Sakamakon maganin marasa lafiya tare da jita-jitar intanit: binciken nazarin gwaji a cikin asibiti game da tasirin tsarin farfadowa na jiki (2014)

Shawarar yanar gizo ta zama damuwa mai girma a yawancin sassa na duniya tare da karuwar yawan 1-2% a Turai kuma har zuwa 7% a wasu ƙasashe Asiya. Bincike na asibiti ya nuna cewa jarabawar Intanet yana tare da hasarar bukatu, rage yawan aiki na zamantakewar al'umma, zamantakewar zamantakewa, da kuma ci gaba da rashin tausayi na psychosocial. Ana buƙatar shirye-shirye na musamman don magance wannan matsala wadda aka ƙara kwanan nan a shafi na DSM-5. Duk da yake akwai nazarin da yawa na nazarin dabi'u na asibiti na marasa lafiya da jaraba da Intanet, sani game da tasiri na shirye-shiryen magani yana iyakancewa. Kodayake samfurin bincike na baya-bayan nan ya nuna cewa waɗannan shirye-shiryen suna nuna alamun, ana buƙatar ƙarin nazarin asibiti a nan. Don ƙara ilimin, mun gudanar da bincike kan matukar tasiri game da tasiri na hanyar haɓakacciyar halayyar jiki na IA. An tsara sunayen 42 da manya don magance buri. Matsayin da suke da su na hali, da yanayin cututtuka, da kuma tsinkayar da ake yi na kai tsaye an tantance su kafin kuma bayan jiyya. Sakamakon ya nuna cewa 70.3% na marasa lafiya sun gama ci gaba akai. Bayan jiyya bayyanar cututtuka na IA ya rage muhimmanci. An rage cututtukan cututtuka na Psychopathological da mawuyacin matsalolin psychosocial. Sakamakon wannan binciken na jirgi ya jaddada abubuwan da aka samo daga ƙirar meta-bincike da aka gudanar har yanzu.

1. Gabatarwa

Dubban binciken da suka shafi shekarun da suka gabata sun nuna cewa cin zarafin yanar gizo ne kamar yadda batun kiwon lafiyar yake faruwa a sassa daban-daban na jama'a. Ra'idodin yawancin kuɗi sun kai har zuwa 6.7% a tsakanin matasa da matasa a kudu maso gabashin Asia [1], 0.6% a Amurka [2], da kuma tsakanin 1 da 2.1% a ƙasashen Turai [3, 4] tare da matasa masu nuna ko da yawan ƙimar kuɗi (misali, [4]). Bisa ga waɗannan abubuwan da aka lura, APA ta yanke shawarar haɗawa da Cibiyar Gamada ta Duniya-ɗaya daga cikin labaran Intanit (IA) -daga sashe na III na DSM-5 "a matsayin yanayin da ke bada ƙarin binciken bincike da ƙwarewa kafin a iya la'akari da shi don hadawa a cikin babban littafi a matsayin cuta na yau da kullum "[5].

Mutane da ke fama da su suna nuna alamun bayyanar kama da waɗanda aka sani daga abubuwan da suke da alaka da wasu abubuwan da ba a sani ba (misali, yanayin caca) maganin jaraba. Suna nuna damuwa da ayyukan yanar-gizon, suna jin cewa ba za su iya yin amfani da yanar gizo ba, suna nuna karar da aka yi amfani da su a kan layi (haƙuri), suna jin haushi da dysphoric lokacin da aka ƙuntatawa ko kuma a hana su shiga yanar gizo yankuna daban-daban na rayuwa (misali, rikice-rikice tare da iyalan iyali da kuma ragowar nasarori a makaranta, koleji, ko aikin), kuma ba su iya yankewa daga halayyarsu (asarar iko). Tun lokacin da aka ba da karin daidaito game da siffofin kwayoyin neurobiological (alal misali, [6]; don nazarin duba [7]) da kuma kamance a cikin yanayin hali (misali, [8, 9]), an ba da shawarar ganin I matsayin wani irin matsalar rashin jaraba da ba'a sani ba. Bugu da ƙari kuma, yawan ƙwayar da aka yiwa com IA a cikin marasa lafiya da ke shan wahala daga wasu nau'i na jaraba da aka ruwaito sun tabbatar da wannan zato [6, 10].

Cibiyar nazarin ilimin lissafi ta kara yawan bayyanar cututtuka da kuma rage matakan yin aiki a cikin marasa lafiya [11], da inganta yanayin rayuwa [12], juyawa zamantakewa, da kuma rarrabewa, kamar [13], da kuma matakan da suka shafi magungunan psychosocial da psychopathological [14, 15 ]. Alal misali, Morrison da Gore [16] sun ruwaito matakan da ke ciki a cikin samfurin mahalarta masu nazarin 1319. Haka kuma, Jang da abokan aiki [17] sun wallafa yawan ƙananan psychosocial, musamman game da alamun cututtukan da ke da matukar damuwa da kuma cututtuka a cikin matasan da ke fama da ita.

Tun da yake AI yana da ƙwarewa sosai a matsayin mummunan rashin hankali na tunanin mutum wanda ya haifar da matsala da kuma rage matakan aiki a wa anda ke da nasaba da shi, kokarin da ake yi wajen bunkasa da kuma rubuta wasu hanyoyin maganin magunguna, ciki har da ayyukan psychotherapeutic and psychopharmacological na IA [18]. Kodayake mutum ya yarda da cewa binciken binciken asibiti na yau da kullum ba shi da cikakken inganci ko kuma yana dogara ne akan samfurin samfurin marasa lafiya kamar haka (domin nazari kan binciken binciken binciken na IA na ganin King et al. [18]), binciken farko game da amsa da sakewa bayan magani a IA yana da alamar alkawari.

