Pain experiences of marginalized children in the emergency department: A scoping review protocol.

INTRODUCTION: Pain affects all children, and in hospitals across North America, this pain is often undertreated. Children who visit the emergency department (ED) experience similar undertreatment, and they will often experience a painful procedure as part of their diagnostic journey. Further, children and their caregivers who experience social injustices through marginalization are more likely to experience healthcare disparities in their pain management. Still, most of our knowledge about children's pain management comes from research focused on well-educated, white children and caregivers from a middle- or upper-class background. The aim of this scoping review is to identify, map, and describe existing research on (a) how aspects of marginalization are documented in randomized controlled trials related to children's pain and (b) to understand the pain treatment and experiences of marginalized children and their caregivers in the ED setting. METHODS AND ANALYSIS: The review will follow Joanna Briggs Institute methodology for scoping reviews using the Participant, Concept, Context (PCC) framework and key terms related to children, youth, pain, ED, and aspects of marginalization. We will search Medline, Embase, PsychInfo, CINAHL, Web of Science, Cochrane Library Trials, iPortal, and Native Health Database for articles published in the last 10 years to identify records that meet our inclusion criteria. We will screen articles in a two-step process using two reviewers during the abstract and full-text screening stages. Data will be extracted using Covidence for data management and we will use a narrative approach to synthesize the data. ETHICS AND DISSEMINATION: Ethical approval is not required for this review. Findings will be disseminated in academic manuscripts, at academic conferences, and with partners and knowledge users including funders of pain research and healthcare professionals. Results of this scoping review will inform subsequent quantitative and qualitative studies regarding pain experiences and treatment of marginalized children in the ED.

A theory of geo-social marginalization: A case study of the licensed cannabis industry in California.

The licensed cannabis industry represents one of the top five most economically valued agricultural commodities in California, yet farming largely remains on remote, environmentally sensitive, "marginal" lands. Using mixed methods, this paper examines the determinants of this marginalization, their embedded elaboration, and their relation to historical policy regimes. We used Generalized Additive Models (GAMs) to determine the most important predictors of licensed cannabis industry development since the inception of a statewide licensing program in 2018 and to compare the distribution of licensed cannabis to other forms of rural agriculture, including vineyards and pasture, to understand landscape factors and environmental sensitivity of land uses. We found that a county's median income and the extent of traditional (non-cannabis) agriculture, as measured by the proportion of on-farm (non-cannabis) employment, were both negatively associated with its amount of licensed cannabis agriculture. Ethnographic data suggests that cannabis is often excluded from traditional agricultural areas, through formal local-level bans, restrictive zoning, high "prime" farmland values, and cultural exclusions from other powerful resource users. The resulting relegation to "marginal" lands foments conflicts with amenity land users and environmentalists, even as it partly supports "legacy" cultivators whose farms were established under prior policy regimes. Results suggest that cannabis is more likely to be grown under conditions that introduce regulatory hurdles, including farming on steeper slopes, with natural streams onsite, and without access to large groundwater aquifers for irrigation. Our findings suggest that failure to allow licensed cannabis farming in traditional agriculture regions has led to a self-fulfilling prophecy wherein cannabis cultivation is largely relegated to environmentally sensitive areas where cultivation activity has an elevated tendency for environmental impacts.

The Eschucha (Listen) Podcast Project: Psychosocial Innovation for Marginalized Mexican Youth and Young Adults.

The COVID-19 pandemic was a challenging period for young people in Mexico, particularly those already contending with social and structural inequality. In March 2021, the Colectivo Frontera, a research collective based in Mexico City, Mexico, which works on advancing equity and psychosocial wellbeing among marginalized communities, carried out an 8-week, online project to provide psychosocial support and promote resilience for marginalized young people from different locations in Mexico. The project entailed weekly journaling with the Pandemic Journaling Project (PJP), as well as weekly phone sessions with a mental health specialist who provided emotional support (acompañamiento emocional) through practices of active listening. The project culminated in the Escucha (Listen) Podcast for which each youth participant created an episode about their experiences during the pandemic. Many also submitted a photo to accompany their recording; one produced a song. Participant episodes were compiled into a series of five chapters. Each chapter of the podcast centers on a common theme, including reflections on loved ones lost to COVID-19, social fragmentation, gender-based constraints on expressing emotions, and the experiences and perspectives of children. The project provides a compelling example of a low-cost approach to providing support for the mental health and wellbeing of marginalized young people. It also demonstrates the importance of creating projects that help young people make meaningful connections and that leverage their creativity to foster resilience, improve social cohesion, and elevate their perspectives and voices.

