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Few studies or investigators involved in community-engaged research or community-based participatory research have examined awareness and adoption of federal regulatory mechanisms. We conducted a survey of investigators affiliated with the 10 National Institutes of Health (NIH) Centers for Population Health and Health Disparities. A questionnaire designed to capture experience with the conduct and oversight of community-engaged research, and awareness of pertinent regulatory mechanisms, including Federalwide Assurances (FWAs), Individual Investigator Agreements (IIAs), and Institutional Review Board Authorization Agreements (IAAs), was completed by 101 respondents (68% response rate). Although most were aware of FWAs, only a minority of those surveyed reported knowledge of IAAs and IIAs and even fewer had used them in their research with community partners. Implications for future training and oversight are discussed. [ABSTRACT FROM PUBLISHER]

Tensions between researchers and ethics committees have been reported in several institutions. Some reports suggest researchers lack confidence in the quality of institutional review board (IRB) reviews, and that emphasis on strict procedural compliance and ethical issues raised by the IRB might unintentionally lead to delays in correspondence between researchers and ethics committees, and/or even encourage prevarication/equivocation, if researchers perceive committee concerns and criticisms unjust. This study systematically analyzed the efficiency of different IRB functions, and the relationship between efficiency and perceived quality of the decision-making process. The major purposes of this study were thus (1) to use the IRB Metrics developed by the Faculty of Tropical Medicine, Mahidol University, Thailand (FTM-EC) to assess the operational efficiency and perceived effectiveness of its ethics committees, and (2) to determine ethical issues that may cause the duration of approval process to be above the target limit of 60 days. Based on a literature review of definitions and methods used and proposed for use, in assessing aspects of IRB quality, an “IRB Metrics” was developed to assess IRB processes using a structure-process-outcome measurement model. To observe trends in the indicators evaluated, data related to all protocols submitted to the two panels of the FTM-EC (clinical and non-clinical), between January 2010–September 2013, were extracted and analyzed. Quantitative information based on IRB Metrics structure-process-outcome illuminates different areas for internal-process improvement. Ethical issues raised with researchers by the IRB, which were associated with the duration of the approval process in protocol review, could be considered root causes of tensions between the parties. The assessment of IRB structure-process-outcome thus provides a valuable opportunity to strengthen relationships and reduce conflicts between IRBs and researchers, with positive outcomes for all parties involved in the conduct of human-subject research. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to examine the case of the Italian Food Bank Foundation, highlighting how ongoing global and European challenges are pushing the organization to adapt and change. The paper aims to identify the new role that the Italian Food Bank should play in response to these new challenges. Design/methodology/approach – A case study was developed. Data were collected through the combination of a survey and in depth interviews with people working for the organization. Findings – Although the Food Bank has done a lot to improve its delivery of food aid and to respond to changing needs, it appears that the organization has not pursued a clearly defined strategy, and thus it should adopt a strategic mindset. Originality/value – The paper provides details on the Italian Food Bank and the importance of adaptation to and management of change. Moreover this is the first attempt to describe the work of the Fondazione Banco Alimentare Onlus for an international readership. [ABSTRACT FROM AUTHOR]

In three experiments, participants completed an Information-Choice Questionnaire (ICQ) in which the aggregation level of information about the consequences of two policy options was manipulated. The results indicate that evaluations of consequences are more extreme when consequences are split into separately to be evaluated components rather than presented as one whole. The aggregation level further affects overall evaluations of options and choices between options. Aggregation level effects are observed for both conventional rating scales (Experiment 1) and magnitude estimation scales (Experiment 2). The effects are strongest when consequences are lengthy and multifaceted, but also occur for short and simple consequences (Experiment 3). We conclude that it is important to consider the level of information aggregation when applying ICQ methodology. [ABSTRACT FROM PUBLISHER]

This article reports on the relationship of personality and euthanasia attitudes. Results from a survey of 165 Iranian students showed that religiosity, honesty–humility, agreeableness, and extraversion were related to negative attitudes toward euthanasia, whereas openness was related to acceptance of euthanasia, with the unconventionality facet driving this relationship. Moreover, openness explained additional variance when added to a multivariate model containing religiosity and HEXACO factors. This study illustrates the possibility of accounting for variation beyond the traditional group level predictors of attitudes toward euthanasia and promoting future cross-cultural studies into personality and end-of-life issues and informing end-of-life conversations at the bedside. [ABSTRACT FROM PUBLISHER]

