ObjectivesThis study examined the association between childhood adversity and cognitive impairment in later life and explored the potential moderation effect of gender and race.MethodsThe study sample included 15,133 participants of the Health and Retirement Study who had complete data on key study measures and were more than 50. The outcome variable is a dichotomous indicator of cognitive impairment as assessed by the Telephone Interview for Cognitive Status for self-respondents and the 16-item Informant Questionnaire on Cognitive Decline in the Elderly for (...) proxies. A total of six childhood adversity indicators included grade retention, parental substance abuse, physical abuse, trouble with the police, moving due to financial hardship, and receipt of help due to financial hardship in early life. The estimation of the association between childhood adversity and cognitive impairment involved Cox proportional hazards regression. Results: Grade retention had the largest effect on incident cognitive impairment, followed by physical abuse by a parent. The impact of grade retention was more detrimental to women than men. Parental substance abuse was associated with a lower risk of incident cognitive impairment for most racial groups, but this association was reversed in “non-Hispanic other” race, consisting mainly of Asians.DiscussionSome aspects of childhood adversity continue to harm cognitive functioning in later life, while some events may have the opposite effect, with evidence of heterogeneity across gender and race. (shrink)

Many major medical institutions have now embraced the idea that it is best to be honest with patients and families when an error causes harm that could have been avoided. This kind of disclosure improves patient safety and quality of care; enhances satisfaction for patients, families, and providers; and reduces malpractice litigation costs. The University of Michigan has perhaps the best‐known program. Since 2001, that institution has seen more than a 55 percent drop in the number of new malpractice claims (...) filed, a comparable reduction in lawsuits, and a dramatic drop in both defense costs and malpractice payouts—money then redirected toward quality improvement. A few states have also embraced this approach, sometimes known as “Candor” (for “communication and optimal resolution”). Yet all of these efforts face a major challenge. Although many physicians would like very much to achieve insight, reconciliation, and quality improvement in just this way, many fear that money paid to resolve an incident in which they were involved can result in a lifelong black mark in the National Practitioner Data Bank. (shrink)

PurposeThis paper is an exploratory study to investigate possible remedial measures accounting for a relatively favorable prognosis of health sector workers who have experienced physical WPV in Zhejiang province, China.MethodsFollowing a proportionate stratified sampling strategy, five tertiary hospitals, eight secondary hospitals, and thirty-two primary care facilities were conveniently selected. Among 4,862 valid respondents out of 6,089 self-conducted questionnaires, 224 health sector workers who have been directly exposed to physical WPV in the past year were included in the present study.ResultsThe present (...) study has three major findings: Victims’ satisfaction with the resolution of the physical WPV conflict was directly associated with the favorable prognosis. Taking days off from work after the violence can promote victims’ satisfaction with the resolution of the physical WPV conflict. Knowing that relevant departments investigated the case can promote victims’ satisfaction with the resolution of the physical WPV conflict.ConclusionWe propose a combined gesture of “offering adequate days off work after physical WPV” and “every physical violence must be investigated” that should be taken by all medical institutions in China. Health sector workers who get involved in physical WPV incidents should prioritize their safety and avoid any behavior that may intensify the conflicts. (shrink)

It is widely claimed that climate change has increased the magnitude and the frequency of natural phenomena such as storms, droughts, and floods with the concomitant costs in terms of damages and victims. This paper using weekly data from global stock market indices in a Fama–French model, examines how and to what extent market agents and investors react to such events. As a yardstick for comparison purposes, the possible market impact of industrial accidents is also incorporated and examined in the (...) empirical investigation. The study uses in a comparative approach the STOXX Global ESG Environmental Leaders index and the STOXX Global index diversified across 1800 top companies. Results reported herein seem to indicate that natural and anthropogenic adversity have no immediate impact on the stock indices, while wildfires have an immediate reduction impact on market risk in the case of the ESG Environmental Leaders index. Moreover, wildfires and industrial accidents appear to cause a significant reduction of systematic risk over the next week following the incident. However, the magnitude of the effect is higher in the case of the ESG Environmental Leaders stock index. Finally, the effect on systematic risk by industrial accidents is temporarily without any lasting imprint. (shrink)

