Genetic testing,life insurance,and adverse selection.

Life insurance is a key element of the UK social structure in terms of family protection and house purchase; it thus needs to be viewed in this broad context, rather than solely as a commercial activity. Insurers have not so far actively requested genetic tests for life insurance, but have insisted on knowing of and being able to act on existing genetic test information. The main reason given for this has been to avoid serious adverse selection; however, this has never been adequately estimated. Review of the different major categories of Mendelian genetic disorders suggests that the scope for adverse selection is extremely limited and that insurers would lose little, and possibly gain more, by foregoing the disclosure and use of this information in relation to life insurance policies of ''normal'' size and nature. The likely future use in service of genetic tests based on susceptibility or population screening makes it especially important that the issue is rapidly resolved for Mendelian disorders; so far there is no sign that insurers are willing to achieve this.     

Survey of general practice audit in Leeds.

OBJECTIVE--To determine general practitioners'' attitudes to medical audit and to establish what initiatives are already being undertaken; to define future ideas for audit and perceived difficulties in implementing audit in primary care. DESIGN--Analysis of responses to a self administered postal questionnaire. SETTING--Urban conurbation with a population of about 750,000. PARTICIPANTS--386 general practitioners on the general medical list of Leeds Family Practitioner Committee. MAIN OUTCOME MEASURES--Extent of recording of practice activity data and outcome measures and clinical data, use of data, and audit performed; ideas for audit and perceived difficulties. RESULTS--317 doctors responded to the questionnaire (individual response rate 82%) from 121 practices (practice response rate 88%). In all, 206 doctors thought that audit could improve the quality of care; 292 collected practice activity data, though 143 of them did not use it. A total of 111 doctors recorded some outcome measures, though half of them did not use them. Varying proportions of doctors had registers, for various diseases (136 had at least one register), disease management policies (60 doctors), and prescribing policies. In all, 184 doctors met monthly with other members of the primary health care team. CONCLUSIONS--Much poorly focused data collection is taking place. Some doctors have experience in setting up basic information systems and practice policies, and some audit is being performed. The family health services authorities need to take seriously the perceived difficulties of time, organisation, and resources concerned with audit.     

基于生态系统服务和农户福祉的生态补偿效果评估研究进展

生态补偿是以经济手段为主调节相关者利益关系的制度安排,最终实现区域生态系统服务和居民福祉"双赢"。尽管我国在生态补偿效果评估方面已开展了大量的研究,但更多关注的是生态系统服务功能的提升,忽略了生态补偿对社区居民福祉的影响及其反馈关系,影响了生态补偿政策的成效和可持续性。围绕生态补偿效果评估中涉及到的主要内容和关键的科学问题,对相关研究进行了归纳总结,认为:生态补偿、农户福祉、生态系统服务三者之间的耦合关系是生态补偿效果评估研究的重要科学问题;生态系统服务、农户生计、成本效益是评估生态补偿效果的3个核心指标;综合自然、人文两个因素统一的生态补偿评估与调控模型与方法体系,是亟待研究探索的重要方向。     

Understanding physicians' response to AIDS.

Attempts to comprehend physicians'' extreme reaction to AIDS (acquired immune deficiency syndrome) have met with great difficulty since the disease brings into question traditional norms and assumptions. As the medical profession struggles to develop guidelines and policies to help it deal with this disease, it can draw on very little systematic research on the effect of AIDS on physicians'' attitudes and practices. We suggest a framework developed from the literature on physicians'' and society''s response to other disorders that would provide a basis for organizing the ever-increasing amount of information on physicians and AIDS and would guide systematic research aimed at understanding and predicting physicians'' participation in the prevention and management of AIDS. Within this framework we consider how characteristics of the disease, elements of the health care system and physicians'' attitudes interact to influence clinical and personal practices. AIDS had led to new delineations of physicians'' responsibility, modification of prevailing beliefs about physician autonomy and thus a redefinition of the role of the physician in North America.     

European influence on diversity policy frames: paradoxical outcomes of Lyon's membership of the Intercultural Cities programme

This paper examines the formulation of policy frames towards new minorities in France by analysing Lyon's membership of the European Commission's and Council of Europe's Intercultural Cities programme (ICP). Here, with culture accounting for 20% of Lyon's budget, emphasis is placed on the adoption of the Charte de Coopération Culturelle to use cultural institutions to implement difference-orientated policies. Critically, important issues emerge with this strategy. The effort to engage new minorities is hampered by significant apathy from cultural institutions in Lyon, and the limited geographical area of Lyon included in the ICP. Finally, institutions who engage with promoting interculturality co-opt existing organizations, with negative implications for the treatment of diversity in the city. This illustrates the problems with a European framework fostering a policy frame based on recognition for minorities in a context that has yet to fully embrace such policies at the national level.     

