社会支持、焦虑和抑郁情绪对中小学教师生活质量影响的路径分析

目的 了解社会支持、焦虑和抑郁情绪对中小学教师生活质量的影响,为改善中小学教师的生活质量提供依据.方法 采用分层整群抽样方法,用世界卫生组织生存质量测定量表简表(WHOQOL-BREF)配合社会支持评定量表(SSRS)、焦虑自评量表(SAS)和抑郁自评量表(SDS)对郴州市城区622名中小学教师进行测评,然后用结构方程模型分析软件Amos7.0作路径分析.结果 中小学教师生活质量的4 个领域(生理领域、心理领域、社会关系领域和环境领域)得分分别为:(60.88±11.67)分、(58.54±12.62)分、(64.46±13.86)分和(41.29±14.37)分;路径分析结果显示,焦虑对生活质量的4个领域均有直接(负向)影响(P<0.05);抑郁对生活质量的心理领域、社会关系领域和环境领域有直接(负向)影响(P<0.05);焦虑、抑郁对社会支持有直接(负向)影响(P<0.05);社会支持对生活质量的4个领域均有直接(正向)影响(P<0.05);社会支持作为中介变量调节焦虑、抑郁与生活质量4个领域的关系.焦虑、社会支持对生活质量4个领域影响的总效应大于抑郁.结论 焦虑和抑郁情绪可能影响中小学教师的生活质量;社会支持作为中介变量调节焦虑、抑郁与生活质量的关系.     

Chinese Medicine Improves Postoperative Quality of Life in Endometriosis Patients: A Randomized Controlled Trial

Objective:To investigate the effect of Chinese medicine(CM) and Western medicine(WM) on quality of life(QOL) after conservative surgery for endometriosis.Methods:A total of 320 patients with endometriosis were randomized into two groups by using random block design,CM group(160 cases,activating blood circulation and removing blood stasis treatment based on syndrome differentiation) and WM group(160 cases,gonadotropin-releasing hormone agonist or gestrinone treatment) after conservative surgery.Treatment was given for 3-6 months(according to the revised American Fertility Society scoring system stage),and the World Health Organization QOL-BREF(WHOQOL-BREF) was applied to patients before and after treatment to assess QOL.Results:There were 136 cases in the CM group and 141 cases in the WM group completing therapy.In the CM group,the use of the WHOQOL-BREF showed that the physical,psychological and environmental scores post- treatment were significantly higher than those at pre-treatment(P<0.05),and for 12 items(pain and discomfort, energy and fatigue,sleep and rest,mobility,activities of daily living,work capacity,negative feelings,health and social care:accessibility and quality,participation in and opportunities for recreation/leisure activities,appetite, QOL score,overall health status and QOL),the difference in scores was significant(P<0.05).In the WM group,4 items(pain and discomfort,opportunities for acquiring new information and skills,QOL score,overall health status and QOL) had significantly different scores post-treatment compared with those at pre-treatment(P<0.05).Before treatment,the QOL in the two groups of patients showed no significant difference(P>0.05).After treatment,the scores for physical health in the CM group were significantly higher than those of the WM group(P<0.05) and the scores of 4 items(mobility,activities of daily living,sexual activity,QOL score) in the CM group were significantly higher than those in the WM group(P<0.05).Conclusions:CM and WM treatment could improve the QOL of patients with endometriosis after conservative surgery.CM treatment is more effective than WM.     

Adjuvant Effects of Fermented Red Ginseng Extract on Advanced Non-Small Cell Lung Cancer Patients Treated with Chemotherapy

Objective

To investigate the adjuvant therapeutic effects of fermented red ginseng (FRG) extract on non-small cell lung cancer (NSCLC) patients treated with chemotherapy.

Methods

A total of 60 patients with advanced NSCLC were divided into two groups using a random number table, i.e., the gemcitabine plus cisplatin (GP) chemotherapy alone group (26 patients) and the FRG + GP chemotherapy group (34 patients), for 60-day treatment. Patients were then assessed according to the Fatigue Symptom Inventory, Chinese medicine symptoms score, Self-Rating Anxiety Scale, Self-Rating Depression Scale, Karnofsky Performance Status Scale, and Functional Assessment of Cancer Therapy-Lung. In addition, chemotherapy toxicity and tumor biomarkers were measured.

Results

For NSCLC patients after chemotherapy, FRG extract significantly improved the FSI score, CM symptoms score, psychological status, physical conditions, and quality of life and reduced chemotherapy toxicity, but the expression levels of carcinoembryonic antigen, cytokeratin-19 fragments, and neuron-specific enolase were not significantly different between the chemotherapy alone and the FRG + chemotherapy groups or between pre- and post-treatments.

Conclusions

This study demonstrated that FRG extract had an adjuvant effect on advanced NSCLC patients treated with chemotherapy. Further studies with a larger sample size will verify the current findings.

