Iatrogenic effects of psychosocial interventions for substance use disorders: prevalence, predictors, prevention

AIMS: To examine the prevalence and personal and intervention-related predictors of potential iatrogenic effects associated with psychosocial interventions for substance use disorders and provide a conceptual framework to guide further research on such effects. METHOD: A review of relevant studies focuses on the prevalence and predictors of potential iatrogenic effects of psychosocial treatment and prevention programs for substance use disorders. RESULTS: Between 7% and 15% of patients who participate in psychosocial treatment for substance use disorders may be worse off subsequent to treatment than before. In addition, several controlled trials of substance use prevention have shown some apparent iatrogenic effects, including more positive expectations about substance use and a rise in alcohol use and alcohol-related problems. Probable person-related predictors of deterioration associated with treatment include younger age and unmarried status, more serious current diagnoses and substance use problems and more psychiatric and interpersonal problems. Probable intervention-related predictors of deterioration include lack of bonding; lack of monitoring; confrontation, criticism and high emotional arousal; deviancy modeling; and stigma, low or inappropriate expectations and lack of challenge. CONCLUSION: A significant minority of individuals with substance use problems appear to deteriorate during or shortly after participation in treatment or prevention programs. Safety standards and monitoring procedures are needed to routinely identify potential adverse consequences of intervention programs; research is needed to clarify whether deterioration is due to iatrogenic effects of interventions and to identify new approaches to counteract any such effects.     

The strategic and systemic management of denial in the cognitive/behavioral treatment of sexual offenders

A rationale is provided for working with denial as a component of the continuum of care offered in the cognitive/behavioral treatment of sexual offenders. Drawing upon a systemic and strategic knowledge base, this model will attempt to prepare offenders, who would otherwise be considered untreatable, for a treatment which requires their direct cooperation in the management of their deviancies. Through this process, the court-ordered or incarcerated sexual offender might more easily accept therapy. The risk of reoffense might thus be reduced and the safety of the community enhanced.     

Quantitative nmr microscopy of multicellular tumor spheroids and confrontation cultures

In cancer research, tumor spheroids are a well established system to study tumor metabolism resembling the situation in vivo more closely cell monolayers. Spherical aggregates of malignant melanoma cells (MV3) and their invasion into rat brain aggregates have been investigated by quantitative NMR microscopy. Relaxation times (T₁, T₂) and diffusion parameter images were acquired with an in-plane resolution of 14 × 14 μm². The authors were able to demonstrate that the morphology of the spheroids can be visualized on these NMR maps. The contrast was mainly manifested in relaxation maps, where average relaxation times T₁ = 1.94 ± 0.17 s and T₂ = 42.8 ± 6.3 ms were obtained for proliferating cells, and T₁ = 2.49 ± 0.31 s and T₂ = 104.3 ± 29.4 ms for the necrobiotic center. The mean diffusion coefficients were 0.59 ± 0.12 μm²/ms and 0.85 ± 0.14 μm²/ms, respectively. The authors could follow the dynamic process of tumor cell invasion in the investigated co-culture system. Knowledge about tumor cell migration and tumor cell invasion is essential for the understanding of cancer and its therapy. Quantitative NMR microscopy can study this dynamic process noninvasively and therefore may help to assess the influence of therapy on the micromilieu of these spheroids.     

Iatrogenic Effects of Psychosocial Interventions: Treatment,Life Context,and Personal Risk Factors

Between 7% and 15% of individuals who participate in psychosocial interventions for substance use disorders may be worse off after treatment than before. Intervention-related predictors of iatrogenic effects include lack of bonding; lack of goal direction and monitoring; confrontation, criticism, and high emotional arousal; models and norms for substance use; and stigma and inaccurate expectations. Life context and personal predictors include lack of support, criticism, and more severe substance use and psychological problems. Ongoing monitoring and safety standards are needed to identify and counteract adverse consequences of intervention programs.     

