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1.
PLoS One ; 17(3): e0264782, 2022.
Article in English | MEDLINE | ID: covidwho-1759948

ABSTRACT

What types of public health messages are effective at changing people's beliefs and intentions to practice social distancing to slow the spread of COVID-19? We conducted two randomized experiments in summer 2020 that assigned respondents to read a public health message and then measured their beliefs and behavioral intentions across a wide variety of outcomes. Using both a convenience sample and a pre-registered replication with a nationally representative sample of Americans, we find that a message that reframes not social distancing as recklessness rather than bravery and a message that highlights the need for everyone to take action to protect one another are the most effective at increasing beliefs and intentions related to social distancing. These results provide an evidentiary basis for building effective public health campaigns to increase social distancing during flu pandemics.


Subject(s)
COVID-19/prevention & control , Health Education/methods , Persuasive Communication , Physical Distancing , Adult , Altruism , Female , Health Promotion/methods , Humans , Male , Risk Reduction Behavior , Self Efficacy , Social Values
4.
J Manag Care Spec Pharm ; 27(9-a Suppl): C2-C3, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1498158

ABSTRACT

DISCLOSURES:: No funding supported the writing of this article. The author has received grants from BeiGene, Ltd., and Pfizer, Inc., and advisory board fees from PhRMA Foundation.


Subject(s)
Awards and Prizes , Cultural Diversity , Health Status Disparities , Social Values , Cost-Benefit Analysis , Drug Industry , Humans
5.
J Med Ethics ; 46(8): 495-498, 2020 08.
Article in English | MEDLINE | ID: covidwho-1467727

ABSTRACT

Key ethical challenges for healthcare workers arising from the COVID-19 pandemic are identified: isolation and social distancing, duty of care and fair access to treatment. The paper argues for a relational approach to ethics which includes solidarity, relational autonomy, duty, equity, trust and reciprocity as core values. The needs of the poor and socially disadvantaged are highlighted. Relational autonomy and solidarity are explored in relation to isolation and social distancing. Reciprocity is discussed with reference to healthcare workers' duty of care and its limits. Priority setting and access to treatment raise ethical issues of utility and equity. Difficult ethical dilemmas around triage, do not resuscitate decisions, and withholding and withdrawing treatment are discussed in the light of recently published guidelines. The paper concludes with the hope for a wider discussion of relational ethics and a glimpse of a future after the pandemic has subsided.


Subject(s)
Decision Making/ethics , Ethics, Clinical , Health Care Rationing/ethics , Health Equity/ethics , Health Personnel/ethics , Pandemics/ethics , Betacoronavirus , COVID-19 , Coronavirus Infections/virology , Disaster Planning , Humans , Moral Obligations , Pneumonia, Viral/virology , Poverty , Practice Guidelines as Topic , Professional-Patient Relations , Resuscitation Orders , SARS-CoV-2 , Social Values , Triage/ethics , Vulnerable Populations , Withholding Treatment/ethics
6.
Nurs Adm Q ; 45(3): 197-200, 2021.
Article in English | MEDLINE | ID: covidwho-1261116

ABSTRACT

Nursing regulation is a specialty area of nursing practice that some may perceive as only performing licensing and disciplinary functions. However, highly effective boards strive to meet their mission of public protection through continuous innovation. This article describes several innovative programs initiated by a board of nursing. Among the examples include regulatory waivers during the pandemic, collaborations with stakeholder organizations, a resource for nursing peer-review committees, and an alternative remediation option for practice breakdown. With strong leadership and committed teams, regulation can both protect the public and play a part in actualizing the value of nursing.


