浅谈外科手术在重度肥胖治疗中的作用

目前在重度肥胖治疗中存在着孤立地,片面地看待疾病,对主要矛盾注意不够的问题,且过度依赖内科治疗。而外科手术对病态肥胖有着良好的效果,是去除代谢综合征(MS)主要致病因素的有效手段。但由于人们观念陈旧,临床上很少有人接受手术治疗。因此转变人们的观念是提高重度肥胖治疗效果的关键和必需的一步。     

Impulsivity predicts treatment outcome in obese children

Treatment for obesity is still running short, particularly on the long term. However, some people do take advantage of treatments and are able to retain their weight loss. What makes the difference between those who can keep their weight loss and those who cannot? One possible predictor of relapse in obesity treatment is impulsivity. Overall, obese people are found to be more impulsive than lean people, especially obese binge eaters. Intuitively, it would make sense that the most impulsive people are less able to keep control over eating behaviour. Therefore, impulsivity could serve as an obstacle for treatment. In the present study impulsivity was measured with a behavioural task (the stop signal task) in 26 obese children. Overweight of the children was measured before and after treatment and at 6 and 12 months follow ups. The results show that impulsivity was related to overweight at all moments: The most impulsive children were the most overweight ones; even after 12 months. Moreover, impulsivity predicted therapy success: the most impulsive children lost less weight. Impulsivity appears to contribute to the difference between succeeding or failing in attempts to lose weight.     

Stigma, obesity, and the health of the nation's children

Preventing childhood obesity has become a top priority in efforts to improve our nation's public health. Although much research is needed to address this health crisis, it is important to approach childhood obesity with an understanding of the social stigma that obese youths face, which is pervasive and can have serious consequences for emotional and physical health. This report reviews existing research on weight stigma in children and adolescents, with attention to the nature and extent of weight bias toward obese youths and to the primary sources of stigma in their lives, including peers, educators, and parents. The authors also examine the literature on psychosocial and physical health consequences of childhood obesity to illustrate the role that weight stigma may play in mediating negative health outcomes. The authors then review stigma-reduction efforts that have been tested to improve attitudes toward obese children, and they highlight complex questions about the role of weight bias in childhood obesity prevention. With these literatures assembled, areas of research are outlined to guide efforts on weight stigma in youths, with an emphasis on the importance of studying the effect of weight stigma on physical health outcomes and identifying effective interventions to improve attitudes.     

Obstetric Autonomy and Informed Consent

I argue that public officials and health workers ought to respect and protect women’s rights to make risky choices during childbirth. Women’s rights to make treatment decisions ought to be respected even if their decisions expose their unborn children to unnecessary risks, and even if it is wrong to put unborn children at risk. I first defend a presumption of medical autonomy in the context of childbirth. I then draw on women’s birth stories to show that women’s medical autonomy is often ignored during labor. Medical interventions are performed during childbirth without women’s consent. Childbirth is risky and some coercive medical interventions may be understood as attempts to protect children and to prevent mothers from acting impermissibly. However, even if it is wrong to make risky choices during childbirth, women have rights to do wrong in these cases. Therefore, coercive medical interventions are impermissible during childbirth and institutions should adopt specific protections for obstetric autonomy.     

社会因素对剖宫产率的影响

近二三十年来,剖宫产率在世界范围内不断升高。究其原因,除了医学因素外,社会因素起着重要作用,从社会经济发展,社会科学文化水平、社会习俗观念、法律、医疗道德、国家计划生育政策、医学教育等多个角度分析了社会因素对剖宫产率的影响,并就如何发挥社会因素的积极作用,消除和避免其消极作用,使剖部率维持在合理的范围内进行了讨论。     

Individual and Family Contributions to Depressive Symptoms in African American Children with Sickle Cell Disease

