THE TREATMENT OF COVERT SELF-INJURY THROUGH CONTINGENCIES ON RESPONSE PRODUCTS

Assessment and treatment of covert self-injurious behavior are complicated because it is difficult to quantify and apply differential consequences to covert responses. In this study, both tangible and social reinforcers were identified using reinforcer assessment methods. These reinforcers were then provided contingent upon the absence of tissue damage identified during physical examinations, resulting in near 100% success in physical assessment checks that was maintained over 10 months.     

Sensitizing Medical Residents to Fantasies and Alignments in the Family: Mastering Psychosocial Skills in the Medical Encounter

In this paper, it is proposed that a) psychosocial medicine is best taught in a setting that provides technical and emotional support, while seizing for teaching only those moments when the learner is most receptive; and b) that the setting should avoid the development of a separate psychosocial skills curriculum, but should take the student where he or she is and integrate the psychosocial skills into his or her everyday biomedical practice. The paper gives specific case examples in which family based psychosocial issues were preeminent in the clinical problem-solving medical residents faced.     

Chronic sorrow: A content analysis of parental differences

Sixty-eight mothers and 64 fathers of children with a neural tube defect responded to a questionnaire about chronic sorrow. Mothers reported a mood state change in very intense category from more pessimistic at time of diagnosis to more optimistic at current time. Fathers, although indicating a mood change in the very intense category to more optimistic, also had more pessimistic responses. Parental similarities and differences were also reported in both times and events that triggered the sorrow response. Categories across times and events were primarily related to health care, school/development concerns and social significance. Clinical and research implications of these findings are discussed.     

Experimental assessment of tinnitus aurium

A 32-year-old male volunteer with an eight year history of chronic unilateral tinnitus (ear-ringing) participated in a behavioral assessment strategy that included a series of measurement and modification procedures. A psychophysical matching technique was employed throughout a planned combination of procedures to assess and manipulate the intensity or loudness of tinnitus responses. Following baseline assessment, measurements were conducted at varying times of the day, concomitant with exposure to music, during progressive relaxation training, and under conditions of caffeine consumption. The value of careful assessment to describe cues and conditions associated with tinnitus and its reduction are discussed with implications for behavior treatment design and evaluation.     

国内外医学专业杂志发表医学人文相关文章情况分析

总结分析了201 2年1月～2013年5月国外4种医学专业杂志(BMJ、JAMA、LANCET和NEJM)医学人文相关文章的发表情况,并与国内4种知名医学专业杂志(《中华医学杂志》、《中国实用内科杂志》、《中华内科杂志》和《中华外科杂志》)发表的医学人文类文章的情况进行对比分析,结果发现,国外医学专业杂志医学人文类文章比重较大,而且涉及的领域较广,包括医疗卫生政策管理、医学社会学、对患者及医生的人文关怀、医疗风险告知和医疗差错告知的文章.而国内与国外杂志相比存在较大差距.     

Enhancing the care of children with chronic diseases through the narratives of patient,physician, nurse and carer

We tested the hypothesis that a narrative approach may enhance a bio‐psycho‐social model (BPS) in caring for chronically ill children. Forty‐eight narratives were collected from 12 children with six different medical conditions, their mothers, physicians, and nurses. By a textual analysis, narratives were classified on their predominant focus as disease (biological focus), illness (psychologic focus), or sickness (social focus). Sixty‐one percent of narrative’ text were classified as illness, 28% as disease and 11% as sickness. All narratives had a degree of illness focus. Narratives by patients and physicians on the one hand, and nurses’ and mothers’ on the other were disease focused. Narratives were also evaluated with respect to the type of medical condition: Illness was largely prevalent in all but Crohn’s disease and HIV infection, the latter having a predominance of sickness most probably related to stigma. Narrative exploration proved a valuable tool for understanding and addressing the needs of children with complex conditions. Narrative approaches allow identification of the major needs of different patients according to health conditions and story tellers. In the narratives, we found a greater illness and disease focus and surprisingly a low sickness focus, except with HIV stories. Narrative medicine provides a tool to strengthen the BPS model in health care.     

Analysing the influence of attitude and habit on bicycle commuting

New transport trends have emerged in developing countries to promote bicycling due to its individual and societal benefits. Although bicycle infrastructure provision has been one of the most utilised strategies to encourage bicycling, it has had a limited immediate impact on the bicycling modal share. Published research indicates the need to incorporate the psychosocial dimension to understand commuters' transport behaviour and explain why bicycling infrastructure usage is lower than expected. This study highlights the processes behind bicycle mode choice decisions, explicitly incorporating pro-bicycle attitudes and habits, while also considering the influence of socioeconomic, bicycle facilities and bicycling experience variables on shaping that attitude. For this purpose, an online survey was designed and sent to students, faculty members and staff of two Chilean universities to collect ad-hoc data. The modelling used an approach based on an integrated choice and latent variable model. The main findings are: attitude in itself is a relevant construct to explain behaviour; bicycling infrastructure contribute to explain bicycle choice but only indirectly through attitude; socioeconomic characteristics, bicycling familiarity and practical issues have both a direct effect on bicycle choice decision and an indirect one by fostering pro-bicycling attitudes. Additionally, results show that the explicit inclusion of habit reduces the contribution of pro-bicycle attitude in explaining bicycle choice. This might be due to interaction and reinforcement between habit and attitude.     

A multi-objective mathematical programming problem with fuzzy relation constraints

In this study we discuss the problem of multi-objective mathematical programming with constraints defined by ‘max-min’ composite fuzzy relation equations. Since the feasible region is normally non-convex, the properties of the efficient points of a non-convex feasible region under multi-objectives are investigated and illustrated by examples. The necessary and sufficient conditions are proposed and proved. To facilitate decisions, a procedure that transforms these efficient points of an interval-valued decision space into a constant-valued decision space is proposed when the level of confidence is given by a decision maker. Then the transformed problem becomes a multi-attribute decision problem that can be evaluated by Yager's method to find the optimal alternative.