Relative contributions of spousal support and illness appraisals to depressed mood in arthritis patients

Objective. To examine the ability of cognitive appraisals of illness and spousal support to modify depressed mood in arthritis patients. Methods. Psychosocial data were collected from 64 married patients with rheumatoid arthritis (RA) within 2 years of diagnosis and at an 18–month fol-lowup. Results. The interaction of challenge appraisals with positive support received from the spouse was related to changes in depression over time. There was an increase in depression as challenge appraisals increased when accompanied by greater receipt of positive support, whereas individuals who did not experience a sense of challenge in response to the diagnosis of RA had the lowest levels of residualized depression when they also received higher positive support from their spouses at the beginning of the study. Conclusion. The results are considered in terms of the cognitive-behavioral mediation model suggested by Kerns and associates concerning the relationship of chronic pain to depression and have implications for interventions aimed at arthritis patients and their spouses.     

Clinical Characteristics of Atopic Dermatitis in Korean School-Aged Children and Adolescents According to Onset Age and Severity

BackgroundAtopic dermatitis (AD) is a heterogeneous disease with different age of onset, disease course, clinical symptoms, severity, and risk of comorbidity. The characteristics of children with AD also vary by age or country. However, little is known about the clinical characteristics of AD in Korean school-aged children and adolescents. Furthermore, there are few studies on phenotypic differences according to onset age. This study aimed to explore the clinical characteristics and phenotypes according to onset age and severity of AD in children and adolescents in Korea.MethodsAD patients aged 6–18 years who presented to 18 hospitals nationwide were surveyed. The patients were examined for disease severity by pediatric allergy specialists, and data on history of other allergic diseases, familial allergy history, onset age, trigger factors, lesion sites, treatment history and quality of life were collected. The results of the patient’s allergy test were also analyzed. The patients were classified into infancy-onset (< 2 years of age), preschool-onset (2–5 years of age), and childhood-onset (≥ 6 years of age) groups. Study population was analyzed for clinical features according to onset-age groups and severity groups.ResultsA total of 258 patients with a mean age of 10.62 ± 3.18 years were included in the study. Infancy-onset group accounted for about 60% of all patients and presented significantly more other allergic diseases, such as allergic rhinitis and asthma (P = 0.002 and P = 0.001, respectively). Food allergy symptoms and diagnoses were highly relevant to both earlier onset and more severe group. Inhalant allergen sensitization was significantly associated with both infancy-onset group and severe group (P = 0.012 and P = 0.024, respectively). A family history of food allergies was significantly associated with infancy-onset group (P = 0.036). Severe group was significantly associated with a family history of AD, especially a paternal history of AD (P = 0.048 and P = 0.004, respectively). Facial (periorbital, ear, and cheek) lesions, periauricular fissures, hand/foot eczema, and xerosis were associated with infancy-onset group. The earlier the onset of AD, the poorer the quality of life (P = 0.038). Systemic immunosuppressants were used in only 9.6% of the patients in the severe group.ConclusionThis study analyzed the clinical features of AD in Korean children and adolescents through a multicenter nationwide study and demonstrated the phenotypic differences according to onset age and severity. Considering the findings that the early-onset group is more severe and accompanied by more systemic allergic diseases, early management should be emphasized in young children and infants.     

女性系统性红斑狼疮患者患病体验的Meta整合

目的:分析与整合女性系统性红斑狼疮（SLE）患者的患病体验。方法:计算机检索PubMed、Web of Science、CINAHL、the Cochrane Library、PsycINFO、中国生物医学文献数据库、万方数据库、维普网、中国知网等中英文数据库中关于女性SLE患者患病体验的质性研究,检索时限为建库至20...     

新生儿安宁疗护服务体系的构建

目的 构建新生儿安宁疗护服务体系,以指导临床实践。方法 以人性化护理理论、舒适护理理论为基础,在文献回顾、质性研究的基础上拟订新生儿安宁疗护服务体系。2020年9月—11月,对来自7个省（市）的25名专家进行2轮专家函询,确定具体内容。结果2轮函询的有效问卷回收率均为100%,专家的权威系数为0.852,肯德尔和谐系数分别为0.124～0.212、0.111～0.204（均P<0.001）,条目重要性评分的变异系数分别为0～0.34、0.07～0.24,可行性评分的变异系数分别为0～0.39、0.08～0.24。形成的新生儿安宁疗护服务体系包括组建安宁疗护团队以及安宁疗护的介入时机、服务对象、服务内容4个一级条目,12个二级条目,38个三级条目。结论 新生儿安宁疗护服务体系具有较好的科学性、可行性,可为临床护理实践提供参考。     

脑出血临床分级量表

自发性脑出血(intracerebral hemorrhage,ICH)是指原发性非外伤性脑实质内出血,病死率和致残率极高.简单易行的脑出血临床分级量表不仅能评估患者的转归,而且对临床治疗和临床研究具有重要的指导意义.文章将对主要的脑出血量表的内容、外部验证、优势和不足等方面进行综述,并说明其适用范围和临床应用.     