Subject(s)
Nursing/methods , Social Control, Formal/methods , Social Values , Creativity , Humans , Nursing/instrumentation
7.
Am J Med ; 134(5): 563-564, 2021 05.
Article in English | MEDLINE | ID: covidwho-1252410
8.
J Health Organ Manag ; ahead-of-print(ahead-of-print)2021 May 25.
Article in English | MEDLINE | ID: covidwho-1238312

ABSTRACT

PURPOSE: This paper aims to investigate the Portuguese general public views regarding the criteria that should guide critical COVID-19 patients to receive medical devices (ventilators and IUC beds) during the current pandemic context. Based on rationing principles and protocols proposed in ethical and medical literature the authors explore how Portuguese general public evaluates the fairness of five allocation principles: "prognosis", "severity of health condition", "patients age", "instrumental value" (frontline healthcare professionals should be prioritized during the pandemic) and "lottery". DESIGN/METHODOLOGY/APPROACH: An online questionnaire was used to collect data from a sample of 586 Portuguese citizens. Descriptive statistics and non-parametric tests were used to define a hierarchy of prioritization criteria and to test for the association between respondents support to them and their socio-demographic and health characteristics. FINDINGS: Respondents gave top priority to prognosis when faced with absolute scarcity, followed closely by the severity of health condition, patient's age with instrumental value receiving lowest support, on average. However, when the age of the patients was confronted with survival, younger-first principle prevailed over recovery. In a pandemic context, lottery was considered the least fair allocation method. The findings suggest that respondents' opinions are aligned with those of ethicists but are partially in disagreement with the protocol suggested for Portugal. ORIGINALITY/VALUE: This study represents the first attempt to elicit public attitudes towards distributive criteria during a pandemic and, therefore, in a real context where the perception is that life and death decisions have to be made.


Subject(s)
COVID-19/epidemiology , COVID-19/prevention & control , Health Care Rationing , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Public Opinion , Age Factors , Decision Making , Health Personnel , Health Priorities , Humans , Pandemics , Pneumonia, Viral/virology , Portugal , Prognosis , SARS-CoV-2 , Severity of Illness Index , Social Values , Surveys and Questionnaires , Value of Life
10.
Global Health ; 17(1): 46, 2021 04 14.
Article in English | MEDLINE | ID: covidwho-1183549

ABSTRACT

Health innovations are generally oriented on a techno-economic vision. In this perspective, technologies are seen as an end in themselves, and there is no arrangement between the technical and the social values of innovation. This vision prevails in sanitary crises, in which management is carried out based on the search for punctual, reactive, and technical solutions to remedy a specific problem without a systemic/holistic, sustainable, or proactive approach. This paper attempts to contribute to the literature on the epistemological orientation of innovations in the field of public health. Taking the Covid-19 and Ebola crises as examples, the primary objective is to show how innovation in health is oriented towards a techno-economic paradigm. Second, we propose a repositioning of public health innovation towards a social paradigm that will put more emphasis on the interaction between social and health dimensions in the perspective of social change. We will conclude by highlighting the roles that public health could play in allowing innovations to have more social value, especially during sanitary crises.


Subject(s)
Biomedical Technology , COVID-19/therapy , Health Care Reform , Health Priorities , Hemorrhagic Fever, Ebola/therapy , Public Health , Access to Information , COVID-19/prevention & control , Cost-Benefit Analysis , Diffusion of Innovation , Health Equity , Health Services Accessibility , Hemorrhagic Fever, Ebola/prevention & control , Humans , Pharmaceutical Preparations , Social Conditions , Social Environment , Social Values , Technology , Vaccines
11.
Health Res Policy Syst ; 19(1): 47, 2021 Mar 31.
Article in English | MEDLINE | ID: covidwho-1166913

ABSTRACT

BACKGROUND: At the height of the COVID-19 pandemic, Thailand had almost depleted its critical care resources, particularly intensive care unit (ICU) beds and ventilators. This prompted the necessity to develop a national guideline for resource allocation. This paper describes the development process of a national guideline for critical resource allocation in Thailand during the COVID-19 pandemic. METHODS: The guideline development process consisted of three steps: (1) rapid review of existing rationing guidelines and literature; (2) interviews of Thai clinicians experienced in caring for COVID-19 cases; and (3) multi-stakeholder consultations. At steps 1 and 2, data was synthesized and categorized using a thematic and content analysis approach, and this guided the formulation of the draft guideline. Within step 3, the draft Thai critical care allocation guideline was debated and finalized before entering the policy-decision stage. RESULTS: Three-order prioritization criteria consisting of (1) clinical prognosis using four tools (Charlson Comorbidity Index, Sequential Organ Failure Assessment, frailty assessment and cognitive impairment assessment), (2) number of life-years saved and (3) social usefulness were proposed by the research team based on literature reviews and interviews. At consultations, stakeholders rejected using life-years as a criterion due to potential age and gender discrimination, as well as social utility due to a concern it would foster public distrust, as this judgement can be arbitrary. It was agreed that the attending physician is required to be the decision-maker in the Thai medico-legal context, while a patient review committee would play an advisory role. Allocation decisions are to be documented for transparency, and no appealing mechanism is to be applied. This guideline will be triggered only when demand exceeds supply after the utmost efforts to mobilize surge capacity. Once implemented, it is applicable to all patients, COVID-19 and non-COVID-19, requiring critical care resources prior to ICU admission and during ICU stay. CONCLUSIONS: The guideline development process for the allocation of critical care resources in the context of the COVID-19 outbreak in Thailand was informed by scientific evidence, medico-legal context, existing norms and societal values to reduce risk of public distrust given the sensitive nature of the issue and ethical dilemmas of the guiding principle, though it was conducted at record speed. Our lessons can provide an insight for the development of similar prioritization guidelines, especially in other low- and middle-income countries.


