Who is most vulnerable? Factors associated with presenting to antenatal care without a male partner in Northern Tanzania.

OBJECTIVE: Male engagement in pregnancy care can be beneficial for maternal and child health outcomes. In Tanzania, pregnant women are strongly encouraged to present to their first antenatal care (ANC) appointment with a male partner, where they jointly test for HIV. For some, this presents a barrier to ANC attendance. The objectives of this study were to identify factors associated with presenting to ANC with a male partner using a cross-sectional design and to assess whether women presenting without partners had significantly delayed presentation. METHODS: Pregnant women (n = 1007) attending a first ANC appointment in Moshi, Tanzania were surveyed. Questions captured sociodemographic characteristics and measures of psychosocial constructs. RESULTS: Just over half (54%) of women presented to care with a male partner. Women were more likely to present with a male partner if they were younger than 25 years old, married, Muslim, attending ANC for their first pregnancy, and testing for HIV for the first time. Women presenting to ANC with a male partner were significantly more likely to attend ANC earlier in their pregnancy than those presenting without male partners. CONCLUSION: Policy change allowing women to present to care with other supportive family members could promote earlier presentation to first ANC. Unmarried women may be at a disadvantage in presenting to ANC when policies mandate attendance with a male partner. Male partners of multiparous women should be encouraged to provide pregnancy support even after first pregnancies, and a wholistic emphasis (beyond HIV testing) on first ANC could encourage male engagement beyond the initial appointment.

Patient and public involvement in the development of health services: Engagement of underserved populations in a quality improvement programme for inflammatory bowel disease using a community-based participatory approach.

INTRODUCTION: Involving people with lived experience is fundamental to healthcare development and delivery. This is especially true for inflammatory bowel disease (IBD) services, where holistic and personalised models of care are becoming increasingly important. There is, however, a significant lack of representation of underserved and diverse groups in IBD research, and there are significant barriers to healthcare access and utilisation among minority groups in IBD. IBD centres need to be aware of these experiences to address barriers via service changes, improve interactions with local communities and promote meaningful engagement for improved health outcomes. METHODS: A pragmatic community-based approach was taken to engage with leaders and members of underserved groups across 11 workshops representing Roma, Afro-Caribbean, people of African descent and the wider black, Asian and minority ethnic (BAME) communities, Muslim women, refugee community members, deprived areas of South Yorkshire, LGBTQ+ and deaf populations. Thematic analysis of field notes identified patterns of attention across the community groups and where improvements to services were most frequently suggested. RESULTS: Findings demonstrated several barriers experienced to healthcare access and utilisation, including language accessibility, staff attitudes and awareness, mental health and stigma, continuity of support, and practical factors such as ease of service use and safe spaces. These barriers acted as a lever to co-producing service changes that are responsive to the health and social care needs of these groups. CONCLUSIONS: Engaging with people from a range of communities is imperative for ensuring that service improvements in IBD are accessible and representative of individual needs and values. PATIENT OR PUBLIC CONTRIBUTION: Local community leaders and members of community groups actively participated in the co-design and development of improvements to the IBD service for a local hospital. Their contributions further informed a pilot process for quality improvement programmes in IBD centres.

Systematic surveillance tools to reduce rodent pests in disadvantaged urban areas can empower communities and improve public health.

Rodents are notorious pests, known for transmitting major public health diseases and causing agricultural and economic losses. The lack of site-specific and national standardised rodent surveillance in several disadvantaged communities has rendered interventions targeted towards rodent control as often ineffective. Here, by using the example from a pilot case-study in the Bahamas, we present a unique experience wherein, through multidisciplinary and community engagement, we simultaneously developed a standardised national surveillance protocol, and performed two parallel but integrated activities: (1) eight days of theoretical and practical training of selected participants; and (2) a three-month post-training pilot rodent surveillance in the urban community of Over-the-Hill, Nassau, The Bahamas. To account for social and environmental conditions influencing rodent proliferation in the Bahamas, we engaged selected influential community members through a semi-structured interview and gathered additional site-specific information using a modified Centers for Diseases Control and Prevention (CDC) exterior and interior rodent evaluation form, along with other validated instruments such as tracking plates and snap trapping, to test and establish a standardised site-specific rodent surveillance protocol tailored for the Bahamas. Our engagement with community members highlighted poor disposal of animal and human food, irregular garbage collection, unapproved refuse storage, lack of accessible dumpsters, poor bulk waste management, ownership problems and structural deficiencies as major factors fuelling rodent proliferation in the study areas. Accordingly, results from our pilot survey using active rodent signs (that is, the presence of rodent runs, burrows, faecal material or gnawed material) as a proxy of rodent infestation in a generalized linear model confirmed that the variables earlier identified during the community engagement program as significantly correlated with rodent activities (and capturing) across the study areas. The successful implementation of the novel site-specific protocol by trained participants, along with the correlation of their findings with those recorded during the community engagement program, underscores its suitability and applicability in disadvantaged urban settings. This experience should serve as a reference for promoting a standardised protocol for monitoring rodent activities in many disadvantaged urban settings of the Global South, while also fostering a holistic understanding of rodent proliferation. Through this pilot case-study, we advocate for the feasibility of developing sustainable rodent control interventions that are acceptable to both local communities and public authorities, particularly through the involvement of a multidisciplinary team of professionals and community members.

