Summary measures of health, such as the quality-adjusted life year and disability-adjusted life year, have long been known to incorporate a number of value choices. In this paper, though, I show that the value choices in the construction of such measures extend far beyond what is generally recognized. In showing this, I hope both to improve the understanding of those measures by epidemiologists, health economists and policy-makers, and also to contribute to the general debate (...) about the extent to which such measures should be adjusted to reflect ethical values. (shrink)

There is no way literally to measure health, because health is multi-dimensional, and there is no metric whereby one person who is healthier than a second with respect to one dimension but less healthy with respect to another counts as healthier, less healthy or equally healthy overall. Health analysts instead measure how good or bad health states are in some regard. If these values are measures of health states, then identical health states must (...) have identical values. But in different circumstances, the same health state may have different values. It may be better or worse. Uniform values can nevertheless be assigned to kinds of health states, either as a weighted average of the values of their tokens or as the value of the performance in a standard environment of the capacity the health state constitutes. These uniform values are not well suited for some of the purposes for which summary measures of population health have been intended, and a set of non-evaluative indicators may be an attractive alternative. (shrink)

This book is a comprehensive and unique text and reference in medical ethics. By far the most inclusive set of primary documents and articles in the field ever published, it contains over 100 selections. Virtually all pieces appear in their entirety, and a significant number would be difficult to obtain elsewhere. The volume draws upon the literature of history, medicine, philosophical and religious ethics, economics, and sociology. A wide range of topics and issues are covered, such as law and medicine, (...) truth-telling by the physician, research, population policy, genetics, abortion, dying, and individual rights in medical care. The selections span the centuries, beginning with material from the works of Hippocrates, continuing through Thomas Percival, John Stuart Mill, and Claude Bernard, down to modern commentators like Henry K. Beecher, Walsh McDermott, David L. Bazelon, Paul Freund, H. L. A. Hart, John Rawls, Paul Ramsey, Richard McCormick, Rashi Fein, and Bernard Barber. The text has eight major divisions, beginning with sections on the ethical dimensions of the physician-patient relationship in history; the moral bases of medical ethics; and regulation, compulsion, and protection of the consumer in clinical medicine and public health. Each of these sections includes key essays that appear for the first time. All of the book's major divisions contain primary documents: codes such as the Hippocratic Oath, Medieval Law for the Regulation of Medicine, and the first as well as the most recent code of the American Medical Association; court decisions, including those on Karen Quinlan and on abortion in the United States and West Germany; government documents such as the statement of the National Commission on the Protection of Human Subjects, the Tuskegee Syphilis Report, the British Parliamentary debate on euthanasia, and the Council of Europe on rights of the sick and dying; and various published guidelines such as the Harvard Medical School brain death criteria, the American Hospital Association on patient's rights, and Pope Pius XII on the prolongation of life. Cases that illustrate moral dilemmas are provided for discussion purposes. Each section is preceded by a succinct editor's introduction. The documents and essays are of practical value for practitioners and students in medicine, law, ethics, and counselling, and for individual patients and groups concerned with medical care. Through encompassing divergent viewpoints, the essays and primary documents were selected to encourage humane practices and deepen understanding of the multiple traditions that shaped and do shape the development of medicine. (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)

Death is something we mourn or fear as the worst thing that could happen―whether the deaths of close ones, the deaths of strangers in reported accidents or tragedies, or our own. And yet, being dead is something that no one can experience and live to describe. This simple truth raises a host of difficult philosophical questions about the negativity surrounding our sense of death, and how and for whom exactly it is harmful. The question of whether death is bad has (...) occupied philosophers for centuries, and the debate emerging in philosophical literature is referred to as the "badness of death." Are deaths primarily negative for the survivors, or does death also affect the deceased? What are the differences between death in fetal life, just after birth, or in adolescence? In order to properly evaluate deaths in global health, we must find answers to these questions. -/- In this volume, leading philosophers, medical doctors, and economists discuss different views on how to evaluate death and its relevance for health policy. This includes theories about the harm of death and its connections to population-level bioethics. For example, one of the standard views in global health is that newborn deaths are among the worst types of death, yet stillbirths are neglected. This raises difficult questions about why birth is so significant, and several of the book's authors challenge this standard view. -/- This is the first volume to connect philosophical discussions on the harm of death with discussions on population health, adjusting the ways in which death is evaluated. Changing these evaluations has consequences for how we prioritize different health programs that affect individuals at different ages, as well as how we understand inequality in health. (shrink)

In recent decades, social and behavioral scientists have begun to explore how and why human beings thrive or flourish and to consider whether traits indicative of thriving or flourishing may themselves influence physical well-being. This stands in contrast to the historical tendency in these fields to focus on pathology: mental illness, psychological dysfunction, deviant behavior, social problems, and so on. In epidemiology, too, the influence of pathology is seen in a tacit emphasis on risk factors for disease outcomes and for (...) rates of morbidity and mortality, as opposed to, say, protective factors promotive of good health. Methodologically, there is nothing substantial that would prohibit looking at the world... (shrink)

Should organ transplants be given to patients who have waited the longest, or need it most urgently, or those whose survival prospects are the best? The rationing of health care is universal and inevitable, taking place in poor and affluent countries, in publicly funded and private health care systems. Someone must budget for as well as dispense health care whilst aging populations severely stretch the availability of resources. The Ethics of Health Care Rationing is a clear (...) and much-needed introduction to this increasingly important topic, considering and assessing the major ethical problems and dilemmas about the allocation, scarcity and rationing of health care. Beginning with a helpful overview of why rationing is an ethical problem, the authors examine the following key topics: What is the value of health? How can it be measured? What does it mean that a treatment is "good value for money"? What sort of distributive principles - utilitarian, egalitarian or prioritarian - should we rely on when thinking about health care rationing? Does rationing health care unfairly discriminate against the elderly and people with disabilities? Should patients be held responsible for their health? Why does the debate on responsibility for health lead to issues about socioeconomic status and social inequality? Throughout the book, examples from the US, UK and other countries are used to illustrate the ethical issues at stake. Additional features such as chapter summaries, annotated further reading and discussion questions make this an ideal starting point for students new to the subject, not only in philosophy but also in closely related fields such as politics, health economics, public health, medicine, nursing and social work. (shrink)

Each of us has written about the importance of reframing the debate over public health paternalism. Our individual explorations of the many and varied paths forward from libertarian “nanny state” objections to the “new public health” have been intimately informed by collaboration. This article represents a summary of our current thinking — reflecting the ground gained through many fruitful exchanges and charting future collaborative efforts.Our starting point is that law is a vitally important determinant of population (...) health, and the interplay among law, social norms, cultural beliefs, health behaviors, and healthy living conditions is complex. Anti-paternalists’ efforts to limit the scope of public health law to controlling only the proximal determinants of infectious diseases are utterly unjustifiable in the face of so much preventable death, disability, and disparity. Equally important, the anti-paternalism push is deeply counter-majoritarian and undemocratic, threatening to disable communities from undertaking measures to improve their own well-being. (shrink)

