老年髋部骨折围手术期医疗风险的分析与对策

髋部骨折是老年人的常见病之一,髋部骨折对老年人生命的危害最大。随着人口老龄化,老年髋部骨折发病率呈逐年上升趋势。老年骨质疏松髋部骨折围手术期的医疗风险临床较常见,如何降低老年骨质疏松髋部骨折围手术期的医疗风险,是临床骨科需要解决的问题。分析存在的风险问题,明确各种风险因素,尽可能降低老年髋部围手术期的医疗风险。     

The community substance use environment: The development and predictive ability of a multi‐method and multiple‐reporter measure

This study tested the feasibility and utility of developing a multiple‐method and multiple‐reporter measure that describes the community substance use environment. Data on community‐level norms and availability of substances were reported by 5261 students and 181 prevention‐focused community leaders (CL) involved in the 28 promoting school–university–community partnerships to enhance resilience (PROSPER) Project communities between 2002 and 2005. Additionally, locations of alcohol and tobacco outlets were geocoded. Initially, these four subscales were aggregated to measure the community substance use environment. Analyses demonstrated this measure was associated with community rates of adolescent reported cigarette use, but it was not associated with community rates of adolescent reported alcohol use. Further analyses tested the relative strength of the four different subscales in predicting rates of student use. Implications of these results for the field of community‐based prevention are discussed, as well as limitations and future directions. Copyright © 2009 John Wiley & Sons, Ltd.     

Preventing HIV infection in heterosexual women: What do we know? What must we learn?

Women are becoming infected with HIV via heterosexual activity at an accelerating rate, both in the United States and globally. Although a number of evaluations of behavioral risk-reduction interventions for women have been reported, many suffer from methodological problems that weaken confidence in their findings, and furthermore it is clear that many women are unable to respond to the interventions that have been tested. Most women infected through heterosexual activity are infected by their primary partner, yet achieving consistent condom use with this partner can be highly challenging for women. The present article presents recent work and innovative ideas for intervention strategies that may be more feasible, and thus more effective, for women at risk for HIV infection by their primary male partner.     

心理疲劳与任务框架对风险决策的影响

本研究探讨心理疲劳对风险决策的影响, 以及任务框架对这一关系的调节作用。研究采用2 (疲劳, 非疲劳) × 2 (获益框架, 损失框架)被试间设计,实验组接受心理疲劳诱导后完成风险决策任务, 控制组直接完成风险决策任务。方差分析结果显示, 相对于非心理疲劳组, 心理疲劳状态下个体更倾向于风险规避, 且不受任务框架的影响。     

模糊决策的认知神经机制

模糊决策是特殊、复杂的风险决策, 还是一种独立的决策类型, 是当前认知神经科学争论的热点问题。一系列的fMRI研究分别得出了不同结论, 但大多数证据支持模糊决策和风险决策之间存在分离, 模糊决策有其独特的决策机制; 模糊决策的认知神经机制也是一个亟待解决的问题。因此本研究拟应用事件相关电位技术、生物反馈技术和基因技术, 采用IGT和GDT任务范式, 通过网络成瘾人群和正常人群的对比研究, 去探索模糊决策和风险决策之间的分离; 应用事件相关电位技术和磁共振技术, 采用IGT范式和选瓶任务范式, 研究模糊决策的认知神经机制; 并从临床角度进一步验证上述结果。该项目的开展, 有助于拓广模糊决策的研究领域和视野, 对理解人类在模糊情境下的决策机制以及模糊决策和风险决策之间的关系, 具有重要的理论意义; 对临床上成瘾人群、脑损伤患者的认知诊断和治疗以及现实中企业和个人的决策, 具有重要的参考价值。     

心理距离与后果严重性对人身安全决策的影响

已有研究发现决策者在为自己与不同他人决策时,其风险偏好存在差异。但是当对后果严重性不同的事件进行决策时,上述结果也并不总是如此。为了探究在人身安全情境中决策者面对后果严重程度不同的任务时,为自己和为他人决策时风险偏好的差异,实验一采用人际亲密度和决策所带来消极结果的严重程度分别操纵心理距离与后果严重性,结果发现决策者在后果严重任务中的决策比后果不严重任务更保守,为自己和为陌生人决策均比为最好朋友决策更冒险。这可能是由于决策者知觉到的决策责任不同所致。因此在实验一的基础上实验二引入决策责任这一变量,考察其在心理距离对风险决策影响中的作用,研究结果证明了我们的假设。     

Evolutionary perspective on indirect victimization in adolescence: the role of attractiveness, dating and sexual behavior

