106例小于胎龄儿临床分析与随访

１０６例小于胎龄儿临床分析与随访青岛市第二人民医院儿科（２６６０３３）郑青，齐瑛，栾红，李军军北京儿童医院刘红小于胎龄儿系宫内发育迟缓的胎儿，由于其生后合并症多，病死率高，而且关系着以后的生长发育及智力水平，近年来日益受到重视。本文就近五年来收治的１...     

瘦素与小于胎龄儿的研究进展

小于胎龄儿(SCA)又称胎儿宫内发育迟缓(IUGR),指出生体重低于该孕周平均体重的第10百分位数,发生率国外报告为496～5%,而我国为3.7%～9.2%.SGA死亡率为正常新生儿死亡率的8倍,存活者远期体格、智力、发育障碍发生率较正常儿高,因此,SGA发生因素的研究是当今国内外关注的围产医学的重要课题.     

大学生亲密伴侣暴力演变及其与抑郁症状的关联

目的:分析亲密伴侣暴力(IPV)转变模式与大学生抑郁症状的关联。方法:于2019年11月-12月,选取安徽省两所医学专科学校的4211名大一年级学生开展基线调查(T1),1年后进行随访(T2)。采用IPV问卷、抑郁自评量表(SDS)评估大学生的IPV和抑郁症状,通过潜在转变分析(LTA)探讨IPV的变化模式。利用多因素logistic回归模型分析IPV不同转变模式和抑郁症状的关联。结果:潜在转变分析显示,70.6%的大学生T2与T1保持一致,其中64.0%的大学生持续低IPV,命名为低水平稳定组;6.6%的大学生持续高IPV,命名为持续高危组。22.4%的大学生高IPV转变为低IPV,命名为缓和组,7.1%的大学生从低IPV转变为高IPV,命名为恶化组。各转变模式中,相对低水平稳定组,缓和组(OR=1.37,95%CI:0.98～1.91)、恶化组(OR=3.68,95%CI:2.33～5.81)与持续高危组(OR=3.80,95%CI:2.37～6.09)与大学生抑郁症状风险增加有关。结论:IPV随时间的转变与大学生抑郁症状风险增加相关,减少IPV有益于大学生抑郁症状的防控。     

胃肠激素检测在小于胎龄儿变化中的临床意义

目的:对68例小于胎龄儿(其中早产36例;足月32例)生后喂奶前及第7d空腹血中生长抑素(somatostatin, SS)、胃动素(motilin, MOT)、胃泌素(gastrin, Gas)浓度进行测定,并以30例足月新生儿作为对照组.方法:应用放射免疫分析测定SS、MOT、Gas浓度.结果:小于胎龄儿组生后喂奶前及第7d空腹血浆MOT、Gas均明显低于对照组,而SS浓度明显高于对照组,并且与胎龄、开始喂养时间及当日进奶等因素相关.结论:小于胎龄儿消化道机能适应胃肠道营养,在严密观察下应用合理的喂养方式早日开始胃肠道营养,将能促进小于胎龄儿胃肠道的发育和成熟.     

小于胎龄儿脐血超敏C反应蛋白水平及意义探讨

目的比较小于胎龄儿（small-for-gestational-age,SGA）与适于胎龄儿（appropriate-for-gestational age,AGA）脐血超敏C反应蛋白（hs-CRP）水平,探索C反应蛋白与心血管病之间的关系。方法检测32例SGA和66例AGA脐血hs-CRP浓度,排除可疑或经证实的宫内感染。结果SGA组hs-CRP浓度显著高于AGA组,中位数（范围）分别为：SGA组0.06 mg/dl（0.02～6.03）、AGA组0.02 mg/dl（0.02～0.61）,P=0.003。hs-CRP浓度高于检测限（0.04mg/dl）分别为：SGA组22例（68.8%）、AGA组26例（39.4%）,（P=0.002）。结论SGA组hs-CRP浓度高于AGA组,提示SGA在胎儿期可能有炎症反应。     

