Pratiquer la responsabilité sociale en santé : de la théorie à la pratique. Une étude Delphi internationale.

INTRODUCTION: Health professionals’ social responsibility in health resists translation into skills that can be taught and implemented concretely in professional practice. PURPOSE OF THE RESEARCH: This study, conducted by the Réseau International Francophone pour la Responsabilité Sociale en Santé (RIFRESS), aims to develop a consensus on the components of doctors’ social responsibility in health from the perspective of experts in medical education. Its findings are intended to inform the creation of a skills profile. A three-round Delphi consensus method was used, with an open first round and closed second and third rounds. Mesydel software was used to organize the process and to do the qualitative analysis of the first round. SPSS was used for consensus analysis for rounds 2 and 3. RESULTS: Thirty-four experts responded to the study. During the first round, 62 codes emerged, grouped into 13 themes. From the initial analysis, 40 items were submitted for the Delphi round 2. Of these 40 items, 23 came out consensual after the second round, as did 13 of the 18 resubmitted items after the third. Examples of items that emerged as consensual are eco-responsibility, advocacy, defense of the common good, critical analysis of practice, and collaborative leadership. CONCLUSIONS: The present study represents a much-needed effort to concretely define the components of doctors’ social responsibility in health. Local context must be taken into account when using these findings. They can help to train tomorrow’s doctors to better meet the priority health needs of society in a profoundly changing world.

Individual and population dietary specialization decline in fin whales during a period of ecosystem shift.

This study sought to estimate the effect of an anthropogenic and climate-driven change in prey availability on the degree of individual and population specialization of a large marine predator, the fin whale (Balaenoptera physalus). We examined skin biopsies from 99 fin whales sampled in the St. Lawrence Estuary (Canada) over a nine year period (1998-2006) during which environmental change was documented. We analyzed stable isotope ratios in skin and fatty acid signatures in blubber samples of whales, as well as in seven potential prey species, and diet was quantitatively assessed using Bayesian isotopic models. An abrupt change in fin whale dietary niche coincided with a decrease in biomass of their predominant prey, Arctic krill (Thysanoessa spp.). This dietary niche widening toward generalist diets occurred in nearly 60% of sampled individuals. The fin whale population, typically composed of specialists of either krill or lipid-rich pelagic fishes, shifted toward one composed either of krill specialists or true generalists feeding on various zooplankton and fish prey. This change likely reduced intraspecific competition. In the context of the current "Atlantification" of northern water masses, our findings emphasize the importance of considering individual-specific foraging tactics and not only population or group average responses when assessing population resilience or when implementing conservation measures.

Framework for ethical international academic partnerships in family medicine: The Besrour Papers: a series on the state of family medicine in Canada and Brazil.

OBJECTIVE: To develop an ethical framework for collaboration in international academic partnerships in family medicine. COMPOSITION OF THE COMMITTEE: A subgroup of the Besrour Centre of the College of Family Physicians of Canada including family medicine and bioethics experts began to collaborate in 2014 to undertake the development of an ethical framework and tools for the establishment of ethically sound international academic partnerships. METHODS: Following 2 consultative workshops and a wider consultation process with the Besrour Centre global community, the authors developed an ethical framework and tools for approval by the Besrour Centre leadership in November 2017. REPORT: Partnerships are essential to family practice and to the field of international development. The flawed nature of many North-South research partnerships underlines the importance of and need for delineating core principles for ethically sound partnerships, of which 10 have been identified in this process: accountability, cost and efficiencies, excellence, equity, humility, justice, leadership, reciprocity, respect for self-determination, and transparency. Based on these principles, a decision-making framework was created to translate these values into actions and to promote a cohesive and transparent structure for discussions. Fostering fairness, transparency, and consistency in decision making reduces the potential for inequity in a partnership, leading to lasting relationships that endure beyond the scope of a partnership agreement.