What worries parents when their preschool children are acutely ill,and why: a qualitative study.

OBJECTIVE: To identify and explore parents'' concerns when young children become acutely ill. DESIGN: Qualitative study making use of semi-structured one to one and group interviews with parents of preschool children. SETTING: Disadvantaged inner city community. SUBJECTS: 95 parents of preschool children. RESULTS: Fever, cough, and the possibility of meningitis were parents'' primary concerns when their children became acutely ill. Parents'' concerns reflected lay beliefs, their interpretation of medical knowledge, and their fears that their child might die or be permanently harmed. Parents worried about failing to recognise a serious problem. Concerns were expressed within the context of keenly felt pressure, emphasising parents'' responsibility to protect their child from harm. They were grounded in two linked factors: parents'' sense of personal control when faced with illness in their child and the perceived threat posed by an illness. CONCLUSIONS: Better understanding of parents'' concerns may promote effective communication between health professionals and parents. Modification of parents'' personal control and perceived threat using appropriate information and education that acknowledge and address their concerns may be a means of empowering parents.     

Alternative hypotheses linking the immune system and mate choice for good genes

Why do males often have extravagant morphological and behavioural traits, and why do females prefer to mate with such males? The answers have been the focus of considerable debate since Darwin''s The descent of man, and selection in relation to sex appeared in 1871. Recently the broadening of investigation to include fields outside evolutionary biology has shed new light on mate choice and sexual selection. Here, we focus on a specific set of hypotheses relating the biology of resisting disease-causing organisms with the production of condition-dependent sexual signals (advertisements). We present a framework that distinguishes three different hypotheses about trade-offs within the immune system that affect general condition. Hamilton and Zuk''s original hypothesis suggests that hosts fight off disease through resistance to particular pathogens, which consequently lowers resistance to other pathogens. Changes in pathogens over evolutionary time in turn favours changes in which genes confer the best resistance. Alternatively, the immunocompetence hypotheses suggests that the energetic costs of mounting a response to any pathogen compete for resources with other things, such as producing or maintaining advertisements. Finally, improving resistance to pathogens could increase the negative impacts of the immune system on the host, via immunopathologies such as allergies or autoimmune diseases. If both disease and immunopathology affect condition, then sexual advertisements could signal a balance between the two. Studies of hypothesized links between genes, condition, the immune system and advertisements likely will require careful consideration of which hypothesis is being considered, and may necessitate different measures of immune system responses and different experimental protocols.     

Withholding or Withdrawing Extraordinary Life Support—Optimizing Rights and Limiting Liability

For many years physicians, ethicists and members of the legal community have attempted to minimize ambiguity and unpredictability in making decisions to withhold or withdraw extraordinary life support. Recent developments in national and California law now afford medical care providers unparalleled protection from criminal and civil liability in surrogate decision-making situations. They also reinforce the concept of patient''s rights by providing medical care consumers with new and effective mechanisms for enforcing their “right to decide,” even after they have lost decision-making capacity. A case in point is California''s new Durable Power of Attorney for Health Care, which serves as a model for other jurisdictions that do not have such legislation. Thus, the medical and legal professions, working together, can contribute immeasurably to respectful medical decision making by educating the public about these developments and by adopting policies that reinforce these rights.     

Humanitarianism and Australian Nationalism in Colonial Papua: Hubert Murray and the Project of Caring for the Self of the Coloniser and Colonised

This paper is about Australian nationalism in Papua at the beginning of the century. It analyses the role of science and humanitarianism in sustaining the colonial project and the white man's identity. Colonialism was formulated as philanthropy operating on a global scale, where the redemption and salvation of humanity involved the ‘higher cultures’ having a ‘sacred trust’ to educate and morally uplift the natives. This duty to pacify and civilise the tribal other was also a process of reworking the boundaries of western identity so as to remove it from too close a kinship with those forms of savage subjectivity over which it claimed moral superiority. Anthropology became part of the ethical task of how to be a good coloniser; it was heavily involved in reforming state power, such that it governed through culture rather than through violence. Indeed, anthropology was used to legitimise new understandings of native culture as something that could not be overly repressed without destroying the natives. A new internal form of colonialism emerged, one which required cultural pluralism and which was worried about the dangers of over-assimilation.     

