Especially Vulnerable Subjects and Categories in the Context of European Migration: Theoretical Regulatory Challenges

While vulnerability and migration are boundary concepts, they have been employed as if they were somewhat neutral and univocal. Based on the umbrella theory of the vulnerability turn, the specialist doctrine has focused its critical analyses on the legal-political dimensions of the different vulnerable subjects and groups. However, migrant vulnerability has a unique impact on the regulatory field of asylum, especially given its ambiguity and lack of legislative harmonisation across EU Member States. A review of the mechanisms for identifying and protecting migrant vulnerability can provide regulatory evidence regarding the different phases of the Common European Asylum System, which in turn can lead to proposals for its reform. This study will analyse the complex and questionable use of the category of ‘vulnerable migrant’ in the main international instruments of legal protection when applied to asylum seekers. It will then present a critical comparative analysis of the national and EU asylum framework.

Implications of mRNA-based SARS-CoV-2 vaccination for cancer patients

SARS-CoV-2 infection and the resulting COVID-19 have afflicted millions of people in an ongoing worldwide pandemic. Safe and effective vaccination is needed urgently to protect not only the general population but also vulnerable subjects such as patients with cancer. Currently approved mRNA-based SARS-CoV-2 vaccines seem suitable for patients with cancer based on their mode of action, efficacy, and favorable safety profile reported in the general population. Here, we provide an overview of mRNA-based vaccines including their safety and efficacy. Extrapolating from insights gained from a different preventable viral infection, we review existing data on immunity against influenza A and B vaccines in patients with cancer. Finally, we discuss COVID-19 vaccination in light of the challenges specific to patients with cancer, such as factors that may hinder protective SARS-CoV-2 immune responses in the context of compromised immunity and the use of immune-suppressive or immune-modulating drugs.

Human Rights and the Vulnerability of Rights-bearers

I seek to understand the relationship between human vulnerability and human rights as something more than a problem that respect for human rights solves. After characterizing vulnerability and noting that human rights are generally regarded as entitlements that respect the dignity of persons by securing their autonomous agency, I draw out the implications of these premises. I argue that human vulnerabilities are constitutive of the capacity for autonomous agency and therefore that the circumstances of respect for persons must include persons’ vulnerability to many sorts of harms. Given that the opportunity to lead one’s life in one’s own way—that is, the opportunity to exercise autonomous agency—is indispensable to human dignity, respect for persons entails respect for the vulnerability that underwrites autonomous agency. If so, rights-bearers are necessarily vulnerable subjects. I further defend this conception of rights-bearers by arguing that it comports with three types of human rights theory: agency-centered, needs-centered, and practice-based accounts of human rights.

Prevention of metropolitan and railway suicide

Railway suicides account for less than 10% of all suicides and are considered a major public health issue because of their consequences for the operation of the transportation system and their deteriorating impact on staff and bystanders. Behaviour patterns include jumping, lying, wandering, and deviant behaviour prodromal to the attempt. Case fatality is 90% of all attempts (railway) or circa 60% (metro). Victims are predominately male and young, with a median age stratum in the range of 25–34 years. The weekly distribution shows a peak at the beginning of the week and a low on weekends. Preventive measures include inhibiting access to the track (e.g. barriers at places of advanced risk or surveillance systems), inhibiting media coverage, or education of gatekeepers to increase awareness, and skilfulness in contact with vulnerable subjects. Railway suicide prevention is a realistic option; however, further research is urgently needed.

Will COVID-19 Vaccine Genetically Modify Humans? Facts and Myths

The vaccines being developed to protect humans from the Coronavirus pandemics have also been developed in the past to save humans from many other pandemics. The current COVID‐19 vaccine research and development involves people from all over the world, therefore raising many questions which must be addressed by all stakeholders. No doubt, it is the need of the day to provide an effective vaccine to control the pandemics that must be balanced with incorporation of the research ethics. In any event, the safety and well‐being of research subjects must be protected, especially that of vulnerable subjects. The consent of the population is very important and usage must be addressed through transparent sharing of information. The current review article will try to unveil some facts and myths related to the safe use of this vaccine against SARS-CoV-2.

