Ethics and health technology assessment: Handmaiden and/or critic?

OBJECTIVES: This study examines the content and role of ethical analysis in health technology assessment (HTA) and horizon scanning publications. It proposes that ethical analysis in HTA is of at least two different types: an ethics of HTA and an ethics in HTA. METHODS: I examine the critical differences between these approaches through the examples of the analysis of genetic screening for breast cancer and home blood glucose testing in diabetes. I then argue that, although both approaches subscribe to similar views concerning HTA and ethics, they use different theoretical and methodological traditions to interpret and explain them. RESULTS AND CONCLUSIONS: I conclude by suggesting that we need the interpretive insights of both these approaches, taken together, to explain why ethics has not been able yet to contribute fully to HTA and to demonstrate the scope and complexity of ethical work in this domain.Annette J. Braunack-Maye

What do we know about men's help-seeking and health service use?

The document attached has been archived with permission from the editor of the Medical Journal of Australia. An external link to the publisher’s copy is included.Men seek help and use health services less frequently than women do. Men's help-seeking practices and health service use are complex issues involving biological, psychological and sociological considerations. Most discussion on men's help-seeking positions them as reluctant consumers or "behaving badly" with respect to their health. Few studies have explored whether health service providers are equipped to deal with men's health issues appropriately. The current health system appears not to be tailored to meet the health needs of men. Better collaboration is required across disciplines, to further investigate men's health using both qualitative and quantitative research methods.James A Smith, Annette Braunack-Mayer and Gary Witter

Health promotion practice, research ethics and publishing in the Health Promotion Journal of Australia

Article > Contents Vol 26(3) Health promotion practice, research ethics and publishing in the Health Promotion Journal of Australia Stacy M. Carter A D, Annette Braunack-Mayer B and Jonine Jancey C A Centre for Values, Ethics and the Law in Medicine, Sydney School of Public Health, Medical Foundation Building K25, University of Sydney, NSW 2006, Australia. B School of Public Health, University of Adelaide, Mail Drop DX 650207, SA 5005, Australia. C School of Public Health, Curtin University, GPO Box U1987, Perth, WA 6845, Australia. D Corresponding author. Email: [email protected] Abstract PDF (58.8 KB) Export Citation Print ShareThis Health Promotion Journal of Australia 26(3) 167-169 http://dx.doi.org/10.1071/HEv26n3_ED2 Published: 21 December 2015 This special issue of the HPJA focuses on ethics in the context of health promotion practice. This editorial takes a narrower focus: the issue of Human Research Ethics Committee (HREC) approval for health promotion research, evaluation and quality assurance (QA). We will focus on three papers in the special issue: each argue that those working in health promotion should consider ethics from the very beginning of their research, evaluation and/or QA activities. The first paper, by Ainsley Newson and Wendy Lipworth, is entitled ‘Why should ethics approval be required before publication of health promotion research?’ In it they argue that ‘journals should not, in general, publish articles with no ethics approval’, even if the findings are interesting or apparently important.1 The second paper, by Peter Sainsbury, is entitled ‘Development and oversight of ethical health promotion quality assurance and evaluation activities involving human participants’. In it he argues that the boundaries between research, evaluation and QA are not clear, and that all of these activities should be underpinned by research ethics principles and focus on the central issue of potential risk to participants.2 The final paper, a commentary by Judy Allen, reflects on the ethical dimensions of health promotion research and evaluation from the inside of an HREC.3SMC is supported by a National Health and Medical Research Council Career Development Fellowship (1032963)

The Purpose and Value for Students of PBL Groups for Learning

Groups are central to problem-based learning (PBL) and educational and professional outcomes relevant to clinical education. However, PBL groups in practice may differ from theoretical conceptions of groups. Therefore, this study explored students’ understandings of the purpose and value of PBL groups for their learning. We conducted a naturalistic study with novice (first-year) students at two dental schools (Australia, Ireland), using observation and interviews analyzed thematically. Students constructed PBL learning as individual knowledge gain, and group purpose as information gathering and exchange; few students acknowledged the learning potential of group processes. Group value depended on assessment and curriculum context. Findings are explained in relation to how students’ epistemologies and perceptions of their learning contexts shaped group behaviour. Implications for health professional education practice are considered

Another Piece of the “Silence in PBL” Puzzle: Students’ Explanations of Dominance and Quietness as Complementary Group Roles

A problem-based learning (PBL) assumption is that silence is incompatible with collaborative learning. Although sociocultural studies have reinterpreted silence as collaborative, we must understand how silence occurs in PBL groups. This essay presents students’ explanations of dominance, leadership, and silence as PBL group roles. An ethnographic investigation of PBL groups, informed by social constructionism, was conducted at two dental schools (in Australia and Ireland). The methods used were observation, interviews, and focus groups. The participants were volunteer first-year undergraduates. Students attributed dominance, silence, and members’ group roles to personal attributes. Consequently, they assumed that groups divided naturally into dominant leaders and silent followers. Sometimes silence had a collaborative learning function, but it was also due to social exclusion. This assumption enabled social practices that privileged some group members and marginalized others. Power and participation in decision making in PBL groups was restricted to dominant group members

