Ethics of sharing medical knowledge with the community: is the physician responsible for medical outreach during a pandemic?

A recent update to the Geneva Declaration's 'Physician Pledge' involves the ethical requirement of physicians to share medical knowledge for the benefit of patients and healthcare. With the spread of COVID-19, pockets exist in every country with different viral expressions. In the Chareidi ('ultra-orthodox') religious community, for example, rates of COVID-19 transmission and dissemination are above average compared with other communities within the same countries. While viral spread in densely populated communities is common during pandemics, several reasons have been suggested to explain the blatant flouting of public health regulations. It is easy to fault the Chareidi population for their proliferation of COVID-19, partly due to their avoidance of social media and internet aversion. However, the question remains: who is to blame for their community crisis? The ethical argument suggests that from a public health perspective, the physician needs to reach out and share medical knowledge with the community. The public's best interests are critical in a pandemic and should supersede any considerations of cultural differences. By all indications, therefore, the physician has an ethical obligation to promote population healthcare and share medical knowledge based on ethical concepts of beneficence, non-maleficence, utilitarian ethics as well as social, procedural and distributive justice. This includes the ethical duty to reduce health disparities and convey the message that individual responsibility for health has repercussions within the context of broader social accountability. Creative channels are clearly demanded for this ethical challenge, including measured medical paternalism with appropriate cultural sensitivity in physician community outreach.

An Internet for Some threatens health for All: What effects could the repeal of net neutrality in the USA have on individual and population health?

In the United States of America, the Federal Communications Commission's repeal of the popular Open Internet Order (a.k.a 'net neutrality') has yielded pointed criticism from many different sectors, but it has yet to be examined for its potential effect on the public's health. In this commentary, we focus on the health implications of this policy change, considering expert opinion on the subject, past history, and global perspectives. We argue that the repeal of net neutrality has the potential to compromise health education and promotion efforts by widening the 'digital divide', thereby impairing health literacy and exacerbating health inequities. By negatively affecting people's ability to access, understand, and use unbiased, evidence-based health information to improve and maintain their health, the repeal of net neutrality may hinder the World Health Organization's vision of 'Health for All' by dismantling public protections in the name of corporate profit.

Collaborative health education for Somali Bantu refugee women in Kansas City.

OBJECTIVE: To partner with and understand the health of Somali Bantu refugee women, small group sessions were designed and conducted using a community-based collaborative action research (CBCAR) approach. Health topics identified by this community were presented in 42 sessions with eleven women. Follow-up individual interviews with the women were used to ask questions about health experiences and plan for future health education. The objective of this qualitative study was to provide refugee women with knowledge to help them adjust to new health challenges in the United States, and to share personal narratives in a safe environment. RESULTS: The process of sharing health information with the women resulted in a collaborative exchange of culture and community. Individual interviews allowed women to voice their opinions outside of the influence of their community elders. CBCAR is an effective tool to involve refugee communities, and other populations small in number, in addressing their unique health challenges. Results from this study demonstrated that small group sessions and a CBCAR approach can be effective in sharing knowledge within small communities of refugee women. Findings from the study will assist in the future planning of health education programs for refugee women and their families in this community.

Public health etichs education in public health masters in Spain: Current status and available resources for teaching / La educación en ética de la salud pública en los másteres de salud pública en España: Situación actual y recursos disponibles para la docencia / L'educació en ètica de la salut pública en els màsters de salut pública a Espanya: Situació actual i recursos disponibles per a la docència

Ethics education of public health (PH) professionals is insufficient, despite general consensus on the need for it. This article aims to describe the extent to which Spanish masters of public health (MPH) have adopted ethic courses, and to review teaching and/or learning resources on PH ethics available in English. We explored Internet sites from current MPH in Spain and searched for teaching resources using different strategies. A total of 14 MPH were identified out of which seven (50.0%) teach ethics. Ethics is taught together with other aspects of PH in all cases. A total of 12 textbooks on PH ethics were reviewed, 5 of them include case studies and most have good or high value as teaching tools

