Who needs education on LGBTQIA+ healthcare inclusion?

The topic of education on healthcare needs and equity of care for LGBTQIA+ populations is an extremely current issue. There is a demand for education on these topics not only from medical and other health sciences students but also from established healthcare professionals. Given this widespread educational deficiency, it is natural to ask whether the teaching class is prepared to satisfy these requests or in turn needs training on these issues and above all whether it is capable of transmitting attention and sensitivity on the issues of inclusion and equality in needs of healthcare.

Student's perspectives of inclusive practices in anatomy education

There is a drive to implement inclusive practices in anatomy by adapting curricula and utilizing inclusive language and resources that negate biases. However, to date there is no data regarding student's perception of inclusivity. Therefore, the study aims to investigate anatomy student's opinions on inclusive practices in anatomy education based on the protected characteristics of age, disability, ethnicity, gender affirmation and sex. One hundred and forty-five students completed a questionnaire with 21 Likert-scale and two open-ended questions. Kruskal-Wallis tests compared responses by groups defined by the protected characteristics of the Equality Act (2010). Most students (71.2%; n = 84) agreed or strongly agreed that "improving inclusivity in anatomy education should be educator's priority". In terms of representation, there was a statistically different response rate from students from different ethnic backgrounds to the statements "there are anatomy educators" (p < 0.001), "images in textbooks" (p < 0.001) and "models in the dissection room" (p < 0.001) "that look like me". Most students agreed or strongly agreed to statements relating to the protected characteristics of age (70.4%; n = 68), disability (78.6%; n = 77), ethnicity (59.8%; n = 64), gender affirmation (46.3%; n = 46) and sex (51.5%; n = 62). Themes identified relating to improving inclusivity included "reflecting reality", "teaching the truth", "the invisibility of women" and the "learning environment". Students have confirmed that anatomists, as gatekeepers of the knowledge of the human body, should foster inclusive teaching practices that will benefit all students and potentially future patient care.

Organizational and social justice paradoxes in EDI

This perspective article positions social justice as an addition to the aims of organizational justice, and core to diversity, equality, and inclusion (DEI). It problematizes simplistic DEI rhetoric and positions paradoxes within DEI, as experienced by employers, based on an explanation of key justice concepts and the introduction of fairness, equality, desert, and need. The paper broadens perspective-taking beyond a sole focus on beneficiaries of DEI, towards tensions that employers experience in working towards the aims of workplace justice, including the embeddedness of social justice within both organizations and social systems. The paper concludes with avenues for future research and a call to carefully examine simplistic notions of organizational justice in effecting DEI, suggesting a paradoxical lens on embracing, rather than avoiding, multiple and often conflicting workplace justice imperatives.

Designing equity, diversity, and inclusion training for postgraduate parasitologists

Equity, diversity, and inclusion (EDI) have received increased attention in the sciences, with increasing expectation that students will receive formal training in this area. However, compared with other biosciences, little guidance has been produced for parasitology educators. Therefore, this article presents the contents and evaluation of pilot training designed for postgraduates.

Improving emergency department care for adults presenting with mental illness: a systematic review of strategies and their impact on outcomes, experience, and performance

Background

Care delivery for the increasing number of people presenting at hospital emergency departments (EDs) with mental illness is a challenging issue. This review aimed to synthesise the research evidence associated with strategies used to improve ED care delivery outcomes, experience, and performance for adults presenting with mental illness.

Method

We systematically reviewed the evidence regarding the effects of ED-based interventions for mental illness on patient outcomes, patient experience, and system performance, using a comprehensive search strategy designed to identify published empirical studies. Systematic searches in Scopus, Ovid Embase, CINAHL, and Medline were conducted in September 2023 (from inception; review protocol was prospectively registered in Prospero CRD42023466062). Eligibility criteria were as follows: (1) primary research study, published in English; and (2) (a) reported an implemented model of care or system change within the hospital ED context, (b) focused on adult mental illness presentations, and (c) evaluated system performance, patient outcomes, patient experience, or staff experience. Pairs of reviewers independently assessed study titles, abstracts, and full texts according to pre-established inclusion criteria with discrepancies resolved by a third reviewer. Independent reviewers extracted data from the included papers using Covidence (2023), and the quality of included studies was assessed using the Joanna Briggs Institute suite of critical appraisal tools.

Results

A narrative synthesis was performed on the included 46 studies, comprising pre-post (n = 23), quasi-experimental (n = 6), descriptive (n = 6), randomised controlled trial (RCT; n = 3), cohort (n = 2), cross-sectional (n = 2), qualitative (n = 2), realist evaluation (n = 1), and time series analysis studies (n = 1). Eleven articles focused on presentations related to substance use disorder presentation, 9 focused on suicide and deliberate self-harm presentations, and 26 reported mental illness presentations in general. Strategies reported include models of care (e.g., ED-initiated Medications for Opioid Use Disorder, ED-initiated social support, and deliberate self-harm), decision support tools, discharge and transfer refinements, case management, adjustments to liaison psychiatry services, telepsychiatry, changes to roles and rostering, environmental changes (e.g., specialised units within the ED), education, creation of multidisciplinary teams, and care standardisations. System performance measures were reported in 33 studies (72%), with fewer studies reporting measures of patient outcomes (n = 19, 41%), patient experience (n = 10, 22%), or staff experience (n = 14, 30%). Few interventions reported outcomes across all four domains. Heterogeneity in study samples, strategies, and evaluated outcomes makes adopting existing strategies challenging.

Conclusion

Care for mental illness is complex, particularly in the emergency setting. Strategies to provide care must align ED system goals with patient goals and staff experience.

Ethical and Quality of Care-Related Challenges of Digital Health Twins in Older Care Settings: Protocol for a Scoping Review

BACKGROUND

Digital health twins (DHTs) have been evolving with their diverse applications in medicine, specifically in older care settings, with the increasing demands of older adults. DHTs have already contributed to improving the quality of dementia and trauma care, cardiac treatment, and health care services for older individuals. Despite its many benefits, the optimum implementation of DHTs has faced several challenges associated with ethical issues, quality of care, management and leadership, and design considerations in older care settings. Since the need for such care is continuously rising and there is evident potential for DHTs to meet those needs, this review aims to map key concepts to address the gaps in the research knowledge to improve DHT implementation.

