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Akter S, Alhatlani BY, Abdallah EM, Saha S, Ferdous J, Hossain ME, Ali F, Kawsar SMA. Exploring Cinnamoyl-Substituted Mannopyranosides: Synthesis, Evaluation of Antimicrobial Properties, and Molecular Docking Studies Targeting H5N1 Influenza A Virus. Molecules 2023; 28:8001. [PMID: 38138491 PMCID: PMC10745968 DOI: 10.3390/molecules28248001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/27/2023] [Accepted: 12/01/2023] [Indexed: 12/24/2023] Open
Abstract
The pursuit of innovative combinations for the development of novel antimicrobial and antiviral medications has garnered worldwide interest among scientists in recent times. Monosaccharides and their glycosides, such as methyl α-d-mannopyranoside derivatives, play a significant role in the potential treatment of viral respiratory pathologies. This study was undertaken to investigate and assess the synthesis and spectral characterization of methyl α-d-mannopyranoside derivatives 2-6, incorporating various aliphatic and aromatic groups. The investigation encompassed comprehensive in vitro antimicrobial screening, examination of physicochemical properties, molecular docking analysis, molecular dynamics simulations, and pharmacokinetic predictions. A unimolar one-step cinnamoylation reaction was employed under controlled conditions to produce methyl 6-O-cinnamoyl-α-d-mannopyranoside 2, demonstrating selectivity at the C-6 position. This represented a pivotal step in the development of potential antimicrobial derivatives based on methyl α-d-mannopyranoside. Subsequently, four additional methyl 6-O-cinnamoyl-α-d-mannopyranoside derivatives were synthesized with reasonably high yields. The chemical structures of these novel analogs were confirmed through a thorough analysis of their physicochemical properties, elemental composition, and spectroscopic data. In vitro antimicrobial assays were conducted against six bacterial strains and two fungal strains, revealing promising antifungal properties of these methyl α-d-mannopyranoside derivatives in comparison to their antibacterial activity. Moreover, cytotoxicity testing revealed that the compounds are less toxic. Further supporting these findings, molecular docking studies were performed against the H5N1 influenza A virus, indicating significant binding affinities and nonbonding interactions with the target protein 6VMZ. Notably, compounds 4 (-7.2) and 6 (-7.0) exhibited the highest binding affinities. Additionally, a 100 ns molecular dynamics simulation was conducted to assess the stability of the complex formed between the receptor 6VMZ and methyl α-d-mannopyranoside derivatives under in silico physiological conditions. The results revealed a stable conformation and binding pattern within the stimulating environment. In silico pharmacokinetic and toxicity assessments of the synthesized molecules were performed using Osiris software (version 2.9.1). Compounds 4 and 6 demonstrated favorable computational and pharmacological activities, albeit with a low drug score, possibly attributed to their higher molecular weight and irritancy. In conclusion, this study showcases the synthesis and evaluation of methyl α-d-mannopyranoside derivatives as promising candidates for antimicrobial and antifungal agents. Molecular docking and dynamics simulations, along with pharmacological predictions, contribute to our understanding of their potential therapeutic utility, although further research may be warranted to address certain pharmacological aspects.
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Affiliation(s)
- Sabina Akter
- Laboratory of Carbohydrate and Nucleoside Chemistry (LCNC), Department of Chemistry, Faculty of Science, University of Chittagong, Chittagong 4331, Bangladesh; (S.A.); (J.F.)
| | - Bader Y. Alhatlani
- Unit of Scientific Research, Applied College, Qassim University, Buraydah 52571, Saudi Arabia
| | - Emad M. Abdallah
- Department of Science Laboratories, College of Science and Arts, Qassim University, ArRass 51921, Saudi Arabia;
| | - Supriyo Saha
- Uttaranchal Institute of Pharmaceutical Sciences, Uttaranchal University, Dehradun 248007, Uttarakhand, India;
| | - Jannatul Ferdous
- Laboratory of Carbohydrate and Nucleoside Chemistry (LCNC), Department of Chemistry, Faculty of Science, University of Chittagong, Chittagong 4331, Bangladesh; (S.A.); (J.F.)
| | - Md Emdad Hossain
- Wazed Miah Science Research Centre, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh;
| | - Ferdausi Ali
- Department of Microbiology, Faculty of Biological Science, University of Chittagong, Chittagong 4331, Bangladesh;
| | - Sarkar M. A. Kawsar
- Laboratory of Carbohydrate and Nucleoside Chemistry (LCNC), Department of Chemistry, Faculty of Science, University of Chittagong, Chittagong 4331, Bangladesh; (S.A.); (J.F.)
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Wu L, Kong X. COVID-19 pandemic: ethical issues and recommendations for emergency triage. Front Public Health 2023; 11:1160769. [PMID: 37213643 PMCID: PMC10196018 DOI: 10.3389/fpubh.2023.1160769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/07/2023] [Indexed: 05/23/2023] Open
Abstract
The current epidemic of Coronavirus Disease 2019 (COVID-19) has become a public health event worldwide. Through ethical analysis of a series of epidemic prevention phenomena and epidemic prevention measures taken by the Chinese (and other countries) government and medical institutions during the COVID-19 pandemic, this paper discusses a series of ethical difficulties in hospital emergency triage caused by the COVID-19, including the autonomy limitation of patients and waste of epidemic prevention resources due to over-triage, the safety problem of patients because of inaccurate feedback information from intelligent epidemic prevention technology, and conflicts between individual interests of patients and public interests due to the "strict" implementation of the pandemic prevention and control system. In addition, we also discuss the solution path and strategy of these ethical issues from the perspective of system design and implementation based on the Care Ethics theory.
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Ramiro Avilés MA, De Miguel Beriain Í. COVID-19, the Immune System, and Organic Disability. Asian Bioeth Rev 2022; 15:1-23. [PMID: 36407414 PMCID: PMC9661456 DOI: 10.1007/s41649-022-00232-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/19/2022] [Accepted: 10/19/2022] [Indexed: 11/16/2022] Open
Abstract
Despite the availability of safe vaccines against SARS-CoV-2, some people will remain vulnerable because they will not be vaccinated. Who are these non-vaccinated people? We can distinguish two groups: (i) persons who cannot be vaccinated for clinical reasons and who, despite having been vaccinated, have not achieved immunity; (ii) persons who voluntarily refuse to get vaccinated. These groups have in common an immune system that will make them vulnerable to COVID-19. The reasons for their vulnerability and the ethical judgment they deserve are different; the solutions offered to them are also different. In the case of those who voluntarily avoid vaccination, States are not compromised to introduce new protective policies. In the case of people who remain involuntarily vulnerable, instead, the response should be articulated on the same rules and principles that inform the social model of disability because they will live with an organic disability.
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Martani A. Editorial: Stockpiling Basic Medical Equipment for Public Health Emergencies and “The-Right-Thing-To-Do.” Charting the Ethical Territory. Int J Public Health 2022; 67:1604679. [PMID: 35719736 PMCID: PMC9199459 DOI: 10.3389/ijph.2022.1604679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 05/13/2022] [Indexed: 12/02/2022] Open
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Yao L, Ngai CSB. Engaging social media users with attitudinal messages during health crisis communication. LINGUA. INTERNATIONAL REVIEW OF GENERAL LINGUISTICS. REVUE INTERNATIONALE DE LINGUISTIQUE GENERALE 2022; 268:103199. [PMID: 34720188 PMCID: PMC8548932 DOI: 10.1016/j.lingua.2021.103199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 06/13/2023]
Abstract
To cope with the COVID-19 pandemic, various policy measures accompanied by health crisis communication were adopted in China to engage publics. In this study, we investigated how People's Daily communicated COVID-19 messages on Weibo. Drawing on the Appraisal Framework, we developed a three-stage mixed method approach to study 400 COVID-19 posts to identify the attitude resources employed and their association with public engagement. We found that attitudinal posts were more engaging than non-attitudinal posts. Judgment, both positive and negative, was positively associated with public engagement, whereas the use of positive Affect and Appreciation could be ineffective. These findings contribute to the understanding of how public engagement on social media can be enhanced through the use of attitudinal messages in health emergencies.
