Bioethical Principles Research Articles

Nutritional, anthropometric characteristics and the probability of suffering disorders of eating behavior in classical dancers in four academies of the central department

Background: Eating behavior disorders (EDs) are mental health disorders characterized by pathological behavior towards food intake and an obsession with weight control, accompanied by distortion of the perception of body image. Methods: An observational, descriptive and cross-sectional study with a quantitative approach was carried out, which included 4 classical dance academies in the Central department, specifically classical dance dancers within the age range 12 to 18 years, whose parents signed an informed consent. Poorly completed surveys and male dancers were excluded. Sociodemographic data, eating and anthropometric characteristics, and the probability of having eating behavior disorders were analyzed using two scales, SCOFF and BULIT. The work regarding the bioethical principles of research to manage the personal data of the participants, only those data strictly necessary to solve the research objectives were taken. A formal letter was provided to the parents to confirm that their daughters could be part of the investigation. The study was presented to the Ethics Committee of the Universidad del Pacifico. Results: Of 91 female classical dancers surveyed, 17 (19 %) were 12 years old; 27 (30 %) are from Academy A; 89 % (n=81) do eat fruit; 86 % (n=78) vegetables; 100 % (n=91) consume meat; dairy products and derivatives 98 % (n=89); legumes it was obtained that 82 % (n=75) consume it; 88 % (n=80) consume sugary drinks; and in terms of the consumption of pure water, 60 % (n=55) make adequate consumption. For the anthropometric data, 43 % (n=39) weigh between 50 and 59.9 kg; 57 % (n=52) measure between 151 and 160 cm, 85 % (n=77) have adequate height, 70 % (n=64) of classical dance students are at risk of suffering behavioral disorders food according to the SCOFF scale; while 99 % (n=90) of the dancers do not present any risk of suffering from Bulimia Nervosa according to the BULIT scale. Conclusion: We conclude that classical dance dancers are likely to suffer from eating disorders, since this population is considered highly exposed, especially in the adolescent stage, since even today there is social pressure on the canon of beauty that they must achieve and sustain to be accepted and included.

Применение желточных антител птиц в медико-биологических исследованиях

Passive immunization, proposed by E. Behring, is still a sought-after treatment option using mammalian antibodies. This principle was developed by F. Klemperer in 1893, showing that antibodies that could inactivate the pathogen appeared in the egg yolks of chickens immunized with tetanus toxin. At this time, E. Behring, S. Kitasato, and other investigators studied the inactivating properties of mammalian sera, and an article by F. Klemperer on the transfer of active antibodies from chicken blood to egg yolk remained unattended. Only after the publication of the 3Rs principles by W.M.S. Russell and R.L. Burch in 1959, it was realized that the extraction of egg yolks from immunized birds was fully consistent with the principles of bioethics because the procedure was physiological and non-invasive. Researchers in many countries began to study the yolk immunoglobulins of birds of different species and use them in the diagnosis, therapy and prevention of human and animal diseases. The following species of birds are used for production of IgY-antibodies: chicken, quail, duck, goose, ostrich. Extraction of immunoglobulins from egg yolks of birds is not a difficult task. Many options for the isolation and purification of yolk immunoglobulins from different avian species have been described in the literature. IgY technology has attracted a lot of interest among researchers, especially in the last 10 years. In addition, advances in laboratory techniques and the application of other technologies in the field have resulted in IgY technology becoming more mature for industrial production of specific antibodies and commercialization of the process. Companies are emerging in many countries producing transovarian (yolk) antibodies against pathogens that cause dental caries, peptic ulcer, celiac disease and other diseases. IgY-technologies are a relatively new direction in immunology, based on the passive immunization technology of E. Behring, but it is not sufficiently appreciated in Russia. The replacement of mammalian IgG with avian transovarial IgY allows to develop commercially significant amounts of specific antibodies that do not cause side effects, expands the possibilities of passive immunization methods for the treatment of lesions caused by viruses, bacteria and toxins. This review describes the properties of IgY from different avian species and examples of their application in therapy and disease prevention.