OBJECTIVE

The review aims to compile and synthesize the best available evidence regarding the problems encountered by older adults and care providers associated with the application of DHTs. The synthesis will collate the evidence of the issues associated with quality of care, the ethical implications of DHTs, and the strategies undertaken to overcome those challenges in older care settings.

METHODS

The review will follow the Joanna Briggs Institute (JBI) methodology. The published studies will be searched through CINAHL, MEDLINE, JBI, and Web of Science, and the unpublished studies through Mednar, Trove, OCLC WorldCat, and Dissertations and Theses. Studies published in English from 2002 will be considered. This review will include studies of older individuals (aged 65 years or older) undergoing care delivery associated with DHTs and their respective care providers. The concept will include the application of the technology, and the context will involve studies based on the older care setting. A broad scope of evidence, including quantitative, qualitative, text and opinion studies, will be considered. A total of 2 independent reviewers will screen the titles and abstracts and then review the full text. Data will be extracted from the included studies using a data extraction tool developed for this study.

RESULTS

The results will be presented in a PRISMA-ScR (Preferred Reporting Items for Systematic Review and Meta-Analysis extension for Scoping Reviews) flow diagram. A draft charting table will be developed as a data extraction tool. The results will be presented as a "map" of the data in a logical, diagrammatic, or tabular form in a descriptive format.

CONCLUSIONS

The evidence synthesis is expected to uncover the shreds of evidence required to address the ethical and care quality-related challenges associated with applying DHTs. A synthesis of various strategies used to overcome identified challenges will provide more prospects for adopting them elsewhere and create a resource allocation model for older individuals.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/51153.

Effects of Sociodemographic Factors on Access to and Outcomes in Congenital Heart Disease in the United States

Congenital heart defects (CHDs) are complex conditions affecting the heart and/or great vessels that are present at birth. These defects occur in approximately 9 in every 1000 live births. From diagnosis to intervention, care has dramatically improved over the last several decades. Patients with CHDs are now living well into adulthood. However, there are factors that have been associated with poor outcomes across the lifespan of these patients. These factors include sociodemographic and socioeconomic positions. This commentary examined the disparities and solutions within the evolution of CHD care in the United States.

Gender, flexibility and workforce in the NHS: A qualitative study

Data from the General Medical Council show that the number of female doctors registered to practise in the UK continues to grow at a faster rate than the number of male doctors. Our research critically discusses the impact of this gender-based shift, considering how models of medical training are still ill-suited to supporting equity and inclusivity within the workforce, with particular impacts for women despite this gender shift. Drawing on data from our research project Mapping underdoctored areas: the impact of medical training pathways on NHS workforce distribution and health inequalities, this paper explores the experiences of doctors working in the NHS, considering how policies around workforce and beyond have impacted people's willingness and ability to continue in their chosen career path. There is clear evidence that women are underrepresented in some specialties such as surgery, and at different career stages including in senior leadership roles, and our research focuses on the structural factors that contribute to reinforcing these under-representations. Medical education and training are known to be formative points in doctors' lives, with long-lasting impacts for NHS service provision. By understanding in detail how these pathways inadvertently shape where doctors live and work, we will be able to consider how best to change existing systems to provide patients with timely and appropriate access to healthcare. We take a cross-disciplinary theoretical approach, bringing historical, spatiotemporal and sociological insights to healthcare problems. Here, we draw on our first 50 interviews with practising doctors employed in the NHS in areas that struggle to recruit and retain doctors, and explore the gendered nature of career biographies. We also pay attention to the ways in which doctors carve their own career pathways out of, or despite of, personal and professional disruptions.

Family Building in Transgender Patients: Modern Strategies with Assisted Reproductive Technology Treatment

Purpose

Transgender and gender diverse (TGD) individuals continue to face adversity, stigma, and inequality, especially in health care. This study aimed to characterize the experience of TGD people and partners of TGD people with regard to fertility treatment.

Methods

All TGD patients presenting to a single academic center between 2013 and 2021 were included. Baseline demographics collected included patient age, body mass index, anti-Mullerian hormone, basal antral follicle count, history of gender-affirming surgery, and/or gender-affirming hormone therapy. Outcomes included total patients who progressed to treatment, cycle type(s), and clinical outcomes.

Results

In total, 82 patients who identified as TGD or had a partner who identified as TGD presented to care seeking fertility treatment. Of the 141 planned cycles, 106 (75.2%) progressed to treatment. Of the 15 in vitro fertilization (IVF) and co-IVF cycles, 12 achieved live birth. Of the 76 intrauterine inseminations 7 patients were discharged with ongoing pregnancies and one achieved live birth.

Conclusion

These findings reaffirm that TGD individuals utilize the entire array of fertility services. With recent advances in access to care and modern medicine, assisted reproductive technology treatment has the power to support TGD patients in building contemporary family structures.

Enhancing gender equality for women using person-centred care and cultural curiosity

Socially constructed gender norms influence people's access to, and experience of, healthcare. Gender norms can negatively affect the health of women, men and people with other gender identities, such as transgender or non-binary individuals. Person-centred care and shared decision-making, which are widely recognised as essential aspects of healthcare, could be effective approaches for enhancing gender equality in healthcare for women. However, many women appear to receive suboptimal person-centred care. Additionally, there is a lack of representation of diverse gender identities in research, as well as a lack of awareness of diverse gender identities among nurses and other healthcare professionals. To enhance gender equality in healthcare for women, nurses and nursing students should be encouraged to reflect on their unconscious biases and adopt a stance of cultural curiosity, while organisations need to improve preregistration and post-registration training on equality and diversity.

Ethical reasoning versus empathic bias: a false dichotomy?

