What is new in adoption

Adoptions arranged through adoption agencies are on the increase because there are more agencies. The Citizens Committee on Adoption of Children in California has concluded that there are very few adoptable children under care in orphanages. Fifty per cent of physicians would prefer agency adoptions, but only 24 per cent actually refer both expectant mothers needing such services and couples wishing to adopt infants to such agencies. The program in this field of social welfare should be child-centered and physicians should seek and give cooperation to such agencies.     

Addressing consumer grievances in medicine: policies and practices of newborn screening programs in the United States

Newborn screening programs collectively administer the largest genetic testing initiative in the United States. The redress of grievances is an important mechanism for consumers to provide input into clinical and public health programs. In this study, we evaluated mechanisms for addressing consumer grievances in newborn screening programs. To do this, we surveyed all 50 state plus the District of Columbia newborn screening programs by questionnaire regarding protocols for receipt and redress of problems reported by parents of newborns and ascertained the existence and nature of complaints and how complaints were documented and addressed. Pertinent state and federal legislation and regulation were also reviewed. Six of 49 newborn screening programs reported having formal policies for handling consumer grievances. Four states reported having pertinent legislation or regulation. Thirty-eight of 49 states reported having received complaints from 1993 to 1995. Thirteen of 49 newborn screening programs reported that they actively seek feedback from consumers. Consumer grievances ranged from minor complaints to potentially life-threatening concerns. In general, complaints are managed on an ad hoc basis; formal policies are typically lacking. As newborn screening programs affect a vast number of Americans, a proactive and comprehensive approach, including solicitation of consumer feedback, could benefit both newborn screening programs and the public served by them.     

Report of the 1989 Asilomar meeting on education in genetic counseling.

In September, 1989, 35 individuals representing training programs for genetic counselors and genetic nurse specialists, the Education Committee of the National Society of Genetic Counselors (NSGC), and others with interest and expertise in genetic counselor education met at Asilomar, CA. The purpose of this meeting was to reevaluate training program curricula, both didactic and experiential; to discuss the need for and desirability of advanced graduate education in genetic counseling; and to consider whether alternatives to master's-level training are needed to overcome a growing manpower shortage in the provision of genetics services. This article summarizes recommendations for master's-level training curricula, reviews options and implications for post-master's genetic counselor education, and examines issues related to training for people without a master's degree who also provide patient and community genetics education.     

Points to Consider: Ethical,Legal, and Psychosocial Implications of Genetic Testing in Children and Adolescents

In 1995, the American Society of Human Genetics (ASHG) and American College of Medical Genetics and Genomics (ACMG) jointly published a statement on genetic testing in children and adolescents. In the past 20 years, much has changed in the field of genetics, including the development of powerful new technologies, new data from genetic research on children and adolescents, and substantial clinical experience. This statement represents current opinion by the ASHG on the ethical, legal, and social issues concerning genetic testing in children. These recommendations are relevant to families, clinicians, and investigators. After a brief review of the 1995 statement and major changes in genetic technologies in recent years, this statement offers points to consider on a broad range of test technologies and their applications in clinical medicine and research. Recommendations are also made for record and communication issues in this domain and for professional education.     

Opinion: predictive testing for Huntington disease in childhood: challenges and implications.

Predictive testing for HD strongly highlights the need for autonomy and the need for each individual to decide about his or her willingness-or unwillingness-to obtain genetic information predictive of the future outcome. In respect of this principle, testing for minors should not be offered at the request of a third party, and prenatal testing which would result in the birth of a child at increased risk for HD should, where possible, be avoided. If we accede to the wishes of the parents for their children to be tested, we will have broken the primary principles of confidentiality, privacy, and individual justice that are owed to those children. This could be the thin edge of a wedge which could result in adoption agencies, educational institutions, insurance companies, and other third parties demanding genetic testing for another individual. Despite years of careful planning, predictive testing for HD is turning out to be more complex and challenging than ever expected. We need a great deal of care and concern in developing our response to this challenge. Careful long-term assessment and documentation of the impact of such testing is needed, so that the appropriate guidelines can be developed, guidelines which both protect families with HD and at the same time give individuals the opportunity to participate in predictive testing programs.     

