In this paper, I reflect on caring and witnessing through engaged ethnography of an urban poor community during the onset of the COVID19 pandemic. The urban poor are individuals and families who live below the poverty line in metropolitan areas, many of whom have little or no political voice and are insufficiently protected by social networks and other institutions. In March 2020, the government placed Metro Manila under Enhanced Community Quarantine to control the spread of COVID19. This left many an urban poor community in Metro Manila to struggle even more against an already precarious existence. By standard, nurses render different levels of care for urban poor clients in almost all health care settings. In public health nursing, we come in close contact to the realities of our clients when we see them in health centers, in the community, or whenever we do our home visits. Now, caring for vulnerable and marginalized groups such as the urban poor has changed due to minimum public health standards of wearing masks, physical distancing, handwashing, and enforcement of lockdowns. As a nurse, an academic, and as a student of anthropology, I came up for self-review while doing an article for a popular social news network derived from a virtually engaged ethnography. While this novel method requires you to see the world through the eyes of the “other,” and generates bioethical dialogue and awareness of personal biases in addressing ethical considerations and challenges, it gives voice and fulfills our roles as client advocates. In May 2020, the article was published with the urban poor organization and its partners as my coauthors. I borrowed from anthropology to arrive at a greater understanding of the socio-cultural effects and political implications of COVID19 to one of the most vulnerable nursing clientele – the urban poor.
Public Health Nursing ; Ethics, Research ; COVID-19

This article describes, categorizes, and discusses the results of a rapid literature review aiming to provide an overview of the ethical issues and corresponding solutions surrounding pregnancies in epidemic outbreaks. The review was commissioned by the World Health Organization to inform responses to the Zika outbreak that began in 2015. Due to the urgency of the response efforts that needed to be informed by the literature search, a rapid qualitative review of the literature published in PubMed was conducted. The search and analysis were based on the operationalization of 3 key concepts: ethics, pregnancy, and epidemic outbreak. Ethical issues and solutions were interpreted within a principlist framework. The data were analyzed using qualitative content analysis. The search identified 259 publications, of which the full text of 23 papers was read. Of those, 20 papers contained a substantive part devoted to the topic of interest and were therefore analyzed further. We clustered the ethical issues and solutions around 4 themes: uncertainty, harms, autonomy/liberty, and effectiveness. Recognition of the identified ethical issues and corresponding solutions can inform and improve response efforts, public health planning, policies, and decision-making, as well as the activities of medical staff and counselors who practice before, during, or after an epidemic outbreak that affects pregnant women or those of reproductive age. The rapid review format proved to be useful despite its limited data basis and expedited review process.
Counseling ; Delivery of Health Care ; Disease Outbreaks ; Ethics ; Female ; Humans ; Medical Staff ; Pregnancy ; Pregnant Women ; Public Health ; Reproductive Health ; Uncertainty ; World Health Organization

This article describes, categorizes, and discusses the results of a rapid literature review aiming to provide an overview of the ethical issues and corresponding solutions surrounding pregnancies in epidemic outbreaks. The review was commissioned by the World Health Organization to inform responses to the Zika outbreak that began in 2015. Due to the urgency of the response efforts that needed to be informed by the literature search, a rapid qualitative review of the literature published in PubMed was conducted. The search and analysis were based on the operationalization of 3 key concepts: ethics, pregnancy, and epidemic outbreak. Ethical issues and solutions were interpreted within a principlist framework. The data were analyzed using qualitative content analysis. The search identified 259 publications, of which the full text of 23 papers was read. Of those, 20 papers contained a substantive part devoted to the topic of interest and were therefore analyzed further. We clustered the ethical issues and solutions around 4 themes: uncertainty, harms, autonomy/liberty, and effectiveness. Recognition of the identified ethical issues and corresponding solutions can inform and improve response efforts, public health planning, policies, and decision-making, as well as the activities of medical staff and counselors who practice before, during, or after an epidemic outbreak that affects pregnant women or those of reproductive age. The rapid review format proved to be useful despite its limited data basis and expedited review process.
Counseling ; Delivery of Health Care* ; Disease Outbreaks* ; Ethics* ; Female ; Humans ; Medical Staff ; Pregnancy ; Pregnant Women* ; Public Health ; Reproductive Health ; Uncertainty ; World Health Organization

