迎接医学人文学科发展的春天

我国医学人文学科的发展与我国的改革开放同步 ,在 2 0世纪 80年代末期到 90年代初曾经经历过一个发展高潮 ,但进入 90年代中期之后 ,随着第一批为我国医学人文学科建立作出卓越贡献的专家学者相继进入退休年龄而退出这一领域之后 ,医学人文科学的研究进入停滞阶段。今年SARS的发生暴露了我国公共卫生建设方面的失误 ,也引发了理论界的深刻反思。公共卫生投入不足、预防保健工作松软乏力 ,与我们对医学目的的认识以及卫生发展理论方面存在误区不无关系。由SARS所引发的公共卫生事件说明公共卫生决不是单纯的医学问题 ,它关系到国家的安全、影响到经济发展 ,需要从国家发展战略的角度来认识和全社会共同参与建设 ,这就为医学人文学科的发展提供了难得的契机     

教师心理健康的标准和对策

本文首先讨论了提高教师心理健康水平对建设高质量教师队伍及提高学生心理健康的重要性 ,它也是落实素质教育的重要举措。文章还阐述了教师心理健康的标准 ,最后提出了提高教师心理素质的对策。     

Effects of momentary assessed stressful events and worry episodes on somatic health complaints

Somatic health complaints are extremely common and are responsible for a large part of human suffering and healthcare costs. It has been recognised that psychosocial stress can affect somatic health. According to the 'perseverative cognition hypothesis', stressful events affect somatic health because people keep on worrying about them. Worry would prolong stress-related physiological activity that can ultimately lead to health problems. In this ambulatory study we tested whether stressful events and worry predict daily somatic complaints, and whether worry mediates the effects of stressful events. In addition, it was tested whether these effects were independent from negative affect. Using electronic diaries, 69 teachers (age 21-60 years) from Dutch primary and secondary schools reported daily stressful events, worry episodes, negative affect and somatic complaints for a period of 6 days. Results showed that worry intensity predicted the number of somatic complaints and mediated the effect of stressful events on somatic complaints. Furthermore, these results were independent from biobehavioural variables and daily negative affect. These findings support the perseverative cognition hypothesis proposing that the negative somatic health effects of stressful events are largely due to the worry; that is, to the prolonged cognitive representation of stressors.     

Clinical Community Psychology: Reflections on the Decades Following Swampscott

The Swampscott report was foundational, but in some ways reflected divisions within community psychology that have continued into the present. Community psychologists trained in the 1970s and, especially, the 1980s confronted a period where the original focus of community mental health began to have less influence in the mental health field due to a variety of public policies, and the growth of third party payments as a significant source of health care funding. Programs that engaged communities and provided a base for prevention interventions were greatly curtailed because of changes in federal legislation and limited opportunities for state and local funding, although prevention interventions found growing interest from research funders. Clinical and community psychologists who trained in this period increasingly looked to a variety of areas outside of mental health. Consequently, the field of community psychology has become more applied and less academic, with increased attention to advocacy, theory, and global perspectives. The sweep of these changes and their implications for the future of the field are discussed here.     

Disabled – therefore,Unhealthy?

This paper argues that disabled people can be healthy. I argue, first, following the well-known ‘social model of disability’, that we should prefer a usage of ‘disabled’ which does not imply any kind of impairment that is essentially inconsistent with health. This is because (a) one can be disabled only because limited by false social perception of impairment and (b) one can be, if impaired, disabled not because of the impairment but rather only because of the social response to it. Second, I argue that it is often wrong to use the term ‘healthy’ in a way that makes health inconsistent with any degree whatsoever of health-relevant bodily dysfunction. Whether someone is ‘healthy’ properly-so-called depends on standards of health presupposed in conversational context. Sometimes, I argue, these standards are or ought to be lax enough to allow some people with some health deficits still to count as ‘healthy’ per se. Taking inspiration from David Lewis and Mary Kate Mcgowan, I go on to argue that denying that someone is ‘healthy’ in a context typically succeeds in shifting going presuppositions to require standards strict enough to make that denial acceptable. And this, I conclude by arguing, often constitutes an abuse of conversational power.     

