Beliefs and practices of physicians in Lebanon regarding promotional gifts and interactions with pharmaceutical companies.

Background: Pharmaceutical companies invest greatly in promotional gifts to influence prescription of medications by physicians, yet there is limited published information evaluating its impact on healthcare. Aim: This study aimed to assess the beliefs and practices of physicians in Lebanon regarding promotional gifts and their interactions with representatives of pharmaceutical companies. Methods: This cross-sectional study was conducted between December 2019 and January 2020 through an email-based questionnaire sent to 5936 physicians of different specialties registered in the Lebanese Order of Physicians. Assessment was done using a validated tool and data analysis was conducted using SPSS version 26.0. Results: Of the 268 respondents, 188 (70.4%) reported that physicians in Lebanon accepted gifts from representatives of pharmaceutical companies. Most of the physicians (31.7%) interacted with company representatives more than once a week. Medication samples (251 respondents) and stationary items (222 respondents) were the most common gifts accepted by physicians who admitted accepting gifts. Overall, 225 (84.9%) respondents believed that prescriptions by physicians in Lebanon were influenced by the gifts. Only 74 (40.0%) of those who accepted gifts from pharmaceutical companies believed that it was unethical, and around half did not know if the Lebanese Code of Medical Ethics allowed them to accept gifts from pharmaceutical companies. Conclusion: Although physicians in Lebanon were aware of the effect that gifts from pharmaceutical companies could have on their prescription behaviours, many of them still accepted the gifts. This study provides evidence to policymakers for decision-making regarding ethical guidance on interactions between physicians and pharmaceutical companies in Lebanon.

Clinical Nurse Specialist Role Advocacy: Quantifying the Financial Contributions Via Development of a Scorecard.

PURPOSE/OBJECTIVES: The purpose of this article is to guide the clinical nurse specialist in constructing a scorecard to track clinical outcomes and identify the associated financial impact. DESCRIPTION OF THE PROJECT/PROGRAM: Creation of a scorecard highlighting the financial impact of the clinical nurse specialist team was used to disseminate financial outcomes to hospital executive stakeholders, allowing the clinical nurse specialist team to demonstrate its clinical and financial value. OUTCOME: During development and ongoing maintenance of the scorecard, the clinical nurse specialist team cultivated skills to identify the financial impact of projects. The team also utilized financial implications of individual and group projects to prioritize work. At the end of fiscal year 2022, the clinical nurse specialist team demonstrated revenue generation of $29 890 and cost avoidance of $2 854 807.30. The clinical nurse specialist scorecard was presented quarterly to the chief nursing officer, who shared with executive leadership. CONCLUSION: Clinical nurse specialists are positioned to make significant and positive financial impact to organizations. A scorecard presented to executive leadership offers a clinical nurse specialist team a tool to capture and disseminate a clinical nurse specialist team's unique financial contribution at the system level.

The role of gifts in building influence with politicians: Thematic analysis of interviews with current and former parliamentarians.

Gifts are a powerful way to acknowledge and strengthen interpersonal relationships. As with any relational space, gifting plays various roles in forming and maintaining relationships in political contexts, but its contribution to relationship-building has attracted little attention. This paper examines how politicians in Aotearoa New Zealand both engage with gifting and how they navigate the perceptions of others. Four current members of parliament (MPs) and six retired MPs participated in semi-structured interviews with questions on common practices and common understandings about political gifting. Their responses indicate their use of four different processes: formal processes are the guidelines provided by the government on gifting, but when these are insufficient, contextual processes regarding perceptions of the media, constituents or colleagues are used, or, alternatively, MPs rely on personal values or view gifting in terms of transactional processes with both parties receiving benefits. The paper explores perceptions and complexities of a sequence of gifts during events (event gifting). The authors recommend an improved awareness and understanding of the contribution of gifting practices to political relationship building.

Eastern Mediterranean Health Journal [2024; Vol.30, Issue 2]

Eastern Mediterranean Health Journal is the official health journal published by the Eastern Mediterranean Regional Office of the World Health Organization. It is a forum for the presentation and promotion of new policies and initiatives in health services; and for the exchange of ideas concepts epidemiological data research findings and other information with special reference to the Eastern Mediterranean Region. It addresses all members of the health profession medical and other health educational institutes interested NGOs WHO Collaborating Centres and individuals within and outside the Region.

