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Kipourgos G, Kourtis G, Papatheodorou M, Elesnitsalis G, Filtiseniou P, Albani E, Tzenalis A. When the first vaccine arrived: An investigation of factors that influenced the intention of health care workers in the national health system of Greece to be vaccinated against the SARS COV-2 virus during the first trimester of vaccine arrival. Nurs Forum 2022; 57:1080-1095. [PMID: 36053028 PMCID: PMC9538693 DOI: 10.1111/nuf.12791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/30/2022] [Accepted: 08/07/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND COVID-19 vaccination started in Greece in the last days of December 2020. Health care workers (HCWs) of the public national health system (NHS) were on the frontline and they would be role models for all the citizens. AIM Investigation of the intention and hesitation of HCWs (doctors, nurses, and nursing assistants) of the NHS of Greece, regarding the vaccine against SARS COV-2 virus and the factors that affect them, during the first trimester of the availability of vaccines, in the country. METHODS A multicenter cross-sectional study was conducted in Greece among health professionals (n = 2484) of the NHS. Data were collected with the use of an online questionnaire through snowballing sampling. RESULTS Acceptance of a safe and effective COVID- 19 vaccines was higher among doctors (85.6%), followed by nurses (66.3%), and nursing assistants (64.1%). This study confirms pre-existing research on the interaction of gender, age, quality of personal information, educational level, training by the employer, and cognitive background regarding viruses and vaccines. CONCLUSION In conclusion, our study showed that once a vaccine was available, most HCWs were willing to be vaccinated. These findings could be used in the future to tailor communication and promotion campaigns, using anthropocentric strategies.
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Affiliation(s)
| | | | | | | | | | - Eleni Albani
- Nursing DepartmentUniversity of PatrasPatrasGreece
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2
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Macip S, Yuguero O. Individual Freedom in the Initial Response to Covid-19. Front Public Health 2022; 10:765016. [PMID: 35719608 PMCID: PMC9203881 DOI: 10.3389/fpubh.2022.765016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 05/16/2022] [Indexed: 11/29/2022] Open
Abstract
The COVID-19 pandemic has been a phenomenal challenge to global health care and will continue to be so in the upcoming months. Beyond its medical toll, COVID-19 has also exacerbated pre-existing social issues and created new inequalities. This has generated a series of ethical problems that will need to be carefully analyzed to avoid repeating similar mistakes in the context of other crises. Among those, we discuss here the bioethical implications of preserving individual freedom in the context of the early response to a pandemic and propose a global approach to the issue that could be applied in future health challenges.
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Affiliation(s)
- Salvador Macip
- Mechanisms of Cancer and Aging Laboratory, Department of Molecular and Cell Biology, University of Leicester, Leicester, United Kingdom
- Food Lab, Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Oriol Yuguero
- Emergency Research Group, Biomedical Research Institute of Lleida (IRBLLEIDA), Lleida, Spain
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3
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Lajeunesse A. Prise de décision, répartition des ressources médicales et personnes âgées en contexte de COVID-19 : une anthropologie de et pour la bioéthique. CANADIAN JOURNAL OF BIOETHICS 2022. [DOI: 10.7202/1094692ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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4
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Thome J, Deloyer J, Coogan AN, Bailey-Rodriguez D, da Cruz E Silva OAB, Faltraco F, Grima C, Gudjonsson SO, Hanon C, Hollý M, Joosten J, Karlsson I, Kelemen G, Korman M, Krysta K, Lichterman B, Loganovsky K, Marazziti D, Maraitou M, Mertens deWilmars S, Reunamen M, Rexhaj S, Sancaktar M, Sempere J, Tournier I, Weynant E, Vis C, Lebas MC, Fond-Harmant L. The impact of the early phase of the COVID-19 pandemic on mental-health services in Europe. World J Biol Psychiatry 2021; 22:516-525. [PMID: 33143529 DOI: 10.1080/15622975.2020.1844290] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE The current COVID-19 pandemic confronts psychiatric patients and mental health services with unique and severe challenges. METHODS In order to identify these trans-national challenges across Europe, an ad-hoc survey was conducted among 23 experts, each answering for one European or aligned country. RESULTS A number of important themes and issues were raised for the impact of COVID-19 on mental health and mental health services, barriers to service provision and future consequences. A number of key issues were reported by colleagues across several jurisdictions, even though these were at different stages of their national epidemics. CONCLUSIONS Based on these findings, we articulate some important learnings from the early stages of the COVID-19 European pandemic, and highlight key considerations for all countries' mental health services as the current pandemic develops and for future pandemics.
