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PloS One 2024At some point in their career, many healthcare workers will experience psychological distress associated with being unable to take morally or ethically correct action,...
OBJECTIVE
At some point in their career, many healthcare workers will experience psychological distress associated with being unable to take morally or ethically correct action, as it aligns with their own values; a phenomenon known as moral distress. Similarly, there are increasing reports of healthcare workers experiencing long-term mental and psychological pain, alongside internal dissonance, known as moral injury. This review examined the triggers and factors associated with moral distress and injury in Health and Social Care Workers (HSCW) employed across a range of clinical settings with the aim of understanding how to mitigate the effects of moral distress and identify potential preventative interventions.
METHODS
A systematic review was conducted and reported according to recommendations from Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Searches were conducted and updated regularly until January 2024 on 2 main databases (CENTRAL, PubMed) and three specialist databases (Scopus, CINAHL, PsycArticles), alongside hand searches of study registration databases and other systematic reviews reference lists. Eligible studies included a HSCW sample, explored moral distress/injury as a main aim, and were written in English or Italian. Verbatim quotes were extracted, and article quality was assessed via the CASP toolkit. Thematic analysis was conducted to identify patterns and arrange codes into themes. Specific factors like culture and diversity were explored, and the effects of exceptional circumstances like the pandemic.
RESULTS
Fifty-one reports of 49 studies were included in the review. Causes and triggers were categorised under three domains: individual, social, and organisational. At the individual level, patients' care options, professionals' beliefs, locus of control, task planning, and the ability to make decisions based on experience, were indicated as elements that can cause or trigger moral distress. In addition, and relevant to the CoVID-19 pandemic, was use/access to personal protection resources. The social or relational factors were linked to the responsibility for advocating for and communication with patients and families, and professionals own support network. At organisational levels, hierarchy, regulations, support, workload, culture, and resources (staff and equipment) were identified as elements that can affect professionals' moral comfort. Patients' care, morals/beliefs/standards, advocacy role and culture of context were the most referenced elements. Data on cultural differences and diversity were not sufficient to make assumptions. Lack of resources and rapid policy changes have emerged as key triggers related to the pandemic. This suggests that those responsible for policy decisions should be mindful of the potential impact on staff of sudden and top-down change.
CONCLUSION
This review indicates that causes and triggers of moral injury are multifactorial and largely influenced by the context and constraints within which professionals work. Moral distress is linked to the duty and responsibility of care, and professionals' disposition to prioritise the wellbeing of patients. If the organisational values and regulations are in contrast with individuals' beliefs, repercussions on professionals' wellbeing and retention are to be expected. Organisational strategies to mitigate against moral distress, or the longer-term sequalae of moral injury, should address the individual, social, and organisational elements identified in this review.
Topics: Humans; Health Personnel; Morals; Social Workers; Qualitative Research; COVID-19; Psychological Distress; Stress, Psychological
PubMed: 38935754
DOI: 10.1371/journal.pone.0303013 -
PloS One 2024Among the consequences of systemic racism in health care are significant health disparities among Black/African American individuals with comorbid physical and mental...
Among the consequences of systemic racism in health care are significant health disparities among Black/African American individuals with comorbid physical and mental health conditions. Despite decades of studies acknowledging health disparities based on race, significant change has not occurred. There are shockingly few evidence-based antiracism interventions. New paradigms are needed to intervene on, and not just document, racism in health care systems. We are developing a transformative paradigm for new antiracism interventions for primary care settings that integrate mental and physical health care. The paradigm is the first of its kind to integrate community-based participatory research and systems science, within an established model of early phase translation to rigorously define new antiracism interventions. This protocol will use a novel application of systems sciences by combining the qualitative systems sciences methods (group model building; GMB) with quantitative methods (simulation modeling) to develop a comprehensive and community-engaged view of both the drivers of racism and the potential impact of antiracism interventions. Community participants from two integrated primary health care systems will engage in group GMB workshops with researchers to 1) Describe and map the complex dynamic systems driving racism in health care practices, 2) Identify leverage points for disruptive antiracism interventions, policies and practices, and 3) Review and prioritize a list of possible intervention strategies. Advisory committees will provide feedback on the design of GMB procedures, screen potential intervention components for impact, feasibility, and acceptability, and identify gaps for further exploration. Simulation models will be generated based on contextual factors and provider/patient characteristics. Using Item Response Theory, we will initiate the process of developing core measures for assessing the effectiveness of interventions at the organizational-systems and provider levels to be tested under a variety of conditions. While we focus on Black/African Americans, we hope that the resulting transformative paradigm can be applied to improve health equity among other marginalized groups.