Visual and socio-cognitive information processing in primate brain evolution.

Social group size has been shown to correlate with neocortex size in primates. Here we use comparative analyses to show that social group size is independently correlated with the size of non-V1 neocortical areas, but not with other more proximate components of the visual system or with brain systems associated with emotional cueing (e.g. the amygdala). We argue that visual brain components serve as a social information ''input device'' for socio-visual stimuli such as facial expressions, bodily gestures and visual status markers, while the non-visual neocortex serves as a ''processing device'' whereby these social cues are encoded, interpreted and associated with stored information. However, the second appears to have greater overall importance because the size of the V1 visual area appears to reach an asymptotic size beyond which visual acuity and pattern recognition may not improve significantly. This is especially true of the great ape clade (including humans), that is known to use more sophisticated social cognitive strategies.     

Pigeon homing and magnetic fields: a response to Luschi et al. (1996)

This paper comments on an article ''Pigeon homing: evidence against reliance on magnetic information picked up en route at release sites'' by P. Luschi, C. del Seppia, E. Crosio and F. Papi, which appeared in this journal. It is pointed out that the particular effects which these authors show to be stress-induced artefacts are restricted to their specific strain of homing pigeons. The same effects could not be observed in pigeons from two other lofts: a difference in response that was shown to have a genetic base. In view of this, conclusions drawn from the results of Luschi et al. must be restricted to their own findings; they cannot be generalized to the other findings which indicate the use of magnetic outward journey information in young homing pigeons.     

PTC Tasting and dental caries

Abstract

In the past decade, significant policy and legal changes have occurred that affect sexually active minors, pregnant adolescents, and adolescents who have become parents. This paper examines U.S. governmental policies and laws relating to (1) the development and dissemination of sex‐related health services and information for male and female adolescents and (2) the formal teaching of sex education in the public schools. It is maintained that despite the progress that has been made during the 1970's, a need for sex‐related services and information to the adolescent population still remains. Much remains to be done to formulate more relevant, effective policies and programs for adolescent males and females.     

Introducing the Internet.

The benefits to medical practitioners of using the Internet are growing rapidly as the Internet becomes easier to use and ever more biomedical resources become available on line. The Internet is the largest computer network in the world; it is also a virtual community, larger than many nation states, with its own rules of behaviour or "netiquette." There are several types of Internet connection and various ways of acquiring a connection. Once connected, you can obtain, free of charge, programs that allow easy use of the Internet''s resources and help on how to use these resources; you can access many of these resources through the hypertext references in the on line version of this series (go to http:@www.bmj.com/bmj/ to reach the electronic version). You can then explore the various methods for accessing, manipulating, or disseminating data on the Internet, such as electronic mail, telnet, file transfer protocol, and the world wide web. Results from a search of the world wide web for information on the rare condition of Recklinghausen''s neurofibromatosis illustrate the breadth of medical information available on the Internet.     

构建促进保护地社区资源使用与保护目标协调的社会情境分析工具——武夷山国家公园试点区实践

结合"公共池塘资源"、"环境权利"和"社会-生态系统"意义认知理论,从话语分析入手研究社会-生态系统中,制度如何作用于社区行为而最终影响生态系统,并以提供政策建议为终点,形成一个针对保护地社区资源利用的社会情境分析工具。研究以武夷山国家公园体制试点区社区为对象,从社区主体认知和研究者外部观察的知识合作入手,首先分析社区资源禀赋和环境权利的实现。研究发现,影响资源权属和使用的关键制度包括宏观层面的土地政策,中观层面的保护地规划和管理,以及微观层面的乡规民约,凸显了法律与民间规范的共同作用。影响生态产品和服务获取以及福利转化等环境权利的关键因素是中观层面的正式制度,包括市场机制和信用体系,以及非正式制度,主要是长期形成并与时俱进的社区集体行动机制等。其次,分析影响社区权利可得性的协商机制。协商需要注意程序合法,重视社区环境自主权;在内容上尊重历史和传统,提供充分信息;在实施上有明确的成本-收益分析。这样才能推动社区认知与保护管理目标相一致,以制度变迁促进生态系统服务持续。研究表明,这一社会情境分析工具以国家公园体制试点为契机,可以帮助提出改善社区的资源禀赋和完善环境权利的专门政策,促进自然生态系统和社区福利双赢。     

Canadians pay for harsh economic policies with their health,physicians warn.

