Effects of zinc supplementation on cognitive function in healthy middle-aged and older adults: the ZENITH study

A randomised double-blind placebo-controlled design was employed to investigate the effects of Zn supplementation on cognitive function in 387 healthy adults aged 55–87 years. Several measures of visual memory, working memory, attention and reaction time were obtained using the Cambridge Automated Neuropsychological Test Battery at baseline and then after 3 and 6 months of 0 (placebo), 15 or 30 mg Zn/d. Younger adults (70 years), and performance improved with practice on some measures. For two out of eight dependent variables, there were significant interactions indicating a beneficial effect (at 3 months only) of both 15 and 30 mg/d on one measure of spatial working memory and a detrimental effect of 15 mg/d on one measure of attention. Further work is required to establish whether these findings generalise to older adults in poorer mental and physical health and with less adequate Zn intake and status than the present sample

Collaboration between Librarians and Learning Technologists to enhance the learning of health sciences students.

Collaboration between Librarians and Learning Technologists at Bournemouth University (BU) has been stimulated and cemented by Pathfinder funding from the Higher Education Academy. This paper will consider four case studies collected as part of the eRes Project that describe the use of Web 2.0 technologies in the School of Health and Social Care at BU. The project aimed to enhance the student learning experience in an increasingly electronic environment. This was achieved by developing and disseminating innovative pedagogical frameworks, bringing together learning activities and academically led quality e-resources within the unit of study. An e-reading strategy which encompasses models for resource discovery and e-literacy was developed, drawing on the experiences and findings of the case studies. Issues considered in this paper will include accessing academic electronic reading materials and using a social bookmarking tool integrated within BU’s virtual learning environment with students studying away from the main campus. Additionally the paper will consider how technology can be used to motivate students, especially in large groups and how it can be used to engage students with a subject perceived as “dry” or “difficult”. The rich possibilities of health science materials can be exploited more fully using new technologies embedded within the curriculum

“Just one animal among many?” Existential phenomenology, ethics, and stem cell research

Stem cell research and associated or derivative biotechnologies are proceeding at a pace that has left bioethics behind as a discipline that is more or less reactionary to their developments. Further, much of the available ethical deliberation remains determined by the conceptual framework of late modern metaphysics and the correlative ethical theories of utilitarianism and deontology. Lacking, to any meaningful extent, is a sustained engagement with ontological and epistemological critiques, such as with “postmodern” thinking like that of Heidegger’s existential phenomenology. Some basic “Heideggerian” conceptual strategies are reviewed here as a way of remedying this deficiency and adding to ethical deliberation about current stem cell research practices

Just regionalisation: rehabilitating care for people with disabilities and chronic illnesses

BACKGROUND: Regionalised models of health care delivery have important implications for people with disabilities and chronic illnesses yet the ethical issues surrounding disability and regionalisation have not yet been explored. Although there is ethics-related research into disability and chronic illness, studies of regionalisation experiences, and research directed at improving health systems for these patient populations, to our knowledge these streams of research have not been brought together. Using the Canadian province of Ontario as a case study, we address this gap by examining the ethics of regionalisation and the implications for people with disabilities and chronic illnesses. The critical success factors we provide have broad applicability for guiding and/or evaluating new and existing regionalised health care strategies. DISCUSSION: Ontario is in the process of implementing fourteen Local Health Integration Networks (LHINs). The implementation of the LHINs provides a rare opportunity to address systematically the unmet diverse care needs of people with disabilities and chronic illnesses. The core of this paper provides a series of composite case vignettes illustrating integration opportunities relevant to these populations, namely: (i) rehabilitation and services for people with disabilities; (ii) chronic illness and cancer care; (iii) senior's health; (iv) community support services; (v) children's health; (vi) health promotion; and (vii) mental health and addiction services. For each vignette, we interpret the governing principles developed by the LHINs – equitable access based on patient need, preserving patient choice, responsiveness to local population health needs, shared accountability and patient-centred care – and describe how they apply. We then offer critical success factors to guide the LHINs in upholding these principles in response to the needs of people with disabilities and chronic illnesses. SUMMARY: This paper aims to bridge an important gap in the literature by examining the ethics of a new regionalisation strategy with a focus on the implications for people with disabilities and chronic illnesses across multiple sites of care. While Ontario is used as a case study to contextualize our discussion, the issues we identify, the ethical principles we apply, and the critical success factors we provide have broader applicability for guiding and evaluating the development of – or revisions to – a regionalised health care strategy

