医生抑郁症的国内外研究概略

抑郁是常见的心理障碍,医生抑郁不仅影响其健康和工作绩效,更是医疗安全隐患,因此已引起各国关注.研究医生抑郁症的流行病学特征,探讨成因和防治方案,对维护医生健康、提高医疗质量有重要意义.     

医生在英国健康保障制度体系建立中的影响

英国健康保障制度体系包括健康保险制度、医疗救济制度和国民保健制度。医生促使了英国医疗救济制度的出现,并使其在20世纪初成为健康保险制度的补充,改变了英国健康保险制度的内容及其管理体制。医生推动了英国国民保健制度的出现,而且对其服务内容、管理体制及其实施进程产生直接影响。     

医疗人工智能的伦理风险及应对策略

医疗人工智能的迅猛发展带给医疗卫生领域更多发展契机的同时,也带来了一系列伦理风险和挑战。从人的道德主体性地位、责任认定、隐私权保护和医生主体性地位四个方面探讨了医疗人工智能带来的伦理风险。提出要实现医疗人工智能健康、有序地发展,需要采取重构责任伦理,强化特殊监管;加强隐私和数据保护,保障公众安全;坚定医生主体地位,优化诊疗质量等应对策略,以趋利避害,更好地促进人类健康和医疗卫生水平的提高。     

第三方远程医疗模式的伦理困境和对策

通过对第三方远程医疗模式的理性思考,阐述了不同主体视角下第三方远程医疗模式面临的伦理困境:患者面临知情权与诊疗需求的冲突,隐私权保护等伦理问题;第三方远程平台视角下,面临经济效益与社会责任的冲突;求诊端医生面临患者的质疑,患者生命健康与自身利益保护的伦理困境;远程端医生面临推卸责任以及自身利益和社会效益冲突的伦理问题。进而提出加强规划和宣传,明晰权利义务;规范平台准入和医疗责任,加强信息安全管理;建立解决医疗伦理问题的常设机构,健全医疗伦理监察制度等建议,以期推动远程医疗健康发展。     

药物替代品电子记录可改变医师处方习惯：一个具有代表性的观察研究

本研究背景为一家健康保健维护组织（HMO）提供给医生有关HMO的推荐药物的替代品的电子记录。目的是调查研究影响医师遵守和评估相关的医疗成本节约的因素。此研究的设计是一个横断面观察研究,研究对象是从2005年6月至2006年2月HMO的诊所的所有医生。     

医疗剧:健康文化传播的主阵地

医疗剧作为一种大众传播媒介,是医学与社会沟通的桥梁,使患者、社会能够更加立体地了解医学、医院和医生,应承担起健康文化传播的社会责任。通过分析中美医疗剧在编剧、制作、传播中的差异,提出国产医疗剧应取长补短,借鉴美国医疗剧的发展经验,本着尊重科学、敬畏生命、尊重事实、崇尚人文的原则,追求医学专业特质的严肃性,呈现医学技术的有限性,正视医疗差错的不可避免性,体现医学专业精神的内涵,制播根植于中国文化背景、具有本土特点的精品医疗剧,发挥健康文化传播主阵地的引领作用。     

不同性别人群非医疗技术服务影响因素认知差异研究——以呼和浩特市综合医院为例

为了探究不同性别人群对非医疗技术服务影响因素的认知情况,提出非医疗技术服务改善对策,使用文献分析法、专家访谈法、问卷调查法和双变量回归法对医患双方的非医疗技术服务影响因素认知的性别差异进行探究。研究发现,不同性别的医生对非医疗技术服务影响因素认知不具有显著性差异(P0.05);不同性别的患者对"医生工作事业心"、"医生遵守法规和工作制度"和"医生不歧视患者"的认知差异具有显著性(P0.05)。不同性别的医生对非医疗技术服务影响因素重视程度相同,男性患者更重视以上非医疗技术服务。     

乡村医生对知情同意与保密的认知态度调查分析

对河北省5个地区近800名乡村医生进行抽样调查显示,乡村医生对知情同意和保密的认知度较高。其中绝大多数医生能够在医疗实践中坚持知情同意和保密的伦理原则,但乡村地域文化和医疗服务的特点决定了乡村医生在履行知情同意时具有不同于城市的独特性。对乡村医生来说,应进一步明确知情同意中尊重患者选择权与乡村医生责任的关系,并通过有效沟通行使知情同意权及规范保密的具体内容,确保在医疗实践中更好地做到知情同意与保密。     

医生医疗行为失范的成因与对策

秦瑞霞张学义王丽娜社会转型带来的医德人格扭曲、医疗行政监管缺位和医疗行为中的诸多法律盲区等是医生医疗行为失范的主因。强化新伦理观教育实现医德建设的与时俱进、创新医疗行政管理制度、出台进一步规范医疗行为的法律法规是矫治医生医疗行为失范的对策。     

