Ukuhlola Izinkinga Zobulili Ezingcolile Ngenxa Yemodeli Yokuziphatha Okungalungile (2019)

Amazwana we-YBOP: NgesiNgisi esicacile, lolu cwaningo luthole (futhi) ukuthi inkolo ayihlotshaniswa nokuzikholelwa ukuthi ungumlutha wezocansi ("umlutha wezithombe zocansi"). Lokhu kuqhuma i-meme yokuthi uJosh Grubbs wasebenza iminyaka "ukuthengisa" emhlabeni, ukuthi ukuzikholelwa ukuthi ungumlutha kuhlobene nehlazo lenkolo. Ucwaningo lwe-Grubbs's CPUI-9 nezimangalo zakhe ezilahlekisayo mayelana nedatha yangempela kuholele ezincekwini eziningi ze-propaganda ezingalungile njengaleli gem: Ukubuka i-Porn kulungile. Ukukholelwa Emlonyeni Wezinshubezi Akuyona.

Iphuzu eliyinhloko: Izifundo zangaphambili zeGrubbs azange zibuze abasebenzisi be-porn uma bazikholelwa ukuba umlutha we-porn. Zonke izifundo zikaJosh Grubbs zaphambilini zisebenzise uhlu lwemibuzo yakhe enamaphutha engu-9 (CPUI-9), eqinisekisa ukuthi izifundo zenkolo zikora kakhulu, ngoba imibuzo emithathu kweyesi-3 ihlola icala nehlazo - hhayi ukulutheka.

Ngokuphambene nalokho, ezifundweni zakhe zakamuva ngale ndaba uGrubbs usebenzise umbuzo owodwa: “Ngikholelwa ukuthi ngiyisidakwa sezithombe zobulili ezingcolile ze-intanethi“. Ukusebenzisa umbuzo owodwa, oqonde ngqo, hhayi i-CPUI-9 yokuhlola amahloni, kuholele ekuhlanganiseni okuncane noma okungekho nhlobo phakathi kwenkolo nokuzikholelwa ukuthi ungumlutha wezocansi.

Njengoba bekulindelekile, kuvela ukuthi "ukubonwa kwezidakamizwa zocansi" kuhlobene kakhulu imvamisa yokusetshenziswa kwezithombe zocansi - okukhombisa ukuthi iningi lalabo "abazibona" ​​njengeziyimilutha kungenzeka ukuthi balungile… kunokuba bazikhohlise, babe izisulu ezigcwele amahloni zemfundiso engasizi ngalutho.

Eqinisweni, lapho kusetshenziswa umbuzo oqondile, olula, inkolo iba kabi ihlobene "nokulutha okubonakalayo kwezithombe zocansi". Ayidlali ndawo ekuluthekeni kwe-porn:

Ucwaningo lwamanje kanye nolwedlule ezimbili (funda i-1, funda i-2ukuvumelanisa nalokho okushiwo yi-YBOP ekuhlaziyweni kwayo kokuqala kwezithombe zobulili ezingcolile zikaJosh Grubbs ezisebenzisa imibuzo (CPUI-9): Ingabe uJoshua Grubbs udonsa uboya phezu kwamehlo ethu ngokucwaninga kwakhe "okucatshangelwa ukubheja kocansi"? (I-2016)

abstract

I-J Med Med. I-2019 Dec 6. pii: S1743-6095 (19) 31783-7. doi: 10.1016 / j.jsxm.2019.11.259

Lewczuk K1, IGlica A2, Manjeakowska I3, I-Gola M4, Grubbs JB5.

ISINGENISO:

Kuze kube manje, izinhlobo eziningi zokusebenzisa izithombe ezingcolile zobuchopho ziphakanyisiwe, kepha imizamo yokuqinisekisa ukuthi ibekhona iye yanqabile.

AIM:

Ocwaningweni lwethu, sihlose ukuhlola Izinkinga Zobulili Ezingcolile ngenxa yemodeli yokuziphatha okungalungile ye-Moral Incongruence ephakamisa ukuthi ukuzihlola kokwethulwa kwezithombe zobulili ezingcolile kususelwa (i) ekudleni okujwayelekile, (ii) imikhuba yokusebenzisa, kanye (iii) nokungaziphathi kahle kokuziphatha phakathi kwezindlela zokuziphatha zangaphakathi . Siphenye ukuthi kungenzeka yini ukuthi imodeli isetshenziselwe ukuchaza ngokwanele imibono yokuzazisa yokuluthwa kwezithombe zobulili ezingcolile (imodeli 1) nento ebanzi yokusetshenziswa kwezinkinga zocansi okuyinkinga (imodeli 2).

IZINDLELA:

Ucwaningo olwenziwe nge-inthanethi, oluyimele kuzwelonke lwenziwa kusampula yabahlanganyeli abadala basePoland abangama-1036, kubo, abangama-880 bethule umlando wokubuka izithombe zocansi.

IMINININGWANE YOKUPHUMA:

Imiphumela yayiwumlutha wezithombe zocansi ozibonayo, ukusetshenziswa kwezinkinga zobulili ezingcolile, ukugwema ukumelana, imvamisa yokusebenzisa izithombe zobulili ezingcolile, inkolo, ukungavunyelwa kokuziphatha okubi kwezithombe zobulili ezingcolile nokunye okuhlobene nalokho.

IZIPHUMA:

Imiphumela yethu ikhombisile ukuthi ukubhekana nokugwema (inkomba yokwehliswa okujwayelekile), imvamisa yokusetshenziswa kwezithombe zocansi (inkomba yemikhuba yokusetshenziswa), kanye nosizi oluxhunywe nokungaziphathi kahle phakathi kokuziphatha kwakho ngokocansi kanye nezinkambiso zangaphakathi, izimo zengqondo nezinkolelo kube nomthelela omuhle ekuzibonakaliseni ukulutha (imodeli 1) kanye nezinkinga zokusebenzisa izithombe zobulili ezingcolile (imodeli 2). Lokhu kuqinisekisa kabanzi ukwakheka okuyisisekelo kwemodeli ye-PPMI. Kwakukhona, noma kunjalo, umehluko ophawulekayo phakathi kwamamodeli. Ukucindezeleka okuhlobene nokuziphatha okungahambisani nokuziphatha kwakungahambisani nobuthakathaka obuzibonayo (β = 0.15, P <.001), enobudlelwano obunamandla bokusetshenziswa kwezithombe zocansi eziyinkinga (β = 0.31, P <.001). Lapho ulawula ezinye izinto, inkolo ibikezela ukuthi ukusetshenziswa kwezithombe zocansi okuyinkinga kunenkinga (β = 0.13, P <.001), kepha hhayi umlutha wokuzibona ocansini (β = 0.03, P = .368). Imvamisa yokusetshenziswa kwezithombe zocansi kwakuyisibikezelo esiqine kakhulu sokulutha okubonakalayo ((= 0.52, P <.001) nokusetshenziswa kwezithombe zobulili ezingcolile okunenkinga (β = 0.43, P <.001).

IMIBUZO YOKUKHULULEKILE:

Izici ezihlongozwayo ngaphakathi kwemodeli ye-PPMI ziyizisulu zokungenelela ezifanele, futhi kufanele zibhekwe ngenkathi kuziwa ekuxilongeni nasekwelashweni.

Amandla kanye nemikhawulo:

Ucwaningo olwethuliwe lungelokuqala ukuhlola imodeli ye-PPMI. Umkhawulo wayo oyinhloko ukuthi unokwakheka kwesigaba.

ISIPHUMELELO:

Imodeli ye-PPMI uhlaka oluthembisayo lokuphenya izinto ezihlobene nokulutha okuzenzakalelayo nokusetshenziswa kwezithombe zocansi eziyinkinga. Ngaphandle komehluko phakathi kwamamodeli namandla wezinto ezithile ezibikezelayo, (i) ukwehla kwesifo, (ii) imikhuba yokusetshenziswa, kanye (iii) nokuziphatha okungaziphathi kahle konke kube nomthelela ohlukile ekubonakaleni okulindayo nasekusebenziseni okuyinkinga kwezithombe zocansi. U-Lewczuk, K., uGlica, A., uNowakowska, I., et al. Ukuhlola Izinkinga Zobulili Ezingcolile Ngenxa Yemodeli Yokungaziphathi Kokuziphatha. J Ucansi Med 2019; XX: XXX-XXX.

KEYWORDS: Isiphazamiso sokuziphatha kahle ocansini okuphoqelekile; Ukukopisha; Ukungathandeki Kokuziphatha; Ukuziphatha Okungafanele; Umlutha Wezocansi; Ukusetshenziswa Kwezithombe Ezingcolile Zobulili; Ukucwaswa

I-PMID: 31818724

I-DOI: 10.1016 / j.jsxm.2019.11.259

Isingeniso

Ukucwaninga maqondana nokuziphatha okuyinselele kwezocansi nokusetshenziswa kobuchopho okuyinkinga kuyanda ngokushesha.1 Amaqembu ahlukahlukene ocwaningo ahlongoze amamodeli ahlukahlukene abika ukuthi ezinye zezindlela zokuziphatha ezinjalo zinjalo.2, 3, 4, 5, 6, 7 Kodwa-ke, imizamo yokuhlola okunamandla kwamamodeli ngokujwayelekile ibilokhu incane futhi ingashisi. Ngokudabukisayo, lokhu kugxekwa kwenkambu akuyona inoveli. Lesi simo sezinto siphikelele iminyaka eminingi futhi saqashelwa futhi sagcizelelwa kakhulu ekuqaleni kwentuthuko enkundleni, ngokwesibonelo, nguGold no Heffner.8 Kodwa-ke, ngemuva kweminyaka engaphezu kwengu-20, le nkinga isekhona futhi ihlolwe ngabaphenyi, ngokwesibonelo, nguGola noPotenza9,10 noma u-Prause.11

