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Perspectives on Medical Education 2024Medical education has acknowledged the impact of structural societal factors on health, prompting the need for curricula seeking to eliminate health inequities upstream...
PROBLEM & BACKGROUND
Medical education has acknowledged the impact of structural societal factors on health, prompting the need for curricula seeking to eliminate health inequities upstream while simultaneously caring for downstream effects of existing inequities. The Keck School of Medicine of USC (KSOM) implemented one such comprehensive curriculum, Health Justice and Systems of Care (HJSC), integrating health systems science, structural competency, and service-learning in a required course spanning the pre-clerkship and clerkship phases with an optional post clerkship elective.
APPROACH
The HJSC course addresses topics including racism in medicine, health inequities, and health systems science. Using transformative learning theory, it fosters critical consciousness and structural competency. Assessments include case analyses, reflections, team-based learning sessions, and group projects related to social justice in healthcare. The program aims to instill cultural humility and practical application, fostering a holistic approach to medical education that implores physicians to become advocates for health justice.
OUTCOMES OF THE INNOVATION
Feedback from students indicated generally positive perceptions of the curriculum. Students provided overall positive comments about discussions with guest speakers. However, students expressed a desire for more concrete examples of how health inequities can be remedied. Some found small-group activities less engaging. Other challenges included providing students of different readiness levels with tailored experiences and seamlessly integrating HJSC content within basic and clinical sciences courses.
CRITICAL REFLECTION
Next steps include continuing to integrate content into the science curriculum and clerkships, improving opportunities for meaningful student interactions, and enhancing faculty development to address health justice concerns in clinical settings.
Topics: Humans; Curriculum; Social Justice; Students, Medical; Delivery of Health Care; Clinical Clerkship
PubMed: 38912167
DOI: 10.5334/pme.1325 -
Annals of Surgery Open : Perspectives... Jun 2024Mini abstract The financial benefits of instituting the American College of Surgeons Geriatric Surgery Verification Program far exceed the costs, with the added benefits...
Mini abstract The financial benefits of instituting the American College of Surgeons Geriatric Surgery Verification Program far exceed the costs, with the added benefits of enhanced patient satisfaction and improved staff morale.
PubMed: 38911623
DOI: 10.1097/AS9.0000000000000439 -
SSM. Qualitative Research in Health Jun 2024Existing literature has portrayed numerous challenges that healthcare workers (HCWs) faced during the COVID-19 pandemic, such as heightened risks of transmission against...
Existing literature has portrayed numerous challenges that healthcare workers (HCWs) faced during the COVID-19 pandemic, such as heightened risks of transmission against the scarcity of protective equipment, burgeoning workload, and emotional distress, to name a few. However, most studies explored HCWs' experiences at the individual level rather than examining the collective responses. Exploring these experiences could reveal the social-cultural locality of the pandemic while identifying the system constraints in public health emergencies. As part of a mixed-method study on COVID-19 pandemic impacts, we analysed qualitative interview data with 129 HCWs and health-related staff to explore their experiences during the pandemic between 2020 and 2021 in Vietnam, Indonesia, and Nepal. Using Bahers' sociological framework, Community of Fate, we describe five themes reflecting the formation of a community of HCWs and the social cohesion underlying their efforts to survive hardship. The first three themes characterise the HCW community of fate, including (1) Recognition of extreme work-related danger, (2) physical and figurative closures where HCWs restrict themselves from the outside world, (3) chronic ordeals with overwhelming workload and responsibilities, encompassing recurrent mental health challenges. Against such extreme hardship, cohesive bonding and social resilience are reflected through two additional themes: (4) a mutual sense of moral and professional duty to protect communities, (5) the vertical and horizontal convergence among HCWs across levels and among government departments. We discuss these HCWs' challenges in relation to systemic vulnerabilities while advocating for increasing investment in public health and collaboration across government sectors to prepare for emergency situations.