     

A cross-sectional study of anxiety and marital quality among women with breast cancer at a university clinic in western Saudi Arabia

Objectives:

To examine relationship between the quality of marital relationship and anxiety among women with breast cancer (BC) in the Kingdom of Saudi Arabia (KSA).

Methods:

This cross-sectional study recruited a consecutive series of 49 married women with BC seen in the Al-Amoudi Breast Cancer Center of Excellence at King Abdulaziz University, Jeddah, KSA in early 2013. Participants completed the Hospital Anxiety and Depression Scale, Spouse Perception Scale, and Quality of Marriage Index forms, and answered questions on demographic and cancer characteristics.

Results:

Anxiety symptoms indicating “possible” anxiety disorder were present in 10.4% and “probable” anxiety disorder in 14.6% (25% total). No significant relationship was found between the quality of marital relationship and anxiety symptoms (B=-0.04, standard error=0.05, t=-0.81, p=0.42). Anxiety was primarily driven by low education, poor socioeconomic status, and young age.

Conclusion:

Anxiety symptoms are prevalent among married women with BC seen in a university-based clinic in the KSA. Further research is needed to determine whether a diagnosis of BC adversely affects marital relationship, and whether this is the cause for anxiety in these women.Breast cancer (BC) is the most common cause of cancer death in women worldwide,1 and the Kingdom of Saudi Arabia (KSA) is no exception.2 Breast cancer has become a particular problem in Arab countries due to its late stage at presentation and its increased occurrence among young women.3 Both during and after treatment, even if the cancer goes into remission, concerns regarding recurrence, effect on the marital relationship, and frequent medical visits for monitoring, often result in high levels of anxiety (including post-traumatic stress-like symptoms).4-8 Anxiety and other mood symptoms are not benign in women with BC, as they are associated with increased mortality and cancer recurrence.9,10Studies in Western countries (United States, Canada, England, Australia, and Germany) indicate a prevalence of significant anxiety ranging from 4-45% in BC patients, depending on anxiety measure, cutoff score, geographical region, and time since diagnosis11-14 (compared with 15-37% of cancer patients in general with anxiety during the first year after diagnosis).15 The most commonly used measure of anxiety symptoms in BC patients is the Hospital Anxiety and Depression Scale (HADS), which assesses for “possible” and “probable” anxiety disorder (with a sensitivity and specificity of approximately 80%).12,16,17 Using this measure, the prevalence of “probable” anxiety disorder in BC patients ranges from 2-23% and “possible” anxiety disorder is present in an additional 19-22% (21-45% combined).11,13,18 Although factors that increase risk of anxiety in women with BC are poorly understood, a few studies largely from Western countries report more symptoms in younger persons and Caucasians, immigrants, those with lower education, later disease stage, and lower social support.8,11,13,19 In one of the few studies from an Eastern country,20 anxiety levels among BC patients from Bangkok, Thailand, were significantly higher among those with poor problem solving skills, more pain and fatigue, and poorer family functioning. Although research is limited almost entirely to the US and other Western countries, studies indicate that support from a spouse (especially emotional support) improves the adjustment of women to BC,21-25 and may even impact survival.26 Not all studies, however, report that having a marital partner buffers against the stress of BC.27,28 The demands of caregiving, the effects of BC and its treatments on sexual relationship, and coping with psychological changes in a BC patient can all lead to lower well-being in a spouse, and decrease his ability to provide support.24 Our exhaustive review of the literature uncovered several studies that have examined the prevalence of emotional reactions to BC in the Middle East, finding that 19-73% of women had significant anxiety symptoms.22,29-34 In those studies, anxiety was associated with poorer physical functioning, the presence of metastatic disease, higher education, lower social support, duration of marriage, and spouse’s level of anxiety. With regard to KSA, there has been a significant increase in the incidence of BC, which occurs at a younger age than in Western countries.35 A recent review of research on coping with BC, however, revealed not a single study from KSA.36 Our review identified only 2 studies37,38 that examined the prevalence or correlates of anxiety in Saudi cancer patients (none specifically in BC), and only one study39 that examined attitudes of Saudi males toward BC. The first study examined anxiety in 30 hospitalized patients with cancer (9 with BC) at the King Khalid National Guard Hospital in Jeddah, KSA.37 Researchers found that anxiety symptoms assessed by the Hamilton Anxiety Scale were significantly higher in cancer patients compared with 39 patients with a range of chronic illnesses; 3 patients with cancer (10%) had a clinical diagnosis of generalized anxiety disorder based on Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria. The second study examined non-pain symptoms in 124 cancer patients (27% with BC) at King Faisal Specialist Hospital in Riyadh, KSA.38 The most frequently reported non-pain symptoms were fatigue (80%), loss of appetite (72%), dry mouth (69%), and anxiety (61%). Finally, researchers examined attitudes toward BC among males accompanying female patients to outpatient clinics at King Abdulaziz Hospital in Jeddah, KSA. When men were asked what they would do if their wives were diagnosed with BC, 9.4% said they would leave their wives.39Given the current knowledge gap on this subject in KSA, we decided to: 1) determine the prevalence of anxiety symptoms in married women seen in an urban-based university outpatient clinic in Jeddah; 2) identify the correlates of anxiety symptoms (especially marital quality [MQ]); and 3) determine whether the relationship between MQ and anxiety differed between Saudi nationals and immigrants. We hypothesized that anxiety symptoms would be prevalent, that higher MQ would be strongly and inversely related to anxiety symptoms, and that this relationship would be particularly strong in women who were Saudi nationals (where cultural factors might have the most influence).     

