地震中有无亲属遇难群体的人格、心身健康及应对方式特点比较

目的:探讨地震中有无亲属遇难群体的人格、心身健康及应对方式差异,为有针对性展开危机干预提供理论依据.方法:选取来自北川县、安县及曲县等重灾区的181名灾民,用修订的人格、应对方式及心身健康量表进行测查.结果:有亲属遇难者在合群、信任、乐观人格维度上得分均低于无亲属遇难者[(3.85±0.80)vs.(4.1l±0.55),(3.69±0.54)vs.(3.90±0.61),(3.15±0.76)vs.(3.59±0.69),均P<0.05];有亲属遇难者心身健康量表各维度得分均高于无亲属遇难者(除自我效能维度外)[如抑郁:(3.18±1.01)vs.(2.49±0.95),P<0.05];有亲属遇难者在退避、自责及幻想上得分均高于无亲属遇难者[如退避:(3.36±0.92)vs(2.92±0.92),均P<0.05].回归分析表明,乐观、敏感人格特征和自责、退避、合理化、幻想应对方式与有亲属遇难者的心身健康相关(β=-0.30,0.14,0.33,0.17,0.23,0.20,均P<0.05);想象、乐观、自律、信任人格特征和退避、自责应对方式与无亲属遇难者的心身健康相关(β=0.27,-0.27,0.18,-0.16,0.39,0.22,均P<0.01).结论:有亲属遇难群体不良的人格特征变得更突出、心身更不健康,应对方式更消极,要重点干预.     

三峡库区后靠移民心理健康状况及其相关因素

目的:分析三峡后靠移民的心理健康问题及其影响因素.方法:采用整群随机抽样,应用自编的基本情况调查问卷、症状自评量表(SCL-90)、团体用心理社会应激调查表及社会支持评定量表对319名三峡后靠移民和327名当地居民进行问卷调查.结果:(1)后靠移民SCL-90总分及躯体化、人际关系敏感、抑郁、敌对和偏执因子分均高于当地居民[(123.5±37.0)vs.(117.4±26.O),(1.8±0.7)vs.(1.7±0.7),(1.3±0.4)vs.(1.2±0.3),(1.4±0.6)vs.(1.3±0.4),(1.3±0.4)vs.(1.2±0.3),(1.2±0.4)vs.(1.1±0.3);P=0.016,0.038,0.028,0.024,0.001,0.012];(2)移民的应激总分、生活事件得分、消极情绪体验得分和消极应对得分均高于当地居民[(36.3±19.2)vs.(29.9±17.1),(2.9±2.O)vs.(2.4±1.8),(2.7±2.6)vs.(2.0±2.2),(2.4 2.2)vs.(1.9 2.0);均P＜0.01];(3)多重线性逐步回归分析,进入模型的变量包括应激总分、主观经济状况、生活事件、社会支持总分和健康状况,后靠移民心理健康的主要相关因素是应激总分、主观经济状况、生活事件、社会支持总分和健康状况(B=0.198,0.152,0.256,-0.151,0.117).结论:三峡后靠移民的心理健康状况比当地居民差,应针对影响后靠移民心理健康的因素,如应激总分、主观经济状况、生活事件、社会支持总分和健康状况等采取相应措施,提高移民心理健康水平.     

乳腺癌患者的焦虑、抑郁、幸福感指数及社会支持

目的:调查不同治疗阶段乳腺癌患者的焦虑、抑郁、幸福感指数和社会支持情况,分析社会支持与情绪状况的关系.方法:收集术前组、术后组与康复组的乳腺癌患者各105例为病例组,以及年龄与教育年限匹配的健康对照105例,应用汉密顿焦虑量表(HAMA,≥8分为可疑焦虑)、汉密顿抑郁量表(HAMD, ≥8分为可疑抑郁)、幸福感指数量表(Index of Well-being)和领悟社会支持量表(PSSS)进行有关测评.结果:病例组的可疑焦虑、抑郁发生率均高于健康对照(42.9％,61.9％,59.0％ vs.9.5％;33.3％,60.0％,46.7％ vs.5.7％;均P＜0.01),病例组的HAMA、HAMD得分均高于健康对照[(7.2±4.3),(9.4±5.1),(9.2±5.6)vs.(3.9±3.1);(6.2±3.8),(9.2±4.8),(7.9±4.6) vs.(3.1±2.4),均P＜0.01];术前组与术后组的幸福感指数低于健康对照[(10.6±2.3),(10.5±2.6) vs.(11.5±2.2),均P＜0.01].病例组中,有可疑焦虑患者的幸福感指数、PSSS得分均低于无焦虑组[如,术后组PSSS得分(63.0±10.1)vs.(70.4±9.1),P＜0.01];有可疑抑郁患者的幸福感指数、PSSS得分低于无抑郁组[如,康复组PSSS得分(63.8±10.6) vs.(70.1±8.4),P＜0.01].结论:本研究提示,不同治疗阶段的乳腺癌患者的可疑焦虑、抑郁发生率和焦虑、抑郁得分均高于健康人群;有可疑焦虑、抑郁患者的幸福感指数和社会支持相对更低.     

