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1.
Scand J Caring Sci ; 38(2): 387-397, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38323688

RESUMO

BACKGROUND: Socially marginalised patients face many challenges related to their health condition and often have several contacts with healthcare and social service workers. The Danish social nursing initiative, whose nurses have experience and knowledge about marginalisation, aims to support socially marginalised patients during hospital admission and through hospital transitions. However, there is limited knowledge about the hospital transitions of patients being supported by a social nurse. OBJECTIVES: The objectives of this study were to explore (1) the perspectives of socially marginalised patients on the transition from hospital to home and (2) how these patients experience the importance of social nursing on patient trajectories after hospital discharge. METHODS: A qualitative study with a phenomenological and hermeneutic approach was performed at a large hospital in southern Denmark. Adult patients who had contact with a social nurse during hospital admission were purposely sampled. Data were collected between January 2023 and March 2023. Initial patient interviews were conducted during hospital admission with a second interview 7-22 days after discharge. Systematic text condensation was used for the analysis, and Nvivo 12 supported data storage and coding. ETHICAL APPROVAL: The study is registered with the Danish Data Protection Agency (22/47509). Informed consent was given by the participants. RESULTS: Sixteen patients participated in the study. The participants experienced major challenges in their transitions from the hospital, which were generally related to their interactions with many different social and healthcare services. While the social nurses supported the patients and helped facilitate care during hospital admission and after discharge, the participants identified transitional care gaps related to multidisciplinary cooperation and standardised care options. CONCLUSIONS: This study identifies challenges related to the hospital transition of socially marginalised patients, which indicates a gap in healthcare services. Future research should focus on improving interprofessional collaboration with socially marginalised patients across healthcare services.


Assuntos
Pesquisa Qualitativa , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Dinamarca , Adulto , Idoso , Marginalização Social/psicologia , Alta do Paciente , Idoso de 80 Anos ou mais
2.
JAMA ; 329(21): 1848-1858, 2023 06 06.
Artigo em Inglês | MEDLINE | ID: mdl-37278814

RESUMO

Importance: The culture of academic medicine may foster mistreatment that disproportionately affects individuals who have been marginalized within a given society (minoritized groups) and compromises workforce vitality. Existing research has been limited by a lack of comprehensive, validated measures, low response rates, and narrow samples as well as comparisons limited to the binary gender categories of male or female assigned at birth (cisgender). Objective: To evaluate academic medical culture, faculty mental health, and their relationship. Design, Setting, and Participants: A total of 830 faculty members in the US received National Institutes of Health career development awards from 2006-2009, remained in academia, and responded to a 2021 survey that had a response rate of 64%. Experiences were compared by gender, race and ethnicity (using the categories of Asian, underrepresented in medicine [defined as race and ethnicity other than Asian or non-Hispanic White], and White), and lesbian, gay, bisexual, transgender, queer (LGBTQ+) status. Multivariable models were used to explore associations between experiences of culture (climate, sexual harassment, and cyber incivility) with mental health. Exposures: Minoritized identity based on gender, race and ethnicity, and LGBTQ+ status. Main Outcomes and Measures: Three aspects of culture were measured as the primary outcomes: organizational climate, sexual harassment, and cyber incivility using previously developed instruments. The 5-item Mental Health Inventory (scored from 0 to 100 points with higher values indicating better mental health) was used to evaluate the secondary outcome of mental health. Results: Of the 830 faculty members, there were 422 men, 385 women, 2 in nonbinary gender category, and 21 who did not identify gender; there were 169 Asian respondents, 66 respondents underrepresented in medicine, 572 White respondents, and 23 respondents who did not report their race and ethnicity; and there were 774 respondents who identified as cisgender and heterosexual, 31 as having LGBTQ+ status, and 25 who did not identify status. Women rated general climate (5-point scale) more negatively than men (mean, 3.68 [95% CI, 3.59-3.77] vs 3.96 [95% CI, 3.88-4.04], respectively, P < .001). Diversity climate ratings differed significantly by gender (mean, 3.72 [95% CI, 3.64-3.80] for women vs 4.16 [95% CI, 4.09-4.23] for men, P < .001) and by race and ethnicity (mean, 4.0 [95% CI, 3.88-4.12] for Asian respondents, 3.71 [95% CI, 3.50-3.92] for respondents underrepresented in medicine, and 3.96 [95% CI, 3.90-4.02] for White respondents, P = .04). Women were more likely than men to report experiencing gender harassment (sexist remarks and crude behaviors) (71.9% [95% CI, 67.1%-76.4%] vs 44.9% [95% CI, 40.1%-49.8%], respectively, P < .001). Respondents with LGBTQ+ status were more likely to report experiencing sexual harassment than cisgender and heterosexual respondents when using social media professionally (13.3% [95% CI, 1.7%-40.5%] vs 2.5% [95% CI, 1.2%-4.6%], respectively, P = .01). Each of the 3 aspects of culture and gender were significantly associated with the secondary outcome of mental health in the multivariable analysis. Conclusions and Relevance: High rates of sexual harassment, cyber incivility, and negative organizational climate exist in academic medicine, disproportionately affecting minoritized groups and affecting mental health. Ongoing efforts to transform culture are necessary.


