• 【重点关注那些需要帮助的人:基于症状的结果调查表,用于在初级保健哮喘诊所中进行邮政邀请和审核。】 复制标题 收藏 收藏
    DOI:10.1038/pcrj.2002.14 复制DOI
    作者列表:Paterson C,Paisley A
    BACKGROUND & AIMS: Aims:To focus asthma care on those patients most in need whilst providing annual audit data. Methods:An observational questionnaire study. Patients on the asthma register received a postal invitation to the asthma clinic plus a questionnaire which enquired about both symptoms and the process of care. Medical records were searched for data on non-responders. Results:Of the 1241 people sent the invitation and questionnaire 682 (57%) returned it and 99 attended the clinic. Follow-up of responders with high morbidity resulted in a further 32 people attending. The 99 attenders had a higher morbidity than non-attenders on the criteria of a course of oral steroids in the last six months(15% v 29%)and a mean symptom score of 3 or more ( 12% v 31%). Conclusions:Whilst the process did focus care on those in need, and resulted in a manageable number of people attending the asthma clinic, many individuals with high morbidity or risk factors did not attend.
    背景与目标: 目的:在提供年度审核数据的同时,将哮喘护理重点放在最需要的患者身上。
    方法:一项观察性问卷调查研究。哮喘登记册上的患者收到了哮喘诊所的邮寄邀请,以及一份询问症状和护理过程的问卷。在病历中搜索无应答者的数据。
    结果:在1241人中发送了邀请,调查表682张(57%)返回了邀请,其中99人参加了诊所。对高发病率应答者的随访导致另外32人参加。根据最近六个月的口服类固醇疗程(99%对29%)和平均症状评分3分或更高(12%对31%),这99名参加者的发病率高于非参加者。
    结论:尽管该过程确实将治疗重点放在了有需要的人群上,并导致哮喘病门诊人数可控,但许多发病率高或有危险因素的人却没有参加。
  • 【Shona症状问卷:在哈拉雷(Harare)开发一种本地化的常见精神障碍测量方法。】 复制标题 收藏 收藏
    DOI:10.1111/j.1600-0447.1997.tb10134.x 复制DOI
    作者列表:Patel V,Simunyu E,Gwanzura F,Lewis G,Mann A
    BACKGROUND & AIMS: The objective of this study was to develop an indigenous measure of common mental disorders (CMD) in the Shona language in Zimbabwe. Ethnographic and qualitative studies elicited idioms of distress of mental disorder leading to the preliminary Shona Symptom Questionnaire (SSQ), and items from the Self-Report Questionnaire (SRQ) were added to it. The 56-item Preliminary Shona Symptom Questionnaire (PSSQ) was administered to 302 randomly selected primary care attenders, of whom 100 were classified as cases on the basis of agreement between care provider assessment and a psychiatric interview. Discriminant analysis identified 14 items that were the strongest predictors of mental disorder. The 14-item SSQ has a high level of internal consistency (Cronbach's alpha = 0.85). The items are a mixture of emic and etic phenomena. The total score correlates strongly with patients' self-assessment of the emotional nature of their illness. Satisfactory specificity and sensitivity occurred at a cut-off point of 7/8. The SSQ is the first indigenous measure of mental disorder developed in sub-Saharan Africa to have included idioms or distress of primary care attenders and involved patients consulting traditional medical practitioners. It promises to be a useful instrument for epidemiological and clinical research. The methodology used is an innovative way of combining etic and emic methods in the evaluation of CMD.

    背景与目标: 这项研究的目的是开发一种津巴布韦以绍纳语为母语的常见精神障碍(CMD)量度。人种学和定性研究引起了精神障碍困扰的成语,导致了初步的《 Shona症状问卷》(SSQ),并且添加了《自我报告问卷》(SRQ)中的项目。对302名随机选择的初级护理人员进行了56项Shona症状初步问卷调查(PSSQ),根据护理人员评估与精神病学访谈之间的协议,将其中100例归类为病例。判别分析确定了14个最能预测精神障碍的项目。 14项SSQ具有很高的内部一致性(Cronbach's alpha = 0.85)。这些项目是emic和etic现象的混合体。总分与患者对疾病情感性质的自我评估密切相关。在7/8的临界点出现了令人满意的特异性和敏感性。 SSQ是在撒哈拉以南非洲开发的第一种本地化的精神障碍测量方法,其中包括基层医疗服务人员的成语或困扰,并使患者咨询传统医学从业者。它有望成为流行病学和临床研究的有用工具。所使用的方法学是在CMD评估中结合了动机和情感方法的创新方法。

  • 【肾移植后严重疲劳:一种高度流行的致残多因素症状。】 复制标题 收藏 收藏
    DOI:10.1111/tri.12166 复制DOI
    作者列表:Goedendorp MM,Hoitsma AJ,Bloot L,Bleijenberg G,Knoop H
    BACKGROUND & AIMS: :Fatigue is a common symptom of patients with chronic kidney disease, but seldom investigated after transplantation. We determined the prevalence, impact and related factors of severe fatigue in kidney transplant recipients (KTRs). Medical records and questionnaires were used to assess kidney function, donor characteristics, fatigue (Checklist Individual Strength), functional impairments (Sickness Impact Profile), work status, body mass index (BMI), pain, depressive symptoms, social support and sleeping problems in 180 participating KTRs. KTRs were compared with sex- and age-matched population-based controls. KTRs were significantly more often severely fatigued (39%) compared to matched controls (22%; P = 0.001). Severely fatigued KTRs had significantly more functional impairments than nonseverely fatigued recipients (effect size ≥ 0.7) P < 0.001, and less often a paid job (27% vs. 48%, P = 0.005). Univariate analysis showed that severely fatigued KTRs received more often a kidney from a deceased donor, had a higher BMI, more pain, discrepancy in social support, depressive symptoms and sleeping problems. In a multivariate analysis (n = 151) the latter two associations remained significant. Severe fatigue is a highly prevalent and disabling symptom in KTRs. Moreover, severe fatigue after kidney transplantation is more strongly related to behavioural and psychosocial factors than specific transplantation-related factors. Findings have implications for fatigue management.
