The mediating role of coping styles in the relationship between fear of COVID-19 and mental health problems: a cross-sectional study among nurses.

Fear of being infected by coronavirus disease 2019 (COVID-19) could trigger mental health problems among nurses at the frontline. In such a situation, coping strategies are needed to deal with the imminent threat. The purpose of this study was to test the mediating effects of coping on relationships of fear of COVID-19 with anxiety, depression and post-traumatic syndrome among nurses who were in contact with COVID-19 patients. A cross-sectional and correlational research design was used to recruit a sample of 278 nurses who treated COVID-19 patients in four government referral hospitals in Indonesia. A bootstrap resampling procedure was used to test the significance of the total and specific indirect effects of coping on relationships of Fear of COVID-19 with anxiety, depression and post-traumatic syndrome. The nurses reported moderate levels of fear of COVID-19, considerable anxiety and depression, and a moderate level of coping. We found coping to be significantly negatively correlated with the reported levels of anxiety, depression and post-traumatic syndrome (p < 0.001). Coping mediated relationships of fear of COVID-19 on depression, anxiety and post-traumatic syndrome after controlling for relevant confounders for each dependent variable. This shows that enacting coping mechanisms is important to achieve an adaptive effect on nurses' mental health. Proper assessments and interventions should be tailored and implemented for nurses who have contact with COVID-19 patients to facilitate their use of coping strategies when needed in stressful situations.

Psychometric properties and cross-cultural adaptation of the Indonesian version of the Brief COPE in a sample of advanced cancer patients.

The Brief COPE Inventory has been proven as acceptable psychometric properties to examine coping strategies among cancer patients. However, most psychometric testing studies have been carried out in Western countries, raising concerns about the properties' relevance and applicability in other cultural contexts. This study aimed to present psychometric properties of the Brief COPE in a sample of patients with advanced cancer in Indonesia. Specifically, we intended to examine the factorial structure and the measure's validity and reliability. This study included 440 patients from the original study who completed the Indonesian version of Brief COPE. We used exploratory factor analysis and confirmatory factor analysis to assess factor structure and evaluate the structural model fit, respectively. Reliability was demonstrated by internal consistency represented by Cronbach's alpha coefficient. The factor analysis identified a 21-items scale with 5-factors (avoidance, religion and acceptance, social support coping, problem solving and distraction). Confirmatory factor analysis demonstrated a good model fit. For the whole scale and its subscales Cronbach's alpha coefficients were acceptable signifying good reliability. Convergent, divergent validity and contrast group comparison were evidenced by significant correlations among subscales and the other instruments used. This study shows that the Indonesian version of Brief COPE is a reliable and valid instrument to measure coping in advanced cancer patients and is ready for use amongst this population in the Indonesian cultural context.

Policy landscapes on human genome editing: a perspective from Latin America.

Policy landscapes are instruments that identify national regulations on human genome editing (HGE). After examining their ethical and political assumptions, we highlight their limitations and effects for Latin America. We suggest creating other landscapes, such as focusing on processes and drawing attention to potential 'circuits of use' within and across borders.

Psychological Distress Among Patients With Advanced Cancer: A Conceptual Analysis.

BACKGROUND: Psychological distress is a common problem that occurs in advanced cancer patients; however, the concept has not been sufficiently specified or clearly described. OBJECTIVE: To develop succinct understanding of psychological distress among advanced cancer patients. METHODS: A literature search was conducted using the CINAHL, PubMed, and MEDLINE databases from 1988 to 2018. The analysis used the 8 steps of concept analysis developed by Walker and Avant. The final articles selected focused on definitions, predictors, determinant factors, and measurements of psychological distress in advanced cancer. RESULTS: Analysis identified that psychological distress in terms of advanced cancer has 5 defining attributes: (1) anxiety, (2) depression, (3) death anxiety, (4) demoralization, and (5) a perceived inability to cope effectively. The primary antecedent is treatment complexity. The consequences are acceptance and living in the present positively, lower performance status, poor quality of life, suicide, and hastened death. CONCLUSIONS: This concept analysis clarifies the meaning of the concept and differentiates the concept of psychological distress from other emotional symptoms that advanced cancer patients commonly experience. It provides clarity in meaning by examining various ways the concept is used in the area of nursing. IMPLICATIONS FOR PRACTICE: The identified attributes of psychological distress play vital roles in nursing assessments and should be used as guidance for nurses to provide appropriate nursing care for advanced cancer patients. Interventions should address antecedents and consequences of the concept and consider individuals as persons with unique characteristics.

