Policy incongruence and public health professionals' dissonance: the case of immigrants and welfare policy

The steady increase in immigrants to the United States has fueled a critical analysis of the process of allocation of health and social benefits to these newcomers. The myriad of interests and values surrounding this issue precipitated the formulation and adoption of the Personal Responsibility and Work Opportunity (Welfare Reform) Act of 1996. This dramatic welfare reform impacts federal, state, and local agencies that are required to determine the eligibility of benefits and manage the attendant consequences to the public as well as members of this vulnerable group. Especially challenging are the decisions confronting public health professionals who struggle to reconcile the resulting policy, programmatic mandates, and compliance imperatives with prevailing public health principles and practice norms. This paper proposes a framework for understanding the incongruence between the provisions of the law as it pertains to legal and illegal immigrants and public health values. The impact of policy incongruence and professionals' dissonance on public health practice norms is explored with an explicit focus on public health outcomes and legal implications. The examination of tuberculosis as a health example reveals the policy conflicts and public health dilemmas. Finally, the paper elicits a range of options available to public professionals for responding to these legal mandates.     

Comment droit et éthique s’enrichissent mutuellement dans la prise en charge médicale des personnes avec handicap

Whatever his or her disability, a person has the right to medical care of the same quality as any other patient. The law tries to meet the needs of vulnerable people, regardless of their situation. For example, a minor, disabled or not, may seek a treatment while preserving confidentiality regarding his/her parents. Privacy is a concept that does not begin at 18. In France, the law of 4 March 2002 already addressed this hypothesis; the law of 26 January 2016 modernizing our health system extended it. An adult, disabled or not, may need help not only for administrative and financial procedures, but also for medical or medicosocial matters. The law offers various support solutions with the family, guardian, support person, relatives, caregivers, attorneys involved with a mandate for future protection. In medical practice, a number of situations, simple in theory, can be very problematic. The ethical approach will be essential to help deal with all these questions.     

临床教学伦理困境下的实习教学方法改革

随着病人主体意识和维权意识的增强,传统的床边教学法常因难于兼顾患者与学生双方的权益而不能充分开展。为了解决临床实习教学面临的难题,我院开展了集床边教学、模拟教学和网络教学等方法于一体的"多位一体"实习教学法的研究和实践。结果显示该模式能更好地兼顾患者与学生的权益,增加学生学习训练的机会,比单纯床边教学法效果更好。     

Therapeutic Dilemma of Sarcoidosis and Treatment-naïve Hepatitis C Manifesting as Tattoo Reactions

A 23-year-old man had an 8-day history of fatigue and dry cough and papulo-nodular reactions on his extensive tattoos. Chest radiography revealed several small granular shadows, and a transbronchial lung biopsy showed non-caseating epithelioid cell granuloma. A skin biopsy of the tattooed area showed histiocytic infiltrates with phagocytized tattoo pigment. Antibody tests for hepatitis C virus were positive. The patient was successfully treated with corticosteroid therapy, and after inflammation was suppressed, he received delayed anti-viral therapy. Sarcoidosis should be considered as a concurrent condition if papules are presented on the tattoos of patients with hepatitis C.     

Common medical ethics dilemmas: Few reflections from a Saudi perspective

Medical ethics plays a crucial role in physicians’ daily practice, as it reflects on themselves, their institution, and, most importantly, the outcome of the treatment they provide to their patients. Common medical ethics dilemmas faced in Saudi Arabia include: end-of-life care, patient rights, which comprise autonomy, informed consent, and confidentiality, reproductive ethics, and equity of resources. The identification of flaws within the healthcare system and the implementation of clear guidelines are important to overcome the risk of malpractice and flawed judgment, and ensure the delivery of the best possible care to patients.     

Opposing effects of oxytocin on moral judgment in males and females

Current perspectives on the evolutionary roots of human morality suggest it arose to incentivize social cooperation by promoting feelings of disgust toward selfish behavior, although the underlying neural mechanisms remain unclear. To investigate whether the ancient mammalian neuropeptide oxytocin (OXT) influences self‐referential processing in the domains of emotion evaluation and moral decision making, we conducted a pharmaco‐functional magnetic resonance imaging (fMRI) and a behavioral experiment involving 157 healthy women and men who were treated with either OXT (24 IU) or placebo (PLC) intranasally. Our results show that OXT facilitated cortical midline responses during self‐processing of disgust and selectively promoted self‐interest moral judgments in men. In contrast, in women OXT increased the reaction time difference between accepted and rejected moral dilemmas and led them to suppress their self‐interest and respond more altruistically for the benefit of others. Taken together, these findings suggest an OXT‐related sexual dimorphism in human moral behavior which evolved adaptively to optimize both protection and nurturing of offspring by promoting selfish behavior in men and altruistic behavior in women. Hum Brain Mapp 35:6067–6076, 2014. © 2014 Wiley Periodicals, Inc.     

临床护理人员面对人员配备不足的感受和反应

目的：探讨临床护理人员面对人员配备不足的感受和反应。方法：运用质性研究中的现象学方法对25位来自上海4个不同等级医院的护士进行深入访谈。结果：护理人员面对人员配备不足的反应为自行解决,尽力而为;报告领导,寻求帮助;服从安排,自我调整;耐心沟通,求得谅解;无奈接受,无力无助。结论：护理人员能积极有效应对人员配备不足带来的压力,护理管理者应合理配备人员,预防和减轻人员紧缺给护士和病人带来的负面影响。