Disability,depression and somatization in a low back pain population

Objective: The aim of this study was to determine the prevalence of low back pain (LBP) in a primary care setting population and examine its association with the symptoms of depression and somatization. Methods: This is a cross‐sectional study, utilising a survey carried out in primary health care clinics (PHCs) in Al‐Ain, United Arab Emirates (UAE). A multistage stratified sampling design was used and a representative sample of 1304 UAE nationals aged 18–65 years who attended PHC clinics for any reason were included and 1103 (84.5%) subjects agreed to participate and responded to the questionnaire during a period from June 2001 to January 2002. A specially designed questionnaire with three parts was used for the data collection: socio‐demographic information of the studied subjects, modified version of the Roland‐Morris scale for evaluating back‐related functional disability and SCL‐90 R for depression and somatization subscales was used to assess depressive and somatic symptoms. Results: Of the total number of subjects surveyed (1103), 586 (53.1%) were men and 517 (46.9%) women. The mean age was 34.9 ± 13.4 years for men and 33.5 ± 11.8 years for women. The prevalence of LBP in the studied subjects was 64.7% (95% CI, 60.7–68.5] with 46.7% among men and 53.3% among women. There were a significant differences between the subjects with LBP and without LBP with respect to gender (P < 0.001), body mass index (BMI) (P < 0.001), occupational status (P < 0.001) and living environment (P = 0.016). Functional disability was higher in patients with LBP. Young patients in aged 15–34 years, patients with preparatory/secondary educational level and students showed higher depressive symptoms. A similar pattern was found in patients with somatic symptoms. Factor analysis revealed a strong association between depression and somatization in LBP patients. Conclusions: Functional disability was higher in with LBP. Furthermore, symptoms of depression and somatization are prevalent among LBP patients.     

运用反应时探究小学生情绪认知发展特点

目的：探究小学儿童情绪认知的发展特点。方法：采用计算机实验方法和反应时评价指标，运用80对情绪词汇推测小学儿童对四个不同类别情绪（基本积极情绪、基本消极情绪、积极自我意识情绪、消极自我意识情绪）的认知发展差异，以及对引发情绪的原因、情绪的外在行为反应、情绪的后继调节三个维度的认知发展差异。结果：小学儿童对引发情绪的原因、外在行为反应、后继调节三个维度的反应时差异有统计学意义（1289．5、1164．6、1295．7，F=13．535，P〈0．001），且三个维度认知反应时2年级学生均长于4、6年级（P〈0．01），对四个不同类别情绪认知的反应时差异无显著性（1237．1、1269．8、1222．8、1305．2，F=1．520，P=0．220），四个类别的情绪认知反应时2年级均长于4、6年级（P〈0．01）。结论：儿童对情绪行为认知的加工速度最快，对消极自我意识认知的发展相对较慢，且均在2—4年级间发展迅速。     

Obstetrician-gynecologists as primary care physicians: The Oregon experience—Early perceptions regarding the effects of legislative action

OBJECTIVE: Our purpose was to assess whether legislative action influenced the role of obstetrician-gynecologists as primary care physicians. STUDY DESIGN: An observational study was performed on the basis of a questionnaire sent to 410 obstetrician-gynecologists and 27 medical directors of managed-care organizations. RESULTS: Of 67% of obstetrician-gynecologists and 96% of medical directors who responded, there was agreement as to the content of primary care, but a minority (38%) of obstetrician-gynecologists identified themselves as primary care providers. A minority of medical directors (35%) felt that obstetrician-gynecologists should serve in that role. Both obstetrician-gynecologists and medical directors felt that legislation had little impact. CONCLUSION: The reticence of obstetrician-gynecologists to assume a major role in primary care appears to be the result of an uneasiness with accepting a more comprehensive role in patient management and gatekeeping. They appear comfortable with the more traditional roles but feel that training and experience has not prepared them well for the management of more complex medical problems. (Am J Obstet Gynecol 1998;178:1222-8.)     

Synchronous growth of triple lung cancer

The case of a 75-year-old man with three synchronous carcinomas of the lung (large cell carcinoma, adenocarcinoma, and small cell carcinoma) is reported. This is the eighth well-documented case report in the literature; however, our case is the first to be reported with the newly described histological combination.     

