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BMC Medical Ethics Jun 2024While the number of emergency patients worldwide continues to increase, emergency doctors often face moral distress. It hampers the overall efficiency of the emergency...
BACKGROUND
While the number of emergency patients worldwide continues to increase, emergency doctors often face moral distress. It hampers the overall efficiency of the emergency department, even leading to a reduction in human resources.
AIM
This study explored the experience of moral distress among emergency department doctors and analyzed the causes of its occurrence and the strategies for addressing it.
METHOD
Purposive and snowball sampling strategies were used in this study. Data were collected through in-depth, semi-structured interviews with 10 doctors working in the emergency department of a tertiary general hospital in southwest China. The interview data underwent processing using the Nvivo 14 software. The data analysis was guided by Colaizzi's phenomenological analysis method.
STUDY FINDINGS
This study yielded five themes: (1) imbalance between Limited Medical Resources and High-Quality Treatment Needs; (2) Ineffective Communication with Patients; (3) Rescuing Patients With no prospect of treatment; (4) Challenges in Sustaining Optimal Treatment Measures; and (5) Strategies for Addressing Moral Distress.
CONCLUSION
The moral distress faced by emergency doctors stems from various aspects. Clinical management and policymakers can alleviate this distress by enhancing the dissemination of emergency medical knowledge to the general public, improving the social and economic support systems, and strengthening multidisciplinary collaboration and doctors' communication skills.
Topics: Humans; China; Qualitative Research; Physicians; Female; Male; Morals; Adult; Emergency Service, Hospital; Attitude of Health Personnel; Stress, Psychological; Communication; Physician-Patient Relations; Middle Aged; East Asian People
PubMed: 38902648
DOI: 10.1186/s12910-024-01074-4 -
Scientific Reports Jun 2024Acetaminophen (APAP) is a leading cause of acute liver failure. The effect of APAP metabolite's effects in the periphery are well characterized; however, associated...
Acetaminophen (APAP) is a leading cause of acute liver failure. The effect of APAP metabolite's effects in the periphery are well characterized; however, associated consequences in the brain remain poorly understood. Animal studies on this subject are few and reveal that frequent APAP intake can trigger cerebral abnormalities that vary depending on the subject's age. Alarmingly, experimental efforts have yet to examine associated consequences in elderly hosts, who correspond to the highest risk of medication overload, impaired drug clearance, and cognitive deficits. Here, we interrogated the cerebral and peripheral pathology of elderly mice submitted to monthly episodes of APAP intoxication since a young adult age. We found that weeks after the final episode of recurrent APAP exposure, mice exhibited worsened non-spatial memory deficit whereas spatial memory performance was unaltered. Interestingly, one month after the period of APAP intoxication, these mice showed increased glial burden without associated drivers, namely, blood-brain barrier disruption, cholesterol accumulation, and elevation of inflammatory molecules in the brain and/or periphery. Our experimental study reveals how recurrent APAP exposure affects the cognitive performance and cellular events in elderly brains. These data suggest that APAP-containing pharmacological interventions may foreshadow the elevated risk of neuropsychiatric disorders that afflict elderly populations.
Topics: Animals; Acetaminophen; Cognitive Dysfunction; Mice; Astrocytes; Microglia; Male; Brain; Mice, Inbred C57BL; Blood-Brain Barrier; Aging; Disease Models, Animal; Spatial Memory
PubMed: 38902507
DOI: 10.1038/s41598-024-65185-z -
Journal of Affective Disorders Jun 2024Informal care is a common form of social support, which can vary greatly in its intensity. While views of aging have shown to be relevant to mental health before, we aim...
BACKGROUND
Informal care is a common form of social support, which can vary greatly in its intensity. While views of aging have shown to be relevant to mental health before, we aim to analyze whether the association between views of aging and depressive symptoms is influenced by the provision of informal care and its intensity.
METHODS
Data of six waves of the Health and Retirement Study in the United States was used. The sample includes up to 41,058 observations pooled over six waves of community-dwelling adults aged ≥50 years. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale (CESD) and attitudes towards own aging (ATOA) with the Philadelphia Geriatric Center Morale Scale (higher score indicates positive attitudes); informal caregiving (no/yes) and caregiving intensity (moderate, intense) were surveyed. Adjusted fixed effects regression analysis with robust standard errors, and with caregiving as moderator variable were calculated.
