死亡素养：安宁缓和医疗的新公共卫生视角

基于新公共卫生视角,对死亡素养的概念起源与内涵、评估工具、养成方式、发展前景进行探讨。死亡素养的提高,有助于生命末期与死亡相关的沟通与实践在社区中常态化,帮助社区为生命末期的照护做好准备。死亡素养在我国的发展需基于社会文化情境,进一步拓展其文化内涵,开发适用于我国的死亡素养评估量表,并注重相关知识和技能的养成与实践。此外,构建符合我国文化环境的社会和公共卫生干预,如预立医疗照护计划、死亡咖啡馆和在线死亡教育,以促进死亡素养在社会层面上的养成,帮助社区更好地应对临终与死亡相关的沟通、决策和行动。

     

社会化媒体时代的医患关系沟通探索

社会化媒体是近年来迅速兴起的新型在线媒体,它从社会交往形式、信息获取方式、语言表达习惯等方面对人们的行为习惯产生了深刻影响。微博作为一种基于网络社会化媒体形式,在许多年轻医生中已经成为一种表达自我的重要平台。在这个平台上,医务人员进行科普教育,同时具有表达自我、舒解情绪的功能,社会化媒体也让医患双方具有平等的话语权,这种医患交流的平台有及时有效反馈信息的功能,具有较强的实效性和现场感,但也面临新的医学伦理问题。发挥社交网络中医患沟通的优势,改善医患关系是一个全新的挑战。     

双轨病历构建

医学实践内容不断扩展,以身体哲学为基础的人文医学进路逐渐清晰,现有标准化病历却没有人文医学空间,需要重新构建双轨病历。双轨病历包含人文医学实践与生物医学实践,是病历管理模式的必然方向。双轨病历的记录内容、记录方式,将成为医学现阶段的一个重要研究课题。在分析生物医学病历书写与叙事医学病历书写之后,全面设计双轨病历,目的是使人文医学与生物医学的实践有机相融,完整、全方位记录全人医学实践。实现双轨病历的关键基础是借助信息技术,利用人文医学本体,智能化记录医学实践是未来的发展方向。

     

童年中晚期攻击的发展轨迹和性别差异：基于母亲报告的分析

采用母亲报告的方法, 对1618名儿童的攻击进行了4年(9岁~12岁)的追踪研究, 分析了童年中晚期攻击的一般发展轨迹、亚组发展轨迹以及性别差异。结果发现：(1)总体上, 童年中晚期儿童的攻击水平随年龄而下降。(2)基于亚组的准参数模型分析表明, 童年中晚期母亲报告的儿童攻击呈现三条不同的发展轨迹, 即无攻击轨迹、低攻击—下降轨迹以及持续高攻击轨迹, 各轨迹组人数比例分别约为68.7%、26.8%、4.5%。持续高攻击轨迹组以及低攻击—下降轨迹组的儿童在童年晚期均面临一定程度的人际适应困难。(3)多项Logit模型以及卡方检验表明, 男生更倾向于归属于攻击轨迹组(高或者低攻击轨迹组), 而女生更倾向于归属于无攻击轨迹组; 但这并不说明高攻击轨迹组中没有女生, 约2%的女生属于高攻击轨迹组。     

Disruption of conditioned taste aversion: evidence that ECS weakens the gustatory engram

Two experiments are reported concerning the neural substrate of conditioned taste aversion (CTA) and the amnesic mechanisms involved when such learning is disrupted by electroconvulsive shock (ECS). Subjects were adult male rats. In the first experiment it is demonstrated that an aversion established to a 2.5% sucrose solution can simulate the learning loss reported in earlier studies which was caused by interpolating ECS between tasting and illness when the aversion was established using a 10% sucrose cue. It is concluded that if ECS acts to disrupt the memory of the taste cue, it possibly reduces it to only about one-quarter of its original strength, a substantial deficit not readily apparent simply from the degree of aversion displayed. In the second experiment, CTAs were established using either a 2.5% sucrose cue or a 10% cue with ECS interpolated during the taste-illness interval. Animals in the two groups were subsequently confronted with a range of sucrose stimuli and their respective aversions were compared. Near identical responses were observed under all conditions tested. These findings are consistent with the theory that ECS disrupts CTA by weakening the gustatory engram.     

