Objective Medical Data Research Articles

Mass hydrogen sulfide poisoning and the role of forensic medical examination in proving

Introduction. Using the example of practical observation, the article describes the features of mass hydrogen sulfide poisoning, as well as the role of the therapeutic and diagnostic process and forensic medical examination in proving it. 
 The aim of the study was to develop effective principles of a comprehensive forensic expert assessment of a case of mass hydrogen sulfide poisoning, as well as to highlight the leading aspects of the role of the therapeutic and diagnostic process in proving the harm to health caused by an environmental crime.
 Material and methods. The material of the study was a case of mass hydrogen sulfide poisoning of residents of the village of Samorodovo of the Orenburg region, which served as the basis for the introduction of an intermunicipal emergency regime on the territory of Orenburg and the Orenburg region. 35 conclusions of the forensic medical examination, 35 medical histories, 1 conclusion of the forensic environmental examination, 1 indictment and 1 sentence were subjected to retrospective analysis.
 Results. Based on the analysis of the considered case of mass poisoning, it can be concluded that to prove a number of environmental crimes, conducting a forensic environmental examination alone is not enough, since objective medical data on the state of health of the victims are also required to establish circumstances significant for the investigation. In other words, the information necessary for the investigation can be obtained only through the most complete clinical and laboratory-instrumental examination of all victims, followed by a forensic medical assessment of the data obtained.
 Limitations. The conducted research was carried out as part of an initiative research work on the analysis of environmental crimes committed on the territory of the Russian Federation in the period from 2016 to 2021. The analyzed documents were provided by the relevant regional divisions of the Investigative Committee of the Russian Federation by prior agreement and included only materials of criminal cases completed by the investigation.
 Conclusion. The results obtained in the framework of this study clearly demonstrate that in situations like the one described, the presence of even minor diagnostic manifestations of poisoning, and most importantly their objective fixation in medical documentation, allow us to obtain the information necessary to establish the objective truth in the case.

Trends in the Main Residency Match From 2007 to 2020.

Background The United States Medical Licensing Exam (USMLE)Step 1 was recently changed from a numerically scored grading system to a pass/fail grading system. Until late 2024, there will be no formal studies about the impact that the grading change will have on the match process. To thoroughly assess the impact that this change will have on the overall match process, it is important to look at what the trends in applicants' objective measures have been in the years before the change. We aim to systematically evaluate the rates of change and mean trend of objective metrics found in residency applications in the main residency match. Methods Objective medical student data of matched and unmatched applicants were queried from the National Matching Program's Charting Outcomes in the Match Reports for the 2007 to 2020 application cycles. Data were used to create linear regression analyses and statistical tests were performed to evaluate trends over time. Results For matched applicants, there were statistically significant positive trends for the mean number of contiguous ranks (m=0.33, p<0.01), having another non-doctoral graduate degree (m=0.67, p<0.01), membership to Alpha Omega Alpha(AOA) honor society (m=0.22, p<0.01), mean USMLE Step 1 score (m=1.01, p<0.01), mean USMLE Step 2 score (m=1.68, p<0.01), mean number of research experiences (m=0.12, p<0.01), and mean number of abstracts, presentations, and publications(m=0.34, p<0.01). Additionally, there was a statistically significant negative trend for the percentage who graduated from a top 40 National Institutes of Health-funded medical school (m=-0.41, p<0.01). For unmatched applicants, there were statistically significant positive trends for having another non-doctoral graduate degree (m=0.83, p<0.01), mean USMLE Step 1 score (m=1.26, p<0.01), mean USMLE Step 2 score (m=2.27, p<0.01), mean number of research experiences (m=0.13, p<0.01), and mean number of abstracts, presentations, and publications (m=0.33, p<0.01). Conclusion Our study shows that there have been statistically significant increases in almost all objective measures in the residency application. Recent changes to the abstracts, presentations, and publications on the Step 1 scoring system will force almost all residency programs to overhaul their application process and potentially increase reliance on Step 2, research, and other nonobjective factors. For students early in their medical education, emphasis on Step 2 and research will yield increased chances of matching into residency in the future.

