情绪与癌症关系研究的进展

关于癌症的研究现已从生物学、遗传学领域扩展到社会学、心理学的领域。近年来．关于癌症与情绪关系问题在医学和心理学领域进行了许多的实验研究．取得了一定的追展。本文试固封相关研究的结果予以分析与总结。     

Psychiatric patients: Views on psychiatrists’ dress and address

Dress styles and forms of address vary among psychiatrists according to personal preferences. Gledhill et al. (Br J Psychiatry 1997;171;228–32) asked the patients in a London psychiatric hospital about their views on their psychiatrists’ dress and address. To survey the preferences of our patients and reproduce the study of Gledhill et al., we interviewed Norwegian psychiatric inpatients and outpatients to identify preferences for dress styles and terms of address. Our patients preferred fairly smart attire. Most patients wanted to be called by their first name; about half wanted to address their doctors by their first name and half by surname. Results were somewhat different from the London survey, but the conclusion is similar: paying more attention to the way psychiatrists interact and present themselves may facilitate the therapeutic alliance with their patients.     

Attachment in mental health institutions: A critical review of assumptions,clinical implications,and research strategies

Attachment is relevant to institutionalized treatment and the therapeutic process in three identifiable ways: (1) patients bring their mental representations of previous and existing attachment relationships to the treatment; (2) attachment is relevant to the extent to which a therapeutic alliance is established and maintained, both in terms of the mental representations of attachment in the patient and in the therapist and how these influence interactive behaviour and expectations in each partner to the therapeutic work; (3) the outcome of the treatment may be related to attachment; for example, when institutional experiences have an enduring impact on attachment representations and the future attachment behaviour of the patient. However, this brief review of attachment concepts reveals that several theoretical, conceptual and empirical questions remain to be answered before evidence-based clinical attachment guidelines can be formulated concerning patient-staff relationships.     

Parent-child emotion communication,attachment, and affective narratives

Forty-four pre-schoolers (ages 4.3 to 5.8 years) and their primary caregivers participated in a study on the connections between parent-child emotion communication and a narrative assessment of pre-schoolers' attachment. Children completed the Separation Anxiety Test (SAT), a narrative assessment of children's responses to attachment-related separations (including self-reliance, avoidance, attachment and coherence scores). Several aspects of parent-child discussions of emotion-eliciting events were also assessed in the Emotion Communication Task. Results indicated that SAT coherence was positively related to SAT attachment and negatively related to SAT avoidance. Furthermore, SAT coherence was positively related to parental scaffolding and negatively related to parental and child negativity during the Emotion Communication Task. Parental scaffolding and child reciprocity were positively related to each other and, in general, were negatively related to parental and child negativity. Discussion focused on the potential contributions of children's interactions with caregivers to the development of children's attachment narratives and emotion-related understanding.     

Aphasia blog talk: How does stroke and aphasia affect the carer and their relationship with the person with aphasia?

Background: Carers of stroke survivors with aphasia are at risk of experiencing negative bio-psychosocial consequences and reduced quality of life. So far, in aphasia studies, this has mainly been explored through qualitative interviews and questionnaires. Unsolicited first-person narratives in the form of blogs offer a novel and rich source of data to examine how stroke and aphasia affect the carer and their relationship with the person with aphasia.

Aims: This study explored how carers of people with aphasia perceive their roles and responsibilities; it also examined the consequences of carrying out these carer roles and duties, in terms of both the carer’s own well-being and their relationship with the person with aphasia; furthermore, it investigated facilitative factors in their adaptation to the carer role.

Methods & Procedures: Publically available blogs written by carers of aphasic stroke survivors, which included information on how stroke and aphasia affect the carer and their relationship with the person with aphasia, were analysed using the Framework Method.

Outcomes & Results: The search resulted in nine carer blogs. The number of posts per blog ranged from 13 to 241. For blogs containing over 90 posts, the first and last 30 relevant posts were collected and analysed. New roles and extra responsibilities identified by participants included having to act as therapists, nurses, counsellors, and administrators and carrying out tasks usually assigned to the other person in the relationship. The extra tasks and duties impacted on the carers’ quality of life and their relationship with the person with aphasia in negative ways, such as leading to physical and mental exhaustion, health issues, feeling lonely, and resentful of their circumstances; however, participants also identified positive changes such as new closeness, new appreciation of life, and pride in achievements. A variety of strategies emerged from the data that helped carers adjust to their new roles. Strategies included positive reframing, allocating time to oneself, and seeking support from family and friends. The activity of blogging was also mentioned as having beneficial effects on the carers’ well-being.

Conclusions: The study provides further evidence for the specific challenges faced by carers of people with stroke and aphasia; it thus confirms the importance of addressing carer related needs in intervention and considering psychosocial well-being for both the carer and the person with aphasia.     

