家庭正向行为支持方案的构建及应用研究

目的 构建家庭正向行为支持（positive behavior support,PBS）方案,并探讨其在学龄前恶性肿瘤患儿情绪行为影响中的应用效果。方法 以家庭系统理论为框架构建家庭PBS方案,选取2019年3月—2020年2月于重庆市某三级甲等儿童医院就诊的100例学龄前恶性肿瘤患儿为研究对象,采用随机数字表法分为试验组（n=50）和对照组（n=50）。试验组在常规护理基础上接受为期3个月的家庭PBS方案,对照组实施常规护理。比较两组干预前后家庭亲密度与适应性量表得分、养育心理灵活性问卷得分及长处与困难问卷得分。结果 两组干预后长处与困难问卷得分低于干预前（均P<0.001）,家庭亲密度与适应性量表得分高于干预前（均P<0.001）;试验组干预后养育心理灵活性问卷得分高于干预前（P<0.001）;干预后试验组长处与困难问卷得分低于对照组（P<0.001）,家庭亲密度与适应性量表得分和养育心理灵活性问卷得分高于对照组（均P<0.05）。结论 应用家庭PBS方案可减少学龄前恶性肿瘤患儿情绪行为问题的发生,改善家庭亲密度与适应性,提高父母养育心理灵活性。     

Modeling hybrid rough set-based classification procedures to identify hemodialysis adequacy for end-stage renal disease patients

Healthcare problems observed in the majority of end-stage renal disease (ESRD) patients regarding hemodialysis (HD) treatment are serious issues for the Taiwanese healthcare services, and an interesting topic is thus the adequacy of HD therapy. This study successfully models a hybrid procedure to measure HD adequacy to assess therapeutic effects and to explore the relationship between accuracy and coverage for interested parties. The proposed model has better accuracy, a lower standard deviation, and fewer attributes than the listed methods under various evaluation criteria. The study results are useful to subsequent researchers to develop suitable applications, and to ESRD patients and their doctors to ensure satisfactory medical quality.     

Linking components of event-related potentials and autonomic measures of the orienting reflex

This study examined autonomic measures and event-related potentials (ERPs) associated with elicitation and habituation of the basic Orienting Reflex (OR). Subjects received 16 innocuous tones with intensity alternating between 60 and 80 dB, at long inter-stimulus intervals. There was no stimulus-related task, so we could examine the effects of stimulus novelty and intensity in the absence of task demands. Cardiac, respiratory, peripheral vasoconstriction, and electrodermal measures were recorded, as well as continuous EEG. Single-trial ERPs were obtained, and components extracted by Principal Components Analysis were examined for potential response fractionation in the central indices of stimulus processing. The predicted fractionation of autonomic measures was obtained: cardiac deceleration showed no systematic change with intensity or trials, respiratory pause showed a substantial main effect of trials but no intensity effects, peripheral vasoconstriction showed intensity but no trials effects, and electrodermal responses showed substantial main effects of trials and intensity. A range of intensity and novelty effects were obtained in components identified as the N1, P3a, P3b, Novelty P3, and the classic Slow Wave. The different stimulus–response profiles of the ERP components are discussed in relation to the autonomic response profiles within the context of a sequential processing theory of OR elicitation.     

La théorie interpersonnelle du suicide. Présentation et application dans la compréhension des idées suicidaires chez l’étudiant en médecine : étude dans un groupe de 178 étudiants

ObjectivesThe current paper presents firstly the Interpersonal Psychological Theory of Suicide (IPTS) and its interest in the risk of suicide in physicians and/or medical students and secondly an original study on 178 medical students.MethodsIn total, 178 medical students of the Université Libre de Bruxelles filled out an ad hoc questionnaire rating suicidal ideations (life-time), recent suicidal plans and recent suicidal ideations rated by the 9th item of the Beck Depression Inventory-II (BDI). The subjects completed the French version of the Interpersonal Needs Questionnaire (INQ) rating Perceived burdensomeness and Thwarted belongingness and the Acquired Capability for Suicide Scale (ACSS) as well as the Beck Depression Inventory-II (BDI-II). Among the 178 medical students, 95 had no suicide risk, 24 had life-time suicidal ideation, 28 had recent suicidal ideations and 26 had recent suicidal plans. The four groups were compared for gender and age as well as for the different rating scales using Chi² tests or analyses of variance (ANOVA).ResultsThe four groups had no significant differences for age, gender and scores on the ACSS. ANOVA revealed significant differences for perceived burdensomeness, thwarted belongingness and depression. To control the potential effect of depression, analyses of covariance (ANCOVA) were done taking as covariate a subscale of the BDI-II rating the cognitive component of depression. The two ANCOVA were significant. Post hoc tests comparing two by two the different groups reported that students with recent suicidal ideations or suicidal plans have significantly higher thwarted belongingness than students without suicide risk or students with life time suicidal ideations. Moreover, higher level of perceived burdensomeness was found only in students with suicidal plans comparatively with the three other groups.ConclusionHigh levels of thwarted belongingness and perceived burdensomeness characterize medical students with recent suicidal ideations or suicidal plans independently of the level of depression.     

Fuzzy entropy based interactive enhancement of radiographic images

In certain radiographic images, fuzziness exists due to the vague nature of image characteristics and limitations of visual perception. Accordingly, a gap exists between the information content of an image and the information that can be retrieved. In this paper, a new fuzzy logic based intensification operator has been proposed for enhancement of images. For applying the operator effectively, selection of crossover point is critical. In this paper, the concept of fuzzy entropy has been proposed for objective selection of crossover point. Owing to semantic nature of information content, the methodology has a provision to change levels of enhancement interactively, to help in retrieving the information as required. The effectiveness of the methodology has been demonstrated. Comparison of the results with the Zadeh's INT operator and conventional histogram equalization techniques has established its superiority.     

