Regulatory and Ethical Considerations on Artificial Intelligence for Occupational Medicine.

Generative artificial intelligence and Large Language Models are reshaping labor dynamics and occupational health practices. As AI continues to evolve, there's a critical need to customize ethical considerations for its specific impacts on occupational health. Recognizing potential ethical challenges and dilemmas, stakeholders and physicians are urged to proactively adjust the practice of occupational medicine in response to shifting ethical paradigms. By advocating for a comprehensive review of the International Commission on Occupational Health ICOH code of Ethics, we can ensure responsible medical AI deployment, safeguarding the well-being of workers amidst the transformative effects of automation in healthcare.

Os efeitos iatrogénicos das técnicas de gestão / The iatrogenic effects of management techniques

O principal objetivo deste texto é apresentar uma perspectiva crítica aos efeitos das técnicas de gestão empresariais sobre a saúde dos trabalhadores. Sabemos que o trabalho é um elemento central na vida das pessoas, porque, entre outros aspetos, a subsistência humana depende maioritariamente do fator trabalho. Essa é uma dimensão ética que tende a ser ignorada no universo laboral contemporâneo. As modernas técnicas de gestão, nomeadamente, a intensificação do trabalho, a qualidade total, a avaliação individual de desempenho, o aumento da precarização, a gestão pelo estresse ou a terceirização estão a destruir as relações sociais de trabalho e, consequentemente, a saúde dos trabalhadores. O adoecimento por via do trabalho é um problema social grave e a sua resolução parece difícil de alcançar, pelo menos nos tempos mais próximos, caso não se alterem profundamente as atuais técnicas de gestão empresariais

This study aims to show a critical perspective of the effects of business management techniques on workers' health. Work is a central element in people's lives because, among other aspects, human livelihood depends mostly on the work factor. This is an ethical dimension which the contemporary work universe tends to ignore. Modern management techniques, i.e., work intensification, total quality, individual performance evaluation, precariousness, and management by stress or outsourcing are destroying work relationships, work groups, and thus workers' health. Sickness due to work is a serious social problem and its resolution seems difficult to achieve (at least in the near future) if current business management techniques are not profoundly altered

Should neurosurgeons continue to work in the absence of personal protective equipment during the COVID-19 era?

The COVID-19 pandemic has resulted in a widespread shortage of personal protective equipment (PPE). Many healthcare workers, including neurosurgeons, have expressed concern about how to safely and adequately perform their medical responsibilities in these challenging circumstances. One of these concerns revolves around the pressing question: should providers continue to work in the absence of adequate PPE? Although the first peak of the COVID-19 crisis seems to have subsided and supply of PPE has increased, concerns about insufficient PPE availability remain. Inconsistent supply, limited efficacy, and continued high demand for PPE, combined with the continued threat of a second COVID-19 wave, mean that the issues surrounding PPE availability remain unresolved, including a duty to work. This paper offers an ethical investigation of whether neurosurgeons should perform their professional responsibilities with limited availability of PPE. We evaluate ethical considerations and conflicting duties and thereby hope to facilitate providers in making a well-considered personal and moral decision about this challenging issue.

CardioPulmonary Resuscitation in patients with suspected or confirmed Covid-19. A consensus of the Working group on CardioPulmonary Resuscitation of the Hellenic Society of Cardiology.

The unprecedented for modern medicine pandemic caused by the SARS-COV-2 virus ("coronavirus", Covid-19 disease) creates in turn new data on the management and survival of cardiac arrest victims, but mainly on the safety of CardioPulmonary Resuscitation (CPR) providers. The Covid-19 pandemic resulted in losses of thousands of lives, and many more people were hospitalized in simple or in intensive care unit beds, both globally and locally in Greece. More specifically, in victims of cardiac arrest, both in- and out- of hospital, the increased mortality and high contagiousness of the SARS-CoV-2 virus posed new questions, of both medical and moral nature/ to CPR providers. What we all know in resuscitation, that we cannot harm the victim and therefore do the most/best we can, is no longer the everyday reality. What we need to know and incorporate into decision-making in the resuscitation process is the distribution of limited human and material resources, the potentially very poor outcome of patients with Covid-19 and cardiac arrest, and especially that a potential infection of health professionals can lead in the lack of health professionals in the near future. This review tries to incorporate the added skills and precautions for CPR providers in terms of both in- and out- hospital CPR.

COVID-19-Related Ethics Consultations at a Cancer Center in New York City: A Content Review of Ethics Consultations During the Early Stages of the Pandemic.

