Las personas portadoras o enfermas del virus de inmunodeficiencia humana han experimentado consecuencias devastadoras en el plano personal, familiar y social desde la aparición de los primeros casos. El objetivo del presente trabajo es analizar el cumplimiento de los principios bioéticos, así como la repercusión derivada de las implicaciones éticas del actuar profesional con estos pacientes, lo cual demuestra la necesidad de vencer los tabúes y la discriminación que han sido objeto desde los inicios de la epidemia. Persons who are (...) carrier of the Acquired Immunodeficiency Syndrome or persons who are sick have experienced destructive consequences in the personal, familiar and social spheres since the appearance of the first cases. The objective of this work is to analyze the fulfilment of the bioethical principles, as well as the repercussion derived from the ethics dilemma of the professional behaviour with these patients, what demonstrate the necessity of overcoming taboos and the discrimination they have suffered from since the beginnings of the disease. (shrink)

AIDS is an example of the global threat. In my article I would like to present the most important ethical dilemmas related to global outspreading of AIDS/HIV epidemic in the world and also make an attempt of finding a possible solution. I assume that the dilemmas could be described in three basic dimensions: The first discussed ethical problem is related to treating sick people by the healthy people. We observe the discrimination of people suffering from AIDS/HIV and it stands in (...) opposition to Christianity and Church which commands to accept sick people, to respect and help them. The second discussed aspect concerns ethical challenges that modern medicine must face regarding the outspread of AIDS and HIV. On one hand, medical stuff who have contact with blood must incessantly confront their fear of infection with duty of helping people and providing medical care. On the other hand, medical professionals may encounter the moral dilemma how to keep medical records in secret and protect interests of people who are exposed to infection. The last important ethical dimension of global AIDS epidemic and other civilisation illnesses, which has been recently observed, is the polarization of the world in the field of health. (shrink)

Human immunodeficiency viruses (HIV) and acquired immunodeficiency syndrome (AIDS), COVID-19 and Ebola have exposed the magnitude of care-related tasks on women. Most often, because of the gendered nature of domestic and reproductive roles, women are expected to assume unpaid care-related, nurturing and domestic work. Despite the valuable duties, women are economically poor and othered. These unpaid care duties are exacerbated by pandemics and ratified even further by religion. For instance, in Nomiya Church (NC), the first African (...) independent church in Kenya, women’s experience narratives and biblical texts such as the story of the Proverbs 31 virtuous woman are used to glorify unpaid charitable work for women. Women’s virtuous personality, hard work and character are upheld in Christian spaces, thus obstructing sound work theologies. This article employed African Women’s theological lens in view of pointing out repressing and transformative tenets in charitable theologies of work for social and gender justice. While applying womanhood hermeneutics in the passage, the article points to valued behavioural postures of hard work in responding to God’s stewardship mandate. An affirmation of fair reward and accumulation of property is embraced as a familial complementary role, especially in pandemic contexts. The article amplifies the accumulation of property as a human right and the mandate of stewardship for all earth communities. Hence, charity work is a stewardship framework that all earth communities must engage in for replenishment and sustenance for all.Contribution: The article challenges literal biblical interpretations that glorify charity work. It advances a stewardship framework in understanding unpaid and charity work that all earth communities must engage in to replenish and sustain all creation. The framework affirms the dignity of all human persons through a transformational understanding of the theology of work as enabled by the African theological hermeneutics. (shrink)

--Do patients have the right to know their physician's HIV status?-Can a dentist refuse treatment to an HIV-positive patient?-How do educators determine whether to allow an HIV-positive child to attend school, and if they do, should the parents of other children be informed?-Should a counselor break confidentiality by disclosing to a wife that her husband is infected with HIV?This collection of original essays carefully examines the difficult moral choices the AIDS pandemic has presented for many professionals-physicians, nurses, dentists, teachers and (...) school administrators, business managers, psychotherapists, lawyers, clergy, journalists, and politicians. In the workplace, problems posed by HIV and AIDS have led to a reexamination of traditional codes of ethics. Providing systematic and reasoned discussions, the authors explore the moral, legal, and ethical issues involved in the reconsideration of policies, standards of conduct, and the practicality of balancing personal and professional ethics. Author note: Elliot D. Cohen is Professor of Philosophy at Indian River Community College and Editor-in-Chief of the International Journal of Applied Philosophy.Michael Davis is Senior Research Associate at the Center for the Study of Ethics in Professions, Illinois Institute of Technology. (shrink)

