Promoting children's rights to health and well-being in the United States.

The United States has a highly sophisticated pediatric healthcare system and spends more than any other country per capita on children's healthcare. However, not all children have access to needed and affordable health care and the life expectancy and health outcomes of children in the country are worse than in any other industrialized nation. These nations typically offer universal healthcare for children as part of a robust recognition of a children's rights framework. In 1989 the United Nations adopted the Convention on the Rights of the Child that recognizes the right of the child to the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health. Currently the United States is the only United Nations member country that has not ratified the Convention on the Rights of the Child. This paper outlines the potential benefits of adopting a child rights approach based on the principles and provisions of the Convention on the Rights of the Child. The fact that countries who invest much less in healthcare compared to the United States can achieve better health outcomes provides the certainty that a solution is possible and within reach.

Rethinking the issue of reparations for Black Americans.

The differential impact of the COVID-19 pandemic on communities of color in the United States along with the civil unrest taking place in 2020 in response to the killing of unarmed Black men and women by the police have increased awareness of the structural racism pervading US society. These developments have reraised the issue of reparations for Black Americans, usually proposed in the context of providing financial compensation for the injustices of slavery to the descendants of those who were enslaved. This paper will discuss the systematic racial inequality and structural racism in US society that have significantly disadvantaged racial and ethnic minorities while giving advantages to white Americans, which most recently have resulted in significantly higher mortality and morbidity among Black, Hispanic, and Native Americans during the pandemic. The paper will conceptualize reparations within the context of theories of reparative justice. It will also consider whether reparations are owed, and if so, by whom, to whom, and in what form. The final section will offer a proposal for collective reparations to the Black community and other people of color.

Do Pluripotent Stem Cells Offer a New Path to Reproduction?

The ability of pluripotent stem to develop into any of the cell types in the human body has meant that it was only a matter of time before scientists would try to transform them into human gametes. Up to now though it has not been possible to do so. Nevertheless a 2016 book written by Henry Greely speculated that in twenty to forty years most people in developed countries will cease reproduction through sex, using sex exclusively for pleasure, and instead will rely on reproduction through pluripotent stem cell-derived gametes. This paper will offer a different perspective. After describing the process through which human pluripotent stem cells might eventually be coaxed into gametes, it will show why the use of pluripotent stem cell-derived gametes for reproductive purposes would present significant safety, ethical, and regulatory challenges.

Climate Justice, Humans Rights, and the Case for Reparations.

The global community is facing an existential crisis that threatens the web of life on this planet. Climate change, in addition to being a fundamental justice and ethical issue, constitutes a human rights challenge. It is a human rights challenge because it undermines the ability to promote human flourishing and welfare through the implementation of human rights, particularly the right to life and the right to health. It is also a human rights challenge because climate change disproportionately impacts poor and the vulnerable people in both low-income and high-income countries. Those living in many low-income countries are subject to the worst impacts of climate change even though they have contributed negligibly to the problem. Further, low-income countries have the fewest resources and capabilities at present to adapt or cope with the severe, long-lasting impacts of climate change. Building on human rights principles of accountability and redress for human rights violations, this paper responds to this injustice by seeking to make long-neglected societal amends through the implementation of the concept of climate reparations. After discussing the scientific evidence for climate change, its environmental and socioeconomic impacts, and the ethical and human rights justifications for climate reparations, the paper proposes the creation of a new global institutional mechanism, the Global Climate Reparations Fund, which would be linked with the United Nations Human Rights Council, to fund and take action on climate reparations. This paper also identifies which parties are most responsible for the current global climate crisis, both historically and currently, and should therefore fund the largest proportion of climate-related reparations.

Sri Lanka and the possibilities of achieving universal health coverage in a poor country.