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic has raised a variety of ethical dilemmas for health care providers. Limited data are available on how a patient's concomitant cancer diagnosis affected ethical concerns raised during the early stages of the pandemic. METHODS: We performed a retrospective review of all COVID-related ethics consultations registered in a prospectively collected ethics database at a tertiary cancer center between March 14, 2020, and April 28, 2020. Primary and secondary ethical issues, as well as important contextual factors, were identified. RESULTS: Twenty-six clinical ethics consultations were performed on 24 patients with cancer (58.3% male; median age, 65.5 years). The most common primary ethical issues were code status (n = 11), obligation to provide nonbeneficial treatment (n = 3), patient autonomy (n = 3), resource allocation (n = 3), and delivery of care wherein the risk to staff might outweigh the potential benefit to the patient (n = 3). An additional nine consultations raised concerns about staff safety in the context of likely nonbeneficial treatment as a secondary issue. Unique contextual issues identified included concerns about public safety for patients requesting discharge against medical advice (n = 3) and difficulties around decision making, especially with regard to code status because of an inability to reach surrogates (n = 3). CONCLUSION: During the early pandemic, the care of patients with cancer and COVID-19 spurred a number of ethics consultations, which were largely focused on code status. Most cases also raised concerns about staff safety in the context of limited benefit to patients, a highly unusual scenario at our institution that may have been triggered by critical supply shortages.

Care in the time of coronavirus: Ethical considerations in head and neck oncology.

As COVID-19 continues to challenge the practice of head and neck oncology, clinicians are forced to make new decisions in the setting of the pandemic that impact the safety of their patients, their institutions, and themselves. The difficulty inherent in these decisions is compounded by potentially serious ramifications to the welfare of patients and health-care staff, amid a scarcity of data on which to base informed choices. This paper explores the risks of COVID-19 incurred while striving to uphold the standard of care in head and neck oncology. The ethical problems are assessed from the perspective of the patient with cancer, health-care provider, and other patients within the health-care system. While no single management algorithm for head and neck cancer can be universally implemented, a detailed examination of these issues is necessary to formulate ethically sound treatment strategies.

Exploring the Factors Triggering Occupational Ethics Risk of Technology Transaction in Chinese Construction Industry.

: The importance of occupational ethics risk considerations during technology transaction in the construction industry is acknowledged. This is particularly in that the industry plays a significant part in a nation's development. The technology transaction has seen an increase in activity due to massive infrastructure development programmers adopted by governments and increase in external investment. The technology transaction, like any other, is not immune to unethical occupational behavior. This study aims to investigate the source of occupational ethics risk during technology transaction in the Chinese construction industry. A review of literature demonstrated that a number of contextual factors can influence unethical occupational risk practices. In total, 130 engineering practitioners took part in a questionnaire survey to explore the source of occupational ethics risk during the technology transaction in the Chinese construction industry. Firstly, there were 25 factors identified through literature review overall, which were sorted and analyzed. Among the twenty-five factors, three were identified as the most significant factors: Unreasonable incentives for technology trading; poor regulation; and asymmetry of information. Then, through exploratory factor analysis (EPA) method, the twenty-five factors were divided into seven groups: legal environment, industry environment, incompleteness of information, asymmetry of information, difficulty of observation of information, differences between the two sides of cooperation, and incorrect conceptual awareness. This study provided an added dimension to the understanding of occupational ethics risk issues during the technology transaction in the Chinese construction industry. This paper therefore contributes to the list of countries where similar studies have been undertaken.

Patients Left Behind: Ethical Challenges in Caring for Indirect Victims of the Covid-19 Pandemic.

In response to the Covid-19 pandemic, health care systems worldwide canceled or delayed elective surgeries, outpatient procedures, and clinic appointments. Although such measures may have been necessary to preserve medical resources and to prevent potential exposures early in the pandemic, moving forward, the indirect effects of such an extensive medical shutdown must not outweigh the direct harms of Covid-19. In this essay, we argue for the reopening of evidence-based health care with assurance provided to patients about the safety and necessity of high-value vaccinations, screenings, therapeutics, and procedures. To ensure that virtually all non-Covid-related services do not come to a halt again, health care systems and physician practices must preemptively increase their capacity, secure adequate personal protective equipment to safeguard health care personnel, and develop a measured approach to reclosing such routine health care, should it become necessary in the future.

