美国的患儿同意及借鉴意义

准确地评定患儿的同意能力,保障患儿的同意权得以有效行使,有利于尊重患儿的人格尊严,促进患儿身心健康。从患儿同意能力和同意权的角度出发,简要回顾了美国患儿同意产生的背景,介绍了美国患儿同意的现状,并对其进行了一定的分析和评价,希望对促进我国患儿同意的发展起到一定的借鉴作用。     

人的尊严与生命伦理

“尊严”是频繁出现在生命伦理学中的一个概念,但关国学者麦克琳却在最近认为,尊严在生命伦理学中是个无用的概念,可以毫无损失地用其它概念,比如尊重人的自主性概念所代替。反驳了麦克琳的观点,定义了尊严的含义,认为生命伦理学的使命就是在当代生命科技高度发达的情况下如何尊重和保护人的尊严。     

Excess use of general practitioners by obese adults: does health-related quality of life account for the association?

As general practitioners (GP) are seeing, and are likely to continue to see, increasing numbers of obese patients in their practices, it is relevant to know with which needs these patients enter general practice. The present study aims to determine whether besides physical comorbidities, health-related quality of life (HRQOL) accounts for associations of obesity with GP use. In a general population survey in Augsburg, Germany (KORA-Survey S4 1999/2001), anthropometric body mass (BMI in kg/(m(2))), physical comorbidities, HRQOL (the 12-item Short Form; SF-12), and visits to GP were assessed, and analyzed by logistic and zero-truncated negative binomial regressions (two-part model). Gender, age, socio-economic status, marital status, health insurance, and place of residence were adjusted for. The sample consisted of N = 942 residents aged 25 - 74, who had been randomly sampled from 17 cluster-sampled communities, and were either normal-weight, overweight, moderately obese, or severely obese. The moderately obese group had higher odds than the normal-weight to report any GP use; however, while being predictive, neither physical comorbidity nor HRQOL mediated this. In contrast, with regard to number of GP visits among users, the severely obese group (BMI >/= 35) reported significantly more visits than the normal-weight group, and both physical comorbidity and physical (but not mental) HRQOL accounted for this. In conclusion, physical comorbidity and HRQOL mediate excess use of GP by severely obese users in terms of number of visits. Thus, for this group, subjective physical health seems to be important besides physical comorbidities, suggesting for general practice to focus both on evaluated and perceived needs of these patients.     

Attachment representations in mothers of preterm infants

The aim of the study was to assess attachment representations in mothers of preterm infants using the Working Model of Child Interview (WMCI) at the 12 months of the infant's corrected age. In addition, the relation between WMCI representation categories and the Edinburgh Postnatal Depression Scale score at 6 months of the infant's corrected age was studied. There were 38 mothers of preterm infants (<1500 g or <32 gestational weeks) and 45 mothers of full-term infants. The results showed no differences between the study groups in the distribution of the three main representation categories (balanced, disengaged and distorted). However, there were qualitative differences in representations between the groups. Furthermore, maternal depression symptoms were associated with distorted representation category. We suggest that despite the qualitative differences in the mothers’ representations, mothers of preterm infants are as likely to form balanced attachments with their infants as mothers of full-term infants.     

Early-Onset Bipolar Spectrum Disorders: Diagnostic Issues

Since the mid 1990s, early-onset bipolar spectrum disorders (BPSDs) have received increased attention in both the popular press and scholarly press. Rates of diagnosis of BPSD in children and adolescents have increased in inpatient, outpatient, and primary care settings. BPSDs remain difficult to diagnose, particularly in youth. The current diagnostic system makes few modifications to accommodate children and adolescents. Researchers in this area have developed specific BPSD definitions that affect the generalizability of their findings to all youth with BPSD. Despite knowledge gains from the research, BPSDs are still difficult to diagnose because clinicians must: (1) consider the impact of the child’s developmental level on symptom presentation (e.g., normative behavior prevalence, environmental limitations on youth behavior, pubertal status, irritability, symptom duration); (2) weigh associated impairment and course of illness (e.g., neurocognitive functioning, failing to meet full DSM criteria, future impairment); and (3) make decisions about appropriate assessment (differentiating BPSD from medical illnesses, medications, drug use, or other psychiatric diagnoses that might better account for symptoms; comorbid disorders; informant characteristics and assessment measures to use). Research findings concerning these challenges and relevant recommendations are offered. Areas for further research to guide clinicians’ assessment of children with early-onset BPSD are highlighted. Principal Investigators and Coinvestigators of Longitudinal Assessment of Manic Symptoms (LAMS) Group are listed in Appendix.     