Assuntos
Cyberbullying , Docentes de Medicina , Incivilidade , Cultura Organizacional , Assédio Sexual , Local de Trabalho , Feminino , Humanos , Masculino , Etnicidade/psicologia , Etnicidade/estatística & dados numéricos , Incivilidade/estatística & dados numéricos , Minorias Sexuais e de Gênero/psicologia , Minorias Sexuais e de Gênero/estatística & dados numéricos , Assédio Sexual/psicologia , Assédio Sexual/estatística & dados numéricos , Local de Trabalho/organização & administração , Local de Trabalho/psicologia , Local de Trabalho/estatística & dados numéricos , Centros Médicos Acadêmicos/organização & administração , Centros Médicos Acadêmicos/estatística & dados numéricos , Cyberbullying/psicologia , Cyberbullying/estatística & dados numéricos , Condições de Trabalho/organização & administração , Condições de Trabalho/psicologia , Condições de Trabalho/estatística & dados numéricos , Marginalização Social/psicologia , Grupos Minoritários/psicologia , Grupos Minoritários/estatística & dados numéricos , Saúde Mental/estatística & dados numéricos , Docentes de Medicina/organização & administração , Docentes de Medicina/psicologia , Docentes de Medicina/estatística & dados numéricos , Medicina/organização & administração , Medicina/estatística & dados numéricos , Estados Unidos/epidemiologia , Asiático/psicologia , Asiático/estatística & dados numéricos , Brancos/psicologia , Brancos/estatística & dados numéricos , Inquéritos e Questionários , Racismo/psicologia , Racismo/estatística & dados numéricos , Sexismo/psicologia , Sexismo/estatística & dados numéricos , Preconceito/etnologia , Preconceito/psicologia , Preconceito/estatística & dados numéricos
3.
Clin Chest Med ; 44(2): 425-434, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-37085230

RESUMO

In the United States, the coronavirus disease-2019 (COVID-19) pandemic has disproportionally affected Black, Latinx, and Indigenous populations, immigrants, and economically disadvantaged individuals. Such historically marginalized groups are more often employed in low-wage jobs without health insurance and have higher rates of infection, hospitalization, and death from COVID-19 than non-Latinx White individuals. Mistrust in the health care system, language barriers, and limited health literacy have hindered vaccination rates in minorities, further exacerbating health disparities rooted in structural, institutional, and socioeconomic inequities. In this article, we discuss the lessons learned over the last 2 years and how to mitigate health disparities moving forward.


Assuntos
COVID-19 , Desigualdades de Saúde , Acessibilidade aos Serviços de Saúde , Determinantes Sociais da Saúde , Discriminação Social , Populações Vulneráveis , Humanos , Negro ou Afro-Americano , COVID-19/epidemiologia , COVID-19/etnologia , COVID-19/prevenção & controle , COVID-19/psicologia , Emigrantes e Imigrantes/psicologia , Emigrantes e Imigrantes/estatística & dados numéricos , Etnicidade/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/economia , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Hispânico ou Latino/psicologia , Hispânico ou Latino/estatística & dados numéricos , Povos Indígenas/psicologia , Povos Indígenas/estatística & dados numéricos , Pobreza/etnologia , Pobreza/psicologia , Pobreza/estatística & dados numéricos , Determinantes Sociais da Saúde/economia , Determinantes Sociais da Saúde/etnologia , Determinantes Sociais da Saúde/estatística & dados numéricos , Discriminação Social/economia , Discriminação Social/etnologia , Discriminação Social/psicologia , Discriminação Social/estatística & dados numéricos , Marginalização Social/psicologia , Confiança/psicologia , Estados Unidos/epidemiologia , Vacinação/economia , Vacinação/psicologia , Vacinação/estatística & dados numéricos , Populações Vulneráveis/psicologia , Populações Vulneráveis/estatística & dados numéricos , Brancos/psicologia , Brancos/estatística & dados numéricos
4.
Ann Fam Med ; 21(Suppl 2): S106-S108, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-36849486

