HIV/AIDS and the principle of non-discrimination and non-stigmatization

The text examines the article 11 of the Universal Declaration on Bioethics and Human Rights of UNESCO that deals with the principle of non-discrimination and non-stigmatization. Both concepts are related to the theme of human dignity, while discrimination is an inherent part of stigma: stigma does not exist if there is no discrimination. In this context, this paper aims to study the relationship between stigma, discrimination and HIV / AIDS. The study argues that to loosen the bonds that hold the subjects that are attached to them is necessary questioning the broader for­ces - social, cultural, political and economic - that structure stigma, stigmatization and discrimination as social processes directly linked to production and reproduction of structural inequalities

Neocolonial Epidemiology: Public Health Practice and the Right to Health in Guatemala

The relationship between public health practice and the fulfilment of the right to health is often assumed to be synergistic. With the goal of understanding how exactly this relationship happens, I studied the everyday practice of epidemiology in Guatemala, seeking to understand how it shapes and is shaped by the notion of health as a human right. Here I present findings from my ethnographic investigation of the Guatemalan Centro Nacional de Epidemiología (National Epidemiology Center), created in 2004 with the explicit mission of contributing to fulfilling the right to health for the inhabitants of Guatemala. While the relationship between epidemiological practice and the right to health is influenced by the specific configuration of local and transnational flows (bureaucratic, economic, ideological, political, scientific, social, and symbolic), epidemiologists also play an important mediating role. There are four intermediate social mechanisms that shape the relevance of epidemiological practice to fulfilling the right to health in Guatemala. Given how the country’s economic and social inequalities translate into enormous health inequities, an epidemiological practice committed to the right to health should aspire to transform, rather than reproduce, the social hierarchies underlying such inequalities. The mechanisms I identified shape how epidemiological practice contributes to the reproduction or transformation of such hierarchies. These mechanisms shape what I call ‘neocolonial epidemiology’, and include: institutional chaos, disciplinary conformism, global health international relations, and social relations at the national level

Neocolonial epidemiology

The relationship between public health practice and the fulfilment of the right to health is often assumed to be synergistic. With the goal of understanding how exactly this relationship happens, I studied the everyday practice of epidemiology in Guatemala, seeking to understand how it shapes and is shaped by the notion of health as a human right. Here I present findings from my ethnographic investigation of the Guatemalan Centro Nacional de Epidemiología (National Epidemiology Center), created in 2004 with the explicit mission of contributing to fulfilling the right to health for the inhabitants of Guatemala. While the relationship between epidemiological practice and the right to health is influenced by the specific configuration of local and transnational flows (bureaucratic, economic, ideological, political, scientific, social, and symbolic), epidemiologists also play an important mediating role. There are four intermediate social mechanisms that shape the relevance of epidemiological practice to fulfilling the right to health in Guatemala. Given how the country’s economic and social inequalities translate into enormous health inequities, an epidemiological practice committed to the right to health should aspire to transform, rather than reproduce, the social hierarchies underlying such inequalities. The mechanisms I identified shape how epidemiological practice contributes to the reproduction or transformation of such hierarchies. These mechanisms shape what I call ‘neocolonial epidemiology’, and include: institutional chaos, disciplinary conformism, global health international relations, and social relations at the national level

Computational Ontologies and Information Systems II: Formal Specification

This paper extends the study of ontologies in Part I of this study (Volume 14, Article 8) in the context of Information Systems. The basic foundations of computational ontologies presented in Part I are extended to formal specifications in this paper. This paper provides a review of the formalisms, languages, and tools for specifying and implementing computational ontologies Directions for future research are also provided

Developing the scales on evaluation beliefs of student teachers

The purpose of the study reported in this paper was to investigate the validity and the reliability of a newly developed questionnaire named ‘Teacher Evaluation Beliefs’ (TEB). The framework for developing items was provided by the two models. The first model focuses on Student-Centered and Teacher-Centered beliefs about evaluation while the other centers on five dimensions (what/ who/ when/ why/ how). The validity and reliability of the new instrument was investigated using both exploratory and confirmatory factor analysis study (n=446). Overall results indicate that the two-factor structure is more reasonable than the five-factor one. Further research needs additional items about the latent dimensions “what” ”who” ”when” ”why” “how” for each existing factor based on Student-centered and Teacher-centered approaches

A Self-Organizing Group Within a Hierarchical Organization

This study was conducted to discover and describe the characteristics of a community of practice (CoP) and the health care system within which it formed. The study explored the relationship between a CoP of primary care physicians and a health care system that was both a hierarchical organization and a complex adaptive entity. It further examined the impact that relationship may have had on the organization’s sustainability within its environment. A qualitative approach was used for the collection and analysis of data. Semi-structured interviews were conducted with four members of the CoP and three members of their administrative hierarchy. There were two aspects to the data analysis: (a) development of themes emerging from interviews aligned with each of the research questions and (b) application of fractal narrative analysis to examine the degree to which each of the interviewees’ responses contained content that was self-similar such that each contributed to the picture of the whole organization. Findings illustrated the application of numerous complexity characteristics. These included (a) attractors that influenced the formation and continued cohesiveness of the CoP and fostered a dynamic tension in the relationship between the CoP and its administrative hierarchy, (b) sensitive dependence found in retrospect when the impact of the attitude and behavior of administrators was looked at in relation to the evolution and political influence of the CoP, (c) phase transitions and fitness peaks that characterized the journey of the CoP, and (d) fractality which revealed a strong alignment of values and beliefs between CoP members and administrators, creating a cohesive picture of the whole organization, but divergence in the two groups’ approaches to realizing them

