Powered by ‘big health data’ and enormous gains in computing power, artificial intelligence and related technologies are already changing the healthcare landscape. Harnessing the potential of these technologies will necessitate partnerships between health institutions and commercial companies, particularly as it relates to sharing health data. The need for commercial companies to be trustworthy users of data has been argued to be critical to the success of this endeavour. I argue that this approach is mistaken. Our interactions with (...) commercial companies need not, and should not, be based on trust. Rather, they should be based on confidence. I begin by elucidating the differences between trust, reliability, and confidence, and argue that trust is not the appropriate attitude to adopt when it comes to sharing data with commercial companies. I argue that what we really should want is confidence in a system of data sharing. I then provide an outline of what a confidence-worthy system of data sharing with commercial companies might look like, and conclude with some remarks about the role of trust within this system. (shrink)

abstract Trusting agents characteristically anticipate beneficial outcomes, under conditions of uncertainty, in their engagement with others. However, debates about trust incorporate different interpretations of risk, uncertainty, calculation, affect, morality and motivation in explaining when trust is appropriate and how it operates. This article argues that discussions about trust have produced a concept without coherent boundaries and with little operational value. Two paradigms are identified, which distinguish the characteristics of trust and confidence. It is argued that a reliance on (...) class='Hi'>confidence in human affairs makes trust redundant and that this has undesirable moral consequences. Discussion is illustrated by the UK Government's ‘modernisation’ policy in health and social care, which privileges confidence in systems over trust in moral agents. (shrink)

I applaud recent improvements upon previous guidelines for the assessment of pain in non-human species and the application of their framework towards decapod crustaceans. Rather than constituting a mere intermediate solution between the scientific difficulty of settling questions of animal consciousness and the need for a framework for the purposes of animal welfare legislation, I will argue that the longer lists of criteria for animal sentience should make us realize that animal sentience is a multi-dimensional phenomenon that must be studied (...) with a plethora of methods in order to assess its diversity across the tree of life. (shrink)

Parental confidence in vaccines is waning. To sustain and improve childhood vaccine coverage rates, insights from multiple disciplines are needed to understand and address the socio-cultural factors contributing to decreased vaccine confidence and uptake.

In a warm and enjoyable dialogue the meaning of health, in its fullest sense, becomes a philosophical issue as much as a biological. For isn't the essence of health a general sense of well-being? Health can be seen as reflecting satisfaction with our quality of life; but how do we achieve that? Here, a character who is heading off for a job teaching health has an extended conversation with a trusted mentor, and they test various definitions, (...) various visions, and some of the infinite possibilities of the idea of health, in the process coming to a deeper and more invigorating understanding of life itself. They arrive at the notion of symbiosis - a living together to the advantage of each. And isn't a good conversation a sort of living together to the advantage of each? In such dialogue, we engage with our hearts and minds. When are we more alive than that? What is the peak of health if not this life, this engagement? The two friends want to know what health is. But they want more: They want to be healthy. They see three basic types of health - bodily, mental, and societal. These three types affect one another. How they affect one another matters in a critical way. But there is more. A friendly conversation allows special access to what is critical. Our guard is down in such a conversation. We are less likely to be defensive. We are more likely to keep our minds open and clear. We are likely to feel the confidence it takes to learn. (shrink)

BackgroundRespecting patients’ confidentiality is an ethical and legal responsibility for health professionals and the cornerstone of care excellence. This study aims to assess health professionals’ knowledge, attitudes, and associated factors towards patients’ confidentiality in a resource-limited setting.MethodsInstitutional based cross-sectional study was conducted among 423 health professionals. Stratified sampling methods were used to select the participants, and a structured self-administer questionnaire was used for data collection. The data was entered using Epi-data version 4.6 and analyzed using SPSS, version (...) 25. Bi-variable and multivariable binary logistic regression analyses were used to measure the association between the dependent and independent variables. Odds ratio with 95% confidence intervals and P value was calculated to determine the strength of association and to evaluate statistical significance.ResultOut of 410 participants, about 59.8% with [95% CI (54.8–68.8%)] and 49.5% with [95% CI (44.5–54.5%)] had good knowledge and favorable attitude towards patents confidentiality respectively. Being male (AOR = 1.63, 95% CI [1.03–2.59]), taking training on medical ethics (AOR = 1.73, 95% CI = [1.11–2.70]), facing ethical dilemmas (AOR = 3.07, 95% CI [1.07–8.79]) were significantly associated factors for health professional knowledge towards patients’ confidentiality. Likewise, taking training on medical ethics (AOR = 2.30, 95% CI [1.42–3.72]), having direct contact with the patients (AOR = 3.06, 95% CI [1.12–8.34]), visiting more patient (AOR = 4.38, 95% CI [2.46–7.80]), and facing ethical dilemma (AOR = 3.56, 95% CI [1.23–10.26]) were significant factors associated with attitude of health professionals towards patient confidentiality.ConclusionThe findings of this study revealed that health professionals have a limited attitude towards patient confidentiality but have relatively good knowledge. Providing a continuing medical ethics training package for health workers before joining the hospital and in between the working time could be recommended to enhance health professionals’ knowledge and attitude towards patient confidentiality. (shrink)

It is sometimes assumed that when the gospels talk about demon possession they are just using different terminology for what would now be called psychosis or epilepsy. However, these terms come from different discourses that need to be distinguished, but do not need to be kept completely separate. The nature of the relationship between religion and mental health is complex. There is usually a positive correlation, but it is more difficult to be confident about the nature of the causal (...) connection. Poor mental health can become intertwined with religion in a way that drags both down. It is a consistent feature of Jesus' interactions that he encourages people to believe that more is possible than might have been imagined. His impact on the mental health of those around him seems to have been largely a matter of what might now be called positive psychology. (shrink)