Advantages of Chinese Medicine for Patients with Acquired Immunodeficiency Syndrome in Rural Central China

Objective

To analyze the effect of Chinese medicine (CM) on mortality and quality of life (QOL) of acquired immunodefificiency syndrome (AIDS) patients treated with combined antiretroviral therapy (cART).

Methods

A random sample of AIDS patients enrolled in the National Chinese Medicine Treatment Trial Program (NCMTP) that met the inclusion criteria was included in this study. NCMTP patients were included as the CM+cART group, and those not in the NCMTP were included as the cART group. Survival from September 2004 to September 2012 was analyzed by retrospective cohort study. QOL was analyzed by cross-sectional study.

Results

The retrospective cohort study included 528 AIDS patients, 322 in the CM+cART group and 206 in the cART group. After 8 years, the mortality in the CM+cART group was 3.3/100 person-years, which was lower than the cART group of 5.3/100 person-years (P<0.05). The hazard ratio (HR) for mortality in the cART group was 1.6 times that of the CM+cART group by Cox proportional hazard model analysis. After controlling for gender, age, marital status, education, and CD4⁺ T-cell count, the HR was 1.9 times higher in the cART group compared with the CM+cART group (P<0.05). The cross-sectional study investigated 275 AIDS patients. The mean scores of all QOL domains except spirituality/personal beliefs were higher in the CM+cART group than in the cART group (P<0.05).

Conclusions

For AIDS patients, CM could help to prolong life, decrease mortality, and improve QOL. However, there were limitations in the study, so prospective studies should be carried out to confifirm our primary results.

     

Psychological Well-being of Medical Students

Background

Training in medicine is emotionally demanding. Psychological well being of medical students is a matter of concern. There is lack of Indian studies in this area.

Methods

A total of 105 medical student of one batch were assessed utilizing psychophysiological state inventory, Institute for personality and ability testing (IPAT) anxiety and depression scale, achievement motivation scale, scale for locus of control and 16 PF in three phases at one-year intervals.

Result

Majority of the students had average achievement, motivation and adaptability. Anxiety and depression scores fell within normal limits. In personality profile factor ‘B’, ‘M’ and ‘Q4₁’ had changed significantly. Achievement motivation showed significant decreases and CSS1 and PO1 scores showed significant increase during the years of medical education.

Conclusion

The results demonstrate that over satisfaction and relaxed attitude may have poor academic outcome.Key Words: Psychological well-being, Anxiety, Depression, Achievement motivation     

Epidemiological Investigation of Risk Factors of the Pregnant Women with Early Spontaneous Abortion in Beijing

Objective

To determine the risk factors of the pregnant women with early spontaneous abortion in Beijing.

Methods

A total of 34,417 cases of pregnant women were participated in the survey from January 2000 to December 2013. A questionnaire was informed to each woman. The content of questionnaire includes four parts: general condition, obstetrical history, past history and family history, and living environment and habits. The mental condition was evaluated with Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS).

Results

A total of 32,296 questionnaires were collected. The spontaneous abortion rate in the total sample was 3.0%. There was no significant difference between the normal pregnancy group and spontaneous abortion group in terms of general condition, obstetrical and past history (P>0.05). Significant differences between the two groups were found in terms of decoration during pregnancy, keeping pets, near mobile communication base station within 100 m around the residence, drinking during pregnancy, having a cold during pregnancy and SAS (P<0.05). Having a cold during pregnancy, decoration during pregnancy, near mobile communication base station within 100 m around the residence, keeping pets and high SAS were determined the independent risk factors of spontaneous abortion by Logistic regression analysis.

Conclusions

Having a cold during pregnancy, decoration, keeping pets, near mobile communication base station within 100 m around the residence and high SAS are the independent risk factors of spontaneous abortion in Beijing.

     

Comprehensive patient care improves quality of life in transfusion dependent patients with β-thalassemia

Objectives:

To investigate levels of quality of life (QOL) among thalassemia patients at the Hereditary Blood Disorders Center in Al-Madinah Al-Munawarah, Kingdom of Saudi Arabia.

Methods:

A cross-sectional study was performed on 43 transfusion dependent thalassemia patients compared with 43 normal subjects, as a control, using the World Health Organization Quality Of Life - Brief questionnaire between May 2012 and September 2012 at the Hereditary Blood Disorders Center, Maternity and Children Hospital in Al-Madinah Al-Munawarah, Kingdom of Saudi Arabia.

