老年甲状腺结节的诊治经验

介绍笔者及科室老年甲状腺结节的诊治经验,对2003年1月至2009年12月期间共收治的144例年龄大于60岁的老年甲状腺结节患者进行分析和总结。老年甲状腺结节以多发为主;压迫症状、异物和不适感、继发性甲状腺功能亢进是老年甲状腺结节患者主要的手术指证;术中发现喉返神经和甲状旁腺有脂肪沉着;病理方面良性结节的钙化率较高;患者术后切口水肿比较明显;暂时性低钙血症的发生率较高;虽然术前麻醉ASA评分较低,但术后心肺并发症的发生率并未上升。老年甲状腺结节患者以全麻为宜,最好采用双甲近全切除术,这不仅可避免术后复发和再次手术率,更可减少甲状腺素制剂的用量,减少药物副作用。     

The application of the satir model of family therapy to the families in Hong Kong: A personal reflection

Practitioners in Hong Kong have shown an increasing interest in various family therapy approaches since the 1980s. This paper offers a critique of the major concepts and techniques of the Satir model applied to families in Hong Kong. Cultural considerations are examined in relation to the family structure and hierarchy, the Chinese self and self-esteem, communication patterns, and family rules. Implications for the application of the Satir model of family therapy in Hong Kong are discussed.     

大学生的冲动性特质与自杀意念的关系:一个有调节的中介模型

以应激-易感模型为依据考察冲动性特质与自杀意念的关系,并在此基础上提出一个有调节的中介模型,探讨负性生活事件影响的中介作用以及家庭环境的调节作用。采用巴瑞特冲动性量表、青少年生活事件量表、家庭环境量表、贝克自杀意念量表对902名大学生进行集体施测,旨在考察负性生活事件的影响对大学生冲动性特质与自杀意念的中介作用以及家庭环境的调节作用,结果表明:(1)冲动性特质和负性生活事件的影响能正向预测大学生的自杀意念;(2)负性生活事件的影响在冲动性特质和自杀意念之间起中介作用;(3)负性生活事件影响的中介作用和冲动性特质的直接作用受家庭环境的调节。这些结果对于综合解释环境与个体因素对自杀意念的作用与机制具有重要意义。     

Belief in a just world and wellbeing in Indian schools

This study investigates the meaning of belief in just world (BJW) for students' subjective justice experiences with their parents and teachers and for students' subjective well-being. The hypotheses tested were that the more strongly students endorse BJW, the less the distress at school and depressive symptoms they experience. Two dimensions of BJW were assessed: personal BJW, reflecting the belief that events in one's own life are generally just, and general BJW, reflecting the belief that the world is basically a just place. The participants were 278 Indian students attending ten 10th grade classes at two private English-medium schools. The results showed that only the personal BJW, not the general BJW, was important in explaining justice experiences and wellbeing. The more the students endorsed the belief in personal just world, the more they felt treated justly by their teachers and their parents alike, and the less distress at school and depressive symptoms they experienced. In addition, teacher justice, but not parent justice, explained distress at school. Finally, the effect of personal BJW on depressive symptoms was partly mediated by both teacher and parent justice. This pattern of results persisted when class effects were controlled. Overall, this pattern of results emphasizes the importance of the individual and subjective experience of justice of the teacher behavior for adolescent wellbeing. Implications for further studies on BJW and wellbeing at school are discussed.     

Social cohesion predicts COVID-19 vaccination intentions and uptake

COVID-19 vaccination is widely regarded as an individual decision, resting upon individual characteristics and demographic factors. In this research, we provide evidence that psychological group membership, and more precisely, social cohesion—a multidimensional concept that encompasses one's sense of connectedness to, and interrelations within, a group—can help us understand COVID-19 vaccination intentions (Study 1) and uptake (Study 2). Study 1 is a repeated-measures study with a representative sample of 3026 Australians. We found evidence that social cohesion can be conceptualised as a multidimensional structure; moreover, social cohesion at Wave 1 (early in the COVID-19) predicted greater vaccination intention and lower perceived risk of vaccination at Wave 2 (4 months later). In Study 2 (a cross-sectional study, N = 499), the multidimensional structure of social cohesion was associated with greater uptake of vaccine doses (in addition to willingness to receive further doses and perceived risk of the vaccine). These relations were found after controlling for a series of demographic (i.e., sex, age, income), health-related factors (i.e., subjective health; perceived risk; having been diagnosed with COVID-19), and individual differences (political orientation, social dominance orientation, individualism). These results demonstrate the need to go beyond individual factors when it comes to behaviours that protect groups, and particularly when examining COVID-19 vaccination—one of the most important ways of slowing the spread of the virus.     

