http://www.ncbi.nlm.nih.gov/pubmed/23817159

J Nerv Ment Dis. 2013 Jul;201(7):602-8. doi: 10.1097/NMD.0b013e3182982b1d.

Birth weight, domestic violence, coping, social support, and mental health of young Iranian mothers in tehran.

Abadi MN, Ghazinour M, Nygren L, Nojomi M, Richter J.

Source

*Department of Social Work, Umeå University, Umeå, Sweden; †Department of Community Medicine, Tehran University of Medical Sciences, Tehran, Iran; and ‡Centre of Child and Adolescent Mental Health, Oslo, Norway.

Abstract

The aim of this study was to investigate associations of birth weight with sociodemographic variables, domestic violence, ways of coping, social support, and general mental health of Iranian mothers. Six hundred mothers aged 15 to 29 years participated between June 2009 and November 2010. t-Test, analysis of variance, Spearman's correlation, and multiple regression were used. The results showed that there was no significant association between birth weight and general mental health of the mothers. Prenatal care visits, the mothers' history of having children with low birth weight (LBW), and weight gain during pregnancy were significantly associated with birth weight. The women who reported physical abuse during pregnancy had infants with lower birth weight. Satisfaction with social support and use of positive reappraisal were significantly associated with higher birth weight. In conclusion, a high quality of prenatal care and screening of pregnant women are recommended. Social environments good enough during pregnancy have protective effects against LBW.

http://www.ncbi.nlm.nih.gov/pubmed/23790570

Eur J Intern Med. 2013 Jun 20. pii: S0953-6205(13)00143-X. doi: 10.1016/j.ejim.2013.05.015. [Epub ahead of print]

Clinical indications for the albumin use: Still a controversial issue.

Caraceni P, Domenicali M, Tovoli A, Napoli L, Ricci CS, Tufoni M, Bernardi M.

Source

U.O. Semeiotica Medica, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy. Electronic address: paolo.caraceni@unibo.it.

Abstract

Human serum albumin (HSA) is the most abundant circulating protein and accounts for about 70% of the plasma colloid osmotic pressure. Beside the well known capacity to act as plasma-expander, HSA is provided of many other properties which are unrelated to the regulation of fluid compartmentalization, including binding and transport of many endogenous and exogenous substances, antioxidant function, immuno-modulation, anti-inflammatory activity, and endothelial stabilization. Treatment (hepatorenal syndrome) or prevention (renal failure after spontaneous bacterial peritonitis and post-paracentesis circulatory dysfunction after large volume paracentesis) of severe clinical complications in patients with cirrhosis and fluid resuscitation in critically ill patients, when crystalloids and non-proteic colloids are not effective or contra-indicated, represents the major evidence-based clinical indications for HSA administration. However, a large proportion of HSA prescription is inappropriate. Despite the existence of solid data against a real benefit, HSA is still given for nutritional interventions or for correcting hypoalbuminemia per se (without hypovolemia). Other clinical uses for HSA administration not supported by definitive scientific evidence are long-term treatment of ascites, nephrotic syndrome, pancreatitis, abdominal surgery, acute distress respiratory syndrome, cerebral ischemia, and enteric diseases. HSA prescription should be not uncritically restricted. Enforcement of clinical practice recommendations has been shown to allow a more liberal use for indications supported by strong scientific data and to avoid the futile administration in settings where there is a lack of clinical evidence of efficacy. As a result, a more appropriate HSA use can be achieved maintaining the health care expenditure under control.

Meningitis deathwatch: 61

http://www.tennessean.com/article/20130701/NEWS07/307010063/Three-more-die-fungal-meningitis-outbreak

Three more die in fungal meningitis outbreak

Written by

Tom Wilemon

The Tennessean

Three more people in the United States have died in the fungal meningitis outbreak, with two deaths reported from Florida and one from Michigan.

And another Tennessean has been diagnosed with the disease, according to the monthly report on the outbreak issued today by the U.S. Centers for Disease Control and Prevention.

The nationwide death toll from people sickened by contaminated steroid medicine made by the New England Compounding Center in Massachusetts has now reached 61.

