Discrimination and Cognition in Midlife Black Women: The Roles of Social Support and Spirituality.

OBJECTIVES: Black women are at high risk for discrimination and cognitive impairment in late life. It is not known if discrimination is a risk factor for cognitive decline in Black women and if so, what factors are protective against the adverse cognitive effects of discrimination. Using the biopsychosocial model of gendered racism, we determined if discrimination is associated with poorer cognition in midlife Black women and if social support and/or spirituality would protect against the deleterious effects of discrimination on cognition. METHODS: Participants were midlife Black women (N = 669) from the Study of Women's Health Across the Nation. Discrimination was measured by the Everyday Discrimination scale. Cognitive outcomes included episodic memory, processing speed, and working memory. Total social support, emotional support, instrumental support, and spirituality were assessed as protective factors. RESULTS: Contrary to expectations, structural equation modeling indicated that discrimination was associated with better immediate recall. For women with more emotional support, greater discrimination was associated with better immediate recall than for women with lower emotional support. Spirituality was not a significant moderator in the association between discrimination and cognition. DISCUSSION: Discrimination had unexpected positive associations with learning and attention-based cognitive skills for midlife Black women. Discrimination might enhance vigilance, which could be facilitated by higher levels of emotional support. There is an opportunity for clinical and public health interventions for cognitive health and discrimination focused on Black women to better incorporate emotional support as a coping resource.

As Much As I Can - Utilizing Immersive Theatre to Reduce HIV-Related Stigma and Discrimination Toward Black Sexual Minority Men.

BACKGROUND: Despite advances in biomedical HIV prevention modalities such as pre-exposure prophylaxis to prevent the transmission of HIV, racial/ethnic and sexual/gender minority populations are disproportionately impacted by HIV epidemic. Alarming rates of HIV have persisted among Black gay and bisexual men, particularly in Southern states. METHODS: Utilizing data from the ViiV ACCELERATE! initiative, we explored the impact of As Much As I Can, an immersive theatre production, on HIV-related stigma behaviors. A self-administered post-performance survey was conducted with a cohort (n = 322) of randomly selected audience members. RESULTS: Overall, the results showed participants had a highly favorable experience, rating the performance with a mean score of 9.77/10. Respondents indicated they intended to change behaviors to promote HIV prevention education and to reduce stigma and discrimination including: (1) Say something if I hear stigmatizing language against people living with HIV (75.4%), (2) Say something if I hear anti-gay language (69.7%) and (3) Tell others about HIV prevention options (e.g., PrEP, PEP, condoms (64.1%). The findings show there is an association between HIV-related behavior intention and linkage to HIV care. Respondents who reported they were more likely to say something about HIV stigma were almost three times (O.R. 2.77; 95% C.I. 0.98-7.8) more likely to indicate they would follow up with a healthcare professional. CONCLUSIONS: This study suggests that immersive theatre is an effective method for communicating HIV prevention education and reducing HIV-related structural stigma and discrimination that increases HIV vulnerability for Black sexual minority men.

Encarceramento feminino: um debate entre criminologia e perspectivas feministas / Female incarceration: a debate between criminology and feminist perspectives / Encarcelamiento femenino: un debate entre la criminología y las perspectivas feministas

Este ensaio teórico-reflexivo tem como objetivo discutir sobre as contribuições dos estudos da criminologia e sua crítica para as diversas formas de aprisionamento feminino, e mais atualmente para o encarceramento em massa no sistema prisional, além de abrir espaço para o debate sobre as diferentes perspectivas feministas e as relações com os estudos criminológicos, sobretudo com os posicionamentos da chamada criminologia crítica. Reconhecem-se importantes avanços e conquistas feministas no debate sobre a estruturação masculinizada do direito penal e do seu fazer jurídico, mas também a manutenção de diversas formas de violência de gênero que configuram um sistema penal antropocêntrico, seletivo, racista e discriminatório. Indica-se a urgência de estudos interseccionais que considerem as particularidades e reinvindicações das mulheres no cárcere e suas formas de militância, sobretudo diante de população carcerária feminina composta majoritariamente por mulheres negras, pobres e periféricas. Faz-se visível a necessidade de uma análise dos fatores que atravessam o encarceramento feminino por uma ótica feminista plural, adequada às realidades que se estudam e atenta às múltiplas perspectivas que podem existir dentro do feminismo.(AU)