Estimates of the burden of disease assess the mortality and morbidity that affect a population by producing summary measures of health such as quality-adjusted life years and disability-adjusted life years. These measures typically do not include stillbirths among the negative health outcomes they count. Priority-setting decisions that rely on these measures are therefore likely to place little value on preventing the more than three million stillbirths that occur annually worldwide. In contrast, neonatal deaths, (...) which occur in comparable numbers, have a substantial impact on burden of disease estimates and are commonly seen as a pressing health concern. In this article we argue in favor of incorporating unintended fetal deaths that occur late in pregnancy into estimates of the burden of disease. Our argument is based on the similarity between late-term fetuses and newborn infants and the assumption that protecting newborns is important. We respond to four objections to counting stillbirths: that fetuses are not yet part of the population and so their deaths should not be included in measures of population health; that valuing the prevention of stillbirths will undermine women's reproductive rights; that including stillbirths implies that miscarriages should also be included; and that birth itself is in fact ethically significant. We conclude that our proposal is ethically preferable to current practice and, if adopted, is likely to lead to improved decisions about health spending. (shrink)

The moral philosopher Dan Brock has argued that equality of health outcomes “even if achievable” is problematic as a goal in its own right—because it is open to the levelling down objection. The levelling down objection to egalitarianism has received surprisingly little attention in the bioethics literature on distribution of health and healthcare and deserves more attention. This paper discusses and accepts an example given by Brock showing that prioritarianism and egalitarianism may judge distributions of health outcomes (...) differently. We should accept that levelling down is never a good thing, all things considered, but that equality often is. By discussing variants of Brock’s example, it is demonstrated that if equality, prioritarianism and aggregation are combined, as in a population-wide summary measure of health, such as the health achievement index, this combined set of principles is not open to levelling down. The paper suggests—although a more thorough investigation of the properties of the achievement index is needed—that this measure is always sensitive to inequality in health, is always sensitive to average health, can assign priority to those with lowest health outcomes and is not sensitive to levelling down. Levelling down is not an embarrassment for egalitarians if they adopt a pluralist theory that integrates fairness with goodness. Equality is not the only value egalitarians promote. But equality is so important that we should not reject it. (shrink)

Donors to global health programs and policymakers within national health systems have to make difficult decisions about how to allocate scarce health care resources. Principled ways to make these decisions all make some use of summary measures of health, which provide a common measure of the value (or disvalue) of morbidity and mortality. They thereby allow comparisons between health interventions with different effects on the patterns of death and ill health within a (...) population. The construction of a summary measure of health requires that a number be assigned to the harm of death. But the harm of death is currently a matter of debate: different philosophical theories assign very different values to the harm of death at different ages. This chapter considers how we should assign numbers to the harm of deaths at different ages in the face of uncertainty and disagreement. (shrink)

Access to urban green space is associated with the enhancement of health and disparities in access generate issues of spatial equity and socioenvironmental justice. The aim of this study is to measure spatial accessibility and investigate access disparities to UGSs in urban areas of Harbin, China. A Gaussian-based two-step floating catchment area method and spatial autocorrelation analysis were used to measure the accessibility and evaluate its distribution patterns in residential tracts. Bivariate correlation was employed to examine the statistical relations (...) between demographic characteristics of residential tracts and green space access. The results show that most residential tracts have minimal green space access within walking distance, while a few have limited access within cycling distance. Additionally, spatial disparities were found with low-accessibility tracts clustering in the center of the city, while high-accessibility tracts were located in northern and southern suburbs. Demographic disparities were also identified in the study: females have less access to UGS than males, areas with a high birth rate generally have more access, and population density is negatively associated with UGS access. The findings not only indicate that Harbin has an uneven distribution and disproportionate provision of UGS for urban residents but also identify which areas and population groups within the city are disadvantaged in access to UGS and thus provide suggestions for future construction and provision of UGS. (shrink)

Population health has recently grown from a series of loosely connected critiques of twentieth-century public health and medicine into a theoretical framework with a corresponding field of research—population health science. Its approach is to promote the public’s health through improving everyday human life: affordable nutritious food, clean air, safe places where children can play, living wages, etc. It recognizes that addressing contemporary health challenges such as the prevalence of type 2 diabetes will take (...) much more than good hospitals and public health departments. -/- Blending philosophy of science/medicine, public health ethics and history, this book offers a framework that explains, analyses and largely endorses the features that define this relatively new field. Presenting a philosophical perspective, Valles helps to clarify what these features are and why they matter, including: searching for health’s “upstream” causes in social life, embracing a professional commitment to studying and ameliorating the staggering health inequities in and between populations; and reforming scientific practices to foster humility and respect among the many scientists and non- scientists who must work collaboratively to promote health. -/- Featuring illustrative case studies from around the globe at the end of all main chapters, this radical monograph is written to be accessible to all scholars and advanced students who have an interest in health—from public health students to professional philosophers. (shrink)

Millions of children who were born during the first decade after the Islamic revolution in Iran are now reaching the age of marriage and childbearing. Short spacing between marriage and the birth of the first child has the potential to cause an excessive and costly increase in the growth of population in Iran. Research into the motivations for the birth of first child among newly married couples can create a knowledge base that will enable health centres to help (...) these couples make better decisions about the timing of their first pregnancy. Using a consecutive sampling technique and administering Miller’s Childbearing Questionnaire, data were gathered regarding the childbearing motivations and desires of 300 couples who had been referred to the Shiraz Health Center for premarital counselling. The Childbearing Questionnaire, with some minor modifications, was found to be a valid and reliable instrument for measuring the childbearing motivations of newly married couples of Shiraz County, Fars Province, Iran. The utility of these findings for counselling in health centres is discussed. Based on the results, a longitudinal study is being designed that will allow the development of models for predicting the time of first pregnancy after marriage. (shrink)

