Background In the context of limited health care budgets in countries where Neglected Tropical Diseases are endemic, scaling up disease control interventions entails the setting of priorities. However, solutions based solely on cost-effectiveness analyses may lead to biased and insufficiently justified priorities. Objectives The objectives of this paper are to 1) demonstrate how a range of equity concerns can be used to identify feasible priority setting criteria, 2) show how these criteria can be fed into a multi-criteria decision-making (...) matrix, and 3) discuss the conditions under which this decision-making procedure should be carried out in a real-world decision-making context. Methods This paper draws on elements from theories of decision analysis and ethical theories of fair resource allocation. We explore six typical NTD interventions by employing a modified multi-criteria decision analysis model with predefined criteria, drawn from a priority setting guide under development by the WHO. To identify relevant evidence for the six chosen interventions, we searched the PubMed and Cochrane databases. Discussion Our in vitro multi-criteria decision analysis suggested that case management for visceral leishmaniasis should be given a higher priority than mass campaigns to prevent soil-transmitted helminthic infections. This seems to contradict current health care priorities and recommendations in the literature. We also consider procedural conditions that should be met in a contextualised decision-making process and we stress the limitations of this study exercise. Conclusion By exploring how several criteria relevant to the multi-facetted characteristics of NTDs can be taken into account simultaneously, we are able to suggest how improved priority settings among NTDs can be realised. (shrink)

BackgroundIn the context of limited health care budgets in countries where Neglected Tropical Diseases (NTDs) are endemic, scaling up disease control interventions entails the setting of priorities. However, solutions based solely on cost‐effectiveness analyses may lead to biased and insufficiently justified priorities.ObjectivesThe objectives of this paper are to 1) demonstrate how a range of equity concerns can be used to identify feasible priority setting criteria, 2) show how these criteria can be fed into a multi‐criteria decision‐making matrix, and (...) 3) discuss the conditions under which this decision‐making procedure should be carried out in a real‐world decision‐making context.MethodsThis paper draws on elements from theories of decision analysis and ethical theories of fair resource allocation. We explore six typical NTD interventions by employing a modified multi‐criteria decision analysis model with predefined criteria, drawn from a priority setting guide under development by the WHO. To identify relevant evidence for the six chosen interventions, we searched the PubMed and Cochrane databases.DiscussionOur in vitro multi‐criteria decision analysis suggested that case management for visceral leishmaniasis should be given a higher priority than mass campaigns to prevent soil‐transmitted helminthic infections. This seems to contradict current health care priorities and recommendations in the literature. We also consider procedural conditions that should be met in a contextualised decision‐making process and we stress the limitations of this study exercise.ConclusionBy exploring how several criteria relevant to the multi‐facetted characteristics of NTDs can be taken into account simultaneously, we are able to suggest how improved priority settings among NTDs can be realised. (shrink)

Effective infectious disease control may require states to restrict the liberty of individuals. Since preventing harm to others is almost universally accepted as a legitimate (prima facie) reason for restricting the liberty of individuals, it seems plausible to employ a mid‐level harm principle in infectious disease control. Moral practices like infectious disease control support – or even require – a certain level of theory‐modesty. However, employing a mid‐level harm principle in infectious disease (...) class='Hi'>control faces at least three problems. First, it is unclear what we gain by attaining convergence on a specific formulation of the harm principle. Likely candidates for convergence, a harm principle aimed at preventing harmful conduct, supplemented by considerations of effectiveness and always choosing the least intrusive means still leave ample room for normative disagreement. Second, while mid‐level principles are sometimes put forward in response to the problem of normative theories attaching different weight to moral principles, employing a mid‐level harm principle completely leaves open how to determine what weight to attach to it in application. Third, there appears to be a trade‐off between attaining convergence and finding a formulation of the harm principle that can justify liberty‐restrictions in all situations of contagion, including interventions that are commonly allowed. These are not reasons to abandon mid‐level theorizing altogether. But there is no reason to be too theory‐modest in applied ethics. Morally justifying e.g. if a liberty‐restriction in infectious disease control is proportional to the aim of harm‐prevention, promptly requires moving beyond the mid‐level harm principle. (shrink)

