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1.
J Law Med Ethics ; 49(4): 633-640, 2021.
Article in English | MEDLINE | ID: covidwho-1616891

ABSTRACT

This paper examines several decision-making models that have been proposed to limit the use of CPR for COVID-19 patients. My main concern will be to assess proposals for the implementation of unilateral DNRs - i.e., orders to withhold CPR without the agreement of patients or their surrogates.


Subject(s)
COVID-19 , Cardiopulmonary Resuscitation , Decision Making , Ethics, Medical , Humans , Resuscitation Orders , SARS-CoV-2
2.
Glob Health Sci Pract ; 9(4): 793-803, 2021 12 31.
Article in English | MEDLINE | ID: covidwho-1599447

ABSTRACT

BACKGROUND: In 2011, the Ministry of Health in Malawi developed and institutionalized a resource-tracking process, known as resource mapping (RM), to collect information on planned funding flows across the health sector to support resource allocation and mobilization decisions. We analyze the RM process and tools and describe key uses of the data for health financing decision making to achieve universal health coverage (UHC). METHODS: We applied a case study approach, written as a collaboration between policy makers who have led the RM process in Malawi and the implementation team who have developed tools, collected data, and reported results over the period. It draws on our experiences in conducting RM in Malawi to document the RM process and data, key uses of data, implementation challenges, and lessons learned. We conducted a gray literature review to understand rounds of RM in which we did not participate. Finally, we conducted a search of published literature to situate our work in the international health resource-tracking literature. RESULTS: The RM exercise in Malawi is iteratively designed around the needs of the end users and policy priorities of the government, which in turn drives institutionalization of the exercise. We describe 4 ways in which RM data has been used, including national and district planning and budgeting; prioritization and coordination of existing funds by estimating resource availability; mobilization of new resources by conducting financial gap analysis against costed national strategic plans; and generation of evidence to support the national response to the coronavirus disease 2019 pandemic. DISCUSSION: To achieve UHC goals in Malawi, RM has equipped the government and development partners with critical data used for resource mobilization and coordination decisions. Lessons learned from RM in Malawi may be applicable to other countries starting or refining their own health resource-tracking exercise.


Subject(s)
COVID-19 , Health Resources , Decision Making , Humans , Malawi , SARS-CoV-2
3.
PLoS One ; 16(12): e0261273, 2021.
Article in English | MEDLINE | ID: covidwho-1594457

ABSTRACT

Vaccination willingness is a critical factor in pandemics, including the COVID-19 crisis. Therefore, investigating underlying drivers of vaccination willingness/hesitancy is an essential social science contribution. The present study of German residents investigates the mental shortcuts people are using to make sense of unfamiliar vaccine options by examining vaccination willingness for different vaccines using an experimental design in a quantitative survey. German vaccines were preferred over equivalent foreign vaccines, and the favorability ratings of foreign countries where COVID-19 vaccines were developed correlated with the level of vaccination willingness for each vaccine. The patterns in vaccination willingness were more pronounced when the national origin was shown along with the vaccine manufacturer label. The study shows how non-scientific factors drive everyday decision-making about vaccination. Taking such social psychological and communication aspects into account in the design of vaccination campaigns would increase their effectiveness.


Subject(s)
COVID-19 Vaccines/immunology , COVID-19/epidemiology , COVID-19/prevention & control , Pandemics/prevention & control , SARS-CoV-2/immunology , Vaccination/psychology , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19 Vaccines/therapeutic use , Decision Making , Female , Germany/epidemiology , Humans , Male , Middle Aged , Surveys and Questionnaires , Young Adult
5.
Am J Public Health ; 112(1): 116-123, 2022 01.
Article in English | MEDLINE | ID: covidwho-1591384

