The concept of professional autonomy has figured prominently in literature that addresses nursing's project of professionalization. Nursing's capacity to determine the nature and scope of its practice is related in important ways to the location of practice. Within highly structured environments such as acute‐care hospitals, nurses' professional autonomy has frequently been contested yet is often implicated by nursing's elite as a necessary condition in the construction of quality work environments. Professional concerns and management practices related to retaining experienced nurses (...) to support sustainability in healthcare delivery systems' impact on the ability of nurses to practice autonomously. Our paper focuses on the emerging field of practice of chronic disease management. We describe the complex relationships negotiated by a nurse in a theoretically autonomous practice setting as she seeks to fulfil both the requirements of a research protocol designed by physician experts representing the specialty of renal medicine, and her professional obligations to respond to the expressed needs of patients with early‐stage renal disease. We utilize a case study approach to explore particular contemporary concerns that nurses in practice confront as they attempt to accomplish professional relationships with patients central to achieving prescribed medical outcomes where nursing practice, as an element of the achievement of those outcomes, is constituted as absent or unacknowledged by the medical researchers leading the project. Implications for nursing's discourses on the professional project of autonomy will be discussed. (shrink)

Differences in perceptions and knowledge of crop diseases constitute a major obstacle in farmer–researcher cooperation, which is necessary for sustainable disease management. Farmers’ perceptions and management of crop diseases in the northern Ethiopian Regional State of Tigrai were investigated in order to harness their knowledge in the participatory development of integrated disease management (IDM) strategies. Knowledge of disease etiology and epidemiology, cultivar resistance, and reasons for the cultivation of susceptible cultivars were investigated in a (...) total of 12 tabias (towns) in ten weredas (districts). Perception of diseases involved both scientific and spiritual conceptual frameworks. Of the more than 30 crop diseases recorded on the major crops in the region, only rusts and powdery mildews (locally called humodia) and a few root rots were considered by farmers to be important. Farmers’ awareness of other diseases was extremely low; some highly damaging but less conspicuous diseases, such as faba bean chocolate spot and chickpea ascochyta blight (also called humodia), were not regarded by farmers as disease but as problems caused primarily by excessive soil moisture. Considering that some of these “unrecognized” diseases can cause complete yield loss and genetic erosion in epiphytotic years, there is an urgent need for bringing together farmers’ and scientists’ knowledge to complement each other. Even when farmers had access to disease-resistant or disease-tolerant cultivars, they grew susceptible local varieties because of multiple criteria including earliness, good yield in years with low humodia severity, suitability for home consumption, market demand/quality, and low soil fertility and land management requirements. Farmer innovation and knowledge were evident in their use of diverse disease control measures, but these were a mixture of the “useful and the useless.” Our findings stress the necessity for extension workers and researchers to understand and improve farmers’ knowledge of crop diseases, and farmers’ ability to observe and experiment, through the Farmer Field School or a similar experiential learning approach. These insights about farmers’ knowledge of crop diseases provide a basis for further collaborative maintenance of crop genetic diversity, development of germplasm, and IPM-related research in Africa. (shrink)

