系统生物学引导阿尔茨海默病治疗新策略

阿尔茨海默病（AD）是一种发生于中老年期的退行性脑神经变性疾病,临床上以进行性智能衰退,伴有人格改变为主要特征.其发病过程涉及许多途径和靶点.现代医学认为脑内胆碱能递质功能紊乱、β-淀粉样蛋白沉积、tau-蛋白过磷酸化、炎症反应以及基因突变等在其发病过程中起着重要作用.治疗方法从胆碱酯酶抑制剂、神经递质受体阻滞剂到补气活血、益精填髓、化痰开窍等中医药疗法不等.但抑制剂、阻滞剂等药物阻滞疗法,从单一环节阻断发病途径,忽略了AD发病的整体复杂性.中医辨证论治从整体观念出发,在宏观上治疗AD,对AD的发病缺乏微观深入研究.AD治疗需要借助于“系统生物学”理论的指导.中西医结合为AD的治疗提供了较为科学、有效的途径和发展空间.     

腔内成形术治疗下肢动脉硬化闭塞症的技巧及临床观察

评价腔内成形术（PTA及PTAS）治疗下肢动脉硬化闭塞症的技巧和临床观察。2010年10月至2013年10月,对37例下肢动脉硬化闭塞症血管多段病变患者采用经皮血管腔内成形术和经皮血管腔内成形＋支架植入术治疗。结果36（97％）例手术成功,术后肢体缺血症状完全消失或明显改善,38条患肢皮温明显升高,间歇性跛行消失或距离延长,静息痛好转。术后踝／肱指数（ABI）（0．83±0．12）与术前（0．35±0．07）比较差异有统计学意义（P〈0．05）。合理的腔内成形术（PTA＋PTAS）是治疗下肢动脉硬化闭塞症安全有效的方法。熟练掌握腔内成形术是提高手术成功率和维持通畅率的关键。     

心理咨询的LIWC语言特征对咨询效果的预测

语言是心理咨询的重要内容。语言探索和词频统计（Language Inquiry and Word Count, LIWC）被广泛用于分析语言使用的心理意义。本研究收集了28名当事人共144次有效咨询录音及每次会谈后当事人的症状自评结果。将录音转录成文本后,抽取当事人的LIWC语言特征,进行主成分降维,结果获得8个因子,解释了总体方差的75.11%。一般线性回归中,躯体感受、功能词、情绪、认知和口语赘词对当事人的症状水平具有显著的预测作用,进一步多层线性模型中,躯体感受和情绪用词显著预测咨询效果。LIWC文本特征能够呈现与当事人症状相关的信息,为未来计算机自动化监控咨询过程和结果提供了新视角。     

Implementation of the Wolverine Mental Health Program,Part 2: Implementation Phase

To enhance mental health care for youth in a midwestern residential treatment facility, Wolverine Human Services partnered with the Beck Institute (an intermediary) and an implementation research team to implement cognitive-behavioral therapy (CBT). CBT has strong evidence supporting effectiveness for treating youth internalizing and externalizing problems, but it is a complex psychosocial intervention that demands a thoughtful implementation approach. This study outlines the implementation phase (2.5 years) of a 5-year collaborative effort. The implementation phase focused on (a) adapting CBT to fit the complex youth needs and the roles of the multidisciplinary team members resulting in a new comprehensive and coordinated care model, and (b) the strategies utilized to support its competent integration by all team members. Six blended implementation strategies were deployed in this phase: forging implementation teams, installing progress monitoring, adapting CBT, training, providing supervision and consultation, and training the trainers. A components-based approach to CBT yielded six core skills: active listening, problem solving, mood monitoring and intervention mapping, activity scheduling, distress tolerance, and cognitive restructuring. By the end of this phase, all staff had robust exposure to and experience with the adapted form of CBT. The work of our academic–community partnership has both research and clinical implications, with respect to integrating an adapted version of CBT for residential environments (CBT-RE).     

Have Phobias,Will Travel: Addressing One Barrier to the Delivery of an Evidence-Based Treatment

Although a host of evidence-based treatments exist for youth with anxiety disorders, less than 30% of youth and their families receive these treatments. One of the main barriers to receiving these treatments is the lack of access to care, due largely to the absence of mental health professionals who have expertise in the delivery of these treatments in certain geographic locales. The current study examined whether a brief intensive treatment for specific phobias (SPs), Augmented One-Session Treatment (OST-A), would result in comparable treatment gains for families who traveled a considerable distance to receive this treatment when compared to families who resided in our local community. Participants included 76 youth with a clinically confirmed diagnosis of SP (38 local families and an age- and sex-matched sample of 38 nonlocal families). Although SP severity at pretreatment was significantly greater for the nonlocal youth than the local youth, both nonlocal and local youth showed commensurate improvement and maintenance of treatment gains over a 6-month period across several clinical outcome measures. Findings from this study show that OST-A is effective when families choose to travel for treatment, addressing at least one of the barriers to use of this evidence-based treatment.     

The Influence of Race and Income on Community Mothers’ Acceptance of Child Management Methods

The consideration of diverse family factors on parents’ acceptance of behavioral parent training (BPT) components aids in the development and delivery of culturally sensitive parenting programs. Perceptions of acceptability are particularly important to investigate among low-income and racial-minority families, as they are less likely to engage in nonadapted BPT programs. Therefore, the current study examines the synergistic effects of race and income on mothers’ acceptance of five common child management methods relevant to BPT. The relationship between mothers’ acceptability ratings and self-reported parenting practices was also explored. Participants were 106 White and Black mothers from different income levels who completed measures related to the acceptability of response cost, positive reinforcement, time-out, spanking, and medication. The results indicated that mothers from varying backgrounds differed in their acceptance of child management methods, particularly with regard to corporal punishment. Additionally, a relationship was found between parents’ acceptability ratings and their self-reported parenting behavior. The findings support the consideration of parents’ perceptions of child discipline methods when recommending and delivering BPT programs to diverse parents.     

“Like Drawing Into Sand”: Acceptability,Feasibility, and Appropriateness of a New e‐Mental Health Resource for Service Providers Working With Aboriginal and Torres Strait Islander People

Cross‐cultural considerations and difficulties recruiting and retaining skilled workers in rural and remote regions may contribute to poorer service use for Aboriginal and Torres Strait Islander people. However, electronic resources may provide the opportunity for remote workforces to deliver structured, evidence‐based, culturally appropriate treatments with limited training burden. The aim was to develop and determine the acceptability, feasibility, and appropriateness of a new e‐mental health resource (the Australian Integrated Mental Health Initiative [AIMhi] Stay Strong App) for service providers working with Aboriginal and Torres Strait Islander people in the Northern Territory. Eleven semi‐structured interviews were conducted with 15 service providers and managers from a range of rural and remote primary health care service settings in the Northern Territory. All participants were given the resource to trial for at least 1 month before being interviewed about perceived barriers and enablers, acceptability, and feasibility. Thematic analysis revealed support for the acceptability, feasibility, and appropriateness of the resource among service providers. Major themes identified included acceptability, building relationships, broad applicability, training recommendations, integration with existing systems, and constraints to implementation. This is one of the first studies to explore the acceptability of e‐mental health approaches for Aboriginal people among the remote health workforce. It is likely that e‐mental health interventions, such as the AIMhi Stay Strong App will assist services to deliver evidence‐based, structured interventions to improve well‐being for Aboriginal and Torres Strait Islander clients.