Rationale, aims and objectives To compare the pharmacotherapeutic approaches to diabetic hypertension of family physicians (FPs) and general practitioners (GPs). Methods A retrospective prescription-based study was conducted in 15 out of a total of 20 health centres, involving 115 primary care physicians – 77 FPs and 38 GPs, representing 74% of the primary care physicians of Bahrain. Prescriptions were collected during May and June 2000 to comprise a study population of 1266 diabetic-hypertensive patients. Results As monotherapy, angiotensin-converting enzyme (ACE) inhibitors (...) (37.9%) and β-blockers (38.3%) were the most commonly prescribed classes of antihypertensives by FPs and GPs, respectively. Calcium channel blockers (CCBs) were ranked third by both categories of physicians. For two-drug combinations, a β-blocker and an ACE inhibitor was the combination of choice for both physician categories. Patients managed by the FPs were more likely to receive a β-blocker–CCB combination (17.4 vs. 14.9%) or a diuretic–ACE inhibitor combination (16.7 vs. 11.4%) and less likely to receive a β-blocker–diuretic combination (11.8 vs. 16.7%) than those managed by the GPs. The proportion of patients receiving antihypertensive combinations was 40.6 and 38.5% for FPs and GPs, respectively. While the GPs prescribed CCB as a monotherapy to the elderly most often, the FPs choice was a β-blocker. Diuretics were less preferred by both FPs and GPs. β-Blocker–ACE inhibitor was again the most preferred combination of both FPs and GPs. FPs prescribed CCB–β-blocker combinations more often than GPs (P = 0.01), whereas CCB–ACE inhibitor combinations were less preferred (P = 0.09). A trend towards excessive use of short-acting nifedipine as monotherapy for elderly patients, both by FPs and by GPs, was noticed. Glibenclamide, alone or in combination with metformin, was the foremost antidiabetic drug prescribed by FPs and GPs. Middle-aged (45–64 years) patients seen by GPs were more likely to receive glibenclamide than those treated by FPs (P = 0.001) and less likely to receive gliclazide (P = 0.01). Combinations of a β-blocker with either glibenclamide or insulin were prescribed considerably more often by GPs.Conclusions Within the same practice setting, a substantial difference was observed between FPs and GPs in terms of preference for different classes of drugs in the management of diabetic hypertension. The compliance of both FPs and GPs was suboptimal; overall, the compliance of the FPs was closer to the recommended guidelines, however. Educational programmes should specifically address these inadequacies in order to improve the quality of health care. (shrink)

Background The use of lengthy, detailed, and complex informed consent forms is of paramount concern in biomedical research as it may not truly promote the rights and interests of research participants. The extent of information in ICFs has been the subject of debates for decades; however, no clear guidance is given. Thus, the objective of this study was to determine the perspectives of research participants about the type and extent of information they need when they are invited to participate in (...) biomedical research. Methods This multi-center, cross-sectional, descriptive survey was conducted at 54 study sites in seven Asia-Pacific countries. A modified Likert-scale questionnaire was used to determine the importance of each element in the ICF among research participants of a biomedical study, with an anchored rating scale from 1 to 5. Results Of the 2484 questionnaires distributed, 2113 were returned. The majority of respondents considered most elements required in the ICF to be ‘moderately important’ to ‘very important’ for their decision making. Major foreseeable risk, direct benefit, and common adverse effects of the intervention were considered to be of most concerned elements in the ICF. Conclusions Research participants would like to be informed of the ICF elements required by ethical guidelines and regulations; however, the importance of each element varied, e.g., risk and benefit associated with research participants were considered to be more important than the general nature or technical details of research. Using a participant-oriented approach by providing more details of the participant-interested elements while avoiding unnecessarily lengthy details of other less important elements would enhance the quality of the ICF. (shrink)

In this age of “free-sex”, gurus, Hare-Krishna chanters and transcendental meditation teachers J. Кrisimamurti stands almost alone as a non-guru of outstanding grandeur. His lecture tours in major centers of the world remind one of the historical Buddha who reversed the Upanishadic tradition of teaching in a forest hermitage to a select few by travelling on foot from village to village in North-Eastern India to carry his message of love, compassion and understanding to the masses regardless of caste, color or (...) sex. But historical comparisons are never complete. Whereas the Buddha used the local dialect, adapted his message to the intellectual level of his audience and made free use of stories and parables, Krishna-multi lectures in the English language in his intense analytic style to rapt audiences without any such aid. No wonder the Buddha's appeal and impact historically has been infinitely wider than that of Krishnamurti. And yet, both eschewed dogma, tradition and metaphysical subtleties, and deliberately refused to offer any sugar-coated pills and panaceas for overcoming the pervasive human condition of suffering. They endeavoured to make people “see” and “understand” the human condition in an act of total awareness so as to take them to the very brink of that “creative emptiness”, ultimate freedom and radical change which alone is conducive to the attainment of transcendent peace. In other words, the doctrine of Krishnamurti as that of the Buddha is not for the weak and effeminate who need “crutches” of all kinds but for those who have the courage to help themselves by an act of understanding the way things are without being entangled in theories and conceptual puzzles. It is the intention of this paper to analyze, understand and critically evaluate Krishamurti's concepts of self, action and freedom. (shrink)

