Can "presumed consent" justify the duty to treat infectious diseases? An analysis

<p>Abstract</p> <p>Background</p> <p>AIDS, SARS, and the recent epidemics of the avian-flu have all served to remind us the debate over the limits of the moral duty to care. It is important to first consider the question of whether or not the "duty to treat" might be subject to contextual constraints. The purpose of this study was to investigate the opinions and beliefs held by both physicians and dentists regarding the occupational risks of infectious diseases, and to analyze the argument that the notion of "presumed consent" on the part of professionals may be grounds for supporting the duty to treat.</p> <p>Methods</p> <p>For this cross-sectional survey, the study population was selected from among physicians and dentists in Ankara. All of the 373 participants were given a self-administered questionnaire.</p> <p>Results</p> <p>In total, 79.6% of the participants said that they either had some degree of knowledge about the risks when they chose their profession or that they learned of the risks later during their education and training. Of the participants, 5.2% said that they would not have chosen this profession if they had been informed of the risks. It was found that 57% of the participants believed that there is a standard level of risk, and 52% of the participants stated that certain diseases would exceed the level of acceptable risk unless specific protective measures were implemented.</p> <p>Conclusion</p> <p>If we use the presumed consent argument to establish the duty of the HCW to provide care, we are confronted with problems ranging over the difficulty of choosing a profession autonomously, the constant level of uncertainty present in the medical profession, the near-impossibility of being able to evaluate retrospectively whether every individual was informed, and the seemingly inescapable problem that this practice would legitimize, and perhaps even foster, discrimination against patients with certain diseases. Our findings suggest that another problem can be added to the list: one-fifth of the participants in this study either lacked adequate knowledge of the occupational risks when they chose the medical profession or were not sufficiently informed of these risks during their faculty education and training. Furthermore, in terms of the moral duty to provide care, it seems that most HCWs are more concerned about the availability of protective measures than about whether they had been informed of a particular risk beforehand. For all these reasons, the presumed consent argument is not persuasive enough, and cannot be used to justify the duty to provide care. It is therefore more useful to emphasize justifications other than presumed consent when defining the duty of HCWs to provide care, such as the social contract between society and the medical profession and the fact that HCWs have a greater ability to provide medical aid.</p

A brain-based pain facilitation mechanism contributes to painful diabetic polyneuropathy.

The descending pain modulatory system represents one of the oldest and most fundamentally important neurophysiological mechanisms relevant to pain. Extensive work in animals and humans has shown how a functional imbalance between the facilitatory and inhibitory components is linked to exacerbation and maintenance of persistent pain states. Forward translation of these findings into clinical populations is needed to verify the relevance of this imbalance. Diabetic polyneuropathy is one of the most common causes of chronic neuropathic pain; however, the reason why ∼25–30% of patients with diabetes develop pain is not known. The current study used a multimodal clinical neuroimaging approach to interrogate whether the sensory phenotype of painful diabetic polyneuropathy involves altered function of the ventrolateral periaqueductal grey—a key node of the descending pain modulatory system. We found that ventrolateral periaqueductal grey functional connectivity is altered in patients suffering from painful diabetic polyneuropathy; the magnitude of which is correlated to their spontaneous and allodynic pain as well as the magnitude of the cortical response elicited by an experimental tonic heat paradigm. We posit that ventrolateral periaqueductal grey-mediated descending pain modulatory system dysfunction may reflect a brain-based pain facilitation mechanism contributing to painful diabetic polyneuropathy.Funding for this work was generously provided from the following sources: National Institute for Health Research Oxford Biomedical Research Centre, Medical Research Council of Great Britain and Northern Ireland, the Wellcome Trust (London, UK) and the Innovative Medicines Initiative Joint Undertaking (Brussels, Belgium), under grant agreement no 115007 resources of which are composed of financial contribution from the European Union’s Seventh Framework Programme (FP7/2007–2013) and EFPIA companies’ in kind contribution. D.L.B. and A.C.T. are members of the DOLORisk consortium funded by the European Commission Horizon 2020 (ID633491). D.L.B. and A.C.T. are members of the International Diabetic Neuropathy Consortium, the Novo Nordisk Foundation (Ref. NNF14SA0006). D.L.B. is a senior Wellcome clinical scientist (Ref. 202747/Z/16/Z). The project was supported by a strategic award from the Wellcome (Ref. 102645). A.R.S., D.L.B., and I.T. are members of the Wellcome Pain Consortium (Ref. 102645). A.C.T. is an Honorary Research Fellow of the Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

