Journal articles on the topic 'Women in combat – United States – Social aspects'

Women involved in all aspects of the United States Armed Forces face mental health needs that are unique from women in the general population. Because the most recent wars in Iraq and Afghanistan are involving more women in combat situations, social workers encounter female clients who are increasingly experiencing post-traumatic stress disorder, substance misuse, and sexual violence. Special attention must be paid particularly to women who serve in the National Guard or Reserves, as they have different concerns than enlisted active duty women. These concerns include less social support and fewer resources upon return from deployment. Thus, it is imperative for social workers in the community to be aware of these military women’s experiences and unique mental health challenges in order to effectively treat their needs.

This study uses system dynamics simulation to explore structural and socio-psychological dynamics associated with the United States Army’s gender integration initiatives for its infantry branch. In 2015, the Army’s Training and Doctrine Analysis Center (TRAC) published the “Gender Integration Study” and the “Ranger Assessment Study,” providing findings that helped shape the Army’s gender integration initiatives across its combat arms branches. The focus of these and many other gender integration studies predominantly focus on whether gender differences, physiological and/or psychological, affect one’s ability to meet requisite performance standards in combat arms branches. As an essential complement to the existing and ongoing performance-focused research, system dynamics modeling will provide a basis to assess social barriers that exist with the Army and American culture, inhibiting broad acceptance of women in the infantry.

Although stigma negatively impacts autistic people globally, the degree of stigma varies across cultures. Prior research suggests that stigma may be higher in cultures with more collectivistic orientations. This study aimed to identify cultural values and other individual differences that contribute to cross-cultural differences in autism stigma (assessed with a social distance scale) between college students in Lebanon ( n = 556) and those in the United States ( n = 520). Replicating prior work, stigma was lower in women than men and in the United States relative to Lebanon. Heightened autism knowledge, quality of contact with autistic people, openness to experience, and reduced acceptance of inequality predicted lower stigma. Collectivism was not associated with heightened stigma. Findings highlight the need to address structural inequalities, combat harmful misconceptions, and foster positive contact to combat stigma.

Rugby, a fast-paced, aggressive contact sport, has a high incidence of injury. This study examines why US women play rugby given the social stigma surrounding women’s participation in sports in general, particularly contact sports, and despite the high risk of injury. In a survey of their injury history and potential injury risk factors, 339 female rugby players from 14 teams of varied quality and levels of play from a wide geographic area in the United States were asked why they played the sport. Their responses indicate that women play rugby because they enjoy the game, they like the aggressive aspects of the sport, they appreciate the social aspects of the game, and they believe the sport provides them with positive benefits, such as increased fitness, confidence, and strength. The results of this study indicate that many women are willing to risk injury for the positive rewards that they associate with rugby.

Based on participant observation and in-depth interviews with 10 college-level female bodybuilders, this paper focuses on several aspects of female bodybuilding that are underexplored in existing literature, including purposeful gender transgressions, gender attribution, racialized bodies, and the conflation of sex, gender, and sexual preference. We draw on critical feminist theory and the social constructionist perspective to enhance collective understanding of the subversive possibilities emerging from female bodybuilders’ lived experience. Collectively, female bodybuilders’ experiences affect somatic and behavioral gender norms in a wider Western-type industrialized society such as the United States.

In the United States, economic inequality is both racialized and gendered, with Black and Latina women consistently at the bottom of the economic hierarchy. Relative to men (across racial groups) and White women, Black and Latina women often have less-desirable jobs, lower earnings, and higher poverty rates. In this essay, we draw attention to the role of the state in structuring such inequality. Specifically, we examine how public policy is related to racial inequities in economic positions among women. Applying an intersectional lens to the contemporary landscape of economic inequality, we probe the associations between public policies and economic outcomes. We find that policies have unequal consequences across subgroups of women, providing prima facie evidence that state-level decisions about how and where to invest resources have differential implications based on women's race and ethnicity. We encourage scholars to use aspects of our approach as springboards for better specifying and identifying the processes that account for heterogeneous policy effects across racial subgroups of women.

This article uses the hegemonic/counter-hegemonic framework of Italian scholar and activist Antonio Gramsci to explain how a movement known as social justice feminism emerged as a counter-hegemonic response to two hegemonic concepts established in and continued, respectively, the post-Civil War United States: laissez-faire industrial capitalism and patriarchal dominance. In four stages from 1899 through 1940, social justice feminists pursued the promotion of an “entering wedge” labor legislation strategy and the increasing participation of women in national politics, particularly in the Democratic Party. While substantially successful in its goals, social justice feminism failed in two important aspects: its inability to work independently of a patriarchal political system, and, most significant, its apparent refusal to include women of color.

Childhood obesity continues to rise in the United States, with now over 17% of children and adolescents considered overweight. Childhood obesity predisposes an entire generation to increased risk of chronic diseases and disabilities and is a severe threat to the economic well-being of the nation. At first thought, the solution to the obesity epidemic may seem simple: encourage people to eat less and exercise more. However, the reality is that behavioral change is difficult to achieve without also considering the interplay of genetics, biological processes, and social and environmental mechanisms. As such, investment in obesity research has been considered an important tool to combat obesity and obesity-related diseases. Childhood obesity research, in particular, has drawn considerable attention, given the lower cost of prevention relative to treatment and the high potential for long-term benefits at a population level.

Head Start, the federal program that provides preschool education, health, and social services for children from poor families, is one of the United States' most popular government programs. Created in 1965, it has endured as a symbol of commitment to children, serving just fewer than one million children a year in neighborhood sites across the country. Most accounts of Head Start's history do not start much before 1964 when Sargent Shriver, charged with directing Lyndon Johnson's antipoverty campaign, decided to focus funds on young children. Neither Shriver nor most of those he consulted in planning the new program were particularly conscious of earlier efforts to combat poverty by educating young children. Nevertheless, the program they designed carried forward important aspects of turn-of-the-twentieth-century free kindergartens and day nurseries, as well as the nursery schools sponsored by the federal government in the 1930s.

In this study, the aim was to describe the adaptation of the Conformity to Feminine Norms Inventory (CFNI; Mahalik et al., 2005) for the Spanish population. The CFNI is used to assess women's conformity to feminine norms in the United States of America, from a multidimensional perspective. The protocol of the International Test Commission was followed when adapting the inventory. The questionnaire was administered to 780 Spanish women between 18 and 59 years of age. Factor analysis revealed a similar profile to that obtained in the USA and, although it is different in some aspects, it supports the structure proposed by the authors. The reliability data (alpha coefficient of the total scale of .87) also confirm the validity of the CFNI for use in the Spanish population.

Matter regarding the political representation of women got the salient position in current era. In sequel of this, many countries focused to enhance participation of women in politics generally. Few of countries incorporated the quota system in their electoral process; others designed laws and policies regarding this concern. In the particular case of Pakistan, it is persistently showed a lenient attitude and easy going approach towards issues of women. Empowerment of women remained dependent on the type of regime, interests and prioritizes of leaders. Democratic policy making process have not adopted for the uplift and empowerment of women. This assignment paper describes only 12 clauses of CEDAW[1] which directly relates to social, cultural and political aspects of Pakistan, which became the signatory on Feb 6, 1996. Pakistan’s membership to CEDAW was the result of pressure from women related organizations, few of societal factors and governmental institutions who felt the need of development for women of Pakistan. The main purpose of this convention is to support the member states in bringing the gender equality in their societies. This convention necessitates the member parties for making the mechanism to combat all forms of gender discrimination through constitutional amendments, administrative and legal reforms.

In the United States since the conclusion of the Vietnam War, the Vietnam veteran has become known as a neglected, troubled, and even scorned individual. According to this view, the Vietnam veteran's problems began in Vietnam where he was forced to participate in a brutal and disturbing war in which he was under fire twenty-four hours a day. The enemy, the wily and tenacious Vietcong and North Vietnamese regulars, were not always clearly defined nor were they above hiding behind or using civilians, leading to the unintentional – and sometimes intentional – killing by American forces of noncombatants, including women and children. Due to the military's policy of limiting the tour of duty in the war zone to one year, combat groups lacked cohesion and suffered from low morale, resulting in the excessive use of marijuana and heroin and an eventual breakdown of discipline, leading to the “fragging” of officers who attempted to reimpose order.

There is a wealth of literature demonstrating the presence of bias throughout the American health care system. Despite acknowledging such presence, however, little is known about how bias functions within medical encounters, particularly how providers grapple with bias in their patient counseling and decision-making. We explore such processes through the case of contraceptive counseling, a highly raced, classed, and gendered context. In-depth interviews with 51 health care providers reveal that providers use four primary strategies to navigate and minimize bias in their care—using scientific rationale, employing “safe” biases, standardizing counseling, and implementing patient-centered care. Paradoxically, using these strategies can exacerbate rather than resolve bias. Understanding these bias management strategies reveals provider-held biases, how they manifest within appointments, and the potential consequences for patients’ health autonomy. Such knowledge informs interventions that promote contraceptive use among women in the United States, addresses bias in health care broadly, and thus ultimately helps combat health disparities.

There is significant evidence that the health needs of women and minorities have been neglected by a medical research community whose agendas and protocols tend to focus on more advantaged segments of society. In response, the National Institutes of Health (NIH) and Food and Drug Administration (FDA) in the United States have recently issued new policies aimed at increasing the utilization of women in clinical studies. As well, the U.S. Congress passed the NIH Revitalization Act of 1993, which specifically mandates increased inclusion of women and racial and ethnic groups in clinical studies. On the face of it, such gender and race-specific policies would appear to be morally problematic because traditionally ethics opposes the use of sex or race as legitimate criteria for distributions of benefits or burdens in social policies. Hence, these policies pose some significant moral questions. Feminist ethics provides us with a framework for evaluating such policies because of its readiness to recognize that socially and politically significant factors such as sex and race are morally relevant in setting public policy. Of course, feminist ethics does not simply endorse all appeals to sex and race but only the policies in which attention to such factors will contribute to social justice. In this essay, I Identify some of the Important ethical questions that a feminist ethics perspective raises about research policies devised to promote the Inclusion of women in clinical studies.

AbstractWe examine the heritability of psychological resilience among US adults aged 25 to 74 years. Using monozygotic and same sex dizygotic twin pairs from the National Survey of Mid-Life Development in the United States (MIDUS) we show that positive affect is equally heritable among men (h2= .60) and women (h2= .59). We then estimate the heritability of positive affect after controlling for an exhaustive list of social and inter-personal stressors, and we operationalize the residual for positive affect as resilience. According to this specification, the heritability of resilience is higher among men (h2= .52) compared to women (h2= .38). We show that self-acceptance is one of the most important aspects of psychological functioning that accounts for the heritability of resilience among both men and women. However, compared to women, men appear to derive additional benefits from environmental mastery that may enable otherwise sex-neutral resilient tendencies to manifest.