Em seus últimos anos de vida, Foucault empreendeu uma genealogia da parresia (do dizer-verdadeiro) no campo da política e na história da filosofia. Alicerçando suas análises nas fontes clássicas, gregas e romanas, Foucault descortinou um cenário no qual a coragem da verdade tem um lugar maior na experiência política desde sempre. O que pretendemos nesse trabalho é discutir alguns pontos que nos parecem problemáticos nessa genealogia foucaultiana, em especial, a referência à verdade na parresia democrática e a relação entre filosofia (...) e política. Palavras-Chave: Foucault. Parresia. Democracia. Filosofia. (shrink)

O objetivo do artigo é compreender alguns aspectos do republicanismo de Maquiavel concedendo atenção à sua teoria dos humores. Mais especificamente, trata-se de entender qual a natureza do desejo do povo e seu papel na vida política. A principal hipótese deste trabalho é a de que a função que Maquiavel atribui ao povo, o guardião da liberdade, exige, para seu cumprimento, a participação ativa do cidadão nos afazeres cívicos, isto é, sua inscrição no espaço público como agente político. Essa inscrição (...) não pode ser inteiramente compreendida se o desejo que caracteriza o povo carecer de qualquer determinação, isto é, se for tomado somente em uma perspectiva negativa. (shrink)

O objetivo deste trabalho é demonstrar que o pensamento de Maquiavel, ao colocar no centro da vida política um conflito insuperável entre as partes constituintes da cidade, lança as bases para uma nova compreensão da república e da liberdade. Esta teoria dos “humores”, como ele a denominava, também lança luz sobre o dinamismo das sociedades democráticas, como podemos constatar nos trabalhos de Claude Lefort.

Aceitando o pressuposto de que política e guerra são domínios afins em Maquiavel, nós pretendemos neste artigo examinar a especificidade da arte da guerra em cotejamento com a arte do Estado. Se as homologias entre os dois campos são evidentes, resta investigar os pontos em que eles se diferenciam de modo decisivo. Para tanto, será preciso fazer duas coisas: por um lado, destacar as principais componentes da arte da guerra como conjunto de práticas; por outro lado, demonstrar que ela somente (...) pode alcançar seus objetivos se for capaz de produzir a união entre os integrantes do exército. (shrink)

Este artigo tem por objetivo mostrar que a crítica de Hannah Arendt ao social, formulada sobretudo em A condição humana, não deve obscurecer o fato de que sua teoria do político não apenas é compatível com a ideia de sociedade civil, mas a mobiliza em determinados contextos, o que pode ser comprovado quando retomamos seu livro sobre as revoluções e seu texto sobre a desobediência civil.

RESUMO Neste artigo pretendemos mostrar as vantagens do modelo epistemológico coerentista quando aplicado ao universo moral. O ponto de partida será apontar que a justificação da crença moral é dada pela coerência com um sistema coerente de crenças que é consistente e que isso pretende resolver o problema da dicotomia entre fato e valor. Posteriormente, apresentam-se as características centrais do coerentismo holístico e investiga-se o método do equilíbrio reflexivo. O próximo passo será fazer referência a três conhecidas objeções ao coerentismo, (...) a saber: o problema do isolamento, os sistemas coerentes alternativos e a circularidade viciosa. Por fim, procuramos responder a essas objeções apelando para os seguintes argumentos: holismo social, razoabilidade e estabilidade social. ABSTRACT In this paper we aim to demonstrate the advantages of the epistemological coherentist model when applied to the moral sphere. The starting point will be to show that the justification of moral belief is a matter of how beliefs fit together with a coherent system of beliefs that is consistent and that it tries to solve the issue of the fact/value dichotomy. Following this, we shall point out the core characteristics of the holistic coherentism and we will investigate the reflective equilibrium method. Next step is to show three standard objections to coherentism, namely, the isolation problem, the alternative coherent systems objection and the vicious circularity. Finally, we shall then try to respond these criticisms with the following arguments: social holism, reasonableness and social stability. (shrink)

The current scandal surrounds the global breast implant scare of silicone implants made by France's Poly Implant Prothese (PIP) Company. An ensuing review recognized that efforts in investigating the distress caused to so many women were hampered by a lack of reliable and comprehensive information about all the adverse incidents relating to PIP breast implants, as well as uncertainty about comparative data on similar products. One of the recommendations following the review was the investigation of the potential for (...) re-establishing a breast implant registry, which could facilitate the availability of adverse incident reporting in cases such as these. The insistence of compulsory inclusion in such registries would override the debate on informed consent in epidemiological studies and public health. The ethics of clinical research with its focus on individual consent is difficult to reconcile with the ethical requirements of research at a population level as in the case of registries. (shrink)

