博弈条件下社区居民与社区医生契约服务关系构建

党的十八届三中全会提出“建立社区医生和居民契约服务关系”,这不仅指出了社区医院在我国医疗改革事业发展中的重要地位,也特别强调了社区医院医生与社区居民之间构建契约服务关系关乎到社区医生与居民和谐关系的建立,关系到我国医疗改革的成败,关系到人民的健康福祉。这要求强化政府引导与监管,提升医生的职业技能与道德水准,提高社区居民的维权意识,构建社区医生与居民的契约服务关系新模式,确保社区居民的身体健康。     

Associations between stress at work and attitudes towards retirement in hospital physicians

Abstract

There is a need to understand the associations between attitudes towards retirement in specific occupations and various psychosocial and work-related factors. This study identified correlates of retirement thoughts and retirement preference in hospital physicians. The sample comprised 447 (251 male and 196 female) physicians from three hospital districts in Finland. After adjustment for gender, age and salary, minor psychiatric morbidity increased likelihood of retirement thoughts and retirement preference. Retirement thoughts and retirement preference were more common in doctors reporting low job control, poor teamwork and unjust supervision than in doctors perceiving their working conditions more favorably. Work preference was associated with high overwork. The associations of work characteristics with retirement thoughts and retirement preference largely persisted after control for indicators of health and social circumstances. In conclusion, in addition to demographic and financial factors and health, retirement attitudes in hospital physicians seem to be related to organizational and managerial factors that are potentially amendable to intervention. This has implications for retaining hospital physicians who might otherwise retire.     

金元医家学术流派产生的社会文化因素

金元时期是中国医学史上以争鸣与创新为主要学术特点的时代，这与当时较为宽松的社会文化大背景、理学的兴起以及医家个人不同的文化思想基础有关，它们是医学流派形成的社会文化因素.     

经方家的魅力

经方家是指以善用经典处方为特色的名中医群体。他们大多性格直率,敢于直言,嫉恶如仇;他们俭朴自安,急病人所急,忧病人所忧,医德医风高尚;他们做学问从不人云亦云,敢于怀疑,敢于创新,重视实践;他们的医案质朴无华,无空话套话,不做表面文章;他们用药不分古今,惟对证是取,无臆测之见,且胆识过人。经方家的身上透发出超越时代的非凡魅力,代表着中医学的灵魂和希望。     

临床医生自我和谐现状及影响因素探究

采用自我和谐量表、临床医生工作压力源问卷和中文版医患关系问卷,调查了湖南省22所医院的363名临床医生。结果表明,临床医生在自我和谐量表各维度的得分均低于常模(P<0.01),其自我和谐现状不容乐观,且在年龄、性别、学历、职称、医院级别等人口学变量上存在差异(P<0.05);临床医生的工作压力源及医患关系均与自我和谐水平有高相关(P<0.001)。文章从工作压力和医患关系两角度探讨了影响临床医生自我和谐的主要因素。     

HIV/AIDS stigma manifestations during clinical interactions with MSM in Puerto Rico

HIV/AIDS stigma can have detrimental effects on physician/patient interactions when manifested by health professionals. Unfortunately, HIV/AIDS stigma is usually manifested in an intersectional manner with other preexisting stigmas, including stigma toward men who have sex with men (MSM). Therefore, our study aimed to examine the behavioral manifestations of HIV/AIDS stigma among physicians in training during simulated clinical interactions with MSM, and explore the interrelation between HIV/AIDS stigma attitudes and behaviors. We implemented an experimental design using Standardized Patient simulations with a sample of 100 physicians in training in Puerto Rico. Results show a significant difference in the two groups’ means (p?<?.001), with a higher number of stigma behaviors in the HIV MSM patient condition (M?=?6.39) than the common cold control condition (M?=?5.20). Results evidence that stigma manifestations toward MSM with HIV may continue to be an obstacle for public health in Puerto Rico, and that medical training to prevent stigma is still needed.     

乡村医生职业嵌入的内卷化困境与治理路径

作为深度嵌入国家的红色赤医之延续,乡村医生在改革开放后40年间呈现脱嵌样态;21世纪以来,村医职业逐渐在制度、结构与认知层面回嵌于国家。引入内卷化概念梳理其嵌入过程发现,在强国家-弱法团的单向度主导与村医自主悬搁之耦合下,村医职业嵌入正在遭遇内卷化危机:以技术理性为表征,精细化、繁复化与形式化的制度干预与规制直接作用于村医职业内容与边界,职业去专业化风险由此滋生;乡-村两级医疗卫生组织间关系的变动与收入结构的调整使得职业管辖权不断弱化,村医职业的法团自主性进一步消弭;职业身份的错置、模糊化与科层化伴随着对药物使用的规制,村医在认知嵌入过程中开始遭遇临床自主性丧失危机,由此带来了基层卫生消解医疗的非预期性后果。在市场与社会之外整合职业社群的力量乃是实现村医职业的发展型嵌入的必行之计。     

南京市社区卫生人力资源配置分析

目的：分析南京市社区卫生人力资源配置情况。方法：以南京市2013年城市社区卫生工作年报为基础,从社区卫生人力数量、学历、职称、医护比等方面分析南京市社区卫生人力配置情况。结果：每万人全科医师为2.37人,医护比为1：0.8,每万人公卫医师为0.38人,专科及以上学历达72.65﹪,初级以下职称达58.38﹪。结论：南京市社区卫生服务机构卫生人力数量不足,专业素质不高,专业结构不合理。建议以需求为导向培养社区卫生人才,通过加强继续教育、提升社会地位、增加职业发展的机会,稳定社区卫生队伍,适当增加公卫医师和护理人员的数量。     

Same Profession,Different People: Stratification,Structure, and Physicians' Employment Choices

Professions such as medicine are in the midst of profound change. This paper explores how recent stratifying forces within the medical profession relate to the trend toward salaried employment for physicians. Specifically, growing segments of female, black and Hispanic, and lower and middle class doctors are focused upon in the analysis. Several important structural forces related to managed care and the nature of medical work are discussed and examined as well. The results suggests that it is useful to consider factors internal to professions in explaining large-scale professional change. This does not mean forgetting about the role played by structure in this change. Instead, it supports incorporating stratification perspectives into studies of professionals and of considering micro levels of analysis which acknowledge and investigate the effects of intraprofessional diversity.     

Associations between stress at work and attitudes towards retirement in hospital physicians

There is a need to understand the associations between attitudes towards retirement in specific occupations and various psychosocial and work-related factors. This study identified correlates of retirement thoughts and retirement preference in hospital physicians. The sample comprised 447 (251 male and 196 female) physicians from three hospital districts in Finland. After adjustment for gender, age and salary, minor psychiatric morbidity increased likelihood of retirement thoughts and retirement preference. Retirement thoughts and retirement preference were more common in doctors reporting low job control, poor teamwork and unjust supervision than in doctors perceiving their working conditions more favorably. Work preference was associated with high overwork. The associations of work characteristics with retirement thoughts and retirement preference largely persisted after control for indicators of health and social circumstances. In conclusion, in addition to demographic and financial factors and health, retirement attitudes in hospital physicians seem to be related to organizational and managerial factors that are potentially amendable to intervention. This has implications for retaining hospital physicians who might otherwise retire.