精神分裂症恢复期患者及家属家庭干预的对照研究

目的：以康复期出院精神分裂症患者和家属为对象，定期复诊进行家庭干预并对照研究。方法：干预组68例，对照组52例，采用BPRS评定；干预组家属74人，对照组家属65人，采用SCL－90评定。结果：6个月后干预组患者BPRS和入组时对照比较均有显著性差异（P＜0．01），说明干预组患者的精神症状，不良情绪及社会功能明显好转，入组时两组家属SCL－90评定与常模对照比较，均有明显差异（P＜0．05或0．01），经干预后干预组与全国常规比较无显著性差异（P＞0．05），说明患者家属普遍存在心理障碍，经干预后家属心理状况明显改善。结论：对康复期病人及家属进行门诊家庭干预，是有效的康复方法，值得推广应用。     

Cluster-Randomized Controlled Trial of An Athletic Trainer-Directed Spit (Smokeless) Tobacco Intervention for Collegiate Baseball Athletes: Results After 1 Year

Context: Athletes in the United States are at high risk for using spit (smokeless) tobacco (ST) and incurring its associated adverse health effects.Objective: To examine whether an athletic trainer-directed ST intervention could decrease initiation and promote cessation of ST use among male collegiate baseball athletes.Design: Stratified, cluster-randomized controlled trial.Setting: Fifty-two California colleges.Patients or Other Participant(s): A total of 883 subjects in 27 intervention colleges and 702 subjects in 25 control colleges participated, as did 48 certified athletic trainers.Intervention(s): For college athletic trainers and associated dental professionals, a 3-hour video conference, and for collegiate athletes, an oral cancer screening with feedback and brief counseling during the preseason health screenings, athletic trainer support for cessation, and a peer-led educational baseball team meeting.Main Outcome Measure(s): The subjects' ST use over 1 year was assessed by self-report. At the end of the study, the certified athletic trainers were mailed a survey assessing their tobacco use and perceptions and behavior related to tobacco control in the athletic environment. We used multivariable logistic regression models for clustered responses (generalized estimating equations) to test the difference between groups in ST-use initiation and cessation and to identify significant overall predictors of noninitiation and cessation of ST use.Results: Of the 1585 athletes recruited, 1248 (78.7%) were followed up at 12 months. In addition, 48 of the 52 athletic trainers (92%) responded to the 1-year follow-up survey. The ST-use initiation (incidence) was 5.1% in intervention colleges and 8.4% in control colleges (generalized estimating equation odds ratio = 0.58, 95% confidence interval = 0.35-0.99). Predictors of ST noninitiation were low lifetime tobacco and monthly alcohol use (odds ratio = 1.98, 95% confidence interval = 1.40- 2.82) and athletic trainers' report that the baseball coach supported ST-use prevention activities (odds ratio = 1.43, 95% confidence interval = 1.11-1.83). Although at 1 year, cessation of ST use was relatively high in both groups (36%), we noted no significant difference between the groups (odd ratio = 0.94, 95% confidence interval = 0.70-1.27).Conclusions: The intervention was significantly effective in preventing incident ST use but did not significantly increase cessation beyond that seen in the control group. The latter finding is inconsistent with previous studies and may be explained by spillover of the intervention to control colleges, other anti-tobacco activity in control colleges, and/or the small sample of dependent ST users enrolled in the study.     

健康教育与心理社会干预对2型糖尿病合并抑郁的影响

目的 :调查 2型糖尿病患者抑郁症状发生率并探讨健康教育及心理社会干预对抑郁症状及糖脂代谢的影响。方法 :采用Zung抑郁自评量表 (SDS)对 10 0例 2型糖尿病患者及 10 0例正常人群进行测评。将抑郁指数≥ 0 5的 5 9例患者随机分为研究组 30例 ,对照组 2 9例。研究组药物治疗的同时合并为期 3个月健康教育加心理社会支持治疗 ,分别于治疗前、治疗后进行抑郁自评量表及代谢控制水平评估。结果 :2型糖尿病并抑郁情绪检出率为 5 9% ,显著高于正常组 (P <0 0 1)。经健康教育加心理社会支持治疗 3个月后 ,观察组抑郁指数显著降低 (P <0 0 5 ) ,糖脂代谢显著改善 (P <0 0 5 )。抑郁转归发生率高 ,与对照组比较有极显著差异 (P <0 0 1)。结论 :2型糖尿病患者常合并忧郁症状 ,健康教育加心理社会支持治疗可改善抑郁症状及糖脂代谢     

Accessibility, clinical effectiveness, and practice costs of providing a telephone option for routine asthma reviews: phase IV controlled implementation study.