亲密伴侣暴力态度量表修订版的中文修订及信效度检验

目的：引进亲密伴侣暴力态度量表修订版,在中国大学生中进行中文版修订和信效度检验。方法：采取整群取样的方法对两个样本的大学生进行集体施测,选取沟通模式问卷、冲突策略量表修订版、父母婚姻满意度量表、支持离婚态度量表作为效标。结果：中文版量表包括16个条目,包括对心理虐待的态度、对身体暴力的态度和对控制行为的态度3个分量表。验证性因素分析表明,三因素模型的拟合指数良好,χ2/df=3.81,RMSEA=0.073,SRMR=0.074。选用沟通模式问卷和冲突策略量表作为聚合效度的效标,相关系数的绝对值为0.14～0.24。选用父母婚姻满意度量表和支持离婚态度量表作为区分效度的效标,在8对相关中有7对未达到显著水平。总量表的内部一致性系数为0.80。结论：亲密伴侣暴力态度量表修订版的中文版有较好的信度和效度,可以作为评估亲密伴侣暴力态度的工具。     

性别方向性、施暴动机和暴力类型对亲密伴侣暴力合理化态度的影响

目的：探讨性别方向性、施暴动机和暴力类型对亲密伴侣暴力合理化态度的影响。方法：采用3×2×2三因素被试间设计的情景研究,在故事情景中操纵亲密伴侣暴力的性别（男性、女性、双向）、动机（冲突、控制）和类型（躯体、精神）,被试随机阅读一则情景材料后回答有关暴力合理化态度的问题。结果：(1)性别、动机和类型对暴力合理化态度的主效应显著。(2)在单向暴力（包括男性或女性施暴）和精神暴力情境中,被试对冲突动机下的暴力合理化态度高于控制动机。(3)性别、动机和类型的三阶交互效应显著。结论：性别方向性、施暴动机和暴力类型共同对亲密伴侣暴力合理化态度产生影响,男性施暴、控制动机和躯体暴力被认为更不合理。     

亲密伴侣暴力施暴者心理干预的发展(综述)

亲密伴侣暴力(intimate partner violence,IPV)是指现在或曾经处于亲密关系的伴侣或配偶之间发生的暴力.亲密伴侣或配偶是指包括恋爱、未婚、已婚、离异、分居的异性或同性伴侣或配偶,不一定有同居或性行为.暴力形式包括任何形式的躯体、性、精神暴力和威胁[1].世界卫生组织进行的全世界15个地区大规模调查发现,IPV躯体或性暴力终生发生率为15%～71%,年发生率为4%～54%[2].     

小于胎龄儿追赶生长特点及影响因素分析

目的探讨中国北方地区小于胎龄儿(SGA)出生后追赶生长特点以及相关影响因素。方法以2012年1月至2013年1月在河北省廊坊市妇幼保健中心出生的新生儿为研究对象,根据出生体质量分为SGA组、适于胎龄儿组(AGA)和大于胎龄儿组(LGA),收集出生时至2岁资料。统计分析SGA出生后追赶生长特点以及相关影响因素。结果研究共纳入SGA、AGA和LGA分别661例(8.3%)、6571例(82.5%)和729例(9.2%)。SGA组2岁时矮小的比例为0.9%,高于AGA组(0.6%)和LGA组(0.3%)(P0.05)。SGA组出生后2年内追赶生长主要出现在1岁以内。相关性分析显示,SGA 1岁内身长增长速度与出生体质量、身长、Apgar评分呈负相关;与胎盘质量呈正相关,而与F/P呈负相关;与喂养方式相关。结论大部分SGA儿童在2岁时完成追赶生长,追赶生长主要出现在出生后1年内,胎盘不适当过重、喂养方式等因素均与SGA追赶生长相关。     

生长激素在小于胎龄儿临床应用的展望

小于胎龄儿(small for gestational age infant,SGA)是指出生体重在同胎龄儿平均体重的第10百分位以下,或低于平均体重2个标准差的新生儿.欧美发达国家的发生率是2.5%,我国的发生率是6.39%,患儿自幼大多生长落后终生身材矮小[1].     

Head injury screening and intimate partner violence: A brief report

Objective: Although the importance of traumatic brain injury has gained public attention in recent years, relatively little attention has been paid to head injuries among women who have experienced intimate partner violence (IPV). The present study screened for lifetime exposure to mild traumatic brain injuries (mTBIs) among a sample of women who had experienced recent IPV (median days since target incident = 26). Method: Participants included ethnically diverse women whose IPV experiences were reported to law enforcement. Women (n = 225) were asked about injuries to the head sustained during the target IPV incident as well as over the lifetime, and related symptoms. Results: The vast majority of women (80%) reported a lifetime head injury. More than half (56%) screened positive for mTBI, defined as at least one instance in which they experienced a change in consciousness or a period of being dazed and confused as a result of a head injury. A minority of women (13%) reported injuries to the head during the target IPV incident. Most women who had experienced a lifetime head injury reported frequent and current cognitive difficulties. Conclusion: These findings highlight the importance of assessing head injuries and related symptoms among women who have experienced IPV, pointing to important implications for policy and practice.     

