Academy Library and Information Service Current Awareness Bulletin – Equality and Diversity June 2021
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Original Research
1. "First do no harm": Clinical practice guidelines, mesolevel structural racism, and medicine's epistemological reckoning. Rondini Ashley C. Social Science & Medicine 2021;279:N.PAG-N.PAG. This paper presents a critique of clinical practice guidelines (CPGs) that standardize the use of race as a proxy for biological difference in medical settings. Drawing on the illustrative example of a pediatric UTI testing guideline, we contend that when CPGs necessitate that Black patients meet a higher threshold of illness severity or duration than their non-Black counterparts to receive comparable medical testing or other medical care, they function as mesolevel sites of race-racism reification processes (see Sewell, 2016) that contribute to the reproduction of racial health disparities. We describe broader implications and make recommendations for the conceptualization and implementation of future research in the sociological study of race, health, and medicine. • Scholarship on racial health inequities has focused primarily on micro- and macro-level factors. • Mesolevel racism in medicine has not received sufficient attention in the sociological
study of medicine and race. • Medical research reifies racist ideas by privileging racialized inferiority myths and invulnerability myth s. • Clinical practice guidelines are mesolevel tools based on past medical research. • CPGs that racialize illness thresholds required for care reproduce mesolevel structural racism. Available online at this link
2. "I Can't Breathe"-COVID-19 Perspectives as a Black Trainee. Asom Anase Academic medicine : journal of the Association of American Medical Colleges 2021;96(6):781-782. Available online at this link
3. "Straight Sex is Complicated Enough!": The Lived Experiences of Autistics Who are Gay, Lesbian, Bisexual, Asexual, or Other Sexual Orientations. Lewis Laura Foran Journal of autism and developmental disorders 2021;51(7):2324-2337. Autistics are more likely than neurotypicals to be gay, lesbian, bisexual, asexual, and other sexual orientations. Autistics and sexual minorities represent populations at high risk for depression, anxiety, and suicidality. Little is known about the experiences of individuals living at this intersection. In this phenomenology, 67 individuals who identified as autistic sexual minorities participated in online interviews to describe the meaning of their experiences. Six themes emerged, including: self-acceptance is a journey; autistic traits complicate self-identification of sexual orientation; social and sensory stressors affect sexual expression; feeling misunderstood and isolated; challenges finding mutually satisfying relationships; and difficulty recognizing and communicating sexual needs. Autistic sexual minorities experience a "double minority" status that complicates identity formation and increases vulnerability in sexual relationships. Available online at this link
4. "There is LGBTQ Life beyond the Big City": Discourses, Representations and Experiences in Two Medium-Sized Spanish Cities. Jubany Olga Journal of homosexuality 2021;:1-20. Whilst debates on sexual diversity in public space have been extensive, these have tended to focus on large cities as the environments within which to analyze sexual and gender diversity, gradually consolidating an intrinsic relationship between the LGBTQ experience and the big city. This emphasis has led to the LGBTQ experiences of small and medium-sized cities being overlooked, neglecting the complexity of the intersection between the urban and the sex-gender. Grounded on an original ethnographic work, this paper explores the experiences of LGBTQ people living in two medium-sized cities in Spain: Girona and Sabadell, to analyze the interrelationships between these cities and Barcelona as their main LGBTQ-friendly reference; and the perceptions of tolerance and hostility toward LGBTQ expressions in public spheres. The paper reveals that all cities are shaped by sexualized discourses and experiences, and argues that the experiences of LGBTQ people in medium-sized cities needs to be recognized to understand the influence of space in shaping the sex- gender experiences. Available online at this link
5. "We're Moving in the Right Direction. Still a Long Way to Go": Experiences and Perceptions of the Climate for LGBTQ+ Employees at a Pediatric Hospital. Katz-Wise Sabra L. Journal of homosexuality 2021;:1-19. A positive LGBTQ+ (lesbian, gay, bisexual, transgender/nonbinary, queer) workplace climate is critical for healthcare employee satisfaction, productivity, and patient care. The current study assessed LGBTQ+ workplace climate among 791 employees from a large urban pediatric hospital. Several workplace climate domains were assessed in an online survey: employee attitudes, training, experiences related to working with LGBTQ+ colleagues, patients and families, and LGBTQ+-specific experiences. For most domains, half or more of respondents perceived an affirming LGBTQ+ climate. LGBTQ+ employees perceived a less affirming climate than cisgender heterosexual employees. LGBTQ+ employees, especially transgender/nonbinary employees, experienced numerous discriminatory situations. Over 90% of participants felt competent and qualified to work with LGB patients/families; 80% felt competent and qualified to work with TNB patients/families. Themes from open-ended survery responses reflected three LGBTQ+ climate components: systemic, interpersonal, and "grassroots" (affinity group) initiatives. Findings inform strategies to improve LGBTQ+ employee experiences and competency caring for LGBTQ+ patients and families. Available online at this link
6. "Whatever you do, just don't let him notice you're a woman!" General beliefs on women's gender ideology as a function of topic in mixed-gender negotiations. Manea Claudia-Neptina International journal of psychology : Journal international de psychologie 2021;56(3):338-348. How one approaches gender differences in general likely influences the way one handles mixed-gender negotiations. In the present paper, we examine general beliefs on how women negotiators do-as opposed to how they "should"-handle gender in order to increase their chances of success. First, we hypothesised that people's general beliefs would support a sexblindness ideology according to which gender is, and indeed should be, ignored in order to succeed. Second, because negotiation comes across as a stereotypically masculine activity, we predicted that prescriptions regarding what women should do to succeed would commonly favour assimilationism (the belief that women need to assimilate to male norms) over sexawareness (the belief that gender differences should be acknowledged and celebrated). We nevertheless predicted a general belief that women might stay away from these prescriptions and rely more on their gender (i.e. endorse sexawareness over assimilationism) within feminine as compared to masculine and neutral-topic negotiations. Together, our two experiments confirm these predictions. We discuss our results in terms of the consequences on women's gender ideology-based strategies, a potentially relevant aspect to their actual negotiating outcomes. Available online at this link
7. A Call for LGBTQ Content in Graduate Medical Education Program Requirements. Pregnall Andrew M. Academic medicine : journal of the Association of American Medical Colleges 2021;96(6):828-835. A well-developed body of literature demonstrates that lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals experience poorer health outcomes and report worse health care experiences than straight/cisgender individuals. Many reforms since 2010 have addressed the LGBTQ-related education of future health care professionals at the undergraduate medical education (UME) level; however, reforms at the graduate medical education (GME) level are lagging, and new literature suggests that didactic education at the UME level is not enough to prepare future physicians to properly and compassionately care for LGBTQ patients. Recently, the Accreditation Council for Graduate Medical Education (ACGME) implemented a major revision of its Common Program Requirements that requires residents to demonstrate, as a competence, respect and responsiveness to diverse populations. Given these revisions and the ongoing failure of many GME training programs to adequately prepare future physicians to care for LGBTQ patients, the authors argue that now is the time for the ACGME to develop and implement LGBTQ health-related residency requirements. In addition, the authors outline a path by which the academic medical community may develop and implement these requirements. Available online at this link
8. A humble approach to address disparities in healthcare. Hajirnis Aditi V. Brown University Child & Adolescent Behavior Letter 2021;37(7):1-5. The United States has seen remarkable growth in cultural diversity over the past few decades, with its population becoming increasingly multiracial and multicultural. The population of minority groups has increased at a much faster rate even among children and youth. At the same time, minority youth face increasing disparities in their mental health and in access to mental health services. These disparities have been further aggravated by the lack of culturally competent services that can address their specific mental health needs within the context of their culture, family, and community. Available online at this link
9. A Nationwide Survey of COVID-19 Testing in LGBTQ+ Populations in the United States. Martino Richard J. Public health reports (Washington, D.C. : 1974) 2021;136(4):493-507. Objectives: Lesbian, gay, bisexual, transgender, or queer and questioning (LGBTQ+) people and populations face myriad health disparities that are likely to be evident during the COVID-19 pandemic. The objectives of our study were to describe patterns of COVID-19 testing among LGBTQ+ people and to differentiate rates of COVID-19 testing and test results by sociodemographic characteristics.; Methods: Participants residing in the United States and US territories (N = 1090) aged ≥18 completed an internet-based survey from May through July 2020 that assessed COVID-19 testing and test results and sociodemographic characteristics, including sexual orientation and gender identity (SOGI). We analyzed data on receipt and results of polymerase chain reaction (PCR) and antibody testing for SARS-CoV-2 and symptoms of COVID-19 in relation to sociodemographic characteristics.; Results: Of the 1090 participants, 182 (16.7%) received a PCR test; of these, 16 (8.8%) had a positive test result. Of the 124 (11.4%) who received an antibody test, 45 (36.3%) had antibodies. Rates of PCR testing were higher among participants who were non-US-born (25.4%) versus US- born (16.3%) and employed full-time or part-time (18.5%) versus unemployed (10.8%). Antibody testing rates were higher among gay cisgender men (17.2%) versus other SOGI groups, non-US-born (25.4%) versus US-born participants, employed (12.6%) versus unemployed participants, and participants residing in the Northeast (20.0%) versus other regions. Among SOGI groups with sufficient cell sizes (n > 10), positive PCR results were highest among cisgender gay men (16.1%).; Conclusions: The differential patterns of testing and positivity, particularly among gay men in our sample, confirm the need to create COVID-19 public health messaging and programming that attend to the LGBTQ+ population. Available online at this link
10. A Trauma-Informed Exploration of the Mental Health and Community Support Experiences of Transgender and Gender-Expansive Adults. Hall Seventy F. Journal of homosexuality 2021;68(8):1278-1297. This study applied a trauma-informed care (TIC) framework to explore transgender and gender-expansive (TGE) adults' experiences with mental health and community supports. Data were drawn from the qualitative component of a more extensive mixed-methods study that aimed to assess TGE individuals' support needs. Participants ( N = 100) were recruited from online support groups using a combination of convenience and snowball sampling and invited to take an online survey. Open-response questions asked participants to describe their most positive experiences with a mental health provider and provide recommendations for improving the supportiveness of the communities to which they belonged. Participants' responses were coded and sorted into five overarching themes: (a) trust and emotional safety, (b) environmental and physical safety, (c) choice and collaboration, (d) empowerment, and (e) cultural and gender issues. Finally, we discussed implications for improving practice and further developing a TIC model that meets the needs of this population. Available online at this link
11. Addressing Racial and Ethnic Disparities in COVID-19 Among School-Aged Children: Are We Doing Enough? White Arica Preventing chronic disease 2021;18:E55. The disproportionate impact of COVID-19 and associated disparities among Hispanic, non-Hispanic Black, and non-Hispanic American Indian/Alaska Native children and teenagers has been documented. Reducing these disparities along with overcoming unintended negative consequences of the pandemic, such as the disruption of in-person schooling, calls for broad community-based collaborations and nuanced approaches. Based on national survey data, children from some racial and ethnic minority groups have a higher prevalence of obesity, asthma, type 2 diabetes, and hypertension; were diagnosed more frequently with COVID-19; and had more severe outcomes compared with their non-Hispanic White (NHW) counterparts. Furthermore, a higher proportion of children from some racial and ethnic minority groups lived in families with incomes less than 200% of the federal poverty level or in households lacking secure employment compared with NHW children. Children from some racial and ethnic minority groups were also more likely to attend school via online learning compared with NHW counterparts. Because the root causes of these disparities are complex and multifactorial, an organized community-based approach is needed to achieve greater proactive and sustained collaborations between local health departments, local school systems, and other public and private organizations to pursue health equity. This article provides a summary of potential community-based health promotion strategies to address racial and ethnic disparities in COVID-19 outcomes and educational inequities among children and teens, specifically in the implementation of strategic partnerships, including initial collective work, outcomes-based activities, and communication. These collaborations can facilitate policy, systems, and environmental changes in school systems that support emergency preparedness, recovery, and resilience when faced with public health crises. Available online at this link
12. Advancing Equity in Academic Medicine. Roberts Laura Weiss Academic medicine : journal of the Association of American Medical Colleges 2021;96(6):771-772.
