Health checks identify disease in individuals without a medical indication. More and more checks are offered by more providers on more risk factors and diseases, so we may speak of an omnipresence of health checks. Current ethical evaluation of health checks considers checks on an individual basis only. However, omnipresent checks have effects over and above the effects of individual health checks. They might give the impression that health (...) is entirely manageable by individual actions and strengthen the norm of individual responsibility for health to the point where people hold themselves and others responsible for health outcomes they cannot reasonably be held accountable for. This process of so-called ‘over-responsibilization’ may result in increased feelings of guilt over health, decreased health solidarity and unfairly distributed health outcomes. Moreover, effects on privacy and peace of mind may be observed. Taking into account all possible harms and benefits of health checks in their ethical evaluation requires evaluation of health checks on an individual basis as well as on the level of all checks. Therefore, we urge the amendment of existing ethical evaluation to include the effects of an omnipresence of health checks. We make a first attempt at the formulation of amended criteria. (shrink)

Health checks or health screenings identify disease in people without a specific medical indication. So far, the perspective of health check users has remained underexposed in discussions about the ethics and regulation of health checks. In 2017, we conducted a qualitative study with lay people from the Netherlands. We asked what participants consider characteristics of good and bad health checks, and whether they saw a role for the Dutch government. Participants consider a (...) good predictive value the most important characteristic of a good health check. Information before, during and after the test, knowledgeable and reliable providers, tests for treatable disease, respect for privacy, no unnecessary health risks and accessibility are also mentioned as criteria for good health checks. Participants make many assumptions about health check offers. They assume health checks provide certainty about the presence or absence of disease, that health checks offer opportunities for health benefits and that the privacy of health check data is guaranteed. In their choice for provider and test they tend to rely more on heuristics than information. Participants trust physicians to put the interest of potential health check users first and expect the Dutch government to intervene if providers other than physicians failed to do so by offering tests with a low predictive value, or tests that may harm people, or by infringing the privacy of users. Assumptions of participants are not always justified, but they may influence the choice to participate. This is problematic because choices for checks with a low predictive value that do not provide health benefits may create uncertainty and may cause harm to health; an outcome diametrically opposite to the one intended. Also, this may impair the relationship of trust with physicians and the Dutch government. To further and protect autonomous choice and to maintain trust, we recommend the following measures to timely adjust false expectations: advertisements that give an accurate impression of health check offers, and the installation of a quality mark. (shrink)

Health checks identify disease in people without symptoms. They may be offered by the government through population screenings and by other providers to individual users as ‘personal health checks’. Health check providers’ perspective of ‘good’ health checks may further the debate on the ethical evaluation and possible regulation of these personal health checks. In 2015, we interviewed twenty Dutch health check providers on criteria for ‘good’ health checks, and (...) the role these criteria play in their practices. Providers unanimously formulate a number of minimal criteria: Checks must focus on treatable/preventable disease; Tests must be reliable and clinically valid; Participation must be informed and voluntary; Checks should provide more benefits than harms; Governmental screenings should be cost-effective. Aspirational criteria mentioned were: Follow-up care should be provided; Providers should be skilled and experienced professionals that put the benefit of users first; Providers should take time and attention. Some criteria were contested: People should be free to test on any disease; Health checks should only be performed in people at high risk for disease that are likely to implement health advice; Follow up care of privately funded tests should not drain on collective resources. Providers do not always fulfil their own criteria. Their reasons reveal conflicts between criteria, conflicts between criteria and other ethical values, and point to components in the organisation of health care that hinder an ethical provision of health checks. Moreover, providers consider informed consent a criterion that is hard to establish in practice. According to providers, personal health checks should meet the same criteria as population screenings, with the exception of cost-effectiveness. Providers do not always fulfil their own criteria. Results indicate that in thinking about the ethics of health checks potential conflicts between criteria and underlying values should be explicated, guidance in weighing of criteria should be provided and the larger context should be taken into account: other actors than providers need to take up responsibility, and ideally benefits and harms of health checks should be weighed against other measures targeting disease. (shrink)

In projects concerning big data, ethical questions need to be answered during the design process. In this paper the Value Sensitive Design method is applied in the context of data-driven health services aimed at disease prevention. It shows how Value Sensitive Design, with the use of a moral dialogue and an ethical matrix, can support the identification and operationalization of moral values that are at stake in the design of such services. It also shows that using this method can (...) support meeting the requirements of the General Data Protection Regulation. (shrink)

Cardiovascular health checks test risk factors for cardiovascular disease. They are offered to improve health: in case of an increased risk, participants receive lifestyle advice and medication. With this review, we investigate what is known about the reasons why people do or do not test for CVD risk factors. To what extent do these reasons relate to health monitoring and/or improvement? And do reasons differ in different contexts in which health checks are offered? We (...) conducted a literature search and included 22 papers in which we identified a broad range of motives. We conclude that people have reasons to test related to health improvement and reasons other than health improvement, practical reasons related to the way health checks are offered play an important role and motives should be understood in the context of the situation in which health checks are offered. Our results are relevant for public health officials and providers of health checks: first, if people undergo testing for reasons unrelated to health, this could explain why participation in health checks does not necessarily lead to health improvement. Second, efforts to improve uptake not necessarily serve justice and may hamper informed consent. (shrink)

Modern medicine, based on enormous progress in science and its applications, has lost dimensions of individualized treatment and compassion which traditionally were an essential part of physician’s service over the millennia in Eastern and Western cultures. Today diseases and symptoms, rather than persons, are treated, based on objective quality norms and inflexible payment schemes rather than the rather than persons. We present a checklist model for personalized health care, which has been successful in teaching and practice to reclaim lost (...) territory in treating patients as persons. (shrink)

In Dobbs v. Jackson Women's Health Organization, the Supreme Court eliminated the long‐standing federal constitutional right to abortion. Discussions of Dobbs tend to emphasize the loss of protection for reproductive choice. But Dobbs also eroded protection for a related yet distinctly important interest that served under Roe v. Wade as a check on government regulation of reproduction: the preservation of health. This erasure has opened the door to increasingly restrictive and punitive abortion bans, which are causing providers to (...) deny or delay care that is necessary to prevent harm to both pregnant and nonpregnant patients. Federal regulatory attempts to prevent these harms will have limited impact, partially due to Congress's own history of exceptionalizing abortion in ways that devalue health. Only federal legislation can ensure adequate and enduring protection for the health of women, trans men, and other patients targeted for reproductive control because of their capacity for pregnancy. (shrink)

Growing opioid misuse in the United States has resulted in more children living with an adult with an opioid use history. Although an abundance of research has demonstrated a link between opioid misuse and negative parenting behaviors, few intervention efforts have been made to target this underserved population. The Family Check-Up has been tested in more than 25 years of research, across multiple settings, and is an evidence-based program for reducing risk behavior, enhancing parenting skills, and preventing the onset of (...) substance use. It is designed to motivate parents to engage in positive parenting practices and to change problematic parenting and has been tested across a variety of ages including early childhood and adolescence. It is highlighted in NIDA’s Principles of Substance Use Prevention for Early Childhood: A research-based guide as one of only three effective selective prevention programs for substance abuse among families with young children. Recently, we developed an online version of the FCU that has now been adapted for early childhood and families with opioid use histories. The online platform and telehealth model allow for wide-scale dissemination, ease of training with community providers, and increased public health reach for families in remote, rural areas. This is particularly important when targeting families with opioid misuse and addiction because there are high rates of addiction in remote areas, yet few services available. In this article, we describe the FCU Online and review new content in the model that targets a population of young adult parents with substance abuse histories, including opioid use. New modules include content focused on harm reduction for this high-risk population of parents, such as safety in the home, substance use while parenting, and managing conflict with partners and friends. (shrink)

