To assess the relatedness of journal content to paid advertisements published in the journal.
The case-control study was performed on a convenience sample of 7 journals subscribed by Central Medical Library in Moscow – 4 international (American Journal of Hypertension, British Journal of General Practice, The Lancet, and New England Journal of Medicine) and 3 Russian peer reviewed journals (Terapevticheskii Arkhiv, Khirurgiia, and Voeno-Meditsinskii Zhurnal). In each issue containing a paid advertisement, classifieds excluded, we searched for articles related to the advertised product and compared this issue with a control issue – the next or a later issue without this advertisement.
In American Journal of Hypertension (33 issues from 2002-2004) 94 placements of advertisements were found, 7 of which were closely related to the article topic in the same issue (7/94) vs 2/66 in the control issue. The odds ratio (OR) and 95% confidence interval (CI) for advertisements to be accompanied by related articles was OR, 2.6; 95%CI, 0.5-13). In British Journal of General Practice (27 issues from 2003-2005) there were 7/63 advertisements related to the article topic vs 0/28 in the control issue (OR, 7.2; 95% CI, 1.3 to 44). In The Lancet (49 issues from 2004) there were 8/162 advertisements related to the article topic vs 8/104 in the control issue (OR, 0.6; 95% CI, 0.3-1.5). In New England Journal of Medicine (37 issues from 2004) there were 12/81 advertisements related to the article topic vs 8/75 in the control issue (OR, 1.5; 95% CI, 0.56-3.79). In Terapevticheskii Arkhiv (10 issues from 2004) there were 38/93 advertisements related to the article topic vs 1/83 in the control issue (OR, 56.66; 95% CI, 4.4-253). In Khirurgiia (25 issues from 2003-2005) there were 3/83 advertisements related to the article topic vs 0/70 in the control issue (OR, 2.7; 95% CI, 0.3-26). In Voeno-Meditsinskii Zhurnal (33 issues from 2003-2005) there were 17/31 advertisements related to the article topic vs 2/31 in the control issue (OR,17.6; 95% CI, 3.6-87).
The strong relatedness between the content of the articles and advertisements placed in 3 of 7 journals and explicit placement of the advertisements face to face or overleaf the related research articles support the hypothesis that journal content is manipulated to place more emphasis on the advertisements.
Across 3 experiments, the authors examined the effects of temporal distance on negotiation behavior. They found that greater temporal distance from negotiation decreased preference for piecemeal, single-issue consideration over integrative, multi-issue consideration (Experiment 1). They also found that greater temporal distance from an event being negotiated increased interest in conceding on the lowest priority issue and decreased interest in conceding on the highest priority issue (Experiment 2). Lastly, they found increased temporal distance from an event being negotiated produced a greater proportion of multi-issue offers, a greater likelihood of conceding on the lowest priority issue in exchange for a concession on the highest priority issue, and greater individual and joint outcomes (Experiment 3). Implications for conflict resolution and construal level theory are discussed.
construal; time; psychological distance; negotiation; integrative
In response to widespread concern about illegal drug use and the associated risk of the spread of HIV/AIDS, a study was undertaken to examine whether it was, in principle, feasible to conduct a trial providing heroin to dependent users in a controlled manner. Such a trial involves real ethical issues which are examined in this paper. The general issues examined are: should a trial be an experiment or an exercise in public policy?; acts and omissions; countermobilization; termination of a trial, and payment for drugs and for a trial. The specific issues examined are: selection of trial participants; privacy; issues for staff working on a trial; coupling the trial with other treatment, and issues for researchers. A number of alternative approaches to the various ethical issues are presented and discussed.
Despite positive aspects of online forums as a qualitative research method, very little is known about practical issues involved in using online forums for data collection, especially for a qualitative research project.
The purpose of this paper is to describe the practical issues that the researchers encountered in implementing an online forum as a qualitative component of a larger study on cancer pain experience.
Throughout the study process, the research staff recorded issues ranged from minor technical problems to serious ethical dilemmas as they arose and wrote memos about them. The memos and written records of discussions were reviewed and analyzed using the content analysis suggested by Weber.
Two practical issues related to credibility were identified: a high response and retention rate and automatic transcripts. An issue related to dependability was the participants’ easy forgetfulness. The issues related to confirmability were difficulties in theoretical saturation and unstandardized computer and Internet jargon. A security issue related to hacking attempts was noted as well.
The analysis of these issues suggests several implications for future researchers who want to use online forums as a qualitative data collection method.
