Towards a Medicine of the Invisible: bioethics and relationship in "The Little Prince".

The Little Prince is one of the most famous fables. In this paper, we attempt to look at three bioethical issues through the Little Prince's eyes: the end-of-life context, the patient-physician relationship and prevention/precaution. The fable gives us the basis for a perspective we have called 'Medicine of the Invisible', which is value-focused. The Little Prince suggests that we seek the invisible-the "thing that is important", the "matters of consequence", even on a gnoseological and epistemological level-as a new type of 'clinical data' which may help to make healthcare more ethical and effective. However, this invisible is attainable only within a relationship, in which the physician needs to be tamed by the patient and the patient needs to be tamed by the physician-each one becoming responsible for the other, each one becoming himself through the dialogue with the other. Responsibility is also projected towards the future, against those threats to life that are still unseen and unknown: owning a part of the world entails the ethical imperative to act, in order to safeguard life. But, without a relationship-saturated with lived time, shared experiences, and individual's uniqueness-no meaning and no value can be given. For this reason, the Medicine of the Invisible reminds bioethics that "the thing that is important is the thing that is not seen".

Communication technologies through an etymological lens: looking for a classification, reflections about health, medicine and care.

Information and communication technologies are widely used in healthcare. However, there is not still a unified taxonomy for them. The lack of understanding of this phenomenon implies theoretical and ethical issues. This paper attempts to find out the basis for a classification, starting from a new perspective: the structural elements are obtained from the etymologies of the lexicon commonly used, that is words like telemedicine, telehealth, telecare and telecure. This will promote a better understanding of communication technologies; at the same time, it will allow to draw some reflection about health, medicine and care, and their semantic and relational nature.

Evaluating non-disclosure of errors and healthcare organization: a case of bioethics consultation.

Sometimes medical errors should not be disclosed. We report a case of semen samples exchange, during a homologous artificial insemination procedure, where a bioethics consultation was required. The bioethics consultation addressed ethical and legal elements in play, supporting non-disclosure to some of the subjects involved. Through a proper methodology, gathering factual and juridical elements, a consultant can show when a moral dilemma between values and rights-privacy versus fatherhood, in our case-is unsubstantial, in a given context, because of the groundlessness of the value or the right itself. However, being the error elicited by organizational factors, a broader ethical pronouncement was needed. Under such circumstances, ethical evaluation should engage in a sort of 'ethical-based root-cause analysis', linking ethical principles to quality aims and showing the opportunity to integrate ethical methodology in healthcare management. From this perspective, errors may become an incentive to promote high-quality organizations, attending to the central value of person even through the organizational process.

Monitoring the web to support vaccine coverage: results of two years of the portal VaccinarSì.

OBJECTIVES: The increasingly widespread use of the Internet by the population to collect information regarding health and medical treatments and the circulation of many non-scientific documents on the effectiveness and safety of vaccines has led the Italian Society of Hygiene (SItI), in 2013, to promote a portal to provide scientific information that is verified and easily understood to counteract the rampant misinformation on health treatments and combat the phenomenon of vaccine hesitancy. METHODS: The project was launched in May 2013 and provides a portal with six main sections (vaccine preventable diseases, registered vaccines, benefits and risks of vaccination, against misinformation, pros & cons and travel immunizations) and other headings that relate to scientific events, comics and news coverage concerning vaccines. The contents are validated and evaluated by a scientific committee of high profile scientists and experts in computer-mediated communication. RESULTS: In the first two years of activity, the portal has published more than 250 web pages on all aspects related to vaccinations. The number of individual users was 860,411, with a constant increase over time. Of these, about 21.7% returned to the website at least once. The total visits in 24 months were 1,099,670, with a total page count of 2,530,416. The frequency of contact was almost exclusively Italian (95.6%), with a higher proportion of males (54.1%) and younger age groups (25-34 years, 33.5%, and18-24 years, 27.5%). The data also show a significant position of the website in the major web search engines. The website has been certified by the Health On the Net Foundation. It is connected with the main social networks and it has recently opened its first regional section (Veneto). CONCLUSIONS: The strong, progressive increase in web contacts, the involvement of several institutional bodies, and the appreciation of various stakeholders give an absolutely positive assessment of the first two years of the VaccinarSì project. The success of the website suggests future developments, with updates, sections devoted to regional problems, in-depth news analysis, and international expansion. The authors conclude that initiatives like this are to be implemented and constitute an effective way to counteract vaccine hesitancy.

Emergency Department Syndromic Surveillance to Monitor Tick-Borne Diseases: A 6-Year Small-Area Analysis in Northeastern Italy.

