As Long As it Lasts-Older Substance Users, Brittle Ties and Danish Health Care

In this article, we examine a group of older marginalized substance-using citizens and their relations to Danish health care. We offer empirical examples collected through ethnographic fieldwork, about how they handle their health situation and encounters with the Danish healthcare system. Analytically, we particularly draw on the concept of disposable ties, and suggest the term "brittle ties" to nuance the term and examine how perceived individual autonomy is weighted against health care trajectories and how these citizens often prefer to fend for themselves or lean on provisional networks rather than enter into health care trajectories and follow-up treatment.

Exploring uses of visual arts-based interventions for mental health of marginalized populations: a scoping review

BACKGROUND

The intentions of this scoping review are to determine current uses of visual arts-based interventions for mental health and trauma support of marginalized populations, and to identify current gaps in knowledge in this emergent field.

METHOD

Six databases (MEDLINE, Embase, CINAHL, Web of Science, PsycINFO, JSTOR) were searched for relevant studies. Following the PRISMA guidelines, 38 articles met the inclusion criteria.

RESULTS

Most interventions focused on improving the mental health of participants, or to provide opportunities for participants to process their experiences of mental health. Participants reported increased well-being, experiences of relaxation and/or distraction, and processing of mental health experiences. They perceived arts-based interventions as helpful and developed mutual social support with other participants.

CONCLUSION

Arts-based interventions have the potential to inform the development of culturally safe and relevant mental health care for marginalized populations beyond current mainstream mental health practices.

Marginalization and women's healthcare in Ghana: Incorporating colonial origins, unveiling women's knowledge, and empowering voices

The origins of marginalization in nursing and the health sector in Ghana can be traced to colonialism and how a colonial era laid a solid foundation for inequities and entrenched disparities, as well as the subsequent normalization of marginalizing acts, in the health sector, particularly for women. Drawing upon varied literature over a 60-year period and perspectives from feminist theory, this paper considers the lasting impact of Ghanaian women's historical position during the colonial era and within the patriarchal system that ensued. Through this process, it becomes possible to shed light on the crucial role that colonialism has played in women's experiences, perspectives, and health-seeking behaviors, and the manner in which it has created a healthcare sector that marginalizes women's health. Although women possess valuable knowledge which should be an asset to consider when providing healthcare services, marginalization of that knowledge has become normalized across society and the healthcare system. There is an urgent need to disrupt and challenge this normalization, and to advocate empowerment and recognition of women's valuable knowledge and experiences, providing women a voice in health decision-making discourses and in the research processes by which we understand and develop healthcare. Through this, healthcare in Ghana could become more empowering, inclusive, and responsive to the unique experiences and needs of Ghanaian women. By understanding something of the historical origins of women's health marginalization within colonialism, nurses can begin to appreciate women's knowledge and integrate it into healthcare strategies that are more gender-sensitive and equitable.

Algorithmic surveillance in the era of the mental health appsphere

Digital mental health applications, also known as mHealth apps, are designed to help users manage their mental health using technology such as mobile devices and smartphones. However, there has been little critical engagement surrounding their impact on marginalized communities, and Black people in Canada. This article aims to explore how state and private actors conceptualize the digitalization of mental health access, leading to the creation and implementation of these apps. It is important to consider the links and interconnections between the platform and the app, and to be cautious and curious before adopting yet another app that claims to manage and mitigate moods and address mental health needs. We should be considering the implications of what comes with this access and apparent ease of use.

Mental Health and Marginalization Stress in Transgender and Gender Diverse Adults: Differences between Urban and Non-Urban Experiences

Background

Transgender and gender diverse (TGD) individuals face high rates of psychological distress, including depression, anxiety, and suicide risk. Further, TGD individuals living outside of urban areas experience additional disparities compared to their urban counterparts. Minority stress theory states that minority stressors (termed marginalization stressors for this paper), such as experiences of discrimination and internalized transphobia, lead to psychological distress. The current study compared marginalization stressors across rural (population less than 2,500), urban cluster (population between 2,500 and 50,000), and urban (population greater than 50,000) samples and tested the degree to which these stressors account for differences across areas of residence.

Methods

Participants were 225 TGD individuals who completed an online survey that included measures of depression, anxiety, suicidal ideation marginalization stress, and protective factors.

Results

In the first model, mental health outcomes, marginalization stressors, and protective factors differed between areas. Urban cluster participants reported experiencing higher levels of depression, anxiety, and suicidal ideation and rural participants reported experiencing higher levels of depression suicidal ideation than urban participants. Both rural and urban cluster participants reported more experiences of several marginalization stressors. In the subsequent path model, indirect effects between area and marginalization stress variables were significant, but urban cluster participants still reported higher depression, anxiety, and suicidal ideation symptoms (p-values < .05).

Discussion

We demonstrate that marginalization stress processes appear to account for some of the differences between TGD individuals living in urban, rural, and urban cluster areas. The differences between areas largely persist, however, after controlling for marginalization stress, especially when comparing urban with urban cluster areas.

The Impact of Intersectional Discrimination and Stigma on HIV Care for African, Caribbean, and Black Women Living With HIV During the COVID-19 Pandemic in British Columbia: A Descriptive Study

ABSTRACT

African, Caribbean, and Black women living with HIV (ACB WWH) in British Columbia experience discrimination on the basis of their race, sex, gender identity, sexual orientation, and HIV status. The various forms of stigma that ACB WWH experience intersect to create a uniquely marginalized experience that has negative consequences for quality of life and overall well-being. Eighteen semistructured interviews were completed with ACB WWH in British Columbia. Interviews were conducted by phone, Zoom, or in-person at the participant's request. Participants consistently reported experiences of various forms of discrimination. There was additional stigmatization due to COVID-19 pandemic that negatively influenced the lives of ACB WWH. Interventions and resources are needed to support ACB WWH in navigating how to work through the multifaceted impacts of intersectional stigmatization. Efforts are needed to identify ways to continue the delivery of resources like social support groups throughout future pandemics.

Cultural immersion, acculturation strategies, and depressive symptoms among first-generation Vietnamese migrants in Germany

BACKGROUND

Worldwide migration represents a major challenge of the 21st century. Despite the strong association between acculturation and mental health, research findings on underlining mechanisms remain inconsistent. Prior research urges to investigate sample characteristics in a more structured manner.

AIMS

The purpose of this study was to systematically investigate factors impacting acculturation and depressive symptoms in a large, not exclusively clinical, sample of Vietnamese migrants in Germany.

METHOD

This study investigated, with multiple regressions, factors (age at arrival, gender, education, religiousness, language skills, residence status, economic status, occupational status, migration motivation, duration of stay, and depressive symptoms) impacting the two dimensions of acculturation, dominant society immersion (DSI) and ethnic society immersion (ESI), in a not exclusively clinical sample (n = 582) of first-generation Vietnamese migrants in Germany. Further, this study examined the relationship between depressive symptoms, DSI and ESI with correlations and acculturation strategies with an ANOVA.

