产褥期抑郁症状发生状况及影响因素的纵向研究

目的 纵向调查产褥期女性抑郁症状的发生状况,分析其影响因素,为产褥期保健提供参考。 方法 采用爱丁堡产后抑郁量表,于产妇产后3 d和产褥期结束时（42 d左右）进行调查。 结果 515名产妇完成研究。产后3 d和产褥期结束时抑郁症状发生率分别为5.8%、6.4%。与配偶关系不好、新生儿性别不符合预期、产后夜间睡眠障碍、没有人帮助喂养新生儿、租房是产后3 d抑郁症状的危险因素（均P＜0.05）;产后3 d发生抑郁症状、产后夜间睡眠障碍、与配偶关系不好及新生儿性别为男是产褥期结束时抑郁症状发生的危险因素（均P＜0.05）。 结论 分娩后早期对产妇进行抑郁症状筛查非常重要,夫妻关系和睡眠问题需要重点关注;男性新生儿导致产妇不良情绪的发生值得进一步研究。     

高危妊娠孕妇集体心理干预效果评价

目的评价高危妊娠孕妇孕期集体心理干预的效果。方法将334例高危妊娠孕妇随机分为干预组和对照组各167例。对照组进行常规的产检和随访;干预组在对照组基础上接受6次集体心理干预课程,其中5次为高危妊娠孕妇心理课程,1次为配偶课程。在孕早中期、孕晚期、产后3 d和42 d采用产后抑郁筛查量表(PDSS)对两组进行评估。结果干预组孕晚期、产后3 d和42 d的PDSS评分显著低于对照组(均P0.01)。参加不同频次干预课程的高危妊娠孕妇孕晚期、产后3 d和42 d的PDSS评分差异无统计学意义(均P0.05),丈夫是否参加干预课程的高危妊娠孕妇PDSS评分差异无统计学意义(P0.05)。结论孕期集体心理干预有利于降低高危妊娠孕妇围生期抑郁发生率,但其治疗的依从性和家庭支持系统有待进一步加强。     

560例产妇产后初期心理状态调查

采用心理、社会(家庭)因素调查表、焦虑自评量表(SAS)及抑郁自评量表(SDS),对560例产妇产后第3天心理状态进行调查.结果产妇产后心理状态不稳定,焦虑、抑郁状态发生率为21.79%,其与生理(分娩)、社会(家庭)因素密切相关.提示及时发现产后异常心理状态,实施干预措施,对产妇身心健康十分重要.     

产妇分娩体验与产后抑郁的相关性研究

目的 了解产妇分娩体验及产后抑郁状况,并分析二者之间的相关性.方法 对产后42 d常规检查的282例产妇采用中文版分娩体验量表和爱丁堡产后抑郁量表进行调查.结果 产妇分娩体验总分(2.73±0.44)分,自我能力维度(2.70±0.61)分、参与感维度(2.62±0.58)分、专业支持维度(3.00±0.58)分、自我感知维度(2.47±0.58)分.产妇抑郁得分(7.39±4.21)分,有产后抑郁症状者31例(10.99％).分娩体验与产后抑郁呈负相关(P＜0.01),自我能力和自我感知维度与产后抑郁得分呈负相关(均P＜0.01).结论 产妇分娩体验水平还有待改善,高水平的分娩体验能够降低产妇发生产后抑郁风险,特别需注意加强产妇自我能力和自我感知方面的体验.     

孕妇妊娠末期睡眠障碍与焦虑抑郁关系的研究

目的 探讨孕妇妊娠末期睡眠质量与焦虑、抑郁情绪的关系.方法 采用匹茨堡睡眠质量指数量表(PSQI)、汉密尔顿焦虑量表(HAMA)、汉密尔顿押郁量表17项版本(HAMD-17),对96名妊娠末期孕妇(孕妇组)及100名正常非孕女性(对照组)的睡眠质量、焦虑和抑郁状态水平进行调查并对比.结果 孕妇组PSQI中睡眠质量、睡眠紊乱、日间功能评分和总分显著高于对照组(P＜0.05,P＜0.01),HAMA总分、躯体性焦虑评分及HAMD-17总分、焦虑/躯体化和睡眠障碍因子分亦显著高于对照组(P＜0.05,P＜0.01).孕妇睡眠质量维度评分、PSQI总分与HAMA总分及各因子分、HAMD-17总分呈显著正相关(均P＜0.05).结论 孕妇在妊娠末期存在明显的睡眠障碍和情绪问题,并且睡眠质量与焦虑和抑郁等情绪症状有正相关关系,应采取措施提高其睡眠质量,改善其心理状态.     