RESUMO

Addressing the unequal impact of health disparities on historically marginalized communities is a top public health priority. Diversifying the work force has been lauded as key to addressing this challenge. Contributing to diversity in the workforce is the recruitment and retention of health professionals previously excluded and underrepresented in medicine. A major obstacle to retention, however, is the unequal way in which health professionals experience the learning environment. Through this perspective of 4 generations of physicians and medical students, the authors seek to highlight the similarities that have persisted over 40 years in the experiences of being underrepresented in medicine. Through a series of conversations and reflective writing, the authors reveal themes that spanned generations. Two common themes among the authors are the feeling of not belonging and feeling invisible. This is experienced in various aspects of medical education and academic careers. The lack of representation, unequal expectations, and over taxation contributes to the feeling of not belonging, leading to emotional, physical, and academic fatigue. Feeling invisible, yet paradoxically being hyper-visible, is also common. Despite the challenges, the authors conclude with a sense of hope for the future, if not for them, for the generations to come.


Assuntos
Diversidade, Equidade, Inclusão , Educação Médica , Pessoal de Saúde , Humanos , Comunicação , Emoções , Minorias Desiguais em Saúde e Populações Vulneráveis , Pessoal de Saúde/educação , Pessoal de Saúde/psicologia , Mão de Obra em Saúde , Seleção de Pessoal , Reorganização de Recursos Humanos , Saúde Pública , Determinantes Sociais da Saúde , Isolamento Social/psicologia , Marginalização Social/psicologia , Estudantes de Medicina/psicologia , Médicos/psicologia
5.
Behav Med ; 49(2): 172-182, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-34818984

RESUMO

Most research on cultural stressors and alcohol has focused on intercultural stressors. Continuing to exclude intracultural stressors (e.g., intragroup marginalization) from alcohol research will yield a biased understanding of the experiences of Hispanics living in a bicultural society. As we amass more studies on intracultural stressors, research will be needed to identify mutable sociocultural factors that may mitigate the association between intracultural stressors and alcohol. To address these limitations, we examined the association between intragroup marginalization and alcohol use severity and the extent to which gender and bicultural self-efficacy may moderate this association. A convenience sample of 200 Hispanic emerging adults ages 18-25 (men = 101, women = 99) from Arizona (n = 99) and Florida (n = 101) completed a cross-sectional survey. Data were analyzed using hierarchical multiple regression and moderation analyses. Higher intragroup marginalization was associated with higher alcohol use severity. Gender functioned as a moderator whereby intragroup marginalization was associated with higher alcohol use severity among men, but not women. Also, higher social groundedness functioned as a moderator that weakened the association between intragroup marginalization and alcohol use severity. Role repertoire did not function as a moderator. Our findings are significant because they enhance the reliability of the association between intragroup marginalization and alcohol use severity, and the moderating effect of gender in this respective association. This emerging line of research suggests that alcohol interventions targeting Hispanics may have a significant limitation by not accounting for intracultural stressors.


Assuntos
Adaptação Psicológica , Consumo de Bebidas Alcoólicas , Hispânico ou Latino , Autoeficácia , Estresse Psicológico , Adolescente , Adulto , Feminino , Humanos , Masculino , Adulto Jovem , Consumo de Bebidas Alcoólicas/etnologia , Consumo de Bebidas Alcoólicas/psicologia , Estudos Transversais , Cultura , Papel de Gênero , Hispânico ou Latino/psicologia , Gravidade do Paciente , Reprodutibilidade dos Testes , Fatores Sexuais , Marginalização Social/psicologia , Estresse Psicológico/etnologia , Estresse Psicológico/psicologia
7.
PLoS One ; 17(2): e0263450, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35171929

