Comparison of Effectiveness regarding a Culinary Medicine Elective for Medical Students in Germany Delivered Virtually versus In-Person.

(1) Background: The Culinary Medicine elective at the German medical schools of the universities of Göttingen, Giessen, and Brandenburg is a teaching kitchen-based elective aimed at training medical students on how to improve patient counselling on nutrition and lifestyle medicine topics. This curriculum was either delivered virtually (2021) or in-person (2022/2023). Changes in teaching effectiveness were evaluated. (2) Methods: The elective included seven modules in the teaching kitchen for 3 h each. It consisted of a short introduction and a hands-on interactive cooking part illustrating important dietary principles in different disease groups. The elective was conducted virtually in 2021 in a fully interactive setup using videoconference tools. Students in this cohort attended from their private kitchens whereas students in the in-person cohort (2022/2023) attended the same classes in the teaching kitchen. Standardized comparative self-assessment questionnaires on counselling competencies, nutrition knowledge, eating habits, and mental well-being (WHO-5) before and after the elective were used to determine teaching effectiveness. Paired and unpaired t-tests were performed to evaluate results. (3) Results: A total of 70 students (mean semester 6.3) were included in the virtual cohort, and 80 students (mean semester 6.3) were in the in-person cohort. In both, counselling competencies on 25 nutrition and lifestyle medicine topics increased significantly. Significant changes also occurred in most nutrition knowledge categories. Subjective well-being as well as personal attitudes towards nutrition counselling in medical practice improved significantly during the elective. Healthy eating habits improved in both groups as students ate significantly less unfavourable foods. There were no significant differences between the two groups apart from minor differences in nutrition knowledge. (4) Conclusions: The elective in Culinary Medicine improved students counselling competencies, nutrition knowledge, attitudes, well-being, and eating habits with no relevant difference between virtual and in-person teaching.

Translating Cultural Safety to the UK.

Disproportional morbidity and mortality experienced by ethnic minorities in the UK have been highlighted by the COVID-19 pandemic. The 'Black Lives Matter' movement has exposed structural racism's contribution to these health inequities. 'Cultural Safety', an antiracist, decolonising and educational innovation originating in New Zealand, has been adopted in Australia. Cultural Safety aims to dismantle barriers faced by colonised Indigenous peoples in mainstream healthcare by addressing systemic racism.This paper explores what it means to be 'culturally safe'. The ways in which New Zealand and Australia are incorporating Cultural Safety into educating healthcare professionals and in day-to-day practice in medicine are highlighted. We consider the 'nuts and bolts' of translating Cultural Safety into the UK to reduce racism within healthcare. Listening to the voices of black, Asian and minority ethnic National Health Service (NHS) consumers, education in reflexivity, both personal and organisational within the NHS are key. By listening to Indigenous colonised peoples, the ex-Empire may find solutions to health inequity. A decolonising feedback loop is required; however, we should take care not to culturally appropriate this valuable reverse innovation.

Enseñando a ser madres: la educación de mujer a mujer en la Valencia del primer tercio del siglo XX / Teaching to be mothers: education from women to woman in valencia in the first third of the 20th century

A comienzos del siglo XX, las altas cifras de morbi-mortalidad infantil generaron una preocupación creciente del movimiento Higienista, que articuló una respuesta sanitaria compleja, que combinó, entre otras medidas, la puesta en marcha de nuevas instituciones dedicadas a la puericultura y la utilización de nuevas estrategias como la educación para la salud y la divulgación sanitaria. En este contexto, las madres, consideradas causa y solución del problema, fueron el objetivo de dichas estrategias sanitarias dirigidas a mejorar las prácticas de los cuidados infantiles. Las profesionales femeninas próximas a las madres y a los niños, sobre todo maestras y enfermeras, se convirtieron en agentes de promoción de la salud, involucrando a las mujeres en las mejoras de la salud familiar. En la presente investigación, se presenta el estudio de caso de Valencia, como ejemplo de la emergencia de una acción profesional femenina que, a pesar de su visibilidad limitada, fue clave en la mejora de la salud infantil.(AU)

At the beginning of the 20th century, high infant morbidity and mortality rates generated a growing concern in the hygienist movement, which articulated a complex health response that combined, among other measures, the implementation of new institutions dedicated to child care and the use of new strategies such as health education and health promotion. In this context, mothers, seen as both the cause and the solution to the problem, were the target of such health strategies aimed at improving childcare practices. Female professionals close to mothers and children, especially teachers and nurses, became agents of health promotion, involving women in family health improvements. In this research, the case study of Valencia is presented as an example of the emergence of a female professional action that, despite its limited visibility, was key in the improvement of child health.(AU)

Doctors have an ethical obligation to ask patients about food insecurity: what is stopping us?

