人类增强技术的伦理考量

人类增强技术作为利用高新技术提高人类机体功能或能力的一种技术干预手段,是对人类身体进行的一种技术上的改变,这必然在“人是什么”、社会公平、安全与自主权等方面引发一定的社会伦理问题。而这正是对“人是目的,而不仅仅是手段”这一绝对律令的违背。由此需要对人类增强技术进行全面的评估,从坚守“增强底线原则”、相关法规的制定和加强伦理审查等方面采取有效对策,预防或减少不良后果的产生。这样才能保证人类增强技术的发展做到有效性与合理性、真理性与价值性、安全性与效益性的完美统一。     

纳米认知增强技术的伦理考量

纳米认知增强技术是在纳米尺度上对大脑进行直接干预,从而提升正常个体认知功能的技术。该技术以其在微观环境下的高效和精准而独得宠爱,但也可引发安全和风险、自主和尊严、公平与正义以及“过时人”方面的伦理问题。在该技术的开发和将来应用过程中,必须遵循生命伦理原则,并从风险评估、伦理审查、研发主体和使用主体的道德约束和责任感、监管体系、社会价值导向和舆论环境等多角度、全方位入手,实施积极有效的对策,以使其始终沿着促进人类福祉的道路发展。

     

癌症控制，防大于治——从《中国癌症预防与控制规划纲要（2004—2010》谈起

世界卫生组织在20世纪80年代初,提出了癌症三级预防的概念,2004年中国卫生部门也制定了《中国癌症预防与控制规划纲要(2004-2010)》,提出把癌医学研究的重点从治疗转向预防。通过多种形式的癌症科普宣教,提高全民和全社会对癌症防治工作的认识,让科学防治观念真正为公众普便知晓,这是目前条件下减少癌症发病率,提高早诊率的重要措施。     

癌症控制,防大于治--从《中国癌症预防与控制规划纲要(2004-2010)》谈起

世界卫生组织在20世纪80年代初,提出了癌症三级预防的概念,2004年中国卫生部门也制定了<中国癌症预防与控制规划纲要(2004-2010)>,提出把癌医学研究的重点从治疗转向预防.通过多种形式的癌症科普宣教,提高全民和全社会对癌症防治工作的认识,让科学防治观念真正为公众普便知晓,这是目前条件下减少癌症发病率,提高早诊率的重要措施.     

对疾病危险因素控制和癌症筛检的考量

目前各项疾病危险因素的“危险性”不够高, 所以通过药物控制单个危险因素来预防疾病的效益很低。癌症筛检虽然使检出的癌症病人增加, 但并不能降低死亡率。因此建议, 在控制慢性病危险因素时, 应首选安全、低成本的有效干预方式方法;采用药物控制手段时, 应优先在综合危险程度较高的人群使用;要努力寻找特异性更高的危险因素指标, 以缩小危险人群;要进一步加强临床研究, 根据国情确定我国自己的诊断与治疗标准。癌症筛检的目标是要检出真正可从治疗中受益的病人, 特别是鉴别出无需治疗的“停滞型”癌症。无论是对疾病危险因素的控制, 还是对癌症筛检, 在改进技术的同时, 更重要的是要从根本上树立正确的健康和医疗观念。     

浅谈“恐惧”、“恐慌”与军人职业的联系

习近平主席在12届全国人大一次会议解放军代表团全体会议上的重要讲话中鲜明提出:建设一支"听党指挥、能打胜仗、作风优良"的人民军队这一党在新形势下的强军目标。这一目标的实现是建立在官兵具有强健的体魄,健康的身心,全面发展的基础之上的。但是,目前我军心理健康情况仍存在问题,对思想政治教育工作的开展造成了一定的影响和阻碍,本文通过对恐惧、恐慌的解读,分析讨论与军人职业特点的联系,通过分析和思考提出了如何驾驭恐惧、克服恐慌的三种方法,旨在为部队提供理论依据和指导。     

