个人化设计在临床研究中的应用——从个体角度研究个体差异

本文从有关研究证据的基础上,介绍了个人化设计的理论基础和实验设计,并在此基础上讨论了个人化设计在临床研究领域中的应用价值,总结出一种适合临床病人使用的研究程序。个人化设计允许对个体的个人价值进行分析,并能同时研究不同刺激信息的作用,在个体水平上分析个体差异。通过简化了的实验程序,个人化设计为解决临床研究中的问题提供了一种新的思维方式。文中还对相关研究法的局限进行了讨论。     

The design and use of the Bioethics Consultation Form

The emergence of the ethics consultation as a means to resolve moral crises in clinical medicine has revealed the need for a worksheet that would facilitate intake and analysis. The author developed the Bioethics Consultation Form as an attempt to remedy this need. The form is arranged in an outline format and is a useful asset to ethics committee discussions and record keeping. The first section covers basic intake data concerning the patient's medical and personal information, advance directives, and values, as well as the values of the physician and family. After the intake section is completed with the above data, the ethics consultant then turns to the analysis section. This second section allows for (1) the discussion of conflicting values, (2) the identification of priorities, and (3) the elucidation of ethical norms relevant to the case.The Bioethics Consultation Form was adopted by the Patient Care Advisory committee of the Franklin Square Hospital Center in Baltimore, Maryland in 1986. The methodology in the use of the form will be discussed. Further, the potential spectrum of consultative cases that can be analyzed using the form will be highlighted.     

Making peace in gestational conflicts

Mary Anne Warren's claim that there is room for only one person with full and equal rights inside a single human skin ([1], p. 63) calls attention to the vast range of moral conflict engendered by assigning full basic moral rights to fetuses. Thereby, it serves as a goad to thinking about conflicts between pregnant women and their fetuses in a way that emphasizes relationships rather than rights. I sketch out what a care orientation might suggest about resolving gestational conflicts. I also argue that the care orientation, with its commitment to the significance of the partial and the particular, cannot be absorbed within standard, impartialist moral theory.     

Voting at 16? 16–17-Year-Old Germans Vote as Correctly as Adults

Lowering the voting age from 18 to 16 years has recently been a hot topic of the political debate in many democratic countries. This study investigated whether the voting quality of 16–17-year-olds is inferior to that of the voting population. Shortly before the 2021 German federal election, two samples, representative for age and gender, indicated personal preferences about various political issues and weighted them according to importance, allowing for the calculation of individual expected values for political parties. Participants then indicated their voting choice. These choices were normatively correct when individuals voted for the party that best reflected their preferences, that is, the one maximizing the expected value. Results show that the voting decisions of 16–17-year-olds were as good as those by eligible voters. The study indicates that the exclusion of 16–17-year-old Germans in democratic elections cannot be justified by their lack of decision-making ability.     

Développement initial et processus de validation de l’échelle d’auto-efficacité émotionnelle au travail

The study aims to develop and present the validation process of a questionnaire on emotional self-efficacy in the work context from the six steps proposed by Dussault et al. (2007). The study is based on the theories of emotional intelligence of Mayer and Salovey (1997), Petrides and Furham (2001) and the self-efficacy of Bandura (1997). Following an expert analysis and a pre-test, the Emotional Self-Efficacy at Work scale is composed of 41 items. The participants are 985 Canadian workers. The results of confirmatory factor analyzes support the seven-dimensional structure, namely the self-efficiency to perceive one's emotions and those of others at work, the self-efficiency to use emotions at work, the self-efficiency to understand one's emotions and those of others at work and finally, the self-efficiency to manage one's emotions and those of others at work. The results also indicate that the seven dimensions have satisfactory internal coherence indices. The results suggest that this questionnaire is well suited to describe emotional self-efficacy at work. The use of the questionnaire will be discussed.     

Treating Young Adult Depression With Text-Delivered Cognitive Behavioral Therapy: A Pilot Randomized Clinical Trial

Young adults (ages 18 to 25) in the U.S. suffer from the highest rates of past-year major depressive episode and are the least likely to receive treatment compared to other age groups. As such, we examined the feasibility, acceptability, and efficacy of a text-message delivered cognitive behavioral therapy: CBT-txt with young adults. The study was a 2-month pilot RCT to test a 4-week intervention for depression that contained 197 text messages (average 12 texts every other day). The sample, recruited via Facebook and Instagram, was 102 U.S. young adults who presented with at least moderate depressive symptomatology. Assessments occurred at baseline prior to randomization and at 1 and 2 months post enrollment. The primary outcome, severity of depressive symptoms, was assessed using the Beck Depression Inventory II. Feasibility benchmarks were met and participants reported high levels of engagement with and acceptability of the intervention. Logistic regression indicated that treatment participants were three times as likely to have minimal or mild depression symptoms at 2 months compared to waitlist control participants. Latent change score modeling found that the strongest significant treatment effect appeared at the 1-month follow-up period, particularly for participants who began with severe depressive symptoms. Mediation analysis revealed significant indirect treatment effects of increases in behavioral activation on reducing depressive symptoms, suggesting a mechanism of change. Limitations were that the sample was relatively small and consisted of primarily women. These results provide initial evidence for the feasibility, acceptability, and efficacy of a text-delivered treatment for young adult depression.     

Psychometric properties and factor structure of the Fear Questionnaire phobia subscale items in two normative samples

Normative data for the Fear Questionnaire (Marks & Mathews, 1979), a popular self-report instrument measuring phobic concerns, were collected from both a community and a collegiate sample. The covariation and internal consistency of the blood-injury phobia (BI), social phobia (SO), and agoraphobia (AG) subscales were assessed in each sample, and the factor structure of the items from these three subscales was examined. Results indicated that, in general, community subjects reported more phobic concerns than did collegiate subjects, and females reported greater phobic concerns than did males. Results from confirmatory factor analyses suggest that the three factors of BI, SO, and AG did not emerge from either data set. Follow-up exploratory factor analyses did identify the general factors of blood-injury phobia and agoraphobia. Normative data from the present study are compared to those obtained previously, and directions for future research are provided.     

Arguers as editors

People use editorial criteria to decide whether to say or to suppress potential arguments. These criteria constitute people's standards as to what effective and appropriate arguments are like, and reflect general interaction goals. A series of empirical investigations has indicated that the standards fall into three classes: those having to do with argument effectiveness, those concerned with personal issues for arguer and target, and those centered on discourse quality. The essay also sketches the affinities certain types of people have for the different criteria.     

Clinical interpretation: The hermeneutics of medicine

I argue that clinical medicine can best be understood not as a purified science but as a hermeneutical enterprise: that is, as involved with the interpretation of texts. The literary critic reading a novel, the judge asked to apply a law, must arrive at a coherent reading of their respective texts. Similarly, the physician interprets the text of the ill person: clinical signs and symptoms are read to ferret out their meaning, the underlying disease. However, I suggest that the hermeneutics of medicine is rendered uniquely complex by its wide variety of textual forms. I discuss four in turn: the experiential text of illness as lived out by the patient; the narrative text constituted during history-taking; the physical text of the patient's body as objectively examined; the instrumental text constructed by diagnostic technologies. I further suggest that certain flaws in modern medicine arise from its refusal of a hermeneutic self-understanding. In seeking to escape all interpretive subjectivity, medicine has threatened to expunge its primary subject — the living, experiencing patient.