Ethical Considerations in Pediatric Surgery.

Pediatric surgeons need to learn to give as much importance to the ethical approach as they have been giving to the systemic methodology in their clinical approach all along. The law of the land and the governmental rules also need to be kept in mind before deciding the final solution. They need to always put medical problems in the background of ethical context, reach a few solutions keeping in mind the available resources, and apply the best solution in the interest of their pediatric patients.

Post-traumatic stress, depression, and anxiety during the 2021 Myanmar conflict: a nationwide population-based survey.

Background: The UN warns that Myanmar faces the 'triple crises' of mass conflict, uncontrolled COVID-19, and economic collapse. Therefore, we aimed to assess the population mental health burden, healthcare needs, and the associated risk factors in Myanmar. Methods: We established a nationwide random sample and recruited 1038 adults via random digit dialling from July 3-Aug 9, 2021, during the ongoing conflict since Feb 1, 2021, and surge in SARS-CoV-2 infections. Probable post-traumatic stress disorder (PTSD) was assessed using the PTSD Checklist-Civilian Version. Probable depression and anxiety were assessed using the Patient Health Questionnaire-2 and the Generalized Anxiety Disorder-2. We calculated population attributable fractions for probable mental disorders using multivariable logistic regression models. Based on the mental health burden and healthcare-seeking patterns, we projected the need for mental health services. Findings: During the 'triple crises', a third of adults in Myanmar (34.9%, 95% CI 32.0-37.7) reported a probable mental disorder. Prevalence of probable PTSD, depression, and anxiety were 8.1% (6.6-9.7), 14.3% (12.0-16.6), and 22.2% (19.7-24.7), respectively. We estimated that up to 79.9% (43.8-97.9) of probable PTSD was attributable to political stress. This corresponds to 2.1 million (1.1-3.2 million) fewer adults with probable PTSD if political stress was removed from the population. The mental health burden could translate into roughly 5.9 million adults seeking mental health services. Interpretation: The mental health burden in Myanmar is substantial, and population mental health might only be restored when the three crises have ended. An accelerated peace process is critical to protecting Myanmar's population mental health. Funding: This research was supported the Research Grants Council of the Hong Kong Special Administrative Region, China (Project No. HKU 17606122) and the Michele Tansella Award.

Ethics guidelines for environmental epidemiologists: 2023 revision.

Recognition of the importance to environmental epidemiology of ethical and philosophical deliberation led, in 1996, to the establishment of Ethics Guidelines for the profession. In 1999, these guidelines were adopted by the International Society for Environmental Epidemiology. The guidelines were revised in 2012 and again in 2023 to ensure continued relevance to the major issues facing the field. Comprising normative standards of professional conduct, the guidelines are structured into four subsections: (1) obligations to individuals and communities who participate in research; (2) obligations to society; (3) obligations regarding funders/sponsors and employers; and (4) obligations to colleagues. Through the 2023 revision of the Ethics Guidelines, the International Society for Environmental Epidemiology seeks to ensure the highest possible standards of transparency and accountability for the ethical conduct of environmental epidemiologists engaged in research and public health practice.

Habituation of Brain Activity with Repetition in Color and Picture-Word Stroop Tests.

As a widely used mental task for functional near-infrared spectroscopy (fNIRS), the original color-word Stroop task has the advantage of being difficult to habituate, but also the disadvantage of being difficult to understand, especially for children. While the introduction of derived Stroop tasks offers highly promising countermeasures, changes in brain activity during these tests have not been well tested. We investigated the degree of habituation between the original and a derived Stroop task by measuring brain activity to obtain a better fNIRS task design. Fourteen healthy adults participated in the study, and a 10-channel fNIRS device was used. A picture-word Stroop task with lower linguistic conflict than the original was conducted. The original and derived Stroop tests were repeated four times in a 1-week interval. We found that the original Stroop test did not show any significant changes in brain activity with repeated measures; however, brain activity decreased during the derived test. The differences in habituation between the original and derived tests may be due to the differences in the strength of the linguistic conflict. Our findings also highlight the need to consider the effects of habituation when using derived Stroop tasks in repeated measures.