Oncology patients' experience of a routine surveillance CT examination: Relationships and communication

IntroductionThe question of radiographers' capacity to establish short time relationships as well as decoding patients' needs and expectations simultaneously with performing high technological examination frequently arises in the clinical practice. Additionally, the constant focus on technology and the fact that radiographers work in high productive departments accentuates the issue. Patients' experiences with radiology seem to be a neglected area of research and may help to identify areas for improvement in this highly technological and productive field. The purpose of the study was to explore oncology patients’ experiences of a routine surveillance CT examination and their need for relationships and communication with the radiographer as part of the CT examination.MethodsThe study included patients diagnosed with cancer and in need of a CT examination as part of their course of treatment, and 21 semi-structured interviews were conducted. The interviews were analysed using qualitative content analysis. Themes were constructed and narratively reported. To increase validity, the themes were identified, discussed and formulated by the author group.ResultsFour themes were constructed based on the analysis: 1: The professional radiographer, 2. Disease and treatment, 3. The examination environment and 4: While waiting.ConclusionThe lack of focus on radiographers' capacity to establish relations, to consider each patient as an individual human being and being able to show sincere interest and empathy were highlighted. Findings illuminated the patient's need for relationship and communication with the radiographer as part of a CT examination.     

Attachment Insecurity and Sexual and Relational Experiences in Saudi Arabian Women: The Role of Perceived Partner Responsiveness and Sexual Assertiveness

BackgroundAttachment and intimacy play an important role in shaping sexual and relational experiences. Yet, their interrelation has rarely been investigated in the context of sexual problems and never been tested in Saudi Arabian women.AimThe present study examined the interrelations of attachment orientation and sexual function, distress, satisfaction, and relational satisfaction in a sample of Saudi Arabian women and explored whether this link can be explained by 2 important aspects of (sexual) intimacy, namely perceived partner responsiveness (PPR) and sexual assertiveness.MethodThis is a cross-sectional, observational study in a sample of 50 heterosexual women with sexual problems and 50 control women without problems, who completed an Arabic version of questionnaires on attachment orientation, sexual assertiveness, PPR, relationship satisfaction, sexual satisfaction, sexual distress, and sexual function.ResultsWe found that both attachment anxiety and sexual refusal showed a significant association with the level of sexual function, sexual distress, and sexual satisfaction (P < .01) in the clinical group. No mediating effects of sexual refusal were found. In the control group, sexual function, sexual distress, and sexual satisfaction were predicted by attachment avoidance (P < .01). Level of sexual function was also predicted by sexual initiation (P < .05). PPR fully mediated the association between attachment anxiety and relational satisfaction in the clinical group (P < .01), while in the control group the link between attachment avoidance and relational satisfaction was only partially mediated by PPR (P < .01).Strengths & LimitationsThis study offers unique information on relational and sexual functioning in a culture in which sexual expression and intimate behavior are restricted, particularly in women.Clinical ImplicationsPerceiving the partner as being more responsive is an important target of intervention to increase satisfaction with the relationship.ConclusionsOur results suggest that attachment anxiety and low sexual assertiveness, as indicated by lower tendencies to refuse sex when not desired, play a significant role in predicting negative sexual experiences in women who cope with sexual difficulties.Attaky A, Kok G, Dewitte M. Attachment Insecurity and Sexual and Relational Experiences in Saudi Arabian Women: The Role of Perceived Partner Responsiveness and Sexual Assertiveness. J Sex Med 2020;17:1383–1394.     

以“不抛弃、不放弃”弥合医患关系的裂隙

汶川地震中医护人员所体现出的“不抛弃、不放弃”的精神，为中国医德建设注入了新内涵，对弥合当前医患关系裂隙、促进和谐医患的构建具有重要的价值。文章从伦理与法律层面来审视医患关系，侧重要求医生不断解决医患关系中出现的新问题、新矛盾，正视总结新经验。指出在中国伦理本位的传统下，医患关系的和谐不可能重复西方法制模式路径，应该通过德法相济和提高社会责任感的过程来建立良好的医患关系。     

关于设立医疗损害赔付基金的建议和思考

依据医学界在治疗疾病过程中医源性疾病和医源性损害不可能完全避免性，为保证医疗消费公平、公正，防止医疗纠纷不断升级的势头，提出“设立医疗损害赔付基金”的建议。医疗损害赔付基金的来源应由医务人员、医疗机构及医药产品的生产、销售企业共同承担，基金的赔付应实行有限补偿、部分损害陪付、特殊病种拒付及损害和责任分享等原则。文章同时就赔付程序及有关细节问题提出相关建议。