Gender-related differences in care-seeking behaviour for newborns: a systematic review of the evidence in South Asia

Introduction

Data indicate substantial excess mortality among female neonates in South Asia compared with males. We reviewed evidence on sex and gender differences in care-seeking behaviour for neonates as a driver for this.

Methods

We conducted a systematic review of literature published between January 1st, 1996 and August 31st, 2016 in Pubmed, Embase, Eldis and Imsear databases, supplemented by grey literature searches. We included observational and experimental studies, and reviews. Two research team members independently screened titles, abstracts and then full texts for inclusion, with disagreements resolved by consensus. Study quality was assessed using National Institute for Health and Care Excellence (NICE) checklists and summary judgements given using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Data were extracted into Microsoft Excel.

Results

Of 614 studies initially identified, 17 studies were included. Low quality evidence across several South Asian countries suggests that care-seeking rates for female neonates are lower than males, especially in households with older female children. Parents are more likely to pay more, and seek care from providers perceived as higher quality, for males than females. Evidence on drivers of these care-seeking behaviours is limited. Care-seeking rates are suboptimal, ranging from 20% to 76% across male and female neonates.

Conclusion

Higher mortality observed among female neonates in South Asia may be partly explained by differences in care-seeking behaviour, though good quality evidence on drivers for this is lacking. Further research is needed, but policy interventions to improve awareness of causes of neonatal mortality, and work with households with predominantly female children may yield population health benefits. The social, economic and cultural norms that give greater value and preference to boys over girls must also be challenged through the creation of legislation and policy that support greater gender equality, as well as context-specific strategies in partnership with local influencers to change these practices.

PROSPERO registration number

CRD42016052256.

Using PhotoVoice to Understand Health Determinants of Formerly Homeless Individuals Living in Permanent Housing in Detroit

Housing First is an evidence-based approach to addressing chronic homelessness that provides permanent, low-barrier housing. Previous literature on the health of tenants of Housing First programs has primarily focused on mental health, substance use, and health care. Using the social-ecological model, we conducted a community-based participatory research (CBPR) PhotoVoice study to better understand what Housing First residents in Detroit identify as factors that impact their health. Seventeen participants were provided cameras and photography training and asked to take photos on the theme "What impacts your health and wellness?" Group sessions were held to discuss photos. Results were organized into four themes: (a) loss of jobs hurts people and communities; (b) blight, more than just abandoned buildings; (c) being pushed out by development; and (d) experiencing the "battlefield" versus feeling peaceful. The social-ecological model was used to indicate potential interventions indicated by study findings.

A Critique of O'Byrne's Understanding of Ethnography and the Politics of Public Health Research

Patrick O'Byrne criticizes the use of ethnography in public health research focused on cultural groups. His main argument is that ethnography disciplines marginalized populations that do not respect the imperative of health. In this article, I argue that O'Byrne has an erroneous understanding of ethnography and the politics of scientific research. My main argument is that a methodology itself cannot discipline individuals. I argue that if data are used as a basis to develop problematic public health policies, the issue is the policies themselves and not the methodology used to collect the data. While O'Byrne discourages researchers from conducting health research like ethnography focused on cultural groups, I argue the exact opposite. This has to do with justice and equity for marginalized communities and the obligation to tailor health services for their specific needs, which may not be the same as those of the general population.

Lesbian, Gay, Bisexual, and Trans Aging in a U.K. Context: Critical Observations of Recent Research Literature

In this article, we provide critical observations of empirical research from leading U.K. researchers relating to the lives of lesbian, gay, bisexual, and trans older adults. We suggest learning that may be applied in differing global contexts as well as contributing to the development of an international evidence base. We illustrate the importance of paying attention to distinct health and care systems and legislation, which present global differences as well as similarities in terms of lesbian, gay, bisexual, and trans people’s perceptions and access to resources. With this contextual background, we then discuss the cutting-edge U.K. research in this field from 2010 onward. We identify key strengths including the contribution our evidence has made to policy and practice and the development of theoretical insights such as the impact of intersectionality. The article concludes with a discussion of future research in this field which has relevance at national and international levels.

Do Infants in the First Year of Life Expect Equal Resource Allocations?

Recent research has provided converging evidence, using multiple tasks, of sensitivity to fairness in the second year of life. In contrast, findings in the first year have been mixed, leaving it unclear whether young infants possess an expectation of fairness. The present research examined the possibility that young infants might expect windfall resources to be divided equally between similar recipients, but might demonstrate this expectation only under very simple conditions. In three violation-of-expectation experiments, 9-month-olds (N = 120) expected an experimenter to divide two cookies equally between two animated puppets (1:1), and they detected a violation when she divided them unfairly instead (2:0). The same positive result was obtained whether the experimenter gave the cookies one by one to the puppets (Experiments 1–2) or first separated them onto placemats and then gave each puppet a placemat (Experiment 3). However, a negative result was obtained when four (as opposed to two) cookies were allocated: Infants looked about equally whether they saw a fair (2:2) or an unfair (3:1) distribution (Experiment 3). A final experiment revealed that 4-month-olds (N = 40) also expected an experimenter to distribute two cookies equally between two animated puppets (Experiment 4). Together, these and various control results support two broad conclusions. First, sensitivity to fairness emerges very early in life, consistent with claims that an abstract expectation of fairness is part of the basic structure of human moral cognition. Second, this expectation can at first be observed only under simple conditions, and speculations are offered as to why this might be the case.

Discourse on Intellectual Disability and Improved Access to Assistive Technologies in Malawi

Assistive technologies are one of the five elements under the Health Component of the World Health Organization CBR Guidelines that Malawi is using to implement the Community Based Inclusive Development (CBID) Programme. The technologies enhance independent living by removing barriers that come due to disability or old age and should, therefore, be prioritized. However, Malawi does not have a straightforward way of providing Assistive Technology. Individuals are considered upon the assessment of their needs whose intervention with respect to assistive products may not be available. This is mostly the case with persons with intellectual disabilities, in which there is very little expertise to work with, in Malawi, although they require assistive products to improve their quality of life just like other persons with disabilities. There are many sectoral policies and laws in Malawi, nonetheless, they do not have a positive input on persons with intellectual disability to access assistive technologies in terms of availability (provision), affordability (cost), and appropriateness (suitability and quality). Therefore, this paper intends to demonstrate the barriers that are faced by persons with intellectual disabilities, examine the policies, and pieces of legislation that would have influenced better access and maps the way on how barriers can be removed to ensure that Assistive Technologies are readily and easily accessed.