Available online at this link
13. Advancing Equity in Academic Medicine. Roberts Laura Weiss Academic medicine : journal of the Association of American Medical Colleges 2021;96(6):771-772. Available online at this link
14. Apparel Consumption and Embodied Experiences of Gay Men and Transgender Women in India: Variety and Ambivalence, Fit Issues, LGBT-Fashion Brands, and Affordability. Chauhan Vishakha Journal of homosexuality 2021;68(9):1444-1470. The purpose of this study was to explore Indian LGBT individuals' apparel consumption practices and embodied experiences related to fashion, style, and the body. Specifically, our research questions were these: What are Indian LGBT individuals' experiences like when navigating the fashion system, and how do they experience their own embodiment in what they wear and how they appear? A qualitative, phenomenological approach was used to answer the research questions. Three gay men and seven transgender women responded to a solicitation for participation and completed a semistructured interview. In our data analysis, we established four themes that relate to two larger areas of emphasis: embodiment and the fashion system. Regarding embodiment, participants related many experiences with their bodies, including (a) variety and ambivalence with bodily practices and (b) difficulty with clothing fit. The other themes centered around knowledge and desires related to the fashion system. Within the fashion system, participants expressed (a) fashion brand awareness and a need for LGBT-centered brands and (b) affordability as a barrier to clothing purchase. Overall, the essence of fashioning one's body as a transgender woman or gay man in India is that, while there has been a significant amount of gender oppression in India, these participants were interested in and desired gender-neutral or LGBT-focused brands. Available online at this link
15. Being counted: LGBTQ+ representation within the American College of Neuropsychopharmacology (ACNP). Fisher Hayley Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology 2021;:No page numbers. Available online at this link
16. Beyond border health: Infrastructural violence and the health of border abolition. Dubal Sam B. Social Science & Medicine 2021;279:N.PAG-N.PAG. Most existing approaches to border health focus on identifying the social determinants that produce ill health and health disparities among migrants, including language barriers, documentation status, and trauma associated with migration. Attention to these kinds of problems can lead to policy and clinical changes that indeed help improve quantitatively measurable outcomes for patients. However, these approaches usually ignore the larger historical and political framework that determines the determinants – the underlying infrastructure of ill health, or what we term the infrastructural determinants of health. In this paper, we outline specific infrastructures involving race, political economy, history, and most importantly, borders themselves, that lay the foundations for border illness. We examine the plans, histories, policies, and peoples involved in building the conditions for migration, particularly out of the Northern Triangle, including forces of colonialism, US imperialism, neoliberalism, and border militarization. In place of a tacit acceptance of the modern system of borders, we argue for border abolition as a vital but underused treatment in the repertoire of medical intervention. Outlining the rights of people to stay and to move, and drawing on lessons from the prison abolition movement, we offer policies and practices towards a 'no borders' system that privileges liberatory solidarity with migrants by explicitly challenging global infrastructures that drive displacement. In doing so, we offer an emergent framework for a medical border abolition that treats both the causes and symptoms of a widespread global sickness. • The framework of infrastructural determinants of health is introduced. • Borders and prisons are forms of infrastructural violence. • The health of border abolition is discussed. • Liberatory solidarity aligns health work with abolitionist efforts. Available online at this link
17. Bridging the Gap in Graduate Medical Education: A Longitudinal Pediatric LGBTQ Health Curriculum. Roth Lauren T. Academic pediatrics 2021;:No page numbers.
Objective: Despite known health disparities, there is limited training in lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ) health, particularly in pediatric graduate medical education (GME). We aimed to develop a longitudinal LGBTQ curriculum for a pediatrics residency program tailored to the needs and interests of our trainees.; Methods: We developed a year-long curriculum based on a formal needs assessment and evaluated changes in provider knowledge, comfort, and self-reported clinical impact through pre- and post-surveys.; Results: The needs assessment was completed by 78 out of 110 providers (70.9% response rate); 60 (54.5%) and 70 (63.6%) completed the pre- and post-curriculum surveys, respectively. Post-curriculum implementation, there was an increase in mean comfort level asking about sexual orientation (4.1 to 4.5, p<0.01), gender identity (3.5 to 3.8, p=0.02), and sexual practices (3.4 to 3.8, p<0.01), psychosocial screening (3.2 to 4.2, p<0.01), applying medical/preventive screening guidelines (2.4 to 3.6, p<0.01), and medically managing transgender patients (1.9 to 3.1, p<0.01). Knowledge-based assessments increased from 25.2% correct to 38.5% (p=0.01). Faculty felt significantly more comfortable teaching this material to trainees (21.7% to 70.0%, p<0.01). Providers reported high scores regarding impact on clinical practice (4.0/5), intent to change practice (4.5/5), importance of (4.8/5) and satisfaction with (4.5/5) the curriculum.; Conclusion: There is a need to incorporate formal LGBTQ health training in GME. Our curriculum improved provider knowledge, comfort, self-reported clinical practice, and faculty preparedness to teach this material. It can serve as a framework for other pediatric programs to develop their own curricula. (Copyright © 2021. Published by Elsevier Inc.) Available online at this link
18. Bullying and Cyberbullying among LGBQ and Heterosexual Youth from an Intersectional Perspective: Findings from the 2017 National Youth Risk Behavior Survey. Angoff Harrison D. Journal of School Violence 2021;20(3):274-286. While LGBTQ youth may be victims of bullying at greater rates than heterosexual youth, research examining in-school bullying and cyberbullying victimization disparities through an intersectional framework is limited. Using the 2017 Youth Risk Behavior Survey, the present study examined the prevalence of in-school bullying and cyberbullying victimization across sexual orientation, gender, race, and grade (N = 13,567). Results position sexual minority youth at higher odds of experiencing in-school bullying and cyberbullying than heterosexual youth and show that bisexual youth were more likely than gay/lesbian youth to be cyberbullied. Findings from intersectional analyses show within-group variation in bullying victimization across sexual orientation based on gender, grade, and race. Specific intersectional results and implications for in-school bullying and cyberbullying prevention and intervention efforts are discussed. Available online at this link
19. Can Results-Based Financing improve health outcomes in resource poor settings? Evidence from Zimbabwe. Fichera Eleonora Social Science & Medicine 2021;279:N.PAG-N.PAG. Result Based Financing (RBF) has been implemented in health systems across low and middle-income countries (LMICs), with the objective of improving population health. Most evaluations of RBF schemes have focused on average programme effects for incentivised services. There is limited evidence on the potential effect of RBF on health outcomes, as well as on the heterogeneous effects across socio-economic groups and time periods. This study analyses the effect of Zimbabwe's national RBF scheme on neonatal, infant and under five mortality, using Demographic and Health Survey data from 2005, 2010 and 2015. We use a difference in differences design, which exploits the staggered roll-out of the scheme across 60 districts. We examine average programme effects and perform sub-group analyses to assess differences between socio- economic groups. We find that RBF reduced under-five mortality by two percentage points overall, but that this decrease was only significant for children of mothers with above median wealth (2.7 percentage points) and education (2.1 percentage points). RBF increased institutional delivery by seven percentage points – with a statistically significant effect for poorer socio-economic groups and least educated. We also find that RBF reduced c-section rates by three percentage points. We find no detectable effect of RBF on other incentivised services. When considering programme effects over time, we find that effects were only observed during the second phase of the programme (March 2012) with the exception of c-sections, which only reduced in the longer term. Further research is needed to examine whether these findings can be generalised to other settings. • Zimbabwe's national Results Based Financing scheme decreased under-five mortality. • Among higher wealth and education groups. • RBF increased institutional deliveries in the poorest and least educated groups and reduced the rate of c-section. • There were no programme effects on other incentivised services. • The RBF programme effects generally appear to be stronger earlier in the implementation process. Available online at this link
20. Characteristics of violence against women in Kairouan, Tunisia, in 2017. Nihel Haddad The Libyan journal of medicine 2021;16(1):1921900. Violence against women represents a serious concern worldwide. In Tunisia, despite an advanced legislative framework, we still receive women victims of violence. This survey aimed to characterize the demographic and clinical profile of women victims of violence in Kairouan, central Tunisia. This survey was designed as a cross-sectional study. It concerned women victims of violence over 18 years old, consulting the emergency department of the University Hospital of Kairouan during 3 months in 2017. We defined violence against women according to the Tunisian protection of gender discrimination law. This survey included 100 Tunisian victims of violence; their median age was 35 (ranging from 18 to 59 years old). This study showed that 58% of victims, CI95% [48.3%, 67.6%], were illiterate or had only a primary level education and that 90%, CI95% [84.1%, 95.8%], had a low or middle socioeconomic level. The Intimate Partner Violence was about 70% among all cases, CI 95% [61.0%, 78.9%]. Most aggressive partners were young (aged between 39 and 51 years old). The most affected part of the body was the face (76%, CI 95% [67.6%, 84.3%]). Alcohol consumption was the primary risk factor of violence in 29.6% of cases, CI95% [20.0%, 37.9%]. Other risk factors were the occupational instability, conflicts with the family in-laws and infidelity. Violence against women remains widespread. Even strict legislations in Tunisia didn't protect women sufficiently from different types of violence. It mostly happens within intimate relationships. Therefore, surveillance and early intervention controlling risk factors are extremely important. Available online at this link
21. Classism and Everyday Racism as Experienced by Racialized Health Care Users: A Concept Mapping Study. Mahabir Deb F. International Journal of Health Services 2021;51(3):350-363. In Toronto, Canada, 51.5 % of the population are members of racialized groups. Systemic labor market racism has resulted in an overrepresentation of racialized groups in low-income and precarious jobs, a racialization of poverty, and poor health. Yet, the health care system is structured around a model of service delivery and policies that fail to consider unequal power social relations or racism. This study examines how racialized health care users experience classism and everyday racism in the health care setting and whether these experiences differ within stratifications such as social class, gender, and immigration status. A concept mapping design was used to identify mechanisms of classism and everyday racism. For the rating activity, 41 participants identified as racialized health care users. The data analysis was completed using concept systems software. Racialized health care users reported "race"/ethnic-based discrimination as moderate to high and socioeconomic position-/social class-based discrimination as moderate in importance for the challenges experienced when receiving health care; differences within stratifications were also identified. To improve access to services and quality of care, antiracist policies that focus on unequal power social relations and a broader systems thinking are needed to address institutional racism within the health care system. Available online at this link
22. Coming Home to One's Self: Butch Muslim Masculinities and Negotiations of Piety, Sex, and Parenthood in Singapore. Maulod Ad Journal of homosexuality 2021;68(7):1106-1143. In Singapore, discrimination toward LGBT citizens has been reinforced through a monolithic notion of the traditional Asian family. This ethnography focuses on the lived experiences of 7 ethnic minority Malay Muslim "butch" individuals and their journey to parenthood. Drawing upon frameworks of intersectionality and piety, I explore how butches negotiate and reconcile their queer practices and desires as Muslim daughters around "coming out," foster children with same-sex partners, being a biological parent and their perceptions of Assisted Reproductive Technologies (ART). Reproductive futures, enacted by Malay Muslim butches, disrupt yet reinforce the durability of "natural" life trajectories scripted through conventions of marriage, family and fatherhood that have, insofar, excluded them. Further, their experiences also offer alternatives to existing literature on same-sex families that tend to render other nonwhite and/or non- Western queer family practices invisible. Available online at this link
23. Coming Home to One's Self: Butch Muslim Masculinities and Negotiations of Piety, Sex, and Parenthood in Singapore. Maulod Ad Journal of homosexuality 2021;68(7):1106-1143. In Singapore, discrimination toward LGBT citizens has been reinforced through a monolithic notion of the traditional Asian family. This ethnography focuses on the lived experiences of 7 ethnic minority Malay Muslim "butch" individuals and their journey to parenthood. Drawing upon frameworks of intersectionality and piety, I explore how butches negotiate and reconcile their queer practices and desires as Muslim daughters around "coming out," foster children with same-sex partners, being a biological parent and their perceptions of Assisted Reproductive Technologies (ART). Reproductive futures, enacted by Malay Muslim butches, disrupt yet reinforce the durability of "natural" life trajectories scripted through conventions of marriage, family and fatherhood that have, insofar, excluded them. Further, their experiences also offer alternatives to existing literature on same-sex families that tend to render other nonwhite and/or non- Western queer family practices invisible. Available online at this link
24. Community norms of the Muscle Dysmorphic Disorder Inventory (MDDI) among cisgender sexual minority men and women. Nagata Jason M. BMC psychiatry 2021;21(1):297. Background: Representing the pathological extreme pursuit of muscularity, muscle dysmorphia (MD) is characterized by a pervasive belief or fear around insufficient muscularity and an elevated drive for muscularity. Despite evidence of elevated body image-related concerns among sexual minority populations, little is known about the degree of muscle dysmorphia (MD) symptoms among sexual minorities, particularly based on Muscle Dysmorphic Disorder Inventory (MDDI) scores. The objective of this study was to examine the nature and severity of MD symptoms in cisgender sexual minority men and women and provide community norms of the MDDI for these populations.; Methods: Data from participants in The PRIDE Study, an existing study of health outcomes in sexual and gender minority people from the United States, were examined. Participants included cisgender gay men (N = 1090), cisgender bisexual plus (bisexual, pansexual, and/or polysexual) men (N = 100), cisgender lesbian women (N = 563), and cisgender bisexual plus women (N = 507). We calculated means, standard deviations (SD), and percentiles for the MDDI total and subscale scores for cisgender sexual minority men and women. We compared MDDI scores by sexual orientation using linear regression models, both unadjusted and adjusted for sociodemographics.; Results: Overall, the sample was 85.2% White, 3.0% Asian or Pacific Islander, 2.0% Black, 0.5% Native American, 3.9% multiracial, and 6.6% Hispanic/Latino/a. The mean age was 38.6 (SD = 14.3) and 69.4% had a college degree or higher. Means (SD) for the MDDI total score were 27.4 (7.7) for cisgender gay men, 26.4 (6.4) for cisgender bisexual plus men, 24.3 (6.1) for cisgender lesbian women, and 24.6 (5.5) for cisgender bisexual plus women. There were no significant differences in MDDI scores between cisgender gay and bisexual plus men, or between cisgender lesbian women and bisexual plus women in unadjusted or adjusted models.; Conclusions: These normative data provide insights into the experience of MD symptoms among cisgender sexual minority men and women and can aid researchers and clinicians in the evaluation of MD symptoms and interpretation of MDDI scores in sexual minority populations. Available online at this link