Subject(s)
COVID-19 , Critical Care , Critical Illness , Health Care Rationing , Health Services Accessibility , Pandemics , Practice Guidelines as Topic , Decision Making , Disclosure , Ethics, Medical , Health Resources , Hospitalization , Humans , Intensive Care Units , Prognosis , SARS-CoV-2 , Social Discrimination , Social Values , Stakeholder Participation , Thailand , Trust
12.
Health Res Policy Syst ; 19(1): 40, 2021 Mar 22.
Article in English | MEDLINE | ID: covidwho-1147268

ABSTRACT

BACKGROUND: This paper critically discusses the use and merits of global indices, in particular, the Global Health Security Index (GHSI; Cameron et al. https://www.ghsindex.org/#l-section--map ) in times of an imminent crisis, such as the current pandemic. This index ranked 195 countries according to their expected preparedness in the case of a pandemic or other biological threat. The coronavirus disease 2019 (Covid-19) pandemic provides the background to compare each country's predicted performance from the GHSI with the actual performance. In general, there is an inverted relation between predicted versus actual performance, i.e. the predicted top performers are among those that are the worst hit. Obviously, this reflects poorly on the potential policy uses of this index in imminent crisis management. METHODS: The paper analyses the GHSI and identifies why it may have struggled to predict actual pandemic preparedness as evidenced by the Covid-19 pandemic. The paper also uses two different data sets, one from the Worldmeter on the spread of the Covid-19 pandemics, and the other from the International Network for Government Science Advice (INGSA) Evidence-to-Policy Tracker, to draw comparisons between the actual introduction of pandemic response policies and the corresponding death rate in 29 selected countries. RESULTS: This paper analyses the reasons for the poor match between prediction and reality in the index, and mentions six general observations applying to global indices in this respect. These observations are based on methodological and conceptual analyses. The level of abstraction in these global indices builds uncertainties upon uncertainties and hides implicit value assumptions, which potentially removes them from the policy needs on the ground. CONCLUSIONS: From the analysis, the question is raised if the policy community might have better tools for decision-making in a pandemic. On the basis of data from the INGSA Evidence-to-Policy Tracker, and with backing in studies from social psychology and philosophy of science, some simple heuristics are suggested, which may be more useful than a global index.


Subject(s)
COVID-19 , Decision Making , Disaster Planning , Global Health , Health Policy , Pandemics , Policy Making , Administrative Personnel , Forecasting , Humans , SARS-CoV-2 , Social Values , Trust , Uncertainty
13.
HEC Forum ; 33(1-2): 1-6, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1146775

ABSTRACT

The essays in this special issue of HEC Forum provide reflections that make explicit the implicit anthropology that our current pandemic has brought but which in the medical ethics literature around COVID-19 has to a great extent ignored. Three of the essays are clearly "journalistic" as a literary genre: one by a hospital chaplain, one by a medical student in her pre-clinical years, and one by a fourth-year medical student who reports her experience as she completed her undergraduate clerkships and applied for positions in graduate medical education. Other essays explore the pandemic from historical, sociological, and economic perspectives, particularly how triage policies have been found to be largely blind to structural healthcare disparities, while simultaneously unable to appropriately address those disparities. Central issues that need to be addressed in triage are not just whether a utilitarian response is the most just response, but what exactly is the greatest good for the greatest number? Together, the essays in this special issue of HEC Forum create a call for a more anthropological approach to understanding health and healthcare. The narrow approach of viewing health as resulting primarily from healthcare will continue to hinder advances and perpetuate disparities. Health outcomes result from a complex interaction of various social, economic, cultural, historical, and political factors. Advancing healthcare requires contextualizing the health of populations amongst these factors. The COVID-19 pandemic has made us keenly aware of how interdependent our health as a society can be.