The epidemic of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) has led to many ethical problems. Most studies have focused on the ethical issues faced by nurses who provide care to persons with AIDS (PWA), rather than the ethical issues faced by PWAs themselves. The purpose of this study, therefore, was to explore the ethical issues faced by five HIV/AIDS-infected African-American women. An analysis of interview data revealed that these women deal with four broad (...) categories of ethical issues: diagnosis; disclosure; treatment by, and of, others; and future pregnancies. The results of this study provide an initial description of the ethical issues faced by HIV/AIDS-infected African-American women, and begin to lay the foundation necessary for nurses appropriately to facilitate and support their decisions. (shrink)

In 1882, Tommaso de Amicis, dermatologist and venereologist at the University of Naples, Italy, published a description of twelve cases of Kaposi's sarcoma. This article is the second report about the above-mentioned disease after the first description of five cases by Moritz Kaposi ten years earlier. The publication by De Amicis was organized as a collection of case reports followed by a section containing general considerations about the etiopathogenesis, pathology, diagnosis and therapy of Kaposi's sarcoma. Ten cases are typical of (...) the so-called 'classic' form of the disease, that has a peculiar indolent chronic course, while two out of the twelve cases strongly resemble the clinical form of Kaposi's sarcoma currently recognized as that associated with the acquired immunodeficiency syndrome (AIDS). The nature of Kaposi's sarcoma is still being debated, but current evidence suggests that it is a viral-associated, if not viral-induced, tumor and its relationship with AIDS is that of an opportunistic disease. Thus, the presence of the clinical form of AIDS-related Kaposi's sarcoma can be used as a marker of the presence of sporadic cases of AIDS much earlier than its pandemic diffusion. (shrink)

Recent legislation, such as the Patient Self-Determination Act, establishes advance directives as an acceptable procedural means of incorporating patients’ preferences for life-sustaining treatments into their medical care. Advance directives can enhance medical decision making since they provide patients with an opportunity to communicate their preferences before suffering from an acute illness that may preclude their ability to do so.Although patients expect discussions about life-sustaining therapies to be initiated by their physicians, very little is known about what prompts physicians to discuss (...) advance directives with their patients. As in other areas of clinical decision making, there is evidence that patients’ sociodemographic factors influence whether discussions about advance directives occur between patients and their physicians. In one study of persons with the acquired immunodeficiency syndrome, those who had not had discussions about advance directives with their physicians tended to be non-white, have no prior hospitalization, and were more likely to have been cared for in a health maintenance organization than in a teaching hospital. (shrink)

Recent legislation, such as the Patient Self-Determination Act, establishes advance directives as an acceptable procedural means of incorporating patients’ preferences for life-sustaining treatments into their medical care. Advance directives can enhance medical decision making since they provide patients with an opportunity to communicate their preferences before suffering from an acute illness that may preclude their ability to do so.Although patients expect discussions about life-sustaining therapies to be initiated by their physicians, very little is known about what prompts physicians to discuss (...) advance directives with their patients. As in other areas of clinical decision making, there is evidence that patients’ sociodemographic factors influence whether discussions about advance directives occur between patients and their physicians. In one study of persons with the acquired immunodeficiency syndrome, those who had not had discussions about advance directives with their physicians tended to be non-white, have no prior hospitalization, and were more likely to have been cared for in a health maintenance organization than in a teaching hospital. (shrink)

The most remarkable thing about the U.S. Supreme Court's 1998 decision in Bragdon v. Abbott was that it was necessary at all. Seventeen years into the epidemic of the acquired immunodeficiency syndrome, the Supreme Court, by a mere 5-4 majority, finally affirmed what most public health officials, health providers, and lawyers working with people with human immunodeficiency virus believed all along: that individuals with HIV infection are entitled to the protections of antidiscrimination law, and that health (...) care providers must respond to a patient's infection based on reason and science, not fear and prejudice. For individuals with HIV, and for those with other disabilities, the Court's ruling was a critical victory. But the very fact that the issues had to be decided by the Supreme Court and that only five justices joined the majority, shows the fragility of legal rights pertaining to HIV as well as the wide gulf between the perspectives of public health and those of public law. (shrink)

On March 9, 1993, in the first ruling of its kind, the Maryland Court of Appeals declared that physicians and hospitals may be sued for failing to inform patients of a practitioner’s human immunodeficiency virus status. What is more significant, these suits may be pursued even in instances when the physician has followed universal precautions and the patient did not contract the virus that causes acquired immunodeficiency syndrome. The Maryland court addressed two central questions in Faya (...) v. Almaraz. First, do HIV-infected physicians have a legal duty to inform their patients of their HIV status? And, second, can patients recover damages for fear induced by a physician’s conduct? While one finds numerous precedents that authorize actions to recover damages based purely on fear of disease and emotional distress, the Faya court’s holdings on the issue significantly expand the scope of potential liability. Moreover, the court’s analysis of the informed consent and HIV-infected physician issue is incomplete, inconsistent, and represents an unjustified and unwise departure from traditional informed consent theory. It, and its progeny, may have widespread and dire repercussions. (shrink)

