“疑难杂症”与医学模式

那些长期困扰患者和医生、查不出病因又久治不愈的病症,被称为“疑难杂症”;然而部分“疑难杂症”并非真正的疑难杂症,而是在诊治疾病的过程中所用医学模式出现了问题,医生往往局限于生物医学模式,忽略患者的心理、社会因素。因此,医学模式应该从实际工作中进行转变,而不能仅仅局限于理论上。笔者就临床常见的“怪”现象、医疗对象的复杂性...     

Loneliness in patients with rheumatic diseases: the significance of invalidation and lack of social support

Rheumatic diseases affect about 20% of the population, leading to common symptoms such as joint problems, pain, fatigue, and stiffness. Loneliness is prevalent in individuals with rheumatic diseases. This could be due to not receiving social support and being stigmatized and invalidated, which might be most common in fibromyalgia, a rheumatic disease that lacks medical evidence. The aim of this study was to compare loneliness in distinct rheumatic diseases and to examine the association of loneliness with social support and invalidation. Participants were 927 patients with ankylosing spondylitis (n = 152), fibromyalgia (n = 341), osteoarthritis (n = 150), rheumatoid arthritis (n = 171), or systemic diseases (n = 113). They completed online questionnaires including an 11-point Likert scale assessing loneliness, the Illness Invalidation Inventory (3*1; Kool et al., 2010), and the Social Support Survey (SSS; De Boer, Wijker, Speelman, & De Haes, 1996; Sherbourne & Stewart, 1991). Patients with fibromyalgia experienced significantly more loneliness than patients with ankylosing spondylitis and patients with rheumatoid arthritis. Besides being younger, having lower education, and not working, in multiple regression analyses both lack of social support and invalidation were independently correlated with loneliness. This suggests that to decrease loneliness, therapeutic attention should be given to both increasing social support as well as decreasing invalidation in patients with rheumatic diseases, especially in patients with fibromyalgia.     

Coherence and correspondence criteria for rationality: experts' estimation of risks of sexually transmitted infections

The aim of this study is to examine both coherence and correspondence criteria for rationality in experts' judgments of risk. We investigated biases in risk estimation for sexually transmitted infections (STIs) predicted by fuzzy‐trace theory, i.e., that specific errors would occur despite experts' knowledge of correct responses. One hundred twenty professionals with specific knowledge of STI risks in adolescents were administered a survey questionnaire to test predictions concerning: knowledge deficits (producing underestimation of risks); gist‐based representation of risk categories (producing overestimation of condom effectiveness); retrieval failure for risk knowledge (producing lower risk estimates); and processing interference in combining risk estimates (producing biases in post‐test diagnosis of infection). Retrieval was manipulated by asking estimation questions that “unpacked” the STI category into infection types or did not specify infection types. Other questions differentiated processing biases from knowledge deficits or retrieval failure by directly providing requisite knowledge. Experts' knowledge of STI transmission and infection risks was verified empirically. Nevertheless, under predictable conditions, they misestimated risk, overestimated the effectiveness of condoms, and also suffered from processing biases. When questions provided better retrieval supports (unpacked format), risk estimates improved. Biases were linked to gist representations, retrieval failures, and processing errors, as opposed to knowledge about STIs. Results support fuzzy‐trace theory's dual‐process assumptions that different types of errors are dissociated from one another, and separate failures of coherence and correspondence among the same sample of experts. Copyright © 2005 John Wiley & Sons, Ltd.