Knowledge,Attitudes and Perceptions of Saudis towards Participating in Clinical Trials

Aim

To assess the knowledge, attitudes, and perceptions of Saudis towards participating in clinical trials (CTs).

Methods

A cross-sectional study was conducted on 232 Saudi adult patients and their companions visiting adult outpatient clinics at King Fahad Medical City, Riyadh, Saudi Arabia. Data were collected using a self-administered questionnaire based on information obtained from the literature. The questionnaire was divided into four sections, one covering the respondents’ demographics, and the other three assessing knowledge, attitudes, and perceptions towards participating in CTs.

Results

A total of 148 (63.8%) respondents were males, and 52 (22.4%) participants had been invited to participate in a CT previously. Of those, 39 (75%) participated. Knowledge about the essential elements of informed consent ranged from 55.7% (number of participants needed) to 85.7% (confidentiality of personal information). The majority (163, 73.8%) of respondents was willing to participate in a CT after consulting their family physician and 130 (58.0%) respondents would be motivated to participate in a CT if they were healthy. Only 36.8% of the respondents believed that patients who participated in a CT received the best care. Moreover, 110 (48.7%) respondents believed that research was conducted in a responsible and ethical manner.

Conclusions

The present study assessed the current understanding of CTs among Saudi participants. Although the majority of participants had an acceptable level of knowledge about CTs, they exhibited conditional attitudes and misperceptions towards participating in a CT. Increased patient awareness may improve patients’ attitudes towards ethical conduct of CTs.     

Dowry and Public Policy in Contemporary India

In modern Indian political discourse the custom of dowry is often represented as the cause of serious social problems, including the neglect of daughters, sex-selective abortion, female infanticide, and the harassment, abuse, and murder of brides. Attempts to deal with these problems through legislative prohibition of dowry, however, have resulted in virtually no diminution of either dowry or violence against women. In contrast, radically different interpretations of dowry can be found in the literatures of structural-functionalist anthropology, economics, and human behavioral ecology which muster wide-ranging forms of qualitative and quantitative evidence to support functional models of dowry as a form of inheritance or investment in daughters and/or their children. This paper argues that a functionalist perspective on dowry could lead to improved dowry policy, and that an approach based in human behavioral ecology (HBE) is uniquely suited to this task. After reviewing the relevant literature on dowry in South Asia, I discuss current dowry legislation and its limitations. I then develop a behavioral ecology model of Indian dowry and test it with quantitative and qualitative data. I conclude that if dowry legislation is to achieve broad support or bring about effective social change, it must address and support the positive motivations for and effects of dowry and take a targeted approach to dowry violence, which is not uniformly distributed across regions, castes, or social classes.     

The Social Value of Knowledge and International Clinical Research

In light of the growth in the conduct of international clinical research in developing populations, this paper seeks to explore what is owed to developing world communities who host international clinical research. Although existing paradigms for assigning and assessing benefits to host communities offer valuable insight, I criticize their failure to distinguish between those benefits which can justify the conduct of research in a developing world setting and those which cannot. I argue that the justification for human subjects research is fundamentally grounded in the social value of knowledge, and that this value is context‐dependent in a manner which should inform our ethical evaluation of the conduct of research in specific settings. I propose a new framework for the assessment of research benefits assigned to developing world host communities, a natural implication of which is to limit the types of research projects which may permissibly be conducted in developing world settings.     

Research Integrity in Greater China: Surveying Regulations,Perceptions and Knowledge of Research Integrity from a Hong Kong Perspective

In their 2010 article ‘Research Integrity in China: Problems and Prospects’, Zeng and Resnik challenge others to engage in empirical research on research integrity in China. Here we respond to that call in three ways: first, we provide updates to their analysis of regulations and allegations of scientific misconduct; second, we report on two surveys conducted in Hong Kong that provide empirical backing to describe ways in which problems and prospects that Zeng and Resnik identify are being explored; and third, we continue the discussion started by Zeng and Resnik, pointing to ways in which China's high‐profile participation in international academic research presents concerns about research integrity. According to our research, based upon searches of both English and Chinese language literature and policies, and two surveys conducted in Hong Kong, academic faculty and research post‐graduate students in Hong Kong are aware of and have a positive attitude towards responsible conduct of research. Although Hong Kong is but one small part of China, we present this research as a response to concerns Zeng and Resnik introduce and as a call for a continued conversation.     

