《绵阳市社会心理服务工作管理办法》解读

2018年,国家卫生健康委员会等10部委联合发布《关于印发全国社会心理服务体系建设试点工作方案的通知》,四川省绵阳市被列为全国第一批试点地区。绵阳市人民政府依据《中华人民共和国精神卫生法》等相关法律法规和文件精神,结合前期调查研究和社会心理服务工作的试点实际,编制出台了《绵阳市社会心理服务工作管理办法》,并于2021年12月25日起施行。本文围绕社会心理服务的相关概念、办法总则、重点内容、保障措施等方面进行解读,以期为社会心理服务工作的规范、持续和有效开展提供参考。     

精神运动康复对住院青壮年精神分裂症患者康复的效果

背景 精神分裂症患者的康复主要依靠药物治疗,然而,单纯药物治疗对患者社会功能和生活质量的改善难以达到预期效果。近年来,非药物康复措施越来越多地应用于精神障碍的治疗中,但关于精神运动康复对住院青壮年精神分裂症患者康复效果影响的研究有限。目的 探讨精神运动康复对住院青壮年精神分裂症患者康复效果的影响,以期为住院青壮年精神分裂症患者的康复治疗提供参考。方法 选取2021年6月—2022年6月在芜湖市第四人民医院住院治疗的、符合《国际疾病分类（第10版）》（ICD-10）精神分裂症诊断标准的104例青壮年患者为研究对象,采用随机数字表法分为研究组和对照组各52例。研究组和对照组均接受利培酮（2~4 mg/d）治疗及常规护理,研究组此基础上接受为期12周、每周2~3次、每次45~55 min的精神运动康复,对照组在研究结束后接受相同干预。于干预前、干预第4、8、12周接受阳性和阴性症状量表（PANSS）、 住院精神病人社会功能评定量表（SSPI）和自知力与治疗态度问卷（ITAQ）评定。结果 PANSS阳性症状分量表评分、阴性症状分量表评分、一般精神病理分量表评分、总评分、SSPI评分以及ITAQ评分的时间效应均有统计学意义（F=33.989、204.245、82.817、279.596、26.144、7.463,P均<0.01）;PANSS阴性症状分量表评分、一般精神病理分量表评分、总评分和SSPI评分以及ITAQ评分的组间效应均有统计学意义（F=30.053、5.306、33.417、33.013、18.608,P<0.05或0.01）;PANSS阳性症状分量表评分、阴性症状分量表评分、一般精神病理分量表评分、总评分和SSPI评分的时间与组间交互效应均有统计学意义（F=3.472、9.798、3.843、14.390、20.661,P<0.05或0.01）。干预第12周,研究组PANSS总评分及各分量表评分均低于干预前,SSPI评分高于干预前,差异均有统计学意义（P均<0.01）,且研究组PANSS总评分及各分量表评分均低于对照组,SSPI评分高于对照组,差异均有统计学意义（P均<0.01）。结论 精神运动康复可能有助于改善住院青壮年精神分裂症患者的精神病性症状和社会功能,提高康复效果。     

How the war on drugs impacts social determinants of health beyond the criminal legal system

There is a growing recognition in the fields of public health and medicine that social determinants of health (SDOH) play a key role in driving health inequities and disparities among various groups, such that a focus upon individual-level medical interventions will have limited effects without the consideration of the macro-level factors that dictate how effectively individuals can manage their health. While the health impacts of mass incarceration have been explored, less attention has been paid to how the “war on drugs” in the United States exacerbates many of the factors that negatively impact health and wellbeing, disproportionately impacting low-income communities and people of colour who already experience structural challenges including discrimination, disinvestment, and racism. The U.S. war on drugs has subjected millions to criminalisation, incarceration, and lifelong criminal records, disrupting or altogether eliminating their access to adequate resources and supports to live healthy lives. This paper examines the ways that “drug war logic” has become embedded in key SDOH and systems, such as employment, education, housing, public benefits, family regulation (commonly referred to as the child welfare system), the drug treatment system, and the healthcare system. Rather than supporting the health and wellbeing of individuals, families, and communities, the U.S. drug war has exacerbated harm in these systems through practices such as drug testing, mandatory reporting, zero-tolerance policies, and coerced treatment. We argue that, because the drug war has become embedded in these systems, medical practitioners can play a significant role in promoting individual and community health by reducing the impact of criminalisation upon healthcare service provision and by becoming engaged in policy reform efforts.

KEY MESSAGES

• A drug war logic that prioritises and justifies drug prohibition, criminalisation, and punishment has fuelled the expansion of drug surveillance and control mechanisms in numerous facets of everyday life in the United States negatively impacting key social determinants of health, including housing, education, income, and employment.
• The U.S. drug war’s frontline enforcers are no longer police alone but now include physicians, nurses, teachers, neighbours, social workers, employers, landlords, and others.
• Physicians and healthcare providers can play a significant role in promoting individual and community health by reducing the impact of criminalisation upon healthcare service provision and engaging in policy reform.

