Vaccination: Is There a Place for Penalties for Non-compliance?

The introduction of punitive measures to control outbreaks of measles in Europe has sparked debate and public protest about the ethical justification of penalties and exclusionary processes for non-immunisation. This article advances an ethics framework related to compulsory vaccination policies, which we use to analyse three case studies: of mandatory policies that are enforced by fines; of policies that require vaccination for the provision of social goods; and of community-led policies in which communities themselves decide how to enforce vaccination compliance. We report on contemporary, ongoing and past measures that have been used to increase vaccine uptake, consider their rationale and the related public responses, elaborate on socio-cultural and contextual influences, and discuss the ethical justification for mandatory vaccination. We argue for a measured approach that protects fundamental human rights to evidence-based information and medical counsel to support health decision making and that simultaneously raises awareness about the role of immunisation in protecting the wider community. We think more emphasis needs to be placed on immunisation as a means of promoting social good, reducing harm and protecting vulnerable groups

Estimating loss in quality of life associated with asthma-related crisis events (ESQUARE): a cohort, observational study

Background: Evidence of quality of life implications of asthma attacks are limited,particularly when measured on a utility scale, which enables calculating Quality-Adjusted Life-Years (QALYs) and comparisons with other health conditions andservices. Therefore, this study sought to estimate the utility loss associated with anasthma-related crisis event (accident and emergency (A&E) attendance or hospitaladmission).Methods: Participants were recruited in a cohort study from A&E and hospitaladmissions at three UK hospitals. They completed the EuroQol-5 Dimensions 5-Level(EQ-5D-5L), Asthma Quality of Life Questionnaire (AQLQ), Time trade-off (TTO), andpeak flow and symptom diary over 8 weeks, where three different methods (EQ-5D-5L,AQLQ, and TTO), were used to estimate utilities. The mean difference between twotime points were estimated using the Wilcoxon signed rank test.Results: From baseline to week 8, mean increases (95% CI) were estimated to be0.086 (0.019-0.153), 0.154 (0.112-0.196) and 0.132 (0.063-0.201) for EQ-5D-5L, AQL-5D (preference-based measure derived from AQLQ), and TTO respectively over 8weeks (p<0.01).Conclusion: Asthma crisis events are estimated to be associated with a mean utilityloss of between 0.086 and 0.132. The utility decrement can be used to assign valuesto asthma-related crisis events, which can enhance economic evaluations

The construct validity and responsiveness of the EQ-5D-5L, AQL-5D and a bespoke TTO in acute asthmatics

Purpose: Measuring quality of life in acute asthmatics is challenging, especially when asthma attacks can occur sporadically. Several questionnaires can be used to measure quality of life in this patient group; however, psychometric testing is limited on questionnaires that can be used to estimate Quality Adjusted Life years. The objective of this study is to assess the construct validity (convergent and discriminative validity) and responsiveness of the EuroQol-5-Dimensions 5-Level (EQ-5D-5L), Asthma Quality of Life Utility Index-5 Dimensions (AQL-5D) and Time Trade-Off (TTO) in acute asthma patients. Methods: Data from a prospective cohort study were used to test the validity and responsiveness of the EQ-5D-5L, AQL-5D and TTO in asthma patients who were recruited from UK accident & emergency departments or hospital wards. The spearman’s rank correlation coefficient, the Kruskal–Wallis test statistic and the standardized response mean were used to test for convergent validity, discriminative validity and responsiveness, respectively. Results: One hundred and twenty-one participants were included in the available case analysis. The EQ-5D-5L and AQL-5D showed moderate to strong correlations for convergent validity at baseline, week 4 and week 8. The AQL-5D and TTO showed moderate correlations at week 4 and week 8. No statistical significance was observed for discriminative validity at baseline. Both the EQ-5D-5L and the AQL-5D also showed that they were sensitive to change for the recovery responses. Conclusions: The EQ-5D-5L and AQL-5D showed stronger construct validity and responsiveness compared to the TTO. Therefore, both the EQ-5D-5L and AQL-5D should be considered for use in future economic evaluations

