Perceived competences, attitudes, and training needs in conflict management among a cohort of Italian physiotherapists: A cross-sectional survey study.

Conflict management is rarely explored among physiotherapists though they often work in teams. Hence, this study explored attitudes, perceived competencies, beliefs, training experiences, and needs in conflict management among Italian physiotherapists. We conducted a cross-sectional online survey study between June and September 2023 among Italian physiotherapists. The survey instrument comprised four sections. Section 1: Socio-Demographic and Professional Data: Explored participant profiles and conflict frequency. Section 2: Attitudes and Competences: assess conflict-related behaviours and management styles (Likert Scale). Section 3: Training Experiences and Needs: Evaluated training importance and conflict-related issues with other professionals (Likert Scale). Section 4: Beliefs About Factors: Participants rated (0-10) factors influencing conflict management and its impact on care and well-being. Descriptive analyses were performed, presenting continuous data as mean (SD) and categorical data as frequencies/percentages. Likert scale responses were dichotomised (agreement/disagreement), and consensus was defined as ≥70% agreement. Median, quartiles, and box-and-whisker plots depicted responses were used for 0-to-10 scales. Physiotherapists (n = 203; mean age: 39±10.40) generally leaned towards a constructive communication style, characterised by compromise and collaboration, viewing conflict management as an opportunity to grow. There was a disparity between their exhibited behaviours and self-assessment of appropriateness in conflict resolution. Only 27.6% considered their conflict resolution skills as satisfactory. However, 85.7% acknowledged the significance of being trained in conflict management. Challenges were evident in conflicts within interprofessional relationships and communication with superiors. Both personal and organisational factors were identified as influencing conflict management, with participants recognising the detrimental impact of conflicts on their well-being and patient care. This study highlighted educational gaps in conflict management among Italian physiotherapists, showing areas of improvement in their training. Our results suggested that physiotherapists might need additional training in conflict management to enhance workplace well-being and the quality of care provided.

The role of truth in victim-offender mediation: Victims of crime who feel they know the "whole" truth are more receptive to apologies.

OBJECTIVE: We conducted three preregistered studies to examine whether victims of crime are more receptive to apologies in victim-offender mediation if they feel they know the "whole" truth about a crime. HYPOTHESES: We predicted that making salient the completeness (vs. incompleteness) of knowledge about a crime would lead victims to (a) have a greater sense of truth knowing and (b) view an apology more favorably. METHOD: Participants in Study 1 (N = 380; Mage = 41.2 years; 51% men; 78% White) and Study 2 (N = 550; Mage = 41.0 years; 65% women; 72% White) imagined being the victim of cybercrime. Participants in Study 3 (N = 670; Mage = 42.7 years; 52% men; 72% White) were real crime victims. Participants imagined taking part in victim-offender mediation during which the offender apologized, and then they evaluated the apology after answering questions that made salient what they either knew or did not know about the crime (complete knowledge salience vs. incomplete knowledge salience). Participants in Study 2 received additional information about the crime from either the offender or the police to test whether truth source acts as a moderator. RESULTS: Participants in the complete (vs. incomplete) knowledge salience condition reported greater truth knowing (Study 1 d = 1.40, Study 2 d = 1.26, Study 3 d = 0.58), readiness for an apology (Study 1 d = 0.25; Study 2 d = 0.23; Study 3 d = 0.09, nonsignificant), perceived completeness of an apology (Study 1 d = 0.26, Study 2 d = 0.31, Study 3 d = 0.19), and acceptance of an apology (Study 1 d = 0.22; Study 2 d = 0.21; Study 3 d = 0.10, nonsignificant). In Study 2, truth source moderated the effect only on apology acceptance (η2 = .009). Across the three studies, complete (vs. incomplete) knowledge salience was indirectly positively related to apology readiness, apology completeness, and apology acceptance (nonsignificant in Study 3), via truth knowing. CONCLUSIONS: Instances of victim-offender mediation should ensure that victims' need for truth is satisfied because this may increase the effectiveness of apologies. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Interrogation, Negotiation, and Subversion of Power Differentials in Community-Based Participatory Research: A Scoping Review.

