In this paper we argue that the responsibility for systematic community-based preventive medicine should not be made part of the role of the general practitioner (GP). Preventive medicine cannot be shown to be more effective than curative or supportive medicine. Therefore, the allocation of the large amount of general practice staff time and resources required for systematic preventive medicine should not come at the expense of the care of the sick and the suffering. The traditional healing role of the (...) GP requires a cooperative patient-centred approach, whereas systematic preventive medicine is driven by rigid pre-set protocols and is intrinsically paternalistic. Trying to merge the two approaches is detrimental to the doctor-patient relationship. Furthermore, a number of potential pitfalls are identified that may be encountered in the implementation of preventive medicine programmes in general practice: interference with the course of the consultation; inadequate explanation and consent; distortion of practice priorities as reflected in quality indicators; temptation to record inaccurate data; conflict of interests where the doctor is rewarded for performance; patient blaming; exacerbation of the health gap. We suggest that a more justifiable strategy would be for GPs to identify patients at high risk and offer them specific preventive advice when the opportunity presents itself and at a time when the patient is likely to be most amenable to cooperate. Opportunistic health promotion offers higher expectations of benefit, as well as a more equitable allocation of the risks associated with preventive medicine, than a systematic community-based approach. (shrink)

Traditional mental health services are often not enough to meet the needs of people at risk for suicide, especially in populations where help-seeking is stigmatized. Stack Up, a non-profit veteran organization whose goal is to use video games to bring veterans together, recognized a need in its gaming-focused online community and created the Overwatch Program. This suicide prevention and crisis intervention program is delivered entirely through the Internet by trained community members through Discord text and voice chat. (...) By combining aspects of virtual gaming communities, veteran mental health, and community-based peer support, this program provides an innovative format for implementing crisis intervention and mental health support programs. We describe here the context and features of the program, an ongoing evaluation project, and lessons learned. (shrink)

Before sailing past the sirens' “flowery meadow,” Ulysses instructed his sailors to lash him to the mast so that he would not succumb to the siren's singing. His advance directive demonstrated that he valued his dispositional or long-term autonomy over his unquestioned right to make decisions. He also indicated to his oarsmen that he understood the nature of temptation and his inability to resist it. Ideas of autonomy and sexual choice are central to this discussion of new AIDS treatments, especially (...) the trials of preventative vaccines. Questions arise over the rights of individuals and the extent that these should be limited by concerns of the gay community. Should the gay community intervene in the risky decisions of individuals if no explicit advance directive exists? If so, how do they justify their paternalism? Could their aims not be better served through strengthening the individual dispositional autonomy of trial participants rather than making specific claims about the common good? (shrink)

RESUMEN Las investigaciones en el campo de la teoría de la comunicación apuntan a que en la actualidad el proceso es, desde lo social, una vía para el logro de las relaciones interpersonales y posee sus potencialidades estratégicas para la construcción social y cultural del hombre. Se realizó una revisión bibliográfica para el acercamiento inicial al estudio de las temáticas de la comunicación social en salud y la prevención de enfermedades en la comunidad. Por ello el objetivo del presente trabajo (...) estriba en establecer los fundamentos teóricos que sustentan el estudio de las relaciones entre la comunicación en salud y la concreción del trabajo preventivo desde la comunidad. Se defiende que la comunicación social en salud promueve el diálogo y el intercambio de información y es un componente imprescindible de todos los servicios de salud. ABSTRACT Research on the theoretical basis of communication point to the fact that nowadays, the process is, from a social point of view, a means of achieving interpersonal relationships and it has strategic potential toward men’s social and cultural construction. A bibliographic review was carried out in order to approach the study of subject matters related to social communication in health and disease prevention in the community. Therefore, this paper aims at stablishing the theoretical basis that support the study of the relationship between communication in health and the implementation of precautionary work from the community. It is defended that social communication in health promotes dialogue and information exchange and it is an essential element in all health services. (shrink)

Introducción: los accidentes son de las primeras causas de muerte a nivel mundial, por lo que la prevención de los mismos es una emergencia. Objetivo: valorar la repercusión de una intervención comunitaria en la disminución de peligros potenciales de accidentes en familias con niños de 0 a 18 meses. Métodos: se realizó un estudio cuasi experimental multietápico, con enfoques cuantitativo y cualitativo, entre enero de 2009 a junio de 2012. Se trabajó con 39 familias entre las que se produjeron nacimientos (...) en el periodo enero de 2008 a enero de 2010 de los Consultorios Médicos del Consejo Popular 26 de julio del Municipio Santo Domingo. Se efectuó una intervención por un grupo de trabajo comunitario conformado por integrantes del Círculo de interés "Prevención es Salud" y brigadistas de la Cruz Roja, liderados por la enfermera de la familia, se empleó para ello la Guía para Análisis de vulnerabilidades y capacidades de la Cruz Roja, modificada en su etapa I. Resultados: Post intervención se logró la reversión de vulnerabilidades en cuanto a capacidades, se manifestaron cambios favorables en los conocimientos y disminuyó significativamente el número de peligros potenciales en cada hogar. Conclusiones: Cuando se trabaja con familias con instrumentos sencillos y accesibles, y con el grupo de trabajo comunitario, se favorece la toma de conciencia sobre el problema en el entorno donde se generó. Introduction: accidents are one of the first causes of death worldwide, so their prevention is an urgency. Objective: assess the effect of a community intervention in the reduction of potential dangers of accidents in family with children aged from zero to 18 months. Methods: a multiage cuasi experimental study was carried out, with quantitative and qualitative approaches, from January 2009 to June 2012. The sample was taken from thirty-nine families who had children in the period ranging from January 2008 to January 2010 belonging to the family doctor´s house of the community called "26 de Julio" from Santo Domingo municipality. An intervention was carried out by a community group work composed by members of centers of interests called ¨Prevention is health¨ and members of the Red Cross led by the family nurse. It was necessary to ask a guide to analyze the vulnerabilities and capabilities of the Red Cross, modified in the first stage. Results: During the post intervention, it was possible to change the vulnerabilities in terms of capacities, favorable changes were present in the knowledge and the number of potential risks significantly decreased in each house. Conclusions: when families are approached with simple and accessible instruments, and with a community group work it is possible to make favorable changes in terms of awareness of the problem in the same place where it emerged. (shrink)