乳腺癌患者的心身症状与生活质量

目的:探讨乳腺癌患者抑郁、焦虑的心理症状与躯体症状之间的关系,心身症状与生活质量的关系以及心身症状和生活质量与患者所接受过的治疗和生存期的关系.方法:本研究采用横断面设计,对北京市315例符合入组标准的乳腺癌患者进行调查,所使用的调查工具包括病人健康问卷(PHQ-15)、病人健康问卷抑郁量表(PHQ-9)、广泛性焦虑量表(GAD-7)及癌症患者生命质量测定量表(QLQ-C30),并对255份有效数据进行了分析.结果:乳腺癌患者躯体症状的严重程度与抑郁、焦虑均呈正相关(r=0.44,0.56;均P＜0.01);在重度躯体症状的患者中,抑郁的发生率为42.3％,焦虑的发生率为50％;抑郁、焦虑与乳腺癌患者总体健康状况相关(β=-0.22,-0.30;均P＜0.01);接受化疗的患者其躯体症状和抑郁、焦虑得分高于未接受化疗的患者[(9.0±5.0)vs.(6.0±4.1),(8.3±6.0) vs.(4.0±3.5),(5.4±5.0)vs.(3.1±3.7);均P＜0.01];生存期5年以上的乳腺癌患者只有焦虑分数低于5年以内的患者[(5.8±5.0)vs.(4.3±4.5),P＜0.05],在躯体症状、抑郁和生活质量方面差异无统计学意义.结论:乳腺癌患者抑郁、焦虑的心理症状与其躯体症状和总体健康状况相关,接受化疗患者的心身症状和生活质量可能会更差一些,生存期5年以上的患者焦虑水平低于5年以内的患者,但躯体症状、抑郁以及生活质量与生存期的延长未见相关.     

儿童的教师权威认知与师生关系的关系

目的:探讨儿童的教师权威认知发展特点,以及与师生关系的相关性。方法:在北京市2所小学选取四、五、六年级儿童共460名,采用两难故事情境评估儿童的教师权威认知水平、教师权威认知量表测验儿童对教师各领域权威认同度、学生版师生关系量表测量儿童的师生关系程度。结果:10岁儿童的教师不良处理方法权威认知得分高于11岁组与12岁组[(10.7±3.1)vs.(9.5±2.9),(10.7±3.1)vs.(9.3±2.6);均P0.05],12岁儿童的教师情感权威认知得分低于10岁组与11岁组[(18.2±2.6)vs.(18.7±1.9),(18.2±2.6)vs.(18.9±1.7);均P0.05]。处于合理化过渡水平的儿童,对教师的不良处理方法权威认知得分低于低水平和自我发展定向水平[(9.4±3.0)vs.(10.3±2.9),(9.4±3.0)vs.(10.3±2.8);均P0.05]。儿童的教师规则和个人生活权威认知得分对师生亲密性[(β=0.20,P0.05)vs.(β=0.23,P0.001)]、支持性[(β=0.23,P0.001)vs.(β=0.17,P0.01)]、满意度[(β=0.30,P0.001)vs.(β=0.13,P0.05)]得分均有正向预测作用,对师生之间的冲突性得分有负向预测作用[(β=-0.24,P0.01)vs.(β=-0.11,P0.05)]。结论:儿童对教师的不良处理方法权威认同存在权威认知水平上的差异,对教师主观方面权威认同度随着年龄的增加而降低,教师客观方面权威认知对师生的亲密性、支持性与满意度的建立具有积极预测作用,对师生冲突具有负向预测作用。     

