医学生性行为的现状调查与分析

目的：了解高年级医学生性行为的现状,探讨性健康教育对策.方法：对某医科大学2000级348名大学生进行整群调查.结果：调查对象中87.62%的医学生知道避孕方法,74.54%赞同在学校内销售避孕套,仅有7.27%不同意在学校内销售避孕套.65.23%的医学生曾有过性生活史,28.80%的从未采用过避孕措施,46.90%的采用避孕套;其中有30名学生有妊娠史,41人次怀孕学生选择了人工流产、药物流产、引产等方式终止妊娠.结论：医学生的性观念发生了变化,无防护性行为增多.这种现状对高校性健康教育提出了更新更高的要求.     

Attitudes of patients after "genetic" termination of pregnancy

Twelve of 15 women who had had abnormal fetuses agreed to be interviewed after termination of the pregnancy. The survey showed that persistent adverse psychological and social reactions may be much commoner in patients undergoing termination of pregnancy for genetic rather than "social" indications. Adequate information and counselling before, and support after, termination of an abnormal pregnancy are essential if these women are to cope with the experience.     

常州市育龄妇女对高危妊娠认知行为分析

目的:了解常州市育龄妇女对高危妊娠危险因素的知识掌握水平和行为现状,为建立针对育龄妇女的高危妊娠管理模式提供依据。方法:围绕育龄妇女的健康和需要,现场调查常州市8个社区的育龄妇女。结果:常州市育龄妇女对于妊娠危险因素知识的掌握程度良好(总合格率达到76.82%),而对于妊娠危险的主动就医程度仍偏低(合格率为53.64%),育龄妇女目前获取知识的主要来源为医院健康宣传栏/宣传手册、电视书刊网络和医务人员指导。结论:常州市在针对育龄妇女的高危妊娠管理中,要从以重点人群为主的管理策略拓展到全人群,建立多元化健康传播格局,最终形成供需双方联动的管理模式。     

Les médecins du Québec: majoritairement pour l''avortement

Over 80% of Quebec's doctors recognize serious mental health dangers, the probability of fetal damage, or pregnancy due to rape as sufficient grounds for abortion. The most liberal 19% also accept pregnancy out of wedlock, or lack of economic support as a sufficient reason, but another 14% reject any basis for abortion, though among those some would accept a few criteria if the abortion were performed by another doctor. These results come from a random sample of the 12,000 doctors registered with the Quebec Medical Association. The high response rate of 45.4% gave ultimate representation to 10% of the medical population of Quebec. 90% of the doctors wanted a uniform set of criteria for hospital abortion committees, which now vary greatly. Protestant and Jewish hospitals being more liberal than Catholic ones. They also stressed sex education, access to contraceptives and services of birth regulation as necessary to stem overuse of abortions. The doctors were unsure of their legal position regarding abortion and tended to consider the law more restrictive than it is. Over 60% do want abortion removed from the Criminal Code. The number of referrals to hospital committees has increased between 1971-1975 though even in 1975 less than 132 doctors made more than half the demand. In 1975 doctors sent 30.1% of abortion demands to a committee, 20.7% to a clinic in the U.S., 14.8% to another doctor, 13.4% to a reference center, 10.4% to a Quebec clinic, 1.9% to a clinic elsewhere in Canada, and 8.7% of the cases were neither referred nor granted an abortion by the doctor. Most doctors agree that necessary action on the abortion issue includes discussions and conferences on the subject for medical personnel and the development of public awareness of the problem.     

Financial burden and financial aid for medical students in Singapore: a national survey across all three medical schools

