Using digital technologies to facilitate social inclusion during the COVID-19 pandemic: Experiences of co-resident and non-co-resident family carers of people with dementia from DETERMIND-C19.

BACKGROUND: The COVID-19 pandemic triggered rapid and unprecedented changes in the use of digital technologies to support people's social inclusion. We examined whether and how co-resident and non-co-resident family carers of people with dementia engaged with digital technologies during this period. METHODS: Throughout November 2020-February 2021, we interviewed 42 family carers of people with dementia from our DETERMIND-C19 cohort. Preliminary analysis was conducted through Framework analysis, followed by an inductive thematic analysis. FINDINGS: Digital technologies served as a Facilitator for social inclusion by enabling carers to counter the effects of the differing restrictions imposed on them so they could remain socially connected and form a sense of solidarity, access resources and information, engage in social and cultural activities and provide support and independence in their caring role. However, these experiences were not universal as carers discussed some Challenges for tech inclusion, which included preferences for face-to-face contact, lack of technological literacy and issues associated with the accessibility of the technology. CONCLUSION: Many of the carers engaged with Information and Communication Technologies, and to a lesser extent Assistive Technologies, during the pandemic. Whilst carers experienced different challenges due to where they lived, broadly the use of these devices helped them realise important facets of social inclusion as well as facilitated the support they provided to the person with dementia. However, to reduce the 'digital divide' and support the social inclusion of all dementia carers, our findings suggest it is essential that services are attuned to their preferences, needs and technological abilities.

A policy pathway: Nursing's role in advancing diversity and health equity.

PURPOSE: The aim of this manuscript is to embolden nurses to engage in policy that promotes diversity, equity, inclusion, and belonging to advance health equity. BACKGROUND: It uses the Future of Nursing Report 2020-2030 to acknowledge the impact of structural racism and the need for a more equitable, just, and fair society. DISCUSSION: It also recognizes that nurses must harness their power and political will, to change and strengthen policies, so all nurses can practice to the full extent of their education and license. CONCLUSION: A case study of the response to COVID-19 in one underserved community is included to illustrate policy in action.

Ethics of participation and social inclusion of older persons in research: lessons learned from the COVID-19 pandemic in Singapore.

The COVID-19 pandemic brought about safe distancing measures that are unprecedented. This article details the impact of the pandemic across research studies involving older persons in Singapore, and assesses the different strategies used to adapt to their needs in the context of evolving public health measures. The pandemic exposed diverse experiences of vulnerability among older persons, pushing for critical reflections on ethics of participation and social inclusion as the new research normal. We emphasize the importance of practicing flexibility: consideration for differentiated approaches to recruitment and data collection that should be proactively embedded in research designs for older persons during the pandemic and beyond.

IMPROVing communication about diversity, equity, and inclusion in health professions education.

There has never been a stronger call for authenticity in health professions education than this moment in time. The health inequities laid bare by the COVID-19 syndemic (a concept that describes the clustering of SARS-CoV-2 infection and disease by political, social, and economic factors) compels health professions educators to learn how to best engage in, sustain, and deepen conversations on diversity, equity, and inclusion (DEI) within our learning environments. Health professions curricula should address such concerns through explicit faculty training programs in dialogue models of communication. In this commentary, I propose that medical improv can help refocus health professions training to the humanistic values of empathy for others and respect for multiple viewpoints. Medical improv refers to teaching methods that adapt improvisation principles and exercises to enhance professional competencies in the health professions, such as communication. I describe a training series implemented at one institution to prepare faculty facilitators to engage in conversations about DEI in a discussion-based core course on the social determinants of health for first year medical students called "Humanity in Medicine." Key elements of dialogue training, including examinations of identity and positionality, caretaking and team-making, and conversations with a skeptic, are viewed through the lens of improv exercises as a pedagogy in communication. I report on facilitator and medical students' positive response to facilitator training and the Humanity in Medicine course. Potential next steps towards a formal evaluation of the method, and outcomes assessments of the use of improv in health professions training are discussed.

21st Century Lens on Diversity, Equity, and Inclusion in Surgery Antiracism Symposium.

