新冠肺炎流行期间医学生的抑郁焦虑症状及相关因素

目的:了解新冠肺炎流行期间医学生的抑郁、焦虑症状及相关因素。方法:使用在线调查平台"问卷星"创建问卷向医学生发放,收回有效问卷5593份。采用自编一般资料问卷、病人健康问卷(PHQ-9)、广泛性焦虑量表(GAD-7)进行调查。结果:有1964名(35.1%)医学生存在抑郁症状,1255名(22.4%)医学生存在焦虑症状。Logistic回归分析显示,女性、大二、大三、大四、关注疫情时间长为抑郁症状(OR=1.28、1.30、1.36、1.25、1.09)、焦虑症状(OR=1.16、1.24、1.46、1.31、1.17)的危险因素;对疫情知识了解为抑郁、焦虑症状的保护因素(OR=0.79、0.82)。结论:新冠肺炎流行期间,医学生抑郁、焦虑症状的检出率较高。     

新冠肺炎流行期间国际航行船舶海员抑郁状况及相关因素

新冠肺炎(COVID-19)的流行给海员群体带来了多重困境[1]。各国为防止疫情传播而采取的旅行和个人行动限制导致超过40万名海员无法进行正常换班,超期服务问题突出[2]。本研究针对国际航行海员这一特殊群体,探讨新冠肺炎疫情大流行形势下的抑郁现状及其相关因素,为实施有针对性的干预措施提供科学依据。     

新冠肺炎流行期间北京市孕妇的焦虑抑郁症状及睡眠状况

目的:评估新冠肺炎流行期间孕妇的焦虑抑郁症状与睡眠问题及其相关因素。方法:2020年2月28日-4月26日,通过网络问卷平台调查北京四家助产机构就诊的885例孕妇的焦虑抑郁症状及睡眠问题。采用广泛焦虑量表(GAD-7)评估焦虑症状,采用患者健康问卷抑郁症状群量表(PHQ-9)评估抑郁症状,采用失眠严重程度指数量表(ISI)评估失眠症状。结果:本样本中焦虑症状、抑郁症状及失眠症状检出率分别为12.2%,24.6%和13.6%。缺少照顾(OR=1.73)、有分娩担忧(OR=3.95)及心理弹性差(OR=4.57)是焦虑症状的危险因素;家庭收入高(OR=1.94)、有分娩担忧(OR=2.39)及心理弹性差(OR=3.04)是抑郁症状的危险因素;除已婚外其他婚姻状况(OR=4.95)、孕周较长(13～27周,OR=2.03;28周及以上,OR=2.13)、有躯体疾病史(OR=1.77)、存在分娩担忧(OR=2.78)及心理弹性差(OR=1.67)是失眠症状危险因素。结论:新冠肺炎流行期间北京市孕妇焦虑症状、抑郁症状及失眠症状常见,尤其是存在分娩担忧及心理弹性差的孕妇。     

新冠肺炎患者焦虑症状及相关因素

目的:调查新冠肺炎患者的焦虑症状并分析相关因素。方法:新冠肺炎患者108例,采用自编一般资料调查表、广泛性焦虑量表(GAD-7)、简易应对方式量表(SCSQ)进行调查。结果:GAD-7总分(10.3±4.5)分。对GAD-7各条目进行秩和检验发现,有焦虑症状患者的GAD-7得分大于无焦虑症状患者(P<0.05)。GAD-7总分与积极应对得分呈负相关(r=-0.44,P<0.001),与消极应对得分呈正相.关(r=0.31,P<0.01)。二分类logistic回归分析显示,有发热症状、有接触史是焦虑症状的危险因素(OR=33.40、18.13),男性、积极应对是焦虑症状的保护因素(OR=0.02、0.03)。结论:新冠肺炎患者为女性、出现发热、有接触史时其焦虑症状越严重。     

