I am currently taking Development and Evaluation of Health Programs, and for that class my group is working with the Guthrie Clinic to develop a survey evaluating the attitudes of health professionals toward preventative screenings. Our aim is to analyze the opinions of physicians on the clinic's guidelines for screenings, as well as any perceived barriers for administering the screenings.
The survey is composed of 35 questions that are broken up into sections. The first section deals with the clinic's guidelines. The second section inquires about any perceived barriers to preventative screenings. The third questions how the physician personally complies with the guidelines. The following section includes sentences that the subjects rate and include any additional comments, and the last section questions the demographics of the sample. Each section has a Likert scale format, except for the last two, which are short answer and multiple choice, respectively. The survey will be e-mailed to every Guthrie health care professional.
We opted to use a survey to acquire our data for a variety of reasons. First, the research committee at Guthrie clinic recommended we use a survey. Second, it is the most convenient. We don't need to gather physicians or interrupt anyone's busy schedule too much. We also figure more people would be willing to sit for a few minutes and do a survey while checking their e-mail than go out of their way to participate. Third, it was the best way to reach the most people. Lastly, our data is quantitative, so a survey with multiple choice or rating questions are the easiest to interpret and analyze.
Actually conducting the survey is interesting because it helps me better understand what is being learned in this class, but I also can apply what I learned to it.
Sunday, October 14, 2007
Sunday, September 23, 2007
Ethics in Research: The "John/Joan" Case
I. This study fell into the lap of Dr. John Money, a psychologist and sexologist pioneering gender identity, back in the 1960's. Bruce Reimer was born in Winnipeg, Manitoba, Canada in 1965 as a perfectly healthy boy, with an exception of phimosis, a condition of the penis in which the foreskin cannot be fully retracted. He had a twin with the same condition. At the age of 8 months, he underwent surgery for a circumcision. However, the surgeon used a Bovie cauterization machine, which is unsuitable for small appendages such as the penis. The penis was destroyed beyond repair. Therefore, it was converted into a vagina following a suggestion by Dr. Money, who believed that one's sexual identity could be molded at an early age. He used Reimer as a case study to determine the effects of the sex change. This was ideal, because his twin, who did not have surgery for the condition, was a perfect control for the study because their genes, environment, and overall condition were exactly the same.
Money believed that identity was relatively plastic in infancy and proposed that it was influenced by social learning in early childhood. Also, while a destroyed penis is completely dysfunctional, a constructed vagina would be more likely to become a successful, functional organ. Money convinced Reimer's parents that sexual reassignment would be in his best interest, so they consented to a surgery to have his testes removed.
After the surgery, Bruce was renamed Brenda and was raised as a girl. "She" continued to see Dr. Money for psychological treatment and outcome assessment. Money believed his case was successful, citing how much more feminine Bruce was than her twin brother. Estrogen was given to Bruce upon adolescense to induce secondary female sex characteristics.
Bruce viewed these visits to Money as highly traumatic. He began pressuring the family to consent to a second reconstructive surgery to create a vagina, but because Bruce was so psychologically stressed by the visits, they discontinued them. He threatened to commit suicide if he had to visit Money again. Money published nothing afterward that suggested his study was not successful.
Bruce admitted that he never identified as female. He was made fun of by peers, and experienced suicidal depression at a young age. At age 15, his parents told him the truth about his past, at which point he began to assume a male identity. He named himself David.
His twin Brian, experienced a pattern of mental disturbances and developed schizophrenia after learning of his relationship with his now "ex-sister". Years later, Bruce underwent treatment to reverse his previous sex change, including testosterone injections and several surgeries. He married a woman and became a stepfather to her three children. He gained popularity and financial security by making his story public, however he separated from his wife, had severe problems with his parents, and experienced the death of his brother from a toxic combination of alcohol and antidepressants. In 2004, at the age of 38, Bruce committed suicide.
II. This study was unethical in myriad ways. According to the Nuremberg Code, the first item is that consent is required, and must be voluntary. Because Bruce was too young to consent, his parents did. However, they were pressured into it by Dr. John Money, who assured them that this was for their son's own good. He also failed to inform them of any possible dangers of the study, including psychological distress, possible physiological malfunction, trauma experienced by friends and family members, etc.
The second item is that the study must be conducted only to benefit society, and only if no other means of study will work. The knowledge gained can certainly benefit society. However, the study was only performed because Money made it so. There could have been other ways to learn.