Inequities in society and health care combined with underlying structural and systemic racism have demonstrated significant consequences which have resulted in a renewed focus on the current state of diversity in health care and the field of surgery. However, efforts to combat racism and increase diversity and inclusion at all levels in the field of surgery require a comprehensive review, significant commitment, and purposeful action to achieve. These actions must include increasing diversity within training program recruitment, improving retention of minority and under-represented trainees, and implementing inclusive, transparent pathways to promotion, leadership, and involvement in scientific inquiry. This symposium brings together experts in surgery, health equity and policy to address antiracism, diversity, equity, and inclusion in a comprehensive manner ranging from workforce diversity and promotion, pipeline diversity, scholarly pursuits, social and political determinants of health.

Diversity, Equity, and Inclusion in Nursing: The Pathway to Excellence Framework Alignment.

The promotion of diversity, equity, and inclusion (DEI) in nursing is a topic of renewed importance, given the civil unrest following the death of George Floyd and identified disparities in health and health outcomes during the COVID-19 pandemic. Despite its progress, the nursing profession continues to struggle with recruiting and retaining a workforce that represents the cultural diversity of the patient population. The authors completed a review of the literature on DEI in nursing and found a scarcity of studies, and that a limitation exists due to the strength of the evidence examined. This article aims to provide a review of the literature on DEI in nursing, outcomes and strategies associated with organizational DEI efforts, and knowledge on how the American Nurses Credentialing Center Pathway to Excellence® Designation Program framework supports DEI initiatives. The authors further provided recommendations for nurse leaders and a checklist of proposed questions for assessing commitment, culture, and structural empowerment initiatives toward a more diverse, equitable, and inclusive organization.

Releasing prisoners during COVID-19: the impact of the support for the early release, perceived insecurity and political orientation on attitudes towards released prisoners in Portugal.

PURPOSE: This study aims to examine how prisoners' early release affects other citizens' perceived insecurity and their attitudes towards those released prisoners, and how citizens' political orientation influences these variables. DESIGN/METHODOLOGY/APPROACH: A total of 383 Portuguese participants were presented with a recommendation from the United Nations for the release of prisoners because of COVID-19 and then asked to fill in a questionnaire measuring their political orientation, support for the early release of prisoners, perceived insecurity regarding such measure and their attitudes towards the released prisoners. FINDINGS: Results showed that support for the release of prisoners during COVID-19 is associated with perceived insecurity and both, in turn, predicts inclusive attitudes regarding these prisoners, while only perceived insecurity is associated with an agreement with an intensification of social control measures. Right-wing participants were found to express the negative side. The more participants felt insecure, the more they believed released prisoners should not have the same rights as common citizens and the more they should be left out of the community. RESEARCH LIMITATIONS/IMPLICATIONS: The major limitation of this study concerns the sample: the authors collected answers from Portuguese participants exclusively, most of which held a university degree. PRACTICAL IMPLICATIONS: At least two major implications can be drawn from this study's results. These implications deal with prisoners' entrance in what can be considered a cycle of exclusion and the promotion of their social reintegration once they are released from prison. SOCIAL IMPLICATIONS: The findings point out the necessity to firstly put an effort in deconstructing the insecurity perception that results from the prospective of having prisoners back into society - that is to understand why it happens and how it can be reduced - promoting efficacy in the inclusion of these prisoners and preventing the emergence of controlling or protective approaches directed to these individuals in their return to society by enhancing people's awareness that the social reintegration of ex-prisoners will benefit the whole community. ORIGINALITY/VALUE: The authors present a different perspective of the impact that managing COVID-19 in prisons has on society.

Brazil: hate and intolerance in times of pandemic in a mixed-race country.

This paper intends to analyse the current political and social situation in Brazil and show how this context has influenced the management of the public health crisis generated by the COVID-19 pandemic. To this end, the authors conducted an investigation into Brazil's historical roots, which have not only engendered deep class differences but, also, social psychopathologies such as dissociation and perversion. Finally, this paper presents a symbolic analysis of social exclusion and how the mythical figure of Sophia can inspire a renewed movement of inclusion and tolerance.

Cet article se propose d'analyser la situation politique et sociale actuelle au Brésil et de montrer comment ce contexte a influencé la gestion de la crise sanitaire publique générée par la COVID-19. Dans ce but, les autrices ont conduit une enquête approfondie sur les racines historiques du Brésil, racines qui ont engendré non seulement de profondes différences de classes mais également des psychopathologies sociales, telles la dissociation et la perversion. Cet article présente en conclusion une analyse symbolique de l'exclusion sociale et montre comment le personnage mythique de Sophia peut inspirer un mouvement renouvelé d'inclusion et de tolérance.

