老年病的特点与预防

老年病是指老年期所罹患的疾病或多发的疾病。老年病的特点可概括为10个"多",即多数老年人患有慢性非传染性疾病(慢性病),多种因素可触发老年病的发生,多数老年病的症状和体征不典型;老年病多数为一体多病,同时伴有多脏器衰竭或多系统功能障碍,有多种老年综合征的表现和多种老年问题的出现;老年病常常存在多重用药和药物副作用的问题,需要多专业医师参与诊治,需要多学科团队参与康复及其护理。如要预防老年病的发生,首先个体要用终身的努力进行自身健康工程的建设,其次要适时进行疾病风险预测,有计划治未病、有信心治已病、有恒心求康复。     

超声住院医师规范化培训中临床专业学员的带教问题与应对策略分析

临床专业规培学员与超声专业规培学员的学历背景、知识构架、学习目的、规培计划均有不同,二者的超声科带教模式及方法应有所区别。本文基于本教研室规培带教经验,分析目前临床专业规培学员超声科带教存在的问题,提出“建立针对临床规培学员超声培训的精品课堂”、“建立针对临床规培学员超声培训的微课-翻转课堂”、“将基于PACS系统的临床典型病例图库应用于临床规培学员教学”、“建立临床典型病例图库/超声仿真病人模拟教学系统”四方面建议,以期完善临床专业规培学员培养模式,为学员提供全面、重点、有针对性的超声知识技能培训,提高规培效率和质量。     

Alcohol dependence and abuse diagnoses: concurrent validity in a nationally representative sample

The Alcohol Dependence Syndrome concept has had a widespread influence on the major nosological classification systems, most recently with its operationalization as DSM-IV alcohol dependence. Although many studies have provided evidence of the validity of the Alcohol Dependence Syndrome in clinical samples, little validation work has been conducted in general population samples on DSM-IV alcohol dependence or the distinction of DSM-IV alcohol dependence from DSM-IV alcohol abuse. We therefore examined the cross-sectional validity of DSM-IV alcohol dependence and abuse in 27,616 household residents who participated in a 1992 national survey on alcohol use disorders. Validity was investigated by testing the association of a set of five "criterion" variables, external to the alcohol diagnostic criteria, with dependence and abuse diagnoses. Results indicated that dependence diagnoses were significantly associated with all criterion variables when compared with those with no diagnosis and also when compared with alcohol abuse. This supported the separation of dependence from abuse. Abuse diagnoses were associated with some, but not all, criterion variables when compared with subjects with no diagnosis. This report replicates many aspects of a similar investigation in a community sample of household residents. Implications for the next steps in research are discussed.     

Behavioral Outcomes among Children of Alcoholics During the Early and Middle Childhood Years: Familial Subtype Variations

This study examined early behavioral outcomes among young children of alcoholics (COAs) as a function of differences in subtype of paternal alcoholism. Participants were 212 children (106 girls and 106 boys, ages 3 through 8) and both of their biological parents. Families were characterized as antisocial alcoholics, nonantisocial alcoholics, and nonalcoholic controls. There were significant familial subtype group differences on parent report measures of children's total behavior problems, externalizing behavior, and internalizing behavior, and on measures of children's intellectual functioning and academic achievement. In all instances, COAs had poorer functioning than controls. In the behavior problem domain, but not for the domain of intellectual functioning, children from antisocial alcoholic families had greater problems than children from nonantisocial alcoholic families. In addition to the subtype effects, boys had higher levels of behavior problems than girls in all three areas, and older children had more internalizing problems than younger children. Maternal functioning pertaining to lifetime alcohol problem involvement and antisocial behavior also contributed to child subtype differences in internalizing behavior. Results indicate that, even at very early ages, male and female COAs are heterogeneous populations that are distinguishable by way of familial subtype membership, as well as distinguishable from their non-COA peers. Thus, findings underscore the need to consider the heterogeneity of alcoholism when looking at its effects on child development     

Changes in Alcohol Use and Alcohol-Related Problems among 7th to 12th Grade Students in New York State, 1983–1994