RESUMO

BACKGROUND: Due to the circumstances of their early lives, young refugees are at risk of experiencing adverse labour market and health outcomes. The post-settlement environment is thought to play a decisive role in determining how this vulnerability plays out. This study compared trends in labour market marginalisation in young refugees and their majority peers during early adulthood in two national contexts, Denmark and Sweden, and explored the mediating role of common mental disorders and secondary school completions. METHODS: Using registry data, 13,390/45,687 refugees were included in Denmark/Sweden and 1:5 matched to majority peers. Inequalities in labour market marginalisation were investigated during 2012-2015 in each country using linear probability models and mediation analysis. Country trends were standardised to account for differences in observed population characteristics. RESULTS: The risk of marginalisation was 2.1-2.3 times higher among young refugees compared with their majority peers, but the risk decreased with age in Sweden and increased in Denmark for refugees. Birth-cohort differences drove the increase in Denmark, while trends were consistent across birth-cohorts in Sweden. Differences in population characteristics did not contribute to country differences. Common mental disorders did not mediate the inequality in either country, but secondary school completions did (77-85% of associations eliminated). CONCLUSIONS: The findings document both the vulnerability of young refugees to labour market marginalisation and the variability in this vulnerability across post-settlement contexts. While the contrast in policy climates in Denmark and Sweden sharpened over time, the risk of marginalisation appeared more similar in younger cohorts, pointing to the importance of factors other than national immigration and integration policies. Institutional efforts to assist young refugees through secondary education are likely to have long-lasting consequences for their socio-economic trajectories.


Assuntos
Transtornos Mentais/epidemiologia , Refugiados/psicologia , Sistema de Registros/estatística & dados numéricos , Instituições Acadêmicas/estatística & dados numéricos , Marginalização Social/psicologia , Fatores Socioeconômicos , Desemprego/estatística & dados numéricos , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Refugiados/estatística & dados numéricos , Adulto Jovem
9.
Psicol. Estud. (Online) ; 27: e47596, 2022.
Artigo em Português | LILACS, INDEXPSI | ID: biblio-1365265

RESUMO

RESUMO. Este estudo pretende colocar a clínica psicológica como um espaço de desvelamento das desigualdades sociais a partir da escuta de sujeitos excluídos através de plantões psicológicos. Percebe-se uma lacuna na literatura especializada em psicologia clínica que, geralmente, não vincula processos clínicos e processos psicossociais, mantendo um discurso hegemônico que pouco articula o psicológico, o social e o político. A Teoria Fundamentada nos dados, metodologia de natureza qualitativa, foi adotada nesse estudo. Através da análise qualitativa de diários de campos produzidos a partir de atendimentos do tipo plantão psicológico, foram geradas categorias que apontam para a fragilidade dos laços familiares e comunitários, os sofrimentos de ser tratado como inferior e a necessidade de ampliações de práticas clínicas com pessoas excluídas. As precariedades materiais e simbólicas vividas pelos sujeitos excluídos são reproduzidas nas suas redes relacionais e comunitárias como violências, opressões e vínculos fragilizados. A inclusão no lugar da inadequação e da inferioridade excluem os sujeitos da possibilidade de se perceberem como dignos e capazes de contribuir com a sociedade, gerando um apagamento de si mesmo. Houve a necessidade de uma prática clínica ampliada que levasse em consideração as vivências específicas de pessoas excluídas e que pudesse produzir novos encontros e novos afetos como contraponto às desqualificações cotidianamente recebidas. Na escuta de sujeitos de classes populares a equipe buscou sustentar a complexidade presente nos sofrimentos, focalizando não só suas questões subjetivas, mas também a produção social e histórica de suas vulnerabilidades.


RESUMEN. Este estudio pretende incluir la clínica psicológica como un espacio para desvelar las desigualdades sociales a través de la escucha de sujetos excluidos con planton psicológico. Se percibe una ausencia en la literatura especializada en psicología clínica que, en general, no vincula procesos clínicos y procesos psicosociales, manteniendo un discurso hegemónico que poco articula problemas psicológicos, sociales y políticos. En este estudio se adoptó la Teoría Fundamentada, una metodologia cualitativa. Através del análisis cualitativo de los registros producidos com el material do planton psicológico, se generaron categorias que apuntan a la fragilidad de los lazos familiares y comunitarios, los sufrimientos de ser tratados como inferiores y la necesidad de ampliar las práticas clínicas con personas excluidas. La precariedad material y simbólica vivida por los sujetos excluidos se reproduce en sus redes relacionales y comunitarias como violencia, opresión y vínculos debilitados. La inclusión en lugar de inadecuación e inferioridad excluye a los sujetos de la posibilidad de percibirse a si mismos como dignos y capaces de contribuir a la sociedad, generando un debilitamiento de si mismos. Se notó la necesidad de una prática clínica ampliada que consideran las vivencias específicas de las personas excluidas y que puede producir nuevos encuentros y nuevos afectos como contrapunto a las descalificaciones diarias recibidas. En la escucha de sujetos de clases populares el equipo buscó sostener la complejidad presente en los sufrimientos, enfocando no sólo sus cuestiones subjetivas, sino también la producción social e histórica de sus vulnerabilidades.