Correlated interdependences of characteristics of carbohydrate metabolism and lipid profile and batokines levels in patients with coronary heart disease and obesity

Research of comorbid coronary heart disease (CHD) and obesity in recent years often rely on the study of inflammatory mediators, among which the first and foremost are batokines, in particular on fibroblast growth factor (FGF-21) and vascular endothelial growth factor A (VEGFa). The aim of our study was to determine the correlational interdependencies of indicators of carbohydrate metabolism and lipid profile and levels of batokines in the comorbidity of CHD and obesity. 70 people aged from 25 to 85 were examined with CHD on the background of obesity. The average age was (63.6±8.8) years. The research do not violate the principles of bioethics, which is confirmed by the conclusion of the Bioethics Committee of the Kharkiv National Medical University. All patients who participated in the study signed an informed voluntary consent. Based on the results of research probable direct strong correlations of total cholesterol (TC) with low-density lipoprotein (LDL) were determined (ρ=0.889; p=0.000); triglycerides (TG) with very low-density lipoprotein (VLDL) (ρ=0.810; p=0.000). The average strength of correlation was determined: glycosylated hemoglobin (HbA1c) with vascular endothelial growth factor A (VEGFA) (ρ=0.374; p=0.001); TC and LDL and AI (respectively ρ=0.615; p=0.000, and ρ=0.648; p=0.000); VLDL with atherogenic index (AI) (ρ=0.367; p=0.002). Probable direct weak correlations of blood glucose levels with TG (ρ=0.253; p=0.034) and VLDL (ρ=0.277; p=0.020) and VEGFA (ρ=0.225; p=0.061) were found; TG and VLDL with VEGFA (ρ=0.256; p=0.032 and ρ = 0.273; p = 0.022, respectively). Inverse interdependencies were recorded: medium strength – high-density lipoprotein (HDL) and AI (ρ=-0.583; p=0.000) and weak – hemoglobin levels with HDL (ρ=-0.251; p=0.036); HbA1c with LDL (ρ=-0.241; p=0.044); HDL with VLDL (ρ=-0.293; p=0.014). Keywords: comorbidity of coronary heart disease and obesity, batokines, FGF21, VEGFA.

IMPOSTORS AMONG FAMILY DOCTORS

Introduction. Human resources policy issues in medicine have always played a significant role in ensuring quality medical care for the population. Young specialists face high labor market demands and constant management pressure, without having ready adaptation strategies. The beginning of a success story is always challenging, and sometimes the impostor syndrome can have its influence. Persistent self-doubt leads to emotional exhaustion and the development of a cynical attitude towards others, which can further transform into burnout syndrome.
 THE AIM: To analyze the prevalence of the impostor phenomenon among young doctors in the field of “General Practice – Family Medicine” and explore potential correlations with burnout syndrome.
 MATERIALS AND METHODS. We conducted an anonymous cross-sectional survey of 27 young family doctors using The Clance Impostor Phenomenon Scale and Maslach Burnout Inventory Human Services Survey for Medical Personnel. The research procedure adhered to accepted moral norms, rights, interests, and personal dignity of the participants, in line with the principles of bioethics outlined in the Helsinki Declaration “Ethical Principles for Medical Research Involving Human Subjects” and the “Universal Declaration on Bioethics and Human Rights (UNESCO)”.
 RESULTS. All respondents demonstrated a certain level of impostor syndrome severity, which might be related to a shift in professional role – the transition from intern to independent practitioner – a family doctor. Every fourth intern already showed signs of emotional exhaustion and depersonalization, with 7% having developed burnout syndrome. It is not excluded that these changes are linked to working conditions and military actions on the territory of Ukraine.
 CONCLUSIONS. Nearly half of the respondents were categorized under intermediate burnout syndrome profiles (Overloaded, Ineffective, Detached), which can be corrected with timely identification and effective management. Without exception, all respondents exhibited various degrees of the impostor phenomenon. The impostor syndrome is closely related to emotional exhaustion (p=0.002) and depersonalization (p=0.000214) within the structure of burnout syndrome, allowing for the development of new correction approaches and optimization of burnout prevention strategies.

