Establishing a Pediatric Health Equity, Diversity, and Inclusion Research Review Process.

Equity, diversity, and inclusion (EDI) research is increasing, and there is a need for a more standardized approach for methodological and ethical review of this research. A supplemental review process for EDI-related human subject research protocols was developed and implemented at a pediatric academic medical center (AMC). The goal was to ensure that current EDI research principles are consistently used and that the research aligns with the AMC's declaration on EDI. The EDI Research Review Committee, established in January 2022, reviewed EDI protocols and provided recommendations and requirements for addressing EDI-related components of research studies. To evaluate this review process, the number and type of research protocols were reviewed, and the types of recommendations given to research teams were examined. In total, 78 research protocols were referred for EDI review during the 20-month implementation period from departments and divisions across the AMC. Of these, 67 were given requirements or recommendations to improve the EDI-related aspects of the project, and 11 had already considered a health equity framework and implemented EDI principles. Requirements or recommendations made applied to 1 or more stages of the research process, including design, execution, analysis, and dissemination. An EDI review of human subject research protocols can provide an opportunity to constructively examine and provide feedback on EDI research to ensure that a standardized approach is used based on current literature and practice.

Sustainable Approach to Justice, Equity, Diversity, and Inclusion Through Better Quality Measurement.

The US health care industry has broadly adopted performance and quality measures that are extracted from electronic health records and connected to payment incentives that hope to improve declining life expectancy and health status and reduce costs. While the development of a quality measurement infrastructure based on electronic health record data was an important first step in addressing US health outcomes, these metrics, reflecting the average performance across diverse populations, do not adequately adjust for population demographic differences, social determinants of health, or ecosystem vulnerability. Like society as a whole, health care must confront the powerful impact that social determinants of health, race, ethnicity, and other demographic variations have on key health care performance indicators and quality metrics. Tools that are currently available to capture and report the health status of Americans lack the granularity, complexity, and standardization needed to improve health and address disparities at the local level. In this article, we discuss the current and future state of electronic clinical quality measures through a lens of equity.

Centering diversity, equity, and inclusion in a regional professional nursing organization.

BACKGROUND: Professional nursing organizations can respond to threats to social justice by strengthening structures to support diversity, equity, and inclusion (DEI). PURPOSE: Describe implementation strategies and outcomes to advance DEI from the Western Institute of Nursing (WIN). METHODS: In 2019, WIN committed to prioritizing DEI by updating its vision and mission. A taskforce was assembled to conduct member surveys, focus groups, and open forums to generate recommendations on developing and implementing organizational change. DISCUSSION: These initiatives culminated in centralized efforts that include the formation of a standing committee, ongoing member surveys, selection of diverse conference topics and speakers, adoption of inclusive practices, and ongoing assessments to make recommendations to the Board to advance DEI. CONCLUSION: The work of the Committee ensures the organization remains committed to DEI. These strategies inform other nursing organizations as they advance DEI to impact research, education, policy, and practice.

Medical Teacher's equity diversity inclusion policy.

Medical Teacher is a leading international journal in health professions education. The Journal recognizes its responsibility to publish papers that reflect the breadth of topics that meet the needs of its readers around the globe including contributions from countries underrepresented in the health professions education arena. This paper sets out the Journal's policy with regard to Equity Diversity Inclusion (EDI) and the steps to be taken to implement the policy in practice.

Understanding the experiences, needs, and strengths of people with incomplete spinal cord injury who can ambulate.

PURPOSE: To identify the experiences, needs, and strengths of people with incomplete spinal cord injury who can ambulate and to explore and discuss potential supports, services, and programs that would best assist them in the community. MATERIAL AND METHODS: In this qualitative descriptive study, interviews were the primary means of data collection. These were supplemented with descriptive standardized measures of function and life satisfaction. Qualitative data were analyzed thematically. RESULTS: Twenty-four participants were interviewed, their average age was 55 years and 46% were female. We identified three themes: 'I really couldn't go there', described the physical and social barriers experienced by participants, 'It'd be really nice to let the public know there are people out there like me' expressed the desire for greater social understanding of incomplete spinal cord injury, and 'I just don't quit', displayed the perseverance that participants demonstrated following their injury. CONCLUSION: Findings indicate service providers to improve the inclusion of ambulatory individuals with incomplete spinal cord injury in their programs. Suggestions include designing programs (community, healthcare, return to work, peer support), environments using the principles of universal design for people with incomplete spinal cord injury who ambulate, and increasing consideration of their perspectives.Implication for rehabilitation:People with incomplete spinal cord injury who can ambulate live with invisible impairments, which are often not acknowledged by family, friends, health professionals, and people with complete spinal cord injuryThey may feel excluded from activities (organized by spinal cord injury associations) that were originally designed for people with complete spinal cord injuryGreater awareness among health professionals, friends, family, and people with complete spinal cord injury of the needs of people with incomplete spinal cord injury who can ambulate is needed to increase their inclusion.

