Preventive medicine最新文献_第10页

Food insufficiency and difficulty affording expenses after the end of Supplemental Nutrition Assistance Program emergency allotments in the United States among households with and without children 在美国有孩子和没有孩子的家庭中，在补充营养援助计划紧急拨款结束后，食物不足和负担费用困难

IF 3.2 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Preventive medicine

Pub Date : 2025-08-07 DOI: 10.1016/j.ypmed.2025.108385

Anna E. Austin , Stephanie Ettinger de Cuba , Courtney N. Maierhofer , Rebecca B. Naumann , May Chen , Kayla N. Anderson , Paul R. Shafer

Objective

Emergency allotments were issued in the Supplemental Nutrition Assistance Program (SNAP), the largest program addressing food insecurity in the United States, during the COVID-19 pandemic. These emergency allotments temporarily increased the amount of monthly food purchasing assistance received by SNAP-participating households. Our aim was to examine the association of the end of SNAP emergency allotments with food insufficiency and difficulty affording expenses, overall and among households with and without children.

Methods

We used March 2021–April 2022 Household Pulse Survey data from respondents in four states that ended emergency allotments in August 2021 (“earlier ender” states) and eight states that ended emergency allotments after the end of the study period (comparison states). We conducted difference-in-differences analyses to compare changes in the risk of food insufficiency and difficulty affording expenses from before to after the end of emergency allotments in August 2021 between SNAP-participating households in “earlier ender” states and comparison states.

Results

Earlier ending of SNAP emergency allotments was associated with a 5.0 percentage point increase in the risk of food insufficiency (risk difference (RD) = 0.05, 95 % confidence interval (CI) 0.03, 0.07) and an 8.0 percentage point increase in the risk of difficulty affording expenses (RD = 0.08, 95 % CI 0.06, 0.09). The increase in the risk of food insufficiency was slightly larger for households with children (RD = 0.06, 95 % CI 0.03, 0.09) than households without children (RD = 0.04, 95 % CI 0.00, 0.08).

Conclusions

SNAP benefit reductions after the end of emergency allotments were associated with difficulty affording food and household expenses among households with and without children.

在2019冠状病毒病大流行期间，补充营养援助计划（SNAP）是解决美国粮食不安全问题的最大计划，并发放了紧急拨款。这些紧急拨款暂时增加了参与该计划的家庭每月获得的粮食购买援助数额。我们的目的是研究SNAP紧急拨款结束与食物不足和负担费用困难之间的关系，无论是在总体上还是在有孩子和没有孩子的家庭中。我们使用了2021年3月至2022年4月来自四个在2021年8月结束紧急拨款的州（“提前结束”州）和八个在研究期结束后结束紧急拨款的州（比较州）的受访者的家庭脉搏调查数据。我们进行了差异中差异分析，以比较2021年8月“提前结束”州和比较州参与snap的家庭在紧急拨款结束前后食物不足风险和支付费用困难方面的变化。结果提前结束SNAP紧急拨款与食物不足风险增加5.0个百分点(风险差（RD) = 0.05, 95%置信区间（CI） 0.03, 0.07）和负担费用困难风险增加8.0个百分点（RD = 0.08, 95% CI 0.06, 0.09）相关。有孩子的家庭食物不足风险的增加略大于没有孩子的家庭（RD = 0.04, 95% CI 0.00, 0.08）（RD = 0.06, 95% CI 0.03, 0.09）。结论：在紧急分配结束后，snap福利减少与有孩子和没有孩子的家庭难以负担食物和家庭开支有关。

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引用次数: 0

Corrigendum to “Reducing perceived barriers to scaling up overdose education and naloxone distribution and medications for opioid use disorder in the United States in the HEALing (Helping End Addiction Long-Term®) communities study” [Preventive Medicine Volume 185 (2024) 108034] “在美国康复（帮助结束长期成瘾®）社区研究中，减少对扩大过量教育和纳洛酮分布和阿片类药物使用障碍的感知障碍”[预防医学卷185(2024)108034]的勘误。