Topics: Humans; Primary Health Care; Health Equity; Racism; Black or African American; Community-Based Participatory Research; Healthcare Disparities; Antiracism
PubMed: 38935743
DOI: 10.1371/journal.pone.0306185 -
PloS One 2024The transformation of the food and industrial agricultural production system into adaptative and sustainable systems capable of being productive within social,...
The transformation of the food and industrial agricultural production system into adaptative and sustainable systems capable of being productive within social, environmental, and economic limits is a crucial factor in reducing the risk to food security and to economic growth. However, the analysis structure of the effect of these variables in sustainable environments remains unknown, whereby the technology and processes are considered as variables of the equivalent critical level as those already described. The purpose of this study is to design a model that enables the characterisation of the agri-food sector based on the determination of sustainable variables from a sustainable and integral systemic approach. Tools, such as the viable system model, are employed to analyse the dynamics and generate the balanced scorecard, to which the items of learning and continuous improvement are added. Lastly, the impact of the principles of sustainability versus the variation of sustainability in the agri-food system is revealed, which is useful in determining the appropriate levels to guarantee a balance in the foundations of circularity. From a systemic approach, this model can be adopted by agronomists and scientists to design alternative strategies for the management of food sustainability.
Topics: Agriculture; Models, Theoretical; Sustainable Development; Humans; Food Supply; Conservation of Natural Resources
PubMed: 38935702
DOI: 10.1371/journal.pone.0305743 -
PloS One 2024Front-of-package labels indicating a product's environmental footprint (i.e., eco-score labels) offer promise to shift consumers towards more sustainable food choices.... (Randomized Controlled Trial)
Randomized Controlled Trial
Front-of-package labels indicating a product's environmental footprint (i.e., eco-score labels) offer promise to shift consumers towards more sustainable food choices. This study aimed to understand whether eco-score labels impacted consumers' perceptions of environmental sustainability and intentions to purchase sustainable and unsustainable foods. US parents (n = 1,013) completed an online experiment in which they were shown 8 food products (4 sustainable and 4 unsustainable). Participants were randomized to a control (n = 503, barcode on product packaging) or eco-score label group (n = 510, eco-score label on product packaging). The eco-score label was color-coded with a grade of A-F based on the product's environmental footprint, where "A" indicates relative sustainability and "F" indicates relative unsustainability. Participants rated each product's environmental sustainability and their future likelihood of purchase. We used multilevel mixed-effects linear regression models and examined moderation by product category and sociodemographic characteristics. The eco-score label lowered perceived sustainability of unsustainable products by 13% in relative terms or -0.4 in absolute terms (95% CI -0.5, -0.3; p<0.001). The eco-score label increased perceived sustainability of sustainable products by 16% in relative terms or 0.6 in absolute terms (95% CI 0.5, 0.7, p<0.001). Effects on purchase intentions were smaller, with a 6% decrease for unsustainable products (p = 0.001) and an 8% increase for sustainable products (p<0.001). For unsustainable products, the effect of eco-score labels on sustainability perceptions was greater for older adults, men, participants with higher educational attainment, and participants with higher incomes. For sustainable products, the effect of ecolabels on sustainability perceptions was greater for those with higher educational attainment. Eco-score labels have the potential to direct consumers towards more sustainable products. Future studies should investigate eco-score label effectiveness on behavioral outcomes.
