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One Health Outlook Jul 2024One Health is being promoted as a transformative approach in health, conservation, and environmental sustainability. The polycrisis of climate change, pandemics, food...
One Health is being promoted as a transformative approach in health, conservation, and environmental sustainability. The polycrisis of climate change, pandemics, food insecurity, biodiversity loss, pollution and inequity is creating an urgency to evolve the epistemology and methods of One Health. However, the amount of effort placed into critical and systematic reflection on One Health is outweighed by advocacy for its use, or for expanding its scope of practice. This paper advocates for reflective One Health practice to foster new ways of knowing and doing that are helpful in the face of a rapidly narrowing window of opportunity to preserve the social and environmental factors that secure health and resilience for all species and generations. We propose six areas for reflection; (1) how to moderate conformity so that One Health does not become its own silo; (2) finding the moral purpose of One Health to align actions with desired outcomes; (3) coping with the problem of too many interacting problems; (4) the strategic trajectory of growth to accelerate action on root causes and ensure One Health is future-ready; (5) how to identify priorities across a vast array of problems, values, and needs and (6) how to know if we are making the world healthier and safer and for whom. Reflective practice requires investment in ongoing conversation to guard against over-confidence that we have captured the "one right way" to meet changing expectations and circumstances in a fair and effective way. Our intention is to stimulate thinking and discussion within the One Health community to ensure that "doing is shaped by knowing". We hope One Health will continue to be an emergent and highly variable set of ever more effective practices that constantly changes in response to the complex, interconnected and changing problems facing the health of people, animals, and the environment.
PubMed: 38951887
DOI: 10.1186/s42522-024-00106-8 -
CJEM Jul 2024People experiencing homelessness and marginalization face considerable barriers to accessing healthcare services. Increased reliance on technology within healthcare has...
OBJECTIVES
People experiencing homelessness and marginalization face considerable barriers to accessing healthcare services. Increased reliance on technology within healthcare has exacerbated these inequities. We evaluated a hospital-based prescription phone program aimed to reduce digital health inequities and improve access to services among marginalized patients in Emergency Departments. We examined the perceived outcomes of the program and the contextual barriers and facilitators affecting outcomes.
METHODS
We conducted a constructivist qualitative program evaluation at two urban, academic hospitals in Toronto, Ontario. We interviewed 12 healthcare workers about their perspectives on program implementation and outcomes and analyzed the interview data using reflexive thematic analysis.
RESULTS
Our analyses generated five interrelated program outcomes: building trust with patients, facilitating independence in healthcare, bridging sectors of care, enabling equitable care for marginalized populations, and mitigating moral distress among healthcare workers. Participants expressed that phone provision is critical for adequately serving patients who face barriers to accessing health and social services, and for supporting healthcare workers who often lack resources to adequately serve these patients. We identified key contextual enablers and challenges that may influence program outcomes and future implementation efforts.
CONCLUSIONS
Our findings suggest that providing phones to marginalized patient populations may address digital and social health inequities; however, building trusting relationships with patients, understanding the unique needs of these populations, and operating within a biopsychosocial model of health are key to program success.
PubMed: 38951473
DOI: 10.1007/s43678-024-00735-y -
Deutsche Medizinische Wochenschrift... Jul 2024Artificial intelligence (AI) is increasingly finding its way into medicine, and it is not yet clear how it will change the practice of medicine and the way doctors see...
Artificial intelligence (AI) is increasingly finding its way into medicine, and it is not yet clear how it will change the practice of medicine and the way doctors see themselves. This article explores the ethical limits of AI by (1) discussing the reductionistic elements inherent in AI, (2) working out the problematic implications of algorithmisation and (3) highlighting the lack of human control as an ethical problem of AI. The conclusion is that although AI is a useful tool to support medical judgement, it is absolutely dependent on human decision-making authority in order to actually prove beneficial for medicine.