This theoretical-reflexive essay aims to discuss the contributions of criminological studies and their critique of the various forms of imprisonment of women, and more recently of mass incarceration in the prison system, in addition to opening space for the debate on the different feminist perspectives and their relations with criminological studies, especially with the positions of the so-called critical criminology. Important feminist advances and conquests are recognized in the debate about the masculinized structure of penal law and its legal practice, but also the maintenance of diverse forms of gender violence that configure an anthropocentric, selective, racist, and discriminatory penal system. It indicates the urgency of intersectional studies that consider the particularities and claims of women in prison and their forms of militancy, especially in the face of the female prison population composed mostly of black, poor, and peripheral women. The need for an analysis of the factors that cross women's imprisonment from a plural feminist perspective, adequate to the realities under study and attentive to the multiple perspectives that may exist within feminism, becomes visible.(AU)

Este ensayo teórico-reflexivo pretende discutir las aportaciones de los estudios criminológicos y su crítica a las distintas formas de encarcelamiento femenino, y más recientemente de encarcelamiento masivo en el sistema penitenciario, además de generar debate sobre las distintas perspectivas feministas y sus relaciones con los estudios criminológicos, especialmente con las posiciones de la Criminología Crítica. Se reconocen importantes avances y logros feministas en el debate sobre la estructuración masculinizada del derecho penal y su práctica jurídica, además del mantenimiento de diversas formas de violencia de género que configuran un sistema penal antropocéntrico, selectivo, racista y discriminatorio. Se necesitan estudios interseccionales que consideren las particularidades y reivindicaciones de las mujeres en prisión y sus formas de militancia, principalmente ante la población penitenciaria femenina compuesta mayoritariamente por mujeres negras, pobres y periféricas. Se hace evidente la necesidad de analizar los factores que inciden en el encarcelamiento femenino desde una perspectiva feminista plural, adecuada a las realidades que se estudian y atenta a las múltiples perspectivas que pueden existir dentro del feminismo.(AU)

Processo transexualizador no sus: questões para a psicologia a partir de itinerários terapêuticos e despatologização / Proceso transexualizador en el sus: cuestiones para la psicología desde itinerarios terapêuticos y despatologización / Transexualizing process in the sus: questions for psychology from therapeutic itinetaries and depathologization

RESUMO. Trata-se de uma pesquisa qualitativa, des critiva e exploratória, realizada no Tratamento Fora de Domicílio, na cidade de Cuiabá-MT, Brasil, que objetivou levantar reflexões sobre os itinerários terapêuticos de pessoas trans, na busca pelo Processo Transexualizador. Participaram três homens trans, duas mulheres trans e uma mulher travesti, com faixa etária de 21 a 32 anos. Os da dos foram coletados por entrevistas semiestruturadas e analisados mediante análise de conteúdo. Os resultados mostram que essas pessoas trans seguem trajetórias diver sas, procurando serviços institucionalizados ou informais (redes de socialidade trans), para a afirmação de suas identidades de gênero. Destacam-se entraves atinentes à patologização, ao acolhimento, à continuidade do cuidado, à resolutividade e à referência na rede de atenção do processo transexualizador. Observaram-se importantes pontos críticos na assistência social, endocrinológica e para a psicologia, sendo a peregrinação pelos serviços de saúde demarcada por constantes discriminações institucionais, permitindo a compreensão de como o sistema de saúde se organiza em relação ao atendimento dessas pessoas, elencando questões para o trabalho da psicologia, nesse campo, a partir de uma perspectiva da experiência e materialidade do gênero.

