Ethical boundary-work in the infertility clinic

Infertility practice and reproductive technologies are generally seen as 'controversial' areas of scientific inquiry that raise many complex ethical issues. This paper presents a qualitative study that considered how clinicians constructed the role of the 'ethical' in their everyday practice. We use the concept of ethical boundary-work to develop a theory of 'settled' and 'controversial' morality to illuminate how infertility clinicians drew boundaries between different conceptions of the role ethics played in their practice. An attention to areas of settled morality, usually rendered invisible by their very nature, enables us to see how clinicians manage the 'ethical' in their practice. We argue that by creating a space of 'no-ethics' in their practice--part of a settled morality that does not require articulation--the informants re-appropriate an area of their practice from 'outside' influences and control. Bringing these elements to light can help 'outsiders' to challenge and question these distinctions and therefore bring additional perspectives to debates over morality in the infertility clinic. Illuminating the everyday ethical concerns of infertility clinicians can help direct ethical thinking towards these practical concerns, as well as to more abstract debates.     

Mobilising modern facts: health technology assessment and the politics of evidence

Conventional models of ‘evidence’ for clinical practice focus on the role of randomised controlled clinical trials and systematic reviews as technologies that promote a specific model of rigour and analytic accountability. The assumption that runs through the disciplinary field of health technology assessment (HTA), for example, is that the quantification of evidence about cost and clinical effectiveness is central to rational policy‐making and healthcare provision. But what are the conditions in which such knowledge is mediated into decision‐making contexts, and how is it understood and used when it gets there? This paper addresses these questions by examining a series of meetings and seminars attended by senior clinical researchers, social care and health service managers in the UK between 1998–2004, and sessions of the House of Commons Health Committee held in 2001 and 2005. These provide contexts in which questions about the value and utility of evidence produced within the frame of HTA were explored in relation to parallel questions about the design, evaluation and implementation of telemedicine and telecare systems. The paper points to the ways that evidence generated in the normative frame of HTA was increasingly seen as one‐dimensional and medicalised knowledge that failed to respond to the contingencies of everyday practice in health and social care settings.     

急救基层卫生适宜技术示范基地建设的实践探索

针对基层医疗卫生机构技术水平和服务能力相对较低的现状,论述了基层卫生适宜技术示范基地建设的必要性,并介绍了急救基层卫生适宜技术示范基地建设的经验以及成效,为卫生适宜技术推广提供有益的借鉴.     

Seeing health and illness worlds – using visual methodologies in a sociology of health and illness: a methodological review

Abstract This review starts from the premise that the visual has been, until recently, a neglected dimension in our understanding of social life, despite the role of vision in other disciplines, including medicine itself. The potential for a visual approach will be analysed drawing on a range of studies, broadly within the sociology of health and illness, which have used visual approaches. I highlight the value of visual methodology projects within qualitative approaches to research more generally, and assess the difficulties as well as the advantages. It is suggested that using visual methodologies does not necessarily lead to greater reactivity in the research process as has sometimes been proposed; and that visual worlds are themselves unique topics of sociological study which may be enhanced by using visual techniques rather than written and spoken language. A combination of visual and traditional methods can also be fruitful. Painting and drawing, video, film, and still photography are included as examples which researchers have used and can use.     

Memorable Messages about Genes and Health: Implications for Direct-to-Consumer Marketing of Genetic Tests and Therapies

The era of genomic health care introduces new realities into decision-making about the prevention and treatment of disease. Despite this reality, relatively little is known about lay audience recollection of images and messages about genes and health, or their perceptions about the role of genetics research for health, and what diseases are inherited. Participants (N = 482) responded to three open-ended thought-listing tasks to consider these issues. Results revealed the significance of movies in framing memorable messages for participants, with print sources and television also represented. Both awareness and product commercials also comprised specific memories. Cloning was a frequently recalled message and often the first thought that came to participants' minds. While a broad range of conditions were associated with health risks inherited from one's family, cancer was most often identified. The messages recalled revealed a number of common features including their tendency to be emotion-laden. The theoretic and pragmatic implications of these results are considered.     

Addressing Human Variability in Next-Generation Human Health Risk Assessments of Environmental Chemicals

Background: Characterizing variability in the extent and nature of responses to environmental exposures is a critical aspect of human health risk assessment.Objective: Our goal was to explore how next-generation human health risk assessments may better characterize variability in the context of the conceptual framework for the source-to-outcome continuum.Methods: This review was informed by a National Research Council workshop titled “Biological Factors that Underlie Individual Susceptibility to Environmental Stressors and Their Implications for Decision-Making.” We considered current experimental and in silico approaches, and emerging data streams (such as genetically defined human cells lines, genetically diverse rodent models, human omic profiling, and genome-wide association studies) that are providing new types of information and models relevant for assessing interindividual variability for application to human health risk assessments of environmental chemicals.Discussion: One challenge for characterizing variability is the wide range of sources of inherent biological variability (e.g., genetic and epigenetic variants) among individuals. A second challenge is that each particular pair of health outcomes and chemical exposures involves combinations of these sources, which may be further compounded by extrinsic factors (e.g., diet, psychosocial stressors, other exogenous chemical exposures). A third challenge is that different decision contexts present distinct needs regarding the identification—and extent of characterization—of interindividual variability in the human population.Conclusions: Despite these inherent challenges, opportunities exist to incorporate evidence from emerging data streams for addressing interindividual variability in a range of decision-making contexts.     

