Sana Loue

Research Bioethics in the Ugandan Context: A Program Summary

A 5-day symposium on bioethical principles governing clinical trials was held in Jinja, Uganda in September 1994. The 13 attending male and female participants were ethicists, physicians, researchers, and pharmacists who had all conducted research themselves. The Ugandan Ministry of Health, Makerere University, the Uganda AIDS Commission, Ugandas National Council of Science and Technology, and the National Chemotherapeutic Laboratory were represented. The workshop was held as the first step toward examining Ugandas system of bioethical review; the applicability of the principles of autonomy, beneficence, nonmaleficence, and justice to biomedical research in Uganda; and strategies for the further development of a Ugandan code of research bioethics. The participants concluded that while the principles of autonomy, beneficence, nonmaleficence, and justice are relevant to research in Uganda, their adoption and implementation must reflect the circumstances and cultural context which are unique to Uganda. The issues considered during the workshop are discussed.

Research with Severely Mentally Ill Latinas: Successful Recruitment and Retention Strategies

Individuals from minority groups in the United States have been found less likely than non-Hispanic whites to participate in research studies. The recruitment and retention of individuals from minority groups has also proved challenging. We describe the challenges that we encountered in recruiting and retaining a sample of severely mentally ill Mexican and Puerto Rican ethnicity for a study of the context of HIV risk. We recruited women in San Diego County, California and northeastern Ohio who were between the ages of 18 and 50 and who had diagnoses of schizophrenia, bipolar disorder, or major depression. We identified challenges to recruitment and retention at the macro, mediator, and micro levels. We were able to retain 81.1% of the Puerto Rican cohort and 26.7% of the Mexican cohort over a 5-year period. The vast majority of barriers to recruitment and retention within the Puerto Rican cohort occurred at the micro (individual) level. Macro level barriers occurred more frequently and impacted retention to a greater extent within the cohort of Mexican women. Our experience underscores the importance of outreach to the community and the interaction between staff and individual participants. Diverse strategies are required to address the impact of migration on follow-up, which may vary across groups.

Locus of Control and HIV Risk Among a Sample of Mexican and Puerto Rican Women

The disproportionate impact of HIV/AIDS on Hispanic women in the United States has been variously attributed to a failure to utilize protective measures due to low levels of HIV knowledge, a denial or minimization of risk, and conflicts with cultural norms. It has been hypothesized that womens relative lack of power in relationships may be associated with higher risk sexual behavior. We examined the relationship between higher risk sexual behavior and perceived locus of control in sexual relationships among a sample of Puerto Rican and Mexican women. We interviewed 71 women of self-reported Mexican ethnicity in San Diego, California, and 79 women of self-reported Puerto Rican ethnicity in Cleveland, Ohio, to examine the relationship between HIV risk, HIV knowledge, and locus of control. Univariate logistic regression indicates that among Puerto Rican women, the perception that locus of control in a sexual relationship resides in the male partner was significantly associated with increased HIV risk, while younger age was significantly associated with increased risk among Mexican women only. In a combined sample of both Puerto Rican and Mexican women, multiple logistic regression analysis indicates that younger age, increased length of residence in the United States, and an other-focused locus of control are significantly associated with increased HIV risk. Women who have been in the United States for relatively longer periods of time may be more likely to integrate U.S. sexual norms into their own behavior and may, as a consequence, be at higher risk of HIV infection. Increased HIV prevention efforts must be made available to Mexican and Puerto Rican women born outside of the United States. These prevention efforts must necessarily focus not only on HIV prevention strategies, but also on the dynamics within male–female intimate relations. Increased attention to younger Puerto Rican and Mexican women is also needed.

HIV Knowledge Among a Sample of Puerto Rican and Mexican Men and Women

This study assessed levels of HIV knowledge and identified factors associated with HIV knowledge among a sample of heterosexual Puerto Rican and Mexican men and women, ages 18 to 45. The sample consisted of 144 men and women living in San Diego County, California, who self-identified as being of Mexican ethnicity and 209 men and women living in Cuyahoga County, Ohio, who self-identified as Puerto Rican. Interviews were conducted by trained, bilingual interviewers. Data were collected on demographic variables, attitudes towards decision-making in relationships, and HIV knowledge and risk behaviors. Puerto Rican individuals were significantly more likely than Mexican individuals to respond correctly to almost one-half of the 12 HIV knowledge items. Multiple logistic regression analysis indicated that higher levels of education, greater U.S. acculturation, legal status and birth in the United States, a self-focused locus of control in relationships, and being male were predictors of higher knowledge.