This paper aims to portray the overall picture of poverty in the world and mentions the key solution to overcome poverty from a critical perspective. The data and figures were quoted from a number of researchers and organizations in the field of poverty around the world. Simultaneously, the information strengthens the correlations among poverty and lack of education. Only appropriate philosophies of education can improve the country’s socio-economic conditions and contribute to effective solutions to worldwide poverty. In the 21st century, despite the rapid development of science and technology with a series of inventions brought into the world to make life more comfortable, human poverty remains a global problem, especially in developing countries. Poverty, according to Lister (2004), is reflected by the state of “low living standards and/or inability to participate fully in society because of lack of material resources” (p.7). The impact and serious consequences of poverty on multiple aspects of human life have been realized by different organizations and researchers from different contexts (Fraser, 2000; Lister, 2004; Lipman, 2004; Lister, 2008). This paper will indicate some of the concepts and research results on poverty. Figures and causes of poverty, and some solutions from education as a key breaker to poverty will also be discussed. Creating a universal definition of poverty is not simple (Nyasulu, 2010). There are conflicts among different groups of people defining poverty, based on different views and fields. Some writers, according to Nyasulu, tend to connect poverty with social problems, while others focus on political or other causes. However, the reality of poverty needs to be considered from different sides and ways; for that reason, the diversity of definitions assigned to poverty can help form the basis on which interventions are drawn (Ife and Tesoriero, 2006). For instance, in dealing with poverty issues, it is essential to intervene politically; economic intervention is very necessary to any definition of this matter. A political definition necessitates political interventions in dealing with poverty, and economic definitions inevitably lead to economic interventions. Similarly, Księżopolski (1999) uses several models to show the perspectives on poverty as marginal, motivation and socialist. These models look at poverty and solutions from different angles. Socialists, for example, emphasize the responsibilities of social organization. The state manages the micro levels and distributes the shares of national gross resources, at the same time fighting to maintain the narrow gap among classes. In his book, Księżopolski (1999) also emphasizes the changes and new values of charity funds or financial aid from churches or organizations recognized by the Poor Law. Speaking specifically, in the new stages poverty has been recognized differently, and support is also delivered in limited categories related to more specific and visible objectives, with the aim of helping the poor change their own status for sustainable improvement. Three ways of categorizing the poor and locating them in the appropriate places are (1) the powerless, (2) who is willing to work and (3) who is dodging work. Basically, poverty is determined not to belong to any specific cultures or politics; otherwise, it refers to the situation in which people’s earnings cannot support their minimum living standard (Rowntree, 1910). Human living standard is defined in Alfredsson & Eide’s work (1999) as follows: “Everyone has the right to a standard of living adequate for the health and well-being of himself and his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.” (p. 524). In addition, poverty is measured by Global Hunger Index (GHI), which is calculated by the International Food Policy Institute (IFPRI) every year. The GHI measures hunger not only globally, but also by country and region. To have the figures multi-dimensionally, the GHI is based on three indicators: 1. Undernourishment: the proportion of the undernourished as a percentage of the population (reflecting the share of the population with insufficient calorie intake). 2. Child underweight: the proportion of children under age 5 who are underweight (low weight for their age, reflecting wasting, stunted growth or both), which is one indicator of child under-nutrition. 3. Child mortality: the mortality rate of children under 5 (partially reflecting the fatal synergy of inadequate dietary intake and unhealthy environments). Apart from the individual aspects and the above measurement based on nutrition, which help partly imagine poverty, poverty is more complicated, not just being closely related to human physical life but badly affecting spiritual life. According to Jones and Novak (1999 cited in Lister, 2008), poverty not only characterizes the precarious financial situation but also makes people self-deprecating. Poverty turns itself into the roots of shame, guilt, humiliation and resistance. It leads the poor to the end of the road, and they will never call for help except in the worst situations. Education can help people escape poverty or make it worse. In fact, inequality in education has stolen opportunity for fighting poverty from people in many places around the world, in both developed and developing countries (Lipman, 2004). Lipman confirms: “Students need an education that instills a sense of hope and possibility that they can make a difference in their own family, school, and community and in the broader national and global community while it prepare them for multiple life choices.” (p.181) Bradshaw (2005) synthesizes five main causes of poverty: (1) individual deficiencies, (2) cultural belief systems that support subcultures of poverty, (3) economic, political and social distortions or discrimination, (4) geographical disparities and (5) cumulative and cyclical interdependencies. The researcher suggests the most appropriate solution corresponding with each cause. This reflects the diverse causes of poverty; otherwise, poverty easily happens because of social and political issues. From the literature review, it can be said that poverty comes from complex causes and reasons, and is not a problem of any single individual or country. Poverty has brought about serious consequences and needs to be dealt with by many methods and collective effort of many countries and organizations. This paper will focus on representing some alarming figures on poverty, problems of poverty and then the education as a key breaker to poverty. According to a statistics in 2012 on poverty from the United Nations Development Program (UNDP), nearly half the world's population lives below the poverty line, of which is less than $1.25 a day . In a statistics in 2015, of every 1,000 children, 93 do not live to age 5 , and about 448 million babies are stillborn each year . Poverty in the world is happening alarmingly. According to a World Bank study, the risk of poverty continues to increase on a global scale and, of the 2009 slowdown in economic growth, which led to higher prices for fuel and food, further pushed 53 million people into poverty in addition to almost 155 million in 2008. From 1990 to 2009, the average GHI in the world decreased by nearly one-fifth. Many countries had success in solving the problem of child nutrition; however, the mortality rate of children under 5 and the proportion of undernourished people are still high. From 2011 to 2013, the number of hungry people in the world was estimated at 842 million, down 17 percent compared with the period 1990 to 1992, according to a report released by the Food and Agriculture Organization of the United Nations (FAO) titled “The State of Food Insecurity in the World 2013” . Although poverty in some African countries had been improved in this stage, sub-Saharan Africa still maintained an area with high the highest percentage of hungry people in the world. The consequences and big problems resulting from poverty are terrible in the extreme. The following will illustrate the overall picture under the issues of health, unemployment, education and society and politics ➢ Health issues: According a report by Manos Unidas, a non- government organization (NGO) in Spain , poverty kills more than 30,000 children under age 5 worldwide every day, and 11 million children die each year because of poverty. Currently, 42 million people are living with HIV, 39 million of them in developing countries. The Manos Unidas report also shows that 15 million children globally have been orphaned because of AIDS. Scientists predict that by 2020 a number of African countries will have lost a quarter of their population to this disease. Simultaneously, chronic drought and lack of clean water have not only hindered economic development but also caused disastrous consequences of serious diseases across Africa. In fact, only 58 percent of Africans have access to clean water; as a result, the average life expectancy in Africa is the lowest in the world, just 45 years old (Bui, 2010). ➢ Unemployment issues: According to the United Nations, the youth unemployment rate in Africa is the highest in the world: 25.6 percent in the Middle East and North Africa. Unemployment with growth rates of 10 percent a year is one of the key issues causing poverty in African and negatively affecting programs and development plans. Total African debt amounts to $425 billion (Bui, 2010). In addition, joblessness caused by the global economic downturn pushed more than 140 million people in Asia into extreme poverty in 2009, the International Labor Organization (ILO) warned in a report titled The Fallout in Asia, prepared for the High-Level Regional Forum on Responding to the Economic Crisis in Asia and the Pacific, in Manila from Feb. 18 to 20, 2009 . Surprisingly, this situation also happens in developed countries. About 12.5 million people in the United Kingdom (accounting for 20 percent of the population) are living below the poverty line, and in 2005, 35 million people in the United States could not live without charity. At present, 620 million people in Asia are living on less than $1 per day; half of them are in India and China, two countries whose economies are considered to be growing. ➢ Education issues: Going to school is one of the basic needs of human beings, but poor people cannot achieve it. Globally, 130 million children do not attend school, 55 percent of them girls, and 82 million children have lost their childhoods by marrying too soon (Bui, 2010). Similarly, two-thirds of the 759 million illiterate people in total are women. Specifically, the illiteracy rate in Africa keeps increasing, accounting for about 40 percent of the African population at age 15 and over 50 percent of women at age 25. The number of illiterate people in the six countries with the highest number of illiterate people in the world - China, India, Indonesia, Brazil, Bangladesh and Egypt - reached 510 million, accounting for 70 percent of total global illiteracy. ➢ Social and political issues: Poverty leads to a number of social problems and instability in political systems of countries around the world. Actually, 246 million children are underage labors, including 72 million under age 10. Simultaneously, according to an estimate by the United Nations (UN), about 100 million children worldwide are living on the streets. For years, Africa has suffered a chronic refugee problem, with more than 7 million refugees currently and over 200 million people without homes because of a series of internal conflicts and civil wars. Poverty threatens stability and development; it also directly influences human development. Solving the problems caused by poverty takes a lot of time and resources, but afterward they can focus on developing their societies. Poverty has become a global issue with political significance of particular importance. It is a potential cause of political and social instability, even leading to violence and war not only within a country, but also in the whole world. Poverty and injustice together have raised fierce conflicts in international relations; if these conflicts are not satisfactorily resolved by peaceful means, war will inevitably break out. Obviously, poverty plus lack of understanding lead to disastrous consequences such as population growth, depletion of water resources, energy scarcity, pollution, food shortages and serious diseases (especially HIV/AIDS), which are not easy to control; simultaneously, poverty plus injustice will cause international crimes such as terrorism, drug and human trafficking, and money laundering. Among recognizable four issues above which reflected the serious consequences of poverty, the third ones, education, if being prioritized in intervention over other issues in the fighting against poverty is believed to bring more effectiveness in resolving the problems from the roots. In fact, human being with the possibility of being educated resulted from their distinctive linguistic ability makes them differential from other beings species on the earth (Barrow and Woods 2006, p.22). With education, human can be aware and more critical with their situations, they are aimed with abilities to deal with social problems as well as adversity for a better life; however, inequality in education has stolen opportunity for fighting poverty from unprivileged people (Lipman, 2004). An appropriate education can help increase chances for human to deal with all of the issues related to poverty; simultaneously it can narrow the unexpected side-effect of making poverty worse. A number of philosophies from ancient Greek to contemporary era focus on the aspect of education with their own epistemology, for example, idealism of Plato encouraged students to be truth seekers and pragmatism of Dewey enhanced the individual needs of students (Gutex, 1997). Education, more later on, especially critical pedagogy focuses on developing people independently and critically which is essential for poor people to have ability of being aware of what they are facing and then to have equivalent solutions for their problems. In other words, critical pedagogy helps people emancipate themselves and from that they can contribute to transform the situations or society they live in. In this sense, in his most influential work titled “Pedagogy of the Oppressed” (1972), Paulo Freire carried out his critical pedagogy by building up a community network of peasants- the marginalized and unprivileged party in his context, aiming at awakening their awareness about who they are and their roles in society at that time. To do so, he involved the peasants into a problem-posing education which was different from the traditional model of banking education with the technique of dialogue. Dialogue wasn’t just simply for people to learn about each other; but it was for figuring out the same voice; more importantly, for cooperation to build a social network for changing society. The peasants in such an educational community would be relieved from stressfulness and the feeling of being outsiders when all of them could discuss and exchange ideas with each other about the issues from their “praxis”. Praxis which was derived from what people act and linked to some values in their social lives, was defined by Freire as “reflection and action upon the world in order to transform it” (p.50). Critical pedagogy dialogical approach in Pedagogy of the Oppressed of Freire seems to be one of the helpful ways for solving poverty for its close connection to the nature of equality. It doesn’t require any highly intellectual teachers who lead the process; instead, everything happens naturally and the answers are identified by the emancipation of the learners themselves. It can be said that the effectiveness of this pedagogy for people to escape poverty comes from its direct impact on human critical consciousness; from that, learners would be fully aware of their current situations and self- figure out the appropriate solutions for their own. In addition, equality which was one of the essences making learners in critical pedagogy intellectually emancipate was reflected via the work titled “The Ignorant Schoolmaster” by Jacques Rancière (1991). In this work, the teacher and students seemed to be equal in terms of the knowledge. The explicator- teacher Joseph Jacotot employed the interrogative approach which was discovered to be universal because “he taught what he didn’t know”. Obviously, this teacher taught French to Flemish students while he couldn’t speak his students’ language. The ignorance which was not used in the literal sense but a metaphor showed that learners can absolutely realize their capacity for self-emancipation without the traditional teaching of transmission of knowledge from teachers. Regarding this, Rancière (1991, p.17) stated “that every common person might conceive his human dignity, take the measure of his intellectual capacity, and decide how to use it”. This education is so meaningful for poor people by being able to evoking their courageousness to develop themselves when they always try to stay away from the community due the fact that poverty is the roots of shame, guilt, humiliation and resistance (Novak, 1999). The contribution of critical pedagogy to solving poverty by changing the consciousness of people from their immanence is summarized by Freire’s argument in his “Pedagogy of Indignation” as follows: “It is certain that men and women can change the world for the better, can make it less unjust, but they can do so from starting point of concrete reality they “come upon” in their generation. They cannot do it on the basis of reveries, false dreams, or pure illusion”. (p.31) To sum up, education could be an extremely helpful way of solving poverty regarding the possibilities from the applications of studies in critical pedagogy for educational and social issues. Therefore, among the world issues, poverty could be possibly resolved in accordance with the indigenous people’s understanding of their praxis, their actions, cognitive transformation, and the solutions with emancipation in terms of the following keynotes: First, because the poor are powerless, they usually fall into the states of self-deprecation, shame, guilt and humiliation, as previously mentioned. In other words, they usually build a barrier between themselves and society, or they resist changing their status. Therefore, approaching them is not a simple matter; it requires much time and the contributions of psychologists and sociologists in learning about their aspirations, as well as evoking and nurturing the will and capacities of individuals, then providing people with chances to carry out their own potential for overcoming obstacles in life. Second, poverty happens easily in remote areas not endowed with favorable conditions for development. People there haven’t had a lot of access to modern civilization; nor do they earn a lot of money for a better life. Low literacy, together with the lack of healthy forms of entertainment and despair about life without exit, easily lead people into drug addiction, gambling and alcoholism. In other words, the vicious circle of poverty and powerlessness usually leads the poor to a dead end. Above all, they are lonely and need to be listened to, shared with and led to escape from their states. Community meetings for exchanging ideas, communicating and immediate intervening, along with appropriate forms of entertainment, should be held frequently to meet the expectations of the poor, direct them to appropriate jobs and, step by step, change their favorite habits of entertainment. Last but not least, poor people should be encouraged to participate in social forums where they can both raise their voices about their situations and make valuable suggestions for dealing with their poverty. Children from poor families should be completely exempted from school fees to encourage them to go to school, and curriculum should also focus on raising community awareness of poverty issues through extracurricular and volunteer activities, such as meeting and talking with the community, helping poor people with odd jobs, or simply spending time listening to them. Not a matter of any individual country, poverty has become a major problem, a threat to the survival, stability and development of the world and humanity. Globalization has become a bridge linking countries; for that reason, instability in any country can directly and deeply affect the stability of others. The international community has been joining hands to solve poverty; many anti-poverty organizations, including FAO (Food and Agriculture Organization), BecA (the Biosciences eastern and central Africa), UN-REDD (the United Nations Programme on Reducing Emissions from Deforestation and Forest Degradation), BRAC (Building Resources Across Communities), UNDP (United Nations Development Programme), WHO (World Health Organization) and Manos Unidas, operate both regionally and internationally, making some achievements by reducing the number of hungry people, estimated 842 million in the period 1990 to 1992, by 17 percent in 2011- to 2013 . The diverse methods used to deal with poverty have invested billions of dollars in education, health and healing. The Millennium Development Goals set by UNDP put forward eight solutions for addressing issues related to poverty holistically: 1) Eradicate extreme poverty and hunger. 2) Achieve universal primary education. 3) Promote gender equality and empower women. 4) Reduce child mortality. 5) Improve maternal health. 6) Combat HIV/AIDS, malaria and other diseases. 7) Ensure environmental sustainability. 8) Develop a global partnership for development. Although all of the mentioned solutions carried out directly by countries and organizations not only focus on the roots of poverty but break its circle, it is recognized that the solutions do not emphasize the role of the poor themselves which a critical pedagogy does. More than anyone, the poor should have a sense of their poverty so that they can become responsible for their own fate and actively fight poverty instead of waiting for help. It is not different from the cores of critical theory in solving educational and political issues that the poor should be aware and conscious about their situation and reflected context. It is required a critical transformation from their own praxis which would allow them to go through a process of learning, sharing, solving problems, and leading to social movements. This is similar to the method of giving poor people fish hooks rather than giving them fish. The government and people of any country understand better than anyone else clearly the strengths and characteristics of their homelands. It follows that they can efficiently contribute to causing poverty, preventing the return of poverty, and solving consequences of the poverty in their countries by many ways, especially a critical pedagogy; and indirectly narrow the scale of poverty in the world. In a word, the wars against poverty take time, money, energy and human resources, and they are absolutely not simple to end. Again, the poor and the challenged should be educated to be fully aware of their situation to that they can overcome poverty themselves. They need to be respected and receive sharing from the community. All forms of discrimination should be condemned and excluded from human society. When whole communities join hands in solving this universal problem, the endless circle of poverty can be addressed definitely someday. More importantly, every country should be responsible for finding appropriate ways to overcome poverty before receiving supports from other countries as well as the poor self-conscious responsibilities about themselves before receiving supports from the others, but the methods leading them to emancipation for their own transformation and later the social change.

