Ethics, Medicine and Public Health最新文献

英文中文

Art to Art during the Human Immunodeficiency Virus Pandemic 人类免疫缺陷病毒大流行期间的艺术对艺术

Q3 Medicine

Ethics, Medicine and Public Health

Pub Date : 2026-01-01 DOI: 10.1016/j.jemep.2025.101236

L. Suárez , V. Asensi , S.T. Donell , A. Perciaccante , P. Charlier , A.I. Cucu , J. Hanning , A.G. Nerlich , R. Bianucci

Background

In 1989, the AIDS pandemic spread worldwide with a heavy death toll in developing countries, generating fear and profound social stigma. HIV was initially associated with men who have sex with men and people who inject drugs, reinforcing marginalization, even within healthcare. Early antiretroviral therapies were costly, difficult to access, and highly toxic.

Methods

We reviewed and analyzed representative works of visual art produced during different phases of the HIV pandemic, including paintings, posters, and photography, to explore how artistic expression reflected and shaped social perceptions, activism, and biomedical progress.

Results

Numerous artists and collectives, many living with HIV, used art to denounce systemic failures, confront stigma, raise public awareness, and pressure regulators and politicians to accelerate drug approval and resource allocation. As scientific advances progressively transformed HIV from a fatal disease into a chronic, manageable condition requiring lifelong therapy, the visual language of HIV also evolved. Early works emphasized fear, uncertainty, and devastation, while later imagery increasingly reflected hope, survival, normalization, and ongoing vulnerability. Despite major therapeutic successes, the pandemic continues to exert a substantial impact, particularly in sub-Saharan Africa, where vertical and heterosexual transmission remain critical challenges. Across emerging infectious diseases, societal responses tend to follow recurrent phases—recognition, crisis, therapeutic development, containment, and long-term management—accompanied by shifting collective emotions from panic and blame to acceptance and cautious optimism.

Conclusion

The HIV pandemic illustrates the powerful role of visual art as a mirror of social trauma and a catalyst for empathy, activism, and public health engagement, beyond historical value.

1989年，艾滋病在全世界蔓延，在发展中国家造成大量死亡，造成恐惧和深刻的社会耻辱。艾滋病毒最初与男男性行为者和注射吸毒者联系在一起，甚至在医疗保健领域也加剧了边缘化。早期的抗逆转录病毒疗法价格昂贵，难以获得，而且毒性很大。方法：我们回顾并分析了在艾滋病流行的不同阶段产生的具有代表性的视觉艺术作品，包括绘画、海报和摄影，以探讨艺术表达如何反映和塑造社会观念、行动主义和生物医学进步。结果：许多艺术家和团体，其中许多是艾滋病毒感染者，利用艺术来谴责系统失败，对抗耻辱，提高公众意识，并向监管机构和政治家施压，以加快药物审批和资源分配。随着科学进步逐渐将艾滋病毒从一种致命疾病转变为一种需要终身治疗的可控制的慢性疾病，艾滋病毒的视觉语言也发生了变化。早期的作品强调恐惧、不确定性和破坏，而后来的图像越来越多地反映了希望、生存、正常化和持续的脆弱性。尽管在治疗方面取得了重大成功，但这一流行病继续产生重大影响，特别是在撒哈拉以南非洲，那里的垂直传播和异性传播仍然是重大挑战。在新出现的传染病中，社会反应往往遵循周期性阶段——认识、危机、治疗开发、遏制和长期管理——伴随着集体情绪从恐慌和指责转变为接受和谨慎乐观。艾滋病毒的流行说明了视觉艺术作为社会创伤的镜子和同理心、行动主义和公共卫生参与的催化剂的强大作用，超越了历史价值。

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引用次数: 0

Blocked from becoming a physician or nurse because of gender: global state-of-the-art review 因性别而无法成为医生或护士：全球最新研究综述

Q3 Medicine

Ethics, Medicine and Public Health

Pub Date : 2025-12-18 DOI: 10.1016/j.jemep.2025.101234

C. Kamau-Mitchell , T. Watari , M.M. Gallagher

Background

Females were historically blocked from or under-represented among physicians, while males were historically discouraged from training as nurses, and previous systematic reviews and meta-analyses have reported the scale of problems such as sexual harassment. There are ongoing attempts at finding solutions, but there is a gap in literature which seeks to understand the surrounding historical, legal and sociocultural reasons why people behave that way.

