Social Justice on the Couch: Collapse and Repair of Social Thirdness

How have the white, middle-class, Eurocentric ideologies and practices of the Western psychoanalytic canon prepared us to make meaning of the complexities of our pluralistic world? Psychoanalysis has been criticized for its predominantly decontextualized and depoliticized perspectives that emphasize universal intrapsychic unconscious dynamics. In the context of a sociopolitically critical view of psychoanalytic theory and practice, I will reflect on what it means to keep conducting ‘business as usual’ in an era where movements like Black Lives Matter, #MeToo, as well as the health inequities that became apparent due to the Covid-19 pandemic are clear warning signs that our world is deeply troubled by injustice. I will argue that psychoanalytic theory and practice is not immune from this injustice. I will also contemplate aspects of a socially just psychoanalytic vision that may reverse decontextualizing, depoliticizing, and prejudicial trends using the principle of social thirdness, which expands traditional views of thirdness to include the patient's and therapist's embeddedness in the larger sociopolitical currents that inform and shape their engagement with each other. Reflecting on themes such as race, sexuality, gender, and sex/gender nonconformity, both the collapse and repair of social thirdness will be described and illustrated with relevant clinical examples.     

Modern Health Journalism and the Impact of Social Media

Scholarly journals are hubs of hypotheses, evidence-based data, and practice recommendations that shape health research and practice worldwide. The advancement of science and information technologies has made online accessibility a basic requirement, paving the way for the advent of open access publishing, and more recently, to web-based health journalism. Especially in the time of the current pandemic, health professionals have turned to the internet, and primarily to social media, as a source of rapid information transfer and international communication. Hence, the current pandemic has ushered an era of digital transformation of science, and we attempt to understand and assess the impact of this digitization on modern health journalism.     

The Impact of Social Media on Medical Professionalism: A Systematic Qualitative Review of Challenges and Opportunities

Background

The rising impact of social media on the private and working lives of health care professionals has made researchers and health care institutions study and rethink the concept and content of medical professionalism in the digital age. In the last decade, several specific policies, original research studies, and comments have been published on the responsible use of social media by health care professionals. However, there is no systematic literature review that analyzes the full spectrum of (1) social media–related challenges imposed on medical professionalism and (2) social media–related opportunities to both undermine and improve medical professionalism.

Objective

The aim of this systematic qualitative review is to present this full spectrum of social media–related challenges and opportunities.

Methods

We performed a systematic literature search in PubMed (restricted to English and German literature published between 2002 and 2011) for papers that address social media–related challenges and opportunities for medical professionalism. To operationalize “medical professionalism”, we refer to the 10 commitments presented in the physicians’ charter “Medical professionalism in the new millennium” published by the ABIM Foundation. We applied qualitative text analysis to categorize the spectrum of social media–related challenges and opportunities for medical professionalism.

Results

The literature review retrieved 108 references, consisting of 46 original research studies and 62 commentaries, editorials, or opinion papers. All references together mentioned a spectrum of 23 broad and 12 further-specified, narrow categories for social media–related opportunities (n=10) and challenges (n=13) for medical professionalism, grouped under the 10 commitments of the physicians’ charter.

Conclusions

The accommodation of the traditional core values of medicine to the characteristics of social media presents opportunities as well as challenges for medical professionalism. As a profession that is entitled to self-regulation, health care professionals should proactively approach these challenges and seize the opportunities. There should be room to foster interprofessional and intergenerational dialogue (and eventually guidelines and policies) on both challenges and opportunities of social media in modern health care. This review builds a unique source of information that can inform further research and policy development in this regard.     

Pharmaceutical Companies and Their Drugs on Social Media: A Content Analysis of Drug Information on Popular Social Media Sites

Background

Many concerns have been raised about pharmaceutical companies marketing their drugs directly to consumers on social media. This form of direct-to-consumer advertising (DTCA) can be interactive and, because it is largely unmonitored, the benefits of pharmaceutical treatment could easily be overemphasized compared to the risks. Additionally, nonexpert consumers can share their own drug product testimonials on social media and illegal online pharmacies can market their services on popular social media sites. There is great potential for the public to be exposed to misleading or dangerous information about pharmaceutical drugs on social media.

Objective

Our central aim was to examine how pharmaceutical companies use social media to interact with the general public and market their drugs. We also sought to analyze the nature of information that appears in search results for widely used pharmaceutical drugs in the United States on Facebook, Twitter, and YouTube with a particular emphasis on the presence of illegal pharmacies.

