Ethical and metaethical criteria for an emerging technology: risk assessment

This paper examines ethical criteria for the shaping of an emergingtechnology applied internationally in environmental regulation:quantitative risk assessment-risk management. The role of thephysician in its application, especially in the genetic testingthat will be employed, underlines the importance of understandingthe nature and prospects for reshaping of this technology toenable ethical practice. The Cartesian or mechanistic model(which currently dominates the technology) excludes factorsof emotion, making the connection between assessment and managementunfruitful functionally and ethically, and makes the model unresponsiveto human needs. The emotional factors, nested and mediated inthe organic hierarchy of the ecologically-defined community,constitute key psychological, social, cultural and politicalelements of the total burden of risk. Ethical criteria consistentwith an open society are suggested for reshaping the model toenable effective management.     

住院精神分裂症患者自杀危险因素调查

对全国９省市９所医院１０年间住院精神分裂症自杀死亡资料分析，自杀率占住院病人总数的０．６３％，占精神分裂症总数的０．７８％，占慢性精神分裂症的０，５０％。偏执型占６５．６·％。自杀原因受幻觉妄想支配２３．８％，悲观厌世２８．６％；精神症状好转（５９．５％）和自知力恢复期（４７．６％）易自杀。自杀方式自缢（５７．１％）和服药（２３．８％）居首。男性自杀多于女性。     

Mothers' Anticipation and Prevention of Unintentional Injury to Young Children in the Home

Investigated anticipation and prevention of children's unintentionalinjuries in the home. 150 mothers of 1-, 2-, and 3-year-oldchildren kept weekly diaries of anticipated injuries and unanticipatedinjuries/near injuries to their child. Mothers anticipated between57 and 67% of all injury events, a majority when the child wasin the same room as the injury-causing agent prior to interactingwith it. Few anticipated injuries led to injury. In these casesno significant differences were found depending on child's ageand sex. In contrast, mothers of younger children most frequentlyreported preventing injury by physically restricting or movingthe child away and by changing the environment, whereas mothersof older children more frequently engaged in teaching.     

外科切口感染危险因素研究

目的：研究术后切口感染危险因素，以降低切口感染率。方法：以１９９４～１９９６年外科手术病人为对象，进行病例对照研究。结果：病例组１３１例切口感染病人和对照组１００例无切口感染病人在手术持续时间、术前抗生素使用种类、免疫抑制剂应用与否以及手术后抗生素使用天数等方面有显著性差异。且随着手术时间延长，术后切口感染的相对危险度呈明显递增趋势。结论：为降低术后切口感染率，必须尽量缩短手术时间，并减少术前术后抗生素使用天数和种类     

Extramarital Involvement: A Core Relationship Issue in Need of a Coherent Model, Comprehensive Research, and Empirically Based Intervention

Clinical interventions for extramarital involvement (EMI) have outpaced empirical knowledge about both risk factors for infidelity and effective treatments. Allen et al. (this issue) provide a systematic review of current knowledge organized around stages of the development of EMI and factors concerning the involved partner, the spouse, the couple's relationship, and the interpersonal context. Their review identifies significant gaps in knowledge for which research is needed. Because EMI has multiple determinants, conceptual models and research on it must be multivariate. This comment focuses on priorities for increasing knowledge about EMI, including (a) clarification of variation in definitions and personal standards for EMI through consideration of participants' subjective experiences as well as the views of outsiders (researchers, clinicians); (b) improved qualitative research using interview methods designed to minimize biased questioning by investigators and biased reporting by subjects, to tap individuals' internal experiences with the developmental process of EMI; (c) nonblaming research on characteristics of the noninvolved spouse and the couple's interaction that predict EMI; and (d) adaptation of generic preventive and relationship enrichment interventions for couples involving communication skill-building and psychoeducation, to include information about ways to "inoculate" relationships against commonly unexpected risks of EMI.     

Association of common missense changes in ELAC2 (HPC2) with prostate cancer in a Japanese case–control series

 The recently identified prostate cancer susceptibility gene ELAC2 (HPC2) harbors two common missense variants, a serine to leucine substitution at residue 217 (Leu217) and an alanine to threonine substitution at residue 541 (Thr541). We genotyped the two variants in a Japanese cohort consisting of 350 prostate cancer patients 242 male population controls, and 114 male low-risk controls. Both missense alleles, Leu217 and Thr541, were carried at higher frequency in Japanese patients than in the controls (Leu217, P = 0.0012; Thr541, P = 0.0145), and the odds ratios associated with carrying these sequence variants were higher in Japanese than in Caucasians. Although the Leu217 and Thr541 variants of ELAC2 are less common in Japanese than in Caucasians, both variants confer significantly increased risk of prostate cancer in Japanese. Carriage of these variants was not associated with age at diagnosis, tumor stage, or tumor grade in these Japanese prostate cancer patients. The allele-specific pattern of risk observed in Japanese and familial Caucasian patients was qualitatively similar; however, the magnitude of that risk was considerably greater in Japanese than in Caucasians. Received: September 3, 2002 / Accepted: October 2, 2002     

