Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: a meta-analysis

Context  The global refugee crisis requires that researchers, policymakers, and clinicians comprehend the magnitude of the psychological consequences of forced displacement and the factors that moderate them. To date, no empirical synthesis of research on these issues has been undertaken. Objective  To meta-analytically establish the extent of compromised mental health among refugees (including internally displaced persons, asylum seekers, and stateless persons) using a worldwide study sample. Potential moderators of mental health outcomes were examined, including enduring contextual variables (eg, postdisplacement accommodation and economic opportunity) and refugee characteristics. Data Sources  Published studies (1959-2002) were obtained using broad searches of computerized databases (PsycINFO and PILOTS), manual searches of reference lists, and interviews with prominent authors. Study Selection  Studies were selected if they investigated a refugee group and at least 1 nonrefugee comparison group and reported 1 or more quantitative group comparison on measures of psychopathology. Fifty-six reports met inclusion criteria (4.4% of identified reports), yielding 59 independent comparisons and including 67 294 participants (22 221 refugees and 45 073 nonrefugees). Data Extraction  Data on study and report characteristics, study participant characteristics, and statistical outcomes were extracted using a coding manual and subjected to blind recoding, which indicated high reliability. Methodological quality information was coded to assess potential sources of bias. Data Synthesis  Effect size estimates for the refugee-nonrefugee comparisons were averaged across psychopathology measures within studies and weighted by sample size. The weighted mean effect size was 0.41 (SD, 0.02; range, –1.36 to 2.91 [SE, 0.01]), indicating that refugees had moderately poorer outcomes. Postdisplacement conditions moderated mental health outcomes. Worse outcomes were observed for refugees living in institutional accommodation, experiencing restricted economic opportunity, displaced internally within their own country, repatriated to a country they had previously fled, or whose initiating conflict was unresolved. Refugees who were older, more educated, and female and who had higher predisplacement socioeconomic status and rural residence also had worse outcomes. Methodological differences between studies affected effect sizes. Conclusions  The sociopolitical context of the refugee experience is associated with refugee mental health. Humanitarian efforts that improve these conditions are likely to have positive impacts.      

20～22岁青年饮酒后酒精代谢的药代动力学性别差异研究*

目的: 建立呼吸酒精经时变化方法学,通过检测20～22岁青年酒精摄入后呼吸酒精经时变化反映血酒浓度,比较酒精代谢动力学性别差异。方法: 采用警用呼吸酒精检测仪检测呼气末酒精浓度的经时变化,使用代谢动力学软件DAS 3.0对代谢动力学数据进行分析,比较20～22岁青年饮酒后代谢的性别差异。结果: 该方法检测变异系数小于5 %。男女青年饮42°100 mL白酒后,女性药时曲线下面积AUC(0-t)大于男性,体内驻留时间MRT(0-t)明显长于男性,清除率CLz小于男性。结论: 该方法简便、无创、可行,重现性好。20～22岁青年饮用同等量的白酒,男性代谢快于女性。体内酒精完全清除女性平均需要3.5 h左右,而男性仅仅需要2.0 h左右。建立了该年龄段的青年饮酒代谢动力学数据。     

Factors associated with difficult electronic health record implementation in office practice

Little is known about physicians' perception of the ease or difficulty of implementing electronic health records (EHR). This study identified factors related to the perceived difficulty of implementing EHR. 163 physicians completed surveys before and after the implementation of EHR in an externally funded pilot program in three Massachusetts communities. Ordinal hierarchical logistic regression was used to identify baseline factors that correlated with physicians' report of difficulty with EHR implementation. Compared with physicians with ownership stake in their practices, physician employees were less likely to describe EHR implementation as difficult (adjusted OR 0.5, 95% CI 0.3 to 1.0). Physicians who perceived their staff to be innovative were also less likely to view EHR implementation as difficult (adjusted OR 0.4, 95% CI 0.2 to 0.8). Physicians who own their practice may need more external support for EHR implementation than those who do not. Innovative clinical support staff may ease the EHR implementation process and contribute to its success.     