Disagreement Gets Mistaken for Bad Listening.

It is important for people to feel listened to in professional and personal communications, and yet they can feel unheard even when others have listened well. We propose that this feeling may arise because speakers conflate agreement with listening quality. In 11 studies (N = 3,396 adults), we held constant or manipulated a listener's objective listening behaviors, manipulating only after the conversation whether the listener agreed with the speaker. Across various topics, mediums (e.g., video, chat), and cues of objective listening quality, speakers consistently perceived disagreeing listeners as worse listeners. This effect persisted after controlling for other positive impressions of the listener (e.g., likability). This effect seemed to emerge because speakers believe their views are correct, leading them to infer that a disagreeing listener must not have been listening very well. Indeed, it may be prohibitively difficult for someone to simultaneously convey that they disagree and that they were listening.

Long-term outcome of microvascular decompression for typical trigeminal neuralgia with autologous muscle: an analysis of 1025 patients from a developing country.

OBJECTIVE: The objective was to evaluate the long-term outcome of microvascular decompression (MVD) utilizing autologous muscle for trigeminal neuralgia (TGN). METHODS: A retrospective review was performed of all first-time MVD patients for typical classic TGN without prior surgical intervention who were treated between 2000 and 2019 at a tertiary supraregional neurosurgery practice. Demographic characteristics, surgical findings, operative results, complications, and recurrence rates at 1 year, 5 years, and last follow-up were collected. Pain outcome was assessed using the Barrow Neurological Institute (BNI) pain score. The chi-square test with continuity correction was used to compare categorical variables, and Kaplan-Meier curves and Cox regression were used to identify factors associated with recurrence. RESULTS: In total, 1025 patients were studied with a median (interquartile range [IQR]) (range) follow-up of 8 (5-13) (3-20) years. In the immediate postoperative period, 889 patients (86.7%) had complete pain relief and 106 (10.3%) had partial pain relief; neither group required medication, and 30 patients (2.9%) had no relief. One hundred forty-one recurrences (13.8%) occurred over a median (IQR) of 3 (2-6) years after surgery. The proportion of patients without recurrence was 97% at 1 year, 90% at 5 years, 85% at 10 years, 82% at 15 years, and 81% at 20 years. There was no significant difference in the probability of recurrence between patients with complete (114/907 [12.6%] recurrences) or partial (19/106 [17.9%] recurrences) postoperative pain relief (p = 0.124, log-rank test). Patients with venous compression (n = 322) had a significantly higher rate of MVD failure (n = 16 [5%]) compared to those with arterial compression (14/703 [2%]) (p = 0.015, chi-square test). In the Cox proportional hazards model, venous compression and lack of immediate postoperative pain relief had hazard ratios of 1.62 (95% CI 1.16-2.27) and 2.65 (95% CI 1.45-4.82) for recurrence, respectively. One hundred twenty-four (12.1%) complications were documented, including facial numbness (44 [4.3%]), facial nerve palsy (37 [3.6%]), CSF leak (13 [1.3%]), and diplopia (5 [0.5%]), which resolved in all patients. CONCLUSIONS: MVD with autologous muscle provides long-lasting pain relief in TGN patients with vascular compression with minimum morbidity and is a viable alternative to synthetic materials.

Spatial spillovers of violent conflict amplify the impacts of climate variability on malaria risk in sub-Saharan Africa.

Africa carries a disproportionately high share of the global malaria burden, accounting for 94% of malaria cases and deaths worldwide in 2019. It is also a politically unstable region and the most vulnerable continent to climate change in recent decades. Knowledge about the modifying impacts of violent conflict on climate-malaria relationships remains limited. Here, we quantify the associations between violent conflict, climate variability, and malaria risk in sub-Saharan Africa using health surveys from 128,326 individuals, historical climate data, and 17,429 recorded violent conflicts from 2006 to 2017. We observe that spatial spillovers of violent conflict (SSVCs) have spatially distant effects on malaria risk. Malaria risk induced by SSVCs within 50 to 100 km from the households gradually increases from 0.1% (not significant, P>0.05) to 6.5% (95% CI: 0 to 13.0%). SSVCs significantly promote malaria risk within the average 20.1 to 26.9 °C range. At the 12-mo mean temperature of 22.5 °C, conflict deaths have the largest impact on malaria risk, with an approximately 5.8% increase (95% CI: 1.0 to 11.0%). Additionally, a pronounced association between SSVCs and malaria risk exists in the regions with 9.2 wet days per month. The results reveal that SSVCs increase population exposure to harsh environments, amplifying the effect of warm temperature and persistent precipitation on malaria transmission. Violent conflict therefore poses a substantial barrier to mosquito control and malaria elimination efforts in sub-Saharan Africa. Our findings support effective targeting of treatment programs and vector control activities in conflict-affected regions with a high malaria risk.