Research suggests that the incidence of moral distress experienced by health professionals is significant and increasing, yet the concept lacks clarity and remains largely misunderstood. Currently, there is limited understanding of moral distress in the context of midwifery practice. The term moral distress was first used to label the psychological distress experienced following complex ethical decision-making and moral constraint in nursing. The term is now used across multiple health professions including midwifery, nursing, pharmacy and medicine, yet is used cautiously due (...) to confusion regarding its theoretical and contextual basis. The aim of this study is to understand the concept of moral distress in the context of midwifery practice, describing the attributes, antecedents and consequences. This concept analysis uses Rodgers’ evolutionary framework and is the first stage of a sequential mixed-methods study. A literature search was conducted using multiple databases resulting in eight articles for review. Data were analysed using NVivo12©. Three core attributes were identified: moral actions and inactions, conflicting needs and negative feelings/emotions. The antecedents of clinical situations, moral awareness, uncertainty and constraint were identified. Consequences of moral distress include adverse personal professional and organisational outcomes. A model case depicting these aspects is presented. A midwifery focused definition of moral distress is offered as ‘a psychological suffering following clinical situations of moral uncertainty and/or constraint, which result in an experience of personal powerlessness where the midwife perceives an inability to preserve all competing moral commitments’. This concept analysis affirms the presence of moral distress in midwifery practice and provides evidence to move towards a consistent definition of moral distress. (shrink)

From a national U.S. sample of senior academic biochemists, ninety-four indicated that they personally knew of an incident of scientific wrongdoing. Among these individuals, less formal actions against an offending individual were endorsed when either actions were believed to have the potential to publicly embarrass the offending individual, or the actions might adversely affect the professional career of the whistleblower. These relationships remain significant after controlling for professional status, career age, and current level of formal departmental administrative responsibility. Study limitations (...) and implications are discussed. (shrink)

Social isolation and loneliness are ongoing threats to health made worse by the coronavirus disease 2019 pandemic. During the pandemic, half the globe's population have been placed under strict physical distancing orders and many long-term care facilities serving older adults went into lockdown mode, restricting access to all visitors, including family members. Before the pandemic emerged, a 2020 National Academy of Sciences, Engineering and Medicine report warned of the underappreciated adverse effects of social isolation and loneliness on health, especially (...) among older populations. Social isolation and loneliness predict all-cause mortality at rates that rival clinical risk factors, such as obesity and smoking; they are associated with greater incidence of psychological, cognitive, and physical morbidities. This paper sets forth a proposal to design robots to function as companions and friends for socially isolated and lonely older people during pandemic emergencies and in aging societies more generally. “The proposal” section presents and defends the proposal. The “Replies to objections” section answers objections based on coercive design, replacement of humans with robots, privacy incursions, and counterfeit companionship. The “Conclusion” section submits that sociable robots offer a promising avenue for addressing social isolation and loneliness during pandemics and hold promise for aging societies more broadly. (shrink)

Recent findings in epigenetics have been attracting much attention from social scientists and bioethicists because they reveal the molecular mechanisms by which exposure to socioenvironmental factors, such as pollutants and social adversity, can influence the expression of genes throughout life. Most surprisingly, some epigenetic modifications may also be heritable via germ cells across generations. Epigenetics may be the missing molecular evidence of the importance of using preventive strategies at the policy level to reduce the incidence and prevalence of common diseases. (...) But while this “policy translation” of epigenetics introduces new arguments in favor of public health strategies and policy-making, a more “clinical translation” of epigenetics is also emerging. It focuses on the biochemical mechanisms and epigenetic variants at the origin of disease, leading to novel biomedical means of assessing epigenetic susceptibility and reversing detrimental epigenetic variants. In this paper, we argue that the impetus to create new biomedical interventions to manipulate and reverse epigenetic variants is likely to garner more attention than effective social and public health interventions and therefore also to garner a greater share of limited public resources. This is likely to happen because of the current biopolitical context in which scientific findings are translated. This contemporary neoliberal “regime of truth,” to use a term from Michel Foucault, greatly influences the ways in which knowledge is being interpreted and implemented. Building on sociologist Thomas Lemke's Foucauldian “analytics of biopolitics” and on literature from the field of science and technology studies, we present two sociological trends that may impede the policy translation of epigenetics: molecularization and biomedicalization. These trends, we argue, are likely to favor the clinical translation of epigenetics—in other words, the development of new clinical tools fostering what has been called “personalized” or “precision” medicine. In addition, we argue that an overemphasized clinical translation of epigenetics may further reinforce this biopolitical landscape through four processes closely related to neoliberal pathways of thinking: the internalization and isolation of socioenvironmental determinants of health and increased opportunities for commodification and technologicalization of health care interventions. (shrink)

