妊娠合并结核临床诊治的决策

妊娠合并结核是一种对母婴健康危害极大的妊娠期疾病。在妊娠期结核病中,多数患者无明显症状,早期症状与妊娠期某些生理反应相似,加之妊娠与结核病的相互影响,x线、CT等重要的影像学检查受限,致使本病易被误诊或误治。某些抗结核药物对母婴的不良影响,使其治疗难以实施,由于结核病本身及治疗后可能对胎儿的影响,在临床上是否终止妊娠往往难以决策。本文就妊娠合并结核诊治过程中的相关问题进行综述,以期为临床诊治决策提供帮助。     

Creative thought in Artists

One hundred and eleven subjects, 14 and 15 years of age, were administered the Coopersmith Self-Esteem Inventory and two questionnaires, modified from Bienvenu's Adolescent Communication Inventory, eliciting adolescents’ perceptions of their communication with both parents. The 10 males and 10 females with the highest self-esteem scores, and the 10 males and 10 females with the lowest scores were identified to form two groups: the High Self-Esteem Group and the Low Self-Esteem Group. Parents of these students completed questionnaires concerning parent-adolescent communication and marital communication and adjustment.

The five hypotheses tested were strongly supported. Adolescents with low self-esteem viewed communication with their parents as less facilitative than did adolescents with high self-esteem. Parents of adolescents with low self-esteem perceived their communication with their spouses as less facilitative, and rated their marriages as less satisfying, than did parents in the High Self-Esteem Group. There was lack of congruence between the perceptions of adolescents with low self-esteem and those of their parents; both mothers and fathers in the Low Self-Esteem Group viewed parent-adolescent communication as more facilitative than did the adolescents themselves.     

Principles of Occupational Therapy Group Outcome Assessment in Mental Health

In today's penurious health care climate, occupational therapists must scrutinize their practice and substantiate their interventions in order to remain viable service providers. This article proposes a method of occupational therapy outcomes assessment in mental health care that is rooted in client-centered functional outcomes. Since little consensus exists on which instruments are most effective, this article begins with an outline of broadly accepted principles for assessment of patient outcomes in mental health. Next, we describe a practical method for selecting outcomes measures in interdisciplinary settings. Finally, we offer pragmatic solutions to address barriers to outcome assessment.     

The secluded minds of violent patients

In this paper, I will present two violent patients suffering from severe Personality Disorders, illustrating the changes that can arise during the course of several years' psychoanalytic treatment in high security hospital. Progress was monitored using the Operationalised Psychodynamic Diagnostics (OPD) system. The clinical presentations will indicate how secluded these patients' minds are to themselves and to those involved in their care. The psychoanalytic treatment, as one part of the overall treatment, is described to show how the secluded parts of the patients'' minds can be approached, including references to the regular regressions that arise, provoked by ‘getting better’.     

Psychodynamic psychotherapy for children and adolescents: a critical review of the evidence base

For many years psychoanalytic and psychodynamic therapies have been considered to lack a credible evidence-base and have consistently failed to appear in lists of ‘empirically supported treatments’. This study systematically reviews the research evaluating the efficacy and effectiveness of psychodynamic psychotherapy for children and young people. The researchers identified 34 separate studies that met criteria for inclusion, including nine randomised controlled trials. While many of the studies reported are limited by sample size and lack of control groups, the review indicates that there is increasing evidence to suggest the effectiveness of psychoanalytic psychotherapy for children and adolescents. The article aims to provide as complete a picture as possible of the existing evidence base, thereby enabling more refined questions to be asked regarding the nature of the current evidence and gaps requiring further exploration.     

Condom Use and Contraception Non-Use Amongst 16-19 Year Olds: A Within Subjects Comparison

Abstract

The present study used a within subject design to examine which situation specific factors discriminated between the use of condoms and non-use of contraception in the context of preventing unwanted pregnancy. Adapting the methodology of Gold et al (1991, 1992), 215 16 to 19 year olds completed a questionnaire concerning the most recent time they had experienced sexual intercourse without using contraception (the “without contraception” encounter) and me most recent time they had experienced sexual intercourse using a condom (the “with a condom” encounter). The results showed that although past behaviour did not differentiate between the two encounters, situational factors relating to preparation for action, affect and interpersonal interaction were important. However, when analysed for men and women separately most of the differences were only found for women. In particular, the results suggest that women report non-contraception use as associated with feeling more guilty, having a partner who is less motivated to use contraception than they are, with neither themselves nor their partner raising the desire to use contraception, not expecting to have sex and not discussing contraception and not having contraception available. In contrast, for men, only the availability of contraception appeared to differentiate between the two encounters. The results are discussed in terms of the usefulness of the methodology and the associated shift in emphasis from users and non-users of contraception to use and non-use. The implications of the results in terms of health education interventions are also considered.     

