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Indian Journal of Medical Ethics 2024To address the under reporting of sexual offences against children, the Protection of Children from Sexual Offences (POCSO) Act, 2012, makes reporting of such offences...
To address the under reporting of sexual offences against children, the Protection of Children from Sexual Offences (POCSO) Act, 2012, makes reporting of such offences mandatory. The duty to report such offences has been extended to healthcare professionals. The inclusion of healthcare professionals within mandatory reporting, however, strikes at the very foundation of the doctor- patient relationship based on trust and confidentiality and conflicts with the patient confidentiality safeguards of the Mental Healthcare Act, 2017. It also has unintended public health consequences, such as denial of medical termination of pregnancy due to fear of prosecution under POCSO. An urgent reassessment of these mandatory reporting norms for healthcare professionals, and a solution-based approach that harmonises societal interest in the reporting of sexual crimes with the child's right to health is essential.
Topics: Child; Pregnancy; Female; Humans; Mandatory Reporting; Sex Offenses; Confidentiality; Health Personnel; Physician-Patient Relations
PubMed: 38375641
DOI: 10.20529/IJME.2024.003 -
Frontiers in Psychiatry 2023Many jurisdictions implement mandatory substance use treatment for justice-involved persons. Germany is one such country; however, debates about the appropriateness and...
Many jurisdictions implement mandatory substance use treatment for justice-involved persons. Germany is one such country; however, debates about the appropriateness and effectiveness of this disposal abound. Very little attention has been paid in the international literature to patients receiving mandatory treatment in Germany. This systematic review synthesises research on patients receiving substance use treatment in forensic hospitals under §64 of the German Penal Code with regard to three primary outcomes: treatment completion, reoffending, and the recurrence of substance use. Forty-five publications reporting on 36 studies were reviewed; publication dates ranged from 1988 to 2023. On average, 47% of patients did not successfully complete treatment, compared to 45% who did. Average follow-up reconviction rates were higher than in mentally ill and general offender populations as reported elsewhere. Approximately half of all patients reused substances during treatment. Suggestions for future research, including a focus on strength- and recovery-based indicators, and harmonising routine outcomes measurements, are given.
PubMed: 38375516
DOI: 10.3389/fpsyt.2023.1217561 -
BMC Public Health Feb 2024Rapid antigen-detection tests for SARS-CoV-2 self-testing represent a useful tool for pandemic control and expanding access to community-level case screening. COVID-19... (Observational Study)
Observational Study
BACKGROUND
Rapid antigen-detection tests for SARS-CoV-2 self-testing represent a useful tool for pandemic control and expanding access to community-level case screening. COVID-19 self-tests have been extensively used in high-income countries since 2021; however, their introduction and programmatic implementation in low- and middle-income countries was delayed. We aimed to identify and continuously improve a weekly COVID-19 self-testing model among staff at healthcare facilities and schools.
METHODS
This mixed-methods, observational prospective study was conducted in 5 healthcare centres and 24 schools in Georgia, between June and December 2022. The study comprised the integration of COVID-19 self-testing into the national mandatory testing programme for high-risk groups, with primary distribution of self-tests among staff performed weekly, plus secondary distribution to their household members. These use cases were selected because NCDC was seeking to strengthen their already strong weekly testing programme, by investigating self-testing to ease the burden of testing in the healthcare system. Online surveys and semi-structured interviews were used for data collection.
RESULTS
In total, 2156 participants were enrolled (1963 female, 72%). At baseline and mid- and end-points, 88%, 97% and 99%, respectively, of participants agreed/strongly agreed they would self-test. Similarly, the majority were willing to report their self-testing results (88%, 98% and 96% at baseline and mid- and end-points, respectively). Weekly reporting of test results to the national COVID-19 database was high during all the implementation. There were 622 COVID-19 positive results reported, and linked to care, from 601 individuals (282 participants and 319 household members). Findings from qualitative interviews showed great satisfaction with self-testing for its convenience, ease of use, trust in the results, no need to travel for diagnostics, and increased perception of safety.