Ɗaya daga cikin binciken da ya sadu da matakai masu yawa na binciken binciken asibiti bisa ga nazarin nazari na Sarki et al. [18] bincika tasiri na tsarin haɓaka-halayen multimodal a cikin matasan tare da IA ​​[19]. 32 marasa lafiya da aka bi saboda IA ​​sun kasance da kididdiga idan aka kwatanta da ƙungiyar kula da jiragen da basu karbi magani (rubutun 24). Bayanan farko na wannan binciken sun haɗa da ma'auni na kai-tsaye ga IA (Intanit Mai Bayarwa ta Intanit ta hanyar Cao da Su [20]) da kuma rahotanni masu dacewa da kimanta ka'idojin gudanarwa na lokaci da kuma alamun lafiyar mutum. An canza canje-canje a cikin wadannan matakan sakamako kafin, nan da nan bayan, kuma a ƙarshen magani. An bi bayan biyan watanni shida bayan jiyya. Sakamakon ya nuna cewa, a cikin kungiyoyi guda biyu, yawan karuwar alamun da ke ciki na NI ya kasance mai lurawa kuma yana da karfin tsawon watanni shida. Duk da haka, ƙungiyar kulawa kawai tana nuna matukar muhimmanci a cikin kula da aikin lokaci da kuma rage matsalolin halayyar kwakwalwa game da matsalolin tashin hankali da zamantakewa.

Hakazalika, nazarin da ake amfani da magani na psychopharmacological sun nuna alamun sakamako mai nuna alamun cewa marasa lafiya da IA ​​sun amfana daga SSRI da Methylphenidate [21, 22], abubuwan da suka dace daga shaida na asibiti a kula da marasa lafiya da matsalar caca [23].

Bugu da ƙari, binciken Wizler da abokan aiki [24] da aka buga a kwanan nan da suka haɗa da gwajin gwaji na 16 tare da hanyoyi daban-daban na likitanci da aka danganta da magunguna na 670 sun nuna tasiri mai kyau na kulawa da IA: cikakkun bayanai suna nuna cewa akwai bambanci da yawa dangane da nau'in na maganin warkewa tare da shirye-shiryen haɓaka-halayen da ke nuna alamun sakamako masu girma () game da rage alamomi na IA fiye da wasu hanyoyin haɗin ƙwalƙwalwa (). Duk da haka, sakamakon gaba ɗaya ya nuna cewa kowane tsarin kulawa da aka gwada ya haifar da sakamako mai mahimmanci.

Duk da haka, wallafe-wallafe game da sakamakon da aka samu a cikin NI har yanzu suna da alaƙa da yawa a hanyoyi da dama, kamar yadda mawallafin mawallafi na 24, 327 ya bayyana a baya: "Duk da haka wannan binciken ya nuna rashin daidaito hanyar nazarin maganin sauti, yana ba da hankali game da binciken da ake yi na maganin rigakafi na zamani, binciken bincike na pont daga "Gabas" da kuma "Yamma" kuma shine mataki na farko a ci gaba da bayar da shawarwarin maganin shaida. "Wannan yana ƙarfafa bukatun ƙarin gwaje-gwaje na asibiti da dogara ga tsarin tsare-tsaren daidaitawa. Bisa ga wannan yanayin, za mu gabatar da shirin kula da tunanin kirkiro na ɗan gajeren lokaci na IA kuma samar da bayanai na farko daga bincike mai matukar jirgi game da amfani da sakamakonta. Kodayake binciken wannan jarrabawar na iya dogara ne a kan karamin samfurin ƙarami kuma ba tare da hada ƙungiyar kula da jirage ba, muna ganin shi yana taimakawa wajen buga waɗannan bayanai na farko.

1.1. Taimakon gajeren lokaci ga Intanet da Kwasfuta Game da Kwamfuta (STICA)

Tun da 2008, ɗayan ƙungiyar Gidajen Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararriya a Jamus ya ba da shawara ga marasa lafiya masu fama da nau'o'in IA. A halin yanzu, game da marasa lafiya 650-yawancin maza da ke tsakanin 16 da 35 shekaru-sun gabatar da kansu a matsayin masu neman magani. Bisa ga haɓaka masu haɗaka da haɗin gwiwa, an kirkira shirin kirkiro na likitanci don ci gaba kuma an tsara fasalin ilimin farfadowa (STICA) [25] wanda ya danganci fasaha na haɓaka-halayen da aka sani daga shirye-shiryen maganin wasu nau'o'in haɓaka. STICA tana nufin amfani dashi don maganin jiyya kuma yana ƙunshi taro na ƙungiyar 15 da ƙarin zaman takwas na farfadowa guda.

Duk lokacin da kowane mutum yake magana da abubuwan da mutum ke ciki, ƙungiyar suna biye da tsari mai mahimmanci. A cikin kashi na uku na wannan shirin, manyan batutuwa sun shafi tsarin ci gaba da manufofin mutum, ganewa da aikace-aikacen Intanet wanda ke hade da alamomi na IA, da kuma gudanar da bincike na bincikar ilimin lissafi, kasawa, albarkatun, da sauransu. damuwa maras kyau. Hanyoyi na motsa jiki suna amfani da su don inganta burin marasa lafiya don yanke lalacewar dysfunctional. A karo na biyu na uku, an gabatar da abubuwa masu kwakwalwa da kuma zurfafa nazari game da yadda ake amfani da yanar-gizon, da mayar da hankali ga abubuwan da ke tattare da shi da kuma halayen mai haƙuri a kan halin da ake ciki, tunanin zuciya, psychophysiological, da kuma halin da ake ciki (SORKC-scheme, [18] , an yi. Ɗaya muhimmiyar mahimmanci a wannan mataki shi ne ci gaba da samfurin jiki na IA ga kowane mai haƙuri, bisa ga hulɗar aikace-aikace na Intanit da aka yi amfani dasu, tsinkaya da kuma kiyaye abubuwan da ke cikin haƙuri (misali, yanayin hali) da yanayin zamantakewar marasa lafiya. A mataki na karshe na farfadowa, yanayi tare da sha'awar neman samun layi na yau da kullum an kayyade da kuma hanyoyin da za'a hana sake dawowa. Ana bayarda cikakkun bayanai game da tsarin STICA a Table 1.
tab1
Table 1: Shirye-shiryen maganin maganin farfadowa "Tsarin lokaci don maganin intanet da kuma jarabawar kwamfuta" (STICA).
1.2. Tambayoyin Bincike

