The Lost Voice: How Libertarianism and Consumerism Obliterate the Need for a Relational Ethics in the National Health Care Service

This article analyzes the contribution Christian ethics mightbe able to make to the ethical debate on policy and caregivingin health and social care in the United Kingdom. The articledeals particularly with the concepts of solidarity and subsidiaritywhich are essential in Christian social ethics and health careethics, and which may be relevant for the ethical debate onhealth and social caregiving in the United Kingdom. An importantargument in the article is that utilitarian and market-drivenpolicies in the National Health Service (NHS) and the socialcare system have marginalized the position of the elderly andhave seriously impoverished the quality of care for the elderly.The neglect of the elderly and other vulnerable groups is alsothe result of widespread consumerist attitudes among patientsand of libertarian models of noninterference which are affirmedby a public ethos of self-sufficiency and counter-dependency.Those who need care dare not make their need known to othersand ask for help, while simultaneously those who could helpare so intimidated by the public affirmation of privacy andnegative rights that they do not dare to offer help except ifthis is explicitly demanded. This distant and standoffish attitudeis in an important way responsible for the fact that the voiceof those in need is altogether lost to the public forum. Christianethics puts much emphasis on responsibility and solidarity withthe needy other but is not able to have much impact on the deliveryof care in a secularized society and health care system likethe NHS. Nonetheless, Christianity still has a powerful andrespected voice, by speaking up for those who cannot speak forthemselves, such as the elderly and the handicapped. Christianscan find allies in the ethics of care and other relational approachesin health care ethics in order to combat libertarianism, consumerism,and utilitarianism.     

The quality of caregiving in child care: relations to teacher complexity of thinking and perceived supportiveness of the work environment

This study examined the relationship between the complexity of thinking about children by child care teachers and observed teachers' caregiving for infants and toddlers. It was hypothesized that the perceived supportiveness of the work environment would affect this relationship. Fifty‐six child care teachers completed a survey assessing complexity of thinking about children's behaviour as well as a measure of the perceived opportunities for professional development. Teachers' quality of caregiving was assessed using the Caregiver Interaction Scale. Planned contrasts revealed that when professional development opportunities were perceived unfavourably, teachers who were complex in thinking about children's behaviour provided significantly more sensitive care than did teachers who were less complex in their thinking. Findings indicate that the complexity of teachers' thinking about children may be very important in understanding teacher's sensitivity when the quality of the work environment is poor. High‐quality work environments may buffer teachers with less complexity of thinking from being less sensitive with children. Efforts to improve quality of care could focus on individual teachers to improve their complexity of thinking as well as on the work environment to make it more supportive of teachers' professional development. Copyright © 2008 John Wiley & Sons, Ltd.     

Patients taking the lead. A naturalistic investigation of a patient led approach to treatment in primary care

In an earlier paper (Carey, T. A. (2005). Can patients specify treatment parameters? A preliminary investigation. Clinical Psychology and Psychotherapy, 12, 326–335) an approach to treatment delivery was examined in which the duration and frequency of the appointments was scheduled by patients. Results of this approach were encouraging but the generalizability of the results was constrained because only one clinician trialed the approach and no standardized assessment measures were used. In the present study there are two clinicians involved and the Depression Anxiety Stress Scale (DASS) was used. The approach was introduced at one GP practice and monitored over a six-month period. Results suggest that this approach might be an effective way of promoting patient access to, and involvement in, service delivery as well as reducing waiting times.     

幽门螺杆菌cagA基因多态性对临床结局的影响:东亚菌株和西方菌株

CagA蛋白是幽门螺杆菌最重要的毒力因子之一.目前已证实cagA基因存在东亚及西方两种亚型.幽门螺杆菌产生CagA蛋白,注入胃上皮细胞后在其羧基端EPIYA重复序列区进行酪氨酸磷酸化,进而与SHP-2酪氨酸磷酸化酶相互作用,参与上皮细胞的信号传导,导致细胞骨架结构的重排,引起细胞表面形状的改变和细胞动力的增强,造成细胞异常的增殖和运动,在胃癌的发生中起了主要作用.cagA基因的羧基端EPIYA重复序列被认为是区分东亚型和西方型菌株的分子标记,东亚型CagA与SHP-2亲和力大于西方型,最终影响着不同CagA+菌株感染的临床表现.     

总结经验 推进新一轮卫生改革

着眼于实现为人人提供保健服务目标的医疗改革,要求卫生服务与医药购销制度的改革必须适应广覆盖、低成本的医疗保险制度;确保公共卫生、社区卫生与合作医疗在整个保健服务体系中的主体地位,在基本卫生保健服务机构与大医院之间建立合作、互补、互制的关系;坚定地对大医院实行调整和管理;构建医药分开的管理与流通体制;政府主导作用到位,投入方向合理,以顺利推进新一轮医疗改革。     

年轻医生如何搞好临床科研

面对目前年轻医生对科研束手无策的状况,提出了科研的重要性.从科研选题要紧密结合临床实际、医学科研选题强调创新与实用的原则、医学科研需要的科研素质、培养独立从事临床科学研究的能力、充分利用优势科研资源,加强科研合作能力的培养五方面进行阐述如何进行临床科研工作,以便更好地促进临床医学事业的发展.     

从细节着手围手术期人文关怀

人文关怀不是能一蹴而就的工作,而是需要从细节着手贯穿始终的系统工程。作为麻醉医生,与患者的接触通常仅限于围手术期。除了为患者提供高质量的麻醉外,还必须注意围手术期的各种细节问题。只有把术前、术中、术后各个阶段的各种"小事"做好了,才能充分体现对患者的人文关怀。这既有利于患者的健康,也有利于建立良好的医患关系。     

结核病控制应加强机构间协作

结核病控制工作是一个需要公共卫生机构与医疗机构密切协作的艰巨任务。然而,长期以来两者之间工作目标的不一致,已经影响了结核病人的转诊和有效管理。从组织学的角度探讨两者之间的关系的现状、现有结核病控制制度的作用有限性和组织创新的必要性,并对建立两者之间良好的关系,促进结核病控制工作提出了建议。     

印度农村医疗的现状与对策

自印度独立以来,政府就致力于采取各种有力措施来改善人们的健康情况并已卓见成效。尽管印度政府采取了一系列的发展政策,经济、地区发展不平衡及男女不平等还是为医疗部门带来了巨大的挑战。分析印度政府在农村所面临的问题以及为解决这些问题政府颁布的新政策。     

Dismantling institutional racism: theory and action

Despite a strong commitment to promoting social change and liberation, there are few community psychology models for creating systems change to address oppression. Given how embedded racism is in institutions such as healthcare, a significant shift in the system's policies, practices, and procedures is required to address institutional racism and create organizational and institutional change. This paper describes a systemic intervention to address racial inequities in healthcare quality called dismantling racism. The dismantling racism approach assumes healthcare disparities are the result of the intersection of a complex system (healthcare) and a complex problem (racism). Thus, dismantling racism is a systemic and systematic intervention designed to illuminate where and how to intervene in a given healthcare system to address proximal and distal factors associated with healthcare disparities. This paper describes the theory behind dismantling racism, the elements of the intervention strategy, and the strengths and limitations of this systems change approach.