Forensic autopsy. The particularities of consent for research

Forensic autopsy has as its main goal to find out the truth about the causes and circumstances of death, when there is a reasonable suspicion to be caused by a violent act. As the legal guardian cannot refuse a forensic autopsy, the forensic physician is free to perform any procedures considered to be necessary for finding out the truth (in order to answer to the objectives asked by the authority). However the use of biological samples or data in research is limited and needs an additional consent, from the legal guardian, which can lead to difficulties in the interpretation of the needed form of consent for research purposes. Forensic studies can be made on the entire body, on biological samples collected from the deceased, archived material or necropsy reports. Biological products collected from the deceased can be collected in order to answer to the objectives required asked by the authorizing authority, or collected specifically for research purposes, and the amount may vary from a few milligrams of biological tissue or fluid up to whole organs. Every situation has specific ethical issues that we will try to summarize in the following pages

Crystallization of the concept of the medical secret in 19th century France

Background. Until recent years medical secret was considered one of the most important applied practical concepts in European medical ethics/deontology, being only surpassed by informed consent in the last half of the century. Little is known about the way this concept evolved in continental Europe, as only a small number of scientific articles in this area are available in the literature written in English. The purpose of this article is to summarize the evolution and crystallization of this concept in France from which it spread to numerous countries in Continental Europe in the 19th century. Materials and methods. A bibliographic search of relevant books, articles, and documents regarding 19th century medical secret in France. Results. The crystallization of medical secret in France started early compared to other European countries; both legal and moral aspects regarding medical secret disseminated widely from France to other countries in Continental Europe, influencing significantly the way this concept was structured at a national level. Conclusions. Many famous cases or debates in the areas of medical ethics and deontology from the countries in Continental Europe are forgotten. However, knowing and discussing them in relation to modern bioethics concepts might help decrease the resistance to these newer concepts, and elaborate a more practical model for the morality of the medical act, which will also include regional particularities

Crystallization of the concept of the medical secret in 19th century France

Background. Until recent years medical secret was considered one of the most important applied practical concepts in European medical ethics/deontology, being only surpassed by informed consent in the last half of the century. Little is known about the way this concept evolved in continental Europe, as only a small number of scientific articles in this area are available in the literature written in English. The purpose of this article is to summarize the evolution and crystallization of this concept in France from which it spread to numerous countries in Continental Europe in the 19th century. Materials and methods. A bibliographic search of relevant books, articles, and documents regarding 19th century medical secret in France. Results. The crystallization of medical secret in France started early compared to other European countries; both legal and moral aspects regarding medical secret disseminated widely from France to other countries in Continental Europe, influencing significantly the way this concept was structured at a national level. Conclusions. Many famous cases or debates in the areas of medical ethics and deontology from the countries in Continental Europe are forgotten. However, knowing and discussing them in relation to modern bioethics concepts might help decrease the resistance to these newer concepts, and elaborate a more practical model for the morality of the medical act, which will also include regional particularities

Femoral fractures in road traffic accidents

Abstract: The purpose of this study is to describe and analyze the severity of road traffic accidents in which a femoral fracture was identified, comparatively, in ante and post-mortem cases. For this purpose we have conducted a retrospective study, using the archives of the National Institute of Legal Medicine from which were selected 82 consecutive cases of clinical medicallegal expertises and 100 cases of autopsy (AR) reports for road traffic accidents. Femoral fractures were identified in 34 cases, of which 12 were in clinical cases and 22 in necropsy cases. Femoral shaft fractures were significantly associated with a lethal outcome, whilst fractures of the proximal extremity were significantly associated with a non-fatal outcome. Femoral fractures have a tendency to occur at younger ages compared with the cases in which such a lesion was not identified. Conclusions. Femoral shaft fractures were more frequent in younger males and fractures of the proximal extremity in older female patients. The presence of a femoral fracture (especially if it is involved the femoral shaft) is associated with an increased risk for an unfavorable outcome

GSK-3 Inhibitors and Tooth Repair: An Ethical Analysis

Tideglusib®, a GSK-3 inhibitor, was initially tested for the treatment of Alzheimer’s disease. However, a recent report has suggested its potential off-label use for the treatment of dental cavities. Even if this effect is not yet confirmed, this off-label use can have significant public/dental health consequences, mainly because of the large number of patients with cavities. The purpose of this mini-review is to perform an ethical analysis of the use of Tideglusib in dentistry. The ethical analysis identified three main areas in which ethical breaches could be significant: 1) respect for the autonomy of the patient, 2) issues raised by horizontal shifts in the translational research process, and 3) the conflict between dental beneficence and general non-maleficence. In conclusion, the use of Tideglusib in dentistry should respect the same strict ethical and regulatory criteria from clinical medicine. A translation of the potential risks should be done only after large-scale, phase-III/IV clinical trials, explicitly designed to test the usefulness of this drug in dental medicine