Compassion at Work: Looking at the Heart of Organizations

As the world moves from one crisis to another, compassion in response to human suffering is an essential, yet often overlooked, aspect of life. Suffering is also pervasive in organizational life as work is an essential part of life. Whether the suffering is stemming from an employee’s life outside of work (e.g., financial problems), part of one’s job role (e.g., taking care of sick patients), or organizationally induced (e.g., abusive leadership), organizations harbor the suffering of its employees and its clients or consumers. Yet there are significant gaps in understanding the antecedents, consequences, and boundary conditions of expressing compassion at work. The objective of this symposium is to offer new methodological and theoretical directions to highlight areas of inquiry focusing on the expression of compassion at work. All four papers in the session employ novel conceptualizations, designs, and analyses (e.g., in the moment, interactional dyadic design, team-level analyses with objective medical error data, and experimental designs) and make new theoretical connections (e.g., using attribution theory, cognitive appraisal theory, process model of emotion regulation) that serve as a catalyst for new scholarship on workplace compassion. The Role of Appraisals and Values-Directed Action in the Compassion Responding Process Presenter: Shanta Dey; U. Of Sydney Presenter: Anya Madeleine Johnson; U. Of Sydney Presenter: Helena Nguyen; U. Of Sydney Presenter: Paul Atkins; Australian National U. Presenter: Felicia Huppert; U. of Cambridge Compassion at Work: Perceived Self-Concern vs. Other Orientation and the Attribution Impacts Presenter: Hongguo Wei; Robert Morris U. Presenter: Jason Kanov; Western Washington U. Presenter: Shaobing Li; Miami U. Ohio Compassion as a Regulatory Strategy for Navigating Challenging Workplace Relationships Presenter: Hooria Jazaieri; Leavey School of Business, Santa Clara U. Collective Compassion on Team Outcomes and Role of Collective Mindfulness and Meditative Practices Presenter: Helena Nguyen; U. Of Sydney Presenter: Karyn L. Wang; U. Of Sydney Presenter: Nickolas Yu; Sydney Local Health District Presenter: Greg Fairbrother; U. Of Sydney

북한 보건의료 체계의 한계와 남북 협력방안

The global COVID-19 pandemic took millions of lives away. Fortunately, the spread of the virus seems to be diminished; it is obvious that international society will be reorganized by the ideas of “health security” and “human security”. However, in the case of North Korea, it does not reveal objective and reliable medical data, so international society has difficulties figuring out its current status. North Korea had insisted that taking care of people’s health by the principle of medical service is the state’s responsibility. However, the official system collapsed during the economic crisis in the 1990s, and the North Korean people’s health index also plummeted. Besides, two Korea’s medical service capability is getting dichotomized, so an alternative is needed. The Kim Jong-un regime set the principle of “politics of affection” and emphasized “people first policy.” The hygiene and medical policy, which is closely linked to people’s life and health, is the core element of the “people first policy.” Therefore, it is the field (humanitarian aid) that North Korea most likely accepts under the current sanction status. Moreover, this project can be a breakthrough that can overcome the current stalemate. Therefore, it is essential to prepare realistic and systematic cooperative projects which can bring a positive response from North Korea. The health and medical cooperation may contribute to establishing a new inter-Korean cooperation paradigm which is practical and realistic.

