Conflict-of-Interest Statement for publications

Send the form electronically to all contributing authors. Each author must complete their own form on screen.

In order for the Editors to make the best decision on how to handle a manuscript it is important that any conflicts of interest that the authors or reviewers of a paper may have are disclosed on submission.

A conflict of interest exists when professional judgement concerning such primary interests as patients’ welfare or validity of research may be influenced by possible financial gain or personal rivalry. It may arise for the authors of an article when they have a financial interest that may influence their interpretation of their results or those of others.

When completing the form below, authors should be aware that questions 1–4 relate to the present article, and that questions 5–7 relate to both the present article and to possible conflicts of interest that the author themselves may have, beyond the bounds of this study.

The Editors will not reject papers simply because of a conflict of interest but believe that any competing interests should be acknowledged and openly stated; therefore, a declaration of interest will be published alongside the final published article.

Name: ______________________________
Manuscript title: _________________________________
Manuscript number (if known): _____________
Publication title: __________________________

1. Have you, in the past 5 years, accepted the following from an organisation that may in any way gain or lose financially from the results of your study or the conclusions of your review, editorial or letter? Please mark ‘yes’ or ‘no’.

Reimbursement for attending a symposium – Yes   No
A fee for speaking – Yes   No
A fee for organising education – Yes   No
Funds for research – Yes   No
Funds for a member of staff – Yes   No
Fees for consulting – Yes   No
Gifts exceeding €200 per year – Yes   No

2. Have you, in the past 5 years, been employed by an organisation that may in any way gain or lose financially from the results of your study or the conclusions of your review, editorial or letter? Please mark the ‘yes’ or ‘no’. If you answer yes, please give details in the appropriate section later in this form.
Yes  No

3. Do you hold any stocks or shares in an organisation that may in any way gain or lose financially from the results of your study or the conclusions of your review, editorial or letter? Please mark ‘yes’ or ‘no’. If you answer yes, please give details in the appropriate section later in this form.
Yes   No

4. Have you acted as an expert witness on the subject of your study, review, editorial or letter? Please mark ‘yes’ or ‘no’. If you answer yes, please give details in the appropriate section later in this form.
Yes   No

5. Do you have any competing financial interests? Please mark ‘yes’ or ‘no’. If you answer yes, please give details in the appropriate section later in this form.
Yes   No

6. Are you or have you ever been in any relationship with or in receipt of any benefit (financial or other) from the tobacco industry or corporate affiliates? Please mark ‘yes’ or ‘no’. If you answer yes, please give details in the appropriate section later in this form.
Yes   No

7. Do you or your spouse knowingly hold stocks or shares in companies in the tobacco industry or companies involved in the tobacco industry? Please mark ‘yes’ or ‘no’. If you answer yes, please give details in the appropriate section later in this form.
Yes   No

If you have answered ‘yes’ to any of the above questions, the Scientific Papers of the Legislation Institute of the Verkhovna Rada of Ukraine considers that you or your institution may have a conflict of interest, which, in the spirit of openness, should be declared. Please draft and add to this form a statement detailing these interests. This statement will be published alongside your article in the event of acceptance. An example of such a statement is given below:

Conflict of interests: ________ has received an educational grant from ________ Pharmaceutical industries; has stocks in excess of ?_____ in _________; and travel to the ________ congress was funded by _____________________.

Please add your statement here: _____________________________

If you did not answer "yes" to any of the questions above, we will publish "Competing interests: None declared."

The above questions are limited to financial interests; however, you might want to disclose another sort of conflict of interest that would embarrass you if it became generally known after publication. The following list gives some examples:

A close relationship with, or a strong antipathy to, a person whose interests may be affected by publication of your paper.

An academic link or rivalry with somebody whose interests may be affected by publication of your paper.

Membership of a political party or special interest group whose interests may be affected by publication of your paper.

A deep personal or religious conviction that may have affected what you wrote and that readers should be aware of when reading your paper.

If you want to declare such a competing interest then please add it to your statement above.