A qualitative study of patient choices in using emergency health care for long-term conditions: The importance of candidacy and recursivity

Objective

We aimed to explore how patients with long-term conditions choose between available healthcare options during a health crisis.

Methods

Patients in North-West England with one or more of four long-term conditions were invited to take part in a questionnaire cohort study of healthcare use. Semi-structured interviews were conducted with a sub-sample of fifty consenting patients. Data were analysed qualitatively, using a framework approach.

Results

Patients described using emergency care only in response to perceived urgent need. Their judgements about urgency of need, and their choices about what services to use were guided by previous experiences of care, particularly how accessible services were and the perceived expertise of practitioners.

Conclusion

Recursivity and candidacy provide a framework for understanding patient decision-making around emergency care use. Patients were knowledgeable and discriminating users of services, drawing on experiential knowledge of healthcare to choose between services. Their sense of ‘candidacy’ for specific emergency care services, was recursively shaped by previous experiences.

Practice implications

Strategies that emphasise the need to educate patients about healthcare services use alone are unlikely to change care-seeking behaviour. Practitioners need to modify care experiences that recursively shape patients’ judgements of candidacy and their perceptions of accessible expertise in alternative services.     

Theory of mind performance and prefrontal connectivity in adolescents at clinical high risk for psychosis

Theory of mind(ToM) impairment is a key feature of psychotic disorders and has been documented in individuals at clinical high-risk for psychosis (CHR), suggesting that it may predate illness onset. However, no study to date has examined brain functional correlates of ToM in individuals at CHR during adolescence. The “Reading-the-Mind-in-the-Eyes” test was used to measure ToM performance in 50 CHR youth, 15 of whom transitioned to psychosis (CHR-t) at follow-up (12 ± 6 months) and 36 healthy volunteers. Resting-state functional MRI was acquired to evaluate functional connectivity within the default mode network. Group by age interaction revealed an age-positive association in ToM performance in healthy volunteers, which was not present in adolescents at CHR-t. Intrinsic functional connectivity in the medial prefrontal cortex was reduced in adolescents at CHR-t relative to those who did not transition and to healthy volunteers. Survival analyses revealed that participants at CHR with lower medial prefrontal cortex connectivity were at greatest risk of developing psychosis at follow-up. We demonstrate that lack of age-related maturation of ToM and reduced medial prefrontal cortex connectivity both precede the onset of psychosis during adolescence. Medial prefrontal cortex connectivity holds potential as a brain-based marker for the early identification of transition to psychosis.     

Theory of Mind as a potential trait marker of schizophrenia: A family study

Introduction. Although there is some evidence that Theory of Mind (ToM) deficits may be trait markers of schizophrenia it is not clear yet if ToM deficits are primary deficits, that is, to be independent of deficits in general intellectual abilities and executive function. The aim was to examine if ToM deficits may be trait markers of the illness and the effect of cognitive inhibition, general intellectual abilities and depression on ToM abilities of patients with schizophrenia and their unaffected parents.

Methods. We assessed ToM abilities (first-order and second-order ToM stories, The Revised Eyes Test), cognitive inhibition (Stroop Task), general intellectual ability (Standard Progressive Matrices Test Plus) in patients with schizophrenia (N=21) and their unaffected fathers (N=21) and mothers (N=21) in comparison with healthy control families (healthy control males, N=21, healthy control fathers, N=21, healthy control mothers, N=21)

Results. Patients showed deficits in first-order ToM tasks but some of these deficits were mediated by general intellectual abilities. Impairments in cognitive inhibition mediated only patients’ performance in The Revised Eyes Test. Patients showed deficits in second-order ToM stories independently of deficits in general intellectual abilities and cognitive inhibition. Unaffected parents did not show deficits in first-order ToM tasks, whereas they showed deficits in second-order ToM stories. However, the deficits that unaffected parents showed in second-order ToM stories were mediated by their deficits in general intellectual abilities, and there was an effect of remitted depression on the unaffected mothers’ performance.

Conclusions. The results suggest that intact neurocognitive and general intellectual abilities are necessary in order patients and their unaffected parents to pass successfully ToM tasks. Patients and their unaffected parents show ToM deficits but these deficits are not similar. Patients show ToM deficits but these deficits seem to be a component of the pathophysiology of the illness (e.g., deficits in executive function, general intellectual abilities).     

Social reasoning in Tourette syndrome

Introduction. Tourette syndrome (TS) is thought to be associated with striatal dysfunction. Changes within frontostriatal pathways in TS could lead to changes in abilities reliant on the frontal cortex. Such abilities include executive functions and aspects of social reasoning.

Methods. This study aimed to investigate executive functioning and Theory of Mind (ToM; the ability to reason about mental states, e.g., beliefs and emotions), in 18 patients with TS and 20 controls. A range of tasks involving ToM were used. These required participants to make judgements about mental states based on pictures of whole faces or the eyes alone, reason about humour in cartoons that featured sarcasm, irony or “slapstick” style humour, and make economic decisions. The executive measures assessed inhibition and verbal fluency.

Results. Patients with TS exhibited significantly poorer performance than controls on all four tasks involving ToM, even when patients with comorbid obsessive-compulsive disorder were excluded. These difficulties were despite no inhibitory deficits. Patients with TS exhibited impairment on the verbal fluency task but their performance on executive and ToM tasks was not related.

Conclusions. We propose that TS is associated with changes in ToM. The observed deficits could reflect dysfunction in frontostriatal pathways involving ventromedial prefrontal cortex.