难治性丙型肝炎研究新进展

随着聚乙二醇化干扰素(IFN)的普及应用和慢性丙型肝炎规范化治疗的开展,其治愈率不断提高.但疗效不佳的慢性丙型肝炎患者不断积累,难治性慢性丙型肝炎患者成为临床医生必须面对的挑战.难治性丙型肝炎患者应当分为两类,第一类为“难治疗”性慢性丙型肝炎患者,该类患者由于宿主条件限制,不能耐受IFN联合利巴韦林(RBV)的标准治疗,如儿童和老年人、慢性肾功能衰竭患者等.第二类为“难治愈”性慢性丙型肝炎患者,该类患者可以耐受标准治疗方案,但按照应答指导的治疗原则(RGT)治疗后,效果仍然不佳或复发.本文就近年关于难治性丙型肝炎的研究进展,从难治性丙型肝炎的定义、机制、治疗诸方面作一综述.     

Problematic,absent and stigmatizing diagnoses in current mental disorders classifications: Results from the WHO-WPA and WHO-IUPsyS Global Surveys

This study examined English- and Spanish-speaking psychologists’ and psychiatrists’ opinions regarding problematic, absent and stigmatizing diagnoses in current mental disorders classifications (ICD-10 and DSM-IV), and their perceived need for a national classification of mental disorders. Answers to open-ended questions included in WHO-WPA and WHO-IUPsyS surveys were examined using an inductive content-analysis method. A total of 3,222 participants from 35 countries were included. The most problematic diagnostic group was personality disorders, especially among psychiatrists, because of poor validity and lack of specificity. Complex posttraumatic stress disorder was the most frequent diagnosis suggested for inclusion, mainly by psychologists, to better account for the distinct processes and consequences of complex trauma. Schizophrenia was the diagnosis most frequently identified as stigmatizing, particularly by psychiatrists, due to lack of public understanding or knowledge about the diagnosis. Of the 14.4% of participants who perceived a need for a national classification system, two-thirds were from Africa or Latin America. The rationales provided were that mental disorders classifications should consider cultural and socio-historical diversity in the expression of psychopathology, differences in the perception of what is and is not pathological in different nations, and the existence of culture-bound syndromes. Implications for ICD-11 development and dissemination are discussed.     

L’avis du CCNE no 126 (15 juin 2017) sur les demandes sociétales de recours à l’assistance médicale à la procréation : un pas en avant et deux en arrière…

On June 15, 2017, the National Consultative Ethics Committee released an opinion in favour of the extension of medically assisted procreation (MAP) to lesbian couples and single women. This opinion recommends a reversal of the medical model, which serves as the starting point for the regulatory framework concerning MAP, and expresses its support to social and family evolutions. Nonetheless this liberal and progressive stand could be a mere smokescreen, if it does not result in any meaningful implementation due to practical hindrances; moreover, this seemingly progressive stand could be questioned in view of the conservative position expressed on the issues of surrogacy and oocyte self-preservation by the committee in the same opinion.     

Secret médical en santé au travail

The occupational physicians are obliged, like any doctor, to respect the ethical obligations imposed on their profession, including in the exercise of the missions specific to occupational medicine and contained in the Labor Code. The occupational physician is not isolated and works in a multidisciplinary team of a health service at work. He must communicate with other health professionals, but also with employers, representative bodies of staff. Medical confidentiality holds a special place in the triangular relationship between the occupational physician, the employee and the employer. The medical practice in the field of occupational health requires that many provisions of the Labor Code be followed, including the respect of the secret of manufacture and the position of advising employers and employees. The occupational physician must communicate with the employer in order to best achieve his mission, but in practice, it may be difficult for the occupational doctor to make his recommendations heard to improve the working conditions of employees without power, when he cannot argue his opinions on medical information.     

A Multimodal Study of Childhood Trauma and Distress Tolerance in Young Adulthood

Individuals with a history of childhood trauma experience deficits in emotion regulation. However, few studies have investigated childhood trauma and both perceived (i.e., self-report) and behavioral measures of distress tolerance. The current study evaluated associations between childhood trauma (i.e., physical abuse, sexual abuse, and witnessing family violence) and measures of perceived (Distress Tolerance Scale) and behavioral distress tolerance (i.e., Paced Auditory Serial Addition Test, breath-holding). Participants were 320 undergraduate students with a history of interpersonal trauma (e.g., sexual/physical assault). Structural equation modeling was used to evaluate associations between frequency of childhood trauma type and distress tolerance. Greater childhood physical abuse was associated with higher perceived distress tolerance. Greater levels of witnessing family violence were associated with lower behavioral distress tolerance on the breath-holding task. No significant effects were found for Paced Auditory Serial Addition Test performance. Associations between childhood trauma and emotion regulation likely are complex and warrant further study.     