Methods

We segmented the world into regions and comprehensively reviewed different countries’ laws within OECD databases, World Health Organization databases about gender representation presently and historically, published literature about history, and current records of gender-related initiatives in medicine and nursing.

Results

For countries with available data, a global average of 47% of physicians are female, whereas 23% of nurses are male, but both vary widely, ranging 8–82% and 0–79% respectively. Good representation is associated with laws about female or male inclusion in medicine/nursing from the mid-19th century, whereas poor representation is associated with adverse sociocultural gender norms and inadequate or absent laws against workplace gender equality, gender-based violence, and unequal rights within families. We report the strengths and limitations of common solutions to the problem, noting that reactive law enforcement (e.g., through employment tribunals or lawsuits) is rare, and that for physicians/nurses gender inequalities often exist even in countries with laws against them because of historical and sociocultural influences.

Conclusions

A promising solution to the problem is “professional norming” which transforms cultures about how to behave, and what is acceptable behavior, among physicians and nurses.

历史上，女性被排除在医生之外或在医生中所占的比例不足，而男性历来不被鼓励接受护士培训，以前的系统回顾和荟萃分析报告了性骚扰等问题的规模。人们一直在努力寻找解决方案，但在试图理解人们那样做的周围历史、法律和社会文化原因的文献中存在空白。方法：我们将世界划分为区域，并在经合组织数据库、世界卫生组织当前和历史性别代表性数据库、已发表的历史文献以及医学和护理中与性别相关的举措的当前记录中全面审查不同国家的法律。在有可用数据的国家，全球平均47%的医生是女性，23%的护士是男性，但两者差异很大，分别为8-82%和0-79%。良好的代表性与19世纪中期有关女性或男性参与医学/护理的法律有关，而代表性差则与不利的社会文化性别规范以及反对工作场所性别平等、基于性别的暴力和家庭内不平等权利的法律不充分或缺失有关。我们报告了这一问题的共同解决办法的优势和局限性，指出被动执法（例如通过就业法庭或诉讼）很少见，而且对医生/护士来说，即使在由于历史和社会文化影响而对他们实施法律的国家，性别不平等现象也经常存在。结论“职业规范”是解决这一问题的一个有希望的方法，它改变了医生和护士之间关于如何行为以及什么是可接受的行为的文化。

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引用次数: 0

Safe spaces for co-operationalizing one health: building on momentum in bioethics 合作实现同一健康的安全空间：以生物伦理为基础

Q3 Medicine

Ethics, Medicine and Public Health

Pub Date : 2025-12-16 DOI: 10.1016/j.jemep.2025.101233

A. Boudreau LeBlanc, C. Dupras, B. Williams-Jones, G.-P. Gadoury-Sansfaçon, J. Barrette-Moran, E. de Leeuw, M. Bouchard, N. Macia, L. Stafford

One Health is, by definition, an interdisciplinary, intersectoral, and interlocal concept. At its origin, it intersects human and veterinary medicine to bridge local-to-global health issues. Local epidemics can escalate into pandemics, while antimicrobial resistance in one species can spread within the microbiotic community. This ecological turn has expanded the scope of health research and practice, which now frequently includes wildlife and landscape. Yet, this expanded scope raises several concerns, starting with the need to build functional mechanisms for interdisciplinary integration, cooperation, and coordination. How do we integrate without reducing, influencing, or (op)pressing disciplinary expertise? One Health, we suggest, is challenged by the same issues faced by other interdisciplinary movements, such as Bioethics. The root of the problem, we argue, is with an organization of science that still dichotomizes knowledge and values in daily practice; pinpointing four core challenges, all of which intersect a boundary: (1) institutions, (2) epistemologies, (3) sectors, and 4) generations. Building on the case of the Université de Montréal, which adopted One Health as a strategic vision for the institution, and the experience of early adopters in the School of Public Health, we argue for a new focus on “boundary intersections” of research, teaching, and service in governance ethics. This model takes the form of a real-world “living laboratory,” structured as a Science for Society collective, and shows how interests can converge across One Health and Bioethics to enable researchers to exchange, learn, and construct a more general methodological approach to operationalize interdisciplinary perspectives effectively in practice.

