Global medicine: Is it ethical or morally justifiable for doctors and other healthcare workers to go on strike?

BACKGROUND: Doctor and healthcare worker (HCW) strikes are a global phenomenon with the potential to negatively impact on the quality of healthcare services and the doctor-patient relationship. Strikes are a legitimate deadlock breaking mechanism employed when labour negotiations have reached an impasse during collective bargaining. Striking doctors usually have a moral dilemma between adherence to the Hippocratic tenets of the medical profession and fiduciary obligation to patients. In such circumstances the ethical principles of respect for autonomy, justice and beneficence all come into conflict, whereby doctors struggle with their role as ordinary employees who are rightfully entitled to a just wage for just work versus their moral obligations to patients and society. DISCUSSION: It has been argued that to deny any group of workers, including "essential workers" the right to strike is akin to enslavement which is ethically and morally indefensible. While HCW strikes occur globally, the impact appears more severe in developing countries challenged by poorer socio-economic circumstances, embedded infrastructural deficiencies, and lack of viable alternative means of obtaining healthcare. These communities appear to satisfy the criteria for vulnerability and may be deserving of special ethical consideration when doctor and HCW strikes are contemplated. SUMMARY: The right to strike is considered a fundamental right whose derogation would be inimical to the proper functioning of employer/employee collective bargaining in democratic societies. Motivations for HCW strikes include the natural pressure to fulfil human needs and the paradigm shift in modern medical practice, from self-employment and benevolent paternalism, to managed healthcare and consumer rights. Minimizing the incidence and impact of HCW strikes will require an ethical approach from all stakeholders, and recognition that all parties have an equal moral obligation to serve the best interests of society. Employers should implement legitimate collective bargaining agreements in a timely manner and high-handed actions such as mass-firing of striking HCWs, or unjustifiable disciplinary action by regulators should be avoided. Minimum service level agreements should be implemented to mitigate the impact of HCW strikes on indigent populations. Striking employees including HCWs should also desist from making unrealistic wage demands which could bankrupt governments/employers or hamper provision of other equally important social services to the general population

Using Polarized Spectroscopy to Investigate Order in Thin-Films of Ionic Self-Assembled Materials Based on Azo-Dyes

Three series of ionic self-assembled materials based on anionic azo-dyes and cationic benzalkonium surfactants were synthesized and thin films were prepared by spin-casting. These thin films appear isotropic when investigated with polarized optical microscopy, although they are highly anisotropic. Here, three series of homologous materials were studied to rationalize this observation. Investigating thin films of ordered molecular materials relies to a large extent on advanced experimental methods and large research infrastructure. A statement that in particular is true for thin films with nanoscopic order, where X-ray reflectometry, X-ray and neutron scattering, electron microscopy and atom force microscopy (AFM) has to be used to elucidate film morphology and the underlying molecular structure. Here, the thin films were investigated using AFM, optical microscopy and polarized absorption spectroscopy. It was shown that by using numerical method for treating the polarized absorption spectroscopy data, the molecular structure can be elucidated. Further, it was shown that polarized optical spectroscopy is a general tool that allows determination of the molecular order in thin films. Finally, it was found that full control of thermal history and rigorous control of the ionic self-assembly conditions are required to reproducibly make these materials of high nanoscopic order. Similarly, the conditions for spin-casting are shown to be determining for the overall thin film morphology, while molecular order is maintained

Evaluating Knowledge, Practice, and Barriers to Informed Consent Among Professional and Staff Nurses in South Africa: An Empirical Study

