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Blind Trust in the Care-Giver: Is Paternalism Essential to the Health-Seeking Behavior of Patients in Sub-Saharan Africa?  [PDF]
Ishmael Norman
Advances in Applied Sociology (AASoci) , 2015, DOI: 10.4236/aasoci.2015.52008
Abstract: In the past, patients put their lives in the care of doctors in blind trust that the doctors would care for them. This kind of trust is no longer common particularly in the western industrialized nations but the same cannot be said about patients in Ghana and Sub-Sahara Africa. The first concern was whether paternalism was essential in medical practice in Ghana. The second was whether paternalism as an ethical standard should be considered from the ethical lens of the western industrialized nations, rather than from the African cultural context. This entailed a review and examination of the literature on paternalism. We searched databases such as PubMed, Medline and others for reports, editorials and published papers in the English Language. A search on Goggle Scholar on “paternalism in medical practice in Africa” yielded over 380,000 entries and “paternalism in medical practice in Ghana” yielded 2.1 million but more than 99% were not relevant in each instant. Hand searching of selected printed journals and grey literature such as technical reports, conference proceedings and workshops were also assessed. The studies that met the inclusion criteria were given additional review but those with poor methodology were excluded but discussed in this review. I assigned an overall score and identified the position taken in the publication or report in relation to the objectives and rated them objectively. The papers that received scores above 2.5 out of 4 in the evaluation were further analyzed. I summarized the findings into their respective units, and interpreted them based upon my skills, knowledge and specialization in medico-legal ethics, public health and law. The result shows that not enough research has been done on whether or not paternalism should be encouraged as a regular feature of medical practice in Ghana due to the lack of education. It also shows that paternalism enhances the health seeking behavior of patients despite developments on patient autonomy and capacity. Where the average patient is illiterate in general and in medical matters, the paternalism of the physician may be inevitable. Ethical standards such as Informed Consent, Autonomy, Due Process, Benevolence and No malfeasance should be defined and operationalized in clinical practice within the cultural context of Sub-Sahara Africa. A systematic indigenization of medico-legal ethical concerns in medical practice is needed in Ghana.
Mitofusin-2 Independent Juxtaposition of Endoplasmic Reticulum and Mitochondria: An Ultrastructural Study  [PDF]
Pierre Cosson, Anna Marchetti, Mariella Ravazzola, Lelio Orci
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0046293
Abstract: Besides its role in controlling the morphology of mitochondria, mitofusin-2 has been proposed to tether mitochondria to the endoplasmic reticulum (ER), based largely on light microscopic analysis. In this study we have examined by electron microscopy the organization of ER and mitochondria in cells expressing or not mitofusin-2. Contrary to previous studies, we observed that loss of mitofusin-2 increased ER-mitochondria juxtaposition. These results suggest that mitofusin-2 does not play a critical role in the juxtapostion of ER and mitochondria, and highlight the essential role of ultrastructural analysis to visualize and measure contact between two intracellular compartments.
Modeling Meiotic Chromosomes Indicates a Size Dependent Contribution of Telomere Clustering and Chromosome Rigidity to Homologue Juxtaposition  [PDF]
Christopher A. Penfold,Paul E. Brown,Neil D. Lawrence,Alastair S. H. Goldman
PLOS Computational Biology , 2012, DOI: 10.1371/journal.pcbi.1002496
Abstract: Meiosis is the cell division that halves the genetic component of diploid cells to form gametes or spores. To achieve this, meiotic cells undergo a radical spatial reorganisation of chromosomes. This reorganisation is a prerequisite for the pairing of parental homologous chromosomes and the reductional division, which halves the number of chromosomes in daughter cells. Of particular note is the change from a centromere clustered layout (Rabl configuration) to a telomere clustered conformation (bouquet stage). The contribution of the bouquet structure to homologous chromosome pairing is uncertain. We have developed a new in silico model to represent the chromosomes of Saccharomyces cerevisiae in space, based on a worm-like chain model constrained by attachment to the nuclear envelope and clustering forces. We have asked how these constraints could influence chromosome layout, with particular regard to the juxtaposition of homologous chromosomes and potential nonallelic, ectopic, interactions. The data support the view that the bouquet may be sufficient to bring short chromosomes together, but the contribution to long chromosomes is less. We also find that persistence length is critical to how much influence the bouquet structure could have, both on pairing of homologues and avoiding contacts with heterologues. This work represents an important development in computer modeling of chromosomes, and suggests new explanations for why elucidating the functional significance of the bouquet by genetics has been so difficult.