Michigan now has more deaths from the multi-state outbreak than Tennessee, with 17 fatalities compared to 15 for Tennessee. It also has the most illnesses with 264 cases compared to 153 for Tennessee.

http://www.ncbi.nlm.nih.gov/pubmed/23797166

JAMA Intern Med. 2013 Jun 24;173(12):1155. doi: 10.1001/jamainternmed.2013.984.

The Demise of the "Evil Specialists": Class Warfare of Specialists vs Primary Care Physicians Fostered by Elimination of the Consultation Code.

Goldman JA.

The article “Unintended Consequences of Eliminating Medicare Payments for Consultations” provides interesting insight into the planning of those who designed this insulting plan.¹ The most cost-effective diagnosis is the correct diagnosis.² I am a solo rheumatologist and find this entire concoction an insult to those of us who provide in-depth care to people with complex musculoskeletal problems.² It is a program to encourage class warfare between the “evil specialists” and the downtrodden primary care physicians. This program was ill defined for those who are caring specialist physicians. Though none of the authors are practicing physicians, they should have also looked at this program through the eyes of the patients and those of us who care for them. Nothing has been calculated to measure the quality of care as a result of this coding change. I realize that this is beyond the scope of this article, but the real insult of this ill-conceived program needs to be carefully considered and not just through spending cost. You need a cost-benefit analysis. All that is offered is a cost analysis. The “complexity” section, which discussed more visits and higher codes and visit numbers, is not a substitute for quality care, and it could be that this program limited the patient's ability to access the sophisticated care of those who have the expertise—“the evil specialists.” This may have actually decreased the quality of health care of those who need specialists. It was a deliberate program to dumb down the care of patients and not designed in any way to improve their quality of care. It specifically endangers patients with complex medical problems and fosters medical class warfare. It is telling me that I as an evil specialist should not spend as much time evaluating patients. How does that improve their care? You need both specialists and primary care physicians to care for people. You do not need to vilify one group against the other. What I do now is still labeled by me as a consultation, I am just paid less! Medicare may be spending more but not to me.

From Imperial College-London: Why Even More Clinical Research Studies May Be False

http://www.ncbi.nlm.nih.gov/pubmed/23825524

PLoS One. 2013 Jun 25;8(6):e65323. Print 2013.

Why Even More Clinical Research Studies May Be False: Effect of Asymmetrical Handling of Clinically Unexpected Values.

Shun-Shin MJ, Francis DP.

Source

International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College, London, United Kingdom.

Abstract

BACKGROUND:

In medical practice, clinically unexpected measurements might be quite properly handled by the remeasurement, removal, or reclassification of patients. If these habits are not prevented during clinical research, how much of each is needed to sway an entire study?

METHODS AND RESULTS:

Believing there is a difference between groups, a well-intentioned clinician researcher addresses unexpected values. We tested how much removal, remeasurement, or reclassification of patients would be needed in most cases to turn an otherwise-neutral study positive. Remeasurement of 19 patients out of 200 per group was required to make most studies positive. Removal was more powerful: just 9 out of 200 was enough. Reclassification was most powerful, with 5 out of 200 enough. The larger the study, the smaller the proportion of patients needing to be manipulated to make the study positive: the percentages needed to be remeasured, removed, or reclassified fell from 45%, 20%, and 10% respectively for a 20 patient-per-group study, to 4%, 2%, and 1% for an 800 patient-per-group study. Dot-plots, but not bar-charts, make the perhaps-inadvertent manipulations visible. Detection is possible using statistical methods such as the Tadpole test.

CONCLUSIONS:

Behaviours necessary for clinical practice are destructive to clinical research. Even small amounts of selective remeasurement, removal, or reclassification can produce false positive results. Size matters: larger studies are proportionately more vulnerable. If observational studies permit selective unblinded enrolment, malleable classification, or selective remeasurement, then results are not credible. Clinical research is very vulnerable to "remeasurement, removal, and reclassification", the 3 evil R's.

