呼吸危重症临床决策中的若干问题

在临床实践中,呼吸危重症的诊断和治疗存在着一些不同的观点。就其中某些热点问题,如慢性阻塞性肺疾病合并哮喘的诊断和机械通气的指征、肺栓塞的诊断、急性呼吸窘迫综合征的治疗、呼吸重症监护病房的建设和呼吸危重症的伦理学问题进行阐述,以期提高对呼吸危重症的认识。     

工作压力反应及其与领导方式的关系研究

本研究通过对537位工作者的调查,探讨工作压力反应的类型及其与领导方式的关系,结果显示:工作压力反应存在四种类型,分别是积极压力反应类型、高压力反应类型、低压力反应类型以及消极压力反应类型。直接领导的不同领导方式与个体不同的工作压力反应类型存在关联。混合式领导方式下的个体积极压力反应最高,消极压力反应最低。变革型领导和交易型领导下的个体积极压力反应和消极压力反应无显著差异。     

The Quality of Home Environment in Brazil: An Ecological Model

Based on Bronfenbrenner's (1999) ecological perspective, a longitudinal, prospective model of individual differences in the quality of home environment (Home Observation for Measurement of the Environment—HOME) was tested in a sample of 179 Brazilian children and their families. Perinatal measures of family socioeconomic status (SES) and child birth weight had direct effects on HOME at preschool age. As either family SES or child birth weight increased, HOME also increased through diminished emotional distress in the mother a month following childbirth. SES had a negative effect on number of children in the household, which in turn had a long-term negative impact on HOME. Compared to mothers who had reported not to plan their pregnancy, those who did were more likely to have fewer children, to report more spouse support during childbearing, and to show less emotional distress a month after childbirth, all of which also influenced HOME at preschool age. These findings are discussed in light of the broader socio-ecological Brazilian context, with direct implications to clinical practice aimed at improving the quality of home environment.     

Changes in externalizing and internalizing behaviours over a school‐year: differences between 6‐year‐old boys and girls

The purpose of this study was to investigate changes in externalizing and internalizing problem behaviours in 6‐year‐olds with a focus on sex differences. Teachers rated problem behaviours at the beginning and at the end of the school year, 8 months apart, in 370 children (197 boys and 173 girls) attending 22 school preparatory classrooms. Although the majority of the children were quite stable, considerable negative and positive changes for both boys and girls in problem behaviours were found. The results showed that girls were more likely to change their externalizing behaviours in a positive direction than boys, whereas a tendency to the opposite pattern was found for internalizing behaviours. Boys were also found to be more prone to a negative change in problem behaviours of both types than girls were. Copyright © 2006 John Wiley & Sons, Ltd.     

Student Ratings of a Male and Female Professors’ Lecture on Sex Discrimination in the Workforce

Using an experimental design, male (n = 41) and female (n = 46) undergraduate students in the southeastern USA evaluated an identical written lecture by a male and female professor on pay disparities between men and women in the workforce suggesting sex discrimination. Regardless of the students’ sex, the male professor and his lecture was rated more positively and less sexist than the female professor. Moderated multiple regression analysis indicated that more traditional and gender stereotypical attitudes toward women in male students were related to greater sexism ratings of the female professor compared to the male professor whereas; no differences on ratings of sexism between the male and female professor were found for male students with more liberal attitudes.     

The Influence of Cancer-related Distress and Sense of Coherence on Anxiety and Depression in Patients with Hereditary Cancer

This study examines the association between Sense of Coherence and anxiety and depression amongst patients at risk of hereditary cancer receiving genetic counseling. When writing this article, 144 patients referred for genetic counseling due to a suspicion of hereditary cancer in the family were recruited for this multicentered longitudinal study on the psychosocial aspects of genetic counseling in Norway. A total of 96 (66%) patients responded to the follow-up survey distributed 6 months after genetic counseling. This survey included the Sense of Coherence-29 Scale, Impact of Event Scale, and Hospital Anxiety and Depression Scale. Multiple regression analyses were applied. Our results show association between cancer-related distress and symptoms of anxiety and depression. Sense of Coherence is significantly associated with both anxiety and depression. The hypothesis of Sense of Coherence buffering cancer-related distress and the possible impact of these findings for genetic counseling are discussed.     

