Relationships Among Disease,Social Support,and Perceived Health: A Lifespan Approach

We examined the relationship between the cumulative presence of major disease (cancer, stroke, diabetes, heart disease, and hypertension), social support, and self‐reported general and emotional well‐being in a community representative sample of predominantly White and African American respondents (N = 1349). Across all ages, greater presence of disease predicted poorer reported general health, and predicted lower emotional well‐being for respondents 40 and above. In contrast, social support predicted better‐reported general and emotional well‐being. We predicted that different types of social support (blood relatives, children, friends, community members) would be relatively more important for health in different age groups based on a lifespan or life stage model. This hypothesis was supported; across all ages, social support was related to better reported general and emotional health, but sources of support differed by age. Broadly, those in younger age groups tended to list familial members as their strongest sources of support, whereas older group members listed their friends and community members. As a whole, social support mediated the effect of disease on reported well‐being, however, moderated mediation by type of support was not significant. The results are consistent with a lifespan approach to changing social ties throughout the life course.     

支气管哮喘的历史回顾及哲学思考

支气管哮喘是一种常见的呼吸道疾病,到目前为止,其发病机理尚未完全阐明。在哮喘的认识过程中,经历了认识的感性阶段;变态反应性疾病阶段;气道高反应性阶段;多种细胞参与的慢性气道炎症阶段。从这个过程可以看出：１哮喘的认识经历了从现象到本质以及辩证发展的理性思维过程;２哮喘的发展过程体现了理论指导实践,实践反过来检验并丰富理论;３哮喘概念的发展体现了科学发现的一般规律。     

The significance of prognosis for a theory of medical practice

A typical problem of modern medicine results from the gap between scientific knowledge and its application in individual cases. Whereas scientific knowledge is generalized and impersonal information, medical practice takes place under conditions which are singular, individual and irreversible. The paper examines whether prognosis is able to bridge this gap or hiatus theoreticus. It is shown that diagnosis of a single case always relies on prognostic considerations. The individual prognosis (as distinguished from the nosologic prognosis of a certain disease) enables doctors to apply scientific knowledge and practice according to the actual situation, the history and personal preferences of the patient. Prognosis – not diagnosis – therefore legitimizes medical interference. A methodology of individual prognosis as the basis for a theory of practice is discussed.     

系统论引领帕金森病治疗思路

帕金森病的病因、不单是多巴胺的缺失或减少,西医学的多巴胺替代疗法忽略了帕金森病发病的复杂性和整体性;中医的辨证论治缺乏对系统内部的深入研究,带有很大的主观性和盲目性。而在系统论指导下的结构还原,深化了对帕金森病的中西医发病机制的系统认识。中西医结合治疗是还原论和系统论的统一,是帕金森病系统治疗的最佳形式。     

A theory of health science and the healing arts based on the philosophy of Bernard Lonergan

This paper represents a preliminary investigation relating Bernard Lonergan’s thought to health science and the healing arts. First, I provide background for basic elements of Lonergan’s theoretical terminology that I employ. As inquiry is the engine of Lonergan’s method, next I specify two questions that underlie medical insights and define several terms, including health, disease, and illness, in relation to these questions. Then I expand the frame of reference to include all disciplines involved in the cycle of clinical interaction under the heading health science and the healing arts. Finally, I analyze the cycle of clinical interaction in terms of Lonergan’s cognitive theory. I compare and contrast my analysis, based on Lonergan, with that of Pellegrino, Thomasma and Sulmasy as I proceed. In closing, I comment briefly on the next stage of this project regarding Lonergan’s theory of the human good in relation to the practice of the healing arts.