Enye incazelo ebabazekayo yalokhu kwehluleka kokuqina okulukhuni ekuhloleni amamodeli wokuziphatha okunjalo ukuthi amamodeli wamanje avame ukutholakala kakhulu i-post hoc kusuka kokunye ukubuyekezwa kokulandisa (ikakhulukazi okungahleliwe) kwezifundo eziningi (bheka isifundo sikaWalton et al5 noBrand et al12) noma ngokubuyekezwa okuhlelekile kanye nokuhlaziywa kwe-meta-amabhendi amancane ezincwadi (bheka isifundo sikaGrubbs et al.3). Imizamo yokuqinisekiswa okuphelele kwamamodeli ngemuva kokuba ihlaziwe ayivelakancane, okuholela ekwandeni kwamamodeli ahlongozwayo kepha usizi lwamamodeli aqinisekiswe amandla. Futhi, lokhu kushiya insimu isesimweni sokuxoxisana okungapheli mayelana nokuba semthethweni noma ukuphakama kwemodeli eyodwa ngaphezulu komunye, ngaphandle kobufakazi obanele bokusekela ngokuqinile noma yikuphi ukubuka okuthile. Ngokubona kwethu, lokhu kuyisithiyo esibalulekile ekuthuthukisweni komkhakha wokucwaninga wokuziphatha okunobungozi kwezocansi. Ngaphezu kwalokho, le ndondo ibucayi kakhulu manje, njengoba ne-CSBD yaphoxeka ekuziphatheni kokuziphatha ngokocansith uhlelo lwe-International Classization of Diseases,13,14 naphezu kokuphikisa okuzwakalayo mayelana nesimo sezisekelo zayo zesayensi.15

Enye yamamodeli asanda kuphakanyiswa Izinkinga Zobulili Ezingcolile Ngenxa yemodeli ye-Moral Incongruence (imodeli yePPMI)3), ethole ukunakwa okubaluleke kakhulu kusuka kubacwaningi ekushicilelweni kwayo.3,16, 17, 18, 19, 20, 21, 22 Imodeli ye-PPMI ibonisa izinkinga ezihlobene nezithombe zobulili ezingcolile njengezivela emaqenjini ama-3 wezinto: (i) ukungafani ngakunye kokuthinta umthethonqubo nokulawulwa kwempembelelo (isb. Ukungabi namandla, amasu okubhekana nokuhlukumezeka okungahambi kahle, ukukhubazeka ngokomzwelo), (ii) imikhuba yokusebenzisa imvamisa ephezulu kanye / noma isikhathi esinikezelwe ukusetshenziswa kwezithombe zocansi), futhi (iii) ukungaziphathi kahle kokuziphatha maqondana nokusetshenziswa kwezithombe zocansi (okungukuthi, ukungqubuzana phakathi kwezinkolelo zokuziphatha komuntu mayelana nokusetshenziswa kwezithombe zobulili ezingcolile nokuziphatha komuntu uqobo). Njengoba igama lemodeli liphakamisa, izici ezihlobene nokuziphatha kokuziphatha zinikezwa ukunakwa okukhethekile ngaphakathi kwemodeli ye-PPMI futhi ubudlelwano phakathi kwabo bunikezwa ngokuningiliziwe.

Okumaphakathi kwemodeli ye-PPMI yisiphakamiso sokuthi phakathi kwabantu abasebenzisa izithombe zobulili ezingcolile, ukwenqatshwa kokuziphatha kokuziphatha okunjalo kungaba nomthelela emizweni yokungalingani phakathi kwezinkolelo zakho, izinkambiso, nesimo sengqondo kolunye uhlangothi nokuziphatha kolunye uhlangothi, okungukuthi, ukungaziphathi kahle kokuziphatha . Ababhali besimodeli bachaza ukungaziphathi kahle kokuziphatha njengokuvela ekuhlanganyeleni kwezinqubo ezifanayo ngokwemvelo nalezo eziphakanyiswe nguFestinger23 emcabangweni wokucabanga kobuhlakani. Ngaphezu kwalokho, ucwaningo lukhombisa ukuthi - okungenani kubantu abaningi — ukungaziphathi kahle kokuziphatha kungavela ezinkolelweni zenkolo,24 okusho ukuthi imodeli ibikezela.

Ocwaningweni olwedlule, ukungavunyelwa kokuziphatha kwezithombe zobulili ezingcolile kanye nenkolo kukhonjiswe kuhlobene kahle nokulutha okuzibonayo,25, 26, 27, 28 ubukhulu bezimpawu ezingezinhle zokuluthwa ngezithombe ezingcolile,29 noma ukwelashwa okufuna ukusetshenziswa kwezinkinga zocansi okuyinkinga30 (ukubukeza, bhekisisa ocwaningweni olwenziwe ngabakwaGrubbs noPerry24).

Imodeli ye-PPMI ingumnikelo obalulekile ezincwadini ezikhona, njengoba iphuzu layo eliyinhloko — ukuqondisisa kokuziphatha kanye nokuhlukahluka okuhlobene nokuziphatha — kuvame ukunganakwa kwamanye amamodeli.

Kodwa-ke, ngaphandle kwalokhu kugxilwe, imodeli ye-PPMI ayikhawulwanga kuphela ekungaziphathi ngokokuziphatha, njengoba ezinye izinto ezingaba nomthelela ekuziphatheni kocansi kanye nokwahlulela kokuziphatha kobulili nazo zibalwa ngemodeli (isib. Ukuhlukahluka okuhlobene nokuziphatha okuhlobene nomuntu). Ngenxa yalokhu, imodeli ingaphathwa njenge hhayi nje kuphela ngohlaka oluncane, oluyisipesheli lwenhloso kepha futhi njengohlaka olujwayelekile kakhulu lokuphenya ngesakhiwo sezinto ezinomthelela ezinkingeni ezihlobene nobulili.

Ngaphezu kwalokho, imodeli yenzelwe ukuchaza izici ezifakayo ekuluthweni kwezithombe zobulili ezingcolile3 futhi isuselwa ocwaningweni lokubikezela umlutha ozibonayo.3,25,31 Kodwa-ke, njengoba abalobi bemodeli bephakamisa ukuthi imodeli ye-PPMI ingaba uhlaka olufanele lokuphenya ngezinto ezithonya isethi ebanzi yezimpawu zokuziphatha, zokuqonda, nezokuxhumana ezixhumene nokusetshenziswa kwezithombe zocansi okuyinkinga futhi kufanele zihlolwe kule ndima.

Imodeli ye-PPMI Ngokuphathelene Nomlutha Wokuzimela

Ukuzibona ngomlutha kusho ukuqiniseka komuntu ukuthi ukulelo qembu lemilutha — lo mbono uqondiswa yincazelo esetshenziswayo, yokweyisa nokwengqondo yokuthi yiluphi umlutha nokuthi yini umlutha womuntu ongumlutha futhi ngenxa yalokho uvame ukulinganiswa ngezitatimende ezilula, ezivumayo zobuso ezinjengokuthi "Ngingumlutha wezithombe zocansi ze-inthanethi"25 noma "ngangizibiza ngomlutha wezocansi we-inthanethi."26 Ukuvumelana nezitatimende ezinjengalesi kukhombisa isenzo sokuziqhenya sokuzibhalela futhi kuvame ukungahambisani nemibono ehlelekile yezengqondo neyengqondo yokulutha. Kodwa-ke, amalebula azisebenzisayo abalulekile njengoba kungaholela ekuzenziseni ngokwakho,32 usizi, noma ukufuna ukwelashwa.3,25 Njengoba indlela okusetshenziswa ngayo "umlutha wokuzibona" ​​kudale impikiswano ethile (engxoxweni, bheka ucwaningo olwenziwe nguBrand et al,16 Grubbs et al,26,31 noFernandez et al33), siphakamisa ukuthi kusetshenziswe kahle kakhulu njengoba besichazile phambilini. Okusho ukuthi, umlutha ozibonayo uchazwa kangcono njengesenzo sengqondo sokuzifaka ngaphakathi kweqembu lemilutha, isilinganiso saso asikho ngokusekelwe ekuchazeni ngokweqile kwezimpawu zokuziphatha (njengokuvama ukusetshenziswa, ubunzima bokugwema, usizi ngokomzwelo, usebenzisa izithombe zobulili ezingcolile njengendlela yokwenza izinto, noma ukufisa). Izimpawu ezinjalo zingakhombisa izincazelo zeklinikhi, ezikhethekile zomlutha kepha akudingeki zibonise incazelo esetshenziswayo nokomuntu uqobo yalokho okufanekisa umlutha, empeleni ongabamba iqhaza ekuziphatheni okufana nokufuna ukwelashwa.3

Imodeli ye-PPMI Ngokuphathelene Nenkinga Yezithombe Zobulili Ezingcolile

Ukusetshenziswa kwezithombe zobulili ezingcolile ngempela kuxhunyiwe kusethi yezimpawu eziyinkimbinkimbi ezingakhonjiswa ekumemezelweni okulula kokuba umlutha. Lokhu kusethwa kwezimpawu kuvame ukubizwa ngokuthi “ukusetshenziswa kobunzima bezithombe zocansi” futhi kungafaka: (i) ukusetshenziswa ngokweqile; (ii) imizamo eminingi engaphumelelanga yokunciphisa ukusetshenziswa kwezithombe zocansi; (iii) ukunxanela izifiso zocansi; (iv) ukusetshenziswa kwezithombe zocansi njengecebo lokubhekana nezimo ezingezinhle; futhi (v) ukuzibandakanya njalo ekusebenziseni izithombe zobulili ezingcolile noma ngabe kuphumela ekucindezelekeni noma eminye imiphumela emibi.34 Kuchazwe ngale ndlela, ukusetshenziswa kobuchopho okuyinkinga kuyakhombisa imibono engokwengqondo nengokwengqondo yokuziphatha okungahambi kahle (futhi nokuziphatha okuluthayo noma okuphoqayo) kakhulu kakhulu kunokuziqhenya okulula, okuzenzakalelayo kokulutha. Le seti ejwayelekile yezimpawu nayo iyisisekelo sazo zonke izindlela zokuncipha zokuhlola izinkinga eziphathelene nezithombe zocansi.35 Ukuchazwa kwenani lezinto zokuziphatha, ezihlobene, nezokuqonda ukuthi lezi zinyathelo zincike kwizingcingo okungenani zecala lokuqonda kwengxenye yommangaleli nezimpawu ezichaziwe kungenzeka noma zingabi yingxenye yencazelo yakhe yomuntu siqu yokulutha. Ngenxa yalokhu, indlela enjalo yokulinganisa ibheka into ehlukile eyisisekelo kunesitatimende esithi "Ngingumlutha wezithombe zocansi." Zombili lezi zigameko ngokusobala kufanelekile ukuba ziphenywe. Kodwa-ke, zivame ukuthakazelisa ezinye izizathu (incazelo esetshenziswayo eholela ekuzenzakaliseni vs incazelo ehlelekile nethembekile yezimpawu ezibonisa ngokunembile imibono yezengqondo) futhi kufanele ihlukaniswe ngokucacile phakathi kocwaningo ngemodeli ye-PPMI nemibuzo yocwaningo ehlobene nalo leli gatsha zocwaningo lwenzeka esiteji salo sokuqala sokuqala. Lokhu kufanele kulethe ukucaciseleka okudingeka kakhulu enkundleni. Ucwaningo lwamanje lulandela umehluko ohlongozwayo.

