A R Howarth, C S Estcourt, R E Ashcroft, J A Cassell
The General Data Protection Regulation (GDPR) was introduced in 2018 to harmonize data privacy and security laws across the European Union (EU). It applies to any organization collecting personal data in the EU. To date, service-level consent has been used as a proportionate approach for clinical trials, which implement low-risk, routine, service-wide interventions for which individual consent is considered inappropriate. In the context of public health research, GDPR now requires that individuals have the option to choose whether their data may be used for research, which presents a challenge when consent has been given by the clinical service and not by individual service users. We report here on development of a pragmatic opt-out solution to this consent paradox in the context of a partner notification intervention trial in sexual health clinics in the UK. Our approach supports the individual's right to withhold their data from trial analysis while routinely offering the same care to all patients.
{"title":"Building an Opt-Out Model for Service-Level Consent in the Context of New Data Regulations.","authors":"A R Howarth, C S Estcourt, R E Ashcroft, J A Cassell","doi":"10.1093/phe/phab030","DOIUrl":"https://doi.org/10.1093/phe/phab030","url":null,"abstract":"<p><p>The General Data Protection Regulation (GDPR) was introduced in 2018 to harmonize data privacy and security laws across the European Union (EU). It applies to any organization collecting personal data in the EU. To date, service-level consent has been used as a proportionate approach for clinical trials, which implement low-risk, routine, service-wide interventions for which individual consent is considered inappropriate. In the context of public health research, GDPR now requires that individuals have the option to choose whether their data may be used for research, which presents a challenge when consent has been given by the clinical service and not by individual service users. We report here on development of a pragmatic opt-out solution to this consent paradox in the context of a partner notification intervention trial in sexual health clinics in the UK. Our approach supports the individual's right to withhold their data from trial analysis while routinely offering the same care to all patients.</p>","PeriodicalId":49136,"journal":{"name":"Public Health Ethics","volume":"15 2","pages":"175-180"},"PeriodicalIF":2.1,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9719338/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10373174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-01Epub Date: 2022-03-27DOI: 10.1007/s10029-022-02584-z
S Docimo, K Seeras, R Acho, A Pryor, K Spaniolas
Background: Health literacy is considered the single best predictor of health status. Organizations including the American Medical Association (AMA) and the National Institutes of Health (NIH) have recommended that the readability of patient education materials not exceed the sixth-grade level. Our study focuses on the readability of self-designated hernia centers websites at both academic and community organizations across the United States to determine their ability to dispense patient information at an appropriate reading level.
Methods: A search was conducted utilizing the Google search engine. The key words "Hernia Center" and "University Hernia Center" were used to identify links to surgical programs within the United States. The following readability tests were conducted via the program: Flesch-Kincaid Grade Level (FKGL), Gunning Fox Index (GFI), Coleman-Liau Index (CLI), Simple Measure of Gobbledygook (SMOG), and Flesch Reading Ease (FRE) score.
Results: Of 96 websites, zero (0%) had fulfilled the recommended reading level in all four tests. The mean test scores for all non-academic centers (n = 50) were as follows: FKGL (11.14 ± 2.68), GFI (14.39 ± 3.07), CLI (9.29 ± 2.48) and SMOG (13.38 ± 2.03). The mean test scores [SK1] for all academic programs (n = 46) were as follows: FKGL (11.7 ± 2.66), GFI (15.01 ± 2.99), CLI (9.34 ± 1.91) and SMOG (13.71 ± 2.02). A one-sample t test was performed to compare the FKGL, GFI, CLI, and SMOG scores for each hernia center to a value of 6.9 (6.9 or less is considered an acceptable reading level) and a p value of 0.001 for all four tests were noted demonstrating statistical significance. The Academic and Community readability scores for both groups were compared to each other with a two-sample t test with a p value of > 0.05 for all four tests and there were no statistically significant differences.