Issues; Online Forums; Cancer Patients; Qualitative Research
The present research suggests that negotiators who represented negotiation issues more abstractly were more likely to reach integrative agreements. Specifically, participants who were prompted to directly think about their negotiation issues in a more abstract manner by generating general descriptions of the issues rather than more concretely about the negotiation issues by generating specific descriptions of the issues made more multi-issue offers and achieved higher joint gain from the negotiation. The role of abstraction in negotiation and conflict resolution is discussed.
This article is part of a series written for people responsible for making decisions about health policies and programmes and for those who support these decision makers.
Policy briefs are a relatively new approach to packaging research evidence for policymakers. The first step in a policy brief is to prioritise a policy issue. Once an issue is prioritised, the focus then turns to mobilising the full range of research evidence relevant to the various features of the issue. Drawing on available systematic reviews makes the process of mobilising evidence feasible in a way that would not otherwise be possible if individual relevant studies had to be identified and synthesised for every feature of the issue under consideration. In this article, we suggest questions that can be used to guide those preparing and using policy briefs to support evidence-informed policymaking. These are: 1. Does the policy brief address a high-priority issue and describe the relevant context of the issue being addressed? 2. Does the policy brief describe the problem, costs and consequences of options to address the problem, and the key implementation considerations? 3. Does the policy brief employ systematic and transparent methods to identify, select, and assess synthesised research evidence? 4. Does the policy brief take quality, local applicability, and equity considerations into account when discussing the synthesised research evidence? 5. Does the policy brief employ a graded-entry format? 6. Was the policy brief reviewed for both scientific quality and system relevance?
There is a substantial body of literature on psychosocial impacts of chemical and nuclear accidents. Less attention, however, has been focused on the program and policy issues that are connected with efforts to provide psychosocial assistance to the victims of such accidents. Because psychosocial assistance efforts are certain to be an essential part of the response to future environmental emergencies, it is vital that relevant program and policy issues by more fully considered. This article discusses the highly complex nature of contamination situations and highlights some of the key policy issues that are associated with the provision of psychosocial services after environmental accidents. One issue concerns the potential for assistance efforts to become objects of conflict. In the context of the intense controversy typically associated with chemical or nuclear accidents, and with debates over the causation of illness usually at the center of environmental accidents, psychosocial assistance services may themselves become contested terrain. Other significant program and policy issues include determining how to interface with citizen self-help and other voluntary groups, addressing the problem of stigma, and deciding how to facilitate stakeholder participation in the shaping of service provision. This article offers a series of policy proposals that may help smooth the way for psychosocial assistance programs in future environmental emergencies.
OBJECTIVES: To compare the perceptions of physician executives and clinicians regarding ethical issues in Saudi Arabian hospitals and the attributes that might lead to the existence of these ethical issues. DESIGN: Self-completion questionnaire administered from February to July 1997. SETTING: Different health regions in the Kingdom of Saudi Arabia. PARTICIPANTS: Random sample of 457 physicians (317 clinicians and 140 physician executives) from several hospitals in various regions across the kingdom. RESULTS: There were statistically significant differences in the perceptions of physician executives and clinicians regarding the existence of various ethical issues in their hospitals. The vast majority of physician executives did not perceive that seven of the eight issues addressed by the study were ethical concerns in their hospitals. However, the majority of the clinicians perceived that six of the same eight issues were ethical considerations in their hospitals. Statistically significant differences in the perceptions of physician executives and clinicians were observed in only three out of eight attributes that might possibly lead to the existence of ethical issues. The most significant attribute that was perceived to result in ethical issues was that of hospitals having a multinational staff. CONCLUSION: The study calls for the formulation of a code of ethics that will address specifically the physicians who work in the kingdom of Saudi Arabia. As a more immediate initiative, it is recommended that seminars and workshops be conducted to provide physicians with an opportunity to discuss the ethical dilemmas they face in their medical practice.
AIMS—To ascertain the
type and extent of problems requiring advocacy in paediatrics. To
develop an approach for analysing problems according to their root
causes and the level of society at which advocacy is needed.
paediatricians kept detailed clinical diaries for two weeks to identify
problems. Classifications were developed to categorise problems by
cause and the level of society at which they needed to be addressed.
The press was surveyed for one week for childhood issues attracting
requiring advocacy were identified. Root causes included failures
within agencies, between agencies, and inadequate provision. In
addition to advocacy required individually, "political" action was
needed at the community level (16 issues), city level (16 issues), and nationally (15 issues). 103 articles were found in the
press, these did not relate closely to issues identified by clinicians.
opportunities for advocacy arise in the course of daily work. A
systematic way of analysing them has been developed for use in planning
action. To optimise the health and health care of children, there is a
need to train and support paediatricians in advocacy work for local as
well as national issues. Ten issues were identified that might be
prioritised by paediatricians working on an agenda for action.
