中国疾控中心公卫医师岗位胜任力模型构建

运用文献研究法、问卷调查法及因子分析法等方法,对2 461名疾病预防控制中心公共卫生医师的岗位胜任力要素进行分析,并构建公共卫生医师岗位胜任力模型。构成要素包括6个公因子,并将其分别命名为综合能力与职业精神、医学基础知识、实践技能、公共卫生知识、健康管理、发展与创新6个维度。其因子权重分别为24.79%、26.34%、14.94%、11.70%、13.06%、9.17%。对要素的重要性评分结果显示,实践技能和综合能力与职业精神这两个维度得分较高。影响公共卫生医师岗位胜任力的要素可以归纳为6个维度,其中医学基础知识和综合能力与职业精神对胜任力的影响最为突出,建议加强对疾病预防控制中心公共卫生医师医学基础知识和综合技能的培训,以建立更优质的疾控人才队伍。     

疫情防控“成功悖论”的伦理解析

疫情防控会造成个人与社会之间的“成功悖论”：虽然疫情防控给社会带来了整体利益,但具体的参与者个人却似乎没有得到什么实际的利益;于是,当疫情防控成功一段时间之后,一些强制性防控措施就会日益受到质疑,越来越多的人会选择逃避防控的“免费搭车”行为,直到再次暴发疫情。“成功悖论”反映出疫情防控中个人权利与公共健康之间的冲突：为了社会整体健康而限制个人权利是否能够得到伦理辩护？悖论的根源在于自由主义价值观导致了个人与社会的割裂,而强调人类命运共同体与人类卫生健康共同体的社会主义价值理念有助于克服这一悖论。

     

合成生物技术伴生风险的刑法规制

合成生物技术的开发和应用潜藏着较大的生物安全风险,既有因人类认知局限而生的客观风险,又有人为故意或过失引发的主观风险。面对合成生物技术对生物安全的严重威胁,现行刑法仅依托零散的相关罪名间接应对,存在针对性不足、规范留有漏洞、事后回应迟延等问题。应对合成生物技术伴生风险需要引入提前预防的理念,这是国家总体安全观的基本要求,也是积极刑法观的自然演绎,更是治理合成生物技术伴生风险的实践需要。具体而言,应以体系性规范取代间接性规制,以事前预防取代事后回应,并借助比例原则防范处罚早期化后出现的制度风险。

     

法学和医学视角对疫情防控的思想对比分析

对于疫情防控措施,法学家坚持道义论,主张以某种最低的规范约束人们的行为,“法无禁止即自由”。而医务工作者则更多主张美德伦理,认为每个人都应该追求更高的道德品质,严于律己,宽以待人。经历了持续的经济增长之后,社会还存在一定的极端个人主义、贫富分化、阶层固化等问题,加之突然遭遇世所罕见的新冠疫情,应该搁置道义论,重新拥抱美德伦理。从个人的角度,对严格的疫情防控措施给予最大的宽容,认真地执行,并积极参与志愿服务;从政府的角度,应该在疫情防控的同时,照顾好群众的生产、生活和就医。

     

探索产科领域的百慕大之谜

妊娠肝内胆汁淤积症 (ICP)往往在妊娠晚期发生胎儿猝死 ,但机制尚不清楚。孕妇和胎儿体内高浓度胆汁酸水平是ICP的显著临床特点。胆汁酸对实验动物心肌细胞具有毒性作用。深入研究胆汁酸对胎儿心脏的毒性作用 ,有可能揭示胎儿死亡之谜。     

Sudden Gains: How Important Are They During Exposure and Response Prevention for Obsessive-Compulsive Disorder?

Symptom reduction over the course of cognitive-behavioral therapy is not always distributed evenly across sessions. Some individuals experience a sudden gain, defined as a large, rapid, and stable decrease in symptoms during treatment. Although research documents a link between sudden gains and treatment for depression and anxiety, findings in the context of obsessive-compulsive disorder (OCD) treatment are mixed. The present study investigated the relationship between sudden gains and treatment outcome in 44 adults with OCD and addressed limitations of previous studies by measuring OCD symptoms dimensionally and comparing individuals who experience sudden gains to those who experience gradual gains of similar magnitude. Sudden gains were observed among 27% of participants, with highest rates among individuals with primary contamination symptoms. Participants who experienced a sudden gain had greater OCD symptom reductions at posttreatment (but not at follow-up), and this difference did not persist after controlling for gain magnitude. Thus, the importance of sudden gains during OCD treatment may be limited. Findings are discussed in light of inhibitory learning models of cognitive-behavioral therapy.     

Using empowerment theory in collaborative partnerships for community health and development

Models of community empowerment help us understand the process of gaining influence over conditions that matter to people who share neighborhoods, workplaces, experiences, or concerns. Such frameworks can help improve collaborative partnerships for community health and development. First, we outline an interactive model of community empowerment that describes reciprocal influences between personal or group factors and environmental factors in an empowerment process. Second, we describe an iterative framework for the process of empowerment in community partnerships that includes collaborative planning, community action, community change, capacity building, and outcomes, and adaptation, renewal, and institutionalization. Third, we outline activities that are used by community leadership and support organizations to facilitate the process of community empowerment. Fourth, we present case stories of collaborative partnerships for prevention of substance abuse among adolescents to illustrate selected enabling activities. We conclude with a discussion of the challenges and opportunities of facilitating empowerment with collaborative partnerships for community health and development. This work was supported by Kansas Health Foundation Grants 9206032B and 9206032A to support and evaluate community partnerships to prevent adolescent substance abuse. Thanks to Tom Wolff for sharing his wisdom about community coalitions so generously, and to Bill Berkowitz and anonymous reviewers for thoughtful comments on an earlier version of this manuscrpt. We also thank our colleagues from the Kansas Health Foundation, Mary K. Campuzano, Steve Coen, and Marni Vliet, and those from collaborating communities, who continue to teach us about ways to enhance community capacities to address local concerns.     

Evaluation of a preventive intervention for a self-selected subpopulation of children

Evaluated an experimental preventive intervention developed for children who perceived their parents as problem drinkers. The 8-session program was designed to improve children's coping, self-esteem, and social competence, and modify alcohol expectancies which were specified as mediators of the effects of parental alcohol abuse on child mental health. Participants were 271 self-selected 4th-, 5th-, and 6th-grade students in 13 schools. The children were randomly assigned to treatment or delayed treatment conditions and the program was given to three successive cohorts of students. A meta-analysis across three different cohorts indicated significant program effects to improve knowledge of the program content and the use of support- and emotion-focused coping behaviors for the full sample. A slightly stronger range of effects was found for a high-risk subsample. This research was funded by the National Institute of Mental Health Grant P50-MH39246 to support a Preventive Intervention Research Center and Prevention Training Grant T32-MH18387-02.     

Safer sex: Lessons from the male sex industry

Discerning the complex factors influencing male sex work is an important element of understanding HIV transmission. The present study examines a sample of London-based masseurs and street workers' ideas concerning their sexual encounters, their partners and their role in society. Unsafe sex is associated with (1) a lack of perception of control in the sexual encounter, (2) attractive clients, and (3) loving relationships with non-clients. The ways in which personal needs and stigma influence sexual practices and the men's sense of identity are considered. For some of the men, unsafe sex demarcates a sphere containing a type of intimacy that is absent from their working life. Since working life is associated with negative social judgements, the importance of this separate sphere is heightened. The findings call into question models of health behaviour that are built on individualist, reason-based tenets and highlight the importance of social and emotional factors in safer sexual behaviour. The implications of the findings for prevention programmes and future research are discussed.