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The main characteristic of Moebius syndrome is a lack of facial expressions, which involves stigmatization in many social contexts. We examined whether an applicant with this syndrome would be rated lower in personnel selection despite having equal qualifications. In two experiments, participants rated two applicants. Ratings of an applicant with Moebius syndrome were significantly lower when videos of job interviews had been watched without giving information about the syndrome. However, ratings did not differ when still images had been presented accompanied by an audio track or when participants were informed about Moebius syndrome ahead of the video. Discriminatory decisions in personnel selection could be reduced by educating about stigma, here, a neurologically caused lack of facial expressions., Competing Interests: Declaration of competing interest The authors declare not conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Representations of migrants influence how they are perceived by others. Hence, how children who have migrated or whose parents have migrated (Children in Migrant Families: CMFs) are represented in clinical practice guidelines (CPGs) for Swedish school health services (SHS) may influence how they are perceived by school nurses. Thus, this study aimed to explore representations of CMFs in school nurses' CPGs. Data consisted of 130 CPGs from municipalities in Sweden. Documents were analyzed using the "What is the Problem Represented to be" (WPR) approach - an analytic strategy for investigating embedded assumptions of "problems". In the analysis, Sarah Ahmed's work on "strangers" and "strangeness" was applied. In the CPGs, the CMFs and their health were repeatedly mentioned in conjunction with the need for particular or additional actions, efforts, or routines when assessing or discussing their health, to a degree beyond what is "usually" provided. This need was motivated by representing the CMFs and their health as being the same, yet different in relation to "Swedish" children in general. Thus, the children were not only represented as different, but they were "foreignized". These representations of difference and foreignness placed the children on a continuum in relation to what is recognized as "familiar" in their health, and constructed elastic boundaries between the strange and the familiar. By illustrating how these boundaries were used for difference-making between "familiar" and "strange", this study showed how CMFs are alternately represented as similar and different, and foreignized while provided with SHS aiming to make them "familiar"., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interests., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Against the backdrop of the healthcare inequities and maltreatment facing LGBT patients, recommendations have been made for the inclusion of LGBT health topics in nursing curricula. Based on data collected in focus group discussions with South African nursing students, we complicate the assumption that training focused on health-specific knowledge will effectively reform providers' prejudicial practices. Findings reveal ambivalence: silence and discrimination versus inclusive humanism. Participants drew on discourses of ignorance, religion, and egalitarian treatment to justify their inadequacy regarding LGBT patients; while doing so, however, they deployed othering discourses in which homophobic and transphobic disregard is rendered acceptable, and "scientifically" supported through binary, deterministic views of sexuality and gender. Such "expert" views accord with Foucault's notion of "grotesque discourse." We conclude with a discussion of the findings' implications for nursing education; we call for the recognition and teaching of binary ideology as a form of discursive violence over LGBT lives.

Everyday expression of prejudice continues to pose a social challenge across societies. We tend to assume that to the extent people are egalitarian, they are more likely to confront prejudice-but this might not necessarily be the case. We tested this assumption in two countries (US and Hungary) among majority members of society, using a behavioral paradigm for measuring confronting. Prejudice was directed at various outgroup minority individuals (African Americans, Muslims and Latinos in the US, and Roma in Hungary). Across four experiments (N = 1116), we predicted and found that egalitarian (anti-prejudiced) values were only associated with hypothetical confronting intentions, but not with actual confronting, and stronger egalitarians were more likely to overestimate their confronting than weaker egalitarians-to the point that while intentions differed, the actual confronting rate of stronger and weaker egalitarians were similar. We also predicted and found that such overestimation was associated with internal (and not external) motivation to respond without prejudice. We also identified behavioral uncertainty (being uncertain how to intervene) as a potential explanation for egalitarians' overestimation. The implications of these findings for egalitarians' self-reflection, intergroup interventions, and research are discussed., (© 2023. The Author(s).)

