bluuebunny/crossref_metadata_2025_split huggingface dataset:
THE PERSPECTIVES OF RESEARCHERS ON OBTAINING INFORMED CONSENT IN DEVELOPING COUNTRIES
Authors: NEWTON SAM K. , APPIAH‐POKU JOHN 
Published: August 2006

ABSTRACTBackground:  The doctrine of informed consent (IC) exists to protect individuals from exploitation or harm. This study into IC was carried out to investigate how different researchers perceived the process whereby researchers obtained consent. It also examined researchers’ perspectives on what constituted IC, and how different settings influenced the process.Methods:  The study recorded in‐depth interviews with 12 lecturers and five doctoral students, who had carried out research in developing countries, at a leading school of public health in the United Kingdom. A purposive, snowballing approach was used to identify interviewees.Results:  Although the concept and application of the doctrine of IC should have been the same, irrespective of where the research was carried out, the process of obtaining it had to be different. The setting had to be taken into consideration and the autonomy of the subject had to be respected at all times. In areas of high illiteracy, and where understanding of the subject was likely to be a problem, there was an added responsibility placed on the researcher to devise innovative ways of carrying out the study, taking into consideration the peculiarities of the environment.Conclusion:  The ethical issues for IC were the same, irrespective of where the research was conducted. However, because the backgrounds, setting, and knowledge of populations differed, there was the need to be similarly sensitive in obtaining consent. The problems of obtaining genuine IC were not limited to developing countries.
SHARING THE BENEFITS OF GENETIC RESOURCES: FROM BIODIVERSITY TO HUMAN GENETICS1
Authors: SCHROEDER DORIS , LASÉN‐DÍAZ CAROLINA 
Published: August 2006

ABSTRACTBenefit sharing aims to achieve an equitable exchange between the granting of access to a genetic resource and the provision of compensation. The Convention on Biological Diversity (CBD), adopted at the 1992 Earth Summit in Rio de Janeiro, is the only international legal instrument setting out obligations for sharing the benefits derived from the use of biodiversity. The CBD excludes human genetic resources from its scope, however, this article considers whether it should be expanded to include those resources, so as to enable research subjects to claim a share of the benefits to be negotiated on a case‐by‐case basis. Our conclusion on this question is: ‘No, the CBD should not be expanded to include human genetic resources.’ There are essential differences between human and non‐human genetic resources, and, in the context of research on humans, an essentially fair exchange model is already available between the health care industry and research subjects. Those who contribute to research should receive benefits in the form of accessible new health care products and services, suitable for local health needs and linked to economic prosperity (e.g. jobs). When this exchange model does not apply, as is often the case in developing countries, individually negotiated benefit sharing agreements between researchers and research subjects should not be used as ‘window dressing’. Instead, national governments should focus their finances on the best economic investment they could make; the investment in population health and health research as outlined by the World Health Organization’s Commission on Macroeconomics and Health; whilst international barriers to such spending need to be removed.
NORTH–SOUTH BENEFIT SHARING ARRANGEMENTS IN BIOPROSPECTING AND GENETIC RESEARCH: A CRITICAL ETHICAL AND LEGAL ANALYSIS
Authors: SCHÜKLENK UDO , KLEINSMIDT ANITA 
Published: August 2006

ABSTRACTMost pharmaceutical research carried out today is focused on the treatment and management of the lifestyle diseases of the developed world. Diseases that affect mainly poor people are neglected in research advancements in treatment because they cannot generate large financial returns on research and development costs. Benefit sharing arrangements for the use of indigenous resources and genetic research could only marginally address this gap in research and development in diseases that affect the poor. Benefit sharing as a strategy is conceptually problematic, even if one, as we do, agrees that impoverished indigenous communities should not be exploited and that they should be assisted in improving their living conditions. The accepted concept of intellectual property protection envisages clearly defined originators and owners of knowledge, whereas the concept of community membership is fluid and indigenous knowledge is, by its very nature, open, with the originator(s) lost in the mists of time. The delineation of ‘community’ presents serious conceptual and practical difficulties as few communities form discrete, easily discernable groups, and most have problematic leadership structures. Benefit sharing is no substitute for governments’ responsibility to uplift impoverished communities. Benefit sharing arrangements may be fraught with difficulties but considerations of respect and equity demand that prior informed consent and consultation around commercialisation of knowledge take place with the source community and their government.1
EXPLORING DISPARITIES BETWEEN GLOBAL HIV/AIDS FUNDING AND RECENT TSUNAMI RELIEF EFFORTS: AN ETHICAL ANALYSIS
Authors: CHRISTIE TIMOTHY , ASRAT GETNET A. , JIWANI BASHIR , MADDIX THOMAS , MONTANER JULIO S.G. 
Published: August 2006