Does empathy necessarily impede equity in altruism? Emerging findings from cognitive and affective science suggest that rationality and empathy are mutually compatible, contradicting some earlier, prominent arguments that empathy impedes equitable giving. We propose alternative conceptualizations of relationships among empathy, rationality, and equity, drawing on interdisciplinary advances in altruism research.

Tackling disrespect in health care: The relevance of socio-relational equality

Disrespect in health care often persists despite firm commitments to respectful service provision. This conceptual paper highlights how the ways in which respect and disrespect are characterised can have practical implications for how well disrespect can be tackled. We stress the need to focus explicitly on disrespect (not only respect) and propose that disrespect can usefully be understood as a failure to relate to people as equals. This characterisation is consonant with some accounts of respect but sometimes obscured by a focus on respecting people's autonomy and dignity. Emphasising equality is consistent with connections patients draw between being (dis)respected and (in)equality. It readily accommodates microaggressions as forms of disrespect, helping to understand how and why experiences of disrespect may be unintentional and to explain why even small instances of disrespect are wrong. Our view of disrespect with an emphasis on equality strengthens the demand that health systems take disrespect seriously as a problem of social injustice and tackle it at institutional, not just individual levels. It suggests several strategies for practical action. Emphasising relational equality is not an easy or short-term fix for disrespect, but it signals a direction of travel towards an important improvement ambition.

Childcare burden and changes in fertility desires of mothers during the COVID-19 pandemic

Objectives

Previous studies have documented a decline in fertility desires and intentions following the COVID-19 outbreak, but the reasons for this decline are not well understood. This study examined whether childcare burden on mothers during the lockdown and quarantines, COVID-related stress, and COVID exposure were associated with a change in the desired number of children.

Methods

The survey was conducted online, in Poland from April to July 2021 on a sample of 622 non-pregnant mothers without diagnosed infertility.

Results

Associations were observed between childcare responsibilities during the quarantine and fertility desires: mothers who solely or mainly took care of their children during the quarantine(s) were more likely to decrease their desired number of children ([adjusted] aOR = 1.91, 95% CI = 1.16-3.15). Mothers with higher levels of COVID-related stress (aOR = 1.81, 95% CI = 1.48-2.22) and a greater COVID exposure index (aOR = 1.39, 95% CI = 1.12-1.72) were more likely to decrease their fertility desires.

Conclusion

Higher childcare burden during quarantines was related to a lower desired number of children among mothers. Both greater COVID-related stress and COVID exposure were associated with fertility desires, regardless of childcare responsibilities during the pandemic.

"There just isn't any other option-so we just have to put up with it": mental health in women's cycling and the necessity of structural change

Historically, bicycle riding connoted freedom, independence, and enhanced mental and physical wellbeing for women. Persevering through criticism and moral panic, female cyclists have been competitive since the late 19th century-many earning substantial prize money and prestige. Unfortunately, this progress was not linear in its trajectory and contemporary professional women's cycling continues to be pervaded by structural and cultural challenges, which can have deleterious effects on athlete mental health. Notably, socioeconomic pressures endure, like unstable employment terms, limited team support, and role conflicts. Furthermore, sexual harassment, body shaming, and manipulation may characterize women's experiences with their coaches and teams. Sizable investment gaps between men's and women's teams and competitions often underpin these scenarios of disadvantage. Alongside hindering the development of women's cycling, these adverse circumstances may induce psychosocial risk factors. Within this context, by highlighting sport-specific and sex-specific considerations, the emerging subdiscipline of sports psychiatry can be valuable for protecting and promoting athlete welfare in women's cycling. Raising awareness about extant symptoms, vulnerabilities, contributing behaviours, and systemic issues, can bolster efforts to develop better conditions and care equivalence. To that end, this perspective article draws upon anecdotal and scholarly evidence to provide an overview of psychiatric concerns in women's professional cycling. This informs recommended strategies to improve mental health and advance equality within the sport, which should involve actions from several stakeholders, such as athletes, teams, and governing bodies.

Supporting transgender patients with their personal hygiene

Attending to one's personal hygiene is a private and ritualistic act that is linked to self-expression and is important for one's well-being and self-esteem. Providing effective support with personal hygiene to patients can demonstrate thoughtfulness and sensitivity to their individual needs. Nurses in all fields of nursing may encounter patients who identify as transgender, but many nurses have expressed concerns about their lack of knowledge and confidence in that area of care. This article discusses the use of gender-affirming language and the factors to consider when supporting transgender patients with their personal hygiene as part of personalised, equitable and inclusive nursing care.

Supporting gender-diverse young people: the role of the nurse

Gender-diverse individuals will need to access healthcare services for various reasons, with most of this care provided outside of specialist gender services. Nurses have an important role in advocating for the specific needs of gender-diverse individuals and providing person-centred care. Therefore, they have a responsibility to ensure their knowledge of appropriate terminology and gender-affirming interventions is up to date. This article provides information about gender diversity to enhance nurses' understanding of this area to enable them to care for gender-diverse people effectively and sensitively. While the focus of this article is on gender-diverse young people, the same principles can be applied across all age groups.

Norm-violating rhetoric undermines support for participatory inclusiveness and political equality among Trump supporters

Over the last decade, the United States has seen increasing antidemocratic rhetoric by political leaders. Yet, prior work suggests that such norm-violating rhetoric does not undermine support for democracy as a system of government. We argue that, while that may be true, such rhetoric does vitiate support for specific democratic principles. We test this theory by extending prior work to assess the effects of Trump's norm-violating rhetoric on general support for democracy as well as for the principles of participatory inclusiveness, contestation, the rule of law, and political equality. We find that Trump's rhetoric does not alter attitudes toward democracy as a preferred system but does reduce support for inclusiveness and equality among his supporters. Our findings suggest that elite rhetoric can undermine basic principles of American democracy.

Nationwide and regional trends in distance and near visual acuities during 2000-2017 in Finland

PURPOSE

To evaluate time trends in distance and near vision at the national and regional levels during 2000-2017 in Finland.

