对医院用药中药物相互作用问题的思考

目的:提高对药物相互作用的认识,促进合理用药。方法:对我国医院用药中药物相互作用存在的问题进行分析。结果与结论:我国对合理用药中的药物相互作用认知度较低,需从多角度加强药物相互作用研究;转变认知理念,引起各级政府部门和医药人员重视;推行临床药师制,重构药学服务模式;扩宽研究领域,加强药物相互作用机制和中西药相互作用研究;加快信息化建设,组建药物相互作用数据库;扩大普及教育,提高社会公众的药物知识等。     

The Behavior Problems Inventory: Reliability and Factor Validity in Institutionalized Adults with Intellectual Disabilities

Background The aim of this study was to reevaluate the reliability (internal consistency, inter‐rater and re‐test) and the factor structure of the Behavior Problems Inventory (BPI‐01) with adults with intellectual disabilities who resided in a state‐run developmental centre. Methods BPI‐01 was administered to informants who had known participants for a minimum of 6 months. For study 1, data were collected in two samples: 100 residents who were selected based on the challenging behaviour targeted in their behaviour treatment plan and 325 randomly selected residents. Results The internal consistencies of the BPI‐01 subscales were in the good to excellent range. Overall, the inter‐rater and test–re‐test reliability of the subscales and items were adequate with relatively lower reliability found for the Stereotypy subscale and items. For study 2, the data of the 425 participants from study 1 were used in a confirmatory factor analysis, which indicated that three a priori BPI‐01 subscales (Self‐Injurious Behavior, Stereotyped Behavior and Aggression/Destruction) were a reasonable fit. Conclusions The current study provides additional support to the reliability and factor structure of the BPI‐01 in adults with intellectual disabilities.     

“网络社会”的伦理问题及其对医德的影响

本文认为“网络社会”的伦理道德问题是由“网络社会”自身的特点决策的，网络社会所涉及的伦理问题主要有：在道德意识方面，伦理相对主义有重新泛滥的倾向，在道德规范方面，传统的道德规范受到严重挑战，在道德行为方面，各种道德规范现象屡见不鲜，这些伦理问题也冲击到了现实社会中的医德医风，对此，文章提出了开展网络道德教育，制定系统的网络行为规范，构建医德教育的新体系等对策。     

Drug use functions predict cocaine-related problems in young people

Over the last decade, concern about young people and stimulant drugs has primarily focused on the use of amphetamines and ecstasy. In the United Kingdom, this concern has recently expanded to include the use of cocaine hydrochloride (powder cocaine). This study examined patterns of illicit substance use, with a particular focus on cocaine consumption, among a sample of 364 young drug users aged between 16 and 22 years. The sample was recruited using snowballing methods and respondents were interviewed in informal settings by peer interviewers. Over half the sample reported lifetime use of powder cocaine and just over 40% of these had used crack cocaine. A seven item scale was used to measure cocaine-related problems. The three most common problems endorsed by the cocaine users were impaired control, 'prioritizing spending money on cocaine over other things' and being pre-occupied with using. In a multiple regression analysis, 50% of the variance in cocaine-related problem scores was predicted by the perceived functions for cocaine use, the number of times of lifetime cocaine use and the total number of days of recent stimulant use. Use of cocaine to alleviate depressed state or negative mood was the most powerful predictor of cocaine problems. The inclusion of a functional appraisal component could be usefully incorporated in further research studies and in service assessment protocols for young people.     

农村健康社区的构建：困境与对策

健康社区是一个包括健康人群、健康环境和健康社会有机结合的整体。建设农村健康社区对于促进农村社会和谐,实现农村公共卫生和基本医疗服务均等化,提升农村社区居民的健康保障水平具有重大的现实意义。目前,构建农村健康社区遭遇一系列困境。针对这些困境进行分析,尝试性地提出走出困境的对策。     

The Role of Religion and Spirituality in Recovery from Drink Problems: A Qualititative Study of Alcoholics Anonymous Members and South Asian Men

Aim: The purpose of this study was to explore the spiritual aspect of recovery for people with drink problems through carrying out a comparative analysis of South Asian men recovering from drink problems and White members of AA. Method: In-depth semi-structured interviews were carried out with participants to explore significant factors that assisted recovery. Interviews were analysed using grounded theory. Participants: Ten participants in total were interviewed, five were South Asian men receiving individual and/or group counselling with South Asian therapists either in an NHS or non-statutory specialist alcohol treatment service, five were white members of AA. Findings and Conclusions: Models of recovery for the two groups were developed and are presented. Spirituality and religion played an important role in the experiences of recovery described by AA and South Asian participants respectively. For AA participants their experiences reflected those described in AA's Big Book although concepts such as that of a Higher Power were complex and multi-layered, with spirituality just one, albeit significant, aspect. South Asian participants generally underwent a re-affirmation of existing beliefs rather than the conversion type of experience described by AA participants. The findings are discussed in relation to implications for service delivery and development and directions for future research.     

