目的:采用系统综述的方法比较基于互联网的认知行为治疗(ICBT)和传统认知行为治疗(CBT)对神经症性障碍患者的治疗效果。方法:检索Medline网络数据库(MEDLINE),世界医学文献数据库(PubMed),荷兰医学文摘(EM-BASE),循证医学图书馆(Cochran...目的:采用系统综述的方法比较基于互联网的认知行为治疗(ICBT)和传统认知行为治疗(CBT)对神经症性障碍患者的治疗效果。方法:检索Medline网络数据库(MEDLINE),世界医学文献数据库(PubMed),荷兰医学文摘(EM-BASE),循证医学图书馆(Cochrane Library),中国期刊全文专题数据库(CNKI),美国科学引文索引网络版数据库(Web of science),中国生物医学文献数据库(Sinomed),维普全文电子期刊(VIP)。由2名研究人员根据纳入和排除标准独立筛选、评价文献。应用Cochrane协作网提供的RevMan5.1软件进行数据处理。结果:共纳入文献8篇,总计样本量n=569。对各研究的临床症状的变化值采用连续性变量的合并标准化平均差值及其95%CI表示,存在异质性的研究进行亚组分析。在神经症性障碍治疗中,基于互联网和传统的认知行为治疗差异无统计学意义[g=-0.07(-0.24～0.09),Pχ~2=0.52,I^2=0%]。结论:ICBT对神经症性障碍的治疗效果同传统CBT无明显差别,其有效性与优越性应引起国内精神卫生从业者的重视。展开更多
Objective:Active and passive smoking are common environmental risk factors,but there is no definite conclusion about their effects on relapse and disability progression in multiple sclerosis(MS)and neuromyelitis optic...Objective:Active and passive smoking are common environmental risk factors,but there is no definite conclusion about their effects on relapse and disability progression in multiple sclerosis(MS)and neuromyelitis optica spectrum disorder(NMOSD).Methods:This was a retrospective cohort study.Patients were included from four centers.Demographic and clinical data were extracted from the clinical database,while data involving environmental exposures during daily life,relapse,and disability progression were obtained through telephone follow-up interviews.Determinants of relapse were assessed by Cox proportional models,and disability progression was assessed by linear regression.Kaplan‒Meier survival was used to estimate relapse within five years after the first attack.Results:A total of 130 MS patients and 318 NMOSD patients were included in this study,and females accounted for 60%and 79.6%,respectively.MS patients with an active smoking history had a higher risk of relapse,for which the association became borderline significant after accounting for covariates(aHR=1.52,95%CI=1.00,2.31;p=0.052).The relapse risk between ever-smokers who smoked more than 10 cigarettes per day and smokers who smoked less than 10 cigarettes per day was not significantly different(aHR=0.96,95%CI=0.63,1.47;p=0.859).However,exposure to passive smoking was associated with a reduced risk of MS relapse(aHR=0.75,95%CI=0.56,1.00;p=0.044)compared with never-exposed patients.No associations were observed between active smoking/passive smoking and the risk of NMOSD relapse,but patients with a history of smoking were associated with a lower annual progression rate by Expanded Disability Status Scale(EDSS)(aβ=−0.20,95%CI=−0.38,−0.01;p=0.036)and Multiple Sclerosis Severity Score(MSSS)(aβ=−0.23,95%CI=−0.44,−0.03;p=0.028).Conclusion:Our research shows that active smoking increases the relapse risk of MS and has a negative impact on disability progression;thus,smoking cessation should be encouraged.展开更多
文摘目的:采用系统综述的方法比较基于互联网的认知行为治疗(ICBT)和传统认知行为治疗(CBT)对神经症性障碍患者的治疗效果。方法:检索Medline网络数据库(MEDLINE),世界医学文献数据库(PubMed),荷兰医学文摘(EM-BASE),循证医学图书馆(Cochrane Library),中国期刊全文专题数据库(CNKI),美国科学引文索引网络版数据库(Web of science),中国生物医学文献数据库(Sinomed),维普全文电子期刊(VIP)。由2名研究人员根据纳入和排除标准独立筛选、评价文献。应用Cochrane协作网提供的RevMan5.1软件进行数据处理。结果:共纳入文献8篇,总计样本量n=569。对各研究的临床症状的变化值采用连续性变量的合并标准化平均差值及其95%CI表示,存在异质性的研究进行亚组分析。在神经症性障碍治疗中,基于互联网和传统的认知行为治疗差异无统计学意义[g=-0.07(-0.24～0.09),Pχ~2=0.52,I^2=0%]。结论:ICBT对神经症性障碍的治疗效果同传统CBT无明显差别,其有效性与优越性应引起国内精神卫生从业者的重视。
基金supported by the National Natural Science Foundation of China (U20A20357)Program for Innovative Research Team of the First Affiliated Hospital of USTC。
文摘Objective:Active and passive smoking are common environmental risk factors,but there is no definite conclusion about their effects on relapse and disability progression in multiple sclerosis(MS)and neuromyelitis optica spectrum disorder(NMOSD).Methods:This was a retrospective cohort study.Patients were included from four centers.Demographic and clinical data were extracted from the clinical database,while data involving environmental exposures during daily life,relapse,and disability progression were obtained through telephone follow-up interviews.Determinants of relapse were assessed by Cox proportional models,and disability progression was assessed by linear regression.Kaplan‒Meier survival was used to estimate relapse within five years after the first attack.Results:A total of 130 MS patients and 318 NMOSD patients were included in this study,and females accounted for 60%and 79.6%,respectively.MS patients with an active smoking history had a higher risk of relapse,for which the association became borderline significant after accounting for covariates(aHR=1.52,95%CI=1.00,2.31;p=0.052).The relapse risk between ever-smokers who smoked more than 10 cigarettes per day and smokers who smoked less than 10 cigarettes per day was not significantly different(aHR=0.96,95%CI=0.63,1.47;p=0.859).However,exposure to passive smoking was associated with a reduced risk of MS relapse(aHR=0.75,95%CI=0.56,1.00;p=0.044)compared with never-exposed patients.No associations were observed between active smoking/passive smoking and the risk of NMOSD relapse,but patients with a history of smoking were associated with a lower annual progression rate by Expanded Disability Status Scale(EDSS)(aβ=−0.20,95%CI=−0.38,−0.01;p=0.036)and Multiple Sclerosis Severity Score(MSSS)(aβ=−0.23,95%CI=−0.44,−0.03;p=0.028).Conclusion:Our research shows that active smoking increases the relapse risk of MS and has a negative impact on disability progression;thus,smoking cessation should be encouraged.
