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Abstract: The opioid epidemic continues to be a prevalent crisis in North America. How best to address this challenge has long been debated. Abstinence is currently the preferred policy within the inpatient hospital setting, however, this is fraught with difficulties such as withdrawal and using substances in secrecy. It can also result in stigma and a lack of knowledge on substance use among health care providers. The concept of harm reduction could provide an ethical approach to supporting people with substance use disorder. Through Principlism and the principles of Autonomy, Beneficence, Justice and Non-Maleficence, this paper suggests that harm reduction practices represent a viable and more ethically sound approach to health care compared to abstinence-based approaches. Harm reduction practices could result in a more equitable health care system that reduces stigma and increases help-seeking behaviour. More empirical research in other jurisdictions or other settings such as long-term care is needed. Future research should address additional theoretical frameworks such as dialogical bioethics, care ethics and the capabilities approach. PubDate: 2025-06-14
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Abstract: Singapore is a small, affluent and technologically advanced city-state located in Southeast Asia. Due to its lack of natural resources, this country relies heavily on its highly educated and skilled workforce to drive its economic engine. However, in recent years, Singapore has been facing a demographic crunch due to its ultra-low fertility rate and rapidly aging population, which poses an existential threat to its survival as a nation-state. The advent of new reproductive technologies such as In Vitro Gametogenesis (IVG) and Stem Cell-Based Embryo Models (SCBEMs) may thus provide novel fertility treatment options for local patients, which may possibly alleviate Singapore’s ultra-low birthrate. Nevertheless, these new technology platforms also raise various controversial ethical, legal and social issues. It is anticipated that the application of SCBEMs (also known as synthetic embryos) in human reproduction will likely be banned because these entities are viewed as human clones. Conversely, IVG technology is expected to receive approval in Singapore for a narrow range of applications in human clinical assisted reproduction, as it seeks to recapitulate the natural process of human sexual reproduction and is more aligned with Singapore’s family laws and sociocultural values. It is anticipated that IVG will be permitted for the treatments of primary infertility and age-related female infertility, facilitating transgender and intersex parenthood and preventing the transmission of genetic diseases. However, the applications of IVG in posthumous reproduction, mass production of donor gametes, genetic enhancement of offspring, same-sex, solo- and multiplex-parenthood, will likely be banned. PubDate: 2025-06-12
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Abstract: The coronavirus disease (COVID-19) pandemic has significantly affected mental health worldwide, highlighting the need for reliable tools to assess emotional impact (cognitive-psysiological repercusiones) and coping strategies. To validate the psychometric properties of an evaluation instrument with an ad hoc design, called the Evaluation Inventory of Cognitive-Physiological Repercussions and Coping Strategies in a Pandemic Situation (EICPCP), which has two scales: “Cognitive and Physiological repercussions arising from the pandemic due to COVID-19” (RCFPC19-13) and “Coping strategies during the pandemic due to COVID-19” (EAPC19-15). A total of 1,629 participants (students, teachers, and healthcare professionals) from Spain and Colombia completed the instrument. Exploratory and confirmatory factor analyses were conducted to assess their structure and reliability. Both exploratory and confirmatory factor analyses supported the five proposed dimensions: cognitive and physiological impacts on the RCFPC19-13 scale, and adaptation, support, and organization on the EAPC19-15 scale. In addition, satisfactory internal consistency, reliability indices, and temporal stability were obtained for both scales. The EICPCP is a valid and reliable tool for evaluating the cognitive-physiological impact of the pandemic and coping strategies employed. This instrument provides valuable insights for clinical research and psychological interventions in pandemic-related mental-health studies.. PubDate: 2025-06-10
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Abstract: The ongoing war in Ukraine, which began in 2022, has displaced millions of people, creating immense challenges for healthcare systems in refugee-receiving countries. While temporary protection aims to grant re... PubDate: 2025-06-07
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Abstract: One in five people worldwide is expected to develop cancer during their lifetime. This study aimed to examine the effect of women’s E-health literacy levels on their healthy lifestyle behaviors about their cancer screening status, within the scope of preventive cancer healthcare services in Türkiye. This cross-sectional analytical study involved 392 women, and a structural equation model (SEM) was used to identify the causal relationships between variables. Data were collected using the “E-health literacy scale” and the “healthy lifestyle behavior scale”. A structural equation model (SEM) was developed to examine the causal relationships among the variables, and the model’s fit indices and test values were analyzed and interpreted. Results showed that both E-health literacy and healthy lifestyle behavior scores were significantly higher among women who had undergone cancer screening. Additionally, women who had been screened for breast and cervical cancer demonstrated higher healthy lifestyle behavior scores. The SEM analysis indicated that E-health literacy had a positive effect on healthy lifestyle behaviors. Based on these findings, enhancing women’s E-health literacy may promote healthier lifestyle behaviors and encourage more consistent participation in preventive screenings such as cancer screenings. PubDate: 2025-06-03