健康、恐慌与道德——论Fitzpatrick《健康的暴政:医生及生活方式的控制》

健康与道德、健康与政治及健康与社会是迈克尔·菲茨帕特里克在《健康的暴政:医生及生活方式的控制》一书中以医生角度进行反思的三个基本主题。其中对于健康与道德的反思是全书的理论支点, 这一关系的讨论以“健康恐慌—道德恐慌”为起点, 以健康是否成为一种新的宗教而结束。其中指出以健康对生活方式进行控制会产生僭越并形成一种暴政, 同时进一步提出医学应该与道德划清界限, 以防止医学用健康的名义给予人过多的控制, 使自身成为束缚人自由的枷锁。     

电影《传染病》对消除社会恐慌与道德危机的启示

社会恐慌与道德危机是疾病传播所产生的两个重要社会效应。《传染病》虽是一部虚构电影作品,但其中对于疾病与恐慌以及私利与道德冷漠的严肃探讨,能够为现实提供警醒和反思借鉴。从疾病传染到恐慌的社会性传播,从社会恐慌到道德危机的产生,恐慌事实上成为了疾病传染与道德危机之间的一个关键反思节点。因疾病而引发的社会恐慌虽然源自知识领域,但其社会效应却作用于道德领域,因此,疾病恐慌的消除既有赖于知识的进步,也依赖于信息的公开。

     

疫苗安全恐慌的心理成因与应对策略

疫苗安全恐慌是由负面报道或阴谋论引发的公众对接种安全性与有效性的怀疑,其后果是导致大面积的接种率或接种意愿短期骤降,它可从信息内容、个体层面的风险感知和群体层面的风险氛围三方面进行解释。公共卫生工作者可通过重建公众对疫苗可预防性疾病的风险感知等策略来预防和应对疫苗安全恐慌,网络平台也可通过信息治理以遏制错误信息的流行,但仍需发展系统的理论以理解疫苗安全恐慌的形成机制并促进公众对正面疫苗信息的积极分享。     

告知癌症患者真实诊断信息的策略

癌症死亡率高的特点,使人们“谈癌色变”.由于考虑到癌症患者得知诊断结果后产生不良影响,现在我国大多数临床医生还在采用隐瞒的告知方式.笔者通过对不告知癌症患者真实诊断的利弊分析以及告知真实诊断的理由论述,提出解决的策略,旨在帮助临床医生解决临床告知中的难题.     

Assessment of Panic Frequency: Reliability and Validity of a Time-Line Follow-Back Method

The purpose of this study was to investigate the reliability and validity of a Panic Attack Frequency Calendar (PAFC), modeled after a time-line follow-back (TLFB) procedure (e.g., Sobell & Sobell, 1979). The latter has been used for years to reliably and validly assess daily alcohol use through self-report over extended periods of time. Seventy-four adult individuals (ages 18–57) who had experienced a panic attack within the past 2 weeks completed a battery of self-report questionnaires, including retrospective frequency measures, and were administered an 8-week PAFC initially and a 10-week PAFC 2 weeks later. Half the participants self-monitored their panic attacks in a diary. The PAFC showed high stability over 2 weeks across several panic behavior variables. The PAFC was also shown to be a valid instrument in assessing panic frequency when compared with panic data obtained from the diary and the retrospective frequency measure.     

Intolerance of Uncertainty as a Contributor to Fear and Avoidance Symptoms of Panic Attacks

Panic disorder symptoms are persistent for 50–80% of cases even after treatment, resulting in experiences of disability and dissatisfaction in life. Previous research has focused on anxiety sensitivity (AS) and its dimensions as contributing to symptoms of panic disorder; however, recent research has suggested that intolerance of uncertainty (IU)—the tendency for a person to consider the possibility of a negative event occurring as threatening, irrespective of the actual probability of its occurrence—may also play a critical role. The current study was designed to assess the specific relationships between dimensions of IU (i.e. prospective IU and inhibitory IU) and the fear and avoidance symptoms associated with panic disorder. Participants included 122 community members (81% women) with a history of at least one panic attack who participated in a larger study on fear. Participants completed measures of AS, IU, and panic disorder symptoms. Correlation and regression analyses supported a significant and substantial relationship between AS, inhibitory IU, and panic disorder symptoms. Inhibitory IU accounted for relatively more variance in avoidance symptoms related to panic disorder than did the fears of physical sensations dimension of AS. As such, further investigation of the role of IU in panic disorder symptoms appears warranted. Comprehensive results, implications, and directions for future research are discussed.     

