자연주의적 탐구조사(Naturalistic Inquiry)

A hypothesized need to form and maintain strong, stable interpersonal relationships is evaluated in light of the empirical literature. The need is for frequent, nonaversive interactions within an ongoing relational bond. Consistent with the belongingness hypothesis, people form social attachments readily under most conditions and resist the dissolution of existing bonds. Belongingness appears to have multiple and strong effects on emotional patterns and on cognitive processes. Lack of attachments is linked to a variety of ill effects on health, adjustment, and well-being. Other evidence, such as that concerning satiation, substitution, and behavioral consequences, is likewise consistent with the hypothesized motivation. Several seeming counterexamples turned out not to disconfirm the hypothesis. Existing evidence supports the hypothesis that the need to belong is a powerful, fundamental, and extremely pervasive motivation.

The need to belong: Desire for interpersonal attachments as a fundamental human motivation.

In this article, the author describes a new theoretical perspective on positive emotions and situates this new perspective within the emerging field of positive psychology. The broaden-and-build theory posits that experiences of positive emotions broaden people's momentary thought-action repertoires, which in turn serves to build their enduring personal resources, ranging from physical and intellectual resources to social and psychological resources. Preliminary empirical evidence supporting the broaden-and-build theory is reviewed, and open empirical questions that remain to be tested are identified. The theory and findings suggest that the capacity to experience positive emotions may be a fundamental human strength central to the study of human flourishing.

http://www.elaborer.org/cours/A13/lectures/Fredrickson2001.pdf

The role of positive emotions in positive psychology. The broaden-and-build theory of positive emotions.

Numerous studies show that happy individuals are successful across multiple life domains, including marriage, friendship, income, work performance, and health. The authors suggest a conceptual model to account for these findings, arguing that the happiness-success link exists not only because success makes people happy, but also because positive affect engenders success. Three classes of evidence--crosssectional, longitudinal, and experimental--are documented to test their model. Relevant studies are described and their effect sizes combined meta-analytically. The results reveal that happiness is associated with and precedes numerous successful outcomes, as well as behaviors paralleling success. Furthermore, the evidence suggests that positive affect--the hallmark of well-being--may be the cause of many of the desirable characteristics, resources, and successes correlated with happiness. Limitations, empirical issues, and important future research questions are discussed.

/pdf/the-benefits-of-frequent-positive-affect-does-happiness-lead-4k0h6bmoho.pdf

The Benefits of Frequent Positive Affect: Does Happiness Lead to Success?

Background 
The quality and quantity of individuals' social relationships has been linked not only to mental health but also to both morbidity and mortality.
Objectives 
This meta-analytic review was conducted to determine the extent to which social relationships influence risk for mortality, which aspects of social relationships are most highly predictive, and which factors may moderate the risk.
Data Extraction 
Data were extracted on several participant characteristics, including cause of mortality, initial health status, and pre-existing health conditions, as well as on study characteristics, including length of follow-up and type of assessment of social relationships.
Results 
Across 148 studies (308,849 participants), the random effects weighted average effect size was OR = 1.50 (95% CI 1.42 to 1.59), indicating a 50% increased likelihood of survival for participants with stronger social relationships. This finding remained consistent across age, sex, initial health status, cause of death, and follow-up period. Significant differences were found across the type of social measurement evaluated (p<0.001); the association was strongest for complex measures of social integration (OR = 1.91; 95% CI 1.63 to 2.23) and lowest for binary indicators of residential status (living alone versus with others) (OR = 1.19; 95% CI 0.99 to 1.44).
Conclusions 
The influence of social relationships on risk for mortality is comparable with well-established risk factors for mortality.

Please see later in the article for the Editors' Summary

/pdf/social-relationships-and-mortality-risk-a-meta-analytic-2ghmxi4ksm.pdf

Social Relationships and Mortality Risk: A Meta-analytic Review

America. It was obvious. Tomatoes belong to the nightshade (Solanaceae) family. The word "nightshade" is usually preceded by the word "deadly," and for good reason. The leaves and fruit of several plants in this family, for example, belladonna and mandrake, can cause death if ingested in sufficient quantity. The fact that the French and Italians were eating tomatoes in increasing quantities without seeming harm did not encourage colonial Americans to try them. It simply did not make sense to eat poisonous food. Not until 1820, when Robert Gibbon Johnson ate a tomato on the steps of the courthouse in Salem, NJ, and survived, did the people of America begin, grudgingly, we suspect, to consume tomatoes.

Rejection of Highly Efficacious Therapies

20th century Ameri-can academic medi-cine has resisted theconcept that supple-mentation with micronutrientsmight have health benefits. Thisresistance is evident in severalways: (1) by the uncritical accep-tance of news of toxicity, such asthe belief that vitamin C supple-ments cause kidney stones; (2) bythe angry, scornful tone used indiscussions of micronutrientsupplementation in the leadingtextbooks of medicine; and (3) byignoring evidence for possible effi-cacy of a micronutrient supple-ment, such as the use of vitamin Efor intermittent claudication.Part of the resistance stemsfrom the fact that the potentialbenefits of micronutrients wereadvanced by outsiders, who tooktheir message directly to the pub-lic, and part from the fact that theconcept of a deficiency disease didnot fit in well with prevailing bio-medical paradigms, particularly thegerm theory. Similar factors mightbe expected to color the responseof academic medicine to any alter-native treatment.In

Attitudes About Micronutrient Supplements in American Academic Medicine

“Is this Dr Goodwin?”

