汶川地震重灾区青少年创伤后应激障碍及其相关因素

目的:了解四川绵竹地区青少年创伤后应激障碍的筛出率及其相关因素。方法:在汶川大地震后3个月,随机整群抽样调查绵竹地区587名中学生。使用自编的创伤暴露基本情况问卷和LosAngeles症状核查表青少年版筛查创伤后应激障碍的现患率。结果:绵竹地区青少年创伤后应激障碍的检出率有4.3%,而且存在明显的性别差异。分层回归分析发现,性别、创伤暴露严重程度(是否目睹或接触尸体、是否目睹死亡和恐惧程度)能够显著预测创伤后应激障碍。结论:对灾区青少年进行创伤后应激障碍的心理辅导和干预时,要对女性以及目睹过死亡和感受到强烈恐惧感的青少年给予特殊关注和干预。     

北川极重灾区小学生地震后创伤症状评估

目的:了解地震半年后受灾地区小学生的心理健康状况,为进一步的干预和辅导提供依据。方法:使用儿童创伤症状量表(TSCC-A)和自编地震经历问卷对1027名北川3-6年级小学生进行评估。结果:震后小学儿童最为突出的症状倾向是焦虑,其次是抑郁和创伤后应激症状,具有地震中受伤经历、有亲人遇难、目睹亲人或他人死亡这些经历的小学生更容易出现高焦虑、高抑郁、创伤后应激障碍和高分离症状。结论:应向具有受伤、有亲人死亡、目睹了亲人或他人死亡经历的小学生提供有针对性的心理辅导和干预。     

汶川地震幸存者的创伤后应激障碍及其影响因素

目的:评估汶川大地震对幸存者所带来的心理影响,以便为进行心理援助和治疗的临床工作者提供更有价值的诊断信息。方法:对安置在绵竹体育中心灾民安置点的956名地震幸存者施测了创伤暴露水平问卷,事件冲击量表(IES-R)和D型人格量表(DS-14)。结果:在地震发生之后不久,有82.6%的被试表现出创伤后应激障碍;在地震中创伤暴露水平高的被试更有可能表现出创伤后应激障碍;女性被试、中年被试、已婚被试以及拥有D型人格的被试更可能产生创伤后应激障碍;回归分析的结果表明性别、年龄、婚姻状态、创伤暴露水平以及D型人格中的负性情绪是影响被试是否表现出创伤性应激障碍的关键因素。结论:有较高比例的地震幸存者表现出创伤后应激障碍,高创伤暴露水平、女性、中年、已婚和负性情绪是幸存者表现出创伤后应激障碍的主要影响因素。     

红十字会救援人员的心理创伤反应及预测因素

目的:旨在考察红十字会救援人员的心理压力等方面的心理状况,为救援人员的心理服务工作提供帮助。方法:对298名南京市红十字会救援人员进行问卷调查,测量其创伤后应激障碍(PTSD)、创伤后成长(PTG)、主动反刍、侵入反刍的水平。结果:(1)救援人员的创伤后应激障碍筛查阳性率为35.2%,创伤后成长的筛查阳性率47.3%;(2)创伤后应激障碍在年龄上有显著差异,年龄≤20岁的救援人员的PTSD分数显著高于年龄20岁的救援人员;(3)创伤后应激障碍在教育水平上存在显著差异,教育程度为大专/本科及以上的救援人员的PTSD分数显著高于高中/中专的救援人员;(4)侵入反刍显著正向预测创伤后应激障碍,主动反刍显著正向预测创伤后成长。结论:救援人员的心理创伤反应在年龄、教育水平存在差异。反刍能够预测救援人员的心理创伤反应。     