    背景与目标: :疲劳是慢性肾脏疾病患者的常见症状,但很少在移植后进行检查。我们确定了肾移植受者(KTR)中严重疲劳的患病率,影响和相关因素。病历和问卷用于评估肾功能,供体特征,疲劳(清单个人力量),功能障碍(疾病影响概况),工作状态,体重指数(BMI),疼痛,抑郁症状,社会支持和睡眠问题。 180个参与的KTR。将KTR与性别和年龄相匹配的基于人群的对照进行了比较。与匹配的对照组(22%; P = 0.001)相比,KTR严重疲劳(39%)的频率明显更高。严重疲劳的KTR比非严重疲劳的接受者具有更大的功能障碍(效应量≥0.7)P <0.001,而有酬工作的频率更低(27%比48%,P = 0.005)。单因素分析表明,严重疲劳的KTR经常从死者的肾脏获得肾脏,BMI更高,疼痛更多,社会支持差异,抑郁症状和睡眠问题。在多变量分析(n = 151)中,后两个关联仍然显着。严重疲劳是KTR的高度普遍和致残的症状。此外,与特定的移植相关因素相比,肾移植后的严重疲劳与行为和社会心理因素的相关性更高。研究结果对疲劳管理有影响。
  • 【身体症状的性别差异:症状感知理论的贡献。】 复制标题 收藏 收藏
    DOI:10.1016/s0277-9536(96)00340-1 复制DOI
    作者列表:van Wijk CM,Kolk AM
    BACKGROUND & AIMS: Health surveys, studies on physical symptom reporting, and medical registration of physical complaints find consistent sex differences in symptom reporting, with women having the higher rates. By and large, this female excess of physical symptoms is independent from the symptom measure, response format and time frame used, and the population under study. As most studies concern healthy individuals, the sex difference can not simply be attributed to a greater physical morbidity in women. In this paper we propose a number of explanations for this phenomenon, based on a biopsychosocial perspective on symptom perception. We discuss a symptom perception model that brings together factors and processes from the extant literature which are thought to affect symptom reporting, such as somatic information, selection of information through attention and distraction, attribution of somatic sensations, and the personality factors somatisation and negative affectivity. Finally, we discuss the explanations for sex differences in physical symptoms that arise from the model.

    背景与目标: 健康调查,有关身体症状报告的研究以及身体不适的医学登记发现,在症状报告中性别差异始终如一,而女性的发病率更高。总体而言,女性过多的身体症状与症状量度,反应形式和使用的时限以及所研究的人群无关。由于大多数研究都涉及健康个体,因此性别差异不能简单地归因于女性更高的身体发病率。在本文中,我们基于对症状感知的生物心理社会学观点,对该现象提出了多种解释。我们讨论一种症状感知模型,该模型将现有文献中的因素和过程综合在一起,这些因素和过程被认为会影响症状报告,例如躯体信息,通过注意力和注意力分散信息选择,躯体感觉的归因以及个性化因素的躯体化和负面情感。最后,我们讨论由模型引起的生理症状中性别差异的解释。

  • 【在美国,瘙痒症是门诊护理中患者报告的症状。】 复制标题 收藏 收藏
    DOI:10.1016/j.jaad.2013.05.029 复制DOI
    作者列表:Shive M,Linos E,Berger T,Wehner M,Chren MM
    BACKGROUND & AIMS: BACKGROUND:European studies have shown that itch is a widespread symptom, yet little is known about its frequency in the United States. OBJECTIVE:We sought to describe ambulatory care visits to clinicians in the United States for which itch was coded as a patient symptom. METHODS:This study uses retrospective data from the National Ambulatory Medical Care Survey from 1999 through 2009. RESULTS:Itch was coded as a symptom for an average of 7 million visits per year or approximately 1% of all outpatient visits, which was nearly 40% of the number of visits for the symptom of low back pain. Patients seen in visits for itch were more likely to be black or Asian than other patients (20% vs 14%). They were also more likely than other patients to receive a new medication (68% vs 36%) and were over twice as likely to receive 2 or more new medications (31% vs 14%). LIMITATIONS:Secondary data sets may not optimally capture patient reports and some of the procedures or medications may have been ordered for reasons other than itch. CONCLUSION:Visits to clinicians for itch represent a sizeable proportion of ambulatory care visits in the United States, and research on the epidemiology, treatments, and causes of itch should be a priority.
