Randomized Controlled Trial of Cognitive–Behavioral Group Therapy for Irritable Bowel Syndrome in a Medical Setting

Standard medical treatments have not been effective for irritable bowel syndrome (IBS) patients. Though individualized cognitive–behavior therapy is an empirically supported treatment option, cognitive–behavioral group therapy (CBGT) has yet to be established as an effective alternative in a randomized controlled trial. This study compared the efficacy of a 10-session CBGT with a home-based symptom monitoring with weekly telephone contact (SMTC) treatment for IBS, extending previous quasi-experimental research in this area. Twenty-eight refractory IBS patients, evaluated and referred by gastroenterologists using the Rome criteria, participated in the study. IBS symptoms, psychological functioning, and health-related quality of life were assessed pre- and posttreatment, and at 3-month follow-up. CBGT patients reported significantly more gastrointestinal (GI) symptom improvement than SMTC patients on posttreatment global measures and had significantly reduced daily diary pain scores at 3-month follow-up. Based on MANOVA, there was significant improvement in psychological distress and health-related quality of life for the CBGT patients in comparison to the SMTC patients. These improvements were also maintained at the 3-month follow-up. Reductions in GI symptoms, psychological distress, and improved health related quality of life may contribute to less behavioral avoidance, disability, and health care utilization in refractory IBS patients.     

市场经济、道德权利与产权伦理

产权伦理是现代市场经济的一个根本性的精神基础,是建立有效的产权制度及其运行机制的重要条件;同时,它是人类道德体系的核心价值理念之一,是基于权利,义务与道德的内在逻辑构建起来的。产权伦理的研究具有重要的理论价值和现实意义,可以构成一门具有特殊的学科特质,研究方法和理论内容的伦理学学科。     

Neuropsychological Performance in Gulf War Era Veterans: Traumatic Stress Symptomatology and Exposure to Chemical–Biological Warfare Agents

Because complaints of diminished concentration and memory are among the most common health symptoms reported by Gulf War (GW) veterans with unexplained illnesses, this study investigated neuropsychological functions among GW veterans and controls. Relationships between neuropsychological performance, severity of posttraumatic stress disorder (PTSD) symptomatology, and exposure to chemical–biological warfare agents (CBW) were assessed. Participants were 225 veterans recruited from three cohorts: GW-deployed veterans from Ft. Devens, MA ( n = 141) and New Orleans, LA (n = 37), and Germany-deployed veterans from a Maine National Guard unit (n = 47). A comprehensive evaluation was completed. Severity of subclinical PTSD symptomatology was significantly related to scores on specific neuropsychological tests. PTSD symptom severity in GW-deployed veterans was found to be greater and associated with a broader range of neuropsychological deficits than in Germany-deployed veterans. PTSD severity was associated with lower performance on a range of neuropsychological tasks, whereas CBW exposure contributed to performance deficits on specific cognitive tasks.     

Cognitive Functioning in Treatment-Seeking Gulf War Veterans: Pyridostigmine Bromide Use and PTSD

Gulf War (GW) deployed veterans have reported health symptoms since returning from the war that suggest dysfunction of the central nervous system (CNS). These symptoms include memory and concentration difficulties, fatigue, and headaches. Leading hypotheses for the etiology of these cognitive complaints include psychological factors and/or exposures to chemicals with neurotoxic properties. In this study, cognitive functioning was compared in treatment-seeking GW-deployed veterans and a treatment-seeking non–GW-deployed veteran control group. Results indicated that GW-deployed veterans performed significantly worse than the comparison group on tests of attention, visuospatial skills, visual memory, and mood. GW-deployed veterans who reported taking pyridostigmine bromide (PB) performed worse than GW-deployed veterans without PB use on executive system tasks. Treatment-seeking GW-deployed veterans with diagnoses of posttraumatic stress disorder (PTSD) did not differ on cognitive test measures compared with GW-deployed veterans without PTSD. No interaction effect of PTSD and PB use was found.     