A face humana do herói: análise do processo saúde-doença de bombeiros a partir de comunidades virtuais / The hero's human face: analyzing firemen's health-disease process based on virtual communities / El rostro humano del héroe: análisis del proceso salud-enfermedad de bomberos a partir de comunidades virtuales

Resumo Poucos estudos na literatura nacional abordam a relação trabalho e saúde dos bombeiros militares; entre tais estudos, muitos focam apenas os indicadores patológicos e/ou consequências físicas, sem colocar em debate suas necessidades de saúde e vida no trabalho. Visando analisar essa relação em uma perspectiva ampliada e humanizada do herói, foi realizado um estudo exploratório e metodologicamente inovador em dois blogs da categoria. Desvelaram-se realidades até então invisíveis ou pouco conhecidas socialmente no tocante ao processo de trabalho do grupo investigado, como precarização das condições laborais, adoecimentos, desvios de função, humilhações e insatisfações, evidenciando a necessidade de reconhecer os bombeiros militares como trabalhadores e que carecem de condições dignas de trabalho e atenção integral à saúde, sobretudo no que diz respeito à saúde mental.(AU)

Abstract Few studies deal with military firemen's work/health relationship in national literature, among which many focus only on pathological indicators and/or physical consequences, not discussing their health and life needs at work. Aiming at analyzing this relationship under a wider, humanized perspective of heroes, an exploratory and methodologically innovative study was conducted in two industry blogs. Invisible or socially little known realities concerning the investigated group's work process were unveiled, such as precarious labor conditions, illnesses, role deviation, humiliation, and dissatisfaction. These realities show the need for acknowledging military firemen as workers who lack decent working conditions and comprehensive healthcare, particularly regarding their mental health.(AU)

Resumen Son pocos los estudios en la literatura nacional que abordan la relación trabajo y salud de los bomberos militares, entre ellos, muchos se enfocan solamente en los indicadores patológicos y/o consecuencias físicas, sin poner en debate sus necesidades de salud y vida en el trabajo. Con el objetivo de analizar esa relación desde una perspectiva ampliada y humanizada del héroe, se realizó un estudio exploratorio y metodológicamente innovador en dos blogs de la categoría. Se revelaron realidades hasta entonces invisibles o poco conocidas socialmente en lo que se refiere al proceso de trabajo del grupo investigado, tales como la precarización de las condiciones laborales, enfermedades, desviaciones de función, humillaciones e insatisfacciones, poniendo en evidencia la necesidad de reconocer a los bomberos militares como trabajadores y que carecen de condiciones dignas de trabajo y de atención integral de la salud, principalmente en lo que se refiere a la salud mental.(AU)

Movimentos sociais, escravidão contemporânea e saúde: saberes, práticas e implicações para o Sistema Único de Saúde (SUS) / Movimientos sociales, esclavitud contemporánea y salud: saberes, prácticas e implicaciones para el Sistema Brasileño de Salud (SUS) / Social movements, modern slavery and health: knowledge, practices and implications to Brazilian National Health System (SUS)

O presente artigo buscou compreender a visão dos movimentos sociais engajados na erradicação da escravidão contemporânea quanto aos impactos desta na saúde dos trabalhadores e suas implicações ao Sistema Único de Saúde (SUS). Trata-se de uma pesquisa qualitativa que se baseou em entrevistas semiestruturadas realizadas com movimentos sociais de um estado brasileiro com alta prevalência de escravidão. Os resultados demonstram que esses movimentos compreendem a escravidão como a destruição física e mental do ser humano, dado o caráter violador da integridade dos trabalhadores. Além disso, destacaram a potencialidade do SUS, com relação à escravidão, em detectar casos, na recuperação das vítimas, na produção de conhecimento e na vigilância de condições laborais em articulação com os movimentos e outros órgãos. Conclui-se a premente necessidade da inserção da escravidão contemporânea na agenda da saúde pública brasileira como garantia do direito à saúde.(AU)

El presente artículo buscó comprender la visión de los movimientos sociales comprometidos en la erradicación de la esclavitud contemporánea en lo que se refiere a los impactos que ella tiene sobre la salud de los trabajadores y sus implicaciones para el Sistema Brasileño de Salud (SUS). Se trata de una encuesta cualitativa con base en entrevistas semiestructuradas realizadas con movimientos sociales de un estado brasileño con alta prevalencia de esclavitud. Los resultados demuestran que esos movimientos entienden la esclavitud como la destrucción física y mental del ser humano, dado el carácter violador de la integridad de los trabajadores. Además, subrayaron la potencialidad del SUS en lo que se refiere a la esclavitud, en la detección de casos, en la recuperación de las víctimas, en la producción de conocimiento, en la vigilancia de condiciones laborales en articulación con los movimientos y otros órganos. Se concluyó sobre la urgente necesidad de la inserción de la esclavitud contemporánea en la agenda de la salud pública brasileña como garantía del derecho a la salud.(AU)

The present article aims to grasp the point of view of social movements engaged in contemporary slavery eradication in terms of worker´s health impacts and its implications to Brazilian National Health System (SUS). It is a qualitative research using structured interviews with social movements in a Brazilian state of high prevalence of slavery. The outcomes show that these social movements comprehend slavery as physical and mental disintegration of human being, due to the violation upon workers integrity. Furthermore, they have highlighted the potentialities of SUS related to slavery in identifying new cases, recovery victims, knowledge production, working conditions surveillance, articulated with social movements and other institutions. The conclusion points out the need of inserting modern slavery in Brazilian public health agenda in order to warrant health´s rights.(AU)

Trust, Conflict, and Engagement in Occupational Health: North American Epidemiologists Conduct Occupational Study in Communities Affected by Chronic Kidney Disease of Unknown Origin (CKDu).

