Health literacy is not only the ability to read, but also the ability of an individual to obtain, process, and understand the basic health information needed to make appropriate health decisions. Over time the concept of health literacy has evolved from considering it a risk factor to be managed to considering it an asset which can be continually built upon. With this in mind health professionals should continue to communicate in simple language, but should also provide their patients with high-quality educational materials and aid them in making the best choices about their health. One way to do this could be with the use of symptom-checking and decision-aiding smartphone apps. In this study, the primary caretakers of children aged 30 months and younger with publicly funded health insurance will be randomized to receive a pediatric symptom-checking smartphone app or a developmental milestone smartphone app. Caretaker health literacy will be measured, and data will be collected on emergency department and primary care office sick visits. It is hypothesized that the use of the pediatric symptom-checking smartphone app will decrease non-urgent visits to the pediatric emergency department. / Urban Bioethics

When looking at the natural course of life, death is the natural conclusion. Majority of the time, people do not choose when and how they die. Death and dying are topics that are difficult to discuss for many individuals. However, when one decides to choose the context of their death, it raises many ethical considerations. Psychiatry, as a field, looks at the psychodynamics of death and dying for individuals. It is also poised to comment on the growing use of physician-assisted suicide and euthanasia for psychiatric disorders. Through a review of the literature, theories in psychiatry regarding the dying process are used to better understand an individual's choice for choosing euthanasia as a medical intervention to end their suffering from a long-standing psychiatric illness. The use of palliative care in conjunction with psychiatry is also explored. / Urban Bioethics

Adverse childhood experiences, known as ACEs, have been shown to negatively impact an individual’s health as an adult. While efforts to decrease children’s exposure to these traumatic experiences are beneficial, they are not able to fully eliminate these experiences and do not address how to help children who have already been exposed. Resilience, which has been defined as managing and adapting to significant sources of trauma, has been thought to be a protective factor against the toxic stress of ACEs. While the relationship between ACEs and poor health outcomes has been established, the relationship between resilience and health outcomes is largely unknown.  This study seeks to determine the association between resilience scores on a validated resilience questionnaire and health outcomes in adolescents. Looking specifically at body mass index, blood pressure, and depression scores on a validated depression screen we hypothesize that higher resilience scores will be associated with better health outcomes. In addition, we examine the relationship between ACE scores and resilience scores. If this validated resilience instrument is able to help predict health outcomes, this can direct development of intervention programs to build resilience in those living in ACE-heavy environments. / Urban Bioethics

The thesis begins by examining the history of the newborn screening (NBS) process in the United States and why it is the way it is today. The next section explores why certain genetic conditions, such as Long QT Syndrome (LQTS), do not fulfill requirements for the recommended uniform screening panel (RUSP). Lastly, ethical considerations of expanded NBS in the age of genomic technology are examined by highlighting the principles of autonomy, beneficence, equity, cost-effectiveness, privacy and trust. Overall, the NBS process benefits children by identifying serious rare diseases and intervening early to prevent harm; however, a deeper ethical analysis highlights some of the concerns with expanding mandatory, universal NBS in the age of precision medicine. The focus must be on educating the public and healthcare professionals about the NBS process and using evidence-based protocols for adding new conditions to the panel. / Urban Bioethics

Correctional populations account for about 2% of persons in the United States, who have a unique right to health care guaranteed by the Constitution per court decisions. However, the quality and breadth of this care is not standardized, and incarceration itself creates risk factors for one’s health. A review of the literature was done to evaluate the health and access to care of prison populations. Prison populations are largely minorities from poor neighborhoods with low socioeconomic status who usually have limited engagement with health services prior to incarceration; there is a large amount of morbidity of chronic diseases in prisons, and prisoners are at increased risk for communicable diseases, substance abuse and mental illness. Former inmates are also at increased risk of death following release. While advances such as telemedicine help to bridge the gaps in correctional health, more research needs to be done to assess the needs of this population, and more education and linkage to care should be accomplished to do right by these populations and ensure they get the care they need. This will in turn lead to better health outcomes in this population and may have a beneficial effect on the communities from which these prisoners come. / Urban Bioethics