Tick-borne diseases (TBD) are endemic in Europe. However, surveillance is currently incomplete. Alternative strategies need to be considered. The aim of this study was to test an Emergency Department Syndromic Surveillance (EDSyS) system as a complementary data source to describe the impact of tick bites and TBD using a small-area analysis approach and to monitor the risk of TBD to target prevention. ED databases in the Local Health Authority 8 District (Veneto, Italy) were queried for tick-bite and TBD-related visits between January 2017 and December 2022. Hospitalisations were also collected. Events involving the resident population were used to calculate incidence rates. A total of 4187 ED visits for tick-bite and 143 for TBD were recorded; in addition, 62 TBD-related hospitalisations (of which 72.6% in over 50 s and 22.6% in over 65 s). ED visits peaked in spring and in autumn, followed by a 4-week lag in the increase in hospital admissions. The small-area analysis identified two areas at higher risk of bites and TBD. The use of a EDSyS system allowed two natural foci to be identified. This approach proved useful in predicting temporal and geographic risk of TBD and in identifying local endemic areas, thus enabling an effective multidisciplinary prevention strategy.

A "matter of communication": A new classification to compare and evaluate telehealth and telemedicine interventions and understand their effectiveness as a communication process.

This article attempts to define functions and applications of telemedicine and telehealth in order to achieve a simplified and comprehensive taxonomy. This may be used as a tool to evaluate their efficacy and to address health policies from the perspective of the centrality of information in the healthcare. Starting from a lexical frame, telemedicine or telehealth is conceived as a communication means and their action as a communication process. As a performance, the communication is related to the health outcome. Three functions ( telemetry, telephasis, and telepraxis) and nine applications are identified. Understanding the mechanisms of telemedicine and telehealth effectiveness is crucial for a value-driven healthcare system. This new classification-focusing on the end effect of telemedicine and telehealth and on the type of interactions between involved actors-moves toward a new and simplified methodology to compare different studies and practices, design future researches, classify new technologies and guide their development, and finally address health policies and the healthcare provision.

How does it work? Factors involved in telemedicine home-interventions effectiveness: A review of reviews.

INTRODUCTION: Definitive evidence of the effectiveness and cost-effectiveness of telemedicine home-interventions for the management of chronic diseases is still lacking. This study examines whether and how published reviews consider and discuss the influence on outcomes of different factors, including: setting, target, and intensity of intervention; patient engagement; the perspective of patients, caregivers and health professionals; the organizational model; patient education and support. Included reviews were also assessed in terms of economic and ethical issues. METHODS: Two search algorithms were developed to scan PubMed for reviews published between 2000 and 2015, about ICT-based interventions for the management of hypertension, diabetes, heart failure, asthma, chronic obstructive pulmonary disease, or for the care of elderly patients. Based on our inclusion criteria, 25 reviews were selected for analysis. RESULTS: None of the included reviews covered all the above-mentioned factors. They mostly considered target (44%) and intervention intensity (24%). Setting, ethical issues, patient engagement, and caregiver perspective were the most neglected factors (considered in 0-4% of the reviews). Only 4 reviews (16%) considered at least 4 of the 11 factors, the maximum number of factors considered in a review is 5. CONCLUSIONS: Factors that may be involved in ICT-based interventions, affecting their effectiveness or cost-effectiveness, are not enough studied in the literature. This research suggests to consider mostly the role of each one, comparing not only disease-related outcomes, but also patients and healthcare organizations outcomes, and patient engagement, in order to understand how interventions work.

Do I need training in public health ethics? A survey on Italian residents' beliefs, knowledge and curricula.

INTRODUCTION: Ethics is needed to support the decision-making process in public health and to face moral issues during practice. However, professionals are often not adequately trained. OBJECTIVES: In 2015, the National Conference of Public Health Medical Residents of the Italian Society of Public Health started the "Public Health Ethics" workgroup to evaluate how the Italian Schools of Public Health train their residents in ethics, and which are residents' beliefs, knowledge and attitudes about public health ethics. METHODS: A survey was built and emailed to the Italian public health residents. RESULTS: Residents are interested in ethics/bioethics (83.2%) and are aware of its importance for professional practice (97.2%). However, few of them (19.6%) evaluated their competence above a satisfactory level. They believe that a training in ethics should be offered during residency (92.1%). Nonetheless, in Italy only two schools required a course on bioethics, and one a course in public health ethics. According to residents, a public health ethics trainer should be a public health professional (23.2%) or a social scientist (22.8%). CONCLUSIONS: In Italy, Schools of Public Health do not train future professionals in ethics or public health ethics during residency. Training should be implemented in curricula, and trainers should have a strong competence in both public health and ethics.