The Conditions For Ethical Application of Restraints

Despite the lack of evidence for their effectiveness, the use of physical restraints for patients is widespread. The best ethical justification for restraining patients is that it prevents them from harming themselves. We argue that even if the empirical evidence supported their effectiveness in achieving this aim, their use would nevertheless be unethical, so long as well known exceptions to informed consent fail to apply. Specifically, we argue that ethically justifiable restraint use demands certain necessary and sufficient conditions. These conditions are that the physician obtain informed consent for their application, that their application be medically appropriate, and that restraints be the least liberty-restricting way of achieving the intended benefit. It is a further question whether their application is ever medically appropriate, given the dearth of evidence for their effectiveness

The Devil is in the Detail: Challenging the UK Department of Health’s 2019 Impact Assessment of the Extent of Online Marketing of Unhealthy Foods to Children

Background: How much unhealthy marketing do children see on digital devices? Marketing of unhealthy food and beverages has long been identified as a factor in children’s preferences, purchase requests and consumption. Rising global obesity mandates States to craft environments that protect children and young people’s health, as recommended by the World Health Organization, among others. However, assessing the impact of marketing restrictions is particularly challenging: the complexity of digital advertising markets means that measurement challenges are profound. In 2019, the UK Department of Health published an Impact Assessment that applied a novel method aiming to calculate costs and benefits of restricting unhealthy food and beverage advertising on digital devices (planned for implementation by 2022). It estimated UK digital unhealthy marketing to children at 0.73 billion advertising impressions annually, compared to television impacts of 3.6 billion. Aim and Method: We assessed this conclusion by reviewing the UK Department of Health/Kantar Consulting’s Online Baseline Methodology (the “Government Model”). We examined the model’s underlying premise and specified the seven analytic steps undertaken. For each step, we reviewed industry and academic evidence to test its assumptions and the validity of data applied. Results: We found that, in each step, the Government Model’s assumptions, and the data sources selected, result in underestimates of the scale of digital advertising of unhealthy foods—at least tenfold, if not substantially more. The model’s underlying premise is also problematic, as digital advertising spend data relate poorly to digital advertising exposure, leading to further underestimation of market scale. Conclusion: We conclude that the Government Model very substantially underestimates the impact of digital unhealthy food advertising restrictions on health. This analysis has relevance for global policy and for the impact of regulation on children’s health and well-being

The Quebec Grade 11 Contemporary World Course and the Immediate Textbook: A Critical Discourse Analysis of How Neoliberalism and its Discontents are Presented In High School

This thesis examines how neoliberal policies are presented to Quebec high school students in the mandatory grade 11 Social Studies course called Contemporary World. The main data are the course’s provincial curriculum, the textbook Immediate, and an interview with Immediate’s main authors. By using Critical Discourse Analysis, the content of Immediate is examined to reveal how neoliberal discourses and practices are situated in the text, along with the resistance of anti-neoliberal social movements. David Harvey’s (2005) understanding of neoliberalism as the project of class restoration and dispossession, as well as various perspectives from Global Citizenship Education (GCE) literature and practice, provide the study’s theoretical framework. The most significant finding is that international institutions and their often neoliberal discourse is highly privileged in Immediate, while grassroots oppositional social movements are either misrepresented or missing. In this way, the textbook and the course emphasize mostly the positive results of neoliberal reforms. Moreover, class struggles and the role of labour in combating neoliberal reforms are absent. Neoliberal practices in the Global South receive more criticism, although the complicit role of NGOs is not explored. As for grassroots environmentalist movements, their presence is overshadowed by the sustainable development discourse that privileges institutions and international agreements. Finally, the textbook and the course model a citizen with analytical skills and global knowledge who lacks a critical GCE due to these missing elements: the critique of Canada’s institutions, social agency, feeling, and a more self-reflective understanding of the ‘other’ living in the Global South

Three Routes Forward For Biofuels: Incremental, Transitional, and Leapfrog

Besides the authors of this paper, many other people from the Sustainable Transportation Energy Pathways (NextSTEPS) research consortium assisted in the underlying analysis and internal review. This includes, but is not limited to, Joan Ogden, Steve Kaffka, Rich Plevin, Mark Delucchi, Sonia Yeh, Colin Murphy, and Paul Gruber. The NextSTEPS biofuels team wishes to thank representatives of the California Energy Commission (CEC) and the California Air Resources Board (ARB) for their valuable comments during a recent presentation of this work. The team also wishes to thank the NextSTEPS consortium members for their intellectual contributions and support of this researc

Facts Matter! Black Lives Matter! The Trauma of Racism

This report is a summary of select research on the blocked opportunities and oppressive burden that young men of color experience. The authors hope that these findings fuel action by our government leaders, policy makers, advocacy and provider organizations and communities. In addition, this report highlights select promising policy and programmatic interventions that could provide steps to address the serious inequities that appear to be fueling the accumulating number of young men of color whose lives are cut short by violence or diminished by lack of opportunities, resources and supports

Pain in amaXhosa women living with HIV/AIDS: a cross-sectional study of ambulant outpatients

Background: Pain is one of the most commonly reported symptoms in people living with HIV/AIDS, whether or not they are receiving anti-retroviral therapy. A recent systematic review identified a paucity of studies exploring pain in women in low and middle income countries. The prevalence and characteristics of pain in women living with HIV/AIDS may differ from that of men as many chronic pain conditions are more prevalent in women. The aims of this study were to establish pain prevalence, characteristics and management in amaXhosa women living with HIV/AIDS. In addition, we aimed to identify whether there were associations between pain in this population and the psychosocial factors of employment, education, self-efficacy, depression, post-traumatic stress disorder, health related quality of life and childhood trauma. Methods: A cross-sectional study of 229 women who had undergone HIV testing and were registered patients at a community health centre was conducted. Data were collected by interview with a demographic questionnaire, the Brief Pain Inventory-Xhosa, Childhood Trauma Questionnaire–Xhosa, Harvard Trauma Questionnaire–Xhosa for PTSD, Self-Efficacy for Managing Chronic Disease 6-Item Scale-Xhosa; the EQ-5D health related quality of life instrument, and the Beck Depression Inventory. Results: 170 of the women had pain, a prevalence rate of 74.24% (95%CI 68.2 – 79.47%). The women reported significant pain with pain severity of 5.06 ± 1.57 and pain interference of 6.39 ± 1.96 out of 10. Only two women were receiving adequate pain management according to the pain management index. Participants reported a mean of 2.42 ± 1.21 different anatomical sites of pain. There were more unemployed participants in the group with pain and they had significantly fewer years of schooling. Those with pain had lower self-efficacy; health related quality of life and increased depression and PTSD symptom severity. Conclusion: This study highlights that pain is a common problem for amaXhosa women living with HIV/AIDS. These data emphasise the need to prioritise pain assessment and management in amaXhosa women living with HIV/AIDS. Routinely assessing for the presence of pain in women with HIV/AIDS has the potential to improve pain management and minimise the impact of pain on function