"Saying something is evil is often a way of ending a conversation, stopping further analysis, letting ourselves be satisfied with thought-dulling mystery."

http://chronicle.com/article/Understanding-Evil/140025/

Understanding Evil

By James Dawes

"Evil" can be a sloppy word, an impediment to understanding. It means "bad" plus "unidentified metaphysical stuff." Saying something is evil is often a way of ending a conversation, stopping further analysis, letting ourselves be satisfied with thought-dulling mystery. "Evil" can also be a dangerous word. To say something is evil is to say it can't be understood; it can only be hated. We use the word "evil" when we need to prepare ourselves to do violence. Evil is the ultimate "other."

But to talk about these men, I need a word that insists there are acts that exceed our normal categories of wrong. I need a word that insists that, no matter how long you stare at it, no matter what light you put it in, there will always remain something beyond what you are able to see or say. These were evil men.

http://www.ncbi.nlm.nih.gov/pubmed/16754432

Am J Bioeth. 2006 May-Jun;6(3):W21-33.

The United States cover-up of Japanese wartime medical atrocities: complicity committed in the national interest and two proposals for contemporary action.

Nie JB.

Source

Dunedin School of Medicine, University of Otago.

Abstract

To monopolize the scientific data gained by Japanese physicians and researchers from vivisections and other barbarous experiments performed on living humans in biological warfare programs such as Unit 731, immediately after the war the United States (US) government secretly granted those involved immunity from war crimes prosecution, withdrew vital information from the International Military Tribunal for the Far East, and publicly denounced otherwise irrefutable evidence from other sources such as the Russian Khabarovsk trial. Acting in "the national interest" and for the security of the US, authorities in the US tramped justice and morality, and engaged in what the English common law tradition clearly defines as "complicity after the fact." To repair this historical injustice, the US government should issue an official apology and offer appropriate compensation for having covered up Japanese medical war crimes for six decades. To help prevent similar acts of aiding principal offender(s) in the future, international declarations or codes of human rights and medical ethics should include a clause banning any kind of complicity in any unethical medicine-whether before or after the fact-by any state or group for whatever reasons.

http://www.ncbi.nlm.nih.gov/pubmed/23813666

Am J Med Genet A. 2013 Jun 27. doi: 10.1002/ajmg.a.36063. [Epub ahead of print]

Dr. Peter Emil Becker and the Third Reich.

Hill F.

Source

The University of Toledo College of Medicine, Toledo, Ohio.

Abstract

In 1985 the physician after whom Becker Muscular Dystrophy is named, German neurologist Dr. Peter Emil Becker (1908-2000), published an autobiographical article in the American Journal of Medical Genetics in which he disavowed any association with the Nazi Party. A closer look at the evidence, however, suggests otherwise. Review of war records and related sources raise concern for Dr. Becker's affiliation with the Nazi Party and his contributions to its ideology.

http://www.ncbi.nlm.nih.gov/pubmed/23798958

Psychiatry Investig. 2013 Jun;10(2):115-20. doi: 10.4306/pi.2013.10.2.115. Epub 2013 May 30.

Comparison of brain activation in response to two dimensional and three dimensional on-line games.

Song WH, Han DH, Shim HJ.

Source

Department of Psychiatry, Chung-Ang University Hospital, Seoul, Republic of Korea.

Abstract

OBJECTIVE:

The present study assessed the difference in the brain activity of professional gamers (excessive players, but not addicts) in response to playing a 3-dimensional online game with an improved interface.

METHODS:

Twenty-three StarCraft I pro gamers and 16 StarCraft II pro gamers were recruited at Chung Ang University Medical Center. Brain activity in response to StarCraft I or II cues was assessed with a 1.5 Tesla Espree MRI scanner.

RESULTS:

StarCraft I pro gamers showed significantly greater activity in 4 clusters in response to the video game cues compared to StarCraft II pro gamers: right superior frontal gyrus, right medial frontal gyrus, right occipital lobe, and left medial frontal gyrus. StarCraft II pro gamers showed significantly greater activity in 3 clusters in response to the video game cues compared to StarCraft I pro gamers: left middle frontal gyrus, left temporal fusiform gyrus and left cerebellum.

DISCUSSION:

This is the first study to show the difference in brain activity between gamers playing either a 2-dimensional or 3-dimensional online game. Current brain imaging studies may confirm the pro gamers' experience when playing StarCraft II, a 3-dimensional game with an improved interface, relative to playing StarCraft I.