METHODS

We used three cross-sectional, nationwide health examination surveys representing the Finnish adult population aged 30 years or older in 2000, 2011 and 2017. Bilateral, habitual distance and near visual acuity (VA) were measured in all three surveys.

RESULTS

The prevalence of good distance vision (VA ≥ 1.0) increased from 76.7% to 81.3% during 2000-2017 while the prevalence of weak or worse distance vision (VA ≤ 0.5) decreased from 7.6% to 3.7%. The improvements were largest among those aged 85 years and older: the prevalence of distance VA ≤ 0.5 decreased from 71.8% to 28.3%. Near vision showed improvement to a lesser extent in the total population; nevertheless, among those aged 85 years and older the prevalence of weak or worse near vision (VA ≤ 0.5) decreased from 62.3% to 27.1%. A similar positive time trend was observed in all main regions of Finland, and differences between urban and rural regions were small.

CONCLUSION

During the past two decades, the overall vision level has improved among the adult population. This is explained mostly by a positive shift from lower to higher vision levels among older age groups, indicating that people live longer with good or adequate vision. This positive trend showed remarkable similarity throughout different regions in Finland, highlighting the importance of equal and accessible eye care throughout the country.

Gender Equality Training for Students in Higher Education: Protocol for a Scoping Review

BACKGROUND

The principles of gender equality are integral to the goals, targets, and indicators of all sustainable development goals. Higher education institutes can be powerful agents for promoting gender equality, diversity, and inclusion not only in the higher education context but also in society as a whole. To address and overcome gender inequality in the higher education environment, experts posit that change needs to occur from day 1 of the student's academic experience. To this end, training is required. A preliminary review of the literature indicates that multiple gender equality-based training programs or initiatives for students have been designed and evaluated in second and third-level education settings. Examples of educational activities undertaken include delivery of didactic teaching, participation in a face-to-face collaboration project, site visits, case studies, and coaching. Yet, our initial search indicated that, to date, a comprehensive review collating the available evidence on gender equality training for third-level students has not yet been carried out.

OBJECTIVE

Our review seeks to identify and explore the existing literature on gender equality training interventions for third-level students, with a particular emphasis on training content, methodology, and outcome evaluation.

METHODS

This scoping review will be structured using the Arskey and O'Malley's 5-stage framework and will consider empirical research and other relevant published works that address gender equality training. Systematic searches will be carried out in 6 research databases and the gray literature using key search terms. Inclusion and exclusion criteria have been defined, and a data charting tool created to methodically extract information from selected literature. The free web software Rayyan will be used for primary screening where each reference will be screened in duplicate first by title, then abstract, and finally by full text.

RESULTS

This review forms part of the LIBRA (Balance) study and has received peer-reviewed grant funding from the Irish Higher Education Authority. LIBRA aims to use simulation-based education to develop a gender equality leadership training program for student leaders in higher education. The findings will be summarized in tabular form, and a narrative synthesis produced to inform curriculum development.

CONCLUSIONS

This review seeks to inform curriculum design by reporting on the gender equality-enabling skills and leadership skills necessary to foster gender equality. This paper should inform recommendations for training and catalyze future research in this rapidly evolving area.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/44584.

Aristotle on identity: close enough!

We present what Aristotle wrote on identity in a leisurely manner, which is much more than is generally known, save among the cognoscenti (Aristotle scholars), and mutatis mutandis about the introduction of the identity-symbol [Formula: see text]. We add two codas, one on the so-called Leibniz' Law, which is different (but resembles) what passes for it in logic and philosophy, and one on the status of identity, as accepted by mathematicians and logicians, in physics. This article is part of the theme issue 'Identity, individuality and indistinguishability in physics and mathematics'.

Abstraction, equality and univalence

We shall propose a conceptual-oriented discussion of the so-called Univalent Foundations Program, that is, of Martin-Löf type theory enriched with a homotopic interpretation, together with the univalence axiom proposed by Voevodsky. We shall argue that the type-theoretic notion of propositional equality encodes the notion of indiscernibility, we shall address the homotopic interpretation of Martin-Löf type theory, and we shall analyse whether Leibniz's principle of the identity of indiscernibles holds or not in Univalent Foundations. We shall finally argue that univalence can be understood as a particular implementation of a constructive notion of abstraction that resolves Fregean abstraction. This article is part of the theme issue 'Identity, individuality and indistinguishability in physics and mathematics'.

Social gradient in use of health services and health-related quality of life of children with attention-deficit/hyperactivity disorder: A systematic review

Aims

ADHD (attention-deficit/hyperactivity disorder) affects 5% of children on average. Despite the high need to access services for ADHD treatment, not all children with ADHD utilise healthcare services equally. This study aims to systematically synthesise evidence of equity and equality in health service use/costs and health-related quality of life (HRQoL)/wellbeing of children with ADHD across socioeconomic (SES) classes.

Methods

The literature search was conducted across seven databases (Academic Search complete, MEDLINE Complete, PsycINFO, ERIC, Global Health, CINAHL and EconLit). The search was limited to peer-reviewed articles published to 23rd January 2023 in English and focused on children. Study quality was assessed using the Critical Appraisal Skills Program (CASP), Joanna Briggs Institute (JBI) and Mixed Methods Appraisal Tool (MMAT) checklists.

Results

25 out of 1207 articles were eligible for inclusion. The results showed that SES was associated with different types of healthcare utilisation. Only three studies were found on HRQoL/well-being. Children with ADHD from low SES families had lower HRQoL than children from high SES families.

Conclusion

This study found that a social gradient exists in both healthcare service use and children's HRQoL among those with ADHD.

The effect of fast and slow decision-making on equity-efficiency tradeoffs and moral repugnance

Fast-and-slow models of decision-making are commonly invoked to explain economic behaviour. However, past research has focused on human cooperation and generosity and thus largely overlooked situations where there are sharp conflicts between efficiency and equality, or between efficiency and more intuitive moral values (repugnance). Here, we contribute to fill this gap in the literature. We conducted a preregistered experiment (n = 1500 recruited from Prolific) to assess the effects of fast, intuitive decisions, under time pressure versus slow, deliberate decisions, under time delay, on (i) people's distributional preferences and (ii) their attitudes toward repugnant transactions. The results show increased preference for equality and decreased preference for efficiency under time pressure, but no effects on moral repugnance. Exploratory analyses revealed that most of the observed treatment effects in our data were accounted for by women. Our results provide some support for theories that associate controlled cognition with concern for efficiency, and intuitive, emotional responses with inequality aversion.

