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In this article we examine ethical aspects of the involvement of children in clinical research, specifically those who are incapable of giving informed consent to participate. The topic is, of course, not a new one in medical ethics but there are some tensions in current guidelines that, in our view, need to be made explicit and which need to be responded to by the relevant official bodies. In particular, we focus on tensions between the World Medical Association Declaration of Helsinki, and the guidance offered by the British Medical Association, the Royal College of Paediatrics and Child Health (formerly the British Paediatric Association), and the Council for International Organizations of Medical Sciences. We conclude with a call for these organisations to make their guidance explicit in relation to the World Medical Association Declaration. [ABSTRACT FROM AUTHOR]

This study explored the personal characteristics and the health and health-related concerns reported by members of the local homeless population in order to design population-specific health programming. The study also examined whether there were significant differences between homeless who are shelter residents and those who are not. An exploratory descriptive design was used to analyze retrospective data collected by a local County Health Department in interviews of 132 homeless adults. The demographic characteristics found reflect many common patterns: marked over-representation of males, mean age in the mid-thirties, education levels comparable to similar socio-economic groups, high unemployment rates, and low health insurance rates. One third of the sample reported self-assessed health statuses of fair or poor. The most frequently identified physical health issue was joint problems, followed by cardiovascular disease. Depression was mentioned most frequently as a self-identified mental health problem. Loneliness was the number one fear identified. Chi Square analysis showed that homeless who did not stay in shelters were significantly longer term residents (p < 0.0001) of the community and reported fear of loneliness significantly more frequently (p < 0.01). This study identifies health concerns that local homeless people themselves find important and provides direction for development of sound population-specific health programming. [ABSTRACT FROM AUTHOR]

Little is known about the health status of homeless women. In this study, we examined the health problems of and services provided to sheltered, homeless, Midwestern women who used a mobile health van. Our objectives were to document these women's ages, self-reported past medical histories, self-reported histories of addictions and hospitalizations, presenting concerns, diagnoses, and visit patterns. To this end, we performed a retrospective review of the 689 records of 408 women who had sought care during a 3-year period. The data were divided into three groups, representing women ages 15-25 (n=111), 26-40 (n=211), and 41-70 (n=86). In all three age groups, respiratory disorders were most frequently treated. Preventive health maintenance concerns were also major concerns of all age groups. Recommendations for improving the quality, continuity, and follow-up care are offered. [ABSTRACT FROM AUTHOR]

A variety of instruments have been used by researchers from several disciplines to assess life change events in adolescents. Most instruments have not been tested for validity and reliability, and have been used in one-time studies, with limited effort to synthesize all studies using the particular instrument. Because of the number of requests, over more than a decade, to use the Adolescent Life Change Event Questionnaire, the authors have attempted to review all known studies using this instrument as a preliminary step toward further testing of the questionnaire for validity and reliability. Twenty-five studies, involving a total of 4,024 adolescent subjects from nine states, were reviewed. Findings included gender and age differences in number of events experienced and the perceived stressfulness, and a relationship between events experienced and suicidal ideation. Recommendations are made regarding future development and use of the instrument. [ABSTRACT FROM AUTHOR]

The 6th International Consensus Conference on Concussion in Sport, Amsterdam 2022, addressed sport-related concussion (SRC) in adults, adolescents, and children. We highlight the updated evidence-base and recommendations regarding SRC in children (5-12 years) and adolescents (13-18 years). Prevention strategies demonstrate lower SRC rates with mouthguard use, policy disallowing bodychecking in ice hockey, and neuromuscular training in adolescent rugby. The Sport Concussion Assessment Tools (SCAT) demonstrate robustness with the parent and child symptom scales, with the best diagnostic discrimination within the first 72 hours postinjury. Subacute evaluation (>72 hours) requires a multimodal tool incorporating symptom scales, balance measures, cognitive, oculomotor and vestibular, mental health, and sleep assessment, to which end the Sport Concussion Office Assessment Tools (SCOAT6 [13+] and Child SCOAT6 [8-12]) were developed. Rather than strict rest, early return to light physical activity and reduced screen time facilitate recovery. Cervicovestibular rehabilitation is recommended for adolescents with dizziness, neck pain, and/or headaches for greater than 10 days. Active rehabilitation and collaborative care for adolescents with persisting symptoms for more than 30 days may decrease symptoms. No tests and measures other than standardized and validated symptom rating scales are valid for diagnosing persisting symptoms after concussion. Fluid and imaging biomarkers currently have limited clinical utility in diagnosing or assessing recovery from SRC. Improved paradigms for return to school were developed. The variable nature of disability and differences in evaluating para athletes and those of diverse ethnicity, sex, and gender are discussed, as are ethical considerations and future directions in pediatric SRC research., (Copyright © 2024 by the American Academy of Pediatrics.)

