J Community Genet. 2014 Jun 12. [Epub ahead of print]

'Cool! and creepy': engaging with college student stakeholders in Michigan's biobank.

Platt T1, Platt J, Thiel DB, Fisher N, Kardia SL.

Author information

• 1Life Sciences and Society Program, University of Michigan School of Public Health, 1415 Washington Heights, Suite 4605, Ann Arbor, MI, 48109-2029, USA, tevah@umich.edu.

Abstract

Large population biobanks, important resources for genomic research, also present ethical challenges. The Michigan BioTrust for Health makes dried bloodspots (DBS) leftover from newborn screening, including ~4.5 million collected before 2010 without written consent, available for health research. Absent prospectively gathered consent and/or current engagement with 18- to 29-year olds, little is known about opinions and beliefs from this age group about use of the bloodspots for research. We engaged 2,101 students-BioTrust participants and their peers-at information booths at 20 college campuses across the state to educate youth about the BioTrust and gather information about consent preferences and about hopes and concerns about this public health program. We surveyed student stakeholder DBS research consent preferences and fielded a "postengagement" survey to gauge the attitudes of participants and to evaluate the campus engagement. The most prevalent themes in open-ended comments were support for biobank research and concern that Michiganders are not aware of their participation. While 78 % of students said they would, if asked, opt in to the BioTrust, half of these preferred to be contacted each time a researcher sought to use their DBS. Students reported great interest in the topic and strong likelihood to share what they had learned. BioTrust participants are interested in learning about their role in an initiative whose goals they widely support. Public engagement is particularly important to biobank participants who, absent traditional consent practices, are unaware of their participation. Health-fair style engagements were effective for targeting college-aged stakeholders, communicating complex messages, and likely increasing knowledge. Retrospective biobanks and biobanks that collect proxy consent need policies to respect those who would opt out and will need resources to educate participants and conduct community outreach that is a safeguard to public trust.

Nurs Ethics. 2014 Jun 10. pii: 0969733014533234. [Epub ahead of print]

Ethical challenges when caring for dying children.

Furingsten L1, Sjögren R2, Forsner M3.

Author information

• 1Dalarna University, Sweden lfu@du.se.
• 2Retired, Mälardalen University and Linnaeus University, Sweden.
• 3Dalarna University, Sweden.

Abstract

BACKGROUND:

Caring for dying children presents special challenges, according to the children themselves, their relatives and healthcare professionals.

OBJECTIVE:

The aim of this study was to describe caring as represented in healthcare workers' experiences of caring for dying children.

METHOD:

A phenomenological approach was chosen, in-depth interviews were carried out and data were analysed in four steps focusing on (a) open reading, (b) meaning units, (c) constituents and (d) essence. Ethical considerations: Four nurses in a general acute paediatric care setting in Sweden participated after providing written informed consent. Voluntary participation and confidentiality were ensured, and the study was ethically approved.

FINDINGS:

The essence of caring for dying children was likened to a musically attuned composition, comprising five constituents: presence, self-knowledge, injustice in dying, own suffering and in need of others. Presence was found to be a prerequisite for caring when a child is dying. Self-knowledge and support from others can be of help when struggling with emotional pain and injustice.

DISCUSSION:

Caring for dying children has been found to be a delicate task for healthcare workers all over the world, and the ethical dimension is emphasized in international research. In this study, emotional pain and suffering accompanied caring, but an atmosphere in which it is possible to give and get support from colleagues and to have time to grieve and time to focus on the patient's needs may ease the burden, as can having time to process thoughts about life and death, and a possibility to grow in self-knowledge.

CONCLUSION:

Caring in ethically demanding situations may be facilitated through presence, atmosphere, self-knowledge and time. The challenge does not demand highly technological solutions; these assets are readily available, no matter where on earth. However, there is a need to further investigate these prerequisites for caring, particularly when a child is dying.

"Sharing end-of-life decisions with parents is a more important duty for physicians than protecting parents from guilt or doubt."