The aim of this study is to develop a valid and reliable measurement tool for determining students' spiritual health and life orientation. For this purpose, the Spiritual Health and Life-Orientation Measure (SHALOM) inventory developed by Fisher (2010) is adapted to Turkish. The adaptation study was carried out on 1591 high school students in three study groups studying in Ankara and Muş. The original English measure consisting of four dimensions and twenty items was translated into Turkish, factor analysis, validity (...) and reliability tests were conducted on the sampling data. As a result of the study, the Turkish-adapted inventory consists of four dimensions (personal, social, environmental and transcendental) which resemble the original inventory. In addition, internal consistency coefficients of the inventory dimensions were in perfect harmony with the original inventory and served the purpose of the scale. In Conclusion The Turkish adaptation of the SHALOM Inventory can be used in different disciplines of psychology, educational sciences, and social sciences. Summary: The concept of religion, which is an important dynamic and carrier of the social field, has gone into a double distinction since the second half of the 18th century; the concept of spirituality has begun to be refined from the concept of religion. The concepts of religion and spirituality are very difficult to define; While the concept of religion focuses ideology and rules of belief, spirituality centers on individual experiences and interrelationships that extend religion. For this reason, different spirituality and religion definitions are made from different perspectives and different spirituality scales were developed within this framework. However, the results of these studies differ significantly from each other; this means that spirituality was defined and conceptualized based on the scale that was used. Early period studies on spirituality mostly focus on religion, health, psychology and work life. In these studies, after defining the concept of spirituality; the relationship between the concept and health, religion, psychology and business life or necessity for human life is discussed. In the West, until the 1950s, the concepts of religion and spirituality were used interrelated. However, today these two concepts are almost completely separated from each other.Literature consists of numerous inventory development studies to measure spirituality. The fact that the inventory works based on different conceptual foundations makes it difficult to draw a general, meaningful and consistent conclusion about spiritual health and life orientation. Furthermore, spirituality measurements reflecting the religion and values ​​of a particular culture cannot be comprehensive or universal. At this point, Fisher criticizes the measurement tools developed for the purpose of measuring spirituality: in terms of "mixing religion and spirituality", "relying on the world of values", "not taking into account cultural differences", "and questioning only the mystical/spiritual experience". As a result, it can be said that no measurement developed in the conceptual structure of the West does not take into account the cultural flexibility and accept its spiritual values as universal or prevalent.The SHALOM inventory developed by Fisher, which adapted to the Turkish culture in present study, is based on four basic (individual, social, environmental and transcendent) areas that constitute the world of interpersonal relationship. In this study, spirituality, as in Fisher's work, emphasizes the interaction with certain concepts of different intensities that are considered as independent from religion and above religions. In this context, the concept of spirituality communicates with one's personal space, social position, nature, and transcendental power. This adaptation study will provide useful information and comments on the students' spiritual health levels. This is the most important motive behind the idea of adapting the SHALOM inventory developed by Fisher to the Turkish culture. In addition, by adapting the SHALOM inventory, which is emphasized to have cultural flexibility and adapted to different languages, a new and different measurement tool will be available to understand the nature of the concept of spirituality.This research was carried out to adapt the inventory of Spiritual Health and Life Orientation scale developed for students to Turkish culture. This inventory adaptation study was performed with the data collected from three working groups in Ankara and Muş provinces and 1591 high school students. The first study group was carried out with 414, the second study group with 788, and the third group with 389 high school students. While the data collected from 414 students were used for Exploratory Factor Analysis (AFA) analysis, data collected from 788 students were used for Confirmatory Factor Analysis (CFA). In addition, 389 students were used to determine the criterion validity of the inventory. The original language of the SHALOM inventory, which is intended to be adapted into Turkish, is English, and translation studies are conducted separately by three linguistic experts who know the grammar and semantic characteristics of both languages. After the translation studies, the scale was applied to the sampling group and AFA was performed on the sample data. The AFA results showed that a factor roof resembling the original inventory was formed. Determining factors are given appropriate names (personal, enviromental, social and transcendental) by taking into consideration the theoretical names and the dimension names in the original form of the SHALOM. The structure was confirmed by DFA, and as a result of the DFA, X2/sd (1.72) ratio and IFI (0.96) fit indicator was found to be the appropiate fit for the model tested. As a result, it is understood that the Spiritual Health and Life Orientation Inventory consists of four dimensions as in the original inventory, the internal consistency coefficients of the inventory dimensions are in harmony with the original inventory and serve the purpose of the scale. In conclusion the Turkish adaptation of the SHALOM Inventory can be used in different disciplines of psychology, educational sciences, and social sciences. Spirituality should not only be defined within the framework of Western theories, but the nature and likelihood of the spirituality predicted by Islam should be discussed. Moreover, the types and dimensions of Islamic spirituality should be determined by taking into account the cultural subjectivity of an Islamic character. In the study of spirituality, the human model which modernity presents universally should not be accepted as the only truth. It should be tried to develop human models that come from Islamic culture and history and which are specific to us and define us. This should be taken into account not only in mental health / religious studies, but also in psychology of religion in general. In addition, culture-specificity should be given importance, and the experience gained from the cultural accumulation developed by the Turkish civilization with the Islamic doctrine should lead to the studies of spirituality. In this respect, this study aims to adapt the value and spiritual orientation of a different culture to Turkish culture, but it is problematic to construct the concept with Western values. Although Western values are similar to Islamic values and principles, it is envisaged that it may be difficult to measure the concept of spirituality in practice. (shrink)

Uncertainty is inherent in new and unexpected viral outbreaks such as the current COVID-19 pandemic. It imposes challenges for health officials in soliciting cooperative behavioural changes based on incomplete information. In this paper, we use evolving mask recommendations in the United States as an example to analyse the ethical importance and practical demonstration of trustworthiness in pandemic messaging and decision-making. We argue that responsible public health interventions in the time of uncertainties requires explicit intersecting ethical considerations both in (...) action and in communication to promote trustworthiness. First, as public health decisions have to be made in the face of incomplete and evolving data, health officials need to exhibit competence while committing to epistemic humility. They can explain the methods used in making and updating mask recommendations as well as explicitly acknowledge the need to incorporate sociocultural and other contextual considerations in translating scientific data into mask recommendations. Second, officials and agencies must uphold and communicate decisional transparency as part of their effort to demonstrate accountability and promote the public’s understanding of the evolving pandemic. Third, especially since both the pandemic and mask recommendations may have disparate impact on different populations, officials should start with the fair implementation of the least restrictive measures that can help reduce harm. (shrink)

Research suggests that the ability to understand one’s own and others’ minds, or mentalizing, is a key factor for mental health. Most studies have focused the attention on the association between global measures of mentalizing and specific disorders. In contrast, very few studies have analyzed the association between specific mentalizing polarities and global measures of mental health. This study aimed to evaluate whether self and other polarities of mentalizing are associated with a multidimensional notion of mental (...) health, which considers symptoms, functioning, and well-being. Additionally, the level or depth of mentalizing within each polarity was also analyzed. A sample of 214 adolescents was evaluated on measures of self- and other- mentalizing, multi-informed measures of psychopathology and functioning based on Achenbach’s system, and measures of psychological well-being. Results revealed no association between mentalizing polarities and higher-order symptom factors. Self-mentalizing was associated with self-esteem and motivation to life goals, and other-mentalizing was associated to general, social and role functioning. This association between aspects of self-other mentalizing and self-other function has important implications for treatment and prevention. Deeper mentalizing within each polarity revealed stronger associations with functioning and well-being. Because mentalizing polarities are associated with functioning and well-being but not with symptoms, a new hypothesis is developed: mentalizing does not contribute to resiliency by preventing symptoms, but by helping to deal with them, thus improving functioning and well-being independently of psychopathology. These findings support that promoting mentalizing across development may improve mental health, even in non-clinical population. (shrink)