OBJECTIVES: To review empirical and peer-reviewed scholarly articles incorporating community-based participatory research approaches and examining discourses of how power differentials are interrogated, negotiated, and redressed within the partnerships using scoping review methodology following The Joanna Briggs Institute framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). DATA SOURCES: Articles were identified across five online databases: Embase, ERIC, PsycINFO, PubMed, and Web of Science. REVIEW METHODS: Keywords used in the search strategy were ("Community-Based Participatory Research" OR "Participa-tory Action Research"). Peer-reviewed scholarly articles discussing in-depth power differentials within the partnership published in English between 2010 and 2020 were included. RESULTS: Findings indicate scholars use critical reflexive qualitative methodologies to recognize and raise relevant questions of power issues between researchers and community stakeholders. Examination of individual biases, assumptions, and exertion of hierarchical top-down power is identified extensively. There is limited analysis on institutional and interdependent power. As a result of raising questions regarding power issues, individual actions to address emerging tensions and conflicts were reported. However, discussions on researchers' efforts to effect institutional and structural changes to redress power imbalances were limited. CONCLUSIONS: Building strong and equitable participatory action research collaborations between researchers and community stakeholders remains an arena of continuous struggle. This review offers some insights and relevant implications to better address power issues within participatory action research partnerships and inform the work of professionals engaged in the development, implementation, and evaluation of health promotion initiatives and policies.

Negotiating Work and Family Spheres: The Dyadic Effects of Flexible Work Arrangements on Fertility Among Dual-Earner Heterosexual Couples.

Academics and policymakers have suggested making flexible work arrangements (FWAs) the default in workplaces to promote a family-friendly workplace culture conducive to having and raising children. However, systematic research investigating how FWAs, as a long-term approach to negotiating work-family spheres, are related to fertility among dual-earner heterosexual couples is limited. Drawing on the linked-lives perspective, we theorize the relationship between FWAs and fertility among couples and potential variation depending on the interplay of both spouses' work and family characteristics. We test our hypotheses using longitudinal couple-level dyadic data in the United Kingdom (2010-2022). We find that although FWA availability alone is unrelated to fertility, wives' (not husbands') FWA use is significantly associated with a higher probability of experiencing a first birth. Moreover, the effect of wives' FWA use is particularly pronounced when both spouses work in professional and managerial occupations and when husbands contribute a larger proportion of income and at least equal housework. This study reveals a gendered effect of FWAs on fertility across work-family arrangements, deepening our understanding of couple-level dynamics in the fertility process.

Analysis of the characteristics, efficiency, and influencing factors of third-party mediation mechanisms for resolving medical disputes in public hospitals in China.

BACKGROUND: Medical disputes, which are prevalent in China, are a growing global public health problem. The Chinese government has proposed third-party mediation (TPM) to resolve this issue. However, the characteristics, efficiency, and influencing factors of TPM in resolving medical disputes in public hospitals in China have yet to be determined. METHODS: We conducted a systematic study using TPM records from medical disputes in Gansu Province in China from 2014 to 2019. A χ2 test was used to compare differences between groups, and binary logistic analysis was performed to determine the factors influencing the choice of TPM for resolving medical disputes. RESULTS: We analyzed 5,948 TPM records of medical disputes in Gansu Province in China. The number of medical disputes and the amount of compensation awarded in public hospitals in the Gansu Province increased annually from 2014 to 2019, with most of the disputes occurring in secondary and tertiary hospitals. Approximately 89.01% of the medical disputes were handled by TPM; the average compensation amount with TPM was Chinese Yuan (CNY) 48,688.73, significantly less than that awarded via court judgment and judicial mediation. TPM was more likely to succeed in settling medical disputes in the < CNY10,000 compensation group than in the no-compensation group (odds ratio [OR] = 3.14, 95% confidence interval [CI] 1.53-6.45). However, as the compensation amount increased, the likelihood of choosing TPM decreased significantly. Moreover, TPM was less likely to be chosen when medical disputes did not involve death (OR = 0.49, 95% CI 0.36-0.45) or when no-fault liability was determined (vs. medical accidents; OR = 0.37, 95% CI 0.20-0.67). CONCLUSION: Our findings demonstrate that TPM mechanisms play a positive role in efficiently reducing compensation amounts and increasing medical dispute resolution rates which was the main settlement method in resolving medical disputes in public hospitals of Gansu Province in China. TPM could help greatly reduce conflicts between doctors and patients, avoid litigation, and save time and costs for both parties. Moreover, compensation amounts, non-fatal outcomes, and no-fault liability determinations influence the choice of TPM for settling medical disputes.

[Home support for vulnerable older people: from shared decision-making to negotiation : A qualitative pilot study]. / L'accompagnement à domicile de personnes âgées vulnérables : de la prise de décision partagée à la négociation : Une étude qualitative pilote.

Shared decision-making allows older people to discuss and change their care with informal caregivers and healthcare professionals. When opinions differ, an older person's decision-making ability can be compromised by many factors. The objective of this qualitative pilot study was to study the dynamics of shared decision-making in home care support for vulnerable older people. Observations were carried out at the older people's homes during appointments with the network's healthcare professionals. Semi structured interviews were then conducted with older people, caregivers and healthcare professionals observed. When opinions differ, negotiation dynamics then develop between older people, caregivers and healthcare professionals. Using a dedicated negotiation framework, we identified four types of negotiation between the stakeholders in home care decision-making, influenced by various articulations of individual, collective and environmental factors.