The advent of HIV focussed broad social attention on the group of people most affected by it in Australia, the so-called ‘gay community’. However, what a gay community actually was, and what kind of rights and duties were being attached to it remained unclear. However, it is obvious that such a community — or communities — did not fit the model proposed by communitarian writers like Michael Sandel and Charles Taylor, whereby subjects cannot stand outside their own (...) constitutive attachments. I also consider the common criticism of communitarianism, and see what kinds of collectives can in fact be considered ethical.The first part of this paper looks at the ethical issues surrounding community attachment of this kind in Australia in relation to the ethics of HIV/aids clinical research. In particular I examine the way in which certain forms of gay community attachment can be used to strengthen personal autonomy and check exploitation within the prevention and research process.The second part of this paper draws upon the issues just discussed. In particular I focus on the use of ‘community’ in the research process in developing countries, and suggest ways in which cultural considerations might strengthen autonomy. However, I go on to suggest that in many cases the idea of community has served the opposite purpose, and has in fact been used to oppress certain individuals and groups within the developing world, in the so-called interests of the greater good. In order to avoid this, I suggest a model of social and ethical research whereby all subjects and researchers in the clinical process might stand in greater relationships of equality with each other. (shrink)

While ethical conflicts in the provision of healthcare are common, the current third-party mediator model is limited by a lack of expert ethical mediators, who are often not on site when conflict escalates. In order to improve clinical outcomes in situations such as conflicts at the end of life, we suggest that clinicians—physicians, nurses and social workers—be trained to prevent and deescalate emerging conflicts. This can be achieved using a mediation model framed by a communication-training approach. A case example is (...) presented and the model is discussed. The implication of this preventative/early intervention model for improving clinical outcomes, in particular end-of life conflict, is considered. (shrink)

Colorado has consistently had one of the highest rates of suicide in the United States, and El Paso County has the highest number of suicide and firearm-related suicide deaths within the state. Community-based solutions like those of the Suicide Prevention Collaborative of El Paso County may be more effective in preventing suicide as they are specific to local issues, sensitive to local culture, and informed by local data, community members, and stakeholders.

Volume 31, Issue 1, December 2020, Page 47-66.

ABSTRACT Because of the nature of preventive vaccination programs, the viability of these public health interventions is particularly susceptible to public perceptions. This is because vaccination relies on a concept of ‘herd immunity’, achievement of which requires rational public behavior that can only be obtained through full and accurate communication about risks and benefits. This paper describes how irrational behavior that threatens the effectiveness of vaccination programs – both in crisis and non‐crisis situations – can be tied to public perceptions (...) created by media portrayals of health risks. I concentrate on childhood vaccination as an exemplar of ‘non‐crisis’ preventive vaccination, and on the recent flu vaccine shortage as a ‘crisis’ situation. The paper concludes with an examination of the steps necessary to resolve these threats through better public communication. (shrink)

This article is concerned with ways better communication between engineers and their managers might help prevent engineers being faced with some of the ethical problems that make up the typical course in engineering ethics. Beginning with observations concerning the Challenger disaster, the article moves on to report results of empirical research on the way technical communication breaks down, or doesn’t break down, between engineers and managers. The article concludes with nine recommendations for organizational change to help prevent communications breakdown.

Many older people in western countries express a desire to live independently and stay in control of their lives for as long as possible in spite of the afflictions that may accompany old age. Consequently, older people require care at home and additional support. In some care situations, tension and ambiguity may arise between professionals and clients whose views on risk prevention or health promotion may differ. Following Antonovsky’s salutogenic framework, different perspectives between professionals and clients on the pathways (...) that lead to health promotion might lead to mechanisms that explain the origin of these tensions and how they may ultimately lead to reduced responsiveness of older clients to engage in care. This is illustrated with a case study of an older woman living in the community, Mrs Jansen, and her health and social care professionals. The study shows that despite good intentions, engagement, clear division of tasks and tailored care, the responsiveness to receive care can indeed not always be taken for granted. We conclude that to harmonize differences in perspectives between professionals and older people, attention should be given to the way older people endow meaning to the demanding circumstances they encounter (comprehensibility), their perceived feelings of control (manageability), as well as their motivation to comprehend and manage events (meaningfulness). Therefore, it is important that both clients and professionals have an open mind and attempt to understand each others’ perspective, and have a dialogue with each other, taking the life narrative of clients into account. (shrink)

