胚胎停育患者创伤后应激症状及相关因素分析

目的:了解胚胎停育患者的心理损伤情况和创伤后应激障碍(PTSD)症状阳性的相关因素。方法:对2012年10月~2013年10月就诊于宁夏医科大学总医院、银川市妇幼保健院的206对胚胎停育患者及配偶,应用创伤后应激障碍筛查量表平民版(PCL-C)对其反复创伤性体验症状、情感麻木与回避状及警觉性过强所致易激惹症状进行客观测量。结果:206名胚胎停育患者PCL-C量表分值为23.7±2.7分,PTSD筛查症状阳性率为13.6%(28/206)。多因素非条件logistic回归分析结果显示,配偶PTSD症状筛查阳性时,胚胎停育患者PTSD症状阳性率高(OR:2.9,95%CI:1.8~9.7),社会支持中从兄弟姐妹得到支持和照顾时,胚胎停育患者PTSD症状阳性率低(OR:0.5,95%CI:0.3~0.9)。结论:胚胎停育事件可能会引起孕妇产生创伤后应激障碍症状。配偶PTSD症状阳性会增加胚胎停育孕妇PTSD症状阳性率,而社会支持,尤其是从兄弟姐妹得到支持和照顾,有助于缓解胚胎停育孕妇PTSD症状。     

Prevalence and related factors of post-traumatic stress disorder among medical staff members exposed to H7N9 patients

ObjectiveThis study aimed to evaluate the prevalence and related factors of post-traumatic stress disorder (PTSD) symptoms among doctors and nurses who were exposed to H7N9 patients during the H7N9 influenza epidemic. To provide scientific basis for promoting the physical and psychological health of these staff members.MethodThe 102 medical staff workers who were exposed to H7N9 patients were recruited through convenient sampling between January 2015 and May 2016. We used a self-reported questionnaire, the PTSD Checklist-Civilian Version (PCL-C), to evaluate the PTSD symptoms among doctors and nurses from an intensive care unit (n = 61), a respiratory department (n = 20), and an emergency department (n = 21). We then analyzed the related factors.ResultsAround 20.59% of the tested doctors and nurses showed PTSD symptoms. The sample had a mean PCL-C score of 30.00 ± 9.95. The differences in the scores of doctors and nurses with different genders, ages, professional titles, contact frequencies, trainings, and experiences were statistically significant (P < 0.05, P < 0.01). Moreover, t-tests and one-way analysis of variance showed that nurses received higher scores than doctors, female participants received higher scores than male participants, and the participants with low professional title and high contact frequency, aged between 20 years and 30 years, with less than five years of work experience, having not received related training and with no related experience obtained higher PCL-C scores than the others (P < 0.05, P < 0.01).ConclusionThe PTSD level of doctors and nurses after their exposure to H7N9 patients was high, which warrant further research. Health and medical institutions should pay attention to the physical and psychological health of these staff members.     

Prevalence and correlates of psychiatric symptoms among first responders in a Southern State

First responders (FRs) respond to critical incidents as an expectation of their profession, and after years of service, exposure to trauma can accumulate and potentially lead to mental health problems, such as posttraumatic stress disorder (PTSD). A gap persists in the research regarding duty-related risk factors and prevalence of mental health problems among FRs. Guided by existing evidence and in partnerships with the state's FR community, this study assessed the mental health needs of FRs, risk factors that may contribute to these problems, and the associations therein. A convenience sample of firefighters and emergency medical technicians/paramedics (n?=?220) were recruited from across Arkansas to complete an online survey. This survey incorporated brief assessment tools to measure various mental health problems, and captured other data regarding possible risk factors. Results found that 14% reported moderate-severe and severe depressive symptoms, 28% reported moderate-severe and severe anxiety symptoms, 26% reported significant symptoms of PTSD, 31% reported harmful/hazardous alcohol use and dependence, 93% reported significant sleep disturbances, and 34% indicated high risk for suicide. Significant group differences were found across measures and gender (female), shift-structure (48?h or more), department setting (rural), relationship status (non-partnered), and having a medical history of hypertension. These findings pose significant implications for mental healthcare providers, as well as other healthcare providers and FR organizations. Findings will guide future research that will address the need for changes in decision-making, funding, and policy regarding FRs' MH and MH services available to them.     