We use a cultural psychology approach to examine the relevance of the Health Belief Model for predicting a variety of behaviors that had been recommended by health officials during the initial stages of the COVID-19 lockdown for containing the spread of the virus and not overburdening the health system in Europe. Our study is grounded in the assumption that health behavior is activated based on locally relevant perceptions of threats, susceptibility and benefits in engaging in protective (...) behavior, which requires careful attention to how these perceptions might be structured and activated. We assess the validity of the HBM in two European countries that have been relatively understudied, using simultaneous measurements during acute periods of infection in Romania and Italy. An online questionnaire provided a total of valid answers from both countries. First, to understand individual difference patterns within and across populations, we fit a General Linear Model in which endorsement was predicted by behavior, country, their interaction, and a random effect for participants. Second, we assess the effect of demographics and health beliefs on prevention behaviors by fitting a multi-group path model across countries, in which each behavior was predicted by the observed health belief variables and demographics. Health beliefs showed stronger relationships with the recommended behaviors than demographics. Confirming previously reported relationships, self-efficacy, perceived severity, and perceived benefits were consistently related to the greater adoption of individual behaviors, whereas greater perceived barriers were related to lower adoption of health behaviors. However, we also point to important location specific effects that suggest that local norms shape protective behavior in highly contextualized ways. (shrink)

Mental health has been declared as the essential component of overall human wellbeing. However, there has been a very steep rate of depression and anxiety in students that exhibit their social and personal burdens. It has been widely accepted that the wellbeing and mental health of individuals are a mix of psychological, genetic, social, lifestyle factors, and environmental exposure. Due to the pandemic, the shift from traditional classroom learning to e-learning has also disturbed the mental health of (...) students, which consequently affects environmental stability. The current study has also measured the effect on the mental health of e-learning behaviors. The population of the study was the undergraduate students enrolled in the colleges of China, and they were chosen via convenient sampling. The findings of the study show that mental health has a significant positive effect on the e-learning behavior of the students and consequently affects environmental sustainability. Educational institutions are improving their e-learning programs by understanding the preferences and challenges of students regarding online learning. Educational institutions should revise their policies on online education and teaching methodologies. Furthermore, the current study has taken undergraduate students as the sample. In future studies, these relationships can be checked in higher education as well. (shrink)

The Continuous Parameter Estimation Model is applied to develop individual genomic-level heritabilities for the latent hierarchical structure and developmental dynamics of Life History (LH) strategy LH strategies relate to the allocations of bioenergetic resources into different domains of fitness. LH has moderate to high population-level heritability in humans, both at the level of the high-order Super-K Factor and the lower-order factors, the K-Factor, Covitality Factor, and General Factor of Personality (GFP). Several important questions remain unexplored. We developed measures (...) of genome-level heritabilities employing an American sample of 316 monozygotic (MZ) and 274 dizygotic (DZ) twin dyads and a Swedish sample of 863 MZ and 475 DZ twin dyads. This novel heritability index measures individual genetic transmissibility, therefore opening new avenues for analyzing complex interactions among heritable traits inaccessible to standard structural equations methods. For these samples: (1) moderate to high heritability of factor loadings of Super-K on its lower-order factors is demonstrated, evidencing biological preparedness, genetic accommodation, and the gene-culture coevolution of biased epigenetic rules of development; (2) moderate to high heritability of the magnitudes of the effect of the higher-order factors upon their loadings on their constituent factors, evidencing genetic constraints upon phenotypic plasticity; and (3) that heritability of the LH factors, of factor loadings, and of the magnitudes of the correlations among factors are weaker among those with slower LH speeds, demonstrating that inter-individual variation in transmissibility is a function of individual socioecological selection pressures. (shrink)

BackgroundAdvance directives (ADs) were implemented in Portugal in 2012. Although more than a decade has passed since Law 25/2012 came into force, Portuguese people have very low levels of adherence. In this context, this study aimed to identify and analyse the attitudes of people aged 18 or older living in Portugal towards ADs and to determine the relationships between sociodemographic variables (gender/marital status/religion/level of education/residence/whether they were a health professional/whether they had already drawn up a living will) and people’s (...) attitudes towards ADs.MethodsAn online cross-sectional analytical study was conducted using a convenience sample. For this purpose, a request (email) that publicized the link to a –form—which included sociodemographic data and the General Public Attitudes Toward Advance Care Directives (GPATACD) scale—was sent to 28 higher education institutions and 30 senior universities, covering all of mainland Portugal and the islands (Azores and Madeira). The data were collected between January and February 2023.ResultsA total of 950 adults from completed the online form. The lower scores (mean 1 and 2) obtained in most responses by applying the GPATACD scale show that the sample of the Portuguese population has a very positive attitude towards ADs. The data showed that women, agnostics/atheists, health professionals and those who had already made a living will had more positive attitudes (p < 0.001) towards ADs. There were no statistically significant differences in the attitudes of the Portuguese population sample towards ADs in relation to marital status, education level, and residence.ConclusionThe results obtained enable us to confirm that this sample of the Portuguese population has a positive attitude towards ADs. We verify that there are certain fringes of this sample with certain sociodemographic characteristics (women, agnostics/atheists, health professionals and those who had already made a living will) that have a more positive attitude towards ADs. This data could facilitate the implementation and adjustment of relevant measures, particularly in the field of health education and aimed at groups with less favourable attitudes, to increase the effectiveness of voluntary exercise of citizens’ autonomy in end-of-life care planning. (shrink)

Increased use of scales in data-driven consumer digital platforms and the management of organisations has led to greater interest in understanding social and psychological measurement expertise and techniques as historically constituted ‘technologies of power’ in the making of what Stark has labelled the ‘scalable subject’. Taking a genealogical approach, and drawing on published and archival data, this article focuses on self-rated health, a scale widely used in population censuses, national health surveys, patient-reported outcome measurement tools, and a (...) variety of digital apps. The article suggests that the first methodological articulation of self-rated health by the investigators of the Cornell Study of Occupational Retirement (1951–58) provides a window into the key epistemic, institutional, and cultural uncertainties about psychological and social measurement, processes of adjustment to ‘old age’, and the capacity of individuals to value their own health. I propose that these uncertainties have become incorporated into extant and operational measurements of health. (shrink)

Introduction. The problems of state and local governance in sparsely populated and rural areas is relevant for the Russian Federation due to the presence of depressed areas, depopulation of the countryside, small towns, monotowns, migration of the rural population to large cities, regional capitals, other regions and abroad. These processes are typical for many other modern states. Solving the problems of rural and sparsely populated areas includes providing socially significant services, protecting the health and safety of residents, developing (...) education, creating and maintaining social infrastructure, and creating jobs. The purpose of the article is to identify the most important management problems in rural and sparsely populated areas and reveal possible solutions to these problems using the example of Great Britain. Methods. The research is based on a systematic approach to management in rural and sparsely populated areas. Analysis of factual data, legal sources, published survey results, foreign Internet sources. Comparative analysis of problems and measures of state policy in different states. Scientific novelty of the research. The author highlights the current measures taken in the UK at the central, local levels in order to overcome the problems of rural and sparsely populated areas. These activities as a basis for developing practical recommendations may be important for solving similar problems in Russian regions, including in the context of the COVID-19 epidemic and economic problems in the near future. Results. As a result the author identifies problems in the field of management in rural and sparsely populated and hard-to-reach areas, as well as possible directions of state policy in the UK and Russia to overcome these problems. Conclusions. The most important direction of state policy for solving the problems highlighted in the study is the development of local interests of the community, the integration of state support measures and local events. As measures aimed at solving social and infrastructural problems of sparsely populated areas in the UK, one can single out government programs implemented at the national and regional levels with the participation of industrial enterprises and businesses, a grant mechanism for the implementation of financial support, combined with the empowerment of local communities. There is no such policy in Russia yet. (shrink)

