中国人群慢性前列腺炎危险因素的Meta分析

目的综合评价中国人群慢性前列腺炎的主要危险因素。 方法检索2000年1月至2017年11月中外数据库,按照拟定的文献纳入与排除标准获得有关慢性前列腺炎危险因素的病例对照研究,提取有效数据,分别采用固定效应模型和随机效应模型计算各危险因素（尿路感染、频繁手淫、长时间固定体位、无节制性生活、长时间憋尿、辛辣食物、饮酒、焦虑、吸烟）的合并OR值和95%CI,进行Meta分析,比较其结果的一致性,分析合并结果的可靠性。 结果共纳入18篇文献,共包括慢性前列腺炎病例15569例,对照组32677例,各危险因素合并OR值（95%CI）由高到低依次为尿路感染（OR=6.05,95%CI：4.40~8.34）、频繁手淫（OR=3.51,95%CI：2.84~4.34）、长时间固定体位（久坐、久骑）（OR=3.48,95%CI：2.88~4.20）、无节制性生活（OR=2.51,95%CI：1.81~3.48）、长时间憋尿（OR=2.49,95%CI：2.08~2.99）、辛辣食物（OR=2.27,95%CI：1.15~4.51）、饮酒（OR=2.16,95%CI：1.57~2.97）、焦虑（OR=2.04,95%CI：1.60~2.61）、吸烟（OR=1.44,95%CI：1.25~1.66）。 结论尿路感染、频繁手淫、长时间固定体位（久坐、久骑）、无节制性生活、长时间憋尿、辛辣食物、饮酒、焦虑、吸烟均为中国人群慢性前列腺炎的危险因素,其中尿路感染对慢性前列腺炎的发病影响最大。     

缺血性脑卒中合并2型糖尿病患者伴发尿路感染危险因素的回顾性分析

目的 探讨缺血性脑卒中合并2型糖尿病患者发生尿路感染的危险因素,为临床早期防治尿路感染提供参考依据。 方法 采用回顾性分析方法,选取首次缺血性脑卒中合并既往2型糖尿病患者459例。根据是否发生尿路感染,分为感染组（149例）和非感染组（310例）。采用单因素分析两组患者的一般资料及实验室指标,包括年龄、性别、缺血性脑卒中类型、身体质量指数（BMI）、冠心病史、糖化血红蛋白（HbAlc）、血清白蛋白（ALB）、血清葡萄糖（GLU）等;采用二元Logistic回归法分析缺血性脑卒中合并2型糖尿病患者伴发尿路感染的危险因素。 结果 共有149例患者（32.5%）发生尿路感染。单因素分析显示,性别、年龄、吸烟、饮酒、缺血性脑卒中类型、合并冠心病、BMI、HbA1c含量、ALB含量可能与发生尿路感染有关（P<0.05）;二元Logistic回归分析显示,女性［OR=13.917,95%CI（7.061,27.431）,P<0.001］、HbA1c≥6.5%［OR=2.425,95%CI（1.397,4.209）,P=0.002］、ALB＜40g/L［OR=2.071,95%CI（1.207,30552）,P=0.008］、肥胖（BMI≥28.0 kg/m2）［OR=2.240,95%CI（1.183,4.241）,P=0.013］、非腔隙性脑梗死［OR=2.649,95%CI（1.639,4.280）,P<0.001］是缺血性脑卒中合并2型糖尿病后尿路感染的危险因素。 结论 缺血性脑卒中合并2型糖尿病患者尿路感染的发生率较高,女性、肥胖、高HbA1c水平、低ALB水平、非腔隙性脑梗死是其并发尿路感染的危险因素。未来可针对以上危险因素进一步采取综合性治疗措施,降低尿路感染的发生率,提高患者的生活质量。     

