综合医院抑郁症和神经症诊疗决策的思考

抑郁症和神经症是一种慢性易复发性精神疾病,发病率高,疾病负担重,多数患者都就诊于综合医院非精神专科,而目前的现状是综合医院的各科医生对此类疾病的识别率低、治疗率低,患者依从性差。结合临床提出了关于综合医院如何提高抑郁症和神经症的识别率,医生在精神疾病诊疗中应注意的问题以及如何提高患者治疗依从性等临床亟待解决的问题。     

Marriage, Parenting, and the Emergence of Early Self-Regulation in the Family System

The early years of toddlerhood mark the emergence of self-regulation and the child's ability to comply with parental requests. The current study examined young children's compliance and noncompliance in a family context by observing mothers, fathers, and two children in a family clean-up paradigm. Marital conflict and mutual responsiveness in the parent-child relationship were used as predictors of children's early self-regulation in an effort to explore risk and protective factors within the family. Several interactions between mother and father behavior as well as between marital conflict and parenting revealed how father-infant attachment moderates the effects of mother-infant attachment on children's compliance and how a close father-child relationship can protect children from the risks associated with high levels of marital conflict. Results indicate that future research on children's early self-regulation needs to be more systemic and move beyond the traditional mother-child dyadic context.     

降压治疗的决策思考

尽管降压药物有了很大发展,高血压的控制率仍很低下。降压治疗中还存在包括医生和患者两方面的许多误区。目前已取得的共识是:降压治疗的益处主要来自血压控制。因此,非常重要的是要达到血压的有效和长期稳定的降低。根据患者的年龄、基线血压、伴随的临床状况等,因人而异地选择副作用小、降压效果好的药物,提高顺应性是改善高血压控制率的关键。     

The relationship between acceptance,fatigue, and subjective cognitive impairment in hematologic cancer survivors

Background/Objective: Cancer and its treatment can have a detrimental impact on psychological well-being. Acceptance as the basis of acceptance and commitment therapy (ACT) has shown beneficial effects on depression and anxiety. However, its relationship to fatigue and cognitive impairment has not been investigated. A protective effect of acceptance may open up a new target for psychological intervention.Method: A cross-sectional postal survey was undertaken. 922 hematological cancer survivors (≥ 2.5 years post diagnosis) were recruited through two regional cancer registries in Germany. Acceptance (AAQ-II), fatigue (BFI) and subjective cognitive impairment (AFI) were assessed.Results: Higher levels of acceptance were negatively associated with fatigue and subjective cognitive impairment (R²= .34 and R²= .26, respectively). The relationship between fatigue and fatigue-related impairment of daily life was weaker for survivors with high acceptance.Conclusions: Acceptance is strongly associated with fatigue and subjective cognitive impairment. ACT may be useful to reduce symptoms of fatigue and subjective cognitive impairment in cancer survivors.     

Effects of decreasing intersession interval duration on graduated exposure treatment during simulated routine dental care

Reports suggest that individuals with developmental disabilities often engage in behavior during dental visits that precludes regular dental care. Graduated exposure therapies are an effective treatment for avoidant behavior in people with developmental delays, and some studies show that the duration of the intersession interval (ISI) can impact the effectiveness of graduated exposure treatments for typically developing individuals. The current study examined the effects of decreasing ISI on outcomes of a graduated exposure treatment during simulated routine dental care for 3 individuals diagnosed with autism. Treatment consisted of graduated exposure and extinction for disruptive behavior. Initially, sessions were conducted once per week. In subsequent conditions, treatment sessions were conducted 3‐5 times per week. A nonconcurrent multiple baseline across subjects design was used to demonstrate experimental control. Results suggest that decreasing ISI durations can produce improved treatment outcomes.     