How police officers juggle work, a life partner, and kids

Police officers frequently encounter stressful social situations during their working days. Furthermore, previous research on policing and families show that police officers' families are impacted in different ways when at least one member of the family has the role of a police officer. Despite work spilling over to family life there is currently little research on police officers' role-balancing. Thus, the purpose of this study was to explore and describe the challenges that arise at the intersection between police officers' professional roles and their private life roles as parents and life partners, as well as how police officers balance these roles in between. We used qualitative content analysis after interviewing 13 uniformed police officers. The findings show how the police officers' professional roles affect their private life roles within three different sub-themes and are summarized under the theme of "Balancing conflicting roles: Coping with professional and private life commitments". The theme revolves around the various challenges of working as a uniformed police officer, such as hypervigilance and risks, as well as the enrichments and conflicts of working shifts while also juggling private life roles. The results also touch on gender and equality in life-partner relationships. The study raises an important question about how these challenges can be mitigated within Police authorities to enable uniformed police officers to balance their professional and personal lives in a healthy and sustainable manner.

Research on equity of medical resource allocation in Yangtze River Economic Belt under healthy China strategy

Objective

This study aimed to assess the fairness of medical resource allocation in the Yangtze River Economic Belt, based on the Healthy China strategy. It aimed to identify the issues with resource allocation fairness and provide optimization suggestions.

Methods

To assess the allocation fairness from a geographical population perspective, the study used the Health Resource Concentration and Entropy Weight TOPSIS methods. Additionally, the study analyzed the allocation fairness from an economic level angle, using the Concentration Curve and Concentration Index.

Results

The study found that the downstream area had higher resource allocation fairness than the midstream and upstream areas. The middle reaches had more resources than the upper and lower reaches, based on population concentration. The Entropy Weight TOPSIS method found that Shanghai, Zhejiang, Chongqing, and Jiangsu had the highest comprehensive score index of agglomeration. Furthermore, from 2013 to 2019, the fairness of medical resource distribution gradually improved for different economic levels. Government health expenditure and medical beds were distributed more equitably, while general practitioners had the highest level of unfairness. However, except for medical and health institutions, traditional Chinese medicine institutions, and primary health institutions, other medical resources were mostly distributed to areas with better economic conditions.

Conclusion

The study found that the fairness of medical resource allocation in the Yangtze River Economic Belt varied greatly based on geographical population distribution, with inadequate spatial accessibility and service accessibility. Although the fairness of distribution based on economic levels improved over time, medical resources were still concentrated in better economic areas. The study recommends improving regional coordinated development to enhance the fairness of medical resource allocation in the Yangtze River Economic Belt.

Is there gender equality?

Sex and gender are often used as synonyms. However, while sex describes only a biological state, gender is a dynamic concept that takes into account psychosocial and cultural aspects of human existence that can change according to place and time. Inequality in medicine has been described in several areas. Among them, gender inequality has been disregarded for many years and is now a matter of concern. Chronic kidney disease (CKD) is a growing epidemic worldwide, affecting approximately 10% of the population. Although both men and women are affected, gender equality, especially in access to different treatments, is a matter of concern. We decided to investigate gender equality in patients with CKD. To this end, we conducted a literature narrative review to determine whether gender inequalities were found in CKD patients in general and in access to different treatment modalities in particular. A non-language restricted search was performed until November 30th 2022 in PubMed, SciELO, Trip Database, Google Scholar, MEDES y MEDLINE. We also investigated the situation in this regard in our country. We found that CKD is more prevalent in women than men, nevertheless this prevalence decreases along the CKD stages to the point that more men reach end stage kidney disease (ESKD) and dialysis. Access to transplant (ATT) is higher in men than in women although posttransplant survival shows no gender differences. Finally, most series have shown that women are more frequently Kidney transplantation (KT) living donors than men. Results in our country are similar to the published literature with the exception of a higher proportion of men as KT living donors. As in other areas, gender inequality in Nephrology has been largely overlooked. In this review we have highlighted gender differences in CKD patients. Gender inequality in Nephrology exists and needs to be looked upon in order to reach a personalized clinical approach.

Decolonising the psychology curriculum: a perspective

Decolonisation seeks to reverse the impact of colonisation on minoritised groups. Governments, healthcare institutions, criminal justice and education systems have procedures and protocols deep-rooted in colonisation and operate through a western lens. Decolonisation reaches beyond increasing inclusivity and aims to re-establish history through the experiences and perspective of those most affected. As with many disciplines, core theories, practices and interventions within Psychology, an ethnocentric viewpoint has been used, continuously reinstated through its curriculum. With awareness around diversification and increase in varying demands, it is important that the Psychology curriculum evolves to suit the needs of its' users. Many recommendations for decolonising the curriculum are trivial surface changes. These involve including required bibliography from diverse minority authors within the modules syllabuses or organising a one-off lecture or workshop from a minority ethnic speaker. Some universities have also suggested that lecturers participate in self-awareness practices to ensure they understand decolonisation to appropriately address it through their teaching, whilst others have provided checklists against which they can check the inclusivity of their modules. All these alterations fail to target the root of the problem. To properly reverse the effects of colonisation within the curriculum it would be necessary to re-evaluate the Westernised history that has been retold for years and teach past events through the experiences of those who suffered. Research into how decolonisation can occur in a structured and comprehensive way is necessary to enable the redress for abolition of colonial practices on a global scale.

