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In this thesis, the author studies the ethical and legal aspects of research conducted on stored tissue samples of deceased persons in North America. / The first part of this thesis presents an overview of what constitutes human tissues and how are they used in research. The author describes the process in which human tissues are acquired and stored by health facilities, their utility for scientific research, and currently used techniques. / The second part is dedicated to the analysis of the current normative framework associated with research involving human tissue samples in North America. The author underlines the presence of two different normative regimes depending on whether the human tissues were removed before or after death. Finally, the author examines international documents in order to evaluate whether or not they can provide guidance to North American national legislation. / The third part evaluates the normative limitations associated with the use of stored tissue samples of deceased persons for research. The author considers that these limitations are related to the presence of conflicting interests, the difficulties in establishing rights over human tissues, the difficulties of establishing the rights of the dead, and the limitations of the theory of informed consent with regards to stored tissue samples. / The last part of this thesis suggests that stored human tissues should be interpreted as if they were part of an individual's medical record. After presenting some of the philosophical arguments in favour of such an interpretation, the author underlines the presence of legal precedents supporting the "tissue as information" model. The author finally examines the legal implications and the potential limitations of this proposal.

Dissertation in compliance with the requirements for the Master's Degree in Technology: Journalism, Durban University of Technology, 2013. / Ethical behaviour by investigators is the cornerstone of scientific research. Recognizing, declaring and avoiding a conflict of interest are key responsibilities for biomedical researchers, particularly since commercial enterprises, such as pharmaceutical companies, have become major funding sources of research. Proactive disclosure of researchers' financial relationships is now a requirement for publication in most scientific journals. The question that arises is whether this same increased scrutiny of financial disclosure and potential for conflict of interest has extended to the mainstream press in Canada. A content analysis of biomedical research articles that appeared in Canadian daily newspapers from 2001 to 2008 showed that 82 per cent of the articles failed to identify the financial connection that existed between the researcher(s) and the commercial funder, and nearly half of the articles did not even identify the commercial funding source of the research. A text analysis showed that 94 per cent of the articles were positive about the drug/device cited by the research, and positive, optimistic words such as “breakthrough”, “significant”, “hope” and “promising” were often used in the news articles. Reporters frequently frame biomedical research articles using a battle-like template that describes a fight between good and evil. Another common approach was to frame the article as a message of hope for the future. A genre analysis showed that the genre of medical research news articles published in newspapers is highly dissimilar to the genre of medical research articles published in scientific journals. It is likely these two genres have been constructed to appeal to very different target audiences. The study results show overwhelmingly that readers are not provided with key information about potential financial conflicts of interest involving the researchers and the commercial sources of funding for the research. Such lack of transparency thwarts the reader’s ability to reach informed conclusions about whether or not the research has been either explicitly or implicitly influenced by the researcher’s potential conflict.

Bakgrund: Arbetsmarknaden har förändrats och statistiken över sjukskrivningar på grund av psykisk sjukdom ökar. För att anställda ska hålla sig friska kan hälsopromotion på arbetsplatsen användas som strategi med arbetsmiljön som en stödjande miljö för hälsan. Hälsoinspiratörer finns inom både privat och offentlig sektor och arbetar för att inspirera till en hälsofrämjande arbetsmiljö. Syftet med studien är att skapa en fördjupad förståelse för hur hälsoinspiratörer inom kommunala verksamheter arbetar med hälsa på arbetsplatsen, vad som motiverar dem till att arbeta med hälsa på arbetsplatsen och undersöka hur deras hälsoarbete kan utvecklas. Metoden som används i studien är kvalitativa metoder och sex semistrukturerade intervjuer med hälsoinspiratörer har genomförts. Sedan