Justice and the inclusion of women in clinical studies: an argument for further reform

Our society's practice of inadequately representing women as subjects of clinical research is unjust, not only because it results in inequalities in the quality and availability of care that have a detrimental impact on women's health, but also because it is linked to women's oppression. Although recent policy changes help to resolve the problems, more must be done. Additional remedies for the injustices of our society's research practices are proposed.     

Do the bishops have it right on health care reform?

The National Conference of Catholic Bishops has argued for significant government involvement in health care in order to assure respect for what they regard as the right to health care. Critics charge that the bishops are wrong because health care is not a right. In this article, it is argued that these critics are correct in their claim that health care is not a right. However, it is also argued that the premise that health care is not a right does not imply that the market is the most equitable and just system for providing health care. Natural law arguments in the tradition of Roman Catholic social teaching lead to the conclusion that a just and prosperous society has a moral obligation to provide health care even if there is no such right. Further, there are strong moral grounds for concluding that the bishops are correct in their claim that health care ought not to be considered a market commodity. It is argued that if health care ought not to be considered a commodity, then national health insurance is the best available alternative for fulfilling the social obligation to distribute health care resources justly and fairly at this time in American history. The bishops' case for government involvement can be made on the strength of the Catholic tradition in theological argumentation, independent of the claim that health care is a right.     

中国军人心理健康状况的横断历史研究：1990~2007

使用1990~2007年18年间的142组数据, 以横断历史研究的元分析方法, 研究了108736位中国军人的心理健康状况随年代的变化趋势。这些数据来自94篇相关研究报告, 这些研究都使用了90项症状自评量表(SCL-90)作为心理健康的测评工具。结果发现：(1)世纪之交的18年间, 中国军人的心理健康越来越好; (2)18年间, 中国军人在“人际敏感”方面变化最大, 而在“躯体化”方面变化最小; (3)18年间, 中国军人在“恐怖”方面最没问题, 而在“强迫症状”和“人际敏感”方面所表现出的问题一直突出; (4)中国独生子女军人(N = 1944)的心理健康状况低于非独生子女军人(N = 2649); (5)中国城市籍军人(N = 7808)的心理健康状况低于农村籍军人(N = 11459); (6)中国高中学历军人(N = 10189)的心理健康状况低于初中(N = 8407)和大学学历(N = 863)的军人。     

Exploring the relationship between compressed work hours satisfaction and absenteeism in front-line service work

There has been an upsurge of interest in compressed workweek schedules because of the opportunities they provide for enhanced organizational efficiency and more balanced work and life roles for employees. This study tested a moderated mediation model of the effects of compressed work hours satisfaction on absenteeism with the purpose of exploring both the mediation effects of emotional exhaustion and physical health and the moderating effects of sex on this relationship. It utilized data drawn from a sample of 236 contact-centre service workers linked to absenteeism data collected for a period of 12 months following the survey. Results indicated that compressed work hours satisfaction was associated with lower absenteeism and that this relationship was mediated sequentially through emotional exhaustion and physical health. Although the indirect effect of compressed work hours satisfaction on absenteeism through emotional exhaustion and physical health was not significantly different between women and men, the relationship between compressed work hours satisfaction and physical health was positive for women but not for men. The implications of these findings are discussed.     

Health of Organisms and Health of Persons: An Embedded Instrumentalist Approach

In a time when we as a society are in the process of deciding what our basic rights to health care are, it is critically important for us to have a full and complete understanding of what constitutes health. We argue for an analysis of health according to which certain states are healthy not in themselves but because they allow an individual to reach actual goals. Recognizing that the goals of an individual considered from the point of view of biology and the goals of the same individual considered as an agent in the world might be different, we introduce a distinction between the health of an individual qua organism and the health of an individual qua person. We then argue that this distinction characterizes the evaluations made by patients and healthcare providers better than the widely discussed distinction between disease and illness.     

Justice,Health, and Healthcare

Healthcare (including public health) is special because it protects normal functioning, which in turn protects the range of opportunities open to individuals. I extend this account in two ways. First, since the distribution of goods other than healthcare affect population health and its distribution, I claim that Rawls's principles of justice describe a fair distribution of the social determinants of health, giving a partial account of when health inequalities are unjust. Second, I supplement a principled account of justice for health and healthcare with an account of fair process for setting limits or rationing care. This account is provided by three conditions that comprise "accountability for reasonableness."     