Deaths in Immigration and Customs Enforcement (ICE) Detention, 2011–2018. Results of an Analysis of 55 Detainee Death Reviews

Research ObjectiveSince 2017, intensified deportation efforts against immigrants have increased the population in Immigration and Customs Enforcement (ICE) detention nationally. ICE assumes responsibility for the health and safety of individuals in their custody for the duration of detention, as mandated by their Performance‐Based National Detention Standards (PBNDS). Following the death of an individual in detention, the ICE Office of Detention Oversight produces Detainee Death Reviews (DDR). DDRs evaluate circumstances surrounding the death and determine whether PBNDS were violated. To gain a more comprehensive understanding of ways in which health systems factors may have contributed to deaths in ICE detention facilities, we systematically analyzed the text of 55 DDRs conducted between 2011 and 2018.Study DesignA total of 55 DDRs from 2011 to 2018 were obtained via a combination of the Official Department of Homeland Security ICE Freedom of Information Act website and from civil rights organizations. Data was extracted from each DDR using a standardized tool. Data extracted described the deceased's demographic information, immigration, criminal, and medical histories, objective medical data, and any PBNDS violations identified and acknowledged in each death report.Population StudiedIndividuals who died while in ICE detention.Principal FindingsThe research team successfully obtained DDRs for 55 (92%) of 69 reported deaths5–7 among individuals in ICE detention between 2011 and 2018. Individuals who died were predominantly male (86%); averaging 42.7 years of age at the time of death. The deceased had lived in the United States for a mean of 15.8 years prior to entering ICE detention and spent a median of 39 days (range 1–1865; mean 120) in ICE custody prior to death. Individuals who died had relatively low burdens of pre‐existing disease as illuminated by Charlson Comorbidity Index (CCI) scores of 0 (33%) or 1–2 (27%). Markedly abnormal vital signs were documented prior to 51% (28) of deaths, with 71% (20) of deaths preceded by abnormal vital signs during multiple encounters prior to death or hospital transfer. Most deaths (n = 47, 85%) were attributed to medical causes, while 8 (15%) were attributed to suicide. None of the individuals who committed suicide were on suicide watch at the time of death; though half had been at some time during their detention. Among 55 death summaries, a total of 86 counts of PBNDS deficiencies were noted across 7 categories. Overall, 43 (78%) of DDRs identified PBNDS deficiencies related to Medical Care, with a mean of 3.16 deficiencies related to Medical Care per case (Range 1–13).ConclusionsFindings suggest that substandard medical care occurring within ICE detention facilities may have contributed to or failed to prevent deaths of multiple individuals in ICE detention between 2011 and 2018. Additionally, the detention death review process found the majority of detention facilities had violated ICE's own medical standards repeatedly.Implications for Policy or PracticeThese results highlight the need for further independent investigations into medical and psychiatric care provided to individuals in ICE detention facilities, and greater mechanisms for external accountability.Primary Funding SourceHaas JR Foundation.

The effect of the scalp on the effectiveness of bicycle helmets' anti-rotational acceleration technologies

Objective Medical data has lead to the common understanding that bicycle helmets need to be improved to better protect against brain injuries resulting from rotational acceleration. Although many different technologies exist for reducing rotational acceleration during impacts, the lack of an official testing standard means that their evaluation is based on customized set-ups that may differ and not represent real accident conditions. Previously, the authors have shown that scalp tissue plays an important role during helmet testing by absorbing energy and creating a low friction interface between head and helmet, thus reducing rotational accelerations and velocities. However, no published study has yet examined the effectiveness of anti-rotational helmet technologies in the presence of a biofidelic scalp layer. The objective of this study is to address this gap. Methods Three different commercially available helmet models, each one equipped with a different technology, were tested in the presence of scalp tissue, in two different scenarios; with and without the technology present. The effectiveness of each of these technologies is already documented in other studies, but only in the absence of a biofidelic scalp layer. Tests were carried out using HIII headform with porcine scalp attached to the outmost layer. Motion tracking was used to compare the impact kinematics of each helmet model in both scenarios. Results Results showed that when a biofidelic scalp layer is present, there is no statistical difference between helmet models with and without the anti-rotational technology in terms of rotational acceleration, velocity, relative rotation, impact duration and injury risk. Conclusions Results suggest that the presence of the scalp can obscure the functionality of anti-rotational acceleration technologies. This could indicate that the effectiveness of technologies tested in previous studies, which have not tested anti-rotational acceleration technologies in the presence of a realistic scalp layer, may exaggerate the contribution of such technologies if compared with a more biofidelic set-up. The study supports the fact that headforms should be better designed by incorporating artificial skin layers that can better imitate scalp’s behavior and, in addition, provides insights for the design of technologies against rotational acceleration.