Methods

Content analyses were performed on (1) social media content on the Facebook, Twitter, and YouTube accounts of the top 15 pharmaceutical companies in the world and (2) the content that appears when searching on Facebook, Twitter, and YouTube for the top 20 pharmaceutical drugs purchased in the United States. Notably, for the company-specific analysis, we examined the presence of information similar to various forms of DTCA, the audience reach of company postings, and the quantity and quality of company-consumer interaction. For the drug-specific analysis, we documented the presence of illegal pharmacies, personal testimonials, and drug efficacy claims.

Results

From the company-specific analysis, we found information similar to help-seeking DTCA in 40.7% (301/740) of pharmaceutical companies’ social media posts. Drug product claims were present in only 1.6% (12/740) of posts. Overall, there was a substantial amount of consumers who interacted with pharmaceutical companies through commenting (23.9%, 177/740). For the drug-specific analysis, we found that the majority of search results contained drug product claims (69.4%, 482/695); more claims mentioned only benefits (44.8%, 216/482) relative to only risks (27.2%, 131/482). Additionally, approximately 25% (150/603) of posts on Twitter and YouTube were presented as personal testimonials. A considerable percentage of content on Facebook contained advertisements for illegal online pharmacies (17%, 16/92).

Conclusions

Pharmaceutical companies avoid making drug product claims on their social media accounts but frequently post content that is consistent with FDA definitions for help-seeking DTCA. Thousands of people often view content posted by pharmaceutical companies on social media; users also share company postings making both direct and indirect influence possible. Finally, people are likely to be exposed to drug product claims and information about illegal pharmacies when searching for information about popular pharmaceutical drugs on social media.     

探讨社会支持应对方式及社会事件对抑郁症的影响

目的 观察抑郁症患者在应对方式、社会支持以及生活事件方面与健康人的差异。方法 选取2018年9月~2019年2月石河子大学医学院第一附属医院康复心理科住院的抑郁症患者30例作为病例组。另选取同时期本院健康体检者30例为对照组。使用简易应对方式问卷（SCSQ）、社会支持量表（SSRS）以及生活事件量表（LES）进行测评并比较。结果 病例组SCSQ总分及积极应对方式得分小于对照组,差异具有统计学意义（P＜0.05）;病例组SSRS总分及客观支持、支持利用度评分低于对照组,差异具有统计学意义（P＜0.05）;病例组LES总分及家庭生活、社交及其他评分高于对照组,差异具有统计学意义（P＜0.05）。结论 在日常生活中受到来自家庭生活方面和社交方面的刺激事件可能更容易引起抑郁症的发生,给予更多的社会支持,提高患者对社会支持的利用度以及在处理事件中选取积极的应对方式,将有助于降低抑郁症的发生。     

The Impact of Smoking on Clinical and Therapeutic Effects in Asthmatics

Smoking is associated with poor symptom control and impaired therapeutic responses in asthma. A total of 843 patients with asthma were recruited. The patients received treatment for 1 yr according to the severity of their asthma. We compared the forced expiratory volume in 1 sec (FEV1), the ratio of FEV1 to forced vital capaity (FVC), atopy, total IgE, emphysema on high-resolution computed tomography (HRCT), the number of near-fatal asthma attacks, and physiological fixed airway obstruction between the smoking and nonsmoking groups. The study population consisted of 159 (18.8%) current smokers, 157 (18.7%) ex-smokers, and 525 (62.5%) nonsmokers. Although the prevalence of atopy was not different between the smoking and nonsmoking groups, the total IgE was higher among the smokers than the nonsmokers. Compared with the nonsmoking group, the smokers had a lower FEV1 % predicted and forced expiratory flow between 25 and 75% of FVC. A greater prevalence of emphysema and a significantly higher number of asthmatic patients with fixed airway obstruction were detected in the smoking versus nonsmoking group. The 37.5% of asthmatic patients who were former or current smokers showed decreased pulmonary function and increased IgE, emphysema on HRCT, and fixed airway obstruction, indicating that smoking can modulate the clinical and therapeutic responses in asthma.     

