过度医疗的成因与对策

近几年卫生费用持续增长,给国家财政、企业和个人造成了沉重的经济负担。其中,过度医疗是拉动医疗费用增长的力量之一。过度医疗造成医患关系紧张和医疗资源的浪费。深入分析过度医疗的成因,对医学伦理学和卫生经济学都具有现实意义。     

Intentional and Skillful Neurons

Abstract

In the mid-1990s, there was a major neuroscientific discovery which might drastically alter sport science in general and philosophy of sport in particular. The discovery of mirror neurons by Giacomo Rizzolatti and colleagues in Parma, Italy, is a substantial contribution to understanding brains, movements, and humans. Famous neuroscientist V. S. Ramachandran believes the discovery of mirror neurons ‘will do for psychology what DNA did for biology’ (http://www.edge.org/3rd_culture/ramachandran/ramachandran_p1.html). Somehow mirror neurons have not received the deserved attention in the philosophy of sport, but perhaps now is the time to reflect on some implications and consequences. The discovery of mirror neurons may increase our insights about our ability to learn, understand, intend, and produce skillful motor actions. In this article I will first examine what mirror neurons are and how they function in monkeys and humans. Second, I will review some objections to the so-called mirror neuron theory of action understanding, and try to reconcile some of these objections. Third, I will inquire into some implications for philosophy, which I believe are also fundamental to several topics in the philosophy of sport. I will then try to relate some of the most interesting aspects of mirror neurons to recent debates in the philosophy of sport. Finally, I will speculate on what further neuroscientific research might teach us about the nature of being a moving subject.     

Lead exposure and child maltreatment as models for how to conceptualize early-in-life risk factors for violence

Although rates of violent crime have been on the decline in the United States for the past two decades, young people—and particularly young men—continue to commit and fall victim to alarmingly high rates of violence. Effective prevention requires data on what the determinants of violence are and when in the life course they emerge. The goal of this review was to identify early-in-life risk factors for violence and to describe (a) who is most affected and (b) effect mechanisms. I focus on abuse and neglect and exposure to lead as risk factors for violence that disproportionately affect young children and that are likely to have causal effects on development. I conclude with future directions for research and intervention.     

From <Emphasis Type="Italic">ego</Emphasis> to <Emphasis Type="Italic">alter ego</Emphasis>: Husserl,Merleau-Ponty and a layered approach to intersubjectivity

This article presents two different phenomenological paths leading from ego to alter ego: a Husserlian and a Merleau-Pontian way of thinking. These two phenomenological paths serve to disentangle the conceptual–philosophical underpinning of the mirror neurons system hypothesis, in which both ways of thinking are entwined. A Merleau-Pontian re-reading of the mirror neurons system theory is proposed, in which the characteristics of mirror neurons are effectively used in the explanation of action understanding and imitation. This proposal uncovers the remaining necessary presupposition of a minimalized version of the Husserlian concept of pairing and its recent and improved version in terms of the intermodal system. This leads to a layered approach to the constitution of intersubjectivity.     

Direct perception in the intersubjective context

This paper, in opposition to the standard theories of social cognition found in psychology and cognitive science, defends the idea that direct perception plays an important role in social cognition. The two dominant theories, theory theory (TT) and simulation theory (ST), both posit something more than a perceptual element as necessary for our ability to understand others, i.e., to “mindread” or “mentalize.” In contrast, certain phenomenological approaches depend heavily on the concept of perception and the idea that we have a direct perceptual grasp of the other person’s intentions, feelings, etc. This paper explains precisely what the notion of direct perception means, offers evidence from developmental studies, and proposes a non-simulationist interpretation of the neuroscience of mirror systems.     

The Proclamation of Charles H. Long in the Time of Black Lives Matter,Standing Rock,and COVID-19

Revisiting Charles H. Long's 1991 proclamation of a modern crisis of materiality, this essay examines Long's theorization of the fetish-commodity legacies, that recreated African persons into objects and commodities, as a means of understanding our present tripartite pandemic of systemic racism, environmental destruction, and COVID-19. Examining the period of, what Long elsewhere terms, the “second creation,” I interrogate what this crisis means for the study of religion and for our society today. Building on Long's conception of “soul stuff” and yet moving beyond notions of human exceptionalism, I argue that to move beyond fetish and colonial legacies and realize a “third creation” (or, in other words, a (re-)re-creation), both scholars and the public must craft a new materialism that honors the ontological reality and value of all existence.     