La educación inclusiva ante los desafíos contemporáneos / Inclusive education in front of contemporary challenges

Introducción: la educación inclusiva constituye actualmente una preocupación para investigadores, docentes, organizaciones internacionales, regionales y nacionales, aunque la toma de conciencia sobre la necesidad de concretar escenarios escolares y sociales inclusivos, ha sido un proceso lento; a pesar de los ingentes esfuerzos de autores reconocidos, instituciones comprometidas y experiencias exitosas, no se generalizan sus resultados, de ahí las motivaciones para la realización de este estudio. Objetivo: actualizar concepciones teóricas sobre la educación inclusiva y su incidencia en un modelo educativo inclusivo contemporáneo. Métodos: se realizó una revisión sistemática de la literatura disponible en sitios web y revistas especializadas, así como artículos compartidos en redes sociales académicas y públicas durante los últimos cinco años, en español e inglés. Se realizó la revisión detallada de autores y la actualización de las referencias bibliográficas utilizadas. Resultados: la educación inclusiva necesita una relación con la propia familia, con una escuela que integre e incluya para lograr una sociedad, un estado y gobierno que no solo vean a su población por lo que les separa y diferencia, sino por lo que les une en la diversidad, mediante aulas inclusivas y un currículo moderno. Conclusiones: ante los retos que se le imponen a la educación frente al panorama mundial, caracterizado por la exclusión social de índole diversa, entre ellos, la desmotivación con los currículos que se ofrecen a los estudiantes, los sistemas educativos se enfrentan a una urgencia: ofrecer una educación de calidad e inclusiva, en atención a la diversidad.

Introduction: inclusive education is currently a concern for researchers, teachers, international, regional, and national organizations, although raising awareness about the need to create inclusive school and social scenarios has been a slow process; despite the enormous efforts of recognized authors, committed institutions and successful experiences, their results are not generalized, hence the motivations for carrying out this study. Objective: update theoretical conceptions about inclusive education and its impact on a contemporary inclusive educational model. Methods: a systematic review of the literature available on websites and specialized journals, as well as articles shared on academic and public social networks over the last five years, in Spanish and English, was carried out. A detailed review of authors and updating of the bibliographic references used was carried out. Results: inclusive education needs a relationship with one's own family, with a school that integrates and includes to achieve a society, a state and government that not only see its population, so it separates and differentiates them, but even though it unites them in diversity, through inclusive classrooms and a modern curriculum. Conclusions: according to the challenges imposed on education in front of the global panorama, characterized by social exclusion of various kinds, including demotivation with the curricula offered to students, educational systems face an urgency: offer quality and inclusive education, in attention to diversity.

Jornalismo, população em situação de rua e eventos internacionais: uma análise de reportagens do jornal O Globo em 2017 / Journalism, homeless population and international events: an analysis of reportages in O Globo newspaper in 2017 / Periodismo, población en situación de calle y eventos internacionales: un análisis de reportajes del periódico O Globo en 2017

Este artigo tem o propósito de analisar as representações das pessoas em situação de rua e da violência em quatro reportagens expressivas do jornal O Globo, a fim de identificar se elas são retratadas como responsáveis pela violência urbana ou como vítimas de grupos violentos. Serão examinadas reportagens publicadas em 2017, um ano após a cidade ter passado por transformações significativas para os Jogos Olímpicos e Paralímpicos, incluindo investimentos em segurança pública por parte dos governos federal e estadual, alterações no espaço urbano e remoção forçada de pessoas em situação de rua das áreas turísticas. Para atingir o objetivo proposto, será utilizada como metodologia a análise de narrativas conforme Bastos e Biar e Spink. Em resumo, o jornal oscilou entre a demonização dessas pessoas, reforçando preconceitos associados a elas, e a abertura, ainda que em menor medida, para a divulgação das violências enfrentadas por esse segmento da população