Clinical course of pro-oxidant processes in brain structures in rats under conditions of experimental hyperthyroxinemia in age-related dynamics

The search for a connection between changes in the indicators of the pro-oxidant system of brain structures and the thyroid gland as a target organ is an urgent issue. The goal is to investigate the features of the pro-oxidant system against the background of experimental hyperthyroxinemia and to evaluate the age-related changes of malondialdehyde and diene conjugates in brain structures. Among Wistar rats (n=50) intact animals ("control", Σ=20) and experimental animals (under simulated hyperthyroxinemia, Σ=30) were selected for observation. The principle of the model of experimental hyperthyroxinemia lies in the addition of levothyroxine in a dosage of 20 μg/day (manufactured by "Berlin-Chemie AG", Germany) in the form of tablets with subsequent grinding at 9 o'clock in the morning with food. On day 14, hyperthyroxinemia in the animals was found, while the thyroxine level in the peripheral blood was >10 μg/dL in the first 48 hours and further, being >25 μg/dL (the results were verified in the laboratory, confirmed by immunoenzymatic method with the participation of the "Humarlander" test system). After functional testing in rats, highly specific parameters (malondialdehyde, diene conjugates) in the cortex, trunk, and hippocampus were further recorded and evaluated. The humane treatment of animals is certified by the local protocol of the meeting of the commission of the Dnipro State Medical University No. 10 dated 21.06.2023, bioethical principles and rules are taken into account during the experimental research. In the presented work, the results of the biochemical method were used to discuss the importance of the pro-oxidant system at the stage of protection against manifestations of stress and anxiety. Functional dependence on the accumulation of intermediate and final products of lipid peroxidation in the structures of the brain during the study of the state of the pro-oxidant system was found; the age-related dynamics of the activity of malondialdehyde and diene conjugates from young to middle-aged rats under conditions of experimental hyperthyroxinemia was observed; age-related changes contribute to a certain depletion of the activity of pro-oxidant compounds in response to stress as a principle of nervous system protection.

中國內地新冠疫情防控新做法的儒家反思

LANGUAGE NOTE | Document text in Chinese; abstract also in English.
 2022年底，中國內地政府發佈了一系列政策，完成了新冠疫情防控從以＂政府”為主體的舊做法，到充分發揮＂家庭＋個人”主體作用的新做法的轉變。本文基於“仁愛”、＂公義”、＂誠信”及“和諧”等儒家生命倫理的四項基本原則，立足於防疫做法轉變過程中的行為主體，探討了防疫主體變化背景下的民派生活和健康保障問題、資源與財富分配公正問題、真實可靠資訊獲取問題、費用共擔與資源共用問題。本文認為，＂家庭＋個人＋政府”多主體協作防疫的實現是必然的；相較於防疫舊做法，新的防疫做法更加可持續。當下中國內地亟需加快恢復正常生產生活，緩解防疫主體變化對全社會帶來的＂陣痛”，與此同時總結經驗，為之後可能出現的疫情反復進行提前準備。
 In late 2022, the central government of China introduced a series of policies for the mainland as part of a comprehensive transformation of COVID-19 Pandemic Prevention and Control (PPC) from the traditional, government-centered approach to a novel approach that prioritizes individuals and families. Drawing upon the four fundamental principles of Confucian bioethics, namely “benevolence,” “justice,” “integrity,” and “harmony,” this paper examines the ethical challenges of safeguarding lives and health, ensuring a fair distribution of resources and wealth, obtaining accurate and reliable information, and openly sharing the costs and resources throughout this transformation in the PPC approach. By focusing on the key actors involved in the process, we propose that the shift from a government-centric to a collaborative “family + individual + government” approach is both necessary and sustainable. Accordingly, we advocate for accelerating the return to normal production and daily life to mitigate the societal “pain” associated with the transformation. Additionally, we urge the government to reflect on its previous experience and prepare for a possible pandemic recurrence.

