转基因食品与人类健康初探

随着转基因食品不断地进入市场,学者和公众对转基因食品是否危害人类健康展开了激烈的争论。介绍转基因食品安全性评价的科学指标,运用伦理学的基本原则对两种观点进行了分析,并提出对转基因食品采取“有罪推定”的战略。     

深化卫生事业改革应关注卫生经济伦理学研究

卫生经济伦理学是应用伦理学的一个分支,相对于经济学和卫生经济学的发展,卫生经济伦理学的建立和发展滞后,导致卫生经济体制改革的经济效果与社会效果的一定程度的偏离。卫生经济伦理学的理论前提是社会结构变迁要求各个相对独立社会领域的规则整合,其研究任务是为社会经济主体的行为提供一个规范性的评判,实现社会的和谐发展。     

日本新的社区保健医疗教育对我们的启示

从2004年开始,日本一改36年来的医师法,对大学本科毕业并获得医师资格的青年医生实行2年的临床必修制度,其中重要内容之一是:加强初级卫生保健的继续教育。在我国已开展十年的临床医生早期规范化培训以来,对初级卫生保健方面的培训尚处于薄弱状态。有必要借鉴日本的新作法,结合中国的实际情况,切实有效地开展此方面的培训工作。     

群体健康与关系“正义”

生命伦理学具有广泛性和综合性,着眼于群体健康是当前生命伦理学发展的趋势。在群体水平的生命伦理学的研究中,有关“正义”的概念是核心的问题。涛慕思·W·博格提出了正义的“关系概念”,借以考察范围广泛的社会制度与健康结果的产生具有什么样的因果关系,进而强调社会制度的制定者和支持者对其产生的健康结果负有责任。通过对此“关系概念”进行分析,以期对中国国内健康领域问题的解决有所启示。     

Investigating the Impact of Strength-Based Assessment on Youth with Emotional or Behavioral Disorders

The trend toward adopting a strengths approach to mental health practice with children and adolescents amounts to a paradigm shift from an emphasis on diagnosing disorders to tapping child capacities and assets toward the achievement of treatment goals. While the potential value and challenges associated with this shift has received ample attention in the literature, minimal research has been conducted to assess the benefits and barriers related to the use of strength-based strategies with youth. Utilizing an experimental design, this author examined the impact of strength-based assessment using the Behavioral and Emotional Rating Scale (BERS) with seriously emotionally or behaviorally disturbed children and adolescents. Results revealed that child functioning outcomes were significantly better for youth who received BERS-guided assessment versus the usual deficit-based assessment protocol only when the treating therapist reported an orientation toward service that reflects highly strength-based attitudes and practices. Furthermore, high adherence to the strength-based assessment protocol was associated with significantly higher parent satisfaction with services and lower rates of missed appointments. These findings highlight the importance of accounting for practitioner effects and treatment fidelity in future studies of strength-based practice effectiveness.     

The Effects of Capitation on Outpatient Mental Health Episodes of Children

We analyzed the effects of the Colorado Medicaid Capitation Program on the duration and services of over 21,000 outpatient mental health episodes for young children. The study spanned a three year period before and after capitation was implemented, and compared episodes of outpatient care for children from 14 capitated Community Mental Health Centers (CMHCs) with those from three CMHCs that remained fee-for-service. Proportional hazards regressions revealed that capitation resulted in an increase in outpatient episode duration, over and above similar effects for the comparison fee-for-service episodes. The hypothesis that there were longer capitated episodes for children who were hospitalized was not supported. Children with behavioral and anxiety disorders had longer capitated episodes. Service intensity decreased over time in the managed care sites. Changes in case mix may have had an impact on changes in episode duration and service intensity. That outpatient episode duration increased over time while costs were lowered in the capitated agencies indicates some effects of capitation in changing patterns of care.     

心理健康的测量与评估:大学生与成人及住院病人的纵向横向研究

对国内有关大学生心理问题比一般成人更严重的研究结论提出了质疑。使用总量4268人的样本,应用自编的心理健康评定量表(PHS)进行了纵向与横向研究。研究发现,大学生人群与一般成人同期相比,心理问题并非更严重。5项分量表中3项(抑郁、焦虑、躯体化)成人却明显比大学生人群要高,另外两项(强迫和精神病性)二者没有显著差异。但是,10年后的大学生与10年前的大学生在所有分量表上均见非常显著的差异,说明10年的变迁中,大学生的心理问题有非常明显的增长趋势,日见复杂化,虽然不能说比成人更严重,但是也足够引起我们的高度重视。将不同人群样本的数据按心理障碍严重性进行排列,依次是:住院精神障碍患者、成人、大学生。     

关于体育高职生心理健康影响因素的研究

本文以117名体育高职生为研究对象,采用心理测量、访谈等方法对在校体育高职生的心理健康现状作了调查,在此基础上分析了影响体育高职生心理健康的主要因素。研究表明:(1)自编的“体育高职生心理健康影响因素问卷”具有良好的信度和效度;(2)体育高职生心理问题的检出率为9.4%;(3)体育高职生心理健康的影响因素在不同专业学生间不存在显著差异,但在不同类别学生间存在显著差异,三校生(来自职校、技校和中专学校的学生)在学校因素和学习因素上的得分显著高于来自普通高中的学生;(4)人际交往因素和学习因素对体育高职生的心理健康水平有显著的回归效应。建议体育职业技术院校在学生中大力加强心理健康教育工作,做到因材施教,对症下药。     

Masks and Faces in the Setting at the Time of Coronavirus

The “health emergency” forced analysts to seek new ways of continuing with analysis. The article focuses, in particular, on the changes brought about in the setting by the presence of the sanitary mask, following a line that begins with the theme of the “mask” in the collective uses of human cultures, and develops through the Jungian concept of persona, as opposed to the “face” that may convey an authentic image of oneself. A clinical vignette illustrates the issues that the mask raises in the setting by obstructing the communication of emotions. When there is no transformative processing of concrete data, “unmasking” can also lead to an uncanny encounter and to moments of darkness and confusion in analysis, when the analyst experiences the kind of “unconscious identity” between therapist and patient that Jung defined as nigredo. The article is intended as a contribution to the analytic community's current reflections on the new and unforeseen challenges encountered in analysis at the time of the Coronavirus. It is possible to learn from these experiences with a view to integrating new elements and thus modify one's own internal setting, the compass with which each analyst orientates himself.     

Can CBT Be Effective for Aboriginal Australians? Perspectives of Aboriginal Practitioners Trained in CBT

The objective of the study was to investigate whether high and low intensity versions of cognitive behaviour therapy (CBT) might be an effective therapeutic approach for enhancing the mental health of Aboriginal Australians. Five university‐educated Aboriginal counsellors received in‐depth training in CBT. Over the following year, they used CBT strategies with their clients, and met 10 times as a participatory action research group. The group addressed three key questions: (a) Does CBT appear to be useful for Aboriginal Australians? (b) If so, what elements of CBT are perceived to be effective? (c) What adaptations might be made to CBT to enhance its effectiveness with Aboriginal Australians? The resulting qualitative data were transcribed and analysed. Counsellors perceived CBT to be very useful for their Aboriginal clients and for themselves. They reported that it enhanced their clients' well‐being, their own clinical skills, and their own well‐being, and it reduced burnout. The qualities of CBT that were perceived to be effective were its adaptability, pragmatic here‐and‐now approach, capacity for low‐intensity interventions, safe containing structure, promotion of self‐agency, and valuable techniques. It was suggested that the prime requirement for adaptations to CBT were that they would need to fit different social and cultural contexts.