This article aims to analyze the representations of people experiencing homelessness and of violence in four significant reportages in O Globo newspaper in order to determine whether they are portrayed as responsible for urban violence or as victims of violent groups. The selected reportages which will be examined were published in 2017, a year after the implementation of significant transformations in the city for the Olympic and Paralympic Games, including investments in public security by the federal and state governments, changes in urban space, and removal of homeless population by force from tourist areas. To achieve the proposed objective, the narrative analysis according to the approaches of Bastos and Biar and Spink will be employed as methodology. In short, the newspaper oscillated between demonising these individuals, reinforcing prejudices associated with them, and opening up, albeit to a lesser extent, to publicise the violence faced by this segment of the population

Este artículo tiene como objetivo analizar las representaciones de las personas en situación de calle y de la violencia en cuatro reportajes significativos del periódico O Globo para determinar si él las retrata como responsables de la violencia urbana o como víctimas de grupos violentos. Serán examinados reportajes publicados en 2017, un año después de que la ciudad había pasado por transformaciones significativas debido a los Juegos Olímpicos y Paralímpicos, que incluyeron inversiones en seguridad pública por parte de los gobiernos federal y estatal, cambios en el espacio urbano y la remoción forzada de personas en situación de calle de las zonas turísticas. Para lograr el objetivo propuesto, se empleará el análisis narrativo como metodología de acuerdo con los enfoques de Bastos y Biar y Spink. En resumen, el periódico osciló entre la demonización de estas personas, reforzando los prejuicios asociados a ellas, y la apertura, aunque en menor medida, a la divulgación de las violencias enfrentadas por este segmento de la población

The VLPFC-Engaged Voluntary Emotion Regulation: Combined TMS-fMRI Evidence for the Neural Circuit of Cognitive Reappraisal.

A clear understanding of the neural circuit underlying emotion regulation (ER) is important for both basic and translational research. However, a lack of evidence based on combined neuroimaging and neuromodulation techniques calls into question (1) whether the change of prefrontal-subcortical activity intrinsically and causally contributes to the ER effect; and (2) whether the prefrontal control system directly modulates the subcortical affective system. Accordingly, we combined fMRI recordings with transcranial magnetic stimulation (TMS) to map the causal connections between the PFC and subcortical affective structures (amygdala and insula). A total of 117 human adult participants (57 males and 60 females) were included in the study. The results revealed that TMS-induced ventrolateral PFC (VLPFC) facilitation led to enhanced activity in the VLPFC and ventromedial PFC (VMPFC) as well as attenuated activity in the amygdala and insula during reappraisal but not during nonreappraisal (i.e., baseline). Moreover, the activated VLPFC intensified the prefrontal-subcortical couplings via the VMPFC during reappraisal only. This study provides combined TMS-fMRI evidence that downregulating negative emotion involves the prefrontal control system suppressing the subcortical affective system, with the VMPFC serving as a crucial hub within the VLPFC-subcortical network, suggesting an indirect pathway model of the ER circuit. Our findings outline potential protocols for improving ER ability by intensifying the VLPFC-VMPFC coupling in patients with mood and anxiety disorders.SIGNIFICANCE STATEMENT Using fMRI to examine the TMS effect, we uncovered that the opposite neural changes in prefrontal (enhanced) and subcortical (attenuated) regions are not a byproduct of emotion regulation (ER); instead, this prefrontal-subcortical activity per se causally contributes to the ER effect. Furthermore, using TMS to amplify the neural changes within the ER circuit, the "bridge" role of the VMPFC is highlighted under the reappraisal versus nonreappraisal contrast. This "perturb-and-measure" approach overcomes the correlational nature of fMRI data, helping us to identify brain regions that causally support reappraisal (the VLPFC and VMPFC) and those that are modulated by reappraisal (the amygdala and insula). The uncovered ER circuit is important for understanding the neural systems underlying reappraisal and valuable for translational research.

Understanding the social inclusion needs of people living in mental health supported accommodation.