The call for family and medical leave reform in the United States was largely the result of sweeping demographic shifts that occurred in the workforce after the 1950s, coupled with an ever-increasing life expectancy and changing social norms concerning the role of women as caretakers. By the early 1990s, the number of women in the workforce had nearly tripled from 1950. During that same period, life expectancy increased by six years for males and seven for females. Meanwhile, the first wave of the Depression-era generation began to reach the age of retirement. In short, the parents of American workers were living longer and retiring in greater numbers while more women, who were more likely to be informal caregivers, decided to join the workforce. As a result, many families with ill or elder parents began to turn to institutional long-term care.

The literature on China's social stratification and mobility has discussed the roles of family background and an individual's education attainment. This article aims to extend the existing literature by examining the interplay of these two aspects in fostering a homogeneous group of scientists, the members (yuanshi) of the Chinese Academy of Sciences (CAS, Zhongguo kexueyuan). Since its establishment in 1955, honorific CAS membership has been awarded to outstanding Chinese scientists in their respective fields. As of the end of 1997, a total of 859 Chinese natural scientists, including 40 women, had been elected to the five Academic Divisions of the CAS – Mathematics and Physics, Chemistry, Biological Sciences, Earth Sciences, and Technological Sciences (Table 1) – of whom 610 were alive. They have been renowned, nationally if not internationally, for their academic achievements and contributions, and they have a reputation and prestige similar to those enjoyed by their counterparts in other countries, such as members of the National Academy of Sciences in the United States and fellows of the Royal Society in Britain. Because the occupational prestige of scientists is very high in China, as it is in other countries, and following similar research on the scientific elite, it is reasonable to define CAS members as the Chinese scientific elite.

Although research indicates that competitiveness, defined as the desire to win in interpersonal situations, is an important individual difference that influences a range of social interactions, little research has focused on competitiveness in cultures outside the United States. This study investigated competitiveness in three cultures by comparing Chinese ( n = 61), Japanese ( n = 232), and American ( n = 161) undergraduate college students. Nationality and sex were compared on two scales of the revised Competitiveness Index. Analysis indicated that American students scored higher on Enjoyment of Competitiveness than Chinese and Japanese students, but no difference was found on Contentiousness. Men scored higher than women on Enjoyment of Competition but not on Contentiousness. The findings indicate that sex and cultural patterns influence some but not all aspects of competitiveness.

This volume of Frontiers: The Interdisciplinary Journal of Study Abroad offers a wide variety of approaches and topics in international education research. First, readers will note the geographic diversity that the articles represent; they examine study abroad topics in Africa, Argentina, Costa Rica, France, Nepal, Thailand, and Vietnam. Second, the articles cover a wide-range of issues, including language acquisition, risk management, recruitment of minority students for study abroad, evaluation of cultural integration, and financial inequities in study abroad. Third, this volume contains articles by a variety of authors, including U.S.-based study abroad administrators, faculty members, and on-site resident directors. Finally, the modes of inquiry are as varied as the topics and authors. Research approaches in this volume include survey instruments, interviews, participant observation, case studies, literature review, as well as analytical essays. This diversity of geography, issues, authors, and modes of inquiry has from the beginning characterized the content of Frontiers and been one of its chief strengths. When the first volume of Frontiers appeared in 1995, one was hard pressed to find many research-based and analytical studies in the field, let alone the diversity of such work that this volume represents. In this regard, Frontiers has matured along with the field of international education, and today, almost ten years later, this volume reflects the growing importance being placed on research on the critical aspects of our work. The opening article by Lilli Engle and John Engle, “Study Abroad Levels: Toward a Classification of Program Types,” offers a revolutionary perspective by which international educators may categorize and judge study abroad programs. Their proposed typology makes qualitative distinctions between study abroad program models based on their view of a spectrum of cultural immersion. Frontiers readers will find their analysis provocative, stimulating study abroad professionals to examine programming in useful ways. In “Women and Cultural Learning in Costa Rica: Reading the Contexts,” Adele Anderson reviews research on Costa Rica’s cultural context, student adjustment and tourism theory, relating them to American student experiences, and she includes data from ethnographic observations and interviews collected during three years as a resident director of short-term programs. Anderson introduces a tool that may be used by resident directors to guide student cultural adjustment more systematically. Mark Ritchie, an on-site resident director in Thailand, provides a very useful analysis of study abroad risk management in his article, “Risk Management in Study Abroad: Lessons from the Wilderness.” Ritchie draws upon the principles of wilderness education, especially as it is conducted in developing countries, in offering recommendations for study abroad risk management. Readers will appreciate his suggestions for reducing risk by applying the experiential techniques of wilderness education. J. Scott Van Der Meid’s study, “Asian Americans: Factors Influencing the Decision to Study Abroad,” examines the factors that influence Asian American students’ decision to study abroad, and provides useful suggestions for considering ways to increase study abroad participation among this population. As the field of study abroad continues to seek ways to increase minority participation in study abroad, Van Der Meid’s study offers a model for examining this question among all ethnic groups. In their analysis of an innovative Vietnam study abroad program, “History Lived and Learned: Students and Vietnam Veterans in an Integrative Study Abroad Course,” Raymond Scurfield, Leslie Root, and Andrew Wiest et al, analyze the collaborative learning experience of students and Vietnam veterans in a program that combined the teaching of Vietnam culture and military history with an exploration of the mental health aspects of combat and post-war recovery of the veterans. This article discusses the lessons learned from the experience of designing and implementing a study abroad program that integrates history education with therapeutic objectives. Jennifer Coffman and Kevin Brennan analyze the economic imbalance of African educational exchange with the United States in their article, “African Studies Abroad: Meaning and Impact of America’s Burgeoning Export Industry.” Coffman and Brennan recommend developing more equitable models of reciprocity by examining the economics of U.S. – African exchanges, and by reconsidering the ways in which African study abroad programs are conceived and implemented in light of their social and intellectual impact. “Development of Oral Communication Skills Abroad” by Christina Isabelli-Garcia examines the impact of a semester study abroad program in Argentina on the second language acquisition of three American university Spanish learners. Isabelli-Garcia’s study measures the development of two aspects of communications skills: first, fluency and performance in the oral functions of narration, and, second, description and supporting an opinion. Her study provides insight into the conditions of a study abroad program that best promote the acquisition of improved oral communication skills in a target language. In “Studying Abroad in Nepal: Assessing Impact,” Patricia Farrell and Murari Suvedi present the perceived impact of studying in Nepal on students’ academic program, personal development, and intellectual development. Using a survey instrument as well as interviews and case studies, the authors link the reported outcomes to the objectives of the study abroad program. We are pleased to include in this volume of Frontiers an essay by Patti McGill Peterson, “New Directions for the Global Century.” McGill Peterson’s analysis of the changing and challenging context for global education inspires us to meet the demands of the 21st century with determination, creativity, and enhanced global collaboration. This volume of Frontiers concludes with reviews of books of interest to international educators, each relating to diverse intellectual foundations of the field: Jean-Philippe Mathy’s Extrême-Occident: French Intellectuals and America, Louis Menand’s The Metaphysical Club: A Story of Ideas in America, and First Great Triumph: How Five Americans Made Their Country a World Power by Warren Zimmermann. We encourage our readers to continue to suggest books of interest, and to submit reviews for consideration. The update on the Forum on Education Abroad that appears at the back of this volume reflects the continuing fruitful collaboration between Frontiers and the Forum. Together with the Forum, Frontiers will continue to encourage and support research studies on study abroad topics, and to disseminate this research as widely as possible. The next volume of Frontiers, due to be published in November, 2004, will be our tenth anniversary volume. It is appropriate that this anniversary volume will be a Special Issue that focuses on the assessment of the learning outcomes of study abroad, a topic that reflects the maturation of a field that is now beginning to document the results of its activity. Other Special Issues that are in the planning stages include: curriculum integration and study abroad, the arts and study abroad, and student development and study abroad. Finally, I want to thank the new sponsors of Frontiers who, together with our existing sponsors, make the publication of this journal possible. The sponsors of Frontiers are institutions with a strong commitment to international education, and we are proud to be supported by them. The editorial board takes seriously its responsibility to provide the very best writing about and research on study abroad to our readers, and the support of our sponsors makes this mission possible. Brian J. Whalen Editor

Abstract Objectives To assess the relationship between perceived level of anxiety and concern with giving birth during COVID-19 and level of prenatal breastfeeding self-efficacy among a sample of pregnant persons in the United States. Methods A sample of 849 pregnant persons, representing all 50 states and 5 US territories, were recruited via social media advertisements to take a 78-item web-based survey between May and December of 2020. The survey items assessed prenatal breastfeeding self-efficacy using the valid PREP to BF scale, breastfeeding intention, anxiety with giving birth during COVID-19, concern for the baby being exposed at birth, and confusion with pregnancy recommendations during COVID-19. Results The sample, mean age 28.9 years, had a relatively high mean PREP to BF score (308.52 ± 62.74; range 39–390). Over 95% indicated a plan to incorporate breastmilk into their infant feeding routine either exclusively (68.96%) or in combination (26.5%). Seventy-one % were not confused by safe pregnancy recommendations, while 50.7% were “concerned” or “very concerned” their baby would be exposed to COVID-19 at birth, and 63.3% indicated they were “anxious” or “very anxious” about giving birth during the pandemic. One-way ANOVAs revealed persons with higher perceived anxiety (P = .024), more confusion over recommendations (P < .001), and more concern for their baby's exposure (P = .002) had significantly lower PREP to BF scores than their counterparts. Conclusions A pregnant person's anxiety, confusion over recommendations, and concern for their baby's safety had significant negative effects on prenatal self-efficacy for successful breastfeeding after birth during COVID-19. Prenatal healthcare teams should aim to discuss these aspects and reassure of proven safety protocols with pregnant patients to ease anxiety, confusion, or fear while helping to maintain or improve self-efficacy for the intended infant feeding method. Funding Sources This material is based upon work supported by the National Institute of Food and Agriculture, US Department of Agriculture, Hatch project LAB94426.

This paper seeks to examine two conflicting strands in the United States Supreme Court's treatment of “freedom of association,” by exploring some aspects of the historical development of the doctrine. It suggests that there are two conceptions of “freedom of association,” an older, traditional one, that eschews forcing odious contact on members of associations, and a newer one which privileges antidiscrimination doctrines over “freedom from association.” These two conceptions still exist on the Court, resulting in irreconcilable decisions such as those permitting the Boy Scouts to exclude gay scoutmasters, but forcing the Jaycees to accept women. The preference of one conception over the other is also evident in the work of different scholars, whose doctrinal approaches are similarly irreconcilable. The Supreme Court has explained the discontinuities in the doctrine by seeking to characterize it in terms of the First Amendment's “freedom of speech” clause, but the paper argues that it makes more sense, in the context of these two cases, to regard them as related to the First Amendment's “freedom of religion” clauses.