RESULTS
Informal caregiving did not interact with ATOA. However, transitioning into intense caregiving significantly moderated the association between ATOA and depressive symptoms. Lower depressive symptoms were associated with better ATOA and this association was significantly stronger in the intense caregiving condition than in the non-caregiving condition. No significant interaction effects were found between any form of caregiving and subjective age.
LIMITATIONS
The possibility of reciprocal effects cannot be excluded.
CONCLUSION
Internalized ageism and depressive symptoms are more strongly related among caregivers who provide intense care. Thus, interventions to reduce internalized ageism could be helpful in particular among this vulnerable group of informal caregivers.
PubMed: 38901694
DOI: 10.1016/j.jad.2024.06.055 -
Global Health Research and Policy Jun 2024Little is known regarding economic impacts of intimate partner violence (IPV) in humanitarian settings, especially the labor market burden. Examining costs of IPV beyond...
BACKGROUND
Little is known regarding economic impacts of intimate partner violence (IPV) in humanitarian settings, especially the labor market burden. Examining costs of IPV beyond the health burden may provide new information to help with resource allocation for addressing IPV, including within conflict zones. This paper measures the incidence and prevalence of different types of IPV, the potential relationship between IPV and labor market activity, and estimating the cost of these IPV-associated labor market differentials.
METHODS
The association between labor market outcomes, IPV experience, and conflict exposure among women ages 15-49 in Nigeria were studied using the 2018 Nigeria Demographic and Health Survey and 2013-17 Uppsala Conflict Data Program data. Descriptive analysis was used to identify patterns of IPV and labor outcomes by region. Based on this, multivariable logistic regression models were used to estimate the association between labor market participation and lifetime IPV exposure. These models were combined with earnings data from the United Nations Human Development Report 2021/2022 and a top-down costing approach to quantify the impacts in terms of lost productivity to the Nigerian economy.
RESULTS
Substantial differences in IPV exposure and labor market outcomes were found between conflict and non-conflict-affected areas. Women with past year or lifetime exposure to physical, emotional, or "any" IPV were more likely to withdraw from the labor market in the past year, although no differences were found for sexual IPV or conflict-affected regions. We estimate an average reduction of 4.14% in the likelihood of working, resulting in nearly $3.0 billion USD of lost productivity, about 1% of Nigeria's total economic output.
CONCLUSIONS
Increased odds of labor market withdraw were associated with several measures of IPV. Withdrawal from the formal labor market sector has a substantial associated economic cost for all of Nigerian society. If stronger prevention measures reduce the incidence of IPV against women in Nigeria, a substantial portion of lost economic costs likely could be reclaimed. These costs underscore the economic case, alongside the moral imperative, for stronger protections against IPV for girls and women in Nigeria.
Topics: Humans; Nigeria; Intimate Partner Violence; Female; Adult; Adolescent; Young Adult; Middle Aged; Employment; Prevalence; Incidence
PubMed: 38898516
DOI: 10.1186/s41256-024-00362-1 -
BMC Nursing Jun 2024Moral courage and team work are the most important aspects of professional competence in clinical nurses; nurses with moral courage and team work are thought to be able...
BACKGROUND
Moral courage and team work are the most important aspects of professional competence in clinical nurses; nurses with moral courage and team work are thought to be able to deliver safe nursing care to patients. The present study aimed to investigate whether moral courage and teamwork correlate with safe nursing care among clinical nurses.
METHODS
This descriptive cross-sectional multicenter study was carried out from December 2023 to February 2024. A total of 375 nurses who were practicing in four hospitals in the south of Iran were enrolled in this study using convenience sampling. The data collection tools used consisted of a demographics survey, Moral Courage Questionnaire (MCQ), Team STEPPS Team Perception Questionnaire (T-TPQ), and the Assessment of Safe Nursing Care Questionnaire (ASNCQ). The data were analyzed using descriptive statistics, t-test, chi-square, multiple regression analysis, and Pearson's correlation coefficient. SPSS version 22 was used to analyze the data.
