终末期肾病患者替代治疗方法的临床决策

血液透析、腹膜透析和肾移植是终末期肾病患者替代治疗的主要方法,三种治疗方法各有优缺点。临床上应根据患者原发病因、替代治疗并发症、卫生经济学、生存质量、所在地医疗条件、非医疗因素等作出科学临床决策,最大限度延长患者生命,提高生存质量。     

终末期肾病患者替代治疗方法的临床决策

血液透析、腹膜透析和肾移植是终末期肾病患者替代治疗的主要方法,三种治疗方法各有优缺点.临床上应根据患者原发病因、替代治疗并发症、卫生经济学、生存质量、所在地医疗条件、非医疗因素等作出科学临床决策,最大限度延长患者生命,提高生存质量.     

重视终末期肾病患者的心理治疗

心理治疗在终末期肾病(ESRD)治疗中的作用非常重要,不但可缓解患者的心理压力,还可改善患者的生理障碍、减少并发症,因此重视对ESRD患者的心理治疗,可使患者保持良好的生理、心理状态,并能提高患者的生活质量,改善预后。     

重视终末期肾病患者的心理治疗

心理治疗在终末期肾病(ESRD)治疗中的作用非常重要,不但可缓解患者的心理压力,还可改善患者的生理障碍、减少并发症,因此重视对ESRD患者的心理治疗,可使患者保持良好的生理、心理状态,并能提高患者的生活质量,改善预后.     

The Psychometric Equivalence of the Personal Wellbeing Index School-Children for Indigenous and Non-Indigenous Australian Adolescents

Despite increasing research interest in the subjective wellbeing (SWB) of Indigenous Australians, SWB measures used in these studies have not been validated for use in this population. Until the measurement equivalence of scales used in this population are demonstrated, inferences regarding potential differences in SWB across Indigenous and non-Indigenous groups cannot be validly inferred. To rectify this, the present study examines the psychometric equivalence of the Personal Wellbeing Index—School Children (PWI-SC) for use among samples of Indigenous and non-Indigenous Australian adolescents using multiple-group confirmatory factor analysis. The Indigenous sample comprised 1,378 adolescents enrolled in the Australian Federal Government’s Youth Connections Program. A sample of 6,401 non-Indigenous adolescents also enrolled in the Youth Connections Program represented a second comparative group. Finally, the third comparative group comprised a convenience sample of 983 Victorian high-school students. The results demonstrated strict factorial invariance between all three adolescent groups, suggesting that the PWI-SC measures the same underlying construct in each sample. These findings support quantitative comparisons between Indigenous and non-Indigenous SWB data as valid. The implications of this research are discussed.     

The Psychometric Equivalence of the Personal Wellbeing Index for Normally Functioning and Homeostatically Defeated Australian Adults

Understanding subjective wellbeing (SWB) at the population level has major implications for governments and policy makers concerned with enhancing the life quality of citizens. The Personal Wellbeing Index (PWI) is a measure of SWB with theoretical and empirical credentials. Homeostasis theory offers an explanation for the nature of SWB data, including the distribution of scores, maintenance and change over time. According to this theory, under normal conditions, the dominant constituent of SWB is Homeostatically Protected Mood (HPMood), which is held within a genetically determined range of values around a set-point. However, in extreme circumstances (e.g., financial hardship, chronic illness), HPMood may dissociate from SWB, as cognitive/emotional reactions to the cause of homeostatic challenge assume control over SWB. This study investigates two groups as people scoring in the positive range for SWB and people who are likely to be experiencing homeostatic defeat/challenge. We test whether the reduced influence of HPMood on SWB due to homeostatic defeat has implications for the validity of SWB measurement. Participants were 45,192 adults (52 % female), with a mean age of 48.88 years (SD = 17.35 years), who participated in the first 23 surveys of the Australian Unity Wellbeing Index over the years 2001–2010. Multiple regression analysis, multiple group confirmatory factor analysis, and Rasch modelling techniques were used to evaluate the psychometric performance of the PWI across the two groups. Results show that while the PWI functioned as intended for the normal group, SWB in the challenged group was lower across all PWI domains, more variable, and the domain scores lacked the strength of inter-correlation observed in the normal, comparison group. These changes are consistent with predictions based on homeostasis theory and one major implication of the findings is that SWB measures may not function equivalently across the entire spectrum of possible domain satisfaction scores.     

The Development and Validation of a Family Wellbeing Index for Hong Kong Chinese Families

Journal of Child and Family Studies - Family wellbeing is studied worldwide. However, there is a dearth of studies on the wellbeing of families in Chinese societies such as Hong Kong, nor is there...     

