Ethical issues related to the artificial heart

This paper is a general survey of ethical issues related to the artificial heart. It begins by looking at the history of funding of the artificial heart program through the National Institute of Health in 1965. Attention is paid to the problem of the lack of planning related to social, ethical, economic, and legal implications. The paper then deals with three areas of ethical concerns. They are those issues relating to the experimental versus therapeutic benefits, the cost, and public involvement with a private interest.     

Ethical issues in psychosocial interventions research involving controls

Psychiatric research is of critical importance in improving the care of persons with mental illness. Yet it may also raise difficult ethical issues. This article explores those issues in the context of a particular kind of research: psychosocial intervention research with control groups. We discuss 4 broad categories of ethical issues: consent, confidentiality, boundary violations, and risk-benefit issues. We believe that, despite the potential difficulties, psychosocial intervention research is vital and can be accomplished in an ethical manner. Further discussion and research into these issues are warranted.     

Process parallels in related groups

The theoretical basis for the repetition of themes in related groups is addressed by describing similar processes in four systems: inpatient psychiatric ward, inpatient psychotherapy group, supervisory group, and group psychotherapy division. The principles of general system theory help explain process parallels in allied groups and illuminate group process.     

Pharmacological interventions in autism: theoretical and practical issues

Focused on issues of drug treatment in relation to autism. Pharmacological treatment studies in autism are complicated by various factors including a tremendous range of syndrome expression, a lack of robust animal models of the disorder, and various methodological problems. Theories have tended to follow treatments, and various neurochemical systems have been the focus of study. Neurochemical systems potentially implicated include those involving dopamine, norepinephrine, serotonin, and neuropeptides. The dopaminergic system has been the most extensively studied. Treatments developed are effective relative to certain disabling symptoms but "core" problems (e.g., in social relatedness and communication) appear less responsive to medications. The development of new approaches to assessment, including integration of behavioral and pharmacological approaches, is an important research priority.     

中国的低生育水平及相关人口研究问题

本文介绍了当前中国低生育率及其相关研究状况,指出社会和人口方面都存在着许多降低生育率的重要因素,而以往研究则因为思想方法问题忽视了它们的存在.本文还就低生育率新时期对人口形势判断及前瞻性研究中的新特点及实际中存在的问题进行了梳理与评论.本文指出,必须及时扭转以往形成的片面观念和思维定势,否则将会在人口发展问题上贻误战机.     

Cognitive-behavioural interventions in a patient with an anxiety disorder related to diabetes

This study extends the data on the efficacy of cognitive interventions for patients with chronic medical problems and describes the case of a 37-year-old woman with an anxiety disorder related to diabetes. The effects on panic frequency, use of safety behaviour and related beliefs were investigated after the introduction of two main cognitive-behavioral interventions. The results are consistent with predictions from the cognitive model of panic. This case demonstrates the usefulness of directly challenging the 'meaning' of the feared situation in order to produce clinically significant improvements in the management of physical disease.     

Public health issues related to infection in pregnancy and cerebral palsy

Cerebral palsy is the most common neuromotor developmental disability of childhood, affecting as many as 8,000 to 12,000 children born in the U.S. each year (corresponding to a prevalence rate of between 2 and 3 per 1000 children). Recent improvements in neonatal care have not resulted in a decline in the overall prevalence of cerebral palsy and, in fact, greater numbers of very preterm/very low birth weight infants are surviving with cerebral palsy and other developmental problems. Infection in pregnancy may be an important cause of the disorder. In preterm infants, there appears to be about a 2-fold increased risk for cerebral palsy from chorioamnionitis, and in term infants the estimated increased risk is about 4-fold. Provisionally, chorioamnionitis might account for 12% of spastic cerebral palsy in term infants and 28% of cerebral palsy in preterm infants. Studies of biochemical markers of fetal inflammation typically associated with infection also suggest that an inflammatory response may be an important independent etiologic factor. If a substantial proportion of cerebral palsy is attributable to acute amnionitis infection and/or neonatal sepsis, cerebral palsy should have decreased in the United States after administration of intrapartum antibiotics became widespread in response to publication of public health consensus guidelines for Group B streptococcus in 1996. However, failure to detect declines could have a number of explanations and these explanations illustrate the many public health challenges related to intrauterine infection and cerebral palsy. Given the gaps in our current knowledge about intrauterine infection and cerebral palsy, public health recommendations for timely and specific prevention activities are limited at this time.     

