Combatting Covid-19. Or, "All Persons Are Equal but Some Persons Are More Equal than Others?"

Vaccines, when available, will prove to be crucial in the fight against Covid-19. All societies will face acute dilemmas in allocating scarce lifesaving resources in the form of vaccines for Covid-19. The author proposes The Value of Lives Principle as a just and workable plan for equitable and efficient access. After describing what the principle entails, the author contrasts the advantage of this approach with other current proposals such as the Fair Priority Model.

Do Black, Asian and Minority Ethnic nurses and midwives experience a career delay? A cross-sectional survey investigating career progression barriers

BACKGROUND

Black, Asian and Minority Ethnic nurses and midwives are under-represented in higher and managerial roles.

AIMS

This study explored the presence and nature of career progression delays for Black, Asian and Minority Ethnic nurses and midwives and investigated where the barriers to progression were.

DESIGN

A secondary analysis of data from a wider cross-sectional survey investigating workplace experiences, burnout and patient safety in nurses and midwives.

METHODS

538 nurses and midwives were recruited from four UK hospitals between February and March 2017. A career progression delay was viewed as being present if Black, Asian and Minority Ethnic nurses and midwives had spent longer on the entry level nursing grade and less time on higher grades in the previous 10 years. The analysis included items pertaining to: receipt of professional training, perceived managerial support for progression, likelihood of submitting applications and application success rates. Data were analysed using linear regression, odds ratios and t-tests. Results were reported using the STROBE Checklist.

RESULTS

Black, Asian and Minority Ethnic nurses and midwives (n = 104; 19.4%) had spent more months working at the entry-level grade (M = 75.75, SD = 44.90) than White nurses and midwives (n = 428; 79.7%; M = 41.85, SD = 44.02, p < 0.001) and fewer months at higher grades (M = 15.29, SD = 30.94 v 29.33, SD = 39.78, p = 0.006 at Band 6; M = 6.54, SD = 22.59 v M = 19.68, SD = 37.83, p = 0.001 at Band 7) over the previous 10 years. Black, Asian and Minority Ethnic nurses and midwives were less likely to have received professional training in the previous year (N = 53; 53.0% v N = 274; 66.0%, p = 0.015) and had to apply for significantly more posts than White nurses and midwives before gaining their first post on their current band (M = 1.22, SD = 1.51 v M = 0.81, SD = 1.55, p = 0.026).

CONCLUSIONS

Interventions are needed to improve racial equality regarding career progression in nurses and midwives. Increasing access to professional training and reducing discriminatory practice in job recruitment procedures may be beneficial.

IMPACT STATEMENT

Black, Asian and Minority Ethnic nurses and midwives experience career progression inequalities. Interventions should improve transparency in recruitment procedures and enhance training opportunities.

Nothing About Us Without Us - Towards Genuine Inclusion of Disabled Scientists and Science Students Post Pandemic

Scientists and students with disabilities have been severely affected by the COVID-19 pandemic, and this must be urgently addressed to avoid further entrenching existing inequalities. The need for rapid decision-making, often by senior colleagues without lived experience of disabilities, can lead to policies which discriminate against scientists with disabilities. This article reflects on disability declaration statistics and research in critical disability studies and social science to explore the challenges experienced by disabled scientists before and during the COVID-19 pandemic and highlights recommendations and examples of good practice to adopt in order to challenge ableism in STEM communities and workplaces. It is vital that disabled staff and students are fully involved in decision making. This is particularly important as we continue to respond to the challenges and opportunities associated with the ongoing COVID-19 pandemic and plan for a post-COVID-19 future. This time of great change can be used as an opportunity to listen, learn, and improve working conditions and access for scientists with disabilities, and by doing so, for everyone.

Engendering Governance After Armed Conflict: Observations From Kosovo

This article addresses gender-responsive governance reforms in post-conflict Kosovo from two perspectives: (1) the perspective of human rights as fundamental for state-building, and (2) the resolutions of the UN Security Council regarding Women, Peace, and Security (WPS), notably the initial UNSCR 1325. Special focus is laid on women's agency in governance matters-at the level of the state and at the level of civil society. A gender approach to three dimensions of governance-political-administrative governance, security governance, and socioeconomic governance-shows successes and problems in this post-conflict society. Special attention is given to the strategies of the women's movement in reaching gender-responsive governance. Some initiatives for new masculinities address the necessity of norm change in gender governance. The analysis of the literature and documents, supplemented by interviews, reveals the transformative potential of gender governance that solidly roots in women's rights and combines a multi-actor approach at grassroots, and at national and international levels with strong alliances and very concrete actions.

Gender Bias Impacts Top-Merited Candidates

Expectations of fair competition underlie the assumption that academia is a meritocracy. However, bias may reinforce gender inequality in peer review processes, unfairly eliminating outstanding individuals. Here, we ask whether applicant gender biases peer review in a country top ranked for gender equality. We analyzed peer review assessments for recruitment grants at a Swedish medical university, Karolinska Institutet (KI), during four consecutive years (2014-2017) for Assistant Professor (n = 207) and Senior Researcher (n = 153). We derived a composite bibliometric score to quantify applicant productivity and compared this score with subjective external (non-KI) peer reviewer scores of applicants' merits to test their association for men and women, separately. To determine whether there was gender segregation in research fields, we analyzed publication list MeSH terms, for men and women, and analyzed their overlap. There was no gendered MeSH topic segregation, yet men and women with equal merits are scored unequally by reviewers. Men receive external reviewer scores resulting in stronger associations (steeper slopes) between computed productivity and subjective external reviewer scores, meaning that peer reviewers "reward" men's productivity with proportional merit scores. However, women applying for assistant professor or senior researcher receive only 32 or 92% of the score men receive, respectively, for each additional composite bibliometric score point. As productivity increases, the differences in merit scores between men and women increases. Accumulating gender bias is thus quantifiable and impacts the highest tier of competition, the pool from which successful candidates are ultimately chosen. Track record can be computed, and granting organizations could therefore implement a computed track record as quality control to assess whether bias affects reviewer assessments.

