Older women face disproportionate health challenges, exacerbated by multiple unprecedented challenges such as global aging, disease outbreaks, and geopolitical as well as technological upheavals. This study examines technology-based mental health interventions for this demographic, aiming to inform policy. A systematic review of randomized controlled trials (RCTs) targeting older women's mental health post-COVID-19 was conducted using databases like Web of Science and PubMed, adhering to PRISMA guidelines and registered with PROSPERO (CRD42020194003). A total of 3463 articles were screened for eligibility, among which, 17 RCTs met the inclusion criteria. The review results show that 17 RCTs were conducted in middle-income and high-income countries. Fifteen RCTs generated statistically significant outcomes and reported specific aspects of their interventions to improve the mental health of older women. Technology-based interventions show promise for improving older women's mental health. Policy recommendations include establishing comprehensive mental health centers, implementing universal healthcare, promoting digital literacy, and strengthening public awareness campaigns.
Taiwan developed legal frameworks for organ transplantation earlier than many other East Asian countries and has achieved relatively successful clinical outcomes. Although its deceased donor rate remains lower than in countries such as Spain and the United States, it exceeds those of Japan, China, and Singapore. This success is often attributed to the efficiency of its transplant network and the strength of its legal infrastructure. However, the sociocultural context of these laws-and how Taiwanese policies engage with prevailing beliefs about death and the body-has received limited scholarly attention. This paper addresses that gap by analyzing legal and policy documents related to deceased organ donation in Taiwan, including legislation, official guidelines, and parliamentary records between 1987 and 2021. It argues that Taiwanese law reframes death with organ donation-whether following brain death or cardiac arrest-as a form of "good death," integrating consent into broader end-of-life decision-making. By clarifying the legal and policy background, the analysis highlights how the government has sought to reconcile biomedical definitions of death with Confucian notions of bodily integrity and socially valued dying. As secularization progresses, this framing may make organ donation more socially acceptable. At the same time, ethical concerns arise from policy discourses that emphasize altruism and social contribution, which may lead individuals to forgo life-sustaining treatments not solely based on personal reasoning, but from a perceived obligation to benefit family or society-potentially constraining expressions of individual preference.
The first implantation of a brain chip into a human paralysis patient by Neuralink demonstrated much potential for treating debilitating neurological diseases and injuries. Nevertheless, brain chips can also be implanted in healthy people to provide an interface between the human brain with computers, robotic machines, and novel artificial intelligence platforms, which generates new ethical issues. The focus here is on the development of brain chip implants that can significantly improve memory, intelligence, and cognition, thereby boosting performance in national examinations for university admissions and securing civil service jobs, thus providing a "game-changer" and "shortcut" for many students and parents. Given that Islam is a major world religion, constituting a significant portion of the global population, it is crucial for the biomedical industry to comprehend Islamic perspectives on emerging medical technologies, which will enable it to more effectively cater to a substantial and growing demographic. We thus critically examine whether the application of brain chip technology to enhance academic performance in highly competitive examinations is consistent with Islamic principles. Based on the Islamic jurisprudential framework, such an application for intellectual enhancement of normal and healthy people without any mental impairment may conflict with the injunction to preserve intellect (Hifz al-Aql) and "consideration of consequences" (murā'āt al-ma'ālāt) in Islam. It may also be viewed as tampering with Allah's creation (Taghyir Khalq Allah). Gaining such unfair advantages in competitive examinations will likely be viewed as unethical, by transgressing the core Islamic precepts of Amanah (trustworthiness), Al-'Adl (justice), Ikhlas (sincerity), and Mujahadah (striving).
RNA interference (RNAi)-based pesticide technology is an alternative to synthetic pesticides or transgenic plants that are able to control, repel, or eliminate pests that could cause harm to crops or livestock. A notable example is Calantha™, the first commercially approved sprayable RNAi biopesticide, which received approval from the US Environmental Protection Agency (EPA) in 2024. Although RNAi technology holds promise with many potential benefits, there are still uncertainties about potential risks to humans and the environment. This study applies the Maslahah-Mafsadah (benefit-harm) framework from Maqasid al-Shari'ah (Islamic bioethics) to evaluate RNAi-based pesticides, analysing their implications through evidence-based, impact-based, and priority-based approaches. By addressing universal bioethical principles such as beneficence and non-maleficence, this study highlights how Islamic bioethical concepts can contribute to broader ethical discussions on emerging biotechnologies. The analysis considers pest management, environmental sustainability, human health, and socio-economic impacts, concluding that RNAi-based pesticides may be categorised as zanniyyah (probable) in terms of their benefits and risks. Consequently, the study underscores the ethical obligation to establish rigorous regulatory oversight, taking into considerations appropriate scientific evidence, environmental impact studies, and health assessments when evaluating the technology.