叙事护理联合六步法乳房按摩对产妇泌乳及产后心理状态的影响

目的 探讨叙事护理联合六步法乳房按摩对产妇泌乳及心理状态的影响.方法 将120例产妇随机分为叙事组、按摩组、联合组三组(每组60例).所有产妇均予以产后常规护理,叙事组在此基础上采取叙事护理,按摩组加以六步法乳房按摩,联合组实施叙事护理联合六步法乳房按摩干预.比较三组产妇乳汁分泌情况、产后疲乏程度及焦虑抑郁状态.结果 三组产妇纯母乳喂养率、乳汁分泌量、开始泌乳时间、产后疲乏及焦虑抑郁评分比较,差异有统计学意义(P＜0.05,P＜0.01).结论 叙事护理联合六步法乳房按摩可缩短产妇开始泌乳时间,提高乳汁分泌量和纯母乳喂养率,改善产后疲劳和不良情绪.     

全程护理干预对产后抑郁的影响

目的 探讨护理干预对产后抑郁的影响.方法 将180例产妇随机分为干预组和对照组各90例.对照组进行常规护理;干预组在此基础上进行全程护理干预,包括对患者及其家属产前进行健康教育指导,针对健康问题进行评估,制订措施,有针对性给予行为干预和心理疏导;产后进行家居护理,帮助产妇照顾婴儿,提供相关信息等.两组干预后分别采用爱丁堡产后抑郁量表(EPDS)进行调查.结果 干预后产妇EPDS评分显著低于对照组(P＜0.01),抑郁发生率显著低于对照组(P＜0.05).结论 全程护理干预能有效降低产后抑郁的发生.     

初产孕妇焦虑状况及其影响因素分析

目的 探讨初产孕妇焦虑状况及其影响因素.方法 对上海地区100例初产孕妇采用焦虑自评量表和社会支持量表进行问卷调查.结果 初产孕妇焦虑总分为36.43±9.39,显著高于国内常模评分(P＜0.01);年龄25～岁,大专以下学历,工人、农民为职业的初产孕妇焦虑水平显著低于其他年龄、学历、职业类型的初产孕妇(均P＜0.01);独生子女、有慢性疾病史的初产孕妇焦虑水平偏高(均P＜0.01);有流产史的初产孕妇焦虑水平偏低(P＜0.05);多元逐步回归显示社会支持程度、是否独生子女、有无流产史与孕妇焦虑水平显著相关(均P＜0.01);因果通径图示,前述3项为影响孕妇焦虑水平的直接因素,慢性病史及担心生产过程是间接因素.结论 初产孕妇孕期焦虑水平较高;年龄、学历、职业类型、慢性疾病史与孕妇焦虑水平相关;社会支持、是否独生子女、有无流产史是预测初产孕妇焦虑水平的重要因素.     

头部按摩对初产妇心理及分娩方式的影响

目的 观察头部按摩对初产妇心理和分娩方式的影响.方法 将200例初产妇随机分为对照组与观察组各100例,对照组采用一对一陪伴分娩服务模式,观察组在此基础上施行头部按摩.比较两组产妇的焦虑、抑郁状态及剖宫产率.结果 观察组第二产程开始时焦虑、抑郁评分及剖宫产率显著低于对照组(P＜0.05、P＜0.01).结论 在分娩过程中对产妇进行头部按摩可有效缓解产妇的焦虑、抑郁情绪,降低剖宫产率.     

孕晚期心身健康问题调查

为探讨孕晚期孕妇主要心身健康问题,随机抽取产前检查决定在本院分娩的孕妇１０５２例,采用自似２６项孕期常见健康问题问卷,进行孕晚期心身健康问题调查,以产后抑郁量表跟踪调查至产生后７ｄ。调查结果显示产后抑郁症的发生与孕晚期心身健康问题有关。提出了加强孕晚期心理护理,采用社区家庭护理干预和自我护理保健,并根据实际情况选择适当的干预方式,可促进孕产妇的身心健康。     

尼尔雌醇防治绝经后及老年妇女骨质疏松的临床观察

对 2 0例绝经后妇女和老年妇女分别给予尼尔雌醇用药 3个月 ,并于给药前后分别测定空腹尿钙与肌酐 (Ca/Cr) ,羟脯氨酸与肌酐 (OHPr/Cr)比值以及血清碱性磷酸酶 (AKP)、雌二醇 (E2 )、降钙素 (CT)的值。以探讨尼尔雌醇减缓不同绝经年限妇女骨量丢失的作用机制。结果显示尼尔雌醇给药前后两组妇女血清E2 的水平未见明显变化 ,但其血清CT的水平均较给药前有程度不同的升高。空腹尿Ca/Cr、OHPr/Cr比值以及血清AKP水平均较给药前显著下降 (P <0 0 0 5及P <0 0 1)。故此提示 ,尼尔雌醇可能通过刺激甲状腺C细胞而增加CT的分泌或直接作用于骨组织等多种途径抑制骨质的吸收 ,维持其骨矿含量的相对稳定。因此 ,本研究在国内首次为尼尔雌醇用于减缓老年妇女骨质的丢失提供了一定的理论依据。     

