关于医学生外科临床实习质量的探讨

外科是一门实践性很强的学科，如何培养实用型医学人才是摆在我们面前的首要问题。本文分析了外科临床实习中存在的问题，并提出一些应对措施。     

Causes and types of health effects during the use of crop protection chemicals: data from a survey of over 6,300 smallholder applicators in 24 different countries

Purpose  The present investigation looks in detail at the causes and types of health incidents reported by 6,300 mainly smallholder agrochemical users in 24 countries during 2005 and 2006. Methods  The investigation is based on a questionnaire survey of knowledge, attitude and practice that concentrated on the sequence of events from purchasing the pesticide to disposal. Information was also collected about health problems experienced while using agrochemicals. The survey targeted mainly smallholder knapsack spray operators who were expected to be at a highest risk of exposure. Results  In the 12 months prior to interview, 1.2% of users reported an agrochemical-related incident that required hospital treatment, 5.8% reported an incident requiring at least trained medical treatment but not hospitalisation and 19.8% reported only a minor sign or symptom. Users who had experienced an incident involving agricultural equipment were 3.38 (95% CI 2.29–4.99) times more likely to experience an agrochemical-related health incident, but confident users who felt that their use of personal protective equipment while spraying was best practice were 0.60 (95% CI 0.44–0.84) times less likely to experience such an incident. Over 80% of product-related incidents were caused by insecticides and the incidence rate per spraying time for incidents linked to insecticides was significantly higher than that for fungicides or herbicides. Headache/dizziness and nausea/vomiting, often smell related, were the most common symptoms reported by users who listed agrochemical products that had caused them health problems (52 and 38% of product mentions, respectively). Conclusions  In most countries, the incidence of serious health effects was low; however, there was a high incidence of minor signs and symptoms in a few countries, especially in Africa. A disproportionate number of incidents occurred during insecticide use relative to the time that they were sprayed. Failure to exercise caution as indicated by whether users had incidents involving agricultural equipment or livestock, and lack of confidence in their practices were the most important predictors of agrochemical-related incidents.     

张謇的教育思想与实践

张謇的教育思想十分丰富 ,并且具有鲜明的时代特点。他在江苏南通的教育实践成就卓著 ,极富特色。他较早地提出了教育为地方经济社会发展服务的思想 ,创造了“以实业辅助教育 ,以教育促进实业”的成功模式 ,反映了教育从边缘走向经济中心这一历史发展的趋势。张謇的教育思想与实践在近代中国教育史上有重要地位     

Postoperative pain management—clinical practice is still not optimal

Major progress in clinical pain assessment and management has been achieved in the last decade. More effective analgesic drugs and improved techniques for pain management have been introduced. However, medical reports published during the last few years on postoperative pain management (POPM) indicate that moderate or even severe pain is still rather commonly experienced by surgical patients in the early postoperative period and that worst-pain-episodes may occur even in the late postoperative phase. Insufficient relief of postoperative pain seems a more common problem on surgical wards than on a postanaesthesia care unit (PACU). The aims of POPM are to inhibit autonomic trauma-induced nociceptive impulses that may result in functional disturbances of vital organs and thereby affect the incidence of potentially severe complications influencing clinical outcome. Considering that recent studies continue to show sub-optimal pain management despite the availability of effective drugs and analgesic techniques it must be considered essential to identify possible barriers to effective pain management in clinical practice so that necessary improvements in POPM routines can be carried out.     

马克思人道主义的哲学路径

马克思登上哲学舞台伊始 ,就深怀着强烈的人道主义情愫 ,这种情愫逐步生长 ,最终构成了马克思历史观的基本内核。高扬自我意识 ,崇尚自由精神 ,吁求自然主义与人道主义和谐的共产主义 ,是青年马克思作为理想人道主义者的价值取向。从超验走向经验 ,以实践本体解构逻辑本体 ,马克思为自己的实践人道主义奠定了哲学基石。从现实的个人出发 ,批判非人的资本主义制度 ,谋求工人阶级的解放 ,并把人的自由而全面的发展作为最高价值诉求 ,马克思在社会历史发展的必然性中找到了人道主义的理想归宿     

中外社区护理模式的比较及启示

就国内外社区护理的发展概况、组织机构、工作内容、工作形式、基本原则以及对护理人员的基本专业要求等方面展开比较,强调以护理改革为先导,大力进行社区护理教育和改革,根据社区需要明确社区护理培养和教育目标,调整组织机构和对护理人员进行专业培训,并引进全科医学护理理念,构建社区护理新模式,以推动我国社区护理的发展。     

Principles and strategies of effective community participation

A framework is offered for understanding the conceptual basisand the strategic implications of community participation, inachieving Health for All goals. Special focus is given to themeaning, settings and levels of participation in official decision-makingstructures and at the community level. Questions such ‘howis participation facilitated?’, ‘who participates?’and ‘what are the benefits and obstacles to participation?’are geared primarily towards the needs of individuals who functionat the city level and expect practical strategic advice andguidance. The structure of the 1989 WHO Healthy Cities Symposiumwhich was devoted to community action was based on the frameworkand conceptual approach of this paper.     

How Can and Do Australian Doctors Promote Physical Activity?

Background.Physical inactivity is recognized as an important public health issue. Yet little is known about doctors' knowledge, attitude, skills, and resources specifically relating to the promotion of physical activity. Our survey assessed the current practice, perceived desirable practice, confidence, and barriers related to the promotion of physical activity in family practice.Methods.A questionnaire was developed and distributed to all 1,228 family practitioners in Perth, Western Australia.Results.We received a 71% response (n= 789). Family practitioners are most likely to recommend walking to sedentary adults to improve fitness and they are aware of the major barriers to patients participating in physical activity. Doctors are less confident at providing specific advice on exercise and may require further skills, knowledge, and experience. Although they promote exercise to patients through verbal advice in the consultation, few use written materials or referral systems.Conclusions.There are significant differences between self-reports of current practice and perceived desirable practice in the promotion of physical activity by doctors. Future strategies need to address the self-efficacy of family physicians and involve resources of proven effectiveness. The potential of referral systems for supporting efforts to increase physical activity by Australians should be explored.