医疗卫生系统整合:医改顶层设计的新理念

从国际和国内医改理论和实践出发,分析医疗卫生系统整合对实现医改目标和顶层设计的影响.论证医疗卫生系统整合是解决卫生系统危机的最佳路径,医疗卫生系统整合对改善卫生系统绩效具有重要影响;提出中国医改的核心是实现体制改革和机制的创新与变革,这一变革的前提是理念的创新;医疗卫生系统整合理念在医改顶层设计和医改目标的实现具有重要的理论和实践意义.当前需要医疗卫生系统整合的新理念来统领医改的顶层设计,不仅有助于破解医改顶层设计的难题,还将推动解决医改目标的实现,也是与国际上卫生系统改革导向和发展趋势相吻合的.     

从系统论视角看全身炎症反应综合征

全身炎症反应综合征已经成为当前危重病医学所面临重大挑战.本文从系统论的角度出发,通过阐述全身炎症反应综合征的发病机制、病理过程及治疗进展,浅谈系统论在全身炎症反应综合征基础研究和临床治疗中的指导作用.     

Difference in microstructure of Zr41Ti14Cu12.5Ni10Be22.5 glasses prepared in a 52 m drop tube and by water quenching

A 52 m drop tube has been used to solidify bulk-glass-forming Zr₄₁Ti₁₄Cu_12.5Ni₁₀Be_22.5 alloy. Glassy balls with different sizes solidified from the droplets whose structural features, glass-transition behaviour and crystallization kinetics have been investigated. The results indicate that the apparent activation energies of the glass transition and main crystallization reaction are significantly different from those of samples prepared by water quenching. The structural difference between the two types of glassy specimen is revealed by compression studies and in situ energy-dispersive X-ray diffraction. The results are important for understanding the structural features of bulk-forming glasses.     

甘精胰岛素注射时段对2型糖尿病患者空腹血糖的影响

比较甘精胰岛素在不同时段注射对2型糖尿痛患者空腹血糖的影响.最终选择89例2型糖尿病患者随机分为两组接受甘精胰岛素早餐前(A组,n=46)和夜间睡前(B组,n=43)注射治疗,观察两组患者空腹血糖的变化.结果显示,所有患者使用甘精胰岛素治疗以后,空腹血糖水平较治疗前均有明显下降,具有统计学差异(P均<0.001).但B组的空腹血糖水平下降幅度更为明显,两者相比具有统计学差异(P<0.001).故在相同剂量的情况下,夜间睡前注射甘精胰岛素较晨间注射具有更强的降糖幅度,效果更好.     

前列腺素E1注射液治疗早期2型糖尿病肾病临床观察

比较不同剂量的前列腺素E1注射液在早期2型糖尿病肾病患者中的临床疗效.最终随机纳入91例早期2型糖尿病肾病患者,分别接受10μg/d(A组,n=47)与20μg/d(B组,n=44)的前列腺素E1治疗,2周后观察8小时尿微量白蛋白排泄率(UAER)、血尿素氮(BUN)和肌酐(Cr)的变化.结果显示,两组患者治疗后UAER、BUN、Cr均较治疗前明显下降,都具有统计学差异(P均<0.05),但A、B两组之间UAER下降幅度不一,B组较A组下降幅度更明显,具有统计学差异(P<0.001);两者之间BUN下降幅度相比没有统计学差异(P>0.05).两者之间的Cr下降幅度相比有统计学差异(P<0.05).由此推断,前列腺素El治疗早期糖尿病肾病,降低尿蛋白确实有效,而且前列腺素E1 20μg/d的剂量要比10μg/d降低尿蛋白效果更好.     

Career success criteria and locus of control as indicators of adaptive readiness in the career adaptation model

The present research had two goals. The first goal was to identify additional individual characteristics that may contribute to adaptive readiness. The second goal was to test if these characteristics fit the career adaptation model of readiness to resources to responses. We examined whether career success criteria (measured at Time 1) and career locus of control (measured at Time 1) would contribute to adaptivity and predict university students’ career decision-making self-efficacy (measured at Time 2) through the mediation of career adaptability (measured at Time 1). Results based on a two-wave survey among a sample of 437 Chinese university students showed that the criteria of intrinsic fulfillment and work-life balance, as well as internal career locus of control positively predicted Chinese university students' career adaptability, which in turn predicted career decision-making self-efficacy. These findings support the career adaption model and carry implications for career construction theory and university students' career development.     

New Professional Roles and Advocacy Strategies for School Counselors: A Multicultural/Social Justice Perspective to Move Beyond the Nice Counselor Syndrome

The transformed role of school counselors as advocates is key in reducing the academic achievement gap. Redefining the school counselors' role requires culturally competent practitioners, social justice advocates, and organizational/social change agents. A major obstacle to implementing culturally responsive social justice advocacy and change in schools is referred to as the nice counselor syndrome (NCS). This article discusses the insidious effects of NCS and outlines a set of recommendations designed to assist school counselors in moving beyond this syndrome.     

青少年自尊与攻击的关系：中介变量和调节变量的作用

以705名初、高中生为被试,采用量表法和同伴提名法收集数据,探讨了自尊与攻击的关系以及对二者关系可能有影响的中介变量和调节变量的作用。结果表明：（1）自尊与攻击的相关系数为-0.21,这说明低自尊与高攻击有关;（2）回归方程纳入自控后,自尊对攻击的预测在统计意义上不明显,表明自尊通过自控对攻击产生影响,自控在自尊与攻击的关系中起着中介的作用;（3）社会地位对自尊与攻击之间的关系具有调节作用,它调节着两者关系的强度;（4）社会影响对自控的中介作用具有调节作用