Mental Health Disorders and Summer Temperature-Related Mortality: A Case Crossover Study

Identifying the most vulnerable subjects is crucial for the effectiveness of health interventions aimed at limiting the adverse consequences of high temperatures. We conducted a case crossover study aimed at assessing whether suffering from mental health disorders modifies the effect of high temperatures on mortality. We included all deaths occurred in the area of Bologna Local Health Trust during the summers 2004–2017. Subjects with mental disorders were identified by using the local Mental Health Registry. A conditional logistic model was applied, and a z-test was used to study the effect modification. Several models were estimated stratifying by subjects’ characteristics. For every 1 °C above 24 °C, mortality among people without mental disorders increased by 1.9% (95% CI 1.0–2.6, p < 0.0001), while among mental health service users, mortality increased by 5.5% (95% CI 2.4–8.6, p < 0.0001) (z-test equal to p = 0.0259). The effect modification varied according to gender, residency and cause of death. The highest probability of dying due to an increase in temperature was registered in patients with depression and cognitive decline. In order to reduce the effects of high temperatures on mortality, health intervention strategies should include mental health patients among the most vulnerable subjects taking account of their demographic and clinical characteristics.

Screening and eradication of Helicobacter pylori for gastric cancer prevention: the Taipei global consensus

ObjectiveA global consensus meeting was held to review current evidence and knowledge gaps and propose collaborative studies on population-wide screening and eradication of Helicobacter pylori for prevention of gastric cancer (GC).Methods28 experts from 11 countries reviewed the evidence and modified the statements using the Delphi method, with consensus level predefined as ≥80% of agreement on each statement. The Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach was followed.ResultsConsensus was reached in 26 statements. At an individual level, eradication of H. pylori reduces the risk of GC in asymptomatic subjects and is recommended unless there are competing considerations. In cohorts of vulnerable subjects (eg, first-degree relatives of patients with GC), a screen-and-treat strategy is also beneficial. H. pylori eradication in patients with early GC after curative endoscopic resection reduces the risk of metachronous cancer and calls for a re-examination on the hypothesis of ‘the point of no return’. At the general population level, the strategy of screen-and-treat for H. pylori infection is most cost-effective in young adults in regions with a high incidence of GC and is recommended preferably before the development of atrophic gastritis and intestinal metaplasia. However, such a strategy may still be effective in people aged over 50, and may be integrated or included into national healthcare priorities, such as colorectal cancer screening programmes, to optimise the resources. Reliable locally effective regimens based on the principles of antibiotic stewardship are recommended. Subjects at higher risk of GC, such as those with advanced gastric atrophy or intestinal metaplasia, should receive surveillance endoscopy after eradication of H. pylori.ConclusionEvidence supports the proposal that eradication therapy should be offered to all individuals infected with H. pylori. Vulnerable subjects should be tested, and treated if the test is positive. Mass screening and eradication of H. pylori should be considered in populations at higher risk of GC.

Physiological Measures of Acute and Chronic Pain within Different Subject Groups: A Systematic Review

Background and Objective. The most frequently used methods for assessing pain are self-reports and observation. However, physiological methods could improve accuracy and reliability for those with communicative difficulties. This review’s objective is to analyze methods used to physiologically assess pain, to rank them by invasiveness per method and vulnerability per subject group, and to assess their technological maturity. Databases and Data Treatment. Six international databases were searched for review papers between 2007 and 2019. Inclusion criteria were as follows: at least one physiological method for acute or chronic pain in humans; languages were as follows: English, French, Dutch, German, and Spanish. Quality of reviews was assessed using the CASP checklist. Results. The methods’ heart rate variability and electroencephalogram show clear and consistent results as acute pain assessment. Magnetic resonance imaging can measure chronic pain. Ordered by invasiveness and vulnerability, a trend shows that the invasive methods are used more with less vulnerable subjects. Only instruments used for skin conductance and automatic facial recognition have a lower-than-average technological maturity. Conclusions. Some pain assessment methods show good and consistent results and have high technological maturity; however, using them as pain assessment for persons with ID is uncommon. Since this addition can ameliorate caregiving, more research of assessment methods should occur.