The long-term effectiveness of the International Child Development Programme (ICDP) implemented as a community-wide parenting programme

Short-term effectiveness of the International Child Development Programme (ICDP) for parents in the general population has been studied. The aim of this paper was to investigate the longer term impact of the ICDP programme on parents looking for sustained changes 6–12 months after the programme. For this, a non-clinical caregiver group attending the ICDP programme (N = 79) and a non-attending comparison group (N = 62) completed questionnaires on parenting, psychosocial functioning, and child difficulties before, on completion and 6–12 months after the ICDP programme. Analyses compare changes in scores over time. The results revealed that the ICDP group showed significantly improved scores on parenting measures, less loneliness, and trends towards improved self-efficacy compared to the comparison group 6–12 months after programme completion. The ICDP group also reported that their children spent significantly less time on television and computer games and a trend towards fewer child difficulties. Key positive effects sustained over time but at a somewhat lower level, supporting community-wide implementation of ICDP as a general parenting programme. It is concluded that more intensive training with follow-up sessions should be considered to sustain and boost initial gains.     

Priming of reach trajectory when observing actions: Hand-centred effects

When another person's actions are observed it appears that these actions are simulated, such that similar motor processes are triggered in the observer. Much evidence suggests that such simulation concerns the achievement of behavioural goals, such as grasping a particular object, and is less concerned with the specific nature of the action, such as the path the hand takes to reach the goal object. We demonstrate that when observing another person reach around an obstacle, an observer's subsequent reach has an increased curved trajectory, reflecting motor priming of reach path. This priming of reach trajectory via action observation can take place under a variety of circumstances: with or without a shared goal, and when the action is seen from a variety of perspectives. However, of most importance, the reach path priming effect is only evoked if the obstacle avoided by another person is within the action (peripersonal) space of the observer.     

When far becomes near: Shared environments activate action simulation

It has been proposed that one means of understanding a person's current behaviour and predicting future actions is by simulating their actions. That is, when another person's actions are observed, similar motor processes are activated in the observer. For example, after observing a reach over an obstacle, a person's subsequent reach trajectory is more curved, reflecting motor priming. Importantly, such motor states are only activated if the observed action is in near (peripersonal) space. However, we demonstrate that when individuals share action environments, simulation of another person's obstacle avoiding reach path takes place even when the action is in far (extrapersonal) space. We propose that action simulation is influenced by factors such as ownership. When an “owned” object is a potential future obstacle, even when it is viewed beyond current action space, simulations are evoked, and these leave a more stable memory capable of influencing future behaviour.     

Therapeutic action in psychoanalytic therapy with toddlers and parents

Psychotherapy with toddlers and parents can focus on promoting attachment, facilitating development and improving interactions. Some techniques provide guidance to the parents, whereas others interpret to them their unconscious fantasies or ‘ghosts’ contributing to the child’s disorder. A recent paper introduced a psychoanalytically oriented technique, which emphasised the therapist’s interaction with the child in the presence of the parent(s). The child was addressed about his/her unconscious motivations in the session and the feelings towards the therapist. Also, the parent’s transference onto the therapist was seen as a vehicle that might further the therapeutic process and was accordingly addressed. The present paper analyses the therapeutic action in such treatments. Whereas work with the parents resembles that of ordinary psychodynamic therapy, therapeutic action is more difficult to conceptualise regarding the toddler, whose understanding of verbal interpretations and the therapist’s dialogues with the parent is more limited than that of an adult. However, a clinical vignette demonstrates a toddler’s precise and swift reactions to communications from mother or therapist. The paper investigates evidence from neuroscience and psychological research as to which communicative channels – beyond words – toddlers might perceive and comprehend. In addition, it is claimed that the countertransference is key to explaining how the therapist understands such communication.