Becoming a Co-Survivor-Reflections From the ICU.

This essay describes what the author learned from being in the intensive care unit with her father during multiple cardiac arrests and surgery.

Restorative Justice for Survivors of Sexual Violence Experienced in Adulthood: A Scoping Review.

Sexual violence (SV) is a widespread human rights issue. Survivors of SV often experience profound dehumanization and poor health outcomes when their trauma is not properly addressed, rendering it critical that they are honored and empowered within subsequent processes of healing and seeking justice. With adjudication through the criminal legal system largely underutilized due to retraumatization, scrutiny from law enforcement professionals, and high rates of case closure, restorative justice (RJ) has emerged as a promising option for survivors to repair harm and experience accountability. Little is known, however, regarding the best practices for its use in cases of SV. To meet this need, a scoping review was conducted to identify the best practices for the implementation of RJ after instances of SV experienced in adulthood. Following the search methodology outlined by the JBI Manual for Evidence Synthesis for scoping reviews, 15 articles met search criteria, including four empirical studies and 11 nonempirical research materials spanning five academic disciplines. Best practices and structures for RJ were subsequently identified, including key phases for appropriate implementation. This review can be used to create increasingly productive RJ processes for SV survivors, which is particularly important for those coming from marginalized communities facing structural inequities, as well as survivors on university campuses. As researchers, we have the power to use science to propel society toward the creation of more efficacious healing spaces for survivors of SV, and optimizing safe RJ processes plays a key role in bringing this to fruition.

Gender Differences of Endowed Professorship in Obstetrics and Gynecology Departments at Top Academic Institutions.

Background: Gender equity is a critical issue in academic medicine. Whether there is equitable access to the prestige and resources of endowed professorships merits evaluation. We investigated this question in obstetrics and gynecology, a field that focuses on the health of women and in which women are much better represented than other specialties of medicine. Materials and Methods: We compiled a list of the top 25 United States departments of obstetrics and gynecology and contacted department chairs (and used department websites) to obtain lists of faculty and their positions. Scopus, department websites, and National Institutes of Health (NIH) RePORTER were used to collect h-Index, number of publications and citations, graduation year, degrees, gender, and NIH-funding. We conducted a bivariate comparison of endowed professorship attainment by gender using a chi-square test and created a multiple variable regression model. Results: Of the 680 obstetrics and gynecology faculty across 23 departments that had endowed chairs, 64 out of 400 women (16%) and 66 out of 280 men (24%) held endowed chairs (p = 0.01). The multivariable model suggested no independent gender difference in attainment of an endowed chair after adjusting for covariates. Conclusion: To our knowledge, this study is the first to examine gender as a variable in endowed chair allocation in top obstetrics and gynecology academic departments. Our findings suggest a significant gender difference in the allocation of endowed chairs. That difference is driven by gender differences in academic rank, graduation year, publications, and funding. To promote the intraprofessional equity necessary to optimally advance women's health, further research and intervention are necessary.

Trauma-Informed Care Curricula for the Health Professions: A Scoping Review of Best Practices for Design, Implementation, and Evaluation.

PURPOSE: Trauma-exposed persons often experience difficulties accessing medical care, remaining engaged in treatment plans, and feeling psychologically safe when receiving care. Trauma-informed care (TIC) is an established framework for health care professionals, but best practices for TIC education remain unclear. To remedy this, the authors conducted a multidisciplinary scoping literature review to discern best practices for the design, implementation, and evaluation of TIC curricula for health care professionals. METHOD: The research team searched Ovid MEDLINE, Cochrane Library, Elsevier's Scopus, Elsevier's Embase, Web of Science, and the PTSDpubs database from the database inception date until May 14, 2021. Worldwide English language studies on previously implemented TIC curricula for trainees or professionals in health care were included in this review. RESULTS: Fifty-five studies met the inclusion criteria, with medicine being the most common discipline represented. The most prevalent learning objectives were cultivating skills in screening for trauma and responding to subsequent disclosures (41 studies [74.5%]), defining trauma (34 studies [61.8%]), and understanding trauma's impact on health (33 studies [60.0%]). Fifty-one of the studies included curricular evaluations, with the most common survey items being confidence in TIC skills (38 studies [74.5%]), training content knowledge assessment (25 studies [49.0%]), participant demographic characteristics (21 studies [41.2%]), and attitudes regarding the importance of TIC (19 studies [37.3%]). CONCLUSIONS: Future curricula should be rooted in cultural humility and an understanding of the impacts of marginalization and oppression on individual and collective experiences of trauma. Moreover, curricula are needed for clinicians in more diverse specialties and across different cadres of care teams. Additional considerations include mandated reporting, medical record documentation, and vicarious trauma experienced by health care professionals.