Ngaphezu kwalokho, uGrubbs et al3 ekuvezeni kwabo imodeli ye-PPMI empeleni ikhombisa ukuthi imodeli kufanele ichaze kabanzi “izinkinga zobulili ezingcolile” hhayi nje imicabango yokulutha. Ngokuthatha zonke lezi zingxabano, kubonakala kufanelekile ukuphenya ukuthi imodeli ye-PPMI ifanelekile yini ukuchaza zombili icala elithile lokuzibona njengomlutha nokwakhiwa okubanzi kokusebenzisa izithombe ezingcolile. Ukuqinisekiswa ngempumelelo kwemodeli kuzo zombili lezi zimo kuzoqinisa futhi kunikeze ukusekelwa okuqinile kohlaka lwe-PPMI.

Ukuziphatha Kokungafaneleki nokungabi nalutho kokuziphatha Ukuziphatha Okungathandekiyo kuPPMI Model noCwaningo Oluhlobene

Kunezinkinga ezi-2 maqondana nale ndaba, ngokombono wethu, ezifanele ukunakwa okwengeziwe. Okokuqala, njengoba kushiwo ngaphambili, ngokuhambisana nemodeli ye-PPMI, ukungaziphathi kahle kokuziphatha kungashukunyiswa kakhulu yizinkolelo zenkolo. Siyavumelana nale mpikiswano futhi sicabanga ukuthi umugqa wophenyo ongavela kuwo kufanele ulandelwe ngamandla. Kodwa-ke, siyabona futhi ukuthi ubudlelwane obudlulisiwe benkolo-nokuziphatha kokuziphatha okungathandeki kungenzeka ukuthi bekuthonywe ocwaningweni lwangaphambilini ngendlela obekuvame ukusetshenziswa ngayo ukungaziphathi kahle kokuziphatha. Emisebenzini yokuqala ngale ndaba, uGrubbs et al36 kusetshenziswe lesi sakhiwo ngalezi zitatimende ezi-4 ezilandelayo: "Ukubuka izithombe ezingcolile kuyi-Internet kukhathaza unembeza wami," "Ukubuka izithombe ezingcolile kuyi-Internet kwephula izinkolelo zami," "Ngikholelwa ukuthi ukubuka izithombe ezingcolile kuyi-Internet kuyisono," nokuthi "Ngikholelwa ukuthi ukubuka izithombe ezingcolile kuyi-Internet akulungile ngokokuziphatha. . ”Ukuphela kwezitatimende ezi-4 zokugcina ezingasho ngqo ezinkolelweni zenkolo noma kusetshenziswe amagama aminyene ngokwenkolo anjengokuthi“ unembeza. ”Embonweni wethu, izinqumo zokuqala ezi-2 kulezi ezine zichazwe ngokunembile njengokuthi kukhulunywa ngokungabi naphutha kwenkolo ngaphezu kokungaziphathi ngokuziphatha. ukubhekisela “kunembeza” kungahle kudonsele inkolo efanayo. Ngokwemvelo, amandla okukholelwa ezenkolo angumthombo wemvelo walolu hlobo lokungazethembeki, kodwa isimilo, njengoba kuvezwa kumodeli wePPMI, kufanele futhi sifundwe ngaphandle komongo wenkolo, ngoba singaba nababikezeli abaningi abangahlobene ngqo inkolo (isib. imibono yezepolitiki neyezenhlalo).19 Ukungamukeleki kokuziphatha noma ukungaziphathi kahle kufanele kusetshenziswe ngendlela ekhombisa leli qiniso futhi ngendlela ethinta ukuzwela kokuziphatha okuningi.

Okwesibili, kolunye ucwaningo, ikakhulukazi izifundo ezisebenzisa imigomo emifushane, ukungaziphathi kahle kokuziphatha kusetshenziswa isitatimende esisodwa kwabangu-4 esachazwa ngaphambi kokuthi “Ngikholelwa ukuthi ukubuka izithombe ezingcolile kuyi-Internet akulungile ngokokuziphatha.”25 Njengoba sekushiwo, lesi sitatimende asisho ngokuqondile isimo senkolo, ngakho-ke izinkathazo ezichazwe ngaphambilini azisebenzi kukho. Kodwa-ke, kunenye futhi inkinga eyengeziwe lapha: lezi zinhlobo zezitatimende azikugcizeleli ngokunembile ukungaziphathi kahle kokuziphatha, kodwa kunalokho ziyangqubuzana nokuziphatha.37 Lokhu kuphawula kuyahambisana neminye yemisebenzi yangaphambilini eholwa nguGrubbs et al,36,38 lapho kusetshenziswe khona ilebula elithi "ukungavunyelwa kokuziphatha". Isizathu si-2 fold: (i) okuguquguqukayo kuswele into yokwazisa noma ukuzwela ekuziphatheni komuntu okwephula izinkolelo ezikholelwayo (bheka isifundo sikaWright22) futhi (ii) ucwaningo oluningi ngobudlelwano phakathi kokuziphatha okungaziphathi kahle nokulutha okuzicabangela ngokwakho kusekelwe ezifundweni ezimemezela ukutholakala kwezithombe zobulili ezingcolile impilo yonke-lokhu futhi kuyisifundo sesifundo samanje. Umkhawulo onjalo usavumela ukwehluka okuningi ekusetshenzisweni kwezithombe zocansi. Kungenzeka ukuthi izihloko ezisebenzisa izithombe zobulili ezingcolile kuyaqabukela (isb., Kanye noma kabili ngonyaka, noma ngisho nokuvama okukhulu) futhi zibone izithombe zobulili ezingcolile zisetshenziswa ngokwezinga elithile ngokuziphatha okungalungile azikabi nemizwa yokungaziphathi kahle ngoba ukwephula umthetho ngezikhathi ezithile kunganakwa kalula. Emsebenzini wakamuva kakhulu, uGrubbs et al37 kusebenze ukungaziphathi kahle kokuziphatha njengoba ukuxhumana phakathi kokungavunyelwa kokuziphatha nokusetshenziswa kwezithombe zocansi, okuwukuthuthuka okukhulu. Kodwa-ke, ikhuluma ngephuzu lesibili elichazwe phambilini, kepha hhayi okokuqala, njengoba le ndlela yokukala isalikhombisi isici sokuqwashisa noma ukuzwela ukungahambi kahle phakathi kokuziphatha komuntu nezinkambiso zakhe. Njengesixazululo salesi simo, esifundweni sethu, ngaphandle kokungavumelani nokuziphatha kokusebenzisa izithombe zobulili ezingcolile, silinganise nokucindezeleka okuhlobene nokuziphatha okungahambisani nokuziphatha (bona Izimpahla nezindlela isigaba), okuyisilinganiso esiqonde ngqo sokubhekana nokungahambi kahle phakathi kwezinkambiso nokuziphatha komuntu ngakho-ke isilinganiso esinembe kakhulu sokungaziphathi kahle kokuziphatha. Sicabanga ukuthi lokhu kufakwa kuyisengezo esidingekayo sohlaka lwe-PPMI.

Isifundo Samanje

Inhloso yokuqala yocwaningo olukhona kwakuwukuhlinzeka ngemininingwane nokwenza ukuhlolwa ngokuqondile kwemodeli ye-PPMI. Lokhu kuzoba ngumzamo wokuqala onjalo ezincwadini ezikhona. Ukuhlola kwethu kususelwa ezindleleni ezi-3 okungabikezelwa ngazo izinkinga ezihlobene nezocansi, kususelwa kwimodeli: (i) indlela yokuphuza, (ii) imikhuba yokusebenzisa, kanye (iii) nendlela yokungasebenzi kahle (Umdwebo 1). Yize uGrubbs et al3 esincomeni sabo sokuqala sigcizelele ukuba khona kwezindlela 1 no-3, ngombono wethu, imikhuba yokusebenzisa ingabalwa ngokuphelele ngabo (umuntu angacabanga ukusetshenziswa okuphezulu kwezithombe zocansi okungewona umphumela wokungasebenzi kahle noma ukungaziphathi kahle kokuziphatha), futhi Ngakho-ke kungacatshangwa ukuthi kwakha indlela eyengeziwe, ehlukile (indlela 2). Ngokubona kwethu, lokhu kuzokwenza ukuhlaziya kwamanje kucace ngokwengeziwe.

 

Ivula isithombe esikhulu

Umdwebo 1

Ukuhlaziywa kwendlela kuhlola Izinkinga Zobulili Ezingcolile Ngenxa Yemodeli Yokuziphatha Yokuziphatha (ngokususelwa kusampula lika-n = 880), eliphakanyiswe nguGrubbs et al.3 Umlutha ozibona ubekwa endimeni yokuguquguquka okuncike kakhulu. Ama-coefficients wendlela ejwayelekile akhonjiswa kwimicibisholo (**P <.001, *P <.05). Ukuze kufundwe isibalo, imodeli ayibonisi enye indlela eyengeziwe: ukucindezeleka okuhlobene nokuziphatha okungahambisani nokuziphatha kwakuhlobene nokubhekana nokugwema (r = 0.21 **).

