Proper utilization of antenatal and postnatal care services plays an important role in reducing the maternal mortality ratio and infant mortality rate. This paper assesses the utilization of health care services during pregnancy, delivery and post-delivery among rural women in Uttar Pradesh and examines its determinants. Data from a baseline survey of UP Community Mobilization project was utilized. A cross-sectional sample of currently married women who delivered a baby 15 months prior to the survey was included. Information was collected (...) from 2208 women spread over five districts of UP. Information on socio-demography characteristics, utilization of antenatal care, delivery and postnatal care services was collected. To examine the determinants of utilization of maternal health services, the variables included were three ANC visits, institutional delivery and PNC within 42 days of delivery. Separate multilevel random intercept logistic regressions were used to account for clustering at a block and gram panchayat level after adjusting for covariates. Eighty-three percent of women had any ANC. Of them, 61% reported three or more ANC visits. Although 68% of women delivered in a health facility, 29% stayed for at least 48 h. Any PNC within 42 days after delivery was reported by 26% of women. In the adjusted analysis, women with increasing number of contacts with the health worker during the antenatal period, women exposed to mass-media and non-marginalized women were more likely to have at least three ANC visits during pregnancy. Non-marginalized women and women with at least three ANC visits were more likely than their counterparts to deliver in an institution. Contacts with health worker during pregnancy, marginalization, at least three ANC visits and institutional delivery were the strong determinants for utilization of PNC services. Self-help group membership had no association with the utilization of maternal health services. Utilization of maternal health services was low. Contact with the health worker and marginalization emerged as important factors for utilization of services. Although not associated with the utilization, SHGs can be used for delivering health care messages within and beyond the group. (shrink)

This essay serves as an introduction to this issue of the Journal of Medicine and Philosophy. The five articles in this issue address a range of topics from the human embryo and substantial change to conceptions of disability. They engage claims of moral status, defense of our humanity, and argue for an accurate and just classification of persons of different communities within a healthcare system. I argue in this essay that though their concerns are diverse, the authors in this issue (...) help to answer a common question: “Who counts as one of us?” Reading these articles through the lens of membership and the themes of dignity illustrates this commonality and bears fruit for further reflection on many of the challenging issues addressed in the subsequent papers. (shrink)

The world’s elderly population is growing, and in Chile they represent 16.2% of the total population. In Chile, old age is marked by retirement, with a dramatic decrease in income that brings precariousness. Older adults are economically, socially, and psychologically vulnerable populations. This condition increases their likelihood of disengaging from their usual social environment, facilitating their isolation, sadness, and discomfort. From the perspective of social identity, well-being can be explained by two principles: social groups’ importance for health and people’s (...) psychological identification with those groups. This study analyzes the relationships between belonging to the neighborhood and extra-neighborhood groups and neighborhood social identification with WB. Urban or rural location and gender are measured, and the sample is 1,475 older Chilean adults of both sexes. The results show that the majority are not members of social groups, and the remaining 48% are members of one or two groups or organizations. Only 4.47% belong to three groups or organizations. Those who belong to groups obtain higher scores, emotional–mental WB, and positive emotions than older adults who do not belong to any organization. Urban and rural older adults have the same level of WB. Membership in close social organizations or distant ones causes different WB associations. Membership in neighborhood councils reduces gender differences in self-assessment of health. This result supports the idea that participation in heterogeneous groups with a shared sense of belonging to the neighborhood is associated with higher WB and lower perceived loneliness. Social identification with the neighborhood, rather than belonging to the group, had the most widespread impact on WB and health indicators. The variable social identification with the neighborhood was consistently associated with indicators of hedonic WB. (shrink)

Public health involves the use of power to change institutions and redistribute resources and deliberately to shape individual thought and behavior. This requires normative legitimation and demands ethical critique. This article explores concepts that are vital to public health ethics, but have been relatively neglected. These are membership, solidarity and the concept of place. The article argues that the practice of public health should recognize the equal rights of membership in communities of health justice. (...) Public health should also rely on a sense of obligation and mutual aid in a world of shared vulnerability and reciprocal recognition. Finally, public health achieves its goals not merely—and perhaps not most fundamentally—through information and altering the logical ratiocination of individuals or groups, but rather through the reformation of sense and sensibility. (shrink)

"Cluster randomized trials," in which groups of patients are randomly assigned to different therapeutic interventions, provide a powerful way of evaluating drugs. CRTs have not been widely used, in good part because of concerns about whether patients must give informed consent to participate in them. A better understanding of how CRTs fit into clinical practice resolves the concerns.