PubMed: 38911289
DOI: 10.1016/j.ssmqr.2024.100404 -
Rural and Remote Health Jun 2024Maternity unit closures in rural and remote settings of Australia have left a substantial gap in services for pregnant women. In the absence of midwives, and when women...
INTRODUCTION
Maternity unit closures in rural and remote settings of Australia have left a substantial gap in services for pregnant women. In the absence of midwives, and when women are unable to attend a maternity facility, registered nurses (RNs) are required to fill the void. While maternity education can attempt to prepare RNs for such encounters, there is little documented to suggest it meets all their physical and psychological needs. The existing challenges for health professionals, practising a vast generalist scope of practice while living and working in a rural and remote location, have been well researched and documented. How nurses feel about the expectation that they work outside their scope of practice to provide maternity care in a rural and remote setting in Australia has not been asked until now. This study explores the perceptions and experiences of RNs who find themselves in this situation.
METHODS
The study utilised a hermeneutic phenomenological methodology to examine the experiences and perceptions of rural and remote nurses providing care for pregnant women. RNs working in rural and remote health facilities that had no maternity services were recruited by a purposive sampling method. Semistructured conversational interviews were recorded and transcribed verbatim. Data analysis was guided by van Manen's analytical approach.
RESULTS
Eight nurses participated, and from the data three themes, each with several subthemes, emerged: 'being-in-the-world of the rural and remote nurse' - described how participants viewed rural and remote nursing as an entity with unchangeable aspects that could not be considered in isolation; 'scope of practice - unprepared or underprepared' described how, despite their existing and extensive nursing skills, participants felt ill-equipped theoretically, practically and mentally to care for pregnant women; 'moral distress' - participants expanded their feelings of unpreparedness to include inadequacy, fear, and appropriateness of care delivery.
DISCUSSION
The realism of rural and remote nursing practice demonstrates that at some point in their career, rural and remote nurses will care for a labouring and/or pregnant woman at high risk for complications. Participants in this study appeared open and honest in their interviews, displaying pride at their extensive nursing skills and job satisfaction. However, they were unanimous in their discussions of what being a nurse and providing maternity care in a rural and remote setting meant to themselves and to pregnant women. They suggested care was fragmented and inadequate from a workforce that is inadequately prepared and stressed.
CONCLUSION
This study has highlighted another concerning aspect of rural and remote midwifery care - the experiences and perceptions of eight nurses delivering care that has previously been overlooked. The united voice of the RNs in this study warrants a platform to speak from and deserves acknowledgement and attention from government and midwifery policy drivers. These nurses, and the women receiving their care, deserve more.
Topics: Humans; Female; Pregnancy; Rural Health Services; Australia; Attitude of Health Personnel; Maternal Health Services; Adult; Rural Nursing; Midwifery; Rural Population; Qualitative Research; Interviews as Topic
PubMed: 38909988
DOI: 10.22605/RRH8721 -
The Science of the Total Environment Jun 2024Agricultural systems in the 21st Century face the double challenge of achieving climate neutrality while maintaining food security. Synthetic fertilizers rich in...
Agricultural systems in the 21st Century face the double challenge of achieving climate neutrality while maintaining food security. Synthetic fertilizers rich in nitrogen (N-fertilizers) boost agricultural production at the expense of increasing climate impact. Public policies, such as the Farm-to-Fork (F2F) Strategy, aim to reduce the extensive use of N-fertilizers with the ultimate goal of achieving a climate neutral European Union (EU). However, the strong link between N-fertilizers and GHG emissions (i.e., CO, CH and, especially, NO) highlights the need to better understand the climate impact of this sector. The present study conducts a climate impact analysis of Spanish N-fertilizer sector for two periods: (i) from 1960 to 2020 using real data and (ii) from 2021 to 2100 considering five forecasted scenarios. The scenarios range from business-as-usual practices to a full accomplishment of the goals pursued by the EU's F2F strategy. The system's climate stability and neutrality are analysed for the different scenarios based on radiative forcing (RF) metrics. Additionally, the study evaluates the short-term impact of the EU decarbonization goals on the climate impact of the Spanish N-fertilizer sector. The results of the study illustrate that the long-lasting climate impact of NO and CO emissions compromise the capacity of N-fertilizer sector to achieve climate stability and approach climate neutrality. However, the decarbonisation of transport and N-fertilizer production activities is an important driver to substantially reduce the life cycle CH and CO emissions in the Spanish N-fertilizer sector. The results also highlight that more severe reductions on N-cycles than those suggested by the EU's F2F are required, especially to reduce the long-lasting NO emissions in the N-fertilizer sector. Overall, the study concludes that using RF-based metrics increases robustness and transparency of climate assessments, which is necessary for a higher integration of climate science within public policymaking.