Inadequate diet is the leading risk factor for morbidity and mortality worldwide. However, approaches to identifying inadequate diets in clinical practice remain inconsistent, and dietary interventions (on both individual and public health policy levels) frequently focus on facilitating 'healthy choices', with limited emphasis on structural constraints. We examine the ethical implications of introducing a routine question in the medical history about ability to access food. Not collecting data on food security means that clinicians are unable to identify people who may benefit from support on an individual level, unable to consider relevant dietary risk factors for disease and disease progression and unable to monitor population trends and inequalities in dietary access in order to design effective policy interventions. We argue that the current lack of routine screening for food insecurity is inconsistent with our approach to other health behaviours (eg, smoking and alcohol use), as well as with doctors' frequent informal role as gatekeepers to the food aid system, and recent calls for governmental action on food insecurity and health inequalities from individual clinicians and professional bodies. Potential ethical barriers to asking patients about food security are addressed, including concerns about stigma, limiting autonomy, fair resource allocation, unclear professional remits and clinicians' ability to offer effective interventions. We suggest that there is an ethical imperative for doctors to ask patients about their ability to access healthy food. Gathering this data provides a valuable first step in re-framing the social determinants of health as modifiable risks, rather than inevitable inequities.

Design and Validation of an Instrument for Evaluating Training and Education for Health and Proper Use of Vaccines "VACUNASEDUCA".

The purpose of this article is to demonstrate the design and validation of a questionnaire, to study the importance of vaccines in the health of children. It is based on the analysis of a complete conceptual framework, considering the factors that show the current situation of vaccines, in the context of education for health and coexistence on the international scene. One thousand subjects from 76 countries participated in the study. The validity of the questionnaire was carried out with 15 experts, resulting in a content validity index (IVC) for each high dimension, with the mean IVC being the questionnaire with a Fleiss' kappa result of 0.96. The process led to a final design consisting of 12 items. The statistic used to identify the degree of consistency in the estimates and calculate the value of the match between the evaluators was the index Fleiss' kappa, which yielded an overall result of 0.57, which was considered moderate. The results obtained make it possible to conclude that the VACUNASEDUCA questionnaire is valid for understanding the status of vaccines, the importance of teacher training on health prevention, and the influence of student vaccination on the health of peers and teachers, from a gender perspective.

Why we should stop using animal-derived products on patients without their consent.

Medicines and medical devices containing animal-derived ingredients are frequently used on patients without their informed consent, despite a significant proportion of patients wanting to know if an animal-derived product is going to be used in their care. Here, I outline three arguments for why this practice is wrong. First, I argue that using animal-derived medical products on patients without their informed consent undermines respect for their autonomy. Second, it risks causing nontrivial psychological harm. Third, it is morally inconsistent to respect patients' dietary preferences and then use animal-derived medicines or medical devices on them without their informed consent. I then address several anticipated objections and conclude that the continued failure to address this issue is an ethical blind spot that warrants applying the principles of respect for autonomy and informed consent consistently.

[The roles of patients in healthcare provision, training and research: A French perspective]. / Rôles des patients dans le système de santé, la formation et la recherche en santé : une perspective française.

In 2002, patients were transformed into users of the French health system. As this opinion piece demonstrates, in 2021 they may at least potentially participate more actively than before. They can convey their knowledge of a disease and its treatments, and voluntarily share their experience. They can intervene in user representation and therapeutic patient education, the objective being to increase the autonomy of one and all, patients and public, in the training of professionals, clinical research and evolution of the health system. The rationale for the involvement of patients and their roles in provision of care, training and clinical research are analyzed from a French perspective. The obstacles to overcome and improvements to be achieved are reviewed, the objective being to promote enhanced health democracy through increased patient engagement. In 2021, however, the role of patients in the design and implementation of therapeutic patient education (TPE) and in the development of medical studies curricula remains limited if not restricted; this is due not only to a lack of information, but also to the resistance of health professionals and universities. Patients could and should assume a major role, fostering evolution toward a more just and effective health care system.

