Strong bones in later life: luxury or necessity?

Osteoporosis is a global problem which will increase in significance as the population of the world both increases and ages. This report looks at how the demographic changes in different countries of the world will be reflected in the incidence and cost of osteoporotic disease. Comparisons are made between the data collected by the European Union's Report on Osteoporosis in the European Community, issued in June 1998, and some of the data available from other parts of the world. The importance of prevention, early detection and appropriate treatment is stressed, as well as the need for national health services to provide reimbursement of the costs of prevention, diagnosis and treatment for high-risk groups.     

The health care assistant: professional supporter or budget necessity?

The budgets of NHS Trust Hospitals are continually under scrutiny in an endeavour to reduce operating costs. Skill mix, the balance of professional staff to non-professional staff, is a part of this process and the NHS has introduced a new level of staff called "health care assistants" (HCA). Examines the role and training of the HCA, and the reaction of professional nurses to their introduction into the area of patient care. Highlights areas of concern in relation to HCA training, selection techniques, and the absence of national guidelines which would ensure the quality level of HCAs produced. There is evidence of some managements leaning towards "cheaper:" staffing, i.e. using HCAs to replace professional nurses, and the conclusions give rise to some concern in quality of patient care and in the falling morale of professional nurses.     

Liver transplantation from a living donor: necessity or an alternative?

Liver transplantations using a part of the liver from a living donor are already being performed around the world. The main arguments for performing such transplantations are the shortage of brain-dead donors and the consequently high mortality rate of patients on the waiting list for a liver transplantation. The disadvantages of this option are the mortality and morbidity risk for the living donor. The shortage of brain-dead donors could also be resolved by the implementation of special techniques such as split-liver and domino-liver transplantations or by using compromised and non-heart-beating donors. Furthermore, measures should be taken to reduce the shortage of brain-dead donors in the Netherlands. If such actions do not lead to an increase in the number of brain-dead donors and a willingness to restrict the indications for transplantation is not forthcoming then donation for liver transplantation by living donors is inevitable. Such a program should satisfy certain conditions and have the requisite medical-ethical and public support.     

Is health care really a luxury?

Much of the work which has led to a widely held view that the income elasticity of health care spending exceeds one has been based on international cross-section data, or on pooled cross-sections and time series. In this paper we re-examine this view in the context of long-run equilibrium relationships between non-stationary time series, possibly including autonomous trends. Our results cast doubt upon the usefulness of pooling and upon the notion of an elasticity above one.     

Sexual rights in southern Africa: a Beijing discourse or a strategic necessity?

This article explores the meaning of sexual rights as interpreted by different stakeholders during the development of the Beijing Programme of Action and within the Southern African Development Community (SADC). It illustrates how the lack of sexual rights as understood in the African context results from poverty as well as gender inequality, particularly in sexual relationships. This lack is manifested in the circumstances surrounding the HIV/AIDS pandemic and violence against women. In the European context, in contrast, sexual rights claims are motivated specifically in relation to sexual orientation. The article explores the extent to which these different discourses are being addressed in practice in SADC member countries and the opportunities that exist for building a concrete practice of sexual rights both in the region and internationally.     

Mucosal HIV vaccines: A holy grail or a dud?

The mucosal immune system appears to be a major target of the HIV infection. Therefore, a strong pre-existing anti-HIV immune response in mucosal compartments might be able to prevent HIV infection. Conflicting views regarding the mechanisms of protection at mucosal sites, inferred by the contradictory results of mucosal vaccines in human clinical trials, attests to our lack of knowledge in understanding the human mucosal immune system. In this article, we briefly review the function of innate and adaptive immune responses and discuss current strategies and potential adjuvants in designing and delivering HIV vaccines through mucosal routes.     

Damon or Pandora?

Americans have recently had thrust into their faces multiple media borne medical and social ethics dilemmas ranging from Dr. Kevorkian's euthanizing a patient on national television to payments by managed care providers for experimental medical treatments,to the nationally telecast situation which this paper will attempt to address. The case at hand concerns a minor in need of a repeat(third) kidney transplant who has been offered a kidney by her father. He also provided a kidney for her second kidney transplant some years ago. The teenage girl went into her current kidney failure/organ rejection state because, feeling well, she stopped taking her antirejection medications. Her father appears to understand the consequences of this offer and is willing nonetheless to donate his remaining kidney to his daughter. His ex-wife and daughter want the kidney and will take it knowing what it will do to him. Of additional interest is that he is incarcerated as a prisoner for a crime for which he will be eligible for parole in the not distant future. This means that although altruistically self-induced, the State will become financially responsible for his medical care and dialysis treatments. This paper will attempt to analyze the competing issues presented by this dilemma and address the underlying conflict between the parameters patient autonomy, parental beneficence and the deontologically based responsibilities of the state and of the health care team. This revised version was published online in July 2006 with corrections to the Cover Date.