On 11 March 2020, the World Health Organization declared a pandemic of the COVID-19 coronavirus disease that was first recognized in China in late 2019. Among the primary effects caused by the pandemic, there was the dissemination of health preventive measures such as physical distancing, travel restrictions, self-isolation, quarantines, and facility closures. This includes the global disruption of socio-economic systems including the postponement or cancellation of various public events (e.g., sporting, cultural, or religious), supply shortages and fears of the (...) same, schools and universities closure, evacuation of foreign citizens, a rise of unemployment, changes in the international aid schemes, misinformation, and incidents of discrimination toward people affected by or suspected of having the COVID-19 disease. The pandemic has brought to the fore unpreparedness in critical areas that require attention, amid prospects and challenges. Moreover, considerable reorganization efforts are required with implications for assets, resources, norms, and value systems. COVID-19 is challenging the concept of globalization and stimulating responses at the levels of local and regional socio-economic systems that lead to the mobilization of assets that have been unrecognized earlier on, such as various forms of economic capital, social capital, cultural capital, human capital, and creative capital. For example, through digital channels, local groups are forming to create schemes of support for physical and mental wellbeing. These emerging exchanges lead to various social and technological innovations by building on skills and assets that are less important in the free-market economy, such as empathy, skills for crafts, making and fixing; locally grown microgreens; and micromanufacturing. Isolation and local living are also making it much harder to ignore the civic responsibilities towards communities, meant as individuals, vulnerable groups, and local businesses. Whilst the pandemic is limiting physical participation, this challenging time is uncovering alternative ways of mutual support, which may create long-term benefits for socio-economic systems, including environmental and biodiversity protection, reduction of the air pollution, and climate action. The pandemic’s threat to public health will hopefully be overcome with implications for disruption for an extended period that we are unable to forecast at this stage. It is key to focus on studies recognizing the activities and interventions leading to the recovery of socio-economic systems after the pandemic. Reflecting and planning on how societies and economies will go back to “business as usual” requires new forms of communication and cooperation, imaginative design thinking, new styles of management, as well as new tools and forms of participation in various public policies. Many questions related to the care of the vulnerable, economic restart, and the risk of future pandemics, to mention but a few, are already occupying the academic, scientific, experts, and activist communities, who have started to imagine the “new normal.”. (shrink)

This paper asks what influences farmers’ adherence to national and international zoonotic disease intervention efforts and argues that development and promotion of biosecurity interventions must take into account the economic and social context informing how livestock sectors operate and how those who work in them are making a living. Specifically, we explore how poultry farms in Viet Nam are managed amidst global efforts to combat disease and national ambitions to sustain growth. The growth of Viet Nam’s livestock sector (...) has been accompanied by a range of disease outbreaks that have caused the deaths of animals and humans, threatened businesses, and led to the introduction and ongoing revisions to biosecurity efforts. Despite a strict national (and international) agenda focusing on disease control through biosecurity strategies, on farms disease management is implemented in various ways and to varying degrees. Based on fieldwork in three provinces of Northern Viet Nam and in-depth interviews with actors working on farms and across the commercial poultry sector, we reflect on social, financial and political factors shaping the country’s biosecurity narratives and discuss key practices farming households engage in that influence their disease management efforts. Our findings reveal that strict adherence to biosecurity guidelines is often practically unfeasible for commercial poultry farming households to implement where zoonotic diseases are not a concern related to bird and human health so much as a potential risk to a household’s living, that exists among a range of diverse opportunities and uncertainties shaping farming operations in Viet Nam’s changing livestock sector. (shrink)

Recent philosophical literature has highlighted the complexities of handling dissent in science. On one hand, scientific dissent can be very harmful, as when “merchants of doubt” strategically appeal to dissent in order to undermine important environmental and public-health initiatives. On the other hand, scientific dissent can also be beneficial when it helps to promote scientific objectivity, progress, and public engagement. Some authors have responded to this tension by suggesting criteria for distinguishing normatively appropriate and inappropriate dissent, while other authors have (...) suggested that it is more fruitful to alter the social context in which science operates in order to alleviate the negative effects of dissent over the long term. This paper proposes another approach that may be helpful for managing particularly challenging cases of scientific dissent. It argues that instances of scientific dissent often incorporate debates over value judgments, so many difficult cases of dissent can be navigated by: (1) identifying and highlighting those value judgments; and (2) managing those value judgments by drawing strategies from the extensive literature on values and science. The paper illustrates this approach by examining a case study of dissent over the treatment of long-term symptoms associated with Lyme disease. (shrink)

Nearly all contemporary people subsist on cultivated plants, most of which are vulnerable to diseases. Yet, there have been few studies of what traditional people know – and do not know – about crop disease. Agricultural scientists in general are becoming aware of the potential contribution of social scientists and farmers in developing integrated management of crop diseases. The International Potato Center (CIP) has focused on stimulating farmer-scientist collaboration in developing management of late blight, a major fungal (...) disease of potatoes and other plants. Understanding farmers' knowledge of this and other plant diseases is an important element in furthering such collaboration. Although not all agricultural scientists recognize the value of social science, this literature search shows that some agricultural scientists now actively collaborate with farmers, in ways that cross the boundary into social science research. During this search, much of the work we found was written by plant pathologists and entomologists. We found over fifty publications on farmer knowledge of crop disease, and we have annotated the material that we thought most relevant to farmer- scientist collaboration for research of crop diseases, especially late blight. (shrink)

