reductionism

还原论
  • 文章类型: Journal Article
    目的:本研究旨在批判性地分析澳大利亚当前和拟议的减少添加糖消费的政策措施。过量食用添加糖是一个重要的公共卫生营养问题。相互竞争的利益,利益相关者之间的价值观和信念意味着他们对哪些政策行动更可取,以减少添加糖的消耗有不同的看法。
    方法:使用目的性的半结构化访谈,滚雪球抽样和政策映射。政策行动按两个框架分类:感知(例如,行为改变沟通、食物环境和食物系统)和变化命令(例如,第一顺序:技术调整,第二个顺序:改革体制,第三级:改造系统)。
    方法:澳大利亚。
    方法:来自食品行业的22个利益相关者,食品监管,政府,公共卫生团体和学术界。
    结果:所有建议和现有的政策行动都针对食品环境/行为的变化;大多数被评估为一级变化,和还原主义者(特定的营养)。对政策行动的影响包括行业力量,利益相关者碎片化,政府意识形态/政治意愿和公众压力。很少有利益相关者考虑到政策行动的潜在风险,特别是非营养甜味剂替代或其他政策的机会成本。
    结论:澳大利亚减少添加糖消耗的大部分政策行动都是还原性的。参考特定的营养素,一级政策行动可以反映既得利益的影响,营养科学和政策的历史上占主导地位的还原论取向,以及追求二阶或三阶变化的感知难度。仅采取一级政策行动可能会导致“令人遗憾的”替代,并为旨在调整更广泛的粮食系统的更全面政策创造机会成本。
    OBJECTIVE: This study aimed to critically analyse Australia\'s current and proposed policy actions to reduce added sugar consumption. Over-consumption of added sugar is a significant public health nutrition issue. The competing interests, values and beliefs among stakeholders mean they have disparate views regarding which policy actions are preferable to reduce added sugar consumption.
    METHODS: Semi-structured interviews using purposive, snowball sampling and policy mapping. Policy actions were classified by two frameworks: NOURISHING (e.g. behaviour change communication, food environment and food system) and the Orders of Change (e.g. first order: technical adjustments, second order: reforming the system, third order: transforming the system).
    METHODS: Australia.
    METHODS: Twenty-two stakeholders from the food industry, food regulation, government, public health groups and academia.
    RESULTS: All proposed and existing policy actions targeted the food environment/behaviour change; most were assessed as first-order changes, and reductionist (nutrient specific) in nature. Influences on policy actions included industry power, stakeholder fragmentation, government ideology/political will and public pressure. Few stakeholders considered potential risks of policy actions, particularly of non-nutritive sweetener substitution or opportunity costs for other policies.
    CONCLUSIONS: Most of Australia\'s policy actions to reduce added sugar consumption are reductionist. Preferencing nutrient specific, first-order policy actions could reflect the influence of vested interests, a historically dominant reductionist orientation to nutrition science and policy, and the perceived difficulty of pursuing second- or third-order changes. Pursuing only first-order policy actions could lead to \'regrettable\' substitutions and creates an opportunity cost for more comprehensive policy aimed at adjusting the broader food system.
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  • 文章类型: Journal Article
    理由:需要药物来提供更多的全人护理。这是对全人护理的几种模型的叙述性回顾,并说明了初级护理中全人模型的商业案例。目标:概述存在哪些全人护理模式,并探索支持这些模式的证据。研究选择:总结和评估在美国广泛使用的代表性全人护理模式。选定的研究重点是门诊初级保健,其中包括整合常规医疗服务的计划,补充和替代医学,以及在社会和文化环境中的自我照顾。方法:2020年12月至2021年2月进行Pubmed搜索。使用“全健康退伍军人管理局”的术语进行两次迭代搜索,“”综合医学,综合健康,补充和替代医学,\"和,因为它们与结果相关,“健康结果,“成本效益”,“降低成本”,“\”患者满意度,“和”医生满意度。“从最初的搜索和作者超过50年的经验中确定了其他研究。我们寻找一般初级保健中使用的全人护理的研究,那些不使用单一模式,只来自美国的做法。结果:共找到125项(1746项)研究,符合我们的纳入标准。我们发现存在全人初级保健模式,他们的方法相当不同,并定期报告改善患者体验的实质性好处,临床结果和降低成本。结论:存在有利于全人护理模式的证据,但定义非常异质且没有重点。需要更多的全人模型的标准化和更多的研究使用整个系统的方法,而不是使用隔离组件的简化尝试。
    Rationale: There is a need for medicine to deliver more whole-person care. This is a narrative review of several models of whole-person care and studies that illustrate the business case for whole-person models in primary care. Objectives: To provide an overview of what whole-person care models exist and explore evidence to support these models. Study Selection: Representative whole-person care models widely used in the United States are summarized and evaluated. Selected studies focused on outpatient primary care with examples from programs that integrate the delivery of conventional medical care, complementary and alternative medicine, and self-care within the context of social and cultural environments. Methods: Pubmed search conducted December 2020-February 2021. Two iterative searches using terms for \"Whole Health Veterans Administration,\" \"integrative medicine,\" \"integrative health,\" \"complementary and alternative medicine,\" and, as they related to the outcomes, of \"health outcomes,\" \"cost-effectiveness,\" \"cost reduction,\" \"patient satisfaction,\" and \"physician satisfaction.\" Additional studies were identified from an initial search and the authors\' experience of over 50 years. We looked for studies of whole-person care used in general primary care, those not using a single modality and only from United States practices. Results: A total of 125 (out of 1746) studies were found and met our inclusion criteria. We found that whole-person models of primary care exist, are quite heterogeneous in their approaches, and routinely report substantial benefits for improving the patient experience, clinical outcomes and in reducing costs. Conclusions: Evidence for the benefit of whole-person care models exist but definitions are quite heterogenous and unfocused. There is a need for more standardization of whole-person models and more research using whole systems approaches rather than reductionistic attempts using isolated components.
