Perspectives of health practitioners on the challenges to accessing sexual and reproductive health care services for Venezuelan migrant women during the COVID-19 pandemic in Quito, Ecuador

[ABSTRACT]. Objectives. To describe the perspectives of health practitioners on the barriers, gaps, and opportunities that Venezuelan migrant women experienced to accessing sexual and reproductive health (SRH) services during the COVID-19 pandemic and how SRH services were affected in Quito, Ecuador. Methods. Health practitioners involved in SRH services at nine public health care facilities in three zones of Quito were surveyed. The Minimum Initial Service Package readiness assessment tool survey, available from the Inter-Agency Working Group on Reproductive Health in Crisis, was adapted for use and data collection in Ecuador. Results. Of 297 respondents, 227 were included in the analysis. Only 16% of the health practitioners agreed that discrimination against migrant Venezuelans women occurred in the health care system. Of those, only 2.3% described specific conditions associated with discrimination, including requiring identification docu- ments (7.5%) and lack of empathy or responsiveness (6.6%). Most (65.2%) respondents reported that the COVID-19 pandemic affected the use of SRH services by women in the general population and by Venezuelan migrant women more so (56.3%) because of more limited access to SRH services, poverty, and vulnerability. There were no differences between perceptions by levels of health care facility, except with regard to the lack of supplies, awareness of discrimination, and the belief that Venezuelan migrant women were affected more negatively than the local population. Conclusion. The perception among health practitioners in Quito was that discrimination occurred infrequently during the COVID-19 pandemic despite affecting the health care system. However, some level of discrim- ination toward migrant Venezuelan migrant women seeking SRH services was acknowledged and may be underrepresented.

[RESUMEN]. Objetivos. Describir las perspectivas de los prestadores de atención de salud sobre los obstáculos, las brechas y las oportunidades que registraron las mujeres migrantes venezolanas para acceder a los servicios de salud sexual y reproductiva (SSR) durante la pandemia de COVID-19 y cómo se vieron afectados estos servicios en Quito (Ecuador). Métodos. Se encuestó a prestadores de atención de salud que trabajan en servicios de SSR en nueve centros de salud pública de tres zonas de Quito. Se utilizó una adaptación de la encuesta sobre el instrumento de evalu- ación de la disposición operativa del paquete de servicios iniciales mínimos, disponible en el Grupo de Trabajo Interinstitucional sobre Salud Reproductiva en Situaciones de Crisis, para la recopilación de datos en Ecuador. Resultados. De las 297 personas encuestadas, 227 quedaron incluidas en el análisis. Solo el 16% de los prestadores de atención de salud estaba de acuerdo en que en el sistema de salud había discriminación con- tra las mujeres migrantes venezolanas. De estos, solo el 2,3% describió circunstancias específicas asociadas a la discriminación, como la exigencia de documentos de identidad (7,5%) y la falta de empatía o capacidad de respuesta (6,6%). La mayoría (65,2%) de las personas encuestadas manifestó que la pandemia de COVID- 19 había impactado en el uso de los servicios de SSR por parte de las mujeres de la población general y, en mayor medida, por parte de las mujeres migrantes venezolanas (56,3%) debido a sus limitaciones para acceder a los servicios de SSR, su pobreza y su vulnerabilidad. No hubo diferencias en las percepciones según el nivel de los centros de salud, excepto con respecto a la falta de insumos, la concientización sobre la discriminación y la creencia de que estas mujeres se vieron más afectadas que la población local. Conclusión. La percepción en los prestadores de atención de salud en Quito fue que, pese a ser un fenómeno que afectaba al sistema de atención de salud, la discriminación había sido poco frecuente durante la pan- demia de COVID-19. Sin embargo, se reconoció cierto nivel de discriminación hacia las mujeres migrantes venezolanas que solicitaban servicios de SSR y que este fenómeno podría estar subrepresentado.