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Affiliation(s)
- Johannes Thome
- Department of Psychiatry, University of Rostock, Rostock, Germany
| | | | - Andrew N Coogan
- Department of Psychology, Maynooth University, National University of Ireland, Maynooth, Ireland
| | | | | | - Frank Faltraco
- Department of Psychiatry, University of Rostock, Rostock, Germany
| | - Cathleen Grima
- Department of Occupational Therapy, Mental Health Services, Mount Carmel Hospital, Attard, Malta
| | | | - Cecile Hanon
- Centre Ressource Régional de Psychiatrie du Sujet Agé, Université de Paris, Issy-les-Moulineaux, France
| | - Martin Hollý
- Psychiatric Hospital Bohnice, Prague, Czech Republic
| | - Jo Joosten
- Private Psychiatric Practice, Brussels and Luxembourg, Brussels, Belgium
| | - Ingegerd Karlsson
- Södra Älvsborgs Sjukhus-Vuxenpsykiatrisk Klinik, Borås Växel, Sweden
| | - Gabriela Kelemen
- Faculty of Educational Science, Psychology and Social Sciences, Aurel Vlaicu University, Arad, Romania
| | - Maria Korman
- Occupational Therapy Department, Ariel University and EJ Safra Brain Research Center for the Study of Learning Disabilities, University of Haifa, Haifa, Israel
| | - Krzysztof Krysta
- Department of Rehabilitation Psychiatry, Medical University of Silesia, Katowice, Poland
| | - Boleslav Lichterman
- Department of Humanities, The IM Sechenov First Moscow State Medical University, Moscow, Russia
| | - Konstantin Loganovsky
- Department of Radiation Psychoneurology, Institute for Clinical Radiology, State Institution "National Research Centre for Radiation Medicine of the National Academy of Medical Sciences of Ukraine", Kyiv, Ukraine
| | - Donatella Marazziti
- Department of Experimental and Clinical Medicine, Section of Psychiatry, University of Pisa, Unicamillus University of Rome and Brain Research Foundation, Lucca, Italy
| | | | | | | | - Shyhrete Rexhaj
- La Source, School of Nursing Sciences, University of Sciences Western Switzerland, HES-SO, Lausanne, Switzerland
| | - Muhammet Sancaktar
- Department of Psychiatry, Gaziantep University Şahinbey Research and Implementation Hospital, Gaziantep, Turkey
| | - Javier Sempere
- Centre de Terapia Interfamiliar and Mental Health Association, Elx, Spain
| | | | - Emilie Weynant
- Centre Neuro Psychiatrique St. Martin, Dave Namur, Belgium
| | - Christiaan Vis
- Department of Clinical, Neuro- & Developmental Psychology, Vrije Universiteit Amsterdam and Amsterdam Public Health Research Institute, Mental Health, Amsterdam, The Netherlands
| | - Marie-Clotilde Lebas
- Département des Sciences de la Santé Publique et de la Motricité, Haute Ecole de la Province de Namur, Namur, Belgium
| | - Laurence Fond-Harmant
- Agence de Coopération Scientifique Afrique-Luxembourg et Europe et LEPS, Laboratoire Education et Pratiques en Santé, Paris 13, Université Sorbonne Paris Nord, Paris, France
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5
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Cameron J, Williams B, Ragonnet R, Marais B, Trauer J, Savulescu J. Ethics of selective restriction of liberty in a pandemic. JOURNAL OF MEDICAL ETHICS 2021; 47:553-562. [PMID: 34059520 PMCID: PMC8327318 DOI: 10.1136/medethics-2020-107104] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 04/13/2021] [Accepted: 04/28/2021] [Indexed: 05/12/2023]
Abstract
Liberty-restricting measures have been implemented for centuries to limit the spread of infectious diseases. This article considers if and when it may be ethically acceptable to impose selective liberty-restricting measures in order to reduce the negative impacts of a pandemic by preventing particularly vulnerable groups of the community from contracting the disease. We argue that the commonly accepted explanation-that liberty restrictions may be justified to prevent harm to others when this is the least restrictive option-fails to adequately accommodate the complexity of the issue or the difficult choices that must be made, as illustrated by the COVID-19 pandemic. We introduce a dualist consequentialist approach, weighing utility at both a population and individual level, which may provide a better framework for considering the justification for liberty restrictions. While liberty-restricting measures may be justified on the basis of significant benefits to the population and small costs for overall utility to individuals, the question of whether it is acceptable to discriminate should be considered separately. This is because the consequentialist approach does not adequately account for the value of equality. This value may be protected through the application of an additional proportionality test. An algorithm for making decisions is proposed. Ultimately whether selective liberty-restricting measures are imposed will depend on a range of factors, including how widespread infection is in the community, the level of risk and harm a society is willing to accept, and the efficacy and cost of other mitigation options.