The knowledge and skills of employees could play a valuable role in organizational success. Organizations seek practices to create a knowledge-sharing culture to take full advantage of individual competencies. However, the knowledge-hiding behavior of individuals is a hurdle in the internal dissemination of knowledge and expertise. It becomes more critical in the case of teaching institutions, where the students are taught and trained. Scholars are now putting their efforts into seeking the antecedents and consequences of knowledge-hiding behavior. This study also (...) attempts to determine the role of interpersonal distrust as an antecedent of knowledge hiding behavior of music education students. Based on the social exchange theory, the present study attempts to check the association of interpersonal distrust with emotional exhaustion and knowledge hiding. For empirical investigation, this study assumes that interpersonal distrust positively enhances knowledge hiding and emotional exhaustion, respectively. Moreover, the present study also attempts to check the association of emotional exhaustion with knowledge hiding. This study also assessed the mediating role of emotional exhaustion in the relationship between interpersonal distrust and knowledge hiding. This current study also aims to check the moderating role of mental health self-efficacy in the relationship between emotional exhaustion and knowledge hiding. For empirical investigation, the present study collected the data from 310 music learning students of various Chinese universities through a structured questionnaire method using a convenient sampling technique. This study applied partial least square structural equation modeling for empirical analyses using Smart PLS software. The findings of this study revealed that interpersonal distrust does not directly influence knowledge hiding; however, interpersonal distrust has a positive association with emotional exhaustion. The findings also acknowledged that emotional exhaustion positively correlates with knowledge hiding. The results also confirmed that emotional exhaustion positively mediates the relationship between interpersonal distrust and knowledge hiding. Further, the outcomes depicted that mental health self-efficacy negatively moderates the relationship between emotional exhaustion and knowledge hiding. In addition, this study’s findings also serve the literature of knowledge hiding by providing important theoretical and practical implications. (shrink)

Visual research methods like photography and digital storytelling are increasingly used in health and social sciences research as participatory approaches that benefit participants, researchers, and audiences. Visual methods involve a number of additional ethical considerations such as using identifiable content and ownership of creative outputs. As such, ethics committees should use different assessment frameworks to consider research protocols with visual methods. Here, we outline the limitations of ethics committees in assessing projects with a visual focus and highlight the sparse (...) knowledge on how researchers respond when they encounter ethical challenges in the practice of visual research. We propose a situated approach in relation to visual methodologies that encompasses a negotiated, flexible approach, given that ethical issues usually emerge in relation to the specific contexts of individual research projects. Drawing on available literature and two case studies, we identify and reflect on nuanced ethical implications in visual research, like tensions between aesthetics and research validity. The case studies highlight strategies developed in-situ to address the challenges two researchers encountered when using visual research methods, illustrating that some practice implications are not necessarily addressed using established ethical clearance procedures. A situated approach can ensure that visual research remains ethical, engaging, and rigorous. (shrink)

Expectations of receiving personal health information as a fringe benefit of biospecimen donation—termed diagnostic misconception—are increasingly documented. We developed an instrument measuring conflation of observational biospecimen-based research and clinical care for use with Latino communities, who may be particularly affected by diagnostic misconception due to limited health care access.

Mental health has been declared as the essential component of overall human wellbeing. However, there has been a very steep rate of depression and anxiety in students that exhibit their social and personal burdens. It has been widely accepted that the wellbeing and mental health of individuals are a mix of psychological, genetic, social, lifestyle factors, and environmental exposure. Due to the pandemic, the shift from traditional classroom learning to e-learning has also disturbed the mental health of (...) students, which consequently affects environmental stability. The current study has also measured the effect on the mental health of e-learning behaviors. The population of the study was the undergraduate students enrolled in the colleges of China, and they were chosen via convenient sampling. The findings of the study show that mental health has a significant positive effect on the e-learning behavior of the students and consequently affects environmental sustainability. Educational institutions are improving their e-learning programs by understanding the preferences and challenges of students regarding online learning. Educational institutions should revise their policies on online education and teaching methodologies. Furthermore, the current study has taken undergraduate students as the sample. In future studies, these relationships can be checked in higher education as well. (shrink)

The past decade has seen a burgeoning of scholarly interest in conscientious objection in health care. Specifically, several commentators have discussed the implications that conscientious objection has for the delivery of timely, efficient, and nondiscriminatory medical care. In this paper, I discuss the main argument put forward by the most prominent critics of conscientious objection—what I call the Professional Duty Argument or PDA. According to proponents of PDA, doctors should place patients’ well-being and rights at the center of their (...) professional practice. Doctors should be prepared to set their personal moral or religious beliefs aside where these beliefs conflict with what is legal and considered good medical practice by relevant professional associations. Conscientious objection, on this account, should be heavily restricted, if even allowed at all. I discuss two powerful objections against PDA. The first objection, which I call the fallibility objection, notes that law and professional codes of conduct are fallible guides for ethical conduct and that conscientious objection has in the past and continues today to provide a check on aberrations in law and professional convention. The second, which I call the professional discretion objection, states that restrictions on conscientious objection undermine one of the cornerstones of good medical practice, namely, a practitioner’s right to independent professional judgment. I argue that these two objections give us reason to retain conscience clauses in professional codes of conduct. (shrink)

Most countries appear to believe that their health system is in a state of semi-crisis with expenditures rising rapidly, with the benefits of many services unknown and with pressure from the public to ensure access to a comprehensive range of services. But whose values should inform decision-making in the health area, and should the influence of different groups vary with the level of decision-making? These questions were put to 54 members of the public and health professionals in (...) eight focus groups. Adopting a different perspective from other studies, participants were not asked if particular groups should be involved in decisions but rather through deliberation and discussion nominated their own potential decision makers. This delivered a clear message that participants saw a legitimate role for a broad range of stakeholders in priority-setting decisions so as to incorporate a diversity of expertise and opinion. Companion themes were the acknowledgment that decisions involve ethical judgments and are not purely technical, that the power of special interest groups (such as clinicians) should be kept in check, and that the process by which decisions are reached is important. The results suggest that qualitative methods of investigation have the potential to improve the legitimacy of policy decisions by contributing to a better understanding of the values of the public and health professionals, and by expanding the range of options available for further research. (shrink)