A cikin wannan binciken, muna nufin tattara bayanai na farko game da tasirin STICA. Har ila yau, mun yi niyya don nuna alamun marasa lafiya da suka haɗa da alamun lafiyar jiki, haɓaka, da halaye na mutum wanda zai iya taka muhimmiyar rawa wajen maganin warkar da cututtuka game da gina wani magungunan warkewa da bambance-bambance a cikin amsa maganin [13]. Bugu da ƙari, ana haifar da cututtukan lahani na psychosocial a farkon yanayin farfadowa da halaye a kan sakamakon maganin. A ƙarshe, muna so mu samar da kwatanta tsakanin marasa lafiya a lokacin da aka kammala farfadowa (kammalawa) da waɗanda suka fita daga shirin (dropouts).

2. Kaya da matakai
2.1. Samun Bayanai da Tattalin Arba'in Tattaunawa

A cikin wannan gwaji, an tattara bayanai daga 42 marasa lafiya a jere su gabatar da kansu zuwa Ciwon Tallafi na Ƙwararrun Ƙwararrun ƙwaƙwalwa a cikin Jamus saboda IA ​​(ƙwararren ƙwaƙwalwar samfurin). Wadannan marasa lafiya sun hada da wani samfurin asibiti na masu bincike na 218. Daga waɗannan, 74 (33.9%) dole ne a cire saboda rashin bin ka'idodi na IA. 29 (13.3%) ya kamata a cire wasu batutuwa saboda kasancewa a cikin shekaru 17. 73 ƙari ƙananan (33.5%) sun kasance saboda mummunan cututtuka, rashin yarda da magani, ko tsanani na IA na yin magani mai asibiti. An tambayi marasa lafiya don samar da bayanan sirri ga aikin kimiyya kuma sun ba da izinin sanarwar da aka rubuta. An gudanar da binciken ne tare da sanarwar Helsinki. Saboda rasa bayanai ko cikakke a cikin maƙalafan farko a T1, an cire maƙasudin 5 daga nazarin bayanan ƙarshe.

Ka'idojin haɓakawa sun kasance kasancewar IA bisa ga AICA-S (Siffar don Aiki na Intanit da Computer Game da Addini, AICA-S [26]; duba sakin layi na 2.2) da kuma nazarin nazarin IYA (AICA-C, Jerin Lissafi na Binciken Nazarin Intanit da Kayan Kwalfuta, [15]). Bugu da ƙari, nau'in jinsi da kuma shekaru fiye da shekaru 16 sun kasance ƙarin bukatun.

Tsarin taƙaice da ake magana da shi ga cututtukan cututtuka masu tsanani (wasu cututtuka masu jaraba, cututtukan zuciya, matsananciyar zuciya, damun hali na hali, da kuma halin mutunci). Har ila yau, marasa lafiya suna bayar da rahoto akan magani yanzu saboda cututtuka na rashin lafiya da kuma wadanda aka bayar da rahotanni a cikin maganin ƙwaƙwalwar magunguna.

A matsayin maƙasudin mahimmancin ra'ayi, da aka ƙaddamar da NAS bisa ga takardar lissafin kai-tsaye (AICA-S). A matsayi na biyu, an canza canje-canje a cikin masu biyowa masu zuwa kamar haka: ƙananan cututtuka na psychosocial, lokacin da aka lalace a kan layi, sakamakon lalacewa saboda amfani da Intanet, da kuma tsammanin aikin kai.

An tantance bayanai a farkon farfadowa (T0) kuma nan da nan bayan an gama farfadowa (T1). Ana bayar da rahotanni na bayanai game da yanayin biyu, da niyyar bi da su (ciki har da marasa lafiya) da kuma kammalawa. Don ƙididdigar da za a yi, an yi amfani da hanya na karshe (LOCF) ta ƙarshe. LOCF ya ba da shawarar yin amfani da bayanan ƙarshe da aka samo a cikin waɗannan batutuwa ba tare da kawo karshen yanayin magani ba akai-akai. A cikin binciken yanzu, ana amfani da bayanai daga T0 don waɗannan batutuwa da suka fice daga shirin kulawa kafin a tantance T1.

Don nazarin ilimin lissafi, an yi amfani da gwaje-gwaje na shagon don kwatanta samfurori masu rikitarwa tare da cramer-v a matsayin ma'auni na girman sakamako. Canje-canje a cikin mahimmanci na farko da na sakandare an auna ta ta yin amfani da takaddun shaida don gabatarwa da baya don samfurin guda, tare da ma'aunin girman girman girman samfurori. Bisa ga shawarar da Dunlap et al. [27], an ƙayyade an ƙidaya idan haɗawa tsakanin pre- da postscores na masu musayar dogara sun fi girma fiye da 0.50. Ana yin nazarin duk ta amfani da SPSS 21.

2.2. Instruments

Don rarrabuwa na IA, an yi amfani da matakai biyu a T0. Domin Siffar da Aikin Aiki na Intanet da Kwarewar Kwasfuta (AICA-S, [26]), an auna ma'aunin kai-da-kai na daidaitaccen AI bisa ka'idodin da aka dace don matsalar caca da kuma abubuwan da ke tattare da abu (misali, damuwa, haƙuri , janyewa, da asarar iko). Kowane siginar da ke nuna AI ana kiyasta ko dai a kan ma'aunin Likert guda biyar (ba a sau da yawa) ko a cikin yanayin dichotomous (a / a'a) kuma za a iya samo asali mai mahimmanci daga tarawar abubuwan da aka gano. An cire nau'in 7 da aka yanke (wanda yake daidai da dukan nau'ikan 4 wanda aka haɗu) an sami mafi kyau bincike a daidaituwa a gano NI (ƙwarewa = 80.5%; musamman = 82.4%) a cikin binciken da marasa lafiya ke shigar da mu. asibitin. Bisa ga binciken da ya gabata, AICA-S za a iya daukanta a matsayin mai kyau na kwarewa na kamfanoni (Cronbach's), ingantattun tsari, da kuma ƙwarewar asibiti [11]. Tun da AICA-S shine maɓallin farko, an kuma tantance shi a T1.

