Brain imaging techniques in the diagnosis of dementia

Various recently developed brain imaging techniques used to assist in the diagnosis of dementia are reviewed. The methods reviewed are x-ray computed tomography scan imaging, magnetic resonance imaging, positron emission tomography, and the older techniques of pneumoencephalography and radioisotope cisternography. It was concluded that while these techniques often offer excellent diagnostic information, none of them provides a definitive characteristic image for Alzheimer's disease.     

The temporality of illness: Four levels of experience

This essay argues that, while much has been gained by medicine's focus on the spatial aspects of disease in light of developments in modern pathology, too little attention has been given to the temporal experience of illness at the subjective level of the patient. In particular, it is noted that there is a radical distinction between subjective and objective time. Whereas the patient experiences his immediate illness in terms of the ongoing flux of subjective time, the physician conceptualizes the illness as a disease state according to the measurements of objective time. A greater understanding of this disparity in temporal experiencing provides insights into the lived experience of illness and can preclude difficulties in communication between physician and patient.     

论疾病的假象

疾病假象是疾病本质的特殊表现形态,是影响临床思维、导致误诊误治的重要制约因素之一。显而易见,研究疾病假象问题,探讨疾病假象的内涵规定和疾病假象一般特点;疾病假象的基本类型和疾病假象的成因分析;疾病假象的识别途径和疾病假象的辨析方法等等,对于提高临床思维水平和医疗质量,有着重要意义     

从心血管疾病的美国模式看肿瘤的中国模式

近年来,心脑血管疾病和癌症的死亡率在世界范围内已上升至前三位。自从美国通过改变生活方式,以控制心血管疾病的方针以来,心血管疾病的患病率减少了５０％,死亡率降低了２５％,人们称之为心血管疾病的美国模式。与此相应的是上海市癌症俱乐部提出了“群体抗癌”的新模式,倡导了“第四医学”和“第三人生”的新理论,１０年努力的结果,使癌症患者的５年生存率延长了３倍,１０年生存率延长了２－３倍,创造了癌症康复的中国模     

Technology in Medicine: Ontology,Epistemology, Ethics and Social Philosophy at the Crossroads

In reference to the different approaches in philosophy(of medicine) of the nature of (medical) technology,this article introduces the topic of this specialissue of Theoretical Medicine and Bioethics, that is,the way the different forms of medical technologyfunction in everyday medical practice. The authorselaborate on the active role technology plays inshaping our views on disease, illness, and the body,whence in shaping our world.     

Health of Organisms and Health of Persons: An Embedded Instrumentalist Approach

In a time when we as a society are in the process of deciding what our basic rights to health care are, it is critically important for us to have a full and complete understanding of what constitutes health. We argue for an analysis of health according to which certain states are healthy not in themselves but because they allow an individual to reach actual goals. Recognizing that the goals of an individual considered from the point of view of biology and the goals of the same individual considered as an agent in the world might be different, we introduce a distinction between the health of an individual qua organism and the health of an individual qua person. We then argue that this distinction characterizes the evaluations made by patients and healthcare providers better than the widely discussed distinction between disease and illness.     

Nonparticipation in Huntington's Disease Predictive Testing: Reasons for Caution in Interpreting Findings

When given the opportunity to clarify their genetic status, most individuals at risk for Huntington's disease (HD) currently show a preference not to know. Our understanding of the characteristics of those who do not request HD predictive testing, and the factors influencing their decision, lags behind our knowledge of test applicants. In the light of our experience with interviewing a random sample of nonparticipants in an ongoing study, we critically analyze research concerning the differences between participants and nonparticipants in HD predictive testing programs and the interpretive characterization of these two groups. The findings concerning nonparticipants are limited to a small sample of the at-risk population, with the problems of biased samples and low response rates. We discuss this and other aspects of research in this area, notably the context and timing of data collection and the predominantly questionnaire-based methodology, that lead us to interpret the conclusions drawn about these two groups with caution.     

Cardiovascular dysfunction related to threat, avoidance, and vigilant work: Application of event-related potential and critique

An integrative approach is suggested to track symbolically simulated work environment stressors, as an act to burden higher cortical function in the exposed groups. ERP would be made together with measurement of end organ stress responses as well as measurements of perceived conditions. Field studies would be the necessary complement. The following conclusions are culled from the reviewed literature: among the pilots, cardiovascular problems are the most important cause of loss of license in Europe and North America. Interactions with coworkers for air traffic controllers have been associated with cardiovascular disability. Comparing various degrees of heart disease severity among professional drivers, the IHD drivers showed the smallest N2 amplitudes and the greatest diastolic blood pressure reactivity. P300 target amplitude showed an inverse correlation with number of work hours behind the wheel. The IHD drivers were envisioned in a phase of disturbance of the selective attentional process. An interrelation has been found between Event-Related Slow Potential ERSP and midinterval heart rate acceleration associated with displeasure and arousal. A positive correlation has been found between the amplitude of the ERSP and ventricular arrhythmia rate in cardiac patients. Lowering of arrhythmia rate in response to antiarhythmic agents was associated with a significant attenuation of the ERSP. Either acceleration or deceleration is associated with the appearance of the late CNV to the aversive noise burst. There might be a “common generator behind both anticipatory heart rate responses and cortical events.” CNV might be related to frontally mediated stress mechanisms.     

Longitudinal Assessment of Pain, Coping, and Daily Functioning in Children with Sickle Cell Disease Receiving Pain Management Skills Training

Objective. To conduct intensive pain management skills training (IST) in children with sickle cell disease (SCD) and their parents and to comprehensively evaluate pain, coping, and daily functioning in children pre, immediately post, and 3 months following treatment. Methods. Three children who received IST in nonpharmacological and pharmacological pain management strategies completed a Coping Strategies Questionnaire (CSQ) at pre, post, and follow-up assessments, and daily pain and activity diaries for 18 weeks, spanning from 1 week pretreatment to 11 weeks posttreatment. Results. From pre- to posttreatment, 1 child receiving IST indicated increased report of active coping attempts and all 3 children indicated decreased report of negative thinking on the CSQ. Participants in IST used coping skills on 90% of days with pain and reported the skills to be moderately helpful on the daily diaries. For daily activities such as eating dinner, playing with friends, and hours slept, children participated similarly on days with pain and days without pain during the posttreatment period. Given the small number of participants in this study, individual cases are discussed to highlight similarities and differences in how participants responded to the treatment and during the 3-month follow-up period. Conclusions. In this pilot study, each participant showed improvement in coping and daily functioning after completing the IST program. Individual differences in response to treatment indicate the need for more targeted intervention programs that incorporate pharmacological and nonpharmacological components. The results of this study highlight both the promise and the complications of conducting comprehensive pain intervention and functional outcome studies in children with SCD.     

正确认识和运用卒中单元的理念

过去几年,卒中单元已经成为脑卒中管理的重要的进展,日益得到重视和应用,但卒中单元强调的是以多维的观点、综合性方法,使卒中病人获得最优化的临床保健和健康后果,是脑血管疾病管理的新模式和新理念,其模式类型、运行方式、费用、具体应用等还有许多问题需要广泛、深入地探索,更研究证据和时间验证和回答。