Change in subjective social status following HIV diagnosis and associated effects on mental and physical health among HIV-positive gay men in Australia

Objective: This study investigates the impact of HIV diagnosis on subjective social status and if changes are linked to health outcomes.

Design: Two measures of subjective social status, socio-economic and standing in the community were examined in 342 Australian HIV-positive gay men in 2014. Participants recalled ratings at diagnosis were compared with current ratings.

Main outcome measures: Self-reported mental (psychological distress, self-esteem, positive mental health and satisfaction with life) and physical health (self-rated health, CD4 count, viral load).

Results: Half of the participants reported improvements in subjective socio-economic status (59%) or standing in the community (52%) since diagnosis, yet one quarter reported socio-economic status (25%) or standing in the community had decreased (23%). Increases in either measure of subjective social status were linked to higher self-esteem, positive mental health, satisfaction with life and better self-rated health. Decreases in subjective social status, however, were strongly linked to poorer outcomes on all mental health measures. Decreases in standing in the community were also associated with poorer physical self-rated health.

Conclusion: Most participants reported their subjective social status were the same or better since diagnosis. Changes in subjective social status following diagnosis were strongly linked to mental health outcomes. Those who reported a decrease in subjective social status were particularly vulnerable to mental health problems.     

Reminiscence functions over time: consistency of self functions and variation of prosocial functions

The current study examines the temporal stability of the tripartite model of reminiscence functions in which eight separate reminiscence functions map onto three second-order factors which contribute significantly to measurement of an overarching reminiscence latent construct. We collected online responses from 411 adults 50+ years of age. Confirmatory factor analytic models were computed at three points of data collection over 16 months. Invariance analyses were next undertaken to simultaneously compare the measurement properties to assess within-person stability of reminiscence functions over time. The tripartite structure of reminiscence functions was replicated at each point of data collection. As hypothesised, self-positive and self-negative functions are consistent across points of data collection, whereas prosocial functions vary over time. The temporal stability of the self functions may be attributed to enduring characteristics of the individual such as personality traits and life attitudes, as well as their solitary nature. Previous research indicates that consistency of self-positive reminiscence functions has ensuing benefits for physical health and psychological well-being; the opposite is true for self-negative functions. The temporal variation of prosocial functions may be due to the varying availability of others to share memories and their responsiveness to the emotional context.     

Prospective effects of social support on internalized homonegativity and sexual identity concealment among middle-aged and older gay men: a longitudinal cohort study

Background and objectives: Middle-aged and older gay men experience higher rates of depression and anxiety compared to their heterosexual counterparts, with internalized homonegativity and sexual identity concealment known to be major stress-related contributors. This study examined the prospective effect of different types and sources of social support on internalized homonegativity and sexual identity concealment experienced among middle-aged and older gay men.

Methods: A longitudinal survey involving two waves of data collection separated by 12 months was conducted among a cohort of 186 gay-identified men aged 40 years and older.

Results: Two types of social support were found to be important. Greater baseline tangible or practical support independently predicted lower internalized homonegativity at 12-month follow-up, while greater baseline emotional or psychological support independently predicted a lower tendency toward sexual identity concealment at 12-month follow-up. Greater baseline support from community or government agencies, such as health services and support organizations, predicted higher internalized homonegativity at 12-month follow-up.

Conclusions: These findings suggest that tangible and emotional support may be beneficial in reducing internalized homonegativity and sexual identity concealment among middle-aged and older gay men. Ensuring that services provide environments that do not compound the stressful impact of stigma also appears to be important.     

Cognitive Behavior Therapy for Older Adults: Practical Guidelines for Adapting Therapy Structure

Cognitive behavioral therapy (CBT) has been shown to be an effective approach for a wide range of problems affecting older adults. While a variety of empirical and clinical papers have examined modifications to the content and delivery of CBT to enhance its efficacy with older adults, changes to the structure of therapy with this population have not been as widely discussed. Issues around optimizing the structure of CBT with older adults are presented, along with suggestions for realizing these changes within a clinical context.     