根据定义，“同一个健康”是一个跨学科、跨部门和跨地方的概念。从起源上讲，它与人类医学和兽医学交叉，以弥合地方与全球的卫生问题。局部流行可升级为大流行，而一个物种的抗菌素耐药性可在微生物群落内传播。这种生态转向扩大了健康研究和实践的范围，现在经常包括野生动物和景观。然而，这种扩大的范围引起了一些关注，首先需要建立跨学科整合、合作和协调的功能机制。我们如何在不减少、影响或（op）压制学科专业知识的情况下进行整合？我们认为，“同一个健康”也面临着其他跨学科运动（如生物伦理学）所面临的同样问题的挑战。我们认为，问题的根源在于，在日常实践中，科学组织仍然将知识和价值观一分为二；确定四个核心挑战，所有这些挑战都交叉在一个边界上：(1)制度，（2)认识论，(3)部门，以及4）世代。基于将“同一个健康”作为该机构战略愿景的蒙特里萨大学的案例以及公共卫生学院早期采纳者的经验，我们主张将新的重点放在治理伦理的研究、教学和服务的“边界交叉点”上。该模型采用了现实世界“生活实验室”的形式，结构为社会科学集体，并展示了如何在一个健康和生命伦理之间融合利益，使研究人员能够交流，学习和构建更通用的方法方法，以便在实践中有效地操作跨学科的观点。

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引用次数: 0

Violence against Chinese medical staff 针对中国医务人员的暴力行为

Q3 Medicine

Ethics, Medicine and Public Health

Pub Date : 2025-12-13 DOI: 10.1016/j.jemep.2025.101235

Hong Zhang

引用次数: 0

Structured exercise and cancer survival: The ethical requirement of enablement, or “no ought without support” 结构化锻炼和癌症生存：实现的伦理要求，或“没有支持就不应该”

Q3 Medicine

Ethics, Medicine and Public Health

Pub Date : 2025-12-10 DOI: 10.1016/j.jemep.2025.101231

T. Daly

引用次数: 0

What are the ethical considerations when supporting single women undergoing medically assisted reproduction (MAR)? 在支持单身妇女进行医学辅助生殖（MAR）时，有哪些伦理考虑？

Q3 Medicine

Ethics, Medicine and Public Health

Pub Date : 2025-12-10 DOI: 10.1016/j.jemep.2025.101229

A. Le Bris , N. Decaux Ferré , C. Ravel

Background

Since the revision of French bioethics laws in 2021, requests for medically assisted reproduction (MAR) from single women have increased significantly. Specific challenges are faced by CECOS (Centre d'Étude et de Conservation des Ovocytes et du Sperme humain).

Purpose

This article questions the ethical aspects of current support for single women undergoing MAR and motherhood.

Methods

Here, we analyze single motherhood through the lens of the founding principles of medical ethics: respect for beneficence, non-maleficence, autonomy and justice.

Findings

The decision of a ‘single’ woman to start a family through MAR, without a partner (which does not mean that she is isolated or lonely) as being on the margins of dominant social family norms. Concerns may be expressed about the absence of a second parent and may sometimes mask value judgements on the part of relatives and healthcare professionals.

Conclusions

It is important to support all types of motherhood by consolidating services dedicated to maternal and child health.

背景：自2021年法国生物伦理法修订以来，单身妇女对医疗辅助生殖（MAR）的请求大幅增加。CECOS （Centre d'Étude et de Conservation des ovocyte et du Sperme human）面临着具体的挑战。目的：本文对目前支持单身女性接受生殖移植和成为母亲的伦理问题提出了质疑。方法从医学伦理学的基本原则——尊重善行、非恶意、自主和正义——来分析单身母亲。一个“单身”女性决定在没有伴侣的情况下通过MAR组建家庭（这并不意味着她是孤立的或孤独的），因为她处于主流社会家庭规范的边缘。人们可能会对缺少第二个父母表示关切，有时可能会掩盖亲属和保健专业人员的价值判断。结论通过加强妇幼保健服务来支持所有类型的母亲是很重要的。

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引用次数: 0

Ethics rooted in ritual: Pamuhat in the Philippines indigenous health research 植根于仪式的伦理：菲律宾土著健康研究中的帕穆哈特

Q3 Medicine

Ethics, Medicine and Public Health

Pub Date : 2025-12-10 DOI: 10.1016/j.jemep.2025.101230

C.J.B. Cainday

引用次数: 0

When father holds first: A call for inclusive Unang Yakap in the Philippines 当父亲首先持有：呼吁菲律宾的包容性Unang Yakap

Q3 Medicine

Ethics, Medicine and Public Health

Pub Date : 2025-12-10 DOI: 10.1016/j.jemep.2025.101232

C.J.B. Cainday

引用次数: 0

A bibliometric analysis of vulnerable populations publication in health science research 卫生科学研究中弱势群体出版物的文献计量学分析