The occurrence of the novel severe acute respiratory syndrome coronavirus-2 at the end of 2019 comes along with many challenges. Besides worry for one’s own health and the well-being of the family, all measures applied to limit the spread of the coronavirus affected daily life. School closures, economic shutdown and contact restrictions have led to high levels of stress. The impact on health and families has been widely discussed. However, population-based data are scarce. Here, we have (...) assessed health, quality of life and intrafamilial relations depending on the COVID-19 pandemic. Using a three-step random-route approach, a population-based sample of 2,515 persons was recruited during the second COVID-19 wave in Germany in winter 2020/21. While the majority of participants reported no change in their health status and the relationship with their partner and children, more than half of participants reported a decreased quality of life since the beginning of the pandemic. Female gender, age above 60 years, a low household income, not living with a partner and the experience of childhood adversity were associated with a higher risk for a worsening of health, quality of life and intrafamilial relations. These had already been well-established risk factors ahead of the pandemic. In order to avoid further increase of inequality in our society and more devastating impact of the pandemic on health and intrafamilial relations, low-level support and intervention programs are urgently needed. (shrink)

In recent years, the principle of equivalence has been accepted in many countries as the standard against which healthcare provision for prisoners should be measured. There are several ways in which this principle can be interpreted, but current policy in the UK and elsewhere seems to focus on the measurement and achievement of equivalence in the process of healthcare provision. We argue that it is not appropriate to apply this interpretation to all aspects of prisoner healthcare, as it does not (...) necessarily address the challenges inherent to the prisoner population and prison setting. Consequently equivalence of health outcomes should also be considered alongside processes in the interests of providing healthcare in prison that is equivalent to that outside prison. (shrink)

This article adopts a population-level bioethics approach to analyzing the ethical implications of novel deep-brain stimulation (DBS) technologies. I claim that a microlevel focus on costs and benefits is necessary but insufficient to address the concerns of social justice and health equity that attend the potential utilization of DBS technologies. A macrosocial, population-based analysis notes two ethically significant trends regarding novel health technologies: (1) that they are the prime mover of hyperinflationary health cost trajectories, and (...) (2) that even where they improve overall population health such technologies may expand health inequalities. Such an expansion could exacerbate what Powers and Faden have identified as “densely-woven patterns of disadvantage,” and therein could contravene mandates of social justice. Such concerns of justice and equity are sharpened by the fact that those populations that bear the highest risk of suffering the injuries and illnesses for which DBS technologies might be warranted are among the most disadvantaged groups in American society. Accordingly, ethical analysis of DBS technologies must include an assessment of the evidence suggesting that in their capacity to improve health and compress health inequalities, whole-population approaches that address the upstream factors that shape distributions of neuropsychiatric injuries and illness may be preferable to acute health interventions. However, the article warns against the false-choice fallacy, and notes that whole-population policies and acute care interventions can be simultaneously endorsed. The article concludes by suggesting that the ethical issue of relative priority between these approaches is best framed via a population-level analysis. (shrink)

Rapid individual cognitive phenotyping holds the potential to revolutionize domains as wide‐ranging as personalized learning, employment practices, and precision psychiatry. Going beyond limitations imposed by traditional lab‐based experiments, new efforts have been underway toward greater ecological validity and participant diversity to capture the full range of individual differences in cognitive abilities and behaviors across the general population. Building on this, we developed Skill Lab, a novel game‐based tool that simultaneously assesses a broad suite of cognitive abilities while providing an (...) engaging narrative. Skill Lab consists of six mini‐games as well as 14 established cognitive ability tasks. Using a popular citizen science platform (N = 10,725), we conducted a comprehensive validation in the wild of a game‐based cognitive assessment suite. Based on the game and validation task data, we constructed reliable models to simultaneously predict eight cognitive abilities based on the users’ in‐game behavior. Follow‐up validation tests revealed that the models can discriminate nuances contained within each separate cognitive ability as well as capture a shared main factor of generalized cognitive ability. Our game‐based measures are five times faster to complete than the equivalent task‐based measures and replicate previous findings on the decline of certain cognitive abilities with age in our large cross‐sectional population sample (N = 6369). Taken together, our results demonstrate the feasibility of rapid in‐the‐wild systematic assessment of cognitive abilities as a promising first step toward population‐scale benchmarking and individualized mental health diagnostics. (shrink)

BackgroundImplementation of quarantine and lockdown to COVID-19 pandemic has created dramatic negative psychological impact mainly the general population’s health worldwide. We aimed to assess the prevalence and predictors of anxiety and stress severity among the Palestinian population.MethodsA cross-sectional web-based survey was conducted. An anonymous online questionnaire and snowball recruiting technique were used to target the general public in Palestine between 6 and 16 April, 2020 during COVID-19 pandemic lockdowns. Multivariate logistic regression models were developed for the outcome (...) variables.ResultsOf the 2819 individuals who completed the questionnaire, more than two thirds of them were females. Nearly, were residing at the West Bank. The mean age of participants was 29.47 years. The anxiety prevalence was with had mild/moderate severity. The stress prevalence was with had mild/moderate severity. The prevalence of both anxiety and stress was. In multivariate analysis, exposure to confirmed case of COVID-19, inadequacy of food supply and jobs that acquire leaving home during lockdown were significantly related to higher anxiety degree. As for stress, low monthly income, cohabitation with a person of a high-risk group and inadequacy of food supply were significantly related to higher stress degree.ConclusionYoung adults with low socioeconomic status and inadequate food supply were more likely to have a higher degree of stress and/or anxiety. Providing alternative economical sources for those in need, and spreading more awareness regarding the pandemic, supporting the population’s psychological wellbeing, community connection and the availability of specialist mental health services are crucial to overcome the mental impacts of COVID-19 in Palestine. (shrink)

Recent research has shown that cultural, linguistic, and sociodemographic peculiarities influence the measurement of trait emotional intelligence. Assessing trait EI in different populations fosters cross-cultural research and expands the construct’s nomological network. In mental health, the trait EI of clinical populations has been scarcely researched. Accordingly, the present study examined the relationship between trait EI and key sociodemographic variables on Trait Emotional Intelligence Questionnaire datasets with mental healthcare patients from three different Spanish-speaking countries. Collectively, these datasets comprised 528 participants, (...) 23% from Chile, 28% from Peru, and 49% from Spain. The sociodemographic variables we used for trait EI comparisons were gender, age, educational level, civil status, and occupational status. Analyses involved Multigroup Exploratory Structural Equation Modelling and analysis of covariance. Our results revealed significant between-country differences in trait EI across the studied sociodemographic variables and interactions between these variables. Measurement invariance across the datasets was attained up to the scalar level regarding gender and education, although analyses on age, civil status, and occupation displayed non-invariance. The resultant psychometric evidence supports the suitability of the TEIQue-SF for the accurate cross-cultural assessment of trait EI in mental health settings. It also highlights the importance of incorporating trait EI into extant psychotherapeutic frameworks to enhance non-pharmacological treatment efficacy. (shrink)

