普通儿科住院患者自动出院的原因分析

单中心回顾性调查2011年1月~2012年11月普通儿科住院患儿自动出院1 088例,自动出院率18.7%（1 088/5 827）,其主要原因集中在症状或体征改善、经济困难、家庭因素、依从性差、医患矛盾、疗效欠佳、病房环境差、转院治疗等.儿科住院患者选择自动出院是对医疗制度与管理、医疗水平、服务态度、沟通技巧、家庭背景、社会救助等因素的综合考量.做好社会、医疗机构和医疗制度三方面积极救助环节是改善医患矛盾、减少患儿自动出院的有效措施.     

Not Just “Study Drugs” for the Rich: Stimulants as Moral Tools for Creating Opportunities for Socially Disadvantaged Students

An argument in the cognitive enhancement literature is that using stimulants in populations of healthy but socially disadvantaged individuals mistakenly attributes pathology to nonpathological individuals who experience social inequalities. As the argument goes, using stimulants as cognitive-enhancing drugs to solve the social problem of poorly educated students in inadequate schools misattributes the problem as an individual medical problem, when it is really a collective sociopolitical problem. I challenge this argument on the grounds that not all types of enhancement have to be explained in medical terms, but rather at least one conception of enhancement can be explained in social terms—opportunity maintenance. Therefore, I propose that as a moral requirement we ought to explore whether stimulants could be a means of remedying underprivileged children's experiences of social inequalities that are borne from inadequate schools for the sake of increasing their chances for opportunities and well-being.     

Characterizing the Linguistic Chameleon: Personal and Social Correlates of Linguistic Style Accommodation

Linguistic style accommodation between conversationalists is associated with positive social outcomes. We examine social power and personality as factors driving the occurrence of linguistic style accommodation, and the social outcomes of accommodation. Social power was manipulated to create 144 face‐to‐face dyadic interactions between individuals of high versus low power and 64 neutral power interactions. Particular configurations of personality traits (high self‐monitoring, Machiavellianism and leadership, and low self‐consciousness, impression management and agreeableness), combined with a low‐power role, led to an increased likelihood of linguistic style accommodation. Further, greater accommodation by low‐power individuals positively influenced perceptions of subjective rapport and attractiveness. We propose individual differences interact with social context to influence the conditions under which nonconscious communication accommodation occurs.     

Empirical correlates of the MMPI-2 Restructured Clinical (RC) Scales in psychiatric inpatients

We identified empirical correlates of the MMPI-2 Restructured Clinical (RC) scales in 1,872 male and 498 female psychiatric inpatients drawn from 2 large tertiary care medical centers. We generated clinical criteria from a systematic review of the patients' intake and discharge medical records. We report zero order correlations between RC scales and clinical criteria and relative risk ratios for dichotomous variables. We found the RC scales to be correlated with conceptually relevant criteria such that for each scale, we identified significant increases in the risk for a variety of emotional, cognitive, and behavioral problems among individuals whose T score exceed 64.     

The Marxist-Leninist concept of personality and its significance for the integration of psychiatric patients

The Marxist view of man as the "ensemble of social relations" is a prerequisite for understanding the personality of the mentally handicapped. The dialectic relationship between biological and social events permits the conclusion that restrictedly developed versions of the personality must be accepted as natural. The particular obligation of society is to ensure the all-round integration, encouragement and care of such handicapped persons. The task of the medical fraternity is to establish a comprehensive system to prevent such handicaps.     