卫生行政强制与相对人自主权行使的道德缓冲

从卫生行政强制保护公共卫生利益与相对人自主权行使存在的矛盾出发,讨论建立道德缓冲机制解决两者间矛盾的必要性、可能性。阐述卫生行政执法者通过职业道德建设与人文精神关怀,以缓冲执法违法;相对人以道德约束缓冲自主权滥用。     

The Irony of Social Trust: Individual‐level and Contextual‐level Links with Protest Intention and Radical Right Support in Switzerland

This research examines how social trust translates into dynamics of mobilisation for inclusion or exclusion in Swiss cantons by studying how social trust is linked to equality‐directed protest intention versus radical right support, comparing individual‐level and contextual‐level relationships. The study is based on data from the Swiss Household Panel collected between 2002 and 2008. The impact of individual‐level and contextual‐level social trust is analysed in three‐level regression models of repeated observations, nested in individuals who are nested in cantons. The results indicate complex patterns that depend on the level at which social trust is assessed and confirm the need for a contextualised view of social trust and social capital. For individuals, higher social trust is associated with higher protest intention and lower radical right support. However, in cantons characterised by higher rates of social trust, individuals are less likely to engage in protest actions and more likely to support the radical right. Further analyses show that canton‐level social trust is intertwined with other contextual factors, suggesting that in certain configurations, that is, combined with low levels of cultural and social diversity, climates of social trust may be linked to more restricted forms of solidarity and the persistence of inequality. Copyright © 2015 John Wiley & Sons, Ltd.     

Self-regulation evaluation of therapeutic yoga and walking for patients with irritable bowel syndrome: a pilot study

With limited efficacy of medications for symptom relief, non-medication treatments may play an important role in the treatment of irritable bowel syndrome (IBS), the most common functional gastrointestinal (GI) disorder. This study aimed to evaluate the efficacy of two self-regulation strategies for symptom relief and mood management in IBS patients. Thirty-five adult participants meeting ROME III criteria for IBS were enrolled, 27 of the 35 participants (77%) completed treatment and pre- and post-treatment visits (89% women, 11% men; M (SD) age = 36 (13)), and 20 of the 27 (74%) completed a 6-month follow-up. Participants were randomly assigned to 16 biweekly group sessions of Iyengar yoga or a walking program. Results indicated a significant group by time interaction on negative affect with the walking treatment showing improvement from pre- to post-treatment when compared to yoga (p < .05). There was no significant group by time effect on IBS severity. Exploratory analyses of secondary outcomes examined change separately for each treatment condition. From pre- to post-treatment, yoga showed significant decreases in IBS severity measures (p < .05), visceral sensitivity (p < .05), and severity of somatic symptoms (p < .05). Walking showed significant decreases in overall GI symptoms (p < .05), negative affect (p < .05), and state anxiety (p < .05). At 6-month follow-up, overall GI symptoms for walking continued to significantly decline, while for yoga, GI symptoms rebounded toward baseline levels (p < .05). When asked about self-regulated home practice at 6 months, significantly more participants in walking than in yoga practiced at least weekly (p < .05). In sum, results suggest that yoga and walking as movement-based self-regulatory behavioral treatments have some differential effects but are both beneficial for IBS patients, though maintenance of a self-regulated walking program may be more feasible and therefore more effective long term.     

The Curious Case of the De-ICD: Negotiating the Dynamics of Autonomy and Paternalism in Complex Clinical Relationships

This article discusses the response of our ethics consultation service to an exceptional request by a patient to have his implantable cardioverter defibrillator (ICD) removed. Despite assurances that the device had saved his life on at least two occasions, and cautions that without it he would almost certainly suffer a potentially lethal cardiac event within 2 years, the patient would not be swayed. Although the patient was judged to be competent, our protracted consultation process lasted more than 8 months as we consulted, argued with, and otherwise cajoled him to change his mind, all to no avail. Justifying our at times aggressive paternalistic intervention helped us to reflect on the nature of autonomy and the dynamics of the legal, moral, and personal relationships in the clinical decision-making process.