What are they in it for? Marginalised group members' perceptions of allies differ depending on the costs and rewards associated with their allyship.

Advantaged group allies can incur costs or rewards as a result of their allyship. The present work investigates whether such costs and rewards affect how marginalised group members perceive these allies. Across four experiments that collectively examine marginalised group members' perceptions of individual and corporate allies in the context of allyship for women's rights, Black Lives Matter and the LGBTQI+ community, we find that allies are perceived differently as a function of the costs and rewards associated with their allyship. Allies who face costs are perceived more positively in terms of tenacity and genuine motivations, and are generally evaluated more favourably compared to allies who do not face costs and those who, instead, garner rewards for their allyship. These findings demonstrate that marginalised group members are cognisant of the costs and rewards allies may reap, and that this information can shape their judgements of allies' investment in the cause.

Police in the rearview mirror: Social marginalization, trauma, and fear of being killed.

An online sample of 528 people was asked to respond to a hypothetical scenario: If a police car came up right behind you with its lights flashing, how much would you worry that you would be killed? Participants also reported on whether they experienced aggressive behavior by police in the past (provoked or otherwise) and, if so, completed a measure of associated posttraumatic stress. At least some fear of being killed by police (FKP) in the rearview mirror scenario was reported by the majority (56%) of Black participants, 39% of those self-describing as "other or mixed" race, and 31% of Hispanic participants, as compared to 26% of those of Asian descent and 19% of those identifying as White. When the highest level of FKP was considered, Black participants were 12 times more likely than White participants to report "extreme" fear of death at the hands of police. Lesbian, gay, bisexual, transgender, queer, and more participants were also more likely than cisgender/heterosexual respondents to report both FKP (35% vs. 20%) and "extreme" FKP (8% vs. 3%). FKP was also more prevalent among those self-reporting unprovoked police aggression in the past and those for whom police aggression had led to posttraumatic stress disorder. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Voices and challenges of marginalized and vulnerable groups in urban informal settlements in Nairobi, Kenya: building on a spectrum of community-based participatory research approaches.

Urbanization is rapidly increasing across Africa, including in Nairobi, Kenya. Many people, recent migrants and long-term residents, live within dense and dynamic urban informal settlements. These contexts are fluid and heterogeneous, and deepening the understanding of how vulnerabilities and marginalization are experienced is important to inform pointed action, service delivery and policy priorities. The aim of this paper is to explore vulnerabilities and marginalization within Korogocho and Viwandani informal settlements in Nairobi and generate lessons on the value of a spectrum of community based participatory research approaches for understanding health and well-being needs and pinpointing appropriate interventions. In the exploratory stages of our ARISE consortium research, we worked with co-researchers to use the following methods: social mapping, governance diaries, and photo voice. Social mapping (including the use of Focus Group Discussions) identified key vulnerable groups: marginalized and precarious child heads of households (CHHs), Persons with disability who face multiple discrimination and health challenges, and often isolated older adults; and their priority needs, including health, education, water and sanitation. The governance diaries generated an understanding of the perceptions of the particularly vulnerable and marginalized informal settlement residents regarding the various people and institutions with the power to influence health and wellbeing; while photo voice highlighted the lived experiences of vulnerability and marginality. Understanding and responding to fluid and intersecting marginalities and vulnerabilities within growing urban informal settlements is particularly critical to achieving inclusive urbanization, where no one is left behind, a theme central to the Sustainable Development Goals and Kenya's Vision 2030.

Overcoming Marginalization by Creating a Sense of Belonging.