BackgroundThe merits and drawbacks of moral relevance models of addiction have predominantly been discussed theoretically, without empirical evidence of these potential effects. This study develops and evaluates a novel survey measure for assessing moral evaluations of patient substance misuse (ME-PSM).MethodsThis measure was tested on 524 health professionals (i.e., physicians, nurses, and other health professionals) in California (n = 173), urban France (n = 102), and urban China (n = 249). Demographic factors associated with ME-PSM were investigated using analyses (...) of variance (ANOVAs) and t-tests, with results suggesting that ME-PSM is higher among younger health professionals, nurses (when compared with physicians and other health professionals), and Chinese health professionals (when compared with French and American health professionals).ResultsResults provide preliminary support for the psychometric quality of the survey measure introduced in this study, including the existence of a single latent structure and partial invariance of collected data across countries.ConclusionThe survey measure for ME-PSM which was developed and tested in the current study appears to hold potential utility for use as a measure of moral views of patient substance misuse. With development, this measure may be used to examine moral evaluations, both as factors of stigma and of other clinical factors associated with the treatment of patients with substance use disorders. (shrink)

OBJECTIVES: This study was designed to identify and compare the attitudes of patients and health care professionals towards advance directives. Advance directives promote recognition of the patient's autonomy, letting the individual exercise a certain measure of control over life-sustaining care and treatment in the eventuality of becoming incompetent. DESIGN: Attitudes to advance directives were evaluated using a 44-item self-reported questionnaire. It yields an overall score as well as five factor scores: autonomy, beneficence, justice, external norms, and the affective dimension. (...) SETTING: Health care institutions in the province of Québec, Canada. Survey sample: The sampling consisted of 921 subjects: 123 patients, 167 physicians, 340 nurses and 291 administrators of health care institutions. RESULTS: Although the general attitude of each population was favourable to the expression of autonomy, multivariate analysis of variance (MANOVA) indicated that physicians attached less importance to this subscale than did other populations (p < .001). Above all, they favoured legal external norms and beneficence. Physicians and administrators also attached less importance to the affective dimension than did patients and nurses. Specifically, physicians' attitudes towards advance directives were shown to be less positive than patients' attitudes. CONCLUSION: More attention should be given to the importance of adequately informing patients about advance directives because they may not represent an adequate means for patients to assert their autonomy. (shrink)

Population-based research is enhanced by biological measures, but biological sampling raises complex ethical issues. The third British National Survey of Sexual Attitudes and Lifestyles (Natsal-3) will estimate the population prevalence of five sexually transmitted infections (STIs) (Chlamydia trachomatis, Neisseria gonorrhoeae, human papillomavirus (HPV), HIV and Mycoplasma genitalium) in a probability sample aged 16–44 years. The present work describes the development of an ethical approach to urine testing for STIs, including the process of reaching consensus on whether to (...) return results. The following issues were considered: (1) testing for some STIs that are treatable and for which appropriate settings to obtain free testing and advice are widely available (Natsal-3 provides all respondents with STI and healthcare access information), (2) limits on test accuracy and timeliness imposed by survey conditions and sample type, (3) testing for some STIs with unknown clinical and public health implications, (4) how a uniform approach is easier to explain and understand, (5) practical difficulties in returning results and cost efficiency, such as enabling wider STI testing by not returning results. The agreed approach, to perform voluntary anonymous testing with specific consent for five STIs without returning results, was approved by stakeholders and a research ethics committee. Overall, this was acceptable to respondents in developmental piloting; 61% (68 of 111) of respondents agreed to provide a sample. The experiences reported here may inform the ethical decision making of researchers, research ethics committees and funders considering population-based biological sampling. (shrink)

In this response to Jonny Anomaly’s ‘Is Obesity a Public Health Problem?’ I argue, contra the author that public health actually increases individuals’ abilities to choose actions that further their health goals, specifically in the case of obesity. The intractability of obesity as an individual medical problem combined with the health benefits of modest (5–10 per cent of body weight) weight loss suggest that public health measures helping people make small changes in eating habits (...) improve population health. I argue that such measures are available to public health via behavioral economic research and policy proposals from libertarian paternalists. I respond to author’s claim that obesity does not constitute a public health problem because: (i) it is not an epidemic and (ii) obesity reduction is not a public good. I argue that epidemic status is not required for classification as a public health problem, but that obesity does have the status of an epidemic. I also point out flaws in author’s reasoning about obesity, public health and social costs. I conclude by suggesting that public health, in partnership with stakeholders and other areas of government, is poised to help create conditions for modest weight loss and increased population health overall. (shrink)

In recent years, genetically engineered (GE) mosquitoes have been proposed as a public health measure against the high incidence of mosquito-borne diseases among the poor in regions of the global South. While uncertainties as well as risks for humans and ecosystems are entailed by the open-release of GE mosquitoes, a powerful global health governance non-state organization is funding the development of and advocating the use of those bio-technologies as public health tools. In August 2016, the US Food (...) and Drug Agency (FDA) approved the uncaged field trial of a GE Aedes aegypti mosquito in Key Haven, Florida. The FDA’s decision was based on its assessment of the risks of the proposed experimental public health research project. The FDA is considered a global regulatory standard setter. So, its approval of the uncaged field trial could be used by proponents of GE mosquitoes to urge countries in the global South to permit the use of those bio-technologies. -/- From a public health ethics perspective, this paper evaluates the FDA’s 2016 risk assessment of the proposed uncaged field trial of the GE mosquito to determine whether it qualified as a realistic risk evaluation. -/- The FDA’s risk assessment of the proposed uncaged field trial did not proximate the conditions under which the GE mosquitoes would be used in regions of the global South where there is a high prevalence of mosquito-borne diseases. -/- Given that health and disease have political-economic determinants, whether a risk assessment of a product is realistic or not particularly matters with respect to interventions meant for public health problems that disproportionately impact socio-economically marginalized populations. If ineffective public health interventions are adopted based on risk evaluations that do not closely mirror the conditions under which those products would actually be used, there could be public health and ethical costs for those populations. (shrink)

Although the birth and early life of an infant is similar throughout the world, meanings ascribed to infants differ according to cultural values and beliefs. This essay describes how scholars and healers have come to see the infant as distinct from other types of people, and what implications this distinction carries for how health care is practiced. The first portion of this essay explores how understanding of the infant, particularly the well-accepted notion of “normal” infant growth and development, came (...) to prominence. Drawing from the history of medicine, philosophical thought and colonial practice, this essay demonstrates that the roots of thinking about the infant in terms of his growth are deep and well-defined in North American and European ideologies. The second portion of this essay describes the practical applications and political implications of beliefs about the “normal” infant. In the arena of applied health, policy makers measure infant growth in light of assumptions about the “normal.” A case study of indigenous populations in Irian Jaya, Indonesia, shows that these measurements are highly political. Here government health officials create and manipulate statistics to ensure that indigenous infant health is represented as being below “normal.” The “normal” infant can thus be understood as a subtle and effective construct which, in Irian Jaya, at the least, is used to assimilate indigenous people into the nation-state. (shrink)

