腰-硬联合麻醉在高海拔高龄患者髋关节置换术中的应用

探讨腰-硬联合麻醉及全身麻醉用于高海拔高龄低氧患者行人工髋关节置换的临床优势。分析2010年1月～2013年11月来我院进行人工髋关节置换术的高龄（年龄＞69岁）低氧患者86例,其中全麻31例,腰-硬联合麻醉55例,记录麻醉后5min、15min、30min及术毕血压、心率,术中低血压发生率,术后转ICU比例等指标。与全麻相比,腰-硬联合麻醉组血流动力学稳定、术中低血压发生率降低（P＜0．05）、入住ICU几率显著降低（P＜0．05）。在高海拔高龄低氧患者行人工髋关节置换术中采用腰-硬联合麻醉可以使患者麻醉效果突出,血流动力学平稳,安全有效,比全麻更有临床应用优势。     

NARCISSISTIC DEFENSES IN THE DISTORTION OF FREE ASSOCIATION AND THEIR UNDERLYING ANXIETIES

This paper examines particular distortions in the process of free association characteristics of patients with narcissistic personality disorders. The author proposes that the dominant narcissistic transference developments typical of the early and middle phases of the analytic treatment of these patients are reflected in these distortions of free association. This paper gathers the various patterns that these defensive distortions present, along with technical interventions geared to deal with them.     

Being positive despite illness: The contribution of positivity to the quality of life of cancer patients

Objective: The purpose of this study was to examine the longitudinal relationship between Positivity (POS), defined as a stable disposition to view at experience under a positive outlook, and physical and psychological functioning in a sample of cancer patients immediately after diagnosis and one year later.

Methods: A total of 110 patients (40% males) with pulmonary, colorectal and breast cancer, aged 30–75 (M age = 59.62; SD = 10.33), have been prospectively enrolled between 2012 and 2013, at the S. Andrea Hospital in Rome. All patients were previously aware of their diagnosis. A follow-up one year after diagnosis was conducted. We used structural equation modeling in order to analyse the specific effects of POS on functioning impairment from diagnosis to follow up.

Results: POS was associated with less functioning impairment both at diagnosis and follow-up assessments. Furthermore, POS level at diagnosis continued to be associated with less functioning impairment one year later, after controlling for its stability.

Conclusions: Patients with higher level of POS tended to report less symptoms associated with negative affect such as anxiety and despondency and to preserve their habitual relationships and social roles. POS may act as a basic disposition that sustains patients’ efforts to deal efficaciously with severe illness, by complying with medical treatment and using cognitive strategies that enable individuals to cope with concurrent and prospective challenges of illness.     

The role of holistic face processing in acquired prosopagnosia: evidence from the composite face effect

Faces are processed more holistically than other objects, and it has been suggested that the loss of holistic face processing causes acquired prosopagnosia. Support for this hypothesis comes from several cases who failed to show holistic face effects as well as the absence of reports of prosopagnosics with unequivocally normal holistic face perception. The current study examines the relationship between holistic face processing and prosopagnosia by testing seven acquired prosopagnosics with the face composite task, a classic measure of holistic face processing. To enhance the robustness of the findings, each prosopagnosic was tested with two versions of the composite task showing upright faces. We also tested an inverted condition to exclude the possibility that more general factors account for composite effects for upright faces. Four of the seven acquired prosopagnosic participants showed consistent upright face composite effects with minimal inverted face composite effects. We conclude that severe face processing deficits can co-occur with intact holistic face processing and that factors other than a loss of holistic processing contribute to the perceptual and recognition deficits in acquired prosopagnosia.     

Exploring correlations between positive psychological resources and symptoms of psychological distress among hematological cancer patients: a cross-sectional study

Hematological cancer patients experience high levels of psychological distress during diagnoses and intensive treatments. The aim of the present study is to explore the effects of positive psychological resources on depressive and anxiety symptoms in hematological cancer patients. This survey was conducted in a hospital during the period from July 2013 to April 2014. A total of 300 inpatients were recruited and finally 227 of them completed the questionnaires. Questionnaires included demographic and clinical variables, the Center for Epidemiologic Studies Depression Scale, the Self-Rating Anxiety Scale, the Life Orientation Scale-Revised, the General Perceived Self-Efficacy Scale, and the Resilience Scale-14. Results showed that the prevalence of depressive and anxiety symptoms was 66.1 and 45.8%, respectively. Both optimism (β = ?.479, p < .001) and resilience (β = ?.174, p < .05) were negatively associated with depressive symptoms, and optimism (β = ?.393, p < .001) was negatively associated with anxiety symptoms. However, resilience (β = ?.133, p > .05) was not significantly associated with anxiety symptoms, and self-efficacy was not significantly associated with depressive (β = ?.032, p > .05) or anxiety symptoms (β = ?.055, p > .05). The results suggest that hematological cancer patients who possess high levels of positive psychological resources may have fewer symptoms of psychological distress. The findings indicate that enhancing positive psychological resources can be considered in developing intervention strategies for decreasing depressive and anxiety symptoms.     

