This paper focuses on the ethical tensions seen in health systems research by researchers owing to their scientific obligations to their research, ethical obligations to study participants, and social obligations to the community. Health systems research differs from other public health research fields in terms of the participants selected, power relations within health systems and the socio-political environment. The study seeks to answer the following questions through experiences in health system research. 1. What are the ethical tensions experienced by researchers in field work? 2. How are the existing guidelines used in resolving tensions arising in field work in India? To understand these ethical tensions, the World Health Organization\'s Ethical Considerations for Health Policy and Systems Research were applied to research conducted in the health system settings. These tensions faced by researchers are explained through four emerging themes: the researcher\'s position in the health system; voluntariness of participation: participation; and social justice.

Health care distance simulation (HCDS) replicates professional encounters through an immersive experience overseen by experts and in which technological infrastructure enriches the learning activity. As HCDS has gained traction, so has the movement to provide inclusive and accessible simulation experiences for all participants. However, established guidelines for best practices in HCDS regarding justice, equity, diversity, and inclusion (JEDI) are lacking. This study aimed to generate consensus statements on JEDI principles in synchronous HCDS education using the nominal group technique (NGT).
Professionals with experience in HCDS education were invited to generate, record, discuss, and vote on ideas that they considered best practices for JEDI. This process was followed by a thematic analysis of the NGT discussion to provide a deeper understanding of the final consensus statements. An independent group of HCDS educators individually reviewed and recorded their agreement or disagreement with the consensus statements created by the NGT process.
Eleven independent experts agreed on 6 key practices for JEDI in HCDS. Educators need to (1) be aware of JEDI principles, (2) be able to define and differentiate JEDI, (3) model JEDI in their environment, (4) have expertise and comfort facilitating conversations and debriefing around JEDI issues, (5) be advocates within their organizations to ensure equitable educational experiences, and (6) achieve JEDI without compromising educational objectives. Experts were divided on the approach to technology to ensure equitable learning experiences: some believed that the most basic technology accessible to all learners should be used, and some believed that the technology used should be determined by the competency of the students or faculty.
Structural and institutional barriers in HCDS education persist despite agreement on key JEDI practices. Conclusive research is needed to guide the optimal policy in HCDS toward creating equitable learning experiences while bridging the digital divide.

Addressing persistent and pervasive health inequities is a global moral imperative, which has been highlighted and magnified by the societal and health impacts of the COVID-19 pandemic. Observational studies can aid our understanding of the impact of health and structural oppression based on the intersection of gender, race, ethnicity, age and other factors, as they frequently collect this data. However, the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline, does not provide guidance related to reporting of health equity. The goal of this project is to develop a STROBE-Equity reporting guideline extension.
We assembled a diverse team across multiple domains, including gender, age, ethnicity, Indigenous background, disciplines, geographies, lived experience of health inequity and decision-making organizations. Using an inclusive, integrated knowledge translation approach, we will implement a five-phase plan which will include: (1) assessing the reporting of health equity in published observational studies, (2) seeking wide international feedback on items to improve reporting of health equity, (3) establishing consensus amongst knowledge users and researchers, (4) evaluating in partnership with Indigenous contributors the relevance to Indigenous peoples who have globally experienced the oppressive legacy of colonization, and (5) widely disseminating and seeking endorsement from relevant knowledge users. We will seek input from external collaborators using social media, mailing lists and other communication channels.
Achieving global imperatives such as the Sustainable Development Goals (e.g., SDG 10 Reduced inequalities, SDG 3 Good health and wellbeing) requires advancing health equity in research. The implementation of the STROBE-Equity guidelines will enable a better awareness and understanding of health inequities through better reporting. We will broadly disseminate the reporting guideline with tools to enable adoption and use by journal editors, authors, and funding agencies, using diverse strategies tailored to specific audiences.