Mental health care and the politics of inclusion: A social systems account of psychiatric deinstitutionalization

This paper provides an interpretation, based on the social systems theory of German sociologist Niklas Luhmann, of the recent paradigmatic shift of mental health care from an asylum-based model to a community-oriented network of services. The observed shift is described as the development of psychiatry as a function system of modern society and whose operative goal has moved from the medical and social management of a lower and marginalized group to the specialized medical and psychological care of the whole population. From this theoretical viewpoint, the wider deployment of the modern social order as a functionally differentiated system may be considered to be a consistent driving force for this process; it has made asylum psychiatry overly incompatible with prevailing social values (particularly with the normative and regulative principle of inclusion of all individuals in the different functional spheres of society and with the common patterns of participation in modern function systems) and has, in turn, required the availability of psychiatric care for a growing number of individuals. After presenting this account, some major challenges for the future of mental health care provision, such as the overburdening of services or the overt exclusion of a significant group of potential users, are identified and briefly discussed.     

The effectiveness and ethical justification of psychiatric outpatient commitment

Studies link involuntary outpatient commitment with improved patient outcomes, fueling debate on its ethical justification. This study compares inpatient utilization for committed outpatients in the 1990s with those who were not under outpatient civil commitment orders. Findings reveal committed outpatients had higher utilization of inpatient services and restraint episodes prior to their commitment compared with a control group. Committed outpatients also were more likely to have been on discharge status at the time of admission, have been admitted involuntarily under emergency legal procedures, and have had a greater number of admissions and hospital days prior to their commitment. Following commitment, patients had fewer hospitalizations, shorter lengths of stay, fewer seclusion episodes and hours, and fewer restraint episodes and hours. Findings are discussed within the context of parens patriae and therapeutic jurisprudence, and support medical and public policy justifications for ethical uses of outpatient civil commitment laws for seriously mentally ill patients.     

Suicide-related behavior after psychiatric hospital discharge: Implications for risk assessment and management

Suicide-related behavior (SRB), including suicide attempts and instrumental SRB, occurs far more often than completed suicide and exacts a toll on patients, their loved ones, and society. Nevertheless, few prospective studies of SRB have been conducted. In this study, 954 patients were interviewed in a psychiatric hospital and then followed for one year after discharge. During this one-year period, nearly one-quarter of patients (23%) engaged in SRB, with the rate of suicide attempts (18%) three times greater than the rate of instrumental SRB (5%). Risk factors for SRB were demographic (White ethnicity, female gender), clinical (past SRB, depression, impaired functioning), and contextual (unemployment, large social networks). In contrast with other studies, there was no "peak" in the risk of SRB shortly after hospital discharge. Instead, patients' rate of SRB was relatively constant over the one-year follow-up. Implications for risk assessment and management in acute inpatient settings are discussed.     

Asylum Seekers,Hotspot Approach and Anti-Social Policy Responses in Greece (2015–2017)

This article discusses the social and housing conditions of refugee flows to Greece in the period 2015–2017. A review of the main institutional initiatives taken by the Greek state to manage the refugee crisis, following pressure from the EU, indicates that the main form of accommodation for asylum seekers is the hotspot. In the second part of the article, field research seeks to examine the fundamental social problems encountered in the hotspots. Inappropriate housing conditions, problematic hotspot management procedures, as well as onerous working conditions for the staff are only some of the issues, which make it clear that such forms of accommodation violate fundamental human rights.     

Something Old, Something New: Evidence of Self-Accommodation to Gendered Social Change

Two studies examined how individuals adapt the self to social trends—in particular, when the social roles of the gender ingroup change, do people readily leave behind traditional roles in favor of nontraditional roles? We hypothesized that self-relevant cognitions and behaviors would accommodate to societal change, and we found that this accommodation took the shape of greater acceptance of nontraditional roles alongside continued acceptance of traditional roles. Experiment 1 included 112 undergraduates from the Midwestern U.S. who learned about social change or social stability by reading articles ostensibly published in a newspaper. Individuals who learned about social change for their gender ingroup, relative to those learning about social stability, projected greater personal success in careers, particularly for gender-nontraditional careers. Experiment 2 examined behavioral responses to social change in a sample of 198 female undergraduates from the Midwestern U.S. Participants learned about social change or social stability and then chose to view either a website focused on physical appearance (i.e., traditional choice) or leadership (i.e., nontraditional choice). Behavioral responses to social change reflected accommodation to the anticipated social structure: Individuals who learned about social change chose to view information about nontraditional rather than traditional roles. These studies provide initial experimental evidence investigating how individuals adapt the self to the social structure.     