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Affiliation(s)
- James Cameron
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Bridget Williams
- School of Public Health and Preventative Medicine, Monash University, Clayton, Victoria, Australia
| | - Romain Ragonnet
- School of Public Health and Preventative Medicine, Monash University, Clayton, Victoria, Australia
| | - Ben Marais
- Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, New South Wales, Australia
| | - James Trauer
- School of Public Health and Preventative Medicine, Monash University, Clayton, Victoria, Australia
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Symons X, Matthews S, Tobin B. Why should HCWs receive priority access to vaccines in a pandemic? BMC Med Ethics 2021; 22:79. [PMID: 34176474 PMCID: PMC8236218 DOI: 10.1186/s12910-021-00650-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 06/17/2021] [Indexed: 11/29/2022] Open
Abstract
Background Viral pandemics present a range of ethical challenges for policy makers, not the least among which are difficult decisions about how to allocate scarce healthcare resources. One important question is whether healthcare workers (HCWs) should receive priority access to a vaccine in the event that an effective vaccine becomes available. This question is especially relevant in the coronavirus pandemic with governments and health authorities currently facing questions of distribution of COVID-19 vaccines. Main text In this article, we critically evaluate the most common ethical arguments for granting healthcare workers priority access to a vaccine. We review the existing literature on this topic, and analyse both deontological and utilitarian arguments in favour of HCW prioritisation. For illustrative purposes, we focus in particular on the distribution of a COVID-19 vaccine. We also explore some practical complexities attendant on arguments in favour of HCW prioritisation. Conclusions We argue that there are deontological and utilitarian cases for prioritising HCWs. Indeed, the widely held view that we should prioritise HCWs represents an example of ethical convergence. Complexities arise, however, when considering who should be included in the category of HCW, and who else should receive priority in addition to HCWs.
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Affiliation(s)
- Xavier Symons
- Plunkett Centre for Ethics, Australian Catholic University, 7 Ice Street, Darlinghurst, NSW, 2010, Australia.
| | - Steve Matthews
- Plunkett Centre for Ethics, Australian Catholic University, 7 Ice Street, Darlinghurst, NSW, 2010, Australia.,Thomas More Law School, Level 7, 486 Albert Street, East Melbourne, 3002, Australia
| | - Bernadette Tobin
- Plunkett Centre for Ethics, Australian Catholic University, 7 Ice Street, Darlinghurst, NSW, 2010, Australia
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Gur-Arie R, Jamrozik E, Kingori P. No Jab, No Job? Ethical Issues in Mandatory COVID-19 Vaccination of Healthcare Personnel. BMJ Glob Health 2021; 6:e004877. [PMID: 33597280 PMCID: PMC7893205 DOI: 10.1136/bmjgh-2020-004877] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 01/14/2021] [Indexed: 12/23/2022] Open
Affiliation(s)
- Rachel Gur-Arie
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, USA
- Oxford-Johns Hopkins Global Infectious Disease Ethics Collaborative, Oxford, UK, Baltimore, Maryland, USA
| | - Euzebiusz Jamrozik
- Oxford-Johns Hopkins Global Infectious Disease Ethics Collaborative, Oxford, UK, Baltimore, Maryland, USA
- Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - Patricia Kingori
- Oxford-Johns Hopkins Global Infectious Disease Ethics Collaborative, Oxford, UK, Baltimore, Maryland, USA
- Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
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8
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Invisible epidemics: ethics and asymptomatic infection. Monash Bioeth Rev 2020; 38:1-16. [PMID: 33326062 PMCID: PMC7738616 DOI: 10.1007/s40592-020-00123-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2020] [Indexed: 11/08/2022]
Abstract
Interactions between microbes and human hosts can lead to a wide variety of possible outcomes including benefits to the host, asymptomatic infection, disease (which can be more or less severe), and/or death. Whether or not they themselves eventually develop disease, asymptomatic carriers can often transmit disease-causing pathogens to others. This phenomenon has a range of ethical implications for clinical medicine, public health, and infectious disease research. The implications of asymptomatic infection are especially significant in situations where, and/or to the extent that, the microbe in question is transmissible, potentially harmful, and/or untreatable. This article reviews the history and concept of asymptomatic infection, and relevant ethical issues associated with this phenomenon. It illustrates the role and ethical significance of asymptomatic infection in outbreaks, epidemics, and pandemics–including recent crises involving drug resistance, Zika, and Covid19. Serving as the Introduction to this Special Issue of Monash Bioethics Review, it also provides brief summaries of the other articles comprising this collection.
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Camporesi S. It Didn't Have to be This Way: Reflections on the Ethical Justification of the Running Ban in Northern Italy in Response to the 2020 COVID-19 Outbreak. JOURNAL OF BIOETHICAL INQUIRY 2020; 17:643-648. [PMID: 33169266 PMCID: PMC7651802 DOI: 10.1007/s11673-020-10056-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 09/23/2020] [Indexed: 05/24/2023]
Abstract
In this paper I discuss the ethical justifiability of the limitation of freedom of movement, in particular of the ban on running outdoors, enforced in Italy as a response to the COVID-19 outbreak in the spring of 2020. I argue that through the lens of public health ethics literature, the ban on running falls short of the criterion of proportionality that public health ethics scholars and international guidelines for the ethical management of infectious disease outbreak recommend for any measure that restricts essential individual freedoms, such as the freedom of movement. The public health ethics framework, however, falls short of explaining the widespread public support that the running ban has had in Italy. I discuss possible factors which could explain the public support for the ban in Italy. Finally, I raise the question of what societal implications the abandonment of the public health ethics framework based on proportionality might have. I conclude that if it is the case, as the history of pandemics teaches us, we will experience further waves of COVID-19 outbreaks, it becomes very important to raise these questions now, with an eye towards informing public health policies for the management of future COVID-19 outbreaks. This discussion should not become politicized along the lines of liberal pro-lockdown/conservative anti-lockdown. Instead, we should reflect on the trade-offs of lockdown policies according to a pluralist framework, in which COVID-19 related deaths are not the only possible value to pursue.
