Vulnerable and without protection: Lifetime experiences of abuse and its influence on mental ill health -—An interview study among Swedish women within general psychiatric care

Violence against women is a major global public health issue, and experiencing violence has substantial consequences for the lives of abused women. This study aims to illustrate experiences of abuse and its influence on mental ill health among women seeking general psychiatric care. Ten women seeking general psychiatric care in southern Sweden participated in a qualitative interview study. Content analysis resulted in four categories: Living in fear that persistently influences the substance of life, living with the sense of being worthless, living with a constant question about who you are and living between hope and despair. The theme evolving from the analysis was: Being vulnerable and without protection in a frightful reality that limits one’s possibilities of living and being the person one wishes to be. The results showed that the women described their mental ill health not only in terms of depression, anxiety and suicidal ideation and self-harm, but also in relation to feelings of hope and despair, fear, worthlessness and living with a constant question about who they are. The abuse reduces freedom of action, and leads to feelings of insecurity, of not having any boundaries, isolation, and self-contempt and a need to escape. This study provides knowledge of abused women self-reported mental ill health in relation to abuse.

What Contributes to Satisfaction with Care for Family Caregivers of Terminal Cancer Patients Admitted to General Wards? A Qualitative Study

Satisfaction with care is an important indicator for family caregivers of patients with terminal cancer and is linked to the quality of life. Despite this, few studies have examined the aspects of satisfaction with care of family caregivers of inpatients with cancer in general wards. This qualitative study aimed to elucidate the elements of satisfaction with the care that inpatients with terminal cancer in general wards and their family caregivers receive from medical staff, as perceived by the family caregivers. Semi-structured interviews were conducted with 10 family caregivers of inpatients with terminal cancer. Participants were asked about the care received until then from medical staff, the features of satisfactory care, and the aspects of care they felt were unsatisfactory or could become satisfactory with improvement. The data were analyzed with the content analysis method and the six categories were extracted. For family caregivers of inpatients with terminal cancer in general wards, along with the care identified as important in palliative care, the methods of alleviating symptoms and explaining the patient’s condition were also important. The results highlight the importance of determining a patient-oriented approach and explanations together with each patient and family caregiver, based on an understanding of the long treatment process.

FINAL SUCCESS AND LONG TERM TNTERESTS COMES FROM CAREFUL OPERATIONAL RESEARCH——A visit to Cai JingHua,executive director and Wu JiaLe,vice general manager of Guangdong Investment Limited

The leading role of undertaking most part of business activities bytapping fund through public listing for Guangdong Enterprises(Holdings)Limited.(here-in-after called GDE)is Played by one of its affiliate,GuangdongInvestment Limited (Here-in-after called GDI).In ten years of activeties,GDIPolicy makers deeply felt that their supreme responsibility was to create thebiggest wealth at present and in the future for the property owner,to achievethe biggest increase of property value,and in the meantime to contribute a bitfor the continuous progress of society.

Effects of General Anesthesia on the Results of Cardiac Catheterization in Pediatric Patients with Ventricular Septal Defect

Background:There is no gold standard sedation method for pediatric cardiac catheterization.In congenital heart diseases with intracardiac shunts,hemodynamic parameters are prone to change depending on the ventilation conditions and anesthetics,although few studies have examined these effects.The purpose of this study was to investigate the effects of two different sedation methods on the hemodynamic parameters.Methods:This study retrospectively evaluated consecutive patients with ventricular septal defect(VSD)below 1 year of age who underwent cardiac catheterization at Aichi Children’s Health and Medical Center,who were divided into age-and VSD diameter-matched general anesthesia(GA)and monitored anesthesia care(MAC)under the natural airway groups(n=40 each),for comparison of hemodynamic parameters.Results:In the GA group,arterial blood pH and arterial partial pressure of oxygen were significantly higher(p<0.01),whereas arterial partial pressure of carbon dioxide was significantly lower than in the MAC group(p<0.01).Mean pulmonary artery pressure(p<0.05)and systemic blood pressure(p<0.01)were lower in the GA group.Pulmonary vascular resistance index(p<0.01)and systemic vascular resistance index(p<0.01)were also significantly lower in the GA group than the MAC group.There were no significant differences in pulmonary blood flow index,systemic blood flow index,and pulmonary/systemic blood flow ratio between the two groups.Conclusions:Cardiac catheterization under GA in VSD patients results in different hemodynamic parameters compared to that under MAC.In particular,when using pulmonary artery pressure and pulmonary vascular resistance measured under GA for judgment regarding the surgical indications or perioperative management,consideration should be given to the fact that these parameters might be lower compared to those measured under MAC.

