抑郁症患者的服药依从性及影响因素

服药依从性是影响抑郁症患者疗效和复发的重要因素, 然而很多研究发现抑郁症患者的服药依从性较低。与服药依从性有关的概念有服从性、依从性和遵从性。抑郁症服药依从性的影响因素包括疾病与治疗因素、医生相关因素、患者相关因素及文化与环境因素四个方面, 主要从医生和患者两方面进行干预。其评定方法包括主观和客观两种。介绍了研究趋势, 未来应发展服药依从性测量工具, 加强本土化和社会文化因素的研究, 加强共病对抑郁症服药依从性影响的研究, 制定个别化的干预措施, 并加强心理学在抑郁症服药依从性领域的交叉研究。     

How equivalent are the action execution,imagery, and observation of intransitive movements? Revisiting the concept of somatotopy during action simulation

Jeannerod (2001) hypothesized that action execution, imagery, and observation are functionally equivalent. This led to the major prediction that these motor states are based on the same action-specific and even effector-specific motor representations. The present study examined whether hand and foot movements are represented in a somatotopic manner during action execution, imagery, and action observation.     

Development of the Diabetes Education, Counseling, Information Delivery and Evaluation (DECIDE) Program: A Health Promotion Intervention For Preadolescents with Type 1 Diabetes

Careful attention to self-care behaviors is crucial to achieving good health outcomes in children and adolescents with type 1 diabetes. Despite the unequivocal research findings that adolescence is a time of poor metabolic control among affected individuals, there have been few prevention efforts geared toward health promotion in this age group. The diabetes education, counseling and information delivery, and evaluation (DECIDE) Program is intended to prevent the deterioration of self-care behaviors often evident during adolescence by intervening during the earlier, more stable time period of preadolescence. This paper describes the foundation for the DECIDE Program and outlines intervention development, current study recruitment, and preliminary program evaluation data. Findings indicate that enrollment into the program is feasible among children and their parents; early feedback suggests that parents and children are also satisfied with their participation. The challenges of conducting randomized controlled trials in health promotion for childhood diabetes are discussed, and ideas are offered for future research directions to improve the integration of child health psychology with public health approaches in this population.     

Resilience,religiosity and treatment adherence in hemodialysis patients: a prospective study

Resilience and religiosity have received attention as an important process in the experience and management of chronic comorbidities; however, there is no study evaluating resilience in hemodialysis patients and its association with other psychological dimensions or with treatment adherence. This observational prospective study assessed resilience (25 item Wagnild and Young Resilience Scale), religiosity under three dimensions (organizational, non-organizational and intrinsic) using DUREL scale, depressive symptoms (Patient Health Questionnaire-9) and health-related quality of life (Short Form-36 questionnaire). The main outcomes were medication adherence using the Morisky Medication Adherence Scale-8 (MMAR-8) and the missing/shortened dialysis sessions in the following six months. Of 208 patients approached, 202 (97.1%) agreed to participate. One hundred twenty-three patients (60.9%) were males and mean age was 52.8 ± 14.8 years-old. The median time on hemodialysis was 36 months (IQR, 12, 84). 82 (40.6%) patients obtained a MMAS-8 score <6 and were considered as having ‘poor adherence’. Overall, the mean score of medication adherence was low (5.7 ± 2.1). About adherence to hemodialysis sessions, patients missed a total of 234 (1.6%) hemodialysis sessions. Forty-eight patients (23.7%) missed an average of at least three sessions in six months. Regarding adherence to medication, there was no association in the uni- or multivariate analysis between religiosity dimensions and MMAS-8 score. After adjustment, resilience was positively associated with MMAS-8 score (standardized β coefficient .239, p = .016). Organized and intrinsic religiosity were associated with adherence to dialysis sessions (standardized β coefficient .258, p = .004 and .231, p = .026, respectively). Interestingly, opposite to medication adherence, more resilient patients were associated with less adherence to hemodialysis sessions (standardized β coefficient ?.296, p = .001). Religiosity was associated with dialysis adherence but not with medication adherence. Resilience was associated with higher medication adherence but lower adherence to dialysis sessions.     

When far becomes near: Shared environments activate action simulation

It has been proposed that one means of understanding a person's current behaviour and predicting future actions is by simulating their actions. That is, when another person's actions are observed, similar motor processes are activated in the observer. For example, after observing a reach over an obstacle, a person's subsequent reach trajectory is more curved, reflecting motor priming. Importantly, such motor states are only activated if the observed action is in near (peripersonal) space. However, we demonstrate that when individuals share action environments, simulation of another person's obstacle avoiding reach path takes place even when the action is in far (extrapersonal) space. We propose that action simulation is influenced by factors such as ownership. When an “owned” object is a potential future obstacle, even when it is viewed beyond current action space, simulations are evoked, and these leave a more stable memory capable of influencing future behaviour.     