RESULTS

Integration (72.5%) was the most common acculturation strategy, followed by separation (26.8%). In contrast, assimilation (0.5%) and marginalization (0.2%) were very rare acculturation strategies. As predictive factors for DSI lower depressive symptoms scores, male gender, higher education, and better German language skills were found significant. For ESI, less German language skills and older age at arrival were found to be significant. Higher ESI and DSI were correlated to lower depressive symptom scores. Compared to the three other acculturation strategies, integration was linked to the lowest depressive symptoms scores.

CONCLUSIONS

The current study identified crucial factors in the acculturation process, such as depressive symptoms, language skills, education, gender, and age at arrival. Our findings emphasize that immersion into both the dominant and the ethnic culture plays an essential supportive role in the mental health of migrants.

Exploring Mediators of Mental Health Service Use Among Transgender Individuals in Ontario, Canada

OBJECTIVES

To determine if and to what degree neighbourhood-level marginalization mediates mental health service use among transgender individuals.

METHODS

This retrospective cohort study identified 2,085 transgender individuals through data obtained from 4 outpatient community and hospital clinics in 3 large cities in Ontario, which were linked with administrative health data between January 2015 and December 2019. An age-matched 1:5 comparison cohort was created from the general population of Ontario. Outcome measures were analysed from March 2020 to May 2022. The primary outcome was mental health service utilization, which included mental health-related visits to primary care providers, psychiatrists, mental health- and self-harm-related emergency department visits, and mental health hospitalizations. Mediation variables included ethnic concentration, residential instability, dependency, and material deprivation at the neighbourhood level and were derived from the Ontario Marginalization Index.

RESULTS

This study identified 2,085 transgender individuals from participating outpatient community and hospital clinics, who were matched to the general population (n = 10,425). Overall, neighbourhood-level marginalization did not clinically mediate mental health service use. However, transgender individuals were more likely to be exposed to all forms of neighbourhood-level marginalization, as well as having higher rates of health service use across all outcome measures.

CONCLUSIONS

In this study, mental health service use among transgender individuals was not clinically mediated by marginalization at the neighbourhood level. This study highlights the need to explore marginalization and mental health service use at the individual level to better understand the mental health disparities experienced by transgender individuals and to ensure that health-care services are inclusive and affirming.

Marginalization and tooth loss in older Mexican adults

OBJECTIVE

To examine the association between the level of marginalization and tooth loss in adults aged ≥50 years in Mexico.

METHODS

A retrospective cross‑sectional study was conducted on 2098 adults selected from communities presenting both high and medium levels of marginalization, with data obtained from the annual reports of the Epidemiological Surveillance System of Oral Pathologies 2019-2022. Analysis considered sociodemographic characteristics such as sex, age, and years of education. The prevalence of tooth loss was determined using the Decayed, Missing and Filled teeth (DMFT) index. Negative binomial regression was used to estimate rate ratio (RR) and 95% confidence intervals (CIs), using the presence of lost teeth as an outcome.

RESULTS

Most (62.4%) participants had lost at least one tooth, of whom 60.3% had a medium level of marginalization, 28.8% a high level, and 10.9% a very high level. More adults who lived in high or very high marginalization communities had lost teeth [RR=1.19 (95% CI 1.08 - 1.30)] than those living in communities with a medium level of marginalization. More males [RR=1.19 (95% CI 1.09 - 1.31)], adults ≥70 years [RR=1.77 (95% CI 1.57 - 1.99)], people who were illiterate [RR=1.60 (95% CI 1.35 - 1.88)] or who had poor oral hygiene [RR=1.26 (95% CI 1.15 - 1.38)] had also lost teeth.

CONCLUSION

High and very high marginalization was associated with tooth loss in adults ≥50 years in Mexico. Effective oral health strategies are required to prevent tooth loss, as are interventions to improve access to and quality of dental services for marginalized communities.

Marginalization Influences Access, Outcomes, and Discharge Destination Following Total Joint Arthroplasty in Canada's Universal Healthcare System

BACKGROUND

The influence of socioeconomic status on outcomes following total joint arthroplasty (TJA) in the Canadian single-payer healthcare system is yet to be elucidated. The objective of the present study was to evaluate the impact of socioeconomic status on TJA outcomes.

METHODS

This was a retrospective review of 7,304 consecutive TJA (4,456 knees and 2,848 hips) performed between January 1, 2001 and December 31, 2019. The primary independent variable was the average census marginalization index. The primary dependent variable was functional outcome scores.

RESULTS

The most marginalized patients in both the hip and knee cohorts had significantly worse preoperative and postoperative functional scores. Patients in the most marginalized quintile (V) showed a decreased odds of achieving a minimal important difference in functional scores at 1-year follow-up (odds ratio [OR] 0.44; 95% confidence interval [CI] [0.20, 0.97], P = .043). Patients in the knee cohort in the most marginalized quintiles (IV and V) had increased odds of being discharged to an inpatient facility with an OR of 2.07 (95% CI [1.06, 4.04], P = .033) and OR of 2.57 (95% CI [1.26, 5.22], P = .009), respectively. Patients in the hip cohort in V quintile (most marginalized) had increased odds of being discharged to an inpatient facility with an OR of 2.24 (95% CI [1.02, 4.96], P = .046).

CONCLUSION

Despite being a part of the Canadian universal single-payer healthcare system, the most marginalized patients had worse preoperative and postoperative function, and had increased odds of being discharged to another inpatient facility.

LEVEL OF EVIDENCE

IV.

Overcoming Marginalization by Creating a Sense of Belonging

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

Amphetamine-Related Emergency Department Visits in Ontario, Canada, 2003-2020

OBJECTIVES

Despite unregulated amphetamine use increasing, there are limited data on related emergency department (ED) visits in Canada. Our primary objective was to examine trends in amphetamine-related ED visits over time in Ontario, including by age and sex. Secondary objectives were to examine whether patient characteristics were associated with ED revisit within 6 months.

METHODS

Using administrative claims and census data, we calculated annual patient- and encounter-based rates of amphetamine-related ED visits from 2003 to 2020 among individuals 18+ years of age. We also performed a retrospective cohort study of individuals with amphetamine-related ED visits between 2019 and 2020 to determine whether select factors were associated with ED revisit within 6 months. Multivariable logistic regression modelling was used to measure associations.

RESULTS

The population-based rate of amphetamine-related ED visits increased nearly 15-fold between 2003 (1.9/100,000 Ontarians) and 2020 (27.9/100,000 Ontarians). Seventy-five percent of individuals returned to the ED for any reason within 6 months. Psychosis and use of other substances were both independently associated with ED revisit for any reason within 6 months (psychosis: AOR = 1.54, 95% CI = 1.30-1.83; other substances: AOR = 1.84, 95% CI = 1.57-2.15), whereas having a primary care physician was negatively associated with ED revisit (AOR = 0.77, 95% CI = 0.60-0.98).

