A Pathological View of Disease

This paper is a response to Christopher Boorse's recent defense of hisBiostatistical Theory (BST) of health and disease. Boorse maintains that hisconcept of theoretical health and disease reflects the ``consideredusage of pathologists.' I argue that pathologists do not use ``disease' inthe purely theoretical way that is required by the BST. Pathology does notdraw a sharp distinction between theoretical and practical aspects ofmedicine. Pathology does not even need a theoretical concept of disease. Itsfocus is not theoretical, but practical; pathology's goal is to contribute tothe healing of patients. Pathology, even experimental pathology, is notvalue-free. Not only ``disease' but also such terms as ``nerve' and ``organ'are laden with conceptual values.     

Defining Death for Persons and Human Organisms

This paper discusses how alternative concepts of personhood affect the definition of death. I argue that parties in the debate over the definition of death have employed different concepts of personhood, and thus have been talking past each other by proposing definitions of death for different kinds of things. In particular, I show how critics of the consciousness-related, neurological formation of death have relied on concepts of personhood that would be rejected by proponents of that formulation. These critics rest on treating persons as qualitative specifications of human organisms (Bernat, Culver, and Gert) or as identical to human organisms (Capron, Seifert, and Shewmon). Since advocates of the consciousness-related, neurological formulation of death are not committed to either of these views of personhood, these critics commit the fallacy of attacking a straw man. I then clarify the substantive concept of personhood (Boethius, Strawson, and Wiggins) that may be invoked in the consciousness-related, neurological formulation of death, and argue that, on this view and contra Bernat, Culver, and Gert, persons have always been the kind of thing that can literally die. I conclude by suggesting that the discussion of defining death needs to focus on which approach to personhood makes the most sense metaphysically and morally.     

健康行动过程取向模型的发展与前景

健康行动过程取向(HAPA)模型的提出源于健康行为社会认知模型的发展和Bandura社会认知理论的应用。在HAPA中, 健康行为变化被视为一个包括行为产生、保持和恢复在内的连续过程; 结果预期、危险感知、三种自我效能感和两类计划被用来解释意图的形成及其向行动的转化; 两个阶段的划分有助于区分三类干预对象, 建议实施菜单式干预。HAPA模型具有明显的理论优势, 也引发了有关模型实质的争论。当前和未来的研究旨在考察更多的自我调节变量、检验因果模型, 在健康行为的多个领域开展应用和干预研究。     

退休人员的应付方式对其心理健康的调节作用研究

本文对298名退休人员做了问卷研究,其结果表明：1．退休人员的应付方式受文化程度影响,高文化程度的退休人员比中、低文化程度的退休人员更多采用面对与探索的应付方式,更少采用幻想和退避的应付方式;2．退休人员原有社会角色丧失后应付方式对其心理健康的调节作用是,社会联系减少对退休人员的心理健康有直接的影响;而社会联系减少、职务地位丧失、经济收入降低共同通过退避、幻想与淡化三种应付方式间接影响心理健康。     

试论老子的养生观

老子的养生观根植于其博大精深的哲学思想;老子的养生思想是我国古代养生思想的理论基础,几乎所有的养生家和医学家都受到其养生思想的影响,被后世诸多大家加以继承、借鉴和发扬;老子的养生观主要有“勤行自律”、“三分长寿法”、“静以养神”、“顺应自然”、“虚心实腹、弱志强骨”、“恬淡寡欲”、“淡泊名利、功成身退”和“咽津养生”。     

当今中国人人际关系与身心健康的关系──社会心理医学研究

从全国29个省、市、自治区回收的1433份有效问卷的统计结果显示,人们的人际关系与身体健康和心理健康是密切关联、相互影响的,人际关系高度影响身体健康和心理健康,但其对于心理健康的影响作用,比之对身体健康更大。     

"中小学生心理健康"公众观的调查和分析

本研究调查分析了家长、教师对中小学生心理健康判断标准的认识.因素分析表明,家长主要强调四个因素"精神和神经病症"、"良好品行"、"健康人格"和"循环性";教师则强调五个因素"精神分裂症状"、"神经质"、"好学生标准"、"不良人格"和"不良品行".公众对于情、意、个性及社会适应等同心理健康的关系认识较为清楚,但对认知、品行及体征与之的关系认识则片面和模糊."好学生标准"对判断有重要影响.     

