=0.558),还可通过抑郁、孤独的部分中介作用间接影响生活质量(β=0.367);抑郁和孤独的中介效应分别占总效应的24.86%和14.81%。结论社区老年人社会隔离风险较高。社会隔离可直接影响或通过抑郁、孤独负性情绪间接影响老年人生活质量,应促进老年人积极融入社会,从而改善其负性情绪,提高生活质量。     

健康赋权在老年2型糖尿病患者述情障碍和自我管理的中介作用

目的 探讨老年2型糖尿病患者述情障碍和自我管理的相关性及健康赋权在两者间的中介作用.方法 采用多伦多述情障碍量表、老年慢性病患者健康赋权量表以及糖尿病自我管理行为量表,对3所三甲医院的210例老年2型糖尿病患者进行问卷调查.结果 老年2型糖尿病患者自我管理得分为(87.18±11.07)分,述情障碍得分为(57.53±10.09)分,健康赋权得分为(91.69±10.67)分;述情障碍与健康赋权、自我管理呈显著负相关(均P＜0.01),健康赋权与 自我管理呈正相关(P＜0.01).健康赋权在述情障碍与 自我管理间起部分中介作用,中介效应占总效应的41.52％.结论 老年2型糖尿病患者述情障碍、健康赋权和自我管理关系密切,述情障碍可通过健康赋权间接影响自我管理.护理人员可通过降低老年2型糖尿病患者的述情障碍程度,提升健康赋权水平,以增强自我管理能力.     

农村慢性病高危人群健康素养与健康结局的关系研究

目的了解农村慢性病高危人群健康现状,探讨农村慢性病高危人群健康素养和健康结局的关系。方法采用随机抽样和便利抽样法,从广州中医药大学护理学院的19个三下乡服务点抽取5个服务村的慢性病高危人群,采用慢性病患者健康素养量表、一般自我效能量表、生活质量量表调查慢性病高危人群的人口学资料、健康素养和健康结局,并构建结构方程模型。结果农村慢性病高危人群健康素养总分为93.5±15.4,具备率为52.2%;自我效能低于全国常模(P0.01);除生理职能维度外,生活质量的其他7个维度得分低于全国普通人群(均P0.01);与全国慢性病患者群组比较,生理功能、生理职能、总体健康和活力4个维度得分较高,躯体疼痛、精神健康2个维度得分较低(P0.05,P0.01);结构方程模型显示,农村慢性病高危人群健康素养水平越高,自我效能感越高,生活质量水平越高(P0.01);自我效能在健康素养和生活质量间具有中介作用(P0.05)。结论农村慢性病高危人群健康素养水平、自我效能、生活质量不尽人意;提高健康素养有助于改善该类人群的健康结局。     

膀胱癌尿流改道腹壁造口患者健康素养与社会支持及健康信念的相关性

目的 了解膀胱癌尿流改道腹壁造口患者健康素养、社会支持和健康信念水平,并探讨三者之间的关系,为制订健康素养干预措施提供参考.方法 采用一般资料问卷、社会支持量表、Champion健康信念模式量表及慢性病患者健康素养量表对211例膀胱癌尿流改道腹壁造口患者进行横断面调查.结果 膀胱癌尿流改道腹壁造口患者健康素养总分为(86.83±12.19)分,4个维度得分从低至高依次为经济支持意愿、交流沟通能力、信息获取能力、改善意愿能力.社会支持及健康信念与健康素养呈正相关(P＜0.05,P＜0.01).结论 膀胱癌尿流改道腹壁造口患者健康素养处于中等水平,社会支持、健康信念与患者健康素养水平显著相关.护理人员可通过加强社会支持、提高患者健康信念,以提高尿路造口患者健康素养水平.     