Ethics: The Heart of Health Care - a classic ethics text in medical, health and nursing studies - is recommended around the globe for its straightforward introduction to ethical analysis. In this new edition David Seedhouse demonstrates tangibly and graphically how ethics and health care are inextricably bound together, and creates a firm theoretical basis for practical decision-making. He not only clarifies ethics but, with the aid of the acclaimed Ethical Grid, teaches an essential practical skill which (...) can be productively applied in day-to-day health care. This edition, which is even more readable than the first, includes additional case studies and teaching exercises, contains new material on ethical theory and offers two further decision-making tools - The Rings of Uncertainty and the Autonomy Test. The engaging new introduction reveals the genesis of the Ethical Grid, illuminates the intent and argument of the first edition, and explains why the book is needed today as much as ever. Intended for all who work in health care or health studies - indeed for anyone with an interest in health issues - this is a highly original, innovative and accessible work on a subject traditionally regarded as lofty and obscure. It clarifies a wide variety of complex ethical issues and will give the reader fresh inspiration and renewed confidence in dealing with the demands of modern health work. (shrink)

This paper draws on nearly two decades of research on health consumer and patients’ organizations in the United Kingdom. In particular, it addresses questions of representation and legitimacy in the health policy process. HCPOs claim to represent the collective interests of patients and others such as relatives and carers. At times they also make claims to represent the wider public interest. Employing Pitkin’s classic typology of formalistic, descriptive, symbolic, and substantive representation, the paper explores how and in what (...) sense HCPOs represent their constituencies. We found that policymakers themselves are less concerned with formal mechanisms adopted by groups and are more concerned with credibility, in particular whether HCPOs carry the confidence of their constituents. While some concerns about legitimacy remain, particularly in relation to funding from commercial interests, we argue that HCPOs bring a unique perspective to the policy process and to focus purely on formalistic representation provides only a partial understanding of their representative role and a constrained view of their collective moral claims. (shrink)

Issues arising in connection with genes and nutrition policy include both nutrigenomics and nutrigenetics. Nutrigenomics considers the relationship between specifc nutrients or diet and gene expression and, it is envisaged, will facilitate prevention of diet-related common diseases. Nutrigenetics is concerned with the effects of individual genetic variation on response to diet, and in the longer term may lead to personalised dietary recommendations. It is important also to consider the surrounding context of other issues such as novel and functional foods in (...) so far as they are related to genetic modification. Ethical issues fall into a number of categories: why nutrigenomics? Will it have important public health benefits? questions about research, e.g. concerning the acquisition of information about individual genetic variation; questions about who has access to this information, and its possible misuse; the applications of this information in terms of public health policy, and the negotiation of the potential tension between the interests of the individual in relation to, for example, prevention of conditions such as obesity and allergy; the appropriate ethical approach to the issues, e.g. the moral difference, if any, between therapy and enhancement in relation to individualised diets; whether the 'technological fix' is always appropriate, especially in the wider context of the purported lack of public confidence in science, which has special resonance in the sphere of nutrition. (shrink)

In spite of doubts in many quarters there seems to be considerable confidence in the benefits of health examinations. In my opinion it is important to analyze the structure and the purpose of the examinations in order to elucidate the practical thinking and logical quality of OHS. In this article I will conceive health examination as an information process and offer types of inference, i.e. prediction, abduction and induction, feasible for the analysis. I will study the logical (...) conditions and possibilities to draw conclusions using these inference methods and try, in a preliminary way, to show how the qualitative or quantitative formulations of presuppositions affect the formulation of the conclusion. Finally I will explicate the implicit purposes of the health examinations stipulated by Finnish legislation with the aid of the above inference methods. I find the methods feasible for analyzing the information process, and will set forth some conditions for presuppositions used with inference and point out the alternative purposes of Finnish occupational health examinations. (shrink)

Globally, universities make use of peer physical examination in health professions students’ teaching of physical examination skills. PPE has many educational benefits, such as teaching normal anatomy and function, development of compassion and empathy, to feel what it is like to be examined from a patient’s perspective, improvement of communication skills, correcting errors in technique and improve confidence. The benefits for patients include protection from repeated examinations by unskilled students. The aim of the study was to investigate (...) class='Hi'>health sciences students’ perceptions of the ethical aspects of PPE. A qualitative investigation, which included two focus group interviews with students and one with lecturers, was used for data collection. Most students and lecturers regarded PPE as beneficial, as it provides a safe environment for students in the health sciences to improve their clinical competence and confidence, without fear of embarrassment or failure. Students stated that PPE promoted the development of empathy with and respect for their patients. It was suggested that in a culturally diverse society, guidelines specifically related to religious customs and convictions should be provided to give students an indication of appropriate and acceptable behaviour towards fellow students when practising PPE. The use of PPE in the training of students in the health professions should support the ethical principles of Beauchamp and Childress, namely beneficence, non-maleficence, autonomy and justice/fairness. (shrink)

