第二讲:循证临床实践成功的范例

1循证临床实践的背景 1.1全球疾病负担呈升高趋势 随着经济与医疗科技的发展,尽管很多经典的疾病诊断标准及治疗方案在疾病控制方面发挥了重要作用,但据近期WHO数据,全球疾病负担趋势仍令人担忧:15岁～59岁劳动力人群的伤残调整生命年(disability-adjusted life year,DALY)占全球总人口的49%(其中0岁～4岁占29%,5岁～14岁占7%,60岁以上占15%)[1];预测2002年～2030年主要疾病死因顺位依次为肿瘤、缺血性心脏病、中风、HIV/艾滋病、其他感染性疾病、交通事故、结核及疟疾,大都呈上升趋势,见图1.     

不良性认知心理是导致心身疾病的关键环节

为了了解大学生不良性认知心理和心身疾病的关系,统计了2002年～2006年5年中因不良性认知心理导致心身疾病休学人数占休学总数的比例.结果显示,5年中因各类疾病休学的人数为330人,其中因心身疾病休学的人数为260人,占休学总数的78.79%.心身疾病发病率与其他疾病构成比有显著性差异(X2=60.12,P<0.01);且呈逐年上升趋势(X2=105.72 P<0.01).因此,大学生不良性认知心理是导致心身疾病的关键环节.     

论我国艾滋病防治工作中的政府职能

艾滋病是世界性的重大公共卫生问题和社会问题.近年来,我国艾滋病的流行呈现快速上升趋势,流行范围广,局部地区疫情相当严重,疫情正在从高危人群向一般人群传播.政府的组织领导是做好我国艾滋病防治工作的根本保证,各级政府要强化政府的公共卫生职责,发挥政府的主导作用,动员足够的防治资源和力量,引导社会各方面力量的广泛参与,打一场防治艾滋病的"人民战争",我们一定能够控制艾滋病的流行.     

正确处理前列腺手术与术后性功能的关系

随着人们生活水平的提高和医疗技术的完善 ,人类老龄化已成为一个社会课题摆在我们的面前。前列腺增生和前列腺癌发病率近年来在逐年上升 ,已成为威胁老年人健康的主要疾病之一 ,国内报道5 0～ 6 0岁的男性前列腺增生的发病率在 6 0 %左右 ,70岁以上的发病率可达 80 %以上。美国报道 ,其国内前列腺癌的发病率在各类癌症中达 2 0 %以上 ,黑人中可达 1/ 3。统计我院泌尿外科 5年来所做的各类手术中 ,前列腺手术占总手术量的 5 2 % ,在这类手术增加的同时 ,伴随着社会进步 ,人们对生活质量要求的提高 ,前列腺术后病人性能力的改变越来越受到临…     

第二讲：循证临床实践成功的范例

1循证临床实践的背景 1．1全球疾病负担呈升高趋势 随着经济与医疗科技的发展,尽管很多经典的疾病诊断标准及治疗方案在疾病控制方面发挥了重要作用,但据近期WHO数据,全球疾病负担趋势仍令人担忧：15岁～59岁劳动力人群的伤残调整生命年（disability-adjusted life year,DALY）占全球总人口的49％（其中0岁～4岁占29％,5岁～14岁占7％,60岁以上占15％）;预测2002年-2030年主要疾病死因顺位依次为肿瘤、缺血性心脏病、中风、HIV／艾滋病、其他感染性疾病、交通事故、结核及疟疾,大都呈上升趋势,见图1。     

领导干部防艾意识的调研报告

1998年中国政府在《中国预防控制艾滋病中长期规划》中将艾滋病防治的总目标确定为 :“建立政府领导、多部门合作和全社会参与的艾滋病性病预防和控制体系 ,在全社会普及艾滋病、性病防治知识 ,控制艾滋病的流行与传播”。在保障这一目标实现的诸因素中 ,最重要的是政府领导。如果政府的主要领导干部像《规划》中所预设的 :将“减轻艾滋病给人民健康及国民经济和社会发展带来的危害”作为自己的工作要务之一 ,多部门合作、全社会参与的有效控制艾滋病流行传播的机制就能形成。党和政府的主要领导干部对防治艾滋病及相关问题怎样看 ?2 0 0 1-…     

不良性认知心理是导致心身疾病的关键环节

为了了解大学生不良性认知心理和心身疾病的关系,统计了2002年-2006年5年中因不良性认知心理导致心身疾病休学人数占休学总数的比例。结果显示,5年中因各类疾病休学的人数为330人,其中因心身疾病休学的人数为260人,占休学总数的78．79％。心身疾病发病率与其他疾病构成比有显著性差异（x^2=60．12,P〈0．01）;且呈逐年上升趋势（x^2=105．72 P〈0．01）。因此,大学生不良性认知心理是导致心身疾病的关键环节。     