Because of the nature of preventive vaccination programs, the viability of these public health interventions is particularly susceptible to public perceptions. This is because vaccination relies on a concept of ‘herd immunity’, achievement of which requires rational public behavior that can only be obtained through full and accurate communication about risks and benefits. This paper describes how irrational behavior that threatens the effectiveness of vaccination programs – both in crisis and non-crisis situations – can be tied to public perceptions created (...) by media portrayals of health risks. I concentrate on childhood vaccination as an exemplar of ‘non-crisis’ preventive vaccination, and on the recent flu vaccine shortage as a ‘crisis’ situation. The paper concludes with an examination of the steps necessary to resolve these threats through better public communication. (shrink)

Community-based interventions (CBIs) show promise as effective and cost-effective obesity prevention initiatives. CBIs are typically complex interventions, including multiple settings, strategies and stakeholders. Cost-effectiveness evidence, however, generally only considers a narrow range of costs and benefits associated with anthropometric outcomes. While it is recognised that the complexity of CBIs may result in broader non-health societal and community benefits, the identification, measurement, and quantification of these outcomes is limited. This study aimed to understand the perspectives of stakeholders on (...) the broader benefits of CBIs and their measurement, as well as perceptions of CBI cost-effectiveness. Purposive sampling was used to recruit participants from three stakeholder groups (lead researchers, funders, and community stakeholders of CBIs). Online semi-structured interviews were conducted, taking a constructivist approach. Coding, theme development and analysis were based on published guidance for thematic analysis. Twenty-six stakeholders participated in the interviews (12 lead researchers; 7 funders; 6 community stakeholders). Six key themes emerged; (1) Impacts of CBIs (health impacts and broader impacts); (2) Broader benefits were important to stakeholders; (3) Measurement of benefits are challenging; (4) CBIs were considered cost-effective; (5) Framing CBIs for community engagement (6) Making equitable impacts and sustaining changes—successes and challenges. Across all stakeholders, broader benefits, particularly the establishment of networks and partnerships within communities, were seen as important outcomes of CBIs. Participants viewed the CBI approach to obesity prevention as cost-effective, however, there were challenges in measuring, quantifying and valuing broader benefits. Development of tools to measure and quantify broader benefits would allow for more comprehensive evaluation of the cost-effectiveness of CBIs for obesity prevention. (shrink)

Many older people in western countries express a desire to live independently and stay in control of their lives for as long as possible in spite of the afflictions that may accompany old age. Consequently, older people require care at home and additional support. In some care situations, tension and ambiguity may arise between professionals and clients whose views on risk prevention or health promotion may differ. Following Antonovsky’s salutogenic framework, different perspectives between professionals and clients on the pathways (...) that lead to health promotion might lead to mechanisms that explain the origin of these tensions and how they may ultimately lead to reduced responsiveness of older clients to engage in care. This is illustrated with a case study of an older woman living in the community, Mrs Jansen, and her health and social care professionals. The study shows that despite good intentions, engagement, clear division of tasks and tailored care, the responsiveness to receive care can indeed not always be taken for granted. We conclude that to harmonize differences in perspectives between professionals and older people, attention should be given to the way older people endow meaning to the demanding circumstances they encounter (comprehensibility), their perceived feelings of control (manageability), as well as their motivation to comprehend and manage events (meaningfulness). Therefore, it is important that both clients and professionals have an open mind and attempt to understand each others’ perspective, and have a dialogue with each other, taking the life narrative of clients into account. (shrink)

STORY L, MAYFIELD‐JOHNSON S, DOWNEY LH, ANDERSON‐LEWIS C, YOUNG R and DAY P. Nursing Inquiry 2010; 17: 373–384 Getting on Target with Community Health Advisors (GOTCHA): an innovative stroke prevention projectHealth disparities along with insufficient numbers of healthcare providers and resources have created a need for effective and efficient grassroots approaches to improve community health. Community‐based participatory research (CBPR), more specifically the utilization of community health advisors (CHAs), is one such strategy. The Getting on Target (...) with Community Health Advisors (GOTCHA) project convened an interdisciplinary team to answer the call from 10 counties in the rural Mississippi Delta area of ‘The Stroke Belt’ to meet the region’s identified health needs, and to impact the health of a disparaged state. This article explores this CBPR project including the community involvement strategies, innovative CHA training curriculum, evaluation plan, and implications to healthcare professionals, particularly nurses. (shrink)