IF 3.2 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Preventive medicine

Pub Date : 2025-08-07 DOI: 10.1016/j.ypmed.2025.108383

Hannah K. Knudsen , Daniel M. Walker , Nicole Mack , Elizabeth N. Kinnard , Timothy R. Huerta , LaShawn Glasgow , Louisa Gilbert , Bryan R. Garner , Anindita Dasgupta , Redonna Chandler , Sharon L. Walsh , Yjuliana Tin , Sylvia Tan , Joel Sprunger , Linda Sprague Martinez , Pamela Salsberry , Merielle Saucier , Maria Rudorf , Sandra Rodriguez , Carrie B. Oser , Mari-Lynn Drainoni

引用次数: 0

Changes in health behaviors and risk of cardiovascular disease among midlife and aging municipal employees with and without metabolic risk factors: A register-linkage cohort study in Finland 芬兰有或没有代谢危险因素的中老年市政雇员健康行为和心血管疾病风险的变化：一项登记连锁队列研究

IF 3.2 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Preventive medicine

Pub Date : 2025-08-05 DOI: 10.1016/j.ypmed.2025.108379

Jaakko Harkko , Olli Pietiläinen , Pekka Jousilahti , Antti Etholén , Luka Vähäsarja , Eero Teppo , Novartis Foundation AI4HealthyCities Group, Tea Lallukka

Objective

To investigate associations between changes in health behaviors and cardiovascular disease (CVD) risk among municipal employees, stratified by baseline metabolic risk factors (hypertension, hypercholesterolemia, obesity, diabetes).

Methods

We followed 4470 municipal employees in Helsinki, Finland (74 % women; median age 56.1 years) for an average of 11 years (2007–2022) to assess incident CVD. Survival curves estimated median survival differences, and hazard ratios (HRs) evaluated CVD risk related to changes in smoking, physical activity, alcohol consumption, diet, and sleep.

Results

During the follow-up, 1879 (42 %) individuals developed CVD. Among those without metabolic risk factors, improvement in health behavior score was linked to reduced CVD risk and an 8.1-year longer median survival (HR = 0.59, 95 % CI = 0.41–0.86). Across metabolic risk-factor groups, the most considerable reductions were observed in the transition from physical inactivity to activity among individuals with hypertension (HR = 0.66, 95 % CI = 0.49–0.87), diabetes (HR = 0.51, 95 % CI = 0.30–0.87), and obesity (HR = 0.63, 95 % CI = 0.43–0.93).

Conclusions

Changes in health behaviors were associated with CVD risk, varying by metabolic factors. Findings support targeted interventions to promote behavior change, particularly increasing physical activity in those with metabolic risks.

目的：通过基线代谢危险因素（高血压、高胆固醇血症、肥胖、糖尿病）分层，探讨市政职工健康行为变化与心血管疾病（CVD）风险的关系。方法：对芬兰赫尔辛基4470名市政雇员进行随访(74% 为女性；中位年龄56.1 岁)，平均11 岁（2007-2022年）来评估心血管疾病的发生率。生存曲线估计中位生存差异，风险比（hr）评估与吸烟、体育活动、饮酒、饮食和睡眠变化相关的心血管疾病风险。结果：随访期间，1879人（42 %）发生心血管疾病。在没有代谢危险因素的患者中，健康行为评分的改善与心血管疾病风险降低和中位生存期延长8.1年相关（HR = 0.59,95% % CI = 0.41-0.86）。在代谢危险因素组,最可观的减少从缺乏身体活动过渡到活动中观察高血压患者中(HR = 0.66,95 CI  % = 0.49 - -0.87)、糖尿病(HR = 0.51,95 CI  % = 0.30 - -0.87),和肥胖(HR = 0.63,95 CI  % = 0.43 - -0.93)。结论：健康行为的改变与CVD风险相关，且随代谢因素的变化而变化。研究结果支持有针对性的干预措施，以促进行为改变，特别是增加有代谢风险的人的身体活动。

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引用次数: 0

Rural-urban differences in the symptoms, side effects, and physical activity of cancer survivors in the United States 美国癌症幸存者的症状、副作用和身体活动的城乡差异

IF 3.2 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Preventive medicine

Pub Date : 2025-08-04 DOI: 10.1016/j.ypmed.2025.108380

Whitney E. Zahnd , Jessica Gorzelitz , Mary E. Charlton , Heather Schacht Reisinger , Sarah H. Nash , Aaron T. Seaman

Objective

To evaluate rural-urban differences in cancer-related symptoms, side effects, activities of daily living, and physical activity among cancer survivors in the United States.

