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In recent years, there have been international references to the vocal approach for the specific group of transgender individuals, although the Latin American literature is still very timid on this matter. The purpose of this article is to identify the current norms, statistics, and vocal approach towards transgender individuals in Chile and Argentina, considering the experience of two speech and language pathologists with more than twenty years of experience on voice therapy. Reflections were made on the transgender reality in these countries, the limitations in the implementation of the depathologization of the transgender group were outlined, some current and unreliable statistics were presented, some innovative actions in the public system were highlighted, and the lack of knowledge about the benefits of vocal work for transgender men and women was discussed. The identified aspects could benefit from multicenter research that strengthens speech therapy actions with this group, contributing to depathologization and positive approach.
Desde los últimos años es posible encontrar referencias internacionales sobre el abordaje vocal al grupo específico de las personas transgénero, aunque la literatura latinoamericana sigue muy tímida en este asunto. La propuesta de este artículo es identificar las normas vigentes, estadísticas y abordaje vocal hacia las personas transgénero en Chile y Argentina, considerando la experiencia de dos fonoaudiólogas con más de veinte años de experiencia en terapia vocal. Se hicieron reflexiones sobre la realidad transgénero en los países citados, se delinearon las limitaciones en la puesta en práctica de la despatologización del grupo transgénero, se expusieron algunas estadísticas -vigentes y poco confiables-, se plasmaron algunas acciones novedosas en el sistema público y el desconocimiento sobre los beneficios del trabajo vocal en hombres y mujeres transgénero. Los aspectos detectados podrían beneficiarse de investigaciones multicéntricas que fortalezcan acciones fonoaudiológicas con este grupo, contribuyendo a la despatologización y el abordaje positivo.
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In a context where different protocols for recommended practices in clinical voice assessment exist, while there are gaps in the literature regarding the evidence base supporting assessment procedures and measures, clinicians from regions where a strong community holding expertise in clinical and scientific voice practices lack can struggle to confidently develop their voice assessment practices. In an effort to improve voice assessment practices and strengthen professional identity among speech-language pathologists in Quebec, Canada, a community of practice (CoP) was established, with the aim of promoting knowledge sharing, implementing change in clinical practice, and improving professional identity. Thirty-nine participants took part in the CoP activities conducted over a four-month period, including virtual meetings and in-person workshops. Participants had a high rate of attendance (> 74% participation rate in virtual meetings), and were highly satisfied with their participation and intended to remain involved after the project's end. Statistically significant changes in voice assessment practices were observed post-CoP, regarding probability of performing assessments (p < .001), and perceived importance of assessment for evaluative purposes (p <.001), as well as improvements in assessment specific confidence, specifically for procedure of auditory-perceptual assessment (p < .001) and purpose of aerodynamic assessment (p = .05). Moreover, there was an increase in professional identity post-CoP (p < .001) and participants felt they made significant learnings. The present study highlighted the need to involve SLPs in future research to identify assessments that are relevant to the specific evaluative objectives of SLPs working with voice, and suggests CoPs are an efficient tool for that purpose.
En un contexto en el que existen diferentes protocolos para las prácticas recomendadas en la evaluación vocal clínica, y en el que se presentan vacíos en la literatura respecto a la base de evidencia que respalda los procedimientos y medidas de evaluación, los profesionales de regiones donde no hay una comunidad sólida con experiencia en prácticas vocales clínicas y científicas pueden enfrentar dificultades para desarrollar con confianza sus prácticas de evaluación vocal. Con el propósito de mejorar las prácticas de evaluación vocal y fortalecer la identidad profesional entre los logopedas de Quebec, Canadá, se estableció una comunidad de práctica (CdP). Esta tenía como objetivo fomentar el intercambio de conocimientos, implementar cambios en la práctica clínica y mejorar la identidad profesional. Un total de treinta y nueve participantes se involucraron en las actividades de la CdP, llevadas a cabo durante un período de cuatro meses, que incluyeron reuniones virtuales y talleres presenciales. Los participantes tuvieron una alta tasa de asistencia (> 74% de participación en las reuniones virtuales) y expresaron un alto grado de satisfacción con su participación, manifestando su intención de continuar involucrados después de la finalización del proyecto. Se observaron cambios estadísticamente significativos en las prácticas de evaluación vocal posterior a la CdP, en lo que respecta a la probabilidad de llevar a cabo evaluaciones (p < .001) y la percepción de la importancia de la evaluación con fines evaluativos (p < .001), así como mejoras en la confianza específica en la evaluación, particularmente en el procedimiento de evaluación auditivo-perceptual (p < .001) y el propósito de la evaluación aerodinámica (p = .05). Además, se registró un aumento en la identidad profesional posterior a la CdP (p < .001) y los participantes sintieron que obtuvieron aprendizajes significativos. El presente estudio destacó la necesidad de involucrar a los logopedas en investigaciones futuras, para identificar evaluaciones pertinentes a los objetivos evaluativos específicos de los logopedas que trabajan con la voz, y sugiere que las CdP son una herramienta eficiente con ese propósito.