PubMed: 38909810
DOI: 10.1016/j.scitotenv.2024.174131 -
BMC Public Health Jun 2024With rapid urbanization, massive migration, and non-family-based eldercare involvement, Chinese concepts of eldercare responsibility and filial piety are shifting. We...
The transition of eldercare responsibility and traditional filial piety concepts and its urban-rural differences in China: an age-period-cohort analysis from 2006 to 2017.
BACKGROUND
With rapid urbanization, massive migration, and non-family-based eldercare involvement, Chinese concepts of eldercare responsibility and filial piety are shifting. We performed age-period-cohort (APC) analyses to assess the transition of old-age pension coverage, eldercare responsibility, and filial piety concepts and its urban-rural differences among Chinese adults using data from the China General Social Survey (2006-2017).
METHODS
Old-age pension coverage (yes/no) and primary eldercare responsibility (government/offspring/self/sharing) were investigated in 2010, 2012, 2013, 2015, and 2017. Filial piety was evaluated using customized questionnaires in 2006 and 2017. The APC effects were estimated using mixed effects and generalized additive models.
RESULTS
Among 66,182 eligible participants (mean age: 48.8 years, females: 51.7%) in the six waves, APC analyses indicated that old-age pension coverage increased with aging and over time. Across cohort groups, it grew as the cohort was younger in urban residents but decreased in rural residents. The concept of offspring-based (> 50%) and government/self/offspring-shared eldercare (> 30%) predominated. APC analyses revealed that the offspring-based concept declined with aging (OR = 0.81, 95% CI: 0.79-0.84), whereas the government-based (OR = 1.37, 95% CI: 1.33-1.41) and self-based (OR = 1.55, 95% CI: 1.47-1.63) concepts increased with aging. People born around the 1940s have a comparatively higher possibility to perceive that the primary eldercare responsibility should be undertaken by the government and elder parents. In contrast, people born in the younger cohort were more likely to perceive that adult children are responsible for their parents' primary eldercare. Filial piety score slightly increased with aging (β = 0.18, SD: 0.05) but decreased as the birth cohort was younger. In addition, rural participants were more likely to perceive offspring-based eldercare and maintain filial piety, and the related urban-rural difference was intensified by aging.
CONCLUSIONS
The traditional concept that eldercare solely relies on offspring has changed to relying on multiple entities, including the government and self-reliance. Diluted filial piety in people born in the young cohort requires reinforcement. Moreover, future healthy aging policies need to focus more on urban-rural disparities to promote equity in social well-being.
Topics: Humans; China; Female; Male; Middle Aged; Rural Population; Aged; Urban Population; Adult; Cohort Studies; Intergenerational Relations; Pensions; Surveys and Questionnaires; Social Responsibility
PubMed: 38909187
DOI: 10.1186/s12889-024-19175-5 -
BMJ Open Jun 2024Clinical practice guidelines (CPGs) are essential for standardising patient care based on evidence-based medicine. However, the presence of financial conflicts of...
OBJECTIVE
Clinical practice guidelines (CPGs) are essential for standardising patient care based on evidence-based medicine. However, the presence of financial conflicts of interest (COIs) among CPG authors can undermine their credibility. This study aimed to examine the extent and size of COIs among authors of psychiatry CPGs in Japan.
