从高血压的新定义分析难治性高血压

ASH公布了高血压新的定义,其中高血压的过度反应需与真性难治性高血压鉴别,从三个层面分析难治性高血压.     

Psychological Dysfunction in Southeast Asian Refugees as Mediated by Sense of Coherence

Investigated Antonovky's (1979, 1987) construct of sense of coherence (i.e., an individual's belief that the world was comprehensible, manageable, and meaningful) as the internal psychological mechanism mediating the effects of external stressors (generalized resistance deficits) and resources on psychological dysfunction (measured by depression, anxiety, and psychosocial dysfunction) in 2,234 Vietnamese, Cambodian, Laotian, Hmong, and Chinese-Vietnamese refugees. Generalized resistance and deficits significantly predicted sense of coherence as well as psychological dysfunction. The amount of variance accounted for increased significantly when the mediating effect of sense of coherence was tested using a path analysis. Sense of coherence significantly reduced the predictive power of generalized resistance and deficits in the psychological dysfunction models. Results support the hypothesized mediating role of sense of coherence. Thus, interventions aiming to enhance Southeast Asian refugees' functioning may gain in effectiveness by targeting and promoting their sense of coherence.     

Making Sense of Abuse: Case Studies in Sibling Incest

This case study focused on the process of making sense of abuse in two Latino families experiencing sibling incest. Participants included five male children ranging in age from 8 to 15 that were members of two families dealing with the issue of sibling incest. The purpose of this study was to build understanding of how families experience sibling incest and its role in their families. Clinical data from therapy sessions was analyzed to reveal that families made sense of the incest in different ways including abuse as normal and abuse as a mistake. Central concepts that explained how the families responded to the sibling incest included (1) level of family cohesion, (2) role of secrecy, and (3) view of outside systems. The findings suggest that treatment needs to include an in-depth assessment regarding these issues.     

Toward an intersectional understanding of violence and resilience: An exploratory study of young Southeast Asian men in Alameda and Contra Costa County, California

There is a nascent, but growing, literature on Southeast Asian youth violence that focuses on the role of acculturation, portraying violence as a problem of maladaptation. However, scholars overlook the ways in which violence holds meaning for the youth who experience it and how violence may be related to racial and gender identity formation. We conducted a qualitative study with young Southeast Asian men to elicit the role violence plays in their understanding of what it means for them to be Southeast Asian and male. We conducted focus groups and semi-structured individual interviews with an ethnically diverse group of 21 young Southeast Asian men 13–17 years of age from Alameda and Contra Costa Counties, California. Data were analyzed using the extended case method approach. Our findings illustrate that violence and engagement with community-based organizations are situational tools that these young Southeast Asian men use to navigate their social contexts in an attempt to be resilient in ecological contexts marked by alienation and discrimination, as well as to construct accepted and successful racial and gender identities. Furthermore, we found that their actions were guided by gendered codes of conduct, such as a “code of the street.”     

Enrichment in Pre-Kindergarten Life Predicts Initiation of Cigarette Smoking in Asian American and Hispanic/Latino Adolescents

The risk of tobacco use during adolescence may be traced back to early childhood, the time when a child is most vulnerable to environmental influence. We examined daily-life enrichment during pre-kindergarten period as a predictor of initiation of cigarette smoking among Asian American and Hispanic/Latino children during adolescence. Survey data were collected from students in grades seven to nine in California. Among the 2,719 participants who completed the survey, 37% were Asian American and 44% were Hispanic/Latino. Five aspects of childhood life before kindergarten were assessed, including having lots of toys for the child, parents' read to the child often, having a plenty of good food for the child, bringing the child to travel, and parents spending adequate time with the child. Findings from our research indicate that children with more enriched early childhood are less likely to start smoking during adolescence. Consequently, enhancing daily life during early childhood may represent a new strategy for adolescent smoking prevention.     

