Condiciones de vida de población en cuatro consultorios del médico y enfermera de la familia / Living Conditions of the Population from Four Family Doctor and Nurse's Offices

Introducción: Las condiciones de vida son las condiciones objetivas en las que los hombres reproducen su existencia social e individual. Objetivo: Describir las condiciones de vida de la población en cuatro consultorios del médico y la enfermera de la familia. Métodos: Estudio descriptivo de corte transversal durante el periodo 2016-2019 en cuatro Consultorios del Médico y la Enfermera de la Familia (CMF), que fueron seleccionados por factibilidad. Se estudiaron 775 personas y las siguientes variables: Sociodemográficas, Clasificación de la familia, Percepción de la situación económica, Problemas de la familia y soluciones para estos problemas y Condiciones de vida. Los datos se introdujeron en una base de datos en Access y se procesaron con el paquete estadístico SPSS versión 20.0 para Windows. Resultados: Predominó el rango de edad de 70-74 (87/11,2 por ciento). El nivel de escolaridad más alto terminado fue el técnico medio (265/34,2 por ciento). El trabajador estatal predominó en la situación laboral (260/33,5 por ciento). Un número importante de amas de casa y jubilados tenían nivel educacional más alto terminado de secundaria básica o menos. Predominaron las familias pequeñas y nucleares, 268 (34,6 por ciento), vivían en familias nucleares solo constituidas por adultos mayores. La percepción de la situación económica tanto para la individual (411/53,0 por ciento) como para la de la familia (418/53,9 por ciento) fue regular. En relación con los equipos electrodomésticos, la mayoría refirió tener cinco de los seis equipos de primera necesidad, en los de segunda necesidad en las viviendas hubo déficit de aire acondicionado, horno micro onda, máquina de coser, computadora, video, freezer, calentador de agua, teléfono y cocina eléctrica. Conclusiones: Las condiciones de vida expresan diferencias según la edad, el nivel de escolaridad, la situación laboral y la percepción de la situación económica(AU)

Introduction: Living conditions are the objective conditions in which human beings reproduce their social and individual existence. Objective: To describe the living conditions of the population in four family doctor and nurse's offices. Methods: Descriptive and cross-sectional study carried out during the period 2016-2019 in four family doctor and nurse's offices, chosen by feasibility. A total of 775 individuals were studied, together with the following variables: of sociodemographical type, family classification, perception of economic situation, family problems and solutions to these problems, as well as living conditions. The data were entered into an Access database and processed with the statistical package SPSS version, 20.0 for Windows. Results: The age range 70-74 predominated (87/11.2 percent). The highest level of schooling was a technical associate (265/34.2 percent). The state-employed worker predominated as occupational status (260/33.5 percent). A significant number of housewives and retirees had the highest level of education completed, senior high school or lower. Small and nuclear families predominated; 268 (34.6 percent) lived in nuclear families with older adults only. Perception about the economic situation was fair for both the individual (411/53.0 percent) and the family (418/53.9 percent). Regarding household appliances, most of the respondents referred they have five of the six first-need appliances; concerning second-need appliances in the dwellings, there was a deficit of air conditioning, microwave oven, sewing machine, computer, video player, freezer, water heater, telephone, or electric stove. Conclusions: Living conditions express differences according to age, level of schooling, occupational status, and perception of the economic situation(AU)

Quinoa, potatoes, and llamas fueled emergent social complexity in the Lake Titicaca Basin of the Andes.