舟曲泥石流5年后居民PTSD与社会支持、心理弹性关系

目的:了解舟曲泥石流5年后受灾居民创伤后应激障碍状况与社会支持、心理弹性的关系,为灾后的远期心理援助工作提供参考依据。方法:采用创伤后应激障碍检查量表平民版(PCL-C)、社会支持评定量、心理弹性量表对舟曲244名受灾居民进行调查。结果:泥石流5年后受灾居民创伤后应激障碍阳性者有82例(33.61%),女性显著高于男性(χ2=21.049,P0.001);PTSD阳性者社会支持与心理弹性得分均低于PTSD阴性者,且有显著性差异(P0.05)。PTSD与社会支持、心理弹性总分呈负相关(r=-0.423,P=0.000;r=-0.158,P=0.014)。结论:泥石流给受灾居民的心理健康造成持续影响,创伤后应激障碍与社会支持、心理弹性有着密切的联系,应重视居民远期心理援助。     

青少年学生创伤后应激障碍症状与个性特征相关性分析

目的了解汶川地震后5个月都江堰青少年学生创伤后应激障碍症状发生情况及其与个性特征的关系。方法采用事件影响量表中文修订版(IES-R)及艾森克人格问卷(简称EPQ(成人版))对四川省都江堰市第一中学和都江堰中学等学校的472名青少年学生进行心理测评。结果在472名青少年学生中,出现创伤后应激障碍症状的有220人,占46.61%。女生与男生创伤后应激障碍症状发生情况的比较差异有统计学意义(高警觉因子t=-2.016,P0.05);参与震后营救和未参与营救的同学所产生的创伤后应激障碍症状有显著差异(闯入因子t=2.054,P0.05)。IES得分阳性的学生N分和P分明显高于IES得分阴性的学生,而E分明显低于IES得分阴性的学生。EPQ-N与IES的各因子之间呈显著正相关(r=0.369～0.522),EPQ-P与IES的高警觉因子呈显著正相关(r=0.057～0.153)。结论灾区青少年学生创伤后应激障碍症状的发生率较高,个性特征与创伤后应激障碍症状密切相关,具有精神质倾向、性格内向及情绪不稳定的个性特征者更容易出现创伤后应激障碍症状,应重视和关注灾区青少年学生的心理健康问题。     

正念干预创伤后应激障碍的研究进展

创伤后应激障碍的治疗一直是创伤心理研究领域的重点问题。研究表明,正念干预对各种创伤后应激障碍群体均有良好的治疗效果。对实证研究梳理总结后发现,监控与接纳理论和创伤复原力模型是正念干预创伤后应激障碍的理论基础。正念干预对创伤后应激障碍的四个典型症状均具有特异性作用。正念对前扣带回等脑区和自主神经系统的调节是其缓解症状的生理机制,正念对认知融合和认知抑制的改善以及情绪的调节是其缓解症状的心理机制。     

PTSD症状自评量表的信效度初步评价

目的：编制创伤后应激障碍症状自评量表。方法：根据诊断标准和Kubany的痛苦事件量表相结合来编制量表；在284名大学生、87名受灾居民和70名消防官兵中进行信度和效度检验。结果：量表的一致性系数为0．88-0．94，重测信度为0.83-0．88，与SCL90的焦虑、抑郁和恐怖因子的相关性在0．73以上，与DSM-IV的诊断符合率在90％以上。结论：量表有很好的信效度．可以用于评估创伤后应激障碍的症状及其严重程度。     

创伤后应激障碍心理咨询一例

<正>求助者是1名33岁的男性,因自己驾车发生车祸并亲眼目睹父亲去世受到心理创伤,出现闯入、回避和高警觉等创伤后的症状。首先通过摄入性会谈、他人反映、原因分析和心理测量,评估诊断为创伤后应激障碍。然后采用理性情绪疗法、现实疗法和森田疗法,对求助者进行干预,减轻并逐步消除其创伤后应激障碍的症状,促进自我认识、自我接纳。经过10周的咨询治疗后,求助者的创伤后症状基本消除,情绪正常,基本恢复正常生活和工作。     