The declaration of the COVID-19 pandemic by the World Health Organization on March 11, 2020, led to unprecedented events. All regions of the world participated in implementing preventive health measures such as physical distancing, travel restrictions, self-isolation, quarantines, and facility closures. The pandemic started global disruption of socio-economic systems, covering the postponement or cancellation of public events, supply shortages, schools and universities’ closure, evacuation of foreign citizens, a rise in unemployment and inflation, misinformation, the anti-vaccine movement, and incidents of discrimination (...) toward people affected by or suspected of having coronavirus disease. Attempts have been made to protect the oldest age group at risk, but in many cases, this has led to over-restriction and age discrimination. The rationale for working on the Research Topic "Socio-economic systems in the post-pandemic world: Design thinking, strategic planning, management, and public policy" was the need to start reflecting on resilience and lessons learned from this public health event that revealed the global unpreparedness in critical areas. Also, the pandemic triggered both top-down and bottom-up responses that needed more in-depth analyzes. This Research Topic covers interdisciplinary contributions addressing new thinking, challenges, and transformations required for post-pandemic global, national, regional, and local realities. The presented Research Topic combines studies focused on recognizing the actions and interventions leading to the recovery of socio-economic systems during the tail end and after the pandemic. The studies delivered recommendations regarding, among others, the care of vulnerable, planning socio-economic restart, and imagining the "new normal.". (shrink)

ABSTRACT Patient self‐management (SM) of chronic disease is an evolving movement, with some forms documented as yielding important outcomes. Potential benefits from proper preparation and maintenance of patient SM skills include quality care tailored to the patient's preferences and life goals, and increase in skills in problem solving, confidence and success, generalizable to other parts of the patient's life. Four central ethical issues can be identified: 1) insufficient patient/family access to preparation that will optimize their competence to SM (...) without harm to themselves, 2) lack of acknowledgement that an ethos of patient empowerment can mask transfer of responsibility beyond patient/family competency to handle that responsibility, 3) prevailing assumptions that preparation for SM cannot result in harm and that its main purpose is to deliver physician instructions, and 4) lack of standards for patient selection, which has the potential to exclude individuals who could benefit from learning to SM. Technology assessment offers one framework through which to examine available data about efficacy of patient SM and to answer the central question of what conditions must be put in place to optimize the benefits of SM while assuring that potential harms are controlled. (shrink)

Chronic diseases are recognized as a leadingcause of mortality, morbidity, health careutilization and cost. A constant tailoring ofcare to the actual needs of individualpatients, complexity and long duration are thedistinguishing features of chronic diseasemanagement.

Our understanding of the complexity of the oral biome and of the role of the various constituent bacteria in the aetiology of dental disease is growing. Probiotics and their relationship with prebiotics, as well as other microbiome‐based interventions, could be useful in preventing and treating dental disease and in promoting oral health. However, given the promise and early stage of this treatment approach, there are also a number of ethical, social and regulatory issues associated with innovative probiotic therapy. (...) In this article, a brief update is given on contemporary theories of the aetiology and management of the two commonest dental diseases, and on the roles of pre‐ and probiotics and oral biome transplant in the management of these diseases. The focus is primarily on four core issues: informed consent, risk–benefit assessment, how to determine suitable healthy donors, and commercialization and regulation. We discuss the safety and benefits of oral probiotics, not only concerning the products and quality control during their manufacture, but also regarding the depth of public knowledge about this topic. We point out that the requirement of listing ingredients honestly might be insufficient, and that the prevalent rhetoric of ‘natural’ and ‘organic’ as well as some health claims in the translational, innovative probiotic industry and markets are themselves misleading and should be carefully scrutinized. Finally, we suggest an ethical imperative to find a balance between scientific research and industry, and public health in the regulation of probiotics. (shrink)

