医学研究生价值观培育探讨

医学伦理课堂教育、“服务-学习”教育模式、体验式临床教学、导师言传身教、多样化社会实践是医学研究生价值观培育的五大途径;通过问卷调查得出,医学研究生更偏向导师言传身教、多样化社会实践、“服务-学习”教育模式的培育途径.     

社会化视角下关于医学生社会实践教育的思考

医学生社会实践教育是医学院校开展实践育人的重要组成部分。针对目前我国大学生社会实践教育社会支持力度不够，没有形成良好社会环境的情况，医学生社会实践教育可通过搭建“医学院-附属医院-实践基地-企业商家”四位一体社会实践架构深化医学生社会实践教育的社会化。     

继续护理学教育实践效果分析与评价

1997年我院依据国家、军队有关“继续医学教育”和“军队护士规范化培训”的件精神,在全院临床科室试行护理人员继续教育学会制管理。结果显示：护理人员专业技能和理论水平及行为规范均取得显效果。继续护理学教育的实施,利于护理人员的综合素质培养,及时评价与修订《实施方案》,是保证继续护理学教育深入发展的前提;建立训练老核-综合评价-管理使用体系是保持继续护理学教育生命力的根本措施。     

医疗保险“两地分离”对流动人口健康自评的影响路径研究

目的:探析参保地对流动人口健康自评的影响路径。方法:以2017年全国流动人口动态监测调查为数据源,基于安德森卫生服务利用行为模型,分析参保地对流动人口健康自评的影响。结果:参保地可以通过“健康档案”“健康教育”“健康档案-健康教育/患病就诊”和“健康教育-患病就诊”等多维路径,影响流动人口的健康自评。结论:医疗保险“两地分离”加剧了流动人口的健康不平等问题,应从宏观层面提高医保统筹层次,推动医保转移接续和异地就医直接结算,重视流动人口的公共卫生服务提供。     

论小学"目标导向-过程干预-评价监控"式心理健康教育模式的建构

针对小学生的心理发展特点和发展现状，从心理健康教育的发展趋势等角度出发，紧密围绕心理健康教育的三个构成要素-教育目标、教育过程和教育质量管理，提出建构“目标导向-过程干预-评价监控”式心理健康教育模式。     

2014“橙心关爱-慢性肾衰患者教育”公益项目启动

近日,“橙心关爱-慢性肾衰患者教育”公益项目2014年启动会举行。“橙心关爱”是中国宋庆龄基金会发起、百特（中国）投资有限公司资助的持续性慢性肾病患者教育公益项目。今年的主题为“走透中国活出自由真精彩”,在全国范围内征集慢性肾衰患者的“一百个特别的精彩瞬间”,通过精彩瞬间的分享和患者间的相互鼓励。让患者增加战胜疾病的勇气,活出自信,展现人生的精彩。     

妇幼保健机构开展健康教育的工作体会

在新形势下,妇幼保健机构医务工作者以“生物-心理-社会医学”模式为指导,在医疗服务过程中引入健康教育,并积极推进健康教育,不断发挥健康教育手段的重要作用,对于促进患者早日康复及社会的和谐与进步都有着重要意义。以下是笔者多年来在妇幼保健机构从事健康教育工作的一些体     

中国乡村医生教育嬗变：历程、机理与趋势

回顾中国乡村医生教育70余年历史，经过了萌芽、探索、深化与创新4个阶段，在施教主体与教育内容方面存在渐进性的阶段差异。在“嬗变起源-嬗变动力-嬗变趋势”框架下分析了中国乡村医生教育嬗变原理。在不同历史情境中农村现实医疗问题逼迫下，村医教育产生了适应性演变，外源力量和内源力量交织共同推动村医教育从“疾风暴雨”式转向“和风细雨”式、从局部零散转向整体集成、从工具性转向价值性。     

怎样唱好“黑脸”、“白脸”这台戏

在谈到教育孩子要一致时 ,家庭教育的指导者差不多都异口同声地对家长说 :“不能一个唱‘黑脸’ ,一个唱‘白脸’。”这种说法究竟对不对呢 ?我以为这种说法是不对的。是把“概念”给弄混了。我们说 ,“教育孩子要一致” ,这说的是“教育原则” ;而“黑脸”、“白脸”之说 ,指的是具体的教育方式方法。二者说的根本不是一码事 ,它们两者形不成一对矛盾。这种说法 ,实际上是把“教育方式方法的灵活性”和“教育原则的坚定性”对立起来了。“教育原则” ,指的是教育行为必须依据的“准则” ,也就是人们常说的“政策”。而“教育方式方法” ,则…     

特殊儿童性教育课程干预及效果评估

探讨基于学校课程的特殊儿童性教育干预方式及效果,为特殊儿童的性教育工作提供参考.方法 采用方便抽样的方法,抽取北京市1所融合学校六年级的12名特殊儿童开展性教育课程.使用“自编特殊儿童性教育访谈提纲和测验表”“自编特殊儿童性教育调查问卷”,于干预前后对12名特殊儿童及其教师和家长进行调查,分析课程效果.结果 在认识身体主题教育前后,学生在“性别区分依据”“生殖器官名称”知识点上的得分均值为(0.17±0.39)和(0.50±0.52),0.00和(0.50±0.52)分,差异均有统计学意义(t值分别为-2.00,-3.45,P值均<0.05);在生命的诞生主题,学生在“脐带认识”和“出生方式”知识点上的得分为(0.17±0.39)和(0.67±0.49),0.00和(0.33±0.49)分,差异均有统计学意义(Z值分别为-2.00,-2.45,P值均<0.05);在隐私部位上,学生在“具体隐私部位”和“学会说不”知识点上的得分为(0.08±0.29)和(0.50±0.52),(0.42±0.52)和(0.75±0.45)分,差异均有统计学意义(t值分别为-2.24,-2.00,P值均<0.05).学生在青春期的身体变化1和青春期的身体变化2涉及到的问题中均有提升,教师与家长反映学生与性相关的行为发生转变.结论 特殊儿童能够通过学校性教育课程了解性健康知识,提高生活技能,树立积极的性态度;性教育课程能促进学校师生之间的情感建立.家校合作是特殊儿童性教育的有效方式,应更加重视特殊儿童性教育.     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.