“Yes.”

“DrGoodwin,mynameisJohnFenton.Iworkatthe coroner’s office.”

“Hi.”

“Hello, were you aware that your patient, Mr Black, passed away yesterday?”

“My patient Mr Black?”

“Marvin Black, an 89-year-old man who lived on Elliot Street? His daughter said you were his physician.”

“I think I remember. Hold on just a second and I can get the electronic record.” Two minutes pass. “Here it is. I saw him about every 6 months; last time was about a year ago. Not a lot of medical problems. He was on drugs for blood pressure and nocturia. He had increasing trouble getting around. Very frail. How did he die?”

“He died at home. His daughter calls him every morning, and when he didn’t answer the phone on Wednesday, she went over to his house and found him dead in bed. He apparently died some time during the night.Iwaswonderingifyouwouldbewillingtosignthe death certificate and state the cause of death.”

“I don’t know the cause of death. I haven’t seen him for a year. He died at home. The cause of death is unknown.”

“If you say unknown causes, that makes it a medical examiner’s case and requires an autopsy. The family would like to avoid that. If you give a cause of death and signthedeathcertificate,wecanreleasethebodytothe funeral home. Just the acute and underlying causes of death, plus any contributing factors.”

“I don’t know. He was very old. He was going down-hill.”

“I’m afraid we’ll need a specific cause of death.”

“I suppose it was natural causes.”

“Natural causes or senility or old age are not acceptable. The CDC [Centers for Disease Control and Prevention] guidelines say there should be a clear and distinct etiologicsequenceincauseofdeath,evenintheelderly.1 If a physician cannot determine that sequence, then it becomes a medical examiner case.”

“When I worked in Minnesota, I could use natural causes on the death certificate.”

“The guidelines are the same everywhere in the country, but different places interpret them differently. Some allow the physician to list natural causes. Others don’t object to unknown causes. But we follow the CDC guidelines1 strictly and require a specific underlying cause of death.”

“Wow. OK, let’s see … let me think … he had some mildhypertension.Whenhewasdiscovered,didhehave a pulse?”

“No, he had been dead for several hours.”

“All right, no pulse … so his heart stopped. That sounds like cardiac arrest for the immediate cause of death, right?”

“Sorry to be such a pest, but a description of the actual event, like cardiac arrest, is not allowed.”

“Really?Backtothedrawingboard,Iguess.Ifhehad a cardiac arrest, then I guess it must have been from an MI [myocardial infarction].”

“Myocardial infarction is fine, Dr Goodwin, for the immediate cause of death. What is the underlying cause of death?”

“Well,ifhisheartstopped,thatsoundslikeheartdisease, so that must be the underlying cause of death.”

“Thanks, Dr Goodwin. Heart disease it is.”

Heart Disease as the Number One Cause of Death Among the Elderly

Background It is not clear if there is a risk of 30-day readmissions following total hip and knee arthroplasty in patients reporting high levels of pain at hospital discharge. We examined the relationship between post-surgical pain on the day of discharge and 30-day readmission in patients who received total knee and hip arthroplasty. Methods Retrospective cohort study was conducted of patients who received total knee (n = 155,284) or hip arthroplasty (n = 89,283) from 2011 to 2018 using electronic health records from the Optum database. Four categories of pain at discharge were created, from none to severe. Multivariate logistic regression models to predict 30-day all-cause readmission were adjusted for patient and clinical characteristics and built separately for knee and hip arthroplasty patients. Results Mean ages for hip and knee patients were 64.4 (standard deviation 11.3) and 65.7 (standard deviation 9.7) years, respectively. The majority of patients were female (hip: 54.4%; knee: 61.5%). The unadjusted rate of 30-day readmission was 3.54% for hip replacement and 3.66% for knee replacement. In models adjusted for patient and clinical characteristics, for patients with total hip replacement, the odds of 30-day readmission for those with severe pain score at discharge vs those with no pain at discharge were 1.60 (95% confidence interval 1.33-1.92). Similarly, readmission likelihood increased as pain at discharge increased (severe pain vs no pain) for patients with total knee arthroplasty (odds ratio 1.38, 95% confidence interval 1.19-1.59). Conclusion Our findings demonstrated that the pain scores on the day of discharge are associated with 30-day hospital readmission.

James S. Goodwin

Papers

Rejection of Highly Efficacious Therapies

Attitudes About Micronutrient Supplements in American Academic Medicine

Heart Disease as the Number One Cause of Death Among the Elderly

Association of Pain on Hospital Discharge with the Risk of 30-Day Readmission in Patients with Total Hip and Knee Replacement.

A case of hyperthyroidism presenting as recurrent pneumonia.