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Abstract: The diagnosis and perception of autism have undergone significant transformations throughout history. Initially conceptualised as a symptom of schizophrenia, autism later emerged as a distinct diagnosis, evolving into the broader classification of autism spectrum disorder (ASD). This essay explores the main shifts in the understanding of autism throughout its history and different approaches to its treatment. While the traditional psychiatric perspective aligns with a naturalist view of disease, the Neurodiversity Movement advocates for a normative approach, emphasising societal adaptation over medical intervention. The study examines historical milestones, including the contributions of Eugen Bleuler, Grunya Sukhareva, Leo Kanner, and Hans Asperger, alongside the conceptual transition from low- and high-functioning autism to the spectrum model. It also discusses the implications of language in shaping autism discourse, highlighting the shift from person-first to identity-first terminology. The essay ultimately argues that the expansion of the autism diagnosis supports the neurodiversity paradigm, which fosters greater inclusion and empowerment of neurodivergent individuals. However, considerations of severity and linguistic framing remain crucial in advancing this perspective. PubDate: 2025-05-29
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Abstract: In October 2024, Türkiye was shocked by the “Newborn Gang” scandal, in which a network of healthcare professionals allegedly exploited newborns for financial gain in private hospitals. The accused are charged with intentionally neglecting, mistreating or even killing of healthy infants in neonatal intensive care units to prolong their stays and maximize government reimbursements. This paper critically examines the structural and ethical failures exposed by the 2024 “Newborn Gang” scandal in Türkiye, in which healthcare professionals in private hospitals allegedly allowed or caused the deaths of newborns to profit from the state’s healthcare reimbursement system. Drawing on the frameworks of neoliberal critique and medical humanities, the study argues that such extreme violations are not isolated incidents of individual misconduct, but manifestations of deeper systemic vulnerabilities fostered by the neoliberalization of healthcare. It explores how deregulation, market incentives, and the erosion of ethical values—exacerbated by Türkiye’s Health Transformation Program—have created an environment where financial gain is prioritized over patient welfare. Comparative case studies are employed to contextualize these findings within broader global patterns of ethical collapse in healthcare systems influenced by market logic. The paper contends that merely strengthening oversight is insufficient; rather, a structural reorientation is needed. As a potential alternative, the study introduces Value-Based Healthcare as a model that aligns clinical outcomes with ethical imperatives. Ultimately, the paper calls for a fundamental moral recalibration of healthcare—one that affirms care, integrity, and justice as core values over profit and efficiency. PubDate: 2025-05-28
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Abstract: Recently, the most critical psychological challenges have compelled healthcare professionals to confront their mental health issues. Consequently, many employees experiencing elevated levels of psychological stress have reported disengagement and dissatisfaction across various aspects of their work. Given the strong association between individual well-being and job satisfaction, how healthcare employees regulate their emotions and psychological health to attain job satisfaction remains largely unexplored. To address this issue, the present study investigates the effects of mindfulness, emotional intelligence, and employee well-being on healthcare workers’ emotional and mental health while considering the mediating role of employee satisfaction and the moderating role of digital leadership. Data were collected through a structured questionnaire distributed to 633 healthcare employees in China. We employed SPSS and Smart PLS for reliability, discriminant validity, and structural equation modeling analyses. The findings reveal that mindfulness (MFN), emotional intelligence (EI), and employee well-being (EWB) significantly and positively influence both emotional health (EH) and mental health (MH). Furthermore, employee satisfaction (ES) mediated the relationship between mindfulness, emotional intelligence, and employee well-being to emotional and mental health. The moderating role of digital leadership (DL) was also examined, demonstrating its influence on emotional and mental health. These findings hold important implications for healthcare professionals, managers, policymakers, practitioners, and other stakeholders seeking to enhance employee well-being and job satisfaction in healthcare settings. PubDate: 2025-05-28