Compassion at Work: Looking at the Heart of Organizations

As the world moves from one crisis to another, compassion in response to human suffering is an essential, yet often overlooked, aspect of life. Suffering is also pervasive in organizational life as work is an essential part of life. Whether the suffering is stemming from an employee’s life outside of work (e.g., financial problems), part of one’s job role (e.g., taking care of sick patients), or organizationally induced (e.g., abusive leadership), organizations harbor the suffering of its employees and its clients or consumers. Yet there are significant gaps in understanding the antecedents, consequences, and boundary conditions of expressing compassion at work. The objective of this symposium is to offer new methodological and theoretical directions to highlight areas of inquiry focusing on the expression of compassion at work. All four papers in the session employ novel conceptualizations, designs, and analyses (e.g., in the moment, interactional dyadic design, team-level analyses with objective medical error data, and experimental designs) and make new theoretical connections (e.g., using attribution theory, cognitive appraisal theory, process model of emotion regulation) that serve as a catalyst for new scholarship on workplace compassion. The Role of Appraisals and Values-Directed Action in the Compassion Responding Process Presenter: Shanta Dey; U. Of Sydney Presenter: Anya Madeleine Johnson; U. Of Sydney Presenter: Helena Nguyen; U. Of Sydney Presenter: Paul Atkins; Australian National U. Presenter: Felicia Huppert; U. of Cambridge Compassion at Work: Perceived Self-Concern vs. Other Orientation and the Attribution Impacts Presenter: Jason Kanov; Western Washington U. Presenter: Hongguo Wei; U. of Central Oklahoma Presenter: Shaobing Li; Miami U. Ohio Compassion as a Regulatory Strategy for Coping with Difficult Colleagues Presenter: Hooria Jazaieri; Leavey School of Business, Santa Clara U. Collective Compassion on Team Outcomes and Roles of Collective Mindfulness and Meditative Practices Presenter: Helena Nguyen; U. Of Sydney Presenter: Karyn L. Wang; U. Of Sydney Presenter: Nickolas Yu; Sydney Local Health District Presenter: Greg Fairbrother; U. Of Sydney

Mother knows best … except when it comes to a diagnosis of preeclampsia: an exploratory study of the convergence between maternal recall of pregnancy-related outcomes and objective medical data

Objective This study details the importance of medical professionals accurately explaining a diagnosis of preeclampsia to their patients. Self-report data were compared to medical record data. We examined reporting and recall of infant data and maternal health during pregnancy. Methods Reliability between maternal self-report and medical record data was explored in 53 women whose infants had recently been discharged from the nearest Level Three Neonatal Intensive Care Unit. Data were collected in a neurodevelopmental follow-up clinic. Results Maternal reporting of gestational age and infant birth weight was highly accurate (r = 0.99, p < .0001 and r = 0.95, p < .0001, respectively), even when controlling for indicators of low socioeconomic status; however, maternal reporting of their own medical diagnoses was weak. There was a discrepancy between the medical records and maternal self-report of preeclampsia (k = 0.50). Conclusions for practice Medical professionals should reiterate to women at postpartum appointments whether or not they had preeclampsia.