CONCLUSIONS

Increasing rates of amphetamine-related ED visits in Ontario are cause for concern. Diagnoses of psychosis and the use of other substances may serve to identify individuals who are most likely to benefit from both primary and substance-specific care.

Racial discrimination moderates associations between sociopolitical discussions and internalizing problems among racially minoritized college students

OBJECTIVE

The present study investigated whether associations between sociopolitical discussions and mental health differed by racial discrimination among racially minoritized college students. We also tested whether associations differed between election years-when sociopolitical discussions may be more frequent-and nonelection years.

METHOD

In November 2020, racially minoritized college students (N = 225; Mage = 19.84, SD = 1.41; 72.89% female; 52.00% Asian, 22.67% Latino, 16.00% multiracial, 9.33% races including Black and Middle Eastern) reported how often they had experienced racial discrimination, their frequency of sociopolitical discussions with friends and family, and their mental health.

RESULTS

Results indicated that participants who had more frequent sociopolitical discussions with friends-but not family-only reported more internalizing problems if they had never or rarely experienced racial discrimination in the past year. To determine whether results were unique to discussions during election years, a second sample (N = 262; Mage = 20.18, SD = 2.30; 82.53% female; 48.86% Asian, 18.56% Latino, 15.42% multiracial, 17.78% races including Black and Middle Eastern) was recruited 1 year later, and racial discrimination did not moderate associations between sociopolitical discussions and internalizing problems.

CONCLUSIONS

Sociopolitical discussions with friends during presidential elections may be related to greater internalizing problems for racially minoritized college students who experience racial discrimination less frequently, potentially because they may feel less prepared or less motivated to have these conversations compared to racially minoritized college students who experience racial discrimination more frequently. Future studies should investigate means of promoting sociopolitical discussions on campus while attenuating the association between sociopolitical discussions and internalizing problems. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Radicalization from a societal perspective

Studies on radicalization tend to focus on the dynamics of extremist groups and how they exploit grievances of vulnerable individuals. It is imperative, however, to also understand the societal factors that lead to such vulnerabilities and grievances. Our social environment plays a key role in how we view the world and shape our beliefs. By understanding the social dynamics, we can gain insight into the motivations that drive people to extremism. Throughout this paper, we examine the societal factors and processes such as discriminative institutional structures and social norms/practices that can make an individual vulnerable and serve as a driving force for them to join a radical group. To do that, we use the process-oriented psychology of Arnold Mindell and the phenomenology of whiteness of Sara Ahmed as our theoretical framework. These frameworks help us map out the societal dynamics causing individuals to carve social niches out of their current social group and into an extremist group. We use interviews with ex-militants of the radical group, Islamic State of Iraq and Syria, to show how certain societal dynamics, such as social injustice, misuse of power, marginalization and discrimination, served as key factors that led these individuals to identify and sympathize with radical ideology. The aim of this paper is to emphasize that, to develop effective preventative measures against recruitment into extremist groups, it is imperative to have a profound understanding of the social dynamics that make an individual susceptible to radicalization in the first place.

A theory of autism bringing across levels of description

Autism impacts a wide range of behaviors and neural functions. As such, theories of autism spectrum disorder (ASD) are numerous and span different levels of description, from neurocognitive to molecular. We propose how existent behavioral, computational, algorithmic, and neural accounts of ASD may relate to one another. Specifically, we argue that ASD may be cast as a disorder of causal inference (computational level). This computation relies on marginalization, which is thought to be subserved by divisive normalization (algorithmic level). In turn, divisive normalization may be impaired by excitatory-to-inhibitory imbalances (neural implementation level). We also discuss ASD within similar frameworks, those of predictive coding and circular inference. Together, we hope to motivate work unifying the different accounts of ASD.

Food Insecurity: A Barrier to Reproductive Justice Globally

Objective: Reproductive Justice identifies three core reproductive rights for all people: (1) the right to not have a child; (2) the right to have a child; and (3) the right to parent children in safe and healthy environments. We aim to illustrate that food insecurity infringes upon on all three of these rights and so is a pressing issue for reproductive justice and for sexual and reproductive health more broadly. Methods: Using a phenomenological approach, we outline potential pathways between food insecurity and reproductive justice. Results: There are numerous potential pathways between food insecurity and reproductive justice, including entry into sexual relationships for material support, links to sexually transmitted infections and infertility, structural violence, prioritization and spending tradeoffs between food and other basic necessities, biological impacts of malnutrition, restricted reproductive choices, population control measures, and social stigma and exclusion. Marginalized people are disproportionately impacted by food insecurity and its consequences, with implications for sexual health and pleasure and for reproductive justice. Conclusions:Meaningful and equitable collaboration between people with lived experience of food insecurity, human rights and reproductive justice activists, and academics is critical to sensitively contextualize this work and mobilize broader social change.

Chronic Struggle: An Institutional Ethnography of Chronic Pain and Marginalization

There have been several recent calls to re-think chronic pain in response to the growing awareness of social inequities that impact the prevalence of chronic pain and its management. This in turn has resulted in new explorations of suffering as it relates to pain. While laudable, many of these clinically oriented accounts are abstract and often fail to offer a critical theoretical understanding of social and structural inequities. To truly rethink pain, we must also reconsider suffering, beginning in the everyday expert knowledge of people with chronic pain who can offer insights in relation to their bodies and also the organization of the social circumstances in which they live. Our team undertook a sociological approach known as institutional ethnography (IE) to explicate the work of people in managing lives beset by chronic pain and the inequities that stem from marginalization. In keeping with our critical paradigm, we describe participant accounts as situated, rather than lived, to de-emphasize the individual in favour of the social and relational. Through our analysis, we offer a new concept of chronic struggle to capture how pain, illness, economic deprivation, and suffering constitute a knot of experience that people living with chronic pain are obliged to simplify in order to fit existing logics of medicine. Our goal is to identify the social organization of chronic pain care which underpins experience in order to situate the social as political rather than medical or individual. PERSPECTIVE: This article explicates the health work of people living with chronic pain and marginalization, drawing on their situated experience. We offer the concept of chronic struggle as a conceptualization that allows us to bring into clear view the social organization of chronic pain in which the social is visible as political and structural rather than medical or individual.

Introduction: The Politics of Abortion 50 Years after Roe

Abortion is central to the Amerian political landscape and a common pregnancy outcome, yet research on abortion has been siloed and marginalized in the social sciences: in an empirical analysis, we find only 22 articles published in this century in the top economics, political science, and sociology journals. This special issue aims to bring abortion research into a more generalist space, challenging what we term the "abortion research paradox" wherein abortion research is largely absent from prominent disciplinary social science journals but flourishes in interdisciplinary and specialized journals. After discussing the misconceptions that likely contribute to abortion research siloization and the implications of this siloization on abortion research as well as social science knowledge more generally, this essay introduces the articles in this special issue. Then, in a call for continued and expanded research on abortion, this essay closes by offering three guiding practices for abortion scholars-both those new to the topic and those already deeply familiar-in the hopes of building an ever-richer body of literature on abortion politics, policy, and law. The need for such a robust literature is especially acute following the United States Supreme Court's June 2022 overturning of the constitutional right to abortion.

