Advocacy and Bioethics: Aspiration, Obligation, and Negotiation.

AbstractA long-standing tenet of healthcare clinical ethics consultation has involved the neutrality of the ethicist. However, recent pressing societal issues have challenged this viewpoint. Perhaps now more than ever before, ethicists are being called upon to take up roles in public health, policy, and other community-oriented endeavors. In this article, I first review the concept of professional advocacy and contrast this conceptualization with the role of patient advocate, utilizing the profession of nursing as an exemplar. Then, I explore the status of advocacy in clinical ethics and how this conversation intersects with the existing professional obligations of the bioethicist, arguing that the goals of ethics consultation and ethical obligations of the clinical ethicist are compatible with the role of professional advocate. Finally, I explore potential barriers to professional advocacy and offer suggestions for a path forward.

[Surftherapy, an innovative mediation in an addiction treatment program]. / La surfthérapie, une médiation innovante dans un parcours de soins en addictologie.

Imagine a dream where ocean waves become allies for the caregiver. This vision took shape in a project begun in 2020 at the Clinique de l'Odet, the addictology department of the public mental health establishment in South Finistère: surf therapy as a tool for addictology care, the ocean as an ecological framework for rehabilitation. In this exceptional adventure, the dream of a care team to support patients' recovery through surfing has become a reality, where every wave is a step towards freedom; every take-off a victory on the road to recovery.

A systematic review on reporting quality of economic evaluations for negotiated glucose-lowering drugs in China national reimbursement drug list.

BACKGROUND: This study aimed to examine the reporting quality of existing economic evaluations for negotiated glucose-lowering drugs (GLDs) included in China National Reimbursement Drug List (NRDL) using the Consolidated Health Economic Evaluation Reporting Standards 2013 (CHEERS 2013). METHODS: We performed a systematic literature research through 7 databases to identify published economic evaluations for GLDs included in the China NRDL up to March 2021. Reporting quality of identified studies was assessed by two independent reviewers based on the CHEERS checklist. The Kruskal-Wallis test and Mann-Whitney U test were performed to examine the association between reporting quality and characteristics of the identified studies. RESULTS: We have identified 24 studies, which evaluated six GLDs types. The average score rate of the included studies was 77.41% (SD:13.23%, Range 47.62%-91.67%). Among all the required reporting items, characterizing heterogeneity (score rate = 4.17%) was the least satisfied item. Among six parts of CHEERS, results part scored least at 0.55 (score rate = 54.79%) because of the incompleteness of characterizing uncertainty. Results from the Kruskal-Wallis test and Mann-Whitney U test showed that model choice, journal type, type of economic evaluations, and study perspective were associated with the reporting quality of the studies. CONCLUSIONS: There remains room to improve the reporting quality of economic evaluations for GLDs in NRDL. Checklists such as CHEERS should be widely used to improve the reporting quality of economic researches in China.

Who to engage in HIV vaccine trial benefit-sharing negotiations? An empirical proposition of a framework.

BACKGROUND: A morally sound framework for benefit-sharing is crucial to minimize research exploitation for research conducted in developing countries. However, in practice, it remains uncertain which stakeholders should be involved in the decision-making process regarding benefit-sharing and what the implications might be. Therefore the study aimed to empirically propose a framework for benefit-sharing negotiations in research by taking HIV vaccine trials as a case. METHODS: The study was conducted in Tanzania using a case study design and qualitative approaches. Data were collected using in-depth interviews (IDI) and focus group discussions (FGD). A total of 37 study participants were selected purposively comprising institutional review board (IRB) members, researchers, community advisory board (CAB) members, a policymaker, and HIV/AIDS advocates. Deductive and inductive thematic analysis approaches were deployed to analyze collected data with the aid of MAXQDA version 20.4.0 software. RESULTS: The findings indicate a triangular relationship between the research community, researched community and intermediaries. However, the relationship ought to take into consideration the timing of negotiations, the level of understanding between parties and the phase of the clinical trial. The proposed framework operationalize partnership interactions in community-based participatory research. CONCLUSION: In the context of this study, the suggested framework incorporates the research community, the community being researched, and intermediary parties. The framework would guarantee well-informed and inclusive decision-making regarding benefit-sharing in HIV vaccine trials and other health-related research conducted in resource-limited settings.