Marginalization encompasses structural, interpersonal, and intergroup dynamics that perpetuate inequality and exclusion. This manuscript advocates that the solution to marginalization lies in fostering a sense of belonging. Belonging is a fundamental human need, critical for mental well-being, academic success, and personal growth. It significantly impacts engagement, retention, and overall development, especially in health professional education settings like nursing schools. When individuals feel they belong, they are more likely to seek support, engage actively in learning, and perform better academically. However, achieving a sense of belonging is not straightforward, and many challenges at both individual and institutional levels hinder its realization. Individual challenges include resistance to change, implicit biases, and lack of awareness of the disparities caused by marginalization. Institutional challenges include insufficient commitment, inadequate resource allocation, and lack of representation from marginalized groups. In the United States, recent legislation obstructing initiatives toward diversity, equity, and inclusion poses additional obstacles. To overcome these challenges and promote belonging, this manuscript offers strategies that highlight the importance of aligning institutional values with policies and practices, recognizing and rewarding inclusive efforts, and actively seeking diverse perspectives.

Impact of social marginalization on oral health-related quality of life in older adults.

The aim of this study was to determine the association between oral health-related quality of life (OHRQoL) and social marginalization in people aged 60 years and older enrolled in social security in Mexico. A cross-sectional and analytical study was carried out in older adults. To assess the OHRQoL, the OHIP-14 instrument was applied, and the degree of social marginalization and sociodemographic characteristics were analyzed. Measures of central tendency and dispersion, simple frequencies and proportions were estimated. Student's t-test was used for comparison of means, and prevalence ratio (PR) and logistic regression were used to assess associations, all with a significance value of 0.05 and 95% confidence intervals. Perceived OHRQoL in the population measured through the OHIP-14 reached an average value of 9.84 ± 8.91, with the highest value in the dimension of physical pain (2.06 ± 1.91). Perceived treatment need was higher among people with social marginality (p = 0.011). The multivariate analysis shows that marginalized people have a lower OHRQoL. Socially marginalized older adults showed a low a better perception of OHRQoL, independent of demographic and clinical factors.

La inteligencia artificial en el cine / Artificial intelligence in movies

La mayor parte de los films sobre inteligencia artificial hacen de esta un pretexto para tratar otras cuestiones: los peligros de la tecnociencia al servicio de intereses económicos, bélicos o políticos, la violencia de género, la segregación, los riesgos de un sistema político totalitario, o la deshumanización de la sociedad consumista en que vivimos. Las películas que optan por imaginar un futuro cercano en que se produzca la "singularidad" de un programa que se subjetive y empiece a desear, odiar o amar, pueden ordenarse en cinco grandes escenarios típicos: programas autoconscientes empoderados, subjetividades humanas transformadas en programa computacional, androides diseñados mediante biotecnología, robots que devienen humanos, y robots que semejan a humanos, pero no lo son

Most films about artificial intelligence make this a pretext to address other issues: the dangers of technoscience at the service of economic, war or political interests, gender violence, segregation, the risks of a totalitarian political system, or the dehumanization of the consumerist society in which we live. The films that choose to imagine a near future in which the "singularity" of a program that becomes subjective and begins to desire, hate or love occurs, can be organized into five large typical scenarios: empowered self-conscious programs, human subjectivities transformed into a computer program, androids designed through biotechnology, robots that become humans, and robots that look like humans, but are not.

A framework for neurodiversity-affirming interventions for autistic individuals.

Despite being targets of intervention practice and research for over 60 years, autistic people have been left out of the conversation. Until recently, nearly no research or implementation work has sought the input of autistic people in regard to the design of interventions and, more importantly, how the goals for such interventions are prioritized and determined. This reframe has profound implications for autism-focused interventions and research, most of which have aimed to reduce or eliminate autism symptoms, with variable empirical support (Bottema-Beutel, 2023). These outcomes are practically and ethically incompatible with a neurodiversity perspective. Most prominently, applied behavior analysis (ABA), which was the first intervention approach widely applied to autistic people, has come under increasing scrutiny and criticism for failing to include autistic people in the design of intervention elements and consideration of goals; moreover, autistic people are increasingly identifying iatrogenic effects they have experienced when receiving ABA (Bottema-Beutel, 2023), with these concerns often being met with minimization rather than an endorsement of their validity and willingness to hear them out. Thus, there is a pressing need for a neurodiversity-affirming interventions (NAI) framework for autism. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Workplace Harassment, Cyber Incivility, and Climate in Academic Medicine.

