Subjective bias in reports of poor work adjustment in depressed patients

Twenty-five depressed inpatients were asked to report their adjustment at work during the 4-month period preceding their hospitalization. Two separate reports were given: the first during the acute illness phase and the second one 10-28 days later, after symptomatic remission following standardized pharmacotherapy. Thirty-two percent more patient ratings showed absence of adjustment problems on the second report compared with the first. Significant differences between the 2 reports were found in 7 of the 9 items on the Structured and Scaled Interview to Assess Maladjustment, which is designed to assess specific aspects of maladjustment at work. The changes in the scores of maladjustment correlated with the changes in the scores of depressive symptoms, and 40% of the variation in maladjustment scores was accounted for by the pessimism item of the Montgomery-Asberg Depression Rating Scale. Much of the poor work adjustment reported by the acutely depressed patients thus seems to be caused by symptom-related subjective bias.     

"11.24"海难援救军人的心理健康状况分析

目的 探讨海难后军队应激援救人员的心理健康特点，为建立特定人群的心理健康评定体系提供科学依据。方法 采用症状自评量表和自行编制的调查表对39名1999－11－24烟台“大禹”海难1mo后的善后援救军人进行了心理健康测试，并将调查结果与对照军人和国内军人常模进行了比较。结果 接受调查的应激人群的SCL－90总分79.5%（31／39）的人评定为正常，总分≥160分为8例，占20.5%。SCL－90总分、射体化、焦虑、恐怖与精神病性因子与国内军人常模比较无显差异，但阳性项目数、强迫症状、人际敏感、抑郁、敌对及偏执因子分均显低于国内军人常模（P＜0.05-0.01）；而阳性症状均分显高于国内军人常模（P＜0.05）。应激人群的阳性项目数明显低于对照人群，而阳性症状的痛苦水平明显高于对照人群（P＜0.01）；阳性症状均分仍显高于对照人群（P＜0.05）。结论 提示受调查的应激人群的阳性症状均分显高于国内军人常模，改善婚姻状况和与同胸关系、完善上级领导工作方法和善后处理可以改善SCL－90结果，减少生活事件的刺激量可望改善其心理健康状况。     

无创正压通气不同压力支持水平对正常人呼吸做功的影响

目的 :观察无创正压通气 (NIPPV)不同压力水平对正常人呼吸做功的影响 ,为临床合理地应用NIPPV提供理论依据。方法 :选择 9例正常人行NIPPV并寻找出“最舒适”的吸气压力水平 (IPAP) ,在此压力基础上增加或减少 2 5 %的压力 ,构成低IPAP、最舒适IPAP和高IPAP三个压力水平 ,每一IPAP水平通气 15min以上 ,比较不同压力水平呼吸做功改变。结果 :受试者认为“最舒适”的IPAP为 (11.33± 3.2 0 )cmH2 O ,EPAP为 (4 .5 6± 0 .88)cmH2 O[相当于PSV水平为 (6 .77± 3.2 0 )cmH2 O]。与自主呼吸相比 ,NIPPV增加VE的同时 ,总的呼吸做功(Wtot)明显增加 (P <0 .0 5 ) ,而受试者吸气肌做功占总的吸气做功的百分比 (Wi,p/Wi)明显减少 (P <0 .0 5 )。在最舒适IPAP时 ,Wi,p/Wi降低到基础值的 14 %± 9%。这种变化趋势与IPAP的水平相关。结论 :NIPPV可以显著降低吸气肌肉做功。吸气肌做功减少的比例与IPAP的水平相关。研究的结果为NIPPV时PSV的参数设定提供了生理学的依据。     

Cardiac rehabilitation and return to work after coronary artery bypass surgery

The work situation of 66 male patients who underwent elective coronary artery bypass surgery (CABS) and who had been randomly allocated to receive cardiac rehabilitation (group R) was compared with the work situation of 59 similar patients allocated to receive only standard care (group H). The follow-up time was one year. The proportions of subjects working in groups R and H were 26% and 20% (p=ns) before the CABS, 45% and 34% (p=ns) 6 months and 56% and 38% (p=ns) 12 months after the CABS, repectively. The increase in proportion of subjects who worked was significant in both groups at both 6 and 12 months after the CABS (p<0.05 for all changes). The increases were not significantly different between the whole groups, but in patients younger than 55 years of age, return to work was more frequent in group R than in group H (at 12 months 60% vs. 35%, p for the difference in change=0.02). Stepwise logistic regression analysis of the factors influencing return to work showed that a patient's judgement of his own working capacity as good 6 months after CABS (odds ratio (OR) 8.5, confidence interval (CI) 2.3–32.0), functional class 16 months after the CABS (OR 6.7, CI 1.8–24.5), his desire to work (OR 6.4, CI 1.6–26.0) and absence from work of less than 3 months before the CABS (OR 4.9, CI 1.2–20.2) were significant positive predictors of return to work 1 year after the CABS.     

