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Heliyon Jul 2023The Ebola epidemic in West Africa (2013-2016) was a learning process for all - the population, health experts and practitioners, as well as government structures....
The Ebola epidemic in West Africa (2013-2016) was a learning process for all - the population, health experts and practitioners, as well as government structures. Learning occurred in all stages of the response, from the initial lack of clarity and denial of Ebola's existence that contributed to public confusion; to the eventual acceptance of the existence of the Ebola threat whereupon fear and stigmatization reigned; to the later stages in which community engagement and ownership of the response arose. In this paper we describe how two urban poor communities in informal settlements in the Western Area of Sierra Leone responded to Ebola Virus Disease and how they deployed efficient strategies like the development and implementation of by-laws for monitoring and surveillance, thus helping to curb the epidemic. For future public health emergencies, we recommend that community engagement be pursued earlier and that efforts are made to ensure two-way knowledge exchange between responders and community stakeholders.
PubMed: 37539138
DOI: 10.1016/j.heliyon.2023.e17425 -
Health and Human Rights Dec 2023The right to the highest attainable standard of health is a fundamental right of every human being without distinction as to race, religion, political belief, or...
The right to the highest attainable standard of health is a fundamental right of every human being without distinction as to race, religion, political belief, or economic or social condition. Spent wisely, aid and other forms of government spending are essential for attaining this right, as well as driving development. However, taxpayer funds from high-income governments such as the UK, France, and Germany are increasingly being funneled through development finance institutions (DFIs) toward multi-million-dollar investments in for-profit health care corporations in low- and middle-income countries. This contributes to the corporatization and financialization of health care in these contexts and is implicated in profiteering and exploitation, the denial of treatment to those who cannot afford it, and a range of human rights abuses-all with little or no accountability. This paper examines the human rights obligations of a sample of European DFIs and the International Finance Corporation, drawing on the "availability, accessibility, acceptability, and quality" right to health framework. We find that this investment approach is not only limiting the realization of the fundamental right to health for all but also placing significant barriers to accessing quality, affordable health services..
Topics: Humans; Human Rights; Health Services Accessibility; France
PubMed: 38145144
DOI: No ID Found -
Clinical Trials (London, England) Oct 2023This article discusses the barriers that prevent deaf people from participating in clinical trials and offers recommendations to overcome these barriers and ensure equal...
BACKGROUND/AIMS
This article discusses the barriers that prevent deaf people from participating in clinical trials and offers recommendations to overcome these barriers and ensure equal access to study participation.
METHODS
Between April and May 2022, we conducted six focus groups with 20 deaf adults who use American Sign Language, all of whom had previous experience as research study participants. Focus group prompts queried community awareness of clinical trial opportunities, barriers and facilitators to deaf people's participation in clinical trials, and recommended resources to improve clinical trial access. This qualitative focus group data is supplemented by survey data gathered from 40 principal investigators and clinical research coordinators between November 2021 and December 2021. The survey queried researchers' prior experiences with enrolling deaf participants in clinical trials and strategies they endorse for enrollment of deaf participants in future clinical trials.
RESULTS
Focus group participants unanimously agreed that, compared to the general hearing population, deaf sign language users lack equivalent access to clinical trial participation. Reported barriers included lack of awareness of clinical trial opportunities, mistrust of hearing researchers, and refusal by clinical trial staff to provide accessible communication (e.g. denial of requests for sign language interpreters). Survey data from 40 principal investigators and clinical research coordinators corroborated these barriers. For example, only 2 out of 40 survey respondents had ever enrolled a deaf person in a clinical trial. Respondents indicated that the most helpful strategies for including deaf sign language users in future clinical trials would be assistance with making recruitment information accessible to deaf sign language users and assistance in identifying qualified interpreters to hire to help facilitate the informed consent process.
CONCLUSION
The lack of communication accessibility is the most common factor preventing deaf sign language users from participating in clinical trials. This article provides recommendations for hearing researchers to improve deaf people's access to clinical trials moving forward, drawing from mixed-methods data.
Topics: Adult; Humans; Communication; Communication Barriers; Focus Groups; Persons With Hearing Impairments; Sign Language; Clinical Trials as Topic
PubMed: 37243366
DOI: 10.1177/17407745231177376 -
International Journal of Qualitative... Dec 2023COVID-19 continues to infect and affect college-aged youth. We lack information about how students experienced the pandemic day-to-day and what they need for recovery,...
PURPOSE
COVID-19 continues to infect and affect college-aged youth. We lack information about how students experienced the pandemic day-to-day and what they need for recovery, from their own perspectives. This study employed peer ethnography to explore student's insights for current and future prevention and care.
METHODS
A team of eight students were trained as peer ethnographers to observe and record conversations with their peers in 15-minute increments during the COVID-19 pandemic. Transcripts of 200 conversations were collated and analysed via theme analysis to identify patterns.
RESULTS
Student conversations revealed dichotomous perspectives about COVID-19. Some students prioritized safety, captured via three themes-caution, rethinking routines, and protecting others. Other students struggled to follow prevention guidelines and took risks, also captured by three themes-parties, denial, and misinformation. A third category of themes captured the results of this dichotomy-tense campus relationships and a health leadership vacuum.