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Affiliation(s)
- Silvia Camporesi
- Department of Global Health & Social Medicine, School of Global Affairs, King's College London, Room 3.10 Bush House NE Wing, 30 Aldwych, London, WC2B 4BG, UK.
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10
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Tan R, Yu T, Luo K, Teng F, Liu Y, Luo J, Hu D. Experiences of clinical first-line nurses treating patients with COVID-19: A qualitative study. J Nurs Manag 2020; 28:1381-1390. [PMID: 32657465 PMCID: PMC7404505 DOI: 10.1111/jonm.13095] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 06/23/2020] [Accepted: 07/05/2020] [Indexed: 02/06/2023]
Abstract
AIM To explore the work experience of clinical first-line nurses treating patients with coronavirus disease 2019 (COVID-19). BACKGROUND COVID-19 has been listed as an international public health emergency. Clinical first-line nurses are at a high risk of infection, and they face a lack of experience and inadequate preparation for COVID-19, leading to physical and psychological disorders. METHODS A qualitative study was conducted from January to February 2020 at a COVID-19-designated hospital in Wuhan, China. Thirty nurses were selected for the study using a purposive sampling method. Data were collected by semi-structured interviews and analysed using content analysis. RESULTS Two main categories were defined in the study from the perspective of nurses: negative experiences during clinical first-line work and positive impacts of clinical first-line work. Under the first category, two subcategories were included: psychological experiences of clinical first-line work and difficulties faced during clinical first-line work. The analysis further yielded two subcategories for the second category: the needs of clinical first-line work and the impact of clinical first-line work on professional attitudes. CONCLUSIONS The results demonstrate that success depends upon strengthening emergency training and knowledge of infectious diseases for nurses, providing adequate protective equipment and improving the emergency response plans of hospitals for public health emergencies. IMPLICATIONS FOR NURSING MANAGEMENT It is believed that our findings will guide hospital managers to make improvements in personal, administrative and institutional areas and that they will provide a reference and inspiration for nurses with regard to public health emergencies in the future.
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Affiliation(s)
- Rong Tan
- Department of OrthopedicsUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Ting Yu
- School of NursingTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Kaiyan Luo
- Department of OrthopedicsUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Fen Teng
- Department of NursingTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Yilan Liu
- Department of NursingUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Jian Luo
- Department of NursingUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Deying Hu
- Department of NursingUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
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McConnell D. Balancing the duty to treat with the duty to family in the context of the COVID-19 pandemic. JOURNAL OF MEDICAL ETHICS 2020; 46:360-363. [PMID: 32332154 PMCID: PMC7211094 DOI: 10.1136/medethics-2020-106250] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/04/2020] [Indexed: 05/26/2023]
Abstract
Healthcare systems around the world are struggling to maintain a sufficient workforce to provide adequate care during the COVID-19 pandemic. Staffing problems have been exacerbated by healthcare workers (HCWs) refusing to work out of concern for their families. I sketch a deontological framework for assessing when it is morally permissible for HCWs to abstain from work to protect their families from infection and when it is a dereliction of duty to patients. I argue that it is morally permissible for HCWs to abstain from work when their duty to treat is outweighed by the combined risks and burdens of that work. For HCWs who live with their families, the obligation to protect one's family from infection contributes significantly to those burdens. There are, however, a range of complicating factors including the strength of duty to treat which varies according to the HCW's role, the vulnerability of family members to the disease, the willingness of family members to risk infection and the resources available to the HCW to protect their family. In many cases, HCWs in 'frontline' roles with a weak duty to treat and families at home will be morally permitted to abstain from work given the risks posed by COVID-19; therefore, society should provide additional incentives to maintain sufficient staff in these roles.
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12
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Thome J, Coogan AN, Simon F, Fischer M, Tucha O, Faltraco F, Marazziti D, Butzer H. The impact of the COVID-19 outbreak on the medico-legal and human rights of psychiatric patients. Eur Psychiatry 2020; 63:e50. [PMID: 32468988 PMCID: PMC7280152 DOI: 10.1192/j.eurpsy.2020.58] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/20/2020] [Accepted: 05/22/2020] [Indexed: 11/29/2022] Open
Abstract
The COVID-19 pandemic has raised significant concerns for population mental health and the effective provision of mental health services in the light of increased demands and barriers to service delivery [1]. Particular attention is being directed toward the possible neuropsychiatric sequelae of both COVID-19 and of the stringent societal mitigation steps deployed by national governments, concerns that are informed by historical increases in the incidence of psychotic disorders following influenza pandemics [2]. However, so far there has been scant attention paid to other important areas of psychiatry during COVID-19, including medico-legal aspects and human rights. In this paper, we discuss the legal implications for psychiatry of the COVID-19 pandemic and report a novel situation in which psychiatric patients may experience diminution of their statutory protections. We believe that this represents a paradigm shift in psychiatric care and that the consideration of the fundamental rights of psychiatric patients as "less important" than infection control measures compel mental health professionals to "advocate for … patients and their caregivers" in this time of crisis [1].