Topics: Artificial Intelligence; Humans; Ethics, Medical; Algorithms
PubMed: 38950550
DOI: 10.1055/a-2302-8919 -
Proceedings of the National Academy of... Jul 2024The human colonization of the Canary Islands represents the sole known expansion of Berber communities into the Atlantic Ocean and is an example of marine dispersal...
The human colonization of the Canary Islands represents the sole known expansion of Berber communities into the Atlantic Ocean and is an example of marine dispersal carried out by an African population. While this island colonization shows similarities to the populating of other islands across the world, several questions still need to be answered before this case can be included in wider debates regarding patterns of initial colonization and human settlement, human-environment interactions, and the emergence of island identities. Specifically, the chronology of the first human settlement of the Canary Islands remains disputed due to differing estimates of the timing of its first colonization. This absence of a consensus has resulted in divergent hypotheses regarding the motivations that led early settlers to migrate to the islands, e.g., ecological or demographic. Distinct motivations would imply differences in the strategies and dynamics of colonization; thus, identifying them is crucial to understanding how these populations developed in such environments. In response, the current study assembles a comprehensive dataset of the most reliable radiocarbon dates, which were used for building Bayesian models of colonization. The findings suggest that i) the Romans most likely discovered the islands around the 1st century BCE; ii) Berber groups from western North Africa first set foot on one of the islands closest to the African mainland sometime between the 1st and 3rd centuries CE; iii) Roman and Berber societies did not live simultaneously in the Canary Islands; and iv) the Berber people rapidly spread throughout the archipelago.
Topics: Humans; Spain; Human Migration; Bayes Theorem; History, Ancient; Radiometric Dating
PubMed: 38950368
DOI: 10.1073/pnas.2302924121 -
Risk Factors for Mid- and Long-term Mortality in Lung Transplant Recipients aged 70 Years and Older.Interdisciplinary Cardiovascular and... Jul 2024With increased lung transplantation in those aged 70 and older, limited literature addresses risk factors affecting their survival. Our study aims to identify...
OBJECTIVES
With increased lung transplantation in those aged 70 and older, limited literature addresses risk factors affecting their survival. Our study aims to identify independent factors impacting mid- and long-term mortality in this elderly population.
METHODS
This study analyzed lung transplant patients over 70 from May 2005 to December 2022 using United Network for Organ Sharing data. The 3- or 5-year cohort excluded multi-organ, secondary transplantation and loss to follow-up. Univariable Cox analysis was conducted to assess recipient, donor, and transplant factors. Factors with a significance level of P < 0.2 were subsequently included in a multivariable Cox model to identify correlations with 3- and 5-year mortality in patients aged over 70.
RESULTS
Multivariable analysis has identified key factors affecting 3- and 5-year mortality in elderly lung transplant patients over 70. Common notable factors include recipient total bilirubin, ICU status at the time of transplantation, donor diabetes, CMV mismatch, and single lung transplantation. Additionally, Hispanic/Latino patients and ischaemia time of the transplant significantly impact the 3-year mortality, while recipient age, diabetes, NO use before transplantation and creatinine were identified as unique independent risk factors affecting the 5-year morality.
CONCLUSIONS
The study identified several independent risk factors that impact the mid- and long-term survival of lung transplantation for individuals over 70 years. These findings can contribute to the optimization of lung transplant treatment strategies and perioperative management in elderly patients, thereby enhancing the survival rate of this age group.
PubMed: 38950182
DOI: 10.1093/icvts/ivae117 -
PloS One 2024Induced abortion is one of the most common gynecological procedures in the world, with as many as three in every ten pregnancies ending in abortion. It, however, remains... (Review)
Review
BACKGROUND
Induced abortion is one of the most common gynecological procedures in the world, with as many as three in every ten pregnancies ending in abortion. It, however, remains controversial. The objective of this scoping review was to explore and map existing literature on the experiences of those who provide abortion care.
