文化与文化能力：浅析医学人类学对医学人文教育的贡献

中国日益恶化的医患关系让人们对医学院现行的人文教育提出了质疑。加强人文教育,培养医学生人文素养的呼声渐起。本文针对目前医学人文教育界所提出的诸多建议,并基于笔者的医学人类学教育实践,围绕北美医学院教育中的"文化能力"和文化人类学中"文化"两个重要的概念展开,简要论述了医学人类学对医学人文教育的贡献。笔者认为医学人类学以其显著的实践性、本土性和反思性,有效地贡献于医学人文教育中对具有移情式关爱能力的临床医生培养的长远目标,可以更好地推动"生物-文化"这一现代医疗模式指导下的临床实践。     

‘Look,think and act’: facilitating learning with people who have mental illness

This project responded to the concerns of experienced community health workers who worked with people who had mental illness and resided in Supported Residential Facilities (SRFs) in South Australia. They had identified that urinary and faecal incontinence was common for this group of people and yet it was an issue that had not previously been addressed. The aim of the research was to develop continence promotion strategies specifically for community dwelling people who have mental illness. The aim of this article is to articulate the authors' reflections of the way learning was facilitated by collaboratively researching with people who have debilitating and enduring mental illness. The authors facilitated 10 Participatory Action Research (PAR) group meetings with people with mental illness and who experienced incontinence during 2002. Using a collaborative research process, participants were facilitated to ‘look, think and act’. That was to look at possible reasons for incontinence, identify self–management strategies and to take action to achieve self-selected goals. In this way, participants sought practical strategies for lifestyle modification and awareness raising, with a strong chance of successful uptake.     

浅论现代护理的问题与对策

随着全民整体文化素质和物质生活的不断提高,人们不再单纯满足于传统的护理技术服务,而是对医护人员有了更高的要求,希望得到更高层次的服务,更多地重视心理因素、环境变化和预防保键。因此,护理功能要从单纯的疾病护理型逐步向临床护理、预防、心理、康复、保键综合型护理转变。本文针对不同要求,加以分析、讨论,并提出护理对策。     

Cultural and Gender Biases in Definitions of Mental and Emotional Health and Illness

This article discusses how cultural and gender bias in definitions of mental and emotional health and illness create critical issues for counseling research.     

Factitious Disorder by Proxy in Educational Settings: A Review

Factitious disorder by proxy (FDP), historically known as Munchausen syndrome by proxy, is a diagnosis applied to parents and other caregivers who intentionally feign, exaggerate, and/or induce illness or injury in a child to get attention from health professionals and others. A review of the recent literature and our experience as consultants indicate clearly that FDP has emerged in educational settings as well. Variants of educational FDP include parents of children with real or fabricated physical disabilities who request excessive or unneeded school health services and parents who request extensive education-related evaluations for children who do not demonstrate any educational need. If such cases continue to emerge, school districts will be asked to test more students who do not have disabilities under the Individuals with Disabilities Education Act. Also, special educational directors will be weighing the cost of providing unneeded testing and educational services against the cost of defending themselves in litigation to prove that the testing and services are unnecessary. A table of guidelines is provided for school and other personnel confronted with repeated requests for unwarranted special education services. Suggestions for future research are included.     

大学生依恋类型与心理健康的关系

通过使用亲密关系体验问卷和症状自评量表（SCL-90）对215名大学生进行了调查,探讨了大学生依恋类型与其心理健康之闻的关系。研究表明大学生依恋类型与其心理健康之间有密切关系。其中专注型男女在躯体化、抑郁、焦虑、偏执、精神病性和其他因素上存在显著差异,冷漠型男女只在抑郁上存在显著差异;只有恐惧型恋爱与没有恋爱在人际关系、敌对、精神病性和其他因素上存在显著差异;安全型与不安全型只有在躯体化水平上差异不显著,在其他各水平上均达到显著。     

Who cares about the bullies?

Children who bully have learned to use their power and aggression to control others, a mode that is not conducive to healthy relationships either in the present or in their future lives. Furthermore, there is evidence that children who bully are also likely to have mental health problems that persist into adult life. There are also wide social and cultural differences in how bullying is perceived and defined. The values and norms of the culture itself strongly influence the behaviour of perpetrators. In this article, we discuss how educators and health care professionals can use this knowledge to help young people who bully develop deeper understanding of themselves and their relationships with others.     

老年门球爱好者情绪稳定性测定与分析

通过实验法、问卷调查法、文献资料法和数理统计法等研究方法,用情绪稳定性测定仪对老年门球爱好者进行情绪稳定性测定分析.测定结果发现,经常参加门球运动和比赛的老年人情绪稳定性较好,说明门球运动能给老年人带来健康,并能减少疾病的发生.建议老年人科学、合理、持续性地参加体育锻炼,调节身心,提高生活质量.     