    背景与目标: 背景:欧洲的研究表明,瘙痒是一种普遍的症状,但在美国对它的发生频率知之甚少。
    目的:我们试图描述对美国临床医生的门诊治疗,其中瘙痒被编码为患者症状。
    方法:本研究使用了1999年至2009年美国国家门诊医疗调查的回顾性数据。
    结果:瘙痒被编码为一种症状,每年平均有700万人次就诊,约占所有门诊就诊人数的1%,几乎是下腰痛症状就诊次数的40%。探访瘙痒的患者比其他患者更有可能是黑人或亚裔(20%比14%)。与其他患者相比,他们接受新药的可能性更高(68%比36%),而接受2种或更多新药的可能性是后者的两倍以上(31%对14%)。
    局限性:次要数据集可能无法最佳地捕获患者报告,并且某些方法或药物可能是出于瘙痒以外的原因而订购的。
    结论:在美国,对临床医生的瘙痒诊治占相当大比例的门诊治疗,对瘙痒的流行病学,治疗方法和原因的研究应作为优先事项。
  • 【创伤后应激障碍症状群,酗酒和妇女使用亲密伴侣暴力。】 复制标题 收藏 收藏
    DOI:10.1002/jts.21829 复制DOI
    作者列表:Hellmuth JC,Jaquier V,Young-Wolff K,Sullivan TP
    BACKGROUND & AIMS: :Exploring how PTSD and alcohol misuse relate to women's use of intimate partner violence (IPV) is vital to develop our understanding of why some women may engage in IPV, which can serve to maximize intervention efforts for women. This study examined the extent to which posttraumatic stress disorder (PTSD) symptom clusters are directly and indirectly related to women's use of IPV through pathways involving alcohol misuse while controlling for severity of women's IPV victimization. The sample was comprised of substance-using, low socioeconomic status community women (N = 143) currently experiencing IPV victimization. The majority of the sample was African American (n = 115, 80.42%). This sample had an average annual household income of $14,368.68 (SD = $12,800.68) and the equivalent of a high school education (11.94 years, SD = 1.32). Path analyses indicated that the strongest statistical relationship emerged between women's use of IPV and women's IPV victimization. PTSD reexperiencing and numbing symptom severity was related to women's use of psychological, minor physical, and severe physical IPV; however, these relationships were indirect through alcohol misuse. Findings lend preliminary support for the application of the self-medication hypothesis to the study of PTSD, alcohol misuse, and IPV among women.
    背景与目标: :探讨PTSD和滥用酒精与妇女使用亲密伴侣暴力(IPV)有何关系,对于增进我们对为什么某些妇女可能参与IPV的理解至关重要,这可以最大程度地为妇女提供干预措施。这项研究检查了创伤后应激障碍(PTSD)症状群在多大程度上与通过滥用酒精的途径控制女性IPV受害程度的女性IPV的使用直接和间接相关。样本由目前正在遭受IPV侵害的使用毒品,社会经济地位低的社区妇女(N = 143)组成。样本的大多数是非裔美国人(n = 115,80.42%)。该样本的平均家庭年收入为$ 14,368.68(SD = $ 12,800.68),相当于高中学历(11.94年,SD = 1.32)。路径分析表明,妇女对IPV的使用与妇女对IPV的受害之间存在最强的统计关系。 PTSD的重新体验和麻木症状严重程度与妇女使用心理,轻微身体和严重身体IPV有关;但是,这些关系是由于滥用酒精而间接造成的。研究结果为自我用药假说的应用提供了初步的支持,以研究女性的PTSD,滥用酒精和IPV。
  • 【在埃及精神分裂症患者中将认知功能与症状域和洞察力相关联。】 复制标题 收藏 收藏
    DOI:10.1177/0020764019897697 复制DOI
    作者列表:Khalil AH,El-Meguid MA,Bastawy M,Rabei S,Ali R,Abd Elmoneam MHE
    BACKGROUND & AIMS: INTRODUCTION:Cognitive impairment is one of the fundamental features among patients with schizophrenia. The relationship between schizophrenia symptoms, insight and cognitive domains remains controversial. We aimed to study these relations in a sample of Egyptian patients with schizophrenia. METHODS:A total of 109 patients with schizophrenia were assessed using Structured Clinical Interview for DSM-IV (Diagnostic and Statistical Manual of Mental Disorders (4th ed.)) Axis I diagnosis (SCID-I), Positive and Negative Syndrome Scale (PANSS) and Scale to Assess Unawareness of Medical Disorder (SUMD). Cognitive functions were assessed using the Wechsler Adult Intelligence Scale (WAIS), the Wisconsin Card Sorting Test (WCST) and the Wechsler Memory Scale (WMS). The cognitive functions would be distributed to cover six cognitive domains: attention/vigilance speed of processing, verbal learning, visual learning, working memory and reasoning/problem solving. RESULTS:There was a significant correlation between all cognitive domains (except attention) and PANSS subscales. PANSS negative and general psychopathology subscales were significantly correlated with five cognitive domains: speed of processing, verbal learning, visual learning, working memory and reasoning/problem solving. PANSS negative subscale was significantly correlated with verbal learning (verbal paired association 1) and visual learning (visual paired association 1). There was a significant correlation between all cognitive domains and SUMD, except verbal and visual learning domains assessed by verbal and visual paired association 1 subtests, as well as attention assessed by failure to maintain set subtest. Only visual learning (trials administered), working memory (percentage error), and processing speed (perseverative responses, and trials to complete first category) were significantly negatively correlated to SUMD. CONCLUSION:Cognitive impairment in patients with schizophrenia is most likely to underlie negative symptoms, general psychopathology symptoms and poor insight, suggesting that treatment strategies minimizing these symptoms would improve cognitive impairment.