har materialet transkriberats och analyserats genom en innehållsanalys. Resultatet visar att hälsoinspiratörer arbetar både med den fysiska- och den psykosociala arbetsmiljön. Vad som motiverar hälsoinspiratörerna till att arbeta med hälsa på arbetsplatsen visar resultatet är att de har ett personligt intresse för hälsa och välbefinnande samt att de upplever hälsoarbetet som meningsfullt för dem. Konklusionen är att hälsoarbete som riktar sig mot den psykosociala arbetsmiljön stärker det sociala klimatet på arbetsplatsen och motiverar både anställda i sina arbetsuppgifter och hälsoinspiratören i sitt hälsoarbete. Ett promotivt hälsoarbete riktat mot en god psykosocial arbetsmiljö kan ses som ett processarbete som inte har en början och inget slut, som ständigt bör utvärderas för att utvecklas.   Background: With a developed market on the working field the conditions is also changing with the development. The statistics tells that sick leave because of psychological illness is increasing and a strategi to keeping employees healthy the organizations can use health promotion as a strategy and the working environment can function as an environment that supports and enhances health. A health motivator is an employee whose job is to inspire to a health supporting working environment. The Aim is to create an understanding for how the health motivator in municipal organizations is working with workplace health promotion, what is motivating them in their inspire assignment and look into how their workplace health promoting can devolop. Method: A qualitative method has been used where six semistuctured interviews with health motivators have been done and transcribed. Thereafter analysed with a content analysis, where the data material was organized, coded and abstracted.  Results: The results shows that health motivators workplace health promotion includes both the physical and the psychologial working environment. And that health motivators inspires a motivation in their assignment for a personal interest in health and wellbeing and find the promotion meaningful for them. Conclusion: Health promoting oriented to the psychosocial work environment reinforces the social climate at the workplace and motivate both employees and health motivators in their work. Health enhancing workplace health promotion unto a good psychosocial work environment can be seen as a process of work that does not have a beginning and no end, which should be continuously evaluated to evolve.

Lam Yuk Fai. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2000. / Includes bibliographical references (leaves 41-43). / Abstracts in English and Chinese. / Chapter 1 --- Basic Concepts --- p.9 / Chapter 1.1 --- Survival data --- p.9 / Chapter 1.1.1 --- An example --- p.9 / Chapter 1.2 --- Some important functions --- p.11 / Chapter 1.2.1 --- Survival function --- p.12 / Chapter 1.2.2 --- Hazard function --- p.12 / Chapter 1.3 --- Cox Proportional Hazards Model --- p.13 / Chapter 1.3.1 --- A special case --- p.14 / Chapter 1.3.2 --- An example (continued) --- p.15 / Chapter 1.4 --- Extension of the Cox Proportional Hazards Model --- p.16 / Chapter 1.5 --- Bootstrap --- p.17 / Chapter 2 --- A New Method --- p.19 / Chapter 2.1 --- Introduction --- p.19 / Chapter 2.2 --- Definition of the test --- p.20 / Chapter 2.2.1 --- Our test statistic --- p.20 / Chapter 2.2.2 --- The alternative test statistic I --- p.22 / Chapter 2.2.3 --- The alternative test statistic II --- p.23 / Chapter 2.3 --- Variations of the test --- p.24 / Chapter 2.3.1 --- Restricted test --- p.24 / Chapter 2.3.2 --- Adjusting for other covariates --- p.26 / Chapter 2.4 --- Apply with bootstrap --- p.28 / Chapter 2.5 --- Examples --- p.29 / Chapter 2.5.1 --- Male mice data --- p.34 / Chapter 2.5.2 --- Stanford heart transplant data --- p.34 / Chapter 2.5.3 --- CGD data --- p.34 / Chapter 3 --- Large Sample Properties and Discussions --- p.35 / Chapter 3.1 --- Large sample properties and relationship to goodness of fit test --- p.35 / Chapter 3.1.1 --- Large sample properties of A and Ap --- p.35 / Chapter 3.1.2 --- Large sample properties of Ac and A --- p.36 / Chapter 3.2 --- Discussions --- p.37

