Health

Christopher Boorse’s Biostatistical Theory of Health has been the main contender among naturalistic accounts of health for the last 40 years. Yet, a recent criticism of this theory, presented by Elselijn Kingma, identifies a dilemma resulting from the BST’s conceptual linking of health and statistical typicality. Kingma argues that the BST either cannot accommodate the situation- specificity of many normal functions or cannot account for many situation-specific diseases. In this article, we expand upon with Daniel Hausman’s response to Kingma’s dilemma. (...) We propose that recalling Boorse’s specification that health is an intrinsic property of its bearers and explicating this intrinsic property in relation to the concept of homeostasis can illuminate how proponents of naturalistic accounts of health should deal with the situation- specificity of normal functions. We argue that beyond what Boorse and Hausman have delineated, the situation- specificity of normal function cannot be fully captured in a simple dichotomy between normal and abnormal environment or between relevant and irrelevant situations. By bringing homeostasis to the fore of the analysis of health, we set out a richer picture of what the various situations that affect living organisms’ functional performance can be. Accordingly, we provide a broader classification of these various situations which, we contend, better accounts for the main intuitions that philosophers of medicine have sought to accommodate than previous naturalistic theories of health. (shrink)

In medical sciences, health is measured by reference to our species-typical anatomy and functional integrity – the objective standard of human health. Proponents of transhumanism are committed to biomedical enhancement of human beings by augmenting our species-typical anatomy and functional integrity. I argue that this normative impasse is not only a problem for the transhumanist movement, but also undermines the rationale for some common medical interventions.

There is a growing focus on public health initiatives that prioritise well-being. The main question of our study is whether this, in its current form, can really represent a new response to the challenges of previous strategies, or whether there is a greater chance that it will essentially reproduce the problems associated with the paradoxical situation of public health. Based on a review, analysis and evaluation of the literature on well-being in public health, we outlined the foundations of a new (...) meta-theory of well-being and a possibility for its social application. In our view, well-being is seen as a social representation of a combination of positive and negative freedom of choice concerning the quality of everyday life, used in a positioning process involving both individual and collective aspects. Health is a particular aspect of the social representation and positioning of well-being, which encompasses aspects of the physical, psychological, social and spiritual functioning of individuals. The well-being meta-theory also opens up the possibility for more effective solutions to the social challenges related to well-being and salutogenetic health. It underscores the importance of the need for a dedicated social subsystem where the goals and organizational culture of the organizations involved are focused on well-being and health promotion. In our study, we consider this to be the Public Well-being System (PWS). (shrink)

Insofar as value theory is relevant to the philosophy of medicine, two goods have dominated reflection: well-being and morality. This essay casts doubt on whether those values are sufficient to resolve an array of important debates about medical practice, maintaining that the value of what makes a life meaningful should play a much larger role. After first indicating how meaningfulness differs from happiness and rightness, the essay argues that meaningfulness cannot reasonably be ignored when thinking comprehensively about the proper aims (...) of medicine, the appropriate constraints on their pursuit, and the effective means by which to realize them. The essay’s goal is not to draw any firm conclusions about the suitable ends, constraints, and means of medical practice, but rather to show that, in order to arrive at any, one has to consider the category of life’s meaning, which should be much more prominent in the philosophy of medicine than it has been. (shrink)

Background: Despite the at least decades long record of philosophical recognition and interest, the intricacy of the deceptively familiar appearing concepts of ‘disease’, ‘disorder’, ‘disability’, etc., has only recently begun showing itself with clarity in the popular discourse wherein its newly emerging prominence stems from the liberties and restrictions contingent upon it. Whether a person is deemed to be afflicted by a disease or a disorder governs their ability to access health care, be it free at the point of use (...) or provided by an insurer; it also influences the treatment of individuals by the judicial system and employers; it even affects one’s own perception of self. -/- Aims: All existing philosophical definitions of disease struggle with coherency, causing much confusion and strife, and leading to inconsistencies in real-world practice. Hence, there is a real need for an alternative. -/- Materials & Methods: In the present article I analyse the variety of contemporary views of disease, showing them all to be inadequate and lacking in firm philosophical foundations, and failing to meet the desideratum of patient driven care. -/- Results: Illuminated by the insights emanating from the said analysis, I introduce a novel approach with firm ethical foundations, which foundations are rooted in sentience, that is the subjective experience of sentient beings. -/- Discussion: I argue that the notion of disease is at best superfluous, and likely even harmful in the provision of compassionate and patient-centred care. -/- Conclusion: Using a series of presently contentious cases illustrate the power of the proposed framework which is capable of providing actionable and humane solutions to problems that leave the current theories confounded. (shrink)

An increasing vaccine hesitancy among parents, which has resulted in insufficient rates of immunization, provides reason to reconsider childhood vaccination practices. Studies suggest that parents' decision‐making process concerning whether to vaccinate their child is highly influenced by cognitive biases. These biases can be utilized to increase vaccination uptake via changes in the choice context. This article considers childhood vaccination programmes, which involve children being vaccinated in school or daycare unless their parents actively ‘opt out’. We suggest that such programmes reconcile (...) parents' decisional authority and vaccination duties. First, opt‐out childhood vaccination based in schools or daycare centres are not disrespectful of parental authority. Second, the programme aligns the default setting with a moral obligation to vaccinate one's child that most parents have. (shrink)

