The substitution effect of financial and non-financial incentives at different income levels in physician recruitment: evidence from medical students in China.

BACKGROUND: Understanding how medical students respond to financial and non-financial incentives is crucial for recruiting health workers and attracting health talents in medical education. However, both incentives are integrated in working practice, and existing theoretical studies have suggested that various income levels may influence the substitution effect of both incentives, while the empirical evidence is lacking. Furthermore, little attention has been paid to the intrinsic motivation. This study aimed to explore the substitution effect of extrinsic incentives at different income levels, also taking intrinsic altruism into account. METHODS: We used the behavioral data from Zhang et al.'s experiments, which involved discrete choice experiments (DCEs) to assess the job preferences of medical students from six teaching hospitals in Beijing, China. The incentive factors included monthly income, work location, work environment, training and career development opportunities, work load, and professional recognition. Additionally, a lab-like experiment in the medical decision-making context was conducted to quantify altruism based on utility function. Furthermore, we separated the choice sets based on the actual income and distinguished the medical students on altruism. The willingness to pay (WTP) was used to estimate the substitution effect of incentives through conditional logit model. RESULTS: There was a significant substitution effect between non-financial and financial incentives. As income increased, non-financial incentives such as an excellent work environment, and sufficient career development became relatively more important. The impact of the increase in income on the substitution effect was more pronounced among individuals with higher altruism. Concerning the non-financial incentive work environment, in contrast to the growth of 546 CNY (84 USD) observed in the low-altruism group, the high-altruism group experienced a growth of 1040 CNY (160 USD) in the substitution effect. CONCLUSIONS: The increase in the income level exerted an influence on the substitution effect of non-financial incentives and financial incentives, especially in high-altruism medical students. Policymakers should attach importance to a favorable environment and promising career prospects on the basis of ensuring a higher income level. Medical school administrations should focus on promoting altruistic values in medical education, enhancing talent incentives and teaching strategies to encourage medical students to devote themselves to the medical professions.

Interdisciplinary research approach based on a mixed-methods design to explore patient altruism at the end of life: a study protocol.

INTRODUCTION: In the end of life context, patients are often seen as somewhat passive recipients of care provided by health professionals and relatives, with little opportunity to be perceived as autonomous and active agents. Since studies show a very high prevalence of altruistic dispositions in palliative care patients, we strive to investigate the concept of patient altruism in a set of six interdisciplinary studies by considering three settings: (1) in the general palliative context-by studying to what extent patient altruism is associated with essential psychological outcomes of palliative care (subproject 1a), how altruism is understood by patients (subproject 1b) and how altruism expressed by patients is experienced by palliative care nurses (subproject 1c); (2) in two concrete decision-making contexts-advance care planning (subproject 2a) and assisted suicide (subproject 2b); and (3) through verbal and non-verbal patient communication in palliative care settings (subproject 3). METHODS AND ANALYSIS: Subproject 1a: a cross-sectional study using validated and standardised questionnaires. Subprojects 1b and 1c: a constructivist grounded theory method aiming at developing a novel theory from semistructured interviews in both patients and nurses. Subproject 2a: a thematic analysis based on (1) audio-recordings of advance care planning encounters and (2) follow-up semidirective interviews with patients and their relatives. Subproject 2b: a qualitative study based on thematic analysis of interviews with patients actively pursuing assisted suicide and one of their relatives.Subproject 3: a conversation analysis based on audio and video-recorded interactions in two settings: (1) palliative inpatient unit and (2) advance care planning discussions. ETHICS AND DISSEMINATION: The study project was approved by the Ethics Committees of the Canton of Vaud, Bern and Ticino (no: 2023-00088). In addition to participation in national and international conferences, each project will be the subject of two scientific publications in peer-reviewed journals. Additional publications will be realised according to result triangulation between projects. A symposium opened to professionals, patients and the public will be organised in Switzerland at the end of the project.

Pediatric Support for Children Eligible for Legal Humanitarian Relief.