Conclusion: Neither Academic nor Community hernia centers met the appropriate reading level of sixth-grade or less. Steps moving forward to improve patient comprehension and/or involving with their care should include appropriate reading level material, identification of a patient with a low literacy level with intervention or additional counseling when appropriate, and the addition of adjunct learning materials such as videos.
背景:健康素养被认为是预测健康状况的最佳指标。美国医学会(AMA)和美国国立卫生研究院(NIH)等组织建议,患者教育材料的可读性不应超过六年级水平。我们的研究重点是美国学术机构和社区组织中自我指定的疝气中心网站的可读性,以确定它们是否有能力以适当的阅读水平提供患者信息:方法:使用谷歌搜索引擎进行搜索。方法:利用谷歌搜索引擎进行搜索,使用关键词 "疝气中心 "和 "大学疝气中心 "来查找美国的手术项目链接。通过该程序进行了以下可读性测试:Flesch-Kincaid Grade Level (FKGL)、Gunning Fox Index (GFI)、Coleman-Liau Index (CLI)、Simple Measure of Gobbledygook (SMOG) 和 Flesch Reading Ease (FRE) score:在 96 个网站中,有 0 个网站(0%)在所有四项测试中都达到了建议的阅读水平。所有非学术中心(n = 50)的平均测试得分如下:FKGL (11.14 ± 2.68)、GFI (14.39 ± 3.07)、CLI (9.29 ± 2.48) 和 SMOG (13.38 ± 2.03)。所有学术课程(n = 46)的平均测试分数[SK1]如下:FKGL (11.7 ± 2.66)、GFI (15.01 ± 2.99)、CLI (9.34 ± 1.91) 和 SMOG (13.71 ± 2.02)。对每个疝气中心的 FKGL、GFI、CLI 和 SMOG 分数与 6.9 值(6.9 或更低被认为是可接受的阅读水平)进行了单样本 t 检验,结果显示所有四项检验的 p 值均为 0.001,具有统计学意义。用双样本 t 检验比较了学术组和社区组的可读性得分,所有四项检验的 p 值均大于 0.05,差异无统计学意义:结论:学术疝气中心和社区疝气中心均未达到六年级或六年级以下的适当阅读水平。为提高患者的理解能力和/或参与护理,今后的措施应包括适当的阅读水平材料、识别识字水平低的患者并在适当时进行干预或额外辅导,以及增加辅助学习材料(如视频)。
{"title":"Academic and community hernia center websites in the United States fail to meet healthcare literacy standards of readability.","authors":"S Docimo, K Seeras, R Acho, A Pryor, K Spaniolas","doi":"10.1007/s10029-022-02584-z","DOIUrl":"10.1007/s10029-022-02584-z","url":null,"abstract":"<p><strong>Background: </strong>Health literacy is considered the single best predictor of health status. Organizations including the American Medical Association (AMA) and the National Institutes of Health (NIH) have recommended that the readability of patient education materials not exceed the sixth-grade level. Our study focuses on the readability of self-designated hernia centers websites at both academic and community organizations across the United States to determine their ability to dispense patient information at an appropriate reading level.</p><p><strong>Methods: </strong>A search was conducted utilizing the Google search engine. The key words \"Hernia Center\" and \"University Hernia Center\" were used to identify links to surgical programs within the United States. The following readability tests were conducted via the program: Flesch-Kincaid Grade Level (FKGL), Gunning Fox Index (GFI), Coleman-Liau Index (CLI), Simple Measure of Gobbledygook (SMOG), and Flesch Reading Ease (FRE) score.</p><p><strong>Results: </strong>Of 96 websites, zero (0%) had fulfilled the recommended reading level in all four tests. The mean test scores for all non-academic centers (n = 50) were as follows: FKGL (11.14 ± 2.68), GFI (14.39 ± 3.07), CLI (9.29 ± 2.48) and SMOG (13.38 ± 2.03). The mean test scores [SK1] for all academic programs (n = 46) were as follows: FKGL (11.7 ± 2.66), GFI (15.01 ± 2.99), CLI (9.34 ± 1.91) and SMOG (13.71 ± 2.02). A one-sample t test was performed to compare the FKGL, GFI, CLI, and SMOG scores for each hernia center to a value of 6.9 (6.9 or less is considered an acceptable reading level) and a p value of 0.001 for all four tests were noted demonstrating statistical significance. The Academic and Community readability scores for both groups were compared to each other with a two-sample t test with a p value of > 0.05 for all four tests and there were no statistically significant differences.</p><p><strong>Conclusion: </strong>Neither Academic nor Community hernia centers met the appropriate reading level of sixth-grade or less. Steps moving forward to improve patient comprehension and/or involving with their care should include appropriate reading level material, identification of a patient with a low literacy level with intervention or additional counseling when appropriate, and the addition of adjunct learning materials such as videos.</p>","PeriodicalId":49136,"journal":{"name":"Public Health Ethics","volume":"11 1","pages":"779-786"},"PeriodicalIF":2.3,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88811674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-29eCollection Date: 2022-04-01DOI: 10.1093/phe/phac006