Use of complementary and alternative medicines by a sample of Turkish women for infertility enhancement: a descriptive study

<p>Abstract</p> <p>Background</p> <p>Infertility patients are a vulnerable group that often seeks a non-medical solution for their failure to conceive. World-wide, women use CAM for productive health, but only a limited number of studies report on CAM use to enhance fertility. Little is known about traditional and religious forms of therapies that are used in relation to conventional medicine in Turkey. We investigated the prevalence and types of complementary and alternative medicine (CAM) used by infertile Turkish women for fertility enhancement.</p> <p>Methods</p> <p>A face-to-face questionnaire inquiring demographic information and types of CAM used for fertility enhancement were completed by hundred infertility patients admitted to a primary care family planning centre in Van, Turkey between January and July 2009.</p> <p>Results</p> <p>The vast majority of infertile women had used CAM at least once for infertility. CAM use included religious interventions, herbal products and recommendations of traditional "hodja's" (faith healers). Of these women, 87.8% were abused in the last 12 months, 36.6% felt not being supported by her partner and 80.5% had never spoken with a physician about CAM.</p> <p>Conclusions</p> <p>Infertile Turkish women use complementary medicine frequently for fertility enhancement and are in need of information about CAM. Religious and traditional therapies are used as an adjunct to, rather than a substitute for, conventional medical therapy. Physicians need to approach fertility patients with sensitivity and should be able to council their patients about CAM accordingly.</p

Effects of Shinrin-yoku Retreat on Mental Health: A Pilot Study in Fukushima, Japan

Shinrin-yoku (forest bathing) is a cost-effective healing practice that has recently attracted the interest of social scientists who have attributed it, in part, to mental health benefits. Japanese university students suffer from high rates of mental health problems, and the number of suicides remain high despite the total number of suicides in Japan decreasing. Effective mental health approaches which increase mental wellbeing and self-compassion, and reduce associated deficits, such as loneliness, are sought after for Japanese students, however healthful treatment has not been identified to date. Accordingly, this pre-post pilot study evaluated the levels of mental wellbeing, self-compassion, and loneliness among 25 Japanese undergraduate students who participated in a three-day shinrin-yoku retreat in Fukushima. Measurements were taken prior, straight after, and two weeks-post intervention. One-way ANOVA with Tukey post hoc analysis revealed that the mean scores of self-compassion, common humanity, and mindfulness increased statistically significantly from pre-retreat to follow-up. The mean scores of mental wellbeing and loneliness did not statistically significantly change. The positive effects on self-compassion indicate that shinrin-yoku retreat should be evaluated within a larger sample and in a shorter time frame to establish optimal shinrin-yoku parameters in this arena.N/

Field-study science classrooms as positive and enjoyable learning environments

We investigated differences between field-study classrooms and traditional science classrooms in terms of the learning environment and students’ attitudes to science, as well as the differential effectiveness of field-study classrooms for students differing in sex and English proficiency. A modified version of selected scales from the What Is Happening In this Class? questionnaire was used to assess the learning environment, whereas students’ attitudes were assessed with a shortened version of a scale from the Test of Science Related Attitudes. A sample of 765 grade 5 students from 17 schools responded to the learning environment and attitude scales in terms of both their traditional science classrooms and classrooms at a field-study centre in Florida. Large effect sizes supported the effectiveness of the field-studies classroom in terms of both the learning environment and student attitudes. Relative to the home school science class, the field-study class was considerably more effective for students with limited English proficiency than for native English speakers

Health-related quality of life in Iranian women with polycystic ovary syndrome: a qualitative study

Background Polycystic ovary syndrome (PCOS) is associated with a range of challenging symptoms which impact patient’s lives. Iranian women with PCOS are likely to face a number of unique difficulties given particular societal and cultural norms for women. Understanding health-related quality of life (HRQoL) from a patients’perspective is critical to developing the appropriate support interventions. The present study aimed to generate an in-depthunderstanding of HRQoL Iranian women with PCOS. Methods Twenty Iranian women were interviewed and data was subjected to thematic analysis. Results Women reported substantial effects of PCOS on their quality of life, Themes generated from the data related to sexual - physical problems (An unsexualised self: loss, change and pain; and Being pained and painful); exposure and nvasion: the rejecting and invading social world (Concealing and Avoiding and Public property: public scrutiny), diminished self and diminished life (Infertile as inferior and Exhausted mind andbody) respectively. Conclusion PCOS is a physical - sexual, psychological and social syndrome; therefore, it is necessary to taking a more holistic approach to patient care beyond treating physical symptoms

