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BMC Medical Education May 2023Kohlberg's theory of moral development asserts that people progress through different stages of moral reasoning as their cognitive abilities and social interactions...
BACKGROUND
Kohlberg's theory of moral development asserts that people progress through different stages of moral reasoning as their cognitive abilities and social interactions mature. Individuals at the lowest stage of moral reasoning (preconventional stage) judge moral issues based on self-interest, those with a medium stage (conventional stage) judge them based on compliance with rules and norms, and those at the highest stage (postconventional stage) judge moral issues based on universal principles and shared ideals. Upon attaining adulthood, it can be considered that there is stability in the stage of individuals' moral development; however, the effect of a global population crisis such as the one experienced in March 2020, when the World Health Organization (WHO) declared the COVID-19 pandemic, is unknown. The purpose of this study was to evaluate the changes in the moral reasoning of pediatric residents before and after one year of the COVID-19 pandemic and compare them with a general population group.
METHODS
This is a naturalistic quasi-experimental study conducted with two groups, one comprised 47 pediatric residents of a tertiary hospital converted into a COVID hospital during the pandemic and another group comprised 47 beneficiaries of a family clinic who were not health workers. The defining issues test (DIT) was applied to the 94 participants during March 2020, before the pandemic initiated in Mexico, and later during March 2021. To assess intragroup changes, the McNemar-Bowker and Wilcoxon tests were used.
RESULTS
Pediatric residents showed higher baseline stages of moral reasoning: 53% in the postconventional group compared to the general population group (7%). In the preconventional group, 23% were residents and 64% belonged to the general population. In the second measurement, one year after the start of the pandemic, the group of residents had a significant decrease of 13 points in the P index, unlike the general population group in which a decrease of 3 points was observed. This decrease however, did not equalize baseline stages. Pediatric residents remained 10 points higher than the general population group. Moral reasoning stages were associated with age and educational stage.
CONCLUSIONS
After a year of the COVID-19 pandemic, we found a decrease in the stage of moral reasoning development in pediatric residents of a hospital converted for the care of patients with COVID-19, while it remained stable in the general population group. Physicians showed higher stages of moral reasoning at baseline than the general population.
Topics: Humans; Child; Adult; Population Groups; Pandemics; COVID-19; Morals; Moral Development
PubMed: 37226125
DOI: 10.1186/s12909-023-04265-6 -
BMC Medical Research Methodology Jan 2022Ensuring fair comparisons of cancer survival statistics across population groups requires careful consideration of differential competing mortality due to other causes,...
BACKGROUND
Ensuring fair comparisons of cancer survival statistics across population groups requires careful consideration of differential competing mortality due to other causes, and adjusting for imbalances over groups in other prognostic covariates (e.g. age). This has typically been achieved using comparisons of age-standardised net survival, with age standardisation addressing covariate imbalance, and the net estimates removing differences in competing mortality from other causes. However, these estimates lack ease of interpretability. In this paper, we motivate an alternative non-parametric approach that uses a common rate of other cause mortality across groups to give reference-adjusted estimates of the all-cause and cause-specific crude probability of death in contrast to solely reporting net survival estimates.
METHODS
We develop the methodology for a non-parametric equivalent of standardised and reference adjusted crude probabilities of death, building on the estimation of non-parametric crude probabilities of death. We illustrate the approach using regional comparisons of survival following a diagnosis of rectal cancer for men in England. We standardise to the covariate distribution and other cause mortality of England as a whole to offer comparability, but with close approximation to the observed all-cause region-specific mortality.
RESULTS
The approach gives comparable estimates to observed crude probabilities of death, but allows direct comparison across population groups with different covariate profiles and competing mortality patterns. In our illustrative example, we show that regional variations in survival following a diagnosis of rectal cancer persist even after accounting for the variation in deprivation, age at diagnosis and other cause mortality.
CONCLUSIONS
The methodological approach of using standardised and reference adjusted metrics offers an appealing approach for future cancer survival comparison studies and routinely published cancer statistics. Our non-parametric estimation approach through the use of weighting offers the ability to estimate comparable survival estimates without the need for statistical modelling.
