Cognitive-behavioral therapy of insomnia: A clinical case series study of patients with co-morbid disorders and using hypnotic medications

Cognitive-behavioral therapy for insomnia (CBTi) has demonstrated considerable efficacy within randomized clinical trials and case-series designs. This case-series study in a community sleep medicine clinic assessed the effectiveness of an eight-session CBTi protocol chronic insomnia patients who were allowed to continue their use of hypnotics (intent-to-treat n = 48), administered by a clinical psychology doctoral student receiving training and supervision in CBTi by a behavioral sleep medicine certified clinician. Outcome measures included daily sleep diaries, self-report measures on insomnia severity, dysfunctional beliefs and attitudes about sleep, daytime sleepiness, as well as medication usage. Patients showed significant improvements in sleep onset latency, wake time after sleep onset, sleep efficiency, insomnia severity, and dysfunctional sleep beliefs from pre- to post-treatment. No changes were seen in daytime sleepiness - patients were not excessively sleepy either before or after treatment. Use of sleep medication declined significantly from 87.5% pre-treatment to 54% post-treatment, despite no active efforts to encourage patients to withdraw. Results demonstrate that a CBTi conducted in a community sleep medicine clinic with patients not required to discontinue sleep-related medications can have similar effects as therapy delivered among those not on medication.     

Before they're victims: Rethinking youth‐targeted relationship abuse prevention in Australia

Intimate partner abuse (or relationship abuse) against women is recognised as a major public health issue. A number of relationship abuse prevention programs targeted at youth have been developed in Australia. These programs are generally aimed at changing attitudes, and take the stance that girls should not be viewed as being responsible for protecting themselves against violence. In this paper it is argued that the current, dominant focus on physical violence, over other forms of relationship abuse, limits the potential effectiveness of programs that might otherwise help young people to resist the development of abusive dynamics. It is also argued that programs that presume a victim status for girls and a perpetrator status for boys are both inconsistent with contemporary evidence and unlikely to empower young people at risk of chronic perpetration and/or victimisation to avoid such outcomes. A dyadic slippery slope model of chronic relationship abuse is proposed and new directions for prevention research in this area are suggested.     

要注意中药对肝的损伤作用

含有生物碱类、皂苷类、萜类、毒蛋白类、重金属类成分的中药易致急性肝损伤.中药对肝脏损伤的原因及机制较为复杂,可能与药物对肝脏的直接毒性或特异性体质有关.此外,中药炮制方法、给药途径、剂型、剂量、疗程及配伍不当也会引起药物性肝损伤.中药所致的药物性肝损伤的诊断主要依据用药史、发病的时间、过程和临床表现并排除其他因素.治疗可选用还原型谷胱甘肽、S-腺苷蛋氨酸、多烯磷脂酰胆碱、熊去氧胆酸、水飞蓟素等药物,重症可选择人工肝脏支持治疗.     

CBL、PBL及Seminar结合的立体教学模式的应用和思考——临床医学八年制呼吸科床旁教学实践中的应用

临床医学八年制内科学床旁教学应用传统的教学模式及基于案例的学习（CBL）单一教学方法难以满足教学要求.将CBL与基于问题的学习（PBL）及研讨会（Seminar）结合的立体教学模式应用于呼吸科的床旁教学实践中,激发了学生学习的积极性、创新性,培养了学生良好的团队合作精神和临床思维模式,提高了学生们解决临床问题的能力,并能加深师生互动交流,达到教学相长的目的.     

新生儿重症监护病房患儿家属心理状况分析

探讨新生儿重症监护病房（NICU）住院患儿家属的心理状况及影响因素。采用焦虑自评量表（SAS）及自行设计的调查问卷对190名NICU住院患儿家属进行调查。结果显示患儿家属表现出不同程度的焦虑,与全国常模（29．78±0．46）相比,其焦虑情绪标准分49．54±1．07,高于常模组（P〈O．05）。影响因素主要包括文化水平、家庭人均收入及患儿病情严重程度等。患儿父母关注的主要问题包括：病情严重程度、预后、医护人员解释病情满意度及病房探视制度。笔者认为医护人员应加强与患儿家属的有效沟通,满足其心理需求,提高医疗护理质量,促进医患关系和谐。     

用达尔文医学的观点看待近视眼的发生和治疗

从近视眼的进化史来看,伴随人类生活方式的改变,眼睛对近距离信息摄取的需求膨胀是近视眼形成的终因.在漫长的人类历史中,近视眼获得的每一种益处,都伴随着相应的代价.而达尔文医学关于生物进化的不完美性决定了近视眼的进化适应和代价将长期共存.因此,从治疗模式来看,应该摒弃达尔文医学固有的消极性而考虑生物的整体性和生态性.近视眼的中医和基因治疗正是避免了达尔文医学治疗模式的理论消极性,而且融入了其有关生物进化、遗传与环境统一的部分理念,可能成为近视眼治疗的候选策略.     

家庭成员间活体器官及组织捐赠的伦理问题

家庭成员间活体器官及组织捐赠是被绝大多数国家所允许的.虽然利益化减少了很多,但是目前发现其也存在许多的伦理问题.就家庭成员间活体器官及组织捐赠的伦理基础,以及就捐赠风险、种族差异、失衡之爱、操纵、拒绝、退出、潜在利益、特殊疾病等涉及的相关伦理问题进行综述,并就存在的相关问题的解决方法进行探讨.     

我国转化医学发展现状的思考

转化医学在当今世界发展迅速,虽然在我国起步较晚,但取得了巨大的成就,建立了许多转化医学研究机构,积极开展合作交流,但不可避免地存在一些问题,诸如创新能力不足、顶层设计不够和人才缺乏等,为此提出相应对策和未来发展的前景,同时指出转化医学在我国不仅是学术问题,而且是社会问题.     

Family social support during the predeparture period: The experience of British migrants

This study explored the stress, wellbeing and social support of predeparture British migrants to New Zealand. The main research questions addressed the relationship between family support and psychological outcomes, differences in migration desire between couples, and the impact of extended family support. A survey recruited 95 participants from online forums for migrants to New Zealand and results indicated that support from immediate family was related to better wellbeing and lower stress. Migrants who considered themselves the driving force behind the move reported significantly more stress and less family support than migrants who had partners who were equally enthusiastic about the move abroad. Sojourners perceived more support from extended family than did migrants who intended to leave permanently. The most difficult parts of the migration process were leaving loved ones, logistical demands, and uncertainty. The most positive parts of the process were adventure and becoming closer as a family. Overall, migration stress and coping began well before departure from the country of origin.     

Concordance Between the Quality of Maternal and Paternal Parenting Behavior Within Couples

There is compelling evidence that the quality of maternal and paternal parenting behavior bears critical importance for child development. Yet, less is known of the degree of similarity between maternal and paternal parenting behavior in families, and especially little is known about the factors that may explain variation in degrees of similarity. This article aims to examine (a) the concordance (similarity) between the quality of mothers’ and fathers’ interactive behavior with their child and (b) the sociodemographic determinants of this concordance. The sample included 74 families (mother, father, and their child). The quality of maternal and paternal interactive behavior was assessed independently, and rated with the Maternal Behavior Q-Sort (mother–infant, 12 months; D. R. Pederson et al., 1990) or the Mutually Responsive Orientation scale (father–toddler, 18 months; N. Aksan et al., 2006). The results indicated that the overall correlation between the quality of mothers’ and fathers’ behavior was moderate. The concordance was greater among higher socioeconomic status families or when interacting with a boy, but did not differ according to the presence or absence of siblings in the family.