The governors of school markets? Local education authorities, school choice and equity in Finland and Sweden

As one of the key elements of the Nordic welfare model, education systems are based on the idea of providing equal educational opportunities, regardless of gender, social class and geographic origin. Since the 1990s, Nordic welfare states have undergone a gradual but wide-ranging transformation towards a more market-based mode of public service delivery. Along this trajectory, the advent of school choice policy and the growing variation in the between-school achievement results have diversified the previously homogenous Nordic education systems.

The aim of our paper is to analyse how Finnish and Swedish local education authorities comprehend and respond to the intertwinement of the market logic of school choice and the ideology of equality. The data consist of two sets of in-depth thematic interviews with staff from the local providers of education, municipal education authorities. The analysis discloses the ways in which national legislation has authorized municipal authorities to govern the provision of education.

Shifting the paradigm in outreach to under-represented groups

This article was migrated. The article was marked as recommended. The Community of Support (COS) is a longitudinal and collaborative initiative that enables students who are Indigenous, Black, Filipino, economically disadvantaged, or who self-identify with having a disability to join and receive support at any stage of their medical school journey. The goal of COS is to increase diversity in the fields of research and medicine, as a diverse physician taskforce is essential to meeting the needs of Canada's patient population. Our program supports students at various points in their academic careers, beginning from first year of undergrad to end of PhD and into the workforce. We offer a variety of support systems that aim to address gaps and empower students. Our three-pronged approach provides COS members with support at the levels of i) admissions information, ii) mentorship and experiential opportunities, and iii) application support (including MCAT prep). Over the past 3 years, we have grown to include over 1,100 participants at various stages of their medical school journeys, from first year undergraduate students to university graduates from institution across Canada. As a result, in just three years, we have supported over 80 students with successful admissions to medical school, and alumni from CoS are now represented in 11/15 Canada's medical schools, with a growing number of US schools, such as Yale University, George Washington, Michigan State and Wayne State.

Unleashing talent in mental health sciences: gender equality at the top

Society is undergoing a shift in gender politics. Science and medicine are part of this conversation, not least as women's representation and pay continue to drop as one progresses through more senior academic and clinical levels. Naming and redressing these inequalities needs to be a priority for us all.Declaration of interestNone.

The Chemical Sciences and Equality, Diversity, and Inclusion

There has been mounting concern over the absence of gender equality in the sciences in recent years. This has been accompanied by a broadening of the perspective, in order to address issues of equality, diversity and inclusion, relating to a wide range of circumstances in which individuals suffer discrimination. While some progress has been made in some countries, nationally or at the level of institutions, much more needs to be done. The chemical sciences can play a leading role in addressing biases, through 1) becoming a model of good systemic practice in policies, processes, and actions; 2) developing practical skills through training in cultural competence; and 3) promoting a stronger evidence base to uncover both the extent of problems and the degree to which approaches to improve equality, diversity, and inclusion are working.

Gender differences in egalitarian behavior and attitudes in early childhood

It is axiomatic that human females are more egalitarian than males. However, surprisingly little empirical research exists that empirically assesses this stereotype. We created two studies designed to objectively examine egalitarian behavior in 3- to 5-year-old children. In Study 1 we compared the egalitarian behavior and attitudes of American girls versus boys by tabulating the extent to which each gender awarded the same number of stickers to, and liked to the same degree, two puppets. One puppet followed the child's instructions or actions while the other did not during a drawing task in which the child played the roles of leader and peer. In the peer role, girls exhibited more egalitarian behavior than boys. In Study 2, French-Canadian children were shown two drawings by unknown peers-one messily and one neatly colored-, then asked to distribute stickers to each peer's drawing. Again, girls exhibited more egalitarian behavior than boys. Results suggest the origins of gender differences in egalitarian behavior occur early in life and merit further investigation.

Disapproved, but Tolerated: The Role of Respect in Outgroup Tolerance

We conducted two studies to test the hypothesis that respect for disapproved outgroups increases tolerance toward them. In Study 1, we employed a panel sample of supporters of the Tea Party movement in the United States and found that Tea Party supporters' respect for homosexuals and Muslims as equal fellow citizens positively predicted Tea Party supporters' tolerance toward these groups. There was no indication that alternative recognition processes (i.e., achievement recognition or need recognition) played a similar role in the development of tolerance. Study 2 replicated the respect-tolerance link with the experimental method and a more comprehensive measure of tolerance. In particular, it demonstrated that the link also holds with regard to tolerance in the public or political sphere. The wider implications of our research for societal pluralism are discussed.

Bridging the Gap: Identifying Global Trends in Gender Disparity Among the Radiology Physician Workforce

RATIONALE AND OBJECTIVES

Women make up half of American medical school graduates, but remain underrepresented among radiologists. This study sought to determine whether workforce gender disparities exist in other countries, and to identify any country-specific indices associated with increased female representation.

MATERIALS AND METHODS

In this cross-sectional study, 95 professional radiology organizations in 75 countries were contacted via email to provide membership statistics, including proportion of female members, female members aged 35 or under, and women in society leadership positions. Country-specific metrics collected included gross domestic product, Gini index, percent female medical school enrollment, and Gender Development Index for the purposes of univariate multiple regression analysis.

RESULTS

Twenty-nine organizations provided data on 184,888 radiologists, representing 26 countries from Europe (n = 12), North America (n = 2), Central/South America (n = 6), Oceania (n = 2), Asia (n = 3), and Africa (n = 1) for a response rate of 34.7% (26/75). Globally, 33.5% of radiologists are female. Women constitute a higher proportion of younger radiologists, with 48.5% of radiologists aged 35 or under being female. Female representation in radiology is lowest in the United States (27.2%), highest in Thailand (85.0%), and most variable in Europe (mean 40.1%, range 28.8%-68.9%). The proportion of female radiologists was positively associated with a country's Gender Development Index (P = .006), percent female medical student enrollment (P = .001), and Gini index (P = .002), and negatively associated with gross domestic product (P = .03).

CONCLUSIONS

Women are underrepresented in radiology globally, most notably in the United States. Countries with greater representation of women had higher gender equality and percent female medical school enrollment, suggesting these factors may play a role in the gender gap.