La formación en ética de los profesionales en salud pública (SP) es necesaria pero insuficiente. Este artículo pretende describir el grado en que los masters de salud pública (MSP) en España incluyen la ética en su programa y revisar los materiales docentes de ética en SP disponibles en lengua inglesa. Examinamos en Internet el programa de los MSP y los materiales docentes utilizando diferentes estrategias de búsqueda. De los 14 MSP identificados, la mitad (7) incluyen la ética en su programa y en todos los casos ésta se enseña junto con otros aspectos de SP. Doce libros de texto fueron revisados, 5 de los cuales incluyen casos prácticos y casi todos tienen un alto valor como material docente

La formació en ètica dels professionals en salut pública (SP) és necessària però insuficient. Aquest article pretén descriure el grau en què els màsters de salut pública (MSP) a Espanya inclouen l'ètica en el seu programa i revisar els materials docents d'ètica en SP disponibles en llengua anglesa. Examinem a Internet el programa dels MSP i els materials docents utilitzant diferents estratègies de cerca. Dels 14 MSP identificats, la meitat (7) inclouen l'ètica en el seu programa i en tots els casos aquesta s'ensenya juntament amb altres aspectes de SP. Dotze llibres de text van ser revisats, 5 dels quals inclouen casos pràctics i gairebé tots ells tenen un alt valor com a material docent

The picture talk project: Aboriginal community input on consent for research.

BACKGROUND: The consent and community engagement process for research with Indigenous communities is rarely evaluated. Research protocols are not always collaborative, inclusive or culturally respectful. If participants do not trust or understand the research, selection bias may occur in recruitment, affecting study results potentially denying participants the opportunity to provide more knowledge and greater understanding about their community. Poorly informed consent can also harm the individual participant and the community as a whole. METHODS: Invited by local Aboriginal community leaders of the Fitzroy Valley, the Kimberley, Western Australia, The Picture Talk project explores the consent process for research. Focus groups of Aboriginal community members were conducted to establish preferences for methods of seeking individual consent. Transcripts were analysed through NVivo10 Qualitative software using grounded theory with inductive and deductive coding. Themes were synthesised with quotes highlighted. RESULTS: Focus groups with Aboriginal community members (n = 6 focus groups of 3-7 participants) were facilitated by a Community Navigator as a cultural guide and interpreter and a researcher. Participants were recruited from all main language groups of the Fitzroy Valley - Gooniyandi, Walmajarri, Wangkatjungka, Bunuba and Nikinya. Participants were aged ≥18 years, with 5 female groups and one male group. Themes identified include: Reputation and trust is essential; The Community Navigator is key; Pictures give the words meaning - milli milli versus Pictures; Achieving consensus in circles; Signing for consent; and Research is needed in the Valley. CONCLUSION: Aboriginal communities of the Fitzroy Valley recommend that researchers collaborate with local leaders, develop trust and foster a good reputation in the community prior to research. Local Aboriginal researchers should be employed to provide cultural guidance throughout the research process and interpret local languages especially for elders. Pictures are preferred to written text to explain research information and most prefer to sign for consent. The Fitzroy Valley welcomes research when collaborative and for the benefit of the community. Future research could include exploring how to support young people, promote health screening and improve understanding of medical knowledge.

Experiential learning in nursing and allied health education: Do we need a national framework to guide ethical practice?

Experiential learning is widely used in health courses to develop students' clinical skills. Students act as models for demonstrations of practical techniques and work in small groups to practise clinical skills. These classes present a number of ethical challenges including removing clothing, physical touch and disclosing personal information. The aim of this study was to ascertain the views of nursing and allied health regulators and professional associations regarding the need for a national framework to facilitate ethical experiential learning in health courses. Ten semi-structured interviews were conducted either face-to-face or by phone and their audio-recordings transcribed verbatim for thematic analysis. Students' willingness to participate as models was taken-for-granted by educators. Risks to students' wellbeing were considered minor and outweighed by the benefits of experiential learning. The increasing diversity of students enrolled in health courses has increased awareness of students' rights, including choosing not to participate in some learning activities. Ongoing cycles of curriculum review provided an opportunity to respond to changing social values, including increased collective awareness and respect for, students' rights, cultural diversity, professional standards, and risk/benefit analysis of all student activities. There is a need for a national framework to guide ethical experiential learning in practical classes.