In this study of ethical ideology and religiosity, 1,255 physicians from Canada, China, Ireland, India, Japan and Thailand participated. Forsyth's () Ethical Position Questionnaire and Rohrbaugh and Jessor's (J Pers 43:136-155, Religiosity Measure were used as the survey instruments. The results demonstrated that physicians from India, Thailand and China reported significantly higher rates of idealism than physicians from Canada and Japan. India, Thailand and China also scored significantly higher than Ireland. Physicians from Japan and India reported significantly higher rates of relativism than physicians from Canada, Ireland, Thailand and China. Physicians from China also reported higher rates of relativism than physicians from Canada, Ireland and Thailand. Overall, religiosity was positively associated with idealism and negatively associated with relativism. This study is the first to explore the differences between ethical ideology and religiosity among physicians in an international setting as well as the relationship between these two constructs. Both religiosity and ethical ideology are extremely generalized, and the extent to which they may impact the actual professional behaviour of physicians is unknown. This paper sets up a point of departure for future research that could investigate the extent to which physicians actually employ their religious and/or ethical orientation to solve ambiguous medical decisions. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to test the cultural suitability of the WHOQOL-BREF Bangladesh for a rural village population in Bangladesh. Methods: Participants ( n = 35) were purposefully stratified for age, gender, education level and location from the Nilphamari district in northern rural Bangladesh. Cognitive interviews were conducted via an emergent probing method to identify issues with language and constructs within the tool. Data were collected through note taking and recordings of interviews. A coding framework was used to identify key issues with questions, which were analysed using SPSS version 19 and Chi-square analysis using a Fisher’s exact test to determine statistically significant variances within the sample. Results: Twenty-two of the 26 questions in the tool were found to be problematic. The majority of problems with questions related to wording and conceptual difficulties. The majority of participants found the tool to be overly formal. Issues with translation appeared to affect the interpretation of a number of questions, and some concepts in the tool were found to be irrelevant in a village setting. There were statistically significant differences between those of different educational backgrounds and between genders. Conclusions: The study found that the WHOQOL-BREF Bangladesh as it currently stands is not culturally or linguistically suitable for use within a rural northern Bangladeshi population. [ABSTRACT FROM AUTHOR]

This review summarizes the effects of more than 20 metals that, research has indicated, may influence male reproductive health. Though males lack an apparent, easily measurable reproductive cycle, progress has been made in evaluating tests to identify chemical hazards and estimate reproductive health risks. Some agents discussed in this review are well known to have potential toxic effects on the male reproductive system, whereas some are not so well established in toxicology. This review attempts to cover most of the known toxicants and their effects on male fertility. The literature suggests a need for further research in those chemicals that are reactive and capable of covalent interactions in biological systems, as well as those defined as mutagens and/or carcinogens, to cause aneuploidy or other chromosomal aberrations, affect sperm motility in vitro, share hormonal activity or affect hormone action, and those that act directly or indirectly to affect the hypothalamo-pituitary-gonadal axis. [ABSTRACT FROM AUTHOR]

The article discusses a study on disease prevalence, disability and functioning in oldest old across 12 nations in Europe and the U.S. Longer life expectancy at age 85 was reported for people in the U.S., England and France. The variation was attributed to arguments on survival of the fittest, access to health insurance or better diets. The authors called for heightened research efforts on health care despite observed patterns on health, disability and longevity of the oldest old.

In this article, we extend insecurity theory by examining the influence of various kinds of insecurities on religiosity. Religiosity is operationalized in terms of a public dimension (church attendance) and a private dimension (subjective religiosity). Using data from four rounds of the European Social Survey (ESS, 2002–2008) on 26 European countries, we find strong support for the main hypothesis of insecurity theory that higher levels of insecurity are associated with increasing religiosity. Furthermore, it appears that all kinds of insecurities play a role. Specifically, we find, among others, that religiosity is higher among people who have an insecure job position, whose parents were unemployed, whose parents had a lower status job, who have experienced a war in their own country, who have lost their partner, and who reside in a country with lower social welfare spending and a higher unemployment rate. On a more general level, it is concluded that both (i) economic and existential; (ii) past and present; and (iii) individual and contextual insecurities are important in explaining (cross-national) variation in religiosity. [ABSTRACT FROM AUTHOR]

Copyright of Academic Emergency Medicine is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: To review Ethics Committee (EC) application forms and to find out similarities and differences in content of five ECs forms in India. Materials and Methods: The completeness of EC application forms was assessed on the following themes: title, study team, sponsor responsibility, scientific aspects, patient safety, regulatory permissions, Informed consent process from 2008-2009. Application forms (available online) of 5 ECs were studied and compared. Results: A total of 445 application forms were analyzed, 382 were academic, 63 were sponsored. The common deficiencies in academic studies were inappropriate titles (25.13%), lack of budget details (90%). More than 95% studies had not mentioned the method of recruitment. The issue of vulnerability was not marked in more than 50% of studies. Compensation for participation/ injury was poorly stated in academic (99%) studies. Among industry sponsored studies, 98% were compliant with regulatory permissions and 41% were CTRI registered. The information pertaining to Informed Consent was mentioned in all forms. Comparative analysis of application forms of 5 ECs showed that the requirements for submission were similar except 1-2 ECs asked for additional information like percentage of time allotted by investigator for studies, GCP training of study team, certification by investigator regarding accuracy of local versions of Informed consent. Conclusion: Our study recommends that increased awareness and vigilance by investigators of academic studies regarding submission of applications to EC will increase efficiency and speed of review process. A common application form for all ECs across India would be an important step to achieve uniformity in functioning of ethics committees. [ABSTRACT FROM AUTHOR]

