International Journal of Risk & Safety in Medicine - Volume 33, issue 3
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The International Journal of Risk and Safety in Medicine is concerned with rendering the practice of medicine as safe as it can be; that involves promoting the highest possible quality of care, but also examining how those risks which are inevitable can be contained and managed.
This is not exclusively a drugs journal. Recently it was decided to include in the subtitle of the journal three items to better indicate the scope of the journal, i.e. patient safety, pharmacovigilance and liability and the Editorial Board was adjusted accordingly. For each of these sections an Associate Editor was invited. We especially want to emphasize patient safety. Our journal wants to publish high quality interdisciplinary papers related to patient safety, not the ones for domain specialists. For quite some time we have also been devoting some pages in every issue to what we simply call WHO news. This affinity with WHO underlines both the International character of the journal and the subject matter we want to cover. Basic research, reports of clinical experience and overviews will all be considered for publication, but since major reviews of the literature are often written at the invitation of the Editorial Board it is generally advisable to consult with the Editor in advance. Submission of news items will be appreciated, as will be the contribution of letters on topics which have been dealt with in the journal.
Abstract: The COVID-19 pandemic has shown us that there are numerous research questions—empirical, political, and philosophical—that need addressing both prior to, during, and after a pandemic. The current organisation of medical research has hindered our ability to efficiently answer these questions. This in turn suggests that there ought to be changes to how the medical research agenda is set.
Keywords: COVID-19, pandemic, research agenda, well-ordered science
Abstract: BACKGROUND: The COVID-19 pandemic has shocked society worldwide. Multiple efforts went immediately into developing treatments for managing and vaccines for preventing the disease. National and international initiatives emerged to deal with the deep economic and social inequalities in our world today. OBJECTIVE: To show that the global inequalities that have become salient during the COVID-19 pandemic and specially with the global vaccination campaign, are the result of a highly privatized system of research and development (R&D), which is first and foremost profit-driven, and where epistemic and social concerns are not prioritized. METHODS: Philosophical analysis.…RESULTS: After exploring the current organization of scientific research, as well as its impact in the development of research at a global scale, the paper shows the way in which this highly privatized organization of research has permeated scientific research on COVID-19, identifying who is currently benefiting from pandemic science, and who on the contrary is suffering the consequences of this organization. Using the COVAX mechanism as an example, the paper argues that international efforts to counteract the power of commercially-driven science has not rendered the expected results. CONCLUSIONS: The current organization of science ought to be shaken and restructured if we aim to be better prepared to address the global challenges of the future with the relevant scientific and technological development.
Keywords: Social organization of science, pandemic science, COVAX, privatization of science, coronavirus
Abstract: BACKGROUND: The pharmaceutical industry is believed to receive considerable support through research and development (R&D) tax credits. OBJECTIVE: The objectives of this paper are (a) to show that many of the pharmaceutical industry’s apparent R&D activities are entangled with marketing efforts, and (b) to argue that supporting these activities through tax credits does not serve public interests in health. METHODS: The bulk of this paper summarizes the author’s extended qualitative mixed-methods approach to following connections between pharmaceutical research and marketing. RESULTS: The pharmaceutical industry’s R&D should be understood as broadly entangled with marketing, and…so generally should be understood as integrated research, development and marketing (RD&M). CONCLUSIONS: R&D tax credits to the pharmaceutical industry largely do not serve public interests.
Keywords: Research and development (R&D), pharmaceutical industry, marketing, tax credits
Abstract: BACKGROUND: The new type of virus (SARS-CoV-2 or COVID-19) from Coronaviridae family, discovered in 2019, caused a global pandemic with several massive lock-downs around the globe. Science and politicians became the center of world attention, receiving many questions without having clear answers. The hopes of many rested on vaccine development, which was done fast, facing novel challenges such as the massive production and distribution for several billions of people. OBJECTIVE: In this paper, the global reaction to the pandemic is reviewed along with some critical comments. METHOD: Different groups, including nations, took part in global…lockdowns, while vaccine development was running in parallel without having enough capacity for some of the biggest medical demands in history. This review will bring together views from all interested groups in this pandemic crisis. RESULTS: The Western world waited too long (4 months), after the first case was confirmed in China, to introduce lock-down and safety measures. On the other side, vaccine development was done too fast to give clear long-term safety profiles of the medications developed. Due to the focus on development, it was overlooked that production and distribution of sterile products such as vaccines might have limitations globally. Usually when such limitations occur, power comes to the surface. Therefore, buyers who had power will get the vaccines they need first. However, we should recognize the economic impact that directly influenced healthcare funding. All of this will lead to post-crisis challenges, including depression, violence, suicide, migration, and many other social problems. CONCLUSIONS: The COVID-19 pandemic is a test for all of us, which many governments, industries and non-state actors are failing. It is a perfect “general probe” to detect some of the weaknesses of the current structure of global health. If politics and science do not work together to make a global production plan for vaccines and learn from this pandemic, then all of the lives lost were for nothing.