Scenario analysis is a strategic planning technique used to describe and evaluate an organization's external environment. A methodology for conducting scenario analysis using the Jefferson County Department of Health and the national, State, and county issues confronting it is outlined. Key health care and organizational issues were identified using published sources, focus groups, questionnaires, and personal interviews. The most important of these issues were selected by asking health department managers to evaluate the issues according to their probability of occurrence and likely impact on the health department. The high-probability, high-impact issues formed the basis for developing scenario logics that constitute the story line holding the scenario together. The results were a set of plausible scenarios that aided in strategic planning, encouraged strategic thinking among managers, eliminated or reduced surprise about environmental changes, and improved managerial discussion and communication.
Empirical studies of ethical issues, which have increased in number and scope in recent years, may themselves raise both practical and ethical issues. One example of such an issue is the question of who may be legitimately enrolled in studies of decision-making capacity; must all participants in studies of consent capacity have capacity to consent? This question may pose a “Catch-22”: For example, if some of the participants in a study of consent capacity are deemed by a particular standard to be incapable of consent. In weighing the risks and benefits of studies of consent capacity, how should reviewers consider the context of actual versus hypothetical trials for which the participant's consent is being sought? Here, we explore these “meta-consent” issues by describing the dimensions of the issue and potential solutions, centering around the concept of “active assent” (requiring expressed understanding of the purpose of the study and its voluntary nature, as well as expression of a choice to participate).
decision-making capacity; research ethics; informed consent; bioethics; clinical trials
This special issue of Hormones and Behavior, “Androgens in health and disease: new insights into roles and mechanisms of action,” is prompted by a number of relatively recent findings that androgens affect brain morphology and function in ways not previously or widely appreciated. Moreover, recent results also make it clear that androgens utilize a variety of signaling molecules to exert their effects on the brain, which may or may not depend on the classic nuclear androgen receptor (AR). The papers in this issue underscore these two points. This overview is not intended as a comprehensive review of androgen action on the nervous system, since the papers in this issue serve that purpose, but rather to frame the basic issues and themes that tie these papers together. The sum effect of the stories told in this issue encourages us to broaden and refocus our view of androgen action on brain and behavior—to recognize that androgens affect many aspects of brain structure and function throughout the lifespan, from shaping its sexual phenotype to influencing its propensity for disease and repair, and that at least some of these actions are exerted via non-classical modes of action that in many cases were first identified in non-neural tissue or cells.
Security is a high priority issue in medical domain, because many institutions performing biomedical research work with sensitive medical data regularly. This issue becomes more complicated, when it is desirable or needed to access and analyze data in a multi-institutional setting. In the NCI cancer Biomedical Informatics Grid (caBIG™) program, several security issues were raised that existing security technologies could not address. Considering caBIG is envisioned to span a large number of cancer centers and investigator laboratories, these issues pose considerable challenge. In this paper we present these issues and the infrastructure, referred to as GAARDS, which has been developed to address them.
OBJECTIVE: To interpret the results of a cross-site study of physician order entry (POE) in hospitals using a diffusion of innovations theory framework. METHODS: Qualitative study using observation, focus groups, and interviews. Data were analyzed by an interdisciplinary team of researchers using a grounded approach to identify themes. Themes were then interpreted using classical Diffusion of Innovations (DOI) theory as described by Rogers . RESULTS: Four high level themes were identified: organizational issues; clinical and professional issues; technology implementation issues; and issues related to the organization of information and knowledge. Further analysis using the DOI framework indicated that POE is an especially complex information technology innovation when one considers communication, time, and social system issues in addition to attributes of the innovation itself. CONCLUSION: Implementation strategies for POE should be designed to account for its complex nature. The ideal would be a system that is both customizable and integrated with other parts of the information system, is implemented with maximum involvement of users and high levels of support, and is surrounded by an atmosphere of trust and collaboration.
Health research database security issues abound. Issues include subject confidentiality, data ownership, data integrity and data accessibility. There are also various stakeholders in database security. Each of these stakeholders has a different set of concerns and responsibilities when dealing with security issues. There is an obvious need for training in security issues, so that these issues may be addressed and health research will move on without added obstacles based on misunderstanding security methods and technologies.