ABSTRACT

Arguing for the importance of robust public participation and meaningful Tribal consultation to address the cumulative impacts of federal projects, we bridge interdisciplinary perspectives across law, public health, and Indigenous studies. We focus on openings in existing federal law to involve Tribes and publics more meaningfully in resource management planning, while recognizing the limits of this involvement when only the federal government dictates the terms of participation and analysis. We first discuss challenges and opportunities for addressing cumulative impacts and environmental justice through 2 US federal statutes: the National Environmental Policy Act and the National Historic Preservation Act. Focusing on a major federal planning process involving fracking in the Greater Chaco region of northwestern New Mexico, we examine how the Department of the Interior attempted Tribal consultation during the COVID-19 pandemic. We also highlight local efforts to monitor Diné health and well-being. For Diné people, human health is inseparable from the health of the land. But in applying the primary legal tools for analyzing the effects of extraction across the Greater Chaco region, federal agencies fragment categories of impact that Diné people view holistically. (Am J Public Health. 2022;112(1):116-123. https://doi.org/10.2105/AJPH.2021.306562).


Subject(s)
Community Participation , Decision Making , Environmental Policy/legislation & jurisprudence , Hydraulic Fracking/legislation & jurisprudence , Federal Government , Government Regulation , Humans , New Mexico/ethnology , Public Health
6.
Int J Environ Res Public Health ; 19(1)2021 Dec 30.
Article in English | MEDLINE | ID: covidwho-1580780

ABSTRACT

The COVID-19 pandemic is permanently changing modern social and economic coexistence. Most governments have declared infection control to be their top priority while citizens face great restrictions on their civil rights. A pandemic is an exemplary scenario in which political actors must decide about future, and thus uncertain, events. This paper tries to present a tool well established in the field of entrepreneurial and management decision making which could also be a first benchmark for political decisions. Our approach builds on the standard epidemiological SEIR model in combination with simulation techniques used in risk management. By our case study we want to demonstrate the opportunities that risk management techniques, especially risk analyses using Monte Carlo simulation, can provide to policy makers in general, and in a public health crisis in particular. Hence, our case study can be used as a framework for political decision making under incomplete information and uncertainty. Overall, we want to point out that a health policy that aims to provide comprehensive protection against infection should also be based on economic criteria. This is without prejudice to the integration of ethical considerations in the final political decision.


Subject(s)
COVID-19 , Pandemics , Decision Making , Germany/epidemiology , Humans , Pandemics/prevention & control , Risk Management , SARS-CoV-2 , Uncertainty
7.
Med Educ Online ; 26(1): 1891610, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1574778

ABSTRACT

Multiple mini-interview (MMI) is a 'multiple sample-based' approach comprising multiple focused encounters intended to access and assess a range of attributes in order to gain more objectively multiple impressions of an applicant's interpersonal skills, thoughtfulness and general demeanour. It is designed to focus on four domains that are not considered to be comprehensive, but are considered to be vital for a successful career in the health sciences: critical thinking, ethical decision making, communication and knowledge of the healthcare system. Traditionally, the MMI is conducted face-to-face, but with COVID-19 pandemic and the implementation of social distancing measures, no onsite or campus teaching, banning of mass gatherings and cancellation of face-to-face interviews, Pengiran Anak Puteri Rashidah Sa'adatul Bolkiah Institute of Health Sciences at Universiti Brunei Darussalam explored the feasibility of conducting MMI through virtual means. This report provides an account of our experience in conducting internet-MMI for the selection of new applicants into the August 2020 cohort of the Medicine programme. We also aimed to determine whether the scores derived from internet-MMI were reliable and equivalent to the scores derived from traditional MMI.


Subject(s)
COVID-19/epidemiology , Interviews as Topic/methods , School Admission Criteria , Schools, Medical/organization & administration , Communication , Decision Making , Ethics, Medical , Health Knowledge, Attitudes, Practice , Humans , Pandemics , SARS-CoV-2 , Thinking
9.
Prenat Diagn ; 41(8): 1009-1017, 2021 07.
Article in English | MEDLINE | ID: covidwho-1544369