Buka isithombe esikhulu | Buka isithombe se-Hi-Res | Landa isilayidi se-PowerPoint

Indlela ye-1

Ukweqa

Ukulandela esinye seziphakamiso esinikezwe ababhali bemodeli 3, ekuhlaziyeni kwethu, sisebenzise amasu wokuphamba okungahambi kahle, ngokuqondile ukugwema ukubhekana nawo, njengesinkomba sokudonsela phansi (indlela 1). Lokhu kuhluka kukhethwe njengoba izifundo zangaphambilini ziletha ubufakazi bokuthi ubudlelwane obuphakathi kokugwemelana nokuziphatha kocansi okunenkinga.39, 40, 41 Ngaphezu kwalokho, sicabange ukuthi ukubeka ukubhekana nokugwema ngaphakathi kwemodeli kuzosiza ukukhombisa ukuxhumana okungenzeka phakathi kwendlela 1 (i-dysregulation) ne-3 (ukungaziphathi kahle kokuziphatha), njengoba ukubhekana nokugwema kungaxhunyaniswa kakhulu nokucindezeleka okuhlobene nokuziphatha okungahambisani nokuziphatha. Siphakamisa ukuthi ukusebenzisa ukubhekana nokugwema kungaxhunyaniswa namazinga aphezulu osizi, asekelwa yimibhalo ecebile kusizinda se-psychology yezempilo (isb., Herman-Stabl et al,42 UHolahan et al,43 noRoth noCohen44).

Indlela ye-2

Imikhuba yokusebenzisa

Imvamisa yezithombe zocansi kungenye yezindlela ezithandwa kakhulu ezibonisa izinga lokuvezwa kwezithombe zocansi futhi yaphathwa njengesikhombisi semikhuba yokusebenzisa (indlela 2). Ngaphakathi kwimodeli ye-PPMI,3 lokhu kuguquguquka kuphathwa futhi njengomlamuli wethonya lokunye ukuhlukahluka (okuphathelene nezindlela 1 no-3, Umdwebo 1) ekuluthambekeni okuzibonayo kwezithombe zobulili ezingcolile, futhi silandela lokhu kucabanga kumodeli yethu.

Indlela ye-3

Ukuziphatha Okungafanele

Njengoba indlela yokungaziphathi kahle yokuziphatha inikezwa ukunakwa okukhethekile ngaphakathi kwemodeli ye-PPMI, sihlaziye ubudlelwano obukule ndlela ngemininingwane enkulu kakhulu, sisebenzisa inkolo, ukungavunyelwa kokuziphatha okubi kwezithombe zobulili ezingcolile, kanye nokukhathazeka okuhlobene nokuziphatha njengezinkomba (Umdwebo 1). Sithole ukuthi inkolo ephakeme izoba nomthelela emazingeni aphezulu wokungavunyelwa kokuziphatha okubi kwezithombe zocansi, imizwa ephakeme yokungaziphathi kahle phakathi kokuziphatha nokuziphatha kwakho kwezocansi, futhi nokuba ngqo, exhunywe ngokuqondile ekuzihloleni kokusebenzisa izithombe ezingcolile okuyizinkinga (bheka ucwaningo olwenziwe ngabakwaGrubbs noPryry24 ukubuyekezwa kobufakazi, uGrubbs et al,26 noLewczuk et al27). Ukulandela imodeli ye-PPMI, sicabange ukuthi ukungavunyelwa kokuziphatha kwezithombe zobulili ezingcolile kanye nemvamisa yokusetshenziswa kwezithombe zobulili ezingcolile kuzoba nomthelela ekucindezelekeni okuhlobene nokuziphatha okubi. Ngamanye amagama, ukungavumi okuphezulu kwezithombe zobulili ezingcolile ezisetshenziswayo kanye nokusetshenziswa okuphezulu uqobo kuzoba nomthelela ekwakheni ukucindezeleka okuhlobene nokungaziphathi kahle. Ngaphezu kwalokho, ngokuhambisana nesiphakamiso sikaGrubbs et al25, sibonisa ukuthi ukucabanga okuhlobene nokungaziphathi kahle okuhlobene nokuziphatha kungabikezela ngokuphelele ukuthambekela kokuzibona kwezithombe zobulili ezingcolile. Idizayini echazwe imodeli iboniswa ku Umdwebo 1.

Inhloso yesibili bekuwukuvivinya ukuthi imodeli ye-PPMI isebenza yini hhayi kuphela ekuzithatheni ngokulutha kwezithombe zobulili ezingcolile (imodeli 1) kodwa nokusebenzisa okuyinkimbinkimbi kokusebenzisa ezocansi (imodeli 2), okuchazwe ezingxenyeni zokuqala ze- Isingeniso. Sabikezela ukuthi imvamisa yokusebenzisa izithombe zobulili ezingcolile izoba nomthelela ophakeme ekuzithatheni kokuthakazelelwa kwezithombe zobulili ezingcolile kunokusebenzisa okunenkinga kwezithombe zobulili ezingcolile, futhi iphethini ehlukile izovela ekucindezelekeni okuhlobene nokungaziphathi kahle okuhlobene nokuziphatha kanye nokubhekana nokugwema ukubhekana nakho.

Inhloso yesithathu bekuwukuvivinya ukuthi imodeli ye-PPMI isebenza yini esimweni sesiko ngaphandle kwe-United States. Sokunye okutholakele okuvela ngaphandle kwase-United States okubonisa ukuthi ubudlelwane phakathi kokuhlukahluka okuhlobene nokuziphatha (isib. Inkolo) kanye nezimpawu zokusebenzisa inkinga yezithombe zobulili ezingcolile kungaxhomekeka kusiko.33,45,46 Ukuqinisekisa imodeli komunye umongo wesiko kungenye yezindlela ezibaluleke kakhulu zokucwaninga, ezakhishwa ababhali bemodeli ngokwazo.3,31

Izimpahla nezindlela

Inqubo kanye Isampula

Imininingwane iqoqiwe ku-inthanethi, ngokusebenzisa ipulatifomu yocwaningo lwePollster (https://pollster.pl/). Abahlanganyeli bacelwe ukuthi bagcwalise isethi yezinyathelo ezihambisana nezinhloso zocwaningo. Iqembu lababambiqhaza laqashwa ukuze limele abantu basePoland (ngokususelwa ezinkambisweni zokubalwa kwabantu zango-2018 ngokobulili nangobudala beminyaka kanye no-2017 kuzo zonke izinto eziguquguqukayo kwezenhlalo; izinkambiso zanikezwa yi-Statistics Poland — isifinyezo sasePoland: Główny Urząd Statystyczny). Isampula elimele laliqukethe izifundo ze-1036 (bheka ucwaningo lukaLewczuk et al27). Ukulandela izifundo zangaphambilini (isb., Grubbs et al25), Ngenhloso yokuhlaziywa kwamanje, i-subset yabahlanganyeli (n = 880) abamemezele ukuxhumana nezithombe zobulili ezingcolile okungenani kanye empilweni yabo kukhethwe futhi kwaba yisisekelo sokuhlaziywa kwethu. Ngakho-ke, imininingwane yezenhlalo yabantu izonikezwa ngezansi kuphela kuleli qembu elincane. Ababambe iqhaza kusampula elivelile babephakathi kweminyaka eyi-18 nengama-69 yobudala: 44.9% abesifazane (n = 395), amadoda angama-55.1% (n = 485); UMage = 43.69; I-SD = 14.06.

Imfundo

Imfundo yabaphenduli yayimi kanje: okuyisisekelo nokufundela umsebenzi (27.7%, n = 244), okwesibili (39.8%, n = 350), nangaphezulu (32.5%, n = 286).

Ubukhulu bendawo Yokuhlala

Indawo abahlala kuyo abaphendulile kwakuyidolobhana (37.6%, n = 331), idolobha elinabantu abangaphansi kwezi-100,000 (32.3%, n = 284), idolobha elinabantu abangu-100,000-499,999 (17.8%, n = 157) , kanye nedolobha elinabantu abangaphezu kuka-500,000 (12.3%, n = 108).

Izindlela

Umlutha ozibonayo, ulandela ezinye izifundo endaweni,25,26 ilinganiswe kusetshenziswa into eyodwa ethathwe ku-Cyber-Pornography Use Inventory-9:47 "Ngingumlutha wezithombe zocansi." Izimpendulo zivela ku-1 (akuvumi kakhulu) kuya ku-7 (ngiyavuma impela).

Ukusetshenziswa kobunzima bezithombe zobulili ezingcolile kwahlolwa nge-Brief Pornography Screener (BPS34), isikali sento engu-5 esenzelwe ukuvivinya izimpawu zokusetshenziswa okunenkinga kwezithombe zobulili ezingcolile. Abahlanganyeli baphendule ngezinga: 1 — Never, 2 — Ngesinye isikhathi, no-3 — Kaningi. Ngenhloso yokuhlaziywa, inani lezikolo ezitholwe ezintweni ze-BPS licatshangelwe (α = .88).

Ukuziphatha kwe-Hypersexual kusetshenziswe ngomaka ojwayelekile ku-Hypersexual Behavior Inventory,48 imibuzo yemibuzo engu-19 yokulinganisa izimpawu zokuziphatha kocansi. Izinketho zezimpendulo zisukela ku-1 (Akukaze) ziye ku-5 (Kaningi kakhulu). Isamba sezikolo ezitholwe kuzo zonke izinto zenze amaphuzu ajwayelekile (α = .96).

