Building workforce capacity for ethical reflection in health promotion: a practitioner's experience

Health promotion does not have a code of ethics, although attempts have been made to assist practitioners in their understanding and application of ethical concepts. This article describes and analyses one such attempt, sustained from 2006 to 2014 in rural South Australia. The attempt comprised capacity‐building activities that were informed by principles of organisational change management, especially the principle of creating champions. The article also presents a framework (largely comprising ethical questions) that may help practitioners as a prompt and guide to ethical reflection. The framework was developed to be as accessible as possible in light of the diverse educational backgrounds found in rural settings. Finally, the article highlights some philosophical dimensions to the framework and defends its role, proposing that ethical reflection is integral to good practice and never simply the province of theorists. The article does all this with a view to stimulating discussion on how to increase the frequency and quality of ethical reflection undertaken by health promotion practitioners.     

How directional change in reading/writing habits relates to directional change in displayed pictures

It has been suggested that reading/writing habits may influence the appreciation of pictures. For example, people who read and write in a rightward direction have an aesthetic preference for pictures that face rightward over pictures that face leftward, and vice versa. However, correlations for this phenomenon have only been found in cross-cultural studies. Will a directional change in reading/writing habits within a culture relate to changes in picture preference? Korea is a good place to research this question because the country underwent gradual changes in reading/writing direction habits, from leftward to rightward, during the 20th century. In this study, we analyzed the direction of drawings and photos published in the two oldest newspapers in Korea from 1920–2013. The results show that the direction of the drawings underwent a clear shift from the left to the right, but the direction of the photos did not change. This finding suggests a close psychological link between the habits of reading/writing and drawing that cannot be accounted for simply by an accidental correspondence across different cultures.     

我国88家医学期刊编辑部伦理意识现状调查与组合评价

目的：了解我国医学期刊的编辑部伦理意识现状。方法：采用自制问卷调查88家医学期刊编辑部的伦理 意识。通过文献分析、系统分析和两轮专家咨询确定了5个维度：投稿须知、初审阶段、外审阶段、稿件处理阶段、 教育与培训;包括11个指标的评价体系。通过专家打分法确定指标的权重,采用层次分析法、TOPSIS法、秩和比法 对编辑部伦理意识状况进行组合评价。结果：56家(63.6%)期刊在2010年的投稿须知中尚无涉及人的生物医学研究的 伦理学要求。我国88家期刊中编辑部伦理意识为上档的有14家(15.9%),中档有45家(51.1%),下档有29家(33.0%)。 不同主管部门的期刊在投稿须知、外审阶段2个维度的得分上差别有统计学意义(HC分别为10.175和7.305,P<0.05); 不同数据库来源的期刊在投稿须知、初审阶段、外审阶段、稿件处理阶段4个维度的得分上差别有统计学意义(HC 分别为11.951,7.661,6.146,8.085,P<0.05);不同数据库来源期刊的综合评价分档结果有统计学意义(HC=6.109, P<0.05)。3种方法评价结果高度相关。结论：国内医学期刊编辑部对涉及人的医学研究的伦理意识有待提高。综合评 价方法的组合评价较采用单一方法评价,结果更可靠、更贴近实际情况。     

Fifty years of newborn screening

Newborn screening has evolved fast following recent advances in diagnosis and treatment of disease, particularly the development of multiplex testing and applications of molecular testing. Formal evidence of benefit from newborn screening has been largely lacking, due to the rarity of individual disorders. There are wide international differences in the choice of disorders screened, and ethical issues in both screening and not screening are apparent. More evidence is needed about benefit and harm of screening for specific disorders and renewed discussion about the basic aims of newborn screening must be undertaken.     

