Wood dust exposure and the association with lung cancer risk

BACKGROUND: Wood dust was designated as a human carcinogen based on increased sinus and nasal cancer rates among exposed workers. However, data on an association with lung cancer have been inconclusive. METHODS: Self-reported wood dust exposure was compared between 1,368 lung cancer patients and 1,192 cancer-free adults, in a lung cancer case-control study. Epidemiological information was collected through a detailed personal interview. RESULTS: Using several definitions of wood dust exposure we consistently observed statistically significant elevated adjusted risk estimates; for example, the adjusted odds ratio (OR) for combined wood dust related occupations and industries was 3.15 (95% confidence intervals (CI) 1.45-6.86) and for an overall summary exposure measure it was 1.60 (95% CI 1.19-2.14). The association was maintained when stratified by histopathological type. Among those exposed to cigarette smoke and wood dust, 21% of the cases were attributable to biologic interaction. CONCLUSIONS: Wood dust exposure is a potential risk factor for lung cancer.     

Classification and coding of commercial fishing injuries by work processes: an experience in the Danish fresh market fishing industry

BACKGROUND: Work-related injuries in commercial fishing are of concern internationally. To better identify the causes of injury, this study coded occupational injuries by working processes in commercial fishing for fresh market fish. METHODS: A classification system of the work processes was developed by participation in fishing vessel trips where observations and video recordings of the work operations on board were collected. Subsequently the system was pilot tested using the Danish Maritime Authority injury reports. RESULTS: The developed classification system contains 17 main categories and up to 13 sub-categories of the work processes for each of the five different types of fishing. A total of 620 injury reports were reviewed and coded. Five percent (n = 33) of these were fatal injuries. The working processes were identified and coded according to the developed classification system for 553 (89%) injury reports: Danish seiner (n = 83), gill-netter (n = 122), beam trawler (n = 71), twin-trawler 2-T (n = 96), single/pair trawler 1-T (n = 181). Sixty-seven (11%) of the reports were unclassifiable due to lack of information. Preparing, shooting, and hauling of the gear and nets accounted for 50% of the injuries; they were most serious type of injuries such as fractures and sprains. Walking about the ship, in particular embarking and disembarking, climbing and descending ladders accounted for nearly one-fifth of the injuries. CONCLUSION: We found that the working processes related to working with the gear and nets vary greatly in the different fishing methods. Coding of the injuries to the specific working processes allows for targeted prevention efforts.     

Sexuality in the nursing home,part 2: Managing abnormal behavior-legal and ethical issues

Everyone, regardless of age, needs love, touch, companionship, and intimacy. The 1.6 million elderly in the 20,000 U.S. nursing homes are not an exception. The literature indicates that nursing home residents continue to have an interest in sexual activity regardless of age. Sexuality, however, is frequently overlooked by physicians and staff working with nursing home residents. Many staff members have only a vague understanding of the sexual needs of the elderly. This results in a perception of residents' sexual interests as behavioral problems rather than expressions of need for love and intimacy. Inappropriate sexual behaviors in the nursing home can create an intense burden for nursing home staff. This article discusses ways to dealing with inappropriate sexual behaviors in long-term care settings and the ethical issues involved.     

Ethical issues arising from a research, technology and development project to support frail older people and their family carers at home

The present paper provides an overview of the application of the key ethical issues which arose in an EU-funded research, technology and development project, Assisting Carers using Telematics Interventions to meet Older Persons' Needs (ACTION). The primary aim of the ACTION project was to support frail older people and their family carers in their own homes across England, Northern Ireland, the Republic of Ireland, Sweden and Portugal via the use of user-friendly information and communication technology. Ethical guidelines were developed in the project and used as a tool to enable the multidisciplinary project team to increase their awareness of ethical issues in their everyday work, and to act as a useful ethical framework for regular team discussions at international and local meetings across the partner countries. A range of ethical issues arose during the field-study phases of the project when the ACTION services were introduced into a number of families' own homes. It can be argued that these ethical issues reflect factors relating both to the application of research into practice, as well as those relating more directly to the use of new technology by families and care professionals. Key issues centre upon the ethical concepts of autonomy, independence, quality of life, beneficence, non-maleficence and justice, and more specifically, on ethical issues of security, privacy and confidentiality, increased expectations, and withdrawal of the service. This paper is intended to facilitate dialogue and debate in the area of enabling (assistive) technology in home care for older people and their families.     

The parturient woman: can there be room for more than ‘one person with full and equal rights inside a single human skin’*?