557名产妇产后42天应激障碍状况及影响因素分析

目的了解产妇产后应激障碍状况。方法应用症状自评量表(SCL-90)和应激评估量表平时版(PCL-C),对西城区助产机构产科557名孕(产)妇进行抽样测试研究。结果①产后42天产妇创伤后应激障碍筛查阳性率为2.87%,不同户籍、年龄、学历、不同孕期心理状态间阳性率差异有统计学意义(P<0.05);②Logistic回归分析显示,产妇年龄和孕期心理是产后应激障碍发生的预测因素(P<0.05);③多元线性回归分析显示,影响PCL-C分数的因素有产妇的户籍、年龄、孕期心理及学历(P<0.05)。结论低龄、低学历、外地、孕期心理不良的孕妇容易出现产后应激障碍。     

Physiological responses to fire fighting activities

Summary Eight professional fire fighters participated in six fire fighting scenarios at a training facility. Data on heart rate (HR), rectal temperature (T_re), and skin temperatures at the chest and thigh were collected using a portable data acquisition system. Average HR ranged from 122 to 151 beats · min⁻¹ during the six scenarios. Detailed analyses indicated that HR and T_re increases are related to both the physical and environmental stresses of the various activities carried out. The most demanding activity, that of building search and victim rescue, resulted in an average HR of 153 beats · min⁻¹ and T_re rise of 1.3‡ C, while the least demanding activity, that of the crew captain who directs the fire fighting, resulted in an average HR of only 122 beats · min⁻¹ and a T_re rise of only 0.3‡ C. This study shows that fire fighting is strenuous work for those directly entering a building and performing related duties, but that the physical demands of other activities are considerably less. The results further suggest that heat strain injuries in fire fighters could perhaps be reduced by rotating duties frequently with other crew members performing less stressful work.     

Evaluation of Relationships among Occupational Stress,Alcohol Dependence and Other Factors in Male Personnel in a Japanese Local Fire Fighting Organization

Recent large-scale disasters have made middle-ranked fire defense officers responsible for routine fire fighting activities, and a tendency of alcohol dependence associated with other stressful problems is noted in Japan. We assessed the alcohol dependence tendency with the alcohol use disorders identification test (AUDIT) in firefighters. Occupational stress, depression and other factors were evaluated with the brief job stress questionnaire, Center for Epidemiologic Studies depression scale, K10 and a face sheet. Subjects were 294 male personnel in a local fire defense headquarters, and 246 of them (83.4%) answered effectively. Data were analyzed first with univariate analysis between the AUDIT score and other items, and then with multivariate analysis of the AUDIT score as a dependent variable and other items as independent variables. The AUDIT score (mean ± SD) in the 246 respondents classified by age ranges was 7.9 ± 5.4 points (the lowest, 0 points; the highest, 27 points). The multivariate analysis showed significant correlations of the AUDIT score with the workplace environment (P = 0.003) and the rank of work (P = 0.019). The present survey was cross-sectional, and we could not clarify the subjects’ past drinking states and applicability of the results to the whole Japan personnel. It is necessary to further investigate the relationship between alcoholism and depression in the present subjects. As a pilot study, we first clarified the state of alcohol dependence in personnel in a Japanese local fire fighting organization, and examined related factors.     

Shock-induced fighting attenuates the effects of prior shock experience in rats

We compared the responses of animals exposed singly to inescapable shock with those of animals exposed to the same shock in pairs and thus able to fight in response to shock. During the shock sessions animals shocked in pairs showed a reduced ACTH response when compared with animals shocked individually, and the reduction in ACTH was not dependent on the amount of fighting which occurred. In addition, if animals had previous opportunities to fight, the response to shock was still attenuated even when the partner was no longer present. When subsequently tested in a novel task it was observed that fighters, like controls, showed a reduced pituitary-adrenal response to novelty when a consummatory response was available. Singly shocked animals, however, exhibited elevated levels of plasma corticosterone whether or not they could drink in the novel chamber. We hypothesized that fighting is a consummatory response, and that the reinforcement provided by performance of this consummatory response reduced the ACTH response to shock and permanently altered subsequent responsiveness.     

