人文医学视域下构建《惠世医学人文素养》课程的教学实践

目的研究医学教育如何将人文精神内化于心,为医疗实践提供思路和方向。方法以《惠世医学人文素养》课程为载体,将心理营养教育融入人文教育,整体化教学整合人文和医学;应用Kirkpatrick模型从反应、学习、行为和结果等4个层次分析课程的教学效果。结果学生对课程满意度高;课程学习后学生增强了信息管理能力、团队合作能力、语言表达能力、自我发展能力等,提高了专业认知度,加强了职业认同感,在技能考核中展现了良好的人文关怀精神和优良的职业素质。结论《惠世医学人文素养》课程作为医学人文教育模式创新的有益尝试,有助于提高医学人文教育的有效性和针对性。     

医学模式的转变促进健康观念的更新

健康是人类追求的永恒目标。随着社会的发展,生物医学模式向生物心理社会医学模式转变,“没有疾病就是健康”的观念已过于陈腐,人们对健康的理解已从“没有疾病”发展到包括生理、心理、社会的完满状态,健康的涵义更为深化,健康观念得到更新。     

Factors related to psychosocial adjustment in children with end-stage renal failure

Psychological functioning and adjustment to dialysis were assessed in the families of 60 children and adolescents undergoing chronic dialysis. Sociodemographic factors, treatment variables, health status and satisfaction with health care provision were also measured. Correlation analyses identified a number of important factors associated with poor adjustment to dialysis and/or anxiety and depression in children and parents. Particularly at risk are parents in lower socioeconomic status households, parents with large families, parents with limited support and parents of young children. Children were more at risk where there was greater functional impairment caused by illness. Received: 10 December 1997 / Revised: 8 March 1999 / Accepted: 16 March 1999     

Does financial hardship account for elevated psychological distress in lone mothers?

Lone mothers have been shown to have higher levels of psychological distress than married mothers, but it is not clear how this difference arises. Using data from the 1958 British birth cohort followed to age 33, we investigated alternative explanations for the excess distress of lone mothers. Logistic regression models were used to estimate odds ratios for distress (measured using the Malaise Inventory) in lone vs married mothers. Odds ratios were adjusted to assess the contribution of explanatory factors. At age 33, psychological distress was greater among lone than married mothers (OR 2.59, 95% CI 1.97, 3.41). The odds ratio decreased to 1.43 (95% CI 1.02, 2.01) after adjustment for all explanatory factors (prior psychological distress, age of youngest child and number of children in the household, and contemporary measures of financial hardship, employment, and social support). Attenuation of the odds ratio was most marked after taking account of financial hardship. Psychological distress was greater among divorced mothers than never married mothers, though not significantly (OR = 1.70, 95% CI 0.88, 3.28). This difference was not explained by the factors examined, and was not due to the immediate distress associated with a recent divorce. Elevated psychological distress of lone mothers appears to be related to financial hardship, while other explanations, including social support and selection, have a more modest impact. Not all of the elevated psychological distress among lone mothers was accounted for, particularly among divorced lone mothers.     

反复心理应激对大鼠儿茶酚胺和酪氨酸代谢的影响

采用ＣｏｍｍｕｎｉｃａｔｉｏｎＢｏｘ大鼠模型研究了反复心理应激对大鼠儿茶酚胺（ＣＡ）和酪氨酸（Ｔｙｒ）代谢的影响,及补充Ｔｙｒ的作用。实验发现：反复心理应激使心理应激组（Ｓ组）和心理应激补充Ｔｙｒ组（ＳＴ组）第１、３、７ｄ２４ｈ尿ＣＡ排出量高于对照组（Ｃ组）（Ｐ＜００５）;而第１４ｄＳＴ组血浆和脑匀浆Ｔｙｒ含量分别高于Ｓ组和Ｃ组（Ｐ＜００１）。反复心理应激７ｄ时,Ｓ组大鼠旷场试验得分低于Ｃ组（Ｐ＜００５）,产生行为缺陷,而补充Ｔｙｒ使ＳＴ组大鼠旷场试验得分降低有所减轻。     