Pregnancy in HIV Clinical Trials in Sub Saharan Africa: Failure of Consent or Contraception?  [PDF]
Agnes Ssali, Stella Namukwaya, Leonard Bufumbo, Janet Seeley, David G. Lalloo, Anatoli Kamali, Rosalind Parkes-Ratanshi
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0073556
Abstract: Objective Higher than expected pregnancy rates have been observed in HIV related clinical trials in Sub-Saharan Africa. We designed a qualitative study to explore the factors contributing to high pregnancy rates among participants in two HIV clinical trials in Sub-Saharan Africa. Methods Female and male participants enrolled in one of two clinical HIV trials in south-west Uganda were approached. The trials were a phase III microbicide efficacy trial among HIV negative women using vaginal gel (MDP); and a trial of primary prevention prophylaxis for invasive cryptococcal disease using fluconazole among HIV infected men and women in Uganda (CRYPTOPRO). 14 focus group discussions and 8 in-depth interviews were conducted with HIV positive and negative women and their male partners over a six month period. Areas explored were their experiences about why and when one should get pregnant, factors affecting use of contraceptives, HIV status disclosure and trial product use. Results All respondents acknowledged being advised of the importance of avoiding pregnancy during the trial. Factors reported to contribute to pregnancy included; trust that the investigational product (oral capsules/vaginal gel) would not harm the baby, need for children, side effects that led to inconsistent contraceptive use, low acceptance of condom use among male partners. Attitudes towards getting pregnant are fluid within couples over time and the trials often last for more than a year. Researchers need to account for high pregnancy rates in their sample size calculations, and consider lesser used female initiated contraceptive options e.g. diaphragm or female condoms. In long clinical trials where there is a high fetal or maternal risk due to investigational product, researchers and ethics committees should consider a review of participants contraceptive needs/pregnancy desire review after a fixed period, as need for children, partners and health status of participants may alter over time.
Juxtaposition of heterochromatic and euchromatic regions by chromosomal translocation mediates a heterochromatic long-range position effect associated with a severe neurological phenotype
Palma Finelli, Silvia Sirchia, Maura Masciadri, Milena Crippa, Maria Recalcati, Daniela Rusconi, Daniela Giardino, Laura Monti, Francesca Cogliati, Francesca Faravelli, Federica Natacci, Leonardo Zoccante, Bernardo Bernardina, Silvia Russo, Lidia Larizza
Molecular Cytogenetics , 2012, DOI: 10.1186/1755-8166-5-16
Abstract: FISH mapped the translocation breakpoints (bkps) to 15p11.2 within satellite III and the 16q12.1 euchromatic band within the ITFG1 gene. The expression of the genes located on both sides of the translocation were tested by means of real-time PCR and three, all located on der(16), were found to be variously perturbed: the euchromatic gene NETO2/BTCL2 was silenced, whereas VPS35 and SHCBP1, located within the major heterochromatic block of chromosome 16q11.2, were over-expressed. Pyrosequencing and chromatin immunoprecipitation of NETO2/BTCL2 and VPS35 confirmed the expression findings. Interphase FISH analysis showed that der(16) localised to regions occupied by the beta satellite heterochromatic blocks more frequently than der(15).To the best of our knowledge, this is the first report of a heterochromatic position effect in humans caused by the juxtaposition of euchromatin/heterochromatin as a result of chromosomal rearrangement. The overall results are fully in keeping with the observations in Drosophila and suggest the occurrence of a human heterochromatin position effect associated with the nuclear repositioning of the der(16) and its causative role in the patient's syndromic phenotype.Patients with syndromic clinical phenotypes include an interesting subset of carriers of de novo balanced chromosomal rearrangements with no apparent loss or gain of genetic material. These abnormalities can be explained by the loss of function of a dose-sensitive gene disrupted by one rearrangement breakpoint [1-3]. The breakpoints of the balanced chromosomal rearrangements associated with a clinical phenotype are often molecularly mapped in an attempt to identify the disease-causing genes affected by the abnormality. Although the rearrangements may lead to the direct disruption of one or two genes, this is not always the case. It has also been shown that breakpoints occur outside the genes themselves and affect their regulation by causing a change in their position within the gen
mHealth in Sub-Saharan Africa  [PDF]
Thomas J. Betjeman,Samara E. Soghoian,Mark P. Foran
International Journal of Telemedicine and Applications , 2013, DOI: 10.1155/2013/482324
Abstract: Mobile phone penetration rates have reached 63% in sub-Saharan Africa (SSA) and are projected to pass 70% by 2013. In SSA, millions of people who never used traditional landlines now use mobile phones on a regular basis. Mobile health, or mHealth, is the utilization of short messaging service (SMS), wireless data transmission, voice calling, and smartphone applications to transmit health-related information or direct care. This systematic review analyzes and summarizes key articles from the current body of peer-reviewed literature on PubMed on the topic of mHealth in SSA. Studies included in the review demonstrate that mHealth can improve and reduce the cost of patient monitoring, medication adherence, and healthcare worker communication, especially in rural areas. mHealth has also shown initial promise in emergency and disaster response, helping standardize, store, analyze, and share patient information. Challenges for mHealth implementation in SSA include operating costs, knowledge, infrastructure, and policy among many others. Further studies of the effectiveness of mHealth interventions are being hindered by similar factors as well as a lack of standardization in study design. Overall, the current evidence is not strong enough to warrant large-scale implementation of existing mHealth interventions in SSA, but rapid progress of both infrastructure and mHealth-related research in the region could justify scale-up of the most promising programs in the near future. 