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Rasesemola RM. Collaboration in the formulation and implementation of policies for noncommunicable diseases in South Africa. Health SA 2023; 28:2100. [PMID: 37064649 PMCID: PMC10091072 DOI: 10.4102/hsag.v28i0.2100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/28/2022] [Indexed: 02/05/2023] Open
Abstract
Background Collaboration between health and other sectors is necessary and much needed when addressing health issues. The health sector alone does not possess all the necessary resources to address health problems in the country. Thus, the burden of disease because of the noncommunicable diseases (NCDs) requires interventions that are sometimes beyond the health sector's mandate. Aim To investigate collaboration in the policy formulation process for prevention and control of NCDs in South Africa. This article presents strategies that could aid South African government to ensure collaboration by various sectors in addressing the NCDs. Setting This study took place in the provincial Department of Health (DoH) of seven South African provinces. Methods This was quantitative descriptive study done among purposefully sampled respondents from various health portfolios from seven provincial Departments of Health. Data were collected using questionnaires and analysed using descriptive statistical data analysis techniques. Results The results indicated that the DoH collaborates with private and government stakeholders in the policy formulation and implementation process but excludes them in the setting the health agenda, adoption of policy options and policy evaluation. Conclusion The lack of participation by other stakeholders in the critical phases of policy formulation will result in continued burden of disease because of poor prevention and control of NCDs in the country. Contribution This article provides recommendations that would ensure collaboration among various sectors to accelerate the response to the prevention and control of NCDs in South Africa.
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Affiliation(s)
- Richard M Rasesemola
- Department of Nursing, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
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Mavis Mulaudzi F, Mulaudzi M, Anokwuru RA, Davhana‐Maselesele M. Between a rock and a hard place: Ethics, nurses' safety, and the right to protest during the COVID-19 pandemic. Int Nurs Rev 2021; 68:270-278. [PMID: 34551118 PMCID: PMC8653359 DOI: 10.1111/inr.12703] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
AIM In this paper, we critically discuss the ethics of nurses' choice to strike during the COVID-19 pandemic, considering legal and ethical arguments, overlaying the Ubuntu philosophy, an African ethic. BACKGROUND The recent unprecedented coronavirus disease pandemic and the increased reports on the absence of personal protective equipment in South Africa places many health workers' lives at risk. Nurses spend most of their time with patients, which exposes them to fatal risks as they work in unsafe environments. RESEARCH METHODS Exploratory literature review was conducted using Pubmed, CINAHL, Google Scholar and Science Direct) and law cases repository. FINDINGS Nurses thus may be justified in striking to protect their safety. State healthcare entities are obliged to ensure safety and protect the health of professionals during the pandemic. According to their Code of Practice and Pledge of Service, they are ethically obliged to put patients first, and as a result, they are legally barred from engaging in strike action. CONCLUSION We conclude that there may be constitutional human rights arguments to support strike action. We also find that ethical principles alone do not provide clear direction to guide nurses in making justified and ethical decisions regarding service provision in an environment threatening to compromise their safety.
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Affiliation(s)
| | - Mutondi Mulaudzi
- Department of Public, Constitutional and International LawUniversity of South AfricaPretoriaSouth Africa
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Kumar V, Aranha V, Rajgarhia R, Royal A, Mehta K. Expanded principles of ethics and its implementation during COVID-19 vaccine trials: A scoping evidence based research synthesis. Hum Vaccin Immunother 2021; 17:3843-3849. [PMID: 34264174 DOI: 10.1080/21645515.2021.1947101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The COVID-19 pandemic will subside only through the emergence and distribution of an efficacious vaccine. The two main aspects that should be maintained in equilibrium: the dire necessity for speedy vaccine research and the need for safeguarding the research subjects, which is of utmost concern in research ethics. This opens up a discussion of what norms to follow during the clinical trials while developing the vaccine. As of now, various companies like Moderna, Pfizer, University of Oxford, Astra-Zeneca and so on have moved beyond the safety, efficacy and immunogenic studies. This narrative review explores and discusses the key principles of ethics: a principle of autonomy, beneficence, non-maleficence, and justice along with its ten general expanded principles. Furthermore, it delves into the different types of vaccines, their mechanisms, side effects, limitations, and advantages.