Introduction. South Asians in the United States have a high prevalence of obesity and an elevated risk for cardiometabolic diseases. Yet, little is known about how aspects of neighborhood environment influence cardiometabolic risk factors such as body mass index (BMI) in this rapidly growing population. We aimed to investigate the association between perceived neighborhood social cohesion and BMI among South Asians. Methods. We utilized cross-sectional data from the MASALA study, a prospective community-based cohort of 906 South Asian men and women from the San Francisco Bay area and the greater Chicago area. Multivariable linear regression models, stratified by sex, were used to examine the association between perceived level of neighborhood social cohesion and individual BMI after adjusting for sociodemographics. Results. Participants were 54% male, with an average age of 55 years, 88% had at least a bachelor’s degree, and the average BMI was 26.0 kg/m2. South Asian women living in neighborhoods with the lowest social cohesion had a significantly higher BMI than women living in neighborhoods with the highest cohesion (β coefficient = 1.48, 95% CI 0.46–2.51, p=0.02); however, the association was not statistically significant after adjusting for sociodemographic factors (β coefficient = 1.06, 95% CI −0.01–2.13, p=0.05). There was no association between level of neighborhood social cohesion and BMI in South Asian men. Conclusion. Perceived neighborhood social cohesion was not significantly associated with BMI among South Asians in our study sample. Further research is recommended to explore whether other neighborhood characteristics may be associated with BMI and other health outcomes in South Asians and the mechanisms through which neighborhood may influence health.

Background:Increasing rates of HIV have been observed in women, African Americans, and Hispanics, particularly those residing in rural areas of the United States. Although cardiovascular (CV) complications in patients infected with human immunodeficiency virus (HIV) have significantly decreased following the introduction of antiretroviral therapy on a global scale, in many rural areas, residents face geographic, social, and cultural barriers that result in decreased access to care. Despite the advancements to combat the disease, many patients in these medically underserved areas are not linked to care, and fewer than half achieve viral suppression.Methods:Databases were systematically searched for peer-reviewed publications reporting infectious and non-infectious etiologies of cardiovascular disease in HIV-infected patients. Relevant articles cited in the retrieved publications were also reviewed for inclusion.Results:A variety of outcomes studies and literature reviews were included in the analysis. Relevant literature discussed the manifestations, diagnosis, treatment, and outcomes of infectious and non-infectious etiologies of cardiovascular disease in HIV-infected patients.Conclusion:In these medically underserved areas, it is vital that clinicians are knowledgeable in the manifestations, diagnosis, and treatment of CV complications in patients with untreated HIV. This review summarizes the epidemiology and causes of CV complications associated with untreated HIV and provide recommendations for management of these complications.

This paper proposes an analysis of the legal aspects present in the narrative of “The Handmaid´s Tale”, a novel by Margaret Atwood. First published in 1985, and heavily influenced by second-wave feminism, “The Handmaid´s Tale” addresses, mainly, the matter of gender inequality, once it creates a reality in which fertile women are compelled to reproduce through a servitude system. Through a rupture with the Cartesian dichotomy whose dualist notion separates objectivity from subjectivity, reason from emotion, this paper exposes that this oppression is not a literary creation by Atwood, but a reproduction of the power relations put forward in the history of humankind. In this regard, it is explored how Literature can aid the Law in facing the questions that come up in the resolution of legal and social problems. Besides gender inequality, it is possible to spot in the novel several violations concerning the principle of human dignity. Therefore, this research analyzes the legal provisions taken in the fictional space of Gilead, as well as in the country that preceded it, the United States of America, as well as in Brazil. In addition, it studies the symbolic violence to which women are submitted in Gilead and how it relates to the experiences lived by contemporary Brazilian women.

The article deals with the definition of a female police officer position in Ukrainian society. The position of women who serve in the bodies of the national police of Ukraine and the observance of female police officers’ rights have been investigated. It was clarified that equality is the foundation of a democratic society that strives for social justice and respect human rights. But, unfortunately, for some reasons, women are discriminated almost in all spheres of life. It was noted that our state, being at the stage of formation of a gender society and law in general, has the goal of the European choice, and many steps have already been done for achieving this goal. Ukraine has pledged to fulfill general international duties to ensure gender equality. Having chosen the European vector of development, our state has ratified a number of international documents, one of which was the order of the cabinet of ministers of Ukraine «on the approval of the national plan for the implementation of un security council resolution no. 1325 Women, Peace, Security for the period up to 2020». Аn resolution 1325 is dedicated to those states where armed conflicts take place, therefore this document is relevant for Ukraine. Thus, gender equality is one of the conditions for ensuring social development. For example, the United Nations provides gender-sensitive policing throughout the United Nations police work as an urgent need to address the differentiated security needs of women, men, girls and boys. A positive moment, testifying to the improvement in the field of gender equality, is the constant increase in the number of women in the ranks of the national police of Ukraine. We consider that this fact improves the image and the attitude of citizens towards the police, because women are more trusted than men in some issues. We state that achieving gender equality ensures preventing violence, protecting the rights of all people and the opportunity to make a meaningful contribution to public life. All mentioned above aspects are impossible without women. Therefore, in the future we plan to study this issue in more detail.

Abstract Approximately 30% of men and women in the United States have experienced age discrimination (Rippon, Zaninotto, & Steptoe, 2015). Experiencing age discrimination may lead to increased risk of depressive symptoms among older adults. Although positive social environments are known to buffer depressive symptoms, it is unknown to what extent a positive social environment may buffer the association between age discrimination and depressive symptoms for older adults in the US. The purpose of this study is to examine the association between perceived age discrimination and depressive symptoms among older adults, and to explore whether this association varies by two aspects of the social environment: social support and neighborhood environment. We explore this topic with data on 5,439 adults aged 50 and older in a sample drawn from the Psychosocial Module of the Health and Retirement Study (HRS, 2016 wave). Our results show a clear association between age discrimination and increased risk of depressive symptoms, net of a range of covariates. Older adults who receive more positive social support and rate their neighborhood environment more positively also report lower depressive symptoms. Finally, we find statistically significant interactions between age discrimination and both measures of the social environment, which suggest that social support and a positive neighborhood environment may buffer the negative impact of age discrimination on depressive symptoms. We discuss these findings in light of the prevalence of age discrimination in the US and cross-nationally, and consider potential mechanisms for improving the social environment of older adults, particularly in the post-COVID era.

We conducted 15 in-depth interviews with women and men in Germany, Switzerland, Finland, Canada, and the United States who were victims of doxxing. The goal was to understand their experiences, their responses, and the consequences they faced. We understand doxxing as a complex, gendered communicative process of harassment. Doxxers use digital media technologies to expose personal information without consent given by those to whom the personal information belongs. We apply a feminist approach to surveillance studies to doxxing, focusing on the constructions of daily, habitual, and ubiquitous assemblages of veillances that disproportionately impact vulnerable individuals. We found that gendered aspects shaped the flow and suspected intent of doxxing and subsequent harassment. Victims experienced uncertainty, loss of control, and fear, while law enforcement and social media providers only helped in a few cases to pursue doxxers or remove unwanted personal information. We ultimately extend the definition of doxxing by considering the ubiquitous nature of information shared online in gendered veillance cultures. Our findings lead us to advocate for protecting the contextual integrity of entering personal information into expected, intentional, or desired spaces.

Originally published in 1994, The Innocence of the Devil, by the Egyptian feminist Nawal El Saadawi, has been reissued in a paperback edition with a striking cover. Included in this edition is a well-written and well-documented Introduction by Fedwa Malti-Douglas, which provides a review of El Saadawi's life, a summary of the story, and insights into many aspects of the book. Malti-Douglas is a professor of Near Eastern Languages and Cultures at Indiana University, Bloomington, and a commentator on El Saadawi's works and life. El Saadawi, a medical doctor and a writer, has used both her fiction and nonfiction as social commentaries on Egyptian—and more specifically, Muslim—society. She was educated in Cairo and the United States, practiced as a physician in Egypt, was director of health education in the Egyptian Ministry of Health from 1958 to 1972, has served on United Nations commissions, and is a practicing psychiatrist. Over the years, she has written several nonfiction books along with numerous short stories and novels. In this book, she comments on many facets of Egyptian culture, but the main thrust is that religion is the underlying cause of women's oppression. She emphasizes theological patriarchy in terms of monotheism (a single male god), the weakness of Eve as fallen woman, a male Satan (the serpent), and males designated as religious leaders who hold authority over women.

Abstract Objectives The USAID's Strengthening Multisectoral Nutrition Programming through Implementation Science Activity (MSNP) in Bangladesh gathered local knowledge to augment national data to ensure nutrition programming delivery was appropriately targeted. Such knowledge allowed MSNP's social protection conditional cash transfer (CCT) activity to reach most at-risk individuals. Methods Using structured field observation forms, six trained staff documented nutrition programming decision-making processes and MSNP project activities regarding appropriate beneficiary targeting in six districts. Numerous project documents were reviewed and site visits conducted to evaluate CCT implementation in action. Data were coded into three aspects of learning (challenges and methods to alleviate them, successes, and recommendations for future programming) and analyzed according to themes identified in research utilization literature. Results CCT, an incentive-based delivery mechanism targeting women based on locally collected data, positively influenced household decision-makers, including women, to provide effective health and nutrition care for themselves and their children. CCT, received upon completion of antenatal care visits and participation in nutrition education sessions, effectively supported the uptake of MSNP community workers’ nutrition advice led to improve water, sanitation, and hygiene practices in remote areas. Requiring CCT beneficiaries to open bKash accounts to ensure financial transparency and that funds reached the intended participants helped establish women as nutrition decision makers, improving financial inclusion for extreme-poor women. Conclusions CCT stimulates use of nutrition and health services, increasing household resources for nutrition-related behaviors and allowing women to exercise financial freedom. To improve evidence utilization in nutrition programming, national indicators must be complemented with local knowledge gathering processes, with local stakeholders and beneficiaries involved to ensure appropriate targeting and to transform knowledge into practice. Funding Sources United States Agency for International Development (USAID).

Opioid use during pregnancy is on the rise in the United States. Neonatal abstinence syndrome (NAS), also known as newborn drug withdrawal, is a public health epidemic. Between 2004 and 2014, Tennessee experienced a fivefold increase in NAS hospitalizations, from 1.5 to 8.0 per 1,000 live births. Soaring increases in the number of newborns with NAS nationwide have caught the attention of many federal and state lawmakers, especially given the unknown burdens associated with medical and social services needed by those affected over time. Tennessee opioid-related regulations and laws enacted between 2000 and 2018 were systematically reviewed and analyzed to identify each law's purpose; effects on families and individuals; pros and cons in terms of social, practical, and legal factors; and implications for nursing practice. Our findings were that Tennessee's laws are intended to decrease the number of opioids prescribed, ensure access to continued prenatal care and substance abuse management for mothers with substance use disorders, and reduce the ease of obtaining opioids. We also found that Tennessee lawmakers have enacted laws and regulations aimed at decreasing the abuse of opioids, but not reducing the incidence of NAS. As new laws are considered, it is critical that health care providers and lawmakers work together to ensure that the developed and enacted laws strike a balance between safely managing the care of both pregnant women and their newborns without producing negative outcomes.

In most other nations, insurance for medical care is called sickness insurance, and it covers sick people. In the United States, we have “health insurance,” and its major carriers — commercial insurers, large employers, and increasingly government programs — strive to avoid sick people and cover only the healthy. This perverse logic at the heart of the American health insurance system is the key to reform debates.Focusing on sick people versus healthy people might seem a strange way to view the coverage issue. Most discussions of insurance categorize people into other groupings: the insured versus the uninsured; Caucasian whites versus other racial and ethnic groups; men versus women; poor and low-income people versus everybody else; children, adults, and the elderly; or citizens versus immigrants and undocumented aliens. More recently, health researchers have begun talking about “vulnerable populations,” using most of the same demographic groupings and adding other illness-inducing factors such as social isolation, stress, and impoverished neighborhoods. But as I will show, insurance plans now use premiums, cost-sharing, and other design features in ways that indirectly divide each of these groups into the sick and the healthy, to the detriment of the sick. By shifting the costs of illness onto people who use medical care — that is, sick people — market-oriented reforms of the last few decades have eroded insurance in the name of strengthening it.

