食管裂孔疝的外科治疗进展

食管裂孔疝即腹腔内脏器经食管裂孔疝入胸腔,并引发烧心、反酸等消化道及其他非消化道症状。按其解剖及临床表现可分为四型。通过病史采集、体格检查及一系列客观检查可以明确食管裂孔疝的诊断、分型及疾病进展程度。食管裂孔滑动疝并发反流、食管裂孔旁疝合并明显症状、混合型及多器官型食管裂孔疝或内科治疗效果不佳的通常应优先考虑手术治疗,以消除疝形成的因素,控制胃食管反流。食管裂孔疝手术目前通常采取腹腔镜下疝修补、补片加强及胃底折叠术,同时也存在食管延长、胃固定等其他替代术式。围手术期通过积极地控制风险因素,有助于降低各类术中、术后并发症风险及复发率。对复发、儿童及肥胖等特殊患者,也应视患者条件积极实施手术治疗。随着研究的进一步深入,食管裂孔疝手术在手术入路、补片材料、复发及并发症控制、日间手术模式应用等方面将取得更大的进展。     

Problematic,absent and stigmatizing diagnoses in current mental disorders classifications: Results from the WHO-WPA and WHO-IUPsyS Global Surveys

This study examined English- and Spanish-speaking psychologists’ and psychiatrists’ opinions regarding problematic, absent and stigmatizing diagnoses in current mental disorders classifications (ICD-10 and DSM-IV), and their perceived need for a national classification of mental disorders. Answers to open-ended questions included in WHO-WPA and WHO-IUPsyS surveys were examined using an inductive content-analysis method. A total of 3,222 participants from 35 countries were included. The most problematic diagnostic group was personality disorders, especially among psychiatrists, because of poor validity and lack of specificity. Complex posttraumatic stress disorder was the most frequent diagnosis suggested for inclusion, mainly by psychologists, to better account for the distinct processes and consequences of complex trauma. Schizophrenia was the diagnosis most frequently identified as stigmatizing, particularly by psychiatrists, due to lack of public understanding or knowledge about the diagnosis. Of the 14.4% of participants who perceived a need for a national classification system, two-thirds were from Africa or Latin America. The rationales provided were that mental disorders classifications should consider cultural and socio-historical diversity in the expression of psychopathology, differences in the perception of what is and is not pathological in different nations, and the existence of culture-bound syndromes. Implications for ICD-11 development and dissemination are discussed.     

Cognitive-behavioral treatment and antidepressants combined with virtual reality exposure for patients with chronic agoraphobia

In this study we compared the efficacy of virtual reality exposure combined with cognitive-behavioral therapy (VRET) to that of traditional cognitive-behavioral therapy (CBT) alone in reducing phobic symptoms in a sample of patients with long-term agoraphobia. The study was a between-subject design with three experimental conditions (VRET group, N = 30; CBT group, N = 30; and medication only group, N = 20) and repeated measures (pre-treatment, post-treatment, and six-month follow-up). All patients were receiving antidepressant medication. Results showed that all therapies were statistically effective both at post-treatment and six-month follow-up. The VRET group showed clinical improvement in most variables measured at follow-up. The CBT group showed the highest dropout rates. These results are discussed pointing out that VRET probably serves as an intermediate procedure for an efficient exposure to phobic stimuli. Besides describing the advantages of VRET for the treatment of agoraphobia symptoms in cost-benefit terms, the study also considered issues related to higher treatment adherence and motivation.     

The “impact factor style of thinking”: A new theoretical framework

Over the last few years, university policy in developed countries has placed too much emphasis on assessing publications on the basis of the impact factor. Any scientific material that has not been published in a journal indexed in the Journal Citation Reports is academically irrelevant. Hence, researchers strive hard to publish in such journals. Failure to achieve this means not having a successful career or receiving any academic recognition. A thorough analysis of the effects of this phenomenon on the researcher community leads to the conclusion that the overestimation of the impact factor is likely to cause disappointment among many researchers. Researchers only have two options: adopting a politically correct behavior, that is, following the “impact factor style of thinking”, or accepting the futility of their research regardless of its relevance. This is an example of the involvement of university policy habitus obsessed impact index. O policy impact index is accepted, or is doomed to academic ostracism, and exclusion from participation in all university policy.     

Qualitative job insecurity and in-role performance: a bidirectional longitudinal relationship?

This study adds to the understanding of the relationship between qualitative job insecurity and employee in-role performance, by analysing the association longitudinally. While social exchange theory predicts that the relationship should be negative and bidirectional, the job preservation motivation model indicates a self-correcting mechanism, where job insecurity leads to increased performance, which, in turn, could decrease job insecurity. We developed competing hypotheses and examined them using structural equation modelling in a heterogeneous sample of 337 employees. For employees with a higher professional level, results pointed towards a reciprocal causal relationship between qualitative job insecurity and in-role performance, indicating a loss cycle. For employees with a lower professional level, results showed a small positive direct causal relationship between qualitative job insecurity and in-role performance, while the negative direct path from in-role performance to qualitative job insecurity did not reach statistical significance. This is the first study to test the diverging theoretical predictions of social exchange theory and the job preservation motivation model, with regard to the relationship between qualitative job insecurity and in-role performance. Being longitudinal, our study only allows us to hint at possible causal relationships between the involved variables, the chronological order being necessary, but not sufficient to prove causality.     