Bioethics for clinicians: 8. Confidentiality

Physicians are obliged to keep information about their patients secret. The understanding that the physician will not disclose private information about the patient provides a foundation for trust in the therapeutic relationship. Respect for confidentiality is firmly established in codes of ethics and in law. It is sometimes necessary, however, for physicians to breach confidentiality. Physicians should familiarize themselves with legislation in their own province governing the disclosure of certain kinds of information without the patient''s authorization. Even when no specific legislation applies, the duty to warn sometimes overrides the duty to respect confidentiality. The physician should disclose only that information necessary to prevent harm, and should reveal this information only to those who need to know it in order to avert harm. Whenever possible any breach of confidentiality should be discussed with the patient beforehand.     

Sharing residential space in the 1920s: Racial and ethnic patterns in cities in Michigan

Since 1989, France has endured repeated, contentious debates about the ‘Islamic’ headscarf. In February 2004, French legislators approved a new law prohibiting students from wearing conspicuous ‘religious signs’ in public schools. Contrary to some observers’ assumptions, this measure was not caused mainly by new efforts to combat terrorism or by pro-Christian prejudice. Explaining France's decision to pass this surprising new legislation requires attention to both historical continuities of French political thinking and the changing French and international context. French republican understandings of citizenship and secularism have long made the headscarves issue peculiarly sensitive in France. However, the new law marks a clear departure from previous French policy. Explaining that rupture requires attention to more immediate social and political factors, most importantly: dissatisfaction with the previous policy; effective mobilization of public sympathy by new feminist groups; concern about rising anti-Semitism; and, somewhat paradoxically, developments in international human rights law.     

Tough tobacco-control legislation begins to have an impact in Ontario.

In 1994 the Ontario government passed one of the world''s toughest packages of antitobacco legislation. The Tobacco Control Act places restrictions on who can sell tobacco products, provides for severe penalties for retailers who sell to minors, bans smoking in many public places and severely restricts the use of designated smoking areas in others. The province has had antismoking legislation before, but enforcement was lax; this time enforcement of the law, particularly as it concerns retailers who sell to minors, has been given priority Brenda Gibson asks if these tough new measures are working.     

Diverse cities and good citizenship: how local governments in the Netherlands recast national integration discourse

Western European national policies increasingly portray diversity as negative and migrants as ‘others’ who do not belong to the national community. This article examines how local governments articulate alternative discourses of belonging based on residents' shared membership in the civic life of the city. In a Dutch case study, the ways in which local policymakers diverge from exclusionary national narratives are examined. It is argued that discourses about urban citizenship offer opportunities for the inclusion of migrants by drawing new boundaries between ‘good’ citizens and those who are unwilling to participate.     

A Boomerang Effect of an All-Clear Message on Radiation Risk

Boomerang effects are changes caused by persuasive communication against the intentions of the communicator. In risk communication, boomerang effects have so far been primarily addressed and shown for warnings in fields such as alcohol, nicotine, and drug use prevention. Boomerang effects of all-clear messages on environmental risks have so far not been demonstrated. Based on this observation, this article essentially makes three points. First, the most prominent theoretical explanations for boomerang effects do not preclude all-clear messages to have this type of effect. Second, it presents an experiment that demonstrates the existence of a boomerang effect of an all-clear message on the risk from cell phone tower radiation. Respondents who were very worried about this risk before the experiment said on average that reading a short all-clear message increased their worries. Third, if this type of boomerang effect is also found for other than radiation risks, people worried about environmental risks (including those worried without a reasonable cause) would be hard to convince they need not worry. This impedes reasonable public risk communication in the long run and creates a social group of people who harbor fears and anxieties not grounded in reality, but are immune against correction.     

Understanding Worry About Risks Associated With Thyroid Hormone Therapy: A National Survey of Endocrinologists,Family Physicians,and Geriatricians

ObjectiveThyroid hormone use is widespread, and prior studies have shown that over- and undertreatment with thyroid hormone are common. Our objective was to understand physician worry regarding risks associated with thyroid hormone therapy, specifically overtreatment or undertreatment.MethodsA nationwide survey was administered to physician members of the Endocrine Society, the American Academy of Family Practice, and the American Geriatrics Society. Participants were asked how often they were worried about various risks that may be associated with thyroid hormone over- or undertreatment, that is, cardiovascular complications, bone complications, and poor quality of life due to overtreatment or undertreatment with thyroid hormone. Multivariable regression analyses were conducted to determine physician characteristics associated with each worry.ResultsThe response rate was 63% (359 of 566); of those who responded, 128 (36%) were primary care physicians, 114 (32%) were endocrinologists, and 113 (32%) were geriatricians. Overall, 74 (21%) physicians reported that they frequently or always worried about cardiovascular complications, 74 (21%) about bone complications, 111 (31%) about the poor quality of life due to symptoms from undertreatment with thyroid hormone, and 87 (24%) about the poor quality of life due to symptoms from overtreatment with thyroid hormone. Endocrinologists were more likely to frequently or always worry about the patients' poor quality of life due to symptoms from overtreatment (odds ratio, 2.05; 95% confidence interval, 1.09-3.93) compared with primary care physicians.ConclusionUp to one third of the physicians frequently or always worried about risks resulting from the thyroid hormone overtreatment or undertreatment. More research is needed across specialties to understand physician perceptions of how thyroid hormone therapy impacts the patients' quality of life.     