El presente trabajo intenta analizar la situación actual política y social en Brasil y muestra como este contexto ha influenciado el manejo de la crisis de la salud pública generada por la pandemia del COVID-19. A este fin, las autoras llevaron a cabo una investigación sobre las raíces históricas de Brasil, las cuales, no solamente han generado profundas diferencias de clase, sino también psicopatologías sociales como disociación y perversión. Finalmente, el presente trabajo presenta un análisis simbólico de la exclusión social y cómo la figura mítica de Sophia puede inspirar un movimiento renovador de inclusión y tolerancia.

The impact of COVID-19 on the social inclusion of older adults with an intellectual disability during the first wave of the pandemic in Ireland.

BACKGROUND: Social restrictions and service closures from COVID-19 have negatively impacted social inclusion and well-being for some people with intellectual disabilities (IDs). METHODS: The fourth wave of a national longitudinal study on ageing in people with ID in Ireland was interrupted during the COVID-19 outbreak. Social inclusion data for pre-existing participants interviewed before COVID-19 (n = 444) were compared with data for pre-existing participants interviewed during/after lockdown (n = 62). RESULTS: More people interviewed after lockdown reported frequent family contact. Significantly greater numbers in the post-lockdown group reported access to and use of technology than the pre-lockdown group. Technology use was higher among those living in grouped residences supported by services compared with individuals living independently or with family. CONCLUSIONS: During the early stages of the COVID-19 pandemic in Ireland, many older adults with ID stayed connected with family and reported rates of contact higher than were reported by others before COVID-19. This connection may have been supported by a significant increase in technology use during the pandemic. However, uneven use of technology may disadvantage some including individuals living with family or independently. Given that COVID-19 restrictions are likely to continue to restrict social opportunities, increased digital support may assist more people with ID to use technology to maintain their social connections.

Inequalities and subjectivity: construction of praxis in the context of the COVID-19 pandemic in vulnerable territory / Desigualdades e subjetividade: construção da práxis no contexto da pandemia de covid-19 em território vulnerável

Resumo A questão da desigualdade social tem sido objeto de muitos estudos que buscam compreender como a dirimir na construção de sociedades mais justas. A pandemia de covid-19 acirrou situações de pobreza e violência vivenciadas pela população excluída de seus direitos. A complexidade da questão estudada exige a abertura de frentes de conhecimento interdisciplinares. Nesta perspectiva, os estudos sobre a afetividade no campo da psicologia sócio-histórica têm fortalecido o papel da subjetividade nos estudos sobre processos dialéticos de inclusão e exclusão social. O objetivo deste dossiê é buscar interpretações possíveis sobre a relação entre saúde e sociedade, visando construir subsídios para a implementação de políticas públicas. Desde 2012 têm sido desenvolvidos estudos, balizados principalmente na pesquisa participante, que consideram as práticas da atenção primária à saúde como desencadeadoras de temas associados ao processo saúde-doença-cuidado em território vulnerável de Cubatão. A hermenêutica de profundidade tem sido a principal referência de análise, que dialoga com o com a epistemologia qualitativa. Os artigos apresentados neste dossiê trazem ricas experiências e reflexões: cuidado em território de exclusão social e interseccional; participação social de lideranças comunitárias neste contexto; vivências da violência em território vulnerável.

Abstract Social inequality has been the subject of several studies seeking the understanding of how to mitigate this issue in the construction of fairer societies. The COVID-19 pandemic aggravated the poverty and violence situations experienced by right-deprived population groups. The complexity of this issue requires the setting of interdisciplinary research fronts. From this perspective, studies on affectivity in social-historical psychology reinforced the role of subjectivity in studies regarding dialectical processes of social inclusion and exclusion. The goal of this dossier is to investigate potential interpretations on the connection between health and society, aiming at building subsidies for the implementation of public policies. Since 2012, participatory research studies considering the practices of Primary Health Care as triggers associated with the health-disease-care process have been conducted in the vulnerable territory of Cubatão, State of São Paulo, Brazil. Depth hermeneutics was the main reference for analysis, which ties up with qualitative epistemology. The papers presented here display a wealth of experiences and considerations: care in a territory of social and intersectional exclusion; social participation of community leaders in this context; experiences with violence in a vulnerable territory.

