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Eur J Health Law ; : 1-23, 2021 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-33827050


The human right to health requires that everyone should have equal opportunities to enjoy the highest attainable standard of health. In practice, this is hard to achieve, as health is shaped by social determinants. This article explores the impact personalized medicine and use of big data may have on health disparities. New health technologies offer a lot of hope for more individual and better health promotion and care, which potentially could be beneficial for the most deprived. However, there are also concerns that not all population groups will profit equally from this new population-based medicine, and that new digital health technologies will maintain - or even reinforce - existing health disparities. This article suggests using insights from poverty studies combined with a patients' and human rights-based approach to ensure that the most deprived are not left behind in the application of new health technologies.

PLoS Biol ; 19(3): e3001167, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33684102


As the vaccines against COVID are slowly becoming available, we need to consider the paradox of why so many people of color are dying from the disease yet cannot get the vaccinations. Concerns focus on vaccine refusal but lack of access is the bigger problem.

Afro-Americanos/psicologia , Hispano-Americanos/psicologia , Racismo/psicologia , Recusa de Vacinação/etnologia , /epidemiologia , /metabolismo , Humanos , Pandemias , Estados Unidos/epidemiologia , Vacinação/métodos , Vacinação/psicologia , Recusa de Vacinação/psicologia , Recusa de Vacinação/tendências
Public Health ; 192: 3-7, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33601306


OBJECTIVES: The catastrophic effects of armed conflict, particularly prolonged armed conflict, on individual and public health are well established. The 'right' to healthcare during armed conflict and its lack of enforcement despite a range of United Nations mandated requirements regarding health and healthcare provisions is likely to be a significant feature in future conflicts, as zoonotic-induced pandemics become a more common global public health challenge. The issue of enforcement of health rights assurance and its implications for the public health management of global pandemics such as coronavirus disease 2019 (COVID-19) in and between countries and regions in conflict is the objective of this Review. STUDY DESIGN: A narrative review was conducted. METHODS: Referenced to the framework of International humanitarian law (IHL) and International human rights law (IHRL) to explore and discuss the deficits in health rights assurances in conflict settings and illustrate how gaps in protection and lack of enforcement compounds the disease response. Both IHL, and IHRL can be leveraged to ensure human and health rights are assured in conflict settings. There is a distinct lack of international criteria with regard to standards of healthcare coverage, infrastructure and service preservation to the civilian population during times of armed conflict. This has far reaching consequences when confounded by a pandemic or even localised disease outbreak. RESULTS: We illustrate how in a pandemic disease emergency, such as COVID-19, all life is threatened; and how leaving the citizen population exposed to this contagion is a human rights breach and an indirect method of warfare. The consequences of failure to effectively address such pandemic infections, (i.e. COVID-19), in a conflict setting are potentially catastrophic as prevention and containment responses are severely constrained by state insecurity, political instability, terrorism, repression, rights abuses, and displacement of citizens. Neglect by State actors potentially constitutes a breach of the universal right to life. States cannot justify their failures to mitigate disease based on claims of lack of resources, even when available resources are minimal. Where discrimination of people with a disease, such as COVID-19, or minority groups at the point of access to health facilities occurs, this further breaches the principle of medical neutrality. CONCLUSIONS: The example of the COVID-19 response may offer a viable route to leverage greater access and coverage of healthcare in conflict and humanitarian settings. A radicalised partnership approach during these times of emergency is warranted, based on an ethical 'humanitarian intervention' approach to provide care to all affected by contagious disease in conflict settings.

