Ethics in women's health: A pathway to gender equity

The differences between women’s and men’s experiences of health and illness are well known. Gender-specific medicine needs to restore equilibrium in order to understand the different clinical signs, diagnostic procedures, and therapeutic needs of diseases in men and women. This new dimension of medicine needs investment in research and health policy. If health professionals and healthcare organizations do not systematically take gender differences into account, inequities may arise and endure. Most discussions of gender involving an ethical perspective begin with the argument that women and men should be regarded as being of equal moral value. Where there are no relevant differences between them, then fairness and justice dictate that they should be treated equally, but if differences in needs exist, service planning should take this into account. Under these circumstances, equity as well as equality should be a guiding principle. The promotion of greater equality between men and women has also become a crucial issue in the bioethical debate, even if there is some confusion about the meaning of equality in this context, and especially of how this can be obtained. Biological differences cannot be removed, but their potentially harmful effects can be mitigated through social policies that take them properly into account, and through health research, policies and projects that give due attention to gender considerations and promote gender equity between women and men

Gene editing and gender-specific medicine: a challenge for dementia research

Abstract Gender-specific medicine is a clinical discipline that studies the impact of sex and gender on physiology, pathophysiology, and diseases. Human genome modification of somatic cells could be useful for treating or preventing a range of diseases and for improving the safety and efficiency of existing gene therapy techniques currently in use or under development for clinical application. Sex and gender differences have been analysed in the incidence and prevalence of dementia. In fact, epidemiological studies have demonstrated that women are at a higher risk than men for developing dementia or Alzheimer's disease (AD); however, the reasons for these differences are not completely known, and the debate is still underway. In recent years, in the effort to clarify the risk of developing dementia or AD, increasing attention has been devoted to the differences between men and women in the causes and manifestations of neurological diseases, as well as to their response to treatment and to outcomes. Through a conceptual analysis we will argue that an emphasis on gender-specific medicine in gene-editing research can contribute to the progress of medicine by introducing a relevant value-driven perspective on health and diseases. This is something we will do on the basis of a gender-specific strategy. In fact, focusing on the effect of sex on dementias and in particular AD may be essential in advancing our understanding, treatment and prevention of these disorders, considering that AD and other dementias disproportionately affect women, and it underlined the relevance of empirical data relating to sex differences and emerging sex-specific findings in dementias in order to assess the scientific approach to these diseases for the improvement of quality of life for both women and men. It may be helpful and suitable to consider how the interventions that modify the genome should include sex and gender as a crucially important variable accounting for the differences between men and women in the causes and manifestations of diseases, as well as in the response to treatment and to outcomes. Of course, gene editing cannot remove biological differences, but its potential harmful effects, on one group relative to another, can be prevented with a research strategy that properly takes them into account with a view to equity between genders

An unusual case of chronic cough: Professional liability in dentistry?

Foreign body aspiration (FBA) is a serious medical problem, also in dental practice. The case report describes the case of a patient who for 12 years has suffered from chronic cough as a result of the aspiration of a polymeric silicone resin fragment during a dental procedure. In November 2002, the patient was underwent dental care, and she points out that, when performing dental imprint, she had sensed that something "went down in the throat" but she was immediately reassured by the dentist. After lung CT was performed, the foreign body was identified and removed with benefit to the patient. The knowledge of this case report could be useful for dentists who perform dental impressions, to be aware of the fact that the material used is radiolucent e.g. cannot be seen on plan radiographs and it can be accidentally inhaled by the patient. The knowledge of the case is also important for doctors who come in contact with patients who previously underwent dental treatment, suffering from persistent cough, in the absence of positive radiological signs

Young people's awareness on biobanking and DNA profiling: results of a questionnaire administered to Italian university students

Current policy approaches to social and ethical issues surrounding biobanks manifest lack of public information given by researchers and government, despite the evidence that Italian citizens are well informed about technical and other public perspectives of biotechnologies. For this reason, the focus of our survey was to interview our University's students on these aspects. The sample consisted of Padua University students (N\u2009=\u2009959), who were administered a questionnaire comprising eight questions covering their knowledge about biobanks, their perception of the related benefits and risks, their willingness to donate samples to a biobank for research purposes, their attitude to having their own DNA profile included in a forensic DNA database, and the reasons behind their answers. The vast majority of the students invited to take part in the survey completed the questionnaire, and the number of participants sufficed to be considered representative of the target population. Despite the respondents' unfamiliarity with the topics explored, suggested by the huge group of respondents answering "I don't know" to the questions regarding Itaian regulation and reality, their answers demonstrate a general agreement to participate in a biobanking scheme for research purposes, as expressed by the 91% of respondents who were reportedly willing to donate their samples. As for the idea of a forensic DNA database, 35% of respondents said they would agree to having their profile included in such a database, even if they were not fully aware of the benefits and risks of such action.This study shows that Italian people with a higher education take a generally positive attitude to the idea of donating biological samples. It contributes to empirical evidence of what Italy's citizens understand about biobanking, and of their willingness to donate samples for research purposes, and also to have their genetic profiles included in a national forensic DNA database. Our findings may have clear implications for the policy discussion on biobanks in Italy, in particular it is important to take into account the Italian population's poor consciousness of forensic DNA database, in order to ensure a better interaction between policy makers and citizens and to make them more aware of the need to balance the individual's rights and the security of society