Exercise-based rehabilitation forms a key part of the UK National Health Service patient-care pathway for cardiac rehabilitation (CR). Only around half of all eligible patients attend core CR, however, with social inequalities affecting participation. Few qualitative studies have explored in-depth the key factors influencing engagement with CR, specifically from a sociological theoretical, and ethnographic perspective. Utilising an ethnographic approach allowed us to get a sense of the embodied experiences of 10 participants attending or declining core CR, together with a further (...) seven family members/significant others. This provided in-depth appreciation of participants’ lifeworld contexts as key influences on CR participation. The article draws on these qualitative data and focuses on 1) participants’ initial thoughts about CR; and 2) navigating the field of CR, analysed via thematic analysis. We utilise a Bourdieusian theoretical perspective to theorise the findings, including salient socio-cultural factors influencing attendance/non-attendance and (non)adherence. The article findings highlight how perceptions of CR and the ability to navigate the field are strongly influenced by habitus and capital, and how personal biographies and socio-material conditions affect adherence to CR programmes. The study provides original insights into embodied experiences of exercise-based CR, and novel understandings of the reasons for drop-out/poor adherence, theorised from a Bourdieusian perspective. (shrink)

This paper combines considerations from ethics, medicine and public health policy to articulate and defend a systematic case for mask wearing mandates (MWM). The paper argues for two main claims of general interest in favour of MWM. First, MWM provide a more effective, just and fair way to tackle the ongoing COVID-19 pandemic than policy alternatives such as laissez-faire approaches, mask wearing recommendations and physical distancing measures. And second, the proffered objections against MWM may justify some exemptions for specific categories (...) of individuals, but do not cast doubt on the justifiability of these mandates. Hence, unless some novel decisive objections are put forward against MWM, governments should adopt MWM. (shrink)

In this paper, I argue that patient preferences concerning human physical attributes associated with race, culture, and gender should be excluded from public healthcare robot design. On one hand, healthcare should be (objective, universal) needs oriented. On the other hand, patient well-being (the aim of healthcare) is, in concrete ways, tied to preferences, as is patient satisfaction (a core WHO value). The shift toward patient-centered healthcare places patient preferences into the spotlight. Accordingly, the design of healthcare technology cannot simply disregard (...) patient preferences, even those which are potentially morally problematic. A method for handling these at the design level is thus imperative. By way of uncontroversial starting points, I argue that the priority of the public healthcare system is the fulfillment of patients’ therapeutic needs, among which certain potentially morally problematic preferences may be counted. There are further ethical considerations, however, which, taken together, suggest that the potential benefits of upholding these preferences are outweighed by the potential harms. (shrink)

There is disagreement among physicians and medical ethicists on the precise goals of Hospice and Palliative Medicine (HPM). Some think that HPM's goals should differ from those of other branches of medicine and aim primarily at lessening pain, discomfort, and confusion; while others think that HPM's practices should, like all other branches of medicine, aim at promoting health. I take the latter position: using the ars moriendi to set a standard for what it means to die well, I argue that (...) if HPM's practices were to aim at mitigating suffering with little regard to promoting health, some patients would die worse deaths than if HPM's practices were to aim at health. According to the ars moriendi, flourishing at the end of one's life requires that one exercise her agency and pursue the goods most important to her. On this view, HPM's practices should promote patients’ health to enable them to pursue these goods. (shrink)

Anti-fat sentiment is pervasive, and fat people suffer a host of harms as a result: workforce discrimination, inferior medical care, relentless teasing, and internalized shame. A significant proportion of the population endures such harms. Yet, that is not typically regarded as a serious problem. Most of us aren’t quite sure: Is it really OK to be fat? This book argues that it is. In Why It’s OK to Be Fat, Nath debunks popular narratives about weight, health, and lifestyle choices that (...) underlie the dominant cultural aversion to fatness. She argues that we should view fatness through the lens of social equality, examining the wide-ranging ways that fat individuals fail to be treated as equals. According to Nath, we ought to recognize "sizeism"—the systematic ways that our society penalizes fat individuals for their size—as a structural injustice, akin to racism, sexism, and homophobia. (shrink)

Was ist Wissen von morgen im Vergleich mit Wissen von heute? Die geschichtliche Erfahrung zeigt diesen Übergang als ein Prozess der Weiterentwicklung der Sprache, weil menschliches Wissen an die Sprache gekoppelt ist, und seine Inhalte zu begreifen nur in sprachlichen Formen möglich ist. Während alte Sprachen vergehen, entstehen neue Sprachen: in diesem Prozess der Erneuerung von sprachlichen Formen wird das Wissen gesammelt, geklärt, und weitergegeben, und das geschieht durch Auswahl der Worte, deren Gebrauchswert ständig geprüft wird.

