美国中东政策评析

美国在中东遇到大麻烦,主要战略目标未能实现。伊拉克安全形势持续严峻,巴以和谈停滞不前,伊朗核问题难以解决,压叙利亚屈服迄未奏效,恐怖活动越反越多,大中东改造计划受挫。美遇到的困难未超出其承受能力,美国在中东仍居主导地位,美中东政策在手法和策略上有所调整,实质上并无变化。     

Responsiveness and calibration of the general well-being adjustment scale in patients with hypertension

We examined the discriminant ability and responsiveness of the General Well-Being Adjustment Scale in patients enrolled in a randomized clinical trial of antihypertensive therapy. We also tried to translate the effects of physical symptoms on general well-being. This secondary analysis used demographic, clinical, physical symptom, and general well-being data for 545 white, male hypertensive patients. General well-being was measured by the General Well-Being Adjustment Scale (GWB) collected on 2 occasions over 8 weeks of treatment. Patients with any one of 14 physical symptoms or problems, compared to those without symptoms, had lower GWB scores (p < 0.003 to p < 0.0001). Decreases of 2.83–8.76 points in GWB scores were observed in patients developing physical symptoms over the 8 week study period (p < 0.05 to p < 0.0001). These effects were demonstrated in patients developing cold sensitivity, sexual problems, chest pain, shortness of breath, loss of taste, nausea, hot or cold spells, numbness and tingling, dry mouth, blurred vision, and dizziness. We conclude that the GWB is responsive to clinically meaningful changes in symptoms and may provide a more complete evaluation of the effects of medical treatment. The GWB is a valid and responsive measure of health status outcomes in the evaluation of antihypertensive treatment.     

Decreased sensitivity to experimental pain in adjustment disorder.

An altered perception of pain has been described for several psychiatric disorders. To date the influence of adjustment disorders (AD) on pain perception has not been described. Here, we investigated perception of experimentally induced pain in 15 patients suffering from AD (subtype with depressive symptoms) and controls matched for age and sex. Thresholds and tolerances were assessed for thermal and electrical pain on both sides of the body. We found an overall increase of pain thresholds and tolerances in AD patients as compared to controls, predominately on the right side of the body. Analogue findings have been reported for pain perception in major depressive disorder (MDD). Of the data obtained, only thermal pain threshold on the right arm correlated with the severity of depressive symptoms. Although the underlying pathology is elusive it is likely that the mechanisms for reduced pain sensitivity are comparable in MDD and AD.     

Psychological reactions in patients with early rheumatoid arthritis

We report the interaction of RA and psychological factors over 2 years in a group of 89 patients with newly established disease. Short-time outcome regarding physical features was fairly good. Disease activity decreased, and disability evaluated by HAQ remained at a low level. Psychological distress as measured by the depression and anxiety subscales of SCL 90 (Symptom Check List) was not very pronounced and not related to disease state factors. A slight decrease of anxiety was recorded after 2 years. A new adjustment test was applied. It contained 13 items focused mainly on negative illness effects such as loss of independence, feelings of guilt, and change of social and leisure time activities. Three factors (regret of lost life values, dysphoric mood, and acceptance) explained 48% of the variance of the 13 items. The validity of the test was acceptable. The patients' degree of adjustment changed slowly or not at all during the 2 years.     

Assessing Residents’ Perceptions of Their Relocation to Long-Term Care: Psychometric Validation of the View of Relocation Scale

ObjectivesRelocation to long-term care is a major challenge for older people. The View of Relocation Scale (VRS) was developed to address the need for a brief instrument to assess residents’ perceptions of the relocation.DesignSecondary analysis of data collected in a cluster randomized trial. The psychometric properties of the VRS examined in this study included factorial structure (using exploratory factor analysis), unidimensionality (Rasch modeling), internal consistency reliability (Kuder-Richardson Formula 20, squared multiple correlations, and item-total correlations), and known groups validity (analysis of variance). The results were used to identify the psychometrically most robust items for inclusion into the final version of the instrument.Setting and ParticipantsParticipants were 202 long-term care residents in Melbourne, Australia (mean age = 85.52 years, standard deviation = 7.33), who had relocated to the facility a mean of 4.4 weeks previously. Residents with moderately severe and severe dementia were excluded.MeasuresThe VRS was developed following a review of the literature describing residents’ views of relocation and was designed for administration shortly after their relocation.ResultsThere was support for a 2-factor, 10-item solution, with separate subscales assessing Perceived Control (degree of control in the decision making and planning for the relocation) and Perceived Need (perceived need for the relocation to long-term care). Participants who were admitted directly from hospital reported higher perceived need but lower perceived control than those admitted to the facility from home.Conclusion and ImplicationsThe VRS can be used to understand the impact of older people's perceptions of relocation to long-term care on their subsequent adjustment and well-being, and to identify those who may benefit from tailored support.     

大学新生适应状况的定性研究

目的 了解定性研究方法在大学新生适应状况研究中的应用价值和特点,为开展新生教育提供依据。方法 应用定性研究专题小组讨论的方法,对某高校新生适应状况进行调查。结果 大学生普遍能接受专题小组讨论的调查形式;定性研究显示,大学新生存在适应问题,学生的适应状况可能与专业、性别及人格特点有关;新生有愿望从学校获得帮助以解决适应问题和缩短适应期。结论 专题小组讨论的方法适用于探讨大学新生的适应问题,可以为深入研究提供线索。     

Responding to the existentials of non-life-threatening chronic conditions

Diagnosis of a major life-threatening illness can prompt a range of existential responses that typically include strong emotions and a reassessment of priorities. What has not attracted attention are the existential responses to being told about less major but permanent medical conditions. A conceptual frame is developed for identifying and speaking about the existential dynamics of permanent change. It introduces two key concepts, finitude and transcendence, and uses them to explain the common sequence of responses first from being told about a chronic condition through to when its presence has become integrated into everyday life. Based on this analysis, a range of recommendations are provided on what types of conversations are helpful through the various stages of adjustment.     

通过调整脊柱治疗臀上皮神经综合征的临床观察

目的观察通过调整脊柱的方法来治疗臀上皮神经综合征的疗效。方法将65例臀上皮神经综合征患者按就诊顺序随机分为对照组(32例)和治疗组(33例)。对照组患者给予基本手法治疗,治疗组在对照组基础上再给予调整脊柱法。两组均以10次为1个疗程,共2个疗程,治疗结束后比较两组疗效。结果治疗组治愈率为93.94%,对照组为56.25%,治疗组疗效明显高于对照组,且治疗组起效时间明显快于对照组,不易复发。结论通过调整脊柱治疗臀上皮神经综合征疗效明显、安全可行。     

Effectiveness of Reinduction and/or Dose Escalation of Ustekinumab in Crohn’s Disease: A Systematic Review and Meta-analysis

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