Keywords: COVID-19, global pandemic, vaccine, development, production
Abstract: BACKGROUND: The pandemic that began around February 2020, caused by the viral pathogen SARS-CoV-2 (COVID-19), has still not completed its course at present in June 2022. OBJECTIVE: The open research to date highlights just how varied and complex the outcome of the contagion can be. METHOD: The clinical pictures observed following the contagion present variabilities that cannot be explained completely by the patient’s age (which, with the new variants, is rapidly changing, increasingly affecting younger patients) nor by symptoms and concomitant pathologies (which are no longer proving to be decisive in recent cases) in relation to…medium-to-long term sequelae. In particular, the functions of the vascular endothelium and vascular lesions at the pre-capillary level represent the source of tissue hypoxia and other damage, resulting in the clinical evolution of COVID-19. RESULTS: Keeping the patient at home with targeted therapeutic support, aimed at not worsening vascular endothelium damage with early and appropriate stimulation of endothelial cells, ameliorates the glycocalyx function and improves the prognosis and, in some circumstances, could be the best practice suitable for certain patients. CONCLUSION: Clinical information thus far collected may be of immense value in developing a better understanding of the present pandemic and future occurrences regarding patient safety, pharmaceutical care and therapy liability.
Keywords: COVID-19, pharmaceutical care, therapy liability, best practice, home treatment, vascular endothelial glycocalyx, epigenetics
Abstract: BACKGROUND: Anaesthesiology practitioners experience extraordinary pressure and stress in their daily work. OBJECTIVE: The purpose of this research is to assess the occupational factors and burnout syndrome among anaesthesiologists and anaesthesiology technicians in Kosovo. METHODS: This is a cross-sectional study carried out on a sample of 154 (out of 220) anaesthesiologists and anaesthesiology technicians in Kosovo. We collected the data using the Maslach Burnout Inventory and Occupational Role Stressors Scale. RESULTS: The mean ± SD age of the study sample was 42.5 ± 8.7 years, and 57% of them were working more than 40 h per…week. A high level of burnout in terms of depersonalization (DP) was found among 48 of anaesthesiologists and anaesthesiology technicians, 26 had high level of emotional exhaustion (EE). EE and DP showed significant positive correlation with work overload, managerial responsibility role, and overall occupational stress (p < 0.05). Female anaesthesiologists and anaesthesiology technicians showed higher score of personal achievement (PA) compared to males (p < 0.05). CONCLUSION: Approximately one-third of Kosovar anaesthesiologists and anaesthesiology technicians showed high level of burnout and it is rising as work overload and the role of managerial responsibility increases. Increasing the number of employed anaesthesiologists and anaesthesiology technicians in health institutions in Kosovo will lead to a better workload distribution and lower burnout syndrome.
Abstract: BACKGROUND: Hepatitis B virus (HBV) infection is a serious global public health problem, with significant morbidity and mortality from acute and chronic complications. Increasing awareness and improving knowledge of HBV helps reduce the risk of the disease. Although many studies have been conducted on HBV in Ghana, few have focused on examining knowledge, attitude and preventive practices among adolescents towards the disease. OBJECTIVE: The objective of this study was to assess HBV knowledge, attitude and practice (KAP) among adolescents in high schools in the Asante Mampong Municipality in the Ashanti Region of Ghana. METHODS: A descriptive…cross-sectional study was conducted among 398 adolescents from six senior high schools within the Asante Mampong Municipality. Data was collected using a 30-item structured questionnaire. Each item had two response options: “Yes” and “No”. A scoring system was generated and respondents were given a score on each item answered. A positive response to an item was scored 1 point and a negative response was scored 0. Scores were then summed up and averaged to give the mean knowledge, attitude and practice scores. RESULTS: The majority of the respondents were male (60%), between 15 and 17 years (45%), Christian (93%) and in their first year of study. The adolescents had basic knowledge, positive attitude, and poor practices towards HBV. There was no significant relationship between the demographic variables of the respondents and KAP mean scores. CONCLUSION: There is the need to introduce health education and awareness programs in schools within the Asante Mampong Municipality to improve students’ level of knowledge of HBV. Countrywide studies examining KAP towards HBV infection among adolescents are also warranted.
Keywords: Hepatitis B infection, adolescents, KAP scores, senior high school, Ghana, HBV
Abstract: BACKGROUND: Induced abortion is a medical practice that has always been much discussed all over the world. Abortion is allowed in most European countries at the request of the woman with limitations that are imposed mainly by the gestational age. However, there are legislative differences between European countries which impose stringent limits on the use of induced abortion. OBJECTIVE: This article analyzes the European legislation on abortion, with a particular focus on countries in which there have been recent legislative changes in recent years, and the possible consequent risk of inequality among European women. METHODS: Government…and ministerial websites of the countries analyzed have been consulted to investigate abortion laws in Europe. In addition, the Global Abortion Policies Database of the World Health Organization was also consulted for a regulatory comparison. RESULTS: The differences between the various European countries are considerable. Although guaranteed by most legislation, abortion remains a fragile right in some European countries. CONCLUSION: Different legislation in the various countries of Europe causes difficulties for women who want to have an abortion but who reside in states where there are strict limits to abortion. In addressing the issue of induced abortion, we must not forget that the center of this practice is the woman. For this reason, it is essential to apply a reasoning based on respect for women’s rights: freedom, health, and self-determination.
Keywords: Abortion, rights, inequality, women, Europe