ABSTRACT
Resumen El presente trabajo expone y fundamenta recomendaciones basadas en la experiencia de investigación en personas transgénero, con la intención de que puedan ser útiles a quienes realicen estudios con dicha población. Estas recomendaciones incluyen orientaciones conceptuales, metodológicas y éticas, aplicables a lo largo del proceso de investigación. En particular, las orientaciones cubren los siguientes temas: definir con precisión el colectivo con el que se trabaja, registrar la variedad de identificaciones de género posibles al interior del mismo, utilizar métodos de muestreo aptos para poblaciones de difícil acceso, retribuir la participación, incluir líderes e investigadores transgéneros como expertos, pilotar los instrumentos en la población que será investigada, optar por modalidades de recolección grupal de datos, ofrecer asistencia individualizada durante la recolección, utilizar un lenguaje no estigmatizante e inclusivo, convocar la participación en conjunto con organizaciones transgénero, atender a la movilidad geográfica de la población, realizar una escucha comprometida y contemplar protocolos de derivación, considerar las diferentes trayectorias de transición, realizar sesiones de interanálisis y, finalmente, difundir apropiadamente los hallazgos al interior de la población transgénero. Se discuten estas proposiciones en términos de sus efectos en las comunidades trans, su utilidad y alcances éticos, su articulación con exigencias generales de toda investigación y sus implicaciones para el activismo.
Abstract Prejudice and discrimination have important effects on the well-being and quality of life of trans people. Hence, investigating with said population implies, in addition to actions to obtain relevant and truthful information, having the necessary actions to attend to their needs and peculiarities. These are populations that are difficult to access (hard-to-reach), stigmatized, in which there is no defined sampling frame, that have physical and mental health indicators lower than those of any other group with which we have worked and that, therefore, it is necessary to take extreme the precautions not to reproduce types of relationships that may be harmful or offensive. The purpose of the present article was to systematize part of our field experience with transgender people, so that it can be useful for those who study with this population. These recommendations aim to provide some conceptual, methodological and ethical guidelines, useful throughout the research process. In particular, we made a series of recommendations that cover from the moment of taking conceptual decisions about the design of the study, through contact with the organizations, until the completion of the field work and subsequent stage of dissemination of results. In particular, a series of recommendations are made regarding: specifying the definition of the group with which one works, recording the variety of gender identifications as people present them, using to sampling methods for hard-to-reach populations or hidden populations, deliver a retribution for the participation (consider participants as experts to be compensated for their work), including activists as experts in every stage of the study (study design, field work, data analysis and dissemination of results), piloting the instruments in specific population, preferably opt for group applications modality and continue with a debriefing, have specific assistance for participants during the application (special needs derived from their age, educational level, reduced mobility, among others), use non-stigmatizing and inclusive language, call together with trans organizations (in order to establish greater trust in the population), attend to a mobility of the population (so as not to replicate the sample in different places), carry out a committed listening and contemplate referral protocols (if necessary given the type of situations described by the participants and their current degree of elaboration), consider different trajectories of transition, conduct inter-analysis sessions and disseminate appropriately within the transgender population. These propositions are discussed in terms of their effects on trans communities, their usefulness and ethical scope, their articulation with the general requirements of all research, and their implications for activism. On the other hand, these recommendations can serve as criteria for evaluating the ethical dimension of research projects with trans people. It may therefore be important to project reviewers, editors, and reviewers of manuscripts submitted for publication. The perspective that we assume in this work is aligned with those called "evidence-based activism", which implies articulating a variety of knowledge, scientifically accredited and of an "experiential" type, in order to explore situations in which the team members Research staff are part of networks that involve them personally in their study topics. It is precisely the relationship with groups that work for the rights of minorities, activists and members of these groups is essential, since they have knowledge acquired through their experience as part of discriminated groups and they can contribute to the mobilization of knowledge in the governance of health issues.
ABSTRACT
Resumo O estudo quali-quantitativo explora o dilema ético da microalocação dos recursos da saúde. Objetiva identificar e comparar a opinião de dois grupos da sociedade portuguesa - estudantes e profissionais de saúde sobre a importância das características pessoais dos pacientes no momento de os priorizar e se as escolhas se explicam por referenciais bioéticos de caráter utilitaristas ou deontológicos. Os dados foram recolhidos através de um questionário aplicado a uma amostra de 180 estudantes universitários e 60 profissionais de saúde. Os respondentes perante hipotéticos cenários de emergência clínica tiveram de escolher de entre dois pacientes (distinguidos por idade, sexo, responsabilidade social, situação económica e laboral, comportamentos lesivos da saúde e registo criminal) quem tratar e justificar a escolha. Foram usados testes estatísticos de associação para comparar as respostas dos dois grupos e análise de conteúdo para categorizar as justificações. Os resultados sugerem a existência de diferenças nas escolhas dos dois grupos, com os profissionais de saúde a revelarem aceitar menos a utilização de critérios sociais em contexto de escassez e coexistência de critérios utilitaristas e deontológicos, com predomínio da eficiência por parte dos profissionais de saúde e da equidade por parte dos estudantes.
