| 481. |
- Nijsingh, Niels, 1977, et al.
(författare)
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Ethics of Screening
- 2017
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Ingår i: International Encyclopedia of Public Health, 2nd Edition, Volume 3. Stella R.Quah (ed.). - Oxford, U.K. : Academic Press (Elsevier). - 9780128037089 ; , s. 28-35
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Bokkapitel (refereegranskat)
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| 482. |
- Nijsingh, Niels, 1977, et al.
(författare)
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Justifying Antibiotic Resistance Interventions: Uncertainty, Precaution and Ethics
- 2020
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Ingår i: Jamrozik E., Selgelid M.J. (eds) Ethics and Drug-Resistance: Collective Responsibility for Global Public Health. - Cham, Switzerland : Springer. - 2211-6680. - 9783030278731
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Bokkapitel (refereegranskat)abstract
- This chapter charts and critically analyses the ethical challenge of assessing how much (and what kind of) evidence is required for the justification of interventions in response antibiotic resistance (ABR), as well as other major public health threats. Our ambition here is to identify and briefly discuss main issues, and point to ways in which these need to be further advanced in future research. This will result in a tentative map of complications, underlying problems and possible challenges. This map illustrates that the ethical challenges in this area are much more complex and profound than is usually acknowledged, leaving no tentatively plausible intervention package free of downsides. This creates potentially overwhelming theoretical conundrums when trying to justify what to do. We therefore end by pointing out two general features of the complexity we find to be of particular importance, and a tentative suggestion for how to create a theoretical basis for further analysis.
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| 483. |
- Nijsingh, Niels, 1977, et al.
(författare)
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Managing pollution from antibiotics manufacturing: charting actors, incentives and disincentives
- 2019
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Ingår i: Environmental health. - : Springer Science and Business Media LLC. - 1476-069X. ; 18
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Tidskriftsartikel (refereegranskat)abstract
- Background Emissions of high concentrations of antibiotics from manufacturing sites select for resistant bacteria and may contribute to the emergence of new forms of resistance in pathogens. Many scientists, industry, policy makers and other stakeholders recognize such pollution as an unnecessary and unacceptable risk to global public health. An attempt to assess and reduce such discharges, however, quickly meets with complex realities that need to be understood to identify effective ways to move forward. This paper charts relevant key actor-types, their main stakes and interests, incentives that can motivate them to act to improve the situation, as well as disincentives that may undermine such motivation. Methods The actor types and their respective interests have been identified using research literature, publicly available documents, websites, and the knowledge of the authors. Results Thirty-three different actor-types were identified, representing e.g. commercial actors, public agencies, states and international institutions. These are in complex ways connected by interests that sometimes may conflict and sometimes pull in the same direction. Some actor types can act to create incentives and disincentives for others in this area. Conclusions The analysis demonstrates and clarifies the challenges in addressing industrial emissions of antibiotics, notably the complexity of the relations between different types of actors, their international dependency and the need for transparency. The analysis however also suggests possible ways of initiating incentive-chains to eventually improve the prospects of motivating industry to reduce emissions. High-resource consumer states, especially in multinational cooperation, hold a key position to initiate such chains.
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| 484. |
- Nijsingh, Niels, 1977, et al.
(författare)
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Screening for multi-drug-resistant Gram-negative bacteria: what is effective and justifiable?
- 2020
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Ingår i: Monash Bioethics Review. - : Springer Science and Business Media LLC. - 1321-2753 .- 1836-6716. ; 38:supplement 1
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Tidskriftsartikel (refereegranskat)abstract
- Effectiveness is a key criterion in assessing the justification of antibiotic resistance interventions. Depending on an intervention’s effectiveness, burdens and costs will be more or less justified, which is especially important for large scale population-level interventions with high running costs and pronounced risks to individuals in terms of wellbeing, integrity and autonomy. In this paper, we assess the case of routine hospital screening for multi-drug-resistant Gram-negative bacteria (MDRGN) from this perspective. Utilizing a comparison to screening programs for Methicillin-Resistant Staphylococcus aureus (MRSA) we argue that current screening programmes for MDRGN in low endemic settings should be reconsidered, as its effectiveness is in doubt, while general downsides to screening programs remain. To accomplish justifiable antibiotic stewardship, MDRGN screening should not be viewed as a separate measure, but rather as part of a comprehensive approach. The program should be redesigned to focus on those at risk of developing symptomatic infections with MDRGN rather than merely detecting those colonised.