This paper attempts a reading of Rohinton Mistry’s novel A Fine Balance (1997) and Gloria Naylor’s Linden Hills (1985) envision insights from recent developments in eco-criticism and eco-feminism. Through Gender theory eco-feminism substantiates the silence of women in Linden Hills. Eco-criticism is a form of literary criticism based on ecological perspectives. It investigates the relation between human and the natural world in literature, such as the way in which environmental issues, cultural issues concerning the environment and attitudes towards nature are presented and analyzed. One of the main goals of eco-criticism concerns the environment and attitudes towards nature and ecological aspects. This form of criticism has gained a lot of attention during recent years (approximately since 2000) due to greater social emphasis on environmental destruction as a result of increased technology. It is hence a way of analyzing and interpreting literary texts. Eco critics investigate such things as the underlying ecological values, what, precisely, is meant by the word nature, and whether the examination of “Place” should be a distinctive category, gender or race. By examining the eco critical discourse in A Fine Balance, the paper posits that Mistry’s vision of development in India is predicated on the conditions of sustainability. The Ecological Feminism is an interdisciplinary movement which interrogates the new ways of thought process concerning natural world, diplomacy, and mysticism. Eco-feminist speculation has exacting and important association between females and natural world. Eco-feminism understands the suppression of women and their mistreatment in phrases of the subjugation and operation of the environment. Naylor discusses gender conditioned with eco-feminism perspectives. She scrutinizes United States as a “Place”, in relation to race of Linden Hills. The postcolonial feminist theory contends that through novel, A Fine Balance comparing with Linden Hills, Mistry interrogate the difficulties of maintaining natural and human diversity in the contemporary economic and social development in the Indian subcontinent. The aspects of paper are tailoring sustainability, ecology, eco - feminism and environment, urbanization and modernization, creation of ecological imbalance and the use of nature ‘as an end to all means’.

AbstractPurposeThis article is part of an ongoing body of investigation examining the experiences of lawyers with diverse and multiple minority identities, with particular focus on lawyers with disabilities; lawyers who identify as lesbian, gay, bisexual, transgender, and queer (“LGBTQ+” as an overarching term); and lawyers with minority identities associated with race and ethnicity, gender, and age. The focus of this article is on discrimination and bias in their workplaces as reported by the lawyers experiencing it.MethodsWe employ survey data from the first phase of this investigation, gathered from the survey responses of 3590 lawyers located across all states in the United States and working in most types and sizes of legal venues. The data were collected between 2018 and 2019, before the 2020 pandemic. We estimate differences across three categories of discrimination reported—subtle-only discrimination, overt-only discrimination, and both subtle and overt discrimination. We estimate the nature and magnitude of associations among individual and organizational variables, and we use multinomial logistic regression to illustrate relative risks of reports of discrimination for intersecting identities.ResultsAs compared to non-disabled lawyers, lawyers with disabilities show a higher likelihood of reporting both subtle and overt discrimination versus no discrimination. Similarly, lawyers who identify as lesbian, gay, bisexual, and queer (“LGBQ”) show a higher likelihood of reporting both subtle and overtdiscrimination, and subtle-only discrimination, as compared to lawyers who identify as straight/heterosexual. Women lawyers and lawyers of color are more likely to report all three types of discrimination. In general, younger lawyers are more likely to report subtle-only discrimination when compared to older lawyers. Lawyers working at a private firm are less likely to report all types of discrimination, while working for a larger organization is associated with a higher relative risk of reporting subtle-only discrimination versus no discrimination.ConclusionsThe current study represents a next, incremental step for better understanding non-monochromatic and intersectional aspects of individual identity in the legal profession. The findings illustrate that primary individual and multiple minority identities, as identified by disability, sexual orientation, gender, race/ethnicity, and age, are associated with reports of discrimination and bias in the legal workplace.

Partner abuse research over the past two decades has divided violent, threatening, or abusive phenomena into discrete areas of interest to researchers that, although distinct, are still broadly defined under the common category of “domestic abuse” or, more recently, intimate partner violence (IPV). Thus, any concerted attempt to typify the various substrata of IPV research must recognize the distinct features of each area regarding their component parts (i.e., behavioral or psychological sequelae, incidence and prevalence, and social or interpersonal context) while maintaining the overarching categorical commonality as variants of IPV.This article constitutes a contemporaneous and systematic review of the research on three aspects of controlling coercive violence (CCV): emotional abuse, sexual coercion, and stalking or obsessive behavior, along with a separate examination of when these IPV substrata are combined with physical assaults on intimate partners. Each CCV substrata is operationally defined in research terms common to the social science research, and tabular and narrative data is provided on the incidence and prevalence of each substrata and the combined category. Notable findings derived from this review are reported for each of the three aspects of CCV. For emotional abuse, prevalence rates might average around 80%, with 40% of women and 32% of men reporting expressive aggression (i.e., verbal abuse or emotional violence in response to some agitating or aggravating circumstance) and 41% of women and 43% of men reporting some form of coercive control. For sexual coercion, national samples demonstrated the widest disparity by gender of victim, with 0.2% of men and 4.5% of women endorsing forced sexual intercourse by a partner. By far, the largest selection of highly variable studies, stalking and obsessive behaviors showed a range from 4.1% to 8.0% of women and 0.5% to 2.0% of men in the United States have been stalked at some time in their life. Women were reported as having a significantly higher prevalence (7%) of stalking victimization than men (2%). For all types of violence, except being followed in a way that frightened them, strangers were the most common perpetrators; as reported in approximately 80% of cases, women were most often victimized by men they knew, most frequently, their current or former intimate partners. Among women who reported repeated unwanted contact, current (15.9%) and former (32.9%) intimate partners were the perpetrators in nearly half of the most recent incidents and the largest subdivision of reports came from college or university student samples.A separate examination reports of these types of IPV combined with physical assaults on intimate partners reported the strongest link was between stalking and other forms of violence in intimate relationships: 81% of women who were stalked by a current or former husband or cohabiting partner were also physically assaulted by that partner and 31% reported being sexually assaulted by that partner. Of the types of IPV reported on, most forms of violence that show the highest rates of reportage come from large national samples, with smaller samples showing increased variability. This article concludes with a brief section delineating conclusions that can be drawn from the review and the potential implications for research, practice, and IPV scholarship.

There is a striking lack of studies on the Palestinian diaspora. Undoubtedlythe pioneering work of Edward Said (“Reflections on Exile,” in Out There:Marginalization and Contemporary Cultures, eds. Russell Ferguson [TheMIT Press: 1990]) on exile and Rashid Khalidi (Palestinian Identity: TheConstruction of Modern National Consciousness [Columbia UniversityPress: 1997]) both touch on many of the related issues of collective memory,cultural identity, and the relationship between the “center” (the homeland)and the diasporic communities and how these issues manifestedthemselves in the Palestinian case. More recently, Abbas Shiblak (Reflectionson Palestinian Diaspora in Europe [2000]), Sari Hanafi (Here andThere: Analyses of the Relationship between Diaspora and the Centre [2001:in Arabic]), and Helena Schulz and Juliane Hammer (The Palestinian Diaspora:Formation of Identities and Politics of Homeland [Routledge: 2003])explore different aspects of the Palestinian diaspora.Juliane Hammer’s new study examines young Palestinian returnees aspart of a larger social, historical, political, and cultural framework (p. 114).She conducted her research in the mid-1990s, a crucial period between twophases: one of peace and hope following the signing of the Declaration ofPrinciples in 1993, and another one that started in 1997 with the deteriorationand breakdown of the peace talks, and, consequently, with the eruption of thesecond Intifada in 2000. For her survey, she chose a sample of two main categoriesof young returnees: those of the Palestinian Authority strata (a`idin)and the children of Palestinian expatriates who live in the West but mainly inthe United States (Amerikans). The interviewees were mainly adolescent oryoung men and women from and around Ramalla and Jerusalem.The return process has been described chronologically, as a series offive steps or stages ranging from the decision to return to plans for the nearfuture. As the study argues, this return entails a process of the returnees’rewriting aspects of their identities. Hammer does not see, however, that thechronological approach is the only way of looking at the process of return.She sees the transformation (what she calls the “rewriting of identities”) alsoby dividing “identity” into different aspects, and then investigating how therespondents remembered these aspects from their childhood and youth in the ...

The creator, Kenja McCray, is an Associate Professor of History at Atlanta Metropolitan State College (AMSC), where she teaches United States and African American history. AMSC is an institution within the University System of Georgia offering an affordable liberal arts education and committed to serving a diverse, urban student population. McCray has a B.A. from Spelman College, an M.A. from Clark Atlanta University, and a Ph.D. from Georgia State University. Her areas of interest are the 19th and 20th century U. S., African Americans, Africa and the diaspora, transnational histories, women, class and social history. The creator of this essay believes education should be a life-altering process, not only in the intellectual or the economic sense, but also cognitively uplifting. She experienced personal change in college through interacting with professors. She strives to give students a similarly inspirational experience. The encounter should be empowering and should change the way they see themselves and their relationships to the world. The intent of this creative piece is to share the creator’s contemplations on a rites of passage program in which she participated during her college years. She asserts that, given current cultural trends signaling a renewed interest in African-centered ideals and black pride, many aspects of the program could interest current students looking for safe spaces in increasingly intolerant times. This essay will interest researchers, student leaders, student activities advisors, and other administrators seeking to create and develop inclusive campus programs.

The relevance of the article is that the analysis of the legislation of foreign countries gives grounds to assert that in most countries of the world legislation on combating domestic violence has not yet been adopted, and in those countries that have laws to prevent domestic violence has not yet had sufficient experience. combating this socially dangerous phenomenon, and some countries completely ignore measures related to domestic violence, although they have laws to combat domestic violence. The article examines the most positive experience in preventing domestic violence in Europe and other countries. It is established that the most acceptable for Ukraine is a positive experience in preventing domestic violence in European countries. It has been established that in Austria the police are empowered to evict offenders and impose prohibition orders. The country has established “intervention centers” that provide free counseling, assistance and support to victims of domestic violence. In the Republic of Bulgaria, such a form of punishment is provided as public condemnation, which is manifested in the public condemnation of the violator before the labor collective in which he works or before the organization of which he is a member. It was found that the practice of cooperation between the police and the community in overcoming the problem of domestic violence, which is regulated by the Claire Act, is relevant. In the Federal Republic of Germany, domestic violence is not only aggressive and violent acts between a woman and a man, but also between children, parents, sisters and brothers. It is emphasized that in the Republic of Poland the public condemnation of the criminal act of the offender is a positive experience, because for offenders it is more unpleasant to condemn society than legal responsibility. In the United States, children’s social services are focused not only on the child, but also on the family as a whole. There are government and community commissions to investigate cases of violence in this state, and special shelters have been set up to house women with children who have left their homes due to ill-treatment.

Men commit suicide more frequently than women in nearly all parts of the world. This is due to a number of factors, including the fact that women tend to seek mental help relatively more often than men. Many developed countries have attempted to implement suicide prevention programmes and initiatives, but only a small proportion of these have targeted men directly. The aims of this paper are to highlight preventive measures focusing on mental problems experienced specifically by men, and provide a detailed description of these measures. Consequently, the paper has both theoretical and practical dimensions, outlining the challenges and presenting potential solutions. The study discusses selected examples of mental health actions targeting men which were carried out in several countries around the world including Japan (“Daddy, have you slept well?”), UK (“Heads Up” campaign), United States (“Real men. Real depression”), Canada (“HeadsUpGuys” campaign), and Australia (Movember), as well as social media campaigns (Instagram: #HereForYou). Men are often reluctant to reveal their mental problems (stress, low mood, insomnia, suicidal ideation), which can be attributed to the so-called macho culture existing in societies. The man is traditionally considered head of the family, a guardian and leader, a strong personality, and a person to rely on. This perception contributes to the fact that men tend not to admit their weaknesses in front of family or friends. It is recommended that preventive actions take into account such aspects as the transfer of knowledge, skills and competences in the areas of identification of mental problems, and abilities to cope with a crisis situation. Mental health actions should be launched in areas frequently visited by men including workplaces, buses, pubs, bars, sports clubs, stadiums or other meeting places, so that the information can reach the largest possible target group.