Some observations on a Popperian experiment concerning observation

In several places Popper describes a little experiment in which an audience is given the non-specific command Observe! He draws a number of conclusions from this experiment, in particular that observation takes place in the presence of theoretical problems, questions, hypotheses or points of view. The paper argues that while Popper's experiment is instructive, it hardly supports the strong conclusions he draws about the theory-dominance of observation in science. In particular, it is argued that talk of principles of selection which guide us to relevant observations, rather than the host of irrelevant observations of the naive inductivist, is misleading. Rather, it is the goals, aims, motives or interests of an observer that guide observation and these need not always involve a theoretical component.     

Practical work in physiotherapy students’ professional development

Learning practical work through cooperation between school and working life is part of physiotherapy higher education. Students learn practical work through the integration of theoretical, practical, tacit and situational knowledge in a socialization process. Workplace practices and habits direct students’ learning. This study answers the question: What kind of conceptions of learning practical work do physiotherapy students have? Longitudinal data written by 21 volunteer students (mean age 25 years) was collected over three and a half years. Thematic analysis was used to analyse the data. Learning practical work proceeds in five phases: (1) the basis of practical work, human movement and action and therapeutic tools is learned at school; (2) the meaning of the profession and practical work takes shape in an interaction with clients and observing how professionals work in real workplaces; (3) the wholeness of the practical work takes shape by gradually participating in the work processes; (4) critical reflection of the work processes – thinking, construction, evaluation and reasoning – develops; and (5) the conception of practical work widens. This study brings new information about learning practical work for developing healthcare education and its curricula. The role of workplaces is huge in learning tacit knowledge of the profession.     

And who thinks on the baby? Thoughts on the method of infant observation

Abstract

After the method of infant observation, as developed by Esther Bick, and its significance for psychoanalytic training have been outlined, the method is critically assessed. The suggestion is then made that infant observation should be supplemented by video-analytic infant observation. Finally, thoughts on modifications of the process of infant observation are presented.     

Parents As Teachers:

A follow-up mail survey of the continuing use of behavior modification procedures was conducted with 30 families who had participated in a training program for parents of preschool children with autism four to seven years previously. According to their reports 86% of the parents had used behavioral procedures during the past week to manage their child's behavior and 54% said they used the techniques to teach their child a new skill. More than half of the parties said they no longer used “formal” behavior modification procedures including data collection. Mothers were more likely to use formal behavior modification than father and systematic paternal use of behavioral techniques was linked to maternal use- only one father used the techniques including data collection when his wife did not. Retrospective parental evaluations of the parent training workshop were all positive, although the parents who viewed their children as doing better gave stronger endorsements than the parents who say their children as more limited.     

AN APPOINTMENT-KEEPING IMPROVEMENT PACKAGE FOR OUTPATIENT PEDIATRICS: SYSTEMATIC REPLICATION AND COMPONENT ANALYSIS

Child health-care appointments that are not kept are an important pediatric problem. Previous research has shown that reducing effort (with a parking pass) and reminding patients (with mailed and telephone reminders) significantly improved appointment keeping for first-time and patient-scheduled appointments. This study, using a posttest-only group design, evaluated the effects of various combinations of that intervention applied to clinic-scheduled follow-up appointments. All combinations of the intervention significantly increased cancellations, but none increased appointments kept or decreased appointments not kept significantly. Log linear analyses showed that the lag time between scheduling and the appointment significantly influenced appointment keeping. The results suggest that if clinics want to increase cancellations, a mailed reminder and effort reduction are sufficient. To increase appointment keeping, other interventions, such as reduced lag time, may be necessary.     

The relationship variable in behavioral consultation

Behavioral consultation has traditionally been conceptualized as a scientific-technological exchange process where the primary goal is the transfer of information. Perceived reluctance of school personnel to use behavioral techniques has been seen as a special problem of educational settings. However, current understanding of this reluctance has emerged from the treatment adherence literature which stresses the complexity of adherence in clinical settings. One important issue which has emerged is the critical importance of the consultation relationship. While behavioral consultation has utilized an expert model focused on client behavior and problem solving, the efficacy of a more collaborative consultation style has been recommended. Behavioral consultants need to attend to factors such as communication strategies that facilitate shared responsibility as well as to understand consultees' explanations for their problems and their treatment expectations. Such skills need to be incorporated directly into the education of behavioral consultants along with behavioral technology if the behavioral model is to be disseminated widely into educational practice.     