The concept of big data, commonly characterized by volume, variety, velocity, and veracity, goes far beyond the data type and includes the aspects of data analysis, such as hypothesis-generating, rather than hypothesis-testing. Big data focuses on temporal stability of the association, rather than on causal relationship and underlying probability distribution assumptions are frequently not required. Medical big data as material to be analyzed has various features that are not only distinct from big data of other disciplines, but also distinct from traditional clinical epidemiology. Big data technology has many areas of application in healthcare, such as predictive modeling and clinical decision support, disease or safety surveillance, public health, and research. Big data analytics frequently exploits analytic methods developed in data mining, including classification, clustering, and regression. Medical big data analyses are complicated by many technical issues, such as missing values, curse of dimensionality, and bias control, and share the inherent limitations of observation study, namely the inability to test causality resulting from residual confounding and reverse causation. Recently, propensity score analysis and instrumental variable analysis have been introduced to overcome these limitations, and they have accomplished a great deal. Many challenges, such as the absence of evidence of practical benefits of big data, methodological issues including legal and ethical issues, and clinical integration and utility issues, must be overcome to realize the promise of medical big data as the fuel of a continuous learning healthcare system that will improve patient outcome and reduce waste in areas including nephrology.
Bias (Epidemiology) ; Classification ; Data Mining ; Decision Support Systems, Clinical ; Delivery of Health Care ; Epidemiology ; Ethics ; Humans ; Learning ; Nephrology ; Propensity Score ; Public Health Surveillance ; Statistics as Topic

Biomedical Research ; ethics ; Human Rights ; Humans ; Public Health

OBJECTIVES: This study aimed at assessing the quality of dental services, as perceived by the disabled, and analyzing the factors identified to be of both high importance and low performance, as identified by IPA. METHODS: The data were collected from June 8 to November 2, 2016, after approval by the institutional review board. Questionnaires were distributed to 1466 disabled dental service consumers, of which 349 cases were included. The data were analyzed by frequency analysis, multi-regression analysis for implicit importance, and IPA matrix for marketing strategy. RESULTS: The performance results revealed that cost level, reduction of the fee, and waiting time for treatments were the sources of greatest dissatisfaction. The IPA matrix results categorized the next appointment, explanation of the fee, waiting time for treatment, professionalism of the staff, and convenient facilities as high-importance, low-performance factors. Meanwhile, the results of the IPA matrix for consumer segmentation, according to recently used dental institutions were different. The dental clinic users evaluated professionalism of the staff, convenience of the facility, explanation of the fee, and cost level as high-importance, low-performance attributes. The dental hospital users indicated that waiting time for treatment and next appointment were high-importance, low-performance attributes. Finally, the public health center users indicated that convenience of booking, waiting time for treatment, convenience of facilities, reduction of the fee, and next appointment as high-importance, low-performance attributes. CONCLUSIONS: To improve the quality of dental service, we need to understand the needs of the dental patients with disability. All attributes that were categorized as high-importance, low-performance must be improved first and should accordingly be used as strategic factors to increase satisfaction with oral medical institutions.
Dental Clinics ; Ethics Committees, Research ; Fees and Charges ; Humans ; Marketing ; Professionalism ; Public Health