Neuroimaging evidence of brain abnormalities in mastocytosis

Mastocytosis is a rare disease in which chronic symptoms are related to mast cell accumulation and activation. Patients can display depression–anxiety-like symptoms and cognitive impairment. The pathophysiology of these symptoms may be associated with tissular mast cell infiltration, mast cell mediator release or both. The objective of this study is to perform morphological or functional brain analyses in mastocytosis to identify brain changes associated with this mast cell disorder. We performed a prospective and monocentric comparative study to evaluate the link between subjective psycho-cognitive complaints, psychiatric evaluation and objective medical data using magnetic resonance imaging with morphological and perfusion sequences (arterial spin-labeled perfusion) in 39 patients with mastocytosis compared with 33 healthy controls. In the test cohort of 39 mastocytosis patients with psycho-cognitive complaints, we found that 49% of them had morphological brain abnormalities, mainly abnormal punctuated white matter abnormalities (WMA). WMA were equally frequent in cutaneous mastocytosis patients and indolent forms of systemic mastocytosis patients (42% and 41% of patients with WMA, respectively). Patients with WMA showed increased perfusion in the putamen compared with patients without WMA and with healthy controls. Putamen perfusion was also negatively correlated with depression subscores. This study demonstrates, for we believe the first time, a high prevalence of morphological and functional abnormalities in the brains of mastocytosis patients with neuropsychiatric complaints. Further studies are required to determine the mechanism underpinning this association and to ascertain its specificity.

Predictors of Posttraumatic Stress and Posttraumatic Growth in Childhood Cancer Survivors.

This longitudinal study aims to analyze predictors of posttraumatic stress symptoms (PTSS) and posttraumatic growth (PTG) among gender, age, objective factors of the disease and its treatment, family environment factors and negative emotionality. The sample consisted of 97 childhood cancer survivors (50 girls and 47 boys) aged 11–25 years who were in remission 1.7 to seven years at T1 and four to 12.5 years at T2. Survivors completed a set of questionnaires including the Benefit Finding Scale for Children and the University of California at Los Angeles Posttraumatic Stress Disorder Index. Regression and correlation analyses were performed. The relation between PTSS and PTG was not proven. A higher level of PTSS (T2) was associated with higher levels of negative emotionality (T1). A higher level of PTG (T2) was connected to a higher level of warmth in parenting (T1), female gender and older age at assessment. Medical variables such as the severity of late effects and the time from treatment completion did not play a significant role in the prediction of PTSS and PTG. PTG and PTSS are more influenced by factors of parenting and emotional well-being of childhood cancer survivors than by objective medical data.

Influence Of Organ Scores On Mortality In Chronic GVHD: Results From The Chronic GVHD Consortium

The global severity score (GS) was devised by experts during the 2005 NIH Consensus for chronic graft-versus-host disease (GVHD) to reflect the overall severity of chronic GVHD at any time point. According to this scale, overall involvement is categorized as mild, moderate or severe. Several studies demonstrated that the NIH GS was associated with subsequent mortality in patients with chronic GVHD. We used multivariate time-varying analysis accounting for longitudinal changes of severity in individual organs over time to try to develop a better global mortality score than the NIH GS. Methods Data were derived from the Chronic GVHD Consortium, a prospective, multicenter, longitudinal, observational study. A total of 2202 visits from 574 adult patients with systemically treated chronic GVHD through January 2013 were used for analysis. At follow-up visits every 3-6 months, clinicians reported standardized information including NIH organ severity scores. Objective medical data including laboratory and pulmonary function test results were abstracted through standardized chart review after each visit. Time-varying Cox models accounting for varied times of entry into the study and longitudinal changes in organ severity over time were used to correlate severity in individual sites with overall mortality. All models were adjusted for time after transplantation, study site and known chronic GVHD mortality risk factors. 424 randomly selected patients with 1602 visit ratings were used to develop a new global mortality score, and the remaining 150 patients with 600 visit ratings were used to validate the model. Risk stratification was compared between the final model and the NIH GS model. Results In the training phase, multivariate models showed that organ severity scores in skin, gastrointestinal tract, liver and lung were independently associated with overall mortality (Table 1), while scores in mouth, eyes, joint or fascia and genital tract were not. Mortality scores were assigned based on observed hazard ratios, and 3 risk groups were identified based on the total mortality score (Table 2). In the validation cohort (n=150), the intermediate (329 visit ratings, HR 3.7, p=0.05) and high-risk categories (89 visit ratings, HR 10.8, p=0.001) were associated with higher risk of overall mortality compared with the low-risk category (185 visit ratings). Using the NIH GS instead, the severe category (196 visit ratings, HR 3.1, p=0.01) was associated with higher risk of overall mortality compared with the mild or moderate category (22 plus 382 visit ratings). Although agreement in risk categories was slight (weighted kappa = 0.32), the two models did not differ statistically based on log likelihood ratios, showing that they performed equally well in identifying groups with different mortality risks. Conclusion The influence of organ scores on mortality differs according to individual sites, with the largest influence from lung followed by liver, skin and gastrointestinal tract. The model fitness did not differ statistically between the 2 models, suggesting that the NIH GS is an adequate model for risk stratification based on mortality in patients with chronic GVHD. Disclosures: No relevant conflicts of interest to declare.