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Affiliation(s)
- Johannes Thome
- Clinic and Policlinic for Psychiatry and Psychotherapy, University of Rostock, Rostock, Germany
| | - Andrew N. Coogan
- Department of Psychology, Maynooth University, National University of Ireland, Maynooth, Ireland
| | - Frederick Simon
- Clinic and Policlinic for Psychiatry and Psychotherapy, University of Rostock, Rostock, Germany
| | - Matthias Fischer
- Clinic and Policlinic for Psychiatry and Psychotherapy, University of Rostock, Rostock, Germany
| | - Oliver Tucha
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Frank Faltraco
- Clinic and Policlinic for Psychiatry and Psychotherapy, University of Rostock, Rostock, Germany
| | - Donatella Marazziti
- Department of Experimental and Clinical Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
- UniCamillus University of Rome, Brain Research Foundation, Lucca, Italy
| | - Hermann Butzer
- Law School, Leibniz University Hannover, Hannover, Germany
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13
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Devereaux A, McPherson C, Etowa J. Public health nurses' experiences during the H1N1/09 response. Public Health Nurs 2020; 37:533-540. [PMID: 32436329 DOI: 10.1111/phn.12749] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/30/2020] [Accepted: 05/02/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE H1N1/09 was the first pandemic flu ever responded to with mass vaccinations. Public health nurses (PHNs) were pivotal in implementing the H1N1/09 vaccination clinics. With the ongoing threat of pandemic influenza and other viral outbreaks, much can be learned from these PHNs' H1N1/09 experiences. This study's purpose was to explore PHNs' experiences in the H1N1/09 mass vaccination clinics. DESIGN AND SAMPLE In a qualitative interpretive description, 23 PHNs (16 immunizers, seven supervisors) who worked in a large Canadian municipal public health agency, participated in semistructured interviews. RESULTS Three overarching themes were identified. 'Anticipating an Emergency' discusses participants' experiences learning about the pandemic response and their role preparation. 'Surviving the Chaos' reflects the challenges of the clinics, particularly during the first few hectic weeks of the response. 'Persevering Over Time' encompasses participants' experiences as they became familiar with clinics' operations and their own responsibilities. CONCLUSIONS Participants' experiences have implications for future public health pandemic planning and research. Key recommendations include to communicate with PHNs in a timely manner about their clinic roles, and to provide PHNs with appropriate training to optimize clinics' operations. This will help support PHNs in their roles to protect the public and provide quality population care.
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Affiliation(s)
- Alana Devereaux
- Bachelor of Science in Nursing Program, Faculty of Health and Human Services, Vancouver Island University, Nanaimo, BC, Canada
| | - Christine McPherson
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Josephine Etowa
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
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Williams JH, Dawson A. Prioritising access to pandemic influenza vaccine: a review of the ethics literature. BMC Med Ethics 2020; 21:40. [PMID: 32408869 PMCID: PMC7224123 DOI: 10.1186/s12910-020-00477-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 04/24/2020] [Indexed: 01/21/2023] Open
Abstract
Background The world is threatened by future pandemics. Vaccines can play a key role in preventing harm, but there will inevitably be shortages because there is no possibility of advance stockpiling. We therefore need some method of prioritising access. Main text This paper reports a critical interpretative review of the published literature that discusses ethical arguments used to justify how we could prioritise vaccine during an influenza pandemic. We found that the focus of the literature was often on proposing different groups as priorities (e.g. those with pre-existing health conditions, the young, the old, health care workers etc.). Different reasons were often suggested as a means of justifying such priority groupings (e.g. appeal to best overall outcomes, fairness, belonging to a vulnerable or ‘at risk’ group etc.). We suggest that much of the literature, wrongly, assumes that we are able to plan priority groups prior to the time of a particular pandemic and development of a particular vaccine. We also point out the surprising absence of various issues from the literature (e.g. how vaccines fit within overall pandemic planning, a lack of specificity about place, issues of global justice etc.). Conclusions The literature proposes a wide range of ways to prioritise vaccines, focusing on different groups and ‘principles’. Any plan to use pandemic vaccine must provide justifications for its prioritisation. The focus of this review was influenza pandemic vaccines, but lessons can be learnt for future allocations of coronavirus vaccine, if one becomes available.
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Affiliation(s)
- Jane H Williams
- Sydney Health Ethics, Sydney School of Public Health, University of Sydney, Level 1, Medical Foundation Building K25, Sydney, NSW, 2006, Australia.,Marie Bashir Institute for Infectious Disease and Biosecurity, University of Sydney, Sydney, Australia
| | - Angus Dawson
- Sydney Health Ethics, Sydney School of Public Health, University of Sydney, Level 1, Medical Foundation Building K25, Sydney, NSW, 2006, Australia. .,Marie Bashir Institute for Infectious Disease and Biosecurity, University of Sydney, Sydney, Australia.