Methods

We analyzed the Health Information National Trends Survey -Surveillance Epidemiology End Results (HINTS -SEER; n = 1054 cancer survivors) from the Greater San Francisco Bay Area, Iowa, and New Mexico between January – August 2021. Respondents were surveyed on cancer-related symptoms and side effects along with their activities of daily living (ADL) and physical activity (PA). We calculated weighted percentages and Rao-Scott chi-square tests for reported differences between rural and urban survivors. Rural/urban status was determined using Rural Urban Continuum Codes.

Results

Rural and urban cancer survivors did not differ in their reporting of symptoms or side effects, with each group reporting approximately 20 % or greater prevalence of each assessed symptom or side effect. For ADLs, rural cancer survivors more frequently reported difficulty dressing/bathing compared to their urban counterparts (7.7 % vs. 3.1 %, p = 0.02), but there were no statistically significant differences for other ADLs. A higher percentage of urban cancer survivors compared to rural reported meeting aerobic PA recommendations of ≥150 minutes moderate intensity activity per week (47.9 % vs. 33.8 %, p < 0.001).

Conclusions

While many cancer survivors report symptoms and side effects of cancer treatment, no substantial variations existed by rurality. Important exceptions to this was that rural cancer survivors reported greater difficulty with bathing and dressing, and lower PA. Interventions and research to address these rural-urban differences will be critical to ensure rural cancer survivors have optimal long-term outcomes.

目的评估美国癌症幸存者在癌症相关症状、副作用、日常生活活动和身体活动方面的城乡差异。方法分析卫生信息全国趋势调查-监测流行病学最终结果(提示-SEER；n = 1054名癌症幸存者)来自大旧金山湾区，爱荷华州和新墨西哥州，时间为2021年1月至8月。调查对象的癌症相关症状和副作用以及日常生活活动（ADL）和身体活动（PA）。我们计算加权百分比和Rao-Scott卡方检验报告农村和城市幸存者之间的差异。使用农村/城市连续代码确定农村/城市状态。结果农村和城市癌症幸存者报告的症状或副作用没有差异，每组报告的每种评估的症状或副作用的患病率约为20%或更高。对于adl，与城市患者相比，农村癌症幸存者更频繁地报告穿衣/洗澡困难（7.7%比3.1%,p = 0.02），但在其他adl中没有统计学上的显著差异。与农村相比，城市癌症幸存者达到有氧运动协会建议的每周≥150分钟中等强度运动的比例更高(47.9% vs 33.8%, p <；0.001)。结论：虽然许多癌症幸存者报告了癌症治疗的症状和副作用，但农村地区没有实质性的差异。重要的例外是，农村癌症幸存者报告洗澡和穿衣更困难，PA更低。解决这些城乡差异的干预措施和研究对于确保农村癌症幸存者获得最佳的长期结果至关重要。

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引用次数: 0

Cigarette smoking and chronic disease in the United States, 2021–2023 吸烟和慢性疾病在美国，2021-2023。

IF 3.2 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Preventive medicine

Pub Date : 2025-07-26 DOI: 10.1016/j.ypmed.2025.108378

Karin A. Kasza , Richard J. O'Connor , K. Michael Cummings , Martin C. Mahoney

Objective

To quantify and describe the U.S. population of adults who smoke cigarettes daily and have chronic disease, determine their use of various products, and determine whether use of each product is associated with cigarette quitting.

Methods

PATH Study data collected in 2021 (Wave 6) and 2022/23 (Wave 7) were analyzed. Participants were adults who smoked cigarettes daily ages 40+ who were diagnosed with chronic obstructive pulmonary disease, chronic bronchitis, emphysema, congestive heart failure, heart attack, stroke, cancer, and/or diabetes as of 2021 (N = 1261). We determined in 2022/23 their past 12-month use of e-cigarettes, nicotine pouches, nicotine replacement therapy (NRT), and bupropion or varenicline; we evaluated whether use differed by several characteristics, and whether use was associated with cigarette quitting.