Limited attention has been paid to the issue of reproductive health as it affects women with intellectual disabilities, despite reproductive health being a vital issue in public health policy for women in the general population. This paper describes caregiver awareness of reproductive health issues relative to women with intellectual disabilities who are being cared for in welfare institutions in Taiwan.
The study employed a cross-sectional, questionnaire-based study which recruited 1,152 caregivers (response rate = 71.87%) from 32 registered disability welfare institutions in Taiwan. We classified their understanding/awareness of reproductive health issues into four domains: menstrual (1) and menopause (2) issues, sex education (3), and reproductive health services (4). Each domain had five associated yes/no questions and the total score for the four domains was out of a maximum of 20. Data were analyzed using SPSS 15.0 software.
We found that most of the caregivers were familiar with matters concerning sex education, menopause, and reproductive health services, but they lacked adequate understanding of issues associated with menstruation in women with ID. Many aspects of reproductive health such as "menstrual pain", "age at menarche", "masturbation", "diet during perimenopause", and "publicly available reproductive health services" were issues in which caregivers lacked adequate knowledge and required further instruction. Logistic regression analysis revealed that female caregivers with a university degree, and those who had experience assisting with reproductive health care were more inclined to have higher reproductive health awareness scores than their counterparts.
This study highlights that service providers should offer appropriate reproductive health education to institutional caregivers, and that more attention be focused on the personal experiences and concerns of intellectually disabled women in future research.
Image retrieval at the semantic level mostly depends on image annotation or image classification. Image annotation performance largely depends on three issues: (1) automatic image feature extraction; (2) a semantic image concept modeling; (3) algorithm for semantic image annotation. To address first issue, multilevel features are extracted to construct the feature vector, which represents the contents of the image. To address second issue, domain-dependent concept hierarchy is constructed for interpretation of image semantic concepts. To address third issue, automatic multilevel code generation is proposed for image classification and multilevel image annotation. We make use of the existing image annotation to address second and third issues. Our experiments on a specific domain of X-ray images have given encouraging results.
Image classification; image annotation; image processing; machine learning
Conducting qualitative interviews with seriously ill individuals about end-of-life issues is challenging for interviewers seeking to understand the problems, processes, and experiences individuals undergo when faced with death and dying. Although all qualitative interviewers face issues of building trust and obtaining answers to their research questions, these issues are exacerbated for interviewers of end-of-life issues due to the challenges of debilitated participants, sensitive subject matter, and heightened emotionalism. The purpose of this article is to offer field-tested techniques to tailor basic interviewing practices for discussions of end-of-life issues with seriously ill individuals. Use of tailored techniques facilitates the comfort of both interviewer and participant and enhances the probability of obtaining complete and accurate data, which in turn can improve the effectiveness of subsequent programs, policies, and clinical practice based on research findings.
Nurse managers have the burden of experiencing frequent ethical issues related to both their managerial and nursing care duties, according to previous international studies. However, no such study was published in Malaysia. The purpose of this study was to explore nurse managers' experience with ethical issues in six government hospitals in Malaysia including learning about the way they dealt with the issues.
A cross-sectional study was conducted in August-September, 2010 involving 417 (69.2%) of total 603 nurse managers in the six Malaysian government hospitals. Data were collected using three-part self-administered questionnaire. Part I was regarding participants' demographics. Part II was about the frequency and areas of management where ethical issues were experienced, and scoring of the importance of 11 pre-identified ethical issues. Part III asked how they dealt with ethical issues in general; ways to deal with the 11 pre-identified ethical issues, and perceived stress level. Data were analyzed using descriptive statistics, cross-tabulations and Pearson's Chi-square.
A total of 397 (95.2%) participants experienced ethical issues and 47.2% experienced them on weekly to daily basis. Experiencing ethical issues were not associated with areas of practice. Top area of management where ethical issues were encountered was "staff management", but "patient care" related ethical issues were rated as most important. Majority would "discuss with other nurses" in dealing generally with the issues. For pre-identified ethical issues regarding "patient care", "discuss with doctors" was preferred. Only 18.1% referred issues to "ethics committees" and 53.0% to the code of ethics.
Nurse managers, regardless of their areas of practice, frequently experienced ethical issues. For dealing with these, team-approach needs to be emphasized. Proper understanding of the code of ethics is needed to provide basis for reasoning.
This paper considers a range of issues related to the financing of health care system and relevant government policies in Iran.
This study used mixed methods. A systematic literature review was undertaken to identify relevant publications. This was supplemented by hand searching in books and journals, including government publications. The issues and uncertainties identified in the literature were explored in detail through semi-structured interviews with key informants. These were triangulated with empirical evidence in the form of the literature, government statistics and independent expert opinions to validate the views expressed in the interviews.