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Objectives: Increasing numbers of women enter medical school annually. The number of female physicians in leadership positions has been much slower to equalize. There are also well-documented differences in the treatment of women as compared to men in professional settings. Female presenters are less likely to be introduced by their professional title ("Doctor") for grand rounds and conferences, especially with a man performing the introduction. This study reviewed the Canadian Society of Otolaryngology-Head and Neck Surgery (CSOHNS) meetings from 2017 to 2020 to determine the proportion of presenters introduced by their professional title and whether this varied by gender. Methods: Recordings from CSOHNS meetings were reviewed and coded for introducer and presenter demographics, including leadership positions and gender. Chi-squared tests of proportion and multivariate logistic regression was used to compare genders and identify factors associated with professional versus unprofessional forms of address. Results: No significant association was found between professional title use and introducer or presenter gender. Female presenters were introduced with professional title 69.6% of the time, while male presenters were introduced with professional title 67.6% of the time (P = 0.69). Residents were introduced with a professional title with the most frequency (75.8%), while attending staff were introduced with a professional title with the least frequency (63.0%) (P = 0.02). Conclusions: The lack of gender bias in speaker introductions at recent CSOHNS meetings demonstrates progress in achieving gender equity in medicine. Research efforts should continue to define additional forms of unconscious bias that may be contributing to gender inequity in leadership positions.
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Non-binary people face numerous stressors in their daily lives, including personal, interpersonal, and environmental. These stressors gain strength when such individuals access healthcare services, and discrimination and cisgenderism become the main barrier to obtaining gender-affirming healthcare. This study aimed to describe the experiences of non-binary people regarding the care and medical attention received in Catalonia (Spain). A qualitative phenomenological study was conducted with 21 non-binary people recruited using snowball sampling in 2022. Data were gathered through open-ended interviews and analyzed using thematic analysis. Two main themes were identified, which were further classified into two categories each: Theme 1-This is me composed of the categories, "My Name and My Pronouns" and "One's Chosen Gender," and Theme 2-I do not exist for the health system consisting of "Uneducated Health System in Sexual Health" and "Feeling Like an Outsider for Being Non-Binary." Non-binary people face multiple stressors when accessing the healthcare services that makes them feel invisible, vulnerable, and marginalized. Further widespread implementation of person-centered care is essential to promote the relationship between non-binary people and the healthcare system. In addition, further sexual health training is required for all health professionals.
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The study explored how young adults with cancer create a cancer identity across the illness trajectory. Young adults with hematological cancers (n = 53, ages 20-39) completed a semi-structured interview and brief questionnaire. Deductive thematic analysis was used to code interviews. Four identity categories (Acceptance, Enrichment, Engulfment, and Rejection) were coded and linked to the cancer stage (pre-treatment, active treatment, post-treatment). Pre-treatment, there was minimal expression about identity. Acceptance during active treatment involved identity work around disclosure and the integration of pre-cancer identity with the treatment experience. Post-treatment, acceptance involved actively making sense of the cancer experience and its long-term impact; Enrichment was more frequent post-treatment. Engulfment was expressed most during treatment. Individuals who remained engulfed post-treatment expressed difficulties moving beyond the patient's identity. Rejection of a cancer identity was rarely expressed. Understanding how young adults integrate the cancer experience into their identity may suggest intervention strategies.