324名乡镇医院护士职业认同现状及影响因素分析

目的 了解乡镇医院护士的职业认同的现状,分析其影响因素。方法 选择湖南省多个地区乡镇医院的324名护士,采用一般资料调查表、修订的乡镇医院护士职业认同感问卷对其进行调查,采用二分类Logistic回归分析乡镇医院护士职业认同的影响因素。结果 324名乡镇医院护士职业认同感得分为（75.36±10.24）分。二分类Logistic回归分析结果显示,职称（OR=3.259,95%CI：2.011~5.282）、初始学历（OR=4.138,95%CI：2.255~7.595）、近1年月平均收入（OR=2.876,95%CI：2.029~4.077）、对从事护理工作满意程度（OR=7.592,95%CI：3.502~16.459）、护患关系（OR=2.192,95%CI：1.423~3.377）是乡镇护士职业认同感的保护性因素。结论 乡镇医院护士职业认同感处于中等水平,职称、初始学历、近1年月平均收入、对从事护理工作满意情况、当前护患关系是护士职业认同感的保护性因素。建议护理管理者给予职业认知感低的护士更多关注,对乡镇护士的护理理论、临床技能进行个性化培训,改善护理人员薪资水平并引导树立正确的职业价值观,提升乡镇医院护士的沟通能力,促进护患之间的有效沟通,进而提升其职业认同感。     

中老年女性发生压力性尿失禁的危险因素分析

目的探讨中老年女性发生压力性尿失禁的危险因素。方法选取2017年1月至2018年12月于我院就诊的100例中老年女性压力性尿失禁患者为观察组,另选同期无压力性尿失禁中老年女性100例为对照组,对两组进行调查,并对中老年女性压力性尿失禁发生危险因素进行单因素及多因素分析。结果多因素分析结果显示,尿路感染史、盆腔手术史、便秘史、子宫脱垂史、绝经、阴道分娩、憋尿习惯是导致中老年女性压力尿失禁的独立危险因素。结论尿路感染史、盆腔手术史、便秘史、子宫脱垂史、绝经、阴道分娩、憋尿习惯为中老年女性发生压力性尿失禁的危险因素,有针对性地对其开展护理干预,可降低其发生的概率,提升其生活质量。     

中国女性乳腺癌发病相关危险因素：病例对照研究

目的筛查中国女性乳腺癌发病相关危险因素,为个体化评估中国女性乳腺癌发病危险性提供依据。方法在全国8个省市14家研究中心开展1∶m配对病例对照研究,采用调查问卷通过面对面交流收集乳腺癌发病相关危险因素信息。乳腺癌患者及其配对健康对照女性年龄、生活环境相匹配。应用1∶m条件Logistic回归分析乳腺癌相关危险因素在病例组和对照组间的分布特点,明确其与乳腺癌发病危险性的相关性。结果共纳入416例乳腺癌患者及1156例健康对照女性。中国女性乳腺癌发病相关危险因素包括体重指数（body mass index,BMI）≥24（OR=4.07,95%CI：2.98~5.55）,乳腺良性病变活检史（OR=1.68,95%CI：1.19~2.38）,初潮年龄≥14岁（OR=1.41,95%CI：1.07~1.87）,生存压力大（1~4级,OR=2.15,95%CI：1.26~3.66;5~9级,OR=3.48,95%CI：2.03~5.95）,绝经（OR=2.22,95%CI：1.50~3.28）（P〈0.05）,乳腺癌家族史（OR=1.72,95%CI：1.15~2.58）,肿瘤家族史（乳腺癌除外）（OR=1.55,95%CI：1.22~1.98）。口服避孕药（OR=1.59,95%CI：0.83~3.05）亦增加乳腺癌发病危险性,但差异未达到显著统计学意义（P〉0.05）。结论中国女性乳腺癌发病相关危险因素包括BMI≥24、乳腺良性病变活检史、初潮年龄≥14岁、生存压力大、绝经、乳腺癌家族史及其他肿瘤家族史。本研究为个体化评估中国女性罹患乳腺癌危险性及广泛开展乳腺癌防治工作提供了依据。     