Cardiovascular disease (CVD) and sustained high blood glucose as prediabetes are an established comorbidity. People's experience in reconciling these long‐term conditions requires deeper appreciation if nurses are to more effectively support person‐centred care for people who have them. Our analysis explores the initial experience of people admitted to hospital with CVD who then find they also have sustained high blood glucose. Our methodology is informed by the philosophy of Gadamer and applies interpretive description to develop an interpretation of participant (...) experiences. The major theme emerging from participant interviews was the ‘invisible disequilibrium’ characterised by three subthemes: ‘losing equilibrium’, ‘becoming embattled’ and ‘evolving illness’. This study examines CVD and prediabetes in conjunction with the Gadamerian notion of the ‘whole’, as being in a social and emotional world in which illness is also a component part. We explore how participants lived within an ‘invisible disequilibrium’, with prediabetes frequently remaining unnoticed, while CVD was manifest. To identify multiple conditions and support effective intervention to manage them as part of person‐centric care, nursing practice should explore the ‘whole’ of the person's experience, value people’s knowledge as potential indicators of complex illness, thereby reducing the risk of accelerating complex illness. (shrink)

Livestock production has been confronted with several epidemics over the last decades. The morality of common animal disease strategies—stamping out and vaccination—is being debated and provokes controversies among farmers, authorities and the broader public. Given the complexity and controversy of choosing an appropriate control strategy, this article explores the potential of nano-enabled diagnostics in future livestock production. At first glance, these applications offer promising opportunities for better animal disease surveillance. By significantly shortening the reaction time from diagnosis to (...) appropriate control, they could complement the current disease management strategies. Although nano-enabled diagnostics will not make livestock disease eradication strategies redundant or completely free of the culling of infected animals, these diagnostics could significantly reduce the number of culled animals and animal suffering. This article aims to demonstrate that the ethical assessment of advanced diagnostics can build on the experiences with decision making in biomedical ethics where nonmaleficence, beneficence, autonomy and justice serve as important benchmarks. Nano-enabled diagnostics may be an ethically sound solution if it can resolve the dilemma between stamping out and vaccination in favor of the latter and if it can balance the autonomy–paternalism dilemma between farmers and authorities. The technology should allow to be switched on and off by farmers, whilst simultaneously allowing for a weak paternalism on behalf of authorities in order to benefit the farmer and broader society and to protect them from harm. (shrink)

Globally, chronic disease and conditions such as diabetes, cardiovascular disease, depression and cancer are the leading causes of morbidity and mortality. Why, then, are public health efforts and programs aimed at preventing chronic disease so difficult to implement and maintain? Also, why is primary care—the key medical specialty for helping persons with chronic disease manage their illnesses—in decline? Public health suffers from its often being socially controversial, personally intrusive, irritating to many powerful corporate interests, and structurally (...) designed to be largely invisible and, as a result, taken for granted. Primary care struggles from low reimbursements, relative to specialists, excessive paperwork and time demands that are unattractive to medical students. Our paper concludes with a discussion of why the need for more aggressive public health and redesigned primary care is great, will grow substantially in the near future, and yet will continue to struggle with funding and public popularity. (shrink)

This book is... a survey history of medicine from the earliest times, centered thematically on how changing concepts of disease have affected its management.... One finds a gratifying mastery of recent as well as classic scholarship in medical history and a careful sidestepping of positivistic excesses.... Disease and Its Control is a fresh and welcome synthesis of historical scholarship that will be accessible to interested laymen. (Annals of Internal Medicine).