Altruísmo , Direitos Humanos , Direito à Saúde , Zoonoses , Animais , Emergências , Instalações de Saúde , Pessoal de Saúde , Acesso aos Serviços de Saúde , Pandemias , Saúde Pública
Cochrane Database Syst Rev ; 2: CD012707, 2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33634854


BACKGROUND: To support patient-centred care, healthcare organisations increasingly offer patients access to data stored in the institutional electronic health record (EHR). OBJECTIVES: Primary objective 1. To assess the effects of providing adult patients with access to electronic health records (EHRs) alone or with additional functionalities on a range of patient, patient-provider, and health resource consumption outcomes, including patient knowledge and understanding, patient empowerment, patient adherence, patient satisfaction with care, adverse events, health-related quality of life, health-related outcomes, psychosocial health outcomes, health resource consumption, and patient-provider communication. Secondary objective 1. To assess whether effects of providing adult patients with EHR access alone versus EHR access with additional functionalities differ among patient groups according to age, educational level, or different status of disease (chronic or acute). SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, and Scopus in June 2017 and in April 2020. SELECTION CRITERIA: Randomised controlled trials and cluster-randomised trials of EHR access with or without additional functionalities for adults with any medical condition. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodological procedures. MAIN RESULTS: We included 10 studies with 78 to 4500 participants and follow-up from 3 to 24 months. Nine studies assessed the effects of EHR with additional functionalities, each addressing a subset of outcomes sought by this review. Five studies focused on patients with diabetes mellitus, four on patients with specific diseases, and one on all patients. All studies compared EHR access alone or with additional functionalities plus usual care versus usual care only. No studies assessing the effects of EHR access alone versus EHR access with additional functionalities were identified. Interventions required a variety of data within the EHR, such as patient history, problem list, medication, allergies, and lab results. In addition to EHR access, eight studies allowed patients to share self-documented data, seven offered individualised disease management functions, seven offered educational disease-related information, six supported secure communication, and one offered preventive reminders. Only two studies were at low or unclear risk of bias across domains. Meta-analysis could not be performed, as participants, interventions, and outcomes were too heterogeneous, and most studies presented results based on different adjustment methods or variables. The quality of evidence was rated as low or very low across outcomes. Overall differences between intervention and control groups, if any, were small. The relevance of any small effects remains unclear for most outcomes because in most cases, trial authors did not define a minimal clinically important difference. Overall, results suggest that the effects of EHR access alone and with additional functionalities are mostly uncertain when compared with usual care. Patient knowledge and understanding: very low-quality evidence is available from one study, so we are uncertain about effects of the intervention on patient knowledge about diabetes and blood glucose testing. Patient empowerment: low-quality evidence from three studies suggests that the intervention may have little or no effect on patient empowerment measures. Patient adherence: low-quality evidence from two studies suggests that the intervention may slightly improve adherence to the process of monitoring risk factors and preventive services. Effects on medication adherence are conflicting in two studies; this may or may not improve to a clinically relevant degree. Patient satisfaction with care: low-quality evidence from three studies suggests that the intervention may have little or no effect on patient satisfaction, with conflicting results. Adverse events: two small studies reported on mortality; one of these also reported on serious and other adverse events, but sample sizes were too small for small differences to be detected. Therefore, low-quality evidence suggests that the intervention may have little to no effect on mortality and other adverse events. Health-related quality of life: only very low-quality evidence from one study is available. We are uncertain whether the intervention improves disease-specific quality of life of patients with asthma. Health-related outcomes: low-quality evidence from eight studies suggests that the intervention may have little to no effect on asthma control, glycosylated haemoglobin (HbA1c) levels, blood pressure, low-density lipoprotein or total cholesterol levels, body mass index or weight, or 10-year Framingham risk scores. Low-quality evidence from one study suggests that the composite scores of risk factors for diabetes mellitus may improve slightly with the intervention, but there is uncertainty about effects on ophthalmic medications or intraocular pressure. Psychosocial health outcomes: no study investigated psychosocial health outcomes in a more than anecdotal way. Health resource consumption: low-quality evidence for adult patients in three studies suggests that there may be little to no effect of the intervention on different measures of healthcare use. Patient-provider communication: very low-quality evidence is available from a single small study, and we are uncertain whether the intervention improves communication measures, such as the number of messages sent. AUTHORS' CONCLUSIONS: The effects of EHR access with additional functionalities in comparison with usual care for the most part are uncertain. Only adherence to the process of monitoring risk factors and providing preventive services as well as a composite score of risk factors for diabetes mellitus may improve slightly with EHR access with additional functionalities. Due to inconsistent terminology in this area, our search may have missed relevant studies. As the overall quality of evidence is very low to low, future research is likely to change these results. Further trials should investigate the impact of EHR access in a broader range of countries and clinical settings, including more patients over a longer period of follow-up, as this may increase the likelihood of detecting effects of the intervention, should these exist. More studies should focus on assessing outcomes such as patient empowerment and behavioural outcomes, rather than concentrating on health-related outcomes alone. Future studies should distinguish between effects of EHR access only and effects of additional functionalities, and investigate the impact of mobile EHR tools. Future studies should include information on usage patterns, and consider the potential for widening health inequalities with implementation of EHR access. A taxonomy for EHR access and additional functionalities should be developed to promote consistency and comparability of outcome measures, and facilitate future reviews by better enabling cross-study comparisons.

