浙江省新型农村合作医疗制度的实践与思考

浙江省农村合作医疗始于20世纪60年代,发展道路曲折,但对解决农民看病问题发挥过巨大的作用.浙江省新型农村合作医疗试点工作于2003年8月启动,新型农村合作医疗具有政府支持力度大、筹资机制较完善、突出大病统筹等与传统合作医疗不同的新特点.但也应该看到,新型农村合作医疗是一项复杂的社会系统工程,实践中会面临许多困难和问题.在建立此项制度的过程中,应加强宣传教育,转变观念,建立相关的法规和制度,完善筹资机制,配套抓好城乡医药卫生体制改革,以保证合作医疗制度的健康发展.     

Understanding and using the implicit association test: I. An improved scoring algorithm

In reporting Implicit Association Test (IAT) results, researchers have most often used scoring conventions described in the first publication of the IAT (A.G. Greenwald, D.E. McGhee, & J.L.K. Schwartz, 1998). Demonstration IATs available on the Internet have produced large data sets that were used in the current article to evaluate alternative scoring procedures. Candidate new algorithms were examined in terms of their (a) correlations with parallel self-report measures, (b) resistance to an artifact associated with speed of responding, (c) internal consistency, (d) sensitivity to known influences on IAT measures, and (e) resistance to known procedural influences. The best-performing measure incorporates data from the IAT's practice trials, uses a metric that is calibrated by each respondent's latency variability, and includes a latency penalty for errors. This new algorithm strongly outperforms the earlier (conventional) procedure.     

The labours of Hercules: some good reasons why social workers should not try to be different, and practice family therapy

Family therapy, despite being an approach to problems in a social context, has, for the most part, been developed and refined in medical settings (Adams, 1979). Family therapy propounds a methodology based on social rather than medical techniques of intervention. It is logical to suggest that workers based in socially-orientated agencies, rather than medical settings, could be predicted to be better placed to utilize and develop this particular approach to human problems. How can it be explained that the main bulk of the innovations are still coming from practitioners who have trained primarily in medical approaches and settings? This article looks at some of the reasons why family therapy practice and development is not flourishing in Social Services Departments as it is in, for example, hospitals and clinics. The authors do not offer any positive conclusions at this stage, but will show, in a later publication, what has been achieved in some Social Services Departments, and how practice has been established despite the organizational and operational constraints implicit in the introduction of a family, or systems orientated method, to an agency traditionally and statutorily focused upon the individual.     

Is What You See What You Really Get? Comparison of Scoring Techniques in the Assessment of Real-World Divergent Thinking

In recent years, the social sciences have seen a resurgence in the study of divergent thinking (DT) measures. However, many of these recent advances have focused on abstract, decontextualized DT tasks (e.g., list as many things as you can think of that have wheels). This study provides a new perspective by exploring the reliability and validity evidence for several methods for scoring real-world DT tasks (i.e., tasks situated within a real-world problem or situation). The results suggest a combination of objective and subjective scoring methods may be optimal for originality scoring for contextualized DT tasks, which stands in contrast to recent research suggesting the objective, percentage scoring technique may be optimal for scoring originality on abstract tasks.     

When is Nothing Something? Editorial for the Null Results Special Issue of Journal of Business and Psychology

This special issue is focused on how null results can meaningfully advance science and practice. This editorial describes some of the unique aspects of creating a special issue devoted to null results, offers opinions regarding why and under what conditions null results should be valued, and offers recommendations for key stakeholders (i.e., editors, reviewers, and authors) in the publication enterprise with respect to submitting and evaluating research with null findings. This editorial also provides summaries of the papers included in this special issue with emphasis on how they serve as example for what constitutes meaningful null results.     