Should we accept a higher cost per health improvement for orphan drugs? A review and analysis of egalitarian arguments

In recent years, the issue of accepting a higher cost per health improvement for orphan drugs has been the subject of discussion in health care policy agencies and the academic literature. This article aims to provide an analysis of broadly egalitarian arguments for and against accepting higher costs per health improvement. More specifically, we aim to investigate which arguments one should agree upon putting aside and where further explorations are needed. We identify three kinds of arguments in the literature: considerations of substantial equality, formal equality, and opportunity cost. We argue that considerations of substantial equality do not support higher costs per health improvement orphan drugs, even if such considerations are considered valid. On the contrary, arguments of formal equality may support accepting a higher cost per health improvement for orphan drugs. However, in order to do so, a number of both normative and empirical issues must be resolved; these issues are identified in the article. For instance, it must be settled to what extent the opportunity cost in terms of foregone health for other patients is acceptable in order to uphold formal equality. We conclude that certain arguments can be set aside, and future focus should be put on the unresolved normative and empirical issues related to formal equality and opportunity cost.

Are Dimensions of Gender Inequality Uniformly Associated With Human Values?

A previous work of Schwartz and Rubel-Lifschitz (2009, https://doi.org/10.1037/a0015546) highlighted the association between human values and gender equality. However, gender equality is not a monolith. Indeed, it is a multidimensional phenomenon. We started from this multidimensionality to understand how the relative importance of human values varies through the different dimensions of Gender Equality Index (GEI)-namely work, money, knowledge, time, power, and health. We have designed a cross-national study based on secondary data analysis from international databases (i.e., European Social Survey [ESS] and GEI). Through the Bayesian correlational analysis of 18 European countries, findings revealed that 1) universalism, benevolence and self-direction are strongly and positively correlated to gender equality; 2) security, power and achievement are strongly and negatively correlated to equality while 3) conformity, tradition, stimulation, and hedonism have weak/non-significant correlation coefficients with gender equality. Relevance to cultural values and ideologies that support social equality are discussed. Furthermore, we find that some values are related to certain specific gender equality dimensions. Our results provide a more fine-grained analysis compared to previous findings, by outlining a more complex scenario.

Against Empathy Bias: The Moral Value of Equitable Empathy

Empathy has long been considered central to living a moral life. However, mounting evidence has shown that people's empathy is often biased toward (i.e., felt more strongly for) others that they are close or similar to, igniting a debate over whether empathy is inherently morally flawed and should be abandoned in efforts to strive toward greater equity. This debate has focused on whether empathy limits the scope of our morality, but little consideration has been given to whether our moral beliefs may be limiting our empathy. Across two studies conducted on Amazon's Mechanical Turk (N = 604), we investigated moral judgments of biased and equitable feelings of empathy. We observed a moral preference for empathy toward socially close over distant others. However, feeling equal empathy for all people is seen as the most morally and socially valuable approach. These findings provide new theoretical insight into the relationship between empathy and morality, and they have implications for navigating toward a more egalitarian future.

Understanding nurses' responsibilities in promoting equality and diversity

Nurses have a duty to promote the values of equality and diversity during their interactions with patients and their families and carers, as well as peers and colleagues. This article defines the terms equality, diversity and inclusion, and explains the importance of the Equality Act 2010 and the Human Rights Act 1998 in protecting people from various types of discrimination. It also outlines nurses' responsibilities in promoting equality and diversity by treating all patients and colleagues with respect and dignity, providing compassionate leadership, and practising in accordance with the ethical principle of justice. The article encourages and empowers nurses to recognise and challenge discrimination wherever they see it, thereby delivering high-quality care to all patients.

Moving academic conferences online: Aids and barriers to delegate participation

In-person academic conferences are important to disseminate research and provide networking opportunities. Whether academics attend in-person conferences is based on the cost, accessibility, and safety of the event. Therefore, in-person conferences are less accessible to academics and stakeholders that are unable to overcome some of these factors, which then act as a barrier to equal and inclusive participation. Additionally, the carbon footprint of conference travel is increasingly becoming a factor in deciding on whether to attend a conference. Online conferences may provide opportunities to mitigate these challenges. Here, we illustrate how a learned society can move their conference online. Then, comparing data acquired from the virtual conference and previous in-person conferences, we explore the aids and barriers influencing the decision of delegates to attend the meetings. Ultimately, moving meetings online aids delegate participation by removing concerns about travel, cost, and carbon emissions, but there remains a barrier to participation as online meetings are perceived as less effective for networking and social opportunities.

Nordic welfare states-still standing or changed by the COVID-19 crisis?

Nordic welfare states are known for their universalistic and all-encompassing approach to welfare and having a long tradition for active labour market policy as tool in economic crises with adverse impact on employment. They have had a long tradition for strong egalitarian approaches and their residents are consistently among the happiest in the world. A key issue is whether a crisis like the COVID-19 outbreak is changing the Nordic welfare states. This article focuses on providing a description of what instruments the Nordic countries have taken or expect to use as part of dealing with the welfare challenges resulting from rising unemployment and greater social and economic insecurity in the wake of the crisis. The tentative conclusion is that the crisis so far has strengthened key characteristics of the Nordic welfare states by the state taking on a strong central role not only for the functioning of the market but also continued in a path-dependent way with universal and relatively generous benefits such as for those who become unemployed or have reduced income because of the crisis.

"Equality", the "Capability Approach" and the Ethical Health Care Paradigm: The Interface

As a means of abating the crises of society, the idea of equality has long been a progressive, universal, moral and legal principle to seek justice. However, equality is open to a broad spectrum of meanings and practical applications, mainly due to its endorsement of different interpretations and concepts that give rise to complementary and competing interests. Likewise, the "capability approach", which is proposed as an alternative to the "ideal of equality", is not only contentious but also insufficient to build the theoretical basis of an ethical health care paradigm. This article aims to expand the discussion on the ambiguity around the concept of equality, particularly how it interacts with the diversities in human capabilities in a given context.