In an effort to increase review-quality and efficiency, research administration at Wake Forest School of Medicine initiated a change in the operational structure of the Institutional Review Board (IRB) via a reconfiguring of the boards and rescheduling of the convened meetings. The number of IRB Panels was doubled and each panel/board began meeting on alternating weeks, rather than once per month as they had previously done. The turn-around time for full board approvals was reduced by over 50% and the quality of review was increased due to the smaller agendas for each meeting, allowing all members the opportunity to more carefully review each submission. More time is now spent discussing each submission item than was possible in the past, yet meetings are much shorter than before, due to the smaller agendas. In addition to fostering higher quality human subject protection, both investigator and board member satisfaction has increased because of the change in the operational structure of the IRB. No additional funds or staff members were needed to carry out this successful change. IRB management at other institutions can replicate this process easily and at no significant cost. [ABSTRACT FROM AUTHOR]

Background: Colonial cinnabar mining and refining began in Huancavelica, Peru, in 1564. With a local source of mercury, the amalgamation process was adopted to refine silver in Potosí, Bolivia, in the early 1570s. As a result, large quantities of mercury were released into the environment. Objectives: We used archival, primary, and secondary sources to develop the first estimate of mercury emissions from cinnabar refining in Huancavelica and to revise previous estimates of emissions from silver refining in Potosí during the colonial period (1564-1810). Discussion: Although other estimates of historical mercury emissions have recognized Potosí as a significant source, Huancavelica has been overlooked. In addition, previous estimates of mercury emissions from silver refining underestimated emissions because of unrecorded (contraband) production and volatilization of mercury during processing and recovery. Archival descriptions document behavioral and health issues during the colonial period that are consistent with known effects of mercury intoxication. Conclusions: According to our calculations, between 1564 and 1810, an estimated 17,000 metric tons of mercury vapor were emitted from cinnabar smelting in Huancavelica, and an estimated 39,000 metric tons were released as vapor during silver refining operations in Potosí. Huancavelica and Potosí combined contributed > 25% of the 196,000 metric tons of mercury vapor emissions in all of Latin America between 1500 and 1800. The historical record is laden with evidence of mercury intoxication consistent with effects recognized today. Our estimates serve as the foundation of investigations of present-day contamination in Huancavelica and Potosí resulting from historical emissions of mercury. [ABSTRACT FROM AUTHOR]

The growth of immigrant populations in the United States over the past 20 years has increased the need to enhance understanding about the risk factors that influence their substance abuse and HIV risk behaviors. Today, Latinos account for the largest majority of immigrants gaining entry into the United States. As the largest and fastest growing minority subgroup in the United States, they bear a disproportionate burden of disease and death compared to non-Latinos. Latinos are confronted with escalating HIV and substance-abuse problems, particularly Latinos between the ages of 18-34. This paper is based on our longitudinal study on the drug using and HIV risk behaviors of 527 recent Latino immigrants between the ages of 18-34 who have lived in the United States less than 1 year. The data collection activities of this study have provided insights in identifying, recruiting, interviewing, and retaining Latinos in community-based studies. Strategies, such as utilizing a combination of translation techniques, ensured the development and implementation of culturally appropriate questionnaires. Respondent-driven sampling facilitated identifying participants. Establishing rapport and trust was critical for interviewing, and maintaining a tracking protocol was most important for retention. The lessons learned from this study can guide substance abuse and HIV researchers when recruiting, interviewing, and retaining recent Latino immigrants in future epidemiologic studies. (Am J Addict 2011;21:11-22) [ABSTRACT FROM AUTHOR]

Social neuroscience and its potential implications create an interesting case study for examining human research ethics policies on the topic of public communication of research. We reviewed mainstream national and international human research ethics guidelines and policies on issues of public communication of research. Our analysis relied on five thematic nets to capture the interactions between research and the public: public understanding, knowledge translation, public participation, social outcomes, and dual use. Coverage of these topics is sparse and inconsistent in mainstream policies and guidelines. We identify three options to address these gaps and analyze their strengths and weaknesses. [ABSTRACT FROM PUBLISHER]