The usage and costs of national drug price-negotiated anticancer medicines in a first-tier city in Northeast China: a study based on health insurance data.

BACKGROUND: The National Drug Price Negotiation (NDPN) policy has entered a normalisation stage, aiming to alleviate, to some extent, the disease-related and economic burdens experienced by cancer patients. This study analysed the use and subsequent burden of anticancer medicines among cancer patients in a first-tier city in northeast China. METHODS: We assessed the usage of 64 negotiated anticancer medicines using the data on the actual drug deployment situation, the frequency of medical insurance claims and actual medication costs. The affordability of these medicines was measured using the catastrophic health expenditure (CHE) incidence and intensity of occurrence. Finally, we used the defined daily doses (DDDs) and defined daily doses cost (DDDc) as indicators to evaluate the actual use of these medicines in the region. RESULTS: During the study period, 63 of the 64 medicines were readily available. From the perspective of drug usage, the frequency of medical insurance claims for negotiated anticancer medicines and medication costs showed an increasing trend from 2018 to 2021. Cancer patients typically sought medical treatment at tertiary hospitals and purchased medicines at community pharmacies. The overall quantity and cost of medications for patients covered by the Urban Employee Basic Medical Insurance (UEBMI) were five times higher than those covered by the Urban and Rural Resident Medical Insurance (URRMI). The frequency of medical insurance claims and medication costs were highest for lung and breast cancer patients. Furthermore, from 2018 to 2021, CHE incidence showed a decreasing trend (2.85-1.60%) under urban patients' payment capability level, but an increasing trend (11.94%-18.42) under rural patients' payment capability level. The average occurrence intensities for urban (0.55-1.26 times) and rural (1.27-1.74 times) patients showed an increasing trend. From the perspective of drug utilisation, the overall DDD of negotiated anticancer medicines showed an increasing trend, while the DDDc exhibited a decreasing trend. CONCLUSION: This study demonstrates that access to drugs for urban cancer patients has improved. However, patients' medical behaviours are affected by some factors such as hospital level and type of medical insurance. In the future, the Chinese Department of Health Insurance Management should further improve its work in promoting the fairness of medical resource distribution and strengthen its supervision of the nation's health insurance funds.

Female genital mutilation and safer sex negotiation among women in sexual unions in sub-Saharan Africa: Analysis of demographic and health survey data.

BACKGROUND: The practice of female genital mutilation is associated with harmful social norms promoting violence against girls and women. Various studies have been conducted to examine the prevalence of female genital mutilation and its associated factors. However, there has been limited studies conducted to assess the association between female genital mutilation and markers of women's autonomy, such as their ability to negotiate for safer sex. In this study, we examined the association between female genital mutilation and women's ability to negotiate for safer sex in sub-Saharan Africa (SSA). METHODS: We pooled data from the most recent Demographic and Health Surveys (DHS) conducted from 2010 to 2020. Data from a sample of 50,337 currently married and cohabiting women from eleven sub-Saharan African countries were included in the study. A multilevel binary logistic regression analysis was used to examine the association between female genital mutilation and women's ability to refuse sex and ask their partners to use condom. Adjusted odds ratios (aORs) with a 95% confidence interval (CI) were used to present the findings of the logistic regression analysis. Statistical significance was set at p<0.05. RESULTS: Female genital mutilation was performed on 56.1% of women included in our study. The highest and lowest prevalence of female genital mutilation were found among women from Guinea (96.3%) and Togo (6.9%), respectively. We found that women who had undergone female genital mutilation were less likely to refuse sex from their partners (aOR = 0.91, 95% CI = 0.86, 0.96) and ask their partners to use condoms (aOR = 0.82, 95% CI = 0.78, 0.86) compared to those who had not undergone female genital mutilation. CONCLUSION: Female genital mutilation hinders women's ability to negotiate for safer sex. It is necessary to implement health education and promotion interventions (e.g., decision making skills) that assist women who have experienced female genital mutilation to negotiate for safer sex. These interventions are crucial to enhance sexual health outcomes for these women. Further, strict enforcement of policies and laws aimed at eradicating the practice of female genital mutilation are encouraged to help contribute to the improvement of women's reproductive health.