The systematic review of published literature showed that no previous publication has addressed issues relating to the financing of healthcare services in Iran. However, a range of opinion pieces outlined issues to be explored further in the interviews. Such issues summarised into four main categories.
The health care market in Iran has faced a period in which financial issues have enhanced managerial complexity. Privatization of health care services would appear to be a step too far in assisting the system to confront its challenges at the current time. The most important step toward solving such challenges is to focus on a feasible, relevant and comprehensive policy, which optimises the use of health care resources in Iran.
Healthcare; Financing; privatization; Iran
With a focus on the Danum Valley area of Sabah, Malaysian Borneo, this special issue has as its theme the future of tropical rainforests in a changing landscape and climate. The global environmental context to the issue is briefly given before the contents and rationale of the issue are summarized. Most of the papers are based on research carried out as part of the Royal Society South East Asia Rainforest Research Programme. The issue is divided into five sections: (i) the historical land-use and land management context; (ii) implications of land-use change for atmospheric chemistry and climate change; (iii) impacts of logging, forest fragmentation (particularly within an oil palm plantation landscape) and forest restoration on ecosystems and their functioning; (iv) the response and resilience of rainforest systems to climatic and land-use change; and (v) the scientific messages and policy implications arising from the research findings presented in the issue.
rainforest; climate change; land-use change; land management; landscape
Doctors undertaking vocational training in general practice in Australia may require assistance, in addition to the normal training offered as part of their training programme. Issues requiring assistance may go undetected for a period of time. Delay in the identification of issues leads to delay in the provision of the assistance. The aim of this study is to determine the most common reasons registrars require extra assistance, and how these issues are identified. The findings of this study will provide direction for 21 regionally based training providers (RTPs) to develop improved tools to ensure earlier detection of registrars requiring assistance.
This study is based on qualitative research methods, using semi-structured interviews with senior medical education staff of four regional general practice training providers in Victoria, Australia.
Issues identified included language and cultural issues, applied knowledge and skills, attitude and professionalism, and health and family issues.
The principal method that training providers identified issues was via the GP supervisor. This was predominantly by informal communication, rather than formal evaluation sheets. Other methods included the external clinical teaching visit and other training formative assessments. These more formalised procedures were more likely to identify issues later than desired. They were also used as a way of clarifying suspected problems. The selection process was not felt to be helpful, and the examinations provided information too late.
An increased awareness of the potential issues leading to a registrar to require assistance enables identification and subsequent action to occur in a more timely and more useful fashion. Informal communication between practices and training programme staff should be encouraged to enable these issues to be dealt with early in training.
General practice; remediation; vocational training
Though much attention in the medical literature has focused on the ethics of critical care, it seems to be disproportionately weighted toward clinical issues. On the presumption that the operational management of an intensive care unit (ICU) also requires ethical considerations, it would be useful to know what these are. This review undertook to identify what literature exists with regard to the non-clinical issues of ethical importance in the ICU as encountered by clinician–managers. We found that in addition to issues of resource allocation, there exist many areas of ethical importance to clinician–managers in the ICU that have been described only superficially. We argue that a renewed focus on ICU ethics is merited to shed light on these other, non-clinical, issues.
critical care; clinician–manager; ethics; management
This symposium provided a useful forum for the discussion of issues relating to the design and conduct of clinical trials. There is a need for greater awareness of the complexity of modern day trials, in which a host of statistical, logistical, regulatory and ethical issues are involved. Issues discussed ranged from the effect of sample size on the outcome, and subgroup analysis, to defining and maintaining discrete endpoints. Some useful debate centred on the use of meta-analysis and the current limitations of combining information from different data sets. This brought up the subjects of trial registries and raw data repositories for all clinical trials. Progress and relevance of the Cochrane collaboration were reviewed. The economics of clinical trials was another important topic. Regulatory issues such as the role of data and safety monitoring boards (DSMB) and the guidelines in place for effective data monitoring and progress analysis were discussed. Representatives of government organisations and industry gave both European and American perspectives. This report however focuses specifically on the section devoted to the subject of clinical trials in developing countries.
clinical trial; developing countries; ethics; publishing; symposium
Australasian Chirpractic & Osteopathy has re-ordered its Volume and Issue numbers. It has skipped from Volume 11, Issue number 2, July 2003, to Volume 12, Issue 1, July 2004. This re-ordering was necessary after an unusual and unexpected set of editorial delays. ACO apologises for this change but advises subscribers that there will be no loss in the number of issues they receive.