The most remarkable thing about the U.S. Supreme Court's 1998 decision in Bragdon v. Abbott was that it was necessary at all. Seventeen years into the epidemic of the acquired immunodeficiency syndrome, the Supreme Court, by a mere 5-4 majority, finally affirmed what most public health officials, health providers, and lawyers working with people with human immunodeficiency virus believed all along: that individuals with HIV infection are entitled to the protections of antidiscrimination law, and that health (...) care providers must respond to a patient's infection based on reason and science, not fear and prejudice. For individuals with HIV, and for those with other disabilities, the Court's ruling was a critical victory. But the very fact that the issues had to be decided by the Supreme Court and that only five justices joined the majority, shows the fragility of legal rights pertaining to HIV as well as the wide gulf between the perspectives of public health and those of public law. (shrink)

It was a characteristically cold, bright morning in Geneva in 1986, and I had just taken the Number 8 bus from the Cornavin to the headquarters of the World Health Organization. I wandered into a cluttered and cramped office filled with unopened boxes and scattered papers. Jonathan Mann and a competent Swiss secretary, Edith Bernard, had just moved in. Together, they alone constituted the WHO team that would mobilize the global effort against an emerging plague-the acquired immunodeficiency (...) class='Hi'>syndrome. Jonathan had recently come from Kinshasa where he led Projet SIDA, an innovative international program to reduce the already weighty burden of the human immunodeficiency virus in Africa. (shrink)

It was a characteristically cold, bright morning in Geneva in 1986, and I had just taken the Number 8 bus from the Cornavin to the headquarters of the World Health Organization. I wandered into a cluttered and cramped office filled with unopened boxes and scattered papers. Jonathan Mann and a competent Swiss secretary, Edith Bernard, had just moved in. Together, they alone constituted the WHO team that would mobilize the global effort against an emerging plague-the acquired immunodeficiency (...) class='Hi'>syndrome. Jonathan had recently come from Kinshasa where he led Projet SIDA, an innovative international program to reduce the already weighty burden of the human immunodeficiency virus in Africa. (shrink)

Life among most African families and communities revolves around women. In both African religion and culture, women’s lives oscillate between two opposite extremes of being at the centre and periphery at the same time. Women are both the healers and the often wounded by the system that respects them when there are problems and displaces them whenever there are opportunities. Their central role is expressed by a Shona proverb musha mukadzi (the home is a woman). This proverb expresses how women (...) endure the pain of both religion and culture to create a decent society. Women also endure the pain of pandemics such as human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) and COVID-19 and at times succumb to the same while taking care of some family members who would have fallen victim to the epidemic. Countless married women have been made susceptible to HIV and AIDS as they try to live according to the African cultural dictates of mothering and/or motherhood. Other women and girls also contract the disease because of how religion and culture exert them to some unbearable circumstances. For example, women and girls nurse their ill relatives without protective equipment and clothing. At times they are abused by men because of some cultural beliefs that unprotected sex is a remedy for HIV and AIDS. In addition, most women and girls were also victims of COVID-19 while serving their family members. In doing all the good work to serve families, women are driven by the proverb musha mukadzi. Using desk research methodology, this paper argues that musha mukadzi is both a toolkit for women’s resilience to endure pandemics and at the same time a subtly oppressive statement often used to manipulate and abuse women to stand in places that are too difficult for their capabilities. Contribution: African women bear the brunt of pandemic burdens such as HIV, AIDS and COVID-19. Sometimes they become susceptible to the same while taking care of their family members affected by pandemics in the name of fulfilling the Shona proverb, musha mukadzi. The topic has contributed to the scope of the journal as it advocates to inculcate a peaceful society. The article also challenges African societies not to use musha mukadzi to ill-treat women as objects of African religio-cultural patriarchal ideology. (shrink)

Objective: To analyse the time variation of topics in bioethical publications as a proxy of the relative importance.Methods: We searched the Medline database for bioethics publications using the words “ethics or bioethics”, and for 360 specific topics publications, associating Medical Subject Heading topic descriptors to those words. We calculated the ratio of bioethics publications to the total publications of Medline, and the ratio of each topic publications to the total bioethics publications, for five-year intervals, from 1970 to 2004. We calculated (...) the time variation of ratios, dividing the difference between the highest and lowest ratio of each topic by its highest ratio. Four topics were described, selected to illustrate different patterns of variation: “Induced Abortion”, “Conflict of Interest”, “Acquired Immunodeficiency Syndrome”, “Medical Education.”Results: The ratio of bioethics publications to total Medline publications increased from 0.003 to 0.012. The variation of the topic’s ratios was higher than 0.7 for 68% of the topics. The Induced Abortion ratios decreased from 0.12 to 0.02. Conflict of Interest ratios increased from zero to 0.07. The Acquired Immunodeficiency Syndrome ratios were nearly zero in the first three intervals, had a peak of 0.06 during 1985–9, followed by a decrease to 0.01. Medical Education ratios varied few, from 0.04 to 0.03.Conclusions: There was an increase of bioethical publications in the Medline database. The topics in bioethics literature have an important time variation. Some factors were suggested to explain this variation: current legal cases, resolution of the issue, saturation of a discussion and epidemiologic importance. (shrink)

