Healthcare workers' perceptions of the duty to work during an influenza pandemic.

Healthcare workers (HCWs) are often assumed to have a duty to work, even if faced with personal risk. This is particularly so for professionals (doctors and nurses). However, the health service also depends on non-professionals, such as porters, cooks and cleaners. The duty to work is currently under scrutiny because of the ongoing challenge of responding to pandemic influenza, where an effective response depends on most uninfected HCWs continuing to work, despite personal risk. This paper reports findings of a survey of HCWs (n = 1032) conducted across three National Health Service trusts in the West Midlands, UK, to establish whether HCWs' likelihood of working during a pandemic is associated with views about the duty to work. The sense that HCWs felt that they had a duty to work despite personal risk emerged strongly regardless of professional status. Besides a strong sense that everyone should pull together, all kinds of HCWs recognised a duty to work even in difficult circumstances, which correlated strongly with their stated likelihood of working. This suggests that HCWs' decisions about whether or not they are prepared to work during a pandemic are closely linked to their sense of duty. However, respondents' sense of the duty to work may conflict with their sense of duty to family, as well as other factors such as a perceived lack of reciprocity from their employers. Interestingly, nearly 25% of doctors did not consider that they had a duty to work where doing so would pose risks to themselves or their families.

Antifungal agents for preventing fungal infections in solid organ transplant recipients.

BACKGROUND: Invasive fungal infections (IFIs) are important causes of morbidity and mortality in solid organ transplant recipients. OBJECTIVES: This study aims to systematically identify and summarise the effects of antifungal prophylaxis in solid organ transplant recipients. SEARCH STRATEGY: The Cochrane Central Register of Controlled Trials (Issue 3, 2003), MEDLINE (1966-June 2003), and EMBASE (1980-June 2003) were searched. Reference lists, abstracts of conference proceedings and scientific meetings (1998-2003) were handsearched. Authors of included studies and pharmaceutical manufacturers were contacted. SELECTION CRITERIA: Randomised controlled trials (RCTs) in all languages comparing the prophylactic use of any antifungal agent or regimen with placebo, no antifungal, or another antifungal agent or regimen. DATA COLLECTION AND ANALYSIS: Two reviewers independently applied selection criteria, performed quality assessment, and extracted data using an intention-to-treat approach. Differences were resolved by discussion. Data were synthesised using the random effects model and expressed as relative risk (RR) with 95% confidence intervals (95% CI). MAIN RESULTS: Fourteen unique trials with 1497 randomised participants were included. Antifungal prophylaxis did not reduce mortality (RR 0.90, 95% CI 0.57 to 1.44). In liver transplant recipients, a significant reduction in IFIs was demonstrated for fluconazole (RR 0.28, 95% CI 0.13 to 0.57). Although less data were available for itraconazole and liposomal amphotericin B, indirect comparisons and one direct comparative trial suggested similar efficacy. Fluconazole prophylaxis did not significantly increase invasive infections or colonisation with fluconazole-resistant fungi. In renal and cardiac transplant recipients, neither ketoconazole nor clotrimazole significantly reduced invasive infections. Overall, the strength and precision of comparisons however were limited by a paucity of data. REVIEWERS' CONCLUSIONS: For liver transplant recipients, antifungal prophylaxis with fluconazole significantly reduces the incidence of IFIs with no definite mortality benefit. Given a 10% incidence of IFI, 14 liver transplant recipients would require fluconazole prophylaxis to prevent one infection. In transplant centres where the incidence of IFIs is high, or in situations where the individual risk is great, antifungal prophylaxis should be considered.

Citizen--patient/citizen--doctor.

In welfare states, no typical user of health care services is only a patient; and no typical provider of these services is simply a doctor, nurse or paramedic. Occupiers of these roles also have distinctive relations and responsibilities--as citizens--to medical services, responsibilities that are widely acknowledged by those who live in welfare states. Outside welfare states, this fusion of civic consciousness with involvement in health care is less pronounced or missing altogether. But the globalization of a very comprehensive understanding of human rights, including rights to state-provided health care, will make welfare state thinking--for better or worse--more of an orthodoxy worldwide than it is now. Medical ethics needs to reflect this.

Morality, consumerism and the internal market in health care.

Unlike the managerially oriented reforms that have brought auditing and accounting into such prominence in the UK National Health Service (NHS), and which seem alien to the culture of the caring professions, consumerist reforms may seem to complement moves towards the acceptance of wide definitions of health, and towards increasing patient autonomy. The empowerment favoured by those who support patient autonomy sounds like the sort of empowerment that is sometimes associated with the patient's charter. For this reason moral criticism of recent NHS reforms may stop short of calling consumerism into question. This, however, would be a mistake: consumerism can be objectionable both within and beyond the health care market.

Effect of oral cadmium exposure during pregnancy on maternal and fetal zinc metabolism in the rat.

To study the effect of cadmium exposure on maternal and fetal zinc metabolism, rats were exposed to 0, 5, 50, or 100 ppm Cd in the drinking water on Days 6 through 20 of pregnancy. In comparison to controls, fetal and maternal weights were slightly reduced in the 50- and 100-ppm groups, but not the 5-ppm group. Multiple regression analysis revealed that in the 50-ppm group, but not in the 100-ppm group, the decrease in fetal weight was not solely a consequence of decreased maternal weight. Cd accumulated in a dose-dependent manner in both maternal organs and fetuses, although the absolute concentrations in fetuses were very low as compared to those of maternal tissues. In the 50- and 100-ppm groups, zinc concentrations were significantly increased in maternal liver and kidney, and significantly decreased in fetal liver. The changes in tissue Zn concentrations were accompanied by altered Zn-metalloenzyme activities in both maternal and fetal tissues. These findings support the hypothesis that Cd-induced maternal zinc retention is responsible for fetal Zn deprivation and impaired fetal growth.