OBJECTIVES: To identify the social inclusion needs that were (i) most commonly identified and (ii) most and least commonly prioritised as support planning goals for mental health service users living in supported accommodation, using the online Social Inclusion Questionnaire User Experience (SInQUE). We qualitatively examined mental health supported accommodation staff and servicer users' views on barriers to offering support with two less commonly prioritised areas: help finding a partner and feeling less lonely. METHODS: Anonymous SInQUE data were collected during a completed study in which we developed and tested the online SInQUE. Four focus groups were conducted with mental health supported accommodation staff (N = 2) and service users (N = 2). RESULTS: The most common social inclusion needs identified by service users (N = 31) were leisure activities, finding transport options, and feeling less lonely. Of the needs identified, those that service users and staff least frequently prioritised as support planning goals were having company at mealtimes, getting one's own furniture, feeling less lonely, help with finances, and help finding a partner. In the focus groups, staff and service users identified barriers to helping with loneliness and finding a partner which related to staff and service users themselves, supported accommodation services, and wider societal factors.

Modeling Adolescent Social Inclusion to Improve School Completion.

Enhancing social inclusion in young people could increase engagement in education, yet few longitudinal studies have examined this relationship. This study aimed to identify whether social inclusion in an Australian adolescent sample predicted high school completion three years later. Using state-representative data from the International Youth Development Study, two waves of the youngest cohort (51.6% female and 94.6% Australian born) during mid-adolescence (n = 825, Mage = 15.99, SD = 0.39) and post-secondary school (n = 809, Mage = 19.03, SD = 0.44) were analyzed. Factor analysis identified a 4-factor structure that represented an overarching social inclusion construct: (1) Citizenship, (2) Connectedness to Community, (3) Connectedness to Family, and (4) Connectedness to and Participation in School. Multivariate regression analyses indicated higher social inclusion levels in mid-adolescence predicted an increased likelihood of high school completion three years later. The implementation of strategies that incorporate the enhancement of social inclusion may improve educational outcomes for young people.

Systematic mapping of gender equality and social inclusion in WASH interventions: knowledge clusters and gaps.

INTRODUCTION: Poor access to water, sanitation and hygiene (WASH) services threatens population health and contributes to gender and social inequalities, especially in low-resource settings. Despite awareness in the WASH sector of the importance of promoting gender equality and social inclusion (GESI) to address these inequalities, evaluations of interventions focus largely on health outcomes, while gender equality and other social outcomes are rarely included. This review aimed to collate and describe available research evidence of GESI outcomes evaluated in WASH intervention studies. METHODS: We applied a systematic mapping methodology and searched for both academic and grey literature published between 2010 and 2020 in 16 bibliographic databases and 53 specialist websites. Eligibility screening (with consistency checking) was conducted according to predetermined criteria, followed by metadata coding and narrative synthesis. RESULTS: Our evidence base comprises 463 intervention studies. Only 42% of studies measured transformative GESI outcomes of WASH interventions, referring to those that seek to transform gender relations and power imbalances to promote equality. A majority of studies disaggregated outcome data by sex, but other forms of data disaggregation were limited. Most included studies (78%) lacked a specific GESI mainstreaming component in their intervention design. Of the interventions with GESI mainstreaming, the majority targeted women and girls, with very few focused on other social groups or intersectional considerations. CONCLUSION: The review points to various areas for future primary and secondary research. Given the potential contribution of WASH to GESI, GESI considerations should be incorporated into the evaluation of WASH interventions. Regular collection of data and monitoring of GESI outcomes is needed as well as developing new and testing existing methods for monitoring and evaluation of such data.

Health in the well-being economy: background paper: working together to achieve healthy, fairer, prosperous societies across the WHO European Region

This is the main evidence synthesis paper for the WHO European Regional High-level Forum on health in the well-being economy. It sets out why we need to shift to well-being economies and the role that can be played by many different stakeholders, as well as outlining several examples already being implemented.