ABSTRACT This study intends to place the psychological clinic as a space for unveiling social inequalities by listening to excluded subjects through the psychological on-call sessions. There is a gap in the specialized literature in clinical psychology that, generally, does not link clinical processes and psychosocial processes, maintaining a hegemonic discourse that barely articulates the psychological, social and political issues. The Grounded Theory, as a qualitative-interpretative methodology, was adopted in this study. The qualitative analysis of field diaries produced based on the psychological on-call sessions generated categories that point to the fragility of family and community bonds, the sufferings of being treated as inferior, and the need to expand clinical practices with excluded people. The material and symbolic precariousness experienced by excluded subjects are reproduced in their relational and community networks as violence, oppression and weakened bonds. Inclusion in place of inadequacy and inferiority excludes people from the possibility of perceiving themselves as worthy and capable of contributing to society, generating an erasure of themselves. There was a need for an expanded clinical practice that considered the specific experiences of excluded subjects, which could produce new encounters and affections as a counterpoint to the disqualifications received daily. In listening to popular classes people, the research team sought to sustain the complexity present in sufferings, focusing not only on their subjective issues but also on the social and historical production of their vulnerabilities.


Assuntos
Humanos , Masculino , Feminino , Psicologia , Psicologia Clínica , Fatores Socioeconômicos , Isolamento Social/psicologia , Violência/psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Relações Familiares/psicologia , Usuários de Drogas/psicologia , Marginalização Social/psicologia , Angústia Psicológica , Serviços de Saúde Mental
10.
Am Psychol ; 76(4): 582-595, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34410736

RESUMO

In this paper, we articulate a conceptual model for the process of ethnic identity development and integration among Asian American children and youth that offers potential explanations for their marginalization as they negotiate multiple facets of their identities and locate themselves in local and national contexts. The conceptual model is based on an integration of theory and empirical research on the intertwined processes of ethnic identity development and socialization of children and youth in Asian American families and is anchored in the developmental domain of identity formation and integration. We present the conceptual model as three overlapping circles to represent salient features of physical and social contexts, prevalent metanarratives that have been empirically established as salient meaning-making frames pertinent to the lived experience of Asian Americans in the United States, and the dynamic individual-context interplay and mutual adjustment that is part of developmental process. We then build on the work of scholars who have advanced the theoretical and empirical literature on the Asian American experience in the United States, to illustrate how the three components (features of context, master narratives, and developmental processes) intersect in the overlapping spaces of the model to foreground the dialectic processes whereby identity is constructed as contextualized in place. The primary contribution of the model is to facilitate generating research questions that can unravel the complexities of how specific ethnic backgrounds (e.g., immigration and settlement histories), developmental status, individual position on societal racial/ethnic hierarchy, and prevalent societal metanarratives contextualize the development of an Asian American ethnic-racial identity. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Asiático/psicologia , Marginalização Social/psicologia , Socialização , Emigrantes e Imigrantes/psicologia , Humanos , Meio Social , Estados Unidos
11.
JAMA Netw Open ; 4(7): e2116364, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34297076

