从“胡为民现象”看我国医疗领域的社会失范

随着我国经济体制的转型,由于市场机制的引进和发展不规范,医药卫生体制改革不成熟,在医疗领域出现了很多失范的现象。透过“胡为民现象”,分析了我国医疗领域社会失范的特点和原因,并针对原因提出了防治医疗领域社会失范的意见和措施     

关注肝炎的"过度医疗"

肝炎诊疗领域存在的过度医疗现象是最具代表性的,集中体现为过度使用联合治疗、过度进行化验等辅助检查、过度使用新特药物、虚假广告泛滥等等,肝炎患者承担了额外风险,不但身心受损,而且经济支出严重超标,因病返贫、因病致贫的现象比比皆是.过度医疗是目前不规范的经济大环境的必然产物,救死扶伤、人道主义本应是医疗工作的准则,现在拜金主义、经济效应第一成为医疗活动的目的,过度诊疗在所难免.另外患者的无知和盲目,以及尚不规范的市场环境加剧了过度医疗现象.制定行业规范,建立社会监督机制,与国际肝炎诊疗指南接轨,是克服和纠正诊疗过度的有效方法.     

“托人看病”的医患博弈策略分析

近年来医患博弈日益激烈.患者为确保在博弈中的最大收益,往往会选择“托人看病”策略.就“托人看病”现象产生的原因、理论基础和社会文化背景进行了分析,进而指出“托人看病”现象是对健康公平的挑战,医疗秩序的失范和医患关系的异化,揭示了“托人看病”是医患博弈的非理性策略,需采取有效措施进行扼制.     

制度伦理与社会转型期的医德建设

市场经济的发展,多元价值观的形成,各种伦理价值观念之间发生了冲突,医疗道德失范现象成为我国社会转型期的一个重要社会问题。制度伦理对道德建设起着基础性和根本性的作用,以制度伦理建设为契机,并辅以正确的激励手段等,可以让医务人员树立正确的道德理念,引导和强化医务人员的价值选择和行为规范,重塑良好医德医风。     

我国竞技体育中的道德失范现象探析

在市场经济环境中,受商业化和职业化冲击、竞技体育管理机制存在缺陷、体育法规制度建设滞后等因素影响,我国竞技体育存在着兴奋剂泛滥、篡改运动员真实年龄、假球黑哨、赛场不文明行为等道德失范现象.这些问题若不及时加以治理,不仅会严重制约我国竞技体育的健康发展,还会影响到社会的安定与和谐.只有在加强竞技体育事业从业人员体育道德教育的同时,逐步完善我国竞技体育事业的法制建设,才能有效遏制我国竞技体育道德失范现象的进一步蔓延.     

简论“道德失范”范畴

本文论述了作为伦理范畴的“道德失范”产生的原因及其内在本质属性,从理论上区分了“常态下的道德失范”与“转型期中的道德失范”两种类型,指出“道德失范”是社会发展中一种正常的现象,既要看到其消极的一面,更要看到它在社会新价值体系或意义系统的形成和更替中体现的积极性的一面     

道德失范：社会安全的腐蚀剂

本文认为 ,我国进入社会转型加速期以来 ,较为普遍的道德失范现象正以自己特有的方式影响着社会的良性运行与协调发展 ,一定程度上正威胁着社会安全。克服道德失范现象 ,应该从构筑社会精神、落实《公民道德建设实施纲要》、做好制度安排几个方面下功夫。     

信任缺失的社会心理分析

信任是人类社会存在和发展的重要基础。当前，我国社会各领域大量存在的不诚信现象以及由此引发的社会信任缺失，已经成为制约经济和社会进一步发展的瓶颈。本从社会心理层面分析了造成信任缺失的原因，并对如何提高我国的社会信任度做了初步探讨。     

