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The Lancet. Planetary Health Oct 2020
Topics: Animals; Biodiversity; Communication; Denial, Psychological; Economic Development; Extinction, Biological; Humans; Politics; Science
PubMed: 33038313
DOI: 10.1016/S2542-5196(20)30229-1 -
Case Reports in Women's Health Jun 2023
PubMed: 37440764
DOI: 10.1016/j.crwh.2023.e00503 -
Journal of Nuclear Medicine : Official... Jul 2020
Topics: Humans; Insurance Coverage; Medicaid; Neuroendocrine Tumors; United States
PubMed: 32611710
DOI: No ID Found -
Journal of Hospice and Palliative Care Sep 2021End-of-life patients experience physical, mental, social, and existential distress. While medical personnel provide medication and care to alleviate patients' distress,... (Review)
Review
End-of-life patients experience physical, mental, social, and existential distress. While medical personnel provide medication and care to alleviate patients' distress, listening to and interacting with patients remains essential for understanding their psychological condition. The most important tool, though difficult to implement in practice, is end-of-life discussion (EOLD). EOLD has been shown to have positive effects on end-of-life treatment choices, achievement of patients' life goals, improvements in the quality of life of patients and their families, and the prevention of depression and complicated grief among bereaved family members. EOLD is not often undertaken in clinical practice, however, due to hesitancy among medical personnel and patients for various reasons. In order to conduct an EOLD, the patient's judgment, psychiatric illnesses such as delirium and depression, and psychological issues such as the side effects of psychotropic drugs, denial, and collusion must be evaluated. Open and honest conversation, treatment goal setting, the doctor's familiarity with the patient's background, and attentiveness when providing information are important elements for any dialogue. Meaning-centered psychotherapy was developed to alleviate the existential distress of cancer patients, and its application may promote EOLD. The future development of meaning-centered psychotherapy in practice and in research is expected to further promote EOLD.
PubMed: 37674559
DOI: 10.14475/jhpc.2021.24.3.135 -
Psychotherapy and Psychosomatics 2023
PubMed: 37619544
DOI: 10.1159/000533449 -
Psychotherapy and Psychosomatics 2023
PubMed: 37634501
DOI: 10.1159/000533124 -
PloS One 2023In Nepal, abortion is legal on request through 12 weeks of pregnancy and up to 28 weeks for health and other reasons. Abortion is available at public facilities at no...
INTRODUCTION
In Nepal, abortion is legal on request through 12 weeks of pregnancy and up to 28 weeks for health and other reasons. Abortion is available at public facilities at no cost and by trained private providers. Yet, over half of abortions are provided outside this legal system. We sought to investigate the extent to which patients are denied an abortion at clinics legally able to provide services and factors associated with presenting late for care, being denied, and receiving an abortion after being denied.
METHODS
We used data from a prospective longitudinal study with 1835 women aged 15-45. Between April 2019 and December 2020, we recruited 1,835 women seeking abortions at 22 sites across Nepal, including those seeking care at any gestational age (n = 537) and then only those seeking care at or after 10 weeks of gestation or do not know their gestational age (n = 1,298). We conducted interviewer-led surveys with these women at the time they were seeking abortion service (n = 1,835), at six weeks after abortion-seeking (n = 1523) and six-month intervals for three years. Using descriptive and multivariable logistic regression models, we examined factors associated with presenting for abortion before versus after 10 weeks gestation, with receiving versus being denied an abortion, and with continuing the pregnancy after being denied care. We also described reasons for the denial of care and how and where participants sought abortion care subsequent to being denied. Mixed-effects models was used to accounting clustering effect at the facility level.
RESULTS
Among those recruited when eligibility included seeking abortion at any gestational age, four in ten women sought abortion care beyond 10 weeks or did not know their gestation and just over one in ten was denied care. Of the full sample, 73% were at or beyond 10 weeks gestation, 44% were denied care, and 60% of those denied continued to seek care after denial. Nearly three-quarters of those denied care were legally eligible for abortion, based on their gestation and pre-existing conditions. Women with lower socioeconomic status, including those who were younger, less educated, and less wealthy, were more likely to present later for abortion, more likely to be turned away, and more likely to continue the pregnancy after denial of care.
