灾疫伦理：应用伦理研究的视野廓大与重心转移

当代人类进入21世纪以来,以自然灾害和流行性疾病为基本内容的灾难,就变成了日常生活内容,人类为了重建生活的安全感、生存的稳定性和存在的根基,寻求重建生境和家园的根本之道,由是,灾疫伦理学应运而生。灾疫伦理学的诞生及其走向未来的发展,必然肩负起为当代人类创建生态文明世界搭建一座认知桥梁,并为国家灾疫防治和灾疫后重建提供伦理化的实践行动方案。因而,灾疫伦理学的发展,必将为医学伦理学、生命伦理学、公共卫生伦理学、灾害伦理学、制度伦理学、法律伦理学、地球生态伦理学、生物伦理学、科技伦理学、企业伦理学、市场伦理学以及政治学、经济学、社会学、公共政策、管理科学、生态科学、环境科学、人类文化学的发展,提供一种生机勃勃的世界观、价值观和开放的视野与方法。     

Estimation of small area event rates and of the associated standard errors

We develop empirical best estimators for small area event rates based on the hierarchical Poisson model with log-normal mixing distribution, when the basic data consists of area level measurements. We derive an approximate expression to the mean squared error of the estimators and we provide a method for estimating this expression.     

Home care reimbursement for technology-dependent children: Its impact on parental distress

The distress of 52 parents with a technology-dependent child at home is measured using a standardized psychological inventory. Fifty-eight percent of these parents report enough symptoms to classify them as needing psychiatric intervention. Cost savings to third-party payers are accelerating the trend toward home care (rather than institutionalized care). Yet, these findings point to an underestimated cost to families in terms of parents' psychological well-being. One factor associated with less distress for mothers is having services reimbursed through the Medicaid Model Waiver Program, which provides a comprehensive plan for home care services. In contrast, services reimbursed by private third-party payers are more variable, placing greater financial strain and uncertainty on parents, which is associated with greater psychological distress. These results suggest the need for further study of the long-term impact on parents caring for technology-dependent children at home.Reprint requests to Barbara J. Leonard, R.N., Ph.D., Maternal and Child Health Major, Division of Human Development and Nutrition, School of Public Health, Box 197 UMHC, University of Minnesota, Minneapolis, MN 55455, (612) 625-3660.This study was supported in part by BRSG Number 2-S07-RR05448-25 awarded to the University of Minnesota, School of Public Health by the Biomedical Research Grant Program, Division of Research and Resources, National Institute of Health. Additional support was provided by the Department of Health and Human Services, State of Minnesota, Academic Computing Services and Systems, University of Minnesota and special project funds from the University of Minnesota School of Public Health.Barbara J. Leonard is an Assistant Professor and Chair of the Maternal and Child Health Major, Division of Human Development and Nutrition, School of Public Health, University of Minnesota, MN 55455. Her research interests include children with developmental disabilities, their parents, and siblings. She received her Ph.D. from the University of Minnesota.Janny Dwyer Brust is a Research Fellow in the Maternal and Child Health Major at the University of Minnesota. Her research interests include issues related to the care of chronically ill children and sexually abused children. She received her M.P.H. from the University of Minnesota.Joan Patterson is an Assistant Professor in the Maternal and Child Health Major and Associate Director of the Center for Children with Chronic Illness and Disability at the University of Minnesota. Her research interests include family adaptation to chronic illness and family stress and coping. She received her Ph.D. from the University of Minnesota.     

Bayesian inference for partially observed stochastic epidemics

The analysis of infectious disease data is usually complicated by the fact that real life epidemics are only partially observed. In particular, data concerning the process of infection are seldom available. Consequently, standard statistical techniques can become too complicated to implement effectively. In this paper Markov chain Monte Carlo methods are used to make inferences about the missing data as well as the unknown parameters of interest in a Bayesian framework. The methods are applied to real life data from disease outbreaks.     

Methods for eliciting aetiological clues from geographically clustered cases of disease, with application to leukaemia–lymphoma data

The nearest neighbour analysis method has been developed to determine whether a disease case may be regarded as being unusually close to other neighbouring cases of the same disease. Using this method, each disease case is classified as spatially 'clustered' or 'non-clustered'. The method is also used to provide a test for global clustering. 'Clusters' are constructed by amalgamating geographically neighbouring clustered cases into one contiguous 'cluster area'. This paper describes a method for studying differences between clustered and non-clustered cases, in terms of case 'attributes'. These attributes may be person related, such as age and sex, or area based, such as geographical isolation. The area-based variables are subject to geographical correlation. The comparison of clustered and non-clustered cases may reveal similarities or differences, which may, in turn, give clues to disease aetiology. A method for studying 'linkage' or similarities in attributes between cases that occur in the same clusters is also described. The methods are illustrated by application to incidence data for leukaemias and lymphomas.     

Testing change in the variance with epidemic alternatives

ABSTRACT

In this paper we consider the dyadic increments statistics (of type DI) based on independent not identically distributed or α-mixing random variables. We obtain their limit distributions under the null hypothesis and we present application for testing epidemic change in the variance in each case. Finally, numerical simulations are done to illustrate these results.     

日本“水俣病”的社会学研究

20世纪五六十年代，日本出现的“水俣病”等公害事件是环境恶化的主要标志。日本社会学界围绕“水俣病”事件及其引发的社会问题展开了学术研究，为事件的最终解决和环境改善发挥了重要作用。“水俣病”的社会学研究成果涉及弱势群体、社会结构、性别、社会和文化方面。近年来，一些学者通过对“水俣病”案例的反思，开始研究环境治理的动力机制。以促使政府改进环境治理的政策和措施。这是日本环境社会学发展到成熟阶段的一种表现。     

鲁迅对文化转型的探求与焦虑

本文对当前某些试图颠覆鲁迅的观点提出质疑，认为鲁迅对近代中国文化转型有独特的探求，也有不应忽视的焦虑，有时表现为传统批判中的偏激。应了解“偏激”的语境和历史理由，同时看到鲁迅还有对传统积极传承的另一面，国民性批判出于启蒙需要，绝非丑化国人，而是极可贵的民族自省，鲁迅对民主，平等，科学等流行观念均有前瞻性的独立思考，他提出应警惕过分崇奉物质带来的现代文明病，至今仍有启示意义。     

Unmet Home Care Service Needs of Rural Older Adults With Alzheimer's Disease: A Perspective of Informal Caregivers

This study assessed unmet service needs of rural older adults with Alzheimer's disease (AD) and identified factors that were related to these needs. Data were collected from 109 informal caregivers of AD patients. Over half of the patients experienced unmet service needs in 1 or more areas of activities of daily functioning. Informal caregiver burden and patient's gender and functional status were significantly related to patients' unmet service needs. Patients' use of formal services was marginally related to their unmet service needs. To better address patients' service needs, a comprehensive needs assessment should be conducted with both patients and their caregivers.     

EDITORIAL

Abstract

Alzheimers Disease is a form of progressive dementia associated with diffuse degeneration of the brain, and has become more common in Hong Kong as the population has aged. Individuals with Alzheimers Disease may experience symptoms such as memory loss, poor judgement, and incontinence. They generally lack selfcare ability and require considerable care as their illness progresses. As the traditional caring function of Chinese families has been eroded, individuals with the disease pose new challenges to their family caregivers. Research using an intensive interview method revealed that family caregivers of people with Alzheimers Disease suffer heavy psychosocial, financial, and physical burdens.