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.     

An information - expectation framework for decisions under uncertainty

Despite being in existence for many decades, normative decision theory has not become a commonly used tool for real-world decisions. This paper considers the reasons for this situation and suggestions for circumventing them. The main suggestion involves a two-stage framework in terms of the information available to the decision maker and his/her expectations under the available acts. This framework is well suited for decisions with incomplete structure, which is typical of real decision situations. Within this framework a specific multiplicative model is also discussed.     

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.     

Fidgeting as self-evidencing: A predictive processing account of non-goal-directed action

Non-goal-directed actions have been relatively neglected in cognitive science, but are ubiquitous and related to important cognitive functions. Fidgeting is seemingly one subtype of non-goal-directed action which is ripe for a functional account. What's the point of fidgeting? The predictive processing framework is a parsimonious account of brain function which says the brain aims to minimise the difference between expected and actual states of the world and itself, that is, minimise prediction error. This framework situates action selection in terms of active inference for expected states. However, seemingly aimless, idle actions, such as fidgeting, are a challenge to such theories. When our actions are not obviously goal-achieving, how can a predictive processing framework explain why we regularly do them anyway? Here, we argue that in a predictive processing framework, evidence for the agent's own existence is consolidated by self-stimulation or fidgeting. Endogenous, repetitive actions reduce uncertainty about the system's own states, and thus help continuously maintain expected rates of prediction error minimisation. We extend this explanation to clinically distinctive self-stimulation, such as in Autism Spectrum Conditions, in which effective strategies for self-evidencing may be different to the neurotypical case.     

医疗信息的风险感知

从信息加工视角探究个体对医疗信息的风险感知过程, 通过医疗信息来源、医疗信息内容与呈现形式和信息加工主体三个方面归纳其影响因素, 并基于经验-分析式加工理论和字面-要义加工理论探讨医疗信息风险感知的认知机制。今后研究可更注重医疗信息风险感知的通用研究与特殊主题研究的平衡、风险感知测量工具的规范性与特异性的结合, 并立足于中国医疗体系建立具有循证依据的预防措施和配套政策。     

当代中国医德建设与相对主义医学伦理学

当代西方相对主义医学伦理学有许多建树,但也有其致命性的缺陷,这就是否定医学道德的客观绝对性和普遍性医学伦理准则。在引进、介绍了这种学说之后,需要下功夫同它进行对话,即以医德绝对性与相对性辩证统一的原理,对这种学说进行追问,从中借鉴有益的经验和教训,以顺利全面地推进我国当代的医学道德建设。     

两种医学模式的方法论问题评价

生物医学模式和生物心理社会医学模式是对医学发展具有重要意义的两种医学模式,它们在对疾病和健康的看法上形成不同的思维方式;且这种思维方式在人们进行医学科研中具有不同的方法论作用。     

论新时期医学院校人文学科建设

加强医学人文学科建设是全面推进素质教育、培养创新精神的重要内容,也是深化医学教育改革步伐的重要举措.医学院校开展医学人文教育教学真正目的是进一步优化高等医学院校人才培养模式,使医学人文学科知识内化为医学生的人文思想和人文精神.