The Republic of Korea is facing a rapidly aging population, with the prevalence of dementia expected to more than double by 2050, which will create major social and economic pressures. The Dementia Management Act (DMA), which came into effect in 2011, provides a national framework for dementia prevention, care and research. The DMA includes provisions to facilitate the substantial registration and statistical utilization of dementia-related data, as well as the establishment of central and regional Dementia Centers. The primary function of these centers is to coordinate care and governance. While these measures have improved monitoring, surveillance and management infrastructure, they have also raised significant neuroethical challenges relating to privacy and stigmatization when utilizing the dataset. In this study, we address these concerns and propose integrating data governance with social governance to strike a better balance between data utilization and societal values of equity and justice.
End-of-life (EOL) care for critically ill individuals is shaped by socioeconomic, legal, and cultural factors for Koreans in South Korea and Korean Americans (KA) in the United States. This scoping review thematically synthesized critical care literature from Korea and community-based literature involving KAs to inform culturally tailored EOL and palliative care research and practice. Following the updated JBI scoping review guidance, we reviewed English and Korean articles across seven databases. Due to the lack of critical care studies involving KAs, the scope of U.S. studies was broadened to all healthcare settings. We conducted a thematic synthesis to identify cross-context cultural insights that are potentially transferable from Koreans in critical care to KAs with similar needs. Evidence on EOL care for Koreans in critical care and for KA communities across U.S. settings was limited. Korea-based critical care studies (N = 23) highlighted physician-initiated decision-making, minimal advance care planning, and a lack of direct patient perspectives. U.S.-based studies (N = 26) focused on hypothetical palliative care preferences among older, community-dwelling KAs, with limited attention to critical care. Both contexts revealed shared cultural preferences for family-centered decision-making, physician-led discussions, and indirect communication about diagnosis and prognosis. Further research is warranted to investigate within-group heterogeneity and preference shifts across illness trajectories to inform culturally tailored EOL interventions for KAs. Findings highlight the need for culturally and structurally informed approaches to improve EOL care in both Korea and the U.S. This cross-context analysis demonstrates how evidence from the heritage country can inform research and practice for immigrant and minoritized populations when domestic data are sparse. Strength-based approaches grounded in community values, combined with culturally specific insights from Korean literature, may enhance culturally responsive support for KA patients and families.
Interethnic differences in natural transdural collaterals-an angiographical hallmark of Moyamoya disease (MMD)-may reflect the genetic and pathophysiological mechanisms underlying ethnic disparities. However, international comparative studies incorporating both angiographic and genetic data are limited. This study investigated differences in cerebral angioarchitecture and clinical presentation between Japanese Asian and Polish Caucasian patients with MMD, with a focus on the RNF213 p.R4810K variant, a known East Asian founder mutation. We retrospectively analyzed consecutive 94 Japanese and 33 Polish patients who underwent diagnostic cerebral angiography and RNF213 p.R4810K genotyping between 2015 and 2025. Suzuki's angiographical stages and the presence of natural-transdural, periventricular, and leptomeningeal collaterals, mainly via posterior cerebral artery (PCA), were evaluated. Interethnic comparisons progressed from full cohort comparisons to genotype-based subgroup analyses with adjustments for angiographical stage and RNF213 p.R4810K genotype. The RNF213 p.R4810K wild-type was present in 31% of Japanese and 100% of Polish patients. A trend toward more hemorrhagic presentation in Japanese was noted (17% vs. 12%, P = 0.10). Polish patients were significantly younger at diagnosis (P = 0.0014). Among 230 un-operated hemispheres, angiographic stages did not significantly differ (P = 0.23). After adjustment, overall prevalence of natural transdural collaterals was similar (41% in entire Japanese and 60% in Polish cohort, P = 0.20), but significantly higher in Polish than in Japanese patients with the wild-type genotype (60% vs 34%, P = 0.0098). Periventricular collaterals were significantly more common in Japanese, independent of genotype (P < 0.0001). No interethnic difference was observed in leptomeningeal collaterals. In conclusion, Polish MMD patients exhibit more natural transdural and fewer periventricular collaterals than Japanese with the wild-type genotype. These genetic and ethnic differences suggest distinct mechanisms of collateral formation across ethnic groups, with implications for genotype-driven pathophysiology and clinical presentation in MMD.