Turning failures into successes: a methodological shortcoming in empirical research on surrogate accuracy

Decision making for incompetent patients is a much-discussed topic in bioethics. According to one influential decision making standard, the substituted judgment standard, a surrogate decision maker ought to make the decision that the incompetent patient would have made, had he or she been competent. Empirical research has been conducted in order to find out whether surrogate decision makers are sufficiently good at doing their job, as this is defined by the substituted judgment standard. This research investigates to what extent surrogates are able to predict what the patient would have preferred in the relevant circumstances. In this paper we address a methodological shortcoming evident in a significant number of studies. The mistake consists in categorizing responses that only express uncertainty as predictions that the patient would be positive to treatment, on the grounds that the clinical default is to provide treatment unless it is refused. We argue that this practice is based on confusion and that it risks damaging the research on surrogate accuracy.

The Holistic Way: John Wesley’s Practical Piety as a Resource for Integrated Healthcare

In the midst of the multifarious healthcare of the 21st century an Anglican clergyman from the 18th century named John Wesley can serve as a valuable resource for contemporary Christians seeking to faithfully live a life of well-being which incorporates different forms of medicine. In order to explore Wesley’s contributions to integrative care this essay will first situate Wesley in his 18th century context—a time period not completely unlike our own in which medicine was also experiencing dramatic shifts in practice and philosophy. In order to demonstrate his integration of the medical knowledge of his day the essay will look at Wesley’s own medical practices and his relationships to physicians as forging a “middle way” between physic and empiricism. The essay will examine Wesley’s theology as a practical piety which is grounded in a holistic sotieriology that sustains an integrative medicine (caring for body, mind, and spirit). Finally, the essay concludes with possibilities for integrated medicine in our own day as informed by a Wesleyan “way” of holistic practice.

Pedestrian behaviors at and perceptions towards various pedestrian facilities: an examination based on observation and survey data

This paper presents findings from an observational study of pedestrian behaviors at various urban crosswalks and a pedestrian user survey which sought pedestrian perceptions toward various pedestrian facilities in a divided urban boulevard located next to a large university campus, Michigan State University, East Lansing, MI, USA. Such facilities included signalized and unsignalized intersection crosswalks, unsignalized marked and non-striped midblock crosswalks, physical barriers (vegetation and two-foot high concrete wall), midblock crosswalk shelters, colored paving (red brick pavement) at medians and curbs, and pedestrian warning signs at midblock crossing locations, messaging “cross only when traffic clears.” Pedestrian behavior data were obtained from the reduction of video images of pedestrian movements recorded throughout the study site. Pedestrian perceptions information was obtained through a user survey completed by pedestrians using the study site. It was found that unsignalized midblock crosswalks were the treatment of preference to pedestrians (83% reported a preference to cross) and also showed high crossing compliance rate of pedestrians (71.2%). It was also evident that the crosswalk location, relative to the origin and destination of the pedestrian, was the most influential decision factor for pedestrians deciding to cross at a designated location (90% said so). Proper traffic control can further encourage pedestrian crossings at designated locations since the effect of the availability of pedestrian signal to influence pedestrians’ decisions to cross at a specific location was quite high (74% said so). Moreover, vegetation and concrete barriers influenced the decision to cross of a significant number of pedestrians surveyed (65%). It is expected that the findings from this study will help traffic engineers, urban planners and policy makers understand pedestrian behaviors and attitudes at/towards pedestrian crosswalks.     

幼儿约束性顺从研究的兴起与进展

20世纪90年代中期,人们对幼儿顺从的认识发生了深刻的变化,提出了约束性顺从的概念。所谓约束性顺从指的是幼儿全心全意地、心甘情愿地遵从成人的要求而约束和调节自己的行为。它是幼儿由外部控制逐渐过渡到自我控制的中间环节,对探讨外界价值的内化和幼儿自我控制能力的形成有重要意义。该文综述了近年来国外对幼儿约束性顺从的研究,并对未来的研究提出了一些建议。     

Sir Karl, Sir Ronald, (Sir) Paul, and the human element in the progress of soft psychology

Meehl’s article related to theoretical risks and tabular asterisks reminds us of the importance of thinking and theorizing as well as hypothesizing and testing, a point that is as relevant today in soft psychology as it was in 1978. Although progress is impeded by the profusion of tabular asterisks, we should recognize as well that the course of events is shaped by the actors involved—theories not only fade away, they are excluded by these actors.