从指南看冠心病降脂治疗的现状及分析

层出不穷的试验研究和不断更新的指南使人们对冠心病防治的认识不断加深,但指南的实施和普及却不理想,大多数冠心病患者并未真正受益于降脂治疗。现就NCEP-ATP指南的更新和目前冠心病患者降脂治疗的现状、主要影响因素(患者的依从性、医务工作者的医疗质量、药物有效性以及效价比与经济条件)及可能的改善措施做一综述。     

ICD-11 guidelines for psychotic,mood, anxiety and stress-related disorders in Mexico: Clinical utility and reliability

Background/Objective: The World Health Organization's diagnostic guidelines for ICD-11 mental and behavioural disorders must be tested in clinical settings around the world to ensure that they are clinically useful and genuinely global. The objective is evaluate the inter-rater reliability and clinical utility of ICD-11 guidelines for psychotic, mood, anxiety- and stress-related disorders in Mexican patients. Method: Adult volunteers exhibiting the selected symptoms were referred from the pre-consultation unit of a public psychiatric hospital to an interview by a pair of clinicians, who subsequently assigned independent diagnoses and evaluated the clinical utility of the diagnostic guidelines as applied to each particular case, on the basis of a scale developed for this purpose. Results: 23 clinicians evaluated 153 patients. Kappa scores were strong for psychotic disorders (.83), moderate for stress-related (.77) and mood disorders (.60) and week for anxiety and fear-related disorders (.43). A high proportion of clinicians considered all diagnostic guidelines to be quite to extremely useful as applied to their patients. Conclusions: ICD-11 guidelines for psychotic, stress-related and mood disorders allow adequate inter-rater consistency among Mexican clinicians, who also considered them as clinical useful tools.     

American college of epidemiology ethics guidelines: Foundations and dissemination

Epidemiology is a core science of public health, focusing on research related to the distribution and determinants of both positive and adverse health states and events and on application of knowledge gained to improve public health. The American College of Epidemiology (ACE) is a professional organization devoted to the professional practice of epidemiology. As part of that commitment, and in response to concerns for more explicit attention to core values and duties of epidemiologists in light of emerging issues and increased scrutiny of epidemiology, the College developed, adopted, and published a set of Ethics Guidelines. The structure of the ACE ethics guidelines is in four parts: (1) a brief statement of core values and duties of epidemiologists, coupled with the virtues important to professional practice; (2) concise statements of key duties and obligations; (3) exposition of the duties and obligations with more applications; and (4) a brief summary and conclusion. The Guidelines have been published on the ACE website and in the official College journal Annals of Epidemiology. The guidelines contain (and maintain) core elements that define the discipline of epidemiology and its fundamental duties, but they are also intended to be dynamic and evolving, responsive to a changing professional and social environment. An earlier version of this paper was presented at the AAAS-Office of Research Integrity (ORI) meeting in Washington DC on the theme: “The Role and Activities of Scientific Societies in Promoting Research Integrity” held on April 10–11, 2000. Affiliations of co-authors: Douglas L. Weed, MD, MPH, PhD is Director of the Cancer Prevention Fellowship Program, Office of Preventive Oncology, National Cancer Institute; Jeffrey P. Kahn, PhD, MPH, is Professor of Medicine and Director of the Center for Bioethics, UMN Twin Cities, Minneapolis; Michael A. Stoto, PhD, is Associate Director for Public Health, RAND Center for Domestic and International Health Security, Arlington, VA.     

Attention to phobic stimuli during exposure: the effect of distraction on anxiety reduction, self-efficacy and perceived control

To replicate and extend the finding that distraction facilitates between session anxiety reduction (), 27 spider phobics underwent three 10-min sessions of in vivo exposure followed by one 10-min exposure session at a 4-week follow-up, while having either stimulus-relevant focused conversation or stimulus-irrelevant distracting conversation with the experimenter. Physiological arousal and subjective anxiety were measured during exposure, and self-efficacy, perceived control and performance on a behavioural task were measured at pre-treatment, post session-3, and follow-up. Monitoring and blunting coping styles were also measured at pre-treatment to assess their impact on treatment outcome. Despite equal physiological activation between the groups, those who underwent distracted exposure showed greater reductions in subjective fear within and between sessions, and showed greater increases in self-efficacy ratings, internal perceived control and performance on a behavioural task. Coping style did not interact with the effect of distraction or focusing during exposure, however blunters had less subjective anxiety reduction overall, particularly when they underwent focused exposure. Results are discussed in terms of the emotional processing model and self-efficacy theory.     