Results:

Forty-three thalassemia patients were examined, 23 males and 20 females, and compared with 43 peers (control group), 24 males and 19 females. There was no statistical difference between patients and controls for psychological domains (53.4 versus 56.9, p=0.059) and environmental domains (56.6 versus 57.0, p=0.884). Patients had better social QOL than the control group (39.3 versus 31.7, p=0.003), while the control group had better physical QOL (55.4 versus 61.9, p=0.047). Among patients, there was no statistical difference in QOL domains for variables of age, desferroxamine use, serum ferritin level, disease severity, presence of complications; splenectomy status, hepatitis C virus status, or family history.

Conclusion:

Quality of life in thalassemia patients is similar to the control group particularly social life, though physical health is less. Improvement of patients care from all aspects will improve their QOL. More studies in this field are needed with a bigger sample size.β-Thalassemia disorders are characterized by defective production of hemoglobin and excessive destruction of red blood cells.1 Thalassemia effects physical health such as physical deformities, growth on retardation, and delayed puberty, may have an impact on physical appearance, for example: bone deformities and short stature, all of which contribute to poor self-image. Other severe complications such as heart failure, cardiac arrhythmia, liver disease, endocrine complications and infections are common among patients with β-thalassemia and may impact negatively on patients’ quality of life (QOL).2 Therefore, β-thalassemia major and its complications carry a profound psychological impact on the patients.3 The aim of regular blood transfusion is to eliminate the primary complication of severe thalassemia by ameliorating anemia and suppressing erythropoiesis.3 Morbidity and mortality related to thalassemia have been reduced significantly with modern medical treatment, and QOL should now be considered an important index of effective health care and an essential outcome when considering options for treatment for individual patients and the allocation of health care resources.4 As per the World Health Organization (WHO) definition, QOL is individuals’ perceptions of their position in life in the context of the culture and value systems in which they live, and in relation to their goals, expectations, standards and concerns.5 In clinical practice the QOL assessments will assist clinicians in making judgments in regards to the areas in which a patient is most affected by disease, and in making treatment decisions.5 Only a few studies have been conducted on QOL worldwide on patients with β-thalassemia. Various studies have shown that thalassemia is stressful, and patients face a variety of physical, psychological, and social problems. The findings also showed that culture and education play a major role in illness experiences.6 For these reasons, we need to have a baseline assessment for our patients so that we can develop strategies to improve their QOL. The present study aimed to compare levels of QOL among patients with β-thalassemia at the Hereditary Blood Disorders Center in Al-Madinah Al-Munawarah, Kingdom of Saudi Arabia with their healthy peers in terms of physical health, psychological, social relationships, and environmental domains.     

Validity and reliability of an Arabic version of the modified dental anxiety scale in Saudi adults

Objectives:

To test the reliability and validity of an Arabic version of the modified dental anxiety scale (MDAS), and to correlate it with other demographic data.

Methods:

The original English version of the MDAS was translated into Arabic, and then translated back into English by experienced bilingual professionals. Four hundred and seventy-four patients referred to dental clinics for treatment at the Faculty of Dentistry Hospital, Jeddah, Kingdom of Saudi Arabia from November 2012 to June 2013 participated in the study. The assessment tool included questions regarding demographic characteristics, frequency of dental visits, the Arabic version of the MDAS, and the patient''s rating of their current level of anxiety using a visual analogue scale (VAS).

Results:

The Arabic version of the MDAS had excellent internal consistency and reliability (Alpha coefficients >0.90). The scale was unidimensional, and the percentage of patients with dental anxiety was 48.3% (using a cutoff total score of >15) and with dental phobia was 2.5% (using a cutoff total score of >16). Younger patients, females, and infrequent visitors to the dentist were more anxious than those who were older, male, and frequent visitors. Visual analogue scale scores correlated significantly with individual items on the MDAS questionnaire and total anxiety score, supporting the criterion validity.

Conclusion:

The Arabic version of the MDAS presented adequate internal consistency reliability, allowing its safe use to assess levels of dental anxiety in Arabic-speaking populations.Anxiety related to dental treatment is a well-known phenomenon that has been reported to cause 6% of the general population to avoid dental treatments.1 This emotional state can also affect the dentist who may become anxious dealing with patients who are known to be difficult to manage and who delay or even cancel their dental appointments.2 Dental anxiety is defined as a patient''s response to stress that is specific to dental situations.3 It is therefore, very important to rate patient anxiety for proper control and management. There is a wide range of psychometric self-assessment scales to assess anxiety in general that are commonly used for research and clinical purposes to assess the dental anxiety and fear. The Corah Dental Anxiety Scale (CDAS) is probably the most widely used scale.4Three shortcomings of the CDAS have been noted: the item responses vary, the responses are not necessarily ordered from lowest to highest anxiety, and the scale does not include an item referring to dental injections.2 A Modified Dental Anxiety Scale (MDAS) was proposed to overcome the psychometric and content validity issues of the original CDAS.5 The MDAS is a 5-item multiple-choice questionnaire, which includes an item that rates respondent anxiety upon receiving local anesthetic injections; thereby, differing from the CDAS. Other small, but important changes were also made to the English version response scheme, creating a simple, quick, and easy-to-complete instrument that will not increase patients’ fear and anxiety.6,7The original English-language version of the MDAS5 has been translated into different languages (which include, but are not limited to, Spanish, Greek, Chinese, Turkish, Romanian, and Tamil) and tested for readability and validity in adult populations in a variety of cross-cultural studies.8-13 It is desirable to establish a linguistic and cultural psychometric equivalent of the MDAS and other psychological scales translated from American or British scales. An Arabic version of the scale was used with Jordanian adolescents;14 the authors recommended that future researchers consider older age groups and differing countries where Arabic is spoken.Spoken Arabic varies considerably across different cultures and countries, especially with regards to colloquial or slang usage. Therefore, it is important to develop an Arabic version of the MDAS, which is suitable for all Arabic-speaking individuals, using simple Arabic, which would be understood by individuals from different cultures or countries. Different cultures, which share Arabic, as a common language would still benefit from different Arabic versions of this scale, which will add further evidence for the reliability, and validity of the MDAS. Therefore, the aim of this study was to test the reliability and validity of an Arabic version of the MDAS. In addition, we evaluated whether the Arabic MDAS can be utilized as an effective tool to assess dental anxiety among Arabic-speaking Saudi adult dental patients, by correlating scale scores with other demographic data.     

Quality of life after first-ever stroke: An interview-based study from Blantyre,Malawi

Background

In post-stroke patients, impairment of quality of life (QOL) has been associated with functional impairment, age, anxiety, depression, and fatigue. Good social support, higher education, and better socioeconomic status are associated with better QOL among stroke survivors. In Africa, studies from Nigeria and Tanzania have reported on post-stroke QOL.

Aim

The aim of this study was to describe QOL more than six months after first-ever stroke in Malawi.

Methods

This was an interview-based study about a stroke-surviving cohort. Adult patients were interviewed six or twelve months after their first ever stroke. HIV status, modified stroke severity scale (mNIHSS) score, and brain scan results were recorded during the acute phase of stroke. At the time of the interviews, the modified Rankin scale (mRS) was used to assess functional outcome. The interviews applied the Newcastle Stroke-specific Quality of Life Measure (NEWSQOL). All the data were analysed using Statview™: the X² test compared proportions, Student''s t-test compared means for normally distributed data, and the Kruskal-Wallis test was used for nonparametric data.

Results

Eighty-one patients were followed up at least six months after the acute stroke. Twenty-five stroke patients (ten women) were interviewed with the NEWSQOL questionnaire. Good functional outcome (lower mRS score) was positively associated with better QOL in the domains of activities of daily living (ADL)/self-care (p = 0.0024) and communication (p = 0.031). Women scored worse in the fatigue (p = 0.0081) and cognition (p = 0.048) domains. Older age was associated with worse QOL in the ADL (p = 0.0122) domain. Seven patients were HIV-seroreactive. HIV infection did not affect post-stroke QOL.

Conclusion

In Malawi, within specific domains, QOL after stroke appeared to be related to patients'' age, sex, and functional recovery in this small sample of patients.     

Progressive Muscle Relaxation Combined with Chinese Medicine Five-Element Music on Depression for Cancer Patients: A Randomized Controlled Trial

Objectives

To evaluate the effects of progressive muscle relaxation training (PMRT) combined with fifive elements music therapy of Chinese medicine (CM) for improving anxiety and depression of cancer patients.

Methods

From June 2015 to March 2016, 60 cancer patients were included into the study. The patients were randomly assigned to a control group and a treatment group by envelope randomization, receiving PMRT and PMRT plus CM five elements music therapy, respectively, for 8 weeks. Hospital Anxiety and Depression Scale (HADS), Benefit Finding Scales (BFS), Functional Assessment of Chronic Illness Therapy-Spiritual (FACIT-Sp), and Intervention Expectations Questionnaire (IEQU) were adopted to assess the depression of the two groups before and after the treatment.

Results

Four cases dropped out during the study, and 29 cases in the treatment group and 27 in the control group were included in the fifinal analysis. Prior to the treatments, the baselines of the 4 questionnaires in the two groups showed no difference. After the 8-week treatment, the treatment group presented better levels of HADS, BFS and FACIT-Sp scores compared with the control group (P<0.05). Among the single items of HADS, 4 items involving vexation, feeling fifidgeted, pleasure and prospecting the future in the treatment group were improved compared with the control group (P<0.05).

