实用性随机对照试验及其方法学特征思考

介绍了实用性随机对照试验的概念和背景,以及它与解释性随机对照试验方法的区别,并针对国际上典型案例举例解析,进一步探索实用性随机对照试验方法学的特征。以期为根据中医临床特点寻找合适的疗效评价方法提供帮助。     

实用性临床试验与解释性临床试验的比较

临床试验的设计实用性和分解释性两种, 实用性临床试验用来衡量一种治疗方法在日常的临床实际中的效果, 而解释性临床试验是用来衡量一种治疗方法在理想条件下的治疗效能。目前国内对实用性临床试验方法介绍甚少, 本文对其特点和优缺点进行了介绍, 并以德国一项针刺疗法治疗腰背痛的实用性临床试验为例具体说明该方法实际中的具体应用, 对试验设计的关键步骤进行详细的解析, 并对实用性临床试验中的常见问题如内部准确度与外部准确度的平衡、结局的评价等问题做出了合理的建议。     

Explanatory Style Predicts Depressive Symptoms Following AIDS-Related Bereavement

The reformulated learned helplessness (RLH) diathesis–stress model of depression (L. Y. Abramson, M. E. P. Seligman, & J. D. Teasdale, 1978) was tested using the explanatory style scores of 30 gay male caregivers. Scores were derived from interviews immediately following AIDS-related bereavement. Concurrently, questionnaire measures of depressive symptoms (CES-D) and stress (Daily Hassles Scale) were taken along with repeated measures of depressive symptoms at 3, 6, 9, and 12 months following bereavement. As predicted by RLH, the interaction between Explanatory Style and Stress scores predicted subsequent depressive symptoms, with initial stress and initial depressive symptoms assuming a more powerful role early in the recovery process. Implications for treatment and future research are discussed.     

Reducing Obesity: Motivating Action While Not Blaming the Victim

Context: The rise in obesity in the United States may slow or even reverse the long‐term trend of increasing life expectancy. Like many risk factors for disease, obesity results from behavior and shows a social gradient. Especially among women, obesity is more common among lower‐income individuals, those with less education, and some ethnic/racial minorities. Methods: This article examines the underlying assumptions and implications for policy and the interventions of the two predominant models used to explain the causes of obesity and also suggests a synthesis that avoids “blaming the victim” while acknowledging the role of individuals' health behaviors in weight maintenance. Findings: (1) The medical model focuses primarily on treatment, addressing individuals' personal behaviors as the cause of their obesity. An underlying assumption is that as independent agents, individuals make informed choices. Interventions are providing information and motivating individuals to modify their behaviors. (2) The public health model concentrates more on prevention and sees the roots of obesity in an obesogenic environment awash in influences that lead individuals to engage in health‐damaging behaviors. Interventions are modifying environmental forces through social policies. (3) There is a tension between empowering individuals to manage their weight through diet and exercise and blaming them for failure to do so. Patterns of obesity by race/ethnicity and socioeconomic status highlight this tension. (4) Environments differ in their health‐promoting resources; for example, poorer communities have fewer supermarkets, more fast‐food outlets, and fewer accessible and safe recreational opportunities. Conclusions: A social justice perspective facilitates a synthesis of both models. This article proposes the concept of “behavioral justice” to convey the principle that individuals are responsible for engaging in health‐promoting behaviors but should be held accountable only when they have adequate resources to do so. This perspective maintains both individuals' control and accountability for behaviors and society's responsibility to provide health‐promoting environments.