[RESUMO]. Objetivos. Descrever as perspectivas dos profissionais de saúde sobre as barreiras, lacunas e oportunidades que as mulheres migrantes venezuelanas encontraram para acessar serviços de saúde sexual e reprodutiva (SSR) durante a pandemia de COVID-19 e como esses serviços foram afetados em Quito, Equador. Métodos. Foram entrevistados profissionais de saúde envolvidos nos serviços de SSR de nove unidades públicas de saúde de três zonas de Quito. Adaptou-se o questionário de avaliação da prontidão para oferecer o pacote de serviço inicial mínimo, disponibilizado pelo grupo de trabalho interagencial sobre saúde reprodu- tiva em situações de crise, a fim de realizar a coleta de dados no Equador. Resultados. Dos 297 respondentes, 227 foram incluídos na análise. Apenas 16% dos profissionais de saúde concordaram que havia discriminação contra mulheres migrantes venezuelanas no sistema de saúde. Desses, apenas 2,3% descreveram condições específicas associadas à discriminação, como cobrança de documen- tos de identificação (7,5%) e falta de empatia ou responsividade (6,6%). A maioria (65,2%) dos respondentes relatou que a pandemia de COVID-19 afetou o uso dos serviços de SSR por mulheres na população de modo geral. As mulheres migrantes venezuelanas foram mais afetadas (56,3%) devido ao acesso limitado a serviços de SSR e à pobreza e vulnerabilidade. Não houve diferenças de percepção entre diferentes níveis de atenção à saúde, exceto no que diz respeito à falta de insumos, sensibilização para a discriminação e crença de que as mulheres migrantes venezuelanas foram afetadas de forma mais negativa que a população local. Conclusão. Para os profissionais de saúde em Quito, a discriminação foi pouco frequente durante a pandemia de COVID-19, embora a pandemia tenha afetado o sistema de saúde. Entretanto, os profissionais reconhece- ram certo nível de discriminação contra as mulheres migrantes venezuelanas que procuram serviços de SSR, que pode estar sub-representado.

Health care access and migration experiences among Venezuelan female sex workers living in the Dominican Republic

[ABSTRACT]. Objective. To identify sexual risk behaviors and barriers to sexual and reproductive health care (SRH) among Venezuelan female sex workers living in the Dominican Republic. Methods. This was a mixed-methods study using four focus group discussions (FGDs) and a cross-sectional quantitative survey with Venezuelan migrant female sex workers. The study was conducted from September through October 2021 in two urban areas (Santo Domingo and Puerto Plata) in the Dominican Republic. Infor- mation collected from the FGDs was analyzed using thematic content analysis, and quantitative data were analyzed using univariate descriptive statistics. Data analysis was conducted from 30 November 2021 to 20 February 2022. Results. In all, 40 Venezuelan migrant female sex workers with a median (range) age of 33 (19-49) years par- ticipated in the FGDs and survey. The FDGs identified barriers to SRH services, including immigration status and its implications for formal employment and health access, mental wellbeing, quality-of-life in the Domin- ican Republic, navigating sex work, perceptions of sex work, SRH knowledge, and limited social support. Findings of the quantitative analysis indicated that most participants reported feeling depressed (78%), lonely/ isolated (75%), and having difficulty sleeping (88%). Participants reported an average of 10 sexual partners in the past 30 days; 55% had engaged in sexual practices while under the influence of alcohol; and only 39% had used a condom when performing oral sex in the past 30 days. Regarding AIDS/HIV, 79% had taken an HIV test in the past 6 months, and 74% knew where to seek HIV services. Conclusions. This mixed-methods study found that nationality and social exclusion have a multilayered influ- ence on migrant female sex workers, sexual risk behaviors, and access to health care. Recommendations for effective evidence-based interventions to address sexual health knowledge need to be implemented to address risky sexual behaviors, improve access to SRH, and reduce affordability barriers.

[RESUMEN]. Objetivo. Determinar los comportamientos sexuales de riesgo y los obstáculos para acceder a los servi- cios de salud sexual y reproductiva (SSR) en trabajadoras sexuales venezolanas residentes en República Dominicana. Métodos: En este estudio se empleó una metodología mixta con cuatro debates en grupos de opinión y una encuesta cuantitativa transversal en trabajadoras sexuales migrantes venezolanas. El estudio se llevó a cabo entre septiembre y octubre del 2021 en dos zonas urbanas (Puerto Plata y Santo Domingo) de República Dominicana. La información recopilada a partir de los grupos de opinión se analizó mediante análisis de contenido temático, y los datos cuantitativos se analizaron mediante estadísticas descriptivas univariadas. El análisis de los datos se realizó del 30 de noviembre del 2021 al 20 de febrero del 2022. Resultados: Un total de 40 trabajadoras sexuales migrantes venezolanas con una mediana (rango) de edad de 33 años (entre 19 y 49) participaron en los grupos de opinión y la encuesta. Los grupos de opinión per- mitieron determinar los obstáculos para acceder a los servicios de SSR, como la situación migratoria y sus implicaciones para el acceso al empleo formal y a los servicios de salud, el bienestar mental, la calidad de vida en República Dominicana, el trabajo sexual y la manera de transitarlo, las percepciones sobre el trabajo sexual, los conocimientos sobre la SSR y el escaso apoyo social. Los resultados del análisis cuantitativo indi- caron que la mayoría de las participantes manifestaron que se sentían deprimidas (78%), solas o aisladas (75%), y que tenían dificultades para dormir (88%). Las participantes también indicaron que habían tenido un promedio de 10 parejas sexuales en los últimos 30 días, el 55% había mantenido relaciones sexuales bajo los efectos del alcohol y solo el 39% había utilizado preservativo al practicar sexo oral en los últimos 30 días. En cuanto a la infección por el VIH/sida, el 79% se había sometido a una prueba del VIH en los últimos 6 meses y el 74% sabía dónde buscar servicios relacionados con el VIH. Conclusiones. En este estudio basado en metodologías mixtas, se observó que la nacionalidad y la exclusión social afectan de diversas formas a las trabajadoras sexuales inmigrantes, sus comportamientos sexuales de riesgo y su acceso a la atención de salud. Es necesario poner en práctica las recomendaciones para la realización de intervenciones eficaces basadas en la evidencia para atender los conocimientos sobre salud sexual con el fin de abordar los comportamientos sexuales de riesgo, mejorar el acceso a la SSR y reducir los obstáculos relacionados con la asequibilidad.