Mediation and moderation of the effects of watching the angiography screen on patients

It has been reported that allowing patients to watch the coronary angiography screen during the procedure results in psychological benefits. This study aimed to investigate the roles of illness perceptions as mediators of this outcome and to examine whether individual differences in monitoring coping style moderated these effects. The experiment compared patients who were instructed to watch the monitor screen (n = 57) with those who were not (n = 51). Questionnaires were used to measure the research variables at one day and one month after the procedure. Results showed that watching the angiography screen increased patients’ personal and treatment control perceptions that mediated changes in self-assessed health, risk perceptions, negative affect, general and diet outcome expectancies, and diet and physical activity intentions. The behavior-related outcomes were moderated by monitoring coping style. These findings illustrate the significance of illness perceptions, perceived control and monitoring coping style in achieving desirable outcomes among patients undergoing coronary angiography, and reveal opportunities for interventions using medical imaging technologies.     

Conflict Transformation, Stigma, and HIV-Preventive Structural Change

Over the prior decade, structural change efforts have become an important component of community-based HIV prevention initiatives. However, these efforts may not succeed when structural change initiatives encounter political resistance or invoke conflicting values, which may be likely when changes are intended to benefit a stigmatized population. The current study sought to examine the impact of target population stigma on the ability of 13 community coalitions to achieve structural change objectives. Results indicated that coalitions working on behalf of highly stigmatized populations had to abandon objectives more often than did coalitions working for less stigmatized populations because of external opposition to coalition objectives and resultant internal conflict over goals. Those coalitions that were most successful in meeting external challenges used opposition and conflict as transformative occasions by targeting conflicts directly and attempting to neutralize oppositional groups or turn them into strategic allies; less successful coalitions working on behalf of stigmatized groups struggled to determine an appropriate response to opposition. The role of conflict transformation as a success strategy for working on behalf of stigmatized groups is discussed.     

男同性恋的身体意象：特点与理论分析

对男同性恋身体意象的研究有近30年的历史。男同性恋比男异性恋更容易出现负面身体意象、身体不满意和进食障碍等。男同性恋追求瘦而有肌肉的理想身体。针对这些特点, 研究者提出一些理论假设进行解释, 包括性客观化理论、内化同性恋污名、性别角色假设、进化心理学假设和AIDS/HIV假设等。未来研究要进行整合的和多样化的研究取向, 方法上采用以网络调查为主的定量研究和以现象学分析为主的定性研究。最后, 国内研究要更注重文化特异性。     

A three city comparison of the public's knowledge and attitudes about AIDS

A survey of knowledge, beliefs and attitudes about AIDS was administered simultaneously in San Francisco, New York and London to a total of 399 persons. The aim was to investigate how such knowledge and attitudes may he influenced by social and cultural contexts, as well as by disease epidemiology. Across all samples of the general public (excluding risk group members) in the three cities, general fear of AIDS and anti-gay attitudes were significantly negatively correlated with knowledge about AIDS. In the London sample, general fear of AIDS and anti-gay attitudes were significantly and positively associated with both sexual and general health behavior change. Only sexual behavior change, however, was significantly correlated with general fear of AIDS and anti-gay variables for the New York sample. Neither of these variables was significantly associated with behavior change of any kind in the San Francisco sample. We accounted for these inter-city differences by proposing a four-stage model of public response to an epidemic over time. Our data support the need for specific programs aimed at the general public that take into account sociocultural and AIDS epidemiologic differences across different sociocultural contexts.     

Knowledge,beliefs, peer norms,and past behaviors as correlates of risky sexual behaviors among college students

Abstract

HIV/AIDS knowledge, age at onset of sexual activity, perceptions of personal risk and peer norms were explored as correlates for risky sexual behaviors among college students. Ninety-nine male and 185 female college students completed a 66-item questionnaire. A majority reported being sexually active with most in mutually monogamous relationships or not currently in a sexual relationship. Multiple regression correlation analyses showed knowledge about HIV/AIDS to be very high but that this knowledge did not independently relate to the extent of risky behaviors. Perceptions of risk were positively related to number of partners and single-time partners but not condom usage. In contrast to previous studies, perceived peer norms did not independently relate to behaviors. Instead, age at first intercourse was found to have substantial overlap with current perceptions, attitudes, and likelihood for engaging in risky behaviors. The necessity for including previous behaviors in analyses of the impact of attitudes and perceived norms on behavioral intentions is discussed.