The INHERIT Model: A Tool to Jointly Improve Health, Environmental Sustainability and Health Equity through Behavior and Lifestyle Change

The need for analysis and action across the interrelated domains of human behaviors and lifestyles, environmental sustainability, health and inequality is increasingly apparent. Currently, these areas are often not considered in conjunction when developing policies or interventions, introducing the potential for suboptimal or conflicting outcomes. The INHERIT model has been developed within the EU-funded project INHERIT as a tool to guide thinking and intersectoral action towards changing the behaviors and lifestyles that play such an important role in today’s multidisciplinary challenges. The model integrates ecological public health and behavioral change models, emphasizing inequalities and those parts of the causal process that are influenced by human behaviors and lifestyles. The model was developed through web-based and live discussions with experts and policy stakeholders. To test the model’s usability, the model was applied to aspects of food consumption. This paper shows that the INHERIT model can serve as a tool to identify opportunities for change in important −food-related behaviors and lifestyles and to examine how they impact on health, health inequalities, and the environment in Europe and beyond. The INHERIT model helps clarify these interrelated domains, creating new opportunities to improve environmental health and health inequality, while taking our planetary boundaries into consideration.

A Darker Side of Hope: Harmony-Focused Hope Decreases Collective Action Intentions Among the Disadvantaged

Hope is viewed as a positive emotion associated with the motivation to change existing conditions. As such, it is highly relevant for social change, particularly when considering disadvantaged groups. We propose that, in the context of unequal intergroup relations, hope may actually undermine motivation for change among disadvantaged group members. Specifically, we distinguish between hope targeted at harmony with the outgroup and hope targeted at social equality between groups. Drawing on insights regarding the consequences of positive intergroup interactions, we predict that hope for harmony with the outgroup can undermine the constructive tension that motivates the disadvantaged toward equality. Across four studies, involving different intergroup contexts, hope for harmony was negatively associated with disadvantaged group members' motivation for collective action. We further found that high identifiers from the disadvantaged group were immune to this effect. We discuss theoretical and practical implications for the role of hope in social change.

Relationship between sociodemographic factors and selection into UK postgraduate medical training programmes: a national cohort study

INTRODUCTION

Knowledge about allocation of doctors into postgraduate training programmes is essential in terms of workforce planning, transparency and equity issues. However, this is a rarely examined topic. To address this gap in the literature, the current study examines the relationships between applicants' sociodemographic characteristics and outcomes on the UK Foundation Training selection process.

METHODS

A longitudinal, cohort study of trainees who applied for the first stage of UK postgraduate medical training in 2013-2014. We used UK Medical Education Database (UKMED) to access linked data from different sources, including medical school admissions, assessments and postgraduate training. Multivariable ordinal regression analyses were used to predict the odds of applicants being allocated to their preferred foundation schools.

RESULTS

Applicants allocated to their first-choice foundation school scored on average a quarter of an SD above the average of all applicants in the sample. After adjusting for Foundation Training application score, no statistically significant effects were observed for gender, socioeconomic status (as determined by income support) or whether applicants entered medical school as graduates or not. Ethnicity and place of medical qualification were strong predictors of allocation to preferred foundation school. Applicants who graduated from medical schools in Wales, Scotland and Northern Ireland were 1.17 times, 3.33 times and 12.64 times (respectively), the odds of applicants who graduated from a medical school in England to be allocated to a foundation school of their choice.

CONCLUSIONS

The data provide supportive evidence for the fairness of the allocation process but highlight some interesting findings relating to 'push-pull' factors in medical careers decision-making. These findings should be considered when designing postgraduate training policy.

Embedding gender equality into institutional strategy

The SiS (Sex in Science) Programme on the WGC (Wellcome Genome Campus) was established in 2011. Key participants include the Wellcome Trust Sanger Institute, EMB-EBI (EMBL-European Bioinformatics Institute), Open Targets and Elixir. The key objectives are to catalyse cultural change, develop partnerships, communicate activities and champion our women in science work at a national and international level (http://www.sanger.ac.uk/about/sex-science). In this paper, we highlight some of the many initiatives that have taken place since 2013, to address gender inequality at the highest levels; the challenges we have faced and how we have overcome these, and the future direction of travel.

Performance-Enhancing Drugs, Sport, and the Ideal of Natural Athletic Performance

The use of certain performance-enhancing drugs (PED) is banned in sport. I discuss critically standard justifications of the ban based on arguments from two widely used criteria: fairness and harms to health. I argue that these arguments on their own are inadequate, and only make sense within a normative understanding of athletic performance and the value of sport. In the discourse over PED, the distinction between "natural" and "artificial" performance has exerted significant impact. I examine whether the distinction makes sense from a moral point of view. I propose an understanding of "natural" athletic performance by combining biological knowledge of training with an interpretation of the normative structure of sport. I conclude that this understanding can serve as moral justification of the PED ban and enable critical and analytically based line drawing between acceptable and nonacceptable performance-enhancing means in sport.

Gender and Publishing in Nursing: a secondary analysis of h-index ranking tables

AIMS

To analyse published ranking tables on academics' h-index scores to establish whether male nursing academics are disproportionately represented in these tables compared with their representation across the whole profession.

BACKGROUND

Previous studies have identified a disproportionate representation of UK male nursing academics in publishing in comparison to their US counterparts.

DESIGN

Secondary statistical analysis, which involved comparative correlation of proportions.

METHODS

Four papers from the UK, Canada and Australia containing h-index ranking tables and published between 2010-2017, were re-analysed in June 2017 to identify authors' sex. Pearson's chi-squared test was applied to ascertain whether the number of men included in the tables was statistically proportionate to the number of men on the pertinent national professional register.

FINDINGS

There was a disproportionate number of men with high h-index scores in the UK and Canadian data sets, compared with the proportion of men on the pertinent national registers. The number of men in the Australian data set was proportionate with the number of men on the nursing register. There was a disproportionate number of male professors in UK universities.

CONCLUSION

The influence of men over nursing publishing in the UK and Canada outweighs their representation across the whole profession. Similarly, in the UK, men's representation in the professoriate is disproportionately great. However, the Australian results suggest that gender inequality is not inevitable and that it is possible to create more egalitarian nursing cultures. This article is protected by copyright. All rights reserved.