医学界对规范自媒体的诉求——基于“小苏打‘饿死’癌细胞”事件的思考

以"小苏打‘饿死’癌细胞"事件为切入点,从自媒体对大众健康及健康教育的影响等方面,阐述了规范自媒体的迫切性和必要性,提出医学界对于规范自媒体的诉求。指出自媒体报道医学事件存在的失范现象,如谣言泛滥、客观性分析缺失、严谨性和专业性缺乏等,并分析了这些失范现象产生的原因,包括自媒体自身的特点、发布和传播主体个体性与传播空间公共性的矛盾、科学传播具有专业性等内部原因,以及监管惩处力度不够,失范报道代价低、发布者和受众媒介素养不高等外部的原因。从医学界、政府和公众三方面对规范自媒体提出了建议。     

临床工作中应重视"安慰剂"效应

目前我国临床工作中对"安慰剂"效应重视不够."安慰剂"效应建立在患者对医生的信任之上.生物医学模式重视疾病的生物学意义而忽视社会、心理因素的影响,导致医生对患者态度冷漠,患者对医生缺乏信任,已成为我国医患关系恶化的重要原因,继而弱化了医疗的"安慰剂"效应.推行生物-心理-社会医学模式,提倡临床工作以人为本而非以疾病为主,建立医患共赢的医疗体制,改善医疗环境,有利于产生和加强临床工作的"安慰剂"效应,切实促进医疗和谐.     

论行政调解的法制建构

行政调解是我国调解制度的重要构成部分,是"大调解"纠纷解决机制的重要环节,对解决社会纠纷、化解社会矛盾具有特殊重要的地位和功能。但是我国行政调解法律制度至今尚未建立起来。本文认为,我国调解法律制度建设的目标是在《人民调解法》的基础上,制定统一的《调解法》,建构较为完备的调解法律制度。当前的重点是建立和完善行政调解制度,建议在《调解法》制定之前由国务院制定《行政调解条例》,建立较为完整的行政调解法律制度,国务院行政法规制定以前,各省、自治区、直辖市人大常委会可以先行制定行政调解的地方性法规,将行政调解纳入法治轨道。进而,本文围绕构建我国行政调解法律制度,对我国行政调解的概念界定、行政调解主体、行政调解的范围、行政调解的基本原则、行政调解的程序和行政调解协议的法律效力等问题进行了较为系统的探讨。     

纵向数据的中介效应分析

目前中介效应检验主要是基于截面数据,但许多时候截面数据的中介分析不适合进行因果推断,因而需要收集历时性的纵向数据,进行纵向数据的中介分析。评介了基于交叉滞后面板模型、多层线性模型和潜变量增长模型的纵向数据的中介分析方法及其四个发展。第一,中介效应随时间变化,如连续时间模型、多层时变系数模型。第二,中介效应随个体变化,如随机效应的交叉滞后面板模型和多层自回归模型。第三,中介模型的整合,如交叉滞后面板模型与多层线性模型整合为多层自回归模型。第四,中介检验方法的发展,建议使用Monte Carlo、Bootstrap和贝叶斯法进行纵向数据的中介分析。总结出一个纵向数据的中介分析流程并给出相应的Mplus程序。随后展望了纵向数据的中介分析的拓展方向。     

A Regression Framework for Causal Mediation Analysis with Applications to Behavioral Science

We introduce and extend the classical regression framework for conducting mediation analysis from the fit of only one model. Using the essential mediation components (EMCs) allows us to estimate causal mediation effects and their analytical variance. This single-equation approach reduces computation time and permits the use of a rich suite of regression tools that are not easily implemented on a system of three equations. Additionally, we extend this framework to non-nested mediation systems, provide a joint measure of mediation for complex mediation hypotheses, propose new visualizations for mediation effects, and explain why estimates of the total effect may differ depending on the approach used. Using data from social science studies, we also provide extensive illustrations of the usefulness of this framework and its advantages over traditional approaches to mediation analysis. The example data are freely available for download online and we include the R code necessary to reproduce our results.     

Introduction to the Special Issue on Mediation Analyses: What If Planetary Scientists Used Mediation Analysis to Infer Causation?