Developing a talent management support network for nurses and midwives

Effective talent management is vital to retain skilled and experienced nurses and midwives in the NHS. In 2019, a group of NHS organisations in London set up a talent management support network (TMSN) aimed at helping specific groups of nurses and midwives facing challenges in fulfilling their professional potential. The network started by supporting nurses and midwives from minority ethnic backgrounds, later also offering the programme to dental nurses across England and to healthcare workers in Brazil. The network uses the power of action learning and networking in a framework that nurtures staff's talents. This article describes the London TMSN team's experience of setting up and running the network. It also explains how nursing and midwifery managers and leaders can create a business case for the development of a similar network in their setting.

Diversity, Equity, and Inclusion in the Environmental Health Workforce: Mapping the Literature and Moving Toward Liberation

Introduction

Diversity, equity, and inclusion, also known as DEI, is an essential topic being discussed across society. The field of environmental health (EH) should certainly not be excluded from the conversation.

Objective

The purpose of this mini-review was to map the literature and identify gaps on the topic of DEI in the EH workforce.

Methods

A rapid scoping review was conducted using standard synthesis science methods to search and map the published literature. All study titles, abstracts, and full texts were screened by 2 independent reviewers among the authorship team.

Results

The search strategy yielded 179 English language papers. Of those, 37 met all inclusion criteria after full text screening. Overall, the majority of the articles had weak or moderate DEI engagement and only 3 articles had strong DEI engagement.

Discussion

There is a significant need for additional research in this realm. Future studies should explicitly focus on workforce issues, and attempt to achieve the highest level of the evidence possible for this field.

Conclusion

Although DEI initiatives are a step in the right direction, the current evidence suggests that inclusivity and liberation may prove to be more impactful and meaningful constructs to fully advance equity in the EH workforce.

Promoting Equality in the Governance of Heritable Human Genome Editing through Ubuntu: Reflecting on a South African Public Engagement Study

In a recent public engagement study on heritable human genome editing (HHGE) conducted among South Africans, participants approved of using HHGE for serious health conditions-viewing it as a means of bringing about valuable social goods-and proposed that the government should actively invest resources to ensure everyone has equal access to the technology for these purposes. This position was animated by the view that future generations have a claim to these social goods, and this entitlement justified making HHGE available in the present. This claim can be ethically justified in the Ubuntu ethic (deriving from South Africa) as it (a) emphasizes the interests of the community, and (b) espouses a metaphysical conception of the community that transcends the present generation and includes past and future generations. On this basis, a compelling claim can be made on behalf of prospective persons in favor of equal access to HHGE.

Against commercial-assisted suicide

The idea of commercial-assisted suicide lives a marginal existence in the bioethical literature, despite its significant presence in popular culture. The practice of commercial-assisted suicide (CAS) is defined as suicide assistance performed for a financial reward through a contractual agreement between a customer and a service-provider, who does not necessarily need to be a medical professional. While CAS does indeed offer some potential solutions regarding the moral controversies surrounding physician-assisted suicide (PAS), I defend the idea that adopting it as policy ultimately proves morally indefensible and practically inefficient. This is due to the fact that the commodification of a given good necessarily implies the creation of a market of said good; as such, what I propose in this paper is a moral and practical evaluation of a market of CAS. In order to do so, I first examine the arguments in favor of CAS as put forward by Roland Kipke, who argues that any liberal defense of PAS necessarily implies a defense of CAS. In the first section, I argue against this idea using the liberal values of autonomy and equality of opportunity. In the second section of the paper, I argue that a market of CAS would be gravely dysfunctional due to one particular characteristic of death, namely, that is not compensable ex post. I conclude by arguing that while the practice of CAS may not prove morally problematic, the inevitable market that it will create should it be legalized most certainly will.

Dermatology Journals' Editorial Boards Require Improved Gender Equity: JMIR Dermatology's Future Directions

Gender disparities exist across all facets of academic medicine including within the editorial boards of dermatology journals. Only 22% of these editorial boards comprised women, even though 51% of full-time, faculty dermatologists are female. When inviting academic dermatologists to our editorial board at JMIR Dermatology, we invited 50% women to represent the gender distribution of academic dermatologists; however, we have not sufficiently reached gender equity among accepted editorial board members. We will continue to strive toward the goal of gender equity on our editorial board and invite other dermatology journals to do the same.

Wage (in)equality matters: the effect of organizational economic inequality on others' and self-ascriptions

Economic inequality has consequences at the social-psychological level, such as in the way people make inferences about their environment and other people. In the present two preregistered studies, we used a paradigm of an organizational setting to manipulate economic inequality and measured ascriptions of agentic versus communal traits to employees and the self. In Study 1 (N = 187), participants attributed more agency than communion to a middle-status employee, and more communion than agency when economic equality was salient. In Study 2 (N = 198) this finding was replicated. Further, this inequality-agency association was explained by perceptions of competitive employee relationships. Results, moreover, suggested that participants mainly attributed more communion than agency to themselves in the equality condition. We conclude that agency and communion ascriptions may be functional and thus inform about the expectations people have on the nature of social relationships in the face of economic inequality.

Equity analysis audit of access and utilisation of Special Care Dental Services by ethnicity and social demographic markers

OBJECTIVE

To identify and investigate any differences in utilisation of the, Sussex Community NHSFT, Special Care Dental Service (SCDS) across multiple demographic factors, including ethnicity, socio-economic groups and age in the Crawley area.

METHOD

Data were audited for all new patients seen at the Crawley Special Care Dental Centre from November 2020-October 2021. Demographic data were compared to population data from the 2011 Census. Deprivation data, using Index of Multiple Deprivation, were also examined against utilisation and failure to attend appointments.

RESULTS

A total of 1250 new patients accessed the Crawley SCDS between November 2020 and October 2021. The data suggests good equity to the service being utilised by the local community; the proportions of patients utilising the service over the course of a year from different ethnic groups reflected the demographic profile of Crawley. The proportion of failed appointments showed no correlation with deprivation decile. There was also no association between ethnic group and proportion of failed appointments.

CONCLUSION

Ensuring equal utilisation of healthcare for all population groups has become a priority for healthcare providers. This audit found minimal inequities in utilisation of the Special Care Dental Service at Crawley.