Patient, Provider and System Factors Impacting on the Diagnosis and Management of Lung Cancer Care in Australia

Background: Lung cancer is the leading cause of cancer death in Australia, with only modest improvements in survival. This study aims to identify factors impacting on diagnosis and management of lung cancer with particular reference to Australian primary care. Methods: A sequential mixed method modified approach employing interview and a two-phased survey technique. Following telephonic interviews with 31 health professionals (individuals representing general practitioners, specialized physicians, nurses and allied health practitioners), interview data was analysed using qualitative thematic analysis, and surveys using descriptive statistics. Emergent themes were organised under patient, provider and system factors. Interviews ceased upon saturation of data. Results: Multiple patient, provider and systems issues were seen to contribute to adverse health outcomes. There is a strong relationship between smoking and outcomes, and factors related to higher smoking rates such as a lower socioeconomic status. For smokers, guilt and/or denial was considered a reason for delay in the decision to seek medical care for cough or shortness of breath. Aboriginal people under-report morbidity related to smoking and chronic obstructive pulmonary disease;other patients fail to recognise the significance of their symptoms. Discussion: Despite the poor prognosis of lung cancer diagnosis, increased awareness of presentation and treatment options can address disparities in health outcomes.

Relationship of general trust with individual health and life related factors among frail elderly residents at home in Hokkaido rural areas in Japan

General Trust (GT), defined as a default expec-tation of other people’s trustworthiness, is assumed to be a predictor for promotion of health and welfare in individuals as well as for strengthening of social capital in the community. An improvement of health and quality of life of the elderly is recently a crucial agenda. Thus, the purpose of the study was to explore which factors regarding health and life associated with GT among frail elderly people living at homes in Japanese rural area. The study selected the subjects who were designated within three mildest degrees in seven stages of long-term care levels and who met at an item and more in the national basic check-list. 209 participants were interviewed by trained health personnel using a structured questionnaire. GT was measured by a dichotomous outcome of inquiring “do you trust people in general?”. In the univariable analysis, educational status (p = 0.004), activity competence index including instrumental activity of daily living (IADL) (p = 0.020), Mini-Mental State Examination (MMSE) (p = 0.029) and Self-rating Depression Scale (SDS) (p = 0.010) were significantly related to GT. By logistic regression analysis using a stepwise method with a like-lihood ratio, educational status alone was sig-nificantly associate with GT (p = 0.010, odds ratio = 1.195 [95% confidence interval;1.043 - 1.371]). Health related factors had nothing to do with GT. Our finding suggested that the higher educated elderly might have had more opportunities to encounter the others and more indispensability to deliberately discern their trustworthiness than the lower, and consequently had higher GT through social intelligence being strengthened.

Short-and long-term health implications of surgical intensive care in the elderly

Background: Treatment of elderly patients on intensive care units is an increasing challenge all over the world. Objectives: To evaluate short- term survival and long-term quality of life im-plications of intensive care for the elderly. Methods: Retrospective analysis of 314 patients 75 years of age or more requiring over 48 hours of intensive care. Results: In multivariate analy-sis, significant risk factors for mortality were chronic renal impairment (OR for survival .30, p 24 h (OR 4.5), hemodialysis (OR 6.8), and vasopressor therapy (OR 2.5, p < 0.001 for each). A health survey questionnaire in an up to 60-month follow-up of 28 patients revealed considerably lower physi-cal subscores of our patients compared to the general elderly population. Conclusions: Elderly patients benefit from intensive care in terms of survival. Complications are frequent, as are severe consequences for long-term quality of life. Short-term mortality in elderly intensive care patients correlates most closely to pre- existing disease, not age.