We studied indirect victimization from an evolutionary perspective by examining links between this type of victimization and several indicators of attractiveness (past sexual behavior, dating frequency and physical appearance). Two thousand three hundred and nineteen (56% female) students (ages 13-18) from a region of southern Ontario, Canada, completed self-report measures of indirect victimization, physical appearance, dating frequency, recent sexual behavior (number of partners in previous month) and past sexual behavior (number of lifetime partners minus number of partners in previous month) as well as indexes of depression, aggression and attachment security, which were used to control for psychosocial maladjustment. Consistent with an evolutionary framework, physical appearance interacted significantly with gender, wherein attractive females were at greater risk for indirect victimization, whereas for males physical attractiveness was a protective factor, reducing risk of victimization. Physical appearance also interacted with grade, being inversely related to indirect victimization for younger adolescents and having a nonsignificant association with victimization for older youth. Finally, recent sexual behavior was associated with increased risk of indirect victimization for older adolescents only, which we discussed with regard to peer perceptions of promiscuity and short-term mating strategies. These findings have important implications for the development of interventions designed to reduce peer victimization, in that victims of indirect aggression may represent a rather broad, heterogeneous group, including attractive individuals with no obvious signs of maladjustment.     

Identification of Early Child and Family Risk Factors for Aggressive Victim Status in First Grade

This prospective investigation sought to discriminate children who were both aggressive towards and victimized by peers in the first grade, from those who were only aggressive, only victimized, or neither (i.e., socially adjusted), using early child and family risk factors. Two hundred thirty-eight children, their mothers, and teachers participated in a longitudinal study since birth. All three aggressor/victim subgroups showed greater temperamental dysregulation than the socially adjusted children, but only aggressive victims had significantly poorer social perception skills. Aggressive victims were distinguished from aggressors by greater exposure to maternal depression and from victims by lower levels of early inhibition, but they shared the experiences of negative family emotional expressiveness with aggressors and greater mother-child negativity with victims. The identification of early risk factors is crucial to prevention and early intervention efforts that have the potential to attenuate the long term emotional, social, and academic problems associated with aggressive victim status.     

Accuracy of the DIBELS Oral Reading Fluency Measure for Predicting Third Grade Reading Comprehension Outcomes

We evaluated the validity of DIBELS (Dynamic Indicators of Basic Early Literacy Skills) ORF (Oral Reading Fluency) for predicting performance on the Florida Comprehensive Assessment Test (FCAT-SSS) and Stanford Achievement Test (SAT-10) reading comprehension measures. The usefulness of previously established ORF risk-level cutoffs [Good, R.H., Simmons, D.C., and Kame’enui, E.J. (2001). The importance and decision-making utility of a continuum of fluency-based indicators of foundational reading skills for third-grade high-stakes outcomes. Scientific Studies of Reading, 5, 257–288.] for third grade students were evaluated on calibration (n_S1 = 16,539) and cross-validation (n_S2 = 16,908) samples representative of Florida's Reading First population. The strongest correlations were the third (February/March) administration of ORF with both FCAT-SSS and SAT-10 (r_S = .70–.71), when the three tests were administered concurrently. Recalibrated ORF risk-level cut scores derived from ROC (receiver-operating characteristic) curve analyses produced more accurate identification of true positives than previously established benchmarks. The recalibrated risk-level cut scores predict performance on the FCAT-SSS equally well for students from different socio-economic, language, and race/ethnicity categories.     

Mentoring Nurses in Familial Cancer Risk Assessment and Counseling: Lessons Learned From a Formative Evaluation

Background. As familial cancer genetic services moves into community practice increased numbers of trained health professionals are needed to counsel individuals seeking cancer risk information. Nurses have been targeted to provide cancer risk assessment and counseling. To help prepare nurses for this role, a 5-day training in familial cancer risk assessment and counseling followed by a long-distance mentorship to support continued skill development in the work environment was conducted by Fox Chase Cancer Center, Philadelphia, PA. Methods. Four cohorts (N = 41) have completed the training and were randomized to either an immediate or delayed mentorship. A formative evaluation assessed the nurse’s ability to consult with other genetic health professionals and build self-efficacy in counseling skills via responses to questionnaire. A post-mentorship interview evaluated the usefulness, timing and length of the mentorship. Results. For both groups, there was a statistically significant improvement in self-efficacy for all skills from baseline to 6 months and an increased number of nurses consulting with genetic health professionals. All the nurses reported the value of the mentorship and those with less cancer risk counseling experience prior to the training needed support and resources for further skill and program development. Lessons learned from this formative evaluation are provided.