المجلة الصحية لشرق المتوسط هى المجلة الرسمية التى تصدرعن المكتب الاقليمى لشرق المتوسط بمنظمة الصحة العالمية. وهى منبر لتقديم السياسات والمبادرات الجديدة فى الصحة العامة والخدمات الصحية والترويج لها، و لتبادل الاراء و المفاهيم والمعطيات الوبائية ونتائج الابحاث وغير ذلك من المعلومات، و خاصة ما يتعلق منها باقليم شرق المتوسط. وهى موجهة الى كل اعضاء المهن الصحية، والكليات الطبية وسائر المعاهد التعليمية، و كذا المنظمات غير الحكومية المعنية، والمراكز المتعاونة مع منظمة الصحة العالمية والافراد المهتمين بالصحة فى الاقليم و خارجه

La Revue de Santé de la Méditerranée Orientale est une revue de santé officielle publiée par le Bureau régional de l’Organisation mondiale de la Santé pour la Méditerranée orientale. Elle offre une tribune pour la présentation et la promotion de nouvelles politiques et initiatives dans le domaine de la santé publique et des services de santé ainsi qu’à l’échange d’idées de concepts de données épidémiologiques de résultats de recherches et d’autres informations se rapportant plus particulièrement à la Région de la Méditerranée orientale. Elle s’adresse à tous les professionnels de la santé aux membres des instituts médicaux et autres instituts de formation médico-sanitaire aux ONG Centres collaborateurs de l’OMS et personnes concernés au sein et hors de la Région.

Gift-giving intentions in pan-entertainment live streaming: Based on social exchange theory.

Pan-entertainment live streaming combines video with two-way communication and real-time viewer participation, allowing viewers to send virtual gifts to their favorite streamers. Drawing on social exchange theory, this study investigates the factors that influence viewers' gift-giving intentions in live streaming from the perspectives of both viewers and streamers. It also explores the moderating role of streamers' deceptive self-presentation. The theoretical framework is tested using AMOS and PROCESS Macro based on survey responses collected from 331 TikTok users in China. The results suggest that streamers' attractiveness, expertise, parasocial interaction, and the viewers' deceptive self-presentation significantly affect viewers' gift-giving intention, and that streamers' deceptive self-representation moderates the relationship between attractiveness, expertise, parasocial inter-action and the viewer's consumer intention. These findings contribute to social exchange theory by highlighting the importance of streamers' deceptive self-presentation in moderating the effects of attractiveness, expertise, parasocial interaction, and the viewer's deceptive self-presentation on the viewer's gift-giving intention.

"Tremendous burdens often unveil enormous gifts": The experiences of South African caregivers implementing speech and language teletherapy for children with cerebral palsy during COVID-19.

PURPOSE: In accordance with South Africa's restrictions to mitigate the spread of COVID-19, some speech-language pathologists (SLPs) attempted to engage in novice teletherapy regimes to ensure continuity of care for children with cerebral palsy (CP). This study aimed to explore the experiences of caregivers of children with CP implementing SLP teletherapy during COVID-19 in South Africa. The goal was to shed light on how these families can be better supported and how teletherapy practices can be adjusted for this population. METHODS: This study employed a qualitative phenomenological research design using in-person and virtual semi-structured interviews with 18 purposively sampled participants with children with CP who received speech and language teletherapy during COVID-19. The data was evaluated using an inductive thematic analysis approach whereby themes elicited from the caregivers' narratives were analyzed. RESULTS: Interviews (n = 18) unveiled the significant understanding caregivers gained by becoming integral and active stakeholders in the provision of teletherapy. Caregivers were able to meaningfully communicate and bond with their children with CP. However, caregivers also assumed the burden that teletherapy placed on them, as they had to renegotiate their role during the pandemic in order to provide routine teletherapy. CONCLUSION: Findings indicated the need for person-centered SLP teletherapy interventions that utilize contextually and culturally responsive techniques and resources.

An Analysis of Political Contributions from Otolaryngologists in the United States.

OBJECTIVE: Doctors can influence the development of sound healthcare policy through financial contributions to political campaigns and candidates. Our objective was to characterize the political contributions of otolaryngologists in the United States, both individually and through the ENT Political Action Committee (ENTPAC) between the years 2003 and 2020. STUDY DESIGN: Retrospective observational study. SETTING: Publicly available information on the internet: fec.gov. METHODS: The Federal Election Commission's website, fec.gov, was used to identify the political contributions of individual otolaryngologists and the ENTPAC between 2003 and 2020. Each contribution is associated with a political group or candidate, designated as a Republican, Democratic, or Independent entity. RESULTS: A total of 1407 distinct political contributions were made by individuals identifying as otolaryngologists between 2003 and 2020, totaling $432,201. Overall, Republicans received more individual donations than Democrats (711 vs 540), while Democrats received more money ($231,139 vs $183,427). Donations peaked during election years, with the total amount overall increasing each election year ($9664 in 2004 vs $75,102 in 2020). The predominant political party receiving donations between 2003 and 2020 in each US state matched each state's predominant party of the governors and senators 48.6% of the time. The ENTPAC donated $3,027,383 between 2003 and 2020 to a variety of political candidates and entities. CONCLUSION: Otolaryngologists are making increased political contributions over time and interest in political advocacy may be at an all-time high. Increased time and attention should be devoted to educating otolaryngologists to best politically advocate for interests which are of the most importance to themselves and the profession.