Genetic Testing for Minors: Comparison between Italian and British Guidelines

Genetic testing in children raises many important ethical, legal, and social issues. One of the main concerns is the ethically inappropriate genetic testing of minors. Various European countries established professional guidelines which reflect the different countries perspectives regarding the main ethical issues involved. In this paper, we analyze the Italian and the British guidelines by highlighting differences and similarities. We discuss presymptomatic, predictive, and carrier testing because we consider them to be the more ethically problematic types of genetic testing in minors. In our opinion, national guidelines should take into account the different needs in clinical practice. At the same time, in the case of genetic testing the national and supranational protection of minors could be strengthened by approving guidelines based on a common framework of principles and values. We suggest that the Oviedo Convention could represent an example of such a common framework or, at least, it could lead to articulate it

The Role of DNA Degradation in the Estimation of Post-Mortem Interval: A Systematic Review of the Current Literature

The determination of the post-mortal interval (PMI) is an extremely discussed topic in the literature and of deep forensic interest, for which various types of methods have been proposed. The aim of the manuscript is to provide a review of the studies on the post-mortem DNA degradation used for estimating PMI. This review has been performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the PRISMA Guidelines. Several analytical techniques have been proposed to analyse the post-mortem DNA degradation in order to use it to estimate the PMI. Studies focused mainly on animal models and on particular tissues. The results have been mixed: while on the one hand literature data in this field have confirmed that in the post-mortem several degradation processes involve nucleic acids, on the other hand some fundamental aspects are still little explored: the influence of ante and post-mortem factors on DNA degradation, the feasibility and applicability of a multiparametric mathematical model that takes into account DNA degradation and the definition of one or more target organs in order to standardize the results on human cases under standard conditions

Collecting sexual assault history and forensic evidence from adult women in the emergency department: A retrospective study

Abstract Background The objective of this retrospective study was to examine the discrepancy between information derived from written medical reports and the results of forensic DNA analyses on swabs collected from the victims in 122 cases of alleged sexual assault treated at the Emergency Department of Padua Hospital. The examination of discrepant results has proved useful to support a broader application of sexual assault management, particularly during the taking of case history. Methods The Laboratory of Forensic Genetics of Padua University have processed samples from 122 sexual assault cases over a period of 5 years. Results Of the 103 cases in which the victim reported a penetration and ejaculation, only 67 (55% of all the samples) correlated with positive feedback match from the laboratory. In 36 cases in which the patient reported penetration with ejaculation, no male DNA was found in the samples collected. Therefore, there was a total of 41 cases in which the patient’s report were not supported by laboratory data. In the remaining ten cases, which had an ambiguous history, 3 tested positively for the presence of male DNA. Conclusions To avoid discrepancies between the medical reporting and reconstruction of sex crimes, it is crucial to deploy strategies which focus not only on the technical aspects of evidence collection, but also on how the victim’s story is recorded; such efforts could lead to better management of sexual assault victims, and to a strengthened legal impact of forensic evidence and of crime reconstruction

Lessons Learned from the COVID-19 Pandemic: A Survey-Based Study on a Sample of Italian Physicians' Opinions on Telemedicine

Telemedicine was born out of the need to ensure clinical evaluation and personal care regardless of the physical presence of the healthcare professional nearby. Information technologies have been vital during the COVID-19 pandemic to ensure medical care and avoid the contagion between patients and clinicians. Accordingly, telecare services multiplied worldwide and gained paramount importance. The present work aims to collect field-based opinions about Telemedicine and ethics among Italian physicians. We developed a web-based questionnaire that was administered to Italian physicians from 1 May to 15 June 2022. The questionnaire was distributed as a link to Google Forms via social networks/instant messaging applications to groups of graduated and qualified physicians. A total of 180 physicians answered the questionnaire (with an age range from 25 to 68 years old). Physicians belonging to the medical area of expertise appear to more frequently use new technologies in comparison to other specialties. The vast majority believe that it is appropriate to use Telemedicine for monitoring and follow-up but not for evaluating a new patient. Concerns about changes in the physician-patient relationship, informed consent, digital barrier, and privacy and data protection also emerged. Finally, telehealth is thought to be a potential useful tool for the future by the majority of respondents but proper training for physicians is therefore needed