Third-party arbitration and forgiving strategies increase cooperation when perception errors are common.

Humans cooperate in groups in which mutual monitoring is common, and this provides the possibility of third-party arbitration. Third-party arbitration stabilizes reciprocity in at least two ways: first, when it is accurate, it reduces the frequency of misunderstandings resulting from perception errors, and second, even when it is inaccurate, it provides a public signal that allows pairs to align their expectations about how to behave after errors occur. Here, we describe experiments that test for these two effects. We find that in an iterated, sequential Prisoner's Dilemma game with errors, players with the highest average payoffs are those who make use of third-party arbitration and who also employ forgiving strategies. The combination of these two behaviours reduces the detrimental effects of errors on reciprocity, resulting in more cooperation.

Price benchmarks of drugs selected for Medicare price negotiation and their therapeutic alternatives.

BACKGROUND: The Centers for Medicare and Medicaid Services (CMS) are currently negotiating prices with pharmaceutical manufacturers for the first 10 Part D drugs selected for Medicare drug price negotiation. Non-publicly available data, including the net prices of selected drugs and their therapeutic alternatives, will play a central role in the determination of the maximum fair prices (MFPs). OBJECTIVE: To estimate price benchmarks involved in the derivation of the starting point of the CMS initial price offer for the 10 drugs selected for Medicare price negotiation. METHODS: For the 10 drugs selected for negotiation, we reported (1) the list price, (2) the net price after manufacturer discounts, (3) the maximum negotiated price based on the minimum statutory discount, and (4) the ceiling of the MFP, estimated as the lowest of the latter 2. We also estimated net prices for therapeutic alternatives to the selected drugs. Net prices were estimated using peer-reviewed methodology that isolates commercial discounts negotiated between payers and manufacturers from mandatory discounts under government programs. All price benchmarks were estimated at the product level, for 30-day equivalent dosing, using 2021 data. RESULTS: 6 products (apixaban, rivaroxaban, empagliflozin, sacubitril/valsartan, etanercept, and insulin aspart) had therapeutic alternatives with lower net prices, which will be integrated with clinical benefit data in the derivation of initial price offers. The other 4 products (ustekinumab, ibrutinib, sitagliptin, and dapagliflozin) had therapeutic alternatives with higher net prices than the drugs selected for negotiation. For ibrutinib and ustekinumab, prices based on the minimum discounts were considerably lower than the estimated net prices and will likely set the starting point of the initial price offer. For dapagliflozin and sitagliptin, the starting point of the initial price offer will likely resemble their existing net prices. CONCLUSIONS: Our analyses identify different negotiation scenarios for the first 10 drugs selected for Medicare price negotiation, based on key elements involved in the derivation of the initial price offer. Our analyses can help improve transparency in the negotiation process, because the CMS is not required to reveal the information used in the derivation of price offers.

When rules are over-ruled: Virtual bargaining as a contractualist method of moral judgment.

Rules help guide our behavior-particularly in complex social contexts. But rules sometimes give us the "wrong" answer. How do we know when it is okay to break the rules? In this paper, we argue that we sometimes use contractualist (agreement-based) mechanisms to determine when a rule can be broken. Our model draws on a theory of social interactions - "virtual bargaining" - that assumes that actors engage in a simulated bargaining process when navigating the social world. We present experimental data which suggests that rule-breaking decisions are sometimes driven by virtual bargaining and show that these data cannot be explained by more traditional rule-based or outcome-based approaches.

Health Controversies: Long-Term Disagreement Management Challenges.

Health controversies involve complex exchanges of disagreements over health and medicine. They unfold differently in different parts of the world, and they often extend over long periods of time. In contemporary argumentation theory, proposals have recently been emerging for "disagreement management at large scale" and for an explicit focus on design of disagreement management methods. Lewinski and Aakhus characterize large-scale disagreement as polylogic: formed of complex networks of players holding contrasting positions that are attacked and defended in multiple places. Large-scale disagreements such as health controversies are important sites for emergence of new disagreement management methods, including new ways of arriving at conclusions about questions of fact (affecting positions) and new formats for coming to decisions about questions of policy (affecting places). The controversy over myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), spanning a period of very rapid change in reasoning about health, has been deeply entangled with the design of new institutional places for managing disagreements about health. It serves well to illustrate both the large, multi-scale structure of health controversies and the importance of long-term disagreement management strategies.