汶川地震两周年后救灾医务人员心理健康和述情障碍的相关性研究

目的 调查汶川地震两周年后灾区医务人员心理健康和述情障碍的相关性.方法 采用症状自评量表（SCL-90）和多伦多述情障碍量表（TAS）,对绵阳市游仙区22个乡镇和3个社区,共计175名医务工作者进行调查,并与安徽省合肥市社区的144名医务工作者作比较.结果 与对照组相比,研究组SCL-90中总分及各因子分均较对照组高,差异有统计学意义（P=0.00）.研究组述情障碍总分,因子1,因子2,因子3得分高于对照组,差异有统计学意义（P=0.00）.研究组述情障碍总分,因子1,因子2与SCL-90中各个因子成正相关,因子3与SCL-90中恐怖成正相关,与其他因子无明显相关性.结论 地震重灾区绵阳市游仙区医务人员相对于一般医务人员的心理健康水平较差,述情障碍作为一种人格特质可能进一步影响心理健康.     

深圳市女同性恋人群生殖健康影响因素分析

目的了解深圳市女同性恋人群生殖健康现况及影响因素。方法采用方便抽样,知情同意原则下,匿名填写调查问卷,抽血检测梅毒和HIV抗体,采集宫颈拭子检测淋球菌和沙眼衣原体;应用SAS8.10软件进行单因素和多因素Logistic回归分析。结果 111例女性同性恋者中,未检出HIV抗体和梅毒阳性,宫颈拭子检测淋球菌及沙眼衣原体均呈阴性;40.54%既往患生殖道感染;40.54%既不愿意接受妇科检查,也不愿意接受血液化验。单因素Logistic回归分析结果表明,深圳市女同性恋人群既往患生殖道感染与年龄、性角色、性伴类别及异性性伴数量有关;多因素分析结果表明,性伴类别是深圳市女同性恋人群既往患生殖道感染的独立影响因素。结论深圳市女同性恋人群医疗卫生服务使用率低,应有针对性地开展生殖健康教育。     

Factors associated with high risk of marginal hyperthermia in elderly patients living in an institution.

The elderly, the very young, and the sick are known to be adversely affected by high environmental temperatures. In a retrospective open case-note review of 872 patients in a large institution during a hot summer we identified characteristics in the elderly that increase the risk of marginal hyperthermia. Women were more likely to be affected than men (25.6% vs 16.9%). We found an age-related increase in marginal hyperthermia, 15.7% of those below 60 years developed a hyperthermia compared to 18.9% in those between 70-79 years (non-significant), 28.3% in those between 80-89 years (p = 0.01) and 50% in those above 90 years (p < 0.01). There was also a direct relationship between the incidence of hyperthermia and the ambient temperature (29% in the warmer wards, compared to 17.2% in cooler ones; p < 0.01) and with the level of dependence (42.3% of the bedridden group, p < 0.01, and 20.4% of the semi-dependent, p < 0.01, compared to 11.1% of the mobile group). These factors were more significant as predictors of risk than the diagnosis. Identifying high risk patients early and taking appropriate measures to avoid hyperthermia and dehydration is important to try to decrease mortality during heatwaves.     

不同分期鼻咽癌患者心理健康水平和生存质量的比较研究

目的 对不同分期鼻咽癌(NPC)患者心理健康水平、生存质量的进行比较.方法 采用生存质量量表(QLQ-C30)、症状自评量表(SCL-90)对110例确诊的NPC患者进行调查、统计和分析.结果 不同分期NPC患者在总体生存质量、躯体功能、情绪功能、社会功能、疼痛、睡眠困难、食欲下降这7个因子评分差异有统计学意义(P＜0.05).NPC患者的躯体化、抑郁、焦虑、恐怖4个因子分均显著高于常模(P＜0.05).不同分期NPC患者在躯体化、抑郁、焦虑3个因子差异有统计学意义(P＜0.05).结论 不同分期NPC患者心理健康水平、生存质量存在显著差异,需要有针对性地进行心理干预.     

老年带状疱疹患者疼痛与社会支持、心理健康状况的相关性研究

目的 探索老年带状疱疹患者的疼痛程度与社会支持、心理健康状况的相关性.方法 运用视觉模拟评分法（VAS）、社会支持评定量表（SSRS）、症状自评量表（SCL-90）,对34例老年带状疱疹患者的疼痛程度与社会支持、心理健康状况进行评估.结果 老年带状疱疹患者疼痛得分较高,社会支持状况得分较中国常模低（t=17.667,P＜0.05）,心理健康状况较中国常模得分高（t=3.017,P＜0.05）;疼痛程度与其社会支持状况呈负相关（r =0.410,P＜0.05）,与心理健康水平SCL-90得分呈显著正相关（r=0.547,P＜0.05）.结论 老年带状疱疹患者疼痛程度严重与其社会支持状况呈负相关、与心理健康状况呈正相关,因此在临床治疗护理过程中应该给予积极建立社会支持系统,采取相应的心理干预和心理支持.     