Cognitive conflict does not always mean high effort: Task difficulty's moderating effect on cardiac response.

This article presents an experiment (N = 127 university students) testing whether the previously found impact of conflict primes on effort-related cardiac response is moderated by objective task difficulty. Recently, it has been shown that primed cognitive conflict increases cardiac pre-ejection period (PEP) reactivity-an index of effort intensity-during the performance of relatively easy tasks. This effect could be attributed to conflict-related negative affect. Consequently, as it has been shown for other types of negative affect, we expected conflict primes' effect to be task-context dependent and thus to be moderated by objective task difficulty. In a between-persons design, we manipulated conflict via embedded pictures of conflict-related vs. non-conflict-related Stroop items in a memory task. We expected primed conflict to increase effort in a relatively easy version of the task but to lead to disengagement when task difficulty was objectively high. PEP reactivity corroborated our predictions. Rather than always increasing effort, cognitive conflict's effect on resource mobilization was context-dependent and resulted in weak responses in a difficult task.

"Caught In Each Other's Traps": Factors Perpetuating Incentive-Linked Prescribing Deals Between Physicians and the Pharmaceutical Industry.

BACKGROUND: Despite known adverse impacts on patients and health systems, 'incentive-linked prescribing', which describes the prescribing of medicines that result in personal benefits for the prescriber, remains a widespread and hidden impediment to quality of healthcare. We investigated factors perpetuating incentive-linked prescribing among primary care physicians in for-profit practices (referred to as private doctors), using Pakistan as a case study. METHODS: Our mixed-methods study synthesised insights from a survey of 419 systematically samples private doctors and 68 semi-structured interviews with private doctors (n=28), pharmaceutical sales representatives (n=12), and provincial and national policy actors (n=28). For the survey, we built a verified database of all registered private doctors within Karachi, Pakistan's most populous city, administered an electronic questionnaire in-person and descriptively analysed the data. Semi-structured interviews incorporated a vignette-based exercise and data was analysed using an interpretive approach. RESULTS: Our survey showed that 90% of private doctors met pharmaceutical sales representatives weekly. Three interlinked factors perpetuating incentive-linked prescribing we identified were: gaps in understanding of conflicts of interest and loss of values among doctors; financial pressures on doctors operating in a (largely) privately financed health-system, exacerbated by competition with unqualified healthcare providers; and aggressive incentivisation by pharmaceutical companies, linked to low political will to regulate and an over-saturated pharmaceutical market. CONCLUSION: Regular interactions between pharmaceutical companies and private doctors are normalised in our study setting, and progress on regulating these is hindered by the substantial role of incentive-linked prescribing in the financial success of physicians and the pharmaceutical industry employees. A first step towards addressing the entrenchment of incentive-linked prescribing may be to reduce opposition to restrictions on incentivisation of physicians from stakeholders within the pharmaceutical industry, physicians themselves, and policymakers concerned about curtailing growth of the pharmaceutical industry.

Comedy, consensus, and conflict framework: Comedy as a norm violation can build consensus or escalate conflict in negotiations.