The DebateQuestion 1: Various commentators have frequently invoked the importance of moderate Muslims and the role that they can play in fighting extremism in the Muslim world. But it is not clear who is a moderate Muslim. The recent cancellation of Tariq Ramadan’s visa to the United States, the raids on several American Muslim organizations, and the near marginalization of mainstream American Muslims in North America pose the following question: If moderate Muslims are critical to an American victory in the war on terror, then why does the American government frequently take steps that undermine moderate Muslims? Perhaps there is a lack of clarity about who the moderate Muslims are. In your view, who are these moderate Muslims and what are their beliefs and politics? GEF: Who is a moderate Muslim? That depends on whom you ask and what that person’s (or government’s) agenda is. Moderate is also a quite relative term, understood differently by different people. For our purposes here, let’s examine two basically different approaches to this question: an American view and a Middle Eastern view of what characterizes a moderate Muslim. Most non-Muslims would probably define a moderate Muslim as anyone who believes in democracy, tolerance, a non-violent approach to politics, and equitable treatment of women at the legal and social levels. Today, the American government functionally adds several more criteria: Amoderate Muslim is one who does not oppose the country’s strategic and geopolitical ambitions in the world, who accepts American interests and preferences within the world order, who believes that Islam has no role in politics, and who avoids any confrontation – even political – with Israel. There are deep internal contradictions and warring priorities within the American approach to the Muslim world. While democratization and “freedom” is the Bush administration’s self-proclaimed global ideological goal, the reality is that American demands for security and the war against terror take priority over the democratization agenda every time. Democratization becomes a punishment visited upon American enemies rather than a gift bestowed upon friends. Friendly tyrants take priority over those less cooperative moderate and democratic Muslims who do not acquiesce to the American agenda in the Muslim world. Within the United States itself, the immense domestic power of hardline pro-Likud lobbies and the Israel-firsters set the agenda on virtually all discourse concerning the Muslim world and Israel. This group has generally succeeded in excluding from the public dialogue most Muslim (or even non-Muslim) voices that are at all critical of Israel’s policies. This de facto litmus test raises dramatically the threshold for those who might represent an acceptable moderate Muslim interlocutor. The reality is that there is hardly a single prominent figure in the Muslim world who has not at some point voiced anger at Israeli policies against the Palestinians and who has not expressed ambivalence toward armed resistance against the Israeli occupation of Palestinian lands. Thus, few Muslim leaders enjoying public legitimacy in the Muslim world can meet this criterion these days in order to gain entry to the United States to participate in policy discussions. In short, moderate Muslimis subject to an unrealistic litmus test regarding views on Israel that functionally excludes the great majority of serious voices representative of genuine Muslim thinkers in the Middle East who are potential interlocutors. There is no reason to believe that this political framework will change in the United States anytime soon. In my view, a moderate Muslim is one who is open to the idea of evolutionary change through history in the understanding and practice of Islam, one who shuns literalism and selectivism in the understanding of sacred texts. Amoderate would reject the idea that any one group or individual has a monopoly on defining Islam and would seek to emphasize common ground with other faiths, rather than accentuate the differences. Amoderate would try to seek within Islam the roots of those political and social values that are broadly consonant with most of the general values of the rest of the contemporary world. A moderate Muslim would not reject the validity of other faiths. Against the realities of the contemporary Middle East, a moderate Muslim would broadly eschew violence as a means of settling political issues, but still might not condemn all aspects of political violence against state authorities who occupy Muslim lands by force – such as Russia in Chechnya, the Israeli state in the Palestine, or even American occupation forces in Iraq. Yet even here, in principle, a moderate must reject attacks against civilians, women, and children in any struggle for national liberation. Moderates would be open to cooperation with the West and the United States, but not at the expense of their own independence and sovereignty.

The DebateQuestion 1: Various commentators have frequently invoked the importance of moderate Muslims and the role that they can play in fighting extremism in the Muslim world. But it is not clear who is a moderate Muslim. The recent cancellation of Tariq Ramadan’s visa to the United States, the raids on several American Muslim organizations, and the near marginalization of mainstream American Muslims in North America pose the following question: If moderate Muslims are critical to an American victory in the war on terror, then why does the American government frequently take steps that undermine moderate Muslims? Perhaps there is a lack of clarity about who the moderate Muslims are. In your view, who are these moderate Muslims and what are their beliefs and politics? GEF: Who is a moderate Muslim? That depends on whom you ask and what that person’s (or government’s) agenda is. Moderate is also a quite relative term, understood differently by different people. For our purposes here, let’s examine two basically different approaches to this question: an American view and a Middle Eastern view of what characterizes a moderate Muslim. Most non-Muslims would probably define a moderate Muslim as anyone who believes in democracy, tolerance, a non-violent approach to politics, and equitable treatment of women at the legal and social levels. Today, the American government functionally adds several more criteria: Amoderate Muslim is one who does not oppose the country’s strategic and geopolitical ambitions in the world, who accepts American interests and preferences within the world order, who believes that Islam has no role in politics, and who avoids any confrontation – even political – with Israel. There are deep internal contradictions and warring priorities within the American approach to the Muslim world. While democratization and “freedom” is the Bush administration’s self-proclaimed global ideological goal, the reality is that American demands for security and the war against terror take priority over the democratization agenda every time. Democratization becomes a punishment visited upon American enemies rather than a gift bestowed upon friends. Friendly tyrants take priority over those less cooperative moderate and democratic Muslims who do not acquiesce to the American agenda in the Muslim world. Within the United States itself, the immense domestic power of hardline pro-Likud lobbies and the Israel-firsters set the agenda on virtually all discourse concerning the Muslim world and Israel. This group has generally succeeded in excluding from the public dialogue most Muslim (or even non-Muslim) voices that are at all critical of Israel’s policies. This de facto litmus test raises dramatically the threshold for those who might represent an acceptable moderate Muslim interlocutor. The reality is that there is hardly a single prominent figure in the Muslim world who has not at some point voiced anger at Israeli policies against the Palestinians and who has not expressed ambivalence toward armed resistance against the Israeli occupation of Palestinian lands. Thus, few Muslim leaders enjoying public legitimacy in the Muslim world can meet this criterion these days in order to gain entry to the United States to participate in policy discussions. In short, moderate Muslimis subject to an unrealistic litmus test regarding views on Israel that functionally excludes the great majority of serious voices representative of genuine Muslim thinkers in the Middle East who are potential interlocutors. There is no reason to believe that this political framework will change in the United States anytime soon. In my view, a moderate Muslim is one who is open to the idea of evolutionary change through history in the understanding and practice of Islam, one who shuns literalism and selectivism in the understanding of sacred texts. Amoderate would reject the idea that any one group or individual has a monopoly on defining Islam and would seek to emphasize common ground with other faiths, rather than accentuate the differences. Amoderate would try to seek within Islam the roots of those political and social values that are broadly consonant with most of the general values of the rest of the contemporary world. A moderate Muslim would not reject the validity of other faiths. Against the realities of the contemporary Middle East, a moderate Muslim would broadly eschew violence as a means of settling political issues, but still might not condemn all aspects of political violence against state authorities who occupy Muslim lands by force – such as Russia in Chechnya, the Israeli state in the Palestine, or even American occupation forces in Iraq. Yet even here, in principle, a moderate must reject attacks against civilians, women, and children in any struggle for national liberation. Moderates would be open to cooperation with the West and the United States, but not at the expense of their own independence and sovereignty.

122 Background: Worldwide there is an increasing number of cancer survivors (CS); in the United States in 2016 there were more than 15 million CS and are predicted to increase to 20 million in 2026. In Mexico (GLOBOCAN 2012), new cancer cases were 148.000 and at least 69.000 will survive. Therefore, it is necessary to focus on cancer survivor’s quality of life (QOL) and its effects in social aspects. Methods: A cross-sectional study was performed including 205 CS with history of non-metastatic cancer (aged ≤65 years, ≥ 2 years from diagnosis and off chemo- or radiotherapy). The QOL-CS questionnaire developed by City of Hope Medical Center was used to measure QOL. Participants reported employment and marital status changes during or after cancer treatment. The aim of this study was to evaluate QOL in CS and its association with employment and marital status. A multivariate logistic regression analysis was conducted to estimate odds ratios (OR). Results: Of the 205 CS 70.2% were women and 29.8% men. Median age at the time of the study was 56 years. Median survival time from diagnosis was 83.6 months. 37.1% had history of invasive breast, 18% colorectal and 8.8% testicular cancers. Disease-related marital status changes presented in 15.6%, 26.8% lost or changed work and 36.6% decreased their work hours. Distress about initial diagnosis, cancer treatment, family and financial burden had the worst score in the QOL-CS. We found no differences in QOL between gender, income, age at diagnosis or type of tumor, but having received chemotherapy was associated with worst QOL (OR 7.33 CI 95% 1.99-26.96 p = 0.003) as well as self-reported neuropathy (OR 2.34 CI 95% 1.06-5.19 p = 0.032). Those with low QOL-CS scores (≤6) were more likely to have a disease-related change in employment (OR 2.34 CI 95% 1.19-4.61 p = 0.014). Disease-related marital status changes were higher in who experienced work status variations (OR 3.87 CI 95% 1.21-12.4 p = 0.023). Conclusions: this is one of the first studies in Mexican CS that associate QOL with relevant social roles. In this cohort having received chemotherapy has the greatest impact in QOL. CS with low QOL were more likely to have changes in employment and therefore, in the marital status.

This book is a very welcome addition to the literature on Muslim women’s dress. It is part of a growing trend to treat Muslim women and their sarto- rial choices through sophisticated theories that recognise the agency, even humanity, of Muslim women. We are far from the days when an Ameri- can author would simply read a headscarf as a symbol of oppression, and Muslim women in need of rescue—at least in the academic realm, though certainly not in the political and journalistic realms. Easy to read and en- gaging (but not simplistic) studies like Bucar’s will, hopefully, eventually trickle out of academia and lead to a sea-change in political and popular discourses as well. Bucar, a professor of philosophy and religion, has turned to ethnog- raphy to complement her philosophical explorations of the relationship between dress, aesthetics, and morality. One of the special features of this book, and what I believe distinguishes it and makes its insights possible, is Bucar’s self-reflective nature, and willingness to share that as she writes. The book begins with a preface, which explains how Bucar came to study this topic while in Tehran to study Persian and Islamic women’s groups in 2004. It opens with her very honest discussion of how she was sitting nervously in the airplane, wondering whether or not she would be able to follow the conditions of her visa to observe local laws and wear “proper hi- jab” (vii). A woman sitting in the aisle across from her winks and pulls out her own scarf and overcoat, setting Bucar at ease, who then follows suit. She describes how she spent a few months adjusting to wearing hijab and figur- ing out the various ways women in Tehran adhere to the hijab laws. Flying next to Turkey, and experiencing some unexpected internal reactions to going bareheaded, made her see that “modest dress had a moral effect on me” (ix), altering her sense of public space and the aesthetics of women’s clothing. “I found surprise, pleasure, and delight in pious fashion, as well as an intellectual challenge to the neat boxes I had once put things in: modest dress as imposed on women, fashion as a symptom of patriarchy, and aes- thetics as separate from ethics. This book is an exploration of this delight and challenge” (ix). Following is the introduction, where she lays out her key terms, meth- odology, and research questions. Bucar explains that she prefers the term “pious fashion” to “modest clothing” or “fashion veiling.” This is so because clothing is a cultural practice that is “governed by social forces as well as daily individual choices” (2). “Fashion” allows people to “construct iden- tities, communicate status, and challenge aesthetic preferences.” “Modest” is generally meant to describe clothing that is “decent and demure,” that discourages sexual attention, but she learned that Muslim women’s dress is more than this, as it is connected to “ethical and religious dimensions… such as character formation through bodily action, regulating sexual de- sires between men and women, and creating public space organized around Islamic moral principles” (3). Hence her preference for the phrase “pious fashion.”Next appear country case studies of how Muslim women in different locales take up “pious fashion”. She did fieldwork in three cities—Tehran, Iran (2004 and remotely 2011); Istanbul, Turkey (2004, 2012, 2013); and Yogyakarta, Indonesia (2011)—observing women in a variety of locations, going shopping, and participating in activities related to pious fashion (in- cluding wearing it herself sometimes). She conducted focus groups and interviews with women between ages eighteen and thirty wearing pious fashion. After opening with a brief introduction to the country-specific poli- tics of modest dress, each chapter is divided into two main sections: “style snapshots” and “aesthetic authorities.” The style snapshots are often very detailed descriptions (half a page for a single outfit) of different kinds of dress, including material, stitching, colour, patterns, style cuts, and accesso- ries. These sections can be a challenge for those not that interested in such details of fashion. The book contains twenty color photographs to illus- trate the styles of dress she discusses, but I still found a laptop an essential component to look up images of the stylists she was referring to, or more basic visual aids to know the difference between “chiffon” and “crepe,” or a “manteau” and a “tunic.” Yet it is such intimate details that give life to her book. These details of fashion are not the object of the book, though, for she embeds these discussions in deeper conversations about aesthetics, moral- ity, piety, beauty, and cultural and political aspects of clothing and fashion. The sections on “aesthetic authorities” cover religious authorities, governments, visual images, educators, fashion designers, magazines, and bloggers’ pious fashion discourses in each country. She is able to highlight differences and similarities across countries, as well as the prevalence of different interpretations and debates amongst all these different voices on what does and does not count as “pious fashion.” She includes discussions about what are counted as “bad hijab” or fashion failures, as an important way to understand the delimitations of pious fashion in each country. Chapter Four presents summarizing conclusions. Here she argues that unlike the normal western approach which considers hijab as a “problem” to be solved, it is rather a woman’s decision about what to wear which should be analytically considered: “the duty to dress modestly does not resolve this question: even if certain institutional structures and public norms related to taste, virtue, and femininity set limits and provide guidance, Muslim wom- en have a great deal of choice when they get dressed every day” (171). She explores the intersections between national identity, modernity, femininity, modesty, aesthetic rebellion, women’s agency, materialism, the consumer lifestyle, aesthetic concepts of beauty and its relationship to morality and fashion, and tradition and change. She concludes that the study of pious fashion teaches us that piety…[is] not just about obedience to orthodox interpretations of sacred texts: it also incorporates good taste, personal style, and physical attrac- tiveness. And fashion becomes a key location through which piety can be realized and contested. Piety is not only about being good – it is about appearing to be good as well…[Women who wear pious fashion] are pi- ous because they are using clothing and adornment to cultivate their own characters, to build community, and to make social critiques. (190) The book ends with an epilogue pointing to a sudden interest, since 2016, in “pious fashion” from the mainstream Western ‘secular’ fashion industry. She notes the two different directions this goes politically—ei- ther to celebrate Muslim women’s inclusion in wider society (CoverGirl’s use of first hijabi spokesperson, Nura Afia, 2016, 195) or to criticise Islam’s pollution of secular fashion (designers are encouraging the enslavement of women) (196). One of the main reasons this book works so well is Bucar’s wonderful ability to be empathetic without being an apologist. She does not wear hijab in her life in the United States; the book is not advocating hijab. She does not gloss feminist concerns over patriarchy and pressures to wear hijab, nor the impact of hijab laws that frustrate many women in Tehran. She recognises the complex nature between dress, identity, fashion, and philo- sophical questions like ethics and the nature of being. She normalizes hijiab so that it can be studied, not as some kind of weird, exotic, oppressive, sui generis piece of cloth, but like any other piece of women’s clothing, like mini-skirts, jeans, high heels, or the bra: While modest clothing can indeed be used as a form of social control or as a display of religious orthodoxy, in practice, it is both much less and much more. Much less, because for many Muslim women, it is simply what they wear. Much more, because like all clothing, Muslim women’s clothing is diverse, both historically and geographically, and is connected with much broader cultural systems. (1) Katherine BullockLecturer, Department of Political ScienceUniversity of Toronto at Mississauga

