医师职业素养评测体系构建的研究进展

随着我国社会经济的发展,医疗体制的改革,医师职业素养的培养成为当今医疗体制下医学在校教育、住院医生培养、医疗卫生管理中必须关注的内容。目前国外对医师职业素养的培养做了大量的工作,也取得了较好的效果,但是对于职业素养的培养不仅需要理论教学的改革,更需要相应评估机制的建立。本文对国外医师执业素养评估的最新进展进行介绍,分析各种方法的优劣,以期为国内医学教育建立统一的、具有广泛公认度的测评体系提供参考。     

Gender-related differences in self-reported problematic exercise symptoms: A systematic review and meta-analysis

AimsTo provide quantitative summarized evidence on gender-related differences in self-reported problematic exercise (PE) symptoms.MethodsEligible studies were searched up to December 31, 2021 in the databases MEDLINE, Current Contents Connect, PsycINFO, Web of Science, SciELO, and Dissertations & Theses Global. Studies were considered eligible if they included information that allowed the calculation of the differences of interest as expressed by either the aggregate or subscales scores of the main self-reported instruments of PE identified by previous research (i.e., Commitment to Exercise Scale, Compulsive Exercise Test, Exercise Addiction Inventory, Exercise Dependence Questionnaire, Exercise Dependence Scale-Revised, and Obligatory Exercise Questionnaire). Data were analysed using three-level meta-analytic models. Potential moderator variables were examined using meta-regressions.ResultsA total of 168 effect-sizes from 117 studies (N = 65,718) were retrieved. Results showed (i) small overall differences favouring males for the aggregate scores of the instruments (g = 0.105), (ii) small-to-moderate differences favouring females for symptoms involving withdrawal (g = 0.169 and 0.118), lack of exercise enjoyment (g = 0.226), and the employment of exercise as a means to ends such as health improvement (g = 0.222), mood management (g = 0.158 and 0.226), and body weight control (g = 0.453 and 0.465); and (iii) small differences favouring males for symptoms involving spending considerable amount of time in the activity (g = 0.250), exercising with greater volume/intensity than planned (g = 0.254), a need for increased amounts of exercise to achieve the desired effect (g = 0.291), loss of control over the behaviour (g = 0.101), reduction or cessation of other activities because of exercise (g = 0.323), and continue to exercise despite physical and/or psychological issues being caused or exacerbated by this behaviour (g = 0.243).ConclusionsAdopting a gender-informed perspective may be needed both in the professional praxis of exercise and health practitioners prescribing and guiding exercise practice and in the design of prevention and treatment efforts aimed at avoiding the occurrence of PE.     

An evaluation of antecedent exercise on behavior maintained by automatic reinforcement using a three-component multiple schedule

We evaluated antecedent exercise for treating the automatically reinforced problem behavior of 4 individuals with autism. We conducted preference assessments to identify leisure and exercise items that were associated with high levels of engagement and low levels of problem behavior. Next, we conducted three 3-component multiple-schedule sequences: an antecedent-exercise test sequence, a noncontingent leisure-item control sequence, and a social-interaction control sequence. Within each sequence, we used a 3-component multiple schedule to evaluate preintervention, intervention, and postintervention effects. Problem behavior decreased during the postintervention component relative to the preintervention component for 3 of the 4 participants during the exercise-item assessment; however, the effects could not be attributed solely to exercise for 1 of these participants.     

有氧运动对记忆的影响及其神经生物学机制

有氧运动是氧气充足时运用大型肌肉群进行有节奏的持续运动。有氧运动可以加快工作记忆任务中的反应速度;在记忆编码前和记忆巩固阶段进行高强度有氧运动有助于提升情景记忆;高强度有氧运动可以促进内隐记忆。有氧运动可以促进神经营养因子的产生,引起长时程增强,激活海马等与记忆相关的脑区并促进神经元再生。未来可探究有氧运动开始和持续时间的影响、有氧运动强度和认知参与的影响、有氧运动对不同年龄性别群体的影响以及脑源性神经营养因子的中介作用,从而深入揭示有氧运动对记忆的影响及其神经生物学机制。     

Metacognitive processes in the self-regulation of performance in elite endurance runners

