致癌因素与机体相互作用的损伤与抗损伤反应

损伤与抗损伤是机体对病因作出的一种防御性反应.正确地认识其在疾病发生发展过程中的作用,不仅有助于现代医学阐明疾病的发生机制,而且有利于传统医学提高辩证施治的效果.本文旨在探讨癌症致病因素与机体相互作用的抗损伤反应中的辩证关系,可望逐步提高医者在临床实践中运用唯物辩证法和方法论的自觉性.     

吉林省城市中小学生超重与肥胖的现状研究

为了更好地了解吉林省城市中小学生的超重和肥胖现状及其影响因素,选取吉林省20所学校的17 893名中小学生(8岁～15岁)进行体格测量与问卷调查.调查结果显示,中小学生超重和肥胖总体检出率为30.5％,并且有39.9％的中小学生对体重的自我认知情况与实际检测结果不相符,存在体重认知的偏移.可见,控制儿童青少年超重与肥胖的工作已刻不容缓,应引起全社会高度重视,从低年级儿童入手,做到早期预防.     

By-Person Factor Analysis in Clinical Ethical Decision Making: Q Methodology in End-of-Life Care Decisions

Objective: To determine the usefulness of Q methodology to locate and describe shared subjective influences on clinical decision making among participant physicians using hypothetical cases containing common ethical issues.

Design: Qualitative study using by-person factor analysis of subjective Q sort data matrix.

Setting: University medical center.

Participants: Convenience sample of internal medicine attending physicians and house staff (n = 35) at one midwestern academic health sciences center.

Interventions: Presented with four hypothetical cases involving urgent decision making near the end of life, participants selected one of three specific clinical actions offered for each case. Immediately afterward and while considering their decision, each respondent sorted twenty-five subjective self-referent items in terms of the influence of each statement on their decision-making process. By-person factor analysis, where participants are defined as variates, yielded information about the attitudinal background the physicians brought to their consideration of each hypothetical case. We performed a second-order factor analysis on all of the subjective viewpoints to determine if a smaller core of shared attitudes existed across some or all of the four case vignettes. Factor scores for each item and post-sort comments from interviews conducted individually with each respondent guided the interpretation of ethical perspective used by these respondents in making clinical decisions about the cases.

Measurements and Main Results: Second-order factor analysis on seventeen viewpoints used by physicians in the four hypothetical urgent decision cases revealed three moderately correlated (r ² < 40%) subjective core attitudinal guides used broadly among all the cases and among sixteen of the seventeen original factors. Across all the cases, our participants were guided in general by: (1) patient-focused beneficence, (2) a patient- and surrogate-focused perspective that includes risk avoidance, and (3) best interest of the patient guided by ethical values. Economic impact on the physician, expediency in resolution of the situation, and the expense of medical treatment were not found to be influential determinants in this study.

Conclusions: Q sorting and by-person factor analysis are useful qualitative methodological tools to study the complex structure of subjective attitudes that influence physicians in making medical decisions. This study revealed the subjective viewpoints used by our physician participants as they made ethically challenging treatment decisions. The three second-order factors identified here are grounded in current bioethical values as well as the personal traits of physicians. The participants' decision methods appear to resemble casuistry more than principle-based decision making. Generalizability of results will require further studies.     

Evaluation of the Religiosity in 5-D Scale

ABSTRACT

The goal of this study was to evaluate the factor structure and measurement equivalence of the Religiosity in 5-D Scale (Faulkner & DeJong, 1966). Using 262 participants from the Georgia Centenarian Study (Poon et al., 1992), analyses included exploratory factor analyses without rotation and using rotation, confirmatory factor analyses of a multiple and single factor religiosity construct, the establishment of measurement equivalence across age groups. The 5-D scale maintained a one-factor construct of religiosity. Dimensions of this factor included ideology, experience, ritual, and consequence. A measurement model of the religiosity construct was then established using summary scores. Confirmatory factor analysis revealed a satisfactory model of fit (GFI = .99; CFI = 1.00). Finally, measurement equivalence was maintained across age groups including sexagenarians (GFI = .95), octogenarians (GFI = .89), and centenarians (GFI = .95). The 5-D scale is an appropriate measure for use in aging research.     