The Ethics of End-of-Trial Obligations in a Pediatric Malaria Vaccine Trial: The Perspectives of Stakeholders From Ghana and Tanzania

This study explores stakeholder experiences and perspectives on end-of-trial obligations at the close of a phase II/III Pediatric Malaria Vaccine Trial (PMVT) [GSK/PATH-MVI RTS, S) (NCT00866619]. We conducted 52 key informant interviews with major stakeholders of an international multicentre PMVT in Ghana and Tanzania. The responses fell into four main themes: (a) Communicating End-of-Trial, (b) Maintaining Health Care Services, (c) Dissemination of Results, and (d) Post-Trial Access. Interviewee responses shared important practical experiences and insights that complement current thinking in the literature on research ethics guidance: (a) accompany end-of-trial communication with information on personal and family health care responsibilities, (b) establish public health indicators to measure the impact of research on a health care system,

[Justice and access to care]

Evoking justice in the field of care can be paradoxical considering the natural inequalities inherent to health. This article reflects on whether the use of the term justice in relation to access to care refers to equality or equity.

A systematic review of interventions to support the careers of women in academic medicine and other disciplines

OBJECTIVE

To summarise quantitative evaluations of interventions designed to support the careers of women in academia of any discipline.

METHOD

A systematic search of English entries in PubMed, CINAHL and Google Scholar was conducted in September 2017. Methodological quality of the studies was independently assessed by two authors using the Joanna Briggs Institute quality appraisal checklists. Meta-analysis was not possible due to heterogeneity in methods and outcomes; results were synthesised and displayed narratively.

RESULTS

Eighteen eligible studies were identified, mostly evaluating programmes in academic medicine departments. The most common interventions were mentoring, education, professional development and/or networking programmes. All programmes took a 'bottom-up' approach in that women were responsible for opting into and devoting time to participation. Study quality was low overall, but all studies reported positive outcomes on at least one indicator. Most often this included improvements in self-rated skills and capabilities, or satisfaction with the programme offered. Results regarding tangible outcomes were mixed; while some studies noted improvements in promotion, retention and remuneration, others did not.

CONCLUSIONS

This review suggests that targeted programmes have the potential to improve some outcomes for women in academia. However, the studies provide limited high-quality evidence to provide information for academic institutions in terms of the best way to improve outcomes for women in academia. The success of an intervention appears to be undermined when it relies on the additional labour of those it is intending to support (ie, 'bottom-up' approaches). As such, academic institutions should consider and evaluate the efficacy of 'top-down' interventions that start with change in practice of higher management.

Organisational perspectives on addressing differential attainment in postgraduate medical education: a qualitative study in the UK

OBJECTIVES

To explore how representatives from organisations with responsibility for doctors in training perceive risks to the educational progression of UK medical graduates from black and minority ethnic groups (BME UKGs), and graduates of non-UK medical schools (international medical graduates (IMGs)). To identify the barriers to and facilitators of change.

DESIGN

Qualitative semistructured individual and group interview study.

SETTING

Postgraduate medical education in the UK.

PARTICIPANTS

Individuals with roles in examinations and/or curriculum design from UK medical Royal Colleges. Employees of NHS Employers.

RESULTS

Representatives from 11 medical Royal Colleges (n=29) and NHS Employers (n=2) took part (55% medically qualified, 61% male, 71% white British/Irish, 23% Asian/Asian British, 6% missing ethnicity). Risks were perceived as significant, although more so for IMGs than for BME UKGs. Participants based significance ratings on evidence obtained largely through personal experience. A lack of evidence led to downgrading of significance. Participants were pessimistic about effecting change, two main barriers being sensitivities around race and the isolation of interventions. Participants felt that organisations should acknowledge problems, but felt concerned about being transparent without a solution; and talking about race with trainees was felt to be difficult. Participants mentioned 63 schemes aiming to address differential attainment, but these were typically local or specialty-specific, were not aimed at BME UKGs and were largely unevaluated. Participants felt that national change was needed, but only felt empowered to effect change locally or within their specialty.

CONCLUSIONS

Representatives from organisations responsible for training doctors perceived the risks faced by BME UKGs and IMGs as significant but difficult to change. Strategies to help organisations address these risks include: increased openness to discussing race (including ethnic differences in attainment among UKGs); better sharing of information and resources nationally to empower organisations to effect change locally and within specialties; and evaluation of evidence-based interventions.

What Facilitates "Patient Empowerment" in Cancer Patients During Follow-Up: A Qualitative Systematic Review of the Literature

Empowerment is a concept of growing importance in cancer care, but little is known about cancer patients' experiences of empowerment during follow-up. To explore this area, a qualitative systematic literature review was conducted in PubMed, CINAHL, and PsycINFO. A total of 2,292 papers were identified and 38 articles selected and included in the review. The thematic synthesis of the papers resulted in seven analytical themes being identified: empowerment as an ongoing process, knowledge is power, having an active role, communication and interaction between patients and health care professionals, support from being in a group, religion and spirituality, and gender. Very few articles explicitly explored the empowerment of cancer patients during follow-up, and the review identified a lack of attention to patients' own understandings of empowerment, a lack of specific focus on empowerment during follow-up, and insufficient attention to collective empowerment, as well as ethnic, social, and gender differences.

Positive bias for European men in peer reviewed applications for faculty position at Karolinska Institutet

Background: Sweden is viewed as an egalitarian country, still most of the professors are Swedish and only 25% are women. Research competence is evaluated using peer review, which is regarded as an objective measure in the meritocracy system. Here we update the investigation by Wold & Wennerås (1997) on women researcher’s success rate for obtaining a faculty position, by examining factors (gender, nationality, productivity, etc.) in applications for an Assistant Professorship in 2014 at Karolinska Institutet.

Methods: Fifty-six applications, 26 Swedish and 21 women applicants, were scored both on merits and projects by six external reviewers. Additional variables, including grants and academic age, calculated as the number of years since PhD excluding parental or sick leave, were gathered. Productivity was assessed by calculating a composite bibliometric score based on six factors (citations, publications, first/last authorships, H-index, high impact publication).

Results: Overall, academic age was negatively correlated with scores on merits, as assessed by peer review, although not reaching statistical significance. In men, associations between scores on merits and productivity ( P-value=0.0004), as well as having received grants ( P-value=0.009) were seen. No associations were found for women. Moreover, applicants with a background from the Middle East were un-proportionally found in the lowest quartile (Fisher exact test P-value=0.007).