From Brown U: Social Determinants of Health and the Affordable Care Act

http://www.ncbi.nlm.nih.gov/pubmed/23819136

R I Med J (2013). 2013 Jul 1;96(7):20-22.

Social Determinants of Health and the Affordable Care Act.

Leong D, Roberts E.

Source

BA in Ethnic Studies, Political Science, and American Studies from Brown University.

Abstract

Healthy living is mainly seen as a product of good genetics and holistic healthcare in the United States, but a growing field of research is also attributing well-being to social determinants of health (SDH), which are the compounded effects that arise from the concentration or lack of social capital. The Affordable Care Act (ACA) was enacted to promote the overall health of the country and its clauses are calling to attention the health disparities that come from social inequalities, the main sources for SDH. The ACA acknowledges that SDH affects marginalized communities in different ways, and to mitigate their effects, it localizes funding in hopes of empowering individuals and communities, but there is no integrated, multi-prong system for addressing SDH.

http://www.archivesofpathology.org/doi/pdf/10.5858/arpa.2012-0358-OA

Kelly A. Khan, Debora A. Smith, and Michael J. Thrall (2013) Only a Small Fraction of High-Grade Cervical Lesions Are Discovered After an Interpretation of Atypical Squamous Cells of Undetermined Significance When Using Imager-Assisted, Liquid-Based Papanicolaou Tests and the Bethesda 2001 System. Archives of Pathology & Laboratory Medicine: July 2013, Vol. 137, No. 7, pp. 936-941.

ORIGINAL ARTICLES

Only a Small Fraction of High-Grade Cervical Lesions Are Discovered After an Interpretation of Atypical Squamous Cells of Undetermined Significance When Using Imager-Assisted, Liquid-Based Papanicolaou Tests and the Bethesda 2001 System

Kelly A. Khan , MD; Debora A. Smith , CT(ASCP); Michael J. Thrall , MD

From the Department of Pathology and Genomic Medicine, The Methodist Hospital and Weill Medical College of Cornell University, Houston, Texas.

Context.—Previous work has reported that most high-grade cervical neoplasia is seen in patients with preceding Papanicolaou test results of atypical squamous cells of undetermined significance. This information was based on conventional test results and the Bethesda 1991 reporting system and was determined before the current treatment guidelines.

Objective.—Our objective was to perform a retrospective review of all histologically confirmed, high-grade cervical neoplasia to determine the diagnosis of the preceding liquid-based Papanicolaou test.

Design.—A total of 189 histologically confirmed, high-grade cervical intraepithelial neoplasia (CIN) cases grade 2 and greater were identified for a 1-year period.

Results.—Of the 189 cases, 10 (5.3%) had a previous diagnosis of atypical squamous cells of undetermined significance; 55 (29.1%) had low-grade squamous intraepithelial lesions; 31 (16.4%) had low-grade squamous intraepithelial lesions, unable to rule out a high-grade squamous intraepithelial lesion; 21 (11.1%) had atypical squamous cells, unable to rule out a high-grade squamous intraepithelial lesion; 68 (36%) had high-grade squamous intraepithelial lesions; 1 (0.5%) had atypical glandular cells; 1 (0.5%) had adenocarcinoma in situ; and 2 (1%) had invasive carcinoma. Combined “low grade” Papanicolaou test results (atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesion) preceded 51 of 103 cases of CIN 2 (49.5%) and 14 of 103 cases (13.6%) of CIN 3/cancer, whereas “high grade” Papanicolaou test results (atypical squamous cells, unable to rule out a high-grade squamous intraepithelial lesion; low-grade squamous intraepithelial lesions, unable to rule out a high-grade squamous intraepithelial lesion; high-grade squamous intraepithelial lesions; atypical glandular cells; adenocarcinoma in situ; and invasive carcinoma) preceded 52 of 103 CIN 2 cases (50.5%) and 72 of 103 CIN 3/cancer cases (69.9%).

Conclusions.—Our data show that we can now more-reliably predict high-grade dysplasia on routine Papanicolaou tests. Only a small fraction of histologically confirmed CIN 2/3 cases are found following a Papanicolaou test diagnosis of atypical squamous cells of undetermined significance.

