论医疗行为中的“可容性危险”原则

对合法的医疗行为进行认定,分析医疗的局限性和社会认知差异,认为在医疗活动中,为谋求对疾病认识,应允许医疗活动带有危险性。对可容性危险原则进行法理分析,结合实际案例,分析医疗行为中的“可容性危险”原则的运用以及司法界对该原则的认知。     

Time for change: using implementation intentions to promote physical activity in a randomised pilot trial

Objective: A common barrier to exercise is a perceived lack of time. The current pilot study examined the effects of an implementation intention intervention to enhance exercise self-efficacy, increase confidence to exercise when facing time constraints, and increase physical activity in middle-aged adults (n?=?63, aged 35–69). Design: Participants received a pedometer (Fitbit) to objectively measure activity and were randomly assigned to either a control or intervention condition. After a 1-week baseline, the intervention condition received instructions to plan how, where, and when they would add steps to their daily routine to meet their step goal, using personalised schedules and maps. Both groups were contacted nightly via email. Main Outcome Measures: Physical activity (steps and time spent in moderate-to-vigorous activity), goal achievement, exercise self-efficacy, time-relevant exercise self-efficacy and affect. Results: Compared to the control, the intervention condition significantly increased in steps, time spent in moderate-to-vigorous activity, and time-relevant exercise self-efficacy. Goal achievement was related to greater time-relevant exercise self-efficacy and more positive affect at the daily level. Conclusion: Findings suggest that the personalised planning intervention increased physical activity and confidence in achieving physical activity goals under time constraints. Avenues for future directions, especially for producing more sustained effects, are discussed.     

Social support and verbal interaction are differentially associated with cognitive function in midlife and older age

Social engagement is associated with healthy aging and preserved cognition. Two dimensions of engagement, verbal interactions and perceived support, likely impact cognition via distinct mechanistic pathways. We explored the cognitive benefit of each construct among enrollees (N = 1,052, mean age = 60.2 years) in the Wisconsin Registry for Alzheimer’s Prevention study, who provide neuropsychological and sociobehavioral data at two-year intervals. Outcomes included six cognitive factor scores representing key domains of executive function and memory. Key predictors included self-reported perceived social support and weekly verbal interaction. Results indicated that after adjusting for lifestyle covariates, social support was positively associated with Speed and Flexibility and that verbal interactions were associated with Verbal Learning and Memory. These findings suggest that support, which may buffer stress, and verbal interaction, an accessible, aging-friendly form of environmental enrichment, are uniquely beneficial. Both are integral in the design of clinical and community interventions and programs that promote successful aging.     

自我信息的反应抑制优势：来自神经振荡的证据

为探明个体对自我信息的反应抑制神经机制,记录了被试在完成面孔识别的停止信号任务时的脑电信号。神经振荡结果显示,反应任务中,加工自我面孔引发了更大的同步化δ节律和去同步化β节律;停止任务中,自我面孔引发了更大的去同步化β节律,特别在大脑前额区和中线上。表明,自我信息的反应抑制优势发生在抑制控制阶段,在于增强的β节律的去同步化促进了运动准备,提高了后续的动作抑制的速度。     

A predictive coding model of gaze shifts and the underlying neurophysiology

A comprehensive model of gaze control must account for a number of empirical observations at both the behavioural and neurophysiological levels. The computational model presented in this article can simulate the coordinated movements of the eye, head, and body required to perform horizontal gaze shifts. In doing so it reproduces the predictable relationships between the movements performed by these different degrees of freedom (DOFs) in the primate. The model also accounts for the saccadic undershoot that accompanies large gaze shifts in the biological visual system. It can also account for our perception of a stable external world despite frequent gaze shifts and the ability to perform accurate memory-guided and double-step saccades. The proposed model also simulates peri-saccadic compression: the mis-localization of a briefly presented visual stimulus towards the location that is the target for a saccade. At the neurophysiological level, the proposed model is consistent with the existence of cortical neurons tuned to the retinal, head-centred, body-centred, and world-centred locations of visual stimuli and cortical neurons that have gain-modulated responses to visual stimuli. Finally, the model also successfully accounts for peri-saccadic receptive field (RF) remapping which results in reduced responses to stimuli in the current RF location and an increased sensitivity to stimuli appearing at the location that will be occupied by the RF after the saccade. The proposed model thus offers a unified explanation for this seemingly diverse range of phenomena. Furthermore, as the proposed model is an implementation of the predictive coding theory, it offers a single computational explanation for these phenomena and relates gaze shifts to a wider framework for understanding cortical function.     

Carry-over effect between diet and physical activity: the bottom-up and top-down hypotheses of hierarchical self-efficacy

Healthy diet and physical activity have consistently been found to be positively correlated; however, most health behavior theories are focused on regulation of changes in single, rather than multiple, behaviors. Thus, this study explored the mechanism of the carry-over effect between diet and physical activity by conducting a longitudinal study with 706 participants to test the bottom-up and top-down hypotheses of hierarchical self-efficacy (SE). At Time 1 (baseline) and Time 3 (4 weeks after baseline), dietary behavior, physical activity, and self-efficacies of these behaviors (at the contextual level) were measured, while at Time 2 (2 weeks after baseline), general SE (at the general level) was assessed. Mediation analysis and structural equation models supported both the bottom-up and top-down hypotheses for different levels of self-efficacies, suggesting that hierarchical SE is an important factor underlying the carry-over mechanism between diet and physical activity.     

