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PubMed2005

Receiving marijuana and cocaine as gifts and through sharing.

This paper presents estimates of the probability that individuals who use marijuana and cocaine receive some of their drug as a gift or through sharing. The analysis utilizes data from the National Household Survey of Drug Abuse in the United States of America. This research expands upon the observation of field researchers that sharing and gift giving are common distribution mechanisms in drug markets. The likelihood an individual marijuana or cocaine user receives drug gifts or receives drugs through sharing by others depends on age, race, gender, income and the amount they consume. These findings should assist policy makers designing drug abstinence programs and drug rehabilitation administrators trying to prevent relapse.

Adolescent↗
PubMed2002

Boundaries in the doctor-patient relationship.

Boundaries in the doctor-patient relationship is an important concept to help health professionals navigate the complex and sometimes difficult experience between patient and doctor where intimacy and power must be balanced in the direction of benefiting patients. This paper reviews the concept of boundary violations and boundary crossings in the doctor-patient relationship, cautions about certain kinds of boundary dilemmas involving dual relationships, gift giving practices, physical contact with patients, and self-disclosure. The paper closes with some recommendations for preventing boundary violations.

Ethics, Medical↗
PubMed2006

Gifts to physicians from the pharmaceutical industry: an ethical analysis.

Gifts to physicians by the pharmaceutical industry pose numerous ethical questions. Although individual patients and physicians may benefit financially and educationally from certain gifts, the risk of bias resulting from such gifts makes them ethically challenging. After a brief description of the nature and scope of the practice of gift giving, this article examines major arguments for and against this practice. We then review the development of guidelines by professional societies, trade organizations, and government agencies. We conclude with a list of summary recommendations designed to help individual physicians, educators, and administrators engage in careful reflection and analysis and make sound ethical decisions about acceptance of gifts.

Conflict of Interest↗
PubMed2006

Giving and receiving of gifts between pharmaceutical companies and medical specialists in Australia.

BACKGROUND: This study investigated the 'gift-relationship' between pharmaceutical companies and doctors. METHODS: The study was based on a survey questionnaire of 823 medical specialists from across Australia. The aim of this study was to investigate gifts offered to medical specialists in Australia by pharmaceutical companies, financial support actively sought by medical specialists for activities other than research and to consider what is ethically appropriate. RESULTS: A high percentage of specialists received offers of food (96%), items for the office (94%), personal gifts (51%) and journals or textbooks (50%). Most specialists were invited to product launches, symposia or educational events (75-84%) and 52% received offers of travel to conferences. A high proportion of offers were accepted (66-79%) except invitations to product launches (49%), sponsored symposia (53%) and offers of travel that included partners (27%). Fifteen per cent of specialists requested financial support from pharmaceutical companies for activities and items, including conferences, travel, educational activities, salaries and donations to specific funds. The study outlined guidelines on gifts from pharmaceutical companies and differing standards applying to gifts and grants for travel. We found that, although most gifts and requests for support complied with professional and pharmaceutical industry guidelines, some--including personal gifts, tickets to sporting events, entertainment and travel expenses for specialists' partners--did not. CONCLUSION: To ensure that physicians' judgements are free from real or perceived influence from industry and to maintain public trust, we support a shift towards more conservative standards on gifts and support for travel evident in recent guidelines.

Adult↗
PubMed1997

Adolescent sexual behavior along the Trans-Africa Highway in Kenya.

OBJECTIVE: To describe the demographic characteristics and HIV-related risk behaviors of adolescents frequenting truck stops along the Trans-Africa Highway in Kenya. METHODS: A cross-sectional study of 200 adolescents (52% female) aged 15-19 years was conducted at the Malaba, Sachangwan and Mashinari truck stops in Kenya. A standardized questionnaire assessing the adolescents' demographic characteristics and sexual behavior was administered. RESULTS: Most (89%) of the adolescents interviewed were out of school. Their median monthly family income was Ksh1000 (US$25). Most felt that their families provided inadequate access to food (72%), clothing (70%) and pocket money (87%). Ninety-three per cent of girls and 87% of boys had ever had sexual intercourse and of these 54% of girls and 38% of boys had ever used a condom. Fifty-two per cent of the girls and 30% of the boys reported ever having had a sexually transmitted disease. Forty-six percent of girls reported usually having sex with truck drivers, 78% of girls reported usually exchanging sex for gifts or money and 59% of boys reported usually giving gifts or money for sex. Subjects engaging in these three risk behaviors were generally less likely to be in school, less likely to live with relatives and less likely to report getting along well with their parents. CONCLUSION: Adolescents at truck stops along the Trans-African Highway in Kenya appear to be at significant risk for HIV infection. In the absence of an immediate and wide-ranging intervention, these conditions are likely to facilitate the spread of HIV from truck drivers and sex workers to adolescents.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Unpredictable food and sexual size dimorphism in insects.