Many experts have emphasised that chatbots are not sufficiently mature to be able to technically diagnose patient conditions or replace the judgements of health professionals. The COVID-19 pandemic, however, has significantly increased the utilisation of health-oriented chatbots, for instance, as a conversational interface to answer questions, recommend care options, check symptoms and complete tasks such as booking appointments. In this paper, we take a proactive approach and consider how the emergence of task-oriented chatbots as partially automated consulting systems (...) can influence clinical practices and expert–client relationships. We suggest the need for new approaches in professional ethics as the large-scale deployment of artificial intelligence may revolutionise professional decision-making and client–expert interaction in healthcare organisations. We argue that the implementation of chatbots amplifies the project of rationality and automation in clinical practice and alters traditional decision-making practices based on epistemic probability and prudence. This article contributes to the discussion on the ethical challenges posed by chatbots from the perspective of healthcare professional ethics. (shrink)

Definition of the problemHealth Apps are becoming increasingly important for a preventive and responsible orientation of the health system. Currently, most of these digital health applications (DiGA) are based on so-called self-tracking technologies which record physiological and psychological data via sensors, usually combined with personalized everyday information. In the last few years, these digital developments have launched an intense and clearly polarized debate about the opportunities and dangers of self-tracking in healthcare.ArgumentsAfter a brief overview of medical self-tracking, this (...) essay wants to systematize and check the polarized discourse on the basis of its decisive individual and social potentials. It turns out that self-measurement techniques have long been an integral part of medical practice in diagnostics and therapy.ConclusionThe area of tension between individual empowerment and potential loss of control by the users will be emphasized as being especially important for the implementation of health Apps in primary health care. Finally, possible implications for the current design of the new German Digital Care Law (Digitale-Versorgung-Gesetz) are shown and some existing “blind spots” are highlighted. (shrink)

Photography has become a pervasive component of contemporary communication. Recent technological advances in creating and manipulating images have provided renewed impetus to decades-long debates on use of photographs in science. With increase in the potential for inappropriate image manipulation, fears about misrepresentation have heightened concern among journal editors and scholars about the 'accuracy' of published images. We discuss how science has responded to growing concerns surrounding falsification and inaccuracy of photography. We document progress in implementing a variety of complementary approaches (...) to addressing the problem. These include digital forensics, photo member checking and the implementation of codes of ethics to enhance the veracity of published photographs in science research. We conclude by acknowledging the irreducible conflict likely to remain between use of the photograph as a creative work of art and employment of this medium as a source of information in the progress of science. (shrink)

BackgroundThe role of consent for research use of health information is contentious. Most discussion has focused on when project-specific consent may be waived but, recently, a broader range of consent options has been entertained, including broad opt-in for multiple studies with restrictions and notification with opt-out. We sought to elicit public values in this matter and to work toward an agreement about a common approach to consent for use of personal information for health research through deliberative public dialogues.MethodsWe (...) conducted seven day-long public dialogues, involving 98 participants across Canada. Immediately before and after each dialogue, participants completed a fixed-response questionnaire rating individuals' support for 3 approaches to consent in the abstract and their consent choices for 5 health research scenarios using personal information. They also rated how confident different safeguards made them feel that their information was being used responsibly.ResultsBroad opt-in consent for use of personal information garnered the greatest support in the abstract. When presented with specific research scenarios, no one approach to consent predominated. When profit was introduced into the scenarios, consent choices shifted toward greater control over use. Despite lively and constructive dialogues, and considerable shifting in opinion at the individual level, at the end of the day, there was no substantive aggregate movement in opinion. Personal controls were among the most commonly cited approaches to improving people's confidence in the responsible use of their information for research.ConclusionBecause no one approach to consent satisfied even a simple majority of dialogue participants and the importance placed on personal controls, a mechanism should be developed for documenting consent choice for different types of research, including ways for individuals to check who has accessed their medical record for purposes other than clinical care. This could be done, for example, through a web-based patient portal to their electronic health record. Researchers and policy makers should continue to engage the public to promote greater public understanding of the research process and to look for feasible alternatives to existing approaches to project-specific consent for observational research. (shrink)

This article examines the contribution that poetry written over the last fifty years might make to the established and burgeoning field of Medical Humanities. It takes poems by women about cancer and depression as a case study of how they can offer insight into the impact of these conditions on the sufferer. Collectively, the poems document and effect shifts in knowledge about, and the associated stigmas concerning, illnesses that carry secrecy and shame, specifically cancer and depression. Additionally, drawing on Virginia (...) Woolf’s remarkable essay “On Being Ill”, we see how the non-verbal features of poems, particularly metaphors and symbols, mark the space of what a patient cannot fully articulate. Accordingly, the poems discussed illuminate how literature can express human interiority but at the same time remind the reader – or health professional – that interiority can never be fully presented. Thus, poetry both contributes to and also checks the ways in which literature is appropriated by the biomedical sciences. The poets included are Eavan Boland, Julia Darling, U.A. Fanthorpe, Jackie Kay, Gwyneth Lewis, Carol Satyamurti and Jo Shapcott. Some poems specify a female subjectivity, some express agency as autonomous individuals, while others presume to speak of common human experience. (shrink)

Healthcare policy and academic literature have promoted improving the transitional care of young people leaving child and adolescent mental health services. Despite the availability of guidance on good practice, there seems to be no readily accessible, coherent ethical analysis of transition. The ethical principles of non-maleficence, beneficence, justice and respect for autonomy can be used to justify the need for further enquiry into the ethical pros and cons of this drive to improve transitional care. The objective of this systematic (...) review was therefore to systematically search for existing ethical literature on child- to adult-orientated health service transitions and to critically appraise and collate the literature, whether empirical or normative. A wide range of bioethics, biomedical and legal databases, grey literature and bioethics journals were searched. Ancestral and forward searches of identified papers were undertaken. Key words related to transition, adolescence and young adulthood, ethics, law and health. The timeframe was January 2000 to at least March 2016. Titles, abstracts and, where necessary, full articles were screened and duplicates removed. All included articles were critically appraised and a narrative synthesis produced. Eighty two thousand four hundred eighty one titles were screened, from which 96 abstracts were checked. Forty seven full documents were scrutinised, leading to inclusion of two papers. Ancestral and forward searches yielded four further articles. In total, one commentary, three qualitative empirical studies and two clinical ethics papers were found. All focused on young people with complex care needs and disabilities. The three empirical papers had methodological flaws. The two ethical papers were written from a clinical ethics context rather than using a bioethical format. No literature identified specifically addressed the ethical challenges of balancing the delivery of transitional care to those who need it and the risk of pathologizing transient and self-limited distress and dysfunction, which may be normal during adolescence. There is very little research on ethical aspects of transitional care. Most existing studies come from services for young people with complex care needs and disabilities. There is much scope for improvement in the amount and quality of empirical research and ethical analysis in this area. (shrink)

I am grateful for the variety of feedback. Three themes struck me: first, commentators recognised the value of open notes but underlined the importance of exploring unintended consequences of the innovation particularly for already disadvantaged populations; second, they suggested nocebo effects might arise via additional routes not identified in my paper; third, they signalled the need for further empirical and ethical exploration of nocebo effects. Exploring all three issues and offering a commentary that was equal parts intriguing and perturbing, Chang (...) and Torous proposed nocebo effects and other harms might be ubiquitous in the digital health space. 1 For example, they hypothesised that the preoccupation with checking health tracking data including adverse readings or outcomes available via downloadable apps and wearable devices might induce nocebo effects. This supposition is worthy of further scrutiny. Chang and Torous also highlighted the lack of research into potentially disparate effects of digital... (shrink)