Importance: Stroke is the fifth-highest cause of death in the US and a leading cause of serious long-term disability with particularly high risk in Black individuals. Quality risk prediction algorithms, free of bias, are key for comprehensive prevention strategies., Objective: To compare the performance of stroke-specific algorithms with pooled cohort equations developed for atherosclerotic cardiovascular disease for the prediction of new-onset stroke across different subgroups (race, sex, and age) and to determine the added value of novel machine learning techniques., Design, Setting, and Participants: Retrospective cohort study on combined and harmonized data from Black and White participants of the Framingham Offspring, Atherosclerosis Risk in Communities (ARIC), Multi-Ethnic Study for Atherosclerosis (MESA), and Reasons for Geographical and Racial Differences in Stroke (REGARDS) studies (1983-2019) conducted in the US. The 62 482 participants included at baseline were at least 45 years of age and free of stroke or transient ischemic attack., Exposures: Published stroke-specific algorithms from Framingham and REGARDS (based on self-reported risk factors) as well as pooled cohort equations for atherosclerotic cardiovascular disease plus 2 newly developed machine learning algorithms., Main Outcomes and Measures: Models were designed to estimate the 10-year risk of new-onset stroke (ischemic or hemorrhagic). Discrimination concordance index (C index) and calibration ratios of expected vs observed event rates were assessed at 10 years. Analyses were conducted by race, sex, and age groups., Results: The combined study sample included 62 482 participants (median age, 61 years, 54% women, and 29% Black individuals). Discrimination C indexes were not significantly different for the 2 stroke-specific models (Framingham stroke, 0.72; 95% CI, 0.72-073; REGARDS self-report, 0.73; 95% CI, 0.72-0.74) vs the pooled cohort equations (0.72; 95% CI, 0.71-0.73): differences 0.01 or less (P values >.05) in the combined sample. Significant differences in discrimination were observed by race: the C indexes were 0.76 for all 3 models in White vs 0.69 in Black women (all P values <.001) and between 0.71 and 0.72 in White men and between 0.64 and 0.66 in Black men (all P values ≤.001). When stratified by age, model discrimination was better for younger (<60 years) vs older (≥60 years) adults for both Black and White individuals. The ratios of observed to expected 10-year stroke rates were closest to 1 for the REGARDS self-report model (1.05; 95% CI, 1.00-1.09) and indicated risk overestimation for Framingham stroke (0.86; 95% CI, 0.82-0.89) and pooled cohort equations (0.74; 95% CI, 0.71-0.77). Performance did not significantly improve when novel machine learning algorithms were applied., Conclusions and Relevance: In this analysis of Black and White individuals without stroke or transient ischemic attack among 4 US cohorts, existing stroke-specific risk prediction models and novel machine learning techniques did not significantly improve discriminative accuracy for new-onset stroke compared with the pooled cohort equations, and the REGARDS self-report model had the best calibration. All algorithms exhibited worse discrimination in Black individuals than in White individuals, indicating the need to expand the pool of risk factors and improve modeling techniques to address observed racial disparities and improve model performance.

Introduction: Pacific Islanders living in Hawai'i with ancestral ties to islands in the western Pacific region of Micronesia are common targets of uninhibited forms of prejudice in multiple sectors, including healthcare. Whether the explicit societal-level attitudes toward this group are reflected in implicit attitudes among healthcare providers is unknown; therefore, we designed a pilot study to investigate this question. Our study measures implicit racial bias toward Pacific Islanders from Micronesia among Obstetrician-Gynecologists (OB-GYNs) in Hawai'i., Methods: We developed 4 new implicit association tests (IATs) to measure implicit attitudes and associations (i.e., stereotypes) toward Pacific Islanders from Micronesia in 2 conditions: (1) Micronesians vs. Whites and (2) Micronesians vs. Japanese Americans. Participants were practicing OB-GYNs in Hawai'i. The study was conducted online and included survey questions on demographic and physician practice characteristics in addition to IATs. The primary outcome was the mean IAT D score. Associations between IAT D scores and demographic and practice characteristics were also analyzed., Results: Of the 49 OB-GYNs, 38 (77.6%) were female, mean age was 40 years, 29.5% were Japanese, 22.7% were White, and none were from a Micronesian ethnic group. The mean IAT D score in the Micronesian vs. White condition (N = 29) was 0.181, (SD: 0.465, p < 0.05) for the Attitude IAT and 0.197 (SD: 0.427; p < 0.05) for the Stereotype IAT., Conclusion: The findings from this pilot suggest a slight degree of implicit bias favoring Whites over Micronesians within this sample of OB-GYNs and warrant a larger investigation into implicit biases toward this unique and understudied Pacific Islander population., (© 2021. The Author(s).)