Making Landscapes Negotiable: Q-methodology as a Boundary-Spanning and Empowering Diagnostic.

Landscapes are conceptually fuzzy and rich, and subject to plural framings. They are places of inquiry and intervention for scientists and practitioners, but also concepts bound to peoples' dynamic identities, knowledge systems, inspiration, and well-being. These varying interpretations change the way landscapes function and evolve. Developed in the 1930s, Q-methodology is increasingly recognized for being useful in documenting and interrogating environmental discourses. Yet its application in the context of how integrated landscape approaches better navigate land-use dilemmas is still in its infancy. Based on our experience and emerging literature, such as the papers in this special collection, this article discusses the value of Q-methodology in addressing landscape sustainability issues. Q-methodology helps unravel and communicate common and contradicting landscape imaginaries and narratives in translational and boundary-spanning ways, thus bridging actors' different understandings of problems and solutions and revealing common or differentiated entry points for negotiating trade-offs between competing land uses. The methodology can be empowering for marginalized people by uncovering their views and aspirational values to decision-makers and policymakers. We argue that this potential can be further strengthened by using Q to identify counter-hegemonic discourses and alliances that combat injustices regarding whose knowledge and visions count. In this way, applying Q-methodology in integrated landscape approaches can become a key tool for transitioning toward just, inclusive, and sustainable landscapes.

Negotiating situational abstinence and moderation: a study of regular and heavy-drinking young Nigerians.

Studies that have examined young people's drinking behaviour, particularly how they abstain from alcohol or drink lightly and their motivations, have focused on Western contexts. Currently, studies on how and why young Africans abstain from alcohol or drink moderately are lacking. Therefore, there is a need to examine young people's drinking behaviours/practices on the continent to facilitate health promotion interventions. This study, which uses qualitative data elicited from 53 participants, explores how young Nigerian men and women who consume alcohol and drink heavily enact and negotiate abstinence and moderate drinking and the factors that motivate their choices. Some participants constructed situational abstinence, while others participated in temporary light drinking in their friendship networks, but these attracted some consequences. Peers pressured them, but some deployed the ability to offer 'valid' explanations and express self-determination and agency to ward off such pressures and negotiate situational abstinence or moderate drinking. Additionally, the fear of public embarrassment, negative publicity on social media due to intoxication and parental influences motivated some participants' occasional sobriety. Others relied on previous personal or friends' negative experiences of drunkenness or the consequences of heavy drinking represented in movies and books to construct occasional light drinking. The findings demonstrated how enacting and rejecting particular forms of masculinity and embodied gendered drinking practices, more generally, in some friendship groups, facilitated situational abstinence and moderation. Policymakers should partner with young people to design interventions that encourage abstinence or moderation and mitigate the current drinking practices in Nigeria, which will enhance health promotion.

The influence of the national drug price negotiation policy reform on the medical expenses of patients in Xuzhou City: an interrupted time series analysis.

Background: To reduce the burden of patients' medical care, the Xuzhou Municipal Government has initiated an exploratory study on the supply model and categorized management of nationally negotiated drugs. This study aims to understand the extent to which Xuzhou's 2021 reform of the National Drug Price Negotiation (NDPN) policy has had a positive impact on the healthcare costs of individuals with different types of health insurance. Methods: The Interrupted Time Series Analysis method was adopted, and the changes in average medical expenses per patient, average medical insurance payment cost per patient and actual reimbursement ratio were investigated by using the data of single-drug payments in Xuzhou from October 2020 to October 2022. Results: Following the implementation of the policy, there was a significant decrease in the average medical expenses per patient of national drug negotiation in Xuzhou, with a reduction of 62.42 yuan per month (p < 0.001). Additionally, the average medical insurance payment cost per patient decreased by 44.13 yuan per month (p = 0.01). Furthermore, the average medical expenses per patient of urban and rural medical insurance participants decreased by 63.45 yuan (p < 0.001), and the average monthly medical insurance payment cost per patient decreased by 57.56 yuan (p < 0.04). However, the mean total medical expenditures for individuals enrolled in employee medical insurance decreased by 63.41 yuan per month (p < 0.001), whereas the monthly decrease was 22.11 yuan per month (p = 0.21). On the other hand, there was no discernible change in the actual reimbursement ratio. Conclusion: After the adoption of the NDPN policy, a noticeable decline has been observed in the average medical expenses per patient and the mean cost of the average medical insurance payment per patient, although to a limited extent. Notably, the reduction in employee medical insurance surpasses that of urban and rural medical insurance.

Roles That Psychiatrists Can Play in International Negotiations to Reduce Conflict.

This Viewpoint discusses how mental health professionals can encourage dialog to reduce the possibility of military conflict.