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Affiliation(s)
- Le Yao
- Faculty of Humanities, The Hong Kong Polytechnic University, Hong Kong, China
| | - Cindy Sing Bik Ngai
- Department of Chinese & Bilingual Studies, The Hong Kong Polytechnic University, Hong Kong, China
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Gaucher N, Trottier ED, Côté AJ, Ali H, Lavoie B, Bourque CJ, Ali S. A survey of Canadian emergency physicians' experiences and perspectives during the COVID-19 pandemic. CAN J EMERG MED 2021; 23:466-474. [PMID: 33999397 PMCID: PMC8127493 DOI: 10.1007/s43678-021-00129-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/29/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND The objective of this study was to explore Canadian emergency physicians' experiences, concerns, and perspectives during the first wave of the coronavirus disease (COVID-19) pandemic. METHODS This cross-sectional survey of physician members of Pediatric Emergency Research Canada and the Canadian Association of Emergency Physicians explored: personal safety/responsibility to care; patient interactions; ethical issues in pandemic care; institutional dynamics and communication practices. Data analysis was descriptive: categorical data were summarised with frequency distributions, continuous data [100 mm visual analog scales (VAS)] were analysed using measures of central tendency. Short open-ended items were coded to identify frequencies of responses. RESULTS From June 29 to July 29, 2020, 187 respondents (13% response rate) completed the survey: 39% were from Ontario and 20% from Quebec, trained in general (50%) or pediatric (37%) emergency medicine. Respondents reported a high moral obligation to care for patients (97/100, IQR: 85-100, on 100 mm VAS). Fear of contracting COVID-19 changed how 82% of respondents reported interacting with patients, while 97% reported PPE negatively impacted patient care. Despite reporting a high proportion of negative emotions (84%), respondents (59%) were not/slightly concerned about their mental health. Top concerns included a potential second wave, Canada's financial situation, worldwide solidarity, and youth mental health. Facilitators to provide emergency care included: teamwork, leadership, clear communications strategies. CONCLUSION Canadian emergency physicians felt a strong sense of responsibility to care, while dealing with several ethical dilemmas. Clear communication strategies, measures to ensure safety, and appropriate emergency department setups facilitate pandemic care. Emergency physicians were not concerned about their own mental health, requiring further exploration.
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Affiliation(s)
- Nathalie Gaucher
- Department of Pediatric Emergency Medicine and Research Center, Department of Pediatrics, CHU Sainte-Justine, 3175 Ch Cote Sainte-Catherine, Montreal, Quebec, H3T1C5, Canada.
- CHU Sainte-Justine Research Center, Montreal, QC, Canada.
- Clinical Ethics Unit, CHU Sainte-Justine, Montreal, QC, Canada.
| | - Evelyne D Trottier
- Department of Pediatric Emergency Medicine and Research Center, Department of Pediatrics, CHU Sainte-Justine, 3175 Ch Cote Sainte-Catherine, Montreal, Quebec, H3T1C5, Canada
| | - Anne-Josee Côté
- Division of Pediatric Emergency Medicine, Alberta Children's Hospital, Calgary, AB, Canada
| | - Huma Ali
- Department of Emergency Medicine, Cummings School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Bertrand Lavoie
- Faculty of Law, Institute for Health and Social Policy, McGill University, Montreal, QC, Canada
| | - Claude-Julie Bourque
- CHU Sainte-Justine Research Center, Montreal, QC, Canada
- Clinical Ethics Unit, CHU Sainte-Justine, Montreal, QC, Canada
- Centre d'excellence en éthique et partenariat, CHU Sainte-Justine, Montreal, QC, Canada
| | - Samina Ali
- Departments of Pediatric and Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Faculty of Medicine and Dentistry, Women and Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada
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Ibáñez MJ, Guerrero M, Yáñez-Valdés C, Barros-Celume S. Digital social entrepreneurship: the N-Helix response to stakeholders' COVID-19 needs. JOURNAL OF TECHNOLOGY TRANSFER 2021; 47:556-579. [PMID: 33814697 PMCID: PMC8007451 DOI: 10.1007/s10961-021-09855-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 01/23/2023]
Abstract
This study explores the emergence of a new entrepreneurship phenomenon (digital social entrepreneurship) as a result of the collaboration among many agents (N-Helix), given the government’s limited capacity to respond to the stakeholders’ needs satisfaction related to an exogenous event (e.g., the COVID-19 pandemic). Our theory development is based on three ongoing academic debates related to (a) the unrepresentativeness of the stakeholder theory in entrepreneurship research; (b) the emergence of digital social entrepreneurship (DSE) as a bridge between stakeholders’ needs, socio-economic actors, and digital-social initiatives; and (c) the role of N-Helix collaborations to facilitate the emergence of global knowledge-intensive initiatives and the rapid adoptions of open innovations. Our results support our assumptions about the positive mediation effect of DSE in the relationship between N-Helix collaborations and stakeholders’ satisfaction. Notably, results show how pandemic has intensified these relationships and how DSE in N-Helix collaborations can generate social impacts globally. Some implications for policy-makers have emerged from our results that should be considered during/post-COVID-19 pandemic.
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Affiliation(s)
- María J Ibáñez
- School of Business and Economics, Universidad del Desarrollo, Av. Plaza 680, Las Condes, Santiago Chile
| | - Maribel Guerrero
- School of Business and Economics, Universidad del Desarrollo, Av. Plaza 680, Las Condes, Santiago Chile.,Northumbria Centre for Innovation, Regional Transformation, and Entrepreneurship (iNCITE). Business and Law Faculty, Newcastle Business School, Sutherland Building, 2 Ellison Pl, Newcastle upon Tyne, UK.,Centre for Innovation Research (CIRCLE), Lund University, Sölvegatan 16, Lund, Sweden
| | - Claudia Yáñez-Valdés
- School of Business and Economics, Universidad del Desarrollo, Av. Plaza 680, Las Condes, Santiago Chile
| | - Sebastián Barros-Celume
- School of Business and Economics, Universidad del Desarrollo, Av. Plaza 680, Las Condes, Santiago Chile
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8
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Ela MZ, Shohel TA, Shovo TEA, Khan L, Jahan N, Hossain MT, Islam MN. Prolonged lockdown and academic uncertainties in Bangladesh: A qualitative investigation during the COVID-19 pandemic. Heliyon 2021; 7:e06263. [PMID: 33615016 PMCID: PMC7881287 DOI: 10.1016/j.heliyon.2021.e06263] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/04/2020] [Accepted: 02/08/2021] [Indexed: 12/27/2022] Open
Abstract
The erratic nature of the novel coronavirus disease (COVID-19) forced the Bangladeshi government to shut down all the educational institutions since March 18, 2020. This prolonged closure not only detached the students from their study but also increased anxiety among them regarding their future academic as well as professional careers. The present study aimed to explore the perception and understanding of the students and teachers regarding the impact of COVID-19 on the academic life and career pursuit of university students in Bangladesh. With a semi-structured interview schedule, data for this qualitative study were collected from 8 purposively selected participants, using telephone interviews, affiliated with a public university in Bangladesh. Students argued that the extended closure is responsible for the delayed graduation of the senior students, thereby, mounting mental stress and frustration among them. The informants unequivocally opposed the online education platform, as a solution for the ongoing gap, due to scarcity of the resources, and unequal accesses and opportunities for all. It has been suggested that the education gap can be reduced by shortening the term, curtailing the preparatory leave, and taking extra classes over the weekends when the universities re-open together with enforced collective health hygiene.
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Affiliation(s)
- Mahfuza Zaman Ela
- Sociology Discipline, Social Science School, Khulna University, Khulna 9208, Bangladesh
| | - Tunvir Ahamed Shohel
- Sociology Discipline, Social Science School, Khulna University, Khulna 9208, Bangladesh.,Social and Political Science (SPS) Program, Faculty of Arts, Monash University, Clayton, 3168, Melbourne, Australia
| | - Taufiq-E-Ahmed Shovo
- Sociology Discipline, Social Science School, Khulna University, Khulna 9208, Bangladesh.,School of Humanities and Social Science, Faculty of Education and Arts, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Lubaba Khan
- Sociology Discipline, Social Science School, Khulna University, Khulna 9208, Bangladesh
| | - Nusrat Jahan
- Sociology Discipline, Social Science School, Khulna University, Khulna 9208, Bangladesh
| | - Md Tanvir Hossain
- Sociology Discipline, Social Science School, Khulna University, Khulna 9208, Bangladesh
| | - Md Nazrul Islam
- Forestry and Wood Technology, Life Science School, Khulna University, Khulna 9208, Bangladesh
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9
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Torrie C, Yanicki S, Sedgwick M, Howard L. Social justice in pandemic immunization policy: We're all in this together. Nurs Ethics 2021; 28:924-934. [PMID: 33522418 DOI: 10.1177/0969733020983395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Policy decisions regarding immunization during a pandemic are informed by the ethical understandings of policy makers. With the possibility that a vaccine might soon be available to mitigate the deadly COVID-19 pandemic, policy makers can consider learnings from past pandemic immunization campaigns. This critical analysis of three policy decisions made in Alberta, Canada, during the 2009 H1N1 influenza pandemic demonstrates the predominance of distributive justice principles and the problems that this created for vulnerable groups. Vulnerable groups identified in Alberta include rural and First Nations populations. We propose a social justice approach as a viable alternative to inform pandemic immunization policy and invite debate.