Public Perceptions of the Attractiveness of Restored Nature

Ecological restoration efforts often encounter public resistance. Recreational visitors resist imposition of restoration efforts they fear may result in a visually unattractive area. Public support is, however, essential for restoration efforts on public lands. This study seeks insight into hiker perceptions of perceived attractiveness of nature before and after efforts to restore exotic conifer plantations to native communities containing bog and wet forest communities. Visitors (N = 247) to a Dutch National Park sorted 32 photographs depicting landscapes before and after restoration efforts. Findings show that the most attractive landscape types (bog and wet forest communities containing visible water) are results of restoration efforts and the least attractive landscape types (young deciduous and coniferous forest) are representative of traditional nature before restoration. However, the “middle category” consists of landscape types existing both before and after restoration efforts. Visitors value old coniferous and old deciduous forests as much as products of restoration that lack water. These perceptions are unrelated to either visitor characteristics or the provision of information to visitors explaining restoration goals. The continued existence of resistance to restoration strategies despite their effect on perceived landscape attractiveness implies that the experience of nature has more than only visual dimensions. We expect that more acceptable results of restoration efforts will emerge from the active engagement of the public before restoration practices take place in processes that specifically address feelings of attachment and resistance to change.     

村医基本公共卫生管理知识和服务情况调查分析

目的:了解乡村基本公共卫生服务知识和服务情况,为有效提高乡村基本公共卫生服务水平提供依据.方法:采用课堂集中填写问卷的方式对某县1046名村医就服务知识和服务能力进行调查.结果:乡村基本公共卫生服务知识调查显示,慢性病服务知识知晓率最高,为78.0％,传染病报告及处理知识知晓率最低,为50.7％,农村居民健康档案管理知识知晓率为56.4％,健康教育服务知识知晓率为51.7％.基本公共卫生服务能力调查显示,55.1％的村医能较为熟练操作微机,99.7％的乡村曾对患者进行过健康教育.结论:某县乡村慢性病服务知识知晓率较高,服务能力尚可,但需进一步强化乡村传染病防治法、慢性病随访内容、健康教育服务内容和健康档案有效使用的专项培训和全员培训.     

Survey ofLymantria obfuscata and its natural enemies in India

The status ofLymantria obfuscata Walker in India is discussed. Notes on its taxonomy, distribution, life-history and economic importance are given for comparison with those of the gypsy moth,Lymantria dispar (L.). Parasites ofL. obfuscata in India are reviewed. A survey in 1961–66 revealed an additional 50 species of natural enemies ofL. obfuscata in India. The incidence and biology of some of the important ones are presented. A comparison is made between these parasites and those ofL. dispar. Some of the natural enemies ofL. obfuscata already attackL. dispar in America. Others are closely related to the parasites of the gypsy moth. The scope for utilisation of parasites ofL. obfuscata in other countries is discussed. Possible use of parasites ofL. dispar from the U.S.A. or elsewhere againstL. obfuscata in India is suggested. Research financed in part by the U.S.D.A. under grant PL-480.     

Knowledge and Perceptions about Clinical Trials and the Use of Biomedical Samples: Findings from a Qualitative Study in Rural Northern Ghana

IntroductionClinical trials conducted in sub-Saharan Africa have helped to address the prevalent health challenges. The knowledge about how communities perceive clinical trials is however only now evolving. This study was conducted among parents whose children participated in past clinical trials in northern Ghana to assess their knowledge and perceptions of clinical trials and the use of biomedical samples.MethodThis was a qualitative study based on eighty in-depth interviews with parents. The participants were randomly selected from among parents whose children were enrolled in a clinical trial conducted in the Kassena-Nankana districts between 2000 and 2003. The interviews were transcribed and coded into emergent themes using Nvivo 9 software. The thematic analysis framework was used to analyze the data.ResultsStudy participants reported that clinical trials were carried out to determine the efficacy of drugs and to make sure that these drugs were suitable for human beings to use. The conduct of clinical trials was perceived to have helped to reduce the occurrence of diseases such as malaria, cerebrospinal meningitis and diarrhea. Quality of care was reported to be better in clinical trials than in the routine care. Parents indicated that participation in clinical trials positively influenced their health-seeking behavior. Apprehensions about blood draw and the use to which samples were put were expressed, with suspicion by a few participants that researchers sold blood samples. The issue of blood draw was most contentious.ConclusionParents perception about the conduct of clinical trials in the study districts is generally positive. However, misconceptions made about the use of blood samples in this study must be taken seriously and strategies found to improve transparency and greater community acceptability.     

