Disparities in access to family physicians among transgender people in Ontario,Canada

Background: Informed by the Gelberg-Andersen behavioral model for vulnerable populations, this study examined the prevalence of and factors associated with not having a family physician among transgender (trans) people in Ontario, Canada.

Methods: Data were drawn from a respondent-driven sampling (RDS) survey of trans Ontarians age 16 and above (n = 433) conducted between 2009 and 2010. All analyses were weighted using RDS II methods. Prevalence ratios were estimated using average marginal predictions from logistic regression models.

Results: An estimated 17.2% (95% CI, 11.0 to 22.9) of trans Ontarians (median age = 28.7, 77.3% White) did not have a regular family physician. In multivariable analyses accounting for other predisposing and need-related factors, transfeminine persons (trans women and non-binary persons assigned a male sex at birth) who were Indigenous and/or persons of color were less likely than other transfeminine persons to have a family doctor. In addition, trans persons who were homeless or had unstable housing were less likely to have a family doctor than those who were adequately housed.

Conclusions: These results provide the first quantitative evidence of health disparities by race and gender within a Canadian transgender population and suggest a social gradient in access to care within Ontario's “universal health insurance” system.     

Moral injury,coherence, and spiritual repair

In the PTSD literature, moral injury represents dissonance between a person’s beliefs about how they and the world should function, and the trauma event(s) they experienced. Given the association of moral injury with the assumptive world, it is not surprising the concept is closely intertwined with spiritual concerns. This paper reports on a spiritually integrated group intervention designed to help veterans with PTSD in the process of moral and spiritual repair. Qualitative findings are shared from interviews conducted with 18 participants who completed the intervention. Themes are centred around participants’ overall response to their experience in the group; where they are at regarding feelings such as guilt, shame, anger, trust, sense of betrayal, and desire for forgiveness; changes in religious/spiritual beliefs and practices and the experience of moral injury; and if they now find meaning in the trauma. The findings support the need for additional treatment options that address the moral and spiritual aspects of trauma.     

家庭认知环境与0~3岁婴幼儿发展的关系:有调节的中介效应

本研究以5914名0~3岁婴幼儿家长为问卷调查对象,考察了家庭认知环境、入托经历、努力控制对0~3岁婴幼儿发展的影响机制。研究发现：（1）婴幼儿努力控制在家庭认知环境与婴幼儿发展中具有中介效应,即家庭认知环境通过作用于努力控制而对婴幼儿发展产生影响;（2）婴幼儿是否入托在“家庭认知环境→努力控制→婴幼儿发展”这一中介路径的前半段中具有调节作用,当婴幼儿有入托经历时,家庭认知环境对婴幼儿努力控制的影响更大。     

Rawls and Research on Cognitively Impaired Patients: A Reply to Maio

In his paper, “The Relevance of Rawls’ Principle of Justice for Research on Cognitively Impaired Patients” (Theoretical Medicine and Bioethics 23 (2002):45–53), Giovanni Maio has developed athought-provoking argument for the permissibility of non-therapeutic research on cognitively impaired patients. Maio argues that his conclusion follows from the acceptance of John Rawls’s principles of justice, specifically, Rawls’s “liberty principle” Maio has misinterpreted Rawls’s “libertyprinciple” – correctly interpreted it does notsupport non-therapeutic research on cognitivelyimpaired patients. Three other ‘Rawlsian’ arguments are suggested by Maio’s discussion –two “self-respect” arguments and a “presumed consent” argument – but none of them are convincing. However, an alternative argument developed from Rawls’s discussion of “justice in health care” in his most recent book, Justice as Fairness: A Restatement, may justify certain kinds of non-therapeutic research on some cognitively impaired patients in special circumstances. We should not expect anything more permissive from a liberal theory of justice. This revised version was published online in June 2006 with corrections to the Cover Date.     

重症医学临床查房流程和思维模式

重症医学作为二级学科成立才10余年,与普通科室不同,重症医学科收治的患者都处于极其危重状态,需要在查房过程中迅速做出诊断、制定治疗决策并高效执行。重症医学临床查房应充分做好查房前准备,简洁汇报病史,运用核查表行结构化查房,组织好多学科查房,注重人文关怀。重症医学查房的临床思维包括：抓住主要矛盾、注重整体,诊断第一、治疗规范,运用连续“提问”和连续“假设”的证伪思维,动态地收集患者信息,不断巩固自己的诊断,或者及时修正自己的诊断和补充自己的诊断,从而让患者得到最优的治疗。

     