ABSTRACT A recent approach for bioterrorism risk management calls for stricter regulations over biotechnology as a way to control subversion of technology that may be used to create a man‐made pandemic. This approach is largely unworkable given the increasing pervasiveness of molecular techniques and tools throughout society. Emerging technology has provided the tools to design much deadlier pathogens but concomitantly the ability to respond to emerging pandemics to reduce mortality has also improved significantly in recent decades. In its historical (...) context determining just how ‘risky’ biological weapons is an important consideration for decision making and resource allocation. Management should attempt to increase capacity, share resources, provide accurate infectious disease reporting, deliver information transparency and improve communications to help mitigate the magnitude of future pandemics. (shrink)

Alzheimer’s, accounting for 60-80% of dementia cases, presents a specific pathologyand a range of symptoms, including memory loss, impaired reasoning, andother cognitive declines. The disease’s progression and management require a comprehensiveapproach involving professional care, family involvement, and individualizedcare plans.The research focuses on methods for working with individuals with Alzheimer’sdisease and their families, highlighting the importance of communication in implementingindividualized care plans. It aims to show that a well-prepared care plan, coupledwith effective communication with family members, can improve quality (...) of life andpotentially slow disease progression. It was conducted in two parts: a questionnaire forcaregivers working with Alzheimer’s patients and a semi-structured interview with 33family members of individuals diagnosed with the disease. This approach provided bothquantitative and qualitative data, offering a comprehensive understanding of the issues.To improve Alzheimer’s care, we recommend enhancing family involvementthrough structured models and training, increasing the accessibility of specializedservices, promoting professional development, strengthening ethical communicationstandards, implementing comprehensive support systems, and regularly evaluatingcare plans. These measures aim to provide holistic and effective care strategies, improvingthe quality of life for individuals with Alzheimer’s and their families. (shrink)

As the recent Ebola outbreak demonstrates, visibility is central to the shaping of political, medical, and socioeconomic decisions. The symposium in this issue of the Journal of Bioethical Inquiry explores the uneasy relationship between the necessity of making diseases visible, the mechanisms of legal and visual censorship, and the overall ethics of viewing and spectatorship, including the effects of media visibility on the perception of particular “marked” bodies. Scholarship across the disciplines of communication, anthropology, gender studies, and visual studies, as (...) well as a photographer’s visual essay and memorial reflection, throw light on various strategies of visualization and legitimation and link these to broader socioeconomic concerns. Questions of the ethics of spectatorship, such as how to evoke empathy in the representation of individuals’ suffering without perpetuating social and economic inequalities, are explored in individual, national, and global contexts, demonstrating how disease visibility intersects with a complex nexus of health, sexuality, and global/national politics. A sensible management of visibility—an “ecology of the visible”—can be productive of more viable ways of individual and collective engagement with those who suffer. (shrink)

DISEASE X is the codename given by the World Health Organisation to a pathogen currently unknown to science that could cause havoc to humankind. Emerging infections are sending us multiple warnings that another Disease X is looming. We've had SARS in 2002, H5N1 bird flu in 2004, H1N1 'swine flu' in 2009, MERS in 2012, Ebola in 2014, Zika in 2015 and now COVID-19. These events are not freak events, but are happening continually, and at an increasing cadence. (...) Written by a long-standing ex-Reuters global health and science correspondent, DISEASE X will use privileged access to the body leading international efforts to control viruses, the Coalition for Epidemic Preparedness Innovations (CEPI), and its CEO, Dr Richard Hatchett. CEPI seed-funded three successful COVID vaccines, including Astra-Zeneca and Moderna. DISEASE X will explore the emergence of the novel coronavirus and the crisis it caused, analysing the responses of global health organisations and experts, including the WHO, national governments such as Britain, China and the USA, COVAX, the global vaccine allocation facility, pharmaceutical companies, and leading research scientists. Weaving in insights from the likes of Bill Gates, Sir Jeremy Farrar, Dr Anthony Fauci and Sir Patrick Vallance, the book will explain how the world's public health scientists are embarking on a 100 Days Mission to snuff out future threats before they become deadly pandemics. This is the inside story written for the public. (shrink)