The evolution of sexual size dimorphism is likely to be affected by the amount of resources each sex invests in offspring. Male nuptial gifts, occurring in many insect species, might reduce the value of large size in females and increase the value for males. For large nuptial gifts and an accompanying shift in dimorphism to evolve, males with larger gifts should be rewarded, in effect trading the larger gift for more offspring. We suggest that food variability, causing some males to have much to provide and some females to be in great need, would be conducive to the evolution of such a mating system, and we present comparative data on butterflies supporting the suggestion. In a gift-giving mating system, growing male and female juveniles should react differently to food shortage. A female maturing at small size can to some extent buffer her disadvantage through nuptial gifts, whereas a male maturing at small size will suffer from his inability to provide substantial gifts. Thus, males benefit more than females from continued growth in the face of food shortage, leading to a shift in size dimorphism. Here we confirm this prediction in a butterfly, Pieris napi, with large nuptial gifts.

Animals↗
PubMed2002

Titmuss and the gift relationship: altruism revisited.

RATIONALE: This paper revisits Richard Titmuss' 1970s blood donation model in the light of its 1997 reprint in order to consider whether we are justified in continuing to accept that the main reason for blood donation (and other donation types) is an altruistic desire to help others. AIM: This paper explores how others have examined the notion of altruism, before concentrating on two major elements of Titmuss' work: blood donors' motives to donate and the social implications of gift-giving in relation to the uniqueness of blood donation. DESIGN: Donor motivation is discussed in detail with particular reference to questions 4 and 5 of Titmuss' blood donor survey and through a critical appraisal approach to his work. FINDINGS: Methodological inconsistencies are revealed in the design and implementation of the survey, as well as in Titmuss' list of blood donation's unique attributes, bringing into question the rigour of his findings. It may be that blood donors are altruistically motivated, but such conclusions cannot be drawn from this work. It is also unclear if 'altruism' can be shown in the example of blood donation or other donation types. RECOMMENDATIONS: We should reconsider the motivation behind gifting in health care in the light of these findings and ensure that evidence-based practice is consistent with methodological rigour. Nurses and other health professionals need to have a clearer understanding of concepts such as altruism in order to appreciate why people seek to donate.

Altruism↗
PubMed2005

Informal payments in government health facilities in Albania: results of a qualitative study.

As governments seek to expand access to quality health care services, policy makers in many countries are confronting the problem of informal payments to medical personnel. The aim of this study was to help health planners in Albania understand informal payments occurring in government health facilities. Researchers used in-depth interviews and focus groups with 131 general public and provider informants in three districts. The results suggest that factors promoting informal payments in Albania include perceived low salaries of health staff; a belief that good health is worth any price; the desire to get better service; the fear of being denied treatment; and the tradition of giving a gift to express gratitude. Members of the general public also believe informal payments create uncertainties and anxiety during the care-seeking process, while providers perceive that informal payments harm their professional reputation, induce unnecessary medical interventions, and create discontinuity of care. The study showed that focusing on the most harmful effects and targeting the most vulnerable populations may be one way to gain consensus for policy reform. Understanding citizens' and caregivers' viewpoints is an important step in designing regulatory and bureaucratic interventions.

Albania↗
PubMed2000

Nuptial gifts and the use of body resources for reproduction in the green-veined white butterfly Pieris napi.

Reproduction in butterflies, as in many holometabolous insects, is usually constrained by the amount of nutrients the animals can collect as juveniles. In polyandric species the females can also supplement their larval-derived reserves with protein-rich donations, so-called nuptial gifts, delivered by the males at mating. Recent findings also indicate that females have access to nitrogen from the histolysis of flight muscles in the thorax. This field study examined how butterflies of the polyandric gift-giving species Pieris napi (Lepidoptera: Pieridae) use body resources in their reproduction and how the male donations affect the females use of stored reserves. The results support earlier studies, indicating that females use resources from the breakdown of thorax muscles to increase their reproductive potential and the results also indicate that males also use thorax material in their reproduction. The study also supports recent findings that the male donation increases the breakdown of body resources and thereby boosts the reproductive output of the female.

Animals↗
PubMed2002

Emergency seed aid in Kenya: some case study insights on lessons learned during the 1990s.

This article reviews the effectiveness of seed-aid distributions in Kenya during the 1990s. It analyses the internal process and effects, i.e. the performance of the aid itself as well as the external process and effects, i.e. how seed-aid intervention affected farmers' broader agricultural management strategies. During the drought emergency of 1997, Kenyan farmers favourably judged many of the immediate seed-aid features such as crop and variety appropriateness and seed quality--even through the overarching goals of the seed assistance were muddled, ranging from assistance to the poor, to generalised gift-giving to stimulating progressive farming practice. However, the longer term analyses, drawn from recollections of a decade of relief activity, showed no concrete evidence that seed aid, per se, had strengthened their farming systems, nor that those who have received it once were less likely to receive it again. Thus, while seed aid has been promoted to lessen the effects of an 'acute' stress, drought, Kenyan farmers, in practice, have been experiencing much wider, 'chronic' seed system problems. This article ends by exploring this distinction between acute and chronic seed system stress and suggests a range of interventions appropriate to each.