From U Oxford: Imaging pain: a potent means for investigating pain mechanisms in patients

http://www.ncbi.nlm.nih.gov/pubmed/23794647

Br J Anaesth. 2013 Jul;111(1):64-72. doi: 10.1093/bja/aet174.

Imaging pain: a potent means for investigating pain mechanisms in patients.

Lee MC, Tracey I.

Source

Nuffield Division of Anaesthetics and Centre for Functional MRI of the Brain (FMRIB), University of Oxford, Oxford , UK.

Abstract

Summary Chronic pain is a state of physical suffering strongly associated with feelings of anxiety, depression and despair. Disease pathophysiology, psychological state, and social milieu can influence chronic pain, but can be difficult to diagnose based solely on clinical presentation. Here, we review brain neuroimaging research that is shaping our understanding of pain mechanisms, and consider how such knowledge might lead to useful diagnostic tools for the management of persistent pain in individual patients.

The United States is “a land where for the most part things work”

http://bookforum.com/inprint/020_02/11679

Anglo Attitudes

How British visitors apprehend America through a glass, darkly

CARLIN ROMANO

"Eagleton occasionally balances the on- slaught with shout-outs to the slivers of America he likes—e.g., Emily Dickinson and “magnificent bacon.” But with so many flaws and delusions, does it matter that we’re also “straight, honest and plain-speaking,” full of “emotional frankness and directness,” preternaturally “enthusiastic,” and “suspicious of the aloof, clinical and impersonal”? That we rank “among the most inventive, imaginative people ever to have walked the earth”? That the United States “is a land where for the most part things work”?

Not much. Especially if such putatively positive traits are, ultimately, indications of rampant egotism and lack of dignity."

Health inequalities as a foundation for embodying knowledge within public health teaching

http://www.ncbi.nlm.nih.gov/pubmed/23809694

Int J Equity Health. 2013 Jun 28;12(1):46. [Epub ahead of print]

Health inequalities as a foundation for embodying knowledge within public health teaching: a qualitative study.

Mabhala MA.

Abstract

INTRODUCTION:

Recent UK health policies identified nurses as key contributors to the social justice agenda of reducing health inequalities, on the assumption that all nurses understand and wish to contribute to public health. Following this policy shift, public health content within pre-registration nursing curricula increased. However, public health nurse educators (PHNEs) had various backgrounds, and some had limited formal public health training, or involvement in or understanding of policy required to contribute effectively to it. Their knowledge of this subject, their understanding and interpretation of how it could be taught, was not fully understood.Methodology: This research aimed to understand how public health nurse educators' professional knowledge could be conceptualised and to develop a substantive theory of their knowledge of teaching public health, using a qualitative data analysis approach. Qualitative in-depth semi-structured interviews (n=26) were conducted with eleven university-based PHNEs.

RESULTS:

Integrating public health into all aspects of life was seen as central to the knowing and teaching of public health; this was conceptualised as 'embodying knowledge'. Participants identified the meaning of embodying knowledge for teaching public health as: (a) possessing a wider vision of health; (b) reflecting and learning from experience; and (c) engaging in appropriate pedagogical practices.

CONCLUSION:

The concept of public health can mean different things to different people. The variations of meaning ascribed to public health reflect the various backgrounds from which the public health workforce is drawn. The analysis indicates that PHNEs are embodying knowledge for teaching through critical pedagogy, which involves them engaging in transformative, interpretive and integrative processes to refashion public health concepts; this requires PHNEs who possess a vision of what to teach, know how to teach, and are able to learn from experience. Their vision of public health is influenced by social justice principles in that health inequalities, socioeconomic determinants of health, epidemiology, and policy and politics are seen as essential areas of the public health curriculum. They believe in forms of teaching that achieve social transformation at individual, behavioural and societal levels, while also enabling learners to recognise their capacity to effect change.

http://www.ncbi.nlm.nih.gov/pubmed/23801370

Integr Psychol Behav Sci. 2013 Jun 26. [Epub ahead of print]

Stripping the Boss: The Powerful Role of Humor in the Egyptian Revolution 2011.

Helmy MM, Frerichs S.

Source

Department of Biosciences, University of Helsinki, 00014, Helsinki, Finland, mohamed.helmy@helsinki.fi.