INTRODUCTIONSingapore has had three medical schools since 2013. We undertook a cross-sectional quantitative national survey to determine the financial impact of medical education on medical students in Singapore.METHODSAll 1,829 medical students in Singapore were invited to participate in this study. Information on demographics, financial aid utilisation and outside work was collected and analysed.RESULTS1,241 (67.9%) of 1,829 students participated in the survey. While the overall proportion of students from households with monthly incomes < SGD 3,000 was only 21.2% compared to the national figure of 31.4%, 85.4% of medical students expected to graduate with debts > SGD 75,000. There were significant differences in per capita incomes among the schools, with 54.5%, 23.3% and 7.8% of Duke-NUS Medical School (Duke-NUS), NUS Yong Loo Lin School of Medicine (NUS Medicine) and Lee Kong Chian School of Medicine (LKCMedicine) students, respectively, reporting a per capita income of < SGD 1,000 (p < 0.001). There were significant differences in financial support: 75.0%, 34.1% and 38.8% of Duke-NUS, NUS Medicine and LKCMedicine students, respectively, received financial aid (p < 0.001). The top reasons for not applying for aid included a troublesome application process (21.4%) and the perception that it would be too difficult to obtain (21.0%).CONCLUSIONStudents in the three medical schools in Singapore differ in their financial needs and levels of financial support received. A national approach to funding medical education may be needed to ensure that financial burdens do not hamper the optimal training of doctors for Singapore’s future.     

疤痕子宫再次妊娠早期终止的时机及方式分析

摘要：目的:探讨疤痕子宫再次妊娠早期终止的最佳时机以及有效方法。方法:选取我院在2013年6月至2014年9月期间收治的自愿要求终止妊娠的疤痕子宫再次妊娠产妇160例,分别将其分为观察组与对照组。其中观察组产妇共80例,采用药流配合清宫术的方法终止妊娠,即采用米非司酮加米索前列醇清宫术前应用。对照组产妇共80例,采用B超引导下负压吸宫术终止妊娠。将两组产妇的阴道出血时间异常率、出血量异常率、并发症发生率以及流产率进行分析对比。结果:观察组产妇术后的并发症发生率明显要少于对照组产妇（P<0.05）;观察组产妇在阴道出血时间异常率、出血量异常率以及流产率方面,与对照组患者相比无显著性差异（P>0.05）。结论:针对疤痕子宫再次妊娠产妇,在选择终止妊娠的最佳时机与方式时,应根据产妇的具体情况以及距本次流产时间、孕周等,综合考虑各种终止妊娠方案的利弊后进行。采用药流配合清宫术对疤痕子宫再次妊娠孕妇终止妊娠具有更高的安全性,且能够有效的降低并发症发生率,值得临床应用及推广。     

Meckel-Gruber syndrome: a rare clinical entity

Meckel-Gruber syndrome is an inherited genetic disorder of unknown aetiology. It is an autosomal recessive condition and its incidence is as rare as 1:13,250 to 1:140,000. Some population show an increased incidence of this condition eg, Finnish and Gujarati Indians. Since the time it was first reported by Meckel in 1822 and subsequently by Gruber in 1934, only 200 cases have been reported. Here the case was diagnosed antenatally by an ultrasound and termination of the pregnancy at an early stage was done as per the wishes of the parents. This interesting and rare case of Meckel-Gruber syndrome is reported here.     

构建三阶段教学模式，提升医学生法律素质

提高医学生法律素质既是现代医学教育发展、医学生自我完善的需要,也是新时期医疗制度改革和建立和谐医患关系的迫切要求。医学院校应当认真整合现有法律教育资源,针对法律素质教育片面化、零星化,缺乏衔接等普遍性问题,构建包括法律基础知识教育阶段、卫生法律知识教育阶段、综合提高阶段的三阶段教学模式,切实提高医学生的法律素质。     

Sequelae and support after termination of pregnancy for fetal malformation

A retrospective study examined the reactions to the termination of pregnancy for fetal malformation and the follow up services that were available. Women resident in Mid Glamorgan who had had a termination between 1977 and 1981 because of positive findings after midtrimester prenatal diagnostic tests for neural tube defect or chromosome abnormalities were interviewed at home using a semistructured interview schedule. Three retrospective internal comparison groups were formed from those women who had also had a spontaneous abortion, previous stillbirth, or neonatal death or previous termination for medicosocial reasons early in pregnancy. Of the 48 women interviewed, 37 (77%) experienced an acute grief reaction after the index pregnancy was ended. This reaction was akin to that documented after stillbirth or neonatal death. Twenty two women (46%) remained symptomatic six months after the pregnancy had been ended, some requiring psychiatric support, compared with no such reaction after spontaneous abortion or termination for medicosocial reasons. All the women who had previously had a stillbirth or neonatal death were visited at home either by the general practitioner or by the midwife after that event but such follow up was limited to only eight of the study group after termination for fetal malformation. The findings suggest that support is inadequate for these patients and that improved follow up and counselling services may lessen the adverse sequelae of termination for fetal malformation.     