Topics: Cause of Death; Humans; Male; Models, Statistical; Population Groups; Probability; Rectal Neoplasms
PubMed: 34991487
DOI: 10.1186/s12874-021-01465-w -
Revista Espanola de Quimioterapia :... Apr 2023The Health Sciences Foundation has assembled a multidisciplinary group around a series of questions about the impact of the COVID-19 pandemic on the mental health of the... (Review)
Review
The Health Sciences Foundation has assembled a multidisciplinary group around a series of questions about the impact of the COVID-19 pandemic on the mental health of the general population and specific groups within that population, particularly healthcare workers. In the general population, the most prevalent mental disorders have been anxiety, sleep disorders and affective disorders, primarily depression. There has been a considerable increase in suicidal behavior, especially in young women and men over 70 years of age. There has been an increase in alcohol abuse and nicotine, cannabis and cocaine use. In contrast, the use of synthetic stimulants during periods of confinement has decreased. With regard to non-substance addictions, gambling was very limited, pornography consumption increased significantly and there was an increase in compulsive shopping and the use of video games. Particularly vulnerable groups include adolescents and patients with autism spectrum disorders. Healthcare workers suffered an increase in depression, anxiety and post-traumatic stress, especially those who were exposed during the early stages of the pandemic. Female sex, being a nurse, proximity to patients with COVID-19, working in a rural environment and having previous psychiatric or organic illnesses were some of the most frequently repeated factors in various studies in this population group. The media have shown a good degree of knowledge about these problems and have dealt with them frequently and from the point of view of ethics, crisis situations, such as the one experienced, have triggered not only physical but also moral claudications.
Topics: Male; Adolescent; Humans; Female; Aged; Aged, 80 and over; COVID-19; Mental Health; Pandemics; SARS-CoV-2; Population Groups; Health Personnel
PubMed: 36800778
DOI: 10.37201/req/018.2023 -
Lancet (London, England) Dec 2019
Topics: Brazil; Conservation of Natural Resources; Female; Human Rights; Humans; Indigenous Peoples; Male; Mining; Population Groups
PubMed: 31868629
DOI: 10.1016/S0140-6736(19)32620-0 -
European Journal of Clinical... Jan 2019
Topics: Bias; Humans; Population Groups; Precision Medicine; Risk Assessment; Sample Size
PubMed: 30251305
DOI: 10.1111/eci.13031 -
Frontiers in Public Health 2021The concept of "race" emerged in the 1600s with the trans-Atlantic slave trade, justifying slavery; it has been used to justify exploitation, denigration and decimation.... (Review)
Review
The concept of "race" emerged in the 1600s with the trans-Atlantic slave trade, justifying slavery; it has been used to justify exploitation, denigration and decimation. Since then, despite contrary scientific evidence, a deeply-rooted belief has taken hold that "race," indicated by, e.g., skin color or facial features, reflects fundamental biological differences. We propose that the term "race" be abandoned, substituting "ethnic group" while retaining "racism," with the goal of dismantling it. Despite scientific consensus that "race" is a social construct, in official U.S. classifications, "Hispanic"/"Latino" is an "ethnicity" while African American/Black, American Indian/Alaska Native, Asian/Pacific Islander, and European American/White are "races." There is no scientific basis for this. Each grouping reflects ancestry in a particular continent/region and shared history, e.g., the genocide and expropriation of Indigenous peoples, African Americans' enslavement, oppression and ongoing disenfranchisement, Latin America's Indigenous roots and colonization. Given migrations over millennia, each group reflects extensive genetic admixture across and within continents/regions. "Ethnicity" evokes social characteristics such as history, language, beliefs, customs. "Race" reinforces notions of inherent biological differences based on physical appearance. While not useful as a biological category, geographic ancestry is a key social category for monitoring and addressing health inequities because of racism's profound influence on health and well-being. We must continue to collect and analyze data on the population groups that have been racialized into socially constructed categories called "races." We must not, however, continue to use that term; it is not the only obstacle to dismantling racism, but it is a significant one.