RESUMEN. Esta es una investigación cualitativa, descriptiva y exploratoria realizada en el tratamiento fuera del domicilio en la ciudad de Cuiabá, Brasil, que tuvo como objetivo plantear reflexiones sobre los itinerarios terapéuticos de las personas trans en la búsqueda del proceso transexual. Participaron tres hombres trans, 2 mujeres trans y 1 mujer travesti de 21 a 32 años. Los datos fueron recogidos a través de entrevistas semiestructuradas y fueron analizados mediante el Análisis de Contenido. Los resultados muestran que estas personas trans siguen caminos divergentes en busca de servicios institucionalizados o informales (redes sociales trans) para afirmar sus identidades de género. Se destacan los obstáculos relacionados con la patologización, acogida, la continuidad de la atención, la resolución y la referencia en la red de atención del Proceso Transexualizador. Se observaron puntos críticos importantes en la asistencia social, la endocrinología y la psicología, em que la peregrinación por los servicios de salud es delimitada por la constante discriminación institucional que permite comprender cómo se organiza el sistema de salud en relación con la atención de estas personas que señalan los problemas para el trabajo de la Psicología en este campo desde una perspectiva de experiencia y materialidad de género

ABSTRACT. This qualitative, descriptive and exploratory research conducted in the Away from Home Treatment (Tratamento Fora de Domicílio [TFD]), in Cuiabá, Brazil, aimed to raise reflections on the therapeutic process itineraries of trans people in the search for the Transsexualizer Process (Processo Transexual [PT]). Three transgender men, two transgender women and one transvestite woman participated. They were aged between 21 and 32 years. Data were collected through semi-structured interviews and analyzed using Content Analysis. The results show that trans people follow different itineraries, looking for institutionalized or informal services (trans sociality networks) to affirm their gender identities. Obstacles related to pathologization, reception, continuity of care, resolution and reference in the care network of the Transsexualizer Process stand out. Important critical points were observed in social, endocrinological and psychological care. The pilgrimage by health services was marked by constant institutional discrimination, allowing for the understanding of how the health system is organized concerning the care of these people, listing issues for the work of Psychology, in this field, from a perspective of the experience and materiality of gender.

Lineamientos técnicos para la provisión de condones masculinos, femeninos y lubricantes a base de agua en el Sistema Nacional Integrado de Salud / Technical guidelines for the provision of condoms male, female and water-based lubricants in the National Integrated Health System

Los presentes lineamientos técnicos han sido elaborados en función de garantizar la cobertura y el acceso universal en salud. Sin embargo, la prevención de ITS/VIH, en particular en los grupos de población clave y vulnerable, se ve impactada por el estigma y discriminación, desigualdad en materia de género, violencia, falta de poder de decisión de las comunidades y vulneraciones de los derechos humanos, derechos sexuales y derechos reproductivos. Es debido a lo anterior, que se han identificado acciones necesarias plasmadas en este documento, para superar dichas barreras de acceso en estos grupos de población

These technical guidelines have been prepared in order to guarantee the coverage and universal access in health. However, STI/HIV prevention, particularly in groups of key and vulnerable population, is impacted by stigma and discrimination, inequality in of gender, violence, lack of decision-making power of the communities and violations of the rights human rights, sexual rights and reproductive rights. It is due to the above, that they have been identified necessary actions embodied in this document, to overcome these barriers of access in these population groups

Lineamientos para la prevención y el control de la tuberculosis en los pueblos indígenas de la Región de las Américas