Hotels re-explored: Experience and influence of reciprocity and social normative appeals.

In this paper we report two high-powered and pre-registered experiments, testing the robustness and conceptual development of reciprocity and social norm appeals. Both experiments assessed both psychological processes for complying with these appeals and pro-environmental behavioral intention in tourism settings. In Experiment 1 (N = 2004), participants reported lower psychological reactance levels after learning that the hotel engaged in resource conservation (i.e., indirect homeomorphic reciprocity). No statistically significant effect was obtained for either obligatory motivation, prosocial motivation, skepticism, or behavioral intentions to reuse hotel towels. Importantly, high baseline intention of reusing hotel towels might have limited the effect of appeals. Therefore, we targeted meat consumption in Experiment 2 (n = 2540). Results first showed stronger obligatory and prosocial motivation for all three reciprocity appeals, compared to the standard appeal. No statistically significant results were found for either reactance or skepticism. Finally, after learning that the hotel had made a financial contribution to an environmental organization (i.e., indirect heteromorphic reciprocity) participants showed reduced meat consumption intentions compared to the standard appeal. Overall, the results provide initial evidence for conceptually refining the norm of reciprocity to encourage pro-environmental behaviors and for understanding the underlying psychological processes.

Public perceptions of physician-pharmaceutical industry relationships and trust in physicians.

BACKGROUND: In Japan, as elsewhere, physicians meet with and receive gifts from pharmaceutical representatives (PRs). This study aimed to clarify the Japanese public perceptions of physicians' relationships with PRs, examine the association between these perceptions and their trust in physicians, and compare the public's and physicians' awareness, acceptance, and perceptions of the influence of physician-PR relationships. METHODS: A cross-sectional, self-administered, anonymous, internet-panel survey was conducted involving 1,000 participants from the general public. The survey implementation was contracted to Cross Marketing Inc. RESULTS: The mean age of the 1000 participants was 44.8 years (standard deviation 18.3). Forty-eight percent were female. Many of our participants were unaware of certain physician-PR relationships. The public was more acceptable with physicians' receiving stationery and/or medical textbooks and attending promotional drug seminars at their workplaces compared with receiving meals at restaurants. Many thought that physicians' involvement in promotional activities influenced their prescribing habits and estimated that the majority of physicians received office stationery and meals from PRs. They were divided as to whether they would like to know about their physicians' relationships with the industry. Factors associated with higher trust in physicians included participants being 65 years or older, having a primary care physician, being in better health, the belief that physicians' involvement in promotional activities is acceptable, and their high estimate that physicians are not receiving gifts from PRs. Compared to the physicians, the public had lower awareness of and was more accepting of physicians' involvement in promotional activities. Meanwhile, the public believed that physician-PR relationships influenced physicians' prescribing habits more than the physicians themselves. CONCLUSION: Our survey provided insights into Japanese public perceptions of physician-pharmaceutical industry relationships and their impact on trust in physicians. Physicians should be aware of these perceptions and carefully consider how to foster appropriate relationships with the industry.

Grace, Inspiration, Fulfillment, Timeless, Soulful (GIFTS): The Why and How of Podcasts for Recognition and Mentoring of Faculty in Medicine.

This commentary offers the reader an alternative to mentoring through the use of PODCASTS. By providing the listener with an understanding of the challenges and opportunities for self-reflection and sharing of experiences by the interviewees, we are impacting the listener attitudes and future goals through lessons learned.

Braiding the Healing Gifts of Photovoice for Social Change: The Means Are Ends in the Making.

Photovoice is an important participatory action method for motivating social change. The potential for this change within the processes of the method remains under-explored. We present the voice and perspectives of three health promotion practitioners who have important connections to photovoice: a grandmother and co-founder of the method, a nurse from Wales, and an early adopter seeking change. Through braided storytelling, the voices describe their history with photovoice and how their relationship to the method has changed over time, arguing ultimately that in photovoice the means are as important as the ends for advancing relations with others, understanding and working with power, and realizing the gifts the processes bring.

The viral picture of well-being: Biggest concerns, losses, and unintended gifts of COVID-19 in the Philippines.

