[Research on reform of epidemiology teaching].

Epidemiology is a traditional subject mainly based on principles and concepts, and its teaching method needs further improving to meet the requirement of the new trend of education reform. Lecture-based teaching, problem-based teaching, case-based teaching, and internet based teaching, such as flip class, massive open online course and micro-lecture, all have its own unique merits in the practice of epidemiology teaching. So the combination of traditional teaching and online teaching is the most promising mode. "Rain class" , a mixed mode, is an efficient tool to present the epidemiology case more actually in class. Thus, teaching design and application of "rain class" are worth research.

Impact of severe respiratory syndrome on anxiety levels of front-line health care workers.

OBJECTIVE: To identify anxiety levels among front-line health care workers during the 2003 severe acute respiratory syndrome outbreak. DESIGN: Questionnaire survey. SETTING: Regional hospital, Hong Kong. PARTICIPANTS: All hospital staff were given a questionnaire; administrative staff who had not had any patient contact served as controls. MAIN OUTCOME MEASURES: Levels of contact with patients who had severe acute respiratory syndrome were measured and correlated with anxiety levels as determined by the State-Trait Anxiety Inventory. RESULTS: Of 4252 questionnaires distributed between May and June 2003, 2040 (48.0%) were returned and 1926 (45.3%) were valid for analysis. Overall, 534 (27.7%) respondents had had contact with patients with severe acute respiratory syndrome. Anxiety scores ranged from 20 to 80, and mean (standard deviation) scores were higher among staff who had had contact with patients with severe acute respiratory syndrome than among those who had not (52.6 [10.5] versus 49.8 [10.1], respectively; P<0.01). Mean anxiety levels were higher among workmen, health care assistants, and nurses than among administrative staff controls or doctors (P<0.01). Anxiety scores were correlated with burnout scores (Pearson's correlation coefficient, 0.52-0.59) and with discomfort from wearing protective gear (0.21-0.32). CONCLUSION: Severe acute respiratory syndrome has likely stressed the public health care system. Prediction and early identification of adverse factors in a crisis situation would allow early implementation of interventions to reduce and counteract the impact of this stress.

Brain morphological abnormality in schizophrenia is independent of country of origin.

OBJECTIVE: The disorder schizophrenia has a worldwide prevalence of 1% and is generally associated with lateral cerebral ventricular enlargement. Whether there is a relationship between these two findings is unclear but has aetiological relevance. METHOD: Consecutively admitted Chinese patients (n = 19) with first episode of schizophrenia and healthy community volunteers (n = 29) underwent magnetic resonance imaging brain scan. The groups were balanced for age, sex, best social class and handedness. These patients were similar on clinical and socio-demographic indices to those who declined participation (n = 15). Semi-automated volumetric analysis of whole brain volume, cortical grey matter, cerebrospinal fluid, sulci and lateral ventricles was performed. RESULTS: Chinese patients in their first episode of schizophrenia have significant enlargement of lateral ventricles. CONCLUSION: Brain morphological abnormality in schizophrenia is present regardless of the country of origin. The importance of genes in driving normal brain development and stable prevalence suggests that aetiology may favour genes over environment.

How good are accident and emergency doctors in the evaluation of psychiatric patients?

The aim of this study was to find out the agreement between psychiatrists and emergency department (ED) doctors in the diagnosis and treatment of psychiatric emergencies. All patients presenting with a psychiatric complaint and who were subsequently referred to the psychiatrist were included. A standard form was used to collect demographic data, provisional diagnoses and initial treatment by ED doctors, diagnoses by psychiatrists, and compatibility of ED diagnoses and treatment as judged by consulting psychiatrists. The mean age of the 223 patients enrolled was 36.5 years and the distribution between males and females was roughly equal. The most frequent presentations were aggressive behaviour (27.9%), depressive mood (13.5%) and suicidal idea (12.1%). Schizophrenia (39%) was the most common diagnosis followed by depression (20%) and adjustment disorders (9.5%). The agreements between psychiatrists and ED doctors in diagnosis and treatment were 61.4% and 89.5% respectively. Schizophrenia and bipolar disorders were least likely to be mis-classified. It is concluded that ED doctors were deficient in the diagnosis of psychiatric conditions especially in the less common diagnostic categories.

Previous private psychiatric treatment among public mental patients: a preliminary local survey.

There has been considerable concern over disturbances to the public-private equilibrium in local health care provision. We investigated the situation among mental patients. Only 11.5% of new patients presenting to a public general hospital psychiatric unit had consulted a private sector psychiatrist previously. Of these, 60% had moved to the public sector for financial reasons and the same proportion had had their last contact with private care within the previous three months. There were no dominant reasons for choosing the private sector initially. No particular privately practising psychiatrist's patients were more likely to seek public treatment subsequently. The results are analysed and the implications discussed.