A Qualitative Exploration of Institutional Betrayals in Rural Communities: An Emerging Typology

To explore individuals' personal narratives of perceived betrayals and injustices committed by institutions, their representatives, or other authority figures and discern in what spheres of life they commonly manifest. 157 adults from largely rural, low-income communities in southern Appalachia participated in semi-structured qualitative interviews that asked them to describe key points in their life experiences, including high points, low points, and turning points. These were reviewed for episodes of institutional betrayals. Interview transcripts were analyzed using a grounded thematic analysis. Participants mentioned numerous instances of betrayals that occurred from interactions with institutions or their representatives. These were grouped into four categories: professional betrayals involving mistreatment from an employer, health care provider, or other authority figure; professional-organizational betrayals where a professional perpetrator was able to get support from a problematic organizational culture; corporate malfeasance involving misdeeds by business entities; and systemic injustices involving the sociopolitical architecture of society. The findings identified a range of institutional betrayal experiences that were unnecessary, unwanted, intentional, and harmful. They could be distinguished by the type of perpetrators and often led to notable harms, including unwanted system involvement and unemployment. Although participants seldom explicitly mentioned the rural setting in their descriptions of institutional betrayal, it is likely that limited options for health care providers, schools, and other institutions exacerbated some harms. Institutional betrayals need to be considered in people's trauma dosage, their cumulative lifetime burden of trauma.

Climates of Distrust in Medicine

Trust in medicine is often conceived of on an individual level, with respect to how people rely on particular clinicians or institutions. Yet as discussions of trust during the Covid-19 pandemic highlighted, trust decisions are not always as individual or interpersonal as this conception suggests. Rather, individual instances of trusting behavior are related to social trust, which is conceived as a willingness to be vulnerable to people in general, based on a sense of shared norms. In this essay, I propose that individual and social trust are connected to each other in what can be termed a "climate of trust." I explain how masking trends during the pandemic facilitated a "climate of distrust," and I consider the role that clinicians might play in transforming climates of distrust into climates of trust.

Cross-cultural adaptation and validation of the Hebrew version of the Injustice Experience Questionnaire - long and short versions

PURPOSE

To translate, validate, and culturally adapt the Injustice Experience Questionnaire (IEQ) and IEQ Short Form (IEQ-SF) into Hebrew, as measuring tools for examining feelings of injustice in cases of accidents and chronic pain.

METHODS

The translation was performed in several steps following the cross-cultural adaptation process. A sample of 150 patients suffering from traumatic injury fill out a battery of questionnaires: IEQ, IEQ-SF, Hospital Anxiety and Depression Scale (HADS), Numeric Pain Rating Scale (NPRS), and Pain Catastrophizing Scale (PCS), which were used for calculating construct validity. A test-retest was performed on 41 patients.

RESULTS

The IEQ and IEQ-SF found Cronbach's alpha of 0.92 and 0.84, respectively. Test-retest reliability for IEQ (ICC: 0.94) was found to be excellent. Spearman's correlation coefficient between IEQ and PCS was 0.68, NPRS (severe pain: 0.45, average pain: 0.51), HADS (anxiety: 0.62, depression: 0.60). The correlation between IEQ-SF and PCS was 0.67, with HADS (anxiety: 0.52, depression: 0.48). A weak correlation was found for NPRS (severe pain: 0.30, average pain: 0.34).

CONCLUSIONS

The Israeli translation and cross-cultural adaptation of the IEQ and IEQ-SF questionnaires were found to be valid and reliable.Implications for rehabilitationThe perception of injustice is a significant mental and psychological factor for recovery after accidents and injuries.This study translated, validated and culturally adapted the Injustice Experience Questionnaire (IEQ) and the short form into Hebrew.The questionnaires were found to be valid and reliable in Hebrew.

Youth baseline and state pain-related injustice appraisals are associated with emotional responses of anger and sadness: An experimental study

Background

Youth pain-related injustice appraisals are associated with adverse functioning; however, mechanisms by which injustice appraisals exert their impact have yet to be elucidated. Adult injustice literature suggests anger, sadness, and attention bias to anger (AB) as potential mechanisms. This study examined the effects of injustice appraisals in a healthy youth sample by applying a justice violation manipulation. We hypothesized the justice violation condition to lead to worse pain outcomes with effects mediated by anger, sadness, and AB as compared to the control condition. We further explored associations between both baseline and state injustice appraisals and anger, sadness, and AB across conditions.