Beliefs About Linear Social Progress

Society changes, but the degree to which it has changed can be difficult to evaluate. We propose that people possess beliefs that society has made, and will make, progress in a linear fashion toward social justice. Five sets of studies (13 studies in total) demonstrate that American participants consistently estimated that over time, society has made positive, linear progress toward social issues, such as gender equality, racial diversity, and environmental protection. These estimates were often not aligned with reality, where much progress has been made in a nonlinear fashion. We also ruled out some potential alternative explanations (Study 3) and explored the potential correlates of linear progress beliefs (Study 4). We further showed that these beliefs reduced the perceived urgency and effort needed to make further progress on social issues (Study 5), which may ultimately inhibit people's willingness to act.

Gender equality in national cardiology societies: a cross-sectional study

BACKGROUND

Higher productivity and team stability has been shown for gender diverse teams. However, there is a relevant and well-known gender gap in clinical and academic cardiovascular medicine. So far, no data concerning gender distribution in presidents and executive boards of national cardiology societies exist.

METHODS

In this cross-sectional analysis, gender equality in presidents and representatives of all national cardiology societies, which are members of or affiliated with the European Society of Cardiology (ESC) in 2022 was analyzed. In addition, representatives of the American Heart Association (AHA) were evaluated.

RESULTS

A total of 106 national societies were screened of which 104 were included in the final analysis. Overall, in these 104 societies, 90 out of 106 (85%) presidents were men while 14 (13%) were women. In the analysis of board members and executives, a total of 1128 individuals were included. Overall, 809 (72%) board members were men, 258 (23%) women and 61 (5%) of unknown gender. Except for society presidents in Australia, women were relevantly outnumbered by men in all world regions.

CONCLUSION

Women were globally underrepresented in leading positions of national cardiology societies in all world regions. As national societies are important regional stakeholders, improving gender equality in executive boards might create women role models, help foster careers and narrow the global cardiology gender gap.

Ethical value and challenges of long-term care insurance

BACKGROUND

Issues of the aging population and disability of older persons have been rapidly developing in China over the past 20 years. Since 2016, the Chinese government has been exploring remedies to alleviate social and family burdens and ensure the dignity of the disabled old persons by implementing long-term care insurance systems in a few pilot cities across the country.

PURPOSE

The purpose of this study is to present the current challenges faced by China's long-term care insurance system and put forth suggestions for the future, based on literature research and the feedback obtained from its implementation in pilot areas.

RESEARCH DESIGN

This paper conducts a theoretical study based on the principles of public health ethics.

STUDY SAMPLE

Since 2016, China has launched two batches of pilot cities for long-term care insurance. The analysis object of this study is the feedback on the policy implementation of the existing 29 pilot cities that participated. The relevant data involved in the analysis are from the authors' field research and published literature on the analysis of pilot cities.

ANALYSIS

The ethical value and importance of long-term care insurance policies in China are evaluated from the perspectives of policy philosophy and social individual interests.

RESULTS

The results of this evaluation show that the core ethical values were not met in the development of China's current long-term care insurance system. Moreover, distributive justice norms were neglected, and access to the system between different social groups and within the groups covered by it was unequal.

CONCLUSIONS

This paper argues that long-term care insurance should not differentiate between urban and rural areas in allocating nursing resources. Additionally, it would be essential to build democratic supervision and manage public opinions by adopting open and transparent information-sharing policies. Standards of disability assessments and treatment payment should be at par to ensure a balance between the rights and obligations of policyholders.

The imperative of professional dementia care

Despite negative effects on their health and social lives, many informal carers of people living with dementia claim to be acting in accordance with a moral obligation. Indeed, feelings of failure and shame are commonly reported by those who later give up their caring responsibilities, suggesting a widespread belief that professional dementia care, whether delivered in the person's own home or in an institutional setting, ought always to be a last resort. In this paper, however, I suggest that this common intuition gets things the wrong way around. Adopting a relational egalitarian framework, I argue that the most serious injustices engendered by present-day dementia care services are contingent on broader societal structures-they can thus be ameliorated relatively easily (if resource intensively) by changing those structures. Informal dementia care, on the other hand, carries similar risks of injustice and is much more resistant to structural reform. While there may be moral obligations to provide informal dementia care in present-day societies, then, they arise because of the deficiencies of professional care, not the virtues of its informal counterpart. Though we may be far from achieving just care arrangements in most of our societies, we must never lose sight of the fact that, when we engage in morally permitted informal dementia care, we are exercising our last resort.

Implementation of Blockchain Technology Could Increase Equity and Transparency in Organ Transplantation: A Narrative Review of an Emergent Tool

In the last few years, innovative technology and health care digitalization played a major role in all medical fields and a great effort worldwide to manage this large amount of data, in terms of security and digital privacy has been made by different national health systems. Blockchain technology, a peer-to-peer distributed database without centralized authority, initially applied to Bitcoin protocol, soon gained popularity, thanks to its distributed immutable nature in several non-medical fields. Therefore, the aim of the present review (PROSPERO N° CRD42022316661) is to establish a putative future role of blockchain and distribution ledger technology (DLT) in the organ transplantation field and its role to overcome inequalities. Preoperative assessment of the deceased donor, supranational crossover programs with the international waitlist databases, and reduction of black-market donations and counterfeit drugs are some of the possible applications of DLT, thanks to its distributed, efficient, secure, trackable, and immutable nature to reduce inequalities and discrimination.

The potential unintended consequences of Mental Health Act reforms in England and Wales on people with intellectual disability and/or autism

The draft Mental Health Bill, which amends the Mental Health Act 1983 for England and Wales, proposes protections for people with intellectual disability and/or autism (ID/A) to prevent detention in hospital in the absence of mental illness. This editorial critically appraises the positive impact and unintended consequences of the proposed reforms for people with ID/A.

