The Impact of Family Relations on Caregivers' Positive and Negative Appraisal of Their Caretaking Activities

This study examined the impact of family support and relationship difficulties between the caregiver and the care recipient on caregivers' satisfaction received from caregiving activities and subjective burden. Ninety‐seven individuals caring for a spouse or an adult child with schizophrenia or bipolar disorder participated in the study. Using hierarchical multiple regression analyses, findings showed that relationship difficulties between the caregiver and the care recipient were associated with both satisfaction received from caregiving activities and subjective burden, after the effects of personal, contextual, and stressor variables were controlled. Family support was not associated with caregivers' appraisal of the situation.     

Education in family and community health: the challenge faced by a new medical school

This paper describes the efforts of the Department of Family and Community Health at Sultan Qaboos University in providing opportunities for the development of 'hands-on' problem-solving skills appropriate for Oman. The curriculum of the Department is discussed, highlighting the unusual emphasis of this discipline in both the preclinical and clinical curriculum of the College of Medicine. The importance of continuous assessment and supervision of students is discussed. Course-work in the preclinical curriculum of the Department is kept to a minimum. Field-work forms an important part of preclinical training, where application and problem-based learning are emphasized. During the clinical years the students are exposed to an integrated series of lectures and practicals covering core knowledge in clinical medicine. Practical clinical training, over a total period of 15 weeks, takes place at a variety of sites where common problems in primary health care in Oman are handled by students under supervision.     

The workload of trainees in general practice

During their first training period in general practice the authors felt that they did not encounter the balanced workload which is the foundation for learning to be a GP. Previous studies confirmed the existence of differences in overall and specific workload between trainees and trainers. From their own experience and from the relevant literature they addressed several factors which might affect the workload of trainees. A study was undertaken to determine differences in workload between trainees and trainers, and to investigate whether certain characteristics of practice and of trainees affect the workload of trainees. Details of surgery consultations with 34 trainee-trainer partnerships were recorded in the north of the Netherlands over 2 weeks. Questionnaires were filled in by trainers, trainees and practice assistants from these 34 general practices. The total number of contacts recorded was 10,103. It was found that trainees see fewer elderly and female patients, less chronic and oncological conditions, but more minor illnesses. They see only 30% of patients with problem behaviour. Factors that influence the trainees' workload, as compared to their trainers' are: list size; selection in the allocation of patients; trainee's experience prior to starting the training stage, and the trainee's sex. Except for problem behaviour, trainees generally see a cross-section of their trainer's practice population. Selection would provide a more balanced workload for trainees.     

Family Resources and Development of Social Competence in Disadvantaged Children in India

Family resources in terms of their qualitative (process) and quantitative (structure) nature influences the development of social competence in children/adolescents. Present study aims at exploring the relationship of family resource variables with three measures of social competence of 300 adolescent belonging to different socio-cultural status. Socio-culturally advantaged group samples were found to have healthy family environment, whereas, socio-culturally disadvantaged group perceived themselves as at disadvantages and were deprived in seeking positive intra-family support. However inspite of their disadvantages, they were found to be more self-competent. On the other hand, advantaged group adolescents were found to be more competent in the areas of peer and teacher related social competence. Product-moment coefficient correlation analysis revealed that parental education, occupation and family income were found to be significantly associated with positive peer and teacher related social competence in case of the samples belonging to the advantaged socio-cultural group. However, negative responses and outside family support was found to be positively associated with the development of disadvantaged group adolescent's self-related competence. In general, present study supports the hypothesis that Indian family system still continues to be considered as the major source of support for the adolescents, in spite of their growing tendency for independence, self-definition and autonomy.     

Gaining a Child: Comparing the Experiences of Biological Parents,Adoptive Parents,and Stepparents

This study compares the experience of gaining a child through birth, adoption, or marriage, extending the focus of investigation beyond biological parenthood and the transition made by first‐time parents. Using a subsample from the National Survey of Families and Households (N = 204), we compared reasons for having children, parental well‐being, family relationships, and work roles among parents who gained a child biologically, through adoption, or by becoming a stepparent. Overall, there were many similarities in the impact of gaining a child across the three parental groups. Repeated measures analyses of covariance showed that across family groups, after gaining a child, respondents reported less depressed affect, more disagreements with their spouse, and more support from their own parents. The differences across groups suggest that the experience of becoming an adoptive parent or a stepparent may be less stressful than the adjustment to biological parenthood.     

