De la difficulté à être reconnus « capables » et « compétents » : des adolescents et jeunes adultes désignés handicapés mentaux en quête d’autonomie

For two decades, the French legislator has been seeking to promote the autonomy of people with disabilities by enabling them, in particular, to increase their power to act on their environment through self-determination. In this respect, many of the devices they are the target of testify to this willingness to support the autonomy of persons designated as mentally disabled, traditionally defined in terms of dependence and incapacities. Based on an ethnographic survey, this contribution examines the paradoxical dynamics that run through public inclusion policy, with an emancipatory aim, within a specialized class system called ULIS. It describes the difficulty faced by a group of adolescents and young adults designated as mentally disabled, enrolled in a vocational high school, in being recognized as “capable” and being part of a process of empowerment. Analysis of the experiences of these young people shows that they face a suspicion of incompetence and a process of infantilization that is less related to their actual disabilities than to the way they are categorized, as “mentally disabled” youth.     

通过多种形式组织专题 提升科技期刊质量

【目的】探索医学期刊组织专题的有效途径,为国内医学期刊提供借鉴与参考。【方法】以《放射学实践》杂志为例,介绍其通过与协办单位合作、及时报道重大科研成果、围绕突发公共卫生事件等多种方式进行专题组稿的经验和体会;比较、分析专题论文和非专题论文的质量。【结果】《放射学实践》近3年成功组织了22个专题,极大地扩大了本刊在业内的影响。专题论文的篇均被引频次和篇均下载量均明显高于非专题论文。【结论】医学期刊编辑应该结合自身杂志特点,充分发挥积极性和主动性,勇于探索,敢于创新,不断开拓专题组稿的新方法和新形式,为提高期刊质量不懈努力。     

果酒中功效成分研究

摘要:目的　水果含有丰富的营养物质和植物化学物,果酒则是以各种水果（包括野果）为原料发酵而成。由于果酒中所含活性成分缺乏系统研究报道,因此,本研究拟通过分析酒中所含活性成分,为果酒提供基础科学资料。方法　选取不同原料的市售果酒（5种）,检测其所含的有机酸、黄酮及酚类物质,并用氧自由基吸收能力测定抗氧化性。结果　有机酸是果酒的主要功效成分之一,总有机酸之和在3 485.95～6 313.76 mg/L之间,不同果酒的有机酸组成均有差异;黄酮类化合物也是果酒的主要功效成分,蓝莓酒中种类最丰富,但含量低于山楂酒和红酒;另外,HPLC法还检测出多种酚类物质,山楂酒和红酒中种类最少,但含量高于其他果酒,特别是山楂酒中的表儿茶素（873.57 mg/L）和红酒中的没食子酸（550.62 mg/L）;果酒的ORAC值在1 331.6～21 001.5 μmol Trolox当量/ml之间,蓝莓酒最高。结论　果酒含有丰富的有机酸、黄酮类和多酚类物质,并具有很强的抗氧化能力。     

卫九项目省(自治区)艾滋病防治机构和能力建设现状

目的了解卫九项目省(自治区,下同)艾滋病防治机构与能力建设现状。方法利用卫九项目艾滋病(AIDS)/性病(STD)预防控制子项目终末评估调查数据进行描述性分析。结果近年来,项目省、市、县各级全面成立了艾滋病防治领导小组,参与领导小组的成员部门数逐年上升;项目省得到了价值数千万元的各类防治与管理设备,各级艾滋病确证与初筛实验室网络建设得到了很好的发展,艾滋病病毒(HIV)监测哨点设置明显增多;疾病预防控制中心、医院及血液管理系统实验室HIV相关检测能力验证及运作管理的信息化程度也有所改善;管理和各类业务人员参加各类会议、培训和参观考察活动超过28万人,有效提高了项目省AIDS/STD防治人员相关知识和技能水平。结论卫九项目省近年艾滋病防治机构与能力建设状况明显改善,对相关省艾滋病防治工作起到积极的推动作用。     