In this work, we propose that humor violates norms that can build consensus or escalate conflict in negotiations. Drawing on social identity theory, we propose that humor commits norm violations that are more likely to be perceived as benign among ingroup observers in negotiations, but perceived as offensive to outgroup observers in negotiations. We introduce the Comedy, Consensus, and Conflict Framework to shed light on the interpersonal effect of humor on negotiations. When humor is expressed to an ingroup observer, relative to neutral communication, humor is more likely to violate weak norms that govern social group membership resulting in the violation as being perceived as benign, which promotes cooperative behaviors in negotiations such as concessions and collaborative problem-solving. By contrast, when humor is expressed to an outgroup observer, relative to neutral communication, humor is more likely to violate strong norms that define social group membership resulting in the violation as being interpreted as offensive, which triggers competitive behaviors in negotiations such as aggressive offers and hardened positions. Furthermore, we suggest that humor not only generates appraisals of social identity threats, but also affective responses that influence negotiation behavior. Finally, we expand our theoretical model about humor to consider key relational factors that influence norm strength, which motivates whether negotiators appraise norm violations as offensive or benign.

Exploring Experiences of Conflict within Medical Teams in an Emergency Department: A Focus Group Approach during the COVID-19 Pandemic.

The factors related to conflicts in emergency departments (EDs) have been studied for decades. The post-pandemic digital era may transform the medical landscape in EDs, potentially changing the patterns of conflict between healthcare professionals. This study used focus group interviews to explore conflicts in EDs. Four groups, each with 4-6 participants, took part in this study. Semi-structured interviews were conducted using six research questions. Summative content analysis was used to analyze the data. The participant's average age was 37.82 years, and the average number of working years was 12.12. The following five themes emerged: multiple patterns of internal conflict; external conflicts arising from cross-departmental coordination; conflicts due to unclear job boundaries; adapting to conflicts in diverse ways; and seeking hospital arbitration. The results of this study suggest extending interdisciplinary collaborative practice from emergency departments to all coordinating departments. An inclusive environment for equality between professions and open communication should be promoted by hospitals.

Conflicts of Interest Among Cardiology Clinical Practice Guideline Authors in Japan.

BACKGROUND: Clinical practice guidelines (CPGs) offer disease management recommendations based on scientific evidence. However, financial conflicts of interest between CPG developers and the pharmaceutical industry could bias these recommendations, potentially affecting patient care. Proper management of these conflicts of interest is particularly crucial for maintaining the integrity of CPGs. The study aimed to evaluate the extent of financial relationships between the pharmaceutical industry and authors of CPGs for cardiovascular diseases in Japan. METHODS AND RESULTS: The study analyzed personal payments from the pharmaceutical industry to authors of cardiovascular disease CPGs published by the Japanese Circulation Society from January 2015 to December 2022. Payment data, including speaking, consultancy, and writing fees from 2016 to 2020, were extracted from a publicly available database containing personal payments disclosed by all major pharmaceutical companies. A total of 929 unique authors from 37 eligible Japanese Circulation Society CPGs were identified. Notably, 94.4% of these authors received personal payments from pharmaceutical companies, totaling >US $70.8 million. The mean±SD payment per author was US $76 314±138 663) and the median payment per author was US $20 792 (interquartile range: US $4262-US $76 998) over the 5-year period. Chairs of CPGs received significantly higher payments than other authors. More than 80% of authors in each CPG received personal payments. CONCLUSIONS: The study elucidated that there were considerable financial relationships between pharmaceutical companies and cardiology CPG authors in Japan. This finding deviates from international conflict of interest management policies, suggesting the need for more stringent conflict of interest management strategies by the Japanese Circulation Society to ensure the development of trustworthy and evidence-based CPGs.

Impacts of attacks to female health care workers in three territories of Colombia.

BACKGROUND: This study explores the impacts of attacks perpetrated in the context of armed conflict, to female health workers in three Colombian territories. METHODS: We conducted a document review of the reports and databases of the Colombian Truth Commission, 17 in-depth semi-structured interviews with experts on the national and regional armed conflict and the medical mission, and 26 female health workers who were victims of attacks. RESULTS: Experts and female health workers reported attacks to health activities, facilities, equipment, and personnel, including attacks to traditional doctors belonging to indigenous communities. The most frequent attacks were threats and retention of health personnel; theft of supplies and medicines; damage and use of infrastructure and means of transport for purposes other than health care; and hinderance of health service provision. The attacks occurred in a framework of structural violence that intersects with poverty, racism, and gender bias. The impacts of these attacks include gender-based violence, significant disruption of the lives of health workers, and physical, emotional, psychological, social, and economic effects on the victims and their families. The government response to protect victims and populations has been absent or insufficient. CONCLUSIONS: Attacks to health care were reported in all the studied territories obstructing adequate health care. Impacts of these attacks affect negatively the professional and personal life of the workers and are aggravated by structural violence and absent or little institutional response.