南北朝象数易学发展特点述略

南朝郑、王易学并立,北朝象数易学占主导,但后期也呈现儒玄并融的趋势．《易传《》和汉代易学创造出来的象数成果得到南北朝易学家的继承,南朝易学家对象数易学中的形式主义学风给予了批判,并呈现出本体论思维与易学象数相结合的思想萌芽．象数易学受到佛教缘起性空理论的批判,但南北朝佛教仍利用易学象数来说明现象世界．在南北朝道教养生理论中,象数易学得到了丰富和发展．在南北朝的宗教风气下,象数易学占验派沦为方伎．     

Anger Can Help: A Transactional Model and Three Pathways of the Experience and Expression of Anger

Anger is a significant human emotion with far‐reaching implications for individuals and relationships. We propose a transactional model of anger that highlights its relational relevance and potentially positive function, in addition to problematic malformations. By evolutionary design, physical, self‐concept, or attachment threats all similarly trigger diffuse physiological arousal, psychologically experienced as anger‐emotion. Anger is first a signaling and motivational system. Anger is then formed to affirming, productive use or malformed to destructive ends. A functional, prosocial approach to anger organizes it for protective and corrective personal and relational adaptation. In our model, threat perception interacts with a person's view of self in relation to other to produce helpful or harmful anger. Inflated or collapsed views of self in relation to other produce distinct manifestations of destructive anger that are harmful to self, other, and relationship. Conversely, a balanced view of self in relation to other promotes constructive anger and catalyzes self, other, and relationship healing. Clinical use of the model to shape healing personal and relational contact with anger is explored.     

Clinical Guidelines for Working With Stepfamilies: What Family,Couple, Individual,and Child Therapists Need to Know

This article draws on four decades of research and clinical practice to delineate guidelines for evidence‐informed, clinically sound work with stepfamilies for couple, family, individual adult, and child therapists. Few clinicians receive adequate training in working with the intense and often complex dynamics created by stepfamily structure and history. This is despite the fact that stepfamilies are a fundamentally different family form that occurs world‐wide. As a result many clinicians rely on their training in first‐time family models. This is not only often unhelpful, but all too often inadvertently destructive. The article integrates a large body of increasingly sophisticated research about stepfamilies with the author's four decades of clinical practice with stepfamily relationships. It describes the ways in which stepfamilies are different from first‐time families. It delineates the dynamics of five major challenges stepfamily structure creates: (1) Insider/outsider positions are intense and they are fixed. (2) Children struggle with losses, loyalty binds, and change. (3) Issues of parenting, stepparenting, and discipline often divide the couple. (4) Stepcouples must build a new family culture while navigating previously established family cultures. (5) Ex‐spouses (other parents outside the household) are part of the family. Some available data are shared on the impact of cultural and legal differences on these challenges. A three‐level model of clinical intervention is presented: Psychoeducational, Interpersonal, and Intrapsychic/Intergenerational Family‐of‐Origin. The article describes some “easy wrong turns” for well‐meaning therapists and lists some general clinical guidelines for working with stepfamily relationships.     

Testing a model of codependency for college students in Taiwan based on Bowen's concept of differentiation

The purpose of this study was to test a model of codependency based on Bowen's concept of differentiation for college students in Taiwan. The relations between family‐of‐origin dysfunction, differentiation of self, codependency traits and related symptoms including low self‐esteem, relationship distress and psychological adjustment problems were examined. Data were collected from 567 college students from 2 large, urban universities in northern Taiwan. Results indicated a significantly negative relationship between levels of codependency and self‐differentiation and that self‐differentiation partially mediated the relationship between family‐of‐origin dysfunction and codependency. The implications of these findings for counselling Taiwanese college students who experience codependency traits and related symptoms as well as suggestions for future research are discussed.     

Evaluating the Factor Structure of the MIDI Personality Scale Using Exploratory Structural Equation Modeling

This study investigated the factor structure of the 26‐item Midlife Development Inventory (MIDI) Personality Scale in a sample of 2,720 Americans. It was found that whereas confirmatory factor analysis (CFA) did not provide an acceptable fit to the data, exploratory structural equation modeling (ESEM) provided an acceptable fit. The results of ESEM revealed that the a priori five‐factor structure of personality was generally consistent with the data, and all items had salient loadings on their target factors. ESEM also revealed that some of the items contributed significantly to more than one personality factor. The results are in line with previous research, and indicate that ESEM is more suitable than CFA for the study of personality traits.