Clinical Ethics in Gabon: The Spectrum of Clinical Ethical Issues Based on Findings from In-Depth Interviews at Three Public Hospitals

Introduction Unlike issues in biomedical research ethics, ethical challenges arising in daily clinical care in Sub-Saharan African countries have not yet been studied in a systematic manner. However this has to be seen as a distinct entity as we argue in this paper. Our aim was to give an overview of the spectrum of clinical ethical issues and to understand what influences clinical ethics in the Sub-Saharan country of Gabon. Materials and Methods In-depth interviews with 18 health care professionals were conducted at three hospital sites in Gabon. Interview transcripts were analyzed using a grounded theory approach (open and axial coding),giving a qualitative spectrum of categories for clinical ethical issues. Validity was checked at a meeting with study participants and other health care experts in Gabon after analysis of the data. Results Twelve main categories (with 28 further-specified subcategories) for clinical ethical issues were identified and grouped under three core categories: A) micro level: "confidentiality and information","interpersonal, relational and behavioral issues","psychological strain of individuals",and "scarce resources";B) meso level: "structural issues of medical institutions","issues with private clinics","challenges connected to the family",and "issues of education, training and competence";and C) macro level: "influence of society, culture, religion and superstition","applicability of western medicine","structural issues on the political level",and "legal issues". Discussion Interviewees reported a broad spectrum of clinical ethical issues that go beyond challenges related to scarce financial and human resources. Specific socio-cultural, historical and educational backgrounds also played an important role. In fact these influences are central to an understanding of clinical ethics in the studied local context. Further research in the region is necessary to put our study into perspective. As many participants reported a lack of awareness of ethical issues amongst other health care professionals in daily clinical practice, we suggest that international organizations and national medical schools should consider infrastructure and tools to improve context-sensitive capacity building in clinical ethics for Sub-Saharan African countries like Gabon

Distribution and diversity of alternate hosts of Maruca vitrata Fabricius in three West African countries

The evolution of resistance to the Bacillus thuringiensis (Bt) toxins by insect pests is a major threat to Bt technology. However, the rate of resistance can be slowed with appropriate integrated insect resistance management (IRM) strategies. Surveys were conducted to identify alternate host species for Maruca vitrata (commonly called the legume pod borer or Maruca) that could serve as refuges for Pod-Borer Resistant (PBR) cowpea in three West African countries (Ghana, Nigeria, and Burkina Faso). Survey sites included 25 in northern Ghana, 44 in northern Nigeria, and 52 in north-central and southwestern Burkina Faso. Alternate hosts of Maruca identified from plant species belonging to the Fabaceae family that showed signs of Maruca damage on cowpea tissues were collected and dissected. Larvae that were found during these dissections were reared to adult moths in the laboratory then identified to species. The alternate host plants including species of Crotolaria, Sesbania, Tephrosia, and Vigna were the most frequently encountered among sites and locations. Flowering and podding of these plants overlapped with flowering and podding of the nearby (~200 m) cowpea crop. Abundance of these wild hosts and overlapping flowering patterns with the cowpea crop in most locations have the potential to sustain ample numbers of Bt susceptible Maruca that will mate with possible resistant Maruca and deter resistance development. Further quantitative studies, however, are required from each location to determine if actual Maruca production from alternate hosts is sufficient for a PBR IRM strategy. If verified, this approach would be compatible with the high dose/refuge IRM strategy that includes alternate hosts and non-Bt crops as refuges

Between-person and within-person approaches to the prediction of ambulatory blood pressure: the role of affective valence and intensity

Identifying momentary influences on ambulatory blood pressure (ABP) will help explain ABP variability; however, most research only examines aggregate ABP at the between-person level. This study used within-person methods to examine whether affective dimensions-valence and arousal-differentially predicted momentary ABP levels. A community sample (n = 39) wore an ABP cuff that took BP measurements every 20 min for 24 h. At each measurement, participants reported levels of valence and arousal on electronic diaries. Multilevel modeling was used to examine the effects of momentary and person-averaged levels of valence and arousal on ABP. Greater momentary negative valence and arousal predicted higher systolic BP compared to more positive or lower arousal assessments; higher averaged levels of arousal predicted higher DBP. The results suggest the independence of the effects of valence and arousal on BP. These findings have important implications for designing interventions to lower ABP