[This corrects the article DOI: 10.1007/s41649-024-00310-8.].
The Act on the Improvement of Mental Health and the Support for Welfare Services for Mental Patients (2017) marks a significant reform in South Korea's mental health system. This study reviews the legal amendments from 2016 to 2023, alongside the mental health policies and programs published in the Health and Welfare White Paper during the same period. The focus is on the ethical challenges and future directions in mental health care, analyzed through the lens of Beauchamp and Childress' four principles of biomedical ethics-autonomy, beneficence, non-maleficence, and justice. In conducting this study, we performed a focused document analysis of legislative amendments and policy reports published between 2016 and 2023. We selected and reviewed the Health and Welfare White Papers and the official amendments to the Mental Health Welfare Act according to predefined inclusion criteria, focusing on relevance to mental health governance and ethical considerations. This paper evaluates how key provisions of the Act address involuntary admission, patient autonomy, the expansion of services, and the integration of mental health care into broader welfare systems. Moreover, by incorporating public health ethics concepts such as equity, solidarity, and the common good, this study highlights the importance of balancing individual rights with broader societal needs-especially during public health crises-to ensure comprehensive and inclusive mental health governance. Additionally, it proposes future policy directions to enhance patient autonomy, maximize well-being, and ensure equitable access to services, particularly for vulnerable populations such as the elderly and low-income groups. Key recommendations include developing informed consent protocols, expanding telemedicine and community-based care, and addressing digital health equity. This paper contributes to ongoing discussions on mental health reform and bioethics, emphasizing the importance of equitable mental health care as a fundamental component of social justice.
Although ethical decision-making in rehabilitation is increasingly complex, physical therapy remains marginal in mainstream philosophical bioethics. This paper critically interrogates the normative limitations of principlism, particularly the framework articulated by Beauchamp and Childress, in addressing moral dilemmas within physical therapy practice, especially in contexts characterized by systemic inequities, cultural plurality, and hierarchical institutional structures. Drawing upon my clinical experience as a licensed physical therapist in both the Philippines and the United States, I analyze ethically charged scenarios involving premature discharge, coerced consent, and institutional practices that undermine therapeutic justice. While principlism offers a widely accepted ethical schema, its abstraction and proceduralism often render it inadequate in morally ambiguous and relationally complex clinical situations. To respond to these limitations, I propose a more context-sensitive and philosophically robust framework by integrating Hare's two-level utilitarianism, Habermas's discourse ethics, feminist care ethics, and Kohlberg's theory of moral development. These perspectives collectively reconceptualize ethical reasoning as dialogical, developmental, and attentive to the affective and political dimensions of care. Through philosophical analysis, narrative reflection, and engagement with lived clinical experience, I argue that physical therapists must be recognized not merely as technical practitioners, but as moral agents engaged in situated ethical judgment. This paper contributes to the evolving discourse on bioethics in allied health professions by foregrounding moral ingenuity, structural critique, and relational accountability as essential to ethical excellence in rehabilitative practice.
Informed consent is essential for protecting patients' rights and ensuring ethical medical practices. This study aimed to evaluate the quality and identify deficiencies in the informed consent forms of surgical patients at Shariati Hospital in Tehran. This descriptive cross-sectional study, conducted in 2022, reviewed the medical records of 288 surgical patients at Shariati Hospital from 2017 to 2021. A researcher-made checklist assessed demographic data, disease specifics, informed consent information, and completeness. Deficiencies in the forms and patients' understanding were evaluated using a Likert scale, with checklist validity confirmed by a pilot study (Cronbach's alpha = 0.75). Data analysis was performed using SPSS v.24. This study of 288 patient records found that while 93.4% had consent forms, only 2.2% were adequately informative and 4.5% understandable. Wound infection was the most discussed complication (89.6%), with no significant link to surgery type. Third-party consent was rare (2.8%), and 83% of forms had witnessed signatures. Residents obtained 98.5% of consents. This study identifies significant gaps in the informed consent process at a hospital, particularly in the disclosure and understanding of risks, benefits, and alternatives. While it does not assess voluntariness or decision-making capacity, it shows positive trends, such as increased healthcare team involvement and reduced third-party authorization, especially for female patients. The findings highlight a shift toward legal protections over ethical considerations, with implicit safeguards, like fingerprints and witness signatures, replacing explicit waivers. The online version contains supplementary material available at 10.1007/s41649-025-00372-2.