Abstract

The Egyptian Revolution 2011 has shaken the Arab world and stirred up Middle-East politics. Moreover, it caused a rush in political science and the neighboring disciplines, which had not predicted an event like this and now have troubles explaining it. While many things can be learned from the popular uprising, and from the limitations of previous scholarship, our focus will be on a moral resource, which has occasionally been noticed, but not sufficiently explored: the role of humor in keeping up the spirit of the Revolution. For 18 days, protestors persevered at Liberation Square in Central Cairo, the epicenter of resistance; at times a few dozens, at times hundreds of thousands. What they did was to fight the terror of the regime, which reached absurd peaks during those days, with humor-successfully. We offer a social-functionalist account of the uprising, which includes behavioral as well as cultural levels of analysis, and illuminates how humorous means helped to achieve deadly serious goals. By reconstructing how Egyptians laughed themselves into democracy, we outline a social psychology of resistance, which uses humor both as a sword and a shield.

Do the solutions to patient safety and healthcare quality problems lie with front-line ownership?

http://www.ncbi.nlm.nih.gov/pubmed/23803352

Healthc Pap. 2013;13(1):36-41.

FLO: The Solution to Knowing but Not Doing.

Gordon S.

Source

Journalist and Editor, The Culture and Politics of Healthcare Work Series, Cornell University Press.

Abstract

Dealing with the failure of many patient safety initiatives to positively impact patient safety is one of the most daunting issues healthcare systems now face. The concept of front-line ownership (FLO) and the research documenting the success of this approach is thus critical to all involved in the effort to make healthcare safer for patients. Focusing on why it is so important to involve front-line workers at every level in designing, implementing and evaluating patient safety initiatives is the subject of this commentary and, in the author's view, the only way to move from theory to practice, and from exhortation to the kinds of changes in behaviour and attitudes upon which patient safety depends.

From University College-London: Commercial conspiracy theories

http://www.ncbi.nlm.nih.gov/pubmed/23818886

Front Psychol. 2013 Jun 27;4:379. doi: 10.3389/fpsyg.2013.00379. Print 2013.

Commercial conspiracy theories: a pilot study.

Furnham A.

Source

Research Department of Clinical, Educational, and Health Psychology, University College London London, UK.

Abstract

There are many ways to categorise conspiracy theories. In the present study, we examined individual and demographic predictors of beliefs in commercial conspiracy theories among a British sample of over 300 women and men. Results showed many people were cynical and sceptical with regard to advertising tricks, as well as the tactics of organisations like banks and alcohol, drug and tobacco companies. Beliefs sorted into four identifiable clusters, labelled sneakiness, manipulative, change-the-rules and suppression/prevention. The high alpha for the overall scale suggested general beliefs in commercial conspiracy. Regressions suggested that those people who were less religious, more left-wing, more pessimistic, less (self-defined as) wealthy, less Neurotic and less Open-to-Experience believed there was more commercial conspiracy. Overall the individual difference variables explained relatively little of the variance in these beliefs. The implications of these findings for the literature on conspiracy theories are discussed. Limitations of the study are also discussed.

From U Michigan-Ann Arbor: Abortion politics and the production of knowledge

http://www.ncbi.nlm.nih.gov/pubmed/23815965

Contraception. 2013 May 30. pii: S0010-7824(13)00296-5. doi: 10.1016/j.contraception.2013.05.013. [Epub ahead of print]

Abortion politics and the production of knowledge.

Harris LH.

Source

Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI 48109, USA; Department of Women's Studies, University of Michigan, Ann Arbor, MI 48109, USA; Medical School, University of Michigan, Ann Arbor, MI 48109, USA; Program in Sexual Rights and Reproductive Justice, University of Michigan, Ann Arbor, MI 48109, USA; Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI 48109, USA. Electronic address: lhharris@med.umich.edu.