<p>Litteraturstudiens syfte var att beskriva om/hur en kvinnas sociala situation och bakgrund inverkar på hennes ohälsosamma alkoholvanor. Datasökningen genomfördes i databasen MedLine (via PubMed). Nio artiklar uppfyllde inklusionskriterierna och bearbetades samt kvalitetsgranskades. Resultatet visade att olika stadier i en kvinnas liv såsom besvärliga uppväxtförhållanden, en tidig alkoholdebut och dåliga relationer i vuxenlivet inverkar negativt på hennes alkoholkonsumtion. Det fanns också ett klass- och genusperspektiv. Resultatet visade att kvinnor som hade en besvärlig uppväxt med våld och övergrepp konsumerade mer alkohol i det vuxna livet än de kvinnor som hade ”normal” uppväxt och vuxenliv. Ohälsosamma alkoholvanor var också relaterat till en tidig alkoholdebut och en tidig alkoholdebut var i sin tur relaterat till flickor som hade en låg självkänsla och ett aggressivt beteende. Kvinnor i relationer där partnern missbrukade, våldtog och misshandlade gjorde att kvinnans alkoholkonsumtion ökade. Klassperspektivet var tydligt sammanlänkat med en högre alkoholkonsumtion hos kvinnor som var skilda eller änkor, kvinnor som hade låg inkomst och låg utbildning, kvinnor som inte hade någon familj eller kvinnor som var deprimerade. Sammanfattningsvis visar resultatet att flera aspekter i en kvinnas liv såsom uppväxtförhållanden och socialsituation inverkar på hennes alkoholvanor. Detta är något som behöver uppmärksammas både i vården och i samhället.</p> / <p>The aim of this literature review was to describe if/how a woman´s social situation and background affects her unhealthy alcohol habits. A search in the Medline database found nine scientific articles. They were thoroughly processed and valued for quality. The results showed that different stages in a woman’s, life, upbringing, age of onset of drinking and relationships in adulthood had a negatively effect on her alcohol consumption. The results also highlighted a class and gender perspective. The results revealed that women, who went through childhood and adulthood with adverse experiences such as, sexually assaulted and abused physically or mentally were more likely to have hazardous high alcohol consumption rates in adulthood. Unhealthy alcohol habits were linked to the age of onset of drinking which also was linked to girls who had an aggressive behavior and a low self-esteem when they grew up. Women who lived in a relationship where the partner abused substance or assaulted her resulted in a more frequent alcohol drinking in more hazardous amounts. The class perspective was strongly associated with a woman’s unhealthy relations’ to alcohol for example; when the woman were widowed, divorced, women with a income around the poverty line, women with low or no education at all, women who had no family or women who were depressed, were more likely to have an high alcohol consumption then women who had a family, a good income and an education. In summary the result showed that several aspects in a woman’s life, upbringing and social situation do affect her alcohol habits. This is knowledge that needs attention both in the health care and in the society.</p>

Psoriatic arthritis (PsA) is an inflammatory joint disease associated with psoriasis. PsA has a heterogeneous pattern, expressed by different manifestations such as mild mono-oligoarthritis or very severe, erosive and destructive polyarthritis. Measurable inflammatory activity is not always prominent. The aetiology is unknown but genetic factors are believed to be of importance. The pattern of inheritance is proposed to be polygenic. The aim of this study was to estimate the prevalence of joint and axial manifestations, characterise the disease in relation to inflammatory and genetic markers, and to identify disease susceptibility gene(s) for PsA in patients from northern Sweden. All patients from the city of Umeå (n=276), selected from a community and hospital based psoriasis register (n=1737) at the Dept of Dermatology, were invited to a prevalence study. Two hundred-two patients were examined and 97 (48%) had inflammatory manifestations such as peripheral arthritis, axial disease, undifferentiated spondylarthropathy (uSpA) and enthesopathies. Of the 67 patients (33 %) with peripheral arthritis and/or axial disease, 30 were not previously diagnosed. The association of clinical manifestations and potential markers of aggressive joint disease with HLA associations were analysed in 88 patients with PsA. We were not able to confirm findings of other groups reporting strong association with several HLA-antigens. The prevalence of HLA-B17, B37 and B62 was increased compared with controls, but the strongest predictive factors among our patients for an aggressive disease, in a multiple logistic analysis, were polyarthritic disease and distal interphalangeal engagement. In order to investigate for disease susceptibility genes, five genetic loci were analysed with microsatellites and single nucleotide polymorphisms in an association study of 120 patients with PsA. There was a significant association with the TNFB locus on chromosome 6p but not with any other loci examined; 1q21 (PSORS4), 3q21 (PSORS5), 8q24 and CTLA4. When stratifying for the TNFB alleles the association was confined to allele 123. In a subgroup of patients who were HLA-typed (n=83), we were not able to verify linkage disequilibrium with the TNFB allele 123 and the HLA antigens; B17, B27, B37, B62 or Cw*0602. The presence of renal abnormalities was evaluated as a manifestation of systemic inflammation in 73 patients with PsA. Renal abnormalities defined as