Challenges and Solutions to Support Oncology Professionals Serving Underserved Populations With Cancer in the United States: Results From the ASCO Serving the Underserved Task Force.

PURPOSE: Little data exist regarding approaches to support oncology professionals who deliver cancer care for underserved populations. In response, ASCO developed the Serving the Underserved Task Force to learn from and support oncology professionals serving underserved populations. METHODS: The Task Force developed a 28-question survey to assess oncology professionals' experiences and strategies to support their work caring for underserved populations. The survey was deployed via an online link to 600 oncology professionals and assessed respondent and patient demographic characteristics, clinic-based processes to coordinate health-related social services, and strategies for professional society support and engagement. We used chi-square tests to evaluate whether there were associations between percent full-time equivalent (FTE) effort serving underserved populations (<50% FTE v ≥50% FTE) with responses. RESULTS: Of 462 respondents who completed the survey (77% response rate), 79 (17.1%) were Asian; 30 (6.5%) Black; 43 (9.3%) Hispanic or Latino/Latina; and 277 (60%) White. The majority (n = 366, 79.2%) had a medical doctor degree (MD). A total of 174 (37.7%) had <25% FTE, 151 (32.7%) had 25%-50% FTE, and 121 (26.2%) had ≥50% FTE effort serving underserved populations. Most best guessed patients' sociodemographic characteristics (n = 388; 84%), while 42 (9.2%) used data collected by the clinic. Social workers coordinated most health-related social services. However, in clinical settings with high proportions of underserved patients, there was greater reliance on nonclinical personnel, such as navigators (odds ratio [OR], 2.15 [95% CI, 1.07 to 4.33]) or no individual (OR, 2.55 [95% CI, 1.14 to 5.72]) for addressing mental health needs and greater reliance on physicians or advance practice practitioners (OR, 2.54 [95% CI, 1.11 to 5.81]) or no individual (OR, 1.91 [95% CI, 1.09 to 3.35]) for addressing childcare or eldercare needs compared with social workers. Prioritization of solutions, which did not differ by FTE effort serving underserved populations, included a return-on-investment model to support personnel, integrated health-related social needs screening, and collaboration with the professional society on advocacy and policy. CONCLUSION: The findings highlight crucial strategies that professional societies can implement to support oncology clinicians serving underserved populations with cancer.

H.O.P.E. grows: An academic-public health partnership to reimagine public health services and increase mental health access among socially vulnerable populations.

OBJECTIVE: To illustrate the process of developing and sustaining an academic-public health partnership for behavioral health integration through an expansion of the Aligning Systems for Health (ASfH) framework. STUDY SETTING: Practice-informed primary data (2017-2023) from the Holistic Opportunity Program for Everyone (HOPE) Initiative based in Charlotte, NC. STUDY DESIGN: The unit of analysis in this descriptive case study is inter-organizational, specifically focusing on an academic-public health relationship. We illustrate the partnership process across the ASfH four core areas, including key challenges and insights. DATA COLLECTION: Utilized a Critical Moments Reflection methodology and review of HOPE program data. PRINCIPAL FINDINGS: (1) Formal partnership structures and processes are essential to monitoring the four ASfH core components for on-going system alignment. (2) Aligning systems for health principally involves two ecologies: (i) the health program and (ii) the partnership. The vitality and sustainability of both ecologies require continuous attention and resource investment. (3) Relationships rest at the heart of aligning systems. (4) With comparative advantages in research methods, the academic sector is especially poised to collaborate with healthcare systems and human service organizations to study, develop, implement, and scale evidence-based health interventions. CONCLUSIONS: The academic sector shares overlapping purposes with the public health, healthcare, and social services sectors while providing complementary value. It is a critical sectoral partner in advancing population health and health equity.