Risk drinking and contraception effectiveness among college women

Risk drinking, especially binge drinking, and unprotected sex may co-occur in college women and increase the risks of STI exposure and pregnancy, but the relationships among these behaviors are incompletely understood. A survey was administered to 2012 women of ages 18–24 enrolled in a public urban university. One-quarter of the college women (23%) drank eight or more drinks per week on average, and 63% binged in the past 90 days, with 64% meeting criteria for risk drinking. Nearly all sexually active women used some form of contraception (94%), but 18% used their method ineffectively and were potentially at risk for pregnancy. Forty-four percent were potentially at risk for STIs due to ineffective or absent condom usage. Ineffective contraception odds were increased by the use of barrier methods of contraception, reliance on a partner's decision to use contraception, and risk drinking, but were decreased by the use of barrier with hormonal contraception, being White, and later age to initiate contraception. In contrast, ineffective condom use was increased by reliance on a partner's decision to use condoms, the use of condoms for STI prevention only, and by risk drinking. Thirteen percent of university women were risk drinkers and using ineffective contraception, and 31% were risk drinkers and failing to use condoms consistently. Risk drinking is related to ineffective contraception and condom use. Colleges should promote effective contraception and condom use for STI prevention and consider coordinating their programs to reduce drinking with programs for reproductive health. Emphasizing the use of condoms for both pregnancy prevention and STI prevention may maximize women's interest in using them.     

Predictors of willingness to register as an organ donor among dutch adolescents

Abstract

In order to identify relevant determinants of organ donor registration among Dutch adolescents, a school-based cross-sectional survey was conducted among 145 high school students. Fifty-one percent of respondents indicated they were willing to register as organ donors and 80% reported a positive general attitude towards registration. Various misconceptions about the registration and donation procedure were identified. On average only moderate knowledge levels related to organ donation were found. In order of strongest association, negative outcome expectancies, past behaviour and experience, positive outcome expectancies, and social outcome expectancies proved to be significant predictors of willingness to register as organ donors. Self-efficacy was indirectly associated with willingness via outcome expectancies. Knowledge about organ donation was not significantly associated with willingness. The results suggest that in order to persuade adolescents to register as organ donors, refutational messages will have to be developed to counterargue the prevailing negative outcome expectancies related to organ donation and registration as an organ donor.     

Affective and health-related outcome expectancies for physical activity in older adults

This study tests the effects of affective and health-related outcome expectancies on physical exercise, assuming stronger direct and indirect (via intention) effects from affective outcome expectancy to physical exercise than from health-related outcome expectancy to exercise. Physical exercise and social cognitive variables were assessed at baseline, and 6- and 12-month follow-up in 335 older adults (60–95 years of age). Applying structural equation modelling, there was a direct effect from affective, but not from health-related outcome expectancy on intentions and behaviour. Also, the indirect effect from self-efficacy on physical exercise via affective outcome expectancy was significant, whereas the mediation via health-related outcome expectancy was not. These findings emphasise the relative importance of affective versus health-related outcome expectancies in predicting intentions and physical exercise in older adults and highlight the importance to separate these facets at a conceptual level to enhance both theory development and health promotion.     

Neuropsychological Functioning in Children with Medium Chain Acyl Coenzyme A Dehydrogenase Deficiency (MCADD): The Impact of Early Diagnosis and Screening on Outcome

Children with medium chain acyl coenzyme A dehydrogenase deficiency (MCADD) have been reported to be at high risk for neurocognitive deficits. However this has not been systematically studied and little is known about the exact nature of neuropsychological sequelae or of the impact of early diagnosis and screening on outcome. We examined cognitive and adaptive outcome in children with MCADD (N?=?38, age range: 2 years, 2 months – 10 years, 3 months) diagnosed either through a newborn screening program (tandem mass spectrometry/MSMS) or upon clinical presentation. There was no evidence of overall intellectual impairment in either groups but there was some suggestion of poorer verbal and specific executive functioning (i.e., planning) abilities in the unscreened cohorts. Adaptive functioning was relatively intact with the exception of reduced Daily Living Skills in both our screened and unscreened groups. Early diagnosis and greater number of hospitalizations were related to higher verbal, communication, and socialization skills. Overall, our results highlight the importance of early diagnosis and management for children with MCADD.