社会支持与产前情绪对产妇产后抑郁的影响

目的研究孕产妇社会支持与产前焦虑和抑郁情绪对产后抑郁的影响。方法对274名产妇用一般情况调查表、自评焦虑量表、自评抑郁量表、社会支持评定量表和爱丁堡产后抑郁量表进行调查,对收集到的数据运用SPSS 17.0进行t检验、χ2检验、相关分析和多元逐步回归分析。结果①产后抑郁的发病率为18.20%;②产后抑郁组和正常组产妇在社会支持、产前焦虑和产前抑郁上均存在显著性差异(P0.01);③产前焦虑与社会支持总分、客观支持和支持利用度呈显著相关(r=-0.329,-0.282,-0.372),产前抑郁与社会支持总分、主观支持、客观支持呈显著相关(r=-0.482,-0.491,-0.587);产后抑郁与产前抑郁情绪、主观支持、客观支持、支持利用度和社会支持总分呈显著相关(r=0.408,-0.212,-0.238,-0.301,-0.232);④产前抑郁、社会支持利用度和主观支持进入抑郁的回归方程,它们能解释产后抑郁发生的29.7%。结论产前抑郁情绪、社会支持利用度和主观支持是影响产后抑郁形成的关键因素。     

硕士研究生人际信任、社会支持与孤独感的关系研究

目的了解在校硕士研究生的人际信任、社会支持和孤独感的现状,并探讨三者之间的关系。方法采用人际信任量表(ITS)、社会支持量表(SSRS)和孤独感量表(UCLA)对太原市3所大学的300名在校研究生进行调查。结果①人际信任(t=4.221,P0.001)和支持的利用度(t=-3.375,P=0.001)在性别上存在显著差异;主观支持(t=2.268,P0.05)、社会支持总分(t=2.292,P0.05)在是否婚恋上存在差异;孤独感在年级上存在差异(F=3.17,P0.05);②人际信任总分和社会支持得分存在负相关(R=-0.21,P0.05),和孤独感得分呈正相关(R=0.32,P0.05),社会支持和孤独感呈显著负相关(R=-0.51,P0.001);③通过逐步回归,从回归方程可以看出人际信任和社会支持可以预测孤独感29.6%的变化量。结论研究生的人际信任、社会支持和孤独感两两呈显著相关,人际信任和社会支持可以有效预测孤独感。     

领悟社会支持及应对方式对县处级干部亚健康的研究

目的 探寻县处级干部亚健康、领悟社会支持、应对方式现状及其关系.方法 采用问卷调查法,分层抽取266名县处级干部进行研究.结果 县处级干部亚健康发生率较高,大专及以下干部"亚健康"状态高于本科及以上干部(P<0.05).干部领悟社会支持处于中等水平偏上(P<0.05),事业单位领悟社会支持度高于机关、企业单位(P<0....     

Scoping Review on Search Queries and Social Media for Disease Surveillance: A Chronology of Innovation

Background

The threat of a global pandemic posed by outbreaks of influenza H5N1 (1997) and Severe Acute Respiratory Syndrome (SARS, 2002), both diseases of zoonotic origin, provoked interest in improving early warning systems and reinforced the need for combining data from different sources. It led to the use of search query data from search engines such as Google and Yahoo! as an indicator of when and where influenza was occurring. This methodology has subsequently been extended to other diseases and has led to experimentation with new types of social media for disease surveillance.

Objective

The objective of this scoping review was to formally assess the current state of knowledge regarding the use of search queries and social media for disease surveillance in order to inform future work on early detection and more effective mitigation of the effects of foodborne illness.

Methods

Structured scoping review methods were used to identify, characterize, and evaluate all published primary research, expert review, and commentary articles regarding the use of social media in surveillance of infectious diseases from 2002-2011.

Results

Thirty-two primary research articles and 19 reviews and case studies were identified as relevant. Most relevant citations were peer-reviewed journal articles (29/32, 91%) published in 2010-11 (28/32, 88%) and reported use of a Google program for surveillance of influenza. Only four primary research articles investigated social media in the context of foodborne disease or gastroenteritis. Most authors (21/32 articles, 66%) reported that social media-based surveillance had comparable performance when compared to an existing surveillance program. The most commonly reported strengths of social media surveillance programs included their effectiveness (21/32, 66%) and rapid detection of disease (21/32, 66%). The most commonly reported weaknesses were the potential for false positive (16/32, 50%) and false negative (11/32, 34%) results. Most authors (24/32, 75%) recommended that social media programs should primarily be used to support existing surveillance programs.