Background: National dementia guidelines provide recommendations about the most effective approaches to diagnosis and interventions. Guidelines can improve care, but some groups such as people with minority characteristics may be disadvantaged if recommended approaches are the same for everyone. It is not known if dementia guidelines address specific needs related to patient characteristics. The objectives of this review are to identify which countries have national guidelines for dementia and synthesise recommendations relating to protected characteristics, as defined in the UK Equality Act 2010: age, disability, gender identity, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex, and sexual orientation., Methods and Findings: We searched CINAHL, PsycINFO, and Medline databases and the Guideline International Network library from inception to March 4, 2020, for dementia guidelines in any language. We also searched, between April and September 2020, Google and the national health websites of all 196 countries in English and in each country's official languages. To be included, guidelines had to provide recommendations about dementia, which were expected to be followed by healthcare workers and be approved at a national policy level. We rated quality according to the iCAHE guideline quality checklist. We provide a narrative synthesis of recommendations identified for each protected characteristic, prioritising those from higher-quality guidelines. Forty-six guidelines from 44 countries met our criteria, of which 18 were rated as higher quality. Most guidelines (39/46; 85%) made at least one reference to protected characteristics, and we identified recommendations relating to age, disability, race (or culture, ethnicity, or language), religion, sex, and sexual orientation. Age was the most frequently referenced characteristic (31/46; 67%) followed by race (or culture, ethnicity, or language; 25/46; 54%). Recommendations included specialist investigation and support for younger people affected by dementia and consideration of culture when assessing whether someone had dementia and providing person-centred care. Guidelines recommended considering religion when providing person-centred and end-of-life care. For disability, it was recommended that healthcare workers consider intellectual disability and sensory impairment when assessing for dementia. Most recommendations related to sex recommended not using sex hormones to treat cognitive impairment in men and women. One guideline made one recommendation related to sexual orientation. The main limitation of this study is that we only included national guidelines applicable to a whole country meaning guidelines from countries with differing healthcare systems within the country may have been excluded., Conclusions: National guidelines for dementia vary in their consideration of protected characteristics. We found that around a fifth of the world's countries have guidelines for dementia. We have identified areas of good practice that can be considered for future guidelines and suggest that all guidelines provide specific evidence-based recommendations for minority groups with examples of how to implement them. This will promote equity in the care of people affected by dementia and help to ensure that people with protected characteristics also have high-quality clinical services., Competing Interests: The authors have declared that no competing interests exist.

Introduction: European societies are rapidly becoming multicultural. Cultural diversity presents new challenges and opportunities to communities that receive immigrants and migrants, and highlights the need for culturally safe healthcare. Universities share a responsibility to build a fair and equitable society by integrating cultural content in the nursing curricula. This paper aims to analyze European student nurses´ experience of learning cultural competence and of working with patients from diverse cultural backgrounds., Materials and Methods: A phenomenological approach was selected through a qualitative research method. 7 semi-structured focus groups with 5-7 students took place at the participants' respective universities in Spain, Belgium, Turkey and Portugal., Results: 5 themes and 16 subthemes emerged from thematic analysis. Theme 1, concept of culture/cultural diversity, describes the participants' concept of culture; ethnocentricity emerged as a frequent element in the students' discourse. Theme 2, personal awareness, integrates the students' self-perception of cultural competence and their learning needs. Theme 3, impact of culture, delves on the participants' perceived impact of cultural on both nursing care and patient outcomes. Theme 4, learning cultural competence, integrates the participants' learning experiences as part of their nursing curricula, as part of other academic learning opportunities and as part of extra-academic activities. Theme 5, learning cultural competence during practice placements, addresses some important issues including witnessing unequal care, racism, prejudice and conflict, communication and language barriers, tools and resources and positive attitudes and behaviors witnesses or displayed during clinical practice., Conclusion: The participants' perceived level of cultural competence was variable. All the participants agreed that transcultural nursing content should be integrated in the nursing curricula, and suggested different strategies to improve their knowledge, skills and attitudes. It is important to listen to the students and take their opinion into account when designing cultural teaching and learning activities., Competing Interests: The authors have declared that no competing interests exist.