前列腺癌患者去势治疗后心理障碍的原因分析及干预策略

去势治疗是晚期前列腺癌患者首选的治疗方法,但其大大降低了患者的生活质量,易使患者陷入自我形象紊乱、自卑、焦虑、恐惧、多疑、疲劳、情绪低落以及抑郁等多种心理障碍,而心理干预是治疗其心理创伤的有效手段。护理人员作为与患者接触最为频繁的群体应了解患者不同时期的心理问题,分析产生的原因,掌握有效的心理干预手段,为患者提供优质的心理护理服务,提高患者的生活质量。该文就前列腺癌患者接受去势治疗后易产生心理障碍的原因及相应的护理干预措施进行综述,为护理人员进行有效的心理干预提供帮助。     

广州市青少年运动员焦虑抑郁情绪相关因素分析

目的 探讨青少年运动员焦虑抑郁的危险因素和保护性因素.方法 随机整群抽取广州市两所中等体育运动学校的520名青少年运动员学生,利用综合性医院焦虑抑郁量表(HADS)对焦虑和抑郁情绪程度进行评估,用多元逐步回归分析焦虑抑郁相关影响因素.结果 438名青少年运动员中处于高危焦虑的有30名(6.9%),处于高危抑郁的有76名(17.4%);其中来自老师和教练压力较大(sβ=5.372)、年龄大于17岁(sβ=4.365)、母亲受教育水平中等(sβ=3.153)是焦虑的保护性因素,而低质量(sβ=2.482)则是焦虑的危险性因素;母亲的受教育水平中等(sβ=6.764)、来自老师和教练压力较大(sβ=4.167)是抑郁的保护性因素,而年龄在15～16岁之间(sβ=3.367)、有家族性慢性病史(sβ=2.765)、所受总的支持较差(sβ=4.365)是抑郁的危险性因素.结论 青少年运动员的焦虑抑郁情绪高发,影响因素众多,正确识别这些因素可以预防青少年运动员相关精神疾病的发生.     

Factors associated with mortality and morbidity among pediatrics with burn injuries in Riyadh,Saudi Arabia

Objectives:To describe characteristics, mechanism, and factors associated with morbidity and mortality of pediatrics with burn injuries.Methods:This cross-sectional retrospective study examined all pediatrics with burn injuries carried out at King Abdulaziz Medical City, Riyadh, Saudi Arabia, from 2015-2020. Collected data included demographics, mechanism of burn, total body surface area (TBSA) burned, body region burned, incidence of infection, renal failure, scars, and respiratory events.Results:The study included 370 patients. Approximately 47.0% were aged ≤2 years, and 61.0% were males. The most common burn mechanism was scald burn (54%), 59.2% had a TBSA of 0-10%, and 60.3% had regional burns on the upper limbs. During follow-up, 5 patients died (incidence rate [IR]=1.60/100 patient/years [PYs]). Morbidity events included blood/sepsis infection (IR=2.87/100 PYs), urine infection (IR=8.30/100 PYs), wound infection (IR=21.72/100 PYs), renal failure (IR=0.96/100 PYs), and respiratory infections (IR=1.60/100 PYs). In a multivariate Cox regression analysis, factors independently associated with combined hazard of morbidity and mortality were female gender (hazard ratio [HR]=1.64, 95% confidence intervel [CI]: [1.01-2.67], p=0.047), TBSA (HR=3.20, 95% CI: [1.828-5.585], p<0.0001), and length of hospital stay (HR=3.14, 95% CI: [1.91-5.17], p=0.000).Conclusion:This study identifies certain characteristics suggestive of poor outcomes of pediatric burn injuries that are relevant to clinical management and prevention programs. Larger multicenter studies are required to fully characterize pediatric patients with burn injuries and to identify factors that adversely affect their prognosis.     