This case yielded immeasurable amounts of unnecessary physical and emotional suffering, which violates the fourth item of the Code.
Although Bruce eventually was able to terminate his "treatment", he was able to only after threatening to end his own life. Money pressured him and his parents into continuing the treatment until that point. According the the ninth item of the Code, subjects should be able to end the experiment at any point they wish, with discouragement or pressure to continue.
The tenth item states that the researcher must be able to end the study if he believes it will result in any type of injury. John Money ignored the fact that Bruce was being severely mentally harmed by the experiment. Even after Bruce terminated the treatment, Money claimed it was a successful procedure. He neglected to include any data in his publishings that did not concur with his beliefs about sexual identity.
III. David Reimer. (n.d.). Wikipedia. Retrieved September 23, 2007, from Wikipedia
Web site: http://en.wikipedia.org/wiki/David_Reimer
Money believed that identity was relatively plastic in infancy and proposed that it was influenced by social learning in early childhood. Also, while a destroyed penis is completely dysfunctional, a constructed vagina would be more likely to become a successful, functional organ. Money convinced Reimer's parents that sexual reassignment would be in his best interest, so they consented to a surgery to have his testes removed.
After the surgery, Bruce was renamed Brenda and was raised as a girl. "She" continued to see Dr. Money for psychological treatment and outcome assessment. Money believed his case was successful, citing how much more feminine Bruce was than her twin brother. Estrogen was given to Bruce upon adolescense to induce secondary female sex characteristics.
Bruce viewed these visits to Money as highly traumatic. He began pressuring the family to consent to a second reconstructive surgery to create a vagina, but because Bruce was so psychologically stressed by the visits, they discontinued them. He threatened to commit suicide if he had to visit Money again. Money published nothing afterward that suggested his study was not successful.
Bruce admitted that he never identified as female. He was made fun of by peers, and experienced suicidal depression at a young age. At age 15, his parents told him the truth about his past, at which point he began to assume a male identity. He named himself David.
His twin Brian, experienced a pattern of mental disturbances and developed schizophrenia after learning of his relationship with his now "ex-sister". Years later, Bruce underwent treatment to reverse his previous sex change, including testosterone injections and several surgeries. He married a woman and became a stepfather to her three children. He gained popularity and financial security by making his story public, however he separated from his wife, had severe problems with his parents, and experienced the death of his brother from a toxic combination of alcohol and antidepressants. In 2004, at the age of 38, Bruce committed suicide.
II. This study was unethical in myriad ways. According to the Nuremberg Code, the first item is that consent is required, and must be voluntary. Because Bruce was too young to consent, his parents did. However, they were pressured into it by Dr. John Money, who assured them that this was for their son's own good. He also failed to inform them of any possible dangers of the study, including psychological distress, possible physiological malfunction, trauma experienced by friends and family members, etc.
The second item is that the study must be conducted only to benefit society, and only if no other means of study will work. The knowledge gained can certainly benefit society. However, the study was only performed because Money made it so. There could have been other ways to learn.
This case yielded immeasurable amounts of unnecessary physical and emotional suffering, which violates the fourth item of the Code.
Although Bruce eventually was able to terminate his "treatment", he was able to only after threatening to end his own life. Money pressured him and his parents into continuing the treatment until that point. According the the ninth item of the Code, subjects should be able to end the experiment at any point they wish, with discouragement or pressure to continue.
The tenth item states that the researcher must be able to end the study if he believes it will result in any type of injury. John Money ignored the fact that Bruce was being severely mentally harmed by the experiment. Even after Bruce terminated the treatment, Money claimed it was a successful procedure. He neglected to include any data in his publishings that did not concur with his beliefs about sexual identity.
III. David Reimer. (n.d.). Wikipedia. Retrieved September 23, 2007, from Wikipedia
Web site: http://en.wikipedia.org/wiki/David_Reimer
Tuesday, September 18, 2007
An Analysis of a Primary Research Study
"Differences in Club Drug Use Between Heterosexual and Lesbian/Bisexual Females"
1. What was the question?
The purpose of the study was to "examine the patterns and contexts of club drug use among people who frequent dance club venues". The researchers sought to investigate any connections between sexual identity and drug use. Because the majority of research focuses primarily on men, this study focuses on women.
