The Women of FOCIS: Promoting Equality and Inclusiveness in a Professional Federation of Clinical Immunology Societies

The authors of this article, all women who have been deeply committed to the Federation of Clinical Immunology Societies (FOCIS), performed a retrospective analysis of gender equality practices of FOCIS to identify areas for improvement and make recommendations accordingly. Gender data were obtained and analyzed for the period from January 2010 to July 2021. Outcome measures included numbers of men and women across the following categories: membership enrollment, meeting and course faculty and attendees, committee and leadership composition. FOCIS’ past and present leaders, steering committee members, FCE directors, individual members, as well as education, annual meeting scientific program and FCE committee members and management staff of FOCIS were surveyed by email questionnaire for feedback on FOCIS policies and practice with respect to gender equality and inclusion. Although women represent 50% of the membership, they have been underrepresented in all leadership, educational, and committee roles within the FOCIS organization. Surveying FOCIS leadership and membership revealed a growing recognition of disparities in female leadership across all FOCIS missions, leading to significant improvement in multiple areas since 2016. We highlight these changes and propose a number of recommendations that can be used by FOCIS to improve gender equality.

Aboriginal and Queer Identity/ies in Western Australia: When There is a Need to Know in Therapeutic Settings

A central question for the exploratory Aboriginal and LGBTQ+ researcher led project 'Breaking the Silence: Being Indigenous and identifying LGBTQ+' (Breaking the Silence) is how provision of genuinely inclusive service responses for Aboriginal and Torres Strait Islander people identifying as LGBTQ+ can be developed. This article presents the qualitative findings of this mixed-methods research project to show how organizational staff working in health, education and social support services in Western Australia consider the Aboriginal LGBTQ+ identity/experience. Analysis of the written, interview and focus group responses to a question about the relevance of LGBTQ+ identity show that these questions need to be considered and evaluated within diverse service cultures and philosophies of services. Staff views are diverse and organizational consensus on the relevance (or not) of LGBTQ+ identity needs to be the precursor before the development or consideration of changes to service delivery and models.

The Decriminilisation of Homosexuality in Botswana

This article discusses the decriminalisation of homosexuality in Botswana. It discusses the various cases that addressed issues relating to LGBTIQ+ in Botswana to highlight the incremental approach toward decriminalisation of homosexuality laws. The article also highlights the role and the contribution of civil society to the decriminalization of homosexuality in Botswana. It does so by providing an overview of queer activism in Botswana and highlights the various queer actors in the country. The article notes that the Botswana Court of Appeal has emphatically settled the debate concerning the constitutional protection of members of the LGBTIQ+. This article points out that the successes recorded in Botswana by civil society as regards the decriminalisation of homosexuality are attributable to several factors. These factors include the consolidated efforts of civil society in the country, the advocacy that accompanied the decriminalisation of homosexuality litigation and the use of various public interest litigation strategies. Combined, these factors paint a clear picture of the nature of queer lawfare in Botswana. Overall, the article highlights that while some sections of the society in Botswana are still reluctant to recognize members of the LGBTIQ+ community as right bearers, there is sufficient evidence to suggest that there has been a great shift toward inclusivity.

Leaving a Mark and Passing the Torch: Intended Legacies of Older Lesbian and Gay Spanish Activists

Aging paradigms should entail all individuals. More research on older LGBT+ adults is needed since the literature has been mainly built on heteronormative and cisgender standards. The creation and shaping of the kind of legacy an individual would like to leave behind when he/she dies is key in aging well. This study explores the intended legacies of older lesbian and gay adults (50+ years old) who were activists in social movements in Spain. Eighteen participants (12 gay men) participated in a semi-structured interview on their intended legacies. Thematic analysis was used to analyze the interviews. The main findings showed that all participants reported intended legacies: i) personal, to transmit their lived knowledge and to be remembered as good and committed persons; ii) broader, to contribute to LGBT+ rights, and to a better society; iii) composite, the desire that younger generations recognize their contributions, and to know they helped to protect new generations. The participants in this study lived a life of intense involvement in social movements, and currently their intended legacies involve leaving a mark and passing the torch to younger generations. This understanding will help us to develop adequate practices that promote well-being in older LGBT+ adults.