The perpetual decline of Zimbabwe’s socio-economic situation can be found in the country legalising prostitution, which it used to regard as an act of criminality. This legalisation promoted the trade from being an offense to a lifestyle and from being an act of immorality to a profession. Prostitutes were also advanced from being social outcasts to commercial sex workers. Although the law appeared to financially empower prostitutes, its negative impact is seen in the level it dehumanises teen girls as they (...) turn themselves into sex objects. Cases of school dropouts among teen girls and human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) are some of the evidences of the negative impact of prostitution, caused by their belief that ‘unprotected sex pays more’. The location of the study was Epworth Booster in Harare, Zimbabwe. Using an African feminist theology framework, this article aims to analyse how women’s theology can be used as a panacea to restore dignity and hunhu-ism to the teen girls whose bodies have been exposed to abuse by their purported fathers. The article uses both unstructured and focus group interviews to collect data from three health personnel and 10 teen girls, respectively. The article grapples with the fact that the legalisation of prostitution in Zimbabwe seriously affected both the social and religious life of teen girls as they risk their lives in order to earn a living, and African feminist theology should be applied to defend these vulnerable girls.Contribution: In the context of socio-economic depletion and laws that suppress women in the name of empowering them, rereading and application of women’s theology should protect women and offer them a future with hope. (shrink)

Book Reviews in This Article:William J. curran Larry Gostin, and Mary Clark, Acquired Immunodeficiency Syndrome: Legal and Regulatory Policy.

No discussion of the informed consent process would be adequate without attention to dilemmas and challenges arising in research in foreign countries, particularly in the less developed countries. In an era of the human immunodeficiency virus and acquired immunodeficiency syndrome, for example, much attention to research issues concerning devastating health conditions in developed and less developed countries has occurred with renewed vigor.

The aim of the study was to determine how the health of people living with Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome is affected by social and structural factors conducive to non-adherence to antiretroviral treatment. In a qualitative study conducted at Victoria Hospital in Alice, a town in the Eastern Cape, South Africa, 23 isiXhosa-speaking participants between the ages of 18 and 60 years were interviewed. Guided by the social-ecological framework of Bronfenbrenner, which is based on (...) the notion that the health-seeking behaviour of people living with HIV/aids is influenced by their social, institutional and physical environments, the analysis of the data identified the following themes conducive to non-adherence to antiretroviral treatment: food insecurity, financial constraints, poor service from health workers, unfair dismissal, fear of the consequences of disclosure, and rejection by church members. Based on these findings, and given that there is no single model of best practice that can appropriately address the various social and structural factors complicating the treatment of HIV/aids and hence the containing of the pandemic, the study suggests the need for not only supportive community initiatives, but a collaborative approach at both local and national level, and particularly in impoverished communities, by the appropriate departments of state to promote adherence to anti-retroviral treatment by making treatment and counselling facilities more accessible to PLWHA and educating communities about the implications and prevention of the disease. (shrink)

To help raise and renew consciousness about this threat to the world, Ethics and AIDS: Compassion and Justice in Global Crisis summarizes the basics of the AIDS epidemic and presents key themes and insights based on the Hebrew and Christian scriptures. This ethical perspective is the result of decades of dialogue among Roman Catholics and other Christians, building on the strengths of the various traditions. This book offers a Christian view, with special emphasis on Roman Catholic thought; many of its (...) ethical insights, however, can be shared by other faith traditions and by all people who desire to respond to the AIDS epidemic. (shrink)

The problem of disease definition is related to theproblem of proving that a certain agent is thenecessary cause of a certain disease. Natural kindterms like ‘rheumatoid arthritis’ and ‘AIDS’ refer toessences which are discoverable rather thanpredeterminate. No statement about such diseases isa priori necessarily true. Because theories onnecessary causes involve natural kind semantics,Koch's postulates cannot be used to falsify or verifysuch theories. Instead of proving that agent A is thenecessary cause of disease D, we include A in atheoretical definition of (...) D, take this to representthe real meaning of ‘D’, and discard thepretheoretical definition. This is illustrated byKoch's own attempt to prove he had discovered thenecessary cause of tuberculosis. Methodologicalarguments about disease causation require a clear viewof our use of diagnostic terms. Medical lexicographersshould do more to provide such a view. (shrink)

This chapter contains sections titled: HIV Testing HIV Infection: Harm to Self or Harm to Others Access to Experimental Drugs and the Ethics of Research Clinical Trials Developing Preventive Vaccines Affordable Access to Life‐preserving Medication HIV Infection in Health‐care Professionals and Patients Final Remarks References Further reading.