    背景与目标: 简介:认知障碍是精神分裂症患者的基本特征之一。精神分裂症症状,洞察力和认知范围之间的关系仍然存在争议。我们旨在研究埃及精神分裂症患者样本中的这些关系。
    方法:采用结构性临床访谈对DSM-IV(精神障碍诊断和统计手册(第四版)),轴I诊断(SCID-I),阳性和阴性综合征量表(PANSS)进行评估,对总共109例精神分裂症患者进行了评估。和规模以评估对医学疾病的认识(SUMD)。使用韦氏成人智力量表(WAIS),威斯康星卡片分类测验(WCST)和韦氏记忆量表(WMS)评估认知功能。认知功能将被分布为涵盖六个认知领域:处理的注意/警惕速度,语言学习,视觉学习,工作记忆和推理/问题解决。
    结果:所有认知领域(注意力除外)与PANSS分量表之间均存在显着相关性。 PANSS阴性和一般心理病理学次级量表与五个认知领域显着相关:处理速度,言语学习,视觉学习,工作记忆和推理/问题解决。 PANSS负分量表与言语学习(语言配对关联1)和视觉学习(视觉配对关联1)显着相关。除通过言语和视觉配对关联1子测验评估的言语和视觉学习域,以及通过不维持设定子测验评估的注意力外,所有认知领域和SUMD之间都存在显着相关性。只有视觉学习(进行试验),工作记忆(误差百分比)和处理速度(持续反应以及完成第一类试验)与SUMD显着负相关。
    结论:精神分裂症患者的认知障碍最有可能是消极症状,一般精神病理学症状和缺乏洞察力的基础,这表明将这些症状降至最低的治疗策略将改善认知障碍。
  • 【症状强度量表,纤维肌痛和纤维肌痛样症状的含义。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Wolfe F,Rasker JJ
    BACKGROUND & AIMS: OBJECTIVE:To characterize a scale for the measurement of fibromyalgia (FM)-like symptoms; to investigate whether FM is a discrete disorder; to understand the significance of FM-like symptoms; and to investigate causal and noncausal factors in the development of such symptoms. METHODS:We evaluated 25,417 patients with rheumatic disease using the Symptom Intensity (SI) Scale, a self-report scale that combines a count of pain in 19 nonarticular regions with a visual analog scale for fatigue. We studied this scale in relation to demographics, clinical symptoms, and serious outcomes, including serious medical illnesses, hospitalization, work disability, and death. RESULTS:Compared with other rheumatic disease assessments, the SI scale was the best identifier of symptoms associated with FM content, including an increase in general medical symptoms. SI scale elevations were associated with increases in cardiovascular disorders, hospitalization, work disability, and death. Persons with socioeconomic disadvantage by reason of sex, ethnicity, household income, marital status, smoking, and body mass had increased SI scores. For almost all clinical variables studied, the prevalence and/or severity of the variable increased linearly with SI scores. CONCLUSION:We identified a clinical marker for general symptom intensification that applies in all patients and is independent of a diagnosis of FM. We found no clinical basis by which FM may be identified as a separate entity. Higher scores on the SI scale were associated with more severe medical illness, greater mortality, and sociodemographic disadvantage, and these factors appear to play a role in the development of FM-like symptoms and symptom intensification.