Bacteria on display-can we, and should we? Artistically exploring the ethics of public engagement with science in microbiology.

The field of microbiology presents unique opportunities, and accompanying challenges, for artistic collaborations. On one hand, artistic works enable exploration of the aesthetics and of issues in biomedical science and new technologies, and draw in new, non-scientific audiences. On the other hand, creating art with microbes requires rigorous consideration of health and safety. Artists working in this field, known as Bio Art, tend to want to push the boundaries of what is possible or 'known', and work with new biomedical tools as they become available. However, when an artist's proposed work is raising novel questions where the risks are not fully understood, who should decide if the benefits outweigh the consequences? The reflections of an art-collaborating scientist are related. Also, considered is how close working relationships between disciplines can enable new ethical frameworks that consider these decisions, respecting artists' endeavours as a beneficial form of research in its own right, and even learning from the rich perspectives of artists to broaden reflections on the practice of science.

About time: how time influences and facilitates patient autonomy in the clinical encounter.

In this article I discuss the little examined relationship between time and patient autonomy. Using the findings from a study on the experience of premenopausal cancer patients making fertility preservation decisions during their treatment, I focus on how the patients in the study understood time, and how this understanding interacted with and influenced their decision-making. I then analyse in more depth the importance of time in patient decision-making, and the relationship of time to concepts of patient autonomy and decision-making in the field of bioethics more generally. Focusing on the relational conception of autonomy, I conclude that time is an integral part of patient autonomy which warrants further research, such that it can be better integrated into concepts of patient autonomy, and the policy and guidelines that they inform and influence.

Transversalización de la ética en intervenciones comunitarias y atención integral en salud para personas viviendo con VIH / Ethics mainstreaming in community interventions and integral health care to people living with HIV

En este artículo se presenta una reflexión sobre la vinculación de las intervenciones comunitarias y la atención integral en salud, para personas infectadas por el virus de la inmunodeficiencia humana (VIH), desde una perspectiva ética. Se parte de revisar los conceptos sobre moral, ética y bioética, además del escenario de las intervenciones comunitarias como estrategia final en la mejora de la salud de una comunidad. La atención integral en salud se valora con acciones de vigilancia, tales como: promoción de salud, prevención de enfermedades, vigilar y controlar el daño, así como brindar una atención dirigida a la recuperación y rehabilitación de la salud de las personas, con pertinencia cultural y enfoques de género, con un componente ético que asegure el adecuado funcionamiento de las intervenciones comunitarias y la atención integral en salud (AU).

This article offers a reflection, from an ethical point of view, on the linking of the community interventions and the comprehensive health care for people living with HIV. It begins reviewing the concepts of moral, ethics and bioethics, and also the surroundings of the community interventions as a final strategy in improving the community health. The comprehensive health care is assessed through surveillance actions as health promotion, disease prevention, monitoring and damage control; it also includes providing care aimed to people´s health recovery and rehabilitation, with cultural pertinence and gender approach and an ethic component, ensuring the adequate functioning of the community interventions and the comprehensive health care (AU).

Transversalización de la ética en intervenciones comunitarias y atención integral en salud para personas viviendo con VIH / Ethics mainstreaming in community interventions and integral health care to people living with HIV

En este artículo se presenta una reflexión sobre la vinculación de las intervenciones comunitarias y la atención integral en salud, para personas infectadas por el virus de la inmunodeficiencia humana (VIH), desde una perspectiva ética. Se parte de revisar los conceptos sobre moral, ética y bioética, además del escenario de las intervenciones comunitarias como estrategia final en la mejora de la salud de una comunidad. La atención integral en salud se valora con acciones de vigilancia, tales como: promoción de salud, prevención de enfermedades, vigilar y controlar el daño, así como brindar una atención dirigida a la recuperación y rehabilitación de la salud de las personas, con pertinencia cultural y enfoques de género, con un componente ético que asegure el adecuado funcionamiento de las intervenciones comunitarias y la atención integral en salud (AU).

