Genetically determined obesity in Prader-Willi syndrome: the ethics and legality of treatment.
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A central characteristic of people with Prader-Willi Syndrome (PWS) is an apparent insatiable appetite leading to severe overeating and the potential for marked obesity and associated serious health problems and premature death. This behaviour may be due to the effects of the genetic defect resulting from the chromosome 15 abnormalities associated with the syndrome. We examine the ethical and legal dilemmas that can arise in the care of people with PWS. A tension exists between a genetic deterministic perspective and that of individual choice. We conclude that the determination of the capacity of a person with PWS to make decisions about his/her eating behaviour and to control that behaviour is of particular importance in resolving this dilemma. If the person is found to lack capacity, the common law principles of acting in a person's "best interests" using the "least restrictive alternative" may be helpful. Allowing serious weight gain in the absence of careful consideration of these issues is an abdication of responsibility. (+info)
On becoming non-judgmental: some difficulties for an ethics of counselling.
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The growth in the availability of counselling services has been accompanied by growing concern about the conduct of counsellors, which in turn has led to the expressed need for an ethics of counselling. This paper will argue that there is an inherent tension between this need and the central tenets of one variety of counselling, client-centred counselling. The tension is identifiable on the basis of an inquiry into the nature of moral judgment which results in the recognition of the implicit value base in client-centred counselling. It is only when this value base is made explicit that any adequate ethics of counselling becomes a viable possibility. (+info)
Are antipsychotic drugs the right treatment for challenging behaviour in learning disability?: The place of a randomised trial.
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People with learning disability sometimes display challenging behaviour. This can be managed by use of antipsychotic medication or behavioural therapy or both. There is no solid evidence, however, that these therapies are safe and effective. A randomised controlled trial of antipsychotic medication has been proposed to deliver such evidence. However, this presents difficult issues in the ethics of research with learning disabled people. In particular, is a trial the most efficient and fairest way to evaluate practice in this area? This paper reviews the clinical situation, gives the rationale for the trial, and analyses the ethical arguments for and against such a trial. (+info)
Health promotion and the First Amendment: government control of the informational environment.
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Government efforts to protect public health often include controlling health information. The government may proscribe messages conveyed by commercial entities (e.g., false or misleading), recommend messages from commercial entities (e.g., warnings and safety instructions), and convey health messages (e.g., health communication campaigns). Through well-developed, albeit evolving, case law, government control of private speech has been constrained to avoid impinging on such values as free expression, truthfulness, and autonomous decision making. No simple legal framework has been developed for the government's own health messages to mediate between the legitimate goals of health protection and these other values. Nevertheless, government recommendations on matters of health raise difficult social and ethical questions and involve important societal trade-offs. Accordingly, this article proposes legal and ethical principles relating to government control of the health information environment. (+info)
A novel skilled-reaching impairment in paw supination on the "good" side of the hemi-Parkinson rat improved with rehabilitation.
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Parkinson's disease is characterized by tremor, rigidity, bradykinesia, and postural abnormalities ascribed to the loss of nigrostriatal dopamine (DA). Symptoms similar to the human condition can be produced in the rat by DA-depleting 6-hydroxydopamine injections made into the nigrostriatal system. After a unilateral lesion, the rat symptoms include sensory and motor impairments and turning biases reflecting motor abnormalities to the contralateral-to-depletion side of the body. In addition, a number of studies on skilled reaching report impairments in the use of the ipsilateral limb. It is suggested that the ipsilateral deficit is secondary to the contralateral motor impairments however. Here we re-examine how rats with unilateral DA depletion use their ipsilateral limb for skilled reaching for food. We provide the first description of an impairment on the ipsilateral-to-depletion side of the body of the rat and the first demonstration of amelioration of the defect using behavioral therapy. Video analysis of rats reaching for single pellets of food with the ipsilateral limb revealed that, although limb advancement and food grasping were normal, paw supination and food release to the mouth were impaired. Consequently, the animals were unable to transport a grasped food pellet to the mouth. Behavioral therapy, consisting of training in a simpler reaching task, strikingly lessened the impairment and improved reaching movements to the point that the rats could transport the food to the mouth. The results are discussed in relation to possible causes of the ipsilateral impairment, its treatment, and to relevant research on human Parkinson patients, indicating that they display bilateral improvements after unilateral treatments. (+info)
Evaluation of an individualised asthma programme directed at behavioural change.