[RESUMO]. Objetivo. Identificar comportamentos sexuais de risco e barreiras aos cuidados de saúde sexual e reprodu- tiva (SSR) entre trabalhadoras do sexo venezuelanas que vivem na República Dominicana. Métodos. Estudo de métodos mistos. Foram realizadas quatro discussões com grupos focais e uma pesquisa quantitativa transversal com trabalhadoras do sexo migrantes venezuelanas. O estudo foi realizado de setem- bro a outubro de 2021 em dois áreas urbanas (Santo Domingo e Puerto Plata) da República Dominicana. As informações coletadas dos grupos focais foram analisadas por meio de análise temática de conteúdo, e os dados quantitativos foram analisados por meio de estatísticas descritivas univariadas. A análise dos dados foi realizada de 30 de novembro de 2021 a 20 de fevereiro de 2022. Resultados. No total, 40 trabalhadoras do sexo migrantes venezuelanas, com mediana de idade de 33 anos (mínimo, 19; máximo, 49), participaram dos grupos focais e da pesquisa. Os grupos focais identificaram barreiras aos serviços de SSR, incluindo status de imigração e suas repercussões para o emprego formal e o acesso à saúde, bem-estar mental, qualidade de vida na República Dominicana, navegação do trabalho sexual, percepções do trabalho sexual, conhecimento de SSR e apoio social limitado. Conforme a análise quantitativa, a maioria das participantes relatou sentir-se deprimida (78%), solitária/isolada (75%) e com difi- culdade para dormir (88%). As participantes relataram uma média de 10 parceiros sexuais nos últimos 30 dias; 55% praticaram sexo sob efeito de álcool; e apenas 39% usaram preservativo na prática de sexo oral nos últimos 30 dias. Em relação ao HIV/aids, 79% fizeram teste de HIV nos últimos 6 meses e 74% sabiam onde procurar serviços de HIV. Conclusões. Este estudo de métodos mistos constatou que a nacionalidade e a exclusão social têm uma influência multifacetada nas trabalhadoras do sexo migrantes, nos comportamentos sexuais de risco e no acesso à atenção à saúde. É preciso implementar recomendações para intervenções eficazes e baseadas em evidências para abordar o conhecimento da saúde sexual, visando a abordar comportamentos sexuais de risco, melhorar o acesso aos serviços de SSR e reduzir as barreiras de acessibilidade.

Activation of the CA2-ventral CA1 pathway reverses social discrimination dysfunction in Shank3B knockout mice.

Mutation or deletion of the SHANK3 gene, which encodes a synaptic scaffolding protein, is linked to autism spectrum disorder and Phelan-McDermid syndrome, conditions associated with social memory impairments. Shank3B knockout mice also exhibit social memory deficits. The CA2 region of the hippocampus integrates numerous inputs and sends a major output to the ventral CA1 (vCA1). Despite finding few differences in excitatory afferents to the CA2 in Shank3B knockout mice, we found that activation of CA2 neurons as well as the CA2-vCA1 pathway restored social recognition function to wildtype levels. vCA1 neuronal oscillations have been linked to social memory, but we observed no differences in these measures between wildtype and Shank3B knockout mice. However, activation of the CA2 enhanced vCA1 theta power in Shank3B knockout mice, concurrent with behavioral improvements. These findings suggest that stimulating adult circuitry in a mouse model with neurodevelopmental impairments can invoke latent social memory function.

