Ethics and health systems research in 'post'-conflict situations

Although considerable attention has been given to ethical issues related to clinical research in developing countries, in particular related to HIV therapy, there has been limited focus on health systems research, despite its increasing importance in the light of current trends in development assistance. This paper examines ethical issues related to health systems research in 'post'-conflict situations, addressing both generic issues for developing countries and those issues specific to 'post'-conflict societies, citing examples from the author's Cambodian experience. It argues that the destruction of health infrastructure results in a loss of structures and processes that would otherwise protect prospective research subjects who are part of vulnerable populations. It identifies the growth of health systems research as part of a trend towards sectoral and programmatic development assistance, the emergence of 'knowledge generation' as a form of research linked to development, and the potential for conflict where multilateral and bilateral donors are both primary funders and users of health systems research. It also examines the position of the health system researcher in relation to the sponsors of this research, and the health system being analysed.

The policy and ethical implications of genetic research on attention deficit hyperactivity disorder

Objective: To review the policy and ethical implications of recent research on the molecular genetics of attention deficit hyperactivity disorder (ADHD). Method: MEDLINE and psycINFO database searches were used to identify studies on the genetics of ADHD. The implications of replicated candidate genes are discussed. Results: The findings for most genes have been inconsistent but several studies have implicated the genes in the dopaminergic pathway in the aetiology of ADHD. Conclusions: The current evidence on the genetics of ADHD is insufficient to justify genetic screening tests but it will provide important clues as to the aetiology of ADHD. Genetic information on susceptibility to ADHD has the potential to be abused and to stigmatize individuals. Researchers and clinicians need to be mindful of these issues in interpreting and disseminating the results of genetic studies of ADHD.

Shoot first, ask questions later: Ethnographic research in an online computer gaming community

For researchers investigating online communities, the existence of the internet has made the activities and opinions of community members visible in a public domain. FPS gaming culture is a highly literate culture - members communicate and represent themselves in textual forms online, and the culture makes use of a wide variety of communication and publishing technologies. While a significant amount of insider knowledge is required to understand and interpret such online content, a large body of material is available to researchers online, and sometimes provides more reliable and enlightening information than that generated by more traditional research methods. While the abundance of data available online in some ways makes research far easier, it also creates new dilemmas and challenges for researchers. What extra knowledge is required of the researcher? How can one ensure that one's interpretations of member statements are made with an understanding of meaning within that culture? What responsibilities does the researcher have in their representation of the culture under examination? What ethical issues must be considered?

A cross-cultural study of the role of religion in consumers' ethical positions

Purpose - Previous studies have looked at how socio-economic and political factors play a role in consumers' ethical positions, but few have considered the role of religion which is a major driver of ethics. This paper seeks to address this. Design/methodology/approach - From a survey of over 700 consumers this paper explores the similarities and differences between consumers' ethical positions in three different religions namely; Christian (from three countries), Islam, and Buddhism. Findings - It was found that a reduced item scale measuring the two factors of Forsyth's idealism and relativism was applicable in all five religions, but variations were seen because of religious teachings. In particular, Austrian Christians were significantly less idealistic and relativistic than all other religions, even other Christians from the United States and Britain. Research limitations/implications - The results have implications for measuring ethical positions internationally and for developing ethically based marketing messages and products. Originality/value - The paper shows for the first time how ethical positions are affected by religions and should be of interest to marketers involved in ethics research and ethical marketing.

The use of e-mail in the therapy process

The therapeutic letter has a long history, with roots in psychoanalytic work and continuing application in family therapy. The advent of e-mail has allowed another form for therapeutic written communication which, while incorporating the benefits of therapeutic letters, adds to these. It has also opened up some potential risks. This article incorporates a brief review of the literature covering therapeutic written communication and offers a case example where e-mail was used as an adjunct in face-to-face therapy with a client who experienced attachment difficulties. This therapy was informed by systemic and psychoanalytic traditions. The authors explore a variety of technical matters including the timing and Crafting of e-mail responses, the integration of written communication with face-to-face therapy, impact on the therapeutic relationship and management of crisis. Ethical issues such as confidentiality and duty of care are also considered.

The use of email in a child and adolescent mental health service: are staff ready?

All staff members of a child and adolescent mental health service were invited to participate in a survey about the use of email. Sixty-two of the 105 staff members responded to the survey, a participation rate of 59%. Of the respondents, 32 were allied health staff, 10 were nurses, seven were administrative staff, six were medical staff, three were operational staff and four were acting in a combination of these roles. The respondents reported extensive work-related email usage and considered that they were confident in using email despite low levels of training. However, they did not feel that they understood the legal and ethical issues involved. Furthermore, there was limited incorporation of email into standard record keeping. The majority of respondents thought that increased use of email would lead to a greater workload, a consequence they considered would probably increase over time. Many commented on the quick and practical use of this medium, but were wary about using email with individuals outside the service organization, especially if it were to contain clinical material. There was low use of email directly with clients, and clinicians were ambivalent about incorporating email into therapy. The results suggest that it is timely to consider the utility and appropriateness of email communication with clients and external service providers, and to formulate guidelines and procedures to ensure the confidentiality of client information and the safety of clients and staff.

Inside ‘Inside View’: reflections on stimulating debate and engagement through a multimedia live theatre production on the dilemmas and issues of pre-natal screening policy and practice

Background The role of applied theatre in engaging both lay and professional publics with debate on health policy and practice is an emergent field. This paper discusses the development, production performance and discussion of ‘Inside View’.1 Objectives The objectives were to produce applied theatre from research findings of a completed study on genetic prenatal screening, exploring the dilemmas for women and health professionals of prenatal genetic screening, and to engage audiences in debate and reflection on the dilemmas of prenatal genetic screening. Methods ‘Inside View’ was developed from a multidisciplinary research study through identification of emergent themes from qualitative interviews, and development of these by the writer, theatre producer and media technologist with input from the researchers. Findings Inside View was performed in London and the Midlands to varied audiences with a panel discussion and evaluation post performance. The audiences were engaged in debate that was relevant to them professionally and personally. Knowledge translation through applied theatre is an effective tool for engaging the public but the impact subsequently is unclear. There are ethical issues of unexpected disclosure during discussion post performance and the process of transforming research findings into applied theatre requires time and trust within the multidisciplinary team as well as adequate resourcing.

How capabilities in operations can influence green production:exploring the issues

This research presents case material of companies within the UK that are attempting to be “Green” in their operations processes. We assess their aspirations by plotting capabilities through their supply networks under five key headings: Strategy; Production planning and procurement; In-house production; Logistics; and Human resource management within operations. We build upon the work of Azzone and Noci, 1998 and Azzone et al., 1997 and we present insights into companies whose commitment to Green Production ranges from “the company tries to delay the adoption of green programs” through to the company adopts a “radical approach to environmental issues.” In doing so we see how operations capabilities in a range of parameters can play a central and pivotal role in achieving some of the aspirations of Green Production within companies.