Managing multiple chronic conditions in Singapore – Exploring the perspectives and experiences of family caregivers of patients with diabetes and end stage renal disease on haemodialysis

Objective: Diabetes mellitus (DM) is the commonest cause of end stage renal disease (ESRD). Despite increasing DM-ESRD prevalence and high dependency on care, there is a lack of literature on DM-ESRD caregivers. We sought to explore the perspectives and experiences of caregivers of patients with DM undergoing haemodialysis in Singapore.

Design: This study employed an exploratory, qualitative design comprising in-depth interviews with caregivers of DM-ESRD patients.

Methods: Semi-structured interviews were conducted with a sample of 20 family caregivers (54.2 ± 12.6 years; 75% female) of DM-ESRD patients. Data were analysed using Thematic Analysis.

Results: Key caregiving challenges identified were managing diet, care recipients’ emotions and mobility dependence. Patients’ emotional reactions caused interpersonal conflicts and hindered treatment management. Difficulties in dietary management were linked to patients’ erratic appetite, caregivers’ lack/poor understanding of the dietary guidelines and caregivers’ low perceived competence. Limited resources in terms of social support and finances were also noted. Physical and psychological well-being and employment were adversely affected by caregiving role.

Conclusion: This study highlights distinctive aspects of the DM-ESRD caregiving experience, which impact on caregivers’ health and challenge care. Disease management programmes should be expanded to support caregivers in dealing with multimorbidity.     

认知老化对于老年人决策过程的影响:动机的调节作用

有关老化和决策制定的研究并没有发现一致的年龄差异。从决策过程的角度,论述了老化对于决策制定的多层面影响。从认知层面来讲,流体认知能力的衰减会使老年人在决策制定前搜索更少的信息,使用非补偿性策略,基于属性进行信息搜索和比较;晶体认知能力的相对保持则在一定情况下弥补了这种消极影响;从动机层面来讲,关注情绪管理目标的老年人会倾向于寻求更多积极的信息,为了避免权衡诱发的消极情绪而更多地使用非补偿性策略。动机对于认知老化的消极影响有调节作用。具体来说,社会情绪选择理论和选择性投入假设认为,当决策任务符合老年人的社会目标,即情绪管理目标时,能够激活老年人投入认知资源的动机,从而缓解认知资源的衰减对于老年人决策表现的消极影响。未来的研究需要通过实验设计进一步探索动机与认知的交互作用,将多种过程追踪技术结合起来,明晰动机和认知能力在老年人决策制定中的作用。另外考虑到在社会目标方面的年龄差异,对于老年人决策质量的衡量应该更加注重主观决策质量。     

Regional gray matter volume mediates the relationship between family socioeconomic status and depression-related trait in a young healthy sample

Socioeconomic status (SES) is a complex phenomenon that is predicted by a broad spectrum of variables and is often conceptualized as a combination of financial, occupational, and educational influences. SES is associated with symptoms of depression and depression-related personality traits. Many studies have focused on the relationship between SES and depression symptoms in clinical subjects; however, there are few studies of the neural basis of the relationship between SES and depression-related personality traits in nonclinical subjects. Thus, in the present study, we studied the neural basis of the relationship between SES and depression-related traits. The first step was to use voxel-based morphometry (VBM) to investigate the neuroanatomical basis underlying family SES in a large sample of healthy subjects. We found a significant negative correlation between family SES and the medial prefrontal cortex (mPFC) that extending to the anterior cingulate cortex (ACC). Then, the mediation analysis revealed that the correlation between family SES, especially family income, and depression-related traits were mediated by the region of the mPFC that extending to the ACC volume. These findings suggest that the family income may play more important role in driving depression-related traits than that of parental education. They also suggest that the mPFC extension to the ACC may play an important role in the correlation between familial SES, especially with respect to family income and the depression-related traits.     