Effectiveness of risk awareness perception training in dynamic simulator scenarios involving salient distractors

The Risk Awareness Perception Training (RAPT) has been shown to improve latent hazard anticipation in young drivers. However, previous evaluation scenarios in a driving simulator often lacked either dynamic road environment features or control for such variations. The current study investigated whether the effectiveness of RAPT persists even in the presence of dynamic and salient distractors. Twenty RAPT-trained drivers and twenty-one Placebo-trained young drivers (aged 18–21) drove through eight simulated driving scenarios with latent hazards. A pedestrian avatar served as a distractor and was placed across from the latent hazard location. In half of the scenarios, the pedestrian remained static while in the other half the pedestrian started to move, without potential interference with the driver’s travelling path, as the drivers approached the latent hazard. Consistent with previous research, RAPT-trained drivers demonstrated better latent hazard anticipation performance than Placebo-trained drivers regardless of dynamic movement of the pedestrian avatar. Additionally, RAPT-trained drivers adopted wider scanning patterns and fixated more frequently on both the latent hazard and the pedestrian compared to Placebo-trained drivers. The results imply that RAPT may protect drivers from being distracted by dynamic stimuli and allow them to scan safety–critical areas containing latent hazards. Furthermore, RAPT may not only improve tactical hazard anticipation skills, but also modal hazard anticipation skills in young drivers.     

Sports Media Representations of Concussions in the National Rugby League

Objective

Concussion is poorly understood by the general public who are regularly exposed to this type of injury via televised sports such as the National Rugby League (NRL). This study investigated media representations of concussion by examining the terminology used by the commentators during the 2010 and 2011 NRL seasons.

Method

Data was obtained through a surveillance design where commentary statements were recorded for each observable concussion.

Results

Dramatic terminology was the most frequently used followed by entertaining and humorous terminology. Commentators often portrayed the way the incident had occurred and the player's reaction to being concussed. However, information about a player sustaining an injury that required medical attention was rarely conveyed.

Conclusion

Media tend to trivialise concussion and this may have an impact on the public's knowledge of, and influence their response to, concussion.     

Intervention research: Integrating practice guidelines with dissemination strategies-A rejoinder to Paul, Stuve, and Cross

Paul, Stuve, and Cross (this issue) misunderstood the importance of the token economy described by Morisse et al. (1996) because they evaluated it solely from a clinical research perspective. Intervention research is a broader paradigm that describes the development of effective interventions via a series of research activities including basic psychological research, clinical research, and dissemination research. Given the wisdom of intervention research, we address three points made by our colleagues: (a) mental health staff should not adapt empirically validated practice guidelines to meet the needs of their program; (b) total-quality-management strategies like Interactive Staff Training should not drive dissemination efforts because they have little empirical support; and (c) user-friendly programs are inappropriate and unethical because they ignore consumer interests.     

Processing spatial-temporal information in recent-onset schizophrenia: the study of short-term memory and its susceptibility to distraction

Memory impairment is a core feature in schizophrenia (SZ). The aim of this study was to investigate short-term memory (STM) and its sensitivity to distraction with visual-spatial material. This study comprised 23 recent-onset SZ patients and 23 healthy controls. The degree of disruption upon recall from interleaving irrelevant items within a sequence of to-be-remembered items-the sandwich effect [Hitch, G. J. (1975). The role of attention in visual and auditory suffix effects. Memory and Cognition, 3, 501-505]-was examined. STM performance, whether in the presence or absence of distraction, was poorer and markedly more vulnerable to disruption in SZ. Our results suggest that processing spatial information in STM is susceptible to interference in SZ.