社会隔离在社区老年人孤独感和述情障碍中的中介效应

目的 探讨社会隔离在社区老年人孤独感与述情障碍之间的中介作用。方法 2022年8～12月采用便利抽样的方法在鞍山市某5个社区进行随机抽样,最终选中418例符合标准的社区老年人作为研究对象,通过一般资料问卷、孤独感量表、Lubben社会网络量表简表、多伦多述情障碍量表进行调查。结果 社区老年人孤独感、社会隔离及述情障碍总分分别为(11.95±2.32)、(13.75±4.62)、(58.81±7.85)分。社区老年人孤独感与述情障碍得分呈正相关,社会隔离与孤独感和述情障碍均呈负相关(均P<0.01),社会隔离在孤独感与述情障碍间起到部分中介效应,中介效应占总效应的19.45%。结论 社区医护人员要密切关注老年人与社会隔离的情况,积极处理社区老年人自身情感孤独对社会隔离产生的影响,从而降低老年人述情障碍的水平。     

农村空巢中老年人社会支持、孤独感与主观幸福感及相关性

目的探讨农村空巢中老年人社会支持、孤独感与主观幸福感的现状及关系。方法采用社会支持评定量表、加利福尼亚大学洛杉矶分校(UCLA)孤独量表和费城老年中心(PGC)信心量表对贵州省5个地市的639名农村中老年人(空巢411人,非空巢228人)进行调查。结果空巢中老年人孤独感显著高于非空巢,社会支持和主观幸福感显著低于非空巢;空巢中老年人孤独感与主观幸福感、社会支持呈显著负相关(P<0.01),主观幸福感与社会支持呈显著正相关(P<0.01)。空巢中老年人孤独感在社会支持与主观幸福感之间起部分中介作用,中介效应占总效应51.56%。结论农村空巢中老年人的孤独感水平较高,社会支持和主观幸福感水平较低。     

宽恕在老年人生命意义与孤独感间的中介作用

目的探讨宽恕在老年人生命意义与孤独感间的中介作用。方法采用老年人生命意义问卷、宽恕特质量表(TFS)和孤独感量表(UCLA),通过方便取样与入户访问结合的方式对福建省福州和厦门地区200名60岁及以上的老年人进行问卷调查,回收有效问卷187份。结果1生命意义及其各维度(苦难认知、主动追寻、被动接纳)与宽恕呈显著正相关,生命意义及其各维度与孤独感呈显著负相关,宽恕与孤独感呈显著负相关;2宽恕在老年人生命意义与孤独感之间起部分中介作用,其中介效应占总效应的35.7%。结论老年人生命意义对孤独感有直接的影响,且部分是通过宽恕的中介作用实现的,对提出老年人生命质量的相关干预策略具有重要的理论依据和现实意义。     

老年人亲子支持、防御机制和抑郁状态:老年依恋的中介作用

目的研究老年人亲子支持、防御机制、老年依恋和抑郁状态的关系及老年依恋的中介作用。方法采用问卷法对江苏、上海等9省市自治区的199名老年人进行调查,使用相关分析、回归分析、结构方程模型进行分析,构建中介模型。结果老年依恋在亲子支持和抑郁状态之间起部分中介作用并负向预测抑郁水平,同时在防御机制和抑郁状态之间起部分中介作用并正向预测抑郁水平;子女对父母的情感支持、父母对子女的情感支持、不成熟防御、依恋焦虑及抑郁状态总分两两之间显著相关;依恋焦虑在情感支持和抑郁状态之间起部分中介作用,在不成熟防御和抑郁状态之间起完全中介作用。结论依恋作为重要中介因素,影响着老年人抑郁水平。     

社区老年人抗逆力在社会支持与正负情绪间的中介效应

目的 探讨抗逆力在社会支持与正负性情绪间的中介效应。方法 应用抗逆力量表,领悟社会支持量表,正负性情绪量表对唐山市某社区751例社区老年人进行问卷调查。结果 社区老年人抗逆力与社会支持、正负性情绪呈相关关系(均P<0.001);社会支持与正负性情绪呈相关关系(P<0.001);抗逆力在社会支持对正负情绪的预测中起部分中介作用,中介效应占总效应的比例分别为14.16%,R²=0.287;12.62%,R²=0.253。结论 增加社会支持,有利于提高社区老年人抗逆力水平,对社区老年人正负情绪有保护作用。     