论希波克拉底的医学哲学思想

被尊称为"西方医学之父"的希波克拉底同时也是当之无愧的"医学哲学之父".希波克拉底的医学哲学思想具有源于而不囿于自然哲学的特征;希波克拉底为医学哲学铸造了基本的理论范式:他对医学哲学的研究对象、研究方法、临床认识主体的人文品格等诸多问题有着原创性的论述,他对医学实践中的普遍问题的研究如医学性质、早期诊断、预后分析、病人个体差异、遗传现象、生理与心理的关系、误诊误治等,为医学哲学理论框架的形成奠定了坚实的基础.     

临床决策:医学哲学研究的一个重要领域

临床决策研究已成为临床医学中的一个重要领域.当下的临床决策问题涉及到医学信息学、循证医学、费用-效益评估、卫生技术评估、医学伦理与法律等学科领域.因此在临床决策中单一的经验-描述的研究纲领已不适应当代医学发展的需要,需要引入综合的决策方法.临床决策问题也为医学哲学研究提供了一个极佳的思想实验场所.临床决策的多维度研究,对于打通学科之间的壁垒,架构科学与人文之间的桥梁,更深刻地理解和把握医疗保健的整体性,使临床医疗达到最佳疗效具有重要意义.     

A Moorean paradox of desire

A prevalent assumption among philosophers who believe that people can intentionally deceive themselves (intentionalists) is that they accomplish this by controlling what evidence they attend to. This article is concerned primarily with the evaluation of this claim, which we may call ‘attentionalism’. According to attentionalism, when one justifiably believes/suspects that not-p but wishes to make oneself believe that p, one may do this by shifting attention away from the considerations supportive of the belief that not-p and onto considerations supportive of the belief that p. The details of this theory are elaborated, its theoretical importance is pointed out, and it is argued that the strategy is supposed to work by leading to the repression of one's knowledge of the unwelcome considerations. However, I then show that the assumption that this is possible is opposed by the balance of a relevant body of empirical research, namely, the thought-suppression literature, and so intentionalism about self-deception cannot find vindication in the attentional theory.     

健康动机的研究进展与展望

健康动机是人们想要健康的愿望, 是影响人们健康行为的一个决定因素。本文回顾了有关健康动机的理论、测量和实证方面的研究。比较值得推崇的健康动机的动力过程理论认为健康动机是一个内在的动力过程, 并把健康动机对健康行为的作用分为四个阶段: 产生健康愿望、制定计划、采取行动和对行动的坚持。对健康动机的测量主要有一般测量和具体测量两类。实证研究表明健康动机能促进个体的健康行为并由此提高其健康水平。     

区域卫生规划与卫生资源配置

区域卫生规划与卫生资源配置的关系密不可分,同时也是解决医疗保健供需平衡的重大举措和主要手段。首先提出了区域卫生规划的现实意义和基本理论,并分析了建立区域卫生规划对解决以上问题怎样产生积极的影响。     

根系生命:医疗卫生体制道德根基探微——《医疗卫生体制改革进程与前景的生命道德思考》一书评介

2009年初启动的深化医疗卫生体制改革也即“新医改”,既是改革开放前30年改革的继续,也是全新改革进程的开始。10年来医改成就惠及人民并得到广泛肯定,体现了改革在经济制度上科学性与伦理性的统一。站在生命道德哲学立场上反观改革的进程,可以为改革方向和道路的合理性提供道德哲学的辩护。医疗卫生体制及其改革是经济学、公共管理学、政策科学等社会科学的研究领域,也是涵括诸多哲学课题的认识和实践领域,生命道德哲学提供的是价值理性的思考。     

健康与疾病的划界：困境与出路

简单回顾了医学对健康和疾病的认识与划界,重点分析了生物医学模式的划界标准、前提,以及它在医学认识与实践中面临的困境。在此基础上,探讨了19世纪以来医疗界走出困境的主要路径。     

Access to Health Care for Transgendered Persons: Results of a Needs Assessment in Boston

SUMMARY

The transgender community is a population group that has experienced an increase in visibility, with only a small, concomitant increase in understanding. This study reports on four focus groups, in which 34 transgendered individuals discussed their experiences and interactions with the health care system.

The specific aims of the study were as follows:

• Identify the health needs of transgender and transsexual (TG/TS) individuals;

• Hear the experiences and perceptions of TG/TS individuals who are using the current health care system;

• Identify any barriers to obtaining services, support and/or resources;

• Assess the extent to which health care providers and systems are able to offer sensitive, high quality and user friendly services that meet TG/TS consumers' needs; and

• Identify ways that health care services can be enhanced to better meet the needs of the target population.