ABSTRACT

OBJECTIVE: We conducted a study to examine the impact of COVID on patients' access and utilization of prenatal genetic screens and diagnostic tests at the onset of the COVID-19 pandemic in the United States. METHODS: We conducted telephone interviews with 40 patients to examine how the pandemic affected prenatal genetic screening and diagnostic testing decisions during the initial months of the pandemic in the United States. An interview guide queried experiences with the ability to access information about prenatal genetic testing options and to utilize the tests when desired. Audio recordings were transcribed and coded using NVivo 12. Analysis was conducted using Grounded Theory. RESULTS: The pandemic did not alter most participants' decisions to undergo prenatal genetic testing. Yet, it did impact how participants viewed the risks and benefits of testing and timing of testing. There was heightened anxiety among those who underwent testing, stemming from the risk of viral exposure and the fear of being alone if pregnancy loss or fetal abnormality was identified at the time of an ultrasound-based procedure. CONCLUSION: The pandemic may impact patients' access and utilization of prenatal genetic tests. More research is needed to determine how best to meet pregnant patients' decision-making needs during this time.


Subject(s)
COVID-19/psychology , Decision Making , Genetic Testing , Prenatal Care/psychology , Prenatal Diagnosis/psychology , Adult , Female , Humans , Pregnancy
10.
Global Health ; 17(1): 132, 2021 11 20.
Article in English | MEDLINE | ID: covidwho-1526647

ABSTRACT

In recent years, "nudging" has become a standard behavioral intervention at the individual level and for the design of social policies. Although nudges are effective, such interventions seem to be limited to a given space and time, and there is only scant evidence to support the contrary view. On the other hand, choice architects may utilize another type of intervention called "boosting," which shows the promise of generalized and lasting behavioral change. A government can use these tools to shape public policy. Behavioral interventions such as policy-making tools have their boundaries, as does the law. We argue that nudging and boosting may serve as active local or global aids in support of the legal system under certain circumstances. Nudging and boosting can also support the legal system, especially in relation to emerging social issues or events that are unprecedented, such as the recent global COVID-19 pandemic, where certain behavioral patterns are expected, but it would be difficult or impossible to enforce them through the law alone.


Subject(s)
COVID-19 , Pandemics , Decision Making , Health Policy , Humans , Pandemics/prevention & control , Public Policy , SARS-CoV-2
13.
Sci Rep ; 11(1): 21812, 2021 11 08.
Article in English | MEDLINE | ID: covidwho-1505841

ABSTRACT

An estimation of the impact of climatic conditions-measured with an index that combines temperature and humidity, the IPTCC-on the hospitalizations and deaths attributed to SARS-CoV-2 is proposed. The present paper uses weekly data from 54 French administrative regions between March 23, 2020 and January 10, 2021. Firstly, a Granger causal analysis is developed and reveals that past values of the IPTCC contain information that allow for a better prediction of hospitalizations or deaths than that obtained without the IPTCC. Finally, a vector autoregressive model is estimated to evaluate the dynamic response of hospitalizations and deaths after an increase in the IPTCC. It is estimated that a 10-point increase in the IPTCC causes hospitalizations to rise by 2.9% (90% CI 0.7-5.0) one week after the increase, and by 4.1% (90% CI 2.1-6.4) and 4.4% (90% CI 2.5-6.3) in the two following weeks. Over ten weeks, the cumulative effect is estimated to reach 20.1%. Two weeks after the increase in the IPTCC, deaths are estimated to rise by 3.7% (90% CI 1.6-5.8). The cumulative effect from the second to the tenth weeks reaches 15.8%. The results are robust to the inclusion of air pollution indicators.


Subject(s)
Air Pollutants , Air Pollution , COVID-19/epidemiology , COVID-19/mortality , Climate , Hospitalization/statistics & numerical data , SARS-CoV-2 , Algorithms , Bayes Theorem , Decision Making , France/epidemiology , Hospitals , Humans , Humidity , Infectious Disease Medicine , Reproducibility of Results , Respiration Disorders , Seasons , Temperature
14.
Public Health Res Pract ; 31(4)2021 Nov 10.
Article in English | MEDLINE | ID: covidwho-1505727