Minor Illnesses,Temperament, and Toddler Social Functioning

Research Findings: Minor illnesses, such as upper respiratory infections, stomachaches, and fevers, have been associated with children's decreased activity and increased irritability. This multi-method investigation of 110 day care–attending children examined whether experience with recurrent, minor illnesses and negative emotionality worked together to predict young children's social functioning. Minor illness experience was assessed via weekly health screenings conducted by nurses. Toddlers' negative emotionality and social behavior were assessed using mothers' and fathers' reports. The two dimensions of negative emotionality and minor illness experience operated in different ways to predict children's functioning. Toddlers rated as more temperamentally angry displayed less social competence, especially when they also experienced high proportions of minor illness. Temperamentally fearful children exhibited more externalizing problems when they experienced a higher frequency of illness, whereas fearfulness was not associated with externalizing problems for children who were not frequently ill. Practice or Policy: Children's frequent experience with minor illnesses combined with negative emotionality appears to place toddlers at a heightened risk for exhibiting behavior problems. These findings have implications for child and family well-being as well as interactions with child care providers and peers within child care settings. Interventions could be developed to target “at risk” children.     

The Longitudinal Link Between Student Health and Math Achievement Scores

This study investigated the relationship between health conditions suffered over time and student scores on the Stanford Achievement Test 9 in Yuma County, Arizona, public grade schools. The majority of children in Yuma County were of Hispanic origin. The poverty and low income status of most of these children placed them at greater risk for health problems. The primary purpose of the study was to ascertain how the rate of math achievement of students who suffered from an illness or injury prior to testing compared to those students who had no known illness or injury. Findings suggested that physical illness influenced math achievement trajectories adversely. Importantly, the achievement gaps associated with several health conditions attenuated over time. However, children who experienced an injury or poisoning, or an endocrine, nutritional, or metabolic disease developed permanent math achievement deficits.     

职场冷暴力论

职场冷暴力是人际冷暴力的一种,即指职场中人际之间用非武力的方式进行伤害,造成人们精神痛苦以及环境窘迫。其常见的类型有：同事之间的漠视和冷言、领导的重压或架空、遭遇心理疾病患者、绯闻和谣言等。它危害集体事业,伤害个人身心健康。消除和纠正这种现象应该成为单位文化建设的一个重要方面,也是建设和谐社会的重要内容。     

Stretching the Boundaries: Schools as Therapeutic Agents in Mental Health. Is it a Realistic Proposition?

It seems self-evident to suggest that our schools should play a part in the identification and the response to school-age pupils with mental health problems/mental illness. Schools have a number of unique advantages as both preventative and curative agents in the mental health discourse. The notion of schools playing an extended role in the health, mental health and safety of children, enshrined in the UK Children Act, 2004, has resulted in further demands on educational professionals to meet a broader care agenda. The school as a site for mental health work appears to be an enlightened rather than radical proposition, yet often there are cultural and systemic barriers to implementation. This article aims to highlight some of the main obstacles to the promotion of therapeutic interventions in schools and proposes that there is a considerable gap between the rhetoric of joint-agency cooperation and the reality of applying mental health strategies in an educational setting. A number of recent UK government programmes have reflected a shift in thinking towards adopting more therapeutic interventions and this is particularly evident in the primary school strategies to improve behaviour and attendance. In tandem, Child and Adolescent Mental Health Services have, through training initiatives and the use of primary mental health workers, actively promoted mental health issues in schools. Yet, despite these initiatives, it is arguable that many schools remain ill-equipped to recognize and respond to mental health problems in school-age children. I believe that schools have a pivotal role to play, but there must be fundamental changes before effective change can take place.     

An evaluation of the educational support for teachers who teach children with life-limiting illness in schools

There are increasing numbers of children living with life-limiting illnesses in mainstream schools. The aim of this literature-based study was to evaluate the current provision of educational support for teachers who are teaching these children in schools. An international literature search produced 23 papers published between 2005 and July 2010 that concerned children with life-limiting illness in relation to education in mainstream schools. The analysis identified that the needs of children with life-limiting illnesses are not being well met, and there appears to be little evidence of educational support for teachers. The paper concludes that schools need to work with both the medical and social models of health/disability in order to meet the needs of children with life-limiting illness. There is some consensus that the way forward needs to include multidisciplinary working within an ecological approach that supports home, schools and the health services working together. Only one paper reported an evaluation of such an intervention. There is a need for more research, evaluation and dissemination about the experience of living with a life-limiting illness in mainstream schools and related interventions, and for this to inform professional education and the coordination of education, health and home systems.     