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| 485. |
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| 486. |
- Nilsson, Thomas, 1954, et al.
(författare)
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The Precarious Practice of Forensic Psychiatric Risk Assessment
- 2010
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Ingår i: Gustavson, C (2010). Risk and prediction of violent crime in forensic psychiatry. - Lund : Lund University, Faculty of Medicine Doctoral Dissertation Series. - 9789186671365
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- The development of forensic psychiatric risk assessments is discussed from a clinical point of view using the example of Sweden. A central task in forensic psychiatry has traditionally been to identify dangerous, mentally disordered subjects considered to be prone to commit violent acts. Over time, “dangerousness” has been reworded into “risk”. Nevertheless, such assessments have generally been based on the psychiatric factors characterising the individual patient, while group interaction, situational factors, or social and cultural circumstances, such as the availability of alcohol and drugs, have been largely overlooked. That risk assessments have a focused on people with a diagnosis of “mental disorder” and been used as grounds for coercive measures and integrity violations has somehow been accepted as a matter of course in the public and political debate. Even the basic question whether offenders with a mental disorder are really more prone to criminal recidivism than other offenders seems to have been treated light-handedly and dealt with merely by epidemiological comparisons between groups of persons with broad ranges of psychosocial vulnerability and the general population. Legal texts, instructions and guidelines from the authorities in charge are often vague and general, while actors in the judicial system seem to put their trust in psychiatric opinions. The exchange of professional opinions, general public expectations, and judicial decision processes poses a huge risk for misunderstandings based on divergent expectations and uses of terminology.
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| 487. |
- Nilsson, Thomas, 1954, et al.
(författare)
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The precarious practice of forensic psychiatric risk assessments
- 2009
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Ingår i: International Journal of Law and Psychiatry. - : Elsevier BV. - 0160-2527. ; 32:6, s. 400-407
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Tidskriftsartikel (refereegranskat)abstract
- The development of forensic psychiatric risk assessments is discussed from a clinical point of view using the example of Sweden. A central task in forensic psychiatry has traditionally been to identify dangerous, mentally disordered subjects considered to be prone to commit violent acts. Over time, “dangerousness” has been reworded into “risk”. Nevertheless, such assessments have generally been based on the psychiatric factors characterising the individual patient, while group interaction, situational factors, or social and cultural circumstances, such as the availability of alcohol and drugs, have been largely overlooked. That risk assessments have a focused on people with a diagnosis of “mental disorder” and been used as grounds for coercive measures and integrity violations has somehow been accepted as a matter of course in the public and political debate. Even the basic question whether offenders with a mental disorder are really more prone to criminal recidivism than other offenders seems to have been treated light-handedly and dealt with merely by epidemiological comparisons between groups of persons with broad ranges of psychosocial vulnerability and the general population. Legal texts, instructions and guidelines from the authorities in charge are often vague and general, while actors in the judicial system seem to put their trust in psychiatric opinions. The exchange of professional opinions, general public expectations, and judicial decision processes poses a huge risk for misunderstandings based on divergent expectations and uses of terminology.
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| 488. |
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| 489. |
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| 490. |
- Peters, Ann-Christin, 1992, et al.
(författare)
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Barriers and Pathways to Environmental Surveillance of Antibiotic Resistance in Middle-and Low-Income Settings: An Exploratory Qualitative Key Expert Study
- 2024
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Ingår i: Global Health Action. - 1654-9880 .- 1654-9880. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- Local and global surveillance of antibiotic resistance (ABR) has proven a challenge to implement effectively in low- and middle income (LMI) settings. Environmental surveillance solutions are increasingly highlighted as a strategy to help overcoming such problems, and thus to promote global health as well as the local management of ABR in LMI countries. While technical and scientific aspects of such solutions are being probed continuously, no study has investigated their practical feasibility. Objective: Explore practical barriers for environmental surveillance of ABR in LMI countries, and pathways for surveillance experts to manage these. Method: To start charting this unknown territory, we conducted an explorative, qualitative interview study with key informants, applying a constructivist grounded theory approach to analyze the results. Results: barriers were identified across infrastructural, institutional and social dimensions, and pathways to manage them were mostly counterproductive from an ABR management perspective, including avoiding entire regions, applying substandard methods and failing to include local collaborators. Conclusion: the research community as well as international agencies, organizations and states have key roles and responsibilities for improving the prospects of feasible environmental ABR surveillance in LMI-settings.
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