Personality characteristics in specialist and generalist intimate partner violence perpetrators

Intimate partner violence (IPV) is one of the most common types of violence against women. Although personality disorders have been associated with IPV, perpetration research regarding personality according to the classification specialist/generalist IPV perpetrators is scarce. The general aim of this study was to describe personality in a large sample of IPV Spanish male perpetrators considering their classification (specialist vs. generalist). Participants were 1093 men convicted of IPV crimes whose ages ranged from 18 to 76 years old (M = 40.15; SD = 10.32). Of them, 554 men were classified as specialist perpetrators and 539 men were classified as generalist perpetrators. Participants completed questionnaires regarding sociodemographic and violence aspects as well as the Spanish version of the Millon Clinical Multiaxial Inventory III. Generalist perpetrators showed higher means in nearly all the personality disorders scales compared to specialist perpetrators. Prevalence rates in the majority of personality disorders were lower than 5%. Higher scores on the avoidant, histrionic, and self-defeating scales and lower scores on the aggressive, borderline, and drug dependence scales were related to being a specialist perpetrator. This study contributes to a better understanding of personality among generalist and specialist perpetrators.     

Differential MCMI-III psychopathological profiles between intimate partner violence perpetrators with and without childhood family violence

This study explored the differential prevalence of personality disorders (PD) and clinical syndromes between male perpetrators of intimate partner violence (IPV) with and without a history of childhood family violence (CFV). A sample of 981 perpetrators of IPV was assessed with the Millon Clinical Multiaxial Inventory-III (MCMI-III). Comparisons of sociodemographic characteristics and MCMI-III scales' scores between perpetrators with (n = 293) and without (n = 688) CFV were carried out. Results showed that IPV perpetrators with CFV had a lower level of education, were less frequently employed, and had higher rates of previous psychiatric history than perpetrators without CFV. Statistically significant differences between groups in almost all the MCMI-III scales were found. Perpetrators with CFV presented with higher scores on most of the evaluated scales and showed a more severe psychopathological profile than perpetrators without CFV. The multivariate analysis showed that the main MCMI-III domains related to CFV were higher scores on the disclosure and alcohol dependence scales and lower scores on the passive-aggressive scale. These findings reveal that CFV is associated with a more severe psychopathological profile in perpetrators of IPV. In order to develop tailored interventions, the presence of CFV and psychopathological symptoms should be assessed in IPV perpetrators.     

Early maladaptive schemas and intimate partner violence victimization and perpetration: A systematic review and meta-analysis

Young's early maladaptive schemas represent a possible pathway between childhood adversity and Intimate Partner Violence (IPV). The aim of this review was to synthesize the evidence on early maladaptive schemas and IPV. PubMed, PsycInfo, and CINAHL databases were searched, in compliance with PRISMA, to identify peer reviewed studies that reported on the relationship between schema or schema domain scores and IPV victimization or perpetration. Based on nine included studies, meta-analyses indicated that IPV victimization showed a moderate association with the Disconnection and Rejection and Impaired Autonomy domains, and a small association with Other-Directedness. The Mistrust Abuse and Vulnerability to Harm schemas were moderately correlated with victimization. Mistrust Abuse was also implicated in perpetration but insufficient data were available for meta-analysis. The evidence suggests that being a victim of IPV is associated with an expectation that one's needs for love and safety will not be met and doubt regarding one's capacity to handle responsibilities or succeed in life.     