Genetic studies on an Alzheimer clinic population

All patients attending the Clinic for Alzheimer Disease and Related Disorders have detailed family histories taken by a geneticist. To date, genetic histories are available for 446 consecutive, unrelated individuals. Of these, 151 (33.9%) are diagnosed as having "probable" (N = 141) or "autopsy-confirmed" (N = 10) Alzheimer disease according to recognized criteria. This data base represents a relatively unselected population with respect to more than one person in the family having dementia. Seventy-one of these 151 index cases (47.0%) have a positive family history of dementia, of which 8 (5.3%) may represent the familial (autosomal dominant) form of Alzheimer disease (FAD). Age-corrected empiric recurrence risks for Alzheimer disease/dementia were calculated for first-degree relatives of these 151 index cases using the Kaplan-Meier lifetable method.     

卫生适宜技术信息资源需求分析

开展卫生适宜技术信息资源需求分析是畅通信息传播通道,促进卫生适宜技术面向基层推广应用的重要基础。本文通过文献研究、问卷调查、个人访谈、专题座谈等方法,研究了我国卫生适宜技术信息资源建设情况,并对浙江省卫生适宜技术的使用方、技术持有方和技术推广方等不同主体的信息资源需求内容、获取途径等进行了深入分析。     

论视力障碍病人的情感需求及其健康教育

视力是人类重要的生理功能。人类视力活动与周围环境的关系和相互作用，以及视力障碍所产生的社会学意义及其对于人们生活质量的价值和影响应该引起医护人员的高度重视。对于视力障碍病人来说，最大的障碍莫过于心理障碍。他们对于理解和尊重的情感需求比正常人更为强烈，因此对于视力障碍者必须给予真诚的情感投入，医护入员有责任任理解他们在机体、精神和意志上的缺陷，尽量满足他们的需求，赋干他们以真诚的情感和社会责任。对于那些需要手术的眼科病人，及时进行科学的健康教育和行为指导是必不可少的。     

On the imperative of thinking through the ethical,health equity,and social justice possibilities and limits of digital technologies in public health

The COVID-19 pandemic has demonstrated both the positive and negative use, usefulness, and impact of digital technologies in public health. Digitalization can help advance and sustain the core functions of public health, including health promotion and prevention, epidemiological surveillance, and response to emergent health issues. Digital technologies are thus—in some areas of public discourse—presented as being both necessary and inevitable requirements to address routine and emergency public health issues. However, the circumstances, ways, and extent to which they apply remain a subject of critical reflection and empirical investigation. In this commentary, we argue that we must think through the use of digital technologies in public health and that their usefulness must be assessed in relation to their short- and long-term ethical, health equity, and social justice implications. Neither a sense of digital technological optimism and determinism nor the demands of addressing pressing public health issues should override critical assessment before development and implementation. The urgency of addressing public health emergencies such as the ongoing COVID-19 pandemic requires prompt and effective action, including action facilitated by digital technologies. Nevertheless, a sense of urgency cannot be an excuse or a substitute for a critical assessment of the tools employed.     

Ethical Issues in the Economic Assessment of Health Care Technologies

This paper challenges traditional views which oppose health economics and medical ethics by arguing that economic assessment is a necessary complement to medical ethics and can help to improve public participation and democratic processes in choices about resource allocation for health care technologies. In support of this argument, four points are emphasized: (1) Most current biomedical ethical debates implicitly deal with economic issues of resource allocation. (2) Clinical decisions, which usually respect the Hippocratic code of ethics, are nevertheless influenced by economic incentives and constraints. (3) Economic assessment is concerned with both efficiency and equity and potential trade-offs between the two, which means that ethical judgements are always embedded in welfare economics. (4) The real debate is not between economics on the one side and medical ethics on the other. Rather it is between different ethical conceptions of social justice and the contrasting approaches they entail to reconciling individual interests and preferences with collective goods and welfare. This revised version was published online in August 2006 with corrections to the Cover Date.     

Uncertainty in the economic evaluation of health care technologies: The role of sensitivity analysis

Given the increased use of economic evaluation to inform decision making in the health service, it is particularly important that the research methods used are critically assessed and, where possible, improved. The systematic handling of uncertainty in economic evaluation is an important area that remains methodologically underdeveloped. With the increased use of the clinical trial as a vehicle for economic evaluation, there has been recent interest in how the statistical methods routinely employed to handle uncertainty in clinical research might be applied to economic evaluation. This paper reviews the types of uncertainty that exist in economic evaluation and argues that some forms of uncertainty are not amenable to statistical methods. Sensitivity analysis is not a single approach but can take a number of different forms. The different types of sensitivity analysis are reviewed, with an indication of their strengths and weaknesses in relation to the different types of uncertainty in economic evaluation.     