1. Introduction Mobile phones are increasingly accessible worldwide. There are an estimated 6.8 billion mobile phones being used in the world in 2013, compared to 1 billion in 2002, corresponding to penetration rates of approximately 96% globally: 128% in developed countries and 89% in developing countries [1]. In sub-Saharan Africa (SSA), the penetration of cell phones is estimated to be 63% in 2013 and projected to pass 70% by 2015 [2]. Hundreds of millions of people in SSA who never gained access to traditional landlines for telecommunication now use mobile phones on a regular basis [3]. In many developing countries, wireless technology is less expensive and more readily available than wired technology [4]. This technology has unique potential to reach large numbers of people living in resource-limited or remote locations. Mobile health (mHealth) is the use of mobile phone technology for health-related purposes. This relatively new, dynamic, and rapidly evolving field includes the development and study of mobile phone applications such as short messaging service (SMS), voice calling, and
Underdeveloped ICT areas in Sub-Saharan Africa  [PDF]
Alfonso AVILA
Informatica Economica Journal , 2009,
Abstract: As universal service in terms of ICTs provision cannot be achieved in the times agreed for several international bilateral and multilateral aid organizations. It is important to create mechanisms to reduce the lack of use of ICTs in sub-Saharan African countries. This paper specifically analyses the different ICT underdeveloped areas in the sub-Saharan African countries and the factors explain such status. At the same time, the paper proposes a set of policy guidelines that might help improving the current situation in several areas such as investment, employment, infrastructure and technology in order that some countries may overcome unfavourable ICT development. The main research question is: is there any chance that sub-Saharan African countries can overcome the critical situation in which they currently are? And if so, what are the key components and processes to develop and to do changes. In this way, a proposed framework is provided for the examination of policy makers, investors, and other stakeholders in the ICT field in these countries.
Desperately Seeking the Tools of Ethics for Traditional Medicine  [PDF]
Ishmael D. Norman
Advances in Applied Sociology (AASoci) , 2016, DOI: 10.4236/aasoci.2016.67021
Abstract: Objective: To determine the perceived adequacy of the Code of Ethics of the Traditional Medicine Practice as contained in Act 575 of 2000, with respect to patient and manufacturer protection. Method: The author reviewed the legal framework for the regulation of Traditional medicine in Ghana. Investigation was conducted on the worldwide web to identify literature that addressed the research question and reviewed for best practice. Result: The Code of Ethics of the Traditional Medicine Council of Ghana is inadequate for client and manufacturer protections. It is a professional code of ethics, which is skewed to industry players. This vacuum provides opportunity for mistakes, patient endangerment and even fatality. Discussion: There is an established national legal framework for the regulation of the industry with the secondary function of the taxonomy under the framework towards enhanced taxcollection by government. Patient protection code of ethics needs to be developed. Conclusion: The Council needs to develop the ethical framework that would protect both the ultimate beneficiaries of their products and services as well as the workers and operators in the industry.
Energy Security and Sub-Saharan Africa  [cached]
Emily Meierding
International Development Policy/Revue Internationale de Politique de Développement , 2012, DOI: 10.4000/poldev.744
Abstract: Published by Palgrave MacmillanOver the last decade the topic of energy security has reappeared on global policy agendas. Most analyses of international energy geopolitics examine the interests and behaviour of powerful energy-importing countries like the US and China. This chapter begins by examining foreign powers’ expanded exploitation of oil and uranium resources in Sub-Saharan Africa. It goes on to examine how energy importers’ efforts to enhance their energy security through Africa are impacting energy security within Africa. It assesses Sub-Saharan states’ attempts to increase consumption of local oil and uranium reserves. Observing the constraints on these efforts, it then outlines some alternative strategies that have been employed to enhance African energy security. It concludes that, while local community-based development projects have improved the well-being of many households, they are not a sufficient guarantor of energy security. Inadequate petroleum access, in particular, remains a development challenge. Foreign powers’ efforts to increase their oil security are undermining the energy security of Sub-Saharan African citizens.
Determinants of Poverty in Sub-Saharan Africa
SL Adeyemi, GT Ijaiya, UA Raheem
African Research Review , 2009,
Abstract: This paper examines the determinants of poverty in Sub-Saharan Africa using a set of cross-country data drawn from 48 countries. It adopts a multiple regression analysis. The results obtained indicates that factors like increase in the rate of population, inflation and external debt servicing, lack of safe water, low economic activities, gender discrimination, ethnic and religious conflicts and HIV/AIDS have influenced the increase in the rate poverty in the sub-region. Given these results, measures such as debt forgiveness, use of family planning devices, stable macro-economic variables like inflation and exchange rate volatility and good governance are suggested as possible solutions to poverty in Sub-Saharan Africa.
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