综合医院开展临床预防服务的可行性

临床预防服务是预防医学的重要组成部分,也是临床医学的重要内容。鉴于慢性非传染性疾病对社会、家庭及个人的负担越来越重,在各级医院尤其综合医院开展临床预防服务,对预防慢性病的发生、发展,降低死亡率、减轻社会、家庭负担,将起到事半功倍的作用,产生深远影响。     

From chaos and insecurity to understanding and coping: experienced benefits of a group-based education programme for people with chronic fatigue syndrome

The aim of this study was to elicit participants' experiences with a multidisciplinary patient education programme and their views regarding the usefulness of the programme. Focus group interviews were conducted with 10 participants immediately and nine months following participation in the programme and analysed using thematic analysis. Initially, the participants experienced confusion and insecurity regarding coping with the illness. Participation in the programme appeared to promote understanding, acceptance and coping through gaining greater knowledge, learning coping strategies and exchanging experiences, as well as receiving understanding and acceptance. Thus, the programme was experienced to be a beneficial intervention. However, the participants expressed a need for more guidance or follow-up to maintain the practice of coping strategies for better coping with their illness.     

慢性应激对大鼠行为和免疫细胞热休克蛋白70表达的影响

目的：研究慢性不确定应激对大鼠急性整体热水浴后外周血和脾脏免疫细胞热休克蛋白70（Heat shock protein 70, HSP70）表达的影响。方法：随机将大鼠分成慢性应激组和控制组（每组14只）。通过4周的慢性不确定性应激诱发实验组大鼠明显的抑郁行为,此期间控制组大鼠正常饲养。随后给予大鼠42度整体热水浴刺激,维持直肠温度41度25min。热刺激后6h,采用流式细胞仪测定大鼠外周血和脾脏免疫细胞HSP70 水平。结果：与控制组大鼠相比,慢性应激大鼠在急性热刺激后HSP70合成明显减少。控制组大鼠的所有被检测的免疫细胞热应激后HSP70合成均明显增加。相反,慢性应激大鼠仅在外周血的单核细胞和粒细胞检测到HSP70合成增加,同时升高的水平明显低于控制组大鼠。结论：慢性应激降低大鼠免疫细胞HSP70的热诱导反应,提示HSP70保护性作用减弱可能参与了慢性应激损害免疫细胞功能的生物学过程     

改变因症就诊的医疗模式搞好慢性呼吸疾病的防控

本文简单介绍了各种慢性呼吸疾病的特点、重要性、病因和发病机理,重点阐述认真搞好三级预防是有效防控慢性呼吸疾病的基础,而目前我国慢性呼吸疾病医疗服务模式是因症就诊,这种医疗服务模式不利于慢性呼吸疾病的管理和控制,必须尽快改变。     

应该发挥医院、医生在慢性病预防中的作用

从必要性分析、可行性分析、预防效果分析及存在的问题等方面探讨在我国必须要发挥医院、医生在慢性病预防中的作用,只有整合医疗资源与疾病预防控制资源,才能更好地预防慢性病。     

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.     

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。     

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.     

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.