To sustain their malignancy, tumour cells acquire several metabolic adaptations such as increased oxygen, glucose, glutamine, and lipids uptake. Other metabolic processes are also enhanced as part of tumour metabolic reprogramming, for example, increased serine metabolism. Serine is a non-essential amino acid that supports several metabolic processes that are crucial for the growth and survival of proliferating cells, including protein, DNA, and glutathione synthesis. Indeed, increased activity of D-3-phosphoglycerate dehydrogenase (PHGDH), the enzyme rate-limiting de novo serine synthesis, has been extensively reported in several tumours. Therefore, selective inhibition of PHGDH may represent a new therapeutic strategy for over-expressing PHGDH tumours, owing to its downstream inhibition of essential biomass production such as one-carbon units and nucleotides. This perspective article will discuss the current status of research into small molecular inhibitors against PHGDH in colorectal cancer, breast cancer, and Ewing's sarcoma. We will summarise recent studies on the development of PHGDH-inhibitors, highlighting their clinical potential as new therapeutics. It also wants to shed a light on some of the key limitations of the use of PHGDH-inhibitors in cancer treatment which are worth taking into account.

The use of platelet rich plasma (PRP) as a novel treatment is discussed in the context of a qualitative research study comprising 38 interviews with sports medicine practitioners and other stakeholders working within the English Premier League during the 2013-16 seasons. Analysis of the data produced several overarching themes: conservatism versus experimentalism in medical attitudes; therapy perspectives divergence; conflicting versions of appropriate evidence; subcultures; community beliefs/practices; and negotiation of medical decision-making. The contested evidence base for the efficacy of PRP is presented in the context of a broader professional shift towards evidence based medicine within sports medicine. Many of the participants while accepting this shift are still committed to casuistic practices where clinical judgment is flexible and does not recognize a context-free hierarchy of evidentiary standards to ethically justifiable practice. We also discuss a tendency in the data collected to consider the use of deceptive, placebo-like, practices among the clinician participants that challenge dominant understandings of informed consent in medical ethics. We conclude that the complex relation between evidence and ethics requires greater critical scrutiny for this emerging specialism within the medical community.

This article provides a critical overview of the ethics and governance of genetic biobank research, using the Athlome Consortium as a large scale instance of collaborative sports genetic biobanking. We present a traditional model of written informed consent for the acquisition, storage, sharing and analysis of genetic data and articulate the challenges to it from new research practices such as genetic biobanking. We then articulate six possible alternative consent models: verbal consent, blanket consent, broad consent, meta consent, dynamic consent and waived consent. We argue that these models or conceptions of consent must be articulated in the context of the complexities of international legislation and non legislative national and international biobank governance frameworks and policies, those which govern research in the field of sports genetics. We discuss the tensions between individual rights and public benefits of genomic research as a critical ethical issue, particularly where benefits are less obvious, as in sports genomics. The inherent complexities of international regulation and biobanking governance are challenging in a relatively young field. We argue that there is much nuanced ethical work still to be done with regard to governance of sports genetic biobanking and the issues contained therein.