新冠肺炎流行期急诊护士心理应激反应及相关因素

目的:了解新冠肺炎流行期急诊护士的心理应激反应现状并分析相关因素,为调控其心理应激反应提供参考依据。方法:使用修订版事件影响量表(IES-R)、一般健康问卷(GHQ-12)、简易应对方式问卷(SCSQ)调查广州地区7所新冠感染者定点救治医院的263名急诊护士的心理应激反应、心理健康水平及应对方式。结果:急诊护士IES-R总分为(28.1±14.8)分,心理应激反应检出率分别为轻度37.6%、中度39.3%、重度13.3%。多重线性回归分析显示,女性、本科及以上受教育程度的护士IES-R得分较高(β=0.11、0.12,均P<0.05),IES-R总分与GHQ-12得分、SCSQ消极应对得分与担心自己感染新冠肺炎程度呈正向关联(β=0.39、0.30、0.24,均P<0.05),与SCSQ积极应对得分呈负向关联(β=-0.15,P<0.05)。结论:新冠肺炎流行期,女性、受教育程度较高、心理健康水平较差、倾向消极应对方式及担心自己感染的护士心理应激反应更严重。     

新冠肺炎疫情发生前后中国大学生焦虑症状及相关因素的meta分析

目的:探讨中国大学生焦虑症状及其相关因素在新冠肺炎疫情(简称疫情)发生前后的变化。方法:检索中英文数据库,收集以焦虑自评量表(SAS)为工具研究中国大学生焦虑相关因素的文献,以纳入文献的调查时间在2020年1月前定为疫情前、此后为疫情期间,运用Stata15.1软件进行meta分析。结果:纳入疫情前文献24篇、疫情期间文献14篇。疫情期间大学生焦虑症状检出率高于疫情前(24.2%vs.21.9%)。13个因素被纳入meta分析,疫情前大四年级、独生子女、性格内向、抑郁症状、身体不健康、睡眠质量差、单亲家庭、家庭经济差是大学生焦虑症状的危险因素(OR=1.48、1.24、1.59、6.62、2.23、1.82、2.77、2.13),女性、体育锻炼、高社会支持是其保护因素(OR=0.82、0.53、0.71);疫情期间大四年级、性格内向、抑郁症状、身体不健康、睡眠质量差、家庭经济差是大学生焦虑症状的危险因素(OR=2.57、1.45、1.34、3.96、1.87、1.59),医学生、体育锻炼、高社会支持是其保护因素(OR=0.73、0.66、0.57)。结论:女性、大四年级、身体不健康、抑...     

新冠肺炎流行期心理热线求助者特点及有关因素

目的:对"心心语"心理热线来电资料进行分析,探究新冠肺炎流行期求助者特点及有关因素。方法:热线志愿者依据求助者的来电状况完成咨询登记问卷,采用χ²检验和回归分析对6680份问卷进行分析。结果:随着时间推移,来电者容易出现抑郁症状,不易出现躯体化症状(OR=1.10、0.95);年龄较大者不易出现抑郁症状,更易出现睡眠问题(OR=0.74、1.51);女性更易出现焦虑症状表现、抑郁症状表现、睡眠问题及危机状况(OR=1.24、1.71、1.29、1.97);所在地为武汉市者(OR=1.40、0.68)更易出现躯体化症状,不易出现危机状况;已婚者不易出现睡眠问题及危机状况(OR=0.60、0.29)。随着时间推移,咨询新冠肺炎预防知识、心理困扰、现实问题减少(OR=0.74、0.89、0.84)。结论:求助者的情绪、来电目的、危机状况特点受时间、性别、年龄、婚姻状况、学历及所在地等因素影响。     

新冠肺炎流行期间江苏省心理援助热线来电特征

目的:了解新冠肺炎流行期间心理援助热线来电问题特征及随时间变化情况。方法:收集2020年2月1日-4月30日新冠肺炎流行期间江苏省心理援助热线来电,对来电内容进行分类,对来电量随时间的变化进行分析。结果:该时段内与新冠肺炎相关的来电数为1610人次,占总来电的23.3%。来电问题包括心理问题(因疫情引发情绪行为问题;原有精神心理问题加重/复发;居家心理问题)、信息咨询和其他问题。心理问题中4月原有精神心理问题加重/复发的来电比例显著高于2月(15.7% vs.5.3%,P<0.05)。结论:新冠肺炎流行期间心理援助热线来电问题主要为心理问题和信息咨询问题,来电量随着疫情形势的好转减少。     

