COVID-19 intensified ethical tensions between clinicians' duty to care and self-protection amid PPE shortages. We explored frontline healthcare professionals' perspectives in Maputo, Mozambique. Semi-structured interviews with healthcare professionals at four hospitals (April-June 2022) were recorded in Portuguese, transcribed, and thematically analyzed. Fixed-response items were captured in REDCap and summarized descriptively. Fifty-three respondents described varied perspectives on duty. Nearly half affirmed unconditional obligations grounded in professional ethics. Many framed duty as contingent on available PPE and institutional support; 8% were unsure. Themes included irregular PPE distribution, unequal training, and reliance on informal information, shaping perceived risk, preparedness, and responsibility. Quantitative summaries echoed these patterns: only 58% reported receiving training, and as PPE re-supply declined many felt exposed. Sustaining duty to care in resource-constrained settings during an outbreak requires reliable PPE provision, equitable and timely training, and trustworthy communication systems to protect workers and strengthen health-system resilience. Sustaining duty to care in resource-constrained settings during an outbreak requires reliable PPE provision, equitable and timely training, and trustworthy communication systems to protect workers and strengthen health-system resilience.

Concerns about weight gain are commonly cited with combined oral contraceptive pill (COCP) use, yet it remains unclear whether perceived weight gain as a reason for discontinuation differs by body mass index (BMI). We analyzed data from the 2017-2019 National Survey of Family Growth (NSFG), including 3709 non-pregnant women aged 20-49 years who had ever used COCPs and had BMI calculated from self-reported height and weight. Trained NSFG staff interviewed participants on reasons for discontinuation and coded them into predefined categories, including weight gain. Discontinuation was examined by BMI category (underweight, normal weight, overweight, obesity) using survey-weighted logistic regression adjusted for demographic and socioeconomic covariates. Overall, 35.2% (95% CI 32.3-38.1%) of women reported discontinuing COCPs due to dissatisfaction, with 20.2% (95% CI 18.1-22.3%) citing side effects. Weight gain was reported by 7.0% (95% CI 5.6-8.4%) of ever-users, with higher prevalence among women with overweight (8.4%) and obesity (7.7%) compared with normal-weight women (5.5%). In adjusted analyses, women with overweight (aOR 1.76, p = 0.048) and obesity (aOR 1.68, p = 0.033) had higher odds of COCP discontinuation due to self-reported weight gain. These findings highlight the importance of addressing weight-related concerns during contraceptive counseling, particularly for women with higher BMI.

Mozambique has a robust HIV control program and currently conducts HIV vaccine trials. One measure of a vaccine's success is development of antibodies, the vaccine-induced seropositivity(VISP). This study assesses the understanding and practices regarding VISP from trial participants and healthcare providers, as well as ethical challenges encountered during the informed consent. We conducted in-depth, semi-structured interviews using open and closed-ended questions with three categories of participants: healthcare professionals [n = 26], researchers [n = 5] and trial participants [n = 20]. For qualitative data, content analysis was performed and thematic axes were assigned. For quantitative analysis, descriptive analysis was performed. Trial participants had a better understanding of VISP's implications than front-line healthcare professionals. 53.8% healthcare professionals interviewed, stated that they would test the trial participants using an HIV rapid test, and initiate antiretroviral therapy immediately if positive. VISP may result in HIV misdiagnoses for trial participants when its broader pratical implications are not well understood.

Background:Strokes are a leading cause of death and disability among African Americans in the United States. Biological markers to predict stroke remain elusive; thus, our objective was to investigate whether inflammation, as measured by high-sensitivity C-reactive protein (hs-CRP), was associated with stroke incidence among African Americans enrolled in the Jackson Heart Study (JHS). Methods:Baseline hs-CRP levels were categorized in quintiles: quintile 1 (0.0084 mg/L); quintile 2 (0.0085-0.0189 mg/L); quintile 3 (0.0190-0.036 mg/L); quintile 4 (0.037-0.0675 mg/L); quintile 5 (≥0.0676 mg/L). Nonfatal stroke incidence was ascertained from passive community surveillance through annual phone calls and adjudicated via hospital records. At baseline, stroke risk factors/covariates were compared across quintiles using a one-way analysis of variance and a chi-square test. The association between baseline hs-CRP levels and stroke incidence was determined using a Cox regression analysis to estimate hazard ratios (HRs) and 95% confidence intervals (CI). Results:In the unadjusted model, hs-CRP levels in quintile 2 (HR, 1.48; 95% CI, 0.96-2.29), quintile 3 (HR, 1.44; 95% CI, 0.93-2.24), and quintile 4 (HR, 1.09; 95% CI, 0.68-1.74) were not associated with stroke incidence when compared with quintile 1 (reference). However, individuals within quintile 5 (HR, 1.78; 95% CI, 1.17-2.72) exhibited a significantly increased risk for stroke compared with those in the reference quintile. This risk persisted after adjusting for stroke risk factors (demographics, anthropometrics, health condition covariates, health behavioral risk factors, and cardiovascular disease history) for quintile 5 (HR, 1.87; 95% CI, 1.17-2.98) compared with reference quintile 1. Conclusions:An increased and independent risk of nonfatal stroke appears at the highest quintile of hs-CRP values (≥0.0676 mg/L) among JHS participants.