Methods

A 2 × 2 time by condition design was used to test hypotheses. 133 healthy youth aged 9-16 years old completed two cold pressor tasks (CPTs). In the experimental (i.e., justice violation) group, participants were initially told to complete one CPT, but were told afterwards to perform it again due to experimenter negligence. In the control group, no justice violation occurred. Baseline injustice appraisals and pain catastrophizing were assessed with the Injustice Experience Questionnaire and Pain Catastrophizing Scale for Children; state outcomes (i.e., injustice, catastrophizing, anger, sadness) were assessed after CPTs. AB was indexed using a dot-probe task.

Results

Findings indicated no effects of the justice violation on pain outcomes or associated mechanisms, nor on injustice appraisals, suggesting manipulation failure. However, across conditions, baseline and state injustice appraisals were positively associated with anger and sadness, but not with AB.

Conclusions

Despite the experimental justice violation failing to elicit differential injustice appraisals across conditions, the current study supports both anger and sadness as key emotional responses associated with pain-related injustice appraisals in a healthy youth sample.

An Ecostructural Lens for Health Ethics

In this commentary, I describe an ecostructural approach to health ethics, which is grounded in a conception of people as ecological subjects and privileges place in supporting health and health justice. This approach sees people as dwelling in health ecosystems that can support or undermine health, and it situates us in social norms and processes, with a particular concern for structural health injustice. In patient care, an ecostructural approach can be operationalized by attending to conditions in the sites where birthing, healing, and dying take place and by critiquing their economic structures. For public health, relationships between people, animals, land, the built environment, and climate demand attention, as do racist norms and economic processes that thwart health justice. For global health, an ecostructural approach might envision a revolution in governance that challenges nationalism, in which health systems treat citizens while depending on human resources supplied through structures that sustain health injustice.

Sociocultural context and pre-clinical pain facilitation: Multiple dimensions of racialized discrimination experienced by Latinx Americans are associated with enhanced temporal summation of pain

The experiences of injustice and their impacts on pain among Latinx Americans are overlooked and understudied. Multidimensional and consequential experiences of racialized discrimination are common for Latinx Americans but have not been considered as factors relevant for enhanced pain experience or risk. In this study, we focused on the experiences of Latinx Americans living in Texas by assessing multiple dimensions of racialized discrimination (total lifetime discrimination, racialized exclusion, stigmatization, discrimination in the workplace or school, and racism-related threat and aggression) and a laboratory marker of central sensitization of pain (temporal summation of mechanical pain, MTS). Among 120 adults who did not have chronic pain, nearly all (94.2%) experienced racialized discrimination. Accumulated lifetime experience of racialized discrimination, as well as the frequency of each dimension of discrimination assessed, was associated with greater MTS. Results suggest that a process of discrimination-related central sensitization may start early, and may reflect enhanced pain experiences and pre-clinical chronic pain risk. Though replication is needed, results also indicate the discrimination and pain burden among Latinx Texans, and Latinx Americans broadly, are likely under-represented in the scientific literature. PERSPECTIVE: : Racialized discrimination is multidimensional. Latinx Texans experience frequent discrimination that is associated with enhanced temporal summation of pain in the laboratory. Results indicate the importance of societal factors in pain processing and may reflect a mechanism of racism-related pre-clinical central sensitization observable before chronic pain onset.

The impact of maternal child- and self-oriented pain-related injustice appraisals upon maternal attention to child pain, attention to anger, and pain-attending behavior

Objectives

The current study investigated the role of maternal child- and self-oriented injustice appraisals about child pain in understanding maternal attention for child pain and adult anger cues and pain-attending behavior.

Methods

Forty-four children underwent a painful cold pressor task (CPT) while their mother observed. Eye tracking was used to measure maternal attention to child pain and adult anger cues. Initial attention allocation and attentional maintenance were indexed by probability of first fixation and gaze duration, respectively. Maternal pain-attending behaviors toward the child were videotaped and coded after CPT completion. Mothers also rated the intensity of pain and anger cues used in the free-viewing tasks. All analyses controlled for maternal catastrophizing about child pain.