Mediation analyses have become extremely popular in the social sciences generally, and in social psychology specifically, because they seem to grant the researcher the ability to draw causal conclusions from correlational data. But this is illusory. Correlation provides poor quality evidence of causation not only in the case of zero-order correlations but also in the case of more complex mediation analyses. The articles in this special issue provide compelling arguments as to why mediation analyses make a weak case for actual mediation. My goal is to cognitively prime the reader for these articles by presenting analyses pertaining to the mean orbital momentum, kinetic energy, and conversion energy of the eight planets of our solar system. Our solar system provides a dramatic case in point where mediation analyses provide blatantly wrong conclusions.     

Parent Alienation Syndrome: A Two Step Approach Toward a Solution

This paper deals with the steps involved in mediation before or while legal action and the courts intervene to force a solution by law to often tragic, acrimonious human interaction between former partners. Professionals such as qualified psychologists or psychiatrists should be able to offer a full course of mediation before partners begin divorce proceedings or decisions regarding the placement of children with one party or the other. A 10-year study involving 16 cases provides evidence that the initial use of mediation may well be superior to the initial use of the adversarial system on its own.     

A family therapy perspective on mediation

Many times, family therapists are both the first to learn that a couple may separate and the last to see them in the same consultation room, still relating to each other and the same professional before the adversarial system takes over. Mediation offers a viable alternative to that system because clients are helped to speak directly and craft the decisions that will delineate their move toward separate lives. Mediation is defined and the divorce process demystified, and the similarities and differences between mediation and therapy are discussed. Brief examples and a longer case discussion are provided to illustrate the mediation process. A familiarity with this process will enable therapists to hold more informed discussions about mediation with their clients and invite them to consider a process that is congruent with many of the values of family therapy.     

类别变量的中介效应分析

在心理学和其他社科研究领域,研究者能熟练地进行连续变量的中介效应分析,但面对自变量、中介变量或(和)因变量为类别变量的中介效应分析,研究者往往束手无策。在阐述类别自变量中介分析方法的基础上,我们建议使用整体和相对中介相结合的类别自变量中介分析方法,并给出了分析流程。以二分因变量为例,讨论了中介变量或(和)因变量为类别变量的中介分析方法的发展过程(即尺度统一的过程),建议通过检验Za×Zb的显著性来判断中介效应的显著性。用二个实际例子演示如何进行类别变量的中介效应分析。最后展望了类别变量的中介效应分析研究的拓展方向。     

Predictors of Engagement in Family Mediation and Outcomes for Families that Fail to Engage

An important limitation to the effectiveness of family mediation in assisting separated parents is parents failing to engage in the mediation process. In 524 parents who presented to a telephone‐based mediation service, 113 (22%) initiating parents withdrew from mediation before the other parent was invited to participate, 241 (46%) initiating parents had respondent parents who declined to participate in mediation, and 170 cases (33%) completed mediation. We tested whether socio‐demographic variables, psychological distress, coparental acrimony, parenting problems, or children's behavioral difficulties predicted mediation engagement. High interparental acrimony predicted failure to engage in mediation, but none of the other variables predicted mediation engagement. We followed a sample of 131 families that did not mediate and found they showed elevated psychological distress, acrimony, parenting problems and child adjustment difficulties, which remained unchanged 6 months later. Further research is needed to explore strategies to enhance respondent parent engagement with mediation, and to address the negative outcomes for those separated families not proceeding with mediation.     

A Comparison of the Effectiveness of Substantive and Contextual Mediation Tactics1

The effectiveness of three mediation tactics was compared in two laboratory studies. It was hypothesized that a content mediation procedure which involved identifying the priorities of both parties and suggesting a trade-off of low for high priority issues would be most effective in helping to resolve the dispute, followed by an issue identification mediation procedure in which priorities were identified but no suggestions were made. A positive framing mediation procedure in which the benefits of a negotiated settlement were emphasized was expected to be somewhat less effective. In Study 1, 64 students played the role of company negotiator and interacted with a programmed citizen group negotiator. All three mediation tactics produced more satisfactory outcomes (higher joint payoffs) than did a no-mediation condition. In Study 2, 46 pairs of students negotiated with one another and received content mediation, issue identification mediation, positive framing mediation, or no mediation. Negotiators receiving content mediation achieved more satisfactory outcomes (higher joint profits) than did negotiators in the other 3 conditions. Results are discussed in terms of a contingency model of mediation effectiveness.