循证医学及其在心血管疾病中的应用

循证医学作为一门新兴的学科,对医学的研究和实践将产生越来越大的影响。在循证医学的操作过程中,如何正确评价和应用所获得的证据极为重要。在短短的十几年间,循证医学给心血管疾病的临床实践带来了根本的变化。     

Evidence of Impaired Glucose Tolerance and Insulin Resistance in Patients With Alzheimer’s Disease

Alzheimer’s disease (AD) and diabetes rarely occur together, a finding that provides a possible clue as to the development of AD. Abnormal glucose metabolism is not limited to diabetes, but also can include impaired glucose tolerance, insulin resistance, and hyperinsulinemia. AD patients have significantly varying insulin levels after drinking sugared sodas and thus may be classified as insulin resistant. After reviewing the literature on impaired glucose tolerance and insulin production in AD, we present several hypotheses as possible explanations for the relationship between insulin resistance and AD. Finally, we suggest future studies, including studies on use of thiazolidinediones (currently used in the treatment of diabetes) in AD.     

助推手卫生的行为干预策略

保持手卫生是感染防控的重要策略,但是如何提高其依从性成为预防传染性疾病和减少医疗机构获得性感染的一大挑战。以行为科学为基础的手卫生助推干预以更“隐性”的方式将洗手转变为一种可自动触发的行为习惯,弥补了以知识分享和健康宣教为主的传统手卫生干预策略的诸多局限性。基于影响机制的不同,手卫生助推干预策略可分为提供决策信息、优化决策选项、影响决策结构、提醒决策方向4个大类的框架体系。多模式助推策略的有效性也已在实践中得到印证,但目前还非常缺乏在中国社会文化情境下开展的助推洗手行为的干预研究,今后可尝试基于行为科学理论有针对性地在医院、学校和社区等公共场所开展此类干预研究和实践,为感染防控、疾病预防和改善公共健康做出相应的贡献。     

浅谈恙虫病的几点认识

恙虫病是自然疫源性急性传染病。通过恙虫病医疗实践，谈几点个人认识：恙虫病流行与该疫源地区鼠类活动有关；恙虫病疫源地会因气候变化而变更；重视恙虫病准确而及时诊断，尽量减少病人疾苦；恙虫病立克次体对人单核-吞噬细胞系统有特别的亲嗜性与专性细胞内寄生，是其临床病理基础；用氯霉素联合双黄连治疗恙虫病可获满意效果。     

民航飞行员冠状动脉粥样硬化情况调查及特点分析

心血管事件成为威胁民航飞行安全的主要因素之一.为更及时地发现飞行员冠状动脉病变,提高用无创性常规辅助检查预测飞行员冠状动脉粥样硬化的准确性,对105例飞行员进行血脂、血压、血糖、体重指数、颈动脉彩色多普勒超声检查、运动负荷心电图试验以及64排双源CT冠状动脉造影检查.比较颈动脉粥样硬化与运动负荷心电图试验阳性、高危因素对冠状动脉预测的敏感性和特异性.飞行员的职业特点可能使其冠状动脉粥样硬化早于其他血管床,危险因素较其他辅助检查可能更具意义,必须综合分析各项检查才可能更准确地预测飞行员冠状动脉病变.     

Resilience in siblings of children with sickle cell disease

This pilot study was conducted to identify factors responsible for promoting resilience in siblings of children with sickle cell disease. Twenty siblings (10–17 years of age) of children (5–13 years) with sickle cell disease were selected from the Pediatric Clinic of Howard University Center for Sickle Cell Disease. The siblings responded to questionnaires, and the data obtained was analyzed by chi-square for association. The results indicated that age, birth order, and gender had no effect on resilience in the siblings. However, family size, number of parents in the home, sibling's knowledge of the illness, degree of morbidity of the illness, socioeconomic status of the family, and parents' attitudes and childrearing practices were all found to affect resilience. These findings provide additional insight into the psychosocial aspects of, and genetic counseling for sickle cell disease, as well as for other chronic genetic disorders.     

The anthropological tradition in the philosophy of medicine

The tradition of anthropological medicine in philosophy of medicine is analyzed in relation to the earlier interest in epistemological issues in medicine around the turn of the century as well as to the current interest in medical ethics. It is argued that there is a continuity between epistemological, anthropological and ethical approaches in philosophy of medicine. Three basic ideas of anthropologically-oriented medicine are discussed: the rejection of Cartesian dualism, the notion of medicine as science of the human person, and the necessity of a comprehensive understanding of disease. Next, it is discussed why the anthropological movement has been superseded by the increasing interest in medical ethics. It is concluded that the present-day moral issues cannot be interpreted and resolved without clarification of the underlying anthropological images.     

AIDS and ‘dirt’: Reflections on the ethics of ritual cleanliness

AIDS and the responses and attitudes it evokes surpass the analytic abilities of standard bioethics. These responses and attitudes are explored in terms of literary and anthropological categories, such as dirt, disorder, pollution and ritual cleanliness. Implications for medical education are suggested.     

Medical Manichaeism

Medical discourse in the contemporary United States is rife with military metaphors. These metaphors have come under vigorous criticism over the last few decades but to no avail; the militaristic tendency has proven tenacious. This essay suggests that its tenacity stems, at least in part, from a dualistic understanding of medicine unaddressed by prior criticisms. For an alternative, this essay turns to Augustine of Hippo, balancing close readings of works that deal explicitly with medical themes—The Catholic Way of Life and the Manichean Way of Life (De moribus) and The Nature of the Good (De natura boni)—with a constructive approach. By adapting Augustine's privative account of evil, we can understand disease as a condition of loss and treatment as a task of restoration. This reconfiguration shifts the focus of our interpretive discourses from malicious invaders to a fuller affirmation of the lived experiences of those who are ill.     

道德判断中的框架效应:一个新的视角

道德领域亦存在框架效应,但有关这类偏差的研究仍然存在不足。研究以600名大学生为对象,以亚洲疾病和工厂风波两类经典情境为实验情境,设置正面和负面两类属性框架,以研究道德判断的框架效应。结果发现,在面临道德判断情境时,在正面框架下被试倾向于选择确定性方案,而在负面框架下被试倾向于选择风险性方案; 在正面框架下被试倾向于评价风险性方案更违背道德,在负面框架下则认为确定性方案更违背道德; 被试对情境中人物选择确定性或风险性方案道德之可谴责性评价与确定性或风险性方案本身之道德违背性评价的判断并不一致:在正面框架下,若情境中人物选择风险性方案,被试认为其行为更应受到谴责; 但在负面框架下,被试对情境中人物选择确定性方案和风险性方案在道德上应受谴责性的评价并无显著差异。研究还发现道德判断框架效应存在性别差异,负面框架下女生更为风险寻求。