Many children in immigrant families may qualify for legal protection-for themselves if unaccompanied, or as a derivative on parents' claims-on humanitarian grounds related to persecution or forced migration. Pediatric providers can offer a spectrum of multidirectional medical-legal supports to increase access to medical-legal services and support children who are undocumented or in mixed-status families. These activities can include providing trusted information, incorporating screening for health-related social needs, establishing networks for multidirectional referrals, and providing letters of support for legal protection. To expand workforce capacity for medical-legal services related to immigration, pediatric providers can also receive training to conduct specialized, trauma-informed forensic evaluations and can advocate at individual, local, state, federal, and global levels to address factors leading to persecution and forced migration while supporting individuals who may be eligible for legal protection. [Pediatr Ann. 2024;53(5):e183-e188.].

Supporting Migrant Children in Pediatric Settings: Lessons Learned from the US Migrant Humanitarian Crisis Response.

This article examines the influx of migrants to the United States and highlights current global and local immigration trends. The authors focus on migrant children-specifically the effect of migration trauma in the context of humanitarian responses to the intentional movement of migrants to Democrat-led cities across the US to humanize the compounded effects of migration trauma, restrictive immigration policies, and the current resettlement landscape for migrants. The authors are directly involved with supporting migrant arrivals who have relocated to Chicago from the southern border, and apply field knowledge to articulate current barriers to accessing health care and best practices within pediatric settings supporting migrant arrivals. Clinical and practice implications for medical providers in pediatric settings are included. The article also highlights the role of interdisciplinary collaboration in providing health care to asylum-seeking migrants and implications for transdisciplinary workforce development in this area. [Pediatr Ann. 2024;53(5):e171-e177.].

Funding emergency response.

Protracted humanitarian emergencies are forcing donors and agencies to rethink their approaches to response. Gary Humphreys reports.

The greenbeard gene tgrB1 regulates altruism and cheating in Dictyostelium discoideum.

Greenbeard genetic elements encode rare perceptible signals, signal recognition ability, and altruism towards others that display the same signal. Putative greenbeards have been described in various organisms but direct evidence for all the properties in one system is scarce. The tgrB1-tgrC1 allorecognition system of Dictyostelium discoideum encodes two polymorphic membrane proteins which protect cells from chimerism-associated perils. During development, TgrC1 functions as a ligand-signal and TgrB1 as its receptor, but evidence for altruism has been indirect. Here, we show that mixing wild-type and activated tgrB1 cells increases wild-type spore production and relegates the mutants to the altruistic stalk, whereas mixing wild-type and tgrB1-null cells increases mutant spore production and wild-type stalk production. The tgrB1-null cells cheat only on partners that carry the same tgrC1-allotype. Therefore, TgrB1 activation confers altruism whereas TgrB1 inactivation causes allotype-specific cheating, supporting the greenbeard concept and providing insight into the relationship between allorecognition, altruism, and exploitation.

Sexual and reproductive health implementation research in humanitarian contexts: a scoping review.

BACKGROUND: Meeting the health needs of crisis-affected populations is a growing challenge, with 339 million people globally in need of humanitarian assistance in 2023. Given one in four people living in humanitarian contexts are women and girls of reproductive age, sexual and reproductive health care is considered as essential health service and minimum standard for humanitarian response. Despite growing calls for increased investment in implementation research in humanitarian settings, guidance on appropriate methods and analytical frameworks is limited. METHODS: A scoping review was conducted to examine the extent to which implementation research frameworks have been used to evaluate sexual and reproductive health interventions in humanitarian settings. Peer-reviewed papers published from 2013 to 2022 were identified through relevant systematic reviews and a literature search of Pubmed, Embase, PsycInfo, CINAHL and Global Health databases. Papers that presented primary quantitative or qualitative data pertaining to a sexual and reproductive health intervention in a humanitarian setting were included. RESULTS: Seven thousand thirty-six unique records were screened for inclusion, and 69 papers met inclusion criteria. Of these, six papers explicitly described the use of an implementation research framework, three citing use of the Consolidated Framework for Implementation Research. Three additional papers referenced other types of frameworks used in their evaluation. Factors cited across all included studies as helping the intervention in their presence or hindering in their absence were synthesized into the following Consolidated Framework for Implementation Research domains: Characteristics of Systems, Outer Setting, Inner Setting, Characteristics of Individuals, Intervention Characteristics, and Process. CONCLUSION: This review found a wide range of methodologies and only six of 69 studies using an implementation research framework, highlighting an opportunity for standardization to better inform the evidence for and delivery of sexual and reproductive health interventions in humanitarian settings. Increased use of implementation research frameworks such as a modified Consolidated Framework for Implementation Research could work toward both expanding the evidence base and increasing standardization. Three hundred thirty-nine million people globally were in need of humanitarian assistance in 2023, and meeting the health needs of crisis-affected populations is a growing challenge. One in four people living in humanitarian contexts are women and girls of reproductive age, and provision of sexual and reproductive health care is considered to be essential within a humanitarian response. Implementation research can help to better understand how real-world contexts affect health improvement efforts. Despite growing calls for increased investment in implementation research in humanitarian settings, guidance on how best to do so is limited. This scoping review was conducted to examine the extent to which implementation research frameworks have been used to evaluate sexual and reproductive health interventions in humanitarian settings. Of 69 papers that met inclusion criteria for the review, six of them explicitly described the use of an implementation research framework. Three used the Consolidated Framework for Implementation Research, a theory-based framework that can guide implementation research. Three additional papers referenced other types of frameworks used in their evaluation. This review summarizes how factors relevant to different aspects of implementation within the included papers could have been organized using the Consolidated Framework for Implementation Research. The findings from this review highlight an opportunity for standardization to better inform the evidence for and delivery of sexual and reproductive health interventions in humanitarian settings. Increased use of implementation research frameworks such as a modified Consolidated Framework for Implementation Research could work toward both expanding the evidence base and increasing standardization.