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Affiliation(s)
- Vaibhav Kumar
- Department of Public Health Dentistry, TPCT'S Terna Dental College, Navi Mumbai, Maharashtra, India
| | - Venetia Aranha
- TPCT's Terna Dental College, Navi Mumbai, Maharashtra, India
| | | | - Abhishek Royal
- Department of Public Health, Faculty of Medicine, Public Health & Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Kedar Mehta
- Community Medicine Department, GMERS Medical College, Gotri, Vadodara, Gujarat, India
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Gooden MJ, Norato G, Martin SB, Nath A, Reoma L. Reducing Events of Noncompliance in Neurology Human Subjects Research: the Effect of Human Subjects Research Protection Training and Site Initiation Visits. Neurotherapeutics 2021; 18:859-865. [PMID: 33475954 PMCID: PMC8423976 DOI: 10.1007/s13311-020-01003-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2020] [Indexed: 11/29/2022] Open
Abstract
In an effort to minimize protocol noncompliance in neurological research studies that can potentially compromise patient safety, delay completion of the study, and result in premature termination and added costs, we determined the effect of investigator trainings and site initiation visits (SIVs) on the occurrence of noncompliance events. Results of protocol audits conducted at the National Institute of Neurological Disorders and Stroke from 2003 to 2019 on 97 research protocols were retrospectively analyzed. Based on the depth of auditing and provision of investigator research training, audit data were separated into four arms: 1) Early Period, 2003 to 2012; 2) Middle Period, 2013 to 2016; and Late Period, 2017 to 2019, further divided into 3) Late Period without SIVs; and 4) Late Period with SIVs. Events of noncompliance were classified by the type of protocol deviation, the category, and the cause. In total, 952 events occurred across 1080 participants. Protocols audited during the Middle Period, compared to the Early Period, showed a decrease in the percentage of protocols with at least 1 noncompliance event. Protocols with SIVs had a further decrease in major, minor, procedural, eligibility, and policy events. Additionally, protocols audited during the Early Period had on average 0.46 major deviations per participant, compared to 0.26 events in protocols audited during the Middle Period, and 0.08 events in protocols audited during the Late Period with SIVs. Protocol deviations and noncompliance events in neurological clinical trials can be reduced by targeted investigator trainings and SIVs. These measures have major impacts on the integrity, safety, and effectiveness of human subjects research in neurology.
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Affiliation(s)
- Matthew J Gooden
- Clinical Trials Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 10 Center Drive, Building 10, Room 2A23, Bethesda, MD, 20814, USA
| | - Gina Norato
- Clinical Trials Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 10 Center Drive, Building 10, Room 2A23, Bethesda, MD, 20814, USA
| | - Sandra B Martin
- Clinical Trials Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 10 Center Drive, Building 10, Room 2A23, Bethesda, MD, 20814, USA
| | - Avindra Nath
- Section of Infections of the Nervous System, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 10 Center Drive, Building 10, Room 7C103, Bethesda, MD, 20814, USA
| | - Lauren Reoma
- Clinical Trials Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 10 Center Drive, Building 10, Room 2A23, Bethesda, MD, 20814, USA.
- Section of Infections of the Nervous System, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 10 Center Drive, Building 10, Room 7C103, Bethesda, MD, 20814, USA.
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Yeager A. Ethical issues raised by intergenerational monitoring in clinical trials of germline gene modification. JOURNAL OF MEDICAL ETHICS 2020; 47:medethics-2020-106095. [PMID: 32839228 DOI: 10.1136/medethics-2020-106095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 07/06/2020] [Accepted: 07/10/2020] [Indexed: 06/11/2023]
Abstract
As research involving gene editing continues to advance, we are headed in the direction of being able to modify the human germline. Should we reach a point where an argument can be made that the benefits of preventing unborn children and future generations from inheriting genetic conditions that cause tremendous suffering outweigh the risks associated with altering the human germline, the next step will be to design clinical trials using this technology in humans. These clinical trials will likely require careful follow-up and monitoring of future generations born with altered genes. This paper addresses some of the ethical issues raised by intergenerational monitoring and sets out to show that these issues can be avoided with careful consideration and clinical trial design.
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Affiliation(s)
- Austen Yeager
- School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
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Ienca M, Vayena E. "Hunting Down My Son's Killer": New Roles of Patients in Treatment Discovery and Ethical Uncertainty. JOURNAL OF BIOETHICAL INQUIRY 2020; 17:37-47. [PMID: 32103412 DOI: 10.1007/s11673-020-09963-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 02/12/2020] [Indexed: 06/10/2023]
Abstract
The past few years have witnessed several media-covered cases involving citizens actively engaging in the pursuit of experimental treatments for their medical conditions-or those of their loved ones-in the absence of established standards of therapy. This phenomenon is particularly observable in patients with rare genetic diseases, as the development of effective therapies for these disorders is hindered by the limited profitability and market value of pharmaceutical research. Sociotechnical trends at the cross-section of medicine and society are facilitating the involvement of patients and creating the digital infrastructure necessary to its sustainment. Such participant-led research (PLR) has the potential to promote the autonomy of research participants as drivers of discovery and to open novel non-canonical avenues of scientific research. At the same time, however, the extra-institutional, self-appointed, and, often, oversight-free nature of PLR raises ethical concern. This paper explores the complex ethical entanglement of PLR by critically appraising case studies and discussing the conditions for its moral justification. Furthermore, we propose a path forward to ensure the safe and effective implementation of PLR within the current research ecosystem in a manner that maximizes the benefits for both individual participants and society at large, while minimizing the risks.
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Affiliation(s)
- Marcello Ienca
- ETH Zurich, Health Ethics & Policy Lab, Department of Health Sciences & Technology (D-HEST), HOA H 13-17, Hottingerstrasse, 10, 8092, Zurich, Switzerland
| | - Effy Vayena
- ETH Zurich, Health Ethics & Policy Lab, Department of Health Sciences & Technology (D-HEST), HOA H 13-17, Hottingerstrasse, 10, 8092, Zurich, Switzerland.
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