Topics: Humans; Male; Consumer Behavior; Female; Adult; Food Labeling; Intention; Middle Aged; United States; Conservation of Natural Resources; Food Preferences; Young Adult; Perception; Choice Behavior; Adolescent
PubMed: 38935699
DOI: 10.1371/journal.pone.0306123 -
PloS One 2024Rising income inequality challenges economic and social stability in developing countries. For China, the fastest-growing global digital economy, it could be an...
Rising income inequality challenges economic and social stability in developing countries. For China, the fastest-growing global digital economy, it could be an effective tool to promote inclusive development, narrowing urban-rural income disparity. It investigates the role of digital financial inclusion (DFI) in narrowing the urban-rural income gap. The study uses panel data from 52 counties in Zhejiang Province, China, from 2014 to 2020. The results show that the development of DFI significantly reduces rural-urban and rural income inequality. The development of DFI helps optimize industrial structure and upgrade the internal structure of agriculture, facilitating income growth for people in rural areas. Such effects are greater in poorer counties. Our findings provide insights into why rapid DFI and the narrowing of the rural-urban income disparity exist in China. Moreover, our results provide clear policy implications on how to reduce the disparity. The most compelling suggestion is that promoting the optimization of industrial structure through DFI is crucial for narrowing the urban-rural income gap.
Topics: China; Income; Rural Population; Urban Population; Humans; Socioeconomic Factors; Industry
PubMed: 38935697
DOI: 10.1371/journal.pone.0303666 -
PloS One 2024Vietnam has achieved significant economic growth, poverty reduction, and social transformation since its 1986 major economic reform. However, industrialization, a key...
Vietnam has achieved significant economic growth, poverty reduction, and social transformation since its 1986 major economic reform. However, industrialization, a key pillar supporting this achievement, has resulted in massive domestic migration from certain parts of the country into industrialized provinces mainly located in the south of Vietnam, leading to various challenges for society. This study investigates the effects of the characteristics of Vietnamese households and their heads, environmental factors, and living conditions of the households in the regions where they have decided to leave behind for a migration decision on domestic migration. Our study also compares the migration trends in the past decade using the Vietnamese Household Living Standard Surveys (VHLSS) in 2010 and 2020, together with a logit model. We find that the average probability that a household and their members migrate is about 10 per cent in 2010, reduced to approximately 6.8 per cent in 2020. Our empirical findings also confirm that a migration decision is strongly associated with the characteristics of the households and their heads, particularly for the household size and the educational level of the household head. The average radiation and rainfall are also associated with a migration decision. Weather temperature, water sources, and electricity supply also play an essential role in Vietnamese households' migration decisions. Policy implications have emerged based on these empirical findings that the Vietnamese government should consider.
Topics: Vietnam; Humans; Family Characteristics; Environment; Male; Female; Socioeconomic Factors
PubMed: 38935689
DOI: 10.1371/journal.pone.0304321 -
PloS One 2024To bolster the dual-circulation development model and green economy, this study delves into the spatiotemporal dynamics of implied carbon transfer in China's...
To bolster the dual-circulation development model and green economy, this study delves into the spatiotemporal dynamics of implied carbon transfer in China's inter-provincial and inter-industrial trade, emphasizing its significance for the "dual carbon" objectives. Utilizing multi-regional input-output data from 2012, 2015, and 2017, we employed the multi-region input-output model to gauge embodied carbon transfers across 31 provinces and 28 industries. The Structural Decomposition Analysis (SDA) model further decomposed the growth of trade-related carbon emissions. Key findings include: (1) The electricity and thermal power sectors dominate carbon transfers, with secondary industries seeing rapid growth; (2) Northern provinces significantly outweigh southern ones in carbon transfers and the main direction of it is towards affluent southern coastal regions; (3) Scale effect plays a pivotal role in these transfers. Conclusively, it is crucial for regulatory authorities to rationally formulate region-specific emission policies for inter-regional coordination, and future studies can focus on industrial and spatial clustering effects.