RESUMO

Importance: Race-based discrimination represents an ongoing public health crisis in the US, manifested by wide-ranging disparities in youth health, mental health, and violence exposure. However, studies of racial discrimination often neglect experiences of identity-based bullying (IBB) stemming from other marginalized identities, such as gender identity and sexual orientation. Objective: To examine associations between experiences of IBB based on race/ethnicity/national origin and other social identities and youth health, mental health, and violence outcomes. Design, Setting, and Participants: This cross-sectional study analyzed responses from an anonymous survey conducted at 13 public high schools in Pittsburgh, Pennsylvania, between October 15, 2018, and October 19, 2018. Participants included in the study were in the 9th through 12th grades. Data were analyzed from October 15, 2020, to February 14, 2021. Exposures: Experiences of bullying and bullying perpetration based on race/ethnicity/national origin and other social identities (ie, gender identity, sexual orientation, religion, physical or mental disability, immigration status, other unspecified reason). Main Outcomes and Measures: Youth health (delayed well care; forgone medical care; physical, mental, or emotional limitations), mental health (nonsuicidal self-injury, suicidal ideation), and violence involvement (weapon perpetration or survivorship, fighting, sexual assault, adolescent relationship abuse, experiencing homicide of friend or family member) were assessed using self-reported items modeled on the Centers for Disease Control and Prevention Youth Risk Behavior Survey. Results: Among 3939 participants, the mean (SD) age was 15.7 (1.3) years; 1380 students (36.3%) identified as Black/African American, 2086 (53.7%) as assigned female at birth, 1021 (32.6%) as belonging to a sexual minority group, and 313 (10.0%) as gender diverse. Among reported social identities, race/ethnicity-based experiences of bullying (375 students [9.5%]) and bullying perpetration (209 students [5.8%]) were the most common. Youth with multiple stigmatized identities experienced even higher rates of experiences of IBB and IBB perpetration. Specifically, the highest rates of IBB were reported by gender diverse Black and Hispanic youth. Experiencing IBB based on multiple stigmatized identities was associated with all outcomes, including delayed well care (aOR, 1.41; 95% CI, 1.20-1.65), forgone medical care (aOR, 1.64; 95% CI, 1.44-1.87), nonsuicidal self-injury (aOR, 2.86; 95% CI, 2.53-3.24), suicidal ideation (aOR, 2.49; 95% CI, 2.20-2.83), and greater violence involvement (experiencing violence: aOR, 2.90; 95% CI, 2.45-3.43; homicide survivorship: aOR, 1.19; 95% CI, 1.06-1.33). Conclusions and Relevance: These results further encourage the development of youth health, mental health, and violence prevention programs that address experiences of bullying based on multiple marginalized identities.


Assuntos
Comportamento do Adolescente/psicologia , Bullying/psicologia , Identificação Social , Adolescente , Bullying/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Masculino , Pennsylvania , Grupos Raciais/etnologia , Grupos Raciais/psicologia , Grupos Raciais/estatística & dados numéricos , Racismo/psicologia , Racismo/estatística & dados numéricos , Instituições Acadêmicas/organização & administração , Instituições Acadêmicas/estatística & dados numéricos , Comportamento Sexual/psicologia , Marginalização Social/psicologia
13.
Psychoneuroendocrinology ; 129: 105215, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34090051

RESUMO

Sexually-diverse individuals (those who seek sexual or romantic relationships with the same and/or multiple genders) and gender-diverse individuals (those whose gender identity and/or expression differs from their birth-assigned sex/gender) have disproportionately high physical health problems, but the underlying biological causes for these health disparities remain unclear. Building on the minority stress model linking social stigmatization to health outcomes, we argue that systemic inflammation (the body's primary response to both physical and psychological threats, indicated by inflammatory markers such as C-reactive protein and proinflammatory cytokines) is a primary biobehavioral pathway linking sexual and gender stigma to physical health outcomes. Expectations and experiences of social threat (i.e., rejection, shame, and isolation) are widespread and chronic among sexually-diverse and gender-diverse individuals, and social threats are particularly potent drivers of inflammation. We review research suggesting that framing "minority stress" in terms of social safety versus threat, and attending specifically to the inflammatory consequences of these experiences, can advance our understanding of the biobehavioral consequences of sexual and gender stigma and can promote the development of health promoting interventions for this population.


Assuntos
Identidade de Gênero , Disparidades nos Níveis de Saúde , Inflamação/epidemiologia , Comportamento Sexual/psicologia , Minorias Sexuais e de Gênero/estatística & dados numéricos , Humanos , Grupos Minoritários/psicologia , Grupos Minoritários/estatística & dados numéricos , Minorias Sexuais e de Gênero/psicologia , Marginalização Social/psicologia , Estigma Social
15.
Am Psychol ; 76(3): 488-501, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32772541