Q3 Medicine

Ethics, Medicine and Public Health

Pub Date : 2025-12-04 DOI: 10.1016/j.jemep.2025.101228

Elise M.R. Smith , Diego Kozlowski , Lorenah E. Vásquez , Lubna Daraz , Vincent Larivière

Background

In biomedical and health research, groups identified as “vulnerable” are often excluded from research resulting in lack of evidence and downstream health disparities. This research aims to map out the landscape of published work about vulnerable populations by analyzing (1) groups that are considered vulnerable in published health research, (2) methods that are used to study them, and (3) external factors (country and dichotomized gender of author) that impact research on vulnerable populations.

Methodology

Based on data sourced from PubMed and Web of Science, we used a cross-sectional bibliometric assessment to identify 40,762 publications from 2003 to 2023 that mentioned “vulnerable population” in the abstract, title or keywords. Main outcome measures included the relative frequency of Medical Subject Headings terms in articles about vulnerable populations and all PubMed articles, and distribution of authorships by gender and nationality.

Results

Compared to all PubMed articles, manuscripts featuring social and environmental factors (poverty, immigration, health disparities) were over twenty times more likely to be associated with vulnerable populations. Additionally, community-based and qualitative approaches were more than five times more likely to be associated with vulnerable populations compared to all PubMed articles. Women served as first authors in 45.2% of all publications in PubMed, while they authored 51.3% of the publications on vulnerable populations. The countries contributing the most to vulnerable population research include the U.S. (39.4%), Canada (7.1%), Australia (6.5%), and England (5.3%).

Conclusions

By exposing the construct of vulnerability in health research, this research helps to understand research gaps and biases.

在生物医学和卫生研究中，被确定为“弱势群体”的群体往往被排除在研究之外，导致缺乏证据和下游健康差距。本研究旨在通过分析(1)在已发表的健康研究中被认为是弱势群体的群体，(2)用于研究这些群体的方法，以及(3)影响弱势群体研究的外部因素（国家和作者的二分性别），来绘制弱势群体的已发表作品的景观。方法基于来自PubMed和Web of Science的数据，采用横断面文献计量学评估方法，对2003年至2023年间在摘要、标题或关键词中提到“弱势群体”的40,762篇出版物进行了分析。主要结果测量包括关于弱势群体的文章和所有PubMed文章中医学主题标题术语的相对频率，以及按性别和国籍划分的作者分布。结果与所有PubMed文章相比，具有社会和环境因素（贫困、移民、健康差距）的论文与弱势群体相关的可能性高出20倍以上。此外，与所有PubMed文章相比，基于社区和定性的方法与弱势群体相关的可能性是其5倍以上。在PubMed的所有出版物中，女性是45.2%的第一作者，而在关于弱势群体的出版物中，女性占51.3%。对脆弱人口研究贡献最多的国家包括美国（39.4%）、加拿大（7.1%）、澳大利亚（6.5%）和英国（5.3%）。结论通过揭示健康研究中的脆弱性结构，本研究有助于了解研究差距和偏见。

{"title":"A bibliometric analysis of vulnerable populations publication in health science research","authors":"Elise M.R. Smith , Diego Kozlowski , Lorenah E. Vásquez , Lubna Daraz , Vincent Larivière","doi":"10.1016/j.jemep.2025.101228","DOIUrl":"10.1016/j.jemep.2025.101228","url":null,"abstract":"<div><h3>Background</h3><div>In biomedical and health research, groups identified as “vulnerable” are often excluded from research resulting in lack of evidence and downstream health disparities. This research aims to map out the landscape of published work about vulnerable populations by analyzing (1) groups that are considered vulnerable in published health research, (2) methods that are used to study them, and (3) external factors (country and dichotomized gender of author) that impact research on vulnerable populations.</div></div><div><h3>Methodology</h3><div>Based on data sourced from PubMed and Web of Science, we used a cross-sectional bibliometric assessment to identify 40,762 publications from 2003 to 2023 that mentioned “vulnerable population” in the abstract, title or keywords. Main outcome measures included the relative frequency of Medical Subject Headings terms in articles about vulnerable populations and all PubMed articles, and distribution of authorships by gender and nationality.</div></div><div><h3>Results</h3><div>Compared to all PubMed articles, manuscripts featuring social and environmental factors (poverty, immigration, health disparities) were over twenty times more likely to be associated with vulnerable populations. Additionally, community-based and qualitative approaches were more than five times more likely to be associated with vulnerable populations compared to all PubMed articles. Women served as first authors in 45.2% of all publications in PubMed, while they authored 51.3% of the publications on vulnerable populations. The countries contributing the most to vulnerable population research include the U.S. (39.4%), Canada (7.1%), Australia (6.5%), and England (5.3%).</div></div><div><h3>Conclusions</h3><div>By exposing the construct of vulnerability in health research, this research helps to understand research gaps and biases.</div></div>","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"34 ","pages":"Article 101228"},"PeriodicalIF":0.0,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Can One Health help reduce the environmental impacts of the healthcare system in Switzerland? Insights from an interdisciplinary focus group One Health能否帮助减少瑞士医疗保健系统对环境的影响？来自跨学科焦点小组的见解

