Medical student abuse: perceptions and experience

Summary. A questionnaire containing 18 vignettes of common clinical educational situations with potentially abusive treatment of medical students and a 10-item attitude assessment about abusive behaviour were administered to the first-and fourth-year medical students at a mid-west US university medical school. The first- and fourth-year groups did not differ significantly on perceived abusiveness of most of the vignettes, although several of the individual vignettes were perceived significantly differently by the two groups. As hypothesized, the fourth-year students had experienced such situations more frequently. Attitudes towards abusive behaviour did not differ between the two groups. The authors contrast teaching interactions perceived as educationally useful and not abusive with those seen as abusive and not useful and offer explanations for the differences observed. Finally, the possible implications of the results for medical education are discussed.     

A population-based study of repeat hospital admissions due to interpersonal violence for children aged 0–9 years

To assess the magnitude and nature of interpersonal violence resulting in hospitalisation of children and to identify subgroups at risk of repeat hospital admissions, a population-based, retrospective study of all violence hospitalisations in Western Australia for children aged 9 years or less was undertaken, using the 1990–2004 linked data retrieved from the Western Australian Mortality Database and the Hospital Morbidity Data System.
Of the 747 patients aged <10 years incurring 834 hospitalisations for the consequences of violence during the study period, 570 (76%) were less than 4 years of age. A total of 43 deaths from violence were recorded and 74 (9%) patients were admitted for more than one episode of violence. Victims aged 0–4 years from rural (hazard ratio [HR] = 2.72; 95% confidence interval [CI] 1.35, 5.43) and remote parts (HR = 2.79; 95% CI 1.25, 6.25) of the state were at increased risk of a subsequent admission for violence compared with those residing within the metropolitan area. Indigenous children aged 5–9 years were significantly more likely (HR = 3.57; 95% CI 1.14, 11.13) to incur a second hospitalisation for violence than their non-Indigenous counterparts. The identification of young victim subgroups at high risk of repeat hospitalisations is important for developing intervention strategies to reduce the burden of interpersonal violence. Young children aged 0–4 years living in rural and remote locations and Indigenous children aged 5–9 years should be specifically targeted for attention.     

The researcher's personal responses as a source of insight in the research process

Drawing on accounts of the author's personal responses while undertaking a qualitative study on the norms governing the relationship between nurses and mothers, it is argued that such responses, rather than being seen as a source of bias, have the potential to be a source of insight and interpretation in the research. This paper tells the 'inside' story of previously published research that was 'sanitized' by the omission of any reference to die researcher's subjective responses. The recognition of such researcher responses has implications for how research is supervised and presented.     

涉外护理专业学生社区毕业实习效果评价

目的 探讨涉外护理专业学生社区毕业实习模式。方法 随机设定实验组(36人),参加慢性疾病调查、建立健康档案和进行相应的健康教育,结束时与不参加社区毕业实习的对照Ⅰ组(31人)、对照Ⅱ组(38人)的实习生同时接受基础知识和能力闭卷测试。然后统计调查问卷和健康档案的正确率,并将三组测试成绩进行比较。结果 实验组调查问卷和健康档案的正确率≥95％。实习生基础知识得分实验组(43.14±2.78)、对照Ⅱ组(42.53±1.96)与对照Ⅰ组(40.65±2.47)比较;能力得分实验组(47.00±2.34)与对照Ⅰ组(41.61±3.41)、对照Ⅱ组(41.42±3.52)比较;总分实验组(90.14±4.30)与对照Ⅰ组(82.26±5.33)、对照Ⅱ组(83.95±4.13)比较,均P<0.01,差异有极显著性意义。结论 社区毕业实习强化了实习生社区护理的基本知识,培养了实习生社区护理的相关能力。但有待于规范化。     

Rational approaches to the neurobiologic study of youth at risk for bipolar disorder and suicide