The COVID-19 pandemic has been overwhelming public health-care systems around the world. With demand exceeding the availability of medical resources in several regions, hospitals have been forced to invoke triage. To ensure that this difficult task proceeds in a fair and organised manner, governments scrambled experts to draft triage guidelines under enormous time pressure. Although there are similarities between the documents, they vary considerably in how much weight their respective authors place on the different criteria that they propose. Since most of the recommendations do not come with ethical justifications, analysing them requires that one traces back these criteria to their underlying theories of distributive justice. In the literature, COVID-19 triage has been portrayed as a value conflict solely between utilitarian and egalitarian elements. While these two accounts are indeed the main antipodes, I shall show that in fact all four classic theories of distributive justice are involved: utilitarianism, egalitarianism, libertarianism, and communitarianism. Detecting these in the documents and classifying the suggested criteria accordingly enables one to understand the balancing between the different approaches to distributive justice-which is crucial for both managing the current pandemic and in preparation for the next global health crisis.

The Consensus Statement on Future Directions for the Behavioral and Social Sciences in Oral Health (Consensus Statement) is a transformational contribution to oral health research synthesizing a wide array of conceptual, methodological, and disciplinary concerns and offering strategies to improve scientific inquiry. The Consensus Statement explicates global oral health equity as a foundational concern of our field. Given this context, a key concern is missing from the statement: oppression!

The recent development of NBIC technologies has led to the emergence of new techniques that allow the modification of genetic, morphological, and physiological aspects of the human being to improve their capacities. In light of this situation, the eternal debate continues: is everything technically possible ethically acceptable? To answer this question, an ethical reflection is needed to assess the scope of enhancement techniques and to direct them to the service of human progress and the common good. Many authors have already begun this reflection, opting for a case-by-case evaluation. However, there is a great lack of specificity in the definition of the criteria that would allow an ethical analysis of each technique, in order to determine the licitness of its application. In response to this need, a practical guide for the ethical assessment of not only human enhancement techniques, but of any intervention on the human body is proposed. This guide is based on the four principles of personalist bioethics proposed by Sgreccia: the principle of defense of physical human life, the principle of totality or the therapeutic principle, the principle of freedom and responsibility, and the principle of sociability and subsidiarity. These principles are the common thread of some questionnaires that serve as support in discerning the licitness of a technique, by virtue of the overall good of the person in their three-dimensional structure: body, mind and spirit, and the respect for their inalienable dignity.

The COVID-19 pandemic has highlighted the global imperative to address health inequities. Observational studies are a valuable source of evidence for real-world effects and impacts of implementing COVID-19 policies on the redistribution of inequities. We assembled a diverse global multi-disciplinary team to develop interim guidance for improving transparency in reporting health equity in COVID-19 observational studies. We identified 14 areas in the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist that need additional detail to encourage transparent reporting of health equity. We searched for examples of COVID-19 observational studies that analysed and reported health equity analysis across one or more social determinants of health. We engaged with Indigenous stakeholders and others groups experiencing health inequities to co-produce this guidance and to bring an intersectional lens. Taking health equity and social determinants of health into account contributes to the clinical and epidemiological understanding of the disease, identifying specific needs and supporting decision-making processes. Stakeholders are encouraged to consider using this guidance on observational research to help provide evidence to close the inequitable gaps in health outcomes.

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To end the international crisis of preventable deaths in low-income and middle-income countries, evidence-informed and cost-efficient health care is urgently needed, and contextualised clinical practice guidelines are pivotal. However, as exposed by indirect consequences of poorly adapted COVID-19 guidelines, fundamental gaps continue to be reported between international recommendations and realistic best practice. To address this long-standing injustice of leaving health providers without useful guidance, we draw on examples from maternal health and the COVID-19 pandemic. We propose a framework for how global guideline developers can more effectively stratify recommendations for low-resource settings and account for predictable contextual barriers of implementation (eg, human resources) as well as gains and losses (eg, cost-efficiency). Such development of more realistic clinical practice guidelines at the global level will pave the way for simpler and achievable adaptation at local levels. We also urge the development and adaptation of high-quality clinical practice guidelines at national and subnational levels in low-income and middle-income countries through co-creation with end-users, and we encourage global sharing of these experiences.