成也萧何败也萧何——工业化语境下当代医学的困境与出路

工业化革命的动力打造了当代医学的昌明和繁盛,而工业化思维即成为当代医学向高层次发展的新羁绊。工业化思维的价值取向,使当代医学走向刻板和教化,耐日益失去应有的灵性和柔性,其僵硬的模式化治疗体系与高度个性化的代谢性新疾病群形成了巨大的反差。医学的技术语汇应匡正“恶”行,择“善”而为,追求和谐,这是当代医学走出工业化阴影的必然出路。     

Human Costs of Organizational Downsizing: Comparing Health Trends Between Leavers and Stayers

We studied health-related selection and consequences of an organizational downsizing among 886 municipal employees. Measurements of health indicators were conducted before any rumor of the downsizing and immediately after the downsizing 3 years later. Results of predownsizing health showed that those who did not find employment after the staff reductions were older employees with high preexisting morbidity. Those getting a new job elsewhere were younger and had better health already before the downsizing than the stayers. After the downsizing, deterioration of health was most likely in the stayers working in groups of major staff reductions and among the nonemployed leavers. In the reemployed leavers, the risk of increased health problems was lower than in others including employees working in no or minor downsizing groups.     

The perceptions of the causes of cardiac diseases: a taxonomy

Objective: This study verifies whether the open-ended question of the B-IPQ can collect causal attributions of patients with cardiac diseases, define the more frequent causal attributions reported, classify them and describe the relation between the classification of the causes and patients’ characteristics.

Design: A group of 2011 patients with cardiac diseases was recruited during the first week of cardiac rehabilitation.

Primary outcome measures: Every participant filled in the B-IPQ and the HADS. The qualitative and quantitative analyses of the text using T-LAB identified the most frequent causal attributions and their co-occurrences.

Results: Among the patients, 26% did not recognise any causal attribution. The likelihood that the patients did not provide an answer was increased in older patients, females, patients with lower levels of education and higher levels of depression. Smoking and stress emerged as the most important attributions, followed by genetics, metabolic syndrome, work and nutrition. Four thematic clusters were identified: ‘work and stress’, ‘metabolic syndrome and hypertension’, ‘displeasures and body care’ and ‘heredity and other related diseases’.

Conclusions: This study suggests a classification of the causal attributions in patients with cardiac diseases and identifies thematic patterns and unknown attributions. The themes identified can serve as categories for future closed-ended questions.     

The association between biopsychosocial factors and disability in a national health survey in South Africa

The association between psychosocial factors and disability is less clear. This study investigated the biological and psychosocial (employment and psychological distress) factors associated with level of disability in an adult sample in South Africa. Data were analysed from a cross-sectional survey among adults aged 18–64 (n = 4974). Multiple linear regression was used to investigate the associations of the selected variables with disability. The mean percentage score on the WHODAS scale of disability was 5.31% (95% CI: 4.74–5.88). Age (p < 0.001) and race (p = 0.0002) were significantly associated with disability, and history of stroke (β = 7.19, 95% CI: 3.19–11.20) and heart-related conditions (β = 2.08, 95% CI: [0.23–3.93) showed positive associations. Of the psychosocial variables, psychological distress (β = 10.49 [8.63–12.35]) showed a strong positive association while employment (?1.62 [?2.36 to ?0.88]) showed a negative association with disability. The association between demographic factors, medical conditions and increased disability confirms the findings in the literature. The finding that psychological distress is associated with increased disability has not been frequently reported. This study highlights specific psychosocial targets that may be usefully addressed by health policies and interventions in order to improve disability management.     

The prevalence of suicidal ideation and suicide attempt in patients with rheumatic diseases: a systematic review and meta-analysis

A number of studies have reported the suicidal ideation (SI) or suicide attempts (SA) of patients with rheumatic diseases. However, the estimated prevalence of those disorders varies substantially between studies. This systematic review aimed to describe the prevalence of SI and SA in rheumatic diseases. Literature search was done using Web of Science, Embase, the Cochrane database library, PubMed and CNKI database through June 2017. Studies were screened according to inclusion and exclusion criteria and the qualities of included studies were evaluated. The data was analyzed using STATA version 12.0. A random-effect meta-analysis was conducted on all eligible data. A total of 17 identified studies matched the inclusion criteria, involving 5174 participants with systemic lupus erythematosus (SLE), osteoarthritis (OA), rheumatoid arthritis (RA) and fibromyalgia (FM). Meta-analysis showed that rheumatic diseases patients have high prevalence of SI (26%, 95% CI: 19%-32%, I²=96.2%) and SA (12%, 95% CI: 3%-21%, I²=96.6%). We also found the prevalence of SI and SA in females may be higher than in males. All of these indicated that rheumatologists should screen for SI and SA in their patients. Early appropriate intervention is therefore essential to promote the patients’ good mental health.     

Psychological consequences of rheumatic diseases in children and adolescents: A first exploratory study

The objective of our study was to make a first exploratory study about the psychological status of children and adolescents with rheumatic diseases exploring, also, the significant differences between girls and boys. A total of 123 children (81 girls and 42 boys) with rheumatic diseases, between the ages of 1 and 19 years old were assessed using different measures for evaluating behavioral and emotional problems. The results showed a picture of a mild or moderate degree of psychological problems in the different measures of anxiety, depression, general distress and behavioral problems. Girls, compared to boys, scored higher in most of the measures used, showing more internalizing than externalizing kinds of symptoms. The results suggest the importance of making a more detailed study of these children, comparing them with matched controls and making prospective, longitudinal studies in order to detect psychological problems, and to explore the influence of predictive variables.     

盆腔炎性疾病的预防

盆腔炎性疾病（pelvic inflammatory disease,PID）是影响妇女健康的常见病,针对其发病的诱因,预防PID可以从以下几个方面进行：（1）加强性教育,减少性传播疾病;（2）积极做好妇女的卫生保健指导工作;（3）重视筛查、早期诊断及一次性根治下生殖道感染;（4）提高医务人员的理论水平和技术,避免医源性感染;（5）持续正确选择避孕措施;（6）避免阴道冲洗。此外,长期放置宫内节育器不会增加PID的风险;口服避孕药对PID无明显预防作用,而仅仅与减轻其严重症状有关。     

行为生命周期假设在慢性病防治中的应用

目前,慢性病已成为妨害人民健康的主要疾病,是我国重要的公共卫生问题,但人们并没有对此给予重视。本文运用行为经济学的理论与方法,对此进行分析解释,认为行为生命周期假说能够有效解释此种现象,并可以通过开展群体活动、完善机制和设立名义账户等措施来改变居民的行为方式,从而有效地防治慢性病。     

Psychologie sociale de la santé et compétences psychosociales en éducation thérapeutique : des enjeux pour la recherche et pour la pratique

The article presents the theoretical-methodological contributions of Social Health Psychology on the evaluation and reinforcement of psychosocial skills in the context of therapeutic patient education. This is illustrated by a synthesis of the results of several empirical researches in the field of pediatric diabetes. This synthesis shows that psychosocial skills are part of a system of actions and interpretations shaped by therapeutic and relational issues as well as social symbolism. Several practical implications emerge from these results for more effective work on the psychosocial skills of patients. The article concludes with the interest of a “psychosocial clinic” which draws on the viewpoint of Social Health Psychology to evaluate, analyze and intervene on the psychosocial determinants of health behaviours.