This study uses data from the Ghana Demographic and Health Survey of 1993 to examine factors determining the use of maternal–child health services in rural Ghana. The MCH services under study are: use of a doctor for prenatal care; soliciting four or more antenatal check-ups; place of delivery; participation in family planning. Bivariate and multivariate techniques are employed in the analyses. The analyses reveal that the use of MCH services tends to be shaped mostly by level of education, (...) religious background and region of residence, and partially by ethnicity and occupation. The implications of these results are discussed. (shrink)

It is evident, backed by research that men tend to avoid medical examinations much more frequently than women. Statistics show that women are more likely to visit medical professionals for preventive measures, health consultations, and examinations, with a probability of over 95%. Surprisingly, despite women having a significantly higher life expectancy, men need to recognize the importance of preventive health examinations. Timely consultations with healthcare providers can effectively prevent various diseases, including those with fatal consequences. Fortunately, many of (...) these conditions can be prevented and treated. To achieve this, it is crucial to launch more proactive campaigns aimed at raising awareness among men on these critical topics. This paper analyses the status of men’s health and provides available data. Additionally, through a quantitative research study, it aims to provide a comprehensive understanding of the situation in the Republic of North Macedonia. The goal is to emphasize the significance of men’s health care, encourage regular medical check-ups, and promote a proactive approach to preventive measures. By doing so, we can ensure better health outcomes for men and contribute to a healthier society overall. (shrink)

Infertility is a global problem affecting 48 to 186 million couples of reproductive age. In Poland, it concerns approx. 1.5 million couples, which amounts to 20% of the population capable of reproducing. One of the factors influencing the incidence of fertility disorders may be lifestyle, understood as a multi-disciplinary accumulation of everyday behaviours and habits. In the study, a group of 201 young adults, students of medical and related faculties, were surveyed in order to check the actual level of knowledge (...) about the impact of lifestyle on reproductive health. The Kohonen network, which is an example of a self-learning neural network, was used to find non-obvious connections between the data. The trained Kohonen neural network formed 4 clusters with different characteristics. Based on analyses of the structure of each cluster, it was found that 2nd year students of Medicine are internally divided into 3 fractions. The first fraction declared a high level of knowledge, but did not have real knowledge. The second fraction was aware of their ignorance, as confirmed by the knowledge test. The last fraction was characterized by a high level of self-confidence regarding their knowledge about reproductive health and obtained a high result in the knowledge test. It was confirmed that people studying at the Medical faculty know more than students of the same year at faculties other than Medicine. Interesting results were obtained for a group of 3rd year students of first-cycle studies in Dietetics. They did not obtain a significantly better result in the knowledge test concerning the influence of diet and lifestyle on reproductive health. It would seem that one could expect at least a few highly knowledgeable students in a group of 3rd year students, but this was not confirmed by the study. In view of the obtained results, it was concluded that the Kohonen neural network is applicable to the analysis of data on the actual state of knowledge about the impact of lifestyle on reproductive health. (shrink)

In the Netherlands, Forensic Flexible Assertive Community Treatment is used as a specialized form of outpatient intensive treatment. This outreaching type of treatment is aimed at patients with severe and long lasting psychiatric problems that are at risk of engaging in criminal behavior. In addition, these patients often suffer from addiction and experience problems in different areas of their life. The aim of this exploratory study was to gain more insight into the characteristics of the ForFACT patient population. More knowledge (...) about these patients may enhance the effectiveness of ForFACT and therefore reduce the risk of recidivism. Data on 132 ForFACT patients were gathered by studying electronic patient records, criminal records, and by conducting semi-structured interviews with practitioners and patients. Additionally, as part of a cognitive screening, two screening instruments were conducted to gain insight into intelligence and possible mild cognitive impairments. This article gives a broad description of the ForFACT patient population, including demographic data and context variables, diagnostics, recidivism risk and offense history, and aspects related to care. Furthermore, several recommendations are given to further improve ForFACT. Based on the results it can be concluded that the ForFACT patient population shows a high degree of diversity in complex care needs and responsivity issues. Therefore, this article highlights the necessity for ForFACT to collaborate with other mental health institutions, as well as probation officers, and forensic or criminal justice institutions. Moreover, it is important to continually check the inclusion and exclusion criteria when admitting patients to ForFACT, and to examine whether ForFACT is still the most adequate care for patients or if they need to be referred. In addition, the results emphasize the importance of cognitive screening for forensic outpatients. Finally, this study zooms in on the interface between forensic psychiatric care and general mental health care. (shrink)

Concerns about emerging and re-emerging infectious diseases have given a new lease of life to quarantinist measures: a series of time-honoured techniques for controlling the spread of infectious diseases through breaking the chain of human contagion. Since such measures typically infringe individual rights or privacy their use is subject to legal regulations and gives rise to ethical and political worries and suspicions. Yet in some circumstances they can be very effective. After considering some case studies that show how epidemics are (...) unique, fluid and affected by a multitude of contingent factors, it is argued that the legal and ethical guidelines may not always be the best approach to discipline the use of quarantinist measures. An alternative model based on ex-post political accountability for reasonableness is proposed. This model restores the centrality of political decision and expert judgement in situations characterized by high risk, uncertainty and contingency. It is argued that such alternative model affords quicker and more flexible responses to serious outbreaks of infections, while providing adequate protection against abuses. (shrink)

I would like to begin by discussing the legal and administrative framework of the role of the federal government in public health. At the heart of it is, of course, the Constitution. At the Department of Health and Human Services we depend, as does much of the federal government, on our power to regulate interstate commerce. Since the Supreme Court in 1942 removed essentially any restraint from the meaning of interstate commerce in Wickard v. Filburn, the federal government (...) has been regulating with wide latitude, in spite of small and, arguably, equivocal reverses in recent years. However, even though the Supreme Court no longer provides any real constitutional check on the federal government's interstate commerce power, some other restraints persist. For example, many parts of the health system have traditionally been deemed inherently state functions, such as the licensing and disciplining of doctors, nurses, and pharmacists, as well as the practice of medicine itself. (shrink)

– Pharmacy sales of over‐the‐counter medicines in the UK represent an economically significant and important mechanism by which customers self‐medicate. Sales are supervised in pharmacies, but this paper seeks to question whether patients' electronic health records – due to be introduced nationally – could be used, ethically, by pharmacists to ensure safe medicines sales., – Using theoretical arguments, three areas of ethical concern are identified and explored in relation to pharmacists' access to EHRs‐consequentialsim, analogies and confidentiality/privacy., – Consequentialist arguments (...) include positive benefits to customer's welfare and control of medicine of abuse, but negative economic healthcare burdens and consequences due to potentially increased or paradoxically, decreased presentation of patients to doctors. Socially accepted analogous practices – credit checks, existing pharmacy access to information and hospital treatment – are then argued to be ethically relevant and supportive of access. Privacy and confidentiality are then considered as reasons not to allow EHR access. A contrasting view is that pharmacy access to EHRs is another form of surveillance and hence the question of pharmacists' assess to EHRs may be answered negatively by empirical research that locates pharmacy customers as expert users and identifies confidentiality and privacy concerns about information technology in healthcare more generally., – This paper offers a unique and valuable contribution to the debate about healthcare professionals' role‐based access to patients' medical records and offers a reflection on the ethical concerns surrounding patient information and the rival concerns of patient qua customer autonomy and safety. (shrink)

