亲属肾移植的社会伦理学思考

随着我国《器官移植条例》和《人体器官移植技术临床应用管理暂行规定》的公布实施,亲属肾移植在全国迅速推广,伦理学问题也随之而来。     

亲属活体肾移植受者的健康教育需求调查与管理

世界上第一例成功的肾移植即为亲属活体肾移植，在供肾短缺Et益加剧的今天，亲属活体肾移植重新成为移植界关注的焦点。相对于尸体肾移植，亲属活体肾移植具有更好的人／肾的存活率；但亲属活体肾移植受者的心理压力较大，更担心手术成功率及预后情况。     

卫生部办公厅关于卫生部人体器官移植技术临床应用委员会聘请有关专家的通知

卫办医发〔2006〕89号各省、自治区、直辖市卫生厅局,新疆生产建设兵团卫生局:根据《人体器官移植技术临床应用管理暂行规定》,为适应我国人体器官移植技术临床应用管理工作的需要,我部人体器官移植技术临床应用委员会决定聘请吴孟超等36位医师作为卫生部人体器官移植技术临床应用委员会的专家(具体名单附后)。该委员会聘请的专家主要职责为:在我部人体器官移植技术临床应用委员会的领导下,为拟定全国人体器官移植技术临床应用规范和评议省级卫生行政部门上报的人体器官移植技术临床应用规划提供技术咨询和建议。请各有关单位对本单位被聘请…     

亲属活体肾移植75例报告

目的通过对75例活体亲属肾移植的实施、观察及随访结果,探讨活体亲属肾移植供体选择指征和治疗经验。方法分析总结1999年3月～2009年7月我院实施的75例亲属活体肾移植的供受者临床资料、风险评估、配型、手术方法及免疫抑制剂方案。结果4例供者术中轻度胸膜损伤,经及时处理无不良后果,1例供者术后发生乳糜淋巴瘘,引流2w后痊愈,其余供者术后未出现并发症,术后肾功能正常。75例受者中有不同程度的排斥反应、移植肾功能延迟恢复、感染等并发症。结论亲属活体肾移植急性排斥反应明显低于尸体肾移植,具有近期移植肾功能恢复好、经济代价小的优势,移植肾长期存活效果还有待随访观察,活体供肾也存在一些伦理学的争议。     

国家卫生计生委、中国红十字会总会关于成立中国人体器官捐献与移植委员会的通知

各省、自治区、直辖市卫生计生委（卫生厅局）、红十字会，新疆生产建设兵团卫生局、红十字会：为贯彻落实国务院《人体器官移植条例》，依法推进人体器官捐献与移植工作，经研究，国家卫生计生委与中国红十字会总会决定将人体器官移植技术临床应用委员会（OTC）与中国人体器官捐献工作委员会（CODC）合并，成立中国人体器官捐献与移植委员...     

中国人体器官移植立法缘何如此之难

2006年3月27日,卫生部在网站上公布《人体器官移植技术临床应用管理暂行规定》,北京大学法学院教授孙东东告诉记者:“我参加卫生部器官移植立法工作小组有三五年时间,以前想做成《器官移植法》,后来降到《器官移植条例》,目前出台的只是部门规章、行政管理条例。原因是器官移植问题涉及器官供体、受体、医生行为、器官来源、储运、调配,是医学、法律、伦理、经济和政治的交叉体,牵涉复杂,立法难度大。”业内普遍认为,暂行规定主要是解决医疗行业内部无序竞争现状,但未能缓解我国人体器官移植的供需根本矛盾。一直参加暂行规定讨论的中华医学…     

亲属活体肾移植

亲属活体肾移植是解决当前器官匮乏最重要的途径。在欧美、东南亚等国家,亲属活体肾移植占有相当大的比例。亲属活体肾移植已成为一种世界性趋势。近年来,由于供移植的尸体器官来源严重短缺,国内活体器官移植迅速发展。     

卫生部关于印发肝脏、肾脏、心脏、肺脏移植技术管理规范的通知

卫医发〔2006〕243号各省、自治区、直辖市卫生厅局,新疆生产建设兵团卫生局:为了规范和加强人体器官移植技术临床应用管理,保证医疗质量和医疗安全,根据《人体器官移植技术临床应用管理暂行规定》,我部组织制定了《肝脏移植技术管理规范》、《肾脏移植技术管理规范》、《心脏移植技术管理规范》和《肺脏移植技术管理规范》。现印发给你们,请遵照执行。二○○六年六月二十七日肝脏移植技术管理规范为规范肝脏移植技术临床应用,保证医疗质量和医疗安全,根据《人体器官移植技术临床应用管理暂行规定》制定本规范。本规范为医疗机构及其医师开…     

