Health Outcome Prioritization in Alzheimer's Disease:Understanding the Ethical Landscape

Objective: Health outcome prioritisation is the ranking in order of desirability or importance of a set of disease related objectives and their associated cost or risk. We analyse the complex ethical landscape in which this takes place in the most common dementia, Alzheimer’s disease. Background: Dementia has been described as the greatest global health challenge in the 21st century on account of longevity gains increasing its incidence, escalating health and social care pressures. These pressures highlight ethical, social, political challenges about healthcare resource allocation, what health improvements matter to patients, and how they are measured. This study highlights the complexity of the ethical landscape, relating particularly to the balances that need to be struck when allocating resources; when measuring and prioritising outcomes; and when individual preferences are sought. Methods: Narrative review of literature published since 2007, incorporating snowball sampling where necessary. We identified, thematised and discussed key issues of ethical salience. Results: Eight areas of ethical salience for outcome prioritisation emerged: (1) Public health and distributive justice, (2) Scarcity of resources, (3) Heterogeneity and changing circumstances, (4) Knowledge of treatment, (5) Values and circumstances, (6) Conflicting priorities, (7) Communication, autonomy and Caregiver issues, (8) Disclosure of risk. Conclusion: These areas highlight the difficult balance to be struck when allocating resources, when measuring and prioritising outcomes, and when individual preferences are sought. We conclude by reflecting on how tools in social sciences and ethics can help address challenges posed by resource allocation, measuring and prioritising outcomes, and eliciting stakeholder preferences.</p

Employment factors associated with opioid misuse and opioid use disorder

The Drug-Free Federal Workplace, implemented in 1986 via Federal Executive Order 12564, required all federal agencies to implement drug free workplace programs featuring drug testing and punitive zero tolerance policies, dealing with substance use disorders (SUDs) as a disciplinary issue. This has led to stigmatizing workers with SUDs, subjecting them to discriminatory and differential treatment by supervisors and peers and fear of job loss or suspension from workers who test positive on a drug test. These drug-free workplace policies treat SUDs as primarily a discipline problem and do not recognize that opioid use disorder is a chronic recurring brain disease that requires access to treatment and recovery resources. Worksite programs that are punitive and stigmatizing may not foster a culture where workers are comfortable coming forward for help or care. No existing study has explored the relationship between workplace testing and drug policies with the prevalence of opioid use and other worker factors (e.g., psychological distress, adult depression, etc.)

Influence of milling on the nutritional composition of bran from different rice varieties

The nutritional composition of bran from four rice varieties namely, Jyothi/IR64, Basmati and Agonibora representing high amylose, intermediate amylose and waxy, respectively were evaluated with friction and abrasive mills at different degrees of milling (DOM). Fat and protein content of the bran inversely correlated to amylose content of rice variety. The fat and fibre contents reduced with increased DOM due to increasing starch influx from the endosperm. Abrasive milling produced bran with higher protein content and total dietary fibre, resulting in superior quality bran, while friction milling led to higher fat. Agonibora bran was found to be superior in terms of nutritional quality. Industrial milling resulted in higher protein content in bran, and Jyothi variety had a better amino acid profile

Multinational evidence-based World Association of Sarcoidosis and Other Granulomatous Disorders recommendations for the use of methotrexate in sarcoidosis: integrating systematic literature research and expert opinion of sarcoidologists worldwide

Item does not contain fulltextPURPOSE OF REVIEW: Although glucocorticosteroids are considered the first-line treatment in sarcoidosis, refractory cases require alternatives, such as methotrexate (MTX). The aim of this study was to develop, on behalf of the World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG), multinational evidence-based recommendations for the use of MTX in sarcoidosis for routine clinical practice. RECENT FINDINGS: A systematic literature search was conducted and combined with the opinions of sarcoidosis experts worldwide to formulate the recommendations. An online survey concerning 10 clinical questions was sent through the WASOG newsletter to sarcoidosis experts. Agreement about the recommendations amongst the world's leading sarcoidologists was evaluated. A total of 237 articles were identified, 43 of which were included. Randomized controlled trial evidence supporting the use of MTX in sarcoidosis was limited. Forty-five per cent (113 of 250) of the sarcoidosis experts contacted completed the survey (Europe 55%, North America 26% and Asia 12%). Ten recommendations were formulated concerning the indications for use, starting dose, folic acid, work-up, contraindications, monitoring, administration options in case of adverse gastrointestinal effects, hepatotoxicity, long-term safety and use during pregnancy and breast feeding. SUMMARY: Ten multinational evidence-based recommendations for the use of MTX in sarcoidosis were developed, which are supported by the world's foremost sarcoidosis experts