Ethical concerns surrounding artificial intelligence in anatomy education: Should AI human body simulations replace donors in the dissection room?

The potential effects of artificial intelligence (AI) on the teaching of anatomy are unclear. We explore the hypothetical situation of human body donors being replaced by AI human body simulations and reflect on two separate ethical concerns: first, whether it is permissible to replace donors with AI human body simulations in the dissection room when the consequences of doing so are unclear, and second, the overarching ethical significance of AI use in anatomy education. To do this, we highlight the key benefits of student exposure to the dissection room and body donors, including nontechnical, discipline-independent skills, awareness and interaction with applied bioethics, and professional identity formation. We suggest that the uniqueness of the dissection room experience and the importance of the key benefits accompanying this exposure outweigh the potential and so far unknown benefits of AI technology in this space. Further, the lack of engagement with bioethical principles that are intimately intertwined with the dissection room experience may have repercussions for future healthcare professional development. We argue that interaction with body donors must be protected and maintained and not replaced with AI human body donor simulations. Any move away from this foundation of anatomy education requires scrutiny. In light of the possible adoption of AI technologies into anatomy teaching, it is necessary that medical educators reflect on the dictum that the practice of healthcare, and anatomy, is a uniquely human endeavor.

The ethics of using body mass index in in-vitro fertilization risk assessment.

In-vitro fertilization clinics across the world currently use the body mass index (BMI) to assess risk for and determine access to in-vitro fertilization (IVF); however, clinics vary widely in both setting specific BMI limits for access to IVF and articulating the reasons for their policies. Given that scholars have begun to question the usefulness of BMI for individual health risk assessment, it is striking that ethicists have not yet systematically evaluated the reasons given for using BMI in assessing individuals' risk in IVF treatments. In this paper, I provide the first systematic analysis of the chief arguments currently offered by IVF programs for using BMI as a criterion for risk assessment. Specifically, I articulate empirical concerns about the success of IVF in high-BMI patients, practical concerns about the ability of high-BMI patients to safely undergo procedures associated with IVF, and ethical concerns about the risk-to-reward ratio for high-BMI patients and their potential children. I advance a series of objections to those arguments, using empirical data regarding IVF procedures and analogies with other high-risk conditions including systemic lupus erythematosus, and science regarding the diagnosis of BMI-correlated comorbidities such as high blood pressure or diabetes to argue that BMI alone is not a reasonable criterion for risk assessment in IVF; moreover, the usage of BMI may involve unacceptable violations of the bioethical principles of justice and respect for autonomy. Instead, I hold that IVF programs should rely on more precise laboratory and clinical measurements to evaluate risk in IVF.

An Ethical Analysis Regarding the COVID-19 Pandemic Impact on Oral Healthcare in Patients with Mental Disorders.

During the COVID-19 pandemic, restrictive measures were imposed that significantly impacted the healthcare system in general, and the dental healthcare system in particular. The literature cites a possible association between mental and oral health, as psychiatric patients have decreased awareness of their oral health and, therefore, poor dental status. Moreover, several studies have found a positive association between SARS-CoV-2 infection and oral health conditions, as well as between SARS-CoV-2 infection and mental health status. This context generated multiple ethical dilemmas in the case of persons with mental health disorders who require dental treatment because they are more vulnerable in this respect. This article aims to analyze the ethical issues in dental care for patients with mental disorders concerning the COVID-19 restrictive measures. The ethical aspects involved here are the basic principles of bioethics and the related elements of accessibility, equity, consent, and confidentiality.

