医学本体论的当代转向——医学教育模式改革的前提性问题

医学本体论,是指“关于医学的”最根本的根据、本质和基础的理论,它是医学赖以存在的本质基础和逻辑根据。当代医学本体论的转向是从人体学本体论向人学本体论的转变。实现这一转变的主要途径在于医学教育模式的改革,而其前提性问题,则是建构人学本体论思想。     

Feasibility of a pilot intervention targeting self-care behaviors in adults with diabetes mellitus

Diabetes has reached epidemic proportions and is widely encountered by clinicians in medical settings. National Standards for diabetes education recommend utilization of an interdisciplinary team, setting individual lifestyle goals and managing barriers. However, typical diabetes education programs lack integration of strategies for translating recommendations into behavioral actions. The present intervention was developed to assess the feasibility and efficacy of a short-term cognitive-behavioral intervention aimed at optimizing self-care behaviors in adults with diabetes in a “real world” medical setting. Participants were 20 adults who had completed medical model outpatient diabetes education. The intervention consisted of 6 weekly sessions that addressed the role of behavior in diabetes including self-care barriers, cognitions and self-regulation. Pre-post intervention data indicated greater specificity in goal-setting. Participants who kept activity records had the greatest lifestyle activity behavior change. Findings suggest that a brief intervention addressing realistic goal-setting is feasible and can promote meaningful health behavior changes. Clinical psychology can provide a bridge between current diabetes care recommendations and available medical resources by providing training in and delivery of empirically supported behavior change strategies and evaluation of diabetes care treatment approaches.     

医疗费用在医疗制度改革中的变化趋势及政策取向

医疗费用的水准及其变化过程主要取决于一个国家的经济发展水平。我们预测其变化趋势可能经历三个新阶段。因此,在宏观管理上要注意四个方面的政策取向：重效率轻收入、重效果轻价格、重科学管理轻粗放经营、重长远利益轻眼前利益。     

作为社会意识的社会心理

思想体系和社会心理,是历史唯物主义领域中关于社会意识的两个范畴,前者是社会意识的高级形式,后者是社会意识的初级形式,这种初级形式是思想体系形成的基本前提。该文区分了社会心理学说与一般社会心理学的界限,并着重从社会心理学说发展的简要历史中,发掘了这门学科对于研究唯物史观和社会意识的重要意义。     

Reflections on the setting in the treatment of adolescents1

The author focuses on the signifi cance of the setting for the development of the psychoanalytic process, especially in the case of adolescents who request analytic treatment. Her main goals are to specify: a) how the setting is confi gured with this type of patients; and b) to what extent it contributes to the creation of an inner space that may internalize a fi gure with reverie‐a good object that will metabolize the bad and thus enable identifi cation. The setting, which is considered the necessary context for analytic work, is defi ned as bearing two facets: that of the analyst, which must be constant and stable, and that of the adolescent, which will progressively change provided that the analyst maintains a fi rm context that contributes to make the adolescent feel contained and accepted. It is such a feeling that will enable the unfolding of the analytic process. The author emphasizes the importance of the presence of the analyst (his or her voice, the manner of his or her speech, and so on), and the need for the analyst to comply with the rules he or she has established together with the patient. She presents a clinical case to illustrate this conceptualization.     

Shifting foundations: religious belief change and adjustment in college students

In a sample of 154 college students, prevalence of religious belief change and its relationship to religiosity and coping variables were examined twice over the course of one month. Students who reported belief change (62%) scored higher than those who did not on measures of religiosity and fared worse on adjustment measures. Significant differences in coping strategies were noted, with the change group using more religious coping and alcohol and drugs to cope. Within the change group, a higher degree of change was related to higher levels of religiousness and religious coping, and poorer adjustment at baseline and follow-up.     

特征变化的连续性影响客体连续表征的维持

本研究采用客体回溯范式考察了特征变化的连续性对维持客体连续表征的作用。实验1和实验2分别探索了形状维度上的变化方式（不变、渐变、突变）和亮度维度上的变化方式（不变、渐变、随机变化）对客体预览利化效应的影响。在特征连续条件下（不变或渐变）,两个实验都获得了客体预览利化效应。而在特征不连续变化条件下（突变或随机变化）,该效应消失。这些结果说明特征变化的连续性同样影响客体连续表征的维持。     

Moving Forward with Systems of Care: Needs and New Directions

The articles in this Special Issue on system change within systems of care (SOCs) provide guidance regarding strategies for modifying SOCs to address the needs of different populations, and ways for changing systems to support more positive child and family outcomes. This paper frames central needs, unanswered questions, and issues that remain for those working to implement SOCs. Specific needs and new directions considered include: (1) rigorous implementation-focused research to identify the necessary and sufficient elements of SOCs and the primary practice approach currently used in SOCs, wraparound; (2) applied research to assess SOCs and document their effectiveness in non-standard or non-traditional settings (i.e., non-mental health settings, including child welfare, juvenile justice, local housing authorities); (3) controlled outcome studies for school-based wraparound initiatives; (4) research to document the effectiveness of the family support efforts that are part of most SOCs; and (5) attention to context, for families, service providers, and collaborative implementation efforts, by researchers and providers alike. Progress in these areas can inform well-targeted system change efforts in the context of SOCs, a critical need given changes in federal funding for these initiatives.     

Sacralisation – the role of individual actors in legitimising religion

The article makes a contribution to the study of religion by developing the analytical concept of sacralisation as the process whereby individual religious actors and groups construct religious tradition by attributing value to single ideas and practices. The concept of sacralisation helps us understand how religious actors engage with their religious tradition and participate in constructing it by legitimising its single elements. The sacred is thus understood as constructed by religious actors as that which is of value for them and distinctive of their specific tradition. This concept has been developed from a three-year long ethnographic research in a Christian evangelical church and is illustrated through an analysis of the research data.     

Mindfulness‐based cognitive therapy is effective as relapse prevention for patients with recurrent depression in Scandinavian primary health care

This study examined the effectiveness of mindfulness‐based cognitive therapy (MBCT) in primary care for patients with recurrent depression (major depressive disorder: MDD). According to the World Health Organization (WHO), MDD is now the leading cause of disease burden in middle‐ and high‐income countries. Patients (N = 45) with three or more previous depressive episodes were recruited to participate in MBCT as a preventative intervention. Using a benchmarking approach, outcome data was compared with data from a recent efficacy study. The methodology is a rigorous approach to assessing effectiveness when evidence‐based UK protocols are transferred into the existing Scandinavian service delivery. Additionally, a person‐centred methodological approach was used to assess clinical significance on the Reliable Change Index (RCI). The analysis revealed comparable or larger effects from pre‐test to post‐test in reduced psychiatric symptoms, increased quality of life and level of mindfulness, and the effects were maintained over 14 months. Analysis of the relapse rate in the current study (16%) compared to the TAU in the efficacy study (68%) yielded an h value of 0.78, a moderate effect size. Only 13% dropped out of the treatment. According to the RCI findings, 65% to 67% of participants in the clinical group improved, no individual worsened, and women showed a significantly greater improvement of depression and anxiety than men. Therapeutic alliance and motivation had no impact on the outcome. The overall result suggests that MBCT can be implemented successfully in Scandinavian primary health care as a preventive intervention for patients with recurrent depression.