健康素养型医疗机构与健康促进医院的概念与特征比较综述

健康素养型医疗机构建设是提升居民健康素养的必要途径和有效手段。通过回顾国内外文献,从医疗机构建设的角度,对健康素养型医疗机构和我国健康促进医院的概念与特征进行介绍与比较,发现两者在服务人群和适用对象、特征内涵及评价工具上均有异同点,提出健康素养型医疗机构建设是实现我国健康促进医院建设目标的必要前提,也是促进医疗机构和医务人员健康促进和健康教育工作开展的有效途径,以为践行《健康中国行动(2019-2030年)》中的相关指标提供参考。

     

孕育生命受限胎儿的围产期预立照护计划

通过对国外孕育生命受限胎儿的围产期预立照护计划的研究现状进行文献综述,为我国围产期安宁疗护的发展提供参考。当发现胎儿生命受限时,围产期预立照护计划成为了抚慰家庭丧亲之痛和协助做出合理医疗决策的关键工具。纵观国内发展情况,我国围产期安宁疗护的发展具有市场需求大、国家重视、国外经验可借鉴等优势。但由于缺乏相关培训和宣传,照护团队的服务水平和推行相关预立照护计划的意识低、大众认知低等问题制约其发展。故建议加大教育和宣传力度,提高公众认知和医护人员相关能力,以保证我国围产期安宁疗护的稳健发展。

     

Surf therapy for improving child and adolescent mental health: A pilot randomised control trial

The aim of this pilot randomised control trial (RCT) was to test, 1) feasibility and acceptability of a surf therapy program to improve symptoms of mental ill-health among children and adolescents, and 2) the design and procedures of an evaluative study. This pilot RCT compared a 6-week mentor-supported surf therapy program with a wait list control group, in Australian children and adolescents aged 8–18yrs (M age = 11.28, SD = 2.34; 15 females), who were help seeking for issues relating to their mental health. Exclusion criteria included if an individual was actively suicidal or experiencing a psychotic episode or being unavailable for program dates. The primary outcome was the feasibility and acceptability of the intervention and study design assessed via 11 pre-defined criteria. A secondary outcome was to investigate the effectiveness signal of the intervention on child indicators of depression and anxiety, assessed via the Revised Children’s Anxiety and Depression Scale-Short Form and the Strengths and Difficulties Questionnaire. Random allocation was computer generated and while it was not possible to blind participants, researchers collecting assessments were blinded to group allocation. Thirty-six youth were randomised (intervention = 18; wait list controls = 18), representing an 84% participation rate among eligible youth. Of the 11 a priori feasibility and acceptability criteria, 4 of 5 relating to the intervention, and 4 of 6 addressing the study design were fully met, with the unmet factors guiding program revision. At the completion of the intervention, children and adolescents receiving the intervention reported reductions in symptoms of depression (ES = 0.57), anxiety (ES = 0.43), emotional problems, (ES = 0.79), peer problems (ES = 0.56), hyperactivity/inattention (ES = 0.28), and overall difficulties (ES = 0.64). These reductions were not sustained 6-weeks after completion of the intervention. Surf therapy is an acceptable and feasible intervention for addressing symptoms of mental ill-health among children and adolescents. Preliminary evidence suggests that surf therapy improves symptoms of mental ill-health in the short-term but that these improvements were not sustained after the intervention is ceased.     

Clinician Perspectives of Diagnosis and Perceived Client Change in “Real World” Psychotherapy for Youth Emotional and Behavioral Disorders

We investigated the extent to which clinician-assigned diagnoses of emotional and behavioral disorders and clinicians’ perceptions of client change are consistent with structured measures of youth clinical functioning and parent/family characteristics within the context of usual care or “real world” psychotherapy. A total of 54 therapists from two publicly-funded youth outpatient mental health clinics and 128 youths and parents from the therapists’ combined caseloads were included in the study. Clinician-assigned diagnosis and youth and family demographics were collected at the initial visit, clinician-reported perceived client change was collected at 6-month follow-up, and structured measures of youth clinical functioning and parent/family characteristics were collected at both time points. Results indicate some overlap between clinician-assigned diagnosis, clinician-reported perceived client change, and structured measures of youth clinical functioning and parent/family characteristics after controlling for demographic factors. Results are discussed in terms of implications for the implementation of evidence-based practices in real world community settings.     

年轻医生如何搞好临床科研

面对目前年轻医生对科研束手无策的状况,提出了科研的重要性.从科研选题要紧密结合临床实际、医学科研选题强调创新与实用的原则、医学科研需要的科研素质、培养独立从事临床科学研究的能力、充分利用优势科研资源,加强科研合作能力的培养五方面进行阐述如何进行临床科研工作,以便更好地促进临床医学事业的发展.