    背景与目标: 目的:表征测量肌纤维痛(FM)样症状的量表;调查FM是否为离散性疾病;了解类似FM的症状的重要性;并调查导致此类症状发展的因果关系和非因果关系。
    方法:我们使用症状强度量表(SI)量表对25,417名风湿病患者进行了评估,该量表是一种自我报告量表,将19个非关节区域的疼痛计数与视觉模拟量表相结合来评估疲劳程度。我们针对人口统计学,临床症状和严重后果(包括严重的医疗疾病,住院,工作残障和死亡)进行了研究。
    结果:与其他风湿性疾病评估相比,SI量表是与FM含量相关的症状(包括一般医学症状增加)的最佳识别者。 SI量表的升高与心血管疾病,住院,工作障碍和死亡的增加有关。因性别,种族,家庭收入,婚姻状况,吸烟和体重而有社会经济劣势的人的SI得分增加。对于几乎所有研究的临床变量,该变量的发生率和/或严重程度随SI分数线性增加。
    结论:我们确定了适用于所有患者且与FM诊断无关的一般症状加剧的临床标志物。我们没有发现可将FM识别为独立实体的临床依据。 SI评分较高与更严重的内科疾病,更高的死亡率和社会人口统计学方面的劣势有关,这些因素似乎在FM样症状的发展和症状加剧中起作用。
  • 【兄弟姐妹反复严重抑郁症的症状模式中的性别差异。】 复制标题 收藏 收藏
    DOI:10.1002/da.20372 复制DOI
    作者列表:Moskvina V,Farmer A,Jones IR,Brewster S,Ferrero F,Gill M,Jones LA,Maier W,Mors O,Owen MJ,Perry J,Preisig M,Rietschel M,McGuffin P,Craddock N,Korszun A
    BACKGROUND & AIMS: :The objectives of this study were to examine sex differences in depressive symptom patterns in 475 sib pairs with well-defined recurrent major depression and to test the hypotheses that (a) symptom patterns show higher intraclass correlations within same sex sib pairs versus mixed sex sib pairs; and (b) symptoms more associated with women, e.g. atypical depressive and anxiety symptoms, account for differences between male and female siblings within the same family. A total of 878 individuals, with a past history of at least two depressive episodes, were interviewed using the Schedules for Clinical Assessment in Neuropsychiatry interview and diagnosed according to DSM-IV using a computerized scoring program (CATEGO5). Intraclass correlations were compared between mixed and same sex sibs, and a conditional regression analysis in mixed sex sib pairs was performed to test whether specific symptoms account for differences between male and female siblings within the same family. Women showed a significantly earlier onset of depression compared with men (23.0 years, SD=10.6 versus 25.5, SD=12.5 years, P=0.0004), and a significantly greater frequency of several aspects of depressed mood was found in women compared with men, including atypical depressive features of fatiguability, appetite gain, weight gain and hypersomnia. Discordant sib-pair data analyses revealed five symptoms that accounted for the sex differences between siblings (P=.000035): phobia (exp(B)=2.04, P=0.017), hypersomnia (exp(B)=1.37, P=0.055), appetite loss (exp(B)=1.38, P=0.004) and appetite gain (exp(B)=2.19, P<0.001). Sex significantly modifies clinical features of depression and an earlier onset of depression and atypical depressive symptoms occur more frequently in women.
    背景与目标: :这项研究的目的是检查475例患有明确复发性重度抑郁症的抑郁同伴对的抑郁症状模式中的性别差异,并检验以下假设:对; (b)与女性更相关的症状,例如非典型的抑郁和焦虑症状是同一个家庭中男性和女性兄弟姐妹之间差异的原因。使用神经精神病学临床评估时间表采访了过去至少经历过两次抑郁发作的878个人,并根据DSM-IV使用计算机评分程序(CATEGO5)进行了诊断。比较了异性同胞和同性同胞之间的类内相关性,并在异性同胞对中进行了条件回归分析,以测试特定症状是否解释了同一家庭中男性和女性同胞之间的差异。与男性相比,女性抑郁症的发作时间要早得多(23.0岁,SD = 10.6对25.5岁,SD = 12.5岁,P = 0.0004),并且与男性相比,女性抑郁情绪的多个方面的发生频率要高得多,包括可征服性,食欲增加,体重增加和失眠的非典型抑郁特征。不一致的同胞对数据分析揭示了导致同胞之间性别差异的五种症状(P = .000035):恐惧症(exp(B)= 2.04,P = 0.017),失眠症(exp(B)= 1.37,P = 0.055 ),食欲不振(exp(B)= 1.38,P = 0.004)和食欲增高(exp(B)= 2.19,P <0.001)。性别显着改变了抑郁症的临床特征,女性更容易发生抑郁症和非典型性抑郁症状。
  • 【症状管理干预对冠状动脉搭桥手术后女性的症状评估,身体功能和身体活动的影响。】 复制标题 收藏 收藏
    DOI:10.1097/01.JCN.0000297379.06379.b6 复制DOI
    作者列表:Zimmerman L,Barnason S,Schulz P,Nieveen J,Miller C,Hertzog M,Rasmussen D,Tu C
    BACKGROUND & AIMS: :The purpose of this subset analysis was to examine the effect of a symptom management (SM) intervention on postoperative symptom evaluation, physical functioning, and physical activity among the female participants (N = 40) of the larger parent study of coronary artery bypass graft patients aged 65 years and older. The intervention group (n = 23) had significantly lower fatigue scores at 6 weeks (Z = 1.96, P < .05) and higher levels of physical activity (Z = -1.71, P < .05) reflected in the expended kcal(-1) x kg x d(-1), as measured by the activity diary at 3 months after coronary artery bypass graft surgery. At 6 weeks and 3 months after surgery, there were significant correlations between cardiac surgery-related recovery symptoms (shortness of breath, fatigue, depression, incision pain, and sleep problems) and physical functioning (physical, vitality, and bodily pain functioning subscale scores), with correlations ranging from 0.31 to 0.46. Given that this was a subset analysis of a larger study, significant differences were not expected for all variables. Study findings support the need for a targeted (women-focused) and tailored (self-management recovery) intervention to assist females in recovering from coronary artery bypass graft surgery to improve symptom management, thereby enhancing physical functioning and physical activity outcomes.