Gender equality in academic publishing: action from the BJPsych

Women in academic publishing and academic psychiatry face many challenges of gender inequality, including significant pay differentials, poor visibility in senior positions and a male-dominated hierarchical system. We discuss this problem and outline how the BJPsych plans to tackle these issues it in its own publishing.

Cracking and moderating secularist assumptions

The four articles that make up this symposium on Tariq Modood's recent collection, Essays on Secularism and Multiculturalism (2019), are based on a public conversation and research colloquium held at Utrecht University on 18 February 2020. In the first article, Modood introduces the conversation with a statement of his thinking over two decades on the subjects of secularism and multiculturalism. This is followed by responses by Pooyan Tamimi Arab and Ernst van den Hemel and, in the fourth and final article, Modood has the last word.

Women and children first? Gender equity in paediatric medicine

There has been an increased focus on diversity and inclusion in medicine in recent years-the field of medicine still has a long way to go to reach gender equity. We assess how paediatrics is performing by examining the role gender plays in our specialty; and we propose some practical solutions to reach an equitable state. Achieving gender equity is not a simple or easy option and will require an ongoing commitment from all facets of the profession.

COVID-19: Another Look at Solidarity

Is there such a thing as corona solidarity? Does voluntary mutual aid solve the problems caused by COVID-19? I argue that the answer to the first question is “yes” and to the second “no.” Not that the answer to the second question could not, in an ideal world, be “yes,” too. It is just that in this world of global capitalism and everybody looking out for themselves, the kind of communal warmth celebrated by the media either does not actually exist or is too weak to rule out the uglier manifestations of group togetherness, driven partly by the pandemic. I make my point by offering two approaches to understanding what solidarity is. According to the first, it is essentially partiality: “us” against “them.” According to the second, it can be many things, including the impartial promotion of the good of others. I show that the second reading would make it possible for mutual aid to solve the problems caused by COVID-19 and other crises. This would happen at the expense of conceptual clarity, but that is a minor concern. The major concern is that the more natural manifestations of group togetherness are incited by negative feelings. This is par for the course within the narrower reading of solidarity, but it means that the potentially positive ideas of identity, care, communal values, and special relations are displayed in violent confrontation instead of a calm recognition of the threats that most of us face together.

Women and the weight of a pandemic: A survey of four Western US states early in the Coronavirus outbreak

In the initial months of the COVID‐19 outbreak in the United States, people struggled to adjust to the new normal. The burden of managing changes to home and work life seemed to fall disproportionately to women due to the nature of women's employment and gendered societal pressures. We surveyed residents of four western states in the first months of the outbreak to compare the experiences of women and men during this time. We found that women were disproportionately vulnerable to workplace disruptions, negative impacts on daily life, and increased mental load. Women with children and women who lost their jobs were particularly impacted. These results contribute to the growing body of findings about the disproportionate impacts of crises on women and should inform organizational and government policies to help mitigate these impacts and to enhance societal resilience in future emergencies.

Understanding equality and diversity in nursing practice

Equality and diversity are terms that are used frequently in nursing, healthcare and workplace settings. Nurses' professional standards of practice and behaviour are underpinned by values of equality and diversity. This means that nurses must treat people as individuals, avoid making assumptions about them, recognise diversity and individual choice, and respect and uphold their dignity and human rights. This article explores what equality and diversity mean in nursing practice, the legal framework that underpins these terms, and the inequalities and discrimination that patients and staff may experience in health and social care settings. It discusses the role of organisational culture in supporting nurses to uphold the values of equality and diversity and encourages nurses to reflect on this topic to enhance their practice.

The Work of Oliver R. Avison in Comparison to that of Albert Schweitzer from a Post-Colonial Perspective

Compared to Nobel Prize Laureate Albert Schweitzer, Oliver R. Avison is not well known. Seeking to achieve more international recognition for Avison, this article elaborates on Avison's work with hospital and educational institutions from a post-colonial perspective. Schweitzer and Avison each wrote their memoires in an autobiographical style, and this article deals primarily with those writings, which are published under the titles Out of My Life and Thought by Schweitzer and The Land of the Morning Calm by Avison. Schweitzer and Avison were contemporaries and worked in medical service in the colonial period. Thus, they have certain commonalities. However, this article will elaborate on how Avison approached his mission differently in order to promote sustainability, equality and subjectivity in his work. Avison carried out more than mere charity work, he also accomplished sustainable development of his hospital, as well as its affiliated educational institution. The current circumstances of Severance Hospital and Yonsei University in Korea, compared to that of the Albert Schweitzer Hospital in Lambaréné, are clear evidence of this. Avison's extraordinary missionary work did not reflect the more negative side effects of colonial heritage intertwined with mission work in the 19th Century. Avison's case should be better known as a model of ecumenical mission towards sustainable development.

Perspectives and Experiences of Obstetricians Who Provide Labor and Delivery Care for Micronesian Women in Hawai'i: What Is Driving Cesarean Delivery Rates?

Access to cesarean delivery is vital for quality obstetrical care, but the procedure can increase maternal mortality, morbidity, and complications in subsequent deliveries. The objective of this study was to describe obstetrician-gynecologists' (OB-GYNs) perspectives on labor and delivery care for Micronesian women in Hawai'i and possible factors contributing to higher cesarean delivery rates among that racial/ethnic group. The Framework Method guided the analysis of 13 semi-structured interviews with OB-GYNs. Study results indicated that OB-GYNs were more likely to attribute racial/ethnic differences in mode of delivery to challenges resulting from nonmedical factors, particularly communication and negative attitudes toward Micronesian patients, than to medical risk factors. In this study, we explored aspects of care that cannot be captured in medical charts or clinical data, but may impact health outcomes for this population. The findings could help improve care for Micronesian women, with lessons applicable to other racial/ethnic minority groups.

Could the UK Foundation Programme training post allocation process result in regional variations in the knowledge and skills of Foundation doctors? A cross-sectional study

BACKGROUND AND AIMS

The allocation of medical school graduates to Foundation Schools (post-qualification training, organized at regional level) in the United Kingdom uses a ranking process that takes into account educational performance at medical school and performance on a situational judgment test (SJT). We aimed to compare the performance of United Kingdom graduates allocated to different United Kingdom Foundation School according to three metrics: educational performance measure (EPM), SJT, and prescribing safety assessment (PSA).