Conclusions

As a simple and reliable and effective intervention, PMRT combined with fifive elements music therapy mitigated anxiety and depression of cancer patients. Cancer patients have been found to respond well to psychological intervention in areas regarding stabilisation of emotions, disease awareness, and therapeutic compliance. This brings about a great difference in improving their quality of life and psychological state, offers an effective approach to better self-management in cancer treatment.

     

广西桂西壮族癫痫患者生活质量调查

目的探讨广西桂西地区壮族癫痫患者的生活质量(QOL)及其影响因素。方法采用癫痫患者生活质量量表-31(QOLIE-31)对78例临床确诊的癫痫患者和60名正常对照者进行评定,并分析不同因素对患者QOL的影响。结果癫痫组的QOLIE-31评分(53.9±8.0)较对照组(77.0±7.1)显著降低(P<0.01)。不同性别、用药数量、病程及发作类型的患者QOLIE-31评分相比较,性别方面差异无显著性(P>0.05),单药较多药治疗者评分高(P<0.01),病程短较病程长者评分高(P<0.05),强直-阵挛发作较其他发作类型者评分低(P<0.01)。结论广西桂西地区壮族癫痫患者QOL明显低于同地区正常人群,用药和发作类型对患者的QOL影响较大。     

Comparison of Electroacupuncture and Mild-Warm Moxibustion on Brain-Gut Function in Patients with Constipation-Predominant Irritable Bowel Syndrome: A Randomized Controlled Trial

Objective

To compare the effects of electroacupuncture (EA) and mild-warm moxibustion (Mox) therapies for constipation-predominant irritable bowel syndrome (C-IBS) patients.

Methods

Sixty C-IBS patients were assigned to 2 groups by simple randomized method, i.e. EA group (30 cases) and Mox group (30 cases). Both EA and Mox treatments were performed on bilateral Tianshu (ST 25) and Shangjuxu (ST 37) for 30 min each time, 6 times per week, for 4 consecutive weeks. The gastrointestinal symptoms and psychological symptoms of the two groups were scored before and after treatment. The effects on the corresponding functional brain areas, namely the anterior cingulate cortex (ACC), insular cortex (IC) and prefrontal cortex (PFC) were observed by functional magnetic resonance imaging (fMRI) before and after treatment.

Results

Compared with the Mox group, greater improvements in abdominal distension, defecation frequency, diffificulty in defecation and stool features were observed in the EA group (all P<0.01), both Hamilton Anxiety Rating Scale and Hamilton Depression Rating Scale scores were signifificantly decreased in the EA group (all P<0.01). Finally, decreased activated voxel values were observed in the ACC, right IC and PFC brain regions of EA group with 150 mL colorectal distension stimulation (P<0.05 or P<0.01).

Conclusions

Both EA and Mox could signifificantly improve some of the most intrusive symptoms of C-IBS patients, and EA was more effective than Mox. The therapeutic effect of these two therapies might through modulating of the brain-gut axis function. (Registration No. ChiCTRTRC-11001349).

     

The SAFE (SGRQ score, air-flow limitation and exercise tolerance) Index: a new composite score for the stratification of severity in chronic obstructive pulmonary disease

Background

This study was proposed to develop a composite of outcome measures using forced expiratory volume percentage of predicted, exercise capacity and quality of life scores for assessment of chronic obstructive pulmonary disease (COPD) severity.

Materials and methods

Eighty‐six patients with COPD were enrolled into a prospective, observational study at the respiratory outpatient clinic, National University Hospital Malaysia (Hospital Universiti Kebangsaan Malaysia ‐ HUKM), Kuala Lumpur.

Results

Our study found modest correlation between the forced expiratory volume in 1 s (FEV₁), 6 min walk distance and the SGRQ scores with mean (SD) values of 0.97 (0.56) litres/s, 322 (87) m and 43.7 (23.6)%, respectively. K‐Means cluster analysis identified four distinct clusters which reached statistical significance which was refined to develop a new cumulative staging system. The SAFE Index score correlated with the number of exacerbations in 2 years (r = 0.497, p<0.001).