ABSTRACTObjective:  To contrast relief efforts for the 26 December 2004 tsunami with current global HIV/AIDS relief efforts and analyse possible reasons for the disparity.Methods:  Literature review and ethical analysis.Results:  Just over 273,000 people died in the tsunami, resulting in relief efforts of more than US$10 bn, which is sufficient to achieve the United Nation’s long‐term recovery plan for South East Asia. In contrast, 14 times more people died from HIV/AIDS in 2004, with UNAIDS predicting a US$8 bn funding gap for HIV/AIDS in developing nations between now and 2007. This disparity raises two important ethical questions. First, what is it that motivates a more empathic response to the victims of the tsunami than to those affected by HIV/AIDS? Second, is there a morally relevant difference between the two tragedies that justifies the difference in the international response?The principle of justice requires that two cases similarly situated be treated similarly. For the difference in the international response to the tsunami and HIV/AIDS to be justified, the tragedies have to be shown to be dissimilar in some relevant respect. Are the tragedies of the tsunami disaster and the HIV/AIDS pandemic sufficiently different, in relevant respects, to justify the difference in scope of the response by the international community?Conclusion:  We detected no morally relevant distinction between the tsunami and the HIV/AIDS pandemic that justifies the disparity. Therefore, we must conclude that the international response to HIV/AIDS violates the fundamental principles of justice and fairness.
POPULATION AGING AND INTERNATIONAL DEVELOPMENT: ADDRESSING COMPETING CLAIMS OF DISTRIBUTIVE JUSTICE
Authors: ENGELMAN MICHAL , JOHNSON SUMMER 
Published: August 2006

ABSTRACTTo date, bioethics and health policy scholarship has given little consideration to questions of aging and intergenerational justice in the developing world. Demographic changes are precipitating rapid population aging in developing nations, however, and ethical issues regarding older people’s claim to scarce healthcare resources must be addressed. This paper posits that the traditional arguments about generational justice and age‐based rationing of healthcare resources, which were developed primarily in more industrialized nations, fail to adequately address the unique challenges facing older persons in developing nations. Existing philosophical approaches to age‐based resource allocation underemphasize the importance of older persons for developing countries and fail to adequately consider the rights and interests of older persons in these settings. Ultimately, the paper concludes that the most appropriate framework for thinking about generational justice in developing nations is a rights‐based approach that allows for the interests of all age groups, including the oldest, to be considered in the determination of health resource allocation.
ETHICAL AND REGULATORY ISSUES SURROUNDING AFRICAN TRADITIONAL MEDICINE IN THE CONTEXT OF HIV/AIDS
Authors: NYIKA ACEME 
Published: August 2006

ABSTRACTIt has been estimated that more than 80% of people in Africa use traditional medicine (TM). With the HIV/AIDS epidemic claiming many lives in Africa, the majority of people affected rely on TM mainly because it is relatively affordable and available to the poor populations who cannot afford orthodox medicine. Whereas orthodox medicine is practiced under stringent regulations and ethical guidelines emanating from The Nuremburg Code,1 African TM seems to be exempt from such scrutiny. Although recently there have been calls for TM to be incorporated into the health care system, less emphasis has been placed on ethical and regulatory issues.In this paper, an overview of the use of African TM in general, and for HIV/AIDS in particular, is given, followed by a look at: (i) the relative laxity in the application of ethical standards and regulatory requirements with regards to TM; (ii) the importance of research on TM in order to improve and demystify its therapeutic qualities; (iii) the need to tailor‐make intellectual property laws to protect traditional knowledge and biodiversity. A framework of partnerships involving traditional healers’ associations, scientists, policy makers, patients, community leaders, members of the communities, and funding organizations is suggested as a possible method to tackle these issues. It is hoped that this paper will stimulate objective and constructive debate that could enhance the protection of patients’ welfare.
GLOBAL BIOETHICS: UTOPIA OR REALITY?
Authors: HELLSTEN SIRKKU K. 
Published: August 2006

ABSTRACTThis article discusses what ‘global bioethics’ means today and what features make bioethical research ‘global’. The article provides a historical view of the development of the field of ‘bioethics’, from medical ethics to the wider study of bioethics in a global context. It critically examines the particular problems that ‘global bioethics’ research faces across cultural and political borders and suggests some solutions on how to move towards a more balanced and culturally less biased dialogue in the issues of bioethics. The main thesis is that we need to bring global and local aspects closer together, when looking for international guidelines, by paying more attention to particular cultures and local economic and social circumstances in reaching a shared understanding of the main values and principles of bioethics, and in building ‘biodemocracy’.
Hospice Enrollment and Evaluation of Its Causal Effect on Hospitalization of Dying Nursing Home Patients
Authors: Gozalo Pedro L. , Miller Susan C. 
Published: August 2006

