Stigma in health facilities: Why it matters and how we can change it

Stigma in health facilities undermines diagnosis, treatment, and successful health outcomes. Addressing stigma is fundamental to delivering quality healthcare and achieving optimal health. This correspondence article seeks to assess how developments over the past 5 years have contributed to the state of programmatic knowledge - both approaches and methods - regarding interventions to reduce stigma in health facilities, and explores the potential to concurrently address multiple health condition stigmas. It is supported by findings from a systematic review of published articles indexed in PubMed, Psychinfo and Web of Science, and in the United States Agency for International Development's Development Experience Clearinghouse, which was conducted in February 2018 and restricted to the past 5 years. Forty-two studies met inclusion criteria and provided insight on interventions to reduce HIV, mental illness, or substance abuse stigma. Multiple common approaches to address stigma in health facilities emerged, which were implemented in a variety of ways. The literature search identified key gaps including a dearth of stigma reduction interventions in health facilities that focus on tuberculosis, diabetes, leprosy, or cancer; target multiple cadres of staff or multiple ecological levels; leverage interactive technology; or address stigma experienced by health workers. Preliminary results from ongoing innovative responses to these gaps are also described. The current evidence base of stigma reduction in health facilities provides a solid foundation to develop and implement interventions. However, gaps exist and merit further work. Future investment in health facility stigma reduction should prioritize the involvement of clients living with the stigmatized condition or behavior and health workers living with stigmatized conditions and should address both individual and structural level stigma

Child Studies Multiple - Collaborative play for thinking through theories and methods

This is the final version. Available on open access from Linköpings University Electronic Press via the DOI in this recordThis text is an exploration of collaborative thinking and writing through theories, methods, and experiences on the topic of the child, children, and childhood. It is a collaborative written text (with 32 authors) that sprang out of the experimental workshop Child Studies Multiple. The workshop and this text are about daring to stay with mess, “un-closure” , and uncertainty in order to investigate the (e)motions and complexities of being either a child or a researcher. The theoretical and methodological processes presented here offer an opportunity to shake the ground on which individual researchers stand by raising questions about scientific inspiration, theoretical and methodological productivity, and thinking through focusing on process, play, and collaboration. The effect of this is a questioning of the singular academic ‘I’ by exploring and showing what a plural ‘I’ can look like. It is about what the multiplicity of voice can offer research in a highly individualistic time. The article allows the reader to follow and watch the unconventional trial-and-error path of the ongoing-ness of exploring theories and methods together as a research community via methods of drama, palimpsest, and fictionary

Basic science232. Certolizumab pegol prevents pro-inflammatory alterations in endothelial cell function

Background: Cardiovascular disease is a major comorbidity of rheumatoid arthritis (RA) and a leading cause of death. Chronic systemic inflammation involving tumour necrosis factor alpha (TNF) could contribute to endothelial activation and atherogenesis. A number of anti-TNF therapies are in current use for the treatment of RA, including certolizumab pegol (CZP), (Cimzia ®; UCB, Belgium). Anti-TNF therapy has been associated with reduced clinical cardiovascular disease risk and ameliorated vascular function in RA patients. However, the specific effects of TNF inhibitors on endothelial cell function are largely unknown. Our aim was to investigate the mechanisms underpinning CZP effects on TNF-activated human endothelial cells. Methods: Human aortic endothelial cells (HAoECs) were cultured in vitro and exposed to a) TNF alone, b) TNF plus CZP, or c) neither agent. Microarray analysis was used to examine the transcriptional profile of cells treated for 6 hrs and quantitative polymerase chain reaction (qPCR) analysed gene expression at 1, 3, 6 and 24 hrs. NF-κB localization and IκB degradation were investigated using immunocytochemistry, high content analysis and western blotting. Flow cytometry was conducted to detect microparticle release from HAoECs. Results: Transcriptional profiling revealed that while TNF alone had strong effects on endothelial gene expression, TNF and CZP in combination produced a global gene expression pattern similar to untreated control. The two most highly up-regulated genes in response to TNF treatment were adhesion molecules E-selectin and VCAM-1 (q 0.2 compared to control; p > 0.05 compared to TNF alone). The NF-κB pathway was confirmed as a downstream target of TNF-induced HAoEC activation, via nuclear translocation of NF-κB and degradation of IκB, effects which were abolished by treatment with CZP. In addition, flow cytometry detected an increased production of endothelial microparticles in TNF-activated HAoECs, which was prevented by treatment with CZP. Conclusions: We have found at a cellular level that a clinically available TNF inhibitor, CZP reduces the expression of adhesion molecule expression, and prevents TNF-induced activation of the NF-κB pathway. Furthermore, CZP prevents the production of microparticles by activated endothelial cells. This could be central to the prevention of inflammatory environments underlying these conditions and measurement of microparticles has potential as a novel prognostic marker for future cardiovascular events in this patient group. Disclosure statement: Y.A. received a research grant from UCB. I.B. received a research grant from UCB. S.H. received a research grant from UCB. All other authors have declared no conflicts of interes

Moving beyond homonormativity in teacher training: experiences from South Australia

As growing numbers of children from lesbian mother families enter the Australian education system, there comes with this an injunction to better include such families. The first step towards such inclusion should be to ensure that teachers are provided with knowledge about lesbian mother families that moves beyond simply refuting stereotypes, and towards acknowledgement of the specific experiences and needs of this family form. However, it is important that educators, when attempting to include lesbian mothers and their children, do not instantiate new norms when attempting to challenge old stereotypes. This paper reports on the development and application of a workshop aimed at providing education students at one South Australian university with a framework for understanding lesbian mother families that is critical of norms in all their forms, including amongst those who research lesbian mother families. It is suggested that the positive findings from the workshop may reflect the utility of challenging both heteronormativity and homonormativity in conjunction with one another so as to present students with a broadly critical approach to sexuality education.Damien W. Riggs and Clemence Du

Transsexual Bodies at the Olympics: The International Olympic Committee's Policy on Transsexual Athletes at the 2004 Athens Summer Games

Sport exists on the premise that males and females are radically different. (Barnes, 2004) Thus sex gradually became an object of great suspicion; the general and disquieting meaning that pervades our conduct and our existence, in spite of ourselves; the point of weakness where evil portents reach through to us; the fragment of darkness that we each carry with us: a general signification, a universal secret, an omnipresent cause, a fear that never ends. (Foucault, 1978: 69) In May 2004 the International Olympic Committee (IOC) implemented a policy enabling transsexual athletes to compete at the summer Olympic Games in Athens. The IOC Medical Commission proposed that transsexual athletes who had Sex Reassignment Surgery (SRS) before puberty shall be admitted to compe-tition; that all other transsexuals must be post-operative (SRS including external genitalia and gonadectomy); must have legal and governmental recognition o