Association of hypertension-related distress with lack of self-care among hypertensive patients

Research on factors associated with poor adherence to self-care focuses primarily on psychiatric emotional disorders such as depression and anxiety, whereas non-psychiatric chronic-disease-related emotional distress has received little attention in hypertensive patients. The objective of this study was to evaluate the association of hypertension-related distress with the lack of self-care including low adherence to pharmacological treatment, lack of regular physical activity, low intake of fruits and vegetables and frequent intake of high-salt foods. A cross-sectional survey was conducted in 2014 in two family medical units affiliated with the Mexican Institute of Social Security. The study included 487 hypertensive patients >19 years of age. The conceptual framework for the study was based on the Health Promotion Model. The analysis included multiple Poisson regression models. We found that 21.1% of participants had hypertension-related distress. Low adherence to pharmacological treatment was identified in 45.8% of patients, whereas 46.8% lacked regular physical activity, 30.8% reported a low consumption of fruits and vegetables, and 54.6% frequently consumed foods high in salt content. Hypertension-related distress was associated with lack of regular physical activity and low intake of fruits and vegetables. These findings highlight the importance of addressing distress in order to improve self-care of hypertensive patients.     

Test–retest reliability of the Brunel Lifestyle Physical Activity Questionnaire

ObjectivesTo establish the test–retest reliability of planned physical activity (PPA) and unplanned physical activity (UPA) components of the Brunel Lifestyle Physical Activity Questionnaire (BLPAQ). To provide evidence of the BLPAQ's stability using the proportion of agreement (PoA) method over a 5-week period.DesignTest–retest over a 5-week period using three diverse samples of adults.MethodsThe 277 participants were subdivided into three adult samples: gymnasium users (n = 80), undergraduate students (n = 111), and university staff members (n = 86). They were asked to complete the test–retest measure in their places of exercise, study, or work respectively.ResultsCorrelation coefficients between test–retest administrations were calculated for each participant group and intraclass correlations were calculated for each item. Pearson's product-moment correlations ranged from r = 0.95 to r = 0.96 for the PPA subscale and r = 0.93 to r = 0.98 for the UPA subscale. Intraclass correlations ranged from R = 0.52 to R = 0.99 for PPA and R = 0.87 to R = 0.99 for UPA. Fisher's z tests indicated that the test–retest correlation coefficients for the BLPAQ subscales were, on the whole, significantly stronger than those of older, comparable subscales from lifestyle physical activity questionnaires. The PoA analysis for each item revealed that the test–retest administrations were in high agreement (>95%).ConclusionsOverall, the PPA and UPA factors of the BLPAQ demonstrated high reliability and stability. The present study also illustrates the utility of PoA analysis in establishing the stability of physical activity measures.     

Self‐efficacy or perceived behavioural control: Which influences consumers' physical activity and healthful eating behaviour maintenance?

This research investigated the role of a commercial program, Michelle Bridges 12 Week Body Transformation (MB12WBT), that uses a variety of tools including social support to influence weight management behaviours such as exercising and eating healthfully. The need for research into weight management remains current given obesity rates have continued to increase in recent decades. Weight management is a complex behaviour that for many consumers involves barriers that influence their commitment to continue exercising and eating healthily. The Theory of Planned Behaviour is frequently used to explain, and to a lesser extent predict, behaviours such as physical activity and healthy eating; however, there is much debate as to whether a perceived behavioural control variable or self‐efficacy is the best predictor of behaviour. Structural equation modelling was used to analyse data from a sample of 724 respondents who answered a baseline and three month follow‐up survey. The analysis revealed self‐efficacy and perceived behavioural control were two distinct constructs. Self‐efficacy was a better predictor of behaviour than perceived behavioural control variables as suggested in the original Theory of Planned Behaviour. Furthermore, self‐efficacy had a significant impact on exercising and eating healthfully behaviour. The findings and implications for both behaviour change theory and practice are discussed.     

Barriers and facilitators of physical activity and sport participation among young transgender adults who are medically transitioning

Background: Transgender people (those who feel incongruence between the gender they were assigned at birth and their gender identity) engage in lower levels of physical activity compared to cisgender (non-transgender) people. Several factors have been shown to affect physical activity engagement in the cisgender population; however, the physical activity experiences of young transgender adults have not been explored. It is therefore the aim of the current study to understand what factors are associated with physical activity and sport engagement in young transgender adults who are medically transitioning.

Method: Semi-structured interviews were conducted with 14 young transgender adults (18–36 years) who had initiated their medical transition at a transgender health service in the United Kingdom. The data were analyzed using thematic analysis.

Results: Two main themes were identified: (1) barriers and (2) facilitators to physical activity and sport. Overall, the young transgender adults were insufficiently active due to inadequate changing facilities, body dissatisfaction, fears surrounding “passing” and not being accepted by others. At the same time, participants were motivated to engage in physical activity to increase their body satisfaction and gender congruence. However, participants felt there was a lack of safe and comfortable spaces to engage in physical activity and sport.

Conclusion: Young transgender adults who are medically transitioning experience several barriers to physical activity and sport, despite being motivated to be physically active. Initiatives to facilitate young transgender adults' ability to put their motivations into practice (i.e. to be more physically active) are needed.