PURPOSE: This study aims to identify perception, performance, and the related factors of performance in regards to patients' medical information protection among allied health college students. METHODS: Four hundred twelve subjects from three colleges located in Jeonbuk and Kyungbuk province consented to participate. Data was collected from November 28 to December 15, 2012. To assess perception and performance in regards to patients' medical information protection, a self-reporting questionnaire was used. Data was analyzed via SPSS 18.0 program. RESULTS: The score of perception and performance about patients' medical information protection were 4.07 and 3.56, respectively. All item's scores of performance were significantly lower than those of perception. The perception score was significantly different according to recognition of hospital ethics code (t=1.95, p=.052), and recognition of association ethics code (t=2.88, p=.004). The performance score was significantly different according to gender (t=-3.32, p=001), major (F=14.41, p<.001), clinical practicum hospitals (F=8.22, p<.001), and method of electronic medical record access (F=3.23, p=.023). The factors influencing performance were perception(beta=.46, p<.001), duration of clinical practice(beta=-.36, p<.001), and gender(beta=.09, p=.033). CONCLUSION: In order to improve performance in regards to patients' medical information protection of allied health college students, we should develop ethical education programs and standardize them through multidisciplinary collaboration.
Codes of Ethics ; Computer Security* ; Confidentiality ; Cooperative Behavior ; Education ; Electronic Health Records ; Ethics, Institutional ; Humans ; Jeollabuk-do ; Medical Records ; Students, Public Health

South Korea's state health insurer, the National Health Insurance Service (NHIS), is in the process of a compensation suit against tobacco industry. The tobacco companies have habitually endeavored to ensure favorable outcomes in litigation by misusing scientific evidence or recruiting scientists to support its interests. This study analyzed strategies that tobacco companies have used during the NHIS litigation, which has been receiving world-wide attention. To understand the litigation strategies of tobacco companies, the present study reviewed the existing literature and carried out content analysis of petitions, preparatory documents, and supporting evidence submitted to the court by the NHIS and the tobacco companies during the suit. Tobacco companies misrepresented the World Health Organization (WHO) report's argument and misused scientific evidence, and removed the word "deadly" from the title of the citation. Tobacco companies submitted the research results of scientists who had worked as a consultant for the tobacco industry as evidence. Such litigation strategies employed by the tobacco companies internationally were applied similarly in Korean lawsuits. Results of tobacco litigation have a huge influence on tobacco control policies. For desirable outcomes of the suits, healthcare professionals need to pay a great deal of attention to the enormous volume of written opinions and supporting evidence that tobacco companies submit. They also need to face the fact that the companies engage in recruitment of scientists. Healthcare professionals should refuse to partner with tobacco industry, as recommended by Article 5.3 of the WHO Framework Convention on Tobacco Control.
Humans ; Public Health/*legislation & jurisprudence ; Republic of Korea ; Smoking/*legislation & jurisprudence ; Tobacco Industry/*ethics

Ethical considerations are essential in planning for and responding to outbreaks of infectious diseases. During the outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) in the Republic of Korea in 2015, serious challenges emerged regarding important ethical issues, such as transparency and the protection of privacy. The development of bioethics in Korea has been influenced by individualistic perspectives applied in clinical contexts, leading to a paucity of ethical perspectives relevant to population-level phenomena such as outbreaks. Alternative theories of public health ethics include the perspectives of relational autonomy and the patient as victim and vector. Public health actions need to incorporate clear and systematic procedures founded upon ethical principles. The MERS-CoV epidemic in Korea created significant public support for more aggressive early interventions in future outbreaks. This trend makes it all the more imperative for ethical principles and procedures to be implemented in future planning and responses to outbreaks in order to promote perceptions of legitimacy and civic participation.
Coronavirus Infections/*epidemiology/prevention & control ; Disease Outbreaks ; Humans ; Pandemics/ethics ; Public Health/*ethics ; Republic of Korea/epidemiology

Contact monitoring is an essential component of the public health response to a Middle East respiratory syndrome coronavirus outbreak, and is required for an effective quarantine to contain the epidemic. The timeliness of a quarantine is associated with its effectiveness. This paper provides a conceptual framework to describe the process of contact monitoring, and proposes a new measure called the "timely quarantined proportion" as a tool to assess the adequacy of a public health response.
Coronavirus Infections/epidemiology/*prevention & control/transmission ; Disease Outbreaks ; Health Personnel/ethics ; Humans ; Public Health/*ethics/legislation & jurisprudence ; Quarantine ; Republic of Korea/epidemiology