医务人员在医疗活动中的利益边界与道德责任分析

当今是一个以利益为轴心的时代,利益伦理是医学伦理学不可忽视的课题。欲望是无穷的,利益是有限的,任何利益都有其边界和限度,我们必须设置利益的道德界限。医患双方未能遵守利益限度和利益边界原则,使矛盾转化为冲突。利益冲突不仅影响医生的专业判断,而且影响了其医疗决定。医生既是医疗职业者,也是社会的一员,社会公众利益最大化是医疗服务的基本目标,为病人最大利益着想是医护专业最根本的道德规范与责任。     

实施社区首诊制的意义及建议

目前,实施社区首诊制有重要的意义在于,可以缓解看病难、看病贵问题,适应人口老龄化的需求,改善流动人口的健康状况,以及减少私人诊所和药店不规范医疗带来的危害。但是,首诊制的实施也必然面临一定的困难。因此,应积极倡导医保制定向社区倾斜的政策,鼓励社区提高医务人员的技术水平、服务质量,并且完善双向转诊制度。     

论首发症状的分析在临床决策中的作用

根据不同标准,首发症状可以划分为常见首发症状、可见首发症状、偶见首发症状、特异性首发症状和非特异性首发症状。首发症状在临床决策中的重要作用表现在:提示早期诊断决策信息、疾病内在特征、病灶发生部位、发病病理机制、疾病发展预后和鉴别诊断要点。首发症状的复杂性表现在其无特异性、不典型性、多样性、本系统疾病以外系统疾病为首发症状、躯体性疾病以精神症状为首发症状和首发并发症现象等方面。     

不同年级学生执行功能发展水平研究

工作记忆、抑制控制及认知灵活性是执行功能的主要成分。以小学三年级、五年级,初中二年级、高中二年级320名学生为被试,研究了他们执行功能各成分的发展。结果发现:工作记忆广度、抑制控制、认知灵活性的发展随着年级(或年龄)的增长而发展,各年级之间存在显著差异。     

The quality of teacher-student interactions: associations with first graders' academic and behavioral outcomes

The associations between the quality of teacher-student interactions and first grade academic and adaptive behavior outcomes were examined in a study of 106 Portuguese students in 64 first grade classrooms. Students' vocabulary, print concepts, math, and adaptive skills were assessed both at the end of preschool and in first grade. Classrooms were observed in the spring of first grade. After taking into account family risk factors and preschool skills, the quality of teacher-student interactions, particularly in terms of classroom organization, was positively associated with students' first grade vocabulary and print concepts. In addition, classroom quality predicted number identification outcomes differently depending on student skills prior to school entry. Students with lower preschool math skills seemed to benefit from higher quality teacher-student interactions. These findings provide further support for the unique contribution of the quality of teacher-student interactions in first grade and suggest that it may be an important mechanism to improve academic skills.     

医疗联合体与就医的自我选择权

涉及民众自由、自我决定及对其的限制, 无疑是一项制度正当性的核心。自我决定权的价值不仅在于其处于人与人格的核心地位, 且从私法与公法、私权利与公权力的角度考量, 在可以避免国家代理的情况下, 必须设计权利直接行使的机制——自我决定权, 这既是权利本位法治理念的必然逻辑, 也是权利制衡和抗衡权力的重要方式。对权利的限制必须遵循必要性原则和适当性原则。我国不满足对民众的就医自我决定权限制的前提。     

医疗机构伦理的内涵、意义及挑战

为推动国家卫生保健政策的落实,解决医务人员面临执业困境的现实问题,对医疗机构伦理的内涵、意义及其面临的挑战展开讨论。医疗机构伦理概念的提出来自于企业伦理经营的启发,其特征表现为实践性、中介性、导向性。医疗机构伦理的意义在于,这是医疗机构对社会的公开承诺,是医疗机构及医务人员行为道德的风向标,是医务人员团结的凝结剂,是执行卫生保健政策的铺路石。同时,应正视医疗机构伦理面临的挑战,包括医学市场化冲击人道主义的行善宗旨、医疗机构人文关怀日渐衰落、治病与致病的矛盾日益显现、医学公平性与可及性受到威胁。     

The Development of Symbolic Uses of Objects in Infants in a Triadic Context: A Pragmatic and Semiotic Perspective

In this study, we address the construction of the first symbolic uses of objects in contexts of triadic interaction (adult–child–object). We assume that symbolic productions are based on public rules of the use of objects previously agreed by the community. The first symbols are not rooted in any literal, evident reality, but in shared rules of uses about the material world. We observed six dyads communicating and interacting together with 10 objects in a semi‐structured situation longitudinally from 9 to 15 months of age. We found that the infants gradually constructed symbolic meanings, and we identified five symbolic levels and sublevels. At 9 months, the infants attended and engaged in the symbolic uses produced by an adult even though they themselves were not yet able to produce them. At 12 months, infants began to use objects symbolically to communicate with adults. The highest percentage of these first symbolic uses was of level 1, that is, with a close relation to the conventional use of the object used to perform the symbol. At 15 months, children increased their symbolic uses and performed symbolic uses at all levels, whereas adults reduced such practices. Adult semiotic mediation and the social meanings of objects can be considered important factors in children's symbolic productions. Copyright © 2014 John Wiley & Sons, Ltd.     

婴儿如何认识他心：“似我”假说述评

Meltzoff的“似我”假说认为,婴儿借助“我他对等”认识解读他人行为和心理状态,通过他人间的互动信息推断和调整自身行为。“似我”认识以动作表征为基础,借助第一人称体验建立双向映射,对“似我”之人进行因果推理,由此构成发展路径引导婴儿认识他心。注视追随与模仿两种初级社会学习机制进一步丰富了婴儿对社交关系的理解,使人类学习的渠道突破了自我体验的局限而变得更加多元。     

Implementation and evaluation of a first-year university induction support programme for business students in Spain

This paper reports new evidence on students’ evaluation of a first-year induction experience programme and examines the relationship between gender and perceptions. The programme was provided to 610 business studies students at the University of Granada (Spain). The programme includes individual and group sessions providing psychosocial and instrumental support. Gender differences were investigated using nonparametric techniques. Structural equation models were used to test relationships between variables of overall satisfaction with the programme and its activities and the moderating effects of gender. The results obtained show that gender significantly influences enrolment and satisfaction with the programme and with the individual sessions. Satisfaction with group and individual activities is directly related to overall satisfaction with the programme. Gender has a moderating effect on the relation of overall satisfaction with individual sessions.