CONCLUSIONS
Our findings identify specific locations for intervention (e.g., off campus parties) and needed community collaborations (e.g., bars and universities) for COVID-19 and future pandemics. Our findings suggest that overarching approaches, like harm reduction or affirmation (versus shame), are helpful intervention frameworks. Findings also celebrate the value of peer-ethnography, to learn about pandemics and solutions from the ground up.
Topics: Adolescent; Humans; Young Adult; COVID-19; Pandemics; Students; Anthropology, Cultural; Communication
PubMed: 37742341
DOI: 10.1080/17482631.2023.2261841 -
The Journal of Men's Studies Oct 2023Culture and Perspectives on Sexual Assault Policy was a qualitative, focus-group study conducted at four Canadian universities to gather culturally diverse student...
Culture and Perspectives on Sexual Assault Policy was a qualitative, focus-group study conducted at four Canadian universities to gather culturally diverse student perspectives on university sexual violence or sexual assault policies and services. This article highlights two categories of dialectical tension expressed during several male focus groups. The Wrongful Blame Dialectic involved tension between anxieties about wrongful accusations and opposition to victim-blaming. Perceived risk of wrongful accusations was often linked to racism or ethnocentrism. The Male Victim Denial/Recognition Dialectic involved tension between denial and recognition of male sexual victimization. Male participants felt more vulnerable to wrongful accusation than to sexual violence. They felt more likely to be blamed and disbelieved, whether as respondents or complainants.
PubMed: 37693227
DOI: 10.1177/10608265231182100 -
Health Care Analysis : HCA : Journal of... Dec 2023Rising health insurance costs and the cost of living crisis are likely leading to an increase in unpaid health insurance bills in many countries. In Switzerland, a...
Rising health insurance costs and the cost of living crisis are likely leading to an increase in unpaid health insurance bills in many countries. In Switzerland, a particularly drastic measure to sanction defaulting insurance payers is employed. Since 2012, Swiss cantons - who have to cover most of the bills of defaulting payers - are allowed by federal law to blacklist them and to restrict their access to medical care to emergencies.In our paper, we briefly describe blacklisting in the context of the Swiss healthcare system before we examine the ethical issues involved in light of what is known about its social and health impacts. We found no evidence that blacklisting serves as an effective way of recovering unpaid health insurance contributions or of strengthening solidarity within the health insurance system. Furthermore, the ambiguous definitions of what constitutes an emergency treatment and the incompatibility of the denial of medical care with the obligation to provide professional assistance complicate the implementation of blacklists and expose care providers to enormous pressure.Therefore, we conclude that blacklists and the (partial) denial of medical care not only pose profound ethical problems but are also unsuitable for fulfilling the purpose for which they were introduced.
Topics: Humans; Insurance, Health; Delivery of Health Care; Costs and Cost Analysis; Switzerland
PubMed: 37498417
DOI: 10.1007/s10728-023-00464-w -
Journal of the Medical Library... Jul 2023For over a millennium, libraries and library workers have advanced the knowledge of human science by building, preserving, and sharing collections and research....
For over a millennium, libraries and library workers have advanced the knowledge of human science by building, preserving, and sharing collections and research. Historically, libraries have also aligned their institutional responsibilities to adhere to and support the values and virtues of oppressive and colonial practices. Library history has shown the mistreatments and denials of information access of marginalized groups. The history of libraries in the health and medical sciences reveals how these institutions and their workers have preserved and circulated research studies perpetuating racial science. This commentary highlights how such institutions shape and contribute to racial science in the field of medicine. By exploring the history of medicine through this lens, we examine how such institutions have been complicit in upholding racial science. We explore historical documents and archival collections that have been collected and preserved, particularly records and data of vulnerable groups, to advance the knowledge and understanding of the human body through the ideology of racial science. We argue that health and medical sciences librarians need to critically interrogate the racism in medical libraries and its history and address how health misinformation is common even in scholarly publications.
Topics: Humans; Archives; Communication; Librarians; Libraries; Libraries, Medical; Medicine; Racism; Diversity, Equity, Inclusion
PubMed: 37483359
DOI: 10.5195/jmla.2023.1728 -
Journal of Psychosomatic Obstetrics and... Dec 2023"Unperceived pregnancy" names the phenomenon when a person becomes pregnant unintentionally and is not aware of being pregnant. Scientific explanations are roughly based...
"Unperceived pregnancy" names the phenomenon when a person becomes pregnant unintentionally and is not aware of being pregnant. Scientific explanations are roughly based on two hypotheses: psychological and physiological. We aim to gain a better understanding of unperceived pregnancy by studying the perspectives of people who experienced an unperceived pregnancy and obstetric professionals. Seventeen semi-structured interviews were conducted: eight with women who had experienced an unperceived pregnancy (≥30 weeks' gestation), six with midwives, and three with gynecologists. Our findings show that women's explanations for not noticing their pregnancy center around the absence of pregnancy symptoms. The failure to recognize more subtle signs of pregnancy was enforced by inattention, physical distractions, and psychological factors. In contrast, psychological explanations are dominant among obstetric professionals. Our study demonstrates a discrepancy in the explanations provided by women who had experienced an unperceived pregnancy and obstetric professionals. Potentially, this could result in people being unheard and misunderstood. We recommend that future research moves beyond a focus on "denial of pregnancy" to consider both psychological and physiological factors, and how these could potentially interrelate. This broadened approach will enhance our understanding of unperceived pregnancy and can contribute to improved counseling by obstetric professionals.