Bringing CAR T cell therapy trials to underserved populations.

There is a critical need for equitable access to cell therapies in cancer treatment, particularly within public safety-net healthcare systems that serve minority and socioeconomically disadvantaged populations. We discuss how the Dan L Duncan Comprehensive Cancer Center at Baylor College of Medicine is piloting a cell therapy program aimed at addressing cancer care disparities and has the potential to serve as a national model for enhancing health equity in cancer care.

Rapid Enrollment Growth In 'Look-Alike' Dual-Eligible Special Needs Plans: A Threat To Integrated Care.

Policy makers are increasingly investing in efforts to better integrate Medicare and Medicaid services for people who are eligible for both programs, including expanding Dual-Eligible Special Needs Plans (D-SNPs). In recent years, however, a potential threat to integration has emerged in the form of D-SNP "look-alike" plans, which are conventional Medicare Advantage plans that are marketed toward and primarily enroll dual eligibles but are not subject to federal regulations requiring integrated Medicaid services. To date, limited evidence exists documenting national enrollment trends in look-alike plans or the characteristics of dual eligibles in these plans. We found that look-alike plans experienced rapid enrollment growth among dual eligibles during the period 2013-20, increasing from 20,900 dual eligibles across four states to 220,860 dual eligibles across seventeen states, for an elevenfold increase. Nearly one-third of dual eligibles in look-alike plans were previously in integrated care programs. Compared with D-SNPs, look-alike plans were more likely to enroll dual eligibles who were older, Hispanic, and from disadvantaged communities. Our findings suggest that look-alike plans have the potential to compromise national efforts to integrate care delivery for dual eligibles, including vulnerable subgroups who may benefit the most from integrated coverage.

Improvement studies for equitable and evidence-based innovation: an overview of the 'IM-SEEN' model.

BACKGROUND: Health inequalities are ubiquitous, and as countries seek to expand service coverage, they are at risk of exacerbating existing inequalities unless they adopt equity-focused approaches to service delivery. MAIN TEXT: Our team has developed an equity-focused continuous improvement model that reconciles prioritisation of disadvantaged groups with the expansion of service coverage. Our new approach is based on the foundations of routinely collecting sociodemographic data; identifying left-behind groups; engaging with these service users to elicit barriers and potential solutions; and then rigorously testing these solutions with pragmatic, embedded trials. This paper presents the rationale for the model, a holistic overview of how the different elements fit together, and potential applications. Future work will present findings as the model is operationalised in eye-health programmes in Botswana, India, Kenya, and Nepal. CONCLUSION: There is a real paucity of approaches for operationalising equity. By bringing a series of steps together that force programme managers to focus on groups that are being left behind, we present a model that can be used in any service delivery setting to build equity into routine practice.

Understanding the mechanisms linking holistic housing renovations to health and well-being of adults in disadvantaged neighbourhoods: A realist review.

Holistic housing renovations combine physical housing improvements with social and socioeconomic interventions (e.g. referral to social services, debt counselling, involvement in decision-making, promoting social cohesion). This realist review aimed at understanding underlying mechanisms linking holistic housing renovations to health and well-being of adults in disadvantaged neighbourhoods. Following systematic and iterative searching, and relevance and quality appraisals, 18 scientific articles and reports were analysed. We identified three pathways via which physical housing improvements affect health, four pathways via which social and socioeconomic interventions affect health, and two pathways via which both reinforce each other in their health effects. Our findings are theoretically novel, relevant for those conducting holistic housing renovations, and point towards gaps in the literature.