孕期焦虑与抑郁情绪调查及相关危险因素分析

目的了解孕期焦虑、抑郁情绪的发生情况及其相关危险因素。方法采用状态-特质焦虑量表（STAI）、自评抑郁量表（SDS）以及自制的孕妇基本情况调查表,对269名孕32~34周孕妇进行测试,并与269名健康已婚未孕妇女比较。结果 269名孕妇状态焦虑情绪发生率为12.3%,特质焦虑情绪发生率为6.3%,抑郁情绪发生率为9.3%。孕期状态焦虑情绪评分和抑郁情绪评分均显著高于健康已婚未孕妇女（t=6.69、18.86,P〈0.01）。孕期与焦虑有关的主要危险因素有：户籍类型（OR=2.89,95%CI=1.95~3.86）、既往胎儿-婴儿死亡（OR=4.88,95%CI=3.15~5.03）、担忧产后经济问题（OR=3.27,95%CI=2.05~3.71）、夫妻关系（OR=43.36,95%CI=38.26~47.53）、婆媳关系（OR=39.22,95%CI=35.61~41.39）、担忧分娩安全（OR=1.58,95%CI=1.26~1.90）和担忧孩子患遗传性疾病（OR=6.31,95%CI=5.11~7.22）;孕期与抑郁情绪有关的主要危险因素有：户籍类型（OR=2.76,95%CI=1.83~3.68）、夫妻关系（OR=39.38,95%CI=37.23~44.53）、担忧产后婴儿健康（OR=7.12,95%CI=5.99~8.33）、是否参加孕妇学校（OR=3.76,95%CI=2.58~4.83）和担忧产后经济问题（OR=3.52,95%CI=2.28~4.36）。结论孕期焦虑、抑郁情绪是普遍存在的,在今后的孕期保健中,不仅要关注孕妇的生理状况,还应注意其心理状态,避免孕妇不良情绪的发生。     

糖尿病患者衰弱危险因素的Meta分析

目的 通过Meta分析明确糖尿病患者衰弱的危险因素,为有效预防糖尿病患者衰弱提供科学依据。方法 计算机检索中国知网、维普、中国生物医学文献数据库、万方、PubMed、Web of Science、Cochrane Library,收集关于糖尿病患者衰弱影响因素的横断面研究、病例对照研究或队列研究,检索时限为自建库至2021年3月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果 共纳入21篇文献,其中14篇横断面研究,4篇队列研究,3篇病例对照研究,糖尿病患者合计6 937例,其中衰弱患者1 562例（22.5%）,涉及影响因素13个。Meta分析结果显示,糖尿病患者衰弱的危险因素为高龄（OR=1.29,95%CI：1.12~1.49）、女性（OR=2.68,95%CI：1.88~3.81）、文化程度较低（OR=2.30,95%CI：1.55~3.42）、糖化血红蛋白水平较高（OR=1.92,95%CI：1.33~2.77）、合并其他疾病（OR=2.35,95%CI：1.49~3.73）、住院次数多（OR=7.28,95%CI：3.56~14.89）、营养状况较差（OR=3.13,95%CI：1.96~4.99）、日常生活活动能力较低（OR=2.74,95%CI：1.98~3.80）和抑郁（OR=1.78,95%CI：1.32~2.41）,而体质量（OR=1.48,95%CI：0.30~7.42）和饮酒（OR=2.12,95%CI：0.67~6.76）与糖尿病患者衰弱无关,运动（OR=0.85,95%CI：0.74~0.97）和25-羟基维生素D₃（OR=0.94,95%CI：0.90~0.98）为糖尿病患者衰弱的保护因素。敏感性分析与发表偏倚结果显示各因素合并结果较稳定,发表偏倚不明显。结论 糖尿病患者的衰弱与多种因素有关,其危险强度由高到低依次为住院次数多、营养状况较差、日常生活活动能力较差、女性、合并其他疾病、文化程度较低、糖化血红蛋白水平较高、抑郁以及高龄。     