Variability in the symptom experience in patients diagnosed with chronic conditions may be related to social determinants of health (SDoH). The purpose of this critical review was to (1) summarize the existing literature on SDoH and symptom clusters (i.e., multiple, co‐occurring symptoms) in patients diagnosed with common chronic conditions, (2) evaluate current variables and measures used to represent SDoH, (3) identify gaps in the evidence base, and (4) provide recommendations for the incorporation of SDoH into future symptom cluster (...) research. We identified 118 articles including information on SDoH in chronic condition symptom cluster research. Articles primarily focused on cancer populations. Few articles had the explicit purpose of investigating relationships between SDoH and symptom clusters, and the inclusion of SDoH was often limited to variables used to describe samples. Future studies should be designed to “move beyond Table 1” in their utilization of SDoH as variables and examine relationships between SDoH and symptom clusters. Attention should be paid to the appropriateness of measures being used to collect information on SDoH, and analysis methods that estimate causal connections between variables should be considered. Research regarding the relationship of SDoH with symptom clusters in patients with chronic conditions has the potential to reveal mechanisms of symptom disparities and guide changes to alleviate these disparities. (shrink)

Volume 20, Issue 10, October 2020, Page W4-W7.

Emotional labor generally exists in organization members. Emotional labor will not only affect employees’ interpersonal relationships, but also affect employees’ mental health. Affected by many factors such as the economic environment, they often need to bear multiple pressures. The degree of stress is positively correlated with the depth of the development of the times and people’s education. As mental health research has become the frontier and hot spot in the field of psychology, the role of mental health (...) in the process of employee creativity has been paid more and more attention. Therefore, this paper proposes a study on the causes of employees’ psychological stress based on emotional feature clustering. Based on the clustering of emotional characteristics, this paper analyzes the causes of employees’ mental health stress from an economic perspective. For teams with low level of team openness, with the improvement of team heterogeneity, team task performance shows a slight upward trend. It is clear from the experiment that when the number of experiments reaches 100, the task performance of high atmosphere level is 12.14, while the task performance of low atmosphere level is only 9.89. Therefore, the atmosphere of team employees is very important to team task performance. Through the cluster analysis of employees’ mental health characteristics, it not only increases employees’ spare time life, but also reduces employees’ daily contradictions. It eases the work pressure of employees, and becomes a platform for employees to improve their awareness and a promoter of harmonious employee relations. (shrink)

Mental health is an important basic condition for college students to become adults. Educators gradually attach importance to strengthening the mental health education of college students. This paper makes a detailed analysis and research on college students’ mental health, expounds the development and application of clustering analysis algorithm, applies the distance formula and clustering criterion function commonly used in clustering analysis, and makes a specific description of some classic algorithms of clustering analysis. Based on expounding the advantages (...) and disadvantages of fast-clustering analysis algorithm and hierarchical clustering analysis algorithm, this paper introduces the concept of the two-step clustering algorithm, discusses the algorithm flow of clustering model in detail, and gives the algorithm flow chart. The main work of this paper is to analyze the clustering algorithm of students’ mental health database formed by mental health assessment tool test, establish a data mining model, mine the database, analyze the state characteristics of different college students’ mental health, and provide corresponding solutions. In order to meet the needs of the psychological management system based on the clustering analysis method, the clustering analysis algorithm is used to cluster the data. Based on the original database, this paper establishes the methods of selecting, cleaning, and transforming the data of students’ psychological archives. Finally, it expounds on the application of data mining in students’ psychological management system and summarizes and prospects the implementation of the system. (shrink)

The ethics of the Flexibility In duty hour Requirements for Surgical Trainees trial have been vehemently debated. Views on the ethics of the FIRST trial range from it being completely unethical to wholly unproblematic. The FIRST trial illustrates the complex ethical challenges posed by cluster randomised trials of policy interventions involving healthcare professionals. In what follows, we have three objectives. First, we critically review the FIRST trial controversy, finding that commentators have failed to sufficiently identify and address many of (...) the relevant ethical issues. The 2012 Ottawa Statement on the Ethical Design and Conduct of Cluster Randomized Trials provides researchers and research ethics committees with specific guidance for the ethical design and conduct of CRTs. Second, we aim to demonstrate how the Ottawa Statement provides much-needed clarity to the ethical issues in the FIRST trial, including: research participant identification; consent requirements; gatekeeper roles; benefit-harm analysis and identification of vulnerable participants. We nonetheless also find that the FIRST trial raises ethical issues not adequately addressed by the Ottawa Statement. Hence, third and finally, we raise important questions requiring further ethical analysis and guidance, including: Does clinical equipoise apply to policy interventions with little or no evidence-base? Do healthcare providers have an obligation to participate in research? Does the power-differential in certain healthcare settings render healthcare providers vulnerable to duress and coercion to participant in research? If so, what safeguards might be implemented to protect providers, while allowing important research to proceed? (shrink)