卫生部关于印发《人体器官移植技术临床应用管理暂行规定》的通知

卫医发〔2006〕94号各省、自治区、直辖市卫生厅局,新疆生产建设兵团卫生局:为了规范和加强人体器官移植技术临床应用管理,保证医疗质量和医疗安全,保护患者健康,我部组织制定了《人体器官移植技术临床应用管理暂行规定》。现印发给你们,请遵照执行。二○○六年三月十六日人体器官移植技术临床应用管理暂行规定第一章总则第一条为规范人体器官移植技术临床应用,保证医疗质量和医疗安全,保护患者健康,根据《执业医师法》和《医疗机构管理条例》等法律、法规,制定本规定。第二条本规定所称人体器官移植技术是指将他人的具有功能的心脏、肺脏、…     

102例亲属活体肾移植围手术期护理

目的总结我院102例亲属活体肾移植供、受者围手术期的护理经验。方法通过对102例亲属活体肾移植供、受者围手术期护理,观察供、受者的心理特点和治疗特征。因地制宜地制定护理方案、提高供、受者治疗效果和生活质量。结果本组102例供者肾功能均在术后一周内恢复正常,未出现严重并发症;受者2例出现急性排斥反应;全部供、受者至今存活,肾功能恢复良好。结论亲属活体肾移植围手术期护理要从供、受者心理、生理、疾病的治疗和伦理学上全方位进行,才有利于其康复;临床护理经验仍需不断总结。     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.     

Assessing occupational and environmental exposure

Exposure assessment is a poorly understood component of the science of epidemiology. The relationship between exposure to chemicals and ill-health outcomes is often calculated using crude exposure measures such as ever/never exposed or duration. When investigating subtle effects, exposures need to be characterized much more fully in terms of intensity, frequency, duration and route. While occupational exposures tend to be much greater than those experienced from the wider environment there is a need to remember that, for many chemicals, exposure can occur occupationally, environmentally and through consumer use of products containing the material of interest. Inhalation exposure has generally been the traditional focus for most epidemiological investigations but there is now growing awareness of the importance of the dermal and ingested routes of contact and internalization. Quantification of the exposure also needs to be related to a biological mechanism of action and exposure metrics need to be selected accordingly. Occupational exposures can generally be measured using simple well-validated techniques. Environmental exposures require much more sensitive instruments and are more difficult to assess. Exposure modelling, particularly for the environmental fate of chemicals has undergone many recent developments and Monte Carlo techniques can be used to characterize model uncertainty and variability. This approach to exposure assessment can now be used in the setting of the wider environment and will enable a far better understanding of the relationship between exposure and disease.     

Mercury toxicity due to the smelting of placer gold recovered by mercury amalgam

A 19-year-old man developed tremor in both hands and fatigue after starting work at a placer gold mine where he was exposed to mercury-gold amalgam. Examination revealed an intention tremor, dysdiadochokinesis and mild rigidity. The 24-h urinary mercury concentration reached a peak of 715 nmol/l (143 ug/l) shortly before the clinical examination, after which he was removed from working in the gold room [Mercury No. Adverse Effect Level: 250 nmol/l (50 ug/l)]. On review 7 weeks later his tremor had almost resolved and the dysdiadochokinesis and rigidity had gone. The 24-h urinary mercury concentration had fallen to 160 nmol/l (32 ug/l). The principal exposure to mercury was considered to be the smelting of retorted gold with previously unrecognized residual mercury in it. The peak air concentration of mercury vapour during gold smelting was 0.533 mg/m3 (Mercury Vapour ACGIH TLV: 0.05 mg/m3 TWA). Several engineering and procedural controls were instituted. This episode occurred at another mine site, unrelated to Mount Isa Mines Limited.     

How Adults with Acquired Brain Damage Perceive Computer Training as a Rehabilitation Tool: A Focus-group Study

The aim of this study was to explore and describe how adult outpatients with acquired brain damage and referred to occupational therapy perceive computer training with the RehaCom programs, in order to evaluate the method of treatment as a tool in the rehabilitation of persons with cognitive disorders. By using focus-group discussions as a qualitative method of research when analysing the result, five themes with corresponding categories emerged, describing a development of understanding and learning about capacities. Themes describing how the participants could apply strategies to overcome shortcomings in daily occupations and the therapeutic role of the occupational therapist were identified as well. The result shows that a computer training program such as RehaCom can be used as an educational tool, for example, to guide a person who is trying to adopt compensatory strategies to avoid overload by taking pauses. It was found that anything the participants learned was also applicable to occupational performance in daily life.