The risks of partner violence following HIV status disclosure,and health service responses: narratives of women attending reproductive health services in Kenya

Introduction

For many women living with HIV (WLWH), the disclosure of positive status can lead to either an extension of former violence or new conflict specifically associated with HIV status disclosure. This study aims to explore the following about WLWH: 1. the women''s experiences of intimate partner violence (IPV) risks following disclosure to their partners; 2. an analysis of the women''s views on the role of health providers in preventing and addressing IPV, especially following HIV disclosure.

Methods

Thirty qualitative interviews were conducted with purposively selected WLWH attending clinics in Kenya. Data were coded using NVivo 9 and analyzed thematically.

Results

Nearly one third of the respondents reported experiencing physical and/or emotional violence inflicted by their partners following the sero-disclosure, suggesting that HIV status disclosure can be a period of heightened risk for partner stigma and abuse, and financial withdrawal, and thus should be handled with caution. Sero-concordance was protective for emotional and verbal abuse once the partner knew his positive status, or knew the woman knew his status. Our results show acceptance of the role of the health services in helping prevent and reduce anticipated fear of partner stigma and violence as barriers to HIV disclosure. Some of the approaches suggested by our respondents included couple counselling, separate counselling sessions for men, and facilitated disclosure. The women''s narratives illustrate the importance of integrating discussions on risks for partner violence and fear of disclosure into HIV counselling and testing, helping women develop communication skills in how to disclose their status, and reducing fear about marital separation and break-up. Women in our study also confirmed the key role of preventive health services in reducing blame for HIV transmission and raising awareness on HIV as a chronic disease. However, several women reported receiving no counselling on safe disclosure of HIV status.

Conclusion

Integration of partner violence identification and care into sexual, reproductive and HIV services for WLWH could be a way forward. The health sector can play a preventive role by sensitizing providers to the potential risks for partner violence following disclosure and ensuring that the women''s decision to disclose is fully informed and voluntary.     

Posttraumatic Stress Disorder Among Incarcerated Battered Women: A Comparison of Battered Women Who Killed Their Abusers and Those Incarcerated for Other Offenses

The present study examined differences in the amount and severity of spousal violence and posttraumatic stress symptoms between incarcerated battered women who killed/seriously assaulted their abusers and battered women incarcerated for other offenses. Additionally, several risk and buffering variables suggested by trauma research were tested to determine their ability to predict present posttraumatic stress disorder (PTSD) symptomatology. Findings revealed that battered women who killed/seriously assaulted their batterers experienced more frequent and severe spousal abuse than those in the comparison group. No significant group differences were found for present PTSD symptom levels. Predictors of present PTSD symptomatology included: childhood sexual abuse, childhood physical abuse, past PTSD symptomatology, length of time elapsed since living with partner and receiving counseling in prison. The implications of the findings are discussed.     

Comparison of effects of estriol on bone mineral density of vertebrae between elderly and postmenopausal women

To compare the efficacy of estriol (E₃) for postmenopausal and senile osteoporosis, we administered orally 1 g/day calcium lactate alone (control groups) or with 2 mg/day estriol (E₃ groups) to 20 postmenopausal women aged 50–65 years and 29 elderly women aged 70–84 years, and determined their bone mineral density (BMD) of the lumbar vertebrae AP scan by dual-energy X-ray absorptiometory. Of 41 subjects who completed 10 months of treatment, 8 postmenopausal women and 12 elderly women in the E₃ groups showed a significant (P < .05) increase in BMD, 5.59% ± 4.79% and 3.83% ± 7.90% of the respective basal values, while 10 postmenopausal women and 11 elderly women in the control groups showed a decrease in BMD, −4.02% ± 7.00% and −3.26% ± 4.60% of the respective basal values, after 10 months. On the other hand, genital bleeding as a side effect of E₃ occurred in 6 elderly subjects at this dose. Moreover, decrease in serum level of corrected calcium was seen only in the elderly women receiving E₃. Although a lower dosage of E₃ may be recommended for elderly subjects, these observations suggest, first, that hormone replacement therapy with E₃ has efficacy for involutional osteoporosis, and, second, that the bones in elderly women also maintain responsiveness to E₃. Received: May 19, 1997 / Accepted: July 7, 1997     

Age-Related Decline in Trabecular and Cortical Density: A 5-Year Peripheral Quantitative Computed Tomography Follow-Up Study of Pre- and Postmenopausal Women