Depressive disorders in children with chronic illnesses have received little attention despite some evidence suggesting that these children experience increased psychological difficulties as a result of their medical condition. Most of the research on depressive disorders among children has been conducted primarily with Caucasian youth, limiting generalizability to ethnically diverse populations. Further, even less research exists on depressive disorders among African American children with Sickle Cell Disease (SCD) and for African American youth from lower socioeconomic status who are at greater risk for depressive disorders. This paper is an extensive review of the major studies conducted on depression and psychosocial aspects of SCD in African American children. The Transactional Stress and Coping model is provided as a conceptual framework. Following the review, clinical and research implications are provided, as well as an illustration of a psychoeducational family intervention with an African American child who has SCD and internalizing behaviors.     

才思泉涌“举步”间：体育运动对创造性思维的影响

创造性思维是运用独特且新颖的观点解决问题的思维形式,发散与聚合思维是两种常见的类型。体育运动对发散与聚合思维具有不同的影响,且受到运动强度、方式、时长以及个体差异等因素的调节。目前解释体育运动如何影响创造性思维的理论有情绪假说、执行功能假说与身心隐喻理论。未来的研究需要在进一步重视研究规范性的基础上,加强神经科学研究并拓宽群体覆盖面,关注体育运动与创造性成就的关系,为开具创造性思维运动处方提供有力的科学支持。     

Problematic eating behaviors and nutritional status in 7 to 12 year-old Chilean children

Overweight and obesity are medical conditions that require a multidisciplinary analysis of their causes and treatment. In Chile a sustained increase in the presence of obesity and excess weight has been observed in children. However, the amount and the dynamics of the aforementioned problematic eating behaviours in Chilean children are unknown. The aim of this study was to assess the relationship between restrained, external, and emotional eating, and variations in body mass index (BMI) in Chilean children. Consequently, 453 children from 7 to 12 years of age responded to the Children's Dutch Eating Behaviour Questionnaire, Spanish version. In addition, their anthropometric data were obtained. A positive association was found between restrained eating and BMI, and a negative correlation between external eating and BMI. Emotional eating demonstrated a modest inverse relationship with BMI. A significant interaction between problematic behaviour and nutritional status (normal-weight, overweight, obese) was revealed. Restrained eating was characteristic of obese children whereas external eating of normal-weight children. These results suggest that problematic eating behaviours and their relationship with body weight are similar to those described in studies in Europe.     

The Harm Principle Cannot Replace the Best Interest Standard: Problems With Using the Harm Principle for Medical Decision Making for Children

For many years the prevailing paradigm for medical decision making for children has been the best interest standard. Recently, some authors have proposed that Mill’s “harm principle” should be used to mediate or to replace the best interest standard. This article critically examines the harm principle movement and identifies serious defects within the project of using Mill’s harm principle for medical decision making for children. While the harm principle proponents successfully highlight some difficulties in present-day use of the best interest standard, the use of the harm principle suffers substantial normative and conceptual problems. A medical decision-making framework for children is suggested, grounded in the four principles. It draws on the best interest standard, incorporates concepts of harm, and provides two questions that can act as guide and limit in medical decision making for children.     

LANGAGE ET PENSÉE

This paper is devoted to some issues which are to be first examined in order to approach the problem of the relations between language and thought in a positive way. The term “thought” arouses distrust in the psychologists who are attached to the scientific method, because it evokes philosophical presuppositions. However, when the problem is posed in terms of what does happen in the subject or what sort of cultural reality does correspond to a system of concepts, an objective analysis is possible and has been realized in some well-known works. Then, the author emphasizes the fact that any attempt at defiring the influence of language on the development of thought, for instance, demands that both terms should not be dealt with as global entities. Discussing the priority of thought over language, or vice versa, is greatly sterilized as long as these terms are treated so. For instance, intelligence does not necessarily correspond to the same abilities before language — or independently from it — as after language — or when intelligence is informed by it. All the same, language is not a whole: a subject who has low abilities in mere grammatical forms can nevertheless use language in an efficient way. Deaf children offer great opportunities for the study of the role of language in mental development, because, by studying them, one avoids wrong explanations based only on correlations which result from the studies in normal children. The collaboration between linguists and psychologists is discussed. The difficulties which psychologists sometimes meet with the works of linguists are outlined; the author eventually suggests some issues on which the cooperation of the linguist could particularly help the psychologist.     