J Med Ethics. 2014 Jun 10. pii: medethics-2013-101395. doi: 10.1136/medethics-2013-101395. [Epub ahead of print]

Parents who wish no further treatment for their child.

de Vos MA1, Seeber AA2, Gevers SK3, Bos AP4, Gevers F5, Willems DL1.

Author information

• 1Section of Medical Ethics, Division of Public Health and Epidemiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
• 2Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
• 3Department of Health Law, Division of Public Health & Epidemiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
• 4Department of Paediatric Intensive Care, Emma Children's Hospital/Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
• 5Egmond, The Netherlands.

Abstract

BACKGROUND:

In the ethical and clinical literature, cases of parents who want treatment for their child to be withdrawn against the views of the medical team have not received much attention. Yet resolution of such conflicts demands much effort of both the medical team and parents.

OBJECTIVE:

To discuss who can best protect a child's interests, which often becomes a central issue, putting considerable pressure on mutual trust and partnership.

METHODS:

We describe the case of a 3-year-old boy with acquired brain damage due to autoimmune-mediated encephalitis whose parents wanted to stop treatment. By comparing this case with relevant literature, we systematically explored the pros and cons of sharing end-of-life decisions with parents in cases where treatment is considered futile by parents and not (yet) by physicians.

CONCLUSIONS:

Sharing end-of-life decisions with parents is a more important duty for physicians than protecting parents from guilt or doubt. Moreover, a request from parents on behalf of their child to discontinue treatment is, and should be, hard to over-rule in cases with significant prognostic uncertainty and/or in cases with divergent opinions within the medical team.

J Acquir Immune Defic Syndr. 2014 Jul 1;66 Suppl 2:S176-S185.

What HIV Programs Work for Adolescent Girls?

Hardee K1, Gay J, Croce-Galis M, Afari-Dwamena NA.

Author information

• 1*Reproductive Health Program Population Council, Washington, DC; †What Works Association, Takoma Park, MD; ‡What Works Association, New York, NY; §Center for Policy and Advocacy, Health Policy Project, Futures Group, Washington, DC; and **Consultant in Epidemiology and Occupational Health (CEOH), Bethesda, MD and former intern, Center for Policy and Advocacy, Health Policy Project, Futures Group, Washington, DC.

Abstract

BACKGROUND::

Adolescent girls face unique challenges in reducing their risk of acquiring HIV because of gender inequalities, but much of HIV programming and evaluation lacks a specific focus on female adolescents.

METHODS::

This article, based on a review of 150 studies and evaluations from 2001 to June 2013, reviews evidence on programming for adolescents that is effective for girls or could be adapted to be effective for girls.

RESULTS::

The evidence suggests specific interventions for adolescent girls across 3 critical areas: (1) an enabling environment, including keeping girls in school, promoting gender equity, strengthening protective legal norms, and reducing gender-based violence; (2) information and service needs, including provision of age-appropriate comprehensive sex education, increasing knowledge about and access to information and services, and expanding harm reduction programs for adolescent girls who inject drugs; and (3) social support, including promoting caring relationships with adults and providing support for adolescent female orphans and vulnerable children.

DISCUSSION::

Numerous gaps remain in evidence-based programming for adolescent girls, including a lack of sex- and age-disaggregated data and the fact that many programs are not explicitly designed or evaluated with adolescents in mind. However, evidence reinforces bolstering critical areas such as education, services, and support for adolescent girls.

CONCLUSIONS::

This article contributes to the growing body of literature on HIV and adolescent girls and reviews the vulnerabilities of girls, articulates the challenges of programming, develops a framework for addressing the needs of girls, and reviews the evidence for successful programming for adolescent girls.

"It is truly shocking how many surgeons are unable to describe the difference between Medicare and Medicaid or describe how hospitals and physicians get paid. "

J Orthop Trauma. 2014 Jul;28 Suppl 1:S25-S41.

Healthcare Fundamentals.

Kauk J1, Hill AD, Althausen PL.

Author information

• 1*Reno Orthopaedic Clinic, Reno, NV; and †Austin Skeletal Trauma Specialists, Austin, TX.