Mismanagement of Panic Disorder in Emergency Departments: Contributors, Costs, and Implications for Integrated Models of Care

Panic disorder (PD) is associated with the rapid onset of fear-related symptomatology, often somatic in nature. As a result, individuals with the disorder often fear that they are experiencing a life-threatening emergency and present in hospital emergency departments (EDs). As the operating heuristics of EDs are geared toward identifying organic causes and allow only brief physician–patient contact, the diagnosis of PD is more often than not overlooked. Those with the disorder go on to incur enormous costs as they seek out an explanation for their symptoms. Efforts to alleviate this problem, including increased physician education and the development of screening instruments, have been largely unsuccessful. The continued misidentification and mismanagement of this disorder argues for greater incorporation of mental health professionals into the ED, allowing collaborative efforts that recognize the relationship between physiological and psychological aspects of panic.     

综合医院惊恐障碍高误诊率引发的思考

惊恐障碍是一种急性焦虑障碍,属精神医学研究范畴。但惊恐障碍患者却反复在综合性医院就诊。目前国内综合医院尤其是基层综合医院普遍未设置精神科,非专科医生对惊恐障碍的识别率又非常低,误诊率甚至高达100%。作者就综合医院惊恐障碍高误诊率的原因、对策、展望与期待、较为理想的就医途径和治疗方法做一探讨。     

Dimensions of Anxiety Sensitivity and Their Relationship to Nonclinical Panic

The goal of the present study was to examine the factor structure of the Anxiety Sensitivity Index (ASI; S. Reiss, R. A. Peterson, D M. Gursky, & R. J. McNally, 1986) and the replicability, reliability, and validity of its dimensions in a nonclinical sample. One-thousand-and-seventy-one undergraduate volunteers completed the ASI and a modified version of the Panic Attack Questionnaire (PAQ; G. R. Norton, J. Dorward, & B. J. Cox, 1986). A principal components analysis, using oblique rotation and parallel analysis, yielded three ASI dimensions that were highly consistent with those reported in previously published studies. Individuals classified as nonclinical panickers scored higher than nonpanickers on the Physical Concerns and Cognitive Concerns subscales of the ASI. Although spontaneous panic attacks were not significantly related to scores on any ASI scale, the occurrence of panic attacks in the past month was related to higher scores on the Cognitive Concerns subscale. The results are discussed in terms of cognitive theories of panic, and limitations of the present study and directions for future research are addressed.     

Panic disorder and depression: A psychodynamic exploration of comorbidity

Eight of twenty-one patients presenting for treatment in an open trial of brief psychodynamic psychotherapy for panic disorder also carried the diagnosis of major depression. For the patients who completed the study, depression remitted as well as panic disorder. The authors highlight psychodynamic factors that they hypothesize may contribute to the significant overlap between panic disorder and depression, and describe three videotaped cases to illustrate these points.     

Prospective Evaluation of Perceived Control, Predictability, and Anxiety Sensitivity in the Pathogenesis of Panic

Increasing evidence suggests that anxiety sensitivity (AS) may be a premorbid risk factor for the development of anxiety pathology. Perceived control and predictability have also been implicated as factors relevant to the genesis of anxiety. The principal aim of this study was to extend this work to examine independent and interactive effects of perceived control, predictability, and AS in the pathogenesis of panic. A large nonclinical sample of young adults (N = 1296) was prospectively followed over a 5- week highly stressful period of time (i.e., military basic training). Perceived control and predictability did not independently predict panic. However, there was evidence suggesting that AS interacted with perceived control such that high perceived control regarding basic training was protective against panic for individuals with high AS. Similarly, high perceived predictability during basic training reduced anxiety symptoms for individuals with high AS.     

从惊恐障碍看生物心理社会医学模式的必要性和紧迫性

归属于精神医学研究范畴的惊恐障碍患者反复就诊于综合医院内科,频繁使用急救医疗服务,是误诊率最高的疾病之一。本文探讨了惊恐障碍患者去综合医院就诊的必然性和误诊误治的原因及危害性,提出了综合医院医师掌握该病诊治方法,由生物医学模式向生物心理社会医学模式转变的必要性和紧迫性。