Abstract This qualitative/quantitative study examines the ethical dilemma of microallocation of health resources. It seeks to identify and compare the opinion of two groups in Portuguese society – students and health professionals – on the importance of personal characteristics of patients at the moment of prioritizing them and if the choices can be explained by bioethical references of a utilitarian or deontological nature. Data were collected by means of a questionnaire administered to a sample of 180 students and 60 health professionals. Faced with hypothetical emergency scenarios, the respondents had to choose between two patients (distinguished by: age, gender, social responsibility, economic and employment situation, harmful health behaviors and criminal record), duly selecting who to treat and then justifying their choice. The results suggest the existence of differences in choices between the two groups, with health professionals revealing they are less prepared to accept the use of social criteria in a context of scarce resources and co-existence of utilitarian and deontological criteria, with a predominance of efficiency on the part of health professionals and equity on the part of students.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Students/statistics & numerical data , Health Personnel/statistics & numerical data , Patient Selection/ethics , Resource Allocation/ethics , Portugal , Students/psychology , Universities , Surveys and Questionnaires , Health Personnel/psychology , Bioethical Issues , EmergenciesABSTRACT
Background: Drug advertisements form one of the major sources for updating drug information by the medical professionals. It has been observed that Indian drug advertisements provide incomplete and poor quality of essential information. However, existing information on comparison of drug advertisements in Indian and foreign journals is limited. Hence, this study was planned to compare the drug advertisements published in Indian and foreign journals. Methods: A total of 200 drug advertisements, 100 each from Indian and foreign journals, were randomly selected excluding those of medical devices, surgical appliances, nutritional supplements and ayurvedic drugs. The drug advertisements from two sources were compared for drug groups, compliance to „Ethical criteria for medicinal drug promotion‟ of World Health Organization (WHO), retrievability of cited reference(s) and mention of any additional information. Results: Drug groups advertised frequently in the Indian journals were those used for chronic diseases whereas chemotherapeutic agents topped the list in foreign journals. Brand names were mentioned in 100% advertisements in both categories of journals whereas information on other ingredients known to cause problems was not mentioned in any of the studied advertisements. Overall, compliance to WHO guidelines by advertisements was 54.6% in Indian journals and 68.2% in foreign journals. The two categories of journals didn‟t differ significantly in retrievability of cited reference(s) and additional information except for information on drug storage which was significantly more mentioned in Indian journals. Conclusions: Drug advertisements in both Indian and foreign journals were incomplete for updating drug information by medical professionals
ABSTRACT
Background: Though drug promotion regulations exist worldwide, low quality of journal drug advertising is a global issue. Medical journals are regarded as a leading source of information for new drugs. They may also modulate prescribing behavior of physicians without their knowledge. A comparative analysis of advertisements from different countries may provide insights regarding strengths and weaknesses of different regulating systems. Aims: Prescription drug advertisements from the Indian Journal of Dermatology, Venereology, and Leprology (IJDVL) and Journal of American Academy of Dermatology (JAAD) were compared to check their compliance with criteria of World Health Organization (WHO) and International Federation of Pharmaceutical Manufacturers and Associations (IFPMA). Methods: All the prescription drug advertisements of at least one page length appearing in all the issues of IJDVL and JAAD from January 2012 till December 2012 were included in this study. The contents of both advertisements were compared for compliance regarding different criteria of ethical codes for drug advertising of WHO and IFPMA. Statistical analysis was done using Fisher’s exact test. Results: Compared to IJDVL, more advertisements in JAAD complied with WHO and IFPMA codes. On the whole, advertisements in IJDVL had signifi cantly less information regarding the approved usage, dosage, abbreviated prescribing information (API), summary of scientifi c information, safety information regarding the drug, and references to the scientifi c literature to support various claims. However, JAAD had more advertisements with multiple claims than IJDVL, and many advertisements interspersed between scientifi c articles while IJDVL had none. Conclusion: The complex issue of ethical drug advertising in dermatology journals requires constant review and discussion. Dermatologists should be cautious in assessing any advertisement or claim even if it seems evidence-based. The results from our study highlight the need for a global, proactive and effective regulatory system to ensure ethical medicinal drug advertising in medical journals.