Registros Eletrônicos de Saúde , Acesso dos Pacientes aos Registros , Adulto , Asma/terapia , Viés , Glicemia/análise , Compreensão , Diabetes Mellitus/sangue , Diabetes Mellitus/diagnóstico , Registros Eletrônicos de Saúde/estatística & dados numéricos , Glaucoma/tratamento farmacológico , Conhecimentos, Atitudes e Prática em Saúde , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Insuficiência Cardíaca/terapia , Humanos , Hipertensão/terapia , Pessoa de Meia-Idade , Acesso dos Pacientes aos Registros/estatística & dados numéricos , Cooperação do Paciente , Participação do Paciente , Satisfação do Paciente , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
BMJ Glob Health ; 6(2)2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33627362


We finally have a vaccine for the COVID-19 crisis. However, due to the limited numbers of the vaccine, states will have to consider how to prioritise groups who receive the vaccine. In this paper, we argue that the practical implementation of human rights law requires broader consideration of intersectional needs in society and the disproportionate impact that COVID-19 is having on population groups with pre-existing social and medical vulnerabilities. The existing frameworks/mechanisms and proposals for COVID-19 vaccine allocation have shortcomings from a human rights perspective that could be remedied by adopting an intersectional allocative approach. This necessitates that states allocate the first COVID-19 vaccines according to (1) infection risk and severity of pre-existing diseases; (2) social vulnerabilities; and (3) potential financial and social effects of ill health. In line with WHO's guidelines on universal health coverage, a COVID-19 vaccine allocation strategy that it is more consistent with international human rights law should ensure that vaccines are free at the point of service, give priority to the worst off and be allocated in a transparent, participatory and accountable prioritisation process.

/prevenção & controle , Acesso aos Serviços de Saúde , Direitos Humanos , Prioridades em Saúde , Humanos
AMA J Ethics ; 23(2): E127-131, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33635192


Health professions educators continuously adapt curricular content in response to new scientific knowledge but can struggle to incorporate content about current social issues that profoundly affect students and learning environments. This article offers recommendations to support innovation and action as students and faculty grapple with ongoing unrest in the United States, including racism, murders of Black people by police, and COVID-19.

/psicologia , Educadores em Saúde , Ocupações em Saúde/educação , Racismo/psicologia , Justiça Social/psicologia , Afro-Americanos , Grupos Étnicos , Disparidades em Assistência à Saúde , Humanos , Aplicação da Lei , Estados Unidos
Trab. educ. saúde ; 19: e00312144, jan. 2021.
Artigo em Português | LILACS | ID: biblio-1139809


Resumo A política de saúde mental no Brasil se vê hoje ameaçada pelo retorno da lógica manicomial e isso constitui um risco aos usuários e familiares, pois o sujeito diagnosticado com transtorno mental deixa de usufruir plenos direitos. O objetivo deste ensaio é propor que o resgate da memória da barbárie manicomial seja parte fundamental de uma educação em direitos humanos; além disso, deveria estar presente na formação dos profissionais da área da saúde para fortalecer os movimentos sociais que dão legitimidade e força ao modelo antimanicomial. Parte-se de uma concepção crítica dos direitos humanos para argumentar que estes constituem a sedimentação histórica de lutas sociais em uma sociedade em conflito. A conclusão aponta que o usufruto do direito à saúde mental está intimamente relacionado à educação dos agentes de saúde, aos usuários e aos movimentos sociais.

