中国城乡空巢老人社会隔离状况及其影响因素分析

目的 分析我国城乡空巢老人社会隔离状况及其影响因素差异。方法 社会隔离可被分为主观社会隔离和客观社会隔离,基于2014年中国老年社会追踪调查（CLASS）数据,纳入4 705名空巢老人,运用二分类logistic回归模型分析城乡空巢老人社会隔离的影响因素差异。结果 本研究空巢老人社会隔离发生率为51.3%,主、客观社会隔离同时发生率为11.9%,且农村社会隔离发生率（57.3%）高于城镇（47.4%）（χ2 = 43.871,P＜0.001）。无配偶、自评健康较差（OR = 1.635,95%CI:1.322～2.022;OR = 1.410,95%CI:1.119～1.777）、患有慢性病、低个人年收入、与子女见面（OR = 2.322,95%CI:1.457～3.701;OR = 2.858,95%CI:1.648～4.955）和电话联系频率低是城乡空巢老人出现社会隔离的危险因素,且ADL受损也是城乡空巢老人同时出现主、客观社会隔离的危险因素;教育程度和个人年收入是城镇空巢老人社会隔离发生的特有因素。结论 我国空巢老人社会隔离存在城乡差异,农村空巢老人社会隔离发生率高于城镇,应对城乡空巢老人采取针对性的干预措施。     

中文版感知社会支持量表在老年癌症患者中的信效度分析

目的 检验中文版感知社会支持量表（the multidimensional scale of perceived social support, MSPSS）在老年癌症患者中应用的信效度。方法 采用整群抽样的方法,使用中文版感知社会支持量表对老年癌症患者进行调查,并对结果进行信效度检验。结果 共收到有效问卷520份,中文版感知社会支持量表的Cronbach α系数为0.877;探索性因子中共提取出公因子3个,累积方差贡献率为69.5%;通过验证性因子分析得出GFI、CFI、IFI指标范围在0.855～0.921之间。结论 中文版社会支持量表在老年癌症患者中应用具有良好的信效度,可用于评估该人群感知社会支持水平。     

社会支持对流动老人积极老化的影响:有调节的中介作用

目的 探讨社会支持对流动老人积极老化的影响及作用机制。方法 采用受访者驱动抽样的方式在抽取流动老人446名,用社会支持评定量表、积极老化测评问卷和老化态度问卷进行问卷调查,对数据进行了独立样本 t 检、相关分析、有调节的中介模型的检验。结果 ①在控制了年龄和性别后,社会支持不仅能够直接预测积极老化（直接效应占比22.45%）,还能通过自我老化态度的中介作用间接预测积极老化（中介效应占比77.55%）;②流动原因在自我老化态度和积极老化之间起调节作用（ β =0.20, t =6.80, P ＜0.01）,自我老化态度对随迁老人的积极老化水平的正向预测作用更加显著（ β =0.95, t =20.39, P ＜0.01）。结论 社会支持通过自我老化态度影响流动老人的积极老化水平,流动原因调节了自我老化态度对积极老化的影响。     

妊娠期糖尿病孕妇和糖耐量正常孕妇妊娠压力与社会支持的相关性研究

目的 分析妊娠期糖尿病（GDM）孕妇和糖耐量正常孕妇妊娠压力与社会支持的相关性,对比该相关性在两组间是否存在差异。方法 选取495名GDM孕妇和352名糖耐量正常孕妇,采用一般情况调查表、妊娠压力量表（PPS）和社会支持评定量表（SSRS）进行问卷调查,并运用典型相关分析来研究妊娠压力和社会支持的相关性。结果 GDM组与正常组孕妇都处于轻度压力状态（0.38±0.32分vs.0.38±0.31分, t =0.061, P> 0.05）,且社会支持度均相对较高（40.68±6.88分vs.40.66±6.71分, t=0.042 , P> 0.05）,组间比较显示差异无统计学意义。GDM组和正常组孕妇妊娠压力与社会支持均存在典型相关关系（ λGDM =0.291, F=4.282 ,P<0.01; λ正常 =0.271, F=2.900 ,P<0.01）。GDM组孕妇妊娠压力主要由“确保母子健康和安全”引起,且主观支持的影响较大;而正常组孕妇妊娠压力主要来自于“认同父母角色”,且客观支持的影响较大。结论 应重视孕妇的妊娠压力状态,根据妊娠压力来源的不同可提供有针对性的社会支持,减缓孕期压力,促进母婴健康。     