This article offers a reflection, from an ethical point of view, on the linking of the community interventions and the comprehensive health care for people living with HIV. It begins reviewing the concepts of moral, ethics and bioethics, and also the surroundings of the community interventions as a final strategy in improving the community health. The comprehensive health care is assessed through surveillance actions as health promotion, disease prevention, monitoring and damage control; it also includes providing care aimed to people´s health recovery and rehabilitation, with cultural pertinence and gender approach and an ethic component, ensuring the adequate functioning of the community interventions and the comprehensive health care (AU).

The emergence of ethical issues in the provision of online sexual health outreach for gay, bisexual, two-spirit and other men who have sex with men: perspectives of online outreach workers.

BACKGROUND: Mobile applications and socio-sexual networking websites are used by outreach workers to respond synchronously to questions and provide information, resources, and referrals on sexual health and STI/HIV prevention, testing, and care to gay, bisexual and other men who have sex with men (GB2M). This exploratory study examined ethical issues identified by online outreach workers who conduct online sexual health outreach for GB2M. METHODS: Semi-structured individual interviews were conducted between November 2013 and April 2014 with online providers and managers (n = 22) to explore the benefits, challenges, and ethical implications of delivering online outreach services in Ontario, Canada. Interviews were digitally recorded and transcribed verbatim. Thematic analyses were conducted, and member-checking, analyses by multiple coders, and peer debriefing supported validity and reliability. RESULTS: Four themes emerged on the ethical queries of providing online sexual health outreach for GB2M: (a) managing personal and professional boundaries with clients; (b) disclosing personal or identifiable information to clients; (c) maintaining client confidentiality and anonymity; and (d) security and data storage measures of online information. Participants illustrated familiarity with potential ethical challenges, and discussed ways in which they seek to mitigate and prevent ethical conflict. CONCLUSIONS: Implications of this analysis for outreach workers, researchers, bioethicists, and policy-makers are to: (1) understand ethical complexities associated with online HIV prevention and outreach for GB2M; (2) foster dialogue to recognize and address potential ethical conflict; and (3) identify competencies and skills to mitigate risk and promote responsive and accessible online HIV outreach.

Hiperentorno para la enseñanza-aprendizaje de la valoración de la capacidad funcional de miembros superiores / Hyperentorno for the teaching-learning of the assessment of the functional capacity of superior members

Las tecnologías de la información y las comunicaciones pueden ser utilizadas con éxito como medios del proceso de enseñanza-aprendizaje en las carreras de las ciencias médicas. Objetivo: Elaborar un hiperentorno para contribuir a la enseñanza-aprendizaje de la valoración de la capacidad funcional de los miembros superiores como contenido de la carrera Rehabilitación en Salud. Metodología: Se utilizaron métodos del nivel teórico y empírico. La población para la aplicación parcial estuvo formada por cuatro profesores y 22 estudiantes de quinto año del curso 2014-2015 de la carrera Rehabilitación en Salud de la Universidad de Ciencias Médicas de Sancti Spíritus(AU)

Information and communication technologies can be used successfully as a mean of the teaching-learning process in medical science careers. Objective: to develop a hyperentorno to contribute to the teaching-learning of the evaluation of the functional capacity of the superior members as content of the Rehabilitation in Health career. Methodology: Theoretical and empirical methods were used. The population for the partial application was formed by four professors and 22 students of fifth year of the course 2014-2015 of the Rehabilitation in Health career from the University of Medical Sciences Of Sancti Spíritus. Results: The hyperentorno "HIPEVAF" was elaborated as an aid for the teaching-learning of the evaluation of the functional capacity of superior members in the Rehabilitation in Health career. Their relevance was assessed by expert judgment. Through its partial application it was obtained a predominance of the very high level of teachers and students in the integration of the knowledge, way of proceeding and affective experiences. Conclusions: The experts assessed the hyperentorno for its practical application and with partial application it was verified its contribution to the improvement of the teaching-learning of the assessment of the functional capacity of superior members(AU)

[Ethics and methodology: the importance of promoting, evaluating and implementing education and humanities research in health]. / Ética y metodología: la necesidad de promover, evaluar e implementar la investigación en educación y humanidades en salud.