医生工作家庭冲突与社会支持、制度支持的关系

目的:了解医生工作家庭冲突的现状及社会支持、制度支持对工作家庭冲突的影响.方法:采用多阶段分层随机抽样,抽取山东、湖北、河北和内蒙占自治区的公立医院医生.用自编工作家庭冲突-支持量表进行调查.发放量表6070份,回收有效量表5677份,有效回收率为95.6%.对数据进行描述性分析、路径分析.结果:5677名医生的工作-家庭冲突得分高于家庭-工作冲突[(3.4±1.0)vs.(2.8±1.0),P＜0.001];男性的工作-家庭冲突、家庭-工作冲突和冲突压力得分均高于女性[(3.5±1.0)vs.(3.3±1.0),(2.9±1.0)vs.(2.6±1.0),(3.3±1.0)vs.(3.2±1.0);均P＜0.001].工作政策、休班安排负向预测工作-家庭冲突(β=-0.230,-0.151;P＜0.01),亲友支持和同事支持正向预测工作-家庭冲突(β=0.107,0.060;P＜0.01);亲友支持、同事支持和值班安排负向预测家庭-工作冲突(β=-0.086,-0.041,-0.054,P＜0.05),领导支持和工作政策支持正向预测家庭-工作冲突(β=0.037,0.103,P＜0.05);工作-家庭冲突比家庭-工作冲突对冲突压力有更好的预测作用(β=0.635,0.166,P＜0.01).结论:公立医院医生工作和家庭角色的冲突较为严重,工作-家庭冲突比家庭-工作冲突更严重,男性比女性医生报告更高的冲突;私人领域的支持可以缓解家庭-工作冲突,组织提供的制度支持能缓解工作-家庭冲突,跨越边界的支持反而加重了医生的冲突感;两种冲突都能导致更高的角色冲突压力,但工作-家庭冲突的效应更大.     

青少年网络成瘾认知行为治疗的对照研究

目的:探索青少年网络成瘾认知行为治疗的方法及效果.方法:将确诊的76例成瘾青少年随机分为研究组和对照组(每组各38人).对研究组成瘾者,给予本研究设计的认知行为治疗.在治疗前和治疗后使用中文网络成瘾量表(Chinese Intemet Addiction Scale,CIAS)、症状自评量表(Symptom checklist-90,SCL-90)及应对方式问卷(Coping Style questionnaire,CSQ)评价治疗效果.结果:治疗前研究组与对照组CIAS得分差异无统计学意义,在治疗结束时,研究组CIAS得分低于对照组[(39.5±8.1)vs.(46.4±6.0),P<0.01],治疗后研究组SCL-90量表的抑郁、焦虑、强迫因子分均低于治疗前[(1.58±0.37)vs.(2.82±0.58),(1.45±0.62)vs.(3.05±0.73),(1.87±0.41)vs.(3.08±0.79);均P<0.01];应对方式中的自责、幻想、退避因子得分低于治疗前[(0.31±0.13)vs.(0.40±0.24),(0.37±0.12)vs.(0.47±0.21),(0.42±0.15)vs.(0.55±0.23);均P<0.01)].结论:本研究设计的认知行为治疗对治疗青少年网络成瘾有明显的效果.     

抑郁症与慢性疼痛共病情况及经济负担

目的:研究抑郁症与慢性疼痛共病的临床特点及经济负担状况.方法:对180例首诊抑郁症患者,用自编的躯体症状特点及经济负担调查问卷、汉密尔顿抑郁量表、慢性疼痛等级评价量表,调查抑郁症与慢性疼痛共病情况、临床特点及经济损害状况.结果:抑郁症与慢性疼痛共病患者出现率为14.9%,与单纯抑郁症组患者相比,抑郁症与慢性疼痛共病组的受教育年数低 [(10.1±3.7)vs.(12.0±3.6),P＜0.05]、病程长[平均秩次:93.8 vs.71.1,P<0.05]、外院就诊次数多[(3.6±2.9)vs.(2.6±1.8),P<0.01].共病组汉密尔顿抑郁量表总分、焦虑/躯体化因子分、认知障碍因子分均高于单纯组[(27.3±9.1)vs.(22.8±5.7)、(1.2±0.6)vs.(0.8±0.3)、(0.7±0.5)vs.(0.4±0.3);均P<0.05], 躯体症状以消化系统症状、头痛/头胀、性欲减退、皮肤麻木较突出.共病组人均间接经济负担高于单纯组,(平均秩次:91.4 vs.71.7,P<0.05),慢性疼痛程度与直接经济负担呈正相关(r=0.32,P<0.01).结论:抑郁症与慢性疼痛共病可能预示临床症状更重、治疗依从性更差、经济负担增加.     