CONCLUSIONS
Our findings contribute to the evidence-base regarding self-testing strategies conducted via workplaces and secondary distribution to households. Willingness to perform a COVID-19 self-test increased after implementation. This pilot enhanced pandemic preparedness through expansion of the national self-testing reporting system, development of communications materials, changes in the national legal framework and coordination mechanisms, and improved perceptions around self-care in the community. The lessons learnt can inform operational aspects of the introduction and scale-up of self-care strategies.
Topics: Female; Humans; COVID-19; SARS-CoV-2; Pilot Projects; Self-Testing; Prospective Studies
PubMed: 38368339
DOI: 10.1186/s12889-024-17930-2 -
Euro Surveillance : Bulletin Europeen... Feb 2024A surge in gonorrhoea in Denmark has occurred since 2022, a 46% increase from 2021. National surveillance, leveraging mandatory reporting and epidemiological data,...
A surge in gonorrhoea in Denmark has occurred since 2022, a 46% increase from 2021. National surveillance, leveraging mandatory reporting and epidemiological data, highlights three distinct clades linked to heterosexual transmission. Despite the rise, these exhibit high susceptibility, contrasting MSM-associated strains. Geographical hotspots and age-specific patterns further illuminate transmission dynamics. The combination of genomic and epidemiological data provides novel insights into the evolving landscape of gonorrhoea, indicating potential shifts in infection dynamics and transmissibility.
Topics: Humans; Anti-Bacterial Agents; Denmark; Gonorrhea; Heterosexuality; Neisseria gonorrhoeae
PubMed: 38362625
DOI: 10.2807/1560-7917.ES.2024.29.7.2400059 -
BMC Infectious Diseases Feb 2024In Japan, carbapenem-resistant Enterobacterales (CRE) infections were incorporated into the National Epidemiological Surveillance of Infectious Diseases (NESID) in 2014,...
The importance of meropenem resistance, rather than imipenem resistance, in defining carbapenem-resistant Enterobacterales for public health surveillance: an analysis of national population-based surveillance.
BACKGROUND
In Japan, carbapenem-resistant Enterobacterales (CRE) infections were incorporated into the National Epidemiological Surveillance of Infectious Diseases (NESID) in 2014, necessitating mandatory reporting of all CRE infections cases. Subsequently, pathogen surveillance was initiated in 2017, which involved the collection and analysis of CRE isolates from reported cases to assess carbapenemase gene possession. In this surveillance, CRE is defined as (i) minimum inhibitory concentration (MIC) of meropenem ≥2 mg/L (MEPM criteria) or (ii) MIC of imipenem ≥2 mg/L and MIC of cefmetazole ≥64 mg/L (IPM criteria). This study examined whether the current definition of CRE surveillance captures cases with a clinical and public health burden.
METHODS
CRE isolates from reported cases were collected from the public health laboratories of local governments, which are responsible for pathogen surveillance. Antimicrobial susceptibility tests were conducted on these isolates to assess compliance with the NESID CRE definition. The NESID data between April 2017 and March 2018 were obtained and analyzed using antimicrobial susceptibility test results.
RESULTS
In total, 1681 CRE cases were identified during the study period, and pathogen surveillance data were available for 740 (44.0%) cases. Klebsiella aerogenes and Enterobacter cloacae complex were the dominant species, followed by Klebsiella pneumoniae and Escherichia coli. The rate of carbapenemase gene positivity was 26.5% (196/740), and 93.4% (183/196) of these isolates were of the IMP type. Meanwhile, 315 isolates were subjected to antimicrobial susceptibility testing. Among them, 169 (53.7%) fulfilled only the IPM criteria (IPM criteria-only group) which were susceptible to meropenem, while 146 (46.3%) fulfilled the MEPM criteria (MEPM criteria group). The IPM criteria-only group and MEPM criteria group significantly differed in terms of carbapenemase gene positivity (0% vs. 67.8%), multidrug resistance rates (1.2% vs. 65.8%), and mortality rates (1.8% vs 6.9%).
CONCLUSION
The identification of CRE cases based solely on imipenem resistance has had a limited impact on clinical management. Emphasizing resistance to meropenem is crucial in defining CRE, which pose both clinical and public health burden. This emphasis will enable the efficient allocation of limited health and public health resources and preservation of newly developed antimicrobials.