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15
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Jorqui-Azofra M. Regulation of Clinical Xenotransplantation: A Reappraisal of the Legal, Ethical, and Social Aspects Involved. Xenotransplantation 2020; 2110:315-358. [DOI: 10.1007/978-1-0716-0255-3_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Selgelid MJ. Gain-of-Function Research: Ethical Analysis. SCIENCE AND ENGINEERING ETHICS 2016; 22:923-964. [PMID: 27502512 PMCID: PMC4996883 DOI: 10.1007/s11948-016-9810-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 06/12/2016] [Indexed: 06/01/2023]
Abstract
Gain-of-function (GOF) research involves experimentation that aims or is expected to (and/or, perhaps, actually does) increase the transmissibility and/or virulence of pathogens. Such research, when conducted by responsible scientists, usually aims to improve understanding of disease causing agents, their interaction with human hosts, and/or their potential to cause pandemics. The ultimate objective of such research is to better inform public health and preparedness efforts and/or development of medical countermeasures. Despite these important potential benefits, GOF research (GOFR) can pose risks regarding biosecurity and biosafety. In 2014 the administration of US President Barack Obama called for a "pause" on funding (and relevant research with existing US Government funding) of GOF experiments involving influenza, SARS, and MERS viruses in particular. With announcement of this pause, the US Government launched a "deliberative process" regarding risks and benefits of GOFR to inform future funding decisions-and the US National Science Advisory Board for Biosecurity (NSABB) was tasked with making recommendations to the US Government on this matter. As part of this deliberative process the National Institutes of Health commissioned this Ethical Analysis White Paper, requesting that it provide (1) review and summary of ethical literature on GOFR, (2) identification and analysis of existing ethical and decision-making frameworks relevant to (i) the evaluation of risks and benefits of GOFR, (ii) decision-making about the conduct of GOF studies, and (iii) the development of US policy regarding GOFR (especially with respect to funding of GOFR), and (3) development of an ethical and decision-making framework that may be considered by NSABB when analyzing information provided by GOFR risk-benefit assessment, and when crafting its final recommendations (especially regarding policy decisions about funding of GOFR in particular). The ethical and decision-making framework ultimately developed is based on the idea that there are numerous ethically relevant dimensions upon which any given case of GOFR can fare better or worse (as opposed to there being necessary conditions that are either satisfied or not satisfied, where all must be satisfied in order for a given case of GOFR to be considered ethically acceptable): research imperative, proportionality, minimization of risks, manageability of risks, justice, good governance (i.e., democracy), evidence, and international outlook and engagement. Rather than drawing a sharp bright line between GOFR studies that are ethically acceptable and those that are ethically unacceptable, this framework is designed to indicate where any given study would fall on an ethical spectrum-where imaginable cases of GOFR might range from those that are most ethically acceptable (perhaps even ethically praiseworthy or ethically obligatory), at one end of the spectrum, to those that are most ethically problematic or unacceptable (and thus should not be funded, or conducted), at the other. The aim should be that any GOFR pursued (and/or funded) should be as far as possible towards the former end of the spectrum.
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Rashid H, Ridda I, King C, Begun M, Tekin H, Wood JG, Booy R. Evidence compendium and advice on social distancing and other related measures for response to an influenza pandemic. Paediatr Respir Rev 2015; 16:119-26. [PMID: 24630149 DOI: 10.1016/j.prrv.2014.01.003] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 01/22/2014] [Accepted: 01/26/2014] [Indexed: 02/01/2023]
Abstract
The role of social distancing measures in mitigating pandemic influenza is not precisely understood. To this end, we have conducted a systematised review, particularly in light of the 2009 pandemic influenza, to better inform the role of social distancing measures against pandemic influenza. Articles were identified from relevant databases and the data were synthesised to provide evidence on the role of school or work place-based interventions, case-based distancing (self-isolation, quarantine), and restriction of mobility and mass gatherings. School closure, whether proactive or reactive, appears to be moderately effective and acceptable in reducing the transmission of influenza and in delaying the peak of an epidemic but is associated with very high secondary costs. Voluntary home isolation and quarantine are also effective and acceptable measures but there is an increased risk of intra-household transmission from index cases to contacts. Work place-related interventions like work closure and home working are also modestly effective and are acceptable, but likely to be economically disruptive. Internal mobility restriction is effective only if prohibitively high (50% of travel) restrictions are applied and mass gatherings occurring within 10 days before the epidemic peak are likely to increase the risk of transmission of influenza.