自我效能与社会支持在尿路造口患者病耻感与生活质量间的中介效应

目的 探讨自我效能和社会支持在尿路造口患者病耻感对生活质量影响中的中介作用,为提高患者的生活质量提供参考。方法 采用一般资料调查表、社会影响量表、社会支持量表、自我效能量表、生活质量量表对298例尿路造口患者进行问卷调查,构建结构方程模型。结果 尿路造口患者病耻感总分为（55.88±9.23）分,生活质量总分为（136.36±18.79）分。尿路造口患者病耻感与生活质量呈负相关（P＜0.05）;自我效能和社会支持在病耻感与生活质量之间起中介作用,中介效应占总效应的69.83%。结论 尿路造口患者的生活质量处于低水平。社会支持、自我效能在尿路造口患者病耻感对生活质量的影响中起中介作用。护理人员应采取积极有效的干预措施,减轻尿路造口患者的病耻感,提高患者的自我效能和社会支持,以促进生活质量的提高。     

社区老年人运动功能及自我感知老化与抑郁的结构方程模型构建

目的探讨社区老年人运动功能、自我感知老化、抑郁现状及三者之间的关系,为制订促进老年人精神心理健康的干预措施提供参考。方法采用老年人运动功能评定量表、简版自我感知老化量表及患者健康问卷抑郁量表对842名新乡市社区老年人进行调查,构建和检验三者关系的结构方程模型。结果社区老年人运动功能障碍综合征发生率为8.31%,抑郁情绪检出率为16.75%,自我感知老化条目均分2.44±0.52。运动功能与自我感知老化、抑郁,自我感知老化与抑郁呈正相关(均P<0.01)。结构方程模型显示,运动功能对抑郁的直接效应显著(效应值0.207,效应量45.5%),自我感知老化在运动功能和抑郁之间的中介作用显著(效应值0.248,效应量54.5%)。结论社区老年人抑郁情绪发生率较高,应采取有效措施帮助老年人树立积极老化态度,维护老年人精神健康。     

The relevance of anxiety,depression, and coping in patients after liver transplantation

The aim of this study is to investigate the effects of anxiety, depression, and coping on quality of life in patients after liver transplantation. Patients were asked to fill out a postal survey. Two hundred thirty-six of 375 patients (63%) who entered the study returned the questionnaires, and 186 of these patients could be included in the assessment. Anxiety and depression were surveyed using the Hospital Anxiety and Depression Scale; health-related quality of life, using the 36-Item Short-Form Health Survey; and coping strategies, using the Freiburg Questionnaire on Coping With Illness. In terms of physical and mental dimensions of health-related quality of life, psychosocial factors are far more relevant in liver transplant recipients than purely somatic factors, such as the number of posttransplantation complications or length of hospital stay. Through multiple regression analysis, we were able to account for 51% of the variance in the physical dimension of health-related quality of life and 58% of the variance in the mental dimension. Physical factors of depression, age, and employment and mental factors of anxiety and depression were significant for predicting health-related quality of life after liver transplantation. Depressive coping, anxiety, and depression, as well as aspects of the social environment, contribute considerably to determine well-being and health-related quality of life of patients after liver transplantation. (Liver Transpl 2002;8:63-71.)     

Health related quality of life, cognitive function, and depression in diabetic patients with foot ulcer or amputation. A preliminary study

BACKGROUND: Diabetic foot ulcers, foot infection, Charcot foot arthropathy, and lower extremity amputation have a severe negative effect on the health-related quality of life in individuals with diabetes. The purpose of this study was to determine if there is a relationship between these negative effects and cognitive impairment or clinical depression. METHODS: Sixty adults with diabetes completed the Short Form 36 (SF-36) Health Survey questionnaire, two screening examinations for cognitive function (Mini Mental Exam and Clock-Drawing Test), and a screening examination for depression (Zung Self-Rating Depression Scale). The two focus groups were composed of 20 subjects each who were undergoing treatment for (1) diabetic foot ulcers or active Charcot foot arthropathy or (2) lower extremity amputation. Twenty diabetic individuals without foot-related morbidity but with evidence of peripheral neuropathy as measured by insensitivity to the Semmes-Weinstein 5.07 (10 gm) monofilament comprised the control group. RESULTS: The SF-36 Health Survey score was significantly impaired in both the diabetic foot ulcer and Charcot arthropathy group (p <0.001) and amputee (p <0.000) group. There was no evidence of cognitive impairment or depression in either group. The negative impact on health-related quality of life was similar in both focus groups (p <0.314). CONCLUSION: The results of this preliminary study suggest that the negative impact on health-related quality of life in diabetic patients with foot ulcers or Charcot foot arthropathy may be as severe as in similar patients with lower extremity amputation. The negative effect did not seem to cause cognitive impairment or clinical depression in either focus group.     

