苏丹就知情同意开展的一项调查

调查目的:调查文化、社会性别问题对不同社会经济地位的人们的知情同意的现实性和可行性的影响.     

Nonconsensual withdrawal of nutrition and hydration in prolonged disorders of consciousness: authoritarianism and trustworthiness in medicine

The Royal College of Physicians of London published the 2013 national clinical guidelines on prolonged disorders of consciousness (PDOC) in vegetative and minimally conscious states. The guidelines acknowledge the rapidly advancing neuroscientific research and evolving therapeutic modalities in PDOC. However, the guidelines state that end-of-life decisions should be made for patients who do not improve with neurorehabilitation within a finite period, and they recommend withdrawal of clinically assisted nutrition and hydration (CANH). This withdrawal is deemed necessary because patients in PDOC can survive for years with continuation of CANH, even when a ceiling on medical care has been imposed, i.e., withholding new treatment such as cardiopulmonary resuscitation for acute life-threatening illness. The end-of-life care pathway is centered on a staged escalation of medications, including sedatives, opioids, barbiturates, and general anesthesia, concurrent with withdrawal of CANH. Agitation and distress may last from several days to weeks because of the slow dying process from starvation and dehydration. The potential problems of this end-of-life care pathway are similar to those of the Liverpool Care Pathway. After an independent review in 2013, the Department of Health discontinued the Liverpool Care pathway in England. The guidelines assert that clinicians, supported by court decisions, have become the final authority in nonconsensual withdrawal of CANH on the basis of “best interests” rationale. We posit that these guidelines lack high-quality evidence supporting: 1) treatment futility of CANH, 2) reliability of distress assessment from starvation and dehydration, 3) efficacy of pharmacologic control of this distress, and 4) proximate causation of death. Finally, we express concerns about the utilitarian-based assessment of what constitutes a person’s best interests. We are disturbed by the level and the role of medical authoritarianism institutionalized by these national guidelines when deciding on the worthiness of life in PDOC. We conclude that these guidelines are not only harmful to patients and families, but they represent the means of nonconsensual euthanasia. The latter would constitute a gross violation of the public’s trust in the integrity of the medical profession.     

Inequality and Social Heterogeneity in Self-Reported Health Status in the Tunisian Population: An Analysis Using the MIMIC Model

Using a MIMIC model with structural equations and two synthetic health scores, this study attempts to explore the impact of the measurement of health status on socioeconomic inequalities in health. The results showed satisfactory internal consistency for both summary measures that are the Physical Component Summary (PCS) and the Mental Component Summary (MCS). A Physical Component Summary and Mental Component Summary calculated from the Short Form health survey (SF-12) items showed the same magnitude of health state and degree of change overtime; Cronbach’s α for PCS-12 and MCS-12 was .93 and .86, respectively. Known subgroups comparison showed that the SF-12 discriminated well between men and women and those who differed in age and educational status. In addition, results suggest the existence of reporting heterogeneity biases for a given latent health state, women and old people are more likely to report physical activity limitations; Mental health problems are over-reported by women and divorced people and under-reported by the oldest people; Clerks, farmers and retired as well as employees and homemakers in the top of the social hierarchy more often report physical activity limitations. Finally, highly educated and socially advantaged people more often report social activities limitations due to the problems of physical and mental health.     

Measuring Situation Awareness in Virtual Environment-Based Training

We evaluated the efficacy of a computer-based situation awareness (SA) measurement system for training dismounted infantry SA in an urban terrain virtual reality (VR) simulation. Based on past research, we hypothesized that the SA measures would be sensitive to individual (squad leader) differences, and that the frequency of specific probes would reveal differences in critical SA requirements among scenarios. Three infantry squads performed multiple trials across two different scenarios. A confederate platoon leader posed probes to squad leaders during trials and experts made ratings afterward. Results revealed squad leaders had similar responses to probes, despite differences in combat experience. Analysis of probe frequency revealed different high priority SA elements and decisions for each scenario. The SA behavior and communication ratings revealed differences among squads, which trended with experience. Measures of SA were also consistent across the test scenario as a result of similar mission types and task difficulties. We discuss the implication of our findings for future research and theory within this area.     