Results

Neither child-oriented nor self-oriented injustice was associated with maternal attentional bias toward child pain. Regarding attention toward self-relevant anger cues, differential associations were observed for self- and child-oriented injustice appraisals, with maternal self-oriented injustice being associated with a greater probability of first fixating on anger and with higher anger ratings, whereas maternal child-oriented injustice was associated with enhanced attentional maintenance toward anger. Neither type of maternal injustice appraisals was associated with maternal pain-attending behavior, which was only associated with maternal catastrophizing.

Conclusions

The current study sheds light on potential differential mechanisms through which maternal self- vs. child-oriented injustice appraisals may exert their impact on parent and child pain-related outcomes. Theoretical implications and future directions are discussed.

Data justice and data solidarity

Datafication shapes and gradually transforms societies. Given this impact, issues of justice around data-driven practices have received more and more attention in recent years as shown, for example, by various reports and guidelines on artificial intelligence and data ethics. In this article, we elaborate on and defend two claims. First, these discourses on justice tend to center primarily around conceptions of fairness. We argue that justice in connection with datafication relates to, but ultimately encompasses more than, solely fairness. Second, although it is an important project to clarify what justice in connection with datafication encompasses, we argue that attention toward attitudes and practices of data solidarity have so far been largely overlooked. They are, however, indispensable as a catalytic element to advance toward data justice in practice.

New technologies such as big data, machine learning, and artificial intelligence are rapidly generating new opportunities and challenges for various social practices. At the same time, they raise important ethical questions. For example, for whom will these opportunities and advantages result in benefits, and who bears the burdens? A fundamental issue is which individuals and groups with their respective claims and particularities are involved and affected by the use of ever-increasing amounts of data and the inferences drawn from them. To navigate this terrain, reference is often made to the notion of justice. Such reference can be helpful to the extent that we are clear about what justice entails and what it takes to get there. In this article, we argue that justice requires us to make visible the claims of those left out, excluded, or disadvantaged in and around the use of data. To this end, we put forward the concept of data solidarity and examine its interplay with data justice.

Exploring the Role of Occupational Therapy and Forced Migration in Canada

BACKGROUND.

In response to increasing forced migration across the globe, Canadian occupational therapists are returning to the profession's social justice roots by exploring this emergent area of practice. Purpose. This research explores occupational therapy practices with forced migrants in a Canadian context. Method. Grounded in critical epistemologies, the researchers conducted 12 semi-structured interviews with occupational therapists, students, and researchers connected to displacement. Data were analyzed using thematic analysis. Findings. Four themes describe current occupational therapy practices related to forced migration: 1) engaging clients in new environments, 2) translating the everyday, 3) connecting and networking, and 4) advocating for occupational justice. Implications. This research contributes to the advancement of occupational therapy and forced migration by documenting the diverse and fluid nature of occupational therapy roles. Further, the paper outlines promising reflexive practices while forwarding advocacy priorities for (occupational) justice.

Development of a Questionnaire to Measure the Perceived Injustice of People Who Have Experienced Violence in War and Conflict Areas: Perceived Injustice Questionnaire (PIQ)

Objectives: The primary aim of this research was to develop a questionnaire that assesses perceived injustice among survivors of war and trauma in conflict areas and to evaluate its psychometric properties. This paper presents the first preliminary validation. Furthermore, the assumption that the general perception of injustice correlates with one’s own experiences of injustice and violence was tested. Methods: The 24-item Perceived Injustice Questionnaire (PIQ) was administered partly online and partly in a paper–pencil version to 89 students of the University of Dohuk in Northern Iraq, an area that has been affected by crisis and war for many years. Principal component analysis was used for factor extraction and internal consistency was determined. The Mann–Whitney-U test was used to calculate the group differences between people with and without experience of physical violence and strong experiences of injustice because Kolmogorov–Smirnov tests showed that the data are not normally distributed. Results: Principal component analysis yielded a four-component solution with eigenvalues being the greater one. Cronbach’s alpha for each scale was acceptable to satisfactory. Significant results of the Mann–Whitney U tests supported our assumptions of between-group differences on each of the subscales (emotional and cognitive consequences, injustice perception, injustice experience, revenge, and forgiveness). Discussion: The findings of this study support the construct validity and the reliability of the PIQ. For this reason, it can be seen as a useful addition to the psychological assessment in psychotherapeutic settings of survivors of war and violence. In conclusion, and based on the PIQ, we suggest the development of a new set of therapy modules with worksheets, focusing on the perception, dealing, and understanding of feeling of injustice as an addition to the existing trauma therapy manual for therapy in war and conflict areas.

