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The Contribution of Social Network Interaction System on Maternal Depression and Acceptance of Cleft Lip and/or Palate Infants: Moderating Effect and Main Effect
No full text生出唇顎裂兒的母親需面對新生兒顏面、生理雙方面的長期照養問題，因此母親本身之心理適應是值得深入探討的議題。本研究由「社會網絡互動系統觀」的角度切入，探討（1）正負向的社會網絡互動（社會支持與社會困擾）、（2）不同社會網絡互動類型（情緒、訊息與工具性）、（3）不同社會網絡來源（丈夫、父、母、公、婆）等三個面向對於唇顎裂兒母親的憂鬱情緒與對嬰兒的接納態度的調節（緩衝或惡化）效果與主要效果。共有50位進行過第一次唇修補手術的唇顎裂兒（平均年齡135天）及49位一般新生兒（平均年齡49天）之母親參與研究。本研究先比較這兩組母親於社會網絡互動系統中之各面向、憂鬱情緒以及對孩子的接納態度之差異。再以階層迴歸分析檢驗在排除了唇顎裂組母親於第一次修補手術之前的「初始衝擊」程度後，唇顎裂兒手術後母親所「覺知到的社會網絡互動系統」對其憂鬱情緒與接納態度的預測力。結果發現，兩組受試母親的憂鬱程度與接納程度沒有顯著差異，但相較於一般新生兒母親，唇顎裂兒母親覺知到較多支持。而且，唇顎裂兒母親的社會支持對於接納態度有顯著預測力；而社會困擾則同時對接納態度與憂鬱情緒都有顯著預測力，其與初始衝擊的交互作用也對接納態度有負向預測力，這些結果顯示了社會支持的主要效果及社會困擾的主要效果及惡化效果。本研究另發現情緒及訊息支持與接納態度有顯著相關，而訊息困擾與憂鬱情緒有顯著相關，丈夫的支持對於母親的接納態度有顯著預測力，而公婆與丈夫帶來的困擾都與母親的憂鬱情緒有顯著相關。本研究的結果符合社會困擾會影響正向心理適應指標的跨越效果假設，也顯示社會困擾對於唇顎裂兒母親的心理適應有獨立於社會支持之外的預測力。本研究另指出了特定類型的社會支持、困擾對唇顎裂兒母親的影響，以及華人家庭中所提供之社會網絡互動對唇顎裂兒母親心理適應的效果，並據以提出了在臨床介入時的具體建議。Mothers of cleft lip and/or palate (CLP) infants have to face chronic facial, physical, and psychological problems of their children. The psychological adjustment of those mothers thus is worth in-depth investigations. The present study adopted a system approach of social network interaction investigating (1) the positive/negative feature (i.e., social support and social undermining), (2) the types (i.e., emotional, informational, and instrumental support/undermining), and (3) the resource (i.e., husband, parents, and parents-in-law) of social network interaction. The goal was to examine the moderating effect (i.e., buffering or exacerbating) and main effect of the social network interaction system on maternal depression and attitude toward accepting the CLP child. Fifty mothers of CLP infants, who have already finished the first lip repair surgery (mean age = 135 days), and 49 mothers of healthy infants (mean age = 49 days) participated in this study. Between-group comparisons with respect to the perceived social network interaction system, the degree of depression, and acceptance toward the CLP infants were conducted. Mothers of CLP infants perceived more social support but were not more depressed or less accepting compared with those in the healthy group. Hierarchical regression analysis on the predictability of social network interaction system to degrees of depression and acceptance indicated that perceived social support significantly predicted the degree of acceptance; while perceived social undermining predicted both acceptance and depression, and its interaction with maternal sense of personal impact over giving birth to CLP infants predicted acceptance negatively. These findings supported the main effect of social support and the main and exacerbating effect of social undermining. This study also found that emotional and informational support were correlated with acceptance, informational undermining with depression, support from husband with acceptance, and social undermining from husband, mother-in-law, and father-in-law with depression. On the whole, this study supported the cross-over effect hypothesis of social undermining and suggested social undermining has a unique contribution, both in terms of main effect and moderating effect, toward maternal psychological adjustment of CLP infants. Moreover, this study also demonstrated that maternal adjustments were most vulnerable to several particular types of social support and social undermining, which may be related to the social network and interaction pattern embedded in Chinese family structure. Clinical suggestions derived from findings of this study were also provided.第一章 緒論 …………………………………………………………1