AIMS OF THE PAPER: The aim of the paper is to raise awareness around the legal and ethical issues involved in the enforcement of caesarean sections on non-consenting women. The paper considers the competing rights of mother and foetus in situations where a mother's wishes may result in harm or death to the foetus. BACKGROUND/RATIONALE: In this light of various court decisions about enforcing caesarean sections, the paper examines the pertinent legal and ethical issues, recognising that health professionals need to operate within an explicit legal and ethical framework. Content. The arguments about a woman's right to autonomous decision-making and a foetus' absolute right to life are examined with the focus throughout being on the legal framework. The need for health professionals to work within this as well as to avoid the temptation to base individual clinical decisions or professional behaviour on subjective moral judgements is emphasized. The attitudes of the judiciary are considered along with recent legal developments. There is an analysis of the way in which established legal principle is sometimes circumvented to override a woman's right to autonomy. The part played by lawyers and health professionals in denying a woman's competence to consent in order to achieve an outcome of which they approve is critically appraised. The basis for the decisions in these cases is deconstructed, along with a discussion of the role of health professionals in contributing to the dilemmas highlighted. CONCLUSION: It is essential that nurses or midwives caring for pregnant women have a full understanding of the legal and ethical issues surrounding this complicated and emotive area and where they, as health professionals, fit within this. The subject matter is also a useful arena for debating such ethical and legal issues as capacity and competence to consent as well as the extent of the right of any patient to full autonomy.     

The relationship between the application of the nursing ethical code and nurses' work satisfaction

Work satisfaction is known to be one of the major factors related to nurses' quality of care. Being able to apply the professional principles of training influences work satisfaction. The nursing ethical code is a good manifestation of these professional principles. The everyday strains on nurses' work might compromise the amount of energy invested in following the ethical code. The gap between the ethical requirements (as perceived by the nurse) and the perceived extent to which they are applied will influence work satisfaction through the mediating effect of role conflict. Demographic variables including age, tenure and number of children might also exert an effect. Structured questionnaires were used to measure the perceptions of nurses regarding their ability to follow the ethical code in a large hospital in Israel. Practical considerations meant that the questionnaire focused on client privacy issues in the ethical code. Results support the mediating hypothesis as the 'ethical gap' did not correlate directly with work satisfaction. This paper highlights that professionalization, manifested by the ethical code, should be applied on an everyday basis in the workplace.     

Moral deliberation: the role of methodologies in clinical ethics

The experience of the last thirty years has shown that whether the different methodologies used in clinical ethics work well or not depends on certain external factors, such as the mentality with which they are used. This article aims to analyze two of these mentalities: the “dilemmatic” and the “problematic.” The former uses preferably the decision-making theory, whilst the latter emphasizes above all the role of deliberation. The author considers that Clinical Ethics must be deliberationist, and that only in this context the different methodologies can be used correctly. This revised version was published online in July 2006 with corrections to the Cover Date.     

医患和谐需要"双向道德规范"

医患关系的特殊性,决定了协调医患关系需要双向道德规范。而对这一问题的探讨,不仅引发了人们思考特殊领域里人际伦理关系协调的双向性特点。而且也从一般意义上凸显了当前双向伦理规范研究的必要性和迫切性。     

后基因组时代生命科学发展的社会伦理思考

随着后基因时代的到来，生命科学必须取得巨大进展，同时不可避免地面临一些社会伦理问题，本文着重从遗传工程与基因歧视、基因诊断与基因检查知情权及知情同意权的原则、基因治疗基因决定论以及基因争夺战等几个方面涉及到的社会伦理问题加以阐述。     

Mild cognitive impairment: Conceptual,assessment, ethical,and social issues

Mild cognitive impairment (MCI) is defined as a condition characterized by newly acquired cognitive decline to an extent that is beyond that expected for age or educational background, yet not causing significant functional impairment. The concept of MCI has received considerable attention in the literature over the past few years, and aspects related to its definition, prevalence, and evolution have been extensively studied and reviewed.Here we attempt to synthesize the implications of the current status of this entity, focusing on the conceptual, methodological, and, in particular, the social and ethical aspects of MCI which have attracted less attention. We discuss the weaknesses of the concept of MCI, which is heterogeneous in etiology, manifestations, and outcomes, and suggest that the emergence of the syndrome at this stage reflects industrial interests related to possible development of drugs for this disorder. On the other hand, the formal diagnosis of MCI, with its implications that the person may develop dementia, may have a grave impact on the psychological state of the individual, at a stage when prediction of outcome is tenuous and possibilities of useful interventions are meager. We present suggestions for the direction of future research in these areas.