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1.
Salud Colect ; 17: e3041, 2021 Jan 28.
Artigo em Espanhol | MEDLINE | ID: mdl-33822543

RESUMO

This paper aims to provide theoretically informed practical proposals for the improvement of current drug policies, which are based on a biological model of disease and the criminalization of people who use drugs. First, we present alternatives to a biologically-oriented scientific conception centered around neuroscientific postulates, which support the idea that the etiology of addiction materializes in the brain, in favor of models based on the social sciences where context plays a relevant role in the description and management approaches regarding different uses of psychoactive substances. Second, epistemological models and proposals are offered from a practical perspective to sustain or implement policies and programs in accordance with a more sustainable approach based on the elimination of stigma and the promotion of political participation of people who use drugs. In short, drug policies based on human rights.

5.
Kennedy Inst Ethics J ; 31(1): 53-76, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33716227

RESUMO

Several ethicists have defended the use of responsibility-based criteria in healthcare rationing. Yet in this article we outline two challenges to the implementation of responsibility-based healthcare rationing policies. These two challenges are, namely, that responsibility for past behavior can diminish as an agent changes, and that blame can come apart from responsibility. These challenges suggest that it is more difficult to hold someone responsible for health related actions than proponents of responsibility-sensitive healthcare policies suggest. We close by discussing public health policies that could function as an alternative to contentious, responsibility-sensitive rationing policies.


Assuntos
Alocação de Recursos para a Atenção à Saúde/ética , Política de Saúde , Justiça Social , Responsabilidade Social , Humanos , Princípios Morais
6.
J Psychiatr Pract ; 27(2): 121-125, 2021 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-33656818

RESUMO

There have been shifts over time in the value placed on long-term psychotherapeutic modalities even though they can be life-saving. For example, the province of Ontario in Canada has been dealing with a government proposal put forward in 2019 to limit the length of psychotherapy treatment. In response, stakeholders from numerous groups came together to advocate for the importance of continuing unrestricted access to long-term psychotherapy. Approaches to this advocacy then had to unexpectedly adapt to the Coronavirus Disease 2019 (COVID-19) pandemic that came to the forefront in 2020 and will continue to develop in response to this changing landscape.


Assuntos
Defesa do Consumidor , Política de Saúde/legislação & jurisprudência , Saúde Mental/legislação & jurisprudência , Psicoterapia/legislação & jurisprudência , Psicoterapia/métodos , Humanos , Ontário , Pandemias , Fatores de Tempo
8.
Development (Rome) ; : 1-6, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33679101

RESUMO

Envisioning democratic and internationalist ways of exercising peoples' sovereignty beyond local and national borders requires the enrichment of human rights thinking with non-European cosmovisions, normative and legal thinking. Integrating human rights, environmental and climate law and the rights of nature plays a key role in building institutions and policies that can genuinely address the root causes of ecological destruction. Likewise, human rights should be at the forefront of the struggle to re-shape financial capitalism and its destructive economic model. They can guide transition processes towards more sustainable ways of production, distribution and consumption, but also towards the necessary protection of and support for care work. Finally, there is an urgent need for innovation in human rights institutions and practices. This goes from securing funding for independent work and combating corporate capture, addressing the colonial legacy still present in international law and human rights architecture, rebalancing the local, national, sub-regional, regional and international dimensions of human rights work, and finding ways to address the dilemmas of a state-centric human rights accountability and governance which do not fall into the traps of multi-stakeholderism.

13.
Nurs Ethics ; : 969733020983395, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33522418

RESUMO

Policy decisions regarding immunization during a pandemic are informed by the ethical understandings of policy makers. With the possibility that a vaccine might soon be available to mitigate the deadly COVID-19 pandemic, policy makers can consider learnings from past pandemic immunization campaigns. This critical analysis of three policy decisions made in Alberta, Canada, during the 2009 H1N1 influenza pandemic demonstrates the predominance of distributive justice principles and the problems that this created for vulnerable groups. Vulnerable groups identified in Alberta include rural and First Nations populations. We propose a social justice approach as a viable alternative to inform pandemic immunization policy and invite debate.

14.
Span J Psychol ; 24: e13, 2021 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-33612140

RESUMO

In recent years, there has been an increasing interest in the consequences of conspiracy theories and the COVID-19 pandemic raised this interest to another level. In this article, I will outline what we know about the consequences of conspiracy theories for individuals, groups, and society, arguing that they are certainly not harmless. In particular, research suggests that conspiracy theories are associated with political apathy, support for non-normative political action, climate denial, vaccine refusal, prejudice, crime, violence, disengagement in the workplace, and reluctance to adhere to COVID-19 recommendations. In this article, I will also discuss the challenges of dealing with the negative consequences of conspiracy theories, which present some opportunities for future research.


Assuntos
Atitude Frente a Saúde , Controle de Doenças Transmissíveis , Comportamentos Relacionados com a Saúde , Política , Preconceito , Recusa de Vacinação , Apatia , Atitude , Mudança Climática , Crime , Cultura , Negação em Psicologia , Fidelidade a Diretrizes , Humanos , Lealdade ao Trabalho , Violência
15.
Hastings Cent Rep ; 51 Suppl 1: S10-S14, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33630342

RESUMO

A civic ideal is an ideal of deliberative self-governance. People who participate in discussing what their own groups should do are being civic. Civic venues, institutions, and habits have waned since the mid-1990s. In the 1990s, a movement arose to restore them, under the banner of "civic renewal." This movement was carefully nonpartisan, often impartial about specific issues, and interested in creating alternative settings that could complement such basic political institutions as Congress and elections. As the condition of democracy has worsened in recent years, this approach looks inadequate or irrelevant. The most promising sources of civic renewal now are parties and social movements that have substantive agendas, such as racial justice, and that improve civic life as a collateral benefit.


Assuntos
Política , Justiça Social , Humanos , Internet
20.
Cochrane Database Syst Rev ; 2: CD012707, 2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33634854

RESUMO

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.


Assuntos
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
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