La dignidad de la mujer como argumento jurídico relevante en la Sentencia del Tribunal Supremo español 277 /2022, de 31 de marzo de 2022, sobre filiación en la gestación subrogada / La dignitat de la dona com a argument jurídic rellevant en la Sentència del Tribunal Suprem espanyol 277 /2022, de 31 de març de 2022, sobre filiació en la gestació subrogada / The dignity of women as a relevant legal argument in Spanish Supreme Court Ruling 277/2022, 31 March 2022, on filiation in surrogacy

Este comentario se centra en analizar uno de los aspectos relevantes de la reciente sentencia dictada por el Pleno de la Sala de lo Civil del Tribunal Supremo español, el 31 de marzo de 2022. La decisión jurisdiccional, aunque tiene por objeto la determinación de la filiación, se pronuncia sobre la polémica cuestión que se sitúa claramente en el ámbito de la Bioética y que está siendo, ya desde hace algún tiempo, objeto de un intenso debate social, político y jurídico, cual es la maternidad subrogada y su incidencia en la dignidad de la mujer, como cualidad intrínseca inherente a sus derechos más básicos y fundamentales. En este supuesto, el Tribunal Supremo, de manera rotunda, considera que se produce una vulneración flagrante de la dignidad de la mujer gestante y de sus derechos inviolables. Tras examinar el significado del principio esencial de la dignidad humana, se concluye que dicha cualidad es innegociable e inalienable y, por tanto, no es susceptible de resignificación que la menoscabe o menosprecie en ningún caso, en ninguna otra cultura ni en ningún otro contexto.(AU)

Aquest comentari se centra aanalitzar un dels aspectes rellevants de la recent sentència dictada pel Ple de la Sala Civil del Tribunal Suprem espanyol, el 31 de març de 2022. La decisió jurisdiccional, encara que té per objecte la determinació de la filiació, es pronuncia sobre la polèmica qüestió que se situa clarament a l'àmbit de la Bioètica i que està sent, ja des de fa algun temps, objecte d'un intens debat social, polític i jurídic, quina és la maternitat subrogada i la seva incidència en la dignitat de la dona, com a qualitat intrínseca inherent als seus drets més bàsics i fonamentals. En aquest cas, el Tribunal Suprem, de manera rotunda, considera que es produeix una vulneració flagrant de la dignitat de la dona gestant i dels seus drets inviolables. Després d'examinar el significat del principi essencial de la dignitat humana, es conclou que aquesta qualitat és innegociable i inalienable i, per tant, no és susceptible de resignificació que la menyscabi o menyspreï en cap cas, en cap altra cultura ni en cap altre context.(AU)

This commentary focuses on analyzing one of the relevant aspects of the recent decision handed down by the Plenary of the Civil Chamber of the Spanish Supreme Court on March 31, 2022. The jurisdictional decision, although its purpose is to determine parentage, pronounces on the controversial issue that is clearly located in the field of Bioethics and which has been, for some time now, the subject of an intense social, political and legal debate, which is surrogate motherhood and its impact on the dignity ofwomen, as an intrinsic quality inherent to their most basic and fundamental rights. In this case, the Spanish Supreme Court categorically considers that there is a flagrant violation of the dignity of pregnant women and their inviolable rights. After examining the meaning of the essential principle of human dignity, it is concluded that said quality is non-negotiable and inalienable and, therefore, it is not susceptible to resignification that undermines or belittles it in any case, in any other culture, or in any other context.(AU)

Influencia de las redes sociales en la autoestima, imagen corporal y satisfacción corporal de adolescentes y jóvenes / Influence of social networks on the self-esteem, body image and body satisfaction of adolescents and young persons

Objetivo: explorar la relación del uso de las redes sociales (RRSS) con la autoestima, la imagen corporal y la satisfacción corporal de adolescentes y adultos jóvenes.Métodos: se llevó a cabo una revisión narrativa. La búsqueda bibliográfica se realizó en las bases de datos PubMed, CINAHL y PsycInfo de artículos publicados en el periodo 2017-2022, usando los descriptores “young adult”, “adolescent”, “social media”, “body dissatisfaction”, “body image” y “self-concept”, así como lenguaje natural. Se incluyeron los artículos con muestra de población masculina y/o femenina entre 12-30 años, que incluyese RRSS de manera genérica o alguna específica (Instagram, TikTok y/o Facebook), que analizara la relación de las RRSS y algunos de los siguientes constructos: autoestima, imagen corporal y/o satisfacción/insatisfacción corporal de manera individual o en su conjunto.Resultados: de los 536 registros iniciales, 29 artículos cumplieron los criterios de selección y fueron revisados en profundidad. Los hallazgos se agruparon en cuatro temas relacionados con los constructos a estudio: comparación social, retroalimentación, dedicación y tendencias en RRSS.Conclusión: las RRSS tienen un efecto negativo sobre la satisfacción corporal y la imagen corporal, aunque el impacto sobre la autoestima está influido por la retroalimentación recibida en las imágenes publicadas y el tiempo invertido. La nueva corriente #bodypositive se relaciona con mayor bienestar psicológico, social y emocional, hábitos más saludables y mejoras en el autocuidado, además de ser un factor protector frente a la insatisfacción corporal. Es necesario desarrollar intervenciones de Enfermería de promoción y prevención de la salud en el entorno escolar y comunitario en función de los hallazgos.(AU)