Sri Lanka has been lauded for providing good health coverage at a low cost despite having a modest per capita income. This article identifies the unique historical factors that enabled Sri Lanka to achieve near universal coverage, but it also discusses how this achievement is now being undermined by inadequate government investment in health services, the burdens of non-communicable diseases, and the growing privatisation of health services. In doing so, the article highlights the challenges of achieving and maintaining universal health coverage in a relatively low income country with a health system designed to treat infectious diseases and provide child and maternal health services as the country undergoes an epidemiological transition from infectious to non-communicable diseases. Using updated information on developments in the Sri Lankan health system, this article argues, in contrast with earlier publications, that Sri Lanka is no longer providing good health at a low cost. It shows that Sri Lanka's low investment in health is detrimental and not an asset to achieving good health. The article also questions the possibilities of providing coverage for noncommunicable diseases at a low cost. The article has four main sections. The first details Sri Lanka's accomplishments in moving toward universal health coverage. The second identifies the factors enabling Sri Lanka to do so. The third describes the equity and access challenges the health system now confronts. The fourth assesses what the Sri Lankan experience suggests about the requirements for universal health coverage when providing health services for treating non-communicable diseases becomes an important consideration.

The nuclear bile acid receptor FXR is a PKA- and FOXA2-sensitive activator of fasting hepatic gluconeogenesis.

BACKGROUND & AIMS: Embedded into a complex signaling network that coordinates glucose uptake, usage and production, the nuclear bile acid receptor FXR is expressed in several glucose-processing organs including the liver. Hepatic gluconeogenesis is controlled through allosteric regulation of gluconeogenic enzymes and by glucagon/cAMP-dependent transcriptional regulatory pathways. We aimed to elucidate the role of FXR in the regulation of fasting hepatic gluconeogenesis. METHODS: The role of FXR in hepatic gluconeogenesis was assessed in vivo and in mouse primary hepatocytes. Gene expression patterns in response to glucagon and FXR agonists were characterized by quantitative reverse transcription PCR and microarray analysis. FXR phosphorylation by protein kinase A was determined by mass spectrometry. The interaction of FOXA2 with FXR was identified by cistromic approaches and in vitro protein-protein interaction assays. The functional impact of the crosstalk between FXR, the PKA and FOXA2 signaling pathways was assessed by site-directed mutagenesis, transactivation assays and restoration of FXR expression in FXR-deficient hepatocytes in which gene expression and glucose production were assessed. RESULTS: FXR positively regulates hepatic glucose production through two regulatory arms, the first one involving protein kinase A-mediated phosphorylation of FXR, which allowed for the synergistic activation of gluconeogenic genes by glucagon, agonist-activated FXR and CREB. The second arm involves the inhibition of FXR's ability to induce the anti-gluconeogenic nuclear receptor SHP by the glucagon-activated FOXA2 transcription factor, which physically interacts with FXR. Additionally, knockdown of Foxa2 did not alter glucagon-induced and FXR agonist enhanced expression of gluconeogenic genes, suggesting that the PKA and FOXA2 pathways regulate distinct subsets of FXR responsive genes. CONCLUSIONS: Thus, hepatic glucose production is regulated during physiological fasting by FXR, which integrates the glucagon/cAMP signal and the FOXA2 signal, by being post-translationally modified, and by engaging in protein-protein interactions, respectively. LAY SUMMARY: Activation of the nuclear bile acid receptor FXR regulates gene expression networks, controlling lipid, cholesterol and glucose metabolism, which are mostly effective after eating. Whether FXR exerts critical functions during fasting is unknown. The results of this study show that FXR transcriptional activity is regulated by the glucagon/protein kinase A and the FOXA2 signaling pathways, which act on FXR through phosphorylation and protein-protein interactions, respectively, to increase hepatic glucose synthesis.

Ethical Guidelines for Genetic Research on Alcohol Addiction and Its Applications.