Conclusions

The use of search queries and social media for disease surveillance are relatively recent phenomena (first reported in 2006). Both the tools themselves and the methodologies for exploiting them are evolving over time. While their accuracy, speed, and cost compare favorably with existing surveillance systems, the primary challenge is to refine the data signal by reducing surrounding noise. Further developments in digital disease surveillance have the potential to improve sensitivity and specificity, passively through advances in machine learning and actively through engagement of users. Adoption, even as supporting systems for existing surveillance, will entail a high level of familiarity with the tools and collaboration across jurisdictions.     

Impact of obesity on autoimmune arthritis and its cardiovascular complications

Obesity can instigate and sustain a systemic low-grade inflammatory environment that can amplify autoimmune disorders and their associated comorbidities. Metabolic changes and inflammatory factors produced by the adipose tissue have been reported to aggravate autoimmunity and predispose the patient to cardiovascular disease (CVD) and metabolic comorbidities. Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are autoimmune arthritic diseases, often linked with altered body mass index (BMI). Severe joint inflammation and bone destruction have a debilitating impact on the patient's life; there is also a staggering risk of cardiovascular morbidity and mortality. Furthermore, these patients are at risk of developing metabolic symptoms, including insulin resistance resulting in type 2 diabetes mellitus (T2DM). In addition, arthritis severity, progression and response to therapy can be markedly affected by the patient's BMI. Hence, a complex integrative pathogenesis interconnects autoimmunity with metabolic and cardiovascular disorders. This review aims to shed light on the network that connects obesity with RA, PsA, systemic lupus erythematosus and Sj?gren's syndrome. We have focused on clarifying the mechanism by which obesity affects different cell types, inflammatory factors and traditional therapies in these autoimmune disorders. We conclude that to further optimize arthritis therapy and to prevent CVD, it is imperative to uncover the intricate relation between obesity and arthritis pathology.     

宫颈上皮内瘤变及其治疗对妊娠的影响

宫颈鳞状上皮内瘤变是一种和HPV感染有关的宫颈癌前病变。根据病变程度分为低度和高度鳞状上皮内病变,其中低度病变包括HPV感染和C IN1,高度病变包括C IN2~3。HPV感染和宫颈上皮内瘤变是一种生育年龄妇女常见的妇科疾病,HPV感染、宫颈病变本身及其治疗对妊娠的影响倍受关注。HPV感染在妊娠期间可能增加,经阴道分娩者新生儿暴露于HPV的机会增多,尚不能下结论对所有HPV感染者均采用剖宫产的分娩方式。妊娠期间发现C IN1,可以观察并产后随访。如果为C IN2~3,妊娠可能不会加重病变程度,但对阴道镜检查不满意者或高度怀疑浸润癌者应在孕期明确诊断,可于妊娠中期行宫颈锥切术。妊娠中期行宫颈锥切术可能使剖宫产率增加。C IN保守治疗对于患者受孕能力无显著的影响;宫颈冷刀锥切及LEEP锥切可能增加早产率,早产率的增加可能和胎膜早破的发生有关。     

Advancing Telecommunication Technology and its Impact on Psychotherapy in Private Practice

This paper is a report on an informal study by a small group of psychotherapists interested in exploring the impact of recent technological innovations on their work as independent clinicians in private practice. The range of technologies studied included websites, email, mobile phones, and internet‐based banking services for payment and receipt of fees. Some of the group had experience of using internet‐based video software (or Voice Over Internet Protocol/VOIP software) for providing therapy and/or establishing supervisory and training links. The study found that these technologies have had both positive and negative impacts on professional practice and, in particular, records how practitioners have managed these changes within their clinical practice. The study notes the lack of professional training about these matters and highlights some of the issues that need to be addressed in redressing this situation.     

亲子支持和孝顺期待对老年人孤独感的影响

目的 :根据“心理不协调”理论 ,探讨老年人与成年子女之间的亲子支持、老年人的孝顺期待对老年人孤独感体验的影响。方法 :采用UCLA孤独感量表和自编的“老年人亲子支持问卷”、“老年人孝顺期待问卷”对 2 88名年龄 5 3～ 87岁的老年人进行问卷调查。结果 :接受子女社会支持高分组的老年人孤独感体验显著比低分组的老年人少 (P <.0 0 1)。接受支持、孝顺期待和老年人孤独感的相关系数分别为 - 0 .2 6 3和 - 0 .16 5。接受成年子女的社会支持和对成年子女的孝顺期待对老年人孤独感有显著的负向预测作用 ,贡献率为 8.2 %。结论 :亲子支持和孝顺期待对老年人的孤独感体验有显著的影响。     