decreased creatinine-clearance (≤ mean - 2SD) and/or urinary albumin &gt;25 mg/24 h was found in 23% of the patients. The predictive factors for renal abnormalities was inflammatory activity (ESR &gt; 25 mm/h and/or CRP &gt;15 mg/L) indicating a systemic effect in some of the patients. In conclusion, we found high prevalence of inflammatory manifestations in patients with psoriasis. There was no strong association between PsA and HLA antigens and predictive factors for aggressive disease were polyarthritic disease and DIP joint engagement. The TNFB locus was associated with PsA and there were no linkage disequilibrium with the HLA antigens B17, B27, B62 or Cw*0602. There were evidence for systemic effects as renal abnormalities in patients with PsA and measurable inflammatory activity.

There is still a debate concerning the evidence base for community interventions. The randomised clinical trial design (RCT) is increasingly challenged as a gold standard for their evaluation. This thesis takes the Norsjö health programme in Västerbotten as the starting point for a discussion about the ethical platform of community interventions and for exploring the role of self-rated health. The specific objectives are: 1) to better understand barriers to community participation and to assess the role of ethical premises among decision-makers, 2) to explore how health related norms and attitudes interact with self-rated health and the risk factor outcome of an intervention and 3) to analyse the gender and socio-cultural interplay of self-rated health with biomedical risk factors for cardiovascular disease. The participation and views of different actors in the planning and implementation phases of the intervention were studied by contrasting information between official documents, interviews with decision makers and professionals and questionnaires to community members. The role of basic values in setting priorities and choosing intervention strategies utilised a questionnaire design with hypothetical scenarios sent to a representative sample of Swedish health care politicians. Qualitative research interviews were used to explore health related norms and attitudes. Health examination measurements and questionnaire data formed the basis for analysis of the development of self-rated health and risk factor load during a 10-year follow-up of the intervention. Access to a stroke registry enabled a case-referent approach for studying the interaction between bio-medical risk factors, socio-demographic factors and self-rated health. Data from the Västerbotten Intervention Programme (VIP) could be utilised for a cross-country comparison with a “sister project” in Otsego, U.S.A. The results point to both strengths and limitations of the efforts made to involve people in the intervention. The problem definition mainly remained with the professionals and participation as a goal in itself, strengthening local democracy was felt to be an exaggerated ambition. However, there was an overall agreement about the seriousness of the health problem, the need to intervene and about the implementation mode. Self-rated health and reported behavioural change were important indicators of participation and young men with bad health seemed to have been least involved. Among Swedish health care politicians there was an overall agreement to allocate resources for prevention directed towards communities when there are serious health problems. The majority preferred an intervention strategy that involved primary health care. The risk of harm by creating some degree of anxiety or stigma was for many considered an acceptable drawback of a successful intervention. The follow-up study revealed a positive risk factor reduction accompanied by a positive development of self-rated health, especially for men. Additional support for an intervention effect was given through a comparison with a reference area. The interaction pattern between risk reduction and self-rated health was more polarised for men than for women, with a corresponding pattern for the lower compared to the higher educated. These results could be linked to a transition in the health related norm system and to “ideal types” representing attitudinal sets towards the intervention. The case-referent analysis suggested an interaction effect between self-rated health and bio-medical risk factor load in predicting stroke that was greater for men than for women. The cross-country comparison revealed a stronger influence of education in the U.S.A. The lower educated, with a high risk load, had a greater risk of self-rated poor health than their Swedish counterparts. The thesis suggests that self-rated health is an unexplored indicator, potentially important for understanding the complexity of community interventions. Self-rated health may predict disease development as well as modify the impact of established risk factors.