METHODS
This cross-sectional analysis of disclosed payments from pharmaceutical companies assesses the prevalence and magnitude of personal payments for lecturing, consulting and writing to CPGs for bipolar disorder and major depressive disorder in Japan between 2016 and 2020.
RESULTS
This study found that 93.3% of authors received payments over a 5-year period, with total payments exceeding US$4 million. The median payment per author was US$51 403 (IQR: US$9982-US$111 567), with a notable concentration of payments among a small number of authors, including the CPG chairperson. Despite these extensive financial relationships, only a fraction of authors disclosed their COIs in the CPGs. These large amounts of personal payments were made by pharmaceutical companies manufacturing new antidepressants and sleeping aids listed in the CPGs.
CONCLUSIONS
This study found that more than 93% of authors of CPGs for major depressive disorder and bipolar disorder in Japan received considerable amounts of personal payments from the pharmaceutical industry. The findings highlight deviations from international COI management standards and suggest a need for more stringent COI policies for psychiatry CPGs in Japan.
Topics: Humans; Japan; Depressive Disorder, Major; Cross-Sectional Studies; Drug Industry; Conflict of Interest; Bipolar Disorder; Practice Guidelines as Topic; Disclosure; Authorship
PubMed: 38908845
DOI: 10.1136/bmjopen-2024-086396 -
Globalization and Health Jun 2024This study delves into the States' accountability for health-related Sustainable Development Goal (SDG) indicators from 2016 to 2020. An analysis of Voluntary National... (Review)
Review
BACKGROUND
This study delves into the States' accountability for health-related Sustainable Development Goal (SDG) indicators from 2016 to 2020. An analysis of Voluntary National Reviews (VNR) is employed as an instrument to scrutinize the alignment of States' indicators with the global indicator framework, shedding light on global health governance within the context of the 2030 Agenda and States' strategic prioritization. A curation of 60 health-related indicators from 195 VNRs, produced during the aforementioned period, is organized into thematic groups.
RESULTS
Our results highlight a concerning discrepancy in the reporting frequency of various health-related themes. The findings reveal a paradoxical coexistence characterized by the concurrent strengthening and diminution of the global health governance articulated in the Agenda's global health governance. This manifests in the increased utilization and consistency of health-related indicators over the study years, coupled with an emphasis on infectious diseases and child and maternal health indicators. Conversely, a discernible governance decline is evidenced by the inadequate representation of health-related indicators in VNRs, notably within the domains of universal health coverage and health system indicators. Furthermore, High-Income States exhibit diminished accountability.
CONCLUSIONS
The VNRs unveil a paradox wherein burgeoning technical capacity coexists with governance deficits, a phenomenon attributable to both statistical capabilities and political preferences. The prevalent use of proxy indicators in VNRs oversimplifies the presentation of official indicators, thereby compromising the aspirational goal of pioneering statistical innovations for measuring intricate issues in the SDGs. In light of our conceptualization of the 2030 Agenda's global health as a regime complex governance, we advocate for comprehensive investigations into each health regime cluster. This approach aims to unravel disputes, discern patterns, and elucidate States' preferences concerning specific thematic areas. Functioning as an accountability mechanism for the Agenda's governance, VNRs underscore States' adaptability and short-term learning capabilities, offering valuable insights for identifying harmful goal prioritization. The discretionary nature of indicator selection by States in the VNRs, enabled by the Agenda's proposition of a contextual adaptation of the SDGs and a blind eye to the guideline's request to review all SDG indicators, highlights a critical flaw in the VNR as an accountability mechanism.
Topics: Humans; Global Health; Sustainable Development; Health Status Indicators; Social Responsibility
PubMed: 38907243
DOI: 10.1186/s12992-024-01051-x -
BMC Medical Ethics Jun 2024Studies from different countries report a stagnation or regression of moral competence in medical students between the first and the last year of their studies, and the... (Observational Study)
Observational Study
BACKGROUND
Studies from different countries report a stagnation or regression of moral competence in medical students between the first and the last year of their studies, and the value of various educational interventions remains uncertain.