Medico-legal jurisdiction over human decision-making, a philosophical constructionist analysis of mental competence

grantor: University of TorontoThe socio-medico-legal practice of assessing mental competence, or decision-making capacity, provokes fundamentally important conceptual, (bio)ethical and political questions given that judgments of incompetence result in the deprivation of human rights. The dominant rationale for competence assessments, based on the view that competence is an intrinsic cognitive feature of a person, is that this practice promotes autonomy and best interests. I argue that this prevailing view is mistaken and its moral and socio-political harms are profound. I demonstrate that while the concept of (in)competence has a descriptive component, it is essentially normative or 'value-laden' insofar as it refers to the meeting, or failure to meet, a certain standard, criterion or norm of competence. I also show that (in)competence is socially constructed, by which I mean that "competence" or "incompetence" does not refer solely to an intrinsic biological property of an individual (e.g., cognition); rather, it refers to the relationship between the individual and a variety of social factors. While certain biological properties are necessary conditions of mental competence, they are not sufficient conditions because (in)competence is relational between a biological individual and social factors. Within a feminist philosophical bioethics framework, I develop a typology of causal social construction involving five different forms. Using this typology I argue that, when incompetence is properly understood to be causally constructed, there are a number of indications that women--especially elderly women, women with disabilities, and women in particular socioeconomic positions--may face excess risk of being assessed for competence and judged to be incompetent. I further develop my feminist constructionist analysis of mental competence in terms of the historical and current (bio)medicalization of human decision-making. I argue that (bio)medicalization and medico-legal control of decision-making through the practice of competence assessment constitutes an intolerable assault on moral integrity, civil rights and social justice. On moral and political grounds, I argue for demedicalizing decision-making, dismantling the practice of competence assessment by practitioners in health care contexts, and radically altering formal legal assessment practices. I provide objectives and recommendations for research, education, policy and practice.Ph.D

Disability and Dignity-Enabling Home Environments

In Canada where long-term care is primarily oriented to elderly persons and affordable accessible housing is limited, younger disabled adults may be living in circumstances that do not meet their health needs and contribute to their social exclusion. The purpose of this study was to undertake an ethical analysis of what constitute an ‘adequate’ home environment for adults with significant mobility disabilities. An integrated design was used that combined qualitative interviews with normative ethical analysis in an iterative process. Twenty interviews with 19 participants were conducted in Ontario, Canada with two groups: younger adults (ages 18 to 55) with mobility disabilities and ‘decision-makers’ who consisted of policy makers, program administrators and discharge planners. Data were analyzed using a critical disability ethics approach and processes of reflective equilibrium. Drawing on Nora Jacobson’s taxonomy of dignity and pluralistic approaches to social justice, the concept of ‘social dignity’ provides a lens for exploring the adequacy of home environments for disabled people. Analyses suggested seven threshold conditions necessary for a dignity-enabling home: the ability to form and sustain meaningful relationships; access to community and civic life; access to control and flexibility of daily activities; access to opportunities for self-expression and identity affirmation; access to respectful relationships with attendants; access to opportunities to participate in school, work or leisure; access to physical, psychological and ontological security. The results have implications for housing, health and social care policies, and political reform. Social-dignity provides a normative ethical grounding for assessing the adequacy of home environments. The threshold elements outline specific dignity-enabling conditions that are open to further specification or elaboration in different contexts.Canadian Institutes of Health Research Catalyst Grant: Ethics (#87367

Just regionalisation: rehabilitating care for people with disabilities and chronic illnesses

Abstract Background Regionalised models of health care delivery have important implications for people with disabilities and chronic illnesses yet the ethical issues surrounding disability and regionalisation have not yet been explored. Although there is ethics-related research into disability and chronic illness, studies of regionalisation experiences, and research directed at improving health systems for these patient populations, to our knowledge these streams of research have not been brought together. Using the Canadian province of Ontario as a case study, we address this gap by examining the ethics of regionalisation and the implications for people with disabilities and chronic illnesses. The critical success factors we provide have broad applicability for guiding and/or evaluating new and existing regionalised health care strategies. Discussion Ontario is in the process of implementing fourteen Local Health Integration Networks (LHINs). The implementation of the LHINs provides a rare opportunity to address systematically the unmet diverse care needs of people with disabilities and chronic illnesses. The core of this paper provides a series of composite case vignettes illustrating integration opportunities relevant to these populations, namely: (i) rehabilitation and services for people with disabilities; (ii) chronic illness and cancer care; (iii) senior's health; (iv) community support services; (v) children's health; (vi) health promotion; and (vii) mental health and addiction services. For each vignette, we interpret the governing principles developed by the LHINs – equitable access based on patient need, preserving patient choice, responsiveness to local population health needs, shared accountability and patient-centred care – and describe how they apply. We then offer critical success factors to guide the LHINs in upholding these principles in response to the needs of people with disabilities and chronic illnesses. Summary This paper aims to bridge an important gap in the literature by examining the ethics of a new regionalisation strategy with a focus on the implications for people with disabilities and chronic illnesses across multiple sites of care. While Ontario is used as a case study to contextualize our discussion, the issues we identify, the ethical principles we apply, and the critical success factors we provide have broader applicability for guiding and evaluating the development of – or revisions to – a regionalised health care strategy