The coronavirus disease 2019 pandemic had a negative psychological impact on the population at scale, yet it is possible that vulnerable patient populations may experience a heavier burden with increased feelings of anxiety and distress. Cancer patients have to trade-off between the fear of exposing themselves to the virus and the need to continue life-saving medical procedures. The present study investigated the prevalence of generalized anxiety and post-traumatic stress symptoms in a population of Italian cancer patients and healthy participants in (...) the months following the COVID-19 outbreak. Using standardized measures of PTSS and generalized anxiety, we found that patients experienced higher levels of adverse mental health outcomes. Several variables were found to negatively affect PTSS and anxiety in this population, including the younger age of respondents, having children, and the impossibility to attend regular medical check-ups. These findings stress the importance of maintaining a clear and regular communication with patients throughout future waves of the pandemic and ensure continuity of care in this vulnerable population. Furthermore, this study indicates the need to establish psychological interventions aimed at patients with cancer, targeting especially younger generations who are more likely to experience adverse psychological outcomes. (shrink)

Mobile applications and socio-sexual networking websites are used by outreach workers to respond synchronously to questions and provide information, resources, and referrals on sexual health and STI/HIV prevention, testing, and care to gay, bisexual and other men who have sex with men. This exploratory study examined ethical issues identified by online outreach workers who conduct online sexual health outreach for GB2M. Semi-structured individual interviews were conducted between November 2013 and April 2014 with online providers and managers to explore (...) the benefits, challenges, and ethical implications of delivering online outreach services in Ontario, Canada. Interviews were digitally recorded and transcribed verbatim. Thematic analyses were conducted, and member-checking, analyses by multiple coders, and peer debriefing supported validity and reliability. Four themes emerged on the ethical queries of providing online sexual health outreach for GB2M: managing personal and professional boundaries with clients; disclosing personal or identifiable information to clients; maintaining client confidentiality and anonymity; and security and data storage measures of online information. Participants illustrated familiarity with potential ethical challenges, and discussed ways in which they seek to mitigate and prevent ethical conflict. Implications of this analysis for outreach workers, researchers, bioethicists, and policy-makers are to: understand ethical complexities associated with online HIV prevention and outreach for GB2M; foster dialogue to recognize and address potential ethical conflict; and identify competencies and skills to mitigate risk and promote responsive and accessible online HIV outreach. (shrink)

Background Advance Care Planning via Group Visits (ACP-GV) is a patient-centered intervention facilitated by a clinician using a group modality to promote healthcare decision-making among veterans. Participants in the group document a “Next Step” to use in planning for their future care needs. The next step may include documentation of preferences in an advance directive, discussing plans with family, or anything else to fulfill their ACP needs. This evaluation seeks to determine whether there are identifiable subgroups of group participants with (...) differing needs prior to delivery of the ACP-GV program and, if so, to use information about the subgroups to enhance the program offered to veterans in United States Department of Veterans Affairs (VA) healthcare settings. Methods We conducted a secondary analysis of national data from a quality improvement evaluation. Patient- and provider-level data from administrative healthcare records for VA users in all 50 states, territories, and the District of Columbia provides data on veterans attending ACP-GV during federal fiscal years 2018–2022 (N = 26,857). Latent class analysis seeks to identify the various subgroups of veterans based on their level of ACP self-efficacy before attending ACP-GV and any demographic differences across the resulting subgroups of veterans attending ACP-GV. ACP self-efficacy is derived from seven items obtained from a participant worksheet used during the group. Results Analysis revealed two distinct groups of veterans, distinguishable by their pre-ACP-GV levels of one aspect of ACP self-efficacy: prior knowledge of ACP. Veterans with higher prior knowledge of ACP are associated with an identified next step focused on checking their current AD status and updating it, and veterans with lower ACP prior knowledge are associated with identifying a next step to discuss ACP more fully with family. Differences in age, sex, race, ethnicity, and marital status exist across subgroups of veterans. Conclusion Greater attention must be paid to ACP and veterans’ prior knowledge of ACP to consistently encourage annual review and status updates. (shrink)

The “Father of the United States Constitution,” James Madison, once described justice as “the end” of both government and of civil society. Yet curiously, Madison said little about justice in elaborating the principles of American federalism in The Federalist Papers and elsewhere. His fundamental concerns, to the contrary, were in contriving a system of separated, countervailing powers and in establishing a first federal principle of enumerated powers — in which federal powers “are few, and defined.” This strategy, for Madison, was (...) the most feasible way of checking the innate tendency of political power to accumulate, centralize, and trample on citizens’ liberties. (shrink)

Consider the following hypothetical scenario: A patient suffering constant abdominal pain is referred to State Hospital A from her local clinic after not responding to simple analgesics for chronic pelvic pain associated with irregular menstruation. The doctors at State Hospital A discover that she has a suspicion of adenomyosis. She gives written informed consent for a hysterectomy. During routine postoperative check-ups she reports no alleviation of the pelvic pain, urinary frequency along with burning on micturition and a persistent vaginal discharge. (...) Preoperatively, she was not told that the surgeons had inserted a surgical mesh to prevent vault prolapse. She is given antibiotics and further simple analgesia. As her symptoms do not improve she self-refers to State Hospital B. She is informed that she needs a CAT scan. However, the hospital’s scanner has been out of order for three years. She is advised to go to State Hospital C, where the scanner works, but is not given a referral note. She is told by Hospital C that the doctors are too busy to see her, and as she does not have an appointment, and is not an emergency case she should go back to Hospital A. She does not want to go back to Hospital A, as during her last visit there, nursing staff accused her of being a nuisance and escorted her off the premises. She approaches Private Hospital D, where her abdomen and pelvis are scanned. The scan shows the surgical mesh inside her pelvis which had disintegrated. She is told that it is too risky to remove all the fragments, but that some could be removed at a cost - which she could not afford. The surgeon refers her back to State Hospital A with a referral note and copy of the CAT scan report. (shrink)

Objective: To explore the accounts and perspectives of junior doctors who were offered an HIV test by their employing National Health Service (NHS) trust and discuss ethical issues posed by this new policy. Design: Qualitative in-depth interview study. Setting: 4 NHS hospital trusts. Participants: 24 junior doctors who had been offered an HIV test as part of their pre-employment occupational health checks. Results: The manner in which HIV tests were offered to junior doctors varied both between and (...) within the NHS trusts. Overall, the doctors were highly critical of the way the HIV test was offered. Recurrent themes surrounding a lack of discussion and information regarding the indications for the test and implications of a positive result influenced the the doctors’ perception of their experiences. As a consequence of the shortcomings of how the test was offered, most of the doctors held the misperception that HIV testing was mandatory and many felt unable to decline the test. The majority of doctors referred to patient protection as adequate justification for being offered an HIV test. Conclusions: Junior doctors offered an HIV test under new Department of Health occupational health guidance were disparaging about how the test was offered. The findings of this study affect thousands of junior doctors in the UK, and the impact of these results is extensive. Participants’ suggestions regarding how the process of offering an HIV test can be improved are discussed and ethical issues regarding the new Department of Health policy are highlighted. (shrink)