Ukudonswa kwamazinyo kwaboniswa ukukopisha ukugwema, okuhlolwe ngohlu lwemibuzo olufushane lweCOPE.49 I-COPE emfushane inezinto ezingama-28 futhi inezinhlinzeko eziyi-14 ezibonisa amasu ahlukile okubhekana nalokhu. Abahlanganyeli babenezinketho zokuphendula ezisukela ku-1 (angikaze ngikwenze lokhu nhlobo) kuye ku-4 (bengikwenza kakhulu lokhu). Ukulandela izifundo zangaphambilini (isb., Schnider et al50), sahlukanisa ukubhekana nokugwema njengeqembu lamasu we-5: ukuziphazamisa, ukuphika, ukuyeka ukuziphatha, ukuzibophezela, nokusetshenziswa kwezidakamizwa (α = .71).

Imikhuba yokusebenzisa izithombe ezingcolile yaboniswa imvamisa yokusetshenziswa kwezithombe zocansi. Ebuzwa imvamisa yokusebenzisa kwabo izithombe zocansi, ababambiqhaza babenenketho yokukhombisa ukuthi abakaze baxhumane nezithombe zobulili ezingcolile empilweni yabo (kubonakaliswe njengo-0) noma bamake okukodwa kokukhethwa maqondana nemvamisa yokusetshenziswa kwezithombe zocansi ngonyaka owedlule, kusukela e-1 ( Ungalokothi ngonyaka wokugcina) uye ku-8 (Kanye ngosuku noma ngaphezulu).

Ukukholwa kuhlolwe ngezinto ze-3 ezisetshenziswe nguGrubbs et al25 (“Ngizithatha njengomuntu okholwayo,” “Ukuba nenkolo kubalulekile kimi,” nokuthi “Ngiya ezinkonzweni zenkolo njalo”). Isikali sokuphendula sisuselwe ku-1 (angivumelani neze) kuya ku-7 (ngivuma ngokuqinile). Isamba sezikolo ezitholakele kulezi zinto ze-3 sicatshangelwe ngenhloso yokuhlaziywa (α = .94).

Lapho ebuzwa ngokuhlangana kwabo nenkolo, iningi lababambiqhaza libike ukuthi lingama-Katolika (i-77.3%), u-3.5% wamemezela okunye ukuhlangana ngokwenkolo (isib. Ubuddha, ubu-Orthodox), u-10.6% wamemezela ukuthi akakholelwa kuNkulunkulu noma akakholelwa kuNkulunkulu, kwathi u-8.6% wababambe iqhaza wakhetha "akekho kulokhu okungenhla ”Impendulo.

Ukungavunyelwa kokuziphatha kokusetshenziswa kwezithombe zobulili ezingcolile kwakulinganiswa ngento eyodwa ("Ngikholelwa ukuthi ukusetshenziswa kwezithombe zocansi akulungile ngokokuziphatha"), kulandela olunye ucwaningo ngokuziphatha okungajwayelekile njengokukhomba ukulutha kwezithombe zocansi (isb., UGrubbs et al25). Isilinganiso sokuphendula sasisuka ku-1 (angivumelani kakhulu) siya ku-7 (ngiyavuma kakhulu).

Ukuhlukumezeka okuhlobene nokungaziphathi kahle okuhlobene nokuziphatha kuhlolwe ngento eyodwa: "Imvamisa ngangizizwa ngiphatheke kabi ngenxa yokuthi imicabango, imicabango kanye nokuziphatha kwami ​​akuhambisani nezinkolelo zami zokuziphatha kanye / noma zenkolo." Ababambe iqhaza baphendula ngezinga: 2-- "Lesi sitatimende besiqinisile empilweni yami okungenani izinyanga ezi-6 kwezingu-12 ezedlule," 1 - "Lesi sitatimende besiqinisile empilweni yami, kodwa hhayi ezinyangeni eziyi-12 ezidlule", no-0- "Lesi sitatimende besingakaze sibe yiqiniso kimi . ”

Ukuhlaziywa kwesitatimende

Ukuhlola imodeli ye-PPMI nokuhlola ukubikezela kwethu, senza ukucubungula kwezindlela, kusetshenziswa i-IBM SPSS Amosi51 kusetshenziswa isilinganiso esilinganisel Ukulandela amazinga amukelwe ezincwadini, ubuhle bokufanele buhlolwe kusetshenziswa le mibandela elandelayo: inkomba yokuqhathanisa efanelekile (i-CFI) inani elingaphezu kuka-0.95, iphutha lesikwele lokulinganisa (RMSEA) elingaphansi kuka-0.06, futhi isikwele esifanisiwe sisho isikwele okusalayo (SRMR) ongaphansi kuka-0.08.52

Ukubhaliswa Kokunye Ukucutshungulwa Kususelwa kusethi efanayo yedatha

Izici eziyisampula, izindlela ezisetshenzisiwe, imibuzo yocwaningo, kanye nokwakhiwa okuyisisekelo kwemigwaqo emi-3 kubhaliswe kabusha ngoHlelo Oluvulekile lweSayensi (https://osf.io/qcwxa). Kodwa-ke, umnyombo wombiko wokubhalisa unikezelwe kolunye uphenyo, olwalubhaliswe ngokusemthethweni ngemininingwane ephakeme. Lokhu kuhlaziya, kususelwa kusethi efanayo yedatha kepha kuphendulwa okuhlukile, noma kunjalo kuhlobene, imibuzo yocwaningo, kubikwa kwenye indawo.27

Ethics

Izindlela zokwakha zalolu cwaningo zivunyelwe yikomidi lezimilo e-Institute of Psychology, ePoland Academy of Science. Ngaphambi kokuqeda isifundo, bonke ababambe iqhaza bagcwalisa ifomu lokuvuma elinolwazi.

Imiphumela

Izibalo ezichazayo ne-Correlations

Ithebula 1 iqukethe izibalo ezichazayo nokuhlangana phakathi kwazo zonke izinto ezihlaziyiweyo. Sekukonke, ama-20.5% wabahlanganyeli abasebenzisa izithombe zobulili ezingcolile esikhathini sabo sokuphila (n = 880) ngezinga elithile bavumile ukuthi ukusetshenziswa kwezithombe zocansi akulungile ngokokuziphatha (izinketho zokuphendula zisuselwa kokunye ngiyavuma ukuvuma ngokuqinile), yize kube yi-5.8% kuphela evumelene nalesi sitatimende ngokuqinile (ngokuqinile vuma impendulo). Izithombe zobulili ezingcolile eziyinkinga zisebenzisa izimpawu ngezinga elikhulu ezahlukile ekuluthekeni okubonakalayo kwezithombe zocansi; Ukuhlangana phakathi kwalokhu kwakhiwa okungu-2 kwakungu-r = .55 (Ithebula 1).

Ithebula 1Izibalo ezichazayo kanye nama-coefficients wokuhlanganisa (Pearson's r) abonisa amandla obudlelwano phakathi kokuguquguqukayo okuhlaziyiweyo (n = 880).
eliguqukayoNgishoSD1234567
1. Umlutha ozibonayo wezithombe ezingcolile1.931.35-
2. Ukusetshenziswa kobuchopho okuyinkinga6.632.32.55 **-
3. Ukugwema ukubhekana11.253.90.20 **.24 **-
4. Imvamisa yokusetshenziswa kwezithombe zocansi3.682.25.53 **.44 **.07 *-
I-5. Ukwethembeka3.811.84-.04.11 **.05−.21 **-
6. Ukungavunyelwa kwesimilo kokusebenzisa izithombe ezingcolile3.461.63−.08 *.03.09 **−.32 **.44 **-
7. Ukuziphatha okungahambi kahle kokuziphatha nokungaphatheki kahle kokuziphatha0.280.59.23 **.40 **.23 **.08 *.22 **.22 **-

Buka ithebula ku-HTML

** P <.001; * P <.05.

Ukuhlola Imodeli ye-PPMI

Model 1 — Umlutha Ozikhuthazayo

Imodeli ehlolwe ikhonjiswe ku Umdwebo 1. Ukuzikhohlisa okubonakalayo kwezithombe zobulili ezingcolile ("Nginomlutha wezithombe zobulili ezingcolile") kufakwa endimeni yokuguquguquka okuyinhloko kwimodeli. Ukubhekana nokubhekana nokugwema ukubikezela ukulutha okuzenzakalelayo (β = 0.13, P <.001), nokuba okuhle, yize kubuthakathaka, kuhlobene nemvamisa yokusetshenziswa kwezithombe zocansi (β = 0.10, P = .001). Imvamisa yokusebenzisa izithombe zobulili ezingcolile, futhi, kwakuyisibikezelo esiqine kakhulu sokulutha okuzenzakalelayo (β = 0.52, P <.001) kanye nesibikezelo esihle sokucindezeleka okuhlobene nokuziphatha okungahambisani nokuziphatha (β = 0.17, P <.001). Endleleni yokuziphatha okungaziphathi kahle, inkolo yayiyisandulela esihle sokwenqaba kokuziphatha kwezithombe zobulili ezingcolile (β = 0.44, P <.001) futhi kwaba nomthelela omuhle ekucindezelekeni okuxhunywe ekuziphatheni okungathandeki kokuziphatha (β = 0.16, P <.001). Ukukholelwa enkolweni kwakuyisibikezelo esibi esibuthakathaka semvamisa yokusetshenziswa kwezithombe zocansi (β = -0.09, P = .013), kepha ithonya layo ekulutheni okubonwa nguwe belingabalulekanga (β = 0.03, P = .368). Ngokuhambisana nokubikezela kwethu, ukungavumelani nezithombe zobulili ezingcolile kwaba nomthelela omubi ekusetshenzisweni kaningi kwezithombe zocansi (β = -0.29, P <.001) kepha wabikezela kahle ukucindezeleka okuhlobene nokuziphatha okungahambisani nokuziphatha (β = 0.19, P <.001). Ngaphezu kwalokho, ukucindezeleka okuhlobene nokuziphatha okungahambisani nokuziphatha kwakuyisibikezelo esihle, esilinganiselwe esinamandla sokulutha okubonakalayo (β = 0.15, P <.001) (Umdwebo 1). Ngaphezu kwalokho, ukubhekana nokucindezeleka okuhlobene nokuziphatha okungathandeki kokuziphatha kwakuxhunywe kahle namasu okubhekana nokugwema (r = 0.21, P <.001), okwabikezelwa, yize kungakhonjisiwe, ngaphakathi kwalesi sibalo ukuze kucace. Imodeli ichaze ukwehluka okungama-33.9% kokuzihlola kokuzilolonga. Izinkomba zokulingana zemodeli zibonise ukulingana okuhle kakhulu: χ2(3) = 9.04, P = .029, i-CFI = 0.992, i-RMSEA = 0.048, ne-SRMR = 0.0274.