El objetivo de este artículo es realizar una historización del sistema sanitario de Neuquén, concretamente atendiendo a los programas de salud aplicados en esta provincia desde su surgimiento hasta el año 2020. En este marco, en primer lugar, me enfocaré en los lineamientos políticos que definieron las bases ideológicas de las políticas públicas llevadas a cabo en la atención sanitaria neuquina, y, en segundo lugar, examinaré las variables estadísticas publicadas por el sistema de salud provincial referidas a las condiciones materiales (...) de atención médica de la población en general, y de las mujeres indígenas mapuce en particular. Para efectuar dicho abordaje, analizaré específicamente la localidad de Las Coloradas. -/- . (shrink)

Introduction: Sexual harassment involves an assortment of coercive behaviors, including physical force, intimidation, and various forms of compulsion, including verbal harassment and forced penetration [1]. Sexual abuse can happen to both men and women. In the United Kingdom(UK), the problem of child sexual abuse (CSA) has epidemic proportions and is a global public health issue [2]. 53,874 incidents were reported under the 2012 Protection of Children from Sexual Offences Act as of 2021 [3]. to their ignorance about puberty, sexuality, and (...) fundamental human biological changes, adolescents have a very difficult time addressing their SRH demands. These underlying causes contribute to high rates of teen pregnancy, STIs, sexual assault, poor negotiating skills, forced marriage, and high fertility rates [4]. -/- Methods: The study used a quantitative technique and a descriptive cross-sectional design. Students at Jahangir Nagar University and the American International University of Bangladesh were the intended target group. Jahangir Nagar University and American International University of Bangladesh served as the study locations. The six-month trial period ran from January 2022 through June 2022. For this investigation, primary sources of data were used. The study unit was the individual student. Non-probability (purposive) sampling techniques were used for the investigation. -/- Results: The majority of survey participants (N=81) 62.2% were aged between 19 and 21 years old, and there was a statistically significant difference in age between students at public and private universities. None of our study participants suffered from any kind of sexual abuse, though they mentioned hearing about it. Regarding the view of sexual abuse, public universities 23% of those polled claimed sexual abuse as a justification for sharing inappropriate photos. At private universities, the response rate for crude jokes is 32.5%. Only the least number of public (2%) and private university (10%) students took part in sexual abuse-related awareness or training programs. Regarding the rights to receive training for prevention and safeguarding from sexual abuse, only 28% of the public and 40% of the private university students replied in affirmative. -/- Conclusion: Sexual harassment is a sensitive issue, though due to various reasons, the rate of reporting and providing justice to the victims is delayed all over the world including Bangladesh. There social, religious, and policy lacking in this context. -/- . (shrink)

This dissertation explores the idea and ethics of vaccination for the sake of others. It conceptually distinguishes four different kinds of vaccination—self-protective, paternalistic, altruistic, and indirect—based on who receives the primary benefits of vaccination and who ultimately makes the vaccination decision. It describes the results of focus group studies that were conducted to investigate what people who might get vaccinated altruistically think of this idea. It also applies the different kinds of vaccination to ethical issues surrounding COVID-19, such as lockdown (...) measures, routine or mandatory vaccination of healthy children, and the ethical justification of restrictive measures for unvaccinated people. A more general philosophical account of vaccination ethics is ultimately developed, which is based not on moral duties, but on the moral reasons that people may have to get vaccinated for the sake of others. It is argued that such reasons may be stronger or weaker, depending on various factors related to the vaccines in question and the specific epidemiological circumstances. (shrink)

Different definitions of well-being result in different choices regarding policies, research, medical practices, and personal decisions. This book provides an overview of well-being sciences, focusing on health, well-being, and quality of life in both biomedical and social settings. In seven chapters meant for a broad audience, the author looks at health as both the lack of disease and overall well-being, discusses various philosophical views on well-being, examines challenges in measurement, and considers the effects on older adults, people with disabilities, and (...) those with chronic illnesses. (shrink)

The paper defends the World Health Organisation (WHO) definition of health against widespread criticism. The common objections are due to a possible misinterpretation of the word complete in the descriptor of health as ‘complete physical, mental and social well-being’. Complete here does not necessarily refer to perfect well-being but can alternatively mean exhaustive well-being, that is, containing all its constitutive features. In line with the alternative reading, I argue that the WHO definition puts forward a holistic account, not a notion (...) of perfect health. I use historical and analytical evidence to defend this interpretation. In the second part of the paper, I further investigate the two different notions of health (holistic health and perfect health). I argue that both ideas are relevant but that the holistic interpretation is more adept for political aims. (shrink)

In the last decades it has become clear that medicine must find some way to combine its scientific and humanistic sides. In other words, an adequate notion of medicine requires an integrative position that mediates between the analytic-reductionist and the normative-holistic tendencies we find therein. This is especially important as these different styles of reasoning separate “illness” (something perceived and managed by the whole individual in concert with their environment) and “disease” (a “mechanical failure” of a biological element within the (...) body). While the demand for an integrative view has typically been motivated by ethical concerns, we claim that it is also motivated, perhaps even more fundamentally, by epistemological and methodological reasons. Evidence-based bio-medicine employs experimental and statistical techniques which eliminate important differences in the ways that conscious humans evaluate, live with, and react to disease and illness. However, it is precisely these experiences that underpin the concepts and norms of bio-medicine. Humanistic disciplines, on the other hand, have the resources to investigate these experiences in an intersubjectively testable way. Medicine, therefore, cannot afford to ignore its nature as a human science; it must be concerned not only with disease and illness, but also with the ways in which patients as persons respond to malady. Insofar as attitudes and expectations influence the criteria of illness and disease, they must be studied as part of the genuine subject matter of medicine as a human science. In general, we urge that this is a necessary step to overcome today's trend to split evidence-based and clinical medicine. (shrink)