Purpose: This paper explores the conceptual content of Paralympism. It exists by exploring the nascent normative framework that the International Paralympic Committee (IPC) has begun to construct around its constituent sports. The IPC sets out four values: Courage, Determination, Inspiration and Equality., Method: Drawing on philosophical ethical methods it offers a critical evaluation of the four values that comprise the IPC position., Conclusion: While courage is undoubtedly a moral virtue, there is more than one conception that might inform Paralympism with either/both active and passive content. It is argued that Determination is an instrumental character trait that is not necessarily ethically praiseworthy. While potentially inspiring, the efforts and abilities of Paralympic athletes need not depend on the reception of spectators whom they have no control over. Finally, being an important ethical idea, it is neither clear what kind of equality is aimed for nor how it would be operationalized within sports with respect to access to expensive technology that is often the precondition of Paralympic sporting success. It is concluded that the Paralympic movement has not yet invested sufficient intellectual effort to articulate its ethical basis, and while these four values may have something to do with Paralympism, they are insufficient to articulate the concept. Implications for Rehabilitation Athletes with disabilities are governed by a range of normative frameworks that affect their preparation for and participation in the Paralympic games and associated events. Medical models often espouse a conception of biostatistical normality that derogates persons with disabilities, yet in elite sports abnormalities in structure and function can be highly valued. There is a lack of clarity about the ethical goals for those assisting Paralympic athletes. Governing bodies in disability sports, such as the International Paralympic Committee need to more critically and coherently spell out their ethical vision for Paralympic sports, which should guide athletes and rehabilitation professionals to behave in ways that would command the general public's admiration. Paralympism, Paralympic values and disability sport: a conceptual and ethical critique.

Eating disorders and disordered eating are more common in high performance sports than the general population, and particularly so in high performance aesthetic sports. This paper presents some of the conceptual difficulties in understanding and diagnosing eating disorders in high performance gymnasts. It presents qualitative and quantitative data from a study designed to ascertain the pattern of eating disorder symptoms, depressive symptoms and levels of self-esteem among national and international level gymnasts from the UK in the gymnastic disciplines of sport acrobatics, tumbling, and rhythmic gymnastics., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Despite considerable scientific dispute the science of concussion, there has been a proliferation of position statements and professional guidelines published on sports concussion management over the last 15 years. A number of ethical and clinical problems associated with concussion management protocols remain concerning, (i) diagnosis and management; (ii) conflicts of interest and coercion; (iii) same day return to play; and (iv) reporting, auditing and confidentiality. These issues are critically discussed in the light of recent Consensus Statements. It is argued that the use of independent match day doctors may ameliorate some of these concerns., (Copyright © 2016 Elsevier Inc. All rights reserved.)

In this paper we discuss the ethics of genetics-based talent identification programs in sports. We discuss the validity and reliability of the tests and the claims made by direct to consumer companies, before presenting a range of ethical issues concerning child-parent/guardian relations raised by these tests, which we frame in terms of parental/guardian duties, children's rights, and best interests. We argue that greater ethical emphasis needs to be put on the parental decision on the wellbeing on the child going forward, not on ex post justifications on the basis of good and bad consequences. Best interests decisions made by a third party seem to comprise both subjective and objective elements, but only a holistic approach can do justice to these questions by addressing the wellbeing of the child in a temporal manner and taking into account the child's perspective on its wellbeing. Such decisions must address wider questions of what a good (sports)parent ought do to help the child flourish and how to balance the future-adult focus necessary to nurture talent with the wellbeing of the child in the present. We conclude that current genetic tests for "talent" do not predict aptitude or success to any significant degree and are therefore only marginally pertinent for talent identification. Claims that go beyond current science are culpable and attempt to exploit widespread but naïve perceptions of the efficacy of genetics information to predict athletic futures. Sports physicians and health care professionals involved in sport medicine should therefore discourage the use of these tests., (Copyright © 2016 the American Physiological Society.)