Topics: Black or African American; Ethnicity; Hispanic or Latino; Humans; Native Hawaiian or Other Pacific Islander; Racism; United States
PubMed: 34557466
DOI: 10.3389/fpubh.2021.689462 -
Journal of Pharmaceutical Sciences Feb 2023Imatinib is used in gastrointestinal stromal tumours (GIST) and chronic myeloid leukaemia (CML). Oncology patients demonstrate altered physiology compared to healthy...
PURPOSE
Imatinib is used in gastrointestinal stromal tumours (GIST) and chronic myeloid leukaemia (CML). Oncology patients demonstrate altered physiology compared to healthy adults, e.g. reduced haematocrit, increased α-1 acid glycoprotein, decreased albumin and reduced glomerular filtration rate (GFR), which may influence imatinib pharmacokinetics. Given that Chinese cancer patients often report raised imatinib plasma concentrations and wider inter-individual variability reported in trough concentration when compared to Caucasian cancer patients, therapeutic drug monitoring (TDM) has been advocated.
METHOD
This study utilised a previously validated a Chinese cancer population and assessed the impact of imatinib virtual-TDM in Chinese and Caucasian cancer populations across a dosing range from 200-800 mg daily.
RESULTS
Staged dose titration to 800 mg daily, resulted in recapitulation to within the target therapeutic range for 50 % (Chinese) and 42.1% (Caucasian) subjects possessing plasma concentration < 550 ng/mL when dosed at 400 mg daily. For subjects with plasma concentrations >1500 ng/mL when dosed at 400 mg daily, a dose reduction to 200 mg once daily was able to recover 67 % (Chinese) and 87.4 % (Caucasian) patients to the target therapeutic range.
CONCLUSION
Virtual TDM highlights the benefit of pharmacokinetic modelling to optimising treatments in challenging oncology population groups.
Topics: Adult; Humans; Imatinib Mesylate; Antineoplastic Agents; Drug Monitoring; Population Groups; East Asian People; Pyrimidines; Piperazines; Benzamides; Leukemia, Myelogenous, Chronic, BCR-ABL Positive
PubMed: 36202248
DOI: 10.1016/j.xphs.2022.09.028 -
International Journal of Legal Medicine May 2024The anterior nasal spine is a pointed, midline projection of the maxilla. This bony structure dictates the overlying soft tissues providing the phenotypic features of...
INTRODUCTION
The anterior nasal spine is a pointed, midline projection of the maxilla. This bony structure dictates the overlying soft tissues providing the phenotypic features of the nose and upper lip and determines the differences in the mid-face morphology. Little data is available on the metric features of the Anterior nasal spine (ANS). This study aimed to perform metric evaluations of the ANS of white and black South African males and females to ascertain if morphological variations exist and if the differences are viable for the use in sex and population identification.
MATERIALS AND METHODS
The sample included 100 CBCT images for each population and sex group. Linear and angular measurements of the ANS were recorded in both the sagittal and axial planes.
RESULTS
Classification decision trees (pruned) were fitted to ascertain the relationship between population group, sex and the ANS measurements including and excluding age. For population group, all the ANS measurements were statistically significant for females but in males, all the ANS measurements were significant when performed individually. However, when fitted to the classification tree, Sagittal 2 did not show any statistical significance. When considering sex, only 2 of the ANS measurements (Sagittal 2 and Axial 1) were found to be significant. The results did not differ significantly when comparing the decision trees including and excluding age.
CONCLUSIONS
White South African individuals presented with a longer ANS that produced a more acute angle whereas black South African individuals presented with a shorter ANS and a more obtuse angle. Additionally, males presented with a longer ANS compared to females. ANS measurements were found to be more relevant for population discernment than for sex.
Topics: Male; Female; Humans; South Africa; Population Groups; Cone-Beam Computed Tomography; Maxilla; Nose
PubMed: 38010514
DOI: 10.1007/s00414-023-03130-x -
Frontiers in Public Health 2022We aimed to comprehensively analyze awareness, knowledge and attitude toward influenza vaccine and the factors associated to vaccine acceptance among the young and...
BACKGROUND
We aimed to comprehensively analyze awareness, knowledge and attitude toward influenza vaccine and the factors associated to vaccine acceptance among the young and middle-aged general population, healthcare workers, and health-related administrators in China. The factors influencing the promotion of influenza vaccination were also evaluated among healthcare workers and administrators.