Motivational Interviewing Promotes Adherence and Improves Wellbeing in Pre-Dialysis Patients with Advanced Chronic Kidney Disease

Low rates of adherence to medical treatments and adverse emotional states are a widespread problem in advanced chronic kidney disease (ACKD). Motivational interviewing using the stages of change model is an effective combination in promoting behavior modifications. The objective of the present study was to determine the effectiveness of an individual, pre-dialysis intervention program (monthly sessions of 90 min over a 6-month period) in terms of adherence, emotional state and health-related quality of life (HRQL). Forty-two patients were evaluated for adherence, depression, anxiety and HRQL with standardized self-report questionnaires. Biochemical markers were also registered. The results show that after the intervention, patients reported significantly higher levels of adherence, lower depression and anxiety levels, and better HRQL (i.e., general health and emotional role domains). Biochemical parameters were controlled significantly better after the intervention, except for iPTH. These findings highlight the potential benefit of applying individual psycho-educational intervention programs based on motivational interviewing and using the stages of change model to promote adherence and wellbeing in ACKD patients.     

农村与城镇终末期肾病患者临床状况比较分析

时比分析农村与城镇终末期肾病患者的临床状况,旨在了解新农合政策带给农村终末期肾病患者的益处及今后还需完善和努力之处.对广西壮族自治区人民医院血液净化治疗中心2007年新增的238例终末期肾病患者按农村与城镇进行分组对比分析.96例农村患者,88例选择血液透析,8例放弃治疗;142例城镇患者,23例选择腹膜透析,108例血液透析,11例放弃.无论是城镇还是农村患者慢性肾炎为主要的原发病、都存在透析过晚、并发症发生率高、急诊透析率高的现象.与城镇组相比,农村组患者平均年龄、肾痛知晓率、残余肾功能、血红蛋白、二氧化碳结合力、尿素清除指数低于城镇组(P<0.05);梗阻性肾病发病率、并发症发生率、急诊透析率、死亡率、失访率高于城镇组(P<0.05).新农合的实施使农村终末期肾病患者获得了治疗的机会,针对农村患者肾病知晓率低、临床状况差的特点,需加强农村慢性肾病的防治工作.     

Perceptions of Adequate Personal Time and Wellbeing among African American Families with Adolescents

The current study examines the perception of adequate personal or leisure time, and its association with family and caregiver functioning, among a sample of low-income African American families. The investigation is grounded in Conservation of Resources (COR) theory which predicts that caregivers who perceive more adequate personal time will also report higher levels of optimism and lower levels of depressive symptoms, and will have adolescents who report more household routines and less psychologically controlling parenting. A total of 115 caregiver-adolescent (age 14–18) dyads were recruited from a low-income, predominantly African American neighborhood in a major metropolitan center in the United States as part of a larger survey on African American family life. Results indicate that caregivers report perceiving inadequate amounts of time to sleep, get enough exercise, and relax. Caregivers also report comparatively less adequate personal time than time with children. Analyses reveal that caregivers who perceive having more adequate leisure or personal time, report fewer depressive symptoms and higher levels of optimism, after controlling for perceptions of adequate financial resources. Alternatively, there was no association between perceptions of free or leisure time and parenting behaviors, including maintenance of household routines and the use of psychological control. The results underscore the need to examine non-material resources, and their association with wellbeing.     

The Anomalous Wellbeing of Disabled People: A Response

Disabled people frequently find themselves in situations where their quality of life and wellbeing is being measured or judged by others, whether in decisions about health care provision or assessments for social supports. Recent debates about wellbeing and how it might be assessed (through subjective and/or objective measures) have prompted a renewed focus on disabled people’s wellbeing because of its seemingly ‘anomalous’ nature; that is, whilst to external (objective) observers the wellbeing of disabled people appears poor, based on subjective assessments, people with disabilities report a good quality of life. In this paper, I examine an article by the philosopher Dan Moller in which he seeks to explain this ‘disability paradox’. Despite agreeing with his analysis that there is more to what people value than happiness, his explanation reflects some of the difficulties presented in philosophical accounts which seek to understand the lives of disabled people: this includes an analysis which fails to problematise definitions of wellbeing and who has the ‘voice’ to do the defining; which negates the multiple identities and subject positions that disabled people occupy; and which lacks recognition of the social contexts which mediate disabled people’s lives. I suggest that there is a need to incorporate disabled people’s voices into research which deepens our empirical knowledge about the relationship between impairment and wellbeing, including the social circumstances that shape disabled people’s agency.     

α-骨化醇对CKD4-5期未透析患者蛋白尿的影响

为了观察α-骨化醇对CKD4-5期未透析患者蛋白尿的影响,对2010年5月～2012年5月在我院就诊的87例CKD4-5期未透析、未肾移植患者进行研究,将其服用α-骨化醇组(S-Alf)和未服用α-骨化醇组(N-Alf),回顾分析α-骨化醇对24小时尿蛋白的影响.结果显示:与治疗前相比,接受α-骨化醇治疗6月后,患者24小时尿蛋白定量减少了13％(P＜0.05),全段甲状旁腺激素(iPTH)下降了11％ (P＜0.05).因此,α-骨化醇能够减少CKD4-5期未透析患者蛋白尿,发挥保护肾脏的作用.     