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

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

The Ongoing Development of Strength-Based Approaches to People Who Hold Systemically Marginalized Identities

ACADEMIC ABSTRACT

Personality and social psychology have historically viewed individuals' systemically marginalized identities (e.g., as people of color, as coming from a lower-income background) as barriers to their success. Such a deficit-based perspective limits psychological science by overlooking the broader experiences, value, perspectives, and strengths that individuals who face systemic marginalization often bring to their societies. The current article aims to support future research in incorporating a strength-based lens through tracing psychology's journey away from an emphasis on deficits among people who contend with systemic marginalization and toward three distinct strength-based approaches: the universal strengths, difference-as-strength, and identity-specific strengths approaches. Through distinguishing between each approach, we advance scholarship that aims to understand systemically marginalized identities with corresponding implications for addressing inequality. Strength-based approaches guide the field to recognize the imposed limitations of deficit-based ideologies and advance opportunities to engage in research that effectively understands and values systemically marginalized people.

PUBLIC ABSTRACT

Inequalities, including those between people from higher- and lower-income backgrounds, are present across society. From schools to workplaces, hospitals to courtrooms, people who come from backgrounds that are marginalized by society often face more negative outcomes than people from more privileged backgrounds. While such inequalities are often blamed on a lack of hard work or other issues within marginalized people themselves, scientific research increasingly demonstrates that this is not the case. Rather, studies consistently find that people's identities as coming from groups that face marginalization in society often serve as a valuable source of unique strengths, not deficiencies, that can help them succeed. Our article reviews these studies to examine how future research in psychology may gain a broader understanding of people who contend with marginalization. In doing so, we outline opportunities for psychological research to effectively support efforts to address persistent inequalities.

Disconnected Out of Passion: Relationship Between Social Alienation and Obsessive Passion

Violent radicalization continues to be a global problem. One of the main proposals for understanding radicalization and support for political violence is based on social alienation as a trigger. That is, individuals who feel alienated from society try to get out of this situation by using violence, if necessary. However, social alienation alone is not enough to explain radicalization. Therefore, we propose that social alienation interacts with other factors to foster radicalization. Particularly, we propose that obsessive passion, an internal compulsion that leads a person to engage in an activity even when they should not, is one of the interacting factors. Following previous literature, we hypothesized that higher social alienation predicts support for political violence to a greater extent the higher the obsessive passion. To test this hypothesis, we performed two studies in which the cause of passion varied (religion: N = 652 and family: N = 873). Both studies assessed social alienation, harmonious and obsessive passion, and support for political violence. The results showed a significant increase in the effect of social alienation on support for political violence when obsessive passion was higher, even controlling by harmonious passion. These results highlight the importance of considering other variables related to social alienation that could facilitate radicalization processes, particularly maintaining an obsessive passion for a cause when one feels a social disconnection. The theoretical and practical implications of these results are discussed given their contributions to prevention based on work on feelings of social disconnection and harmonization of causes.

Racism in public health services: A research agenda

Despite racism and its impact on health inequities being increasingly studied in health care settings, racism in public health services has so far been neglected in public health research. Studying racism in public health services provides many opportunities to explore the relationship between racism and health protection. We identify several research themes to be explored on (1) non-stigmatizing and community-driven risk communication, (2) surveillance by public health authorities of racialized minority groups, (3) racism experiences in everyday interactions with public health authorities, (4) legal consequences of encounters with public health authorities and (5) public health infrastructure, structural racism and the intersectionality of marginalization. Tackling these research themes will help to start building an evidence base on how racism interferes with equitable health protection and how to dismantle it.

Research on Underwater Complex Scene SLAM Algorithm Based on Image Enhancement

Underwater images typically suffer from less explicit feature point information and more redundant information due to wild conditions. To solve these degradation problems, we propose the VINS-MONO algorithm to enhance the quality of the underwater image. Specifically, we first used the FAST feature point extraction algorithm to improve the extraction speed. Then, the inverse optical flow method was used to improve the accuracy of feature extraction. At the same time, several kinds of residual information were extracted and marginalized, separately, in the marginalization part of the back-end, in order to improve the marginalization speed. Extensive experiments on underwater dataset HAUD-Dataset and public dataset EuRoC show that our approach is superior to the original VINS-MONO algorithm. In addition, the original algorithm optimizes the situation in which the feature point information is not obvious, and the redundant information is more complex in the underwater environment, which effectively improves the visual quality of the underwater image.

Overlooked by nurses: A scoping review on health stressors, problems and coping of migrant domestic workers

AIM

The first scoping review is to map and synthesize the stressors, problems and coping strategies surrounding the health issues of migrant domestic workers.

DESIGN

Scoping review using Arksey and O'Malley's five-stage framework.

METHODS

Ten electronic databases were systematically searched by keywords for literature published between January 1995 and December 2019. Data were extracted into tables and collated and summarized into themes for presentation.

RESULTS

Twenty-seven reports were included in the final review. Analysis revealed that stressors to health included abuse, poor health service accessibility, ongoing financial hardship despite demanding working conditions and social isolation. Physical and mental health problems were identified for which migrant domestic workers largely depended on social networks and religion to cope with stressors and health problems. Training para-professional peer leaders of migrant domestic workers by community nurses and including them in interprofessional teams is a possible way for nurses to promote their health and well-being.

A Resistance Framework for Racially Minoritized Youth Behaviors During the Transition to Adulthood

The transition from adolescence to adulthood is a challenging time marked by rapid changes in relational connections, housing status, and academic or work trajectories. We emphasize how structural inequality shapes racially minoritized youth behaviors and center the potential for resistance, arguing that a resistance lens allows us to deepen our understanding of the transition to adulthood for racially minoritized youth. Throughout the paper, we include research on how racially minoritized youth experience marginalizing institutional structures concurrently across multiple systems and their resulting behaviors. We end with the clinical and research implications of a resistance framework to illuminate resistance-informed responses such as rethinking risk and creating spaces for youth-led self-making, youth-adult partnerships to scaffold transitions, and cultivating youth activism.

"Bring the Hoses to Where the Fire Is!": Differential Impacts of Marginalization and Socioeconomic Status on COVID-19 Case Counts and Healthcare Costs

OBJECTIVES

Local health leaders and the Director General of the World Health Organization alike have observed that COVID-19 "does not discriminate." Nevertheless, the disproportionate representation of people of low socioeconomic status among those infected resembles discrimination. This population-based retrospective cohort study examined COVID-19 case counts and publicly funded healthcare costs in Ontario, Canada, with a focus on marginalization.

METHODS

Individuals with their first positive severe acute respiratory syndrome coronavirus 2 test from January 1, 2020 to June 30, 2020, were linked to administrative databases and matched to negative/untested controls. Mean net (COVID-19-attributable) costs were estimated for 30 days before and after diagnosis, and differences among strata of age, sex, comorbidity, and measures of marginalization were assessed using analysis of variance tests.