Canada''s fiscal policies are damaging the health of Canadians, two physicians told a conference that examined globalization''s impact on the country. Near-record unemployment levels and the recent recession have forced 41% of families in which the parents are 30 or younger to live below the poverty level; more than 21% of Canadian children are also considered to live in poverty. The impact tight fiscal policies have on health and well-being are enormous, say the dean of medicine at the University of Western Ontario and the chair of the Canadian Institute of Child Health.     

新疆区域水资源对产业生态系统与经济增长的动态关联——基于VAR模型

新疆正面临"五化同步"对水资源的需求不断增长与水资源开发利用过度的矛盾。水资源瓶颈制约已成为影响新疆经济可持续发展和长治久安的突出问题之一。运用VAR模型,通过ADF检验、脉冲响应函数和方差贡献度分解,对2000—2014年新疆耗水产业生态系统和经济增长的长期均衡关系进行实证分析。结果表明:(1)经济增长与总用水量、工业用水量和农业用水量之间均存在长期均衡关系;(2)经济发展对用水量产生负向冲击,工业用水量和农业用水量随着经济发展出现正向冲击效应。(3)新疆经济快速增长伴随着水资源的大力开发和过度利用。据此提出对策建议,通过实施严格的退地减水政策,明确用水总量控制和定额指标,加强跨流域调水工程建设,防止浪费等多途径维持新疆水资源可持续利用和耗水产业健康发展。     

Lessons from international experience in controlling pharmaceutical expenditure. III: Regulating industry.

This is the third of three papers that review international policies to control spending on drugs and to improve the efficiency of drug use. This paper reviews policies regulating the supply of drugs, particularly licensing and reimbursement controls, price and profit regulation. Price and profit controls contain few incentives for improving cost effective use of drugs, and focus on cost containment and profitability of domestic industry. Carefully monitored economic evaluation could lead to improvements in efficiency and benefits to patients and the health care system.     

Regional material flow accounts for China: Examining China's natural resource use at the provincial and national level

Over the last three decades, China has experienced the most dynamic economic development lifting living standards and resulting in fast‐growing use of natural resources. In the past, the focus has been on national MFA accounts which do not do justice to the second largest economy, home to 19% of the world population and having 30% of global material use. In this research, we calculate material extraction for China at the regional level during 1995–2015 using the most recent available statistical data and applying the most up‐to‐date international calculation methods. In particular, we combine a bottom‐up and top‐down approach for constructing the dataset of China's economically used Domestic Extraction (DEU) in an integrated way. This approach also improves the Chinese national material flow accounts and allows us to present a reliable database of DE of materials for China to date. Our new dataset provides the basis for calculating material footprints and environmental impacts of China's regions. The dataset enables us to evaluate regional resource efficiency trends in China. We find that during the past two decades, China's material use has grown strongly from 11.7 billion tonnes in 1995 to 35.4 billion tonnes in 2015. Material use has accelerated between 2000 and 2010 but slowed down between 2010 and 2015 reflecting the economic contraction caused by the Global Financial Crisis which reduced the global demand for China's manufacturing and a reorientation of China's economic policy settings toward quality of growth. Unsurprisingly, different regions play different roles in the supply chain of materials, achieving different economic performances resulting in very diverse material efficiency outcomes. This information is important to allow for a targeted policy approach to increase resource efficiency, reduce environmental impacts of resource use, and grow wellbeing in China with large positive implications for global sustainability. This study provides the basis for the development of relevant resource management policies for different regions in the future.     