The HIV/AIDS epidemic in Haiti has often been referred to as a “mystery,” and “striking similarities” between patterns of disease in Haiti and in sub-Saharan Africa are often underlined. The occurrence of AIDS in Haitians has also led to the postulation of a number of theories positing a Haitian origin for AIDS and linking the syndrome in Haitians to voodoo. A review of the epidemiological data gathered and published in the early years of the pandemic suggests that these “exotic” (...) theories are not necessary to explain the Haitian epidemic, which is clearly linked not to Africa but to the United States. Patterns of risk identified among many of the first Haitians with AIDS are similar to risk factors identified in North America and Europe (same-sex contact with an HIV-infected individual and blood transfusion). The Haitian epidemicsubsequently came to resemble patterns seen in sub-Saharan Africa, where AIDS is predominantly a heterosexually transmitted disease. Similarly shifting patterns are described for several other Caribbean nations, underlining the importance of a historical analysis of the Caribbean pandemic as well as the necessity to link analysis of local epidemiology of AIDS/HIV to larger considerations of political economy. (shrink)

AIDS is a debilitating and fatal disease that was first identified as an infectious disease syndrome in the 1970s. The discovery of a nearly universally fatal infectious and rapidly spreading disease in the post–antibiotics era created apprehension in the medical community and alarm in the general population. Questions about how patients should be handled in medical and nonmedical settings resulted in the ostracizing of many AIDS patients and inappropriate patient management. Scientific investigation into modes of disease transmission and control (...) helped to shape the management of AIDS patient care in such a way that ethical and protective practices could be developed. In this article I discuss some of the ethical questions that were addressed by appropriate scientific inquiry. (shrink)

This article focuses on the ways that sexual risk behaviors are related to race, class, and gender among low-income, culturally diverse women in South Florida. Data concerning sexual risk and gender are presented in terms of race and class variations. Results indicate that, in general, these women have a high degree of knowledge about acquired immune deficiency syndrome, a quite contemporary awareness of women's gendered subordination, and a lack of trust in heterosexual relationships. Attitudes, beliefs, and knowledge, however, (...) are not translated into sexual behaviors with men partners that would reduce their vulnerability to infection with the human immunodeficiency virus. The data indicate that race is a major factor that places women into an underclass position. Consequently, without socioeconomic resources, gendered behaviors have a direct influence on sexual risk. Multivariate analyses indicate that those women who are sex workers are significantly more likely to negotiate safe sex with clients than with main partners. The research not only challenges mainstream thinking about race, class, and gender but also provides overdue information on the vulnerability of women to HIV infection. (shrink)

The thymus gland, which plays a key role in the maturation and functioning of the lymphoid system, is implicated in the acquired immune deficiency syndrome (AIDS). The observation that the thymic hormone, thymosin α1, is elevated in individuals at risk for AIDS (as opposed to being depressed in other immunodeficient states) has provided the first direct evidence that the thymus is malfunctioning early in the course of this deadly disease. These observations have been valuable in screening for the (...) syndrome with a rapid radioimmunoassay and in the initiation of the first clinical trials with thymosin in high risk homosexuals and hemophiliacs. If the progressive immune paralysis in AIDS is due to a dying thymus, the early identification of asymptomatic carriers of AIDS or individuals with modest AIDS‐related dysfunction may lead to therapy with thymosin or other thymomimetic agents that can restore immune function and prevent the onset of frank AIDS. (shrink)

The rapid spread of the Acquired Immune Deficiency Syndrome (AIDS) and its causative agent, the Human Immunodeficiency Virus (HIV), has posed people with difficult ethical questions. Philosophically, one of the most interesting problems is whether or not there is a right to remain in ignorance about one's own HIV infection.Being informed about a positive HIV test result has caused many people anguish and led some to suicidal thoughts. On these grounds a prima facte right not to know (...) could be constructed. Paternalistic arguments have been put forward to refute the alleged right, but these arguments are invalid, as is shown in the paper.However, by a utilitarian argument it can be shown that the prima facie right to remain in ignorance is overridden by other people's rights not to be infected. With certain qualifications, even a non-voluntary testing programme for HIV is justifiable. (shrink)