农村老年人心理压力对生活满意度的影响——孤独感的中介作用

目的分析农村老年人心理压力、孤独感及生活满意度的关系,并探讨孤独感在心理压力与生活满意度间的中介作用。方法采用多阶段随机抽样的方法选取山东省5 514位农村老年人,采用一般资料调查表、生活满意度量表(SWLS)、心理压力量表(K10)及孤独感量表(ULS-8)分别调查农村老年人的一般情况、生活满意度、心理压力及孤独感。SPSS19.0软件分层回归分析和Process宏程序对孤独感在心理压力和生活满意度间的中介效应进行检验。结果农村老年人的生活满意度评分为(30.55±5.13)分。农村老年人的心理压力评分与孤独感评分和生活满意度评分呈负相关(均P0.01)。孤独感显著预测生活满意度的净解释量为2.7%,中介效应的效果量为13.5%。Bootstrap检验结果显示间接效应为β=-0.102(P0.001,95%CI=-0.122～-0.083),说明孤独感在农村老年人心理压力与生活满意度间存在中介效应。结论山东省农村老年人的生活满意度较高。农村老年人的心理压力和孤独感是影响生活满意度的因素,孤独感可以中介心理压力与生活满意度的关系。     

老年人同伴关系与主观幸福感、孤独感的关系

目的探讨老年人同伴关系与主观幸福感、孤独感之间的关系。方法采用自编同伴关系问卷及主观幸福感量表、情绪-社交孤独量表对406名老年人进行调查。结果 1老年人同伴关系在性别、年龄、是否丧偶、婚姻自评、居住地、文化程度、职业、家庭结构、健康自评、子女个数、是否有退休金和经济收入上呈显著差异(P<0.05);2老年人同伴关系与主观幸福感、孤独感呈显著相关(P<0.05),并且对主观幸福感和孤独感有良好的预测功能。回归分析表明,接受性、拒斥性、密切性及和谐性共解释了主观幸福感总变异的81.9%;接受性、拒斥性及密切性共解释了孤独感总变异的22.1%。结论老年人同伴关系能预测主观幸福感和孤独感,可以通过改善老年人的同伴关系,来对其孤独感消极情绪体验进行积极干预,并促使老年人社会适应良好发展。     

抑郁、心理弹性对老年人自我护理能力的影响及衰弱的调节效应

目的探讨抑郁、心理弹性对老年人自我护理能力的影响及衰弱的调节效应。方法采用简版老年抑郁量表(GDS)-15、心理弹性量表简表(RS)-14、老年人自我护理能力量表(SASE)对518名老年人进行调查。结果老年人自我护理能力总分为(70. 90±8. 97)分;衰弱老年人的自我护理能力明显低于健康老年人;老年人心理弹性与抑郁、自我护理能力呈相关关系(r=-0. 47、0. 60,P<0. 01);抑郁与自我护理能力也呈相关关系(r=-0. 50,P<0. 01);心理弹性在抑郁和自我护理能力之间具有部分中介效应;衰弱在老年人的抑郁、心理弹性和自我护理能力关系中起到调节效应。结论心理弹性在老年人抑郁情绪和自我护理能力间具有中介作用,有无衰弱在三者关系间起调节效应,临床护理工作中应提高存在抑郁风险老年人的心理弹性水平,从而加强自护行为。     

社区老年人孤独感在自我感知老化与成功老化之间的中介效应

目的 探讨社区老年人自我感知老化和成功老化的关系及孤独感在两者之间的中介效应。方法 采用一般资料调查表、自我感知老化量表(B-APQ)、孤独感量表(UCLA)、成功老化量表(SAI)对社区老年人进行问卷调查。结果 收回有效问卷318份。自我感知老化、孤独感和成功老化得分两两显著相关(P<0.05)。自我感知老化对成功老化有负向影响(B=-0.71,P<0.001),自我感知老化对孤独感有正向影响(B=0.58,P<0.001),孤独感对成功老化有负向影响(B=-0.35,P<0.001)。孤独感在自我感知老化与成功老化之间的标准化间接效应为-0.203,中介效应占总效应的22.23%。结论 消极的自我感知老化和强烈的孤独感是社区老年人成功老化的不良影响因素。医护人员可通过改善老年人的消极自我感知老化情绪和孤独感促进社区老年人成功老化。     

失能老年人照料者抑郁情绪的二因素模型

目的结合照料者心理健康二因素模型和自我效能感探究照料者抑郁情绪产生途径。方法使用自编人口学问卷、功能独立性评定量表、社会支持问卷、修订版负担指数量表、一般自我效能感量表、流调中心抑郁量表对185名失能老年人照料者进行调查。结果 (1)照料者抑郁程度与被照料者年龄,照料者负担指数,社会支持水平、和自我效能感水平显著相关;(2)照料者的自我效能感在其社会支持和抑郁情绪间起到部分中介作用;(3)照料者的负担指数在被照料者功能独立性和照料者抑郁情绪之间起到完全中介的作用。结论照料者抑郁情绪受到积极消极因素的共同影响,且照料者自我效能感在抑郁产生过程起中介作用。     