Nietzsche assesses values, moralities, religions, cultures, and persons in terms of health. He argues that we should reject those that are unhealthy and develop healthier alternatives. But what is Nietzsche’s conception of health, and why should it carry such normative force? In this paper I argue for reading Nietzsche’s concept of health as the overall ability to meet the demands of one’s motivational landscape. I show that, unlike other interpretations, this reading accounts for his rejection of particular features of a (...) prevailing, then as now, model of health; for his association of health with strength and with psychic unity; and for his claim that health is compatible with, and can even be enhanced by, functional impairments such as those from which he personally suffered. Throughout I draw connections to recent literature on health and disability. (shrink)

In this paper, I argue that a modified version of well-being subjectivism can avoid the standard, yet unintuitive, conclusion that morally horrible acts may contribute to an agent’s well-being. To make my case, I argue that “Modified Subjectivists” need not accept such conclusions about well-being so long as they accept the following three theoretical addenda: 1) there are a plurality of values pertaining to well-being, 2) there are some objective goods, even if they do not directly contribute to well-being, and (...) 3) some of these values and goods are bound-up with one another. (shrink)

In the recent literature across philosophy, medicine and public health policy, many influential arguments have been put forward to support the use of randomization procedures to allocate scarce life-saving resources. In this paper, I provide a systematic categorization and a critical evaluation of these arguments. I shall argue that those arguments justify using RAND to allocate SLSR in fewer cases than their proponents maintain and that the relevant decision-makers should typically allocate SLSR directly to the individuals with the strongest claims (...) to these resources rather than use RAND to allocate such resources. (shrink)

We live in tragic times. Millions are sheltering in place to avoid exacerbating the Coronavirus (COVID-19) pandemic. How should we respond to such tragedies? This paper argues that the human right to health can help us do so because it inspires human rights advocates, claimants, and those with responsibility for fulfilling the right to try hard to satisfy its claims. That is, the right should, and often does, give rise to what I call_ the virtue of creative resolve_. This resolve (...) embodies a fundamental commitment to finding creative solutions to what appear to be tragic dilemmas. Contra critics, we should not reject the right even if it cannot tell us how to ration scarce health resources. Rather, the right gives us a response to apparent tragedy in motivating us to search for ways of fulfilling everyone’s basic health needs. (shrink)

ABSTRACT What kind of basic minimum do we owe to others? This paper defends a new procedure for answering this question. It argues that its minimally good life account has some advantages over the main alternatives and that neither the first-, nor third-, person perspective can help us to arrive at an adequate account. Rather, it employs the second-person perspective of free, reasonable, care. There might be other conditions for distributive justice, and morality certainly requires more than helping everyone to (...) secure a basic minimum. Still, if the minimally good life account is correct, and we owe everyone a basic minimum, we must ensure that everyone lives well enough. (shrink)

Lockdown measures in response to the COVID-19 pandemic involve placing huge burdens on some members of society for the sake of benefiting other members of society. How should we decide when these policies are permissible? Many writers propose we should address this question using cost-benefit analysis, a broadly consequentialist approach. We argue for an alternative non-consequentialist approach, grounded in contractualist moral theorising. The first section sets up key issues in the ethics of lockdown, and sketches the apparent appeal of addressing (...) these problems in a CBA frame. The second section argues that CBA fundamentally distorts the normative landscape in two ways: first, in principle, it allows very many morally trivial preferences—say, for a coffee—might outweigh morally weighty life-and-death concerns; second, it is insensitive to the core moral distinction between victims and vectors of disease. The third section sketches our non-consequentialist alternative, grounded in Thomas Scanlon’s contractualist moral theory. On this account, the ethics of self-defence implies a strong default presumption in favour of a highly restrictive, universal lockdown policy: we then ask whether there are alternatives to such a policy which are justifiable to all affected parties, paying particular attention to the complaints of those most burdened by policy. In the fourth section, we defend our contractualist approach against the charge that it is impractical or counterintuitive, noting that actual CBAs face similar, or worse, challenges. (shrink)

Review of: Fiona MacDonald: Individualising risk (Singapore: Palgrave Macmillan, 2021, 223 pp, 130€ HB). MacDonald advances several claims. First, the ‘gig economy’ and ‘cash-for-care’ marketisation of social care and health support work come with major pitfalls: These are explored with reference to specific cases in Australia and England. Second, processes that underlie the individualisation of care need to be identified and critically evaluated. For when risk and responsibility are shifted onto individual workers, what we can expect to see, given the (...) evidence, is a marked decrease in the quality of care that the elderly and people with disability receive. [...]. (shrink)