Efforts for a Circular Economy in China: A Comprehensive Review of Policies

Circular economy concepts, practices, and policies are increasingly drawing attention as important means for the pursuit of sustainable development. This article uses a conceptual framework to catalogue and investigate policy efforts for the circular economy in China. Based on the framework, policy prototypes and specific examples are identified: resource‐oriented, production‐oriented, waste, and use‐oriented and life cycle policies. A comprehensive review of 280 related policies shows that China has a long history of resource‐oriented policies and implemented production‐oriented policies very quickly after the year 2000. China's policies toward the circular economy became more comprehensive through time, with a broad engagement of government agencies, an extensive and progressive coverage of recycling opportunities, production initiatives across multiple scales, and use of different policy instruments. The continuous progress has been driven by proactive state actors and their learning from the international society. The current policy framework, however, is concerned more with the means rather than the ends of the circular economy, and relies too much on direct subsidies and other financial incentives. Policy making can be improved by more explicit consideration of the whole production life cycle and use of market‐based policy design.     

Using information from asthma patients: a trial of information feedback in primary care.

OBJECTIVE--To test the effects of feedback of information about patients'' asthma to primary care teams. DESIGN--Patients'' reports of morbidity, use of health services, and drug use on questionnaire was given to primary care teams. Randomised controlled trial with general practices as the subject of the intervention was used to test effectiveness of supplying information. SETTING--Primary care in district health authority, London. SUBJECTS--23 general practices, each of which notified at least 20 asthmatic patients aged 15-60 years for each principal. Practices were randomly allocated to an invention group (receiving feedback of information on control of asthma) or a control group (no feedback). INTERVENTION--Information on cards inserted in patients'' medical records; booklet copies of information for team members; formal presentation to primary care teams; poster displays of data on patients in each practice. MAIN OUTCOME MEASURES--Type and frequency of asthma symptoms, use of health services, use of asthma drugs. RESULTS--Reported morbidity at entry to the study was substantial: 45% (818) patients reported breathlessness at least once a week. Less than half these patients were using inhaled steroids regularly. Intervention and control groups did not differ in practice or patient characteristics on entry to the study. In spite of the potential for improvement no differences were observed between the two practice groups at the end of the study--for example, breathlessness at least once a week in last six months was experienced by 36% in intervention group v 35% in control group (t = -0.27, P < 0.79); surgery attendance in last six months by 48% v 48% (t = -0.05, P < 0.96); regular use of inhaled steroids by 60% v 58% (t = 0.51, P < 0.62). CONCLUSION--Feedback to general practitioners of information about patients'' asthma does not on its own lead to change in the outcome of clinical care.     

Health,humanitarian relief,and survival in former Yugoslavia.

Since the World Health Organisation''s effort in former Yugoslavia started in July 1992 it has been concerned with the public health policies of survival. It has provided advice to the United Nations High Commission for refugees, helped the voluntary agencies coordinate their work, assessed health needs, and provided practical help in the field to all parties to the conflict. Three features of the Bosnia war have particularly deplorable effects on health: ethnic cleansing, deliberate attacks on hospitals, and systematic rape. The WHO''s response has included initiatives in nutrition, winter survival, and medical supplies. This experience shows that the WHO can have a useful role complementary to that of other agencies in situations where the basic elements for survival of the population are seriously compromised by war.     

Migrant deportability: Israel and Ireland as case studies

This article critiques policies of deportation and deportability – a technology emanating from three seemingly conflicting rationalities: states' obligations under international human rights regimes, capitalism's need to facilitate the movement of labour, and the need to reaffirm state sovereignty. After outlining the concept of deportability, we argue that although justified by state actors as an integral part of asylum and immigration policies, deportability epitomizes the paradox of immigration regimes at a point of crisis. We use Israel and Ireland as case studies to illustrate that migrant deportability circumvents human rights and domestic legislation that hinder the power of the state to deport unwanted migrants. Paradoxically, in both, policies that engender the deportability of asylum seekers are a response to their undeportability. Despite their differences, Israel and Ireland are unusual immigration destinations and quintessential diaspora nations, whose histories of dispersal configure Jewishness and Irishness in ethno-racially rigid yet spatially fluid terms, as illustrated by their citizenship regimes.     

When Domestic Environmental Policy Meets International Trade Policy: Venezuela's Challenge to the U.S. Gasoline Rule

The role of the World Trade Organization (WTO) in the setting and enforcement of international and domestic environmental policy continues to evolve. This paper reviews the first case that focused clearly on environmental issues that involved WTO mediation: the case of Venezuela's challenge of the legality of United States restrictions on the importation of gasoline based on requirements to reduce health risks under the Clean Air Act. In this case, the WTO deemed the U.S. Environmental Protection Agency's policy as a barrier to free trade and this has important implications for future policies. We explore the underlying issues of the decision and its implications for future cases that focus on environmental risks.