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Fitri FI, Lage C, Mollayeva T, Santamaria-Garcia H, Chan M, Cominetti MR, Daria T, Fallon G, Gately D, Gichu M, Giménez S, Zuniga RG, Hadad R, Hill-Jarrett T, O’Kelly M, Martinez L, Modjaji P, Ngcobo N, Nowak R, Ogbuagu C, Roche M, Aguzzoli CS, Shin SY, Smith E, Yoseph SA, Zewde Y, Ayhan Y. Empathy as a crucial skill in disrupting disparities in global brain health. Front Neurol 2023; 14:1189143. [PMID: 38162446 PMCID: PMC10756064 DOI: 10.3389/fneur.2023.1189143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 09/26/2023] [Indexed: 01/03/2024] Open
Abstract
Brain health refers to the state of a person's brain function across various domains, including cognitive, behavioral and motor functions. Healthy brains are associated with better individual health, increased creativity, and enhanced productivity. A person's brain health is intricately connected to personal, social and environmental factors. Racial, ethnic, and social disparities affect brain health and on the global scale these disparities within and between regions present a hurdle to brain health. To overcome global disparities, greater collaboration between practitioners and healthcare providers and the people they serve is essential. This requires cultural humility driven by empathy. Empathy is a core prosocial value, a cognitive-emotional skill that helps us understand ourselves and others. This position paper aims to provide an overview of the vital roles of empathy, cooperation, and interdisciplinary partnerships. By consciously integrating this understanding in practice, leaders can better position themselves to address the diverse challenges faced by communities, promote inclusivity in policies and practices, and further more equitable solutions to the problem of global brain health.
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Affiliation(s)
- Fasihah Irfani Fitri
- Department of Neurology, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, Dublin, Ireland
| | - Carmen Lage
- Department of Neurology, Marques de Valdecilla University Hospital - Valdecilla Research Institute (IDIVAL), Santander, Spain
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
| | - Tatyana Mollayeva
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, Dublin, Ireland
- Canada Research Chairs, Ottawa, ON, Canada
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Acquired Brain Injury Research Lab, Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Hernando Santamaria-Garcia
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
- Center of Memory and Cognition Intellectus, Hospital Universitario San Ignacio Bogotá, Bogotá, Colombia
- Pontificia Universidad Javeriana (PhD Program in Neuroscience) Bogotá, Bogotá, Colombia
| | - Melissa Chan
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, Dublin, Ireland
- Department of Social Sciences, University of Luxembourg, Luxembourg, Luxembourg
| | - Marcia R. Cominetti
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, Dublin, Ireland
- Department of Gerontology, Federal University of São Carlos, São Carlos, Brazil
| | - Tselmen Daria
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
- Gladstone Institutes, San Francisco, CA, United States
| | - Gillian Fallon
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
| | - Dominic Gately
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, Dublin, Ireland
| | - Muthoni Gichu
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, Dublin, Ireland
- Division of Geriatric Medicine at the Ministry of Health, Nairobi, Kenya
| | - Sandra Giménez
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
- Multidisciplinary Sleep Unit, Memory Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Raquel Gutierrez Zuniga
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, Dublin, Ireland
- Hospital Quirónsalud Valle del Henares, Madrid, Spain
| | - Rafi Hadad
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
- Rambam Health Care Campus, Haifa, Israel
| | - Tanisha Hill-Jarrett
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
- Memory and Aging Center, Medical Center, University of California, San Francisco, CA, United States
| | - Mick O’Kelly
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
- National College of Art and Design, Dublin, Ireland
| | - Luis Martinez
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
- Memory and Aging Center, Medical Center, University of California, San Francisco, CA, United States
| | - Paul Modjaji
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, Dublin, Ireland
| | - Ntkozo Ngcobo
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, Dublin, Ireland
- Department of Psychiatry, University of KwaZulu-Natal, Durban, South Africa
| | - Rafal Nowak
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
- Neuroelectrics (Spain), Barcelona, Spain
| | - Chukwuanugo Ogbuagu
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
- Faculty of Basic Clinical Sciences, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - Moïse Roche
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, Dublin, Ireland
- Division of Psychiatry, UCL, London, United Kingdom
| | - Cristiano Schaffer Aguzzoli
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - So Young Shin
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
- College of Nursing, Inje University, Busan, Republic of Korea
| | - Erin Smith
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
- Stanford University, Stanford, CA, United States
| | - Selam Aberra Yoseph
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yared Zewde
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yavuz Ayhan
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