Research on the genomic correlates to addiction raises ethical issues in a number of different domains. In this paper, we evaluate the status of genetic research on alcohol dependence as background to addressing the ethical issues raised in conducting research on addiction and the application of that research to the formulation of public policies. We conclude that genetic testing is not yet ready for use in the prediction of alcohol dependence liability. Pharmacogenetic testing for responses to treatments may have more clinical utility, although additional research is required to demonstrate utility and cost-effectiveness. Genetic research on addiction raises potential risks for participants that must be clearly communicated to participants, including limitations on the ability of researchers to protect their privacy. Responsible communication of research findings is essential to prevent common misunderstandings about the role of genetics in addiction liability, to prevent its premature or inappropriate use, and to reduce discrimination and stigmatization experienced by addicted individuals. More research is needed to determine the impact of genetic explanations on addicted individuals, treatment-seeking behavior, and on public attitudes towards addicted persons. Importantly, genetic research on addiction must not be at the expense of investments in social, behavioral, and psychological research on addiction.

Successful return to work of individuals with chronic pain according to health care providers: a meta-synthesis / Retorno bem-sucedido ao trabalho para indivíduos com dor crônica, segundo os profissionais de saúde: uma metassíntese

: Introduction: Chronic pain is a persistent disease that causes personal and social economic problems when individuals are unable to return to work. Objective: This meta-synthesis investigated the perspectives of health professionals on the best mechanisms (triggering change) and approaches to support people with chronic pain on return to work. Method: Peer-reviewed articles published until October 2017 were searched in databases such as PsycINFO, EMBASE, CINAHL and Pubmed. The search was based on three concepts: "chronic pain", "return to work" and "therapist". Six articles were analyzed. Meta-ethnography was used to synthesize data extracted from qualitative studies. Results: Five second-order interpretations were revealed: social interactions contribute to rehabilitation and can interrupt the return to work; inadequate coordination and excessive bureaucracy complicates the return to work; communication between worker and other stakeholders is critical for return to work; health professionals are not clear about their roles; the congruence between health professionals and the workers'perspectives and goals on return to work impacts the treatment and its outcomes. A posterior analysis produced two third-order syntheses: 1. the need for assertive communication to lay the groundwork for best practices; and 2. inadequate coordination in the current system complicates return to work in cases of chronic pain. Conclusion: Stakeholders and health professionals need to understand their roles and responsibilities to consistently set goals and action plans for return to work.

Introdução: Dor crônica é doença persistente que causa problemas econômicos, pessoais e sociais, quando indivíduos não conseguem voltar ao trabalho. Objetivo: Esta metassíntese investigou as perspectivas dos profissionais de saúde acerca dos melhores mecanismos (desencadeantes da mudança) e abordagens para apoiar trabalhadores com dor crônica, no retorno ao trabalho. Método: Artigos revisados por pares foram pesquisados em bases de dados, como PsycINFO, EMBASE, CINAHL e Pubmed, publicados até outubro de 2017. As buscas empregaram três conceitos: "dor crônica", "retorno ao trabalho" e "terapeuta". Foram analisados seis artigos. Metaetnografia foi utilizada para sintetizar os dados extraídos de estudos qualitativos. Resultados: Foram reveladas cinco interpretações de segunda ordem: 1. as interações sociais contribuem para a reabilitação e podem interromper o retorno ao trabalho; 2. a coordenação inadequada e a burocracia excessiva complicam o retornoao trabalho; 3. a comunicação entre o trabalhador e os demais atores é fundamental para o retorno ao trabalho; 4. os profissionais de saúde não têm clareza sobre seus papéis, e 5. a congruência entre o profissional de saúde e as perspectivas e os objetivos do trabalhador, no retorno ao trabalho, impacta o tratamento e os resultados. Uma análise posterior produziu duas sínteses de terceira ordem: 1. a necessidade de comunicação assertiva para estabelecer as bases para as melhores práticas, e 2. a coordenação inadequada no sistema atual complica o retorno ao trabalho, nos casos de dor crônica. Conclusão: As partes interessadas precisam compreender seus papéis e responsabilidades para, de forma congruente, estabelecer metas e planos de ação para o retorno ao trabalho.