From gratitude to injustice: Neurocomputational mechanisms of gratitude-induced injustice

Gratitude shapes individuals' behaviours and impacts the harmony of society. Many previous studies focused on its association with prosocial behaviours. A possibility that gratitude can lead to moral violation has been overlooked until recently. Nevertheless, the neurocognitive mechanisms of gratitude-induced moral violation are still unclear. On the other hand, though neural correlates of the gratitude's formation have been examined, the neural underpinnings of gratitude-induced behaviour remain unknown. For addressing these two overlapped research gaps, we developed novel tasks to investigate how participants who had received voluntary (Gratitude group) or involuntary help (Control group) punished their benefactors' unfairness with functional magnetic resonance imaging (fMRI). The Gratitude group punished their benefactors less than the Control group. The self-report and computational modelling results demonstrated a crucial role of the boosted protection tendency on behalf of benefactors in the gratitude-induced injustice. The fMRI results showed that activities in the regions associated with mentalizing (temporoparietal junction) and reward processing (ventral medial prefrontal cortex) differed between the groups and were related to the gratitude-induced injustice. They suggest that grateful individuals concern for benefactors' benefits, value chances to interact with benefactors, and refrain from action that perturbs relationship-building (i.e., exert less punishment on benefactors' unfairness), which reveal a dark side of gratitude and enrich the gratitude theory (i.e., the find-bind-remind theory). Our findings provide psychological, computational, and neural accounts of the gratitude-induced behaviour and further the understanding of the nature of gratitude.

Folk Moral Objectivism: The Case of Harmful Actions

It is controversial whether ordinary people regard beliefs about the wrongness of harmful actions as objectively correct. Our deflationary hypothesis, consistent with much of the evidence, is that people are objectivists about harmful actions that are perceived to involve injustice: when two parties disagree about whether such an action is wrong, people think that only one party is correct (the party believing that the action is wrong). However, Sarkissian and colleagues claimed that this evidence is misleading, showing that when the two disagreeing parties are from radically different cultures or species, people tend to think that both parties are correct (a non-objectivist position). We argue that Sarkissian et al.'s studies have some methodological limitations. In particular, participants may have assumed that the exotic or alien party misunderstood the harmful action, and this assumption, rather than a genuinely non-objectivist stance, may have contributed to the increase in non-objectivist responses. Study 1 replicated Sarkissian et al.'s results with additional follow-up measures probing participants' assumptions about how the exotic or alien party understood the harmful action, which supported our suspicion that their results are inconclusive and therefore do not constitute reliable evidence against the deflationary hypothesis. Studies 2 and 3 modified Sarkissian et al.'s design to provide a clear-cut and reliable test of the deflationary hypothesis. In Study 2, we addressed potential issues with their design, including those concerning participants' assumptions about how the exotic or alien party understood the harmful action. In Study 3, we manipulated the alien party's capacity to understand the harmful action. With these changes to the design, high rates of objectivism emerged, consistent with the deflationary hypothesis. Studies 4a and 4b targeted the deflationary hypothesis more precisely by manipulating perceptions of injustice to see the effect on objectivist responding and by probing the more specific notion of objectivism entailed by our hypothesis. The results fully supported the deflationary hypothesis.

Presuming incapacity in anorexia nervosa is indefensible: A reply to Ip

Eric C. Ip has recently argued that seriously anorexic service users ought to be assumed to be legally incapacitous to refuse life-saving artificial nutrition unless they can demonstrate otherwise, reversing the ordinary legal presumption in place to protect patients' liberty and values. In this response, I argue against this proposal on two grounds. Firstly, the proposal is wrongfully discriminatory; it would expose service users to serious harm, and wrong them in numerous ways, on the basis of their diagnosis alone, without significantly benefitting them in any way relative to the status quo. Secondly, he is unable to show that a large majority of such service users actually are incapacitous to refuse life-saving artificial nutrition. This means that his proposal would likely involve declaring a large number of actually capacitous patients to be incapacitous, without even the requirement of a formal assessment, and burdening them with the responsibility of proving their clinical team wrong if they wish to avoid deprivation of liberty and/or compelled treatment. Given this, his proposal is indefensible.