METHODS AND FINDINGS
This exploratory review followed the Levac et al. guidelines and was reported in accordance with the PRISMA-ScR checklist. CINAHL, Cochrane, EMBASE, PsycInfo, PubMed, and Web of Science were used to identify peer-reviewed, original research articles published on providers' experience of abortion. We identified 106 relevant studies, which include a total sample of 4,250 providers from 28 countries and six continents. Most of the studies were qualitative (n = 83), though quantitative (n = 15) and mixed methods (n = 8) studies were also included. We identified two overarching themes: (1) Providers' experiences with abortion stigma and (2) Providers' reflections on their abortion work. Our findings suggest that providers from around the world experience challenges within society and their communities and workplaces which reinforce the stigmatization and marginalization of abortion and pose questions about the morality of this work. Most, however, are proud of their work, believe abortion care to be socially important and necessary, and remain committed to the provision of care.
CONCLUSIONS
The findings of this review provide a comprehensive overview on the known experiences of providing abortion care. It is a key point of reference for international providers, researchers, and advocates to further this area of research or discussion in their own territories. The findings of this review will inform future work on how to support providers against stigmatization and will offer providers the chance to reflect on their own experiences.
Topics: Humans; Abortion, Induced; Female; Pregnancy; Health Personnel; Social Stigma; Attitude of Health Personnel
PubMed: 38950040
DOI: 10.1371/journal.pone.0303601 -
JAMA Network Open Jul 2024Compared with early cord clamping (ECC), umbilical cord milking (UCM) reduces delivery room cardiorespiratory support, hypoxic-ischemic encephalopathy, and therapeutic... (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Compared with early cord clamping (ECC), umbilical cord milking (UCM) reduces delivery room cardiorespiratory support, hypoxic-ischemic encephalopathy, and therapeutic hypothermia in nonvigorous near-term and full-term infants. However, UCM postdischarge outcomes are not known.
OBJECTIVE
To determine the 2-year outcomes of children randomized to UCM or ECC at birth in the Milking in Nonvigorous Infants (MINVI) trial.
DESIGN, SETTING, AND PARTICIPANTS
A secondary analysis to evaluate longer-term outcomes of a cluster-randomized crossover trial was conducted from January 9, 2021, to September 25, 2023. The primary trial took place in 10 medical centers in the US, Canada, and Poland from January 5, 2019, to June 1, 2021, and hypothesized that UCM would reduce admission to the neonatal intensive care unit compared with ECC; follow-up concluded September 26, 2023. The population included near-term and full-term infants aged 35 to 42 weeks' gestation at birth who were nonvigorous; families provided consent to complete developmental screening questionnaires through age 2 years.
INTERVENTION
UCM and ECC.
MAIN OUTCOMES AND MEASURES
Ages and Stages Questionnaire, 3rd Edition (ASQ-3) and Modified Checklist for Autism in Toddlers, Revised/Follow-Up (M-CHAT-R/F) questionnaires at ages 22 to 26 months. Intention-to-treat analysis and per-protocol analyses were used.
RESULTS
Among 1730 newborns from the primary trial, long-term outcomes were evaluated in 971 children (81%) who had ASQ-3 scores available at 2 years or died before age 2 years and 927 children (77%) who had M-CHAT-R/F scores or died before age 2 years. Maternal and neonatal characteristics by treatment group were similar, with median birth gestational age of 39 (IQR, 38-40) weeks in both groups; 224 infants (45%) in the UCM group and 201 (43%) in the ECC group were female. The median ASQ-3 total scores were similar (UCM: 255 [IQR, 225-280] vs ECC: 255 [IQR, 230-280]; P = .87), with no significant differences in the ASQ-3 subdomains. Medium- to high-risk M-CHAT-R/F scores were also similar (UCM, 9% [45 of 486] vs ECC, 8% [37 of 441]; P = .86).
