The Current State of Workforce Diversity and Inclusion in Pediatric Critical Care.

Literature suggests the pediatric critical care (PCC) workforce includes limited providers from groups underrepresented in medicine (URiM; African American/Black, Hispanic/Latinx, American Indian/Alaska Native, Native Hawaiian/Pacific Islander). Additionally, women and providers URiM hold fewer leadership positions regardless of health-care discipline or specialty. Data on sexual and gender minority representation and persons with different physical abilities within the PCC workforce are incomplete or unknown. More data are needed to understand the true landscape of the PCC workforce across disciplines. Efforts to increase representation, promote mentorship/sponsorship, and cultivate inclusivity must be prioritized to foster diversity and inclusion in PCC.

A preliminary research on transcultural capacity in global public health: from the view of public health professionals.

BACKGROUND: Transcultural capacity is a key component of consolidated global public health assistance cooperation (GPHAC). The aim of this study is to investigate the transcultural capacity perceptions of public health professionals from China's disease control and prevention system after relative training in order to provide a reference for enhancing transcultural capacity during the practice of GPHAC. METHODS: A cross sectional qualitative survey in which self-administrated questionnaire with 5 open ended questions was used. The questionnaire was disseminated on the completion of an online training for China's senior public health professions on transcultural capacity in GPHAC. Descriptive statistics, word frequency analysis and content analysis were used to analyze the questionnaire data. RESULTS: Totally, 45 participants took part in this training, 25 of them voluntarily participated in this survey. The participants demonstrated the need for transcultural competence in public health services and suggested improvement in the course content arising from their wealth of knowledge and practical experience in the field. 96% of the participants considered that the training course was "very necessary" and "meaningful". The most interested topics were "Overview of transcultural adaptation and GPHAC", "Transcultural adaptation and response" and "African culture and health". The contents about "Country-specific analysis on cultural factors in public health", "rapid transcultural adaptation" and "more specific practical experiences in diverse cultural backgrounds" were suggested to be added in future training. The participants considered that transcultural capacity ensured the smooth progress of GPHAC and they both could complement each other, transcultural adaptation was the premise of gaining trust and reaching cooperation, it can be conducive to the health assistance professionals to integrate into local cultural life, facilitating their foreign assistance work to be effective and efficient, and impart experiences well. The participants hoped to put the concept into action. CONCLUSION: The importance of transcultural competence in GPHAC is becoming a consensus of public health professionals. Enhanced transcultural competence reflected in the attitude of public health as well as other health workers would promote GPHAC and would foster efficient emergency health response management among many countries.

Cultural Competence and Humility.

The increasing diversification of the United States has led to more racially and ethnically discordant visits between health care providers and patients; this is especially true in dermatology due to the lack of diversity in the field. Diversifying the health care workforce has been shown to reduce health care disparities and is an ongoing goal of dermatology. Improving cultural competence and humility among physicians is an important part of addressing health care inequities. This article reviews cultural competence, cultural humility, and practices dermatologists can incorporate to address this challenge.

Multicultural Identity Integration versus Compartmentalization as Predictors of Subjective Well-Being for Third Culture Kids: The Mediational Role of Self-Concept Consistency and Self-Efficacy.

Globalization has resulted in an exponential increase in the number of Third Culture Kids (TCKs), defined as being raised in a culture other than that of their parents (or the passport country) and meaningfully interacting with different cultures. Inconsistencies regarding the effect of multicultural and transient experiences on well-being exist in the psychological literature. We aimed to reveal associations between multicultural identity configurations (integration, categorization, compartmentalization) and well-being with the mediating role of self-concept consistency and self-efficacy. Participants (n = 399, M = 21.2 years) were students at an international university in the United Arab Emirates. We used the Multicultural Identity Integration Scale, the Berne Questionnaire of Subjective Well-Being, the General Self-Efficacy Scale, and the Self-Consistency Subscale from the Self-Construal Scale. The findings suggest that not merely exposure to diversity but also internal integration versus identity compartmentalization moderate the well-being of TCKs. We explained such mechanisms via partial mediation of self-consistency and self-efficacy. Our study contributed to a better understanding of the TCKs' identity paradigm and pointed to multicultural identity integration as vital to TCKs' well-being via its effect on self-consistency and self-efficacy. Conversely, identity compartmentalization decreased well-being via a reduction in the sense of self-consistency.

Know your role: Using social action in social justice advocacy development initiatives.

This article will describe the work of the Cultural Leadership Institute (CLI), a one-day institute with interactive workshops designed to facilitate students' understanding of diversity, multiculturalism, and social justice to explore leadership within a diverse society.

Topic: Intentional diversity in academia: Recruiting, admitting, enrolling, and retaining underrepresented students in nursing programs.

Currently, 60 % of the United States population is White, while the remaining belong to ethnic or racial minorities. By 2045, the Census Bureau predicts that there will no longer be any single racial or ethnic majority group in the United States. Yet, people across all healthcare professions are overwhelmingly non-Hispanic and White, leaving people from underrepresented groups severely underrepresented. The lack of diversity in healthcare professions is an issue because there is overwhelming evidence that patients from underrepresented groups experience disparities in healthcare at alarmingly high rates when compared to their White counterparts. Diversity is especially important in the nursing workforce since nurses are often the healthcare providers that engage with patients the most frequently and intimately. Additionally, patients demand a diverse nursing workforce that can provide culturally competent care. The purpose of this article is to summarize nationwide undergraduate nursing enrollment trends and discuss strategies to improve recruitment, admissions, enrollment, and retention of nursing students who belong to underrepresented groups.

Why and How Epidemiologists Should Use Mixed Methods.

The field of epidemiology's current focus on causal inference follows a quantitative approach and limits research questions to those that are strictly quantifiable. How can epidemiologists study biosociocultural public health problems that they cannot easily quantify? The mixed-methods approach offers a possible solution by incorporating qualitative sociocultural factors as well as the perspective and context from the population under study into quantitative studies. After a pluralist perspective of causal inference, this article provides a guide for epidemiologists interested in applying mixed methods to their observational studies of causal identification and explanation. We begin by reviewing the current paradigms guiding quantitative, qualitative, and mixed methodologies. We then describe applications of convergent and sequential mixed-methods designs to epidemiologic concepts including confounding, mediation, effect modification, measurement, and selection bias. We provide concrete examples of how epidemiologists can use mixed methods to answer research questions of complex bio-socio-cultural health outcomes. We also include a case study of using mixed methods in an observational study design. We describe how mixed methods can enhance how epidemiologists define underlying causal structures. Our alignment of mixed-methods study designs with epidemiologic concepts addresses a major gap in current epidemiology education- how do epidemiologists systematically determine what goes into causal structures?

Inclusion of Cultural and Linguistic Diversity in COVID-19 Public Health Research: Research Design Adaptations to Seek Different Perspectives in Victoria, Australia.

Participation of people from culturally and linguistically diverse (CALD) communities in public health research is often limited by challenges with recruitment, retention and second-language data collection. Consequently, people from CALD communities are at risk of their needs being marginalised in public health interventions. This paper presents intrinsic case analyses of two studies which were adapted to increase the cultural competence of research processes. Both cases were part of the Optimise study, a major mixed methods research study in Australia which provided evidence to inform the Victorian state government's decision-making about COVID-19 public health measures. Case study 1 involved the core Optimise longitudinal cohort study and Case study 2 was the CARE Victorian representative survey, an Optimise sub-study. Both case studies engaged cultural advisors and bilingual staff to adjust the survey measures and research processes to suit target CALD communities. Reflexive processes provided insights into the strengths and weaknesses of the inclusive strategies. Selected survey results are provided, demonstrating variation across CALD communities and in comparison to participants who reported speaking English at home. While in most cases a gradient of disadvantage was evident for CALD communities, some patterns were unexpected. The case studies demonstrate the challenge and value of investing in culturally competent research processes to ensure research guiding policy captures a spectrum of experiences and perspectives.

Extremely premature birth bioethical decision-making supported by dialogics and pragmatism.

Moral values in healthcare range widely between interest groups and are principally subjective. Disagreements diminish dialogue and marginalize alternative viewpoints. Extremely premature births exemplify how discord becomes unproductive when conflicts of interest, cultural misunderstanding, constrained evidence review, and peculiar hierarchy compete without the balance of objective standards of reason. Accepting uncertainty, distributing risk fairly, and humbly acknowledging therapeutic limits are honorable traits, not relativism, and especially crucial in our world of constrained resources. We think dialogics engender a mutual understanding that: i) transitions beliefs beyond bias, ii) moves conflict toward pragmatism (i.e., the truth of any position is verified by subsequent experience), and iii) recognizes value pluralism (i.e., human values are irreducibly diverse, conflicting, and ultimately incommensurable). This article provides a clear and useful Point-Counterpoint of extreme prematurity controversies, an objective neurodevelopmental outcomes table, and a dialogics exemplar to cultivate shared empathetic comprehension, not to create sides from which to choose. It is our goal to bridge the understanding gap within and between physicians and bioethicists. Dialogics accept competing relational interests as human nature, recognizing that ultimate solutions satisfactory to all are illusory, because every choice has downside. Nurturing a collective consciousness via dialogics and pragmatism is congenial to integrating objective evidence review and subjective moral-cultural sentiments, and is that rarest of ethical constructs, a means and an end.

Meeting the Accreditation Standard for Diversity.

ABSTRACT: While increasing diversity has been an ongoing concern in physician assistant (PA) education, there is now a concentrated focus on diversity, equity, inclusion, and social justice, elevating these to top priorities. To achieve the goal of diversifying the PA workforce, PA programs, with their institution's support, must systematically inculcate strategies for overcoming and dismantling barriers against students of color and students underrepresented in medicine (URiM). These strategies should disrupt the status quo and expand structural processes that ensure successful diversification of students, especially URiM students, LGBTQ students, students from medically underserved areas, and first-generation college students.

The Puzzle of Belief.

The notion of belief appears frequently in cognitive science. Yet it has resisted definition of the sort that could clarify inquiry. How then might a cognitive science of belief proceed? Here we propose a form of pluralism about believing. According to this view, there are importantly different ways to "believe" an idea. These distinct psychological kinds occur within a multi-dimensional property space, with different property clusters within that space constituting distinct varieties of believing. We propose that discovering such property clusters is empirically tractable, and that this approach can help sidestep merely verbal disputes about what constitutes "belief."

[Between chemotherapies, herbalism and spiritualities: Anthropological study of therapeutic pluralism in adults with cancer in Mexico]. / Entre quimioterapias, herbolaria y espiritualidades. Estudio antropológico sobre el pluralismo terapéutico en adultos con cáncer en México.

OBJECTIVES: To analyze the characteristics of therapeutic pluralism in adult patients at a hospital Cancer Center, based on their health/illness/care-neglect trajectories. METHODS: Analytical-explanatory, ethnographic, transversal-applied qualitative study. Data was provided by ten participants with cancer treated at the Veracruz State Cancer Center. Ethnographic records, participant observation and semi-structured interviews were carried out using observational guides, semi-structured interview guides and hospital clinical records. Participants were identified with pseudonyms for privacy and confidentiality. RESULTS: Two main results were: 1) characterization of the diversity of therapies utilized by participants throughout their biographical trajectory related to their health/disease/care-neglect processes; 2) identification of the cultural characteristics involved in these complex processes of therapeutic plurality, closely related to the appearance of cancer. CONCLUSION: Sociocultural aspects are interwoven with emerging therapeutic pluralities in the complex disease processes in cancer. The implications of these factors in the health/disease/care-neglect processes in cancer are manifest even before the first symptoms, in daily actions of self-care and preventive care. The mixing of therapies is an effect of the globalization characteristic of capitalist societies, in which therapeutic pluralism becomes an optimal phenomenon for commercialization and consumption.

OBJETIVOS: Analizar las características del pluralismo terapéutico en torno al cáncer de adultos, atendidos en un hospital de cancerología, a partir de sus trayectorias de salud/enfermedad/atención-desatención. MÉTODOS: Estudio analítico-explicativo, etnográfico, transversal-aplicado y de carácter cualitativo. Se realizaron registros etnográficos, observación participante y entrevistas semiestructuradas. Para el artículo se tomaron los datos proporcionados por diez personas participantes con cáncer, atendidas en el Centro Estatal de Cancerología de Veracruz. La identificación de participantes se hará mediante seudónimos, para preservar la privacidad de datos personales. Los instrumentos de trabajo estuvieron conformados por guías de observación, guías de entrevistas semiestructuradas y expedientes clínicos del hospital mencionado. RESULTADOS: Se muestran dos resultados principales: 1) caracterización de la diversidad de terapias de acuerdo con las referencias de los participantes, y lo que utilizaron durante toda su trayectoria biográfica en torno a procesos salud/enfermedad/ atención-desatención; 2) identificación de los aspectos socioculturales que intervienen en estos procesos complejos de pluralidad terapéutica, estrechamente relacionados con la aparición del cáncer. CONCLUSIÓN: Los aspectos socioculturales están entretejidos con la pluralidad terapéutica emergente en los procesos complejos de la enfermedad del cáncer. La implicación de dichos factores en los procesos salud/enfermedad/atención-desatención al cáncer se manifiestan incluso antes de los primeros síntomas, es decir, en las acciones cotidianas del autocuidado y acciones de atención preventiva. El mestizaje terapéutico registrado da cuenta de los efectos de la globalización, característica de las sociedades capitalistas, en la que el pluralismo de terapias deviene en un fenómeno óptimo de comercialización y consumo.

Enhancing Diversity and Inclusion in Clinical Trials.

Women and people from most racial and ethnic groups in the United States have historically been under-represented in clinical trials of investigational medical products. Inadequate representation of these groups may lead to an incomplete understanding of the safety and efficacy of new drugs, devices, biologics, and vaccines, and limit the generalizability of trial findings. As a result, new medical products may not be beneficial to all people who need them, and existing inequities in outcomes among various population groups may remain unchanged or worsen, or new disparities may arise. Although much work has focused on study-level strategies, research organizations must make systemic changes to how clinical trials are envisioned and implemented to achieve sustainable support for diversity and inclusion in clinical trials. The Clinical Trials Transformation Initiative (CTTI) conducted interviews with leaders at institutions that conduct clinical trials to explore perspectives on organizational-level practices that promote diversity and inclusion in clinical trials. Leaders described motivations, such as an ethical and moral imperative; organizational practices, such as staff investment and resource allocation; perceived return on investments, such as better science; and deterrents, such as cost and time. The CTTI also convened an expert meeting to discuss the interview findings and provide guidance. We present the interview findings and expert guidance in a framework that describes four key areas-commitment, partnerships, accountability, and resources-on sustaining organizational-level approaches for improving diversity and inclusion in clinical trials, with the ultimate goal of advancing health equity. Institutions who conduct and support clinical trials should implement organizational-level approaches to improve equitable access and diverse patient participation in clinical trials.

Diversity in Clinical Pharmacology: A Call to Action.

Prioritization of diversity, equity, and inclusion in all facets of our work is long overdue for the clinical pharmacology community. Increasing diversity in clinical research will deepen our understanding of nuanced patient populations and help improve all patient outcomes. Fostering an inclusive and diverse workforce will lead to broader perspectives that can better inform critical decisions and create work environments where everyone can thrive. In this call to action, we invite you to join us.

Estrategia y plan de acción sobre etnicidad y salud 2019-2025. Indicadores de impacto y de proceso. Edición revisada

El propósito de esta publicación es dar continuidad a la cooperación técnica con los Estados Miembros de la Organización Panamericana de la Salud (OPS) en la estimación y el seguimiento de las metas y los indicadores propuestos en la Estrategia y plan de acción sobre etnicidad y salud 2019-2025 en los diferentes países y territorios, con el fin de medir los procesos y el impacto derivado de implementar las orientaciones contenidas en la Política sobre etnicidad y salud. El compendio y las fichas que conforman esta publicación se dirigen en especial a las personas que, desde el sector salud, otros sectores y cooperantes apoyan las acciones interculturales en salud. Esto incluye principalmente a los ministerios de salud de los países y territorios, y la participación de otros ministerios e instituciones gubernamentales, sin olvidar el apoyo de asociados y cooperantes clave. La elaboración de esta herramienta técnica, en consonancia con la Política sobre etnicidad y salud, se orienta bajo un objetivo fundamental de calcular y registrar para la Región de las Américas los avances que entre 2019 y 2025 se alcancen frente al desarrollo de medidas necesarias para garantizar el enfoque intercultural en el acceso a la atención y los servicios de salud, teniendo en cuenta los determinantes sociales de la salud, desde un plano de igualdad y respeto mutuo, valorando las prácticas culturales de los grupos étnicos de la Región, sus estilos de vida, su organización social, sus sistemas de valores, sus tradiciones y sus cosmovisiones. En esta edición revisada se han realizado ajustes en el tercer indicador de impacto, que mide la reducción de la incidencia de la tuberculosis: en la página 9, para armonizarlo con la medición del indicador de alto nivel de la Estrategia Fin de la Tuberculosis de la OMS, y en las páginas 19 y 21, para actualizar su utilidad y cálculo, respectivamente.

New Ecological Paradigm and third culture kids: Multicultural identity configurations, global mindset and values as predictors of environmental worldviews.

Ecological degradation threatens human survival, increasing the need to understand factors related to pro-environmental attitudes and worldviews. In a globalising world, new paradigms arise as central to social sciences, including the New Ecological Paradigm (NEP) and the multicultural identities of individuals raised between the cultures, third culture kids (TCKs). NEP is an ecocentric perspective that stresses the interdependence between nature and humans, opposite to anthropocentrism. TCKs' exposure to cultural diversity during developmental years might support global issues engagement and ecocentric worldviews. The present study focused on non-Western TCKs (N = 399; mean age 21 years), aiming to explore whether multicultural identity configurations (integration, categorisation, compartmentalisation), values dimensions (self-transcendence, openness and conservation) and global mindset predicted ecocentric and anthropocentric worldviews. The results demonstrated that TCKs were ecocentrically inclined. The path model revealed that ecocentrism could be directly positively predicted by integrated multicultural identity, self-transcendence and a global mindset. Anthropocentrism was predicted by multicultural identity categorisation and conservation values. Also, values of self-transcendence and openness buffered the impact of compartmentalisation and categorisation on ecocentrism and anthropocentrism. This study set innovative directions in multiculturism and environmentalism discourse through understanding a multicultural identity's relationships with pro-environmental attitudes.

Evidence-based Best Practices in Recruitment of Diverse Residents: A Perspective From a Diversity Officer.

The recruitment of a diverse resident workforce is the immediate proximate step to growing a diverse physician workforce. This recruitment requires intentionality on the part of residency programs and institutional graduate medical education offices. This article describes evidence-based recruitment "best practices" and encourages programs to stay committed.