Towards collective moral resilience: the potential of communities of practice during the COVID-19 pandemic and beyond.

This paper proposes communities of practice (CoP) as a process to build moral resilience in healthcare settings. We introduce the starting point of moral distress that arises from ethical challenges when actions of the healthcare professional are constrained. We examine how situations such as the current COVID-19 pandemic can exponentially increase moral distress in healthcare professionals. Then, we explore how moral resilience can help cope with moral distress. We propose the term collective moral resilience to capture the shared capacity arising from mutual engagement and dialogue in group settings, towards responding to individual moral distress and towards building an ethical practice environment. Finally, we look at CoPs in healthcare and explore how these group experiences can be used to build collective moral resilience.

Family members, ambulance clinicians and attempting CPR in the community: the ethical and legal imperative to reach collaborative consensus at speed.

Here we present the personal perspectives of two authors on the important and unfortunately frequent scenario of ambulance clinicians facing a deceased individual and family members who do not wish them to attempt cardiopulmonary resuscitation. We examine the professional guidance and the protection provided to clinicians, which is not matched by guidance to protect family members. We look at the legal framework in which these scenarios are taking place, and the ethical issues which are presented. We consider the interaction between ethics, clinical practice and the law, and offer suggested changes to policy and guidance which we believe will protect ambulance clinicians, relatives and the patient.

Physician unionisation in the USA: ethical and empirical considerations and the free-rider problem.

While American physicians have traditionally practised as non-unionised professionals, there has been increasing debate in recent years over whether physicians in training (known also as interns, residents or house staff) are justified in unionising and using collective action. This paper examines specific ethical criteria that would permit union action, including a desire to ameliorate patient care as well as the goal of improving the conditions of working physicians. We posit that traditional rebuttals to physician unionisation often lean on an infinite conception of a doctor's energies and obligations, one that promotes burnout and serves to advance the financial motives of hospital management and administration. Furthermore, this paper explores the empirical justifications for collective action, which include substantial reductions in medical error. Finally, we address the free-rider problem posed by non-union physicians who might benefit from working improvements garnered through union action. We conclude that in order to maintain a notion of justice as fairness, resident physicians who benefit from union deliberations are impelled to acquire union membership or make a commensurate donation and that the healthcare organisations for which they work ought to share in the responsibility to improve patient care.

Como trabalhar com narrativas: uma abordagem metodológica de compreensão interpretativa no campo das Ciências Humanas em Saúde / How to work with narratives: a methodological approach to interpretive understanding in the field of health and human sciences / Cómo trabajar con narrativas: un abordaje metodológico de comprensión interactiva en el campo de las Ciencias Humanas en Salud

Partindo de uma investigação que procurou compreender as repercussões da leitura e da discussão de obras literárias entre estudantes e profissionais da área da Saúde, as reflexões teórico-metodológicas deste artigo nasceram das dificuldades enfrentadas na hora de "organizar", "analisar", "compreender" e "interpretar" o vultoso volume de material qualitativo produzido. Desse modo, em um esforço de organizar e, ao mesmo tempo, evitar compreensões ingênuas, sistematizamos um método imersivo fundamentado na fenomenologia hermenêutica, em que as narrativas produzidas foram transcriadas em uma nova produção textual, como resultado da tentativa de explicitar as compreensões das narrativas obtidas. Surpreendidos pelos bons resultados dessa Compreensão Interpretativa, concluímos que esse método pode ser adequado não somente para o aprofundamento em textos narrativos, mas para organizar discursos, apreender percepções, significados e compreensões, possibilitando interpretações plausíveis e interligadas, sobretudo quando há uma demanda vultosa de dados qualitativos. (AU)