25. COVID-19 Threatens Progress Toward Gender Equity Within Academic Medicine. Woitowich Nicole C. Academic medicine : journal of the Association of American Medical Colleges 2021;96(6):813-816. Women remain underrepresented within academic medicine despite past and present efforts to promote gender equity. The authors discuss how the COVID-19 pandemic could stymie progress toward gender parity within the biomedical workforce and limit the retention and advancement of women in science and medicine. Women faculty face distinct challenges as they navigate the impact of shelter-in-place and social distancing on work and home life. An unequal division of household labor and family care between men and women means women faculty are vulnerable to inequities that may develop in the workplace as they strive to maintain academic productivity and professional development without adequate assistance with domestic tasks and family care. Emerging data suggest that gender differences in academic productivity may be forthcoming as a direct result of the pandemic. Existing gender inequities in professional visibility, networking, and collaboration may be exacerbated as activities transition from in-person to virtual environments and create new barriers to advancement. Meanwhile, initiatives designed to promote gender equity within academic medicine may lose key funding due to the economic impact of COVID-19 on higher education. To ensure that the gender gap within academic medicine does not widen, the authors call upon academic leaders and the broader biomedical community to support women faculty through deliberate actions that promote gender equity, diversity, and inclusion. The authors provide several recommendations, including faculty needs assessments; review of gender bias within tenure-clock-extension offers; more opportunities for mentorship, sponsorship, and professional recognition; and financial commitments to support equity initiatives. Leadership for these efforts should be at the institutional and departmental levels, and leaders should ensure a gender balance on task forces and committees to avoid overburdening women faculty with additional service work. Together, these strategies will contribute to the development of a more equitable workforce capable of transformative medical discovery and care. Available online at this link
26. COVID-19-The Case for Rethinking Health and Human Rights in Prisons. Pont J.örg American journal of public health 2021;111(6):1081-1085. This article considers health and human rights implications for people deprived of liberty during the COVID- 19 crisis. The health risks of incarceration for individual and community health, particularly in overcrowded and underresourced prisons and detention centers, are well known, but with the COVID-19 pandemic have become a public health emergency.Physical distancing in prisons is hardly manageable, and protective means are poor or lacking. Emergency releases have been shown to be feasible in terms of public safety but lack sustainability in reducing the number of people living in detention, and, globally, only a small proportion of them have been released. Without controlling the infection inside prisons, global efforts to tackle the spread of the disease may fail. People living in detention are not only more vulnerable to infection with COVID-19 but they are also especially vulnerable to human rights violations induced by inappropriate restrictions under the pretext of infection control. Therefore, alternatives for detention should be promoted and the number of incarcerated people radically decreased.This article calls on policymakers and all professionals involved in public health and criminal justice not to waste the opportunities provided by the crisis but to act now. Available online at this link
27. Differences in Rape Acknowledgment and Mental Health Outcomes Across Transgender, Nonbinary, and Cisgender Bisexual Youth. Anderson RaeAnn E. Journal of interpersonal violence 2021;36(13-14):NP7717-NP7739. The purpose of this study was to document the rates of rape acknowledgment (labeling rape as rape rather than using a minimizing label) and the corresponding mental health correlates using the minority stress framework in a unique and vulnerable sample: racially diverse sexual and gender minority young adults. Participants were 245 young adults who identified their sexual orientation as under the bisexual umbrella. A total of 159 of these participants (65.2%) identified their gender identity as nonbinary. All participants completed a series of online questionnaires regarding their sexual victimization history, mental health outcomes (depression, anxiety, and posttraumatic stress disorder [PTSD]), and constructs relevant to minority stress theory (level of outness, internalized bisexual negativity, connection to LGBTQ [lesbian, gay, bisexual, transgender, questioning] community). Rape acknowledgment was significantly greater among gender nonbinary participants (79.9%) than among trans and cisgender male participants (17.9%). Lack of rape acknowledgment was associated with increased anxiety, depression, and PTSD. Outness was significantly associated with greater rape acknowledgment. Despite the highly increased vulnerability for sexual violence among sexual and gender minorities, very little is understood about the mechanisms of this increased vulnerability or their unique needs for recovery. The results of this study strongly suggest the importance of a minority stress framework for understanding this increased vulnerability and for designing sexual violence prevention and recovery interventions for sexual and gender minority populations. Available online at this link
28. DISPARITY OF TREATMENT AND DUTY TO RESPECT PATIENT AUTONOMY IN MENTAL HEALTH CARE OF NATIVE AMERICANS. Santori Gina Journal of Cultural Diversity 2021;28(2):33-38. Promotion of a culturally sensitive, community-based approach is fundamental to mitigating the high rate of depression, as well as, encouraging self-autonomy among Native populations. This article reveals the many challenges in caring,for Native Americans with mental health issues. Knowledge of cultural competence will assist practitioners in understanding effective ways to communicate with Native American depressed patients. This article explores the challenges and potential solutions to these issues. Available online at this link
29. Do educational reforms increase or decrease health inequalities: A matter of methods? Oude Groeniger Joost Social Science & Medicine 2021;279:N.PAG-N.PAG. Evaluating whether social policies reduce health inequalities is complicated by the fact that these upstream determinants may also change the socioeconomic distribution. Failure to account for these compositional changes may severely bias the effect estimation procedure. In this article, we illustrate how a health inequality impact assessment of a policy that (also) changes the socioeconomic distribution may produce biased results. First, we show why analyses that do not account for compositional changes fail to estimate the correct counterfactual outcome. This problem most notably occurs when using repeated cross-sectional data, often the only available option to evaluate the health effect of large-scale policies. Second, we conducted a microsimulation study to estimate the magnitude of the bias under various conditions. The results showed that the actual impact of the policy on health inequalities is often underestimated and may even produce results that are in the opposite direction of the actual causal effect of the policy. Future studies should explore new strategies, such as simulation methods, to assess the impact of policies that (also) cause changes in the socioeconomic composition of the population, to enable researchers to accurately estimate their effect on health inequalities. • Evaluating the effect of social policies on health inequalities is important. • Effect evaluations will be biased without correction for compositional changes. • Results from microsimulations show this bias may be substantial. Available online at this link
30. Doing the Daily, Deliberate Work of Addressing Systemic Racial Injustice in Health Care. Ghandakly Elizabeth C. Academic medicine : journal of the Association of American Medical Colleges 2021;96(6):781. Available online at this link
31. Envisioning queer curricula: A systematic review of LGBTIQ + topics in teacher practitioner literature. Suárez Mario I. Journal of LGBT Youth 2021;18(3):239-255. Given the current political and social climate, teaching children about sexual orientation and gender identity is more important than ever. The present literature review seeks to address the following questions: How are LGBTIQ + topics addressed in practitioner literature and in what content areas are these topics most prevalent? How prevalent are LGBTIQ + topics in practitioner literature before 2015, prior to the publication of Miller's Queer Literacy Framework (QLF)? How prevalent are these topics after QLF's publication in 2015? The search for LGBTIQ + topics in the journals led to a total of 74 articles which were then coded by three independent researchers. To explore the prevalence of LGBTIQ + topics in articles published in journals most accessible to PreK-12 classroom teachers, the 13 top practitioner journals across all major content areas (i.e., English/Language Arts, social studies, mathematics, and science) and grade levels were selected. These results produce two salient conclusions. First, LGBTIQ + themes are present in articles published over the years. Second, individuals included under the LGBTIQ + umbrella are silenced. There is evidence of the use of the QLF before and after 2015, indicating that LGBTIQ + topics were addressed. Implications for teacher education and suggestions for future research are included. Available online at this link
32. Event-level patterns of methamphetamine and poly-drug use among millennial sexual minority men: The P18 Cohort Study. Martino Richard J. Addictive behaviors 2021;117:106831. INTRODUCTIONKnowledge on methamphetamine use among a new generation of sexual minority men (SMM) is limited. This study describes the event-level patterns of methamphetamine use and characteristics of methamphetamine users across time among Millennial SMM emerging into adulthood.METHODSA prospective cohort study was conducted in two waves: 2009-2014 (Wave I) and 2014-2019 (Wave II) in the New York City metropolitan area. A total of 600 Millennial SMM ages 18-19 years were recruited for Wave I. A total of 665 SMM ages 22-23 years were recruited for Wave II, of which 41.2% (n = 274) were retained from Wave I. The Timeline Followback assessment was conducted every six months to record event-level drug use in the 30 days prior to the visit.RESULTSA total of 5.4% of participants of between the ages of 18-27 reported methamphetamine use throughout the study period. The average number of days of methamphetamine use was significantly higher among racial/ethnic minority men in Wave II (F = 4.34, p = 0.0029). We found methamphetamine use occurred more often on weekend days and same-day use of methamphetamine occurred most often with cannabis and gamma-hydroxybutyrate. Usage of methamphetamine was significantly greater among SMM in Wave II who by design were older than Wave I.CONCLUSIONWe have identified differences in methamphetamine use by race/ethnicity. Weekend use and poly-drug use were common among methamphetamine-using SMM. Data indicate differential use in the population and that attempts to address this addictive behavior must be linked to other drug use and socialization among young SMM. Available online at this link
33. Examination of gender differences in patients with takotsubo syndrome according to left ventricular biopsy: two case reports. Murakami Tsutomu Journal of medical case reports 2021;15(1):281. BACKGROUNDTakotsubo syndrome is a stress-induced disease that makes up 2-3% of acute coronary syndrome cases. However, its onset mechanism remains unclear. Although females are overwhelmingly affected, males end up having more cardiac complications.CASE PRESENTATIONWe examined the differences in stress responses in the myocardium between sexes in patients with takotsubo syndrome. We biopsied samples from an over 70-year-old Japanese male and an over 80-year-old Japanese female. Tissues from the left ventricle apex in the acute phase and the apical ballooning-type were examined using histopathology and deoxyribonucleic acid (DNA) microarray analysis. Our data showed that left ventricular ejection fractions were 38% and 56%, and peak creatinine kinase concentrations during hospitalization were 629 U/L and 361 U/L, for the male and female patient, respectively. The pulmonary capillary wedge pressure was 26 mmHg and 11 mmHg for the male and female patient, respectively. Negative T did not return to normal in the male subject after 6 months. Histopathology results indicated that contraction band necrosis and lymphocyte infiltration were more common in the male subject.CONCLUSIONSWe noticed that possible differences may exist between male and female patients using pathological examination and some DNA analyses. In particular, it may help treat acute severity in males. We will elucidate the mechanism of takotsubo syndrome development by increasing the number of samples to support the reliability of the data in the future. Available online at this link
34. Exploring new tendencies of gender and health in university students. Esteban-Gonzalo Sara Archives of women's mental health 2021;24(3):445-454. In light of the impact of gender roles on health, the aims of the present study are (1) to assess the associations between femininity/masculinity and gender typologies, and health indicators (mental health, wellbeing, and self-perceived health) and (2) to identify patterns of gender roles and health indicators, thus exploring new tendencies in gender and health in Spanish university students in the framework of the androgyny model. The sample was made up of 795 university students from Madrid and Toledo. Data collection was completed during 2019. Measures of self-rated health, mental health (GHQ12), and wellbeing (MHC-SF) were considered as health indicators, while the Bem Sex Roles Inventory (BSRI) was used to measure gender roles. Multilevel analysis was employed to value associations between masculinity and femininity and gender typologies with self-rated health, mental health, and wellbeing. Furthermore, cluster analysis was used to explore general tendencies in gender roles and health, while also considering biological sex composition. The best predictor of mental health was found to be masculinity, rather than femininity. Cluster analysis showed a dominance of androgyny and undifferentiated typologies with proportionally similar biological sex composition. Results confirmed the androgyny model, highlighting the role of androgyny and masculinity as protective factors of mental health. Cluster analysis suggested less gender- typed individuals and more flexible ways of adapting to gender roles in university students. Health systems, governments, and public institutions must take these results into account when designing health prevention and intervention policies. Social agents, educators, and the media must also collaborate in the achievement of equalitarian gender roles, which could result in a minimization of gender-related health differences. Available online at this link
35. Factors Associated with Self-Reported PTSD Diagnosis among Older Lesbian Women and Gay Men. Alba Beatrice Journal of gerontological social work 2021;:1-14.