The Lake Titicaca basin was one of the major centers for cultural development in the ancient world. This lacustrine environment is unique in the high, dry Andean altiplano, and its aquatic and terrestrial resources are thought to have contributed to the florescence of complex societies in this region. Nevertheless, it remains unclear to what extent local aquatic resources, particularly fish, and the introduced crop, maize, which can be grown in regions along the lakeshores, contributed to facilitating sustained food production and population growth, which underpinned increasing social political complexity starting in the Formative Period (1400 BCE to 500 CE) and culminating with the Tiwanaku state (500 to 1100 CE). Here, we present direct dietary evidence from stable isotope analysis of human skeletal remains spanning over two millennia, together with faunal and floral reference materials, to reconstruct foodways and ecological interactions in southern Lake Titicaca over time. Bulk stable isotope analysis, coupled with compound-specific amino acid stable isotope analysis, allows better discrimination between resources consumed across aquatic and terrestrial environments. Together, this evidence demonstrates that human diets predominantly relied on C3 plants, particularly quinoa and tubers, along with terrestrial animals, notably domestic camelids. Surprisingly, fish were not a significant source of animal protein, but a slight increase in C4 plant consumption verifies the increasing importance of maize in the Middle Horizon. These results underscore the primary role of local terrestrial food resources in securing a nutritious diet that allowed for sustained population growth, even in the face of documented climate and political change across these periods.

Relationships between urbanization and CO2 emissions in China: An empirical analysis of population migration.

China's announcement of its goal of carbon neutrality has increased the practical significance of research on carbon dioxide (CO2) emissions that result from urbanization. With a comprehensive consideration of population migration in China, this study examines the impact of urbanization on CO2 emissions based on provincial panel data from 2000 to 2012. Two indicators (resident population and household registration population) are used to measure urbanization rate. The results reveal that the impact of urbanization on CO2 emissions in China is closely correlated with the structure of urban resident population and interregional population migration. The estimation results are still robust by using generalized method of moments (GMM) estimator and two-stage least squares (2SLS) estimator. The proportion of temporary residents is introduced as a proxy variable for population migration. The panel threshold model regression results show that the proportion of temporary residents has a marginal effect on the relationship between urbanization and CO2 emissions. In regions with a higher proportion of temporary residents, the positive effects of resident population urbanization on CO2 emissions tend to be weaker. These findings are consistent with the theories of ecological modernization and urban environmental transition. This paper makes suggestions on China's urbanization development model and countermeasures are proposed to minimize the CO2 emissions caused by urbanization.

The effect of medical and social conditions on the mode of delivery: a prospective questionnaire-based study applied to 404 Turkish obstetricians.

PURPOSE: To identify the factors that influence provider's decisions on method of delivery in a country where national cesarean delivery rate (CDR) among all births increased steadily from 21 to 56% in a 16-year period. METHODS: We planned nine birth scenarios, in which both delivery modes were plausible, and we used self-administered questionnaire to ask obstetricians for their preferred mode of delivery in these scenarios. If the choice was cesarean delivery (CD), the provider was asked to state the reason for choosing this method. We grouped respondents according to number of years in their occupation, working sector (state, university or private hospital) and academic degree. RESULTS: Four hundred and four obstetricians completed the questionnaire. Preference for CD in all scenarios was comparable between male and female obstetricians (p = 0.334) and between specialists, associate professors and professors (p = 0.812). The most frequent reason for choice of CD in all nine scenarios was fear of fetal risk and/or fear of litigation. CONCLUSION: Fear of litigation was found to be the major factor influencing CD choice. This fear not only increases the CDR but also results in loss of training in breech delivery and operative vaginal delivery, forming a vicious cycle.

Trend of social iniquities in reports of sexual violence in Brazil between 2010 and 2014. / Tendência das iniquidades sociais nas notificações de violência sexual no Brasil entre 2010 e 2014.