Objective.To examine the patient, nursing home (NH), hospice provider, and local market factors associated with the selection of the Medicare hospice benefit by eligible NH residents, and evaluate the causal effect of hospice on end‐of‐life hospitalization rates.Data Sources/Study Setting.Secondary data for 1995–1997 for NH residents.Study Design.This retrospective cohort study includes NH residents in five states (Kansa, Maine, New York, Ohio, South Dakota) who died in the years 1995–1997. Medicare claims identified hospice enrollment and hospitalizations. Geocoding of NHs, hospice providers, and hospitals was used to identify local markets. The two outcome measures are hospice enrollment and hospitalization of NH residents in their last 30 days of life.Data Collection/Extraction Method.A file was constructed linking MDS assessments to Medicare claims and denominator files, NH provider files (OSCAR), hospice provider of service files, and the area resource file.Principal Findings.Twenty‐six percent of hospice and 44 percent of nonhospice residents were hospitalized in their last 30 days of life (odds ratio [OR] 0.45; 95 percent confidence interval [CI]: 0.42–0.48). Adjusting for confounders, hospice patients were less likely than nonhospice residents to be hospitalized (OR 0.47; 95 percent CI: 0.45–0.50). Adding inverse propensity score weighting, hospice patients were still less likely than nonhospice residents to be hospitalized (OR 0.56; 95 percent CI: 0.53–0.61).Conclusions.Hospice selection introduces some bias in the evaluation of the causal effect of hospice on end‐of‐life hospitalization rates. However, even after adjusting for selection bias, hospice does have a powerful effect in reducing end‐of‐life hospitalization rates.
Reflection on a patient’s airway management during a ward‐based resuscitation
Authors: Shepherd Carolyn 
Published: August 2006

Abstract Background: The bag‐valve‐mask (BVM) system is a common adjunct used during adult resuscitation to ventilate the lungs and deliver oxygen to patients in cardiopulmonary arrest. Gastric inflation, regurgitation and aspiration are well‐documented complications of BVM ventilation, which can have serious consequences for patients. Aim: The aim of this paper is to review the cause of gastric inflation, regurgitation and aspiration during BVM ventilation and to consider techniques that have been suggested to reduce these problems.Method: Using a reflective model, the author revisits an actual cardiac arrest, and within a structured framework considers the event itself, the context of the event and looks at ways in which practice could be improved in future.Results: It is clear from the evidence that a reduction in peak airway pressure can reduce the risk of gastric inflation, regurgitation and aspiration. A review of the available research strongly suggests that in expert hands, the most effective means of reducing peak airway pressure is by reducing tidal volume by using a smaller bag.Conclusion: Although the evidence, as presented, for a reduction in bag size is convincing, there appears to be a problem that less regular users do not appear to be able to produce effective tidal volumes when using a smaller bag. If a reduced bag size is standardized, further research using a diverse group of health care workers with the BVM is required before a clear policy can be achieved. It is likely that training and practice will be shown to be important for nursing staff expected to use the smaller BVM.
The effect of music listening on older adults undergoing cardiovascular surgery
Authors: Twiss Elizabeth , Seaver Jean , McCaffrey Ruth 
Published: August 2006

AbstractThe purpose of this study was to determine the effect of music listening on postoperative anxiety and intubation time in patients undergoing cardiovascular surgery. Coronary artery disease and valvular heart disease affect approximately 15 million Americans and 5 million persons in the UK annually, with the majority of these patients being older adults. The anxiety experienced before, during and after surgery increases cardiovascular workload, thereby prolonging recovery time. Music listening as a nursing intervention has shown an ability to reduce anxiety. The study used a randomized control trial design. Sixty adults older than 65 years were randomly assigned to the control and the experimental groups. The experimental group listened to music during and after surgery, while the control group received standard postoperative care. The Spielberger State Trait Anxiety Inventory was administered to both groups before surgery and 3 days postoperatively. The mean of the differences between scores was compared using analysis of variance. Differences in mean intubation time were measured in both groups. Older adults who listened to music had lower scores on the state anxiety test (F= 5·57, p = ·022) and had significantly fewer minutes of postoperative intubation (F = 5·45, p = ·031) after cardiovascular surgery. Older adults undergoing cardiovascular surgery who listen to music had less anxiety and reduced intubation time than those who did not.
Correcting arterial blood gases for temperature: (when) is it clinically significant?
Authors: Bisson Jamie , Younker Jackie 
Published: August 2006

