A Cross-Lagged Panel Approach to Understanding Social Support and Chronic Posttraumatic Stress Disorder Symptoms in Veterans: Assessment Modality Matters

Although there is a strong and consistent association between social support and posttraumatic stress disorder (PTSD), the directionality of this association has been debated, with some research indicating that social support protects against PTSD symptoms, whereas other research suggests that PTSD symptoms erode social support. The majority of studies in the literature have been cross-sectional, rendering directionality impossible to determine. Cross-lagged panel models overcome many previous limitations; however, findings from the few studies employing these designs have been mixed, possibly due to methodological differences including self-report versus clinician-administered assessment. The current study used a cross-lagged panel structural equation model to explore the relationship between social support and chronic PTSD symptoms over a 1-year period in a sample of 264 Iraq and Afghanistan veterans assessed several years after trauma exposure. Approximately a third of the sample met criteria for PTSD at the baseline assessment, with veterans’ trauma occurring an average of 6 years prior to baseline. Two separate models were run, with one using PTSD symptoms assessed via self-report and the other using clinician-assessed PTSD symptoms. Excellent model fit was found for both models. Results indicated that the relationship between social support and PTSD symptoms was affected by assessment modality. Whereas the self-report model indicated a bidirectional relationship between social support and PTSD symptoms over time, the clinician-assessed model indicated only that baseline PTSD symptoms predicted social support 1 year later. Results highlight that assessment modality is one factor that likely impacts disparate findings across previous studies. Theoretical and clinical implications of these findings are discussed, with suggestions for the growing body of literature utilizing these designs to dismantle this complex association.     

卜弥格《医学的钥匙》探微

波兰籍传教士卜弥格（Michel Boym）是17世纪中医西传过程中的重要人物之一,其作品《医学的钥匙》引发了国内外学者的关注。旨在对这部著作的文章架构与基本内容作出分析并从中管窥卜弥格对中国医学身体知识的认识。其中,卜弥格个人的欧洲古典医学和哲学背景对中医知识的阐释发挥了相当大的作用。他对于中医知识体系内身体知识的解读可归结为三种类型：一是左右二分的身体;二是以圆为图式的身体;三是不断变化的身体。实际上,卜弥格的这三种身体观念是一套兼具中欧两种医学的特点,却又与二者都有差别的一种知识体系。

     

神经科学决定论与自由意志——兼论自由意志与自我是否可能?

神经科学的最新研究成果为决定论提供了科学依据,由此推断没有自由意志和恒定不变的自我。而传统生命伦理学中我们对其它生命体的伦理义务乃是基于这个生命体具备自由意志,即有自我的精神生活。神经科学技术对自由意志和自我的挑战不会对我们的伦理实践产生重要影响。只有在实践生活中人们采用了科学研究结论,从神经科学的发现到影响我们伦理实践的范式转换才会发生。从相容性与非相容性、物理系统自身的识别、神经科学的其它证据等方面探讨了怀疑的内在原因,认为不会因为神经科学家的新发现而否认自由意志和恒定自我。     

新型冠状病毒肺炎定点医院医护人员心理状况调查分析

为了解定点收治新型冠状病毒肺炎患者的医院中医护人员心理状况,从而针对性地进行心理护理,采用便利抽样法,应用《医护人员心理健康调查表》对3所定点收治新型冠状病毒肺炎患者的医院中1 266名医护人员进行问卷调查。结果显示,定点医院医护人员中,27.5%存在抑郁,26.3%存在焦虑,26.0%存在孤独。女性、已婚、传染科、发热门诊、监护室相比男性、未婚、普通门诊更容易抑郁;传染科、监护室相比普通门诊更容易焦虑。因此,医院应加强对这类群体的心理疏导和人文关怀,以减轻心理压力,提高工作效率。     

医学伦理学与生命伦理学关系类型辨析——基于国内外文献的考察

医学伦理学与生命伦理学的关系在逻辑上有包容论、互异论和交叉论（延续论）三种可能的类型。包容论认为,后者关注范围更广,前者作为一个部分包括在生命伦理学当中。互异论主张,两个概念在跨学科特点方面不同,生命伦理学必须通过跨学科协作,以公共性为导向,而医学伦理学较为单一,以职业性为目标。交叉论（延续论）强调,医学伦理学经历了古代医德学,近现代医学伦理学和生命伦理学。包容论与互异论过于强调二者的相同或区别,割裂了二者内在联系,片面性显而易见。交叉论（延续论）看到了二者内在逻辑,反映了本体属性,是更为合理的评价。     

直觉思维在麻醉临床决策中的应用

围手术期麻醉医师面临问题的复杂性、动态性和模糊性,要求其在具备良好逻辑思维能力的同时,还要学会应用直觉思维来进行麻醉危机管理。通过决策判断的双加工理论模型探讨说明直觉思维在临床麻醉决策中的可应用性,并给出麻醉医师直觉思维的培养途径,提高麻醉医师的思考能力,增加应急处理课程和临床训练,重视临床经验的学习,营造良好的教学氛围。为了在围手术期更好地保证患者的安全,麻醉医师应重视直觉思维在临床麻醉决策中的应用。     

科学假说在揭示嗅觉奥秘中的作用——解读2004年度诺贝尔医学奖

通过分析2004年诺贝尔医学奖的发现过程,揭示假说对科学研究的指导意义。只有勤观察,多思考,大胆假设,小心求证,才能揭示自然规律。     

The Dynamics of Internalised and Extrinsic Motivation in the Ethical Decision-Making of Small Business Owners

We investigate the ethical behaviour of small business owners by focusing on individuals' motivations to comply with tax obligations. In a study of 330 small business owners, we assess the role of internalised motivation to pay taxes versus extrinsic motivation in driving tax compliance. First, we find that internalised and extrinsic motivation have distinct predictors. Internalised motivation is related to strong personal moral norms to comply and a sense that the fiscal system is fair. Extrinsic motivation is related to perceptions that penalties are severe, that checks are likely, and is associated with a perceived lack of tax knowledge. Second, we find that, when considered together, internalised motivation but not extrinsic motivation predicts self-reported tax compliance. Third, we test the undermining hypothesis by which the presence of extrinsic motivation may crowd out the positive effect of internalised motivation. We find evidence of a motivation crowding effect only at very high levels of extrinsic motivation. We discuss avenues for further integration of motivation theory in research on tax compliance behaviour, and more generally the study of regulatory compliance and ethical behaviour in business settings.