Immersive virtual reality (VR) emerges as a promising research and clinical tool. However, several studies suggest that VR induced adverse symptoms and effects (VRISE) may undermine the health and safety standards, and the reliability of the scientific results. In the current literature review, the technical reasons for the adverse symptomatology are investigated to provide suggestions and technological knowledge for the implementation of VR head-mounted display (HMD) systems in cognitive neuroscience. The technological systematic literature indicated features pertinent to display, (...) sound, motion tracking, navigation, ergonomic interactions, user experience, and computer’s hardware that should be considered by the researchers. Subsequently, a meta-analysis of 44 neuroscientific or neuropsychological studies involving VR HMD systems was performed. The meta-analysis of the VR studies demonstrated that the new generation HMDs induced significantly fewer dropouts and VRISE. Importantly, the commercial versions of the new generation HMDs with ergonomic interactions had zero incidents of adverse symptomatology and dropouts. Solely, HMDs equivalent to or greater than the commercial versions of contemporary HMDs accompanied with ergonomic interactions are suitable for implementation in cognitive neuroscience. In conclusion, researchers’ technological competency, along with meticulous methods and reports pertinent to software, hardware, and VRISE, are paramount to ensure the health and safety standards and the reliability of neuroscientific results. (shrink)

Research in the subject area of economics (as a social science) has defined its ontologie of scientific investigation through economic methodology; a philosophical approach entailing the proviso of empirical evidence and backed by an understanding of human interaction in their natural habitat. The contention of economic methodology being refuted for its non-scientific means of investigation and particularly with the application of Ceteris Paribus (CP) law, has been critically addressed in this article, with Sierra Leone as a case example. Sierra Leone (...) is a complex economy and issues surrounding the assumption of CP has been brought to the fore, with a view of the political economy structure being made transparent so as to make it possible for economists to address critical issues surrounding corruption (exogenous factors), not accounted for in econometric modelling. This is not necessarily that which is considered as the most obvious, with the use of CP concept, for example, the influence of naturally occurring incidents like adverse weather conditions, flooding and earthquakes. (shrink)

This article examines the ways in which Bruce Nauman’s art installations provoke audience experiences analogous to those felt during traumatic events. A central assertion of the present study is that the looping mechanisms of Nauman’s video artworks produce a theoretical stilling of the moving image that is reflective of the fight-flight-or-freeze response to a highly charged incident, which often entails a temporal shift as time appears to slow to a halt. Whereas in the past, the human response to acute stress (...) was typically prompted by a physical threat in the natural environment, today an evolutionary misfire occurs when this survival mechanism becomes prompted instead during everyday situations. Throughout human history, the experience of viewing an artwork has developed into an act of aesthetic appreciation involving a search for meaning. However, in this case, the sensory overload triggered by Nauman’s artwork purposefully impedes neuroprocessing, highlighting the adverse effects of mediation saturation in contemporary society; therefore, a stilling of the moving image in essence functions as a biological adaptation strategy in an attempt to come to terms with the puzzling nature of these artworks. By applying French philosopher Roland Barthes’s theories of the image, this article expands Barthes’s thought from the image to the performative as a reflection of human adaptation to technological advancement. (shrink)