Justice, health, and healthcare

Healthcare (including public health) is special because it protects normal functioning, which in turn protects the range of opportunities open to individuals. I extend this account in two ways. First, since the distribution of goods other than healthcare affect population health and its distribution, I claim that Rawls's principles of justice describe a fair distribution of the social determinants of health, giving a partial account of when health inequalities are unjust. Second, I supplement a principled account of justice for health and healthcare with an account of fair process for setting limits of rationing care. This account is provided by three conditions that comprise "accountability for reasonableness."     

The Intermingling of Social and Evolutionary Psychology Influences on Hair Color Preferences

Hypotheses were tested as explanations for why men and women have specific hair color preferences for mates. Traditional evolutionary psychology approaches suggest that men should prefer light hair on women because it signals youth and health, while women should desire dark hair on men because it signals maturity and stability. Repeated exposure predicts people prefer the hair color on mates they are exposed to most frequently. Uniqueness implies that men and women should desire the least prevalent hair colors on potential mates because of its scarcity and rarity. Findings primarily support traditional evolutionary psychology predictions and occasionally the repeated exposure hypothesis, but not uniqueness predictions. Sex and regional differences indicate that social and evolutionary processes combine to influence hair color preferences.     

Implementation of a brief early intervention in times of socio-economic crisis: effects on parental stress

The paper investigates the effect of brief early intervention on parental stress in the midst of a socio-economic crisis, such as the one that struck Greece in the past decade. During this period, a psychoanalytically oriented prevention programme with parents and their infants/young children, named ‘Early Intervention Programme’, was designed and implemented in the Department of Child Psychiatry at ‘Aghia Sophia’ Children’s Hospital in Athens, Greece. The families that attended the programme were asked to participate in a research study regarding its effectiveness; data were collected from 102 mothers and 73 fathers. This paper presents the statistical findings regarding parental stress, mainly because it is a factor that has systematically been shown to negatively influence several aspects of a child’s development, but also because our hypothesis was that parental stress would be influenced by the negative external conditions. The results showed that both mothers’ and fathers’ stress levels were high before their participation to the programme (with fathers’ Total Stress scores falling within the clinical range), while they decreased to a statistically significant level after the completion of the programme. These findings are discussed in conjunction with some illustrative clinical material. Based on these, it is argued that the implementation of a psychoanalytically oriented brief early intervention programme with parents and infants/young children can alleviate parental stress, and thus support the parental capacity to efficiently deal with the high demands of early development, even in periods of economic crisis where the tensions for young parents are significant and the available mental health resources are scarce.     

How does higher in‐group social value lead to positive mental health? An integrated model of in‐group identification and support

Previous research has indicated that the effects of in‐group social value on mental health are mediated by the extent to which individuals identify with their in‐group. Other research has shown that in‐group identification leads to positive mental health because it provides in‐group members with a psychological basis for social support. We examine how the individual's perception of the social value of the in‐group leads to positive mental health, integrating the effects of identification with and support from the in‐group. As predicted, the relationship between higher social value and decreased mental health (e.g. depression, perceived stressful events) is mediated by higher in‐group identification, which in turn leads the members to expect support from the in‐group but not the out‐group. An integrated model of the effects of perceived in‐group social value, identification, and support on mental health is proposed, and the implications are discussed.     

Are mental health awareness efforts contributing to the rise in reported mental health problems? A call to test the prevalence inflation hypothesis

In the past decade, there have been extensive efforts in the Western world to raise public awareness about mental health problems, with the goal of reducing or preventing these symptoms across the population. Despite these efforts, reported rates of mental health problems have increased in these countries over the same period. In this paper, we present the hypothesis that, paradoxically, awareness efforts are contributing to this reported increase in mental health problems. We term this the prevalence inflation hypothesis. First, we argue that mental health awareness efforts are leading to more accurate reporting of previously under-recognised symptoms, a beneficial outcome. Second, and more problematically, we propose that awareness efforts are leading some individuals to interpret and report milder forms of distress as mental health problems. We propose that this then leads some individuals to experience a genuine increase in symptoms, because labelling distress as a mental health problem can affect an individual's self-concept and behaviour in a way that is ultimately self-fulfilling. For example, interpreting low levels of anxiety as symptomatic of an anxiety disorder might lead to behavioural avoidance, which can further exacerbate anxiety symptoms. We propose that the increase in reported symptoms then drives further awareness efforts: the two processes influence each other in a cyclical, intensifying manner. We end by suggesting ways to test this hypothesis and argue that future awareness efforts need to mitigate the issues we present.     