What the study found was a system that was anything but high quality in meeting the needs of TG/TS individuals. Ignorance, insensitivity and discrimination appear to be the norm. Specifically, the focus groups found the following:

• Transgendered and transsexual persons frequently encounter providers who will not treat them and blatantly say so. There is a need for education and a change in anti-discrimination law needed to change this.

• The lack of provider training on transgender issues creates insensitivity to simple issues of respect for trans people. One example is the unwillingness to address TG/TS people by the pronoun preferred by the patient/client.

• Many providers lack the knowledge to adequately treat many of the routine health care needs of TG/TS individuals when such treatment relates to issues of hormone use, gynecological care, HIV prevention counseling, or other concerns related to gender or sexuality.

• Providers frequently refer to trans issues in unrelated health care situations such as setting a broken bone, filling a cavity or treating a cold. Greater familiarity with the health care needs of the trans population would reduce such incidents.

• Mental health and substance abuse treatment providers need additional training in order to work cooperatively with TG/TS clients to identify when gender issues are or are not relevant to specific mental health or substance abuse treatment episodes. Sometimes gender issues are central to mental health or substance abuse treatment, sometimes they are peripheral and sometimes they are unrelated.

• Discrimination in health insurance is the rule, not the exception. There is a need for education to encourage policy changes on the part of insurers and public policy changes on the part of legislators and regulators.

     

目前国内常用心理健康量表的回顾与反思

对国内近10多年来常被用于评鉴心理健康的7大类量表的分析结果表明,我国常用心理健康评估工具具有逐年增加、从单纯引进转向创造性地自编、自编量表的内容从学习与人格向多领域延伸、自编量表的方法从不完全到完全的特点。已编制出一些信效度较高的量表,但是仍存在一些问题。存在的主要问题是量表的信效度较低、自编量表有低水平重复现象、测量积极心理的量表少。     

《医学与哲学:人文社会医学版》2001-2006年的论文作者分析

依据文献计量学原理,探讨《医学与哲学：人文社会医学版》杂志以及该杂志改版后的“人文社会医学版”（2005年9月）载文作者、机构及地区情况,客观地反映了我国医学哲学的研究现状和发展趋势。讨论《医学与哲学：人文社会医学版》发文各项统计数量的意义。《医学与哲学：人文社会医学版》的作者队伍分布范围广,具有一定的国际性质。     

中国人的人格与心理健康

系统总结了中国人人格与心理健康之间关系的研究。首先,对心理健康的含义进行了理论分析,提出了心理健康由心身症状的缺失、行为抑制的降低、自我和谐水平的提高以及主观幸福感的提升等4个不同的水平构成,并对人格与心理健康的4个水平之间的关系进行了综述,特别分析了人格与心理健康的结构方程模型,以及不同人格维度对心理健康的促进、抑制、及促进-抑制作用。文中还提出了建立中国人的人格耐受性模型的设想,并对将来研究的方向进行了讨论     

Health and Social Services for Male-to-Female Transgender Persons of Color in San Francisco

SUMMARY

This article presents findings from an investigation of health needs, service utilization, and perceived barriers to services among male-to-female (MtF) transgender persons of color in San Francisco. Focus groups (n = 48) and survey interviews (n = 332) were conducted with convenience samples recruited from the community. Participants reported a range of health and social services needed during the previous year, with African-Americans and Latinas showing particularly strong service needs. Rates of utilizing services were high for basic health care but lower for social services, substance abuse treatment, psychological counseling, and gender transition-related medical services. No significant ethnic group differences in health service utilization were found. Qualitative findings evinced the call for transgender-specific programs and advanced provider training on transgender issues such as hormone use, gender transition, HIV/ AIDS care and prevention, substance abuse, and mental health problems.     

老年人健康风险因素与干预意愿研究——以高校退休教师调查为例

为了解高校离退休教师健康风险因素与干预意愿, 调查了1 342名高校退休教师的健康状况并收集其健康体检数据, 对比分析其健康风险因素危险度评分、慢性病发病率及其干预意愿。结果显示, 健康风险因素危险度评分为51.26±8.91分;慢性病发病率为68.24%, 年龄增加危险度评分和发病率数值增加, 不同年龄段数据对比差异有统计意义 (P<0.01) ;不同性别、职业、职称的差异无统计意义 (P>0.05) 。干预意愿依序是健康管理、健康教育和健康咨询。认为高校离退休教师健康风险因素及慢性病发病率随年龄显著增加, 健康管理应该是未来风险干预的方向。