Mediation of Coping Strategies among Patients with Advanced Cancer.

The purpose of this study was to test the mediating effects of coping on relationships of psychological distress and stress with anxiety, depression, and quality of life. A cross-sectional and correlational research study was used to recruit a sample of 440 patients with advanced cancer in Indonesia. A bootstrap resampling procedure was used to test the significance of the total and specific indirect effects of coping. Data analysis showed that problem-focused coping (PFC) mediated relationships of psychological distress and stress on depression, anxiety and functional well-being. PFC also mediated the relationship between stress and social well-being. Emotional-focused coping (EFC) mediated the relationship of stress with physical and emotional well-being. EFC also mediated the relationships between psychological distress and physical well-being. Thus, proper assessments and interventions should be tailored and implemented for patients in order to facilitate their use of coping strategies when needed in stressful situations.

Perspectives on Challenges to Cell Therapy Development in Taiwan: Strengthening Evidential Standards and Ways Forward.

Over the past years, the field of regenerative medicine and cell therapy has garnered much interest, extending beyond the bench to broader use, and commercialization. These therapies undergo stringent regulatory oversight as a result of their complexities and potential risk across different jurisdictions. Taiwan's government, with the aim of developing the country as a hub for regenerative medicine in Asia, enacted a dual track act to promote the development of regenerative and cell therapy products. This qualitative study used purposive sampling to recruit sixteen experts (Twelve respondents from medical institutions and four respondents from the industry) to understand their perspectives on one of the regulatory tracks which governs the medical use of cell technologies and challenges regarding its implementation. Semi-structured interviews were conducted, transcribed, coded and thematically analyzed. Three major themes emerged from the analysis: 1) Perceptions of the "Special Regulation for Cell Therapy" 2) Emerging issues and controversies on the medical use of cell technologies in private clinics, and 3) Challenges impeding the clinical innovation of cell technologies. As reported by the experts, it was clear that the special regulation for cell therapy was aimed at legalizing the clinical use of cell therapy in a similar fashion to an evidence-based pathway, to promote clinical innovation, ensure manufacturing consistency, and improve oversight on cell-based therapies. Thus, the regulation addresses the issues of safety concerns, patient's access and stem cell tourism. However, the limited approved cell techniques, quality control during cell processing, time, and criteria used in evaluating applications in addition to the need to develop evidential standards for clinical evidence are some of the difficulties faced. Thus, policy interventions on funding, educational resources, training, and regulatory clarity addressing these challenges may positively impact clinical innovation of cell therapy in Taiwan.

Doctors as moral pioneers: Negotiated boundaries of assisted conception in Colombia.

New biotechnologies such as assisted conception are socially embedded artefacts that raise context-specific ethical, moral and social anxieties. In contexts where the regulations of these profitable developments are limited or ambiguous, and competition between private facilities is high, individual doctors become morally and socially responsible for determining the parameters of administering such therapies. Ethnographic research at two private fertility centres in Colombia reveals that doctors do not determine boundaries based on monetary gain but rather personal morals, social norms and professional obligations. Medical professionals hold diverse perceptions of assisted conception, and often struggle to make decisions regarding who should access such therapies, who are ideal gamete donors and the fate of extra embryos. The complexity of these perceptions applied in a context of limited regulation and the competition of private medicine impacts the praxis of assisted conception. As doctors determine the boundaries of their practice they not only create variation between clinical practices, but also make moral decisions regarding who should be parents, how families should be formed and the significance of embryos. Thus, in navigating their everyday practices, doctors also shape the social world.

