公立医院“医疗联合体”改革探析

公立医院“医疗联合体”改革模式为解决“看病难”问题提供了新思路, 其目的是促使优质医疗资源通过医疗联合体纵向下沉, 从而达到医疗资源最大化利用和居民就诊的合理分流。为了推进我国“医疗联合体”改革模式的发展, 首先分析了医疗联合体的作用和面临的障碍, 然后介绍我国上海、北京、湖北、重庆的“医疗联合体”改革实践模式, 在此基础上对我国“医疗联合体”改革发展提出相关建议, 期望对我国这种改革模式的实施推进提供一定的参考价值。     

Divergent effects of healthy ageing on semantic knowledge and control: Evidence from novel comparisons with semantically impaired patients

Effective use of semantic knowledge requires a set of conceptual representations and control processes which ensure that currently relevant aspects of this knowledge are retrieved and selected. It is well-established that levels of semantic knowledge increase across the lifespan. However, the effects of ageing on semantic control processes have not been assessed. I addressed this issue by comparing the performance profiles of young and older people on a verbal comprehension test. Two sets of variables were used to predict accuracy and RT in each group: (1) the psycholinguistic properties of words probed in each trial and (2) the performance on each trial by two groups of semantically impaired neuropsychological patients. Young people demonstrated poor performance for low-frequency and abstract words, suggesting that they had difficulty processing words with intrinsically weak semantic representations. Indeed, performance in this group was strongly predicted by the performance of patients with semantic dementia, who suffer from degradation of semantic knowledge. In contrast, older adults performed poorly on trials where the target semantic relationship was weak and distractor relationships strong – conditions which require high levels of controlled processing. Their performance was not predicted by the performance of semantic dementia patients, but was predicted by the performance of patients with semantic control deficits. These findings indicate that the effects of ageing on semantic cognition are more complex than has previously been assumed. While older people have larger stores of knowledge than young people, they appear to be less skilled at exercising control over the activation of this knowledge.     

The heterogeneity of attention‐deficit/hyperactivity disorder symptoms and conduct problems: Cognitive inhibition,emotion regulation,emotionality, and disorganized attachment

This study examined the contributions of several important domains of functioning to attention‐deficit/hyperactivity disorder (ADHD) symptoms and conduct problems. Specifically, we investigated whether cognitive inhibition, emotion regulation, emotionality, and disorganized attachment made independent and specific contributions to these externalizing behaviour problems from a multiple pathways perspective. The study included laboratory measures of cognitive inhibition and disorganized attachment in 184 typically developing children (M age = 6 years, 10 months, SD = 1.7). Parental ratings provided measures of emotion regulation, emotionality, and externalizing behaviour problems. Results revealed that cognitive inhibition, regulation of positive emotion, and positive emotionality were independently and specifically related to ADHD symptoms. Disorganized attachment and negative emotionality formed independent and specific relations to conduct problems. Our findings support the multiple pathways perspective on ADHD, with poor regulation of positive emotion and high positive emotionality making distinct contributions to ADHD symptoms. More specifically, our results support the proposal of a temperamentally based pathway to ADHD symptoms. The findings also indicate that disorganized attachment and negative emotionality constitute pathways specific to conduct problems rather than to ADHD symptoms.     

“直觉调整差误”偏向对贝叶斯推理成绩的影响

采用贝叶斯推理问题作为实验材料,探讨被试解决贝叶斯推理问题的启发式策略,从认知偏向的角度分析该问题的困难原因。结果发现:(1)贝叶斯推理问题解决过程中的可得性启发与后验概率估计过程中的直觉调整差误密切相关;(2)贝叶斯推理问题解决过程中文、理科被试都同样会产生直觉调整差误偏向;(3)贝叶斯推理问题解决过程中的后验概率估计值和对推理问题中包括虚报率信息的命题的可得性测量所得主观概率之间存在显著的负相关。     

思维与语言的关系：来自认知神经科学的证据

在有关人类心智的研究中,思维与语言的关系始终是一个复杂而重要的课题。借助于新的技术手段和研究思路,当代认知神经科学从新的角度探讨了这个古老而神秘的课题。其研究的基本逻辑是：如果某种特定的思维过程（比如简单的算术运算或者三段论推理）在本质上是“语言的”,那么,在进行这种思维活动时,大脑中负责语言信息处理的区域就会参与;反之,如果某种思维过程在本质上是“空间的”,则大脑中负责空间信息处理的区域就会参与其中。结合来自直观的脑功能图谱证据与其它的跨领域证据（如来自行为实验和脑损伤研究的证据）,能够帮助我们更加深入地认识和理解思维与语言的关系问题。     

Changes in Anxiety Control Beliefs Following a Brief CBT Treatment and Their Association With Anxiety Symptom Reduction

Anxiety control beliefs (i.e., beliefs regarding one’s ability to cope with external, fear-inducing threats and internal reactions to those perceived threats) have been found to negatively predict anxiety symptoms in children and adults and to be modifiable by cognitive-behavioral therapy for anxiety disorders. The current study examines whether changes in anxiety control beliefs were seen following a brief, intensive treatment for specific phobias, and whether those changes were associated with improvements in the targeted phobia and comorbid anxiety disorder symptoms. Participants were 135 children and adolescents (M age = 9.01 years, 49% male) who received one-session treatment (OST) with or without parental involvement for their primary specific phobia. Results indicated that self-reported anxiety control beliefs significantly increased following treatment and that these increases significantly predicted reductions in specific phobia severity and symptoms of comorbid anxiety disorders 6 months and 1 year following treatment. Findings illustrate that involvement in a single 3-hour OST was associated with changes in anxiety control beliefs and demonstrate the potential importance of targeting control beliefs in pediatric anxiety treatment.