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This essay argues for the importance of formalizing public engagement efforts around bioethics as something we might call "bioethics communication," and it outlines the Johns Hopkins Berman Institute of Bioethics' plans for engaging in this effort. Because science is complex and difficult to explain to nonexperts, the field of science communication has arisen to meet this need. The field involves both a practice and a subject of empirical research. Like science, bioethics is also complex and difficult to explain, which is why the world needs bioethics communication. The authors are engaged in a brand-new effort to establish the sort of public bioethics efforts that would constitute bioethics communication, through a program which they call the Dracopoulos-Bloomberg iDeas Lab. The authors invite colleagues to experiment and learn with them as they invest in the development of bioethics communicators and their products.
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Bioética , Humanos , Investigación Empírica , Comunicación , Academias e Institutos , AprendizajeRESUMEN
The coronavirus disease 2019 pandemic may require rationing of various medical resources if demand exceeds supply. Theoretical frameworks for resource allocation have provided much needed ethical guidance, but hospitals still need to address objective practicalities and legal vetting to operationalize scarce resource allocation schemata. To develop operational scarce resource allocation processes for public health catastrophes, including the coronavirus disease 2019 pandemic, five health systems in Maryland formed a consortium-with diverse expertise and representation-representing more than half of all hospitals in the state. Our efforts built on a prior statewide community engagement process that determined the values and moral reference points of citizens and health-care professionals regarding the allocation of ventilators during a public health catastrophe. Through a partnership of health systems, we developed a scarce resource allocation framework informed by citizens' values and by general expert consensus. Allocation schema for mechanical ventilators, ICU resources, blood components, novel therapeutics, extracorporeal membrane oxygenation, and renal replacement therapies were developed. Creating operational algorithms for each resource posed unique challenges; each resource's varying nature and underlying data on benefit prevented any single algorithm from being universally applicable. The development of scarce resource allocation processes must be iterative, legally vetted, and tested. We offer our processes to assist other regions that may be faced with the challenge of rationing health-care resources during public health catastrophes.
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COVID-19 , Defensa Civil/organización & administración , Asignación de Recursos para la Atención de Salud , Fuerza Laboral en Salud , Salud Pública/tendencias , Asignación de Recursos , COVID-19/epidemiología , COVID-19/prevención & control , COVID-19/terapia , Gestión del Cambio , Planificación en Desastres , Asignación de Recursos para la Atención de Salud/métodos , Asignación de Recursos para la Atención de Salud/normas , Humanos , Colaboración Intersectorial , Maryland/epidemiología , Asignación de Recursos/ética , Asignación de Recursos/organización & administración , SARS-CoV-2 , Triaje/ética , Triaje/organización & administraciónRESUMEN
Genomic studies of patients with COVID-19, or exposed to it, are underway to delineate host factors associated with variability in susceptibility, infectivity, and disease severity. Here, we highlight the ethical implications-both potential benefits and harms-of genomics for clinical practice and public health in the era of COVID-19.