Teaching controversial environmental issues in 16-19 A level geography : possibilities and problems

Environmental issues are often controversial and involve a range of possible viewpoints or attitudes. They are poorly understood hi the general population and, even amongst well respected scientists, there is often little consensus as to the causes and effects of environmental problems. Teachers are sometimes accused of exacerbating this situation by indoctrinating children with simplistic 'green slogans', rather than teaching a deeper understanding of the complexity of the issues. However, the advice provided for teachers is contradictory: much of the literature on teaching environmental issues encourages teachers to promote pro-environmental attitudes or behaviour, whilst simultaneously encouraging independence of thought amongst their students. Literature on teaching environmental and other controversial issues suggests several possible teaching strategies, but all are open to criticism on varying grounds and therefore provide little in the way of guidance for teachers. This study examines the beliefs and practices of three experienced geography teachers in relation to teaching about controversial environmental issues in the Schools' Council 16-19 A level course. This course was one of the first to embrace the teaching of controversial environmental issues, and provides explicit guidance for teachers on the development of students' environmental attitudes. Using unstructured observation, and informant-style interviews with the teachers and their sixth form students, the research investigates the similarities and differences between the teachers' beliefs and practices, and considers the educational problems and possibilities with teaching controversial environmental issues. The findings reveal a substantial divergence between the teachers' beliefs and the espoused aims of both the environmental education literature and the 16-19 syllabus. These teachers reject the aim of promoting pro-environmental attitudes in favour of a form of balanced learning. This involves the twin aims of providing access to a diversity of viewpoints, whilst maintaining a stance of non-intervention, by which they hope to encourage students to make independent decisions about appropriate environmental behaviour. A variety of imaginative teaching strategies are utilised in the pursuit of these aims. However, the findings of this study also illustrate the difficulties encountered by these teachers in trying to implement their beliefs, problems which can be explained by the influence of various constraints, such as the syllabus and examinations, the students' behaviour and characteristics, the subject matter being taught, and the teachers' own knowledge, pedagogical skills, and attitudes

Teaching controversial environmental issues in 16-19 A level geography : possibilities and problems

Environmental issues are often controversial and involve a range of possible viewpoints or attitudes. They are poorly understood hi the general population and, even amongst well respected scientists, there is often little consensus as to the causes and effects of environmental problems. Teachers are sometimes accused of exacerbating this situation by indoctrinating children with simplistic 'green slogans', rather than teaching a deeper understanding of the complexity of the issues. However, the advice provided for teachers is contradictory: much of the literature on teaching environmental issues encourages teachers to promote pro-environmental attitudes or behaviour, whilst simultaneously encouraging independence of thought amongst their students. Literature on teaching environmental and other controversial issues suggests several possible teaching strategies, but all are open to criticism on varying grounds and therefore provide little in the way of guidance for teachers. This study examines the beliefs and practices of three experienced geography teachers in relation to teaching about controversial environmental issues in the Schools' Council 16-19 A level course. This course was one of the first to embrace the teaching of controversial environmental issues, and provides explicit guidance for teachers on the development of students' environmental attitudes. Using unstructured observation, and informant-style interviews with the teachers and their sixth form students, the research investigates the similarities and differences between the teachers' beliefs and practices, and considers the educational problems and possibilities with teaching controversial environmental issues. The findings reveal a substantial divergence between the teachers' beliefs and the espoused aims of both the environmental education literature and the 16-19 syllabus. These teachers reject the aim of promoting pro-environmental attitudes in favour of a form of balanced learning. This involves the twin aims of providing access to a diversity of viewpoints, whilst maintaining a stance of non-intervention, by which they hope to encourage students to make independent decisions about appropriate environmental behaviour. A variety of imaginative teaching strategies are utilised in the pursuit of these aims. However, the findings of this study also illustrate the difficulties encountered by these teachers in trying to implement their beliefs, problems which can be explained by the influence of various constraints, such as the syllabus and examinations, the students' behaviour and characteristics, the subject matter being taught, and the teachers' own knowledge, pedagogical skills, and attitudes.</p