Cumulative Adversity as a Correlate of Posttraumatic Growth: The Effects of Multiple Traumas,Discrimination, and Sexual Harassment

While trauma is, by definition, a necessary precursor of posttraumatic growth, other aspects of individuals’ life experiences affect their ability to cope with trauma, foster resilience, and grow following adversity. Most research on posttraumatic growth overlooks the accumulation of trauma and sub-trauma stressors as possible predictors of growth. In addition, most research on cumulative adversity omits all but the most extreme examples of discrimination and sexual harassment stressors. This exploratory study of 46 university students with trauma histories used measures of posttraumatic growth, trauma, major (sub-trauma) life events, chronic stressors, sexual harassment, and discrimination to examine the relationship between cumulative adversity and the development of posttraumatic growth. We found that cumulative adversity is positively correlated with posttraumatic growth, and that there are important relationships between gender, race, and cumulative adversity. A hypothesized curvilinear relationship between cumulative adversity and posttraumatic growth was not supported. These findings suggest that successfully coping with some amount of sub-trauma adversity may facilitate the development of posttraumatic growth. Additionally, sexual harassment and discrimination were closely linked to the number of chronic stressors; thus, they need to be included in measures of cumulative adversity to more fully represent the experiences of marginalized groups.     

贫困损害儿童执行功能的作用机制

贫困儿童往往表现出较差的执行功能,贫困的长期危害甚至持续到成人期。为揭示贫困与儿童执行功能弱化之间的作用机制,已有研究分别从行为、生理和脑层面开展了探索。本文沿着行为-生理-脑的内在联系与思路,系统地梳理了有关单一风险、累积风险、剥夺性风险、适应负荷以及前额叶结构和功能等内在机制的最新研究。最后提出未来研究可以关注贫困对儿童执行功能某些成分的塑造、聚焦剥夺性风险因素的作用机制、开展适应负荷生理机制和相关脑区激活的认知神经机制等方面的研究,以构建行为-生理-脑的整合框架,进一步拓展未来研究领域。     

家庭早期的累积风险对青少年内化问题的影响

基于累积风险框架,检验个人素质和社会互动在家庭早期的累积风险影响青少内化问题上的相对贡献以及中介作用。751名青少年完成Achenbach青少年自评量表、自我效能感问卷、感恩问卷、个人主动性量表、领悟社会支持量表的测试以及累积家庭风险问卷。结果发现: (1)个人素质与社会互动在家庭早期的累积风险影响青少年内化问题过程中起着平行中介作用;(2)社会互动的间接效应大于个人素质的间接效应;(3)家庭早期的累积风险对内化问题存在直接影响。个人素质和社会互动在家庭早期风险影响内化问题的内在过程并非相互竞争,而是作为一种平行中介在运作。研究结果有助于揭示家庭早期的累积风险影响内化问题的内在作用。     

如何书写好内科病历

病历是医疗活动的原始记录或历史记载,是最准确,可信的记录。在现代医院管理中,病历作为医疗活动信息的主要载体,不仅是医疗、教学、科研的第一手资料,而且也是综合评价医院医疗质量、技术水平、管理水平的依据。即病历质量好坏体现医生的学术和品德,体现医院的管理水平和医疗质量。病志书写的水平,是一位医生理论基础、技术水平、临床经验、表达能力、逻辑思维的综合检验。然而现在有些病历,特别是大医院的病历质量不高的原因是工作太忙,病人太多。下级医师对疾病特点了解不够,概念不清楚。上级医师要养成习惯把您心里想的思路说出来,以提问的方式讲更好,这样对下级医生的印象会更深,同时也可以掌握他们是否理解正确了,督促下级医生平时的学习,始终要抓"三基三严",强调临床基本功。本文把内科病历书写中的常见问题一一列出,并具体指导如何改进。     

从《病历书写基本规范》的施行谈对患者同意权的再认识

本文通过对《病历书写基本规范》中有关患者同意权内容的研究,重点探讨了患者同意权的应用范围、发展变化以及尚需进一步解答的具体问题。为在实践中充分领会"《规范》"内容,不断深化患者权益保障,促进医院管理水平稳步提高作出了笔者力所能及的贡献。     

Suboptimal choice and initial‐link requirement

Pigeons (n = 14) were trained in a concurrent‐chains suboptimal choice procedure that tested the effect of an increased ratio requirement in the initial links. Fixed‐ratio 1 and 25 conditions were manipulated within subjects in a counterbalanced order. In all conditions, distinct terminal‐link stimuli on a suboptimal alternative signaled either primary reinforcement (20% of the time) or extinction (80% of the time). On an optimal alternative, two distinct terminal‐link stimuli each signaled a 50% chance of primary reinforcement. Preference for the suboptimal alternative was significantly attenuated, and in some birds completely reversed, by the larger response requirement irrespective of condition order. This larger response requirement also generated a notable increase in between‐subject variability. A measure of cumulative choice responding is introduced to mitigate the problems associated with traditional session averages. Ordinal predictions of some current theories of suboptimal choice are also considered in light of the results.     

Cumulative trauma,emotion reactivity and salivary cytokine levels following acute stress in healthy women

Background and Objectives: To better understand how trauma leads to poor health, this study examined whether cumulative trauma and emotion reactivity contribute to pro- (IL-1β) and anti-inflammatory (IL-10) salivary cytokine levels after stress.

Design: Seventy-three women, screened to be physically and mentally healthy, completed an acute stress paradigm and measures of lifetime trauma exposure.

Method: Saliva was collected 10?min before (i.e., baseline) and 35?min after the onset of a 10-min stressor. State negative and positive emotion were measured at baseline and post-stress.

Results: Most participants reported exposure to at least one trauma, with a mean of five. Cumulative trauma was associated with higher post-stress IL-1β and IL-1β/IL-10, but not with IL-10 or changes in emotion. Declines in positive emotion correlated with greater post-stress IL-1β.

Conclusions: These findings suggest that both cumulative trauma exposure and positive emotion have implications for salivary cytokine responses to acute stress. The inclusion of healthy women strengthens internal validity, and increases confidence that observed associations between trauma and salivary cytokine responses can be attributed to trauma, rather than to confounding health problems. This study adds to the growing literature examining how trauma may connect to cytokines, and ultimately, poor health.