RESULTS

We included 28 893 COVID-19 cases (mean age 54 years, 56% female). Most cases remained in the community (20 545, 71.1%) or in long-term care facilities (4478, 15.5%), whereas 944 (3.3%) and 2926 (10.1%) were hospitalized, with and without intensive care unit, respectively. Case counts were skewed across marginalization strata with 2 to 7 times more cases in neighborhoods with low income, high material deprivation, and highest ethnic concentration. Mean net costs after diagnosis were higher for males ($4752 vs $2520 for females) and for cases with higher comorbidity ($1394-$7751) (both P < .001) but were similar across levels of most marginalization dimensions (range $3232-$3737, all P ≥ .19).

CONCLUSIONS

This study suggests that allocating resources unequally to marginalized individuals may improve equality in outcomes. It highlights the importance of reducing risk of COVID-19 infection among marginalized individuals to reduce overall costs and increase system capacity.

Age- and Sex-Specific Association Between Vegetation Cover and Mental Health Disorders: Bayesian Spatial Study

BACKGROUND

Despite growing evidence that reduced vegetation cover could be a putative risk factor for mental health disorders, the age- and the sex-specific association between vegetation and mental health disorder cases in urban areas is poorly understood. However, with rapid urbanization across the globe, there is an urgent need to study this association and understand the potential impact of vegetation loss on the mental well-being of urban residents.

OBJECTIVE

This study aims to analyze the spatial association between vegetation cover and the age- and sex-stratified mental health disorder cases in the neighborhoods of Toronto, Canada.

METHODS

We used remote sensing to detect urban vegetation and Bayesian spatial hierarchical modeling to analyze the relationship between vegetation cover and mental health disorder cases. Specifically, an Enhanced Vegetation Index was used to detect urban vegetation, and Bayesian Poisson lognormal models were implemented to study the association between vegetation and mental health disorder cases of males and females in the 0-19, 20-44, 45-64, and ≥65 years age groups, after controlling for marginalization and unmeasured (latent) spatial and nonspatial covariates at the neighborhood level.

RESULTS

The results suggest that even after adjusting for marginalization, there were significant age- and sex-specific effects of vegetation on the prevalence of mental health disorders in Toronto. Mental health disorders were negatively associated with the vegetation cover for males aged 0-19 years (-7.009; 95% CI -13.130 to -0.980) and for both males (-4.544; 95% CI -8.224 to -0.895) and females (-3.513; 95% CI -6.289 to -0.681) aged 20-44 years. However, for older adults in the 45-64 and ≥65 years age groups, only the marginalization covariates were significantly associated with mental health disorder cases. In addition, a substantial influence of the unmeasured (latent) and spatially structured covariates was detected in each model (relative contributions>0.7), suggesting that the variations in area-specific relative risk were mainly spatial in nature.

CONCLUSIONS

As significant and negative associations between vegetation and mental health disorder cases were found for young males and females, investments in urban greenery can help reduce the future burden of mental health disorders in Canada. The findings highlight the urgent need to understand the age-sex dynamics of the interaction between surrounding vegetation and urban dwellers and its subsequent impact on mental well-being.

Nonresident Fathers' Voice: Marginalized, Disempowered, and Silenced

Nonresident fathers, following separation/divorce, are more likely to experience multiple forms of family types simultaneously than any other sociodemographic group. Although there is considerable writing on the factors and issues surrounding nonresident fathers from academics, the Family court, the Child Support Agency, and women's and welfare groups, the voice of nonresident fathers themselves is rarely heard. This is due to nonresident fathers being marginalized, disempowered, and silenced by these same entities. The voice of nonresident fathers is routinely minimized, dismissed, and labeled as anti-feminist or a backlash to feminism. This opinion piece argues that there is a need for qualitative research to be undertaken to investigate, document, and explore nonresident fathers' voices from their own perspective to hear what they have to say of themselves so that a better understanding of the dynamics that impact and influence them can be achieved. This would mean that actions can be identified and undertaken to better understand nonresident fathers' situation while providing insights for the development of social policies by Government and Welfare agencies together with support care for nonresident fathers highlighting their desires and needs.

Liver cancer in Hidalgo State, Mexico: analysis of the status, risk factors and regional public health policy requirements: a cross-sectional correlational study

BACKGROUND

In Latin America, liver cancer is one of the top causes of cancer mortality. It is the fifth most common cause of death among malignant tumors in Mexico and is the leading cause in Hidalgo State (43.8% of the population living in poverty).

OBJECTIVE

To conduct a correlational analysis on the main risk factors for liver cancer in Hidalgo State, Mexico, including municipal disaggregation and comparison with the national level.

DESIGN AND SETTING

Cross-sectional, correlational, descriptive and comparative epidemiological study using Mexican governmental databases covering 1990-2019.

METHODS

A comprehensive review of the databases of the General Directorate of Health Information (DGIS) was performed to analyze official death figures, hospital discharges and national and municipal population projections, using specific search criteria defined in the Global Burden of Disease classification, based on the risk factors for liver cancer.

RESULTS

Liver cancer rates showed an evident rise in Hidalgo (183%), moving from 21st place in Mexico in 1990 to 9th place in 2019. This increase was correlated with alcoholism. An increasing trend for liver cancer deaths, of 133.89%, is projected for 2030. Females and the population over 60 years of age are more affected. There are some critical regions with liver cancer death rates twice the national rate or more.

CONCLUSION

Targeted effective public health strategies should be structured by identifying, characterizing and regionalizing critical marginalized municipalities that are vulnerable to alcoholism and other risk factors for liver cancer. This approach may be helpful for other states in Mexico or similar countries.

Marginalized COVID-19 patients and their significant others in Kashmir (India): manifesting the hidden structural vulnerabilities

Using a qualitative approach, this study aimed to undertake an in-depth exploration of the experiences of COVID-19 patients and their significant others among the economically weaker sections in Kashmir. The study was conducted on 18 participants of different households solely from rural Kashmir while using the purposive sampling technique to recruit the participants and the principle of data saturation to determine the sample size. Data were collected using semi-structured in-depth interviews and analyzed through Braun and Clarke's thematic analysis framework. From the data analysis, six overarching themes of diagnosis, healthcare, treatment, survival thereof, social support and stigma were arrived at, which delineated the direct or indirect experiences of participants with COVID-19. The findings of the study revealed that the economically weaker sections of rural Kashmir are deprived of requisite healthcare facilities, which further intensifies their vulnerabilities to COVID-19 and associated health issues. They lie at the core of acute health disadvantage amid the COVID-19 crisis, and are hence drifted toward extreme marginality and socioeconomic adversity.