RESUMO

Within mainstream institutions such as colleges and universities, scientists and social leaders, alike, are faced with persistent and new challenges to forging paths toward inclusion among marginalized group members (e.g., Latino/a/x and African Americans). Integrating theoretical perspectives that conceptualize identity among marginalized groups as tied to culture and strengths with literatures on threat and stigma, we propose a "pride and prejudice" approach to inclusion. We provide support for the efficacy of inclusion as 2 pathways-one route that is associated with recognizing "pride" or the history and culture of marginalized groups and another that is related to reducing "prejudice" or perceived discrimination toward marginalized groups. Specifically, we demonstrate using actual demands for inclusion generated by students attending 80 colleges and universities that a pride and prejudice approach is consistent with collective calls for institutional change voiced by marginalized group members and their allies (Study 1). Then, Study 2, using longitudinal data of Latino/a/x and African American students (N = 1,967) attending 27 colleges and universities we reveal the impact of pride (e.g., taking an ethnic studies course) and prejudice (e.g., perceived discrimination) experiences on sense of belonging, and in turn academic and health outcomes (e.g., graduation rates, depression). We provide evidence for 1 theory-based process whereby individual experiences tied to pride and prejudice can impact belongingness through intragroup and intergroup relations. Theory and policy implications for institutional inclusion efforts including the importance of fostering ties to ingroup and outgoup members are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Preconceito/prevenção & controle , Identificação Social , Etnicidade/psicologia , Processos Grupais , Humanos , Preconceito/psicologia , Grupos Raciais/psicologia , Marginalização Social/psicologia , Estigma Social , Universidades
16.
J Pers Soc Psychol ; 120(5): 1287-1316, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-32757585

RESUMO

Members of high-status groups (e.g., men) often lead social justice efforts that seek to benefit low-status groups (e.g., women), but little is known about how observers respond to such instances of visible and influential solidarity. We presented information about a nonprofit organization seeking to address gender (Study 1, N = 198) or racial (Study 2, N = 216) inequality, in which the leadership team was manipulated to include a numerical majority of either high-status group members or low-status group members. Members of low-status groups who read about the majority high-status leadership team reported lower levels of collective action intentions, compared with those who read about the majority low-status leadership team. Mediation analyses (Studies 1 and 2) and an experimental-causal-chain design (Study 3, N = 405) showed that lower collective action intentions in response to the majority high-status leadership team were mediated by participants' perception of a specific problem presented by high-status group leaders (lower awareness of inequality) and lower levels of hope. Study 4 (N = 555) demonstrated that low-status group members responded more negatively to a majority high-status leadership team in an organization seeking to benefit their low-status ingroup (solidarity context), compared with organizations seeking to benefit other groups (nonsolidarity contexts). Results provide the first evidence that the presence of influential high-status group leaders can discourage members of low-status groups from joining a social justice effort that seeks to benefit their ingroup, and that these negative responses extend beyond preferences predicted by frameworks of ingroup bias and role congruity. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Hierarquia Social , Liderança , Justiça Social , Marginalização Social/psicologia , Adolescente , Adulto , Idoso , Feminino , Identidade de Gênero , Humanos , Masculino , Pessoa de Meia-Idade , Grupos Raciais , Adulto Jovem
18.
Diabetes Metab Syndr ; 14(5): 817-823, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32540735

RESUMO

BACKGROUND AND AIMS: 2019-coronavirus disease (COVID-19) is causing insurmountable psychosocial impact on the whole mankind. Marginalized community, particularly those with substance use disorders (SUD), are particularly vulnerable to contract the infection and also likely to suffer from greater psychosocial burden. This article analyses the intricate bi-directional relationship between COVID-19 and addiction. METHODS: Pubmed and Google Scholar are searched with the following key terms- "COVID-19", "SARS-CoV2", "Pandemic", "Addiction", "Opioid", "Alcohol", "Smoking", "Addiction Psychiatry", "Deaddiction", "Substance use disorders", "Behavioral addiction". Few newspaper reports related to COVID-19 and addiction have also been added as per context. RESULTS: People with SUD are at greater risk of worse COVID-19 outcome. There is surge of addictive behaviors (both new and relapse) including behavioral addiction in this period. Withdrawal emergencies and death are also being increasingly reported. Addicted people are especially facing difficulties in accessing the healthcare services which are making them prone to procure drugs by illegal means. CONCLUSION: COVID-19 and addiction are the two pandemics which are on the verge of collision causing major public health threat. While every effort must be taken to make the public aware of deleterious effects of SUD on COVID-19 prognosis, the resumption of deaddiction services and easier accessibility of prescription drugs are needs of the hour.


