生活方式医学的演进与启示

系统梳理了美国、澳大利亚、英国三个典型国家生活方式医学的发展历程,其大致分为: 萌芽期、成长期、发展期。美国生活方式医学发展历史周期长,组织健全,课程开设和考试认证较为成熟;澳大利亚在协会成立和各种政策制定方面还不完善;英国在临床实践方面尚存缺陷。我国生活方式医学起步晚、发展缓慢,但发展空间大。鉴于此,本研究从依托政府政策支持和专业协会发展、健全人才培养体系、利用“互联网+”优化培训效果、与社区服务有机结合、同中医协同发展等方面提出建议,以期为实现我国生活方式医学教育可持续发展提供依据。

     

安宁疗护分级诊疗模式的探讨

为充分利用医疗以及社会资源以适应当今日益增长的需求,对安宁疗护的分级诊疗模式的发展、实施及特点进行探讨。安宁疗护的分级诊疗实施场所包括三级综合性医院、二级医院、一级医院、社区以及居家。在具体实施中应注意加强各级机构间的联系转诊,建立健全高效的评估及转诊机制,并充分利用各机构安宁疗护的特点,整合资源并加强人员培训,以提供更优质的服务。安宁疗护分级诊疗模式的进一步发展完善,可以使终末期患者及其家属得到更高质量的照护,有助于提高患者及其家属的生活质量并减轻痛苦。

     

医联体中实施老年患者中期照护模式的实践探索

对中期照护的定义、市场需求和国内实施难度进行了介绍。介绍了苏北人民医院医联体内开展中期照护的相关背景、基础条件、评估指标、医保结算、绩效分配及专家补贴方式。对在医联体联合病房内开展中期照护前后的情况进行比较,如对是否进行中期照护的急性肩袖损伤老年患者术后康复效果进行比较,苏北医院平均住院日及患者非计划再入院率,患者和工作人员的满意度,数据都有明显优化。说明在医联体联合病房内开展中期照护模式较适合术后需要康复的老年患者,应提升卫生院工作质量,加快三级医院运营效率,促进分级诊疗进一步推进。     

《针灸治疗学》教材的改革应当紧跟临床需要——建立现代针灸学临床诊疗体系的思考

以“辨证治疗”为主体的针灸教材,与针灸临床实践需要相脱节。主要的针灸专业杂志的文献多数采用“辨病治疗”模式。脱离临床的针灸学课本知识制造了“学非所用,用非所学”的尴尬状态。虽然新版针灸教材仍然以“辨证诊疗”为主体,但和旧版教材比较仍然展现了针灸临床“辨病治疗”模式的发展趋势。为了适应针灸临床的实践需要,《针灸治疗学》教材应当进行更为务实的改革。建立现代针灸学临床诊疗体系既是适应环境变化的客观需要,也是针灸学术发展的内在要求。基于数据和事实,从学术发展的历史角度,论述了针灸临床的辨证施治模式向辨病治疗模式转化的客观趋势。     

Estimating the effect of gang membership on nonviolent and violent delinquency: a counterfactual analysis

This study reconsiders the well‐known link between gang membership and criminal involvement. Recently developed analytical techniques enabled the approximation of an experimental design to determine whether gang members, after being matched with similarly situated nongang members, exhibited greater involvement in nonviolent and violent delinquency. Findings indicated that while gang membership is a function of self‐selection, selection effects alone do not account for the greater involvement in delinquency exhibited by gang members. After propensity score matching was employed, gang members maintained a greater involvement in both nonviolent and violent delinquency when measured cross‐sectionally, but only violent delinquency when measured longitudinally. Additional analyses using inverse probability of treatment weights reaffirmed these conclusions. Aggr. Behav. 36:437–451, 2010. © 2010 Wiley‐Liss, Inc.     