Schools have been the main context for physical activity and sedentary behavior interventions among adolescents, but there is inconsistent evidence on whether they also improve dimensions of the health−related quality of life. The aim of this study was to evaluate the effects of a school-based active lifestyle intervention on dimensions of HRQoL. A secondary aim was to verify whether sex, age, and HRQoL at baseline were moderators of the intervention effect. A cluster-randomized controlled trial was conducted at three (...) control and three intervention schools in Florianopolis, Brazil. All students from 7th to 9th grade were invited to participate. A school year intervention, designed primarily to increase PA and reduce SB, included strategies focused on teacher training on PA, SB, and nutrition, and availability of teaching materials related to these contents; environmental improvements ; and education strategies, with the availability of folders and posters regarding PA, SB, and nutrition. Participants and the research staffs were not blinded to group assignment, but a standardized evaluation protocol was applied at baseline and after the intervention using the KIDSCREEN−27 to assess HRQoL across five dimensions. Mixed linear models were performed to evaluate the effect of the Movimente intervention on the five HRQoL dimensions. Of the 921 students who answered the questionnaire at baseline, 300 and 434 completed the study in control and intervention groups, respectively. The results revealed no significant effects of the intervention on any HRQoL dimensions. A reduction of the school environment dimension was observed in both the control and intervention groups. Sensitivity analyses showed that students in the highest baseline tertiles of HRQoL in any dimension had a reduction in their respective scores from pre- to post-intervention in both school groups. In conclusion, our results demonstrated no intervention effect on HRQoL dimensions and those students with the highest levels of HRQoL at baseline on all dimensions reduced from pre to post-intervention.Clinical Trial RegistrationThe trial is registered at the Clinical Trial Registry. (shrink)

Theory of health care ethics -- Principles of health care ethics -- The moral status of gametes and embryos : storage and surrogacy -- The ethical challenges of the new reproductive technology -- Ethics and aging in America -- -- Healthcare ethics committees : roles, memberships, structure, and difficulties -- Ethics in the management of health information systems -- Technological advances in health care : blessing or ethics nightmare? -- Ethics and safe patient handling and mobility (...) -- Spirituality and healthcare organizations -- A new era of health care : the ethics of healthcare reform -- Health inequalities and health inequities -- The ethics of epidemics -- Ethics of disasters : planning and response -- Domestic violence : changing theory, changing practice -- Looking toward the future. (shrink)

Cluster randomised trials are an increasingly important methodological tool in health research but they present challenges to the informed consent requirement. In the relatively limited literature on the ethics of cluster research there is not much clarity about the reasons for which seeking informed consent in cluster randomised trials may be morally challenging. In this paper, I distinguish between the cases where informed consent in cluster trials may be problematic due to the distinct features of (...) ‘population-based’ interventions, which have not been adequately discussed in the research ethics literature, and the cases where informed consent may be problematic for reasons that investigators also encounter in other research designs. I claim that informed consent requirements in cluster trials should be adjusted to the level of risk involved, arguing for a more comprehensive notion of research risk than that currently found in the research ethics guidelines, and the amount of freedom to be sacrificed in relation to a particular research aim. I conclude that these two factors are the most important to consider when assessing whether a cluster study should proceed when informed consent is infeasible or difficult to obtain. (shrink)

_BMC Medical Ethics_ is an open access journal publishing original peer-reviewed research articles in relation to the ethical aspects of biomedical research and clinical practice, including professional choices and conduct, medical technologies, healthcare systems and health policies. _BMC __Medical Ethics _is part of the _BMC_ series which publishes subject-specific journals focused on the needs of individual research communities across all areas of biology and medicine. We do not make editorial decisions on the basis of the interest of a study (...) or its likely impact. Studies must be scientifically valid; for research articles this includes a scientifically sound research question, the use of suitable methods and analysis, and following community-agreed standards relevant to the research field. Specific criteria for other article types can be found in the submission guidelines. _BMC series - open, inclusive and trusted_. (shrink)

We show unintended consequences of quota regulations to get women on boards. Board members may have different characteristics, and even among women, there are variations. We assume that the characteristics of the board members have an influence on their contributions to boards, to businesses as well as to society. In this paper, we argue that different types of societal pressure to get women on boards have an influence on the social capital characteristics of the women getting multiple board memberships. The (...) paper is drawing on institutional theory and social capital theory, and we distinguish between mimetic, normative, and coercive types of pressure. Through a cluster analysis of 58 Italian “golden skirts”, we show that different types of societal pressure may lead to differences in social capital characteristics. The study has implications for the ongoing international debate about women and diversity on boards, and we propose developing a pressure theory for getting women on boards. (shrink)

A dam is a complex and important water-retaining structure. Once the dam is broken, the flood will cause immeasurable damage to the lives and properties of the downstream people, so it is particularly important to have the dam risk management. Since the dam-break flood is a severe-consequence low-frequency event, the corresponding fatalities caused by it are difficult to estimate due to the lack of relevant data and poor data continuity. This paper analyzes the direct and indirect factors affecting the risk (...) of life loss in dam failures and studies the characteristics, distribution rules, and membership functions of each factor. An adaptive differential evolution method is constructed through an optimization of the mutation factors and cross factors of the differential evolution method. This proposed evaluation method also combines with the fuzzy clustering iterative method that is capable of evaluating the similarity of life loss in dam accidents. The effectiveness of the proposed method is verified by 16 dam-break case studies. (shrink)

