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There have been 188 rural hospital closures in the United States since 2010 with approximately 20% of these in Appalachia. Telehealth has become a way that nurses can reach rural patients who might not otherwise receive health care. The purpose of this paper is to (1) outline the federal policies enacted during COVID-19 for broadband expansion; and (2) suggest how advanced practice nursing care might be affected by broadband expansion and telehealth in the region. A search of PubMed was conducted in January 2023, using the search words, "policy", "telehealth", "broadband", and "Appalachia". New laws appropriated funds to expand broadband infrastructure that made it possible for telehealth to be used by nurses to deliver health care to rural patients. This discussion paper found that broadband legislation was instrumental in expanding telecommunications and telehealth by NPs. There is a great need for broadband to continue to expand and for trained nurses to provide care via telehealth. [ABSTRACT FROM AUTHOR]

In this paper, we apply the reproductive justice framework to discuss how gendered racism disadvantages pregnant and parenting young Black women aging out of foster care. Specifically, we highlight the reversal of Roe v Wade as reflective of the United States' long legacy of efforts to control Black women's reproduction. We then discuss the structural factors contributing to the reproductive injustices of young Black women aging out of care, including a lack of access to sexual and reproductive health education, barriers to educational attainment, and foster care-based relational and placement deficits. We conclude with research, practice, and policy enhancements. [ABSTRACT FROM AUTHOR]

Environmental health remains a niche topic in bioethics, despite being a prominent social determinant of health. In this paper we argue that if bioethicists are to take the project of health justice as a serious one, then we have to address environmental injustices and the threats they pose to our bioethics principles, health equity, and clinical care. To do this, we lay out three arguments supporting prioritizing environmental health in bioethics based on bioethics principles including a commitment to vulnerable populations and justice. We also highlight and advocate for environmental law efforts that align with these priorities, focusing specifically on the need for a right to a healthy environment. Our intention is to draw attention to the legal and ethical concepts that underlie the importance of a healthy environment, and urge bioethicists to prioritize both legal and ethical advocacy against environmental injustices in their practice. [ABSTRACT FROM AUTHOR]

The emergence of molecular HIV surveillance (MHS) and cluster detection and response (CDR) programs as key features of the United States (US) HIV strategy since 2018 has caused major controversies. HIV surveillance programs that re-use individuals' routinely collected clinical HIV data do not require consent on the basis that the public benefit of these programs outweighs individuals' rights to opt out. However, criticisms of MHS/CDR have questioned whether expanded uses of HIV genetic sequence data for prevention reach beyond traditional public health ethics frameworks. This study aimed to explore views on consent within MHS/CDR among critical stakeholders. In 2021 we interviewed 26 US HIV stakeholders who identified as being critical or concerned about the rollout of MHS/CDR. Stakeholders included participants belonging to networks of people living with HIV, other advocates, academics, and public health professionals. This analysis focused on identifying the range of positions among critical and concerned stakeholders on consent affordances, opt-outs, how to best inform people living with HIV about how data about them are used in public health programs, and related ethical issues. Participants were broadly supportive of introducing some forms of consent into MHS/CDR. However, they differed on the specifics of implementing consent. While some participants did not support introducing consent affordances, all supported the idea that people living with HIV should be informed about how HIV surveillance and prevention is conducted and how individuals' data are used. MHS/CDR has caused sustained controversy. Among critical stakeholders, consent is generally desirable but contested, although the right for people living with HIV to be informed was centrally supported. In an era of big data-driven public health interventions and routine uses of HIV genetic sequence data in surveillance and prevention, CDC and other agencies should revisit public health ethics frameworks and consider the possibility of consent processes. [ABSTRACT FROM AUTHOR]

Throughout the COVID-19 pandemic, politicization of public health policy has loomed over the governmental response in the United States. The scope of politicization is underscored by instances of political pressures faced by public employees across state and local government. Observation of such instances prompts questions regarding the implications of highly politicized crisis on public personnel systems. Using systematic qualitative content analysis of data from syndicated news articles, this study identifies publicized instances of adverse personnel actions experienced by public employees during the first six months of the COVID-19 pandemic. Following the identification of publicized instances, this study also explores legislative trends focusing on public personnel systems during highly politicized emergency conditions. Results outline the positional roles subject to adverse actions, along with traits of legislative activity changing public personnel systems in the states identified. Implications of the study and considerations for future research are then discussed. [ABSTRACT FROM AUTHOR]