METHODS

We used a cross-sectional study design using data from the UK Medical Education Database, studying 19 United Kingdom Foundation School groups. A total of 33 730 graduates from United Kingdom medical schools in the period 2014 to 2018 (inclusive) who started Foundation Training in August 2018 or earlier were included in the study, excluding those allocated to the Academic Foundation Programme or the Armed Forces Deanery. The outcomes were within-year standardized mean scores (by Foundation School) on the EPM, SJT, and PSA.

RESULTS

There was a significant difference between Foundation Schools in the Educational Performance Measure (F = 401, P < .001), SJT (F = 213, P < .001), and PSA (F = 95, P < .001). Tukey-Kramer pairwise comparisons between Foundation Schools showed a very high percentage of statistical significance (78%, 402/513 comparisons). The Cohen's d effect size for the difference in means and Tukey-Kramer 95% confidence intervals between the Foundation Schools with the highest (North West Thames) and lowest (West Midlands North) means were 1.92 (1.77-2.07) for the EPM, 1.59 (1.44-1.73) for the SJT, and 0.94 (0.79-1.09) for the PSA.

CONCLUSION

There is a statistically significant difference between the knowledge and skills of doctors (as measured by the three metrics used in this study) entering the Foundation Programme in different Foundation Schools. It is less clear whether this has an impact on patient care and thus is unfair from the perspective of the patient.

Awareness, Intention to Act and Action in the Exercising of Patients' Rights: A Case Study of Patients in Khmer Soviet Friendship Hospital, Phnom Penh, Cambodia

Background and Objectives

In Cambodia, the patients' rights guideline was officially released in 2007 as a measure of the government policy to promote greater awareness and empower Cambodian people to exercise their rights as patients. The aim of this study was to identify the proportion of patients aware of the existence of patients' rights and compare the proportions of patients intending to exercise their rights and those actually exercising their rights among the aware and unaware groups.

Methods

Data were collected with a structured questionnaire, using face-to-face interview technique, from 142 randomly selected outpatients visiting the Khmer Soviet Friendship Hospital in Phnom Penh, Cambodia. Intention to exercise patients' rights was measured on a 5-point Likert scale (ranging from 1 "definitely not" to 5 "definitely yes").

Results

The proportion of Cambodian patients who were aware of the existence of patients' rights was 31.0% (95% CI: 23.5, 39.3). The average intention to act scores was 4.0±0.5 for the whole group, and 4.3±0.4 and 3.9±0.5 for those aware and unaware of the existence of patients' rights, respectively. The difference in the mean scores of intentions to act between the aware and unaware groups was statistically significant (mean difference =0.40, 95% CI: 0.22, 0.58, t₁₄₀=4.514, P< 0.001). Patients reported a total of 250 situations in which they believed they should take action to exercise their rights and 96 times that they took action (38.4%, 95% CI: 35.46, 41.34).

Conclusion

The proportion of Cambodian outpatients aware of the existence of patients' rights and the proportion of outpatients that exercised their rights were both low. Nevertheless, it appeared that raising awareness of the existence of patients' rights raised patient's intention to act, which corresponds to the hierarchy-of-effects behavioral model.

Web-Based Patient Segmentation in Finnish Primary Care: Protocol for Clinical Validation of the Navigator Service in Patients With Diabetes

BACKGROUND

An aging population and increasing multimorbidity challenge health care systems worldwide. Patient segmentation aims to recognize groups of patients with similar needs, offer targeted services to these groups, and reduce the burden of health care. In this study, the unique Finnish innovation Navigator, a web-based service for patient segmentation, is presented. Both patients and health care professionals complete the electronic questionnaire concerning patients' coping in everyday life and health state. Thus, it considers the patient perspective on self-care. One of four customership-strategy (CS) groups (self-acting, community, cooperating, and network) is then proposed in response to the answers given. This resulting strategy helps both professionals to coordinate patient health care and patients to utilize appropriate health services.

OBJECTIVE

This study aims to determine the feasibility, validity, and reliability of the Navigator service in the segmentation of patients with diabetes into four CS groups in a primary care setting. Patient characteristics concerning demographic status, chronic conditions, disabilities, health-related quality of life, and well-being in different CS groups will be described. We hypothesize that patients in the network group will be older, have more illnesses, chronic conditions or disabilities, and require more health care services than patients in the self-acting group.

METHODS

In this mixed methods study, data collection was based on questionnaires (user experience of Navigator, demographic and health status, World Health Organization Disability Assessment Schedule 2.0, EuroQol 5D, Wellbeing Questionnaire 12, and the Diabetes Treatment Satisfaction Questionnaire) issued to 300 patients with diabetes and on user-experience questionnaires for and semistructured focus-group interviews with 12 nurses. Navigator-database reports and diabetes-care values (blood pressure, BMI, HbA1c, low-density lipoprotein, albumin-creatinine, smoking status) were collected. Qualitative and descriptive analyses were used to study the feasibility, content, concurrent, and face validity of Navigator. While criterion and concurrent validity were examined with correlations, reliability was examined by calculating Cohen kappa and Cronbach alpha. Construct validity is studied by performing exploratory-factor analysis on Navigator data reports and by hypothesis testing. The values, demographics, and health status of patients in different groups were described, and differences between groups were studied by comparing means. Linear regression analysis was performed to assess which variables affect CS group variation.

RESULTS

Data collection was completed in September 2019, and the first feasibility results are expected by the end of 2020. Further results and publications are expected in 2021 and 2022.

CONCLUSIONS

This is the first scientific study concerning Navigator's psychometric properties. The study will examine the segregation of patients with diabetes into four CS groups in a primary care setting and the differences between patients in groups. This study will assist in Navigator's further development as a patient segmentation method considering patients' perspectives on self-care. This study will not prove the effectiveness or efficacy of Navigator; therefore, it is essential to study these outcomes of separate care pathways.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/20570.