The impact of legal medicine education on medical students' attitudes toward law

Physicians' negative attitudes toward law and the legal system derive in part from the physician's lack of understanding of basic legal principles relating to medical practice. Required legal medicine education at the medical school level offers a vehicle for changing these attitudes while at the same time clarifying physicians' rights and responsibilities under the law. The authors in this study assess the impact of required curriculum programming in legal medicine at Southern Illinois University School of Medicine on medical students' attitudes toward law and the legal system. A total of 80 students completed a survey instrument prior to and immediately following required instruction in legal medicine. This instrument enabled the authors to gather information regarding students' attitudes toward law and the legal system as well as students' perceptions of ther medical/legal knowledge. The results suggest that legal medicine education has a favorable impact on the attitudes of medical students toward law and the legal system.     

我国基层医疗卫生机构医护人员对医防整合的认识评价

背景　基层医疗卫生机构医护人员是基本医疗和公共卫生服务的关键提供者,其对医防整合的认识影响整合服务提供,研究个体对医防整合的认识对制定和实施医防整合相关政策具有重要价值。目的　了解和评价基层医护人员主观上对医防整合的认识,分析其影响因素,为医防整合服务体系建设提供参考。方法　于2019年4-10月,设计医防整合主观认识评价问题,采用全国性多阶段抽样法,以基层医护人员为调查对象,共计发放问卷810份,回收有效问卷725份,有效回收率89.5%。借鉴Likert评分等级赋分,运用因子分析法对12个变量降维,提取和解释公因子,计算因子得分。结果　反映医防整合主观认识的因子可以归纳为机构层次的环境支持公因子、科室层次的合作互动公因子和个人层次的专业界限公因子,累积方差贡献率为70.43%。经因子四分制转化,环境支持得分（2.97±0.54）分,合作互动得分（2.81±0.55）分,专业界限得分（2.46±0.65）分,医防整合认识综合得分（2.86±0.53）分。结论　医护人员在基层卫生体系中,感知到的整合服务的环境支持程度不高,缺少科室协作,并且仍存在较强的专业界限。构建整合型卫生服务体系,实现基层卫生服务中的医防整合,需要体系和机构层面更多支持政策,加强不同卫生人员专业合作,转变医护人员医防割裂的专业思维。     

Alberta Euthanasia Survey: 3-year follow-up.

OBJECTIVE: To determine whether the opinions of Alberta physicians about active euthanasia had changed and to assess the determinants of potential changes in opinion. DESIGN: Follow-up survey (mailed questionnaire) of physicians included in the 1991 Alberta Euthanasia Survey. SETTING: Alberta. PARTICIPANTS: Of the 1391 physicians who participated in the 1991 survey 1291 (93%) had indicated that they were willing to take part in a follow-up survey. A follow-up questionnaire was mailed in 1994 to 1146 physicians who could be traced through the 1994 Medical Directory of the provincial college of physicians and surgeons; 25 questionnaires were returned because they could not be delivered. OUTCOME MEASURES: Physicians' opinions about (a) the morality of active euthanasia, (b) changes in the law to permit active euthanasia and (c) the practice of legalized euthanasia. RESULTS: Of the 1121 physicians sent a follow-up questionnaire 866 (77%) returned it completed. The responses of these same 866 physicians in 1991 provided a basis for comparison. Of the 866, 360 (42%) stated in the 1994 survey that it is sometimes right to practise active euthanasia; a similar proportion (384 [44%]) gave this response in 1991. However, other opinions changed significantly. In 1991, 250 of the respondents (29%) indicated that they would practise active euthanasia if it were legalized, as compared with 128 (15%) in 1994 (p < 0.01). In 1991, 429 (50%) of the respondents thought that the law should be changed to permit active euthanasia, as compared with 316 (37%) in 1994 (p < 0.01). Religious activity was the most important characteristic associated with changes in opinion. Despite the decrease in support for the practice and legalization of active euthanasia between 1991 and 1994, in both surveys at least 70% of those who responded to this question indicated that active euthanasia, if it were legalized, should be performed only by physicians and should be taught at medical sites. CONCLUSION: Alberta physicians' support for the practice and legalization of active euthanasia decreased considerably between 1991 and 1994. However, most physicians remain in favour of restricting active euthanasia, if it were legalized, to the medical profession. These results suggest a need for caution and deliberation when changes in the law concerning active euthanasia are examined.     