Topic-focused analysis in a case of integrative psychotherapy with a father fearing his own anger

Even though evidence-based knowledge is considered the foundation of clinical practice, many clinicians question the clinical relevance of published research. Clinicians increasingly define themselves as having an integrative stance, in contrast to the tendency for most research to be based on clearly defined psychotherapies. Qualitative single case studies make it possible to generate knowledge about what actually occurs in integrative therapy. Topic change process analysis (TCPA) is used in the analysis of brief integrative therapy conducted by a very experienced psychotherapist drawing on a complex variety of therapeutic approaches. The client was a man in his late thirties, worrying about his strong anger, particularly related to one of his children. Analysis of topic areas, topic shifts, response patterns within topics and changes in perspective made it possible to identify key processes and key patterns of the therapy which resulted in a very positive outcome for the client. Implications of these findings for practice, and future research, are discussed.     

Influences on anger in German urban cyclists

Previous research shows that anger and aggression among road users lead to maladjusted driving and a higher risk of accidents. Especially cyclists as vulnerable road users have a high risk of being injured if they are involved in accidents. This paper examines reasons for cycling anger in two studies. The first study aimed at identifying anger provoking events. Seventy-three cyclists were invited to discuss anger provoking events in a focus group setting. These events were rated regarding their anger intensity, clustered within focus groups, and aggregated across all groups. The first study revealed 208 unique cycling anger provoking events of varying anger intensity that were summarized in six clusters. The second study aimed at validating these anger provoking events, the ratings, and the clusters. Here, 129 participants were asked to complete a four-time point diary study (over the course of ten days), in which they registered all anger provoking events that they experienced while cycling. The results of this study validated most of the anger provoking events of the first study. Both studies show that most anger provoking events are related to conflicts between cyclists with other road users like car drivers and pedestrians. Moreover, conflicts with car drivers seem to cause stronger anger among cyclists than conflicts with other cyclists or pedestrians. Implications for further research and the planning of road infrastructure are discussed.     

Lost in the great divide: Motivation in religious studies classrooms

One of the most illuminating finds in Barbara E. Walvoord's Teaching and Learning in College Introductory Religion Courses (2008) is what she calls “the great divide,” a mismatch between instructors’ goals for their courses, which are academic, and the students’ reasons for taking them, which relate to their personal interests and development. Motivation – or, rather, the lack thereof – is not explicitly considered as a potential victim of this mismatch. This article will turn its attention squarely to this issue. First, I will review data about the “great divide” and link them to the common practice of asking our students to bracket the personal when they take our courses. The article will juxtapose this practice with what research tell us about motivation, which will allow us to further explore why the divide Walvoord and others have identified is so problematic. The article will conclude with pedagogical strategies that can help instructors intentionally influence motivation in religion courses. Ultimately, I suggest that we may be doing students – as well as ourselves, as the purveyors of our discipline – a disservice, if we do not attend to (or, worse, if we actively avoid) what we know motivates students to learn.     

User acceptance of automated shuttles in Berlin-Schöneberg: A questionnaire study

Automated shuttles are now in a prototyping phase in several research projects. However, there is still a paucity of knowledge on the acceptance of these shuttles. This paper presents the results of a questionnaire study among individuals (n = 384) who physically experienced an automated shuttle on an office campus in Berlin-Schöneberg. The findings indicate that the respondents were positive towards automated shuttles and could envision their use as feeders to public transport systems, in both urban and rural areas. The respondents were less satisfied with the effectiveness of the shuttle compared to their existing form of travel, the speed of the shuttle, and the space for luggage. A principal component analysis resulted in the retention of three components: (1) intention to use, (2) shuttle and service characteristics, and (3) shuttle effectiveness compared to existing transport. Older respondents expressed a higher intention to use, but found the shuttle less effective than their existing travel. We argue that automated shuttles are a valued concept, but speed and efficiency have to improve, in order for automated shuttles to become viable on a wide scale. Future research should use more objective measures and establish long-term effects in larger, more representative samples.     

Positive mental health moderates the association between depression and suicide ideation: A longitudinal study

Background/Objective: Depression and suicide ideation regularly occur together. Yet, little is known about factors that buffer individuals against the development of suicide ideation. The present study investigated, whether positive mental health buffers the association between depression and suicide ideation in a longitudinal study design. Methods: A total of 207 German students (70.3% female; age: M = 26.04, SD = 5.33) were assessed at a baseline evaluation and again twelve months later. Data were collected using self-report questionnaires. Linear hierarchical regression analysis was used to analyze the data. Positive mental health was considered to moderate the impact of depression on suicide ideation – controlling for age and gender. Results: Positive mental health was shown to moderate the impact of depression on suicide ideation: in those students who reported higher levels of positive mental health, depression severity showed no association with suicide ideation over time. Conclusion: Positive mental health seems to confer resilience and should be taken into account, when assessing individuals for suicide risk.