Innovation is progressively needed in responding to global challenges. Moreover, the increasing complexity of challenges implies demand for the usage of multisectoral and policy mix approaches. Wicked problems can be tackled by "integrated innovation" that combines the coordinated implementation of social, technological, and health innovation co-created by entities of the public sector, the private sector, the non-governmental sector, and the informal sector. This Research Topic focuses on filling the knowledge gaps about the selected types of innovation. First, regarding social innovation (...) that can be understood as new strategies, concepts, products, services, and organizational forms that allow the satisfaction of human needs. Second, a technological innovation that refers to new or remarkably improved products, goods, or services in terms of their technical specifications, components, materials, software, design, or other functional features. Third, health innovation that focuses on novel or enhanced health policies, systems, products, technologies, services, and care delivery schemes to improve people’s health. Finally, this Research Topic highlights attempts to develop integrated innovation that can add value to social policy, health policy, and environmental policy by improving efficiency, effectiveness, quality, sustainability, safety, and affordability. (shrink)

Vaccination can protect vaccinated individuals and often also prevent them from spreading disease to other people. This opens up the possibility of getting vaccinated for the sake of others. In fact, altruistic vaccination has recently been conceptualized as a kind of vaccination that is undertaken primary for the benefit of others. In order to better understand the potential role of altruistic motives in people’s vaccination decisions, we conducted two focus group studies with a total of 37 participants. Study 1 included (...) three focus groups on the subject of HPV vaccination for boys. Study 2 included three focus groups on the subject of pertussis and measles vaccination for childcare workers. We found substantial evidence of other-regarding motives across all focus groups, which suggests that altruistic motives could be an important factor when it comes to people’s vaccination decisions. We address the significance of these findings for vaccination policy surrounding HPV vaccination for boys and vaccination for childcare workers. We also extend the findings to normative work on vaccination for the sake of others more generally. (shrink)

[In Czech] This article aims to explain how Merleau-Ponty’s phenomenological account of embodiment contributes to the theory and practice of physiotherapy. The mechanistic conception of the body, to which physiotherapy usually refers, assumes a universal model of its functioning and interprets its relationship to the environment causally. In fact, however, it does not allow a satisfactory explanation of the efficiency of the therapeutic methods used in practice. In contrast, Merleau-Ponty’s concept of motor intentionality points to the fact that the body (...) “understands” the practical meaning of a situation. Bodily understanding is then manifested in particular by the ability to adequately differentiate, adapt or vary motor and postural responses to environmental challenges. This change in the conception of embodiment also has important implications for understanding the therapist-patient relationship and the intervention itself. Physiotherapists should draw more on the fact that they are themselves a body and, on this basis, guide the patient’s bodily intentionality towards a more developed understanding of the practical meaning of situations. (shrink)

The 1948 constitution of the World Health Organization (WHO) defines health as ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’. It was a bold and revolutionary health idea to gain international consensus in a period characterized by fervent anti-communism. This article explores the genealogy of the health definition and demonstrates how it was possible to expand the scope of health, redefine it as ‘well-being’, and overcome ideological resistance to progressive and (...) international health approaches. The first part of the article demonstrates how the health definition was composed through a trajectory of draft ideas from scholars in the history of medicine, as well as political actors working to promote national health insurance. The definition was authored by League of Nations veteran Raymond Gautier, but secretly drew heavily on medical historian Henry E. Sigerist’s controversial book Socialized Medicine in the Soviet Union (1937). The second part analyses how it was possible to resist the ideological pushback against the WHO and secure US ratification. The WHO’s progressive constitution was not simply a deviation from dominant health ideas, but a direct outcome of the entrenched health conflict. The genealogy is based on original archival material from international organizations and US government archives. The article contributes to understandings of the political controversies surrounding the WHO and to scholarship on understandings of health. It also illustrates how influential health ideas cross the boundaries between politics and health sciences, as well as the boundaries between domestic health policy and global health. (shrink)

The definitions and conceptualizations of health, and the management of healthcare have been challenged by the current global scenarios (e.g., new diseases, new geographical distribution of diseases, effects of climate change on health, etc.) and by the ongoing scholarship in humanities and science. In this paper we question the mainstream definition of health adopted by the WHO—‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’ (WHO in Preamble to the constitution of (...) the World Health Organization as adopted by the international health conference, The World Health Organization, 1948)—and its role in providing tools to understand what health is in the contemporary context. More specifically, we argue that this context requires to take into account the role of the environment both in medical theory and in the healthcare practice. To do so, we analyse WHO documents dated 1984 and 1986 which define health as ‘coping with the environment’. We develop the idea of ‘coping with the environment’, by focusing on two cardinal concepts: adaptation in public health and adaptivity in philosophy of biology. We argue that the notions of adaptation and adaptivity can be of major benefit for the characterization of health, and have practical implications. We explore some of these implications by discussing two recent case studies of adaptivity in public health, which can be valuable to further develop adaptive strategies in the current pandemic scenario: community-centred care and microbiologically healthier buildings. (shrink)