产后尿潴留发病危险因素Meta分析

目的 通过Meta分析明确产妇发生尿潴留的危险因素,为其防治提供科学依据。方法 计算机检索中国知网、维普、中国生物医学文献数据库（CBM）、万方、PubMed、Embase、EBSCO、Web of Science、Cochrane Library,收集关于产妇产后并发尿潴留危险因素的病例对照研究或队列研究,检索时限为自建库至2019年6月。研究者按照标准进行文献筛选、资料提取和质量评价,采用RevMan 5.3软件进行定量综合Meta分析。结果 最终纳入14篇文献,累计病例组产妇1 818例,对照组人群5 194例,共10项危险因素。Meta分析结果显示,产钳助产（OR=5.40,95%CI:4.48~6.52）、手转胎头（OR=5.12,95%CI:3.05~8.60）、存在不良情绪（OR=4.84,95%CI:3.84~6.10）、会阴撕裂伤（OR=2.80,95%CI:1.25~4.24）、会阴切开术（OR=1.95,95%CI:1.23~3.09）、产程延长（OR=1.68,95%CI:1.59~1.77）、分娩镇痛（OR=1.48,95%CI:1.32~2.45）是产后尿潴留的危险因素,而胎头吸引（OR=2.95,95%CI:0.85~10.23）、初产妇（OR=1.33,95%CI:0.96~1.83）、产前排空膀胱（OR=1.10,95%CI:0.28~4.28）与产后尿潴留发病无关。敏感性分析与发表偏倚结果显示各因素合并结果较稳定,发表偏倚不明显。结论 产后尿潴留的发生与多种暴露因素有关,其危险强度由高到低依次为产钳助产、手转胎头、存在不良情绪、会阴撕裂伤、会阴切开术、产程延长、分娩镇痛。     

597名深圳市退休老年人孤独情绪及其危险因素分析

目的了解深圳市退休老年人孤独的发生状况,探讨孤独的危险因素。方法研究对象是某疗养机构的597名60岁以上离退休老年人。使用UCLA孤独量表调查老年人孤独的发生状况。性别、年龄、文化程度、业余爱好、社交活动、居住情况和慢性病患病情况等信息由问卷调查获得。孤独的危险因素的多因素分析用Logistic回归分析进行评估。结果 UCLA的平均得分为30.30(标准差为8.52,范围:20~59)。在597名老人中,523人(87.6%)有轻中度孤独感。多因素分析显示男性(OR=2.04,95%CI:1.20~3.46)、老龄(OR=1.06,95%CI:0.93~1.65,1岁增加)、慢性疾病(OR=1.23,95%CI:1.01~1.95,1个增加)、独居(OR=2.66,95%CI:0.34~21.38)、缺乏社会活动(OR=2.07,95%CI:1.16~3.69)和低学历(OR=1.69,95%CI:0.98~2.90)是孤独的危险因素。结论退休老人的孤独情绪发生率高。积极参加社会活动,防治慢性病和避免独居有助于减少孤独的发生,制定孤独预防策略还需考虑学历和性别差异。     

2002-2018年浙江省舟山市剖宫产变化趋势及影响因素分析

目的了解2002 — 2018年浙江省舟山市剖宫产率变化趋势,并分析其影响因素。方法利用该市电子医疗记录数据库,提取孕妇首次随访数据与分娩信息,采用多因素非条件logistic回归分析探讨剖宫产的影响因素。结果研究共纳入舟山市2002 — 2018年共43 034名孕妇,该市剖宫产率总体为50.61%,从2013年开始呈现下降趋势,至2016年下降至40%左右。 孕妇年龄较高（OR＝1.115,95%CI:1.106 ~ 1.123）、孕前体质指数（BMI）较高（OR＝1.080,95%CI:1.070 ~ 1.090）、孕次为2次及以上（OR＝1.199,95%CI:1.145 ~ 1.256）、高危妊娠（OR＝1.407,95%CI:1.317 ~ 1.504）、胎儿出生体质量较大（OR＝1.730,95%CI:1.641 ~ 1.824）、非头位分娩（OR＝7.620,95%CI:7.037 ~ 8.251）更容易发生剖宫产。 根据年份分层,在2014年前文化程度较高是孕妇剖宫产的影响因素。结论舟山市孕妇总剖宫产率较高,孕妇年龄、孕前BMI、孕次、是否高危妊娠、胎儿出生体质量以及分娩胎位是剖宫产的影响因素。     