The appeal to nature implicit in certain restrictions on public funding for assisted reproductive technology

An early version of the paper was presented at the 10th World Congress of Bioethics (Singapore, 2010).Certain restrictions on public funding for assisted reproductive technology (ART) are articulated and defended by recourse to a distinction between medical infertility and social infertility. We propose that underlying the prioritization of medical infertility is a vision of medicine whose proper role is to restore but not to improve upon nature. We go on to mark moral responses that speak of investments many continue to make in nature as properly an object of reverence and gratitude and therein (sometimes) a source of moral guidance. We draw on the work of Ludwig Wittgenstein in arguing for the plausibility of an appeal to nature in opposition to the charge that it must contain a logical fallacy. We also invite consideration of the moral plausibility of some appeal to nature. Finally, we examine what follows in the case of ART. Should medicine respect as natural limits that should not be overcome: the need for a man and a woman in reproduction; menopause; and even declining fertility with age? We must first ask ourselves to what degree we should defer to nature in the conduct of medicine, at least in the particular if not the general case. This will involve also asking ourselves what we think is natural and in what instances and spirit might we defy nature. Divergent opinions and policies concerning who should receive ART treatment and public funding are more easily understood in view of the centrality, complexity and fundamental nature of these questions.Drew Carter and Annette Braunack-Maye

The information needs of women diagnosed with Polycystic Ovarian Syndrome - implications for treatment and health outcomes

Background: This paper reports the findings of an exploratory study about the information women diagnosed with Polycystic Ovarian Syndrome (PCOS) want to know about their condition and the consequences of this information for future treatment and health outcomes. Methods: In-depth qualitative interviews regarding their information needs were undertaken with ten South Australian women diagnosed with PCOS. These women were aged 28–38 years and at differing stages of their fertility experience. The time since diagnosis ranged from 1–17 years. The main outcome measures sought were the identification of the information needs of women diagnosed with Polycystic Ovarian Syndrome (PCOS) during different periods of their lives; how and where they obtain this information, and the consequences of this information for future treatment and health outcomes. Results: The women with PCOS in this study preferentially used the Internet for their information needs, as it had the advantages of convenience, privacy and accessibility, when compared with traditional mechanisms of information provision. Conclusion: Giving a name to a collection of symptoms may bring relief and provide recognition that there really is a problem. However, with a diagnosis comes the need to have questions answered. A diagnosis of a chronic condition such as PCOS necessitates decision-making regarding possible treatment strategies and lifestyle choices. Information is needed in order to participate in shared decision making. The Internet proved to be a most versatile and beneficial source of information source for women with PCOS, if its limitations are taken into consideration.Jodie C Avery and Annette J Braunack-Maye

Psychological perspectives in urinary incontinence: a metasynthesis

Introduction: Urinary incontinence with co-morbid depression has been found to have a significant effect on quality of life. Examining the associations between the psychosocial factors related to urinary incontinence and mental health may help in improving the care for patients with these conditions. The aim of this research study is to explore the relationship between mental health status and urinary incontinence, focusing on the role of psychosocial factors. Materials and Methods: A search of Medline, CINAHL and SCOPUS databases yielded 15 studies on the topic, and 10 studies were found to be in scope. A metasynthesis using Noblit and Hare’s approach of meta-ethnography was undertaken. This involved a number of steps including determining how studies are related and identifying major themes. Results: Three psychosocial aspects of urinary incontinence appear to influence mental health status: living with, management of and attitudes about incontinence. Other smaller component themes included control, seeking help and personal beliefs. Discussion: Psychosocial factors appear to mediate the relationship between urinary incontinence and mental health status. An increased awareness of the major psychosocial issues that can influence both incontinence and mental health may contribute to a better management of the condition as well as reduce the burden of the condition on individuals. Conclusion: Incontinence and psychological wellbeing are intertwined and this adversely affects a number of aspects of life. Enquiring about the mental health status of those with incontinence should include an assessment of psychosocial factors to help reduce the burden of incontinence. To improve the management of these conditions, further research should investigate whether psychological issues precede incontinence or vice versa.JC Avery, AJ Braunack-Mayer, NP Stocks, AW Taylor, P Dugga

Targeting population nutrition through municipal health and food policy: implications of New York City's experiences in regulatory obesity prevention

Abstract not availableJana Sisnowski, Jackie M. Street, Annette Braunack-Maye

Citizens' perspectives on disinvestment from publicly funded pathology tests: a deliberative forum

Abstract not availableJackie M. Street, Peta Callaghan, Annette J. Braunack-Mayer, Janet E. Hille