浅谈医生与卫生资源使用效率的关系

医生应该学习和掌握医疗服务过程的经济活动和经济方面的基本知识。医生要在诊疗过程中进行分析与思考。由于科学技术的进步,医疗技术提供卫生保健的可能性急剧增加,但我国正处在不发达的社会主义初级阶段,卫生保健资源的可供量十分有限,医疗技术的可能性与医疗资源的可供性之间,差距正在增大。医生在对医疗服务的微观经济活动进行分析思考时,应站在这一宏观的角度,认识和了解卫生资源的利用与医疗保障制度之间的矛盾,以及不同形式的医疗保障制度之间的显著差异,为病人提供正确、恰当、合理的医疗服务。医生对医疗服务过程的微观经…     

Utility of the Multidimensional Health Profile—Psychosocial Functioning Scales (MHP-P) for Assessing Psychosocial Adjustment in Gastric Bypass Surgery Patients

This study examined the utility of the Multidimensional Health Profile—Psychosocial Functioning (MHP-P) for the preoperative assessment of gastric bypass surgery (GBS) applicants. The MHP-P, a 58-item screening inventory that assesses 4 psychosocial areas relevant to health (mental health, life stress, social resources, and coping skills), was administered to 449 morbidly obese patients who were being considered for GBS. Data were compared with the results of a much more lengthy assessment procedure involving a 273-item comprehensive biographical and medical history interview, the MMPI-2, the Basic Personality Inventory, and the Beck Depression Inventory. The 17 measures of the MHP-P showed highly significant correlations with other measures considered to be of relevance in GBS outcome, confirming the utility of the MHP-P as a cost-effective procedure for use in this clinical medical setting.     

Routine Depression Screening in an MS Clinic and Its Association with Provider Treatment Recommendations and Related Treatment Outcome

Depression, a frequent concomitant disorder in multiple sclerosis (MS), can impact MS treatment adherence and quality of life. Depression screening in MS care settings may facilitate needed intervention when providers are responsive to screening findings. This study sought to examine the relationship between depression screening results and provider depression treatment recommendations documented in the medical records of 283 patients receiving care in an integrated MS clinic. Forty-six percent of patients screening positive for depression received a treatment recommendation; females, those with past mental health diagnoses, on psychotropic medications, and those with higher symptom severity were more likely to receive a treatment recommendation. On subsequent screenings, patients reported fewer depressive symptoms regardless of whether a formal treatment recommendation was documented. These findings suggest that while depression screening does lead to depression related intervention in many cases, more research is necessary to determine who is most likely to benefit and under what conditions.     

军校医学生心理应激影响因素的通径分析

目的探讨军校医学生心理应激的影响因素及其相互作用方式。方法选用军校医学生日常困扰评定量表、应付方式问卷、特质焦虑问卷、自尊量表和流调中心用抑郁量表对935名军校医学生进行测试，采用SPSS10．0对数据进行统计分析。结果日常困扰主要通过间接作用影响军校医学生的心理应激；自尊和特质焦虑对心理应激具有直接作用和间接作用。应付方式是日常困扰、个性特点影响心理应激的中间环节。结论维护军校医学生的身心健康，可以把优化其个性结构，加强应对训练作为一个切入点。     

Factorial and Diagnostic Validity of the Beck Depression Inventory-II (BDI-II) in Croatian Primary Health Care

The aim of this study was to examine the factorial and diagnostic validity of the Beck Depression Inventory-Second Edition (BDI-II) in Croatian primary health care. Data were collected using a medical outpatient sample (N = 314). Reliability measured by internal consistency proved to be high. While the Velicer MAP Test showed that extraction of only one factor is satisfactory, confirmatory factor analysis indicated the best fit for a 3-factor structure model consisting of cognitive, affective and somatic dimensions. Receiver operating characteristics (ROC) analysis demonstrated the BDI-II to have a satisfactory diagnostic validity in differentiating between healthy and depressed individuals in this setting. The area under the curve (AUC), sensitivity and specificity were high with an optimal cut-off score of 15/16. The implications of these findings are discussed regarding the use of the BDI-II as a screening instrument in primary health care settings.     

Quality of social support in mental and physical health

The current study investigates the relationship between social support and mental and physical health. Results indicate that poor functional support (or quality of support) is related to physical health problems while structural support (or social network size) is not. Moreover, although both poor functional and structural support are related to depression and anxiety, functional support is more strongly related to these outcome variables, the strongest relationship being associated with depression. Depression and hostility are also related to social isolation, although the relationship is again stronger for depression. The results suggest that the quality of social relationships is more important than quantity for optimal mental and physical health. The clinical relevance of these findings is that the quality of social support in the lives of individuals is central to recovery and should be addressed in medical and mental health treatment planning whenever it is an etiological or maintaining factor. The author dedicates this paper to her beloved father, Charles VanderVoort and her colleagues Dr. Uwe Stuecher and Dr. Gay Barfield whom she describes as “natural altruists, the rarest and most loving type of people in the world.”     

