The origin of parental care in relation to male and female life history

The evolution of maternal, paternal, and bi‐parental care has been the focus of a great deal of research. Males and females vary in basic life‐history characteristics (e.g., stage‐specific mortality, maturation) in ways that are unrelated to parental investment. Surprisingly, few studies have examined the effect of this variation in male and female life history on the evolution of care. Here, we use a theoretical approach to determine the sex‐specific life‐history characteristics that give rise to the origin of paternal, maternal, or bi‐parental care from an ancestral state of no care. Females initially invest more into each egg than males. Despite this inherent difference between the sexes, paternal, maternal, and bi‐parental care are equally likely when males and females are otherwise similar. Thus, sex differences in initial zygotic investment do not explain the origin of one pattern of care over another. However, sex differences in adult mortality, egg maturation rate, and juvenile survival affect the pattern of care that will be most likely to evolve. Maternal care is more likely if female adult mortality is high, whereas paternal care is more likely if male adult mortality is high. These findings suggest that basic life‐history differences between the sexes can alone explain the origin of maternal, paternal, and bi‐parental care. As a result, the influence of life‐history characteristics should be considered as a baseline scenario in studies examining the origin of care.     

英国健康服务整合进展及对中国的启示

通过万方、知网、PUMED和谷歌学术搜索,查阅获取近年来有关英国健康服务整合的文献和政策文件,分析了健康服务整合的内涵,归纳总结了英国健康服务整合实践的政策历程,目前的整合实践模式,并归纳分析了英国健康服务整合的应对策略,最后结合中国实际,提出对健康和社会保健相关职能部门进行整合,对中央和地方的责权利进行合理划分,从而落实健康服务的整合供给,通过信息化和多媒体,建立以患者为中心的健康保健提供的激励约束机制,建立现代化的健康和社会保健服务的人才保障机制。     

Developing an instrument to support oral care in the elderly

Background: The dramatic increase in the number of dependent elderly in developed countries has created a great need for their improved oral care. However, optimal oral care by caregivers is not possible because of time constraints, difficulty involved in brushing other individuals' teeth, lack of co‐operation, and the lack of perceived need. Therefore, the development of an effective instrument simplifying and supporting oral care to relieve the strain on caregivers is a matter of some urgency. Purpose: In order to clean the mouths of elderly dependent patients, we have developed a new oral care support instrument (an electric toothbrush in combination with an antibacterial‐agent supply and suction system). The purpose of the present study was to develop and evaluate a new oral care support instrument. Methods: a) Plaque removal study: The plaque‐ removing ability of this new instrument in 70 outpatients was compared with the Plak Control D9011 (Braun Gillette Japan Inc.) as a control by means of the Turesky modification of the Quigley and Hein plaque index, b) Clinical study: The subjects were 10 dependent elderly who received oral care using the new oral care support instrument for two weeks. The plaque and gingival indices were used for clinical evaluations. Results: a) Plaque removal study: Brushing with the new oral care support instrument removed significantly more plaque than with the Plak Control D9011. b) Clinical study: The new oral care support instrument allows a more effective removal of dental plaque and shows a significant improvement in the gingival indices in dependent elderly. Conclusion: It is concluded that the new oral care support instrument is effective and can be recommended for oral care in the dependent elderly.     

What Rationality Adds to Animal Morality

Philosophical tradition demands rational reflection as a condition for genuine moral acts. But the grounds for that requirement are untenable, and when the requirement is dropped morality comes into clearer view as a naturally developing phenomenon that is not confined to human beings and does not require higher-level rational reflective processes. Rational consideration of rules and duties can enhance and extend moral behavior, but rationality is not necessary for morality and (contrary to the Kantian tradition represented by Thomas Nagel) morality cannot transcend its biological roots. Recognizing this helps forge a complementary rather than competitive relation between feminist care-based ethics and rationalistic duty-based ethics.     

The discovery of hatching and transition to feeding young by male Mountain Bluebirds

In many bird species, only females incubate the eggs, but both sexes feed nestlings. The means by which males of such species discover hatching and transition to feeding their offspring remains almost completely unexplored. Of particular interest are species with nests whose contents are concealed from view. During June and early July 2015 in the Bighorn Mountains of Wyoming, we used continuous video‐recording of nests of cavity‐nesting Mountain Bluebirds (Sialia currucoides) to document the transition to feeding young by males. We saw no evidence that females used distinct vocal or visual displays to signal hatching to males. Observing mates carrying eggshells away from, or food into, nest boxes did not appear to trigger provisioning by males. Rather, at all 24 nests observed, males did not begin feeding until they had come to nest boxes and presumably sensed the presence of hatchings directly. Individual males varied, however, in both the manner in which they inspected nest contents and the number of times they did so before starting to feed young. Although most males fully entered nest boxes where they could see, touch, hear, and possibly smell hatchlings (or eggshell parts), other males may have detected hatchlings only by sound or possibly smell while perched at a nest‐box entrance. Based on past studies of mice and doves, we suggest that, for provisioning behavior to begin, some kind of direct sensation of offspring may be necessary to activate relevant neurons in the medial preoptic area of the hypothalamus of males, an area of the brain important in parental care. Additional research is necessary to test this, and to examine the effects of factors such as hormone levels and breeding experience on the means and rapidity by which males discover hatching and transition to nestling provisioning.     