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10
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Arnold M, Kerridge I. Accelerating the De-Personalization of Medicine: The Ethical Toxicities of COVID-19. JOURNAL OF BIOETHICAL INQUIRY 2020; 17:815-821. [PMID: 32840851 PMCID: PMC7445805 DOI: 10.1007/s11673-020-10026-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 08/06/2020] [Indexed: 05/16/2023]
Abstract
The COVID-19 pandemic has, of necessity, demanded the rapid incorporation of virtual technologies which, suddenly, have superseded the physical medical encounter. These imperatives have been implemented in advance of evaluation, with unclear risks to patient care and the nature of medical practice that might be justifiable in the context of a pandemic but cannot be extrapolated as a new standard of care. Models of care fit for purpose in a pandemic should not be generalized to reconfigure medical care as virtual by default, and personal by exception at the conclusion of the emergency.
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Affiliation(s)
- Mark Arnold
- School of Rural Health (Dubbo/Orange), Sydney Medical School, Faculty of Medicine and Health, University of Sydney, PO BOX 1043, Dubbo, NSW, 2830, Australia.
- Sydney Health Ethics, Faculty of Medicine and Health, University of Sydney, Campertown, NSW, 2006, Australia.
| | - Ian Kerridge
- Sydney Health Ethics, Faculty of Medicine and Health, Haematology Department, Royal North Shore Hospital, University of Sydney, Sydney, NSW, Australia
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11
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Banerjee D, Rao TSS. Sexuality, sexual well being, and intimacy during COVID-19 pandemic: An advocacy perspective. Indian J Psychiatry 2020; 62:418-426. [PMID: 33165372 PMCID: PMC7597708 DOI: 10.4103/psychiatry.indianjpsychiatry_484_20] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/25/2020] [Accepted: 06/17/2020] [Indexed: 12/11/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome (SARS)-CoV-2, has emerged as a global public health threat. The implications are much beyond just health crisis, and it has long-lasting psychosocial and economic implications. Although the psychological offshoots such as depression, anxiety, posttraumatic stress, and sleep disturbances are being studied in-depth, there is a dearth of literature on the sexual well-being and sexual practices during this pandemic. Considering the physical distancing; travel restrictions; the high human-human transmission rate; misinformation and uncertainty about the sexual routes of transmission for SARS-CoV-2; and fear about intimacy, sexuality, and safe sexual practices have increased significantly. This is more prominent in newly settled or distanced couples and the frontline health workers, with increased risk exposure to the virus. For them, guilt and distress associated with sexual relationships might increase primary psychiatric and sexual disorders. This, in turn, impacts relationships and emotional bonding in couples and affects healthy coping during the pandemic crisis. Although sexual abstinence is the safest practice to prevent transmission, it is not practically feasible in all cases. Risk reduction counseling, sex with quarantined partners, and digital sex are other options that are worth exploring. There are additional concerns of digital safety, unhealthy use of technology, cyber-crimes, and online extortion. Keeping this in the background, this advocacy article glances through the effects of past outbreaks on sexuality, reviews the current recommendations, and proposes methods and approaches for sexual well-being during the COVID-19 pandemic, which is vital for overall public health.
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Affiliation(s)
- Debanjan Banerjee
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - T. S. Sathyanarayana Rao
- Department of Psychiatry, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
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Abstract
Community-networks such as families and schools may foster and propagate some types of public health disasters. For such disasters, a communitarian-oriented ethical lens offers useful perspectives into the underlying relational nexus that favors the spread of infection. This chapter compares two traditional bioethical lenses—the communitarian and care ethics framework—vis-à-vis their capacities to engage the moral quandaries elicited by pandemic influenza. It argues that these quandaries preclude the analytical lens of ethical prisms that are individual-oriented but warrant a people-oriented approach. Adopting this dual approach offers both a contrastive and a complementary way of rethinking the underlying socioethical tensions elicited by pandemic influenza in particular and other public health disasters generally.
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13
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Sambala EZ, Manderson L. Policy perspectives on post pandemic influenza vaccination in Ghana and Malawi. BMC Public Health 2017; 17:227. [PMID: 28245803 PMCID: PMC5331702 DOI: 10.1186/s12889-017-4058-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 01/24/2017] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND In the late 1990s, in the context of renewed concerns of an influenza pandemic, countries such as Ghana and Malawi established plans for the deployment of vaccines and vaccination strategies. A new pandemic was declared in mid-June 2009, and by April 2011, Ghana and Malawi vaccinated 10% of the population. We examine the public health policy perspectives on vaccination as a means to prevent the spread of infection under post pandemic conditions. METHODS In-depth interviews were conducted with 46 policymakers (Ghana, n = 24; Malawi, n = 22), identified through snowballing sampling. Interviews were supplemented by field notes and the analysis of policy documents. RESULTS The use of vaccination to interrupt the pandemic influenza was affected by delays in the procurement, delivery and administration of vaccines, suboptimal vaccination coverage, refusals to be vaccinated, and the politics behind vaccination strategies. More generally, rolling-out of vaccination after the transmission of the influenza virus had abated was influenced by policymakers' own financial incentives, and government and foreign policy conditionality on vaccination. This led to confusion about targeting and coverage, with many policymakers justifying that the vaccination of 10% of the population would establish herd immunity and so reduce future risk. Ghana succeeded in vaccinating 2.3 million of the select groups (100% coverage), while Malawi, despite recourse to force, succeeded only in vaccinating 1.15 million (74% coverage of select groups). For most policymakers, vaccination coverage was perceived as successful, despite that vaccination delays and coverage would not have prevented infection when influenza was at its peak. CONCLUSIONS While the vaccination strategy was problematic and implemented too late to reduce the effects of the 2009 epidemic, policy makers supported the overall goal of pandemic influenza vaccination to interrupt infection. In this context, there was strong support for governments engaging in contracts with pharmaceutical companies to ensure the timely supply of vaccines, and developing well-defined guidelines to address vaccination delays, refusals and coverage.
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Affiliation(s)
- Evanson Z. Sambala
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrew’s Road, Parktown, Johannesburg, 2193 South Africa
| | - Lenore Manderson
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrew’s Road, Parktown, Johannesburg, 2193 South Africa
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14
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Leber A, Bassaganya-Riera J, Tubau-Juni N, Zoccoli-Rodriguez V, Lu P, Godfrey V, Kale S, Hontecillas R. Lanthionine Synthetase C-Like 2 Modulates Immune Responses to Influenza Virus Infection. Front Immunol 2017; 8:178. [PMID: 28270815 PMCID: PMC5318425 DOI: 10.3389/fimmu.2017.00178] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 02/07/2017] [Indexed: 11/13/2022] Open
Abstract
Broad-based, host-targeted therapeutics have the potential to ameliorate viral infections without inducing antiviral resistance. We identified lanthionine synthetase C-like 2 (LANCL2) as a new therapeutic target for immunoinflammatory diseases. To examine the therapeutic efficacy of oral NSC61610 administration on influenza, we infected C57BL/6 mice with influenza A H1N1pdm virus and evaluated influenza-related mortality, lung inflammatory profiles, and pulmonary histopathology. Oral treatment with NSC61610 ameliorates influenza virus infection by down-modulating pulmonary inflammation through the downregulation of TNF-α and MCP-1 and reduction in the infiltration of neutrophils. NSC61610 treatment increases IL10-producing CD8+ T cells and macrophages in the lungs during the resolution phase of disease. The loss of LANCL2 or neutralization of IL-10 in mice infected with influenza virus abrogates the ability of NSC61610 to accelerate recovery and induce IL-10-mediated regulatory responses. These studies validate that oral treatment with NSC61610 ameliorates morbidity and mortality and accelerates recovery during influenza virus infection through a mechanism mediated by activation of LANCL2 and subsequent induction of IL-10 responses by CD8+ T cells and macrophages in the lungs.
