“疑难杂症”与医学模式

那些长期困扰患者和医生、查不出病因又久治不愈的病症,被称为“疑难杂症”;然而部分“疑难杂症”并非真正的疑难杂症,而是在诊治疾病的过程中所用医学模式出现了问题,医生往往局限于生物医学模式,忽略患者的心理、社会因素。因此,医学模式应该从实际工作中进行转变,而不能仅仅局限于理论上。笔者就临床常见的“怪”现象、医疗对象的复杂性...     

Coping strategies of mother carers of children living with chronic illness and disease in a rural South African community

The present study explored the coping strategies used by mother carers of children living with chronic illness and disease (CID) in a rural South African community. Ten mothers (age range = 30 to 56 years) were selected through snowball sampling to participate in the present study. They provided care to their children, a majority (50%) of whom had epilepsy, followed by asthma (20%) and other conditions. Data on the coping strategies used by mothers of children living with CID were collected using semi-structured interviews and analysed thematically. The results showed that mother carers tended to use three types of coping strategies, namely: appraisal-focused, problem-focused and emotion-focused strategies. Appraisal-focused was commonly used by mother carers whose children had epilepsy, whilst mother carers of children with asthma tended to use problem-focused coping strategies. All mother carers were found to use emotion-focused strategies to varying degrees in coping with the chronic diseases of their children.     

Psychologie de la santé et éducation thérapeutique : état des lieux et perspectives

The aim of Patient Education (PE) is to make patients with chronic diseases more autonomous by facilitating their adherence to treatments and improving their quality of life. It is a multidisciplinary and expanding device. This article's aim is to propose a state of play of PE and its perspective in relation to psychology, especially health psychology, as a discipline and a practice. First, the development of PE in its historical context is presented as well as its definition. Then, the place and contribution of health psychology and psychologists in PE is presented. The following points deal with the contributions of research to understand the efficacy of PE, the difficulties that the different professionals face and the place of relatives. Finally, a reflexion about the links between the training of psychologists and the training for PE is proposed.     

行为免疫系统理论及其研究:新视野下的再考察

行为免疫系统理论认为, 为了应对流行病威胁, 人类进化出了一套特殊的行为反应倾向, 包括对疾病线索的警觉、厌恶, 对健康配偶的偏好, 对外群体的排斥, 对集体主义的推崇等。已有研究主要从宏观(群体)和微观(个体)两个水平开展, 虽然有大量研究结果支持该理论, 但也存在不少不一致甚至相反的发现。研究方法、理论基础和现代适用性等方面的不足可能是出现这种情况的原因。未来研究需克服上述问题, 并进一步拓展该理论的研究内容, 检验理论和相关研究的边界, 探讨行为免疫背后的生理机制等。     

从幽门螺旋杆菌的发现看中西医结合模式

从幽门螺旋杆菌的发现及中西医对其与胃炎、上消化道溃疡乃至胃癌的关系研究,探讨中西医不同的看法及结论,提出并证明对中西医结合必须要：１．超然于东西方传统文化观念之上,超脱于整体观与还原论之外;２．建主结构精确,逻辑严密的系统与模式;３．在基本理论和概念上有所取舍,有所发扬,有所更新。     

从SARS到EV71：国外传染病疫情监测预警经验及其启示

英国、美国和法国在传染病疫情监测预警方面积累了丰富的经验,本文从不同角度简要介绍了这三个国家的传染病监测经验,并从疫情监测形式、检验检测水平、专业人员能力、疫情信息报告等方面分析了我国疫情监测预警系统存在的问题和差距,最后针对性地提出了一些政策建议。     

一个新的中医研究范式:从非线性动力学的角度解读中医

西方对中医的研究多是利用随机控制试验来检验其疗效。通过讨论,认为这类研究有其局限性。同时探讨一种新的研究范式,即非线性动力学理论。认为这一理论能够提供理论依据来设计适合中医特征的临床试验,并可望得出为西方医学界所接受的研究结果。     

Improving Service Evaluation in Clinical Genetics: Identifying Effects of Genetic Diseases on Individuals and Families

Outcome measurement in clinical genetics is challenging. Outcome attributes used currently have been developed by service providers or adapted from measures used in other areas of healthcare. Many of the ‘patients’ in clinical genetics are healthy but at risk of developing or transmitting a condition. Usually no pharmacological or surgical treatment is offered, although information-giving is an objective of most consultations. We argue that services should be evaluated on the basis of how well they alleviate the effects of disease, from a patient perspective. This paper describes a qualitative study using seven focus groups with health professionals, patients and patient representatives. Social and emotional effects of genetics diseases were identified. Some differences emerged between the effects identified by health professionals and those identified by patients. These findings will be used to inform the evaluation of existing outcome measures and develop robust measures of outcome for clinical genetics services.     

辩证思维在心脏外科疾病诊治中的应用

辩证思维是最普遍适用,最重要的科学思维方法之一。介绍尝试将辩证思维应用于心脏外科工作中的心得,并用具体案例介绍了在心脏外科疾病的诊断与治疗中辩证思维常用的基本原则。     

Loneliness in patients with rheumatic diseases: the significance of invalidation and lack of social support

Rheumatic diseases affect about 20% of the population, leading to common symptoms such as joint problems, pain, fatigue, and stiffness. Loneliness is prevalent in individuals with rheumatic diseases. This could be due to not receiving social support and being stigmatized and invalidated, which might be most common in fibromyalgia, a rheumatic disease that lacks medical evidence. The aim of this study was to compare loneliness in distinct rheumatic diseases and to examine the association of loneliness with social support and invalidation. Participants were 927 patients with ankylosing spondylitis (n = 152), fibromyalgia (n = 341), osteoarthritis (n = 150), rheumatoid arthritis (n = 171), or systemic diseases (n = 113). They completed online questionnaires including an 11-point Likert scale assessing loneliness, the Illness Invalidation Inventory (3*1; Kool et al., 2010), and the Social Support Survey (SSS; De Boer, Wijker, Speelman, & De Haes, 1996; Sherbourne & Stewart, 1991). Patients with fibromyalgia experienced significantly more loneliness than patients with ankylosing spondylitis and patients with rheumatoid arthritis. Besides being younger, having lower education, and not working, in multiple regression analyses both lack of social support and invalidation were independently correlated with loneliness. This suggests that to decrease loneliness, therapeutic attention should be given to both increasing social support as well as decreasing invalidation in patients with rheumatic diseases, especially in patients with fibromyalgia.