BACKGROUND: Attendance for routine asthma reviews is poor. A recent randomised controlled trial found that telephone consultations can cost-effectively and safely enhance asthma review rates; however, concerns have been expressed about the generalisability and implementation of the trial's findings. AIM: To evaluate the effectiveness of a telephone option as part of a routine structured asthma review service. DESIGN OF STUDY: Phase IV controlled before-and-after implementation study. SETTING: A large UK general practice. METHOD: Using existing administrative groups, all patients with active asthma (n = 1809) received one of three asthma review services: structured recall with a telephone-option for reviews versus structured recall with face-to-face-only reviews, or usual-care (to assess secular trends). Main outcome measures were: proportion of patients with active asthma reviewed within the previous 15 months (Quality and Outcomes Framework target), mode of review, enablement, morbidity, and costs to the practice. RESULTS: A routine asthma review was provided for 397/598 (66.4%) patients in the telephone-option group compared with 352/654 (53.8%) in the face-to-face-only review group: risk difference 12.6% (95% confidence interval [CI] = 7.2 to 17.9, P<0.001). The usual-care group achieved a review rate of 282/557 (50.6%). Morbidity was equivalent in the three groups; however, enablement (P = 0.03) and confidence (P = 0.007) in asthma management were greater in the telephone-option versus face-to-face-only group. The cost per review achieved by providing the telephone-option service was lower than the face-to-face-only service (10.03 pounds versus 12.74 pounds, mean difference 2.71 pounds; 95% CI = 1.92 to 3.50, P<0.001); usual-care costs were 11.85 pounds per review achieved. CONCLUSION: Routinely offering telephone reviews cost-effectively increased asthma review rates, enhancing patient enablement and confidence with management, with no detriment to asthma morbidity. Practices should consider a telephone option for their asthma review service.     

老年抑郁障碍患者的心理干预对比分析

目的 :探讨老年抑郁障碍心理干预的效果。方法 :采用对比研究的方法 ,在流行病学调查的基础上选择符合CCMD -Ⅱ -R诊断标准的 72例抑郁性神经症和 10例抑郁症患者 ,按性别、年龄、文化等基本相同 ,分成对照和实验组各一半 ,实验组给以 6周的心理干预 ,两组均不用药物治疗 ,分别于治疗前及三个月后 ,测评老年抑郁量表、生活满意度指数及社会支持评定量表 ,并进行对比分析。结果 :心理干预前两组老年抑郁量表 (SDS)得分分别为 17 41± 3 19、 17 5 1± 2 44,三个月后对照组下降不显著 ,而实验组明显下降 ( 17 5 1± 2 44/ 8 93± 5 5 2 ,t=10 89,P <0 0 0 1) ;生活满意度 (t=4 33,P <0 0 0 1)实验组显著提高 ;对照组无明显变化 ,社会支持评定实验组 ( 31 15± 6 37/ 36 32± 6 86 ,t =4 93,P <0 0 0 1)也显著提高 ,而对照组则不明显。结论 :社区综合性心理干预可改变抑郁性神经症患者的抑郁情绪 ,改善认知水平 ,从而提高生活满意度。     

Psychological and social effects of orthodontic treatment

Adolescents with commonly occurring forms of malocclusion often are presumed to be at risk for negative self-esteem and social maladjustment. A randomized control group design was used to assess the psychosocial effects of orthodontic treatment for esthetic impairment. Ninety-three participants, 11 to 14 years old, with mild to moderate malocclusions, were randomly assigned to receive orthodontic treatment immediately or after serving as delayed controls. A battery of psychological and social measures was administered before treatment, during treatment, and three times after completion of treatment, the last occurring one year after termination. Repeated measures analyses of variance assessed group differences at the five time points. Parent-, peer-, and self-evaluations of dental-facial attractiveness significantly improved after treatment, but treatment did not affect parent- and self-reported social competency or social goals, nor subjects' self-esteem. In summary, dental-specific evaluations appear to be influenced by treatment, while more general psychosocial responses are not.This research was supported by Grant NIH-NIDR-R01-DE06154 from the National Institute of Dental Research.     