Conclusions: In summary, the gender inequality shown in peer review processes in Sweden 20 years ago still exists. Furthermore, a bias for ethnicity was found. In order to keep the best scientific competence in academia, more efforts are needed to avoid selection bias in assessments to enable equal evaluations of all researchers.

That's what friends are for: how intergroup friendships promote historically disadvantaged groups' substantive political representation

The interests of historically disadvantaged groups risk being overlooked if they are not present in the decision-making process. However, a mere presence in politics does not guarantee political success. Often groups need allies to promote their interests successfully. We argue that one way to identify such allies is to judge politicians by whether they have friends in historically disadvantaged groups, as intergroup friendships have been shown to make people understand and feel empathy for outgroups. In other words, intergroup friendships may function as an important complement to descriptive representation. We test our argument with a unique survey that asks all elected political representatives in Sweden's 290 municipalities (response rate 79 per cent) about their friendship ties to, and their representation of, five historically disadvantaged groups: women, immigrants, youths, pensioners and blue-collar workers. We find a strong correlation between representatives' friendship ties to these groups and their commitment to represent them. The correlation is especially strong for youths and blue-collar workers, which likely can be explained by the fact that these groups usually lack crucial political resources (such as experience and education). We conclude that friendship ties function as an important complement to descriptive representation for achieving substantive representation.

The Case for Same-Sex Marriage Before the European Court of Human Rights

For proponents of same-sex marriage, this essay sets forward a critical analysis of relevant arguments before the European Court of Human Rights. The privacy aspect of Article 8 European Convention of Human Rights will never be a successful argument with reference to marriage, which involves a public status. The equality argument (Article 14) is useful in addressing this issue with its close connections with citizenship, symbolic value, and proven record internationally. Difficulties remain with the equality argument; its conditional status, the width of the margin of appreciation allocated, and the need for an equality comparator. The equality argument needs reinforcement by use alongside a developing family law argument under Article 8 and a dynamically interpreted Article 12 (right to marry) argument. Ultimately, the success of any argument depends on convincingly influencing the European Court to consider that sufficient consensus has developed among Member States of the Council of Europe.

Testing Equality: Insanity, Treatment Refusal and the CRPD

The Convention on the Rights of Persons with Disabilities is considered to be a radical international treaty that affords persons with disability recognition and protection of equal rights in socio-cultural, political, medical and legal arenas. Drawing from the Convention's core principles of equality and non-discrimination, the High Commissioner for Human Rights and the Convention's Committee have called for a replacement of the insanity defence with a disability-neutral doctrine. The rationale is that retaining this special defence is, in itself, discriminatory, given its function is necessarily based on the presence of mental disability and the assumption that such disabilities impair capacity and reasoning. This article interrogates the rationale behind 'abolitionist' views, and asks whether equality necessarily means treating all persons identically regardless of capacity to reason about conduct.

Protecting Pregnant Workers while Fighting Sexism: Work-Pregnancy Balance and Pregnant Nurses' Resistance in Québec Hospitals: Protéger les travailleuses enceintes en luttant contre le sexisme: équilibre travail-grossesse et résistance d'infirmières enceintes dans des hôpitaux québécois

Women's workplaces should guarantee healthy pregnancies while supporting pregnant women as workers. In Québec (Canada), a pregnant worker exposed to a "danger" for herself or her fetus may ask her employer to be reassigned to other work appropriate to her skills. This approach differs from other regulatory contexts in North America in that protection of fetal and maternal health is embedded in the health and safety legislation. The advantage is that the pregnant worker is guaranteed access to her full salary, but some may question whether specific provisions for pregnant women single out such women and produce risks for their careers or, conversely, pregnancy should receive even more special consideration. These questions are discussed using the results of a qualitative analysis of interviews with pregnant nurses, their supervisors, and their union representatives in ten hospitals in Québec. We think that the management of pregnancy under this legislation generally protects health, but that, in the absence of true employer commitment to the health of all workers, undue burdens may be placed upon other members of the work team. Résumé Les lieux de travail des femmes devraient garantir des grossesses saines tout en soutenant les femmes enceintes en tant que travailleurs. Au Québec (Canada), une travailleuse enceinte exposée à un danger pour elle-même ou son fœtus peut demander à son employeur d'être réaffectée à d'autres tãches sans danger et adaptéches à ses compétences. Cette approche diffère des autres contextes réglementaires en Amérique du Nord en ce sens que la protection de la santé foetale et maternelle est intégrée dans la législation sur la santé et la sécurité. Certains peuvent se demander si des dispositions spécifiques pour les femmes enceintes singularisent ces travailleuses et contribuent à la précarisation de leur emploi. Ou, à l'inverse, si la grossesse devrait recevoir une considération encore plus spéciale. Ces questions sont discutées à la lumière du récit d infirmières enceintes, de gestionnaires et de représentants syndicaux responsables des dossiers de conciliation travail-grossesse dans dix hôpitaux du Québec. Nous constatons que la gestion de la grossesse en vertu de cette législation est généralement protectrice de la santé, mais qu'en l'absence d'un véritable engagement de l'employeur envers la santé de tous les travailleurs, des charges excessives peuvent être imposées aux autres membres de l'équipe de travail.

[Telemedicine in current nursing practices]

The first priority telemedicine programme focused, from 2011, on five areas, with the aim of guaranteeing equal access to care to everybody across a healthcare region. Experiments were financed by public authorities. These practices are now integrated into the organisation of healthcare.

The cancer care experiences of gay, lesbian and bisexual patients: A secondary analysis of data from the UK Cancer Patient Experience Survey

Understanding the effects of population diversity on cancer-related experiences is a priority in oncology care. Previous research demonstrates inequalities arising from variation in age, gender and ethnicity. Inequalities and sexual orientation remain underexplored. Here, we report, for the first time in the UK, a quantitative secondary analysis of the 2013 UK National Cancer Patient Experience Survey which contains 70 questions on specific aspects of care, and six on overall care experiences. 68,737 individuals responded, of whom 0.8% identified as lesbian, gay or bisexual. Controlling for age, gender and concurrent mental health comorbidity, logistic regression models applying post-estimate probability Wald tests explored response differences between heterosexual, bisexual and lesbian/gay respondents. Significant differences were found for 16 questions relating to: (1) a lack of patient-centred care and involvement in decision-making, (2) a need for health professional training and revision of information resources to negate the effects of heteronormativity and (3) evidence of substantial social isolation through cancer. These findings suggest a pattern of inequality, with less positive cancer experiences reported by lesbian, gay and (especially) bisexual respondents. Poor patient-professional communication and heteronormativity in the healthcare setting potentially explain many of the differences found. Social isolation is problematic for this group and warrants further exploration.

