IntroductionOver time, surrogacy has become more broadly available to a variety of people (e.g. male same-sex couples or transgender women). Whether the wider public supports surrogacy, and what contributes to such support remains unclear. This study investigated what demographic and surrogacy arrangement-based (which people participate in the arrangement) factors shape attitudes towards surrogacy.MethodA representative sample of Dutch adults (N = 1,074) reported their attitudes on four (out of 30) randomly assigned vignettes in 2023. Each vignette described a surrogacy family with variations in sexuality and gender of parents, the social and genetic bonds between the parents, the surrogate, and the oocyte donor, and was followed by an attitude questionnaire (6 items). Multilevel regression analyses were conducted with attitudes as the dependent variable and demographic factors (gender, Dutch background, age, education, sexual orientation, urbanisation, and religiosity) and arrangement-based factors (parental composition, genetic and social bonds with the surrogate, and oocyte donors).ResultsParticipants held fairly positive attitudes towards surrogacy. People identifying as women, with only having a Dutch background, who were younger, more highly educated, non-heterosexual, or less religious were more likely to have positive attitudes. Participants had more positive attitudes if surrogacy arrangements entailed cis-man cis-woman parents compared to cis-man cis-man or transgender parents, and when there was no social bond between parents and oocyte donor.ConclusionsAttitudes are influenced by both demographic and arrangement-based factors. Based on these findings, families can be informed of fairly positive reactions they might encounter from their environment.
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"We must know whether we want to change the world to experience it with the same sensorial system like the one we already possess, or whether we’d rather modify our body, the somatic filter through which it passes."
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Non-intubated patients with acute respiratory failure due to COVID-19 could benefit from awake proning. Awake proning is an attractive intervention in settings with limited resources, as it comes with no additional costs. However, awake proning remains poorly used probably because of unfamiliarity and uncertainties regarding potential benefits and practical application. To summarize evidence for benefit and to develop a set of pragmatic recommendations for awake proning in patients with COVID-19 pneumonia, focusing on settings where resources are limited, international healthcare professionals from high and low- and middle-income countries (LMICs) with known expertise in awake proning were invited to contribute expert advice. A growing number of observational studies describe the effects of awake proning in patients with COVID-19 pneumonia in whom hypoxemia is refractory to simple measures of supplementary oxygen. Awake proning improves oxygenation in most patients, usually within minutes, and reduces dyspnea and work of breathing. The effects are maintained for up to 1 hour after turning back to supine, and mostly disappear after 6–12 hours. In available studies, awake proning was not associated with a reduction in the rate of intubation for invasive ventilation. Awake proning comes with little complications if properly implemented and monitored. Pragmatic recommendations including indications and contraindications were formulated and adjusted for resource-limited settings. Awake proning, an adjunctive treatment for hypoxemia refractory to supplemental oxygen, seems safe in non-intubated patients with COVID-19 acute respiratory failure. We provide pragmatic recommendations including indications and contraindications for the use of awake proning in LMICs.
