血液系统恶性肿瘤患者相关疲劳的生物-心理-社会模式探讨

普遍的疲劳感是引起血液系统恶性肿瘤患者治疗及康复过程中生活质量显著降低的主要因素之一.因此如何减少肿瘤相关疲劳逐渐引起了血液病医生的关注.在医学从传统的"生物"模式向新的"生物-心理-社会"模式转变的背景下,本文就如何利用生物心理社会模式分析血液系统恶性肿瘤相关疲劳的病因、机制、评估、干预进行探讨.     

生物医学研究的环境风险初探

生物医学研究的环境风险,因研究与人体密切相关,由医疗器械设备和研究实施过程以及病毒性传播等导致的环境破坏引起。传统医学是以人类为中心的,医学模式是"生物-心理-社会"模式,医学研究对象主要是从人的肉体、精神到社会,缺少生态视角。规避相关的环境风险,应秉承非人类中心主义生态伦理思路,借鉴"生物-心理-社会-生态"模式。具体操作可加入环境风险评估内容;实行环境影响的空间排序机制及时间积累的环境风险评估机制;增强应急环境风险管控;对一定范围内的环境进行赋价。     

"人体-环境"新系统医学模式探讨

运用系统论观点分析"生物-心理-社会"医学模式的优越性和局限性,提出以人为主体,将人作为一完整系统,人与环境合为大系统,以整体论的健康观为理念的"人体-环境"新系统医学模式,旨在更好地推动中西医结合和预防医学的发展,加速学科间的相互渗透,唤起健康和环保意识,以及更加重视政治和法律政策对现代医学的作用.     

医学模式的转变与对腰痛患者实施认知行为治疗

随着医学模式从生物医学模式向生物-心理-社会医学模式的转变,心理社会因素对腰痛患者疼痛的影响亦日益引起社会的普遍关注.从心理社会因素对腰痛患者疼痛的影响探讨医学模式转变的必要性以及给腰痛患者实施认知行为治疗的可行性.     

生物-心理-社会医学模式与社区医疗的科学定位

对生物-心理-社会医学模式与社区医疗的结合进行探讨,生物-心理-社会医学模式在社区医疗中的应用,尤其是其社会性、整体性、综合性、以人为本的思想无疑会给社区医疗带来全新的发展,促使社区医疗科学定位,转变服务模式.而社区医疗的发展也会促进生物-心理-社会医学模式在实践中的应用.     

生物-心理-社会医学模式:医学整合的学术范式

生物-心理-社会医学模式适合了医学目的、WHO的健康观和医学实践需要整合的要求,成为医学整合的学术范式.在生物-心理-社会医学模式视域下,医学科研在更深刻的分析基础上趋向于整合,医学临床把病人作为整体看待,维护了病人的健康权益,在医学教育中强调了医学科学精神与人文精神的融合,彰显了医学整合"以人为本"的终极目的.     

军事训练中心理疲劳产生的原因及预防

本文探讨广大官兵在军事训练中的心理疲劳概念及表现，分析在军事训练中产生心理疲劳的原因，探讨官兵如何利用正确的方式、方法对军事训练中产生的心理疲劳进行预防和调控。     

生物-心理-社会医学模式的实践与医学整合

影响生物-心理-社会医学模式实践的原因是多方面的.推进临床学科间的整合,实现医院与基层医疗的结合,大力发展临床流行病学和社会医学,是落实生物-心理-社会医学模式的基本条件.     

“人体-环境”新系统医学模式探讨

运用系统论观点分析“生物-心理-社会”医学模式的优越性和局限性,提出以人为主体,将人作为一完整系统,人与环境合为大系统,以整体论的健康观为理念的“人体-环境”新系统医学模式,旨在更好地推动中西医结合和预防医学的发展,加速学科间的相互渗透,唤起健康和环保意识,以及更加重视政治和法律政策对现代医学的作用。     

试论"生理-心理-伦理-社会"相结合的大学生心理健康教育模式

提出了"生理-心理-伦理-社会"相结合的大学生心理健康教育模式,指出这种模式是建立在健康新概念的指导下,全面考虑了影响心理健康的各种因素,以当代大学生心理健康的现状与原因为基础和依据的具有中国特色的大学生心理健康教育模式.     

Clinical Differences Exist Between Patients Fulfilling the 1988 and 1994 Case Definitions of Chronic Fatigue Syndrome

Despite the existence of 2 different case definitions for chronic fatigue syndrome, little data exist to evaluate how each performs. We evaluated the symptom patterns of patients fulfilling either the more demanding 1988 or the less demanding 1994 case definitions of Chronic Fatigue Syndrome over an 11-year period from 1991 to 2001. Factor analysis identified 3 factors: muscular–skeletal, viral, and sleep:memory symptom factors accounting for significant variation in the data. Further discriminant analysis showed that the first 2 factors and a self-reported measure of decrease in activity alone gave 91% accuracy in the placement of patients into their respective case definitions. This analysis did indicate that both case definitions were capturing the same broad group of patients. However, the patients in the 1994 group do not endorse infectious-type symptoms as often or to the same degree of severity as those in the 1988 group. This may mean that infection as a cause of CFS is more likely in patients fulfilling the earlier, more demanding case definition.     