From Diversity and Inclusion to Antiracism in Medical Training Institutions.

The glaring racial inequities in the impact of the COVID-19 pandemic and the devastating loss of Black lives at the hands of police and racist vigilantes have catalyzed a global reckoning about deeply rooted systemic racism in society. Many medical training institutions in the United States have participated in this discourse by denouncing racism, expressing solidarity with people of color, and reexamining their diversity and inclusion efforts. Yet, the stagnant progress in recruiting, retaining, and supporting racial/ethnic minority trainees and faculty at medical training institutions is well documented and reflects unaddressed systemic racism along the academic pipeline. In this article, the authors draw upon their experiences as early-career physicians of color who have led and supported antiracism efforts within their institutions to highlight key barriers to achieving meaningful progress. They describe common pitfalls of diversity and inclusion initiatives and call for an antiracist approach to systems change. The authors then offer 9 recommendations that medical training institutions can implement to critically examine and address racist structures within their organizations to actualize racial equity and justice.

Gender Bias: Another Rising Curve to Flatten?

The COVID-19 pandemic and the upheaval it is causing may be leading to novel manifestations of the well-established mechanisms by which women have been marginalized in professional roles, robbing the field of the increased collective intelligence that exists when diverse perspectives are embraced. Unconscious bias, gendered expectations, and overt hostility minimize the contributions of women in academic medicine to the detriment of all. The current environment of heightened stress and new socially distant forms of communication may be exacerbating these well-recognized obstacles to women contributing to the field. Of note, none of these actions requires ill intent; all they require is the activation of unconscious biases and almost instinctive preferences and behaviors that favor the comfortable and familiar leadership of men in a time of extreme stress. The authors argue that it is time to investigate the frequency of behaviors that limit both the recognition and the very exercise of women's leadership during this pandemic, which is unprecedented but nevertheless may recur in the future. Leaders in health care must pay attention to equity, diversity, and inclusion given increases in undermining and harassing behaviors toward women during this crisis. The longer-term consequences of marginalizing women may hamper efforts to combat the next pandemic, so the time to flatten the rising gender bias curve in academic medicine is now.

The Spatial Impacts of COVID-19 Restrictions on LGBTIQ Wellbeing, Visibility, and Belonging in Tasmania, Australia.

International emergency management and disaster risk reduction policies and planning have rarely included lesbian, gay, bisexual, transgender, intersex, and queer (LGBTIQ) people's specific health and wellbeing concerns, despite increasing research showing that these groups face some specific vulnerabilities and additional challenges. Emerging studies in the US and UK noted increased feelings of loneliness, minority stress, and vulnerability to family violence since the outbreak of COVID-19. However, little is known about LGBTIQ people's experiences of COVID-19 in Australia. This article explores the effects of COVID-19 on LGBTIQ mental health and wellbeing in Tasmania, Australia. Drawing on a survey of 231 LGBTIQ respondents aged 14-78, we use the spaces of wellbeing framework to examine the impacts of COVID-19 restrictions on LGBTIQ (in)visibility in relation to the public, private, and online spaces, arguing that COVID-19 restrictions affected LGBTIQ Tasmanians' experiences and use of spaces in ways that detracted from wellbeing, visibility, and belonging.

'Getting back to normality seems as big of a step as going into lockdown': the impact of the COVID-19 pandemic on people with early to middle stage dementia.

People with dementia can experience shrinkage of their social worlds, leading to a loss of independence, control and reduced well-being. We used 'the shrinking world' theory to examine how the COVID 19 pandemic has impacted the lives of people with early to middle stage dementia and what longer-term impacts may result. Interviews were conducted with 19 people with dementia and a thematic analysis generated five themes: the forgotten person with dementia, confusion over government guidance, deterioration of cognitive function, loss of meaning and social isolation, safety of the lockdown bubble. The findings suggest that the pandemic has accelerated the 'shrinking world' effect and created tension in how people with dementia perceive the outside world. Participants felt safe and secure in lockdown but also missed the social interaction, cognitive stimulation and meaningful activities that took place outdoors. As time in lockdown continued, these individuals experienced a loss of confidence and were anxious about their ability to re-engage in the everyday practises that allow them to participate in society. We recommend ways in which the government, communities and organisations might counteract some of the harms posed by this shrinking world.