Empowering Muslim children’s spirituality in Malay Archipelago: integration between National Philosophical Foundations and Tawakkul (trust in God)

Multiple studies indicated that children raised to be spiritual were found to be happier, have more resilience and positive outlook towards life events. This paper attempts to explore and integrate the value of spirituality and religious practices. It is approached through the understanding and application of the tawakkul (trust in God) concept, as perceived from an Islamic viewpoint. This aspect is explored through the consolidation of the ‘believing in God’ component, as highlighted in the National Philosophical Foundations in Brunei, Indonesia and Malaysia to tawakkul. It will further seek to find the prospect of empowering Muslim children’s spirituality through such integration. This theoretical paper is based on the Islamic foundations and characteristics; its implementation and implications. The outcome illustrates indication of ‘divine involvement’ as the main essence of tawakkul; resulting sustainable religious, spiritual and moral enhancement. Moreover, an internalised and implicit form of tawakkul should be encouraged to promote self-understanding.     

Reading and reflecting sacred texts in the presence of the other. An empirical study on the use of ‘scriptural reasoning’ in teacher education

In this article the method of Scriptural Reasoning (SR), a text-based approach to interreligious dialogue between participants of the three Abrahamic religions, was implemented for a teacher education setting at a German university. Not only students with an outspoken religious conviction but also agnostic and atheist students, preparing themselves to become teachers in public schools, were invited into the conversation. The article documents and discusses the qualitative-empirical research in which the SR meetings were embedded. The aim of the article is not to create a hermeneutical theory for SR but rather to explore how SR as a method, with its specific learning tool of text-work, can be turned into a broader didactical model which can be transferred to other learning environments and which can in the long run provide empirical evidence on successful teacher education in multi-religious and multi-worldview societies and schools.     

What kind of tensions are involved in the pedagogical use of religious narratives? Perspectives from Finnish Evangelic Lutheran and Islamic religious education

Abstract

In this article, we examine how narratives of religious traditions are used as resources in religious education (RE) and compare practices from Evangelic Lutheran religious education (LRE) and Islamic religious education (IRE) in Finnish public schools. The sacredness of narratives from holy books entails that there can be contestations over their pedagogical use, and teachers need to negotiate the possible tensions between the pedagogical aims of liberal RE and the integrity of the holy narratives. The research data consists of interviews with teachers of LRE (n = 4) and IRE (n = 5) as well as classroom observations. The results of qualitative content analysis show that teachers use narratives as pedagogical resources when teaching about and from religion. However, tensions occurred between the ideals of student-centred, experiential and creative learning, on one hand, and respecting the sacredness of the narratives, on the other. We also present teachers’ ways of negotiating the tensions as well as some differences between LRE and IRE in the pedagogical use of narratives.     

Gut interpretations: how difficulties in emotion regulation may help explain the relation of visceral sensitivity with depression and anxiety among young adults with gastrointestinal symptoms

It is widely recognized that abdominal pain and discomfort are common problems in the United States and are often associated with negative quality of life. The prevalence of anxiety/depression elevations and disorders among persons with gastrointestinal disturbances (GI) is estimated to be at least two to three times the rate in the general population. Visceral sensitivity reflects anxiety about GI sensations and its accompanying contexts and often leads to worsening of sensations (e.g. bloating, upset stomach, diarrhea). Among individuals with GI symptoms, visceral sensitivity may be associated with interpreting common sensations as catastrophic which may be related to greater difficulties with emotion dysregulation (e.g. severe anxiety and depression). The current study evaluated the indirect association of visceral sensitivity via emotion dysregulation in relation to depression, anxious arousal, and social anxiety symptoms among 344 young adults with a current history of GI symptoms and problems. Results indicated an indirect effect of visceral sensitivity via emotion dysregulation. These findings provide novel empirical support for the association of visceral sensitivity with emotional distress symptoms among young adults with GI symptoms. Based on the results, targeting emotion dysregulation may be a promising health promotion tactic among young adults with GI symptoms and disorders.