The General Public and Young Adults' Knowledge and Perception of Palliative Care: A Systematic Review.

Background: As a result of demographic change, chronic and oncological diseases are gaining importance in the context of public health. Palliative care plays a crucial role in maintaining the quality of life of those affected. International guidelines demand access to palliative care not only for the elderly but also for younger people who face severe illnesses. It can be assumed that palliative care will become increasingly important for them. In order to develop public health strategies which are able to promote palliative care, it is important to assess the knowledge of, and attitude towards, palliative care as found among members of the general public and its specific target groups. In particular, little is known about young adults' knowledge and perceptions of palliative care. Objectives and design: This work aimed to assess the understanding and viewpoints regarding palliative care among the general population and among young adults aged 18 to 24. We therefore conducted a systematic review, which, for this target population, could be seen as a novel approach. Methods: Exclusion and inclusion criteria were developed using the PICOS process. Literature was researched within MEDLINE (via PubMed), Google Scholar and Web of Science. A search string was developed and refined for all three databases. Grey literature was included. Duplicates were excluded using Mendeley. The literature was independently screened by two researchers. Narrative synthesis was used to answer the main research question. Results: For the general public, palliative care is still associated with death and dying and comforting sick people towards the end of their lives. Multiple social determinants are linked to better knowledge of palliative care: higher education, higher income, female gender, having relatives that received palliative care, and permanent employment. The population's knowledge of palliative care structures increases, the longer such structures have been established within a country. Young adults are familiar with the term palliative care, yet their understanding lacks nuance. They associate palliative care with death and dying and perceive palliative care to be a medical discipline primarily for the elderly. Nevertheless, young adults demand participation within the planning of interventions to destigmatize palliative care. Conclusions: The general public still lacks a detailed understanding of palliative care. Palliative care faces stigma at multiple levels, which creates barriers for those who set out to implement it. However, addressing young adults as a crucial peer group can help break down barriers and promote access to palliative care.

Destigmatizing Palliative Care among Young Adults-A Theoretical Intervention Mapping Approach.

Background: In medicine, stigmatization pertains to both afflicted individuals and diseases themselves but can also encompass entire medical fields. In regard to demographic change and the rising prevalence of oncological diseases, palliative care will become increasingly important. However, palliative care faces multiple stigmas. These include equating of palliative care with death and dying. A timely integration of palliative care would have the potential to alleviate symptom burden, diminish the risk of overtreatment, and thus save healthcare-related costs. Several interventions have been developed to destigmatize palliative care. However, they have mainly focused on the general public. Aim: The aim of this work is to develop a theoretical framework for an interventional campaign targeted at young adults to systematically destigmatize palliative care. Methods: The basis for the development of the campaign is a systematic review conducted by our working group that assessed the perception and knowledge of palliative care of young adults aged 18 to 24 years. To design a possible intervention, the Intervention Mapping approach was used. Results: The target group of young adults can be effectively reached in secondary schools, vocational schools, and universities. The target population should be able to discuss the content of palliative care and openly talk about death and dying. At the environmental level, palliative care should be more present in public spaces, and death and dying should be freed from taboos. Within an intervention with palliative care experts and patients serving as interventionists, these changes can be achieved by incorporating evidence-based methods of behavioral change. Conclusions: An early engagement with palliative care could contribute to the long-term reduction of stigmas and address the demographic shift effectively. A multimodal intervention approach comprising knowledge dissemination, exchange, and media presence provides an appropriate framework to counter the existing stigmatization of palliative care within the peer group of young adults.

[Awards in pathology-a man's world?] / Preise in der Pathologie ­ eine Männerdomäne?

BACKGROUND: Awards provide their recipients with fame and recognition, and subsequently facilitate publications and acquisition of external funding through increased visibility. We hypothesize that despite increasing representation in pathology, women are underrepresented as awardees in the German Society of Pathology and consequently there is an associated imbalance between genders. MATERIAL AND METHODS: Published data from the German Society of Pathology on female awardees during the period from 2000 to 2022 were examined. Only awards specifically dedicated to the field of pathology were considered. In addition, the publicly available data of the German Medical Association on gender and age distribution of pathologists in Germany were considered as reference material. RESULTS: A total of six different awards were included in the analysis. Among the 143 awardees across 150 individual awards in the period from 2000 to 2022, 55 (38.4%) of the awardees were female compared to an average percentage of 31% of women working in the field of pathology in the 23-year period under consideration. Consequently, female awardees in pathology were not underrepresented when compared to the national figures on the proportion of women in the field of pathology. However, the distribution of female awardees across individual awards suggests that women were increasingly represented in less prestigious research and doctoral awards, while men made up a large proportion of awardees of honorary awards (0% women) and prestigious awards (17% women).