论我国艾滋病防治工作中的政府职能

艾滋病是世界性的重大公共卫生问题和社会问题。近年来,我国艾滋病的流行呈现快速上升趋势,流行范围广,局部地区疫情相当严重,疫情正在从高危人群向一般人群传播。政府的组织领导是做好我国艾滋病防治工作的根本保证,各级政府要强化政府的公共卫生职责,发挥政府的主导作用,动员足够的防治资源和力量,引导社会各方面力量的广泛参与,打一场防治艾滋病的“人民战争”,我们一定能够控制艾滋病的流行。     

脑血管病防治任重而道远

目前,我国居民前5位死亡原因依次是脑血管病、恶性肿瘤、呼吸系统疾病、心脏病以及损伤和中毒.全国每年新发病例250万,死于脑血管病超过150万,幸存者600万～700万,残疾率高达75%.中国脑血管病直接医疗费用年平均增长速度为18.04%,年均增长速度几乎倍于同期GDP增长速度(8.95%).更为严重的是,随着人口老龄化、城市化进程的加快及不良生活方式的影响,我国脑血管病发病呈逐年上升的趋势,防治形势将日益严峻.国际间比较研究显示,中国人群脑血管病的发病率和死亡率高于国际平均水平,仅次于前苏联或东欧等少数几个国家.     

良人属我,我也属他——合神心意的两性亲密关系(上)

据中国疾病控制中心性病艾滋病预防控制中心主任吴尊友披露：“截至2006年10月31日,全国历年累计报告艾滋病183733例。感染人数在亚洲位居第二位,在全球居第十四位,艾滋病疫情进一步蔓延的危险因素仍然存在。”2012年2月29日国务院办公厅关于印发《中国遏制与防治艾滋病“十二五”行动计划》的通知指出,艾滋病流行形势严峻,性传播已成为中国艾滋病传播主要途径。     

Seeing and hearing and space and space and time

A previous experiment had shown spatial location to be judged in terms of the framework provided by the modality in which stimuli were presented. In the present study, digits were either auditorally or visually presented, and in either form the three digits appeared successivly to the left, in the center, and to the right of the S. The digit which occurred temporally in the middle of the sequence was never central from the spatial viewpoint. The S was asked to indicate which digit was the middle one. Ss were blind, deaf, or normal. The deaf and two control groups saw visual displays, and the blind and their controls heard auditory displays. The former groups predominantly chose the spatially middle digit and the latter groups the temporally middle. It was concluded that modality of presentation was the trigger which switched in the coding dimension of time or space.     

Bob and Carol and Tess and Ali

Conflicting religious experiences in different traditions do not necessarily defeat the rationality of conflicting beliefs sustained by those experiences in those traditions. The circularity that protects religious beliefs from such mutual defeat is not vicious. Moreover, the lack of ‘epistemological humility’ exhibited by such believers poses no threat to world peace. In fact, a campaign for compulsory humility would itself constitute a much greater threat.     

Law and Gospel,and Youth and Family Ministry

Abstract : If “faith comes through hearing” the word of God comprised in law and gospel, how do the imperatives that characterize ‘Youth and Family Ministry’ make such hearing possible? Here, literature delineating ‘Youth and Family Ministry’ is analyzed in light of its biblical foundations. The primary lens implemented in this analysis is the law/gospel hermeneutic advocated by Martin Luther and other reformers.     

Extremes of self-esteem and narcissism and the experience and expression of anger and aggression

This study examined the level of self-esteem and narcissism as personality variables involved in the disposition to experience and express anger. Three hundred thirty-eight subjects were sampled across two higher education centres and one student teaching programme in the United Kingdom. It was reasoned that individuals with both high self-esteem and narcissism would report especially high tendencies to experience and express anger and aggression and that those with high self-esteem and low narcissism would report the lowest. These predictions were influenced by theories that emphasise the role of threats to high self-esteem in the production of aggression and violence. Results indicate that groups defined by their extreme scores on self-esteem and narcissism scales produced levels of anger expression in the predicted direction. The importance of considering extreme levels of self-esteem and narcissism (in conjunction with other factors) in an analysis of anger is discussed with reference to currently influential theories in the field. Aggr. Behav. 24:421–438, 1998. © 1998 Wiley-Liss, Inc.     

Dance and psychotherapy--possibilities and limits

From a starting point of therapeutic and prophylactic components identifiable in the dance, the authors regard the dance as deserving of greater attention than was hitherto the case in programs of physiotherapy, psychotherapy, and sociotherapy. From the existing essays at a therapy basing on body and motion, they infer basic common points, and to promote discussion, they state their attitudes in respect of the potential and rank of the dance in the concept of complex multimodal psychotherapy.     

