职业倦怠与性别的相关性及其生物学基础的研究*

从上个世纪七十年代开始,职业倦怠就引起了欧美发达国家相关学者的关注。在中国,对这方面的研究相对较少。近年来,随着我国社会经济的快速发展,人们的工作压力增大,而职业倦怠对人们工作和生活造成的影响也日趋严重,已经成为日常生活中一个不可回避的问题。男性和女性之间职业倦怠的表现和程度存在一定差异,本文从环境和生物学的角度分析男性和女性之间职业倦怠的表现和程度不同的原因。     

护士职业压力与职业倦怠的相关性研究

目的:了解护士职业压力、职业倦怠现状;探讨两者之间的关系。方法:方便抽样,抽取哈尔滨市5所三级医院的468名护士进行问卷调查。采用护士一般情况调查表、护士工作压力源量表、职业倦怠量表进行调查。结果:护士职业倦怠程度为中等,去人格化属于中度倦怠,情感衰竭、低成就感程度达到了高度倦怠;职业压力得分为87.56±20.43,以工作量及时间分配维度压力最高,病人护理维度压力最低。情感耗竭与除工作环境及资源之外的职业压力维度呈显著正相关;去人格化与职业压力各维度均呈显著正相关;低成就感与职业压力中护理专业及工作、病人护理呈显著负相关(P0.05)。护士职业压力各维度对其职业倦怠的3个维度均有较好的预测作用,尤其对护士情感耗竭的解释程度达25.5%。结论:护士职业倦怠现象不容忽视,护理管理者有针对性的对护士进行管理,鼓励护士加强自身修养、学会自我疏导,适当授权等是降低护士职业倦怠的正性激励措施。     

职业倦怠与焦虑的相关性及其生物学基础研究

职业倦怠作为当前社会从业人员普遍存在的心理现象,其生理机制主要与长期过度应激引起神经系统的紊乱相关,焦虑与职业倦怠关系密切,都受到神经系统和内分泌系统共同调节。神经系统中神经递质及其受体:如5-羟色胺,去甲肾上腺素和多巴胺的异常,导致焦虑的发生,可能诱发了职业倦怠。本文从激素水平、分子水平、基因水平三个方面分别阐述了职业倦怠发生和焦虑发生的机制以及两者之间相互作用的生物原理,为今后职业倦怠的心理预防以及基因治疗提供了生物医学研究相关的基础理论,也为职业倦怠易感人群,尤其是女性易感人群的焦虑情绪产生的机制研究奠定了详尽的生物医学方面的基础。     

TNF-α在抑郁症中的作用和机制研究

抑郁症是一种情感精神疾病,临床上以显著而持久的心境低落为主要特征。抑郁症严重危害人们身心健康,降低生活质量,增加社会负担。抑郁的产生原因比较复杂,发病机制存在多种假说。在过去的几十年,虽然对于抑郁症的研究取得了一定的进展,但其确切的病因及病理生理机制目前仍不明确。近期,研究显示,促炎性细胞因子,尤其是肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)在抑郁症的发生、发展及临床药理机制中扮演着重要角色。现通过对TNF-α的生物学特征、在抑郁症发病和抗抑郁治疗中的作用、基因多态性与抑郁症关联性以及未来的应用与展望等进行综述,以期从多方面阐明TNF-α在抑郁症中的作用。     

氯胺酮在麻醉和治疗抑郁症中的研究进展

抑郁症是一种精神障碍性疾病,它的主要症状是持续的情绪低落.根据WHO的研究报告:全世界有大约25％的人患有抑郁症,其中约10％的人是重性抑郁症,也即是说难治性抑郁症.抑郁症严重地影响着人们的正常生活、工作和学习,特别值得注意地,患有重性抑郁症的患者是自杀的高危人群.氯胺酮是临床常用的麻醉药,尤其在小儿麻醉手术中被广泛应用,近几年的研究表明氯胺酮能迅速缓解抑郁症患者症状,且治疗效果持续可达一周.本文将就氯胺酮在手术麻醉和治疗抑郁症过程中的研究进行综述.     