Ectogenesis and gender-based oppression: Resisting the ideal of assimilation

In a recent article in this journal, Kathryn MacKay advances a defence of ectogenesis that is grounded in this technology's potential to end-or at least mitigate the effects of-gender-based oppression. MacKay raises important issues concerning the socialization of women as 'mothers', and the harms that this socialization causes. She also considers ectogenesis as an ethically preferable alternative to gestational surrogacy and uterine transplantation, one that is less harmful to women and less subject to being co-opted to further oppressive ends. In this article, I challenge some of the assumptions that underlie MacKay's case in favour of ectogenesis by questioning whether the relationship between women's capacity to gestate and birth children and gender-based oppression is as strong as MacKay makes it out to be. I subsequently argue that-even if MacKay's reading of this relationship is accurate-ectogenesis is not a desirable means to end gender-based oppression. It embodies a strategy that could be used to pursue liberating projects that follow what Iris Marion Young defines as 'the ideal of assimilation', but that must be resisted. I then concur with MacKay's contention that ectogenesis is better than gestational surrogacy and uterine transplantation. My argument is that many of the problematic issues that MacKay herself sees as features of these practices will not disappear with ectogenesis. Finally, I conclude that MacKay's narrow focus on women's biology and ectogenesis as a solution to gender-based oppression results in the overlooking of broader systemic issues that contribute to the upholding of oppressive norms.

Implementing reasonable adjustments for -disabled people in healthcare services

Disabled people are one of the groups in society with the greatest health needs, yet they experience some of the most significant barriers to accessing healthcare services. This article describes examples of how three healthcare services have met the Equality Act 2010 duty to make reasonable adjustments for disabled people, so that they are not disadvantaged in accessing these services. Each of these services identified disabled patients, and considered and recorded the specific reasonable adjustments that were required. In doing so, they took time to fully understand the needs of the individual from their perspective. The services collaborated and coordinated the provision of reasonably adjusted care by communicating effectively with other health and social care providers, working together as a team, and treating disabled people as individuals.

Billions in Misspent EU Agricultural Subsidies Could Support the Sustainable Development Goals

The Common Agricultural Policy (CAP) is the guiding policy for agriculture and the largest single budget item in the European Union (EU). Agriculture is essential to meet the Sustainable Development Goals (SDGs), but the CAP's contribution to do so is uncertain. We analyzed the distribution of €59.4 billion of 2015 CAP payments and show that current CAP spending exacerbates income inequality within agriculture, while little funding supports climate-friendly and biodiverse farming regions. More than €24 billion of 2015 CAP direct payments went to regions where average farm incomes are already above the EU median income. A further €2.5 billion in rural development payments went to primarily urban areas. Effective monitoring indicators are also missing. We recommend redirecting and better monitoring CAP payments toward achieving the environmental, sustainability, and rural development goals stated in the CAP's new objectives, which would support the SDGs, the European Green Deal, and green COVID-19 recovery.

Reluctant educators and self-advocates: Older trans adults' experiences of health-care services and practitioners in seeking gender-affirming services

Background

Trans‐identifying individuals experience unique barriers and challenges in negotiating health‐care systems due to the cisnormative attitudes and practices which obstruct the receipt of trans‐inclusive care. To date, there has been little exploration of older trans consumers’ experiences of contemporary health‐care services when seeking to transition medically in later life.

Objectives

Qualitative findings are presented from a study of trans ageing and trans‐related health and social care needs in Wales, UK (2016‐18). The objectives are to (1) examine supportive and obstructive points of interaction with health‐care professionals, and (2) identify key learning messages for improving trans‐related health care from the perspectives of trans‐identifying adults in later life.

Design

Trans‐identifying participants self‐selected to take part in two interviews—a life‐history interview and a semi‐structured interview. Interview data were analysed thematically using the framework method approach.

Setting and participants

This paper focuses on the accounts of 19 participants (50‐74 years of age) who identified as trans and were seeking to transition medically in mid‐ to later life.

Results

Findings indicate how older trans patients are positioned as reluctant educators for GPs in primary care settings and illustrate the transphobic practices and cisnormative assumptions encountered across health‐care interactions and systems that impede their journey of transitioning in later life.

Discussion and conclusions

Messages from this study speak to the importance of improving professionals’ knowledge of gender identity diversity across the life course and making changes at a systemic level in redressing cisnormative assumptions and systems that reinforce inequities on the basis of gender identity.

AI Surveillance during Pandemics: Ethical Implementation Imperatives

Artificial intelligence surveillance can be used to diagnose individual cases, track the spread of Covid‐19, and help provide care. The use of AI for surveillance purposes (such as detecting new Covid‐19 cases and gathering data from healthy and ill individuals) in a pandemic raises multiple concerns ranging from privacy to discrimination to access to care. Luckily, there exist several frameworks that can help guide stakeholders, especially physicians but also AI developers and public health officials, as they navigate these treacherous shoals. While these frameworks were not explicitly designed for AI surveillance during a pandemic, they can be adapted to help address concerns regarding privacy, human rights, and due process and equality. In a time where the rapid implementation of all tools available is critical to ending a pandemic, physicians, public health officials, and technology companies should understand the criteria for the ethical implementation of AI surveillance.

Learning hand in hand: Engaging in research-practice partnerships to advance developmental science

Developmental science research often involves research questions developed by academic teams, which are tested within community or educational settings. In this piece, we outline the importance of research-practice partnerships, which involve both research and practice-based partners collaborating at each stage of the research process. We articulate challenges and benefits of these partnerships for developmental science research, identify relevant research frameworks that may inform these partnerships, and provide an example of an ongoing research-practice partnership.

Female Faculty: Why So Few and Why Care?