The COVID-19 pandemic revealed more than anticipated about global human functioning and resiliency. This Philippines-based study replicated a recent U.S. COVID analysis on psychological well-being (PWB). Factors examined herein were grouped into categories for analysis: 1) predictors of PWB, 2) areas of greatest stress or worry (biggest concerns), 3) perceived or real losses across SES, and 4) identified "unintended gifts" across PWB. Participants (n = 1345) were volunteers who responded to an online survey from August to September 2021, peak of the Delta variant. Three general groups of predictors (biological, psychological, and socio-economic) contributed to PWB. A regression model containing a total of 11 variables was significant, F(11, 1092) = 116.02, p < .00, explaining 53.9% of the variance. The model indicated PWB was significantly predicted by physical health, age, spirituality, emotional loneliness, social loneliness, sense of agency, and income. The strongest predictors of PWB were a sense of agency, social loneliness, and spirituality. Qualitative data analysis was conducted examining biggest concerns, losses due to COVID, and unintended gifts. Top ranking participant concerns were the health of family and friends, personal wellness, and governmental inefficiency/lack of concern. Losses compared to pre-COVID life were analyzed by SES group, with the most frequent responses being missing face-to-face interactions and the freedom to go/do what they please. Low SES groups were most likely to endorse missing everyday routine and experiencing changes in housing conditions due to the pandemic. Unintended gifts of COVID explored by PWB, high PWB individuals significantly appreciated intentional time with family and friends, deepening their spiritual lives, the ability to work from home, less pollution, and more time for physical exercise. Low PWB individuals reported nothing gained, except more time playing video games and watching TV. Those with higher PWB identified more unintended gifts of COVID and coped more actively.

Changes in Japanese physicians' relationships with the pharmaceutical industry between 2008 and 2021: A national survey.

BACKGROUND: A national survey we conducted in 2008 showed that many Japanese physicians interacted with and received gifts from pharmaceutical representatives (PRs) and had a positive attitude toward relationships with PRs. The revised promotion code of the Japan Pharmaceutical Manufacturers Association in 2019 prohibited the provision of non-educational promotional aids including sticky notes, mouse pads, and calendars. During the COVID-19 pandemic in 2020, face-to-face meetings were socially restricted. This study assessed the extent of current Japanese physicians' involvement in pharmaceutical promotional activities and their attitudes toward relationships with PRs and to ascertain any changes between 2008 and 2021. We also examined the factors that predicted positive attitudes toward gifts from PRs. METHODS: From January to March 2021, we conducted a national mail survey of Japanese physicians in seven specialties: internal medicine, surgery, orthopedics, pediatrics, obstetrics-gynecology, psychiatry, and ophthalmology. RESULTS: There were 1636 participants and the response rate was 63.2%. Most physicians met face-to-face with PRs (78.8%), whereas only a minority received meals outside the workplace (4.5%). PRs were thought to have an important role in continuing medical education (66.1%) and to provide accurate information about new drugs (74.2%). Opinions were divided on the appropriateness of gifts from PRs. Most thought that stationery and meals provided by the industry did not affect prescribing behavior (89.7% and 75.8%, respectively). Factors that predicted a positive attitude toward gifts from PRs were male, orthopedic specialty vs. internal medicine, more interactions with PRs, a positive attitude toward informational value, and no rules banning meetings with PRs. CONCLUSION: Involvement in pharmaceutical promotional activities is still common among practicing physicians in Japan, although the extent of the involvement had declined. Rules banning meetings with PRs appear to continue being effective at limiting a physician's involvement with promotional activities and their critical attitudes toward gifts from PRs.

Financial contribution as reason to opt out of non-invasive prenatal testing.

OBJECTIVE: First trimester non-invasive prenatal testing (NIPT) provides pregnant women with a reliable, non-invasive method to screen for fetal aneuploidies. In the Netherlands, there is a nationwide prenatal screening program in which pregnant women and their partners are counseled about their options around 10 weeks of pregnancy. The first trimester and second trimester scan are fully reimbursed but the NIPT has an own financial contribution of €175 per participant, irrespective of type of insurance. The arguments for this own contribution are fear of uncritical use of NIPT or routinization. NIPT has a relatively stable uptake of 51%, against over 95% for second trimester anomaly scan. We aimed to explore the effect of this financial contribution on the decision to opt out of NIPT. STUDY DESIGN: We performed a survey among 350 pregnant women undergoing a second trimester anomaly scan in our center, Amsterdam UMC, between January 2021 and April 2022. All pregnant women who declined NIPT in the first trimester, were asked to participate and answered 11-13 questions about the decision-making process, the reasons to opt out and the financial contribution. RESULTS: Information about NIPT was desired in 92% of women and 96% felt sufficiently informed. Most women took the decision not to perform NIPT with their partner and did not experience difficulties in taking this decision. The most important reason to decline NIPT was: "Every child is welcome" (69%). "The test was too expensive" was answered in 12% and was significantly correlated with lower maternal age. Additionally, one in five women (19%) said they would have done NIPT if it had been for free, which was significantly higher in younger women. CONCLUSIONS: The own financial contribution plays a role in the decision-making to decline NIPT and partly explains the low uptake in the Netherlands. This suggests that there is no equal access to fetal aneuploidy screening. To overcome this inequality, this own contribution should be abandoned. We speculate that this will have a positive effect on the uptake, which will increase to at least 70% and potentially 94%.