The Future Detection and Prevention of Institutional Abuse: Giving Children a Chance to Participate in Research

The involvement of children in research studies is historically fraught with difficulties. Experiments on children without their consent or knowledge have been carried out in the past and thus the need for stringent ethical control is undoubtedly necessary. However this paper argues that the need to protect children from unethical research has somehow become entwined in the web of secrecy that surrounds the very nature of child abuse. In the name of 'protection' are children in danger of not having their voice heard?

In the foreword to 'Listening to Children' (Alderson, 1995) Roger Singleton writes, 'much research is carried out on and about children, but seldom with children. Children themselves are often strangely silent'. This paper draws on recent literature on the institutional abuse of young people in residential care and the lack of voice that those abused in residential care have traditionally had, suggesting that their silence is not 'strange' but perhaps contrived.

This paper does not repeat the work of Alderson (1995) and make suggestions as to how research with children may best be carried out, but seeks to address the issues in relation to research with children who are in institutions.     

Sources of P300 attenuation after head injury: Single-trial amplitude, latency jitter, and EEG power

Single trial amplitude, latency jitter, and electroencephalographic (EEG) power were examined as sources of the group difference in averaged P300 amplitude among 15 traumatically brain injured and 20 control individuals in an auditory oddball paradigm. Mean amplitude of the individual trials was highly correlated with the amplitude of the averaged P300, with little additional unique variance attributable to latency jitter or EEG power. The group difference in P300 amplitude was also explained by the mean amplitude of the single trials. These results support the robustness of the event-related potential averaging technique within the paradigm used.     

Assessment of sexual abuse and trauma: Clinical measures

Examined are several measures currently used in the assessment of child abuse, sexual abuse, and trauma. These measures include structured clinical interviews, self report measures, screening inventory, symptom checklist, and some measures that include decision making properties. Issues and implications for clinical practice are explored.     

神经移位修复臂丛神经根性撕脱伤

１９８７年７月～１９９４年６月，对２１例臂丛神经根性撕脱伤采用神经移位修复。其中复合移位４组神经（膈神经、副神经、颈丛运动支、肋间神经）者１例，３组（膈神经、副神经、颈丛运动支）者６例，２组（膈神经、副神经）者９例，１组（膈神经或颈丛运动支或肋间神经）者５例。术中发现臂丛神经变异１例，对４例合并锁骨下动脉损伤者，在神经移位的同时进行血管修复，促进患肢的血液循环，有利于神经的康复。随访到１９例，随访时间为８个月～６年２个月，优良率达７３．７％。认为，神经移位术是修复神经根性撕裂伤的常规方法，合并血管损伤者也应同时修复，对促进神经功能恢复有利     

带蒂胸腹轴型皮瓣早期修复上肢深度蛇伤溃疡

总结胸腹轴型皮瓣早期修复上肢不同部位的深度蛇伤溃疡的经验，评价其应用价值。本组１６例，胸脐皮瓣２例，侧胸腹皮瓣１例，髂腰皮瓣５例，下腹皮瓣６例，下腹分叶皮瓣１例，髂腰加下腹Ｙ形皮瓣１例。术后１例皮瓣远端坏死，３例轻度感染，１６例断蒂后全部成活。随访３个月～７年，皮瓣质地和弹性均好，手功能基本恢复。认为，带蒂胸腹轴型皮瓣是修复上肢深度蛇伤溃疡理想的方法。     

Open extremity fracture penetrating the skull

We present a case in which an open fracture of the ulna penetrated the skull and caused a comminuted, depressed skull fracture with a large intraparenchymal hematoma containing bone fragments.     

近节指骨段屈肌腱鞘不同范围损伤对肌腱功能的影响

目的 探索手指屈肌腱在近节指骨段不同范围损伤时对屈指肌腱功能的影响。方法 采用12只成人尸体手指。实验分为:第一阶段屈指肌腱完整,以后四个阶段依次沿近节指骨掌侧小线闭开小央1/4、1/2、3/4及全长。在掌指关节被动屈80°和掌指关节屈80°同时近侧指关节屈100°时,测量指浅屈肌腱(FDS)和指深屈肌腱(FDP)的滑动距离。根据肌腱力臂和滑动距离的关系,得出屈指肌腱在掌指关节处和近侧指间关节及肌腱在近节指骨段的弓弦畸形程度。结果 腱鞘中央1/4切开时,指屈肌腱的滑动距离、力臂均无显著变化;1/2切开后,单纯屈曲掌指关节时的FDS腱和掌指、近节指间关节屈曲时的FDS、HDP腱的滑动距离和力臂较腱鞘完整时显苫增大(P<0.05);切开3/4长度后,FDS、FDP腱滑动距离均有统计学意义变化,FDS、FDP腱力臂平均增加8～9％;全切开腱鞘,FDS、FDP腱滑动距离变化正统计学上有高度显著性(P<0.01),两腱力臂分别增加16％和15％。随腱鞘切开范围增大,FDS、FDP在近节指骨段的弓弦畸形程度也越来越大。结论 从肌腱的生物力学变化可见,近节指骨段腱鞘的小范围损伤如中间1/4以内损伤时,对肌腱功能影响小,可以不予修复;若损伤超过1/2长度,尤其对腱鞘全长损伤,应予以修复以恢复肌腱功能。     

上海市少年儿童住院医疗保险费用分析

本文研究了上海市少年儿童住院医疗保险的费用水平、特点和影响因素。研究结果表明:手术与否、患者年龄、就诊地点、家长医疗保健制度和医院等级的差异造成次均费用的差异;次均费用构成比较合理,药品费比例低于全市水平。病种费用居前三位的是白血病、肺炎和先天性心脏病;特殊病种占总医疗服务人次的4.90％,而医疗费用占总费用的32.57％。