Organisational environment and challenging behaviour in services for people with intellectual disabilities: A review of the literature

Background

This literature review explores the relationship between the organisational environment of residential disability services and challenging behaviour in people with intellectual disabilities (ID) using Bronfenbrenner's ecological theory as a theoretical framework.

认知行为干预结合正面激励对面部瘢痕整形患者心理健康的影响

目的:研究认知行为干预结合正面激励对面部瘢痕整形患者心理健康的影响。方法:纳入2018年1月-2020年4月笔者医院收治的72例面部瘢痕整形患者为研究对象,按照随机数字表法分为对照组(常规护理)及观察组(认知行为干预结合正面激励)。比较两组患者干预前及干预3个月后心理健康[症状自评量表(Symptom checklist 90,SCL-90)]、心理韧性[心理韧性量表(Connor-davidson resilience scale,CD-RISC)]、体象障碍[体象障碍自评量表(Body image rating scale,BIRS)]、躯体自信[躯体自信量表(The body-esteem scale,BES)]、幸福水平[总体幸福感量表(General well-being schedule,GWB)]。结果:干预3个月后,观察组SCL-90、BIRS评分水平明显低于干预前及同期对照组,差异有统计学意义(P<0.05)。干预3个月后,观察组CD-RISC、BES、GWB评分水平明显高于干预前及同期对照组,差异有统计学意义(P<0.05)。结论:认知行为干预结合正面激励能够改善面部瘢痕整形患者心理健康,提升其对自身的信心及幸福感。     

2008－2013年我国中医类医疗机构服务量分析

中医类医疗机构的服务主要分为门诊服务和住院服务两部分。本文通过对最近6年的全国中医院门诊、急诊总诊疗人次数、出院人数、每百门急诊的入院人数、病床使用率、平均住院日、医师工作效率这6个指标进行对比分析,了解近年中医类医疗机构的服务情况,并据此提出合理化建议。     

建立社区护理服务中心的构想

本文就建立社区护理服务中心的领导体制、服务队伍、服务模式等主要问题进行了初探，提出了相应的可行性构想。     

Lesions of the paraventricular nucleus of the thalamus differentially affect sign‐ and goal‐tracking conditioned responses

Recently, evidence has emerged suggesting a role for the paraventricular nucleus of the thalamus (PVT) in the processing of reward‐associated cues. However, the specific role of the PVT in these processes has yet to be elucidated. Here we use an animal model that captures individual variation in response to discrete reward‐associated cues to further assess the role of the PVT in stimulus–reward learning. When rats are exposed to a Pavlovian conditioning paradigm, wherein a discrete cue predicts food reward, two distinct conditioned responses emerge. Some rats, termed sign‐trackers, approach and manipulate the cue, whereas others, termed goal‐trackers, approach the location of reward delivery upon cue presentation. For both sign‐ and goal‐trackers the cue is a predictor, but only for sign‐trackers is it also an incentive stimulus. We investigated the role of the PVT in the acquisition and expression of these conditioned responses using an excitotoxic lesion. Results indicate that PVT lesions prior to acquisition amplify the differences between phenotypes – increasing sign‐tracking and attenuating goal‐tracking behavior. Lesions of the PVT after rats had acquired their respective conditioned responses also attenuated the expression of the goal‐tracking response, and increased the sign‐tracking response, but did so selectively in goal‐trackers. These results suggest that the PVT acts to suppress the attribution of incentive salience to reward cues, as disruption of the functional activity within this structure enhances the tendency to sign‐track.     

社区公共卫生及基本医疗项目“标准工作当量”的测算研究及其意义

目的：通过测算社区公共卫生及基本医疗项目各种工作量的“标准计算单元”(即“标准工作当量”),并以此将社区公共卫生和社区基本医疗共84种工作量进行转换。方法根据各个项目的服务流程和服务规范,通过“作业成本法”对社区健康服务的各种工作量进行成本测算,根据不同工作量之间的人力资源成本(以“人·天”为单位),设立一个“标准工作当量”进行转换。结果选择一项具有代表性的工作量为参照单位来转换各种工作量,以社区公共卫生项目的“1人次的规划内疫苗的预防接种”或社区基本医疗项目中的“1人次的社区常见病多发病诊疗服务(西医药服务)”作为标准工作当量,把84种不同种类工作量转换成统一的计量单位。结论采用“标准工作当量”可以直接、客观地衡量社区健康服务的工作负荷,并进行财政经费分配和绩效管理。     

An investigation into the effects of different types of exercise on the maintenance of approach motivation levels

BackgroundThis study looked to investigate the interaction between exercise and approach motivation (AM) levels in a non-clinical sample as a first step towards investigating the impact of acute exercise upon hypomanic states within Bipolar Disorder. The Behavioural Activation System (BAS) dysregulation theory proposes that AM levels in individuals with Bipolar Disorder, are hyper-reactive to relevant cues and prone to fluctuation such that excessive levels underpin hypomania/mania. We hypothesise that exercise may interact with high AM levels to further increase AM levels in both the general population and individuals with BD, with this effect being exacerbated in the latter group. As an initial test of this theory we explore the impact of moderate and vigorous exercise and sedentary activity upon AM in an unselected student sample. We also tested the extent to which hypomania vulnerability predicts the impact of exercise.MethodParticipants were recruited from a University student population. After completing a measure of hypomanic personality traits, 61 participants completed a task designed to induce higher levels of AM before taking part in one of three 15 min activities (sedentary, moderate exercise or vigorous exercise). AM levels as well as variables relevant to hypomanic symptoms were measured prior to and post AM induction, at 5 min intervals during the activities and twice during a recovery period.ResultsVigorous exercise significantly increased individuals' AM levels in comparison to moderate or no exercise. No association was found between hypomania vulnerability and exercise impact.ConclusionsThese results provide a first step in investigating the possible risks associated with engaging in different intensities of exercise during a hypomanic episode. Any recommendations within this study should however be taken in light of the limitations identified. Further research replicating these results with a larger sample and among individuals with Bipolar Disorder is recommended.