Topics: Pregnancy; Female; Humans; Midwifery; Qualitative Research
PubMed: 37086382
DOI: 10.1080/0167482X.2023.2197139 -
Frontiers in Public Health 2023The objectives were (1) to describe and compare headache-related clinical features between teleworkers with migraine and those with tension-type headache (TTH) and (2)...
OBJECTIVES
The objectives were (1) to describe and compare headache-related clinical features between teleworkers with migraine and those with tension-type headache (TTH) and (2) to determine the association between coping strategies and headache frequency, and intensity in the context of the COVID-19 pandemic.
METHODS
This cross-sectional online survey was conducted with 284 teleworkers (127 with migraine and 157 with TTH). Sociodemographic data, information related to work factors, headache clinical features, coping strategies used during the COVID-19 pandemic, and headache-related clinical features were compared between headache profiles. Bivariate logistic regression analyses were used to determine the association between coping strategies and headache frequency, and intensity.
RESULTS
Results showed that teleworkers with migraine had longer and more painful headache episodes than teleworkers with TTH ( < 0.001). Higher migraine frequency was associated with the use of the denial coping strategy ( = 0.006) while lower migraine intensity was associated with planning ( = 0.046) and the use of positive reframing ( = 0.025). Higher TTH frequency was associated with the use of venting, self-blame, and behavioral disengagement ( < 0.007) while higher TTH intensity was associated with substance use and behavioral disengagement (s < 0.030). All associations remained significant after adjusting for BMI as a covariate.
DISCUSSION/CONCLUSION
Teleworkers with migraine had more intense and longer headache episodes than teleworkers with TTH. This could be explained by the fact that a greater proportion of individuals suffering from migraine experienced headaches prior to the beginning of the pandemic compared with teleworkers suffering from TTH. Regarding coping strategies, both primary headache profiles were associated with different types of coping strategies. Most of the coping strategies associated with headache frequency or intensity were maladaptive except for planning and positive reframing that were found to be inversely associated with migraine intensity.
Topics: Humans; Pandemics; Coping Skills; Cross-Sectional Studies; COVID-19; Headache; Tension-Type Headache; Migraine Disorders
PubMed: 38213645
DOI: 10.3389/fpubh.2023.1303394 -
Harm Reduction Journal Mar 2024People who use drugs experience pain at two to three times the rate of the general population and yet continue to face substantial barriers to accessing appropriate and...
BACKGROUND
People who use drugs experience pain at two to three times the rate of the general population and yet continue to face substantial barriers to accessing appropriate and adequate treatment for pain. In light of the overdose crisis and revised opioid prescribing guidelines, we sought to identify factors associated with being denied pain medication and longitudinally investigate denial rates among people who use drugs.
METHODS
We used multivariable generalized estimating equations analyses to investigate factors associated with being denied pain medication among people who use drugs reporting pain in three prospective cohort studies in Vancouver, Canada. Analyses were restricted to study periods in which participants requested a prescription for pain from a healthcare provider. Descriptive statistics detail denial rates and actions taken by participants after being denied.
RESULTS
Among 1168 participants who requested a prescription for pain between December 2012 and March 2020, the median age was 47 years and 63.0% were male. Among 4,179 six-month observation periods, 907 (21.7%) included a report of being denied requested pain medication. In multivariable analyses, age was negatively associated with prescription denial (adjusted odds ratio [AOR] = 0.98, 95% confidence interval [CI]:0.97-0.99), while self-managing pain (AOR = 2.48, 95%CI:2.04-3.00), experiencing a non-fatal overdose (AOR = 1.51, 95%CI:1.22-1.88), engagement in opioid agonist therapy (AOR = 1.32, 95%CI:1.09-1.61), and daily use of heroin or other unregulated opioids (AOR = 1.32, 95%CI:1.05-1.66) were positively associated with being denied. Common actions taken (n = 895) after denial were accessing the unregulated drug supply (53.5%), doing nothing (30.6%), and going to a different doctor/emergency room (6.1%). The period following the introduction of new prescribing guidelines was not associated with a change in denial rates.
CONCLUSIONS
A substantial proportion of people who use drugs continue to be denied prescriptions for pain, with such denial associated with important substance use-related harms, including non-fatal overdose. Guidelines specific to the pharmaceutical management of pain among people who use drugs are needed.
Topics: Humans; Male; Middle Aged; Female; Analgesics, Opioid; Prospective Studies; Practice Patterns, Physicians'; Canada; Drug Overdose; Pain; Prescription Drugs; Prescriptions
PubMed: 38549113
DOI: 10.1186/s12954-024-00956-5