再析温州市鹿城区私人诊所现状与前景

温州私人诊所的发展不容乐观,我们必须在私人诊所自身内部找缺陷,通过其自身努力发展走出困境,同时希望政府改革相关管理制度,实行有效的宏观调控,给予理性地支持.     

Community Influences on Adjustment in First Grade: An Examination of an Integrated Process Model

We examined the impact of neighborhood characteristics both directly and indirectly as mediated by parent coaching and the parent/child affective relationship on behavioral and school adjustment in a sample of urban dwelling first graders. We used structural equations modeling to assess model fit and estimate direct, indirect, and total effects of neighborhood structural and social characteristics on parenting behavior and child outcomes. Observed physical incivilities in the neighborhood were associated with lower levels of parent eliciting behavior and higher levels of child behavior problems. The effects of neighborhood structural characteristics were mediated partially through neighborhood community involvement with children, which had a direct significant impact on parent eliciting behavior and an indirect effect on child behavior problems. Neighborhood community involvement with children was associated with higher levels of parent eliciting behavior and lower levels of child behavior problems. Observed physical incivilities had a significant indirect association with poor school adjustment and a marginally significant association with positive school adjustment to first grade. Neighborhood community involvement with children was more strongly associated with positive school adjustment than poor school adjustment.     

Self-esteem and interpersonal functioning in psychiatric outpatients

This study explored associations between self-esteem and interpersonal functioning in a one-year clinic cohort of psychiatric outpatients ( n = 338). At intake, patients completed questionnaires measuring self-esteem, interpersonal problems, interpersonal style, and general symptomatic distress. They were also diagnosed according to the ICD-10. Interpersonal behaviour was measured along the agency and communion dimensions of the Inventory of Interpersonal Problems – Circumplex [IIP-C]. The results show that lower self-esteem was associated with higher levels of interpersonal problems in general. Further, lower self-esteem was first and foremost linked to frustrated agentic motives, as measured by the IIP-C. Hence, the study concludes that fostering patient agency should be considered as an important goal in psychotherapy. Furthermore, the analyses revealed an interaction effect of agency and communion on self-esteem, indicating a need for balancing the two motive dimensions. Finally, some questions are raised concerning the interpretation of the IIP-C subscales in general.     

The sleep patterns and problems of clinically anxious children

Childhood sleep problems have been associated with a range of adverse cognitive and academic outcomes, as well as increased impulsivity and emotional disorders such as anxiety and depression. The aim of the study was to examine subjective reports of sleep-related problems in children with anxiety disorders during school and weekend nights. Thirty-seven children with clinically-diagnosed anxiety disorders and 26 non-clinical children aged 7-12 years completed an on-line sleep diary to track sleep patterns across school nights and weekend nights. Anxious children reported going to bed significantly later (p = 0.03) and had significantly less sleep (p = 0.006) on school nights compared to non-anxious children. No significant differences in sleep onset latency, number of awakenings or time awake during the night, daytime sleepiness, or fatigue were found between the two groups. On the weekends, anxious children fell asleep quicker and were less awake during the night than on weeknights. School-aged anxiety disordered children showed a sleep pattern that differs from their non-anxious peers. Although the mean 30 min less sleep experienced by anxious children may initially seem small, the potential consequences on daytime performance from an accumulation of such a sleep deficit may be significant, and further investigation is warranted.     

Stepping Stones Triple P: An RCT of a Parenting Program with Parents of a Child Diagnosed with an Autism Spectrum Disorder

Whilst the Triple P Positive Parenting Program has a large evidence base (Sanders, Clinical Child and Family Psychology Review 2:71–90, 1999; Sanders, Journal of Consulting and Clinical Psychology 68:624–640, 2000) and preliminary evidence indicates that Stepping Stones Triple P is also efficacious (Roberts, Journal of Clinical Child and Adolescent Psychology, 35(2):180–193, 2006), to date Stepping Stones has not been evaluated with the ASD population. Fifty-nine families with a child with ASD aged between 2 and 9 participated in this randomized controlled trial. The results demonstrate significant improvements in parental reports of child behaviour and parenting styles with the treatment effects for child behaviour, parental over reactivity and parental verbosity being maintained at follow-up 6 months later. Further, the results suggest significant improvements in parental satisfaction and conflict about parenting as well as a sleeper effect for parental efficacy. The results indicate that Stepping Stones Triple P is a promising intervention for parents of children with ASD. Limitations and future research are also addressed.     