Family physicians' attitudes toward advance directives.

OBJECTIVE: To examine the attitudes toward, the experience with and the knowledge of advance directives of family physicians in Ontario. DESIGN: Cross-sectional survey. PARTICIPANTS: A questionnaire was mailed to 1000 family physicians, representing a random sample of one-third of the active members of the Ontario College of Family Physicians; 643 (64%) responded. RESULTS: In all, 86% of the physicians favoured the use of advance directives, but only 19% had ever discussed them with more than 10 patients. Most of the physicians agreed with statements supporting the use of advance directives and disagreed with statements opposing their use. Of the respondents 80% reported that they had never used a directive in managing an incompetent patient. Of the physicians who responded that they had such experience, over half said that they had not always followed the directions contained in the directive. The proportions of physicians who responded that certain patient groups should be offered the opportunity to complete an advance directive were 96% for terminally ill patients, 95% for chronically ill patients, 85% for people with human immunodeficiency virus infection, 77% for people over 65 years of age, 43% for all adults, 40% for people admitted to hospital on an elective basis and 33% for people admitted on an emergency basis. The proportions of physicians who felt that the following strategies would encourage them to offer advance directives to their patients were 92% for public education, 90% for professional education, 89% for legislation protecting physicians against liability when following a directive, 80% for legislation supporting the use of directives, 79% for hospital policy supporting the use of directives, 73% for reimbursement for time spent discussing directives with patients and 64% for hospital policy requiring that all patients be routinely offered the opportunity to complete a directive at the time of admission. CONCLUSIONS: Family physicians favour advance directives but use them infrequently. Most physicians support offering them to terminally or chronically ill patients but not to all patients at the time of admission to hospital. Although governments emphasize legislation, most physicians believe that public and professional education programs would be at least as likely as legislation to encourage them to offer advance directives to their patients.     

Survey of States' 2000 Soils Cleanup Standards for Petroleum Contamination

The establishment of cleanup standards for petroleum-contaminated soils (PCS) at the state level in the U.S. has had a fairly recent history beginning in the mid-1980s. Kostecki et al. (1988) surveyed the 50 states in 1985 and found of the 22 states that reported having established levels of cleanup for PCS, only five states considered the levels formal. The remaining 18 states considered the levels informal with 8 states considering establishing formal levels. Only 1 state had a formal numerical cleanup standard, and 3 had informal numerical standards. One state directly applied federal groundwater standards directly to soils. A follow-up survey in 1987 (Bell et al., 1989) indicated the rapid development of myriad different cleanup standards between and within states, including action levels, remediation goals, cleanup levels, etc. With the implementation of EPA's Office of Underground Storage Tanks final rules for regulating underground storage tanks in 1988 and the existing state of confusion regarding policies, rules and regulations for the cleanup of PCS at the state level, the Association for the Environmental Health of Soils (AEHS) began conducting state-by-state surveys of environmental regulatory agencies in 1990 to determine cleanup standards for PCS for use by the regulated community. The following tables represent AEHS' compilation of state data for PCS cleanup standards for 2000. The Survey was conducted by telephone interviews and submission of written information by the appropriate listed agencies. Many of the states' programs have changed to or are in the process of changing to Risk Based Corrective Action (RBCA) approaches. Thus, the format of the summaries are less standardized than past surveys in order to accurately reflect the states' program. Every attempt has been made to accurately represent states' cleanup standards, however, users should be cautioned to the limitations of compiling complex regulatory information into tabular form. The information should only be used as a reference guide and legal, economic or technical decisions should be based on specific information obtained directly from the appropriate agency in each state for each specific site.     