Enhancing Well‐being of Homeless Individuals by Building Group Memberships

There is growing recognition that social isolation and a lack of connectedness with social groups is one of the reasons why the subjective well‐being of homeless individuals is generally worse than the rest of the population. Past research amongst a range of populations suggests that the ability of an individual to take on new group memberships and/or their ability to maintain their memberships in meaningful groups is an important predictor of well‐being. In a mixed method study (N = 119), we examined the extent to which experiences at homeless accommodation form building blocks for the formation of multiple group memberships and to what extent this predicts positive well‐being. Qualitative analysis reveals the importance of feeling connected to the homeless service and supported by homeless accommodation staff. Linking these data to quantitative data from a second wave, we found that these experiences predicted well‐being. These findings provide further support for a strength‐based approach to homelessness, by providing insights into the ways that experiences at homeless accommodation can contribute to the development of multiple group memberships (i.e. social capital), and enhance the well‐being of those experiencing, and exiting, homelessness. Copyright © 2016 John Wiley & Sons, Ltd.     

Confucianism,Perfectionism, and Liberal Society

Confucian scholars should satisfy two conditions insofar as they think their theories enable Confucianism to make contributions to liberal politics and social policy. The liberal accommodation condition stipulates that the theory in question should accommodate as many reasonable conceptions of the good and religious doctrines as possible while the intelligibility condition stipulates that the theory must have a recognizable Confucian character. By and large, Joseph Chan’s Confucian perfectionism is able to satisfy the above two conditions. However, contrary to Chan and many other Confucian scholars, I argue that any active promotion of Confucianism will violate the liberal accommodation condition. I propose the “wide view of moderate perfectionism,” which enables Confucianism to shed light on a wide range of political and social issues without promoting Confucianism actively. Thus, I present a new approach to the long-standing question of how Confucianism may improve political and social development in a liberal society.     

The face of love: spontaneous accommodation as social emotion regulation

The present research investigated whether accommodation, typically formulated as the tendency to deliberately inhibit a destructive reaction in response to a partner's destructive behavior, could also occur spontaneously. Supporting this notion, results of the first study revealed that participants respond to their partner's angry face with a spontaneous smile, whereas strangers' angry faces are mimicked and thus lead to a spontaneous frown. Importantly, the facial EMG data are moderated by participants' daily interaction styles: People perceiving themselves in a communal relationship show spontaneous acts of accommodation, whereas this is not the case for people in exchange relationships. The moderation occurred in our first (spontaneous) and third (forced accommodation) studies. The results of the second study replicated the first study in that participants in communal relationships frowned less toward partner's subliminally presented angry faces but more to their sad faces. The authors discuss their findings as spontaneous social emotion regulation.     

Catatonic signs in medical and psychiatric catatonias

Patients with psychiatric catatonias vs those with medical catatonias may differ in catatonic phenomenology. To determine if these could be distinguished, the following methods were used: 1) a review of the literature; 2) a chart review; and 3) a prospective series. The literature review of 467 reports of medical catatonias yielded 240 cases that met research criteria. A chart review of 47 episodes of catatonia revealed a higher frequency of negativism in patients with medical catatonias. Prospective data obtained from rating scales revealed an increased frequency of echophenomena in patients with medical catatonias; however, no discriminate pattern of catatonic signs for medical catatonias arose. Overall, catatonic signs appear to share a similar distribution. These findings suggest that psychiatric and medical catatonias are indistinguishable based upon catatonic sign.     