Healthcare Bioethics: A Vital Branch of Bioethics and a New Possible Pillar for Modern Healthcare Systems Strengthening Worldwide

Globally, all people deserve the highest level of respect for their dignity, rights, and health. Bioethics has been recognized as a powerful discipline that aims to ensure such respect. Fritz Jar (1895–1953) and Van Rensselar Potter (1911–2001) will remain heroic men who ushered in the existence of the discipline of bioethics. Bioethics has been recognized as the science of survival and a bridge to the future. Thus, bioethics aims to enrich people’s wisdom. Wisdom is the knowledge of how to use knowledge for human survival and improvement in the quality of life. Worldwide, all people must widely possess such knowledge. Unfortunately, after many years of existence, implementing the principles and goals of bioethics remains centralized and confined to academic fields. Due to its centralized status, few branches of bioethics have been recognized. Besides, both pre-standard and standard practices still exist in the field of bioethics. Healthcare bioethical principles have been mentioned in numerous publications. However, healthcare bioethics has not been recognized as a vital branch of bioethics. The lack of well-established healthcare bioethics hinders strategies for eradicating many of the ephemeral and heuristic approaches that are still obstructing the achievement of optimum health status for numerous people worldwide. Integrating bioethical principles in all healthcare sectors in decentralized manners would lead to the existence of healthcare bioethics. The purpose of this manuscript is to describe healthcare bioethics as a vital branch of bioethics with respect to its description, branches, core principles, functions, system components, and pre-standard and standard practices of healthcare bioethics.

The Sociotechnical Construction of Distrust during the Covid-19 Pandemic.

What were the impacts of the Covid-19 pandemic on trust in public health information, and what can be done to rebuild trust in public health authorities? This essay synthesizes insights from science and technology studies, information studies, and bioethics to explore sociotechnical factors that may have contributed to the breakdown of trust in public health information during the Covid-19 pandemic. The field of science and technology studies lays out the dynamic nature of facts, helping to explain rapid shifts in public health messaging during Covid-19 and reasons they produced a lack of trust in public health authorities. The information field looks at how facts are sociotechnically constructed through systems of classification, illustrating how extrascientific factors influence public health authorities. Putting these perspectives alongside bioethics principles raises additional factors to consider. The goal of this essay is to learn from past failures to point toward a brighter future where trust in public health authorities can be rebuilt, not on faith, but rather through striving for calibrated trust within which, through a virtuous circle, trust is validated.

Protecting the Autonomy of Patients with Severe Mental Illness Through Psychiatric Advance Directive Peer-Facilitation

Protecting the Autonomy of Patients with Severe Mental Illness Through Psychiatric Advance Directive Peer-Facilitation

Defending explicability as a principle for the ethics of artificial intelligence in medicine

The difficulty of explaining the outputs of artificial intelligence (AI) models and what has led to them is a notorious ethical problem wherever these technologies are applied, including in the medical domain, and one that has no obvious solution. This paper examines the proposal, made by Luciano Floridi and colleagues, to include a new ‘principle of explicability’ alongside the traditional four principles of bioethics that make up the theory of ‘principlism’. It specifically responds to a recent set of criticisms that challenge the supposed need for such a principle to perform an enabling role in relation to the traditional four principles and therefore suggest that these four are sufficient without the addition of explicability. The paper challenges the critics’ premise that explicability cannot be an ethical principle like the classic four because it is explicitly subordinate to them. It argues instead that principlism in its original formulation locates the justification for ethical principles in a midlevel position such that they mediate between the most general moral norms and the contextual requirements of medicine. This conception of an ethical principle then provides a mold for an approach to explicability on which it functions as an enabling principle that unifies technical/epistemic demands on AI and the requirements of high-level ethical theories. The paper finishes by anticipating an objection that decision-making by clinicians and AI fall equally, but implausibly, under the principle of explicability’s scope, which it rejects on the grounds that human decisions, unlike AI’s, can be explained by their social environments.

