Ethics, Medicine and Public Health最新文献

Iconodiagnosis consists of a retrospective medical diagnosis carried out on a work of art depicting a human person. For a hundred years, physicians have embarked on this practice, making it possible to supplement epidemiological data on the existence of diseases in ancient periods or past populations, but also to train physicians in their clinical and semiological sense. Faced with the exponential increase in publications in this field, it was necessary to propose clear rules and a precise and rigorous methodology allowing a serious practice of iconodiagnosis.

Background

The COVID-19 pandemic has led to an unprecedented global mobilization of biomedical research, especially as some countries have experienced a shortage of medical resources. Bioethicists have proposed to question the entanglement of care and research in the event of a pandemic. Above all, research could be seen as a moral duty for professionals but also as the best interest of patients in a context of uncertainty. In addition, participating in biomedical research could be a decisive factor in the prioritization decision in the event of a shortage of medical resources. However, these proposals from American bioethicists have not been submitted for approval by French health professionals.

Methodology

The Research Ethics Committee of the University Hospital of Bordeaux, France, has conceived a survey exploring the opinion of health professionals of the institution concerning the current French regulations on research ethics in the pandemic, on the intertwining of care and research during a pandemic, and concerning proposals on reciprocity between care and research in a context of a global pandemic.

Results

Out of 439 responses collected, the main results showed that a large majority of healthcare professionals agreed that research constitutes an ethical duty for professionals but must also be considered as the best interests of patients in the event of pandemic (90.6% and 75.5% respectively). Health professionals also considered a possible reciprocal commitment of patients through their inclusion in biomedical research since they benefit from care in situations of scarcity of medical resources (from 55.6% to 86.2% depending on the type of study). Contrary to recommendations, the respondents were mostly opposed to the prioritization of patients included in biomedical research in the event of a prioritization process for the allocation of medical resources (64.7% against the use of this criterion in triage decisions).

Discussion

This survey showed that health professionals of our institution were ready to consider a paradigm shift in the way care and research could be considered in times of a pandemic of an emerging infectious agent, and in a context of tension for access to medical resources. A deeper entanglement of care and research needs careful consideration given the possible implications for consent processes and the ethical review of research protocols. In addition, it involves the preparedness and coordination of health professionals and health systems on a large scale.

Conclusion/Perspectives

Additional studies, including in-depth explorations with stakeholders, especially representatives of patients and society, are needed to better understand how a pandemic context should induce major adaptations in the way of considering the interaction between care and research.

Background

Stress is widely acknowledged to have an influence on physical activity and dietary habits. The prevalence of stress levels has drastically increased following the unprecedented Covid-19 outbreak. The transition to the endemic phase of Covid-19 is currently underway in Malaysia. This study aims to investigate the perceived stress levels, physical activity habits, and dietary behaviors of young adults in Malaysia during this transition to the endemic phase.

Methods

This cross-sectional study was conducted from 5th November to 30th December 2022, using an online questionnaire consisting of three main sections: sociodemographic, physical activity and dietary behavior scale, and perceived stress scale.

Results

The prevalence of low perceived stress (LPS) was found to be greater than high perceived stress (HPS), with LPS accounting for 54% and HPS accounting for 46%. HPS young adults exhibited significantly higher levels (P < 0.05) of stress eating, overeating, and skipping main meals compared to LPS. Positive correlations were observed between perceived stress and stress eating (P = 0.001), skipping breakfast (P = 0.025), skipping lunch (P = 0.005), skipping dinner (P = 0.001), and overeating (P = 0.007).

Conclusion

The present study reveals the need to implement health interventions focusing on nutrition and stress management for young adults experiencing high levels of perceived stress.

Background

Unfortunately, many unreasonable measures and biased positions constituted the pandemic scenario in the last years worldwide.

Methodology

It is a critical theoretical essay.

Discussion

Reinforcement of dilemmas without criteria fostered the impoverishment of the discourses. In the current stage, when many measures, research data, and government documents are reviewed in depth, dealing with truth becomes a big challenge.

Perspectives

Considering the possibility that countless lives could have been preserved if the real principles of science and rational debate were not misrepresented, the near future will not be easy.

Background

To address health inequity with evidence-based care, research needs to be inclusive. One of the most common practices when facing language barriers is the exclusion of participants with limited English proficiency (LEP). Language provisions in clinical research are necessary to ensure diversity and inclusion in research, and thus health equity. We evaluated the inclusion or exclusion of participants with LEP through provisions (or lack thereof) of language accommodations in research study designs and protocols at our institution.

Methodology

A cross-sectional quality improvement evaluation reviewed approved submissions to the University of British Columbia Children's & Women's (UBC C&W) research ethics board (REB) between 2017 to 2021 inclusively. Qualitative data was thematically coded and quantitatively analyzed to assess provisions for research activities to be completed in non-official languages.

Results/Discussion

Six hundred and ninety-eight prospective study submissions involving interaction with patients and public participants approved by the UBC C&W REB were reviewed. Just under a third (228/698) of submissions specifically excluded participants based on English language proficiency. Of the submissions that included participants with LEP, only 53.0% (249/470) made any mention of provisions for participants with LEP. All studies providing full language provisions, including translation of study documents and interpretation for the informed consent process, were funded in some capacity.

Conclusion/Perspectives

A third of REB submissions at the UBC C&W make provisions for research participants with LEP to include them in clinical research. Insufficient funding may be a key factor prohibiting provision of language accommodations, which may be a targetable barrier in designing accessible and inclusive clinical studies.

Background

The attainment of sustainable development goals has necessitated shifting focus from maternal mortality to maternal morbidity arising from perinatal mental health (PMH) conditions. In 2014, the World Health Organization (WHO) informed about insufficient evidence to recommend routine briefing for postnatal depression (PPD). However, the WHO Recommendations, published in the year 2022, provide for routine screening for PMH conditions including PPD, and anxiety, using validated tools.

Method

By adopting methods including comparative content analysis, and thematic analysis, this work underscores the health policy changes suggested by the 2022 Recommendations in contrast to the 2014 Recommendations, regarding the PMH conditions. The limitations and gaps left uncovered by the 2022 Recommendations will also be discussed in the context of findings of epidemiological studies.

Result

The 2022 Recommendations, unlike the 2014 Recommendations, consolidated positioning of PMH services in the postnatal healthcare framework and introduced road map for managing PMH conditions. However, the issues which still remained unattended can impede attainment of objectives of the 2022 Recommendations, and its positive impact. Policymakers need to be precautious about these limitations while formulating health policies based on the 2022 Recommendations.

Conclusion

There is an urgent need of adopting more holistic approach while introducing PMH related health laws and policies. Preclusion of antenatal care guidelines, and high-risk populations from the scope of these Recommendations warrants introduction of new recommendations, at the earliest, to fill the void.

Background

Do physicians have a moral obligation to oppose war? Historical examples suggest the conundrum associated with dealing with that issue. During the First World War some 16,000 men were identified as Conscientious Objectors in England. Conspicuously absent from these men were any physicians.

Historical Examples

William Osler (1849–1919) put on a public face of supporting the War effort, yet he and his wife Grace worried privately about the possibility of their son, Revere, participating. With the loss of Revere to the War, Osler's attitude towards war changed dramatically and he bemoaned the cost associated with war and questioned whether Science would be the salvation or the ruin of mankind. Several of Osler's contemporaries took pacifist stances against war.

Contemporary Perspective

Contemporarily, how should physicians project their authority in a world still aflame with the possibility of war? This paper will provide contemporary thoughts on the issue and provide insight into the dilemmas faced by physicians and war.