This book is a very welcome addition to the literature on Muslim women’s dress. It is part of a growing trend to treat Muslim women and their sarto- rial choices through sophisticated theories that recognise the agency, even humanity, of Muslim women. We are far from the days when an Ameri- can author would simply read a headscarf as a symbol of oppression, and Muslim women in need of rescue—at least in the academic realm, though certainly not in the political and journalistic realms. Easy to read and en- gaging (but not simplistic) studies like Bucar’s will, hopefully, eventually trickle out of academia and lead to a sea-change in political and popular discourses as well. Bucar, a professor of philosophy and religion, has turned to ethnog- raphy to complement her philosophical explorations of the relationship between dress, aesthetics, and morality. One of the special features of this book, and what I believe distinguishes it and makes its insights possible, is Bucar’s self-reflective nature, and willingness to share that as she writes. The book begins with a preface, which explains how Bucar came to study this topic while in Tehran to study Persian and Islamic women’s groups in 2004. It opens with her very honest discussion of how she was sitting nervously in the airplane, wondering whether or not she would be able to follow the conditions of her visa to observe local laws and wear “proper hi- jab” (vii). A woman sitting in the aisle across from her winks and pulls out her own scarf and overcoat, setting Bucar at ease, who then follows suit. She describes how she spent a few months adjusting to wearing hijab and figur- ing out the various ways women in Tehran adhere to the hijab laws. Flying next to Turkey, and experiencing some unexpected internal reactions to going bareheaded, made her see that “modest dress had a moral effect on me” (ix), altering her sense of public space and the aesthetics of women’s clothing. “I found surprise, pleasure, and delight in pious fashion, as well as an intellectual challenge to the neat boxes I had once put things in: modest dress as imposed on women, fashion as a symptom of patriarchy, and aes- thetics as separate from ethics. This book is an exploration of this delight and challenge” (ix). Following is the introduction, where she lays out her key terms, meth- odology, and research questions. Bucar explains that she prefers the term “pious fashion” to “modest clothing” or “fashion veiling.” This is so because clothing is a cultural practice that is “governed by social forces as well as daily individual choices” (2). “Fashion” allows people to “construct iden- tities, communicate status, and challenge aesthetic preferences.” “Modest” is generally meant to describe clothing that is “decent and demure,” that discourages sexual attention, but she learned that Muslim women’s dress is more than this, as it is connected to “ethical and religious dimensions… such as character formation through bodily action, regulating sexual de- sires between men and women, and creating public space organized around Islamic moral principles” (3). Hence her preference for the phrase “pious fashion.”Next appear country case studies of how Muslim women in different locales take up “pious fashion”. She did fieldwork in three cities—Tehran, Iran (2004 and remotely 2011); Istanbul, Turkey (2004, 2012, 2013); and Yogyakarta, Indonesia (2011)—observing women in a variety of locations, going shopping, and participating in activities related to pious fashion (in- cluding wearing it herself sometimes). She conducted focus groups and interviews with women between ages eighteen and thirty wearing pious fashion. After opening with a brief introduction to the country-specific poli- tics of modest dress, each chapter is divided into two main sections: “style snapshots” and “aesthetic authorities.” The style snapshots are often very detailed descriptions (half a page for a single outfit) of different kinds of dress, including material, stitching, colour, patterns, style cuts, and accesso- ries. These sections can be a challenge for those not that interested in such details of fashion. The book contains twenty color photographs to illus- trate the styles of dress she discusses, but I still found a laptop an essential component to look up images of the stylists she was referring to, or more basic visual aids to know the difference between “chiffon” and “crepe,” or a “manteau” and a “tunic.” Yet it is such intimate details that give life to her book. These details of fashion are not the object of the book, though, for she embeds these discussions in deeper conversations about aesthetics, moral- ity, piety, beauty, and cultural and political aspects of clothing and fashion. The sections on “aesthetic authorities” cover religious authorities, governments, visual images, educators, fashion designers, magazines, and bloggers’ pious fashion discourses in each country. She is able to highlight differences and similarities across countries, as well as the prevalence of different interpretations and debates amongst all these different voices on what does and does not count as “pious fashion.” She includes discussions about what are counted as “bad hijab” or fashion failures, as an important way to understand the delimitations of pious fashion in each country. Chapter Four presents summarizing conclusions. Here she argues that unlike the normal western approach which considers hijab as a “problem” to be solved, it is rather a woman’s decision about what to wear which should be analytically considered: “the duty to dress modestly does not resolve this question: even if certain institutional structures and public norms related to taste, virtue, and femininity set limits and provide guidance, Muslim wom- en have a great deal of choice when they get dressed every day” (171). She explores the intersections between national identity, modernity, femininity, modesty, aesthetic rebellion, women’s agency, materialism, the consumer lifestyle, aesthetic concepts of beauty and its relationship to morality and fashion, and tradition and change. She concludes that the study of pious fashion teaches us that piety…[is] not just about obedience to orthodox interpretations of sacred texts: it also incorporates good taste, personal style, and physical attrac- tiveness. And fashion becomes a key location through which piety can be realized and contested. Piety is not only about being good – it is about appearing to be good as well…[Women who wear pious fashion] are pi- ous because they are using clothing and adornment to cultivate their own characters, to build community, and to make social critiques. (190) The book ends with an epilogue pointing to a sudden interest, since 2016, in “pious fashion” from the mainstream Western ‘secular’ fashion industry. She notes the two different directions this goes politically—ei- ther to celebrate Muslim women’s inclusion in wider society (CoverGirl’s use of first hijabi spokesperson, Nura Afia, 2016, 195) or to criticise Islam’s pollution of secular fashion (designers are encouraging the enslavement of women) (196). One of the main reasons this book works so well is Bucar’s wonderful ability to be empathetic without being an apologist. She does not wear hijab in her life in the United States; the book is not advocating hijab. She does not gloss feminist concerns over patriarchy and pressures to wear hijab, nor the impact of hijab laws that frustrate many women in Tehran. She recognises the complex nature between dress, identity, fashion, and philo- sophical questions like ethics and the nature of being. She normalizes hijiab so that it can be studied, not as some kind of weird, exotic, oppressive, sui generis piece of cloth, but like any other piece of women’s clothing, like mini-skirts, jeans, high heels, or the bra: While modest clothing can indeed be used as a form of social control or as a display of religious orthodoxy, in practice, it is both much less and much more. Much less, because for many Muslim women, it is simply what they wear. Much more, because like all clothing, Muslim women’s clothing is diverse, both historically and geographically, and is connected with much broader cultural systems. (1) Katherine BullockLecturer, Department of Political ScienceUniversity of Toronto at Mississauga

RESUMENLa diversidad en el ámbito educativo abarca una gran cantidad de acepciones, tales como la diversidad cultural, lingüística, de identidad sexual, de género y de capacidad educativa, entre otros aspectos. La finalidad de este estudio es analizar el desarrollo de las investigaciones sobre la diversidad en el ámbito educativo, teniendo en cuenta la producción científica en la base de datos de Web of Science (WoS), en el periodo comprendido entre 2009 y 2019, ambos inclusive. Para ello se ha desarrollado un estudio bibliométrico haciendo uso de técnicas de rastreo, cuantificación documental y mapeo analítico. Se han analizado un total de 25958 documentos extraídos de la búsqueda, realizada en Web of Science, mediante las siguientes combinaciones de palabras: diversity AND education, diversity AND inclusión y diversity AND intervention. Los resultados muestran el auge de la temática de estudio en la comunidad educativa, en la que los artículos escritos en inglés son los principales medios utilizados para comunicar las investigaciones, siendo Estados Unidos el país que más repercusión tiene actualmente. Se puede concluir que la temática “diversidad” se centra en aspectos relacionados con la equidad, la justicia social, los estudiantes, la identidad, la inclusión, la educación, el multiculturalismo y el género, aunque también está cogiendo fuerza estudios relacionados con las actitudes, las mujeres y la desnutrición, siendo cada vez más relevantes y abundantes dichas investigaciones sobre esta temática.ABSTRACT Diversity in education encompasses a wide range of meanings, such as cultural diversity, linguistic diversity, sexual identity, gender diversity and educational capacity, among others. The purpose of this study is to analyze the development of research on diversity in the educational field, taking into account the scientific production in the Web of Science (WoS) database, in the period from 2009 to 2019, both inclusive. To this end, a bibliometric study has been developed using tracking techniques, documentary quantification and analytical mapping. A total of 25958 documents extracted from the Web of Science search were analysed using the following word combinations: diversity AND education, diversity AND inclusion and diversity AND intervention. The results show the rise of the study topic in the educational community, in which articles written in English are the main means used to communicate the research, being the United States the country that has more repercussion at the moment. It can be concluded that the theme of diversity focuses on aspects related to equity, social justice, students, identity, inclusion, education, multiculturalism and gender, although studies related to attitudes, women and malnutrition are also gaining strength, with such research being increasingly relevant and abundant on this subject.