Within cross-border surrogacy, particularly in consumer countries, the protection of children's human rights presents complex and significant challenges. This study examines how Australian surrogacy facilitators perceive and navigate the rights of children born through such arrangements. Despite striving to adopt child-centred practices, facilitators face structural barriers, including conflicting interests between intended parents and children, the commodification of children in surrogacy contracts, and legal ambiguities around parental relationships. These challenges create a persistent tension between the universal recognition of children as independent rights holders and the practical demands of facilitating surrogacy arrangements. The findings highlight the need for robust regulatory frameworks and clearer accountability mechanisms to ensure children's rights are upheld. This study advances the scholarship on surrogacy and human rights and informs the ongoing review of Australian surrogacy laws, emphasizing the need for stronger protections for children in international surrogacy arrangements.
This survey analyzes the knowledge and perceptions of members and staff of ethics committee and investigators toward conflicts of interest in clinical research. This cross-sectional survey in China included 324 respondents from November to December 2022. The 12-item questionnaire estimated the knowledge of respondents on conflicts of interest and correct answers were given by at least 47%. According to perception scores, most respondents (88%) believed that strengthening conflicts of interest management was necessary, such as through national government, institutional regulation, ethics training, avoidance systems, timely reporting, the declaration and management of nonfinancial conflicts of interest, and the assessment of relevant conflicts of interest for the chief reviewer. However, less believed it was necessary to establish a conflicts of interest committee in institutions (74.1%), to enroll more members from other institutions (61.4%), and to avoid appointing a scientific research department leader as the chairperson of ethics committee (72.5%). Technical title and ethics training both significantly affected median knowledge scores (P < 0.05). Further, technical title and ethics training also had an obvious influence on the average perception score (P < 0.05). These findings are critical for enhancing conflicts of interest management in clinical research in China. The online version contains supplementary material available at 10.1007/s41649-025-00361-5.
Enteric infectious diseases claim more than 1 million lives annually and are among the top ten causes of death in children younger than 5 years. Remarkable global investment has been dedicated to enteric infectious disease prevention and control; however, the shifting global health landscape is testing the continuance of progress. To evaluate the current status and guide future interventions, we present the latest epidemiological estimates of enteric infectious diseases from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 and assess progress towards the Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) mortality target of fewer than 20 deaths per 100 000 children younger than 5 years by 2025. We quantified the incidence, mortality, and disability-adjusted life-years (DALYs) of enteric infectious diseases by age, sex, and year across 204 countries and territories from 1990 to 2023. In GBD 2023, the following were considered under the category of enteric infectious diseases: diarrhoeal diseases, enteric fever (typhoid and paratyphoid), invasive non-typhoidal Salmonella spp (iNTS) infections, and other intestinal infectious diseases. We also examined 15 aetiologies contributing to diarrhoeal diseases. Incidence and prevalence were estimated with DisMod-MR (version 2.1), a Bayesian meta-regression tool, drawing on data from systematic reviews, population-based surveys, claims data, and hospital sources. Cause-specific mortality was modelled with Cause of Death Ensemble Modelling based on data from sources including vital registration, mortality surveillance, verbal autopsy, and minimally invasive tissue sampling. Years of life lost and years lived with disability were computed and combined to derive DALYs. For aetiology-specific estimation, population-attributable fractions (PAFs) for 15 pathogens were derived with a counterfactual framework. Point estimates and 95% uncertainty intervals (UIs) were generated from 250 draws from the posterior distribution. In 2023, enteric infectious diseases resulted in an estimated 1·27 million (95% UI 0·963-1·68) deaths globally, declining