Absent, Incapable, and "Normal": Understanding the Inclusiveness of Visually Impaired Students' Experiences in Integrated Physical Education

The purpose of this study was to examine the inclusiveness of visually impaired youths' experiences in integrated physical education. An experiential qualitative research approach was utilized, and 22 visually impaired youth (age 12-17 years) acted as participants. Data sources included one-on-one Zoom interviews, written responses to long-answer prompts, and reflexive interview notes. Data were analyzed using a reflexive thematic analysis approach, and three themes were constructed: (a) I'm not there, so how could I: The absent person; (b) I can't see, so I can't do it: The incapable person; and (c) It'd be nice to feel like everyone else: The "normal" person. Participants described that feelings of inclusion were unavailable to them and that feeling, and being viewed as, absent, incapable, and (not) "normal" highlighted this unavailability.

Young People Who Use Drugs Views Toward the Power and Authority of Police Officers

Many young people who use drugs are structurally vulnerable to policing powers given the ongoing criminalization of drug possession. Police authority limits and the expression of that authority may play a significant role in police encounters among young people who use drugs. This qualitative study explores the views of young people who use drugs toward police power and authority in their recent encounters with police officers. Interviews were conducted with 38 young people who recently used illegal drugs in British Columbia, Canada. We found five interrelated themes related to perceptions of police authority: (1) skepticism and distrust toward authority; (2) paternalism and authority over drug use; (3) officer use of force; (4) police as power-hungry; and (5) officers above the law. Participants described police authority as limitless, unpredictable, untethered, easily abused, and lacking accountability. Participants feared holding police officers accountable to power abuses in a criminal justice system that they saw as stacked against them. Moving forward, institutional reforms may consider and account for the expression, limits, and use of police authority among young people who use drugs and other structurally vulnerable communities.

Emancipatory Photovoice Research: A Primer

Photovoice can be more than a research method for communities to identify and mitigate social oppressions. Photovoice has the potential for emancipatory outcomes and the transformation of power relations. This article serves as a primer for beginning researchers who are new to the emancipatory power of the photovoice method or for advanced researchers who would like to re-imagine their current use of the photovoice method to an emancipatory approach that elevates and empowers. Our purpose is to provide a framework for deciding structures, processes, and outcomes of emancipatory photovoice. We specifically prescribe steps with respect to power relations among partners, design prompts or heuristics, and the anticipated and unanticipated outcomes. We base our perspectives on over a decade of photovoice research experiences. Emancipatory photovoice research, if implemented thoughtfully, can facilitate power sharing, collective learning, healing, and growth.

The Incidence of Psychotic Disorders and Area-level Marginalization in Ontario, Canada: A Population-based Retrospective Cohort Study

BACKGROUND

There is limited Canadian evidence on the impact of socio-environmental factors on psychosis risk. We sought to examine the relationship between area-level indicators of marginalization and the incidence of psychotic disorders in Ontario.

METHODS

We conducted a retrospective cohort study of all people aged 14 to 40 years living in Ontario in 1999 using health administrative data and identified incident cases of psychotic disorders over a 10-year follow-up period. Age-standardized incidence rates were estimated for census metropolitan areas (CMAs). Poisson regression models adjusting for age and sex were used to calculate incidence rate ratios (IRRs) based on CMA and area-level marginalization indices.

RESULTS

There is variation in the incidence of psychotic disorders across the CMAs. Our findings suggest a higher rate of psychotic disorders in areas with the highest levels of residential instability (IRR = 1.26, 95% confidence interval [CI], 1.18 to 1.35), material deprivation (IRR = 1.30, 95% CI, 1.16 to 1.45), ethnic concentration (IRR = 1.61, 95% CI, 1.38 to 1.89), and dependency (IRR = 1.35, 95% CI, 1.18 to 1.54) when compared to areas with the lowest levels of marginalization. Marginalization attenuates the risk in some CMAs.

CONCLUSIONS

There is geographic variation in the incidence of psychotic disorders across the province of Ontario. Areas with greater levels of marginalization have a higher incidence of psychotic disorders, and marginalization attenuates the differences in risk across geographic location. With further study, replication, and the use of the most up-to-date data, a case may be made to consider social policy interventions as preventative measures and to direct services to areas with the highest risk. Future research should examine how marginalization may interact with other social factors including ethnicity and immigration.

Do COVID-19 and Food Insecurity Influence Existing Inequalities between Women and Men in Africa?

This review sought to understand what is currently known about how the ongoing COVID-19 pandemic and restrictive measures are affecting food security and equality between women and men in all of Africa. A review of both the academic and grey literature was performed by following PRISMA guidelines. Results showed that a general disparity exists in gender-inclusive/-sensitive research. Most reported increases in inequalities between women and men were predictive only. Evidence-based articles found were mainly conducted online and target tertiary educated populations, among which neutral effects were found. A general lack of disaggregated data (e.g., women vs. men) was found to be a barrier in gaining a complete understanding of the situation on-the-ground. Furthermore, documents reporting on food security seldom included all four pillars (i.e., availability, access, utility, stability) in their analysis despite the reciprocal connection between them all. Within household disparities and the impacts on power relationships within households were also overlooked. Future studies must focus on rural settings and gender disaggregated interview processes as well as consider all pillars of food security. Doing so will help to better inform governments and humanitarian groups leading to better designed policies and social supports that target where they are most needed.

[The typology of social predictors as a research tool of studying personnel crisis in Russian health care: The publications review]

In conditions of societal transformations, social institutions undergo significant alterations that are manifested by institutional inconsistency and dysfunctionality. The transformation of social professional structure of health care system resulted in change of status and trends of social mobility of social professional groups. The purpose of the study is to typologize social predictors of professional activity of physicians in health care of the Russian Federation. The social economic transformation and reforms of the National health care system of recent decades initiated trends of deprofessionalization in medicine, status inflation and marginalization of professional groups. The phenomenon of professional marginalization of physicians is discussed from perspective of the "concept of status inconsistency" by G. Lensky. In aurhoring typology low income of physicians, financial deprivation, reducing of prestige and relative status inflation of medical profession, professional stress, social frustrations and professional burnout are considered as social predictors of professional activity of physicians. The destructive consequences of status inflation are considered as social threat to preservation of manpower potential of health care of the Russian Federation.

COVID-19 Outbreaks in Settings With Precarious Housing Conditions in Germany: Challenges and Lessons Learned

Two COVID-19 outbreaks occurred in residential buildings with overcrowded housing conditions in the city of Göttingen in Germany during May and June 2020, when COVID-19 infection incidences were low across the rest of the country, with a national incidence of 2.6/100,000 population. The outbreaks increased the local incidence in the city of Göttingen to 123.5/100,000 in June 2020. Many of the affected residents were living in precarious conditions and experienced language barriers. The outbreaks were characterized by high case numbers and attack rates among the residents, many asymptomatic cases, a comparatively young population, and substantial outbreak control measures implemented by local authorities. We analyzed national and local surveillance data, calculated age-, and gender-specific attack rates and performed whole genome sequencing analysis to describe the outbreak and characteristics of the infected population. The authorities' infection control measures included voluntary and compulsory testing of all residents and mass quarantine. Public health measures, such as the general closure of schools and a public space as well as the prohibition of team sports at local level, were also implemented in the district to limit the outbreaks locally. The outbreaks were under control by the end of June 2020. We describe the measures to contain the outbreaks, the challenges experienced and lessons learned. We discuss how public health measures can be planned and implemented through consideration of the needs and vulnerabilities of affected populations. In order to avoid coercive measures, barrier-free communication, with language translation when needed, and consideration of socio-economic circumstances of affected populations are crucial for controlling infectious disease transmission in an outbreak effectively and in a timely way.