The experience of pain is subjective, yet many people have their pain invalidated or not believed. Pain invalidation is associated with poor mental health, including depression and lower well-being. Qualitative investigations of invalidating experiences identify themes of depression, but also social withdrawal, self-criticism, and lower self-worth, all of which are core components of shame. Despite this, no studies have quantitatively assessed the interrelationship between pain invalidation, shame, and depression. To explore this relationship, participants recounted the frequency of experienced pain invalidation (...) from family, friends, and medical professionals, as well as their feelings of internalized shame and depressive symptoms. As shame has been shown to be a precursor for depression, we further explored the role of shame as a mediator between pain invalidation and depressive symptoms. All sources of pain invalidation were positively associated with shame and depressive symptoms, and shame fully mediated the relationship between each source of pain invalidation and depression. Relative to other sources, pain invalidation from family was most closely tied to shame and depression. Overall, findings indicate that one mechanism by which pain invalidation may facilitate depression is via the experience of shame. Future research may explore shame as a potential upstream precursor to depression in the context of pain. Findings provide more insight into the harmful influence of pain invalidation on mental health and highlight the impact of interpersonal treatment on the experiences of people in pain. (shrink)

We argue for the existence of a state constitutional legal right to language. Our purpose here is to develop a legal framework for protecting the civil rights of the deaf child, with the ultimate goal of calling for legislation that requires all levels of government to fund programs for deaf children and their families to learn a fully accessible language: a sign language. While our discussion regards the United States, the argument we make is based on human rights and the (...) nature of law itself, and can likely be adapted to any country.We begin with an introduction to the biological facts surrounding language acquisition and how these facts impact the deaf child, where lack of language has devastating effects on individuals and negative effects on society in general. (shrink)

Around 96 percent of children with hearing loss are born to parents with intact hearing, who may initially know little about deafness or sign language. Therefore, such parents will need information and support in making decisions about the medical, linguistic, and educational management of their child. Some of these decisions are time-sensitive and irreversible and come at a moment of emotional turmoil and vulnerability (when some parents grieve the loss of a normally hearing child). Clinical research indicates that a deaf (...) child’s poor communication skills can be made worse by increased level of parental depression. Given this, the importance of reliable and up-to-date support for parents’ decisions is critical to the overall well-being of their child. In raising and educating a child, parents are often offered an exclusive choice between an oral environment (including assistive technology, speech reading, and voicing) and a signing environment. A heated controversy surrounds this choice, and has since at least the late 19th century, beginning with the International Congress on the Education of the Deaf in Milan, held in 1880. While families seek advice from many sources, including, increasingly, the internet, the primary care physician (PCP) is the professional medical figure the family interacts with repeatedly.The present article aims to help family advisors, particularly the PCP and other medical advisors in this regard. We argue that deaf children need to be exposed regularly and frequently to good language models in both visual and auditory modalities from the time hearing loss is detected and continued throughout their education to ensure proper cognitive, psychological, and educational development. Since there is, unfortunately, a dearth of empirical studies on many of the issues families must confront, professional opinions, backed by what studies do exist, are the only option. We here give our strongly held professional opinions and stress the need for improved research studies in these areas. (shrink)

This study investigates the role that moral identity, religiosity, and the institutionalization of ethics play in determining the extent of justification of norm violating behavior among business practitioners. Moral justification is where a person, rather than assuming responsibility for an outcome, attempts to legitimize ethically questionable behavior. Results of the study indicate that both the internalization and symbolization dimensions of moral identity as well as intrinsic religiosity and the explicit institutionalization of ethics within the organization are significant determinants of the (...) moral justification of unethical behaviors. (shrink)