ABSTRACT

OBJECTIVES: The NSW Health COVID-19 Research Program was established in April 2020 to contribute to minimising the health, social and economic impacts of the coronavirus disease 2019 (COVID-19) pandemic in New South Wales (NSW). This paper describes the establishment and implemention of one element of the Program, the Emergency Response Priority Research (Emergency Response) workstream, which is focused on the rapid creation of evidence to support urgent operational work for the public health management of COVID-19 in NSW. METHODS: Narrative description. RESULTS: As at June 2021, nine Emergency Response projects had been funded. Mechanisms used to expedite projects included: embedding academic researchers in NSW Health to work directly with routinely collected NSW Health data; adapting existing research projects to include a COVID-19 component; leveraging established research partnerships to conduct rapid pilots; and directly commissioning urgent projects with experienced and trusted local researchers. LESSONS LEARNT: Evidence from Emergency Response projects has contributed directly to informing the NSW public health response. For example, findings from a study of COVID-19 transmission in schools and childcare settings in the early stages of the pandemic informed decisions around the resumption of on-campus education in 2020 and helped shape policy around higher risk activities to help reduce transmission in education settings. Similarly, findings from a project to validate methods for identifying SARS-CoV-2 virus fragments in wastewater were subsequently incorporated into the NSW Sewage Surveillance Program, which continues to provide NSW Health with information to support targeted messaging and testing. The approach to establishing and implementing the Emergency Response workstream highlights the importance of continuing to ensure a well-trained public health research community and actively supporting a collaborative research sector.


Subject(s)
COVID-19 , Decision Making , Humans , New South Wales , Pandemics , SARS-CoV-2
15.
J Infect Public Health ; 14(10): 1513-1559, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1500074

ABSTRACT

The problem complexity of multi-criteria decision-making (MCDM) has been raised in the distribution of coronavirus disease 2019 (COVID-19) vaccines, which required solid and robust MCDM methods. Compared with other MCDM methods, the fuzzy-weighted zero-inconsistency (FWZIC) method and fuzzy decision by opinion score method (FDOSM) have demonstrated their solidity in solving different MCDM challenges. However, the fuzzy sets used in these methods have neglected the refusal concept and limited the restrictions on their constants. To end this, considering the advantage of the T-spherical fuzzy sets (T-SFSs) in handling the uncertainty in the data and obtaining information with more degree of freedom, this study has extended FWZIC and FDOSM methods into the T-SFSs environment (called T-SFWZIC and T-SFDOSM) to be used in the distribution of COVID-19 vaccines. The methodology was formulated on the basis of decision matrix adoption and development phases. The first phase described the adopted decision matrix used in the COVID-19 vaccine distribution. The second phase presented the sequential formulation steps of T-SFWZIC used for weighting the distribution criteria followed by T-SFDOSM utilised for prioritising the vaccine recipients. Results revealed the following: (1) T-SFWZIC effectively weighted the vaccine distribution criteria based on several parameters including T = 2, T = 4, T = 6, T = 8, and T = 10. Amongst all parameters, the age criterion received the highest weight, whereas the geographic locations severity criterion has the lowest weight. (2) According to the T parameters, a considerable variance has occurred on the vaccine recipient orders, indicating that the existence of T values affected the vaccine distribution. (3) In the individual context of T-SFDOSM, no unique prioritisation was observed based on the obtained opinions of each expert. (4) The group context of T-SFDOSM used in the prioritisation of vaccine recipients was considered the final distribution result as it unified the differences found in an individual context. The evaluation was performed based on systematic ranking assessment and sensitivity analysis. This evaluation showed that the prioritisation results based on each T parameter were subject to a systematic ranking that is supported by high correlation results over all discussed scenarios of changing criteria weights values.


