英国本科医学教育培养目标的嬗变——基于《明日的医生》报告的解读

英国医学总会在1993年、2003年和2009年先后出版了三份《明日的医生》报告,为本科医学教育提供了综合性框架,指导本科医学课程设计和评价体系的形成。从知识、技能、医学伦理和职业道德三个层面,比较英国本科医学教育人才培养目标的嬗变,发现其要求不断趋于全面、细化、深入。并进一步分析了政治、多元文化、国家医疗政策、医学领域自身及医学教育内部等诸因素对英国本科医学教育的影响,以期为我国的本科医学教育提供借鉴。     

Assessing and treating sexual dysfunctions in Orthodox Jewish couples: a summary of 41 consecutive cases

ABSTRACT

Orthodox Jews are a distinct subgroup with specific beliefs and values towards sexuality, reproduction, modesty, and openness to mental health treatment. This paper reviews the treatment of 41 Orthodox Jewish couples who presented for sex therapy. Most couples were referred by a rabbinical leader. The most common presenting problem was an unconsummated relationship; present in 27 couples. In 34 couples the initial presenting complaint was a male sexual problem yet in 20 of 41 couples both partners described having some sexual problem. Almost 50 per cent of both men and women were also diagnosed with a comorbid psychiatric disorder, which was almost always previously undiagnosed. The most common presenting problems were vaginismus, male inhibited arousal, and/or inhibited male orgasm. Two case examples illustrate some adaptations to assessment and treatment that can be helpful in treating sexual problems in Orthodox Jewish couples.     

Depression in adults with type 2 diabetes: the role of adherence, body mass index, and self-efficacy.

Considerable evidence links depression with the development and worsening of diabetes, but the factors contributing to this link have not been established. The authors examined the role of adherence, body mass index (BMI), and self-efficacy. Adult patients with Type 2 diabetes (N = 56) completed self-report measures of diet and exercise adherence, diet and exercise self-efficacy, and depression. BMI was obtained from medical records. Path and mediation analyses indicated that both adherence and BMI independently contributed to self-efficacy. Self-efficacy mediated both the association between adherence and depression and the association between BMI and depression. These findings are consistent with the proposal that lower self-efficacy in reaction to adherence failure and higher BMI contributes to depression in adults with diabetes.