Healthcare professionals', students', patients' and donors' perceptions of stem cell research and therapy: a systematic review protocol.

INTRODUCTION: Stem cell research (SCR) and the biomedical potential of developing therapies are crucial topics in biomedicine. Like other biotechnologies, stem cells are context specific entities understood through local conceptualisations of culture, politics, nationhood, as well as their perceived therapeutic efficacy. There is a need to recognise how these developments are understood within the healthcare community and by those who may use them. This protocol describes a systematic literature review that aims to explore healthcare professionals', healthcare students', patients', and donors' perceptions of SCR and therapy (SCR/T) and the factors that influence their perceptions. METHODS AND ANALYSIS: Following Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines a systematic review will be undertaken. Web of Science, Scopus, Medline+Journals @Ovid and Ariti Library will be systematically searched for studies on healthcare professionals', healthcare students', patients' and donors' perceptions of SCR and developing therapies. All articles will be screened by a researcher for inclusion and evaluation based on 12 criteria for evaluating qualitative research. At least 20% of articles will also be reviewed by a second researcher and any disagreement will be solved via consensus. Data extracted from the articles will be analysed using thematic synthesis enabling the identification of concepts across studies and the development of new theory. ETHICS AND DISSEMINATION: As part of a larger research project, ethical approval has been provided by the Institutional Research Board (IRB) at Chang Gung Memorial Hospital. This review will be able to determine the impact that certain perceptions of SCR/T will have on the development of future medical knowledge and practice. The results of the study will be published in a peer-reviewed journal and disseminated at relevant conferences. PROSPERO REGISTRATION NUMBER: CRD42018103627.

Professionalism lapses and hierarchies: A qualitative analysis of medical students' narrated acts of resistance.

Resistance is classified as a reaction against confining social structures. During their education, medical students encounter traditional medical and interprofessional hierarchies as they learn to become doctors. These create a power disparity that may prevent their empowerment and ability to resist. Despite their subordinate position, students are not always powerless when encountering situations that contradict their ethical, moral, and professional understandings of appropriate medical practice - so called 'professionalism dilemmas.' A qualitative analysis of over 1500 narratives from interviews, focus groups, and questionnaires with 808 medical students in the UK and Australia highlights how students draw on a number of direct and indirect, verbal and bodily, instantaneous and delayed forms of resistance to counter the professionalism lapses of their seniors, which they face in everyday clinical and educational interactions. Within students' narratives of resistance we come to see how they resist hegemonic practices and their reasons for doing so, such as to prevent patient and student abuse, promote hygienic practice, and uphold patient consent. Through these various acts of resistance (and their narration), medical students may promote the subtle transformation of the dominant medical structure either consciously or unconsciously. They may do this through reflecting on acts of resistance to professionalism lapses, making sense of their moral position and the development of their professional identities, by encouraging others to also resist through sharing resistance narratives, and finally, by altering the professional conduct of their seniors. We encourage all workplace learning stakeholders to better understand the social dynamics of hierarchies and resistance and to encourage the enactment of resistance in the face of professionalism lapses in order to protect the health and wellbeing of learners and patients.

The Familial and the Familiar: Locating Relatedness in Colombian Donor Conception.

In this article, I explore how women undergoing in vitro fertilization with familial or anonymous egg donors located relatedness with a donor-conceived child through familial and social identities. Recognizing gametes as substances that contain biological and sociocultural/behavioral traits shaped women's narratives around interconnected notions of the familial and familiar, or the social understanding of biological and social inheritance, and knowledge of the genetic materials involved. Women's narratives of relatedness reflect their relationships with family and society and their desire to reproduce these relationships in their child(ren), a process that reproduces prevailing Colombian social values and notions of ideal citizens.