学校心理干预对中小学生心身健康水平的影响

目的了解心理卫生教育对中小学生心身健康的影响. 方法以学校心理卫生教育干预形式,结合家庭干预,对小学四年级一个班52名学生和初中一个班50名学生进行一个学期16课时的心理教育和四个学时的家长公开课相结合.以53名同校四年级和51名同校初二另二个班学生为对照,用SCL--90分别进行测查. 结果心身健康水平有显著提高,其中强迫、人际敏感、焦虑、精神病性四项心理指标的提高较为显著,男女生干预前后在某些指标上的变化却有差异.本实验对有轻微心理症状学生的心身健康水平的改善最为明显,而对存在明显心理障碍学生的心身健康水平的改善不明显. 结论心理干预能够减少或消除不良因素,预防心理疾病的发生,提高中小学生的心身健康水平.     

三资企业从业人员心理卫生状况调查

[目的 ]　了解三资企业从业人员心理卫生现状。　 [方法 ]　采用症状自评量表 (SCL— 90 )对 776名三资企业从业人员心理卫生情况进行调查及分析。　 [结果 ]　三资企业从业人员SCL— 90量表得分均值高于全国常模 (P<0 .0 1) ;5年工龄以下 ,操作工人的躯体化、强迫症状、敌对、偏执、精神病性症状得分均值高于行政管理人员 (P <0 .0 5或P <0 .0 1) ;除强迫症状、精神病性症状外 ,有毒有害接触人员得分均值高于不接触有毒有害作业人员 (P <0 .0 5或P<0 .0 1) ;除敌对、精神病性症状外 ,女性得分均值高于男性 (P <0 .0 5或P <0 .0 1)。 5年以上工龄 ,除精神病性症状外 ,操作工人得分均值高于行政人员 (P <0 .0 5或P <0 .0 1) ;接触有毒有害人员以及女性得分均值分别高于不接触有毒有害人员和男性 (P <0 .0 5或P <0 .0 1)。　 [结论 ]　三资企业从业人员存在一定心理问题 ,有必要开展职业心理卫生的健康干预。     

桂西山区中学生伤害与心理健康状况的关系

目的了解桂西山区少数民族中学生伤害的发生与心理健康状况的关系,以便为预防和控制青少年伤害的发生提供科学依据.方法以随机整群抽样的方法,对桂西3所中学1 855名中学生采用SCL-90症状自评量表进行心理健康测评,并作伤害问卷调查.结果伤害总发生率为32.02%,发生2次及以上伤害的发生率为10.51%;初中生伤害发生率明显高于高中生,男女生伤害发生率差异无显著性.发生伤害学生的心理健康水平明显低于未发生伤害的学生,尤以强迫、精神病性、焦虑、躯体化、抑郁较为突出.多因素Logistic回归分析表明,年龄、父亲文化程度以及SCL-90因子中躯体化、强迫、人际敏感、抑郁、焦虑、精神病性为伤害发生的主要影响因素.结论 心理健康状况可能是影响伤害发生的重要因素,加强心理健康维护可控制伤害的发生.     

妊娠期糖尿病孕妇情绪状态及危险因素分析

目的 :探讨妊娠期糖尿病 ( GDM)孕妇情绪状态及糖尿病的危险因素。方法 :对 4 3例 GDM孕妇和 74例正常孕妇进行对照研究。采集两组孕妇的一般资料 ,并以汉密顿焦虑量表 ( HAMA)、汉密顿抑郁量表 ( HAMD)为工具评定焦虑及抑郁症状。结果 :GDM孕妇焦虑及抑郁症状的发生率均为 2 5 .6 % ( 11/ 4 3) ,焦虑症状的发生率显著高于对照组。GDM孕妇的 HAMA总分及因子分均显著高于对照组。L ogistic回归分析发现 ,孕周、孕妇体重指数、家庭经济状况及 HAMA总分为 GDM的危险因素。结论 :GDM孕妇孕中期焦虑及抑郁症状的发生率较高 ,并且焦虑是 GDM的风险因素。应加强对 GDM孕妇情绪状态变化的检测 ,及时进行心理辅导及心理治疗