Agriculture↗
PubMed1996

The subculture of adolescence: beliefs about care, health and individuation within Leininger's theory.

The purpose of this ethnonursing investigation, which was part of a larger study, was to describe and explain the meanings and experiences of adolescents in relation to their care and health within their peer subculture and family contexts. Data were collected using observation-participation and interviews with adolescents in southwestern Ontario, Canada. Interviews were tape recorded, coded and entered on to a computer. The following themes were abstracted from the verbatim descriptors and patterns. (a) Care for adolescents meant "being there' for listening in confidence, helping, gift giving, humour and demonstrating love in time of need. (b) Health for adolescents meant well-being, absence of illness, being fit, dealing with problems, and taking responsibility. (c) The adolescents valued family, friends, education, money, sports, and honesty. (d) Clothes, hair and music were metaphors for adolescents' emerging identities.

Adolescent↗
PubMed1999

Heading off boundary problems: clinical supervision as risk management.

The effective management of risk in clinical practice includes steps to limit harm to clients resulting from ethical violations or professional misconduct. Boundary problems constitute some of the most damaging ethical violations. The authors propose an active use of clinical supervision to anticipate and head off possible ethical violations by intervening when signs of boundary problems appear. The authors encourage a facilitative, Socratic method, rather than directive approaches, to help supervisees maximize their learning about ethical complexities. Building on the idea of a slippery slope, in which seemingly insignificant acts can lead to unethical patterns of behavior, the authors discuss ten cues to potential boundary problems, including strong feelings about a client; extended sessions with clients; gift giving between clinician and client; loans, barter, and sale of goods; clinician self-disclosures; and touching and sex. The authors outline supervisory interventions to be made when the cues are detected.

Ethics, Professional↗
PubMed2006

Informal payments for health care: definitions, distinctions, and dilemmas.

There is increasing interest in the issue of informal payments for health care in low- and middle-income countries. Emerging evidence suggests that the phenomenon is both diverse, including many variants from cash payments to in-kind contributions and from gift giving to informal charging, and widespread, reported from countries in at least three continents. However, cross-national research is hampered by the lack of consensus among researchers on the definition of informal payments, and the definitions that have been proposed are unable to incorporate all forms of the phenomenon that have been described so far. This article aims to overcome this limitation by proposing a new definition based on the concept of entitlement for services. First, the various forms of informal payment observed in practice are reviewed briefly. Then, some of the proposed definitions are discussed, pointing out that none of the distinctive characteristics implied by these definitions, including illegality, informality, and corruption, is adequate to capture all varieties of the phenomenon. Next, an alternative definition is formulated, which identifies the distinctive feature common to all forms of informal payments as something that is contributed in addition to the terms of entitlement. Then, the boundaries implied by this definition are explored and, finally, the implications for research and policy making are discussed with reference to the lessons developed countries can learn from the experiences of transitional countries.

Delivery of Health Care↗
PubMed2006

Boundaries & adolescents in residental teatment settings: what clinicians need to know.

Working with adolescents in psychiatric treatment settings poses unique challenges related to boundaries. Staff are typically from a range of disciplines, and some are from nonregulated professions. Three potential boundary-crossing areas are touching, gift giving, and self-disclosure. To enhance quality of care, staff needs an orientation aimed at boundary education, including the concepts of transference and countertransference; an atmosphere of safety to discuss their observations of themselves and others; to be willing to provide feedback; and a sound knowledge base of adolescent growth and development.

Adolescent↗
PubMed1990

Transference phenomena in medical practice: being whom the patient needs.

Transference is a process in which individuals displace patterns of behavior that originate through interaction with significant figures in childhood onto other persons in their current lives. It is a powerful determinant of patient behavior in medical encounters. Transference can affect the kind of physician-patient relationship a patient seeks and his or her response to interventions prescribed by physicians. The relationship is also strongly affected by the physician's own transference or countertransference. Rather than approach every patient in a uniform way, tailoring the approach to fit the relationship needs of the individual patient is advocated. Such tailoring would affect whether the physician is collaborative or prescriptive, how much personal information he or she shares, and how close or distant he or she is. Transference issues can also affect level of somatization and patient adherence to medical regimens. We discuss other problems with transference, such as the seductive patient and gift giving. By paying attention to the transference needs of patients, physicians can enhance the therapeutic alliance in which patients optimally participate in fulfilling their medical needs.

Adult↗
PubMed1991

Preparation for incapacity essential to plan. The Health Care Group.

Many peoples' thoughts of estate planning begin and end with their wills. But there are several more elements to any complete, properly prepared estate plan, including trusts, gift giving programs, and family partnerships. In particular, two often overlooked documents--"a durable general power of attorney" and a "living will"--are very important. Without them your plan is not complete.

Humans↗