Despite slow ongoing progress in increasing the representation of women in academia, women remain significantly under-represented at senior levels, in particular in the natural sciences and engineering. Not infrequently, this is downplayed by bringing forth arguments such as inherent biological differences between genders, that current policies are adequate to address the issue, or by deflecting this as being "not my problem" among other examples. In this piece we present scientific evidence that counters these claims, as well as a best-practice example, Genie, from Chalmers University of Technology, where one of the authors is currently employed. We also highlight particular challenges caused by the current COVID-19 pandemic. Finally, we conclude by proposing some possible solutions to the situation and emphasize that we need to all do our part, to ensure that the next generation of academics experience a more diverse, inclusive, and equitable working environment.

Gendered White Lies: Women Are Given Inflated Performance Feedback Compared With Men

Are underperforming women given less truthful, but kinder performance feedback ("white lies") compared with equally underperforming men? We test this hypothesis by using a "benchmark" of truthful (objective) evaluation of performance and then either manipulating (Study 1) or measuring (Study 2) the extent to which the feedback given to women is upwardly distorted. In Study 1, participants were asked to guess the gender of an underperforming employee who had been given more or less truthful feedback. Participants overwhelmingly assumed that employees who had been told "white lies" were more likely to be women. In Study 2, in a naturalistic feedback paradigm, participants gave both quantitative and qualitative feedback to a male and a female writer directly. Participants upwardly distorted their original, gender-blind, quantitative evaluations of women's work and gave more positive comments to women. The findings suggest that women may not receive the same quality of feedback as men.

Exploring health and social care professionals' initial perceptions of caring for trans patients

AIM

To investigate the initial perceptions that health and social care professionals have when caring for trans patients.

METHOD

This was a qualitative study that involved semi-structured interviews with five participants in one geographical area as a snapshot study. The research transcripts were analysed, and themes were identified and examined.

FINDINGS

The main themes identified from the interviews with participants were: discrimination; lack of understanding of the trans body and gender identity; confusion around terminology; cultural perceptions and attitudes towards trans people; professionalism; the need for trans awareness training; and social recognition for trans staff members.

CONCLUSION

The findings of this study suggest there is a need to develop trans awareness training for staff working in areas of practice that are likely to provide care for trans people, such as acute care, emergency departments and mental health services. This could improve health outcomes for trans people and increase the likelihood of them accessing health and social care services in the future.

Disability-inclusive compassionate care: Disability competencies for an Indian Medical Graduate

The new curriculum of the Medical Council of India (MCI) lacks disability-related competencies. This further involves the risk of perpetuating the medicalization of diverse human experiences and many medical students may graduate with little to no exposure to the principles of disability-inclusive compassionate care. Taking into consideration the UN Convention, the Rights of Persons with Disabilities, Act 2016, and by involving the three key stakeholders – disability rights activists, doctors with disabilities, and health profession educators – in the focus group discussions, 52 disability competencies were framed under the five roles of an Indian Medical Graduate (IMG) as prescribed by the MCI. Based on feedback from other stakeholders all over India, the competencies were further refined into 27 disability competencies (clinician: 9; leader: 4; communicator: 5; lifelong learner: 5; and professional: 4) which the stakeholders felt should be demonstrated by health professionals while they care for patients with disabilities. The competencies are based on the human rights approach to disability and are also aligned with the competencies defined by accreditation boards in the US and in Canada. The paper describes the approach used in the framing of these competencies, and how parts of these were ultimately included in the new competency-based medical education curriculum in India.

Gender issues from the perspective of health-care professionals in Neuro-oncology: an EANO and EORTC Brain Tumor Group survey

Background

Women represent an increasing proportion of the overall workforce in medicine but are underrepresented in leadership roles.

Methods

To explore gender inequalities and challenges in career opportunities, a web-based survey was conducted among the membership of the European Association of Neuro-Oncology and the Brain Tumor Group of the European Organisation for Research and Treatment of Cancer.

Results

A total of 228 colleagues responded to the survey: 129 women (median age 45 years; range, 25-66 years) and 99 men (median age 48 years; range, 24-81 years); 153 participants (67%) were married and 157 participants (69%) had at least 1 child. Women less often declared being married (60% vs 77%, P = .007) or having a child (63% vs 77%, P = .024). Men more frequently had a full-time position (88% vs 75%, P = .036). Women and men both perceived an underrepresentation of women in leadership positions. Half of participants agreed that the most important challenges for women are leading a team and obtaining a faculty position. Fewer women than men would accept such a position (42% vs 56%). The main reasons were limited time for career and an inappropriate work and life balance. Women specifically cited negative discrimination, limited opportunities, and lack of self-confidence. Discrimination of women at work was perceived by 64% of women vs 47% of men (P = .003).

Conclusion

Women are perceived as experiencing more difficulties in acquiring a leadership position. Personal preferences may account for an underrepresentation of women in leadership positions, but perceived gender inequalities extend beyond disparities of access to leadership.

Non-biological lesbian mothers' experiences of accessing healthcare for their children

BACKGROUND

Lesbian, gay, bisexual and trans (LGBT) parents may have negative experiences when accessing healthcare for their children as a result of homophobia, transphobia or other forms of prejudice. Patients and their families have reported receiving inappropriate comments from healthcare professionals about sexual orientation, despite policy and government recommendations advising healthcare professionals to provide care that demonstrates respect, dignity and compassion.

AIM

The aim of this pilot study was to understand the experience of non-biological lesbian mothers accessing healthcare for their children and the types of attitudes and language they encountered. The pilot was also carried out to determine that the style of questioning allowed differentiation between sexuality and gender.

METHOD

This narrative enquiry pilot study used interviews conducted with three non-biological lesbian mothers aged 36-45 years. Two of the participants were a married couple with adopted children; the other had undergone in vitro fertilisation (IVF) with her partner. Of the three participants, two were the authors of this study. The data were coded using thematic analysis.

FINDINGS

The participants' interviews revealed mixed experiences with healthcare professionals' attitudes. Four common themes emerged: attitudes and managing healthcare experiences; acknowledgement of sexual orientation; professional standards; and family constellation.

CONCLUSION

The study found that non-biological lesbian mothers experience positive and negative interactions with healthcare professionals but feel disenfranchised because of their non-biological status. A reason for the negative interactions could be a lack of training for healthcare professionals about the challenges that lesbian mothers face when accessing healthcare for their children.