Conclusion

We have developed the SGRQ, Air‐Flow limitation and Exercise tolerance Index (SAFE Index) for the stratification of severity in COPD. This index incorporates the SGRQ score, the FEV₁ % predicted and the 6 min walk distance. The SAFE Index is moderately correlated with the number of disease exacerbations.The diagnosis of chronic obstructive pulmonary disease (COPD) is confirmed by spirometry when the forced expiratory volume in 1 s to forced vital capacity (FEV₁/FVC) ratio is less than 70%. Both the American Thoracic Society and the European Respiratory Society recommend a simple staging system to assess COPD severity based on post‐bronchodilator FEV₁ as percentage of the predicted value (FEV₁%Pred).The FEV₁ cut‐off points used to define different stages of COPD are arbitrary and have not been clinically validated. Although FEV₁ does not accurately measure small airflow obstruction, it is the most objective and reproducible measurement to assess physiologically the degree of airflow limitation. A recent study suggested that prognosis of all‐cause mortality was found to be strongly associated with age, smoking, and the best attainable FEV₁%Pred in COPD.¹On the contrary, other studies have shown good correlation between disease severity and quality of life (QOL) scores independent of the underlying physiologic markers measured by spirometry.^2,3,4 Patients with poor QOL scores based on the St George''s Respiratory Questionnaire (SGRQ) are at greater risk of hospital readmission whereas the FEV₁%Pred or FVC is not related to readmission.³QOL scores and spirometric values also measure different dimensions of disease severity.⁵ Wijnhoven et al found that a reduced score on the Health‐Related Quality of Life Questionnaire (HRQOL) was strongly associated with greater respiratory complaints whereas no association between pulmonary function level and symptoms was found.¹Another aspect of disease severity in COPD is exercise tolerance. Studies in pulmonary rehabilitation have shown that assessment of exercise tolerance correlates well with disease severity.^6,7,8 Walking distance also corresponds well with QOL scores, independent of the severity as assessed by spirometry.⁸ In another study by Wegner et al, exercise capacity, dyspnoea scores and airway obstruction independently characterised the pathophysiologic conditions of patients with severe COPD.⁹Would it be possible then to determine the severity of COPD using other independent parameters in addition to the degree of airway obstruction as measured by FEV₁%Pred? In a landmark study, Celli et al introduced and validated a multifactorial grading system that incorporated the body mass index, degree of airflow obstruction, functional dyspnoea and exercise capacity of patients with COPD. The cumulative scores of the BODE index correlated well with mortality.¹⁰ However, no QOL questionnaires were used in the study. The incorporation of a QOL assessment would have provided a more holistic stratification of severity in patients with COPD.Currently the severity of COPD is determined arbitrarily by a spirometric measure of a lung function, FEV₁. Although the decline of FEV₁ is a good marker of disease progression, it does not accurately assess the global manifestations of COPD. We hypothesised that inclusion of other outcome measures such as exercise capacity and health‐related QOL scores, in addition to the spirometric measurement FEV₁%Pred, would provide better overall assessment of COPD severity. In this study we have developed a composite of outcome measures using post‐bronchodilator FEV₁%Pred, exercise capacity and QOL scores to assess the severity of COPD. In addition, we validated the new composite score against the patients'' exacerbation frequency.     

Foundation Programme Impact on Junior Doctor Personality and Anxiety in Northern Ireland

Objectives

The main objectives of this study were to assess personality traits and levels of anxiety in Foundation Year 2 (F2) doctors during the foundation doctor training programme in the Northern Ireland Deanery (NIMDTA).

Methods

A prospective survey-based study was conducted for all F2 doctors attending the mandatory generic skills programme at NIMDTA. Anxiety was measured using the State-Trait Anxiety Inventory (STAI) while personality was assessed using the IPIP-NEO questionnaire. These previously validated questionnaires were completed at the start and again at the end of the F2 year.

Results

147 (M=65, F=82) and 106 (M=55, F=51) F2 doctors completed questionnaires at both time points. STAI scores suggested a moderate level of anxiety amongst both male and female doctors at baseline and at the end of the academic year. There was no difference between gender for either parameter (Baseline-State: 34.0 vs. 36.0, p=0.48 and Trait: 39.0 vs. 40.5, p=0.33) (End-State: 41.0 vs. 36.0, p=0.14 and Trait: 42.0 vs. 40.5, p=0.78). IPIP-NEO scores for F2 doctors were consistently higher in the Accommodation (93.9 & 92.3) and Consolidation (88.8 & 87.6) personality factors and lower in the Neuroticism factor (66.3 & 65.9) at both assessment time-points. Female F2 doctors scored significantly higher in the accommodation factor at the end of the academic year when compared to their male counterparts (88.0 vs. 94.0, p<0.001). There was no difference between the genders for the other personality factors at the end of the year (p>0.09).

Conclusion

This first cohort of F2 doctors were exposed to many emerging changes in their training which did not appear to have any detrimental effect on their anxiety levels or personality profiles and suggests that junior doctors may not be affected by external influences or changing educational environments.Keywords>: Anxiety, Doctor, Foundation, Personality, Programme     

Evaluation of a scale of patient-reported outcomes for the assessment of myasthenia gravis patients in China

<正>Objective:To evaluate a scale of patient-reported outcomes for the assessment of myasthenia gravis patients(MG-PRO) in China.Methods:A total of 100 MG patients were interviewed for the field testing.Another 56 MG patients were selected and assessed with the MG-PRO scale before treatment and at 1,2 and 4 weeks after treatment.The classical test theory and item response theory(IRT) were used to assess the psychometric characteristics of the MG-PRO scale.Results:The MG-PRO scale included 4 dimensions:physical,psychological, social environment,and treatment.Confirmatory factor analysis showed that each dimension was consistent with the theoretical construct.The scores of the physical and psychological dimensions increased significantly at 1 week after treatment(P0.05).All the dimension scores and the MG-PRO score increased significantly at 2 and 4 weeks after treatment(P0.05).IRT showed that person separation indices were greater than 0.8,most of the item fit residual statistics were within±2.5,and no item had uniform or non-uniform differential item functioning(DIF) between gender and age(40,≥40).Conclusions:The MG-PRO scale is valid for measuring the quality of life(QOL) of MG patients, with good reliability,validity,responsiveness,and good psychometric characteristics from IRT.It can be applied to evaluate the QOL of MG patients and to assess treatment effects in clinical trials.     