不同心理韧性高中生的日常情绪状态与情绪自我调节方式

目的:比较高、中、低心理韧性水平高中生的日常情绪状态及情绪自我调节方式.方法:选取202名高中生,施测青少年心理韧性量表(RSCA)、正负情绪情感量表(PANAS)和情绪调节方式问卷(ERQ).依据RSCA得分分为高(n=87)、中(n=61)、低心理韧性组(n=54),比较不同心理韧性组日常情绪状态及积极、消极情绪的调节方式差异.结果:高心理韧性组PANAS积极情绪情感得分高于中、低心理韧性组[(33.3±6.2)vs.(30.8±5.2),(29.4±6.9)；P＜0.001],低心理韧性组PANAS消极情绪情感得分高于高、中心理韧性组[(27.5±7.7)vs.(22.3±6.0),(24.0±7.3)；P＜0.001].在积极情绪调节方式上,高心理韧性组ERQ重视得分高于低心理韧性组[(3.4±0.6)vs.(3.0±0.8)；P＜0.05],宣泄得分高于中、低心理韧性组[(3.2±0.7)vs.(3.0±0.6),(2.8±0.9)；P＜0.01],而抑制得分低于中、低心理韧性组[(1.4±0.5)vs.(1.6±0.5),(1.8±0.8)；P＜0.01]；在消极情绪调节方式上,高心理韧性组抑制得分低于中、低心理韧性组[(2.2±0.7)vs.(2.5±0.6),(2.6±0.8)；P＜0.05],而低心理韧性组重视得分高于高、中心理韧性组[(2.1±0.7)vs.(1.8±0.5),(1.9±0.5)；P＜0.001)].结论:不同心理韧性高中生日常情绪状态存在差异,高心理韧性高中生倾向于对积极情绪采用更多的重视、宣泄和更少的减弱调节,对消极情绪则采用更少的重视和抑制调节.     

早期乳腺癌患者术后家庭类型与生活质量的相关性

目的: 研究早期乳腺癌患者术后家庭类型现状和对生活质量的影响,为家庭干预提供依据.方法: 采用家庭亲密度和适应性量表中文版(Family Adaptability and Cohesion Scale,Second Edition,Chinese Version,FACESⅡ-CV)和乳腺癌生活质量专用量表(EORTC Quality of Life Questionnaire,Breast Cancer 53,EORTC QLQ-BR53),对196例早期乳腺癌患者术后家庭类型构成、家庭类型对生活质量的影响及影响生活质量的因素进行调查.结果: 本组乳腺癌患者术后家庭类型,与既往研究中122个正常家庭类型相比,极端型和中间型较多(29.6% vs.16.4%,39.8% vs.29.5%),平衡型较少(30.6% vs.54.1%)(χ2= 18.028,P<0.001);极端型家庭患者的整体生活质量得分高于中间型和平衡型[(70.0±19.6)vs.(61.0±19.8),(57.4±18.0);P＜0.01],而疲乏、系统疗法副作用得分低于中间型和平衡型 [疲乏:(23.2±20.5)vs.(29.3±15.2),(32.8±18.2);P＜0.01.系统疗法副作用:(20.7±17.1)vs.(27.1±14.7),(28.9±16.0);P＜0.05],恶心呕吐得分低于平衡型[(5.5±13.7)vs.(11.7±19.0);P＜0.05].回归分析显示家庭类型是影响乳腺癌患者整体生活质量及系统疗法副作用的最主要因素(β=0.252,β=-0.183).结论: 早期乳腺癌患者术后家庭类型现状为极端型和中间型增多,平衡型减少.家庭类型是影响乳腺癌患者生活质量的重要因素,极端型家庭患者生活质量好于平衡型和中间型.临床中应加强对乳腺癌患者家庭干预,有意识引导其他家庭类型向极端型转化.     

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.