自然流产妇女的心理健康状况调查分析

目的 了解自然流产妇女的心理健康状况,探索心理因素对自然流产的影响。方法 选取100名发生自然流产的妇女,采用症状自评量表（SCL-90）测评。结果 自然流产的妇女有较多的心理问题,特别是焦虑、抑郁、人际关系敏感、强迫和恐怖较突出。结论 应加强妇女孕前与孕期心理健康教育,对怀孕作好充分的心理准备,避免不良情绪和不良环境刺激,防止因心理原因的自然流产。     

Commentary on the Women's Health Initiative

The Women's Health Initiative (WHI), established by the National Institutes of Health in 1991, is a long-term national health study that focuses on strategies for preventing heart disease, breast and colorectal cancer and osteoporosis in postmenopausal women. These chronic diseases are the major causes of death, disability and frailty in older women of all races and socioeconomic backgrounds. The WHI a 15-year multi-million dollar endeavor, and one of the largest U.S. prevention studies of its kind. The study involves over 161,000 women aged 50-79, and is one of the most definitive, far reaching clinical trials of women's health ever undertaken in the U.S. The WHI Clinical Trial and Observational Study will attempt to address many of the inequities in women's health research and provide practical information to women and their physicians about hormone replacement therapy, dietary patterns and calcium/vitamin D supplements, and their effects on the prevention of heart disease, cancer and osteoporosis. Emerging information from the NIH Women's Health Initiative and other studies of women's health begun in the 1990's should be changing the landscape of options for older women in the years to come.     

Development of an interdisciplinary women's health training model.

In response to expanded residency training requirements in women's health, faculty from internal medicine, obstetrics/gynecology, and psychiatry at Yale University School of Medicine established an interdisciplinary women's health training and education model, the Interdisciplinary Women's Health Clinic (IWHC). The model was one component of a larger, comprehensive women's health program at Yale funded by the Department of Health and Human Services between 1996 and 2000 under the National Centers of Excellence in Women's Health (CoE) designation. This article describes the structure and function of the model, its value to residents and the institution, and its limitations that led to its closure when Department of Health and Human Services support ended. The IWHC was designed as a consultation service that augmented the primary care provided to low-income, minority-group women in an established outpatient primary care setting. An interdisciplinary team of residents and faculty provided and coordinated a range of services for patients and participated in a weekly core curriculum. The model was an important resource to residents and provided high-level integrated care to patients. The combined educational experience helped refine a core interdisciplinary women's health curriculum. Despite these benefits, the IWHC could not be sustained outside the financial and programmatic structure of the larger CoE program. This experience suggests that longitudinal models where residents from different disciplines train in a shared educational and clinical setting may be more durable. Interdisciplinary models are effective ways to train residents and provide integrated care to women. The model's success depends on highly developed collaborative relationships between faculty, nonclinical sources of support, and long-term institutional commitment.     

经管类院校新生心理健康状况及其教育对策研究

目的了解经管类院校新生的心理健康状况，提出相应的教育对策。方法采用16PF、SCL-90对391名大学生进行问卷调查，用SPSS10．0统计软件对结果进行分析。结果测出心理障碍阳性38例，发生率9．9%。结论在实施学校心理健康教育过程中，应以预防为主，针对其性别、年级、专业等差异有针对性的开展工作。     

Racial variation in wanting and obtaining mental health services among women veterans in a primary care clinic

Epidemiologic studies suggest that African-American women may be less likely to obtain mental health services. Racial differences were explored in wanting and obtaining mental health services among women in an equal access primary care clinic setting after adjusting for demographics, mental disorder symptoms, and a history of sexual trauma. Participating in the study were women veterans at a primary care clinic at the Durham Veterans Affairs Medical Center. Consecutive women patients (n = 526) between the ages of 20 and 49 years were screened for a desire to obtain mental health services. Patients were given the Primary Care Evaluation of Mental Disorders questionnaire (PRIME-MD) and a sexual trauma questionnaire. Mental health service utilization was monitored for 12 months. The median age of the women was 35.8 years; 54.4% of them were African-American. African-American women expressed a greater desire for mental health services than whites, yet mental health resources at the clinic were similarly used by both racial groups. African-American women may want more mental health services; however, given an equal access system, there were no racial differences in mental health use.     