What to listen for in the consultation. Breast cancer patients’ own focus on talking about acceptance-based psychological coping predicts decreased psychological distress and depression

Objective

To analyze whether qualitative themes in breast cancer patients’ self-presentations predicted symptoms of psychological distress and depression in order to improve the consultation process.

Methods

Ninety-seven breast cancer patients gave unstructured, 10-min self-presentations at their first consultation in a clinical registered trial (CRT identifier: NCT00990977). Self-presentations were categorized thematically and the most prevalent themes investigated as predictors for scores on the symptom check-list 90-revised (SCL-90-R) and the center for epidemiological studies depression scale (CES-D).

Results

Among the qualitative themes, only the percentage of words spent on talking about ‘Acceptance-based psychological coping’ was related to symptoms. In regression models controlling for age, education and time since diagnosis, a stronger focus on acceptance-based coping predicted less psychological distress and depression, respectively. A cross-validation including only the first few minutes of speech per patient confirmed these results and supported their practical utility in health consultations.

Conclusion

Patients’ focus on acceptance-based coping significantly predicted decreased psychological distress and depression, respectively. No other qualitative themes predicted symptoms. Doctor–patient studies may benefit from combined qualitative–quantitative methods.

Practice implications

While quantitative symptom assessment is important for a consultation, health care providers may improve their understanding of patients by attending to patients’ presentations of acceptance-based psychological coping.     

疾病严重程度评价量表的建立与应用研究

目的 探讨护理分级中疾病严重程度的量化评估方法.方法 在李玉乐等研究的分级护理标准要素指标的基础上,参考国外危重疾病严重程度评分工具,采用专家小组讨论法,形成了疾病严重程度评价量表初表;首先对200例住院患者进行测试,调整各项指标赋予的分值及护理级别确定范围,形成最终的量表;用量表对我院2095例住院患者进行评定,将评分结果与医嘱的护理级别、标准的护理级别进行对比分析,以验证量表的可靠性.结果 医嘱组、评分组均与标准组呈正相关,但评分组与标准组相关性较高.3种方法划分的护理级别比较,医嘱组与标准组比较,差异有统计学意义(P＜0.05);评分组与标准组比较,差异无统计学意义(P＞0.05).4个护理级别中,特级护理在3组中差异无统计学意义(P＞0.05);一级、二级、三级护理在3组中,医嘱组与标准组比较,差异有统计学意义(P＜0.05),评分组与标准组比较,差异无统计学意义(P＞0.05).结论 疾病严重程度评价量表可作为划分护理级别的客观依据,具有一定的临床意义.     

精神疾病病耻感研究进展

本文对近年来国内学者对精神疾病病耻感的研究涉及不同人群、测评工具、公众态度、病耻感现状分析、相关影响因素及干预措施等研究现状进行了总结,旨在为深入研究精神疾病患者病耻感的影响因素及干预方法等提供依据。     

Illness experience,depression, and anxiety in chronic fatigue syndrome

Objective: Given the high rate of psychiatric comorbidity with chronic fatigue syndrome (CFS), we considered two possible correlates of anxiety and depression: lack of illness legitimization and beliefs about limiting physical activity. Method: A total of 105 people diagnosed with CFS reported on their experiences with medical professionals and their beliefs about recovery and completed the depression and anxiety subscales of the Brief Symptom Inventory. Results: Those who said that their physician did not legitimize their illness (36%) had higher depression and anxiety scores (P's<.05) than their counterparts. Those who believed that limiting their physical exertion was the path to recovery (55%) had lower depression and anxiety scores (P's<.01) than their counterparts. Conclusion: Lack of illness legitimization ranked high as a source of dissatisfaction for CFS patients, and it may aggravate psychiatric morbidity. Many CFS patients believed that staying within what they felt to be their physical limits would improve their condition. This belief, and possibly an accompanying sense of control over their symptoms, may alleviate psychiatric morbidity.