The rapid spread of the Acquired Immune Deficiency Syndrome (AIDS) and its causative agent, the Human Immunodeficiency Virus (HIV), has posed people with difficult ethical questions. Philosophically, one of the most interesting problems is whether or not there is a right to remain in ignorance about one's own HIV infection.Being informed about a positive HIV test result has caused many people anguish and led some to suicidal thoughts. On these grounds a prima facte right not to know (...) could be constructed. Paternalistic arguments have been put forward to refute the alleged right, but these arguments are invalid, as is shown in the paper.However, by a utilitarian argument it can be shown that the prima facie right to remain in ignorance is overridden by other people's rights not to be infected. With certain qualifications, even a non-voluntary testing programme for HIV is justifiable. (shrink)

Tick bite induced α‐gal syndrome (AGS) following consumption of mammalian meat is a recently described intriguing disease occurring worldwide. Here we argue that AGS and delayed allergy in general is an adaptive defence method against cancer. Our hypothesis synthesizes two lines of supporting evidence. First, allergy has been shown to have direct anti‐cancer effects with unknown mechanism. Second, eating processed meat was shown to be linked to developing cancer. Humans lost their genes encoding molecules α‐gal 30 MYA and Neu5Gc (...) 2 MYA, the latter co‐occurring with the start of using fire. These molecules are acquired from external sources, as tick bite for α‐gal and mammalian meat for Neu5Gc, the latter accumulating in tumors. The resulting specific delayed allergic response is a molecular adaptation to fight cancer. By further testing and applying our hypothesis, new avenues in cancer research and therapy will open that might save lives and decrease human suffering. (shrink)

Brazil has occupied a central role in the access to medicines movement, especially with respect to drugs used to treat those with the human immunodeficiency virus that causes the acquired immune deficiency syndrome. Contrary to previous literature centered on the role of the domestic pharmaceutical industry, politicians seeking electoral gains, and civil society activists, I argue that the state, especially the National AIDS Program, led the struggle in contesting a corporate-driven international intellectual property regime. After reviewing the (...) origins of Brazil’s treatment policies and patent reforms, I trace the actions and relationships between the state, civil society, transnational corporations, and local industry in three instances when Brazilian officials used compulsory licenses to reduce the price of medicines. Coalition-building and “naming and shaming” tactics contributed to Brazil’s success, while changing pharmaceutical capabilities limited more aggressive actions. (shrink)

Immunological mechanisms and therapy approaches in psychotic syndromes were recently supported by the discovery of autoantibody-associated limbic and non-limbic encephalitis. However, how clinical diagnostic procedures in psychiatry should be adapted to these new insights is still unclear. In this study, we analyzed the cerebrospinal fluid (CSF) and neuroimmunological alterations and their association with cerebral MRI (cMRI) and electroencephalographic (EEG) findings. From 2006 until 2013, we acquired 180 CSF samples from psychotic patients. Between 2006 and 2009, CSF examinations were only (...) performed in cases in which organic brain disease was suspected. Since then, this procedure has been integrated into our routine diagnostic workup. CSF basic diagnostics were supplemented by measuring antineuronal antibodies against intracellular synaptic antigens, antibodies against intracellular onconeural antigens, antibodies against neuronal cell surface antigens and thyroid antibodies. In addition, cMRIs and EEGs were conducted. We found white cell counts elevated in 3.4% of the cases, albumin quotient elevated in 21.8%, and protein concentration elevated in 42.2%. Evidence of intrathecal immunoglobulin synthesis was found in 7.2% of the cases. Antibodies measured against neuronal cell surface antigens were positive in 3.2%. Reactivity on antibodies against intracellular onconeural antigens were detected in 3.5%. Serum thyroid antibodies were elevated in 24.7%. Abnormalities were found in 39.5% of cMRIs and in 34.3% of EEGs. The main finding of our study was the high prevalence of CSF and autoantibody abnormalities in 54.4% of psychotic patients. In combination with cMRIs and EEGs, 75.6% showed abnormal findings. Our results are discussed with regard to the concept of immunological encephalopathy. Future studies should analyze the efficacy of immunomodulatory therapies. (shrink)

Application of evolutionary principles to epidemiological problems indicates that cultural characteristics influence the evolution of parasite virulence by influencing the success of disease transmission from immobilized, infected hosts. This hypothesis is supported by positive correlations between virulence and transmission by biological vectors, water, and institutional attendants. The general evolutionary argument is then applied to the causes and consequences of increased virulence for three diseases: cholera, influenza and AIDS.

