The role of psychological and social factors in the relationship between attachment and suicide: A systematic review

Insecure attachment is widely accepted to be a risk factor for suicidal thoughts and behaviour. To increase our understanding of this distal association, the current systematic review aimed to evaluate empirical evidence that has investigated the role of psychosocial mechanisms within this relationship. Sixteen original research articles were identified, with the majority carrying out mediational analyses to test their hypotheses. Substantial heterogeneity was found across studies with regards to their theoretical approach to assessing attachment, suicide‐related outcomes, sample population, statistical analyses, and the psychological factors under investigation. Nevertheless, this emergent evidence base indicates that a range of predisposing, precipitating, and crisis‐state factors may mediate the association between attachment security and suicidality. Studies that investigated moderating factors did not report significant findings, and the mediating role for psychiatric diagnoses remains unclear. Furthermore, this emerging research base is limited by an over‐reliance on cross‐sectional designs and self‐reported data. Longitudinal and experimental designs are required to verify causal pathways and to investigate whether trait vulnerabilities interact with acute stressors to increase suicide risk. Finally, disorganized attachment has been overlooked so far and should be given greater consideration going forward.     

Defining Laterality of the Descending Thoracic Aorta in a 4‐Chamber View of the Heart

Objective. Right descending aortas have been correlated with an increased risk of congenital heart disease. Nevertheless, the aortic position remains a largely overlooked diagnostic tool in second‐trimester sonography because no formal system for assessing the position exists. By developing a method of assigning the position of the aorta relative to the thoracic midline, diagnostic use of the descending aorta's position might be implemented more easily. Methods. The method of assessing the position relative to the midline was tested by comparing the analysis of 2 independent observers, who showed a 94.4% concordance rate. Results. Comparison of the percentages of aortic positions between the gestational ages (GAs) of 18 and 21 weeks showed no significant correlation between the aortic position and GA. Conclusions. We suggest simply paying attention to the aortic position in an already standard view. The extra effort is minimal, and it has the potential to improve the diagnostic accuracy of the 4‐chamber view.     

The role of Aflibercept in the management of age-related macular degeneration

ABSTRACT

Introduction: During the past decade, significant advances have occurred in the management of neovascular age-related macular degeneration (NV-AMD). The advent of anti-vascular endothelial growth factor (anti-VEGF) therapy has shifted the treatment goal of NV-AMD from merely salvaging vision to improving visual acuity and maintaining a good quality of life. Aflibercept (AFL) is a significant addition to the arsenal of anti-VEGF therapies against the NV-AMD. In the index review, pharmacology and efficacy of AFL has been reviewed.

Areas Covered: An extensive literature search was performed to identify preclinical and clinical studies performed to illustrate the role of AFL in NV-AMD. Randomized clinical trials evaluating other anti-VEGF agents were also included for comparison. Additionally, studies where AFL was employed to treat anti-VEGF-resistant cases agents have been reviewed.

Expert Opinion: AFL is an effective agent in the management of NV-AMD and its efficacy has been found to be comparable to ranibizumab (RBZ). Additionally, AFL is a good alternative agent in patients with NV-AMD resistant to RBZ and bevacizumab (BVZ), and can potentially lessen the treatment burden. As more research is conducted, the role of AFL in varying dosing regimens, as monotherapy and in combination with other agents, will become further defined.     

运用中医整体观综合治疗代谢综合征的探讨

整体观念是中医学的基本特点之一。通过西医、中医对代谢综合征的认识及其异同,明确代谢综合征的诊断,提出预防八法、综合治疗三大原则及五种方法。     

Are adolescents who moderate their cannabis use at lower risk of later regular and dependent cannabis use?

Aims   To examine whether moderation of cannabis use among adolescent cannabis users is associated with reductions in cannabis use frequency and risk of dependence in young adulthood.
Design   Ten-year representative cohort study with six surveys in adolescence (mean age 14.9–17.4 years) and two in young adulthood (mean age 20.7 and 24.1 years).
Participants   Inception cohort of 1943 Victorian secondary school students (96% response rate), with 1520 (78% of adolescent participants) interviewed in the final wave.
Measurements   Participants were classified into six groups according to the maximum level of adolescent use and the extent of subsequent moderation in such use: non-users, occasional to abstinence, occasional persisting, weekly to abstinence, weekly to occasional and weekly persisting. Outcome measures were weekly+ cannabis use and DSM-IV cannabis dependence at 20 and 24 years.
Findings   Thirty-one per cent reported cannabis use during adolescence. Most adolescent users had moderated their use: from occasional to abstinence (71% of occasional users), weekly to abstinence or weekly to occasional (28% and 48% of weekly+ users, respectively). By age 24, both occasional use groups were at similar, elevated risk of regular and dependent cannabis use compared to non-users. Weekly+ adolescent users were at greatest risk of these outcomes, although the weekly to abstinence group exhibited lower risk than those in the weekly persisting and weekly to occasional groups, who were at similar risk.
Conclusions   While many young people have dynamic cannabis use patterns, a pattern of moderating adolescent cannabis use was associated with less risk of later problematic use than among those persisting, but risks were still elevated substantially compared with never-users.     

坚持科学发展观 创建节约型医院

“看病难、看病贵”问题已成为社会反响强烈的热点问题。医院成为矛盾的聚集地，但不是问题的发源地。医院只有坚持科学发展观，从自身出发，通过挖掘潜力、强化管理等措施创建节约型医院，来缓解“看病难、看病贵”的问题。     

坚持科学发展观努力构建节约型医院

在新的世纪,节约有了新的时代内涵。节约已不是过去贫穷时的捉襟见肘和窘迫无奈,而是在相对富足条件下的自我节制和自主追求,是一种在科学发展观指导下的崭新的文明境界与道德风尚。节约型医院中的"节约",一是指医院采取各种有效措施,科学高效地管理、利用有限的医疗卫生资源;二是行医过程中,坚持合理用药、合理检查、合理收费,在不影响医院合理收入的情况下,尽量降低病人费用,减轻病人负担,创造社会效益。     

以科学发展观创建医院先进文化

本文探讨了医院文化在医院建设中的作用,强调医院文化建设是现代医院管理的重要组成部分,创建医院先进文化对医院全面发展有着重要的意义。提出了深刻理解科学发展观的内涵,才能建设先进的医院文化观念;积极适应科学发展观的要求,才能理清医院文化建设的思路。     

Oracle数据库升级或迁移的方法探讨

目的：“军卫一号”医院信息系统中Oracle数据库升级到Oracle 10g第2版。方法：利用数据库升级助手、手工脚本升级、导入／导出工具、表空间传输特性、tablecopy、实体化视图等技术分别实现数据库的升级测试。结果：测试的结果表明，这些方法均可以实现Oracle数据库的升级。结论：虽然各种升级方法均可以实现Oracle数据库的升级，但是它们的操作步骤和效率还是有区别．实际工作中可以根据应用的具体情况选择合适的方法。