QUESTIONABLE COMPENSATION CLAIMS—Principles of Special Examination

In deciding a disputed claim of disability arising from occupation, physicians should ascertain whether a patient''s medical history has any bearing on the disability; they should attempt psychologic evaluation of the patient as it may reflect on the conditions they observe in physical examination; they should investigate symptoms complained of by the patient rather than accept them as prima facie evidence of disability; and they must have knowledge of the extent to which an injury can cause disability.It is urged that standards of physical ability and disability, as well as of other physical factors which may affect compensation claims, be established by organized research.     

Questionable compensation claims; principles of special examination

In deciding a disputed claim of disability arising from occupation, physicians should ascertain whether a patient's medical history has any bearing on the disability; they should attempt psychologic evaluation of the patient as it may reflect on the conditions they observe in physical examination; they should investigate symptoms complained of by the patient rather than accept them as prima facie evidence of disability; and they must have knowledge of the extent to which an injury can cause disability. It is urged that standards of physical ability and disability, as well as of other physical factors which may affect compensation claims, be established by organized research.     

Psychopathology in adolescent children of physicians.

The clinical records of 27 adolescent children of physicians who were treated in a psychiatric unit for adolescents were studied. Most of the children had been referred by their physician fathers for evaluation of conduct or mood disorders. These referrals were often the focus of family distress. There appeared to be no typical syndrome presented by physicians'' children. Those treating such patients should be especially sensitive to the possibility that parental denial will increase the patient''s resistance to therapy. Family therapy, an effective treatment for psychologic problems in adolescents, is often avoided by physicians.     

Die „Pathologische Realangst“ am Beispiel kardiovaskulärer Erkrankungen

Fears of patients suffering from chronic or life threatening diseases are frequently observed as adjustment reactions. Left untreated they may lead to an unfavorable course of the disease and a generally poor outcome. Difficulties in diagnostic standard procedures arise from the question whether the anxiety symptoms are an expression of physical illness, or an independent anxiety disorder of clinical significance. The concept of Pathological Realistic Fear derives from these considerations, and describes the fear of a real threat, particularly in patients with chronic disease, especially those suffering from life threatening illnesses. Distorted perceptions of the primary disease, caused by subjective ideas about disease mechanisms often lead to misguided assumptions and frequently result in a distorted interpretation of the physical symptoms of illness. As a result a fearful attention focus evolves, which triggers the ultimate development of a Pathological Realistic Fear as. The following article is a first attempt to elaborate on the concept of Pathological Realistic Fear as a pathology and to describe its clinical relevance. The concept contributes to a more precise diagnosis of anxiety and could stimulate an interdisciplinary patient care.     

Hypoprothrombinemic hemorrhage due to cholestyramine therapy.

Somatization is the tendency to experience and communicate psychologic distress in the form of somatic symptoms that the patient misinterprets as signifying serious physical illness. Patients with persistent somatization relentlessly seek medical diagnosis and treatment despite repeated reassurance that physical illness is either absent or insufficient to account for their symptoms and disability. Such abnormal illness behaviour leads to overuse of health care facilities and contributes to the high cost of health care. Somatization may occur transiently in response to stressful life events or it may be persistent and result in chronic partial or total disability. Diagnostic and therapeutic guidelines that may help physicians identify and manage such patients more effectively are discussed.     

The archeological determination of diet and natural resources, and the case for cooperation

There is no doubt that archeological and physical anthropological specialists have mutual problems, mutual interests and many mutual goals. There can be some doubt that they have attacked their problems and pushed toward their aims in as efficient a method as is scientifically possible. This efficiency could be developed and increased by the use of a planned approach to the gathering and study of skeletal and cultural data. An outline that should aid in a fruitful cooperation is suggested and several lines of field and laboratory approach are briefly described or discussed. It is not in the author's mind that he has a panacea which should cure every ill of communication or data processing but rather that he has offered a basic method that will, at the least, get more knowledge for the research dollar.     

