Ethics, Medicine and Public Health最新文献

{"title":"The art of care: How self-care fuels caring for others. Can care be a public health goal in the context of equity and hospital practices?","authors":"P. Ahtoy","doi":"10.1016/j.jemep.2025.101099","DOIUrl":"10.1016/j.jemep.2025.101099","url":null,"abstract":"<div><div>This article examines the concept of <em>care</em> as a lever to promote equity in public health, with a specific focus on public hospitals as central care providers. It explores how self-care among healthcare professionals directly impacts their ability to deliver compassionate, inclusive, and equitable care to patients. By analyzing innovative hospital practices, field examples, and theoretical perspectives, the article offers actionable recommendations for embedding <em>care</em> principles in public hospitals to enhance equity and public health outcomes. Public hospitals face mounting challenges: job cuts, budgetary constraints, increasing workloads, failing and ageing hospital equipment, health professional mental burdens sometimes leading to burnouts. These issues occur in an environment with growing health disparities, undermining health professionals’ capacity to provide equitable and human-centered care.</div><div>As a researcher, I have found that my personal self-care practices—<em>hygge</em> moments of coziness, beauty rituals, yoga and meditation—significantly enhance my mental and physical well-being. These practices create a foundation that allows me to approach my work with greater patience, empathy and attentiveness, benefiting both my colleagues, students, interviewees and work partners.</div><div>In public hospitals, where time pressures and emotional demands are intense, professionals often neglect self-care. This oversight can lead to burnout, diminished quality of care, and inequities in patient outcomes.</div><div>How can health professionals’ personal self-care practices serve as a model for fostering a culture of <em>care</em> in public hospitals, contributing to equity and better health outcomes?</div><div>Can <em>care</em>, understood as both an attentive practice and an ethical framework, become a key strategy for improving equity and public health in public hospitals?</div><div>Firstly, we shall analyze the links between equity and public health through the lens of <em>care</em>. Then, we shall highlight the importance of health professionals’ well-being in delivering high-quality, equitable care. Finally, we shall propose concrete recommendations for integrating <em>care</em> principles into public hospital policies and practices.</div></div>","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"33 ","pages":"Article 101099"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143816067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fundamental principles of French bioethics — Between myth and reality","authors":"C. Byk","doi":"10.1016/j.jemep.2025.101078","DOIUrl":"10.1016/j.jemep.2025.101078","url":null,"abstract":"<div><div>French bioethics is often perceived as an ethic that gives precedence to legislative norms over flexible ethical standards. In our view, the French approach is more nuanced. Although its regulatory force is based essentially on State standards, these combine a series of principles inspired by human rights with provisions specific to each biomedical technique, the latter themselves being influenced by the practices of healthcare professionals. In addition, this legislation has a dual political aim: to ensure that citizens have access to new medical technologies, and to enhance the professional, moral and economic quality of the healthcare system, hence the need for new players (ethics committees and health agencies) to oversee this dynamic. The result is a complex system, with a multiplicity of players whose roles sometimes overlap, leading to a number of phenomena: risks of incoherence and the temptation of a State takeover, further neglecting clinical ethics and citizen participation in the development of public policy.</div></div>","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"33 ","pages":"Article 101078"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143704971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“ReArm Europe”: A potential further disarmament of health systems?","authors":"A. Cioffi,&nbsp;C. Cecannecchia","doi":"10.1016/j.jemep.2025.101076","DOIUrl":"10.1016/j.jemep.2025.101076","url":null,"abstract":"","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"33 ","pages":"Article 101076"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143643305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Organ selling and the disrespect to human dignity","authors":"D.A. Cordero Jr.","doi":"10.1016/j.jemep.2025.101097","DOIUrl":"10.1016/j.jemep.2025.101097","url":null,"abstract":"","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"33 ","pages":"Article 101097"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143873754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The practice of electroconvulsive therapy without patient consent: a French naturalistic study","authors":"L. Chevalier ,&nbsp;S. Lespagnol ,&nbsp;J. Charron ,&nbsp;L. Cheval ,&nbsp;S. Bulteau ,&nbsp;A. Sauvaget ,&nbsp;A. Laurin","doi":"10.1016/j.jemep.2025.101051","DOIUrl":"10.1016/j.jemep.2025.101051","url":null,"abstract":"<div><h3>Introduction</h3><div>Free and informed consent is essential in care, though it may be impossible to obtain in psychiatry due to the impairment of discernment caused by mental illness. In this context, the law authorizes coerced care, including electroconvulsive therapy (ECT), a highly effective treatment that can at least partially restore discernment. However, the practice of ECT without consent is poorly documented, as is the question of reassessing consent during ECT. We need to take stock of the situation in order to improve practices.