Lesbian women and gay men are at greater risk of post-traumatic stress disorder (PTSD) than heterosexual people, however few studies have examined PTSD in older lesbian women and gay men. This study examined predictors of having ever been diagnosed with PTSD, as well as relationships to current quality of life, among 756 lesbian women and gay men aged 60 years and older in Australia. Participants were surveyed on their sociodemographic characteristics, experiences of sexual orientation discrimination over their lifetime, whether they had ever been diagnosed with PTSD, whether they were currently receiving treatment for PTSD, and their current quality of life. After adjusting for sociodemographic variables, participants who reported having a PTSD diagnosis (11.2%) had significantly more frequent experiences of discrimination over their lifetime and were significantly less likely to currently be in a relationship. Older lesbian women were significantly more likely than older gay men to report ever having had a PTSD diagnosis. Additionally, having ever been diagnosed with PTSD significantly predicted current poorer quality of life. These findings suggest that a history of PTSD among older lesbian women and gay men is linked to experiences of discrimination and other factors, with associated links to current quality of life. Available online at this link
36. Feasibility and Acceptability of a Program to Promote Positive Affect, Well-Being and Gender Empowerment in Black Women Living with HIV. Bassett S. M AIDS and behavior 2021;25(6):1737-1750. While programs and interventions intended to increase positive affect among people living with HIV (PLWH) and other chronic diseases have been associated with improved health outcomes, including decreased depression, programs have not been tailored specifically for Black women. We tailored a program designed to increase positive affect and to decrease depressive symptoms in PLWH to a group format for Black WLWH. We also added skills to increase gender empowerment. We then tested the acceptability and feasibility of this program with 8 Black WLWH. The program was acceptable and relatively feasible, as assessed by women's participation and feedback about program clarity and helpfulness, which women rated above 9 on a 10-point scale. A few women suggested that optimal delivery point for some skills taught would be shortly after HIV diagnosis. A proof-of-concept program intended to bolster positive emotions and gender empowerment and decrease depression can be tailored for Black WLWH and is relatively feasible and acceptable. A randomized controlled trial is needed to assess the preliminary efficacy of this program on positive affect, depression, and other health outcomes for WLWH. Available online at this link
37. Frequency of Sexual Orientation and Gender Identity Documentation After Electronic Medical Record Modification. Sokkary Nancy Journal of pediatric and adolescent gynecology 2021;34(3):324-327. STUDY OBJECTIVEDocumentation of sexual orientation (SO) and gender identity (GI) is crucial to identify lesbian, gay, bisexual, and transgender youth and perform meaningful research to improve health disparities in this community. As a result, some electronic medical records (EMRs) have incorporated SO and GI into part of the provider's workflow for documentation. We aimed to evaluate the effect this modification has had on the frequency of SO and GI documentation. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: This was a retrospective chart review of patient encounters from an outpatient pediatric and adolescent gynecology clinical practice. The rate of documentation of SO and GI were compared between encounters that took place before the implementation of the EMR modification and those that took place after. Additionally, we examined rates of GI and SO documentation according to visit type and patient race.RESULTSA statistically significant increase in the frequency of SO and GI documentation after the EMR modification was detected. The documentation rate of SO increased from 10/73 (13.7%) to 32/73 (45.1%) (P < .01) and GI documentation rate went from 1.4% to 46.5% (P < .01) after the EMR changes were implemented. SO or GI was most commonly documented in social history (90%). There were no differences in documentation on the basis of race or type of encounter.CONCLUSIONIncluding a specific tab for SO and GI in the EMR significantly increased the frequency of SO and GI documentation. Despite this increase, frequency of documentation remained at less than 50%, emphasizing the need for further improvement. Available online at this link
38. Gender Bias: Another Rising Curve to Flatten? Lewiss Resa E. Academic medicine : journal of the Association of American Medical Colleges
2021;96(6):792-794. The COVID-19 pandemic and the upheaval it is causing may be leading to novel manifestations of the well- established mechanisms by which women have been marginalized in professional roles, robbing the field of the increased collective intelligence that exists when diverse perspectives are embraced. Unconscious bias, gendered expectations, and overt hostility minimize the contributions of women in academic medicine to the detriment of all. The current environment of heightened stress and new socially distant forms of communication may be exacerbating these well-recognized obstacles to women contributing to the field. Of note, none of these actions requires ill intent; all they require is the activation of unconscious biases and almost instinctive preferences and behaviors that favor the comfortable and familiar leadership of men in a time of extreme stress. The authors argue that it is time to investigate the frequency of behaviors that limit both the recognition and the very exercise of women's leadership during this pandemic, which is unprecedented but nevertheless may recur in the future. Leaders in health care must pay attention to equity, diversity, and inclusion given increases in undermining and harassing behaviors toward women during this crisis. The longer-term consequences of marginalizing women may hamper efforts to combat the next pandemic, so the time to flatten the rising gender bias curve in academic medicine is now. (Copyright © 2021 by the Association of American Medical Colleges.) Available online at this link
39. Gender-role behaviour and gender identity in girls with classical congenital adrenal hyperplasia. Seneviratne Sumudu Nimali BMC pediatrics 2021;21(1):262. INTRODUCTIONGirls with classical congenital adrenal hyperplasia (CAH) are exposed to excess fetal adrenal androgens in-utero, and often born with masculinised genitalia. They are conventionally reared as females, but show more "boyish" gender-role behaviour (GRB) and gender-identity (GI) issues in childhood and adolescence. Male-rearing is also reported mainly due to delayed treatment and/or socio-cultural factors. We compared GRB/GI in girls with CAH with healthy age matched children, and explored for associations with socio-demographic and diagnosis/treatment related factors.METHODSGRB and GI were assessed using the Gender Identity Questionnaire for children (GIQC) in 27 girls with classical CAH at a specialised clinic, and compared with 50 age-matched healthy controls, with exploratory-analysis based on socio-demographic and diagnosis/treatment-related factors.RESULTSGirls with CAH had lower total GIQC scores compared to healthy children (3.29 vs. 4.04, p = < 0.001) with lower GRB score (3.39 vs. 4.23, p < 0.001), and tendency for lower GI score (3.19 vs. 3.5, p = 0.08). Exploratory analysis showed no differences based on diagnosis/treatment factors including age, degree of virilisation at diagnosis and surgical procedures. and only subtle changes based on ethnicity and maternal education.DISCUSSION/CONCLUSIONGirls with CAH managed at a specialised centre showed more masculinised GRB and tendency for ambiguous GI, which did not vary upon diagnosis/treatment related factors, suggesting that prenatal androgen exposure was the likely contributor. Clinicians should be vigilant about the increased risk of gender-related problems in girls with CAH, irrespective of sociocultural background and despite early treatment. Available online at this link
40. Get up to speed to protect vulnerable people's rights: Nurses should be aware of changes being implemented in spring 2022, when Deprivation of Liberty Safeguards will be replaced. Johnson Wendy Learning Disability Practice 2021;:9-9. In the UK we are afforded freedoms that people in some countries do not enjoy. Under the European Convention on Human Rights we have many rights, including that of liberty and freedom of expression. These rights are protected under the Deprivation of Liberty Safeguards (DoLS), designed to protect people's rights if they are deprived of their liberty in a hospital or care home in England or Wales and lack mental capacity to consent. Available online at this link
41. Harnessing Trainees to Address Language Barriers During COVID-19. Chandrashekar Pooja Academic medicine : journal of the Association of American Medical Colleges 2021;96(6):784-785. Available online at this link
42. Healthcare disparities among anticoagulation therapies for severe COVID-19 patients in the multi-site VIRUS registry.
Kirkup Christian Journal of medical virology 2021;93(7):4303-4318. Here we analyze hospitalized andintensive care unit coronavirus disease 2019 (COVID-19) patient outcomes from the international VIRUS registry (https://clinicaltrials.gov/ct2/show/NCT04323787). We find that COVID-19 patients administered unfractionated heparin but not enoxaparin have a higher mortality-rate (390 of 1012 = 39%) compared to patients administered enoxaparin but not unfractionated heparin (270 of 1939 = 14%), presenting a risk ratio of 2.79 (95% confidence interval [CI]: [2.42, 3.16]; p = 4.45e-52). This difference persists even after balancing on a number of covariates including demographics, comorbidities, admission diagnoses, and method of oxygenation, with an increased mortality rate on discharge from the hospital of 37% (268 of 733) for unfractionated heparin versus 22% (154 of 711) for enoxaparin, presenting a risk ratio of 1.69 (95% CI: [1.42, 2.00]; p = 1.5e-8). In these balanced cohorts, a number of complications occurred at an elevated rate for patients administered unfractionated heparin compared to patients administered enoxaparin, including acute kidney injury, acute cardiac injury, septic shock, and anemia. Furthermore, a higher percentage of Black/African American COVID patients (414 of 1294 [32%]) were noted to receive unfractionated heparin compared to White/Caucasian COVID patients (671 of 2644 [25%]), risk ratio 1.26 (95% CI: [1.14, 1.40]; p = 7.5e-5). After balancing upon available clinical covariates, this difference in anticoagulant use remained statistically significant (311 of 1047 [30%] for Black/African American vs. 263 of 1047 [25%] for White/Caucasian, p = .02, risk ratio 1.18; 95% CI: [1.03, 1.36]). While retrospective studies cannot suggest any causality, these findings motivate the need for follow-up prospective research into the observed racial disparity in anticoagulant use and outcomes for severe COVID-19 patients. (© 2021 The Authors. Journal of Medical Virology Published by Wiley Periodicals LLC.) Available online at this link
43. Hispanic Identity and Its Inclusion in the Race Discrimination Discourse in the United States. Fernández Cristina R. Academic medicine : journal of the Association of American Medical Colleges 2021;96(6):788-791. As protests against racism occur all over the United States and medical institutions face calls to incorporate antiracism and health equity curricula into professional training and patient care, the antiracism discourse has largely occurred through a Black/African American and White lens. Hispanics, an umbrella category created by the U.S. government to include all people of Spanish-speaking descent, are the largest minority group in the country. Hispanics are considered an ethnic rather than a racial group, although some Hispanics self-identify their race in terms of their ethnicity and/or country of origin while other Hispanics self-identify with any of the 5 racial categories used by the U.S. government (White, Black/African American, American Indian or Alaska Native, Asian, or Native Hawaiian or Other Pacific Islander). Expanding the antiracism discourse in medicine to include Hispanic perspectives and the diversity of histories and health outcomes among Hispanic groups is crucial to addressing inequities and disparities in health and medical training. A lack of inclusion of Hispanics has contributed to a growing shortage of Hispanic physicians and medical school faculty in the United States as well as discrimination against Hispanic physicians, trainees, and patients. To reverse this negative trend and advance a health care equity and antiracist agenda, the authors offer steps that medical schools, academic medical centers, and medical accreditation and licensing bodies must take to increase the representation of Hispanics and foster their engagement in this evolving antiracism discourse. (Copyright © 2021 by the Association of American Medical Colleges.) Available online at this link
44. Hispanic Identity and Its Inclusion in the Race Discrimination Discourse in the United States. Fernández Cristina R. Academic medicine : journal of the Association of American Medical Colleges 2021;96(6):788-791. As protests against racism occur all over the United States and medical institutions face calls to incorporate antiracism and health equity curricula into professional training and patient care, the antiracism discourse has largely occurred through a Black/African American and White lens. Hispanics, an umbrella category created by the U.S. government to include all people of Spanish-speaking descent, are the largest minority group in the country. Hispanics are considered an ethnic rather than a racial group, although some Hispanics self-identify their race in terms of their ethnicity and/or country of origin while other Hispanics self-identify with any of the 5 racial categories used by the U.S. government (White, Black/African American, American Indian or Alaska Native, Asian, or Native Hawaiian or Other Pacific Islander). Expanding the antiracism discourse in medicine to include Hispanic perspectives and the diversity of histories and health outcomes among Hispanic groups is crucial to addressing inequities and disparities in health and medical training. A lack of inclusion of Hispanics has contributed to a growing shortage of Hispanic physicians and medical school faculty in the United States as well as discrimination against Hispanic physicians, trainees, and patients. To reverse this negative trend and advance a health care equity and antiracist agenda, the authors offer steps that medical schools, academic medical centers, and medical accreditation and licensing bodies must take to increase the representation of Hispanics and foster their engagement in this evolving antiracism discourse. Available online at this link
45. How the prohibition of torture under human rights law applies to nursing. Griffith Richard British Journal of Nursing 2021;30(11):680-681. Richard Griffith, Senior Lecturer in Health Law at Swansea University, considers the prohibition of torture under Article 3 of the European Convention on Human Rights (1950) and why it is relevant to nursing Available online at this link
46. In Addition to Stigma: Cognitive and Autism-Related Predictors of Mental Health in Transgender Adolescents. Strang John F. Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53 2021;:1-18. Objective : Autism spectrum disorder (ASD) is significantly over-represented among transgender adolescents. Independently, ASD and gender diversity are associated with increased mental health risks. Yet, mental health in autistic-transgender adolescents is poorly understood. This study investigates mental health in the largest matched sample to date of autistic-transgender, non-autistic (allistic) transgender, and autistic- cisgender adolescents diagnosed using gold-standard ASD diagnostic procedures. In accordance with advancing understanding of sex/gender-related autism phenotypes, slightly subthreshold autistic diagnostic presentations (common in autistic girls/women) are modeled. Method : This study includes 93 adolescents aged 13-21, evenly divided between autistic-transgender, autistic-cisgender, and allistic-transgender groups; 13 transgender adolescents were at the margin of ASD diagnosis and included within a larger "broad-ASD" grouping. Psychological and neuropsychological evaluation included assessment of mental health, IQ, LGBT stigma, ASD-related social symptoms, executive functioning (EF), and EF-related barriers to achieving gender- related needs. Results : Autistic-transgender adolescents experienced significantly greater internalizing symptoms compared to allistic-transgender and autistic-cisgender groups. In addition to stigma-related associations with mental health, ASD-related cognitive/neurodevelopmental factors (i.e., poorer EF and greater social symptoms) were associated with worse mental health: specifically, social symptoms and EF gender barriers with greater internalizing and EF problems and EF gender barriers with greater suicidality. Comparing across all ASD and gender-related groups, female gender identity was associated with greater suicidality. Conclusions : Parsing the heterogeneity of mental health risks among transgender youth is critical for developing targeted assessments and interventions. This study identifies ASD diagnosis, ASD phenotypic characteristics, and EF-related gender barriers as potential risks for poorer mental health in transgender adolescents. Available online at this link