While death is surely inevitable, the timing and circumstances of our deaths may vary widely and are likely to be negotiable in response to the changing needs of patients and families for physical, emotional and spiritual support as their diseases and illnesses evolve. Patients and families need to become aware of specific care options and supports that are available for them so they can be accessed in order to achieve their own “good death”. The professional health care team is obliged to assist patients and families become knowledgeable about potentially appropriate resources to assist them to become more comfortable with their roles thus more effectively supporting the patient as well as each other. Through literature review and interviews with diverse stakeholders, I will explore what a good death means from the divergent perspectives of patients, families and the clinicians who provide care for hospitalized dying patients. / Urban Bioethics

Research has long shown that breastfeeding provides many concrete health benefits for both mothers and infants that other forms of infant feeding do not. As such, unsurprisingly, breastfeeding has been deemed the preferred infant feeding method by the national and global medical communities and widespread initiatives promoting breastfeeding have followed. However, despite being well-intentioned, messaging around breastfeeding has left some people who cannot or choose to not breastfeed feeling othered and inadequate. While the health benefits of breastfeeding should not be understated, there are other experiences and perspectives that deserve to be in the conversation when thinking about breastfeeding and breastfeeding promotion. This thesis seeks to analyze breastfeeding and breastfeeding promotion from a bioethical perspective, providing an alternative lens through which to think critically about the way breastfeeding recommendations and initiatives are impacting real people. In this thesis, I will discuss the history of breastfeeding in the United States, why breastfeeding has come to be the gold standard of infant feeding, and real-life experiences of breastfeeding. I will also analyze breastfeeding, breastfeeding messaging, and current breastfeeding initiatives through the four principles of bioethics: beneficence, maleficence, autonomy, and justice. Lastly, I will offer my view and recommendations on how to incorporate bioethical perspectives into breastfeeding promotional strategies to create a more effective, inclusive, and supportive breastfeeding culture at the individual, community, and national level. / Urban Bioethics

abstract: Advocacy groups work across many aspects of “death with dignity” practice and treatment, and provide insight across multiple aspects of “death with dignity”. This study argues that key advocacy groups in the American death with dignity movement influenced the broader conceptualization of death with dignity in a way that makes patients more able to achieve it. This influence has been a dynamic process across different periods of practice starting the discussion of “death with dignity” in 1985 through today, although this thesis extends only to 2011. The question in this study is how do the three main historical advocacy groups in the US: the Hemlock Society, Compassion in Dying, and Compassion and Choices, conceptualize death with dignity with regards to patient and doctor relationship, legal and policy factors, and medical technologies and protocols? This study found that the Hemlock Society (1980-2005) characterized death with dignity as a terminally ill patient being able to “self-deliver” from suffering via autoeuthanasia regardless of medical community approval or legality. Compassion in Dying (1993-2007) characterized death with dignity as involved advocacy work with terminal patients and their communities to pursue palliative care and hospice up to the point of assisted death. This organization was also involved in the passing of Oregon Death with Dignity Act. Compassion and Choices (2007-present) characterized death with dignity similarly to Compassion in Dying but also advocated for adequate management of pain and suffering symptoms in palliative care to prevent people from desiring death over the illness. Conceptualizing death with dignity is important for understanding why patients want death with dignity and better accommodating their end of life needs when they are suffering with terminal illness. / Dissertation/Thesis / Masters Thesis Biology 2019

No description available.

Background: Therapeutic misunderstanding (TMU) and its three facets: therapeutic misconception, therapeutic misestimation, and therapeutic optimism have been identified as major challenges to the ethical conduct of clinical research and obtaining informed consent from research participants. However, the prevalence of TMU among clinicians and researchers has not been explored. Since most physicians will be exposed to clinical research over the course of their career, the understanding of clinical research procedures is important. In this study we attempted to determine the prevalence of TMU among medical students: future clinicians. Methods: Twenty-two BUSM undergraduate medical students took part in a two-part, survey evaluating the prevalence of therapeutic misunderstanding using "The Therapeutic Misunderstanding Scale". The attitudes of the students towards increasing the exposure to clinical research topics through the medical school curriculum were also determined. Results: The majority of the medical students exhibited therapeutic misunderstanding, particularly in the area of therapeutic misconception. In particular, the misunderstanding the difference between evidence-based clinical care versus hypothesis driven clinical research was exhibited. Although there was strong agreement that education in clinical research and clinical research ethics was important, the participants though increases of clinical research topics in the curriculum was not needed. Conclusions: The increased prevalence of TMU among future physicians underscores the need to teach clinical research and research ethics. Further research on a larger sample needed to validate the findings.