Abstract

SUMMARY::

In order for a trauma surgeon to have an intelligent discussion with hospital administrators, healthcare plans, policymakers, or any other physicians, a basic understanding of the fundamentals of healthcare is paramount. It is truly shocking how many surgeons are unable to describe the difference between Medicare and Medicaid or describe how hospitals and physicians get paid. These topics may seem burdensome but they are vital to all business decision making in the healthcare field. The following chapter provides further insight about what we call "the basics" of providing medical care today. Most of the topics presented can be applied to all specialties of medicine. It is broken down into 5 sections. The first section is a brief overview of government programs, their influence on care delivery and reimbursement, and past and future legislation. Section 2 focuses on the compliance, care provision, and privacy statutes that regulate physicians who care for Medicare/Medicaid patient populations. With a better understanding of these obligations, section 3 discusses avenues by which physicians can stay informed of current and pending health policy and provides ways that they can become involved in shaping future legislation. The fourth section changes gears slightly by explaining how the concepts of trade restraint, libel, antitrust legislation, and indemnity relate to physician practice. The fifth, and final, section ties all of components together by describing how physician-hospital alignment can be mutually beneficial in providing patient care under current healthcare policy legislation.

"What we are living and what we have seen over the last two days is horrible and catastrophic."

"What we are living and what we have seen over the last two days is horrible and catastrophic."

HT:PP

"...doctors must learn to advocate on behalf of their profession if the potential benefits of the ACA are to be realized."

Int J Risk Saf Med. 2014 Jan 1;26(2):81-8. doi: 10.3233/JRS-140614.

The Affordable Care Act: Opportunities for collaboration between doctors and lawyers.

Fontugne EA.

Author information

• Stetson University College of Law, Gulfport, FL, USA.

Abstract

BACKGROUND:

In 2010, the Affordable Care Act (ACA) was signed into law. The Act seeks to improve the access of Americans to improved quality health care, while controlling the nation's escalating health care expenditures. The Act is scheduled for further implementation in 2014.

OBJECTIVE:

This article elucidates the opportunities and challenges that the ACA presents for constructive, innovative collaboration between the legal and medical professions in contributing to the quest for a more affordable and accessible high quality health care system.

METHODS:

The author analyzed the text of the Act, as well as secondary sources in the areas of law, medicine, and public health. This allowed for the creation of a comprehensive conceptual and empirical framework through which the Act could be properly analyzed and understood.

RESULTS:

The research described the pitfalls inherent in the Act, but demonstrated that the ACA presents more opportunities than challenges iflawyers and doctors are willing to work together to bring about needed social change.

CONCLUSION:

The article qualified these findings by emphasizing that doctors must learn to advocate on behalf of their profession if the potential benefits of the ACA are to be realized.

Michelle Boardman: Consent and Sensibility-A Review of Margaret Jane Radin's Book, "Boilerplate: The Fine Print, Vanishing Rights, and the Rule of Law."

Consent and SensibilityA Review of Margaret Jane Radin's Book, "Boilerplate: The Fine Print, Vanishing Rights, and the Rule of Law."

Michelle Boardman 

George Mason University School of Law
May 1, 2014

Harvard Law Review, Vol. 127, No. 7, p. 1967, 2014 
Abstract:      

In this book, Professor Margaret Radin offers a fresh look at the fit between boilerplate contracts and our notions of consent. She also builds a case against allowing certain contract terms to create a "rights deletion scheme" aimed at shrinking access to legal redress.

This review explores both rich lines of analysis but concludes they need not intertwine. Radin's argument is crafted in the language of consent; I argue that her proposed resolution concerns not consent but welfare. To the extent the widespread use of redress clauses leads to a collective harm, the issue is not one of individual consent. If the rights at hand are basically inalienable, as Radin holds, the problem is not that one does not consent but that one is permitted to do so; improving the quality of individual consent will not address the harm.

Taking Radinian consent on its own merits, the review also explores how Radin confronts the challenge of presenting a conception of consent that delegitimizes boilerplate without delegitimizing "ordinary" contractual consent. I compare Radin's approach with other conceptions of consumer consent and offer the possibility of consenting to a continuum of options, where the consumer agrees to a deal ignorant of a specific term but aware of the possible range of terms.