     

从宏观结构及微观分布揭示医学学科发展战略情报

选择ESI免疫学高被引论文为数据源,对高频主题词与来源文献进行双聚类分析,绘制战略坐标图谱和社会网络图谱并将两者结果相互融合嵌入。社会网络分析嵌入战略坐标,从宏观结构和微观分布揭示全球免疫学领域热点结构与内部主题分布情况,为该领域发展方向提供参考。     

Chronic Δ9-Tetrahydrocannabinol in rats: Effect on social interactions,mouse killing,motor activity,consummatory behavior,and body temperature

Behavioral and physiologic effects of daily administration of ⁹-tetrahydrocannabinol (THC) were assessed over a 60-day period, investigating different dose levels (10, 20, 50 mg/kg), routes of administration (i.p., p.o.), drug vehicles [5%–18% propylene glycol(PG)/1% Tween 80-saline; sesame oil], and rat strains (Sprague-Dawley, Wistar, Long-Evans, Fischer). All THC-treated rats showed compulsive motor routines (i.e., forepaw treading, rhythmic jaw movements, prolonged head grooming, and biting of cage wires) after 3–4 weeks. Whether maintained on a restricted feeding regimen or not, three was no evidence for increased aggressive behavior between cagemates in any of the treatment groups. Mouse killing was induced in 70%–75% of all Sprague-Dawley (i.p., PG/Tween 80-saline vehicle) and Fischer rats (p.o., sesame oil vehicle), but not in the other THC-treated groups. Rearing activity was greatly decreased in all THC-treated groups throughout the treatment period. Food and water intake decreased by approximately 40% during the first 2–6 days of THC administration. Growth rate was reduced for the entire treatment period in THC-treated rats. THC decreased rectal temperature on the 1st day, and also on the 2nd day in Fischer rats receiving the drug in sesame oil, but not thereafter. This pattern of effects shows that tolerance develops rapidly to THC's effects on body temperature and consummatory behavior, but not to changes of certain motor activities.     

个性化的健康指导及技能训练对康复期精神分裂症患者的影响

目的 探讨健康指导及技能训练对康复期精神分裂症患者的影响.方法 对自愿入组的50例患者,每月进行1次健康指导及技能训练,共6次,每次1h.在入组时与入组6个月末分别采用生活质量综合评定问卷(GQOLI)、社会功能缺陷筛选量表(SDSS)及患者服药依从性调查表进行评价和比较.结果 患者入组6个月后生活质量综合评定显著高于入组时(P＜0.05),尤其在躯体功能和社会功能方面,改善更为明显(P＜0.01);SDSS 6个月后评分显著低于入组时(P＜0.05);患者的服药依从性入组后6个月明显优于入组时(P＜0.01).结论 健康指导及技能训练可提高康复期精神分裂症患者的生活质量,进一步改善患者的社会功能,对提高患者的服药依从性,促进患者早日回归社会具有重要作用.     

社会支持对精神分裂症患者生活质量和康复效果的影响

目的 探讨社会支持对精神分裂症患者生活质量和康复效果的影响.方法 选取华北理工大学附属开滦精神卫生中心于2014年2月-2015年8月收治的慢性精神分裂症278例,按照干预方法分成观察组和对照组,每组139例.对照组给予常规康复干预,观察组在对照组基础上实施社会支持模式干预.采用社会支持评定量表(SSRS)、精神分裂症患者生活质量量表(SQLS)评分和简明精神病评定量表(BPRS)评估干预后患者的生活质量和康复效果.结果 观察组干预后SSRS评分高于干预前和对照组,SQLS和BPRS评分均低于干预前和对照组(P＜0.05).观察组SQLS总均分与SSRS中主观支持、客观支持和总均分呈负相关,BPRS总均分与SSRS中客观支持、支持利用度和总均分呈负相关(P＜0.05).结论 社会支持能明显改善精神分裂症患者生活质量和康复水平,应重视社会支持对精神分裂症预后的影响.     

云南不明原因猝死病区人群社会支持状况与生命质量的关系

目的 探讨猝死病区人群社会支持与生命质量的关系,为制定提高和改善病区人群生命质量的措施提供科学依据.方法 采用横断面入户调查方式,利用社会支持评定量表对病区人群进行社会支持调查,利用世界卫生组织生命质量评定量表简表对病区人群进行生命质量调查.结果 云南猝死病区人群的社会支持总分及主观支持、客观支持维度得分[（40.85±8.34）分、（9.58±3.58）分、（23.86±4.87）分]均低于对照组相同维度得分[（41.82±7.12）分、（10.47±3.26）分、（24.51±4.68）分]（均P＜0.05）.病区人群社会支持利用度[（7.41±2.67）分]与对照人群社会支持利用度[（6.84±2.56）分]之间差异没有统计学意义（P＞0.05）.用多重线性回归控制家庭人均收入等混杂因素后,社会支持总分、主观支持、客观支持及支持利用度分别与生命质量总分及各维度得分均呈正相关关系（社会支持总分与生命质量各维度的相关系数分别为：0.30,0.11,0.29,0.28,0.36;客观支持得分与生命质量各维度的相关系数分别为：0.15,0.05,0.13,0.14,0.19;主观支持得分与生命质量及各维度的相关系数分别为：0.18,0.06,0.21,0.23;支持利用度与生命质量各维度的相关系数分别为：0.11,0.05,0.10,0.09,0.11）（均P＜0.05）.结论 云南猝死病区人群获得社会支持较少,且对社会支持的利用度低,使得病区人群生命质量较差,要改善这一状况,必须在提供更多社会支持的基础上,加强对社会支持的利用.     

炎症性肠病患者生存质量及其影响因素的调查

目的研究炎症性肠病（IBD）患者的生存质量（QOL）影响因素。方法应用中文IBgQ、SF-36、焦虑自评量表、抑郁自评量表、简易应对方式问卷、社会支持评定量表,对广州市4所医院的71例炎症性肠病患者的QOL进行横断面调查,通过相关分析和多元回归分析,筛选出影响IBD患者QOL的主要因素。结果IBD患者的生存质量得分明显下降,显著低于正常对照组的生存质量,P〈0．05。多元回归分析提示,对生存质量影响的因素为：抑郁、病情、焦虑、病期、年龄。结论IBD患者的生存质量水平较低,其中年轻（〈35岁）、病情重的IBD患者的生存质量较低;缓解期IBD患者主要在心理健康方面的QOL受到影响。焦虑、抑郁水平越高,患者的生存质量越低。