Objective: to explore the relationship between the use of social networks and the self-esteem, body image and body satisfaction of adolescents and young adults.Methods: a narrative review was conducted. There was a bibliographic search in the PubMed, CINAHL and PsycInfo databases, for articles published during the 2017-2022 period, using the descriptors “young adult”, “adolescent”, “social media”, “body dissatisfaction”, “body image” and “self-concept”; as well as natural language. Articles with a male and/or female population sample between 12 and 30 years of age were included., with social networks mentioned generically or specifically (Instagram, TikTok and/or Facebook), and analysing the relationship between social networks and some of the following constructs: self-esteem, corporal image, and/or body satisfaction/dissatisfaction, either individually or as a whole.Results: out of the 536 initial records, 29 articles met the selection criteria and were reviewed in depth. Findings were grouped into four themes associated with the constructs to be studied: social comparison, feedback, dedication, and trends in social networks.Conclusion: social networks have a negative impact on body satisfaction and body image, although their impact on self-esteem is influenced by the feedback received for the images published and the time invested. The new #bodypositive trend is associated with higher psychological, social and emotional wellbeing, healthier habits and improvements in self-care, as well as being a protective factor against body dissatisfaction. It is necessary to develop Nursing interventions for health promotion and prevention in the school and community settings, based on these findings.(AU)

Social Stigma Towards Mental Health Problems in Spain: A Systematic Review / El estigma social hacia los problemas de salud mental en España: una revisión sistemática

Introduction: This review focuses on social stigma associated with mental health problems in Spain in recent years. Method: A systematic search was conducted in SCOPUS, PsycInfo and Pubmed from 2010 to 2021. Twenty-six articles met inclusion criteria, and their quality was assessed following the STROBE-checklist. Results: In the Spanish population, stigmatising dynamics are detected in three dimensions of stigma: cognitive (beliefs of dangerousness, unpredictability, irresponsibility); emotional (prejudices and emotions of fear, anger, blaming for the psychological problem); and behavioural (discriminatory behaviours, avoidance, coercion). The results also show significant levels of stigma among health professionals. In contrast, those who have contact with mental health problems, or are trained in mental health, tend to show lower stigma. Conclusions: Longitudinal studies with rigorous methodology are needed to access strong empirical evidence in this field. Contact and education may be relevant factors in programming interventions, both in the general population and in health professionals. (AU)

Introducción: Esta revisión se centra en el estigma social asociado a los problemas de salud mental en España en los últimos años. Método: Se realizó una búsqueda sistemática en SCOPUS, PsycInfo y Pubmed de 2010 a 2021. Veintiséis artículos cumplían los criterios de inclusión y su calidad se evaluó siguiendo la lista de comprobación STROBE. Resultados. En la población española se detectan dinámicas estigmatizadoras en tres dimensiones del estigma: cognitiva (creencias de peligrosidad, imprevisibilidad, irresponsabilidad), emocional (prejuicios y emociones de miedo, ira, culpabilización del problema psicológico) y conductual (conductas discriminatorias, evitación, coacción). Los resultados también muestran niveles significativos de estigma entre los profesionales sanitarios. Por el contrario, aquellas personas que tienen contacto con problemas de salud mental o están formadas en el tema tienden a mostrar un menor estigma. Conclusiones: Se necesitan estudios longitudinales con una metodología rigurosa para acceder a evidencia empírica sólida en este campo. El contacto y la educación pueden ser factores relevantes a la hora de programar intervenciones antiestigma, tanto en la población general como en los profesionales sanitarios. (AU)

Parental Sexuality Disclosure, Discrimination, and Depression Among Black Sexual Minority Men and Black Transgender Women.

