骨科疾病诊治中的辩证观

骨科医生在复杂的临床工作中,需要掌握科学的方法论。特别是掌握科学的辩证思维方法,建立局部与整体的观念,善于抓住主要矛盾。培养起辩证逻辑思维的能力。有助于正确分析和理解骨科疾病的诊断和治疗中的各种复杂问题,提高认识水平和实践能力。     

个体心理模式对慢性疾病预后的探讨

21世纪,慢性疾病逐渐成为威胁人类健康的重要原因。然而其预后一直不理想,对慢性疾病患者的心理模式进行了分析,结合工作实际,提出慢性疾病患者如何看待疾病和自身———有意识的或无意识的———在很大程度上决定了疾病的预后。     

宗教心理-鬼神心理疾病—濒死体验的诊断与预后

濒死体验是科学现象而不是灵学现象,有初步问卷和最终量表可供筛查和诊断;是心理疾病而不是精神病。美国精神病学学会《精神疾病诊断与统计手册》标定为“宗教—鬼神问题”。除非获得适当的心理治疗与社会心理康复,患者预后不良。     

人际关系紧张的伦理因素与疾病相关性研究--心身疾病和神经症患者的社会伦理病因调查

伦理道德与健康疾病的相关性研究对预防疾病,增进健康,推动医学模式转变,促进和谐社会的建设有积极的意义.502个病例调查说明,伦理道德与疾病有密切相关性;不道德的因素是危害心身健康的主要伦理因素.     

Selective attention in early Dementia of Alzheimer Type

This study explored possible deficits in selective attention brought about by Dementia of Alzheimer Type (DAT). In three experiments, we tested patients with early DAT, healthy elderly, and young adults under low memory demands to assess perceptual filtering, conflict resolution, and set switching abilities. We found no evidence of impaired perceptual filtering nor evidence of impaired conflict resolution in early DAT. In contrast, early DAT patients did exhibit a global cost in set switching consistent with an inability to maintain the goals of the task (mental set). We discuss these findings in relation to the DAT literature on executive attention, dual-tasking, and working memory.     

Consenting to uncertainty: challenges for informed consent to disease screening—a case study

This paper uses chronic beryllium disease as a case study to explore some of the challenges for decision-making and some of the problems for obtaining meaningful informed consent when the interpretation of screening results is complicated by their probabilistic nature and is clouded by empirical uncertainty. Although avoidance of further beryllium exposure might seem prudent for any individual whose test results suggest heightened disease risk, we will argue that such a clinical precautionary approach is likely to be a mistake. Instead, advice on the interpretation of screening results must focus not on risk per se, but on avoidable risk, and must be carefully tailored to the individual. These points are of importance for individual decision-making, for informed consent, and for occupational health.

Diagnosis of Fabry Disease via Analysis of Family History

Fabry disease is an X-linked lysosomal storage condition caused by a deficiency of α-galactosidase A. In order to determine the average number of family members who are diagnosed with Fabry disease following the diagnosis of a proband, four lysosomal storage disease centers across the United States reviewed the completed pedigrees of their Fabry disease patients. In addition, data from three Fabry disease families from other centers were submitted by patients directly. The pedigree review found 74 probands (54 males and 20 females) who had 357 diagnosed family members, of which 223 were female (60.5%) and 146 were male (39.5%). Analysis found that, on average, there were five family members diagnosed with Fabry disease for every proband. Now that enzyme replacement therapy (ERT) is available for the treatment of Fabry disease, this finding emphasizes the need for all health care professionals to ensure a detailed pedigree has been constructed for each patient affected by Fabry disease and to encourage testing and evaluation of all at-risk family members.     

Reaction time and established risk factors for total and cardiovascular disease mortality: Comparison of effect estimates in the follow-up of a large, UK-wide, general-population based survey

Higher cognitive function is associated with faster choice reaction time (CRT), and both are associated with a reduced risk of mortality from all-causes and cardiovascular disease (CVD). However, comparison of the predictive capacity of CRT, an emerging risk factor, with that for established ‘classic’ risk factors for mortality, such as smoking, hypertension or obesity, is lacking. The purpose of this study was to compare the relative impact of CRT with a range of established risk factors for all-cause and CVD mortality. The UK Health and Lifestyle Survey (HALS) is a national sample survey of adults in England, Scotland, and Wales. In 1984/85, data on lifestyle factors, socioeconomic status, and health were collected for 9003 individuals. CRT data were available for 7414 individuals. With different predictor variables having differing coding structures, we used the relative index of inequality (RII) to explore the relation of a range of risk factors with mortality by computing the risk in disadvantaged (high risk; e.g., smokers) relative to advantaged (low risk; e.g., non-smokers) persons. During an average of 20 years of follow-up, there were 1289 deaths (568 ascribed to CVD). In age- and sex-adjusted models in which all-cause mortality was the outcome of interest, CRT mean (RII = 2.57, 95% CI = 1.98, 3.33) was the second most important predictor of death after smoking (RII = 3.03, 95% CI = 2.45, 3.75). For death from CVD, CRT mean (RII = 2.31, 95% CI = 1.55, 3.43) was again the second most important risk factor for death, behind systolic blood pressure (RII = 4.37, 95% CI = 3.03, 6.29). These analyses suggest that CRT, a moderately high correlate of intelligence, is an important risk factor for death from all-causes and CVD.     

Cognition and incident coronary heart disease in late midlife: The Whitehall II study

The purpose of this study was to investigate whether cognitive function in midlife predicts incident coronary heart disease (CHD), followed up over 6 years. Data on 5292 (28% women, mean age 55) individuals free from CHD at baseline were drawn from the British Whitehall II study. We used Cox regression to model the association between cognition and CHD in analyses adjusted for socio-demographic variables, cardiovascular risk factors and health behaviors. The results show a one standard deviation lower score on the “general” cognitive measure and measures of reasoning and vocabulary to be associated with elevated CHD risk. There was some evidence that these effects differed between high and low socioeconomic status (SES) groups with associations only seen in the low SES group. These results were not explained by threshold effects or by the different SES groups representing different parts of the cognitive test score distribution. Three other possible explanations of these results are discussed: sub clinical vascular disease drives the observed association but no effect is observed in the high SES group due to compensation provided by greater cognitive reserve, cognition is a marker of overall bodily integrity particularly in low-SES groups, and SES is a moderator of the association between cognition and CHD, because it marks a range of other risk factors.