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Infecciones por Coronavirus/patología , Predisposición Genética a la Enfermedad/genética , Pruebas Genéticas/ética , Genómica/ética , Neumonía Viral/patología , Salud Pública/ética , Betacoronavirus , COVID-19 , Toma de Decisiones Clínicas/métodos , Infecciones por Coronavirus/terapia , Genómica/métodos , Humanos , Pandemias , Neumonía Viral/terapia , Salud Pública/métodos , SARS-CoV-2Asunto(s)
Vacunas contra la COVID-19/administración & dosificación , COVID-19/prevención & control , Estudios Clínicos como Asunto/ética , Experimentación Humana/ética , Vacunas contra la COVID-19/efectos adversos , Vacunas contra la COVID-19/uso terapéutico , Desarrollo de Medicamentos/ética , Humanos , Medición de RiesgoAsunto(s)
Fibrilación Atrial/complicaciones , Fibrilación Atrial/tratamiento farmacológico , Clonazepam/uso terapéutico , Moduladores del GABA/uso terapéutico , Trastorno de Pánico/complicaciones , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Adulto JovenRESUMEN
Abstract Objective To evaluate attachment patterns in subjects with schizophrenia and their relationships to early traumatic events, psychotic symptoms and comorbidities. Methods Twenty patients diagnosed with schizophrenia according to criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) underwent retrospective symptom assessment and careful assessment of the number and manner of childhood caregiver changes. The Diagnostic Interview for Psychosis and Affective Disorders (DI-PAD) was used to assess symptoms related to schizophrenia (positive and negative symptoms), depression and mania. Anxiety disorder comorbidities were assessed by the Liebowitz Social Anxiety Scale (LSAS), Yale-Brown Obsessions and Compulsions Scale (Y-BOCS) and Panic and Schizophrenia Interview (PaSI). Experience in Close Relationships - Relationship Structures (ECR-RS) and Early Trauma Inventory Self Report-Short Form (ETISR-SF) were used to assess attachment patterns and traumatic history, respectively. Results Moderate and significant correlations between attachment patterns and early trauma showed that greater severity of anxious attachment was predicted by a higher frequency of total early traumas (Spearman ρ = 0.446, p = 0.04), mainly general traumas (ρ = 0.526, p = 0.017; including parental illness and separation, as well as natural disaster and serious accidents). Among the correlations between early trauma and comorbid symptoms, panic attacks occurring before the onset of schizophrenia showed significant and positive correlations with ETISR-SF total scores and the sexual trauma subscale. Conclusion Children with an unstable early emotional life are more vulnerable to the development of psychopathology, such as panic anxiety symptoms. Traumatic events may also predict later schizophrenia.
Resumo Objetivos Avaliar o padrão de apego em portadores de esquizofrenia e discutir a relação que tais padrões apresentam com a sintomatologia psicótica e as comorbidades dos pacientes investigados. Métodos Vinte pacientes diagnosticados com esquizofrenia de acordo com os critérios do Manual Diagnóstico e Estatístico de Transtornos Mentais, 5ª edição (DSM-5) foram submetidos a avaliação de sintomas retrospectivos e avaliação cuidadosa do número e modo de mudança de cuidador da infância. A Entrevista Diagnóstica para Psicoses e Transtornos Afetivos (DI-PAD) foi utilizada para avaliar sintomas relacionados à esquizofrenia (sintomas positivos e negativos), depressão e mania. As comorbidades de transtorno de ansiedade foram avaliadas pela Escala de Ansiedade Social de Liebowitz (LSAS), Escala de Sintomas Obsessivo-Compulsivos de Yale-Brown (Y-BOCS) e Entrevista de Pânico e Esquizofrenia (PaSI). Os instrumentos Questionário das Experiências nas Relações Próximas-Estruturas Relacionais (ECR-RS) e Inventário de Autorrelato de Trauma Precoce - Forma Curta (ETISR-SF) foram utilizados para avaliar padrões de apego e histórico traumático, respectivamente. Resultados Foram identificadas correlações significativas entre a ocorrência de traumas precoces e o apego do tipo ansioso. Também foi verificada a relação entre traumas gerais e sintomas de pânico, constatando-se que as crises de pânico antecipam surtos quando predominam sintomas ansiosos, somáticos, alucinações e ideias delirantes. Foi observado que a ocorrência de traumas precoces contribui para o pânico, elevando o risco de episódios psicóticos. Conclusão . Os resultados indicam que as adversidades ambientais na infância estão associadas com o risco de desenvolvimento de esquizofrenia e de outras psicoses mais tarde na vida.