47. Incorporating Transformative Intersectional Psychology (TIP) into Our Understanding of LGBTQ Muslims' Lived Experiences, Challenges, and Growth. Etengoff Chana Journal of homosexuality 2021;68(7):1075-1082. This article serves as the first in a series of six articles providing a theoretically and empirically informed approach to understanding Muslim LGBTQ lives from an intersectional positive-growth framework, transformative intersectional psychology (TIP). Within this perspective, LGBTQ Muslims' religious, gender and sexual identities are mutually interactive and situated within the dynamic systems of power, privilege and oppression. This approach recognizes that LGBTQ individuals negotiate multiple minority identities as they navigate oppression and build pathways of resilience. In the present article, we provide an introduction to TIP and this theory's relevance to the distinct experiences of LGBTQ Muslims. We then conclude with an overview of the goals of this Special Issue, The LGBTQ Muslim Experience, and introduce the subsequent articles in the series. The articles in this Special Issue address the implications of transformative intersectional psychology for LGBTQ Muslim research, training and clinical practice. Available online at this link
48. Incorporating Transformative Intersectional Psychology (TIP) into Our Understanding of LGBTQ Muslims' Lived Experiences, Challenges, and Growth. Etengoff Chana Journal of homosexuality 2021;68(7):1075-1082. This article serves as the first in a series of six articles providing a theoretically and empirically informed approach to understanding Muslim LGBTQ lives from an intersectional positive-growth framework, transformative intersectional psychology (TIP). Within this perspective, LGBTQ Muslims' religious, gender and sexual identities are mutually interactive and situated within the dynamic systems of power, privilege and oppression. This approach recognizes that LGBTQ individuals negotiate multiple minority identities as they navigate oppression and build pathways of resilience. In the present article, we provide an introduction to TIP and this theory's relevance to the distinct experiences of LGBTQ Muslims. We then conclude with an overview of the goals of this Special Issue, The LGBTQ Muslim Experience, and introduce the subsequent articles in the series. The articles in this Special Issue address the implications of transformative intersectional psychology for LGBTQ Muslim research, training and clinical practice. Available online at this link
49. Interrogating academic hegemony in community-based participatory research to address health inequities. Alang Sirry Journal of Health Services Research & Policy 2021;26(3):215-220. Community–based participatory research holds promise for addressing health inequities. It focuses on issues salient to specific populations, prioritizes community engagement and amplifies the voices of marginalized populations in policy formulation and designing interventions. Although communities are partners, academic hegemony limits their level of influence over the research initiative. Drawing from our own collaborative research experiences, we raise questions for community-engaged health services researchers to reflect upon as a means of interrogating academic hegemony in partnerships that seek to address health inequities. We describe what it means for researchers to acknowledge and relinquish the power they wield in the community-engaged health services research enterprise. We propose three guiding principles for advancing equity: authentic engagement, defining and living values, and embracing accountability. Available online at this link
50. Is NHS Test and Trace exacerbating COVID-19 inequalities? Briggs Adam D. M Lancet (London, England) 2021;396(10267):1972. Available online at this link
51. It's not all rainbows and unicorns: Straight teacher allies reflect on privilege. Potvin Leigh Journal of LGBT Youth 2021;18(3):273-286. The role of allies in social movements is an area of social justice activism that is at times celebrated and at other times contested. Sometimes, allies are celebrated for the "good work" that they do to support marginalized people in their struggle against oppression. They undertake challenging and demanding social justice work, often with little to no institutional support or training motivated by a desire to support all the students they teach. In other circumstances, allies are criticized (in some cases quite appropriately) for being naïve, self-interested, privileged, and—put pejoratively—"do-gooders." Despite the discomfort that discussions of allies and their contributions may cause, particularly for some allies themselves, the role that allies play in social movements is an important area of exploration. In this discussion, I argue that teacher allyship needs to be envisioned differently, but not completely discontinued. Drawing on data from interviews with educators in Ontario, I argue that teacher allies must become responsible assets to social justice by resisting the dominant narrative of allyship and strive for on-going reflexivity. Available online at this link
52. Language Preference and Risk of Primary Cesarean Delivery: A Retrospective Cohort Study. Schaefer Kimberly M. Maternal & Child Health Journal 2021;25(7):1110-1117. Objectives: While some medical indications for cesarean delivery are clear, subjective provider and patient factors contribute to the rising cesarean delivery rates and marked disparities between racial/ethnic groups. We aimed to determine the association between language preference and risk of primary cesarean delivery. Methods: We conducted a retrospective cohort study of nulliparous, term, singleton, vertex (NTSV) deliveries of patients over 18 years old from 2011–2016 at an academic medical center, supplemented with data from the Massachusetts Department of Public Health. We used modified Poisson regression with robust error variance to calculate risk ratios for cesarean delivery between patients with English language preference and other language preference, with secondary outcomes of Apgar score, maternal readmission, blood transfusion, and NICU admission. Results: Of the 11,298 patients included, 10.3% reported a preferred language other than English, including Mandarin and Cantonese (61.7%), Portuguese (9.7%), and Spanish (7.5%). The adjusted risk ratio for cesarean delivery among patients with a language preference other than English was 0.85 (95% CI 0.72–0.997; p = 0.046) compared to patients with English language preference. No significant differences in risk of secondary outcomes between English and other language preference were found. Discussion: After adjusting for confounders, this analysis demonstrates a decreased risk of cesarean delivery among women who do not have an English language preference at one institution. This disparity in cesarean delivery rates in an NTSV population warrants future research, raising the question of what clinical and social factors may be contributing to these lower cesarean delivery rates. Available online at this link
53. LGBT testimony and the limits of trust. Priest Maura Journal of medical ethics 2021;:No page numbers. In, 'Forever young: the ethics of ongoing puberty suppression (OPS) for non-binary adults,' Notini et al discuss the risks, harms and benefits of treating non-binary patients via identity-affirming OPS. Notini et al 's article makes a strong case for OPS's permissibility, and their conclusion will not be disputed here. Instead, I directly focus on issues that their article addressed only indirectly. This article will use a hypothetical case study to show that while Notini et al 's ethical conclusion might be spot on, that perhaps the method they took to get there was superfluous. If the medical community is to take LGBT testimony seriously (as they should) then it is no longer the job of physicians to do their own weighing of the costs and benefits of transition-related care. Assuming the patient is informed and competent, then only the patient can make this assessment, because only the patient has access to the true weight of transition-related benefits. Moreover, taking LGBT patient testimony seriously also means that parents should lose veto power over most transition-related paediatric care. (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.) Available online at this link
54. Location Matters: Disparities in the Likelihood of Receiving Services in Late Life. Weaver Raven H. International Journal of Aging & Human Development 2021;93(1):653-672. Moving beyond typical dichotomous rural–urban categorizations, this study examines older adults' likelihood of receiving home- and community-based services. Data from 1608 individuals aged 60+ who requested assistance from Area Agencies on Aging in Virginia in 2014–2015 were analyzed; 88% of individuals received at least one service. Receiving services was associated with geographic-based factors. Individuals living in completely rural areas were significantly less likely to receive any service compared to individuals in mostly rural (OR = 2.46, p =.003) and mostly urban (OR = 1.97, p =.024) areas. There were subtle but significant geographic-based differences in the likelihood of receiving specific services including food/meal, fresh food, information and referral, in-home care, utilities support, and transportation. Findings provide nuanced insights about geographic-based disparities in the receipt of services and suggest the need for new and modified service delivery strategies that maximize older adults' ability to live. Available online at this link
55. Making effective reasonable adjustments for women with learning disabilities during pregnancy. Daniels Lynsey Learning Disability Practice 2021;:10-17. An increasing number of women with learning disabilities are forming relationships and having children. These women are likely to have additional needs during pregnancy and to experience barriers in their access to maternity services. This article details a literature review on maternity care for women with learning disabilities during pregnancy and explains how the findings were used to inform the planning of a service improvement initiative. The literature review identified that this patient population is inconsistently and ineffectively supported by maternity services. Based on these findings, a service improvement initiative was designed to raise awareness of the needs of women with learning disabilities during pregnancy among healthcare professionals working in maternity services in Devon, England. It was decided that a one-day conference be held for up to 120 delegates in the summer of 2021. Its outcomes will be used to advance the service improvement initiative, create learning disability champions and provide practical suggestions on how reasonable adjustments can be made for women with learning disabilities during pregnancy.
Available online at this link
56. Marching with Pride? Debates on Uniformed Police Participating in Vancouver's LGBTQ Pride Parade. Holmes Andy Journal of homosexuality 2021;68(8):1320-1352. How do activists defend their opinions regarding uniformed police being celebrated in Pride parades? Twelve semi-structured in-depth interviews were conducted in Vancouver, Canada with six people who supported the celebration of uniformed police and six people unsupportive of uniformed police in Vancouver's Pride parade. Findings show four ways people frame their stance on uniformed police in Vancouver's Pride parade. Those who support a police presence justify their stance with two arguments: historical progress and the transnational versus local resonance of social movements. Activists who do not support the police invoke two different arguments: memory of historical marginalization, and pinkwashing. These findings show that people who support the police in Pride parades focus on positive social change that the LGBTQ community has achieved, while those who are against focus on the specific ongoing oppression of members of the LGBTQ community by the police. Available online at this link
57. Mental health spillovers from serious family illness: Doubly robust estimation using EQ-5D-5L population normative data. Henry Edward Social Science & Medicine 2021;279:N.PAG-N.PAG. People are interconnected and ill-health is rarely experienced in isolation. However, while there has been extensive research on health spillovers related to informal caregiving, there is comparatively little evidence on how ill-health may impact upon non-caregiving family members. This paper analyses EQ-5D-5L normative data from a nationally representative sample of adult residents of Ireland to estimate the independent relationship between serious family illness and five distinct dimensions of health. The empirical strategy combines inverse probability weighting and multivariate ordered probit regression in a doubly robust estimation. We find that experience of serious family illness is associated with large mental health decrements that are independent of caring responsibilities, while similar results are not evident for the four other health dimensions. Furthermore, stratified sub-sample analyses indicate considerable heterogeneity by sex and by income. In particular, we find evidence consistent with larger mental health spillovers for females than for males, as well as for low- and medium-income households relative to high-income households. The latter suggests that such spillovers may be substantially worse for those with fewer resources. Overall, the findings have a range of potential implications, including for the provision of mental health supports and services, for equity of health outcomes, as well as for health economic evaluation. For example, we calculate that our estimates of health spillovers are consistent with a 1.3% reduction in health utility for non- caregiving family members. • We present evidence relating to health spillovers from serious family illness. • Find serious family illness is independently associated with poorer mental health. • There is considerable heterogeneity in the relationship by sex and by income. • Similar results are not evident for other dimensions of health. • Results suggest a 1.3% reduction in health utility for non-caregiving family members. Available online at this link
58. Navigating the mental health system: Narratives of identity and recovery among people with psychosis across ethnic groups. Lawrence Vanessa Social Science & Medicine 2021;279:N.PAG-N.PAG. There is consistent evidence that members of the black Caribbean population in the UK are more likely to have coercive relationships with mental health services, typified by high levels of police involvement and compulsory treatment. This research has relied upon a medical epidemiological framework that has enumerated differences in service use but failed to unravel the complex interplay of individual, social, and cultural factors that inform the pathway to care. The purpose of this study was to explore the journey through mental health services from the perspective of individuals from the black Caribbean and majority white British population to help understand variation in the use of mental health services. Individual interviews were conducted with 17 black Caribbean, 15 white British, and 3 non-British white people with psychosis as part of AESOP-10, a 10 year follow up of an ethnically diverse cohort of individuals with first episode psychosis in the UK. Thematic narrative analysis identified three overarching narrative categories: 'losing self within the system' narratives gave primacy to individuals' identity as a chronic psychiatric patient with participants unable to break the cycle of service use; 'steadying self through the system' narratives combined recognition of the value of psychiatry and its limitations with the ability to access psychological therapy and protect valued social roles; 'finding strength beyond the system' narratives challenged negative dominant discourses and emphasised social, interpersonal and intrapersonal factors in recovery. We found variation in narratives across ethnic groups with 'losing self within the system' and 'finding strength beyond the system' narratives most common, though not exclusive to, black Caribbean participants. Distress appeared rooted in social structures that disadvantage black people, and psychiatry appeared to be experienced as a further form of oppression, that initially provoked resistance and fear, and over time, resignation to the identity of psychiatric patient. • Novel study of the journey through mental health services across ethnic groups. • The psychiatric meta-narrative threatened to engulf participants' voices. • Distress appeared rooted in social structures that disadvantage black people. • Social and cultural factors help to resist/cast off the role of 'chronic patient'. • Social interventions are required across multiple domains. Available online at this link