Minority stress and health: Implications for lesbian,gay, bisexual,transgender, and questioning (LGBTQ) young people

Historically, the pathologization of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) orientations shaped research and professional practice, while the impact of stigma was not considered. Within a minority stress conceptualization however, stigma-related prejudice and discrimination experienced by LGBTQ people constitute chronically stressful events that can lead to negative health outcomes. Minority stress has been linked to psychological distress among gay men and lesbians and may contribute to elevated rates of distress frequently observed among LGBTQ youth. This study explored the impact of minority stress on psychological distress among LGBTQ youth in Ireland. Measures assessing three components of minority stress (sexual identity distress, stigma consciousness, and heterosexist experiences) were administered online to LGBTQ youth aged 16–24 years (N = 301). Each minority stressor had a significant independent association with distress. Stepwise regression analyses identified the linear combination of minority stressors as significantly predictive of distress [F(3,201) = 30.80, p ≤ 0.001]. Results suggest that the oppressive social environment created through sexual/transgender identity-related stigma negatively impacts on the well-being of LGBTQ youth. These findings have implications for health professionals and policy makers interested in the concerns of LGBTQ youth experiencing difficulties related to minority status and will facilitate the development and tailoring of interventions aimed at reaching those most at risk.     

重症急性胰腺炎并发急性呼吸窘迫综合征危险因素的分析

为了探讨重症急性胰腺炎（SAP）并发急性呼吸窘迫综合征（ARDs）的危险因素,回顾性分析了我院76例SAP患者入ICU时的年龄、血糖、APACHEⅡ评分等17项指标,根据是否合并ARDS对各项指标进行单因素及多因素Logistic回归分析。单因素分析显示两组在年龄、呼吸频率、血糖、感染、APACHEⅡ评分、Ranson评分、CT评分、ICU住院日方面差异有显著性（P〈0．05）,多因素Logistic回归分析显示年龄、血糖、感染、APACHEⅡ、Ranson、CT评分与SAP并发ARDS有关。故得出结论,年龄、血糖、感染、APACHEⅡ、Ranson与CT评分是SAP并发ARDS的独立危险因素。     

Clients’ in-session acceptance and cognitive defusion behaviors in acceptance-based treatment of tinnitus distress

Cognitive-behavioral treatment (CBT) is considered to be an effective treatment of distress associated with tinnitus (perception of internal noises without any outer auditory stimulation), but the processes by which the therapy works remain unclear. Mindfulness and acceptance is receiving increased attention in the treatment literature for chronic medical conditions. However, few studies have examined these and related processes with behavioral or observer measures. In the present study 57 videotapes (a total of 1710 min) from 19 clients who participated in a controlled trial of an acceptance-based treatment for tinnitus distress, were coded for frequency and peak level of verbal behaviors expressing either acceptance or cognitive defusion. Frequency of cognitive defusion behaviors and peak level of cognitive defusion as well as peak level of acceptance rated in Session 2, predicted symptom reduction 6 month following treatment. These relationships were not accounted for by the improvement that had occurred prior to the measurement point of the process variables. Moreover, prior symptom changes could not predict process variables rated later in therapy (after most of the improvement in therapy had occurred). Thus, clients’ in-session acceptance and cognitive defusion behaviors appear to play an important role in the reduction of negative impact of tinnitus.     

Students' Divergent Thinking and Teachers' Ratings of Creativity: Does Gender Play a Role?

The differences between genders regarding the properties of divergent thinking and teachers' ratings of students' creativity are the issue of the present research. Data gathered from three previous experimental studies in Greek primary school students (N total = 228) was used for this purpose. In these studies, divergent thinking tasks were assigned to students and teachers' ratings were collected. The results showed that there were indeed differences in performance — except in the subscale of originality — in favor of girls who were more likely to perform better when they had a male teacher. Teachers' ratings of creativity were not related to students' gender but to teachers' gender.