This paper and its subsequent parts (Part II and Part III) build on an earlier publication (McKenna 1986). They suggest that important clinical data on the relationship between infantile constitutional deficits and microenvironmental factors relevant to SIDS can be acquired by examining the physiological regulatory effects (well documented among nonhuman primates) that parents assert on their infants when they sleep together.I attempt to show why access to parental sensory cues (movement, touch, smell, sound) that induce arousals in infants while (...) they sleep could possibly help one of many different subclasses of infants either to override certain kinds of sleep-induced breathing control errors suspected to be involved in SIDS or to avoid them altogether. I do not suggest that solitary nocturnal sleep “causes” SIDS, that all parents should sleep with their infants, or that traditional SIDS research strategies should be abandoned. However, using evolutionary data, I do suggest that an adaptive fit exists between parent-infant sleep contact and the natural physiological vulnerabilities of the neurologically immature human infant, whose breathing system is more complex than that of other mammals owing to its speech-breathing abilities. This “fit” is best understood, it is argued, in terms of the 4–5 million years of human evolution in which parent-infant contact was almost certainly continuous during at least the first year of an infant’s life. Thus, to dismiss the idea that solitary sleep has no physiological consequences for infants does not accord with scientific facts. (shrink)

We studied the patient JP who has exceptional abilities to draw complex geometrical images by hand and a form of acquired synesthesia for mathematical formulas and objects, which he perceives as geometrical figures. JP sees all smooth curvatures as discrete lines, similarly regardless of scale. We carried out two preliminary investigations to establish the perceptual nature of synesthetic experience and to investigate the neural basis of this phenomenon. In a functional magnetic resonance imaging (fMRI) study, image-inducing formulas produced larger (...) fMRI responses than non-image inducing formulas in the left temporal, parietal and frontal lobes. Thus our main finding is that the activation associated with his experience of complex geometrical images emerging from mathematical formulas is restricted to the left hemisphere. (shrink)

ObjectiveThis study aims to evaluate the effectiveness of the MotivAir program—a phone-based intervention based on Motivational Interviewing principles and techniques—in enhancing adherence to Continuous Positive Airway Pressure therapy among patients with Obstructive Sleep Apnea Syndrome.MethodsA multicenter randomized controlled trial design with random allocation at the level of the individual will be conducted to compare the impact of the experimental program with a control group receiving usual care only in improving selected clinical and psychological parameters in the patients. A minimum (...) sample of 80 participants will be recruited in each center according to the inclusion criteria. After the initial screening, participants will be randomly assigned to either the experimental group or the control condition. The program will last 180 days and will be delivered by a trained nurse. The impact of the MotivAir program on selected primary and secondary outcomes will be measured at baseline, and after 1-, 3-, and 6-month from CPAP initiation.DiscussionParticipants are expected to show an increased level of adherence to CPAP and to acquire the skills and self-confidence necessary to deal with the psychological consequences of their chronic condition. (shrink)

Two experiments are reported that evaluated survey learning of youth with DS and typically developing children (TD) matched on Mental Age (MA). In Experiment 1, the experimenter navigated participants through a novel virtual environment along a circuitous path, beginning and ending at a target landmark (i.e., a door). Then, the participants were placed at a pre-specified location in the environment and instructed to navigate to the same door using the shortest possible path from their current location. They completed the task (...) three times: once after being shown the environment one time, once after three exposures, and once after five exposures. Results indicated that the participants with DS exhibited significantly less skill at identifying the shortcut than did the TD participants. In Experiment 2, participants learned two overlapping routes through a simple environment. Following acquisition, they were tested on several measures of survey knowledge: finding a shortcut, identifying the direction of landmarks not currently visible from their location in the environment, and recognizing a bird’s-eye representation of the overall environment. The results of Experiment2 indicated that the participants with DS were at least as good as the TD participants on all of our measures of survey learning. Hence, we concluded that people with DS can acquire some survey knowledge when they learn a simple environment. However, the performance of both groups was relatively poor in Experiment 2, indicating a need to consider identifying the mechanisms underlying the poor performance on wayfinding of people with DS. Identifying the underlying mechanisms, is a logical first step in devising methods of enhancing environmental learning of people with DS. (shrink)

Obesity and type 2 diabetes arise from a set of complex gene–environment interactions. Explanations for the heritability of these syndromes and the environmental contribution to disease susceptibility are addressed by the “thrifty genotype” and the “thrifty phenotype” hypotheses. Here, the merits of both models are discussed and elements of them are used to synthesize a “thrifty epigenotype” hypothesis. I propose that: (1) metabolic thrift, the capacity for efficient acquisition, storage and use of energy, is an ancient, complex trait, (2) the (...) environmentally responsive gene network encoding this trait is subject to genetic canalization and thereby has become robust against mutational perturbations, (3) DNA sequence polymorphisms play a minor role in the aetiology of obesity and type 2 diabetes—instead, disease susceptibility is predominantly determined by epigenetic variations, (4) corresponding epigenotypes have the potential to be inherited across generations, and (5) Leptin is a candidate gene for the acquisition of a thrifty epigenotype. BioEssays 30:156–166, 2008. © 2008 Wiley Periodicals, Inc. (shrink)