Background: Informed consent (IC) is an ethical and legal obligation protected by constitutional rights to bodily integrity, well-being, and privacy in South Africa. The National Health Act 2003 codified IC regulations, requiring that all healthcare professionals inform patients about diagnosis, risks, benefits, options, and refusal rights while factoring in patients’ language and literacy levels. Objectives: This study’s primary aim was to determine the extent of South African professional/staff nurses’ compliance with current IC regulations and ascertain socio-cultural impediments impacting proper IC practice. Methods: A cross-sectional survey using semi-structured questionnaires was used to evaluate knowledge and practice of IC among nurses in KwaZulu-Natal province. Data were analyzed using SPSS, v.21. Descriptive statistics, chi-squared tests, and content analysis were used to compare nursing domains. Results: Three hundred fifty-five (355) nurses, 92% females, with 1 to 41 years of professional experience, completed this study. Information disclosed by nurses to patients included diagnosis (77%), treatment benefits (71%), risks (69%), recommendations (65%), risks of refusal (80%), and right of refusal (67%). Nurses (80%) felt information disclosure was adequate, while 85% reported that patients understood disclosed information. Conclusions: Nurses practicing in local public hospitals had moderate knowledge of IC regulations. Practical implementation appeared deficient. Barriers to IC included language, workload, time constraints, lack of interpreters, and skewed gender norms in the nursing profession. Nurses require continuing professional education in healthcare law and ethics, a “corps of trained interpreters”, and gender transformation in the nursing profession to improve IC practice and overall quality of healthcare service delivery in South Africa.Contexte : Le consentement éclairé (CE) est une obligation éthique et juridique protégée par les droits constitutionnels à l’intégrité corporelle, au bien-être et à la vie privée en Afrique du Sud. La loi nationale sur la santé de 2003 a codifié les règlements en matière de CE, exigeant que tous les professionnels de la santé informent les patients sur le diagnostic, les risques, les avantages, les options et les droits de refus, tout en tenant compte de la langue et du niveau d’alphabétisation des patients. Objectifs : L’objectif principal de cette étude était de déterminer le degré de conformité des infirmières professionnelles/du personnel infirmier sud-africain avec les réglementations actuelles en matière de CE et de vérifier les obstacles socioculturels ayant un impact sur la pratique correcte de la CE. Méthodes : Une enquête transversale utilisant des questionnaires semi-structurés a été utilisée pour évaluer les connaissances et la pratique de la CI parmi les infirmières de la province de KwaZulu-Natal. Les données ont été analysées à l’aide de SPSS, v.21. Des statistiques descriptives, des tests de chi carré et une analyse de contenu ont été utilisés pour comparer les cadres/domaines infirmiers. Résultats : Trois cent cinquante-cinq (355) infirmières, 92% de femmes, ayant de 1 à 41 ans d’expérience professionnelle, ont participé à cette étude. Les informations divulguées par les infirmières aux patients comprenaient le diagnostic (77 %), les avantages du traitement (71 %), les risques (69 %), les recommandations (65 %), les risques de refus (80 %) et le droit de refus (67 %). Les infirmières (80 %) ont estimé que la divulgation des informations était adéquate, tandis que 85 % ont déclaré que les patients comprenaient les informations divulguées. Conclusions : Les infirmières exerçant dans les hôpitaux publics locaux avaient une connaissance modérée des règlements sur la CE. La mise en œuvre pratique semblait déficiente. Les obstacles à la CE sont la langue, la charge de travail, les contraintes de temps, le manque d’interprètes et les normes de genre biaisées dans la profession infirmière. Pour améliorer la pratique de la CE et la qualité globale des services de santé en Afrique du Sud, les infirmières ont besoin d’une formation professionnelle continue en matière de droit et d’éthique de la santé, d’un « corps d’interprètes formés » et d’une transformation de la profession infirmière en fonction du genre

JC virus as a marker of human migration to the Americas

Fil: Stoner, Gerald L. National Institutes of Health. National Institute of Neurological Disorders and Stroke. Neurotoxicology Section, Bethesda, Maryland; Estados Unidos.Fil: Jobes, David V. National Institutes of Health. National Institute of Neurological Disorders and Stroke. Neurotoxicology Section, Bethesda, Maryland; Estados Unidos.Fil: Fernández Cobo, Mariana. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Departamento de Virología. Servicio de Biología Molecular; Argentina.Fil: Agostini, Hansjürgen T. University of Freiburg. Department of Ophthalmology; Alemania.Fil: Chima, Sylvester C. National Institutes of Health. National Institute of Neurological Disorders and Stroke. Neurotoxicology Section, Bethesda, Maryland; Estados Unidos.Fil: Ryschkewitsch, Caroline F. National Institutes of Health. National Institute of Neurological Disorders and Stroke. Neurotoxicology Section, Bethesda, Maryland; Estados Unidos.JC virus is a ubiquitous human polyomavirus present in populations worldwide. Seven genotypes differing in DNA sequence by approximately 1-3% characterize three Old World population groups (African, European and Asian) as well as Oceania. It is possible to follow Old World populations into the New World by the JC virus genotypes they carried. The first population to settle in the Americas, the Native Americans, brought with them type 2A from northeast Asia. European settlers arriving after Columbus carried primarily type 1 and type 4. Africans brought by the slave trade carried type 3 and type 6

Molecular Epidemiology of Human Polyomavirus JC in the Biaka Pygmies and Bantu of Central Africa

Polyomavirus JC (JCV) is ubiquitous in humans and causes a chronic demyelinating disease of the central nervous system , progressive multifocal leukoencephalopathy which is common in AIDS. JCV is excreted in urine of 30-70% of adults worldwide. Based on sequence analysis of JCV complete genomes or fragments thereof, JCV can be classified into geographically derived genotypes. Types 1 and 2 are of European and Asian origin respectively while Types 3 and 6 are African in origin. Type 4, a possible recombinant of European and African genotypes (1 and 3) is common in the USA. To delineate the JCV genotypes in an aboriginal African population, random urine samples were collected from the Biaka Pygmies and Bantu from the Central African Republic. There were 43 males and 25 females aged 4-55 years, with an average age of 26 years. After PCR amplification of JCV in urine, products were directly cycle sequenced. Five of 23 Pygmy adults (22%) and four of 20 Bantu adults (20%) were positive for JC viruria. DNA sequence analysis revealed JCV Type 3 (two), Type 6 (two) and one Type 1 variant in Biaka Pygmies. All the Bantu strains were Type 6. Type 3 and 6 strains of JCV are the predominant strains in central Africa. The presence of multiple subtypes of JCV in Biaka Pygmies may be a result of extensive interactions of Pygmies with their African tribal neighbors during their itinerant movements in the equatorial forest