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  • 文章类型: Journal Article
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  • 文章类型: Journal Article
    全球心理健康运动(MGMH)认为,道德上必须向全世界所有社区提供精神病治疗。但是精神病学理论,西方世界出现的类别和干预措施是基于一系列关于自我和社会性质的假设,自然和超自然,健康和治疗尚未被普遍接受。在本文中,我们认为,在精神病学思想的输出方面,有更强的道德理由要谨慎。如果没有对这种想法的批判性审讯,MGMH就有可能对多样化的人造成很大的伤害,有时是脆弱的,已经存在于世界各地的医疗系统。
    The Movement for Global Mental Health (MGMH) argues that there is a moral imperative that psychiatric treatments should be made available to all communities across the world. But psychiatric theories, categories and interventions emerged in the Western world are based on a set of assumptions about the nature of the self and society, nature and the supernatural, health and healing that are not universally accepted. In this paper we argue that there is a stronger moral case for caution with regard to the export of psychiatric thinking. Without a critical interrogation of such thinking the MGMH is at risk of doing a great deal of harm to the diverse, and sometimes fragile, systems of care that already exist across the world.
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  • 文章类型: Journal Article
    本文的目的是认为,严格简化精神病学的方法代表了心理科学的神经生物学和社会文化方面之间富有成效的综合的理论和临床障碍。我们研究了这种方法背后的理论和实践动机,通过分析抑郁症的病例,根据《精神疾病诊断和统计手册》(DSM)第五版的定义,以及“丧亲排除条款”的相关删除。“我们首先探讨了DSM是理论上的说法,观察到这一点,远非理论上的,DSM采用隐式,生物学启发的思想观点;我们表明,这种观点导致了抑郁症定义的某种循环性,其中精神药理学似乎起着关键作用。然后我们转向从这个位置衍生的进一步问题,分析抑郁症治疗中的安慰剂效应问题和精神病理学诊断的规范性先决条件的哲学问题。最后,我们解决主观性问题,which,连同主题关系上下文的相关方面,似乎对任何关于精神障碍的科学理论都至关重要,尽管DSM试图排除它。我们为精神障碍的非简化主义观点辩护,然而,并不意味着我们赞同任何形而上学的二元论,或反诊断或反精神病的立场。相反,我们认为,采用简化主义立场实际上削弱了解释抑郁症的理论和临床准确性。
    The aim of this paper is to argue that a strictly reductionist approach to psychiatry represents a theoretical and clinical obstacle to a fruitful synthesis between neurobiological and sociocultural aspects of the sciences of mind. We examine the theoretical and practical motivations underlying this approach, by analyzing the case of depressive disorders, as defined in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), and the related removal of the \"bereavement exclusion clause.\" We first explore the claim that DSM is atheoretical, observing that, far from being atheoretical, DSM adopts an implicit, biologically inspired view of the mind; we show that such a view leads to a sort of circularity in the definition of depressive disorders, in which psychopharmacology seems to play a key role. We then turn to further problems deriving from this position, analyzing the issue of placebo effects in the treatment of depressive disorders and the philosophical question of normative preconditions for psychopathological diagnosis. Finally, we address the issue of subjectivity, which, together with the related aspect of the subject\'s relational context, appears to be crucial to any scientific theorizing about mental disorders, despite DSM\'s attempt to exclude it. Our defense of a non-reductionist view of mental disorders, however, does not imply that we endorse any sort of metaphysical dualism, or anti-diagnostic or anti-psychiatric positions. On the contrary, we argue that the adoption of a reductionist position actually undermines the theoretical and clinical accuracy in explaining depressive disorders.
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