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Affiliation(s)
- Andrew Leber
- Nutritional Immunology and Molecular Medicine Laboratory, Biocomplexity Institute, Virginia Tech , Blacksburg, VA , USA
| | - Josep Bassaganya-Riera
- Nutritional Immunology and Molecular Medicine Laboratory, Biocomplexity Institute, Virginia Tech , Blacksburg, VA , USA
| | - Nuria Tubau-Juni
- Nutritional Immunology and Molecular Medicine Laboratory, Biocomplexity Institute, Virginia Tech , Blacksburg, VA , USA
| | - Victoria Zoccoli-Rodriguez
- Nutritional Immunology and Molecular Medicine Laboratory, Biocomplexity Institute, Virginia Tech , Blacksburg, VA , USA
| | - Pinyi Lu
- Nutritional Immunology and Molecular Medicine Laboratory, Biocomplexity Institute, Virginia Tech , Blacksburg, VA , USA
| | - Victoria Godfrey
- Nutritional Immunology and Molecular Medicine Laboratory, Biocomplexity Institute, Virginia Tech , Blacksburg, VA , USA
| | - Shiv Kale
- Nutritional Immunology and Molecular Medicine Laboratory, Biocomplexity Institute, Virginia Tech , Blacksburg, VA , USA
| | - Raquel Hontecillas
- Nutritional Immunology and Molecular Medicine Laboratory, Biocomplexity Institute, Virginia Tech , Blacksburg, VA , USA
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15
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Smith MJ. Ebola and Learning Lessons from Moral Failures: Who Cares about Ethics? Public Health Ethics 2015; 8:305-318. [PMID: 32288786 PMCID: PMC7107108 DOI: 10.1093/phe/phv028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The exercise of identifying lessons in the aftermath of a major public health emergency is of immense importance for the improvement of global public health emergency preparedness and response. Despite the persistence of the Ebola Virus Disease (EVD) outbreak in West Africa, it seems that the Ebola 'lessons learned' exercise is now in full swing. On our assessment, a significant shortcoming plagues recent articulations of lessons learned, particularly among those emerging from organizational reflections. In this article we argue that, despite not being recognized as such, the vast majority of lessons proffered in this literature should be understood as ethical lessons stemming from moral failures, and that any improvements in future global public health emergency preparedness and response are in large part dependent on acknowledging this fact and adjusting priorities, policies and practices accordingly such that they align with values that better ensure these moral failures are not repeated and that new moral failures do not arise. We cannot continue to fiddle at the margins without critically reflecting on our repeated moral failings and committing ourselves to a set of values that engenders an approach to global public health emergencies that embodies a sense of solidarity and global justice.
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A literature review to identify factors that determine policies for influenza vaccination. Health Policy 2015; 119:697-708. [DOI: 10.1016/j.healthpol.2015.04.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 03/31/2015] [Accepted: 04/10/2015] [Indexed: 11/18/2022]
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Laar A, DeBruin D. Ethics-sensitivity of the Ghana national integrated strategic response plan for pandemic influenza. BMC Med Ethics 2015; 16:30. [PMID: 25947354 PMCID: PMC4427965 DOI: 10.1186/s12910-015-0025-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 04/29/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Many commentators call for a more ethical approach to planning for influenza pandemics. In the developed world, some pandemic preparedness plans have already been examined from an ethical viewpoint. This paper assesses the attention given to ethics issues by the Ghana National Integrated Strategic Plan for Pandemic Influenza (NISPPI). METHODS We critically analyzed the Ghana NISPPI's sensitivity to ethics issues to determine how well it reflects ethical commitments and principles identified in our review of global pandemic preparedness literature, existing pandemic plans, and relevant ethics frameworks. RESULTS This paper reveals that important ethical issues have not been addressed in the Ghana NISPPI. Several important ethical issues are unanticipated, unacknowledged, and unplanned for. These include guidelines on allocation of scarce resources, the duties of healthcare workers, ethics-sensitive operational guidelines/protocols, and compensation programs. The NISPPI also pays scant attention to use of vaccines and antivirals, border issues and cooperation with neighboring countries, justification for delineated actions, and outbreak simulations. Feedback and communication plans are nebulous, while leadership, coordination, and budgeting are quite detailed. With respect to presentation, the NISPPI's text is organized around five thematic areas. While each area implicates ethical issues, NISPPI treatment of these areas consistently fails to address them. CONCLUSIONS Our analysis reveals a lack of consideration of ethics by the NISPPI. We contend that, while the plan's content and fundamental assumptions provide support for implementation of the delineated public health actions, its consideration of ethical issues is poor. Deficiencies include a failure to incorporate guidelines that ensure fair distribution of scarce resources and a lack of justification for delineated procedures. Until these deficiencies are recognized and addressed, Ghana runs the risk of rolling out unjust and ethically indefensible actions with real negative effects in the event of a pandemic. Soliciting inputs from the public and consultation with ethicists during the next revision of the NISPPI will be useful in addressing these issues.
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Affiliation(s)
- Amos Laar
- Department of Population, Family and Reproductive Health, School of Public Health, College of Health Sciences, University of Ghana, Box LG 13, Legon, Accra, Ghana.
| | - Debra DeBruin
- Center for Bioethics, University of Minnesota, 410 Church Street S.E MN, 55455-0346, Minneapolis, USA.
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Massé R, Désy M. Lay people's interpretation of ethical values related to mass vaccination; the case of A(H1N1) vaccination campaign in the province of Quebec (French Canada). Health Expect 2014; 17:876-87. [PMID: 23016511 PMCID: PMC5060925 DOI: 10.1111/hex.12005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2012] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Pandemic influenza ethics frameworks are based on respect of values and principles such as regard for autonomy, responsibility, transparency, solidarity and social justice. However, very few studies have addressed the way in which the general population views these moral norms. OBJECTIVES (i) To analyse the receptiveness of the population of French-speaking Quebecers to certain ethical principles promoted by public health authorities during the AH1N1 vaccination campaign. (ii) To add to the limited number of empirical studies that examine the population's perception of ethical values. DESIGN Eight months after the end of the AH1N1 vaccination campaign in the Province of Quebec (Canada), 100 French-speaking Quebecers were assembled in ten focus groups. Discussions focussed on the level of respect shown by public health authorities for individual autonomy, the limits of appeals for solidarity, the balance between vaccination efficiency and social justice towards non-prioritized subpopulations, vaccination as a demonstration of civic duty and social responsibility. RESULTS The population acknowledged a high level of individual responsibility towards family members and agreed to vaccination to protect children and ageing parents. However, the concepts of civic duty and solidarity did not elucidate unanimous support, despite the fact that social justice stood out as a dominant value of public morals. CONCLUSION The ethical principles promoted in influenza pandemic ethics frameworks are subject to reinterpretation by the population. An ethic of public health must consider their understanding of the fundamental values that legitimize mass vaccination.
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Affiliation(s)
- Raymond Massé
- Department of AnthropologyLaval UniversityQuebec CityQCCanada
| | - Michel Désy
- Quebec Public Health Ethics CommitteeMontrealQCCanada
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Informing the gestalt: an ethical framework for allocating scarce federal public health and medical resources to states during disasters. Disaster Med Public Health Prep 2014; 8:79-88. [PMID: 24612854 DOI: 10.1017/dmp.2014.9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
During catastrophic disasters, government leaders must decide how to efficiently and effectively allocate scarce public health and medical resources. The literature about triage decision making at the individual patient level is substantial, and the National Response Framework provides guidance about the distribution of responsibilities between federal and state governments. However, little has been written about the decision-making process of federal leaders in disaster situations when resources are not sufficient to meet the needs of several states simultaneously. We offer an ethical framework and logic model for decision making in such circumstances. We adapted medical triage and the federalism principle to the decision-making process for allocating scarce federal public health and medical resources. We believe that the logic model provides a values-based framework that can inform the gestalt during the iterative decision process used by federal leaders as they allocate scarce resources to states during catastrophic disasters.