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An individualised asthma programme directed at behavioural change was evaluated in asthmatic subjects who reported complaints and impairment, despite adequate medical treatment. Mild-to-moderate asthma patients (n=23) were randomly assigned to a programme or waiting list condition. Outcome measures were: McMaster Asthma Quality of Life Questionnaire, Asthma Symptom Checklist, Negative Emotionality Scale, Knowledge, Attitude and Self-Efficacy Asthma Questionnaire, Adherence Scale, and peak flow measurements. Both groups were evaluated at three consecutive moments, each separated by 3 months; the programme was delivered between the first two evaluations. At onset the patient received a workbook containing information, exercises and homework assignments. Psycho-education, behavioural and cognitive techniques were introduced during six 1-h individual sessions. Compared with controls the programme group reported less symptoms (obstruction, fatigue), better quality of life (activity, symptoms, emotions), decreased negative affectivity, and increased adherence, immediately after finishing the programme and at 3 months follow-up. All three cognitive variables (knowledge, attitude towards asthma, self-efficacy) and day and night peak flow ratings improved in the programme group but not in the waiting list group. Participation in an individualised programme resulted in improvement of asthma morbidity, and asthma-related behaviour and cognitions, in subjects reporting symptoms and impairment despite adequate medical therapy. (+info)
Persistence of effects of a brief intervention on parental restrictions of teen driving privileges.
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OBJECTIVE: The purpose of this study was to determine the extent to which effects of exposure to a brief intervention designed to increase parental restrictions on teen driving privileges persisted over time. DESIGN: A total of 658 parents and their 16 year old adolescents were recruited from a local motor vehicle administration (MVA) site as adolescents successfully tested for provisional licenses. At the MVA, parents completed written surveys about expected teen driving during the first month of provisional licensure. Afterwards, on weeks assigned as intervention, parents watched a video and were given the video and a driving agreement to take home. Both parents and teens completed follow up telephone interviews about communication, amounts, and limits on teen driving at one month (579 dyads), four months (529 dyads), and nine months (528 dyads). RESULTS: The results indicated that both intervention parents and teens were much more likely to report using a driving agreement at each follow up during the nine month period. Significant treatment group differences persisted for communication about driving, but effects related to limits on teen driving that were evident at one month declined over time. Reports for passenger, road, and overall limits remained significant at four months; fewer were present at nine months. There were no differences in amounts of teen driving at four or nine months. CONCLUSIONS: It is possible to reach parents through brief interventions at the MVA and successfully promote increases in initial parental restrictions on teen driving with modest persistence for at least four months. (+info)
Acceptability and feasibility of a computer-tailored physical activity intervention using stages of change: project FAITH.
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This study investigated the feasibility and acceptability of a new computer-tailored intervention promoting physical activity in a general population, and explored if there are differences in the reported feasibility and acceptability between stages of change, gender, age groups, education levels and familiarity with computer use. The computer-tailored intervention program consists of questionnaires concerning demographics, physical activity and psychosocial determinants, leading to a 'physical activity advice' and an 'action plan'. This feedback was constructed taking the stages of change into account, at content level as well as in the way participants were approached. One hundred and ninety-two participants, between 25 and 55 years of age, ran through the tailored materials, and completed an acceptability and feasibility questionnaire afterwards. This questionnaire contained feasibility and acceptability questions about all the intervention aspects: intervention questions, physical activity advice, action plan and computer use. High acceptability and feasibility scores were found for all intervention parts. Only a few significant differences in acceptability and feasibility scores between stages of change, gender, age groups, education levels and familiarity with computer use were found. These results suggest that this computer-tailored intervention is an acceptable and feasible tool for promoting physical activity for respondents having different stages of change, ages, gender, education levels and computer use. (+info)