The increasing use of cluster randomised trials in low-resource settings raises unique ethical issues. The Ottawa Statement on the Ethical Design and Conduct of Cluster Randomised Trials is the first international ethical guidance document specific to cluster trials, but it is unknown if it adequately addresses issues in low-resource settings. In this paper, we seek to identify any gaps in the Ottawa Statement relevant to cluster trials conducted in low-resource settings. Our method is to analyse a (...) prototypical cluster trial conducted in a low-resource setting with the Ottawa Statement; to identify ethical issues in the design or conduct of the trial not captured adequately and to make recommendations for issues needing attention in forthcoming revisions to the Ottawa Statement. Our analysis identified six ethical aspects of cluster randomised trials in low-resource settings that require further guidance. The forthcoming revision of the Ottawa Statement should provide additional guidance on these issues: streamlining research ethics committee review for collaborating investigators who are affiliated with other institutions; the classification of lay health workers who deliver study interventions as health providers or research participants; the dilemma experienced by investigators when national standards seem to prohibit waivers of consent; the timing of gatekeeper engagement, particularly when researchers face funding constraints; providing ancillary care in health services or implementation trials when a routine care control arm is known to fall below national standards and defining vulnerable participants needing protection in low-resource settings. (shrink)

This paper discusses the issue of overriding the right of individual consent to participation in cluster randomised trials (CRTs). We focus on CRTs testing the efficacy of non-pharmaceutical interventions. As an example, we consider school closures during the COVID-19 pandemic. In Norway, a CRT was promoted as necessary for providing the best evidence to inform pandemic management policy. However, the proposal was rejected by the Norwegian Research Ethics Committee since it would violate the requirement for individual informed consent. This (...) sparked debate about whether ethics stand in the way of evidence-based health policy, since the Norwegian Research Ethics law’s strict requirements for individual consent make it practically impossible to carry out CRTs of public health interventions. We argue that, in the case of the school closure trial, the suggested CRT would not have eliminated an epistemic gap and thus would not have justified the violation of consent rights. First, we focus on the methodological challenges to estimating quantifiable effects of school closures in the specific case of an airborne infectious disease. Second, in line with Evidential Pluralism, we highlight the value of alternative lines of evidence for informing school closure policy in a pandemic. In general, we propose that a trial requiring the waiver of participants’ consent rights must be highly likely to eliminate an epistemic gap. We elaborate on the practical aspects of this criterion and discuss the potential advantages of adding it to the Ottawa Statement on the Ethical Design and Conduct of Cluster Randomized Trials. (shrink)

I argue for a conception of health as a person's ability to achieve or exercise a cluster of basic human activities. These basic activities are in turn specified through free-standing ethical reasoning about what constitutes a minimal conception of a human life with equal human dignity in the modern world. I arrive at this conception of health by closely following and modifying Lennart Nordenfelt's theory of health which presents health as the ability to achieve vital (...) goals. Despite its strengths I transform Nordenfelt's argument in order to overcome three significant drawbacks. Nordenfelt makes vital goals relative to each community or context and significantly reflective of personal preferences. By doing so, Nordenfelt's conception of health faces problems with both socially relative concepts of health and subjectively defined wellbeing. Moreover, Nordenfelt does not ever explicitly specify a set of vital goals. The theory of health advanced here replaces Nordenfelt's (seemingly) empty set of preferences and society-relative vital goals with a human species-wide conception of basic vital goals, or ‘central human capabilities and functionings’. These central human capabilities come out of the capabilities approach (CA) now familiar in political philosophy and economics, and particularly reflect the work of Martha Nussbaum. As a result, the health of an individual should be understood as the ability to achieve a basic cluster of beings and doings—or having the overarching capability, a meta-capability, to achieve a set of central or vital inter-related capabilities and functionings. (shrink)

We examine the extent to which multiple social identities are associated with enhanced health and well-being in retirement because they provide a basis for giving and receiving social support. Results from a cross-sectional study show that retirees ( N = 171) who had multiple social identities following (but not prior to) retirement report being (a) more satisfied with retirement, (b) in better health, and (c) more satisfied with life in general. Furthermore, mediation analyses revealed an indirect path from (...) multiple social identities to greater satisfaction with retirement and better health through greater provision, but not receipt, of social support to others. These findings are the first to point to the value of multiple group membership post-retirement as a basis for increased opportunities to give meaningful support to others. We discuss the theoretical and practical implications for the management of multiple identities in the process of significant life transitions such as retirement. (shrink)