抑郁症相关的静息态脑功能网络异常

近年来,静息态脑功能磁共振成像(resting-state functional magnetic resonance imaging, rf MRI)被大量用于揭示抑郁个体脑功能网络的异常,主要体现在默认网络、认知控制网络和情绪网络各自内部及三大网络之间交互作用方面.与正常人相比,抑郁个体默认网络内部的异常主要表现为前部功能连接增强而后部功能连接减弱,前后两部分的异常可能有着分离的模式;认知控制网络内部的异常表现为功能连接减弱;而在情绪网络内部,抑郁个体的异常主要表现为边缘系统功能连接增强以及奖赏回路功能连接减弱.抑郁症对不同网络之间交互作用的影响主要体现在各个网络代表节点之间的功能连接异常.这些功能网络之间的交互异常可能反映了抑郁个体大脑在资源分配以及信息整合两方面存在缺陷.基于当前研究存在的不足,未来研究可关注抑郁症的多维度大数据整合和个体化研究,并将抑郁症与其他精神疾病脑网络异常的共性与特异性进行比较,在更深入揭示抑郁症神经机制的基础上为临床诊断和干预提供有效的生物学标记.     

人体肠道微生物群与抑郁症的相关性研究进展

抑郁症又称抑郁障碍,是一种常见的精神疾病,主要表现为情绪低落、悲观、思维迟缓、以及言语动作减少,迟缓等。抑郁症严重困扰患者的生活和工作,给家庭和社会带来沉重的负担,约15%的抑郁症患者死于自杀。肠道菌群作为寄居在人消化道内的大量微生物,是人体健康和疾病转换过程中的重要环境因素。肠-脑轴是联系大脑和胃肠功能的双向信息调节系统,肠道微生物在生理和病理条件下均能参与肠-脑轴活动,影响大脑功能和某些关联行为。因此,深入研究肠道微生物与抑郁症的相互作用,开发以肠道菌群为靶点的个性化药物,能够为抑郁症的临床预防和治疗提供新的研究思路和方法。     

哈尔滨地区手术室护士职业倦怠现状与社会支持的相关分析

目的:研究哈尔滨地区手术室护士职业倦怠现状与社会支持现状,分析其相关性,通过提高社会支持,减轻职业倦怠感.方法:通过目的抽样选取哈尔滨地区8所二甲以上的医院468名手术室护士进行调查,回收有效问卷450份,调查工具包括一般情况调查表、职业倦怠量表与社会支持量表.结果:在职业倦怠量表中,情感耗竭得分为29.42± 9.58,去个性化得分为7.45± 4.32,个人成就感得分为28.12±9.29.手术室护士的情感耗竭与主观支持存在显著相关(P＜0.01).去个性化与主观支持和支持利用度存在显著相关(P＜0.05,P＜0.01).结论:预防手术室护士职业倦怠,应努力增加护士的社会支持,塑造良好的人格,更好地为社会大众服务.     

抗抑郁症药物的临床应用进展

抑郁症（depression）是一类受遗传因素影响,有一定生物学基础的疾病,其发生还受社会、心理、文化等多因素共同作用。抑郁症是以情感性精神障碍为主要表现,显著而持久的心境低落为主要特征的综合征。主要表现为情绪低落,言语减少,睡眠障碍,甚至企图自杀等症状[2]。其以高发病率、高复发率和高自杀率对社会造成极大危害,对个人、家庭产生深远的负面效果和沉重的经济负担。     

肠道菌群与多囊卵巢综合征并发抑郁症关系的研究进展

抑郁症是多囊卵巢综合征（polycystic ovary syndrome,PCOS）常并发的精神障碍性疾病,不仅严重影响PCOS患者的生活质量,还会进一步加重内分泌代谢的紊乱,形成恶性循环,增加治疗疾病的难度。目前临床上对PCOS并发抑郁症主要采用分开诊治的方案,并未根据两者之间内在的联系找到针对性的治疗药物。近年的研究表明,PCOS患者的肠道菌群存在明显失衡,而失衡的肠道菌群可通过“肠-脑轴”导致抑郁症的发生。因此肠道菌群与PCOS并发抑郁症的发生密切相关。本文就肠道菌群与PCOS并发抑郁症关系的研究进展进行综述,以期为临床上治疗PCOS并发抑郁症提供参考。     

Depression and bipolar disorder: relationships to impaired fatty acid and phospholipid metabolism and to diabetes, cardiovascular disease, immunological abnormalities, cancer, ageing and osteoporosis. Possible candidate genes.