After acquiring knowledge of the neuroscience of learning, memory, stress and emotions, teachers incorporate more cognitive engagement and student-centered practices into their lessons. However, the role understanding neuroscience plays in teachers own affective and motivational competencies has not yet been investigated. The goal of this study was to investigate how learning neuroscience effected teachers’ self-efficacy, beliefs in their ability to teach effectively, self-responsibility and other components of teacher motivation. A pilot training-of-trainers program was designed and delivered in Liberia combining basic (...) neuroscience with information on social, emotional, behavioral and mental health issues faced by students. Tier I of the professional development was a 2 weeks workshop led by a visiting neuroscientist. A subset of the 24 Tier I secondary science teachers formed a Leadership Team who adapted the content to the Liberian context and subsequently led additional workshops and follow-up sessions for the Tier II secondary science teachers. Science teachers in both tiers completed the affective-motivational scales from the internationally vetted, multiscale Innovative Teaching for Effective Learning Teacher Knowledge Survey from the OECD. Tier II teachers completed the survey in a pre-post-delayed post design. Tier I teachers completed the survey after the workshop with their attitudes at that time and separately with retrospective projections of their pre-workshop attitudes. Ten of the 92 Tier II teachers participated in structured interviews at follow-up. Statistical analysis of survey data demonstrated improved teacher self-efficacy, self-responsibility for student outcomes, and motivation to teach. Qualitatively, teachers expressed more confidence in their ability to motivate students, engage them through active learning, and manage the class through positive rather than negative reinforcement. Teachers’ own self-regulation improved as they made efforts to build supporting relationships with students. Together, these results demonstrated that (i) teacher affective-motivational attitudes can be altered with professional development, (ii) basic neuroscience, as knowledge of how students learn, can improve teacher competency, and (iii) a training-of-trainers model can be effective in a low and middle income country for disseminating neuroscience knowledge, increasing teachers’ knowledge of students’ social and emotional needs, and promoting educational improvement. (shrink)

This paper draws on findings from qualitative interviews with queer and trans patients and with physicians providing care to queer and trans patients in Halifax, Nova Scotia, Canada, to explore how routine practices of health care can perpetuate or challenge the marginalization of queers. One of the most common “measures” of improved cultural competence in health care practice is self-reported increases in confidence and comfort, though it seems unlikely that an increase in physician comfort levels with queer (...) and trans patients will necessarily mean better health care for queers. More attention to current felt discomfort in patient–provider encounters is required. Policies and practices that avoid discomfort at all costs are not always helpful for care, and experiences of shared discomfort in queer health contexts are not always harmful. (shrink)

This paper considers the justifications for adhering to a principle of confidentiality within medical practice. These are found to derive chiefly from respect for individual autonomy, the doctor/patient contract, and social utility. It is suggested that these will benefit more certainly if secrecy is rejected and the principle of confidentiality is removed from the area of health care.

On the basis of PM2.5 data of the national air quality monitoring sites, local population data, and baseline all-cause mortality rate, PM2.5-related health economic benefits of the Air Improvement Action Plan implemented in Wuhan in 2013–2017 were investigated using health-impact and valuation functions. Annual avoided premature deaths driven by the average concentration of PM2.5 decrease were evaluated, and the economic benefits were computed by using the value of statistical life (VSL) method. Results showed that the number of avoided (...) premature deaths in Wuhan are 21,384 (95% confidence interval (CI): 15,004 to 27,255) during 2013–2017, due to the implementation of the Air Improvement Action Plan. According to the VSL method, the obtained economic benefits of Huangpi, Wuchang, Hongshan, Xinzhou, Jiang’an, Hanyang, Jiangxia, Qiaokou, Jianghan, Qingshan, Caidian, Dongxihu, and Hannan District were 8.55, 8.19, 8.04, 7.39, 5.78, 4.84, 4.37, 4.04, 3.90, 3.30, 2.87, 2.42, and 0.66 billion RMB (1 RMB = 0.1417 USD On 14 October 2019), respectively. These economic benefits added up to 64.35 billion RMB (95% CI: 45.15 to 82.02 billion RMB), accounting for 4.80% (95% CI: 3.37% to 6.12%) of the total GDP of Wuhan in 2017. Therefore, in the process of formulating a regional air quality improvement scheme, apart from establishing hierarchical emission-reduction standards and policies, policy makers should give integrated consideration to the relationship between regional economic development, environmental protection and residents’ health benefits. Furthermore, for improving air quality, air quality compensation mechanisms can be established on the basis of the status quo and trends of air quality, population distribution, and economic development factors. (shrink)

Performing and creative artists have unique occupational and lifestyle stresses and challenges that can negatively affect self-esteem. Low self-esteem not only has serious implications for their psychological and physical health, it can also affect their performance and creativity. There is a need to establish effective interventions to deal with this issue. To the best of our knowledge, there are no reported studies specific to workshops or interventions on enhancing self- esteem for artists. The Al and Malka Green Artists’ (...) class='Hi'>Health Centre at the Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada, is a unique multidisciplinary and integrative clinic serving the special needs of the artist population. We developed a workshop entitled “Building Confidence and Self Esteem Toolbox Workshop” to address this this need. We then designed a single-blind, randomized, prospective, pilot study to evaluate the effectiveness of the workshop on enhancing self-esteem in artists, and to evaluate the long-term effectiveness of using the recommended tools in maintaining a healthy self-esteem, as well as maintaining physical and emotional health. Both quantitative and qualitative data were collected. A validated “Self-Esteem Checkup” questionnaire was administered pre- and immediately post workshop, as well as at 2, 6, and 12 months post workshop. Open-ended questions were posed to study participants via email at 2 and 12 months following the workshop, and at 6 months in in-person interviews. Thirty-five professional artists consented to participate in the study, with 26 completing all study visits. Mean scores for all time points, and the individual questionnaire statement mean scores for the five timepoints increased significantly immediately post-workshop and remained statistically significantly improved by the by the 3rd follow-up 12 months later. (p<0.001). The mean self-esteem rating score increased significantly post-workshop and remained statistically significantly improved by the 3rd follow-up 12 months later. (p<0.01). Qualitative data showed positive feedback on the utilization of the tools learned in the workshop that helped maintain this improvement over a one-year period. This workshop may be an effective means of addressing the issue of self-esteem in artists. Further controlled studies of larger sample size and longer duration are needed to confirm these findings. (shrink)