Pervading global narratives suggest that political polarization is increasing, yet the accuracy of such group meta-perceptions has been drawn into question. A recent US study suggests that these beliefs are inaccurate and drive polarized beliefs about out-groups. However, it also found that informing people of inaccuracies reduces those negative beliefs. In this work, we explore whether these results generalize to other countries. To achieve this, we replicate two of the original experiments with 10,207 participants across 26 countries. We focus on local group divisions, which we refer to as fault lines. We find broad generalizability for both inaccurate meta-perceptions and reduced negative motive attribution through a simple disclosure intervention. We conclude that inaccurate and negative group meta-perceptions are exhibited in myriad contexts and that informing individuals of their misperceptions can yield positive benefits for intergroup relations. Such generalizability highlights a robust phenomenon with implications for political discourse worldwide., (© 2021. The Author(s), under exclusive licence to Springer Nature Limited.)

The objective of this study was to determine the attitudes, skill level, and preferred educational interventions of pediatric residents related to implicit bias and caring for diverse patient populations. A cross-sectional survey of pediatric residents at a single, large urban residency program was utilized. Surveys were completed by 88 (55%) residents who were 69% female and 35% non-White or mixed race. Almost all residents felt that it was very or extremely important to receive training on health disparities, diverse patient populations, and implicit bias. Self-assessment of skill level revealed that residents felt confident in areas often covered by cultural competency curricula, such as interpreter use, but were less confident in other areas. The top 3 areas identified for further training included implicit bias, working with transgender and gender nonconforming patients, and weight bias. For the majority of diversity and bias-related skills, prior training was significantly correlated with higher skill level ( P < .05).

Abstract: The field of physical medicine and rehabilitation should strive for a physician workforce that is ethnically/racially, sex, and ability diverse. Considering the recent realities of disparities in health outcomes related to COVID-19 and in racial injustice in the United States, we are called to be champions for antiracism and equity. The specialty of physical medicine and rehabilitation should be the leaders in fostering a culture of inclusion and pay special attention to the population of applicants who are underrepresented in medicine. The specialty needs tools to start addressing these disparities. This article aims to provide strategic and intentional evidence-based recommendations for programs to follow. Holistic review, implicit bias training, structured interviews, and targeted outreach for those underrepresented in medicine are some of the tools that will help students enter and become successful in our specialty. Furthermore, this article provides novel guidance and considerations for virtual interviews during the COVID-19 pandemic., Competing Interests: Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Escaping Nazi annexation of Austria, Sigmund Freud and his family left there in 1938 to live the rest of their lives in exile in the house now known as the Freud Museum in London. This paper is based upon the author's Holocaust Day Memorial Lecture delivered virtually at this museum on January 27, 2021, which marked the 75th anniversary of the liberation of Auschwitz-Birkenau, the largest Nazi death camp. Besides remembering those who were lost during World War II, the content of this paper includes a description of different types of massive traumas, with a focus on disasters at the hand of the Other, and their impact on individuals and large groups. Sigmund Freud's ideas about relationships between communities and countries with adjoining territories, as well as large-group psychology, are updated, and individuals' and large groups' needs to grasp onto large-group identities is explained and illustrated with case reports.

Background: The potential exists for unconscious bias to influence decisions throughout the admission process to nursing school and derail holistic admission review processes. Although little is known about unconscious bias in nursing school admissions, unconscious bias has been demonstrated in nurse educators at levels similar to the general population., Method: This article examines concepts of unconscious bias, factors that may interfere with accurate and fair assessment of applicants to nursing school, and ways to mitigate unconscious bias in the application and admission decision processes., Results: Interventions that have shown success in reducing unconscious bias center on increased awareness of the presence of unconscious bias and cognitive strategies that include motivation and effort to counter the unconscious bias., Conclusion: Creating structures in the admission process that promote fairness and reduce the risk of relying on automatic judgments can minimize the influence of unconscious bias on admission decisions. [ J Nurs Educ . 2021;60(6):317-323.] .