Treatment Decision-Making Capacity in Forensic vs Non-forensic Psychiatric Patients: A European Comparison.

Background: Consent to treatment is a cornerstone of medical ethics and law. Nevertheless, very little empirical evidence is available to inform clinicians and policymakers regarding the capacities of forensic patients with schizophrenia spectrum disorders (SSDs) to make decisions about their treatment, with the risk of clinical and legal inertia, silent coercion, stigmatization, or ill-conceived reforms. Study Design: In this multinational study, we assessed and compared with treatment-related decisional capacities in forensic and non-forensic patients with SSD. 160 forensic and 139 non-forensic patients were used in Austria, Germany, Italy, Poland, and England. Their capacity to consent to treatment was assessed by means of the MacArthur Competence Assessment Tool for Treatment (MacCAT-T). Multiple generalized linear regression models were used to identify the socio-demographic and clinical variables associated with MacCAT-T scores. Study Results: In total, 55 forensic (34.4%) and 58 non-forensic patients (41.7%) showed high treatment-related decisional capacity, defined as scoring ≥75% of the maximum scores for the understanding, appreciation and reasoning, and 2 for expressing a choice. Forensic patients showed differences in their capacity to consent to treatment across countries. Of all socio-demographic and clinical variables, only "social support" was directly relevant to policy. Conclusions: Forensic patients have treatment-related decisional capacities comparable with their non-forensic counterparts. Social contacts might provide a substantial contribution towards enhancing the decisional autonomy of both forensic and non-forensic patients, hence improving the overall quality and legitimacy of mental health care.

Philosophical whitewashing. Ludwig Binswanger (1881-1966) and the sterilisation of manic-depressive patients.

The Swiss psychiatrist Ludwig Binswanger is known as the founder of the Daseinsanalyse (existential analysis) and more generally for having applied contemporary philosophical concepts and theories to psychiatry. The fortune of the philosopher Binswanger constituted a formidable obstacle to a historical scrutiny of his actual clinical practice. In the long run, the philosopher overshadowed the psychiatrist. The present paper takes the move from a "minor" work, an essay on the sterilisation of manic-depressive patients Binswanger published in 1938. This essay represents a rare exception in Binswanger's scientific production in many respects: for its editorial collocation, for the subject (a concrete medical intervention) and the complete absence of philosophical references. Nevertheless, or precisely for this reason, the essay has been largely ignored by the scholarship, both of Swiss eugenics and of Binswanger himself. This paper explores the epistemological circumstances of this negligence and its historiographic significance, with special attention to the philosophical-anthropological refashioning of a psychiatric myth.

A conceptual approach to the rationale for SARS-CoV-2 vaccine allocation prioritisation.

Currently vaccines protecting from COVID-19 are a scarce resource. Prioritising vaccination for certain groups of society is placed in a context of uncertainty due to changing evidence on the available vaccines and changing infection dynamics. To meet accepted ethical standards of procedural justice and individual autonomy, vaccine allocation strategies need to state reasons for prioritisation explicitly while at the same time communicating the expected risks and benefits of vaccination at different times and with different vaccines transparently. In this article, we provide a concept summarising epidemiological considerations underlying current vaccine prioritisation strategies in an accessible way. We define six priority groups (vulnerable individuals, persons in close contact with the vulnerable, key workers with direct work-related contact with the public, key workers without direct work-related contact to the public, dependents of key workers and members of groups with high interpersonal contact rates) and state vaccine priorities for them. Additionally, prioritisation may follow non-epidemiological considerations including the aim to increase intra-societal justice and reducing inequality. While national prioritisation plans integrate many of these concepts, the international community has so far failed to guarantee equitable or procedurally just access to vaccines across settings with different levels of wealth.

E Pluribus Octo - Building Consensus on Standards of Care and Experimentation in Cephalopod Research; a Historical Outlook.

The Directive 2010/63/EU "on the protection of animals used for scientific purposes" originally induced some concern among cephalopod researchers, because of the inclusion of cephalopod mollusks as the only invertebrates among the protected species. Here we reflect on the challenges and issues raised by the Directive on cephalopod science, and discuss some of the arguments that elicited discussion within the scientific community, to facilitate the implementation of the Directive 2010/63/EU in the scientific research context. A short overview of the aims of the COST Action FA1301 "CephsInAction," serves as a paradigmatic instance of a pragmatic and progressive approach adopted to respond to novel legislative concerns through community-building and expansion of the historical horizon. Between 2013 and 2017, the COST Action FA1301 has functioned as a hub for consolidation of the cephalopod research community, including about 200 representatives from 21 countries (19 European). Among its aims, CephsInAction promoted the collection, rationalization, and diffusion of knowledge relevant to cephalopods. In the Supplementary Material to this work, we present the translation of the first-published systematic set of guidelines on the care, management and maintenance of cephalopods in captivity (Grimpe, 1928), as an example of the potential advantages deriving from the confluence of pressing scientific concerns and historical interests.