Don ci gaba da tabbatar da asali na IA, an yi amfani da sanannen ƙwararren asibiti. Lissafin Lissafi na Intanit da Kwasfuta Game da Kwamfuta (AICA-C, [15]) an yi amfani dasu don wannan dalili. AICA-C ya hada da ka'idodi guda shida na IA (farfadowa, hasara na kulawa, janyewa, sakamakon rashin lafiya, haƙuri da kuma sha'awar) wanda masanin ilimin horar da ya kamata ya nuna shi a kan ma'aunin maki shida daga 0 = ma'auni wanda ba a sadu ba zuwa 5 = cikakkiyar ma'auni. Bisa ga binciken da ke tattare da bincikensa daidai, cutarwa na 13 maki ya samar da mafi kyawun dabi'un (ƙwarewa = 85.1%; musamman = 87.5%). An samu nasarar binciken shi don ƙwaƙwalwar kamfanoni (Cronbach's) da daidaitattun asibiti [15].

Anyi amfani da Girman Sakamakon Ƙarƙashin Kai (GSE; [28]) don tantance aikin gina jiki mai mahimmanci ta hanyar abubuwa goma. An fahimci GES kamar yadda yawancin ka'idodin shari'ance na yawan adalcin mutum ya iya magance matsaloli da kalubale a yau. Yawancin binciken sun ruwaito cewa GSE dole ne a ɗauka a matsayin muhimmiyar matsala, tare da babban GSE wanda ya kebantawa da canjin halin aiki da kuma sa mutane su fuskanci yanayi na musamman [29]. An gudanar da GSE a T0 da T1.

An kirkiro NNUXNNXX na NAS da aka tsara don auna ma'auni guda biyar daga cikin Ciniki Dalilai guda biyar. Ya ƙunshi abubuwa na 30 da aka amsa a kan 60-ma'auni Sikakken Sikakke kuma yana daya daga cikin matakan da ake amfani da su a cikin bincike na mutum. Yawancin binciken sun jaddada ingantattun mahimmanci da ƙwarewa [5]. An yi amfani da NEO-FFI ne kawai a T4 don bincika ikon da aka sani game da abubuwan biyar akan farfadowa da daidaituwa.

A ma'auni, T0 da T1, alamun cututtuka na psychopathological an gwada su ta hanyar amfani da 90R [31] Lissafin Jigilar Halittu, wanda aka yi amfani dashi na tambayoyi na asibiti tare da abubuwa masu mahimmanci na zuciya [32]. Hakanan 90 abubuwa (0 = babu alamun cututtuka ga 4 = karfi da alamar cututtuka) suna ƙaddamar da ƙwayar cutar Psychopathological. SCL-90R tana nufin batun da batun ya samo alamar cutar a makon da ya wuce. Ƙididdiga mai zurfi na duniya (GSI) -a cikewar duniya gaba ɗaya a cikin rassa tara - wakiltar ƙuntatawa ta gaba.

3. Sakamako
3.1. Bayani na Samfurin

Za a iya samun labarun zamantakewa na masu neman magani a Table 2.
tab2
Table 2: Bayanan zamantakewa na masu neman magani sun haɗa da wannan gwaji.

Kamar yadda za'a iya samuwa daga Table 2, yawancin marasa lafiya ba su cikin haɗin gwiwa tare da kusan rabin su ke zaune a gida tare da iyayensu. Yawancin masu neman magunguna ba su aiki ba amma suna da makarantar sakandare.

Yawancin marasa lafiya sun nuna amfani da kayan yin amfani da layi ta kwamfuta-kwamfuta (78.4%). 10.8% suna amfani da aikace-aikace na Intanit daban-daban, 8.1% amfani da shafukan sadarwar zamantakewa, kuma 2.7% suna yin bincike mai zurfi a bayanan bayanan bayanai.

Game da siffofi masu rarraba, an gano alamun nan na NEO-FFI: () don neuroticism, () don cirewa, () don budewa, () don yarda, da kuma () don ƙwarewa.

3.2. Canje-canje a Matsayi na Farko da na Farko

70.3% (26) ya gama ci gaba akai (kammalawa), marasa lafiya na 29.7% (11) sun fita a lokacin hanya (ragowar ƙasa). Sakamakon ya nuna cewa masu kammalawa suna da muhimmancin cigaba a cikin firamare da kuma mafi yawan mahimman bayanai. Za'a iya samo abubuwan da aka kafa na farko da na sakandare don masu kammalawa daga

Table 3: Canje-canje a cikin matakan farko da na sakandare a cikin masu kammalawa.

Kamar yadda ake gani a cikin Table 3, ƙimar da aka samu a cikin AICA-S na iya gani bayan magani. Bugu da ƙari kuma, raguwa mai yawa a cikin hours da aka kashe a kan layi ta kowace rana da rage rage rikice-rikice saboda amfani da yanar-gizon a cikin biyar daga cikin yankuna shida da aka kiyasta ana iya gani. Haka kuma, an samu raguwa mai yawa a cikin GSI, tare da kammalawa da ke nuna ƙananan karatun bayan jiyya a cikin kashi bakwai na cikin tara na SCL-90R.

