Priority setting in health care: on the relation between reasonable choices on the micro-level and the macro-level

There has been much discussion about how to obtain legitimacy at macro-level priority setting in health care by use of fair procedures, but how should we consider priority setting by individual clinicians or health workers at the micro-level? Despite the fact that just health care totally hinges upon their decisions, surprisingly little attention seems being paid to the legitimacy of these decisions. This paper addresses the following question: what are the conditions that have to be met in order to ensure that individual claims on health care are well aligned with an overall concept of just health care? Drawing upon a distinction between individual and aggregated needs, I argue that even though we assume the legitimacy of macro-level guidelines, this legitimacy is not directly transferable to decisions at micro-level simply by adherence to the guidelines’ recommendation. Further, I argue that individual claims are subject to the formal principle of equality and the demands of vertical and horizontal equity in a way that gives context- and patient-related equity concerns precedence over equity concerns captured at the macro-level. I conclude that if we aim to achieve just health care, we need to develop a complementary framework for legitimising individual judgment of patients’ claims on health care resources. Moreover, I suggest the basic structure of such a framework.     

Prevalence and functions of stereotyped behaviors in nonhandicapped children in residential care

Caregivers in nine residential care institutions rated the occurrence of 15 stereotyped behaviors in 142 nonhandicapped children aged from 10 months to 11 years. The frequency and duration of each stereotypy as well as the typical situations in which it occurred were assessed. The most frequent stereotypies were thumbsucking, hair twisting, and body rocking in infants and young children; thumbsucking and making faces in preschool-age children; and nail biting/chewing in school-age children. Boys exhibited stereotypies more frequently than girls, and children with a suspected history of child abuse more frequently than other children. Typical situations for stereotypies could be classified to four types: concentration/demand, arousal/frustration, boredom/monotony, and stimulation/distraction. Nail biting/chewing and lip biting occurred predominantly in concentration/demand; thumbsucking and hair twisting in boredom/monotony; and pulling faces and scratching oneself in arousal/frustration and concentration/demand situations. These results provide preliminary indications regarding the different functions of individual stereotypies.The author would like to thank Jonathan Harrow (University of Bielefeld) for translating this paper from German into English.     

Sequent-systems and groupoid models. II

The purpose of this paper is to connect the proof theory and the model theory of a family of prepositional logics weaker than Heyting's. This family includes systems analogous to the Lambek calculus of syntactic categories, systems of relevant logic, systems related to BCK algebras, and, finally, Johansson's and Heyting's logic. First, sequent-systems are given for these logics, and cut-elimination results are proved. In these sequent-systems the rules for the logical operations are never changed: all changes are made in the structural rules. Next, Hilbert-style formulations are given for these logics, and algebraic completeness results are demonstrated with respect to residuated lattice-ordered groupoids. Finally, model structures related to relevant model structures (of Urquhart, Fine, Routley, Meyer, and Maksimova) are given for our logics. These model structures are based on groupoids parallel to the sequent-systems. This paper lays the ground for a kind of correspondence theory for axioms of logics with implication weaker than Heyting's, a correspondence theory analogous to the correspondence theory for modal axioms of normal modal logics.Below is the sequel to the first part of the paper, which appeared in the previous issue of this journal (vol. 47 (1988), pp. 353–386). The first part contained sections on sequent-systems and Hilbert-formulations, and here is the third section on groupoid models. This second part is meant to be read in conjunction with the first part.     

A comparison of the category fluency deficits associated with Alzheimer's and Huntington's disease

The supermarket verbal fluency test of the Dementia Rating Scale (DRS) was administered to 20 patients with mild Alzheimer's disease (Mi-DAT), 20 patients with moderately severe Alzheimer's disease (Mo-DAT), 20 patients with Huntington's disease (HD), and 40 normal control subjects. The findings confirmed previous reports that Mo-DAT patients retrieved fewer words per category of supermarket items sampled and had a greater propensity to generate category labels (superordinates) than did intact controls. Similar disruptions of the structure of semantic knowledge were also noted in the fluency performances of the Mi-DAT and HD patients. The Mi-DAT patients' tendency to generate few exemplars for each category sampled suggested that a significant disruption in the structure of semantic knowledge occurred even in the earliest stages of DAT. When the present fluency findings for the HD patients were considered with previous reports of linguistic changes in this disorder, it appeared that HD patients' deterioration in semantic knowledge involved associative changes rather than the bottom-up breakdown associated with DAT.     

图形拓扑性质对相似性判断和分类的影响

使用Stevens数量估计法研究了限时和不限时呈现材料条件下,图形的平面几何特征和拓扑特征对相似性判断及分类的影响。结果表明：（1）材料特征对图形的相似性估计的影响显著,平面几何特征的差异对应着更大的差异估计量。（2）呈现方式对平面几何特征差异的估计影响大,而并不影响对拓扑差异的估计。（3）男性对拓扑特征差异的估计较女性大;对平面几何特征差异的估计没有显著的性别差异。（4）不限时呈现时被试倾向于按平面几何特征分类;限时呈现时倾向于按拓扑特征分类。     

Self-Assessed Risk of HIV and Other STIs Among Young Adults in Norway and Croatia

The purpose of the present study is to explore how sexually active young Norwegian and Croatian adults assess the risk of being infected with HIV and other STIs. Study results are based on a 2009–2010 large-scale national probability survey of young adults aged 18–24 in Croatia (n = 1,005) and Norway (n = 871). A majority of sexually active young adults in Croatia and Norway assessed the risk of becoming infected with HIV or other STIs as low or negligible. Among non-condom users, 85–98% determined they had low or no risk of getting infected with HIV. The corresponding figures for STIs were 77–79%. In both countries a higher HIV risk self-assessment was observed among those who had had same-sex sexual experience, those who reported a higher number of sex partners during the past year, and those who were single. When investigating the patterns of HIV/STI risk assessment, gender and country-related differences appeared. Condom use associated with higher risk assessment was significant only among Croatian men. The strong perception of condom use as being a male responsibility in Croatia may be the reason for a higher risk assessment for unwanted pregnancy and HIV/STIs when protection fails. The risk assessment for HIV/STIs was not associated with partner turnover in Croatian men. New campaigns need to develop gender-sensitive messages, particularly targeting men who believe that a great number of sexual partners is a sign of manliness and women who shy away from their responsibility to use protection.