During the course of the COVID-19 pandemic, a wide range of digital technologies and data analytics have been incorporated into pandemic response models globally, in the hope of better detecting, tracking, monitoring and containing outbreaks. This increased digital involvement in disease control has offered the prospect of heightened effectiveness in all of the above, but not without raising other concerns. This paper contributes to ongoing discussions of the digital transformation in disease control by proposing a materialist (...) analysis of how such control has become operative and what its effects may be, both now and in the future. Using Taiwan's digital pandemic response as a case study, the paper explores specific ways in which material processes and arrangements have shaped digital measures, as well as the actions that rendered such measures operable, with their ensuing consequences. This analysis illustrates the importance of historical, material and technological specificities and contingencies to our understanding of how digital disease control takes a particular shape. It also demonstrates how shifting regimes of practice continually reconfigure the ways in which digital disease control functions. The paper argues that paying greater attention to the materialities of digital disease control can provide a more nuanced understanding of the complex ways in which society may be protected or harmed by its use, possibly simultaneously. It is hoped that such increased attentiveness may inform more considered and careful preparation for subsequent pandemics. (shrink)

A central tenet of medical ethics holds that it is permissible to perform a medical intervention on a competent individual only if that individual has given informed consent to the intervention. However, in some circumstances it is tempting to say that the moral reason to obtain informed consent prior to administering a medical intervention is outweighed. For example, if an individual’s refusal to undergo a medical intervention would lead to the transmission of a dangerous infectious disease to other members (...) of the community, one might claim that it would be morally permissible to administer the intervention even in the absence of consent. Indeed, as we shall discuss below, there are a number of examples of public health authorities implementing compulsory or coercive measures for the purposes of infectious disease control (IDC). The plausibility of the thought that non-consensual medical interventions might be justified when performed for the purpose of IDC raises the question of whether such interventions might permissibly be used to realize other public goods. In this article we focus on one possibility: whether it could be permissible to non-consensually impose certain interventions that alter brain states or processes through chemical or physical means on serious criminal offenders. We shall suggest that some such interventions might be permissible if they safely and effectively serve to facilitate the offender’s rehabilitation and thereby prevent criminal recidivism. (shrink)

코로나 전염병에 관한 담론을 주제로 한 본 연구는 이중적 목적을 갖고 있다. 첫째 방역정책에 있어 개인의 행동에 초점을 두는 미시적 담론에서 가장 논란이 되는 “신체주권(bodily Sovereignty)”이란 개념을 전염병 현실과 관련하여 분석한다. 이 개념의 원조인 J.S. 밀의 저작에서 신체주권이 무엇을 의미하는지 파악하고, 이를 코로나 현실 상황에 적용하여 신체주권에 기반한 주장의 타당성을 검토한다. 둘째 이렇게 미시적으로 분석된 내용을 사회-정치체계의 장기적 방향을 논의하는 거시적 담론과 연결시켜 논쟁의 향방을 ‘가늠’해보려고 시도한다. 아감벤과 지젝이 서로 대척점에 선거시논쟁에서 본 연구는 미시담론적 분석이 지젝쪽의 주장에 좀 더 무게를 (...) 실어주지 않나 어림잡아 본다. 미시와 거시라는 두 수준에서 각기 분석하여 연결을 이와 같이 시도하는 것은 코로나 전염병에 관한 담론의 전반적 구도를 드러내어 이 주제에 관한 향후 논의에 담론적 개요를 제공할 수 있기를 기대하기 때문이다. (shrink)

To tackle zoonotic disease threats, a One Health approach is currently commonplace and generally understood as an integrated effort of multiple disciplines to promote the health of humans, animals and the environment. To implement One Health strategies in zoonotic disease control, many countries set up early warning systems, in which human and veterinary health professionals cooperate. These systems, like the Dutch Zoonoses Structure, can be successful to detect emerging disease threats. However, these systems are not well (...) equipped to handle moral dilemmas that can arise in zoonotic disease control, like the culling of healthy animals. This research studies the role of normative presuppositions of professionals involved in zoonotic disease control policies in the Netherlands. We found that these professionals in general adhered to a holistic view of the One Health concept, however, in practice an anthropocentric approach was dominant. Public health was identified as the trumping moral value, which reveals an inherent field of tension with the core of One Health thinking. The lack of ethical expertise in control systems for zoonotic diseases can lead to misconception of ethical principles, like the precautionary principle which is frequently evoked to justify disease control measures. (shrink)