A Survey of Women in the Perfusion Workforce: 2021

A diverse and equitable working environment is desirable. In 2011, a survey was distributed to all female perfusionists in the United States. This survey suggested that the female perfusionists share the same difficulties as women in the labor force. The role of women in society in general is clearly changing. Female perfusionists have been part of that evolution. Promoting equality and respecting diversity are central to life today. A follow-up survey was distributed to evaluate the status and the change in gender stereotypes in the field of perfusion over the past 10 years. Women make up nearly half of the U.S. labor force and 35.7% of the present perfusion workforce in North America (1,077 certified women). Women make 82 cents for every dollar that men earn and this disparity widens for women with more education. The purpose of this survey was to poll women in perfusion to evaluate concerns and opinions in their careers and to compare to the 2011 survey results. In December 2021, a 39-question survey (surveymonkey.com, San Mateo, CA) was made available to all female perfusionists in North American via social media websites (Facebook.com, Perfusion.com, LinkedIn.com, Perflist, Perfmail, and FPP Listserv). There were 384 responses to the 2021 survey compared to the 538 responses in 2011. About 32.1% of the survey participants have been used in perfusion for more than 20 years; 37.6% have earned a master's degree compared to 2011, where 18.3% had master's level education; 72.5% are the financial providers for their family with 44.2% earning $101-150,000.00 and 40.3% greater than $200,000.00, which is a significant change from 2011; 61.5% consider themselves under moderate stress compared to 63.0% in 2011; 94.3% take call on a regular basis; and 74.1% feel they miss essential family functions because of their schedules. Similarly, 62.8% felt discriminated against because of gender compared to 50.9% in 2011. This survey suggests that the female perfusionists have shown to be assertive (72% are the primary financial supporter of their families) and competent in the field of cardiovascular perfusion (nearly 40% have masters degrees). Further analysis is needed to discern whether female perfusionists are treated with comparable respect as their male colleagues when 50.0% report some discrimination or harassment in their workplace.

Beyond the garden: The complexity of "global and individual living" at the heart of the international commitment towards a healthy, more resilient and fairer society

BACKGROUND

The right to fully enjoy the highest possible state of health is certainly nothing new in the agenda of the world's governments, and yet today it becomes a top priority not just in the restructuring of the health care system, but also in the promotion of multi-sector policies aimed at fostering and safeguarding the potential of every individual to achieve what could be defined, in general terms, as "common good".

OBJECTIVE

The current paper aimed at singling out the most useful strategies to promoting and achieving a healthy, more resilient and fairer society.

METHODS

Starting from principles 1 and 14 of the Declaration of Rome, the aim was to analyse and develop the concepts of resilience and health, questioning their possible future variations against the background of the current health emergency and the increasingly radical widespread use of new technologies as universally-applied and cross-sectional tools for human progress.

RESULTS

The "health for all" objective can only be achieved if we act on three key aspects: 1. Adding life to years; 2. Adding life to life; 3. Adding years to life.

CONCLUSIONS

Each individual should raise their health awareness as a key resource to leading a fulfilling existence and to developing the required qualities to fully tap into health possibilities - whether integral or residual - to tackle life.

Socioeconomic Disparities in Cleft Lip Care

OBJECTIVE

The purpose of this study was to utilize a multicenter dataset to elucidate whether socioeconomic factors were associated with access to cleft lip surgery, treatment by higher-volume providers, and family choice for higher-volume centers.

DESIGN

Retrospective cohort study.

SETTING

Hospitals participating in the Pediatric Health Information System.

PATIENTS

Primary cleft lip repair performed in the United States between 2010 and 2020.

OUTCOMES

Travel distance, hospital volume, hospital choice.

RESULTS

During the study interval, 8954 patients underwent unilateral (78.4%, n  =  7021) or bilateral (21.6%, n  =  1933) primary cleft lip repair. Patients with unilateral cleft lip were repaired significantly earlier if they were White (P < .001) and significantly later if they lived in an urban community (P  =  .043). Similarly, patients with bilateral cleft lip were repaired significantly earlier if they were White (P < .001). Patients from above-median income households (P  =  .011) and living in urban communities (P < .001) were significantly more likely to be treated at high-volume hospitals, whereas those living in underserved communities (P < .001) were significantly less likely to be treated at high-volume hospitals. White patients were significantly more likely to be treated by high-volume surgeons (P < .001). Patients with White race were significantly more likely to choose a higher-volume hospital than the one most locally available (P < .001).