Although male infertility is well researched, the effects of inorganic mercury on male reproduction and fertility are less well known. Studies pertaining to mercury and male fertility identified reduced concentration of testosterone in the serum of male workers, a toxic influence on fertility of organic mercury compounds within concentrations at the workplace, and increased days to pregnancy. We evaluated the effect of chronic mercuric chloride (HgCl2) exposure in male rats on reproductive endpoints. Thirty-day old male Sprague Dawley rats (n = 31) were exposed to 0.0, 1.0, or 2.0 mg/kg/day of HgCl2 via gavage. After 60 days exposure, they were housed with nonexposed females for 21 days. A survivor analysis revealed the exposed animals took longer to impregnate the females and had a lower rate of impregnation. Further statistical analysis revealed a lower correlation between testicular testosterone levels and days to impregnate, and also lower sperm counts in the epididymis head and body of the exposed males. The results indicate that HgCl2 exposure had significant adverse effects on male rat reproduction endpoints including fertility at a dose that was not clinically toxic. [ABSTRACT FROM AUTHOR]

Background: Tensions between IRBs and researchers in the US and elsewhere have increased, and may affect whether, how, and to what degree researchers comply with ethical guidelines. Yet whether, how, when, and why IRBs respond to these conflicts have received little systematic attention. Findings: I contacted 60 US IRBs (every fourth one in the list of the top 240 institutions by NIH funding), and interviewed leaders from 34 (response rate = 55%) and an additional 12 members and administrators. IRBs often try to respond to tensions with researchers and improve relationships in several ways, but range widely in how, when, and to what degree (e.g., in formal and informal structure, content, and tone of interactions). IRBs varied from open and accessible to more distant and anonymous, and in the amount and type of "PR work" and outreach they do. Many boards seek to improve the quantity, quality, and helpfulness of communication with PIs, but differ in how. IRBs range in meetings from open to closed, and may have clinics and newsletters. Memos can vary in helpfulness and tone (e.g., using "charm"). IRBs range considerably, too, in the degrees to which they seek to educate PIs, showing them the underlying ethical principles. But these efforts take time and resources, and IRBs thus vary in degrees of responses to PI complaints. Conclusions: This study, the first to explore the mechanisms through which IRBs respond to tensions and interactions with PIs, suggests that these committees seek to respond to conflicts with PIs in varying ways - both formal and informal, involving both the form and content of communications. This study has important implications for future practice, research, and policy, suggesting needs for increased attention to not only what IRBs communicate to PIs, but how (i.e., the tone and the nature of interactions). IRBs can potentially improve relationships with PIs in several ways: using more "open doors" rather than anonymity, engaging in outreach (e.g., through clinics), enhancing the tone as well as content of interactions, educating PIs about the underlying ethics, and helping PIs as much and proactively as possible. Increased awareness of these issues can help IRBs and researchers in the US and elsewhere. [ABSTRACT FROM AUTHOR]

Background: Researchers often relate personal experiences of difficulties and challenges with Institutional Review Board (IRB) review of their human genetic research protocols. However, there have been no studies that document the range and frequency of these concerns among researchers conducting human genetic/genomic studies. Methods: An online anonymous survey was used to collect information from human genetic researchers regarding views about IRB review of genetic protocols. Logistic regression was used to test specific hypotheses. Results from the national online survey of 351 human genomic researchers are summarized in this report. Results: Issues involving considerable discussion with IRBs included reconsent of subjects (51%), protection of participants' personal information (39%) and return of results to participants (34%). Over half of the participants had experienced one or more negative consequences of the IRB review process and approximately 25% had experienced one or more positive consequences. Respondents who had served on an IRB were about 80% more likely to report positive consequences of IRB review than their colleagues who had never served on an IRB (p = 0.03). Survey responses were mixed on the need for reconsent before data sharing and risks related to participant reidentification from genomic data. Conclusion: The results from this study provide important perspectives of researchers regarding genetic research review and show lack of consensus on key research ethics issues in genomic research. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Job strain has been associated with hypertension among younger workers; however, whether this relationship persists among older workers, particularly older racial/ethnic minorities, is unresolved. This study evaluated whether job strain and workplace discrimination are associated with hypertension and poor blood pressure control among older workers and whether these relationships vary by gender and race/ethnicity. Data were drawn from the Health and Retirement Study, and analysis was restricted to employed participants with complete information on job strain and blood pressure ( N = 3,794). In adjusted models, high job strain was associated with lower likelihood of hypertension (odds ratio (OR): 0.75, 95% confidence interval (CI): 0.63, 0.89) relative to low job strain. Stratified analyses indicated this association was only significant among white (OR: 0.71, 95% CI: 0.58, 0.86) and male (OR: 0.61, 95% CI: 0.47, 0.79) workers. High job strain was not significantly associated with hypertension among African American (OR: 1.14, 95% CI: 0.63, 2.07) or Hispanic (OR: 0.56, 95% CI: 0.29, 1.09) workers. Workplace discrimination was not associated with hypertension among any group. Neither job strain nor discrimination was associated with poor blood pressure control. These findings suggest that persistence in work characterized by high job strain in later life may signal resilience to the influence of work-related stressors on health. Future research efforts should examine the factors that contribute to gender and racial differences in these relationships. [ABSTRACT FROM AUTHOR]