Kamar yadda ake sa ran, farfadowar farfadowa ya kasance da karami yayin da ake kara magunguna ga nazarin. Duk da haka, ƙididdiga-da-maimaitawa ta nuna cewa bayan magani, kashi a cikin AICA-S ya rage ƙwarai (,;). Haka kuma an lura da yawan adadin lokacin da aka yi amfani da shi a layi a wata rana na karshen mako (,;) da kuma duk wani mummunan sakamako da ya shafi yanar gizo (,;). Bugu da ƙari, a cikin bayyanar cututtuka, ƙwarewar mahimmanci da kuma musayar ra'ayoyin sun kasance tabbatacce, game da GSI (,;;) da kuma SCL-suna da matukar damuwa (,;), rashin tsaro na zamantakewa (,;), damuwa (,;), damuwa (,; ), zalunci (,;), jijiyar hankali (,;), da kuma psychoticism (,;). Bugu da ƙari, tsinkayar mahimmanci na kai ya kara muhimmanci bayan jiyya (,;).
3.3. Hanyoyin Jagora kan Jagoran Kulawa

Binciken na bambancin zamantakewar al'umma tsakanin masu cikawa da dropouts bai nuna matukar sakamako game da shekaru, haɗin gwiwa, matsayi na iyali, halin rayuwa, ko matsayin aiki. Bambanci kawai wanda yake nuna muhimmancin (;; cramer-v = .438) ya samu a cikin ilimin tare da cikakke wanda yake nuna makaranta na makarantar firamare (76.9%) fiye da lalata (63.7%).

Game da tasirin hali na mutuntaka a kan farfadowa, ba a sami bambance-bambance mai mahimmanci ba, banda faɗakarwar factor. Wani muhimmin abin da ya faru yana nuna cewa kammala (;) suna nuna maki fiye da lalacewa (;;,). Haka kuma, ba a sami bambance-bambance daban-daban game da alamun lafiyar jiki a cikin T0 (SCL-90R) ko kuma mataki na sa ido na kai-tsaye (GSE). Har ila yau, yawancin bayyanar cututtukan NI ba su nuna bambanci a tsakanin masu cikawa da kuma ragowar su ba kuma ba su da adadin lokutan da aka kashe a kan layi (AICA-S).

4. Tattaunawa

A cikin wannan binciken na gwaji, mun binciki sakamakon ilimin psychotherapy na gajeren lokaci akan samfurin abokan ciniki da ke fama da ita. Don wannan dalili, an fara biyan marasa lafiya na 42 farko bisa ga tsarin farfado da yanayin lafiyar lafiyar mutum wanda aka tantance lokacin da yake shiga farfasa kuma nan da nan bayan an gama shi. A matsayinmu na farko, mun tantance alamomi na IA kamar yadda ma'aunin kai rahoton (AICA-S; [26]). Bugu da ƙari, lokaci ya ɓace a kan layi, sakamakon da ya haifar da mummunar tasiri daga ayyukan layi, tsinkayar aikin kai, da kuma alamun halayyar kwakwalwa da aka ƙayyade a matsayin dalilai na biyu.

Game da 70% na masu neman maganin sun wuce shirin ci gaba cikakke (kammalawa), kuma kimanin kashi ɗaya cikin uku ya fita daga lokacin farfadowa. Saboda haka, labarun da aka lalace yana da kyau a cikin tsinkayen magunguna a cikin kula da lafiyar jiki (duba [33]; 19-51%) amma ya wuce wadanda aka ruwaito ta hanyar Winkler da abokan aiki (duba [24]; 18.6%). Ƙarin binciken ya nuna cewa tsarin kulawa yana da alamun sakamako. Bayan farfadowa, karamin karuwar yawan bayyanar cututtuka na IA za a iya kiyayewa. Sakamakon masu girma da aka samu a nan an samo ga masu kammalawa da kuma cikakkiyar samfurin ciki har da maɓuɓɓuka. Bisa ga ma'anar Cohen [34], ana iya ganin hakan a matsayin alamar babban sakamako. Bugu da ƙari kuma, ya dace da ƙwarewar halin da ake ciki a halin yanzu bayan da ya dace da hankali (tare da amincewa da juna tsakanin .84 da 2.13) sun ruwaito a cikin maganganu-ta-kwaskwarima ta Winkler et al. [24]. Bugu da ƙari, lokacin da aka yi amfani da shi akan labaran karshen mako ya rage raguwa bayan farfadowa da nauyin sakamako mai girma kamar yadda aka bayar da sababbin bincike-bayanan akan batun (duba [24];).

Yana da mahimmanci a bayyana cewa manufar wannan farfadowa na farfadowa ba shine ya hana marasa lafiya daga kowane amfani da Intanet ba. Maimakon haka, an tsara wasu manufofin farfadowa bisa ga sakamakon fasalin da aka yi amfani da ita don amfani da hanyoyin amfani da Intanet na masu haƙuri da kuma matsalolin amfani da abubuwan Intanet. Manufar maganin da ke motsa wanda ya yi haƙuri ya fara haɓaka daga aiki na Intanet wanda aka gano yana da alaka da ainihin alamun bayyanar AI, kamar ɓataccen iko da sha'awar. Saboda haka, ba a sa ran farashin zauren da aka yi amfani da shi a kan layi ba. Lallai, lokaci na lokaci na 2.6 na yau da kullum a kowace rana yana da kyau a cikin iyakar yawan mutanen Jamus. A cikin wani wakilci na wakilci game da batun 2500 Jamus, Müller et al. [35] ya ruwaito cewa lokacin da aka yi amfani da shi a kan labaran karshen mako ya kasance 2.2 hours a cikin masu amfani da Intanet.

Bugu da ƙari kuma, mafi yawan mahimman ra'ayi na biyu sun canza mahimmanci yayin farfadowa. Da farko dai, matsalolin da suka taso daga yin amfani da yanar-gizon ba da launi ba su raguwa a wurare da dama, game da yawan rikice-rikice na iyali, musun sauran ayyukan wasanni, yawan matsalolin kiwon lafiya, yin gwagwarmaya da abokai, da kuma mummunar tasiri a makaranta ko aiki. Tsaro mai ingancin mutum ya karu tare da matsanancin ƙarfin hali da mahimmanci a cikin GSE bayan jiyya ya yi kama da wanda aka samu daga yawan mutanen Jamus [28]. Wannan ya nuna cewa tsammanin sa zuciya ga iyawar mutum na haifar da matsalolin bayyanar da kalubalanci ya kai matakin karɓa bayan magani. Idan bambance-bambance a cikin tsinkayyar mahimmanci tsakanin marasa lafiya bayan magani za a iya ganewa a matsayin mai hangen nesa ga tsakiyar-da kuma tsayayyar farfadowa, dole ne a bincika sakamakon binciken karatu.