The association between perceived relationship discord at childbirth and parental postpartum depressive symptoms: a comparison of mothers and fathers in Sweden

Aim.

To examine whether mothers'' and fathers'' levels of perceived relationship discord at childbirth were associated with postpartum depressive symptoms when the child was 3 months old. Another aim was to examine parents'' levels of self-reported depressive symptoms. The hypothesis was that parents with high levels of perceived relationship discord have higher levels of postpartum depressive symptoms than parents with low levels of perceived relationship discord.

Method.

One week after childbirth, 305 couples'' perceived level of relationship discord was measured using the Dyadic Consensus Subscale (DCS) of the Dyadic Adjustment Scale (DAS). At 3 months postpartum, the same couples answered the Edinburgh Postnatal Depression Scale (EPDS) questionnaire. The relations between perceived level of relationship discord and postpartum depressive symptoms were analysed using standard non-parametric statistical methods.

Results.

The mothers and fathers partly differed regarding which areas of their relationship they perceived that they disagreed with their partners about. Furthermore, 16.5% of the mothers and 8.7% of the fathers reported postpartum depressive symptoms, and there was a moderate level of correlation between the DCS and EPDS scores.

Conclusion.

These results may be useful for professionals in antenatal care and child health centres as well as for family caregivers who need to be aware that mothers and fathers may have different views on relationship discord and of the high level of depressive symptoms in recent parents. Further research is needed to examine perceived relationship discord and the development of depressive symptoms postpartum over a longer term.     

Effect of electro-acupuncture combined with psychological intervention on mental symptoms and P50 of auditory evoked potential in patients with internet addiction disorder

OBJECTIVE

To observe the therapeutic effects of electro-acupuncture (EA) combined with psychological intervention on the symptom of somzatization or obsession and mental symptom of depression or anxiety and P50 of Auditory Evoked Potential (AEP) on internet addiction disorder (IAD).

Mortality in epilepsy in the West of Ireland: a 10-year review

Background

Sudden and unexpected death is not an uncommon event in otherwise healthy epileptics.

Aims

To study the autopsied cases of sudden death in known epileptic patients in the West of Ireland.

Methods

A retrospective study was carried out which involved the review of 3,103 autopsy reports over a 10-year period in Galway University Hospital.

Results

Twenty-two cases were classified as sudden, unexpected death in epilepsy (SUDEP). Forty-five per cent had been found dead in bed. The mean age was 38 years and 68% were males. Of 16 cases with data about antiepileptic drug (AED) levels, 68% had absent or low levels at postmortem. Eighty-eight per cent of the cases had a past history of a generalised seizure. Pulmonary oedema was present in 86% of cases at postmortem.

Conclusions

Compliance with treatment and frequent nightly observations to those at high risk of sudden death may help to minimise its incidence. The patients and their families should be aware of this potential outcome.

     

Comprehensive Treatment with Chinese Medicine in Patients with Advanced Non-Small Cell Lung Cancer: A Multicenter, Prospective, Cohort Study

Objective: To determine whether additional Chinese medicine(CM) could prolong survival and improve the quality of life(QOL) in patients with advanced non-small cell lung cancer(NSCLC) compared with Western medicine(WM) alone. Methods: This was a multicenter, prospective cohort study. A total of 474 hospitalized patients with stage Ⅲ–Ⅳ NSCLC were recruited and divided into 2 groups. Patients in the WM group received radiotherapy, chemotherapy, and optimal supportive therapy according to the National Comprehensive Cancer Network(NCCN) guidelines. In the integrative medicine(IM) group, individualized CM(Chinese patent medicines and injections) and WM were administered. The primary end point was overall survival, and the secondary end points were time to disease progression, adverse events, and QOL. Follow-up clinical examinations and chest radiography were performed every 2 months. Results: The median survival was 16.60 months in the IM group and 13.13 months in the WM group(P0.01). The incidences of loss of appetite, nausea, and vomiting in the IM group were significantly lower than those in the WM group(P0.05). The QOL based on Functional Assessment of Cancer Therapy-Lung in the IM group was markedly higher than that in the WM group at the fourth course(P0.05). Conclusions: Additional CM may prolong survival and improve the QOL patients with NSCLC. The adverse effects of radio-and chemotherapy may be attenuated as CM is used in combination with conventional treatments.