Gender differences in processing information for making self-assessments of health

OBJECTIVE: This study proposes that women's greater inclusiveness of various sources of information when making self-assessed health (SAH) judgments accounts for the finding that SAH is a weaker predictor of mortality in women than in men. METHODS: Data from a sample of 830 elderly residents of a retirement community and a 5-year mortality follow-up study were used to examine the bases for women's and men's reports of negative affect (NA) and judgments of SAH. The degree to which each health-related measure accounts for the SAH-mortality association in each gender group was examined. RESULTS: The findings support two possible explanations for the lower accuracy of SAH as a predictor of mortality among women: 1) In both men and women, NA is associated with poorer SAH, but in men, NA is more closely linked to serious disease in conjunction with other negative life events, whereas in women, NA reflects a wider range of factors not specific to serious disease. 2) Men's SAH judgments reflect mainly serious, life-threatening disease (eg, heart disease), whereas women's SAH judgments reflect both life-threatening and non-life-threatening disease (eg, joint diseases). CONCLUSIONS: Women's SAH judgments and NAs are based on a wider range of health-related and non-health-related factors than are men's. This difference can explain gender differences in the accuracy of SAH judgments and may be related to other documented differences in women's physical and mental health and illness behavior. The findings emphasize the need to study the bases of NA and other self-evaluations separately for women and men.     

Determinants of mental distress in adults with a severe auditory impairment: differences between prelingual and postlingual deafness

OBJECTIVE: To investigate the determinants of mental health among severe hearing-impaired adults in the Netherlands, separately by prelingual and postlingual age of onset. METHODS: Five hundred twenty-three face-to-face interviews were carried out by persons with practical skills in communication with hearing-impaired people. RESULTS: Of prelingually and postlingually deaf men, 27.1% and 27.7%, respectively, reported mental distress (scores on the General Health Questionnaire > or = 2), and among women these figures were 32.4% and 43.2%. These rates are higher than in the general population (men: 22.0%; women: 26.6%). Among the prelingual category, none of the demographic or hearing loss-related characteristics was associated with mental health status as measured by the General Health Questionnaire (GHQ). Of these variables, only additional impairment or serious illness was associated with the brief Symptom Checklist (SCL-8D). Among the postlingual category, female gender and equilibrium disturbance was associated with both the GHQ and SCL-8D, and additional impairment or serious illness with the SCL-8D. For both categories, the risk of mental distress also was higher in those with more communication problems, lower levels of self-esteem, and poorer acceptance of the hearing loss. Opportunities for identification in youth and social support were not associated with mental health. CONCLUSIONS: Mental health status differs between the hearing-impaired and the general population, but not as much as is sometimes suggested. Mental distress is greater in those in certain categories of the hearing-impaired.     

中国精神卫生服务及其政策:对1949-2009年的回顾与未来10年的展望

目的:对中国1949-2009年精神卫生服务提供模式和相关政策进行了系统回顾,分析不同发展阶段的特征,为我国精神卫生改革提供借鉴。方法:通过检索电子期刊数据库和我国卫生部官方网站等数据库并配合相应的手工检索,纳入收集整理与精神疾病流行病学、精神卫生服务提供、精神卫生服务利用、精神卫生政策和规划高度相关的资料。访谈国内外从事精神卫生服务工作的多名知名专家和主管领导,对其访谈内容记录、录音,进行归纳、分析、总结。结果:共纳入216篇文献,213人参与访谈。研究显示,60年来中国精神卫生资源和服务模式的演变经历了快速发展、稳步发展和改革等三个阶段;中国精神卫生服务体系在60年间发生了巨变化,但仍存在资源短缺、精神病治疗率较低、普通人群和医务人员精神卫生知识匮乏、社会对精神病人的偏见严重等现状;60年间,中国精神卫生服务政策也经历了巨大的变化,正向着建立以社区精神卫生服务为主的综合服务网络方向前进。结论:我国应继续强化社区卫生服务,提高精神卫生服务的公平性和可及性。     

