Are General Practitioners Willing and Able to Provide Genetic Services for Common Diseases?

Primary care in the United Kingdom has been advocated as an optimal location for the provision of genetic services for common diseases. Little, however, is known about general practitioners' own views toward this suggestion or the possible demand for such services from patients. To assess general practitioners' attitudes to providing genetic services for common diseases, and to estimate the demand from patients for these services, we used a single-page postal questionnaire survey of all 359 general practitioners registered with the Oxfordshire Health Authority; 339 (94%) responded. These physicians reported that a mean 4.1 patients (95% CI, 3.3–4.9) out of every 1,000 consulting them were concerned about their own risk of a common disease associated with a diagnosis in a family member. Half of the general practitioners (95% CI, 45–56%) counseled about genetics in the last year. A majority of general practitioners accept the need to provide genetic services, but far fewer are competent to do so. Although 60% (95% CI, 55–65%) believed they should be involved with genetic screening for common diseases, only 29% (95% CI, 24–34%) felt sufficiently prepared to take family histories and draw pedigrees, and only 15% (95% CI, 11–19%) felt sufficiently prepared to counsel patients about their genetic test results. Given the necessary training and information, 63% (95% CI, 58–68%) and 64% (95% CI, 59–69%) were willing to provide these services. Even with training and information, not all would be willing to provide these services, and lack of time may be a major deterrent. Practice-enabling strategies, such as computerized aids in genetics, may be useful.     

Understanding Chest Pain: What Every Psychologist Should Know

Chest pain is one of the most frequent presenting complaints in Emergency Rooms and other medical settings. A considerable number of these patients do not have significant coronary artery disease. This led to plausible alternative explanations for these presenting symptoms and these patients tend to have unremarkable cardiac outcomes. Nevertheless, many studies have also documented that symptoms and related disability persist in the face of reassurances about benign cardiac status. Given the implied threat of chest pain (e.g., myocardial infarction) and the presence of chest pain symptoms in other noncardiac conditions (including anxiety and panic), it is not surprising that many of these patients present with considerable emotional distress. Consequently, chest pain symptoms represent diagnostic and treatment dilemmas for physicians and psychologists alike. The extent to which cardiac and noncardiac factors contribute to all forms of chest pain remains unknown. The function of this review is to provide mental health professionals with a primer on relevant clinical issues in chronic chest pain. We examine several common medical and psychiatric causes of chronic chest pain and selectively review (1) the relevant medical and psychiatric diagnostic and treatment considerations for chest pain and (2) the hypothetical biobehavioral mechanisms relevant to psychological intervention, (3) while expanding on existing conceptual models for understanding chest pain, and (4) offering some suggestions for future research.     

Psychological distress and subjective well‐being in partners of somatically ill or physically disabled: The Nord‐Trøndelag Health Study

Borren, I., Tambs, K., Idstad, M., Ask, H. & Sundet, J. M. (2012). Psychological distress and subjective well‐being in partners of somatically ill or physically disabled: The Nord‐Trøndelag Health Study. Scandinavian Journal of Psychology 53, 475–482. This study investigated the cross‐sectional associations between various somatic conditions in one partner and the level of distress and well‐being in the spouse. The study is based on survey data from the Norwegian Nord‐Trøndelag Health Study, HUNT II (1995–1997). A sample of 9,797 married or cohabiting couples with valid data on subjective well‐being (SWB), psychological distress (Hopkins Symptom Check List (SCL)‐10) and somatic illness were identified. Regression analyses stratified by sex were conducted with SCL‐10 and SWB scores as dependent variables and a joint somatic score as predictor, including; stroke, cancer, angina, myocardial infarction and physical disability (PD). The contribution of each somatic condition was also explored. Spouses of persons previously diagnosed with at least one somatic condition scored significantly lower on SWB and significantly higher on SCL‐10 than spouses of healthy persons, though effect sizes were small. The effect seems to be at least partly mediated by the ill partner’s psychological distress. Of the specific conditions, PD had the most significant contribution for both genders, though an association between male angina and spousal distress/SWB was also demonstrated.     

IgG4相关性胆胰疾病的诊断和治疗

近年来发现,IgG4相关性疾病可累及全身多系统多器官,目前研究提示IgG4相关性胆胰疾病主要有IgG4相关性硬化性胆管炎和自身免疫性胰腺炎（AIP）.前者是一种免疫发病机制未明、生化学特点以及胆管影像学表现与原发性硬化性胆管炎（PSC）相似,对糖皮质激素应答良好的疾病.后者临床表现为复发性胰腺炎、梗阻性黄疸,伴胆管、涎腺等其他器官受累.实验室检查血清和组织学IgG4明显升高.影像学表现为胰腺呈“腊肠样”外观,伴主胰管弥漫不规则狭窄,同样对激素治疗敏感.二者常同时受累、关系密切,易误诊为胆管癌、硬化性胆管炎或胰腺癌,本文将当前国内外研究现状做一介绍,供临床诊治参考.     