METHODS
We used Moral Competence Test (MCT) to measure C-scores of moral competence to determine the change in the MCT C-scores between the first- and the fifth-year medical students from two medical schools in the Czech Republic in the academic year 2022/2023 and to analyze factors associated with the C-scores (observational study). In addition, for the first-year students, we compared the results of the MCT before and after an intervention in medical ethics curriculum (interventional study). We used a cross-sectional and descriptive design for the observational study. Students completed the MCT, consisting of two moral dilemmas (Worker´s Dilemma and Doctor´s Dilemma), the results measured by the C-score, which represents moral competence.
RESULTS
In total, 685 students participated in the observational study. Objective 1: based on the analysis of the C-score, we observed a decrease in moral competence between the first and the fifth-year medical students (p < .001). Objective 2: we did not observe a statistically significant effect of gender (p = .278), or self-rated religiosity (p = .163). Objective 3: in the interventional study, 440 students participated in the pretest and 422 students participated in the posttest. The test of statistical significance found no improvement in students' moral competence after the intervention (p = .253).
CONCLUSION
Medical students show a regression in moral competence during medical education; it was lower in medical students in their fifth year, compared to the first-year medical students without the effect of gender, or self-rated religiosity. Although educational intervention consisting of multiple tools of medical ethics teaching (PBL, CBL, KMDD and StorED) did not lead to increase in moral competence, the longitudinal effect of such intervention remains to be seen.
Topics: Humans; Students, Medical; Female; Male; Ethics, Medical; Morals; Cross-Sectional Studies; Curriculum; Czech Republic; Education, Medical, Undergraduate; Adult; Narration; Young Adult
PubMed: 38907238
DOI: 10.1186/s12910-024-01073-5 -
Journal of Neurodevelopmental Disorders Jun 2024Continued dietary treatment since early diagnosis through newborn screening programs usually prevents brain-related complications in phenylketonuria (PKU). However,...
BACKGROUND
Continued dietary treatment since early diagnosis through newborn screening programs usually prevents brain-related complications in phenylketonuria (PKU). However, subtle neurocognitive and brain alterations may be observed in some adult patients despite early treatment. Nevertheless, neuropsychological and neuroimaging studies in the field remain scarce.
OBJECTIVES
This work aimed to determine possible neuropsychological and structural brain alterations in treated adult patients with PKU.
METHODS
Thirty-five patients with PKU and 22 healthy controls (HC) underwent neuropsychological assessment and T1-weighted magnetic resonance imaging on a 3 T scanner. FreeSurfer (v.7.1) was used to obtain volumetric measures and SPSS (v27.0.1.0) was used to analyze sociodemographic, neuropsychological, volumetric, and clinical data (p < 0.05).
RESULTS
Adult patients with PKU showed significantly lower performance than HC in Full Scale IQ (t = 2.67; p = .010) from the WAIS-IV. The PKU group also showed significantly lower volumes than HC in the pallidum (U = 224.000; p = .008), hippocampus (U = 243.000; p = .020), amygdala (U = 200.000; p = .002), and brainstem (t = 3.17; p = .006) as well as in total cerebral white matter volume (U = 175.000; p = .001). Blood phenylalanine (Phe) levels in PKU patients were negatively correlated with the pallidum (r = -0.417; p = .013) and brainstem (r = -0.455, p = .006) volumes.
CONCLUSIONS
Adult patients with early-treated PKU showed significantly lower global intelligence than HC. Moreover, these patients showed reduced global white matter volume as well as reductions in the volume of several subcortical grey matter structures, which might be related to the existence of underlying neurodevelopmental alterations. Higher blood Phe levels were also negatively correlated with pallidum and brainstem, suggesting a higher vulnerability of these structures to Phe toxicity.
Topics: Humans; Phenylketonurias; Phenylalanine; Male; Female; Adult; Magnetic Resonance Imaging; Brain; Young Adult; Neuropsychological Tests
PubMed: 38907189
DOI: 10.1186/s11689-024-09553-w