Factors associated with failure to undergo health check-ups in Nagasaki Prefecture,Japan

Objective: Municipal National Health Insurance (NHI) in Nagasaki Prefecture in Japan struggles with poor attendance of health check-ups, which was only 39.6% in 2018. This study aimed to evaluate factors that encourage healthy behaviors, including opting for health check-ups, and the characteristics of middle-aged and older individuals who did not undergo health check-ups.Materials and Methods: This cross-sectional study, using a self-administered questionnaire, was conducted in August 2020 in three municipalities of Nagasaki Prefecture. In addition to questions regarding sociodemographic information, such as sex, age, educational status, self-rated economic status, and family structure, the questionnaire included questions on daily lifestyle habits such as alcohol intake and exercise, current medical treatment, self-rated health, and information related to health check-ups. Of the 18,710 questionnaires distributed in the three municipalities, 8,756 (46.8%) were collected by the end of December 2020, of which 7,840 were valid for analysis. The compliance rate for health check-ups was obtained from the Public Health and Welfare Bureau of Nagasaki Prefecture. Statistical analyses were performed according to two age groups: 40−59 and 60−74 years.Results: Among the respondents who did not undergo health check-ups in the year prior to this study, “lack of time” and being “too bothersome” were the most popular reasons for not attending health check-ups. “Living alone” and “low self-rated economic status” were negative factors for receiving health check-ups regardless of age group.Conclusions: Vulnerable middle-aged and older persons, such as those living alone and with low economic status, were less likely to undergo health check-ups. Emphasis on home visits by public health nurses may also be needed to increase awareness of individual health conditions, especially for people living alone and those who are socioeconomically disadvantaged.     

18～35岁原发性自发性气胸患者首次发作后同侧复发原因分析

目的 探索影响中青年患者原发性自发性气胸(primary spontaneous pneumothorax, PSP)首次发作后再次复发的因素,为该疾病的治疗选择提供参考。方法 回顾性分析我院2008年6月至2013年6月年龄在18～35岁,首次发作并有完整资料PSP患者215例,随访12～72个月(38.5±18.6个月)。全组随访期间同侧复发57例(复发组),无同侧复发158例(未复发组),对比两组的各项病例资料: 年龄、性别、BMI指数(kg/m²)、吸烟习惯、首次气胸发作情况、治疗情况、复发时间、发作时CT表现等,明确复发的危险因素。结果 全组215例随访期间有57例同侧复发,复发率为26.51 %。复发组的年龄相对较轻(24.6±4.98 vs. 26.35±5.42,P＜0.05),复发组少量气胸患者的比例较低(P>0.05)。复发组含气病变(91.2% vs. 71.5%,P＜0.05)、肺大泡(47.4% vs. 21.5%,P＜0.05)的比例明显高于未复发组,多发肺大泡(31.6% vs. 12.0%,P＜0.05)和Ⅰ型肺大泡(26.3% vs. 7.0%, P<0.05)的比例复发组明显高于未复发组,复发组胸膜粘连的比例也明显高于未复发组(29.8% vs. 12.7%,P＜0.05),两组在其他方面均无统计学差别。经Cox多元回归分析显示,CT显示含气病变、肺大泡、多个肺大泡、Ⅰ型肺大泡为同侧复发的危险因子(P＜0.05)。结论 对于18～35岁首次发作的PSP患者,同侧复发与CT所见的含气病变、肺大泡、胸膜粘连明显相关,尤其是Ⅰ型肺大泡及多发肺大泡。以上复发危险因素可作为首次PSP发作后患者是否行腔镜手术的参考。     

流动人口在现居住地获取避孕节育知识的途径和意愿及其影响因素分析

目的了解城市中流动人口在现居住地获得避孕节育知识的途径及对避孕节育知识的需求,并探讨其获得避孕节育知识的影响因素。方法采用整群抽样的方法,于北京、上海和成都三个人口高度集中的大城市选择研究对象6 304人,并就获得避孕节育知识的途径以及意愿问题对所抽取的研究对象进行问卷调查。结果流动人口在近1年内获得过避孕节育知识的比例上,成都（32.59%）低于上海（43.38%）和北京（34.43%）;不同城市、不同性别、年龄、婚姻状况、学历、工作场所、家庭人均月收入、现居住地的主要居住方式、小孩个数、性生活频率、是否采取避孕措施等因素与是否获得避孕节育知识有关联;在现居住地,调查对象获取避孕节育知识的主要来源为宣传资料（37.25%）;流动人口最期望获得避孕节育知识的途径是面对面咨询（43.56%）;最期望获得避孕节育知识的内容是避孕方法的使用（33.96%）。结论流动人口的避孕节育知识水平相对较低,获取避孕节育知识的途径较少,对于流动人口的计划生育宣传不够,政府对于开展流动人口有关性与生殖健康知识的咨询和指导也有很大的不足与欠缺。