Barriers to provision of dental care in long-term care facilities: the confrontation with ageing and death

Objective: The aim of the study was to reveal barriers to providing dental care for residents in long‐term care (LTC) facilities. Design: Participants were selected randomly from the dentist register in Berlin and Saxony, Germany. The sample consisted of 60 self‐employed and 60 employed dentists, a further 60 dentists worked in their own dental practice but also part‐time in an LTC facility. In semi‐structured interviews a questionnaire with 36 statements concerning working conditions, administration and cost, insecurity concerning treatment decisions as well as confrontation with ageing and death was employed. Subsequently, the study participants were asked to rank the four dimensions concerning their impact on the decision against providing dental care in an LTC facility. Results: The random sample was representative in age and gender for the dental register in Berlin and Saxony. Fifty‐six per cent of the participants (63% of the men and 51% of the women; 52% of the self‐employed, 60% of the employed and 56% of the consultant dentists) indicated unfavourable working conditions as biggest obstacle in providing dental care in an LTC‐facility. Thirty‐two per cent of participants rated administration and cost, 7% the insecurity in treatment decisions as major hindrance. Only 5% of the participants rated the confrontation with age and death as substantial barrier. There were no age and gender differences. Dentists in Berlin seemed more concerned about administration and cost of a consultancy activity and less secure in their therapy decisions than the colleagues from Saxony (p < 0.001). Dentists who work partly in LTC facilities were the least concerned about the confrontation with ageing and death (not significant), employed dentist showed the least secure in their treatment decisions (p > 0.001). Conclusion: It can be concluded that the awareness of infra‐structural and financial aspects in providing dental care in LTC facilities should be raised with health politicians and that these aspects should be considered when inaugurating or re‐structuring the consultancy services to LTC facilities. Further it would be desirable to establish more postgraduate training programmes to increase clinical and ethical competence in the area of gerodontology.     

Effects of reproductive status on behavioral and endocrine responses to acute stress in a biparental rodent, the California mouse (Peromyscus californicus)

In several mammalian species, lactating females show blunted neural, hormonal, and behavioral responses to stressors. It is not known whether new fathers also show stress hyporesponsiveness in species in which males provide infant care. To test this possibility, we determined the effects of male and female reproductive status on stress responsiveness in the biparental, monogamous California mouse (Peromyscus californicus). Breeding (N = 8 females, 8 males), nonbreeding (N = 10 females, 10 males) and virgin mice (N = 12 females, 9 males) were exposed to a 5-min predator-urine stressor at two time points, corresponding to the early postpartum (5-7 days postpartum) and mid/late postpartum (19-21 days postpartum) phases, and blood samples were collected immediately afterwards. Baseline blood samples were obtained 2 days prior to each stress test. Baseline plasma corticosterone (CORT) concentrations did not differ among male or female groups. CORT responses to the stressor did not differ among female reproductive groups, and all three groups showed distinct behavioral responses to predator urine. Virgin males tended to increase their CORT response from the first to the second stress test, while breeding and nonbreeding males did not. Moreover, virgin and nonbreeding males showed significant behavioral changes in response to predator urine, whereas breeding males did not. These results suggest that adrenocortical responses to a repeated stressor in male California mice may be modulated by cohabitation with a female, whereas behavioral responses to stress may be blunted by parental status.     

Biparental care is predominant and beneficial to parents in the burying beetle Nicrophorus orbicollis (Coleoptera: Silphidae)

Parenting strategies can be flexible within a species and may have varying fitness effects. Understanding this flexibility and its fitness consequences is important for understanding why parenting strategies evolve. In the present study, we investigate the fitness consequences of flexible parenting in the burying beetle Nicrophorus orbicollis, a species known for its advanced provisioning behaviour of regurgitated vertebrate carrion to offspring by both sexes. We show that, even when a parent is freely allowed to abandon the carcass at any point in time, biparental post‐hatching care is the most common pattern of care adopted in N. orbicollis. Furthermore, two parents together raised more offspring than single parents of either sex, showing that the presence of the male can directly influence parental fitness even in the absence of competitors. This contrasts with studies in other species of burying beetle, where biparental families do not differ in offspring number. This may explain why biparental care is more common in N. orbicollis than in other burying beetles. We suggest how the fitness benefits of two parents may play a role in the evolution and maintenance of flexible biparental care in N. orbicollis.     