新冠肺炎住院患者疾病认知状况的相关因素

目的:分析新冠肺炎住院患者的疾病认知水平及其相关因素。方法:选取某定点医院救治住院的新冠肺炎患者118例,采用自编一般资料调查问卷、自编新冠肺炎相关知识调查问卷及疾病认知调查问卷修订版(IPQ-R)进行调查。结果:与普通内科患者相比,新冠肺炎患者的IPQ-R病程、波动性、后果、情感陈述维度得分较低,而治疗控制、疾病一致性维度得分较高(均P<0.001)。新冠肺炎患者居住地、就诊前服药、活动耐力、睡眠与病程维度有关联(β=-0.23~-0.35),睡眠、疾病知识与波动性维度有关联(β=-0.19、-0.19),家庭月收入、活动耐力、负面影响与后果维度有关联(β=-0.18、-0.22、0.36),家庭月收入、恐慌程度与个人控制维度有关联(β=0.19、-0.23),性别、居住地、就诊前服药、食欲、负面影响与治疗控制维度有关联(β=-0.19、0.31、0.29、0.19、-0.20),家人感染、就诊前自认为感染、情绪状态与疾病一致性维度有关联(β=-0.18、-0.21、0.29),情绪状态、恐慌程度、负面影响与情感陈述维度有关联(β=-0.18、0.36、0.32)。结论:新冠肺炎患者存在一定程度的负性疾病认知,性别、家庭月收入、居住地等多个因素与其疾病认知有关联。     

新冠肺炎疫情期间医务人员与非医务人员焦虑抑郁水平及相关因素

目的:探索新冠肺炎疫情暴发期间医务人员与非医务人员焦虑抑郁水平及相关因素。方法:通过微信公众号方式发放在线问卷,共调查医务人员170名,非医务人员217名。内容包括一般情况调查表、广泛性焦虑量表(GAD-7)、患者健康问卷(PHQ-9)和心理弹性量表(CD-RISC-10),采用logistic回归分析焦虑、抑郁情绪的相关因素。结果:医务人员中抑郁情绪检出率42.9%,焦虑情绪检出率46.5%。非医务人员抑郁情绪检出率62.7%,焦虑情绪检出率52.5%。在所有被调查者中,非医务人员(OR=0.58,95%CI:0.36～0.93,P<0.05)是抑郁情绪的危险因素,接触(疑似)感染者(OR=2.63,95%CI:1.43～4.85,P<0.01)是焦虑情绪的危险因素。心理弹性差是抑郁情绪(医务人员：OR=10.36,95%CI:3.46～31.05,P<0.001,非医务人员：OR=17.14,95%CI:6.39～45.97,P<0.001)和焦虑情绪(医务人员：OR=14.30,95%CI:4.68～43.69,P<0.001,非医务人员：OR=11...     

团体干预对地震灾区初中生创伤后应激和抑郁症状的作用

目的:探索团体干预是否有助于缓解地震灾区初中生的创伤后应激症状和抑郁症状。方法:在汶川地震发生后6个月,以方便取样的原则选取四川彭州地区某学校初二的2个班级,1个班为对照组(n=38),另1个班为干预组(n=47),对干预组实施以提高社会支持为目标的班级团体干预方案(共2周,每周2次)。用儿童事件影响量表(Children’s Revised Impact of Event Scale,CRIES)和儿童抑郁量表(Children’s Depression Inventory,CDI)进行测量,比较两组在干预前(前测)、干预2周后(后测)及干预结束4个月后(追踪)CRIES和CDI得分的变化。结果:在CRIES得分上,组别和测量时间交互作用显著,前测时两组得分差异无统计学意义(P>0.05),干预2周后,两组的CRIES得分均降低,但干预结束4个月后,干预组得分持续降低,而对照组升高;在CDI得分上,组别和测量时间交互作用不显著。在3个时间点上,干预组得分始终低于对照组,并且两组CDI得分均持续降低,干预组下降程度要高于对照组(P<0.01)。结论:团体干预能够在短期内降低初中生的创伤后应激症状和抑郁水平。在干预结束后较长时间内,干预的作用持续存在。     