Results

Among adults who smoked with chronic disease, 40 % were not recently advised by a clinician to quit smoking and 27 % did not plan to ever quit. Between 2021 and 2022/23, 16 % used e-cigarettes, 14 % used NRT, 8 % used bupropion or varenicline, 3 % used nicotine pouches. Overall, <6 % quit smoking in 2022/23; quit rates were higher for those who used e-cigarettes (9 %) and those who used NRTs (12 %) than those who did not use each respective product (5 % and 5 %).

Conclusions

There are 9.9 million people with chronic disease who smoke cigarettes daily in the U.S; findings highlight opportunity for healthcare providers to enhance efforts to help people quit smoking, opportunity to improve low use rates of FDA-approved smoking cessation pharmacotherapies, and potential for e-cigarettes as a smoking cessation tool.

目的：量化和描述美国每天吸烟并患有慢性疾病的成年人人口，确定他们对各种产品的使用，并确定每种产品的使用是否与戒烟有关。方法：对2021年（第6波）和2022/23年（第7波）收集的PATH研究数据进行分析。参与者是每天吸烟的成年人，年龄在40岁以上，截至2021年被诊断患有慢性阻塞性肺病、慢性支气管炎、肺气肿、充血性心力衰竭、心脏病发作、中风、癌症和/或糖尿病（N = 1261）。我们在2022/23年度确定了他们过去12个月使用电子烟、尼古丁袋、尼古丁替代疗法（NRT）和安非他酮或伐尼克兰的情况；我们评估了使用是否因几个特征而不同，以及使用是否与戒烟有关。结果：在慢性疾病吸烟的成年人中，40% %最近没有被临床医生建议戒烟，27% %不打算戒烟。在2021年至2022/23年期间，16% %使用电子烟，14% %使用NRT， 8% %使用安非他酮或伐尼克兰，3% %使用尼古丁袋。总的来说，结论是：在美国有990万慢性疾病患者每天吸烟；研究结果强调了医疗保健提供者加强努力帮助人们戒烟的机会，改善fda批准的戒烟药物疗法的低使用率的机会，以及电子烟作为戒烟工具的潜力。

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引用次数: 0

Disability and receipt of the Papanicolaou test for cervical cancer screening: A systematic review and meta-analysis 残障和接受帕帕尼科劳试验用于宫颈癌筛查：一项系统回顾和荟萃分析。

IF 3.2 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Preventive medicine

Pub Date : 2025-07-25 DOI: 10.1016/j.ypmed.2025.108376

Hasmik Beglaryan , Jayati Khattar , Caroline Kassee , Kathryn Barrett , Susan E. Bronskill , Aisha Lofters , Hilary K. Brown

Objective

To synthesize literature comparing Papanicolaou (Pap) test receipt between women with and without disabilities.

Methods

We searched the following databases from inception to March 1, 2024: OVID Medline (1946–), EBSCO CINAHL Plus (1981–), OVID EMBASE (1974–), and OVID APA PsycINFO (1806–). Eligible studies were peer-reviewed and compared receipt of Pap tests in women with physical, hearing, vision, or intellectual/developmental disability versus those without disabilities. We extracted data using a standardized form; study quality was appraised using the Newcastle-Ottawa Scale; and results were synthesized using random-effects meta-analyses, where possible. Findings that could not be meta-analyzed were summarized following Synthesis Without Meta-analysis guidelines. Grading of Recommendations, Assessment, Development and Evaluation was used to assess the strength of evidence.

Results

Of 1946 unique studies screened, 43 were included in the review, and 21 were meta-analyzed. Studies were primarily cross-sectional (65.1 %), used survey data (76.7 %), and were conducted in the United States (60.5 %). Quality was rated high (30.2 %), medium (55.8 %), and low (14.0 %). Women with disabilities had a lower likelihood of receiving a Pap test (adjusted pooled OR 0.78, 95 % CI: 0.66–0.91). Disparities were more pronounced among those with physical (adjusted pooled OR 0.74, 95 % CI: 0.68–0.80) and intellectual/developmental disabilities (adjusted ORs ranging from 0.21 to 0.37). The overall strength of evidence was low.

Conclusions

Women with disabilities could benefit from efforts to improve cervical cancer screening receipt. Future studies should continue to explore this association, including using population-based data that may better capture the needs of this group.