PURPOSE OF REVIEW: Science has been used as a tool of colonialism, and aspects of science privilege researchers in the global North (USA and Europe). The environmental justice and worker health movements in the USA and globally have influenced aspects of how occupational and environmental health research is conceived and conducted so that it is more equitable. This review provides a case example of research in the area of chronic kidney disease of unknown origin (CKDu). RECENT FINDINGS: In the present work, the author describes aspects of community-based participatory research and anti-colonial research that influence a current occupational epidemiology study of CKDu in Mesoamerica among workers in agriculture and non-agricultural industries. The research includes investigators from numerous countries in the global North and South and funding from the US government and corporations. The role of industry in science and the misuse of science by corporate interests remain substantial threats to research integrity. The ability of researchers to navigate potentially conflicting interests with industry and workers, and establish trust within and outside the scientific community, is essential for sustained engagement in longitudinal studies. Trust is about human relationships. It takes time and effort to build and is essential for creating equitable, empowering research relationships.

Addressing bullying behaviour by patients and families.

This article explores the ethical dilemma of maintaining patient experience and care team well-being when faced with coercive behaviour, specifically bullying by patients, families and substitute decision-makers, which is directed toward providers and health support workers. We discuss some of the contributing societal and environmental factors, the ethical implications for health leaders, and suggest some practical options for managing bullying situations in hospitals.

What Are Best Practices for Ethical Use of Nanosensors for Worker Surveillance?

Many employers now offer workers wearable or implantable devices that can monitor their health, productivity, and wellness. Nanotechnology enables even more powerful and functional monitoring capacity for these devices. A history of workplace monitoring programs suggests that, despite nanosensors' potential benefits to employers and employees, they can only be successful and sustainable when a company's motivations for offering them are acceptable and transparent to workers. This article describes 5 best practices for motivating nano-enabled worker monitoring programs that are acceptable, effective, and ethical.

A vision of ethics in efficient occupational healthcare.

BACKGROUND:: Occupational healthcare is nowadays more and more regulated by economic demands of gain and efficiency. AIM AND RESEARCH QUESTIONS:: The aim of this study is to reach a new understanding of ethics in occupational healthcare by uncovering this from occupational healthcare nurses' own views. The research questions are as follows: (1) What is the core of an ethical value base in occupational healthcare? (2) What does it mean for occupational healthcare nurses to fulfill their ethical value base in occupational healthcare? RESEARCH DESIGN, PARTICIPANTS, AND RESEARCH CONTEXT:: The study uses a hermeneutical approach. The context of the study is occupational healthcare. The material was collected through interviews with four occupational healthcare nurses in Finland. The texts were interpreted through hermeneutical reading. ETHICAL CONSIDERATIONS:: The data storage, study participation, and data handling for research purposes were approved by the participants when they provided their informed consent. FINDINGS:: The study revealed that the core of ethical values in occupational healthcare is something universal that concerns justice, honesty, and faithfulness. To fulfill the ethical value base means to continuously strive toward the inner core of love and bravely choose to listen to the this core in the name of the client and the universal good even if it involves a struggle or a sacrifice. DISCUSSION:: The ethical value base is not primarily tied to profession but is something that is general and universal. Nor do ethics and the implementation of ethical values stand in opposition to, for example, external values such as demands for efficiency and economic gain. However, ethics may promote efficiency. CONCLUSION:: The fulfillment of nurses' ethical value base in occupational healthcare requires that ethics first and foremost is allowed to enter the leadership and is prioritized on a leadership level. Creating caring cultures that encourage openness and support ethical discussions is fundamental.

Turning Away From Industrial Health Care Toward Careful and Kind Care.

The health care industry is increasingly driven by the pursuit of value. The author of this Invited Commentary believes this value is nothing more than a business rebranding of efficiency with little connection to care. Overclocked clinicians, increasingly impaired by symptoms of burnout and too focused on documenting, cannot see patients in high definition. The author shows that treatment which is blind to patients' contexts often overwhelms patients with medical errands, a topic absent from medical curricula. Care must not be the means by which health care satisfies its industrial mission but, rather, the end for which it mobilizes its means. In unhurried consultations, clinicians must appreciate and respond sensibly to patients' problematic situation, and care for and about them. Medical training must cultivate future clinicians who value caring over caring for value. Medical educators and trainees at all levels must turn away from industrial health care, toward careful and kind care for all.