Level of cognitive performance as a correlate and predictor of health behaviors that protect against cognitive decline in late life: The path through life study

There is a lack of information on how cognitive ability relates to both health behaviors and change in health behaviors over time. This study examined verbal ability and processing speed as predictors of health behaviors in the PATH Through Life Study that includes cohorts aged in their 20s, 40s and 60s. Higher cognitive scores were associated with higher levels of physical activity, greater likelihood of taking vitamin and mineral supplements, reduced likelihood of current smoking and not abstaining from alcohol. However, lower level of verbal ability and processing speed were associated with higher levels of use of cholesterol lowering medication in the 60s cohort. Physical activity, consumption of vitamins and minerals and taking cholesterol lowering and antihypertensive medication over the four-year follow-up period increased in this cohort. The likelihood of adopting healthier behaviors was greatest for those with the lowest cognitive scores. We conclude that while higher levels of cognitive performance are associated with health promoting behaviors, improvements in health behavior are more likely to be due to non-cognitive, contextual and societal factors.     

Research ethics and the principle of Justice as Fairness – A restatement

In my recent article, I addressed the question of whether a potential categorical exclusion of decisionally impaired patients from non-therapeutic medical research would be inaccordance with the Principle of Justice as Fairness. I came to the conclusion that a categorical exclusion of decisionally impaired persons from relevant research projects may collide with Rawls’s understanding of Justice as Fairness. Derek Bell has criticized my paper by denying that it is legitimate to apply Rawls to this bioethical problem. In my restatement I try to show that an extrapolation of John Rawls’s thought to such bioethical cases is possible, because Rawls himself has written that his orientation towards decisionally non-impaired persons is an idealized situation that allows extrapolations. In a second part I try to show that Bell hasroughly misunderstood my concept of “presumed consent” which I make a prerequisite for the legitimisation of research on decisionally impaired persons. In using advance consent as a proposal for resolving the problem, Bell has indirectly confirmed my approach because he is using a similar construct of consent, which operates with similar hypotheses and probabilities of error. I see here no categorical difference between Bell’s conclusion and my discussion. Thus, Bell’s reply does not represent a refutation of my thoughts, but rather it is a para phrased confirmation of my central theses. I conclude by showing the relevance of Rawls, pointing out that the discussion between Bell and me illustrates how Rawls’s concept of reflective equilibrium is an appropriate approach to finding a solution to this bioethical problem. This revised version was published online in June 2006 with corrections to the Cover Date.     

关于医学的人文科学性质

医学具有显著的人文科学性质。新医学模式的确立标志着医学人文科学性质的重新发现;科技进步和市场经济建设使医学的人文科学性质凸显;医学人文科学性质的研究对于医学发展意义重大。     

同性恋的社会伦理评价

按照WHO的健康定义与Engel疾病模式,同性恋仍然是一种疾病;也仍然是一种性偏离或性变异。同性恋如同其他性行为或性变异一样,必须受到社会控制和道德控制。而男同性恋对艾滋病传播的负面影响绝不能忽视。     

循证医学与医学教育改革

循证医学这一新的医疗模式反映了世界医学的发展趋势,代表了现代医学的前进方向。医学教育必须应这一趋势,按照循证医学的基本精神促进观念更新,推进医疗模式、教学内容、教学方法和继续教育等方面的改革,全面提高医学教育质量。     

现代医学的有限与无奈

在充分肯定现代医学在取得巨大进步的同时,分别从疾病病因、发病机制、早期诊断、疗效和预后等8个方向阐述了现代医学在防治人类疾病中的局限性,并简要分析了产生这种局限性的原因。     

“象”模型：易医会通的交点——兼论中医学的本质及其未来发展

易学与中医学的会通问题历来是一个有争议的问题,本文从一个特定的层面即思维方式的层面探讨了这一问题,提出“象”思维是医易学共同的思维方式,是医易会通的交点。“象”思维包括“象”思维方法和“象”思维模型,本文认为“象”思维方法是一种模型思维方法,“象”思维模型有卦爻模型、阴阳模型、易数模型,五行模型、干支模型等多级同源、同质、同构的子模型。文章进而探讨了“象”思维具有整体性、全息性、功能性、关系性、超形态性、时序性以及重直觉、体悟、程式、循环的特征,指出这一特征正是中医学理论的本质。中医学与西医学的本质差别就是“模型论”与“原型论”的差别,两者各有优劣。文章还从“象”模型角度提出了“修补”中医思维方式、促进中医学术发展的中医未来观。     

Prévenir et agir sur les problèmes de santé au travail : les services de santé au travail à la croisée des chemins

This article presents an ongoing research regarding work-related health issues as they are perceived and identified by professionals practicing in occupational health services. The study is based on interviews with occupational doctors, nurses, technicians in prevention of occupational hazards and assistants, employed in two general services. The article starts with an overview of the recent changes in the workplace and in the practicing conditions of the professionals in the services. It then analyses the types of issues they identify among the employees they have in charge. Finally, the article examines the actions that can be done by the services, and the limitations of these actions. The professionals appear to be negotiating with various strains.     

医学科研与医学科研伦理的辩证思考

医学科研中出现许多伦理问题。其必然性在于科学与伦理的不同：即属性不同、评价标准不同、变革速度不同。医学伦理可以告诉人们什么样的医学科研活动是善的,什么样的科研行为是应该做的。医学科研中要把握医学伦理观,体现医学科技观,富有医学创新观。     

从中西医结合角度探讨代谢综合征

代谢综合征的发生、发展、变化错综复杂,中医的病因病机学说有很多包括脾胃功能失常、肝失疏泄、痰浊瘀血阻滞等。由于老年人抗病能力和修复能力低下,往往同时合并多种其他病变。所以,在辨证研究上需要一个标准化的、符合实际情况的、临床可行的分型。由于目前的中医临床研究的深度和广度还不足以产生一个辨证分型的方案,所以可分期对待,在分期的基础上进一步辨证论治。治疗的重点在于纠正代谢紊乱,改善和延缓合并症的发生及发展。中医学整体调整的理念和中药中的多种成分的多重作用,有利于多因素多系统病变的防治。中药可通过不同途径和环节改善胰岛素敏感性,在防治代谢综合征方面可能有着广阔的前景。