A ƙarshe, psychosocial bayyanar cututtuka hade da IA ​​ya rage muhimmanci bayan magani. Wannan shi ne lamarin ga jerin abubuwan da ke faruwa a duniya da kuma kashi bakwai na tara na SCL-90R. An yi girma manyan ƙananan sakamako ga yanayin duniya mai tsanani da kuma rugujewa-da karfi da cututtuka, da kuma rashin tsaro na zamantakewa.

Abin mamaki shine, ba mu sami wani bambanci da ke bambanta tsakanin marasa lafiya da ke ci gaba da cikakkiyar farfadowa da kuma waɗanda ke fita daga cikin shirin da zai iya kasancewa alamar alamar samun nasara. Akwai wani yanayin da ya nuna mahimmanci wanda ya nuna cewa marasa lafiya da cibiyoyin ilmantarwa sun fi dacewa su gama gwadawa akai-akai. Bugu da ƙari, mun sake samowa - wadanda marasa lafiya sun kammala nunawa mafi girma a cikin halin mutuntaka. A cikin wallafe-wallafe na wallafe-wallafe, ana bayyana yadda ake sha'awar sauye-sauye ga tunanin gargajiya da aiki da kuma nuna sha'awar sababbin abubuwa da hanyoyi na tunani [36]. Mutum zai iya yin hakan daga wannan ne cewa marasa lafiya suna daukar hoto a kan wannan lamari na iya samun halin kirki game da psychotherapy kuma sabili da haka sun fi samun damar shiga cikin canje-canje na psychotherapy. Duk da haka, dangantaka da aka ruwaito a nan ba ta da muhimmanci kawai. Wannan ƙila za a iya kwatanta wannan ƙananan samfurin, musamman ma game da marasa lafiya da suka watsar da magani. A bayyane yake, ana buƙatar karin bincike don gano magungunan maganin farfadowa a cikin marasa lafiya tare da IA.

Wannan binciken yana da ƙididdiga da dama da ake buƙatar magance su. Babban kuskuren dole ne a gani a cikin rashin ƙungiyar kulawa, ko mai sarrafa jiragen jiragen sama (WLC) ko farfesa kamar yadda aka saba gudanarwa (TAU). Tun da akwai kawai yanayin guda ɗaya na ƙungiyar kulawa, ƙididdigar lissafi (ta hanyar jituwa tsakanin bangarori) da iyakokin fassarori suna bayyane. Ba zai yiwu ba a karshe ƙayyade idan sakamakon rage rage alamun bayyanar cututtuka na IA da kuma ƙwaƙwalwar ƙwaƙwalwar haɓaka ta hanyar ƙwaƙwalwar magunguna ko asali daga masu canji waɗanda ba a sarrafa su ba. Abu na biyu, an yi amfani da samfurin samfurin masu neman magunguna ba tare da wata hanya ba. Wannan ya haifar da tambaya idan masu halartar wannan binciken su zama zaɓaɓɓe. Bugu da ƙari, ƙananan marasa lafiyar 42 ne kawai suka samo asibiti a karkashin bincike. Wannan ƙananan samfurin samfurin ne wanda ba ya ƙyale duk wani nazari na ƙididdigar lissafi (misali, rinjayar daban-daban na sakamako na IA akan). Tun da samfurin ya kunshi kawai marasa lafiya, ba za a iya samun cikakkiyar binciken ga marasa lafiya ba. A ƙarshe, zane-zane ba ya haɗa da biyo baya ba, saboda haka ba zai yiwu a zana shawara game da zaman lafiyar farfadowar farfadowa da aka lura nan da nan bayan magani. Don gyara wadannan kuskuren, marubuta suna gudanar da gwaji na asibiti a yanzu [17]. Wannan aikin da ke nufin hada 193 marasa lafiya da ke shan wahala daga IA sun ƙunshi jigilar mutane da yawa da kuma gwagwarmayar sarrafawa tare da kimanin watanni 12 bayan ƙaddamar da farfadowa.
5. Kammalawa

Bisa ga bayanan da aka bayar a cikin wannan binciken na jirgi, yana da kyau a tsammanin cewa magani na likitanci na marasa lafiya da ke shan wahala daga IA yana da tasiri. Bayan an yi amfani da wani maganin haɓakaccen halayen zuciya, mun sami canje-canje mai mahimmanci a cikin bayyanar AI, lokacin da aka kashe a kan layi, abubuwan da ba su da kyau bayan amfani da yanar-gizon, da kuma alamun cututtuka na psychopathological, tare da mafi girma a kan cututtukan da ke cikin damuwa. Wannan binciken na matukin jirgi, wanda aka gudanar don gabatar da gwagwarmaya ta gwagwarmaya, ya ba da tabbacin cewa Winkler da abokan aiki [24] sun samo asali daga bayanan maganganun su: IA ta nuna rashin lafiya ne wanda za a iya magance shi da kyau ta hanyar dabarun ilimin psychotherapeutic - akalla lokacin da yake magana akan farfadowa na gaggawa.
Rikici na Bukatun

Mawallafa sun furta cewa babu rikice-rikice akan bukatun game da buga wannan takarda.