Spontaneous gallbladder perforation—An unusual presentation of carcinoma of the pancreas

A 50 year old man with a two month history of upper abdominal pain and a one month history of anorexia and weight loss, presented with icterus and evidence of peritonitis. Laparotomy revealed biliary peritonitis which had been caused by a rupture of the fundus of the gallbladder. The common bile duct was dilated and there was a large growth in the head of the pancreas with multiple hepatic metastases. A cholecysto-jejunostomy and gastrojejunostomy were done and the patient had an uneventful recovery.     

现阶段县级卫校在初级卫生保健中的作用探析

依据乡村医生人力结构现状调查结果,就现阶段县级卫校在初级卫生保健中的作用及今后面向乡村医生办学的可行性作了具体的分析和探讨。结论是:提高质量,加强对在岗乡医进行系统化正规中专层次的职后复训,应是县级卫校今后1O年的最主要的任务。     

血清Ⅲ型原胶原含量与肝纤维化的关系（附102例肝活检分析）

为进一步研究血清Ⅲ型原胶原（ＰＣⅢ）含量与肝纤维化的关系，对肝炎患者血清ＰＣⅢ含量与肝炎组织学变化进行对比分析．方法：用ＲＩＡ法测定６１６例急、慢性肝炎及肝硬化患者的血清ＰＣⅢ含量，其中１０２例同时做肝活检，按照Ｋｎｏｄｅｌｌ肝组织炎症活动性指数标准记分．结果：急、慢性肝炎及肝硬化患者血清ＰＣⅢ含量明显高于正常人，差异有显著性（Ｐ＜ｏ．０５～０．０１）．其升高的血清ＰＣⅢ含量与肝细胞坏死范围及门管区炎症程度无相关性（ｒ＝０．４９４，Ｐ＞０．０５），而与肝纤维化程度呈正相关（ｒ＝０．６６８，Ｐ＜０．０１）．结论：血清ＰＣⅢ测定是判断慢性肝炎及肝硬化时肝纤维化程度的有用指标．     

A combined course of primary health care practice and family medicine at the University of Gezira

The community-based course presented is a longitudinal course running through four semesters in the Faculty of Medicine, University of Gezira, Sudan. Students combine their regular work in primary health care centres with attachments to a number of families in Wad Medani town. They continue to visit these families regularly throughout their entire medical course with the aim of studying them and helping them with some of their medical and psychosocial problems.     

P53、P16、Bcl-2基因及产物在原发性肺癌中的表达及其临床病理意义

目的 :探讨原发性肺癌 Mtp5 3、p16、Bcl- 2的异常表达与肺癌发生、发展的关系 ,以及它们之间的调控关系。 方法 :用免疫组化技术检测 (L SAB) 114例原发性肺癌组织中 p5 3、p16、Bcl- 2的表达。并用 PCR技术对 6 2例 p16蛋白丢失的肺癌组织中 p16外显子 2 (p16 E2 )的缺失进行分析。 结果:p5 3蛋白异常表达与肺癌组织学类型、分化程度无关 (P >0 .0 5 ) ,但与淋巴结转移情况有关 (P >0 .0 5 )。 p16蛋白阳性表达率与肺癌的组织学类型无关 ,但是其表达水平与非小细胞肺癌 (NSCL C)的细胞分化程度和淋巴结转移密切相关 (P <0 .0 5 )。 NSCL C中 p16E2的缺失率为 45 .2 %,其缺失水平随淋巴结转移和组织学分级的升高而升高 (P <0 .0 5 )。 SCL C(小细胞肺癌 )和正常肺组织中无 p16 E2的缺失。 Bcl- 2在小细胞肺癌中阳性率 6 2 .2 %显著高于 Sq Ca(鳞癌 )的 2 5 %和 Ad Ca(腺癌 )的 9.1%(P <0 .0 5 ) ,与细胞分化程度和淋巴结转移情况无关。另外 ,p5 3与 p16蛋白之间存在调控关系。 结论 :(1) p16、p5 3、Bcl- 2的异常参与肺癌的发生、发展过程。 (2 ) p16基因及产物的异常表达与 NSCL C的组织学分级和淋巴结转移相关 ,可能参与 NSCL C的发生、发展和转移过程。 (3) Bcl- 2反映 SCL C的分之生物学行为和临床     

肝动脉变异及其在肝癌介入治疗中的意义

本文收集１９９２年１月至１９９５年５月在我科作肝动脉化疗栓塞术和肝动脉化疗灌注术的中晚期肝癌１６０例，将每例病人的肝动脉造影所见与临床资料及随访结果一起进行分析。