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

We Are Still Here: Omission and Perceived Discrimination Galvanized Civic Engagement Among Native Americans.

Leading up to the 2020 U.S. presidential election, Native American organizations and tribes launched get-out-the-vote campaigns that motivated Native peoples to vote in record numbers and helped flip battleground states. We conducted four studies (total N = 11,661 Native American adults) to examine the social and cultural factors explaining this historic Native civic engagement (e.g., campaigning). Results revealed that the more participants identified as being Native, the more they reported (a) engaging in civic activities, including get-out-the-vote behaviors during the 2020 election (Study 1); (b) civic engagement more broadly across a 5-year period (pilot study, Study 2); and (c) intentions to engage in civic activities in the future (Study 3). Moreover, participants who more strongly identified as Native were more likely to recognize the omission of their group from society and perceive greater group discrimination, which both independently and serially predicted greater civic engagement. These results suggest that leveraging the link between Native identification and group injustices can motivate action.

Uso de móviles, problemas de sueño y obesidad en una zona de exclusión social / Mobile phone use, sleep disorders and obesity in a social exclusion zone

Introducción: Existe poca información del impacto del abuso del teléfono móvil (AM) en zonas con necesidad de transformación social (ZNTS). Nuestro objetivo es estimar la prevalencia de AM en ZNTS, y su asociación con problemas de sueño, rendimiento escolar y obesidad. Pacientes y métodos: Muestreo consecutivo de sujetos entre 10 y 17 años que acuden a consulta de atención primaria en ZNTS entre octubre 2019 y marzo de 2020. Realización de entrevista clínica, antropometría, datos sociodemográficos, de uso de móvil y sueño. Resultados: Se estudiaron 214 sujetos. El AM durante la semana (más de dos horas diarias) fue de 37,5% en el grupo de 10-12 años y de 65,2% en el grupo de 13 a 17 años; durante el fin de semana, las prevalencias fueron de 66,6 y 81,3%, respectivamente. El AM durante la semana se asoció a más obesidad; menor nivel de estudios maternos, mayor dificultad para despertarse, somnolencia diurna y mayor frecuencia de suspensos. El riesgo ajustado se duplica para sobrepeso u obesidad (odds ratio [OR] 1,90; intervalo de confianza del 95% [IC 95%] 1,04 a 3,47), obesidad (OR 2,45; IC 95% 1,23 a 4,89) y problemas de sueño o duración de sueño menor de siete horas (OR 2,26; IC 95% 1,31 a 3,92). El AM durante el fin de semana se asoció a problemas de sueño o duración menor de siete horas (OR 2,68; IC 95% 1,40 a 5,11). Conclusiones: Existe una alta prevalencia de AM en zonas de exclusión social, que se asocia con problemas del sueño, suspensos escolares y obesidad. (AU)

Introduction: There is little information on the impact of mobile phone overuse (MPO) in areas in need of social transformation (ANST). Our objective was to estimate the prevalence of MPO in an ANST and its association with sleep disorders, academic performance and obesity. Patients and methods: Consecutive sampling of patients aged 10–17 years who visited a primary care centre in an ARST between October 2019 and March 2020. The study involved performance of a clinical interview with collection of anthropometric, sociodemographic, mobile phone use and sleep data. Results: The analysis included 214 participants. The prevalence of MPO during weekdays (more than 2 h a day) was 37.5% in children aged 10–12 years and 65.2% in 13- to 17-year-olds; in the weekend, the prevalence increased to 66.6% and 81.3%, respectively. In weekdays, MPO was associated with an increased prevalence of obesity, lower maternal educational attainment, greater difficulty waking up, daytime sleepiness and higher frequency of school failure. The adjusted risk was double for excess weight (odds ratio [OR] 1.90, 95% confidence interval [95% CI] 1.04–3.47), obesity (OR 2.45, 95% CI 1.23–4.89) and sleep disorders or sleep duration of less than 7 h (OR 2.26; 95% CI 1.31–3.92). Weekend MPO was associated with sleep disorders or sleep duration of less than 7 h (OR 2.68; 95% CI 1.40–5.11). Conclusions: The prevalence of mobile phone overuse is high in areas of social exclusion and is associated with sleep disorders, school failure, and obesity. (AU)

Intersectionality and adolescent medicine: an overview.