Conversation level syntax similarity metric

The syntax and semantics of human language can illuminate many individual psychological differences and important dimensions of social interaction. Accordingly, psychological and psycholinguistic research has begun incorporating sophisticated representations of semantic content to better understand the connection between word choice and psychological processes. In this work we introduce ConversAtion level Syntax SImilarity Metric (CASSIM), a novel method for calculating conversation-level syntax similarity. CASSIM estimates the syntax similarity between conversations by automatically generating syntactical representations of the sentences in conversation, estimating the structural differences between them, and calculating an optimized estimate of the conversation-level syntax similarity. After introducing and explaining this method, we report results from two method validation experiments (Study 1) and conduct a series of analyses with CASSIM to investigate syntax accommodation in social media discourse (Study 2). We run the same experiments using two well-known existing syntactic metrics, LSM and Coh-Metrix, and compare their results to CASSIM. Overall, our results indicate that CASSIM is able to reliably measure syntax similarity and to provide robust evidence of syntax accommodation within social media discourse.     

从医师的视角浅析医疗差错的辩证观

医疗差错是影响医疗安全的最重要因素。有效预防和正确处理医疗差错,需要以科学辩证的认识为前提。当前,我国医院管理实践在一定程度上缺乏对医疗差错的辩证认识,导致在处理上存在些许不足。本文从医师的视角,对如何辩证地认识医疗差错进行浅述。指出,医疗差错在相当程度上源于人的出错之天性和医学的复杂性,广泛存在于医疗实践中,发生具有必然性;虽然从表象上看,医疗差错的原因是局部的,但其本质的原因是系统性的;医疗差错是医疗安全系统运行状况的"指示灯",有助于及时地了解安全系统的薄弱环节,为完善和提升系统安全、提高医疗服务水平提供契机。     

Profiles of Latino Adaptation at Elite Colleges and Universities

Drawing on frameworks of blocked opportunity, social identity, and immigrant adaptation processes, we tested competing hypotheses about Latino achievement, focusing on variation in the ways in which Latino students at elite colleges perceive and navigate minority status. Using data from 916 participants in the National Longitudinal Survey of Freshmen, cluster analyses identify three profiles of perceived opportunity and social exclusion. Students in the assimilation profile do not believe minority status impacts opportunity. Those in the accommodation profile believe unequal opportunity can be overcome by individual effort. Finally, students in the resistance profile are most skeptical about opportunity for minorities, and these students also report more on-campus ethnic prejudice than their peers. As freshmen, perceived prejudice predicted lower grades only for students in the accommodation profile; however, accommodators later report higher academic achievement than resisters as sophomores. We discuss the conceptual utility of examining multiple beliefs about opportunity in concert.     

Children and adolescents discharged from public psychiatric hospital: Evaluation of outcome in a continuum of care

Ninety children and adolescents admitted to two state-operated psychiatric hospitals were followed from the time of their admission through one year post discharge. Data were collected from the children and adolescents, their families and clinicians at three intervals (during hospitalization, three months post discharge, and one year post discharge) to identify demographic, clinical, and service history characteristics of the children and adolescents, as well as to track their placement and other dispositional status following discharge from the hospital. The data indicated that the children and adolescents were seriously emotionally and behaviorally disturbed, came from families which were economically disadvantaged, and did not typically live in two-parent families. While the majority of the children and adolescents received recommended aftercare services during the three months following discharge from the hospital, there was a decline in placement stability for the children at the one-year post discharge followup. The most important predictors of successful outcome at discharge were living with a family member at the time of hospitalization and the participation of the family in the treatment planning during hospitalization.     

Formalising social representation to explain psychiatric symptoms

Recent work in social cognition has moved beyond a focus on how people process social rewards to examine how healthy people represent other agents and how this is altered in psychiatric disorders. However, formal modelling of social representation has not kept pace with these changes, impeding our understanding of how core aspects of social cognition function, and fail, in psychopathology. Here, we suggest that belief-based computational models provide a basis for an integrated sociocognitive approach to psychiatry, with the potential to address important but unexamined pathologies of social representation, such as maladaptive schemas and illusory social agents.