Evidence of a large carnivore population recovery: Counting bears in Greece

Reliable population and density estimates are the cornerstone of effective conservation and management planning, as conservation priorities often arise in relation to population numbers. Despite increased public interest and costly conservation programs limited information on brown bear (Ursus arctos, Linnaeus, 1758) abundance and density in Greece exists. We carried out systematic non-invasive genetic sampling using hair traps on power poles, as part of a capture-mark-recapture study design in order to rigorously estimate abundance and density of the Pindos bear population in Greece. From 2007–2010 we identified 211 and estimated a mean of 182.3 individuals in four sampling areas; bear densities ranged from 10.0 to 54 bears/1000 km². These results indicate an important population recovery of this large carnivore in Greece in recent years; a conservative population estimate would place the population size in the entire country >450 individuals. Considering the results of the study and the increased negative interactions between humans and bears recorded currently in Greece, we suggest that systematic genetic monitoring using power poles should continue in order to collect the necessary information that will enable the definition of an effective Action Plan for the long-term conservation of this species.     

Education of nurses in genetics.

The need for education of nurses in genetics was articulated more than 25 years ago. This article reviews the knowledge of practicing nurses about genetics as well as the content of genetics in nursing curricula. Implementation of federal legislation that mandated increased availability of genetic services and genetics education provided support for the examination of genetics content in curricula for health professionals, including nurses, and for the development of model programs to expand this content. Recent efforts to begin to develop a pool of nurse faculty who are well prepared in genetics will be described, as well as programs to provide the necessary content through continuing-education efforts. These efforts are expected to substantially improve the capability of nurses to contribute more effectively in the delivery of genetic services.     

State legislative efforts to regulate use and potential misuse of genetic information.

The purpose of this study was to review existing and proposed legislation specifically intended to regulate the collection, use, and potential misuse of genetic data. The study encompasses laws relating to confidentiality, informed consent, discrimination, and related issues. It excludes from consideration legislation relating to medical records generally that may bear indirectly on genetic information. It also excludes both legislation relating to the regulation of DNA data collection for law enforcement purposes and state laws relating to the confidentiality of data collected by newborn-screening programs. While relatively few laws that explicitly regulate the treatment of genetic information have been enacted to date, a considerable amount of activity is currently underway in the nation's legislatures. Although most of the bills under consideration are not comprehensive in scope, they reflect a growing societal awareness that the uncontrolled dissemination and use of genetic data entails significant risks.     

DTC genetic testing companies fail transparency prescriptions

In 2007, the American Society of Human Genetics issued recommendations for what the new and largely self-regulating industry offering genetic tests directly to consumers should disclose to potential customers. Websites for every DTC company offering health-related genetic tests as identified by a public policy group were evaluated for compliance with those transparency recommendations. The results showed that only six of the 25 companies studied met even 70% of the standards and that overall, the industry complied with the disclosure standards just 44% of the time. Further, the study revealed that even when companies met the letter of the law, they often failed to disclose to consumers the shortcomings associated with the tests and thus promoted genetic determinism. By failing to meet the spirit of the ASHG transparency recommendations, the DTC genetic testing industry demonstrates disdain toward the ethical principle of informed consent.     

Prediction of adoption versus euthanasia among dogs and cats in a California animal shelter

The purpose of this retrospective cohort study was to investigate determinants of adoption of cats and dogs from a large municipal animal shelter. The subjects were 4,813 cats and 3,301 dogs impounded by the Sacramento County Department of Animal Care and Regulation and offered for adoption September 9, 1994 to May 26, 1995. The study constructed models predicting the conditional probability of adoption using logistic regression and a final multiple logistic regression model from variables found to be important predictors of adoption. Age, sex, coat color, and reason for relinquishment were major determinants of adoption in cats. Age, sex, coat color, reason for relinquishment, breed, purebred status, and injury status were major determinants of adoption in dogs. Shelter personnel could utilize this information to increase the adoption of frequently overlooked animals. Alternatively, shelters could use this to focus their resources on animals with characteristics the public prefers.     