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Humanos , Masculino , Femenino , Adulto , Esquizofrenia/complicaciones , Esquizofrenia/epidemiología , Psicología del Esquizofrénico , Adultos Sobrevivientes de Eventos Adversos Infantiles/psicología , Apego a Objetos , Escalas de Valoración Psiquiátrica , Trastorno Bipolar/complicaciones , Trastorno Bipolar/epidemiología , Comorbilidad , Factores de Riesgo , Trastorno de Pánico/complicaciones , Trastorno de Pánico/epidemiología , Depresión/complicaciones , Depresión/epidemiología , Alucinaciones/complicaciones , Alucinaciones/epidemiologíaRESUMEN
OBJECTIVE: To evaluate attachment patterns in subjects with schizophrenia and their relationships to early traumatic events, psychotic symptoms and comorbidities. METHODS: Twenty patients diagnosed with schizophrenia according to criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) underwent retrospective symptom assessment and careful assessment of the number and manner of childhood caregiver changes. The Diagnostic Interview for Psychosis and Affective Disorders (DI-PAD) was used to assess symptoms related to schizophrenia (positive and negative symptoms), depression and mania. Anxiety disorder comorbidities were assessed by the Liebowitz Social Anxiety Scale (LSAS), Yale-Brown Obsessions and Compulsions Scale (Y-BOCS) and Panic and Schizophrenia Interview (PaSI). Experience in Close Relationships - Relationship Structures (ECR-RS) and Early Trauma Inventory Self Report-Short Form (ETISR-SF) were used to assess attachment patterns and traumatic history, respectively. RESULTS: Moderate and significant correlations between attachment patterns and early trauma showed that greater severity of anxious attachment was predicted by a higher frequency of total early traumas (Spearman ρ = 0.446, p = 0.04), mainly general traumas (ρ = 0.526, p = 0.017; including parental illness and separation, as well as natural disaster and serious accidents). Among the correlations between early trauma and comorbid symptoms, panic attacks occurring before the onset of schizophrenia showed significant and positive correlations with ETISR-SF total scores and the sexual trauma subscale. CONCLUSION: Children with an unstable early emotional life are more vulnerable to the development of psychopathology, such as panic anxiety symptoms. Traumatic events may also predict later schizophrenia.
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Adultos Sobrevivientes de Eventos Adversos Infantiles/psicología , Apego a Objetos , Esquizofrenia/complicaciones , Esquizofrenia/epidemiología , Psicología del Esquizofrénico , Adulto , Trastorno Bipolar/complicaciones , Trastorno Bipolar/epidemiología , Comorbilidad , Depresión/complicaciones , Depresión/epidemiología , Femenino , Alucinaciones/complicaciones , Alucinaciones/epidemiología , Humanos , Masculino , Trastorno de Pánico/complicaciones , Trastorno de Pánico/epidemiología , Escalas de Valoración Psiquiátrica , Factores de RiesgoAsunto(s)
Antivirales , Hepatitis C Crónica , Hepatitis C , Alelos , Femenino , Genotipo , Hepacivirus/genética , Humanos , Interleucinas , Periodo Posparto , Carga ViralRESUMEN
Twenty patients with DSM5 schizophrenia were comprehensively and formally assessed by an experienced psychiatrist. All subjects were assessed for: positive and negative psychotic symptoms; social anxiety; panic anxiety; obsessive compulsive disorder, atypical depression; major depression; suicide risk; and global assessment of functioning. Different profiles of clinical presentation and symptom evolution emerged for patients with schizophrenia who had co-morbid depression (15%), OCD (15%), panic or limited symptom attacks (55%) and social anxiety (5%). At least eighty percent of the sample had one or more of these co-morbidities. Summing up, the data support our previous finding that panic is highly prevalent in Schizophrenia with Auditory Hallucinations (>73% here, versus 100% before), and panic was paroxysmally concurrent with voice onset. Moreover, characteristic clinical findings may help point clinicians to five specific co-morbidity psychosis subtypes. Moreover, co-morbidity dissection of psychotic diagnoses recalls and parallels the historical psychopharmacologic dissection of non-psychotic anxiety and depressive subtypes diagnoses. Larger studies should further test and explore these preliminary findings.