Yin and Yang,and the Hot and the Cold

Yin and Yang are important concepts in ancient Chinese philosophy.Western scholars have become more familiar with these two concepts recently,but for a long time almost no one considered comparing them with their own tradition such as the ancient Greek philosophy,and especially with the ideas of the Hot and the Cold in Presocratic philosophy.In this paper,I make an attempt to do exactly that,and especially make a detailed comparison between the thoughts of two ancient thinkers:Laozi and Anaximander.I discuss the thought of Yin and Yang in Laozi-who was the earliest philosopher making use of the concepts Yin and Yang-to express his cosmological thought in ancient Chinese philosophy.Comparatively,I discuss the ideas of the Hot and the Cold in Anaximander,the earlier among Presocratic philosophers referring to the Hot and the Cold as fundamental concepts used to establish his cosmological system.Through this comparison,I indicate that the similarity between ancient Chinese and Western traditions is far more significant than what people are used to imagining.     

Perversion and infancy and adolescence

Abstract

Studying the works of Freud and Lacan, the authors carried out research on perversion in childhood. Their work covered the perverse polymorphism of infantile sexuality and the perception of the anatomic difference between the sexes that leads the child to create sexual theories and fantasies. The phallic mother and the fetish are viewed as imaginary solutions directly related to the Oedipus and castration complexes. In perversion, a particular position is taken in relation to the Oedipus complex: a serious flaw occurs in the symbolization of the law, and the mechanisms of denial and disavowal take form. Sexuality requires a second “logical time,” separated from infancy by the latency period, in order to confirm (in action) that a fixed position of jouissance (enjoyment) has actually been established. This can only happen in a period after adolescent enhancement. The distinction between perverse traces and a perverse structure is made, taking into account the fact that, in the case of child analysis, the analyst should free the child from the family fantasy and help him/her to build his/her own fantasy.

Campos Santoro V. et al. Perversion und Kindheit und Adoleszenz.

Im Studium der Arbeiten von Freud und Lacan haben die Autoren Forschung über Perversion in der Kindheit gemacht. Die Studien behandeln den perversen Polymorphismus der infantilen Sexualität und die Wahrnehmung des anatomischen Unterschiedes zwischen den Geschlechtern, welche das Kind dazu führt, Sexual-Theorien und Phatasien zu schaffen.

Die phallische Mutter und der Fetisch werden als imaginäre Lösungen angesehen, die sich direkt auf den Ödipus- und Kastrations-Komplex beziehen. Bei der Perversion wird eine besondere Position in Bezug auf den Ödipus angenommen; ein ernsthafter Mangel tritt bei der Symbolisierung des Rechts auf; die Mechanismen der Verneinung und der Verleugnung bilden sich. Sexualität erfordert eine zweite “logische Zeit”, von der Kindheit durch die Latenz Periode getrennt, um (in der Handlung) zu bestätigen, daß eine fixierte Position der jouissance (Vergnügung) sich tatsächlich etabliert hat. Das kann sich nur in einer Periode nach der adoleszenten Verstärkung ereignen.

Es wird die Unterscheidung zwischen perversen Spuren und einer perversen Struktur gemacht, in Rechnung stellend, daß im Fall der Kinder-Analyse der Analytiker das Kind von der Familien-Phantasie befreien sollte und ihm/ihr helfen sollte, seine/ihre Phantasie auszubilden.

Campos Santoro V. Perversión e infancia y adolescencia.

Estudiando los trabajos de Freud y Lacan, los autores han investigado la perversión en la niñez. Los estudios cubren la sexualidad infantil perversa polimorfa y la percepción de la diferencia anatómica entre los sexos, que llevan al niño a crear teorías sexuales y fantasías.

La madre fálica y el fetiche son vistos como soluciones imaginarias relacionadas directamente con el complejo de Edipo y de castración. La perversión, toma una posición particular en relación al Edipo; un fallo importante tiene lugar en la simbolización de la ley; los mecanismos de negación y repudio toman forma. La sexualidad requiere un segundo “tiempo lógico” separado de la infancia por el periodo de latencia, para confirmar (en acto) que una posición fija de jouissance (goce) se ha establecido. Esto solo puede ocurrir en un periodo posterior a la intensificación adolescente.

La distinción entre las huellas perversas y la estructura perversa se ha hecho, teniendo en cuenta que, en el caso del análisis de niños, el analista debe librar al niño de la fantasía familiar y ayudar a el/ella a construir su propia fantasía.     

神圣、凡俗与净明、忠孝

本文结合有关宗教学理论,对宋元净明道所推崇的"净明"、"忠孝"概念进行了解析.作者以为:宋元净明道视世俗性的道德实践为"神圣"的宗教修炼,实与宗教学中的凡俗可以"转换"为神圣之理论相合;而净明道徒的这种"转换",则多与其个体的"宗教体验"有关.至于元代净明道借"无极"概念来释"净明",以"净明"为回复宇宙根源之境界,则合于宗教人经验到与万物的根源、终极的本体或神圣的世界契合之感.换言之,宋元净明道的"净明"、"忠孝"说,实与各种宗教的本质有着相通之处.