Within mainstream institutions such as colleges and universities, scientists and social leaders, alike, are faced with persistent and new challenges to forging paths toward inclusion among marginalized group members (e.g., Latino/a/x and African Americans). Integrating theoretical perspectives that conceptualize identity among marginalized groups as tied to culture and strengths with literatures on threat and stigma, we propose a "pride and prejudice" approach to inclusion. We provide support for the efficacy of inclusion as 2 pathways-one route that is associated with recognizing "pride" or the history and culture of marginalized groups and another that is related to reducing "prejudice" or perceived discrimination toward marginalized groups. Specifically, we demonstrate using actual demands for inclusion generated by students attending 80 colleges and universities that a pride and prejudice approach is consistent with collective calls for institutional change voiced by marginalized group members and their allies (Study 1). Then, Study 2, using longitudinal data of Latino/a/x and African American students (N = 1,967) attending 27 colleges and universities we reveal the impact of pride (e.g., taking an ethnic studies course) and prejudice (e.g., perceived discrimination) experiences on sense of belonging, and in turn academic and health outcomes (e.g., graduation rates, depression). We provide evidence for 1 theory-based process whereby individual experiences tied to pride and prejudice can impact belongingness through intragroup and intergroup relations. Theory and policy implications for institutional inclusion efforts including the importance of fostering ties to ingroup and outgoup members are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Scientific research aims to bring forward innovative ideas and constantly challenges existing knowledge structures and stereotypes. However, women, ethnic and cultural minorities, as well as individuals with disabilities, are systematically discriminated against or even excluded from promotions, publications, and general visibility. A more diverse workforce is more productive, and thus discrimination has a negative impact on science and the wider society, as well as on the education, careers, and well-being of individuals who are discriminated against. Moreover, the lack of diversity at scientific gatherings can lead to micro-aggressions or harassment, making such meetings unpleasant, or even unsafe environments for early career and underrepresented scientists. At the Organization for Human Brain Mapping (OHBM), we recognized the need for promoting underrepresented scientists and creating diverse role models in the field of neuroimaging. To foster this, the OHBM has created a Diversity and Inclusivity Committee (DIC). In this article, we review the composition and activities of the DIC that have promoted diversity within OHBM, in order to inspire other organizations to implement similar initiatives. Activities of the committee over the past four years have included (a) creating a code of conduct, (b) providing diversity and inclusivity education for OHBM members, (c) organizing interviews and symposia on diversity issues, and (d) organizing family-friendly activities and providing childcare grants during the OHBM annual meetings. We strongly believe that these activities have brought positive change within the wider OHBM community, improving inclusivity and fostering diversity while promoting rigorous, ground-breaking science. These positive changes could not have been so rapidly implemented without the enthusiastic support from the leadership, including OHBM Council and Program Committee, and the OHBM Special Interest Groups (SIGs), namely the Open Science, Student and Postdoc, and Brain-Art SIGs. Nevertheless, there remains ample room for improvement, in all areas, and even more so in the area of targeted attempts to increase inclusivity for women, individuals with disabilities, members of the LGBTQ+ community, racial/ethnic minorities, and individuals of lower socioeconomic status or from low and middle-income countries. Here, we present an overview of the DIC's composition, its activities, future directions and challenges. Our goal is to share our experiences with a wider audience to provide information to other organizations and institutions wishing to implement similar comprehensive diversity initiatives. We propose that scientific organizations can push the boundaries of scientific progress only by moving beyond existing power structures and by integrating principles of equity and inclusivity in their core values., (Copyright © 2021. Published by Elsevier Inc.)

Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

There is considerable evidence to suggest that individuals with mental illness as well as their carers and families are discriminated against across a number of domains. It is also well recognized that people with mental illness are likely to die younger than their counterparts who do not have mental illness. We propose that a Magna Carta is urgently needed to protect the rights of people with mental illness and help reduce discrimination. In this paper a background and rationale for this is offered alongside suggestions for reducing discrimination. The simple message is this; progress in health, economic, environmental and global development will not be made without improvements in mental health. The reasons are equally straightforward as mental illnesses cause more disability than any other health condition and bring enormous pain and suffering to individuals, their families and communities. These impacts lead to early death, damage to the economy and restrain individual progress. Every country needs to take urgent responsibility for defending the rights of individuals with mental illness.

The past decade has seen rapid growth in research that evaluates methods for reducing prejudice. This essay reviews 418 experiments reported in 309 manuscripts from 2007 to 2019 to assess which approaches work best and why. Our quantitative assessment uses meta-analysis to estimate average effects. Our qualitative assessment calls attention to landmark studies that are noteworthy for sustained interventions, imaginative measurement, and transparency. However, 76% of all studies evaluate light touch interventions, the long-term impact of which remains unclear. The modal intervention uses mentalizing as a salve for prejudice. Although these studies report optimistic conclusions, we identify troubling indications of publication bias that may exaggerate effects. Furthermore, landmark studies often find limited effects, which suggests the need for further theoretical innovation or synergies with other kinds of psychological or structural interventions. We conclude that much research effort is theoretically and empirically ill-suited to provide actionable, evidence-based recommendations for reducing prejudice.