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Buccieri K, Gaetz S. Ethical Vaccine Distribution Planning for Pandemic Influenza: Prioritizing Homeless and Hard-to-Reach Populations. Public Health Ethics 2013. [DOI: 10.1093/phe/pht005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
ABSTRACTThe prospect of a severe influenza pandemic poses a daunting public health threat to hospitals and the public they serve. The event of a severe influenza pandemic will put hospitals under extreme stress; only so many beds, ventilators, nurses, and physicians will be available, and it is likely that more patients will require medical attention than can be completely treated. Triage is the process of sorting patients in a time of crisis to determine who receives what level of medical attention. How will hospitals sort patients to determine priority for treatment? What criteria will be used? Who will develop these criteria? This article formulates an answer to these questions by constructing a conceptual framework for anticipating and responding to the ethical issues raised by triage in the event of a severe influenza pandemic. (Disaster Med Public Health Preparedness. 2008;2:114–118)
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Charania NA, Tsuji LJS. A community-based participatory approach and engagement process creates culturally appropriate and community informed pandemic plans after the 2009 H1N1 influenza pandemic: remote and isolated First Nations communities of sub-arctic Ontario, Canada. BMC Public Health 2012; 12:268. [PMID: 22472012 PMCID: PMC3434059 DOI: 10.1186/1471-2458-12-268] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 04/03/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Public health emergencies have the potential to disproportionately impact disadvantaged populations due to pre-established social and economic inequalities. Internationally, prior to the 2009 H1N1 influenza pandemic, existing pandemic plans were created with limited public consultation; therefore, the unique needs and characteristics of some First Nations communities may not be ethically and adequately addressed. Engaging the public in pandemic planning can provide vital information regarding local values and beliefs that may ultimately lead to increased acceptability, feasibility, and implementation of pandemic plans. Thus, the objective of the present study was to elicit and address First Nations community members' suggested modifications to their community-level pandemic plans after the 2009 H1N1 influenza pandemic. METHODS The study area included three remote and isolated First Nations communities located in sub-arctic Ontario, Canada. A community-based participatory approach and community engagement process (i.e., semi-directed interviews (n = 13), unstructured interviews (n = 4), and meetings (n = 27)) were employed. Participants were purposively sampled and represented various community stakeholders (e.g., local government, health care, clergy, education, etc.) involved in the community's pandemic response. Collected data were manually transcribed and coded using deductive and inductive thematic analysis. The data subsequently informed the modification of the community-level pandemic plans. RESULTS The primary modifications incorporated in the community-level pandemic plans involved adding community-specific detail. For example, 'supplies' emerged as an additional category of pandemic preparedness and response, since including details about supplies and resources was important due to the geographical remoteness of the study communities. Furthermore, it was important to add details of how, when, where, and who was responsible for implementing recommendations outlined in the pandemic plans. Additionally, the roles and responsibilities of the involved organizations were further clarified. CONCLUSIONS Our results illustrate the importance of engaging the public, especially First Nations, in pandemic planning to address local perspectives. The community engagement process used was successful in incorporating community-based input to create up-to-date and culturally-appropriate community-level pandemic plans. Since these pandemic plans are dynamic in nature, we recommend that the plans are continuously updated to address the communities' evolving needs. It is hoped that these modified plans will lead to an improved pandemic response capacity and health outcomes, during the next public health emergency, for these remote and isolated First Nations communities. Furthermore, the suggested modifications presented in this paper may help inform updates to the community-level pandemic plans of other similar communities.
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Affiliation(s)
- Nadia A Charania
- Department of Environment and Resource Studies, University of Waterloo, Waterloo, ON, Canada.
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23
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Rosoff PM. Unpredictable drug shortages: an ethical framework for short-term rationing in hospitals. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2012; 12:1-9. [PMID: 22220948 DOI: 10.1080/15265161.2011.634483] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Periodic and unexpected shortages of drugs, biologics, and even medical devices have become commonplace in the United States. When shortages occur, hospitals and clinics need to decide how to ration their available stock. When such situations arise, institutions can choose from several different allocation schemes, such as first-come, first-served, a lottery, or a more rational and calculated approach. While the first two approaches sound reasonable at first glance, there are a number of problems associated with them, including the inability to make fine, individual patient-centered decisions. They also do not discriminate between what kinds of patients and what types of uses may be more deserving or reasonable than others. In this article I outline an ethically acceptable procedure for rationing drugs during a shortage in which demand outstrips supply.
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Literatur zu Schwartz F.W. et al.: Public Health – Gesundheit und Gesundheitswesen. Public Health 2012. [DOI: 10.1016/b978-3-437-22261-0.16001-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lee S, Golinski M, Chowell G. Modeling Optimal Age-Specific Vaccination Strategies Against Pandemic Influenza. Bull Math Biol 2011; 74:958-80. [DOI: 10.1007/s11538-011-9704-y] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Accepted: 10/28/2011] [Indexed: 11/29/2022]
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Cowden J, Crane L, Lezotte D, Glover J, Nyquist AC. Pre-pandemic planning survey of healthcare workers at a tertiary care children's hospital: ethical and workforce issues. Influenza Other Respir Viruses 2011; 4:213-22. [PMID: 20836796 PMCID: PMC4940933 DOI: 10.1111/j.1750-2659.2010.00145.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Prior to the development of written policies and procedures for pandemic influenza, worker perceptions of ethical and workforce issues must be identified. OBJECTIVE To determine the relationship between healthcare worker (HCW) reporting willingness to work during a pandemic and perception of job importance, belief that one will be asked to work, and sense of professionalism and to assess HCW's opinions regarding specific policy issues as well as barriers and motivators to work during a pandemic. METHODS A survey was conducted in HCWs at The Children's Hospital in Denver, Colorado, from February to June 2007. Characteristics of workers reporting willingness to work during a pandemic were compared with those who were unwilling or unsure. Importance of barriers and motivators was compared by gender and willingness to work. RESULTS Sixty percent of respondents reported willingness to work (overall response rate of 31%). Belief one will be asked to work (OR 4.6, P < 0.0001) and having a high level of professionalism (OR 8.6, P < 0.0001) were associated with reporting willingness to work. Hospital infrastructure support staffs were less likely to report willingness to work during a pandemic than clinical healthcare professionals (OR 0.39, P < 0.001). Concern for personal safety, concern for safety of family, family's concern for safety, and childcare issues were all important barriers to coming to work. CONCLUSIONS Educational programs should focus on professional responsibility and the importance of staying home when ill. Targeted programs toward hospital infrastructure support and patient and family support staff stressing the essential nature of these jobs may improve willingness to work.
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Affiliation(s)
- Jessica Cowden
- Department of Pediatrics, University of Colorado, Denver, CO, USA.
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27
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Some factors affecting the decision on non-mandatory vaccination in an influenza pandemic: comparison of pandemic (H1N1) and seasonal influenza vaccination. Zdr Varst 2011. [DOI: 10.2478/v10152-011-0002-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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28
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Appleby B. Relational Personhood, Social Justice and the Common Good: Catholic Contributions toward a Public Health Ethics. CHRISTIAN BIOETHICS 2010; 16:296-313. [PMID: 30546267 PMCID: PMC6283016 DOI: 10.1093/cb/cbq022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Worldwide, there is renewed public and political attention focused on public health fueled by the globally explosive H1N1 pandemic. Pandemic planning emerged as a major area for public action in the absence of an overarching ethics framework appropriate for the community and population focus of public health. Baylis, Sherwin, and Kenny propose relational personhood and relational solidarity as core values for a public health ethics. The Catholic faith tradition makes three useful contributions in support of a relational ethic: first, a religious ontology that aligns with the view that human persons are inherently relational; second, a coherent account of the requisite social and communal ideals and structures that this belief demands; and third, inspiration and motivation for the attitudes and actions that are required in response to a relational ontology.