References

    K.-W. Fu, WSC Chan, PWC Wong, da kuma PSF Yip, "Tashin yanar-gizon yanar-gizon: farfadowa, nuna bambanci da daidaitawa a tsakanin matasa a Hongkong," Jaridar Birtaniya ta Lafiya, Harshen. 196, a'a. 6, shafi na 486-492, 2010. Duba a Publisher · Duba a Google Scholar · Duba a Scopus
    E. Aboujaoude, LM Kur'ani, N. Gamel, MD Large, da kuma RT Serpe, "Alamar da ke iya amfani da ita ta amfani da intanet: nazarin wayar tarho na 2,513 manya," CNS Spectrums, vol. 11, a'a. 10, shafi na 750-755, 2006. Duba a Scopus
    G. Floros da K. Siomos, "Yin amfani da yanar-gizo mai yawa da mutunci," Rahoton Neuroscience na yanzu, vol. 1, shafi na 19-26, 2014.
    G. Murray, D. Rawlings, NB Allen, da kuma J. Trinder, "Sakamakon jari-hujja guda biyar: abubuwan da ke cikin kwakwalwa a cikin samfurin al'umma," Ƙididdiga da Bayani a Tattaunawa da Ƙaddamarwa, vol. 36, a'a. 3, shafi na 140-149, 2003. Duba a Scopus
    Ƙungiyar Ƙwararrun Ƙwararrun Amurka, Dokar Harsarki da Ta'idodi na Manyan Lafiya, (DSM-5), Ƙwararren Ƙwararrun Ƙasar Amirka, 5th edition, 2013.
    CH Ko, JY Yen, CF Yen, CS Chen, CC Weng, da CC Chen, "Ƙungiyar dake tsakanin jita-jita ta intanet da kuma barazanar barazanar amfani dasu a cikin matasan: ƙirar matsala," Cyberpsychology and Behavior, vol. 11, a'a. 5, shafi na 571-576, 2008. Duba a Publisher · Duba a Google Scholar · Duba a Scopus
    CH Ko, GC Liu, JY Yen, CF Yen, CS Chen, da kuma WC Lin, "Harkokin kwakwalwa don yin amfani da wasan kwaikwayon wasan kwaikwayon da kuma shan fyade a tsakanin batutuwan da suka hada da jita-jita ta yanar gizo da kuma nicotine dogara," Journal of Psychiatric Research, kundi. 47, a'a. 4, shafi na 486-493, 2013. Duba a Publisher · Duba a Google Scholar · Duba a Scopus
    DJ Kuss da MD Griffiths, "Intanet da wasan kwaikwayo na wasan kwaikwayon: nazari na wallafe-wallafe game da nazarin neuroimization," Kimiyya Brain, vol. 2, a'a. 3, shafi na 347-374, 2012. Duba a Publisher · Duba a Google Scholar
    KW Müller, ME Beutel, B. Egloff, da K. Wölfling, "Bincike abubuwan da ke haddasa halayen wasan kwaikwayon intanit: kwatanta marasa lafiya tare da wasan kwaikwayo na nishaɗi, masu caca da masu kare lafiyar jiki da kuma kulawar lafiya game da manyan halayen mutum biyar, . 20, a'a. 3, shafi na 129-136, 2014. Duba a Publisher · Duba a Google Scholar
    KW Müller, A. Koch, U. Dickenhorst, ME Beutel, E. Duven, da kuma K. Wölfling, "Yin bayani game da batun maganin cututtuka-ƙananan halayen yanar gizo na intanet: kwatanta halin mutum a cikin marasa lafiya tare da ciwon haɗari da kuma intanet buri, "BioMed Research International, kundi. 2013, Tambaya na ID 546342, 7 shafuka, 2013. Duba a Publisher · Duba a Google Scholar · Duba a Scopus
    KW Müller, ME Beutel, da kuma K. Wölfling, "Kyautattun labarun yanar-gizon yanar-gizon Intanet a cikin samfurin masu neman magani: inganci na kima, rashin daidaituwa da kwakwalwar jiki da kuma irin rashin lafiya," Kwararren Kwayoyi, Vol. 55, a'a. 4, shafi na 770-777, 2014. Duba a Publisher · Duba a Google Scholar
    G. Ferraro, B. Caci, A. D'Amico, da MD Blasi, "rikicewar jita-jitar intanet: nazarin Italiyanci," Cyberpsychology da Halayyar, vol. 10, babu. 2, shafi na 170-175, 2007. Duba a Madaba'i · Duba a Masanin Google · Duba a Scopus
    TR Miller, "Amfani da ilimin psychotherapeutic na abubuwa biyar na halayen mutum: kwarewar likita," Journal of Personality Assessment, vol. 57, babu. 3, shafi na 415-433, 1991. Duba a Scopus
    Mista Beranuy, U. Oberst, X. Carbonell, da kuma A. Chamarro, "Harshen yanar-gizo mai amfani da wayar tafi-da-gidanka da kuma maganin asibiti a daliban kolejin: aikin da tunanin tunanin mutum," Kwamfuta a Harkokin Dan Adam, vol. 25, a'a. 5, shafi na 1182-1187, 2009. Duba a Publisher · Duba a Google Scholar · Duba a Scopus
    K. Wölfling, ME Beutel, da kuma KW Müller, "Ginar wata jarrabawar jarrabawa don nazarin jita-jitar yanar gizo: binciken farko game da amfani da AICA-C," Journal of Addiction Research and Therapy, vol. S6, labarin 003, 2012. Duba a Publisher · Duba a Google Scholar
    EJ Moody, "Amfani da Intanet da dangantaka da lalata," Cyberpsychology and Discipline, vol. 4, a'a. 3, shafi na 393-401, 2001. Duba a Publisher · Duba a Google Scholar · Duba a Scopus
    S. Jäger, KW Müller, C. Ruckes et al., "Hanyoyin da ake amfani da shi na gajeren lokaci na yanar gizo da kuma cin zarafi game da kwamfuta (STICA): nazarin binciken don gwajin gwagwarmayar da bazuwar rayuwa," Gwagwarmaya, kundi. 13, rubutun 43, 2012. Duba a Publisher · Duba a Google Scholar · Duba a Scopus