Health Econ Policy Law. 2014 Jun 9:1-8. [Epub ahead of print]

In search of real autonomy for fertility patients.

Johnston J1, Gusmano MK2, Patrizio P3.

Author information

• 11Director of Research & Research Scholar,The Hastings Center,Garrison,NY,USA.
• 22Research Scholar,The Hastings Center.
• 33Professor of Obstetrics,Gynecology and Reproductive Sciences, Director,Yale Fertility Center,Yale School of Medicine,CT,USA.

Abstract

Nearly one in eight infants in the United States is born preterm. A variety of factors are associated with preterm birth, including multiplicity. In the United States fertility treatments are currently associated with high rates of multiplicity, but these rates could be reduced significantly if changes can be made to fertility treatment policy and practice. These include reducing the financial pressure on patients to prioritize pregnancy chances over safety by expanding insurance coverage and altering the way we calculate success rates and insurance benefits so that two consecutive single embryo transfers is equivalent to one double embryo transfer.

"We tend to reduce death to a duty of management."

Herz. 2014 Jun 7. [Epub ahead of print]

[When letting-be is more important than actions : Plea for a new culture of dying.]

[Article in German]

Maio G.

Author information

• Institut für Ethik und Geschichte der Medizin, Universität Freiburg, Stefan-Meier-Str. 26, 79104, Freiburg i. Br., Deutschland, maio@ethik.uni-freiburg.de.

Abstract

The fact of "being mortal" and mortality are of an existential meaning for every human being. The knowledge of death and the imagination of a finiteness of life have a crucial impact on the whole life. Today it has become a common approach to plan death, to organize and to regulate it. We tend to reduce death to a duty of management. With this rationalization of death we try to get within distance of it. Active euthanasia and assisted suicide seem to be the adequate answers to this approach but is death really well understood if we only try to handle it this way? Is autonomy really the only relevant principle to respect the concerns of dying individuals or desperate people who want to die? This contribution pleads for an emphasis on a new ethics of caring, because a truly human medicine is not possible without caring. It shows that care does not necessarily get in conflict with autonomy but that it is the prerequisite for autonomy.

Front Hum Neurosci. 2014 May 16;8:239. eCollection 2014.

Big data, open science and the brain: lessons learned from genomics.

Choudhury S1, Fishman JR2, McGowan ML3, Juengst ET4.

Author information

• 1Division of Social and Transcultural Psychiatry, McGill University and Lady Davis Institute, Jewish General Hospital Montreal, QC, Canada.
• 2Biomedical Ethics Unit, Social Studies of Medicine Department, McGill University Montreal, QC, Canada.
• 3Department of Bioethics, Case Western Reserve University School of Medicine Cleveland, Ohio, USA.
• 4Center for Bioethics, University of North Carolina Chapel Hill, NC, USA.

Abstract

The BRAIN Initiative aims to break new ground in the scale and speed of data collection in neuroscience, requiring tools to handle data in the magnitude of yottabytes (1024). The scale, investment and organization of it are being compared to the Human Genome Project (HGP), which has exemplified "big science" for biology. In line with the trend towards Big Data in genomic research, the promise of the BRAIN Initiative, as well as the European Human Brain Project, rests on the possibility to amass vast quantities of data to model the complex interactions between the brain and behavior and inform the diagnosis and prevention of neurological disorders and psychiatric disease. Advocates of this "data driven" paradigm in neuroscience argue that harnessing the large quantities of data generated across laboratories worldwide has numerous methodological, ethical and economic advantages, but it requires the neuroscience community to adopt a culture of data sharing and open access to benefit from them. In this article, we examine the rationale for data sharing among advocates and briefly exemplify these in terms of new "open neuroscience" projects. Then, drawing on the frequently invoked model of data sharing in genomics, we go on to demonstrate the complexities of data sharing, shedding light on the sociological and ethical challenges within the realms of institutions, researchers and participants, namely dilemmas around public/private interests in data, (lack of) motivation to share in the academic community, and potential loss of participant anonymity. Our paper serves to highlight some foreseeable tensions around data sharing relevant to the emergent "open neuroscience" movement.