INTRODUCTION: Sexual violence has emerged in the health field with changes in the epidemiological profiles of populations. METHODOLOGY: An ecological study with 5,565 Brazilian municipalities between 2010 and 2014. A descriptive analysis of the variables (Population rate of sexual violence reporting, household income per capita and HDI) and their stratification by quintile was performed. In order to explore the factors associated with changes in social inequalities regarding the rate of reporting of sexual violence, the Slope Index of Inequality and Relative Index of Inequality were adopted. An Equiplot was constructed for the outcome on each independent variable. RESULTS: The mean rate of reports of sexual violence in Brazil was 4.38 reports/100,000 inhabitants for the period. There was an increase in the rate of sexual violence and improvement in socioeconomic conditions. There was a higher rate of reporting in the quintile with better living conditions. An increase in the inequality of the rate of sexual violence as a function of household income and the HDI was observed. Several factors seem to influence the increase of reports of sexual violence in the country, among them the improvement in the living conditions of the population and greater moral sensitivity to violence. However, there is still a disparity in reporting among municipalities according to their socioeconomic status. CONCLUSION: The lack of public policies on social equity in health has interfered with reports of sexual violence in the country and has widened health inequities.

Conference Report on First Certificate Course in Health Professions Educationat College of Medicine, University of Kerbala, Iraq.(September 2019).

The current status of medical education in Iraq requires complete transformation to conform to the latest trends of modern education. Presently it is compromised due to the influence of political factors, finances, weakness or fragility of planning and security. It has to be re-shaped for the future of medical education to produce good and efficient medical professionals. It is necessary to reform and revise the curriculum as accreditation in accordance with international medical universities. The initial requirement is faculty development in areas including but not limited to, curriculum development, teaching and learning improvement, research capacity building, and leadership development. The capacity building of faculty at College of Medicine, University of Kerbala (CMUCK) has been initiated in collaboration with Medics International at a local and the government level. Medics International conducted the current Course on Certificate in Health Professions Education (CHPE) programme in September, 2019 to facilitate the faculty to revise their curriculum and improve their current educational practices. Further steps will be taken to develop the faculty for Masters in Medical Education (MME), PhD, and fellowship programmes. To face the on-going challenges in the medical and health care system, continous efforts are required for faculty education. Medics International has volunteered to begin a series of Webinars through its global faculty to reach out to the Iraqi Board followed by engagement of the Arab Board covering 18 countries.

Pandemia y ansiedad social / Pandemic and social anxiety

La pandemia del COVID-19 ha generado una crisis en el ser humano y en su contexto de cómo vivir ante lo desconocido, estableciendo parámetros de un desequilibrio de la salud mental y una reinvención de sostenimiento imaginario de lo incomprensible, desarticulando los esquemas socialmente aceptados y articulando modelos nuevos que le permitan al hombre continuar con la vida, encontrando formas de fortalecer al Eros y disminuir la proliferación de Thanatos. (AU)

The COVID-19 pandemic has generated a crisis in the human being and in its context of how to live in the face of the unknown, establishing parameters of an imbalance of mental health and a reinvention of imaginary maintenance of the incomprehensible, disarticulating socially accepted schemes and articulating new models that allow man to continue with life, finding ways to strengthen Eros and decrease the proliferation of Thanatos (AU)

Tendência das iniquidades sociais nas notificações de violência sexual no Brasil entre 2010 e 2014 / Trend of social iniquities in reports of sexual violence in Brazil between 2010 and 2014

RESUMO: Introdução: A violência sexual tem despontado no cenário da saúde com as mudanças nos perfis epidemiológicos das populações. Metodologia: Estudo ecológico com 5.565 municípios brasileiros entre 2010 e 2014. Realizou-se análise descritiva das variáveis (taxa populacional de notificação de violência sexual, renda domiciliar per capita e índice de desenvolvimento humano - IDH) e suas estratificações por quintil. Para explorar os fatores associados às mudanças nas desigualdades sociais na taxa de notificação de violência sexual, foram adotados o coeficiente angular de desigualdade e o índice relativo de desigualdade. Construiu-se equiplot para o desfecho em cada variável independente. Resultados: A taxa média de notificações de violência sexual no Brasil foi de 4,38 notificações/100 mil habitantes para o período. Houve incremento na taxa de violência e melhoria nas condições socioeconômicas. Observou-se maior taxa de notificações no quintil com melhores condições de vida, bem como aumento na desigualdade da taxa de notificações de violência sexual em função da renda domiciliar e do IDH. Diversos fatores parecem influenciar o aumento das notificações de violência sexual no país. Entre eles, destacam-se a melhoria nas condições de vida da população e a maior sensibilidade moral à violência, contudo ainda há disparidade de notificações entre os municípios de acordo com sua condição socioeconômica. Conclusão: A falta de políticas públicas de equidade social em saúde tem interferido nas notificações de violência sexual no país e ampliado as iniquidades em saúde.