Clinical issues in mental health service delivery to refugees

Serious limitations exist in the delivery of mental health services to refugees throughout the resettlement process. Having survived harrowing physical and psychological traumas prior to reaching refugee camps, many refugees encounter mental health services in overseas camps that are characterized by fragmentation, instability, language barriers, and severe staff shortages. Refugees requiring mental health intervention after resettlement in the United States confront additional barriers, including frequent misdiagnosis, inappropriate use of interpreters and paraprofessionals, and culturally inappropriate treatment methods. Suggestions for improving mental health services for refugee populations emphasize modifying diagnostic assumptions and treatment approaches, recognizing potential problems associated with using interpreters and paraprofessionals, and examining the role of consultation, prevention, and outreach services in addressing refugee mental health concerns.     

Some ethical issues in feminist-oriented therapeutic groups for women

Review of the origins of group psychotherapy reveals concerns with social as well as with personal "psychopathology." Thus, group processes have been mobilized for curative or change purposes for ideological as well as individual therapeutic goals. Psychopolitical as well as personal change are the goals for some groups. The ethical problem stems from a persistent assumption that the group's processes are inherently benign and curative and beneficial to individual participants. A more sophisticated understanding takes into account their essential neutrality and their potential use (or abuse) for purposes of ideological persuasion that may or may not be personally therapeutic. As in other ethically implicated issues in the psychotherapies, the question becomes one of treatment versus exploitation, or therapy for the individual versus recruitment on behalf of a cause.     

Within-family reproductive technologies as a solution to childlessness due to infertility: Psychological issues and interventions

Patients choosing new reproductive technologies benefit from psychological consultation as they face unforeseen emotional and interpersonal sequalae from these procedures. This paper focuses on those patients who choose family members or close friends (i.e., known donors) to donate sperm or eggs or uteri in order to conceive and produce their babies. Medical family therapy offers these patients and families a framework from which to examine the biological, psychological, and interpersonal issues involved in these within-family solutions to childlessness due to infertility.This paper is a revision of a talk, Medical Family Therapy, Infertility, and the New Reproductive Technologies, given at the 1994 annual meeting of the American Psychological Association on August 4 in Los Angeles, CA, as part of the Mini-convention on Families panel on Clinical Issues in Families and Health.     

孔子与《易传》相关问题覆议(续)

三、孔门传易说 到了汉代，则孔门传《易》言之凿凿，自孔子以下，代代相传至于汉初，便有了清清楚楚的传授名单。但即就这份名单来看，《史记》和《汉书》也互有异同。《史记·仲尼弟子列传》所说的传授系统是这样的： 孔子→（鲁）商瞿→（楚）肝臂子弘→（江东）骄子庸疵→（燕）周子家竖→（淳于）光 子乘羽→（齐）田子庄何→（东武）王子中同→（ 川）杨何而《汉书·儒林传》的系统则约略如下： 孔子→（鲁）商瞿子木→（鲁）桥庇子庸→（江东） 臂子弓→（燕）周丑子家→（东 武）孙虞子乘→（齐）田何子装→ （东武）王同子中一（畜…     

孔子与《易传》相关问题覆议

孔子赞<易>,作<十翼>,自<史><汉>以来,学者习承其说.下逮北宋,始有疑其说之不足恃者;嗣后绍述,代不乏人.民初疑古学风盛兴,疑者益众;然笃信旧说者亦未灭迹.近年大陆地下考古发掘出土文物,其盛迈逾前代,尤如马王堆帛本<易>经、传之面世,于传世文献外增加不少可供参考之资料,引起海内外<易>学研究者的热烈讨论.然而对于孔门传<易>此一近千年以来争讼不休的论题,事实上并未因出土文献而得以论定.近年海峡两岸学者论及此题,即有据新出土文物以坚旧说者;亦有因之而作其他推论以修正新说者.本文即就此一问题,综合传世文献与新出资料重作检讨,提出个人浅见,虽不足以尽释群疑,然于若干相关问题,庶或可得相当的厘清.     

Research workshop on methodological issues in evaluating preventive interventions using mutual support

The Prevention Research Branch, Division of Clinical Research, of the National Institute of Mental Health held a research workshop on the methodological issues in evaluating preventive interventions using mutual support. This workshop, held in June 1989, was part of an effort to stimulate high-quality research on preventive interventions using mutual support. These interventions include but are not limited to naturally occurring self-help groups. Participants reviewed methodological problems, generated strategies for dealing with these problems, and made recommendations for future research in this area.