Depression and bipolar disorder are two of the commonest illnesses in the developed world. While some patients can be treated effectively with available drugs, many do not respond, especially in the depression related to bipolar disorder. Depression is associated with diabetes, cardiovascular disease, immunological abnormalities, multiple sclerosis, cancer, osteoporosis and ageing: in each case depressed individuals have a worse outcome than non-depressed individuals. In all of these conditions there is now evidence of impaired phospholipid metabolism and impaired fatty acid-related signal transduction processes. Impaired fatty acid and phospholipid metabolism may be a primary cause of depression in many patients and may explain the interactions with other diseases. Several novel gene candidates for involvement in depression and bipolar disorder are proposed.     

Depression among older nursing home patients. A review

Depression is a common disorder in later life. The prevalence of depression in aged nursing home patients in 36 studies in various countries was reviewed. Results show prevalence rates ranging from 2% to 61%. Average prevalences were calculated for depressive symptoms, minor depression and major depression each. The averages thus found are 43.9% for depressive symptoms, 25.7% for minor depression and 15.5% for major depression. In order to find an explanation for the variation in occurrence of depression in nursing homes, factors that may have influenced the results are described. Both the definition of depression and the kind of instrument used in measuring depression appear to be highly responsible for the variations found.     

Moving Away from Exhaustion: How Core Self-Evaluations Influence Academic Burnout

Background

Academic burnout refers to students who have low interest, lack of motivation, and tiredness in studying. Studies concerning how to prevent academic burnout are rare.

Objective

The present study aimed to investigate the impact of core self-evaluations on the academic burnout of university students, and mainly focused on the confirmation of the mediator role of life satisfaction.

Methods

A total of 470 university students accomplished the core self-evaluation scale, Satisfaction with Life, and academic burnout scale.

Results

Both core self-evaluations and life satisfaction were significantly correlated with academic burnout. Structural equation modeling indicated that life satisfaction partially mediated the relationship between core self-evaluations and academic burnout.

Conclusions

Core self-evaluations significantly influence academic burnout and are partially mediated by life satisfaction.     

Depression-Burnout Overlap in Physicians

Background

Whether burnout is a distinct phenomenon rather than a type of depression and whether it is a syndrome, limited to three “core” components (emotional exhaustion, depersonalization and low personal accomplishment) are subjects of current debate. We investigated the depression-burnout overlap, and the pertinence of these three components in a large, representative sample of physicians.

Methods

In a cross-sectional study, all Austrian physicians were invited to answer a questionnaire that included the Major Depression Inventory (MDI), the Hamburg Burnout Inventory (HBI), as well as demographic and job-related parameters. Of the 40093 physicians who received an invitation, a total of 6351 (15.8%) participated. The data of 5897 participants were suitable for analysis.

Results

Of the participants, 10.3% were affected by major depression. Our study results suggest that potentially 50.7% of the participants were affected by symptoms of burnout. Compared to physicians unaffected by burnout, the odds ratio of suffering from major depression was 2.99 (95% CI 2.21–4.06) for physicians with mild, 10.14 (95% CI 7.58–13.59) for physicians with moderate, 46.84 (95% CI 35.25–62.24) for physicians with severe burnout and 92.78 (95% CI 62.96–136.74) for the 3% of participants with the highest HBI_sum (sum score of all ten HBI components). The HBI components Emotional Exhaustion, Personal Accomplishment and Detachment (representing depersonalization) tend to correlate more highly with the main symptoms of major depression (sadness, lack of interest and lack of energy) than with each other. A combination of the HBI components Emotional Exhaustion, Helplessness, Inner Void and Tedium (adj.R² = 0.92) explained more HBI_sum variance than the three “core” components (adj.R² = 0.85) of burnout combined. Cronbach’s alpha for Emotional Exhaustion, Helplessness, Inner Void and Tedium combined was 0.90 compared to α = 0.54 for the combination of the three “core” components.

Conclusions

This study demonstrates the overlap of burnout and major depression in terms of symptoms and the deficiency of the three-dimensional concept of burnout. In our opinion, it might be preferable to use multidimensional burnout inventories in combination with valid depression scales than to rely exclusively on MBI when clinically assessing burnout.     