Topics: Humans; Meropenem; Imipenem; Public Health Surveillance; Bacterial Proteins; beta-Lactamases; Cefmetazole; Escherichia coli; Anti-Infective Agents; Microbial Sensitivity Tests; Anti-Bacterial Agents
PubMed: 38360618
DOI: 10.1186/s12879-024-09107-4 -
Dental Materials : Official Publication... Mar 2024The Dental Biomaterials Adverse Reaction Unit was initiated by the Norwegian health authorities in 1992 as a response to the public concern regarding the safety of...
OBJECTIVES
The Dental Biomaterials Adverse Reaction Unit was initiated by the Norwegian health authorities in 1992 as a response to the public concern regarding the safety of dental amalgam and other dental materials. In this paper, experiences from the Unit are briefly summarized.
METHODS
The Norwegian health authorities' strategy included four main topics: (i) development of a manufacturer-independent system for monitoring adverse reactions related to dental materials, (ii) funding of a specialty unit for clinical examinations of referred patients, (iii) development of official guidelines for examination and treatment of patients with health complaints attributed to dental materials, and (iv) funding of an experimental treatment project for patients with health complaints attributed to dental amalgam.
RESULTS
From the start, more than 2700 adverse reaction reports were received. In the initial years, amalgam was the most frequent material mentioned in the reports. Reports about polymer-based composite materials have not increased after the prohibition of amalgam in Norway. Clinical examination of referred patients is complex and time consuming, and it is important to consider differential diagnoses. There are methodological challenges associated with the design of experimental treatments used on patients with adverse reactions attributed to dental materials. However, the results from the treatment project indicate lower symptom load after replacement of amalgam with other dental restorative materials.
SIGNIFICANCE
Producer independent adverse reaction reporting can provide valuable information about the safety of these materials and could serve as a complement to the mandatory reporting system described in the European medical device regulations (MDR).
Topics: Humans; Dental Materials; Dental Amalgam; Dental Restoration, Permanent; Norway
PubMed: 38336526
DOI: 10.1016/j.dental.2024.01.004 -
NTM Mar 2024This article examines the impact of the reporting practice and paper technologies like forms on reports that were later used for national morbidity statistics by...
[Mandatory Reporting as the Basis of Epidemiological Statistics: The Impact of the Reporting Practice and Usage of Paper Technologies on the Informative Content of Morbidity Statistics 1886-1921].
This article examines the impact of the reporting practice and paper technologies like forms on reports that were later used for national morbidity statistics by studying the Swiss reporting system for infectious diseases between 1886 and 1921. Analysing the production processes of notifications shows the difficulties and solutions in the implementation of the statutory reporting process. Two disease outbreaks-a smallpox outbreak in Schaffhausen and a typhoid outbreak in the canton of Lucerne-serve as case studies. It is shown that reports are not only objective representations of diseases, but also symbolize the medico-social interactions that produce them, timed by administrative tools like reporting forms and the act of reporting. This destabilises historical statistics and illustrates the complexity of the historical source material, as these interactions and their impact on reporting must be considered. These findings are further supported by examining the Swiss reporting system during the Spanish flu of 1918 and its failure to record influenza cases.
Topics: History, 20th Century; Humans; Mandatory Reporting; Influenza Pandemic, 1918-1919; Communicable Diseases; Disease Outbreaks; Influenza, Human; Morbidity
PubMed: 38319387
DOI: 10.1007/s00048-024-00375-4 -
Frontiers in Nutrition 2023Food prices have experienced unprecedented increases in recent times. Simultaneously, grocers are facing allegations of capitalizing on inflation to generate...
Food prices have experienced unprecedented increases in recent times. Simultaneously, grocers are facing allegations of capitalizing on inflation to generate unjustifiable profits. Escalating expenses and a lack of transparency have engendered heightened consumer skepticism. This perceived presence of barriers and excessive profitability gives rise to ethical concerns. Our case study delves into the ethical landscape surrounding Canadian grocers, aiming to probe the public's demand for accountability. To comprehend the factors responsible for the transformation in consumer perception of Canadian grocers in 2022, we conducted an analysis utilizing data from consumers, corporate watchdogs, and industry sources. We extended the paradox perspective on corporate sustainability framework to include a historical aspect to use as our analytical lens. This study sheds light on the alterations in circumstances that have led Canadian consumers to question entire industries and accounting practices that were previously considered unproblematic. As a remedy, we recommend the establishment of a mandatory code of conduct for grocers and an enhancement in the transparency of financial reporting. Paradoxically, corporate profits may continue to grow when societal needs are no longer perceived as being neglected or, even worse, exploited.