Isibonelo 2 — Ukuziphatha Okuzungezile

Ukuphenya ukusebenza kwemodeli ye-PPMI ekwakhiweni okubanzi kwenkinga yokusebenzisa izithombe ezingcolile, silinganise imodeli efanayo ne-BPS amamaki ajwayelekile njengokuhlukahluka okuthembekile okukhulu (Umdwebo 2). Ukubhekana nokugwema (β = 0.13, P <.001) kanye nemvamisa yokusetshenziswa kwezithombe zocansi (β = 0.43, P <.001) yabikezela ukuthi izithombe zocansi eziyinkinga zisebenzisa kahle, kepha ubudlelwano babunamandla kokuguquguquka kokugcina. Ukukholwa kwabikezela ukusetshenziswa kwezithombe zocansi okuyinkinga (β = 0.13, P <.001), njengoba kwenza ukucindezeleka okuhlobene nokuziphatha okungathandeki (β = 0.31, P <.001) (Umdwebo 2). Bonke obunye ubudlelwano bebungafani nemodeli yokuqala ekhonjiswe kuyo Umdwebo 1. Imodeli ehlaziyiweyo ichaze i-35.9% yokwahluka kwezimpawu zokuziphatha kwe-hypersexual. Izinkomba ezilinganayo zemodeli yethu yesibili nazo ziveze ukulingana okuhle kakhulu: χ (3) = 9.93, P = .019, i-CFI = 0.991, i-RMSEA = 0.051, ne-SRMR = 0.0282.

 

Ivula isithombe esikhulu

Umdwebo 2

Ukuhlaziywa kwendlela kuhlola Izinkinga Zobulili Ezingcolile Ngenxa Yemodeli Yokuziphatha Yokuziphatha (ngokususelwa kusampula lika-n = 880), eliphakanyiswe nguGrubbs et al.3 Ukusetshenziswa kobuchopho okuyinkinga, njengoba kusetshenzelwa Isithonjana Sezithombe Ezingcolile Zobulili kubekwe engxenyeni yokuhlukahluka okuncike kakhulu. Ama-coefficients wendlela ejwayelekile akhonjiswa kwimicibisholo (**P <.001, *P <.05). Ulayini onamachashazi ukhombisa ubudlelwane obungabalulekile. Ukuze kufundwe isibalo, imodeli ayikhombisi ukuhlangana phakathi kokucindezeleka okuhlobene nokuziphatha okungahambisani nokuziphatha nokubhekana nokugwema (r = 0.21 **).

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Umsebenzi owethulwe ungenye yokuzama okumbalwa okungekho emibhalweni eyiqiniso yanoma iyiphi imodeli yokuluthwa kwezithombe zobulili ezingcolile, ukusetshenziswa kwezithombe zobulili ezingcolile okunenkinga noma ukuzibandakanya ocansini okuyinkinga, futhi owokuqala ukwenza njalo ngemodeli yePPMI. Ezingeni elijwayelekile, imiphumela yethu iqinisekise ukufaneleka kwesimo esiyisisekelo semodeli ukukhombisa ukwakheka kwababikezeli bokulutha kwabo bobabili okuzibonayo (imodeli 1, Umdwebo 1) nokusebenzisa okuyizinkinga kwezithombe zocansi Umdwebo 2). Kodwa-ke kwezinye izindawo, imiphumela yethu iyahlukahluka kusuka kokuqagelwa okuvela kwimodeli, futhi kunezinto ezimbalwa ezibalulekile kepha ezibalulekile ezidinga ukucatshangelwa futhi ezinemithelela ekwakhekeni kwemodeli nokucwaninga okuzayo.

Njengoba kuchaziwe ngaphambili, ukuhlaziywa okubikwe esifundweni samanje kwakususelwa ezindleleni ze-3 eziphakanyiswe ngaphakathi kwemodeli ye-PPMI: indlela yokudonswa kwegazi (njengoba kukhonjisiwe ukubhekana nokugwema), imikhuba yokusebenzisa indlela (ekhonjiswe ngemvamisa yokusetshenziswa kocansi) nendlela yokuziphatha yokungaziphathi kahle (kusetshenzisiwe ngokukholelwa, ukungavumelani nokuziphatha kwezithombe zobulili ezingcolile, nokucindezeleka okuhlobene nokuziphatha okungahambisani nokuziphatha). Sekukonke, imiphumela ikhombise ukuthi zonke izindlela ze-3 ngokuhlukile futhi zibamba iqhaza elikhulu ekuchazeni ukulutha okuzibonayo kanye nesethi ebanzi yezimpawu eziwela ngaphansi kwelebuli yokusetshenziswa kocansi okuyizinkinga. Ngaphezu kwalokho, imiphumela yethu iqinisekisile ukuthi izithombe zobulili ezingcolile eziyinkinga zisebenzisa izimpawu zihlukile ekumemezelweni okulula kokuba umlutha. Ukuhlangana phakathi kwalokhu kwakhiwa okungu-2 kwakungu-r = 0.55. Ngokuya ngemiphumela yethu, akukho neyodwa yezindlela ezi-3 ebekiwe ngaphakathi kwemodeli engancishiselwa kwenye noma isuswe ngaphandle kokuwohloka kwekhwalithi nokubaluleka kokuqagela kwemodeli. Lokhu kuqinisekisa ukubikezela okuyisisekelo okususelwa kumodeli ye-PPMI.3 Amamodeli alinganisiwe achaze ingxenye enkulu yokuhlukahluka kumlutha oziqonda wena uqobo (33.9%, imodeli 1) nokusebenzisa okuyinselele kwezithombe zocansi (35.9%, imodeli 2).

Iziphetho eziphathelene nalezi zindlela ezi-3 zemodeli zichazwe esigabeni esilandelayo.

Indlela Yokuziphatha Engalungile

Abantu ababhekene nengcindezi yokuziphatha ehlobene nokungaziphathi kahle babike amazinga aphakeme kakhulu wokuzilibazisa nokuzibona usebenzisa inkanuko. Lokhu kuqinisekisa ukubikezelwa kwababhali bemodeli ye-PPMI3,31 maqondana nendima edlalwa ukungaziphathi kahle kokuziphatha ekwakhekeni kokuziphambanisa komuntu siqu24 futhi ilwedlulisela kuzimpawu ezivame kakhulu zokusebenzisa izithombe ezingcolile. Kodwa-ke, ukubikezela kwemodeli ukuthi ukungaziphathi kahle kokuziphatha kufanele kube yisibikezeli esinamandla somlutha wokuzibona wezithombe zobulili ezingcolile kunokuvama kokusetshenziswa nokuphuza,3,31 okungaqinisekiswa kokutholakele kwethu. Imiphumela yethu ihambisana nomsebenzi wakamuva obonisa ukuthi imvamisa yokusebenzisa izithombe zobulili ezingcolile iyisibikezeli esinamandla somlutha wokuzibona wezithombe ezingcolile kunokungaziphathi kahle kokuziphatha26 (bheka futhi ocwaningweni lukaLewczuk et al27 Ukuhlaziywa okwenziwe kusampula efanayo nesifundo samanje) Kungenzeka futhi ukuthi umthelela ophansi wokucabanga okuhlobene nokungaziphathi kahle okuhlobene nokulutha kokuzibona kubangelwa okungenani ingxenye yokuvunyelwa kokuziphatha okuhle kokusebenzisa izithombe zobulili ezingcolile kusampula yamanje yasePoland, kuqhathaniswa, ngokwesibonelo, isampula elimele yabantu abadala base-US.25 Ocwaningweni lwethu, ama-20.5% ababambiqhaza abasebenzisa izithombe zobulili ezingcolile esikhathini sabo sokuphila bavumile ukuthi ukusetshenziswa kwezithombe zocansi akulungile ngokokuziphatha (izinketho zokuphendula zazisukela kokuthi "ngiyavuma" kuya "ngivuma ngokuqinile"), kanti impendulo efanayo yanikezwa ama-24% aseMelika. Ngaphezu kwalokho, ngokususelwa esilinganisweni esifanayo, ababambiqhaza base-US bamemezele ukuthi banenkolo ethe xaxa ngokwesilinganiso (M = 4.10, SD = 1.9525) kunababambiqhaza basePoland kusampula yamanje (M = 3.81, SD = 1.84), engahle ichaze nomthelela obuthakathaka wendlela yokuziphatha yokungaziphathi kahle ekuluthweni kwezithombe zocansi okuzibona kunemodeli ye-PPMI esekwe ikakhulu ocwaningweni olwenziwe ezibikezelweni zase-US.

Ngaphezu kwalokho, ukuhlupheka okuhlobene nokungaziphathi-okuhlobene nokuziphatha kwakuxhunywe ngokuqinile ekusetshenzisweni kwezithombe zobulili ezingcolile kunokuzibona njengomlutha. Ukuchazwa okungenzeka kwaleli phethini ngukuthi, uma kuqhathaniswa nokulutha kokuzizwa, ukusetshenziswa kwezithombe zobulili ezingcolile kufaka iqembu ebanzi lemiphumela yokucabanga neyaziwayo kanye nezinqumo zokusetshenziswa kwezithombe zocansi. Enye yazo ngamazinga akhulayo wecala ngokusetshenziswa kwezithombe ezingcolile, okungaba umphumela wokungaziphathi kahle kokuziphatha.20 Isitatimende esisodwa se-5 ku-BPS,34 obekuyinkomba yokusebenzisa kabi izithombe zobulili ezingcolile ocwaningweni lwethu, ifundeka ukuthi "Uyaqhubeka nokusebenzisa izithombe zocansi yize uzizwa unecala ngakho." Ubuhlobo obuphakathi kokuzibhala njengowumlutha nokucindezelwa okuhlobene nokungaziphathi kahle kokuziphatha akusikho eduze njengasekuqaleni ezinye izifundo, eziboniswa kokutholakele kwethu.

