Baseline immune activation as a risk factor for the onset of depression during interferon-alpha treatment.

BACKGROUND: Major depression has been associated cross-sectionally with increased cell-mediated immune activation but causality has been difficult to establish. This study prospectively investigated the hypothesis that baseline level of immune activation predicts the development of depression during interferon-alpha (IFN-alpha) treatment. METHODS: Sixteen hepatitis C patients without psychiatric disorder underwent IFN-alpha treatment. Proinflammatory and anti-inflammatory cytokines were determined before starting treatment. Presence of a major depressive disorder (MDD) was assessed at baseline and several times during treatment. RESULTS: Baseline soluble interleukin-2 receptor (sIL-2r), interleukin-6 (IL-6), and interleukin-10 (IL-10) concentrations were significantly increased in the five subjects that developed MDD during treatment compared with those that did not, with standardized effect sizes of 1.08, 1.16, and 1.25, respectively, controlling for marijuana use, cigarette smoking, and baseline level of depressive symptoms. CONCLUSIONS: Results suggest that increased immune activation, rather than an epiphenomenon, is a causal risk factor for the development of MDD.     

Concerns for medical radiation programs in Australian universities

The Australian higher education system is in a state of great change. The Federal education minister, Dr Brendan Nelson, has indicated that he intends to continue introducing far-reaching reforms that will impact significantly on how universities conduct teaching and research. The future allocation of government funding for university programs, including those in medical radiation, will have a significant effect on how those programs are delivered and could even determine whether programs remain viable. There will be a financial imperative for academic departments to strengthen research activity and to obtain funding from non-government sources, such as full-fee paying students, in order to generate enough income to cover program delivery. Medical radiation education in Australia is also facing many other challenges. Some of these are longstanding, such as the high cost of medical radiation program delivery, poor levels of research activity and difficulty in recruiting and retaining academic staff. Other problems have arisen recently, such as increased competition for students and a critical shortage of available training placements in clinical practice. The aim of this paper is to raise and explore these issues from a university perspective.     

肝移植术后糖尿病危险因素分析

目的 探讨肝移植术后糖尿病（PTDM）的发生及发展的危险因素。方法 回顾性分析98例肝移植受者的临床资料。根据其肝移植术后是否发生糖尿病，分为糖尿病组（36例）和非糖尿病组（62例）。以术前和术后可能的9个危险因素作为分析指标，进行这些指标的单因素分析和χ^2检验。结果 在对两组患者的年龄、乙型肝炎病毒（HBV）感染情况、有无肝硬化及肝硬化的程度、术前糖耐量情况、免疫抑制剂的选择及其血药浓度、激素的使用时间的比较分析中发现：术前肝硬化患者PTDM的发生率明显高于无肝硬化者；肝硬化失代偿期患者PTDM的发生率高于代偿期。术前糖耐量异常的患者PTDM的发生率明显高于糖耐量正常者。激素半年内撤离的患者PTDM的发生率明显低于半年内未撤离者。而两组患者的年龄、HBV的感染情况、免疫抑制剂的选择及其血药浓度相比较，差异均无统计学差异。结论 肝硬化、尤其是肝硬化失代偿期，糖耐量异常，长期使用激素是PTDM发生的危险因素。     

Framing the child at risk

Risk Assessment Reports are one form of accounting practice which delineate the space of risk considered in a child abuse neglect investigation. The paper analyses two Risk Assessment Reports, contrasting what is reported, what is directly observed and what is hypothesized and implied by child protection practitioners during the assessment of risk. From an analysis of these two reports (each 4 – 5 pages long), the paper identifies the rhetorical strategies and their realizations used by two practitioners in framing the child at risk. The paper problematizes the tension between the institutional need to constrain the exercise of professional judgement through Risk Assessment Models, and the extent to which practitioners actually localize the framing of risk to specific areas of investigation.     

试论加强国际合作与促进我国医学伦理学教育的发展

原北京医科大学(现为北京大学医学部)从20世纪90年代初开始,积极寻求与美国中华医学基金会的合作以促进医学伦理学的学科发展和国际化水平的提高。十几年来,北京大学医学部作为基地和依托极大地支持和引领了我国医学伦理学的教学改革与发展,增强了相关人员的医学伦理意识以及医学伦理学理论对实践的指导作用,促进了伦理学知识和能力的培训,提升了我国生物医学科研伦理的实力,奠定了医学伦理学继续教育的基础,使医学伦理学实现了系统性和跨越式的发展。     

医科院校学生心理危机管理浅探

结合医科院校学生心理危机管理的实践，阐述大学生心理危机的内涵、类型、特征及心理危机管理的特性，并从建立预警系统、增设心理委员、危机处理的专业化及危机干预策略等方面探讨在医科院校加强学生心理危机管理的对策。     

从天价医药费事件折射出当前我国医疗机构存在的问题

目前，我国许多医院的医疗卫生工作人员在为患者进行医疗卫生服务的过程中，为了医院和个人的经济利益，存在着过度医疗消费现象。最典型的是哈尔滨医科大学第二附属医院发生的天价医药费事件。导致这种现象出现的原因是由于法律的不健全、制度的不完善等而导致的监督力度不够，加之有些医务工作者在经济利益的驱使下使自己的职业道德滑坡，从而导致了老百姓看病贵现象的出现。     

20世纪后半叶美国高等医学教育改革历程

美国现代高等医学教育模式的确立是以20世纪初Flexner报告发表为开端的。第二次世界大战前，现代高等医学教育体系已基本完善，并经历了二战的考验。二战后，随着社会和医学发展，美国高等医学教育一直在进行着改革。按照时间顺序在50年代、60年代以及70、80年代进行了改革。分析历次改革的背景、主要内容及改革的特点特别对指导20世纪80年代后医学教育改革的纲领性文件——GPEP报告进行详细阐述，包括GPEP报告的内容、作用以及与Flexner报告的对比分析。通过回顾与分析，对美国医学教育改革历程中的成功经验和不足之处进行梳理，为我国正在进行的高等医学教育改革提供借鉴与参考。     

Low level of response to alcohol as associated with serotonin transporter genotype and high alcohol intake in adolescents.

BACKGROUND: A low level of response to alcohol has been associated with both the genetic constitution of the regulatory region (SLC6A4) of the human serotonin (5-hydroxytryptamine, 5-HT) transporter (5-HTT) and with future alcohol intake and an increased risk for alcoholism. To date, all studies of relevant polymorphisms have been carried out in populations in the United States. METHODS: Data were extracted from a subset (n = 243) of a cohort of children who have been observed since birth through evaluation of the family history of alcoholism and psychosocial risk influences. At age 16 years, the response to alcohol was assessed with the Self-Rating of the Effects of Alcohol (SRE) questionnaire, and the average amount of alcohol intake per month was assessed during the prior 6 months. Additional variables that were measured included the 5-HTT genotype, externalizing behavior, and sociodemographic variables, such as gender and age. RESULTS: The level of response to alcohol was significantly lower among carriers of two long alleles of the 5-HTT regulatory region compared with carriers of one or two short alleles (Mann-Whitney U = 5225.0, p = .005). In a multiple regression analysis, the level of response to alcohol and externalizing behavior but not psychosocial factors significantly predicted the average amount of alcohol intake per month. CONCLUSIONS: This study demonstrates that, independent of the assessed psychosocial variables, the 5-HTT genotype correlated with the level of response to alcohol and predicted alcohol intake among 16-year-old adolescents.