Economic, Social, and Psychological Factors Associated With Health-Related Quality of Life of Chronic Hemodialysis Patients in Northern Taiwan: A Multicenter Study

This study evaluated the associations between economic, social, psychological factors, and health-related quality of life of hemodialysis patients. Cross-sectional study design was used. End-stage renal disease patients who had received maintenance hemodialysis for more than 2 months at 14 centers in northern Taiwan were invited to participate. Demographic, economic, and psychosocial data of patients were collected. Depression was assessed by the Beck Depression Inventory. Health-related quality of life was measured by the Medical Outcomes Study Short-Form 36. Multivariable linear regression analyses were performed. Eight hundred sixty-one patients (373 males, mean age 59.4 ± 13.2 years) completed the study. Higher monthly income was positively associated with role emotional and mental health ( P  < 0.05), and so was increased frequency of social activities with social functioning ( P  <  0.05). The more worries, the stronger the inverse associations with social functioning ( P  < 0.05) and mental health ( P  < 0.01). Higher depression scores were associated with lower scores of all Short-Form 36 dimensions ( P  < 0.01). Higher monthly income and increased social activities are associated with better health-related quality of life, whereas more worries and higher depression scores are associated with worse health-related quality of life of hemodialysis patients.     

老年脑卒中患者基于IKAP理论的口腔管理健康教育

目的 探讨基于IKAP理论的口腔管理健康教育对老年脑卒中患者的影响。方法 将108例老年脑卒中患者按照住院时间分为对照组和干预组各54例。对照组实施常规健康教育,干预组在此基础上实施基于IKAP理论的口腔管理健康教育。比较干预前、干预完成时及干预后3个月两组患者口腔健康状况、口腔健康素养及口腔相关生活质量。结果 对照组50例、干预组51例完成研究。干预完成时及干预后3个月,两组口腔健康状况、口腔相关生活质量及口腔健康素养得分比较,组间效应、时间效应及交互效应差异有统计学意义（均P＜0.05）。结论 基于IKAP理论的口腔管理健康教育能够提高老年脑卒中患者口腔健康状况、口腔健康素养水平及口腔相关生活质量。     

Improvement in patient-reported outcomes in Chinese adults after bariatric surgery: 1-year follow-up of a prospective cohort

