ICU向患者家属开放的理论研究

ICU实行的基本是封闭式管理,这不仅带来了一些伦理问题,也容易引发医疗纠纷,从伦理学的需要、预防医疗纠纷、改善医患关系等方面探讨ICU向患者家属开放的必要性,分析开放存在的问题,论证了ICU向患者家属开放的可行性。     

韵律在语言加工中的作用及其神经机制

综述了近年来使用即时加工方法进行的韵律理解和作用机制方面的一些研究。首先, 介绍了韵律特征在句法加工中的作用, 从重音、韵律边界和韵律单元三个研究角度分析了韵律在句子理解中所起的作用及作用的时间点; 然后, 探讨了韵律加工的脑机制问题。论文最后提出未来的研究应在更广阔的视野中对韵律的加工阶段以及韵律与其他心理过程之间的关系进行探讨。     

Co‐development of child‐mother gestures over the second and the third years

This study looks at whether there is a relationship between mother and infant gesture production. Specifically, it addresses the extent of articulation in the maternal gesture repertoire and how closely it supports the infant production of gestures. Eight Spanish mothers and their 1‐ and 2‐year‐old babies were studied during 1 year of observations. Maternal and child verbal production, gestures and actions were recorded at their homes on five occasions while performing daily routines. Results indicated that mother and child deictic gestures (pointing and instrumental) and representational gestures (symbolic and social) were very similar at each age group and did not decline across groups. Overall, deictic gestures were more frequent than representational gestures. Maternal adaptation to developmental changes is specific for gesturing but not for acting. Maternal and child speech were related positively to mother and child pointing and representational gestures, and negatively to mother and child instrumental gestures. Mother and child instrumental gestures were positively related to action production, after maternal and child speech was partialled out. Thus, language plays an important role for dyadic communicative activities (gesture–gesture relations) but not for dyadic motor activities (gesture–action relations). Finally, a comparison of the growth curves across sessions showed a closer correspondence for mother–child deictic gestures than for representational gestures. Overall, the results point to the existence of an articulated maternal gesture input that closely supports the child gesture production. Copyright © 2006 John Wiley & Sons, Ltd.     

新生儿重症监护室中放弃治疗的伦理问题

对于新生儿重症监护室中的一部分危重新生儿,虽然可以借助高新尖的医疗技术挽留他们的性命,但却不能避免其出现影响远期生存质量的后遗症。因此患儿家属和医务人员陷入了是否对这些危重新生儿实施放弃治疗的两难困境。对NICU中放弃治疗的对象、伦理学依据、伦理学意义以及如何实施放弃治疗的问题加以讨论,为NICU医务人员提供有益参考。     

Spontaneous emotional coordination of first-born dizygotic twins and singletons with their mothers in early infancy

We compare matching of facial expressions of emotion, completion of the positive valence of emotional expression, attunement of emotional intensity, and non-matching of emotion, in engagements with their mothers of firstborn dizygotic twins and of singletons. Nine twins and nine singletons were video-recorded at home in spontaneous face-to-face interactions from the second to the sixth month after birth. Microanalysis of infant and maternal facial expressions of emotion revealed qualitative and quantitative differences that indicate that engagements with twins had more frequent and more accurate emotional matching and attunements compared to those with singletons. Singletons displayed more emotional completion and non-matching reactions. Expressions of matching for pleasure and interest followed different developmental patterns in the two kinds of dyads. These results are discussed in relation to the theory of innate affective intersubjectivity. Differences may shed light on the relationship between sharing early life with a twin, and development of self-other awareness.     