初中生自杀意念及影响因素的3年纵向研究

目的:了解初中生的自杀意念检出率及影响因素,为预防和减少青少年自杀意念提供针对性策略。方法:在深圳市选取2016级初一学生共1301人,进行每年1次、共3年的追踪测查。使用危险行为评定量表(RBES)、流调中心用抑郁量表(CES-D)、积极青少年发展量表(CPYDS)和家庭功能量表(CFAI)进行测查。结果:本样本的自杀意念逐年检出率分别为21.4%、22.2%、16.9%,抑郁症状检出率分别为33.4%、34.6%、28.8%。二分类logistic回归分析结果显示,女生(初一、初二、初三OR=1.48、1.35、2.47)、有抑郁症状(初一、初二、初三OR=4.41、1.83、1.83)的学生具有较高的自杀意念风险,而积极青少年发展水平高(初一和初三OR=0.72、0.67)和家庭功能好(初一和初三OR=0.68、0.73)的学生,其自杀意念风险较低。结论:深圳市初中生存在一定的自杀意念检出率,关注特定人群,提升积极青少年发展水平、改善家庭功能能降低自杀意念风险。     

Evaluating the knowledge acquisition of lower limb anatomy among medical students during the post-acute COVID-19 era

Anatomy is the foundation of many medical and surgical specialties yet knowledge acquisition and retention among medical students is questionable. Over the years the anatomy teaching environment and teaching modalities have changed, even more so with the onset of the COVID-19 pandemic and the shift to a virtual environment. The aim of this study was to evaluate the knowledge acquisition of applied musculoskeletal lower limb clinical anatomy among first year medical students in Malta following the transition back to face-to-face lectures. The Kahoot online game-based quiz platform was used through a best out of four multiple-choice setting across four sessions. Scores generated by the platform along with frequencies of correctly answered questions were utilized to measure knowledge acquisition. The average scores for each question across sessions were statistically analyzed using ANOVA and student's t-test accordingly. Across the four sessions, the positive percentage response for clinical based questions remained higher than for pure anatomy questions. Anatomy knowledge acquisition appears to be subjective to clinical based knowledge rather than pure anatomy. There may be a plethora of reasons as to this outcome including the misconception that anatomy is not essential for clinical practice as well as the potential aftermath of the COVID-induced virtual learning environment. Further research is merit to ensure that students are provided with the best tools to enhance their knowledge acquisition, both as students and as future doctors.     

Rapid response of a medical center upon the surge of COVID-19 epidemic in Taiwan

A surge of coronavirus disease (COVID-19) cases emerged in northern Taiwan in mid-May 2021. In spite of over one-year preparedness, the medical system in this area suffered from the crisis. Far Eastern Memorial Hospital (FEMH) responded quickly with decreased total hospitalization cases (about 50%) to free manpower and space. With simple construction work, the in-hospital service capacity increases from 11 negative-pressure ward (1 unit) and 2 negative-pressure ICU (1 unit) beds to over 130 ward (5 units) and 58 ICU beds (4 units) without negative-pressure design within 3 weeks. For a period of time, FEMH takes care of 10% of all intensive care services in Taiwan. The vaccination rate of workers reaches 90% since mid-May. The amount of testing performed during the period, including PCR and rapid tests, comprised of more than 20% of tests performed in New Taipei City. Two hotels for mild/asymptomatic COVID patients were handled by FEMH workers. By mid-July, about one-fifth of COVID-19 cases in New Taipei City received services from the FEMH system. With determined leadership and concerted efforts, combined interventions can increase the capacity of medical care within weeks and help society against the COVID-19 epidemic.     