from 3·69 million (3·04-4·56) in 1990. The global age-standardised mortality rate (ASMR) decreased from 74·1 (62·0-92·9) per 100 000 population to 16·4 (12·6-21·3) per 100 000 population during the same period. Diarrhoeal diseases accounted for most deaths in 2023 (1·11 million [0·811-1·54]), followed by enteric fever and iNTS. South Asia and sub-Saharan Africa remained the most affected regions in 2023, with 599 000 (441 000-882 000) and 501 000 (373 000-648 000) deaths due to enteric infectious diseases, respectively, predominantly from diarrhoeal disease. Rotavirus was the leading cause of all-age diarrhoeal disease deaths (PAF 16·3% [12·0-21·5]), followed by norovirus (10·2% [2·4-17·0]) and Shigella spp (9·3% [5·4-15·2]). Among children younger than 5 years, PAFs of deaths due to diarrhoeal diseases were 40·2% (32·5-48·5) for rotavirus, 24·0% (15·1-36·7) for Shigella spp, and 23·4% (13·7-34·3) for adenovirus. Across 204 countries and territories, 141 met the GAPPD mortality target in 2023. The driving aetiologies among countries that did not meet the target in 2023 varied slightly by GBD super-region, but the highest or second-highest number of deaths in children younger than 5 years were consistently attributed to rotavirus. Astrovirus and sapovirus, newly included in GBD 2023, were responsible for 24 600 (6290-49 000) and 18 800 (4650-44 400) deaths, respectively, in 2023, mainly in children younger than 5 years. Our findings show that mortality and ASMRs of enteric infectious diseases declined substantially between 1990 and 2023. This decline is consistent with the expansion of public health measures and broader socioeconomic development. However, the burden in 2023 remains considerably high, with the highest mortality concentrated in sub-Saharan Africa and south Asia. Considering that more than a quarter of all countries had yet to meet the GAPPD mortality target in 2023, sustained efforts are needed to address the persistent burden in affected countries and to adapt to the changing global health landscape. Gates Foundation.
It is common to say that the term malpractice is unclear in Indonesia as legal officers do not have sufficient knowledge regarding its full understanding. We can see the inconsistent rulings from Pengadilan Negeri to Mahkamah Agung. These inconsistencies do not merely rely on the officers' ability to comprehend the issues assigned to them but also on regulations that do not provide enough clarity regarding the matters. To put an end to this inconsistency, I propose dividing the term malpractice into three categories, namely general malpractice, which is malpractice in its original meaning a-non-fulfillment of the standard of care; management malpractice or maladministration, which is caused by a person with a non-therapeutic relationship with the patient; and maltreatment, which contains intention-mens rea. Additionally, to clarify this division, I want to reintroduce the peer-review method by professional organizations as primary evidence in medical disputes, not only as support evidence.
To evaluate real-world efficacy, durability, and safety of faricimab in treatment-naïve Asian patients with neovascular age-related macular degeneration (nAMD). Retrospective study of treatment-naïve nAMD eyes treated with faricimab at a single centre in South Korea. After four monthly loading doses, treatment intervals (Q8W, Q12W, Q16W) were assigned based on disease activity at weeks 20 and 24. Comprehensive assessments included best-corrected visual acuity (BCVA), central subfield thickness (CST), pigment epithelial detachment (PED) height, subfoveal choroidal thickness (SFCT), and intraretinal/subretinal fluid (IRF/SRF) presence. Eighty-eight treatment-naïve eyes were included. Mean age was 72.8 (9.0) years. At week 20, BCVA improved from 62.1 (15.4) to 69.3 (14.6) ETDRS letters (+ 7.1 letters, P < 0.001). CST decreased from 414 (150) to 280 (94) µm (- 134 μm, P < 0.001). PED height decreased from 297 (167) to 171 (116) µm (- 43%, P < 0.001). SFCT decreased from 208 (91) to 184 (83) µm (- 12%, P < 0.001), with PCV eyes showing the greatest reduction (- 32 μm, P < 0.001). IRF presence (1 mm/6 mm) decreased from 33%/34% to 7%/9%, and SRF from 78%/84% to 12%/20% at week 20. At week 60, 52.3% achieved Q16W and 67.0% achieved ≥Q12W intervals. Among 168 eyes in the safety analysis, there was 1 case of mild vitritis and 2 cases of RPE tear, with no cases of endophthalmitis or retinal vasculitis reported. Initiation of faricimab in treatment-naïve nAMD patients resulted in favourable visual and anatomical outcomes with durable treatment intervals and a low incidence of adverse events in a real-world setting.