Effects of reinforcement magnitude and ratio values on behaviour maintained by a cyclic ratio schedule of reinforcement

In Experiments 1 and 2, lever pressing by rats was reinforced on a cyclic ratio schedule of food reinforcement, comprising a repeated sequence of fixed-ratio component schedules. Reinforcement magnitude was varied, on occasional sessions in Experiment 1 and across blocks of sessions in Experiment 2, from one to two or three 45-mg food pellets. In the one-pellet condition, post-reinforcement pauses increased with component schedule value. At higher magnitudes, post-reinforcement pauses increased, and overall response rates declined. Response rate on component schedules was a decreasing linear function of the obtained rate of reinforcement in all conditions. Plotted against component schedule value, response rate increased exponentially to an asymptote that decreased when reinforcement magnitude increased. These findings are consistent with regulatory accounts of food reinforced behaviour. In Experiment 3, rats were trained under a cyclic ratio schedule comprising fixed-ratio components including higher values, and some inverted U-shaped response functions were obtained. Those rats that did not showthis relationship were trained on cyclic ratios with even higher values, and all showed inverted U-shaped response functions. This suggests that behaviour on cyclic ratio schedules can reflect activating of reinforcement as well as the satiating effects seen in Experiments 1 and 2.     

CTPI和CTA在椎底动脉系统TIA诊断中的互补性

研究CT灌注成像(CTPI)和CT血管造影(CTA)对椎底动脉系统短暂性脑缺血发作(TIA)的诊断价值.采用64排螺旋CT对30例患者进行常规CT、CT灌注成像和CT血管造影检查.30例CT平扫无责任病灶.CT灌注成像正常14例,异常16例.CTA正常4例,异常26例,CT灌注成像和CT血管造影联合应用有利于椎底动脉系统短暂性脑缺血发作的诊断和治疗方案的选择.     

Retrieval-induced forgetting in an eyewitness-memory paradigm

The potential impact of repeated questioning of a witness was examined. Subjects were shown slides depicting the aftermath of a theft and subsequently were asked several times to recall selected details of what they saw. Previous experiments employing simple verbal materials have demonstrated that information addressed by questioning becomes more recallable in the future than it would have been without such retrieval practice, but other information, especially that bearing a categorical similarity to the practiced items, becomes less recallable. Such positive and negative effects appeared in subjects’ later recall of crime-scene details in the present experiment. These results have an important implication for legal practice: Repeated interrogation of a witness can modify the witness’s memory-enhancing the recall of certain details while inducing the forgetting of other details-even when no misinformation is contained or implied in the questioning.     

A modern psychoanalytic approach to caregiver support groups

Caregiver support groups traditionally focus on education, reduction of social isolation, and supportive sharing. However, the support group literature has increasingly reflected an interest in the emotional effects of caregiving. While some authors promote the therapeutic value of supporting defenses against painful feelings, others have documented the value of encouraging their expression in groups. This paper is based on the author’s experience in co-leading an Alzheimer’s family support group, using a modern psychoanalytic approach which encourages the full expression of the caregivers’ emotional experience. Using emotional communication to explore resistances to intimacy and aggression in groups, the author demonstrates how the interplay of co-leadership and Modern Psychoanalytic theory and techniques promotes group cohesion and encourages maturational growth in group members. This model is also prescribed as an antidote to leader “burnout,” a not uncommon phenomenon for leaders of such emotionally charged groups. Private Practice, New York, New York.     

Lost in the Rhythm: Effects of Rhythm on Subsequent Interpersonal Coordination

Music is a natural human expression present in all cultures, but the functions it serves are still debated. Previous research indicates that rhythm, an essential feature of music, can enhance coordination of movement and increase social bonding. However, the prolonged effects of rhythm have not yet been investigated. In this study, pairs of participants were exposed to one of three kinds of auditory stimuli (rhythmic, arrhythmic, or white‐noise) and subsequently engaged in five trials of a joint‐action task demanding interpersonal coordination. We show that when compared with the other two stimuli, exposure to the rhythmic beat reduced the practice effect in task performance. Analysis of the behavioral data suggests that this reduction results from more temporally coupled motor movements over successive trials and that shared exposure to rhythm facilitates interpersonal motor coupling, which in this context serves to impede the attainment of necessary dynamic coordination. We propose that rhythm has the potential to enhance interpersonal motor coupling, which might serve as a mechanism behind its facilitation of positive social attitudes.