人格特征对胃癌发病的影响

使用Ｃ型行为特征问卷、生活事件量表和ＲＢＣ－Ｃ_（３ｂ）Ｒ、ＲＢＣ－ＩＣ、ＲＣＩＡ、ＣＩＣ和Ｃ_３等免疫功能的检测,调查和检测了３０名胃癌患者和５０名健康者。结果表明：（１）胃癌组比健康组在焦虑、抑郁、愤怒内泄、控制等方面得分高,在愤怒外泄、乐观、社会支持等方面得分低;（２）胃癌患者在确诊前８年内有７６％的患者遇到生活事件,在确诊前３年内有６２％的患者遇到生活事件;（３）胃癌组ＲＢＣ－Ｃ_（３ｂ）Ｒ含量低,ＲＣＩＡ含量和ＣＩＣ水平上升。初步结论：胃癌的发生与患者的一些行为特点有关,主要是抑郁并不表达愤怒;生活事件可作为应激源诱发胃癌;其机制可能与免疫功能有关。     

Quality of life and social support of patients being evaluated for bone marrow transplantation

A sample of 437 patients completed self-report measures of quality of life and social support while they were being evaluated for bone marrow transplantation (BMT) at The Johns Hopkins Oncology Center. Generally, the candidates showed reasonably high levels of quality of life (QOL) on the Satisfaction with Life Domains Scale (SLDS), their present ranking on the Cantril Self-Anchoring Ladder of Life, and their scores on the Bradburn Positive Affect Scale. The level of QOL of these candidates for transplant was significantly related to their level of social support. Both availability and adequacy of social support for these transplant candidates were found to be significantly related to QOL as measured by the SLDS. Availability of social support as measured by patient membership in religious and other organizations was significantly related to Positive Affect but not Negative Affect. The Family APGAR and Relational Support Scales measures of social support were significantly correlated with both Positive and Negative Affect.     

右侧基底节损伤遗忘症患者的知觉性启动效应与语义性启动效应的分离与定位

采用偏好、自由联想、字根补笔和字辨认等4项任务观察一例单纯性右侧基底节损伤遗忘症患者和两组正常对照的启动效应。结果发现：（1）该患者知觉性启动效应障碍,而语义性启动效应正常。认为知觉性启动效应的神经学基础可能在基底节。（2）该患者知觉性启动效应与语义性启动效应分离。认为神经组织的损伤可导致不同形式启动效应的分离,提出内隐记忆或启动效应的不同形式可能存在不同的神经学基础。     

Billing and Record-Keeping for Familial Cancer Risk Counseling: A National Survey

We surveyed 111 genetic counselors providing cancer risk counseling (CRC) in order to document their billing and record-keeping practices. Of the 75 respondents, billing was generally done under the supervising physician with a wide variation in charges. Follow-up telephone interviews with 28 counselors who charge patients revealed that billing was usually done using the CPT codes for consultations, and the ICD-9 diagnostic codes for cancer (if applicable), a medical complaint, or a family history of cancer code. Most counselors exclude some clinical information from the patient's medical record. In consultation notes, 81% of counselors document a discussion of genetic testing, but only 37% document the patient's actual testing decision, and only 19% document test results. In anticipation of increased referrals for CRC, data are needed on the components of a CRC visit, the amount of time required to provide CRC, patient outcomes measures, and charges and reimbursement. The feasibility and advisability of keeping results separate from the patient's medical record also needs to be addressed.     

Women's Understanding of Their Risk of Developing Breast/Ovarian Cancer Before and After Genetic Counseling

Many studies have reported that individuals frequently over- or underestimate their risk of developing cancer both before and after they attend genetic counseling for breast and/or ovarian cancer. Using a combination of interviews and written questionnaires, we investigated counselees' understanding of their risk of developing cancer before and after genetic counseling. We demonstrate that although 76% of the sample thought that their risk was elevated relative to women in general, only a small proportion (17%) were willing or able to provide a numerical estimate of their risk of developing cancer before they attended the clinic. Following the consultation, 43% indicated that their risk of developing cancer was lower than they had anticipated. Twenty-two percent described their risk in absolute rather than relative terms, i.e., that they would definitely (not) develop cancer in the future. The implications of these findings for further research are discussed.     

Comment on “The Angry Patient”

This article formulates the main problem of the angry patient treated by Dr. Curtis as one of poor ego functioning. This is possibly of neuropsychological origin. Treatment would be training to strengthen ego functions and the patient–therapist relationship would be task oriented. The anger is not dealt with directly except as it interferes with the training. It is predicted that as the ego becomes stronger, the anger will become more controllable. There is some question of whether this patient would be able to cooperate with such a program.     

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     

Duty to Re-Contact: A Study of Families at Risk for Fragile X

DNA testing for Fragile X syndrome is now routinely available through a large number of diagnostic laboratories. We have surveyed individuals from British Columbia Fragile X families identified prior to the availability of DNA testing for FMR1 to determine if they are subsequently receiving information about DNA testing. Of the 78 individuals first seen before the cloning of the FMR1 gene, 39 (50%) had not been seen in the clinic to discuss DNA testing. We initiated a contact program with these 39 patients to determine their interest in DNA testing. Contact was made with 28 individuals, 20 of whom stated interest in testing either for themselves or for a relative. Patient opinions about DNA testing were assessed through questionnaires. In those individuals who stated an interest in DNA testing, the most common reason for wishing testing was to provide information to children or grandchildren. The most common disadvantages of testing indicated by this group were that they had finished their families and that they felt the test would not have a direct impact. The most common reasons individuals were not interested in DNA testing were that there were no family members appropriate to test and that the respondent had completed his or her family. DNA testing has been performed for 13 of the 28 (46%) contacted individuals and/or at least one relative. In view of the high level of interest for testing in families who had not been seen since the cloning of the FMR1 gene, we feel that FMR1 screening programs should include actively contacting previously seen individuals.     

Multidimensional Assessment of Chronic Low Back Pain: Predicting Treatment Outcomes

This study explored responses of chronic low back pain patients to treatment for different types of patients (dysfunctional, interpersonally distressed, and minimizer/adaptive coper), as classified using the Multidimensional Pain Inventory (MPI). In addition, changes in MPI scores during treatment were examined separately for each patient type. Finally, this study explored the relationships between changes in MPI scores and physical improvement. Between-group differences in improvement were significant, with dysfunctional patients showing the most improvement on several scales. MPI scales that best predicted physical improvement differed according to patient type. Implications for treatment of low back pain patients are suggested, based upon differential reactions to treatment and different predictors of physical improvement for each patient group.     

Family Communication and Genetic Counseling: The Case of Hereditary Breast and Ovarian Cancer

In familial breast/ovarian cancer, the information that the proband is able to supply about other family members is of critical importance for genetic counseling. This frequently requires family communication. Forty-six women attending a cancer genetics clinic were interviewed as part of a longitudinal study. Nearly all reported affected maternal, rather than paternal relatives, which may indicate lack of awareness by women with paternal histories. There was also much more communication among female relatives. Mothers, where they were still alive, were key figures in supplying family information. Although the majority of the sample contacted at least one relative regarding counseling, most named a relative with whom they did not feel able to communicate on this subject. Probands balanced the perceived obligation of passing on information with that of not causing alarm. Communication, both obtaining and giving information, was impeded by adoption, divorce and remarriage, family rifts, and large age gaps between siblings.