三甲综合医院住院医师职业倦怠现状调查与影响因素分析

目的:探究三甲综合医院住院医师职业倦怠的发生现状及其影响因素,为预防三甲综合医院住院医师发生职业倦怠提供依据。方法:选择三甲综合医院各临床住院医师218名为研究对象,采用问卷调查住院医师性别、年龄、文化程度、职务、婚姻状况、职称、工作时间、编制及身体健康情况等基线资料及职业倦怠程度,采用logistics回归分析住院医师职业倦怠的影响因素。结果:218例三甲住院医师中119例人(54.59%)发生职业倦怠,其中轻度倦怠者60人(27.52%),中度倦怠者49人(22.48%),重度倦怠者10人(4.59%);身体健康状况一般、差(OR=1.547,5.342;P0.05)是住院医师发生职业倦怠的危险因素,职称为初级、中级、副高及以上(OR=0.893,0.827,0.736;P0.05)是住院医师发生职业倦怠的保护因素。结论:三甲住院医师职业倦怠发生的现状不容乐观,无编制、身体健康状况一般、差是住院医师发生职业倦怠的危险因素,职称为初级、中级、副高及以上是住院医师发生职业倦怠的保护因素。     

Molecular Biological Aspects of Depressive Disorders: A Modern View

Molecular Biology - Depression is a serious mental disorder that affects more than 300 million people worldwide. Due to the lack of effective treatment methods, the pathogenesis of depression is...     

Years of Potential Life Lost Due to Occupational Fatal Injury in the United States

Fatal injury surveillance data coupled with life expectancy data may be used to assess the impact of occupational fatal injuries on years of potential life lost (YPLL). We compare three definitions of YPLL and trends over time in YPLL. Two definitions determine YPLL as expected life lost to fixed life expectancies of 65 or 85 years. The third definition uses actuarial adjustments of life expectancy given survival to a given age stratified by gender and race. Fatalities from the National Traumatic Occupational Fatality (NTOF) database are used to illustrate the three definitions of YPLL. The three YPLL measures were similar in magnitude and direction of the trend in YPLL over 1980-1992. Proper interpretation of these trends can only be made in conjunction with other measures (e.g., rates). Almost all YPLL trends are declining, implying that over time fatal injuries are shifting to older workers. The exception is the increasing trend in YPLL for the retail trade industry, injury rates have also been increasing over time for this industry. Mining and construction have the highest YPLL among all industries. This analysis suggests efforts to prevent the occupational fatalities of younger workers should focus on the retail trade, mining, and construction industries.     

Rates of medication errors among depressed and burnt out residents: prospective cohort study

Objective To determine the prevalence of depression and burnout among residents in paediatrics and to establish if a relation exists between these disorders and medication errors.Design Prospective cohort study.Setting Three urban freestanding children’s hospitals in the United States.Participants 123 residents in three paediatric residency programmes.Main outcome measures Prevalence of depression using the Harvard national depression screening day scale, burnout using the Maslach burnout inventory, and rate of medication errors per resident month.Results 24 (20%) of the participating residents met the criteria for depression and 92 (74%) met the criteria for burnout. Active surveillance yielded 45 errors made by participants. Depressed residents made 6.2 times as many medication errors per resident month as residents who were not depressed: 1.55 (95% confidence interval 0.57 to 4.22) compared with 0.25 (0.14 to 0.46, P<0.001). Burnt out residents and non-burnt out residents made similar rates of errors per resident month: 0.45 (0.20 to 0.98) compared with 0.53 (0.21 to 1.33, P=0.2).Conclusions Depression and burnout are major problems among residents in paediatrics. Depressed residents made significantly more medical errors than their non-depressed peers; however, burnout did not seem to correlate with an increased rate of medical errors.     

抑郁症的成因及其新药治疗研究进展

抑郁症是一种发病率高、危害大的精神疾病,且发病的人群正在急剧增加。抑郁症的成因复杂,其病因机制尚不十分清楚。目前研究的病因主要包括神经递质受体异常、神经退化及内分泌、炎症细胞因子、表观遗传调节和大脑衍生神经营养因子等。随着新病因的揭开,抑郁症治疗的新药及其作用机理研究也取得了较大的进展。研发的新药主要包括:选择性5-羟色胺(5-HT)、去甲肾上腺素(NE)再摄取抑制剂、选择性NE再摄取抑制剂、肾上腺素能和特异性5-HT抗抑郁药、以及新药氯胺酮。本文就抑郁症发病的成因及主要的新药治疗策略进行了综述,为揭示抑郁症致病机制及其新药研发提供了理论依据。