基于通道的内源性注意对声音诱发闪光错觉的影响

声音诱发闪光错觉是指当视觉闪光伴随不相等数量的听觉声音在100 ms内相继或同时呈现时, 个体会错觉性地知觉到视觉闪光的个数与听觉声音的数量相等。研究采用经典的声音诱发闪光错觉范式, 将注意以内源性的方式指向视觉通道或者听觉通道, 考察了基于通道的内源性注意对声音诱发闪光错觉的影响。结果发现, 当注意内源性地指向视觉通道时, 相对于基线条件, 裂变错觉的量显著减小; 当注意内源性地指向听觉通道时, 相对于基线条件, 裂变错觉的量存在增大的趋势。说明了基于通道的内源性注意可以影响声音诱发闪光错觉中的裂变错觉, 但不影响融合错觉。     

感恩对自我控制的影响

过去的研究表明感恩能减弱时间贴现,但是并不清楚这种现象是受对未来结果的考虑影响还是受与自我控制关系更密切的对即时结果的考虑影响。本文通过两个研究从特质和状态两个层面考察了感恩与自我控制之间的关系。研究一发现,感恩特质与自我控制特质存在显著的正相关,并且这种相关在控制了一般积极情感特质之后仍然显著。研究二发现,状态性感恩情绪启动补偿了自我损耗,并提升了状态性自我控制。本文对该发现进行了讨论并对未来的研究方向进行了展望。     

文化如何影响道德?文化间变异、文化内变异与多元文化的视角

道德判断与行为具有高度的文化敏感性, 来自不同文化背景、具有不同文化经历的个体, 对于同一道德现象的理解与建构存在显著差异。随着20世纪80年代文化心理学的复兴繁荣和全球化进程的不断深化, 文化视角的道德心理学在当代社会心理学语境中备受关注, 并已开展了初步的理论探索, 积累了大量的实证证据。基于文化心理学的视角, 本文将分别从文化间变异、文化内变异和多元文化三个方面梳理和评述不同文化因素(比如地域、生态、社会阶层等)如何影响个体的道德判断与行为, 期望推动未来研究进一步探索快速而剧烈的文化变迁背景下中国人的道德心理和价值体系已经发生了或正在发生着怎样的演变过程。     

外源性注意与多感觉整合的交互关系

外源性注意与多感觉整合的交互关系是一个复杂且具有争议的研究领域, 一直以来备受研究者们关注。为了解释两者间的交互作用机制, 本文基于已有研究成果从两方面综述了外源性注意与多感觉整合的交互关系：(1)外源性注意可以通过自下而上的方式调节多感觉整合, 包括空间不确定性、感知觉敏感度和感觉通道间信号强度差异三种理论假说; (2)多感觉整合可以调节外源性注意。一方面, 来自多感觉通道的刺激能够以自下而上的方式自动整合, 整合后的多感觉通道刺激比单通道刺激具有更大的凸显性从而有效地吸引注意。另一方面, 整合后的多感觉通道刺激能够作为多感觉信号模板存储于大脑之中, 从而在任务中实现自上而下地调节注意捕获。     

CHRM3基因与孤独症谱系障碍

孤独症谱系障碍是一类具有遗传基础的儿童发展障碍疾病。近些年, 研究者们从分子病理学层面发现中枢胆碱能神经系统异常与孤独症患者认知和行为异常存在相关性。尸检研究、临床案例、动物模型研究均发现毒蕈碱型(M型)乙酰胆碱受体异常和孤独症的发生有着密切的关系。在以小鼠为模型的行为学研究中, 编码毒蕈碱型乙酰胆碱受体Ⅲ亚型的CHRM3基因突变会导致小鼠出现认知障碍、刻板行为等孤独症样表现。深入了解CHRM3基因的功能将能够帮助研究者进一步解释孤独症的相关行为特征, 为孤独症儿童教育方案的制定提供新的思路和方法。     

预期错误在复合恐惧记忆提取消退中的作用

基于记忆再巩固理论的提取消退范式被证明是一种有效和颇有前景的消除不良记忆的方法。本研究将预期错误(Prediction Error, PE)应用于提取消退范式中, 采用多感官复合刺激模型(声音 + 图片)作为条件刺激, 以皮电反应作为恐惧反应指标, 考察在提取阶段不同的预期错误设置(无PE、单个负性PE、单个正性PE和多重PE)对条件性恐惧记忆提取消退效果有何差异。结果表明：无PE组和多重PE组出现了恐惧的自发恢复和重建效应, 而负性PE组和正性PE组均没有出现恐惧的自发恢复和重建效应。说明了在对复合恐惧记忆进行提取消退时, 提取阶段适当的PE才能使记忆进入再巩固过程, 随后传统消退达到抑制恐惧返回效果, 提取阶段没有PE或PE量过多都不能达到恐惧消退效果。