RESULTS
The participants' mean age was 32.66 ± 6.63 years, and their work experience was 8.56 ± 6.22 years. The total mean scores for moral courage, teamwork, and safe care were 422.37 ± 52.92, 144.09 ± 18.43, 315.84 ± 41.95, respectively. A statistically significant positive correlation was found between teamwork and safe care (r = 0.57, p < 0.001), teamwork and moral courage (r = 0.49, p = 0.002), and moral courage and safe nursing care (r = 0.59 p < 0.001). According to the results, work experience, moral courage, and teamwork explained 44.4% of the variance in safe nursing care (R2 = 0.44, p < 0.001).
CONCLUSION
The results indicated that the moral courage and teamwork of nurses were positively and significantly correlated with the participants' safe nursing care. Accordingly, since moral courage and teamwork are the qualities that can contribute to improving the quality of care and ensuring safe nursing care, it is recommended that nursing managers pay special attention to these factors.
PubMed: 38898506
DOI: 10.1186/s12912-024-02097-3 -
Public Health Jun 2024The purpose of this work is to characterize scenarios under which it may be in a donor country's own public health interests to donate vaccine doses to another country...
OBJECTIVES
The purpose of this work is to characterize scenarios under which it may be in a donor country's own public health interests to donate vaccine doses to another country before its own population has been fully vaccinated. In these scenarios, vaccinating other countries can delay the evolution of new variants of the virus, decrease total deaths, and, in some cases, decrease deaths in the donor countries.
STUDY DESIGN
We simulate the effects of different vaccine donation policies using an epidemiological model employing COVID-19 transmission parameters.
METHODS
We use the epidemiological model of Holleran et al. that incorporates virus mutation to simulate epidemic progression and estimate numbers of deaths arising from several vaccine allocation policies (donor-first, non-donor-first, and vaccine sharing) across a number of scenarios. We analyze the results in light of herd immunity limits derived in Holleran et al.
RESULTS
We identify realistic scenarios under which a donor country prefers to donate vaccines before distributing them locally in order to minimize local deaths during a pandemic. We demonstrate that a non-donor-first vaccination policy can delay, sometimes dramatically, the emergence of more-contagious variants. Even more surprising, donating all vaccines is sometimes better for the donor country than a sharing policy in which half of the vaccines are donated, and half are retained because of the impact donation can have on delaying the emergence of a more contagious virus. Non-donor-first vaccine allocation is optimal in scenarios in which the local health impact of the vaccine is limited or when delaying the emergence of a variant is especially valuable.
CONCLUSION
In all cases, we find that vaccine distribution is not a zero-sum game between donor and non-donor countries, illustrating the general moral reasons to donate vaccines. In some cases, donor nations can also realize local health benefits from donating vaccines. The insights yielded by this framework can be used to guide equitable vaccine distribution in future pandemics.
PubMed: 38897068
DOI: 10.1016/j.puhe.2024.05.011 -
Revista Brasileira de Parasitologia... 2024Horse fly females (Diptera, Tabanidae) are hematophagous and can vector pathogens that affect livestock. Complexes of cryptic species are common in Tabanidae, as...
Horse fly females (Diptera, Tabanidae) are hematophagous and can vector pathogens that affect livestock. Complexes of cryptic species are common in Tabanidae, as exemplified by some species of Tabanus, including Tabanus triangulum and Tabanus occidentalis, both prevalent in the Southern region of Brazil. In this study, geometric morphometrics were employed to ascertain the wing venation in species identification. It was demonstrated that this tool effectively differentiates T. triangulum from T. occidentalis in the coastal plain of Rio Grande do Sul state, situated within the Pampa biome. The results indicate that T. triangulum and T. occidentalis occupy distinct regions of the morphological space, allowing their precise identification through geometric morphometrics, which is fast, affordable, and easy to implement.
Topics: Animals; Diptera; Female; Brazil; Body Size; Wings, Animal
PubMed: 38896757
DOI: 10.1590/S1984-29612024028 -
The Animal Welfare Consequences and Moral Implications of Lethal and Non-Lethal Fox Control Methods.Animals : An Open Access Journal From... Jun 2024Control methods are applied worldwide to reduce predation on livestock by European red foxes (). Lethal methods can inflict suffering; however, moral debate about their...