Black lives matter … in the cath lab, too! A proposal for the interventional cardiology community to counteract bias and racism

Structural racism in the United States underlies racial disparities in the criminal justice system, in the healthcare system generally, and with regards to the COVID-19 pandemic. In the year 2020, these inequities combined and magnified to such a degree that it left Black Americans and physicians caring for them questioning how much Black lives matter. Academic medical centers and the major cardiology organizations responded to a global call to end racism with bold statements and initiatives. Interventional cardiologists utilize advanced equipment to mechanically treat a wide spectrum of heart problems, yet this technology has not been applied in an equitable manner. Interventional therapies are often underutilized in Blacks, exacerbating healthcare disparities and contributing to the excess cardiovascular morbidity and mortality in these communities. Racial bias, whether intentional, unconscious, systemic, or at the individual level, plays a role in these disparities. Many in the interventional cardiology community aspire to take intentional steps to reduce the impact of bias and racism in our specialty. We discuss several proposals here and provide a "report card" for interventional programs to perform a self-assessment.

Injustice for the sake of public health: Freeing prisoners in Portugal during the COVID-19 pandemic

This case study analysis looks at Portuguese policy during the COVID-19 pandemic whereby convicts were freed for the sake of public health. I defend this policy negatively by refuting the argument that suggested it involved various forms of injustice.

The Global Kidney Exchange: Revisiting exploitation arguments

The Global Kidney Exchange (GKE) program, introduced by Rees et al. (2017), has been described as an innovative method to address the global shortage of kidneys for the purpose of transplantation. However, the concept of the GKE has evoked controversy and various international bodies have accused it of being a form of low- and middle-income country (LMIC) exploitation. Using Julian Koplin's framework of exploitation, we consider three different conceptualizations of wrongful advantage taking in the unique setting formed by the GKE. The analysis contributes to a better understanding of the controversy and gives insight into how to deal with background conditions that influence the fairness of such a global social cooperation.

The Pain-to-Well-Being Relationship in Patients Experiencing Chronic Orofacial Pain

Introduction: Orofacial pain features may negatively influence a person's well-being and vice versa. Some aspects of well-being can be measured with axis II instruments that assess patients' psychosocial and behavioral status. The aim of this study was to investigate associations between pain features and psychosocial variables as indicators of well-being. Materials and Methods: Seven hundred ninety-nine anonymized datasets collected using the Web-based Interdisciplinary Symptom Evaluation (WISE) of patients reporting to the Interdisciplinary Orofacial Pain Unit, University of Zurich, between March 19, 2017 and May 19, 2019, were analyzed. Pain features including intensity, number of locations, impact, and duration were evaluated. Psychometric measures assessed pain-related catastrophizing and disability, illness perception, distress, anxiety, depression, injustice experience, dysmorphic concerns, and insomnia. Results: Most patients were between 30 and 59 years old (58.3%), female (69.8%), working (66.0%), and experienced pain for more than 6 months (68.5%). Pain intensities were higher in women than men and higher in disabled than working patients. Scores indicating elevated stress and depression were also observed in disabled patients. The sample prevalence rates of clinically relevant axis II instrument scores were as follows: Graded Chronic Pain Scale for the Head (GCPS-H), 27%; Patient Health Questionnaire 4 (PHQ4), 21%; PHQ9, 21%; Pain Catastrophizing Scale (PCS), 20%; General Anxiety Disorder 7 (GAD7), 15%; Insomnia Severity Index (ISI), 15%; Injustice Experience Questionnaire (IEQ), 14%; GCPS for the Body (GCPS-B), 13%; PHQ for Stress (PHQstr), 6%; and Dysmorphic Concern Questionnaire (DCQ), 2%. Noteworthy results of correlation analysis of the clinically relevant axis II scores and pain measures were as follows: the PHQstr had moderate associations (0.34-0.43) with the sum of pain intensity at rest and during function, number of pain locations, and typical pain intensity. The IEQ scores were moderately associated with typical pain intensity at 0.39. The DCQ scores were moderately associated with pain extension at 0.41. Conclusions: Moderate correlations of certain pain and well-being measures were found in patients reporting clinically relevant stress, injustice experience, and dysmorphic concern, all of which reflect impaired well-being. PHQ4 is suitable for routine distress screening in the clinical setting.