Se realizó una investigación en sistemas y servicios de salud de tipo descriptiva transversal, con el objetivo de elaborar un sistema de acciones de capacitación para el profesional de la enfermería comunitaria en la prevención del embarazo en la adolescencia. Se aplicaron métodos teóricos y empíricos propios de la investigación científica. El universo lo constituyeron 20 profesionales de enfermería que laboran en consultorios del Área Salud "Tula Aguilera". La muestra quedó conformada por los 12 profesionales que aceptaron participar en el (...) estudio. El criterio de exclusión fue la libre decisión de cada individuo para participar o retirarse de la investigación. Se aplicó una encuesta estandarizada, previo consentimiento informado, para determinar el nivel de conocimientos sobre salud reproductiva en la adolescencia. Los resultados constatados reflejaron que la mayoría de los encuestados tenían criterios estrechos, no fundamentados científicamente ni actualizados sobre el tema, por lo que se diseñó un sistema de acciones de capacitación basado en conocimientos científicos actualizados, pertinentes y contextualizados. Cada actividad se propuso demostrar la factibilidad e importancia de utilizar técnicas participativas y la fundamentación de las ventajas de su uso en diferentes actividades comunitarias, encaminadas a enfatizar en la organización, movilización, concientización y capacitación a los diferentes sujetos sociales involucrados en la prevención del embarazo en la adolescencia, para que estos se conviertan en transformadores de su propia realidad, en correspondencia con sus necesidades y demandas sociales. A descriptive transversal study was carried out on health systems and services aiming at designing a system of training actions for the community professional nurses in order to prevent pregnancy in adolescence. Theorical and empirical methods were applied. The universe was made up of twenty professionals who consented to participate in the study. The inclusion criterion was the free decision of each individual on either participating or not in the investigation. A standard survey was applied -with a previous informed consent , to determine the knowledge about reproductive health in adolescence. The results revealed that most of the surveyed people had narrow criteria with no updated scientific grounds on the issue, thus a system of training actions based on updated scientific pertinent contextualized information was designed Each activity aimed at demonstrating the feasibility study of using participative techniques as well as the reasons for the advantages of their use in a variety of community activities to emphasize the organization and understanding of the different social subjects involved in the prevention of pregnancy in adolescence. (shrink)

상황의 위기는 정보의 위기이다. 왜냐하면 위기는 사건에 대한 정보의 부족이나 공백을 발생시키기 때문이다. 따라서 그런 결함들을 처리하고 불확실성을 제거하기 위해서 위기 상황에서는 사회적 메시지가 발화된다. 그러므로 ‘어떤 메시지가 그리고 어떻게 소통되어야 하는지’는 위기를 극복하는데 있어서 매우 중요한 요소이다. 현재 인류는 코로나19 팬데믹으로 인해서 경제적이고, 사회적이고, 심리적인 심각한 위기에 봉착해 있다. 신종 전염병인 코로나 19에는 예방 백신이 없을 뿐더러 치료제를 개발하는 데도 상당한 기간이 소요될 것으로 예상된다. 그리고 단지 시점이 언제이냐의 문제일 뿐이지 인류는 새로운 감염병인 이른바 “질병 X”를 겪을 것으로 예상된다. (...) 따라서 본 논문은 이러한 장기적이고 반복될 수 있는 위기를 극복하기 위한 방안의 일환으로 ‘메시지의 소통’ 문제를 논의하고자 한다.BR코로나19 사태에서 대중이 매일 듣는 가장 중요한 메시지는 ‘사회적 거리두기’이다. 그리고 자가격리 대상자에게는 ‘자가격리’라는 메시지가 전달된다. 그런데 이 두 메시지는 과연 적합한 또는 최선의 메시지인가? 필자는 코로나19 팬데믹 상황에서 메시지가 갖추어야 할 요건들을 검토한다. 이 요건들에 의거해서 ‘자가격리’와 ‘사회적 거리두기’라는 메시지를 비판적으로 고찰했을 때에, ‘격리 중 자기돌봄’과 ‘감염확산방지를 위한 거리두기’라는 메시지가 더 바람직하다. 뿐만 아니라 효과적일 수도 있다고 필자는 주장한다. 코로나19처럼 신종감염병이 창궐하는 상황에서 사전예방과 사후치료를 위한 의료적 수단이 부재할 경우에, 사회적 메시지는 최대한 의료적인 성격의 메시지여야 한다. (shrink)

Meat is a multi-billion-dollar industry that relies on people performing risky physical work inside meat-processing facilities over long shifts in close proximity. These workers are socially disempowered, and many are members of groups beset by historic and ongoing structural discrimination. The combination of working conditions and worker characteristics facilitate the spread of SARS-CoV-2, the virus that causes COVID-19. Workers have been expected to put their health and lives at risk during the pandemic because of government and industry pressures to keep (...) this “essential industry” producing. Numerous interventions can significantly reduce the risks to workers and their communities; however, the industry’s implementation has been sporadic and inconsistent. With a focus on the U.S. context, this paper offers an ethical framework for infection prevention and control recommendations grounded in public health values of health and safety, interdependence and solidarity, and health equity and justice, with particular attention to considerations of reciprocity, equitable burden sharing, harm reduction, and health promotion. Meat-processing workers are owed an approach that protects their health relative to the risks of harms to them, their families, and their communities. Sacrifices from businesses benefitting financially from essential industry status are ethically warranted and should acknowledge the risks assumed by workers in the context of existing structural inequities. (shrink)