Kristin Voigt
In several countries, governments have implemented so-called 'COVID passport' schemes, which restrict access to venues such as bars or sports events to those who are vaccinated against COVID-19 and/or exempt vaccinated individuals from public health measures such as curfews or quarantine requirements. These schemes have been the subject of a heated debate. Concerns about inequality have played an important role in the opposition to such schemes. This article highlights that determining how COVID passports affect equality requires a much more nuanced analysis than is typically assumed. I identify a range of broadly egalitarian considerations that could be affected by the introduction of COVID passport schemes. While these schemes could undermine certain aspects of equality, I argue that they could also be used to promote equality. The magnitude and severity of these different effects, both promoting and undermining equality, depend on how precisely these schemes are framed and the local context in which they are implemented.
{"title":"COVID-19 Vaccination Passports: Are They a Threat to Equality?","authors":"Kristin Voigt","doi":"10.1093/phe/phac006","DOIUrl":"10.1093/phe/phac006","url":null,"abstract":"<p><p>In several countries, governments have implemented so-called 'COVID passport' schemes, which restrict access to venues such as bars or sports events to those who are vaccinated against COVID-19 and/or exempt vaccinated individuals from public health measures such as curfews or quarantine requirements. These schemes have been the subject of a heated debate. Concerns about inequality have played an important role in the opposition to such schemes. This article highlights that determining how COVID passports affect equality requires a much more nuanced analysis than is typically assumed. I identify a range of broadly egalitarian considerations that could be affected by the introduction of COVID passport schemes. While these schemes could undermine certain aspects of equality, I argue that they could also be used to <i>promote</i> equality. The magnitude and severity of these different effects, both promoting and undermining equality, depend on how precisely these schemes are framed and the local context in which they are implemented.</p>","PeriodicalId":49136,"journal":{"name":"Public Health Ethics","volume":"15 1","pages":"51-63"},"PeriodicalIF":1.4,"publicationDate":"2022-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9188378/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61606035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Public reason demands that policies are justified to all reasonable citizens. Public health aims at protecting or improving aggregated health outcomes. Since health is not an uncontroversial value, an insurmountable chasm between public reason and public health seems to preclude any viable synthesis between the two outlooks. For any given public health policy, some reasonable citizen seems to have a reason to support ‘no policy’ over ‘some policy’, meaning that the policy cannot be justified to all. The paper first spells out what exactly this conflict is about. Then, using smoking as a case, the paper outlines a model of reconciliation between public reason and public health that should give us some optimism if we want to have public health policies that are compatible with treating citizens as free and equal in the public reason sense.