Objectives:  The aims of this paper are to provide an overview of neuroimaging findings specific to bipolar disorder and suicide, and to consider rational approaches to the design of future in vivo studies in youth at risk.
Methods:  Neuroimaging and related neurobiological literature pertaining to bipolar disorder and suicide in adult and pediatric samples was reviewed in a non-quantitative manner.
Results:  Specific structural and functional brain findings in bipolar disorder are described, where possible in the context of relevant current neurobiological theories of etiology. Diagnostic and prognostic implications are discussed.
Conclusions:  The simultaneous use of complementary neurobiological approaches may be a powerful way of identifying and validating factors reliably associated with bipolar disorder and suicide. A profile of neurobiological markers with which to screen for bipolar disorder and suicide risk may provide for earlier and more accurate diagnosis, perhaps even in the pre- or subsyndromal stages in high-risk youth.     

Neurobiology of Bipolar Illness: Implications for Future Study and Therapeutics

Many findings implicating prefrontal cortical and limbic areas of the brain and endocrine systems in the neuropathology and pathophysiology of bipolar illness have greatly increased our understanding of the neurobiology of the illness. New imaging techniques such as PET, MRI, SPECT, and MRS have detailed more evidence of specific regional alterations in the brains of bipolar patients than was thought possible just 20 years ago. These methods are beginning to be used to help predict response to treatment. Examining the mechanisms of action of mood stabilizers (such as lithium, carbamazepine, and valproate) has provided clues to potential underlying neurobiological abnormalities in the illness. Recent studies of postmortem brain tissue have begun to confirm prefrontal cortical and limbic neurochemical and microstructural alterations in patients with bipolar illness compared with controls. It is postulated that it is the balance between primary pathological versus secondary adaptive alterations in gene expression in the illness and their enhancement or dampening by pharmacotherapy, that may determine the episodic course of mood fluctuations and remissions. Further examination of the pathophysiology and neurobiology of bipolar illness should lead to both more effective treatments and, potentially, secondary and even primary episode prevention.     

Do discrepancies in interpersonal perception predict relapse?: A comparison of remitted depressed patients and collaterals

In an effort to examine whether disturbed interpersonal relationships are associated with relapse in depression, discrepancies in self-ratings provided by formerly depressed patients and their collateral informants were compared. Thirty-eight remitted depressed patients and their collateral informants were asked to monitor moods, life events, and stress levels on a bimonthly basis for a 1-year period. It was hypothesized that patient/collateral dyads displaying a greater discrepancy in interpersonal perception would have a higher risk of relapse than dyads who showed more agreement in their ratings. Results indicated that while discrepancies in the perceptions of patients' life events were associated with the duration of a relapse once it occurred, discrepancies were generally not related to the emergence of new episodes of depressive disorder. The implications of these findings for models seeking to integrate cognitive and interpersonal models of depression, through the study of environmentally determined and personally appraised adversity, is discussed.This research was supported by grants to the first and third authors from the Canadian Psychiatric Research Foundation and the Laidlaw Foundation.     

医学院校大学生宿舍人际关系对抑郁情绪的影响分析

目的 分析医学院校大学生宿舍人际关系对其抑郁情绪的影响,为促进大学生身心健康发展提供依据。方法 采用分层随机抽样法,抽取西南地区某医科大学的1215名在校大学生,采用流调用抑郁自评量表（CES-D）和感知亲密关系质量量表（PRQC）修改版进行问卷调查。采用t检验、方差分析和多元线性回归进行统计分析。结果 大学生CES-D量表平均得分14.25±9.11分,抑郁情绪检出率为24.5%,其中轻、中、重抑郁情绪检出率分别为18.3%、5.4%、0.8%。有抑郁情绪的大学生宿舍人际关系总得分及各维度得分均低于无抑郁情绪者（t=14.471,P<0.05）,多元线性回归分析显示年级、家庭所在地、宿舍亲密度、宿舍信任度、宿舍氛围影响大学生抑郁情绪（P<0.05）。结论 宿舍人际关系对大学生抑郁情绪有影响,高校工作者应重视早期识别抑郁情绪的学生,关注学生的宿舍人际关系状况,提高大学生的心理健康水平。