Okulandelayo, imiphumela yethu ngokuvamile iqinisekise ukucaciswa kwethonya lethonya phakathi kokuhluka okuhlobene nokuziphatha, yize kungenayo i-bakoat. Abantu abaningi benkolo bathambekele kakhulu ekubonaka ukusetshenziswa kwezithombe zobulili ezingcolile njengokuziphatha okugwenxa futhi bethambekele kakhulu ekuzweni imizwa yokungalungile phakathi kokuziphatha kwakho ngokobulili nezinkolelo zokutholwa, izimo zengqondo kanye nemikhuba. Umthelela wenkolo wawungenamandla kulezi zimo, ngoba indlela yethu yokulinganisa ayisho ngokuqondile isimo sezenkolo (bona i- Isingeniso isigaba seminye imininingwane ngalolu daba). Njengoba bekulindelekile, ukucindezeleka okuxhunyaniswe nokuziphatha-ukungalungiswa kahle kwesimo kunqunywe yizici ezingeziwe ze-2: imvamisa yokuziphatha (imvamisa yokusebenzisa izithombe zobulili ezingcolile) kanye nokuvinjelwa kwesimo sengqondo (ukwenqaba isimilo sezithombe zobulili ezingcolile; bhekisa esifundweni esenziwe nguGrubbs et al.3). Kodwa-ke, yize inkolo nokungavunyelwa kokuziphatha kubikezela kakhulu usizi oluhlobene nokungaziphathi kahle okuhlobene nokuziphatha, umnikelo wabo ubulinganiselwe. Abanye ababikezeli okungenzeka kufanele baphenywe, bobabili baxhumeke kweminye imithombo yezindlela ezinganquma ukungavunyelwa kwezithombe zocansi, ngokwesibonelo, ukubukwa kwezenhlalo, isisekelo senkolo53,54 noma amagatsha athile obufazi,55 kanye nokuhlukahluka okuhlobene nokuqwashisa nokuzwela kokuziphatha okungahambi kahle ngezinkolelo zakho, izimo zengqondo, nezindlela zangaphakathi (isib. ukuzazisa, ukuqwashisa, ukukhathazeka ngamaphutha, ukuthanda izinto ngokuphelele, ubukhulu bezimo ezikhuthaza izimo zengqondo zocansi nobungqingili) . Lapha, siphakamisa iziphakamiso ezashiwo abanye ababhali ekuphawuleni kwabo ngemodeli.19,22

Ngaphezu kwalokho, imiphumela yethu ikhombisile ukuthi, ngokulawula okunye okuguquguqukayo, abantu benkolo ethe xaxa bamemezele amazinga aphezulu okusebenzisa izithombe zocansi okuyinkinga. Ithonya lenkolo ekusebenziseni izithombe zobulili ezingcolile lalinobuthakathaka, kepha lalikhona-okuvumelana okungenani nengxenye enkulu yezifundo zangaphambilini ezibonisa ubuhlobo obuthakathaka, obuhle phakathi kwenkolo nenkolo yokusebenzisa izithombe ezingcolile.25,26 (bheka futhi ocwaningweni lukaLewczuk et al27). Ubudlelwano obuhambelanayo abutholakalanga ukuzicabangela ngokwakho umlutha.

Imikhuba Yokusebenzisa Indlela

Imvamisa yokusetshenziswa kwezithombe zobulili ezingcolile kwakuyisibikezelo esinamandla kunazo zonke sokulutha okubonakalayo kwimodeli 1 kanye nezinkinga eziyizithombe zobulili ezingcolile ezisetshenziswa kumodeli 2. Lokhu kukhombisa ukuthi ukuzihlola ngokwakho kwezinkinga ezihlobene nezithombe zocansi akuthembeli nje ekuboneni lokhu kuziphatha njengokwephula imikhuba yomuntu siqu , okungukuthi, akuwona umsebenzi wokukholelwa nje (bheka ingxoxo ocwaningweni lukaHumphreys56). Ingxenye ephawulekayo yokwahluka ichazwa kangcono imvamisa yokusetshenziswa, eqinisekisa imodeli yokuphazamiseka yokusetshenziswa kwezithombe zocansi eziyinkinga futhi iyafana nesifo sophawu lwezinye izimo zokuphazamiseka kokusetshenziswa kwezidakamizwa nokunye ukuluthwa kokuziphatha, okusetshenziswa ngokweqile ngesikhathi okungenani ingxenye ethile yenkambo yokuphazamiseka iyindlela yokuchaza (bheka isifundo sikaKraus et al1 noPotenza et al57). Ukuvama kokusetshenziswa kwezithombe zobulili ezingcolile nakho kwakuyisimo esibalulekile sokusetshenziswa kwezithombe zobulili ezingcolile okunenkinga, yize ithonya lalo lalibuthakathaka kancane kunokuzibona komlutha (β = 0.43 vs β = 0.52). Lokhu kuyaqondakala, njengoba ukusetshenziswa okuyinkinga kunendawo ebanzi kunokuzibona ngokwakho ukulutha, okubandakanya hhayi kuphela ukusetshenziswa kwezithombe zocansi ezeqile kepha nokulahleka kolawulo, usebenzisa izithombe zobulili ezingcolile njengendlela yokubhekana necala kanye necala elixhumene nokusetshenziswa kwezithombe zocansi.34

Indlela Yokuhudula

Isitayela sokuphinda uvikeleke kwakuyinkomba yokuphuza kumodeli yethu. Abantu abasebenzisa isitayela sokugwema ukwenqabela njalo babethambekela kakhulu ekuzibona beyimilutha yezithombe zobulili ezingcolile futhi benobunzima obukhulu bezimpawu zokusebenzisa kabi izithombe zobulili ezingcolile. Lokhu kuhambelana nocwaningo lwangaphambilini, olukhombise ukubaluleka okukhethekile kwesitayela sokugwema ukukopisha ekuziphatheni okunobunzima kocansi.39, 40, 41 Lo mphumela uvumelana nezifundo ezibonisa ukuthi ukuzibandakanya ekuziphatheni ngokocansi uqobo kungakha isu lokugwema (isb., Ukugwema imizwa engemihle ehambisana nezinye izindawo zempilo yomuntu). Kodwa-ke, umthelela ekubhekaneni nokugwema kokuhlukahluka kokuncika wawubuthaka ((= 0.15, P <.001) futhi yayingenamandla ekusetshenzisweni kwezithombe zobulili ezingcolile ezinenkinga kunokuzihlola ngokwakho kokulutha. Lokhu kungathathwa njengokumangazayo, njengoba ukusetshenziswa kwezithombe zobulili ezingcolile okunenkinga kunengxenye yokubhekana nezithombe zocansi (njengoba uzithola usebenzisa izithombe ezingcolile ukubhekana nemizwa enamandla, isb. Ukudabuka, intukuthelo, isizungu, njll.) Kungenye yezinto ze-BPS ezenze inkinga ukusetshenziswa kwezithombe zocansi esifundweni sethu).

Imiphumela ye-Shape ye-Model ne-future research

Ukuthola kwethu kukhombisa ukuthi imodeli ye-PPMI ingasebenza njengemodeli ejwayelekile yezinto ezinomthelela ekuzibona ngokwakho komlutha wezocansi nokusebenzisa izithombe ezingcolile zobunzima. Kodwa-ke, indlela ye-dysregulation ithuthukiswa kunguqulo yamanje yemodeli. Lokhu kuphinde kuvezwe abanye abaphenyi.16 Le ndlela kufanele ichazwe ngemininingwane eminingi futhi inwetshwe. Esiphakamisweni sabo sokuqala semodeli, uGrubbs et al3 kugxilwe ezintweni ezihlobene nokungaziphathi kahle kokuziphatha ezichaza indlela yokuphuza imininingwane engaphansi. Le ndlela iyaqondakala njengoba ukungaziphathi kahle kokuziphatha kuyigxila eliphambili lemodeli. Kodwa-ke, njengomphumela, ukucatshangelwa komqondo kwamanje kwe-PPMI imodeli ibeka zonke izinto ezihlobene nokuphuza (okufana nokuzwa komoya, ukufakwa kokuqina, ukukopishwa, ukuphoqelelwa) esigabeni esisodwa esivamile nesingachazwanga futhi kugwema ukubonisa izindlela zokuthonya phakathi kwalokhu okuguqukayo, ukubabonisa amadigri ahlukanisayo okubaluleka noma okubonisa ubudlelwano phakathi kokuhlukahluka okuhlobene nokuphuza kanye nokuhluka okuhlobene nokuziphatha okuhlobene nokuziphatha. Ubudlelwano obunjalo buye banconywa abanye16,22 futhi kuyabonakala ekuhlaziyweni kwethu, njengoba ukubhekana nokugwema ukuxhumeka ekucindezelekeni okuhlobene nokuziphatha okungahambisani nokuziphatha (r = 0.21, P <.001) okukhombisa ukuthi amasu okubhekana nokugwema angasebenza njengendlela yokubhekana nokuziphatha okungaziphathi kahle.

Njengoba imodeli ye-PPMI yaqale yaqinisekiswa ocwaningweni olukhona, sibeka ukuthi kufanele ukunwetshwa futhi kungenzeka ukuthi kuphinde kwenziwa kabusha imodeli yokuthanda kakhulu, ejwayelekile lapho ukuhlukahluka okuhlobene nokuphuza kuzophathwa khona ngezinga elifanayo lokuqapha njengoba kuhlobene nokuziphatha okuhle. . Ukufeza lokhu, amamodeli athile — njengenguqulo yamanje yemodeli ye-PPMI — kufanele ahlanganiswe namamodeli abanzi (isib. Imodeli ye-I-PACE12,58) ezingena ngemininingwane eminingi maqondana nezinto eziphathelene nokuziphatha okuhlobene nokuziphatha, kepha, njengamanje, indiva indima yokuhlukahluka okuhlobene nokuziphatha. Kubukeka sengathi yile ndlela kuphela engavumela isithombe esigcwele sezinto ezinethonya zombili ukuzikhohlisa kokusebenzisa umlutha nokusebenzisa izithombe ezingcolile okuyizinkinga ukubalwa. La magatsha ama-2 ocwaningo akufanele futhi angakhuli ngokuhlukile ngenxa yethonya lawo angashiyana.16,22 Ngenxa yalokhu kuncika, ukwakheka kwendlela yokungaziphathi kahle ayikwazi ukucaciswa kahle lapho uhlangothi oluhlobene nemodeli lungakhuli kahle.