Career development that adequately addresses the needs of multicultural students is important. The authors explored whether a constructivist career course might be a viable mechanism for improving career decision self-efficacy for 81 Asian American and African American college students. Results indicated significant increases in all 5 elements of career decision self-efficacy: self-appraisal, occupational information, goal selection, planning, and problem solving. Hence, constructivism shows potential as a way to integrate multicultural and career competencies in the classroom. [ABSTRACT FROM AUTHOR]

The article discusses research ethics committee (REC) oversight of studies conducted through the community-based participatory research (CBPR) approach. The Protecting the Hood Against Tobacco (PHAT) study is cited which involved human subjects and the problems between PHAT researchers and the University of California San Francisco (UCSF) REC on the issue of community versus the individual. It is concluded that open dialogue can help researchers and RECs in meeting challenges and improving collaboration on CBPR research.

Aim. The objectives of this study are to compare the risk of psychological depression after medical and surgical abortions in first two trimesters and to evaluate the risk factors for post-abortion depression. Method. A retrospective study was conducted throughout 367 women who underwent surgical abortion and 458 women who underwent medical abortion between January 2006 and January 2007 in Dr. Zekai Tahir Burak Women's Health Hospital. Women were assessed by clinical psychologists one week after the intervention. The clinical characteristics and psychological assessment of these women were statistically correlated by means of non-parametric tests. Results. Of the study population, 27.1% was diagnosed with post-abortion depression. The frequency of post-abortion depression was 34.3% in surgical abortion patients and 22.8% in medical abortion patients. The women who underwent surgical abortion were found to have significantly elevated risk of post-abortion depression. The women with a high risk of post-abortion depression were significantly younger and had a more frequent history of psychiatric and depressive disorders. Conclusion. An important quotient of women experiences post-abortion mood depression which is significantly more frequent after surgical abortion. Women with past psychiatric and anxiety disorders should be carefully monitored for depression when they would undergo an abortion. [ABSTRACT FROM AUTHOR]

The article presents a web-based study which examines the views, attitudes, and experiences of human subjects protection (HSP) professionals towards genetic research reviews. The study covered five general topics including committee functions, application process, and review process. Majority of respondents believe that genetic protocol review needs different guidance from other human subjects research. The study suggests the need for collaborative approach to ethics of genetic research.

The article focuses on the development of an International Review Board (IRB) in Shaw University in Raleigh, North Carolina by partnering with University of North Carolina at Chapel Hill (UNC-CH). It states that the IRB development requires the guidance of experienced personnel from the field of human research ethics. It adds that the IRB development includes an interim IRB administrator who will assure that the faculty and staff had completed human subjects protection training certification.

The article presents a comparative study on the perspective of informed consent (IC) in Nigerian guidelines, Council for International Organizations of Medical Sciences (CIOMS), and the Declaration of Helsinki. It says that IC is required before conducting an ethical research involving human subject. It uses content analysis of three guidelines to evaluate the Nigerian guidelines. It shows that Nigerian guidelines promote the welfare of the participants by establishing research friendship.

The article focuses on the study regarding the perspective of neuroimagers on the ethics review process of their research in Canada. The study conducted online survey to 100 neuroimagers from 13 Canadian neuroscience centers and one-on-one semi-structured interview to 35 selected survey participants. It shows that most ethical issues were dealt well by research ethics board (REBs) and the most common issue reported by the neuroimagers was the incidental findings.

Background: For ethical approval of a multicentre study in Canada, investigators must apply separately to individual Research Ethics Boards (REBs). In principle, the protection of human research subjects is of utmost importance. However, in practice, the process of multicentre ethics review can be time consuming and costly, requiring duplication of effort for researchers and REBs. We used our experience with ethical review of The Canadian Perinatal Network (CPN), to gain insight into the Canadian system. Methods: The applications forms of 16 different REBs were abstracted for a list of standardized items. The application process across sites was compared. Correspondence between the REB and the investigators was documented in order to construct a timeline to approval, identify the specific issues raised by each board, and describe how they were resolved. Results: Each REB had a different application form. Most (n = 9) had a two or three step application process. Overall, it took a median of 31 days (range 2-174 days) to receive an initial response from the REB. Approval took a median of 42 days (range 4-443 days). Privacy and consent were the two major issues raised. Several additional minor or administrative issues were raised which delayed approval. Conclusions: For CPN, the Canadian REB process of ethical review proved challenging. REBs acted independently and without unified application forms or submission procedures. We call for a critical examination of the ethical, privacy and institutional review processes in Canada, to determine the best way to undertake multicentre review. [ABSTRACT FROM AUTHOR]