Synthesis, potent anti-staphylococcal activity and QSARs of some novel 2-anilinobenzazoles

Synthesis and anti-staphylococcal activity of a number of substituted 2-anilinobenzimidazoles, benzothiazoles and benzoxazoles are reported. The anti-staphylococcal activities were evaluated in standard in vitro MIC assay method. While anilinobenzimidazole derivatives 11-45 showed very potent anti-staphylococcal activities (greatest activity with an MIC value of 0.095 microg/mL), none of the 2-anilinobenzothiazoles and benzoxazole derivatives exhibited inhibitory activity. QSAR analysis of the anilinobenzimidazoles was studied on the relationship between the anti-staphylococcal activity (MIC in mug/ml) and extrapolated log k(w) values.     

如何做好儿科实习医生

实习医生是医学生向临床医生过渡的关健时期,掌握好儿科特点,注重儿科临床实践技能和临床思维能力的培养,加强良好的沟通能力和技巧的培养,是做好一名儿科实习医生的关键。     

A brief tool to assess capacity to consent for medical care among homeless individuals with problematic substance use: study protocol

Background

Public health care increasingly uses outreach models to engage individuals who are marginalized, many of whom misuse substances. Problematic substance use, together with marginalization from the health care system, among homeless adults makes it difficult to assess their capacity to consent to medical care. Tools have been developed to assess capacity to consent; however, these tools are lengthy and unsuitable for outreach settings. The primary objective of this study is to develop, validate, and pilot a brief but sensitive screening instrument which can be used to guide clinicians in assessing capacity to consent in outreach settings. The goal of this paper is to outline the protocol for the development of such a tool.

Methods/Design

A brief assessment tool will be developed and compared to the MacArthur Competency Assessment Tool for Treatment (MacCAT-T). As list of 36 possible questions will be created by using qualitative data from clinician interviews, as well as concepts from the literature. This list will be rated by content experts according to the extent that it corresponds to the test objectives. The instrument will be validated with 300 homeless adult volunteers who self-report problematic substance use. Participants will be assessed for capacity using the MacCAT-T and the new instrument. A combination of Classical Test Theory and advanced psychometric methods will be used for the psychometric analysis. Corrected Item-Total correlation will be examined to identify items that discriminate poorly. Guided exploratory factor analysis will be conducted on the final selection of items to confirm the assumptions for a unidimensional polytomous Rasch model. If unidimensionality is confirmed, an unstandardized Cronbach Alpha will be calculated. If multi-dimensionality is detected, a multidimensional Rasch analysis will be conducted. Results from the new instrument will be compared to the total score from the MacCAT-T by using Pearson’s correlation test. The new instrument will then be piloted in real-time by street outreach clinicians to determine the acceptability and usefulness of the new instrument.

Discussion

This research will build on the existing knowledge about assessing capacity to consent and will contribute new knowledge about assessing individuals whose judgment is impaired by substance use.     

Best interests at end of life: A review of decisions made by the Consent and Capacity Board of Ontario

Purpose

When patients are unable to communicate their own wishes, surrogates are commonly used to aid in decision making. Although each jurisdiction has its own rules or legislation governing how surrogates are to make health care decisions, many rely on the notion of “best interests” when no prior expressed wishes are known.

Methods

We purposively sampled written decisions of the Ontario Consent and Capacity Board that focused on the best interests of patients at the end of life. Interpretive content analysis was performed independently by 2 reviewers, and themes that were identified by consensus as describing best interests were construed, as well as the characteristics of an end-of-life dispute that may be most appropriately handled by an application to the Consent and Capacity Board.

Results

We found that many substitute decision makers rely on an appeal to religion or God in their interpretation of best interests, whereas physicians focused narrowly on the clinical condition of the patient in their interpretations.

Conclusions

Several lessons are drawn for the benefit of health care teams engaged in end-of-life conflicts with substitute decision makers over the best interests of patients.