Patient benefit as a goal of humanization

Patient empowerment is one of the main pillars of humanisation. Therefore, considération of patients’ preferences and expectations should be taken into account during the practice of any healthcare professional. Improving overall survival and quality of life are the main wishes of patients. Indeed, the recent emergence of Patient Reported Outcomes has become an important focus for healthcare providers. The hospital pharmacist specialised in drug evaluation is a professional who evaluates the efficacy, safety, appropriateness and efficiency of treatments prescribed by physicians, and decision-making must be based on both technical factors and the four principles of bioethics. The correct application of evidence-based clinical practice allows to provide patients with increases in survival and/or quality of life, adapting the convenience and costs to the current situation. With this in mind, it could be said that the evaluation of medicines involves a strong commitment to humanisation. On the other hand, organisations that promote the rigorous evaluation and selection of medicines stand as allies of patients, as they have a direct impact on them and an indirect impact on society. Regulatory agencies in charge of approving and financing medicines in healthcare systems play a key role in the process of humanising clinical decision-making and empowering patients. If these agencies approve the use of new medicines based on data that do not measure quality of life or survival of patients when there are already other therapeutic alternatives for these pathologies, they are indirectly failing to meet patients’ expectations and are infringing bioethical principles. This can have a considerable influence on the benefit-risk ratio of drugs, and patients may be treated with regimens that do not provide benefit, or may even harm them. Therefore, where should the process of humanisation be oriented? It seems reasonable that the benefit of the patient should be the fundamental objective of the process of humanisation of healthcare, evidently.

Autonomy and bioethics in fan responses to Orphan Black.

Viewers' responses to Orphan Black (2013-2017), a popular, genetics-themed sci-fi television series, reveal much about public understanding of the ethical challenges associated with genetic science. In this article, we assess how fans of Orphan Black process the bioethical themes that are prominent in the show through an analysis of 182 viewer-created blog posts. Using a mixed methods approach, our findings reveal that Orphan Black's fans distill the essence of the show down to its characters' fight for autonomy. Furthermore, fan blogs reveal two notable pathways through which this bioethical principle is explored: gender and reproduction. Viewers draw striking connections between the moral problems they observe on screen in Orphan Black and those they see in the real world-both today and in a possible future-particularly as those problems affect women. While existing scholarship acknowledges these themes in the show itself, our approach demonstrates science fiction fans' active participation in meaning-making and bioethical reasoning and offers a novel approach to studying fan-generated content for public understanding of science research.

Stimulating the Uptake of Preconception Care by Women With a Vulnerable Health Status Through mHealth App-Based Nudging (Pregnant Faster): Cocreation Design and Protocol for a Cohort Study.

Women with a low socioeconomic status often have a vulnerable health status due to an accumulation of health-deteriorating factors such as poor lifestyle behaviors, including inadequate nutrition, mental stressors, and impaired health literacy and agency, which puts them at an unnecessary high risk of adverse pregnancy outcomes. Adequately preparing for pregnancy through preconception care (PCC) uptake and lifestyle improvement can improve these outcomes. We hypothesize that nudging is a successful way of encouraging engagement in PCC. A nudge is a behavioral intervention that changes choice behavior through influencing incentives. The mobile health (mHealth) app-based loyalty program Pregnant Faster aims to reward women in an ethically justified way and nudges to engage in pregnancy preparation by visiting a PCC consultation. Here, we first describe the process of the cocreation of the mHealth app Pregnant Faster that aims to increase engagement in pregnancy preparation by women with a vulnerable health status. Second, we describe the cohort study design to assess the feasibility of Pregnant Faster. The content of the app is based on the eHealth lifestyle coaching program Smarter Pregnancy, which has proven to be effective in ameliorating preconceptional lifestyle behaviors (folic acid, vegetables, fruits, smoking, and alcohol) and an interview study pertaining to the preferences of the target group with regard to an mHealth app stimulating PCC uptake. For moral guidance on the design, an ethical framework was developed based on the bioethical principles of Beauchamp and Childress. The app was further developed through iterative cocreation with the target group and health care providers. For 4 weeks, participants will engage with Pregnant Faster, during which opportunities will arise to earn coins such as reading informative blogs and registering for a PCC consultation. Coins can be spent on small fun rewards, such as folic acid, fruits, and mascara. Pregnant Faster's feasibility will be tested in a study including 40 women aged 18 to 45 years, who are preconceptional or <8 weeks pregnant, with a low educational level, and living in a deprived neighborhood. The latter 2 factors will serve as a proxy of a low socioeconomic status. Recruitment will take place through flyers, social media, and health care practices. After finalization, participants will evaluate the app through the "mHealth App Usability Questionnaire" and additional interviews or questionnaires. Results are expected to be published by December 2023. Pregnant Faster has been designed through iterative cocreation with the target group and health care professionals. With the designed study, we will test Pregnant Faster's feasibility. If overall user satisfaction and PCC uptake is achieved, the app will be further developed and the cohort will be continued with an additional 400 inclusions to establish effectiveness. DERR1-10.2196/45293.