Loneliness,social support,social isolation and wellbeing among working age adults with and without disability: Cross-sectional study

BackgroundLoneliness is significantly related to health and wellbeing. However, there is little information on the prevalence of loneliness among people with disability or the association between disability, loneliness and wellbeing.Objective/hypothesisFor a nationally representative sample of adults (age 16–64) with/without disability, to examine exposure to three indicators of low social connectedness (loneliness, low perceived social support, social isolation), and to evaluate the association between low social connectedness and wellbeing. To test whether disability status moderated the relationship between low social connectedness and wellbeing.MethodsSecondary analysis of data from three annual rounds of the cross-sectional English Community Life Survey (CLS) 2016–19.ResultsPeople with disability experienced loneliness, low perceived social support and social isolation at significantly higher rates than people without disability. Effect sizes were significantly greater for loneliness. Disability was associated with lower wellbeing. With one exception, low social connectedness was associated with lower wellbeing. Again, effect sizes were significantly greater for loneliness. The prevalence of loneliness was highest among adults with disability who were younger, economically inactive, living in rented or other accommodation, living alone and with low levels of access to environmental assets. There was no evidence that disability status moderated the association between exposure to low social connectedness and low wellbeing.ConclusionsLoneliness was a particularly significant driver of poor wellbeing among people with disability. The relative independence between different indicators of social connectedness suggests that interventions to reduce loneliness will need to do more than simply increase rates of social contact or social support.     

Musculoskeletal injury survivors’ resiliency: A systematic review

BackgroundMusculoskeletal traumas are on the rise in the United States; however, limited studies are available to help trauma providers assess and treat concerns beyond the physical impact. Little is understood about the psychological, social, and spiritual factors that protect patients from adverse effects after a physical trauma or their experiences with each factor afterward.ObjectiveThis systematic review was conducted to investigate and review advancements in research related to risk and resiliency factors experienced by survivors of traumatic musculoskeletal injuries. The use of biopsychosocial-spiritual (BPS–S) framework and resiliency theory guided the analysis.MethodsResearchers reviewed 1003 articles, but only seven met the search criteria. Due to the complexity and uniqueness of traumatic brain injuries, studies on that target population were excluded.ResultsOf the seven articles reviewed, three identified psychological protective factors that protect against negative health outcomes; three identified negative psychological, social, or spiritual outcomes; and none investigated social or spiritual health.ConclusionsThere are significant gaps in the literature surrounding risk and resiliency factors related to the BPS-S health of musculoskeletal injury survivors.     

Improving health care for disabled people in COVID-19 and beyond: Lessons from Australia and England

COVID-19 has exacerbated pre-existing difficulties children and adults with disability face accessing quality health care. Some people with disability are at greater risk of contracting COVID-19 because they require support for personal care and are unable to physically distance, e.g. those living in congregate settings. Additionally, some people with disability have health conditions that put them at higher risk of poor outcomes if they become infected. Despite this, governments have been slow to recognise, and respond to, the unique and diverse health care needs of people with disability during COVID-19. While some countries, including Australia, have improved access to high-quality health care for people with disability others, like England, have failed to support their citizens with disability. In this Commentary we describe the health care responses of England and Australia and make recommendations for rapidly improving health care for people with disability in the pandemic and beyond.     