Effect of family role on response to disaster

This study hypothesized that family role (marital and parental status) would moderate the effect of disaster exposure on the mental health of victims. The study included St. Louis residents exposed to floods and dioxin, as well as Puerto Rican respondents exposed to floods and mudslides. In St. Louis, worst outcomes were found for single and married parents exposed to disaster, substantially exceeding the symptomatology of all unexposed respondents except non-victim single parents. In Puerto Rico, victims without families had higher levels of alcohol abuse symptoms than did any other subgroup. Perceived emotional support was found to be an important moderator of disaster's effect on psychiatric distress in this site, generally overriding the effect of family role. Single parents in both sites who were exposed to disaster had substantially reduced levels of emotional support available to them, as compared to unexposed single parents, suggesting that single parents are at particularly high risk for losing access to emotional support following a disaster. This study suggests that both single and married parents constitute important high-risk victim groups. The findings also suggest that those perceiving they lack adequate emotional support, regardless of family role, may be in special need of services.     

单发性双侧面横裂伴有家族遗传和染色体异常3例报告

报告3例单发性双侧面横裂伴有三代家族遗传史和相同的染色体异常核型,相同的对称性恒牙(胚)先天性缺如,并对面横裂的发病机制及病因学进行了讨论。这是一组极罕见的病例,在所涉猎的文献中,迄今尚未见相同报道,是否为一种新的综合征,目前尚不能定论,有待今后进一步探讨     

Lifestyle factors in monozygotic and dizygotic twins

In examining genetic influences on biological variables using twins, it may be important to examine the distribution between and within twin pairs of demographic and lifestyle factors that may themselves affect the biological variable being studied. We explored the distribution of demographic and lifestyle factors that may affect blood lipid levels or ischaemic heart disease (IHD) risk among a sample of 106 monozygotic (MZ) and 94 like-sex dizygotic (DZ) twin pairs. In our sample, MZ twins were statistically significantly different from DZ twins only in marital status, cigarette smoking habits, and the ratio of polyunsaturated to saturated fat (P:S ratio) in their dietary intake. The latter variable was among many dietary variables examined (using 4-day weighed food diaries), and the size of the difference in intake was small. When comparisons were made of the similarities within twin pairs, we found members of MZ twin pairs to be statistically significantly closer than DZ twins in educational achievement, occupation, cigarette smoking, and exercise habits, and the number of days a week on which alcohol was consumed. These last three variables were consistently closer among twins with closer contact than among those with a smaller degree of current shared environment. For 12 of the 13 nutrients examined, the within-pair correlations were higher for MZ than for DZ twins, although our test for significant genetic variance showed statistical significance only for intake of complex carbohydrates. We conclude that MZ twins share demographic and lifestyle factors that might influence the risk of IHD and blood lipid levels to a greater degree than do DZ twins, although it is difficult to say if these similarities in lifestyle result from genetic influences or not. Nevertheless, ascribing differences between correlations in MZ and DZ twin pairs for lipid levels as being purely "genetic"--as implicit in conventional measures of heritability--is likely to overestimate the influence of genetic factors.     

基于信任源模型的全科医疗服务医患信任问题及对策建议

在全科医疗服务制度背景下,增强医患信任是提升医疗服务质量的关键。基于医患信任源模型,结合文献分析,本文对全科医疗服务中的医患信任问题进行了深入探索,得出卫生行政部门对签约服务的监督力度、社区卫生服务机构的设施环境、全科医生提供的服务质量、居民自身的信任倾向是影响医患信任的关键因素。基于此,文章从四方主体角度出发,提出要加强卫生行政部门监管力度、提升制度信任、加强医患沟通、增强人际信任、发挥居民的社会监督力量等建议,以进一步提高居民对基层医疗卫生服务的利用意愿和全科医疗的服务质量。