Distress in patients with newly diagnosed brain tumours

Patients with intracranial tumours often suffer from clinically relevant psychological distress. However, levels of distress and contributing factors have not been systematically evaluated for the early course of the disease. Using the National Comprehensive Cancer Network's Distress Thermometer (DT), we evaluated the extent and sources of distress within a population of patients with intracranial neoplasms. One hundred and fifty-nine patients were included who underwent craniotomy for newly diagnosed intracranial tumours at our department. All patients completed the DT questionnaire, a single-item 11-point visual analogue scale measuring psychological distress. The appendant problem list (PL) consists of 40 items representing problems commonly experienced by cancer patients. Patients were asked to mark any experienced sources of distress. Percentage of patients suffering from relevant distress was 48.4% (cut-off ≥6). DT-scores were significantly associated with depression and anxiety as well as reported number of concerns. On average, patients reported 6.9 sources of cancer-related distress. Objective medical data (e.g. tumour stage) as well as sociodemographic data (e.g. gender, IQ) were not associated with psychological distress at this early phase. Prevalence of elevated distress is high shortly after primary neurosurgical treatment in patients with intracranial tumours and cannot be predicted by objective data. As a consequence, sources of distress can and should be routinely assessed and targeted in these individuals in this particular period. Further studies are needed to help to identify patients who are at risk of suffering from long-term emotional distress in order to enable targeted psychosocial intervention.

The MMPI-2 Symptom Validity Scale (FBS) Not Influenced by Medical Impairment: A Large Sleep Center Investigation

The Symptom Validity Scale (Minnesota Multiphasic Personality Inventory-2-FBS [MMPI-2-FBS]) is a standard MMPI-2 validity scale measuring overstatement of somatic distress and subjective disability. Some critics assert the MMPI-2-FBS misclassifies too many medically impaired persons as malingering symptoms. This study tests the assertion of malingering misclassification with a large sample of 345 medical inpatients undergoing sleep studies that standardly included MMPI-2 testing. The variables included standard MMPI-2 validity scales (Lie Scale [L], Infrequency Scale [F], K-Correction [K]; FBS), objective medical data (e.g., body mass index, pulse oximetry), and polysomnographic scores (e.g., apnea/hypopnea index). The results showed the FBS had no substantial or unique association with medical/sleep variables, produced false positive rates <20% (median = 9, range = 4-11), and male inpatients showed marginally higher failure rates than females. The MMPI-2-FBS appears to have acceptable specificity, because it did not misclassify as biased responders those medical patients with sleep problems, male or female, with primary gain only (reducing sickness). Medical impairment does not appear to be a major influence on deviant MMPI-2-FBS scores.

Perceptions of Disease State, Treatment Expectations, and Prognosis Among Patients with Myelodysplastic Syndromes.