Ezifundweni zesikhathi esizayo, ezinye izinkomba zokuwohloka komqondo ejwayelekile (isb., Impulsivity, regalaptive regulation regislation ,phelele) kufanele kuhlolwe ngaphakathi kwemodeli ye-PPMI ukunweba nokunikeza ukusekelwa okwengeziwe kohlaka okuxoxwe ngalo. Ukunwetshwa okunjalo kubonakala sengathi kubikezelwe futhi kwamukelwa ngababhali bemodeli,31 esivumelana ngokuphelele nakho.

Olunye udaba okufanele lusiveze ukuthi ukuhlaziya kwethu kusekelwe kusampula enabantu abaningi. Enye yezinkomba ezibalulekile zesikhathi esizayo zocwaningo olwengeziwe futhi nokuqinisekisa imodeli esekwe kumasampula emtholampilo, sithola izinga lomtholampilo lezimpawu zobulili ezingcolile. Lokhu kubaluleke kakhulu ngoba ukubaluleka kwezinto ezibikezela ukusetshenziswa kwezithombe zobulili ezingcolile kungashintsha izinga lomtholampilo, uma kuqhathaniswa nophenyo oluningi. Izifundo zesikhathi esizayo kufanele futhi zisebenzise imodeli ye-PPMI ku-CSBD eqashelwa ku-ICD-1113,14 lapho kuthathwa izinyathelo zokuhlola lokhu kuphazamiseka ukuze zisetshenziswe. Sivumelana nabanye abacwaningi abaphakamise ukutadisha izinqubo zokuziphatha okungahambi kahle kwezokuziphatha kobulili ngaphandle kokusebenzisa inkinga yezithombe zocansi eziyinkinga,20 okungaholela ekwandisweni kwemodeli ukuchaza izimpawu ezivamile zokuziphatha kobulili.

Ukukhathazeka okwengeziwe mayelana nodaba lokusebenzisa ukungaziphathi ngokuziphatha noma ukwenqatshwa kokuziphatha okubi kwezithombe zobulili ezingcolile (bheka Izinto Nezindlela isigaba) nokuluthwa okuzenzakalelayo okuphathelene nokusetshenziswa kocansi okungalunganga okusekelwe encazelweni esemthethweni yomtholampilo (njengokusebenzisa okuyizinkinga kwezithombe zocansi) bheka Isingeniso isigaba) kwaphawulwa ezingxenyeni zokuqala zombhalo wesandla.

Ucwaningo lwamanje lwengeza ucwaningo ngemodeli ye-PPMI komunye umongo wamasiko, okungukuthi, abahlanganyeli basePoland. Kodwa-ke, iPoland yabelana ngokufana namasiko ne-United States njengoba kuyizwe elinamaKhrestu (ama-77.3% ababambiqhaza ekuhlaziyweni kwamanje okumenyezelwe ukuthi kungamaKatolika) Ucwaningo lwekusasa kufanele luqhubeke nokuqinisekisa imodeli, ngokususelwa kumibuthano eyahlukene yenkolo namasiko.

Ukulinganiselwa

Eminye imikhawulo yocwaningo lwamanje yayivele ibaluliwe (isici esisodwa esihlobene nokuqwashisa). Siphawula futhi ukuthi lo msebenzi wamanje ususelwa ekwakhiweni kwesigaba esinqunyelwe, esivimbela ukucubungula kokuqondisa noma ukubusa. Okusho ukuthi, yize umsebenzi okhona uhambisana ne-PPMI, ngaphandle kokuqashelwa obude obuhlola umkhondo walezi zinto eziguqukayo ngokuhamba kwesikhathi, akunakwenzeka ukuthi kuhlolwe ngokuphelele noma iyiphi imodeli yokusebenzisa izithombe zobulili ezingcolile. Ekugcineni, asifakanga nencazelo yezithombe zocansi kwababambe iqhaza kwinhlolovo eku-inthanethi.

iziphetho

Sekukonke, imiphumela yethu ikhombisa ukuthi imodeli ye-PPMI, esigabeni sayo samanje sokuvela, isivele isisisekelo esithembisayo sokuchaza izinto ezinomthelela ekuzibukeni kokulutha kwezithombe zocansi kanye nokusetshenziswa kwezithombe zobulili ezingcolile okunenkinga. Ukubikezela okubilayo kwalezi zimo zombili kuze kufike emaqenjini ama-3 wezici ezinomthelela, ukwehla kwesisu, imikhuba yokusetshenziswa, nokungaziphathi kahle kokuziphatha, kuyinto ebonakalayo, yize-ngenxa yemiphumela yethu-ilusizo futhi yanele ngokwanele. Indlela echazwe ngamaqembu ama-3 echazayo ithembisa futhi iyaphikisana ngokwanele ukuthi sincoma ukuqhubeka kophenyo emizamweni yocwaningo lwesikhathi esizayo. Njengezici ezihlobene nokukhubazeka, imikhuba yokusetshenziswa, kanye nokungaziphathi kahle kokuziphatha konke kufaka isandla ngokukhethekile ekubukekeni kwezimpawu zombili ukuzibona kokulutha nokusetshenziswa kwezithombe zobulili ezingcolile okunenkinga, konke kufanele kubhekelwe ekwelashweni. Yize izimpawu ezingezinhle ezivela kuleyo naleyo yezindlela ezi-3 zingabonakala zifana, zine-etiology ehluke kakhulu, okufanele ifanelwe indlela yokwelashwa eyehlukile, futhi nokuhlonza okungenzeka kube nokwehluka (bheka ocwaningweni lukaGrubbs et al,3,31 UKraus noSweeney;18 godu biza ukuhlupheka okuhlobene nokungabi bikho njengesikhombiso sokususa ngaphandle se-CSBD: World Health Organisation,13 UKraus et al,14 noGola et al59). Ucwaningo lwesikhathi esizayo kufanele lunqume izindlela zokwelashwa ezisebenzayo ukubhekana nezici ezixhunyaniswe ekuhlukaniseni, imikhuba yokusebenzisa, kanye nokungaziphathi kahle kokuziphatha. Sibona lokhu kucatshangelwa njengesemqoka kunokuba kube yipherifalal, manje njengoba i-CSBD ifakiwe ku-ICD-1113 Ukhiye wokugwema ukweqisa okuthe xaxa kokuziphatha okuphezulu kwezocansi60, 61, 62 kubantu abangahlangabezani nokwehliswa kolawulo noma kubantu okuthi imikhuba yokuziphatha noma yezenhlalo ivuse imibono engemihle ngezenzo zakho zocansi, kubenze balawule ngokweqile imisebenzi yezocansi ngenxa yalokho.18,63 Ukuxilonga i-CSBD yalabo bantu kuzoqamba i-misdiagnosis. Izindlela zokuxilonga ze-CSBD zicace bha kakhulu ukuthi ukucindezelwa okuhambisana nezinkolelo zenkolo noma ukwenqatshwa kokuziphatha ngokobulili akuyona yodwa eyanele ukuthola le nkinga.14 Kodwa-ke, uma kucatshangelwa ukuthi ukucabanga okunjalo kokuziphatha kungashintsha imizwa yokuzibona komuntu yokuziphatha kwabo ngokobulili, kunesidingo sokunakekelwa ekusebenziseni lokhu kutholwa. Ochwepheshe bemitholampilo kufanele banakisise lokhu kuhlukaniswa kwenqubo yokuxilongwa ukuze bagweme ukuthi i-CSBD ibe “yisambulela” esisetshenziswe ngephutha ekubhaleni izizinda zezengqondo ezinobunzima ngemithi ehlukile. Ngaphezu kwalokho, njengoba ukungaziphathi kahle kokuziphatha kungenzeka kube nomthelela ekuziboneni ngokwakho kwezinye izindlela zokuziphatha (umlutha we-inthanethi, umlutha wokuxhumana nabantu, umlutha wegeyimu),27 lokhu kukhathazeka akuchazi kuphela kumlutha wezithombe zocansi ozivezile.

Okokugcina, imiphumela yethu isekela umbono wokuthi izimemezelo ezilula zokuba umlutha, ngezinga elikhulu, ziyehlukaniswa nobunzima bezimpawu zokusebenzisa izithombe zobulili ezingcolile, noma ngabe zombili lezi zinhlaka zisuselwe ekulinganiselweni okwehliswayo. Kokubili ukulutha okubonakalayo kokuzigqaja nokusebenzisa okuyizinkinga kwezithombe zocansi kufanele kuphenywe mayelana nemodeli ye-PPMI nemibuzo yocwaningo oluhlobene.

Isitatimende sokubhala

    Isigaba 1

  • (A)

    Ukuklama nokuklama

    • UKarol Lewczuk; Mateusz Gola

  • (B)

    Ukutholwa kwedatha

    • UKarol Lewczuk; Iwona Nowakowska

  • (C)

    Ukuhlaziywa nokuhunyushwa kweDatha Karol Lewczuk; Iwona Nowakowska

    Isigaba 2

  • (A)

    Ukuhlelwa kwe-Article

    • UKarol Lewczuk; U-Agnieszka Glica

  • (B)

    Ukuyibuyekeza Ngokuqukethwe Kwengqondo

    • Mateusz Gola; UJoshua B. Grubbs

    Isigaba 3

  • (A)

    Ukuvunyelwa kokugcina kwesiGungu esiqediwe

    • Karol Lewczuk; Mateusz Gola; UJoshua B. Grubbs; Agnieszka Glica; Iwona Nowakowska

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