AN INDEX FOR ASSESSING WEIGHT CHANGE IN CHILDREN: WEIGHT/HEIGHT RATIOS1

Weight and height data from two studies were recomputed, and original data were computed using a Weight Index formula that accounts for the interaction of actual weight/height changes in growing children and compares this ratio with that of normed weight/height ratios for equal-aged children. Recomputing the data of one study showed that the Weight Index is a more sensitive procedure for assessing long-term behavioral treatment of obesity for girls than weight alone. Recomputing the data of a second study showed that the Weight Index formula is consistent for boys and girls and is a more sensitive procedure for assessing long-term effects of a variety of medical treatments for obesity than the Ponderal Index or weight alone. Computation of the data for 17 “normal” children in a preschool class showed a zero Weight Index score before and after a six-month interval elapsed without treatment. The procedure may be useful in assessing ponderosity or anorexia over intervals of six months or more with growing children or difference between actual and normed weight over shorter intervals.     

Employment and health among married women with children

A sample of nearly 500 urban married women with children was used to evaluate the possible effect of outside-the-home employment on the mental and physical health of married mothers. Six measures of health were used, some drawn from interviews with the women, others from a medical examination. After controlling for ethnicity, education, and age of the women, the husband's occupation, number of children in the family, and length of time the woman has been married, it was found that wives who had been employed for more than a year were healthier than wives not employed outside the home and wives who had worked less than one year. Housewives who had never worked outside the home were healthier, on the whole, than wives who had been employed at some time in the past. Poor marital relationships and having no preschool age children seemed to increase the health advantage of long-term employed wives over those in the housewife categories. The occupational status of wife and husband did not seem to change these health differences very much.An earlier version of this paper was presented at the annual meeting of the Southwest Social Science Association, San Antonio, March 1975. The authors would like to thank Donna Duvall, Ministry of State for Urban Affairs, Ottawa; Elaine Hess, University of Nebraska at Omaha; and David R. Johnson, University of Nebraska — Lincoln for their comments. Gilles Robert and Marie Josepha Hebert ably assisted with various aspects of this project. Support for the project was provided by the Ministry of State for Urban Affairs, but the views expressed here are those of the authors and not necessarily those of the Ministry.     

Influence of Siblings on Child Health Behaviors and Obesity: A Systematic Review

Family structure plays an important role in childhood obesity but the association between having siblings and childhood obesity is not well established. The purpose of this systematic review was to examine the relationship between sibling factors and child health behaviors and child obesity. CINAHL, Cochrane Reviews, PsycINFO and PubMed were searched to identify relevant publications between 2000 and 2016. Of 141 identified studies, 22 peer-reviewed, primary research reports satisfied inclusion criteria and were included in the review. Findings indicated that children without siblings are more likely to be overweight or obese. Having fewer siblings was associated with decreased physical activity, inadequate sleep, and unhealthy dietary habits. The relationship between the number of siblings and childhood obesity persisted over time. All but two studies reported an association between birth order and childhood obesity. Youngest siblings were at a higher risk of becoming overweight or obese than their older siblings. Overall, the findings emphasize the importance of sibling factors in the development of childhood obesity. Further studies are needed to understand the dynamics underlying the effect of siblings on child’s health-related behaviors in order to develop effective childhood obesity prevention programs. Healthcare professionals should focus on family structure and at-risk children when intervening to prevent childhood obesity.     