Access to treatment, in HIV vaccine trials (HVTs), remains ethically controversial. In most prevention trials, including in South Africa, participants who seroconvert are referred to publicly funded programmes for treatment. This strategy is problematic when there is inadequate and uneven access to public sector antiretroviral therapy (ART) and support resources. The responsibilities, if any, of researchers, sponsors and public health authorities involved in HVTs has been hotly debated among academics, scholars, representatives of international organizations and sponsors. However, there is (...) little published on community perceptions. Recent guidance asserts that communities should make inputs into treatment and care decisions. This qualitative study explored a South African community's perceptions of who should provide what to HVT participants as well as how and why this should be done. Twenty-nine adults working at or attending five primary health care clinics in two rural areas in KwaZulu-Natal participated in in-depth interviews. Respondents expressed that researchers should ‘help participants to access’ treatment and care ‘because they are in a position to do so’ and ‘are in a relationship with’ trial participants. Respondents suggested that researchers could help by ‘facilitating referral’ until such time that participants can access care and treatment on their own. We highlight a series of implications for researchers in HVTs, including their need to be aware of prospective participants' considerable trust in and respect for researchers, the responsibility that this places on them, and the need for clear communication with communities so as not to erode community trust. (shrink)

This paper explores three selected issues which present ethical challenges unique to the development and testing of preventive HIV vaccines. The issues are: when to move forward with large scale efficacy testing of vaccines, how to incorporate behavioral interventions into the study of vaccine efficacy, and how to plan for and mitigate social harms associated with participation in an HIV vaccine trial. Careful and ongoing consideration must be given to the ethical implications of these decisions. Proposed solutions include planning for (...) a more complex prevention trial which would integrate the evaluation of behavioral interventions and vaccine efficacy; scrupulous attention to the process of individual informed consent and community participation; and serious and deliberate attempts to plan for, educate about, and minimize the social harms. Keywords: behavioral interventions, HIV, subject protection, trial design, vaccines CiteULike Connotea Del.icio.us What's this? (shrink)

In these twelve papers notable ethicists use the resources of ethical theory to illuminate important theoretical and practical topics, including the nature of public health, notions of community, population bioethics, the legitimate role of law, the use of cost-effectiveness as a methodology, vaccinations, and the nature of infectious disease.

In some jurisdictions, the institutions of criminal justice may subject individuals who have committed crimes to preventive detention. By this, I mean detention of criminal offenders (i) who have already been punished to (or beyond) the point that no further punishment can be justified on general deterrent, retributive, restitutory, communicative or other backwardlooking grounds, (ii) for preventive purposes—that is, for the purposes of preventing the detained individual from engaging in further criminal or otherwise socially costly conduct. Preventive detention, thus understood, (...) shares many features with the quarantine measures sometimes employed in the context of infectious disease control. Both interventions involve imposing (usually severe) constraints on freedom of movement and association. Both interventions are standardly undeserved: in quarantine, the detained individual deserves no detention (or so I will, for the moment, assume), and in preventive detention, the individual has already endured any detention that can be justified by reference to desert. Both interventions are, in contrast to civil commitment under mental health legislation, normally imposed on more-or-less fully autonomous individuals. And both interventions are intended to reduce the risk that the constrained individual poses to the public. Yet despite these similarities, preventive detention and quarantine have received rather different moral report cards. (shrink)

Awareness, care and preventative action regarding HIV/aids, and those affected by it, is growing in the evangelical Christian Community in French-speaking Sub-Saharan Africa. Yet, even though the issues seem to be addressed through teaching and preaching in the churches, the real issues, questions and struggles of the people are not discussed. This article describes some of the most important outcomes of a qualitative research in this people group, looking at the values and beliefs around sexuality and community and (...) what impact they have on current HIV/aids prevention practices and strategies. This description highlights the seeming discrepancy between people’s values and their daily lives, the role community can play – as both a community of grace and a countercultural yet contextually relevant community, and the role of leaders, grass-root communities and partnership processes in strategy development. This article argues for a contextual relevant approach in which the specific evangelical worldview is encountered as a possible strength, rather than a problem. (shrink)

Ethical issues flow from and are embedded in contexts of practice. Contexts of practice refer to the diverse social settings where interventions occur. Primary prevention activities require new professional roles in these diverse social settings. These new roles engage the professional in new activities, which in mm allow new ethical issues to arise. This article takes an ecological perspective on ethical issues arising from the enactment of new preventive roles intended to affect groups or communities. Within this perspective, the (...) concepts of context and culture take on special conceptual significance. Four ecological assumptions about preventive interventions intended to affect groups or communities are offered as a means of framing ethical issues in such interventions. Finally, several approaches to developing ecological knowledge about the contexts of practice are presented as ways of furthering our ability to conceptualize and cope with ethical issues in preventive interventions intended to affect groups or communities. (shrink)

Healthcare institutions have been making increasing efforts to standardize consultation methodology and to accredit both bioethics training programs and the consultants accordingly. The focus has traditionally been on the ethics consultation as the relevant unit of ethics intervention. Outcome measures are studied in relation to consultations, and the hidden assumption is that consultations are the preferred or best way to address day-to-day ethical dilemmas. Reflecting on the data from an internal quality improvement survey and the literature, we argue that having (...) general ethics education as a key function of ethics services may be more important in meeting the contemporaneous needs of acute care settings. An expanded and varied ethics education, with attention to the time constraints of healthcare workers’ schedules, was a key recommendation brought forward by survey respondents. Promoting ethical reflection and creating a culture of ethics may serve to prevent ethical dilemmas or mitigate their effects. (shrink)