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Trastornos de Ansiedad/diagnóstico , Trastornos de Ansiedad/epidemiología , Trastorno Depresivo Mayor/diagnóstico , Trastorno Depresivo Mayor/epidemiología , Esquizofrenia/diagnóstico , Esquizofrenia/epidemiología , Adulto , Trastornos de Ansiedad/psicología , Comorbilidad , Trastorno Depresivo Mayor/psicología , Femenino , Alucinaciones/diagnóstico , Alucinaciones/epidemiología , Alucinaciones/psicología , Humanos , Masculino , Persona de Mediana Edad , Trastorno Obsesivo Compulsivo/diagnóstico , Trastorno Obsesivo Compulsivo/epidemiología , Trastorno Obsesivo Compulsivo/psicología , Trastorno de Pánico/diagnóstico , Trastorno de Pánico/epidemiología , Trastorno de Pánico/psicología , Proyectos Piloto , Prevalencia , Trastornos Psicóticos/diagnóstico , Trastornos Psicóticos/epidemiología , Trastornos Psicóticos/psicología , Estudios Retrospectivos , Psicología del EsquizofrénicoAsunto(s)
Alucinaciones/psicología , Trastorno de Pánico/psicología , Trastornos Psicóticos/psicología , Esquizofrenia , Antipsicóticos/uso terapéutico , Ansiedad/psicología , Femenino , Alucinaciones/tratamiento farmacológico , Humanos , Persona de Mediana Edad , Trastorno de Pánico/tratamiento farmacológico , Trastornos Psicóticos/tratamiento farmacológico , Esquizofrenia/tratamiento farmacológico , Psicología del EsquizofrénicoAsunto(s)
Humanos , Femenino , Persona de Mediana Edad , Trastornos Psicóticos/psicología , Esquizofrenia/tratamiento farmacológico , Trastorno de Pánico/psicología , Alucinaciones/psicología , Ansiedad/psicología , Trastornos Psicóticos/tratamiento farmacológico , Psicología del Esquizofrénico , Antipsicóticos/uso terapéutico , Trastorno de Pánico/tratamiento farmacológico , Alucinaciones/tratamiento farmacológicoAsunto(s)
Regulación Gubernamental , Enfermedades Mitocondriales/prevención & control , Terapia de Reemplazo Mitocondrial/ética , Terapia de Reemplazo Mitocondrial/normas , Oocitos , Cigoto , Núcleo Celular/genética , ADN Mitocondrial/genética , Ética Médica , Humanos , Enfermedades Mitocondriales/genética , Estados Unidos , United States Food and Drug AdministrationRESUMEN
In recent years, there have been prominent calls for a new social contract that accords a more central role to citizens in health research. Typically, this has been understood as citizens and patients having a greater voice and role within the standard research enterprise. Beyond this, however, it is important that the renegotiated contract specifically addresses the oversight of a new, path-breaking approach to health research: participant-led research. In light of the momentum behind participant-led research and its potential to advance health knowledge by challenging and complementing traditional research, it is vital for all stakeholders to work together in securing the conditions that will enable it to flourish.
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Ética en Investigación , Experimentación Humana/ética , Política Pública , Sujetos de Investigación , Humanos , Política Pública/legislación & jurisprudencia , Política Pública/tendencias , Responsabilidad SocialRESUMEN
Social anxiety disorder (SAD) patients may have self-referential ideas and share other cognitive processes with paranoid delusional disorder (PDD) patients. From an evolutionary perspective, SAD may derive from biologically instinctive social hierarchy ranking, thus causing an assumption of inferior social rank, and thus prompting concerns about mistreatment from those of perceived higher rank. This naturalistic longitudinal study followed four patients with initial SAD and later onset of PDD. These four patients show the same sequence of diagnosed SAD followed by diagnosed PDD, as is often retrospectively described by other PDD patients. Although antipsychotic medication improved psychotic symptoms in all patients, those who also had adjunctive serotonin-specific reuptake inhibitors for SAD had much more improvement in both psychosis and social functioning. From an evolutionary perspective, it can be conjectured that when conscious modulation of the SAD social rank instinct is diminished due to hypofrontality (common to many psychotic disorders), then unmodulated SAD can lead to paranoid delusional disorder, with prominent ideas of reference. Non-psychotic SAD may be prodromal or causal for PDD.