浅谈ICU中肺损伤与急性呼吸窘迫综合征的防治

ICU中危重病人较多,急性肺损伤(ALI)与急性呼吸窘迫综合征(ARDS)较普通病房更为常见,常可由严重的感染、误吸、脓毒症、创伤、反复输血以及弥散性血管内凝血等因素引起,病理生理过程十分复杂,治疗也很困难,须从多个方面综合考虑,才能提高病人的生存率,挽救病人生命。     

Clinical Characterization and Risk Profile of Individuals Seeking Genetic Counseling for Hereditary Breast Cancer in Brazil

Hereditary breast cancer (HBC) accounts for 5–10% of breast cancer cases and it significantly increases the lifetime risk of cancer. Our objective was to evaluate the sociodemographic variables, family history of cancer, breast cancer (BC) screening practices and the risk profile of cancer affected or asymptomatic at-risk women that undergo genetic counseling for hereditary breast cancer in public Brazilian cancer genetics services. Estimated lifetime risk of BC was calculated for asymptomatic women using the Gail and Claus models. The majority of women showed a moderate lifetime risk of developing BC, with an average risk of 19.7% and 19.9% by the Gail and Claus models, respectively. The average prior probability of carrying a BRCA1/2 gene mutation was 16.7% and overall only 32% fulfilled criteria for a hereditary breast cancer syndrome as assessed by family history. We conclude that a significant number of individuals at high-risk for HBC syndromes may not have access to the benefits of cancer genetic counseling in these centers. Contributing factors may include insufficient training of healthcare professionals, disinformation of cancer patients; difficult access to genetic testing and/or resistance in seeking such services. The identification and understanding of these barriers is essential to develop specific strategies to effectively achieve cancer risk reduction in this and other countries were clinical cancer genetics is not yet fully established.     

Using Adult Learning Theory Concepts to Address Barriers to Cancer Genetic Risk Assessment in the African American Community

Utilization of cancer genetic risk assessment can be profoundly influenced by an individuals’ knowledge of risk assessment, attitudes regarding illness and healthcare, and affective reactions derived from social norms. Race and ethnicity play a powerful role in the development of an individual's attitudes and should be considered when attempting to understand a person's openness to cancer genetic risk assessment (Lannin et al., 1998). Until recently, however, cancer screening and prevention programs have been primarily based on data from studies conducted with the Caucasian population, yielding data that are not fully applicable to the African American community. In the last several years, research findings regarding African American's knowledge, attitudes, and feelings about genetic counseling and testing have grown (Matthews et al., 2000; Singer et al., 2004; Thompson et al., 2003). However, to the authors’ knowledge, these data have yet to be presented in a manner that both summarizes the barriers that African Americans have reported regarding cancer genetic risk assessment, while at the same time suggesting methods individual genetic counselors can utilize during community presentations to help address these barriers. This article will first summarize previous empirical findings regarding African Americans’ knowledge, attitudes, and feelings about cancer genetic risk assessment. The article will then apply adult learning theory to those findings to provide genetic counselors with practical, theory based techniques to apply toward community based educational programs with African American groups.     

Risk perception in Taiwan

In a questionnaire study, 51 Taiwanese college students were asked to judge 48 natural and human-made hazards on nine risk characteristics. Another group of 61 students were asked to rate the magnitude of 80 hazards and their attitudes toward these hazards. To evaluate the dimensionality of risk perception, participants' ratings for the nine risk characteristics were analyzed using Profile Analysis via Multidimensional Scaling approach. Two dimensions of risk perception were identified: (i) Involuntary versus Immediate Effect; and (ii) Delayed Effect versus Known to Science and Chronic. The relationships of risk perceptions and perceived public and private responsibilities in risk management were examined. Catastrophic, certain-to-be-fatal, dreaded, and uncontrollable risks were perceived as more deserving of public risk management, while controllable risks that were known to science, known to those exposed, and chronic were perceived as more deserving of private management. In particular, diseases are perceived as most deserving of private risk management and least deserving of public risk management; and technologies are perceived as most deserving of public risk management and least deserving of private risk management.     