2. What was done?
The study took place in various, randomly selected clubs in Manhattan from December 2004 through July 2005. 1104 females were sampled. Field staff randomly approached club patrons and asked them to do a quick, five minute survey. Surveys were conducted with the use of palm pilots with those who consented, and the age, gender, and ethnicity were noted of those who did not. The survey included whether or not the patron used club drugs, which ones were used, and frequency of use. The data was interpreted using Chi-square analyses to examine the differences in rates of drug use, and by using stepwise logistic regression analyses to examine the predictive nature of age and sexual orientation in club drug use.
3. What was found?
Of the women studied, 53.3% were heterosexual, while 46.3 identified as lesbian or bisexual. The ages ranged from 18 to 49. Whites accounted for 57.9% of the sample, while Latinas comprised 15.9%, blacks 10.4%, Asians/Pacific Islanders 5.7%, and other or mixed roughly 10%. The majority of those surveyed (72.2%) reported to previous drug use, with MDMA or ecstasy being the most common. One in 5 women were "active" drug users (they used at least once within the past three months). Older women (over the age of 30) reported higher lifetimes rates, though younger women admitted to higher active club drug use. Lesbian and Bisexuals were significantly more likely to use drugs than heterosexuals. Overall, a lesbian or bisexual identity is predictive of lifetime use of almost every club drug, as well as current or active use.
4. What does the study mean?
While older women were more likely to be lifetime users, younger women were more likely to be active users. This means that prevention and education should be aimed at younger women. Also, because lesbian and bisexual women were more likely to use club drugs than heterosexuals, more prevention programs need to be targeted toward them. Because health promotion programs are primarily aimed at gay men, it is easy to see why lesbian and bisexual women need more attention. Future research should be aimed at learning and understanding the prevalence rates within and between female subgroups because as of now, too little information is available.
Parsons, J. T., Kelly, B. C., & Wells, B. E. (2006, December). Differences in
Club Drug Use Between Heterosexual and Lesbian/Bisexual Females.
Addictive Behaviors, 31(12), 2344-2349. Retrieved September 18, 2007,
from Science Direct database.
1. What was the question?
The purpose of the study was to "examine the patterns and contexts of club drug use among people who frequent dance club venues". The researchers sought to investigate any connections between sexual identity and drug use. Because the majority of research focuses primarily on men, this study focuses on women.
2. What was done?
The study took place in various, randomly selected clubs in Manhattan from December 2004 through July 2005. 1104 females were sampled. Field staff randomly approached club patrons and asked them to do a quick, five minute survey. Surveys were conducted with the use of palm pilots with those who consented, and the age, gender, and ethnicity were noted of those who did not. The survey included whether or not the patron used club drugs, which ones were used, and frequency of use. The data was interpreted using Chi-square analyses to examine the differences in rates of drug use, and by using stepwise logistic regression analyses to examine the predictive nature of age and sexual orientation in club drug use.
3. What was found?
Of the women studied, 53.3% were heterosexual, while 46.3 identified as lesbian or bisexual. The ages ranged from 18 to 49. Whites accounted for 57.9% of the sample, while Latinas comprised 15.9%, blacks 10.4%, Asians/Pacific Islanders 5.7%, and other or mixed roughly 10%. The majority of those surveyed (72.2%) reported to previous drug use, with MDMA or ecstasy being the most common. One in 5 women were "active" drug users (they used at least once within the past three months). Older women (over the age of 30) reported higher lifetimes rates, though younger women admitted to higher active club drug use. Lesbian and Bisexuals were significantly more likely to use drugs than heterosexuals. Overall, a lesbian or bisexual identity is predictive of lifetime use of almost every club drug, as well as current or active use.
4. What does the study mean?
While older women were more likely to be lifetime users, younger women were more likely to be active users. This means that prevention and education should be aimed at younger women. Also, because lesbian and bisexual women were more likely to use club drugs than heterosexuals, more prevention programs need to be targeted toward them. Because health promotion programs are primarily aimed at gay men, it is easy to see why lesbian and bisexual women need more attention. Future research should be aimed at learning and understanding the prevalence rates within and between female subgroups because as of now, too little information is available.
Parsons, J. T., Kelly, B. C., & Wells, B. E. (2006, December). Differences in
Club Drug Use Between Heterosexual and Lesbian/Bisexual Females.
Addictive Behaviors, 31(12), 2344-2349. Retrieved September 18, 2007,
from Science Direct database.
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