Based on an investigation that sought to understand the repercussions of the reading and discussion of literary works by health students and professionals, the theoretical and methodological reflections in this article arose from the difficulties faced in "organizing", "analyzing", "understanding" and "interpreting" the huge volume of qualitative material produced. In an effort to organize and, at the same time, avoid naive understandings of this material, we systematized an immersive method based on hermeneutic phenomenology, in which the narratives produced were transcreated, resulting from an attempt to shed light on the understanding of the obtained narrative. Surprised by the results of this interpretive understanding, we conclude that this method can be adapted not only to delve deeper into narrative texts, but also to organize discourses and capture perceptions, meanings and understandings, enabling plausible and interconnected interpretations, especially when there is a large volume of qualitative data. (AU)

Partiendo de una investigación que buscó entender las repercusiones de la lectura y discusión de obras literarias entre estudiantes y profesionales del área de la salud, las reflexiones teórico-metodológicas de este artículo nacieron de las dificultades enfrentadas en el momento de "organizar", "analizar", "comprender" e "interpretar" el gran volumen de material cualitativo producido. De tal forma, en un esfuerzo de organizar y, al mismo tiempo, evitar comprensiones ingenuas, sistematizamos un método de inmersión, fundamentado en la fenomenología hermenéutica, en la cual las narrativas producidas se transcrearon en una nueva producción textual, como resultado de la tentativa de explicar las comprensiones de las narrativas obtenidas. Sorprendidos por los buenos resultados de esa Comprensión Interpretativa, concluimos que ese método puede ser adecuado no solo para la profundización en textos narrativos, sino para organizar discursos, captar percepciones, significados y comprensiones, posibilitando interpretaciones plausibles e interconectadas, principalmente cuando hay una gran demanda de datos cualitativos. (AU)

Aproximaciones teóricas sobre el aprendizaje cooperativo para la educación en salud en el contexto universitario / Theoretical approaches on the cooperative learning for education in health in the university context

Se realizó una revisión bibliográfica exhaustiva, con el objetivo de analizar algunas concepciones teóricas que revelan las potencialidades del aprendizaje cooperativo, como método para la educación en salud, en el proceso de formación universitaria. Para ello se efectuó un estudio documental contentivo de planes y programas de estudio, de artículos científicos y de tesis doctorales; entrevistas a estudiantes, profesores e investigadores universitarios, así como la observación de los comportamientos y modos de actuación relacionados con el aprendizaje cooperativo de los estudiantes en sus diferentes contextos de formación. El estudio desarrollado verificó que existen insuficiencias teóricas sobre el conocimiento del aprendizaje cooperativo (AC) como método para educar en salud desde el proceso de formación del estudiante universitario.

An exhaustive literature review was carried out with the objective of analyzing some theoretical conceptions that reveal the potentialities of the cooperative learning, as method for the education in health, in the process of university training. That is the reason why a documental study, with plans and study programs, scientific articles and doctoral thesis was carried out; also, some students, professors and university investigators were interviewed and the behaviors and performance ways were observed in this respect. The developed study allowed to verify that there are theoretical deficiencies on the knowledge of this learning.

Aligning patient and physician views on educational pelvic examinations under anaesthesia: the medical student perspective.

Recent media articles have stirred controversy over anecdotal reports of medical students practising educational pelvic examinations on women under anaesthesia without explicit consent. The understandable public outrage that followed merits a substantive response from the medical community. As medical students, we offer a unique perspective on consent for trainee involvement informed by the transitional stage we occupy between patient and physician. We start by contextualising the role of educational pelvic examinations under anaesthesia (EUAs) within general clinical skill development in medical education. Then we analyse two main barriers to achieving explicit consent for educational pelvic EUAs: ambiguity within professional guidelines on how to operationalize 'explicit consent' and divergent patient and physician perspectives on harm which prevent physicians from understanding what a reasonable patient would want to know before a procedure. To overcome these barriers, we advocate for more research on patient perspectives to empower the reasonable patient standard. Next, we call for minimum disclosure standards informed by this research and created in conjunction with students, physicians and patients to improve the informed consent process and relieve medical student moral injury caused by performing 'unconsented' educational pelvic exams.

May Measurement Month 2018: an analysis of blood pressure screening results from Argentinean cohort.