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Abstract: Shared decision-making (“SDM”) has increased in acceptance and become a gold standard in medical decision-making over the last two decades. Despite this, there continues to be disagreement about several facets of SDM that many existing models or versions do not sufficiently address, including: that there is a lack of agreement about which version or model of SDM to utilize in practice; that there are practical limitations on when SDM ought to be utilized; that SDM may be required to use different “harm thresholds” when making decisions for patients who have lost decision-making capacity or competence, or for those who have never had such capacity in the first place; and that many existing models of SDM succumb to what is known as the “framing problem,” among other concerns. Elsewhere, this author presented a model of SDM titled, the Professionally-Driven Zone of Patient or Surrogate Discretion (or, Professionally-Driven ZPSD) as a more comprehensive and defensible way forward. This article sets out to expand on the expected benefits of the model, and apply it to several case studies in the acute-care setting in order to demonstrate its functionality as a model of SDM. PubDate: 2025-05-20
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Abstract: This study aims to evaluate scientific publications on “Medical Informatics” and “Data Privacy” using a bibliometric approach to identify research trends, the most studied topics, and the countries and institutions with the highest publication output. The search was carried out utilizing the WoS Clarivate Analytics tool across SCIE journals. Subsequently, text mining, keyword clustering, and data visualization were applied through the use of VOSviewer and Tableau Desktop software. Between 1975 and 2023, a total of 7,165 articles were published on the topic of data privacy. The number of articles has been increasing each year. The text mining and clustering analysis identified eight main clusters in the literature: (1) Mobile Health/Telemedicine/IOT, (2) Security/Encryption/Authentication, (3) Big Data/AI/Data Science, (4) Anonymization/Digital Phenotyping, (5) Genomics/Biobank, (6) Ethics, (7) Legal Issues, (8) Cloud Computing. On a country basis, the United States was identified as the most active country in this field, producing the most publications and receiving the highest number of citations. China, the United Kingdom, Canada, and Australia also emerged as significant countries. Among these clusters, “Mobile Health/Telemedicine/IOT,” “Security/Encryption/Authentication,” and “Cloud Computing” technologies stood out as the most prominent and extensively studied topics in the intersection of medical informatics and data privacy. PubDate: 2025-05-14
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Abstract: Despotic leadership harms both employee motivation and well-being. It has been studied using several theories, including social exchange and social learning theory, the latter suggesting learning stems from imitation. This study explores dark side of leadership, particularly in current healthcare reforms in Pakistan, such as Medical Teaching Institute (MTI). The need to review changing structural hierarchies is emphasized, as unilateral decisions often lead to defensive silence rather than workplace aggression and bullying. This study investigated the moderating role of neuroticism in the relationship between despotic leader- ship and workplace deviance, with emotional exhaustion mediating factor among healthcare sector employees. This study involved 294 professionals from public healthcare centres in Pakistan, achieving a 73% response rate. Five hypotheses were tested using Smart PLS for model testing and structural measurement along with SPSS and Preacher Hayes process models for moderated-mediation analysis. Results of linear regression analysis revealed that despotic leadership, mediated by emotional exhaustion, significantly impacts interpersonal and organizational deviance. Interestingly, neuroticism does not moderate this relationship, challenging previous literature. This study sheds light on despotic leadership’s broader influence beyond personality attributes, offering new theoretical and practical implications and guiding future research directions. PubDate: 2025-05-05
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Abstract: Compliance and regulatory bodies often encourage health care providers’ disclosure of and apologies for wrongdoing. Patients may perceive that forgiveness is expected and feel pressure to grant it. However, forgiveness carries consequences, which can bring limits to forgiveness. Understanding these limits is crucial for understanding when forgiveness can either heal or add to trauma. This paper explores 10 context-dependent limits to forgiveness across four categories. The first category outlines conceptual limits: not all harm requires forgiveness, some evil acts may be beyond human forgiveness, and blame can be incompatible with forgiveness. Secondly, moral and ethical limits result from how accountability strains forgiveness, how moral absolutism can hinder it, and how proxy forgiveness may lack moral legitimacy. The third category identifies relational and social limits. Forced reconciliation can undermine forgiveness. System negligence diffuses culpability, hindering individual forgiveness, and requires prioritizing the victim’s healing and benefit despite the diluted accountability. Finally, the fourth category highlights temporal and process-related limits. It emphasizes that ongoing or unaddressed harm can obstruct forgiveness, while variations in healing trajectories may delay or complicate it. Updating current understanding, this framework adds insight into when forgiveness may be inappropriate. It offers providers ethical guidance in navigating this terrain through a person-centred approach balancing empathy and accountability. The framework aims to facilitate healing for the patient and provider, regardless of whether forgiveness occurs. PubDate: 2025-04-28