[Health systems in countries of origin]

This paper introduces few concepts to help clinicians to get an idea of the health systems of the migrants they care for, on a daily basis. Health systems are complex to analyze, and is an open, dynamic system, facing diverse influences from multiple levels. Recent globalization has complexified an already complex system. The paper first sets some definitions and then describes succinctly the history of international health financing. It eventually compares several countries' health systems, drawing on few health indicators. Despite significant progresses in terms of global health, the gap between countries, and, within countries between wealthier and poorer people, is increasing. This is particularly worrying while the global aim is health equity.

Effort-Reward Imbalance: A Risk Factor for Exposure to Workplace Bullying

Previous research shows that work environment factors are important antecedents of workplace bullying (WB), because of the stress they may induce. While previous studies have typically used Karasek’s Job Demand-Control model or the Demands-Resources model, the present study investigates whether another important occupational stress model, that is the Effort-Reward Imbalance model, is also associated to WB. A survey study in 19 Belgian organizations (n = 5727) confirmed that employees experiencing an imbalance between efforts and reward were more likely to be targets of exposure to bullying. In line with previous research, this study illustrates that stressful situations increase the risk of exposure to WB. It shows that the perceived incongruence between effort and reward may increase employee vulnerability to bullying. The perceived injustice may lead employees to engage in norm-breaking behavior and also signal low social standing to others, thereby potentially eliciting negative behaviors from others.

Childhood Victimization, Recent Injustice, Anger, and Forgiveness in a Sample of Imprisoned Male Offenders

The links between childhood victimization, subsequent emotional dysregulation, and insufficient coping skills have been repeatedly documented in the scientific literature. However, there is a gap in the literature regarding the role of forgiveness as a coping strategy and relationships between offense-specific hurt, chronic anger, and early victimization. The goals of our study were (a) to explore how offenders cope with recent unjust treatment, and test the links between type of injustice, hurt experienced due to injustice, and use of forgiveness; (b) to test the links between childhood victimization, hurt, and chronic anger; and (c) to assess the mediating role of chronic anger in relation to hurt and forgiveness. The results reveal that multiplicity and severity of victimization exposure in the prison sample are positively associated with chronic anger, but not with hurt. The type of injustice affects the level of hurt and forgiveness, while chronic anger mediates the link between hurt and forgiveness. To improve coping and promote forgiving, offenders should be helped to identify everyday sources of stress and learn to express vulnerable feelings beneath anger.

Indoor air problems and experiences of injustice in the workplace: A quantitative and a qualitative study

This study explores subjective injustice experiences of individuals suffering from suspected or observed indoor air problems in their workplaces in two studies. We focus on injustice experiences because they influence how individuals cope with and recover from health problems. The first study reports associations between the perceived harmfulness of the indoor environment (ie, mold/inadequate ventilation) and subjective injustice experiences in workplaces in a representative sample of Finnish working-aged people (N = 4633). Altogether, 37% of the respondents perceived their workplaces' indoor environments to be harmful. Multivariate logistic regression analyses revealed that the risks of reporting subjective injustice experiences (eg, information, attitudes, and remuneration) were significantly higher for those reporting harmful indoor environments compared to those who reported no such problems (OR 1.28-1.95 for different situations). The second study explored injustice experiences more closely by qualitatively analyzing the content of 23 essays. These essays were written by people who suffered from suspected or observed indoor air problems in their workplaces. The respondents reported multidimensional experiences of injustice, which related to conflicts, and moral exclusions. Awareness of these psychosocial effects is important for the prevention of unnecessary escalation of psychosocial problems in workplaces with observed and suspected indoor air problems.