Racial and sexuality-based discrimination can induce depressive symptoms among Black sexual minority men and transgender women (BSMM/BTW). BSMM and BTW who disclose their sexuality to parents may be better prepared to cope with discrimination. We explored the relationship between discrimination and depression among BSMM and BTW and whether parental disclosure modified this relationship. Secondary analysis of The MARI Study was used to test the relationship between discrimination and depression modified by level of disclosure of sexuality to parents among 580 BSMM and BTW in Jackson, Mississippi, and Atlanta, Georgia. Bivariate tests and linear regression models were stratified by sexuality disclosure to parents. Discrimination was associated with greater depression, with significant dose-response modification across levels of disclosure. After adjustment, maximum discrimination scores were associated with depression scores 10.7 units higher among participants with very open disclosure (95% CI, 10.4-11.8), 15.3 units higher among participants with somewhat open disclosure (95% CI, 3.7-26.9), and 19.5 units higher among participants with no disclosure (95% CI, 10.2-26.8). Disclosure of sexuality to supportive parents can substantially benefit the mental health of BSMM and BTW. Future studies should explore intervention approaches to providing social support for BSMM and BTW in unsupportive families.

Multiple forms of discrimination and inflammation in Black Americans: Are there differences by sex?

RATIONALE: Discrimination is a risk factor and potential pathway through which social determinants such as race and sex contribute to chronic inflammation in Black Americans in middle and later adulthood. Questions remain regarding which forms of discrimination are most salient for inflammatory dysregulation, and whether there are sex-based differences in these pathways. OBJECTIVE: This exploratory study investigates sex differences in the relationships between four forms of discrimination and inflammatory dysregulation among middle aged and older Black Americans. METHODS: Using cross-sectionally linked data from participants in the Midlife in the United States (MIDUS II) Survey (2004-2006) and Biomarker Project (2004-2009) (N = 225, ages 37-84, 67% female), this study conducted a series of multivariable regression analyses. Inflammatory burden was measured using a composite indicator comprised of five biomarkers: C-reactive protein (CRP), interleukin-6 (IL-6), fibrinogen, E-selectin, and intercellular adhesion molecule (ICAM). Discrimination measures were lifetime, daily, and chronic job discrimination and perceived inequality at work. RESULTS: Black men generally reported higher levels of discrimination than Black women (3 out of 4 forms), though only sex differences in job discrimination achieved statistical significance (p < .001). In contrast, Black women exhibited more overall inflammatory burden than Black men (2.09 vs. 1.66, p = .024), particularly elevated levels of fibrinogen (p = .003). Lifetime discrimination and inequality at work were associated with higher levels of inflammatory burden, after adjusting for demographic and health factors (p = .057 and p = .029, respectively). The discrimination-inflammation relationships further varied by sex, such that more lifetime and job discrimination predicted greater inflammatory burden in Black women, but not in Black men. CONCLUSION: These findings highlight the potentially detrimental impact of discrimination and emphasize the importance of sex-specific research on biological mechanisms of health and health disparities in Black Americans.

Lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI+) healthcare in Singapore: perspectives of non-governmental organisations and clinical year medical students.

PURPOSE: International studies document that lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI+) patients face significant health disparities. Studies exploring the attitudes, knowledge, preparedness and comfort levels of healthcare students towards LGBTQI+ health have been conducted in the United States, United Kingdom and Malaysia. This study aims to investigate stigma in healthcare for LGBTQI+ patients in Singapore, and possible upstream factors within medical education. METHODS: This mixed-methods study adopts a convergent parallel design. The Health Stigma and Discrimination Framework was referenced to devise in-depth interviews with representatives from 13 LGBTQI-affirming non-governmental organisations, analysed through thematic analysis. 320 clinical medical students were surveyed about attitudes, knowledge, comfort, preparedness, and perceived importance of/towards LGBTQI+ health, analysed via descriptive statistics and multivariate regression. RESULTS: Prevailing stigma in Singaporean society against LGBTQI+ individuals is exacerbated in healthcare settings. Doctors were cited as unfamiliar or uncomfortable with LGBTQI+ health, possibly from lack of training. Among medical students surveyed, the median composite attitudes, comfort and preparedness index was 3.30 (Interquartile Range (IQR) = 0.50), 3.17 (IQR = 0.83), 2.50 (IQR = 1.00) respectively. Only 12.19% of students answered all 11 true-false questions about LGBTQI+ health correctly. CONCLUSION: Medical students in Singapore have scored sub-optimally in their knowledge and preparedness towards LGBTQI+ health, while interpersonal and structural stigma in healthcare towards LGBTQI+ people in Singapore negatively affects health and wellbeing. These findings are an impetus to improve medical training in this area. High scores among medical students in attitudes, comfort and perceived importance of LGBTQI+ topics demonstrate that there is space for LGBTQI+ health in the local medical education curriculum. Curricular interventions can prioritise content knowledge, communication skills and sensitivity.

