转变医学思维模式看朊病毒之谜

朊病毒是一种特殊的传染性病原体,与普遍意义上的病原体不同的是,它不合生命最基本的遗传物质核酸,可引起多种传染性的中枢神经系统退行性病变,如库鲁病、牛海绵状脑病等.必须转变固有的医学思维模式来看待朊病毒之谜,并从哲学角度探讨了朊病毒病的出现.     

Kidney Transplants From Young Children and the Mentally Retarded

Kidney donation by young children and the mentally retarded has been supported by court decisions, arguments based on obligations inherent in family relationships, an array of contextual factors, and the principle of beneficence. These justifications for taking organs from people who cannot protect themselves are problematic and must be weighed against our obligation to protect the vulnerable. A compromise solution is presented that strongly protects young children and the mentally retarded but does not abdicate all responsibility to relieve suffering. Guidelines are proposed that prohibit the retrieval of kidneys from young children and the mentally retarded but permit one exception. They would allow retrieval of a kidney when the consequence to a first order relative with whom the donor has a meaningful and valuable relationship is otherwise imminent death. This would be done in accordance with additional guidelines that minimize harm to the donor. Since most patients with end stage renal disease can be maintained on dialysis the need for a kidney to prevent death should be an uncommon occurrence. This compromise is proposed as a solution to a dilemma that exists because two ethical principles are in conflict and one cannot be honored without violating the other.     

临床整合医学的必要性及实施中存在的问题——以慢性阻塞性肺疾病及其合并症的诊治为例

近年来人们逐渐认识到慢性阻塞性肺疾病(COPD)是一种全身性疾病,即COPD不仅会影响到气道和肺,还会引起一系列合并症,包括心血管疾病、骨质疏松、焦虑和抑郁、癌症、感染、代谢综合征和糖尿病等。这些合并症会显著地影响COPD疾病严重程度和预后,因而必须对COPD进行整体防控,然而COPD的上述合并症的诊治分属不同学科,所以要做好COPD的整体防控就需要相关学科进行医学整合。     

Dieulafoy 病导致上消化道大出血的成功救治体会

一例肾移植术后患者行盆腔磁共振检查后出现剧烈呕吐,引起严重的上消化道大出血,行急诊胃镜后确诊为 Dieu-lafoy 病并给予内镜下钛夹止血治疗,治疗效果满意,随访至今未再复发。消化内镜对于 Dieulafoy 病的诊断及治疗均具有重要的意义：内镜不仅成为 Dieulafoy 病变诊断的首选,也逐渐成为该病治疗及诊断的一线选择方案。本文病例的成功诊治,亦得益于及时的急诊胃镜,故可见胃镜对于 Dieulafoy 病诊治的可行性与重要性。     

冠心病患者的抑郁和焦虑

许多临床研究表明,冠心病患者常发生抑郁及焦虑。而在严重精神症状（如抑郁或/和焦虑）者中有较高的冠心病发生率。抑郁增加冠心病患者的不良心血管事件发生率,影响预后。其机制有如下几个方面：对医疗措施及生活方式改变的依从性差、血小板功能异常、血管内皮功能紊乱以及心率变异性降低。选择性5-羟色胺再摄取抑制剂由于其较好的耐受性且无明显的心血管副作用而应用于冠心病合并抑郁及焦虑的药物治疗并改善患者的生活质量。但仍需要更大规模的临床研究以确定抑郁及焦虑对冠心病预后的影响。临床上应更加关注焦虑对冠心病的影响,进一步探讨焦虑能否作为冠心病的危险因素。     

Is burnout solely job‐related? A critical comment

Within the field‐dominating, multidimensional theory of burnout, burnout is viewed as a work‐specific condition. As a consequence, the burnout syndrome cannot be investigated outside of the occupational domain. In the present paper, this restrictive view of burnout's scope is criticized and a rationale to decide between a work‐specific and a generic approach to burnout is presented. First, the idea that a multidimensional conception of burnout implies a work‐restricted scope is deconstructed. Second, it is shown that the burnout phenomenon cannot be confined to work because chronic, unresolvable stress – the putative cause of burnout – is not limited to work. In support of an integrative view of health, it is concluded that the field‐dominating, multidimensional theory of burnout should abandon as groundless the idea that burnout is a specifically job‐related phenomenon and define burnout as a multi‐domain syndrome. The shift from a work‐specific to a generic approach would allow both finer analysis and wider synthesis in research on chronic stress and burnout.     

Trajectories of self-efficacy in persons with chronic illness: An explorative longitudinal study

Background: Self-efficacy is important for changing health behaviour in persons with chronic illness. Longer term trajectories have not been previously explored.

Objective: This study’s objective was to explore the trajectories of self-efficacy in two different groups with chronic illnesses attending a patient education course.

Design: The study design was a longitudinal, comparative cohort study with five time points during a one-year follow-up, using repeated measures analysis of variance.

Setting and participants: Persons with morbid obesity (n = 55) and persons with chronic obstructive pulmonary disease (COPD; n = 56) were recruited at the start of patient education courses in Norway and followed-up four times the following year.

Main outcome measure: The General Self-Efficacy Scale was the main outcome.

Results: Obese persons showed a linear pattern of increasing self-efficacy during the follow-up period, whereas persons with COPD had an initial increase followed by a decrease in self-efficacy. Having paid work was associated with a more positive self-efficacy trajectory.

Conclusion: The results provide support for the currently employed patient education course for morbidly obese persons. In contrast, persons with COPD may need more extensive and/or more frequent support in order to increase and maintain self-efficacy across time.     

High-functioning depression among women in South Africa: An exploratory study

The study estimated the prevalence and trends of chronic depressive symptoms among women in South Africa from the National Income Dynamics Study (NIDS) data collection waves (2008, 2010, 2012, 2014/2015). NIDS utilised the Center for Epidemiological Studies Depression (CES-D) scale to assess depressive symptoms among adults. From the trend analysis, we observed a decrease in self-reported significant depressive symptoms over the eight-year period in black women (2.66%), followed by mixed-race (coloured) women (1.15%). Across race, significant depressive symptoms were associated with socioeconomic status variables such as income, education, and occupational status. Within race, prevalence rates were higher among individuals with low socioeconomic status (lower income, less educated, and less skilled occupations). Black women were at a higher risk of exhibiting high-functioning depression due to their overrepresentation among low socioeconomic status individuals. Symptom prevalence may be explained largely by psychosocial stressors in patriarchal legacy communities.     

Spaced Retrieval Enhances Memory for a Name–Face–Occupation Association in Older Adults With Probable Alzheimer's Disease

The authors trained 4 older adults with probable Alzheimer's disease to recall a name–face–occupation association using the spaced retrieval technique. Six training sessions were administered over a 2-week period. On each trial, participants selected a target photograph and stated the target name and occupation at increasingly longer retention intervals, contingent upon successful recall. Two transfer tasks were included to determine whether the trained association transferred to the person whose picture served as the training stimulus. Results yielded a positive effect of spaced retrieval on memory for the trained association. Analyses of errors revealed that participants remembered the target person's occupation more often than his or her name. There was modest evidence of transfer of the name–face–occupation association to the actual person. Implications of these data for memory remediation and quality of life in cognitively impaired older adults are considered.