INTRODUCTION:A novel Graduate Training and Education Center (GTEC) under the National Institutes of Health funded Jackson Heart Study (JHS) at the University of Mississippi Medical Center (UMMC) was launched for doctoral students from backgrounds underrepresented in biomedical sciences. UMMC GTEC supports scholars through a program in cardiovascular epidemiology with research training institutes, scientific mentoring, and participation in professional coaching. This manuscript describes the program's origins, features, and evaluation findings, and discusses the feasibility and limits of complementary research training and mentoring to enhance the biomedical research workforce. METHODS:A program evaluation framework was used to describe the processes, outcomes, and lessons learned. Data from program graduates were synthesized using a convergent parallel design. RESULTS:Between 2021 - 2024, 22 scholars graduated from UMMC GTEC, all of whom were from groups characterized by the National Science Foundation as underrepresented in biomedical research in the United States. There was evidence of convergence between the qualitative themes with eight quantitative measures to support the findings of significant increases in self-efficacy for science communication, varying changes in career outcome expectations, and no significant changes in science identity. Five findings diverged on career interests and mentor influence. Five scholars (22.7 %) submitted their UMMC GTEC project manuscripts to a peer-reviewed journal, four (80.0 %) of which have been published. Fifteen of 22 scholars (68.2 %) submitted abstracts for presentation at national conferences. DISCUSSION:The feasibility of peer-reviewed publication during the training program was low but the submission of conference abstracts from completed projects was high. Mentors worked effectively with each scholar, and the program contributed positively to the number of next generation cardiovascular epidemiology researchers in Mississippi.

This article reviews contemporary issues in telepsychiatry and telepsychotherapy. The authors examine ethics within a larger social context, particularly access to care and cost of care. They consider the evolving scientific validation of telepsychiatry and the ethical significance of telepsychiatry in various practice settings. They also focus on the doctor-patient relationship, assessments, and provision of psychiatric treatments such as medication management and psychotherapy. The authors consider concerns about malpractice liability and medicolegal constraints on telepsychiatry. They do not address artificial intelligence in virtual mental health care, nor online communications outside the clinical encounter (eg, social media, email).

This article reviews the development and evolution of Fogarty International Center-funded research ethics training programs in West Africa over the past decade. In response to local and global challenges in bioethics and biomedical research, these programs are fostering ethical awareness, shaping local and national ethics review systems, and enhancing bioethics capacity in the region. These efforts have expanded alongside increased democratic governance, technological advances, and significant increases in global research funding and international research collaborations, particularly related to HIV/AIDS and malaria. We believe that the West Africa Bioethics (WAB) Training Program in Nigeria played a central role in this growth, serving as a model for subsequent programs in Ghana, Mali, and The Gambia. This paper describes the nature, successes, and challenges of these programs. It also outlines an agenda and strategies for future work to enhance research ethics and bioethics capacities in the region, both in terms of education and governance.

Research integrity remains a challenge to public trust in science around the world. Retracted scientific papers can erode the public's trust by raising doubt about the reliability of the published literature. This paper assesses article retractions involving Mexican authors through analysis of relevant data and retraction patterns. The study examines 55 retracted articles with Mexican corresponding authors, categorizing them by publication venue, article type, scientific area, reasons for retraction, and time between publication and retraction. The findings underscore core challenges to research integrity in Mexico and the need to strengthen both research training and research integrity initiatives in Mexican research institutions. The paper concludes with recommendations for contextually relevant strategies for Mexican academia to foster research integrity.

Ten years have passed since the last regional assessment of the state of Fogarty International Center-funded research ethics education and challenges facing research ethics in Latin America and the Caribbean basin. Program directors and faculty from four international research ethics education programs met in Spring 2024 to discuss their progress, challenges, and future priorities. The themes that emerged from these discussions were the structural difficulties faced by regional ethicists, the use of pedagogical innovations to mitigate different barriers faced by fellows, and the need to anticipate future challenges for the region including climate change.

