如何破解乡镇区域群体“看病难”之困局

我国乡镇区域群体“看病难”之主要成因,在于医疗资源总体缺乏、政府经费投入不足以及乡镇区域群体经济收入增长缓慢。“看病难”困局的破解之道包括:制定《国民健康法》,明确政府部门在全民医疗保健方面的法律责任;根据国民经济的发展状态,合理计算各个阶段政府卫生经费的投放总额,并将经费的主要部分投向乡镇区域;实施医药管理体制改革,资源共享;加强医学专门人才的培养、促进高级医学人才向基层单位合理流动。     

Difficult Patients in Group Analysis: The Personification of (ba) I:A/M

Following a discussion of the treatment of difficult patients in group analysis, two theories are proposed concerning a fourth basic assumption in the unconscious life of groups, called Incohesion: Aggregation/Massification or (ba) I:A/M and the personification of basic assumption processes, in particular that of (ba) I:A/M by difficult patients. These theories are illustrated with clinical data. Special attention is given to crustacean and amoeboid forms of encapsulation as a defence against the fear of annihilation within the context of the traumatogenic process. It is suggested that for difficult patients the treatment of choice is dyadic psychotherapy/psychoanalysis followed by group analysis.     

策略转换的成本与顺序效应

灵活的策略转换是个体有效地解决问题的重要条件。策略转换需要成本已得到大量证明,但策略转换成本是否为对称转换成本尚无定论。基于已有研究,对策略转换中存在策略顺序困难效应与较差策略顺序调节效应两种典型的顺序效应进行了具体介绍。在此基础上提出了不对称策略转换成本可能是对称转换成本与策略顺序困难效应之和的假设,并进而提出设想:可通过操纵时间变量来分离策略顺序困难效应与较差策略顺序调节效应。此外,从策略转换成本的角度创新地阐释了策略选择的惰性与倒退现象。     

5-10岁儿童发展性学习困难的教育干预研究

本研究采用教育自然实验和纵向研究设计对100名5-10岁学习困难儿童进行训练,以认知能力训练为主,同时综合进行运动和感觉统合能力训练,以及儿童自我意识和同伴关系,亲子关系调整的训练方法,研究发现训练有较为明显的效果,训练所采取的游戏性学习方式和小组训练方式都有助于加强训练效果。     

Dominance and age-related changes in the play fighting of intact and post-weaning castrated male rats (Rattus norvegicus)

The play fighting behaviour of male rats (Rattus norvegicus) castrated at weaning was compared to that of intact controls during the juvenile and post-pubertal phases of development. Following puberty, both the castrated and intact animals exhibited an age-related change in their play fighting; the frequency of initiating play fighting decreased and juvenile patterns of playful defense were replaced by more adult-like patterns. As these changes occurred even in the absence of the pubertal surge of gonadal hormones, they were more likely to result from the organizational effects of gonadal hormones in the perinatal period than the activational effects of these hormones at puberty. Although the castrated animals exhibited the age-related changes in behaviour, they did not exhibit the asymmetries in play associated with dominance relationships. As demonstrated in previous studies, in pairs of intact rats, the animal that attacks the most and uses more juvenile defenses during play fighting and weighs the least is typically the subordinate. In the castrates, asymmetries in weight and playful defense are not related to play frequency, indicating the absence of a dominance relationship. Although the characteristic changes in male play fighting at puberty are independent of the activational effects of gonadal hormones, dominance relationships and their associated changes in play fighting are dependent on these hormones. Therefore, in the perinatal period gonadal hormones most likely organize the age-related changes in play behaviour, whereas post-pubertally gonadal hormones activate dominance relationships and thus, indirectly modify play fighting by affecting dominance-associated assymetries in behaviour. © 1996 Wiley-Liss, Inc.     

现代医学在人文困境中自我蜕变

从现象学方法论的观察与分析视角,围绕医学现代性和医学人文困境对现代医学给予了过程上的、人性层面上的剖析,对当下医学模式转型于医学现代性的内在关联发表了独到见解,得出医学作为“人学”最终不能回避文化救赎的结论。     

呼吸机依赖患者撤机失败原因及对策

机械通气是近年来抢救呼吸衰竭患者的重要生命支持手段,但使用呼吸机的时间超过2周可导致撤机困难。本文详细分析了诸如心理障碍、营养不良、心肺功能不全以及撤机方法不当等各种可导致困难撤机的原因,并针对各个原因提出相应的治疗及护理对策,从而降低临床上困难撤机的发生率。     

Agonistic behaviour and bite wound patterns in wild water voles (Arvicola terrestris L.)

Intra‐specific aggression was investigated in a wild colony of Water voles between 1999 and 2004 in South Wales, UK. The occurrence and location (i.e. on the head, neck, body or tail) of bite wounds were recorded for adult and juvenile male and female voles. The greatest (33%) incidence of bite wounds were recorded on juvenile females and the lowest (18%) in adult females. Seasonal analysis of wound data in adults revealed that females were more likely to be bitten during the breeding season whereas bite patterns in males did not vary seasonally. Analysis of bite pattern topography revealed that most Water voles seemingly attempt to bite vulnerable target areas of the body (namely the head and tail). This is in contrast with studies on rats and mice where competitive forms of attack (particularly involving males) largely avoid these areas of the attacked animal's body. Targeting vulnerable areas is normally a characteristic of defensive modes of attack. Patterns of bite topography and agonistic behaviour in this species seem to reflect competitive interactions between individuals, particularly between territorial females and their female offspring, over access to essential resources. Aggr. Behav. 32:599–603. 2006. © 2006 Wiley‐Liss, Inc.     

生物医学人体受试者研究未来面临的挑战

人体受试者研究的伦理问题在今后将会愈益引起关注,如何看待知情同意的代理权？如何处理不同文化背景下的知情同意原则？在商业利益诱惑下背离本人健康利益和知情同意是否有效？受试者的利益回报,以及体试验研究要求的双盲,随机、对照等原则可能面临的新问是,都是人体受试者研究未来面临的挑战。     

Pre‐outcome regret: Widespread and overlooked

Many real‐life decisions (e.g. promises, plans and agreements) involve a time interval between when the decision is made and the main outcome is revealed. Nearly all regret studies focus on anticipated or experienced post‐outcome regret. We argue that regret is also frequently experienced in the pre‐outcome period, and that this ‘pre‐outcome regret’ has other sources than regret experienced after the outcome is known. Regret experienced in the pre‐outcome period has an important function post‐outcome regret (usually) cannot have, namely to motivate the decision maker to reconsider the ongoing decision process and reverse the initial decision. Pre‐outcome regret should for these reasons be distinguished from post‐outcome regret, and studied separately. In two scenario studies, participants were asked to imagine their regret after agreeing to perform an inconvenient task. In both, more regret was reported before than after the event, even when they had imagined a ‘worst case’ outcome. In the third study, participants described a difficult choice from their own life. Again, regret was perceived as higher in the pre‐outcome period than afterwards. In a fourth study, participants reported regret ‘online’ during an economic game (a version of the ultimatum game). They regretted their decisions more before than after they knew the outcome. We conclude that experienced pre‐outcome regret is often stronger than post‐outcome regret, and typically increases during the pre‐outcome period. We suspect that the absence of JDM studies of pre‐outcome regret is a legacy of the dominant gambling metaphor within decision research. Copyright © 2010 John Wiley & Sons, Ltd.