‘Do-It-Yourself’ Healthcare? Quality of Health and Healthcare Through Wearable Sensors

Wearable sensors are an integral part of the new telemedicine concept supporting the idea that Information Technologies will improve the quality and efficiency of healthcare. The use of sensors in diagnosis, treatment and monitoring of patients not only potentially changes medical practice but also one’s relationship with one’s body and mind, as well as the role and responsibilities of patients and healthcare professionals. In this paper, we focus on knowledge assessment of the online communities of Fitbit (a commercial wearable device) and the Quantified Self movement. Through their online forums, we investigate how users’ knowledge claims, shared experiences and imaginations about wearable sensors interrogate or confirm the narratives through which they are introduced to the publics. Citizen initiatives like the Quantified Self movement claim the right to ‘own’ the sensor generated data. But how these data can be used through traditional healthcare systems is an open question. More importantly, wearable sensors trigger a social function that is transformative of the current idea of care and healthcare, focused on sharing, socialising and collectively reflecting about individual problems. Whether this is aligned with current policy making about healthcare, whose central narrative is focused on efficiency and productivity, is to be seen.     

Personality and spirituality: comparative TATs of high-achieving Rajneeshees

The Thematic Apperception Test (TAT) was administered to followers of Bhagwan Shree Rajneesh in their commune in central Oregon. The Rajneeshee subjects had been high achievers (with advanced degrees and/or previous incomes greater than 30,000 dollars in 1984 dollars). Later, TATs were administered to persons matched for gender, age, education, and occupation but not involved in new religions. The final matched sample included 24 men and 20 women, half of whom were Rajneeshees. TATs were coded for a variety of formal variables as well as personality ratings. Though the analysis showed no between-group differences on most variables, significant mean differences occurred on ratings of unusual conditions, quest, and narcissism, with Rajneeshees higher than comparison subjects. Gender differences in personality variables were not conspicuous. Factor analysis established a strong productivity element. Card 16 (the blank card) provided the greatest number of differences.     

Estimating Between-Person and Within-Person Subscore Reliability with Profile Analysis

Subscores are of increasing interest in educational and psychological testing due to their diagnostic function for evaluating examinees' strengths and weaknesses within particular domains of knowledge. Previous studies about the utility of subscores have mostly focused on the overall reliability of individual subscores and ignored the fact that subscores should be distinct and have added value over the total score. This study introduces a profile reliability approach that partitions the overall subscore reliability into within-person and between-person subscore reliability. The estimation of between-person reliability and within-person reliability coefficients is demonstrated using subscores from number-correct scoring, unidimensional and multidimensional item response theory scoring, and augmented scoring approaches via a simulation study and a real data study. The effects of various testing conditions, such as subtest length, correlations among subscores, and the number of subtests, are examined. Results indicate that there is a substantial trade-off between within-person and between-person reliability of subscores. Profile reliability coefficients can be useful in determining the extent to which subscores provide distinct and reliable information under various testing conditions.     

Computer scoring of the Levels of Emotional Awareness Scale

The Levels of Emotional Awareness Scale (LEAS; Lane, Quinlan, Schwartz, Walker, & Zeitlan, 1990) is the most commonly used measure of differentiation and complexity in the use of emotion words and is associated with important clinical outcomes. Hand scoring the LEAS is time consuming. Existing programs for scoring open-ended responses cannot mimic LEAS hand scoring. Therefore, Leaf and Barchard (2006) developed the Program for Open-Ended Scoring (POES) to score the LEAS. In this article, we report a study in which the reliability and validity of POES scoring were examined. In the study, we used three participant types (adult community members, university students, children), three LEAS versions (paper based, computer based, and the LEAS for children), and a diverse set of criterion variables. Across this variety of conditions, the four POES scoring methods had internal consistencies and validities that were comparable to hand scoring, indicating that POES scoring can be used in clinical practice and other applied settings in which hand scoring is impractical.     

Psychometric properties of the Depressive Experiences Questionnaire in a college population

The Depressive Experiences Questionnaire (DEQ; Blatt, D'Afflitti, & Quinlan, 1976) was developed to permit the study of the continuities between normal and pathological forms of depression. Since its publication over 10 years ago, the DEQ has been increasingly used in a wide range of investigations of depression in clinical and nonclinical samples and as a measure of two major personality dimensions in a number of studies of differential responsiveness to various life stressors. This study provides an analysis of the DEQ responses in a large sample of undergraduate subjects in an attempt to articulate more clearly the psychometric properties of the DEQ. The DEQ consists of 66 items describing experiences frequently reported by depressed individuals. In the original development of the DEQ, factor analyses using male and female undergraduate samples yielded three orthogonal factors, Dependency, Self-Criticism, and Efficacy (Blatt et al., 1976). Most subsequent studies have used the factor scoring coefficients from the female sample to score men and women's DEQs. The factor loadings in the new male and female samples were very similar to one another and to the original female factor loadings. Thus, the continued use of the scoring parameters from the original female sample is recommended. Factor scores for Dependency and Self-Criticism continue to be uncorrelated in both men and women. Normative data are presented from the new samples, with men scoring higher on Self-Criticism and women scoring higher on Dependency.     