H.R.成人成套神经心理测验在我国的修订

本文是修订Halstead—Reitan成套神经心理测验(H·R·B)成人本的总结。从15个省市取样,正常组885名,脑病组350例。根据测验结果按性别和年龄制定了各分测验的划界分,按划界分计算了两组受试的损伤指数(DQ)。并制定了脑病损的诊断和定侧的标准。按此标准对样本病人进行了脑损伤的诊断和定侧。诊断符合率为80.3％,右侧病损的符合率为70.8％,左侧为45.7％。分测验的重则相关系数分别为0.93—0.39。     

Minimum Muscle-Tension Change Trajectories Predicted by Using a 17-Muscle Model of the Monkey's Arm

Four computational problems to be solved for visually guided reaching movements, hand path, and trajectory formations, coordinate transformation, and calculations of muscle tensions are ill-posed in redundant biological control systems. These problems are ill-posed in the sense that there exist an infinite number of possible solutions. In this article, it is shown that the nervous system can solve those problems simultaneously by imposing a single global constraint: finding the smoothest muscle- tension trajectory that satisfies the desired final hand position, velocity, and acceleration. Horizontal trajectories were simulated by using a l7-muscle model of the monkey's arm as the controlled object. The simulations predicted gently curved hand paths for lateral hand movements and for movements from the side of the body to the front, and a roughly straight hand path for anterioposterior movements. The tangential hand velocities were roughly bell shaped. The simulated results were in agreement with the actual biological movements.     

一种快速记忆法个案报告

作者以自己为被试,运用自己创造的一系列数序形象挂钩法识记105位化学元素名称和300位圆周率数字,结果表明:运用此法记忆顺序性极强、数量很大、难于记住的材料快速高效,能倒顺背诵和随点随背,能冲破前摄和倒摄干扰,使识记很快通过短时记忆而迅速地顺利进入长时记忆,在识记后的开初(26小时)遗忘不多也不快,在隔一天以后进行检查(复习)并强化未记牢的材料,可使保持率在数百日后不下降,因而作者认为,艾宾浩斯遗忘曲线应界定为机械识记的遗忘曲线较为妥当。作者在文中第一次较详细地公开了在一天内就能倒顺背诵105位化学元素名称和300位圆周率数字的数序形象挂钩法及其关键与技巧。     

采用构造玩具教学对幼儿创造力发展的影响

本研究采用自然实验法,探索采用构造玩具、进行启发儿童想象力的教学对发展幼儿创造力的作用。被试为50名均龄4岁8个月的寄宿幼儿园儿童,教学中纳入的变量为四种方法:(1)模仿-改进法;(2)改变模仿对象法;(3)模仿生活原型法;(4)改造生活原型法。控制班只采用模仿法进行教学。经过七个月的实验教学后,实验班儿童的一般智力和创造力都明显超过了控制班。测验资料证明,幼儿的一般智力占创造力之间,有0.4左右的正相关。     

学习和记忆的神经生物学基础在无脊椎动物的研究进展

本文综述了Kandel及其同事们在海兔的研究,以示学习和记忆的神经生物学基础在无脊椎动物的研究进展。全文分四个部份:行为观察、细胞机制、分子水平研究和敏感化与经典条件化的比较。各部份又分若干段落综述。本文认为他们的工作在细胞机制方面可说是有所突破。