Psychoendocrine and physical performance responses in male Tunisian rugby players during an international competitive season

The aim was to investigate a follow-up study based on hormonal, physical, and psychological parameters among rugby players who trained during a whole season interspersed with competitions on an international level. Fitness or reciprocally tiredness as well as competitive anxiety were evaluated, respectively, using the French Society for Sports Medicine (SFMS) and the sport competition anxiety test (SCAT) questionnaires. In this study, SFMS and SCAT scores increased respectively over the competitive season. The SFMS score revealed a state of relative tiredness at the end of the season, highlighted by a slight decrement in physical performances. The SCAT score changes are related to the competition context and therefore increased accordingly to the importance of the competition stake. We analyzed the corticotrope and the gonadotrope axis before (T(1)), and at the end of the national and international rugby season (T(2)). Training did not affect the resting salivary cortisol (Csal) levels, but induced a decrease in resting testosterone (Tsal) values, resulting in a dropped T/C ratio. Competition, in both periods (T(1)-T(2)), provoked a significant increase in Csal levels, but the Tsal responses depended on the match stake. Their concentrations increased when the competition generated an important stress and decreased when the psychological conditions remained relatively stable. SFMS is preferentially correlated with resting Csal levels and T/C values measured at 08:00 hr but not with Tsal. SCAT is highly correlated with competitive Csal and Tsal concentrations measured before and after the matches.     

Ethical challenges with the left ventricular assist device as a destination therapy

The left ventricular assist device was originally designed to be surgically implanted as a bridge to transplantation for patients with chronic end-stage heart failure. On the basis of the REMATCH trial, the US Food and Drug Administration and the US Centers for Medicare & Medicaid Services approved permanent implantation of the left ventricular assist device as a destination therapy in Medicare beneficiaries who are not candidates for heart transplantation. The use of the left ventricular assist device as a destination therapy raises certain ethical challenges. Left ventricular assist devices can prolong the survival of average recipients compared with optimal medical management of chronic end-stage heart failure. However, the overall quality of life can be adversely affected in some recipients because of serious infections, neurologic complications, and device malfunction. Left ventricular assist devices alter end-of-life trajectories. The caregivers of recipients may experience significant burden (e.g., poor physical health, depression, anxiety, and posttraumatic stress disorder) from destination therapy with left ventricular assist devices. There are also social and financial ramifications for recipients and their families. We advocate early utilization of a palliative care approach and outline prerequisite conditions so that consenting for the use of a left ventricular assist device as a destination therapy is a well informed process. These conditions include: (1) direct participation of a multidisciplinary care team, including palliative care specialists, (2) a concise plan of care for anticipated device-related complications, (3) careful surveillance and counseling for caregiver burden, (4) advance-care planning for anticipated end-of-life trajectories and timing of device deactivation, and (5) a plan to address the long-term financial burden on patients, families, and caregivers.     

Anxiety and Depression in Cancer Patients: The Association with Religiosity and Religious Coping

There is a lack of studies looking into religiosity and religious coping in cancer patient. In this cross-sectional study, we examined the religiosity using Duke University Religion Index, religious coping using Brief Religious Coping Scale, anxiety and depression based on Hospital Anxiety and Depression Scale among 200 cancer patients. The association between religiosity and religious coping with anxiety and depression was studied. The findings showed that subjects with anxiety or depression used more negative religious coping and had lower non-organization religiosity. Hence, measurements in reducing negative religious coping and encouraging religious activities could help to reduce psychological distress in cancer patients.     

Automatic priming of grip force following action observation

Research shows that action observation can prime execution. Evidence for this comes from experiments that show that action observation influenced temporal (e.g., speed) or spatial (e.g., peak grasp aperture or trajectory) aspects of executed movement. In the paper presented here, we for the first time show that observation can also prime executed action force. Following observation of force actions, participants executed grip-force responses using a dynamometer, and the data showed that their force was modulated by the condition observed. The findings of the study are discussed in terms of a likely cause of the force modulation effect and potential uses that the effect may have for strength rehabilitation.     

Wives’ career progression among dual-career ethno-cultural couples: Husbands’ perspectives

This study explored the perspectives of husbands regarding the participation of their wives in professional occupations. The participants included nine South African Indian men in dual-career marriages (ages ranging from 25 to 54 years old). The completed semi-structured, life-story interviews focused on the socio-historic and contemporary influences on marital and familial dynamics with working spouses. Thematic analysis of the data revealed the husbands to be supportive of their spouses across familial and occupational roles. The findings contradict the stereotype that South African Indian husbands are unsupportive of their working spouses.