Community and family approaches to combating the radicalization and recruitment of Somali-American youth and young adults: A psychosocial perspective

Between late 2007 and autumn 2008, an estimated 18 or more Somali-American adolescent boys and young men living in the Minneapolis area secretly left their homes and flew to Somalia to join militant extremist training camps run by the Al Shabaab extremist organization. Political instability in Somalia, the 2006 Ethiopian invasion, social difficulties in US refugee communities, family instability, and local networks, all adeptly exploited by extremist recruiters, have together created contextual risks for violent radicalization amongst those Somalis resettled as refugees in the US as children and adolescents. While existing terrorism prevention efforts may interact with the community and family processes that influence radicalization and recruitment, the lack of adequate conceptualization of these processes poses a major challenge. In particular, it impedes progress in the development of prevention strategies. In this paper we examine the situation of Somalis in Minnesota from a psychosocial perspective. Specifically, we propose strategies derived from public health interventions for managing the risks of radicalization and recruitment by focusing on ways to enhance community and family protective resources for those at risk.

ELDER ABUSE AND NEGLECT IN MEDICINE AND LAW: THE NEED FOR REFORM

* Associate Professor, Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University. Professor Loue holds secondary appointments in the Center for Biomedical Ethics and the Center for International Health at Case Western Reserve University. The author gratefully recognizes Sandra M. Ferber, Jay F. Fiedler, and Fatoumata Traore for their valuable research assistance. Gretchen Holsinger-Kunke l and Zane Jennings deserve acknowledgemen t for their critical review of this manuscript. Address correspondenc e to Professor Loue at Department of Epidemiology and Biostatistics, MetroHealth Medical Center, 2500 Metrohealth Drive, Rammelkamp Building R-213A, Cleveland, Ohio 44109-1998 . 1 A.A. Baker, Granny Bashing, 5 MODERN GERIATRICS 20 (1975). 2 Mary A. Beachler, Mistreatment of Elderly Persons in the Domestic Setting (unpublished manuscript cited in SIMON BIGGS ET AL., ELDER ABUSE IN PERSPECTIVE 37 (1995)). 3 MARILYN BLOCK & JAN D. SINNOTT , THE BATTERED ELDER SYNDROME (1979). 4 RiCHARD L. DOUGLASS ET AL., A STUDY OF MALTREATMENT OF THE ELDERLY AND OTHER VULNERABLE ADULTS (1980). 5 Mervyn Eastman & Margaret Sutton, Granny Battering, GERIATRIC MED., Nov. 1982, at 11. 6 MERVYN EASTMAN, OLD AGE ABUSE (1984).

Expanding the Universe of Universal Coverage: The Population Health Argument for Increasing Coverage for Immigrants

As the US recession deepens, furthering the debate about healthcare reform is now even more important than ever. Few plans aimed at facilitating universal coverage make any mention of increasing access for uninsured non-citizens living in the US, many of whom are legally restricted from certain types of coverage. We conducted a critical review of the public health literature concerning the health status and access to health services among immigrant populations in the US. Using examples from infectious and chronic disease epidemiology, we argue that access to health services is at the intersection of the health of uninsured immigrants and the general population and that extending access to healthcare to all residents of the US, including undocumented immigrants, is beneficial from a population health perspective. Furthermore, from a health economics perspective, increasing access to care for immigrant populations may actually reduce net costs by increasing primary prevention and reducing the emphasis on emergency care for preventable conditions. It is unlikely that proposals for universal coverage will accomplish their objectives of improving population health and reducing social disparities in health if they do not address the substantial proportion of uninsured non-citizens living in the US.

Redefining the Emotional and Psychological Abuse and Maltreatment of Children: Legal Implications

Emotional abuse, a label often used synonymously with the terms emotional maltreatment, psychological battering, psychological abuse, and soul murder, has been called “the most elusive and damaging of all types of maltreatment for a child” and represents “the core issue and most destructive factor across all types of child abuse and neglect.” The very elusiveness, however, of the identification of emotional and psychological abuse casts doubt on the accuracy of available data relating to its occurrence, and it is likely that the incidence and prevalence of such abuse are subject to significant underreporting. Nevertheless, it appears from numerous studies that the emotional abuse of children has been and continues to be a growing problem.

Preventing HIV, eliminating disparities among hispanics in the United States

HIV/AIDS has disproportionately impacted Hispanics/Latinos in the United States. This literature review focuses on the disparities that exist in the impact of HIV/AIDS across Hispanic subgroups. Elimination of these disparities requires attention to underlying biological, behavioral and psychological, social and cultural, and economic and structural factors. Attention to factors within these domains has important implications for the reduction of other health-related disparities that exist across Hispanic/Latino subgroups in the United States.

Integrating Buddhism and HIV prevention in U.S. southeast Asian communities.

Asian Pacific Islander communities in the United States have experienced an alarming increase in HIV infection over the past few years, possibly due to a lack of knowledge and the relative absence of appropriate educational interventions. The authors propose a new approach to the development of HIV prevention programs in U.S. southeast Asian communities. This article reviews the cultural and economic factors that may facilitate HIV transmission within these communities. Relying on the basic precepts of Buddhism, the dominant religion of many southeast Asian populations in the United States, the health belief model is utilized to demonstrate how recognizable, acceptable religious constructs can be integrated into the content of HIV prevention messages. This integration of religious concepts with HIV prevention messages may increase the likelihood that the message audience will accept the prevention messages as relevant. This nuanced approach to HIV prevention must be validated and refined through field research.