    背景与目标: :本子集分析的目的是研究在较大的冠状动脉搭桥术母体研究的女性参与者(N = 40)中,症状管理(SM)干预对术后症状评估,身体功能和身体活动的影响65岁及以上的患者。干预组(n = 23)在6周时的疲劳评分显着较低(Z = 1.96,P <.05),而较高的体力活动水平(Z = -1.71,P <.05)反映在支出的kcal(- 1)x kg xd(-1),通过在冠状动脉搭桥手术后3个月的活动日记进行测量。手术后6周和3个月,与心脏手术相关的恢复症状(呼吸短促,疲劳,抑郁,切口疼痛和睡眠问题)与身体功能(身体,活力和身体疼痛功能亚量表)得分之间存在显着相关性),相关系数范围从0.31到0.46。鉴于这是一个较大研究的子集分析,所以预期并非所有变量都存在显着差异。研究结果支持需要有针对性的(以女性为中心)和有针对性的(自我管理的恢复)干预措施,以帮助女性从冠状动脉搭桥手术中恢复以改善症状管理,从而增强身体机能和身体活动结果。
  • 【一项新的患者报告的牛皮癣症状日记的项目级心理计量学属性。】 复制标题 收藏 收藏
    DOI:10.1016/j.jval.2013.07.002 复制DOI
    作者列表:Strober BE,Nyirady J,Mallya UG,Guettner A,Papavassilis C,Gottlieb AB,Elewski BE,Turner-Bowker DM,Shields AL,Gwaltney CJ,Lebwohl M
    BACKGROUND & AIMS: OBJECTIVES:This research evaluated the psychometric properties of a new Psoriasis Symptom Diary, identified diary responder definitions for use in determining whether a patient has experienced clinically meaningful change, and refined diary item content for use in future clinical trials. METHODS:The Psoriasis Symptom Diary was administered in a phase 2 clinical trial of AIN457 to US adult outpatients (N = 172) with physician-diagnosed moderate to severe chronic plaque-type psoriasis. Participant compliance with daily diary administration and item score variability, reliability, construct and discriminant validity, sensitivity to change, and interpretation were all evaluated. RESULTS:Participants completed 94% of scheduled diary assessments across 12 study weeks. Diary items were generally normally distributed, and no floor or ceiling effects were observed. Item reliability (reproducibility) was acceptable (intraclass correlation coefficients > 0.80), with an exception for one item (skin color). At week 12, items significantly related to criterion measures as predicted (Psoriasis Area and Severity Index r = 0.27-0.57; Investigator's Global Assessment r = 0.25-0.59), with the exception of items that measured skin color and difficulty using hands. Most items generated change scores that were synchronous to changes as measured by the Psoriasis Area and Severity Index, Investigator's Global Assessment, Dermatology Life Quality Index (r > 0.37), as well as the Patient Global Impression of Change. Responders experienced a 2- to 3-point and 3- to 5-point change in item scores for minimal and large improvements, respectively. Four items that did not perform well were dropped from the diary. CONCLUSIONS:The 16-item Psoriasis Symptom Diary demonstrated favorable psychometric properties and is a brief, useful tool for measuring patient-based symptoms and the impact of chronic plaque psoriasis.
    背景与目标: 目的:本研究评估了一种新的牛皮癣症状日记的心理计量学特性,确定了日记应答者定义以用于确定患者是否经历了具有临床意义的变化,并完善了日记项的内容以用于未来的临床试验。
    方法:银屑病症状日记是在AIN457的2期临床试验中向美国诊断为中度至重度慢性斑块型牛皮癣的成年门诊患者(N = 172)服用的。评估参与者对日常日记管理的依从性以及项目评分的可变性,可靠性,结构和判别有效性,变化的敏感性以及解释性。
    结果:参与者在12个研究周中完成了计划的日记评估的94%。日记物品通常呈正态分布,没有观察到地板或天花板的影响。物品的可靠性(可重复性)是可以接受的(类内相关系数> 0.80),但一件物品(肤色)除外。在第12周时,与预测的标准措施显着相关的项目(牛皮癣面积和严重性指数r = 0.27-0.57;研究者的全球评估r = 0.25-0.59),但使用双手测量肤色和困难程度的项目除外。大多数项目产生的变化评分与银屑病面积和严重性指数,研究者的总体评估,皮肤病生活质量指数(r> 0.37)以及患者对变化的整体印象所衡量的变化是同步的。响应者在项目得分上经历了2到3分和3到5分的变化,分别实现了最小和较大的改进。表现不佳的四个项目从日记中删除。
    结论:16项牛皮癣症状日记显示出良好的心理测量特性,是一种简短,有用的工具,可用于测量基于患者的症状和慢性斑块状牛皮癣的影响。
  • 【全基因组连锁扫描定量特征代表多重精神分裂症家族中症状的大小。】 复制标题 收藏 收藏
    DOI:10.1016/j.psychres.2013.08.015 复制DOI
    作者列表:Ryu S,Won HH,Oh S,Kim JW,Park T,Cho EY,Cho Y,Park DY,Lee YS,Kwon JS,Hong KS
    BACKGROUND & AIMS: :Symptom dimensions of schizophrenia are likely to be the intermediate phenotypes under the control of disease-susceptibility genes, or separate traits related to disease-modifier genes. This study aimed to identify chromosomal loci linked to symptom dimensions of schizophrenia through genome-wide quantitative trait locus (QTL) linkage analysis. The study subjects consisted of 56 families with 183 members including 123 affected individuals. Symptom evaluations were performed on lifetime basis. Through principal component factor analysis, eight quantitative phenotypes representing symptom dimensions were identified. Genotyping was done for 6008 SNP markers, and genome-wide QTL linkage analysis was performed. No symptom dimension showed a significant linkage attaining genome-wide empirical thresholds. We observed seven regions yielding linkage signals attaining genome-wide empirical thresholds for suggestive linkage (NPL Z score = 2.78-3.49); chromosome 15q26.1 for 'non-paranoid delusion factor', 2p24.3 and 7q31.1 for 'prodromal impairment factor', 1q32.1, 9p21.3, and 9q31.2 for 'negative symptom factor', and 10p13 for 'disorganization factor'. Among these loci, chromosome 2p24.3 and 1q32.1 overlap with susceptibility loci of schizophrenia identified in our previous linkage studies. This study suggests the existence of genetic loci related to various clinical features of schizophrenia. Further genetic analyses for these dimensional phenotypes are warranted.