Background Left ventricular mass (LVM) is suggested to be a sensitive predictor of adverse cardiovascular outcomes, such as heart failure. In recent years, genome-wide association studies have discovered loci that associate with outcomes related to LVM, providing an opportunity for the development of genetic risk scores. However, the relevance of these genetic variants to non-European ancestry groups requires additional testing. Here, we examined if variants that have been associated with heart failure and LVM in multi-ancestry populations are associated with LVM among African American individuals in the Jackson Heart Study (JHS).Methods Heart failure and LVM associated variants were identified from two published multi-ancestry studies. Two polygenic risk scores (PRSs) were computed for 2175 African American participants (mean age 53, 63% female). We assessed the linear association of both PRSs with LVM indexed to height (LVMh) and indexed to body surface area (LVMbsa) and fit a multivariate general linear model to LVM containing both PRS and covariates (age, sex, body mass index (BMI), diabetes and hypertension). Type III MANOVA Pillai tests were run to assess the effects of the PRS on the log LVM values.Results Linear correlation analysis showed positive associations between age and LVMh (r=0.278) and LVMbsa (r=0.296) as well as BMI with LVMh (r=0.320). A strong linear correlation was observed between LVMh and LVMbsa (r=0.894). Elevated LVM among individuals with diabetes and hypertension was observed. When accounting for age, sex, BMI, diabetes and hypertension, we found insufficient evidence to suggest that the heart failure PRS affected either measure of LVM; the same can be said for the LVM PRS.Conclusion We find insufficient evidence to suggest that heart failure and LVM genetic variants derived from predominantly European multi-ancestry populations are linearly associated with log LVM among African American participants in the JHS.

BACKGROUND:Initiatives in responsible conduct of research (RCR) have often been ineffective, since they are based on several problematic assumptions. These include that (1) integrity issues in biomedical research serve as paradigm cases for those in research in general, (2) the primary cause of research misconduct is individual researchers' behavior, (3) educational interventions alone can prevent research misconduct, and (4) RCR can be addressed at the level of institutions. However, the research ecosystem comprises various partners, including funding agencies, research institutions, professional societies, and accreditation bodies. METHODS:This study employs a review of literature and critical reflection to analyze how partners comprising the research ecosystem shape research environments, making policy recommendations on that basis. RESULTS:Research misconduct should be understood as resulting from misaligned incentives throughout the research ecosystem. Just as institutional cultures shape individuals, the policies of partners comprising the research ecosystem shape institutional cultures. An ecosystems approach to RCR consists in understanding how partners comprising the research ecosystem depend on each other, using these relations to ensure each holds the others accountable to promote the production of valid and reliable research. CONCLUSION:Viewing RCR through an ecosystems lens highlights the need for coordinated accountability among research partners.

Public trust in government agencies plays an important role in the formation of public opinion about public policy issues. However, the association between public trust in regulatory agencies and public support for policy development in emergent biotechnologies such as gene drive is not well understood. The United States Department of Agriculture (USDA), the Food and Drug Administration (FDA), and the Environmental Protection Agency (EPA) are tasked with coordinating and regulating biotechnology. Drawing on past literature, this study examines how public trust in these federal agencies is associated with public opinion on various options for gene drive policy. Using data from a nationally representative public opinion survey (n = 1220) conducted in 2021, our statistical analyses show that respondents who report higher levels of trust in regulatory agencies are more likely to support policy proposals that promote gene drive research and ultimately, may lead to regulatory policies that allow gene drive to be researched and employed to manage agricultural pests, establishing a pathway for scientists, developers, producers, and consumers alike to realize the benefits of this technology.

OBJECTIVE:The primary objective of this study was to determine whether Healthy Eating Index (HEI) and Alternative Healthy Eating Index (AHEI) scores were associated with incident metabolic syndrome. DESIGN:This study is a secondary analysis of data from the Jackson Heart Study. HEI and AHEI scores were divided into quintiles and Cox proportional hazards regression models were analysed for 1864 African American adults free from metabolic syndrome at Exam 1 to examine the incidence of metabolic syndrome by quintile of dietary quality score. SETTING:Hinds, Madison and Rankin counties, Mississippi, USA. PARTICIPANTS:African American adults, ages 21-94 years, 60·9 % female. RESULTS:Over a mean follow-up time of 6·7 years, we observed 932 incident cases of metabolic syndrome. After adjusting for multiple covariates, a higher HEI score at Exam 1 was not associated with the risk of incident metabolic syndrome, except when looking at the trend analysis for the subgroup of adults with two metabolic syndrome components at Exam 1 (P-trend = 0·03). A higher AHEI score at Exam 1 was associated with the risk of incident metabolic syndrome (hazard ratio for those in the highest quintile compared to the lowest: 0·80 (95 % CI: 0·65, 0·99), P-trend = 0·03). CONCLUSION:These findings suggest that a dietary pattern that scores higher on the AHEI may help reduce the risk of metabolic syndrome, even for adults who already have two of the minimum of three components required for a diagnosis of metabolic syndrome.