ABSTRACT: Introduction: Sexual violence has emerged in the health field with changes in the epidemiological profiles of populations. Methodology: An ecological study with 5,565 Brazilian municipalities between 2010 and 2014. A descriptive analysis of the variables (Population rate of sexual violence reporting, household income per capita and HDI) and their stratification by quintile was performed. In order to explore the factors associated with changes in social inequalities regarding the rate of reporting of sexual violence, the Slope Index of Inequality and Relative Index of Inequality were adopted. An Equiplot was constructed for the outcome on each independent variable. Results: The mean rate of reports of sexual violence in Brazil was 4.38 reports/100,000 inhabitants for the period. There was an increase in the rate of sexual violence and improvement in socioeconomic conditions. There was a higher rate of reporting in the quintile with better living conditions. An increase in the inequality of the rate of sexual violence as a function of household income and the HDI was observed. Several factors seem to influence the increase of reports of sexual violence in the country, among them the improvement in the living conditions of the population and greater moral sensitivity to violence. However, there is still a disparity in reporting among municipalities according to their socioeconomic status. Conclusion: The lack of public policies on social equity in health has interfered with reports of sexual violence in the country and has widened health inequities.

Exploring the perception of survivors on the bidirectional impact between cancer and their social contexts: A mixed-methods approach.

OBJECTIVE: The purpose of the current study was to use a mixed-methods approach to assess the perspective of cancer survivors on the bidirectional impact between cancer and their social contexts. METHOD: A fixed concurrent triangulation mixed-methods survey design was used with open- and closed-ended questions that were predetermined and administered to participants. Quantitative items included demographic questions and the Life Impact Checklist. Qualitative questions were designed to explore the bidirectional impact between the patient and specific contexts including spirituality/faith, the spousal/partner relationship, and the family. A cross-sectional descriptive approach was used to evaluate the quantitative items and the constant comparative method guided the analysis of open-ended questions. RESULT: Among 116 participants (mean age 58.4 years), the majority were female (66.7%) with breast cancer (27.9%). Nearly one-half the respondents endorsed a positive impact of cancer on their spirituality/faith, but qualitative results suggested less of a bidirectional impact. The importance of the spouse/partner during the cancer experience was emphasized, including the subthemes of instrumental and emotional support; however, there was often a negative impact of cancer on the spouse/partner relationship, including sexual functioning. Survivors indicated family members provided instrumental and emotional support, but not as regularly or directly as a spouse/partner. SIGNIFICANCE OF RESULTS: Social contexts are important among cancer survivors, with many cancer survivors relying more on their spouse/partner than other family members for support. The cancer experience is stressful not only for survivors, but also for individuals in their social contexts and relationships.

The burden of disease in Russia from 1980 to 2016: a systematic analysis for the Global Burden of Disease Study 2016.

