德国医学院医学交流能力培养模式探究

德国政府和高校对医学生医学交流技能的培养非常重视,由德国联邦卫生部医学交流纵向示范课程项目开发的医学交流纵向示范课,为德国各大高校医学院医学交流课程的构建和实施提供上层指导。以德国几所知名高校医学院为例,分别对医学交流课程内容设置、教学方式、师资团队构建、课程测试和评估等方面进行阐述,剖析德国医学交流课程体系特点：基于临床案例的教学素材、主题模块的课程形式、丰富的教学方式、专业的教学团队等,德国医学交流课程标准一致,课程体系完善,为我国医学交流课程完善和改革提供参考。     

伤害回避的脑机制及其生物基础

伤害回避是指个体对厌恶刺激信号做出强烈的反应,并学会被动地回避惩罚的一种倾向,这一倾向使得个体反复思考未来的结局,并谨慎小心地对待不确定情景中的事件,进而更有可能诱发情感障碍。伤害回避涉及的神经网络包括三个子网络,即额顶叶-前扣带皮层的连接、皮层-杏仁核的连接和白质通道的结构性连接,这三个子网络分别与羞怯感-易疲劳性、预期担心以及不确定环境中的害怕情绪有关。而其生物基础则包括单一基因多态性和基因多态间的交互作用。今后的研究应该集中在深化伤害回避神经网络与生物基础间的联合机制、研究三种及以上基因多态间的交互作用、考察其他因素对基因效应的调节作用、注重伤害回避四种亚型相关神经网络之间的连接、探讨5-HT4等其他几种5-羟色胺受体多态性与伤害回避的关系以及分析伤害回避内部机制在抗抑郁治疗中的作用等方面。     

Effects of post-trial administration of naloxone and beta-endorphin on shock-induced fighting in rats

To study the involvement of endogenous opioid peptides in the development of shock-induced fighting, naloxone (2 mg/kg) or beta-endorphin (10 micrograms/kg) was administered subcutaneously immediately after the session and during nine consecutive daily sessions to rats repeatedly exposed to electric shocks. beta-Endorphin blocked the development of shock-induced fighting while naloxone facilitated it but only when shock-induced fighting occurred at a low rate. The effects of beta-endorphin were time dependent since when beta-endorphin was injected 90 min after the shock session instead of immediately after, its impairing effect disappeared. In addition, naloxone blocked the impairment produced by beta-endorphin. Differential postsession treatment of each member of pairs of rats with naloxone and beta-endorphin resulted in a higher probability of rats treated with naloxone to be dominant over rats treated with beta-endorphin in the test situation. These results are discussed in relation with the possible involvement of endogenous opioids in the modulation of the physiological consequences of defensive behavioral responses to shock.     

A Multitrait-multimethod examination of Minnesota Multiphasic Personality Inventory (MMPI) and Millon Clinical Multiaxial Inventory (MCMI)

Recently, certain Minnesota Multiphasic Personality Inventory (MMPI) and Millon Clinical Multiaxial Inventory (MCMI) scales have seen increasing usage for the measurement of DSM-III personality disorders. The current study sought to identify the convergent and discriminant validity of these two sets of scales for this purpose. In general, the results indicated significant convergence across the two instruments. However, better convergent validity was found for scales representing those DSM-III disorders which are most consistent with the typology upon which the MCMI was based. In particular, convergent and discriminant validity results were poorest for Compulsive, Antisocial, and Passive-Aggressive personality scales.     

Effects of Communication Expectancies,Actual Communication,and Expectancy Disconfirmation on Evaluations of Communicators and Their Communication Behavior

The current investigation addressed (a) the perseverance of preinteraction expectancies in the face of actual communication behavior, (b) the separate effects of personal attribute and communication expectancies, and (c) the role of expectancy confirmation or disconfirmation on postinteraction evaluations. Participant perceivers were induced to hold positive or negative expectancies regarding a target partner's general personal attributes and specific communication behavior prior to a problem-solving discussion. They then interacted with a confederate target who communicated in a pleasant, involved fashion or its opposite, after which perceivers evaluated target personal attributes and communication behavior. All three hypotheses received at least partial support. Preinteractional expectancies, especially personal attribute ones, caused perceivers to evaluate targets and their communication behavior differently, with negatively valenced expectancies serving as negative violations. Relative to a pleasant, involved communication style, unpleasant, uninvolved communication was less expected and evaluated negatively, thus functioning as a negative violation; it also reduced credibility, attraction, and perceived rewardingness of the target. Finally, disconfirmatory communication altered target evaluations relative to confirmatory communication, especially for high-valence targets. These results lend support to the premises and predictions of expectancy violations theory.     

Two Contrasting Explanations of Involvement Violations:

Among the theories that address the impact of variations in immediacy behaviors during ongoing interactions are expectancy violations (EV) and discrepancy arousal (DA) theories. This study of the effects of violations of expectations on arousal, reciprocity, and compensation in the medical practitioner-patient relationship contrasts EV predictions with DA predictions. EV theory predicts that given a communicator with high reward valence, high and very high involvement (including touch and close proximity) should be met with reciprocation (increased involvement), and low and very low involvement should be met with compensation (increased involvement). DA theory predicts compensating very high involvement with decreased involvement, reciprocating high involvement with increased involvement, compensating low involvement with increased involvement, and reciprocating very low involvement, with decreased involvement. Results supported neither theory as all involvement changes were met with reciprocity. Additionally, although all violations/discrepancies were followed by changes in arousal, size of arousal change was not monotonically related to size of involvement change, as predicted by DA theory. Finally, although positive versus negative emotional experiences were not related to physiological indicators of arousal change, size of involvement change was directly related to the experience of positive and negative emotions. Thus, it appears that involvement change size directly predicts emotional experience and is not mediated by arousal change.     

Emotional sharing and the extended mind

Synthese - This article investigates the relationship between emotional sharing and the extended mind thesis. We argue that shared emotions are socially extended emotions that involve a specific...