- Department of Psychiatry, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
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Brown J, Pfeiffer RM, Shrewsbury D, O'Callaghan S, Berner AM, Gadalla SM, Shiels MS, Jackson SS. Prevalence of cancer risk factors among transgender and gender diverse individuals: a cross-sectional analysis using UK primary care data. Br J Gen Pract 2023; 73:e486-e492. [PMID: 37365010 PMCID: PMC10325612 DOI: 10.3399/bjgp.2023.0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/07/2023] [Accepted: 03/23/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Transgender and gender diverse (TGD) individuals experience an incongruence between their assigned birth sex and gender identity. They may have a higher prevalence of health conditions associated with cancer risk than cisgender people. AIM To examine the prevalence of several cancer risk factors among TGD individuals compared with cisgender individuals. DESIGN AND SETTING A cross-sectional analysis was conducted using data from the UK's Clinical Practice Research Datalink to identify TGD individuals between 1988-2020, matched to 20 cisgender men and 20 cisgender women on index date (date of diagnosis with gender incongruence), practice, and index age (age at index date). Assigned birth sex was determined from gender-affirming hormone use and procedures, and sex-specific diagnoses documented in the medical record. METHOD The prevalence of each cancer risk factor was calculated and the prevalence ratio by gender identity was estimated using log binomial or Poisson regression models adjusted for age and year at study entry, and obesity where appropriate. RESULTS There were 3474 transfeminine (assigned male at birth) individuals, 3591 transmasculine (assigned female at birth) individuals, 131 747 cisgender men, and 131 827 cisgender women. Transmasculine people had the highest prevalence of obesity (27.5%) and 'ever smoking' (60.2%). Transfeminine people had the highest prevalence of dyslipidaemia (15.1%), diabetes (5.4%), hepatitis C infection (0.7%), hepatitis B infection (0.4%), and HIV infection (0.8%). These prevalence estimates remained elevated in the TGD populations compared with cisgender persons in the multivariable models. CONCLUSION Multiple cancer risk factors are more prevalent among TGD individuals compared with cisgender individuals. Future research should examine how minority stress contributes to the increased prevalence of cancer risk factors in this population.
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Affiliation(s)
- Jalen Brown
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, US
| | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, US
| | - Duncan Shrewsbury
- Department of Medical Education, Brighton and Sussex Medical School, Brighton, UK
| | | | - Alison M Berner
- Barts Cancer Institute, Queen Mary University of London, London, UK; Gender Identity Clinic, Tavistock and Portman NHS Foundation Trust, London, UK
| | - Shahinaz M Gadalla
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, US
| | - Meredith S Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, US
| | - Sarah S Jackson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, US
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Whelan I, Strachan S, Apea V, Orkin C, Paparini S. Barriers and facilitators to HIV pre-exposure prophylaxis for cisgender and transgender women in the UK. Lancet HIV 2023; 10:e472-e481. [PMID: 37271160 DOI: 10.1016/s2352-3018(23)00080-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/24/2023] [Accepted: 04/05/2023] [Indexed: 06/06/2023]
Abstract
Uptake of oral HIV pre-exposure prophylaxis (PrEP) among cisgender and transgender women in the UK has been low. In this Review, we explore the barriers and facilitators to PrEP access for these groups, with a focus on health equity. We included 20 studies, including seven abstracts presented at conferences. The study samples were disparate, with minimal overlap between papers. We identified barriers at the individual, interpersonal, and structural levels, including poor awareness and acceptability; stigma, race, and ethnicity; restricted access to PrEP; and exclusion from clinical trials. We found hidden subpopulations of women who could potentially benefit from PrEP, of whom little is known about their PrEP knowledge, preferences, and access due to a lack of UK research. These subpopulations include non-Black African women, transgender women, sex workers, migrant women, women experiencing intimate partner violence, incarcerated women, and women who inject drugs. We highlight opportunities to address these obstacles. Research on the use of PrEP by women in the UK is scarce, and existing research has poor granularity. Without a better understanding of the needs and preferences of the full spectrum of women who could benefit from PrEP, the UK will not reach zero transmissions by 2030.
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Affiliation(s)
- Isabelle Whelan
- SHARE Collaborative, Queen Mary University of London, London, UK; Barts Health NHS Trust, London, UK.
| | | | - Vanessa Apea
- SHARE Collaborative, Queen Mary University of London, London, UK; Wolfson Institute of Population Health, Queen Mary University of London, London, UK; Barts Health NHS Trust, London, UK
| | - Chloe Orkin
- Department of Infection and Immunity, Blizard Institute, Queen Mary University of London, London, UK; SHARE Collaborative, Queen Mary University of London, London, UK; Barts Health NHS Trust, London, UK
| | - Sara Paparini
- SHARE Collaborative, Queen Mary University of London, London, UK; Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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