The intellectual challenge of doing bioethics in South Africa

Contemporary bioethics is a complex and multidisciplinary combination of medicine, philosophy and law, made more difficult because few, if any, bioethicists are masters of all three disciplines. To further complicate matters, each discipline contains specialised subdisciplines and internal debates. Philosophy is used to illustrate this point. Given constraints of expertise on practising bioethicists in South Africa, a few modest proposals are suggested to make bioethics as a discipline more rigorous in its use of medicine, philosophy and law

Smoking and intention to quit in deprived areas of Glasgow: is it related to housing improvements and neighbourhood regeneration because of improved mental health?

Background: People living in areas of multiple deprivation are more likely to smoke and less likely to quit smoking. This study examines the effect on smoking and intention to quit smoking for those who have experienced housing improvements (HI) in deprived areas of Glasgow, UK, and investigates whether such effects can be explained by improved mental health. Methods: Quasi-experimental, 2-year longitudinal study, comparing residents’ smoking and intention to quit smoking for HI group (n=545) with non-HI group (n=517), adjusting for baseline (2006) sociodemographic factors and smoking status. SF-12 mental health scores were used to assess mental health, along with self-reported experience of, and General Practitioner (GP) consultations for, anxiety and depression in the last 12 months. Results: There was no relationship between smoking and HI, adjusting for baseline rates (OR=0.97, 95% CI 0.57 to 1.67, p=0.918). We found an association between intention to quit and HI, which remained significant after adjusting for sociodemographics and previous intention to quit (OR 2.16, 95% CI 1.12 to 4.16, p=0.022). We found no consistent evidence that this association was attenuated by improvement in our three mental health measures. Conclusions: Providing residents in disadvantaged areas with better housing may prompt them to consider quitting smoking. However, few people actually quit, indicating that residential improvements or changes to the physical environment may not be sufficient drivers of personal behavioural change. It would make sense to link health services to housing regeneration projects to support changes in health behaviours at a time when environmental change appears to make behavioural change more likely

Should the state support the \'right to die\'?

Euthanasia and physician-assisted suicide (hereafter E/PAS) is a practice with a long history. It was a frequent occurrence in the Ancient World, despite the prohibitions of the Hippocratic Oath (which had no legal standing and was supported by a minority of Greco-Roman physicians). It was condemned as murder by the Christian community and prohibited in Christian Europe (though – like abortion – was no doubt practised secretly). Strong support and advocacy for E/PAS re-emerged in the 19th century in Europe and North America. The first attempts to legalise it, in a number of states in the USA, were defeated in the early 1900s, though voluntary euthanasia societies advocating for reform of existing laws proliferated there and throughout Europe.1 Although not legal, cases brought before the courts – particularly in the USA, Britain and The Netherlands – were treated with remarkable leniency. South African Journal of Bioethics & Law Vol. 1 (2) 2008: pp. 47-5

Improving performance through HEI–industry engagements in the built environment

The poor performance and inefficiencies of the construction industry are well recognized and documented. Through a variety of combined industry and government initiatives there has been a continual expression in the UK over the last decade of the urgent need to address the fragmented nature of the industry to improve its performance. A major challenge is for education and industry stakeholders to create closer and more effective relationships with each other to facilitate greater mutual understanding. ‘Accelerating Change in Built Environment Education’ (ACBEE) is a sponsored initiative designed to encourage the closer working together of industry, education and professional bodies to provide more relevant training and education. This paper introduces ACBEE, along with an evaluation framework for measuring the performance of engagements at various levels. This is followed by an analysis of the application of this performance measurement framework through case studies of industry–education engagement. A number of case studies were identified as operating at the grades of ‘strategic alliance’ and ‘partnership’ (as classified in the ACBEE evaluation framework). The analysis of these cases focuses on the drivers behind and the purpose of the engagement, and how these are aligned with the business strategy of the collaborating organizations and measurement of the activity. Evidence of meeting the explicit business needs and strategic objectives and the contribution to good practice knowledge are also discussed

Analytical and experimental investigations of low level acceleration measurement techniques

Construction techniques for accelerometer with low level threshold sensitivit

How robust is the evidence of an emerging or increasing female excess in physical morbidity between childhood and adolescence? Results of a systematic literature review and meta-analyses

For asthma and psychological morbidity, it is well established that higher prevalence among males in childhood is replaced by higher prevalence among females by adolescence. This review investigates whether there is evidence for a similar emerging female ‘excess’ in relation to a broad range of physical morbidity measures. Establishing whether this pattern is generalised or health outcome-specific will further understandings of the aetiology of gender differences in health. Databases (Medline; Embase; CINAHL; PsycINFO; ERIC) were searched for English language studies (published 1992–2010) presenting physical morbidity prevalence data for males and females, for at least two age-bands within the age-range 4–17 years. A three-stage screening process (initial sifting; detailed inspection; extraction of full papers), was followed by study quality appraisals. Of 11 245 identified studies, 41 met the inclusion criteria. Most (n = 31) presented self-report survey data (five longitudinal, 26 cross-sectional); 10 presented routinely collected data (GP/hospital statistics). Extracted data, supplemented by additional data obtained from authors of the included studies, were used to calculate odds ratios of a female excess, or female:male incident rate ratios as appropriate. To test whether these changed with age, the values were logged and regressed on age in random effects meta-regressions. These showed strongest evidence of an emerging/increasing female excess for self-reported measures of headache, abdominal pain, tiredness, migraine and self-assessed health. Type 1 diabetes and epilepsy, based on routinely collected data, did not show a significant emerging/increasing female excess. For most physical morbidity measures reviewed, the evidence broadly points towards an emerging/increasing female excess during the transition to adolescence, although results varied by morbidity measure and study design, and suggest that this may occur at a younger age than previously thought