I explore the role that values and interests, especially ideological interests, play in managing and balancing epistemic risks in medicine. I will focus in particular on how diseases are identified and operationalized. Before we can do biomedical research on a condition, it needs to be identified as a medical condition, and it needs to be operationalized in a way that lets us identify sufferers, measure progress, and so forth. I will argue that each time we do this, we engage in (...) epistemic risk balancing that inevitably draws upon values and interests, often including social and ideological values. My main interest here is in the conceptualization of infertility as a disease. Infertility is a rich test case for exploring the interplay between interests and epistemic risk management. There is no uncontested or standardized definition of infertility. The various definitions of it are internally ambiguous and tension-ridden, and in spectacular contradiction with one another. Many interest groups who are invested in framing infertility as a pressing problem deserving of social and medical redress are quick to insist that it is a legitimate ‘disease,’ but they cannot agree on which disease it is, what its symptoms or diagnostic markers are, or even what its basic ontology is. I suggest that there are political explanations for this epistemic mess. Indeed, I contend that there are good scientific and ethical reasons to reduce away the category of ‘infertility,’ especially understood as a scientific or medical category; I argue that we should excise the concept from our research and clinical practices. (shrink)

Coronavirus disease 2019 pandemic is continuing to have severe effects on tourism-related industries, as safety precautions have become essential to follow. Based on this, this study aims to explore the role of perceptions of the tourist of safety in tourism destination choice with the mediating effect of tourist trust in the context of the Chinese tourism sector. In addition, this study considers improvements to safety measures for sustainable tourism and the benefits of the technology transformation in the travel industry (...) because of COVID-19. For this study, a quantitative approach was used, and data were collected through convenient sampling. The questionnaire was measured on a 5-point Likert scale, and a cross-sectional approach was adopted for data analysis. The findings of this study show that the effect of the perceived safety of the social environment, perceived safety of facility and equipment elements, perceived safety of human elements, perceived safety of management elements, and perceived safety of natural environments is significant and positive on the tourist destination choice. In addition, TT is a significant mediator between these elements and TDC. Furthermore, this study concluded that COVID-19 had increased travel anxiety, with particularly negative effects on the Chinese tourism sector, but that the adoption of perceived safety measures could be beneficial in regaining TT for traveling, eventually giving tourists confidence in choosing their traveling destination. (shrink)

This paper discusses some of the anthropological andphilosophical features of the use of self-managementplans by patients with a chronic disease, focusing onpatients with asthma. Characteristics of thistechnologically mediated form of self-care arecontrasted with the work of Mauss and Foucault on bodytechniques and techniques of self. The similaritiesand differences between self-management of asthma andFoucault's technologies of self highlight some of theways in which self-management contributes tomodifications in the definitions of patients andphysicians. Patients, in measuring their lungfunction, first come (...) to rely on measurements more thanon felt disturbances, but next, felt disturbancesbecome modified by previous measurements. Physicians,on the other hand, see their role changed from expertto being a participant in a joint treatment. It isargued that the concept of agency is more appropriatefor describing the advantage of self-management forpatients than autonomy. (shrink)

This paper starts by establishing a prima facie case that disadvantaged groups or individuals are more likely to get a chronic disease and are in a disadvantaged position to adhere to chronic treatment despite access through Universal Health Coverage. However, the main aim of this paper is to explore the normative implications of this claim by examining two different but intertwined argumentative lines that might contribute to a better understanding of the ethical challenges faced by chronic disease health (...) policy. The paper develops the argument that certain disadvantages which may predispose to illness might overlap with disadvantages that may hinder self-management, potentially becoming disadvantageous in handling chronic disease. If so, chronic diseases may be seen as disadvantages in themselves, describing a reproduction of disadvantage among the chronically ill and a vicious circle of disadvantage that could both predict and shed light on the catastrophic health outcomes among disadvantaged groups—or individuals—dealing with chronic disease. (shrink)

Background In the context of limited health care budgets in countries where Neglected Tropical Diseases are endemic, scaling up disease control interventions entails the setting of priorities. However, solutions based solely on cost-effectiveness analyses may lead to biased and insufficiently justified priorities. Objectives The objectives of this paper are to 1) demonstrate how a range of equity concerns can be used to identify feasible priority setting criteria, 2) show how these criteria can be fed into a multi-criteria decision-making matrix, (...) and 3) discuss the conditions under which this decision-making procedure should be carried out in a real-world decision-making context. Methods This paper draws on elements from theories of decision analysis and ethical theories of fair resource allocation. We explore six typical NTD interventions by employing a modified multi-criteria decision analysis model with predefined criteria, drawn from a priority setting guide under development by the WHO. To identify relevant evidence for the six chosen interventions, we searched the PubMed and Cochrane databases. Discussion Our in vitro multi-criteria decision analysis suggested that case management for visceral leishmaniasis should be given a higher priority than mass campaigns to prevent soil-transmitted helminthic infections. This seems to contradict current health care priorities and recommendations in the literature. We also consider procedural conditions that should be met in a contextualised decision-making process and we stress the limitations of this study exercise. Conclusion By exploring how several criteria relevant to the multi-facetted characteristics of NTDs can be taken into account simultaneously, we are able to suggest how improved priority settings among NTDs can be realised. (shrink)