Perceptions of Disease State, Treatment Expectations, and Prognosis Among Patients with Myelodysplastic Syndromes.

Nobody likes premies: the relative value of patients’ lives

The objective of this study was to examine whether patient selection or triage requires placing a relative value on human lives and whether the values placed on these lives are consistent with current ethical theories. An anonymous questionnaire was administered to groups of physicians and students in Montreal. It presented eight currently incompetent patients with potential neurological sequelae requiring emergency care. Predicted outcomes were explicitly described. Four patients had a predicted 50% survival and a 50% chance of impairment; they were a preterm and a term neonate, a 2-month-old and a 50-year-old. Two already disabled patients, a 7-year-old and an 80-year-old, had 50% predicted survival. A 14-year-old and a 35-year-old had 5% survival, but differing impairment. Respondents were asked if they would resuscitate and in what order they would resuscitate if all needed intervention simultaneously. Eighty-five percent response rate, n=524. The proportion stating they would always resuscitate was smallest for the 80-year-old (18% P<0.001 compared to other patients), then the preterm (35%, P<0.001), then the term and the 50-year-old (53 and 58%, P<0.01). The 2-month-old and the 7-year-old would be resuscitated most frequently (74 and 77%, P<0.01), followed by the patients with 5% survival (64 and 68%, P<0.001). The median order of triage was first the 2-month-old, followed by the 7-year-old, the 14-year-old, the term newborn, the 50-year-old, the 35-year-old, the premature newborn and the 80-year-old. Order of resuscitation was not closely related to the predicted survival, impairment or potential life years gained. Age appeared to have a strong influence, with children's lives being valued more than the adults'. This tendency was reversed for the newborn infants who were undervalued compared with older children, and most particularly for the premature. The value placed on the life of newborns, in particular the premature, is less than that expected by any objective medical data and was not consistent with any ethical theory that we tested.

Are Newborns Morally Different from Older Children?

Policies and position statements regarding decision-making for extremely premature babies exist in many countries and are often directive, focusing on parental choice and expected outcomes. These recommendations often state survival and handicap as reasons for optional intervention. The fact that such outcome statistics would not justify such approaches in other populations suggests that some other powerful factors are at work. The value of neonatal intensive care has been scrutinized far more than intensive care for older patients and suggests that neonatal care is held to a higher standard of justification. The relative value placed on the life of newborns, in particular the preterm, is less than expected by any objective medical data or any prevailing moral frameworks about the value of individual lives. Why do we feel less obligated to treat the premature baby? Do we put newborns in a special and lesser moral category? We explore this question from a legal and ethical perspective and offer several hypotheses pertaining to personhood, reproductive choices, "precious children," and probable evolutionary and anthropological factors.

Quality of life in long-term childhood cancer survivors and the relation of late effects and subjective well-being

The purpose of the present study was the assessment of health-related quality of life in adult long-term survivors of childhood cancer and the detection of possible treatment- and cancer-related late effects. The relation of objective medical data and subjective appraisal was also examined by combining the doctor's and the patient's views of the perceived health status. Seventy-eight young adults at the age of at least 18 years who had been diagnosed with cancer in the years 1975-1995 and were off therapy at least 5 years with no evidence of disease participated. Cancer survivors completed self-rating instruments [SF-36 Health Survey, Nottingham Health Profile (NHP), Beck's Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI) trait-anxiety scale]; the doctor assessed the patient's health by means of the Common Toxicity Criteria (CTCv2). The cancer survivors showed a mostly higher-than-average positive subjective rating of the various areas of quality of life. In comparison to the general population, the cancer survivors showed lower extents of depression. In 64.1% of the cancer survivors, medical rating and self-assessment regarding the perceived health status corresponded. Cancer survivors who felt severely impaired regarding their subjectively perceived well-being showed worse results in some dimensions of quality of life than persons who subjectively felt mildly impaired. The so-called "unfortunate" persons showed the worst assessment of quality of life and the highest extent of depression and anxiety. The results of the present study may be helpful in planning an appropriate multidisciplinary, long-term follow-up of childhood cancer survivors.