CONCLUSIONS

Patients with White race are more likely to travel farther and be treated by high-volume surgeons although at smaller hospitals. Patients from underserved areas travel significantly farther for cleft care and are treated at lower-volume hospitals. Patients in urban communities have shorter travel distances and are treated at higher-volume hospitals.

Practising cultural humility to promote person and family-centred care

The concept of cultural humility in nursing involves an awareness of diversity and how an individual's culture can affect their health behaviours. Nurses can use this awareness to develop sensitive, tailored and person-centred approaches to patient care, which ultimately contribute to a positive healthcare experience. This article examines the concept of cultural humility with reference to person and family-centred care. It also explores how individuals and organisations can challenge discriminatory attitudes and behaviours in the workplace.

Colonization, cadavers, and color: Considering decolonization of anatomy curricula

Anatomy is a discipline that, despite its universal nature, offers limited diversity in terms of representation in cadavers, imagery, technology, and models used within teaching. The universal move toward inclusive curricula has put anatomy education under the microscope, particularly with respect to efforts to decolonize curricula. This paper considers the challenges and opportunities to diversify the anatomy curriculum. Decolonizing anatomy education curricula will entail addressing the ingrained cultures within the disciplines, such that produces a number of challenges including: underrepresentation of certain bodies, difficulty talking about difference, and the hidden curriculum in anatomy education. In order to aid educators in achieving inclusive anatomy curricula, a toolkit and considerations are presented, alongside both do's, don'ts and case examples. We highlight the black-or-white dichotomy, and the absence of brown in between. The paper is a conversation starter for what it means to begin the process of decolonizing the curriculum within anatomy education.

On the morality of vaccination tourism

Vaccination tourism (whereby citizens of one nation travel to a different, usually more developed nation to receive a vaccine unavailable or with little availability at home) during the COVID pandemic raises a host of moral issues and is usually met with criticism. From the perspective of the society of origin, the criticism is that those who use their socio-economic privileges to go abroad and receive the vaccine ahead of other citizens instead of 'making the line' act objectionably because in doing so they use their purchasing power to obtain a benefit that should not be distributed like any other product in the market. From the perspective of the society of destination, the criticism is that citizens and residents should receive the vaccines first; after all, their government purchased vaccines (with their taxes) to immunize the local population. The paper calls into question both objections to vaccination tourism. There might be other reasons to oppose it, but this pair of objections cannot ground a moral criticism of the practice.

Inequality in early childhood chronic health conditions requiring hospitalisation: A data linkage study of health service utilisation and costs

BACKGROUND

The cost of socioeconomic inequality in health service use among Australian children with chronic health conditions is poorly understood.

OBJECTIVES

To quantify the cost of socioeconomic inequality in health service use among Australian children with chronic health conditions.

METHODS

Cohort study using a whole-of-population linked administrative data for all births in Queensland, Australia, between July 2015 and July 2018. Socioeconomic status was defined by an areas-based measure, grouping children into quintiles from most disadvantaged (Q1) to least disadvantaged (Q5) based on their postcode at birth. Study outcomes included health service utilisation (inpatient, emergency department, outpatient, general practitioner, specialist, pathology and diagnostic imaging services) and healthcare costs.

RESULTS

Of the 238,600 children included in the analysis, 10.4% had at least one chronic health condition. Children with chronic health conditions in Q1 had higher rates of inpatient (6.6, 95% confidence interval [CI] 6.4, 6.7), emergency department (7.2, 95% CI 7.0, 7.5) and outpatient (20.3, 95% CI 19.4, 21.3) service use compared to children with chronic health conditions in Q5. They also had lower rates of general practitioner (37.5, 95% CI 36.7, 38.4), specialist (8.9, 95% CI 8.5, 9.3), pathology (10.7, 95% CI 10.2, 11.3), and diagnostic imaging (4.3, 95% CI 4.2,4.5) service use. Children with any chronic health condition in Q1 incurred lower median out-of-pocket fees than children in Q5 ($0 vs $741, respectively), lower median Medicare funding ($2710, vs $3408, respectively), and higher median public hospital funding ($31, 052 vs $23, 017, respectively).