咪达唑仑消除新生儿机械通气中人-机对抗的疗效观察

目的探讨咪达唑仑消除新生儿机械通气中出现的人一机对抗的临床价值。方法选择2006年7月至2012年6月收治于我院新生儿科的需要机械通气的出现人一机对抗的新生儿病例83例,并依据是否使用咪达唑仑将患儿分为2组：对照组43例常规给予安定、苯巴比妥类和水合氯醛等镇静处理;观察组40例使用咪达唑仑镇静。对比两组患儿呼吸机参数、脱管率、应用机械通气时间、镇静评分,并进行统计学分析。结果观察组使用咪达唑仑后吸气峰压由（25．2±0．6）cmH20（1emH20=98Pa）下调至（19．2±0．7）cmH20,对照组由（24．7±0．5）cmH20下调至（213±0．9）emH20,下调明显,差异有统计学意义（P〈0．05）。观察组氧浓度由（65．5±0．5）％下调至（40．6±0．7）％,对照组由（66．4±0．4）％下调至（62．4±0．6）％,下调明显,差异有统计学意义（P〈0．05）。观察组无1例患儿因烦躁导致脱管,对照组有11例,差异有统计学意义（P〈0．05）。观察组应用机械通气时间（79.3±15．5）h,对照组（101．3±16．3）h,两组比较差异有统计学意义（t=2．9,P〈0．01）。用药前,观察组与对照组的镇静评分差异无统计学意义（P〉0．05）,观察组应用咪达唑仑后0．5、1、2、24h无操作时与对照组应用安定、苯巴比妥及／和水合氯醛等维持镇静的评分差异均有统计学意义（P〈0．05）。结论持续静脉滴注咪达唑仑能有效减轻机械通气治疗过程中的不适感,减少生理应激反应,达到自主呼吸与呼吸机协调同步,改善通气,稳定血氧饱和度。     

领悟社会支持在恶性肿瘤患者性格优势与应对方式间的中介效应

目的 了解恶性肿瘤患者性格优势、领悟社会支持及应对方式现状,探讨三者的关系。方法 以便利抽样法选取235例恶性肿瘤患者,采用一般资料调查表、三维度性格优势问卷、领悟社会支持量表、医学应对方式问卷进行调查。结果 恶性肿瘤患者性格优势总分（52.40±4.34）分,领悟社会支持总分（62.55±7.42）分,应对方式中面对、回避、屈服维度得分分别为（17.57±3.33）分、（16.08±2.49）分、（8.70±2.12）分。性格优势与领悟社会支持、面对及回避呈正相关（均P＜0.05）,屈服与性格优势、领悟社会支持呈负相关（均P＜0.05）。领悟社会支持在性格优势与屈服间起部分中介作用,间接效应占总效应的21.04%。结论 恶性肿瘤患者性格优势为中等水平,领悟社会支持为高支持状态,最常使用的应对方式是回避,性格优势可以通过领悟社会支持影响患者应对方式。建议医护人员制订基于性格优势的干预措施,调动并利用患者的社会支持系统,促进患者积极应对疾病。     

"卫勤蓝军"组建与效果评价

假想敌部队广泛用于对抗演练中,能够有效提高演练的实战性.但在中外演练中,尚未出现过成建制的卫勤对抗分队.讨论在卫勤演练中组建专门的对抗分队,实现卫勤对抗的可行性,并在系列实践研究中得到初步验证.     

A Confrontation Crook for Visual Field Assessment

ABSTRACT This paper describes a simple instrument for testing peripheral visual fields by confrontation. The procedure enables target position to be varied easily without providing cues to the patient from the hand movement or arm position of the examiner.     

Context effects on verb production in specific language impairment (SLI): Confrontation naming versus connected speech

A handful of studies have shown that verbs are more vulnerable than nouns to retrieval deficits on picture-based naming tasks for children with specific language impairment (SLI). The aim of this study was to examine if the disproportionate verb as opposed to noun production deficit reported for naming is also found in connected speech. Sixteen children participated in the study: eight children diagnosed with SLI (mean age: 6:3 years) and eight typically language developing (TLD, mean age: 5:9 years) controls. Verb and noun production was measured in connected speech and compared to picture confrontation naming. Both groups of children showed a significant difficulty naming verbs compared to nouns. In contrast, they did not differ on the total number of both verb tokens and verb types produced in connected speech. The findings indicate that the previously reported verb retrieval difficulties in SLI are a product of the confrontation naming task demands rather than a true verb deficit.