Developing and Validating a Tablet Version of an Illness Explanatory Model Interview for a Public Health Survey in Pune,India

Background

Mobile electronic devices are replacing paper-based instruments and questionnaires for epidemiological and public health research. The elimination of a data-entry step after an interview is a notable advantage over paper, saving investigator time, decreasing the time lags in managing and analyzing data, and potentially improving the data quality by removing the error-prone data-entry step. Research has not yet provided adequate evidence, however, to substantiate the claim of fewer errors for computerized interviews.

Methodology

We developed an Android-based illness explanatory interview for influenza vaccine acceptance and tested the instrument in a field study in Pune, India, for feasibility and acceptability. Error rates for tablet and paper were compared with reference to the voice recording of the interview as gold standard to assess discrepancies. We also examined the preference of interviewers for the classical paper-based or the electronic version of the interview and compared the costs of research with both data collection devices.

Results

In 95 interviews with household respondents, total error rates with paper and tablet devices were nearly the same (2.01% and 1.99% respectively). Most interviewers indicated no preference for a particular device; but those with a preference opted for tablets. The initial investment in tablet-based interviews was higher compared to paper, while the recurring costs per interview were lower with the use of tablets.

Conclusion

An Android-based tablet version of a complex interview was developed and successfully validated. Advantages were not compromised by increased errors, and field research assistants with a preference preferred the Android device. Use of tablets may be more costly than paper for small samples and less costly for large studies.     

The Role of Medical Language in Changing Public Perceptions of Illness

This study was designed to investigate the impact of medical terminology on perceptions of disease. Specifically, we look at the changing public perceptions of newly medicalized disorders with accompanying newly medicalized terms (e.g. impotence has become erectile dysfunction disorder). Does using “medicalese” to label a recently medicalized disorder lead to a change in the perception of that condition? Undergraduate students (n = 52) rated either the medical or lay label for recently medicalized disorders (such as erectile dysfunction disorder vs. impotence) and established medical conditions (such as a myocardial infarction vs. heart attack) for their perceived seriousness, disease representativeness and prevalence. Students considered the medical label of the recently medicalized disease to be more serious (mean = 4.95 (SE = .27) vs. mean = 3.77 (SE = .24) on a ten point scale), more representative of a disease (mean = 2.47 (SE = .09) vs. mean = 1.83 (SE = .09) on a four point scale), and have lower prevalence (mean = 68 (SE = 12.6) vs. mean = 122 (SE = 18.1) out of 1,000) than the same disease described using common language. A similar pattern was not seen in the established medical conditions, even when controlled for severity. This study demonstrates that the use of medical language in communication can induce bias in perception; a simple switch in terminology results in a disease being perceived as more serious, more likely to be a disease, and more likely to be a rare condition. These findings regarding the conceptualization of disease have implications for many areas, including medical communication with the public, advertising, and public policy.     

Public Attitudes in India and Australia toward Elephants in Zoos

ABSTRACT

We surveyed the attitudes of people toward captive elephants in australia, where importation into zoos has been controversial recently, compared with India, where elephants are indigenous. Both australian (AR, n = 101) and Indian (IR, n = 101) respondents rated conservation as the most important reason for the role of zoos and sanctuaries. Australian respondents were more concerned about the husbandry conditions for keeping wild animals in zoos and sanctuaries than Indian respondents (p = 0.02). This concern for captive animals increased with the higher educational level of the respondents. Female australian respondents were more concerned about the practice of keeping elephants in captivity than australian men. More australian respondents were prepared to pay extra to visit a zoo with elephants (AR 42.6%, IR 7.9%, p < 0.001). Indian respondents believed more than their australian counterparts that it was important for any zoo to display elephants, and wanted to interact with elephants by feeding, touching, and riding on them. While australian respondents? perceptions of captive elephants acknowledged their scientific value, Indian respondents viewed elephants primarily of religious, cultural, and historical significance. We conclude that australians and Indians have different requirements for keeping elephants in zoos, which should inform zoo directors about the best way to present them to the public.     