In recent decades, rescue archaeology in Europe has uncovered a much larger number of remains than planned archaeology. The mass of information resulting from this preventive research is such that its processing is a colossal task, but also unavoidable if preventive excavations are not to become synonymous with the destruction of the remains – which is precisely what they are supposed to prevent. The effort that our society must make (in terms of time and financial resources in particular) may seem (...) heavy, even insurmountable to some; nevertheless, this effort is imperative and essential, because preventive excavations raise major challenges, both scientific and societal. This article aims to detail these issues and analyse them in the light of the deleterious effects of neoliberal logic on rescue archaeology and the associated ecological and societal difficulties. (shrink)

Pétrie d’injonctions à s’approprier le temps selon ses propres canons, la prévention semble ne prêter que peu d’attention à la pluralité des temps sociaux, ainsi qu’à leurs contextes de production et d’énonciation. Dans la mesure où les inégalités sociales de santé résident en partie dans la capacité de l’individu à mettre en pratique les normes préventives, et donc à agir aujourd’hui pour sa santé de demain, et où la pauvreté contribue à entraver la projection dans un à venir, nous avons (...) souhaité analyser les positionnements de personnes se trouvant dans différentes situations de précarité face aux discours préventifs et à l’entreprise de leurs propres projets de santé, tout en plaçant la « question » des rapports au temps au cœur de nos travaux. Aussi, selon les contextes socio-économiques, les ressources mobilisables, les perspectives d’ascension ou de déclassement social, les normes préventives ne sont pas appropriées et restituées de la même façon. Il ressort de cet article que sous des revendications apparemment communes, impulsées par le désir d’adhérer à la norme, s’inscrivent en réalité des motivations et des pratiques diverses, largement influencées par des régimes de temporalités socialement différenciés. (shrink)

This study investigated how young Italian people experienced the period of peak spread of COVID-19 in their country by probing their emotions, thoughts, events, and actions related to interpersonal and community bonds. This approach to the pandemic will highlight social dimensions that characterized contextual interactions from the specific perspective of Community Psychology. The aim was to investigate young people's experiences because they are the most fragile group due to their difficulty staying home and apart from their peers and (...) because they are, at the same time, the most potentially dangerous people due to their urge to gather in groups. The research involved 568 university students, 475 females, and 93 males, with an average age of 21.82 years. The collected data were analyzed with the Grounded Theory Methodology, using the Atlas 8.0 software. From the textual data, representative codes were defined and grouped into 10 categories, which reflect the individuals' prosocial attitudes, behaviors, and values. These categories formed three macro-categories, called: “Collective Dimensions,” which includes Connectedness, Solidarity, Italian-ness, Social Problems, and Collective Mourning; “Prosocial Orientation,” which includes Trust and Hope; and “Collective Values,” which includes Values of Freedom, Respect of Social Rules, and Civic-Mindedness. All these macro-categories are indicative of the shared feelings experienced by Italians during the first time of the pandemic. Further practical implications of these results will be discussed, including a consideration of the risk of developing distress and improving well-being, as well as promoting preventive behaviors. (shrink)

The present study investigates the association between mental health problems and criminal behavior among adolescents in Sweden. Community crime prevention in a Swedish context is also discussed. Every two years, pupils from schools in Stockholm answer the Stockholm School Survey with questions and statements about their social situation, alcohol and drug use, attitudes, school climate, school grades and criminal behavior. Data collected from pupils who answered the survey in 2014, 2018 and 2020 form the basis of this study. (...) A significant association between mental health problems and criminal behavior was shown, even after controlling for factors suggested in international literature. Mental health problems were shown to be a strong explanation for criminal behavior among adolescents. (shrink)

IN THE UNITED STATES, 25 PERCENT OF PEOPLE LIVING WITH HIV/AIDS HAVE spent time in the correctional system. HIV is known to spread among incarcerated individuals through high-risk behaviors including unprotected sex, injection drug use, tattooing, and body piercing. When released from prison, persons living with HIV can spread the disease in the wider community. This essay explores the complex problem of HIV infection among US prisoners from a common good approach rooted in Catholic social teachings by examining available (...) data on US prison populations, describing recent trends in the prosecution of drug-related crimes, and proposing concrete policy recommendations for HIV prevention interventions in US prisons. (shrink)

In 2004, the first ever multi‐sited clinical trials studied the prospect of HIV biomedical prevention (referred to as pre‐exposure prophylaxis—‘PrEP’). The trials were implemented at several international sites, but many officially closed down before they completed. At most sites, both scientists and community AIDS advocates raised concerns over the ethics and scientific rationales of the trial. Focusing on the Nigerian trial site, we detail the controversy that emerged among mostly Nigerian research scientists who scrutinized the research design and (...) protocol. While some of the disputes, especially those pertaining to community engagement mechanisms, were ultimately resolved in international fora and implemented in later PrEP trials, concerns over science rationales and assumptions were never addressed. We argue that scientific rationales should be treated as ethical concerns and suggest that such concerns should be deliberated at host sites before the trial protocol is finalized. (shrink)