Hypertension continues to be the leading cause of death and disability in the industrialized world, with a high level of unawareness and unacceptably poor control. Therefore, the Argentinian Society of Hypertension, in agreement with the May Measurement Month (MMM) initiative of the International Society of Hypertension, implemented for the second consecutive year an educational campaign during the month of May 2018. A volunteer cross-sectional survey was carried out in public spaces and health centres during the month of May 2018 across 33 cities in Argentina. Hypertension was defined as systolic blood pressure (BP) ≥140 mmHg or diastolic BP ≥90 mmHg based on the mean of the 2nd and 3rd of three consecutive BP measurements, or in those on treatment for high BP. Statistical analysis including multiple imputation followed the MMM protocol. A total of 70 418 individuals were screened during MMM18, after excluding those under 18 years old. Of the total, 43.8% of participants were classified as hypertensive, 77.7% were aware of their diagnosis, 69.1% were on pharmacological treatment, and 38.7% were controlled. Of those on antihypertensive medication, 56.0% were controlled. It is necessary to reinforce strategies not only to increase the awareness and control of hypertension but also to identify the population groups, in which these strategies would have the greatest impact, helping to reduce the enormous health burden attributed to hypertension.

Pharmaceutical industry sponsorship of academic conferences: ethics of conflict of interest.

Sponsorship of medical conferences by the pharmaceutical industry has led to many ethical issues, especially in resource-poor developing countries. The core issue in these instances is to reduce or avoid conflicts of interests (COIs). COI is a set of circumstances that creates a risk that professional judgment or actions regarding a primary interest will be unduly influenced by secondary interests. Disruption of social trust should also be considered. This deontological approach should be complemented by a consequentialist approach. Towards this, the concept of distal interests (DI) is introduced. DI lies beyond the immediately visible COIs and the consequences of immediate decisions. They are 'distal' in time or place: 'DI in time' means consequence of the decision in future scenarios, while 'DI in space' means those that impinge on other institutions or bodies. In judging the consequences, it is also necessary to consider the reality of the existing relationship between the pharmaceutical industry and organisers of conferences. In more developed countries, these relationships are governed by stricter regulations, adherence to codes of conduct by both parties and stronger institutional oversights. In contrast, developing countries such as Sri Lanka the regulatory environment is lax and the demarcation of interests between the pharmaceutical industry and the medical profession is considerably blurred. Therefore, establishing clear rules of engagement between the stakeholders should be considered as an attempt to clear the muddy waters. The paper proposes a set of guidelines to capture these approaches.

Open data, trials and new ethics of using others' work.

Data and ideas are the capital of research productivity. Is it ethical to preempt the publication of another researcher's unpublished data or preliminary analysis, perhaps without citation? The long-established answer is 'certainly not'-but recent 'open data' use suggests otherwise. A research competition was held using data from The Systolic Blood Pressure Intervention Trial (SPRINT). This SPRINT Data Analysis Challenge created a novel environment for using open data as data became open early. This allowed third-party researchers the opportunity to assess some of the trial's outcomes before trialists. Could this infringe on trialists' right to analyse their data? Simultaneously, trialists had access to analyses from submissions to the competition that were not formally 'published' with a typical author credit or citation. Therefore, trialists had the opportunity to view the competition submissions and published on those ideas first without a typical way to cite the source of that idea. Could this infringe on researchers' right to be credited for their ideas? This is not intended as a criticism of open data, the SPRINT Data Analysis Challenge, or similar systems/ventures, but is an effort to objectively note what may be remediable flaws in the worthwhile, growing and dynamic uses of open data. We offer preliminary analytics to shed more light and provide fodder for additional discussion.

A discussion on controversies and ethical dilemmas in prostate cancer screening.

Prostate cancer (PCa) is one of the the most common cancers in men. A blood test called prostate-specific antigen (PSA) has a potential to pick up this cancer very early and is used for screening of this disease. However, screening for prostate cancer is a matter of debate. Level 1 evidence from randomised controlled trials suggests a reduction in cancer-specific mortality from PCa screening. However, there could be an associated impact on quality of life due to a high proportion of overdiagnosis and overtreatment as part of the screening. The US Preventive Services Task Force (USPSTF) in 2012 recommended that PSA-based PCa screening should not to be offered at any age. However, considering the current evidence, USPSTF recently revised its recommendation to offer the PSA test to men aged 55-69 years with shared decision-making, in line with earlier guidelines from the American Cancer Society and the American Urological Association. A shared decision making is necessary since the PSA test could potentially harm an individual. However, the literature suggests that clinicians often neglect a discussion on this issue before ordering the test. This narrative discusses the main controversies regarding PCa screening including the PSA threshold for biopsy, the concept of overdiagnosis and overtreatment, the practical difficulties of active surveillance, the current level 1 evidence on the mortality benefit of screening, and the associated pitfalls. It offers a detailed discussion on the ethics involved in the PSA test and highlights the barriers to shared decision-making and possible solutions.