PURPOSE OF REVIEW: This review defines intersectionality, discusses recent studies that use an intersectional framework in adolescent health research, and outlines ways where clinicians can use intersectionality to address health disparities in youth of color through clinical practice, research, and advocacy. RECENT FINDINGS: Research using an intersectional framework can identify populations at risk for certain disorders or behaviors. Recent studies in adolescent health research using an intersectional lens identified lesbian girls of color as an at-risk population for e-cigarette use, demonstrated lower skin color satisfaction among Black girls of all ages predicted greater binge-eating disorder symptoms, and showed that two-thirds of Latine (gender-neutral term that refers to people with Latin American roots) youth who recently immigrated to the United States experienced at least one traumatic event during their migration journey, putting them at risk for PTSD and other mental health disorders. SUMMARY: Intersectionality refers to how multiple social identities intersect to produce a specific experience that reflects overlapping systems of oppression. Diverse youth contain multiple identities that intersect to produce unique experiences and health inequities. Using an intersectional framework acknowledges that youth of color are not homogenous. Intersectionality becomes an important tool to care for marginalized youth and advance health equity.

Lessons Learned from Health Disparities in Coronavirus Disease-2019 in the United States.

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

Biomass use and its health effects among the vulnerable and marginalized refugee families in the Gaza Strip.

Introduction: Biomass fuel remains the most common type of fuel used in many developing countries, leading to indoor air pollution and serious health impacts. Objective: The objective of this study was to compile evidence on the impact household fuel combustion has on child and adult health, with an emphasis on solid fuel use in Gaza. Methods: In this cross-sectional study, 110 structured self-administered questionnaires were distributed in April 2019 among families living in the Al-Maghazi refugee camp. Results: Participants reported that the main fuel used were wood, coal, cardboard, and a mix of wood, cardboard, and plastic, which were used for cooking, heating, baking, boiling water, and lighting. The most common symptoms were nasal irritation (71.8%), followed by headache (66.4%) and dizziness (65.4%). The results of logistic regression showed that the participants who used wood fuel had a higher chance of feeling eye irritation than those who used a mix of wood, cardboard, and dried grass (OR = 1.316; 95% CI = 1.54-8.99). The participants who opened windows during the burning process of biomass fuel were five times more likely to develop pneumonia than those who closed windows (OR = 5.53; 95%CI = 11.60-19.0). Conclusion: there is an urgent need for community awareness campaigns designed to inform people about the risks of exposure to biomass fuel smoke and how to better implement household ventilation.

Health of Young Adults Experiencing Social Marginalization and Vulnerability: A Cross-National Longitudinal Study.

People who experience social marginalization and vulnerability have uniquely complex health needs and are at risk of poor health outcomes. Regression analyses using longitudinal data from a cross-national, population-based sample of young adults participating in the International Youth Development Study, tested associations between social marginalization and vulnerabilities and physical health, mental health, and substance use outcomes. Participants from Victoria, Australia, and Washington State in the US were surveyed at ages 25 (2014) and 29 years (2018; N = 1944; 46.7% male). A history of adverse childhood experiences (ACEs), LGBT identity, financial insecurity, and justice system involvement at age 25 predicted poor health outcomes at age 28, including lower perceived health status, risk for chronic illness, depression and anxiety symptoms, and diagnosed mental health/substance use disorders. Tests of model equivalence across states showed that a history of ACEs was more strongly related to health status and serious injury at age 28 and justice system involvement at age 25 was more strongly related to age 28 serious injury in Victoria than in Washington State. Findings strengthen the case for future population-based research identifying life-course interventions and state policies for reducing poor health and improving health equity among members of socially marginalized groups.

Our Souls Look Back and Wonder: Reflections on Belonging and Being Invisible in Medicine.

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