Impact of urinary incontinence on sexual quality of life in Portuguese adults

Urinary incontinence (UI) is a symptom of an underlying disorder with a high prevalence, constituting an important public health problem due to its physical, psychological and social consequences. The impact it has on the individuals' quality of life is revealed in their daily activities, self‐perception, socialization, emotional health and in their sexual life. The objective of this study is to analyse the impact of incontinence on the sexual quality of life, identifying the role of the variables: gender, duration and severity of incontinence, impact of incontinence on the quality of life and type of incontinence. The sample was composed by 55 patients (54·05% male and 45·5% female) from health facilities, in Lisbon, with a mean age of 55 years, who answered a set of questionnaires, which included: the Incontinence Impact Questionnaire (IIQ‐7); the Urogenital Distress Inventory (UDI‐6); the Questionnaire on Sexual Quality of Life, male and female versions (SQoL‐F/SQoL‐M) and a sociodemographic questionnaire. The results indicate that UI has a negative impact on the sexual quality of life in general, especially if the incontinence symptoms endure for a long period of time; also the impact of UI on social relationships, and the stress UI has a significant and negative impact on the sexual quality of life. In this study, UI has a negative impact on sexual life compounded by restrictions and other negative consequences of living with urinary leakage. The authors conclude that further research is required to ascertain the full impact of UI on sexual quality of life. Finally, implications for nurses are also discussed: in addressing the sexual health of their patients, nurses have an important contribution in assuring that experiencing UI should not necessarily translate into negative sexual quality of life.     

Pelvic Floor Muscle Training to Manage Overactive Bladder and Urinary Incontinence

Overactive bladder (OAB) and urinary incontinence (UI) are common chronic conditions that can negatively affect women’s quality of life. Pelvic floor muscle training is the first-line treatment. Two recent Cochrane Reviews examining pelvic floor muscle training for the treatment of UI and OAB are summarized here to provide women’s health nurses with current recommendations for UI and OAB management. This column also identifies practice improvement education in the area of pelvic floor muscle training and treatment for OAB and UI.     

Women's narratives of long-term urinary incontinence

PURPOSE: The purpose of this study was to use narrative analysis as a method for examining the lived experience and meaning of long-term, female urinary incontinence (UI). METHOD: Cognitive anthropology and critical medical anthropology provided the overall framework for this study. Theoretical saturation (Strauss, 1987) was achieved after 17 community-dwelling women with long-term (greater than 5 year's duration) UI were interviewed. Informants participated in two face-to-face, audiotaped, interviews and a semi-structured, topical outline for each interview was used. A field journal was used to supplement and validate other data. Informant's narratives were analyzed to emphasize the overall plot type of their stories. FINDINGS: In this study, three dominant plot types emerged from women's narratives: the UI Quest Narrative, UI Restitution and Redemption Narratives, and the UI Victim Narrative. These plot types provide a beginning understanding of the lived experience and meaning of long-term female UI. CONCLUSIONS: Study findings suggest (a) long-term female UI is primarily conceptualized as a condition integrated into a larger life story, (b) women with long-term UI relate stories that follow a narrative format, and (c) long-term, female UI is heterogeneous. Findings go beyond existing literature by suggesting that women's UI narratives serve an important function in understanding the lived experience and the meaning of UI.     

广州市番禺区女性尿失禁的流行特征及其相关因素分析

目的了解广州市番禺区女性尿失禁的流行特征及发病的相关因素。方法采用问卷形式调查广州市番禺区城镇和农村居民区自然人群3959例成年女性，共回收有效问卷3785份（95．6％）。结果尿失禁的总发病例数为1495例，发病率39．50％；其中以压力性尿失禁为多；该疾病的发生与年龄、阴道分娩、阴道助产、会阴裂伤、感染、产程延长、胎儿高体质量、产后休息时间短、绝经、肥胖等因素相关。结论广州市番禺区成年女性尿失禁患病率较高，尿失禁的发生与多种因素有关。产褥期得到充分休息及在产后进行适当的功能锻炼可减少尿失禁的发生。     

The meaning of women's experience of living with long-term urinary incontinence is powerlessness