OBJECTIVES/SPECIFIC AIMS: Stigma has been recognized as a major impediment to accessing mental health care among Vietnamese and Asian Americans (Leong and Lau, 2001; Sadavoy et al., 2004; Wynaden et al., 2005; Fong and Tsuang, 2007). The underutilization of mental health care, and disparities in both access and outcomes have been attributed to a large extent to stigma and cultural characteristics of this population (Wynaden et al., 2005; Jang et al., 2009; Leung et al., 2010; Spencer et al., 2010; Jimenez et al., 2013; Augsberger et al., 2015). People with neurotic or behavioral disorders may be considered “bad” as many Vietnamese people believe it is a consequence of one’s improper behavior in a previous life, for which the person is now being punished (Nguyen, 2003). Mental disorders can also been seen as a sign of weakness, which contributes to ambivalence and avoidance of help-seeking (Fong and Tsuang, 2007). Equally important is the need to protect family reputation; having emotional problems often implies that the person has “bad blood” or is being punished for the sins of his/her ancestors (Herrick and Brown, 1998; Leong and Lau, 2001), which disgraces the entire family (Wynaden et al., 2005). In these cases, public stigma (as opposed to internal stigma) is the primary reason for delays in seeking help (Leong and Lau, 2001). Other research has also highlighted the influences of culture on how a disorder may be labeled in different settings, although the presentation of symptoms might be identical (see Angel and Thoits, 1987). In Vietnamese culture, mental disorders are often labeled điên (literally translated as “madness”). A điên person and his or her family are often severely disgraced; consequently the individuals and their family become reluctant to disclose and seek help for mental health problems for fear of rejection (Sadavoy et al., 2004). Despite the critical role of stigma in accessing mental health care, there has been little work in trying to understand how stigmatizing attitudes towards mental illness among Vietnamese Americans manifest themselves and the influences of acculturation on these attitudes. Some previous work indicated a significant level of mental illness stigma among Vietnamese Americans, and experiences of living in the United States might interact with the way stigma manifests among this population (Do et al., 2014). Stigma is a complex construct that warrants a deeper and more nuanced understanding (Castro et al., 2005). Much of the development of stigma-related concepts was based on the classic work by Goffman (1963); he defined stigma as a process by which an individual internalizes stigmatizing characteristics and develops fears and anxiety about being treated differently from others. Public stigma (defined by Corrigan, 2004) includes the general public’s negative beliefs about specific groups, in this case individuals and families with mental illness concerns, that contribute to discrimination. Public stigma toward mental illness acts not only as a major barrier to care, but can also exacerbate anxiety, depression, and adherence to treatment (Link et al., 1999; Sirey et al., 2001; Britt et al., 2008; Keyes et al., 2010). Link and Phelan (2001) conceptualized public stigma through four major components. The first component, labeling, occurs when people distinguish and label human differences that are socially relevant, for example, skin color. In the second component, stereotyping, cultural beliefs link the labeled persons to undesirable characteristics either in the mind or the body of such persons, for example people who are mentally ill are violent. The third component is separating “us” (the normal people) from “them” (the mentally ill) by the public. Finally, labeled persons experience status loss and discrimination, where they are devalued, rejected and excluded. Link and Phelan (2001) emphasized that stigmatization also depends on access to social, economic, and political power that allows these components to unfold. This study aims to answer the following research questions: (1) how does public stigma related to mental illness manifest among Vietnamese Americans? and (2) in what ways does acculturation influence stigma among this population? We investigate how the 4 components of stigma according to Link and Phelan (2001) operationalized and how they depend on the level of acculturation to the host society. Vietnamese Americans is the key ethnic minority group for this study for several reasons. Vietnamese immigration, which did not start in large numbers until the 1970s, has features that allow for a natural laboratory for comparisons of degree of acculturation. Previous research has shown significant intergenerational differences in the level of acculturation and mental health outcomes (e.g., Shapiro et al., 1999; Chung et al., 2000; Ying and Han, 2007). In this study, we used age group as a proxy indicator of acculturation, assuming that those who were born and raised in the United States (the 18–35 year olds) would be more Americanized than those who were born in Vietnam but spent a significant part of their younger years in the United States (the 36–55 year olds), and those who were born and grew up in Vietnam (the 56–75 year olds) would be most traditional Vietnamese. The language used in focus group discussions (FGDs) reflected some of the acculturation, where all FGDs with the youngest groups were done in English, and all FGDs with the oldest groups were done in Vietnamese. METHODS/STUDY POPULATION: Data were collected through a set of FGDs and key informant interviews (KIIs) with experts to explore the conceptualization and manifestation of mental illness public stigma among Vietnamese Americans in New Orleans. Six FGDs with a total of 51 participants were conducted. Participants were Vietnamese American men and women ages 18–75. Stratification was used to ensure representation in the following age/immigration pattern categories: (1) individuals age 56–75 who were born and grew up in Vietnam and immigrated to the United States after age 35; (2) individuals age 36–55 who were born in Vietnam but spent a significant part of their youth in the United States; and (3) individuals age 18–35 who were born and grew up in the United States. These groups likely represent different levels of acculturation, assuming that people who migrate at a younger age are more likely to assimilate to the host society than those who do at a later age. Separate FGDs were conducted with men and women. Eleven KIIS were conducted with 6 service providers and 5 community and religious leaders. In this analysis, we focused on mental illness public stigma from the FGD participants’ perspectives. FGDs were conducted in either English or Vietnamese, whichever participants felt more comfortable with, using semistructured interview guides. All interviews were audio recorded, transcribed and translated into English if conducted in Vietnamese. Data coding and analysis was done using NVivo version 11 (QSR International, 2015). The analysis process utilized a Consensual Qualitative Research (CQR) approach, a validated and well-established approach to collecting and analyzing qualitative data. CQR involves gathering textual data through semistructured interviews or focus groups, utilizing a data analysis process that fosters multiple perspectives, a consensus process to arrive at judgments about the meaning of data, an auditor to check the work of the research team, and the development of domains, core-ideas, and cross-analysis (Hill et al., 2005). The study was reviewed and approved by Tulane University’s Internal Review Board. RESULTS/ANTICIPATED RESULTS: Components of public stigma related to mental illness. The 4 components of public stigma manifest to different extents within the Vietnamese Americans in New Orleans. Labeling was among the strongest stigma components, while the evidence of the other components was mixed. Across groups of participants, Vietnamese Americans agreed that it was a common belief that people with mental disorders were “crazy,” “acting crazy,” or “madness.” “Not normal,” “sad,” and “depressed” were among other words used to describe the mentally ill. However, there were clear differences between younger and older Vietnamese on how they viewed these conditions. The youngest groups of participants tended to recognize the “craziness” and “madness” as a health condition that one would need to seek help for, whereas the oldest groups often stated that these conditions were short term and likely caused by family or economic problems, such as a divorce, or a bankruptcy. The middle-aged groups were somewhere in between. The evidence supporting the second component, stereotyping, was not strong among Vietnamese Americans. Most FGD participants agreed that although those with mental disorders may act differently, they were not distinguishable. In a few extreme cases, mentally ill individuals were described as petty thefts or being violent towards their family members. Similarly to the lack of strong evidence of stereotyping, there was also no evidence of the public separating the mentally ill (“them”) from “us”. It was nearly uniformly reported that they felt sympathetic to those with mental disorders and their family, and that they all recognized that they needed help, although the type of help was perceived differently across groups. The older participants often saw that emotional and financial support was needed to help individuals and families to pass through a temporary phase, whereas younger participants often reported that professional help was necessary. The last component, status loss and discrimination, had mixed evidence. While nearly no participants reported any explicit discriminatory behaviors observed and practiced towards individuals with mental disorders and their families, words like “discrimination” and “stigma” were used in all FGDs to describe direct social consequences of having a mental disorder. Social exclusion was common. Our older participants said: “They see less of you, when they see a flaw in you they don’t talk to you or care about you. That’s one thing the Vietnamese people are bad at, spreading false rumors and discrimination” (Older women FGD). One’s loss of status seemed certain if their or their loved one’s mental health status was disclosed. Shame, embarrassment, and being “frowned upon” were direct consequences of one’s mental health status disclosure and subsequently gossiped about. Anyone with mental disorders was certain to experience this, and virtually everyone in the community would reportedly do this to such a family. “You get frowned upon. In the Vietnamese culture, that’s [a family identified as one with mental health problems] the big no-no right there. When everybody frowns upon your family and your family name, that’s when it becomes a problem” (Young men FGD). This is tied directly to what our participants described as Vietnamese culture, where pride and family reputation were such a high priority that those with mental disorders needed to go to a great extent to protect—“We all know what saving face means” as reported by our young participants. Even among young participants, despite their awareness of mental illness and the need for professional help, the desire to avoid embarrassment and save face was so strong that one would think twice about seeking help. “No, you just don’t want to get embarrassed. I don’t want to go to the damn doctor and be like ‘Oh yeah, my brother got an issue. You can help him?’ Why would I do that? That’s embarrassing to myself…” (Young men FGD). Our middle-aged participants also reported: “If I go to that clinic [mental health or counseling clinic], I am hoping and praying that I won’t bump into somebody that I know from the community” (Middle-aged women FGD). Vietnamese people were also described as being very competitive among themselves, which led to the fact that if a family was known for having any problem, gossips would start and spread quickly wherever they go, and pretty soon, the family would be looked down by the entire community. “I think for Vietnamese people, they don’t help those that are in need. They know of your situation and laugh about it, see less of you, and distant themselves from you” (Older women FGD). Culture and mental illness stigma, much of the described stigma and discrimination expressed, and consequently the reluctance to seek help, was attributed to the lack of awareness of mental health and of mental health disorders. Many study participants across groups also emphasized a belief that Vietnamese Americans were often known for their perseverance and resilience, overcoming wars and natural disasters on their own. Mental disorders were reportedly seen as conditions that individuals and families needed to overcome on their own, rather than asking for help from outsiders. This aspect of Vietnamese culture is intertwined with the need to protect one’s family’s reputation, being passed on from one generation to the next, reinforcing the beliefs that help for mental disorders should come from within oneself and one’s family only. Consequently persons with mental health problems would be “Keeping it to themselves. Holding it in and believing in the power of their friends” (Middle-aged FGD) instead of seeking help. Another dimension of culture that was apparent from FGDs (as well as KIIs) was the mistrust in Western medicine. Not understanding how counseling or medicines work made one worry about approaching service providers or staying in treatment. The habit of Vietnamese people to only go see a doctor if they are sick with physical symptoms was also a hindrance to acknowledging mental illness and seeking care for it. Challenges, including the lack of vocabulary to express mental illness and symptoms, in the Vietnamese language, exaggerated the problem, even among those who had some understanding of mental disorders. It was said in the young men FGD that: “when you classify depression as an illness, no one wants to be sick,… if you call it an illness, no one wants to have that sort of illness, and it’s not an illness that you can physically see…” (Young men FGD). Another young man summarized so well the influence of culture on mental illness stigma: “Us Southeast Asian, like, from my parents specifically has Vietnam War refugees. I think the reason why they don’t talk about it is because it’s a barrier that they have to overcome themselves, right? As refugees, as people who have been through the war… [omitted]They don’t want to believe that they need help, and so the trauma that they carry when they give birth to us is carried on us as well. But due to the language barrier and also the, like, they say with the whole health care, in Vietnam I know that they don’t really believe in Western and Eurocentric medicine. So, from their understanding of how, like from their experience with colonization or French people, and how medicine works, they don’t believe in it” (Young men FGD). One characteristic of the Vietnamese culture that was also often mentioned by our FGD participants (as well as KIIs) was the lack of sharing and openness between generations, even within a family. Grandparents, parents, and children do not usually share and discuss each other’s problems. Parents and grandparents do not talk about problems because they need to appear strong and good in front of their children; children do not talk about problems because they are supposed to do well in all aspects, particularly in school. The competitiveness of Vietnamese and high expectations of younger generations again come into play here and create a vicious cycle. Young people are expected to do well in school, which put pressure on them and may result in mental health problems, yet, they cannot talk about it with their parents because they are not supposed to feel bad about school, and sharing is not encouraged. The Asian model minority myth and the expectations of parents that their children would do well in school and become doctors and lawyers were cited by many as a cause of mental health problems among young people. “Our parents are refugees, they had nothing and our parents want us to achieve this American Dream…. [omitted] It set expectations and images for us…. It was expected for all the Asians to be in the top 10, and for, like a little quick minute I thought I wasn’t going to make it, I was crying” (Yong men FGD). As a result, the mental health problems get worse. “If you’re feeling bad about something, you don’t feel like you can talk about it with anyone else, especially your family, because it is not something that is encouraged to be talked about anyway, so if you are feeling poorly and you don’t feel like you could talk to anybody, I think that just perpetuates the bad feelings” (Middle-aged women FGD). Acculturation and mental illness stigma Acculturation, the degree of assimilation to the host society, has changed some of the understanding of mental illness and stigmatizing attitudes. Differences across generations expressed in different FGDs indicated differences in perceptions towards mental illness that could be attributed to acculturation. For example, the young generation understood that mental illness was a health problem that was prevalent but less recognized in the Vietnamese community, whereas a prominent theme among the older participants was that mental illness was a temporary condition due to psychological stress, that it was a condition that only Caucasians had. Some of the components of public stigma related to mental illness seemed to vary between generations, for example the youngest participants were less likely to put a label on a person with mental health problems, or to stereotype them, compared to the oldest and middle-aged participants. This was attributed to their education, exposure to the media and information, and to them “being more Americanized.” However, there was no evidence that acculturation played an important role in changing the other components of public stigma, including stereotyping, separating, and status loss and discrimination. For example, the need to protect the family reputation was so important that our young participants shared: “If you damage their image, they will disown you before you damage that image” (Young men FGD). Young people, more likely to recognize mental health problems, were also more likely to share within the family and to seek help, but no more likely than their older counterparts to share outside of the family—“maybe you would go to counseling or go to therapy, but you wouldn’t tell people you’re doing that” (Young women FGD). The youngest participants in our study were facing a dilemma, in which they recognized mental health problems and the need for care, yet were still reluctant to seek care or talk about it publicly because of fears of damaging the family reputation and not living up to the parents’ expectations. Many young participants reported that it actually made it very difficult for them to navigate mental health issues between the 2 cultures, despite the awareness of the resources available. “I think it actually makes it harder. Only because you know to your parents and the culture, and your own people, it’s taboo, and it’s something that you don’t talk about. Just knowing that you have the resources to go seek it… You want advice from your family also, but you can’t connect the appointment to your family because you’re afraid to express that to your parents, you know? So I think that plays a big part, and knowing that you are up and coming, but you don’t want to do something to disappoint your family because they are so traditional” (Young men FGD). Some participants felt more comfortable talking about mental health problems, like depression, if it was their friend who experienced it and confided in them, but they would not necessarily felt open if it was their problem. Subtle cultural differences like this are likely overlooked by Western service providers. One older participant summarized it well “They [the young generation] are more Americanized. They are more open to other things [but] I think that mental health is still a barrier.” DISCUSSION/SIGNIFICANCE OF IMPACT: This study investigated how different components of public stigma related to mental illness manifest among Vietnamese Americans, a major ethnic group in the United States, and how acculturation may influence such stigma. The findings highlighted important components of public stigma, including labeling and status loss, but did not provide strong evidence of the other components within our study population. Strong cultural beliefs underlined the understanding of mental health and mental illness in general, and how people viewed people with mental illness. