[A top-down path to promote environmental justice in a contaminated area. The experience with the community of Porto Torres (Sardinia, Italy)]. / Un percorso top-down di promozione della giustizia ambientale in un sito contaminato. L'esperienza con la comunità di Porto Torres.

Nowadays, in Italy, researchers from various disciplines and institutions are referring to environmental justice to promote health equity in relation to environmental risks and benefits. This presents an opportunity for the convergence of bottom-up and top-down perspectives, which differ in nature, to advance environmental justice at the local level. This contribution presents the experience of researchers from the Italian National Institute of Health in the contaminated area of Porto Torres (Sardinia). The experience began with the development of study activities aimed at describing the health profile of the population residing in Porto Torres. These activities embraced the requests of the local community and included interactions with local institutional and social actors. The study activities were designed with a focus on environmental justice, which requires an understanding of the local context and of its history. The contribution describes the various stages that led from the development of the study to the engagement with local institutional and social actors, communication of study results, and participation in local initiatives on environmental justice. Finally, the text proposes some considerations on how researchers from a central institution can develop and conduct study activities to promote environmental justice at the local level.

Negative outcomes pertaining to patients that leave against medical advice: a systematic review and meta-analysis.

OBJECTIVE: Leaving Against Medical Advice (LAMA) is a prevalent issue in healthcare settings that may lead to negative patient outcomes. We conducted a systematic review and meta-analysis to assess the impact of LAMA on patient outcomes. MATERIALS AND METHODS: A comprehensive literature search was performed across PubMed, MEDLINE, Embase, Cochrane Library, CINAHL, PsycINFO, Web of Science, and Scopus. Studies reporting adverse outcomes, including mortality and hospital readmission rates, in patients who underwent LAMA were included. The odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using a random-effects model. RESULTS: Eight studies were included in the review, with four contributing to the meta-analysis on 1-year mortality and five to the meta-analysis on hospital readmission rates. LAMA was not significantly associated with higher 1-year mortality [OR = 0.66, 95% CI (0.38, 1.16), p = 0.15] or hospital readmission rates [OR = 0.61, 95% CI (0.30, 1.23), p = 0.16] across the studies. However, there was substantial heterogeneity in the results (I2 = 91% for mortality; I2 = 99% for readmissions). CONCLUSIONS: While individual studies reported varying outcomes, the pooled results did not show a significant association between LAMA and increased 1-year mortality or hospital readmission rates. However, the high degree of heterogeneity suggests the influence of diverse patient populations, healthcare settings, and study methodologies on these outcomes. Further research is needed to better understand the factors contributing to the adverse outcomes associated with LAMA and to develop targeted interventions to mitigate them.

Effect of health rights accessibility on the urban integration of minority rural migrants in China: a cross-sectional study.

BACKGROUND: Accessing health rights is an integral component of people's aspirations for a better life. Existing discussions and evaluations regarding the accessibility of health rights for minority rural migrants are insufficient. In comparison to objective health conditions, inequalities in health rights lead to chronic and long-term depletion of human capital among minority rural migrants. This study aimed to assess the overall impact, heterogeneity effects, and mechanisms of health rights accessibility on the urban integration of minority rural migrants. METHODS: Based on the 2017 China Migrants Dynamic Survey Data (CMDS), this study employs OLS models, 2SLS models, conditional mixed process (CMP) methods, and omitted variable tests to estimate the impact of health rights accessibility on the urban integration of minority rural migrants. Additionally, from the perspectives of migration scope and illness experience, this study explored the heterogeneity in the relationship between health rights accessibility and urban integration. Finally, using the Karlson-Holm-Breen (KHB) model, this study dissects the mechanisms through which health rights accessibility influences the urban integration of minority rural migrants. RESULTS: Health rights accessibility significantly enhances the urban integration of minority rural migrants. Moreover, compared to minority rural migrants who move across provinces and who have no history of illness, those who migrate within the same province and who have experienced illness are more sensitive to the positive impact of health rights accessibility. However, the enhancing effect of health rights accessibility does not significantly differ between the new and old generations of minority rural migrants. Furthermore, health rights accessibility can indirectly improve the urban integration of minority rural migrants by elevating health levels, improving health habits, and reinforcing health behaviors. Among these, the indirect effects mediated by health habits are more pronounced. CONCLUSION: The research conclusions underscore the issue of health accessibility and urban integration among minority rural migrants, providing a reexamination and clarification of the policy effects of health rights in promoting the urban integration of minority rural migrants. Relevant policy design should commence with improving the health rights of minority rural migrants, enhancing their health integration capabilities, and effectively boosting their ability to integrate into urban life.

Gender norms in a context of legal pluralism: Impacts on the health of women and girls in Ethiopia.

To achieve Sustainable Development Goal 5 for gender equality by 2030, it is crucial for health and development professionals and governmental officials to understand how legal systems empower or oppress populations on the basis of gender worldwide, including opportunities and challenges of statutory provisions created by legal pluralism. Using Ethiopia as a case study, this paper examines how local laws applied in Sharia and Customary Dispute Resolution courts impact gender equality and the health of women and girls inspite of the inculcation of human rights statutes into national legislation, including the Constitution. We identify several key issues with the substantive law and its enforcement. First, laws which have been instituted at the national level to improve gender equally have been poorly enforced at the local level. Second, there is a sustained enforcement of laws that oppress women and that protect male perpetrators of gender-based violations. Third, local courts limit female representation and uphold patriarchy. To improve the health of women and girls, stakeholders must take into consideration the ways in which legal systems uphold harmful gender norms and obstruct and/or advance progress towards equal representation, opportunities, and constitutionally-mandated protections for all.

Reflexiones sobre la aplicación de la "Ley Trans” en la atención sanitaria / Reflections on the application of the “trans law” in health care

En este artículo se reflexiona sobre la reciente ley aprobada por el Congreso de los Diputados conocida como Ley 4/2023 para la igualdad real y efectiva de las personas trans y para la garantía de los derechos de las personas LGTBI (BOE-A-2023-5366, 2023). Se analizan inicialmente los artículos que más polémica han causado en el ámbito social, que son los relativos a la rectificación registral (Art. 43-51), y posteriormente los que hacen referencia directa o indirectamente a aspectos sanitarios; 1) el que prohíbe de métodos, programas o las llamadas terapias de conversión (Art. 17), 2) los que definen cómo debe ser en términos generales la atención sanitaria (Art. 56-59), y 3) finalmente el único artículo que menciona a los menores (Art 70). Se comenta que el término utilizado de persona trans, al englobar un amplio abanico de diversidades sexuales, variantes y expresiones de género, incluye tanto a personas que necesitan una atención médica como a otras que no. Se plantea que la rectificación registral acorde con esta ley 2023 al no precisar ningún requisito para su inscripción, ofrece menos garantías que la legislación ya existente de marzo 2007. Se considera que las directrices de la nueva ley se están traduciendo en una toma de decisiones por parte del usuario sin disponer de una valoración o diagnóstico por el equipo de profesionales que atienden el caso. Se destaca que la ley no incluye ninguna referencia a la atención por salud mental. Y en conjunto, se concluye que el texto aprobado, en el ámbito sanitario, puede mermar la calidad de la asistencia integral, sobre todo en menores, o personas con identidades complejas, dudosas, o con comorbilidades, que pueden generar discrepancia entre el criterio del profesional y la opinión del usuario.(AU)

Direitos reprodutivos das mulheres submetidas à cesárea em Moçambique: uma revisão integrativa / Drets reproductius de les dones sotmeses a cesària a Moçambic: una revisió integradora / Derechos reproductivos de las mujeres sometidas a cesárea en Mozambique: una revisión integradora / Reproductive rights of women undergoing cesarean section in Mozambique: an integrative review

O presente artigo está voltado às questões referentes aos direitos reprodutivos e ao parto cesárea das mulheres em Moçambique. O objetivo foi analisar as ações/estratégias governamentais e não governamentais que visem a efetivação dos direitos reprodutivos das mulheres submetidas ao parto cesárea em Moçambique, discutindo sobre as fragilidades que configuram a violação desses direitos. Para tanto, foi realizada uma revisão integrativa da literatura nas bases de dados Elsevier, GALE, PubMed, Web of Science e DOAJ a partir da combinação dos descritores cesarean section OR reproductive rights AND Mozambique. Depois de aplicadas as estratégias de inclusão e exclusão, resultaram 13 artigos elegíveis para elaboração do presente estudo. Os resultados apontam para a falta de aplicabilidade das ações governamentais que, apesar de existirem, ainda são ineficazes para que as mulheres de Moçambique tenham seus direitos reprodutivos garantidos e assistidos.(AU)

Aquest article es centra en qüestions relacionades amb els drets reproductius i el part per cesària de les dones a Moçambic. L'objectiu era analitzar les accions/estratègies tant governamentalscom no governamentals que busquen l'efectivitat dels drets reproductius de les dones sotmeses a cesària a Moçambic, discutint les debilitats que constitueixen la violació d'aquests drets. Per fer-ho, es va realitzar una revisió integradora de la literatura a les bases de dades Elsevier, GALE, PubMed, Web of Science i DOAJ a partir de la combinació dels descriptors cesarean section OR reproductive rights AND Mozambique. Després d'aplicar les estratègies d'inclusió i exclusió, es van obtenir 13 articles elegibles per a l'elaboració del present estudi. Els resultats assenyalen la manca d'aplicabilitat de les accions governamentals que, malgrat existir, encara són ineficaços per garantir i atendre els drets reproductius de les dones a Moçambic.(AU)

El presente artículo se centra en cuestiones relacionadas con los derechos reproductivos y el parto por cesárea de las mujeres en Mozambique. El objetivo fue analizar las acciones/estrategias gubernamentales y no gubernamentales que buscan la efectividad de los derechos reproductivos de las mujeres sometidas a cesárea en Mozambique, discutiendo las debilidades que constituyen la violación de estos derechos. Para ello, se realizó una revisión integradora de la literatura en las bases de datos Elsevier, GALE, PubMed, Web of Science y DOAJ a partir de la combinación de los descriptores cesarean section OR reproductive rights AND Mozambique. Después de aplicar las estrategias de inclusión y exclusión, se obtuvieron 13 artículos elegibles para la elaboración del presente estudio. Los resultados señalan la falta de aplicabilidad de las acciones gubernamentales que, a pesar de existir, aún son ineficaces para garantizary atender los derechos reproductivos de las mujeres en Mozambique.(AU)

This article addresses issues related to reproductive rights and cesarean delivery for women in Mozambique. The objective was to analyze governmental and non-governmental actions / strategies aimed at the realization of the reproductive rights of women submitted to cesarean delivery in Mozambique, discussing the weaknesses that constitute the violation of these rights. To this end, an integrative literature review was carried out in the Elsevier, GALE, PubMed, Web of Science and DOAJ databases based on the combination of the descriptors cesarean section OR reproductive rights AND Mozambique. After applying the inclusion and exclusion strategies, 14 articles were eligible for the preparation of this study. The results point to the lack of applicability of government actions that, although they exist, are still ineffective for women in Mozambique to have their reproductive rights fully guaranteed and assisted.(AU)

Caja de Herramientas de Objetivos de Desarrollo Sostenible – ODS en Bibliotecas

Material seleccionado y organizado que ayudará a orientarse en el proceso de planificación, identificación de responsabilidades y diseño de actividades para la implementación de los ODS en su Institución.

[HIV and human rights: political action to achieve ZERO stigma]. / VIH y derechos humanos: acción política para alcanzar CERO estigma.

According to Sustainable Development Goals 10.2 and 10.3, it is imperative to promote the elimination of discriminatory laws, as well as implement policies and practices for the inclusion of vulnerable social groups on the social, economic and political fronts. In this regard, HIV-related discrimination and stigma remain unaddressed in many European Union countries. Fighting HIV-related stigma has been one of the main priorities of the Spanish Presidency of the Council of the European Union. This commitment was reflected in the High Level Meeting entitled HIV and Human Rights. Political action to achieve ZERO stigma. This meeting provided an opportunity to discuss a variety of strategies and agreements for eradicating stigma and discrimination associated with HIV in a variety of social, political, and institutional contexts.

Los objetivos de desarrollo sostenible 10.2 y 10.3 ponen de manifiesto la importancia de fomentar la eliminación de leyes discriminatorias, así como de implantar políticas y prácticas orientadas a la inclusión social, económica y política de los grupos sociales vulnerables. En este sentido, abordar la discriminación y el estigma asociados al VIH sigue siendo una asignatura pendiente dentro de los países que conforman la Unión Europea. De ahí que esta cuestión haya sido una prioridad política de la Presidencia española del Consejo de la Unión Europea, reflejada en la Reunión de Alto Nivel VIH y derechos humanos. Acción política para alcanzar CERO estigma. En esta reunión se abordaron diferentes estrategias y acuerdos para promover la eliminación del estigma y la discriminación asociada al VIH en diferentes ámbitos y dimensiones sociales, políticas e institucionales.

Framing UN Human Rights Discourses on Climate Change: The Concept of Vulnerability and its Relation to the Concepts of Inequality and Discrimination.

The concept of vulnerability is widely used in human rights policy documents, reports, and case law focusing on the impacts of climate change on human rights. In academic discussions, the concept, however, has also sparked a discussion on its benefits and challenges for the advancement of human rights, especially concerning the principles of equality and non-discrimination. This article aims at contributing to this debate from a frame-analytical perspective. In social sciences, frame-analysis is a form of discourse analysis which focuses on the consequences of different concepts for legal, political, and social discussions and norms. With the example of selected UN documents on different human rights issues in the context of climate change, the article, firstly, analyzes whether and how the concept of vulnerability is defined in the documents and why it is used in the documents. Secondly, it is elaborated to which individuals and groups the concept is applied. Thirdly, it is discussed how vulnerability is conceptualized in relation to or in distinction to the concepts of inequality and discrimination. In a further section it is analyzed what narratives are mobilized by the frame of vulnerability. The article concludes that from a discourse-analytical perspective the frame of vulnerability mobilizes problematic narratives which has gendered and racialized implications for those labeled vulnerable.

Ethnic Disparities in COVID-19 Vaccine Mistrust and Receipt in British Columbia, Canada: Population Survey.

BACKGROUND: Racialized populations in the United States, Canada, and the United Kingdom have been disproportionately affected by COVID-19. Higher vaccine hesitancy has been reported among racial and ethnic minorities in some of these countries. In the United Kingdom, for example, higher vaccine hesitancy has been observed among the South Asian population and Black compared with the White population, and this has been attributed to lack of trust in government due to historical and ongoing racism and discrimination. OBJECTIVE: This study aimed to assess vaccine receipt by ethnicity and its relationship with mistrust among ethnic groups in British Columbia (BC), Canada. METHODS: We included adults ≥18 years of age who participated in the BC COVID-19 Population Mixing Patterns Survey (BC-Mix) from March 8, 2021, to August 8, 2022. The survey included questions about vaccine receipt and beliefs based on a behavioral framework. Multivariable logistic regression was used to assess the association between mistrust in vaccines and vaccine receipt among ethnic groups. RESULTS: The analysis included 25,640 adults. Overall, 76.7% (22,010/28,696) of respondents reported having received at least 1 dose of COVID-19 vaccines (Chinese=86.1%, South Asian=79.6%, White=75.5%, and other ethnicity=73.2%). Overall, 13.7% (3513/25,640) of respondents reported mistrust of COVID-19 vaccines (Chinese=7.1%, South Asian=8.2%, White=15.4%, and other ethnicity=15.2%). In the multivariable model (adjusting for age, sex, ethnicity, educational attainment, and household size), mistrust was associated with a 93% reduced odds of vaccine receipt (adjusted odds ratio 0.07, 95% CI 0.06-0.08). In the models stratified by ethnicity, mistrust was associated with 81%, 92%, 94%, and 95% reduced odds of vaccine receipt among South Asian, Chinese, White, and other ethnicities, respectively. Indecision, whether to trust the vaccine or not, was significantly associated with a 70% and 78% reduced odds of vaccine receipt among those who identified as White and of other ethnic groups, respectively. CONCLUSIONS: Vaccine receipt among those who identified as South Asian and Chinese in BC was higher than that among the White population. Vaccine mistrust was associated with a lower odds of vaccine receipt in all ethnicities, but it had a lower effect on vaccine receipt among the South Asian and Chinese populations. Future research needs to focus on sources of mistrust to better understand its potential influence on vaccine receipt among visible minorities in Canada.

Cardiorespiratory fitness and physical activity in the lens of social justice - Reporting on the disparities that exist.

Cardiorespiratory fitness (CRF), heavily influenced by physical activity (PA), represents a strong and independent risk factor for a wide range of health conditions, most notably, cardiovascular disease. Substantial disparities in CRF have been identified between white and non-white populations. These disparities may partly account for group differences in susceptibility to poor health outcomes, including non-communicable disease. Race and ethnic differences in CRF may partly be explained by social injustices rooted in persistent structural and systemic racism. These forces contribute to environments that are unsupportive for opportunities to achieve optimal CRF levels. This review aims to examine, through the lens of social justice, the inequities in key social ecological factors, including socioeconomic status, the built environment, and structural racism, that underly the systemic differences in CRF and PA in vulnerable communities. Further, this review highlights current public health initiatives, as well as opportunities in future research, to address inequities and enhance CRF through the promotion of regular PA.

Shifting from Equality toward Equity: Addressing Disparities in Research Participation for Clinical Cancer Research.

AbstractThere is societal consensus that cancer clinical trial participation is unjust because some sociodemographic groups have been systematically underrepresented. Despite this, neither a definition nor an ethical explication for the justice norm of equity has been clearly articulated in this setting, leading to confusion over its application and goals. Herein we define equity as acknowledging sociodemographic circumstances and apportioning resource and opportunity allocation to eliminate disparities in outcomes, and we explore the issues and tensions this norm generates through practical examples. We assess how equality-based enrollment structures in clinical cancer research have perpetuated historical disparities and what equity-based alternatives are necessary to achieve representativeness and an expansive conception of participatory justice in clinical cancer research. This framework addresses the breadth from normative to applied by defining the justice norm of equity and translating it into practical strategies for addressing participation disparities in clinical cancer research.