Abstract

It is common to think of scientific research and the knowledge it generates as neutral and value free. Indeed, the scientific method is designed to produce "objective" data. However, there are always values built into science, as historians of science and technology have shown over and over. The relevant question is not how to rid science of values but, instead, to ask which values and whose values belong? Currently, antiabortion values consistently determine US research policy. Abortion research is declared illegitimate in covert and overt ways, at the level of individual researchers and research policy broadly. Most importantly, federal policy impedes conduct of both basic and clinical research in abortion. However, it is not just research in abortion that is deemed "illegitimate;" research in infertility and in vitro fertilization is as well. Federal funding of any reproductive health research agenda that would pose more than minimal risk to a fetus or embryo is banned. This leaves unanswered scientific questions about abortion, infertility, miscarriage and contraception among other areas. Since moral ground is occupied not just by abortion opponents but also by people who support abortion rights, there is at the very least a competing moral claim to consider changing federal research funding policy. Women and families deserve access to knowledge across the spectrum of reproductive health issues, whether they seek to end or start a pregnancy. Thus, research funding is an issue of reproductive justice.

Problematic: MDs goal is to treat and cure; intrusions by MDs or govt not proven cost effective; liberty-limiting and nannystatism-promoting; already well-publicized

http://www.ncbi.nlm.nih.gov/pubmed/23821092

JAMA. 2013 Jul 3;310(1):85-90.

The Paradox of Disease Prevention: Celebrated in Principle, Resisted in Practice.

Fineberg HV.

Source

Institute of Medicine, Washington, DC.

Abstract

Prevention of disease is often difficult to put into practice. Among the obstacles: the success of prevention is invisible, lacks drama, often requires persistent behavior change, and may be long delayed; statistical lives have little emotional effect, and benefits often do not accrue to the payer; avoidable harm is accepted as normal, preventive advice may be inconsistent, and bias against errors of commission may deter action; prevention is expected to produce a net financial return, whereas treatment is expected only to be worth its cost; and commercial interests as well as personal, religious, or cultural beliefs may conflict with disease prevention. Six strategies can help overcome these obstacles: (1) Pay for preventive services. (2) Make prevention financially rewarding for individuals and families. (3) Involve employers to promote health in the workplace and provide incentives to employees to maintain healthy practices. (4) Reengineer products and systems to make prevention simpler, lower in cost, and less dependent on individual action. (5) Use policy to reinforce choices that favor prevention. (6) Use multiple media channels to educate, elicit health-promoting behavior, and strengthen healthy habits. Prevention of disease will succeed over time insofar as it can be embedded in a culture of health.

Smoking behaviours and cessation services among male physicians in China

http://www.ncbi.nlm.nih.gov/pubmed/23821489

Tob Control. 2013 Jul 2. [Epub ahead of print]

Smoking behaviours and cessation services among male physicians in China: evidence from a structural equation model.

Huang C, Guo C, Yu S, Feng Y, Song J, Erikson M, Redmon P, Koplan J.

Source

Department of Global Health, George Washington University, , Washington, District of Columbia, USA.

Abstract

OBJECTIVE:

To investigate smoking prevalence and cessation services provided by male physicians in hospitals in three Chinese cities.

METHODS:

Data were collected from a survey of male physicians employed at 33 hospitals in Changsha, Qingdao and Wuxi City (n=720). Exploratory factor analysis was performed to identify latent variables, and confirmatory structural equation modelling analysis was performed to test the relationships between predictor variables and smoking in male physicians, and their provision of cessation services.

RESULTS:

Of the sampled male physicians, 25.7% were current smokers, and 54.0% provided cessation services by counselling (18.8%), distributing self-help materials (17.1%), and providing traditional remedies or medication (18.2%). Factors that predicted smoking included peer smoking (OR 1.14 95% CI 1.03 to 1.26) and uncommon knowledge (OR 0.94 95% CI 0.89 to 0.99), a variable measuring awareness of the association of smoking with stroke, heart attack, premature ageing and impotence in male adults as well as the role of passive smoking in heart attack. Factors that predicted whether physicians provided smoking cessation services included peer smoking (OR 0.82 95% CI 0.76 to 0.89), physicians' own smoking (OR 0.87 95% CI 0.81 to 0.93), training in cessation (OR 1.36 95% CI 1.27 to 1.45) and access to smoking cessation resources (OR 1.69 95% CI 1.58 to 1.82).