In 1892, the British agricultural authorities introduced a policy of slaughtering animals infected with foot and mouth disease (FMD). This measure endured throughout the 20th century and formed a base line upon which officials superimposed the controversial "contiguous cull" policy during the devastating 2001 epidemic. Proponents of the slaughter frequently emphasized its capacity to eliminate FMD from Britain, and claimed that it was both cheaper and more effective than the alternative policies of isolation and vaccination. However, their discussions reveal (...) that a less obvious but nonetheless important reason for maintaining the slaughter policy was the conviction that in its manner of operation and its outcomes, it benefited the state and status of the British nation. To its supporters, slaughter was far more than a method of disease control; it acted also as a moralizing and civilizing force, an indicator of veterinary ability and a "virility symbol" of British international leadership. This "cultural" rationale for FMD control by slaughter declined during the late 20th century and was wholly undermined by the 2001 epidemic, when extensive culling failed to convey the intended image of an organized, enlightened Britain. (shrink)

This study investigates the intersection of existing computational frameworks for zoonotic disease control within the emerging societal paradigm, Society 5.0. Technologies in human-centric computing can facilitate real-time data collection and analysis, enabling early detection and rapid response to zoonotic disease outbreaks, thereby enhancing surveillance and containment efforts for public health protection. It aims to explore challenges and opportunities within these frameworks and delineate future research directions to serve as a benchmark. Conducting a three-layered analysis, the study identifies (...) high-level technologies, second-layer technologies within those brackets, and minutely analyzes each technology in the second layer. The focus includes a comprehensive examination of the evolving landscape of zoonotic disease control and the influence of computational tools in public health. The findings highlight the potential of leveraging computational frameworks to predict, monitor, and control zoonotic diseases more effectively within Society 5.0. The major identified thrust areas include One Health and governmental integration, digital and data-driven solutions, healthcare and medical technologies, technologies for communication and information dissemination, and socio-cultural and ethical considerations. The integration of large-scale healthcare services offer a robust data source for AI-driven models, enabling early detection and dynamic response to zoonotic threats using data acquired from IoT surveillance and data acquisition infrastructures. However, challenges such as data privacy and equitable healthcare access need addressing. The study emphasizes the opportunities arising from the integration of computational frameworks with Society 5.0 for zoonotic disease control, proposing potential benefits in terms of improved disease surveillance and response. To fully realize this potential, the study suggests exploring specific technological landscapes for further investigation in the context of zoonotic disease control. (shrink)

Increases in international travel and migratory flows have enabled infectious diseases to emerge and spread more rapidly than ever before. Hence, it is increasingly easy for local infectious diseases to become global infectious diseases (GIDs). National governments must be able to react quickly and effectively to GIDs, whether naturally occurring or intentionally instigated by bioterrorism. According to the World Health Organisation, global partnerships are necessary to gather the most up-to-date information and to mobilize resources to tackle GIDs when necessary. Communicable (...) disease control also depends upon national public health laws and policies. The containment of an infectious disease typically involves detection, notification, quarantine and isolation of actual or suspected cases; the protection and monitoring of those not infected; and possibly even treatment. Some measures are clearly contentious and raise conflicts between individual and societal interests. In Europe national policies against infectious diseases are very heterogeneous. Some countries have a more communitarian approach to public health ethics, in which the interests of individual and society are more closely intertwined and interdependent, while others take a more liberal approach and give priority to individual freedoms in communicable disease control. This paper provides an overview of the different policies around communicable disease control that exist across a select number of countries across Europe. It then proposes ethical arguments to be considered in the making of public health laws, mostly concerning their effectiveness for public health protection. (shrink)

When in 2006 the Centers for Disease Control and Prevention issued revised recommendations for HIV testing in health care settings, vocal opponents charged that use of an ?opt-out? approach to presenting HIV testing to patients; the implementation of nontargeted, widespread HIV screening; the elimination of a separate signed consent; and the decoupling of required HIV prevention counseling from HIV testing are unethical. Here we undertake the first systematic ethical examination of the arguments both for and against the recommendations. (...) Our examination reveals that the ethical concerns raised by the critics predominately pertain not to ethically suspect elements of the recommendations themselves, but to suspicions that they will be implemented improperly. It has not been shown that the recommendations cannot be implemented properly. Here we show that in the United States the recommendations are morally justifiable and that safeguards or regulatory oversight may serve to ensure that the recommendations are properly implemented. (shrink)