第一節 唇顎裂……………………………………………………3
第二節 唇顎裂新生兒母親的初始衝擊………………………………5
第三節 唇顎裂新生兒母親的心理適應…………………………6
第四節 社會網絡互動與心理適應 ……………………………9
第五節 唇顎裂新生兒母親的社會網絡互動系統 ………… 18
第六節 研究目的與假設 ………………………………………… 22
第二章 研究方法 ………………………………………………… 26
第一節 研究對象 …………………………………………… 26
第二節 研究程序 …………………………………………… 27
第三節 研究工具 …………………………………………… 29
第三章 研究結果 ………………………………………………… 36
第一節 對照組與唇顎裂組的差異分析 …………………… 36
第二節 社會網絡互動系統問卷之各分量表間及其與各項心理
指標間的相關分析 ………………………………… 39
第三節 唇顎裂兒母親在修補手術後之社會網絡互動系統對接
納及憂鬱的預測力…………………………………… 43
第四節 情緒、訊息與工具性的支持與困擾對唇顎裂兒母親憂
鬱與接納之預測力 ………………………………… 45
第五節 家族和丈夫的支持與困擾對唇顎裂兒母親憂鬱與接納
之預測力 …………………………………………… 48
第四章 討論 ……………………………………………………… 52
參考文獻 …………………………………………………………… 61
附錄 ………………………………………………………………… 70
附錄一 致唇顎裂兒母親之邀請函 ………………………… 70
附錄二 第一階段之研究問卷說明 ………………………… 71
附錄三 家庭背景資料 ……………………………………… 72
附錄四 社會網絡互動系統問卷 …………………………… 7
The Association between Testosterone Related Markers and Aging Males' Symptoms Scale
No full text前言
男性血液中的睪固酮濃度會隨著年齡而下降，因而產生一些相關症狀。生殖腺官能低下(Hypogonadism)即代表了血液中睪固酮不足的狀況。而晚發性生殖腺官能低下(late-onset hypogonadism, LOH)即表示除了血液中睪固酮濃度不足以外，還加上有相對應的症狀。老年男性症狀量表即用來評估相對應的症狀。之前有一些研究探討了它與血液中睪固酮濃度的相關性，但是結果都很不一致。因此本研究主要目的試探討睪固酮與其相關生物標記和男性老年症狀評量表之相關性。此外，本研究也探討是否有其他因子會干擾此相關性。
方法與研究對象
本研究納入了774位40歲以上，於2008年十一月至2009年十月間至台大醫院接受自費健檢的男性。他們均回答了老年男性症狀評量表，也接受抽血檢測，包含睪固酮在內的多項生化值。睪固酮的絕對值被分為三等分，此外，本研究創造了兩個生物標記，即生物可利用睪固酮比例(bioavailable testosterone ratio, BTR)與游離睪固酮比例(free testosterone ratio, FTR)。本研究的結果即老年男性症狀量表，將其依嚴重度雙切。此外，一些其他重要的變項也一起放入模式中調整。統計使用邏輯斯回歸進行資料分析。
結果
睪固酮會隨著年齡增加而降低（此趨勢的p值小於0.0001）。被三等份的睪固酮與老年男性症狀量表的相關性十分不一致也不穩定。相反的，較高的BTR與FTR產生精神性症狀的危險性較低（BTR調整後的勝算比為0.98, 95%信賴區間 0.97-0.99，FTR調整後勝算比為0.62, 95%信賴區間0.40-0.95）。同樣的，較高的BTR與FTR產生總和症狀的危險性也較低（BTR調整後的勝算比為0.94, 95%信賴區間 0.90-0.98，FTR調整後勝算比為0.25, 95%信賴區間0.08-0.72）。而當使用多項邏輯斯回歸分析時也得到相似的結果。一些重要共變項，如：高血壓、高血脂、高尿酸、婚姻狀態、年紀、與C反應蛋白(CRP)等，與睪固酮並不存在交互作用，其交互作用p值均大於0.05。
討論
由於平均年齡增加，老年已變成一個重要的議題。LOH會使得健康相關的生活品質惡化，因此在無禁忌症且有正確診斷的情況下，可以考慮給補充睪固酮。過去的研究大多以睪固酮的絕對值來分析研究而得到了不一致的結果，因此對LOH的診斷較無幫助。BTR與FTR為兩個相對穩定的生物標記，可代表一段時間內的睪固酮分布，在本研究中它顯示了與老年男性症狀評量表的精神症狀一致且穩定的保護相關性。睪固酮可以穿過腦-血管-障蔽並與腦內的睪固酮受器作用，因此會影響人類的情緒與精神狀況。至於其他的重要共變項則不存在與BTR, FTR的交互作用。
結論
本研究顯示，BTR與FTR與老年男性症狀評量表中的精神領域與總和症狀有保護性的相關性。相反的，睪固酮的絕對值則顯示出不一致且不穩定的相關性。因此，使用BTR與FTR應該可以幫助泌尿科醫師在診斷 LOH並進一步給與治療時更有實用價值。Introduction
Serum testosterone can be classified as sex hormone binding globulin (SHBG)-bound, albumin-bound and free forms. The latter two combined are termed bioavailable testosterone. Testosterone decreases with age and thus causes related symptoms. Hypogonadism indicates the condition of decreased serum testosterone. Late-onset hypogonadism (LOH) has been used to describe hypogonadism in combination with its related symptoms. The crude prevalence is about 12% in Taiwan. Aging males’ symptoms scale (AMS) has been used widely to evaluate symptoms related to hypogonadism. Its association with serum testosterone has been studied with inconsistent conclusions. Our aim is to explore the association between serum testosterone related markers and the symptoms of hypogonadism. In addition, this study also explored other factors which may interfere with the association.
Materials and Methods
