The impact of social support on the acceptance process among RA patients: A qualitative study

Acceptance is an important component of pain management, being associated with improved quality of life and lower levels of pain and depression. In enabling patients with chronic diseases to accept unpleasant consequences and to establish a new way of living, the support they receive from their social environment may play a decisive role. In this article, we identify the key sources and types of social support that are relevant for rheumatoid arthritis (RA) patients, and explore when and how those sources are important across the different stages of the acceptance process. We conducted a qualitative study involving 20 semi-structured interviews with RA patients in Switzerland. Analysis of the data followed the precepts of grounded theory. We found that, amid the complexity and variety of patients’ struggles for acceptance, there were some common experiences or ‘key moments’ in which social support played an important role. While three sources of support – family, physicians and the external social context – are fundamental for RA patients, all three may inhibit as well as encourage acceptance, due to the invisible and unpredictable character of the disease. There is a pervasive risk either of underestimating patients’ suffering or of over-supporting, both of which prevent patients accepting the disease and developing a new ‘normal’ life. We conclude that sources of social support need to find a middle way between scepticism and solicitousness.     

Personality trait change and life satisfaction in adults: The roles of age and hedonic balance

This paper examines whether changes in personality traits influenced life satisfaction (LS). This involved investigating whether these associations were moderated by age and mediated by hedonic balance (i.e., positive and negative affect). Participants included 11,104 Australian adults aged 18–79 years, with data available from two time points (baseline and 4-year follow up). Latent difference score modeling indicated that increased neuroticism was associated with lower LS, whereas increased extraversion, conscientiousness, and agreeableness were associated with higher LS. These relationships were moderated by age, and were less evident in older adults. Hedonic balance partially mediated the relationships between change in neuroticism and extraversion with LS. These findings provide important insights into longitudinal associations between personality change and LS.     

Approximate entropy used to assess sitting postural sway of infants with developmental delay

Infant sitting postural sway provides a window into motor development at an early age. The approximate entropy, a measure of randomness, in the postural sway was used to assess developmental delay, as occurs in cerebral palsy. Parameters used for the calculation of approximate entropy were investigated, and approximate entropy of postural sway in early sitting was found to be lower for infants with developmental delay in the anterior-posterior axis, but not in the medial-lateral axis. Spectral analysis showed higher frequency features in the postural sway of early sitting of infants with typical development, suggesting a faster control mechanism is active in infants with typical development as compared to infants with delayed development, perhaps activated by near-fall events.     

Tonic postural lean after-effects influenced by support surface stability and dynamics

Tonic neuromuscular processes are evident during lean after-effects, which occur after prolonged standing on a fixed ramp. Postural processes underlying lean after-effects were examined here using dynamic surface conditions. Three tilt adaptation conditions were tested with eyes-closed (n = 11). Tilt adaptation conditions involved standing for 120 s on a fixed toes-up ramp (7°) or on a toes-up sinusoidally tilted surface (7° ± 3°), which was followed by 120 s of standing on either a fixed horizontal surface or sway-referenced surface. All participants showed postural after-effects (p < .003). Specifically, standing on a fixed horizontal surface after sine-tilt adaptation, resulted in forward leaning which decayed over 120 s back to baseline. Standing on a sway-referenced surface after tilt-adaptation, initially showed no lean after-effect, however over the course of the trial the center-of-pressure shifted backward (p < .02). This after-effect during sway-reference conditions was also evident in the sway-induced surface tilt, which increased in dorsiflexion (p < .002), rather than decaying back to baseline. Thus, adaptation occurs on a dynamically tilted surface, while reliability of the surface as a stable reference affects the return of the center-of-pressure and surface tilt to baseline. These findings relate to changes in flexor/extensor muscle tonic set-point which also occur following a prolonged voluntary isometric contraction.     

Sensori-motor integration during stance: Time adaptation of control mechanisms on adding or removing vision

Sudden addition or removal of visual information can be particularly critical to balance control. The promptness of adaptation of stance control mechanisms is quantified by the latency at which body oscillation and postural muscle activity vary after a shift in visual condition. In the present study, volunteers stood on a force platform with feet parallel or in tandem. Shifts in visual condition were produced by electronic spectacles. Ground reaction force (center of foot pressure, CoP) and EMG of leg postural muscles were acquired, and latency of CoP and EMG changes estimated by t-tests on the averaged traces. Time-to-reach steady-state was estimated by means of an exponential model. On allowing or occluding vision, decrements and increments in CoP position and oscillation occurred within about 2 s. These were preceded by changes in muscle activity, regardless of visual-shift direction, foot position or front or rear leg in tandem. These time intervals were longer than simple reaction-time responses. The time course of recovery to steady-state was about 3 s, shorter for oscillation than position. The capacity of modifying balance control at very short intervals both during quiet standing and under more critical balance conditions speaks in favor of a necessary coupling between vision, postural reference, and postural muscle activity, and of the swiftness of this sensory reweighing process.     

