Turning Away From Industrial Health Care Toward Careful and Kind Care

The health care industry is increasingly driven by the pursuit of value. The author of this Invited Commentary believes this value is nothing more than a business rebranding of efficiency with little connection to care. Overclocked clinicians, increasingly impaired by symptoms of burnout and too focused on documenting, cannot see patients in high definition. The author shows that treatment which is blind to patients' contexts often overwhelms patients with medical errands, a topic absent from medical curricula. Care must not be the means by which health care satisfies its industrial mission but, rather, the end for which it mobilizes its means. In unhurried consultations, clinicians must appreciate and respond sensibly to patients' problematic situation, and care for and about them. Medical training must cultivate future clinicians who value caring over caring for value. Medical educators and trainees at all levels must turn away from industrial health care, toward careful and kind care for all.

The Influence of Supportive and Ethical Work Environments on Work-Related Accidents, Injuries, and Serious Psychological Distress among Hospital Nurses

The healthcare industry in Japan has experienced many cases of work-related injuries, accidents, and workers' compensation claims because of mental illness. This study examined the influence of supportive and ethical work environments on work-related accidents, injuries, and serious psychological distress among hospital nurses. Self-reported questionnaires were distributed to nurses (n = 1114) from 11 hospitals. Valid responses (n = 822, 93% women, mean age = 38.49 ± 10.09 years) were used for analyses. The questionnaire included items addressing basic attributes, work and organizational characteristics, social capital and ethical climate at the workplace, psychological distress, and experience of work-related accidents or injuries in the last half year. The final model of a multivariate logistic regression analysis revealed that those who work less than 4 h of overtime per week (OR = 0.313), those who work on days off more than once per month (OR = 0.424), and an exclusive workplace climate (OR = 1.314) were significantly associated with work-related accidents or injuries. Additionally, an exclusive workplace climate (OR = 1.696) elevated the risk of serious psychological distress. To prevent work-related compensation cases, which are caused by these variables, strengthening hospitals' occupational health and safety is necessary.

A new method for scoring financial conflicts of interest

BACKGROUND

There is a large and consistent body of evidence showing that research sponsored by for-profit industries tends to have pro-industry conclusions in comparison with similar research or re-analyses not funded by industry. Disclosure of financial conflicts via statements is presently the standard method for notification of potential biases. However, many journals are not consistent in publishing financial conflicts of interest (FCoI) statements. Furthermore, even when divulged, disclosure merely shifts the burden of evaluating conflicts to readers and the general public. Moreover, there has been an absence of a means of quantifying FCoI.

OBJECTIVES

To propose a solution for the question: What are we doing about FCoI that continue to compromise the integrity of the scientific enterprise?

METHODS

The FCoI Scale was developed for scoring and comparing FCoI and describing potential biases.

RESULTS

The FCoI Scale consists of a score that may be expressed in whole numbers and decimal fractions, correlated to descriptive terms for potential biases and examples of financial conflicts at 11 levels.

CONCLUSIONS

The FCoI score (FCoIS) provides a means for a more uniform and concise method of disclosure compared to statements, while at the same time permitting flexibility. It encourages the disclosure of relevant information and transparency in the reporting of financial conflicts. The FCoI Scale has the potential to become the standard basis for measuring, reporting, and comparing financial conflicts, suitable for disciplines in science, medicine, and beyond.

CardioPulmonary Resuscitation in patients with suspected or confirmed Covid-19. A consensus of the Working group on CardioPulmonary Resuscitation of the Hellenic Society of Cardiology

The unprecedented for modern medicine pandemic caused by the SARS-COV-2 virus ("coronavirus", Covid-19 disease) creates in turn new data on the management and survival of cardiac arrest victims, but mainly on the safety of CardioPulmonary Resuscitation (CPR) providers. The Covid-19 pandemic resulted in losses of thousands of lives, and many more people were hospitalized in simple or in intensive care unit beds, both globally and locally in Greece. More specifically, in victims of cardiac arrest, both in- and out- of hospital, the increased mortality and high contagiousness of the SARS-CoV-2 virus posed new questions, of both medical and moral nature/ to CPR providers. What we all know in resuscitation, that we cannot harm the victim and therefore do the most/best we can, is no longer the everyday reality. What we need to know and incorporate into decision-making in the resuscitation process is the distribution of limited human and material resources, the potentially very poor outcome of patients with Covid-19 and cardiac arrest, and especially that a potential infection of health professionals can lead in the lack of health professionals in the near future. This review tries to incorporate the added skills and precautions for CPR providers in terms of both in- and out- hospital CPR.

Trust, Conflict, and Engagement in Occupational Health: North American Epidemiologists Conduct Occupational Study in Communities Affected by Chronic Kidney Disease of Unknown Origin (CKDu)

PURPOSE OF REVIEW

Science has been used as a tool of colonialism, and aspects of science privilege researchers in the global North (USA and Europe). The environmental justice and worker health movements in the USA and globally have influenced aspects of how occupational and environmental health research is conceived and conducted so that it is more equitable. This review provides a case example of research in the area of chronic kidney disease of unknown origin (CKDu).