Assessment of decision-making capacity (DMC) can be difficult in acquired brain injury (ABI) particularly with the syndrome of organic personality disorder (OPD) (the “frontal lobe syndrome”). Clinical neuroscience may help but there are challenges translating its constructs to the decision-making abilities considered relevant by law and ethics. An in-depth interview study of DMC in OPD was undertaken. Six patients were purposefully sampled and rich interview data were acquired for scrutiny using interpretative phenomenological analysis. Interview data revealed (...) that awareness of deficit and thinking about psychological states can be present. However, the awareness of deficit may not be “online” and effectively integrated into decision-making. Without this online awareness of deficit the ability to appreciate or use and weigh information in the process of deciding some matters appeared absent. We argue that the decision-making abilities discussed are: (1) necessary for DMC, (2) threatened by ABI, and (3) assessable at interview. Some advice for practically incorporating these abilities within assessments of DMC in patients with OPD is outlined. (shrink)

This paper and its subsequent parts (Part II and Part III) build on an earlier publication (McKenna 1986). They suggest that important clinical data on the relationship between infantile constitutional deficits and microenvironmental factors relevant to SIDS can be acquired by examining the physiological regulatory effects (well documented among nonhuman primates) that parents assert on their infants when they sleep together. I attempt to show why access to parental sensory cues (movement, touch, smell, sound) that induce arousals in infants (...) while they sleep could possibly help one of many different subclasses of infants either to override certain kinds of sleep-induced breathing control errors suspected to be involved in SIDS or to avoid them altogether. I do not suggest that solitary nocturnal sleep “causes” SIDS, that all parents should sleep with their infants, or that traditional SIDS research strategies should be abandoned. However, using evolutionary data, I do suggest that an adaptive fit exists between parent-infant sleep contact and the natural physiological vulnerabilities of the neurologically immature human infant, whose breathing system is more complex than that of other mammals owing to its speech-breathing abilities. This “fit” is best understood, it is argued, in terms of the 4–5 million years of human evolution in which parent-infant contact was almost certainly continuous during at least the first year of an infant’s life. Thus, to dismiss the idea that solitary sleep has no physiological consequences for infants does not accord with scientific facts. (shrink)

This paper and its subsequent parts (Part II and Part III) build on an earlier publication (McKenna 1986). They suggest that important clinical data on the relationship between infantile constitutional deficits and microenvironmental factors relevant to SIDS can be acquired by examining the physiological regulatory effects (well documented among nonhuman primates) that parents assert on their infants when they sleep together. I attempt to show why access to parental sensory cues (movement, touch, smell, sound) that induce arousals in infants (...) while they sleep could possibly help one of many different subclasses of infants either to override certain kinds of sleep-induced breathing control errors suspected to be involved in SIDS or to avoid them altogether. I do not suggest that solitary nocturnal sleep “causes” SIDS, that all parents should sleep with their infants, or that traditional SIDS research strategies should be abandoned. However, using evolutionary data, I do suggest that an adaptive fit exists between parent-infant sleep contact and the natural physiological vulnerabilities of the neurologically immature human infant, whose breathing system is more complex than that of other mammals owing to its speech-breathing abilities. This “fit” is best understood, it is argued, in terms of the 4–5 million years of human evolution in which parent-infant contact was almost certainly continuous during at least the first year of an infant’s life. Thus, to dismiss the idea that solitary sleep has no physiological consequences for infants does not accord with scientific facts. (shrink)

This article explores some of the issues raised by Munchausen’s Syndrome by Proxy (MSbP) and the relationship between medicine and law, specifically the discourses which feature in the courtroom portraying motherhood and expectations of parenting. These discourses are often hidden yet play a determining role in prosecutions for alleged maltreatment of children involving medically unexplained infant death syndrome. We offer a critique of MSbP and seek to unveil the assumptions about mothers, the parent predominantly affected by the ‘diagnosis’, (...) and mothering that underlie the association of women accused of deliberating harming their children. We suggest such insights are valuable because although the syndrome has never acquired a clear medical or legal definition, it has had repeated appearances in the literature and courtroom over the last 25 years and has more recently attracted attention from government, health care practitioners, academics and the media. We explore these issues through an examination of two recent Court of Appeal decisions in England: those of Sally Clark and Angela Cannings. (shrink)