Mercury induces structural and functional damage in several organs, however the effects of subtoxic doses of the metal on the male reproductive system are not well defined. In order to analyze testicular and epididymal morphological alterations and changes in IL-4 or IFN-γ serum levels, adult male Sprague-Dawley rats received 0.01, 0.05 or 0.1 μg/ml of mercuric chloride (HgCl2) in deionized water for 1 to 7 months by oral route. Controls received deionized water alone. Twenty rats, separated in four groups of five animals each, were used per time of exposure. Progressive degenerative lesions consisting of lack of germ cell cohesion and desquamation, arrest at spermatocyte stage and hypospermatogenesis were observed in seminiferous epithelium by light and electron microscopy. Leydig cells showed cytoplasmic vacuolation and nuclear signs of cell death. Loss of peritubular cell aggregation was evidenced in the epididymis. Mercury accumulation was detected in both organs by mass spectroscopy. Rats showed enhanced IFN-γ serum levels as compared to controls but only reached significance after 7 months of mercury administration. Subtoxic doses of inorganic mercury could lead to reproductive and immunological alterations. The results demonstrate that sublethal concentrations of mercuric chloride are enough to induce morphological and ultrastructural modifications in male reproductive organs. These contribute to functional alterations of spermatogenesis with arrest at spermatocyte stage, hypospermatogenesis and possibly impaired steroidogenesis which together could affect male fertility. [ABSTRACT FROM AUTHOR]

End of life decisions, such as physician-assisted suicide (PAS), have continued to be controversial as health care policy, moral, and individual health care issues. This study considers knowledge of end of life options and death attitudes as predictors of attitudes toward PAS. Data were gathered from approximately 300 adults through a mailing sent to a household research panel. Validated measures of attitudes toward PAS, knowledge about that state's assisted suicide laws, demographics, and attitudes toward death as measured through the Death Attitude Profile-Revised (DAP-R) were collected and analyzed. The data indicate that attitudes toward PAS are a function of knowledge of end of life options as well as death attitudinal factors. [ABSTRACT FROM AUTHOR]

Excessive exposures to airborne crystalline silica have been known for over 100 years to pose a serious health hazard. Work practices and regulatory standards advanced as the knowledge of the hazards of crystalline silica evolved. This article presents a comprehensive historical examination of the literature on exposure, health effects, and personal protective equipment related to silica and abrasive blasting operations over the last century. In the early 1900s, increased death rates and prevalence of pulmonary disease were observed in industries that involved dusty operations. Studies of these occupational cohorts served as the basis for the first occupational exposure limits in the 1930s. Early exposure studies in foundries revealed that abrasive blasting operations were particularly hazardous and provided the basis for many of the engineering control and respiratory protection requirements that are still in place today. Studies involving abrasive blasters over the years revealed that engineering controls were often not completely effective at reducing airborne silica concentrations to a safe level; consequently, respiratory protection has always been an important component of protecting workers. During the last 15-20 yr, quantitative exposure-response modeling, experimental animal studies, and in vitro methods were used to better understand the relationship between exposure to silica and disease in the workplace. In light of Occupational Safety and Health Administration efforts to reexamine the protectiveness of the current permissible exposure limit (PEL) for crystalline silica and its focus on protecting workers who are known to still be exposed to silica in the workplace (including abrasive blasters), this state-of-the-science review of one of the most hazardous operations involving crystalline silica should provide useful background to employers, researchers, and regulators interested in the historical evolution of the recognized occupational health hazards of crystalline silica and abrasive blasting operations and the related requirements for respiratory protection. [ABSTRACT FROM AUTHOR]

The Scandinavian countries are often assumed to constitute a coherent and unique social service model characterized by a comparatively high level of universalism and a strong capacity to defamilialize care responsibilities. In examining whether we really can identify such a model when comparing current social service systems, social services in the Scandinavian countries are contrasted with their counterparts in three continental European countries. The resulting data indicate that only Denmark complies with the image of the Scandinavian social service model. Both Norway and Sweden deviate significantly. Norwegian childcare services and Swedish elderly-care services do not stand out as particularly universalistic or defamilializing compared with those of other Western European countries. Given these findings, it may be questioned whether it is reasonable to speak of a 'Scandinavian social service model'. [ABSTRACT FROM AUTHOR]

When patients pursue a hastened death, how is the labor of family caregiving affected? The authors examined this question in a qualitative study of 35 families. Four cases reveal the main themes: "taking care" included mutual protection between patients and family members; "midwifing the death" without professional support left families unprepared for adverse events; "tying up loose ends" included dealing with family members' fear of legal consequences; and "moving ahead" involved a greater risk of complicated grief when families encountered complications during the dying process. These results highlight the positive and negative consequences of family members' participation in a hastened death. [ABSTRACT FROM AUTHOR]