Prevention of Bias and Discrimination in Clinical Practice Algorithms.

This Viewpoint discusses a proposed DHHS rule to address discrimination in clinical algorithms and the need for additional considerations to ensure the burden of liability for biased algorithms is not disproportionately placed on health care professionals.

Pulse Oximeters and Violation of Federal Antidiscrimination Law.

This Viewpoint discusses how some pulse oximeters can provide incorrect oxygen saturation data for dark-skinned patients compared with light-skinned patients, describes the reasons that biased oximeters remained in use, and highlights why a rule recently proposed by the US Department of Health and Human Services may bring about needed change in the use of pulse oximetry for patients with dark skin.

Ableism to Empowerment: Navigating School Structures When Working With Students Who Stutter.

PURPOSE: School-based speech-language pathologists (SLPs) face uniquely complex webs of guidelines and criteria that can undermine their ability to move toward disability-affirming practices. The purpose of this clinical focus article is to present a contrast between ableist and disability-affirming practices in school-based stuttering therapy while highlighting the critical perspectives of students who stutter. Practical examples of disability-affirming stuttering therapy in public school settings are provided. CONCLUSIONS: This clinical focus article outlines practical guidelines and specific examples of affirming collaboration, eligibility decisions, goal choice, and accommodations for students who stutter. These discussions demonstrate how SLPs can adopt updated assessment therapy planning and institutional practices to affirm students who stutter while informing school cultures and society about the dignity and value of stuttered voices. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21818028.

Recommandations pour une surveillance éthique de la variole simienne

La surveillance est une activité essentielle de santé publique mais se heurte à des défis éthiques. La flambée de la variole simienne touche principalement les hommes gays, les hommes bisexuels et les autres hommes ayant des rapports sexuels avec des hommes. La surveillance de la variole simienne comporte donc des risques de discrimination et de stigmatisation, ainsi que de risques de mesures punitives dans les juridictions où les comportements de certains groupes de la population sont criminalisés. La sensibilisation à ces risques et l'orientation spécifique pour relever d'autres défis éthiques de la surveillance de la variole simienne sont nécessaires afin promouvoir une surveillance éthique. Ce bref document fournit des recommandations visant à garantir que la surveillance de la variole simienne soit menée de manière éthique. Ces recommandations ont été élaborées sur la base des lignes directrices de l'OMS sur les questions éthiques en matière de surveillance de la santé publique.

[Discrimination perceived by elderly adults in the use of health services: an integrative review]. / Discriminação percebida por adultos mais velhos no uso de serviços de saúde: uma revisão integrativa.

This paper analyzes the current evidence on discrimination perceived by elderly adults (> 50 years) in the use of health services and identifies factors associated with this discriminatory experience. It involved an integrative literature review, carried out on the Biblioteca Virtual de Saúde, CINAHL, Medline, Scopus, and Web of Science search websites, in June/2021. The key words used were social discrimination or ageism; middle-aged, or aged 80 and over or elderly; health services or health services for the elderly, including synonyms, in Portuguese, English, and Spanish. The search strategy identified 1,165 articles; 19 met the eligibility and inclusion criteria and were included in this integrative review. They comprise quantitative and qualitative studies published between 2002 and 2021; about 60% carried out in the United States and Australia. The prevalence of discrimination in the use of health services ranged from 2% to 42%. The report of discriminatory practices was associated with ethnic-racial characteristics, sex, age, sexual orientation, physical appearance, and social class. By giving visibility to the theme, this work aims to stimulate the definition of concrete ways to tackle discrimination, in an attempt to interrupt the perpetration of inequities in the health care area.

Este trabalho analisa as evidências atuais sobre a discriminação percebida por adultos mais velhos (> 50 anos) no uso de serviços de saúde e identifica os fatores associados a essa experiência. Trata-se de uma revisão integrativa da literatura, realizada a partir de pesquisa nos sítios eletrônicos Biblioteca Virtual de Saúde, CINAHL, Medline, Scopus e Web of Science, em junho de 2021. Foram utilizados os descritores: discriminação social ou ageismo; pessoa de meia-idade ou idoso de 80 anos ou mais ou idoso; e serviço de saúde ou serviço de saúde para idosos, incluindo sinônimos, nos idiomas português, inglês e espanhol. A estratégia de busca identificou 1.165 artigos; 19 cumpriram os critérios de elegibilidade e inclusão. O acervo inclui estudos quantitativos e qualitativos publicados entre 2002 e 2021; cerca de 60% realizados nos Estados Unidos e Austrália. A prevalência de discriminação no uso de serviços de saúde variou de 2% a 42%. O relato de práticas discriminatórias se mostrou associado a características étnico-raciais, sexo, idade, orientação sexual, aparência física e classe social. Ao dar visibilidade ao tema, este trabalho visa estimular a definição de formas concretas de enfrentamento à discriminação e interromper a perpetração de iniquidades no âmbito da atenção à saúde.