Maintenance of proper health and prevention of diseases of civilization are now significant public health problems. Nutrition is an important factor in the development of youth, as well as the current and future state of health. The aim of the study was to show the benefits of the application of cluster analysis to assess the dietary habits of high school students. The survey was carried out on 1,631 eighteen-year-old students in seven randomly selected secondary schools in (...) Bialystok using a self-prepared anonymous questionnaire. An evaluation of the time of day meals were eaten and the number of meals consumed was made for the surveyed students. The cluster analysis allowed distinguishing characteristic structures of dietary habits in the observed population. Four clusters were identified, which were characterized by relative internal homogeneity and substantial variation in terms of the number of meals during the day and the time of their consumption. The most important characteristics of cluster 1 were cumulated food ration in 2 or 3 meals and long intervals between meals. Cluster 2 was characterized by eating the recommended number of 4 or 5 meals a day. In the 3rd cluster, students ate 3 meals a day with large intervals between them, and in the 4th they had four meals a day while maintaining proper intervals between them. In all clusters dietary mistakes occurred, but most of them were related to clusters 1 and 3. Cluster analysis allowed for the identification of major flaws in nutrition, which may include irregular eating and skipping meals, and indicated possible connections between eating patterns and disturbances of body weight in the examined population. (shrink)

I would like to raise a pressing issue relating to the World Health Organization which should concern the medical profession throughout the UK. The WHO Charter advocates the provision of health to all—as a human right. It is therefore to be regretted that these Charter obligations have not been exercised with respect to Taiwan whose 23 million citizens still cannot benefit from its protection. This democratic country which is a beacon of human rights in Asia, is still excluded (...) from the WHO. It is expected that in 2005 the island will …. (shrink)

Part of a symposium devoted to ‘Prediction, Understanding, and Medicine’, in which Alex Broadbent argues that the nature of medicine is determined by its competences, i.e., which things it can do well. He argues that, although medicine cannot cure well, it can do a good job of enabling people not only to understand states of the human organism and of what has caused them, but also to predict future states of it. From this Broadbent concludes that medicine is (at least (...) in part) essentially a practice of understanding and predicting, not curing. In reply to this bold position, I mount two major criticisms. First, I maintain that the reasons Broadbent gives for doubting that medicine can cure provide comparable reason for doubting that medicine can provide an understanding; roughly, the best explanation of why medicine cannot reliably cure is that we still lack much understanding of health and disease. Second, I object to the claim that a practice is medical only if it facilitates understanding and prediction. Although Broadbent has brought to light certain desirable purposes of medicine that are under-appreciated, my conclusion is that he has not yet provided enough reason to think that understanding and prediction are essential to it. Instead of supposing that medicine has an essence, in fact, I suggest that its nature is best understood in terms of a property cluster. (shrink)

Clustering is one of the most fundamental and essential data analysis tasks with broad applications. It has been studied in various research fields: data mining, machine learning, pattern recognition and in engineering, economics and biomedical data analysis. Headache is not a disease that typically shortens one’s life, but it can be a serious social as well as a health problem. Approximately 27 billion euros per year are lost through reduced work productivity in the European community. This paper is focused (...) on a new strategy based on a hybrid model for combining fuzzy partition method and maximum likelihood estimation clustering algorithm for diagnosing primary headache disorder. The proposed hybrid system is tested on two data sets for diagnosing headache disorder collected from Clinical Centre of Vojvodina in Serbia. (shrink)

The traditional recognition method of whitewash behavior of accounting statements needs to analyze a large number of special data samples. The learning rate of the algorithm is low, resulting in low recognition accuracy. To solve the aforementioned problems, this article proposes a method to identify the whitewash behavior of university accounting statements based on the FCM clustering algorithm. This article analyzes the motivation of university accounting statement whitewashing behavior, studies the common means of statement whitewashing, and establishes a fuzzy set (...) for the identification of university accounting statement whitewashing behavior. By calculating the fuzzy partition coefficient, the membership matrix of whitewash behavior recognition is established, and the whitewash behavior is classified through the iteration of the FCM algorithm. The comparative experimental results show that the recognition method has good recognition performance, low recognition error rate, and recognition accuracy of 82%. (shrink)

Harrowing stories reported in the media describe Covid‐19 ravaging through families. This essay reports professional experiences of this phenomenon, family clustering, as encountered during the pandemic's spread across Southern California. We identify three ethical challenges following from it: Family clustering impedes shared decision‐making by reducing available surrogate decision‐makers for incapacitated patients, increases the emotional burdens of surrogate decision‐makers, and exacerbates health disparities for and the suffering of people of color at increased likelihood of experiencing family clustering. We propose that, (...) in response to these challenges, efforts in advance care planning be expanded, emotional support offered to surrogates and family members be increased, more robust state guidance be issued on ethical decision‐making for unrepresented patients, ethics consultation be increased in the setting of conflict following from family clustering dynamics, and health care professionals pay more attention to systemic and personal racial biases and inequities that affect patient care and the surrogate experience. (shrink)