Culturally Responsive Counseling for Asian Americans: Clinician Perspectives

Research has consistently found acute mental health treatment disparities among Asian Americans. One proposed reason for the underutilization of mental health services by Asian Americans is that available services are not culturally competent. This exploratory study presents qualitative data gathered from interviews with professional counselors who serve Asian American clients. Findings revealed significant barriers to counseling due to cultural stigma and shame, suppression of emotions, and communication gaps between clients and counselors. In response, clinicians frequently made adjustments to therapeutic approaches to accommodate the cultural beliefs and practices of clients and families. Implications for practice and research are discussed.     

The role of managed mental health care in counseling gifted children and families

This study examined the role of managed mental health care in the counseling of gifted children and families. When gifted children and their families experience difficulties resulting from giftedness, they have the option of choosing a private provider, although cost is often prohibitive. Moreover, when insurance is used to offset the cost, most mental health insurance policies have a managed care component. One requirement of managed care is that services be medically necessary to alleviate a recognized mental illness diagnosis. Problems resulting from giftedness may not be recognized as a mental illness. As a result, insurance may not pay for these counseling costs. However, this does not have to be the case because of the flexibility managed care case managers have to make judgments. 40 managed care case managers were surveyed to address this issue. 14 of the case managers consented to individual interviews. The results indicate that some case managers would approve reimbursement and others would not. The study describes criteria and conditions that need to be met for reimbursement.     

Counselling skills training for adolescent health: A WHO approach to meet a global need

In recent years as public health measures such as improved sanitation, water supply, and immunization have taken effect in developing as well as economically developed countries, there has been an increase in attention to health problems arising from voluntary behaviour such as sexual activity and substance abuse rather than simply from passively acquired infection. This is of special relevance to adolescents who have generally been given lower priority in health services because they are relatively disease-free yet whose patterns of behaviour have great significance for their present and future health. However establishing or changing health behaviour during the dynamic period of adolescence can be difficult especially when the environment is rapidly changing too. This is especially so in developing countries where the traditional directive approach to guidance may need to give way to a somewhat more non-directive style of counselling in order to accommodate greater adolescent autonomy, without loss of fundamental cultural values. Because few people in developing countries are experienced in such techniques WHO has developed a module for training counselling skills for adolescent sexual and reproductive health which preserves culture specificity in a non-directive approach and uses behavioural techniques to train communication microskills.     

Counseling Vietnamese refugees: the new challenge

In working with Vietnamese American refugees the mental health worker needs to be knowledgable of and sensitive to several areas: (1) the cultural history and history of the migration experience of the group; (2) the group's mental health dispositions; (3) cultural and systemic biases affecting counseling; and (4) the role of paraprofessionals.Some of the cultural factors affecting the utilization of mental health services are saving face, stoicism, respect for authority and discrimination which may cause them to seek help only at advanced stages of illness.Mental health counseling in the United States has run into some difficulty in serving the refugees as it has been mainly a white middle class profession that has focused on the individual which can be considered culturally biased when dealing with family centered Vietnamese Americans.For the reasons previously stated, in addition to language difficulties and cultural differences, many agencies employ indigenous paraprofessionals. While it is beneficial there are also problems to be considered.Recommendations for addressing these problems include: (1) the development of a community education and prevention program by actively involving ethnic community leaders in the planning process; (2) supporting ethnic community leaders; (3) training indigenous paraprofessionals about the mental health care system; (4) providing mental health services through medical care facilities; and (5) focusing on family therapy as oppossed to individual therapy.Prepared for presentation at the International Round Table for the Advancement of Counselling, University of Utrecht, The Netherlands, July 15–19, 1985.     

试论太极拳抗衰老的机理

太极拳在扶植体内正气,疏通气机,引气活血,舒活筋骨,营养精神方面是优于其他体育项目的,对中、老年人或病患者来说,更是如此,这种动静结合的太极拳确是扶正祛邪,防病健身,抵抗衰老,延年益寿的良剂佳药．     

Do you hear voices? Problems in assessment of mental status in deaf persons with severe language deprivation

When mental health clinicians perform mental status examinations, they examine the language patterns of patients because abnormal language patterns, sometimes referred to as language dysfluency, may indicate a thought disorder. Performing such examinations with deaf patients is a far more complex task, especially with traditionally underserved deaf people who have severe language deficits in their best language or communication modality. Many deaf patients suffer language deprivation due to late and inadequate exposure to ASL. They are also language dysfluent, but the language dysfluency is usually not due to mental illness. Others are language dysfluent due to brain disorders such as aphasia. This paper examines difficulties in performing a mental status examination with deaf patients. Issues involved in evaluating for hallucinations, delusions, and disorganized thinking are reviewed. Guidelines are drawn for differential diagnosis of language dysfluency related to thought disorder vs. language dysfluency related to language deprivation.