Self-reported discrimination against adults with hearing loss in Brazilian health services: results of the National Health Survey. / Discriminação social em adultos com deficiência auditiva nos serviços de saúde brasileiro: resultados da Pesquisa Nacional de Saúde.

This article aims to estimate the prevalence of self-reported discrimination against people with hearing loss in Brazilian health services and analyze associated factors. We conducted a cross-sectional population-based study using data from the 2013 National Health Survey. The final study sample comprised 1,464 individuals with self-reported hearing loss. Poisson regression was used to calculate crude and adjusted prevalence ratios (PR) and respective 95% confidence intervals. The overall prevalence of discrimination was 15%. Prevalence was higher among black people and respondents who reported experiencing limitations in activities of daily living. Prevalence of discrimination in Brazilian health services was highest in black people with limitations in activities of daily living. The implementation of policies and actions to address this problem is recommended, including strategies during the education and training of health professionals.

O artigo tem como objetivo estimar a prevalência de discriminação social autorreferida em pessoas com deficiência auditiva nos serviços de saúde brasileiros, verificando fatores associados à discriminação. Estudo transversal de base populacional, com dados de um inquérito epidemiológico domiciliar realizado ponderadamente em todo o território brasileiro no ano de 2013. A amostra final deste estudo compreendeu 1.464 adultos com perda auditiva autorreferida. Utilizou-se regressão de Poisson com variância robusta para cálculo de razões de prevalência (RP) brutas e ajustadas para a investigação das prevalências de discriminação autorreferida nos serviços de saúde e seus respectivos intervalos de confiança de 95%. A prevalência de discriminação em adultos com deficiência auditiva nos serviços de saúde brasileiros foi de 15%. Indivíduos de cor/raça preta e que relataram que a perda auditiva limita as suas atividades de vida diária apresentaram maior associação com discriminação. Pessoas com deficiência auditiva de cor/raça preta e que apresentam limitação nas atividades da vida diária em decorrência da perda auditiva relataram maior discriminação nos serviços de saúde. Estratégias de enfrentamento à discriminação de profissionais da área da saúde devem ser implementadas para que esse cenário seja modificado.

Ableism in Health Care.

Improving our knowledge of disability can reduce stereotypes and stigma.

Coordinación para el abordaje de la viruela del mono con perspectiva de diversidad afectiva y sexual / Coordination for an affective and sexual diversity approach to monkeypox

En mayo de 2022 se detectaron las primeras cadenas de transmisión de la viruela del mono fuera de los países endémicos. Este brote presenta características clínicas y epidemiológicas diferentes de las observadas en los brotes anteriores, con un mayor impacto en el grupo de hombres que tienen sexo con hombres. El abordaje de brotes epidémicos que conlleva intervenciones sobre comunidades o poblaciones en riesgo de estigmatización resulta un desafío. La independencia y la capacidad profesional de las sociedades científicas permiten adoptar iniciativas para dar respuestas rápidas a este tipo de desafíos. Mediante el trabajo colaborativo y la iniciativa profesional se elaboró un documento orientado a evitar la estigmatización a la vez que se promovían la prevención y el control de la enfermedad. Para su divulgación se emplearon distintos canales y se contó con los agentes de interés. El trabajo en equipo, dentro de las estructuras de participación de una sociedad científica, permite impulsar acciones rápidas basadas en recomendaciones técnicas. (AU)

In May 2022, the first monkeypox transmission chains were detected outside endemic countries. This outbreak presents clinical and epidemiological characteristics different from those observed in previous outbreaks, with a greater impact among the group of men who have sex with other men. The approach of epidemic outbreaks that requires interventions on communities or populations at risk of stigmatization is a major public health challenge. The independence and professional capacity of scientific societies allow to be take initiatives to provide rapid responses to this type of challenges. Through collaborative work and professional initiative, a document was issued aimed at avoiding stigmatization while promoting the prevention and control measures. For its dissemination, different channels were used counting with key partners. Teamwork, within the participation structures of a scientific society, allows to promote rapid public health actions based on technical recommendations. (AU)