CONCLUSIONS AND RELEVANCE
In this secondary analysis of a randomized clinical trial among late near-term and full-term infants who were nonvigorous at birth, ASQ-3 scores at age 2 years were not significantly different between the UCM and ECC groups. Combined with previously reported important short-term benefits, this follow-up study suggests UCM is a feasible, no-cost intervention without longer-term neurodevelopmental risks of cord milking in nonvigorous near-term and term newborns.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT03631940.
Topics: Humans; Female; Infant, Newborn; Male; Infant; Umbilical Cord Clamping; Cross-Over Studies; Umbilical Cord; Hypoxia-Ischemia, Brain; Child, Preschool
PubMed: 38949814
DOI: 10.1001/jamanetworkopen.2024.16870 -
Journal of Counseling Psychology Jul 2024Reports an error in "Defining racial allies: A qualitative investigation of White allyship from the perspective of people of color" by Cassandra L. Hinger, Cirleen...
Reports an error in "Defining racial allies: A qualitative investigation of White allyship from the perspective of people of color" by Cassandra L. Hinger, Cirleen DeBlaere, Rebecca Gwira, Michelle Aiello, Arash Punjwani, Laura Cobourne, Ngoc Tran, Madison Lord, Jordan Mike and Carlton Green (, 2023[Nov], Vol 70[6], 631-644). An additional citation was added for the structure of the definition of White allies in the second paragraph of the introduction. The online version of this article has been corrected. (The following abstract of the original article appeared in record 2024-23216-002.) While interdisciplinary scholars and activists urge White allies to engage in racial justice work led by the voices of Black, Indigenous, and people of color (BIPOC), to date, most research on racial allyship has centered exclusively on the perspective of White allies themselves. Thus, the purpose of this study was to create a framework of racial allyship from the perspective of BIPOC. Utilizing constructivist grounded theory (Charmaz, 2014), focus groups were conducted to understand how BIPOC describe the knowledge, skills, and actions of White allies. Participants across eight focus groups described allyship as an ongoing interpersonal process that included a lifelong commitment to (a) building trust, (b) engaging in antiracist action, (c) critical awareness, (d) sociopolitical knowledge, (e) accountability, and (f) communicating and disseminating information. The findings of this study point to several avenues through which White counseling psychologists can incorporate racial allyship in their research, training, clinical, and advocacy work that align with our field's emphasis on social justice, multiculturalism, and prevention. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Topics: Humans; Female; Adult; Qualitative Research; Male; Racism; White People; Social Justice; Middle Aged
PubMed: 38949779
DOI: 10.1037/cou0000741 -
Journal of Social Work in End-of-life &... Jul 2024
PubMed: 38949629
DOI: 10.1080/15524256.2024.2365368 -
Revista Da Escola de Enfermagem Da U S P 2024To understand the experience of nurses working in pediatric units in the face of innovations and changes in the process of caring for children and families during the...
OBJECTIVE
To understand the experience of nurses working in pediatric units in the face of innovations and changes in the process of caring for children and families during the COVID-19 pandemic. Also, the objective is to understand the typical experience of nurses in this care.
METHOD
Qualitative research, which involved the participation of 16 nurses from pediatric units of a public teaching hospital. The data were analyzed according to the theoretical-methodological framework of Alfred Schütz's social phenomenology.
RESULTS
The participants' reports generated the categories: the challenge of experiencing changes amid fear, the team's adaptation to innovations and changes caused by the COVID-19 pandemic and the expectation for care and the work process.
CONCLUSION
The understanding of the nurses' experience highlighted changes, team adaptations and expectations for the care of children and families, which, although permeated by learning, were experienced by ethical dilemmas and moral suffering for these professionals.
Topics: COVID-19; Humans; Child; Pediatric Nursing; Qualitative Research; Female; Adult; Male; Pandemics; Family; Nursing Staff, Hospital
PubMed: 38949511
DOI: 10.1590/1980-220X-reeusp-2023-0355en