In this article we address torture in military and police organizations as a public health and human rights challenge that needs to be addressed through multiple levels of intervention. While most mental health approaches focus on treating the harmful effects of such violence on individuals and communities, the goal of the project described here was to develop a primary prevention strategy at the institutional level to prevent torture from occurring in the first place. Such an approach requires understanding and (...) altering the conditions that cause and sustain “atrocity producing situations”. Given the persistence of torture across the world and its profound health consequences, this is an increasingly important issue in global health and human rights. (shrink)

Universities and research funders’ growing emphasis on community partnerships, engagement and outreach has seen a rise in collaborations between university researchers and staff of community organisations (COs) on research projects. What ethical issues and concerns are experienced as part of these collaborations has largely not been described,particularly from the perspective of COs. As part of a recent, broader qualitative study, several concerns arising during health research collaborations between COs and university researchers were captured during thematic analysis. The concerns (...) were described in semistructured interviews by four staff of three COs that work with marginalised groups (ie, migrants and refugees, women who experience domestic violence, indigenous populations) in a high-income country. In this paper, the three concerns are taken as the starting point for ethical analysis. Interview data are first used to illustrate the three concerns: being restricted to a recruitment role in studies, reinforcement of stereotypes of marginalised groups and weakening CO-community relationships. The paper then explores why the concerns are morally troubling and demonstrates how each concern generates feelings of disrespect, creates harm(s), and/or reflects or reinforces unfairness or injustice. It concludes by proposing three ethical criteria for CO-researcher partnerships: fair division of labour, balancing CO advocacy goals with research goals and balancing CO service goals with research goals. Where researchers and COs discuss how to meet these criteria at the start and during research collaborations, it can potentially help mitigate or prevent the occurrence of the concerns described in this paper. (shrink)

Purpose The purpose of this paper is to address the following question: In times of permanent connectivity, what forms of freedom need to be considered to prevent permanent availability as an unintended consequence? By using the Hegelian perspective on freedom, the paper categorizes three forms of freedom to transfer them to a common, contemporary understanding of freedom relating it to freedom through human-to-human digital communication. The aim is to show that freedom is not only about independence and realizing choices but (...) also about embedding and committing oneself. Design/methodology/approach This mainly conceptual paper derives implications based on the Hegelian theory. This is supplemented by an interdisciplinary approach, whereby categories of other philosophers, ethicists, economists and sociologists are applied. The analysis of the contemporary perspective on freedom is enriched by referencing empirical studies. Findings Digital communication offers new freedom such as working with fewer restrictions from time and space, especially for knowledge workers. It is theoretically possible to work 24 h per day from anywhere, as well as to decide on the final location and timing of one’s work. When solely focusing on these – seemingly advantageous – forms of freedom in times of permanent connectivity, unintended consequences such as the expectation of permanent availability develop. The key message of the paper is that considering one’s temporal and social dependencies is an indispensable part of actual freedom to avoid unintended consequences. Practical implications Organizations need to invest in moral discernment to understand unintended consequences, as well as to cope with them. Originality/value Applying the Hegelian theory on freedom based on digital communication to better understand social dynamics of digital communication is a largely unexplored avenue in the existing scientific literature. The decision to undertake this venture resulted from the identified necessity of understanding freedom better. It is often not clear what is meant by freedom through digital communication. Although freedom is a complex construct, it is often reduced to independence/having a choice and realizing choices. When solely focusing on independence and realizing choices, unintended consequences such as permanent availability often go unnoticed. It is exactly because of these issues that this paper endeavors to examine the meaning of the powerful, yet complex, term of freedom. (shrink)

RESUMEN Introducción: El proceso de cuidar es el resultado de una construcción propia de cada situación, se origina con la identificación de los problemas de salud y las necesidades reales o potenciales de las personas, familia y comunidad que demandan cuidado. Objetivo: Evaluar el impacto del Diplomado Prevención del Síndrome de Burnout, en el autocuidado del personal de enfermería de la Atención Secundaria de Salud de la provincia Camagüey. Métodos: Se realizó un estudio descriptivo observacional, en el Hospital Amalia Simoni (...) Argilagos de Camagüey, durante el Diplomado Prevención del Síndrome de Burnout dirigido al personal de enfermería de la Atención Secundaria de Salud. Para ello se aplicó una encuesta y el Test Psicológico de Maslach y Jackson al inicio y al final de la aplicación del Diplomado. Los datos aportados por estos instrumentos se complementaron con los provenientes de la aplicación de la técnica del PNI. Resultados: Predominó el sexo femenino. El total de los cursistas son licenciados en Enfermería. Con la ejecución del diplomado se constatan cambios importantes en cuanto a la autopreparación, el rendimiento, los hábitos de descanso, satisfacción personal y realización de ejercicios físicos. Discusión: La aplicación del diplomado logró transformar estilos de trabajo, afrontamientos al estrés, así como una mejor satisfacción personal y colectiva. ABSTRACT Introduction: The process of taking care is the result of a proper construction of every situation, it originates with the identification of the problems of health and the real or potential needs of the persons, family and community that demand care. Objective: To evaluate the impact of Postgraduate Course Prevention of the Syndrome of Burnout, in the self-care of the personnel of infirmary of the Secondary Attention of Health of the Camagüey province. Methods: a descriptive, observational study was carried out in the Hospital Amalia Simoni Argilagos of Camagüey, during Postgraduate Course Prevention of the Syndrome of Burnout directed to the personnel of infirmary of the Secondary Attention of Health. For that reason, a survey and the Psychological Test of Maslach and Jackson was applied at the beginning and at the end of the application of the course. The information contributed by these instruments complemented itself with the originated ones from the application of the technique of the PNI. Results: The sex that predominated was the feminine one. All of the students are licensed in Infirmary. With the execution of the course important changes are stated as for the self-preparation, the yield, the habits of rest, personal satisfaction and achievement of physical exercises. Discussion: The application of the course managed to transform styles of work, confrontations to the stress, as well as a better personal and collective satisfaction. (shrink)