A questionnaire survey of stress and bullying in doctors undertaking research

Background: Research is an increasingly important aspect of higher medical training for many doctors. Studies investigating sources of stress, isolation, and workplace bullying have not previously sought information in this setting. Methods: An internet based questionnaire survey of doctors undertaking research (n = 259) was conducted to examine stressors and levels of job satisfaction in this potentially vulnerable group. In order to assess overall levels of satisfaction, we asked whether doctors would recommend their research post to a colleague. Results: There was a statistically significant association between those who would not recommend their post to a colleague and those who had difficulties in arranging funding and in writing up (p<0.001). Further significant correlations were found between dissatisfaction with the post and lack of help, support, and advice from supervisors and colleagues, wanting to change supervisors, experience of the major categories of workplace bullying, and having an inadequate clinical commitment (p<0.001). When the significant variables were entered into a multivariate analysis, the results showed that dissatisfaction was associated with wanting to change supervisors and with a threat to professional status. Conclusions: Stress and bullying are common in doctors undertaking research. These findings have important implications for medical training and for doctors choosing research projects. Setting up systems of support may have important benefits.     

Experience and attitudes of final-year medical students to digital rectal examination

OBJECTIVE: To assess the attitudes of final-year medical students to digital rectal examination (DRE) and their experience of performing DRE during clinical training. DESIGN: Questionnaire-based survey. SETTING AND PARTICIPANTS: All students in the final year of medical school at the University of Melbourne in 2003. OUTCOME MEASURES: Agreement with statements about attitude to DRE; number of DREs performed and abnormalities palpated; and ratings of frequency of supervision and perceived barriers to performing DRE. RESULTS: 222 of 256 students (87%) responded. Almost all (97%) believed that DRE is an essential requirement for a medical practitioner, and 94% that they should have the skill before graduating, while 92% said they had been taught how to perform it. The median number of DREs performed was two, with 17% of students performing none. Sixty-three per cent had palpated a prostate, 24% a prostate cancer, 19% a rectal tumour, and 11% faecal constipation. Half the students (52%) felt they could give a reasonable or confident opinion based on their DRE findings. The most often cited reason for not performing DREs was the lack of a doctor to act as a supervisor. CONCLUSIONS: A concerted effort is needed from academics, supervising doctors and students to improve medical students' proficiency in performing DRE and confidence about their findings.     

医学实习生岗前法规培训对防患医疗纠纷的调查与分析

目的培养医学生法律意识,防范医患纠纷的发生,提高医学生的从业素质,和谐医患关系。方法采用问卷调查的方式,对2007年1月-2008年7月在我院实习的两届254名医学生进行和谐医患关系意识调查。结果经过相关法律知识学习及行为规范培训的08届学生在实习前与未经过学习和培训的07届学生在实习前的行为完善,处理纠纷的能力上存在差别（P〈0．01）。结论实习生在校期间对其进行卫生法规教育、医患纠纷防患意识教育、行为规范教育是有必要的,而且应作为一项常规教育坚持进行并加以推广。     

Spontaneous and induced abortion among resident physicians

Female resident physicians are believed to be at an increased risk for a variety of third-trimester pregnancy complications. However, early pregnancy complications have been less well studied. This report compares spontaneous and induced abortions in a nationally representative sample of 5096 female medical school graduates (who experienced 1284 pregnancies) and of the sexual partners of 5000 of their male classmates (who experienced 1481 pregnancies). The response to the survey was 86.1%. The life-table probability of spontaneous abortion was 14.8% for female residents compared with 12.6% for the sexual partners of male residents. However, female residents were more likely than the male residents' sexual partners to terminate a pregnancy voluntarily (8.2% vs 2.7%). The increased risk of voluntary termination persisted when only married women were studied (3.6% vs 1.4%). However, female residents' pregnancies were at approximately half the risk of voluntary termination compared with pregnancies among the general US population of women aged 25 to 34 years. These results provide reassurance to those residents who would like to become pregnant but are concerned about the possible effect of their occupation on the course of the pregnancy.     