COVID-19 IN NEWBORNS: OWN EXPERIENCE ON THE EXAMPLE OF CLINICAL CASES

Introduction. Currently, there is controversial information regarding the epidemiologic characteristics and severity of COVID-19 in pregnant women and newborns. Most researchers report the same severity of disease in pregnant and non-pregnant women, and a milder course of disease in the neonatal period, with the possibility of critical illness in some infants. Ideas about the possibility of transmission of SARS-CoV-2 to a newborn have changed. Since intrauterine transmission of the novel coronavirus is currently considered rare, COVID-19 in newborns is usually associated with postnatal transmission of the virus.The aim of the work was to analyze the epidemiologic and clinical features of the COVID-19 in newborns based on the analysis of clinical cases.Material and methods. On 2020, at the beginning of the COVID-19 pandemic, 11 newborns were admitted to the infectious diseases departments of Chernivtsi Regional Children's Clinical Hospital, 9 children were referred from home by a family physician, and 2 children were transferred from maternity care facilities. Diagnosis was confirmed by PCR-RT detection of SARS-CoV-2 RNA in nasal/oropharyngeal swabs.The research was conducted in accordance with the principles of bioethics, the conclusion of the Commission on Biomedical Ethics of the Bukovinian State Medical University on the observance of moral and legal rules for conducting medical-scientific research, Protocol No. 6 dated March 16, 2023.The research was carried out within the framework of scientific and research activity of the Department of Pediatrics and Infectious Diseases of Children of the Bukovinian State Medical University "Modern epidemiological, clinical-paraclinical and diagnostic features of the most common inflammatory infectious and non-infectious diseases in children", state registration number: 0122U002208.Results. The analysis of the epidemiologic data allowed to identify an intrafamilial source of infection in all identified cases (in one case the source of infection could not be identified), in most cases it was the mother, in one case the source of infection was the father and the grandmother. In most families there are older siblings who could serve as a potential additional source of infection, but respiratory symptoms in siblings were identified in one third of the families.In the late neonatal period, cases of horizontal virus transmission were characterized by mild symptoms of upper respiratory tract infection as acute nasopharyngitis, one case - as a mixture with secretory diarrhea. COVID-19 in another child was accompanied by acute gastroenteritis and moderate dehydration. The clinical picture of coronavirus infection in the remaining third of cases was characterized by lower respiratory tract infection as acute tracheobronchitis, acute obstructive bronchitis and bronchiolitis.Two infants were transferred from the maternity hospital after delivery because of COVID-19 maternal symptoms and SARS-CoV-2 RNA detection in the infants' nasal/oropharyngeal swabs on the first day of life. These children were asymptomatic with no clinical or laboratory evidence of an infectious-inflammatory process during observation.Conclusions. The presence of an exclusively family source of infection can be considered an epidemiological feature of COVID-19 in the neonatal period. In the case of horizontal transmission of the SARS-CoV-2 virus in newborns, the disease COVID-19 in most cases proceeds as mild upper respiratory tract infection, less often – as lower respiratory tract infection and/or secretory diarrhea. In the case of maternal COVID-19 disease before childbirth the vertical and/or antenatal infection mode and the subsequent asymptomatic neonatal COVID-19 cannot be denied.