Objective: Deficits in affective processing are associated with impairments in both mental and physical health. The role of affective processing in patients with functional somatic complaints such as irritable bowel syndrome remains unclear. Most studies have focused on the capacity for emotional awareness and expression, but neglect other dimensions of affective processing. Therefore, this study aimed to systematically analyze differences in six different dimensions of affective processing between patients with IBS and healthy controls. Additionally, we exploratively investigated the impact of (...) IBS symptom severity, psychological distress, and attachment styles on affective processing in IBS. Methods: A controlled cross-sectional multi-center study was conducted. Overall, 127 patients with IBS were compared with 127 matched HCs using multivariate analysis of variances. Affective processing was operationalized in line with the affect cascade model on six specific dimensions: emotional experience, emotional awareness, affect tolerance, affect differentiation, affect regulation, and emotional communication. They were measured using two subscales of the Mentalizing Questionnaire and four subscales of the Operationalized Psychodynamic Diagnosis–Structure Questionnaire. Linear regression analysis was used to investigate the influence of IBS symptom severity, depression, anxiety, and anxious and avoidant attachment styles on the different dimensions of affective processing in IBS. Results: Patients with IBS compared to HCs showed deficits in all six dimensions of affective processing. Deficits were largest for affect tolerance and lowest for emotional experience and emotional awareness. Moderate effect sizes were found for affect differentiation, emotional communication, and affect regulation. Moreover, explorative analyses indicated that affective processing in patients with IBS was significantly influenced by levels of anxiety and insecure attachment. Conclusion: The results indicate a specific pattern of affective processing abilities in patients with IBS. The deficits in affective processing are more prominent in the area of understanding and tolerating difficult affective states than experiencing affective states. This opens interesting perspectives for the development of specific psychotherapeutic interventions. (shrink)

Cardiovascular disease is a major complication of type 2 diabetes mellitus. In addition to traditional risk factors, psychological determinants play an important role in CVD risk. This study applied Deep Neural Network to develop a CVD risk prediction model and explored the bio-psycho-social contributors to the CVD risk among patients with T2DM. From 2017 to 2020, 834 patients with T2DM were recruited from the Department of Endocrinology, Affiliated Hospital of Harbin Medical University, China. In this cross-sectional study, the patients' bio-psycho-social (...) information was collected through clinical examinations and questionnaires. The dataset was randomly split into a 75% train set and a 25% test set. DNN was implemented at the best performance on the train set and applied on the test set. The receiver operating characteristic curve analysis was used to evaluate the model performance. Of participants, 272 were diagnosed with CVD. The developed ensemble model for CVD risk achieved an area under curve score of 0.91, accuracy of 87.50%, sensitivity of 88.06%, and specificity of 87.23%. Among patients with T2DM, the top five predictors in the CVD risk model were body mass index, anxiety, depression, total cholesterol, and systolic blood pressure. In summary, machine learning models can provide an automated identification mechanism for patients at CVD risk. Integrated treatment measures should be taken in health management, including clinical care, mental health improvement, and health behavior promotion. (shrink)

Children’s reasoning on food properties and health relationships can contribute to healthier food choices. Food properties can either be positive (“gives strength”) or negative (“gives nausea”). One of the main challenges in public health is to foster children’s dietary variety, which contributes to a normal and healthy development. To face this challenge, it is essential to investigate how children generalize these positive and negative properties to other foods, including familiar and unfamiliar ones. In the present experiment, we hypothesized that children (...) might rely on cues of food processing (e.g., signs of human intervention such as slicing) to convey information about item edibility. Furthermore, capitalizing on previous results showing that food rejections (i.e., food neophobia and picky eating) are a significant source of inter-individual variability to children’s inferences in the food domain, we followed an individual approach. We expected that children would generalize the positive properties to familiar foods and, in contrast, that they would generalize more often the negative properties to unfamiliar foods. However, we expected that children would generalize more positive and less negative properties to unfamiliar sliced foods than to whole unfamiliar foods. Finally, we expected that children displaying higher levels of food rejections would generalize more negative properties than children displaying lower levels of food rejections. One-hundred and twenty-six children, aged 3–6 years, performed an induction task in which they had to generalize positive or negative health-related properties to familiar or unfamiliar foods, whole or sliced. We measured children’s probability of generalization for positive and negative properties. The children’s food rejection score was assessed on a standardized scale. Results indicated that children evaluated positively familiar foods (regardless of processing), whereas they tend to view unfamiliar food negatively. In contrast, children were at chance for processed unfamiliar foods. Furthermore, children displaying higher levels of food rejections were more likely to generalize the negative properties to all kinds of foods than children displaying lower levels of food rejections. These findings entitle us to hypothesize that knowledge-based food education programs should take into account the valence of the properties taught to children, as well as the state of processing of the food presented. Furthermore, one should take children’s interindividual differences into account because they influence how the knowledge gained through these programs may be generalized. (shrink)

How the sense of smell is involved in human health has been the subject of increasing inquiry over the past several decades. The two main avenues of investigation are: “aromatherapy” – how the inhalation of various odors can produce positive effects on psychological and physiological wellness; how abnormal decreases in olfactory sensitivity are linked to various disease states and an increased risk of premature mortality. In this chapter, I evaluate pertinent aspects of both of these topics. First, with regard to (...) aromatherapy, popular accounts for underlying mechanisms are debunked and scientific explanations provided; I then present a focused review of the empirical literature on scent and pain management and discuss why pain may be especially well suited to aromatherapeutic approaches. Second, the clinical significance of abnormal olfactory loss as a harbinger for premature mortality and as a prodromal maker for Alzheimer’s disease, Parkinson’s disease, and most recently Covid-19, is examined. Following from this, I suggest how simple do-at-home smell tests can be implemented and should become a standard part of basic healthcare screenings. (shrink)