La tuberculosis sigue representando un problema grave de salud pública en la Región de las Américas, y más aún en el caso de los pueblos indígenas, en los que registra una incidencia muy superior a la de la población general. Para el control de la tuberculosis en estos pueblos es necesario responder a sus necesidades diversas desde una perspectiva intercultural, que permita la aplicación de un abordaje holístico —desde un plano de igualdad y respeto mutuo— y considere el valor de sus prácticas culturales. En la Región de las Américas se ha avanzado en el reconocimiento de la necesidad de integrar la interculturalidad en los servicios de salud, pero persisten obstáculos basados en la discriminación, el racismo y la exclusión que se ejercen sobre las poblaciones indígenas y otros grupos étnicos. Para responder a esta situación, la Organización Panamericana de la Salud (OPS) ha elaborado estos lineamientos que, a partir de un enfoque intercultural que está en consonancia con las líneas prioritarias de la actual Política sobre etnicidad y salud de la OPS y su desarrollo práctico en los pueblos indígenas de la Región, constituyen un instrumento de ayuda para implementar la Estrategia Fin de la TB. Esta publicación integra la experiencia acumulada de la OPS y las buenas prácticas desarrolladas por sus Estados Miembros en los últimos años, incluidas las discusiones y experiencias compartidas en las reuniones regionales celebradas sobre el tema, y pone el acento en la innovación y la inclusión social. Esto requiere cambiar con urgencia los paradigmas tradicionales, partiendo de las acciones específicas que reducen gradualmente la incidencia de la TB para dirigirnos hacia acciones multisectoriales de eficacia demostrada en la contención rápida de la epidemia.

People living with HIV/AIDS: appraisal on dental care in Salta, Argentina / Personas que viven con VIH-SIDA: apreciación sobre la atención odontológica en Salta, Argentina

Abstract Introduction: many patients living with HIV-AIDS (PLHIV) feel discriminated due to their disease, both socially and in health centers, including dental care. However, no current studies are available in Argentina regarding the preferences of these patients when visiting a dentist, the places where they prefer to be treated, or if they disclose their HIV(+) status, among other situations. Objective: to determine PLHIV's appraisal on dental care in Salta, Argentina. Methods: descriptive, cross-sectional study. The study population were subjects who attended the HIV/STIs Program in the Salta Province in the period June-September 2015. Sociodemographic data, underlying disease, and dental care were collected in a survey created for this purpose. Results: 200 PLHIV were surveyed. 54% were male aged 37 years in average (IQR 29.2-45), with a median period of disease evolution of 78 months (IQR 30-126). 78% of respondents consulted a dentist in the last two years and 60% did so in public institutions. 70% perceived that their dentist has some knowledge on HIV. 50.5% disclosed their serological status to the treating professional. 87% reported that there were no prejudices during the service provided. Of the 49.6% who did not disclose their diagnosis, 55% claimed fear of discrimination. Conclusion: although PLHIV's appraisal of dental care was positive, with no prejudices in most cases, fear of discrimination is the main reason for not informing the dentist of their diagnosis. Interdisciplinary work would help PLHIV in comprehensive care, thus avoiding one more reason for non-adherence to treatment.

Resumen Introducción: muchos pacientes que viven con VIH-SIDA (PVVS) se sienten discriminados por su enfermedad, tanto en el ámbito social como en establecimientos de salud, incluyendo la atención odontológica. Sin embargo, en la actualidad no existen en Argentina estudios que permitan establecer las preferencias de estos pacientes al momento de acudir a un odontólogo, como el lugar donde prefieren ser atendidos, o si mencionan su condición de VIH(+), entre otros aspectos. Objetivo: determinar la apreciación de las PVVS sobre la atención odontológica en Salta, Argentina. Métodos: estudio descriptivo, de corte transversal. La población estudiada fueron sujetos que acudieron al Programa Provincial VIH/ITS de Salta entre junio y septiembre de 2015. Se recolectaron datos sociodemográficos, enfermedad de base y atención odontológica, en una encuesta diseñada para tal fin. Resultados: se encuestaron 200 PVVS: 54% de género masculino, con una edad promedio de 37 años (RIC 29,2-45), tiempo mediano de evolución de la enfermedad de 78 meses (RIC 30-126). Un 78% consultó al odontólogo en los últimos dos años y 60% utilizó establecimientos públicos como lugar de atención. Un 70% percibió que el odontólogo tiene conocimientos sobre VIH. El 50,5% manifestó su estado serológico al profesional tratante. 87% refirió que recibieron atención odontológica sin ningún prejuicio. Del 49,6% que no dio a conocer su diagnóstico, el 55% adujo miedo a la discriminación. Conclusión: si bien la apreciación de las PVVS sobre la atención odontológica fue positiva, mayoritariamente sin prejuicios, el miedo a la discriminación es la principal causa para no dar a conocer el diagnóstico al odontólogo. El trabajo interdisciplinario ayudaría a las PVVS en la atención integral, evitando ser un motivo más para la falta de adherencia al tratamiento.