The promise of equal education not kept: Specific learning disabilities - The invisible disability

BACKGROUND

This research is part of a larger project on the exploration of inequalities in South African higher education. This current study focussed on the implementation of policies to eradicate inequalities in an inclusive education system.

OBJECTIVES

This article aimed to establish the implementation of policy by researching the lived experiences of students with specific learning disabilities (SLDs) studying in the university.

METHOD

A qualitative, systematic review was employed as the research methodology. Original peer-reviewed qualitative studies published between 1994 and 2017 were systematically reviewed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used to ensure rigorous reviews. The Critical Appraisal Skills Programme (CASP) was used to guide the process of critical appraisal of the selected articles which resulted in a total of 10 articles being selected for reviewing. The target population of this research comprised undergraduate students diagnosed with SLD. Semi-structured interviews were the main data collection tools used in the studies that were reviewed. Data from the selected articles were extracted and synthesised.

RESULTS

The dominant themes that emerged from the review were: (1) fear of stigmatisation; (2) gaps in policy implementation; (3) experiences vary across departments; and (4) self-determination and family support as success factors.

CONCLUSION

An important aspect in the transformation of higher education institution is to ensure the closing of the disjuncture between policy and implementation in support of students with SLD.

Understanding the Experiences and Needs of Migrant Women Affected by Female Genital Mutilation Using Maternity Services in Australia

Female genital mutilation (FGM) is a cultural practice defined as the partial or total removal of the external female genitalia for non-therapeutic reasons. Changing patterns of migration in Australia and other high-income countries has meant that maternity care providers and health systems are caring for more pregnant women affected by this practice. The aim of the study was to identify strategies to inform culturally safe and quality woman-centred maternity care for women affected by FGM who have migrated to Australia. An Appreciative Inquiry approach was used to engage women with FGM. We conducted 23 semi-structured interviews and three focus group discussions. There were four themes identified: (1) appreciating the best in their experiences; (2) achieving their dreams; (3) planning together; and (4) acting, modifying, improving and sustaining. Women could articulate their health and cultural needs, but they were not engaged in all aspects of their maternity care or considered active partners. Partnering and involving women in the design and delivery of their maternity care would improve quality care. A conceptual model, underpinned by women’s cultural values and physical, emotional needs, is presented as a framework to guide maternity services.

Reverse mentoring for senior NHS leaders: a new type of relationship

Purpose

The Reverse Mentoring for Equality, Diversity and Inclusion (ReMEDI) programme was rolled out in Guy's and St Thomas' NHS Foundation Trust in 2018 and paired senior white leaders (mentees) with black and minority ethnic (BME) staff (mentors) to help them explore their mentees' practices in relation to equality, diversity and inclusion.

Background

The authors, two BME staff, participated in the first cohort of the programme. We reverse mentored a senior white male director, who we met six times over a 6-month period.

Methods

We used a variety of methods to gain information about and to appraise our mentee, including one-to-one interviews, observations of his team meetings and visual inspections of his department.

Main findings

We noted a number of positive practices in our mentee's various levels of operation, which we classified as individual, departmental, organisational and symbolic. These findings included the use of gender inclusive language and compliance with BME staff targets.

Conclusions

This exercise was very useful to our mentee, however, more time with our mentee would have provided greater insight. It would also be helpful to obtain feedback from our mentee's BME staff, to provide a 360-degree view and complete appraisal of his performance.

Gender and role models in the education of medical doctors: a qualitative exploration of gendered ways of thinking

OBJECTIVES

To examine how 'gendered ways of thinking' relate to role models in medical education.

METHODS

This study employed an explorative, qualitative, and cross-sectional design. A total of 57 interviews were held with medical students (28 interviews) and with faculty members (29 interviews) at a Swedish medical school. Participants were asked to describe their role models and the attributes that made certain individuals role models. Data were analysed using an inductive approach in three separate steps that explored the relationship between role models and gender.

RESULTS

Males do not generally consider female doctors as role models, and male role models are generally viewed as more admirable than female role models. This was shown in all steps of the analysis and most prominently in how male role models were described as qualitatively more admirable than female role models. Male role models are thus more common (for male and female students) and described as more admirable. The results point to the persistence of 'gendered ways of thinking' that subtly shape medical students.

CONCLUSIONS

Gendering role models is disadvantageous to female doctors in several ways, so the results have implications for women's career paths and opportunities. The results can thus form a basis for discussing and teaching the importance of gender in role modelling and in medical education in general.

Does human genome editing reinforce or violate human dignity?

Germline genome editing is often disapproved of at the international policy level because of its possible threats to human dignity. However, from a critical perspective the relationship between this emerging technology and human dignity is relatively understudied. We explore the main principles that are referred to when 'human dignity' is invoked in this context; namely, the link with eugenics, the idea of a common genetic heritage, the principle of equal birth and broader equality and justice concerns. Yet the concept is also used in favour of germline genome editing as it might improve the overall well-being of future generations. We conclude that dignity concerns do not justify a complete ban on safe heritable genome editing but should inform the implementation of side constraints to ensure that the value judgements about human traits that are inherent in this practice do not result in a diminished basic respect for those people affected by them.

Gender and Editorial Authorship in High-Impact Epidemiology Journals

Women comprise about half of senior epidemiologists, but little is known about whether they are also viewed as leaders (i.e., authorities) in the field. We believe editorial roles are markers of leadership in a field. Our objective was to describe the distribution of gender across authorship of editorials published in 5 high-impact epidemiology journals over the past 8 years. We included editorials and commentaries published in American Journal of Epidemiology, European Journal of Epidemiology, Epidemiology, International Journal of Epidemiology, and Journal of Clinical Epidemiology between 2010 and 2017. We classified genders of all authors as woman, man, or unknown and computed the proportions of women editorial authors over all journals and according to position (e.g., first author). Only 31% (682/2,228) of all editorial authors and 36% (524/1,477) of unique editorial authors (i.e., counting each editorial author name only once) were women. We identified 1,180 editorials; 594 had sole authors, 24% (141/594) of whom were women, and 586 had 2 or more authors, 31% (184/586) of which had women as first authors. If women are underrepresented as editorial authors across epidemiology journals (e.g., as a marker of epidemiology leadership), the situation merits immediate correction.