What impressions do medical students of the University of Benin have about anaesthesia and anaesthesiologists?

A survey on the impressions 500 level medical students of the University of Benin have about anaesthesia and anaesthesiologists was carried out from May to August 1999. The survey showed the mean age of the students to be 25.3 years and a male to female ratio of 3:1. The study also showed that 170 (82.5%) of the students were unaware of the scope of anaesthesia before the posting. After the posting, this figure decreased to 58 (34.5%) (chi2 = 11.7, p < 0.05, df = 2). Approximately same number of females (71.1%) and males (72.3%) had low awareness (unaware and limited awareness) about the scope of anaesthesia. However, more males (16.9%) were fully aware about anaesthesia and anaesthesiologists than female students (9.4%). Similarly, 76 (54.3%) of the students knew that anaethesiologists were doctors before the posting. This figure improved to 109 (85.2%) after the posting and was statistically significant. Interest in the specialty was exhibited by only 2 (2%) of the students before the posting and 21 (25%) of them became interested during and 4 (5%), after the posting in anaesthesia. The impressions had by those uninterested in anaesthesia include the unchallenging, non-lucrative and stereotyped nature of the specialty. It also included the dependency of the specialty on other specialties and that it attracted dull, lazy doctors whose job was unrecognized. This study's findings suggest the need for better exposure of medical students to anaesthesia to increase awareness and for the specialty to grow. Keywords: medical students, awareness, anaesthesia, anaesthesiologists.     

输血治疗知情同意书签署缺陷的分析与对策

目的分析病案中输血治疗知情同意书签署存在的问题,以提高书写质量,避免医疗纠纷。方法对某院2011年一、二季度输血病案分别于季度末进行质控,并将存在的缺陷项目进行统计。结果终末质控输血病案：一季度1330份,输血治疗知情同意书签署缺陷355份,占质控总数的26.69%,缺陷率最高的是输血治疗知情同意书缺医师签名189份,占质控总数的14.21%;二季度1584份,输血治疗知情同意书签署缺陷346份,占质控总数的21.84%,缺陷率最高的仍是输血治疗知情同意书缺医师签名163份,占质控总数的10.29%。结论医疗机构通过增加病案环节质量管理及加强医务人员对《执业医师法》、《医疗事故处理条例》等法律法规的学习,提高了医务人员的法律意识、证据意识,注重输血治疗知情同意书的填写质量,从而维护医患双方的合法权益,避免医疗纠纷。     

Medical manpower in Victoria, 1977.

A medical manpower survey in Victoria in 1977 revealed that there were 7823 registered medical practitioners, giving an apparent ratio of doctors to population of 1:483. However, only 81% of respondents were working in Victoria, and therefore the ratio of doctors in active practice in the State to population was estimated to be 1:597. Data from the survey revealed that the median age was 40 years. Female doctors comprised 17%, but the proportion of women was much higher amongst younger graduates. Private practitioners accounted for 60% of respondents (general practitioners, 36%; specialists, 24%), full-time hospital staff members for 28%, and practitioners in other salaried appointments for 12%. The ratio of general practitioners to population was estimated to be 1:1560 in the Melbourne statistical division, 1:1780 in the country, and 1:1617 in Victoria as a whole. Long hours of work were reported by the great majority of doctors. The impact of changing numbers and distribution of various categories of medical manpower on future work and postgraduate training is discussed. Early consideration of regulating the number of doctors by reducing the number of undergraduates entering Australian medical schools and by restricting the immigration of doctors from overseas is advocated.