CONCLUSIONS:

The smoke-free policy is not strictly implemented at healthcare facilities, and smoking remains a public health problem among male physicians. A holistic approach, including a stricter implementation of the smoke-free policy, comprehensive education on the hazards of smoking, training in standard smoking-cessation techniques and provision of cessation resources, is needed to curb the smoking epidemic among male physicians and to promote smoking cessation services in China.

Physicians giving up? "lower distress level may also be due to professional and ethical resignation"

http://www.ncbi.nlm.nih.gov/pubmed/23817260

Tidsskr Nor Laegeforen. 2013 Jun 25;133(12/13):1310-1314.

Moral distress and professional freedom of speech among doctors.

[Article in English, Norwegian]

Førde R, Aasland OG.

Abstract

BACKGROUND Previous studies indicate that Norwegian doctors experience distress in their encounter with differing and partly contradictory ideals, such as the obligation to criticise unethical and inappropriate practices. The objective of this study was to investigate the perception of moral distress and professional freedom of speech among Norwegian doctors as of today, as well as identify changes that have occurred since the previous study undertaken in 2004.

MATERIAL AND METHODS A total of 1 522 economically active doctors received a questionnaire listing various statements describing the perception of moral distress and professional freedom of speech. The responses were compared to responses to the 2004 study.

RESULTS Altogether 67 % of the doctors responded to the questionnaire. The proportion who reported «fairly strong» or «strong» moral distress varied from 24 % to 70 % among the different statements. On the whole, the «rank and file» hospital doctors reported the highest degree of moral distress. Nevertheless, a decrease in the scores for moral distress could be observed from 2004 to 2010. During the same period, the perception of professional freedom of speech increased slightly.

INTERPRETATION A reduced level of distress associated with ethical conflicts in working life may be due to improved methods for handling distressing situations, or because the consequences of the health services reorganisations are perceived as less threatening now than in 2004, immediately after the introduction of the hospital reform. However, the perceived lower distress level may also be due to professional and ethical resignation. These findings should be followed up by a qualitative study.

http://www.ncbi.nlm.nih.gov/pubmed/23815042

Yale J Health Policy Law Ethics. 2013 Winter;13(1):135-97.

Innovation incentives or corrupt conflicts of interest? Moving beyond Jekyll and Hyde in regulating biomedical academic-industry relationships.

Taylor PL.

Source

Harvard Medical School, USA.

Abstract

The most contentious, unresolved issue in biomedicine in the last twenty-five years has been how to best address compensated partnerships between academic researchers and the pharmaceutical industry. Law and policy deliberately promote these partnerships through intellectual property law, research funding programs, and drug and device approval pathways while simultaneously condemning them through conflict-of-interest (COI) regulations. These regulations have not been subjected to the close scrutiny that is typically utilized in administrative law to evaluate and improve regulatory systems. This Article suggests that the solution to this standoff in biomedical law and policy lies in an informed, empirical approach. Such an approach must both recognize such partnerships' legal and practical variations, as well as classify them based on their benefit to innovation and their harm to research biases. Ultimately, this approach must facilitate administrative reforms that would convert what is now an inherently arbitrary, yet widespread, regulatory regime into an epistemically rich mechanism for distinguishing between harmful and beneficial partnerships.

From U Vermont: The role of chronic inflammation in obesity-associated cancers

http://www.ncbi.nlm.nih.gov/pubmed/23819063

ISRN Oncol. 2013 May 30;2013:697521. doi: 10.1155/2013/697521. Print 2013.

The role of chronic inflammation in obesity-associated cancers.

Ramos-Nino ME.

Source

Department of Pathology and Department of Medical Laboratory Sciences, University of Vermont, Burlington, VT, USA.

Abstract

There is a strong relationship between metabolism and immunity, which can become deleterious under conditions of metabolic stress. Obesity, considered a chronic inflammatory disease, is one example of this link. Chronic inflammation is increasingly being recognized as an etiology in several cancers, particularly those of epithelial origin, and therefore a potential link between obesity and cancer. In this review, the connection between the different factors that can lead to the chronic inflammatory state in the obese individual, as well as their effect in tumorigenesis, is addressed. Furthermore, the association between obesity, inflammation, and esophageal, liver, colon, postmenopausal breast, and endometrial cancers is discussed.