Turning pain into strength: prosocial behaviours in coping with trauma.

Background: Various coping strategies have been shown to alleviate the negative effects of trauma, yet the significance of prosocial behaviour in this realm has been notably underexplored. The present study explored the hypothesis that engaging in prosocial behaviour mitigates the impacts of trauma by promoting a sense of competence and relatedness, post-traumatic growth (PTG), and reconstruction of meaning.Methods: Three consecutive studies were conducted with college students to compare differences in consequence of prosocial behaviours between a trauma group and a control group. Study 1 (N = 96) used self-reported experiences of traumatic vs non-traumatic events; Study 2 (N = 43) used exposure vs. no exposure to video of an earthquake; Study 3 (N = 20) used a randomized controlled trial (RCT) of a prosocial-themed intervention vs. no intervention. Outcomes in all studies were assessed by self-report questionnaires.Results: Trauma damaged participants' sense of competence and meaningfulness. Prosocial behaviour relieved the impact of trauma on meaning, specifically manifested in the individuals' sense of meaningfulness and their search for meaning. Group interventions with a prosocial theme (based on effect size results) reduced post-traumatic stress disorder (PTSD) and enhanced PTG in victims. The promoting effect on PTG persisted a month later, and its enhancing effect on meaning manifested with a delay.Conclusion: Prosocial behaviour can potentially serve as a beneficial strategy for individuals coping with trauma because it helps enhance meaning and promotes PTG in victims. This conclusion is supported by laboratory experiments and a tentative small-scale intervention study, which provide an innovative perspective for future trauma interventions.

Prosocial behaviour can potentially serve as a beneficial strategy for individuals coping with trauma.Prosocial behaviour relieved the impact of trauma on meaning.Prosocial-themed intervention reduced PTSD and enhanced PTG in victims (based on effect size results).

Exploring the perspectives and practices of humanitarian actors towards the Participation Revolution in humanitarian digital health responses: a qualitative study.

BACKGROUND: As crises escalate worldwide, there is an increasing demand for innovative solutions to enhance humanitarian outcomes. Within this landscape, digital health tools have emerged as promising solutions to tackle certain health challenges. The integration of digital health tools within the international humanitarian system provides an opportunity to reflect upon the system's paternalistic tendencies, driven largely by Global North organisations, that perpetuate existing inequities in the Global South, where the majority of crises occur. The Participation Revolution, a fundamental pillar of the Localisation Agenda, seeks to address these inequities by advocating for greater participation from crisis-affected people in response efforts. Despite being widely accepted as a best practice; a gap remains between the rhetoric and practice of participation in humanitarian response efforts. This study explores the extent and nature of participatory action within contemporary humanitarian digital health projects, highlighting participatory barriers and tensions and offering potential solutions to bridge the participation gap to enhance transformative change in humanitarian response efforts. METHODS: Sixteen qualitative interviews were conducted with humanitarian health practitioners and experts to retrospectively explored participatory practices within their digital health projects. The interviews were structured and analysed according to the Localisation Performance Measurement Framework's participation indicators and thematically, following the Framework Method. The study was guided by the COREQ checklist for quality reporting. RESULTS: Varied participatory formats, including focus groups and interviews, demonstrated modest progress towards participation indicators. However, the extent of influence and power held by crisis-affected people during participation remained limited in terms of breadth and depth. Participatory barriers emerged under four key themes: project processes, health evidence, technology infrastructure and the crisis context. Lessons for leveraging participatory digital health humanitarian interventions were conducting thorough pre-project assessments and maintaining engagement with crisis-affected populations throughout and after humanitarian action. CONCLUSION: The emerging barriers were instrumental in shaping the limited participatory reality and have implications: Failing to engage crisis-affected people risks perpetuating inequalities and causing harm. To advance the Participation Revolution for humanitarian digital health response efforts, the major participatory barriers should be addressed to improve humanitarian efficiency and digital health efficacy and uphold the rights of crisis-affected people.