Abstract The mental health policy in Brazil is threatened by the return of asylum logic and this constitutes a risk to users and family members, as the subject diagnosed with mental disorder no longer enjoys full rights. The purpose of this essay is to propose that the rescue of the memory of asylum barbarism is a fundamental part of human rights education; in addition, it should be present in the training of health professionals to strengthen social movements that give legitimacy and strength to the anti-asylum model. It starts with a critical conception of human rights to argue that they constitute the historical sedimentation of social struggles in a society in conflict. The conclusion points out that the enjoyment of the right to mental health is closely related to the education of health agents, users and social movements.

Resumen La política de la salud mental en Brasil se ve hoy amenazada por el retorno de la lógica manicomial, lo que constituye un riesgo hacia los usuarios y sus familiares, pues el sujeto diagnosticado con trastorno mental deja de usufructuar plenos derechos. El objetivo de este ensayo es proponer que el rescate de la memoria de la barbarie manicomial sea parte fundamental de la educación en derechos humanos; además de eso, debería estar presente en la formación de los profesionales del área de la salud para fortalecer los movimientos sociales que le dan legitimidad y fuerza al modelo antimanicomial. Se parte de una concepción crítica de los derechos humanos para argumentar que ellos constituyen la sedimentación histórica de las luchas sociales en una sociedad en conflicto. La conclusión apunta que el usufructo del derecho a la salud mental está íntimamente relacionado a la educación de los agentes de salud, a los usuarios y a los movimientos sociales.

Humanos , Direitos Humanos/educação , Saúde Mental , Agentes Comunitários de Saúde
Ann Surg ; 273(4): e125-e126, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33351468


The SARS-CoV-2 pandemic has highlighted existing systemic inequities that adversely affect a variety of communities in the United States. These inequities have a direct and adverse impact on the healthcare of our patient population. While civic engagement has not been cultivated in surgical and anesthesia training, we maintain that it is inherent to the core role of the role of a physician. This is supported by moral imperative, professional responsibility, and a legal obligation. We propose that such civic engagement and social justice activism is a neglected, but necessary aspect of physician training. We propose the implementation of a civic advocacy education agenda across department, community and national platforms. Surgical and anesthesiology residency training needs to evolve to the meet these increasing demands.

Anestesiologia/educação , Educação de Pós-Graduação em Medicina/métodos , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde , Papel do Médico , Justiça Social/educação , Especialidades Cirúrgicas/educação , Anestesiologia/ética , Educação de Pós-Graduação em Medicina/ética , Política de Saúde , Disparidades em Assistência à Saúde/ética , Humanos , Defesa do Paciente/educação , Defesa do Paciente/ética , Justiça Social/ética , Especialidades Cirúrgicas/ética , Estados Unidos
Nat Hum Behav ; 5(3): 349-360, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33318662


Given the near-historic levels of economic inequality in the United States, it is vital to understand when and why people are motivated to reduce it. We examine whether the manner in which economic inequality and policy are framed-in terms of either upper-socio-economic-class advantages or lower-socio-economic-class disadvantages-influences individuals' reactions to inequality. Across five studies, framing redistributive policy (Study 1) as disadvantage-reducing (versus advantage-reducing) and economic inequality (Studies 2-5) as lower-class disadvantages (versus upper-class advantages or a control frame) enhances support for action to reduce inequality. Moreover, increased support is partly driven by perceptions that inequality is more unjust if framed as lower-class disadvantages. Using diverse methodologies (for example, social media engagement on Facebook) and nationally representative samples of self-reported upper-class and lower-class individuals, this work suggests that the ways in which economic inequality is communicated (for example, by the media) may reliably influence people's reactions to and concern for the issue.

Política Pública , Justiça Social , Percepção Social , Fatores Socioeconômicos , Adulto , Processos Grupais , Humanos , Classe Social