Nocebo

Psychiatr Danub. 2014 Jun;26(2):100-7.

Placebo and nocebo effect: a mini-review.

Požgain I1, Požgain Z, Degmečić D.

Author information

• 1Department of Psychiatry, University Hospital Centre Osijek, J. Huttlera 4, 31000 Osijek, Croatia, ivan.pogain96@gmail.com.

Abstract

It is well-known that placebo is a substance without medical effects, which benefits the health status because of the patient's belief that the substance is effective and that the nocebo is defined as a substance without medical effects but which worsenes the health status of the person taking it by the negative beliefs and expectations of the patient. Starting with the history of the placebo effect and giving a review of the most significant studies reporting about the placebo effect from 1939-2013 it was our intention to give the all-around look on this phenomena discussing the neurobiological and other theories of its origin and concentrating especially on the field of psychiatry and finally coming to conclusions regarding the conductance of clinical trials and ethics. Regarding psychiatry, the placebo effect has a substantial role in most of psychiatric conditions including depression, anxiety, addictions, and contrary to what may have been expected, schizophrenia. Likewise, the nocebo effect is not to be neglected as the studies are being conducted to identify the factors causing it so it could be prevented.

Bioethics. 2014 Jun 9. doi: 10.1111/bioe.12102. [Epub ahead of print]

The Concept of Human Dignity in the Ethics of Genetic Research.

Chan DK.

Abstract

Despite criticism that dignity is a vague and slippery concept, a number of international guidelines on bioethics have cautioned against research that is contrary to human dignity, with reference specifically to genetic technology. What is the connection between genetic research and human dignity? In this article, I investigate the concept of human dignity in its various historical forms, and examine its status as a moral concept. Unlike Kant's ideal concept of human dignity, the empirical or relational concept takes human dignity as something that is affected by one's circumstances and what others do. I argue that the dignity objection to some forms of genetic research rests on a view of human nature that gives humans a special status in nature - one that is threatened by the potential of genetic research to reduce individuals to their genetic endowment. I distinguish two main philosophical accounts of human nature. One of these, the Aristotelian view, is compatible with the use of genetic technology to help humans realize their inherent potential to a fuller extent.

Lung Cancer. 2014 May 22. pii: S0169-5002(14)00221-9. doi: 10.1016/j.lungcan.2014.05.012. [Epub ahead of print]

Interim results in clinical trials: Do we need to keep all interim randomised clinical trial results confidential?

Stephens RJ1, Langley RE2, Mulvenna P3, Nankivell M2, Vail A4, Parmar MK2.

Author information

• 1MRC Clinical Trials Unit, Aviation House, 125 Kingsway, London WC2B 6NH, United Kingdom. Electronic address: richardjamesstephens@gmail.com.
• 2MRC Clinical Trials Unit, Aviation House, 125 Kingsway, London WC2B 6NH, United Kingdom.
• 3Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne NE7 7DN, United Kingdom.
• 4Centre for Biostatistics, University of Manchester, Clinical Sciences Building, Salford Royal NHS Foundation Trust, Stott Lane, Salford M6 8HD, United Kingdom.

Abstract

OBJECTIVES:

Guidelines for the conduct of clinical trials emphasize the importance of keeping the interim results from the main endpoints confidential, in order to maintain the integrity of the trial and to safeguard patients' interests. However, is this essential in every situation?

MATERIALS AND METHODS:

We review the evidence for these guidelines and consider recent randomised trials that have released interim results, to assess their impact on the success of the trial. However, because the strength of opinion to keep interim results confidential is so strong, there are limited examples of such trials.