Assuntos
Comportamento Aditivo/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Comportamento Aditivo/complicações , Comportamento Aditivo/psicologia , Betacoronavirus/fisiologia , COVID-19 , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Atenção à Saúde/métodos , Atenção à Saúde/organização & administração , Atenção à Saúde/tendências , Acessibilidade aos Serviços de Saúde/organização & administração , Acessibilidade aos Serviços de Saúde/normas , Acessibilidade aos Serviços de Saúde/tendências , Humanos , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Prognóstico , SARS-CoV-2 , Marginalização Social/psicologia , Transtornos Relacionados ao Uso de Substâncias/complicações
19.
Rev Esp Sanid Penit ; 22(1): 23-31, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32406478

RESUMO

OBJECTIVES: To examine the predictive validity of the HCR-20 (The Historical Clinical Risk Management-20) to predict future violent incidents in a representative sample of patients with severe mental disorders and with a history of previous admission to prison, who after release are in a situation of extreme social exclusion. MATERIAL AND METHOD: The study sample was selected from the 235 patients treated by the Mental Health Street Team of Madrid (ECASAM) from June 2014 to June 2017, including those with a previous history of a previous internment in a penitentiary (about which, the HCR-20 was completed). RESULTS: Of the 44 patients included, 29.6% (n=13) ended up participating in a violent incident after the release. The ROC curves (Receiver Operating Characteristic) analysis indicated that the total score of HCR-20 (AUC 0.98, p=0.01) has a high predictive validity. CONCLUSIONS: The social and medical changes that take place after the release of patients with severe mental illness justify the need to reassess the risk of violence. In this evaluation, the HCR-20 guide is a useful tool for predicting the risk of involvement in future violent incidents, and the inclusion of factors such as social exclusion and its consequences, as well as problems with substance use is especially important.


Assuntos
Criminosos/psicologia , Pessoas Mal Alojadas/psicologia , Transtornos Mentais/psicologia , Testes Psicológicos , Reincidência/psicologia , Isolamento Social/psicologia , Violência/psicologia , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prisioneiros/psicologia , Curva ROC , Estudos Retrospectivos , Medição de Risco , Gestão de Riscos , Marginalização Social/psicologia , Violência/prevenção & controle
20.
BMC Public Health ; 20(1): 525, 2020 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-32306931

RESUMO

BACKGROUND: The last decade has highlighted how menstrual hygiene management (MHM) is a public health issue because of its link to health, education, social justice and human rights. However, measurement of MHM has not been validated across different studies. The objective of this manuscript was to test the psychometric properties of a MHM scale. METHODS: An embedded mixed-method design was utilized. The girls (age 12-19) were from three districts of Uttar Pradesh (Mirzapur, Jaunpur and Sonebhadra), India. A total of 2212 girls participated in the structured questionnaire. Trained interviewers collected the data on tablets using computer assisted personal interviewing. A total of 36 FGDs were conducted among 309 girls between. Trained moderators collected the data. Factor analysis and thematic analysis was conducted to analyze and triangulate the data. RESULTS: More than 90% of the girls were from a marginalized caste. Overall, 28% of the girls practiced all six MHM behaviors adequately. The factor analysis found five separate constructs corresponding to menstrual health and hygiene management (MHHM) with a variation of 84% and eigenvalue of 1.7. Preparation of clean absorbent, storage of clean absorbent, frequency of changing and disposal loaded separately, corresponding to menstrual health. Privacy to change and hygiene loaded together (eigenvalue 0.91 each), corresponding to hygiene management. An underlying theme from the FGD was menstruation as a taboo and lack of privacy for changing the absorbent. CONCLUSION: MHM is multi-dimensional construct comprising of behaviors which were time-bound by menstruation (menstrual health) and behaviors not time-bound by menstruation (hygiene management). Based on these results, the author recommends that MHHM is used as an acronym in the future and proposes a revised definition for MHHM.


Assuntos
Higiene , Menstruação/psicologia , Escalas de Graduação Psiquiátrica/normas , Autocuidado/psicologia , Inquéritos e Questionários/normas , Adolescente , Criança , Pesquisa Participativa Baseada na Comunidade , Estudos Transversais , Análise Fatorial , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Índia , Produtos de Higiene Menstrual , Privacidade/psicologia , Psicometria , Marginalização Social/psicologia , Adulto Jovem
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