利益相关者分析方法在卫生政策改革中的应用

利益相关者分析作为一种新的方法,已经广泛应用于西方国家的企业管理与卫生政策改革研究和实践中,并取得初步成效,但在我国尚未得到应有的重视.在介绍该方法的基础上,结合我国卫生改革的实际,对利益相关者分析方法在我国卫生政策改革中的应用问题进行了初步的探讨,力图为正处于转型时期的我国卫生改革政策的制定与实施提供新的视角.     

WISC-R Subtest But No Overall VIQ–PIQ Difference in Dutch Children with PDD-NOS

VIQ–PIQ differences have been studied in children with autism and Asperger syndrome but have not been studied in a separate group of children with PDD-NO, although, PDD-NOS has a much higher prevalence rate than autism and deficits in communication and social interaction are severe. The Wechsler Intelligence Scale for Children-Revised (WISC-R) was administered to 100 children, aged 6–12 years, with PDD-NOS (n = 76), autism (n = 13), and Asperger syndrome (n = 11). PDD-NOS was diagnosed using explicit research criteria. No overall differences between VIQ and PIQ were found in PDD-NOS and autism. Peaks in the subtest scores on Information, Similarities, Picture Arrangement, and Mazes, and troughs in the subtest scores on Comprehension, Digit Span, and Coding were demonstrated in children with PDD-NOS. Their score on the Freedom from Distractibility factor was lower than the scores on the Verbal Comprehension factor and the Perceptual Organization factor. Children with PDD-NOS seemed to have a similar VIQ–PIQ profile as children with autism, and on the subtest level children with PDD-NOS showed some similarities to children with Asperger syndrome or autism. It was not possible to distinguish PDD-NOS from autism or Asperger syndrome by using IQ scores.     

Room for a view: on the metaphysical subject of personal identity

Sydney Shoemaker leads today’s “neo-Lockean” liberation of persons from the conservative animalist charge of “neo-Aristotelians” such as Eric Olson, according to whom persons are biological entities and who challenge all neo-Lockean views on grounds that abstracting from strictly physical, or bodily, criteria plays fast and loose with our identities. There is a fundamental mistake on both sides: a false dichotomy between bodily continuity versus psychological continuity theories of personal identity. Neo-Lockeans, like everyone else today who relies on Locke’s analysis of personal identity, including Derek Parfit, have either completely distorted or not understood Locke’s actual view. Shoemaker’s defense, which uses a “package deal” definition that relies on internal relations of synchronic and diachronic unity and employs the Ramsey–Lewis account to define personal identity, leaves far less room for psychological continuity views than for my own view, which, independently of its radical implications, is that (a) consciousness makes personal identity, and (b) in consciousness alone personal identity consists—which happens to be also Locke’s actual view. Moreover, the ubiquitous Fregean conception of borders and the so-called “ambiguity of is” collapse in the light of what Hintikka has called the “Frege trichotomy.” The Ramsey–Lewis account, due to the problematic way Shoemaker tries to bind the variables, makes it impossible for the neo-Lockean ala Shoemaker to fulfill the uniqueness clause required by all such Lewis style definitions; such attempts avoid circularity only at the expense of mistaking isomorphism with identity. Contrary to what virtually all philosophers writing on the topic assume, fission does not destroy personal identity. A proper analysis of public versus perspectival identification, derived using actual case studies from neuropsychiatry, provides the scientific, mathematical and logical frameworks for a new theory of self-reference, wherein “consciousness,” “self-consciousness,” and the “I,” can be precisely defined in terms of the subject and the subject-in-itself.     

Autism Spectrum Symptomatology in Children: The Impact of Family and Peer Relationships

This study examines the potential impact of family conflict and cohesion, and peer support/bullying on children with autism spectrum disorder (ASD). While such impacts have been established for a range of non-ASD childhood disorders, these findings may not generalize to children with ASD because of unique problems in perspective-taking, understanding others’ emotion, cognitive rigidity, and social reasoning. A structural model-building approach was used to test the extent to which family and peer variables directly or indirectly affected ASD via child anxiety/depression. The sample (N = 322) consisted of parents of children with ASD referred to two specialist clinics. The sample contained parents of children with Autistic Disorder (n = 76), Asperger Disorder (n = 188), Pervasive Disorder Not Otherwise Specified (n = 21), and children with a non-ASD or no diagnosis (n = 37). Parents completed questionnaires on-line via a secure website. The key findings were that anxiety/depression and ASD symptomatology were significantly related, and family conflict was more predictive of ASD symptomatology than positive family/peer influences. The results point to the utility of expanding interventions to include conflict management for couples, even when conflict and family distress is low. Further research is needed on the potentially different meanings of family cohesion and conflict for children with ASD relative to children without ASD.     

直立位机械通气可行性的探讨

机械通气是治疗急性肺损伤／急性呼吸窘迫综合征（ALI／ARDS）的重要措施之一,本文从理论上探讨直立位机械通气的可行性,推测其可能的机制,与肺保护通气策略的关系,尚需要解决的问题,以期证明优于传统机械通气方式。     

中国古代医政组织的演进及评价

中医概念体系需要细化和重构,在对中医辨证、辨病内涵实质进行再分析基础上,认为目前中医辨病辨证认识存在着关系不清、临床功能定位模糊等问题,阐述了细化重构中医辨治理论模型的必要性,并初步探析了辨病与辨证二者的趋同关系、互补关系、矛盾关系等,给出了面对辨病、辨证、辨症等多重认识时的处理原则。     

难治性肾病综合征典型病例的临床决策

难治性肾病综合征在肾内科临床实践中并不少见,其主要治疗是联合应用激素和细胞毒药物（如环磷酰胺、环孢素等）。少数患者,经以上联合治疗后仍不能达到临床缓解。而对于这些患者,长期使用激素及细胞毒药物不仅不能取得满意的效果,而且可能出现严重感染等并发症,甚至危及患者的生命,故在临床中应权衡利弊进行治疗决策。     

代谢综合征：一个颇具争论的病名

代谢综合征（MS）囊括了肥胖、高血糖、高血压、血脂紊乱等代谢异常,其预测心血管疾病和糖尿病的能力得到公认。但是,医学界对MS的探索并没有停步,有关其命名、病因、不同组分预测疾病的能力等存在着争议。客观评价MS将有助于提高医生对疾病相互关系的认识。     

肠道菌群与代谢综合征

人类肠道内定植着大量的微生物,肠道菌群通过多种机制参与机体的能量代谢,影响着宿主食物向能量的转化,对宿主的健康有着重要作用,因此,可以将肠道菌群看作是具有多种调节功能的“体外器官”。近年来研究的结果提示人类胃肠道菌群的改变参与了肥胖及胰岛素抵抗的发生。本综述旨在探讨肠道正常菌群与代谢综合征的关系。     

The Monkey as a Psychological Subject

Many species in long-term captivity have tried to kill time by playing friendly games with their warders. In the end, only rhesus monkeys (Macaca mulatta) could tolerate the tedious hide-and-seek games that their human jailers prefer to play. In this article, written many years before the Stockholm syndrome was first described, the author relates how it was eventually discovered which species is most willing to contribute to the development of a genuinely scientific human psychology. Harry F. Harlow died in 1981 and Dr. Frank C.P. van der Horst (fhorst@fsw.leidenuniv.nl) of Leiden University stands as the person to addess correspondence to.

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