Sending people to care homes in lower-income countries: A qualified defence

In recent years, a proportion of older Germans has been sent to relatively high-end care homes within lower-income countries where the care tends to be cheaper and more extensive than that in German care homes. Destination countries are found predominantly within Eastern Europe (e.g. Poland, Hungary, Czech Republic), but to a lesser extent also within South-East Asia (e.g. Thailand). At the same time, these expatriations have caused much controversy, with some German commentators calling them ‘inhumane’ and ‘shameful’. In this article, I argue that such criticisms are overdrawn. Although sending an older individual to a care home within a lower-income country can be morally impermissible, I find that there are at least three sets of conditions under which it is not.     

Self‐perceived burden to others as a moral emotion in wishes to die. A conceptual analysis

Patients at the end of their life who express a wish to die sometimes explain their wish as the desire not to be a burden to others. This feeling needs to be investigated as an emotion with an intrinsically dialogical structure. Using a phenomenological approach, two key meanings of the feeling of being a burden to others as a reason for a wish to die are identified. First, it is an existential suffering insofar as it contains the perception of a plight so desperate that it can only be relieved by the end of the patient’s existence. Second, it is an empathic concern that implies caring about those who bear the burden of caring for the person at the end of their life. It is therefore a moral emotion, encompassing a series of difficulties, including the subjective perception of a stark imbalance between giving and taking, the adequacy of the representation of the caregiver burden in the patient’s mind, and the danger of diminishing the worth of one’s life out of shame or self‐denigration. R. D. Laing’s terminology of crossed perspectives in interexperience is used to systematically distinguish the actual caregiver burden, the patient’s view of the caregiver burden, the stress for the patient in feeling that s/he is a burden to the caregiver, and the caregiver’s view of the patient’s stress. The sense of being a burden implies the belief that the caregiver feels burdened, and the fear that this burden could become unbearable.     

Providers and staff respond to Medicaid managed care: the unintended consequences of reform in New Mexico

In 1997 a new Medicaid managed care (MMC) program called Salud! was implemented by the State of New Mexico. This article serves as an introduction to a special issue of Medical Anthropology Quarterly that assesses the unintended consequences of this reform and its impact on providers and staff who work in clinics, physician offices, and emergency rooms where Medicaid patients are served. MMC fused state and corporate bureaucracies, creating a complex system where enrollment and access was difficult. The special issue focuses on providers' responses to these new structures, including ways in which staff buffer the impact of reform and the role of the discourses of medical necessity and accountability in shaping the way in which MMC functions.     

Attitudes to oral care among caregivers in Japanese nursing homes

Objectives: The purpose of this study is to investigate oral care practice and awareness of it among caregivers in Japanese nursing homes. Methods: Caregivers were surveyed by means of a self‐administered questionnaire designed to elicit the following information: awareness of oral care, its importance, the burden involved in oral care, and systemization of oral care. Results: The results showed that most caregivers are adequately informed of the importance of oral care, but are inadequately educated in oral care and have little training in systematic oral care. Conclusion: The importance of providing appropriate and systematic oral care training must be stressed among caregivers along with the need to develop equipment to simplify and support oral care.     

O2 replenishment to fish nests: males adjust brood care to ambient conditions and brood development

Parental care through nest defense and maintenance enhancesoffspring success. In nature, obligate anemone-dwelling fishesand their nests of benthic eggs are protected against most predatorsby their host anemone; thus, parental care generally consistsof nest tending through fanning and mouthing. Tending in fishesis believed to oxygenate the eggs; however, a real-time linkbetween fanning and oxygenation is tenuous. This study investigatedwhether tending modified the oxygen microenvironment of theembryos and, subsequently, whether tending was modified accordingto ambient dissolved oxygen (DO), increasing metabolic demandsof developing embryos, and water temperature. There was a timelag of approximately 1 s between tending and increases in theamount of oxygen within the nest, demonstrating that DO is directlyaffected by parental tending. While there was evidence of biparentalcare, males invested more time tending embryos (40% initially)than did females (20–30%), and male investment increasedto 70% as embryo development progressed and embryonic metabolicdemands increased. Additionally, male fish adjusted tendingeffort on a diel cycle as ambient DO fluctuated: time spenttending was lowest between 1000 and 1400 h (35%), when ambientDO was highest, and increased throughout the day, reaching apeak of 70% between 2200 and 0200 h, when ambient DO was lowest.Increased water temperature reduced the number of tending boutsper minute throughout the day but did not influence any otheraspect of tending behavior. These results suggest that fishadjust tending behavior coincident to changing conditions inthe nest, both on a daily basis and throughout development ofthe embryos.     