Q3 Medicine

Ethics, Medicine and Public Health

Pub Date : 2025-12-02 DOI: 10.1016/j.jemep.2025.101227

G. Brulé , P. Boiko , T. Maillet Mezeray , D. Nadal , S. Vuilleumier , N. Senn , J. Fehr , L. Crivelli , J. Zinsstag , N. Probst-Hensch

Background

Healthcare systems contribute to about 5% of the emissions of the greenhouse gases globally when taken together. With 6.7% of its national emissions of greenhouse gases, the Swiss healthcare system is among the biggest contributors worldwide when taken per capita. Although isolated initiatives to reduce environmental impacts have emerged these last years, there is a strong need for better understanding the barriers and the possibilities for a heuristic framework like One Health to facilitate transformation, in particular in the Swiss context.

Objective

The main objective is to explore to what extent One Health can facilitate transformation of the Swiss healthcare system and a secondary objective is to examine the role of bioethics in reducing healthcare's environmental impact.

Methods

A focus group was conducted with nine experts from different disciplines (medicine, environment, veterinary medicine, public health) at the premises of the Swiss Medical Association in Bern on January 27th, 2025. The discussion lasted 180 min and was audio-recorded. Verbatim was transcribed and analyzed using thematic analysis following COREQ guidelines. Three additional individual interviews were conducted with participants who were not able to attend the focus group.

Results

Six key themes emerged: the need to reorganize healthcare delivery, the specificity of the Swiss governance system, the need to adopt solutions that are “good enough”, One Health as a heuristic framework for systemic change, the required expansion of the borders of bioethics to include environmental and animal welfare considerations and the possible tensions between different dimensions within the One Health framework.

Conclusions

Integrating environmental perspectives through a One Health approach is a possible solution to reduce the environmental impacts of the Swiss healthcare system. The study identifies both barriers (complexity of the Swiss healthcare system, siloed departments) and opportunities (professional willingness to collaborate, the development of post-Covid initiatives) for implementing sustainable healthcare transformation in Switzerland.

卫生保健系统的温室气体排放量加起来约占全球温室气体排放量的5%。瑞士医疗保健系统的温室气体排放量占全国的6.7%，按人均计算，瑞士医疗保健系统是世界上最大的贡献者之一。虽然近年来出现了一些减少环境影响的孤立举措，但迫切需要更好地了解诸如“同一个健康”这样的启发式框架促进变革的障碍和可能性，特别是在瑞士的情况下。主要目的是探索在多大程度上一个健康可以促进瑞士医疗保健系统的转型和次要目标是检查生物伦理在减少医疗保健的环境影响中的作用。方法于2025年1月27日在伯尔尼瑞士医学会总部对来自医学、环境、兽医学、公共卫生等不同学科的9名专家进行焦点小组调查。讨论持续了180分钟，并进行了录音。按照COREQ指南，逐字转录并使用主题分析进行分析。另外还对未能参加焦点小组的参与者进行了三次单独访谈。结果出现了六个关键主题：需要重组医疗保健服务，瑞士治理系统的特殊性，需要采用“足够好”的解决方案，一个健康作为系统变革的启发式框架，需要扩大生物伦理学的边界，包括环境和动物福利的考虑，以及一个健康框架内不同维度之间可能存在的紧张关系。结论通过“同一个健康”方法整合环境观点是减少瑞士医疗保健系统对环境影响的可能解决方案。该研究确定了在瑞士实施可持续医疗保健转型的障碍（瑞士医疗保健系统的复杂性、孤立的部门）和机会（专业合作意愿、制定后疫情举措）。

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