前临床期痴呆的认知特征：当前研究进展和未来研究展望

在这篇文章中, 我将讨论从正常老化到痴呆, 这一通常被称为痴呆前临床阶段的认知功能的转变。研究表明, 阿尔茨海默症和血管性痴呆病人在临床确诊之前的几年中, 会出现明显的认知损伤。早期最突出的损伤存在于情节记忆、加工速度以及执行功能。这些功能性损伤与神经生物学研究证实的边缘系统和新皮层区存在多重损伤是相一致的。虽然早在临床诊段之前, 病人组和控制组的平均成绩存在巨大差异, 但同时这两组测试成绩的分布在很大程度上是重叠的。寻求降低这种重叠度的方法是未来研究的一个重要任务。这有可能通过将认知的和其他指标(如基于脑的、基因的、临床的、社会的)相结合构建预测模型来实现。此外, 在未来研究中以下三方面也是急需考虑问题: (a) 找出在 前临床期间认知功能急速下降的时间点: (b) 评估从前临床到临床诊断变化速率中存在的个体差异; (c) 确定特定因素与随后发生的痴呆之间的关联强度是如何随时间向临床确诊推进而逐渐变化的。     

I felt low and my purse feels light: depleting mood regulation attempts affect risk decision making

We propose that negative affect can induce people to engage in risky decisions. We test two alternative hypotheses as to how this effect may emerge. The mood repair hypothesis states that risky choices in risk decision making serve as a means to repair one's negative affect. The depletion hypothesis, in contrast, states that risky choices in risk decision making are the mere consequence of a state of depletion resulting from engagement in active mood regulation attempts. The results of a first laboratory study establish a link between risky choices in risk decision making and negative affect. Subsequent experiments provide evidence that depletion due to active mood regulation attempts, rather than mood repair, is the underlying process for this link. Copyright © 2008 John Wiley & Sons, Ltd.     

Better safe than sorry: Precautionary reasoning and implied dominance in risky decisions

In four studies, student and nonstudent participants evaluated the possible outcomes of binary decisions involving health, safety, and environmental risks (e.g., whether to issue a dam‐failure evacuation order). Many participants indicated that false positives (e.g., evacuation, but no dam failure) were better than true negatives (e.g., no evacuation and no dam failure), thereby implying that the more protective action dominated the less protective action. A common rationale for this response pattern was the precautionary maxim “better safe than sorry.” Participants apparently evaluated outcomes partly on the basis of the decisions that might lead to them, in conflict with consequentialist decision models. Consistent with this explanation, the prevalence of implied dominance decreased substantially when the emphasis on decisions was reduced. These results demonstrate that an initial preference for a decision alternative can alter the evaluation of possible consequences of both the preferred alternative and a competing alternative, suggesting positive feedback loops that reinforce the initial preference. The rationality of considering the decision itself as an attribute of possible outcomes is discussed. Copyright © 2009 John Wiley & Sons, Ltd.     

Evaluating a dual‐process model of risk: affect and cognition as determinants of risky choice

In three studies we addressed the impact of perceived risk and negative affect on risky choice. In Study 1, we tested a model that included both perceived risk and negative affect as predictors of risky choice. Study 2 and Study 3 replicated these findings and examined the impact of affective versus cognitive processing modes. In all the three studies, both perceived risk and negative affect were shown to be significant predictors of risky choice. Furthermore, Study 2 and Study 3 showed that an affective processing mode strengthened the relation between negative affect and risky choice and that a cognitive processing mode strengthened the relation between perceived risk and risky choice. Together, these findings show support for the idea of a dual‐process model of risky choice. Copyright © 2008 John Wiley & Sons, Ltd.     

不同主题和风险下的人际信任:“信任圈”的中、加比较

在人际关系网络中,那些被信任者构成了个体的"信任圈",信任圈的规模可以代表个体表现出的信任水平。本研究考察了在不同交流主题(借钱、正面和负面信息交流)和风险等级下,中国人和加拿大人信任圈规模的差异。对202名中国和加拿大成年被试的调查表明,交流主题对信任水平有影响,在借钱和交流正面信息时信任圈明显大于交流负面信息时;风险等级越高,信任圈越小,在借钱时人们对风险等级尤其敏感;无论分享正面还是负面信息时,中国人的信任圈都比加拿大人更小,而在借钱方面中国人比加拿大人的信任圈更大。可见,人际信任与主题、风险和文化因素及其交互作用有关,这些结果对于理解信任的文化差异和跨文化交往实践非常有意义。     

重症急性胰腺炎并发急性呼吸窘迫综合征危险因素的分析

为了探讨重症急性胰腺炎（SAP）并发急性呼吸窘迫综合征（ARDs）的危险因素,回顾性分析了我院76例SAP患者入ICU时的年龄、血糖、APACHEⅡ评分等17项指标,根据是否合并ARDS对各项指标进行单因素及多因素Logistic回归分析。单因素分析显示两组在年龄、呼吸频率、血糖、感染、APACHEⅡ评分、Ranson评分、CT评分、ICU住院日方面差异有显著性（P〈0．05）,多因素Logistic回归分析显示年龄、血糖、感染、APACHEⅡ、Ranson、CT评分与SAP并发ARDS有关。故得出结论,年龄、血糖、感染、APACHEⅡ、Ranson与CT评分是SAP并发ARDS的独立危险因素。