Topics: China; Carbon; Industry
PubMed: 38935676
DOI: 10.1371/journal.pone.0300478 -
PloS One 2024The role of non-kin caregivers, such as friends, neighbours, and acquaintances, in providing end-of-life care is significant but often overlooked in research and policy...
BACKGROUND
The role of non-kin caregivers, such as friends, neighbours, and acquaintances, in providing end-of-life care is significant but often overlooked in research and policy discussions. These caregivers provide extensive support for individuals in end-of-life care, in addition to or instead of family members. However, there is limited evidence in the literature regarding the experiences, burdens, and benefits of non-kin caregivers.
AIMS
The aim of this research is to examine the role and contributions of non-kin caregivers in end-of-life care. The study intends to uncover their experiences, associated challenges, benefits, and requirements for support.
METHODS
In order to achieve this objective, a mixed-methods approach will be employed, gathering data through structured questionnaires from approximately 150 non-kin caregivers and in-depth interviews with up to 25 participants. The questionnaires will measure the impact, burden, and benefits of caregiving. The Burden Scale for Family Caregivers, the Benefits of Being a Caregiver Scale, the Family Inventory of Needs, the Positive Mental Health Scale, a Graphic Closeness Scale, and selected items of the Eurofamcare Common Assessment Tool for socio-demographic and caregiving-related data will be used. Quantitative data will be analysed using IBM SPSS Statistics 28 for descriptive analysis and group comparison. The objective of the qualitative in-depth interviews is to obtain a comprehensive picture of the personal experiences, motivations and support needs of members of the non-kin caregivers cohort, who are as heterogeneous as possible in terms of gender, socio-economic status, and facility with the German language. The qualitative data from the interviews will be examined using MAXQDA software, adopting a grounded theory approach for analysis.
DISCUSSION
This research will develop a comprehensive framework that captures the nuanced experiences of non-kin caregivers at the end of life. The framework will identify areas where support for non-kin caregivers is lacking and where further research is needed.
TRIAL REGISTRATION
The study was prospectively registered in the German Clinical Trials Register (Deutsches Register Klinischer Studien) (Registration N° DRKS00033889; date of registration: 05 April 2024). The study is searchable under the International Clinical Trials Registry Platform Search Portal of the World Health Organization, under the German Clinical Trials Register number.
Topics: Humans; Caregivers; Terminally Ill; Surveys and Questionnaires; Terminal Care; Family; Male; Female
PubMed: 38935665
DOI: 10.1371/journal.pone.0306282 -
PloS One 2024Research on gender inequality is crucial as it unveils the pervasive disparities that persist across various domains, shedding light on societal imbalances and providing...
BACKGROUND
Research on gender inequality is crucial as it unveils the pervasive disparities that persist across various domains, shedding light on societal imbalances and providing a foundation for informed policy-making.
AIM
To investigate gender differences in scientometric indices among faculty members in dental schools across Iran. This included overall data and speciality-specific data.
METHODS
The publication profiles of academic staff in all dental schools were examined using the Iranian Scientometric Information Database (ISID, http://isid.research.ac.ir). Variables analyzed were working field, academic degree, the total number of papers, papers per year, total number of citations, percentage of self-citation, h-index, g-index, citations per paper, gender, university type, number of years publishing, proportion of international papers, first-author papers, and corresponding-author papers. Mann-Whitney and Kruskal-Wallis nonparametric tests were used to analyze the relationship between background characteristics and scientometric indicators. The extracted data were analyzed using R v4.0.1.