Balancing effective medical treatment with a patient's goals of care has become increasingly complex as advanced medical technology offers a still incomplete ability to improve health in a way that the patient may or may not be able to appreciate. We can neither maintain a physician directed decision-making strategy nor offer patients a menu of options and expect them to understand the consequences of their medical decisions. Developing a robust patient-physician partnership committed to communi-cation that elicits values and goals of care is a necessary part of practicing standard -of-care medicine. The challenge moving forward will be how to create the space and time to execute this process and offer adequate sources of information to optimize pa-tient engagement.

Background The COVID-19 pandemic placed healthcare workers worldwide under significant physical and psychological stress due to increased workplace demands causing fatigue and burnout. In addition, shortages in personal protective equipment (PPE) were commonly, leading to fears for their own personal safety. The pandemic also renewed ethical questions about how to reconcile healthcare workers´ duty to care with concern for their personal health, safety, and well-being. Our study aimed to explore this dynamic from the perspectives of frontline healthcare workers. Methods We conducted a mixed-methods, descriptive study in which we carried out semi-structured, in-depth interviews in April-June 2022, with frontline healthcare workers at four hospitals in Maputo Province, Mozambique. Qualitative interviews were audio-recorded, transcribed and entered into Microsoft Excel for content analysis. Quantitative data was entered in REDCap with descriptive analysis in SPSS. Results We interviewed 53 frontline workers (physicians, nurses and assistants). When asked about their ethical responsibility to provide care during a pandemic, 20 (38%) respondents affirmed that, despite the risk, they had an obligation to care for patients with COVID-19, even without PPE, due to their professional commitment. Eighteen participants (34%) stated that they were not obligated to provide patient care, without PPE, due to the risk of contracting the virus. The remaining 15 (28%) said that they would take care of patients in rare situations. Thirteen (25%) respondents reported first-hand knowledge of examples during the pandemic in which patients were discriminated against in the health care setting, received poor care, or had health workers who refused to provide them care all together. Conclusion Our findings show that frontline healthcare workers in Mozambique were divided as to the limits of their professional responsibility to care for patients with COVID-19. Risk management strategies for highly infectious diseases like COVID-19 must be reformulated to improve service delivery while safeguarding providers.

National Institutes of Health’s policies for Responsible Conduct of Research (RCR) instruction for individual career development awards (K-awards) stress appropriateness to the career stage and tailoring to the individual’s needs. Early-career faculty have unique needs for RCR instruction. While our institution requires RCR education for ALL graduate students and postdoctoral trainees, we found that many K-awardees 1) are early-career faculty not eligible to participate in postdoc programs, and 2) many had received formal RCR instruction at only basic or intermediate levels. We identified 45 K-award recipients with active grants, 26 of whom needed RCR instruction. We developed a program specifically designed for early-career faculty researchers. Through the first three iterations of the course, we had a total of 24 participants, ranging from senior postdoctoral and clinical fellows to instructor-level and assistant professors. This paper describes our experience and challenges in developing and conducting this course.

With limited understanding of most new biotechnologies, how do citizens form their opinion and what factors influence their attitudes about these innovations? In this study, we use gene drive biotechnology in agricultural pest management as an example and theoretically propose that given low levels of knowledge and awareness, citizens' acceptance of, or opposition to, gene drive is significantly shaped by two predisposition factors: individuals' general orientation toward science and technology, and their specific benefit-risk assessment frame. Empirically, we employ data collected from a recent US nationally representative public opinion survey (N = 1220) and conduct statistical analyses to test the hypotheses derived from our theoretical expectations. Our statistical analyses, based on various model specifications and controlling for individual-level covariates and state-fixed effects, show that citizens with a more favorable general orientation toward science and technology are more likely to accept gene drive. Our data analyses also demonstrate that citizens' specific gene drive assessment frame-consisting of a potential benefit dimension and a potential risk dimension, significantly shapes their attitudes as well-specifically, people emphasizing more on the benefit dimension are more likely to accept gene drive, whereas those who place more importance on the risk dimension tend to oppose it. We discuss contributions of our study and make suggestions for future research in the conclusion.