AIDSCAP initiative expands prevention efforts for women

By 2000, women will likely comprise 50% of HIV-infected persons worldwide. Women, regardless of number of sexual partners, are especially vulnerable to HIV. One act of intercourse puts women at an 18 times greater risk than men of acquiring HIV. Traditional gender roles denying women the power to protect their own health exacerbate their biological susceptibility to HIV infection. AIDSCAP's Women's Initiative (AWI) aims to secure culturally and gender-sensitive AIDSCAP interventions and strategies and to advance AIDSCAP's leadership role in developing HIV/AIDS prevention models for women. More than 50% of AIDSCAP current projects target women. AWI integrates a broader gender perspective into AIDSCAP's project design, technical assistance, evaluation and monitoring, and policy projects. It has expanded target women's groups beyond the groups traditionally considered at high risk. To date, various AIDSCAP projects have trained and educated about one million women. The Christian Reformed World Relief Committee (CRWRC) is involved in HIV/AIDS prevention activities. Its AIDS and Sexually Transmitted Disease (STD) Health Promotion Prevention Program with Market Women in Senegal targets self-employed market women and urban female youth in Dakar, Kaoloack, and Thies. CRWRC worked with two women's groups to develop a sexual health promotion package with HIV/AIDS and STD IEC (information, education, and communication) materials and has trained 20 facilitators to use the promotion package. It helps the two collaborating groups to develop their organization capacities so they can implement and evaluate sustainable HIV/STD prevention programs. AIDSCAP also supports training of Kenyan family planning provider activities in HIV prevention of the JSI Family Planning Sector Project. It collaborates with the Center of Women Workers in Haiti to provide women factory workers IEC and condoms to promote risk reduction behavior. AWI also conducts research and policy activities (e.g., perceptions of the female condom in 3 countries).     

Toward Beijing: linking HIV / AIDS to other women's issues is imperative

The senior advisor to the AIDSCAP Women's Initiative, Dr. E. Maxine Ankrah, is actively lobbying to secure the inclusion of HIV/AIDS language in the draft platform of the UN Fourth World Conference on Women: Action for Equality, Development and Peace scheduled for September 1995 in Beijing. She organized the only workshop on HIV/AIDS at the preparatory meeting in New York in March 1995. It examined the effects of poverty on the expanding epidemic among females. Workshop presentations included international perspectives on: the effect of structural adjustment programs on women's vulnerability; the relationship between poverty, female prostitution, and AIDS; credit schemes and education to empower rural women; reproductive rights; ethnic issues; and the need for women to help women. Obstacles that obscured the relationships between HIV/AIDS and other women's issues have been: that AIDS was initially defined as a medical problem; that risk groups were narrowly defined; and the emphasis on behavior that blames persons infected with HIV. Despite earlier obstacles, the draft platform has several sections with HIV/AIDS language. Strategic Objective C.3: Undertake Multi-Sectoral Initiatives Sensitive to Women's Life Situations addresses the HIV pandemic and other sexual and reproductive health issues. Some of the actions called for in this objective are involvement of women in decision making, expansion of peer education and outreach, and supporting research of woman-controlled prevention methods. AIDSCAP Women's Initiative and other nongovernmental organizations will work together focus attention on HIV/AIDS in Beijing. AIDSCAP plans to have resource publications available in Beijing as well as to host networking sessions. Unless it is waived, the policy prohibiting HIV-infected persons from entering China will preclude HIV-infected women from taking part in the Conference.     

506例孕妇心理状态及影响因素分析

目的探讨孕妇的年龄、文化程度对心理状态的影响。方法采用症状自评量表对506例孕妇进行问卷调查。结果随孕妇年龄的增加、文化程度的提高,躯体化症状反应强度呈减弱趋势;同时,随年龄的增加,人际关系敏感、恐惧症状、精神病性症状反应强度明显增大。初中文化的孕妇主要以焦虑症状反应为主,并有显著性差异。结论建议结合孕妇不同年龄、不同文化给予相应的心理辅导。     

Centralized vs. Decentralized Child Mental Health Services

One of the basic tenets of the Community Mental Health Center movement is that services should be provided in the consumers'' community. Various centers across the country have attempted to do this in either a centralized or decentralized fashion. Historically, most health services have been provided centrally, a good example being the traditional general hospital with its centralized medical services. Over the years, some of these services have become decentralized to take the form of local health centers, health maintenance organizations, community clinics, etc, and now various large mental health centers are also being broken down into smaller community units. An example of each type of mental health facility is delineated here.     