Breast cancer risk with postmenopausal hormonal treatment

This review was designed to determine from the best evidence whether there is an association between postmenopausal hormonal treatment and breast cancer risk. Also, if there is an association, does it vary according to duration and cessation of use, type of regimen, type of hormonal product or route of administration; whether there is a differential effect on risk of lobular and ductal cancer; and whether hormone treatment is associated with breast cancers that have better prognostic factors? Data sources for the review included Medline, the Cochrane Database of Systematic Reviews (Cochrane Library, 2005) and reference lists in the identified citations. Eligible citations addressed invasive breast cancer risk among postmenopausal women and involved use of the estrogen products with or without progestin that are used as treatment for menopausal symptoms. Abstracted data were demographic groupings, categories of hormone use, categories of breast cancer, two-by-two tables of exposure and outcome and adjusted odds ratios, relative risks (RRs) or hazard rates. Average estimates of risk were weighted by the inverse variance method, or if heterogeneous, using a random effects model. The average risk of invasive breast cancer with estrogen use was 0.79 [95% confidence interval (95% CI) = 0.61-1.02] in four randomized trials involving 12 643 women. The average breast cancer risk with estrogen-progestin use was 1.24 (95% CI = 1.03-1.50) in four randomized trials involving 19 756 women. The average risks reported in recent epidemiological studies were higher: 1.18 (95% CI = 1.01-1.38) with current use of estrogen alone and 1.70 (95% CI = 1.36-2.17) with current use of estrogen-progestin. The association of breast cancer with current use was stronger than the association with ever use, which includes past use. For past use, the increased breast cancer risk diminished soon after discontinuing hormones and normalized within 5 years. Reasonably adequate data do not show that breast cancer risk varies significantly with different types of estrogen or progestin preparations, lower dosages or different routes of administration, although there is a small difference between sequential and continuous progestin regimens. Epidemiological studies indicate that estrogen-progestin use increases risk of lobular more than ductal breast cancer, but the number of studies and cases of lobular cancer remains limited. Among important prognostic factors, the stage and grade in breast cancers associated with hormone use [corrected] do not differ significantly from those in non-users, but breast cancers in estrogen-progestin users are significantly more likely to be estrogen receptor (ER) positive. In conclusion, valid evidence from randomized controlled trials (RCTs) indicates that breast cancer risk is increased with estrogen-progestin use more than with estrogen alone. Epidemiological evidence involving more than 1.5 million women agrees broadly with the trial findings. Although new studies are unlikely to alter the key findings about overall breast cancer risk, research is needed, however, to determine the role of progestin, evaluate the risk of lobular cancer and delineate effects of hormone use on receptor presence, prognosis and mortality in breast cancer.     

Relationship between adherence to inhaled corticosteroids and poor outcomes among adults with asthma

BACKGROUND: Regular use of inhaled corticosteroids (ICSs) can improve asthma symptoms and prevent exacerbations. However, overall adherence is poor among patients with asthma. Objective To estimate the proportion of poor asthma-related outcomes attributable to ICS nonadherence. METHODS: We retrospectively identified 405 adults age 18 to 50 years who had asthma and were members of a large health maintenance organization in southeast Michigan between January 1, 1999, and December 31, 2001. Adherence indices were calculated by using medical records and pharmacy claims. The main outcomes were the number of asthma-related outpatient visits, emergency department visits, and hospitalizations, as well as the frequency of oral steroid use. RESULTS: Overall adherence to ICS was approximately 50%. Adherence to ICS was significantly and negatively correlated with the number of emergency department visits (correlation coefficient [ R ] = -0.159), the number of fills of an oral steroid ( R = -0.179), and the total days' supply of oral steroid ( R = -0.154). After adjusting for potential confounders, including the prescribed amount of ICS, each 25% increase in the proportion of time without ICS medication resulted in a doubling of the rate of asthma-related hospitalization (relative rate, 2.01; 95% CI, 1.06-3.79). During the study period, there were 80 asthma-related hospitalizations; an estimated 32 hospitalizations would have occurred were there no gaps in medication use (60% reduction). CONCLUSIONS: Adherence to ICS is poor among adult patients with asthma and is correlated with several poor asthma-related outcomes. Less than perfect adherence to ICS appears to account for the majority of asthma-related hospitalizations.     

Developmental aspects of children's behavior and safety while cycling

OBJECTIVE: To examine children's competence while cycling, as demonstrated in mistakes in performance and failure to comply with safety rules. METHODS: Children in three age groups (8, 10, and 12 years) participated in a realistic yet simulated traffic environment. RESULTS: The boys' cycling speed increased steadily with age, while that of the girls increased from 8 to 10 but decreased at age 12. Most children had adequate motor control by age 10, and the youngest compensated for their less developed skills by cycling slowly and braking early at junctions. Serious mistakes, often related to the children's age and gender, consisted of the children failing to stop at signals or stopping too late, especially at short stopping range. CONCLUSIONS: There are considerable individual differences in children's cycling competence that are related to biological factors, such as age and gender, and psychological factors, such as rule compliance and choice of cycling speed.