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Affiliation(s)
- Brenda Appleby
- St. Francis Xavier University, Antigonish, Nova Scotia, Canada
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29
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Nicholas D, Patershuk C, Koller D, Bruce-Barrett C, Lach L, Zlotnik Shaul R, Matlow A. Pandemic planning in pediatric care: a website policy review and national survey data. Health Policy 2010; 96:134-42. [PMID: 20137826 PMCID: PMC7132461 DOI: 10.1016/j.healthpol.2010.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Revised: 01/07/2010] [Accepted: 01/11/2010] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study investigates current policies, key issues, and needs for pandemic planning in pediatrics in Canada. METHODS Online pandemic plans from national, provincial and territorial government websites were reviewed to identify: plans for children and families, and psychosocial and ethical issues. A survey was administered to gather participants' perspectives on the needs in pediatric planning, as well as important elements of their organizations' and regions' pandemic plans. A thematic analysis was conducted on qualitative survey responses. RESULTS The majority of existing plans did not adequately address the unique needs of pediatric populations, and mainly focused on medical and policy concerns. Several gaps in plans were identified, including the need for psychosocial supports and ethical decision-making frameworks for children and families. Similarly, survey respondents identified parallel gaps, in their organization's or region's plans. CONCLUSIONS Although many plans provide guidelines for medical and policy issues in pediatrics, much more work remains in psychosocial and ethical planning. A focus on children and families is needed for pandemic planning in pediatrics to ensure best outcomes for children and families.
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Affiliation(s)
- David Nicholas
- Faculty of Social Work (Central and Northern Alberta Region), University of Calgary, #444 11044-82 Avenue, Edmonton, Alberta, Canada.
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Pandemic influenza and the critically ill pediatric patient: addressing the right issues for the "worst case" scenario. Pediatr Crit Care Med 2010; 11:436-8. [PMID: 20453622 DOI: 10.1097/pcc.0b013e3181dab208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lee S, Chowell G, Castillo-Chávez C. Optimal control for pandemic influenza: the role of limited antiviral treatment and isolation. J Theor Biol 2010; 265:136-50. [PMID: 20382168 DOI: 10.1016/j.jtbi.2010.04.003] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2009] [Revised: 02/22/2010] [Accepted: 04/02/2010] [Indexed: 11/30/2022]
Abstract
The implementation of optimal control strategies involving antiviral treatment and/or isolation measures can reduce significantly the number of clinical cases of influenza. Pandemic-level control measures must be carefully assessed specially in resource-limited situations. A model for the transmission dynamics of influenza is used to evaluate the impact of isolation and/or antiviral drug delivery measures during an influenza pandemic. Five pre-selected control strategies involving antiviral treatment and isolation are tested under the "unlimited" resource assumption followed by an exploration of the impact of these "optimal" policies when resources are limited in the context of a 1918-type influenza pandemic scenario. The implementation of antiviral treatment at the start of a pandemic tends to reduce the magnitude of epidemic peaks, spreading the maximal impact of an outbreak over an extended window in time. Hence, the controls' timing and intensity can reduce the pressures placed on the health care infrastructure by a pandemic reducing the stress put on the system during epidemic peaks. The role of isolation strategies is highlighted in this study particularly when access to antiviral resources is limited.
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Affiliation(s)
- Sunmi Lee
- Mathematical and Computational Modeling Sciences Center, School of Human Evolution and Social Change, Arizona State University, PO Box 871904, Tempe, AZ 85287, USA.
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Chong SA, Capps BJ, Subramaniam M, Voo TC, Campbell AV. Clinical Research in Times of Pandemics. Public Health Ethics 2010. [DOI: 10.1093/phe/phq005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Leider JP, Brunker PAR, Ness PM. Convalescent transfusion for pandemic influenza: preparing blood banks for a new plasma product? Transfusion 2010; 50:1384-98. [PMID: 20158681 PMCID: PMC7201862 DOI: 10.1111/j.1537-2995.2010.02590.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Due to the potential of a severe pandemic to limit efficacy or availability of medical countermeasures, some researchers have begun a search for new interventions that could complement the planned antiviral‐ and vaccine‐based response to an influenza pandemic. One such countermeasure—the transfusion of pandemic influenza‐specific antibodies from surviving patients to the clinically ill—is the focus of this commentary. Passive immunotherapy, which includes the use of monoclonal antibodies (MoAbs), hyperimmune globulin, or convalescent plasma, had been used before the advent of antibiotics and has recently reentered the limelight due to the accelerating development of MoAb therapies against cancer, a number of microbes, allograft rejection, and a host of other conditions. After the plausible biologic mechanism and somewhat limited data supporting the efficacy for this modality against influenza are reviewed, safety and logistical concerns for utilization of this potential new product (fresh convalescent plasma against influenza [FCP‐Flu]) are discussed. FCP‐Flu could indeed prove useful in a response to a pandemic, but two necessary items must first be satisfied. Most importantly, more research should be conducted to establish FCP‐Flu efficacy against the current and other pandemic strains. Second, and also importantly, blood banks and donor centers should examine whether offering this new product would be feasible in a pandemic and begin planning before a more severe pandemic forces us to respond without adequate preparation.
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Affiliation(s)
- Jonathon P Leider
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
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Abstract
The 2009 influenza A/H1N1 pandemic seems to be only moderately severe. In the future, a pandemic influenza with high lethality, such as the Spanish influenza in 1918-1919 or even worse, may emerge. In this kind of scenario, lethality rates ranging roughly from 2% to 30% have been proposed. Legal and ethical issues should be discussed before the incident. This article aims to highlight the legal, ethical and professional aspects that might be relevant to anaesthesiologists in the case of a high-lethality infectious disease such as a severe pandemic influenza. The epidemiology, the role of anaesthesiologists and possible threats to the profession and colleagueship within medical specialties relevant to anaesthesiologists are reviewed. During historical plague epidemics, some doctors have behaved like 'deserters'. However, during the Spanish influenza, physicians remained at their jobs, although many perished. In surveys, more than half of the health-care workers have reported their willingness to work in the case of severe pandemics. Physicians have the same human rights as all citizens: they have to be effectively protected against infectious disease. However, they have a duty to treat. Fair and responsible colleagueship among the diverse medical specialties should be promoted. Until disaster threatens humanity, volunteering to work during a pandemic might be the best way to ensure that physicians and other health-care workers stay at their workplace. Broad discussion in society is needed.
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Affiliation(s)
- I Pahlman
- Faculty of Social Sciences, University of Kuopio, Kuopio, Finland
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Abstract
BACKGROUND One of the ethical issues identified in response to a possible pandemic is healthcare workers' duty to provide care during a communicable disease outbreak. Healthcare employees may be subject to a variety of work obligations under such conditions. Questions of duty to treat remain controversial, and debate continues as to the ethical articulation of a duty to treat. This study aimed to investigate opinions from healthcare workers themselves on the perceived duty to treat, and how they might respond to a severe avian flu pandemic. METHODS Using system-wide e-mail, we surveyed employees at our rural tertiary/quaternary care health system regarding their knowledge of our institution's pandemic planning policy and their willingness to work in the event of a virulent avian pandemic. RESULTS Results (N=908) show that employees felt a responsibility for"duty to care." Over 60% disagreed that it was ethical to abandon the workplace during a pandemic. However, opinions also stated that employees wanted autonomy to decide whether or not to work (65%). When asked about volunteering, 79% would agree to volunteer, given some incentives and protective options, the most salient being protective equipment (with relative training for use) and infectious disease training. CONCLUSIONS Our research demonstrated that the healthcare workers a tour institution voiced an earnest willingness to work in the event of an avian flu pandemic, if provided with the necessary input, protections and tools, and education. The use of an electronic methodology for dissemination of surveys allowed the low-cost solicitation of information from a vast proportion of the workforce with ease, providing the institutional ethics committee with the empirical data needed to articulate more meaningful,thoughtful, and robust suggestions for ethical pandemic planning.