An Analysis of Stakeholder Views on Children's Mental Health Services

The purpose was to examine the perspectives of mental health stakeholders as a means to guide the adaptation of evidence-based treatments. The Mental Health System Ecological (MHSE) model was used to organize therapist, administrator, and parent perspectives gathered using qualitative methods. The MHSE model posits the influences of client-level, provider-level, intervention-specific, service delivery, organizational, and service system characteristics on implementation. Focus groups and interviews were conducted with community mental health stakeholders and included parents, therapists, and administrators (N = 21). Participants included 11 primarily Caucasian (90.48%) female participants, ranging in ages between 31 and 57 years. Data were analyzed according to the MHSE model. Frequency counts were tabulated for each theme and stakeholder group differences were determined using the Mann-Whitney test. Stakeholder groups mentioned needs at each level of the MHSE model. Stakeholder group differences most notably emerged with child and family themes, which included complexity of mental health issues, parenting differences, and family stressors. Stakeholders identified challenges for optimal mental health services for children across multiple levels of an ecological model. Implications of the findings are discussed, including the continued relevance of adapting mental health interventions by increasing their flexible application across multiple target problems and the promise of partnership approaches.     

Mental health services for residents: more important than ever.

The mental health of physicians in training is a topic of considerable concern. Recent attention to the issue of patient safety has led to examination of the relationship between residents' stress and compromised clinical performance. Few mental health programs dedicated to residents and formally structured to meet their specific needs are reported in the literature. The authors raise the question of why there are so few programs and why more residents don't take advantage of services that do exist. They then describe the development and utilization of the University of Michigan Health System's House Officer Mental Health Program. The program was structured to overcome barriers to utilization such as lack of funding, concerns about confidentiality, ease of access and residents' financial constraints and to provide comprehensive services for a wide range of diagnoses. Data are presented on the first four years of operation from 1997-01 that show increasing utilization and high levels of satisfaction over this time period by house officers at all levels of training and in all departments of the Health System. As increasing attention is paid to how to deal with medical errors, the establishment of such programs should be considered, not only as a means to address the general mental health of residents but also as an appropriate venue to deal with the stress that can contribute to and be induced by medical mishaps.     

Depression, estrogen, and the Women's Health Initiative

This clinical observation report compares hormone use and clinical presentation in a series of middle-aged depressed women before and after publication of the Women's Health Initiative. Depressed women over age 40 seen at a general hospital academic women's affective disorders practice 6 months before and after publication of the Women's Health Initiative were compared for medication changes, hormone therapy, lifetime depressive episodes, time since last episode, time to depression recurrence after hormone cessation, symptoms, and treatment response. More women stopped hormone therapy and reported onset of depression within 3 weeks of hormone discontinuation after than before publication of the Women's Health Initiative. Depression in most women responded to reinstitution of estrogen or initiation or increase in antidepressant dose. Discontinuation of hormone therapy appears to be associated with the rapid recurrence of depression in some women with a history of depression. Randomized controlled trials in middle-aged depressed women of estrogen or a selective estrogen receptor modulator as monotherapy or as an augmentation agent are urgently needed.     

Women's preferences for their gynecologist or obstetrician

OBJECTIVE: The objective of this study was to evaluate women's preferences in selecting their gynecologist or obstetrician. METHODS: This cross-sectional study was performed at the Women's Health Center "Netka", Tel Aviv over a 1-month period in 2006 and included 287 participants. Women were asked to complete an anonymous questionnaire. RESULTS: Most women (60.3%) reported that the gender of their gynecologist or obstetrician was not an important consideration when choosing a gynecologist or an obstetrician. The major determinants in their choice of a gynecologist or an obstetrician included professionalism (98.9%), courtesy (96.6%) and board certification (92%). The rating of the two most important factors in their choice revealed the following order: professionalism (45.3%), courtesy (25.8%), board certification (10.8%), availability (10.1%), comprehension (6.5%) and communication (1.5%). CONCLUSION: Israeli women's model of choice of their gynecologist involved physicians' professionalism and courtesy while availability and physician's gender was significantly less important. PRACTICE IMPLICATIONS: The presented data may help health providers during patients' education and counseling along with facilitating better understanding of patients' needs.     