This 5-year prospective study assessed changes in trabecular and cortical volumetric bone density at the non-weight-bearing radius and weight-bearing tibia among clinically healthy pre- and postmenopausal women. Altogether 79 premenopausal (mean age ± SD at baseline 33 ± 2 years) and 108 postmenopausal (68 ± 2 years) women participated in the baseline and follow-up measurements. Trabecular density (TrD) of the distal radius and tibia and cortical density (CoD) of the radial and tibial shafts were assessed by peripheral quantitative computed tomography (pQCT). Repeated measures analysis of variance was used to analyze differences of means and mean changes between the age groups. As expected, TrD and CoD values were greater among premenopausal than postmenopausal women. Changes in radial TrD were similar in both age groups: mean (95% confidence interval) TrD of the distal radius declined by 3.0 mg/cm³ (−0.9 to 7.0) and 5.1 mg/cm³ (1.8–8.5) in the younger and older age groups, respectively. The respective declines in TrD of the distal tibia were 4.1 mg/cm³ (2.1–6.0) and 2.8 mg/cm³ (1.2–4.3). Decline in CoD was greater in the older than younger age group at both the radial and tibial shafts (P < 0.001). The mean absolute declines in radial CoD were 33.3 mg/cm³ (27.9–38.7) and 49.4 mg/cm³ (44.9–53.9) in younger and older women, and the declines in tibial CoD were 16.5 mg/cm³ (12.6–20.2) and 28.1 mg/cm³ (25.0–31.2), respectively. In conclusion, volumetric TrD in the weight-bearing tibia and non-weight-bearing radius showed similar age-related declines among pre- and postmenopausal women, while the decline in CoD was greater among postmenopausal women.     

Comparison of bone densitometry of the phalanges,distal forearm and axial skeleton in early postmenopausal women participating in the EPIC study

We present baseline bone densitometry from the Early Postmenopausal Interventional Cohort study (EPIC, sponsored by Merck, Sharp & Dohme) for the first time, in which 1609 women from England, Oregon, Hawaii and Denmark are participating to investigate the efficacy of daily oral alendronate to prevent early postmenopausal bone loss. We compared radiographic absorptiometry (RA) of the phalanges for bone mineral density (BMD) measurement with single-energy X-ray absorptiometry (SXA) of the distal forearm, and dual-energy X-ray absorptiometry (DXA) of the lumbar spine, proximal femur and distal forearm. In a random subgroup of 308 women, aged 45–60 years, on average 6 years since menopause (YSM), bone densitometry was measured once at baseline by RA of the phalanges besides the mandatory measurements by DXA. Bone densitometry was furthermore measured by SXA at the Danish site (89 women). Sixty-eight of the women had duplicate measurements performed within 1–3 weeks to evaluate the short-term precision error (CV%). One hundred and one healthy premenopausal women, aged 25–48 years, were recruited at the Danish and Hawaiian sites to establish a reference group. The precision error was 1.5% for RA of the phalanges and in the range 1.0–2.2% for SXA and DXA. BMD by RA correlated with BMD measured by SXA and DXA in the range 0.45<r<0.72 (p<0.001). In conclusion, bone densitometry by RA of the phalanges is highly correlated with bone densitometry by SXA and DXA. RA of the phalanges has a short-term precision error comparable to that of SXA and DXA.     

Comparison of Clinical Features and Treatment Outcome of Breast Cancers in Young and Elderly Chinese Patients

BACKGROUND: This study aimed to investigate the clinicopathological features and prognosis of operable breast cancers in young and elderly Chinese women. PATIENTS AND METHODS: This study included 209 patients aged ≤35 years and 213 patients aged ≥60 but <70 years, who received treatment between January 2000 and December 2004. The clinicopathological features, molecular subtypes, therapeutic strategies, and prognosis were evaluated. RESULTS: Tumor size was of significant difference between the 2 groups (p = 0.018), with more T2 and T3 tumors in the young group and more lymph node involvement in young patients with stage T1 tumors (p = 0.033). There were more triple-negative and less luminal A tumors in the young group (p = 0.018). 47.1% of tumors were not detected by mammography in the young group as compared to 5.5% in the elderly group (p < 0.001). More patients received chemotherapy in the young group (p < 0.001) and preferred breast-conserving surgery (p = 0.031). The 6-year disease-free survival (DFS) was 80 and 66% in the elderly and the young group, respectively (p = 0.001), but no difference was seen in overall survival. CONCLUSIONS: Compared with elderly women, young breast cancer patients have different clinicopathological features and molecular subtypes, and poorer DFS. Furthermore, the insidious onset of breast cancer in young women suggests that clinicians should pay more attention to young women with breast abnormalities.