This thoughtful reflection on a valuable questionnaire survey of patients' attitudes regarding being told that their dentist had been infected with hepatitis B is of very direct relevance to HIV, as the authors show.1 The measured tone and analytical approach are a welcome change from the stridency that has characterised some of the debate elsewhere. I am very conscious that more time and effort has gone into drafting and redrafting, amending, revising and refining policy in this area than in any (...) other area of HIV control, with the probable exception of blood transfusion. Yet this is the setting that has the lowest risk among all established routes. Why has it been so hard to establish a satisfactory policy and practice to deal with this situation?Many factors, of course, apply. However, much seems to stem from a prevailing view, fostered by recent political administrations, that health care can be delivered in a risk-free way. This has also been linked with a “blame culture”, where adverse outcomes are seen as someone's fault, and where the professions are regarded with distrust. It has been fuelled by levels of concern about risk for HIV that have stemmed more from media “stories” about risk than careful risk assessment.Hence Blatchford et al comment that public anxiety about HIV relative to hepatitis B was a factor in assessing how the incident was handled, implying that HIV was of greater concern - even though the risk of transmission is some two orders of magnitude less. Interestingly, they also comment that, because the risk of death with HIV is higher than for hepatitis B, this balances the overall risk. I am not sure of the validity of this argument, …. (shrink)

Predictions about the health risks of low level radiation combine two sorts of measures. One estimates the amount and kinds of radiation released into the environment, and the other estimates the adverse health effects. A new field called health physics integrates and applies nuclear physics to cytology to supply both these estimates. It does so by first determining the kinds of effects different types of radiation produce in biological organisms, and second, by monitoring the extent of these effects produced (...) by given levels of exposure. This essay examines the interplay between evidential constraints and external, contextual interests and values in studying the biological hazards of radiation. By analyzing the debate over linear vs. quadratic dose response models, the essay focuses on problems of developing quantitative, rather than qualitative, estimates of the risks of increased cancer incidence in an exposed population. (shrink)

Surgeons have an ethical obligation to ensure all patients, regardless of their personal characteristics, receive the same quality of care. Established surgeons also have an obligation to ensure equal treatment for their peers and for those who would like to join the field. The commitment to ethical hiring and working standards entails making certain all individuals have the same opportunities free from discriminatory practices. The world of business has long realized the positive implications of having a diverse and inclusive workforce. (...) Studies have shown a positive correlation between increased racial and gender diversity and company performance. Diversity can lead to an increase in knowledge by sharing ideas with individuals who come from different life experiences and breakdown cultural barriers. We have already begun to see the impact of ignoring the importance of diversity within healthcare, including surgery. Healthcare disparities are defined by the NIH as “differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups.” Healthcare disparities persist despite decades acknowledging their existence, and they are pernicious and prevalent in surgery. One proposed method to help reduce or eliminate healthcare disparities is to increase the diversity of the workforce treating the patients, which would in turn reduce potential bias the patients face in the healthcare setting. Implicit bias can play a key role in interactions with patients and colleagues and needs to be explored on an individual basis. Cultural competence training can also provide surgeons the ability to effectively communicate with not only a diverse population of patients but also a diverse surgical workforce. All surgeons regardless of their role can have a positive impact on diversity as it relates to patient care and the surgical workforce. (shrink)

Though genome editing is a powerful technology, germline GE engineering is strongly objectionable for a huge ethical challenge. The after-effects of the genome-edited babies incident have been emerging in China, whether technology or ethics. It is very noticeable that the case has been adverse effects on the application of GE technology in other fields, especially in GE crops. After the incident, research and development of GE crops was affected obviously. It is clear that GE crops and other basic research (...) and application related to GE technology should be encouraged and should not be treated differently. An ethically acceptable development route of GE technology needs to be established in China. (shrink)

There is overwhelming evidence that wind turbines cause serious health problems in nearby residents, usually stress-disorder-type diseases, at a nontrivial rate. The bulk of the evidence takes the form of thousands of adverse event reports. There is also a small amount of systematically gathered data. The adverse event reports provide compelling evidence of the seriousness of the problems and of causation in this case because of their volume, the ease of observing exposure and outcome incidence, and case-crossover data. (...) Proponents of turbines have sought to deny these problems by making a collection of contradictory claims including that the evidence does not “count,” the outcomes are not “real” diseases, the outcomes are the victims’ own fault, and that acoustical models cannot explain why there are health problems so the problems must not exist. These claims appeared to have swayed many nonexpert observers, though they are easily debunked. Moreover, though the failure of models to explain the observed problems does not deny the problems, it does mean that we do not know what, other than kilometers of distance, could sufficiently mitigate the effects. There has been no policy analysis that justifies imposing these effects on local residents. The attempts to deny the evidence cannot be seen as honest scientific disagreement and represent either gross incompetence or intentional bias. (shrink)