CONCLUSIONS

Children of most disadvantage are more likely to access public hospital provided services, which are accessible free of charge to patients. These children are less likely to access general practitioner, specialist, pathology and diagnostic imaging services; all of which are critical to the ongoing management of chronic health conditions, but often attract an out-of-pocket fee.

Assisted dying requests from people in detention: Psychiatric, ethical, and legal considerations-A literature review

The principle of equivalence of care states that prisoners must have access to the same standard of health care as the general population. If, as recent court decisions suggest, assisted dying is not limited to people with a terminal physical illness or irremediable suffering, it might also be requested by people with severe mental illness in detention. Some of the countries with legal regulations on assisted dying also have recommendations on how to handle requests from prisoners. However, detention itself can lead to psychological distress and suicidality, so we must consider whether and how people in such settings can make autonomous decisions. Ethical conflicts arise with regard to an individual's free will, right to life, and physical and personal integrity and to the right of a state to inflict punishment. Furthermore, people in prison often receive insufficient mental health care. In this review, we compare different practices for dealing with requests for assisted dying from people in prison and forensic psychiatric facilities and discuss the current ethical and psychiatric issues concerning assisted dying in such settings.

'Conversion Therapy' As Degrading Treatment

This article responds to the widespread uncertainty in UK and international human rights law over the legality of 'conversion therapy', a set of practices that aim to eradicate LGBTIQ+ sexualities and gender identities. The article pursues two main arguments. First, it is argued that all forms of 'conversion therapy' are disrespectful of the equal moral value of LGBTIQ+ people and violate specific protected areas of liberty and equality that are inherent in the idea of human dignity. Secondly, the article develops a theoretical account of degrading treatment under article 3 of the European Convention on Human Rights that illuminates the relationship between the prohibition of degrading treatment, human dignity and antidiscrimination. It is then argued that 'conversion therapy', in all its different forms, spawns the specific kind of degradation that UK and international human rights law prohibit. The article ends by analysing the positive state obligations that arise in this context.

Developing Future Physical Education Teachers' Intercultural Competence: The Potential of Intertwinement of Transformative, Embodied, and Critical Approaches

Purpose: This article is based on a study that explored learning processes related to intercultural competence of PE teacher trainees. The context of the study was the Faculty of Sport and Health Sciences at the University of Jyväskylä, Finland. The study was conducted in connection to two courses that focused on equality in physical education and sport in 2020-2021. Methods: Adopting an interpretive, as well as a critical approach, the authors focused on how the students described their conceptions and learning experiences. Based on their analysis they have then aimed to shed light on how interculturality, equality, equity, and diversity may be addressed in higher education in a more profound manner. The students' accounts were analyzed first through an open reading and subsequently through a more critical lens. The analysis was supported by theories of transformative learning, embodied learning, and intercultural education. Results: Students' initial interest toward equity, equality, and interculturality seemed to expand during the courses. They increasingly reflected on the complexity of these issues and discussed the widening professional responsibilities of future PE teachers in promoting equality and supporting pupils in cultural heterogeneous classes. Discussions and practical activities that involved emotional and embodied elements seemed to be important in facilitating their learning processes. However, it is difficult to foresee how permanent the changes in their habits of mind and subsequent actions are. Discussion: The authors suggest that embodied, practical approaches where the student is fully engaged in the learning process, and where conceptual, reflective, emotional, and affective levels are connected, may be a key in developing teachers' intercultural competence. They also suggest that it is crucial to revise higher education curricula from the perspectives of intercultural competence and structural inequality. In addition to separate courses, equality, equity, and diversity should be seen as red threads throughout higher education.

Real-World Evidence for Equality

As stakeholders in the transformative medical research ecosystem, real-world evidence researchers must conduct observational research with an awareness of racism. Advancements in understanding of the impact of racism on health outcomes, the abundance of health care data, and innovations in health information technology provide tools that create opportunities to conduct more focused research that illustrates how racism in health care deters the advancement of equity.

A kinder approach to science

To be kind is to protect and promote the well-being of others. We borrow this definition from the philosophical literature to formulate a simple and powerful principle to make scientific communities and institutions healthier, fairer, and more inclusive.