In recent years there has been considerable discussion and controversy concerning the concepts of mental health and mental illness. The controversy has centered around the problem of providing criteria for an adequate conception of mental health and illness, as well as difficulties in specifying a clear and workable system for the classification, understanding, and treatment of psychological and emotional disorders. In this paper I shall examine a cluster of these complex and important issues, focusing on attempts to (...) define ‘mental health’ and ‘mental illness’; diverse factors influencing the ascription of the predicates ‘is mentally ill’ and ‘is mentally healthy’; and some specific problems concerning these concepts as they appear in various theories of psychopathology. The approach here will be in the nature of a survey, directed at the specification of a number of problems—conceptual, methodological, and pragmatic—as they arise in various attempts to define and to provide criteria for applying the concepts of mental health and mental illness. (shrink)

It is accepted throughout the world today that a new approach is needed to health care, one that brings to the forefront the role of economic development. This situation has also increased the importance of the health care sector and health data have begun to take a significant place in countries’ development indicators. Health care services as a basic indicator of social and economic development in Turkey, as in the rest of the world, continue to gain (...) in importance. However, there is a significant difference between health indicators for Turkey, which is a candidate for full membership of the European Union, and European Union countries. (shrink)

This paper traces the diverse contexts of radiation protection from liberation in post-1945 South Korea to its professionalization by the early 1970s, using the emerging field of health physics as the focus. The Korean nuclear center, AERI, started two affiliates, RRIA and RRIM in the early 1960s. In particular, RRIM emphasized the use of radiation within cancer research, especially the use of cobalt in treating patients. In this context, health physics initially took the form of “radiation medicine.”With the (...) two institutes returning to AERI’s fold in 1973, health physics took another turn: the second major subfield, following “radiation medicine,” invoked a broader conception of “radiation protection,” which now referred to a cluster of related interests, including the environment and the effects of industrialization.Rather than a simple transfer of American and international models after 1953, Korean health physics reflects its origins in a post-colonial research setting, one more diverse than its “official” institutional context at AERI. (shrink)

This discourse analytic study integrates theories of stance and membership categorization to investigate one online discussion thread initiated by a woman who asks for diet and health advice on behalf of her boyfriend, an interactive move we term ‘asking for another’. Posters to the thread, in relatively explicit ways, construe the original poster as a ‘nag’ and ‘mother-figure’ and her boyfriend as a ‘victim of nagging’ and ‘childish’. Our analysis illuminates how two features of the asking-for-another post evoke (...) these identities: extreme case formulations, created via adjectives and adverbs, lead others to view the woman as inappropriately involved and controlling and her boyfriend as immature, and details about the boyfriend’s diet, provided via nouns and adjectives, index cultural ideologies of food and identity. This study illuminates the ambiguity and polysemy of the move of asking for another, contributing to research on identity construction and health-related advice-seeking online. (shrink)

Background Despite the growth of biomedical research in South Africa, there are few insights into the operation of Research Ethics Committees (RECs) in this setting. We investigated the composition, operations and training needs of health RECs in South Africa against the backdrop of national and international guidelines. Methods The 12 major health RECs in South Africa were surveyed using semi-structured questionnaires that investigated the composition and functions of each REC as well as the operational issues facing committees. Results (...) Health RECs in SA have an average of 16 members and REC members are predominantly male and white. Overall, there was a large discrepancy in findings between under-resourced RECs and well resourced RECs. The majority of members (56%) are scientists or clinicians who are typically affiliated to the same institution as the health REC. Community representatives account for only 8% of membership. Training needs for health REC members varied widely. Conclusion Most major health RECs in South Africa are well organized given the resource constraints that exist in relation to research ethics in developing countries. However, the gender, racial and occupational diversity of most of these RECs is suboptimal, and most RECs are not constituted in accordance with South African guidelines. Variability in the operations and training needs of RECs is a reflection of apartheid-entrenched influences in tertiary education in SA. While legislation now exists to enforce standardization of research ethics review systems, no provision has been made for resources or capacity development, especially to support historically-disadvantaged institutions. Perpetuation of this legacy of apartheid represents a violation of the principles of justice and equity. (shrink)

Mental health professionals working in hospitals or community clinics inevitably face the realisation that we possess imperfect conceptual means to understand mental disorders. In this paper the authors bring together ideas from the fields of Philosophy, Psychiatry, Cognitive Psychology and Linguistics to reflect on the ways we represent phenomena of high practical importance that we often take for granted, but are nevertheless difficult to define in ontological terms. The paper follows through the development of the concept of psychosis over (...) the last two centuries in the interplay of three different conceptual orientations: the categorical, dimensional and network approaches. Each of these represent the available knowledge and dominant thinking styles of the era in which they emerged and take markedly different stances regarding the nature of mental phenomena. Without particular commitment to any ontological positions or models described, the authors invite the reader into a thinking process about the strengths and weaknesses of these models, and how they can be reconciled in multidisciplinary settings to benefit the process of patient care. (shrink)

Clinical research under the usual regulatory constraints may be difficult or even impossible in a public health emergency. Regulators must seek to strike a good balance in granting as wide therapeutic access to new drugs as possible at the same time as gathering sound evidence of safety and effectiveness. To inform current policy, I reexamine the philosophical rationale for restricting new medicines to clinical trials, at any stage and for any population of patients (which resides in the precautionary principle), (...) to show that its objective to protect public health, now or in the future, could soon be defeated in a pandemic. Providing wider therapeutic access and coordinating observations and natural experiments, including service delivery by cluster (wedged cluster trials), may provide such a balance. However, there are important questions of fairness to resolve before any such research can proceed. (shrink)