Suffering and the moral orientation of presence: lessons from Nazi medicine for the contemporary medical trainee.

Medical trainees should learn from the actions of Nazi physicians to inform a more just contemporary practice by examining the subtle assumptions, or moral orientations, that led to such heinous actions. One important moral orientation that still informs contemporary medical practice is the moral orientation of elimination in response to suffering patients. We propose that the moral orientation of presence, described by theologian Stanley Hauerwas, provides a more fitting response to suffering patients, in spite of the significant barriers to enacting such a moral orientation for contemporary trainees.

Prepared for practice? UK Foundation doctors' confidence in dealing with ethical issues in the workplace.

This paper investigates the medical law and ethics (MEL) learning needs of Foundation doctors (FYs) by means of a national survey developed in association with key stakeholders including the General Medical Council and Health Education England. Four hundred sevnty-nine doctors completed the survey. The average self-reported level of preparation in MEL was 63%. When asked to rate how confident they felt in approaching three cases of increasing ethical complexity, more FYs were fully confident in the more complex cases than in the more standard case. There was no apparent relationship with confidence and reported teaching at medical school. The less confident doctors were no more likely to ask for further teaching on the topic than the confident doctors. This suggests that FYs can be vulnerable when facing ethical decisions by being underprepared, not recognising their lack of ability to make a reasoned decision or by being overconfident. Educators need to be aware of this and provide practical MEL training based on trainee experiences and real-world ethics and challenge learners' views. Given the complexities of many ethical decisions, preparedness should not be seen as the ability to make a difficult decision but rather a recognition that such cases are difficult, that doubt is permissible and the solution may well be beyond the relatively inexperienced doctor. Educators and supervisors should therefore be ensuring that this is clear to their trainees. This necessitates an environment in which questions can be asked and uncertainty raised with the expectation of a supportive response.

[Effectiveness of a nursing program of self-care and Mindfulness, in the approach to the common mental disorder in primary care]. / Efectividad de un programa de enfermería en autocuidados y mindfulness, para el abordaje del trastorno mental común, en atención primaria.

OBJECTIVE: To evaluate the effectiveness of the implementation of a mindfulness and self-care program to treat common mental health disorders in primary care. DESIGN: Quasi-experimental non-controlled, non-randomised study, with repeated measurements. SETTING: Seven health centres, in area v of the Principality of Asturias, between 2014 and 2018. PARTICIPANTS: Subjects between 18-65 years with mixed anxiety, depressive, and adaptive disorders, with no serious mental disease. Non-probabilistic convenience sampling was used. INTERVENTION: A group intervention was made, consisting of 9 weekly sessions of 90min, daily practice, and reinforcement sessions at one month, 3, 6, and 12 months. MAIN MEASUREMENTS: Pre-post measurements using validated and self-administered questionnaires; medium-term (3-6 months) and long-term (>12 months) of the variables: trait anxiety/state anxiety (Status-Trait Anxiety Questionnaire -STAI-); anxiety/depression (Goldberg Anxiety and Depression Scale -GHQ28-), mindfulness (Five Facet Mindfulness Questionnaire -FFMQ-), reduction of pharmacological treatment (open questions). RESULTS: The study included a final sample of 314 subjects. A statistically significant difference in means was found in the 3 follow-up periods as regards the baseline values for all the scales/subscales. There was a reduction of 54.3% in the taking of anxiolytic/antidepressant baseline medication in the long-term follow-up (P<.001). CONCLUSIONS: A moderate reduction of the symptoms, together with the reduction of the medication, indicate that the intervention of mindfulness supervised by the primary care nurse can be a treatment option for the mental disorders common in this level of care.