59. Older People With Minority Background Lost in Vulnerability and Inequality. Nielsen Dorthe S. Journal of Transcultural Nursing 2021;32(4):443-443. The article discusses that the Cultural differences in health beliefs, health behavior, and health care of minority elders are well documented, and there are multiple, complex causes of health disparities, is known that older minority adults are more likely to have difficulties in adjusting to new culture. Available online at this link
60. Outcomes for Youth Living in Canada's First LGBTQ2S Transitional Housing Program. Abramovich Alex Journal of homosexuality 2021;68(8):1242-1259. This article offers descriptive and evaluative data for the first cohort of youth who lived in Canada's first transitional housing program for LGBTQ2S youth, operated by the YMCA of Greater Toronto. The purpose of this mixed-methods study was to report on how youth experienced living in an LGBTQ2S population-based housing program in relation to mental health, self-esteem, community participation and family connectedness, and how access to culturally competent services impact experiences of homelessness. The outcomes of this study are important for service providers, program managers, and policymakers to review in order to better understand how LGBTQ2S youth experience population-based housing programs and whether or not they positively impact their transition to adulthood. Although this study took place in Toronto, Canada, it has broader relevance nationally and internationally, and can be used to build the evidence base to guide the improvement, development, and evaluation of future LGBTQ2S housing services for youth. Available online at this link
61. Parent-LGBTQ child communication about disclosure to their social networks. Tyler Tee R. Journal of LGBT Youth 2021;18(3):305-323. This study explores communication between parents and LGBTQ children as they jointly negotiate whether to disclose the child's LGBTQ identity to members of their social networks, e.g., extended family. Data includes 11 parent and 11 LGBTQ adult child qualitative interviews. The adult children in this study reported ages from 19 to 43 years. Three pairs of discourses animated parent-LGBTQ child dyads communication regarding disclosure with their outside social networks: hopeful anticipation vs. fearful hesitation, cautious inclusion vs. selective privacy, and proactive advocacy vs. reserved support. This study highlights the role parents can play in the emotional well-being and positive identity development of their LGBTQ children. Available online at this link
62. Parental Responses to Transgender and Gender Nonconforming Youth: Associations with Parent Support, Parental Abuse, and Youths' Psychological Adjustment. Grossman Arnold H. Journal of homosexuality 2021;68(8):1260-1277. The purpose of this study was to examine parental responses to transgender and gender nonconforming [TGNC] youths' gender identities and explore associations of parent support with parental abuse, depressive symptoms, and LGBT-identity disclosure stress. TGNC youth ( N = 129), ages 15-21 ( M = 18.00, SD = 1.74), completed surveys (2011-2012); experiences of transfeminine (TF; n = 58) and transmasculine (TM; n = 71) youth were analyzed separately. Among mothers of TF youth, 42.0% of initial and 45.3% of current responses were positive; among fathers, 30.0% of initial and 36.0% of current responses were positive. Among mothers of TM youth, 26.0% of initial and 53.3% of current responses were positive; among fathers, 24.0% of initial and 44.6% of current responses were positive. Among TM youth, higher levels of parental support were associated with more positive responses from mothers and fathers. Among both TF and TM youth, greater parent support was associated with less parental abuse, depressive symptoms, and LGBTQ-identity disclosure stress. Parental responses to youths' gender identities became more positive with time for TF youth; however, approximately 50% of all TGNC youth continued to experience minority stress related to parent rejection. Limitations and implications for practice and research are discussed. Available online at this link
63. Participation by Women With Physical Functional Diversity: From Inherited Oppression to Social Integration. Corona-Aguilar Antonia Australian Social Work 2021;74(3):320-331. This paper analyses the participation processes displayed by women with physical functional diversity in Spain, from the perspective of feminism and human rights. Responses from 18 participants with physical functional diversity allowed us to describe the female participants, as well as to explain their participation histories and plans, including any enabling or obstructing elements. This feedback also allowed us to interpret the participation models of women in positions or situations of influence. This paper, using qualitative methodology, combines grounded theory, intersectionality, and discourse narration to analyse the life contexts and elements that impede access to social participation on a level playing field for these women. The results present emancipatory tools for women and arguments for political decision-making that can help women overcome oppression and violence, thereby facilitating their integration into society. The defence of people's rights is a professional endeavour grounded in social work theory and involves drawing attention to inequalities, in this case, those faced by women with functional diversity. Social work training should prepare social workers for advocacy based on human rights and be led by people with disabilities themselves. Research into disability in social work yields advances in strategies for social and civic participation, particularly for women with functional diversity. Available online at this link
64. Pulling back the curtain on racial inequities in ocular health care. Fountain Tamara Ophthalmology Times 2021;46(10):9-9. The article discusses the racial gap in health outcomes in the U.S. Topics include reasons for the racial disparities in societal institutions over and above healthcare according to Dr. Tamara Fountain, president of the American Academy of Ophthalmology (AAO), the Minority Ophthalmology Mentoring (MOM) program which targeted medical students in their first two years of medical school, and the task forces developed by the AAO. Available online at this link
65. Queer Students, International Service-Learning, and Inclusivity: Insights into Identity, Activism, and Learning. Donahue David Journal of homosexuality 2021;68(9):1417-1443. This qualitative study examines the experiences of LGBTQ students involved in international service-learning, exploring the possibilities, positive impacts, and complexities of navigating LGBTQ identities while participating in international service-learning. Analysis of their experiences yielded three themes that played an important role shaping their experiences: balancing their stance as learners and as activists, viewing their LGBTQ identities as assets as well as objects of structural barriers, and navigating language to make sense of their context and make themselves understood. These findings have implications for how universities and community partners prepare, train, and support students before, during and after their experiences abroad. Available online at this link
66. Racial and socioeconomic disparities in congenital heart surgery: A research article. Richardson Crystal J. Journal of cardiac surgery 2021;36(7):2454-2457. Background: Though the modern era has proven to be reassuring with the advancement of perioperative care leading to improved survival, congenital heart disease (CHD) continues to underscore its significance in the lives of newborns and families worldwide. Particularly, CHD has disproportionately afflicted vulnerable minorities such as Black and Hispanic populations from the standpoint of ethnic disparities in mortality following heart surgery, increased resource utilization, and longer durations of stay. This study aims to identify and provide insight regarding the relationships between the aforementioned factors to develop targeted strategies of intervention to mitigate the outcomes for patients of these specific populations.;
Methods: Free, current peer-reviewed literature from databases such as the American Heart Association, The European Heart Journal, Science Direct, and PubMed regarding CHD, racial disparities, and socioeconomic variances were accessed. The study was narrowed to a patient population including only infants without chromosomal anomalies or those that passed away before hospital discharge.; Results: Having private insurance and maternal education showed positive correlations with positive outcomes of patients post congenital heart surgery. Teaching hospitals were linked with increased mortality and complications. Male infants showed higher rates of complications. Hispanics had increased odds of complications. Black patients had increased risk for failures in being rescued.; Conclusions: Race plays a major role in the disparities in CHD, it is imperative to evaluate the socioeconomic contributors, surgical efforts, and provisions in place regarding minority patients. The apparency of these disparities, and willingness to invoke changes in practice has the potential for improvements in outcomes for these patients. (© 2021 Wiley Periodicals LLC.) Available online at this link
67. Reflections on project ECHO: qualitative findings from five different ECHO programs. Agley Jon Medical education online 2021;26(1):1936435. Project ECHO (Extension for Community Healthcare Outcomes) was developed in 2003 as an innovative model to facilitate continuing education and professional development. ECHO emphasizes 'moving knowledge, not people.' To accomplish this, ECHO programs use virtual collaboration and case-based learning to allow practitioners, including those in rural and underserved areas, to receive specialist training. The ECHO model has expanded rapidly and is now used in 44 countries. Preliminary research on ECHO's efficacy and effectiveness has shown promising results, but evidence remains limited and appropriate research outcomes have not been clearly defined. To improve the evidence basis for ECHO, this study of 5 ECHO programs (cancer prevention/survivorship, integrated pain management, hepatitis C, HIV, and LGBTQ+ health care elucidated actionable insights about the ECHO programs and directions in which future evaluations and research might progress. This was a qualitative study following COREQ standards. A trained interviewer conducted 10 interviews and 5 focus groups with 25 unique, purposively sampled ECHO attendees (2 interviews and 1 focus group for each of the 5 programs). Data were transcribed verbatim and analyzed using the general inductive approach, then reviewed for reliability. We identified four major categories (reasons to join ECHO, value of participating in ECHO, ways to improve ECHO, and barriers to participation) composed of 23 primary codes. We suggest that thematic saturation was achieved, and a coherent narrative about ECHO emerged for discussion. Participants frequently indicated they received valuable learning experiences and thereby changed their practice; rigorous trials of learning and patient-level outcomes are warranted. This study also found support for the idea that the ECHO model should be studied for its role in convening communities of practice and reducing provider isolation as an outcome in itself. Additional implications, including for interprofessional education and model evolution, were also identified and discussed. Available online at this link
68. Reframing Personal and Professional Values: A Substantive Theory of Facilitating Lesbian, Gay, Bisexual, Transgender and Intersex Youth-Inclusive Primary Health Care by Nurses. Sefolosha Annah Journal of homosexuality 2021;68(8):1298-1319. LGBTI youth are prone to health-care inequalities and experience poorer health outcomes than the general population. Nurses are not always equipped to effectively respond to LGBTI healthcare needs. The aim of the study was to develop substantive theory based on the social processes involved in facilitating LGBTI youth- inclusive primary healthcare. Using a constructivist grounded theory approach, a sample of seven nurses was interviewed. The codes and categories, that emerged during data analysis were conceptualized to develop the theory: "reframing personal and professional values" which is outlined in three phases. Phase 1 illuminates subtle and covert ways that nurses used to identify value-laden tension and conflict as barriers to LGBTI youth-inclusive care. Phase 2 and 3 reflect thoughtful and reflexive strategies that nurses used to facilitate nurse-patient interaction to resolve value-laden tension and conflict. The substantive theory provides a way of improving the healthcare and health-seeking behavior of LGBTI youth. Available online at this link
69. Resistance as a form of resilience in sexual and gender minorities: Differential moderating roles of collective action on the discrimination-depression relationship among sexual minority men and
women. Chan Randolph C. H Social science & medicine (1982) 2021;280:114056. Background: As a fundamental means for transforming and advancing the conditions of lesbian, gay, bisexual, and transgender (LGBT) individuals, collective action has gained increasing attention in research, policy, and practice over the past decade. While collective action is influential in driving public awareness and policy changes, less is known about its psychological effects on individuals undertaking collective action.; Methods: The present study developed a scale to measure collective action for LGBT rights and examined the underlying dimensions of collective action in a sample of 1050 LGBT individuals in Hong Kong. The moderating roles of collective action on the relationship between perceived discrimination and depressive symptoms were also examined.; Results: The LGBT Collective Action Scale measured two dimensions of collective action, i.e., private and public collective action. Private collective action moderated the association between perceived discrimination and depressive symptoms among sexual minority men and women; however, the moderating effect of public collective action was only found in sexual minority women.; Conclusions: These differential moderating effects could be attributed to gender role socialization and gender-specific coping mechanisms in response to minority stress. Although public collective action is more powerful in triggering structural changes than private collective action, individuals in less democratic societies may not necessarily have access to public collective action due to the absence of opportunity structures. Private collective action, which is able to be initiated and undertaken individually, can be directed to transform heterosexist biases in interpersonal context. For LGBT individuals in less democratic societies, private collective action may be a more manageable way to maintain mental health in the face of stigmatization. (Copyright © 2021 Elsevier Ltd. All rights reserved.) Available online at this link
70. Rethinking sex-assigned-at-birth questions. Alpert Ash B. BMJ (Clinical research ed.) 2021;373:1. Available online at this link
71. Safe spaces, agency, and resistance: a metasynthesis of LGBTQ language use. Schreuder Mary-Celeste Journal of LGBT Youth 2021;18(3):256-272. The purpose of this metasynthesis is to present a structured review of the literature on lesbian, gay, bisexual, transgender, and queer (LGBTQ) language usage. Much of the rhetoric surrounding individuals who identify as LGBTQ focuses on their victimization and oppression. To problematize this limited perspective, this metasynthesis of literature suggests that LGBTQ youth are actively working against marginalization, oppression, and silencing through language practices that employ critical literacy and elicit the disruption of hegemonic ideology. Drawing on Darvin and Norton's (2015, Identity and a model of investment in applied linguistics. Annual Review of Applied Linguistics, 35, 36–56) key concepts from the model of investment and queer theory, I explore three uses of LGBTQ language: the creation of safe spaces, agency, and resistance. My findings reveal the need for safety within classrooms in order for LGBTQ students to participate successfully in critical literacy practices. Available online at this link