Background: In 2006, the Centers for Disease Control and Prevention (CDC) recommended three changes to HIV testing methods in US healthcare settings: (1) an opt-out approach, (2) removal of separate signed consent, and (3) optional HIV prevention counseling. These recommendations led to a public debate about their moral acceptability. Methods: We interviewed 25 members from the fields of US HIV advocacy, care, policy, and research about the ethical merits and demerits of the three changes to HIV testing methods. (...) We performed a qualitative analysis of the participant responses in the interviews and summarized the major themes. Results: In general, arguments in favor of the methods were based upon their ultimate contribution to increasing HIV testing and permitting the consequent benefits of identifying those who are HIV infected and linking them to further care. Conclusions: The prevailing theme of ethical concern focused on suspicions that the methods might not be properly implemented, and that further safeguards might be needed. (shrink)

The 2006 Centers for Disease Control and Prevention (CDC) revised recommendations for HIV testing in clinical settings contained seven specific changes to how health care facilities should provide HIV testing. These seven elements have been both supported and challenged in the lay and medical literature. Our first paper in BMC Medical Ethics presented an analysis of the three HIV testing procedural changes included in the recommendations. In this paper, we address the four remaining elements that concern HIV screening (...) policy changes: (1) nontargeted HIV screening, (2) making HIV screening similar to screening for other treatable conditions, (3) increasing HIV screening without assured additional funding for linkage to care, and (4) making patients bear the costs of increased HIV screening in health care settings. (shrink)

Livestock production has been confronted with several epidemics over the last decades. The morality of common animal disease strategies—stamping out and vaccination—is being debated and provokes controversies among farmers, authorities and the broader public. Given the complexity and controversy of choosing an appropriate control strategy, this article explores the potential of nano-enabled diagnostics in future livestock production. At first glance, these applications offer promising opportunities for better animal disease surveillance. By significantly shortening the reaction time from diagnosis (...) to appropriate control, they could complement the current disease management strategies. Although nano-enabled diagnostics will not make livestock disease eradication strategies redundant or completely free of the culling of infected animals, these diagnostics could significantly reduce the number of culled animals and animal suffering. This article aims to demonstrate that the ethical assessment of advanced diagnostics can build on the experiences with decision making in biomedical ethics where nonmaleficence, beneficence, autonomy and justice serve as important benchmarks. Nano-enabled diagnostics may be an ethically sound solution if it can resolve the dilemma between stamping out and vaccination in favor of the latter and if it can balance the autonomy–paternalism dilemma between farmers and authorities. The technology should allow to be switched on and off by farmers, whilst simultaneously allowing for a weak paternalism on behalf of authorities in order to benefit the farmer and broader society and to protect them from harm. (shrink)

The infection rates of COVID-19 have been exponential in some countries despite the imposition of infectious disease control measures such as lockdowns and physical distancing, which form one of the basic principles of public health and infectious disease control. There have been significant problems with leaders and citizenry deliberately ignoring and not complying with such measures and which have directly resulted in sudden rises in infection numbers. Here, I show the nature and extent of the widespread (...) problem and argue that the problem is in large part due to our modern society characterised by liberal individualism. I apply the philosophy proposed by philosopher Alasdair MacIntrye to show that one key underlying cause of the non-compliant behaviour of citizenry is due to modern liberal individualism that has deprived the modern nation state of the opportunities and authority for it to teach or to dictate what is the common good of the society as a whole to individuals in its community. This is the first time MacIntyre’s philosophy has been applied to public health, and this paper demonstrates the need for ethics education to counter-balance liberal individualism in order to contain and to prevent another pandemic and public health crisis in modern society. (shrink)

Social media applications such as Twitter, YouTube and Facebook have attained huge popularity, with more than three billion people and organizations predicted to have a social networking account by 2015. Social media offers a rapid avenue of communication with the public and has potential benefits for communicable disease control and surveillance. However, its application in everyday public health practice raises a number of important issues around confidentiality and autonomy. We report here a case from local level health protection (...) where the friend of an individual with meningococcal septicaemia used a social networking site to notify potential contacts. (shrink)

Social media applications such as Facebook hold great promise as means of communicable disease control. We argue here that the use of social media in communicable disease control may cause various forms of harm, and that these harms are aggravated by some of the very same features making social media attractive in the attempt to control disease. We point to alternative measures of disease control and further argue that although disease (...) class='Hi'>control may be the primary task of health practitioners, there is no good reason why the choosing of the least invasive measures in terms of privacy and confidentiality should not also be a key priority. (shrink)

The purpose of this article is to explore both the legal difficulties and policy objections in using public nuisance against conduct which exposes others to the risk of contracting a harmful disease. Drawing on the judicial and legislative responses in Australia, Canada, New Zealand and the United Kingdom, I will identify the important issues of legal principle and public policy which must be addressed when considering the imposition of criminal liability in these circumstances.