    背景与目标: :精神分裂症的症状表现可能是疾病易感性基因或与疾病调节基因相关的单独性状控制下的中间表型。这项研究旨在通过全基因组定量特征位点(QTL)连锁分析来确定与精神分裂症症状维度相关的染色体基因座。研究对象包括56个家庭,有183名成员,其中包括123个人。症状评估是基于终生进行的。通过主成分因子分析,确定了代表症状维度的八种定量表型。对6008个SNP标记进行了基因分型,并进行了全基因组QTL连锁分析。没有症状维度显示达到全基因组经验阈值的显着联系。我们观察到七个区域产生连锁信号,达到暗示性连锁的全基因组经验阈值(NPL Z评分= 2.78-3.49);染色体15q26.1代表'非偏执妄想因子',2p24.3和7q31.1代表'前驱性损伤因子',1q32.1、9p21.3和9q31.2代表'阴性症状因子',10p13代表'混乱因素”。在这些基因座中,染色体2p24.3和1q32.1与我们先前的连锁研究中确定的精神分裂症易感基因座重叠。这项研究表明存在与精神分裂症的各种临床特征有关的遗传基因座。这些维度表型的进一步遗传分析是必要的。
  • 【南部非洲感染艾滋病毒/艾滋病的男女的疲劳症状负担。】 复制标题 收藏 收藏
    DOI:10.1016/j.jana.2007.05.001 复制DOI
    作者列表:Voss JG,Sukati NA,Seboni NM,Makoae LN,Moleko M,Human S,Molosiwa K,Holzemer WL
    BACKGROUND & AIMS: :HIV-related fatigue is a debilitating and disabling symptom that persists for months and years. In 743 HIV/AIDS patients from Southern Africa, the authors found ratings of HIV-related fatigue to be highly prevalent. The authors conducted a secondary data analysis within the theoretical context of the University of California, San Francisco Symptom Management Model. The analysis focused on 538 patients who reported fatigue to investigate correlates and predictors of fatigue severity in relationship to demographic and HIV/AIDS illness indicators, as well as HIV-specific physical and psychological symptoms. A hierarchical regression model explored the contributions of those five blocks on fatigue severity. Of the 47% of the total variance in fatigue severity, a combination of variables within the health and illness block (6%), the physical symptoms block (7%) and the psychological symptom block (2%) contributed significantly to the increase in fatigue severity scores. Fatigue severity in Southern Africa was moderate, and the factors contributing to the perceived fatigue were most likely related to symptoms of acute HIV disease (such as fever and gastrointestinal problems). In conclusion, fatigue severity is less impacted by demographic or environmental variables but much more by co-occurring symptoms and HIV disease severity. The results of this study imply the need for more research to understand if improvements in water quality and access to food would prevent infection and diarrhea and whether sufficient access to antiretroviral treatments to manage the HIV infection would improve fatigue and co-occurring symptom profiles.
    背景与目标: 与HIV相关的疲劳是一种令人衰弱和致残的症状,持续数月和数年。在来自南部非洲的743名HIV / AIDS患者中,作者发现与HIV相关的疲劳程度非常普遍。作者在加州大学旧金山分校症状管理模型的理论背景下进行了二次数据分析。该分析集中于538名报告疲劳的患者,以研究疲劳严重程度与人口统计学和HIV / AIDS疾病指标以及HIV特定的身体和心理症状的相关性和预测因素。分层回归模型探索了这五个区块对疲劳严重程度的贡献。在疲劳严重程度总变化的47%中,健康和疾病障碍(6%),身体症状障碍(7%)和心理症状障碍(2%)内的变量组合显着地增加了疲劳严重程度评分。南部非洲的疲劳严重程度是中等的,导致感觉疲劳的因素最有可能与急性HIV疾病的症状(如发烧和胃肠道问题)有关。总之,疲劳严重程度受人口或环境变量的影响较小,而受同时出现的症状和HIV疾病严重程度影响更大。这项研究的结果意味着需要进行更多的研究,以了解改善水质和获得食物是否可以预防感染和腹泻,以及获得抗逆转录病毒治疗药物来控制HIV感染是否会改善疲劳和并发症状。
  • 【昏迷是原发性HIV感染的表现症状。】 复制标题 收藏 收藏
    DOI:10.1136/sti.2006.020222 复制DOI
    作者列表:Umgelter A,Huber W,Schmid RM,Reindl W
    BACKGROUND & AIMS: :Primary HIV infection (PHI) is symptomatic in 50-90% of patients. The diagnosis, however, is seldom made at first presentation. This is probably because of the multifaceted and unspecific manifestations, the omission to perform adequate diagnostic testing and the failure to assess risks for PHI. Meningoencephalitis has been described as a fairly common presenting condition in PHI, with nuchal rigidity, fatigue, photophobia and headache; therefore, PHI should be considered in the differential diagnosis of aseptic meningitis. We present the case of a man with acute coma and a presumptive diagnosis of viral encephalitis in whom serological testing showed HIV encephalitis during PHI.