Imagining the brain as a book: Oskar and Cécile Vogt's "library of brains".

In 1927, the German popular science magazine Die Koralle published an article entitled "The Library of Brains." The article was about the Kaiser Wilhelm Institute for Brain Research in Berlin, established in 1914 as the continuation of the "Neurological Central Station" founded by Oskar Vogt (1870-1959) in 1898. The library metaphor plays on the huge collection of human and animal brains Oskar and his wife Cécile (1875-1862) had gathered over several decades. For examination, the brains were cut into paper-thin slices and embedded in paraffin: from one single organ, up to 30,000 slices could be extracted, which were to be "read" and studied like the pages of a book. In this chapter, we take the metaphor at face value, arguing that Vogt's institute actually functioned as a library. Numerous publications have emphasized the role of the Vogts and, in particular, of the brain collection for the constitution of modern neuroscience. The "library," however, has never been closely investigated. How was it designed? How was it filled? According to which criteria were the brains collected and ordered? How did the order and the collection itself reflect the Vogts' research program? Through a detailed investigation of the collection and the Vogt Archive, we will examine this "library" and reconstruct the order of the Vogt brains. The mutual relationship between collecting, sorting, examining and publishing about the brain will be discussed.

Sharing intimacy in "open" intensive care units.

PURPOSE: Opening intensive care units (ICUs) is particularly relevant because of a new Swiss law granting the relatives of patients without decision-making capability a central role in medical decisions. The main objectives of the study were to assess how the presence of relatives is viewed by patients, health care providers, and relatives themselves and to evaluate the perception of the level of intrusiveness into the personal sphere during admission. MATERIAL AND METHODS: In a longitudinal and prospective design, qualitative questionnaires were submitted concomitantly to patients, relatives, and health care providers consecutively over a 6-month period. The study was conducted in the 4 ICUs of the public hospitals of Canton Ticino (Switzerland). RESULTS: The questionnaires collected from patients, relatives, and health care providers were 176, 173, and 134, respectively. The analysis of the answers of 120 patient-relative pairs showed consistent results (P < .0001), whereas those of health care providers were significantly different (P < .0001), regarding both the usefulness of opening ICUs to patient relatives and what was stressful during admission. CONCLUSIONS: Relatives in these "open" ICUs share a great deal of intimacy with the patients. Their presence and the deriving benefits were seen as very positive by patients and relatives themselves. Skepticism, instead, prevailed among health care providers.

Clever Hans and his effects: Karl Krall and the origins of experimental parapsychology in Germany.

Shortly before the outbreak of World War I, the so-called Elberfeld horses, the counting and speaking animals, were among the most debated subjects of the newborn comparative psychology. Yet, they have left little trace in the historiography of this discipline, mostly as an appendix of the more famous Clever Hans. Their story is generally told as the prelude to the triumph of reductionistic experimental psychology. By paying a more scrupulous attention than has so far being done to the second life of Hans, and to the endeavours of his second master, Karl Krall, this article explores the story of the Elberfeld horses as an important, if so far neglected, chapter in the history of experimental parapsychology.

The place of the unknown in the Medical Humanities.

In the birth and development of the Medical Humanities, literature has played a crucial role, both as an educational resource and as an analytical device. This article proposes an appraisal of this approach by focussing on a model literary situation. Taking the move from Alberto Barrera Tyszka's novel La enfermedad [The illness], the authors identify and explore some of the "places of ignorance" that can emerge in the doctor-patient relationship, as potentially in any form of intersubjective encounter. The analysis aims at highlighting the constructive potential of such spaces of not knowing as a positive element to deal with, rather than a mere limitation of our power of intervention.

["A little scourge of humanity". Notes on the term 'tic']. / "Un piccolo flagello dell'umanità". Note sul termine 'tic'.

The assimilation by the medical community of terms belonging to current language is a rare phenomenon. The word 'tic' constitutes a remarkable exception to this rule. In this article, the author explores the origins and some historical and epistemological consequences of this case of osmosis between two different discourses, focusing on the attempts, by the XIX Century French medical community, to appropriate from common language and redefine both the term and the concept of 'tic'. Consequently, I highlight the substantial semantic shifts to which the term was subjected in the course of this dispute.