In this editorial we initially expose the agreements that have set the mechanisms to guarantee safety and fair treatment to human subjects in research. Later on, we offer alternatives from translational and multidisciplinary research to promote education and humanities research in health.

En el presente editorial se exponen, en un primer momento, los acuerdos que han establecido los mecanismos para garantizar la seguridad y el trato digno a las personas sujetas a investigación. Más tarde, se ofrecen alternativas, desde la investigación traslacional y la multidisciplina, para promover en el ámbito de la salud la investigación en educación y las humanidades.

Ethical considerations for sleep intervention in organizational psychology research.

Over the past several years, interest into the role of sleep in the workplace has grown. The theoretical shift from research questions examining sleep as an outcome to placing sleep as the independent variable has increased experimental approaches to manipulating sleep in organizational studies. This is an exciting trend that is likely to continue in the organizational sciences. However, sleep experimentation can also pose special challenges for organizational researchers unaccustomed to sleep science. In this commentary, I discuss five ethical considerations of conducting negative sleep interventions in organizational psychology research. I also provide recommendations for organizational researchers-or even other researchers in disciplines outside of sleep science-who wish to implement sleep interventions in their studies.

Vaccine Rejecting Parents' Engagement With Expert Systems That Inform Vaccination Programs.

In attempting to provide protection to individuals and communities, childhood immunization has benefits that far outweigh disease risks. However, some parents decide not to immunize their children with some or all vaccines for reasons including lack of trust in governments, health professionals, and vaccine manufacturers. This article employs a theoretical analysis of trust and distrust to explore how twenty-seven parents with a history of vaccine rejection in two Australian cities view the expert systems central to vaccination policy and practice. Our data show how perceptions of the profit motive generate distrust in the expert systems pertaining to vaccination. Our participants perceived that pharmaceutical companies had a pernicious influence over the systems driving vaccination: research, health professionals, and government. Accordingly, they saw vaccine recommendations in conflict with the interests of their child and "the system" underscored by malign intent, even if individual representatives of this system were not equally tainted. This perspective was common to parents who declined all vaccines and those who accepted some. We regard the differences between these parents-and indeed the differences between vaccine decliners and those whose Western medical epistemology informs reflexive trust-as arising from the internalization of countering views, which facilitates nuance.

Teachers' subjectivities and emotionality in HIV/AIDS teaching.

Schools play a significant role in conveying essential knowledge, skills and attitudes about HIV and AIDS to millions of learners, and are therefore at the forefront of addressing the HIV/AIDS pandemic. This has resulted in a shift in HIV/AIDS research to focus on the crucial role of teachers in HIV prevention. This paper explores the influence of teachers' subjectivities and emotionality on their teaching about HIV/AIDS. The paper draws on qualitative, narrative data gathered from five teachers teaching in a midlands town in KwaZulu-Natal, South Africa. It finds that teachers' subject positions play a significant role in presenting compassionate, supportive and knowledgeable subjectivities in the classroom; and that their positive and negative emotions pivotally influence their teaching about HIV/AIDS. We argue that it is vital to consider how teachers position themselves, as this is intricately linked with their teaching about HIV/AIDS, and we draw attention to teaching about HIV/AIDS as an emotional practice.

Vaccine Refusal and Trust: The Trouble With Coercion and Education and Suggestions for a Cure.

There can be little doubt about the ethical imperative to ensure adequate vaccination uptake against certain infectious diseases. In the face of vaccine refusal, health authorities and providers instinctively appeal to coercive approaches or increased education as methods to ensure adequate vaccine uptake. Recently, some have argued that public fear around Ebola should be used as an opportunity for such approaches, should an Ebola vaccine become available. In this article, the author describes the difficulties associated with coercion and education when addressing vaccine opposition. Both coercion and education can cause opposite effects than intended in certain circumstances. The correct area of focus is to address the breakdown in trust within clinical relationships. The author presents suggestions for an approach towards vaccine refusal that may be more promising.