Posttraumatic stress symptoms after childhood cancer.

The posttraumatic stress model has recently been applied to understand the impact of life-threatening illness in adults and in children. From 1991 to 2001, 20 studies have reported posttraumatic stress symptoms and/or posttraumatic stress disorder (PTSD) in childhood cancer survivors and/or their parents. A review of these studies is proposed. Prevalence of posttraumatic stress symptoms and/or PTSD in children and in their parents has been estimated, across studies, between 2 and 20 % in survivors and between 10 and 30 % in their parents, even many years after the end of cancer treatment. Time elapsed since the diagnosis of cancer is usually not predictive of persistent symptoms. Subjective appraisal of life threat and illness beliefs are more important predictors than objective medical data. The presence of symptoms in survivors is not always related to that in their parents. The posttraumatic stress model renews the approach and understanding of psychopathological reactions of children with cancer, regarding trauma features and the role of parental responses. This model has important implications for individual and family clinical interventions. A reflection on the disruption of family functioning by childhood cancer (an example being bone marrow transplantation with a related donor) and on the recovery processes is needed.

Allostatic load and work conditions

Adverse work characteristics and poor social support have been associated with an increased risk for cardiovascular disease and other adverse health outcomes in otherwise apparently healthy adults. We undertook a cross-sectional study to evaluate the relationship between objective health status and work characteristics in industrial workers in Germany. Volunteers ( n=324) were recruited from a representative random sample ( n=537) of employees of an airplane manufacturing plant. Psychosocial work characteristics were assessed by the 52-item, 13-subscale salutogenetic subjective work analysis (SALSA) questionnaire, which assesses potentially salutogenic and pathogenic conditions. Factor analysis revealed three factors: decision latitude, job demands and social support. Biological health status was determined by the revised allostatic load score with 14 components: body-mass index, waist-to-hip ratio; systolic and diastolic blood pressure; plasma levels of C-reactive protein (CRP), tumor-necrosis factor- α, HDL, cholesterol, dehydroepiandrosterone sulfate; glycosylated hemoglobin; urinary cortisol, epinephrine, norepinephrine, and albumin. Score points were given for values in the high-risk quartile (maximum=14). General linear models revealed that older individuals and men had significantly higher allostatic load scores than younger participants or women. Of the SALSA factors, only job demands related significantly to allostatic load. The effect of demands was stronger in older individuals. Post-hoc analysis showed possible positive associations between high job demands and blood pressure or CRP, and between low social support and nocturnal excretion of cortisol or plasma levels of CRP. We conclude that this cross-sectional study on industrial employees found a weak association between a health summary score based on objective medical data and self-reported adverse work characteristics.

Stress post-traumatique et cancer chez l’enfant

The post-traumatic stress model has been recently applied for understanding the impact of life-threatening illness in adults and in children. Since 1991, 17 studies have found post-traumatic stress symptoms in childhood cancer patients and/or their parents. Symptoms prevalence in children and in parents is various according to studies, but it is possible to identify it in a subset of children (from 5 to 20 % of them) many years after the end of cancer treatment. Time since the cancer diagnosis is not usually a predictor of persistent symptoms. Subjective appraisal of life threat and illness beliefs are more important as predictors than objective medical data. The presence of symptoms in children is not always correlated to their presence in parents. We will show how post-traumatic stress model renews the approach and the understanding of psychopathological reactions of children with cancer with the role of parental responses, trauma features and also indirect transgenerational traumatic effects. This model has important implications for individual and familial clinical interventions. A reflection on interactions between trauma and somatization processes, on disruption of family functioning by childhood cancer (with bone marrow transplantation with related donor as an example) and on recovery processes is needed.