My Back Is To A Life Passed. A year, maybe more, in liminal space. Waiting. For a vaccine. For better therapeutics. For a political climate to shift. All the while, the actual climate turns against us.The waters rise in the East. Fires rage in the West.My back is to a life passed. Retirement, just before the pandemic. Post-retirement and lockdown, simultaneous. A turn to a writing life—solitary, self-directed, coming at a time when my options are limited. My go-to places for (...) connection and inspiration—museums, coffeehouses, lectures, and readings—all off-limits. The natural world, my cathedral, also inaccessible. The fires rage, and the air is unbreathable.Over morning coffee, in our quiet house, the windows shut against dangerously high particulates and a darkened sky, I read an article by Julian Lucas in The New Yorker, “When a Virus Becomes a Muse.” He reviews the work of Hervé Guibert, the French writer who died from AIDS in 1991. Guibert focused on the body. His young, sexual body, with its confounding insistence. His failing body, ravaged by disease. AIDS was his muse, blasting him into a wildly creative few years, writing four books in the last three years of his life (Lucas).How will this virus, the novel coronavirus, serve as muse? The pandemic sets limits: Where can I go? Who can I see? I live within constructs and limitations imposed much like the rules of poetic form. Within those—the sonnet, the haiku—how is language wrought? How sharp, how bright, its expression? If I cannot hug you, how do I show my devotion? In my separate state, how do I live connection? I have a new expression. Mouth and nose covered, only my eyes showing, framed by glasses I need in order to see, I punctuate exchanges at the checkout counter, and with the health-check staff at the entrance to my daughter's physical therapy facility, by forcing my eyes into a warm, glad squint. I want them to beam. From people's responses—the moment of recognition, the tender mirroring, the body tilting to the side, eyes crinkled, head nodding—I can tell that the beam is working. It took time to develop this new way. I learned that I have to smile with my mouth, with my whole face, even when it can't be seen, for my feelings to show.Life, like art, requires structure, the boundaries of form. How to structure a day? It could be embodied. Filled. Wasted. Or used. My back is to a life where hours and minutes had a particular meaning. I am no longer expected at work by a certain hour, nor to put in three hours before my morning break. The collective future, where we tossed plans, goals, places we would see—again, or for the first time!—cannot be reached over the smoothed and worn stepping-stones of, say, weeks until a holiday. The broad swaths of the day become the new metric. The slow, mounting morning. A walk, or a longer one, before getting to the bulk of the day's writing. The noontime pivot, heat of the day rising, the birds quiet. Lunch, and a few chores. Essential errands. Medical appointments.The downslope of afternoon, with its nagging refrain, in the time you have left... The swirling, heated world. Greta Thunberg, 16 years old, sails from Europe to the United States to address a conference on climate change. She sails, rather than flies, so as not to add to her carbon footprint. It takes time, that voyage. She waits on deck while moving toward her future. The past recedes. The stormy Atlantic rises.Is it any clearer now that the food chain originates not in boardrooms but in hot fields, that the first essential worker drops from the back of a truck before sunup with a knife and a crate held in roughened, swollen hands?At night, sitting on the sofa, we watch television, the police procedurals that offer entertainment. Escape and relief. The day has passed. These are the rewards for getting through another day of uncertainty, managing the anxiety of risking exposure in order to get groceries and prescriptions and to bring my daughter to physical therapy. The TV detectives we favor work in teams as they interview suspects, talk to witnesses, confer with one another as they refine their theories and move photographs and bits of evidence around on the bulletin board. Our shows always tie up nicely in the end. In my life now, without the team or the interviews or the meetings that keep the detectives connected, I pretend that I am one of them, that my notebooks and plot maps and drawings and time lines are all clues to a mystery that I will solve. Despite my enervated state, I get up, I work, I look at and handle all the materials I have acquired. The day passes. Each night, a reward for getting through the day. Another day. Standing between worlds. Waiting. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Time of the Magicians: Wittgenstein, Benjamin, Cassirer, Heidegger, and the Decade That Reinvented Philosophy by Wolfram EilenbergerDavid HermanTime of the Magicians: Wittgenstein, Benjamin, Cassirer, Heidegger, and the Decade That Reinvented Philosophy, by Wolfram Eilenberger, trans. Shaun Whiteside; 432 pp. New York: Penguin Press, 2020.Is it possible to write a deeply researched and technically precise contribution to the history of philosophy that reads like a gripping novel? Time of (...) the Magicians, originally published in German in 2018 as Zeit der Zauberer, convincingly demonstrates that this feat can indeed be accomplished. However, it may be achievable only by the rare expert who, like Wolfram Eilenberger, combines a thoroughgoing knowledge of the field, an unstinting commitment to recreating a public forum for philosophy, and a gift for the exposition—and dramatization—of philosophical debates, the broader circumstances in which they took place, and the motivations and aims of those who participated in them.The book, stylishly translated by Shaun Whiteside, begins by plunging us into the middle of things. Eilenberger provides snapshots of what his four focal thinkers were up to in 1929, before backtracking, in subsequent chapters, to cover key events in the decade that brought them to this point. Then, in the epilogue, he briefly sketches their post-1929 lives and careers. The book's readability is further enhanced by the way the text is broken up into short sections with eye-catching titles ("A Hut of One's Own," "Existential Health Check," "Self-Fashioning through Openness").The opening pages center on June 1929, when Ludwig Wittgenstein, having previously renounced his portion of his family's fortune and taught for several years at primary schools in rural Austria, undertook an oral defense of his doctoral thesis at the University of Cambridge at age forty. Wittgenstein's "thesis" just so happened to be Tractatus Logico-Philosophicus, the influential, sometimes gnomic book he had published in 1921; and at the conclusion of the defense, the candidate is rumored to have said to his examiners, Bertrand Russell and G. E. Moore, "Don't worry, I know you'll never understand it."In fact, as Eilenberger discusses in a later chapter, by 1929 Wittgenstein's own thinking was no longer where it had been when he wrote the Tractatus. The [End Page 492] philosopher's primary concern had shifted away from identifying the logical structure of meaningful propositions; instead, he had become interested in how meaning emerges from the way language is used in particular, concrete contexts. Apropos the evolving nature of Wittgenstein's ideas, one of the funniest parts of the book describes the philosopher's meetings with members of the Vienna Circle, a group that, in seeking to reorient philosophy around the natural sciences, had come to see the Tractatus as a touchstone for their work. During his first meeting with the group, in 1927, Wittgenstein, instead of talking shop, recited poems by Indian poet Rabindranath Tagore, standing with his back turned to the audience. Later discussions did involve philosophy, but eventually, as Eilenberger puts it, although the "Vienna Circle had hoped for something that coincided with their ideal of objective research," they "were instead left to grapple with an extremely idiosyncratic style of thinking that, in both execution and results, seemed directly contrary to it" (p. 274).Meanwhile, a few months prior to Wittgenstein's defense of a thesis that no longer reflected his real tendencies of mind, two of Eilenberger's other focal thinkers, Ernst Cassirer and Martin Heidegger, engaged in a much-anticipated public debate at the Grand Hôtel Belvédère in Davos, Switzerland. When he first mentions it, Eilenberger furnishes just enough detail to whet readers' curiosity about this epochal contest between the eminent neo-Kantian Cassirer, whose reputation for encyclopedic erudition had just been sealed by the publication of the final volume of his masterwork, The Philosophy of Symbolic Forms, and the considerably younger Heidegger, a one-time student of Edmund Husserl who had made a radical departure from Husserlian phenomenology in Being and Time.By the time readers return to the debate, some three hundred pages later, Eilenberger has provided a decade's worth of historical context, which casts a... (shrink)