PsicoQuilombologia: escrevivência de uma psicologia das encruzilhadas em tempos pandêmicos / PsychoQuilombology: writexperience of a psychology of crossroads in pandemic times / PsicoQuilombología: escrivivencia de una psicología de la encrucijada en tiempos pandémicos

O texto é um relato de experiência da participação no Grupo de Estudos psicoQuilombologia ocorrida nos meses de setembro de 2020 a março de 2021, período atravessado pela segunda onda da pandemia de COVID-19 no Brasil. O objetivo do relato é apresentar o conceito-movimento de psicoQuilombologia como uma proposta epistemológica quilombola de agenciamento de cuidado e saúde, com base em uma escuta que se faça descolonial e inspirada no fecundo e ancestral acervo de cuidado dos povos africanos, quilombolas e pretos, preservado e atualizado em nossos quilombos contemporâneos. A metodologia utilizada é a escrevivência, método desenvolvido por Conceição Evaristo que propõe uma escrita em que as vivência e memórias estão totalmente entrelaçadas, imersas e imbricadas com a pesquisa. O resultado das escrevivências dessa pesquisa descortinam que os povos pretos desenvolveram práticas de cuidado e acolhimento às vulnerabilidades do outro, enraizadas no fortalecimento de laços e conexões coletivas de afetos e cuidado mútuos. Práticas de cuidado que articulam memória, ancestralidade, tradição, comunidade, transformação, luta, resistência e emancipação, engendrando modos coletivos de ser e viver. Nas quais cuidar do outro implica tratar suas relações e situar o cuidado como extensão de uma cura que se agencia no coletivo. O trabalho conclui apontando que o cenário pandêmico vigente acentua a pungência de se desenvolver estratégias de cuidado baseadas em epistemologias pretas e quilombolas, valorizando os sentidos de ancestralidade, comunidade, pertencimento e emancipação.(AU)

The text is an experience report of the participation in the psicoQuilombology Study Group that carried out from September 2020 to March 2021, during the second wave of the COVID-19 pandemic in Brazil. The purpose of the report is to introduce the concept-movement of psicoQuilombology as a quilombola epistemological proposal for the development of care and health, based on a decolonial listening and inspired by the rich care collection of African peoples, quilombolas and Blacks, preserved and updated in our contemporary quilombos. The methodology used is writexperience [escrevivências], a method developed by Conceição Evaristo who proposes a writing in that the experiences and memories are totally involved with the research. The result of the writability of this research show that Black people have developed practices of care and acceptance of the other's vulnerabilities, based on the strengthening of ties and collective connections of mutual affection and care. Care practices that mix memory, ancestry, tradition, community, transformation, struggle, resistance and emancipation, outlining collective ways of being and living. The core idea is that taking care of the other means treating your relationships and maintaining care as an extension of a cure that takes place in the collective. The paper concludes by pointing out that the current pandemic scenario demonstrates the urgent need to develop care strategies based on black and quilombola epistemologies, valuing the senses of ancestry, community, belonging and emancipation.(AU)

Este es un reporte de experiencia de la participación en el Grupo de Estudio psicoQuilombología que ocurrió en los meses de septiembre de 2020 a marzo de 2021, periodo en que Brasil afrontaba la segunda ola de la pandemia de la COVID-19. Su propósito es presentar el concepto-movimiento de psicoQuilombología como una propuesta epistemológica quilombola para el desarrollo del cuidado y la salud, basada en una escucha decolonial e inspirada en el rico acervo asistencial de los pueblos africanos, quilombolas y negros, conservado y actualizado en nuestros quilombos contemporáneos. La metodología utilizada es la escrivivencia, un método desarrollado por Conceição Evaristo quien propone una escrita en que las vivencias y los recuerdos están totalmente involucrados con la investigación. El resultado de la escrivivencia muestra que las personas negras han desarrollado prácticas de cuidado y aceptación de las vulnerabilidades del otro, basadas en el fortalecimiento de lazos y conexiones colectivas de afecto y cuidado mutuos. Prácticas de cuidado que mezclan memoria, ascendencia, tradición, comunidad, transformación, lucha, resistencia y emancipación, perfilando formas colectivas de ser y vivir. El cuidar al otro significa tratar sus relaciones y mantener el cuidado como una extensión de una cura que tiene lugar en lo colectivo. El trabajo concluye que el actual escenario pandémico demuestra la urgente necesidad de desarrollar estrategias de atención basadas en epistemologías negras y quilombolas, y que valoren los sentidos de ascendencia, comunidad, pertenencia y emancipación.(AU)

O cuidado em saúde promovido pelas religiões afro-brasileiras / Health care promoted by afro-brazilian religions / El cuidado en salud promovido por las religiones afrobrasileñas