METHODS
This is a multicenter, cross-sectional study. General population adults, healthcare workers (HCWs), and health administrators were enrolled in seven regions across China during the 2020-2021 flu season. Data were collected an online questionnaire, which included information request as to awareness, knowledge, and attitude toward influenza vaccination. Statistical significance set at -values < 0.05.
RESULTS
A total of 3,239 individuals were included in our analyses. There were gaps in consciousness to action, especially between awareness (87.1%) and knowledge (57.7%), and between willingness (57.3%) and vaccination (22.3%). The downward trends were similar in all three groups. HCW group and the health administrator group showed more positive propensity to accept influenza vaccines than the general population group. For the general population group, those with a lower educational level (lower than a bachelor's degree) were less likely to be vaccinated (aOR = 0.66, 95% CI: 0.45-0.96). For the HCW group, practitioners older than 45 years were more reluctant to be vaccinated than those under 25 years (aOR = 0.41, 95% CI: 0.19-0.86). For the health administrator group, personnel aged 26 years and above were less inclined to be vaccinated (aORs = 0.17-0.20). In all groups, people who had received influenza vaccines in the past 5 years (aOR = 1.72, 95% CI: 1.31-2.26 in general population group, 13.05, 95% CI: 7.71-22.10 in HCW group, and 19.30, 95% CI: 9.66-42.63 in health administrator group) were more likely to be vaccinated in future seasons. People who were not covered by the free program or those without awareness of the related programs were less likely to be vaccinated (aORs < 0.63). Most (70.8%) of HCWs showed intention to recommend the influenza vaccine. Clinical doctors, those who had flu shots themselves, and those who had more knowledge, were more like to make recommendations. Health administrators stated that insufficient budget resources and workforce, and low public awareness are main difficulties in the promotion of influenza vaccine.
CONCLUSION
The influencing factors of the attitude toward influenza vaccination vary across populations. Governments need to carry out focused vaccination promotion programs, especially for healthcare workers, to improve the coverage of influenza vaccination.
Topics: Adult; Middle Aged; Humans; Influenza Vaccines; Influenza, Human; Cross-Sectional Studies; Population Groups; Vaccination; China
PubMed: 36330121
DOI: 10.3389/fpubh.2022.950532 -
International Journal of Environmental... May 2017The study aims to investigate sleep duration in four different population groups in a national probability sample of older South Africans who participated in the Study...
The study aims to investigate sleep duration in four different population groups in a national probability sample of older South Africans who participated in the Study of Global Ageing and Adult Health (SAGE) Wave 1. A national population-based cross-sectional study with a sample of 3284 aged 50 years or older in South Africa was conducted in 2008. The questionnaire included socio-demographic characteristics, health variables, and self-reported sleep duration. Results indicate that White Africans compared to other population groups had the lowest mean sleep duration (7.88 h among men and 7.46 h among women). The prevalence of short sleep was the highest among both men and women among the White African (18.8% in men and 16.9% in women) and Indian or Asian African population groups (14.5% in men and 17.1% in women), and lowest among both men and women in the Black African (7.0% in men and 6.5% in women) and multi-ancestry population groups (15.6% in men and 12.7% in women). The prevalence of long sleep was among both men and women the highest in the Black African population group (56.2% in men and 58.5% in women), and the lowest in the White African population group (36.4% in men and 24.3% in women). In a Poisson regression model, adjusted for sociodemographics and chronic disease status, coming from the male and female White African population group was associated with short sleep. In addition, coming from the Indian or Asian African population group was associated with short sleep. No population group differences were found regarding long sleep prevalence. White Africans reported more short sleep duration than the other population groups, while there were no racial or ethnic differences in long sleep. White Africans are more likely to have sleep durations that are associated with negative health outcomes. An explanation of the high short sleep prevalence among White Africans may be related to their racial or ethnic minority status in South Africa.
Topics: Age Factors; Aged; Aging; Asian People; Black People; Cross-Sectional Studies; Female; Humans; Male; Middle Aged; Prevalence; Racial Groups; Self Report; Sex Factors; Sleep; South Africa; Time Factors; White People
PubMed: 28486421
DOI: 10.3390/ijerph14050502