Bovine tuberculosis is an important animal health policy issue in Britain, which impacts farmers, the public, domestic farmed cattle and the wild badger population. The Westminster government’s badger culling policy in England, which began in 2013, has caused considerable controversy. This is in part because the Independent Scientific Group advised against culling, based on the Randomised Badger Culling Trial. Those opposed to badger culling support more stringent cattle-based measures and the vaccination of badgers. This paper argues for (...) ethical analysis of public policy options which impact sentient species. It provides a summary Animal Welfare Impact Assessment of a do-nothing approach, badger culling, and badger vaccination. A utilitarian analysis is then applied to these policy options considering human wellbeing and animal welfare. The analysis compares a badger culling policy that achieves a 19% reduction in bovine TB incidence, a badger vaccination model achieving a 12.5% reduction, and a do-nothing approach. Policy options are assessed over 9 years and a longer timeframe, and uncertainty is considered. The analysis finds that non-culling approaches, particularly badger vaccination, result in greater total utility, compared to badger culling. Badger culling causes 30% reduction in the badger population in England as well as substantial harms due to the culling process. Culling is opposed by public opinion and is associated with considerable risks and uncertainty. In contrast, non-culling approaches, such as cattle-based measures and badger vaccination, are supported by public opinion and are not associated with such risks. (shrink)

IntroductionAn individual’s level of mindfulness can predict his/her level of general health, anxiety, and anger. If we have a valuable tool for measuring mindfulness, we can predict such factors more concisely. Therefore, the aim of this study was to compare a narrowband and a broadband mindfulness scale in predicting the level of general health, anxiety, and anger in a general population.Materials and MethodsThis was a cross-sectional study on an Iranian general population from September 22, 2020 to (...) April 14, 2021. The convenience sampling method was used. Data were collated via electronic and paper forms of the Relaxation/Meditation/Mindfulness Tracker t-Persian version, the Freiburg Mindfulness Inventory- Short-Form-Persian version, the General Health Questionnaire, the trait anxiety section of the State–Trait Anxiety Inventory, and the trait anger section of the State–Trait Anger Expression Inventory-2.ResultsThe FMI-P predicted 0.05% of GHQ variance while the first and third levels of RMMt-P predicted 0.145%. The FMI-P predicted 0.19% of anxiety variance, while the first and third levels of RMMt-P predicted 0.195%. The FMI-P predicted 0.0% of anger variance, while the first, second, and third levels of RMMt-P predicted 0.08%. RMMt-P Level 1 was a better predictor of general health, anger, and anxiety.ConclusionThe current study found that the RMMt-P was a better predictor of general health and anger than the FMI-P. These findings suggest that the type of questionnaire used in the study of mindfulness is important, but more research is needed to determine the extent of these relationships. (shrink)

ObjectiveMental health is critical to the healthy development of adolescents. However, mental health encompasses more than the absence of mental illness; and should include indicators of mental wellness. A critical review of available mental wellness instruments for adolescents were conducted to identify operational definitions of mental wellness concepts for this population group.MethodA systematic review of literature published between 2000 and 2020 was done to identify mental wellness instruments for adolescent populations. The review followed the PRISMA operational steps.ResultsWe (...) identified 2,543 articles from the search strategy and screened titles and abstracts for eligibility. After appraisal, 97 studies were included in the qualitative synthesis; of which, 79 mental wellness instruments were identified. Most studies did not provide a definition for mental wellness. We identified thirteen mental wellness concepts from 97 studies, namely: life satisfaction, mental wellbeing [general], resilience, self-efficacy, self- esteem, connectedness, coping, self-control, mindfulness/spiritual, hope, sense of coherence, happiness, and life purpose.ConclusionThe review reflected previous research identifying a lack of consensus around the definitions of mental health, mental wellness, and mental wellbeing. This has implications for developing instruments for adolescents that adequately measure these constructs. Most of the instruments identified in the review were predominantly English and from developed countries. This indicates a need for instrument that are explicitly conceptualised and operationalised for adolescents in all their varied contexts. (shrink)

Background: The brief generic Multicultural Quality of Life Index is a culturally informed self-report 10-item questionnaire used to measure health-related quality of life. QoL is an important outcome measure in guiding healthcare and is held as a substantial parameter to evaluate the effectiveness of healthcare. Attention Deficit Hyperactivity Disorder in children might negatively influence the parents’ QoL. Having a validated questionnaire to measure QoL for this population will therefore be a vital first step in guiding healthcare for parents (...) of children with ADHD. We aimed to examine the reliability and validity of the Norwegian version of the MQLI in a sample of parents of children with ADHD.Methods: In a cross-sectional study, 128 parents of children with ADHD were recruited from four outpatient clinics within the Child and Adolescents Mental Health Services in Norway. They completed the MQLI along with an alternative well-being scale, the Five-item World Health Organization Well-being Index, and a form including demographic variables. Reliability and validity of the MQLI were examined. We conducted a factor analysis and calculated internal consistency and the correlation between the MQLI and the WHO-5.Results: Factor analysis of the parents reported MQLI yielded a one-factor solution. For the MQLI, Cronbach’s alpha was 0.73. The correlation between the two measures of MQLI and WHO-5 was high, reflecting convergent validity since the association between the two measures was strong.Conclusion: Results from this study support the reliability and validity of the Norwegian version of the MQLI for assessment of quality of life in parents of children with ADHD with good psychometric properties. Study findings support the use of the questionnaire in CAMHS. (shrink)

Informed choice is increasingly recognised as important in supporting patient autonomy and ensuring that people are neither deceived nor coerced. In cancer screening the emphasis has shifted away from just promoting the benefits of screening to providing comprehensive information to enable people to make an informed choice. Cancer screening programmes in the UK now have policies in place which state that it is their responsibility to ensure that individuals are making an individual informed choice. There is a need to evaluate (...) whether such policies mean that those people invited for screening are making informed choices, and how comprehensive information affects other variables such as uptake, cost effectiveness, and satisfaction. At the present time, there is no validated measure of informed choice in cancer screening. Such a measure could be used to evaluate the effectiveness of interventions to increase informed choice and levels of informed choice in a population invited for screening. It could encourage health professionals to be accountable. Factors important when measuring informed choice in cancer screening include an individual’s understanding of the limitations of screening, the ability to make an autonomous choice, and the difference between choice and behaviour. (shrink)

Many healthcare goods, such as surgical instruments, textiles and gloves, are manufactured in unregulated factories and sweatshops where, amongst other labour rights violations, workers are subject to considerable occupational health risks. In this paper we undertake an ethical analysis of the supply of sweatshop-produced surgical goods to healthcare providers, with a specific focus on the National Health Service of the United Kingdom. We contend that while labour abuses and occupational health deficiencies are morally unacceptable in the production (...) of any commodity, an additional wrong is incurred when the health of certain populations is secured in ways that endanger the health and well-being of people working and living elsewhere. While some measures have been taken to better regulate the supply chain to healthcare providers in the UK, further action is needed to ensure that surgical goods are sourced from suppliers who protect the labour and occupational health rights of their workers. (shrink)