Prenatal gender selection: medical, ethical and psychological aspects

The aim: to summarize the methodology of prenatal gender selection and the ethical aspects of its implementation.&#x0D; Materials and methods: the authors conducted the review in the database of scientific periodicals PubMed.&#x0D; Results: based on scientific publications, the principal techniques to determine sex in the pre-implantation period, in the embryo and fetus, are presented. Invasive and non-invasive procedures of prenatal diagnosis are described. Invasive procedures include examination of the fetus by chorionic villus sampling karyotyping of cells obtained by amniocentesis. Non-invasive techniques related to pregnant women's blood biochemistry and ultrasound markers of Down syndrome are given. Fetal blood DNA testing is a more sensitive diagnostic parameter that reduces the indication for invasive procedures. The newest and most effective method of sex determination in the pre-implantation period is sperm separation screening. Medical and non-medical reasons for prenatal gender determination, such as prevention of X-linked genetic disorders in a child, a couple's choice to balance the sex of children in the family and social gender preferences are shown. Gender selection for the prevention of X-linked disorders is justified. Ethical issues regarding the balance of children in the family, giving preference to certain sex with the help of advanced diagnostic techniques, and selective abortion are discussed. The bioethical principles for preventing selective abortion resulting from gender reasons are established.&#x0D; Conclusion: for preventing prenatal gender discrimination is highlighted more strongly by the need legal regulation and the ethical control of scientific technologies in reproductive medicine.

The Role of Step Therapy in the Treatment of Migraine.

This review examines recent evidence and applies bioethical principles to evaluate the benefits and risks of using step therapy in the treatment of migraine. With the CGRP mAbs, gepants, and lasmiditan now on the market for up to 5years, new research, including network meta-analyses and long-term use studies, can evaluate the comparative efficacy, tolerability, and adherence of these medications relative to older acute and preventive medications for the treatment of migraine. Deciding how medications are chosen for patients requires accounting for many factors including sustainability, efficacy, tolerability, and preference. Newer research can help give clarity on the appropriateness of gating certain treatment options behind others.

Nursing ethics as a distinct entity within bioethics: Implications for clinical ethics practice

The question of whether nursing ethics is a distinct entity within bioethics is an important and thought-provoking one. Though fundamental bioethical principles are appreciated and applied within the practice of nursing ethics, there exist distinct considerations which make nursing ethics a unique subfield of bioethics. In this article, we focus on the importance of relationships as a distinguishing feature of the foundation of nursing ethics, evidenced in its education, practice, and science. Next, we consider two objections to our claim of distinctiveness: first, that nursing ethics is merely an application of bioethical principles; second, that many bioethical subfields emphasize relationships. We respond by highlighting that throughout nursing education and generally in every career path that follows, the creation and nurturing of relationships is emphasized. Compassion and respect for the dignity of every patient is the framework upon which these therapeutic relationships are built. Much of the focus of nursing science rests on creating meaningful interpersonal experiences and human connection. After responding to each objection, we turn to the implications of this distinctiveness on clinical ethics practice, arguing that the strengths of our approach outweigh the limitations. The deep emphasis on creating meaningful interpersonal experiences and human connection supports a greater integration of relationships and social contexts into the evaluation of whether an action is ethically permissible, which is an important benefit in addressing the challenging human situations that patients face. Moreover, this perspective allows nurse ethicists to account for diverse and complex social structures and their influence in making ethical determinations. These strengths outweigh the limitations of potential inconsistencies between nurse and non-nurse clinical ethicists on the same service, a result we attribute to nursing ethics—and, in turn, the practice of the nurse ethicist—being framed by relationships to a larger extent than other bioethical subfields.