We intuitively think and talk about health care as a human right. Moreover, we tend to talk about health in the language of basic rights or human rights without a clear sense of what such rights mean, let alone whose duty it is to fulfill them. Additionally, in the care ethics literature, we tend to think of a dividing line between care and justice. In this dissertation I aim to draw care and justice together in what I call (...) care justice. To attend to care justice requires the reconceptualization of the value and practice of health care, and of the moral communities in which we enact care and justice. First, I argue for a strong right to health care, though not to health. Second, I argue that health care includes much more than mere medical care. On this account health care is special for the practices of care it values and communicates. Third, I establish a theoretical framework for why, and importantly how, health care entails other forms of care: social, economic and political. My approach engages a complicity framework to rethink moral community formation and participation, and the rights and responsibilities of individuals as participants in a collective moral community. I argue that it is within communities of membership, which I define as ethical homes, that we have duties to and expectations from others. The moral community as complicit ethical home provides a way to reimagine individual shared responsibility within moral communities, and particularly regarding responsibility for practices of care. (shrink)

Despite the burgeoning literature on professionalism in other health professions, psychology lags behind in the level of attention given to this core competency. In this article, we review definitions from other health professions and how they address professionalism. Next, we review how this competency evolved within health service psychology (HSP), and we propose a definition. We offer an approach for assessing professionalism within HSP. Consideration is given to strategies and methods for providing effective education and training in (...) this multifaceted competency. Finally, recommendations are made for creating a culture of professionalism within HSP and honoring psychology’s social contract with multiple publics. (shrink)

In this paper, I attempt to clarify the ideas of equality underlying section 15 claims for benefits such as welfare and health care; I use the name ‘economic rights claims’ for these types of claims. I adopt Joseph Raz’s division of equality claims into rhetorical egalitarian claims, which are based in a failure to equally respect a universal claim , and strict egalitarian claims, which are based on an actually existing unequal distribution of resources . I show how the (...) dignity-based approach to equality stemming from Law v. Canada is an example of a rhetorical egalitarian claim. With this groundwork set, I turn my attention to the economic rights claims. I survey three reasons for thinking that an unequal distribution of some benefit might, even absent any failure to respect or recognize the dignity of those at the losing end, be thought of as wrong or unjust. The first two reasons – an appeal to an idea of sufficiency, and the fear that some stigma might be associated with the inequality – I reject in favour of the third, which is that in a situation in which all the participants have some equal claim to a benefit, a fair procedure will result in their benefiting equally. Following John Rawls, I suggest that our society, as a cooperative venture for mutual advantage, creates in its members at least a prima facie equal claim to share in the society’s benefits. The economic rights claims, then, are claims that this prima facie equal claim has not been respected. But the benefits being claimed for, as benefits created by the society, are not benefits automatically due to everyone just in virtue of their humanity, instead they are due to the worst-off once the best off have come to be able to benefit from them. Thus they take a strict egalitarian form – once some members of our society benefit in a certain way, then the equality of all members as contributors to the cooperative venture for mutual advantage implies that the other members of our society gain a claim to that benefit. The fact that these economic rights claims are strict egalitarian claims means they cannot be grounded in arguments about dignity, as dignity-based claims are rhetorical egalitarian claims for benefits due to all in virtue of their universal human dignity. I conclude by returning to Law to highlight a passage which I believe provides a grounding for a recognition of economic rights in line with my argument; I also make some brief comments on the need for a stricter division of labour between section 15 and section 1 in the context of economic rights claims and on the effect of this argument on Canadian federal law more generally. (shrink)

To optimize the data clustering effect of public health emergencies, an application research on social governance ability under public health emergencies based on artificial intelligence is proposed. First, the firefly optimization algorithm is used to collect the information data of the social governance ability of public health emergencies, establish a unified format, and save it. Then, artificial intelligence technology is used to mine the correlation of clustering data, and on this basis, a learning model integrating global structure (...) information and local structure information is established. Finally, the social governance model under public health emergencies is established. The experimental results show that the design method has high clustering accuracy, regularization cross index, and adjusted rand index (ARI) index. This shows that the design method can improve the social governance ability of data fusion clustering and improve the social governance ability. (shrink)

