现行《医疗事故处理办法》的修改探析

现行《医疗事故处理办法》颁布实施１０ 年之久,新形势下需要对其进行修改和完善。“办法”的修改应该体现平等保护医患双方合法权益原则,合理界定医疗事故范围,调整医疗事故鉴定委员会的组成,建立完善的证据管理制度,明确医疗事故损失赔偿的范围和额度。     

Perceived stress in prodromal Huntington disease

This study examines perceived stress and its relationship to depressive symptoms, life changes and functional capacity in a large sample of individuals who are positive for the Huntington disease (HD) gene expansion but not yet diagnosed. Participants were classified by estimated proximity to HD diagnosis (far, mid, near) and compared with a non-gene-expanded comparison group. Persons in the mid group had the highest stress scores. A significant interaction between age and time since HD genetic testing was also found. Secondary analyses using data from a different data collection point and including a diagnosed group showed the highest stress scores in the diagnosed group. Possible explanations and implications are discussed.     

Construction and validation of the South African version of the Fear Survey Schedule for Children: an exploratory factor analysis

The Fear Survey Schedule for Children-Revised (Ollendick, 1983) is an 80-item self-report instrument that has been used internationally to asses the number of fears and general level of fearfulness among children. Despite its widespread use, this instrument has not been adapted to the South African context. The present study addressed this gap by means of a 2-phase investigation aimed at developing a South African version of the instrument. In Phase 1, semistructured interviews were conducted with 40 children (7 to 13 years of age). Qualitative data obtained from these interviews were used to construct additional items for inclusion in the South African Fear Survey Schedule for Children-Revised. The modified scale, consisting of 97 items, was then administered to a sample of 646 children between the ages of 7 and 13 years. Further psychometric considerations resulted in the final version of the scale consisting of 74 items with high internal consistency (α=.97). The factor structure was explored by means of principal component analysis with varimax rotation and a 5-factor solution was found to provide the best conceptual fit. The factors identified were as follows: Fear of Death and Danger; Fear of the Unknown; Fear of Small Animals and Minor Threats to Self; Large Animal Fears; and Situational Fears. Differences between the South African version and the original Fear Survey Schedule for Children-Revised are noted and implications for the study of fear in South Africa and other countries are discussed.     

Two models of unawareness: comparing the object-based and the subjective-state-space approaches

Over the past 20 years or so, a small but growing literature has emerged with the aim of modeling agents who are unaware of certain things. In this paper we compare two different approaches to modeling unawareness: the object-based approach of Board and Chung (Object-based unawareness: theory and applications. University of Minnesota, Mimeo, 2008) and the subjective-state-space approach of Heifetz et al. (J Econ Theory 130:78–94, 2006). In particular, we show that subjective-state-space models (henceforth HMS structures) can be embedded within object-based models (henceforth OBU structures), demonstrating that the latter are at least as expressive. As long as certain restrictions are imposed on the form of the OBU structure, the embedding can also go the other way. A generalization of HMS structures (relaxing the partitional properties of knowledge) gives us a full converse.     

Additive effects of social and non‐social attention during infancy relate to later autism spectrum disorder

Emerging findings from studies with infants at familial high risk for autism spectrum disorder (ASD), owing to an older sibling with a diagnosis, suggest that those who go on to develop ASD show early impairments in the processing of stimuli with both social and non‐social content. Although ASD is defined by social‐communication impairments and restricted and repetitive behaviours, the majority of cognitive theories of ASD posit a single underlying factor, which over development has secondary effects across domains. This is the first high‐risk study to statistically differentiate theoretical models of the development of ASD in high‐risk siblings using multiple risk factors. We examined the prediction of ASD outcome by attention to social and non‐social stimuli: gaze following and attentional disengagement assessed at 13 months in low‐risk controls and high‐risk ASD infants (who were subsequently diagnosed with ASD at 3 years). When included in the same regression model, these 13‐month measures independently predicted ASD outcome at 3 years of age. The data were best described by an additive model, suggesting that non‐social attention, disengagement, and social attention as evidenced by gaze following, have a cumulative impact on ASD risk. These data argue against cognitive theories of ASD which propose that a single underlying factor has cascading effects across early development leading to an ASD outcome, and support multiple impairment models of ASD that are more consistent with recent genetic and neurobiological evidence.     

Development and Pilot Testing of a Decision Aid for Genomic Research Participants Notified of Clinically Actionable Research Findings for Cancer Risk

Germline genomic testing is increasingly used in research to identify genetic causes of disease, including cancer. However, there is evidence that individuals who are notified of clinically actionable research findings have difficulty making informed decisions regarding uptake of genetic counseling for these findings. This study aimed to produce and pilot test a decision aid to assist participants in genomic research studies who are notified of clinically actionable research findings to make informed choices regarding uptake of genetic counseling. Development was guided by published literature, the International Patient Decision Aid Standards, and the expertise of a steering committee of clinicians, researchers, and consumers. Decision aid acceptability was assessed by self-report questionnaire. All 19 participants stated that the decision aid was easy to read, clearly presented, increased their understanding of the implications of taking up research findings, and would be helpful in decision-making. While low to moderate levels of distress/worry were reported after reading the booklet, a majority of participants also reported feeling reassured. All participants would recommend the booklet to others considering uptake of clinically actionable research findings. Results indicate the decision aid is acceptable to the target audience, with potential as a useful decision support tool for genomic research participants.     

Preschoolers with Asthma: Narratives of Family Functioning Predict Behavior Problems

This study tested a model predicting behavior symptoms in preschoolers with asthma. Specifically, it examined the role that asthma severity and children's representations of family functioning may play in the development of child behavior problems in a sample of 53 low-income preschoolers. The study included parent report of asthma severity and a narrative story-stem method to assess children's representations of both general and disease-specific family processes. A regression model tested the inclusion of both types of family processes in predicting child internalizing and externalizing behavior. Disease severity and children's family narratives independently predicted children's behavior over and above the combined effects of demographic variables including child age, socioeconomic status, and family structure. Although children's narratives about general family functioning predicted children's behavior, narratives about family response to asthma symptoms did not. Findings support that both disease severity and family functioning are important considerations in understanding children's behavior problems in the context of asthma. Clinical applications of findings may include: (1) Informing family based-assessments to incorporate children's narratives, and (2) A focus on reducing asthma symptoms and strengthening family functioning to prevent or address child behavior problems.     

Male Emotional Intimacy: How Therapeutic Men's Groups Can Enhance Couples Therapy

Men's difficulty with emotional intimacy is a problem that therapists regularly encounter in working with heterosexual couples in therapy. The first part of this article describes historical and cultural factors that contribute to this dilemma in men's marriages and same-sex friendships. Therapeutic men's groups can provide a corrective experience for men, helping them to develop emotional intimacy skills while augmenting their work in couples therapy. A model for such groups is presented, including guidelines for referral, screening, and collaboration with other therapists. Our therapeutic approach encourages relationship-based learning through direct emotional expression and supportive feedback. We emphasize the development of friendship skills , core attributes of friendship ( connection, communication, commitment, and cooperation ) that contribute to emotional intimacy in men's relationships. Case examples are included to illustrate how this model works in clinical practice, as well as specific suggestions for further study that could lead to a more evidence-based practice.