目的：综合文献比较残疾妇女和非残疾妇女接受巴氏涂片检查的情况。方法：检索OVID Medline（1946-）、EBSCO CINAHL Plus（1981-）、OVID EMBASE（1974-）和OVID APA PsycINFO（1806-）数据库。符合条件的研究经过同行评审，并将接受巴氏试验的身体、听力、视力或智力/发育残疾妇女与无残疾妇女进行比较。我们使用标准化表格提取数据；采用纽卡斯尔-渥太华量表评价研究质量；在可能的情况下，使用随机效应荟萃分析来综合结果。不能进行meta分析的研究结果按照不进行meta分析的综合指南进行总结。建议、评估、发展和评价的分级用于评估证据的强度。结果：在筛选的1946项独特研究中，有43项纳入本综述，21项进行了meta分析。研究主要是横断面（65.1 %），使用调查数据（76.7 %），并在美国进行（60.5 %）。质量被评为高（30.2% %）、中（55.8% %）和低（14.0% %）。残疾妇女接受巴氏试验的可能性较低（调整后的合并OR为0.78,95 % CI: 0.66-0.91）。在身体残疾（调整后的综合OR为0.74,95 % CI: 0.68-0.80）和智力/发育残疾（调整后的OR为0.21至0.37）患者中，差异更为明显。证据的总体强度很低。结论：残疾妇女可以从改善宫颈癌筛查接收的努力中受益。未来的研究应继续探索这种联系，包括使用基于人口的数据，以更好地捕捉这一群体的需求。

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引用次数: 0

Examining US adolescent cigarette smoking prevalence by rurality and gender, 2002–2019 2002-2019年美国农村和性别青少年吸烟率调查

IF 3.2 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Preventive medicine

Pub Date : 2025-07-25 DOI: 10.1016/j.ypmed.2025.108377

Tyler G. Erath , Fang Fang Chen , Michael DeSarno , Stephen T. Higgins

Objective

Examine changes in cigarette smoking prevalence among US adolescents by rural-urban residence, gender, and time.

Methods

We compared trends in smoking prevalence by rural-urban residence and gender using 18 years of cross-sectional data (2002–2019) from 298,530 respondents aged 12–17 in the US National Survey on Drug Use and Health. The two primary outcomes were past-month and daily smoking prevalence. Weighted logistic regression models tested whether smoking prevalence varied by rural-urban residence, gender, and time along with two-way and three-way interactions of these variables.

Results

Past-month and daily smoking declined over time for all four rural-urban residence and gender combinations. Regarding past-month smoking, there was a significant rural-urban residence by time interaction (p < .001) with higher prevalence and slower rates of decline among rural (adjusted odds ratio [AOR] = 0.86; 95 %CI = 0.85,0.87) versus urban participants (AOR = 0.83; 95 %CI = 0.82,0.84). A significant gender by time interaction (p < .001) was also observed.

The rate of decline was faster among females (AOR = 0.82; 95 %CI = 0.81,0.83) versus males (AOR = 0.85; 95 %CI = 0.84,0.86) with prevalence initially higher (2002−2003) yet ending lower (2018–2019) among females. Regarding daily smoking, there was a significant rural-urban residence by time interaction (p = .005) with higher prevalence and slower rates of decline among rural (AOR = 0.82; 95 %CI = 0.80,0.85) versus urban participants (AOR = 0.79; 95 %CI = 0.78,0.80).

Conclusions

Findings provide novel evidence of shrinking yet persistent rural disparities in both past-month and daily smoking, and less declines in past-month smoking among males over time. Together, findings support continued need for tobacco control and regulatory efforts to reduce adolescent smoking and specific efforts to reduce rural and gender disparities.