72. Senior Centers and LGBTQ Participants: Engaging older adults virtually in a pandemic. Marmo Suzanne Journal of gerontological social work 2021;:1-21. Upon the outbreak of Covid-19, recommendations to cease all non-essential in person services were mandated across the United States to prevent transmission to non-infected individuals. As a result, approximately 96% of all senior centers in the United States were closed to in-person programming. Senior centers have had a long history of engaging older adults, maintaining community connections, enhancing social support and reducing social isolation. SAGE, the first publicly funded senior center for LGBT older adults in the US, serves a traditionally under-served population with a vast array of services and programs. This exploratory, cross-sectional study utilized an online survey to evaluate the experiences of 113 SAGE members after the Coronavirus pandemic closed their senior center. Participants reported a relatively easy adaptation to technology, steady participation in programs and services, satisfaction with virtual senior center programming and a stable sense of engagement with their peers. Higher levels of engagement with senior center programs was associated with stronger feelings of social support. Additionally, stronger perceptions of social support and participation in exercise and fitness programming were associated with higher life satisfaction and lower depression and anxiety. Implications and recommendations for other gerontological service providers are offered. Available online at this link
73. Sex Disparities in COVID-19 Mortality Vary Across US Racial Groups. Rushovich Tamara Journal of general internal medicine 2021;36(6):1696-1701. BACKGROUNDInequities in COVID-19 outcomes in the USA have been clearly documented for sex and race: men are dying at higher rates than women, and Black individuals are dying at higher rates than white individuals. Unexplored, however, is how sex and race interact in COVID-19 outcomes.OBJECTIVEUse available data to characterize COVID-19 mortality rates within and between race and sex strata in two US states, with the aim of understanding how apparent sex disparities in COVID-19 deaths vary across race.DESIGN AND PARTICIPANTSThis observational study uses COVID-19 mortality data through September 21, 2020, from Georgia (GA) and Michigan (MI).MAIN MEASURESWe calculate age-specific rates for each sex- race-age stratum, and age-standardized rates for each race-sex stratum. We investigate the sex disparity within race groups and the race disparity within sex groups using age-standardized rate ratios, and rate differences.KEY RESULTSWithin race groups, men have a higher COVID-19 mortality rate than women. Black men have the highest rate of all race-sex groups (in MI: 254.6, deaths per 100,000, 95% CI: 241.1-268.2, in GA:128.5, 95% CI: 121.0-135.9). In MI, the COVID-19 mortality rate for Black women (147.1, 95% CI: 138.7- 155.4) is higher than the rate for white men (39.1, 95% CI: 37.3-40.9), white women (29.7, 95% CI: 28.3- 31.0), and Asian/Pacific Islander men and women. COVID-19 mortality rates in GA followed the same pattern. In MI, the male:female mortality rate ratio among Black individuals is 1.7 (1.5-2.0) while the rate ratio among White individuals is only 1.3 (1.2-1.5).CONCLUSIONWhile overall, men have higher COVID-19 mortality rates than women, our findings show that this sex disparity does not hold across racial groups. This demonstrates the limitations of unidimensional reporting and analyses and highlights the ways that race and gender intersect to shape COVID-19 outcomes. Available online at this link
74. Sexual and gender minority publication trends in the dermatology literature. Shahwan Kathryn T. Archives of dermatological research 2021;:No page numbers. In the greater medical literature, publication rates on topics relevant to the lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) communities have been on the rise. The publication rates in the dermatology literature have not yet been described. We performed an analysis of the dermatology literature from 1980-2020 to characterize LGBTQ-relevant publication rates and themes over time. PubMed, CINAHL, and Embase were searched using terminology related to sexual and gender minorities and dermatology. Articles were included if they were published in a peer-reviewed dermatology journal, used human subjects, and included terminology related to sexual or gender minorities in the title or abstract. Publication year, journal, study design, corresponding author country, and best-fit article theme were recorded. The searches yielded 2,019 articles, with 225 meeting inclusion criteria. LGBTQ-relevant articles increased substantially over time, particularly between 2015 and 2020. Overall, most centered on HIV and other infectious diseases (62.2%), followed by other dermatologic conditions (20.4%), workforce and culturally competent care (12.4%), and gender-affirming procedures (4.9%). Although the number of infectious disease-related articles also increased over time, representation of the other three themes increased substantially, particularly since 2011. Although sexually transmitted diseases remain a common theme in the dermatology literature, the last 10 years have seen an explosion of publications on other topics such as non-infectious dermatoses, gender-affirming procedures, and access to culturally competent care. Available online at this link
75. Sociodemographic inequalities in patients' experiences of primary care: an analysis of the General Practice Patient Survey in England between 2011 and 2017. Saunders Catherine L. Journal of Health Services Research & Policy 2021;26(3):198-207. Objective: Younger people, minority ethnic groups, sexual minorities and people of lower socioeconomic status report poorer experiences of primary care. In light of NHS ambitions to reduce unwarranted variations in care, we aimed to investigate whether inequalities in patient experience of primary care changed between 2011 and 2017, using data from the General Practice Patient Survey in England. Methods: We considered inequalities in relation to age, sex, deprivation, ethnicity, sexual orientation and geographical region across five dimensions of patient experience: overall experience, doctor communication, nurse communication, access and continuity of care. We used linear regression to explore whether the magnitude of inequalities changed between 2011 and 2017, using mixed models to assess changes within practices and models without accounting for practice to assess national trends. Results: We included 5,241,408 responses over 11 survey waves from 2011–2017. There was evidence that inequalities changed over time (p < 0.05 for 27/30 models), but the direction and magnitude of changes varied. Changes in gaps in experience ranged from a 1.6 percentage point increase for experience of access among sexual minorities, to a 5.6 percentage point decrease for continuity, where experience worsened for older ages. Inequalities in access in relation to socio- economic status remained reasonably stable for individuals attending the same GP practice; nationally inequalities in access increased 2.1 percentage points (p < 0.0001) between respondents living in more/less deprived areas, suggesting access is declining fastest in practices in more deprived areas. Conclusions: There have been few substantial changes in inequalities in patient experience of primary care between 2011 and 2017. Available online at this link
76. Special Symposium: Social and gender norms and violence against children: exploring their role and strategies for prevention. Kohli Anjalee Global public health 2021;16(6):815-819. Violence against children occurs in all countries, affecting children of all ages, genders, race and socio- economic strata. A multiplicity of factors contributes to children's experience of violence. Social and gender norms can act as risk and protective factors exposing children to violence or preventing them from having well-being and healthy development. This Special Symposium was conceived of during the first International Viable and Operable Ideas for Child Equality (VOICE) Conference in 2018 in Bali, Indonesia. The four manuscripts in this Special Symposium illustrate with evidence the importance of social norms to preventing violence against children and the importance of understanding norms in context. The authors find that understanding how geographic location, social cohesion, group roles and identities, age and gendered expectations inform whether, when and which children experience violence, who perpetrates it, and how individuals and communities respond to it. The global COVID-19 pandemic has illustrated how rapidly behaviours can shift towards caregiving and health, as well as against it. If we are to prevent violence against children, and ensure the safety, well-being, and opportunity to thrive for all children, advancing our understanding of norms in relation to violence against children is critical to effective programming and learning. Available online at this link
77. Spirituality and Religious Engagement, Community Involvement, Outness, and Family Support: Influence on LGBT+ Muslim Well-Being . Stuhlsatz Greta L. Journal of homosexuality 2021;68(7):1083-1105. The current study utilized data from the Social Justice Sexuality Project to investigate influences on psychological well-being of LGBT+ Muslims (N = 75) in the United States. Specifically, path analyses were used to examine the association between spiritual and religious engagement, LGBT community involvement, outness, and family support with psychological well-being. Control variables included lifespan Islam involvement, age, income, and the age at which the participant came out to themselves. Findings illustrate spiritual and religious engagement, outness, and income were all positively related to psychological well- being. Moreover, individuals who had converted to Islam but were not raised in the faith had significantly lower psychological well-being than those who had a consistent experience with Islam from their childhood until the time of the study. The present investigation provides critical contributions to the study of gender and sexual minorities in the United States and the experiences of currently practicing LGBT+ Muslims and those who were raised Muslim. Clinical implications and future research suggestions are discussed. Available online at this link
78. Stigma Is Associated With Widening Health Inequities: Challenges From the Current COVID-19 Pandemic. Yeh Ming-Chin American journal of public health 2021;111(6):1022-1023. Available online at this link
79. Telestroke Across the Continuum of Care: Lessons from the COVID-19 Pandemic. Guzik Amy K. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association 2021;30(7):105802.
While use of telemedicine to guide emergent treatment of ischemic stroke is well established, the COVID-19 pandemic motivated the rapid expansion of care via telemedicine to provide consistent care while reducing patient and provider exposure and preserving personal protective equipment. Temporary changes in re- imbursement, inclusion of home office and patient home environments, and increased access to telehealth technologies by patients, health care staff and health care facilities were key to provide an environment for creative and consistent high-quality stroke care. The continuum of care via telestroke has broadened to include prehospital, inter-facility and intra-facility hospital-based services, stroke telerehabilitation, and ambulatory telestroke. However, disparities in technology access remain a challenge. Preservation of reimbursement and the reduction of regulatory burden that was initiated during the public health emergency will be necessary to maintain expanded patient access to the full complement of telestroke services. Here we outline many of these initiatives and discuss potential opportunities for optimal use of technology in stroke care through and beyond the pandemic. (Copyright © 2021 Elsevier Inc. All rights reserved.) Available online at this link
80. The "Real" Chechen Man: Conceptions of Religion, Nature, and Gender and the Persecution of Sexual Minorities in Postwar Chechnya. Scicchitano Dominic Journal of homosexuality 2021;68(9):1545-1562. In March of 2017, the Russian LGBT Network received their first reports of police violence against individuals in Chechnya because of their perceived sexual orientation. In the following months, news spread of a campaign of forced disappearances and torture specifically targeting suspected homosexual men. Between December, 2018 and February, 2019, police carried out another wave of unlawful detentions of men on the basis of their sexual orientation. The reports of unlawful detentions and extrajudicial killings of queer men may seem surreal in a world that has slowly grown more progressive with regard to LGBT rights issues. And yet, this violence is the reality faced by gay and bisexual men in Chechnya under Ramzan Kadyrov, the hypermasculine Chechen leader. This paper explores the ways in which religious practice, imaginations of nature, and conceptions of gender have influenced Chechnya's current anti-LGBT climate. Available online at this link
81. The Colorblind Rainbow: Whiteness in the Gay Rights Movement. Hinkson Kasia Journal of homosexuality 2021;68(9):1393-1416. Discourse on "identity politics" tends to treat political minority identities as distinct entities, discussing them as if an individual is either black or a woman or LGBT, etc. This separates race and sexuality in a way that, supported by white homonormativity and a possessive investment in whiteness, renders the LGBT community "white" despite racial diversity. This masks the ways that the policy preferences of LGBT individuals are structured along racial lines and hinders inter-minority coalition building. Utilizing a Pew Research Center dataset of LGBT Americans collected in 2013, I show that race is significantly correlated with economic policy preferences and perceptions of racial discrimination. While a majority of white LGBT Americans hold liberal positions, the significant differences between white and nonwhite individuals and the well-documented self-reports of experiences of racism by nonwhite LGBT Americans, suggest that white LGBT Americans must actively address the question of race in order to build successful coalitions. Available online at this link
82. The role of disclosure & perceptions about providers in health discussions among gay and bisexual young men. Gioia Sarah A. Patient education and counseling 2021;104(7):1712-1718. Objectives: Gay and bisexual men may feel discomfort discussing sensitive topics such as sexual behaviors and substance use with their health providers, which may prevent them from receiving important health information. This study investigates whether patients' perceptions of their provider's sexual orientation predicts patient-provider discussions of sexual and general health topics, and whether this relationship is moderated by patients' disclosure of sexual orientation to providers.; Methods: Data were collected online from a sample of 576 gay and bisexual men living in the USA, aged 18-26. Adjusted risk ratios were estimated by using modified Poisson regression with robust error variance.; Results: Participants who believed their providers were gay or bisexual were more likely to have discussed sexual health topics, but not general health topics; simple slopes analyses revealed that this effect was stronger among those who had not disclosed to their providers. Disclosure was also consistently associated with increased likelihood of discussing almost all topics.; Conclusions: Findings highlight differences in communication based on disclosure and perceived sexual orientation of provider, suggesting the need to further explore how these differences influence young gay and bisexual men's health.; Practice Implications: Dyads may be more likely to discuss sexual health topics when patients believe their providers are sexual minorities themselves. In addition, patient-provider dyads may be likelier to discuss various health topics when providers are aware of patients' sexual minority statuses. (Copyright © 2021 Elsevier B.V. All rights reserved.) Available online at this link
83. The Tsunamic Model of LGBTQ+ Deaths of Despair: A Systemic Review to Identify Risk Factors for Deaths of Despair among LGBTQ+ People. Terrell Kassie R. Journal of homosexuality 2021;:1-21. The term Deaths of Despair (DOD) was introduced to capture the phenomenon of mortality associated with suicide, drug overdose, and alcoholic liver disease. The LGBTQ+ population consistently evidences disproportionately high rates of DOD. This study reviewed the literature on DOD within this community to create a conceptual model that identifies risk factors that work together to potentiate DOD in the LGBTQ+ community. Ten DOD-Related Factors were identified and used to create The Tsunamic Model of LGBTQ+ Deaths of Despair. DOD-Related Factors include: (1) Stigma, (2) Demographics, (3) Identity Development, (4) Internalized Homophobia, (5) Depression, (6) Victimization, (7) Isolation/Rejection, (8) Sensation Seeking, (9) Risky Behavior, and (10) Uninformed Care. Each factor is associated with increased risk for DOD among the LGBTQ+ community. This model can help health professionals by providing a framework for prevention and early intervention programs. Available online at this link