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Affiliation(s)
- Harunor Rashid
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, NSW 2145, Australia.
| | - Iman Ridda
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, NSW 2145, Australia; School of Public Health, Tropical Medicine & Rehabilitation Sciences, James Cook University, Townsville, Australia
| | - Catherine King
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, NSW 2145, Australia
| | - Matthew Begun
- School of Public Health and Community Medicine, Faculty of Medicine, The University of New South Wales, Sydney, NSW 2052, Australia
| | - Hatice Tekin
- School of Mathematics and Statistics, The University of Sydney, Australia
| | - James G Wood
- School of Public Health and Community Medicine, Faculty of Medicine, The University of New South Wales, Sydney, NSW 2052, Australia
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, NSW 2145, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, The University of Sydney, Australia
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Braunack-Mayer A, Tooher R, Collins JE, Street JM, Marshall H. Understanding the school community's response to school closures during the H1N1 2009 influenza pandemic. BMC Public Health 2013; 13:344. [PMID: 23587175 PMCID: PMC3636092 DOI: 10.1186/1471-2458-13-344] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 04/10/2013] [Indexed: 11/28/2022] Open
Abstract
Background During the 2009 H1N1 influenza pandemic, Australian public health officials closed schools as a strategy to mitigate the spread of the infection. This article examines school communities’ understanding of, and participation in, school closures and the beliefs and values which underpinned school responses to the closures. Methods We interviewed four school principals, 25 staff, 14 parents and 13 students in five schools in one Australian city which were either fully or partially closed during the 2009 H1N1 pandemic. Results Drawing on Thompson et al’s ethical framework for pandemic planning, we show that considerable variation existed between and within schools in their attention to ethical processes and values. In all schools, health officials and school leaders were strongly committed to providing high quality care for members of the school community. There was variation in the extent to which information was shared openly and transparently, the degree to which school community members considered themselves participants in decision-making, and the responsiveness of decision-makers to the changing situation. Reservations were expressed about the need for closures and quarantine and there was a lack of understanding of the rationale for the closures. All schools displayed a strong duty of care toward those in need, although school communities had a broader view of care than that of the public health officials. Similarly, there was a clear understanding of and commitment to protect the public from harm and to demonstrate responsible stewardship. Conclusions We conclude that school closures during an influenza pandemic represent both a challenge for public health officials and a litmus test for the level of trust in public officials, government and the school as institution. In our study, trust was the foundation upon which effective responses to the school closure were built. Trust relations within the school were the basis on which different values and beliefs were used to develop and justify the practices and strategies in response to the pandemic.
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Affiliation(s)
- Annette Braunack-Mayer
- School of Population Health, The University of Adelaide, Adelaide, South Australia 5005, Australia.
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Moodley K, Hardie K, Selgelid MJ, Waldman RJ, Strebel P, Rees H, Durrheim DN. Ethical considerations for vaccination programmes in acute humanitarian emergencies. Bull World Health Organ 2013; 91:290-7. [PMID: 23599553 DOI: 10.2471/blt.12.113480] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 12/20/2012] [Accepted: 12/26/2012] [Indexed: 11/27/2022] Open
Abstract
Humanitarian emergencies result in a breakdown of critical health-care services and often make vulnerable communities dependent on external agencies for care. In resource-constrained settings, this may occur against a backdrop of extreme poverty, malnutrition, insecurity, low literacy and poor infrastructure. Under these circumstances, providing food, water and shelter and limiting communicable disease outbreaks become primary concerns. Where effective and safe vaccines are available to mitigate the risk of disease outbreaks, their potential deployment is a key consideration in meeting emergency health needs. Ethical considerations are crucial when deciding on vaccine deployment. Allocation of vaccines in short supply, target groups, delivery strategies, surveillance and research during acute humanitarian emergencies all involve ethical considerations that often arise from the tension between individual and common good. The authors lay out the ethical issues that policy-makers need to bear in mind when considering the deployment of mass vaccination during humanitarian emergencies, including beneficence (duty of care and the rule of rescue), non-maleficence, autonomy and consent, and distributive and procedural justice.
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Affiliation(s)
- Keymanthri Moodley
- Centre for Medical Ethics and Law, Faculty of Medicine and Health Sciences, University of Stellenbosch, PO Box 19063, Tygerberg 7505, Cape Town, South Africa.
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Russell JA, Nelson SB. An HIV testing conundrum: balancing the health and privacy considerations of multiple stakeholders. Continuum (Minneap Minn) 2012; 18:1417-21. [PMID: 23221848 DOI: 10.1212/01.con.0000423854.47770.5e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Legal standards for HIV testing are evolving in an attempt to achieve an ethical equilibrium between the privacy rights of infected or potentially infected individuals and public health considerations that seek to limit the spread and severity of the disease through early recognition and treatment. Although guided by US Centers for Disease Control and Prevention recommendations, these standards are determined by state law. In this case, an ethical dilemma is presented and discussed in which the privacy interests of an HIV-infected individual come into conflict with the health considerations of an inadvertently exposed neurology resident and her unborn child, a conundrum amplified by the restricted HIV testing laws of the state in which the incident took place.
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Affiliation(s)
- James A Russell
- Lahey Clinic Medical Center, Department of Neurology, 41 Mall Road, Burlington, MA 01805, USA.