No decorrer da história, sempre foram infindáveis os casos em que os sujeitos recorriam a centros espíritas ou terreiros de religiões de matrizes africanas em decorrência de problemas como doenças, desempregos ou amores mal resolvidos, com o objetivo de saná-los. Por conta disso, este artigo visa apresentar os resultados da pesquisa relacionados ao objetivo de mapear os processos de cuidado em saúde ofertados em três terreiros de umbanda de uma cidade do litoral piauiense. Para isso, utilizamos o referencial da Análise Institucional "no papel". Os participantes foram três líderes de terreiros e os respectivos praticantes/consulentes dos seus estabelecimentos religiosos. Identificamos perspectivas de cuidado que se contrapunham às racionalidades biomédicas, positivistas e cartesianas, e faziam referência ao uso de plantas medicinais, ao recebimento de rezas e passes e à consulta oracular. A partir desses resultados, podemos perceber ser cada vez mais necessário, portanto, que os povos de terreiros protagonizem a construção, implementação e avaliação das políticas públicas que lhe sejam específicas.(AU)

In history, there have always been endless cases of people turning to spiritual centers or terreiros of religions of African matrices due to problems such as illnesses, unemployment, or unresolved love affairs. Therefore, this article aims to present the research results related to the objective of mapping the health care processes offered in three Umbanda terreiros of a city on the Piauí Coast. For this, we use the Institutional Analysis reference "on Paper." The participants were three leaders of terreiros and the respective practitioners/consultants of their religious establishments. We identified perspectives of care that contrasted with biomedical, positivist, and Cartesian rationalities and referred to the use of medicinal plants, the prescript of prayers and passes, and oracular consultation. From these results, we can see that it is increasingly necessary, therefore, that the peoples of the terreiros lead the construction, implementation, and evaluation of public policies that are specific to them.(AU)

A lo largo de la historia, siempre hubo casos en los cuales las personas buscan en los centros espíritas o terreros de religiones africanas la cura para sus problemas, como enfermedades, desempleo o amoríos mal resueltos. Por este motivo, este artículo pretende presentar los resultados de la investigación con el objetivo de mapear los procesos de cuidado en salud ofrecidos en tres terreros de umbanda de una ciudad del litoral de Piauí (Brasil). Para ello, se utiliza el referencial del Análisis Institucional "en el Papel". Los participantes fueron tres líderes de terreros y los respectivos practicantes / consultivos de los establecimientos religiosos que los mismos conducían. Se identificaron perspectivas de cuidado que se contraponían a las racionalidades biomédicas, positivistas y cartesianas, y hacían referencia al uso de plantas medicinales, al recibimiento de rezos y pases y a la consulta oracular. Los resultados permiten concluir que es cada vez más necesario que los pueblos de terreros sean agentes protagónicos de la construcción, implementación y evaluación de las políticas públicas destinadas específicamente para ellos.(AU)

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)

Expectativas de mães e cuidadoras sobre participação em um programa de prevenção à violência / Expectations of mothers/caregivers regarding the participation in a violence prevention program / Expectativas de madres/cuidadoras sobre la participación en un programa de prevención de la violencia

O presente estudo qualitativo objetivou compreender as expectativas de mães e cuidadoras sobre a sua participação no Programa ACT para Educar Crianças em Ambientes Seguros na versão remota, no período da pandemia de covid-19. Também visou identificar a percepção das participantes sobre educar uma criança em um ambiente seguro. Foram realizadas entrevistas semiestruturadas on-line com doze mães e cuidadoras, antes da participação no Programa ACT. Os resultados indicaram diferentes expectativas sobre a participação no Programa ACT, entre elas: adquirir novos conhecimentos, aprimorar as habilidades parentais, trocar experiências, receber auxílio no momento da pandemia de covid-19 e possibilitar para a criança um desenvolvimento saudável. Na percepção das mães e cuidadoras, a versão remota do Programa ACT apresenta aspectos positivos; entre eles, a participação de pais e cuidadores que não residem na cidade em que é oferecida a intervenção. No entanto, apontaram como fatores negativos a ausência do contato físico e as interrupções que podem acontecer a partir das falhas de internet. Para as mães e cuidadoras, educar a criança em um ambiente seguro estava relacionado a promover os direitos estabelecidos no Estatuto da Criança e do Adolescente (ECA), como educação, saúde, lazer, cuidado, afeto, assim como protegê-la de situações de violência. Considera-se que as expectativas das participantes estavam alinhadas aos objetivos do Programa ACT. Torna-se prioritário oferecer programas de prevenção à violência aos pais e cuidadores, em especial em momentos adversos como o da pandemia de covid-19, a fim de promover o desenvolvimento e a saúde das crianças, assim como prevenir situações de violação de direitos.(AU)