Barriers to access intimate partner violence services in female Romanian immigrants in Spain: A Delphi study

Immigrant women may be at higher risk of intimate partner violence (IPV) and may seek specialized services less frequently than other populations. In Spain, Romanian origin foreigners comprise the second-highest proportion among immigrant population. This study aimed to identify, from the perspective of experts, (1) the main barriers faced by immigrant women of Romanian origin in accessing specialized services for IPV in Spain; and (2) the most useful strategies to combat these barriers. A Delphi study was conducted with a panel of 23 experts. The coefficient r_WG was calculated to established agreement among participants. The results showed 58 barriers and 31 strategies with high agreement among the experts (r_WG ≥ 0.80). Barriers in access to services that were considered to be highly influential included: having been in the host country for a short time; lack of language proficiency; job insecurity; difficulty with family-work reconciliation; and fear of the social consequences for help-seeking. The strategies considered most useful were: facilitating access to the job market and decent housing; promoting a social support network; translating material into Romanian; and increasing training among professionals. The findings offer guidelines for the improvement of the accessibility of specialized services to immigrant women of Romanian origin.     

Women reporting intimate partner violence in India: Associations with PTSD and depressive symptoms

Intimate Partner Violence (IPV) is prevalent worldwide and often has mental health sequelae. The aims of this study were (a) to describe the prevalence and the nature of PTSD symptoms among Indian women reporting IPV, (b) to study the relationship between symptoms of PTSD and depression, and (c) to examine the relationship between sexual coercion and PTSD symptoms. Consecutive women (n = 105) presenting to an adult psychiatry outpatient unit of National Institute of Mental Health and Neuro Sciences in South India were recruited. These women were assessed for IPV, sexual coercion, PTSD symptoms, and depression. Fifty-nine women (56%) reported a history of IPV, of whom 41 (70%) also reported sexual coercion. Among women reporting IPV, seven (14%) exceeded cut-off scores for PTSD and twelve (20%) exceeded cut-off scores for sub-threshold PTSD. The majority of those reporting IPV exceeded cut-off scores for a depressive disorder. Compared to women without a history of IPV, women reporting IPV had higher scores on PTSD and depression. Severity of violence and sexual coercion correlated positively (r = 0.39) with PTSD severity. The findings highlight the importance of screening women for IPV and its sequelae, in mental health settings.     

Health professionals’ perceptions of intimate partner violence against women in Serbia: Opportunities and barriers for response improvement

Objective

The aim of this study was to determine the perceptions and attitudes of health professionals toward violence against women in intimate relationships, and to discuss them as opportunities and barriers for improving health professionals’ response.

Methods

Six focus groups were conducted with 71 health professionals employed in the public primary health care centers in Belgrade (Serbia). The data were analyzed according to the direct approach of the qualitative content analysis.

Results

Findings suggest that the majority of health professionals perceive IPV as an unjustifiable act. They showed an understanding for women; see their role as providing support to women and collaborating with other institutions. They are willing to help, but do not know how. However, some health professionals appeared to be judgmental in terms of what preceded violence, and would insist on extracting a woman's disclosure that violence had occurred. As barriers, they emphasized the lack of training and specific education on IPV, a weak support network, and overall social insecurity.

Conclusion

There is a gap between health professionals’ willingness to help and resources needed, along with prejudice and interrogative attitudes. Barriers appeared at individual, organizational and societal levels.

Practice implications

Proper education and protocols are priorities in strengthening health professionals’ response to IPV.     

Psychological and physical sequelae of intimate partner violence among women with limitations in their activities of daily living

Summary Objective: To compare the psychological and physical sequelae of physical/sexual intimate partner violence in women with and without activity limitations. Methods: We analyzed data from the Canadian 1999 General Social Survey. We included women reporting intimate partner violence in the previous 5 years (n = 897). Results: As a result of the violence, women with activity limitations were significantly more likely to feel ashamed/guilty (21.7 vs. 14.5%), depression/anxiety (31.5 vs. 19.8%), fearful (43.0 vs. 33.0%), lowered self-esteem (35.2 vs. 21.1%), increased caution/awareness (20.3 vs. 10.9%), and problems relating to men (16.4 vs. 5.4%). Significantly more women with activity limitations reported physical injury from violence (57.0 vs. 36.6%) and having to take time off from everyday activities (42.1 vs. 30.3%). Women with activity limitations had higher medication use for sleeping problems (OR = 3.17, 95% CI = 1.36, 5.73), anxiety (OR = 3.29, 95% CI = 1.75, 6.19) and depression (OR = 2.63, 95% CI = 1.41, 4.90). Conclusion: Results suggest an additive effect between intimate partner violence and activity limitations that adds disproportionately to the burden of health for women with activity limitations.