This paper investigates the medical law and ethics learning needs of Foundation doctors by means of a national survey developed in association with key stakeholders including the General Medical Council and Health Education England. Four hundred sevnty-nine doctors completed the survey. The average self-reported level of preparation in MEL was 63%. When asked to rate how confident they felt in approaching three cases of increasing ethical complexity, more FYs were fully confident in the more complex cases than in the (...) more standard case. There was no apparent relationship with confidence and reported teaching at medical school. The less confident doctors were no more likely to ask for further teaching on the topic than the confident doctors. This suggests that FYs can be vulnerable when facing ethical decisions by being underprepared, not recognising their lack of ability to make a reasoned decision or by being overconfident. Educators need to be aware of this and provide practical MEL training based on trainee experiences and real-world ethics and challenge learners’ views. Given the complexities of many ethical decisions, preparedness should not be seen as the ability to make a difficult decision but rather a recognition that such cases are difficult, that doubt is permissible and the solution may well be beyond the relatively inexperienced doctor. Educators and supervisors should therefore be ensuring that this is clear to their trainees. This necessitates an environment in which questions can be asked and uncertainty raised with the expectation of a supportive response. (shrink)

In this paper, we tell the story of efforts currently underway, on diverse fronts, to build digital knowledge repositories to support research in the life sciences. If successful, knowledge bases will be part of a new knowledge infrastructure—capable of facilitating ever-more comprehensive, computational models of biological systems. Such an infrastructure would, however, represent a sea-change in the technological management and manipulation of complex data, inducing a generational shift in how questions are asked and answered and results published and circulated. Integrating (...) such knowledge bases into the daily workflow of the lab thus destabilizes a number of well-established habits which biologists rely on to ensure the quality of the knowledge they produce, evaluate, communicate and exploit. As the story we tell here shows, such destabilization introduces a situation of unfamiliarity, one that carries with it epistemic risks. It should elicit—to use Niklas Luhmann’s terms—the question of trust: a shared recognition that the reliability of research practices is being risked, but that such a risk is worth taking in view of what may be gained. And yet, the problem of trust is being unexpectedly silenced. How that silencing has come about, why it matters, and what might yet be done forms the heart of this paper. (shrink)

The capacity to provide satisfactory nursing care is being increasingly compromised by current trajectories of healthcare funding and governance. The purpose of this paper is to examine how well Marxist theories of the state and its relationship with capital can explain these trajectories in this period of ever‐increasing austerity. Following a brief history of the current crisis, it examines empirically the effects of the crisis, and of the current trajectory of capitalism in general, upon the funding and organization of the (...) UK and US healthcare systems. The deleterious effect of growing income inequalities to the health of the population is also addressed. Marx's writings on the state and its relation to the capitalist class were fragmentary and historically and geographically specific. From them, we can extract three theoretical variants: the instrumentalist theory of the state, where the state has no autonomy from capital; the abdication theory, whereby capital abstains from direct political power and relies on the state to serve its interests; and the class‐balance theory, whereby the struggle between two opposed classes allows the state to assert itself. Discussion of modern Marxist interpretations includes Poulantzas's abdication theory and Miliband's instrumentalist theory. It is concluded that, despite the pluralism of electoral democracies, the bourgeoisie do have an overweening influence upon the state. The bourgeoisie's ownership of the means of production provides the foundation for its influence because the state is obliged to rely on it to manage the supply of goods and services and the creation of wealth. That power is further reinforced by the infiltration of the bourgeoisie into the organs of state. The level of influence has accelerated rapidly over recent decades. One of the consequences of this has been that healthcare systems have become rich pickings for the evermore confident bourgeoisie. (shrink)

BackgroundFew studies have identified the willingness rate of developing countries population to be enrolled in clinical trials.MethodsAll participants including patients, healthy volunteers and doctors completed a questionnaire to examine factors affecting the consent to participate in medical research.ResultsOverall, 80 % of the included population agree to participate in health research. This rate was lower for trials dealing with life-threatening diseases. Altruism and perceived risk of harm were the main reason to respectively accept or refuse to participate in clinical trials. (...) Factors significantly associated with willingness were: age <40 years 1.6 [95 % Confidence Interval 1.2-2.1]) and prior history of blood donation.ConclusionMost participants expressed their willingness to be included in medical research especially if they are young or if they have history of blood donation. However, consent to participate is low when medical research required acute care. (shrink)

The study is designed to provide an informal summary of what is known about consumer switching of health insurance plans and to contribute to knowledge about what motivates consumers who choose to switch health plans. Do consumers switch plans largely on the basis of critical reflection and assessment of information about the quality, and price? The literature suggests that switching is complicated, not always possible, and often overwhelming to consumers. Price does not always determine choice. Quality is very (...) hard for consumers to understand. Results from a random sample survey ( n = 2791) of the Alkmaar region of the Netherlands are reported here. They suggest that rather than embracing the opportunity to be active critical consumers, individuals are more likely to avoid this role by handing this activity off to a group purchasing organization. There is little evidence that consumers switch plans on the basis of critical reflection and assessment of information about quality and price. The new data reported here confirm the importance of a group purchasing organizations. In a free-market-health insurance system confidence in purchasing groups may be more important for health insurance choice than health informatics. This is not what policy makers expected and might result a less efficient health insurance market system. (shrink)

Over 1.3 billion people in the world are challenged to access good and cheap healthcare when become ill. Health insurance policies are a fantastic strategy to assist people who can't afford medical care. For middle- and low-income nations, there hasn't been much research on the ability to pay for health insurance for public employees like school teachers. Therefore, this cross-sectional questionnaire based research has been undertaken to explore the reflection of health insurance among 383 Bangladeshi school teachers (...) of 5 divisional city center primary school and were being surveyed online between 1st August to 30th August 2022. According to survey, monthly average (mean) health expenditure of respondents were 7668.93 BDT (Bangladeshi Taka equivalent to $80.72) with 95% confidence interval. Of 35% responders suffered from high blood pressure, approximately 8% people were suffering from arthritis and asthma, 7.8% people have heart disease and 8.1 % people suffer from cholesterol problem. Maximum respondents (80%) agreed that health insurance is burden for them. About 51% teachers had no idea about health insurance. However, there was no significant relation in between educational status and health insurance perception for male and female teacher respondents. Moreover, the comparative data highlighted that more awareness and more exploration might be needed in health insurance perception for primary school teachers. This result can contribute to form people’s choice-oriented health insurance policy. (shrink)