Navigating Cardiology's Leaky Pipeline.

This essay describes the author's experience of gender-based discouragement as a woman medical student.

Trauma Recovery Rubric: A Mixed-Method Analysis of Trauma Recovery Pathways in Four Countries.

Research is beginning to examine gender-based violence (GBV) survivors' recovery, but little is known about diverse recovery trajectories or their relationships with other distress and recovery variables. This interdisciplinary, international multisite mixed-method study developed and used the TRR to identify and classify survivors' trauma pathways. This study describes the phases of the initial development of the preliminary TRR (Phase 1), refines and calibrates the TRR (Phase 2), and then integrates the TRR into quantitative data from four countries (Phase 3). Seven recovery pathways with six domains emerged: normalizing, minimizing, consumed/trapped; shutdown or frozen, surviving, seeking and fighting for integration; finding integration/equanimity. Depression scores were related to most recovery domains, and TRR scores had large effect sizes. At the same time, PTSD was not statistically related to TRR scores, but TRR had a medium effect size. Our study found that the TRR can be implemented in diverse cultural settings and promises a reliable cross-cultural tool. The TRR is a survivor-centered, trauma-informed way to understand different survivorship pathways and how different pathways impact health outcomes. Overall, this rubric provides a foundation for future study on differences in survivor healing and the drivers of these differences. This tool can potentially improve survivor care delivery and our understanding of how to meet best the needs of the survivor populations we intend to serve.

Pushing for the same thing on the same set of tracks: a qualitative study exploring the anti-trafficking response in Bihar and Uttar Pradesh.

BACKGROUND: Human trafficking is a critical public health issue particularly pervasive in the Indian states of Bihar and Uttar Pradesh (UP), which share a border with Nepal. Many NGOs are participating in prevention, protection, prosecution, and capacity building initiatives. The aim of this study was to identify factors hindering and enhancing the efficacy of anti-trafficking programs in the region. METHODS: A qualitative study was conducted using semi-structured interviews and focus groups with key stakeholders in Bihar, Uttar Pradesh, and Nepal. RESULTS: Thematic analysis revealed that the barriers hindering the anti-trafficking movement include police corruption, insufficient enforcement of national law, discrimination toward trafficking victims, inadequate funding, and lack of government involvement. Recommendations for overcoming these barriers were through empowering survivors and increasing cooperation, coordination, and communications between NGOs and the government. CONCLUSIONS: In mitigating these barriers and increasing survivor autonomy, anti-trafficking interventions have the opportunity to create individualized environments for those with an experience of trafficking to thrive. Ultimately, elevating community accountability, honoring individual autonomy, and recognizing the value of the persons with a lived experience of trafficking are critical as we continue to use a public health lens in the fight against human trafficking and for human rights.

Trauma Recovery Is Cultural: Understanding Shared and Different Healing Themes in Irish and American Survivors of Gender-based Violence.