In sickness and in health: associations between physical and mental well-being, employment and parental status in a British nationwide sample of married women

Many studies have been published which have examined the relationship between paid employment and women's health. As employment outside the home is likely to have differential effects for women with different family commitments, further analysis taking account of the association between paid employment and household circumstances is necessary. Using data from a large, representative British sample, this paper examines the effects of interactions between paid employment, social class, and parental status on women's health. The results show differential effects of these variables on physical and mental health. The most important influence on women's mental health (as measured by the 30-item General Health Questionnaire) is the age of their youngest child; women with children under five are most likely to show signs of psychological disturbance. With respect to physical health, age of the youngest child has no significant effect, but there is an interaction between employment status and social class. Paid employment, particularly full-time work, is associated with good physical health for middle-class women but not for working-class women.     

Organizing women for policy-making and implementation

Women's involvement in AIDS and sexually transmitted disease (STD) prevention promotion can be enhanced through coalition building, strategy planning, organization, and consciousness raising. Each of these topics is discussed as a means to increasing women's influence on policy making, program development, and implementation. It is essential that women understand the grave consequences for themselves and their families of HIV/STD infections; women can be effective in preventing the spread of AIDS and in coping with illness. The most effective way of reaching women is through interpersonal contact at all age levels. Young girls, who have not reached puberty, and older women, who may be educators or advisors, should be targeted. Contact can be made through women's groups, social groups, and church groups for those with affiliations; for those without affiliations, clinics, schools and fields or open spaces in neighborhoods may serve as meeting places. The subject matter must be directed to the dangers of AIDS/STDs for women as persons without any statement about moral status. Women's influence can be enhanced by joining forces and combining resources. New organizations can be formed with AIDS/STDs as the significant issue, or, the AIDS agenda can be added to the functions of existing groups. Membership must be the force behind activities, the content must be relevant to members lives. Human resources from outside the group can be used to strengthen skills or share experiences, but should not dominate the group. Strategy involves short, medium, and longterm planning. Short-term goals bring immediate results, which benefit women directly, and also strengthen group cohesion. Examples of short-term activities, which do not require many resources, are organizing a neighborhood education session or preparing an AIDS prevention message. Medium-term goals help to maintain the momentum of the group and may involve securing funding. Long-term goals might be directed to influencing policy. Coalitions can be formed with neighboring villages, local aid groups, other women's groups, or at conferences.     

朝鲜族青少年心理健康素质调查

目的调查朝鲜族青少年心理健康素质状况。方法运用教育部《大学生心理健康测评系统》课题组编制的《青少年心理健康素质调查表》对辽宁省不同城市朝鲜族聚居区689名青少年进行分层整体取样调查。结果①朝鲜族青少年心理健康素质个性素质、动力系统、归因风格分量存在显著的年级差异；②朝鲜族青少年的动力系统、自我、认知风格和归因风格分量表存在显著的性别差异。结论①不同年级朝鲜族青少年个性素质、动力系统、归因风格发展水平不同；②男、女生的动力系统、自我、认知风格和归因风格发展水平不同。     

CLARIFYING THE PHILOSOPHY BEHIND THE COMMUNITY MENTAL HEALTH ACT AND COMMUNITY‐BASED INTERVENTIONS

The passing of the Community Mental Health Act was supposed to signal a change in the treatment of mental disorders. The idea was to embed interventions as much as possible in a community, so that treatment is accessible and appropriately designed. However, many programs that strive to be community‐based never achieve this status. The problem is that becoming community‐based is often treated as merely a methodological or tactical change, rather than a new philosophy. Clinics were built and services offered without a coherent theory to explain why better assessments and treatments should accompany a community‐based strategy. The purpose of this article, therefore, is to clarify the basis for such an approach so that mental health services are not simply placed in communities, but rather are defined and controlled by the persons who reside in these neighborhoods.