Identifying High-Risk Medication Prescriptions to Prevent Potentially Severe Adverse Drug Events in Primary-Care Patients with Chronic Multimorbidities:The Polychrome Study

Background:The association between multimorbidities and polypharmacy among elderly individuals is well documented,and polypharmacy has been shown to increase the risk of adverse drug events(ADEs).However,little information is available about the risks associated with the lifelong use of medications to treat chronic multimorbidities.Objective:To determine the prevalence and nature of high-risk prescriptions among primary-care patients with chronic multimorbidities.Methods:We studied a weighted stratified random sample of 105 prescriptions for different patients with chronic multimorbidities taken from the Polychrome database established using information from the French primary-care record database(Observatoire de la Médecine Générale).A medication review was conducted to identify contra-indications and potential drug-drug interactions for each prescription.Results:Contra-indications were identified for 60(57.1%)prescriptions,potential drug-drug interactions for 70(66.7%),absolute contra-indications for 9(8.6%),and inadvisable drug combinations for 11(10.5%).In all,19(18.1%)different patients were at risk for major ADEs.Cardiovascular and nervous-system drugs contributed 66.2% of contra-indications and 69.3% of potential drug-drug interactions.Conclusions:This exploratory study confirms the high prevalence and potential seriousness of prescriptions at risk for ADEs in a population of primary-care patients with chronic multimorbidities.The high prevalence of interactions involving the cardiovascular and nervous systems indicates that efforts to improve prescription practices should target these two categories of conditions and drugs in patients with chronic multimorbidities.

上海市全科医生需求预测模型构建及应用

目的系统分析影响全科医生需求的因素,构建系统动力学模型,预测上海全科医生的需求数量,为上海全科医生的发展规划提供决策支撑。方法基于“卫生服务需要-卫生服务需求-卫生服务利用-全科医生需求”的逻辑框架,通过专家咨询、文献资料、统计资料收集指标数据,运用系统动力学方法构建模型并进行仿真预测。结果根据构建的系统动力学模型,对2018—2030年上海全科医生的需求情况分别按照平稳趋势、变化趋势进行预测。当模型参数保持不变时,2030年上海全科医生需求总量将达到14093人,每万常住人口的全科医生需求数将达到5.7人。当模型参数按照既往趋势变化时,2030年上海全科医生需求总量将达到16444人,每万常住人口的全科医生需求数将达到6.6人。结论预测全科医生的需求应综合考虑卫生服务需要、需求与利用等诸多因素。基于系统动力学的需求预测模型能够为全科医生数量规划提供技术支持。上海应重视不断增长的全科医生需求,做到定期动态监测、预测预警。

Perioperative"remote"acute lung injury:recent update

Perioperative acute lung injury（ALI） is a syndrome characterised by hypoxia and chest radiograph changes.It is a serious post-operative complication,associated with considerable mortality and morbidity.In addition to mechanical ventilation,remote organ insult could also trigger systemic responses which induce ALI.Currently,there are limited treatment options available beyond conservative respiratory support.However,increasing understanding of the pathophysiology of ALI and the biochemical pathways involved will aid the development of novel treatments and help to improve patient outcome as well as to reduce cost to the health service.In this review we will discuss the epidemiology of peri-operative ALI;the cellular and molecular mechanisms involved on the pathological process;the clinical considerations in preventing and managing perioperative ALI and the potential future treatment options.

Predicting the outcome of closed-loop small bowel obstruction by preoperative characteristics

BACKGROUND Closed-loop small bowel obstruction(CL-SBO)can threaten the viability of the intestine by obstructing a bowel segment at two adjacent points.Prompt recognition and surgery are crucial.AIM To analyze the outcomes of patients who underwent surgery for CL-SBO and to evaluate clinical predictors.METHODS Patients who underwent surgery for suspected CL-BSO on computed tomography(CT)at a single center between 2013 and 2019 were evaluated retrospectively.Patients were divided into three groups by perioperative outcome,including viable bowel,reversible ischemia,and irreversible ischemia.Clinical and laboratorial variables at presentation were compared and postoperative outcomes were analyzed.RESULTS Of 148 patients with CL-SBO,28(19%)had a perioperative viable small bowel,86(58%)had reversible ischemia,and 34(23%)had irreversible ischemia.Patients with a higher age had higher risk for perioperative irreversible ischemia[odds ratio(OR):1.03,95%confidence interval(CI):0.99-1.06].Patients with American Society of Anaesthesiologists(ASA)classification≥3 had higher risk of perioperative irreversible ischemia compared to lower ASA classifications(OR:3.76,95%CI:1.31-10.81).Eighty-six patients(58%)did not have elevated C-reactive protein(>10 mg/L),and between-group differences were insignificant.Postoperative in-hospital stay was significantly longer for patients with irreversible ischemia(median 8 d,P=0.001)than for those with reversible ischemia(median 6 d)or a viable bowel(median 5 d).Postoperative morbidity was significantly higher in patients with perioperative irreversible ischemia(45%,P=0.043)compared with reversible ischemia(20%)and viable bowel(4%).CONCLUSION Older patients or those with higher ASA classification had an increased risk of irreversible ischemia in case of CL-SBO.After irreversible ischemia,postoperative morbidity was increased.