Quality of Social Support in Mental and Physical Health

The current study investigates the relationship between social support and mental and physical health. Results indicate that poor functional support (or quality of support) is related to physical health problems while structural support (or social network size) is not. Moreover, although both poor functional and structural support are related to depression and anxiety, functional support is more strongly related to these outcome variables, the strongest relationship being associated with depression. Depression and hostility are also related to social isolation, although the relationship is again stronger for depression. The results suggest that the quality of social relationships is more important than quantity for optimal mental and physical health. The clinical relevance of these findings is that the quality of social support in the lives of individuals is central to recovery and should be addressed in medical and mental health treatment planning whenever it is an etiological or maintaining factor. The author dedicates this paper to her beloved father, Charles VanderVoort and her colleagues Dr. Uwe Stuecher and Dr. Gay Barfield whom she describes as “natural altruists, the rarest and most loving type of people in the world.”     

False Memory Susceptibility in OEF/OIF Veterans With and Without PTSD

False memory susceptibility was measured in 80 Iraq/Afghanistan veterans with (n = 32) and without posttraumatic stress disorder (PTSD; n = 48) using a modified Deese-Roediger-McDermott (DRM) word list task that included trauma-related critical (nonpresented) lures. PTSD was classified using medical record diagnoses. Participants completed a variety of self-report assessments, including the Beck Depression Inventory, the Anxiety and Stress subscales of the Depression Anxiety Stress Scales, the Dissociative Experiences Scale, and the Tellegen Absorption Scale. Veterans with PTSD displayed global memory impairments on all types of items, except for trauma-related critical lures; on these critical lures, they exhibited false memory levels equal to those seen in veterans without PTSD. The magnitude of most effects were reduced, but not entirely eliminated, when controlling for depression, suggesting that neither PTSD nor co-occurring depression entirely explain these findings. The potential effects of other mental health conditions, such as alcohol dependence, could not be ruled out. Our results support explanations of PTSD that emphasize differential processing of trauma-related information.     

Prevalence of depressive symptoms and its correlates among medical students in China: a national survey in 33 universities

We conducted a national survey among medical students in China to estimate the prevalence of depressive symptoms and explore associated risk factors based on an established questionnaire composed of demographic information, life events in the past four weeks before survey, and the validated Chinese version of the 21-item Beck’s Depression Inventory (BDI). The mean age of enrolled 9010 students was 20.7 (standard deviation: 1.6) years. BDI scores indicated that 19.9% had depressive symptoms based on the cut-off score of 14. Socioeconomic factors and student characteristics such as male sex, low monthly income per capita, father’s poor education background, and higher year of study were associated with higher prevalence of depressive symptoms among medical students. Students who studied in comprehensive universities were more likely to have depressive symptoms compared with those from medical universities. Habitual smoking and alcohol drinking, sleep deprivation, and hospitalization or medication for one week or more in the last four weeks also predisposed students to higher risk of depressive symptoms. Our results indicate that depressive symptoms are becoming a highly prevalent health problem among Chinese medical students. Primary and secondary prevention should be prioritized to tackle this issue based on potential risk factors.     

Modification of coronary-prone behaviors in coronary patients of low socio-economic status

The purpose of this study is to determine the effectiveness of a group cognitive-behavioral treatment to modify coronary-prone behaviors in patients from a fairly low social and educational level. Participants were 98 male coronary patients randomly allocated to one experimental and two control groups. All groups received standard medical treatment. The experimental group received an additional psychological treatment and one of the two control groups received a health education treatment. Results showed that only the psychological treatment group significantly reduced Pressured Drive and Speed-Impatience after treatment, and at 1- and 2-year follow-ups. Depression was also significantly reduced only in this group at 2-year follow-up. The results are considered a reliable first step in the process of validating this program designed to improve coronary heart disease patients' quality of life.     

Physical self-efficacy, perceived physical status, and depressive symptomatology in older adults

Perceptions of physical, general, and social self-efficacy were assessed in 200 residents of a retirement village. The subjects were administered the Depression Adjective Checklist (Lubin, 1967a) and the CES-D Depression Scale (Radloff, 1977) and were asked to rate their physical status (number of health problems, number of monthly physician visits, and health and activity levels). Pearson correlations suggested strong relationships between the self-efficacy measures and depressive symptomatology. Most important, physical self-efficacy was seen to be the strongest predictor of depressive symptoms, much stronger than the objective physical status variables.