甲亢合并急性冠脉综合征的临床及冠脉特点研究

探讨甲亢合并急性冠脉综合征（ACS）患者的临床及冠状动脉病变特点.选取2010年1月至2013年6月于我院住院诊断的甲亢合并ACS患者（甲亢组）64例及甲状腺功能正常的ACS患者（对照组）56例,分析其临床及冠脉病变特点.甲亢组静息性心绞痛、高血压、糖尿病的发生率,纤维蛋白原（FIB）、氨基末端B型利钠肽前体（NT-proBNP）水平、零病变及冠状动脉痉挛比例明显高于对照组（P＜0.05）,低密度脂蛋白胆固醇（LDL-C）、总胆固醇（TC）水平明显低于对照组（P＜0.05）.甲亢合并ACS患者常发生静息性心绞痛,冠心病危险因素与甲状腺功能正常患者有所不同,零病变及冠脉痉挛比例高,冠状动脉痉挛可能是其发生急性心肌缺血的重要机制.     

自身抗体检测新技术及其临床应用

自身抗体的检测在自身免疫性疾病（A ID ）的诊断,判断疾病的严重程度及评价疗效方面拥有十分重要的临床意义。随着免疫检测技术的进步,新的自身抗体特异性靶抗原被发现,自身抗体的检测技术也越来越多,出现如何评估自身抗体检测方法及诊断价值的新问题。本文介绍自身抗体检测的新技术及自身抗体检测技术的发展趋势,评估自身抗体检测方法应用现状,分析了临床自身抗体检测技术的优缺点,让临床实验室更加合理有效选择自身抗体检测技术。     

心血管病患者择期介入手术前后焦虑抑郁及影响因素分析

探讨择期介入治疗心血管病患者术前术后焦虑抑郁水平及其影响因素。连续调查我院心内科行择期介入治疗的住院患者100例,分别于术前及术后记录患者静息血压和心率,填写贝克抑郁量表、状态焦虑量表、自制担心评定量表、SF-36生活质量调查问卷;SPSS 17．0软件对焦虑抑郁影响因素进行了统计分析。介入患者术后血压（141．2＆#177;10．6）mmHg /（75．1＆#177;11．9）mmHg 较术前（145．4＆#177;18．0）mmHg/（79．8＆#177;12．2）mmHg 显著下降,心率（72．1＆#177;11．6）次/分也较术前（78．2＆#177;12．9）次/分显著降低;术前患者普遍存在焦虑情绪（43．4＆#177;8．4）,焦虑水平与学历、血压及心率均呈正相关（P＜0．05）,与年龄、生活质量呈负相关（P＜0．05）;介入术后患者焦虑水平显著下降（41．2＆#177;7．6,P＜0．03）;抑郁水平在手术前后无明显变化。本结果提示择期介入治疗心血管病患者术前存在明显焦虑,焦虑水平与年龄、学历、血压、心率及生活质量密切相关。     

论疾病诊治中的顾此失彼

"顾此失彼"指在疾病的诊治中发现、意识或处理了事物的一个方面或一个事物,而遗漏、忽视了事物的另一个方面或另一个事物。首先,表现在没有全面地收集和分析相关的临床资料。其次,表现为疾病诊断的不全面。再次,表现为疾病治疗的总体安排、治疗方案或药学监护等方面的顾此失彼。与疾病诊断和治疗有关的"彼"是必须被发现和意识的。但在处理时,则根据"彼"与诊断或治疗关系的程度分别对待。为减少或减轻疾病诊治中"顾此失彼"的不良后果,需要采取一系列相应对策,如实施毕业后规范化培养、学习诊治指南和临床路径、重视疾病诊治的程序、提高临床技能、积累临床经验、丰富相关知识、培养临床思维、提高职业素养等。     

Psychotherapy,complementary and alternative medicine and social dysfunction

This article investigates a bio-psycho-social approach to psychotherapy which works, where possible, with interdisciplinary complementary and alternative medicine teams. The model, called anthroposophic psychotherapy, sees body, soul and spirit as interconnected and the study discusses the bio-psycho-social aspects of the model by linking cardiovascular disease, psychological stress, asocial behaviour and social dysfunction utilizing single case study methodology. The limitations of this method are acknowledged and discussed, but it is also argued that the study has a valuable part to play in a research programme which may also later include efficacy and effectiveness research. The methodology incorporates the principle of data synthesis, as well as data analysis, in accordance with the holistic nature of the clinical model, since it takes the view that all of the elements in the research field are connected. The anxieties presented by the client were linked to arteriosclerotic symptoms and social problems. All of these elements had their roots in childhood and needed to be treated with a number of interventions, including anthroposophic psychotherapy and medicine, which incorporates the homeopathic principle of ‘like cures like’.     

Does timeframe adjustment of the Life Orientation Test-Revised assess optimism as a state?

ABSTRACT

Optimism is prospectively associated with superior health outcomes in cardiac patients, making it an attractive target for well-being interventions in this population. However, optimism measured by the Life Orientation Test-Revised (LOT-R) has largely been considered a static, dispositional construct. Among 125 patients with a recent acute coronary syndrome who received a positive psychology intervention, we assessed the properties of a modified LOT-R that changed the timeframe of items from general dispositional statements to queries about ‘right now.’ We aimed to learn whether this modified LOT-R was more dynamic than the original LOT-R via administration of both instruments at three timepoints over the 16-week study period. Contrary to our hypothesis, this modified LOT-R showed no greater change in mean score or intra-individual variance than the original LOT-R over 16 weeks. This suggests that simply changing the timeframe of the LOT-R may not facilitate assessment of more state-like optimism in medical patients.