Capacity to Consent: Policies and Practices that Limit Sexual Consent for People with Intellectual/Developmental Disabilities

Sexuality and Disability - Consent determination is a common practice that has been championed as a logical approach (Lyden in Sex Disabil 25(1):3–20, 2007) to the sexual activity of...     

Minor Consent and Delivery of Adolescent Vaccines

PurposeTo explore whether, and to what extent, minor consent influences adolescent vaccine delivery in the United States.MethodsA telephone survey was completed by 263 professionals with responsibilities for adolescent health care and/or vaccination in 43 states. Measures included perceived frequency of unaccompanied minor visits and perceived likelihood of vaccine delivery to unaccompanied minors in hypothetical scenarios that varied by adolescent age, vaccine type, visit type, and clinical setting.ResultsAmong the 76 respondents most familiar with private primary care clinics, 47.1% reported perceptions that 17-year-old patients often present without a parent/legal guardian. Among the 104 respondents most familiar with public primary care clinics, 56.7% reported that 17-year-old patients often present alone. In response to hypothetical scenarios, approximately 30% of respondents familiar with private clinics and 50% of respondents familiar with public clinics reported perceptions that unaccompanied 17-year-old adolescents would not receive influenza, Tdap, or human papillomavirus vaccines during routine check-ups because they could not provide consent. Perceived likelihood of unaccompanied minors receiving vaccines when seen for confidential services in primary care, sexually transmitted disease, and Title X/family planning clinics varied significantly by vaccine type and clinical setting. On average, respondents reported that they would support minors having the ability to self-consent for vaccines at age 14.ConclusionsThe inability of minors to consent for vaccines is likely one barrier to vaccination. Interventions to increase adolescent vaccination should consider strategies that increase the ability of unaccompanied minors, particularly older minors, to receive vaccines within the context of legal, ethical, and professional guidelines.     

流行性感冒疫苗免疫现状与展望

流行性感冒(流感)是一种急性呼吸道传染病,在幼儿和老年人中常导致严重并发症。流感疫苗接种是目前预防流感最有效的措施。该文对现行流感灭活疫苗的免疫效果和免疫策略、其它类型流感疫苗和接种途径的研究状况、禽流感及其预防措施进行了综述。     

The Adolescent with Cystic Fibrosis: Developmental Issues

Cystic fibrosis is one of the most complex and progressive chronic illnesses faced by pediatric care practitioners, both physiologically and psychologically Improved medical management has resulted in a longer life span for those with the disease At the same time, such improvements have presented patients with the new challenge of facing adolescent developmental tasks as well as the disease's effects on them The author looks at the impact of cystic fibrosis on various adolescent developmental tasks and briefly discusses approaches that the health care team can adopt to facilitate the patient's development.     

预防接种门诊的告知义务与受种对象的知情同意权

医护人员告知义务与受种者的知情权是对应的权利和义务关系,我国从行政法规及部门规章的规定告知义务,同时赋予了受种对象的知情同意权。该文主要论述告知义务包括预防接种政策的告知和疫苗针对疾病与疫苗相关知识的告知、一般接种禁忌证的告知,疫苗接种程序的、疫苗效果和费用的、疫苗接种后注意事项的及疫苗接种反应处理的告知等。护士履行告知义务要利用多种形式和契机随时随地地进行,并及时记录告知内容,以保障受种对象的知情同意权。取得受种监护人（家长）的积极配合,有利于提高疫苗接种质量减少医患纠纷建立相互信任、互相理解的医患关系有着至关重要的意义。     

Sexuality Education for Students Who Are Deaf: Current Practices and Concerns

A questionnaire was sent to all the Deaf Schools in the U.S. including State Deaf Schools, Private Deaf Schools, and Public Schools that were listed as having a program specifically for students who are deaf. Ninety-two questionnaires were mailed and 76 were returned for a response rate of 83%. The questionnaire elicited information regarding current practices in sexuality education including materials used, mode of communication, media materials utilized, topics covered, and the instructor's perception of the quality of materials being used. Results indicate that teachers are spending more than 2 hours per week modifying materials for their sexuality curriculum. Most of the respondents expressed concerns about obtaining materials that are accessible and appropriate for students who are deaf, developing an overall curriculum, obtaining materials for students who have multiple disabilities, and obtaining materials that do not require modification before they are used with students who are deaf.     

知情同意制度若干难点问题探究

以法律规定和法学理论为基础，结合医疗实践，就知情同意的难点问题提出了相关建议。医务人员应当首先保证患者本人的知情同意权，而不是患者家属或其他关系人。对监护人不利于患者的医疗选择．应当试图获得其他监护人的意见。医务人员应当以非专业术语与患者沟通交流，保证患者充分地享有知情同意权。     

The Future Adolescent Medicine Workforce: A Survey of Current Adolescent Medicine Fellows

PurposeTo ensure a workforce of board-certified adolescent medicine (AM) specialists, the reasons why physicians choose this specialty must be understood. This study sought to develop a profile of AM fellows and to delineate common experiences that influenced them to seek AM training.MethodsIn April 2008, all AM fellows in Accreditation Council of Graduate Medical Education-accredited fellowships and those committed to begin training in July 2008 or after were electronically surveyed. Survey links were e-mailed to fellowship program directors who forwarded them to current and incoming fellows. The survey included questions regarding demographics, training experiences, career expectations, and attitudes and beliefs about AM. Open-ended questions allowed fellows to describe influential experiences. Means, medians, and percentages were calculated. Three independent reviewers identified themes in open-ended questions.ResultsFifty-two respondents completed the survey: 42 of 59 (71%) current fellows, 10 incoming fellows (approximately 35%). Sixty-seven percent reported first exposure to AM before or during medical school and 31% decided to pursue AM before starting residency. Qualitative responses revealed the importance of interactions with those established in the field, the intrinsic appeal of adolescents and their clinical issues, and the inherent personal qualities of the respondents. Many spoke of multiple exposures to AM or adolescents through high school activities, volunteer work, personal experiences, or during medical training.ConclusionsA variety of experiences with AM and/or adolescents is important in establishing interest in AM as a career. Serving as mentors and capitalizing on brief role modeling opportunities could promote further interest in AM fellowship training.