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Affiliation(s)
- Robert B. Shabanowitz
- Geisinger Medical Center, Dept. of OB/GYN, 100 North Academy Avenue, Danville, PA 17822-2920 USA
| | - Judith E. Reardon
- Center for Health Research, Geisinger Medical Center, 100 North Academy Avenue, Danville, PA 17822-3003 USA
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Kinlaw K, Barrett DH, Levine RJ. Ethical guidelines in pandemic influenza: recommendations of the Ethics Subcommittee of the Advisory Committee of the Director, Centers for Disease Control and Prevention. Disaster Med Public Health Prep 2009; 3 Suppl 2:S185-92. [PMID: 19675459 DOI: 10.1097/dmp.0b013e3181ac194f] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Because of the importance of including ethical considerations in planning efforts for pandemic influenza, in February 2005 the Centers for Disease Control and Prevention requested that the Ethics Subcommittee of the Advisory Committee to the Director develop guidance that would serve as a foundation for decision making in preparing for and responding to pandemic influenza. Specifically, the ethics subcommittee was asked to make recommendations regarding ethical considerations relevant to decision making about vaccine and antiviral drug distribution prioritization and development of interventions that would limit individual freedom and create social distancing. The ethics subcommittee identified a number of general ethical considerations including identification of clear goals for pandemic planning, responsibility to maximize preparedness, transparency and public engagement, sound science, commitment to the global community, balancing individual liberty and community interests, diversity in ethical decision making, and commitment to justice. These general ethical considerations are applied to the issues of vaccine and antiviral drug distribution and use of community mitigation interventions.
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Poland GA, Jacobson RM, Tilburt J, Nichol K. The social, political, ethical, and economic aspects of biodefense vaccines. Vaccine 2009; 27 Suppl 4:D23-7. [PMID: 19837281 DOI: 10.1016/j.vaccine.2009.08.054] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Revised: 08/11/2009] [Accepted: 08/14/2009] [Indexed: 11/20/2022]
Abstract
Besides natural disasters and naturally occurring novel infectious diseases, nothing potentially threatens the health and stability of nations and health systems as much as the devastating threat and unfathomability of bioterrorism. Other than attempts at political solutions and interdictive attempts, only antimicrobials and vaccines offer possible means for protection. Of these, vaccines offer the most immediate and definitive of preventive solutions. Limiting the development and use of vaccines however are social, political, ethical, and economic considerations, and this article will provide a brief exploration of each of these issues and the intersection with the need for such vaccines. In this article we define bioterrorism as the deliberate use of naturally occurring or bioengineered microorganisms in order to cause harm to people, animals, or plants.
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Affiliation(s)
- Gregory A Poland
- Mayo Vaccine Research Group, Mayo Clinic, Rochester, MN 55905, USA.
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Baum NM, Jacobson PD, Goold SD. "Listen to the people": public deliberation about social distancing measures in a pandemic. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2009; 9:4-14. [PMID: 19882444 DOI: 10.1080/15265160903197531] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Public engagement in ethically laden pandemic planning decisions may be important for transparency, creating public trust, improving compliance with public health orders, and ultimately, contributing to just outcomes. We conducted focus groups with members of the public to characterize public perceptions about social distancing measures likely to be implemented during a pandemic. Participants expressed concerns about job security and economic strain on families if businesses or school closures are prolonged. They shared opposition to closure of religious organizations, citing the need for shared support and worship during times of crises. Group discussions elicited evidence of community-mindedness (e.g., recognition of an extant duty not to infect others), while some also acknowledged strong self-interest. Participants conveyed desire for opportunities for public input and education, and articulated distrust of government. Social distancing measures may be challenging to implement and sustain due to strains on family resources and lack of trust in government.
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Affiliation(s)
- Nancy M Baum
- University of Michigan School of Public Health., Health Management and Policy, 109 Observatory, Ann Arbor, MI 48109, USA.
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Washington ML. Evaluating the Capability and Cost of a Mass Influenza and Pneumococcal Vaccination Clinic via Computer Simulation. Med Decis Making 2009; 29:414-23. [PMID: 19564434 DOI: 10.1177/0272989x09333126] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective. To determine if a mass influenza/pneumococcal vaccination clinic could vaccinate 15,000 clients in 17 h; optimize personnel configuration to maximize number of clients vaccinated; and estimate costs (opportunity and clinic) and revenue. Method. The author used a discrete event simulation model to estimate the throughput of the vaccination clinic as the number of clients (arrival intensity) increased and as staff members were reassigned to different workflows. We represented workflows for 3 client types: ``Medicare,'' ``Special,'' and ``Cash,'' where ``Special'' designates Medicare clients who needed assistance moving through the clinic. The costs of supplies, staff sal-aries, and client waiting time were included in the model. We compared the ``original'' model based on the staffing and performance of an actual clinic to an ``optimized'' model in which staff were reassigned to optimize number of clients vaccinated. Results. A maximum of 13,138 and 15,094 clients in the original and optimized models, respectively, were vaccinated. At the original arrival rate (8300 clients vaccinated in 17 h), supplies cost about $191,000 and were the most expensive component of the clinic operation in both models. However, as the arrival intensity increased to 140%, the ``Medicare'' client opportunity cost increased from $23,887 and $21,474 to $743,510 and $740,760 for the simulated original and optimized models, respectively. Conclusion. The clinic could reach their target of 15,000 vaccinees with 2 fewer staff members by rearranging staff assignments from ``Special'' to ``Medicare'' and ``Cash'' stations. Computer simulation can help public health officials determine the most efficient use of staff, machinery, supplies, and time.
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Kass NE, Otto J, O'Brien D, Minson M. Ethics and severe pandemic influenza: maintaining essential functions through a fair and considered response. Biosecur Bioterror 2009; 6:227-36. [PMID: 18795832 DOI: 10.1089/bsp.2008.0020] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The response to severe pandemic influenza will be managed by experts in public health and infectious disease and by government officials to whom the public will turn for information and direction. Nonetheless, there remain important ethical considerations that can shape what goals are given priority, how scarce resources are distributed, how the public is included, and how we treat the most vulnerable in our response to a pandemic. This article assumes that the secondary consequences of severe pandemic influenza could be greater than deaths and illness from influenza itself. Response plans, then, must consider threats to societal as well as medical infrastructures. While some have suggested that scarce medical countermeasures be allocated primarily to first responders and then to the sickest, we suggest that an ethical public health response should set priorities based on essential functions. An ethical response also will engage the public, will coordinate interdependent sectors as a core preparedness priority, and will address how plans affect and can be understood by the least well off.
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Affiliation(s)
- Nancy E Kass
- Johns Hopkins Berman Institute of Bioethics, Bloomberg School of Public Healtth, Department of Health Policy and Management, Johns Hopkins University, Baltimore, MD 21205, USA.
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Baylis F, Kenny NP, Sherwin S. A Relational Account of Public Health Ethics. Public Health Ethics 2008. [DOI: 10.1093/phe/phn025] [Citation(s) in RCA: 137] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Garoon JP, Duggan PS. Discourses of disease, discourses of disadvantage: A critical analysis of National Pandemic Influenza Preparedness Plans. Soc Sci Med 2008; 67:1133-42. [DOI: 10.1016/j.socscimed.2008.06.020] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2007] [Indexed: 12/24/2022]
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Strengthening public health ethics at the centers for disease control and prevention. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2008; 14:348-53. [PMID: 18552645 DOI: 10.1097/01.phh.0000324562.80157.ef] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In early 2005, the Centers for Disease Control and Prevention (CDC) launched an initiative to strengthen leadership in public health ethics. This resulted in the formation of an external Ethics Subcommittee of the Advisory Committee to the Director, an internal CDC Public Health Ethics Committee, and the creation of a new position, the CDC Public Health Ethics Coordinator, to oversee the activities of these two committees and to serve as the main point of contact for public health ethics at the agency. Through this effort, the CDC is collaborating with the Ethics Subcommittee to develop ethical guidance documents that address specific public health program concerns, including pandemic influenza, emergency preparedness and response, and genomics. It is anticipated that as the public health ethics activities grow within the CDC, benefits will be seen in greater participation and partnership with affected stakeholders and strengthened public trust in health recommendations.
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Patel MS, Phillips CB, Pearce C, Kljakovic M, Dugdale P, Glasgow N. General practice and pandemic influenza: a framework for planning and comparison of plans in five countries. PLoS One 2008; 3:e2269. [PMID: 18509538 PMCID: PMC2386973 DOI: 10.1371/journal.pone.0002269] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2008] [Accepted: 04/12/2008] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Although primary health care, and in particular, general practice will be at the frontline in the response to pandemic influenza, there are no frameworks to guide systematic planning for this task or to appraise available plans for their relevance to general practice. We aimed to develop a framework that will facilitate planning for general practice, and used it to appraise pandemic plans from Australia, England, USA, New Zealand and Canada. METHODOLOGY/PRINCIPAL FINDINGS We adapted the Haddon matrix to develop the framework, populating its cells through a multi-method study that incorporated the peer-reviewed and grey literature, interviews with general practitioners, practice nurses and senior decision-makers, and desktop simulation exercises. We used the framework to analyse 89 publicly-available jurisdictional plans at similar managerial levels in the five countries. The framework identifies four functional domains: clinical care for influenza and other needs, public health responsibilities, the internal environment and the macro-environment of general practice. No plan addressed all four domains. Most plans either ignored or were sketchy about non-influenza clinical needs, and about the contribution of general practice to public health beyond surveillance. Collaborations between general practices were addressed in few plans, and inter-relationships with the broader health system, even less frequently. CONCLUSIONS This is the first study to provide a framework to guide general practice planning for pandemic influenza. The framework helped identify critical shortcomings in available plans. Engaging general practice effectively in planning is challenging, particularly where governance structures for primary health care are weak. We identify implications for practice and for research.