Theories of social justice are necessarily abstract, reaching beyond the particular and the immediate to the general and the timeless. Yet such theories, addressing the world and its problems, must respond to the real and changing dilemmas of the day. A brilliant work of practical philosophy, Frontiers of Justice is dedicated to this proposition. Taking up three urgent problems of social justice neglected by current theories and thus harder to tackle in practical terms and everyday life, Martha Nussbaum seeks a (...) theory of social justice that can guide us to a richer, more responsive approach to social cooperation. The idea of the social contract--especially as developed in the work of John Rawls--is one of the most powerful approaches to social justice in the Western tradition. But as Nussbaum demonstrates, even Rawls's theory, suggesting a contract for mutual advantage among approximate equals, cannot address questions of social justice posed by unequal parties. How, for instance, can we extend the equal rights of citizenship--education, health care, political rights and liberties--to those with physical and mental disabilities? How can we extend justice and dignified life conditions to all citizens of the world? And how, finally, can we bring our treatment of nonhuman animals into our notions of social justice? Exploring the limitations of the social contract in these three areas, Nussbaum devises an alternative theory based on the idea of capabilities. She helps us to think more clearly about the purposes of political cooperation and the nature of political principles--and to look to a future of greater justice for all. (shrink)

Many clusters of small and medium enterprises (SMEs) in Less Developed Countries (LDC) are counteracting the “race to the bottom” by becoming competitive while at the same time “socially upgrading” in order to successfully improve their innovation capacity, social, environmental and labor standards, and health-and-safety issues. There is significant literature on the competitiveness of clusters and SMEs, but little research about how and why competitive small firms in LDCs are socially upgrading. Issues such as Corporate Social Responsibility (CSR) and (...) public policies have influenced the initiatives for cluster social upgrading. The objective of this article is to discuss a conceptual framework to understand what factors may lead SMEs to organize themselves to overcome obstacles to collective action for social upgrading.The traditional cluster literature relies on the internal dynamics of the clusters for upgrading. Through interaction among cluster members (firms, supporting organizations, etc.), firms would learn from each other. This would help firms to innovate and develop new products, processes, functions and markets. Besides this literature, three other basic frameworks that explain the way firms can upgrade have been developed recently in the literature: upgrading through markets, through CSR and through better enforcement of regulation. Those frameworks can bring certain insights to a better understanding of social upgrading. (shrink)

Background and objectives: Summary measures of overall health inequality are independent of group membership and enable international comparisons of distribution of health. We compare inequality between and within countries over time and identify normative issues underlying such comparisons. Methods: We used a set of modeled historical life tables for 193 World Health Organization member states from the years 1990, 2000 and 2008 and calculated inequality in age at death and inequality-adjusted life expectancy. Results: Our calculations suggest (...) that overall health inequalities in age at death have been decreasing in the period 1990–2008 in most countries of the world. Only 20 countries experienced increasing distribution in age at death. Simultaneously, overall life expectancy has increased in 85 per cent of all countries. Thus, the combined measure IALE has improved globally. The same overall trend of reduced health inequality applies to all groups of countries stratified by income level. Conclusion: Overall health inequalities, in addition to average health outcomes, could be reported regularly to monitor the health status of populations and the performance of health systems. We find, on normative grounds, the combined measure IALE to be preferable to measuring trends in inequality only. Likewise, we find the Absolute GiniH to be preferable to Relative GiniH. (shrink)

This article delves into a potential mindset that may be responsible for the recent financial meltdown. Research relating to this mindset from different perspectives is reviewed. The findings from this literature review are used to create a conceptual framework for the empirical, ethical, and corporate social responsibility study of financial professionals. Data were collected from a survey of the professional membership of a large national association of financial professionals. This article reports the results of the analysis of data relative (...) to the relationships among the four constructs—financial professionals' perceived organizational value clusters, ethics, corporate social responsibility, and corporate performance. The findings indicate that organizational core values significantly affect corporate ethics, social responsibility, and financial performance. We propose that organizations in the financial industry can move toward being more ethical and socially responsible by adopting organic core values (e.g., democratic, open, trusting, enterprising, creative, stimulating) and moving away from mechanistic values (e.g., structured, regulated, procedural, authoritarian, closed, callous). We also found the adaptation of organic core values does not require the organization to suffer a loss in financial performance. (shrink)

Informed consent is thought to exist as a well-defined entity. Altered concepts of patient autonomy, differential cultural understanding of the entity, and the failure of clients to distinguish between research and clinical ethics, and various hierarchical cultural views of informed consent all suggest that alterations may be needed in the traditional concept. By using the methodology outlined by Gasking in which he defines the idea of “cluster concepts,” one may be able to enlarge the definition and augment the understanding (...) of the informed consent and include the time and culture-specific variants which exist. (shrink)

Ethics consultation is a novel paradigm in European health-care institutions. In this paper, patient involvement in all clinical ethics activities is scrutinized. It is argued that patients should have access to case consultation services via clearly defined access paths. However, the right of both health-care professionals and patients indicates that patients should not always be notified of a consultation. Ethics education, another well-established function of an ethics committee, should equally be available for patients, lay people and hospital staff. (...) Beyond access and utilization, lay membership on a clinical ethics service is a matter of transparency, equal participation, empowerment and democratization. Lay and patient perspectives will contribute to the quality of ethics services on all levels from case consultations to ethics education and policy development. (shrink)