Does the "eyes lead the hand" principle apply to reach-to-grasp movements evoked by unexpected balance perturbations?

A fundamental principle that has emerged from studies of natural gaze behavior is that goal-directed arm movements are typically guided by a saccade to the target. In this study, we evaluated a hypothesis that this principle does not apply to rapid reach-to-grasp movements evoked by sudden unexpected balance perturbations. These perturbations involved forward translation of a large (2 × 6 m) motion platform configured to simulate a “real-life” environment. Subjects performed a common “daily-life” visuo-cognitive task (find a telephone and make a call) that required walking to the end of the platform, which was triggered to move as they approached a handrail mounted alongside the travel path. A deception was used to ensure that the perturbation was truly unexpected. Eleven of 18 healthy young-adult subjects (age 22-30) reached to grasp or touch the rail in response to the balance perturbation. In support of the hypothesis, none of these arm reactions was guided by concurrent visual fixation of the handrail. Seven of the 11 looked at the rail upon first entering the environment, and hence may have used “stored” central-field information about the handrail location to guide the subsequent arm reaction. However, the other four subjects never looked directly at the rail, indicating a complete reliance on peripheral vision. These findings add to previous evidence of distinctions in the CNS control of volitional and perturbation-evoked arm movements. Future studies will determine whether similar visuo-motor behavior occurs when the available handhold is smaller or when subjects are not engaged in a concurrent visuo-cognitive task.     

Assessment of postural control in patients with Parkinson’s disease: Sway ratio analysis

Analysis of the postural stability impairments in neurodegenerative diseases is a very demanding task. Age-related declines in posturographic indices are usually superimposed on effects associated with the pathology and its treatment. We present the results of a novel postural sway ratio (SR) analysis in patients with Parkinson’s disease (PD) and age-matched healthy subjects. The sway ratios have been assessed based upon center of foot-pressure (CP) signals recorded in 55 parkinsonians (Hoehn and Yahr: 1-3) and 55 age-matched healthy volunteers while standing quiet with eyes open (EO) and then with eyes closed (EC). Complementing classical sway measure abnormalities, the SR exhibited a high discriminative power for all controlled factors: pathology, vision, and direction of sway. Both the anteroposterior (AP) and mediolateral (ML) sway ratios were significantly increased in PD patients when compared to the control group. An additional SR increase was observed in the response to eyes closure. The sway ratio changes documented here can be attributed to a progressive decline of a postural stability control due to pathology. In fact, a significant correlation between the mediolateral SR under EO conditions and Motor Exam (section III) score of the UPDRS was found. The mediolateral sway ratios computed for EO and EC conditions significantly correlated with the CP path length (r = .87) and the mean anteroposterior CP position within the base of support (r = .38). Both indices reflect postural stability decline and fall tendency # in parkinsonians. The tremor-type PD patients (N = 34) showed more pronounced relationships between the mediolateral SR and selected items from the UPDRS scale, including: falls (Kendall Tau = .47, p < .05), rigidity (.45, p < .05), postural stability (retropulsion) (.52), and the Motor Exam score (.73). The anteroposterior SR correlated only with tremor (Kendal Tau = .77, p < .05). It seems that in force plate posturography the SR can be recommended as a single reliable measure that allows for a better quantitative assessment of postural stability impairments.     

肝移植术中氧代谢的平衡原则

接受肝移植术的患者往往处于危重状态,常规的血流动力学指标已不能全面地反映术中病人的状况,通过对氧供和氧耗以及氧摄取率等氧代谢指标的观测,根据氧代谢的平衡原则,将各项指标综合运用,能更有效地指导术中的麻醉管理。     

耗散结构视野下神经质症发生机理与心理治疗——从森田疗法到新森田疗法的嬗变

神经质症发病机理至今尚无公认的解释。森田疗法是当前公认用于神经质症治疗的有效手段,该理论是一种集东方智慧生活哲学的体现。可以尝试从系统科学耗散结构论的角度出发来初步探讨森田疗法及其进展对于神经质发生机理与治疗存在的合理性与积极意义。     

论艾滋病人及艾滋病毒感染者权利与义务的平衡

《艾滋病防治条例》,对于艾滋病病毒感染者和艾滋病人的权利和义务进行了精巧的设计。本着保护人权和预防疾病的需要,对艾滋病病毒感染者和艾滋病人在医疗活动、人身权益和社会经济各方面的权利与义务都进行了很好的平衡。