RESUMO
In light of a history of categorical exclusion, it is critical that pregnant people are included in research to help improve the knowledge base and interventions needed to address public health. Yet the volatile legal landscape around reproductive rights in the United States threatens to undue recent progress made toward the greater inclusion of pregnant people in research. We offer ethical and practical guidance for researchers, sponsors, and institutional review boards to take specific steps to minimize legal risks and ensure the ethical conduct of research with pregnant people in an evolving legal environment.
Assuntos
Pesquisa Biomédica , Gestantes , Feminino , Humanos , Gravidez , Estados Unidos , Pesquisa Biomédica/ética , Decisões da Suprema CorteRESUMO
BACKGROUND: Mixed methods are valuable in understanding multifaceted health behaviors like medication adherence. Kidney transplant recipients (KTRs) have complex medication regimens and are more vulnerable to nonadherence relative to other transplant recipients. Yet mixed methods have not been widely applied to examine adherence among KTRs, especially in relation to prescribed medications beyond immunosuppressants. OBJECTIVES: As part of a sequential approach, we used in-depth interviews to better understand findings from a previous quantitative study and to describe additional factors that influence prescription medication-taking among adult KTRs. METHODS: Semi-structured interviews were conducted with a purposive sample of 14 adult KTRs recruited from a transplant center in Chicago, IL. Deductive and inductive content analysis was used to code transcripts and identify key themes. RESULTS: Across the sample, we identified insurance challenges, disruptions in routine, and poor mental well-being as barriers to adherence at the patient level. For Black and Hispanic KTRs, poor communication between providers and disjointed care transitions posed additional barriers at the health system level. Compared with White KTRs, Black and Hispanic KTRs experienced greater medication burden due to comorbidities, while medication and digital literacy challenges were unique to Hispanic KTRs. CONCLUSION: KTRs are often motivated to take medications as prescribed, but sometimes lack the capacity or support to do so. Eliciting KTR perspectives is necessary in addressing knowledge and resource gaps at the patient and health system levels to improve adherence. In addition, recognizing the relative burden of taking comorbidity medications compared with immunosuppressants may important, particularly for Black and Hispanic KTRs.
Assuntos
Transplante de Rim , Adulto , Humanos , Imunossupressores/uso terapêutico , Adesão à MedicaçãoRESUMO
OBJECTIVE: To systematically review studies that evaluated the impact of employer-led efforts in the United States to improve the value of health spending, where employers have implemented changes to their health benefits to reduce costs while improving or maintaining quality. METHODS: We included all studies of employer-led health benefit strategies that reported outcomes for both employer health spending and employee health outcomes. RESULTS: Our search returned 44 studies of employer health benefit changes that included measures of both health spending and quality. The most promising efforts were those that lowered or eliminated cost sharing for primary care or medications for chronic illnesses. High deductible health plans with a savings option appeared less promising. CONCLUSIONS: More research is needed on the characteristics and contexts in which these benefit changes were implemented, and on actions that address employers' current concerns.
Assuntos
Planos de Assistência de Saúde para Empregados , Custo Compartilhado de Seguro , Humanos , Benefícios do Seguro , Estados UnidosRESUMO
In 1974, President Gerald Ford signed into law the Safe Drinking Water Act, the first piece of legislation of its kind to provide a comprehensive regulatory framework for overseeing the nation's drinking water supply. The law has proven instrumental in setting standards for ensuring that the US population can access drinking water that is safe. However, the law delegates much of its monitoring requirements to states, creating, at times, a confusing and complicated system of standards that must be adhered to and enforced. Although it has proven valuable in the safety standards it specifies, the law's administration and enforcement poses tremendous challenges.
Assuntos
Água Potável , Regulamentação Governamental , Segurança , Qualidade da Água/normas , Abastecimento de Água/legislação & jurisprudência , Água Potável/normas , Meio Ambiente , Humanos , Estados Unidos , Abastecimento de Água/normasRESUMO
In 2010, the nation of Haiti was leveled by a shattering earthquake that killed thousands and devastated its already fragile infrastructure. During relief efforts to aid Haiti's suffering population, the United Nations sent troops to Haiti to assist the rebuilding of country's most basic services. But those troops unknowingly carried with them the bacteria that cause cholera, and through the UN's negligent actions, it triggered a horrifying cholera epidemic that continues to harm the Haitian people. Those injured by the cholera epidemic have sought relief in the US federal court system to obtain justice for those killed or sickened by the cholera outbreak. The UN has declared legal immunity for causing the epidemic, yet the litigation on this matter is ongoing.
Assuntos
Portador Sadio/microbiologia , Cólera/transmissão , Surtos de Doenças/legislação & jurisprudência , Terremotos , Responsabilidade Legal , Socorro em Desastres , Justiça Social , Cólera/etiologia , Cólera/microbiologia , Surtos de Doenças/ética , Haiti , Humanos , Militares , Nações Unidas , Estados Unidos , Vibrio choleraeAssuntos
Pessoal de Saúde/legislação & jurisprudência , Movimentação e Reposicionamento de Pacientes , Saúde Ocupacional/legislação & jurisprudência , Traumatismos Ocupacionais/etiologia , Gestão da Segurança/legislação & jurisprudência , Humanos , Enfermeiras e Enfermeiros/legislação & jurisprudênciaAssuntos
Surtos de Doenças , Governo Federal , Financiamento Governamental , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Programas de Troca de Agulhas/economia , Programas de Troca de Agulhas/legislação & jurisprudência , Abuso de Substâncias por Via Intravenosa , Infecções por HIV/transmissão , Humanos , Indiana/epidemiologia , Programas de Troca de Agulhas/ética , Programas de Troca de Agulhas/tendências , Política , Saúde Pública , Estados UnidosAssuntos
Experimentação Humana/legislação & jurisprudência , Consentimento Livre e Esclarecido/legislação & jurisprudência , Pesquisadores/legislação & jurisprudência , Sujeitos da Pesquisa/legislação & jurisprudência , Manejo de Espécimes , Criança , Ensaios Clínicos como Assunto/legislação & jurisprudência , Comitês de Ética em Pesquisa , Financiamento Governamental , Experimentação Humana/ética , Humanos , Pesquisadores/ética , Apoio à Pesquisa como Assunto , Estados Unidos , United States Dept. of Health and Human Services , Populações VulneráveisAssuntos
Distúrbios de Guerra/reabilitação , Pessoas com Deficiência/reabilitação , Cães , Transtornos de Estresse Pós-Traumáticos/reabilitação , Veteranos , Sintomas Afetivos/epidemiologia , Sintomas Afetivos/etiologia , Sintomas Afetivos/prevenção & controle , Animais , Humanos , Preconceito/tendências , Reabilitação/ética , Estados Unidos , United States Department of Veterans Affairs , Veteranos/psicologia , Veteranos/estatística & dados numéricos , GuerraAssuntos
Crime/legislação & jurisprudência , Comportamento Sexual/história , Crime/história , Feminino , História do Século XIX , História do Século XX , História do Século XXI , Homossexualidade/história , Homossexualidade Masculina/história , Humanos , Masculino , Decisões da Suprema Corte/história , Estados UnidosRESUMO
The aims of this study were to describe the overall pattern and predictors of attitudes toward criminalizing unprotected sex without disclosure by persons living with HIV among a broad sample of men who have sex with men (MSM) living in the USA, and to examine whether attitudes and sexual risk behavior differ by states with HIV-specific laws or no such laws. Participants (n=1725) were recruited in a 3.5 month period to complete a cross-sectional 70-minute online survey assessing attitudes and high risk sexual behavior. Participants self-identified as male, 18 years of age or older, a US resident, and having ever had sex with a man. In addition, participants were coded as residing in a state with HIV-specific laws or not. Results showed that most (65%) respondents believed it should be illegal for persons living with HIV to have unprotected sex without disclosure. However, among the total sample and HIV-positive MSM, attitudes and unprotected sex with recent partners did not vary by state law. Believing that it should not be illegal for persons living with HIV to have unprotected sex without disclosure was associated with HIV-positive status (OR=0.33), higher education (ORs=0.42-0.64), gay orientation (non-gay orientation: OR=1.54), perceptions that state residents were somewhat or very accepting toward homosexuality (OR=0.75), unprotected anal intercourse with two or more recent sexual partners (OR=0.72), and lower perceptions of responsibility (OR=0.75). The results did not support the proposition that HIV-specific laws deter high-risk sexual behavior, however further research is needed to examine whether they act as a barrier for MSM at highest risk for acquiring or transmitting HIV.
Assuntos
Atitude Frente a Saúde , Revelação/legislação & jurisprudência , Infecções por HIV/prevenção & controle , Homossexualidade Masculina/psicologia , Jurisprudência , Comportamento Sexual , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Infecções por HIV/transmissão , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos , Sexo sem Proteção , Adulto JovemRESUMO
This study sought to identify how urban gay communities are undergoing structural change, reasons for that change, and implications for HIV prevention planning. Key informants (N=29) at the AIDS Impact Conference from 17 cities in 14 countries completed surveys and participated in a facilitated structured dialog about if gay communities are changing, and if so, how they are changing. In all cities, the virtual gay community was identified as currently larger than the offline physical community. Most cities identified that while the gay population in their cities appeared stable or growing, the gay community appeared in decline. Measures included greater integration of heterosexuals into historically gay-identified neighborhoods and movement of gay persons into suburbs, decreased number of gay bars/clubs, less attendance at gay events, less volunteerism in gay or HIV/AIDS organizations, and the overall declining visibility of gay communities. Participants attributed structural change to multiple factors including gay neighborhood gentrification, achievement of civil rights, less discrimination, a vibrant virtual community, and changes in drug use. Consistent with social assimilation, gay infrastructure, visibility, and community identification appears to be decreasing across cities. HIV prevention planning, interventions, treatment services, and policies need to be re-conceptualized for MSM in the future. Four recommendations for future HIV prevention and research are detailed.