Clinical Predictors of Depression in Patients with Low-Grade Brain Tumors: Consideration of a Neurologic Versus a Psychogenic Model

Few studies have examined quality of life issues in patients with brain tumors, though coping with cancer is stressful and is associated with heightened levels of depression. We used regression to examine the clinical factors that might predict depression in a group of 57 adults with low-grade brain tumors after surgery but prior to radiotherapy and chemotherapy. A neurological model comprised of tumor characteristics and treatment was compared with a psychogenic model comprised of both psychosocial and psychodynamic variables. Demographic variables and level of fatigue were also included. A model consisting primarily of fatigue (also clinically elevated) and secondarily of tumor location and aggressiveness of surgical treatment accounted for 33% of the depression score. In a small group at a later follow-up when patient depression was clinically elevated (4–6 years after baseline), fatigue, female sex, cognitive dysfunction, increased family support, and increased report of physical symptoms were associated with depression. The late out findings remain exploratory because of the small sample size, but they suggest that depression develops over time and results from a combination of neurological and psychosocial problems that ensue initial treatments. Treating these collateral problems may reduce the complications from depression.     

Exploration of the effects of task-related fatigue on eye-motion features and its value in improving driver fatigue-related technology

Mental fatigue has been lacked attention in developing eye-tracking fatigue detection system for drivers. However, it has great influence on eye movement which could account for the poor validity of current fatigue detectors only focusing on sleep-related fatigue. This work sought to investigate the influence of two types of task-related mental fatigue on eye movement by examining 8 saccade-based, 3 blink-based, and 1 pupil-based metrics. We propose that two types of task-related fatigue caused by cognitive overload and prolonged underload will induce different physiological responses to eye-motion features. Twenty participants completed a vigilance task before and after a 1-h driving with a secondary task in a virtual simulation environment, while forty participants, divided equally into two groups, finished the same task before and after a 1-h and 1.5-h monotonous driving. T-test was applied to analyse the eye-motion, subjective and vigilance data during vigilance task. We found that overload driving made drivers vigilance ability decrease. The eye metrics showed different changes in underload and overload scenario. The blink duration, the mean velocity of saccade and saccade duration increased after 1-h overload driving, while the pupil diameter decreased. However, none of those changes were observed in 1.5-h underload driving, but saccade duration had a significant increase. The fatigue response to heavy demands over short periods of driving is different from the lighter demands over long periods in terms of eye-motion metrics. Considering mental fatigue in designing an eye-tracking fatigue detection system could possibly improve its accuracy.     

体育锻炼与疲劳关系的综述研究

通过文献综述法简要地总结了疲劳的概念、研究历史及现状,介绍了疲劳的机理研究,探讨了体育锻炼与疲劳的关系及疲劳的判断、消除等。研究结果表明：（1）目前,有关体育锻炼的生理疲劳的研究相当系统、全面;但体育锻炼的心理疲劳的研究相当薄弱、少见。（2）体育锻炼的心理疲劳并非生理疲劳的必然结果,而受个人心理因素以及个体周围环境的影响等等。（3）随着心理健康的日渐重要,未来有关心理疲劳的研究将倍受重视。     

The past,present, and future of the biopsychosocial model: A review of The Biopsychosocial Model of Health and Disease: New philosophical and scientific developments by Derek Bolton and Grant Gillett

Health psychology is a growing field generating exciting advances in theory, research, and applications that significantly improve the lives of individuals, shape the medical profession, and inform global public policy. For over 40 years, the field has been guided by the biopsychosocial model (Engel, 1977), an interdisciplinary and multifaceted model that posits the interrelations among the biological, psychological, and socio-environmental influences on health and disease. The theoretical implications and empirical research that it has generated have been vast. In The Biopsychosocial Model of Health and Disease: New philosophical and scientific developments, Derek Bolton and Grant Gillett (2019) present a summary of four decades of scholarship. They conclude that the model has fallen short clinically, scientifically, and philosophically. Although their book is timely, well-written, thought-provoking, and designed to highlight weaknesses that could drive science and practice forward, their criticisms are not fully convincing and are open to debate. The contributions this book could make may be to challenge a new generation of scholars and scientists to demonstrate that the biopsychosocial model is more relevant than ever, especially as areas such as social genomics, psychoneuroimmunology, health disparities, and global health become more important. Despite interesting philosophical challenges presented by Bolton and Gillett, theory, research, and practice focused on health, disability, illness, and wellness should remain grounded in the biopsychosocial model.     