Component Processes of Decision Making in a Community Sample of Precariously Housed Persons: Associations With Learning and Memory, and Health-Risk Behaviors

The Iowa Gambling Task (IGT) is a widely used measure of decision making, but its value in signifying behaviors associated with adverse, "real-world" consequences has not been consistently demonstrated in persons who are precariously housed or homeless. Studies evaluating the ecological validity of the IGT have primarily relied on traditional IGT scores. However, computational modeling derives underlying component processes of the IGT, which capture specific facets of decision making that may be more closely related to engagement in behaviors associated with negative consequences. This study employed the Prospect Valence Learning (PVL) model to decompose IGT performance into component processes in 294 precariously housed community residents with substance use disorders. Results revealed a predominant focus on gains and a lack of sensitivity to losses in these vulnerable community residents. Hypothesized associations were not detected between component processes and self-reported health-risk behaviors. These findings provide insight into the processes underlying decision making in a vulnerable substance-using population and highlight the challenge of linking specific decision making processes to "real-world" behaviors.

Self-Care Needs and Technology Preferences Among Parents in Marginalized Communities: Participatory Design Study

BACKGROUND

Ten million parents provide unpaid care to children living with chronic conditions, such as asthma, and a high percentage of these parents are in marginalized communities, including racial and ethnic minority and low-income families. There is an urgent need to develop technology-enabled tailored solutions to support the self-care needs of these parents.

OBJECTIVE

This study aimed to use a participatory design approach to describe and compare Latino and non-Latino parents' current self-care practices, needs, and technology preferences when caring for children with asthma in marginalized communities.

METHODS

The participatory design approach was used to actively engage intended users in the design process and empower them to identify needs and generate design ideas to meet those needs.

RESULTS

Thirteen stakeholders participated in three design sessions. We described Latino and non-Latino parents' similarities in self-care practices and cultural-specific preferences. When coming up with ideas of technologies for self-care, non-Latino parents focused on improving caregiving stress through journaling, daily affirmations, and tracking feelings, while Latino parents focused more on relaxation and entertainment.

CONCLUSIONS

Considerations need to be taken beyond language differences when developing technology-enabled interventions for diverse populations. The community partnership approach strengthened the study's inclusive design.

Recommendations to Improve Palliative Care Provision for Marginalized Populations: Summary of a Roundtable Discussion

Palliative care is increasingly recognized as fundamental to health and human dignity. However, a growing body of evidence highlights the variations in access to palliative care based on personal characteristics, belonging to a certain group, and socioeconomic background. Discriminatory attitudes and behaviors and lack of legal reform protecting the rights of marginalized populations are still common, particularly across Lebanon and the Middle East and North Africa region. This article presents a summary of a roundtable discussion organized by the Lebanese Medical Association for Sexual Health in collaboration with the Lebanese Center for Palliative Care-Balsam, focusing on improving palliative care provision for the following populations: prisoners; lesbian, gay, bisexual, and transgender people; refugees; migrant domestic workers; and people with substance use disorder. It also offers recommendations based on the key themes identified from the discussion, in the hope that they will guide the development of guidelines and policy to advance equity in palliative care provision for marginalized populations.

Citizen science as a data-based practice: A consideration of data justice

Citizen science has been motivated by several perspectives, including increased efficiency in data collection and distributed analysis, democratizing knowledge production, making science more responsive to community needs, and improving the representation of marginalized populations in public data. Despite the potential of citizen science to achieve social justice agendas through a data-intensive and data-driven participatory scientific enquiry, scholarship in critical data studies offers several problematizations of data-based practices, highlighting risks of exclusion and inequality. To understand the extent to which citizen science supports and challenges forms of injustice, this study used a “data justice” analytical framework to critically explore the assemblages of citizen science. We examined four citizen science cases with different levels of citizen engagement, intended outcomes, and data systems. The analysis suggests instances of injustice occurring throughout the data processes of the citizen science cases across the dimensions of procedural, instrumental, rights-based, structural, and distributive data justice.

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A “data justice” analytical framework was used to study citizen science

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Five dimensions of data justice were explored in citizen science cases

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Some forms of injustice were found in citizen science cases under review

Citizen science has been regarded for its contribution to scientific research, inclusive science engagement, and addressing of social justice issues. Within citizen science, social justice is pursued through different approaches, including facilitating public participation in research and utilizing citizen science data in social justice advocacy. Although citizen science is a data-based practice, the structural dimensions of the data processes that support and hamper the pursuit of social justice in citizen science remain understudied. This article applies a “data justice” framework to unpack the elements and practices that constitute the generation, circulation, and use of data and data-related outcomes in citizen science. We demonstrate the relevance and limitations of the framework with regard to the domain of citizen science. This work thus contributes to the growing research interest in critical data studies, i.e., the study around equity issues in data science.

Hot spots for pediatric asthma emergency department visits in Ottawa, Canada

OBJECTIVE

Pediatric asthma emergency department (ED) visits and repeat visits place a substantial burden on healthcare. National and provincial level studies demonstrate geographic variation in asthma ED visits and links to marginalization, but preclude translation into practical targeting of healthcare delivery. It is important to understand the relationship between pediatric asthma ED visits and marginalization at a more granular level. To map the city-level geographic variation in pediatric asthma ED visit and re-visit rates at the Children's Hospital of Eastern Ontario (CHEO) in Ottawa, Canada and the relationship with marginalization.

METHODS

We performed a single center retrospective cohort study of children ages 1-17 with one or more ED visits for asthma at the CHEO in Ottawa. Using postal codes, we linked patients to census tracts. Per census tract, we mapped pediatric asthma ED visit and re-visit rates within one year and identified overlap with the Ontario Marginalization Index.

RESULTS

Of 1,620 children with an index ED visit, 18.5% had a repeat ED visit. We identified 10 hot spot census tracts each for pediatric asthma ED visit and re-visit rates. We identified an overlap between urban hot spots and areas with high ethnic concentration or low dependency.

CONCLUSION

At a granular, city-wide level, pediatric asthma ED visit and re-visit rates are heterogeneous. Urban hot spots, in contrast to rural, have more overlap with marginalization, especially ethnic concentration. These methods can be used in other jurisdictions to inform practical community strategies for geographically-targeted prevention of pediatric asthma-related ED visits in vulnerable areas.Abbreviations:ED:Emergency department;CHEO:Children's Hospital of Eastern Ontario;PRAM:Pediatric Respiratory Assessment Measure;ON-Marg:Ontario Marginalization Index;SES:Socioeconomic status;US:United States.