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OBJECTIVE: Little research explores military perspectives on medical disability-related transition. A qualitative study sought to understand transition experiences of United States military Service members found unfit for duty following medical and physical evaluation boards (MEBs and PEBs). METHODS: Confidential telephone interviews were conducted with 25 current and prior Service members. Participants were asked to share their experiences before, during, and after the MEB and PEB processes. Interview questions explored (1) health conditions that prompted the medical disability evaluation, (2) reactions to being recommended for separation, (3) transition-related stress and challenges, and (4) coping strategies. Salient themes were identified across chronological narratives. RESULTS: Participants expressed that debilitating physical (e.g., injury) and/or mental (e.g., post-traumatic stress disorder) illnesses prompted their medical evaluation. In response to the unfit for duty notice, some participants reported emotional distress (e.g., anxiety, anger) connected to uncertainty about the future. Other participants reported relief connected to a sense of progression toward their medical disability claim status. Transition stress included the length of the MEB/PEB process, impact of the COVID-19 pandemic on the process, financial stress, impact on family life, and compounded effect of these stressors on emotional distress, including depression and suicidal thoughts. Participants reported using adaptive (e.g., psychotherapy) and maladaptive (e.g., excessive drinking) strategies to cope with stress. CONCLUSION: Preliminary reports of emotional distress and transition stress following unfit for duty notices highlight the need for increased support and interventions to facilitate adaptive coping strategies during this vulnerable period.
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Purpose: Mental health disparities in sexual orientation and/or gender identity and/or expression (SOGIE) minority groups are well-documented, with research consistently showing higher levels of suicidality, even in Canada, considered one of the world's most accepting countries of SOGIE minority groups. Adverse outcomes in these groups are often framed using minority stress theory, with social support frequently studied as an integral buffer to these outcomes. This analysis explores facets of minority stress and social support associated with past-year suicidal ideation and suicide attempts. Methods: A cross-sectional internet survey of SOGIE diverse people in Canada (n = 1542) was conducted. Binary logistic regression calculated bivariate and multivariate factors associated with past-year suicidal ideation and suicide attempts. Backward elimination (retaining sociodemographic factors and self-rated mental health) identified salient minority stress and social support (provisions) factors. Results: Over half (56.72%) of participants had ever thought of dying by suicide, with 24.84% having attempted suicide. During the past year, 26.80% had thought of dying by suicide, with 5.32% having attempted suicide. Victimization events, and guidance (e.g., someone to talk to about important decisions) and attachment (e.g., close relationships providing emotional security) social provision subscales remained salient after backward elimination procedures. Conclusion: Our findings emphasize that a fulsome, multilevel approach considering structural, community, and individual strategies to address overt discrimination, integrating social connections and guidance, is necessary to prevent dying by suicide.
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AIM: This study seeks to review how the use of digital technologies in clinical nursing affects nurses' professional identity and the relations of power within clinical environments. DESIGN: Literature review. DATA SOURCES: PubMed and CINAHL databases were searched in April 2023. METHODS: We screened 874 studies in English and German, of which 15 were included in our final synthesis reflecting the scientific discourse from 1992 until 2023. RESULTS: Our review revealed relevant effects of digital technologies on nurses' professional identity and power relations. Few studies cover outcomes relating to identity, such as moral agency or nurses' autonomy. Most studies describe negative impacts of technology on professional identity, for example, creating a barrier between nurses and patients leading to decreased empathetic interaction. Regarding power relations, technologically skilled nurses can yield power over colleagues and patients, while depending on technology. The investigation of these effects is underrepresented. CONCLUSION: Our review presents insights into the relation between technology and nurses' professional identity and prevalent power relations. For future studies, dedicated and critical investigations of digital technologies' impact on the formation of professional identity in nursing are required. IMPLICATIONS FOR THE PROFESSION: Nurses' professional identity may be altered by digital technologies used in clinical care. Nurses, who are aware of the potential effects of digitized work environments, can reflect on the relationship of technology and the nursing profession. IMPACT: The use of digital technology might lead to a decrease in nurses' moral agency and competence to shape patient-centred care. Digital technologies seem to become an essential measure for nurses to wield power over patients and colleagues, whilst being a control mechanism. Our work encourages nurses to actively shape digital care. REPORTING METHOD: We adhere to the JBI Manual for Evidence Synthesis where applicable. EQUATOR reporting guidelines were not applicable for this type of review. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.
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Purpose: The objective of this study was to determine the minimum number of teeth in the anterior dental arch that would yield accurate results for individual identification in forensic contexts. Materials and Methods: The study involved the analysis of 28 sets of 3-dimensional (3D) point cloud data, focused on the labial surface of the anterior teeth. These datasets were superimposed within each group in both genuine and imposter pairs. Group A incorporated data from the right to the left central incisor, group B from the right to the left lateral incisor, and group C from the right to the left canine. A comprehensive analysis was conducted, including the evaluation of root mean square error (RMSE) values and the distances resulting from the superimposition of dental arch segments. All analyses were conducted using CloudCompare version 2.12.4 (Telecom ParisTech and R&D, Kyiv, Ukraine). Results: The distances between genuine pairs in groups A, B, and C displayed an average range of 0.153 to 0.184 mm. In contrast, distances for imposter pairs ranged from 0.338 to 0.522 mm. RMSE values for genuine pairs showed an average range of 0.166 to 0.177, whereas those for imposter pairs ranged from 0.424 to 0.638. A statistically significant difference was observed between the distances of genuine and imposter pairs (P<0.05). Conclusion: The exceptional performance observed for the labial surfaces of anterior teeth underscores their potential as a dependable criterion for accurate 3D dental identification. This was achieved by assessing a minimum of 4 teeth.
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Purpose: The goal of this study was to examine plurisexual identity, intimate partner violence (IPV), reproductive coercion, and parental monitoring among pregnant 13-21-year-olds. Methods: We conducted a cross-sectional analysis of data collected from a cohort of pregnant adolescents and young adults between October 2019 and May 2023 (n = 398). Logistic regression was completed to assess IPV and reproductive coercion as a function of plurisexual identity. Next, we assessed potential interactions between parental monitoring and plurisexual identity and examined IPV and reproductive coercion as a function of parental monitoring for the full sample and stratified by plurisexuality. Results: Plurisexual identity was associated with IPV (adjusted odds ratio [aOR] = 2.3; confidence interval [CI]: 1.4-4.0). IPV was inversely related to parental monitoring among plurisexual participants (aOR: 0.51; CI: 0.32-0.82), but this association was not significant for heterosexual participants (aOR: 1.1; CI: 0.75-1.6). Conclusions: This work demonstrates the importance of parental monitoring in supporting young plurisexual pregnant people.
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Objective: To explore the relationships among motivation, professional identity, and innovative ability of nursing intern students. Background: Professional identity and innovative ability are important for nursing students' core competitiveness and care quality. During the internship, nursing students integrate theoretical knowledge and practice, and have a rapid growth. Motivation is positively associated with professional identity and innovative ability. However, there are limited studies examining the professional identity, motivation, and innovative ability of nursing intern students. Design: A descriptive cross-sectional online study. Methods: Students in the nursing schools in southwest and central of China were included in this study and conducted from June to July 2022. A total of 474 nursing intern students were recruited from 16 nursing schools. Research data were collected with "Participants' Demographics Form", "the Professional Identity Questionnaire for Nursing Students", "the Revised Life Goals Questionnaire", and "the Revised Multidimensional Innovative Questionnaire". Independent-sample t-tests, one-way analysis of variance, correlation coefficients, and structural equation modeling were used in data analysis. This study adhered to the STROBE guidelines. Results: A significantly positive correlation was determined among the professional identity (67.55 ± 8.42), motivation (53.38 ± 5.54), and innovative ability (47.99 ± 5.46) of nursing students (r > 0.4, P < 0.001). Motivation had a mediating effect on professional identity and innovative ability (P = 0.003), accounting for 10.9% (0.075/0.689) of the total effect. Conclusions: There was a positive correlation among professional identity, motivation, and innovative ability. Developing motivation and professional identity can enhance nursing intern students' ability to innovate.