Saúde mental e cotas: um estudo comparativo entre estudantes universitários no Brasil / Mental health and quotas: a comparative study among university students in Brazil / Salud mental y cuotas: un estudio comparativo entre estudiantes universitarios en Brasil

Com a instauração da política de cotas, ocorreram profundas transformações no perfil dos estudantes das universidades públicas brasileiras. Essa nova composição do corpo discente, com maior representatividade de minorias e/ou estudantes de baixa renda, traz consigo novas demandas relacionadas à saúde mental do estudante. Apesar disso, ainda são escassas as pesquisas que investiguem esse contexto específico. Este estudo visa comparar a saúde mental de estudantes cotistas e não cotistas, avaliando diferenças nas prevalências de sintomas de depressão, ansiedade e estresse entre os dois grupos. Participaram da pesquisa 6.103 estudantes de graduação de uma universidade pública federal, dos quais 2.983 (48,88%) cotistas e 3.120 (51,12%) não cotistas. O levantamento de dados foi feito por meio de questionário on-line contendo questionário sociodemográfico e de hábitos de vida, e pelo Depression Anxiety and Stress Scale, na sua versão reduzida de 21 itens (DASS-21), utilizada para avaliar sintomas de depressão, ansiedade e estresse. Os resultados indicaram que os estudantes cotistas apresentaram maiores prevalências de sintomas de depressão e ansiedade quando comparados aos não cotistas. As áreas de Ciências Exatas e da Terra, e os Bacharelados Interdisciplinares apresentaram maiores diferenças entre os dois grupos em relação a esses problemas em saúde mental. Os resultados apontam para a necessidade de que as universidades estejam atentas às novas demandas em saúde mental dos estudantes e que estas sejam contempladas nas políticas de atenção à saúde estudantil.(AU)

With the introduction of the quota policy, profound changes took place in the profile of students in Brazilian public universities. This new composition of the student body, with greater representation of minorities and/or low-income students, brings new demands related to student mental health. Despite this, there are still few studies investigating this specific context. This study aims to compare the mental health of quota and non-quota students, evaluating differences in the prevalence of symptoms of depression, anxiety, and stress between the two groups. A total of 6,103 undergraduate students from a federal public university participated in the research, of which 2,983 (48.88%) were quota students and 3,120 (51.12%) were nonquota students. Data collection was carried out via an online questionnaire containing a sociodemographic and lifestyle questionnaire, and the Depression Anxiety and Stress Scale, in its reduced version of 21 items (DASS-21) was used to assess symptoms of depression, anxiety, and stress. The results indicated that quota students had higher prevalence of symptoms of depression and anxiety when compared to non-quota students. The areas of Exact and Earth Sciences and Interdisciplinary Bachelors were the ones that showed the greatest differences between the two groups in relation to these mental health problems. The results point to the need for universities to be attentive to the new demands in mental health of students and for these to be included in student health care policies.(AU)

Con la introducción de la política de cuotas, se produjeron cambios profundos en el perfil de los estudiantes de las universidades públicas brasileñas. Esta nueva composición del alumnado, con mayor representación de minorías y/o estudiantes de escasos recursos, trae consigo nuevas demandas relacionadas con la salud mental del alumno. Pero todavía existen pocas investigaciones sobre el contexto específico. Este estudio tiene como objetivo comparar la salud mental de los estudiantes beneficiarios de las políticas de cuotas y los no beneficiarios, y evaluar las diferencias en la prevalencia de síntomas de depresión, ansiedad y estrés entre los dos grupos. En la investigación participaron un total de 6.103 estudiantes de grado de una universidad pública federal, de los cuales 2.983 (48,88%) son estudiantes beneficiarios y 3.120 (51,12%) son estudiantes no beneficiarios. Los datos se recolectaron de un formulario en línea, que estaba compuesto por un cuestionario sociodemográfico y de hábitos de vida, y por la Escala de Depresión, Ansiedad y Estrés, en su versión reducida de 21 ítems (DASS-21), utilizada para evaluar síntomas de depresión, ansiedad y estrés. Los resultados destacaron que los estudiantes beneficiarios de las políticas de cuotas tenían una mayor prevalencia de síntomas de depresión y ansiedad en comparación con los estudiantes no beneficiarios. Las áreas de Ciencias Exactas y de la Tierra y Licenciaturas Interdisciplinarias presentaron las mayores diferencias entre los dos grupos con relación a estos problemas en salud mental. Los resultados apuntan a la necesidad de que las universidades sean conscientes de las nuevas demandas sobre la salud mental de los estudiantes y de que estas se incluyan en las políticas de atención de la salud estudiantil.(AU)