Little research has focused on the trauma healing processes of survivors of gender-based violence (GBV) worldwide. Even less research has utilized cross-cultural comparison to understand shared or culturally-distinct healing goals, creating a gap in understanding how to provide adequate, culturally relevant, and trauma-informed care to survivors. The purpose of this study was to cross-culturally compare shared healing influences and themes of the trauma recovery process in samples of Irish and American female survivors of GBV. To gather healing data, an ethnographic narrative interview was used with 19 American and 12 Irish female survivors who self-identified as having experienced GBV. Thematic analysis was used to examine and compare desired healing outcomes, focusing on the definitions, influences, and meanings of healing experiences. Our analysis revealed shared healing objectives of reconnecting to the self, others, and the world. Within reconnecting with the self, shared themes included regaining control and feelings of competency. Within reconnecting to others, shared themes included building and maintaining relationships, living one's life authentically, and feeling heard and understood. Within reconnecting to the world, shared themes included feelings of serenity, finding fulfillment, and having hope for a brighter future. Although these themes were shared, the way they manifested in each culture was often different. A vital component of the healing dynamic in the Irish sample was survivors' mothering responsibilities and feelings of unconditional devotion to their children. Conversely, the American sample focused on personal growth and resolving feelings of weakness. This information reveals shared as well as cultural nuances of important healing objectives following GBV. The present study's results can be used to create culturally sensitive and relevent healing spaces for survivors. These results can also inform intervention and messaging strategies aimed at promoting healing in these populations.

Silently Screaming in the Dark: Gender-Based Dynamics of Distress in Japanese Migrants.

Prior literature has shown the female Japanese population experiences higher susceptibility to mental health disorders. The causal influences of help-seeking for distressed women were investigated through analysis of 24 interviews of Japanese immigrant women in the Detroit Metropolitan Area. The Clinical Ethnographic Narrative Interview (CENI) was utilized as the interviewing technique, investigating Japanese culture as a determinant of personal wellness. This study was a grounded theory examination of the interactions among gender, social context, cultural displacement, and a causal model for Japanese women's distress experiences. The resulting theoretical model revealed the familial and social dynamics traditional to Japanese culture developed feelings of poor self-worth common amongst study participants. This negative perception of self was exacerbated by gendered challenges of expatriation and intense pressures within this region's Japanese migrant community. These findings show the need for increased contact with at-risk populations to understand their causal models and help-seeking behaviors and expectations.

Gender in the time of COVID-19: Evaluating national leadership and COVID-19 fatalities.

In this paper we explore whether countries led by women have fared better during the COVID-19 pandemic than those led by men. Media and public health officials have lauded the perceived gender-related influence on policies and strategies for reducing the deleterious effects of the pandemic. We examine this proposition by analyzing COVID-19-related deaths globally across countries led by men and women. While we find some limited support for lower reported fatality rates in countries led by women, they are not statistically significant. Country cultural values offer more substantive explanation for COVID-19 outcomes. We offer several potential explanations for the pervasive perception that countries led by women have fared better during the pandemic, including data selection bias and Western media bias that amplified the successes of women leaders in OECD countries.

Healing is not linear: Using photography to describe the day-to-day healing journeys of undergraduate women survivors of sexual violence.

The purpose of this study was to describe the day-to-day healing processes of women who experienced undergraduate sexual violence. We engaged 19 women in a photo-elicitation experience with follow-up individual interviews to identify themes of both healing and darker moments in survivors' everyday lives. Healing was found to function on a continuum influenced by darker moments (i.e., moments that elicited fear, anxiety, loneliness, guilt, anger, and worthlessness) and healing moments (i.e., rebuilding moments of self-care, self-love, connection, hope, peace, and freedom). Responses to darker moments included feeling overwhelmed, disconnected, and intentional vulnerability. Healing moments were influenced by self-reflection, authentic interactions, and resource utilization. The photographs taken in this study shed light on the impact of sexual violence in women's daily lives long after these traumatic and unjust experiences. This knowledge can be used to foster a sense of universality in survivors who are currently struggling and growing after their experiences as well as give service providers greater insight into what survivors' day-to-day needs may be.