武警森林部队基层医疗保障问题分析及改进对策探讨

通过查阅文献资料和问卷调查,本文对武警森林部队基层医疗保障的机构建设水平、卫生队伍建设情况、卫生人员结构比例和保障模式等方面存在的主要问题进行了归纳分析,并结合武警森林部队的特点提出相应的改进措施,为促进武警森林部队基层医疗保障工作更好更快地发展提供重要的理论参考。     

Hypoactive Sexual Desire Disorder: International Society for the Study of Women's Sexual Health (ISSWSH) Expert Consensus Panel Review

The objective of the International Society for the Study of Women's Sexual Health expert consensus panel was to develop a concise, clinically relevant, evidence-based review of the epidemiology, physiology, pathogenesis, diagnosis, and treatment of hypoactive sexual desire disorder (HSDD), a sexual dysfunction affecting approximately 10% of adult women. Etiologic factors include conditions or drugs that decrease brain dopamine, melanocortin, oxytocin, and norepinephrine levels and augment brain serotonin, endocannabinoid, prolactin, and opioid levels. Symptoms include lack or loss of motivation to participate in sexual activity due to absent or decreased spontaneous desire, sexual desire in response to erotic cues or stimulation, or ability to maintain desire or interest through sexual activity for at least 6 months, with accompanying distress. Treatment follows a biopsychosocial model and is guided by history and assessment of symptoms. Sex therapy has been the standard treatment, although there is a paucity of studies assessing efficacy, except for mindfulness-based cognitive behavior therapy. Bupropion and buspirone may be considered off-label treatments for HSDD, despite limited safety and efficacy data. Menopausal women with HSDD may benefit from off-label testosterone treatment, as evidenced by multiple clinical trials reporting some efficacy and short-term safety. Currently, flibanserin is the only Food and Drug Administration–approved medication to treat premenopausal women with generalized acquired HSDD. Based on existing data, we hypothesize that all these therapies alter central inhibitory and excitatory pathways. In conclusion, HSDD significantly affects quality of life in women and can effectively be managed by health care providers with appropriate assessments and individualized treatments.     

Prevalence of Sexual Problems and Associated Distress in Aging Men Across 4 European Countries

BackgroundAmong older men, comparable cross-cultural investigations of sexual problems and associated distress that also include a multitude of relevant explanatory variables of these sexual problem and related distress are rare in the research literature.AimsTo investigate prevalence rates of sexual problems and associated distress among older men across 4 European countries (Norway, Denmark, Belgium, and Portugal) and assess for associated mental and physical health–related factors.MethodsMultinational cross-sectional questionnaire study using self-report measures.OutcomesPrevalence rates of sexual problems and associated distress levels.ResultsWe found a high prevalence of sexual problems persisting for months or longer across countries, but noted that many affected men experienced minimal or no distress related to these problems. We also found marked cross-cultural differences in reported distress about sexual problems, with southern European men (ie Portugal) reporting significantly more distress related to the majority of sexual problems investigated compared with northern European men (ie Denmark and Norway). Finally, we identified several relational, physical, and mental health problems associated with the reported number of sexual problems and the distress related to these problems.Clinical ImplicationsWe suggest that healthcare professionals also target distress when considering sexual problems among older men and contextualize these considerations within a multifactorial approach to general health in which (other) mental and physical health factors relevant to these patients’ sexual health and function are also jointly considered.Strengths & LimitationsStrengths of this study include the large sample size, inclusion of participants from 4 European countries, assessment of distress associated with sexual problems, and similar research design and method of data collection across the 4 included countries. Limitations of the study include the cross-sectional design, which precludes causal conclusions; the low response rate in the Portuguese sample; the lack of homosexual participants; and the lack of comprehensive assessments of dyadic factors that may be of relevance to sexual problems and associated distress.ConclusionThis study identified a high prevalence of sexual problems persisting for 3 months or longer among older men across 4 European countries, but also found that many of the men with sexual problems experienced minimal or no distress related to these problems.G.M. Hald, C. Graham, A. ?tulhofer, et al. Prevalence of Sexual Problems and Associated Distress in Aging Men Across 4 European Countries. J Sex Med 2019;16:1212–1225.