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Characters play an integral role in animated narratives, but their visual racial presentation has received limited attention. A diverse group of U.S. children watched a 15-min physical activity-promoting animated Sci-Fi narrative. They were randomly assigned to one of three conditions, which varied the lead characters' racial presentation: realistic racially unambiguous (Original: White children, Black mother), realistic racially ambiguous (Ambiguous: All with brown skin without specified race/ethnicity), and fantastical racially ambiguous (Fantastical: All with brown skin with fantastical hair-and-eye color schemes). We assessed narrative engagement, wishful identification, and physical activity intention. Controlling for social desirability and multigroup ethnic identity, children who watched Fantastical characters showed significantly higher narrative engagement than those who watched Original characters, but they did not statistically differ from those who watched Ambiguous characters. Structural equation modeling indicated that narrative engagement and wishful identification fully mediated the racial representation effect (Fantastical vs. Original) on physical activity intention.
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Objective: To explore what aromanticism is, common misconceptions about this identity, and the experiences people have connecting with an aromantic identity. Methods: An online, international open-ended survey with a convenience sample of aromantic individuals (N = 1642) analyzed with thematic analysis. Results: To identify as aromantic involves a spectrum of experiences with romance commonly tied to experiencing stigma. Connecting with an aromantic identity allows for a greater understanding of the self and a connection to a community. Conclusions: Future research is needed to explore the experiences and perspectives of this community to gather better understanding of their needs and how to prevent/limit stigmatizing experiences.
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The ongoing debate within neuroethics concerning the degree to which neuromodulation such as deep brain stimulation (DBS) changes the personality, identity, and agency (PIA) of patients has paid relatively little attention to the perspectives of prospective patients. Even less attention has been given to pediatric populations. To understand patients' views about identity changes due to DBS in obsessive-compulsive disorder (OCD), the authors conducted and analyzed semistructured interviews with adolescent patients with OCD and their parents/caregivers. Patients were asked about projected impacts to PIA generally due to DBS. All patient respondents and half of caregivers reported that DBS would impact patient self-identity in significant ways. For example, many patients expressed how DBS could positively impact identity by allowing them to explore their identities free from OCD. Others voiced concerns that DBS-related resolution of OCD might negatively impact patient agency and authenticity. Half of patients expressed that DBS may positively facilitate social access through relieving symptoms, while half indicated that DBS could increase social stigma. These views give insights into how to approach decision-making and informed consent if DBS for OCD becomes available for adolescents. They also offer insights into adolescent experiences of disability identity and "normalcy" in the context of OCD.
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PURPOSE: To explore how medical teachers navigate their professional identities when required to implement critical pedagogy during an undergraduate curriculum renewal initiative. METHODS: A qualitative exploratory study was conducted, using focus groups and individual interviews with twenty-six purposively selected undergraduate medical teachers at a South African university. Data were transcribed, coded, and thematically analysed. Concepts of Landscapes of Practice Theory and Teacher Identity Learning provided an interpretive framework. RESULTS: Findings show that medical teachers' perceived capacity to implement critical pedagogy was influenced by identities that were constructed within the boundaries of a traditional biomedical curriculum. Three themes were identified, highlighting the inherent liminality of traversing a changing educational landscape: engaging in new practices: moving into the boundary space; attempting alignment: navigating identity in the boundary space; imagining the future: embracing identity in the boundary space. CONCLUSION: Globally directed curriculum renewal imperatives may challenge the established pedagogical practices and professional identities of medical teachers. There is a need for institutional spaces that foster collaboration, dialogue, and reflection with a view to supporting the ongoing identity learning and development of knowledgeability of medical teachers responsible for curriculum transformation.
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In the present research, we introduce and validate a single-item measure of identity leadership-the visual identity leadership scale (VILS). The VILS uses Venn diagrams of sets of overlapping circles to denote different degrees of alignment between a leader's characteristics and behaviours and a group's values and goals. Key advantages of the VILS over other existing multi-item scales are that it provides a holistic assessment of identity leadership, is short, and can be adapted to address novel research questions that are impractical to address with existing scales (e.g. in diary studies, assessing multiple comparisons of many leaders or groups). Data from three studies (conducted in India, the United States and Germany) provide evidence of the VILS' construct reliability and validity. Results also showcase the instrument's capacity to be adapted to assess variations of identity leadership-for example, by assessing a leader's convergence with descriptive and ideal notions of collective self (i.e. with 'who we are' and 'who we want to be'). We discuss the value of including the VILS in the toolbox that researchers and practitioners can utilize to expand our understanding of identity processes in leadership and group behaviour.