CRF受体对五羟色胺系统的调节作用及早期环境因素的影响

早期环境因素持续影响脑与行为的发展,增加个体成年后应激相关精神疾病患病的易感性.应激反应的中枢启动因子促肾上腺皮质激素释放因子(corticotropin-releasing factor,CRF)通过两种受体CRF1和CRF2调节中缝背核(dorsal raphe nucleus,DRN)-五-羟色胺(serotonin,5-HT)系统,后者已被证实在应激相关情绪疾患发病和治疗过程中发挥重要作用.已知CRF受体以相互影响相互拮抗的方式动态调节DRN-5-HT系统,提示这两种受体相对作用的调节对于协调复杂环境中DRN-5-HT系统的应激反应过程起着关键性作用.早期环境因素和遗传因素交互作用导致CRF受体的分布和反应性持续改变并造成DRN-5-HT系统反应异常,可能是导致应激反应和精神疾病易感性个体差异的重要神经基础.     

Facets of the Childhood Anxiety Sensitivity Index Among Serbian Youth

Data from factor analytic studies using the Child Anxiety Sensitivity Index (CASI) suggest that global anxiety sensitivity (AS) is best represented by three or four underlying factors or facets. The aim of this study was to identify facets best representing the CASI structure in its Serbian version. Confirmatory factor analysis was used on data collected from 456 non-referred children in Serbia. A 13-item version of the CASI provided a better fit to the data than the original 18-item version. The four-factor model of the CASI-13 with disease, unsteady, mental incapacitation, and social concerns facets provided the best fits for the data and it was found to be fully invariant (configural, metric, and scalar invariance) across gender and age. Among Serbian children, hierarchical structure was found for a 13-item CASI version with a single higher-order factor of global AS represented by four underlying facets. Future research will consider these AS facets and their role in the development, maintenance, and exacerbation of anxiety symptoms in children.     

Factors associated with traumatic symptoms and internalizing problems among adolescents who experienced a traumatic event

Abstract

The aim of the present study was to identify factors that are related to the traumatic symptoms and problem behavior among adolescents who experienced the New Years fire in 2001 in Volendam, The Netherlands. Three groups of factors were considered: pre-trauma (personality and coping), trauma-related (physical and emotional proximity to disaster), and post-trauma factors (received social support). Forty-five adolescents completed the questionnaire. Two years after the disaster, these adolescents experienced significant traumatic stress reaction (70% within the clinical range) and showed clinically significant levels of internalizing problems (37%). Pre-trauma, individual factors were identified as the most important predictors of distress, followed by received social support. The indicators of physical and emotional proximity to disaster explained little variance in distress.     

Factorial structure and psychometric properties of the French adaptation of the Dissociative Experiences Scale (DES) in non-clinical participants

IntroductionThe Dissociative Experiences Scale (DES) is a widely used instrument for assessing dissociation. However, there is disagreement regarding the internal structure of the DES and scores tend to be highly skewed.ObjectiveThe present study was designed to test the psychometric properties of a French version of the DES in non-clinical participants, in addition to applying a response scale as recommended by Wright and Loftus (1999) in order to resolve the problem of skewed scores.ResultsExploratory and confirmatory factor analysis (computed in two independent samples) suggested a two-factor solution, which seem to represent two forms of dissociation (“automatic pilot” related dissociation episodes and “defensive” dissociation episodes). Results also revealed high internal consistency, and satisfactory results in terms of skewness and floor effects. Finally, significant associations with other measures (anxiety, depression, traumatic experiences) indicate good concurrent validity.ConclusionsThis study offers evidence that the present version of the French adaptation of the DES reveals good psychometric properties. Analyses of the internal structure of the DES suggest that two types of dissociative experiences are being measured: automatic pilot-related dissociation episodes (e.g., associated with different types of cognitive failures) and defensive dissociation episodes that may act as defensive mechanisms, especially in persons who have been traumatized (e.g., the avoidance of a memory related to a traumatic event).     

The Factor Structure and Reliability of a Six-Item Sense of Coherence Measure

The study investigated the factor structure and reliability of a six-item sense of coherence (SOC) measure. Participants were a South African white collar employee sample (n=7185) purposively selected from over 300 different companies across various business sectors. The sample constituted 34% male and 66% female and 34% Black, 18% Coloured, 11% Indian and 37% White employees. Exploratory factor analysis (EFA) was used for the structural analysis. The reliability of the scores was also estimated. A unidimensional structure seemed to best represent the six-item SOC measure. The internal reliability of the scores from the measure was high.