Supplemental data for this article can be accessed at publisher's website.

Some people just want to watch the world burn: the prevalence, psychology and politics of the 'Need for Chaos'

People form political attitudes to serve psychological needs. Recent research shows that some individuals have a strong desire to incite chaos when they perceive themselves to be marginalized by society. These individuals tend to see chaos as a way to invert the power structure and gain social status in the process. Analysing data drawn from large-scale representative surveys conducted in Australia, Canada, the United Kingdom and the United States, we identify the prevalence of Need for Chaos across Anglo-Saxon societies. Using Latent Profile Analysis, we explore whether different subtypes underlie the uni-dimensional construct and find evidence that some people may be motivated to seek out chaos because they want to rebuild society, while others enjoy destruction for its own sake. We demonstrate that chaos-seekers are not a unified political group but a divergent set of malcontents. Multiple pathways can lead individuals to 'want to watch the world burn'. This article is part of the theme issue 'The political brain: neurocognitive and computational mechanisms'.

Workplace Aggression: Exploring Experiences of Occupational Therapy Practitioners in Healthcare Settings

Workplace aggression (WPA) among healthcare workers is a pervasive and serious problem in the healthcare industry, yet there is a poor understanding of WPA in the profession of occupational therapy (OT). The authors employed a mixed method design using a Likert scale survey and focus groups from two different settings and locations to explore WPA experiences of OT practitioners working in healthcare settings. Participants for the focus groups totaled 14 and 109 surveys were returned. The findings revealed that 100% of the focus group participants and 67% of the survey respondents report exposure to specific types of WPA. Key underlying causes relate to the challenges occupational therapy practitioner's face in advocating their professional role and values in a predominant biomedical setting. These findings are important not only to increase awareness among practitioners, leaders, and educators but to further examine how occupational therapy's unique role in healthcare can be fully recognized.

Health Patterns Reveal Interdependent Needs of Dutch Homeless Service Users

Background: Homelessness is an increasing problem in Western European countries. Dutch local authorities initiated cross-sectional reviews to obtain accurate health and needs information on Homeless Service (HS) users. Methods: The Homeless People Treatment and Recovery (HOP-TR) study uses a comprehensive assessment strategy to obtain health data. Using a naturalistic meta-snowball sampling in 2015-2017, 436 Dutch HS users were assessed. The lived experience of HS users was the primary data source and was enriched with professional assessments. The InterRAI Community Mental Health questionnaire and "Homelessness Supplement" provided information in different areas of life. The approach for mental health assessments was transdiagnostic. Raw interview data were recoded to assess health and needs. The positive health framework structured symptomatic, social, and personal health domains relevant to recovery. Results: Most subjects were males, low educated, with a migration background. The majority were long-term or intermittently homeless. Concurrent health problems were present in two domains or more in most (95.0%) subjects. Almost all participants showed mental health problems (98.6%); for a significant share severe (72.5%). Frequent comorbid conditions were addiction (78%), chronic physical conditions (59.2%), and intellectual impairments (39.9%). Conclusion: The HOP-TR study reveals significant concurrent health problems among Dutch HS users. The interdependent character of different needs requires an integrated 3-D public health approach to comprehensively serve symptomatic, social, and personal dimensions, required to facilitate recovery.

Towards abandoning the master's tools: The politics of a universal nursing identity

Healthcare environments continue to prove discriminatory and marginalizing towards patients and healthcare workers themselves, which contributes to inequitable health outcomes across lines of socially constructed difference. This content and discourse analysis of nursing identity scholarship asks whether there is a connection between nursing identity and oppressive behaviour by examining the construction of nursing identity and the foundational discourses, sometimes in absentia, that support such a construction. Bourdieu's concepts of social fields and Audre Lorde's concept of the master's house are applied as a framework towards understanding the constructs of power and status in healthcare. The analysis identifies a gap in nursing identity literature where social constructs of difference are not considered. In the reviewed literature, nursing identity has been co-opted by the professionalization project in effort to stabilize a conceptualization of nursing's contribution to healthcare towards gaining professional and societal status. This leads to a monolithic, apolitical representation of nursing identity that erases difference, denies historical influence, universalizes nursing work and further marginalizes marginalized identities. The oppressive and hegemonic nature of a universal nursing identity may contribute to a lack of disciplinary reflexivity about the ongoing influences of foundational discursive constructs of gender, epistemology, power and professional status.

Promoting Men's Health Equity

Men's health equity is an area of men's health research and practice that combines the literature on men's health with that of health equity. More research is needed that describes how to intervene to promote men's health equity. This introduction to the American Journal of Men's Health special collection on promoting men's health equity was created to feature research that describes aspects of promising interventions that (a) are population-specific approaches that consider the unique biopsychosocial factors that affect the health of socially defined populations of men; or (b) use a comparative approach to close or eliminate gaps between socially defined groups of men and women and among socially meaningful groups of men that are unnecessary, avoidable, considered unfair and unjust, and yet are modifiable. The dozen papers from across the globe included in the special collection are grouped in three areas: conceptual approaches and reviews; formative research; and evaluation findings. The papers represent a diverse array of populations under the umbrella of men's health and a range of strategies to improve men's health from tobacco cessation to microfinance. The collection features a range of alternative masculinities that emerge from original research by the contributors that are used in novel ways in the interventions. This editorial argues that more qualitative research is needed to evaluate the intended and unintended findings from interventions. This editorial also highlights the benefits that men's health equity can gain from embracing dissemination and implementation science as a tool to systematically design, implement, refine, and sustain interventions.

Perceived Workplace Experiences of Adapted Physical Educators and Physical Educators

Purpose: The purpose of this study was to compare the workplace experiences of physical education and adapted physical education teachers while also considering biological sex. Role socialization theory was used as a guiding lens. Method: Participants included 653 teachers (women = 382) who taught physical education (n = 420) or adapted physical education (n = 233). Five instruments were used to examine workplace experiences regarding: (a) marginalization and isolation, (b) two elements of perceived mattering, (c) three role stressors, (d) resilience, and (e) emotional exhaustion. Group comparisons were analyzed using a 2 × 2 (discipline x biological sex) factorial MANCOVA while including years of teaching experience as a covariate. Results: No significant interaction effect between teacher group and biological sex was detected; however, there were significant main effects of teacher group, F(9,640) = 19.49, p < .001; Wilk's Λ = .79, partial-η² = .22, and of biological sex, F(9,640) = 2.81, p < .01; Wilk's Λ = .96, partial-η² = .04, on the dependent variables. Significant follow-up univariate tests showed that the adapted physical education teachers perceived less marginalization, less isolation, more perceived mattering, and less emotional exhaustion than the physical education teachers. Women from both groups felt significantly more role overload when compared to the men. Conclusion: Collectively, these findings both relate to and extend role socialization theory in explaining how adapted physical education teachers are socialized through the workplace in comparison to their physical education counterparts. Practical implications for preservice and inservice teacher preparation and future research directions are discussed.