Microaggressive incidents towards women in the healthcare context: A qualitative and intersectional perspective

Microaggressions are subtle forms of discrimination, expressed in slights, insults, invalidations and indignities directed to minority, marginalized and discriminated groups. Microaggressions are often unconsciously perpetrated, socially normalized and naturalized. The present qualitative study aimed to analyze and understand the microaggressive incidents experienced by women with different intersectional identities (White women, women of Color, immigrant women, straight women, LGBTQ+ women, functionally diverse women) in the Portuguese healthcare context. Semi-structured interviews, centered around the Critical Incident Technique, were conducted. Seventeen women that self-identified as feminists, activists and/or that were engaged with NGOs and organizations actively committed to social causes, participated in the study. Content and thematic techniques for qualitative analysis were used in order to recognize the different microaggressive forms (microinsults, microinvalidations, microinvalidations), levels of manifestation (verbal, nonverbal/behavioral, environmental) and themes perpetrated in the healthcare context. At the end of the study, and based on the information collected, brief vignettes showcasing critical incidents were created with the potential of being implemented in diversity training programmes.As microagressões são uma forma sutil de discriminação, expressas sob ofensas, insultos e invalidações e dirigidas a grupos sociais minoritários, marginalizados e discriminados. As microagressões são frequentemente perpetuadas de modo inconsciente, sendo socialmente normalizadas e naturalizadas. O presente estudo qualitativo incide sobre as situações de microagressão vividas por mulheres de diversas identidades interseccionais (mulheres brancas, mulheres negras, mulheres imigrantes, mulheres heterossexuais, mulheres LGBTQ+, e mulheres com diversidade funcional) no contexto de saúde português. A investigação foi conduzida através de entrevistas semiestruturadas, baseadas na "técnica de incidentes críticos". Participaram dezassete mulheres que se identificaram como feministas, ativistas e/ou envolvidas em organizações não governamentais e outras organizações ativamente comprometidas em causas sociais. Foi usada análise temática e análise de conteúdo aos dados recolhidos com o objetivo de identificar, entender e analisar as diversas formas de microagressão (microinsultos, microinvalidações, microassaltos), níveis de manifestação (verbal, não-verbal/comportamental, ambiental) e temas das microagressões perpetuadas no contexto de saúde português. No fim da dissertação, e com base nas informações obtidas, foram criadas vinhetas exemplificando alguns incidentes críticos, tendo em vista a sua implementação em programas de intervenção e formação para a diversidade

Feynman parametrization and Mellin summation at finite temperature

We show that the Mellin summation technique (MST) is a well defined and useful tool to compute loop integrals at finite temperature in the imaginary-time formulation of thermal field theory, especially when interested in the infrared limit of such integrals. The method makes use of the Feynman parametrization which has been claimed to have problems when the analytical continuation from discrete to arbitrary complex values of the Matsubara frequency is performed. We show that without the use of the MST, such problems are not intrinsic to the Feynman parametrization but instead, they arise as a result of (a) not implementing the periodicity brought about by the possible values taken by the discrete Matsubara frequencies before the analytical continuation is made and (b) to the changing of the original domain of the Feynman parameter integration, which seemingly simplifies the expression but in practice introduces a spurious endpoint singularity. Using the MST, there are no problems related to the implementation of the periodicity but instead, care has to be taken when the sum of denominators of the original amplitude vanishes. We apply the method to the computation of loop integrals appearing when the effects of external weak magnetic fields on the propagation of scalar particles is considered.Comment: 16 pages, 1 figure. Discussion expanded. References added. Published versio

Expressions of microaggressions against women in the healthcare context: a critical incident approach

Objetivo. Os pacientes pertencentes a minorias sociais podem ser expostos a várias formas de discriminação no contexto de cuidados de saúde. A investigação prévia nesta área não tem dado especial atenção às manifestações de microagressões dirigidas às mulheres e ao papel das identidades interseccionais. O presente estudo tem como objetivo realçar os temas subjacentes às manifestações de microagressões vividas por diversas mulheres em Portugal. Método. Recorrendo ao modelo de entrevista baseado na Técnica de Incidentes Críticos (Flanagan, 1954), entrevistaram-se 17 mulheres a propósito das microagressões vividas no contexto de cuidados de saúde. Entre as identidades interseccionais, algumas mulheres pertenciam a grupos minoritários baseados na etnicidade, LGB e diversidade funcional. Resultados. Foram identificados 17 temas relativos às microagressões, cinco dos quais dirigidos às mulheres no geral, e sete dirigidos às mulheres com identidades interseccionais específicas. Outros quatro temas refletiram atitudes microagressivas dos profissionais de saúde dirigidas a pacientes no geral, sem relação com o género ou à pertença a outras minorias sociais, e um tema foi criado para descrever microagressões sistémicas. Conclusões. Alguns dos temas encontrados foram relacionados com microagressões que as mulheres vivem no dia-a-dia, sendo agravados pela disparidade de poder entre profissionais de saúde e pacientes. Outros temas pareceram ser específicos do contexto de saúde e relacionados com a falta de abordagens centradas no/a paciente

Fulminant septic shock caused by Capnocytophaga canimorsus in Italy: Case report

Capnocytophaga canimorsus infection was recently recognized as a zoonosis. We report the first case of fulminant septic shock in Italy caused by this pathogen. The patient, with a history of splenectomy, died at the main hospital in Brescia with a presumptive diagnosis of sepsis. PCR and sequencing on post mortem samples confirmed C. canimorsus as a causative organism. Our purpose is to alert medical professionals to the virulence of C. canimorsus in asplenic and immunocompromised patients. Keywords: Capnocytophaga canimorsus, septic shock, PCR, sequencin

Fast simulations of patient-specific haemodynamics of coronary artery bypass grafts based on a POD-Galerkin method and a vascular shape parametrization

In this work a reduced-order computational framework for the study of haemodynamics in three-dimensional patient-specific configurations of coronary artery bypass grafts dealing with a wide range of scenarios is proposed. We combine several efficient algorithms to face at the same time both the geometrical complexity involved in the description of the vascular network and the huge computational cost entailed by time dependent patient-specific flow simulations. Medical imaging procedures allow to reconstruct patient-specific configurations from clinical data. A centerlines-based parametrization is proposed to efficiently handle geometrical variations. POD-Galerkin reduced-order models are employed to cut down large computational costs. This computational framework allows to characterize blood flows for different physical and geometrical variations relevant in the clinical practice, such as stenosis factors and anastomosis variations, in a rapid and reliable way. Several numerical results are discussed, highlighting the computational performance of the proposed framework, as well as its capability to carry out sensitivity analysis studies, so far out of reach. In particular, a reduced-order simulation takes only a few minutes to run, resulting in computational savings of 99% of CPU time with respect to the full-order discretization. Moreover, the error between full-order and reduced-order solutions is also studied, and it is numerically found to be less than 1% for reduced-order solutions obtained with just O(100) online degrees of freedom. (C) 2016 Elsevier Inc. All rights reserved

Beta-Blocker Use in Older Hospitalized Patients Affected by Heart Failure and Chronic Obstructive Pulmonary Disease: An Italian Survey From the REPOSI Register

Beta (β)-blockers (BB) are useful in reducing morbidity and mortality in patients with heart failure (HF) and concomitant chronic obstructive pulmonary disease (COPD). Nevertheless, the use of BBs could induce bronchoconstriction due to β2-blockade. For this reason, both the ESC and GOLD guidelines strongly suggest the use of selective β1-BB in patients with HF and COPD. However, low adherence to guidelines was observed in multiple clinical settings. The aim of the study was to investigate the BBs use in older patients affected by HF and COPD, recorded in the REPOSI register. Of 942 patients affected by HF, 47.1% were treated with BBs. The use of BBs was significantly lower in patients with HF and COPD than in patients affected by HF alone, both at admission and at discharge (admission, 36.9% vs. 51.3%; discharge, 38.0% vs. 51.7%). In addition, no further BB users were found at discharge. The probability to being treated with a BB was significantly lower in patients with HF also affected by COPD (adj. OR, 95% CI: 0.50, 0.37-0.67), while the diagnosis of COPD was not associated with the choice of selective β1-BB (adj. OR, 95% CI: 1.33, 0.76-2.34). Despite clear recommendations by clinical guidelines, a significant underuse of BBs was also observed after hospital discharge. In COPD affected patients, physicians unreasonably reject BBs use, rather than choosing a β1-BB. The expected improvement of the BB prescriptions after hospitalization was not observed. A multidisciplinary approach among hospital physicians, general practitioners, and pharmacologists should be carried out for better drug management and adherence to guideline recommendations

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950-2019 : a comprehensive demographic analysis for the Global Burden of Disease Study 2019

Background: Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods: 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings: The global TFR decreased from 2·72 (95% uncertainty interval [UI] 2·66–2·79) in 2000 to 2·31 (2·17–2·46) in 2019. Global annual livebirths increased from 134·5 million (131·5–137·8) in 2000 to a peak of 139·6 million (133·0–146·9) in 2016. Global livebirths then declined to 135·3 million (127·2–144·1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2·1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27·1% (95% UI 26·4–27·8) of global livebirths. Global life expectancy at birth increased from 67·2 years (95% UI 66·8–67·6) in 2000 to 73·5 years (72·8–74·3) in 2019. The total number of deaths increased from 50·7 million (49·5–51·9) in 2000 to 56·5 million (53·7–59·2) in 2019. Under-5 deaths declined from 9·6 million (9·1–10·3) in 2000 to 5·0 million (4·3–6·0) in 2019. Global population increased by 25·7%, from 6·2 billion (6·0–6·3) in 2000 to 7·7 billion (7·5–8·0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58·6 years (56·1–60·8) in 2000 to 63·5 years (60·8–66·1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019