Health anxiety is, among other things, a response to a universal epistemological problem about whether changes in one’s body indicate serious illness, a problem that grows more challenging to the individual with age and with every advance in medical science, detection, and treatment. There is growing evidence that dysfunctional metacognitive beliefs – beliefs about thinking – are the driving factor, with dysfunctional substantive beliefs about the probability of illness a side‐effect, and that Metacognitive Therapy (MCT) is more effective than (...) Cognitive Behavioral Therapy (CBT). However, hypochondria is distinct from other forms of anxiety, I argue, in ways that make some reality‐checking techniques of CBT and MCT of limited usefulness. I propose a Re‐Calibration Technique (RCT) that complements these therapies by focusing on a metacognitive belief that has not been studied: the patient’s presumption of his own personal reliability in judging symptoms, an assumption exposed every time he disagrees with a doctor. I propose a technique whereby a patient keeps a long‐term register of every episode of alarm about symptoms and its resolution, possibly years later. When healthcare‐seeking impulses arise the patient then uses his own track record to re‐calibrate his confidence that medical attention is needed. The new technique allows one to improve self‐judgment about whether one has an illness or not by improving self‐knowledge of one’s own reliability. (shrink)

Health research for progress in the control and conquest of disease afflicting man is unquestionable. Concerns arise when motives other than the advancement of scientific knowledge and benefit for individuals and society are the driving force behind clinical trials. These conflicts of interests become even more pronounced when dealing with populations rendered vulnerable by virtue of poverty and ignorance. South Asia with its teeming millions represents one such region. This essay examines the reasons that make this population vulnerable to (...) exploitation. Informed consent in the process of research is an area where such conflicts are prone to arise. In order to ensure that conflicting interests of researchers and funding agencies are kept in check, the processes of informed consent and ethical review of research need to be strengthened. Suggestions are put forward to modify the consent process to match the needs of South Asia and to strengthen the ethical review process for safeguarding the rights of the study subjects. But perhaps the most important safeguard against exploitation is the virtuous researcher himself with noble intentions. (shrink)

This study investigates the role of parental and peer relationships’ quality on homophobic victimization and possible consequences on mental health during adolescence. Participants were 394 adolescents, (41.6% male and 58.4 % female) aged 15-20 years (M = 16.55; SD =.85), attending the third and fourth classes of public high schools in Italy. Participants completed the Homophobic Bullying Scale to evaluate homophobic victimization toward gays and lesbians or assumed homosexuals, the Symptom Check-list-90 to evaluate mental health, and the Inventory (...) of Parent and Peer Attachment to investigate quality of peer and parental relationships (in term of communication, disaffection and trust). Results show how quality of peer relationships is not connected with victimization, as well as quality of parental relationships is linked with homophobic victimization, that is also connected with anxiety and somatization problems. Theoretical and educational implications were discussed. (shrink)

Well–being, health and freedom are some of the many phenomena of interest to science whose definitions rely on a normative standard. Empirical generalizations about them thus present a special case of value-ladenness. I propose the notion of a ‘mixed claim’ to denote such generalizations. Against the prevailing wisdom, I argue that we should not seek to eliminate them from science. Rather, we need to develop principles for their legitimate use. Philosophers of science have already reconciled values with objectivity in (...) several ways, but none of the existing proposals are suitable for mixed claims. Using the example of the science of well-being, I articulate a conception of objectivity for this science and for mixed claims in general. _1_ Introduction _2_ What Are Mixed Claims? _3_ Mixed Claims Are Different _3.1_ Values as reasons to pursue science _3.2_ Values as agenda-setters _3.3_ Values as ethical constraints on research protocols _3.4_ Values as arbiters between underdetermined theories _3.5_ Values as determinants of standards of confirmation _3.6_ Values as sources of wishful thinking and fraud _4_ Mixed Claims Should Stay _4.1_ Against Nagel _5_ The Dangers of Mixed Claims _6_ The Existing Accounts of Objectivity _6.1_ The perils of impartiality _7_ Objectivity for Mixed Claims _8_ Three Rules _8.1_ Unearth the value presuppositions in methods and measures _8.2_ Check if value presuppositions are invariant to disagreements _8.3_ Consult the relevant parties _9_ Conclusion. (shrink)

Background Healthcare professionals (HCPs) face a myriad of ethical challenges during the coronavirus disease 2019 (COVID-19) pandemic. However, there is limited literature examining the ethical challenges faced by HCPs in low- and medium-income countries. The research was designed to explore the ethical challenges experienced by HCPs in a Malaysian hospital setting during the pandemic. Methods Semistructured interviews were conducted via video calls with 10 Malaysian HCPs across different clinical disciplines involved in managing patients diagnosed with COVID-19 infections. The calls were (...) audio-recorded, transcribed verbatim and checked. Thematic analysis with constant comparison across transcripts was carried out to identify categories and themes. Results Three main themes emerged. Firstly, there was deprioritisation of care for non-COVID-19 patients resulting from resource limitations. HCPs raised concerns that there was curtailed access to various healthcare services by non-COVID-19 patients. There was also a trade-off between protecting individual patient safety and public health interests. Secondly, patients were disempowered from decision-making; the decision to segregate suspected COVID-19 patients to high-risk areas without seeking patients’ approval may result in an increased risk of infection. Lastly, HCPs expressed internal conflicts when balancing the professional duty of care against concerns about contracting COVID-19 and spreading it to their family members. Conclusion The study highlighted ethical issues faced by HCPs in Malaysia during the pandemic. It underscores the need for clinical ethics consultation services in hospitals to navigate the various ethical dilemmas. (shrink)

This study examines the ethical position and behaviour of multinational mining companies regarding hazardous employment and health and safety of employees in the South African mining industry. Mining companies have long had a reputation for being unethical on health and safety issues. Too often there are occurrences of fatal accidents, which bring the ethical behaviour of multinational mining companies into question. The litmus test for the mining companies is to devise benchmark standards that will reduce accidents tremendously at (...) their place of operations. This study addresses this issue by examining measures and regulations set up to check the occurrences of mining accidents in South Africa. It follows that the remedy needs to be fundamental and thoroughgoing. (shrink)