消防武警新兵应激性焦虑诱发因素的研究

目的研究探索造成消防武警新兵应激性焦虑的可能社会、文化因素。方法以SAS量表检测筛查某部新兵集训队的所有成员．按相应标准将人群划分为有焦虑症状人群（观察组）和健康人群（对照组）,同时调查对比两组人群中造成焦虑的可疑因素暴露情况。结果所观察因素中,是否首次离家独立生活、以前是否经历过火灾现场、是否愿意干消防工作、部队情况与自己期望是否相符和、参军前是否参加过工作．这5项在两组间的暴露情况经统计学处理显示差异有显著性（P〈0．01）。结论可以认为如上结果所示的5项因素的阳性暴露,是造成消防武警新兵进入应激状态出现焦虑症状的主要诱因。     

Playing With Fire: A Development Assessment of Children's Fire Understanding and Experience

Investigated children's involvement with fire, focusing upon developmental changes in and correlates of fire play. Fire and burns are a frequent cause of injury and death among children and adolescents. Seven hundred seventy 6- to 14-year-olds children completed a survey assessing their attitudes toward and experiences with fire. Variables assessed included exposure to fire at home, assigned responsibilities for fire activities, understanding and sense of control over fire, access to ignition materials, and expected response from parents should they get caught with matches or lighters. Results suggested that fire play was relatively frequent, increased linearly with age, and was most common in junior high children. Controlling for child age, fire play was positively associated with a sense of control over fire, access to ignition materials, exposure to and responsibilities for fire activities, and expectations that parents would not respond in any manner should they find the child with matches or a lighter. Implications of the results for prevention are discussed.     

Fire ant venom hypersensitivity. I. Comparison of fire ant venom and whole body extract in the diagnosis of fire ant allergy

Levels of IgE antibody to fire ant whole body extract (FA-WBE) and fire ant venom (FAV) were evaluated in 60 patients with clinical histories of fire ant sting hypersensitivity and 11 frequently stung individuals without significant clinical reactivity to fire ant. An overlap of levels of IgE antibody to FA-WBE and FAV was seen between groups of patients with increasingly severe clinical reactivity; however, the group mean IgE antibody level of patients without significant clinical reactivity differed markedly from the group means of patients with more severe clinical reactivity (p less than 0.001). In 31 patients a good correlation (r = 0.6935) was found comparing FA-WBE IgE antibody level with FA-WBE skin tests, and in 26 patients a good correlation (r = 0.8564) was obtained comparing FAV IgE antibody levels with FAV skin tests. An excellent Spearman rank correlation coefficient (r = 0.9197) was found on comparison of FAV and FA-WBE IgE antibody levels in 71 individuals. Cross-reactivity of FAV and FA-WBE was demonstrated by the ability of these reagents to competitively inhibit the binding of IgE antibody to solid-phase FA-WBE and FAV in the radioallergosorbent test (RAST). From these results we conclude that FAV and FA-WBE both contain relevant allergens important in fire ant-allergic individuals and that skin tests and RAST are both valid as diagnostic tests for fire ant allergy. Finally, there is a good correlation between RAST and skin tests using FA-WBE or FAV as test reagents, since these reagents are highly cross-reactive as demonstrated by their ability to inhibit each other in the RAST.     