Three comparable representative samples of 7th to 12th grade students in New York State were surveyed in 1983, 1990, and 1994 to determine changes in the patterns of alcohol use over the past decade. Each of the three samples was large ( n = 27,335, 23,860, and 19,321, respectively), permitting detailed analysis of changes in alcohol use in various adolescent subgroups according to age, gender, and race/ethnicity. Previous research revealed that there were marked decreases in the prevalence of overall drinking, heavy drinking, and alcohol-related problems from 1983 to 1990, yet recent national reports indicate that since 1990 there has been an upsurge in substance use among adolescents. Whereas the proportion of drinkers did not significantly increase between 1990 and 1994, average consumption, heavy drinking, and alcohol-related problems all showed modest, but significant increases in the 1990s. Furthermore, between 1990 and 1994, the age distributions for alcohol use, heavy drinking, and alcohol problems changed, as evidenced by significant age by year of survey interactions. These findings indicate that adolescents are currently drinking, drinking heavily, and experiencing alcohol-related problems at younger ages than they were in past years. Prevention efforts should be targeted at delaying alcohol use in early adolescence.     

Alcohol-Related Problems and Intimate Partner Violence Among White, Black, and Hispanic Couples in the U.S.

OBJECTIVES: This study analyzes gender and ethnic/racial differences in the prevalence of alcohol-related problems among white, black and Hispanic couples in the United States, and assesses their contribution to the risk of intimate partner violence (IPV). METHODS: Our study population consisted of 1440 white, black, and Hispanic couples obtained through a multistage area household probability sample from the 1995 National Alcohol Survey. Alcohol-related problems (i.e., drinking consequences and alcohol dependence symptoms in the last 12 months) were assessed among respondents and their partners. Male-to-female and female-to-male partner violence (MFPV, FMPV) were measured separately using the Conflict Tactics Scale. RESULTS AND CONCLUSIONS: Alcohol-related problems were more prevalent among men than women. Our bivariate analysis demonstrated a significant positive association between male alcohol-related problems and IPV across racial/ethnic groups, and a similar association between female alcohol-related problems and IPV for white and black couples. In the multivariate logistic regression analyses, however, many of these associations were attenuated. After controlling for sociodemographic and psychosocial covariates, male alcohol-related problems were no longer significantly associated with an increased risk of MFPV among white or Hispanic couples. Female alcohol-related problems predicted FMPV, but not MFPV, among white couples. Among black couples, however, male and female alcohol-related problems remained strong predictors of intimate partner violence. SIGNIFICANCE: Alcohol-related problems are important predictors of intimate partner violence, and the exact association between problems and violence seems to be ethnic-specific. Alcohol-related problems, rather than level of alcohol consumption, may be the more relevant factor to consider in the alcohol-partner violence association. Future research is needed to explore the temporal relationships between the development of alcohol-related problems and the occurrence of partner violence.     

Beyond Living with Drugs : an interview with Mike Gossop

Living with Drugs [1] has now been printed in four editions, a rare achievement for any text in the drug field. Many consider the book, which clearly enunciates the history, debate and controversies in the drug field, to be an essential read for researchers, clinicians, educators and students. Gossop was recently in Australia as a National Drug Strategy Visiting Fellow. This provided the opportunity to explore the author's views on a number of key policy, clinical and research issues. [Allsop SJ. Beyond Living with Drugs : an interview with Mike Gossop. Drug Alcohol Rev 1998;17:93-98]     

滑寿学术思想管窥

元代著名医学滑寿对文义深奥、不易体会的《内经》、《难经》采用“ 删去繁芜,撮其枢要”的方法,大胆提出分门别类,钞而读之。他以门脉为纲,统括三十种脉象。使脉学研究更为纲举和,脉诊之大纲致于清晰,使后之学者见象知理,易于掌握。其所著《十四经发挥》,把督、任二脉与十二经合论为十四经,并考诸《内经》,厘定穴位657个,分归于十四经中,使经络学说益臻系统、完善。     

在基础医学课程教学中自主学习能力提升的实践探索

基础医学课程抽象度高、综合性强、学习难度大的特点决定以传统课堂讲授为主的教学模式行不通,因此,转换教学模式,提升医学生的自主学习能力成为基础医学课程教学的关键。文章以某医学院2016级和2015级医学生为研究对象,从医学生自主学习能力的现状和问题、医学生自主学习能力提升的策略及成效的角度出发,对目前医学生自主学习能力提升的实践探索进行了总结,为进一步深化基础医学课程教学模式改革,提升医学生的自主学习能力提供新思路。