Deliberation favours social efficiency by making people disregard their relative shares: evidence from USA and India

Groups make decisions on both the production and the distribution of resources. These decisions typically involve a tension between increasing the total level of group resources (i.e. social efficiency) and distributing these resources among group members (i.e. individuals' relative shares). This is the case because the redistribution process may destroy part of the resources, thus resulting in socially inefficient allocations. Here we apply a dual-process approach to understand the cognitive underpinnings of this fundamental tension. We conducted a set of experiments to examine the extent to which different allocation decisions respond to intuition or deliberation. In a newly developed approach, we assess intuition and deliberation at both the trait level (using the Cognitive Reflection Test, henceforth CRT) and the state level (through the experimental manipulation of response times). To test for robustness, experiments were conducted in two countries: the USA and India. Despite absolute-level differences across countries, in both locations we show that: (i) time pressure and low CRT scores are associated with individuals' concerns for their relative shares and (ii) time delay and high CRT scores are associated with individuals' concerns for social efficiency. These findings demonstrate that deliberation favours social efficiency by overriding individuals' intuitive tendency to focus on relative shares.

Same but different: Comparative modes of information processing are implicated in the construction of perceptions of autonomy support

An implicit assumption behind tenets of self-determination theory is that perceptions of autonomy support are a function of absolute modes of information processing. In this study, we examined whether comparative modes of information processing were implicated in the construction of perceptions of autonomy support. In an experimental study, we demonstrated that participants employed comparative modes of information processing in evaluating receipt of small, but not large, amounts of autonomy support. In addition, we found that social comparison processes influenced a number of outcomes that are empirically related to perceived autonomy support such as sense of autonomy, positive affect, perceived usefulness, and effort. Findings shed new light upon the processes underpinning construction of perceptions related to autonomy support and yield new insights into how to increase the predictive validity of models that use autonomy support as a determinant of motivation and psychological well-being.

The emergence of longevous populations

The human lifespan has traversed a long evolutionary and historical path, from short-lived primate ancestors to contemporary Japan, Sweden, and other longevity frontrunners. Analyzing this trajectory is crucial for understanding biological and sociocultural processes that determine the span of life. Here we reveal a fundamental regularity. Two straight lines describe the joint rise of life expectancy and lifespan equality: one for primates and the second one over the full range of human experience from average lifespans as low as 2 y during mortality crises to more than 87 y for Japanese women today. Across the primate order and across human populations, the lives of females tend to be longer and less variable than the lives of males, suggesting deep evolutionary roots to the male disadvantage. Our findings cast fresh light on primate evolution and human history, opening directions for research on inequality, sociality, and aging.

Clinical Impact Research - how to choose experimental or observational intervention study?

BACKGROUND

Interventions directed to individuals by health and social care systems should increase health and welfare of patients and customers.

AIMS

This paper aims to present and define a new concept Clinical Impact Research (CIR) and suggest which study design, either randomized controlled trial (RCT) (experimental) or benchmarking controlled trial (BCT) (observational) is recommendable and to consider the feasibility, validity, and generalizability issues in CIR.

METHODS

The new concept is based on a narrative review of the literature and on author's idea that in intervention studies, there is a need to cover comprehensively all the main impact categories and their respective outcomes. The considerations on how to choose the most appropriate study design (RCT or BCT) were based on previous methodological studies on RCTs and BCTs and on author's previous work on the concepts benchmarking controlled trial and system impact research (SIR).

RESULTS

The CIR covers all studies aiming to assess the impact for health and welfare of any health (and integrated social) care or public health intervention directed to an individual. The impact categories are accessibility, quality, equality, effectiveness, safety, and efficiency. Impact is the main concept, and within each impact category, both generic- and context-specific outcome measures are needed. CIR uses RCTs and BCTs.

CONCLUSIONS

CIR should be given a high priority in medical, health care, and health economic research. Clinicians and leaders at all levels of health care can exploit the evidence from CIR. Key messages The new concept of Clinical Impact Research (CIR) is defined as a research field aiming to assess what are the impacts of healthcare and public health interventions targeted to patients or individuals. The term impact refers to all effects caused by the interventions, with particular emphasis on accessibility, quality, equality, effectiveness, safety, and efficiency. CIR uses two study designs: randomized controlled trials (RCTs) (experimental) and benchmarking controlled trials (BCTs) (observational). Suggestions on how to choose between RCT and BCT as the most suitable study design are presented. Simple way of determining the study question in CIR based on the PICO (patient, intervention, control intervention, outcome) framework is presented. CIR creates the scientific basis for clinical decisions. Clinicians and leaders at all levels of health care and those working for public health can use the evidence from CIR for the benefit of patients and the population.

Bread and Roses: A Gender Perspective on Environmental Justice and Public Health

Gender continues to be a relatively marginal issue in environmental justice debates and yet it remains an important aspect of injustice. To help redress the balance, this article explores women’s experience of environmental justice through a review of the existing literature and the author’s prior qualitative research, as well as her experience of environmental activism. The analysis confirms that women tend to experience inequitable environmental burdens (distributional injustice); and are less likely than men to have control over environmental decisions (procedural injustice), both of which impact on their health (substantive injustice). It is argued that these injustices occur because women generally have lower incomes than men and are perceived as having less social status than their male counterparts as a result of entwined and entrenched capitalist and patriarchal processes. In the light of this analysis, it is proposed that environmental justice research, teaching, policy and practice should be made more gender aware and feminist orientated. This could support cross-cutting debates and activities in support of the radical social change necessary to bring about greater social and environmental justice more generally.