The thematic apperception test: toward a standard measure of the big three motives

The application of the Thematic Apperception Test to the assessment of motives has been heralded as an important milestone in personality psychology. However, although this approach is well established, there is at present no standard battery of cues for measuring the Big Three motives (achievement, affiliation, power). Furthermore, the extent to which scoring subcategories contribute to overall motive scores has been neglected. Our research with students and managers examined the effectiveness of picture cues in eliciting motive imagery and the prevalence of scoring subcategories within each motive scoring system. Results from 2 data sets comprising 547 men and women suggested that there were 3 cues that should be retained for future research and that motive scoring systems could be refined through removal of redundant subcategories. Further research is needed to systematically investigate the effectiveness of a standard battery of cues and the validity of revised motive scoring systems.     

Psychometric Properties of the Depressive Experiences Questionnaire in a College Population

The Depressive Experiences Questionnaire (DEQ; Blatt, D'Afflitti, & Quinlan, 1976) was developed to permit the study of the continuities between normal and pathological forms of depression. Since its publication over 10 years ago, the DEQ has been increasingly used in a wide range of investigations of depression in clinical and nonclinical samples and as a measure of two major personality dimensions in a number of studies of differential responsiveness to various life stressors. This study provides an analysis of the DEQ responses in a large sample of undergraduate subjects in an attempt to articulate more clearly the psychometric properties of the DEQ. The DEQ consists of 66 items describing experiences frequently reported by depressed individuals. In the original development of the DEQ, factor analyses using male and female undergraduate samples yielded three orthogonal factors, Dependency, Self-Criticism, and Efficacy (Blatt et al., 1976). Most subsequent studies have used the factor scoring coefficients from the female sample to score men and women's DEQs. The factor loadings in the new male and female samples were very similar to one another and to the original female factor loadings. Thus, the continued use of the scoring parameters from the original female sample is recommended. Factor scores for Dependency and Self-Criticism continue to be uncorrelated in both men and women. Normative data are presented from the new samples, with men scoring higher on Self-Criticism and women scoring higher on Dependency.     

The Challenge of Integrated Care for Mental Health: Leaving the 50 minute hour and Other Sacred Things

A growing body of research has demonstrated the effectiveness of integrating mental/behavioral healthcare with primary care in improving health outcomes. Despite this rich literature, such demonstration programs have proven difficult to maintain once research funding ends. Much of the discussion regarding maintenance of integrated care has been focused on lack of reimbursement. However, provider factors may be just as important, because integrated care systems require providers to adopt a very different role and operate very differently from traditional mental health practice. There is also great variability in definition and operationalization of integrated care. Provider concerns tend to focus on several factors, including a perceived loss of autonomy, discomfort with the hierarchical nature of medical care and primary care settings, and enduring beliefs about what constitutes “good” treatment. Providers may view integrated care models as delivering substandard care and passively or actively resist them. Dissemination of available data regarding effectiveness of these models is essential (e.g. timeliness of treatment, client satisfaction). Increasing exposure and training in these models, while maintaining the necessary training in traditional mental health care is a challenge for training at all levels, yet the challenge clearly opens new opportunities for psychology and psychiatry.     

Prenatal Representations of Coparenting Among Unmarried First‐Time African American Mothers

Results of semistructured interviews with 45 pregnant unmarried first‐time African American mothers indicated a wide range of expectancies concerning the coparenting relationship they would develop with others once their baby arrived. Most common coparenting systems projected by respondents involved maternal grandmothers and/or the babies' fathers, though other caregivers were explicitly anticipated in a smaller number of cases. Multiperson coparenting systems were the norm, and only 2 of 45 respondents anticipated that they would be entirely on their own with no coparental system whatsoever. Qualitative analyses of mothers' narratives about postbaby coparenting systems revealed five main constructions: having thought about and anticipating coparenting, positive in outlook; having thought about and anticipating coparenting, but with mild concerns (conflict, unreliability); having thought about coparenting and anticipating limited or no support; having thought about coparenting and anticipating significant conflict and nonsupport; and having not thought much about coparenting, being neither focused on nor worried about this issue. Illustrations of each of these types are provided, and directions for family science and practice are discussed.     