CONCLUSION
Denial of legal abortion care in Nepal is common, particularly among those with fewer resources. The majority of those denied in the sample should have been able to obtain care according to Nepal's abortion law. Abortion denial could have significant potential implications for the health and well-being of women and their families in Nepal.
Topics: Pregnancy; Humans; Female; Infant, Newborn; Abortion, Legal; Longitudinal Studies; Prospective Studies; Nepal; Abortion, Induced
PubMed: 36943824
DOI: 10.1371/journal.pone.0282886 -
Innovations in Pharmacy 2021Should decision making in health care, notably in respect of the allocation of resources between individuals and disease states, rest on notions of the burden of disease...
Should decision making in health care, notably in respect of the allocation of resources between individuals and disease states, rest on notions of the burden of disease and denial of care as assessed by societal evaluations or on the extent to which the need of patients and caregivers is fulfilled. The prospect of the denial of health care, for those deemed 'unworthy' has a long history in the eugenics movement. Many have assumed that this 'utilitarian aberration' has long been discredited. Unfortunately, once the question of the allocation of limited health care resources is considered it reasserts itself; manifested in the creation of health state preferences and states worse than death, and application of the cost-per-QALY calculus driving claims for pricing and access. In the US, this focus on cost-per-QALY claims is most closely associated with the Institute for Clinical and Economic Review (ICER) with its regular clinical assessments and modelled imaginary simulations supporting recommendations which, in many if not most cases, give support to the denial of care. The purpose of this commentary is to point to the unfortunate similarities between 'eugenic' decision making and the application of thresholds in burden of illness cost-per-QALY exercises. If we are to finally rid ourselves of a 'eugenic' approach to health care resource allocation, then we must abandon preferences and the QALY calculus.
PubMed: 35601582
DOI: 10.24926/iip.v12i3.4291 -
Journal of Bioethical Inquiry Mar 2023In this paper I use normative analysis to explore the curious and seemingly singular phenomenon whereby some dog owners deny the physical and moral facts about a...
In this paper I use normative analysis to explore the curious and seemingly singular phenomenon whereby some dog owners deny the physical and moral facts about a situation where it is claimed their dog harmed or irritated others. I define these as epistemic and ethical denial, respectively, and offer a tentative exploration of their implications in terms of relational autonomy and responsible behaviour in public spaces.
PubMed: 36749536
DOI: 10.1007/s11673-023-10229-8 -
Substance Abuse : Research and Treatment 2022Denial, or lack of awareness of problems related to substance misuse, is a common feature of drug use disorders and can affect engagement in treatment and recovery. This...
INTRODUCTION
Denial, or lack of awareness of problems related to substance misuse, is a common feature of drug use disorders and can affect engagement in treatment and recovery. This study tested for association of denial with severity of symptoms used in the diagnosis of Methamphetamine Dependence.
METHODS
This secondary analysis used data from 69 participants (52.2% male) who met criteria for the diagnosis of Methamphetamine Dependence on the Structured Clinical Interview for DSM-IV (SCID). The association between diagnostic severity, determined from a SCID summary score (8 items), and denial, measured by the (URICA) Precontemplation score, was tested by Pearson correlation. In post hoc -tests, participants who differed on individual SCID items were compared on the Precontemplation score. The additional URICA subscales (Contemplation, Maintenance, Action) were also tested on a secondary basis.
RESULTS
SCID summary scores were negatively correlated with URICA Precontemplation scores ( = .003). Post-hoc tests revealed that participants who denied continued methamphetamine use despite persistent or recurrent problems (SCID item 6) had significantly higher Precontemplation scores than those who endorsed these problems ( = 3.066, = .003). In contrast, positive correlations were observed between diagnostic severity and greater openness/willingness to change on the URICA (eg, Maintenance, = .26; = .01).
CONCLUSIONS
The findings highlight the importance of a patient's insight regarding their addiction in clinical diagnosis. Because minimizing the impact of methamphetamine use may preclude or delay treatment, it is advised that self-report be supplemented to improve accuracy of diagnosis.
PubMed: 36385745
DOI: 10.1177/11782218221135721