Parent Satisfaction with Case Managed Systems of Care for Children and Youth with Severe Emotional Disturbance

Case management has emerged as an integral component of current efforts to reform the delivery of mental health services to children and youth with Severe Emotional Disturbance (SED). We examined parental satisfaction with one program's case management system for SED children. In order to validly address parental satisfaction, the program first turned to a group of its parents to develop a satisfaction measure, the Family Satisfaction Survey (FSS). Of the 51 parents who returned an FSS, 74% of the parents were generally satisfied while 26% indicated that they were dissatisfied with their families' case management services. Multivariate regression analyses were employed to examine the role played by client, service, and outcome variables in predicting parental satisfaction. After controlling for child diagnoses, severity of impairment, and levels of psychosocial stress, parent satisfaction with case management services was best predicted by the frequency of monthly contact and fewer days is a psychiatric hospital proportional to length of service. Our results suggest that parent satisfaction is based not only on what case managers do but on how this service impacts SED children's ability to remain at home and in their communities.     

The Cultural Adaptation of the Youth Quality of Life Instrument-Research Version for Latino Children and Adolescents

We reviewed the Spanish translation of the Youth Quality of Life Instrument-Research Version (YQOL-R) and culturally adapted the measure with Puerto Rican and Mexican American children and adolescents. The YQOL-R is a self-reported measure that includes four domains: Sense of Self, Social Relationships, Environment, and General Quality of Life. A total of 10 focus groups were conducted with children aged 9 to 11, adolescents aged 12 to 17, their parents, and mental health providers. Five focus groups were conducted in San Diego, California and five in San Juan, Puerto Rico. Eligible participants were recruited from children’s outpatient psychiatry clinics. We followed an iterative and recursive process in reviewing changes and modifications to the instrument using a bilingual committee and a Multi National Bilingual Committee. Greater semantic, content, and technical equivalence of the Spanish and English versions for the YQOL-R was achieved for the two largest U.S. Latino subgroups: Mexican Americans and Puerto Ricans. The cultural adaptation process revealed several important issues regarding the measurement of quality of life in different age groups. Additional items for school, relationships (both family and friends) and spare time suggested the need for a future children’s version of the instrument. For the adolescents, additional items were suggested in the areas of sexuality, intergenerational conflict and acculturative stress.     

Adaptive Coping Reduces the Impact of Community Violence Exposure on Violent Behavior among African American and Latino Male Adolescents

This study examined whether coping moderated the impact of community violence exposure (CVE) on violent behavior among 285 urban African American and Latino adolescent males assessed annually across 5 years. Composites indicating overall CVE (having knowledge of others’ victimization, witnessing violence, direct victimization) and approach to coping with CVE were created by averaging across years 1–3 (Time 1; mean ages 14–16). Adolescents classified as coping effectively tended to respond to CVE in beneficial ways (e.g., developing long-term solutions, engaging in positive reappraisal). Violent behavior was examined across years 1–3 (Time 1) and years 4–5 (Time 2; mean ages 18–19). CVE was longitudinally associated with greater violent behavior, adjusting for Time 1 levels of violent behavior. This association was significant only among adolescents with less effective coping strategies. Interventions targeting the enhancement of coping skills may be an effective method of reducing the impact of CVE on adolescent violent behavior. Sonya S. Brady is now an Assistant Professor in the Division of Epidemiology and Community Health, School of Public Health at the University of Minnesota (1300 South Second Street, Suite 300, Minneapolis, MN 55454-1015, USA; Tel.: +1-612-6241818; Fax: +1-612-6240315.     

ADHD Correlates, Comorbidity, and Impairment in Community and Treated Samples of Children and Adolescents

Patterns of correlates, comorbidity and impairment associated with attention-deficit hyperactivity disorder (ADHD) in children and youth were examined in representative samples from the community and from treatment facilities serving medically indigent youth in Puerto Rico. Information from caretakers and youths was obtained using the Diagnostic Interview Schedule for Children, (version IV), measures of global impairment, and a battery of potential correlates. In the community (N = 1,896) and the treated samples (N = 763), 7.5 and 26.2% of the children, respectively, met criteria for DSM-IV ADHD in the previous year. Although the prevalence rates and degree of impairment differed, the general patterns of correlates, comorbidity and impairment were similar in both populations. The exceptions were associated with conduct disorder, anxiety, impairment in the ADHD comorbid group, and age factors that appeared to be related to selection into treatment.     