Healthcare-associated infections due to multidrug-resistant organisms continue to increase in incidence. To control the transmission of these pathogens, such as methicillin-resistant Staphylococcus aureus , some have advocated active surveillance cultures of all hospitalized patients, followed by institution of contact precautions. While there has been extensive debate about the effectiveness of this approach in reducing infections, little attention has been given to the ethical issues raised by the intervention. Active surveillance for multidrug-resistant organisms is a quality improvement measure and ethical implications (...) arise through the potential to inadvertently cause harm. Unintended adverse effects may include decreased contact with healthcare workers, increased depression and anxiety, and increased rates of noninfectious adverse events among patients placed in contact precautions. The potential risks and benefits are not distributed fairly; patients placed in contact precautions are exposed to the risks, while those not isolated experience the benefit. Ethical challenges involve a conflict between the interests of the individual patient and the patient population not already colonized with the organism. For healthcare systems, active surveillance increases the complexity of bed management, exacerbating problems with patient placement, patient throughput, emergency department overcrowding and ambulance diversion for some hospitals. It also poses ethical dilemmas regarding societal resource allocation. Investing in an unproven or marginally beneficial quality improvement activity such as this must be balanced against other public health priorities competing for scarce resources. CiteULike Connotea Del.icio.us What's this? (shrink)

Electroacupuncture (EA) and electroconvulsive therapy (ECT) are often used in the management of schizophrenia. This study sought to determine whether additional EA and ECT could augment antipsychotic response and reduce related side effects. In this retrospective controlled study, 287 hospitalized schizophrenic patients who received antipsychotics (controls, n = 50) alone or combined with EA (n = 101), ECT (n = 55) or both (EA+ECT, n = 81) were identified. EA and ECT were conducted for 5 and 3 sessions per week, (...) respectively, with a maximum of 12 sessions for ECT during hospitalization. The Scale for the Assessment of Positive Symptoms (SAPS) and Scale for the Assessment of Negative Symptoms (SANS) were used to assess the severity of psychotic symptoms. Clinical response on SAPS and SANS, weight gain, and adverse events were compared. Survival analysis revealed that the ECT and EA+ECT groups had markedly greater clinical response rate than controls on SAPS [72.7% and 90.1% vs. 64.0%; relative risk (RR), 1.974 and 2.628, respectively, P ≤ 0.004] and on SANS (67.3% and 70.4% vs. 42.0%; RR, 1.951 and 2.009, respectively, P ≤ 0.015). A significantly greater response rate on SANS than controls was also observed in the EA group (64.4% versus 42.0%; RR = 1.938, P = 0.008). EA-containing regimens remarkably reduced weight gain and incidences of headache, insomnia, dry mouth, and electrocardiographic abnormalities. These results suggest that EA and ECT can serve as additional treatment for enhancing antipsychotic response and reduce the side effects in hospitalized patients with schizophrenia. (shrink)

Worries about safety of approved drugs have pushed post registration research to become the fastest growing drug research phase. Until recently, phase IV studies were mainly conducted for marketing purposes and run much like a phase III trial—at institutions with experienced investigators and a list of inclusion and exclusion criteria. Innovative phase IV studies involve ordinary physicians in research naïve communities. This brings ethical issues familiar to medical research into clinical practice. As a consequence, individual physicians are challenged to protect (...) scientific integrity and to secure the ethical conduct of research. Several ethical issues need to be addressed in the process of developing a scientifically sound and ethically high principled practice of phase IV research.PHASE IVEssential to phase IV research is the focus on how drugs work in the real world. The research goal may be to explore a specific pharmacological effect, to establish the incidence of adverse reactions, or to determine the effects of long-term administration of a drug. They may also be designed to establish a new clinical indication for a drug.1 Subjects may or may not be randomised, and the studies typically involve large numbers of patient-subjects and physicians.Doubts concerning the scientific rigor and clinical value have put postmarketing research in a poor light. However, high quality phase IV research is badly needed to further pharmaceutical science. First, because it can provide reliable data on the effectiveness, safety and optimal use of a drug in treated populations.2 3 In pre-registration clinical trials , a pharmaceutical product is studied under unrealistic circumstances. Under-representation of women and elderly are common and the concomitant use of medicines is usually extremely restrictive in these trials.4 Second, phase IV can provide much needed data for evidence-based …. (shrink)