The devastating impact of the COVID‐19 (coronavirus disease 2019) pandemic is prompting renewed scrutiny of practices that heighten the risk of infectious disease. One such practice is refusing available vaccines known to be effective at preventing dangerous communicable diseases. For reasons of preventing individual harm, avoiding complicity in collective harm, and fairness, there is a growing consensus among ethicists that individuals have a duty to get vaccinated. I argue that these same grounds establish an analogous duty to avoid buying and (...) eating most meat sold today, based solely on a concern for human welfare. Meat consumption is a leading driver of infectious disease. Wildlife sales at wet markets, bushmeat hunting, and concentrated animal feeding operations (CAFOs) are all exceptionally risky activities that facilitate disease spread and impose immense harms on human populations. If there is a moral duty to vaccinate, we also should recognize a moral duty to avoid most meat. The paper concludes by considering the implications of this duty for policy. (shrink)

Michael Ondaatje’s Warlight (2018), his latest novel to-date, contains nostalgic elements of strangeness and cartography. In this paper, I short-circuit such themes with health under medical humanities, which heeds a Nietzschean counsel of close reading in literature. To do so, I explore the case of Rachel's illness, namely her epileptic seizures, as an instance that drives her impetus for active forgetting and eventual convalescence. A close hermeneutical reading of the novel can reveal that both of Nietzsche’s ideas on active forgetting (...) and convalescence provide traction in terms of what this paper constructs as Rachel’s pathography or narration of illness. Shifting the focus from the main narrator, Nathaniel, I argue that it is not the novel's reliance on memory but the subplot events of Nathaniel's sister and her epilepsy that form a substantial case of medical or health humanities. (shrink)

Managing cardiac illness is not easy because it dramatically disrupts people’s daily life and both the patient and his/her spouse are at risk for experiencing distress, which, in turn, may affect the support provided by the partner as caregiver. The partner, in fact, is the main source of support, but his/her support may sometimes be inadequate. In addition, dyadic coping could likely be a moderating factor. The main aim of the present study was to examine the role that dyadic coping (...) plays in moderating the link between patient and partner cardiac illness-related distress and partner support. The study included 100 married couples faced with cardiac illness who completed a self-report questionnaire. We analyzed our data in PROCESS using multiple regressions in order to assess the moderating effects of DC responses in the relationship between the couple’s cardiac illness-related distress and partner support. With regard to patient distress, results showed that higher levels of patient anxiety and depression were linked with ineffective partner support. With regard to partner distress, higher levels of partner depression were linked with hostility; higher levels of partner depression and anxiety were associated with less partner support for patient engagement. Moreover, the association between distress and partner support was moderated by the quality of DC. In particular, low positive DC represented a risk factor for both the patient and the partner during a cardiac illness, as low positive DC exacerbated the link between patient and partner distress and less effective partner support styles. Also, higher levels of negative DC were risky for couples: The association between distress and less adequate partner supportive behaviors was stronger in the case of higher negative DC. These results imply a need for psychosocial interventions for couples in cardiac illness, especially for couples lacking relational competences, such as positive dyadic coping. (shrink)

In this article, we develop a measure of complete well-being. The framework is derived from the theoretical model of human flourishing understood as a state in which all aspects of a human life are favorable. The approach extends beyond psychological well-being and reflects the World Health Organization definition of health that not only considers the health of body and mind but also embraces the wholeness of the person. The Well-Being Assessment is a comprehensive instrument designed to assess holistic well-being in (...) six domains: emotional health, physical health, meaning and purpose, character strengths, social connectedness, and financial security. Although each of these domains is distinct, all of them are nearly universally desired, and all but financial security constitute ends in themselves. Data were collected from a representative sample of working adults. A sample of 276 employees participated in the pilot, 2,370 participated in the first wave and 1,209 in the second wave of the survey. The WBA showed a good fitting, satisfactory reliability, test–retest correlation, and convergent/discriminant validity in relation to stability over time and relevant health measures, as well as a good fit to the data that were invariant over time, gender, age, education, and marital status. The instrument can be of use for scientists, practitioners, clinicians, public health officials, and patients. Adoption of more holistic measures of well-being that go beyond psychological well-being may help to shift the focus from health deficiencies to health and well-being promotion. (shrink)

As governments around the world imposed lockdowns or stay-at-home measures, people began to feel the stress as time dragged on. There were already reports on some individuals committing suicide. How do governments respond to such a phenomenon? Our main focus is the Philippine government and how it responded to the COVID-19 pandemic. In this paper, we argue that the problem with COVID-19 went forth just dealing with physical health. First, people suffer not just from being infected but the psychological stress (...) of possibly getting the virus and the toll of the government lockdown or quarantine. Second, the Philippine Bayanihan ‘We Heal As One Act’ lacks focus on mental health issues while the government's response seemed to focus on security issues. Third, there are countries around the world that have acted effectively in protecting people’s mental health. Lastly, we propose appropriate measures to help address the people's mental health while still in the pandemic and for a future one. (shrink)