Which Socio-Economic Factors Influence Patients’ Choice to Opt for the ED or the GPC during Out-of-Hours: An Explorative Study in Flanders

Background: Overcrowding of emergency departments (ED) during out-of-hours health care is a common problem in many Western countries. An appealing alternative for ED’s is the general practices cooperatives (GPC): regional networks of GP’s during the out-of-hours. The aim of this study is to investigate the socio-economic determinants of patients’ choice to opt for one of both health care providers. Methods: We gathered patient level data between May and December 2012 in Flanders (Belgium) from three emergency departments and three general practices cooperatives. Chi square analyses were used in order to study the bivariate relationship between opting for a health care facility (ED or GPC) and various socio-economic factors. To determine the independent association, a logistic regression analysis was conducted. Results: Self-referral to the ED is significantly associated with: being male, being younger, being less educated, having a (lower educated) partner and living in a rural area. Conclusion: The results of this study show that opting for the ED during the out-of-hours is, in general, related to a lower socio-economic status. Therefore the government should focus on patients with a lower socio-economic status when disseminating information on the organisation of health care with an emphasis on the accessibility of the primary health care during out-of-hours. To meet the needs for health care during these out-of-hours, a possible solution could be an integrated facility of GPC and ED with one access to medical care for all patients.

FORGET: Pilot of an Innovative and Simple History Based Screening Tool for Dementia Community Clinics and Acute Medical Hospitals

The aim of this study is to pilot FORGET as screening tool for dementia in community OP clinic and acute medical hospital assessments. Sample size included 30 each of memory clinic and acute medical hospital patients. Assessments included FORGET and MMSE. Psychometric test parameters were calculated for FORGET (Cut-off >1 in OP clinic and >3 in acute medical hospital). Of 30 referrals to memory clinic, 25 had dementia. A score >1 on FORGET had sensitivity 80%, specificity 80%, PPV 95.24%, NPV 44.44%, OR 16.00 (p = 0.02) for diagnosis of dementia. Of 30 acute hospital referrals, 20 had dementia. A score >3 on FORGET had sensitivity 95%, specificity 90%, PPV 95% and NPV 90%, OR 171 (p = 0.0005). FORGET at a score of >1 in community and >3 in acute medical hospital is a useful screening tool for dementia.

“Three essential elements”of the primary health care system:A comparison between California in the US and Guangdong in China

The primary health care system(PHCS)is the portal and basis for the national health delivery system.There are a number of elements which comprise the PHCS,but the system cannot be established and developed without the support of“three essential elements,”including general practitioners(GPs),health insurance,and government health investment.Through comparative analysis of the“three essential elements”of the PHCS between California in the US and Guangdong in China,this article indicates that there are three important aspects in developing a PHCS in China,as follows:training qualified GPs;establishing a diversified health insurance system to strengthen the policy connections between health insurance and the PHCS thereby increasing government health investment;and broadening health financing channels.

Process engineering for primary care:Quality improvement and population health

A fundamental paradox of the health care delivery systems in many industrialized nations is that desired population health metrics are often not achieved despite large expenditures in the health care delivery system.For example,the United States commits nearly 18%of its GDP to the health care delivery system,the largest amount of any nation,yet is 37th in achieving health or health care delivery metrics.This article addresses how general practice can be an important driver of population health in the Chinese health care delivery system through the application of quality improvement methods.The article shows examples of how the cause-and-effect diagram,the process map,and the plan,do,study,act(PDSA)cycle are important techniques to assist primary care practitioners for improving population health.