Explore the aftermath of traumatic stress as it affects various populations, including therapists themselves! This book will educate you about the aftermath of traumatic stress as it impacts people in a variety of settings. It explores the factors that lead to increased or reduced vulnerability to the effects of traumatic stress, emphasizing the impact of cumulative/multiple trauma rather than the effects of a single traumatic incident, to help you design and implement effective prevention and intervention programs. The specific populations and (...) groups addressed in this important book include: adolescent girls involved in armed conflict in Colombia’s guerilla war urban African-American youth—a theoretical model for risk and resiliency people with strong spiritual/religious beliefs—how spirituality can affect a person’s reaction to traumatic stress women in recovery in a community aftercare shelter female trauma therapists—factors affecting vicarious traumatization of helping professionals college students with histories of abuse Providing a framework for understanding traumatic stress-related issues based on a variety of methodologies and measures, Traumatic Stress and Its Aftermath addresses important questions, such as: What is the relationship between the experiences of trauma or other stressful life events, and subsequent traumatic stress? What are the protective factors that can buffer or ameliorate the development of traumatic stress in the face of adverse life experiences, trauma, or other stressful events? How do these questions evolve in different cultural or community contexts, and with different populations? What are the implications for interventions for community institutions and mental health workers? What roles do self-esteem and spirituality play in a person’s reaction to traumatic stress? How do reactions to traumatic stress differ between women who have been sexually abused as children and women who have not? From editor Sandra S. Lee: “Contemporary developments in the study of traumatic stress are shifting. This book reflects an emphasis on the study of traumatic stress in normal community, cultural, or college student populations and groups, while other literature has focused on individuals specifically diagnosed with PTSD. In addition, Traumatic Stress and Its Aftermath: Cultural, Community, and Professional Contexts emphasizes the search for risk and protective factors and factors that can buffer the relationship between trauma exposure and subsequent distress.”. (shrink)

Violence is a known risk factor for health problems. In this epidemiological study across 5,385 male patients, we investigate the prevalence of perpetrated violence, exposure to violence, their overlap and the relationship between violence, mental, and psychosomatic health, as well as adverse health behaviors, such as self-harming behavior and the consumption of drugs. Participants completed an anonymous questionnaire addressing violence experience, age of victimization/perpetration, frequency, and perceived severity of violence exposure. We considered physical, psychological as well as sexual violence. (...) Information on health status and adverse health behaviors complemented the data. Results showed that 48.4% of the sample reported having experienced violence. The victim-perpetrator overlap formed the largest group, in which the incidence of having experienced multiple types of violence was significantly higher compared to victims and perpetrators. The age-crime curve flattened more slowly with increasing age in this group. Although the perceived severity of exposure to violence is lower in the overlap group, its health status and adverse health behaviors were worse. Interventions should focus on this group since they constitute a burden for the healthcare system. (shrink)

PurposeThe COVID-19 pandemic caused a massive healthcare crisis. To investigate what makes healthcare system resilient and physicians better at coping during a crisis situation, our study investigated the role risk exposure, such as working at COVID-19 entry points, sleep, and perceived work safety played in reducing negative psychological functioning at work, as well as their effects on adverse and potentially fatal incidences of compromised safety and medical errors.MethodsOur study included a representative sample of 1,189 physicians, from all 12 Slovenian (...) regions and all medical occupations, as registered by the Medical Chamber of Slovenia. For the purposes of this study, a Questionnaire of Sleep and Psychological Functioning at Work was developed in the form of an online retrospective self-report. Additionally, our study included items assessing physicians perceived work safety and frequency of negative outcomes during the first month of the Covid-19 epidemic.ResultsPhysicians working at COVID-19 entry points were more likely to experience night awakening, slept less than 5 h per night, experience nightmares, and had lower levels of psychological functioning in comparison to other physicians. Both hypothesized models showed adequate fit. A higher score on the sleep scale has been shown to predict lower levels of negative psychological functioning at work and, indirectly, reduced incidences of compromised safety and medical errors. Contrary to our expectations, no significant direct effect of sleep on compromised safety and medical errors was found. When perceived work safety was added into the model, the model showed improved fit, with perceived work safety predicting better sleep, less negative psychological functioning at work, and less compromised safety.ConclusionSleep and safety both play an important role in reducing negative psychological functioning at work and, by doing so, decreasing the negative and potentially fatal incidents during the pandemic, such as compromised safety and medical errors. Further, research is needed to see how medical guidelines can be updated to ensure physicians sleep and that their safety is protected. (shrink)