Validation of the 2012 European Social Survey Measurement of Wellbeing in Seventeen European Countries

The measurement of wellbeing provides an important indicator of the welfare of nations and presents opportunities for policy making. Researchers generally share the view of wellbeing as a multidimensional concept. The 2012 European Social Survey (ESS) measurement of personal and social wellbeing, a combination of theoretical models and evidence from statistical analysis, is defined as a six-dimensional construct: evaluative wellbeing, emotional wellbeing, functioning, vitality, community wellbeing and supportive relationships. In this paper, the proposed theoretical structure is investigated and the psychometric properties of the measure are assessed for 17 European countries. This involved splitting each country’s sample randomly into halves and performing Exploratory Factor Analysis (EFA) on the first half-samples. EFA resulted in a four-factor solution for Germany, Netherlands, Portugal, Slovenia, Spain, Switzerland and the UK, a five-factor solution for Belgium, Finland, France, Ireland, Norway, Poland, Russian Federation and Sweden, and a six-factor solution for Denmark and Hungary. These results were supported by Confirmatory Factor Analysis (CFA) performed on the second half-samples. Subscales were constructed based on analysis of the total samples, applying a simple transformation in order to deal with the different number of response categories used for the wellbeing items. Reliabilities and internal consistencies were investigated. Although the definition of each subscale differs from the proposed structure and across countries, the analysis did produce reliable and valid summary measures (subscales) of wellbeing for informing social policy in each country.

     

慢性肾脏病治疗的临床决策

慢性肾脏病(CKD)的治疗以前主要集中在终末期肾病(ESRD),但ESRD仅仅是CKD患者群体中的一小部分,因此CKD患者应根据不同阶段采取不同的治疗:早期治疗强调预防为主,中期治疗在于延缓肾病进展,晚期治疗应选择一体化肾替代治疗.慢性肾脏病需肾科医师与患者及家属共同参与,以期达到最佳的治疗目标.     

Temperament and Personal Wellbeing in a Sample of 12 to 16 Year-Old Adolescents

Working on the basis that temperament – understood as the root from which personality traits emerge – is related to subjective wellbeing, a study was conducted on a sample of 1.483 students in compulsory secondary education aged between 12 and 16, half of whom attended schools in a rural or semiurban area and half in an urban setting. The aims of the study were as follows: a) to determine the level of personal wellbeing in a sample of 12 to 16 year-old adolescents measured using scores obtained from the Personal Wellbeing Index (PWI), and b) to analyse the relationship between temperament, measured using the Early Adolescent Temperament Questionnaire (EATQ-R), and personal wellbeing. Results indicate, among other things, that those temperament dimensions which best predict a high level of personal wellbeing are activity level, affiliation, shyness (with a negative weight), inhibitory control and activation control.     

Cross-Cultural Validation of the Rorschach Developmental Index

The Developmental Index (DI) has recently been introduced as a composite Rorschach measure of psychological development and maturation, which can be used both with the Comprehensive System (Exner, 2003), and with the recently developed Rorschach Performance Assessment System (Meyer, Viglione, Mihura, Erard, & Erdberg, 2011). As the DI is new, and its validity has not yet been investigated with independent non-U.S. samples, we tested the correlation between DI and age using 3 relatively large samples, 2 of which were from outside the United States (total N = 902). Other Rorschach variables presumably associated with maturation, such as complexity and productivity, were also investigated. As expected, the DI significantly correlated with age, with small variations across the 3 samples. Importantly, the correlation between DI and age remained statistically significant also after controlling for productivity (i.e., the number of responses) and complexity.     

Development and Validation of the Navy Climate Index

Because military work environments have unique contexts, characteristics, and challenges, military policymakers need to understand how personnel perceive the work environment and how this affects individual and organizational outcomes. This study describes the development and testing of the Navy Climate Index (NCI), a new measure comprising items from the Navy-wide Personnel Survey (NPS) that captures eight aspects of psychological climate: advancement/promotion, autonomy/challenge, leadership, communication, fairness, job security, Tempo, and work group. Using NPS data for 3,610 active duty personnel, confirmatory factor analyses support the validity of the NCI. NCI scores were positively associated with job satisfaction, morale, organizational commitment, and retention intentions.     

Situational Determinants of Personal Validation of General Personality Interpretations

Groups of Ss were matched with respect to their pre-experimental opinions regarding the value of psychological tests used by trained professionals to describe personality. Ss were then given either the Rorschach, TAT, FIRO-B, or Marlowe-Crowne Social Desirability Scale and were later given identical general personality interpretations supposedly based on the test results. An analysis of variance of Ss ratings of the accuracy of the personality interpretation indicated that neither the type of test S took nor whether the personality interpretation was presented as being derived “for you specifically” or “for people in general” had differential effects on Ss' acceptance of the interpretation; all groups rated the interpretation as being between “good” and “excellent.”