</div></div><div><h3>Method</h3><div>We conducted a monocentric observational retrospective chart-based study at Nantes University Hospital (France) involving 162 patients treated by ECT between 2018 and 2022.</div></div><div><h3>Results</h3><div>Our results showed that 36% of patients were treated by ECT without their consent, but with the agreement of a close relative (32% spouse, 31% child). ECT without the patient’s consent was mainly carried out in patients hospitalized under restraint, with a manic or mixed state, suffering from a catatonic or dementia syndrome. Despite an efficacy rate of 97%, only 3% of patients regularized their consent at the end of the ECT course. Surprisingly, 21 patients were treated with ECT without their consent, with the agreement of a third party, while in open hospitalization, and 26 patients were treated with ECT with their consent while in restricted hospitalization.</div></div><div><h3>Conclusion</h3><div>The ability to consent during ECT treatment must be reassessed.</div></div>","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"33 ","pages":"Article 101051"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143099342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medically assisted procreation (MAP): from the treatment of infertility to the completion of a parental project, evolution or revolution?","authors":"M. Girer","doi":"10.1016/j.jemep.2024.101036","DOIUrl":"10.1016/j.jemep.2024.101036","url":null,"abstract":"<div><div>French law regarding medically assisted procreation (MAP) has undergone profound changes, which were initiated by the law of August 2, 2021 on bioethics. This text significantly changes the legal framework of MAP, which involves three main aspects. First, the use of gametes other than those of the couple may be necessary: gamete donation is authorized, provided that it is voluntary, free and anonymous. These same requirements apply to the reception of embryos. Secondly, the purpose of MAP has been profoundly modified: although the medical purpose is still acknowledged (to combat pathological infertility in a couple or to avoid the transmission of a disease to the child or to the other member of the couple), it has taken a back seat to the notion of parental project. This shift in the purpose of MAP makes it possible to open up access to female couples and unmarried women. Finally, the establishing of the bond of filiation with the child born from a MAP and the legal securing of this bond are specified by the legislator, with the creation of the anticipated joint recognition for couples of women and the possible lifting of the anonymity of the third party donor at the age of majority of the child.</div></div>","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"33 ","pages":"Article 101036"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143099347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehensive public health response and preparedness: key lessons from Rwanda’s effective containment of the 2024 Marburg virus outbreak","authors":"M.M. Ahmed ,&nbsp;O.J. Okesanya ,&nbsp;A. Gilbert","doi":"10.1016/j.jemep.2024.101037","DOIUrl":"10.1016/j.jemep.2024.101037","url":null,"abstract":"","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"33 ","pages":"Article 101037"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143099350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding research gaps and priorities for tobacco harm reduction in low-income and middle-income countries","authors":"Y.A. Adebisi ,&nbsp;S. Lungu ,&nbsp;A. Curado ,&nbsp;G. Oke ,&nbsp;D. Yach","doi":"10.1016/j.jemep.2025.101117","DOIUrl":"10.1016/j.jemep.2025.101117","url":null,"abstract":"<div><h3>Introduction</h3><div>Tobacco use is among the leading preventable causes of premature death worldwide, with disproportionate effects in low-income and middle-income countries (LMICs). Global tobacco control efforts have shown inconsistent results, highlighting the need for innovative approaches, such as tobacco harm reduction (THR), to complement existing strategies. We aimed to identify gaps in THR research in the global and LMIC contexts.</div></div><div><h3>Methods</h3><div>We conducted a bibliometric review, using Scopus, to identify articles addressing THR published from January 2014 to August 2024. Research output was categorized by product type, geographical focus, volume of research output, and funding sources. A narrative synthesis was performed to outline research gaps and propose a strategic research agenda.</div></div><div><h3>Results</h3><div>THR research was dominated by e-cigarettes, primarily from high-income countries. Citations per 1 million smokers were highest in New Zealand (1,128.0), United Kingdom (634.3), United States (466.4), Australia (432.1), Switzerland (177.1), and South Korea (132.9). By contrast, rates were very low across Asia, Africa, and South America (range 1.8–53.5). Over the study period, research output increased only for e-cigarettes and heated tobacco products. Publicly funded research tended to focus on public health concerns, while private-sector research focused on product safety and efficacy.</div></div><div><h3>Conclusions</h3><div>THR research remains disproportionately concentrated in high-income countries and reflects a clear divergence between public and private research agendas. More research is needed to evaluate the long-term impacts, affordability, and real-world effectiveness of THR products using rigorous and standardized methodologies in diverse settings. Strengthening the evidence base in LMICs will be essential for developing affordable, accessible, and acceptable THR strategies tailored to local needs.