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Some ethical, social, and legal considerations of xenotransplantation. Methods Mol Biol 2012. [PMID: 22566004 DOI: 10.1007/978-1-61779-845-0_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
Abstract
Xenotransplantation has changed its focus from solid organs to cells and tissues, and it is now mainly conceived of and regulated as a pharmaceutical product. Animal cell therapies are showing promising results and may involve fewer risks than organs. However, countries should be cautious about allowing xenotransplantation clinical trials to develop. Regulatory frameworks should contain specific conditions about the safety of the source animals, of the xenotransplantation product, and of the manufacturing process. In turn, these frameworks should ensure that preclinical studies indicate safety and efficacy of the procedure and that risk-management protocols are in place to identify, contain, and combat any outbreak of infection in a timely manner. The fragile balance between individual and collective rights and the tensions of globalization make necessary a coordinated international action to harmonize global practices in this field. Xenotransplantation clinical trials should be carried out in a context in which specific safety and ethical issues are addressed, and in an environment in which specific practices that facilitate public engagement as a form of shared responsibility for regulatory decision making are promoted as well.
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Kamradt-Scott A. Changing perceptions: of pandemic influenza and public health responses. Am J Public Health 2012; 102:90-8. [PMID: 22095332 PMCID: PMC3490545 DOI: 10.2105/ajph.2011.300330] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2011] [Indexed: 11/04/2022]
Abstract
According to the latest World Bank estimates, over the past decade some US $4.3 billion has been pledged by governments to combat the threat of pandemic influenza. Presidents, prime ministers, and even dictators the world over have been keen to demonstrate their commitment to tackling this disease, but this has not always been the case. Indeed, government-led intervention in responding to the threat of pandemic influenza is a relatively recent phenomenon. I explore how human understandings of influenza have altered over the past 500 years and how public policy responses have shifted accordingly. I trace the progress in human understanding of causation from meteorological conditions to the microscopic, and how this has prompted changes in public policy to mitigate the disease's impact. I also examine the latest trend of viewing pandemic influenza as a security threat and how this has changed contemporary governance structures and power dynamics.
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Affiliation(s)
- Adam Kamradt-Scott
- Department of Global Health and Development, Faculty of Public Health Policy, London School of Hygiene and Tropical Medicine, London, UK.
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Luyten J, Vandevelde A, Van Damme P, Beutels P. Vaccination Policy and Ethical Challenges Posed by Herd Immunity, Suboptimal Uptake and Subgroup Targeting. Public Health Ethics 2011. [DOI: 10.1093/phe/phr032] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bennett B, Carney T. Pandemic preparedness in Asia: a role for law and ethics? Asia Pac J Public Health 2011; 23:419-30. [PMID: 21551132 DOI: 10.1177/1010539511408411] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Management of pandemic influenza relies on complex coordination of many different dimensions of the health and social care systems, emergency services, levels of national and local government, civil society, communications and media, and cultural expectations. Law is one small but important component of those arrangements, which touch on fundamental ethical debates. This review demonstrates that the Asian region is actively engaging those issues in diverse ways in light of their varied socioeconomic and cultural backgrounds, but scope remains for prioritising further research into these relationships.
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Affiliation(s)
- Belinda Bennett
- Faculty of Law, University of Sydney, Sydney, New South Wales, Australia.
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Braut G, Holt J. Meticillin-resistant Staphylococcus aureus infection – the infectious stigma of our time? J Hosp Infect 2011; 77:148-52. [DOI: 10.1016/j.jhin.2010.09.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Accepted: 09/24/2010] [Indexed: 10/18/2022]
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Abstract
This article discusses two approaches to controlling the newly identified influenza A (H1N1): via Bayesian and frequentist statistical reasoning. This study reviewed the measures implemented in China as an example to illustrate these two approaches. Since May 2009, China has deployed strict controlling mechanisms based on the strong prior Bayesian assumption that the origin of influenza A (H1N1) was from outside China and as such strict border control would keep the virus from entering China. After more than 4 months of hard work by Chinese health professionals and officials, the number of confirmed influenza A (H1N1) has increased steadily against the expectations of the general public. Taking into account the great financial burden in maintaining strict measures, Chinese health authorities have slowly adjusted their policies of controlling influenza A (H1N1) in China according to frequentist reasoning since July 2009.
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Affiliation(s)
- Dejian Lai
- The University of Texas School of Public Health, Houston, TX, USA
- Jiangxi University of Finance and Economics, Nanchang, China
| | - Chiehwen Ed Hsu
- The University of Texas School of Public Health, Houston, TX, USA
- The University of Texas School of Biomedical Informatics, Houston, TX, USA
| | - Jay H. Glasser
- The University of Texas School of Public Health, Houston, TX, USA
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Draper H, Sorell T, Ives J, Damery S, Greenfield S, Parry J, Petts J, Wilson S. Non-Professional Healthcare Workers and Ethical Obligations to Work during Pandemic Influenza. Public Health Ethics 2009. [DOI: 10.1093/phe/php021] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Selgelid MJ. A Moderate Pluralist Approach to Public Health Policy and Ethics. Public Health Ethics 2009. [DOI: 10.1093/phe/php018] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Sim F, Mackie P. Pandemic or no pandemic: Emergence of swine influenza A (H1N1) in 2009. Public Health 2009; 123:405-6. [DOI: 10.1016/j.puhe.2009.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2009] [Indexed: 10/20/2022]
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