‘Medicine’s Next Goldmine?’ The Implications of New Genetic Health Technologies for the Health Service

There is considerable uncertainty about the implications of the new genetics for health services. These are the enthusiasts who argue that molecular genetics will transform health care and others argue that the scope for genetic interventions is limited. The aim of this paper is to examine some of the questions, tensions and difficulties which face health care providers particularly in developed countries as they try to come to terms with the dilemmas raised by new genetic health care technologies (NGHTs). It identifies questions for research which may help the development of robust and flexible strategies for implementation.     

老年人健康管理的研究前沿和热点

目的揭示我国老年人健康管理的研究现状、研究热点和研究前沿。方法采用可视化分析软件分别做出研究作者、机构和关键词的网络图谱,对图谱进行深入分析。结果老年人健康管理研究的热点为:慢性病、健康教育、社区卫生服务中心和中医体质辨识。研究前沿主要集中在社区卫生服务中心和中医体质辨识等方面。结论随着健康管理学科的发展,老年人的健康管理研究尤为重要,因此受到了人们更多的关注和重视。     

‘Birthing a Better Future’: A mixed‐methods evaluation of an exhibition on the early years of life

BackgroundOur study aimed to evaluate to what extent Zero2 Expo''s ‘Birthing a Better Future’, a co‐created multimedia exhibition, was effective in raising awareness on the importance of the first 1001 days of life and explore what refinements would help to optimize the impact of future exhibitions.MethodsWe conducted a mixed‐methods evaluation of the exhibition delivered in the John Radcliffe Hospital, Oxford. Through convenience sampling, 14 participants were selected to participate in 12 structured interviews and 19 participants completed a questionnaire. Interviews were thematically analysed alongside quantitative analysis of questionnaire responses through Likert scales.ResultsThe majority (78.6%, n = 11/14) of participants who completed the questionnaire either agreed or strongly agreed that the exhibition raised their awareness about the first 1001 days of life. This was supported by the analysis of interviews. The use of art was found to provoke an emotional engagement from participants. Participants felt that the length of the written pieces and location of the exhibition were important factors for designers to consider in future exhibitions.ConclusionThis study demonstrated that multimedia exhibitions, combining science with art, may be an effective way to raise awareness of public health messages. Engaging with key stakeholders will be an essential step in order to improve future public health exhibitions.Public ContributionWhen designing the study, the public reviewed the study tools, which were refined based on their feedback. At every phase of the study, members of the public who are artists co‐created the exhibition content.     

孕前门诊健康教育对不良嗜好戒除的效果评价

目的评价对孕前有不良嗜好的妇女实施健康教育的效果。方法选择自2008年6月至2009年5月,在第一妇婴保健院进行孕前检查的妇女中,有饲养宠物或有吸烟饮酒嗜好的妇女共169名,进行健康教育,并进行为期2年的随访。结果有46．2％的受查妇女对医生宣教很满意。各类不良嗜好的完全戒除率分别为：家中饲养宠物60：0％,明显被动吸烟62．9％,每日吸烟75．0％,每日重度饮酒50．0％。医生宣教的质量与孕前饲养宠物（Rs=0．326,P=0．014）,明显被动吸烟（Rs=0．377,P=0．ooo）的戒除呈正相关。孕前无或已戒除明显被动吸烟者妊娠不良结局发生率低于未戒除者（Fisher’s exact=0．014）。结论孕前健康宣教对改变不良嗜好起到了一定的作用。应针对工作的薄弱点加强健康教育。     

社区公共卫生和临床医学整合模式的研究与实践

该文分析了宁波市构建社区公共卫生和临床医学整合模式的实践措施及其特点,提出了加强区域卫生资源整合,构建大协作组织网络．加强卫生应急能力建设,构建一体化卫生信息体系;加强社区健康管理．构建慢性病综合防治模式;加强医学教育改革,培养防治结合型卫生人才等四个方面措施,并进行了进一步实践运用,取得了较好成效,值得推广应用。     

婚前体检人群生殖健康状况及保健

目的　了解婚前体检人群的生殖健康状况。方法　对８９６８ 份婚前医学检查资料分析。结果　生殖系统疾病检出率为７ ．４３ ％ ，占查出的各系统疾病的构成比为５６．４９ ％ 。男性检出率为１０．８２ ％ ，女性为４ ．０５ ％ 。男女对象中都查出梅毒等性传播疾病。未婚妇女的妊娠和人流发生率分别为２３ ．５０ ％ ，１７ ．８８％ 。ＨＢｓＡｇ 总阳性率为６．３１％ 。结论　婚前体检人群存在较多的生殖健康问题。应加强对婚前体检人群的性知识宣传和婚育指导，进一步提高婚前保健质量