Interest in understanding the experience of moral distress has steadily gained traction in the 30 years since Jameton first described the phenomenon. This curiosity should be of no surprise, since we now have data documenting the incidence across most caregiver roles and healthcare settings, both in the United States and internationally. The data have also amplified healthcare providers’ voices who report that the quality of the ethical environment is pivotal to preventing and containing the adverse effects caused by moral (...) distress. Healthcare providers are asking for a moral space where ethics occurs at the bedside, in real time, applied to real cases. They are asking for ethics expertise to be available as part of the care team during their daily work, when treatment goals must be determined and decisions must be made. They are asking for an embedded ethicist who can help cultivate an ethical environment where formal ethics policy is properly applied to practice. This discussion advocates for an embedded ethics resource model that responds to contemporaneous ethics needs as a strategy to mitigate the effects of moral distress. (shrink)

Nursing homes' ethics committees play a role in designing policies to assure ethical care. The administrative structure of nursing homes is not as large as that of hospitals. Nursing home staff and administration can respond to medical accidents in a way that treats family unethically and does serious harm to the facility. This paper describes incidents in which nursing homes attempted to conceal accidental deaths. It describes how such incidents are discovered, and the consequences of such efforts, and (...) suggests ways to prevent such incidents.This paper presents a retrospective review of a convenience sample of eight cases in which it was discovered that a nursing home attempted to conceal an accidental death. The effort to conceal an accidental death requires a coordinated effort to: [1] limit dissemination of information about the accident by staff and records, [2] decrease suspicion about the death, and [3] decrease the likelihood that an inquiry, if launched, will succeed. This effort begins as a reflexive, emotional and defensive response to the accident and consolidates as an institutional strategy to conceal both the accident and the concealment. The effort is coordinated by administrators who coerce cooperation from front line staff, alter medical records, and fail to follow reporting procedures. The attempt to conceal a lethal accident adversely affects the facility and the healthcare system. Ethics committees should work with professional organizations and administrator to assure proper management and disclosure of harmful accidents. (shrink)

We investigate how negative news coverage of borrower’s impacts on climate change affects bank loan contracting. Using a sample of publicly traded US firms for the period 2000–2016, we show that loans initiated following negative news coverage about firm’s adverse climate-related incidents have significantly higher spreads, shorter maturities, more covenant restrictions, and a higher likelihood of collateral security requirements. We find no changes in client firm’s credit fundamentals after such incidents, indicating that lender’s reputational concerns rather than (...) the longer-term environmental impacts of their borrower’s actions are the primary drivers of these changes. This observation highlights the need for increased scrutiny of banks’ lending practices to ensure that they are genuinely committed to sustainability rather than merely engaging in symbolic actions. (shrink)

Purpose The proliferation of surveillance-enhancing laws, policies and technologies across African countries deepens the risk of privacy rights breaches, as well as the risks of adverse profiling and social sorting. There is a heightened need for dedicated advocacy and activism to consistently demand accountability and transparency from African states, governments and their allies regarding surveillance. The purpose of this paper is to understand the issue frames that accompany anti-surveillance and privacy advocacy in Ghana and the related implications. Design/methodology/approach Using (...) a qualitative and interpretivist approach, the author focuses on three different surveillance-oriented incidents/programs in Ghana and analyzes the frames underpinning the related advocacy and narratives of various non-state actors. Findings Privacy and anti-surveillance advocacy in Ghana tends to be less framed in the context of privacy rights and is more driven by concerns about corruption and value for money. Such pecuniary emphasis is rational per issue salience calculations as it elevates principles of economic probity, transparency and accountability and pursues a high public shock value and resonance. Practical implications Economics-centered critiques of surveillance could be counterproductive as they create a low bar for surveillance promoters and sustains a culture of permissible statist intrusions into citizens’ lives once economic virtues are satisfied. Originality/value While anti-surveillance and privacy advocacy is budding across African countries, little is known about its nature, frames and modus compared to such advocacy in European and North American settings. To the best of the author’s knowledge, this is likely the first paper or one of the first dedicated fully to anti-surveillance and advocacy in Africa. (shrink)