Biobanks are repositories that store human biological materials and their associated data. They are rapidly becoming part of national and international networks and give rise to unique ethico-regulatory issues. Whether consent is informed and whether this term should be used when specimens are collected for biobank research is questionable. Where risks occur, they are usually social and relate to identifiability. Public trust and confidence are important for the success of this type of research. Consensus is growing that governance of (...) biobanks should be harmonised. Controlled specimen and data access agreements are essential. The South African National Health Act and its Regulations, that provide the foundation for the legal framework with regard to human tissue and research in South Africa, are silent on the issue of biobanks and the law lags behind while science and technology advance rapidly. The use of biobank assets will lead to significant benefits in human health and should be encouraged while taking account of the associated ethical, legal and social issues and working towards a balance between these two positions. (shrink)

The psychological problems and employment problems of college students have always been the focus of attention of all sectors of society. The COVID-19 epidemic has a great impact on the mental health and employment of Chinese college students. Under this background, this study discusses how epidemic anxiety affects the employment confidence and perception of employment situation of Chinese college students. Through the online questionnaire survey of 1,132 college students nationwide, and the ordinal logistic regression analysis of the survey (...) data using Stata 16.0 software, the results show that: Epidemic anxiety negatively affects Chinese college students' employment confidence and employment situation perception, and has a significant impact on employment confidence. The three control variables of employment guidance, older age and higher education have a significant positive impact on college students' employment confidence and employment situation perception. College students in the eastern region have stronger employment confidence and more optimistic employment situation perception. But the expected monthly salary is negatively correlated with employment confidence. Male college students and Science and Engineering students' epidemic anxiety have a stronger negative impact on employment confidence and employment situation perception. Employment guidance has a moderating effect on the relationship between epidemic anxiety, employment confidence and employment situation perception. Employment guidance can enhance college students' employment confidence and reduce their sense of employment crisis by alleviating epidemic anxiety. Combined with the research conclusions, it is proposed that the state and schools should pay attention to the psychological counseling of college students, strengthen the employment guidance of colleges and universities, vigorously support the development of small, medium-sized and micro enterprises, and improve the employment and entrepreneurship service system of college students, so as to promote the employment of college students. (shrink)

Research FocusThe promotion of domain-specific knowledge is a central goal of higher education and, in the field of medicine, it is particularly essential to promote global health. Domain-specific knowledge on its own is not exhaustive; confidence regarding the factual truth of this knowledge content is also required. An increase in both knowledge and confidence is considered a necessary prerequisite for making professional decisions in the clinical context. Especially the knowledge of human physiology is fundamental and simultaneously critical (...) to medical decision-making. However, numerous studies have shown difficulties in understanding and misconceptions in this area of knowledge. Therefore, we investigate how preclinical medical students acquire knowledge in physiology over the course of their studies and simultaneously gain confidence in the correctness of this knowledge as well as the interrelations between these variables, and how they affect the development of domain-specific knowledge.MethodIn a pre–post study, 169 medical students’ development of physiology knowledge and their confidence related to this knowledge were assessed via paper-pencil questionnaires before and after attending physiology seminars for one semester. Data from a longitudinal sample of n = 97 students were analyzed using mean comparisons, regression analyses, and latent class analyses. In addition, four types of item responses were formed based on confidence and correctness in the knowledge test.ResultsWe found a significant and large increase in the students’ physiology knowledge, with task-related confidence being the strongest predictor. Moreover, a significantly higher level of confidence at t2 was confirmed, with the level of prior confidence being a strong predictor. Furthermore, based on the students’ development of knowledge and confidence levels between measurement points, three empirically distinct groups were distinguished: knowledge gainers, confidence gainers, and overall gainers. The students whose confidence in incorrect knowledge increased constituted one particularly striking group. Therefore, the training of both knowledge and the ability to critically reflect on one’s knowledge and skills as well as an assessment of their development in education is required, especially in professions such as medicine, where knowledge-based decisions made with confidence are of vital importance. (shrink)

The digitization of society and academic research endeavours have led to an explosion of interest in the potential uses of population data in research. Alongside this, increasing attention is focussing on the conditions necessary for maintaining a social license for research practices. Previous research has pointed to the importance of demonstrating “public benefits” from research for maintaining public support, yet there has been very little consideration of what the term “public benefits” means or what public expectations of “public benefits” are. (...) In order to address this pressing issue a series of deliberative workshops with members of the public were held across Scotland in May and June 2017. The workshops aimed to engage a cross-section of the Scottish population in in-depth discussions of the ways that the public – or publics – might benefit from data-intensive health research. The findings reported here discuss workshop participants’ understandings and expectations of health research; who they considered to be “the public” that should benefit from health research and; in what ways they felt “the public” should benefit. Workshop participants’ preference was clearly for the widest possible public benefit to be felt by all, but they also acknowledged the value in research aiming to primarily benefit vulnerable groups within society. A key focus of discussions was the extent to which workshop participants were confident that potential public benefits would be realised. A crucial consideration then is the extent to which mechanisms and political support are in place to realise and maximise the public benefits of data-intensive health research. (shrink)