地市级大型公立医院临床研究型发展模式可行性研究

地市级大型公立医院选择临床研究型发展模式是国家政策的引导、区域医疗的需求以及医疗市场竞争和医疗机构自身发展的需要。确立“临床研究型医院”战略、建设“临床研究型医院”管理体系、学科人才、创新平台和文化氛围是“临床研究型医院”的主要发展路径。同时,建设“临床研究型医院”必须妥善处理好临床医疗与科研教学、规模扩张与内涵提升、自主创新与引进吸收的关系。     

Assessing Youth Perceptions and Knowledge of Ethics at 4-H Horse Shows in Louisiana

Due to the increased awareness of animal welfare issues and sensitized attitudes throughout society, youth animal projects provide a unique opportunity to assess and impact youth understanding and attitudes regarding animal welfare. Animal ethics training is not an uncommon requirement for participants in 4-H livestock programs. However, participants in 4-H horse projects are not universally held to the same standard. The purpose of this study was to assess youth knowledge, attitudes, and confidence in understanding of equine welfare at the 4-H state horse show, as well as to determine the beliefs and observations of unethical practices, and if differences exist between those parameters in youth competitors. The results suggest that 4-H competitors are interested in ethics and believe that unethical behavior rarely occurs within the state 4-H horse project. However, youth report observing common unethical behaviors at the show, suggesting a disconnect between what they believe is unethical and what they actually observe. Educational opportunities exist within these animal projects and should be enhanced to address the gap in understanding.     

公立医院临床医生薪酬体系结构研究

临床医生是医疗服务的提供者,其行为直接影响医院医疗服务的质量和水平。文章在分析公立医院临床医生薪酬体系现状及问题的基础上,构建了基于闭环控制的动态薪酬体系,使薪酬体系更加科学地服务于临床医生,可以有效激励临床医生的医疗服务行为,更好地提高公立医院的医疗服务质量。     

Salt Sensitivity,Insulin Resistance and Public Health in India

ObjectiveTo provide a current overview of the worldwide prevalence and pattern of cardiovascular disease and discuss the role of sodium intake and salt sensitivity, with a focus on the Asian Indian population.MethodsAn extensive search of the literature from PubMed and the Cochrane Library was undertaken. Moreover, the pathophysiologic basis of the relationship between sodium intake and insulin sensitivity in various populations was reviewed.ResultsHigh blood pressure is the most common cause of cardiovascular disease and mortality globally. Although salt sensitivity is a frequent determinant of hypertension, a strong link between salt sensitivity and cardiovascular disease associated with insulin resistance has not received adequate attention. This may be particularly relevant to the public health challenges of increasing prevalences of obesity, diabetes, and cardiometabolic syndrome in India where, according to recent estimates, approximately 60% of the world’s cases of cardiovascular disease occur and the salt consumption is among the highest in any large population.ConclusionThere is evidence for a strong link between increased salt sensitivity and insulin resistance leading to metabolic syndrome and cardiovascular disease. This relationship may be particularly relevant to the escalating epidemic of cardiovascular disease in the southern Asian Indian population. A broad-based community action to achieve at least a modest restriction of salt intake can yield important health benefits and is urgently needed. (Endocr Pract. 2010;16:940-944)     

公立医院临床诊疗付费模式运行机制探讨

目前我国主要采用按医疗服务项目付费的临床诊疗模式,其最大弊端在于容易促使医疗机构提供过渡的医疗服务,诱导刺激医疗消费,导致医疗费用过快增长。通过学习国外的实践经验,发现DRGs-PPS模式更能使政府、医疗机构、患者三方共赢,更有利于控制医疗费用的不合理上涨,同时对提高医疗服务质量、规范医疗行为具有更重要的意义。