脓毒症研究进展及启示

脓毒症(sepsis)是是当前外科ICU所面临的棘手难题.对感染和脓毒症的研究已成为外科学十分活跃的领域之一,所取得的进展已使人们从本质上更深刻、更准确地了解感染与脓毒症,从而为解决这一棘手问题开辟新的途径.脓毒症的研究揭示了人类科学发现和科学认识的普遍规律.     

美国社区卫生服务运行机制和管理模式研究

美国的卫生服务系统由社区卫生服务和医院服务两大部分组成。通过从组织形式、筹资机制、人力资源、动力与约束机制以及管理几个方面,对美国社区卫生服务的运行机制与管理模式进行分析,以期对我国社区卫生的发展有所借鉴与帮助。     

社区卫生服务——体现效率与公正特征的改革之路

社区卫生服务比较全面地体现了公正与效率的原则,是卫生改革的一项重大举措。它公正有效地突破了固有的卫生体制;公正有效地实现了“人人享有初级卫生保健”的目的;公正有效地推进了医学模式的转移;公正有效地抓住了纠风的症结;公正有效地解决了医疗费居高不下的顽症。     

Case Studies and Genetic Records of Two Gifted Negroes

The purpose of the present study was to test fifth graders' (N = 210) reaction to pressure under peer, adult, and control conditions. Four measures of moral judgment were taken: resistance to temptation, severity of punishment, tendency to confess, and level of guilt feelings. The results show that in the peer-pressure condition, Israeli children tended to give less socially approved responses and to associate more severe punishment and guilt feelings with transgression than in either adult-pressure or control situtations. This was found to apply almost equally for boys and girls. The results are discussed in the context of moral socialization in the Israeli society.     

Survey of School Psychologists' Attitudes,Feelings, and Exposure to Gay and Lesbian Parents and Their Children

Abstract

School psychologists' attitudes and feelings toward gay and lesbian parents were surveyed in relation to their training and exposure, and professional services offered to gay and lesbian parents and their children. The relationship between attitudes, feelings, training, exposure, and demographic characteristics was explored as well. A stratified random sample of 500 school psychologists who were members of NASP was surveyed using a 30-item questionnaire. Out of the 500 surveys sent, 267 school psychologists (53.4%) returned them. Overall, school psychologists have positive attitudes and feelings toward gay and/or lesbian parents. More specifically, school psychologists who were female, homosexual/bisexual, or living in the Western region of the United States had significantly more positive attitudes and feelings toward gay and/or lesbian parents. Although few school psychologists (30%) received any formalized training, those who had some training indicated more positive attitudes. The majority of school psychologists (89.4%) reported having personal associations with homosexual individuals. More exposure to homosexual individuals by a school psychologist indicated more positive attitudes as well as feelings. Implications of the findings and future research directions are discussed.     

Psychiatric Hospitalization and School and Community Adjustment of Children and Adolescents with Acquired Brain Injury

There is a high prevalence of psychiatric disorders in children and adolescents who have acquired brain injury (ABI). We examined the records of 82 students with ABI who were admitted to a community-based school for education and neurorehabilitation over a three-year period to determine how many experienced one or more psychiatric hospitalizations before admission, and whether hospitalization status was related to positive school and community adjustment. Results were that 30.4% of the students had a documented history of one or more psychiatric hospitalizations. Of this group, 60.0% were able to be maintained in the community-based school program and 40.0% were discharged to other settings. When discharged, 70.0% of students entered more restrictive treatment programs (e.g., psychiatric hospital, secure residential facility, residential school). The number of psychiatric hospitalizations did not predict discharge from the community-based school and was unrelated to the type of discharge setting. Clinical and research issues concerning psychiatric disorders in children and adolescents with ABI in relation to post-acute adjustment are discussed.