ObjectiveOur objective was to evaluate whether those individuals with previous involvement with formal clinical ethics processes differ in their attitudes towards the resolution of prototypical clinical ethics cases than general health care professionals. We hypothesized that those individuals with previous participation in ethics consultation would have significantly different attitudes on the appropriate role of ethics committees in the assessment and resolution of clinical ethical dilemmas than those who have not.MethodsWe conducted a case-based survey of health care professionals at (...) six US hospitals. We administered the survey to health care professionals in a variety of clinical roles at each center and further sub-categorized these by respondents reporting or not reporting their membership on an ethics committee or participation as an ethics consultant/requestor of ethics consult services. Using the analysis of variance test, we present the variation in attitudes using a 5-point Likert scale with 95% confidence intervals and significance set at p ≤ 0.05.ResultsA total of 240 respondents completed the survey (response rate: 63.6%) from all six surveyed centers (128 respondents with involvement with ethics consultation, 112 respondents without). Health care professionals not previously involved with formal clinical ethics processes were less likely to view the ethics committee as having a role in resolving the presented clinical ethical dilemmas ( p = 0.01 for analysis of variance comparison).ConclusionIn this multi-center survey study, health care providers without previous involvement with formal clinical ethics processes were less likely than those with previous involvement to support a role for ethics committees aiding in ethical case resolution. (shrink)

Trust is a key component in delivering quality and respectful care within health care systems. However, a growing lack of confidence in health care, particularly among specific subgroups of the population in the United States, could further widen health disparities. In this essay, we explore one approach to building trust and reaching diverse communities to promote health: engaging community‐based organizations (CBOs) as trusted community messengers. We present case studies of partnerships in health promotion, community (...) education, and outreach that showcase how CBOs’ programs build and leverage trust in health care systems through their workforce, services, and engagement with the community. (shrink)

Objective: To assess the relation between autocratisation—substantial decreases in democratic traits (free and fair elections, freedom of civil and political association, and freedom of expression)—and countries’ population health outcomes and progress toward universal health coverage (UHC). -/- Design: Synthetic control analysis. -/- Setting and country selection: Global sample of countries for all years from 1989 to 2019, split into two categories: 17 treatment countries that started autocratising during 2000 to 2010, and 119 control countries that never autocratised from (...) 1989 to 2019. The treatment countries comprised low and middle income nations and represent all world regions except North America and western Europe. A weighted combination of control countries was used to construct synthetic controls for each treatment country. This statistical method is especially well suited to population level studies when random assignment is infeasible and sufficiently similar comparators are not available. The method was originally developed in economics and political science to assess the impact of policies and events, and it is now increasingly used in epidemiology. -/- Main outcome measures: HIV-free life expectancy at age 5 years, UHC effective coverage index (0-100 point scale), and out-of-pocket spending on health per capita. All outcome variables are for the period 1989 to 2019. -/- Results: Autocratising countries underperformed for all three outcome variables in the 10 years after the onset of autocratisation, despite some improvements in life expectancy, UHC effective coverage index, and out-of-pocket spending on health. On average, HIV-free life expectancy at age 5 years increased by 2.2% (from 64.7 to 66.1 years) during the 10 years after the onset of autocratisation. This study estimated that it would have increased by 3.5% (95% confidence interval 3.3% to 3.6%, P<0.001) (from 64.7 to 66.9 years) in the absence of autocratisation. On average, the UHC effective coverage index increased by 11.9% (from 42.5 to 47.6 points) during the 10 years after the onset of autocratisation. This study estimated that it would have increased by 20.2% (95% confidence interval 19.6% to 21.2%, P<0.001) (from 42.5 to 51.1 points) in the absence of autocratisation. Finally, on average, out-of-pocket spending on health per capita increased by 10.0% (from $4.00 (£3.1; €3.4) to $4.4, log transformed) during the 10 years after the onset of autocratisation. This study estimated that it would have increased by only 4.4% (95% confidence interval 3.9% to 4.6%, P<0.001) (from $4.0 to $4.2, log transformed) in the absence of autocratisation. -/- Conclusions: Autocratising countries had worse than estimated life expectancy, effective health service coverage, and levels of out-of-pocket spending on health. These results suggest that the noticeable increase in the number of countries that are experiencing democratic erosion in recent years is hindering population health gains and progress toward UHC. Global health institutions will need to adjust their policy recommendations and activities to obtain the best possible results in those countries with a diminishing democratic incentive to provide quality healthcare to populations. (shrink)

There are three main categories of rationale for withholding information or telling lies: if overwhelming harm can only be averted through deceit; complete triviality such that it is irrelevant whether the truth is told; a duty to protect the interests of others. Public health authorities are frequently having to form judgements about the public interest, whether to release information or issue warnings. In June 1992, routine surveillance detected patulin levels (a known carcinogen) in samples of apple juice exceeding safety (...) threshold. Remedial actions were promptly taken and it was planned to subsequently publish the information in the routine way. However, the media portrayed the handling of the problem as a conspiracy and there was a short term reduction in juice sales. In October 1995, the UK Committee on Safety of Medicines issued a warning about certain brands of the contraceptive pill, based on the interim results of three unpublished studies. The increased risk of thromboembolism was small, but the resulting scare led to an increase in unwanted pregnancies. The handling of the B.S.E. crisis in the U.K. also led to accusations of incompetence or conspiracy. Public health authorities have to handle uncertainty and frequently have to form judgements for public safety on the basis of evidence of poor quantity and quality. Their task is not helped by the sometimes conflicting agenda of scientists and media. The public also have differing perceptions and interpretations of risk. The series of scares and crises are having a detrimental effect on public confidence in public health authorities. (shrink)