Treatment Adherence in Children with Sickle Cell Disease: Disease-Related Risk and Psychosocial Resistance Factors

To identify disease-related risk factors and psychosocial resistance factors that impact adherence to prescribed treatment in the context of admission to a Hematology Acute Care Unit (HACU) designed to provide acute care for children with sickle cell disease (SCD) presenting with pain or fever. A total of 73 primary caregivers and 24 children (if age 8 or older) completed standardized forms during the HACU admission. Treatment adherence variables (medical staff rating, SCD-related care activities, percentage of agreement between treatment recommendations made and care activities, and attendance at hematology clinic) indicated moderate-to-high adherence. Based on regression analyses, the risk variable of disease-related stress and the resistance variables of family flexibility and less reliance on passive coping accounted for significant portions of the variance in treatment adherence. Empirical evaluation of interventions designed to improve communication regarding expectations for the care of children with SCD and to support active family problem solving during times of SCD-related stress must be ongoing.     

Infant observation and the French model

Psychoanalytic training in the French Societies belonging to the International Psychoanalytic Association does not grant any place to the observation of babies as it exists in certain societies of other countries. Infant observation is even the object of sharp critiques by eminent French theoreticians. The reasons given for condemning infant observation and refusing to give it any place in the training programme lie in theoretical positions concerning the very nature of the Freudian discovery and its interpretation, which is more idealistic than empirical. The author discusses these reasons while drawing attention to the frequent confusion between a reference to empiricism and a reference to the experimental. The fear of a psychologizing deviation of metapsychology and of a denial of psychic reality leads, in the French model, to placing the emphasis on personal analytic experience during the candidate's psychoanalysis, prolonged by supervisions. It excludes any academic teaching of metapsychology or of related disciplines. The confusion between the empiricism of Esther Bick's method and the recourse to experimental procedures in developmental research stands in the way of making a place for infant observation and of recognizing its training value, not so much for the acquisition of new knowledge or the validation of metapsychological models, as for its usefulness in developing a mode of psychoanalytic observation and an increase in the candidates' containing capacities.     

当事人的投入:概念、测量与影响因素

当事人的投入是其从心理咨询与治疗中获益的基本前提,它是指当事人为了实现改变的目标,在咨询或治疗过程中主动参与、不懈努力的心理和行为过程。目前对投入的研究主要考察了行为表现,包括出席会谈、会谈中的投入和会谈外的投入三个核心成分,对应有不同的测量方法。与投入有关的因素包括当事人因素、咨询师及互动因素、家庭和社会文化因素、其他客观因素等,其中当事人的认知动机因素对投入有重要影响。未来研究应继续探讨当事人投入的成分、动力性和影响因素,完善其评估方法及增强当事人投入的干预方法,并进一步检验当事人的投入与咨询效果的关系。     

Use of Multisystemic Therapy to Improve Regimen Adherence Among Adolescents with Type 1 Diabetes in Poor Metabolic Control: A Pilot Investigation

The purpose of the current study was to conduct a pilot investigation to determine the effectiveness of Multisystemic Therapy (MST) for improving regimen adherence and metabolic control among adolescents with poorly controlled Type 1 diabetes. Thirty-one adolescents were randomly assigned to either MST or a control condition. MST treatment lasted approximately six months. Data were collected at study entry and at a six-month posttest. Twenty-five adolescents completed the study. Adolescents who received MST had significantly improved adherence to blood glucose testing and metabolic control from study entry to the six-month posttest, whereas controls did not. Adolescents receiving MST also had a decreased number of inpatient admissions at the six-month posttest. Improvements in metabolic control were related to improvements in parent report of adolescent adherence. Results suggest that MST holds promise as an intervention for improving adherence behavior and health outcomes among adolescents in poor metabolic control.     

Caregiver Knowledge and Adherence in Children With Sickle Cell Disease: Knowing is Not Doing

Though the impact of disease knowledge on adherence to medical recommendations has long been the focus of research, little of this research has focussed on sickle cell compliance in the child and adolescent population. The present study examined the relationship of caregiver knowledge of sickle cell disease (SCD) and children's adherence to prescribed behaviors. Though caregivers with high levels of knowledge of SCD were more likely to report higher levels of adherence, knowledge test score did not predict adherence for the majority of participants (72%). The effect of caregiver knowledge on reported adherence was greater among preadolescents (age ≤ 11) than adolescents (age ≥12). The relationship between knowledge and adherence may not be as strong or direct as is assumed in many theories of health behavior change.