Dominant role of the kidneys and accessory role of whole-body autoregulation in the pathogenesis of hypertension

In this paper I have presented two closely related themes both of which seem to be fundamental in understanding the pathophysiology of hypertension. The first theme is the dominant role of the volume-excretion function of the kidneys in setting the long-term arterial pressure level. That is, each person in general has a rather steady intake of salt, water, and those other constituents that make up extracellular fluid. When the arterial pressure is normal, the kidney excretion of these constituents is exactly the correct amount to balance the intake of each of them. When the pressure is too great, there is more loss than gain, and the body fluid volume decreases; therefore, the pressure falls until the exact balance point is reached again; it is only at this balance point that the loss and gain are equal. At any pressure below the balance point, volume gain is greater than loss, and the pressure will continue to rise until the exact balance level is again reached. This capability of the kidney mechanism to return the pressure all-the-way back to the level of balance between input and output--not merely part-way back--is called the "infinite gain" characteristic of this pressure control system, and the level to which the pressure is controlled is called the "set-point" of the system. In pathophysiological states, the set-point for pressure control can be increased to hypertensive levels as a result of (1) a pathophysiological change in renal function or (2) increased salt and volume intake; then hypertension will ensue. Other abnormalities of circulatory function that do not affect one of these two factors cannot cause chronic hypertension because of the infinite gain feature of the renal-volume mechanism for pressure control. One such condition that does not cause hypertension without some concurrent abnormality that affects renal function is a primary increase in total peripheral resistance. The second theme is that whole-body autoregulation causes the blood flow in all parts of the body to return or remain near to normal when high arterial pressure tries to increase the flow. It does this by increasing the resistance in all parts of the peripheral arterial tree. Therefore, in effect, autoregulation converts any tendency to high cardiac output hypertension into high resistance hypertension. Yet, in so far as is now known, the pressure level will be the same with or without autoregulation.(ABSTRACT TRUNCATED AT 400 WORDS)     

Ventricular diastole and the role of the pericardium

In order to understand the mechanics of left ventricular (LV) diastolic filling it has become important to understand the role of the pericardium. This is because it has been demonstrated that the LV pressure-volume relationship can be shifted by previously unrecognized changes in pericardial "pressure" and, therefore, LV end-diastolic pressure (LVEDP) may be ambiguous as a measure of preload. The key to this understanding is to appreciate that (except in the case of pericardial effusion or tamponade) the pericardium impedes cardiac filling by exerting a stress, not by raising the pressure in the pericardial fluid, and that the magnitude of this stress is variable and relatively great. When animals or humans are volume loaded acutely, this stress is approximately equal to right ventricular (RV) filling pressure. Thus, while it may not be possible to estimate true preload from simple measurements of LVEDP, subtracting RV filling pressure from LVEDP may provide a useful estimate of transmural LVEDP. As an example of the effect of the pericardium, recent laboratory results indicated that the decrease in stroke volume which resulted from acute pulmonary embolization could be explained by reductions in LV preload. Transmural LVEDP and end-diastolic volume decreased in spite of the fact that LVEDP rose markedly. Since LVEDP increased while stroke volume decreased, it might have been concluded that contractility had decreased. However, this was shown not to be the case, since the reduction in stroke volume only corresponded to the reductions in transmural LVEDP and end-diastolic volume. Thus, appropriately accounting for pericardial constraint may allow many changes in LV systolic performance, hitherto thought to represent changes in contractility, to be explained on the basis of preload changes and the Frank-Starling mechanism.     

Snoring and the role of the dental practitioner

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Snoring and the role of the dental practitioner     

Myofascial pain and the role of myoglobin

The plasma myoglobin concentration was measured before and after massage of 26 patients with myofascial pain. Twenty-one patients had a successful treatment and a significant increase was observed in the plasma myoglobin concentration (median 125 micrograms/l, range 35-439) within a maximum of 2 hours after the first massage treatment (p less than 0.0001). A positive correlation was found between the degree of muscle tension and pain, and the increase in plasma myoglobin concentration. After repeated massage treatment a gradual decline in the increase in plasma myoglobin concentration could be demonstrated parallel to a reduction in the muscle tension and pain. Five patients did not benefit from massage treatment and no significant increase in the myoglobin in plasma was measured. These patients were in pain and had a high degree of muscle tension. The observed increase in myoglobin in plasma after massage indicates a leak of myoglobin from the muscle fibres in 21 patients, whose myofascial pain seem to be linked with a muscle fibre disease. It is suggested that 5 patients with the same muscle symptoms have another, still unknown muscle disease.