84. The Unequal Burden of COVID-19 Deaths in Counties With High Proportions of Black and Hispanic Residents. Glance Laurent G. Medical care 2021;59(6):470-476. BACKGROUNDUnderstanding the current burden of coronavirus disease 2019 (COVID-19) deaths in vulnerable populations will help inform efforts by policymakers to address disparities in COVID-19 outcomes.OBJECTIVEThe objective of this study was to examine the association between COVID-19 deaths and the county-level proportions of non-Hispanic Black and Hispanic residents.RESEARCH DESIGN AND METHODSA retrospective study using COVID-19 mortality data from USA Facts linked to data from the US Census Bureau, the Health Resources & Services Administration Area Health Resources file, and the US Census Bureau. Negative binomial regression was used to estimate the association between the total county COVID-19 deaths during consecutive 30-day intervals and the proportion of non-Hispanic Blacks and Hispanic residents after adjusting for resident demographics, comorbidity burden, rurality, social determinants of health, and health care resources.RESULTSIn April, counties (n=179) with >40% Blacks had 6-fold higher death rates than counties (n=1521) with <2% Blacks [incident rate ratio (IRR)=6.58, 95% confidence interval (CI): 3.29-13.2, P<0.001]. These counties had higher death rates until October, but were no different than referent counties in November. In April, death rates in counties with >40% Hispanic residents were similar to death rates in counties with <2% Hispanic residents. Death rates in these counties peaked in August (IRR=3.14, 95% CI: 1.69-5.82, P<0.001) but were also no different than referent counties in November. These effects were robust after adjusting for county-level characteristics. Before August, death rates differed little by insurance status, but since then, counties with >15% uninsurance rates had up to 2-fold higher mortality rates (IRR=1.97, 95% CI: 1.19-3.27, P<0.001) than counties with <5% uninsurance rates.CONCLUSIONCounties with high concentrations of non-Hispanic Blacks were disproportionately affected by COVID-19 throughout most of the pandemic, but other social determinants of health such as health insurance are now playing a more prominent role than race and ethnicity. Available online at this link
85. The Use of Simulation to Enhance LGBTQ+ Care Competencies of Nursing Students. Pittiglio Laura Clinical Simulation in Nursing 2021;56:133-136. • Discrimination in healthcare settings, or the fear thereof, creates disparities in individuals who identify as lesbian, gay, bisexual, transgender, queer, or another sexual identity outside of the heterosexual norm (LGBTQ+). • The lack of culturally sensitive LGBTQ+ health education in nursing can result in poorer patient outcomes. • Simulation can effectively provide an environment where nursing students can acquire the skills necessary for providing culturally competent LGBTQ+ healthcare. Current literature demonstrates that a lack of education in nursing programs regarding culturally-competent care for lesbian, gay, bisexual, transgender, queer, and other sexual identities outside of the heterosexual norm (LGBTQ+), results in health disparities. A simulation experience using a narrative script and a high-fidelity manikin was incorporated into an undergraduate nursing course (N = 91). A simulation scenario designed to facilitate the delivery of healthcare to a transgender identifying patient was piloted within the undergraduate curriculum. A pre-simulation and post-simulation survey served as the evaluation for this pilot program. Paired sample t-tests compared participants' (n = 77) attitudes, beliefs, comfort, and competency regarding providing care for LGBTQ+ individuals. There was a significant difference in pre- and post-simulation scores. Results demonstrate that simulation can be an effective educational intervention for promoting knowledge related to culturally- sensitive LGBTQ+ healthcare. Available online at this link
86. This Being is a Guest House: Embracing Humility, Liberation & Strengths in Therapy with Sexual and Gender Diverse Muslims. Vaughan Michelle Journal of homosexuality 2021;68(7):1196-1222. The complexity of the lives of sexual and gender diverse Muslims within the United States calls for mental health providers to own our power and privilege. Embracing cultural humility in service of aligning ourselves with liberation psychology, we call for an intersectionally informed, strengths-based approach to empowering/affirming clients whose diverse religious experiences intersect with their experiences of marginalization as sexual and gender diverse (SGD) Muslims. Drawing on extant personal narratives around mental health and therapy of this population, the authors offer critical reflections, processes and opportunities for clinicians to take responsibility in honoring the diverse journeys and experiences of SGD Muslims in serving them in journeys of healing. Available online at this link
87. Trauma-Informed Care and Health Among LGBTQ Intimate Partner Violence Survivors. Scheer Jillian R. Journal of interpersonal violence 2021;36(13-14):6670-6692. Intimate partner violence (IPV) and its health consequences occur among lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals at rates equal to or higher than cisgender heterosexual individuals. Trauma- informed care (TIC) is one service approach with emerging empirical support for use with IPV survivors, but without attention to the LGBTQ population. Structural equation modeling was used to assess associations between TIC and mental and physical health through several mechanisms among 239 LGBTQ adults who had experienced IPV and sought healthcare services within the past year ( M age = 27.66; 66.7% White; 43.9% cisgender women). Participants reported their perceptions of TIC in their services received; their sense of empowerment, emotion regulation, shame, and social withdrawal (all conceived as mobilizing mechanisms through which TIC could be associated with health); and their mental health (depression and posttraumatic stress disorder [PTSD]), and physical health (somatic symptoms and chronic health conditions). Those who perceived greater TIC in their services reported greater empowerment and emotion regulation, and lower social withdrawal. In turn, lower social withdrawal and shame were associated with better mental health, while lower shame also was associated with better physical health. Indirect associations between TIC and mental and physical health through the four mobilizing mechanisms were not significant, however, with the exception of a small indirect effect on mental health through lower social withdrawal. Results suggest that practitioners need to develop services to be used in conjunction with a general TIC approach to improve health and target shame among LGBTQ IPV survivors. Available online at this link
88. Understanding nurses' responsibilities in promoting equality and diversity. Stonehouse David Peter Nursing Standard 2021;:27-33. Why you should read this article: • To understand the terms equality, diversity and inclusion • To recognise your responsibilities in promoting equality and diversity • To count towards revalidation as part of your 35 hours of CPD, or you may wish to write a reflective account (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers) Nurses have a duty to promote the values of equality and diversity during their interactions with patients and their families and carers, as well as peers and colleagues. This article defines the terms equality, diversity and inclusion, and explains the importance of the Equality Act 2010 and the Human Rights Act 1998 in protecting people from various types of discrimination. It also outlines nurses' responsibilities in promoting equality and diversity by treating all patients and colleagues with respect and dignity, providing compassionate leadership, and practising in accordance with the ethical principle of justice. The article encourages and empowers nurses to recognise and challenge discrimination wherever they see it, thereby delivering high-quality care to all patients. Available online at this link
89. Uneven power dynamics must be levelled in COVID-19 vaccines access and distribution. Alaran Aishat Jumoke Public health in practice (Oxford, England) 2021;2:100096. COVID-19 is one of the major global health threats of the 21st century, causing unprecedented humanitarian crises worldwide. Despite concerted efforts to curb the spread of the disease, the pandemic continues to strain healthcare systems globally and a safe, highly effective, and globally acceptable and equitable vaccination program, together with pre-existing precautionary measures, is essential to effectively contain the outbreak. We commented on the need to level any uneven power dynamics in COVID-19 vaccines access and distribution. The COVID-19 vaccines distribution must not allow for sovereignty which is tightly linked to historical imbalances in power and resources to result into discrimination between rich and poor countries. Poor countries must be supported in ensuring access to COVID-19 vaccines by levelling the power dynamics that perpetuate inequality and fuel inequity. We must ensure equity, fairness and transparency in COVID-19 vaccines distribution and gain public trust in COVID-19 vaccines through participatory community engagement. COVID-19 vaccines distribution and access must be equitable and not politicized. (© 2021 The Author(s).) Available online at this link
90. Variation in diet quality across sexual orientation in a cohort of U.S. women. Solazzo Alexa L. Cancer causes & control : CCC 2021;32(6):645-651. PURPOSEExtensive prior research has shown that sexual minority women are more likely to have a number of cancer risk factors, thereby putting them at higher risk for cancer than heterosexual women. However, there has been little research evaluating the association between sexual orientation and diet quality.METHODData come from participants (aged 24-54 years) enrolled in Nurses' Health Study 3, an ongoing, U.S.-based cohort study (N = 15,941). We measured diet using recommendations from the Dietary Approach to Stop Hypertension (DASH) and American Health Association (AHA) 2020 Strategic Impact Goals.RESULTSWe found limited evidence of differences across diet quality by sexual orientation. When examining predicted DASH scores, mostly heterosexual [predicted mean score (95% confidence interval), 24.0 (23.8, 24.3)] and lesbian [24.3 (23.8, 24.9)] women had healthier predicted DASH scores than the reference group of completely heterosexual women with no same-sex partners [23.6 (23.5, 23.7)]. Even though certain sexual minority women had overall healthier predict DASH scores, their consumption of certain food groups-low-fat dairy and fruit-was lower than completely heterosexual women with no same- sex partners. When measuring AHA scores, most sexual minority groups (completely heterosexual women with same-sex partners, mostly heterosexual women, and lesbian women) had higher diet quality compared to the reference group of completely heterosexual women with no same-sex partners.CONCLUSIONSexual minority women, particularly mostly heterosexual women and lesbian women, had healthier diet quality than completely heterosexual women with no same-sex partners. These data suggest that cancer risk factors (e.g., smoking, drinking, and inactivity) other than diet would drive higher cancer rates among sexual minority compared to heterosexual women. Nonetheless, it is critical for all women to improve their diet quality since diet quality was poor among participants of all sexual orientations. Available online at this link
91. Variation in Reporting of the Race and Ethnicity of COVID-19 Cases and Deaths Across US States: April 12, 2020, and November 9, 2020. Douglas Megan D. American journal of public health 2021;111(6):1141-1148. Despite growing evidence that COVID-19 is disproportionately affecting communities of color, state-reported racial/ethnic data are insufficient to measure the true impact.We found that between April 12, 2020, and November 9, 2020, the number of US states reporting COVID-19 confirmed cases by race and ethnicity increased from 25 to 50 and 15 to 46, respectively. However, the percentage of confirmed cases reported with missing race remained high at both time points (29% on April 12; 23% on November 9). Our analysis demonstrates improvements in reporting race/ethnicity related to COVID-19 cases and deaths and highlights significant problems with the quality and contextualization of the data being reported.We discuss challenges for improving race/ethnicity data collection and reporting, along with opportunities to advance health equity through more robust data collection and contextualization. To mitigate the impact of COVID-19 on racial/ethnic minorities, accurate and high-quality demographic data are needed and should be analyzed in the context of the social and political determinants of health. Available online at this link
92. Voices of Resistance and Agency: LBTQ Muslim Women Living Out Intersectional Lives in North America. Khan Maryam Journal of homosexuality 2021;68(7):1144-1168. This qualitative study critically examined, from an interpretive perspective, 14 life stories of LBTQ Muslim women across North America. This paper explored how LBTQ Muslim women navigated Muslim and LGBTQ hegemonic norms and exclusions as they negotiated and lived out identity intersections. Transnational and critical race feminisms, intersectionality, and critical Islamic liberationist approaches to gender and sexuality framed the project. The study findings suggested that LBTQ Muslim women resisted hegemonic norms by mapping out alternative paths grounded in Islam, and in living out lives in LGBTQ communities. Participants discussed their experiences of being "othered" within LGBTQ communities, how they challenged the notion of a monolithic Islam, how they expanded coming-out frameworks to include their own experiences, as well as how they asserted their own religious agency and resistance. Participants demonstrated that living out an intersectional identity was a complex task where constant negotiations of positionality were transpiring concurrently. Available online at this link
93. Voices of Resistance and Agency: LBTQ Muslim Women Living Out Intersectional Lives in North America. Khan Maryam Journal of homosexuality 2021;68(7):1144-1168. This qualitative study critically examined, from an interpretive perspective, 14 life stories of LBTQ Muslim women across North America. This paper explored how LBTQ Muslim women navigated Muslim and LGBTQ hegemonic norms and exclusions as they negotiated and lived out identity intersections. Transnational and critical race feminisms, intersectionality, and critical Islamic liberationist approaches to gender and sexuality framed the project. The study findings suggested that LBTQ Muslim women resisted hegemonic norms by mapping out alternative paths grounded in Islam, and in living out lives in LGBTQ communities. Participants discussed their experiences of being "othered" within LGBTQ communities, how they challenged the notion of a monolithic Islam, how they expanded coming-out frameworks to include their own experiences, as well as how they asserted their own religious agency and resistance. Participants demonstrated that living out an intersectional identity was a complex task where constant negotiations of positionality were transpiring concurrently. Available online at this link
94. Why structural racism in the NHS is still a live issue: Prejudice persists in the health service, say groups representing black and minority ethnic nurses, despite the findings of a report by a commission on race. Jones-Berry Stephanie Nursing Standard 2021;:19-21. Nurses have spoken out about structural racism in the NHS in the wake of a widely-condemned review of race and ethnic disparities. Available online at this link
95. Women on the Frontline: A Changed Workforce and the Fight Against COVID-19. Rabinowitz Loren Galler Academic medicine : journal of the Association of American Medical Colleges 2021;96(6):808-812. COVID-19 is a worldwide pandemic, with frontlines that look drastically different than in past conflicts: that is, women now make up a sizeable majority of the health care workforce. American women have a long history of helping in times of hardship, filling positions on the home front vacated by men who enlisted as soldiers during World War I and similarly serving in crucial roles on U.S. military bases, on farms, and in factories during World War II. The COVID-19 pandemic has represented a novel battleground, as the first in which women have taken center stage, not only in their roles as physicians, respiratory therapists, nurses, and the like, but also by serving in leadership positions and facilitating innovations in science, technology, and policy. Yet, the pandemic has exacerbated multiple pain points that have disproportionally impacted women in health care, including shortages in correctly sized personal protective equipment and uniforms, inadequate support for pregnant and breastfeeding providers, and challenges associated with work-life balance and obtaining childcare. While the pandemic has facilitated several positive advancements in addressing these challenges, there is still much work to be done for women to achieve equity and optimal support in their roles on the frontlines. (Copyright © 2021 by the Association of American Medical Colleges.) Available online at this link
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