This qualitative study aims to understand the expectations of mothers and caregivers about participating in the ACT Raising Safe Kids Program in its remote version, during the COVID-19 pandemic period. It also aims to identify the participants' perception of raising a child in a safe environment. Semi-structured on-line interviews were conducted with 12 mothers/caregivers, prior to participation in the ACT Program. The results indicated different expectations regarding the participation in the ACT Program, for example: acquiring new knowledge, improving parenting skills, exchanging experiences, receiving support during the COVID-19 pandemic, and enabling the child to have a healthy development. In the perception of mothers and caregivers, the remote version of the ACT Program has positive aspects, such as the participation of parents and caregivers who do not live in the city where the intervention is offered. However, they pointed out as negative factors absence of physical contact and interruptions due to internet failures. For the mothers/caregivers, educating children in a safe environment was related to promoting the rights established by the Brazilian Child and Adolescent Statute, namely education, health, leisure, care, affection, as well as protecting them from situations of violence. The expectations of the participants were aligned with the objectives of the ACT Program. Offering violence prevention programs to parents and caregivers is a priority, especially in adverse moments such as the COVID-19 pandemic, in order to promote the development and health of children, as well as prevent situations of violation of rights.(AU)

Este estudio cualitativo pretendió comprender las expectativas de madres y cuidadoras sobre la participación en el Programa de ACT para Educar a Niños en Ambientes Seguros en la versión remota, en el periodo de la pandemia de la COVID-19. También se propuso identificar la percepción de las participantes sobre educar a un niño en un ambiente seguro. Se llevaron a cabo entrevistas semiestructuradas en línea con 12 madres/cuidadoras, antes de la participación en el Programa ACT. Los resultados señalaron diferentes expectativas con la participación del Programa de ACT, entre ellas: adquirir nuevos conocimientos, perfeccionar las habilidades parentales, intercambiar experiencias, recibir auxilio en el momento de la pandemia de la COVID-19 y posibilitar al niño un desarrollo saludable. En la percepción de las madres y cuidadoras, la versión remota del Programa de ACT presenta aspectos positivos, como la participación de padres y cuidadores que no residen en la ciudad donde es ofrecida la intervención. Sin embargo, señalaron como factores negativos la ausencia del contacto físico y las interrupciones, que pueden ocurrir por fallas en Internet. Para las madres/cuidadoras, educar al niño en un ambiente seguro estaba relacionado a promover los derechos establecidos en el Estatuto del Niño y del Adolescente de Brasil, como educación, salud, ocio, cuidado, afecto, así como protegerlo de situaciones de violencia. Se considera que las expectativas de las participantes estaban alineadas con los objetivos del Programa de ACT. Es prioritario ofrecer programas de prevención a la violencia a los padres y cuidadores, en especial en momentos adversos como el de la pandemia de la COVID-19, con el fin de promover el desarrollo y la salud de los niños, así como prevenir situaciones de vulneración de derechos.(AU)

Militância enquanto convite ao diálogo: o caso da militância monodissidente / Activism as an invitation for the dialogue: the case of monodissident activism / La militancia como invitación al diálogo: el caso de la militancia monodisidente

Este artigo é uma produção teórica de caráter reflexivo que focaliza a relação entre pesquisa e militância a partir do construtivismo semiótico-cultural em psicologia, tendo como base o caso da militância monodissidente. A noção de monodissidência foi cunhada no percurso da militância bissexual para se referir a uma ferramenta analítica de ordem político-comunitária que contempla todas as pessoas que se atraem sexual e/ou romanticamente por mais de um gênero. São contrapostas concepções distintas de militância político-social em psicologia: de um lado, militância é entendida a partir de um autocentramento do militante, vinculado a uma rede de exclusões, negações, vedação e defesas psicológicas em relação à experiência; de outro, há uma compreensão dialógica de militância. Metodologicamente, a proposta de pesquisa se fundamenta no campo da participação observante, entendendo que o pesquisador está, primeiro, na condição de participante de certo campo sociocultural, a partir do qual passa a observar e refletir sobre fenômenos que ocorrem nele. Tomamos como ilustração a trajetória de construção da militância monodissidente do primeiro autor, trazendo tensionamentos dialógicos para a análise, postos em discussão com outras reflexões situadas sobre o tema. O conjunto de tensionamentos dialógicos emergidos nesse percurso foi mapeado e compreendido como um processo de multiplicação dialógica no encontro de self pesquisador com o self militante.(AU)