AbstractInterpreting arterial blood gases (ABGs) is a common practice in intensive care units. The use of the temperature correction facility, however, is not standardized, and the effects of temperature correction on the ABG result may affect the overall management of the patient. The aim of this study was to discuss the significance of temperature correction. Current practice in the UK and Australia is discussed along with a review of physiological principles of oxygenation and acid‐base balance. The alpha‐stat and pH‐stat methods of blood gas analysis are presented, with arguments for and against using the temperature correction facility for blood gas analysis. The study concludes with recommendations for practice.
Critical care outreach 1: an exploration of fundamental philosophy and underpinning knowledge
Authors: Durham Lesley , Hancock Helen C 
Published: August 2006

AbstractCritical care outreach (Outreach) is central to the effective management of critically ill patients. Its recent, expedited and somewhat uncoordinated introduction has, however, resulted in a lack of understanding about the fundamental philosophical theories and sources of knowledge that underpin it. Furthermore, there is a lack of understanding of the context in which these are applied. It is important that we understand and are able to provide sound rationale and guidance for current and future Outreach practice, for the education of practitioners and in order to evaluate and show the impact of Outreach on patient care. The need for this is heightened in the context of current changes in roles and role boundaries, in which there are significant pressures and expectations from organizations for Outreach teams to demonstrate their effectiveness. The authors argue that the complex situations encountered and managed by Outreach are not amenable to traditional forms of measurement and that its impact on patient care is, therefore, not readily acknowledged by those external to the service. This study explores the philosophical underpinnings and types of knowledge inherent in the practice of Outreach. In doing so, it illuminates how they apply and contribute to the practice and impact of Outreach.
Critical care outreach 2: uncovering the underpinning philosophy and knowledge through collaborative reflection
Authors: Durham Lesley , Hancock Helen C 
Published: August 2006

AbstractCritical care outreach (Outreach) was introduced as part of a government strategy to address increasing demands on limited intensive care (level 3) and high‐dependency (level 2) resources. The discipline of Outreach developed rapidly and, as a result, the fundamental philosophical theories and sources of knowledge that underpin its practice remain, at least to some extent, unexplored, and their contribution to practice overlooked. It is important that we understand these philosophical theories and sources of knowledge so that we are able to provide sound rationale and guidance for practice and address the increasing pressure to demonstrate effectiveness. The authors argue that the complex situations encountered and managed by Outreach are not entirely amenable to traditional forms of measurement, and that its impact on patient care is, therefore, not readily acknowledged. In applying a model of collaborative reflection, this study analyses the management of a clinical case by a nurse consultant in Outreach. In doing so, it explores the realities of practice by deconstructing the complexity of a particular situation and highlights the variety of knowledge that contributes to effective Outreach practice.
Associations of Variations in Alcohol Dehydrogenase Genes With the Level of Response to Alcohol in Non‐Asians
Authors: Duranceaux Nicole C. E. , Schuckit Marc A. , Eng Mimy Y. , Robinson Shannon K. , Carr Lucinda G. , Wall Tamara L. 
Published: August 2006

Background: Risk and protective factors for alcohol use disorders (AUDs) are complex and reflect both environmental and genetic factors. Genetic components account for about 50% of the variation and influence several phenotypes, including the level of response (LR) to alcohol as well as alcohol‐metabolizing enzyme polymorphisms. Variations in the ADH1B and ADH1C genes may influence the LR to alcohol by increasing levels of acetaldehyde during alcohol metabolism, although most data on this question come from Asian populations.Methods: This study evaluated associations of ADH1B and ADH1C genotypes in a non‐Asian sample. Participants (N=117, 69.2% female) were 18‐ to 29‐year‐old men and women, primarily Caucasian (70.1%) and black (26.5%), recruited in San Diego, California. The Semi‐Structured Assessment for the Genetics of Alcoholism Interview was used to assess demographic, substance use, and psychiatric history information, and the Family History Assessment Module was used to determine first‐degree family history of alcohol dependence. An alcohol challenge paradigm was used to gather data on the LR to alcohol over 210 minutes.Results: Participants with the ADH1B*1/*2 genotype had a higher LR to alcohol early in the alcohol challenge (i.e., 30, 60, and 90 minutes after drinking) as measured by both alcohol‐related changes in subjective feelings of intoxication and body sway, even when controlling for sex and Russian/Eastern European ancestry. A similar trend was seen for ADH1C*1/*1 genotype, although the results were not significant.Conclusions: These findings suggest that studies searching for genes relating to the LR to alcohol as a vulnerability factor for AUDs should consider controlling for ADH1B genotype, as the ADH1B*2 allele could obscure the impact of other genetic polymorphisms.