ObjectiveThis study sought to investigate the dynamics of attentional focus and cognitive control during endurance activity from a metacognitive perspective. The study also intended to examine the situational factors which may influence cognitive strategy use by elite endurance runners.DesignSemi-structured qualitative interviews were utilised.MethodTen elite-level endurance runners were interviewed to explore retrospectively their attentional focus and cognitive strategy use during endurance running.ResultsThe findings revealed that metacognitive strategies such as planning, monitoring, reviewing and evaluating, and metacognitive experiences were fundamental to cognitive control and cognitive strategy use in elite endurance runners. The findings also added to the array of active self-regulatory strategies previously reported in the literature.ConclusionsThese results suggest that metacognitive processes are central to effective cognitive control in elite endurance athletes during running. The findings allowed for the development of an integrative metacognitive framework, which incorporates dimensions of attentional focus. This model may better represent the processes which underpin cognitive control and determine cognitive strategy use in elite athletes during endurance running.     

Window view of nature after brief exercise improves choice reaction time and heart rate restoration

Research indicates that natural environments induce restorative effects on cognitive capacity and autonomic arousal. The present study investigates differences in choice reaction time (CRT) and heart rate responses in students (n = 9) resting with or without a window view of a modest natural environment after a physical exertion. Subjects performed a CRT-task before pedaling a spinning bike, followed by resting in a chair with either a window view of a natural environment, or no view. Heart rate was obtained during the rest-period, and the CRT task was performed again immediately after resting.Results indicated that subjects elicited significantly larger improvement in CRTs and more efficient heart rate restoration after resting with a window view, compared to resting without a view. Resting with a modest view of a natural environment after brief exercise demonstrated both a greater effect of cognitive enhancement and more efficient physiological restoration compared to resting without a view. These findings advance prior research by demonstrating both cognitive and physiological benefits from resting in a modest natural environment.     

Are self-perceptions of ageing modifiable? Examination of an exercise programme with vs. without a self-perceptions of ageing-intervention for older adults

Objective: Longitudinal studies have consistently shown beneficial effects of positive self-perceptions of ageing (SPA) on health. However, SPA are more often negative than positive, particularly in older adults. For this reason, the present study tested the effectiveness of an intervention to promote more positive SPA in the context of an exercise programme for older adults.

Design: Eighty-four community-dwelling older adults (66-88 years; M(SD)=76.8(5.29)) were randomly assigned to a group-based exercise programme over 12 weeks with (n?=?46) or without (n?=?38) a psychological intervention to change SPA, consisting of four intervention units over the programme period.

Main Outcome Measures: A gain- and a loss-related domain of SPA were assessed at baseline, after the first half of the programme, directly after the programme and in a follow-up four weeks later.

Results: Latent change score models showed an improvement of participants’ SPA in the intervention group in both SPA domains after the programme, whereas SPA did not change in the control group. Both groups showed an improvement in physical performance, however, only the IG showed additional improvements in mental health.

Conclusion: The implementation of an SPA intervention is a promising approach in regular health promotion programmes for older adults.     

Hopeful struggling for health: Experiences of participating in computerized cognitive training and aerobic training for persons with stress-related exhaustion disorder

It is important to understand how people with exhaustion disorder (ED) perceive interventions aiming to facilitate cognitive functioning. Therefore, the overall aim of this study was to explore experiences from persons with ED after participating in a 12-week intervention of either computerized cognitive training or aerobic training. Both interventions were performed in addition to a multimodal rehabilitation programme. Thirteen participants, 11 women and 2 men, were interviewed about pros and cons with participating in the training. The interviews were analysed with Qualitative Content Analysis. The analyses resulted in the theme hopeful struggling for health and the categories support, motivation and sensations. It was hard work recovering from ED. Support from others who are in the same situation, family members, and technology and routines for the training were strongly emphasized as beneficial for recovery. Timing, i.e., matching activities to the rehabilitation programme, getting feedback and perceiving joy in the training were important for motivation. Participants in both interventions experienced positive sensations with improved memory performance, everyday life functioning and increased faith in the prospect of recovery. However, it is important to consider various aspects of support and motivation in both computerized cognitive training and aerobic training to enable participants to pursue their participation.