“Because we have really unique art”: Decolonizing Research with Indigenous Youth Using the Arts

Indigenous communities in Canada share a common history of colonial oppression. As a result, many Indigenous populations are disproportionately burdened with poor health outcomes, including HIV. Conventional public health approaches have not yet been successful in reversing this trend. For this study, a team of community- and university-based researchers came together to imagine new possibilities for health promotion with Indigenous youth. A strengths-based approach was taken that relied on using the energies and talents of Indigenous youth as a leadership resource. Art-making workshops were held in six different Indigenous communities across Canada in which youth could explore the links between community, culture, colonization, and HIV. Twenty artists and more than 85 youth participated in the workshops. Afterwards, youth participants reflected on their experiences in individual in-depth interviews. Youth participants viewed the process of making art as fun, participatory, and empowering; they felt that their art pieces instilled pride, conveyed information, raised awareness, and constituted a tangible achievement. Youth participants found that both the process and products of arts-based methods were important. Findings from this project support the notion that arts-based approaches to the development of HIV-prevention knowledge and Indigenous youth leadership are helping to involve a diverse cross-section of youth in a critical dialogue about health. Arts-based approaches represent one way to assist with decolonization for future generations

Impulsive, Disinhibited Behavior—Dining in a Restaurant

Dining in a restaurant with a loved one who has dementia can be an ordeal, especially if the expectations of the caregiver do not match those of the patient and the restaurant environment is not suitable for patients with dementia. The size of the dining area, lighting, background music or noise, décor of the room, number of customers, variety of the items on the menu, number of plates and cutlery on the table, in addition to flowers, candles, and other decorations on the table are all potent distractors. There are so many stimuli; the patient can be overwhelmed with information overload and not able to focus on the main purpose of the event: have dinner and especially enjoy the other person’s company. In this case scenario, we present a 62-year-old man diagnosed with behavioral variant frontotemporal dementia (bvFTD). His daughter “invited” him to have dinner with her at a very fancy restaurant to celebrate her promotion at work. Unfortunately, whereas the evening started very well, it had a catastrophic ending. We discuss what went wrong in the patient/daughter interaction and how the catastrophic ending could have been avoided or averted

Fronto-Temporal Dementia, Diabetes Mellitus and Excessive Eating

Diabetes mellitus is common among older people. Hypoglycemia is a sign of poorly controlled diabetes mellitus and may lead to irritability, agitation, anxiety, hunger, and an excessive food intake, which in turn may make the control of diabetes more difficult. Excessive, inappropriate food intake is also a sign of Fronto-Temporal Dementia (behavioral variant: bvFTD). In this case study, we describe the events leading to an altercation that developed between an older diabetic patient with bvFTD and the staff in an Assisted Living Facility. His first dose of insulin was given early that morning while he was still asleep. He, subsequently, woke up feeling hungry, agitated, and irritable. This, in turn, exacerbated the hyperorality associated with bvFTD. We examine what went wrong in the patient/caregiver interaction and how this potentially catastrophic situation could have been avoided or defused

Driving and Patients With Dementia

Driving is a symbol of autonomy and independence, eagerly awaited during adolescence, cherished during adulthood and reluctantly rescinded during old age. It is nevertheless an individual’s privilege, not right, especially as driving may affect other drivers and pedestrians on the road. It is therefore not only the individual patient who is at stake but essentially the entire community. In this case scenario, we describe the situation that arose when a patient with multi-infarct dementia wanted to go for a drive and his son and grandson tried to convince him that he could no longer drive. What went wrong in the caregivers/patient interaction is presented. The futility of arguing with patients who have dementia is highlighted as well as the suspiciousness it may generate. Alternate actions that can be useful to avoid/avert the situation from escalating and having a catastrophic ending are discussed. Testing/evaluating patients with dementia for fitness to drive is also reviewed and a list of select resources is included