Ethics, Medicine and Public Health最新文献

Our relationship with the body and life varied throughout history, as it adapts to beliefs and life circumstances and is influenced by our interactions with non-human entities, whether living or non-living. Additionally, our understanding of the body is shaped by our analytical techniques and disciplines that have rationalized our understanding of the world we inhabit. The 21st century has become the century of biology, following the clinical and therapeutic revolution. The knowledge acquired so far has expanded to encompass a molecular and genetic perspective on our bodies. This biological revolution already offers, and will continue to offer, dizzying possibilities for modifying the human being, which raises an inconceivable number of ethical questions. Through an interdisciplinary approach, we address the contemporary evolution of our relationship to the body and its fragility.

Background

The quality of registry-based research depends on the quality of the registered data. The registration of cause of death could be affected by medical history e.g., if cause of death is unclear in a man previously suspected of prostate cancer. Therefore, we assessed the cause of death in men with initial non-malignant prostate biopsy.

Methods

From the Danish Prostate Cancer Registry (DaPCaR) men with initial non-malignant biopsies between January 1st, 1995 to December 31st, 2016 who, according to the Danish Register of Cause of Death, subsequently died of prostate cancer (n = 964) or other causes (n = 9,362) until December 31st, 2019 were identified. All men with prostate cancer death and 1000 randomly selected men who died of other causes, were manually assessed by two experienced urologists. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated for the Cause of Death registry with the manual assessment as standard.

Results

According to manual assessment, 183 men with non-malignant biopsy and subsequent prostate cancer death had metastatic disease at time of non-malignant biopsy and were excluded for further analysis. There was a total of 428 true positives and 353 false positives for prostate cancer-specific death. Moreover, 993 true negatives and 7 false negatives were assessed for other causes of death. The NPV was 99.3% (95%CI: 98.6–99.7), the PPV 54.8% (95%CI: 51.2–58.3), the sensitivity 98.4% (95%CI: 96.7–99.4), the specificity 73.8% (95%CI: 71.3–76.1) and the accuracy 79.8% (95%CI: 77.8–81.6).

Conclusion

In men with initial non-malignant biopsy, the cause of death registry is highly reliable in defining who does not die of the disease at the cost of overestimating the disease-specific death. Thus, future registry studies in similar settings should control the cause of death to assure that disease-specific mortality is not inflated.

Introduction

In the recent past, due to the pandemic and humanitarian crisis, the healthcare system has dived into turmoil, especially regarding core facilities for women and maternal health. Afghanistan has the highest maternal mortality rate globally according to the WHO.

Methodology

Extensive research was performed regarding maternal health crises in Afghanistan using appropriate keywords. The inclusion criteria were case reports, case studies, systematic reviews and original articles in English.

Implications of current crises on the problem

In such a decrepit system, regime changes resulted in major donors withdrawing from the national primary care service program leading to serious consequences for Afghani.

Challenges

Major challenges faced by the Afghan healthcare system include the cessation of international funding due to the humanitarian crisis, the shortage of medicines and the failure to deliver salaries to healthcare workers. More than 90% of healthcare facilities are at risk of closure, leading to an estimated 4.8 million unattended pregnancies and 51,000 maternal deaths between 2021 and 2025.

Current efforts

To ensure such a catastrophe does not arise, the World Bank, Office for the Coordination of Humanitarian Affairs and UNFPA in collaboration with governments around the world have pledged aid, both monetary and in terms of equipment & resources to Afghanistan.

Recommendations

Local Afghan organizations such as the AHDS and JACK must also be supported to further their work in providing healthcare services.

Conclusion

The health system in Afghanistan, particularly maternal health, has suffered greatly in the last two years and therefore, if no aid or funding is provided, a disaster is bound to occur.

Background and aim

WHO's definition of oral health extends beyond the state of the teeth and dental pathologies. However, dental pathologies form a significant component of oral health and impact a person's quality of life. Thus, dental pathologies can elucidate intra-vitam oral health and dietetics of ancient or contemporary populations. This paper aimed at predicting the oral health and intra-vitam stress of past inhabitants across five regions in Ghana from dental pathologies.

Method

The study employed the mixed research approach involving standard anthropological observational scoring systems to examine five dental pathologies: caries, calculus, abscess, enamel hypoplasia, and cementum hyperplasia. The scores were translated into absent (0)/present (1) pathology categories and the frequency was calculated in an Excel sheet.

Results and discussion

Dental pathologies constituted 60% of the total pathologies recorded on human remains, with calculus being dominant (35%), followed by caries (30%), enamel hypoplasia (21%), abscess (9%), and hypercementosis (7%). In general, the individuals from Sekondi presented the highest percentage of dental pathologies, i.e., 69% caries, 66% calculus, 50% abscess, 44% enamel hypoplasia, and 5% hypercementosis. Begho and Yapei individuals had equal percentages of abscesses, enamel hypoplasia, and calculus, while hypercementosis was relatively low in all cases. More than one individual combined multiple dental pathologies, while 6 had none. Grounded on the high caries and calculus expression rates and their direct influence on other dental pathologies, the individual's oral health could have been compromised by dietary patterns, developmental factors, functional stress on the teeth, and inadequate oral hygiene.

Conclusion

The assessment of the dental pathologies of these Ghanaian ancestors offered valuable insights into dietetics, oral health, and some intra-vitam developmental and functional stress on the teeth.

Background

Two widely quoted sayings about the importance of hearing compared with vision, are considered.

Methodology

The words “not to see will distance me from things, while not to listen will distance me from people” have been attributed to Immanuel Kant. The similar words “blindness cuts us off from things, but deafness cuts us off from people” have been attributed to Helen Keller.

Results

Neither attribution seems to be correct. Both authors however, had insights into hearing versus seeing. From there, we can reflect upon hearing versus listening, and consider in what ways deaf persons may think (for example, speech-words, sign gestures, emotions, or facial expressions). Listening is a prerequisite to having a meaningful dialogue, in order to come to know truth.

Conclusion

Having an open and reflective dialogue is arguably the foundation for shared decision-making, aimed at helping patients and clinicians decide what course of action will maximize their good, in their clinical situation.