RESULTS:

In the QUARTZ trial (which is assessing the value of whole brain radiotherapy in patients with brain metastases from non-small cell lungcancer) the decision to release interim results was taken in response to threatened closure due to poor accrual, whereas in the GRIT trial (which compared two obstetric strategies for the delivery of growth retarded pre-term fetuses) the regular release of interim results was pre-planned. Nevertheless there are a number of common factors between these two trials. In particular, the trial treatments were already in wide use, with no reliable randomised evidence on which treatment should be used for which patients, and there was diverse clinical opinion, which meant that accrual was likely to be challenging. In a situation where a quarter to a third of trials do not accrue their required number of patients, the QUARTZ trial continues to accrue patients, and the GRIT trial successfully accrued its target of nearly 600 babies.

CONCLUSIONS:

This article therefore argues that there is a need to re-consider whether it is always essential to keep the interim results of randomized clinical trials confidential, and suggests some criteria that may help groups planning or running challenging trials decide whether releasing interim results would be a useful strategy.

Lancet Infect Dis. 2014 Jun 3. pii: S1473-3099(14)70766-2. doi: 10.1016/S1473-3099(14)70766-2. [Epub ahead of print]

Research into a functional cure for HIV in neonates: the need for ethical foresight.

Shah SK1, Persaud D2, Wendler DS3, Taylor HA4, Gay H5, Kruger M6, Grady C3.

Author information

• 1Clinical Center Department of Bioethics, National Institutes of Health, Bethesda, MD, USA. Electronic address: shahse@mail.nih.gov.
• 2Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, MD, USA.
• 3Clinical Center Department of Bioethics, National Institutes of Health, Bethesda, MD, USA.
• 4Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health and Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, USA.
• 5Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, USA.
• 6Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa.

Abstract

In 2013, researchers announced that a newborn child from Mississippi, USA might have been functionally cured of HIV by being given combination antiretroviral therapy within hours of birth. Public and media attention has since been captured by the possibility of finding a cure for HIV transmitted from mother to child. Research into the strategy used for the Mississippi patient is crucially important to establish whether it can be replicated and shown to work in diverse populations. At the same time, any ethical issues likely to arise in such studies should be addressed and not ignored in the pursuit of a functional cure. In this Personal View we identify ethical issues that could arise in research towards achievment of a functional cure for HIV in neonates, including difficult trade-offs associated with choosing the study population and questions about the broader social implications of the research, and propose ways to resolve them.

Soc Sci Med. 2014 May 20;114C:10-17. doi: 10.1016/j.socscimed.2014.05.029. [Epub ahead of print]

The effect of age and time to death on primary care costs: The Italian experience.

Atella V1, Conti V2.

Author information

• 1University of Tor Vergata, Department of Economics and Finance, Via Columbia 2, 00133 Rome, Italy; Centre for Economic and International Studies (CEIS), University of Tor Vergata, Via Columbia 2, 00133 Rome, Italy; University of Stanford, Department of Economics, 450 Serra Mall, Stanford, CA 94305-2004, USA. Electronic address: atella@uniroma2.it.
• 2University of Tor Vergata, Department of Economics and Finance, Via Columbia 2, 00133 Rome, Italy; Centre for Economic and International Studies (CEIS), University of Tor Vergata, Via Columbia 2, 00133 Rome, Italy. Electronic address: conti@economia.uniroma2.it.

Abstract

A large body of literature shows that time to death (TTD) is by far a better predictor of health spending than age. In this paper, we investigate if this finding holds true also in presence of primary care costs (pharmaceuticals, diagnostic tests and specialist visits) in Italy, where they represent an important share (about 30%) of the total health care expenditure (HCE). Our analysis is based on a large sample of the Italian population (about 750,000 individuals), obtained from the Health Search-SiSSI database, which contains patient-level data collected routinely by General Practitioners in Italy since 2002. We study individuals aged 19 and older, over the period 2006-2009. By means of a two-part model which accounts for the presence of zero expenditure, our findings show that age represents the most important driver of primary care costs in Italy, although TTD remains a good predictor. These results suggest that age and TTD can have a different role in shaping health care costs according to the component of health expenditure examined. Therefore, our advice to policy makers is to use disaggregated models to better disentangle these contributions and to produce more reliable health spending forecasts.

From Harvard: Reproductive Health Access Among Deployed U.S. Servicewomen: A Qualitative Study

Mil Med. 2014 Jun;179(6):645-652.