Objective: To clarify the role of 'melancholia' in psychiatric nomenclature. Most clinicians and researchers are convinced that the syndrome currently termed major depressive disorder encompasses multiple subgroups that differ meaningfully in phenomenology, natural history, treatment response, and pathophysiology. Delusional depression and melancholia have attracted the most empirical work, but efforts to define the latter condition have declined in recent years following a number of failures to show the validity of the melancholic/nonmelancholic distinction. Method: Review of experience. Results: Beyond the DSM-IV symptom profile, melancholia has been associated with greater overall severity, a low likelihood of placebo response, an episodic course, a family history of depression without alcoholism, a relatively healthy personality, and hypothalamic-pituitary-adrenal axis hyperactivity. Evidence for the validity of the melancholia concept lies in the fact that the presence of each of these characteristics has been shown to increase the likelihood of one or more of the others. Conclusion: A diagnosis of melancholia may eventually prove valuable in treatment selection, but the necessary evidence will not be forthcoming until a widely accepted definition exists that is both inherently valid and that can be applied consistently across research sites. [ABSTRACT FROM AUTHOR]

To examine public opinion regarding the effectiveness of means restriction as an approach to preventing suicide we asked a national sample of 2,770 respondents a hypothetical question about what effect a suicide barrier might have had on the ultimate fate of the more than 1,000 people who have jumped to their death from the Golden Gate Bridge. Thirty-four percent of respondents believed that every single jumper would have found another way to complete suicide and an additional 40% believed that "most" would have completed suicide using other means. The strongest predictors of belief in complete substitution were firearm ownership and cigarette smoking. Belief in the inevitability of suicide may be a political impediment to adopting potentially effective suicide prevention efforts. [ABSTRACT FROM AUTHOR]

This article examines racial differences in attitudes toward euthanasia. Many researchers assert distrust of medicine as a substantive explanation for less favorable attitudes toward euthanasia among African Americans, although quantitative measurement has been unsuccessful in showing this. In this article, spiritual meaning, perceived capacity for discrimination (distrust), individual experiences with physicians, and access to healthcare are hypothesized as intervening variables in the relationship between race and attitudes toward euthanasia. With a distinction between individual and collective experiences with discrimination we use path analysis to test previous assertions that African American distrust of medicine leads to more negative attitudes toward euthanasia. Results indicate that while African Americans exhibit higher levels of distrust of medicine, this is not related to attitudes toward euthanasia, which seem predominantly to be a spiritual matter. Our findings have implications for legislative policy, treatment interventions, doctor-patient relations, and sociological understanding of the interaction of race, spirituality, experience, and attitudes. [ABSTRACT FROM AUTHOR]

Comments on the elevation of plasma cortisol levels in patients with Cushing's disease and in patients with severe mood disorders. Interest in cortisol functioning in psychiatric patients that led to the development of the dexamethasone suppression test; Occurrence of abnormal cortisol regulation and failure to suppress with dexamethasone in severely depressed patients.

In the Netherlands there has been ongoing debate in the past W years about the availability of a hypothetical ‘suicide pill’, with which older people could end their life in a dignified way if they so wished. Data on attitudes to the suicide pill were collected in the Netherlands from 410 physicians, 1,379 members of the general population, and 87 relatives of patients who died after euthanasia or physician-assisted suicide. The general population and relatives were more in favor than physicians. Fifteen percent of the general population and 36% of the relatives thought a suicide pill should be made available. [ABSTRACT FROM AUTHOR]

The topic of euthanasia has been a matter of public debate for several decades. Although empirical research should inform policy, scale measurement is lacking. After analyzing shortcomings of previous work, we offer a systematically designed scale to measure attitudes toward euthanasia. We attempt to encompass previously unspecified dimensions of the phenomenon that are central to the euthanasia debate. The results of our pretest show that our attitude towards euthanasia (ATE) scale is both reliable and valid. We delineate active and passive euthanasia, no chance for recovery and severe pain, and patient's autonomy and doctor's authority. We argue that isolating these factors provides a more robust scale capable of better analyzing sample variance. Internal consistency is established with Cronbach's alpha = .871. Construct external consistency is established by correlating the scale with other predictors such as race and spirituality. [ABSTRACT FROM AUTHOR]