The Critical Need to Recognize That Families Matter for Adult Health: A Systematic Review of the Literature

A systemic approach to researching families and health should capture the complex network within which family members are embedded, including multiple family relationships and larger systems of health care. However, much of the families and health research focused on adult family members has focused solely on intimate partnerships, usually the marital relationship. This neglects the remainder of the powerfully influencing family relationships adults retain, and may increasingly focus on as they age. We conducted a systematic review of the families and adult health literature, retaining 72 articles which were subsequently thematically coded to highlight main foci of this area of research. Results highlight six themes, which include family relationship quality, family composition, behavioral factors in health and health care, psychophysiological mediators, caregiving, and aging health. Findings support an underrepresentation of family members, other than the intimate partner, in research on adult health.     

The effects of clinical motor variables and medication dosage on working memory in Parkinson’s disease

In this study, we investigate the interrelationship between clinical variables and working memory (WM) in Parkinson’s disease (PD). Specifically, the aim of the study was to investigate the relationship between disease duration, dopaminergic medication dosage, and motor disability (UPDRS score) with WM in individuals with PD. Accordingly, we recruited three groups of subjects: unmedicated PD patients, medicated PD patients, and healthy controls. All subjects were tested on three WM tasks: short-delay WM, long-delay WM, and the n-back task. Further, PD encompasses a spectrum that can be classified either into akinesia/rigidity or resting tremor as the predominant motor presentation of the disease. In addition to studying medication effects, we tested WM performance in tremor-dominant and akinesia-dominant patients. We further correlated WM performance with disease duration and medication dosage. We found no difference between medicated and unmedicated patients in the short-delay WM task, but medicated patients outperformed unmedicated patients in the long-delay WM and n-back tasks. Interestingly, we also found that akinesia-dominant patients were more impaired than tremor-dominant patients at various WM measures, which is in agreement with prior studies of the relationship between akinesia symptom and basal ganglia dysfunction. Moreover, the results show that disease duration inversely correlates with more demanding WM tasks (long-delay WM and n-back tasks), but medication dosage positively correlates with demanding WM performance. In sum, our results show that WM impairment in PD patients depend on cognitive domain (simple vs. demanding WM task), subtype of PD patients (tremor- vs. akinesia-dominant), as well as disease duration and medication dosage. Our results have implications for the interrelationship between motor and cognitive processes in PD, and for understanding the role of cognitive training in treating motor symptoms in PD.     

Preliminary exploration of secondhand smoke exposure in youth with Sickle Cell Disease: biochemical verification,pulmonary functioning,and health care utilization

Exposure to secondhand smoke (SHSe) can compound an already challenging set of health problems for youth with Sickle Cell Disease (SCD). Exposure to electronic cigarettes may also impact SCD symptomology and respiratory functioning. This study built on these previous findings by a) utilizing two objective measures of SHSe, salivary cotinine and exhaled carbon monoxide and b) examining the association of SHSe with emergency department utilization, physician-reported sickle cell crises, and pulmonary functioning. Caregivers (N = 31 dyads; M_age = 37.6 years; SD = 8.5 years) of youth with SCD (M_age = 9.0 years; SD = 4.5 years) completed self-report measures of tobacco/nicotine use. Youth provided a saliva sample to assess cotinine levels, and performed pulmonary function tests. Dyads provided breath samples for measurement of eCO. A chart review was conducted to obtain medical history and utilization. Majority of youth (88%) were exposed to SHS via salivary cotinine. Interestingly, no significant associations were observed between youth cotinine levels and emergency department utilization, physician-reported sickle cell crises, or pulmonary functioning. Present findings indicate a need to assess for SHSe using objective assessment measures. Future research should investigate which specific factors contribute to increase SHSe/SHVe in youth with SCD.     

论疾病的诱因

疾病诱因是医学实践中的一个重要现象,对疾病的预防、诊断、治疗和医学科研有显著意义。由于种种原因,对疾病诱因一直缺乏深入研究。本文提出并探讨了以下问题：研究疾病诱因的意义;疾病诱因的本质属性;疾病诱因与病因、危险因素的关系：“诱发”和“疾病危险因素”两概念辨析;疾病诱因的不同类型;疾病诱因发生作用的一般机制和医学实践中处理诱因的一般对策。