CONTINGENCY MANAGEMENT PROMOTES SMOKING REDUCTIONS IN RESIDENTIAL SUBSTANCE ABUSE PATIENTS

Rates and consequences of cigarette smoking are more severe in substance abusers. In this 12‐week pilot study, residential substance abuse treatment patients received standard care for smoking cessation (n = 12) or prize contingency management (n = 12) for expired carbon monoxide (CO) tests ≤ 8 ppm and salivary cotinine < 10 ng/ml, which are indicative of smoking abstinence. Percentage of negative CO tests and the highest number of consecutive negative CO tests were greater in contingency management compared to standard care.     

Weighing the Evidence: Empirical Assessment and Ethical Implications of Conversion Therapy

The American Psychological Association's (APA's) as well as other professional organizations' (e.g., American Psychiatric Association) removal of homosexuality as a mental disorder represented a paradigmatic shift in thinking about exual orientation. Since then, APA (2000) American Psychiatric Association. 2000. Position statement on attempts to change sexual orientation (conversion and reparative therapies).. American Journal of Psychiatry, 157: 1719–1721. [PubMed], [Web of Science ®] , [Google Scholar] disseminated guidelines for working with lesbian, gay, and bisexual (LGB) clients, and a variety of scholars and researchers alike have advocated affirmative therapeutic interventions with LGB individuals. Despite these efforts, the controversy over treating individuals with LGB orientations using nonaffirmative techniques continues. In this discussion, the limited evidence regarding the efficacy and effects of conversion therapy is surveyed, particularly in the context of empirically supported treatment criteria summarized by Division 12 (clinical psychology) of the APA. Authors then consider the resulting ethical considerations in performing conversion therapy and propose alternative uses of affirmative therapy on the basis of ethical standards defined by APA. Finally, options for treating LGB individuals who are coming to terms with their sexual orientations are discussed.     

Putting the client in control: The perception of control in the behavioral treatment of anxiety

Traditional explanations of anxiety reduction through behavioral interventions such as extinction, habituation, reciprocal inhibition, and counterconditioning do not adequately account for all instances and aspects of anxiety reduction and clinical methods employed in contemporary behavior therapy. This article examines the role of an additional process — the alterations of perceptions of control — believed to be operative in anxiety reduction. We discuss three targets for establishing control in behavioral treatments of anxiety: (1) control over one's physiological responding while in an anxiety-producing situation, (2) control over the anxiety-producing stimulus or situation itself, and (3) control over the conduct of exposure. These three types of control perceptions are differentially important for different types of anxiety disorders. Implications for the conduct of behavioral treatments and possibilities for increasing client perceptions of control in anxiety treatment programs are outlined. We also recommend that client perceptions of control should be systematically assessed in order to relate them to treatment successes and failures.     

Future Directions in Mandated Standards for Domestic Violence Offenders

Summary

Over the past decade, states have been enacting domestic violence legislation, which often empowers judges to mandate batterers into intervention programs. To insure that these programs meet reasonable standards and that there is some homogeneity among programs, collateral laws mandating the development of batterer treatment standards are also common. The standards that have emerged have become a source of controversy. The current volume was developed in order to examine the issues and evidence, and to suggest some guidelines, if not for the standards themselves, then for the process that states might use in developing rational, useful standards, or in reevaluating and revising existing standards. To that end, this article offers a synthesis of the selections in this special volume and a suggested set of recommendations that committees might consider as they engage in the difficult processes of standard development or revision.     

Development of a Brief Motivational Enhancement Intervention for Intimate Partner Violence in Alcohol Treatment Settings

The current studies were a manual development study and a small pilot study of a 90-minute motivational enhancement style intervention to address intimate partner violence in alcohol-treatment-seeking men. Analyses of feedback provided during manual development suggest participants (a) liked the intervention, (b) reported behavior change intentions, and (c) found the feedback compelling. Findings from the pilot study suggest the intervention might be superior to referral only in increasing short-term help-seeking and lead to marginally significant enhancements in motivation and self-reported intimacy. Help-seeking and motivation findings were associated with medium-large to large effect sizes. At 3- and 6-month follow-up, both groups showed improvements in self-reported alcohol outcomes, anger, and verbal and physical aggression. These findings support further research on this intervention.