目的：研究美国青少年吸烟率随城乡居住、性别和时间的变化。方法：我们使用美国全国药物使用与健康调查中298,530名年龄在12-17岁的受访者的18 年横断面数据（2002-2019），比较城乡居住和性别的吸烟率趋势。两个主要结果是过去一个月的吸烟率和每日吸烟率。加权逻辑回归模型检验了吸烟率是否随城乡居住、性别和时间的变化而变化，以及这些变量的双向和三向相互作用。结果：在所有四种城乡居民和性别组合中，过去一个月和每天的吸烟率都随着时间的推移而下降。关于过去一个月的吸烟情况，通过时间的相互作用存在显著的城乡居民差异（p ）。结论：研究结果提供了新的证据，表明过去一个月和每天吸烟的农村差异正在缩小，但持续存在，而且随着时间的推移，男性过去一个月吸烟的下降幅度较小。总之，调查结果支持继续需要进行烟草控制和监管工作，以减少青少年吸烟，并具体努力减少农村和性别差异。

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引用次数: 0

Response to commentary by Akhter et al. titled, “Beyond biomarkers: Underexplored considerations in SREC trials for people with HIV who smoke” 对Akhter等人题为“超越生物标志物：吸烟艾滋病病毒感染者SREC试验中未充分探索的考虑因素”的评论的回应。

IF 3.2 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Preventive medicine

Pub Date : 2025-07-24 DOI: 10.1016/j.ypmed.2025.108374

Patricia A. Cioe , William V. Lechner , Garrett S. Stang , Christopher W. Kahler , Karen T. Tashima , Thomas Eissenberg , Jennifer W. Tidey

引用次数: 0

Beyond biomarkers: Underexplored considerations in standardized research electronic cigarette trials for people with HIV who smoke 超越生物标志物：对吸烟的艾滋病毒感染者进行电子烟试验的标准化研究中未充分开发的考虑因素。

IF 3.2 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Preventive medicine

Pub Date : 2025-07-23 DOI: 10.1016/j.ypmed.2025.108373

Javeria Akhter , Javed Iqbal , Syed Muhammad Ali

引用次数: 0

Human-centred design thinking as a co-creation process: A commentary 以人为本的设计思维是一个共同创造的过程：评论

IF 4.3 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Preventive medicine

Pub Date : 2025-07-23 DOI: 10.1016/j.ypmed.2025.108375

Vivian Romero , Elise Rivera

Objective

Co-creation, a collaborative process of engaging with stakeholders to define complex problems and design solutions that are contextually relevant to stakeholders' needs, has gained traction in public health and preventive medicine to address “wicked problems” through meaningful engagement with stakeholders. The way in which co-creation approaches are used and/or described in public health are not always entirely clear. How might we enhance co-creation processes to improve health? The objective of this commentary is to argue for the integration of human-centred design thinking (HCDT) to direct co-creation processes by defining its framework and use of empathetic perspectives and iterative problem framing.

Methods

This commentary defines human-centred design thinking HCDT as a framework for co-creation with an emphasis on divergent and convergent thinking and introduces designer mindsets. The role of empathy and problem framing is explored using examples from the field.

Results

This commentary argues for the added value of applying HCDT as an approach to co-creation in public health and provides tools associated with this process that can complement traditional co-creation processes, such as the Double Diamond model, HCDT field guides with detailed and established activities, “designerly ways of knowing”, empathy mapping, and problem reframing.

Conclusions

By integrating HCDT into co-creation processes, we can foster deeper empathetic responses and problem framing through collaboration.

“生态创造目标”是一个与利益攸关方接触，确定复杂问题并设计与利益攸关方需求相关的解决方案的协作过程，它已在公共卫生和预防医学领域获得支持，通过与利益攸关方有意义的接触来解决“棘手问题”。在公共卫生中使用和/或描述共同创造方法的方式并不总是完全清楚。我们如何加强共同创造过程以改善健康？这篇评论的目的是通过定义以人为中心的设计思维（HCDT）的框架和使用移情视角和迭代问题框架来指导共同创造过程。这篇评论将以人为中心的设计思维定义为共同创造的框架，强调发散和收敛思维，并介绍了设计师的思维方式。共情和问题框架的作用，探讨了使用来自该领域的例子。本评论论证了将HCDT作为公共卫生领域共同创造方法的附加价值，并提供了与此过程相关的工具，这些工具可以补充传统的共同创造过程，如双钻石模型、HCDT实地指南，其中包含详细和已建立的活动、“设计师式的认识方式”、移情映射和问题重构。通过将HCDT整合到共同创造过程中，我们可以通过协作培养更深层次的共情反应和问题框架。

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引用次数: 0