</div></div>","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"33 ","pages":"Article 101117"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143943762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel Psychoactive Substances epidemic: The hidden perils of youthful exploration in Africa","authors":"A. Ripanda ,&nbsp;A.A. Nyundo ,&nbsp;E.C. Nyanza ,&nbsp;B.B.L. Srivastava ,&nbsp;M. Hossein ,&nbsp;R. Bakari ,&nbsp;S.A.H. Vuai","doi":"10.1016/j.jemep.2025.101111","DOIUrl":"10.1016/j.jemep.2025.101111","url":null,"abstract":"<div><h3>Background</h3><div>The swift rise of Novel Psychoactive Substances (NPS) is a salient, yet pressing public health and equity challenge in Africa, disproportionately impacting young people. These \"designer drugs\" or \"legal highs\" are synthetically engineered to imitate the effects of traditional narcotics while evading present legal controls. The unregulated nature of these substances exposes users to untested and potentially harmful compounds, posing significant health risks to users. The easy accessibility, through online platforms and local dealers, coupled with limited public awareness, exacerbates the crisis. This growing epidemic highlights deep systemic inequities, including gaps in African healthcare systems and regulatory frameworks, which struggle to address NPS-related health issues or keep pace with the relentless emergence of new substances, leaving vulnerable populations at heightened risk.</div></div><div><h3>Results</h3><div>The rise of NPS in Africa reveals a complex and escalating crisis, particularly affecting the youth. These substances, marketed as legal or safer alternatives to traditional drugs, are easily accessible through online platforms and local dealers, yet their volatile chemical compositions, presumed safety and legality pose significant health risks, including poisoning, addiction potential, and long-term neurotoxicity. The hasty evolution of NPS structures outpaces regulatory frameworks, leaving law enforcement and public health systems struggling to respond effectively. Limited awareness among users, coupled with socioeconomic drivers like poverty and unemployment, exacerbates the issue, while healthcare systems remain ill-equipped to manage NPS-related emergencies due to a lack of state of art diagnostic tools and treatment protocols. The emerging links to organized crime, which amplify the challenge of controlling, production, and trafficking of NPS compounds.</div></div><div><h3>Conclusion</h3><div>The NPS epidemic has aggravated health and equity challenges among youth, leading to a surge in adverse health outcomes including erratic reactions, addiction, and potential progression to more injurious substances especially in low resource settings. Tackling the NPS crisis in Africa requires equity-focused effort involving governments, international organizations, and local stakeholders. This may include public education, stricter regulation, regional cooperation, prevention, harm reduction, stewardships, and robust healthcare interventions to safeguard Africa’s youth. Further, ensuring equitable access to resources, education, and support will help curb the spread of harmful substances and protect vulnerable youth from the disproportionate health and social impacts of this growing epidemic.</div></div>","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"33 ","pages":"Article 101111"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143882330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient demographics and their impact on discharge patterns following cardiac valve surgery","authors":"J. Katsiroubas ,&nbsp;S. Basharkhah ,&nbsp;S. Balaram","doi":"10.1016/j.jemep.2025.101071","DOIUrl":"10.1016/j.jemep.2025.101071","url":null,"abstract":"<div><h3>Objective</h3><div>The objective of this study is to find factors associated with increased length of stay and type of patient disposition after cardiac valve surgery</div></div><div><h3>Methods</h3><div>The Statewide Planning and Research Cooperative System (SPARCS) database for the most recent year available was queried to identify patients who had undergone non-endovascular cardiac valve surgery. Patient demographics including gender, race, and age, were analyzed. Primary outcomes were length of stay and patient disposition.</div></div><div><h3>Results</h3><div>A total of 4,815 patients were queried via the SPACRCS database, all of whom had undergone a non-endovascular heart valve procedure in the year 2021. The majority of these patients, constituting 62.2 percent, were male. Age was categorized into five groups, with the largest proportion, 48.91 percent, falling within the 50–69 age range. Race data indicated that 67.1 percent were White, 9.1 percent were Black/African American, 1.2 percent were multiracial, and 22.7 percent identified as other races. The mean length of stay (LOS) was calculated at 11.4 days. Notably, Black/African American patients had the longest mean LOS at 14.3 days, whereas White patients had an average LOS of 10.2 days, multiracial patients had 11.3 days, and those identifying as other races had 13.7 days. When it came to discharge dispositions, 47.6 percent were sent home with home care. Among these patients, a significant portion, 64.8 percent, were male, and 66.1 percent were White. Conversely, only 3.4 percent of patients were discharged to an inpatient rehabilitation facility, and within this group, 54.4 percent were aged 70 or older. Patients discharged to an inpatient rehabilitation facility averaged a LOS of 22.3 days versus 10.2 days for patients discharged home with home services.</div></div><div><h3>Conclusion</h3><div>A variety of factors influence the discharge pattern of after cardiac valve surgery in New York State. Further research and analysis would be beneficial to understand the underlying factors driving these trends and to improve the quality of care and resource allocation for this patient population.</div></div>","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"33 ","pages":"Article 101071"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143577659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}