Subject(s)
COVID-19 Vaccines , COVID-19 , Decision Making , Fuzzy Logic , Humans , SARS-CoV-2
16.
Cuad Bioet ; 32(106): 301-320, 2021.
Article in English | MEDLINE | ID: covidwho-1498354

ABSTRACT

The paper aims to provide an overview of current knowledge related to the ethicality of health-promoting nudges and a further elaboration, particularly in terms of linking the interpretation of the findings of the study and the conclusions adopted. A comprehensive narrative review of literature on the topic of interest was undertaken, aiming to contribute to the current debate on the topic of interest. It is practically hard to determine whether or not the nudgee's agency will be eroded by the particular nudge because the line of distinction between emotions or automatic ways of human reasoning and cognitive ways of human reasoning remains blurry, and the various types of nudges fall on a combination of two continuums: the one ranging from transparent to non-transparent and the other ranging from reflective to automatic. Therefore, the majority of nudges are most likely to work as reason-bypassing nonargumentative influences, thus eroding the nudgee's agency. It is time to accept a deviation from the strict commitment to the principle of (individualistic) autonomy in degrees proportional to the incontestably anticipated patient's benefit. In case that patient's best interest is less than clear or the nudging promotes another individual's best interest (not the decider's one), or even the common good, the ethicality of nudging is not always beyond reasonable doubt. In such cases the deviation should be as minimal as possible (i.e. limited to nudges that are transparent or almost transparent and work reflectively or almost reflectively). Nudging may be used against the COVID-19 pandemic.


Subject(s)
COVID-19 , Pandemics , Decision Making , Emotions , Humans , SARS-CoV-2
17.
Am J Public Health ; 111(S3): S197-S200, 2021 10.
Article in English | MEDLINE | ID: covidwho-1496724

ABSTRACT

COVID-19 highlights preexisting inequities that affect health outcomes and access to care for Black and Brown Americans. The Marion County Public Health Department in Indiana sought to address inequities in COVID-19 testing by using surveillance data to place community testing sites in areas with the highest incidence of disease. Testing site demographic data indicated that targeted testing reached populations with the highest disease burden, suggesting that local health departments can effectively use surveillance data as a tool to address inequities. (Am J Public Health. 2021;111(S3):S197-S200. https://doi.org/10.2105/AJPH.2021.306421).


Subject(s)
COVID-19 Testing , COVID-19/epidemiology , Health Equity , Population Surveillance , Public Health , Decision Making , Humans , Indiana/epidemiology
18.
BMC Health Serv Res ; 21(1): 1170, 2021 Oct 28.
Article in English | MEDLINE | ID: covidwho-1496167

ABSTRACT

BACKGROUND: The COVID-19 pandemic has been recognized as a trigger for redefining supply chains at the global level, and has created an intense debate within the academic community and among policy-makers and practitioners. Among other industries, health care has been dramatically hit by the scarcity of "medical products," specifically for personal protective equipment (PPE-like), due to supply chain disruptions coupled with dramatically increased demand. We aimed to analyze how the scarcity of PPE-like during the COVID-19 pandemic has modified the behavior of decision-makers in the PPE-like supply chain at the hospital level, and to explore what changes could be implemented to cope with future PPE-like shortages. METHODS: We used an explorative approach based on semi-structured interviews with key informants in the Spanish health care industry. More specifically, we held interviews to industry experts at three hospitals in three Spanish regions to map the consequences of the COVID-19 pandemic onto the buying decision-making process. RESULTS: Different strategies were developed by decision-makers at hospitals before, during, and after the first wave of the COVID-19 pandemic in Spain. Our paper offers two main findings: a) decision-makers changed their purchasing behavior from a cost main driver to guaranteeing the availability of supplies; b) they supported the idea of giving more "strategic autonomy" to Spain or Europe through back and nearshoring decisions. CONCLUSIONS: This paper could be of interest to health care management at the national, regional, and hospital levels, as well as for policy-makers, since it could help to establish and configure policies to support the sourcing of medical products (specifically PPE-like) to anticipate potential supply disruptions. Our paper contributes to the limited existing literature on how purchasing strategies at the decision-maker level and supply vary in the health care industry when a public health crisis appears, and what potential solutions might be for policy-makers and practitioners involved in the health care industry.


Subject(s)
COVID-19 , Personal Protective Equipment , Decision Making , Hospitals , Humans , Pandemics , SARS-CoV-2
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