痰热清联合抗菌药物对社区获得性肺炎患者CRP、PCT的影响及疗效分析

目的 探讨联合抗菌药物对社区获得性肺炎患者CRP、PCT的影响及疗效.方法 180例社区获得性肺炎患者随机分为治疗组和对照组,对照组予抗菌药物加常规对症治疗,治疗组在此几乎上予痰热清治疗,比较两组临床疗效,细菌清除率,以及PCT、CRP水平的变化情况和不良反应发生情况.结果 治疗组总有效84例,有效率达93.3％,明显高于对照组(81.1％)(P＜0.05).治疗组细菌清除率为94.0％,高于对照组(82.3％)(P＜0.05).与治疗前比较,治疗后两组CRP、PCT均降低(P＜0.05).而治疗后治疗组CRP、PCT水平均低于对照组(P＜0.05).两组不良反应发生率差异无统计学意义(P＞0.05).结论 痰热清联合抗菌药物对CAP具有较高的疗效和安全性,并且可以降低CAP患者CRP、PCT水平.     

HIV感染对机体MDSC细胞分化及其免疫抑制功能的影响

骨髓源性抑制细胞是一群具有免疫抑制作用的异质性细胞,HIV感染后的机体免疫系统异常调节可能与MDSC有关。因此,我们采用流式细胞分析检测HIV感染者及健康人群外周血MDSC亚群及细胞内精氨酸酶(Arg1)的表达,分析比较MDSC亚群及细胞内Arg1在以上两组间的差异;并通过HIV感染者血清与健康人外周血单个核细胞体外共培养方法,5d后观察HIV感染者血清对健康人MDSC的诱导与分化;采用免疫磁珠分选的方法分选HIV阳性血清诱导的MDSC,与CFSE标记的CD8+T淋巴细胞以2∶1的比例在CD3/CD28免疫磁珠的诱导下体外共培养3d,流式细胞仪检测共培养前后CD8~+T淋巴细胞在培养体系所占比例及CFSE荧光强度的改变。结果显示,与健康人外周血MDSC亚群比较,HIV感染者Lin~-HLA-DR~-CD33~+CD11b~+CD14~+标记的M-MDSC有显著统计学差异(P=0.01);HIV感染者M-MDSC细胞内Arg1的水平呈现高表达(23.1±9.3)%,与G-MDSC细胞内Arg1的水平比较(4.7±1.3)%,具有显著性差异(P=0.00);HIV阳性血清与健康人单个核细胞共培养后,M-MDSC的亚群高于培养前(P=0.008);HIV诱导的MDSC与CFSE标记的CD8~+T淋巴细胞在CD3/CD28刺激后,CD8~+T淋巴细胞在培养体系中所占比例低于单纯的CD3/CD28诱导组(43.7%±6.7%,64.7%±8.2%;P0.05),CFSE荧光强度的改变亦低于单纯的CD3/CD28诱导组。以上结果提示我们,HIV患者外周血MDSC亚群以M-MDSC为主;Arg1是M-MDSC发挥免疫抑制作用的重要途径;HIV阳性血清可诱导MDSC向M-MDSC方向分化,且HIV诱导后的MDSC抑制CD8~+T淋巴细胞的增殖。     

复可托治疗小儿反复肺炎支原体感染的疗效及对 免疫功能和肺功能的影响

目的 探讨复可托治疗小儿反复肺炎支原体感染的疗效及对免疫功能和肺功能的影响。方法 选取我院2015年1月~2017年1月收治的88例反复MP感染患儿为研究对象,采用随机数字表法分为两组,各44例。对照组患儿给予常规治疗,观察组在对照组基础上口服复可托,对比两组患儿临床疗效、免疫指标、肺功能指标。结果 观察组总有效率为97.73%,高于对照组的81.82%,差异有统计学意义（P＜0.05）。观察组患儿IgA、IgM、IgG、CD4+、CD8+、CD4+/CD8+等免疫指标优于对照组,差异有统计学意义（P＜0.05）。观察组患儿肺功能指标FVC、FEV1、PEF、FEF25、FEF50、FEF75均优于对照组,差异具有统计学意义（P＜0.05）。结论 复可托治疗小儿反复MP感染临床疗效显著,可有效改善免疫功能和肺功能。