BRAIN-DAMAGED CHILDREN—The Problem of Relations in the Family Group

Children with minimal brain damage show a characteristic pattern of behavior.Often there are no physical signs of abnormality, but the diagnosis can be made from the history, electroencephalographic tracings, psychologic tests and repeated observations.The behavior is a composite of the effects of the brain damage and the response of the child to his environment. The behavior of the brain-damaged child is frequently so frustrating to parents that attitudes of rejection, withdrawal or excessive punitive measures occur.In the present study, when drugs were given and the child''s behavior improved, the parents were better able to understand the needs of the child and create a better home environment in which there was less frustration and emotional pressure.     

rhBNP 在心力衰竭合并肾功能不全中的应用前景

心力衰竭同时合并肾功能不全或肾功能恶化,也称为心肾综合征,是临床心血管疾病的终末阶段,患者的死亡率及再住院率较高。重组人脑利钠肽是利用重组DNA技术制成的人脑利钠肽,与内源性脑利钠肽具有相同的药理作用:扩张血管,降低右房压力及肺毛细血管楔压,减轻心脏负荷,可以选择性扩张冠状动脉,增加冠状动脉的血流量;通过激活心肌细胞内c GMP依赖的蛋白激酶PKG-1,产生细胞应激性保护,降低心肌耗氧量;抑制RAAS及SNS,抑制反射性心动过速和血管收缩,无正性肌力作用和正性心率作用,抑制心脏重塑。重组人脑利钠肽作用于肾脏可以改善肾脏血流灌注,提高肾小球滤过率。虽然重组人脑利钠肽治疗心力衰竭取得了很好地效果,但其对心力衰竭患者肾功能的影响仍存在争议。重组人脑利钠肽具有多重活性且不良反应少,已被许多专家视为很有应用前景的新药。     

青海省大学生吸烟现状及其影响因素分析

目的：探讨青海省大学生吸烟现状及其影响因素分析。方法：选择青海省综合性大学学生1106 例作为调查对象,采用分层 整群随机抽样的调查方法,对入选者使用自制问卷进行调查。结果：不同性别、不同专业、不同年级及父母是否抽烟的学生吸烟率 比较,差异具有统计学意义（P＜0.05）。对影响大学生吸烟行为的相关影响因素进行单因素分析发现,性别、周围朋友吸烟、父母不 反对以及抑郁或伤心是造成大学生吸烟的相关危险因素（P＜0.05）。对以上相关危险因素进行多因素回归分析发现,四者均是造 成大学生吸烟的独立危险因素（P＜0.05）。结论：性别、父母态度、周围朋友吸烟状况及自身抑郁心理是造成青海省大学生吸烟行 为的主要危险因素,高校应针对不同大学生的自身现状制定相应的控烟措施,减少大学生吸烟率。     

Traditional Health Beliefs and Practices Among Lower Class Black Americans

The medical belief system of lower class black Americans reflects their social, political and economic marginality in the larger society. A moderate life-style is regarded as the basis for good health with special emphasis on protecting one''s body from cold, keeping it clean inside and out and maintaining a proper diet. Illnesses and other life events are classified as “natural” or “unnatural.” Natural illnesses result from the effects of cold, dirt and improper diet on the body causing changes in the blood. A number of beliefs about blood and its functions have important clinical implications for the treatment of hypertension and venereal disease and for family planning. Natural illnesses also result from divine punishment and serve as an instrument of social control. Unnatural illnesses are the result of witchcraft and reflect conflict in the social network. It is believed that physicians do not understand and cannot effectively treat such illnesses, but a variety of traditional healers offer help to the victims. Physicians must elicit such beliefs if they are to interact effectively and sensitively with black patients. Social change is required, however, to eliminate the feelings of powerlessness at the root of many of the health problems of poor black Americans.     

Severity of labour pain: influence of physical as well as psychologic variables.

The role of physical factors in the severity of labour pain has been neglected. The amount of cervical dilation, the frequency of the contractions, the woman''s height and usual weight before the pregnancy and other physical factors were therefore examined in relation to the intensity of labour pain in 141 primiparous and 99 multiparous women. In general, pain increased gradually during labour in both groups of women, though the severity of the pain was lower in the women who had received prepared childbirth training than in those who had not. Although the average pain scores in this study were high, there were striking individual differences, some women having extremely severe pain and others having almost none. The pain scores in both groups of women were significantly correlated with the ratios of the women''s usual weight to height. In the multiparous women the scores were also correlated with the woman''s usual weight and the baby''s weight but not with the woman''s weight gain during pregnancy. Thus, the results show that physical as well as psychologic factors contribute to the severity of labour pain.     