Fatigue and Quality of Life Following Radiotherapy for Breast Cancer: A Comparative Study

Clinical reports suggest that fatigue is a common and disruptive long-term side effect of radiotherapy; however, there has been little systematic attention given to this phenomenon. The primary aim of this study was to assess fatigue its impact on quality of life in women who had completed radiotherapy for breast cancer. A key feature of this study was the inclusion of a comparison group of women of similar age with no history of cancer. The results indicated that the fatigue experienced by women after radiotherapy for breast cancer was not significantly different in intensity, duration, or disruptiveness from fatigue experienced by healthy women. In addition, radiotherapy recipients reported a quality of life similar to that of the healthy women. For both groups of women greater fatigue was related to a poorer quality of life. These findings suggest that following radiotherapy for breast cancer, women can expect to experience fatigue which is not worse than what they might normally experience. This information may be a useful part of psychoeducational interventions designed for women scheduled to begin radiotherapy for breast cancer.     

Personal factors related to compassion fatigue in health professionals

This study examines the role of some personal and professional factors in compassion fatigue among health-care professionals. Research participants included 182 (89 mental and 93 medical) health-care professionals who completed an assessment battery measuring compassion fatigue, emotion management, trait emotional intelligence, situation-specific coping strategies, and negative affect. Major findings indicate that both self-report “trait” emotional intelligence and ability-based emotion management are inversely associated with compassion fatigue; adaptive coping is inversely related to compassion fatigue; and differences exist between mental and medical professions in emotional intelligence, coping strategies, and negative affect. Furthermore, problem-focused coping appears to mediate the association between trait emotional intelligence and compassion fatigue. These findings shed light on the role of emotional factors in compassion fatigue among health-care professionals. Beyond enhancing our knowledge of practitioners' professional quality of life, the current study serves as a basis for the early identification of groups of practitioners at risk for compassion fatigue.     

Fatigue and Quality of Life in Hepatitis C: Fact or Fiction?

The chronic hepatitis C virus (HCV) has traditionally been impossible to treat. Recently there has been increased attention in the treatment of HCV due to the development of drug treatments (i.e., Interferon and Ribavirin). As clinical attention to the assessment and treatment of HCV has increased, the issue of fatigue has become a central concern. Fatigue is one of the major symptoms reported by those suffering from HCV but it is not clear whether fatigue should be treated as a major symptom that is an important focus on attention or if it is a minor and irrelevant concern. In this paper, we examine the issues of fatigue in HCV in light of the importance of health-related quality of life in HCV. We present evidence to suggest that fatigue is a major issue that warrants clinical attention. We also propose that fatigue be reconceptualized as lassitude and provide an operationalized definition of dysfunctional lassitude, a new clinical construct that may have value as a psychological diagnosis. The purpose of this paper is to provide those interested in psychological issues in HCV, and chronic illnesses for which fatigue is a major symptom, guidelines for future clinical and research efforts.     

Book Reviews

Research has shown that those with insomnia focus primarily on their sleep as a cause of daytime fatigue rather than the multitude of other possible causes of fatigue. This can create sleep-related anxiety and further perpetuate the sleep disturbance. In order to lessen the increased focus on sleep, the present study investigated whether people could learn to consider other attributions for fatigue via an information-based manipulation. Undergraduate students (N = 88) were randomized to two information groups: They either received information about common factors that could explain daytime fatigue (the fatigue information condition) or received generic sleep-related information (the control condition). Each group was tested pre- and post-intervention. Fatigue information participants were significantly more likely to consider non-sleep-related attributions for fatigue at post-intervention, relative to control participants. These results demonstrate that attributions for fatigue may be amenable to change via an information-based intervention; thus, this research explores a preliminary step toward investigating refinements to insomnia treatments.     

Correlates of general quality of life are different in patients with primary insomnia as compared to patients with insomnia and psychiatric comorbidity

Chronic insomnia is known to have a negative influence on quality of life (QOL). To date, most studies on chronic insomnia have focused on health-related aspects of QOL. General QOL, which is a different construct, has not been studied in detail. Moreover, it is not known which factors are associated with general QOL in insomnia, and whether the presence of mental disorders, a condition known as comorbid insomnia, affects these variables. The present study focused on identifying sleep and psychosocial variables that might be associated with general QOL in primary and comorbid insomnia. Personality traits, coping variables, anxiety and depressive symptoms, fatigue and subjective sleep variables were assessed in 218 consecutive well-characterized patients with primary and comorbid insomnia, referred to a third line centre for sleep medicine. In primary insomnia, higher extraversion and lower discrepancies in social support were associated with higher QOL. Surprisingly, insomnia severity was not significantly associated with QOL in this group. However, lower fatigue, which can be seen as an important daytime consequence of insomnia was correlated with higher QOL in patients with primary insomnia. In both insomnia groups, low anxiety and depressive symptoms and low fatigue were associated with higher general QOL. In contrast with the primary insomnia group, lower insomnia severity was correlated with higher QOL in patients with comorbid insomnia. These results stress the importance of assessing and treating daytime fatigue in insomnia. In primary insomnia, improving social support might be an important treatment goal. Furthermore, this study supports the concept that treatment of insomnia should not be neglected in patients with comorbid insomnia. Indeed, both insomnia and indices of psychiatric disease are strongly associated with general QOL in this condition.