Exposure to Adverse Events and Associations with Stress Levels and the Practice of Yoga: Survey Findings from a Population-Based Study of Diverse Emerging Young Adults.

Objectives: This study examines the prevalence of exposure to adverse events and associations with stress levels among a diverse population-based sample of young people. The study further explores whether these vulnerable populations, who have the potential to benefit from the mind-body practice of yoga, engage in a regular yoga practice. Design: EAT 2018 (Eating and Activity over Time) is a population-based study in which survey data were collected from 1568 ethnically/racially diverse (81.2% nonwhite) emerging young adults (mean age: 22.0 ± 2.0 years). Results: Exposure to adverse events was highly prevalent. For example, 43.9% reported at least one adverse childhood experience (ACE) (e.g., physical, emotional, or sexual abuse before age 18), whereas 40.1% reported experiencing discrimination. Exposure to adverse events was associated with higher stress levels. Practicing yoga at least 30 min/week was reported by 12.7% of the population, with variation across sociodemographic characteristics. Young adults exposed to adverse events were either more or similarly likely to practice yoga than young adults not reporting adverse events. Conclusions: The high prevalence of exposure to adverse events and associations with higher levels of stress points to a need for public health interventions. Thus, it was promising to find that young people exposed to adverse events, who may have greater emotional burdens, practice yoga at equal or greater proportions to those without these exposures. Given the potential benefits of yoga for populations living with high stress, it is important to develop further outreach efforts and provide accessible, acceptable, and affordable opportunities for practicing yoga.

Confronting the culture of care: a call to end disrespect, discrimination, and detainment of women and newborns in health facilities everywhere.

Quality and respect are increasingly recognized as critical aspects of the provision of health care, and poor quality may be an essential driver of low health care utilization, especially for maternal and neonatal care. Beyond differential access to care, unequal levels of quality exacerbate inequity, and those who need services most, including displaced, migrant, and conflict-affected populations, may be receiving poorer quality care, or may be deterred from seeking care at all.Examples from around the world show that mothers and their children are often judged and mistreated for presenting to facilities without clean or "modern" clothing, without soap or clean sheets to use in the hospital, or without gifts like sweets or candies for providers. Underfunded facilities may rely on income from those seeking care, but denying and shaming the poor further discriminates against vulnerable women and newborns, by placing additional financial burden on those already marginalized.The culture of care needs to shift to create welcoming environments for all care-seekers, regardless of socio-economic status. No one should fear mistreatment, denial of services, or detainment due to lack of gifts or payments. There is an urgent need to ensure that health care centers are safe, friendly, respectful, and hospitable spaces for women, their newborns, and their families.

Intergenerational Influences on Faith-based Strategies Used in Response to Racial Discrimination Among Young African American Adults.

OBJECTIVE: In this report, we used a qualitative descriptive design to explore young African American adults' intergenerationally influenced strategies to experienced racial discrimination. METHODS: The study was guided by a qualitative descriptive design using criterion and snowball sampling, and semi-structured interview questions. We also explored, quantitatively, gender differences among the racial discrimination experiences encountered and the strategies used. FINDINGS: Forty-nine participants included in this report were an average age of 29.5 (SD = 10.1). Racial discrimination experiences included daily microaggressions such as insensitive comments, stereotyping, exclusion from work and school activities, perceived low expectations, inequities in employment, and police profiling. Intergenerationally influenced strategies used in response to these experiences included religious beliefs and practices, positive reframing, and modeling behaviors used by previous generations. These intergenerationally influenced strategies enabled participants to remain calm, to express goodwill toward others, and to be patient and hopeful for a better future. CONCLUSION: Since intergenerationally influenced strategies are likely potential sources of strength and resilience for young African Americans, knowledge of these strategies might be useful to health care practitioners seeking to improve the mental health care of this population.