In light of the World Anti Doping Agency's 2013 Code Revision process, we critically explore the applicability of two of three criteria used to determine whether a method or substance should be considered for their Prohibited List, namely its (potential) performance enhancing effects and its (potential) risk to the health of the athlete. To do so, we compare two communities of human guinea pigs: (i) individuals who make a living out of serial participation in Phase 1 pharmacology trials; and (ii) elite athletes who engage in what is effectively 'unregulated clinical research' by using untested prohibited or non-prohibited performance enhancing substances and methods, alone or in combination. Our comparison sheds light on norms of research ethics that these practices exacerbate with respect to the concepts of multiplicity, visibility, and consistency. We argue for the need to establish a proper governance framework to increase the accountability of these unregulated research practices in order to protect the human guinea pigs in elite sports contexts, and to establish reasonable grounds for the performance enhancing effects, and the risks to the health of the athlete, of the methods and substances that might justify their inclusion on the Prohibited List.

There is evidence of a small but significant proportion of adolescents engaging in doping practices. Young athletes face very specific pressures to achieve results as they strive for a career at an elite level. This study used an anonymized questionnaire to survey 403 (12-21 years old) talented young athletes' attitudes toward performance-enhancing substances and supplements. Two-thirds of the sample comprised males. Athletes were generally against the use of doping substances to enhance sporting performance. Within this generally unfavorable view, males tended to express a more permissive attitude toward performance-enhancing methods than females. Those convinced of the necessity of supplementation for sporting success were also more likely to express permissive attitudes. When asked whether they would take a "magic" drug that, while undetectable, would significantly enhance performance, the overwhelming majority of athletes said "no," but many thought others would take the substance. Interestingly, there was a significant association between the projected use of the hypothetical drug by competitors and the individual respondent's willingness to take the hypothetically "magic" substance. The study offers an insight into young athletes' attitudes toward specific forms of performance enhancement, and the strength of their beliefs in the face of a tempting hypothetical scenario., (© 2010 John Wiley & Sons A/S.)

Criticisms of the ethical justification of antidoping legislation are not uncommon in the literatures of medical ethics, sports ethics and sports medicine. Critics of antidoping point to inconsistencies of principle in the application of legislation and the unjustifiability of ethical postures enshrined in the World Anti-Doping Code, a new version of which came into effect in January 2009. This article explores the arguments concerning the apparent legal peculiarities of antidoping legislation and their ethically salient features in terms of: notions of culpability, liability and guilt; aspects of potential duplication of punishments and the limitations of athlete privacy in antidoping practice and policy. It is noted that tensions still exist between legal and ethical principles and norms that require further critical attention.

Sports medicine ethics is neither a well established branch of sports medicine nor of medical ethics. It is therefore important to raise to more general awareness some of the significant ethical implications of sports medicine practices. The field of genetics in sports is likewise in its infancy and raises significant ethical concerns. It is not yet clear how genetics will alter our understanding of human potential and performance in sports. While a number of professional medical bodies accept genetic interventions of a therapeutic nature, we argue that the use of genetic technologies to predict sports potential may well breach both the European bioethics convention and North American anti-discrimination legislation, which are designed to support important ethical ideals and the ongoing commitment of the physician to the welfare of their patient. We highlight further ethical problems associated with confidentiality and consent that may arise in genetic testing as opposed to more conventional methods of testing in sports medicine. We conclude that genetic testing in sport that is not strictly limited to the protection of the athlete against harm, should be viewed in a very sceptical light by sports medicine professionals.

The purpose of this paper is to examine the concept of Schadenfreude--the pleasure felt at another's misfortune--and to argue that feeling it in the course of health care work, as elsewhere, is evidence of a deficient character. In order to show that Schadenfreude is an objectionable emotion in health care work, I first offer some conceptual remarks about emotions generally and their differential treatment in Kantian and Aristotelian thought. Second, I argue that an appreciation of the rationality of the emotions is crucial to our self-understanding as persons in general and nurses in particular. Third, I present a critique of Portmann's (2000, When Bad Things Happen to Other People. London: Routledge) defence of Schadenfreude with examples from both nursing and medical scenarios. Specifically, I show how his exculpation of the emotion in terms of low self-esteem and a commitment to justice are not compelling. I argue that we are active in the construction of our emotional experiences of Schadenfreude, how we may indeed 'nurse' the emotion, and thus become culpable for them in ethical terms.