Social context rather than behavioral output or winning modulates post-conflict testosterone responses in Japanese quail (Coturnix japonica)

Testosterone regulates the expression of sexual and aggressive behavior in male vertebrates and treatments with testosterone may promote territorial aggression and winning in dyadic contests. Conversely, individual testosterone levels respond to sexual or aggressive interactions and the social environment. Post-conflict testosterone in winner males though appears to be more complex than simply reflecting conflict outcome. Expression and degree of post-conflict testosterone responses may adapt to additional modulators such as repeated winning experience, audience presence, opponent's fighting ability, and self-assessment. We present simulated intrusion experiments with male Japanese quail using mirror-elicited aggression and fights with real opponents (‘direct challenge’). We recorded agonistic behavior and measured immunoreactive testosterone metabolites (TM) non-invasively from individual droppings. Frequencies of initiated agonistic behavior were similar whether towards the mirror or in direct challenge tests, although some of the males were behaviorally non-responsive to the mirror (‘mirror submissives’). However, there was no TM response to the mirror test in both, mirror fighters and mirror submissives, thus independently of behavioral output. After direct challenges TM levels were elevated in all males (focal males winning or conflict unresolved after 30 min), hence independently of conflict outcome. Thus, in male quail a combination of physical stimuli and the individual perception of own and opponent's fighting ability explained the expression of post-conflict TM responses rather than behavioral performance, conflict outcome, or any of these factors alone. In sum, our results emphasize that the degree of androgen responsiveness to agonistic behavior is fine-tuned by components related with social context and environment.     

Developing legally defensible physiological employment standards for prominent physically demanding public safety occupations: a Canadian perspective

Canadian court decisions and human rights legislation impose strict legal criteria for developing applicant and incumbent physiological employment standards to qualify as a bona fide occupational requirement. These legal criteria compel researchers and employers to ensure that the standards are criterion-based and validly linked to the critical life threatening physically demanding tasks of the occupation, and this has led to the establishment of a systematic research process template to ensure this connection. Validation of job-related physiological employment standards is achieved using both construct and content procedures and reliability is established via test–retest procedures. The 1999 Supreme Court of Canada Meiorin Decision also obliges employers to demonstrate that it is impossible to accommodate an individual applicant or employee who is adversely impacted by lowering the physiological employment standards without imposing undue hardship on the employer. Recent evidence has demonstrated convincingly that familiarization opportunities, motivational feedback/coaching during test performance, and participation in a 6-week job-specific physical fitness training program can overcome the adverse impact of a physiological employment standards on a sub-group of participants, thereby providing “de facto” accommodation. In this article, the authors review the physiological employment standards for prominent Canadian physically demanding public safety occupations; police, correctional officers, nuclear emergency personnel, structural fire fighters, and wildland fire fighters, to illustrate the steps, challenges, and solutions involved in developing and implementing physiological employment standards designed to meet the requirements to qualify as a bona fide occupational requirement.     

The developmental onset of a rudimentary form of play fighting in C57 mice

Play fighting in its most elaborate form involves nonagonistic wrestling between pairmates, where one partner grabs, holds, bites, or otherwise contacts the other. Such play occurs in the absence of the functional consequences associated with serious fighting (e.g., resource acquisition or protection). Typically, the biting, nosing, or grooming contact during play fighting is directed at specific body targets. House mice have been classified as a species that lacks such play, even though play fighting is present in closely related species such as the rat. In this study, six litters of C57 mice were observed daily from the week before weaning until the week after weaning (15-30 days postnatally). Thirty-min videotaped records were collected daily for each litter. Consistent with other studies, over 85% of all play involved locomotor play, and most of the social play involved noncontact locomotion (86%). However, a rudimentary pattern of the "attack and defense" typical of play fighting was found to occur, albeit at a low frequency (2% of all play). Most playful attacks involved snout contact with the partner's rump, but evidence is provided that suggests that this rump contact may be transitory, with the nape area being the primary target for play. Most of the playful attacks elicited playful defense (97%), which in all cases involved the defender evading such contact by leaping or running away, or by dodging laterally away from the attacker. Therefore, there appears to be directed playful attacks in this species, with defense limited to evasion. Defensive tactics leading to wrestling were never observed. That is, play fighting in mice involves only a small subset of what other species, such as rats, exhibit. Nonetheless, the basic components of attack and defense are present in mice.