PubMed: 38283908
DOI: 10.3389/fnut.2023.1284377 -
BMJ Paediatrics Open Jan 2024Increasingly large numbers of children and youth are migrating across international borders with many seeking employment in both formal and informal work sectors. These... (Review)
Review
Increasingly large numbers of children and youth are migrating across international borders with many seeking employment in both formal and informal work sectors. These young people are at high risk of exploitation. Healthcare professionals need to be able to recognise vulnerable patients and advocate for their protection and safety, yet there is a paucity of literature that provides guidance on how to accomplish this. The goal of this paper is to provide guidance to clinicians on identifying and assisting migrant paediatric patients at risk of being exploited in the work sector, including conducting a risk assessment and making decisions about mandatory reporting. First, the best interest of the youth within their cultural context should be examined respecting their desires and goals, as well as immediate and longer-term physical health, mental health and safety issues. Second, clinicians should consider the best interest of the family, with attention to varying socioeconomic and psychosocial conditions including acculturation, immigration challenges, as well as cultural norms and values. Third, the situation must be evaluated within the legal framework of the host country regarding child labour, exploitation and trafficking. Cultural humility, open-mindedness, the active engagement of patients and families and an understanding of child labour within cultural contexts and legal statutes will empower healthcare professionals to identify and support patients at risk of exploitation in work settings. These recommendations serve to prioritise the best interests of vulnerable working migrant children and youth. The healthcare and migration systems of the USA will be used as a case for exploration.
Topics: Adolescent; Humans; Child; Transients and Migrants; Emigration and Immigration; Mental Health; Child Labor; Delivery of Health Care
PubMed: 38272540
DOI: 10.1136/bmjpo-2023-002427 -
Journal of Comparative Effectiveness... Mar 2024Catheter ablation is used to treat symptomatic atrial fibrillation (AF) and is performed using either cryoballoon (CB) or radiofrequency (RF) ablation. There is limited...
Catheter ablation is used to treat symptomatic atrial fibrillation (AF) and is performed using either cryoballoon (CB) or radiofrequency (RF) ablation. There is limited real world data of CB and RF in the US as healthcare codes are agnostic of energy modality. An alternative method is to analyze patients' electronic health records (EHRs) using Optum's EHR database. To determine the feasibility of using patients' EHRs with natural language processing (NLP) to distinguish CB versus RF ablation procedures. Optum de-identified EHR dataset, Optum Cardiac Ablation NLP Table. This was a retrospective analysis of existing de-identified EHR data. Medical codes were used to create an ablation validation table. Frequency analysis was used to assess ablation procedures and their associated note terms. Two cohorts were created (1) index procedures, (2) multiple procedures. Possible note term combinations included (1) cryoablation (2) radiofrequency (3) ablation, or (4) both. Of the 40,810 validated cardiac ablations, 3777 (9%) index ablation procedures had available and matching NLP note terms. Of these, 22% (n = 844) were classified as ablation, 27% (n = 1016) as cryoablation, 49% (n = 1855) as radiofrequency ablation, and 1.6% (n = 62) as both. In the multiple procedures analysis, 5691 (14%) procedures had matching note terms. 24% (n = 1362) were classified as ablation, 27% as cryoablation, 47% as radiofrequency ablation, and 2% as both. NLP has potential to evaluate the frequency of cardiac ablation by type, however, for this to be a reliable real-world data source, mandatory data entry by providers and standardized electronic health reporting must occur.
Topics: Humans; Treatment Outcome; Cardiac Catheters; Retrospective Studies; Electronic Health Records; Natural Language Processing; Atrial Fibrillation; Catheter Ablation
PubMed: 38261335
DOI: 10.57264/cer-2023-0053