论公共卫生领域个人隐私保护

新型冠状病毒肺炎疫情已成为全球重大突发公共卫生事件。防疫工作中,既要维护公共利益,又要保护个人隐私。从公共卫生伦理学角度,认为保护个人隐私是实现社会公平正义的需要,是实现个人安全需要、尊重需要、情感需要、生活需要的前提;而隐私保护不足的表现主要为个人信息的泄露和网络人肉搜索。其原因是法律规范不足、公开界限模糊、道德规范滞后、隐私意识薄弱、群体存在利己心理和偏颇的推理心理。由此提出合理利用《个人信息保护法》保护个人隐私权益、拓宽隐私保护意识培育途径、给予弱势群体人文关怀的对策。

     

我国高等教育中健康社会工作教育现状及发展路径

从躯体健康、心理健康、社会适应和道德健康方面分析健康社会工作的内涵与必要性。从开设健康社会工作方向的院校情况、健康社会工作的课程开设情况、健康社会工作的师资情况、健康社会工作方向学生的就业情况方面分析我国高等教育中健康社会工作教育的现状。以此为基础,从加强健康社会工作办学力量、完善健康社会工作课程体系、加强健康社会工作师资队伍、助推健康社会工作学生就业方面提出未来高等教育中健康社会工作教育的发展路径。

     

Effects of sleep deprivation on executive functioning,cognitive abilities,metacognitive confidence,and decision making

Performance on many decision‐making tasks is underpinned by metacognitive monitoring, cognitive abilities, and executive functioning. Fatigue‐inducing conditions, such as sleep loss, compromise these factors, leading to decline in decision performance. Using a 40‐hr sleep deprivation protocol, we examined these factors and the resulting decision performance. Thirteen Australian Army male volunteers (aged 20–30 years) were tested at multiple time points on psychomotor vigilance, inhibitory control, task switching, working memory, short‐term memory, fluid intelligence, and decision accuracy and confidence in a medical diagnosis‐making test. Assessment took place in the morning and night over two consecutive days, during which participants were kept awake. Consistent with previous work, cognitive performance declined after a night without sleep. Extending previous findings, self‐regulation and self‐monitoring suffered significantly greater declines immediately after the sleepless night. These results indicate that the known decline in complex decision‐making performance under fatigue‐inducing conditions might be facilitated by metacognitive rather than cognitive mechanisms.     

A Community's Response to Adverse Childhood Experiences: Building a Resilient,Trauma‐Informed Community

Adverse childhood experiences, or ACEs, may be mitigated by trauma‐informed social environments—programs, services, systems, communities—that offer responses to trauma that promote healing, recovery, and resilience. However, there is currently little empirical evidence to support the use of specific approaches to do so. Guided by a population health perspective, this paper describes a participatory community change process in response to ACEs that seeks to build a resilient, trauma‐informed community in Pottstown, PA. We examine the initial implementation phase of this change process, centered originally on the education sector and the social and behavioral health services sector, and then eventually expanding to 14 community sectors across two years. A variety of data sources and methods are used to track individual and organizational processes, as well as service system network processes. A central feature of this research is the use of data to generate hypotheses rather than test them. Data were also used to guide understanding and decision‐making during implementation. The results show that moving forward the community is well‐positioned to establish stronger inter‐agency and system supports for trauma‐informed practice in the service system and in the broader community. We discuss results for their implications for building resilient, trauma‐informed communities.     

构建21世纪美国公共卫生体系的原则

美国卫生与福利部长沙拉拉博士在一次演讲中提出了构建２１世纪美国公共卫生体系的十大原则,这些原则包括公共卫生与信息革命;大力发展预防医学;医学研究;消除卫生保健的悬殊状况;新世纪卫生人卫生人培养;保护大学生卫生中心以及医学伦理学等主要内容。这些原则对我们思考规划２１世纪的医疗卫生体系及医学教育系不无借鉴启迪意义。     

Chronic Pain and Neuropsychological Functioning

This review article examines the effect of chronic pain on neuropsychological functioning. Primary attention is given to studies that include patient groups without a history of traumatic brain injury (TBI) or neurologic disorders. Numerous studies were identified that demonstrate neuropsychological impairment in patients with chronic pain, particularly on measures assessing attentional capacity, processing speed, and psychomotor speed. Despite suggestive findings, further studies are needed to clarify the variables that mediate the impact of pain on neuropsychological functioning and the unique role of various symptoms often associated with chronic pain.     