BACKGROUND: Over the past few decades, social and economic changes have had substantial effects on health and wellbeing in Russia. We aimed to use data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to evaluate trends in mortality, causes of death, years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life-years (DALYs), and associated risk factors in Russia from 1980 to 2016. METHODS: We estimated all-cause mortality by use of a multistage modelling process that synthesised data from vital registration systems, surveys, and censuses. A composite measure of health loss due to both fatal and non-fatal disease burden (DALYs) was calculated as the sum of YLLs and YLDs for each age, sex, year, and location. Health progress was evaluated in comparison with patterns of change in similar countries by use of the Socio-demographic Index that was developed for GBD 2016. FINDINGS: Following rapid decreases in life expectancy after the collapse of the Soviet Union, life expectancy at birth in Russia improved between 2006 and 2016. The all-cause mortality rate decreased by 16·6% (95% uncertainty interval 9·4-33·8) between 1980 and 2016. This overall decrease encompasses the cycles of sharp increases and plateaus in mortality that occurred before 2005. Child mortality decreased by 57·5% (53·5-61·1) between 2000 and 2016. However, compared with countries at similar Socio-demographic Index levels, rates of mortality and disability in Russia remain high and life expectancy is low. Russian men have a disproportionate burden of disease relative to women. In 2016, 59·2% (55·3-62·6) of mortality in men aged 15-49 years and 46·8% (44·5-49·5) of mortality in women were attributable to behavioural risk factors, including alcohol use, drug use, and smoking. INTERPRETATION: Trends in mortality in Russia from 1980 to 2016 might be related to complicated patterns of behavioural risk factors associated with economic and social change, to shifts in disease burden, and to changes in the capacity of and access to health care. Ongoing mortality and disability from causes and risks amenable to health-care interventions and behaviour modifications present opportunities to continue to improve the wellbeing of Russian citizens. FUNDING: Bill & Melinda Gates Foundation.

Social constraints and fear of recurrence in couples coping with early stage breast cancer.

OBJECTIVE: Fear of cancer recurrence (FCR) is a top concern of breast cancer (BC) survivors and their spouses. FCR often occurs within an interpersonal context, yet there has been little research on relationship processes that may influence FCR in patients and spouses. It was hypothesized that the inhibition of disclosure of cancer-related concerns, thoughts, and feelings because of perceived partner disinterest or avoidance (termed social constraints) would predict greater FCR in BC patients and their spouses both globally and in the context of everyday life. METHOD: Two studies, 1 cross-sectional (N = 46 couples) and 1 daily diary (21 days; N = 72 couples), were conducted to examine the between-person and within-person associations between social constraints and FCR in early stage BC patients and their spouses. Assessments were conducted about 6 months after BC surgery. RESULTS: Global social constraints predicted greater global FCR in patients and spouses at the cross-sectional level, controlling for anxiety symptoms, relationship quality, and patient age, physical impairment, and BC stage. At the within-person level, results indicated that on days when more social constraints were reported, both partners were more likely to report greater FCR, controlling for momentary negative affect and relationship quality. CONCLUSIONS: This study is the first to examine the within-person association between social constraints and FCR. These findings suggest relationship processes, particularly inhibition of disclosure, can uniquely influence the experience of FCR for both BC patients and their spouses, pointing to an important consideration for future research and possible intervention development. (PsycINFO Database Record

[Brain-enhancement: anthropological, sociological and legal issues]. / La neuro-amélioration des sujets « sains ¼ : enjeux anthropologiques, sociologiques et juridiques.

With advances in neuroscience, the neuro-improvement market is booming. Independently of the possible risks on public health, neuro-improvement seems to come from a free decision and self-definition. However, this evolution, benefiting from the ambiguity between the notions of health and performance, leads to question. Because this medicalization of society can carry risks for the human person and introduce an imbalance in social relations.

Prevalência e fatores associados da violência sexual contra a mulher: revisão sistemática / Prevalence and associated factors with sexual violence against women: systematic review / Prevalencia y factores asociados de la violencia sexual contra la mujer: revisión sistemática