创伤后应激检查量表平民版的效度、信度及影响因素的研究

目的 调查创伤后应激障碍检查量表平民版(PCL-C量表)在中国医学生中的信度、效度及其参考值范围,进一步研究心理、人格和应对方式等因素与PTSD的关系.方法 采用PTSD检查量表平民版(PCL-C)、特质应对方式问卷(TCSQ)、症状自评量表(SCL-90)、艾森克人格问卷(EPQ)及基本情况问卷.对某医科院校一年级的学生192人进行整体抽样调查.结果 ①PCL-C量表在中国医学院校学生中有良好的信度和效度.②学生PCL-C得分呈正偏态分布,男女无差异.参考值范围为38～47.③SCL-90中偏执、强迫、焦虑三因子得分高,PCL-C得分就高;EPQ中N分高,PCL-C得分高;积极应对得分高者,PCL-C得分低.④SCL-90总分与P分、消极应对、N分呈正相关,与积极应对呈负相关;家庭居住城市的学生SCL-90得分低于居住农村的学生.结论 PCL-C量表在中国医学院校学生中有良好的信度和效度,其内容和结构都比较合理.环境、人格等因素影响着人的心理,同时也影响着PTSD的发生.     

Validation of the electronic version of the BREAST-Q in the army of women study

Women undergoing surgery for primary breast cancer can choose between breast conserving therapy and mastectomy (with or without breast reconstruction). Patients often turn to outcomes data to help guide the decision-making process. The BREAST-Q is a validated breast surgery–specific patient-reported outcome measure that evaluates satisfaction, quality of life, and patient experience. It was originally developed for paper-and-pencil administration. However, the BREAST-Q has increasingly been administered electronically. Therefore, the aim of this study was to evaluate the psychometric properties of an electronic version of the BREAST-Q in a large online survey. Women with a history of breast cancer surgery recruited from the Love/AVON Army of Women program completed an electronic version of the BREAST-Q in addition to the Impact of Cancer Survey and PTSD Checklist. Traditional psychometric analyses were performed on the collected data. BREAST-Q data were collected from 6748 women (3497 Breast Conserving Therapy module, 1295 Mastectomy module, 1956 Breast Reconstruction module). Acceptability was supported by a high response rate (82%), low frequency of missing data (<5%), and maximum endorsement frequencies (<80%) in all but 17 items. Scale reliability was supported by high Cronbach's α coefficients (≥0.78) and item-total correlations (range of means, 0.65–0.91). Validity was supported by interscale correlations, convergent and divergent hypotheses as well as clinical hypotheses. The electronically administered BREAST-Q yields highly reliable, clinically meaningful data for use in clinical outcomes research. The BREAST-Q can be used in the clinical setting, whether administered electronically or using paper-and-pencil, at the choice of the patient and surgeon.     

Diffusion weighted imaging and neuropsychological correlates in adults with mild traumatic brain injury

Diffusion Tensor Imaging (DTI) is increasingly being used as a research tool in mild Traumatic Brain Injury (mTBI). This article reviews the concepts of diffusion tensor imaging, neuropsychological testing and results to date when applied to mTBI in adults. DTI is being used in conjunction with neuropsychological and electrophysiological measures to provide improved structural/functional correlations of mTBI. Future directions and applications of DTI in mTBI research are suggested.     

Validity of a single PTSD checklist item to screen for insomnia in survivors of critical illness

Background

There is no insomnia screening tool validated in intensive care unit (ICU) survivors.

“后疫情时期”武汉市某三甲医院护理人员创伤后应激障碍、职业倦怠与离职倾向分析

  目的  分析“后疫情时期”护理人员创伤后应激障碍、职业倦怠情况和离职倾向。
  方法  便利抽取武汉市某三甲医院护理人员299名,采用一般资料问卷、创伤后应激障碍量表平民版（PCL-C）、职业倦怠量表（MBI）、护士离职倾向量表（TIQ）调查护理人员的人口学特征及创伤后应激障碍、职业倦怠与离职意愿情况,采用多元线性回归分析护理人员离职倾向的影响因素。
  结果  护理人员创伤后应激障碍阳性症状检出率为39.1%。职业倦怠量表中,87.2%的护理人员存在不同程度的情感耗竭,82.6%的护理人员存在不同程度的去人格化,83.9%的护理人员存在不同程度的个人成就感低下。护士离职倾向量表得分显示,25.8%的护理人员离职倾向较低,60.2%的离职倾向较高,13.0%的离职倾向很高。多元线性回归结果显示:工作年限、用工类型、情感耗竭、去人格化能够解释护士离职倾向的27.9%,其中工作年限越长、合同制的护理人员有较低的离职倾向;情感耗竭与去人格化对离职倾向有正向影响（调整R2=0.279,F=29.891,P < 0.01）。
  结论  该三甲医院护理人员存在创伤后应激障碍和职业倦怠,且离职倾向较高;创伤后应激障碍与职业倦怠是离职倾向的影响因素。护理管理部门应该关注护士的身心健康,及时给予心理干预,注重人文关怀。