Microbial Primer: Cooperation in bacteria.

The growth and success of many bacteria appear to rely on a stunning range of cooperative behaviours. But what is cooperation and how is it studied?

Recalling experiences of scarcity reduces children's generosity relative to recalling abundance.

Does a sense of having less or more than what one needs affect one's generosity? The question of how resource access influences prosocial behavior has received much attention in studies with adults but has produced conflicting findings. To better understand this relationship, we tested whether resource access affects generosity in the developing mind. In our preregistered investigation, we used a narrative recall method to explore how temporary, experimentally evoked states of resource abundance or scarcity affect children's sharing. In this study, 6- to 8-year-old American children (N = 148) recalled an experience of scarcity or abundance and then chose how many prizes to share with another child. We found that children in the scarce condition rated themselves as sadder, viewed their resource access as more limited, and shared fewer tokens than children in the abundant condition. Our results indicate that recalling past experiences of resource access creates distinct behavioral consequences for children and suggest that a sense of "having less" may encourage a strategy of resource conservation relative to a sense of "having more," even at a young age.

I help, therefore, I am? - A registered report on longitudinal inter-relations of the three-dimensional moral self-concept and prosocial behaviours in preschool children.

Children's moral self-concept (MSC) has been proposed to relate to prosocial behaviour. However, systematic assessments of their inter-relations are scarce. Therefore, this longitudinal study investigated the development, structure and inter-relation of prosocial behaviours and the MSC in childhood, using three measurement points at ages 4, 5 and 6 years. We assessed children's MSC and helping, sharing and comforting behaviours in a laboratory setting. Confirmatory factor analyses revealed a three-dimensional MSC structure at 5 and 6 years, but not at 4 years. There was inconsistent stability across time points regarding prosocial behaviour and MSC. For the comforting domain, but not the other domains, cross-lagged relations between self-concept and behaviour were present. Moreover, helping behaviour and self-concept were inter-related at 6 years. Results provide support for reciprocal associations between MSC and prosocial behaviour, albeit only in the comforting domain. They highlight the importance of distinguishing between types of prosocial behaviour and corresponding dimensions of the self-concept, as different developmental trajectories and associations emerge.

Altruism, reciprocity, and probability: Examining relations through a discounting framework.

Probability and reciprocation have been implicated as key variables for understanding altruism and cooperation. Social discounting, which describes the decline in reward value as the recipient increases in social distance, has provided a framework through which to examine altruistic and cooperative choice. A previous study introduced reciprocal discounting as a way of studying perceived altruism from others (termed reciprocal altruism). But probability discounting has not yet been examined in relation to reciprocal discounting. In order to extend research on reciprocal discounting, the present study evaluated correlations between social, reciprocal, and probability discounting as well as relations between standard social distance (used in social discounting) and reciprocal social distance (the participant's perceived social distance placement on someone else's list) among 129 participants. Upon evaluation, the fit of median reciprocal discount rates to the hyperbolic form was replicated. A strong correlation between social and reciprocal discount rates and a moderate correlation between social and probability discount rates were found as well. Additionally, reciprocal and probability discount rates yielded moderate correlations while reciprocal and standard social distance analyses revealed more correspondence between reward values when persons were socially close (i.e., Person 1) or socially distant (i.e., Person 100). This study provides further evidence that reciprocation and probability likely impact altruistic choice while laying groundwork for further investigations into social distance.