Biobanks are repositories that store human biological materials and their associated data. They are rapidly becoming part of national and international networks and give rise to unique ethico-regulatory issues. Whether consent is informed and whether this term should be used when specimens are collected for biobank research is questionable. Where risks occur, they are usually social and relate to identifiability. Public trust and confidence are important for the success of this type of research. Consensus is growing that governance of (...) biobanks should be harmonised. Controlled specimen and data access agreements are essential. The South African National Health Act and its Regulations, that provide the foundation for the legal framework with regard to human tissue and research in South Africa, are silent on the issue of biobanks and the law lags behind while science and technology advance rapidly. The use of biobank assets will lead to significant benefits in human health and should be encouraged while taking account of the associated ethical, legal and social issues and working towards a balance between these two positions. (shrink)

Most self-improvement programs train people to identify and solve problems by grappling with them endlessly, often to no avail. Executive coach Steve Sisgold, however, knows that the body--not the mind--is the most reliable and effective pathway to realizing your innermost desires and achieving success. His unique, body-centric approach will show you how to get out of your head and take charge of every area of your life with increased awareness, clarity, and confidence. Whole Body Intelligence teaches you how to (...) become aware of subtle body sensations--such as gripping the phone or clenching your jaw during a tense conversation--and how to interpret their meanings, linking them to negative thoughts and behaviors that are impeding your success and happiness. You will recognize the patterns and imprints that have shaped your experiences and decisions for your entire life and learn how to change these thoughts and behaviors before they become self-sabotaging. No more overthinking! Decisions will become easier to make and you will stay engaged, resilient, and relaxed in any situation. With an easy-to-follow 30-day plan, body centric stress management tools, and inspiring stories of people who have changed their lives using this system, Whole Body Intelligence empowers you to channel the power of your body to achieve your wildest dreams. (shrink)

Professionals within the mental health services face many ethical dilemmas and challenging situations regarding the use of coercion. The purpose of this study was to evaluate the significance of participating in systematic ethics reflection groups focusing on ethical challenges related to coercion. In 2013 and 2014, 20 focus group interviews with 127 participants were conducted. The interviews were tape recorded and transcribed verbatim. The analysis is inspired by the concept of ‘bricolage’ which means our approach was inductive. Most participants (...) report positive experiences with participating in ethics reflection groups: A systematic and well-structured approach to discuss ethical challenges, increased consciousness of formal and informal coercion, a possibility to challenge problematic concepts, attitudes and practices, improved professional competence and confidence, greater trust within the team, more constructive disagreement and room for internal critique, less judgmental reactions and more reasoned approaches, and identification of potential for improvement and alternative courses of action. On several wards, the participation of psychiatrists and psychologists in the reflection groups was missing. The impact of the perceived lack of safety in reflection groups should not be underestimated. Sometimes the method for ethics reflection was utilised in a rigid way. Direct involvement of patients and family was missing. This focus group study indicates the potential of ethics reflection groups to create a moral space in the workplace that promotes critical, reflective and collaborative moral deliberations. Future research, with other designs and methodologies, is needed to further investigate the impact of ethics reflection groups on improving health care practices. (shrink)

Information is clearly vital to public health, but the acquisition and use of public health data elicit serious privacy concerns. One strategy for navigating this dilemma is to build 'trust' in institutions responsible for health information, thereby reducing privacy concerns and increasing willingness to contribute personal data. This strategy, as currently presented in public health literature, has serious shortcomings. But it can be augmented by appealing to the philosophical analysis of the concept of trust. Philosophers distinguish (...) trust and trustworthiness from cognate attitudes, such as confident reliance. Central to this is value congruence: trust is grounded in the perception of shared values. So, the way to build trust in institutions responsible for health data is for those institutions to develop and display values shared by the public. We defend this approach from objections, such as that trust is an interpersonal attitude inappropriate to the way people relate to organisations. The paper then moves on to the practical application of our strategy. Trust and trustworthiness can reduce privacy concerns and increase willingness to share health data, notably, in the context of internal and external threats to data privacy. We end by appealing for the sort of empirical work our proposal requires. (shrink)

Against the backdrop of cultural and political ideals, this article highlights both the significance of mental health nursing in meeting population needs and the regulatory barriers that may be impeding its ability to adequately do so. Specifically, we consider how ambiguous notions of ‘proficiency’ in nurse education—prescribed by the regulator—impact the development of future mental health nurses and their mental health nursing identity. A key tension in mental health practice is the ethical‐legal challenges posed by sanctioned (...) powers to restrict patients' freedom at the same time as the desire (and obligation) to promote patients' self‐determined recovery. The genericism of the UK's Future Nurse Standards do little to prepare mental health nurses to navigate the tensions that ensue. This has consequences for nurses and patients alike, as both risk experiencing the distress and dissonance that attends giving or receiving poor care. We argue that more needs to be done to enable mental health nurses to define and articulate the nuances of the profession as part of becoming critical, thoughtful and confident practitioners. Educators can contribute to this mission by aligning curriculum, pedagogy and assessment to create meaningful opportunities for mental health nursing students to engage with the complexities of mental health nursing practice. Without this, the credibility of the profession will continue to be questioned; its future uncertain. (shrink)

Collaboration between the arts and health sectors is gaining momentum. Artists are contributing significantly to public health efforts such as vaccine confidence campaigns. Artists and the arts are well positioned to contribute to the social conditions needed to build trust in the health sector. Health professionals, organizations, and institutions should recognize not only the power that can be derived from the insights, artefacts, and expertise of artists and the arts to create the conditions that make (...) trust possible. The health sector must also recognize that, while it can gain much from partnership with artists, artists risk much—namely, the public's trust—when they are in such partnerships. This essay unpacks these claims and considers the care and ethical considerations that must be brought to these partnerships to yield constructive pathways for ethical collaboration as well as for both establishing public trust and continuing to hold the health care profession accountable for becoming more trustworthy. (shrink)