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Evidence suggests that social identities, which provide purpose and a sense of belonging, enhance resilience against psychological strain and safeguard well-being. This applies to first-generation migrant populations facing adverse experiences, including prejudice and disconnection from previous identities during host country integration, negatively impacting their well-being. The importance of social identity also extends to first-generation migrant descendants, confronting dual-identity challenges and experiencing exclusion and discrimination despite being native born. Building on the social identity approach to mental health, 20 semi-structured interviews were conducted to investigate how migrants construct their social identities, their perspective on the challenges and changes they experience in relation to group memberships and ultimately, the influence this has on their psychological well-being. Findings emphasize the significance of social identity continuity and gain pathways in first-generation migrants' successful adjustment and psychological well-being. For second-generation migrants, dual-identity development is especially difficult during adolescence due to social exclusion and discrimination in schools. Even in early adulthood, pressure to maintain heritage identity can lead to negative mental health outcomes over time. The current study contributes to and strengthens the social identity approach to migrant mental health and has wider implications for psychological interventions and policy.
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Transgender adolescents often categorize themselves in the same way that cisgender adolescents do-that is, as girls/women and boys/men. Potential differences in the extent to which these self-categorizations matter to transgender and cisgender adolescents, however, have yet to be explored, as has the relative importance transgender adolescents place on their gender compared to their transgender self-categorization. In the current study, we explored self-reported identity importance in a sample of 392 primarily White (70%) and multiracial/ethnic (20%) 12-18-year-old (M = 15.02) binary transgender (n = 130), binary cisgender (n = 236), and nonbinary (n = 26) adolescents in the United States and Canada. Results revealed that binary transgender adolescents considered their gender self-categorization to be more important to them than both binary cisgender and nonbinary adolescents did. Most binary transgender adolescents rated their gender self-categorization as maximally important to them. Additionally, transgender adolescents considered their gender self-categorization to be more important to them than their transgender self-categorization (that is, their identification with the label "transgender"). These findings demonstrate that the identities that are often denied to binary transgender adolescents may be the very identities that are most important to them. Results also suggest that gender diverse adolescents with different gender identities may differ in the importance they place on these identities.
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PURPOSE: To examine the lifespace of participants referred for occupational therapy driving assessment following acquired brain injury, to understand how, why, where and with whom access and participation in community-based occupations is occurring during the period of driving disruption. MATERIALS AND METHODS: The mixed methods, convergent research design utilised a travel diary and Lifespace Mobility Assessment-Composite quantitative elements and semi-structured interviews analysed qualitatively with an interpretive description lens. RESULTS: Forty-eight participants (56.25% male) aged between 26 and 65 years, left home on average once/day, primarily to conduct instrumental activities of daily living, health management, and social participation community-based occupations. Most reported restricted lifespace (54.2%) requiring assistance to conduct community occupations (68.1%). Support was primarily provided by family members (80.3%). Analysis of semi-structured interviews (n = 15) created three themes that shaped participant occupational experience during driving disruption: (i) changes to occupational participation; (ii) reliance on others for community access and participation; and (iii) trying to move forward. CONCLUSION: The period of driving disruption following the onset of acquired brain injury is a time of occupational disruption which restricts lifespace, changing how, why, where and with whom participation in community-based occupations occurs. Rehabilitation facilitating occupational adaptation process to enhance community access capacity is indicated.
The period of driving disruption following the onset of acquired brain injury is a time of occupational disruption which restricts lifespace and influences participation in community-based occupations.Occupational therapists should provide an individualised potential pathway to return to driving with frequent and varied means of reinforcing interim advice to abstain from driving.Implementing occupational adaptation can progress community participation goals by establishing community access skills, habits, routines and confidence to foster participation and satisfaction and rebuild occupational identity following acquired brain injury.