RESUMO Esta revisão objetiva identificar na literatura a prevalência e fatores associados à Violência Sexual (VS) contra as mulheres adolescentes e adultas. Foi realizado levantamento de estudos de base populacional, publicados entre 2011 e 2016, em inglês, português e espanhol, nas bases de dados Pubmed/Medline, Lilacs e SciELO. Os estudos foram analisados e descritos, detalhando suas características e informações sobre prevalência e fatores associados à VS. Dentre os 3 002 artigos encontrados, de acordo com os critérios de elegibilidade, 15 estudos foram objetos desta revisão. A maioria dos estudos se concentra na Ásia e na África, locais os quais também apresentam as maiores prevalências de VS. A faixa etária predominantemente investigada foi de 15-49 anos. Houve grande variação da prevalência de VS entre os países, quando analisada a VS cometida por parceiro íntimo, esta variou de 1 % na Alemanha no atual relacionamento a 92 % Zimbábue. Em relação aos fatores associados, destacam-se a baixa escolaridade, a idade jovem, condições de saúde mental e saúde sexual e reprodutiva, bem como o uso de álcool e outras drogas. A revisão evidencia a necessidade de aprofundamento de estudos sobre violência sexual, de modo a contribuir às políticas públicas, ao enfrentamento da violência contra as mulheres e à equidade de gênero.(AU)

ABSTRACT This review aims to identify in the literature the prevalence and factors associated with Sexual Violence (SV) against adolescents and adult women. It were reviewed the population-based study, published between 2011 and 2016, in English, Portuguese and Spanish, in Pubmed / Medline, Lilacs and SciELO databases. The studies were analyzed and described, detailing their characteristics and information on prevalence and factors associated with SV. Of the 3,002 articles found, according to the eligibility criteria, 15 studies were objects of this review. Most studies focus on Asia and Africa, which also have the highest prevalence of SV. The predominantly investigated age group was 15-49 years. There was a great variation in the prevalence of SV among the countries, when SV was analyzed by intimate partner, it varied from 1 % in Germany in the current relationship to 92 % Zimbabwe. In relation to the associated factors, low educational level, young age, mental health conditions and sexual and reproductive health, as well as the use of alcohol and other drugs are highlighted. The review highlights the need to deepen studies on sexual violence to contribute to public policies, to combat violence against women and to gender equity.(AU)

RESUMEN La revisión se propuso identificar en la literatura la prevalencia y factores asociados con la violencia sexual (VS) contra las mujeres adolescentes y adultas. Se revisaron estudios poblacionales, publicados entre 2011 y 2016, en inglés, portugués y español, en las bases de datos PubMed/Medline, Lilacs y SciELO. Los estudios fueron descritos y analizados, detallando sus características e informaciones sobre prevalencia y factores asociados a la VS. Entre los 3 002 artículos encontrados, de acuerdo con los criterios de inclusión, 15 estudios fueron objetos de esta revisión. La mayoría de los estudios se concentran en Asia y África, que también presentan las mayores prevalencias de VS. El grupo de edad predominante fue de 15 a 49 años. Se observó una gran variación de la prevalencia de VS entre los países. Con respecto a la VS cometida por una persona íntima, ésta varió del 1 % en Alemania al 92 % en Zimbabue. En cuanto a los factores asociados, se destacan la baja escolaridad, la juventud, las condiciones de salud mental y la salud sexual y reproductiva, así como el uso de alcohol y otras drogas. La revisión muestra la necesidad de profundizar en estudios sobre la violencia sexual, para contribuir a las políticas públicas, a detener la violencia contra las mujeres y la equidad de género.(AU)

Increased alcohol use after Hurricane Ike: The roles of perceived social cohesion and social control.

Hurricane Ike, the third costliest hurricane in US history, made landfall in the Galveston Bay Area in September, 2008. Existing literature postulates that maladaptive behavior such as increased alcohol use is often exhibited by disaster survivors in coping with both disaster-related traumatic events and post-disaster stressful events. In addition, it has also been postulated that survivors' perceptions of social cohesion and social control can potentially serve to moderate such behavior. The purpose of this paper is to study such hypotheses for Hurricane Ike. In particular, we investigate the following four hypotheses: (H1) There is an increase of alcohol use by survivors of Hurricane Ike in the Galveston Bay Area; (H2) There are positive associations between both Ike-related trauma and post-Ike stress events and the increase in alcohol use; (H3) There are negative associations between both perceived social cohesion and social control and the increase in alcohol use following Ike; and finally that (H4) perceived social cohesion and social control serve to moderate the associations between both Ike-related trauma and post-Ike stress events and increased alcohol use after Ike. Using public use survey-weighted data from the Galveston Bay Recovery Study (GBRS) of Ike survivors (N = 658), we tested these hypotheses using logistic regressions controlling for other key socioeconomic variables. Our results confirm H1 and H2. Hypotheses H3 and H4 are partially confirmed with respect to social control, but show that (i) there is a positive association between perceived social cohesion and the increase in alcohol use following Ike, and that (ii) while perceived social cohesion and social control do moderate the association between post-Ike stress events and increased alcohol use, they have no effect on the association between Ike-related trauma and increased alcohol use.