Although clinical ethics support services are becoming increasingly prevalent in Europe and North America, they remain an uncommon feature of the Irish healthcare system and Irish health professionals lack formal support when faced with ethically challenging cases. We have developed a variant on existing clinical ethics decision-making tools which is designed to build capacity and confidence amongst Irish practitioners and enable them to confront challenging situations in the absence of any dedicated support structure. The tool provided below follows (...) a transparent stepwise procedure which avoids an overcomplicated analysis while remaining sensitive to the complexity of the issues addressed. The novelty of the tool lies in the explicit association it makes between each step in the process and one or more responsibilities based on established norms of ethical decision-making in the public domain. (shrink)

BackgroundThe role of consent for research use of health information is contentious. Most discussion has focused on when project-specific consent may be waived but, recently, a broader range of consent options has been entertained, including broad opt-in for multiple studies with restrictions and notification with opt-out. We sought to elicit public values in this matter and to work toward an agreement about a common approach to consent for use of personal information for health research through deliberative public dialogues.MethodsWe (...) conducted seven day-long public dialogues, involving 98 participants across Canada. Immediately before and after each dialogue, participants completed a fixed-response questionnaire rating individuals' support for 3 approaches to consent in the abstract and their consent choices for 5 health research scenarios using personal information. They also rated how confident different safeguards made them feel that their information was being used responsibly.ResultsBroad opt-in consent for use of personal information garnered the greatest support in the abstract. When presented with specific research scenarios, no one approach to consent predominated. When profit was introduced into the scenarios, consent choices shifted toward greater control over use. Despite lively and constructive dialogues, and considerable shifting in opinion at the individual level, at the end of the day, there was no substantive aggregate movement in opinion. Personal controls were among the most commonly cited approaches to improving people's confidence in the responsible use of their information for research.ConclusionBecause no one approach to consent satisfied even a simple majority of dialogue participants and the importance placed on personal controls, a mechanism should be developed for documenting consent choice for different types of research, including ways for individuals to check who has accessed their medical record for purposes other than clinical care. This could be done, for example, through a web-based patient portal to their electronic health record. Researchers and policy makers should continue to engage the public to promote greater public understanding of the research process and to look for feasible alternatives to existing approaches to project-specific consent for observational research. (shrink)

Media reporting of recent business scandals, ranging from systemic accounting fraud to individual executive greed, has shed new light on the urgent need for organizational ethics in corporate America. The essay argues that organizational ethics can foster virtuous organizations by developing their sense of stewardship and integrity. This approach can inspire the ethical decision-making processes and standards of conduct for personnel throughout the organization. Another crucial role for organizational ethics is to regain lost trust and to recover the confidence (...) of our communities, whether we are discussing the business community or the health care community. Corporate America and organizations in health care need to win back the respect of skeptical customers, disheartened patients, and distrusting communities. But this task can be accomplished properly only when organizations and their business practices have a renewed commitment to ethics. The essay discusses how organizational ethics can permeate the entire organization in order to instill trust and confidence among its constituencies. Although the focus of the essay is upon the role of organizational ethics in health care, the argument also applies to the renewal of business practices in corporations across the nation. (shrink)

The pandemic caused by the SARS-CoV2 novel coronavirus is creating a global crisis. There is a global ambience of uncertainty and anxiety. In addition, nations have imposed strict and restrictive public health measures including lockdowns. In this heightened time of vulnerability, public cooperation to preventive measures depends on trust and confidence in the health system. Trust is the optimistic acceptance of the vulnerability in the belief that the health system has best intentions. On the other hand, (...) confidence is assessed based on previous experiences with the health system. Trust and confidence in the health system motivate people to accept the public health interventions and cooperate with them. Building trust and confidence therefore becomes an ethical imperative. This article analyses the COVID-19 pandemic in the south Indian state of Tamil Nadu and the state’s response to this pandemic. Further, it applies the Trust-Confidence-Cooperation framework of risk management to analyse the influence of public trust and confidence on the Tamil Nadu health system in the context of the preventive strategies adopted by the state. Finally, the article proposes a six-pronged strategy to build trust and confidence in health system functions to improve cooperation to pandemic containment measures. (shrink)

The aim of the present study was to investigate relationships among epidemic risk perception, perceived stress, mental health, future time perspective, and confidence in society during the novel coronavirus disease pandemic in China. Especially, we wonder that whether perceived stress mediates associations between epidemic risk perception and mental health and that whether future time perspective and confidence in society moderate the link between perceived stress and mental health. This cross-sectional study was conducted among 693 Chinese (...) adults aged 18–60 years. The results showed that epidemic risk perception was positively related to perceived stress, depression, and anxiety. The correlations between epidemic risk perception and depression and anxiety were reduced when perceived stress was included, suggesting that perceived stress mediated these relationships. Moreover, the boundary conditions for the associations among perceived stress, depression, and anxiety were found in the study. Specifically, positive future time perspective could buffer the negative effects of perceived stress on depression, and confidence in society could weaken the negative effects of perceived stress on anxiety. Based on these findings, practical guidance and theoretical implications are provided for the public to maintain mental health during COVID-19 pandemic. Limitations and future directions are also discussed. (shrink)

Prominent scientists and policymakers assert with confidence that there is no scientific controversy over the health effects of genetically modified organisms —that genetically modified crops currently in commercial use and those yet to be commercialized are inherently safe for human consumption and do not have to be tested. Those who disagree are cast as “GMO deniers.” This article examines scientific reviews and papers on GMOs, compares the findings of professional societies, and discusses the treatment of scientists who have (...) reported adverse effects in animal feeding experiments. This article concludes by exploring the role that politics and corporate interests have had in distorting an honest inquiry into the health effects of GMO crops. (shrink)