The COVID-19 pandemic has shown that zoonotic diseases are a great threat for humanity. During the course of such a pandemic, public health authorities often apply the precautionary principle to justify disease control measures. However, evoking this principle is not without ethical implications. Especially within a One Health strategy, that requires us to balance public health benefits against the health interests of animals and the environment, unrestricted use of the precautionary principle can lead to moral dilemmas. In this (...) article, we analyze the ethical dimensions of the use of the precautionary principle in zoonotic disease control and formulate criteria to protect animals and the environment against one-sided interpretations. Furthermore, we distinguish two possible conceptions of the precautionary principle. First, we notice that because of the unpredictable nature of zoonotic diseases, public health authorities in general focus on the idea of precaution as preparedness. This reactive response often leads to difficult trade-offs between human and animal health. We therefore argue that this policy should always be accompanied by a second policy, that we refer to as precaution as prevention. Although zoonotic diseases are part of our natural world, we have to acknowledge that their origin and global impact are often a consequence of our disturbed relation with animals and the environment. (shrink)

This book is... a survey history of medicine from the earliest times, centered thematically on how changing concepts of disease have affected its management.... One finds a gratifying mastery of recent as well as classic scholarship in medical history and a careful sidestepping of positivistic excesses.... Disease and Its Control is a fresh and welcome synthesis of historical scholarship that will be accessible to interested laymen. (Annals of Internal Medicine).

(No abstract is available for this citation).

Beginning in 1989, the breakup of the Soviet Bloc disrupted trade and cut off Cuba's source of subsidized fuel oil, making many modern agricultural practices impossible, including the wide use of pesticides. Among Cuba's responses was an emphasis on biological control of plant diseases. Research into biological control began in the 1930s, and after the revolution many scientists maintained an unofficial interest. When the 1989 economic crisis occurred, the government placed a high priority on biocontrol, and researchers were (...) in a position to begin immediate implementation. For example, the construction of factories for the mass production of biological agents had been approved in 1988, and are currently in operation. Disease monitoring was undertaken before the current crisis, with more than 90% of Cuban agriculture using it to some extent. Such monitoring has allowed a reduction in pesticide use. Since the 1989 onset of economic crisis the monitor system has not been greatly modified for use with biological control techniques, but an example of a successful transition from chemical treatment to biocontrol in Cuba is in banana plantations.At the various research centers, research is being conducted in the biocontrol of vegetable diseases, tobacco root diseases, nematodes, and pasture weeds. Technical research is being done on mass production of inoculum, the production of application formulations, and storage of biocontrol products. Because wide use of biocontrol agents was urgently desired, the government cooperated at every step of research, including in regulatory matters. Obstacles to successful biocontrol mentioned by Cuban scientists were the lack of taxonomic knowledge and the need for strict quality control.There are few economic studies of biocontrol agents despite the importance of such studies. Cuban scientists are in an excellent position to do such research. Forced by the economic crisis to act, Cuba has made a major change in national agronomic policy that may represent a significant and new direction for “modern” agricultural practices. (shrink)

The scientific understanding of common chronic disease began in the mid-19th century, driven in large part by the development of the modern autopsy. For cardiovascular disease, the recognition that rigid plaques were obstructing muscular arteries, especially in the coronary arteries, provided a mechanism to explain what had been a mysterious "chest pain–sudden collapse" syndrome. The origin of these plaques was totally obscure, however, and they were given the descriptive name of "atherosclerosis," or "hardened porridge" in Greek. Not until (...) 50 years later, when animal experimental models serendipitously revealed the hyper-lipidemic consequences of a diet high in animal fat, followed by accretion of lipid... (shrink)

Online personalized genetic testing services offer accessible and convenient options for satisfying personal curiosity about health and obtaining answers about one’s genetic provenance. They are especially attractive to healthy people who wish to learn about their future risk of disease, as Paul Mason’s case study of “Jordan” illustrates. In this response, we consider how online genetic testing services are used by people diagnosed with a common neurodegenerative disease, Parkinson’s disease, to gain a sense of certainty regarding the (...) future. (shrink)