This was a cross-sectional study. A total of 774 men aged 40 years or older were recruited from the self-paid health checkup service at National Taiwan University Hospital (NTUH) from November 2008 to October 2009. All of them completed the AMS and blood sample was collected to determine serum testosterone level along with other biomarkers. Absolute value of testosterone was tertiled and two testosterone-related markers were created, bioavailable and free testosterone ratio (BTR, FTR). The outcome of this study was AMS, and it was dichotomized by severity. Other covariates were also adjusted in the study. Logistic regression and multinomial logistic regression analyses were used for data analysis.
Results
Testosterone decreased with age (p for trend <0.0001). The association between tertiled testosterone and AMS was inconsistent and unstable. In contrast, higher BTR and FTR showed a decreased risk of developing psychological symptoms (AOR for BTR=0.98, 95% CI=0.97-0.99; AOR for FTR=0.62, 95% CI=0.40-0.95). Higher BTR and FTR were also associated with decreased risks of developing severe overall symptoms (AOR for BTR=0.94, 95% CI=0.90-0.98; AOR for FTR=0.25, 95% CI=0.08-0.72). Similar results were also found by multinomial logistic regression. However, effect modification by some covariates, e.g., hypertension, hyperuricemia, hyperlipidemia, CRP, marital status and age, were not significant.
Discussions
Lifespan has expanded nowadays so aging has become an important issue. LOH may deteriorate health-related quality of life so testosterone replacement therapy can be considered if correct diagnosis is made, and no contraindication exists. Previous studies used absolute value of testosterone to analyze its association with symptoms, but the conclusions were inconsistent. In our study, BTR and FTR were two stable biomarkers which were consistently associated with psychological AMS. Testosterone can cross the blood-brain-barrier and act on the androgen receptors in the brain. Therefore, decreased testosterone is associated with the development of psychological symptoms. Other covariates were also adjusted in this study. However, none of them significantly modified the association between testosterone related markers and AMS.
Conclusions
Bioavailable and free testosterone ratios (BTR and FTR) were significantly associated with psychological and total AMS with a protective effect. In contrast, the association between absolute value of testosterone and AMS was inconsistent and unstable. Therefore, BTR and FTR can help urologists in making correct diagnosis of LOH
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
koamabayili/VECTRON-author-checklist: VECTRON author checklist
No full textWe have done our best to complete the author checklist relating to the use of animals in the hut study. Note that the objective for the hut study was to evaluate the IRS treatment applications for residual efficacy against Anopheles mosquitoes, including the local An. coluzzii mosquito population. Cows were only used to attract mosquitoes into the huts and no tests were carried out directly on the cows. The author checklist is intended for use with studies where experiments are carried out on animals, which is why we have had such difficulty in completing this for the hut study, as many of the questions do not relate to how the cows were used
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