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The coronavirus severe acute respiratory syndrome (COVID-19) pandemic has placed increased stress on healthcare workers (HCWs). While anxiety and post-traumatic stress have been evaluated in HCWs during previous pandemics, moral injury, a construct historically evaluated in military populations, has not. We hypothesized that the experience of moral injury and psychiatric distress among HCWs would increase over time during the pandemic and vary with resiliency factors. From a convenience sample, we performed an email-based, longitudinal survey of HCWs at a tertiary care hospital between March and July 2020. Surveys measured occupational and resilience factors and psychiatric distress and moral injury, assessed by the Impact of Events Scale-Revised and the Moral Injury Events Scale, respectively. Responses were assessed at baseline, 1-month, and 3-month time points. Moral injury remained stable over three months, while distress declined. A supportive workplace environment was related to lower moral injury whereas a stressful, less supportive environment was associated with increased moral injury. Distress was not affected by any baseline occupational or resiliency factors, though poor sleep at baseline predicted more distress. Overall, our data suggest that attention to improving workplace support and lowering workplace stress may protect HCWs from adverse emotional outcomes. © 2021 by the authors. Licensee MDPI, Basel, Switzerland. ; https://doi.org/10.3390/ijerph18020488

Objectives: To explore the consumption patterns of energy drinks and associated factors, amongst medical students and foundation year doctors in Malta. Methods: Data was collected from medical students and foundation year doctors from the Faculty of Medicine and Surgery, University of Malta, by means of an electronically administered cross-sectional, self-reported survey. The response rate was 42% (n=305). IBM SPSS 23 was used for statistical analysis. Results: Energy drinks consumption amongst the sample was 68.2% (n= 208). Most participants (60.1%) started consuming energy drinks between 16-20 years, followed by those between 11-15 years (34.6%). Males are more likely to consume energy drinks than females. Participants who consume energy drinks are more likely to also drink coffee (85.1%), alcohol (88.0%) and smoke tobacco (18.3%). Common reasons for drinking energy drinks were for mixing with alcohol (37.5%) and during studying/major projects (30.8%). The majority of the participants (52.1%) experience psychological side effects due to energy drinks, the most common being stimulating/hyperactivity (42.6%), followed by anxiety (14.8%). Over half of the participants (54.8%) claimed to suffer from physical side effects Conclusions: Energy drink consumption is common amongst this population and certain aspects of consumption are a cause for concern. Greater public education of the risks of these drinks is recommended especially to young age groups. Legislation may be required to control the marketing and sales and accessibility of these drinks. ; peer-reviewed

The Laws relating the offences against the human body has completely changed with the promulgation of the Criminal Law Ordinance, commonly called Qisas and Diyat Law but the doctors in their medicolegal certificates still express their opinions according to the previous law, which causes problem for the courts to assess the true nature of injury. This practice should immediately be stopped as it confuses the facts, dims the issue and hinders the dispensation of justice. Qisas and Diyat Law has introduced new classification of hurt (injury), which is more clear and elaborate. Besides, this law has provided compensation for physical sufferings due to criminal hurts for the first time in Pakistan. The provisions for the grant of compensation for criminal damages are Arsh, Daman and diyat. In addition there is a provision of qisas. These legal terms should be clearly understood before undertaking medico legal certification.

'Financial statecraft', or the intentional use of credit, investment and currency levers by the incumbent governments of creditor - and sometimes debtor - states for both international economic and political advantage, has a long history, ranging from money doctors to currency wars. A neorealist, zero-sum framing of international monetary relations is not inevitable, yet casts a persistent shadow especially during periods of prospective interstate power transitions when previously peripheral countries find themselves with unexpected new capabilities. This article seeks to understand and theorise the financial statecraft of emerging economies, moving beyond the traditional understanding that closely identifies the concept with financial sanctions imposed by a strong state on a weaker state. We propose that the aims of financial statecraft may be either 'defensive' or 'offensive'. Financial statecraft may be targeted either 'bilaterally' or 'systemically'. Finally such statecraft may employ instruments that are either 'financial' or 'monetary'. As emerging market economies have moved up in the ranks in the interstate distribution of capabilities, they have also expanded their financial statecraft strategies from narrowly defensive and bilateral to those involving offensive tactics and targeted at the global and systemic level. Historical and contemporary examples illustrate the analysis. Adapted from the source document.