Tick and tick-borne diseases, especially East Coast fever, caused byTheileria parva, are amongst the most important factors limiting cattle production in Eastern, Central, and Southern Africa. In the past, they have been controlled mainly by the use of acaricides to kill ticks. Immunization has been shown to be an effective alternative method of control of tick-borne diseases in limited field trials. A development program has been initiated to produce vaccines and implement immunization on a wide scale in the region (...) in a sustainable manner as part of an integrated tick and tickborne disease control program. The consequent reduction in cattle mortality is expected to have far-reaching benefits for the region. (shrink)

Sham surgery is a controversial and rarely used component of randomised clinical trials evaluating surgical interventions. The recent use of sham surgery in trials evaluating efficacy of intracerebral fetal tissue grafts in Parkinson’s disease has highlighted the ethical concerns associated with sham surgery controls. Macklin, and Dekkers and Boer argue vigorously against use of sham surgery controls. Macklin presents a broad argument against sham surgery controls while Dekkers and Boer present a narrower argument that sham surgery is unnecessary in (...) the specific setting of fetal tissue engraftment for Parkinson’s disease. I defend sham surgery controls against both these criticisms. Appropriate clinical trial design, sometimes including sham surgery, is needed to ensure that false positive trial results do not occur and endanger public safety. Results of a completed trial of fetal tissue grafting for Parkinson’s disease are used to illustrate the potential benefits of, and problems associated with, sham surgery controls. Sham surgery controls, however, should be employed only when absolutely necessary. I suggest criteria for appropriate use of sham surgery controls. (shrink)

ABSTRACT Patient self‐management (SM) of chronic disease is an evolving movement, with some forms documented as yielding important outcomes. Potential benefits from proper preparation and maintenance of patient SM skills include quality care tailored to the patient's preferences and life goals, and increase in skills in problem solving, confidence and success, generalizable to other parts of the patient's life. Four central ethical issues can be identified: 1) insufficient patient/family access to preparation that will optimize their competence to SM without (...) harm to themselves, 2) lack of acknowledgement that an ethos of patient empowerment can mask transfer of responsibility beyond patient/family competency to handle that responsibility, 3) prevailing assumptions that preparation for SM cannot result in harm and that its main purpose is to deliver physician instructions, and 4) lack of standards for patient selection, which has the potential to exclude individuals who could benefit from learning to SM. Technology assessment offers one framework through which to examine available data about efficacy of patient SM and to answer the central question of what conditions must be put in place to optimize the benefits of SM while assuring that potential harms are controlled. (shrink)

Differences in perceptions and knowledge of crop diseases constitute a major obstacle in farmer–researcher cooperation, which is necessary for sustainable disease management. Farmers’ perceptions and management of crop diseases in the northern Ethiopian Regional State of Tigrai were investigated in order to harness their knowledge in the participatory development of integrated disease management (IDM) strategies. Knowledge of disease etiology and epidemiology, cultivar resistance, and reasons for the cultivation of susceptible cultivars were investigated in a total of 12 (...) tabias (towns) in ten weredas (districts). Perception of diseases involved both scientific and spiritual conceptual frameworks. Of the more than 30 crop diseases recorded on the major crops in the region, only rusts and powdery mildews (locally called humodia) and a few root rots were considered by farmers to be important. Farmers’ awareness of other diseases was extremely low; some highly damaging but less conspicuous diseases, such as faba bean chocolate spot and chickpea ascochyta blight (also called humodia), were not regarded by farmers as disease but as problems caused primarily by excessive soil moisture. Considering that some of these “unrecognized” diseases can cause complete yield loss and genetic erosion in epiphytotic years, there is an urgent need for bringing together farmers’ and scientists’ knowledge to complement each other. Even when farmers had access to disease-resistant or disease-tolerant cultivars, they grew susceptible local varieties because of multiple criteria including earliness, good yield in years with low humodia severity, suitability for home consumption, market demand/quality, and low soil fertility and land management requirements. Farmer innovation and knowledge were evident in their use of diverse disease control measures, but these were a mixture of the “useful and the useless.” Our findings stress the necessity for extension workers and researchers to understand and improve farmers’ knowledge of crop diseases, and farmers’ ability to observe and experiment, through the Farmer Field School or a similar experiential learning approach. These insights about farmers’ knowledge of crop diseases provide a basis for further collaborative maintenance of crop genetic diversity, development of germplasm, and IPM-related research in Africa. (shrink)