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Affiliation(s)
- Mahomed S Patel
- College of Medicine and Health Sciences, Australian National University, Canberra, Australian Capital Territory, Australia.
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Watkins RE, Cooke FC, Donovan RJ, MacIntyre CR, Itzwerth R, Plant AJ. Influenza pandemic preparedness: motivation for protection among small and medium businesses in Australia. BMC Public Health 2007; 7:157. [PMID: 17634112 PMCID: PMC1934907 DOI: 10.1186/1471-2458-7-157] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2007] [Accepted: 07/17/2007] [Indexed: 12/03/2022] Open
Abstract
Background Community-wide preparedness for pandemic influenza is an issue that has featured prominently in the recent news media, and is currently a priority for health authorities in many countries. The small and medium business sector is a major provider of private sector employment in Australia, yet we have little information about the preparedness of this sector for pandemic influenza. This study aimed to investigate the association between individual perceptions and preparedness for pandemic influenza among small and medium business owners and managers. Methods Semi-structured face-to-face interviews were conducted with 201 small and medium business owners or managers in New South Wales and Western Australia. Eligible small or medium businesses were defined as those that had less than 200 employees. Binomial logistic regression analysis was used to identify the predictors of having considered the impact of, having a plan for, and needing help to prepare for pandemic influenza. Results Approximately 6 per cent of participants reported that their business had a plan for pandemic influenza, 39 per cent reported that they had not thought at all about the impact of pandemic influenza on their business, and over 60 per cent stated that they required help to prepare for a pandemic. Beliefs about the severity of pandemic influenza and the ability to respond were significant independent predictors of having a plan for pandemic influenza, and the perception of the risk of pandemic influenza was the most important predictor of both having considered the impact of, and needing help to prepare for a pandemic. Conclusion Our findings suggest that small and medium businesses in Australia are not currently well prepared for pandemic influenza. We found that beliefs about the risk, severity, and the ability to respond effectively to the threat of pandemic influenza are important predictors of preparedness. Campaigns targeting small and medium businesses should emphasise the severity of the consequences to their businesses if a pandemic were to occur, and, at the same time, reassure them that there are effective strategies capable of being implemented by small and medium businesses to deal with a pandemic.
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Affiliation(s)
- Rochelle E Watkins
- Australian Biosecurity Cooperative Research Centre, Curtin University of Technology, Perth, Australia
| | - Feonagh C Cooke
- Australian Biosecurity Cooperative Research Centre, Curtin University of Technology, Perth, Australia
| | - Robert J Donovan
- Social Marketing Research Unit, School of Marketing, Curtin University of Technology, Perth, Australia
| | - C Raina MacIntyre
- Discipline of Paediatrics and Child Health, Faculty of Medicine, University of Sydney, Sydney, Australia
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Children's Hospital at Westmead, Sydney, Australia
| | - Ralf Itzwerth
- Discipline of Paediatrics and Child Health, Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Aileen J Plant
- Australian Biosecurity Cooperative Research Centre, Curtin University of Technology, Perth, Australia
- Deceased
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Thomas JC, Dasgupta N, Martinot A. Ethics in a pandemic: a survey of the state pandemic influenza plans. Am J Public Health 2007; 97 Suppl 1:S26-31. [PMID: 17413066 PMCID: PMC1854979 DOI: 10.2105/ajph.2006.093443] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
A pandemic of highly pathogenic influenza would threaten the lives of hundreds of thousands in the United States and confront governments and organizations, with ethical issues having wide-ranging implications. The Department of Health and Human Services and all states have published pandemic influenza plans. We analyzed the federal and state plans, available on the Internet, for evidence of ethical guidance as judged by the presence of ethical terms. The most striking finding was an absence of ethical language. Although some states acknowledged the need for ethical decisionmaking, very few prescribed how it should happen. If faced by a pandemic in the near future, we stand the risk of making many unjust and regrettable decisions.
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Affiliation(s)
- James C Thomas
- Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, NC 27599-7435, USA.
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Schuklenk U, Gartland KMA. Confronting an influenza pandemic: ethical and scientific issues. Biochem Soc Trans 2007; 34:1151-4. [PMID: 17073773 DOI: 10.1042/bst0341151] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The prolonged concern over the potential for a global influenza pandemic to cause perhaps many millions of fatalities is a chilling one. After the SARS (severe acute respiratory syndrome) scares [1], attention has turned towards the possibility of an avian influenza virus hybridizing with a human influenza virus to create a highly virulent, as yet unknown, killer, on a scale unseen since the Spanish flu outbreak of 1918, which produced more fatalities than the Great War. In deciding how countries should react to this potential pandemic, individually and collectively, a reasonable and practical balance must be struck between the rights and obligations of individual citizens and protection of the wider community and, indeed, society as a whole. In this communication, ethical issues are discussed in the context of some of the scientific questions relating to a potential influenza pandemic. Among these issues are the rights and obligations of healthcare professionals, difficulties surrounding resource allocation, policies that have an impact on liberty and trade, when and how to introduce any vaccine or other form of mass treatment, global governance questions and the role of health policies in contemporary society. By considering these issues and questions in advance of an influenza, or indeed any other, pandemic commencing, countries can be better prepared to deal with the inevitably difficult decisions required during such events, rather than dusting down outdated previous plans, or making and implementing policy in an ad hoc manner with a resultant higher risk of adverse consequences.
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Affiliation(s)
- U Schuklenk
- Centre for Ethics in Public Policy and Corporate Governance, Glasgow Caledonian University, Glasgow G4 0BA, Scotland, UK
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Thompson AK, Faith K, Gibson JL, Upshur REG. Pandemic influenza preparedness: an ethical framework to guide decision-making. BMC Med Ethics 2006; 7:E12. [PMID: 17144926 PMCID: PMC1698926 DOI: 10.1186/1472-6939-7-12] [Citation(s) in RCA: 169] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2005] [Accepted: 12/04/2006] [Indexed: 11/10/2022] Open
Abstract
Background Planning for the next pandemic influenza outbreak is underway in hospitals across the world. The global SARS experience has taught us that ethical frameworks to guide decision-making may help to reduce collateral damage and increase trust and solidarity within and between health care organisations. Good pandemic planning requires reflection on values because science alone cannot tell us how to prepare for a public health crisis. Discussion In this paper, we present an ethical framework for pandemic influenza planning. The ethical framework was developed with expertise from clinical, organisational and public health ethics and validated through a stakeholder engagement process. The ethical framework includes both substantive and procedural elements for ethical pandemic influenza planning. The incorporation of ethics into pandemic planning can be helped by senior hospital administrators sponsoring its use, by having stakeholders vet the framework, and by designing or identifying decision review processes. We discuss the merits and limits of an applied ethical framework for hospital decision-making, as well as the robustness of the framework. Summary The need for reflection on the ethical issues raised by the spectre of a pandemic influenza outbreak is great. Our efforts to address the normative aspects of pandemic planning in hospitals have generated interest from other hospitals and from the governmental sector. The framework will require re-evaluation and refinement and we hope that this paper will generate feedback on how to make it even more robust.
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Affiliation(s)
- Alison K Thompson
- Centre for Research on Inner City Health, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada
| | - Karen Faith
- Clinical Ethics Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario M4N 3M5, Canada
| | - Jennifer L Gibson
- Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, M5G 1L4, Canada
| | - Ross EG Upshur
- Primary Care Research Unit, Sunnybrook Health Sciences Centre, and Joint Centre for Bioethics, Toronto, Ontario M5G 1L4, Canada
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