    背景与目标: :50-90%的患者有主要的HIV感染(PHI)症状。但是,很少在初诊时进行诊断。这可能是由于多方面的和非特定的表现,未进行足够的诊断测试以及未能评估PHI风险所致。脑膜脑炎已被描述为是PHI中相当普遍的一种表现病态,伴有颈部僵硬,疲劳,畏光和头痛。因此,在鉴别诊断无菌性脑膜炎时应考虑使用PHI。我们介绍了一个人的急性昏迷和病毒性脑炎的推定诊断,其中在PHI期间血清学检查显示为HIV脑炎的病例。
  • 【症状患病率和慢性病对癌症幸存者和非癌症个体生活质量的不同影响:一项人口研究。】 复制标题 收藏 收藏
    DOI:10.1158/1055-9965.EPI-16-1007 复制DOI
    作者列表:Huang IC,Hudson MM,Robison LL,Krull KR
    BACKGROUND & AIMS: :Background: To compare associations of symptom prevalence, chronic conditions, and health-related quality of life (HRQOL) between cancer survivors and non-cancer individuals using the U.S. National Health Interview Survey.Methods: Study samples comprised 604 survivors and 6,166 non-cancer individuals. Symptoms included sensation abnormality, pain, fatigue, cognitive disturbance, depression, and anxiety. Physical and mental HRQOL was measured by the Patient-Reported Outcomes Measurement Information System.Results: Compared with non-cancer individuals, survivors had higher prevalence in sensation abnormality (OR = 2.4; 95% CI = 1.9 to 3.0), pain (OR = 2.1; 95% CI = 1.7 to 2.6), fatigue (OR = 1.4; 95% CI = 1.1 to 1.8), and decremented physical HRQOL (difference = -3.7; 95% CI = -4.7 to -2.6). The prevalence of individual symptoms was significantly associated with decremented physical HRQOL [range = -5.9 (anxiety) to -8.9 (pain)] and mental HRQOL [range = -4.7 (sensation) to -8.4 (depression)]. The association between cancer experience and physical and mental HRQOL was chiefly explained by the prevalence of six symptoms and presence of chronic conditions. Pain (β = -4.0; 95% CI = -4.5 to -3.6) and ≥2 chronic conditions (β = -9.2; 95% CI = -10.2 to -8.2) significantly decremented physical HRQOL. Depression (β = -5.2; 95% CI = -5.8 to -4.6) and ≥2 chronic conditions (β = -3.3; 95% CI = -4.4 to -2.3) significantly decremented mental HRQOL.Conclusions: Cancer survivors experience more symptom burden than non-cancer individuals, which is associated with more chronic conditions and impaired HRQOL.Impacts: Interventions to manage symptom prevalence especially for older cancer survivors and survivors with more chronic conditions may improve their HRQOL outcomes. Cancer Epidemiol Biomarkers Prev; 26(7); 1124-32. ©2017 AACR.
    背景与目标: 背景:通过美国国家健康访问调查,比较癌症幸存者和非癌症个体之间的症状患病率,慢性病和健康相关生活质量(HRQOL)的关联。方法:研究样本包括604名幸存者和6,166名非幸存者。癌症个体。症状包括感觉异常,疼痛,疲劳,认知障碍,抑郁和焦虑。结果:与非癌症患者相比,幸存者在感觉异常(OR = 2.4; 95%CI = 1.9至3.0),疼痛(OR = 2.1; 95%CI = 1.7至2.6),疲劳(OR = 1.4; 95%CI = 1.1至1.8)和降低的身体HRQOL(差异= -3.7; 95%CI = -4.7至-2.6)。个体症状的患病率与身体HRQOL降低[范围= -5.9(焦虑)至-8.9(疼痛)]和精神HRQOL [范围= -4.7(感觉)至-8.4(抑郁)]显着相关。癌症经验与身心HRQOL之间的关联主要由六种症状的普遍性和慢性病的存在来解释。疼痛(β= -4.0; 95%CI = -4.5至-3.6)和≥2种慢性病(β= -9.2; 95%CI = -10.2至-8.2)显着降低了身体HRQOL。抑郁(β= -5.2; 95%CI = -5.8至-4.6)和≥2种慢性疾病(β= -3.3; 95%CI = -4.4至-2.3)明显降低了心理HRQOL。与非癌症个体相比负担更大,这与更多的慢性疾病和HRQOL受损有关。影响:干预措施以管理症状患病率,尤其是对于年长的癌症幸存者和患有更长期疾病的幸存者,可能会改善他们的HRQOL结果。癌症流行病生物标志物26(7); 1124-32。 ©2017 AACR。

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