After centuries of symbolic and political oppression, Galicia has been recognized by the Spanish constitution as a historic nationality. However, despite a certain degree of political autonomy, Galician identity is threatened by increasing homogenization in the economic, social, cultural and linguistic fields. In the early 1990s the aesthetic movement Bravú constructed an aesthetic community, sustained by an ideological project, and with the aim to, on the one hand, prevent Galician culture from becoming folklore stuck in a time warp and, (...) on the other hand, to validate Galician identity. The Bravú artists refused the historically inherited outsider position and contributed to a reinvention of Galician identity and of a political ideal within a cosmopolitan, internationalist framework and by reversing social stigmas through their works and performances. (shrink)

Background: Research suggests that humans have the tendency to increase the valence of events when these are imagined to happen in the future, but to decrease the valence when the same events are imagined to happen in the past. This line of research, however, has mostly been conducted by asking participants to value imagined, yet probable, events. Our aim was to re-examine this time-valence asymmetry using real-life data: a Reuter’s news and a Facebook status updates corpus. Method: We organized the (...) Reuter news (120,000,000 words) and the Facebook status updates data (41,056,346 words) into contexts grouped in chronological order (i.e., past, present, and future) using verbs and years as time markers. These contexts were used to estimate the valence of each article and status update, respectively, in relation to the time markers using natural language processing tools (i.e., the Latent Semantic Analysis algorithm). Results: Our results using verbs, in both text corpus, showed that valence for the future was significantly higher compared to the past (future > past). Similarly, in the Reuter year condition, valence increased approximately linear from 1994 to 1999 for texts written 1996-7. In the Facebook year condition, the valence of the future was also significantly higher than past valence. Conclusion: Generally, the analyses of the Reuters data indicated that the past is devaluated relative to both the present and the future, while the analyses of the Facebook data indicated that both the past and the present are devaluated against the future. On this basis, we suggest that people strive to communicate the promotion of a bright future and the prevention of a dark future, which in turn leads to a temporal-valence asymmetrical phenomenon (valence = pastshrink)

Ethics dumping is the practice of undertaking research in a low- or middle-income setting which would not be permitted, or would be severely restricted, in a high-income setting. Whilst Kenya operates a sophisticated research governance system, resource constraints and the relatively low number of accredited research ethics committees limit the capacity for ensuring ethical compliance. As a result, Kenya has been experiencing cases of ethics dumping. This article presents 11 challenges in the context of preventing ethics dumping in Kenya, namely (...) variations in governance standards, resistance to double ethics review, resource constraints, unresolved issues in the management of biological samples, unresolved issues in the management of primary data, unsuitable informed consent procedures, cultural insensitivity, differing standards of care, reluctance to provide feedback to research communities, power differentials which facilitate the exploitation of local researchers and lack of local relevance and/or affordability of the resultant products. A reflective approach for researchers, built around the values of fairness, respect, care and honesty, is presented as a means of taking shared responsibility for preventing ethics dumping. (shrink)

Chronic diseases are major causes of health inequalities. Community nurses can potentially make large contributions to chronic illness prevention and management in Israel but may be obstructed by professional dominance of physicians. However, insufficient research exists about community nursing in Israel, and how it may differ from other countries. This study aims to document chronic disease‐related community nursing roles in Israel, identify changes and trends in community nursing roles that may increase social justice, and understand (...) how the roles and trends in community health nursing in Israel may differ from developments in other countries. In‐depth interviews were performed with 55 Israeli health system professionals, and 692 nurse care‐givers were asked open‐ended questions. Interview answers were analyzed to find themes and trends. The study found that community nurse roles in Israel have expanded, especially for chronic disease control. Commonalities exist with countries such as the United States and the UK, albeit with important differences. However, continued conflicts with physicians exist, which can limit nurses' contributions to reducing health inequalities. Community nurses' importance is growing. Enabling them to overcome professional dominance and improve chronic disease control can help reduce health inequalities in Israel and elsewhere. (shrink)

Malpractice lawsuits serve as a great source of pain, consternation and loss for physicians and patients alike, usually leaving all parties involved in the process with a sense of betrayal. A significant number of physicians will be sued at least once in their career, especially if they practice in some of the more vulnerable specialties. In addition, there is some evidence that the threat of malpractice lawsuits changes the practice style of many physicians, leading to the practice of “defensive medicine” (...) and raises the total cost of health care. Clearly, the prevention of medical malpractice is an issue that deserves considerable attention from physicians and from those who train them.Empirical evidence suggests that medical negligence may play a relatively minor role in malpractice lawsuits. As demonstrated by Localio, et al., one in thirty-five cases of negligence or incompetence actually results in a lawsuit. (shrink)