Addressing Gender Inequality in Our Disciplines: Report from the Association of Pulmonary, Critical Care, and Sleep Division Chiefs

Despite the increasing proportion of women in U.S. medical schools, there are relatively few women in leadership positions, and a number of recent publications have highlighted many factors that could contribute to gender inequity and inequality in medicine. The Association of Pulmonary, Critical Care, and Sleep Division Directors, an organization of Division Directors from across the United States, convened a workshop to review data and obtain input from leaders on the state of gender equity in our field. The workshop identified a number of factors that could contribute to gender inequality and inequity: gender climate (including implicit and perceived biases); disproportionate family responsibilities; lack of women in leadership positions; poor retention of women; and lack of gender equality in compensation. The panel members developed a roadmap of concrete recommendations for societies, leaders, and individuals that should promote gender equity to achieve gender equality and improve retention of women in the field of pulmonary, critical care, and sleep medicine.

An ambiguity in Habermas's argument against liberal eugenics

In his book The future of human nature, Jürgen Habermas argues against a scenario of liberal eugenics, in which parents are free to prenatally manipulate their children's genetic constitution via germline interventions. In this paper, I draw attention to the fact that his species-ethical line of argument is pervaded by a substantial ambiguity between an argument from actual intervention (AAI) and an argument from mere controllability (AMC). Whereas the first argument focuses on threats for the autonomy and equality of prenatally modified persons, the second argument takes all human beings, whether they have been modified or not, into account. Hence, when invoking Habermas in these debates, bioethicists need to consider carefully which argument they are referring to.

How healthcare professionals can support older LGBTQ+ people living with dementia

Older lesbian, gay, bisexual, trans, queer and others (LGBTQ+) people living with dementia have specific needs related to their sexual orientation and identity that should be addressed to maintain their personhood. They may face challenges in health and social care settings, such as heteronormativity and lack of awareness of older LGBTQ+ needs. Service provision for older LGBTQ+ people with dementia is lacking. Healthcare professionals' attitudes towards older LGBTQ+ people with dementia are often poor and there is a clear need for better training, while increased knowledge and awareness would help to challenge the concept of heteronormativity. This article explores some of the needs of older LGBTQ+ people with dementia, the role of legislation and regulation and how healthcare professionals can provide support.

The gender injustice of abortion laws

This commentary is a response to Katarzyna Sękowska-Kozłowska’s article on the treatment of criminal abortion laws as a form of sex discrimination under international human rights law through a study of the communications, Mellet v. Ireland and Whelan v. Ireland. The commentary offers a reading of these communications, and specifically the sex discrimination analysis premised on inequalities of treatment among women, as an engagement with the structural discrimination that characterises abortion laws, and as a radical vision for gender justice under international human rights law.

Equality as an ethical concept within the context of nursing care rationing

The concept of equality is subject to many different interpretations, and it is closely connected to similar concepts such as equity, justice, fairness, and human rights. As an ideal, equality entails many aspects that are untenable. For instance, genetic and social inequalities may never be extinct, but they can both be ameliorated by proper distribution of society's resources. Likewise, within the context of health care, equality can be promoted by proper rationing of health resources, amongst which nursing care stands out. In the field of nursing, the principle of equality presents itself in various forms of ethical and deontological mandates. However, beyond good intentions and abstract notions, there is a need to examine the ways in which nurses enforce this principle in practice, within the reality of modern health systems. Although there is scarcity of qualitative evidence in the nursing care rationing literature, existing studies suggest that fair treatment pertains to a largely intuitive sense of equality which involves subjective perceptions and judgements about rationing. Nurses' initial predisposition is to view all patients as equal and treat them in an equal manner; yet, on an individual basis, each patient has a different starting point, different needs and different prospects that render rationing decisions complex and uncertain. Equality should be accepted with its unavoidable limitations in practice and be further examined within the context of nursing care rationing, in the hope that it can be advanced in a consistent way, despite the idealistic nature in many of its aspects.

Individual Differences in Theory of Mind Predict Inequity Aversion in Children

Early in human development, children react negatively to receiving less than others, and only later do they show a similar aversion to receiving more. We tested whether theory of mind (ToM) can account for this developmental shift we see in middle childhood. We conducted a face-to-face fairness task that involved a ToM manipulation, measured individual differences in ToM, and collected parent-ratings of children's empathy, a construct related to ToM. We find that greater ToM capacities lead to more rejections of unequal offers, regardless of the direction of inequality, demonstrating that children with greater ToM are more likely to engage in costly compliance with fairness norms. Moreover, drawing attention to mental states sufficiently elicits aversion to advantageous inequity in younger children. These findings contribute to our growing understanding that people's concerns for fairness rely not just on their own thoughts and beliefs but on the thoughts, beliefs, and expectations of others.

Demonstrating Nursing Excellence Through Equality: The Relationship Between Magnet® Status and Organizational LGBTQ Client Services and Support

Introduction: Human Rights Campaign annually scores health care treatment of lesbian, gay, bisexual, transgender, and queer (LGBTQ) employees and clients among four measured dimensions in its Healthcare Equality Index (HEI). The purpose of this study was to determine if the score organizations earned on the 2018 HEI dimension measuring LGBTQ client services and support correlated with organizations' American Nurses Credentialing Center Magnet® recognition status, a distinction of nursing excellence. Method: Using a secondary data analysis approach, data obtained from Human Rights Campaign that specifically rated LGBTQ client services and support in 2018 HEI participating organizations (n = 626) were compared with the most recent inventory of American Nurses Credentialing Center Magnet health care organizations (n = 477). Results: LGBTQ client services and support HEI scores positively correlated with Magnet status (p = .0002). Discussion: Provision of LGBTQ client services and Magnet recognition is strongly related to higher quality nursing care, suggesting organizations earning Magnet recognition provide more equitable services to its LGBTQ clients.