提取诱发遗忘的研究现状与展望

提取诱发遗忘强调对相关项目的提取会造成对其竞争项目的抑制,从而导致对这些竞争项目的暂时遗忘。文章阐释了提取诱发遗忘的概念界定与实验范式、有关理论以及实证研究,并重点介绍了提取诱发遗忘的机制研究,对抑制说与非抑制说的争论及实验研究进行了全面的综述,最后指出未来的研究应更侧重于抑制的具体过程、抑制在哪个水平上执行、激活扩展如何被限制及提取诱发遗忘的情境化研究     

Some ethical dilemmas in counselling and counselling research

This paper raises a number of dilemmas in relation to the ethical practice of counselling, counsellor training and research and evaluation of counselling which reflect the author's increasing concerns about therapeutic ethics. A number of relevant issues are explored to develop awareness and understanding of ethical matters, though this is in the spirit of exploration and inquiry rather than having definitive answers to offer. These issues include: use of training videos of therapists with real clients; informed consent; how research and evaluation changes the therapeutic process; how sensitive and ongoing consent for counselling and counselling research could be best obtained; publication of research in ways that respect the research participant; and the value and implications of the new British Association for Counselling and Psychotherapy ethical framework. Finally, the concept of 'ethical mindfulness' is considered as a creative, if demanding, response to a concern to be ethical in research and practice.     

Domain-general and domain-specific developmental assessments: do they measure the same thing?

The concept of epistemological development is useful in psychological assessment only insofar as instruments can be designed to measure it consistently, reliably, and without bias. In the psychosocial domain, most traditional stage assessment systems rely on a process of matching concepts in a scoring manual generated from a limited number of construction cases, and thus suffer from bias introduced by an over-dependence on particular content. In contrast, the Hierarchical Complexity Scoring System (HCSS) employs criteria for assessing the hierarchical complexity of texts that are independent of specific conceptual content. This paper examines whether the HCSS and a conventional stage assessment system, Kohlberg’s Standard Issue Scoring System (SISS), measure the same dimension of performance. We scored 378 moral judgment interviews with both scoring systems. We then conducted a multidimensional partial credit analysis to determine the extent to which the two scoring systems assess the same dimension of performance. The disattenuated correlation between performance estimates on the SISS and HCSS is .92. Based on this and other evidence, we conclude that a single latent trait — hierarchical complexity — is the predominant dimension assessed by the two systems.     

A comparative analysis of the validity of several approaches to the scoring of the behavior of the preterm infant

A group of very low birthweight preterm infants (mean WEIGHT = 1193.6 g; mean gestational AGE = 31.1 weeks) were examined with the PREMIE. The PREMIE is a modification of the scoring system of the full term Brazelton Neonatal Behavioral Assessment (BNBAS) examination for use with preterm infants. Infants were assessed during the acute phase of cardio-respiratory illness (mean AGE = 7 days) and during the recovery phase (mean AGE = 22 days). Many modifications in procedure were required. Several analyses were performed to assess the redundancy and the comparative validity of the scoring systems of the PREMIE, the BNBAS, and the BNBAS + (the BNBAS plus a set of five additional preterm items). Results indicated that the three scoring systems were highly redundant, that they were equally related to physiologic and clinical variables, and that they were similar in their sensitivity to behavioral change and stability. Overall the results offered little in the way of differentiating among these three scoring systems with this group of infants, raising doubts about the need to use the PREMIE or other scoring systems like it for many research purposes.     

Translating Evidence to Practice: Two Stories from the Field

Translating research evidence into daily practice is a challenging process at the organizational level. Conceptual models about this process point to the importance of resources for change and environmental influences as two key factors that need to be addressed in translation efforts. Two organizational case studies focused on improving care for adults with depression are described that illustrate lessons about translating evidence to practice that may be helpful to others.