INTRODUCTION: Unlike issues in biomedical research ethics, ethical challenges arising in daily clinical care in Sub-Saharan African countries have not yet been studied in a systematic manner. However this has to be seen as a distinct entity as we argue in this paper. Our aim was to give an overview of the spectrum of clinical ethical issues and to understand what influences clinical ethics in the Sub-Saharan country of Gabon. MATERIALS AND METHODS: In-depth interviews with 18 health care professionals were conducted at three hospital sites in Gabon. Interview transcripts were analyzed using a grounded theory approach (open and axial coding), giving a qualitative spectrum of categories for clinical ethical issues. Validity was checked at a meeting with study participants and other health care experts in Gabon after analysis of the data. RESULTS: Twelve main categories (with 28 further-specified subcategories) for clinical ethical issues were identified and grouped under three core categories: A) micro level: "confidentiality and information", "interpersonal, relational and behavioral issues", "psychological strain of individuals", and "scarce resources"; B) meso level: "structural issues of medical institutions", "issues with private clinics", "challenges connected to the family", and "issues of education, training and competence"; and C) macro level: "influence of society, culture, religion and superstition", "applicability of western medicine", "structural issues on the political level", and "legal issues". DISCUSSION: Interviewees reported a broad spectrum of clinical ethical issues that go beyond challenges related to scarce financial and human resources. Specific socio-cultural, historical and educational backgrounds also played an important role. In fact these influences are central to an understanding of clinical ethics in the studied local context. Further research in the region is necessary to put our study into perspective. As many participants reported a lack of awareness of ethical issues amongst other health care professionals in daily clinical practice, we suggest that international organizations and national medical schools should consider infrastructure and tools to improve context-sensitive capacity building in clinical ethics for Sub-Saharan African countries like Gabon. ; peerReviewed

In spite of major coverage expansions under the Patient Protection and Affordable Care Act (ACA), a large proportion of immigrants will continue to remain outside the scope of coverage. Because various provisions of the ACA seek to enhance access, advancing knowledge about immigrant access to health care is necessary. The authors apply the well‐known Andersen model on health care access to two measures—one focusing on perceptions of unmet health care needs and the other on physician visits during the last year. Using data from the New Jersey Family Health Survey, the authors find that prior to implementation of the ACA coverage expansions, immigrants in New Jersey reported lower levels of unmet health care needs despite poorer self‐rated health compared with U.S.‐born residents. The article concludes with a discussion of the use of Andersen model for studying immigrant health care access and the broader implications of the findings.

AbstractThis article classifies 32 Organisation for Economic Co‐operation and Development (OECD) healthcare systems based on data from 2001 and 2007. It shows that European countries are clustered in different types of healthcare systems and that traditional typologies are only partially represented in the four types of healthcare systems identified in this study. Type 1 represents countries with low total health expenditure (THE), high public financing, and low out‐of‐pocket payment (OOP). In‐patient healthcare is higher and out‐patient healthcare lower than the OECD average. General practitioners (GPs) are paid by capitation, and patients' access to healthcare is strictly regulated. Type 2 represents countries with an average level of THE, high public financing, above‐average OOP, and high in‐patient and out‐patient healthcare. GPs receive a salary, and access regulation is strict. Type 3 is characterized by very low THE, low public financing, and very high OOP. Both in‐patient and out‐patient healthcare is well below average, and GPs are paid a salary. Type 4 includes systems with the highest THE, the highest public financing, and the lowest direct payments by patients. In‐patient healthcare is below the OECD mean and out‐patient healthcare is well above it. GPs are paid by fee‐for‐service, and most countries offer free choice of medical doctors. The clusters for the years 2001 and 2007 are quite robust. During this time period, THE increased, and patients' access to medical doctors has since become more regulated.