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Abstract: Patent-based intellectual property (IP) has come under progressively substantiative attack in the peer-reviewed literature as many studies have shown it retards innovation. In addition, the monopoly period no longer fits the innovation cycle. Although the vast majority of patents are not useful, patent proponents argue monopoly-based economic incentives are specifically necessary to fund medical technologies. Rather than use simple economics, quantifying human deaths has also been proposed as a means to guide public policies. Such an approach can be applied to patents by investigating the lives saved by patents as well as those lost in the current IP systems. This study is the first to provide such a theoretical approach to quantifying human mortality costs of patent-based IP systems. To illustrate the mechanism by which patents are responsible for premature deaths, a case study of the 100-year-old innovation of insulin is provided. The U.S. and Canada were selected to compare because the approach to drug costs in the two countries allows for a fraction of the additional costs of IP to be quantified. By comparing the different death rates of diabetics in U.S. and Canada, it was found that insulin-related patents result in over 94,000 American premature deaths annually (in 2021). The results also make it clear that many human deaths are related to price increases and lack of accessibility to needed medications due to the current monopolistic IP system. These findings require patent proponents to defend the continued existence of patents in the medical innovation space. PubDate: 2025-04-02
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Abstract: In recent years, artificial intelligence (AI) has become more important in healthcare. It has the ability to completely change how patients are diagnosed, treated, and cared for. To make sure AI is properly supervised in healthcare, many problems need to be solved. This calls for a broad approach that includes policy, technology, and involving important people. This study investigates the governance of AI within healthcare, highlighting the importance of policy, technology, and stakeholder engagement. Adopting a mixed-methods research design, the study encompasses surveys, interviews, and document analysis to comprehensively explore diverse perspectives on AI governance. Purposive sampling techniques were employed to gather 897 valid samples, ensuring diversity across stakeholder groups. Surveys gathered quantitative data on demographic characteristics and attitudes toward AI governance, while interviews provided deeper insights into stakeholders’ experiences and recommendations. Document analysis supplemented data collection by reviewing policy documents, guidelines, and academic literature related to AI governance. This study merges quantitative and qualitative data to thoroughly investigate AI governance, enabling the identification of policy implications and actionable recommendations. This study contributes novel insights by adopting a comprehensive approach to AI governance in healthcare, integrating policy, technology, and stakeholder engagement perspectives. Unlike previous studies focusing solely on individual aspects of AI governance, this research provides a holistic understanding of the complex dynamics involved. This research offers important insights into AI governance by investigating the impact of stakeholder engagement, ethical considerations, digital health disparities, governance structures, and health communication strategies on AI integration in healthcare, ultimately aiding in policy development and implementation. PubDate: 2025-03-06
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Abstract: In this paper we discuss whether effective public health interventions and policies are environmentally sustainable. First, we suggest that the environmental impact from public health interventions and policies should be considered in the perspective of a human lifecycle. Second, we spell out in greater detail what we take it to mean for a public health intervention or policy to be environmentally sustainable. Third, environmental sustainability regards not only environmental impact, but also shares of our environmental “budgets”, also referred to as environmentally safe operating spaces. Such budgets represent the limits of the sustainability of a group of individuals, e.g. a population. Each individual is assigned a share of the budget for each category of environmental impact, which represents how much the individual may impact the environmental category in question without doing so unsustainably. We discuss whether individuals ought to have a larger share of these budgets as a function of their ongoing life as this would make a better case for thinking that public health interventions and policies are environmentally sustainable. But we argue that this is incompatible with maximizing health within our environmental budgets and therefore mistaken. Instead, individuals ought to be ascribed a share of these budgets for life, a share that does not increase as individuals get older. We conclude that while some public health interventions and policies might be environmentally sustainable, we cannot merely assume that public health and sustainability are win-win; indeed, we have positive reason to think that some interventions and policies are not environmentally sustainable. Finally, we elaborate on how we ought to think about and react to this conclusion. PubDate: 2025-03-04