执行功能与儿童流行性肥胖的关系

流行性肥胖被认为是由于能量摄入和能量消耗间长期的不平衡导致的一种反常的、脂肪堆积过多的状态, 近期研究发现执行功能与儿童流行性肥胖关系密切。与正常体重儿童相比, 肥胖儿童执行功能差主要体现在抑制控制上, 他们难以抑制对食物线索的注意, 并且更容易对其做出冲动反应, 表明他们干扰抑制中的注意抑制以及反应抑制存在不足。脑机制研究发现, 前额皮质(PFC)与肥胖关系密切, 肥胖被试对食物线索表现出较低的眼窝前额皮质(OFC)激活水平与较高的背外侧前额皮质(DLPFC)激活水平; 奖励回路也与肥胖密切相关, 肥胖或许是由PFC与奖励回路间复杂的相互作用引起的。执行功能与流行性肥胖之间可能是双向作用关系, 执行功能差可能是个体BMI增加的潜在因素, 而肥胖个体的体重减少在一定程度上则有助于其执行功能改善。少量对儿童肥胖的干预研究表明执行功能训练或许在减肥效果保持上有一定优势, 未来研究应当关注对执行功能, 尤其是抑制控制进行有效训练的方法, 并将其与其他干预方式结合, 更好地解决儿童流行性肥胖问题。     

Science on the periphery: Can it contribute to mainstream science?

Science is a global phenomenon that knows no frontiers. But in the real world, production and efficient utilization of scientific knowledge are highly concentrated in a few countries. A large majority of countries—those on the periphery, contribute precious little to the growth of scientific knowledge. Indeed, the distribution of science is even more skewed than is the distribution of wealth among nations. As a result, peripheral countries are left out of the intellectual discourse that is at the very foundation of the knowledge enterprise. The extent of this skewness and the relative neglect of the perihpery can be seen in some quantitative form from publication and citation data. However, while it may be true that mainstream science has not greatly benefitted from the efforts of the periphery, scientifically advanced societies are certainly benefitting from the traditional medical and agricultural knowledge base of the peripheral societies. Countless numbers of plants used in the traditional medical systems of India, China, Africa and Latin America are being drafted into the western system of medicine. A number of multinationals are learning from folk medicine and are gathering tons of plant material from these regions for the manufacture of modern medicine. Ironically, very little transfer of knowledge from ancient to modern systems takes place in the pheripheral countries themselves. Even when it does occur, it does not result in the manufacture and marketing of products for profit. This is a revised version of a paper presented at the ORSTOM-UNESCO conference on 20th Century Science—Beyond the Metropolis; September, 1994, Paris.     

The effects of exergaming on physical activity among inactive children in a physical education classroom

Childhood obesity, which is due in part to lack of physical activity, is a serious concern that requires the attention of the behavioral community. Although excessive video game play has been noted in the literature as a contributor to childhood obesity, newer video gaming technology, called exergaming, has been designed to capitalize on the reinforcing effects of video games to increase physical activity in children. This study evaluated the effects of exergaming on physical activity among 4 inactive children in a physical education (PE) classroom. Results showed that exergaming produced substantially more minutes of physical activity and more minutes of opportunity to engage in physical activity than did the standard PE program. In addition, exergaming was socially acceptable to both the students and the PE teacher. Exergaming appears to hold promise as a method for increasing physical activity among inactive children and might be a possible intervention for childhood obesity.     

Intervention,integration and translation in obesity research: Genetic,developmental and metaorganismal approaches

Obesity is the focus of multiple lines of inquiry that have -- together and separately -- produced many deep insights into the physiology of weight gain and maintenance. We examine three such streams of research and show how they are oriented to obesity intervention through multilevel integrated approaches. The first research programme is concerned with the genetics and biochemistry of fat production, and it links metabolism, physiology, endocrinology and neurochemistry. The second account of obesity is developmental and draws together epigenetic and environmental explanations that can be embedded in an evolutionary framework. The third line of research focuses on the role of gut microbes in the production of obesity, and how microbial activities interact with host genetics, development and metabolism. These interwoven explanatory strategies are driven by an orientation to intervention, both for experimental and therapeutic outcomes. We connect the integrative and intervention-oriented aspects of obesity research through a discussion of translation, broadening the concept to capture the dynamic, iterative processes of scientific practice and therapy development. This system-oriented analysis of obesity research expands the philosophical scrutiny of contemporary developments in the biosciences and biomedicine, and has the potential to enrich philosophy of science and medicine.     