[Life Satisfaction, Perceived Discrimination, Religiosity, and Mental Health in Sufism: a Perspective from Montreal]. / Satisfaction à l'égard de la vie, discrimination perçue, religiosité et santé mentale dans l'islam soufi : une perspective montréalaise.

Objective The central objective of this paper is to explore the dynamic interactions between 5 sets of variables, which are Sociodemographic Characteristics, Satisfaction with Life, Perceived Discrimination, Religiosity and Emotional Distress within Montreal's Tariqa Qadiriya Boudchichiya, a Muslim Sufi way whose origins are Moroccan and date back to the 18th century. Method As a method, we considered psychological distress as the dependent variable and performed univariate descriptive statistical analyzes, bivariate correlation analyzes (Pearson correlation), one-way ANOVA analyzes, and multivariate analyzes (linear regressions). Results Our results, although preliminary due to a relatively small sample (n = 56), allow us to put forward a new hypothesis suggesting that the intense spiritual practice that characterizes the Tariqa, would allow "a work of the self on self" through a set of "techniques of the self" (Foucault) that contribute to a certain emotional well-being, if not to mental health. Conclusion Our conclusion underlines the importance of investigating more in depth the possible contribution of religiosity to the subject's capacity to act on oneself in order to emerge as a spiritual, ethical and political subject.

Folk theories of gender and anti-transgender attitudes: Gender differences and policy preferences.

Transgender rights and discrimination against transgender people are growing public policy issues. Theorizing from social, cognitive, and evolutionary psychology suggests that beyond attitudes, discrimination against transgender people may derive from folk theories about what gender is and where it comes from. Transgender identity is met with hostility, in part, because it poses a challenge to the lay view that gender is determined at birth, and based on observable physical and behavioral characteristics. Here, in two pre-registered studies (N = 1323), we asked American adults to indicate the gender of a transgender target who either altered their biology through surgical interventions or altered their outward appearance: to what extent is it their birth-assigned gender or their self-identified gender? Responses correlate strongly with affect toward transgender people, measured by feeling thermometers, yet predict views on transgender people's right to use their preferred bathrooms above and beyond feelings. Compared to male participants, female participants judge the person's gender more in line with the self-identified gender than the birth-assigned gender. This is consistent with social and psychological theories that posit high status (e.g., men) and low status (e.g., women) members of social classification systems view group hierarchies in more and less essentialist ways respectively. Gender differences in gender category beliefs decrease with religiosity and conservatism, and are smaller in higher age groups. These results suggest that folk theories of gender, or beliefs about what gender is and how it is determined have a unique role in how transgender people are viewed and treated. Moreover, as evident by the demographic variability of gender category beliefs, folk theories are shaped by social and cultural forces and are amenable to interventions. They offer an alternative pathway to measure policy support and possibly change attitude toward transgender people.

Help-seeking behaviors among Chinese people with mental disorders: a cross-sectional study.

BACKGROUND: Failure to seek treatment for mental health disorders is a serious public health concern. Unfortunately, there is little insight into help-seeking and its associated factors in China which has undergone rapid economic development in the past 30 years and has an increasing prevalence of mental disorder. Therefore, this study aimed to (1) investigate help-seeking rates in healthcare and non-healthcare settings and (2) investigate the correlates of help-seeking behavior in a large Chinese survey. METHODS: Data came from the Tianjin Mental Health Survey (TJMHS), a representative sample of adult community residents in the Chinese municipality of Tianjin (n = 11,748). Of these, 1759 individuals had ≥1 axis-I diagnosis according to the Diagnostic and Statistical manual- fourth edition (DSM-IV) and were administered a Help-Seeking Questionnaire. RESULTS: 15.7% of patients reported that they had ever sought help during their entire lifetime before the interview, with 4.5% seeking help in mental healthcare, 3.2% in other healthcare and 8.1% in non-healthcare settings (e.g., family, friends, and spiritual advisor). Among help-seekers, the first help was mostly sought in non-healthcare settings (58.4%), followed by healthcare (27.5%) and mental healthcare settings (24.5%). Female gender, younger age, having 7-9 years vs 0-6 years of education, a low income, a psychotic disorder and having ≥2 disorders were associated with increased help-seeking. Older age, being married and having a psychotic or organic disorder were associated with increased help-seeking in healthcare vs. non-healthcare settings. CONCLUSION: A small percentage of persons with mental disorders in the Tianjin region seek help and among those who do, variations in the types of help-seeking may be partially explained by demographic and clinical characteristics.