Meeting the health and social care needs of LGBT+ people

Rapid sociocultural shifts in understanding and acceptance of variations in sexual orientation and gender identity have occurred in recent decades, and UK health and social care providers have a legal obligation to address inclusion, discrimination and equality in policies and services. Despite this, lesbian, gay, bisexual and transgender + (LGBT+) people continue to report inadequate health outcomes and suboptimal experiences of care. This article considers the health ecology in relation to those who identify as LGBT+ and outlines the concept of intersectionality. The author discusses some of the issues experienced by LGBT+ people in relation to various physical and mental health conditions and services. The article aims to encourage nurses to consider what steps they can take to improve care for this group.

Access to effective but expensive treatments: An analysis of the solidarity argument in discussions on funding of medical treatments

The development of new effective but expensive medical treatments leads to discussions about whether and how such treatments should be funded in solidarity-based healthcare systems. Solidarity is often seen as an elusive concept; it appears to be used to refer to different sets of concerns, and its interrelations with the concept of justice are not well understood. This paper provides a conceptual analysis of the concept of solidarity as it is used in discussions on the allocation of healthcare resources and the funding of expensive treatments. It contributes to the clarification of the concept of solidarity by identifying in the literature and discussing four uses of the concept: (1) assisting patients in need, (2) upholding the solidarity-based healthcare system, (3) willingness to contribute and (4) promoting equality. It distinguishes normative and descriptive uses of the concept and outlines the overlap and differences between solidarity and justice. Our analysis shows that the various uses of the concept of solidarity point to different, even conflicting, ethical stances on whether and how access to effective, expensive treatments should be provided. We conclude that the concept of solidarity has a role to play in discussions on the accessibility and funding of newly approved medical treatments. It requires, for instance, that healthcare policies promote and maintain both societal willingness to contribute to the care of others and the value of providing care to vulnerable patients through public funding.

Female Dynamics in Authorship of Scientific Publications in the Public Library of Science: A 10-year Bibliometric Analysis of Biomedical Research

Women are generally underrepresented in science, technology, engineering, and mathematics (STEM). As scientific production reflects scholarly impact and participation in the scientific process, the number of journal publications forms a pertinent measure of academic productivity. This study examined the prevalence and evolution of female representation in prominent author positions across multidisciplinary biomedical research. Publications from seven exemplar cross-specialty journals of the Public Library of Science (PLoS Medicine, PLoS Biology, PLoS One, PLoS Computational Biology, PLoS Genetics, PLoS Pathogens, and PLoS Neglected Tropical Diseases) between January 2010 and December 2020 were extracted from Web of Science. Using Genderize.io, the gender of authors from their first names was estimated using a 75% threshold. The association between female prevalence in first and last authorship and journal was evaluated using a binary logistic regression, and odds ratios were estimated against a 50:50 reference on gender. In 266,739 publications, 43.3% of first authors and 26.7% of last authors were females. Across the ten-year period, female first authorship increased by 19.6% and last authorship by 3.2%. Among all journals, PLoS Neglected Tropical Diseases had the greatest total proportion of female first authors (45.7%) and PLoS Medicine of female last authors (32%), while PLoS Computational Biology had the lowest proportion in these categories (23.7% and 17.2%). First authors were less likely to be females in all PLoS journals (p < 0.05) except for PLoS Neglected Tropical Diseases (odds ratio: 0.84, 95% confidence interval: 0.71-1.00), where the odds of female authorship were not significantly different (p = 0.054). Last authors were not more likely to be females in all PLoS journals (p < 0.001). Overall, women still appear underrepresented as first authors in biomedical publications and their representation as last authors has severely lagged. Efforts towards gender equality in scholarly authorship will contribute to the representation of women in biomedical research and ensure that their potential is not lost.

Examining Psychosocial and Economic Barriers to Green Space Access for Racialised Individuals and Families: A Narrative Literature Review of the Evidence to Date

BACKGROUND

Social prescribing (such as green social prescribing), aims to address health disparities cross-culturally to improve well-being. However, evidence highlights racial disparities in relation to access to quality green space (including local/national parks and recreational spaces). This review aimed to identify the psycho-socioeconomic barriers to green space access for racialised individuals/families and Black Indigenous People of Colour (BIPOC), to understand what cultural adaptations might be made to help support them to access green social prescribing within the UK.

METHOD

A narrative systematic review was conducted to identify barriers to green space access for racialised individuals/families and BIPOC. Searches of publication databases (APA PsycInfo, Cochrane Database of Systematic Reviews [CDSR], Cochrane Central Register of Controlled Trials [CENTRAL], Cumulated Index to Nursing and Allied Health Literature [CINAHL], and SCOPUS Preview) were undertaken from January to February 2022, to identify quantitative peer reviewed studies. Of the 4493 abstracts identified, ten studies met the inclusion criteria and were included for final review.

RESULTS

The results suggest that interpersonal, practical (such as transportation costs, entrance fees and lodging costs) and environmental factors can act as barriers to green space access for racialised individuals/families. Most frequently reported barriers were perceptions of safety and costs associated with travel and accessing green spaces, particularly for families.

CONCLUSION

Factors such as diversity-friendly schemes (e.g., multiple languages on signs and additional prayer spaces in parks), funding and strategies to improve safety should be considered in the design and commissioning of green space and green social prescribing initiatives in primary care. By mitigating these barriers green space can become more accessible and improve inclusivity for racialised individuals/families. Future research could explore the inter-racial differences between racialised populations and which mechanisms reduce barriers to access and in what contexts.

Gendering of care and care inequalities in couple therapy

Reciprocal partner or spousal caregiving in romantic relationships has been identified as a key determinant of the quality of couple relationships. In this article, we interrogate this premise concerning the presumed reciprocity of caregiving in romantic relationships, focusing on cisgender heterosexual relationships and offering implications for relationships of all genders and sexualities. Looking beyond the conventional focus on individual or dyadic processes, we theorize imbalances in care as gendered. Feminists have repeatedly critiqued gender ideology that devalues caring labor and allocates it to women. Gendered power dynamics can lead to imbalances in care-seeking and care provision. We discuss how the gendering of care and care inequalities can manifest in couple therapy, illustrating with examples from recorded interactions. Implications for therapy practice are discussed.