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Abstract: All healthcare professionals (HCPs) have responsibilities to provide information to patients according to the duties found within UK decision-making guidance and with regards to theory about the doctor-patient relationship. While routinisation can be understood in a number of different ways, this paper is concerned with how routines might negatively affect patients in the decision-making process. Therefore, in this manuscript, medical decision making is understood as problematically routine when a medical test or procedure is framed as a standard one and—given the way options are presented—it is implied that someone can decide to use that test or treatment without being given sufficient opportunities to think through their choices. Routinisation, when understood in this way, can affect the quality and amount of information provided to patients and the ways in which patients reflect upon their choices when making decisions. With the introduction of non-invasive prenatal testing (NIPT) into the UK healthcare system, bioethicists have questioned whether this new technology will be routinised and what the implications of routinisation on the decision-making process might be. While there have been numerous studies investigating the views and attitudes of pregnant women who use NIPT, there are fewer studies that look at the views and attitudes of healthcare professionals (HCPs). This study interviewed 20 UK-based HCPs who either offer NIPT or counselled pregnant women on the use of NIPT. One important finding was that many HCPs held the attitude that the NIPT decision-making process had become routine, however there was disagreement about whether routine NIPT was problematic or not. This study provides insights about the context that surrounds decision making for NIPT, and it raises important questions about how NIPT routinisation might be evaluated. PubDate: 2025-02-21
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Abstract: In Great Britain, abortion has long proven to be contentious in the context of policy making, with it remaining a criminal offence. Despite progress over the last decade to permit home use of abortion medications and remote consultation, we have seen prosecutions in recent years. Regulatory frameworks such as this have been framed as ‘abortion exceptionalism’, such that termination of pregnancy is far more tightly regulated than comparable healthcare. One example of this exceptionalism is the strict abortion reporting requirements found in Great Britain. Per these requirements, any doctor providing abortion care must notify the relevant Chief Medical Officer or Public Health Scotland of each and every termination, including a startling amount of information about the patient. The extent of these requirements raises serious questions in relation to patient confidentiality and is, I suggest, an outlier in these terms. Further, it is questionable whether such reporting can be in any way said to be in the public interest. I begin by outlining the Abortion Regulations 1991, which apply in England and Wales, before considering the updated Scottish approach brought about by the Abortion (Scotland) Amendment Regulations 2021. I then move to examine the abortion reporting requirements against our general conception of patient confidentiality, highlighting the discordance. I ultimately argue that the requirements are not adequately justified and represent yet another, often forgotten, example of abortion exceptionalism in Great Britain. Thus, I suggest that all three nations that comprise Great Britain ought to further revise their approach to abortion data. PubDate: 2025-02-13
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Abstract: An emerging approach to complement randomised controlled trial (RCT) data in the development of radiotherapy treatments is to use routinely collected ‘real-world’ data (RWD). RWD is the data collected as standard-of-care about all patients during their usual cancer care pathway. Given the nature of this data, important questions remain about the permissibility and acceptability of using RWD in routine practice. We involved and engaged with patients, carers and the public in a two-day citizens’ jury to understand their views and obtain decisions regarding two key issues: (1) preferred approaches to consent for the use of RWD within the context of patients receiving radiotherapy for lung cancer in RAPID-RT and (2) how RWD use should be best communicated to patients. Individual views were polled using questionnaires at various stages of the jury, whilst group discussion activities prompted further dialogue about the rationale behind choices of consent. Key decisions obtained from the jury include: (1) an opt-out approach to consent for the use of RWD; (2) the opt-out approach to consent should be informed. Furthermore, it was advised that information and communication regarding the consent process and use of RWD should be accessible, clear and available in a variety of formats. It is important that the consent process for patient data use is underpinned by principles of autonomy and transparency with clear channels of communication between those asking for and giving consent. Moreover, the process of seeking consent from patients should be proportionate to the risks presented from their participation. PubDate: 2025-02-10
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