Sickle cell disease describes an inherited group of blood disorders that affect the lives of more than 4 million people around the globe. More than 43 million additional people are believed t...

The purpose of this article is to analyze the policy decisions made by the World Health Organization (WHO) in working to fight the spread of the first truly global infectious disease, severe acute respiratory syndrome (SARS), of the 21st century. In particular, the author pays attention to the WHO’s Global Outbreak Alert and Response Network (GOARN) and analyzes how it was employed in coordinating a variety of response efforts around the world. In addition, he identifies and assesses the successes (...) and failures of the GOARN’s policies with regard to the monitoring and containment of the SARS outbreak. (shrink)

BackgroundIn the context of limited health care budgets in countries where Neglected Tropical Diseases (NTDs) are endemic, scaling up disease control interventions entails the setting of priorities. However, solutions based solely on cost‐effectiveness analyses may lead to biased and insufficiently justified priorities.ObjectivesThe objectives of this paper are to 1) demonstrate how a range of equity concerns can be used to identify feasible priority setting criteria, 2) show how these criteria can be fed into a multi‐criteria decision‐making matrix, and 3) (...) discuss the conditions under which this decision‐making procedure should be carried out in a real‐world decision‐making context.MethodsThis paper draws on elements from theories of decision analysis and ethical theories of fair resource allocation. We explore six typical NTD interventions by employing a modified multi‐criteria decision analysis model with predefined criteria, drawn from a priority setting guide under development by the WHO. To identify relevant evidence for the six chosen interventions, we searched the PubMed and Cochrane databases.DiscussionOur in vitro multi‐criteria decision analysis suggested that case management for visceral leishmaniasis should be given a higher priority than mass campaigns to prevent soil‐transmitted helminthic infections. This seems to contradict current health care priorities and recommendations in the literature. We also consider procedural conditions that should be met in a contextualised decision‐making process and we stress the limitations of this study exercise.ConclusionBy exploring how several criteria relevant to the multi‐facetted characteristics of NTDs can be taken into account simultaneously, we are able to suggest how improved priority settings among NTDs can be realised. (shrink)

The highly contagious 2019 novel coronavirus disease (COVID-19) outbreak has not only impacted health systems, economies, and governments, it has also rapidly grown into a global health crisis, which is now threatening the lives of millions of people globally. While, on one hand, medical institutions are critically attempting to find a cure, on the other hand, governments have introduced striking measures and policies to curtail the rapid spread of the disease. Although COVID-19 has achieved pandemic status and is (...) predominantly viewed as a biomedical issue, it is argued that it should also be treated as a psychological crisis. This paper also reviews the literature to examine and comment on the detrimental effects of isolation, which has been enforced as one of the primary preventative measures to manage the spread of COVID-19. This paper further outlines key recommendations that should be addressed across different levels to buffer against the known adverse effects of isolation, which is especially relevant for the current COVID-19 situation, where a large proportion of the global population is isolated, confined, and/or quarantined. (shrink)

Self-management interventions are a heterogeneous group of interventions that are regarded as important tools for the management of chronic diseases. They consist of a broad range of techniques and are available for a large variety of chronic organic as well as mental conditions or illnesses, which are by definition generally chronic. These interventions aim that the individual concerned takes substantial responsibility for managing the symptoms, treatment, and physical and psychosocial consequences associated with having a chronic medical condition, disability (...) or disease. Alternate terms used in this context, among others, are self-care... (shrink)