    FH Kanfer da JS Phillips, Tushen Ilmantarwa na Halayyar havabi'a, John Wiley & Sons, New York, NY, Amurka, 1970.
    Y. Du, W. Jiang, da kuma A. Vance, "Tsarin lokaci na bazara, jagorancin rukuni na maganganu na ilimin likita na Intanit a makarantar yara a Shanghai," Australian da New Zealand Journal of Psychiatry, vol. 44, a'a. 2, shafi na 129-134, 2010. Duba a Publisher · Duba a Google Scholar · Duba a Scopus
    F. Cao da L. Su, "Abubuwan da suka danganci yin amfani da yanar-gizo a makarantun sakandare," injin jarida ta kasar Sin, mai suna Vol. 39, shafi na 141-144, 2006.
    DH Han, YS Lee, C. Na et al., "Sakamakon methylphenidate a kan wasan bidiyon Intanet wanda ke wasa a yara da nakasawa / gurguntaccen cututtuka, 50, a'a. 3, shafi na 251-256, 2009. Duba a Publisher · Duba a Google Scholar · Duba a Scopus
    B. Dell'Osso, S. Hadley, A. Allen, B. Baker, WF Chaplin, da E. Hollander, “Escitalopram a cikin maganin rashin karfin amfani da intanet mai tursasawa: gwajin bude tambari da mai ido biyu ya biyo baya lokacin dakatarwa, ”Journal of Clinical Psychiatry, vol. 69, babu. 3, shafi na 452-456, 2008. Duba a Scopus
    JE Grant da MN Potenza, "Escitalopram maganin labarun caca da rikice-rikicen rikice-rikice: binciken da aka yi wa jarrabawar da aka yi wa lakabi tare da rufewar makamai," International Clinical Psychopharmacology, vol. 21, a'a. 4, shafi na 203-209, 2006. Duba a Publisher · Duba a Google Scholar · Duba a Scopus
    A. Winkler, B. Dörsing, W. Rief, Y. Shen, da kuma JA Glombiewski, "Gudanar da jita-jita na yanar-gizon: maganin bincike-bincike," Clinical Psychology Review, vol. 33, a'a. 2, shafi na 317-329, 2013. Duba a Publisher · Duba a Google Scholar · Duba a Scopus
    K. Wölfling, C. Jo, I. Bengesser, ME Beutel, da KW Müller, Computerspiel-und Internetsucht-Ein kognitiv-behaviorales Behandlungsmanual, Kohlhammer, Stuttgart, Jamus, 2013.
    K. Wölfling, KW Müller, da ME Beutel, "Diagnostische Testverfahren: Skala zum Onlinesuchtverhalten bei Erwachsenen (OSVe-S)," a Prävention, Diagnostik und Therapie von Computerspielabhängigkeit, D. Mücken, A. Teske, F. Rehbein, da B da Wildt, Eds., pp. 212-215, Mawallafin Kimiyya, Lengerich, Jamus, 2010.
    WP Dunlap, JM Cortina, JB Vaslow, da kuma MJ Burke, "Meta-bincike na gwaje-gwaje tare da kungiyoyi masu dacewa ko maimaita zane-zane," Hanyar Ilimin Kimiyya, kundi. 1, a'a. 2, shafi na 170-177, 1996. Duba a Scopus
    R. Schwarzer da M. Urushalima, “Gabaɗaya Ingantaccen Ingantaccen Inganci,” a cikin Matakai a cikin Ilimin halin Healthabi’ar Lafiya: Fayil na Mai amfani. Causal da Gudanar da Imani, J. Weinman, S. Wright, da M. Johnston, Eds., Shafi na 35-37, NFER-NELSON, Windsor, UK, 1995.
    M. Urushalima da J. Klein-Heßling, "Soziale Kompetenz. Entwicklungstrends und Förderung in der Schule, "Zeitschrift für Psychologie, vol. 210, a'a. 4, shafi na 164-174, 2002. Duba a Publisher · Duba a Google Scholar
    PT Costa Jr. da RR McCrae, Nemi Neo-Inventory Neo (NEO-PI-R) da NEO-Ciniki Inventory (NEO-FFI) na Kasuwanci, Ilimin Kimiyya na Psychological, Odessa, Fla, Amurka, 1992.
    LR Derogatis, SCL-90: Gudanarwa, Bincike da kuma Hanyar Jagora-I ga R, (Revised) da kuma sauran na'urori na Ƙwararren Ƙwararren Ƙwararrakin Kasuwanci, Makarantar Kimiyya na Jami'ar Johns Hopkins, Chicago, Ill, USA, 1977.
    CJ Brophy, NK Norvell, da kuma DJ Kiluk, "Binciken ka'idar factor da kuma canzawa da kuma nuna bambanci na SCL-90R a cikin ɗakunan shan magani," Journal of Personality Assessment, vol. 52, a'a. 2, shafi na 334-340, 1988. Duba a Scopus
    JE Wells, M. Browne, S. Aguilar-Gaxiola et al., "Saukewa daga rashin kulawa da lafiyar hankali a cikin shirin binciken Lafiya ta Duniya na Hukumar Lafiya ta Duniya," The British Journal of Psychiatry, vol. 202, a'a. 1, shafi na 42-49, 2013. Duba a Madaba'i · Duba a Masanin Google · Duba a Scopus
    J. Cohen, Ma'aikatar Tattalin Arziki na Kimiyya, Lawrence Erlbaum Associates, Hillsdale, NJ, Amurka, 2 edition, 1988.
    KW Müller, H. Glaesmer, E. Brähler, K. Wölfling, da kuma ME Beutel, "Harkokin yanar-gizo, a cikin yawan jama'a. Sakamakon binciken da aka samu daga yawan mutanen Jamus, "Harkokin Kasuwancin da Kasuwancin Fasaha, vol. 33, a'a. 7, shafi na 757-766, 2014. Duba a Publisher · Duba a Google Scholar
    RR McCrae da PT Costa Jr., Matsayinta a Ƙarshe: Ainihin Hanyoyin Gini guda biyar, Guilford Press, New York, NY, Amurka, 2003.