The U.S. National Institute of Allergies and Infectious Diseases and the National Institute of Mental Health have a new research priority: inclusion of terminally ill persons living with HIV in HIV cure-related research. For example, the Last Gift is a clinical research study at the University of California San Diego for PLWHIV who have a terminal illness, with a prognosis of less than 6 months. As end-of-life HIV cure research is relatively new, the scientific community has a timely opportunity to (...) examine the related ethical challenges. Following an extensive review of the EOL and HIV cure research ethics literature, combined with deliberation from various stakeholders and our experience with the Last Gift study to date, we outline considerations to ensure that such research with terminally ill PLWHIV remains ethical, focusing on five topics: 1) protecting autonomy through informed consent, 2) avoiding exploitation and fostering altruism, 3) maintaining a favorable benefits/risks balance, 4) safeguarding against vulnerability through patient-participant centeredness, and 5) ensuring the acceptance of next-of-kin/loved ones and community stakeholders. EOL HIV cure-related research can be performed ethically and effectively by anticipating key issues that may arise. While not unique to the fields of EOL or HIV cure-related research, the considerations highlighted can help us support a new research approach. We must honor the lives of PLWHIV whose involvement in research can provide the knowledge needed to achieve the dream of making HIV infection curable. (shrink)

Knowledge as a Feeling offers new reflective and metacognitive tools that help meet this moment in the evolution of our information ecosystem. The book has significant implications for information science, challenging theoreticians and practitioners to reconsider how individuals process information.

Для широкого круга читателей (слушателей, аспирантов, преподавателей) интересующихся данной проблемой.

In lieu of an abstract, here is a brief excerpt of the content:570 BOOK REVIEWS like reasonable rule for economic life. This effort is worthy of more attention than is possible here, but let it be noted that it must inevitably suffer the same fate as any ethical calculus: someone must decide for others what is their due and what is not. How much wealth, for example, makes for a concentration [of wealth] that would be " demonstrably detrimental to some (...) people's exercise of their generic rights "? His is ultimately an entitlement or rights ethic, rather than an aitial ethic of goal-purposive fulfillment for the individual, projected outwards for a common good scenario. While his rejection of goal ethics's inability to detail principles for distribution of goods is noteworthy, it does not appear that a tightened version of generic rights theory will come closer to either of Phillips's desiderata: a justification of moral reasoning apart from any theory of nature or a calculus for its application. Desan and Phillips wish to think against the limits of the human situation. For Desan, rising above limitation is a moral task and obligation facing us each, if there is to be a common future. His call is to be World Citizen in a Polis of Nations. Phillips's vision is more concrete, a distribution of benefits to benefit all with well-being and freedom. But this mundane task is no less difficult than Desan's transcendent one. Indeed, according to Augustine, even the Divine Mind must utilize an artifice in dealing with human creation: "He loves each of us as though there were only one of us." Both ethicists have striven to show us how we might think this vision for ourselves, i.e., for each other of us. ]OIIN B. DAVIS, O.P. ' Detroit, Michigan Catholics, Anglicans, and Puritans: Seventeenth-Century Essays. By HUGH TREVOR-ROPER. Chicago: The University of Chicago Press, 1988. Pp. xiii + 317. $27.50 (hardbound). Even to list the changes and events which occurred in seventeenth century England is a difficult task: the century spans the period from the death of Queen Elizabeth to the Glorious Revolution and beyond, through the Civil War, the accession and exile (twice) of the Stuarts, the rise of science, the transformation of the theological and religious issues of the English Reformation, to name only the most obvious. To conceive a book, in the form of occasional essays, which not only addresses these changes and events but does so by establishing the connections which were present with European currents at the same time surely tempts fate, even when it does not tempt reviewers. BOOK REVIEWS 571 But Hugh Trevor-Roper is a master, both of the period under survey and of the form of the essay. With one exception, each of these essays began as a lecture or seminar paper, and the pleasantly legible style in which they are written must bear some trace of that origin. The occasional flashes of wit, mixed with rthe fairly non-technical style, make the book a joy to read and a welcome escape from the usually constipated style of scholarly prose. In his Introduction, the essayist clearly sets forth his thesis that English intellectual history does not exist apart from the currents of European intellectual history (a thesis for which Trevor-Roper has already staked a claim). That leads to what may very well be the major problem with these essays: its end is in its beginning. The list of names cited in these essays only partially coincides with the list of names in the index; the former is much longer than the latter. And while the style of the essay welcomes the reader to the period, it also throws up more names and places and events than can be explained or even annotated adequately. This occurs both on a large and on a small scale. The first essay, on "Nicholas Hill, the English Atomist" contains such a vast array of names that at times it becomes the prosopo· graphical equivalent of a telephone book. On a large scale, there is the problem with a definition of Arminianism. No definition, at least no formal definition, is attempted-and this is probably wise. But, particularly in... (shrink)