School and Family Factors Predicting Adolescent Cognition Regarding Bystander Intervention in Response to Bullying and Victim Retaliation.

Youth aggression occurs at high rates. Aggressive acts can be curbed through bystander intervention; yet, little is known about school and family factors that predict bystander intervention in response to both aggression and victim retaliation. This research examines school and family factors related to standing up to aggression and intervening before possible retaliation occurs. Participants included 6th and 9th graders (N = 896, 52.8% female), who evaluated how likely they would be to intervene if they observed aggression and if they heard the victim was planning to retaliate. Family and school factors are important predictors of bystander intervention, with higher family management, and more positive school climate associated with greater likelihood of intervention and higher feelings of social exclusion and teacher and peer discrimination associated with inactive responses to aggression and retaliation. Thus, a complex constellation of factors relate to the likelihood of intervening if someone is being victimized or considering retaliation in response to victimization. The results provide guidance and new directions for possible school- and family-based interventions to encourage bystander intervention in instances of aggression.

"A Whole Bunch of Love the Sinner Hate the Sin": LGBTQ Microaggressions Experienced in Religious and Spiritual Context.

Research on microaggressions experienced by LGBTQ people has focused largely on a general understanding of this concept; however, no research exists that focuses exclusively on microaggressions that LGBTQ people face across religious and spiritual communities. The present study addressed this gap in the literature by using a qualitative method to allow LGBTQ people (N= 90) to directly report microaggressions that they have experienced within their religious and spiritual communities. Thematic analysis revealed three predominant themes: (1) LGBTQ identities as inauthentic; (2) religious/spiritual tolerance of LGBTQ Identities, and (3) LGBTQ and religious/spiritual identities as incompatible. Implications and future directions discussed.

Professional Pragmatism and Abortion Stigma: Assessing the Performance of the Stigmatizing Attitudes, Beliefs and Actions Scale (SABAS) among Ethiopian Midwives.

This study assessed the applicability to medical professionals in Ethiopia of an abortion stigma assessment tool developed for community members, and examined the relationship between stigma and willingness to provide safe abortion care (SAC). The Stigmatizing Attitudes, Beliefs and Actions Scale (SABAS) was fielded to a convenience sample of 397 Ethiopian midwives. Scale reliability and validity were assessed, and associations were examined using multivariate linear and logistic regression. Levels of stigma were low compared to those reported elsewhere, and 49% of midwives were willing to provide SAC. The revised SABAS was reliable (alpha = 0.82), but items did not group into SABAS' conceptual categories, and some had limited face validity. SABAS scores had a small but significant negative association with willingness to provide SAC (OR=0.95, p < 0.05), with negative stereotyping subscale items most predictive. SABAS' limitations found here suggest the need for an adapted scale for medical professionals.

Challenges for health care providers, parents and patients who face a child hood cancer diagnosis in Zambia.