Associations of social capital with binge drinking in a national sample of adults: The importance of neighborhoods and networks

BackgroundWhile considerable research on adult binge drinking has focused on social influences, the potential role of social capital has been largely overlooked. This study examines the role of social capital, assessed in terms of both neighborhood and social network characteristics, in understanding adult binge drinking.MethodsAdults ages 30–80 were randomly drawn from the RAND American Life Panel and completed an online survey (analytic sample n = 1383). The main predictor variables were neighborhood cohesion, neighborhood order, and social network density. Associations of social capital with past month binge drinking (any, number of days) were examined, controlling for demographic characteristics.ResultsZero-inflated negative binominal regression analysis indicated that any binge drinking was more likely among adults who lived in highly ordered neighborhoods and who had denser social networks but was negatively associated with neighborhood cohesion. However, binge drinking was more frequent among those who lived in neighborhoods lacking order and who had sparser social networks, but had no association with neighborhood cohesion. Age was not found to moderate associations of social capital with binge drinking.ConclusionsGiven that the associations of social capital with adult binge drinking behavior appear to differ by level of influence and type of drinking behavior, there is a need to gain a more nuanced understanding of these complex associations, including the mechanisms through which they operate.     

Association of Social Behaviors With Community Discharge in Patients with Total Hip and Knee Replacement

ObjectivesUnderstand the association between social determinants of health and community discharge after elective total joint arthroplasty.DesignRetrospective cohort design using Optum de-identified electronic health record dataset.Setting and ParticipantsA total of 38 hospital networks and 18 non-network hospitals in the United States; 79,725 patients with total hip arthroplasty and 136,070 patients with total knee arthroplasty between 2011 and 2018.MethodsLogistic regression models were used to examine the association among pain, weight status, smoking status, alcohol use, substance disorder, and postsurgical community discharge, adjusted for patient demographics.ResultsMean ages for patients with hip and knee arthroplasty were 64.5 (SD 11.3) and 65.9 (SD 9.6) years; most patients were women (53.6%, 60.2%), respectively. The unadjusted community discharge rate was 82.8% after hip and 81.1% after knee arthroplasty. After adjusting for demographics, clinical factors, and behavioral factors, we found obesity [hip: odds ratio (OR) 0.81, 95% confidence interval (CI) 0.76–0.85; knee: OR 0.73, 95% CI 0.69–0.77], current smoking (hip: OR 0.82, 95% CI 0.77–0.88; knee: OR 0.90, 95% CI 0.85–0.95), and history of substance use disorder (hip: OR 0.55, 95% CI 0.50–0.60; knee: OR 0.57, 95% CI 0.53–0.62) were associated with lower odds of community discharge after hip and knee arthroplasty, respectively.Conclusions and ImplicationsSocial determinants of health are associated with odds of community discharge after total hip and knee joint arthroplasty. Our findings demonstrate the value of using electronic health record data to analyze more granular patient factors associated with patient discharge location after total joint arthroplasty. Although bundled payment is increasing community discharge rates, post-acute care facilities must be prepared to manage more complex patients because odds of community discharge are diminished in those who are obese, smoking, or have a history of substance use disorder.     

健康管理背景下慢性病社会问题

我国社会进程的急速变迁使得居民的疾病模式以及健康行为均发生了较大的转变,各种疾病的危险因素不断增加导致慢性病发病率不断上升,同时也使得慢性病危险度有所增加,目前我国慢性病发病出现了逐渐年轻化趋势,疾病对患者的危害也在不断加剧,不仅影响患者的生理、心理健康,还会导致其生活质量下降,同时还可能加重患者的家庭负担和社会负担,因此开展慢性病相关研究具有十分重要的现实意义和理论意义。该文以健康管理为背景,对慢性病健康管理构建中的社会问题和文化意义进行了梳理,以明确健康管理在社会经济发展以及人生进程中的作用和意义,以加强民众对慢性病防治的了解,提升慢性病管理质量,改善慢性病患者的病情和生活质量,同时也为慢性病防治提供新种学术依据。