Aim. The aim was to illuminate the meaning of women's experiences of living with urinary incontinence (UI). Background. Living with long‐term UI means a variety of consequences for everyday life. Women's narratives about their lived experiences are important in enabling nurses to better understand and to help women achieve symptom control. No previous study could be found that has focused on the meaning of women's experience of living with UI from a symptom management perspective. Method. Fourteen women with UI (range: 34–52 years) who had sought professional help were interviewed. A phenomenological hermeneutic method was used to analyse and interpret the interview texts. Findings. The women's experiences of living with UI are presented in terms of two interlaced themes of being in a vulnerable situation and striving for adjustment. Being in a vulnerable situation means that the women had no control over UI and experienced powerlessness. The sub‐themes in this case were living with an uncontrolled body, living with incontinence as taboo and experiencing a less satisfying encounter. Striving for adjustment means that the women tried to handle their incontinence in different ways to regain power and continue to live as normal. The sub‐themes here were living in readiness, making urine leakage comprehensible, accepting living with UI and being familiar with the situation. Conclusion. The meaning of women's experience of living with UI is powerlessness. Relevance to clinical practice. Nurses should supervise women in pelvic floor muscle training to achieve control over incontinence, thereby helping them regain power. Additionally, Integrated Approach to Symptom Management can help nurses enhance women's self‐care abilities.     

Discovering older women's experience of urinary incontinence

Grounded theory was used to acquire an understanding of older women's experience of urinary incontinence (UI). Women explained that accidents or other problems related to the UI were threats to their self-esteem. These threats provided strong incentives to develop an effective continence care system which would help to protect their self-esteem. If they were successful in developing an effective system, it was possible that they could accept the UI and lead "normal" lives. Examination of the data using the constant comparative method revealed the self-care system that the women in this study produced to manage the UI, but not how they developed or sustained it. Further investigation into how women with UI develop and sustain continence care routines is needed, so that nurses can provide better assessments and nursing care.     

The role of the nurse in community continence care: a systematic review

Urinary incontinence (UI) is a condition that is associated with decreased quality of life. Apart from this impact on quality of life, UI is also a very costly problem. It is recognised that 'usual care' for patients suffering from UI is not optimal. Specialised nurses can play an important role in the care for community-dwelling incontinent patients, as they have the appropriate interpersonal and technical skills to provide patient-tailored care. This systematic review analyses the effect of treatment by nurses on clinical and economic outcomes. A total of 12 randomised controlled trials (RCTs) were found, varying in terms of population, setting, outcome measurement and control/intervention. There is limited evidence that treatment by nurses results in a decrease in incontinence. No evidence was found for cost reduction. Recommendations are made for future studies.     

Older people, continence care and catheters: dilemmas and resolutions

Urinary incontinence (UI) is a common problem and has a profound impact on quality of life among older people. There are various nursing interventions and treatments which can improve UI for the majority of people. Catheterization should be considered for specific clinical indications only when other options have been ruled out. Many complications are associated with catheterization, including catheter-associated urinary tract infections (CAUTIs), which are the most common cause of hospital-acquired infections. It is important for nurses and other healthcare professionals to appreciate how catheters produce infection so that appropriate catheter care is used. The best way to avoid CAUTI is to avoid catheterization, whenever possible, and to remove indwelling catheters when they are no longer required. There is a need to raise public awareness about UI and the interventions and treatments available so that more older people seek help. The challenge for nurses is to avoid using catheters and develop alternative approaches to the care of older people with incontinence.     

Activities of daily living and cognitive status: associations with urinary incontinence in Korea

Urinary incontinence (UI) is a prevalent condition among nursing home (NH) residents and a major cause of undesirable health outcomes and high costs of care. The overall aim is to determine the association between activities of daily living (ADL) and cognitive status among elderly residents with UI in NHs in Korea. Secondary analyses from a cross‐sectional study were performed in this study. Records of 221 elderly residents aged 65 or above who had no indwelling Foley catheter, were included. UI, ADL, cognitive status, depressive symptoms and co‐morbidities were measured through interviews with the residents and staff nurses. Logistic regression models were developed to assess the association between UI and ADL and cognitive status. The mean age of the participants was 80·3 (±7·2). Approximately 68% (n = 150) had UI based on information obtained from nurses. Age, gender, hypertension, arthritis, walking ability, ADL and cognitive status were significant factors in the univariate analyses. For the logistic regression model, ADL [odd ratio, 1·41; 95% confidence interval (CI), 1·26–1·57] and cognitive status (odd ratio, 1·10; 95% CI, 1·02–1·18) remained significant predictors for UI, after controlling for demographics and co‐morbidities. The ability to perform ADL and cognitive status are two factors that are strongly associated with UI. Future studies should examine the impact of environmental and organizational factors on UI in NH residents in Korea to develop a comprehensive and culturally sensitive intervention for this population.