A Multilayer perspective for the analysis of urban transportation systems.

Public urban mobility systems are composed by several transportation modes connected together. Most studies in urban mobility and planning often ignore the multi-layer nature of transportation systems considering only aggregated versions of this complex scenario. In this work we present a model for the representation of the transportation system of an entire city as a multiplex network. Using two different perspectives, one in which each line is a layer and one in which lines of the same transportation mode are grouped together, we study the interconnected structure of 9 different cities in Europe raging from small towns to mega-cities like London and Berlin highlighting their vulnerabilities and possible improvements. Finally, for the city of Zaragoza in Spain, we also consider data about service schedule and waiting times, which allow us to create a simple yet realistic model for urban mobility able to reproduce real-world facts and to test for network improvements.

Exploring the Interconnected Trauma of Personal, Social, and Structural Stressors: Making "Sense" of Senseless Violence.

Although violence is a timeless characteristic of human behavior and history, its prevalence and many forms are proliferated repeatedly through the media. In particular, "senseless" violence against both random and targeted victims puzzles and petrifies onlookers and survivors. Integrating developmental psychology with critical theory, this manuscript begins with a conceptual definition of senseless violence that is coupled with a mapping of the personal, social, and structural etiologies of such violence. This inquiry explores the origins, contexts, and varied manifestations of violence, helps redirect sense-making around such violence, and informs how to cope with and possibly reduce or mitigate it. Utilizing a person-centered perspective from multiple points of view, the analysis focuses primarily on the everyday or chronic experiences of stressors and their relation to internalized and externalized types of violence (i.e., mass shootings, interpersonal violence, self-injury). The manuscript concludes with ways to reduce violence and promote justice on personal, social, and structural levels.

Neutrality in medicine and health professionals from ethnic minority groups: The case of Arab health professionals in Israel.

The ethos of neutrality dominates biomedicine. It has, however, been criticized for leading to a disregard for diversity in medicine. In this article we employ the 'inclusion and difference' approach to gain an understanding of why the ethos of neutrality, on the one hand, and tensions associated with race/ethnicity, on the other, are relevant to the work of ethnic minority health professionals. We sought to explore tensions associated with neutrality in medicine from the point of view of ethnic minority professionals who work in a context of political conflict. We conducted 33 in-depth interviews with Arab health professionals - physicians, nurses and pharmacists - working in Israeli health organizations. The Arab health professionals perceive medical knowledge as being politically neutral; and medical practice as being impartial, universal and humanitarian. They regard the healthcare sector as a relatively egalitarian workplace, into which they can integrate and gain promotion. Nevertheless, the interviewees experienced various instances of treatment refusal, discrimination and racism. In line with the ethos of neutrality, the Israeli medical code of ethics does not relate specifically to Arab professionals and takes their inclusion and integration in healthcare organizations for granted. The ethos of neutrality in medicine underlies the ambivalence inherent in the approach of 'inclusion and difference'. While perceptions of neutrality, alongside values such as equality, cultural competency, impartiality and humanitarian healthcare, do indeed promote the inclusion of minority professionals in health organizations, these same perceptions mask the need to address political events that impinge on the medical milieu and may present an obstacle to designing specific policies to deal with such events.