非严重遗传病产前诊断及PGT的伦理思考

随着近年基因诊断技术的飞速发展,出现了要求通过产前诊断或胚胎植入前遗传学检测（preimplantation genetic testing,PGT）技术阻断某些非严重遗传病在家族中传递的新需求。从非严重遗传病定义,目前产前诊断及PGT技术发展现状、适应证及各自本身存在的伦理问题,遗传咨询原则等进行阐述,并以白化病和成人多囊肾为例,讨论遗传咨询医师应该如何根据国情、现行法律以及伦理原则对这类患者进行知情同意并实现医患共同决策。呼吁国家组织专家探讨共识,明确相关规定,遵循相关医学伦理学原则。     

适宜技术与诊疗最优化的可行性研究

在案例分析的基础上,作出了医生是临床诊疗中适宜技术的主要选择者的判断;论证了运用适宜技术实现诊疗最优化的可行性;认为适宜技术难以选择和实施的主要原因是利益关系、责任心不强和管理措施不到位;提出了必须着力培育适合于适宜技术生长的土壤的对策,即:实行政策引导与资金支持、进一步加大监管力度、营造良好的氛围、高度重视并加强医生道德素质的培养。     

医生健康素养认知调查及内涵探析

调查医生对健康素养概念及内涵、健康教育方式、存在问题等方面的认知情况。调查显示,一半以上的医生对健康素养了解程度一般,96.3%的医生认为病人的健康素养一般或差,96.7%的医生认为其有责任对病人进行健康教育,同时86.2%的医生认为医生健康素养与病人有区别。基于调查,提出医生健康素养应该具有双重属性,第一重属性为医生作为个体应该具备维持和促进自身健康的知识和能力;第二重属性为作为医生应该具备的本科室常见病相关健康教育知识、运用健康知识,针对病人健康问题进行有效沟通,提高病人健康素养水平的能力。

     

公立医院“医疗联合体”改革探析

公立医院“医疗联合体”改革模式为解决“看病难”问题提供了新思路, 其目的是促使优质医疗资源通过医疗联合体纵向下沉, 从而达到医疗资源最大化利用和居民就诊的合理分流。为了推进我国“医疗联合体”改革模式的发展, 首先分析了医疗联合体的作用和面临的障碍, 然后介绍我国上海、北京、湖北、重庆的“医疗联合体”改革实践模式, 在此基础上对我国“医疗联合体”改革发展提出相关建议, 期望对我国这种改革模式的实施推进提供一定的参考价值。     

Rejection sensitivity,complaint‐related communication,and relational satisfaction: A mediation analysis

This study examines the links among rejection sensitivity (RS), communication about complaints, and relational satisfaction in intimate relationships. A total of 260 individuals completed an online survey through Amazon Mechanical Turk. RS was positively associated with complaint avoidance and negatively associated with positive politeness and negative politeness when voicing complaints. Furthermore, RS had indirect associations with relational satisfaction, partially mediated through complaint avoidance and positive politeness. The results of this study suggest that communicating complaints openly to one's partner, in concert with positive politeness (i.e., affirming the partner while voicing complaints), may help serve as a buffer against relational dissatisfaction associated with RS.     

Social networks with two sets of actors

Traditional network research analyzes relational ties within a single group of actors: the models presented in this paper involve relational ties exist beteen two distinct sets of actors. Statistical models for traditional networks in which relations are measured within a group simplify when modeling unidirectional relations measured between groups. The traditional paradigm results in a one-mode socionatrix; the network paradigm considered in this paper results in a two-mode socionatrix; A statistical model is presented, illustrated on a sample data set, and compared to its traditional counterpart. Extensions are discussed, including those that model multivariate relations simultaneously, and those that allow for the inclustion of attributes of the individuals in the group.We thank the Editor and two anonymous reviewers for their helpful comments. We are also grateful to George Barnett for allowing us to analyze his data.     

Relational frame theory,acceptance and commitment therapy,and a functional analytic definition of mindfulness

The present article interprets mindfulness from the point of view of the effects of language and cognition on human action. Relational Frame Theory is described to show how human suffering is created by entanglement with the cognitive networks made possible by language. Mindfulness can be understood as a collection of related processes that function to undermine the dominance of verbal networks, especially involving temporal and evaluative relations. These processes include acceptance, defusion, contact with the present moment, and the transcendent sense of self. Each of these components of mindfulness are targeted in Acceptance and Commitment Therapy, and there is some evidence that they underlie the therapeutic changes induced by this approach. The relation between the present approach to mindfulness and other approaches is discussed.     

认知诊断缺失数据处理方法的比较：零替换、多重插补与极大似然估计法

数据缺失在测验中经常发生, 认知诊断评估也不例外, 数据缺失会导致诊断结果的偏差。首先, 通过模拟研究在多种实验条件下比较了常用的缺失数据处理方法。结果表明：(1)缺失数据导致估计精确性下降, 随着人数与题目数量减少、缺失率增大、题目质量降低, 所有方法的PCCR均下降, Bias绝对值和RMSE均上升。(2)估计题目参数时, EM法表现最好, 其次是MI, FIML和ZR法表现不稳定。(3)估计被试知识状态时, EM和FIML表现最好, MI和ZR表现不稳定。其次, 在PISA2015实证数据中进一步探索了不同方法的表现。综合模拟和实证研究结果, 推荐选用EM或FIML法进行缺失数据处理。     

A Longitudinal Study of Relational Aggression, Physical Aggression, and Children's Social–Psychological Adjustment

Although great strides have recently been made in our understanding of relational aggression and its consequences, one significant limitation has been the lack of prospective studies. The present research addressed this issue by identifying and assessing groups of relationally aggressive, physically aggressive, relationally plus physically aggressive (co-morbid), and nonaggressive children during their third grade year in elementary school and then reassessing them a year later, during fourth-grade (N = 224, 113 girls). Two aspects of social–psychological adjustment were assessed during both assessment periods including internalizing difficulties (i.e., withdrawal, depression/anxiety, and somatic complaints) and externalizing problems (i.e., aggressive behavior, delinquency). It was revealed that the strongest predictor of future social–psychological adjustment problems and increases in these problems from third to fourth was the combination of relational and physical aggression. Relational aggression also contributed unique information, relative to physical aggression, in the prediction of future maladjustment. Implications of these findings for future research and prevention efforts, particularly for aggressive girls, are discussed.