BACKGROUND: Zambia is experiencing high prevalence of childhood cancer. However, very few children access and complete treatment for cancer. This study aimed to document the challenges for health care providers, parents and patients who face a child hood cancer diagnosis in Zambia, and their coping strategies. METHODS: This was an exploratory health facility-based qualitative study that was conducted at a Paediatric oncology ward at referral hospital in Zambia. In-depth individual interviews conducted with fifteen (15) caregivers and seven (7) key informants were analysed using thematic analysis. RESULTS: Several challenges related to managing the childhood cancer diagnosis were recorded. Individual and family challenges were inadequate knowledge on childhood cancer, lack of finances to meet treatment and transport costs as well as long period of hospitalisation that affected women's ability to perform multiple responsibilities. Whereas challenges at community level were inadequate support to address emotional and physical distress and social stigmatisation experienced by caregivers. Health systems issues included inadequate specialised health workers, poor communication among health workers, limited space and beds as well as insufficient supplies such as blood. Cultural related factors were the belief that cancer is a product of witchcraft as well as religious beliefs regarding the role of faith healing in childhood cancer treatment. Coping strategies used by parents/ caregivers included praying to God, material support from organisations and church as well as delaying having another child. CONCLUSION: Addressing the challenges for health care providers, parents and patients who face a childhood cancer diagnosis may require adopting a systems or an ecological approach that allows developing strategies that simultaneously address challenges related to the individual, family, community, health system and cultural aspects.

Rationing elective surgery for smokers and obese patients: responsibility or prognosis?

BACKGROUND: In the United Kingdom (UK), a number of National Health Service (NHS) Clinical Commissioning Groups (CCG) have proposed controversial measures to restrict elective surgery for patients who either smoke or are obese. Whilst the nature of these measures varies between NHS authorities, typically, patients above a certain Body Mass Index (BMI) and smokers are required to lose weight and quit smoking prior to being considered eligible for elective surgery. Patients will be supported and monitored throughout this mandatory period to ensure their clinical needs are appropriately met. Controversy regarding such measures has primarily centred on the perceived unfairness of targeting certain health states and lifestyle choices to save public money. Concerns have also been raised in response to rhetoric from certain NHS authorities, which may be taken to imply that such measures punitively hold people responsible for behaviours affecting their health states, or simply for being in a particular health state. MAIN BODY: In this paper, we examine the various elective surgery rationing measures presented by NHS authorities. We argue that, where obesity and smoking have significant implications for elective surgical outcomes, bearing on effectiveness, the rationing of this surgery can be justified on prognostic grounds. It is permissible to aim to maximise the benefit provided by limited resources, especially for interventions that are not urgently required. However, we identify gaps in the empirical evidence needed to conclusively demonstrate these prognostic grounds, particularly for obese patients. Furthermore, we argue that appeals to personal responsibility, both in the prospective and retrospective sense, are insufficient in justifying this particular policy. CONCLUSION: Given the strength of an alternative justification grounded in clinical effectiveness, rhetoric from NHS authorities should avoid explicit statements, which suggest that personal responsibility is the key justificatory basis of proposed rationing measures.

Gendered Safety and Health Risks in the Construction Trades.

Objectives: Despite women's increased representation in the overall workforce, construction remains a male-dominated industry. Prior studies have noted that the hazardous workplace environment combined with a culture that can be discriminatory and openly hostile can threaten women workers' health and safety. However, little information exists about the current physical and psychosocial hazards at work affecting tradeswomen. Methods: We examined differences in workplace exposure between women and men, and the association of these exposures with self-reported stress and work injury, in order to highlight how gendered conditions of work negatively affect tradeswomen's health. A holistic view of health that included the influence of both home and work spheres as well as hazards related to women's social experience was considered. Almost 300 workers (198 tradeswomen and 93 tradesmen) throughout Washington State completed surveys. We used descriptive statistics to compare exposures between genders, and logistic regression to model the association between psychosocial exposures and injury and stress outcomes. Results: We found that women were significantly more likely than men to report high perceived stress (31 and 18%, respectively) and being injured at work in the past year (31 and 12%, respectively). Ten of the 12 work-related psychosocial exposures were found to be associated with either stress (job strain, gender and age discrimination, bullying, work/life balance, isolation, sexual harassment, safety climate, and social support) or injury (gender discrimination, bullying, overcompensation, and sexual harassment) for women. Conclusions: The industry continues to lag in supporting tradeswomen's health and safety needs. This study suggests that multiple exposures (including discrimination, overcompensation, and work/life balance) have an important impact on worker well-being. The findings underscore the complex interaction of gender, psychosocial exposures, and occupational risks, and indicate areas for intervention.