Maternal depression and infant attachment security: A meta-analysis

The purpose of this study is to clarify the magnitude of the association between maternal depression and infant attachment nonsecurity, and to identify possible moderators of this relationship. An extensive literature search was conducted using multiple databases of both published and unpublished studies. A meta-analysis was conducted to determine the relationship between maternal depression and infant attachment security and to establish the effect size. The main findings from this meta-analysis, which included 42 studies, indicate that there is a small, yet significant, relationship between maternal depression and infant attachment nonsecurity. The rate of nonsecurity in infants of mothers with depression was approximately 20% higher than expected rates in a nonclinical population, and the association between depressive symptoms and nonsecurity was small, but significant. Infants of mothers with depression were nearly twice as likely to have a nonsecure attachment than were infants of healthy mothers. Depression measure and maternal sample source were identified as significant moderators of the odds ratio effect size. Results of this study demonstrate that there is a significant relationship between maternal depression and infant attachment nonsecurity, and suggest that interventions that focus on both maternal mental health and the attachment relationship are warranted.     

Maternal experience of their infants’ crying in the context of war trauma: Determinants and consequences

We examined, first, how prenatal maternal mental health and war trauma predicted mothers’ experience of their infant crying, indicated by emotions, cognitions, and behavior; and second, how these experiences influenced the mother–infant interaction and infant development. Participants were 511 Palestinian mothers from the Gaza Strip, reporting their war trauma, symptoms of posttraumatic stress disorder (PTSD), depression, and perceived stress during pregnancy (Time 1). They reported experiences of infant crying at 4 months (Time 2), and the mother–infant interaction and infant sensorimotor and language development at 12 months of infants’ age (Time 3). Results revealed that maternal mental health problems, but not war trauma, were important to experiences of infant crying. A high level of PTSD symptoms predicted negative emotions evoked by infant crying, and high depressive symptoms predicted low active and positive responses to crying. Unexpectedly, high prenatal perceived stress predicted high active and positive responsiveness. Concerning the consequences, mothers’ sensitive interpretation of infant crying predicted optimal infant sensorimotor development, and mothers’ active and positive responses predicted high emotional availability in mother–infant interaction. Crying is the first communication tool for infants, and mothers’ sensitive responses to crying contribute to infant well-being. Therefore, reinforcing mother's optimal responses is important when helping war-affected dyads.     

镇静与镇痛在ICU机械通气患者中的应用变化

探讨ICU内机械通气患者应用镇痛剂、镇静剂及肌松剂的情况及其对机械通气和预后的影响。回顾性分析我院中心ICU2006年、2007年收治的244例行有创机械通气治疗超过48h患者的临床资料,并将患者分为2006年组和2007年纽,用统计软件分析患者在年龄、性别、入ICU时APACHEⅡ评分、血糖、血浆白蛋白、基础疾病,气管插管时间、机械通气时间、ICU住院天数、镇痛与镇静剂应用的时间、机械通气时是否使用肌松剂、Ramsay评分及病死率方面是否存在差别。统计分析显示2006年组和2007年组在年龄、性剐、入ICU时APACHEⅡ评分、血糖、血浆白蛋白、是否使用肌松剂及基础疾病方面无差别;与2006年组相比2007年组患者气管插管时间、机械通气时间及ICU住院天数均缩短,镇痛与镇静剂应用时间均缩短,Ramsay评分降低,病死率下降。提示对机械通气的危重症患者应合理使用镇痛剂与镇静剂。     

Group-based reasons for action

This article endorses a familiar, albeit controversial, argument for the existence of group-based reasons for action, but then rejects two doctrines which other advocates of such reasons usually accept. One such doctrine is the willingness requirement, which says that a group-based reason exists only if (sufficient) other members of the group in question are willing to cooperate. Thus the paper argues that there is sometimes a reason, which derives from the rationality of some group action, to play one's part unilaterally in that group action. This seems implausible only because we tend wrongly to accept a second doctrine, monism about the unit of agency. Monism claims that, for any given deliberative problem, there is only one unit of agency to which reasons attach. If we are monists who believe in group-based reasons, the willingness requirement will seem necessary in order to avoid recklessness. We should reject monism, and if we do so we can recognise genuine conflict between individual-based and group-based reasons, and in doing so we can explain, without endorsing the willingness requirement, why we should not act recklessly.