Gender diversity in nursing: time to think again

Despite recent discussions and campaigns to widen nursing's appeal to people of diverse gender identities, it continues to be perceived as a largely female profession. In the context of an ageing workforce, and alongside recruitment and retention challenges, efforts should be directed at developing a more inclusive profession rather than focusing on why people other than women do not become nurses. To attract more men, transgender people and those who identify as nonbinary, as well as women, the approach to nursing recruitment needs to change. The profession must develop a more inclusive culture and examine and promote the advantages that gender diversity can bring to nursing. This article explores the lack of gender diversity in contemporary nursing, briefly examines the history of gender in nursing, and considers how the profession might evolve into a more gender-diverse and inclusive workforce.

Proactive measures to eradicate Malaysia's poverty in IR4.0 era: a shared prosperity vision

Background: In the country's shared prosperity vision, Malaysia aspires to uplift the bottom 40% household income group (B40) by addressing wealth and income disparities. By 2030, the nation seeks to eradicate poverty through the provision of employment opportunities and career progression plans. A grey area between the nation's aspirations and actions in practice can be observed because the goals have not been achieved despite numerous efforts aimed at the upliftment of the B40 group. The nation is still way behind its targeted outcomes despite various policies being implemented, which could be attributed to the mismatch between government policies and that of organisational practice. Thus, this study explores the rationale of strategic government intervention in managing B40 talent in the IR4.0 era. Methods: A general qualitative inquiry method that used 11 semi-structured interviews was carried out with representatives of Malaysia's policy makers', training providers, and trainees. All Interview questions centred around measures, importance and outcomes of B40 youth training from a multi-stakeholder perspective. Data were thematically analysed in five stages using NVivo. Results: Training, which includes IR4.0 era digital skills, is the key to uplifting the B40 youth to eradicate poverty. Proactive measures are imperative in the success of B40 youth training towards poverty eradication. Conclusions: This study contributes to the existing literature and helps practitioners by addressing the current gap in Malaysia's aspirations versus organisational practice. Stakeholders should formulate proactive strategies to ensure that the right trainees are matched with the right training providers and government policies. A linkage between government policies and industry requirements needs to be established as opposed to the present discontinuity. A structured training needs analysis should be applied through a collaboration between industries and governments. Then, B40 individuals commonly found in lower-level positions can be pooled into the career pathway towards a shift into M40.

Proactive measures to eradicate Malaysia's poverty in IR4.0 era: a shared prosperity vision

Background: In the country's shared prosperity vision, Malaysia aspires to uplift the bottom 40% household income group (B40) by addressing wealth and income disparities. By 2030, the nation seeks to eradicate poverty through the provision of employment opportunities and career progression plans. A grey area between the nation's aspirations and actions in practice can be observed because the goals have not been achieved despite numerous efforts aimed at the upliftment of the B40 group. The nation is still way behind its targeted outcomes despite various policies being implemented, which could be attributed to the mismatch between government policies and that of organisational practice. Thus, this study explores the rationale of strategic government intervention in managing B40 talent in the IR4.0 era. Methods: A general qualitative inquiry method that used 11 semi-structured interviews was carried out with representatives of Malaysia's policy makers', training providers, and trainees. All Interview questions centred around measures, importance and outcomes of B40 youth training from a multi-stakeholder perspective. Data were thematically analysed in five stages using NVivo. Results: Training, which includes IR4.0 era digital skills, is the key to uplifting the B40 youth to eradicate poverty. Proactive measures are imperative in the success of B40 youth training towards poverty eradication. Conclusions: This study contributes to the existing literature and helps practitioners by addressing the current gap in Malaysia's aspirations versus organisational practice. Stakeholders should formulate proactive strategies to ensure that the right trainees are matched with the right training providers and government policies. A linkage between government policies and industry requirements needs to be established as opposed to the present discontinuity. A structured training needs analysis should be applied through a collaboration between industries and governments. Then, B40 individuals commonly found in lower-level positions can be pooled into the career pathway towards a shift into M40.