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ABSTRACT

This paper looks at the attitudes that scientists hold toward their use of animals, and at some implications for the welfare of laboratory animals. The framework for this analysis is recent changes in the law regulating the use of animals in British science. We note how ambivalent many scientists are about the way they perceive the animals they use, and the moral dilemmas such use poses. We argue, however, that the legislation itself cannot mediate improvements in animal welfare, as it is inevitably policed by the scientific community itself and thus dependent upon values and social relationships within science. We also argue that debates about the promotion of lab animals' welfare tend to use the distancing stance of science; they focus on scientific studies of welfare and behavior, but ignore the context. An important part of that context is the relationships between humans and animals in the lab, which should be taken into account more fully if animals are to benefit.     

The case of philanthropy: bringing scientists and philanthropic donors together,for good

Summary: Philanthropists and scientists share many common interests, and yet they are not familiar with each other''s ways of thinking. This Editorial highlights how to improve their mutual understanding to advance research and life sciences.

“Wealth is not new. Neither is charity. But the idea of using private wealth imaginatively, constructively, and systematically to attack the fundamental problems of mankind is new.” – John Gardner

Philanthropy, derived from private wealth, stands unique as a vital source of scientific funding. Yet many scientists don''t truly understand the workings of this form of charitable giving. Some are even wary of it, and believe that a divide between the worlds of science and business is a normal state of affairs. My experience has exposed striking similarities between the two specialties: both dedicate their resources to innovation and the sincere desire to do good for their fellow man.I''ve been lucky to work on both sides of the fence. I conducted research for my PhD at the Wistar Institute in Philadelphia, PA, and at Sloan Kettering Institute in New York City, NY, where I worked on the Id1 gene and its role in the molecular mechanism of mammalian cell differentiation. I later moved to the Pershing Square Foundation. In 2013, to support young investigators with bold and risky ideas in cancer research in the New York area, the Pershing Square Foundation partnered with the Sohn Conference Foundation to create the Pershing Square Sohn Research Alliance (PSSCRA). Since the organization''s founding, I have served as its Executive Director. As a result of my career experience, I understand firsthand the role of philanthropic support of medical research. I am always excited to work with new, young and innovative talent, and to introduce that talent into the social mainstream.     

The mathematical biophysics of some mental phenomena: II. Anxieties and elations

A neural mechanism is discussed which explains certain states of anxieties, in which an individual is worried about things which may be possible, but are exceedingly improbable. Certain quantitative relations are derived.Mutatis mutandis similar considerations apply to some states of elations. An application to certain types of paranoia is discussed.     

Understanding Statin Non-Adherence: Knowing Which Perceptions and Experiences Matter to Different Patients

Background

Non-adherence to statins is substantial and is associated with numerous perceptions and experiences. However, time limits in clinical practice constrain in depth explorations of these perceptions and experiences.

Objectives

To propose and examine a strategy aimed at an efficient assessment of a wide array of perceptions and experiences regarding the efficacy, side effects, and practical problems of statins. Furthermore, to assess associations between this wide array of experiences and perceptions and non-adherence and to examine whether patients'' ''perceived self-efficacy'' moderated these associations.

Methods

Patients were recruited through community pharmacies. A wide array of specific patient perceptions and experiences was efficiently assessed using the electronic Tailored Medicine Inventory that allows people to skip irrelevant questions. Adherence was measured through self-report and pharmacy refill data.

Results

Of the two-hundred twenty-nine patients who participated (mean age 63.9, standard deviation 10.2), 40%-70% doubted the necessity of or lacked knowledge about the efficacy of statins, 20%-35% of the patients were worried about joint and muscle side effects or had experienced these, and 23% had encountered practical problems regarding information about statins, intake of tablets, the package, or the blister. Experiencing more practical problems was associated with increased unintentional non-adherence (Odds ratio 1.54, 95%CI:1.13–2.10, P < 0.01), whereas worrying about side effects was associated with increased intentional non-adherence (Odds ratio 1.90, 95%CI:1.17–3.08, P < 0.01). Higher ''perceived self-efficacy'' did not moderate these associations.