Poverty, Inequality, And Discrimination As Sources Of Depression Among U.S. Women

Poverty, inequality, and discrimination endanger women's well-being. Poverty is one of the most consistent predictors of depression in women, probably because it imposes considerable stress while attacking many potential sources of social support. Economic inequalities within societies are associated with reduced life expectancy and a variety of negative physical health outcomes. Parallel research on economic inequalities and depression has just begun. Discrimination maintains inequalities, condemns women to lives of lessened economic security, and exposes them to unmerited contempt. Although the mental health impact of poverty is documented and largely understood, the implications of inequality and discrimination are less well known. Much important work remains to be done, particularly research that connects individuals' mental health to ecological characteristics of the communities and societies in which they live.     

Health Problems and Male Firearm Suicide

Drawing on constructs of masculinity as it relates to both gun ownership and men's health, we use a rich data set, the New Jersey Violent Death Reporting System as well as hospital discharge data, to analyze 3,413 completed male suicides between the years of 2003 and 2009. We test the hypotheses that the use of firearms is more common when physical health problems are cited as suicide circumstances, and that suicide decedents who use firearms have poorer physical health than those who used other methods. Results show that firearms are disproportionately used in male suicides when physical health is listed as a circumstance. Additionally, among suicide decedents with a hospitalization during the 3 years prior to death, those who used firearms were in poorer health than those who used other methods. These findings have implications for prevention efforts, because restricting access to lethal means is an important aspect of suicide prevention.     

A Genetics Primer for Social Health Research

The recently completed sequencing of the human genome heralds a new era in the study of social influences upon health. Because the interactions between genes and the environment are bidirectional, expertise in the areas of psychosocial processes and health behaviors will be necessary for elucidating how genes, behavior, and the environment interact to affect health outcomes. For investigators whose primary background is in social health research, the terminology used by geneticists may seem like a foreign language. To help navigate this foreign territory, the nature of genetic variation and gene action is presented in non‐technical terms using the serotonin transporter gene as an example because it is thought to influence sensitivity to the social environment. In addition, we describe several methodological pitfalls to be avoided when associating genetic variation with psychosocial and behavioral risk factors for poor health outcomes.     

Environmental risks: Scientific concepts and social perception

Using the example of air pollution, I criticize a restricted utilitarian view of environmental risks. It is likely that damage to health due to environmental pollution in Western countries is relatively modest in quantitative terms (especially when considering cancer and comparing such damage to the effects of some life-style exposures). However, a strictly quantitative approach, which ranks priorities according to the burden of disease attributable to single causes, is questionable because it does not consider such aspects as inequalities in the distribution of risks. Secondly, the ability of epidemiological research to identify some health effects is limited. Third, the environment has symbolic and aesthetic components that overcome a strict evaluation of damage based on the impairment of human health. It is not acceptable that priorities be set just balancing the burden of disease caused by pollution in the environment against economic constraints. As an example of a computation that inherently includes economic analysis, I refer to the proposal of an estimator of mortality in coal mining, i.e., a rate which puts deaths in the numerator and tons of coal extracted in the denominator. According to this estimator, mortality due to accidents decreased from 1.15 to 0.42 in the period 1950–1970 in the United States, for each million tons of coal extracted. However, considering the steep decline in the workforce in the same period, the traditional mortality rate (deaths over persons-time) actually increased. The proposal of a measure of mortality based on the amount of coal extracted is just one example of the attempts to influence decisions by including an economic element (productivity) in risk assessment. This paper has three purposes: One, to describe empirical research concerning the health effects of environmental pollutants; two, to discuss the scientific principles and methods used in the identification of environmental hazards; and three, to critically discuss some of the ethical principles which are applied in medicine and in the assessment and management of risk.