The place and role of (moral) anger in organizational behavior studies

The aim of this article is to conceptually delineate moral anger from other related constructs. Drawing upon social functional accounts of anger, we contend that distilling the finer nuances of morally motivated anger and its expression can increase the precision with which we examine prosocial forms of anger (e.g., redressing injustice), in general, and moral anger, in particular. Without this differentiation, we assert that (i) moral anger remains theoretically elusive, (ii) that this thwarts our ability to methodologically capture the unique variance moral anger can explain in important work outcomes, and that (iii) this can promote ill-informed organizational policies and practice. We offer a four-factor definition of moral anger and demonstrate the utility of this characterization as a distinct construct with application for workplace phenomena such as, but not limited to, whistle-blowing. Next, we outline a future research agenda, including how to operationalize the construct and address issues of construct, discriminant, and convergent validity. Finally, we argue for greater appreciation of anger's prosocial functions and concomitant understanding that many anger displays can be justified and lack harmful intent. If allowed and addressed with interest and concern, these emotional displays can lead to improved organizational practice.

A psychological flexibility conceptualisation of the experience of injustice among individuals with chronic pain

Accumulating evidence suggests that the experience of injustice in patients with chronic pain is associated with poorer pain-related outcomes. Despite this evidence, a theoretical framework to understand this relationship is presently lacking. This review is the first to propose that the psychological flexibility model underlying Acceptance and Commitment Therapy (ACT) may provide a clinically useful conceptual framework to understand the association between the experience of injustice and chronic pain outcomes. A literature review was conducted to identify research and theory on the injustice experience in chronic pain, chronic pain acceptance, and ACT. Research relating injustice to chronic pain outcomes is summarised, the relevance of psychological flexibility to the injustice experience is discussed, and the subprocesses of psychological flexibility are proposed as potential mediating factors in the relationship between injustice and pain outcomes. Application of the psychological flexibility model to the experience of pain-related injustice may provide new avenues for future research and clinical interventions for patients with pain.

SUMMARY POINTS

• Emerging research links the experience of pain-related injustice to problematic pain outcomes. • A clinically relevant theoretical framework is currently lacking to guide future research and intervention on pain-related injustice. • The psychological flexibility model would suggest that the overarching process of psychological inflexibility mediates between the experience of injustice and adverse chronic pain outcomes. • Insofar as the processes of psychological inflexibility account for the association between injustice experiences and pain outcomes, methods of Acceptance and Commitment Therapy (ACT) may reduce the impact of injustice of pain outcomes. • Future research is needed to empirically test the proposed associations between the experience of pain-related injustice, psychological flexibility and pain outcomes, and whether ACT interventions mitigate the impact of pain-related injustice on pain outcomes.

The ethical imperative of addressing oral health disparities: a unifying framework

Health disparities are preventable differences in the burden of disease or opportunities to achieve optimal health that are experienced by socially disadvantaged population groups. Reducing health disparities has been identified as an ethical imperative by the World Health Organization's Commission on Social Determinants of Health and numerous other national and international bodies. Significant progress has been made over the past years in identifying vulnerable groups, and 'distal' factors including political, economic, social, and community characteristics are now considered pivotal. It is thus unsurprising that the remarkable advances in the science and practice of dentistry have not led to notable reductions in oral health disparities. In this review, we summarize recent work and emphasize the need for a solid theoretical framing to guide oral health disparities research. We provide a theoretical framework outlining pathways that operate across the continuum of oral health determinants during the lifecourse and highlight potential areas for intervention. Because oral health disparities emanate from the unequal distribution of social, political, economic, and environmental resources, tangible progress is likely to be realized only by a global movement and concerted efforts by all stakeholders, including policymakers, the civil society, and academic, professional, and scientific bodies.

Losing trust in the world: Humiliation and its consequences

The author identifies acts of humiliation as a specific and often traumatic way of exercising power, with a set of consistently occurring elements and predictable consequences, including a loss of the ability to trust others. It is argued that these consequences are serious and long-lasting. The article makes a distinction between 'shame' as a state of mind and 'humiliation' as an act perpetrated against a person or group. The interplay between humiliation and shame after a humiliating act is discussed. It is argued that the patient's recovery of the capacity to resume a relatively normal life is made more likely if the therapist acknowledges the specificity of humiliation, the impossibility of reversing a humiliating act and the importance of focussing on the consequences of humiliation.

Cases of injustice done to prominent figures of the Cluj Medical School

This is a presentation of few cases in the history of the Medical School of Cluj, when outstanding figures were victims of injustice, with respect to the acknowledgement of their priority works.