耐多药肺结核患者首次就诊过程调查

了解现阶段耐多药肺结核患者的首次就诊过程,分析医患双方对耐多药肺结核患者就诊过程的影响。在全国选取5个项目市,使用自制调查问卷采取面对面方式对样本人群进行访谈式调查。耐多药肺结核患者以文化水平较低、年龄偏大的农民为主。32.6%的患者初次就诊时有全身乏力或消瘦症状,37.6%的患者初次就诊单位为村卫生室或乡镇卫生院,28.4%的患者初次就诊时被误诊,31.6%的患者发生就诊延迟,79.8%的患者在结核病专科医院或防治机构确诊,33.3%的患者确诊延迟。加大对群众结核病相关知识宣传力度,加强结核病防治机构技术力量尤其是实验室诊断技术,加强对参与结核病防治工作医生尤其是村医的专业培训,针对医疗机构转诊建立适当的激励机制。     

Conditioned reinforcement value and resistance to change

Three experiments examined the effects of conditioned reinforcement value and primary reinforcement rate on resistance to change using a multiple schedule of observing-response procedures with pigeons. In the absence of observing responses in both components, unsignaled periods of variable-interval (VI) schedule food reinforcement alternated with extinction. Observing responses in both components intermittently produced 15 s of a stimulus associated with the VI schedule (i.e., S+). In the first experiment, a lower-valued conditioned reinforcer and a higher rate of primary reinforcement were arranged in one component by adding response-independent food deliveries uncorrelated with S+. In the second experiment, one component arranged a lower valued conditioned reinforcer but a higher rate of primary reinforcement by increasing the probability of VI schedule periods relative to extinction periods. In the third experiment, the two observing-response components provided similar rates of primary reinforcement but arranged different valued conditioned reinforcers. Across the three experiments, observing-response rates were typically higher in the component associated with the higher valued conditioned reinforcer. Resistance to change was not affected by conditioned reinforcement value, but was an orderly function of the rate of primary reinforcement obtained in the two components. One interpretation of these results is that S+ value does not affect response strength and that S+ deliveries increase response rates through a mechanism other than reinforcement. Alternatively, because resistance to change depends on the discriminative stimulus-reinforcer relation, the failure of S+ value to impact resistance to change could have resulted from a lack of transfer of S+ value to the broader discriminative context.     

结核患者服药依从性的研究现状

结核病控制是全球卫生工作的一个重点,服药依从性则是其中关键的一环。本文对结核患者服药依从性的重要性、影响因素及提高依从性的措施进行综述,认为实施直接督导短程化疗（DOTS）、强化督导、改善患者对服药依从性的认识、简化给药方案、减轻患者经济负担、设置患者提醒物等可提高服药依从性。     

从生态自然观看细菌的耐药

伴随抗菌药物强大的抗感染疗效的同时,细菌等病原体对抗菌药物的耐药性问题日渐显露出来。运用生态自然观辨证地对细菌进行剖析,旨在突破传统思维认识细菌耐药性产生本质,从而更加有效,更加科学地控制细菌耐药的发生。     

差异蛋白质组学研究与应用进展

差异蛋白质组学是蛋白质组学的一种重要研究策略,着重于比较不同生物体在不同时刻或状态下蛋白质表达的变化,在目前技术背景下有重要的现实意义.将近年来新发展的差异蛋白组学技术,如激光捕获微切割、蛋白芯片及蛋白质定量研究方面等的技术和差异蛋白组学应用进展进行总结.     

结核病直接督导短程化疗策略的伦理学视角

从伦理学角度探讨了结核病直接监督下短程化疗(DOTS)策略以及DOTS策略实施过程中若干问题。DOTS策略被认为是当今结核病诊治和管理的最有效方法,体现了医学伦理学的公益论;尊重病人的选择及隐私是有效控制结核的重要内容,标准化疗方案和个体化疗方案应视病情而定;医务人员应有良好的综合素质。     

Stimuli, Reinforcers, and the Persistence of Behavior

This article reviews evidence from basic and translational research with pigeons and humans suggesting that the persistence of operant behavior depends on the contingency between stimuli and reinforcers, and considers some implications for clinical interventions.     

特殊人群结核病的流行病学调查

为了了解某监狱犯人中结核病的患病及结核菌耐药情况,为防治提供依据,采用痰检和结核菌素试验的方式对研究对象进行普查,结核分枝杆菌采用罗氏培养,药敏试验采用比例法。结果显示,PPD试验总阳性率为60．54％。痰检发现24例患者,涂阳患病率为898．54／10万。培养菌株总耐药率为95．83％,其中初治耐药率、复治耐药率和多重耐药率分别为87．5％,100％和73．91％。提示该特殊人群结核病患病率高于一般人群。     

心理性胰岛素抵抗及应对策略

糖尿病易导致严重的慢性并发症,已成为影响人们生活质量的一种常见疾病。早期应用胰岛素是使2型糖尿病患者血糖得到良好控制、减少并发症发生的有效手段。但许多患者不愿接受或延迟胰岛素治疗。本文旨在探讨胰岛素应用过程中患者及医护人员存在的心理障碍,即心理性胰岛素抵抗,并进一步阐述其应对策略。     

Child versus adult psychoanalysis: Two processes or one?

Child analysis continues to be seen as a different technique from adult analysis because children are still involved in a developmental process and because the primary objects continue to play active roles in their lives. This paper argues that this is a false dichotomy. An extended vignette of the analysis of a latency‐aged girl is used to demonstrate that the psychoanalytic process that develops in child analysis is structurally the same as that in adult analysis. Both revolve around the analysis of resistance and transference and use both to promote knowledge of the patient’s mind at work. And both techniques formulate interventions based on the analyst’s appraisal of the patient’s mental organization. It is hoped that stressing the essential commonality of both techniques will promote the development of an overarching theory of psychoanalytic technique.