In this paper, two central questions will be addressed: ought we to implement medical AI technology in the medical domain? If yes, how ought we to implement this technology? I will critically engage with three options that exist with respect to these central questions: the Neo-Luddite option, the Assistive option, and the Substitutive option. I will first address key objections on behalf of the Neo-Luddite option: the Objection from Bias, the Objection from Artificial Autonomy, the Objection from Status Quo, and (...) the Objection from Inscrutability. I will thereafter present the Demographic Trends Argument and the Human Enhancement Argument in support of alternatives to the Neo-Luddite option. In the second half of the paper, I will argue against the Substitutive option and in favour of the Assistive option, given the existence of two chief formal deficits in medical AI technology: the causality deficit and the care deficit. (shrink)

Background: Depressive disorder is one of the main health problems worldwide. Many risk factors have been associated with this pathology. However, while the association between risks factors and adult depression is well established, the mechanisms behind its impact remains poorly understood. A possible, yet untested explanation is the mediating impact of levels of personality functioning, i.e., impairments with regard to self and interpersonal.Method: Around 162 patients were assessed at the beginning of their therapy, with regard to risk factors, such as (...) sociodemographic, physical, hereditary, and adverse childhood experiences. Depressive symptoms and personality functioning were also measured. Associations between the related variables as well as other possible covariates were examined by means of zero-order correlations and bootstrapping-based mediation analysis.Results: Of all the risk factors taken into account, level of education and physical illness were associated with depression. On the other hand, the most significant predictor of depressive symptomatology was ACE, and this relationship was mediated by personality functioning. This indicates that patients presenting adverse childhood experiences are more likely to develop deficiencies in personality functioning, which in turn increases their likelihood of developing depressive symptomatology.Conclusion: These results reaffirm the importance of incorporating risk and vulnerability factors such as personality functioning in understanding depression. (shrink)

This paper defends the hypothesis of a potential causal link between increased usage of hormonal contraceptives (HCs) and significant rises in instances of Autism Spectrum Disorders (ASDs) worldwide. It develops a background theory that supports this hypothesis through analysis of: observed correlations between increased usage of HCs and increased instances of ASDs; consistent evidence from independent studies linking “birth spacing” intervals and ASD-risk; evidence from studies on the effects of HCs on folate and B12 absorption; and hypotheses concerning disruptions to (...) mechanisms of delivery of folate and B12 during periods of in utero brain development. The proposed theory is then defended through discussion of how it may explain numerous puzzling correlations with increased instances of ASDs documented in certain demographics. (shrink)

Nicole Hassoun here makes a philosophical argument for health, and access to essential medicines, as essential human rights, and she proposes the Global Health Impact system as a way to ensure those rights. She reports how life-saving medicines are inaccessible and costly for the global poor, and that rather than focusing on treatments for critical, deadly global health problems, pharmaceutical companies instead invest in more profitable drugs. To address this problem, Hassoun's proposal will rate pharmaceutical companies based on their medicines' (...) impact on the improvement of global health, and will reward highly-rated medicines with a Global Health Impact label. (shrink)

The novel coronavirus has not only brought along disruptions to daily socio-economic activities, but sickness and deaths due to its high contagion. With no widely acceptable pharmaceutical cure, the best form of prevention may be precautionary measures which will guide against infections and curb the spread of the disease. This study explored the relationship between COVID-19 knowledge, risk perception, and precautionary behavior among Nigerians. The study also sought to determine whether this relationship differed for men and women. A web-based cross-sectional (...) design approach was used to recruit 1,554 participants from all geopolitical zones in Nigeria, through social media platforms using a snowball sampling technique. Participants responded to web-based survey forms comprising demographic questions and adapted versions of the Ebola knowledge scale, SARS risk perception scale, and precautionary behavior scale. Moderated mediation analysis of the data showed that risk perception mediated the association between COVID-19 knowledge and precautionary behavior and this indirect effect was in turn moderated by gender. Results indicate that having adequate knowledge of COVID-19 was linked to higher involvement in precautionary behavior through risk perception for females but not for males. It was also noted that awareness campaigns and psychological intervention strategies on COVID-19 related activities may be particularly important for males more than females. Drawing from the health belief model, we recommend that COVID-19 awareness campaigns should target raising more awareness of the risks associated with the infection to make individuals engage more in precautionary behaviors. (shrink)

Hynek Bartos does the field of ancient philosophy a great service by detailing the influence of early Greek thinkers (such as Heraclitus, Empedocles, Anaxagoras, Democritus, and Diogenes of Apollonia) on the Hippocratic work On Regimen, and by demonstrating that work’s innovative engagement with contemporary scientific and philosophical concepts as well as its direct influence on Plato and Aristotle. His study usefully counteracts the lamentable tendency among ancient philosophers to ignore or downplay the influence of medical literature on philosophy in general, (...) and to heap scorn on this text in particular, which Kirk, Raven, and Schofield considered ‘an eclectic and very superficial quasi- philosophical treatise’ and Barnes famously called ‘a silly farrago of ill-digested Presocratic opinions’. (shrink)

We argue that pandemic and lockdown can be usefully interpreted as transformative experiences, albeit of a sort with interestingly different features to those discussed by L.A. Paul.