Religion and culture

Religion, belief and culture should be recognized as potential sources of moral purpose and personal strength in healthcare, enhancing the welfare of both clinicians and patients amidst the experience of ill-health, healing, suffering and dying. Communication between doctors and patients and between healthcare staff should attend sensitively to the welfare benefits of religion, belief and culture. Doctors should respect personal religious and cultural commitments, taking account of their significance for treatment and care preferences. Good doctors understand their own beliefs and those of others. They hold that patient welfare is best served by understanding the importance of religion, belief and culture to patients and colleagues. The sensitive navigation of differences between people's religions, beliefs and cultures is part of doctors' civic obligations and in the UK should follow the guidance of the General Medical Council and Department of Health. In particular, apparent conflict between clinical judgement or normal practices and a patient's culture, religion and belief should be considered carefully. Doctors' own religion or culture may play an important role in promoting adherence to this good practice. In all matters, doctors' conduct should be governed by the law and arrangements for conscientious objection that are in effect.

Medical Need, Equality, and Uncertainty

Many hold that distributing healthcare according to medical need is a requirement of equality. Most egalitarians believe, however, that people ought to be equal on the whole, by some overall measure of well-being or life-prospects; it would be a massive coincidence if distributing healthcare according to medical need turned out to be an effective way of promoting equality overall. I argue that distributing healthcare according to medical need is important for reducing individuals' uncertainty surrounding their future medical needs. In other words, distributing healthcare according to medical need is a natural feature of healthcare insurance; it is about indemnity, not equality.

Children's understanding of equity in the context of inequality

In the context of a pre-existing resource inequality, the concerns for strict equality (allocating the same number of resources to all recipients) conflict with the concerns for equity (allocating resources to rectify the inequality). This study demonstrated age-related changes in children's (3-8 years old, N = 133) ability to simultaneously weigh the concerns for equality and equity through the analysis of children's judgements, allocations, and reasoning in the context of a pre-existing inequality. Three- to 4-year-olds took equity into account in their judgements of allocations, but allocated resources equally in a behavioural task. In contrast, 5- to 6-year-olds rectified the inequality in their allocations, but judged both equitable and equal allocations to be fair. It was not until 7-8 years old that children focused on rectifying the inequality in their allocations and judgements, as well as judged equal allocations less positively than equitable allocations, thereby demonstrating a more complete understanding of the necessity of rectifying inequalities. The novel findings revealed age-related changes from 3 to 8 years old regarding how the concerns for equity and equality develop, and how children's judgements, allocations, and reasoning are coordinated when making allocation decisions.

Integrated modeling and design for realizing a two-wheeled wheelchair for disabled

Two-wheeled wheelchairs are considered highly nonlinear and complex systems. The systems mimic a double-inverted pendulum scenario and will provide better maneuverability in confined spaces and also to reach higher level of height for pick and place tasks. The challenge resides in modeling and control of the two-wheeled wheelchair to perform comparably to a normal four-wheeled wheelchair. Most common modeling techniques have been accomplished by researchers utilizing the basic Newton's Laws of motion and some have used 3D tools to model the system where the models are much more theoretical and quite far from the practical implementation. This article is aimed at closing the gap between the conventional mathematical modeling approaches where the integrated 3D modeling approach with validation on the actual hardware implementation was conducted. To achieve this, both nonlinear and a linearized model in terms of state space model were obtained from the mathematical model of the system for analysis and, thereafter, a 3D virtual prototype of the wheelchair was developed, simulated, and analyzed. This has increased the confidence level for the proposed platform and facilitated the actual hardware implementation of the two-wheeled wheelchair. Results show that the prototype developed and tested has successfully worked within the specific requirements established.

Aspects of Equality in Mandatory Partnerships - From the Perspective of Municipal Care in Norway

INTRODUCTION

This paper raises questions about equality in partnerships, since imbalance in partnerships may effect collaboration outcomes in integrated care. We address aspects of equality in mandatory, public-public partnerships, from the perspective of municipal care. We have developed a questionnaire wherein the Norwegian Coordination Reform is an illustrative example. The following research question is addressed: What equality dimensions are important for municipals related to mandatory partnerships with hospitals?

THEORY/METHODS

Since we did not find any instrument to measure equality in partnerships, an explorative design was chosen. The development of the instrument was based on the theory on partnership and knowledge about the field and context. A national online survey was emitted to all 429 Norwegian municipalities in 2013. The response rate was in total 58 percent (n = 248). The data were mainly analysed using Principal component analysis.

RESULTS

It seems that the two dimensions "learning and expertise equality" and "contractual equality" collects reliable and valid data to measure aspects of equality in partnerships.

DISCUSSION

Partnerships are usually based on voluntarism. The results indicate that mandatory partnerships, within a public health care system, can be appropriate to equalize partnerships between health care providers at different care levels.

In vitro gametogenesis: just another way to have a baby?

Advances in science have made possible the derivation of reproductively viable gametes in vitro from mice. The research on human cells suggests that in vitro gametogenesis ("IVG") with reproductive potential may one day be possible with humans. This technology would allow same-sex couples to have children who are biologically related to both of them; allow single individuals to procreate without the genetic contribution of another individual; and facilitate "multiplex" parenting, where groups of more than two individuals procreate together, producing children who are the genetic progeny of them all. IVG could also make prenatal selection a much more refined and comprehensive process than it is today, allowing for the selection of embryos on the basis of multiple factors. Evaluating IVG under a relational autonomy framework, this article argues that the potential benefits or harms of IVG depend on the social, scientific, and legal context in which it is situated and how it is used. It concludes that IVG is preferable to some forms of assisted reproductive technologies in certain instances and substantially more problematic in others. Finally, it suggests that its capacity to "perfect" prenatal selection in many ways exacerbates the problematic aspects of increasingly expansive prenatal selection.

System impact research - increasing public health and health care system performance

BACKGROUND

Interventions directed to system features of public health and health care should increase health and welfare of patients and population.

AIMS

To build a new framework for studies aiming to assess the impact of public health or health care system, and to consider the role of Randomized Controlled Trials (RCTs) and of Benchmarking Controlled Trials (BCTs).

METHODS

The new concept is partly based on the author's previous paper on the Benchmarking Controlled Trial. The validity and generalizability considerations were based on previous methodological studies on RCTs and BCTs.

RESULTS

The new concept System Impact Research (SIR) covers all the studies which aim to assess the impact of the public health system or of the health care system on patients or on population. There are two kinds of studies in System Impact Research: Benchmarking Controlled Trials (observational) and Randomized Controlled Trials (experimental). The term impact covers in particular accessibility, quality, effectiveness, safety, efficiency, and equality.