This paper is a theoretical production of reflective character that focuses on the relationship between research and activism from the semiotic-cultural constructivism in psychology, based on the case of monodissident activism. The notion of monodissent was coined during bisexual activism to refer to an analytical tool of a political-community order that includes all people who are sexually and/or romantically attracted to more than one gender. Different conceptions of political-social activism in psychology are opposed: on the one hand, activism is understood from the militant's self-centeredness, linked to a network of exclusions, denials, gatekeeping, and psychological defenses regarding experience; on the other hand, there is a dialogical understanding of activism. Methodologically, the research proposal is based on the field of observant participation, understanding that the researcher is, first, in the condition of a participant in a certain sociocultural field, from which he starts to observe and reflect on phenomena that occur there. We take as an illustration the trajectory of the construction of the monodissident activism of the first author, bringing dialogical tensions to the analysis, discussed with other reflections on the subject. The set of dialogic tensions that emerged in this path was mapped and understood as a process of dialogic multiplication in the encounter of the researcher self with the activist self.(AU)

Este artículo realiza una producción teórica y reflexiva sobre la relación entre investigación y activismo desde el constructivismo semiótico-cultural en Psicología, a partir del caso del activismo monodisidente. La noción de monodisidencia fue acuñada en el transcurso de la militancia bisexual para referirse a una herramienta analítica de orden político-comunitario que incluye a todas las personas que se sienten atraídas sexual y / o románticamente por más de un género. Se contraponen distintas concepciones de la militancia político-social en Psicología: por un lado, la militancia se entiende desde el egocentrismo del militante, vinculado a un entramado de exclusiones, negaciones, sellamientos y defensas psicológicas con relación a la experiencia; por otro, existe una comprensión dialógica de la militancia. La investigación utiliza como metodología la participación del observador, entendiendo que el investigador se encuentra, en primer lugar, en la condición de participante de determinado campo sociocultural, desde donde comienza a observar y reflexionar sobre los fenómenos que allí ocurren. Tomamos como ilustración la trayectoria de la construcción de la militancia monodisidente del primer autor, trayendo tensiones dialógicas al análisis, discutidas con otras reflexiones sobre el tema. El conjunto de tensiones dialógicas que surgieron en este camino se caracteriza y se comprende como un proceso de multiplicación dialógica en el encuentro del self investigador con el self militante.(AU)

Improving cancer care for underserved populations in an academic and community practice setting: protocol for a community health worker pilot navigation programme.

INTRODUCTION: Delaying cancer treatment following diagnosis impacts health outcomes, including increasing patient distress and odds of mortality. Interventions to promote timely healthcare engagement may decrease patient-reported stress and improve quality of life. Community health workers (CHWs) represent an enabling resource for reducing delays in attending initial oncology treatment visits. As part of an ongoing programme evaluation coordinated by the Merck Foundation, we will implement a pilot navigation programme comprising CHW-conducted needs assessments for supporting patients and their caregivers. We aim to investigate (1) the programme's influence on patients' healthcare utilisation within the period between their first diagnosis and initial treatment visit and (2) the logistic feasibility and acceptability of programme implementation. METHODS AND ANALYSIS: We will employ a hybrid implementation design to introduce the CHW navigation programme at the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center. CHW team members will use a consecutive sampling approach. Participants will complete the Problem-Checklist, Chronic Illness Distress Scale and the Satisfaction with Life Domains instruments. CHWs will provide tailored guidance by sharing information available on the Johns Hopkins Electronic Resource databases. The investigators will evaluate patients' time to initial oncology treatment and healthcare utilisation by reviewing electronic medical records at 3 and 6 months postintervention. Bivariate analyses will be completed to evaluate the relationships between receiving the programme and all outcome measures. ETHICS AND DISSEMINATION: This study's protocol was approved by the Johns Hopkins School of Medicine's institutional review board (IRB00160610). Informed consent will be obtained by phone by the CHW navigator. Dissemination planning is ongoing through regular meetings between members of the investigator team and public members of two community advisory groups. Study plans include collaborating with other experts from the Johns Hopkins Institute for Clinical and Translational Research and the Johns Hopkins Center for Health Equity for ideating dissemination strategies.