未婚妇女意外妊娠时的心理状况和伦理干预

目的：研究未婚妇女意外妊娠时的心理状况,并进行必要的伦理干预。方法：选择2010年1月～2014年5月我院接诊的未婚女性意外妊娠1567例作为观察组,再选择100例已婚妇女意外妊娠作为对照组。分析两组妇女意外妊娠时的心理状况,完成心理状况的评估。结果：观察组妇女焦虑与抑郁的情况明显高于对照组,两组对比差异显著,有统计学意义（P＜0．05）。结论：未婚女性一旦发生意外妊娠,一定要提供必要的心理干预,避免未婚女性的情绪与情感出现异常。     

Ethical implications of home telecare for older people: a framework derived from a multisited participative study

Context

Telecare and telehealth developments have recently attracted much attention in research and service development contexts, where their evaluation has predominantly concerned effectiveness and efficiency. Their social and ethical implications, in contrast, have received little scrutiny.

Objective

To develop an ethical framework for telecare systems based on analysis of observations of telecare‐in‐use and citizens’ panel deliberations.

Design

Ethnographic study (observation, work shadowing), interviews, older citizens’ panels and a participative conference.

Setting

Participants’ homes, workplaces and familiar community venues in England, Spain, the Netherlands and Norway 2008–2011.

Results

Older respondents expressed concerns that telecare might be used to replace face‐to‐face/hands‐on care to cut costs. Citizens’ panels strongly advocated ethical and social questions being considered in tandem with technical and policy developments. Older people are too often excluded from telecare system design, and installation is often wrongly seen as a one‐off event. Some systems enhance self‐care by increasing self‐awareness, while others shift agency away from the older person, introducing new forms of dependency.

Conclusions

Telecare has care limitations; it is not a solution, but a shift in networks of relations and responsibilities. Telecare cannot be meaningfully evaluated as an entity, but rather in the situated relations people and technologies create together. Characteristics of ethical telecare include on‐going user/carer engagement in decision making about systems: in‐home system evolution with feedback opportunities built into implementation. System design should be horizontal, ‘two‐way’/interactive rather than vertical or ‘one‐way’. An ethical framework for telecare has been developed from these conclusions (Table 1).     

The Genome Clinic: A Multidisciplinary Approach to Assessing the Opportunities and Challenges of Integrating Genomic Analysis into Clinical Care

Our increasing knowledge of how genomic variants affect human health and the falling costs of whole‐genome sequencing are driving the development of individualized genetic medicine. This new clinical paradigm uses knowledge of an individual's genomic variants to guide health care decisions throughout life, to anticipate, diagnose, and manage disease. While individualized genetic medicine offers the promise of transformative change in health care, it forces us to reconsider existing ethical, scientific, and clinical paradigms. The potential benefits of presymptomatic identification of at risk individuals, improved diagnostics, individualized therapy, accurate prognosis, and avoidance of adverse drug reactions coexist with the potential risks of uninterpretable results, psychological harm, outmoded counseling models, and increased health care costs. Here, we review the challenges of integrating genomic analysis into clinical practice and describe a prototype for implementing genetic medicine. Our multidisciplinary team of bioinformaticians, health economists, ethicists, geneticists, genetic counselors, and clinicians has designed a “Genome Clinic” research project that addresses multiple challenges in genomic medicine—ranging from the development of bioinformatics tools for the clinical assessment of genomic variants and the discovery of disease genes to health policy inquiries, assessment of clinical care models, patient preference, and the ethics of consent.     

《黄帝内经》脉时相关理论与应用

[目的]探究《内经》脉时合参思想和经验,以期更全面地学习中医学脉学理论,提高临床疗效。[方法]撷选《内经》相关原文,对脉诊理论中的时间因素做简要分析,探讨昼夜、月相、季节等时间因素对脉象的影响,总结《内经》脉时合参思辨方法。[结果]昼夜、月相、季节等时间因素与脉象关系密切,自然界的阴阳消长等具有明显的时间性,人体脉象与其相适应。脉时合参不仅可以知晓脉象随昼夜、月相、季节等的生理变化,还可根据脉、脏、时的关联准确判定病位,通过脉逆四时与否细测病情轻重,依据脉象随病情发展的阶段性规律预判病势预后,以及因时制宜指导临床治疗。[结论]《内经》脉时合参思想,内容丰富,在临床中运用广泛,蕴涵着天人一体的整体观和中医学哲学思辨方法,值得深入挖掘和学习。