Objective This study aims to increase self-awareness in patients with Parkinson’s disease (PD) using a newly developed mindfulness-based intervention, tailored for the specific needs of PD patients. Its impact on self-awareness and patients’ daily lives is currently being evaluated. Background Recently, the phenomenon of impaired self-awareness for motor symptoms (ISAm) and some non-motor symptoms has been described in PD. ISAm can negatively influence patients’ daily lives, e.g., by affecting therapy adherence, and is therefore the main focus of this study. (...) The main goal is the development of IPSUM (“Insight into Parkinson’s Disease Symptoms by using Mindfulness”), a PD-specific intervention for increasing patients’ mindfulness and thereby reducing ISAm. Methods The effectiveness of IPSUM is evaluated by comparison of an intervention group with a waitlist-control group. A pre-post design with an additional 8-week follow-up measurement is applied, resulting in three measurement points: before, directly after and 8 weeks after completing the intervention protocol. In total, up to 180 non-depressed PD patients without severe cognitive impairment (non-demented) will be included. The primary outcome is a quantitative score for measuring ISAm. Secondary outcome measures are affective changes, neuropsychological performance and self-awareness of cognition. At pre- and post-measurement an fMRI scan is performed to connect behavioral and neurobiological findings. At post- and follow-up-measurement each patient will take part in a semi-structured interview to explore IPSUM’s impact on self-awareness and patients’ everyday lives. Results The conception of the intervention protocol is finished, the resulting 8-week program is presented in detail. It has successfully been tested in the first group of patients, their feedback so far was quite promising. Recruitment is ongoing and a first interim analysis will be performed once 30 patients have completed IPSUM. Conclusion For the first time, the intervention protocol of IPSUM has successfully been tested in a group of PD patients. As the study goes on, more quantitative data is collected for statistical analyses to evaluate its effectiveness. More qualitative data is collected to evaluate feasibility and effectiveness. We hope for this intervention to be capable of reducing the patients’ ISAm and improving their quality of life on many levels. (shrink)

What justified the Center for Disease Control's1999 determination to require HIV casereporting? Why were names necessary? Why didopponents view the reporting of names with suchalarm? This paper retells the history of theencounters over HIV reporting that had occurredsince the mid 1980s. In placing HIV reportingwithin a larger context, however, we understandthe clash between privacy and public healthnecessity as a complex issue, both inhistorical and contemporary practice. Byunderscoring the similarities and differenceswith the histories of surveillance for otherinfectious diseases, vaccination, (...) occupationaldiseases, cancer, and birth defects, and HIVreporting internationally, we can betterunderstand the implications of the HIV debatefor an ethics of surveillance more generally. (shrink)

Postural instability in Parkinson’s disease (PD) is characterized by impaired postural responses to transient perturbations, increased postural sway in stance and difficulty transitioning between tasks. In addition, some studies suggest that loss of dopamine in the basal ganglia due to PD results in difficulty using proprioceptive information for motor control. Here, we quantify the ability of subjects with PD and age-matched control subjects to use and re-weight sensory information for postural control during steady-state conditions of continuous (...) rotations of the stance surface or visual surround. We measure the postural sway of subjects in response to a pseudorandom, surface-tilt stimulus with eyes closed, and in response to a pseudorandom, visual-tilt stimulus. We use a feedback control model of the postural control system to interpret our results, focusing on sensory weighting as a function of stimulus amplitude. We find that subjects with PD can re-weight their dependence upon sensory information in response to changes in surface- or visual-stimulus amplitude. Specifically, subjects with PD behaved like age-matched control subjects by decreasing proprioceptive contribution to stance control with increasing surface-tilt amplitude, and decreasing visual contribution with increasing visual-tilt amplitude. However, subjects with PD do not decrease their reliance on proprioception as much as age-matched controls for small increases in surface-stimulus amplitudes. Levodopa medication did not affect sensory re-weighting behaviors for postural control. The impairment in PD subject’s ability to respond differently to small changes in surface rotation amplitudes is consistent with an increased threshold for perceiving proprioceptive signals, which may result from decreased signal-to-noise in the dopaminergic pathways associated with sensory processing and/or sensory integration. (shrink)