Patient-Reported Measures of a Breast Cancer Nurse Navigator Program in an Underserved, Rural, and Economically Disadvantaged Patient Population.

OBJECTIVES: To assess the efficacy of the University of New Mexico Comprehensive Cancer Center's (UNMCCC's) breast cancer nurse navigator (BCNN) program in addressing gaps in cancer care for an underserved, rural, and economically disadvantaged population. SAMPLE & SETTING: 54 navigated patients under the care of the BCNN and 32 non-navigated patients whose care began prior to the start of the program. METHODS & VARIABLES: Surveys were administered anonymously to patients during regularly scheduled appointments at UNMCCC. RESULTS: Navigated patients more strongly agreed that they were prepared for the beginning of treatment and that calls were returned promptly, and showed a decreased desire for an after-treatment summary compared to non-navigated patients. IMPLICATIONS FOR NURSING: Navigated patients report better understanding of and engagement with the healthcare system when assisted by a BCNN during breast cancer treatment with curative intent, as well as desire fewer services than non-navigated peers, indicating greater satisfaction.

Empowerment-based support program for vulnerable populations living with diabetes, obesity or high blood pressure: a scoping review.

BACKGROUND: The management of chronic diseases such as diabetes, obesity and high blood pressure is a major global health challenge, particularly among the most disadvantaged populations. Beyond the biomedical management of these diseases, comprehensive support that takes into account the peoples' economic and social situation is fundamental. The objective of this scoping review is to create an inventory and an analysis of the different types of support for these chronic diseases among disadvantaged, immigrant or minority populations to contribute to a better definition and characterization of what should be global support for these vulnerable populations suffering from these diseases. METHODS: A search of PubMed, PsycINFO, Sages Journals and Web of Science was conducted (between March and May 2021) for articles published between January 2000 and May 2021. Articles were selected after screening titles, abstracts and full texts according to our 5 inclusion criteria. RESULTS: We included 16 articles. The diabetes, obesity and high blood pressure support programs described in these articles operate to improve physical and mental health and access to care. The approaches of these interventions are focused on the training and participation of people and the implementation of support actions adapted to the person. The majority of these interventions have a real attachment to the community. CONCLUSIONS: This review of the literature shows that support for people with chronic diseases such as diabetes, obesity or high blood pressure is based on three pillars: empowerment, peer mediation and holistic and tailor-made support for the individual. The empowerment approach, which considers the capacities and resources of individuals and whose goal is to strengthen their ability to act on their health, appears to be entirely suited to the support of these chronic diseases. This review underlines the importance of moving away from a biomedical approach to a holistic approach truly focused on the person, their capacities and their needs.

Huddling with families after disaster: Human resilience and social disparity.

Disasters, from hurricanes to pandemics, tremendously impact human lives and behaviors. Physical closeness to family post-disaster plays a critical role in mental healing and societal sustainability. Nonetheless, little is known about whether and how family colocation alters after a disaster, a topic of immense importance to a post-disaster society. We analyze 1 billion records of population-scale, granular, individual-level mobile location data to quantify family colocation, and examine the magnitude, dynamics, and socioeconomic heterogeneity of the shift in family colocation from the pre- to post-disaster period. Leveraging Hurricane Florence as a natural experiment, and Geographic Information System (GIS), machine learning, and statistical methods to investigate the shift across the landfall (treated) city of Wilmington, three partially treated cites on the hurricane's path, and two control cities off the path, we uncover dramatic (18.9%), widespread (even among the partially treated cities), and enduring (over at least 3 months) escalations in family colocation. These findings reveal the powerful psychological and behavioral impacts of the disaster upon the broader populations, and simultaneously remarkable human resilience via behavioral adaptations during disastrous times. Importantly, the disaster created a gap across socioeconomic groups non-existent beforehand, with the disadvantaged displaying weaker lifts in family colocation. This sheds important lights on policy making and policy communication to promote sustainable family colocation, healthy coping strategies against traumatic experiences, social parity, and societal recovery.