CONCLUSIONS

System Impact Research - creating the scientific basis for policy decision making - should be given a high priority in medical, public health and health economic research, and should also be used for improving performance. Leaders at all levels of health and social care can use the evidence from System Impact Research for the benefit of patients and population. Key messages The new concept of SIR is defined as a research field aiming at assessing the impacts on patients and on populations of features of public health and health and social care systems or of interventions trying to change these features. SIR covers all features of public health and health and social care system, and actions upon these features. The term impact refers to all effects caused by the public health and health and social care system or parts of it, with particular emphasis on accessibility, quality, effectiveness, adverse effects, efficiency, and equality of services. SIR creates the scientific basis for policy decisions. Leaders at all levels of health and social care can use the evidence from SIR for the benefit of the patients and the population.

Women in evolution - highlighting the changing face of evolutionary biology

The face of science has changed. Women now feature alongside men at the forefront of many fields, and this is particularly true in evolutionary biology. This special issue celebrates the outstanding achievements and contributions of women in evolutionary biology, by highlighting a sample of their research and accomplishments. In addition to original research contributions, this collection of articles contains personal reflections to provide perspective and advice on succeeding as a woman in science. By showcasing the diversity and research excellence of women and drawing on their experiences, we wish to enhance the visibility of female scientists and provide inspiration as well as role models. These are exciting times for evolutionary biology, and the field is richer and stronger for the diversity of voices contributing to the field.

Complementing Gender Analysis Methods

The existing gender analysis frameworks start with a premise that men and women are equal and should be treated equally. These frameworks give emphasis on equal distribution of resources between men and women and believe that this will bring equality which is not always true. Despite equal distribution of resources, women tend to suffer and experience discrimination in many areas of their lives such as the power to control resources within social relationships, and the need for emotional security and reproductive rights within interpersonal relationships. These frameworks believe that patriarchy as an institution plays an important role in women's oppression, exploitation, and it is a barrier in their empowerment and rights. Thus, some think that by ensuring equal distribution of resources and empowering women economically, institutions like patriarchy can be challenged. These frameworks are based on proposed equality principle which puts men and women in competing roles. Thus, the real equality will never be achieved. Contrary to the existing gender analysis frameworks, the Complementing Gender Analysis framework proposed by the author provides a new approach toward gender analysis which not only recognizes the role of economic empowerment and equal distribution of resources but suggests to incorporate the concept and role of social capital, equity, and doing gender in gender analysis which is based on perceived equity principle, putting men and women in complementing roles that may lead to equality. In this article the author reviews the mainstream gender theories in development from the viewpoint of the complementary roles of gender. This alternative view is argued based on existing literature and an anecdote of observations made by the author. While criticizing the equality theory, the author offers equity theory in resolving the gender conflict by using the concept of social and psychological capital.

Tolerance as a function of disapproval and respect: The case of Muslims

The article assesses a disapproval-respect model of tolerance according to which tolerance is made possible when disapproval of others' beliefs, preferences, or practices is balanced by respect for them as equal fellow citizens. Employing a sample of Muslims living in Germany, we predicted and found that such respect was more predictive of outgroup toleration when respondents disapproved rather than approved of the outgroups' beliefs, preferences, or practices. Moreover, respondents who displayed the critical combination of extreme disapproval and full respect indeed showed outgroup toleration. A parallel pattern of results was observed for willingness to engage in intergroup cooperation. Practical implications are discussed.

Marriage equality is a mental health issue

OBJECTIVE

We aim to review marriage equality in New Zealand and Australia and critically evaluate the health impact of such a legal change.

METHOD

We undertook a review of the literature using the search terms "marriage equality", "same sex marriage" and "gay marriage" in combination with "health", "wellbeing", "psych*", "mental illness" and "distress". This search included medical literature, legal literature and mass media.

RESULTS

This review indicates that Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) people disproportionately face negative health stressors and negative health events compared with the general population and this is related to the stress of being a stigmatised minority group. The evidence strongly supports the proposition that marriage equality is related to improved health outcomes. A diverse range of professional health groups advocate for the legislative progression to marriage equality. The authors found no evidence that marriage equality harms opposite-sex marriage.

CONCLUSION

Marriage equality is still lacking in Australia and as a positive correlate of health should be strongly supported.

Justice and Negotiation

This review article examines the literature regarding the role played by principles of justice in negotiation. Laboratory experiments and high-stakes negotiations reveal that justice is a complex concept, both in relation to attaining just outcomes and to establishing just processes. We focus on how justice preferences guide the process and outcome of negotiated exchanges. Focusing primarily on the two types of principles that have received the most attention, distributive justice (outcomes of negotiation) and procedural justice (process of negotiation), we introduce the topic by reviewing the most relevant experimental and field or archival research on the roles played by these justice principles in negotiation. A discussion of the methods used in these studies precedes a review organized in terms of a framework that highlights the concept of negotiating stages. We also develop hypotheses based on the existing literature to point the way forward for further research on this topic.

Exploring the compatibility of mental health nursing, recovery-focused practice and the welfare state

Mental health nurses are expected to adhere to a range of professional values. The values of social integration that mental health nurses practise are somewhat at odds with the values of the British welfare state. Alternative systems of welfare support are demonstrated in other countries. Mental health nurses must consider models of practice, such as that described by Clifton et al. (2013b), to manage the disconnection between what is expected and what can be achieved. This discussion paper considers the implications for mental health nursing practice when working alongside individuals in receipt of state benefits. There is arguably a profound impact on an individual's recovery from mental ill health when that individual is also dependent on financial support from the government. Access to welfare benefits can have a significant impact on the recovery journey of that individual. This discussion paper will consider the practice implications for mental health nurses whose professional values include maxims such as 'challenging inequality' and 'respecting diversity', and will seek to examine the implications for practice when such values are divergent from those demonstrated in government policy. The paper will make comparisons with international welfare systems to demonstrate the way in which alternative configurations of state welfare can promote a system of social justice that is in greater equilibrium with the professional values of mental health nurses. Finally, the discussion will focus on the options for mental health nurses to either subscribe to government policy or to find compromise solutions that enable attention to remain focused and active on a strong value base of social justice and recovery-focused practice.