The claim from adoption

In this article several justifications of what I call 'the claim from adoption' are examined. The claim from adoption is that, instead of expending resources on bringing new children into the world using reproductive technology and then caring for these children, we ought to devote these resources to the adoption and care of existing destitute children.
Arguments trading on the idea that resources should be directed to adoption instead of assisted reproduction because already existing people can benefit from such a use of resources whereas we cannot benefit individuals by bringing them into existence are rejected. It is then argued that a utilitarian argument proposed by Christian Munthe that supports the claim from adoption in some situations should be rejected because the support it offers does not extend to certain situations in which it seems morally obvious that resources should be expended on adoption rather than assisted reproduction. A version of the Priority View improves upon Munthe's utilitarianism by supporting the claim from adoption in the cases in which Munthe's argument failed. Some allegedly counterintuitive implications of the Priority View are then discussed, and it is concluded that the Priority View is more plausible than utilitarianism.
n a concluding section on policy issues it is argued that, even though the claim from adoption can be justified in a variety of situations, it does not follow that, in these situations, governments should direct resources away from assisted reproduction and towards adoption.     

Abstinence-only education and teen pregnancy rates: why we need comprehensive sex education in the U.S

The United States ranks first among developed nations in rates of both teenage pregnancy and sexually transmitted diseases. In an effort to reduce these rates, the U.S. government has funded abstinence-only sex education programs for more than a decade. However, a public controversy remains over whether this investment has been successful and whether these programs should be continued. Using the most recent national data (2005) from all U.S. states with information on sex education laws or policies (N = 48), we show that increasing emphasis on abstinence education is positively correlated with teenage pregnancy and birth rates. This trend remains significant after accounting for socioeconomic status, teen educational attainment, ethnic composition of the teen population, and availability of Medicaid waivers for family planning services in each state. These data show clearly that abstinence-only education as a state policy is ineffective in preventing teenage pregnancy and may actually be contributing to the high teenage pregnancy rates in the U.S. In alignment with the new evidence-based Teen Pregnancy Prevention Initiative and the Precaution Adoption Process Model advocated by the National Institutes of Health, we propose the integration of comprehensive sex and STD education into the biology curriculum in middle and high school science classes and a parallel social studies curriculum that addresses risk-aversion behaviors and planning for the future.     

EARTH to farmers: Extension and the adoption of environmental technologies in the humid tropics of Costa Rica

The diffusion of innovations model has been used by social scientists for decades to understand the adoption of new agricultural technologies, but its applicability to environmental as opposed to commercial technologies has been the source of much debate. The “classic” model's ability to account for the diffusion of environmental innovations is hampered by its social–psychological roots and voluntarist assumptions. A model more appropriate to the adoption of environmental technologies in a developing country setting should take into account institutional factors, including the mode of interaction between farmers and extension agencies. This paper examines patterns of adoption of a set of environmental farm technologies in the humid tropics of Costa Rica, paying particular attention to the role of a local agricultural engineering university's outreach activities. Our findings indicate that overall patterns of adoption remain low; that farm size is the only structural variable significantly related to adoption; and that of the various extension activities analyzed, farmer attendance at a university meeting or workshop is by far the strongest predictor.     

Cervical cytology quality assurance in Washington State.

The objectives of this study were to establish a profile of cervical cytology laboratories in Washington State, identify quality assurance problems amenable to correction through education or legislation, and describe differences between large and small cytology laboratories. All 43 Washington laboratories that perform cervical cytology were surveyed by mail during 1989. Completed surveys were returned by 37 (86%) of the laboratories. Nearly half (43%) of the respondents reported processing less than 10,000 Papanicolaou smears annually. Only one-third (35%) of the respondents reported participating in relevant proficiency programs. A proportion of smaller cytology laboratories were compensating their cytotechnologists on the basis of the number of slides read and allowing Papanicolaou smears to be read outside the confines of the laboratory. The results of this study suggest that cytotechnologists in some larger Washington laboratories have been exceeding work load limits recommended by professional associations. Recent legislation includes regulations that address cervical cytology quality assurance. However, continued efforts will need to be made to encourage voluntary adoption of quality control measures not addressed by this legislation.     