Trust And Healthcare: A Qualitative Analysis Of Trust In Spanish And English Language Group Well-Child Care

Trust and healthcare: a qualitative analysis of trust in Spanish and English language group well-child care Nicolas Muñoz, Patricia Nogelo, Benjamin Oldfield, Ada Fenick, Marjorie Rosenthal Yale Pediatric Primary Care Center and Yale Clinic for Hispanic Children, Department of Pediatrics Yale University School of Medicine, New Haven, CT Background: Trust, in the healthcare setting, is defined as the optimistic belief that providers and systems serve patient’s best interest. It is a multidimensional concept including competence, and value congruence, and exists due to patient vulnerability. Trust has been demonstrated to impact healthcare utilization. In pediatric patients, trust is key for strong and effective provider-patient relationships though Black and Latinx parents of children have lower trust in their physicians when compared to non-Hispanic white parents. Group well-child care (GWCC) is a model of care redesign that has been associated with increased trust among participants, and has demonstrated efficacy in serving black and Latinx as well as low socioeconomic families. This study aimed to describe themes related to trust among parents who participated in both English and Spanish language GWCC. Methods: GWCC includes a 90-minute health care visit in the first year of life that takes place instead of traditional well-child care. We performed purposeful interview sampling of parents who participated in either Spanish or English Language GWCC at the Yale Primary Care Center from 2016-2017 using a semi-structured interview guide. Directed content analysis was performed using a theoretical framework for trust in healthcare. Results: Twenty interviews were performed in total with half being parents in each Spanish and English GWCC. A majority of parents participating were mothers (81%), hispanic/latinx (56%) and 39% participated with their first liveborn child. Three themes related to trust and GWCC emerged: 1) group dynamic flattens traditional hierarchies in care, 2) opportunity for cross-validation and triangulation of information, and 3) structural competency from providers and the healthcare system is associated with trust. Conclusions: As healthcare is redesigned strategies to increase trust in healthcare for minority patients is important to achieve the triple aim of less per capita cost, greater population health and better patient experience. In this study we characterize how trust works in the GWCC setting, and facilitates structurally competent care for families

Minoritized Medical Students\u27 Integration of Professional Identities: A Phenomenological Study

This qualitative study fills a gap in the extant literature by exploring how medical students with minoritized identities make meaning about sense of self-definition and emerging professional identities while enrolled in medical school. More specifically, the focus of this study explored how minoritized medical students perceived their sense of self and dimensions of identity were shaped during their medical education, and what perceptions these medical students had about how they manage their professional identity development. Emergent themes included: (a) making connections between self-definition and professional identities, (b) past experience of difference shaping identities, (c) self-definition with complexity, (d) fluidity as a learner, (e) experiencing white coats differently, and (f) tailoring their white coats. A review of relevant literature, conceptual framing, research methods, researcher positionality, limitations of the study, discussion of the findings, implications and recommendations for practice, future research directions, and concluding thoughts are also included

Process, Factors, Resources, and Health Consequences of Burnout in Psychiatrists

Burnout among psychiatrists in the United States is prevalent; however, scholarly literature lacks studies exploring why psychiatrists are burnt out, what resources mitigate burnout, and the health implications of burnout, which is needed to improve health education programs for psychiatrists. Understanding the reasons for psychiatrist burnout, the resources that can mitigate burnout, and the health implications of burnout provided the purpose for this dissertation and foundation for the four research questions. The multidimensional theory of burnout, job demands-resource model, and the conservation of resources theory grounded the study. A qualitative, exploratory, multiple case study was conducted using data gathered from 14 participants. Surveys and semistructured interviews were thematically analyzed. Results indicated that the burnout process for psychiatrists occurred gradually over time, was precipitated by work stress, and was a multidimensional experience. Factors that contributed to burnout included feelings of ineffectiveness, challenging patients, lack of appreciation, secondary trauma, excessive work demands, insufficient organizational support, and burnout culture. Resources that were found to be protective included relational support, self-care, enhancing self-awareness, collaborative communication, notice and appreciation, manageable case load, and increased flexibility. Finally, results indicated that psychiatrists perceived both physical and mental health consequences as an outcome of their burnout; however, mental health consequences were prominent. This research could inform health promotion programs aimed at reducing burnout in psychiatrists, which could ultimately contribute to a reduction in psychiatrists leaving their job due to burnout

The Role of Argumentation in Hypothetico-Deductive Reasoning During Problem-Based Learning in Medical Education: A Conceptual Framework

One of the important goals of problem-based learning (PBL) in medical education is to enhance medical students’ clinical reasoning—hypothetico-deductive reasoning (HDR) in particular—through small group discussions. However, few studies have focused on explicit strategies for promoting students’ HDR during group discussions in PBL. This paper proposes a novel conceptual framework that integrates Toulmin’s argumentation model (1958) into Barrows’s HDR process (1994). This framework explains the structure of argumentation (a claim, data, and a warrant) contextualized in each phase of HDR during PBL. This paper suggests four instructional strategies—understanding argument structures, questioning, elaborating on structural knowledge, and assessing argumentation—for promoting medical students’ argumentation in relation to HDR processes. Further implications of the proposed framework for other disciplines, such as science, legal, and engineering education, are also discussed