Subject(s)
COVID-19/epidemiology , Pandemics/ethics , Triage/ethics , Humans , Politics , SARS-CoV-2 , Social Responsibility , Social Values
14.
Balkan Med J ; 38(2): 65-67, 2021 03.
Article in English | MEDLINE | ID: covidwho-1143724
15.
Work ; 68(2): 269-283, 2021.
Article in English | MEDLINE | ID: covidwho-1112580

ABSTRACT

BACKGROUND: The COVID-19 pandemic has changed the social environment of most laborers around the world and has profoundly affected people's ontological security and behavior choices. Among them, the migrant workers are one of the groups most affected by the pandemic. OBJECTIVE: This study explored the mechanism of the impact of the scarcity of ontological security caused by the pandemic on the risk-taking tendency of migrant workers in China through two studies. METHODS: This study adopts two experimental method, with 514 participants in the first study and 357 participants in the second study. RESULTS: The results show that the pandemic-induced scarcity perception of ontological security promotes their risk-taking tendency, and the migrant workers' cognitive reflection ability, sense of unfairness and expected benefits play a significant mediating role in this process. The scarcity perception of ontological security promotes migrant workers' risk-taking tendency by reducing the cognitive reflection ability, triggering the sense of unfairness and overstating expected benefits. CONCLUSIONS: The conclusion of this study can help migrant workers, enterprises and government to avoid potential workplace and social bad behavior.


Subject(s)
COVID-19/epidemiology , Employment , Mental Health/statistics & numerical data , Social Security/statistics & numerical data , Transients and Migrants/psychology , Transients and Migrants/statistics & numerical data , Workplace , Adult , COVID-19/prevention & control , COVID-19/transmission , China , Female , Humans , Male , Middle Aged , Pandemics , Risk-Taking , SARS-CoV-2 , Social Values
17.
Bioethics ; 35(4): 348-355, 2021 05.
Article in English | MEDLINE | ID: covidwho-1072549

ABSTRACT

The rapid development of vaccines against COVID-19 represents a huge achievement, and offers hope of ending the global pandemic. At least three COVID-19 vaccines have been approved or are about to be approved for distribution in many countries. However, with very limited initial availability, only a minority of the population will be able to receive vaccines this winter. Urgent decisions will have to be made about who should receive priority for access. Current policy in the UK appears to take the view that those who are most vulnerable to COVID-19 should get the vaccine first. While this is intuitively attractive, we argue that there are other possible values and criteria that need to be considered. These include both intrinsic and instrumental values. The former are numbers of lives saved, years of life saved, quality of the lives saved, quality-adjusted life-years (QALYs), and possibly others including age. Instrumental values include protecting healthcare systems and other broader societal interests, which might require prioritizing key worker status and having dependants. The challenge from an ethical point of view is to strike the right balance among these values. It also depends on effectiveness of different vaccines on different population groups and on modelling around cost-effectiveness of different strategies. It is a mistake to simply assume that prioritizing the most vulnerable is the best strategy. Although that could end up being the best approach, whether it is or not requires careful ethical and empirical analysis.