Securitization of infectious diseases may involve suspension of ordinary human rights and liberties. In the event of an epidemic, therefore, it is important to limit the occasions upon which draconian disease control measures are implemented in the name of security. The term ‘security’, moreover, should not be used too loosely if it is to retain force and meaning in political discourse. It may be argued that the bar for disease securitization should be set high so that it (...) is limited to contexts involving rapidly spreading pathogens. Such an approach, however, would rule out securitization of more slowly spreading, endemic diseases such as HIV/AIDS. An advantage of characterizing HIV/AIDS as a security threat in developing countries, where the burden of the disease is concentrated, is that this is likely to mobilize resources needed to improve the situation there. That is, if HIV/AIDS is convincingly framed as a security threat, then governments may recognize self‐interested reasons to ramp up control measures. Following consideration of arguments for narrow (excluding HIV/AIDS) versus broad (including HIV/AIDS) conceptions of security, we conclude that the legitimacy of ‘securitizing’ HIV/AIDS ultimately turns on empirical and semantic issues, and we emphasize the importance of distinguishing (1) the nature of the threat posed by HIV/AIDS and (2) the measures required to address that threat. (shrink)

This case for discussion highlights some of the ethical difficulties that may arise in the use of molecular typing techniques in the control of infectious diseases. Molecular typing techniques offer evidence (stronger than regular epidemiological exploration of sources and contacts) for claims about infection routes. Such evidence will mean that public health authorities need to think about how to respond ethically to causal responsibility for contagion. In this context, questions are raised about the use of molecular typing methods for (...) source and contact tracing in the control of infectious diseases. (shrink)

Surveillance is essential for communicable disease prevention and control. Traditional notification of demographic and clinical information, about individuals with selected infectious diseases, allows appropriate public health action and is protected by public health and privacy legislation, but is slow and insensitive. Big data–based electronic surveillance, by commercial bodies and government agencies, which draws on a plethora of internet- and mobile device–based sources, has been widely accepted, if not universally welcomed. Similar anonymous digital sources also contain syndromic information, which (...) can be analysed, using customised algorithms, to rapidly predict infectious disease outbreaks, but the data are nonspecific and predictions sometimes misleading. However, public health authorities could use these online sources, in combination with de-identified personal health data, to provide more accurate and earlier warning of infectious disease events—including exotic or emerging infections—even before the cause is confirmed, and allow more timely public health intervention. Achieving optimal benefits would require access to selected data from personal electronic health and laboratory records and the potential to re-identify individuals found to be involved in outbreaks, to ensure appropriate care and infection control. Despite existing widespread digital surveillance and major potential community benefits of extending its use to communicable disease control, there is considerable public disquiet about allowing public health authorities access to personal health data. Informed public discussion, greater transparency and an ethical framework will be essential to build public trust in the use of new technology for communicable disease control. (shrink)

Human skin produces numerous neurohormones and neuropeptides. Recent evidence has shown that the neuroendocrine regulation of human skin biology also extends to keratins, the major structural components of epithelial cells. For example, thyrotropin‐releasing hormone, thyrotropin, opioids, prolactin, and cannabinoid receptor 1‐ligands profoundly modulate human keratin gene and protein expression in human epidermis and/or hair follicle epithelium in situ. Since selected keratins are now understood to exert important regulatory functions beyond mechanical stability, we argue that neuroendocrine pathways of keratin regulation are (...) important for maintaining skin and hair follicle homeostasis. This invites innovative neuroendocrine therapeutic interventions for skin disorders characterized by abnormal keratin expression, ranging from psoriasis to genodermatoses, and for promoting skin wound healing and hair growth. This strategy can be probed in simple, but instructive and readily available human skin and hair follicle organ culture assays as ideal models for exploring this new neuroendocrine frontier in translational epithelial biology. (shrink)

In 2004 a survey was conducted in the member states of the European Union designed to gain greater insight into the views on control strategies for foot and mouth disease, classical swine fever, and avian influenza with respect to the epidemiological, economic and social-ethical consequences of each of these animal diseases. This article presents the results of the social-ethical survey. A selection of stakeholders from each member state was asked to prioritize issues for the prevention and control (...) of these diseases. A majority of stakeholders chose preventive measures as the preferred issue. An analysis was done to determine whether there were differences in views expressed by stakeholders from member states with a history of recent epidemics and ones without such a history, and whether there were regional differences. There were no differences between member states with or without a history of recent epidemics. There were indeed regional differences between the priority orders from Northern and Southern Europe on the one hand, and from Eastern Europe on the other. (shrink)