BackgroundImpaired health-related quality of life is commonly observed in patients with obesity who are scheduled for bariatric surgery. However, bariatric surgery tends to improve quality of life physically, with no final conclusion regarding mental domains.ObjectiveTo assess changes of patient-reported outcomes in terms of health-related quality of life, depression, anxiety status, and physical activity (PA) after bariatric surgery among patients with obesity.SettingsQueen Mary Hospital, Tung Wah Hospital, and United Christian Hospital, Hong Kong SAR; a longitudinal study.MethodsA multicenter, prospective, observational cohort study was conducted in Hong Kong between 2017 and 2018. Follow-up interviews at 1, 3, 6, and 12 months postoperatively were administrated via telephone. Short Form-12 Health Survey Version 2, Euroqol 5-dimension-5-level, and Impact of Weight on Quality of Life-Lite were used to assess health-related quality of life. Scores of anxiety and depression were evaluated by Hospital Anxiety and Depression Scale. Walking, moderate, and vigorous metabolic equivalent tasks and PA levels were measured by International Physical Activity Questionnaire-Short Form. Demographic and clinical characteristics, including age, sex, body mass index, and preexisting co-morbidities at baseline were collected. Comparisons of scores were made between baseline and 12 months using paired t test or McNemar test.ResultsA total of 25 patients who have received bariatric surgery (laparoscopic sleeve gastrectomy: 96%; laparoscopic gastric bypass: 4%) and 25 control patients matched using propensity scores derived by baseline covariates were involved. Significant improvements were observed in health-related quality of life regarding physical functioning (P < .001), role physical (P = .013), bodily pain (P = .011), general health (P < .011), vitality (P = .029), social functioning (P = .017), and physical composite summary (P < .001) of Short Form-12 Health Survey Version 2 from baseline to follow-up 12 months after surgery. Scores of physical composite summary, mental composite summary, and Short Form-6 D of surgical patients all had an overall upward trend during observation compared with those in the control group. All domains in Impact of Weight on Quality of Life-Lite were significantly higher at 12 months compared with baseline (P = .001 in sexual life domain, P < .001 in other domains). Patients experienced a decrease in depression score of Hospital Anxiety and Depression Scale 12 months after bariatric surgery (P = .026), while anxiety score was not found to differ from baseline (P = .164). No significant differences in total metabolic equivalent tasks (P = .224) and PA levels (P = .180) between baseline and 12-month follow-up were found.ConclusionAfter 12 months of follow-up, increase in physical quality of life, reduction in depression status and less impairment caused by weight were observed, without significant changes in anxiety score and postoperative PA.     

木香顺气丸加减联合草酸艾司西酚普兰片治疗抑郁症的临床研究

目的：探讨木香顺气丸加减联合草酸艾司西酚普兰片治疗抑郁症的临床效果。方法选取本院2011年12月～2014年2月诊治的抑郁症患者116例,采用数字随机法分为两组,58例患者采用草酸艾司西酚普兰片治疗为对照组,58例患者采用木香顺气丸加减联合草酸艾司西酚普兰片治疗为观察组,采用汉密尔顿抑郁量表（HAMD）评定抑郁状况,采用世界卫生组织生活质量量表（WHOQOL-BREF）评定生活质量,比较两组患者的抑郁情况、生活质量、治疗效果、不良反应情况。结果治疗后,两组患者HAMD评分均显著下降,而生活质量评分均明显增加。观察组患者HAMD评分、不良反应发生率均明显低于对照组,观察组患者生活质量评分、总有效率均明显高于对照组,差异均有统计学意义（P＜0.05）。结论木香顺气丸加减联合草酸艾司西酚普兰片是治疗抑郁症的有效方法,可明显改善患者的抑郁状况,显著提高患者的生活质量,不良反应少且安全性高,值得临床推广使用。     

Coping strategies in patients with interstitial cystitis: relationships with quality of life and depression

PURPOSE: Previous research has demonstrated that interstitial cystitis patients experience depressive symptoms and decrements to quality of life. However, to our knowledge the extent to which patients may be able to influence quality of life and depressive symptoms through coping strategies has not been investigated in this population. In a number of other chronic conditions specific coping strategies have been associated with the degree of impairment beyond disease severity. Therefore, the association of coping strategies with depressive symptoms, quality of life and self-reports of pain was assessed in patients with interstitial cystitis. MATERIALS AND METHODS: A total of 64 females with interstitial cystitis were recruited from a urology clinic at a tertiary medical center. Questionnaires assessing depression, quality of life, coping and symptom severity were completed and returned at a clinic appointment. Depression was also measured through a standardized semi-structured interview (Hamilton Rating Scale for Depression). All analyses controlled for age. RESULTS: Patients coping by greater catastrophizing reported greater impairments in various domains, including depressive symptoms, general mental health, social functioning, vitality and pain. Greater venting was associated with greater depressive symptoms and poorer mental health. Seeking instrumental social support was associated with fewer depressive symptoms. CONCLUSIONS: These findings suggest that maladaptive coping strategies are associated with higher levels of depressive symptoms and quality of life decrements in patients with this condition. Psychosocial interventions aimed at increasing adaptive coping may positively impact the female experience with interstitial cystitis.