Do working parents in the United States expect work location to impact job and family satisfaction in the post-pandemic period? Evidence from a survey experiment.

The pandemic response allowed many parents in the United States and globally to work remotely for the first time ever which, for many, continued into the recovery. It is unclear whether, after a period when a large segment of the United States labor force worked remotely, remote work is viewed favorably or unfavorably among employed parents. We present results from a survey experiment assessing whether employed parents in the United States perceive that remote work will impact a hypothetical employed parents' job and family satisfaction and, critically, whether perceptions of work-family conflict and anticipated job rewards mediate this relationship. We find that respondents who are also employed parents perceive that hypothetical employed parents who access remote work will report lower job satisfaction and higher family satisfaction. Perceptions of work-family conflict do not mediate this association. Rather, we find that job rewards (e.g., pay, promotion, etc.) fully mediate the relationship between remote work and perceived job satisfaction. Ultimately, this indicates that employed parents perceive that remote work will bring workers like them less pay and thus lower job satisfaction but greater family satisfaction. This extends arguments about remote work in the light of the conceptualization of a flexibility stigma and a flexibility paradox. Implications for practice and theory are discussed.

The paradoxical effects of high involvement work practices on employees and service outcomes: a trichromatic perspective.

This research delves into the complex impact of High Involvement Work Practices (HIWPs) on various facets of employee well-being and service outcomes within the framework of the trichromatic service conception. Utilizing the Job Demands-Resources (JD-R) model, the study uncovers the dual, both beneficial and detrimental, effects of HIWPs on service performance, work-family conflict, subjective well-being, and work-family enrichment. Examining the conflicting paths of job demands (workload) and job resources (customer orientation), the analysis incorporates the moderating influence of a strategic contextual factor-supervisor support. Data was collected through self-administered questionnaires from 475 respondents in Pakistani banks, and the analysis employed moderated mediation analysis using SPSS, AMOS, and the PROCESS Macro. All proposed hypotheses received support. The results indicate that HIWPs enhance service performance by promoting customer orientation but concurrently escalate workload, leading to adverse consequences for subjective well-being and work-family conflict. The study underscores the importance of implementing HIWPs under supportive leadership to maximize positive outcomes and mitigate negative consequences. Ultimately, this approach enables employees to effectively serve customers, maintain a healthy work-family balance, and contribute to the long-term growth and sustainability of organizations.

The changing dynamics of work from home and its association with sleep disturbance through work-family conflict during the COVID-19 pandemic.

OBJECTIVES: Work from home (WFH) can increase sleep disturbances. However, only few studies have examined the connection between WFH and sleep disturbance while considering work-family conflict (WFC) and the changes brought about by the coronavirus disease 2019 (COVID-19). This study aimed to examine the association between WFH and sleep disturbance, considering WFC, and assessed how this association changed during the COVID-19 pandemic. METHODS: We used data from the fifth and sixth Korean Working Conditions Survey. WFH workers and a control group were selected using propensity score matching. Conditional logistic regression analysis was used to estimate the odds ratios (ORs) with 95% confidence intervals (CIs) for sleep disturbance in the WFH and control groups. RESULTS: The workers working from home showed significantly higher ORs (95% CIs) for sleep disturbance before (4.26, 3.59-5.05) and during (1.52, 1.26-1.83) COVID-19 pandemic. When stratified by WFC, the association was significant only in the workers with WFC before COVID-19. However, the association was not significant during COVID-19 among the workers with WFC. CONCLUSIONS: WFH was significantly associated with sleep disturbance among workers before COVID-19, but this association was not observed during the COVID-19 pandemic. Considering the significant role that WFC plays in this association, companies should provide a family-friendly WFH environment when adopting WFH practices.