音乐治疗对眼底手术病人焦虑的影响

目的：在于观察经听觉通道输入音乐对眼底手术病人焦虑状态的影响。方法：实验对象为39名择期进行眼底手术的男性病人，他们被随机地分为实验和对照两组，其中实验组19人，对照组20人，在手术过程中通过耳机给患者输入他们自己选定的音乐、观察焦虑（STAI），抑郁（SDS），视觉模拟焦虑（VAS）和脑电（BI）的变化。结果：实验组STAI，SDS，VAS值与对照组比明显降低，病人的焦虑、抑郁情绪有了明显改善，而脑电的变化没有显著性的差异。结论：音乐治疗可降低择期眼底手术男性病人的焦虑、抑郁与视觉模拟焦虑水平。     

HIV/AIDS人员心理卫生状况与心理社会影响因素

目的 :研究HIV/AIDS (艾滋病毒感染者 /艾滋病患者 )人群的心理卫生状态与心理社会因素的影响。方法 :采用病例对照研究方法。病例组与对照组两组对象均接受一般情况问卷、症状自评量表(Symptomchecklist 90 ,SCL -90 )、生活事件量表 (LifeEventScale ,LES)、生活质量综合评定问卷 (GenericQualityofLifeInventory -74,GQOLI -74)、自我接纳问卷 (Self -AcceptanceQuestionnaire ,SAQ )五个量表的测查。结果 :(1)病例组的SCL -90各个因子分高于对照组 (P <0 0 0 1) ;(2 )病例组总生活事件和负性生活事件得分高于对照组 (P =0 0 0 1) ;(3 )病例组自我接纳得分低于对照组 (P =0 0 0 1) ;(4 )病例组生活质量综合评定得分低于对照组 (P <0 0 0 1) ;(5 )多因素逐步回归分析 ,SCL -90总因子分相关因素主要为躯体症状严重程度 (负向评分 )、负性生活事件和自我接纳因子 ,躯体症状严重程度与SCL -90总因子分呈负相关 ,负性生活事件得分与SCL -90总因子分呈正相关 ,自我接纳得分与SCL -90总因子分呈负相关。结论 :HIV/AIDS组较对照组心理健康状态有明显差异 ,有较多的负性生活事件 ;自我接纳得分低于对照组 ;生活质量低于对照组。     

Behavior of 3-year-old children in a prospective randomized trial of reduced saturated fat and cholesterol diet since infancy: The strip baby project

Interventions aimed at decreased exposure of children to known atherosclerosis risk factors may have untoward behavioral side effects. We examined how children’s behavior or parent’s perception of the behavior of the children at 3 years of age was influenced by the intervention in a prospective randomized trial that began in infancy and effectively decreased scrum cholesterol concentration. This Special Turku coronary Risk factor Intervention Project for babies (STRIP) began when the infant was 7 months old. Half of 1.062 children received individualized dietary counseling at 1-to 3-month intervals during the first 2 years of age and then half-yearly; the other half had an unrestricted diet. At 3 years of age a standardized questionnaire of the child’s behavior was sent to 791 families (76% returned the questionnaire). At the onset of the trial the sociodemographic data of the families and scrum lipid values of the intervention and control children were similar. Later, mean serum cholesterol values of the intervention children remained constantly at a level 6% to 10% below the values of the control children. At 3 years of age the parental perceptions of the child’s behavior suggested minimal differences between the intervention and control children. The intervention children were slightly less jealous and more active and creative, but showed slightly more negative signs of behavior (bed-wetting, problems in falling asleep, fears) than the controls. We conclude that long-term, individualized dietary and lifestyle intervention that begins in infancy slightly influences children’s behavior or parent’s recognition of the behavior of the children at the age of 3 years. This work was supported in part by grants from the Varsinais-Suomi Regional Fund of the Finnish Cultural Foundation, the Mannerheim League for Child Welfare, the Academy of Finland, and the Alli Paasikivi Foundation.     

Working despite pain: Factors associated with work attendance versus dysfunction

A cross-sectional investigation of psychosocial variables in 63 female employees matched for experienced pain was conducted to study the difference between back pain sufferers who were working (Copers) and those who were off work (Dysfunctional). The subjects reported moderate to severe pain often or always during the past year and were employed at the same hospital. Thirty-seven women who had not been off work for pain made up the Copers group, whereas 26 women who had been off work for their pain made up the Dysfunctional group. Subjects were interviewed and completed a battery of questionnaires designed to penetrate level of dysfunction, perceived health, work and social satisfaction, perceived workload, coping strategies, and pain beliefs. Multiple covariate analyses that controlled for perceived workload, smoking, low-back mobility, and obesity revealed significant differences between the groups on levels of functioning, pain beliefs, and coping strategies used. Dysfunctional subjects had stronger beliefs that pain was directly related to activities that they had little control over their pain, that their health was poor, and that they tended to focus more on their pain. A discriminant analysis correctly classified 83% of the subjects as to work status based on six psychosocial variables. These results not only demonstrate the importance of psychosocial factors in back pain, but underscore the fact that work absence for back pain may he controlled by psychological factors related to beliefs and coping strategies. Future research may attempt to use these factors in the screening of patients.