Emotional eating as a mediator between anxiety and cholesterol in population with overweight and hypertension

Although the relationship between cholesterol and mood states (especially anxiety) has been well studied, few researches have included the role of eating styles in this relationship. This study explored the associations among eating styles, negative emotional symptoms, and levels of cholesterol (and other medical variables) in a population with hypertension and overweight or obesity, analyzing the possible mediation mechanisms involved. A cross-sectional study was conducted in 68 adults with hypertension and overweight/obesity, and stepwise multiple regression analysis and mediation analyses were carried out to test the hypothesis that eating styles mediate the relationship between negative emotional symptoms and cholesterol. Several significant correlations among age, anthropometric, medical, and psychological variables (eating styles and negative emotional symptoms) were found. There was a significant indirect effect of anxiety on total cholesterol and LDL cholesterol through emotional eating. Results suggest that emotional eating has a relevant role in the rise in total and LDL cholesterol, acting as a mediator in the relationship between anxiety and cholesterol. This finding could have important implications, since it introduces a new variable in the relationship between emotions and cholesterol and, therefore, changes the way of understanding this relationship, and of treating high cholesterol in a hypertensive sample.     

Cyberbullying: An overrated phenomenon?

The paper argues that several claims about cyberbullying made in the media and elsewhere are greatly exaggerated and have little empirical scientific support. Contradicting these claims, it turns out that cyberbullying, when studied in proper context, is a low-prevalence phenomenon, which has not increased over time and has not created many “new” victims and bullies, that is, children and youth who are not also involved in some form of traditional bullying. These conclusions are based on two quite large samples of students, one from the USA and one from Norway, both of which have time series data for periods of four or five years. It is further argued that the issue of possible negative effects of cyberbullying has not received much serious research attention and a couple of strategies for such research are suggested together with some methodological recommendations. Finally, it is generally recommended that schools direct most of their anti-bullying efforts to counteracting traditional bullying, combined with an important system-level strategy that is likely to reduce the already low prevalence of cyberbullying.     

‘Heart-talk:’ Considering the Role of the Heart in Therapy as Evidenced in the Quran and Medical Research

The emphasis on scientific approaches and evidence-based therapy has been a key force in developing and refining existing models of therapy. While this has been unquestioningly invaluable, it has similarly restricted the development and so implementation of those models that do not lend themselves easily to current research methodology, since the lack of evidence-practice research means they are not considered as ‘legitimate’ therapeutic practice. That the mind and body have an inter-dependent relationship is readily evidenced in numerous religious texts, but the lack of acknowledgement of that relationship in contemporary therapeutic approaches means that patients are not able to benefit from its use in sessions. Ironically, it is current developments in medical research that have discovered the reality around this relationship that have enabled such models to be further explore within an accepted context of evidence-based practice. This paper highlights the relationship between the heart and brain function as evidenced with brief reference to Quranic verses and medical (namely, neurocardiological) research. Further, it raises questions around the implications of this information for therapists working in both physical and mental health. The concept of ‘heart talk’ is an extension of the term ‘heart brain’ coined by Dr Armour (Professor of Pharmacology) in 1991 and is suggestive of its use in the world of psychological therapy. It relates to those cognitions which patients suggest come ‘from the heart’ which though previously dismissed are now suggestive of having some scientific basis and are potentially a legitimate source of information in understanding patients experiences.