The School and Community Study: Characteristics of Students Who Have Emotional and Behavioral Disabilities Served in Restructuring Public Schools

We present selected initial results from a study investigating the effects of school restructuring and reform activities on outcomes for students who are identified as having serious emotional and behavioral disabilities. A review of the literature revealed six key areas of reform for investigation: accountability, governance, parent involvement, includedness, curriculum and instruction, and pro-social discipline. Ten schools (five elementary, two K-8, one middle, and two high schools) actively engaged in school restructuring and reform efforts were selected to participate in the study, and their status related to these six areas is presented. Characteristics of the students identified as having emotional and behavioral disabilities and served in these schools in special education settings (N = 116) are described. Results from the administration of standardized assessments revealed that these students have significant levels of emotional and behavioral disabilities that impair their functioning at school and at home. Further, school staff are providing the majority of counseling services to these students during the school day, with non-school professionals providing services to 25% of the students.     

Concordance Between Parent Reports of Children's Mental Health Services and Service Records: The Services Assessment for Children and Adolescents (SACA)

The concordance between parent reports of children's mental health services and medical and administrative service records were assessed in a field test of the Services Assessment for Children and Adolescents (SACA) interview instrument. Service use reports from primary caregivers, usually mothers, for their child's emotional or behavioral problems were compared against inpatient, outpatient, and school records in St. Louis, one of the pilot sites for the Multi-Site Study of Service Use, Need, Outcomes and Costs in Child and Adolescent Populations (UNOCCAP). A global any use service variable, comprised of inpatient, outpatient, and school reports, yielded an overall service use concordance kappa of .76 between parent reports and records. Parent reports of inpatient hospitalization services using the SACA yielded the highest agreement with medical records, with kappa statistics of 1.00 for use of any inpatient hospital care and for medication use. Parent reports of specific inpatient services concurred with medical records more moderately, yielding kappas from .50 to .66. Reports of any outpatient mental health services yielded variable rates of agreement, with kappas ranging from .67 for any use of outpatient care, to .66 for medication use, to negligible kappas for specific treatments. Parent reports of school services were weakly related to records for most services, except for moderate agreement (.48) on placement in special classrooms for emotional or behavioral problems. Family burden or impact discriminated more powerfully than other variables between respondents who concurred with records and those who did not.     

Physician-Assisted Suicide in the United States: Confronting Legal and Medical Reasoning – Part Two

In the United States, judicialrulings that unrealistically addressed the complexityof cases and demonstrated limited understanding ofprinciples, helped to create a legal quagmire whichlegislatures had to confront. Moreover, thelegislative response was often slow and inadequate interms of both the scope and clarity of the laws. However, since the 1970s, progress has been made onmany fronts, particularly in regard to advancedirectives dealing with end-of-life decisions. Thedebate over physician-assisted suicide has spawned arepetition of moral and legal arguments. Thoseagainst legalization have failed to make a realisticappraisal of the dilemmas facing patients and theirfamilies in an age of technological medicine deliveredin the context of the marketplace. The underlyingproblem is a system in dire need of reform that willno longer treat health care as a commodity of themarketplace and provide universal health care. Terminal care as an integral part of health care willsubstantially benefit from such reforms because amajor obstacle to comprehensive palliative care is thecondition of the present system.     

The President’s New Freedom Commission: Capitalizing on Opportunities to Advance School-Based Mental Health Services

The report from President George W. Bush’s New Freedom Commission on Mental Health (NFC), Achieving the Promise: Transforming Mental Health Care in America(2003), proposes goals and recommendations for improving mental health services. This report has significant implications for the delivery of mental health services through the schools. A focused discussion of the potential opportunities and challenges of implementing NFC recommendations related to school-based mental health is presented. Strategies for addressing five key areas at the intersection of school mental health and the Commission’s recommendations include: stigma reduction, suicide prevention, expansion and improvement of school mental health, and screening and treatment of co-occurring mental health and substance abuse disorders.