Life history evolution in cichlids 1: revisiting the evolution of life histories in relation to parental care

Empirical links between egg size and duration of parental care in fishes have generated a considerable amount of theory concerning life history evolution. However, to date, this link has not been investigated in relation to other important life-history traits such as clutch size and body size, or while controlling for shared ancestry between species. We provide the first phylogenetically based tests using a database with information on egg size, clutch size, body size and care duration in cichlid fishes (Cichlidae). Multiple regression analyses, based on independent contrasts on both the species and the genus level, showed that clutch size is the variable most closely related to duration of care. This pattern appeared to be driven by post-hatch care relationships. Our results show that, contrary to expectation, there is no positive link between egg size and care duration in Cichlidae. Instead, greater reproductive output through increased clutch size investment appears to have coevolved with greater care of offspring. We suggest that re-evaluation of the generality of current models of the evolution of egg size under parental care in fishes is needed.     

Plas'O'Soins: An Interactive ICT Platform to Support Care Planning and Coordination within Home-Based Care

Background

Due to the rising demand in home healthcare services in France as well as in other European countries, homecare organizations are facing challenges in terms of coordination and continuity of care. In both cases, the problem is linked to the efficiency in which care interventions are distributed and managed among the different participants involved in home care processes. Project Plas'O'Soins which was developed within the framework of the French research program TecSan, aims to address these contemporary problems by providing an interactive ICT platform to improve coordination and continuity of care within homecare organizations.

Understanding the expanding role of primary care physicians (PCPs) to primary psychiatric care physicians (PPCPs): enhancing the assessment and treatment of psychiatric conditions

Aim In the current healthcare system primary care physicians (PCPs) have, in effect, become the primary psychiatric care physicians (PPCPs) for many of their patients. Being the PPCP in an already busy and stressful medical industry presents additional time management and treatment challenges to successfully manage patients' medical and psychiatric needs. The aim of the study was to ascertain PCPs' psychiatric assessment and treatment practices and to determine the extent to which PCPs have a need for using a structured psychiatric assessment tool.Method We sent 300 PCPs a survey to examine their psychiatric assessment and treatment practices. A one-page questionnaire was used to inquire about PCPs' psychiatric care practice habits including types of conditions treated, psychiatric medications prescribed, assessment methods used, interest in using a structured assessment tool and referral sources used. Sixty-eight usable surveys (23%) were returned.Results PCPs identify approximately one-third of their patients as mental health patients. They are treating a wide range of psychiatric conditions and prescribing a variety of psychiatric medications. The vast majority are using traditional clinical interviewing as their primary method of psychiatric assessment. However, the majority were willing to use a structured psychiatric assessment tool.Conclusion PCPs are serving a useful role in providing psychiatric treatment to many of their patients. Using a more structured psychiatric assessment method in practice could ultimately strengthen the assessment and treatment of psychiatric conditions in primary care settings.     

关于构建对医生人文关怀保障机制的思考

医生作为一种高危职业,面临着巨大的职业压力。尤其在医患关系紧张的今天,医生面临着前所未有的压力。而在这种情况下,无论是社会还是医院,多数时候,过多的只是强调对患者的人文关怀,却忽视了对医生的人文关怀。若医院能在工作上、风险保障上、经济上、心理上给予医生更多的人文关怀,既可以减轻医生的压力,使医生更好地为患者服务;又可以改善医患关系,建立良好和谐的医患关系。     

Unintended pregnancies and exposure to potential human teratogens

BACKGROUND: We aimed to investigate the risk factors associated with unintended pregnancies as well as the association between unintended pregnancies and potential teratogenic exposures. METHODS: A cross-sectional survey was performed among women attending the Maternity School of the Samsung Cheil Hospital and Women's Health Care Center in Seoul, Korea. Demographic data, obstetric history, socioeconomic status, intention to become pregnant, and exposure to potential teratogens were obtained. RESULTS: A total of 1354 women with median age of 29 years and median gestational age of 29 weeks were included. Of these, an educational level above high school was 74.2%, primigravida was 77.3% and unintended pregnancy was 48%. In the logistic regression analysis, women younger than 24 years of age had a relative risk (RR) of 2.5 (95% confidence interval [CI], 1.3-4.7) of having an unintended pregnancy and women with lower household monthly income level had a RR of 1.3 (95% CI, 1.0-1.6). Women with unintended pregnancies had an RR of 1.9 (95% CI, 1.5-2.5), 3.0 (95% CI, 2.0-4.5), 1.5 (95% CI, 1.0-2.3), 2.9 (95% CI, 1.1-7.2), and 2.0 (95% CI, 1.62.4) of being exposed to alcohol, medications, cigarette smoking, X-rays, or to any of these, respectively, during the first trimester of pregnancy. CONCLUSIONS: Unintended pregnancies are more likely to occur among young women with a lower household monthly income level. Prenatal counseling should be especially recommended for women with unintended pregnancies in order to evaluate whether they have been exposed to potential teratogenic agents.