Community vs. Clinic-Based Modular Treatment of Children with Early-Onset ODD or CD: A Clinical Trial with 3-Year Follow-Up

This study examines the treatment outcomes of 139, 6–11 year-old, clinically referred boys and girls diagnosed with Oppositional Defiant Disorder (ODD) or Conduct Disorder (CD) who were randomly assigned to a modular-based treatment protocol that was applied by research study clinicians either in the community (COMM) or a clinic office (CLINIC). To examine normative comparisons, a matched sample of 69 healthy control children was included. Multiple informants completed diagnostic interviews and self-reports at six assessment timepoints (pretreatment to 3-year follow-up) to evaluate changes in the child’s behavioral and emotional problems, psychopathic features, functional impairment, diagnostic status, and service involvement. Using HLM and logistic regression models, COMM and CLINIC showed significant and comparable improvements on all outcomes. By 3-year follow-up, 36% of COMM and 47% of CLINIC patients no longer met criteria for either ODD or CD, and 48% and 57% of the children in these two respective conditions had levels of parent-rated externalizing behavior problems in the normal range. We discuss the nature and implications of these novel findings regarding the role of treatment context or setting for the treatment and long-term outcome of behavior disorders. This study was supported by grants to the first author from the National Institute of Mental Health (MH 57727) and to the second author by the National Institute of Nursing Research (NR 07615). The fourth author was supported by grant K01 MH078039 from the National Institute of Mental Health. The authors acknowledge the research and clinical staff of the Resources to Enhance the Adjustment of Children (REACH) program, and Drs. David Brent, Tammy Chung, William Gardner, John Lochman, and Wayne Osgood. Reprints may be obtained from Dr. Kolko, WPIC, 3811 O’Hara St., Pittsburgh, PA 15213.     

Parent management training for reducing oppositional and aggressive behavior in preschoolers

This article provides an overview of parent management training (PMT) for preschool-age children with aggressive and oppositional behaviors. Assessment strategies and basic concepts of PMT are provided. Theoretical underpinnings and research outcomes are highlighted for some variations of PMT programs that have strong empirical support. These programs include Helping the Noncompliant Child, Parent–Child Interaction Therapy, Incredible Years Training Series, Triple P-Positive Parenting Program, and Oregon Early Intervention Foster Care.     

Social Cognition and Externalizing Psychopathology: An Investigation of the Mediating Role of Language

The present study integrates findings from three lines of research on the association of social cognition and externalizing psychopathology, language and externalizing psychopathology, and social cognition and language functioning using Structural Equation Modeling (SEM). To date these associations have been examined in pairs. A sample of 354 clinic-referred children (aged 7 to14 years) recruited from a children’s mental health centre were tested on measures of language, social cognition, working memory, and child psychopathology. We compared a hypothesized model presenting language functioning as a mediator of the association between social cognition and externalizing psychopathology to a model presenting the independent contribution of language and social cognition to externalizing psychopathology. As hypothesized, we found that the mediation model fits the data better than the alternative model. Our findings have implications for developing and modifying intervention techniques for children with dual language and externalizing psychopathology. This research was supported by a grant from Health Canada (NHRDP, 6606-4835) to the third author.     

Influential observations in principal factor analysis

We propose a method for detecting influential observations in iterative principal factor analysis. For this purpose we derive the influence functionsI(x; LL ^T ) andI(x; ) for the common variance matrixT =LL ^T and the unique variance matrix , respectively, in the common factor decomposition =LL ^T + . A numerical example is given for illustration.The authors are grateful to Tomoyuki Tarumi and Atsuhiro Hayashi for their kind permission to use their software Seto/B for drawing Figures 1 and 2 and to anonymous reviewers for comments on the paper.     

越轨同伴交往与青少年睡眠问题的交叉滞后分析

本研究采用交叉滞后设计探讨越轨同伴交往与青少年睡眠问题之间的双向关系。通过越轨同伴交往问卷与匹兹堡睡眠质量指数（PSQI）对广东省某地区887名青少年（43.90%男生; M = 15.55）进行为期一学年的追踪研究。在控制了性别、年龄后,结果发现:（1）学年初始的睡眠问题可以显著正向预测青少年学年末的越轨同伴交往（b2 = 0.12, SE = .05, p < .05）,即青少年在学年初始睡眠问题越多,学年末则表现出更多的越轨同伴交往;（2）研究并未发现学年初始的青少年越轨同伴交往可以显著预测其学年末的睡眠问题（b1 = –0.07, SE = .06, p > .05）。因此,本研究的结果支持了睡眠问题对青少年越轨同伴交往的单向预测作用,即睡眠问题可能是增加青少年越轨同伴交往的重要风险因素之一。