Commentary: assessing the effects of environmental pollution when people know that they have been exposed.

OBJECTIVE: To examine the effectiveness of routine clinic review in detecting relapse after treatment for Hodgkin''s disease. DESIGN: Review of hospital records. SETTING: Regional centre for cancer treatment and research. SUBJECTS: 210 patients with Hodgkin''s disease recruited to a chemotherapy trial protocol between 1984 and the end of 1990 who had achieved a complete or partial remission after treatment. MAIN OUTCOME MEASURES: The number of clinic visits made by patients over the period of observation, the number of relapses occurring during that time, and the route by which relapse was detected. RESULTS: The 210 patients generated 2512 outpatient reviews, and 37 relapses were detected. Thirty relapses (81%) were diagnosed in patients who described symptoms, which in 15 cases had resulted in an earlier appointment being arranged. In only four cases (11%; 95% confidence interval 4% to 25%) was relapse detected as a result of routine physical examination on investigation of a patient who did not have symptoms. CONCLUSIONS: Relapse of Hodgkin''s disease after treatment is usually detected as a result of the investigation of symptoms rather than by routine screening of asymptomatic patients. It is therefore proposed that the frequency of routine follow up visits should be reduced and greater emphasis placed on patient education. This should underline the importance of symptoms and encourage patients to arrange an earlier appointment if these develop.     

Seeing Minds in Others – Can Agents with Robotic Appearance Have Human-Like Preferences?

Ascribing mental states to non-human agents has been shown to increase their likeability and lead to better joint-task performance in human-robot interaction (HRI). However, it is currently unclear what physical features non-human agents need to possess in order to trigger mind attribution and whether different aspects of having a mind (e.g., feeling pain, being able to move) need different levels of human-likeness before they are readily ascribed to non-human agents. The current study addresses this issue by modeling how increasing the degree of human-like appearance (on a spectrum from mechanistic to humanoid to human) changes the likelihood by which mind is attributed towards non-human agents. We also test whether different internal states (e.g., being hungry, being alive) need different degrees of humanness before they are ascribed to non-human agents. The results suggest that the relationship between physical appearance and the degree to which mind is attributed to non-human agents is best described as a two-linear model with no change in mind attribution on the spectrum from mechanistic to humanoid robot, but a significant increase in mind attribution as soon as human features are included in the image. There seems to be a qualitative difference in the perception of mindful versus mindless agents given that increasing human-like appearance alone does not increase mind attribution until a certain threshold is reached, that is: agents need to be classified as having a mind first before the addition of more human-like features significantly increases the degree to which mind is attributed to that agent.     

THE DUTY TO DIE AND THE BURDENSOMENESS OF LIVING

This article addresses the question of whether the arguments for a duty to die given by John Hardwig, the most prominent philosophical advocate of such a duty, are sound. Hardwig believes that the duty to die is relatively widespread among those with burdensome illnesses, dependencies, or medical conditions. I argue that although there are rare circumstances in which individuals have a duty to die, the situations Hardwig describes are not among these. After reconstructing Hardwig's argument for such a duty, highlighting his central premise that ill, dependent, or aged individuals can impose unfair burdens upon others by continuing to live, I clarify precisely what Hardwig intends by his thesis that many of us have a duty to die. I then show that an important disanalogy exists between an uncontroversial example in which an individual has a duty to die and the situations in which Hardwig proposes individuals have a duty to die. More specifically, in situations where a duty to die exists, an individual's having a duty to die logically implies that those she burdens have a right to kill that individual in self‐defense. I then suggest that the burdens that ill, dependent, or aged individuals impose on their families, loved ones, or caregivers do not constitute the kind of threat that warrants the latter killing the former in self‐defense. Hence, the duty to die is much rarer than Hardwig supposes.