Changes in disease burden in Poland between 1990-2017 in comparison with other Central European countries : a systematic analysis for the Global Burden of Disease Study 2017

BACKGROUND:Systematic collection of mortality/morbidity data over time is crucial for monitoring trends in population health, developing health policies, assessing the impact of health programs. In Poland, a comprehensive analysis describing trends in disease burden for major conditions has never been published. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides data on the burden of over 300 diseases in 195 countries since 1990. We used the GBD database to undertake an assessment of disease burden in Poland, evaluate changes in population health between 1990-2017, and compare Poland with other Central European (CE) countries. METHODS:The results of GBD 2017 for 1990 and 2017 for Poland and CE were used to assess rates and trends in years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life years (DALYs). Data came from cause-of-death registration systems, population health surveys, disease registries, hospitalization databases, and the scientific literature. Analytical approaches have been used to adjust for missing data, errors in cause-of-death certification, and differences in data collection methodology. Main estimation strategies were ensemble modelling for mortality and Bayesian meta-regression for disability. RESULTS:Between 1990-2017, age-standardized YLL rates for all causes declined in Poland by 46.0% (95% UI: 43.7-48.2), YLD rates declined by 4.0% (4.2-4.9), DALY rates by 31.7% (29.2-34.4). For both YLLs and YLDs, greater relative declines were observed for females. There was a large decrease in communicable, maternal, neonatal, and nutritional disease DALYs (48.2%; 46.3-50.4). DALYs due to non-communicable diseases (NCDs) decreased slightly (2.0%; 0.1-4.6). In 2017, Poland performed better than CE as a whole (ranked fourth for YLLs, sixth for YLDs, and fifth for DALYs) and achieved greater reductions in YLLs and DALYs than most CE countries. In 2017 and 1990, the leading cause of YLLs and DALYs in Poland and CE was ischaemic heart disease (IHD), and the leading cause of YLDs was low back pain. In 2017, the top 20 causes of YLLs and YLDs in Poland and CE were the same, although in different order. In Poland, age-standardized DALYs from neonatal causes, other cardiovascular and circulatory diseases, and road injuries declined substantially between 1990-2017, while alcohol use disorders and chronic liver diseases increased. The highest observed-to-expected ratios were seen for alcohol use disorders for YLLs, neonatal sepsis for YLDs, and falls for DALYs (3.21, 2.65, and 2.03, respectively). CONCLUSIONS:There was relatively little geographical variation in premature death and disability in CE in 2017, although some between-country differences existed. Health in Poland has been improving since 1990; in 2017 Poland outperformed CE as a whole for YLLs, YLDs, and DALYs. While the health gap between Poland and Western Europe has diminished, it remains substantial. The shift to NCDs and chronic disability, together with marked between-gender health inequalities, poses a challenge for the Polish health-care system. IHD is still the leading cause of disease burden in Poland, but DALYs from IHD are declining. To further reduce disease burden, an integrated response focused on NCDs and population groups with disproportionally high burden is needed

Global, regional, and national levels and trends in burden of oral conditions from 1990 to 2017 : a systematic analysis for the Global Burden of Disease 2017 Study

Government and nongovernmental organizations need national and global estimates on the descriptive epidemiology of common oral conditions for policy planning and evaluation. The aim of this component of the Global Burden of Disease study was to produce estimates on prevalence, incidence, and years lived with disability for oral conditions from 1990 to 2017 by sex, age, and countries. In addition, this study reports the global socioeconomic pattern in burden of oral conditions by the standard World Bank classification of economies as well as the Global Burden of Disease Socio-demographic Index. The findings show that oral conditions remain a substantial population health challenge. Globally, there were 3.5 billion cases (95% uncertainty interval [95% UI], 3.2 to 3.7 billion) of oral conditions, of which 2.3 billion (95% UI, 2.1 to 2.5 billion) had untreated caries in permanent teeth, 796 million (95% UI, 671 to 930 million) had severe periodontitis, 532 million (95% UI, 443 to 622 million) had untreated caries in deciduous teeth, 267 million (95% UI, 235 to 300 million) had total tooth loss, and 139 million (95% UI, 133 to 146 million) had other oral conditions in 2017. Several patterns emerged when the World Bank’s classification of economies and the Socio-demographic Index were used as indicators of economic development. In general, more economically developed countries have the lowest burden of untreated dental caries and severe periodontitis and the highest burden of total tooth loss. The findings offer an opportunity for policy makers to identify successful oral health strategies and strengthen them; introduce and monitor different approaches where oral diseases are increasing; plan integration of oral health in the agenda for prevention of noncommunicable diseases; and estimate the cost of providing universal coverage for dental care