The gender of PrEP: Transgender men negotiating legitimacy in France.

Transmasculine people (TM) constitute an invisibilized group within the transgender population. Little is known about their relationship to sexuality in transgender medicine. Their presence and needs are still unacknowledged within HIV prevention research and services. Pre-exposure prophylaxis (or PrEP) is an oral medication that prevents HIV in HIV-negative individuals at risk of infection with the virus. This paper proposes to bring TM back into the focus of PrEP research by questioning how they navigate and situate themselves in relation to existing PrEP categorization and services, and how they think about and (re)shape the meanings of PrEP. It is based on the "interpretative descriptive" method and a transfeminist theoretical framework applied to the analysis of ten semi-structured interviews with TM conducted in France between 2019 and 2023. Findings show that PrEP is gendered. We identify specific barriers to getting PrEP as well as to access healthcare and we show that a cisnormative and homonormative approach to prevention generates them. PrEP use and PrEP disclosure are embedded in structural and symbolic power relations between cisgender and transgender MSM that are reflected in the intimate sphere. TM use PrEP to prevent sexual assault and to alleviate the difficulty of condom negotiation. PrEP comes into play following major changes in TM's sexualities and is integrated post-exposure.

Gamification in hospitality: Enhancing workplace thriving and employee well-being.

This study examines the effect of gamification on workplace thriving and employee well-being in the hospitality and tourism organizations, investigating the mediating effects of conflict resolution and working relationships while assessing the moderating influence of top management support. We conducted a time-lagged study with 451 employees from various hospitality and tourism organizations. Our research aimed to understand how gamification affects workplace thriving and employee well-being, with a focus on the mediating roles of conflict resolution and working relationships. We also examined the moderating effect of top management support. Our results demonstrate a positive link between gamification and workplace thriving, as well as a connection between gamification and employee well-being. Conflict resolution was found to mediate the relationship between gamification and workplace thriving, while working relationships mediated the connection between gamification and employee well-being. Additionally, top management support significantly moderated the relationships between gamification, conflict resolution, and workplace thriving.

A pandemic agreement is within reach.

At the end of May, 194 member states of the World Health Organization (WHO) will meet for the World Health Assembly. Negotiations underway now will determine whether they vote then to adopt a pandemic agreement. For the past 2 years, discussions have focused on articulating essential components of a robust and equitable architecture for pandemic preparedness and response. Despite this, talks have failed to produce sufficient consensus on a detailed draft, prompting the intergovernmental negotiating body to propose a "streamlined" version. The new text, released on 16 April, consolidates provisions for research and development, technology transfer, pathogen access and benefit sharing (including pandemic products such as medicines and vaccines), with many particulars deferred to future procedures. Ultimately, success of the agreement will depend on these details and implementation. Nevertheless, member states shouldn't bypass the consensus reached to date, but continue progress to adopt this agreement.

Entrepreneurship in the Favela: Negotiating Precarity and Mental Health During Covid-19.

This paper aims to explore the impact of the COVID-19 pandemic on the health and mental health of necessary entrepreneurs in Brasilian favelas, the social problems they experienced and implications for public health social work. The study used structured in-person interviews within selected Favela's, with a sample size of 721 entrepreneurs, aged between 16-70 years. All participants both worked and were resident in 15 out of the 27 Brasilian federal states. The bespoke questions explored socio-demographic questions, sought information on their entrepreneurship, health and administered the Warwick-Edinburgh Mental Wellbeing Scale for Health. The results highlighted that many entrepreneurs have engaged in this form of enterprise due to economic necessity, with 64% of women and 43.6% of men identifying increased levels of anxiety through the pandemic, with the presence of children in the family being statistically significant (p ≤ 0.05 chi-square test) for anxiety. Of the 9.8% sample respondents have accessed the health care service and for women with children, the impact of the pandemic accentuated existing problems of childcare and patriarchy. We conclude by highlighting the importance of universal and accessible health and mental health support and care, their ongoing accessibility, along with the importance of social work during crisis.

New energy vehicles' technology innovation coordination strategy based on alliance negotiation under dual credit policy.