RECENT FINDINGS

In the present work, the author describes aspects of community-based participatory research and anti-colonial research that influence a current occupational epidemiology study of CKDu in Mesoamerica among workers in agriculture and non-agricultural industries. The research includes investigators from numerous countries in the global North and South and funding from the US government and corporations. The role of industry in science and the misuse of science by corporate interests remain substantial threats to research integrity. The ability of researchers to navigate potentially conflicting interests with industry and workers, and establish trust within and outside the scientific community, is essential for sustained engagement in longitudinal studies. Trust is about human relationships. It takes time and effort to build and is essential for creating equitable, empowering research relationships.

What Are Best Practices for Ethical Use of Nanosensors for Worker Surveillance?

Many employers now offer workers wearable or implantable devices that can monitor their health, productivity, and wellness. Nanotechnology enables even more powerful and functional monitoring capacity for these devices. A history of workplace monitoring programs suggests that, despite nanosensors' potential benefits to employers and employees, they can only be successful and sustainable when a company's motivations for offering them are acceptable and transparent to workers. This article describes 5 best practices for motivating nano-enabled worker monitoring programs that are acceptable, effective, and ethical.

Should neurosurgeons continue to work in the absence of personal protective equipment during the COVID-19 era?

The COVID-19 pandemic has resulted in a widespread shortage of personal protective equipment (PPE). Many healthcare workers, including neurosurgeons, have expressed concern about how to safely and adequately perform their medical responsibilities in these challenging circumstances. One of these concerns revolves around the pressing question: should providers continue to work in the absence of adequate PPE? Although the first peak of the COVID-19 crisis seems to have subsided and supply of PPE has increased, concerns about insufficient PPE availability remain. Inconsistent supply, limited efficacy, and continued high demand for PPE, combined with the continued threat of a second COVID-19 wave, mean that the issues surrounding PPE availability remain unresolved, including a duty to work. This paper offers an ethical investigation of whether neurosurgeons should perform their professional responsibilities with limited availability of PPE. We evaluate ethical considerations and conflicting duties and thereby hope to facilitate providers in making a well-considered personal and moral decision about this challenging issue.

How Should Physicians Help Patients Who Are Ill Because They Work in Agriculture?

Occupational health issues are not just common for farmworkers; they are practically unavoidable. Farmworkers who seek treatment for work-related injury or illness are often unable to meaningfully reduce their exposure to risk factors without further jeopardizing their already fragile well-being and tenuous livelihoods. This case commentary addresses why and how physicians presented with patients who are ill because they work in agriculture should adjust their clinical practices to better meet the unique challenges faced by this patient population. In recognition of physicians' ethical duty to participate in activities to protect and promote the health of the public, this commentary also recommends specific actions that medical professionals can take to support systemic change that would improve farmworker health and well-being.

Occupational health practice and exposure to nanoparticles: reconciling scientific evidence, ethical aspects, and legal requirements

The paper aims at focusing the relationship between scientific evidence and ethical values' issues of occupational health practice according to the new Italian law 81/2008 stating that the occupational health physician (OHP) is required to act according to the Code of Ethics of the International Commission on Occupational Health. The code itself emphasizes that (i) the practice should be relevant, knowledge-based, sound, and appropriate to the occupational risks and (ii) the objectives and methods of health surveillance must be clearly defined. Because exposure to nanoparticles involves several uncertainties about health effects and may limit the effectiveness of workers' health surveillance, OHPs face a several ethical dilemmas, involving different stakeholders. The dilemmas arising from the practice should be dealt with according to the ethical principles of beneficence, autonomy, and justice in order to take a decision.

Ethics in occupational health and safety: case studies from Gujarat

Rapid industrialisation in India is giving employment to millions of people in the formal sector, and many more in the unorganised sector. However, the absence of clear policies, poorly enforced regulations, lack of systematic reporting of occupational diseases, lamentable socioeconomic conditions of the workers and their limited access to healthcare make occupational health and safety (OHS) a critical area.

Psychosocial risks and ethical implications of technology: considerations for decent work

Decent work, a United Nations Sustainable Development Goal, is built on the ethical treatment of workers and ensures respect of their security, freedom, equity, and dignity. In the future, a wide range of technological forces may pose significant impediments to the availability and quality of decent work. This paper applies a prescriptive taxonomy to categorize evidence of the psychosocial impacts technology may bring to the future of work and elucidate the associated ethical concerns. Ethical objectives in support of a future defined by decent work are also offered. Central to this technoethical discourse are the principles of nonmaleficence, beneficence, autonomy, justice, and respect for persons. Expanded technoethical education, ethical technology assessments, ethical foresight analysis, and revised ethical standards are important ways to address technology-related ethical challenges on a larger scale. The findings in this paper may serve as a foundation for the systemic prevention and control of adverse effects and ethical concerns from the use of technology in the workplace of the future.