Conclusions

Insight into patients'' specific barriers with regard to appropriate statin use may reveal personal reasons for being non-adherent. The Tailored Medicine Inventory is a promising tool to devise individualized intervention strategies aimed at improving adherence by the clinician-patient alliance.     

Marginalising ‘eugenic anxiety’ through a rhetoric of ‘liberal choice’: a critique of the House of Commons Select Committee Report on reproductive technologies

In light of a recent House of Commons Select Committee investigation into the regulation of human reproductive technologies, this article critically evaluates the Committee's case for a devolved, libertarian-inspired framework for the regulation of reproductive technologies. In assessing the appropriate balance between legislation, regulation and reproductive freedom, the Committee rightly challenged those who exhibit a myopic history of eugenics to justify restricting reproductive choice. However, by uncritically embracing the tropes of procreative liberty and genetic progress, and defining eugenics in terms of intention rather than consequence, the Committee appeared to ignore or marginalise a number of sociological challenges to the presumptions couched within the doctrine of ‘liberal choice’. This article suggests that failure to consider the cultural and political context within which new technologies are shaped and social needs constructed might undermine any ostensible virtues of a devolved system of governance for reproductive medicine.     

Education about dementia. Effectiveness of a public lecture

Memory and dementia are often topics of educational activities, however there is only limited information about the effectiveness of this education. In this study the effectiveness of a lecture, as part of a series of lectures about dementia, has been evaluated. The results showed an improvement in knowledge after the lecture and the participants were satisfied afterwards. Finally, it showed that there is a need for this kind of education; for professionals and for people who were worried about their memory or their partners' memory.     

The World Medical Association: can hope triumph over experience?

The World Medical Association was set up in 1947 in the wake of outrage about war crimes committed by doctors in Hitler''s Germany. For nearly 50 years it has lurched from one controversy to another, arguing within itself about its funding, its voting system, and the representativeness and political affiliation of some of its member medical associations. The BMA withdrew from the association in 1984, supporting a breakaway "Toronto" group including Canada, the Scandinavian countries, the Netherlands, Ireland, and Jamaica. All but Britain and Jamaica have now rejoined and membership is growing, but the association is still struggling to gain credibility and clout. After 20 years of part time stewardship the recent appointment of a new full time secretary general has fuelled expectations that internal reforms will be implemented, and the WMA''s standing and profile improved.     

Clathrin: A good view of a shapely leg

The crystal structure of an amino-terminal fragment of the clathrin heavy chain has recently been determined, revealing a globular β-propeller domain attached by an α-zig-zag connecting rod to the heavy chain's distal segment. The structure sheds interesting new light on the design features of this versatile protein.     

A randomised controlled trial comparing two schedules of antenatal visits: the antenatal care project.

OBJECTIVE--To compare the clinical and psychological effectiveness of the traditional British antenatal visit schedule (traditional care) with a reduced schedule of visits (new style care) for low risk women, together with maternal and professional satisfaction with care. DESIGN--Randomised controlled trial. SETTING--Places in south east London providing antenatal care for women receiving shared care and planning to deliver in one of three hospitals or at home. SUBJECT--2794 women at low risk fulfilling the trial''s inclusion criteria between June 1993 and July 1994. MAIN OUTCOME MEASURES--Measures of fetal and maternal morbidity, health service use, psychosocial outcomes, and maternal and professional satisfaction. RESULTS--Pregnant women allocated to new style care had fewer day admissions (0.8 v 1.0; P=0.002) and ultrasound scans (1.6 v 1.7; P=0.003) and were less often suspected of carrying fetuses that were small for gestational age (odds ratio 0.73; 95% confidence interval 0.54 to 0.99). They also had some poorer psychosocial outcomes; for example, they were more worried about fetal wellbeing antenatally and coping with the baby postnatally, and they had more negative attitudes to their babies, both in pregnancy and postnatally. These women were also more dissatisfied with the number of visits they received (odds ratio 2.50; 2.00 to 3.11). CONCLUSIONS--Patterns of antenatal care involving fewer routine visits for women at low risk may lead to reduced psychosocial effectiveness and dissatisfaction with frequency of visits. The number of antenatal day admissions and ultrasound scans performed may also be reduced. For the variables reported, the visit schedules studied are similar in their clinical effectiveness. Uncertainty remains as to the clinical effectiveness of reduced visit schedules for rare pregnancy problems.