The development of new energy vehicles (NEVs) is one of the effective ways to alleviate carbon emissions, environmental pollution, and energy scarcity in the transportation sector. The Chinese government has innovatively proposed the "dual credit policy," but it is still a hot topic whether it can promote the NEVs' technological innovation. In this study, we construct game models and obtain the technological innovation strategies for NEVs under the dual credit policy, considering that the NEV supply chain contains one manufacturer and N suppliers. Further, we construct bargaining game models and study how to encourage manufacturers and suppliers to enhance technological innovation, realize supply chain coordination, and give the alliance strategy to maximize suppliers' profit. We found that the dual credit policy can effectively stimulate technological innovation, and the higher the credit price or technological innovation credit factor, the higher the technical level of NEVs. The findings could guide the government to adjust and revise the policy. Second, we found that the bargaining games could coordinate the NEV supply chain so that decentralized enterprises can achieve optimal technological innovation under centralized decision-making. Third, we found that suppliers can improve their profits by choosing a suitable alliance strategy under the manufacturer's different negotiating power.

Connecting the dots: Exploring brain connectivity during responsibility recognition in construction contract negotiations.

Despite recent advancements in monitoring brain activity, causal relationships within the brain during responsibility identification in construction contracts remain unexplored. We aimed to understand the neural mechanisms involved in the cognitive components and their interactions related to contract text reading by delving into the brain mechanisms of contract responsibility identification. This study investigated students' brain connectivity using electroencephalography (EEG) data during a text-based contract responsibility-identification task. It employed an adaptive directed transfer function based on Granger causality to simulate directed and time-varying information flow in observed brain activity. We evaluated the EEG records of 18 participants under two reading conditions (involving or not involving contractor responsibility). During responsibility identification, the most substantial information exchange occurs in the somatosensory area of the brain. The results revealed a "top-down" cortical mechanism for responsibility identification, with the left parietal-occipital area (PO3) as the central hub promoting connectivity structures. These findings indicate that the perceptual processing of contract responsibility texts is associated with higher visual learning and memory quality. Contracts without contractor-responsibility clauses resulted in more substantial information flow output in the frontal cortex and consumed more cognitive resources. Our findings advance the understanding of cognitive processes involved in contract responsibility identification, providing a framework for investigating causal relationships within the brain and novel insights into cortical mechanisms. By identifying the neural basis of responsibility identification, stakeholders can develop effective training programs for negotiators and enhance their ability to interpret and implement construction contracts.

Examining the reliability of the emotional conflict resolution and adaptation effects in the emotional conflict task via secondary data analysis, systematic review, and meta-analysis.

The emotional conflict task measures emotional conflict resolution and adaptation, but some studies are unable to find resolution or adaptation effects using this task. We examined boundary conditions and replicability of the emotional conflict resolution and adaptation effects through secondary data analysis, systematic review, and meta-analysis of studies in the field. In our data, we were unable to fully replicate the emotional conflict resolution or adaptation effects and found that most studies using this task (n = 94) do not report analysis of emotional conflict resolution, with only 28% (n = 26) studies doing so. Our meta-analysis suggests that studies reporting emotional conflict resolution and adaptation analyses overall report significant but small effects, suggesting the effect is difficult to consistently replicate. Our meta-analysis revealed that controlling for contingency learning may impact the ability of studies to identify conflict resolution. These findings have implications for assessment and interpretation of the emotional conflict task. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Negotiating periodised training programmes in youth soccer development: A social process.

The purpose of the study was to develop new knowledge about the everyday realities when implementing periodised training programmes in professional soccer Academies. Specifically, this project enhances understanding in relation to 1) those stakeholders involved in periodised training programmes in professional soccer Academies, 2) factors that facilitate and constrain the design, implementation, and monitoring of periodised programmes, 3) the extent to which practitioners perceive that education programmes adequately prepared them for this aspect of their work. Academy managers, coaches and sport science support staff were approached to complete an online survey, with 30 individuals (33.6 ± 9.5 years old) agreeing to do so. Findings highlight that practitioners "have" to adapt their practices accordingly in response to contextually constraining factors. Here, the importance of developing richer insights into the social aspects of work in applied settings, greater recognition of facilitating and constraining factors, and an improved awareness and development of the educational interventions that can prepare practitioners in applied practice is emphasised.