Control methods are applied worldwide to reduce predation on livestock by European red foxes (). Lethal methods can inflict suffering; however, moral debate about their use is lacking. Non-lethal methods can also inflict suffering and can unintentionally lead to death, and yet both the welfare consequences and ethical perspectives regarding their use are rarely discussed. The aim of this study was to investigate the animal welfare consequences, the level of humaneness, the ethical considerations and the moral implications of the global use of fox control methods according to Tom Regan's animal rights view and Peter Singer's utilitarian view. According to Regan, foxes ought not to be controlled by either lethal or potentially harmful non-lethal methods because this violates the right of foxes not to be harmed or killed. According to Singer, if an action maximises happiness or the satisfaction of preferences over unhappiness or suffering, then the action is justified. Therefore, if and only if the use of fox control methods can prevent suffering and death in livestock in a manner that outweighs comparable suffering and death in foxes is one morally obligated to use them. It is clear that lethal fox control methods and some non-lethal methods are inhumane.
PubMed: 38891719
DOI: 10.3390/ani14111672 -
Animals : An Open Access Journal From... Jun 2024Trends in dietary habits have far-reaching implications, but their impact on animals remains insufficiently explored, as many people continue to dissociate meat from...
Trends in dietary habits have far-reaching implications, but their impact on animals remains insufficiently explored, as many people continue to dissociate meat from individual animal lives. This research study quantifies the temporal development of the number of animal lives affected by meat consumption within the G20 countries between 1961 and 2020 and forecasts for 2030. Production (including slaughter) and historical and projected food balance data were analyzed to explore these trends. The results indicate an increase in the number of animal lives affected due to increasing consumption, but discrepancies exist between different countries and animal categories. Increases are stronger in emerging countries, such as China, than in more industrialized countries, such as Germany. Overall, the number of animals affected grows 1.7 times as fast as meat consumption due to a shift towards poultry. Poultry birds are affected by far the most, and their dominance in number only slightly reduces when considering the differentiated moral values of the animals, reflecting their sentience. Until 2030, we can expect further increases in the number of animal lives affected. The findings highlight the need for progressive legislation to address the complex trade-offs and challenges in reversing the increasing trends in the number of animals affected.
PubMed: 38891709
DOI: 10.3390/ani14111662 -
BMC Medical Ethics Jun 2024The nursing profession considers conscience as the foundation and cornerstone of clinical practice, which significantly influences professional decision-making and...
BACKGROUND
The nursing profession considers conscience as the foundation and cornerstone of clinical practice, which significantly influences professional decision-making and elevates the level of patient care. However, a precise definition of conscience in the nursing field is lacking, making it challenging to measure. To address this issue, this study employed the hybrid approach of Schwartz Barcott and Kim to analyze the concept of conscience-based nursing care.
METHODS
This approach involves a three-phase process; theoretical, fieldwork, and analytical. A systematic literature review was conducted using electronic databases during the first phase to find relevant papers. The content of 42 articles that met the inclusion criteria was extracted to determine the attributes, antecedents, and consequences of consciousness care using thematic analysis. Based on the working definition as a product of this phase, the plan of doing the fieldwork phase was designed. During this phase, data were collected through interviews with nurses all of whom were responsible for patient care in hospitals. In this phase, 5 participants were chosen for in-depth interviewing by purposeful sampling. Data were analyzed using directed content analysis. The findings of the theoretical and fieldwork phases were integrated and the final definition was derived.
RESULTS
The integration of the theoretical and fieldwork phases resulted in identifying four key characteristics of conscience-based nursing care. Firstly, it involves providing professional care with a conscientious approach. Secondly, ethics is at the core of conscience-based care. Thirdly, external spirituality plays a significant role in shaping one's conscience in this context. Finally, conscience-based nursing care is both endogenous and exogenous, with professional commitment being the central focus of care.
CONCLUSION
Conscience-based nursing care is an essential component of ethical care, which elevates clinical practice to professional care. It requires the integration of individual and social values, influenced by personal beliefs and cultural backgrounds, and supported by professional competence, resources, and a conducive organizational atmosphere in the healthcare field. This approach leads to the provision of responsive care, moral integrity, and individual excellence, ultimately culminating in the development of professionalism in nursing.
Topics: Humans; Conscience; Nursing Care; Attitude of Health Personnel; Ethics, Nursing; Concept Formation
PubMed: 38890687
DOI: 10.1186/s12910-024-01070-8