The quality of doctoral-level biochemistry (N=139), botany (N=83), cellular/molecular biology (N=89), microbiology (N=134), physiology (N=101), and zoology (N=70) programs at United States universities was assessed, using 16 measures. These measures focused on variables related to: (1) program size; (2) characteristics of graduates; (3) reputational factors (scholarly quality of faculty, effectiveness of programs in educating research scholars/scientists, improvement in program quality during the last 5 years); (4) university library size; (5) research support; and (6) publication records. Chapter I discusses (...) prior attempts to assess quality in graduate education, development of the study plans, and the selection of disciplines and programs to be evaluated. Chapter II discusses the methodology used, focusing on each of the assessment measures. Chapters III to VIII present, respectively, findings from the analyses of the biochemistry, botany, cellular/molecular biology, microbiology, physiology, and zoology programs. Chapter IX includes a summary of results, correlations among measures, several additional analyses, and suggestions for future studies. Among the findings reported are those indicating that cellular/molecular biology programs had, on the average, the largest number of faculty and that students in cellular/molecular biology, biology, biochemistry, microbiology, and physiology received a relatively high fraction of financial support. (Survey instruments and supporting documentation are included in appendices.) (JN). (shrink)

The quality of doctoral-level chemistry (N=145), computer science (N=58), geoscience (N=91), mathematics (N=115), physics (N=123), and statistics/biostatistics (N=64) programs at United States universities was assessed, using 16 measures. These measures focused on variables related to: program size; characteristics of graduates; reputational factors (scholarly quality of faculty, effectiveness of programs in educating research scholars/scientists, improvement in program quality during the last 5 years); university library size; research support; and publication records. Chapter I discusses prior attempts to assess quality in (...) graduate education, development of the study plans, and the selection of disciplines and programs to be evaluated. Chapter II discusses the methodology used, focusing on each of the assessment measures. Chapters III to VIII present, respectively, findings from the analyses of the chemistry, computer science, geoscience, mathematics, physics, and statistics/biostatistics programs. Chapter IX includes a summary of results, correlations among measures, several additional analyses, and suggestions for future studies. Among the findings reported are those indicating that mathematics programs had, on the average, the largest number of faculty (N=33) in December 1980 followed closely by physics (N=28) and chemistry (N=23), and that 80 percent of computer science students had job commitments by graduation. (Survey instruments and supporting documentation are included in appendices.) (JN). (shrink)

Introduction: Globally, vitamin D deficiency is one of the most common deficiencies, affecting nearly half the world's population. The objective of this survey was to assess and compare the knowledge about vitamin D and the perceived state of health in Emirati and international tourist female students in Dubai, UAE. Methods: This is a cross-sectional study that took place in universities in Dubai, UAE. This survey consisted of 17 multiple choice questions. The first part of the survey assessed levels (...) of supplementation, diet and UV exposure. Another section evaluated the participants’ self-assessed state of health regarding vitamin D testing, symptoms related to vitamin D deficiency and general welbeing. The collected data were statistically analyzed using SPSS statistics for windows version 26.0 (SPSS Inc., Chicago, IL). Statistical significance was set at P<0.05. Results: 105 respondents were Emiratis and 65 were international students. The average age was 21, with an average BMI 23.3. Almost one-third of each group reported using Vitamin D supplements once weekly. The majority of both groups reported rarely getting tanned. Almost all participants reported regular consumption of Vitamin-D rich foods. In both groups, more than half reported consuming milk and cheese regularly and up to one-third reported consuming fish in a regular manner. Although more than half of the students rated their health as good; more than two-thirds reported experiencing muscle pain; only half reported having their blood Vitamin D levels measured once; half reported experiencing problems with concentration and more than three-quarters reported experiencing bad mood in the past month. The prevalence of these symptoms was almost similar across different categories of vitamin D supplementation, tanning habits, dietary intake, or nationality. No statistically significant differences were noted between the 2 groups. Conclusion: more Emirati students were aware of the association between vitamin D and osteoporosis than International tourist students (40% vs. 21.9%, respectively; p<0.05). On the other hand, both groups had lower knowledge about the relationship between vitamin D deficiency and depression, Rheumatoid Arthritis and Hypertension, and the optimal vitamin D level; however, no statistically significant differences were noted regarding this knowledge of Emiratis and international students. (shrink)

Background: Screen time among adults represents a continuing and growing problem in relation to health behaviors and health outcomes. However, no instrument currently exists in the literature that quantifies the use of modern screen-based devices. The primary purpose of this study was to develop and assess the reliability of a new screen time questionnaire, an instrument designed to quantify use of multiple popular screen-based devices among the US population. -/- Methods: An 18-item screen-time questionnaire was created to (...) quantify use of commonly used screen devices (e.g. television, smartphone, tablet) across different time points during the week (e.g. weekday, weeknight, weekend). Test-retest reliability was assessed through intra-class correlation coefficients (ICCs) and standard error of measurement (SEM). The questionnaire was delivered online using Qualtrics and administered through Amazon Mechanical Turk (MTurk). -/- Results: Eighty MTurk workers completed full study participation and were included in the final analyses. All items in the screen time questionnaire showed fair to excellent relative reliability (ICCs = 0.50–0.90; all < 0.000), except for the item inquiring about the use of smartphone during an average weekend day (ICC = 0.16, p = 0.069). The SEM values were large for all screen types across the different periods under study. -/- Conclusions: Results from this study suggest this self-administered questionnaire may be used to successfully classify individuals into different categories of screen time use (e.g. high vs. low); however, it is likely that objective measures are needed to increase precision of screen time assessment. (shrink)

The Covid-19 pandemic has led to a health crisis of a scale unprecedented in post-war Europe. In response, a large amount of healthcare resources have been redirected to Covid-19 preventive measures, for instance population-wide vaccination campaigns, large-scale SARS-CoV-2 testing, and the large-scale distribution of protective equipment to high-risk groups and hospitals and nursing homes. Despite the importance of these measures in epidemiological and economic terms, health economists and medical ethicists have been relatively silent about the (...) ethical rationales underlying the large-scale allocation of healthcare resources to these measures. The present paper seeks to encourage this debate by demonstrating how the resource allocation to Covid-19 preventive measures can be understood through the paradigm of the Rule of Rescue, without claiming that the Rule of Rescue is the sole rationale of resource allocation in the Covid-19 pandemic. (shrink)

In this paper, I explore one way to bring bioethics and environmental ethics closer together. I focus on a question at the interface of health, sustainability, and justice: How well does a society promote health with the use of no more than a just share of environmental capacity? To address this question, I propose and discuss a mode of assessment that combines a measurement of population health, an estimate of environmental sustainability, and an assumption about what (...) constitutes a fair or just share. This mode of assessment provides an estimate of the just and sustainable life expectancy of a population. It could be used to monitor how well a particular society promotes health within just environmental limits. It could also serve as a source of information that stakeholders use when they deliberate about programs, policies, and technologies. The purpose of this work is to focus attention on an ethical task: the need to fashion institutions and forms of life that promote health in ways that recognize the claims of sustainability and justice. (shrink)