Fitness for work in health care workers from the prospective of ethics, science and good practices

Fitness for work (FFW) is the final task of both risk assessment and health surveillance, aimed at protecting workers' health and working capacity. There are numerous specific concerns regarding health care workers. In particular: i) the frequent difficulty in determining at pre-employment/pre-placement examinations the specific task that the individual worker will perform; ii) the prevalence of female workers and the contemporary presence of numerous occupational risk factors that are a potential cause of harmful effects on women's reproductive health; iii) the progressive aging of the staff especially nurses; iv) the risk to third parties, with particular reference to the issues of biological risk and substance abuse, also in relation to shift work, fatigue and occupational stress; v) the increasing number of immigrant workers among support staff In such cases the occupational physician, respecting both ethical principles and regulations and with an appropriate balance between scientific evidence and the precautionary principle, should express a FFW judgment that allows both the adaptation of work to the worker and vice versa, as recommended by the World Health Organization (WHO) and the International Commission on Occupational Health (ICOH). Proper FFW judgment also permits the expected benefits to be achieved, not only for the workers but also for employers, companies and society.

The internet of things deployed for occupational health and safety purposes: A qualitative study of opportunities and ethical issues

The deployment of the Internet of Things (IoT) technology (connected devices enabling algorithmic analysis of behaviour and individualized feedback) has been growing increasingly over the last decades, including in the workplace where they can serve occupational safety and health (OSH) purposes. However, although the IoT is deployed for good aims, the use of these devices raises numerous ethical issues which have had little literature specifically dedicated to them. To fill this gap, we have investigated the ethical views of key stakeholders on the deployment of IoT for OSH. We conducted a focus group and semi-structured interviews including 24 stakeholders and analysed transcripts with an open coding method. Participants were favourably disposed towards the use of some versions of IoT (posture-tracker chair, step-tracker watch), but rejected other devices (sound-tracker on computer). They highlighted an important number of ethical issues which could be grouped into five overarching categories: goal relevance, adverse side effects, role of employees, data process, and vagueness. Their inputs were remarkably coherent with the issues highlighted in the academic literature. They also felt quite disenchanted and shed a stark light on the lack of information at the disposal of stakeholders in the front line to assess such technology. Our results provide important ground material on which to base necessary and still-awaited guidelines and regulation instruments.

MEASUREMENT OF PERSONAL RISK BEHAVI-OR IN OCCUPATIONAL RISK STUDIES AMONG HEALTH CARE WORKERS

Risky behaviours, particularly illegal and heavily stigmatized behaviours, are difficult to measure through self-report in both high risk groups and the general population. Underreporting can result in substantially biased estimates of non-injection drug use (IDU) risk of hepatitis C virus (HCV) infection. We hypothesized that asking about the existence of social networks injection drug use may be a useful marker of IDU. A cross-sectional survey of physicians and nurses was conducted in seven hospitals in Georgia. Based on survey responses participants were categorized into three IDU risk groups: ever used injecting drugs (Self IDU), reported a friend, family member or colleague used injecting drugs (Associate IDU), or reported neither (No IDU). Testing on anti-HCV was done using third generation ELISA methods. Both unadjusted and adjusted prevalence ratios between IDU risk groups and HCV prevalence were estimated. Of the 1312 (82.2%) participants, 10 (0.8%), 75 (5.7%), and 1227 (93.5%) were categorized as Self IDU, Associate IDU and No IDU, respectively; with HCV prevalence of 20%, 9.3% and 4.6%, respectively (p=0.016). The association was due primarily to women's reports. Those who reported some IDU risk were more likely to report other personal risk behaviors (e.g., multiple sex partners) and occupational risk behaviors (e.g., frequent exposure to blood and body fluids). This study represents a start of measurement development by assessing the potential usefulness of a marker to measure of IDU. Improved measurement of stigmatized behaviors is needed for confounding adjustment to improve estimates of occupational risks of blood-borne infections.

Behind the good of digital tools for occupational safety and health: a scoping review of ethical issues surrounding the use of the internet of things

Introduction

The internet of things (IoT) is increasingly used for occupational safety and health (OSH) purposes in private and public organisations. Current practices and regulations are unclear, and some stakeholders raised concerns about deploying this technology at work.

Methods

Following the PRISMA-ScR checklist, we reviewed the main opportunities and ethical issues raised by using IoT devices for OSH purposes, as discussed in the academic literature. We searched peer-reviewed papers from 2008 to September 2023, written in English and available in "Web of Science," "PhilPapers," and "Google Scholar." We found 1,495 articles, of which 61 fulfilled the selection criteria. We classified ethical topics discussed in the papers in a coherent description frame.

Results

We obtained 6 overarching categories: "ethical opportunities," "surveillance and problematic data re-purposing," "difficulty to inform, consult, and obtain consent from employees," "unintended and unpredictable adverse effects," "suboptimal data management," and "external factors that are conducive to ethical issues." The resulting list of problematic issues is unexpectedly furnished and substantial. Such a list provides information and guidance for those who wish to develop evaluation frameworks in line with a preventive regulatory approach. It also informs policymakers and practitioners about the governance of such tools for ensuring more OSH.