Genetic counseling for beta-thalassemia trait following health screening in a health maintenance organization: comparison of programmed and conventional counseling.

Providing adequate counseling of patients identified in genetic screening programs is a major responsibility and expense. Adults in a health maintenance organization, unselected for interest, were screened for beta-thalassemia trait as part of preventive health care. Counseling was provided by either a trained physician (conventional counseling) or by a videotape containing the same information followed by an opportunity to question a trained physician (programmed counseling). Immediately before and after counseling, knowledge of thalassemia, knowledge of genetics, and mood change were assessed by questionnaire. Comparable mood changes and similar learning about thalassemia and genetics occurred with both counseling methods. Thus, as judged by immediate effects on knowledge and mood, videotaped instruction can greatly reduce professional time required for genetic counseling and facilitate the incorporation of genetic screening into primary health care.     

Comparison of Adoption Agency Breed Identification and DNA Breed Identification of Dogs

Governmental and other agencies may require dog caregivers (owners) to provide breed identification of their dogs. This study compares breed identification by adoption agencies with identification by DNA analysis in 20 dogs of unknown parentage. Of the 20 dogs who had been adopted from 17 different locations, the study identified 16 dogs as having (or probably having) 1 or 2 specific breed(s) in their ancestry. DNA analysis of these dogs indicated that 25% (4/16) did in fact contain genetic evidence of an adoption agency's identified breed as one of the predominant breeds in a dog's ancestry. DNA analysis did not detect all specified breeds in 14 of these dogs. That is, 87.5% of the dogs identified by an adoption agency as having specific breeds in their ancestry did not have all of those breeds detected by DNA analysis. The discrepancies between opinions of adoption agencies and identification by DNA analysis suggest that it would be worthwhile to reevaluate the reliability of breed identification as well as the justification of current public and private policies pertaining to specific dog breeds.     

军队医院医疗风险管理的措施及意义

随着我国法治社会的发展及医疗体制的改革,医疗风险成为军队医院管理面临的难题和挑战。目前,我国现有的医疗法规不够完善,医务人员与患者的医疗风险防范意识不足,社会舆论导向性偏移等问题制约着我国医疗系统的发展。作为医疗卫生系事业的重要力量,军队医院要加强医疗风险管理,制定风险评估方法,完善风险管理体系以及加强风险教育,进一步提高医疗服务质量,从而有利维护军队医院在群众心中的信誉和形象。     

政策认知对农户低碳农业技术采纳决策的影响

农业碳排放已经成为我国温室气体排放的第二大来源,不仅给农业减排工作带来巨大压力,还严重影响我国粮食安全和农业可持续发展。当前我国低碳农业技术并没有得到大面积推广,这与农户对低碳农业政策的认知密切相关。因此,如何促进农户采纳以绿色、可持续为目标的低碳农业技术,成为实现农业碳减排的关键。本研究基于江汉平原704户农户的调研数据,运用熵值法和Heckman样本选择模型,从农户政策了解程度、政策参与程度、政策满意程度3个维度出发,构建了基于全过程视角的农户低碳政策认知变量,实证分析农户全过程政策认知对其低碳农业技术采纳行为的影响。结果表明: 农户低碳政策认知整体水平有待提高,农户的政策认知整体水平仅为1.89;农户对单项低风险、高效益的低碳农业生产技术采纳率较高,但对多项的低碳农业技术采纳程度偏低,平均采纳程度仅为1.62;农户政策认知对其低碳农业技术采纳与否、采纳程度均有显著性的正向影响。据此提出加大低碳农业技术政策宣传力度、完善低碳农业技术培训、提高专项补贴标准等政策建议。