{"title":"Public Reason and Public Health: Can Anti-smoking Policies Be Justified According to a Public Reason Account of Justification?","authors":"M. Nielsen","doi":"10.1093/phe/phac007","DOIUrl":"https://doi.org/10.1093/phe/phac007","url":null,"abstract":"\u0000 Public reason demands that policies are justified to all reasonable citizens. Public health aims at protecting or improving aggregated health outcomes. Since health is not an uncontroversial value, an insurmountable chasm between public reason and public health seems to preclude any viable synthesis between the two outlooks. For any given public health policy, some reasonable citizen seems to have a reason to support ‘no policy’ over ‘some policy’, meaning that the policy cannot be justified to all. The paper first spells out what exactly this conflict is about. Then, using smoking as a case, the paper outlines a model of reconciliation between public reason and public health that should give us some optimism if we want to have public health policies that are compatible with treating citizens as free and equal in the public reason sense.","PeriodicalId":49136,"journal":{"name":"Public Health Ethics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2022-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43782015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract In this short piece, I attempt to respond to some of the challenges raised by Jessica Nihlén Fahlquist and Karen Meagher in their commentaries on my paper, ‘Public Health Virtue Ethics’. While these authors have made many insightful and challenging remarks, I mostly focus on two questions here: first, about the nature of collectives as moral agents, in response to Nihlén Fahlquist, and second, about the concept of a collective-level virtue, in response to Meagher.
在这篇短文中,我试图回应Jessica nihl n Fahlquist和Karen Meagher对我的论文“公共卫生美德伦理”的评论中提出的一些挑战。虽然这些作者发表了许多富有洞察力和挑战性的言论,但我在这里主要关注两个问题:第一,关于集体作为道德行为体的本质,回应nihl Fahlquist;第二,关于集体层面美德的概念,回应Meagher。
{"title":"Response: Collective Moral Agents and Their Collective-Level Virtues","authors":"K. MacKay","doi":"10.1093/phe/phac008","DOIUrl":"https://doi.org/10.1093/phe/phac008","url":null,"abstract":"Abstract In this short piece, I attempt to respond to some of the challenges raised by Jessica Nihlén Fahlquist and Karen Meagher in their commentaries on my paper, ‘Public Health Virtue Ethics’. While these authors have made many insightful and challenging remarks, I mostly focus on two questions here: first, about the nature of collectives as moral agents, in response to Nihlén Fahlquist, and second, about the concept of a collective-level virtue, in response to Meagher.","PeriodicalId":49136,"journal":{"name":"Public Health Ethics","volume":"15 1","pages":"23 - 26"},"PeriodicalIF":2.1,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61606174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Conservative assumptions in medical ethics risk immense harms during a pandemic. Public health institutions and public discourse alike have repeatedly privileged inaction over aggressive medical interventions to address the pandemic, perversely increasing population-wide risks while claiming to be guided by 'caution'. This puzzling disconnect between rhetoric and reality is suggestive of an underlying philosophical confusion. In this paper, I argue that we have been misled by status quo bias-exaggerating the moral significance of the risks inherent in medical interventions, while systematically neglecting the (objectively greater) risks inherent in the status quo prospect of an out-of-control pandemic. By coming to appreciate the possibility and significance of status quo risk, we will be better prepared to respond appropriately when the next pandemic strikes.
{"title":"Pandemic ethics and status quo risk","authors":"R. Chappell","doi":"10.1093/phe/phab031","DOIUrl":"https://doi.org/10.1093/phe/phab031","url":null,"abstract":"Conservative assumptions in medical ethics risk immense harms during a pandemic. Public health institutions and public discourse alike have repeatedly privileged inaction over aggressive medical interventions to address the pandemic, perversely increasing population-wide risks while claiming to be guided by 'caution'. This puzzling disconnect between rhetoric and reality is suggestive of an underlying philosophical confusion. In this paper, I argue that we have been misled by status quo bias-exaggerating the moral significance of the risks inherent in medical interventions, while systematically neglecting the (objectively greater) risks inherent in the status quo prospect of an out-of-control pandemic. By coming to appreciate the possibility and significance of status quo risk, we will be better prepared to respond appropriately when the next pandemic strikes.","PeriodicalId":49136,"journal":{"name":"Public Health Ethics","volume":"15 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61605811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}