Prevalence and factors related to COVID-19 vaccine hesitancy and unwillingness in Canada: A systematic review and meta-analysis

This systematic review and meta-analysis examined the prevalence and factors associated with vaccine hesitancy and vaccine unwillingness in Canada. Eleven databases were searched in March 2022. The pooled prevalence of coronavirus disease 2019 (COVID-19) vaccine hesitancy and unwillingness was estimated. Subgroup analyses and meta-regressions were performed. Out of 667 studies screened, 86 full-text articles were reviewed, and 30 were included in the systematic review. Twenty-four articles were included in the meta-analysis; 12 for the pooled prevalence of vaccine hesitancy (42.3% [95% CI, 33.7%–51.0%]) and 12 for vaccine unwillingness (20.1% [95% CI, 15.2%−24.9%]). Vaccine hesitancy was higher in females (18.3% [95% CI, 12.4%−24.2%]) than males (13.9% [95% CI, 9.0%−18.8%]), and in rural (16.3% [95% CI, 12.9%−19.7%]) versus urban areas (14.1% [95%CI, 9.9%−18.3%]). Vaccine unwillingness was higher in females (19.9% [95% CI, 11.0%−24.8%]) compared with males (13.6% [95% CI, 8.0%−19.2%]), non-White individuals (21.7% [95% CI, 16.2%−27.3%]) than White individuals (14.8% [95% CI, 11.0%−18.5%]), and secondary or less (24.2% [95% CI, 18.8%−29.6%]) versus postsecondary education (15.9% [95% CI, 11.6%−20.2%]). Factors related to racial disparities, gender, education level, and age are discussed.     

Exploring variables related to medical surrogate decision-making accuracy during the COVID-19 pandemic

ObjectiveSurrogate medical decision making is common in the United States healthcare system. Variables that may influence surrogate decision making have been proposed. Little work has examined relations between these variables and outcomes of surrogate decision making. This study investigated whether surrogates’ characteristics, including their knowledge of treatment options, and interpersonal factors predicted surrogates’ accuracy and intervention selections. Specifically, predictor variables included: trust in the medical profession, trait-level anxiety, depression, anxiety about COVID-19, religiosity, perceived emotional support, understanding of treatment options, empathy, willingness to accept responsibility for medical decisions, reluctance to burden others, and perceived similarity between oneself and the patient.Methods154 pairs of patients and their surrogates completed an online survey. Patients indicated preferred treatments in hypothetical decision scenarios. Surrogates indicated the treatment that they thought the patient would prefer.ResultsWhen taken all together in a predictive model, the variables significantly predicted surrogates? accuracy, F (6) = 3.03, R² = .12, p = .008. Variables also predicted selection of intensive interventions, F (4) = 5.95, R² = .14, p = .00. Surrogates reporting greater anxiety about COVID-19 selected more intensive interventions.ConclusionsConsistent with prior research, this study found that surrogates’ characteristics influence the interventions they choose, with anxiety about COVID-19 having considerable bearing on their chosen interventions.Practice implicationsThese findings can inform development of decision-making interventions to improve surrogates’ accuracy. Providers may attend to variables highlighted by this study to support surrogates, particularly within the stressful context of COVID-19 and possible future pandemics.     

汶川震后初中生创伤后成长状况及相关因素

目的:了解汶川地震后初中生的创伤后成长状况及相关因素。方法:在汶川地震后3年,对地震灾区1665名初中生采用创伤后成长量表(PTGI)、Connor-Davidson韧性量表(CD-RISC)、儿童主观感知的社会支持问卷(CSPSSQ)、简明大五人格量表(Mini-IPIP)进行调查。结果:少数民族、住校、父母受教育程度高的学生PTGI总分高于汉族、走读、父母受教育程度低的学生(均P0.05)。回归分析显示,年龄与PTGI总分和他人关系、个人力量因子得分正相关;心理韧性总分与PTGI总分及各因子得分均呈正相关(β=0.53,0.37,0.53,0.55,0.42,均P0.05);社会支持总分与PTGI总分及他人关系、新可能性、欣赏生活因子得分正相关(β=0.14,0.19,0.10,0.11,均P0.05);简明大五人格量表的外向性、宜人性、谨慎性、开放性因子得分与PTGI总分均呈正相关(β=0.07,0.10,0.06,0.08,均P0.05),神经质因子得分与PTGI总分及各因子得分均不相关。结论:初中生的心理韧性、主观感知的社会支持以及外向性、宜人性、谨慎性、开放性人格特质可能有助于产生创伤后成长。