Subject(s)
COVID-19 Vaccines/administration & dosage , COVID-19 Vaccines/supply & distribution , COVID-19/prevention & control , Ethical Analysis , Health Priorities/ethics , Cost-Benefit Analysis , Humans , Quality-Adjusted Life Years , SARS-CoV-2/immunology , Social Values , United Kingdom/epidemiology
18.
J Health Commun ; 25(12): 990-995, 2020 12 01.
Article in English | MEDLINE | ID: covidwho-1066120

ABSTRACT

Masks, now recommended and worn by a growing proportion of the world's population, have reflected various perceived meaning across time. This paper provides a brief history of the socio-cultural perceptions attached to wearing a mask by surveying how masks were perceived in ancient Greece and Rome, the origins of medical masks, and the ascribed socio-cultural meaning of masks during the COVID-19 pandemic. The use of a mask has historically diverse perceived meanings; currently, wearing a mask communicates a bipolar socio-cultural meaning and a nuanced, divisive symbology. To some, masks communicate a belief in medical science and a desire to protect one's neighbor from contagion. To others, a mask communicates oppression, government overreach, and a skepticism toward established scientific principles. It is the mask's ability to signal a deception, or extrapolated more broadly, a value system, that is highly relevant to current public health guidelines encouraging mask use to decrease the transmission of SARS-CoV-2, the novel coronavirus responsible for the COVID-19 pandemic. Public health officials and providers should utilize evidence-based health communication strategies when findings warrant a reversed recommendation of a symbol (such as masks) with a legacy of socio-cultural underpinnings that are deep-seated, complex, and emotional.


Subject(s)
Communication , Masks/history , Social Values , COVID-19/prevention & control , History, 17th Century , History, 18th Century , History, 19th Century , History, 20th Century , History, 21st Century , History, Ancient , Humans
19.
HEC Forum ; 33(1-2): 109-124, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1064550

ABSTRACT

Throughout the COVID-19 pandemic the use of the term "hero" has been widespread. This is especially common in the context of healthcare workers and it is now unremarkable to see large banners on hospital exteriors that say "heroes work here". There is more to be gleaned from the rhetoric of heroism than just awareness of public appreciation, however. Calling physicians and nurses heroes for treating sick people indicates something about the concept of medicine and medical professionals. In this essay, I will examine three aspects of the social role of medicine exposed by the language of heroism. One, if a hero is someone who goes above and the call of duty, then does that mean exposing oneself to risk of infection is no longer a duty of physicians (as it used to be)? If so, does that mean the "profession" of medicine is much like any other business? Two, physicians and nurses are not the only "heroes" this go-around. Anyone deemed essential to the US "infrastructure" is designated by the US government as having "special responsibilities" to remain at their posts for the public good, which explicitly puts physicians in the same category as sewage workers and grocery store cashiers. Three, what does it mean to belong to a profession that does (or does not) have self-sacrifice and risk-taking as part of its mission-especially a profession that rarely gets called upon to practice these obligations?


Subject(s)
COVID-19/therapy , Courage , Health Personnel , Professional Role , Professional-Patient Relations , Self Concept , COVID-19/epidemiology , Humans , Pandemics , SARS-CoV-2 , Social Values , United States/epidemiology
20.
Work ; 68(2): 269-283, 2021.
Article in English | MEDLINE | ID: covidwho-1058400

ABSTRACT

BACKGROUND: The COVID-19 pandemic has changed the social environment of most laborers around the world and has profoundly affected people's ontological security and behavior choices. Among them, the migrant workers are one of the groups most affected by the pandemic. OBJECTIVE: This study explored the mechanism of the impact of the scarcity of ontological security caused by the pandemic on the risk-taking tendency of migrant workers in China through two studies. METHODS: This study adopts two experimental method, with 514 participants in the first study and 357 participants in the second study. RESULTS: The results show that the pandemic-induced scarcity perception of ontological security promotes their risk-taking tendency, and the migrant workers' cognitive reflection ability, sense of unfairness and expected benefits play a significant mediating role in this process. The scarcity perception of ontological security promotes migrant workers' risk-taking tendency by reducing the cognitive reflection ability, triggering the sense of unfairness and overstating expected benefits. CONCLUSIONS: The conclusion of this study can help migrant workers, enterprises and government to avoid potential workplace and social bad behavior.


Subject(s)
COVID-19/epidemiology , Employment , Mental Health/statistics & numerical data , Social Security/statistics & numerical data , Transients and Migrants/psychology , Transients and Migrants/statistics & numerical data , Workplace , Adult , COVID-19/prevention & control , COVID-19/transmission , China , Female , Humans , Male , Middle Aged , Pandemics , Risk-Taking , SARS-CoV-2 , Social Values
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