Graduate Education in the Field of Substance Abuse

Abstract: Twenty-six part-time students from a variety of professional backgrounds are enrolled in the first year of a Graduate Diploma in Social Science (Drug Dependence) at the Phillip Institute of Technology in Victoria. The course is conducted under the auspices of the School of Social Work and commenced in 1984. It is argued that the graduates from this unique course could play a key role in providing personnel to fill positions in the areas of clinical work, staff development, drug education, programme development and management and research.     

A definition and systems view of anaerobic capacity

The purpose of this paper is both to define terms used in exercise physiology, i.e. anaerobic capacity, anaerobic work capacity and anaerobic potential, and develop a systems perspective of anaerobic capacity. Philosophical argument is used to support the proposed definitions and systems view, which is an approach to assist in the universal acceptance of such terms amongst scientific investigators, coaches and athletes, and provide a focus on physiological mechanisms associated with anaerobic capacity which may be the subject of future investigation.     

Serum gastrin and pepsinogen in shift workers

Summary Gastrointestinal complaints, including peptic ulcer, are believed to be associated and enhanced by shift work (SW). However, there are no clear reports in the literature about this acquired pathology. Serum gastrin (G) and group I pepsinogen (PG1) are thought to play a role in the pathogenesis of peptic ulcer and may be considered a useful test of the gastric function. Five adult male foundry shift workers, without any demonstrated gastrointestinal pathology, were studied over a month's span during the following weekly rotating shift schedule: 07.45–16.45, 06.00–14.00, 14.00–22.00, 22.00–06.00. Six adult, day-working males acted as controls. Blood samples drawn at the beginning and at the end of each weekly shift were assayed for G and PG1 utilizing RIA kits. Our data showed that SW causes a prominent change in the gastrin/acidopepsin secretion system.     

解构与重构思想政治工作在卫生部门实践社会主义荣辱观中的路径选择

社会主义荣辱观是当代中国社会发展的价值取向和道德支撑。树立社会主义荣辱观与思想政治工作的社会功能发挥休戚相关。思想政治工作如何在卫生部门实践社会主义荣辱观中发挥最大的社会功能．从对思想政治工作解构与重构的两条逻辑主线中，来探究思想政治工作在卫生部门实践社会主义荣辱观中的独特路径与价值意蕴。     

质疑Frank—Starling心脏定律

心脏收缩释放的能量（作功）是心肌纤维长度（心室舒张末期容积，EDV）的函数，即Frank—Star一1ing（FS）心脏作功定律，被誉为心脏生理学中的“经典”理论。对此，笔者从各种不同角度进行了探讨：首先分析了Frank伸展离体心肌和Starling及其同事使用心肺制备做的实验与动物生理实际的差异，以及人们在实验中观测到的增加心肌前负荷引起收缩力增强的现象（FS现象），认为：①在正常生理条件下的动物体内，来自心脏以外的、如同心肺制备中那样人工控制心室充盈压力升高、引起EDV增加的那种血液的重力动力是不存在的。②另一方面，人为地增加前负荷，那是改变了心肌收缩时的外环境条件。③由此而激发出的FS现象，是心脏适应其外环境条件变化所作出的反应。④此种心肌收缩力增强的反应，需通过心肌细胞内部与收缩过程发生有关的心肌兴奋一收缩和化学一力学偶联等一系列生化机制（不恒定因素）方能得以实现。⑤根据他们实验中观测到的FS现象，在逻辑上不能得出前负荷这一心肌收缩时的外环境条件变化调控其作功的推论。换言之，所有的在实验中被激发出来的FS现象，都不足以成为支持FS心脏定律的证据。然后，引用国内外公认的计算心脏每搏射血作功（w）的生物物理学公式“w=P×（EDV—ESV）”，证明了w和EDV之间没有函数关系。根据心脏作功的医用物理学和生物数学的基本原理，笔者认为Frank—Starling心脏定律表达的不是心脏作功的规律。     

Predicting work status following interdisciplinary treatment for chronic pain.

The effectiveness of interdisciplinary treatments for chronic pain is well established. In general, these treatments decrease psychosocial distress and increase physical abilities. Further, return to work rates following interdisciplinary treatment tend to be quite high. Previous studies have highlighted a number of factors that individually influence return to work rates; however, there is a need for more comprehensive and unified models that allow an evaluation of the inter-relations among these factors. The present investigation examined how demographic and treatment outcome variables interacted to influence post-treatment return to work rates in a sample of individuals with chronic pain following interdisciplinary treatment. Results indicated that patient age, lifting ability, pain duration, depression level, and reported disability were individually related to return to work; however, when these variables were evaluated relative to one another, level of depression and patient age had the best ability to predict post-treatment work status. These results add to the literature by specifically highlighting post-treatment factors that best discriminate patients who had returned to work from those that had not. Furthermore, they provide evidence that general emotional distress is perhaps the most important predictor of work status following treatment.