经脐单孔免气腹腹腔镜阑尾切除术

总结经脐单孔免气腹腹腔镜行阑尾切除术的优势。对40例阑尾炎患者行经脐单孔免气腹腹腔镜阑尾切除术。结果手术均获成功,无中转开腹,所有手术患者均痊愈出院,无手术并发症及死亡。经脐单孔免气腹腹腔镜阑尾切除术能扩大腹腔镜阑尾切除术适应证,增加了手术的安全性。而且其良好的美容效果是传统腔镜手术不具备的。     

日益孤独的中国老年人：一项横断历史研究

随着社会的巨大变迁, 我国老年人孤独感水平可能逐年增高。通过采用横断历史研究的方法, 对使用UCLA孤独量表(第三版)调查老年人孤独感的25篇文献进行元分析, 调查年代跨度为1995年至2011年, 共涉及13280名老年人。研究结果表明：(1)我国老年人孤独感水平随年代的变迁呈上升趋势; (2)不同婚姻状况、不同性别老年人的孤独感水平随年代均呈上升趋势; (3)老年人孤独感水平存在婚姻状况差异, 但不存在性别差异。     

前额叶在老年阶段的可塑性及相关机制

大量研究表明, 前额叶的结构和功能更容易受年老化影响; 然而, 近年来的研究发现, 前额叶的结构和功能在老年阶段具有一定的可塑性。对老年人进行认知训练, 能够延缓前额叶皮层厚度的萎缩, 提高白质完整性, 改善神经网络的功能连接和分化, 并可能通过调节多巴胺系统的活动改变前额叶皮质和皮质下结构的功能激活模式。有氧锻炼能够改善心脑血管功能, 保护和促进神经元的存活和生长, 引起前额叶灰质、白质体积的增加及功能激活的变化。认知训练与有氧锻炼等相结合的整合性训练不仅引起前额叶及相关认知功能的改变, 而且具有更好的生态学效度, 使老年人日常认知能力和生活质量得到提高。未来研究应采用多种技术手段, 从多个层面理解老年阶段前额叶的可塑性及相关机制; 加强对与前额叶关系密切的多种认知功能可塑性神经机制的研究; 并重视与整合性训练有关的前额叶可塑性。     

Ⅰ期颈椎前后路联合手术治疗嵌夹脊髓型颈椎病

为了探讨前后路联合手术治疗嵌夹脊髓型颈椎病的疗效,对50例患者行Ⅰ期颈后路单开门-前路减压内固定术。术后随访脊髓功能改善情况,植骨融合率及并发症。结果显示,50例患者经平均6．5月随访,内固定均获牢固融合,脊髓功能明显改善,无明显并发症。提示Ⅰ期颈椎前后路联合手术是治疗嵌夹脊髓型颈椎病的较理想方案。     

Computerised cognitive‐behaviour therapy (cCBT) and older people: A pilot study to determine factors that influence willingness to engage with cCBT

Objective: The aim of this study was to explore whether older people with depression and/or anxiety were potentially willing to engage with computerised cognitive‐behaviour therapy (cCBT). Method: A short questionnaire was sent to 60 service users aged 65+ who were identified as having anxiety and/or depression. Results: There was a 63.3% response rate for the questionnaire. Almost half of the respondents said they would be interested in using cCBT, and would be willing to learn the necessary computer skills. Conclusions: This pilot study suggests that older people with anxiety and/or depression may be willing to engage with cCBT. However, a number of important factors are highlighted that would need to be considered in deciding whether to develop access to cCBT for older people.     

Understanding Pamina's recovery: An application of the hermeneutic single‐case efficacy design

This article reports an effectiveness case study of the individual systemic therapy of a 22‐year‐old Portuguese woman with a diagnosis of paranoid personality disorder, conducted in a university‐based clinic in Lisbon, Portugal. Data were analysed using the hermeneutic single‐case efficacy design, a non‐experimental interpretive approach that aims to determine whether change occurred, whether change was due to therapeutic strategies, and what in therapy caused the change. Results indicate that the treatment was effective and that de‐pathologising Pamina's condition and genogram‐based exploration techniques played a crucial role in her recovery.