Background: Systematized Nomenclature of Medicine—Clinical Terms (SNOMED CT, hereafter abbreviated SCT) is acomprehensive medical terminology used for standardizing the storage, retrieval, and exchange of electronic healthdata. Some efforts have been made to capture the contents of SCT as Web Ontology Language (OWL), but theseefforts have been hampered by the size and complexity of SCT. Method: Our proposal here is to develop an upper-level ontology and to use it as the basis for defining the termsin SCT in a way that will (...) support quality assurance of SCT, for example, by allowing consistency checks ofdefinitions and the identification and elimination of redundancies in the SCT vocabulary. Our proposed upper-levelSCT ontology (SCTO) is based on the Ontology for General Medical Science (OGMS). Results: The SCTO is implemented in OWL 2, to support automatic inference and consistency checking. Theapproach will allow integration of SCT data with data annotated using Open Biomedical Ontologies (OBO) Foundryontologies, since the use of OGMS will ensure consistency with the Basic Formal Ontology, which is the top-levelontology of the OBO Foundry. Currently, the SCTO contains 304 classes, 28 properties, 2400 axioms, and 1555annotations. It is publicly available through the bioportal athttp://bioportal.bioontology.org/ontologies/SCTO/. Conclusion: The resulting ontology can enhance the semantics of clinical decision support systems and semanticinteroperability among distributed electronic health records. In addition, the populated ontology can be used forthe automation of mobile health applications. (shrink)

One of the goals of medicine is to improve well-being, in line with the principle of beneficence. Likewise, scientists claim that the goal of human embryonic stem cell research is to find treatments for diseases. In hESC research, stem cells are harvested from a 5-day-old embryo. Surplus embryos from infertility treatments or embryos created for the sole purpose of harvesting stem cells are used in the research, and in the process the embryos get destroyed. The use of human embryos for (...) research purpose raises ethical concern. In this context, the religious leaders play the role to be the moral compass and “reality check” to engage with the public. In Malaysia, the Ministry of Health has outlined the Guidelines for Stem Cell Research and Therapy, reflecting on Islamic principles. Since there has not been much focus on the viewpoints of other faiths in Malaysia, this study attempts to explore the ethical guiding principles deliberated by religious leaders from the Buddhist, Hindu and Catholic traditions and identify if there is a common ground between the mainstream religious views and principles of medical ethics, in relation to hESC research. Eleven religious leaders representing the Buddhist, Hindu and Catholic traditions were interviewed. Interestingly, though reasoning of religious leaders came from different angles, their underlying concerns revolve around the values of “do no harm” and “intention to save lives”. These values are also the key principles in medical ethics. The findings are applied to answer the question as to whether religious and medical guiding principles can co-exist and complement in ethical decision-making, without compromising the values. (shrink)

Definition of the problem: Advances in medical technology resulting in an explosion of therapies available, considered within the context of the current demographic development, raise the question as to whether these advances can be made available to all in an equitable manner. Arguments: The following suggestions are being made in the discussion of how the costs can be held in check: (1) the prevention of expensive procedures being introduced into medical practice, (2) a far-reaching shifting of financing the health (...) care services into the private sector, and (3) excluding certain groups of persons from receiving expensive therapies, namely those whose ”quality of life” is considered to be very low and whose care constitutes a burden to society (e.g. the aged, the chronically ill and the handicapped). Suggestions 2 and 3 violate the basic – Christian – ethical principles of human dignity, justice and solidarity with regard to the gift of life and corresponding good health. Conclusion: The standard for the distribution of generally offered medical services must also be – with respect to persons – available for the chronically ill and for handicapped persons dependent upon care. (shrink)

IntroductionInternet addiction is characterized by excessive and uncontrolled use of the internet affecting everyday life. Adolescents are the primary risk group for internet addiction. Data on internet addiction is lacking in Africa. Thus, this review aimed to determine the pooled prevalence of internet addiction and its associated factors among high school and university students in Africa.MethodsA comprehensive literature search was conducted using electronic databases to locate potential studies. Heterogeneity between studies was checked using Cochrane Q test statistics and I2 test (...) statistics and small-study effects were checked using Egger's statistical test at a 5% significance level. A sensitivity analysis was performed. A random-effects model was employed to estimate the pooled prevalence and associated factors of internet addiction among students. The primary outcome of measure of this review was the prevalence of internet addiction and the secondary outcome of measures are the factors associated with internet addiction.ResultsA total of 5,562 studies were identified among the five databases. Of these, 28 studies from 10 countries with 14,946 high school and university students were included in this review. The overall pooled prevalence of internet addiction among the students was 34.53% [95% Confidence Interval : 26.83, 42.23, I2 = 99.20%]. Male sex [Pooled Odds Ratio = 1.92, 95% CI:1.43, 2.57 I2 = 0.00], urban residence, and duration of daily internet use for more than 4 h (POR = 2.25, 95% CI:1.20, 4.21, I2 = 0.00%, were significantly associated with internet addiction among adolescents.ConclusionAlmost one-third of university and high school students in Africa are addicted to the internet. Male students, those from urban areas, and those who use the internet for more than 4 h per day have higher odds of internet addiction. Thus, we recommend that health planners and policymakers pay attention to the use of the internet and internet addiction in Africa. (shrink)

Faced with the exponential development of Big Data and both its legal and economic repercussions, we are still slightly in the dark concerning the use of digital information. In the perpetual balance between confidentiality and transparency, this data will lead us to call into question how we understand certain paradigms, such as the Hippocratic Oath in medicine. As a consequence, a reflection on the study of the risks associated with the ethical issues surrounding the design and manipulation of this "massive (...) data" seems to be essential. This book provides a direction and ethical value to these significant volumes of data. It proposes an ethical analysis model and recommendations to better keep this data in check. This empirical and ethico-technical approach brings together the first aspects of a moral framework directed toward thought, conscience and the responsibility of citizens concerned by the use of data of a personal nature. Defines Big Data applications in health Presents the ethical value of the medical datasphere via the description of a model of an ethical analysis of Big Data Provides the recommendations and steps necessary for successful management and governance of personal health data Helps readers determine what conditions are essential for the development of the study of Big Data. (shrink)

For last couple of years, the subcontinent of India has witnessed a number of influenza epidemic outbreaks. History reveals influenza epidemic to be a constant but neglected companion of India. Considering the repeated occurrences of the event on Indian soil, including influenza A H1N1 after 2009-10 pandemic event, a check to the planning measures has been done at national level. A literature survey on the initiative measures, planning accomplishments etc. reveals that it is only after the emergence of A H5N1, (...) national health authorities have began planning efforts to mitigate and respond to influenza outbreaks. This paper outlines the evolution of Indian pandemic planning that can be traced in the research literature, summarize the accomplishments, and explain the importance of pandemic planning in India. Pandemic influenza, as it is commonly known, emerges, evolves, attacks, and sways a large part of world declaring public health emergency in a short span. Several outbreak events such as SARS, Avian influenza A H5N1, and H1N1 have demonstrated the need of international concern for public health emergency and had established the value of planning in advance. Preparedness planning in India is found to be at its nascent stage and it needs further improvement at multiple aspects to tackle the future public health crises, to rectify ethical failures. (shrink)