Reproductive Health Access Among Deployed U.S. Servicewomen: A Qualitative Study.

Manski R1, Grindlay K1, Burns B1, Holt K2, Grossman D3.

Author information

• 1Ibis Reproductive Health, 17 Dunster Street, Suite 201, Cambridge, MA 02138.
• 2Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Avenue, SPH 3, Floor 7, Boston, MA 02115.
• 3Ibis Reproductive Health, 1330 Broadway, Suite 1100, Oakland, CA 94612.

Abstract

Servicewomen's reproductive health experiences during deployment are important given that the majority of women in the U.S. military are of reproductive age and that this population experiences a disproportionately high rate of unintended pregnancy. Few studies have explored women's reproductive health experiences and their perceived barriers and facilitators to health care access during deployment. From May 2011 to January 2012, we conducted 22 in-depth interviews with women in the U.S. military about their reproductive health experiences during deployment, including their access to health services. Participants identified a range of barriers to accessing medical care in deployment settings, including confidentiality concerns, lack of female providers, and health-seeking stigma, which were reported to disproportionately impact reproductive health access. Some participants experienced challenges obtaining contraceptive refills and specific contraceptive methods during deployment, and only a few participants received predeployment counseling on contraception, despite interest in both menstruation suppression and pregnancy prevention. These findings highlight several policy and practice changes that could be implemented to increase contraceptive access and reduce unintended pregnancy during deployment, including mandated screening for servicewomen's contraceptive needs before operational duty and at least annually, and increasing the number of female providers in deployed settings.

Await announcement of U Alabama tuition hike

Government Union Demands Major Upgrades to Taxpayer-Funded Research Facility

Newly completed water center at University of Alabama cost $18.8 million

The labor union representing employees at the National Weather Service is demanding major upgrades to a new water resources facility at the University of Alabama, including that each employee have a soundproof office, receive a pay increase, and have access to a community garden.

HT:AP

Methodological and ethical challenges in studying psychiatric patients' perceptions of coercion

BMC Psychiatry. 2014 Jun 4;14(1):162. [Epub ahead of print]

Methodological and ethical challenges in studying patients' perceptions of coercion: a systematic mixed studies review.

Soininen P, Putkonen H, Joffe G, Korkeila J, Välimäki M.

Abstract

BACKGROUND:

Despite improvements in psychiatric inpatient care, patient restrictions in psychiatric hospitals are still in use. Studying perceptions among patients who have been secluded or physically restrained during their hospital stay is challenging. We sought to review the methodological and ethical challenges in qualitative and quantitative studies aiming to describe patients' perceptions of coercive measures, especially seclusion and physical restraints during their hospital stay.

METHODS:

Systematic mixed studies review was the study method. Studies reporting patients' perceptions of coercive measures, especially seclusion and physical restraints during hospital stay were included. Methodological issues such as study design, data collection and recruitment process, participants, sampling, patient refusal or non-participation, and ethical issues such as informed consent process, and approval were synthesized systematically. Electronic searches of CINALH, MEDLINE, PsychINFO and The Cochrane Library (1976-2012) were carried out.

RESULTS:

Out of 846 initial citations, 32 studies were included, 14 qualitative and 18 quantitative studies. A variety of methodological approaches were used, although descriptive and explorative designs were used in most cases. Data were mainly collected in qualitative studies by interviews (n = 13) or in quantitative studies by self-report questionnaires (n = 12). The recruitment process was explained in 59% (n = 19) of the studies. In most cases convenience sampling was used, yet five studies used randomization. Patient's refusal or non-participation was reported in 37% (n = 11) of studies. Of all studies, 56% (n = 18) had reported undergone an ethical review process in an official board or committee. Respondents were informed and consent was requested in 69% studies (n = 22).

CONCLUSIONS:

The use of different study designs made comparison methodologically challenging. The timing of data collection (considering bias and confounding factors) and the reasons for non-participation of eligible participants are likewise methodological challenges, e.g. recommended flow charts could aid the information. Other challenges identified were the recruitment of large and representative samples. Ethical challenges included requesting participants' informed consent and respecting ethical procedures.