This study aimed at investigating attitudes toward assisted suicide among individuals with amyotrophic lateral sclerosis, and the differences in health status (illness severity and functional disability) and psychosocial adjustment (depression, perceived stress, social support, and coping) between those in favor of and those against assisted suicide. This study also aimed at describing the characteristics of terminally-ill individuals who acknowledge contemplating assisted suicide. Forty-four individuals diagnosed with amyotrophic lateral sclerosis were surveyed about theft attitudes and the circumstances that would make them contemplate assisted suicide and filled out standardized measures of mood, stress, social support, coping, and illness status. Seventy percent of the sample found assisted suicide morally acceptable and 60% thought it should be legalized. In addition, 60% of patients agreed they could foresee circumstances that would make them contemplate assisted suicide, but only three (7%) indicated they would have requested it already if it had been legal. Willingness to contemplate assisted suicide was associated with reports of elevated levels of depressive symptoms and reports of hopelessness. Results highlight the need to assess psychological status carefully when terminally ill individuals begin contemplating assisted suicide or voice a request for it. [ABSTRACT FROM AUTHOR]

African American women commit suicide less than other U.S. women and men, perhaps partly due to strong, anti-suicide attitudes. To see if suicide attitudes might be softened by extenuating circumstances such as terminal illness, 192 African American and European American women imagined themselves in one of four extenuating circumstances, then completed measures of suicide acceptability and religiosity. Both ethnic groups reported a greater likelihood of suicide when imagining depression, regardless of religiosity. Religiosity, but not extenuating circumstances, corresponded with negative attitudes toward suicide and physician assisted suicide. These African American and European American young women remained steadfastly against suicide, regardless of circumstance. [ABSTRACT FROM AUTHOR]

A comparison of the views of geriatric medicine physicians and intensive care physicians in the United Kingdom on the topics of active voluntary euthanasia and physician-assisted suicide revealed rather different attitudes. Eighty percent of geriatricians, but only 52% of intensive care physicians, considered active voluntary euthanasia as never justified ethically. Gender and age did not play a major part in attitudinal differences of the respondents. If the variability of attitudes of these two medical specialties are anywhere near illustrative of other physicians in the United Kingdom, it would be difficult to formulate and implement laws and policies concerning euthanasia and assisted suicide. In addition, ample safeguards would be required to receive support from physicians regarding legalization. [ABSTRACT FROM AUTHOR]

A comparison of the views of geriatric medicine physicians and intensive care physicians in the United Kingdom on the topics of active voluntary euthanasia and physician-assisted suicide revealed rather different attitudes. Eighty percent of geriatricians, but only 52% of intensive care physicians, considered active voluntary euthanasia as never justified ethically. Gender and age did not play a major part in attitudinal differences of the respondents. If the variability of attitudes of these two medical specialties are anywhere near illustrative of other physicians in the United Kingdom, it would be difficult to formulate and implement laws and policies concerning euthanasia and assisted suicide. In addition, ample safeguards would be required to receive support from physicians regarding legalization. [ABSTRACT FROM AUTHOR]

A major depressive episode can be categorised as severe based on depressive symptoms, scores on depression rating scales, the need for hospitalisation, depressive subtypes, functional capacity, level of suicidality and the impact that the depression has on the patient. Several biological, psychological and social factors, and the presence of comorbid psychiatric or medical illnesses, impact on depression severity. A number of factors are reported to influence outcome in severe depression, including duration of illness before treatment, severity of the index episode, treatment modality used, and dosage and duration of and compliance with treatment. Potential complications of untreated severe depression include suicide, self-mutilation and refusal to eat, and treatment resistance. Several antidepressants have been studied in the treatment of severe depression. These include tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), serotonin-noradrenaline (norepinephrine) reuptake inhibitors, noradrenergic and specific serotonergic antidepressants, serotonin 5-HT(2) receptor antagonists, monoamine oxidase inhibitors, and amfebutamone (bupropion). More recently, atypical antipsychotics have shown some utility in the management of severe and resistant depression. Data on the differential efficacy of TCAs versus SSRIs and the newer antidepressants in severe depression are mixed. Some studies have reported that TCAs are more efficacious than SSRIs; however, more recent studies have shown that TCAs and SSRIs have equivalent efficacy. There are reports that some of the newer antidepressants may be more effective than SSRIs in the treatment of severe depression, although the sample sizes in some of these studies were small. Combination therapy has been reported to be effective. The use of an SSRI-TCA combination, while somewhat controversial, may rapidly reduce depressive symptoms in some patients with severe depression. The combination of an antidepressant and an antipsychotic drug is promising and may be considered for severe depression with psychotic features. Although the role of cognitive behaviour therapy (CBT) in severe depression has not been adequately studied, a trial of CBT may be considered in severely depressed patients whose symptoms respond poorly to an adequate antidepressant trial, who are intolerant of antidepressants, have contraindications to pharmacotherapy, and who refuse medication or other somatic therapy. A combination of CBT and antidepressants may also be beneficial in some patients. Electroconvulsive therapy (ECT) may be indicated in severe psychotic depression, severe melancholic depression, resistant depression, and in patients intolerant of antidepressant medications and those with medical illnesses which contraindicate the use of antidepressants (e.g. renal, cardiac or hepatic disease). [ABSTRACT FROM AUTHOR]