Evaluating the impact of pharmacist health education on the perceptions of the pharmacist's role among women living in a homeless shelter / Evaluación del impacto de la educación sanitaria por el farmacéutico sobre las percepciones del papel del farmacéutico entre mujeres que viven en un refugio de personas sin hogar

Objectives: To determine the impact of pharmacist provided educational seminars on the participant’s perception of the pharmacist’s role in providing women’s health education. Secondary objectives include the participant’s level of perceived benefit from the information provided during each presentation, as well as determining characteristics of participants who are interested in attending seminars. Methods: This is a prospective study conducted within a homeless women’s shelter in Phoenix, Arizona. Pharmacists and pharmacy students provided 10 monthly educational seminars on topics related to women’s health. Participants completed a pre- and post-seminar survey regarding their perceptions of the presentations and pharmacists. Results: Fifty-six participants attended at least one of 10 seminars from January to November 2014. The average age was 46 years old, taking approximately 3 medications, and 66% completed a high school degree or lower. Prior to the presentations, 30% of participants agreed or strongly agreed that they would seek advice from a pharmacist on the topic presented, which increased ignificantly to 82% of participants after the presentation (p<0.001). Similarly, 55% of participants rated themselves as agreeing or strongly agreeing with being knowledgeable on the topic presented prior to the presentation, and this increased significantly to 77% after the presentation (p=0.001). After attending the educational session, 70% of participants agreed or strongly agreed that they would make changes to their health, and that they would attend an additional session. The participants noted their increased learning about the topic, the clarity of visual aids and presentation, and knowledge of the presenters as the best parts of the presentation. Conclusion: Pharmacist’s participation in providing educational seminars in the homeless women’s population increases the participant’s knowledge and perception of the pharmacist’s role within the population. Future studies can further investigate an evolving role of pharmacists in optimizing healthcare in the homeless population (AU)

Objetivos: Determinar el impacto de seminarios educativos proporcionados por farmacéuticos sobre la percepción de los participantes del papel del farmacéutico en la provisión de educación sanitaria a mujeres. Los objetivos secundarios incluyeron el nivel del participante del beneficio percibido de la información proporcionada durante cada presentación, así como las características determinantes de los participantes que estaban interesados en asistir a los seminarios. Métodos: Este es un estudio prospectivo realizado en un refugio de mujeres sin hogar en Phoenix, Arizona. Farmacéuticos y estudiantes de farmacia proporcionaron unos seminarios educativos durante 10 meses sobre asuntos relacionados con salud de la mujer. Los participantes completaron un cuestionario pre- y postseminario sobre sus percepciones de las pr4sentaciones y de los farmacéuticos. Resultados: 56 participantes asistieron al menos a uno de los 10 seminarios entre enero y noviembre de 2014. La media de edad fue de 46 años, tomando aproximadamente 3 medicamentos, y el 66% había acabado la educación secundaria o menos. Antes de las presentaciones, el 30% de los participantes concordaba o concordaba fuertemente que buscarían consejo en un farmacéutico sobre el asunto presentado, lo que aumentaba significativamente al 82% después de la presentación (p<0,001). Del mismo modo, el 55% de los participantes se calificó como de acuerdo o fuertemente de acuerdo con saber suficientemente del asunto antes de la presentación, y esto aumentó significativamente al 77% después de la presentación (p=0,001). Después de asistir a la sesión educativa, el 70 % de los participantes concordó o fuertemente concordó que harían cambios en su salud, y que asistirían a otra sesión. Los participantes señalaron su aumento de aprendizaje sobre el asunto, la claridad de las ayudas visuales y la presentación, y el conocimiento de los presentadores como las mejores partes de la presentación. Conclusión: La participación del farmacéutico proporcionando seminarios educativos a una población de mujeres sin hogar aumenta el conocimiento de las participantes y la percepción del papel del farmacéutico en esta población. Próximos estudios pueden investigar en detalle el papel en evolución del farmacéutico optimizando los cuidados de salud de la población sin hogar (AU)