Injuries in Quidditch: A Prospective Study from a Complete UK Season

Background

Quidditch is a mixed-gender, full-contact sport founded in the USA in 2005, played worldwide by an estimated 25,000 players. It is one of the few mixed-gender full-contact sports, yet there remain few published studies regarding injury rates and patterns. A previous study suggested that the overall rate of injury in quidditch is in line with other contact sports, however raised concerns that female players were sustaining a higher rate of concussion when compared to male players.

Purpose

To examine injury rates and injury patterns in UK quidditch athletes over the course of a single season.

Study design

Prospective epidemiological study

Methods

Data were prospectively collected by professional first aid staff for the 2017-18 season spanning all major UK tournaments, involving 699 athletes. Anonymized player demographics were collected by an online survey. Time loss injury rates were measured per 1000 athletic exposures (AEs) and hours of play.

Results

The overall time loss injury rate was 20.5 per 1000 hours or 8.0 per 1000 AEs. The combined rate of concussion was 7.3 per 1000 hours or 2.8 per 1000 AEs. There was no statistical difference between time loss injuries in males (20.9/1000 hours and 8.1/1000 AEs) and females (13.9/1000 hours and 5.4/1000 AEs) (p=0.30) and no statistical difference between concussion rates in males (n=7) and females (n=4) (p=0.60).

Conclusions

Total time loss injury rates in quidditch appear to be comparable with other full-contact sports such as football. The rate of concussions for both males and females appear higher when compared to other contact sports.

Level of evidence

3

What Price Are We Willing to Pay for the Dream of Equal Justice?†

The injustices wrought by unequal access to the legal system pose a direct threat to the rule of law, yet such injustices are widespread in England and elsewhere. Lawyers regularly criticise governments for a lack of funding for the legal system, but the private market for delivering legal services receives much less scrutiny. A private market for legal resources is antithetical to equal justice because it makes the outcome of cases turn on arbitrary factors such as wealth. The solution, according to Wilmot-Smith in his book Equal Justice, is to socialise the allocation of legal services so that the rich cannot buy the best lawyers, and to prevent them from contracting out of this public system by making private arbitrations unenforceable. This review article argues that Wilmot-Smith's thesis is persuasive, but there might also be second-best solutions that could deliver greater legal equality at lower cost.

Women in neurointervention, a gender gap? Results of a prospective online survey

BACKGROUND AND PURPOSE

Women's representation in medicine has increased over time yet the proportion of women practicing neurointervention remains low. We conducted an anonymous online survey through which we could explore the gender gap in neurointervention, identify potential issues, difficulties, or obstacles women might face, and evaluate if men encounter similar issues.

METHODS

An online questionnaire was designed in SurveyMonkey®. Invitation to participate was emailed through national and international neurointerventional societies as well as directly through private mailing lists to men and women working in neurointervention. Responses were collected from 10 May 2019 to 10 September 2019.

RESULTS

There were 295 complete responses, 173 (59%) male and 122 (41%) female. Most respondents (83%) fell within age categories 35-60 years, with representation from 40 countries across five continents. In all 95% were working full time, 73% had worked as a neurointerventionalist for >6 years, 77% worked in University-affiliated teaching institutions. Almost half of the respondents indicated no female neurointerventionalist worked in their center. Female respondents were younger and age-adjusted analysis was undertaken. Significantly fewer females than males were married and had children. Significantly fewer females held supervisory roles, held academic titles, and significantly less had a mentor. Females were less satisfied in their careers. More females felt they receive less recognition than colleagues of the opposite sex. Males had a greater proportion of work time dedicated to neurointervention. Similar proportions of both genders experienced bullying in work (40%-47%); however, sexual harassment was more common for females. There were no differences between genders in how they dealt with complications or their effects on mental well-being.

CONCLUSION

There are many potential reasons why women are underrepresented in neurointervention, however, the literature suggests this is not unique to our specialty. Multiple long-term strategies will be necessary to address these issues, some of which are discussed in the article.

Enhancing the care of transgender and non-binary patients through effective communication

There is increasing evidence to suggest that transgender (trans) and non-binary people encounter significant societal discrimination, stereotypical and misleading representation in the media, and frequent misgendering. They may also experience several barriers to accessing healthcare, as well as discrimination from staff and other patients. This article explores how and why trans and non-binary people experience discrimination, and discusses how healthcare professionals, including nurses, can enhance the care experience for these patients, with a particular emphasis on language and communication.