General practice training in China:A multimodal experiential program provided by Australian educators

Our small group of expert GP academic trainers from Monash University and the University of Melbourne have been collaborating over the last decade to develop a GP model training program based in Luohu,Shenzhen,that deeply engages Chinese GPs and seeks to provide personal and professional development of the GPs.The program is closely linked to continuing offshore GP education in Australia,with many trainees of the program having attended intensive training hosted by Monash University in Australia.

Striking a balance:The critical importance of sense-making and valuescongruent partnerships between general practitioners and patients following stroke

Objective:People with a recent experience of stroke commonly rely on general practice for assistance to manage everyday consequences and associated disability.In this study,we were in-terested in qualitatively exploring how the relationship between these people and their general practitioners assisted daily self-management.Methods:One hundred twenty-six participants were involved in five in-depth interviews over an 18-month period after discharge from an acute care setting.Data were thematically analyzed by two independent researchers.Results:Three themes comprehensively accounted for the expectations participants had about their interactions with general practitioners.They were(1)the critical sense-making role of general practitioners,(2)the requirement for collaborative partnerships in which personhood was vali-dated,and(3)the importance of confirming self-management actions.Conclusion:To comprehensively assist people to adjust to living with the residual conse-quences of a recent stroke,general practitioners need to engage in collaborative,person-centered interactions.

Primary care for cancers at diagnosis and follow-up:a narrative review

This paper is concerned about the family physician’s role in early cancer diagnosis and follow-up with his/hers patients who have just been diagnosed with cancer;treatment modalities for cancer;and family physician continuous roles for patients who are under definitive cancer treatment,experiencing side-effects of cancer treatment;some of the effective means to reduce these side-effects during cancer treatment and management of oncologic emergencies.Having some knowledge on the current cancer therapies would undoubtedly help family physicians to follow up patients with cancer more confidently,to appreciate their side-effects,symptomatic treatment,recognize the limit of primary care and be even useful for counseling and consultation with patients or their family members with a family history of cancer.Systematic searches with terms comprised“cancer”,“malignancy”,“primary care”,“general practice”,“cancer AND diagnosis”and“cancer AND follow-up”were done in the major databases such as Pubmed,ScienceDirect and Ovid.We employed selective searches with the above terms and their combination in some of the major journal such as The Lancet Oncology,The Lancet,New England Journal of Medicine,etc.These were followed by snowballing the relevant articles from the citation of references in those selected papers.The goal of this narrative review is not to provide exhaustive documentation of sound evidence for practice of primary care for cancer patients at diagnosis and follow-up.It mainly aims to provide specific evidence-based information and suggestions that are thought to be relevant for primary care professionals and policymakers.

Disconnect between primary care and cancer follow-up care: An exploratory study from Odisha, India

Objective:There has been a steady increase in the demand for cancer follow-up care in India.Compared with Western countries,there is little evidence on the capacity of the Indian primary care workforce to accommodate such tasks.We explored the perceptions of oncologists,general practitioners,and patients with regard to the involvement of primary care in cancer follow-up care.Methods:We undertook semistructured focus-group discussions with eight oncologists,nine general practitioners,and 17 cancer patients to gain an understanding of their perceived roles and responsibilities with regard to primary care in delivering follow-up care and the potential concerns.Data from the focus groups were transcribed verbatim,translated,and analyzed with use of a the-matic approach.Results:Most general practitioners felt that their job is to see‘normal’patients,and cancer patients were exceptions to routine care.Oncologists were apprehensive with regard to the com-petence of general practitioners and patient trust.Patients consult oncologists for cancer follow-up care as they perceive it to be very specialized.Patients expressed difficulty in accessing follow-up care and want specialized oncological care by trained personnel in their vicinity.Conclusion:Despite the growing number of cancer survivors,we found a disconnect between primary care and cancer follow-up care.

儿童急性酒精中毒致痴呆及癫痫发作一例报告

儿童急性酒精中毒致痴呆及癫痫发作一例报告陈爱琴，马连华，刘荣华患儿，男，６岁，１９８２年１２月３０日入我院。主诉：３个月前饮６０°白酒约２００ｇ后出现抽搐、昏迷，继发呆傻及行为异常。家族中其父嗜酒。个人史：自幼生长发育正常，聪明，受家人溺爱。患儿逢年...