In this article, transhumanism is considered to be a quasi-medical ideology that seeks to promote a variety of therapeutic and human-enhancing aims. Moderate conceptions are distinguished from strong conceptions of transhumanism and the strong conceptions were found to be more problematic than the moderate ones. A particular critique of Boström's defence of transhumanism is presented. Various forms of slippery slope arguments that may be used for and against transhumanism are discussed and one particular criticism, moral arbitrariness, that undermines both weak and strong transhumanism is highlighted.

Objective: To determine the usefulness of performing routine postprocedure chest radiographs (CXRs) following percutaneous dilatational tracheostomy (PDT) under bronchoscopic visualization., Design: Retrospective, chart review., Setting: Medical-surgical ICU of a teaching hospital., Methods: Sixty patients who underwent PDT under bronchoscopic visualization, for persistent ventilator dependence, in our medical-surgical ICU were studied. We noted the occurrence of any perioperative complications, physician anticipation of postoperative complications, and postprocedure CXR findings. We compared postprocedure CXRs with the last preprocedure CXR. Immediate postoperative complication was defined as a clinical worsening, hemodynamic instability, or a new radiographic finding such as atelectasis, paratracheal placement, pneumothorax, and pneumomediastinum. We determined whether the postprocedure CXRs led to any change in patient management., Observation: Two patients (3.3%) had postoperative complications detected on their CXRs, one with a pneumomediastinum and the other with a tension pneumothorax. Both procedures were noted to be difficult, with a high physician anticipation of complication. In the remaining 58 patients (96.7%), no postoperative complications were detected on the postprocedure CXRs that necessitated any change in patient management., Conclusion: We concluded that routine CXR following PDT that had been performed under bronchoscopic visualization is unnecessary in the absence of clinical deterioration or the anticipation of postoperative complications.

The number of homeless persons in the United States is increasing on an annual basis, with men accounting for the greatest number. Accessing health care for this group is difficult for many reasons, particularly those related to finances, transportation, lack of insurance, and transiency of lifestyle. Consequently, data regarding homeless men's health problems/concerns are difficult to obtain, and often the information reported is only for acute care services provided by emergency rooms and clinics. The purpose of this study was to determine the demographic characteristics and health problems/concerns of sheltered homeless men using the services of a mobile van for health care over a 4-year period. A total of 2,086 records, representing 1,171 men aged 19 and over, were retrospectively reviewed to determine demographic and health characteristics (age, sex, self-reported medical and addiction histories, and self-reported medication use). Data on presenting concerns, diagnoses, visit patterns, treatments, medications and teaching provided were also collected and analyzed. Recommendations to improve the quality, continuity, and follow-up of care for homeless men are included.

Hypothermia is not an uncommon clinical problem in the geriatric population. Several factors place elderly individuals at risk, including their reduced ability to sense and react to cold and their underlying medical conditions and medications. Successful detection and treatment of these patients involve an awareness of these risk factors and the characteristic physiology of the elderly, as well as an appreciation of the often controversial aspects of hypothermia management. Elderly victims of severe hypothermia have a particularly grave prognosis. We present one of the oldest reported survivors of severe hypothermia, and discuss some unique aspects of his presentation.

Objective: To present the case of a Jehovah's Witness with severe anemia and to review the religious philosophy of such patients, the ethical and medicolegal aspects of their care, and the therapeutic options available to clinicians., Data Sources: A MEDLINE literature search (1980 to 1992) identified most studies. Other studies were selected from the bibliographies of identified articles., Study Selection: Selection of articles was limited to the history, philosophy, medicolegal and ethical issues, and clinical management of anemic Jehovah's Witnesses; a recent article on recommendations for red cell transfusion was also reviewed., Conclusions: A clear understanding of the philosophy of the Jehovah's Witnesses regarding blood transfusion and of the medicolegal and ethical aspects of their care is essential to clinicians who care for such patients. One must also be aware of the many alternative therapeutic options that can maximize oxygen delivery and minimize oxygen consumption. The insights gained from this review are applicable to any severely anemic patient who refuses blood transfusion.