RESULTS
The database included 1850 faculty members, of which about 60% (1104 of 1850) were women. Men (n = 746) had a higher number of papers (6583 vs. 6255) and citations (60410 vs. 39559) compared with women; 234 of the 376 faculty members with no papers were women. Almost half of the women (N = 517 of 1104) were in Type 2 universities, and nearly half of the men (N = 361 of the 746) were faculty members at Type 1 universities (Type 1 universities ranking higher than Type 2 and 3 universities). The medians of scientometric indices were higher in men, except for self-citation percentage (0 (IQR = 2) vs. 0 (IQR = 3), P = 0.083), international papers percentage (0 (IQR = 7.5) vs. 0 (IQR = 16.7), P<0.001). The proportion of corresponding-author papers was more than 62% higher in women (25 (IQR = 50) vs. 15.4 (IQR = 40), P<0.001). Men had a two-fold higher median h-index (2 (IQR = 4) vs. 1 (IQR = 3), P<0.001). Restorative dentistry and pediatric dentistry had the highest men-to-women ratios (1.5 for both). Dental materials and oral and maxillofacial surgery showed the lowest men-to-women ratios (0.42 and 0.5, respectively).
CONCLUSIONS
Women made up the majority of dental faculty members in Iran. Nevertheless, men showed better scientometric results in several significant indices. Having identified scientometric information reflecting differences across faculty members, further research is now needed to better understand the drivers of these differences.
Topics: Iran; Humans; Male; Female; Faculty, Dental; Publications; Bibliometrics; Sex Distribution; Schools, Dental; Publishing
PubMed: 38935641
DOI: 10.1371/journal.pone.0300698 -
PloS One 2024A lifestyle front office (LFO) in the hospital is a not yet existing, novel concept that can refer patients under treatment in the hospital to community-based lifestyle...
Implementation barriers and facilitators for referral from the hospital to community-based lifestyle interventions from the perspective of lifestyle professionals: A qualitative study.
PURPOSE
A lifestyle front office (LFO) in the hospital is a not yet existing, novel concept that can refer patients under treatment in the hospital to community-based lifestyle interventions (CBLI). The aim of this study was to identify implementation barriers and facilitators regarding the implementation of an LFO in the hospital from the perspective of CBLI-professionals and to develop evidence-based implementation strategies to reduce these identified barriers.
METHODS
We conducted semi-structured interviews until data saturation, with 23 lifestyle professionals working in the community. A semi-structured topic guide was used, inquiring about (1) community-based lifestyle interventions; (2) their views about referral from the LFO; and (3) their preferences, needs and recommendations for collaboration with the LFO in the hospital. The online interviews lasted on average 46 minutes, were audio-recorded and transcribed verbatim. A thematic content analysis was conducted. Found barriers and facilitators regarding the LFO where mapped using the consolidated framework for implementation research (CFIR) whereafter evidence based strategies were developed using the CFIR-Expert Recommendations for Implementing Change Strategy Matching Tool V.1.0 (CFIR-ERIC).
RESULTS
Barriers and facilitators were divided into two main themes: 1) barriers and facilitators related to the referral from LFO to CBLI (i.e. financial, cultural, geographical, quality) and 2) barriers and facilitators related to the collaboration between LFO and CBLI (i.e. referral, communication platform and partnership). Thirty-seven implementation strategies concerning 15 barriers were developed and clustered into six overarching strategies: identify referral options, determine qualifications lifestyle professionals, develop support tools, build networks, facilitate learning collaboratives, and optimize workflow.
CONCLUSIONS
In this study, barriers and facilitators for the development of the LFO were found and matching implementation strategies were developed. Practical improvements, like identifying specific referral options or develop support tools, can be implemented immediately. The implementation of other strategies, like connecting care pathways in basic services, primary, secondary and tertiary care, will take more time and effort to come to full potential. Future research should evaluate all implemented strategies.
Topics: Humans; Referral and Consultation; Qualitative Research; Life Style; Female; Male; Adult; Middle Aged; Hospitals; Health Personnel
PubMed: 38935601
DOI: 10.1371/journal.pone.0304053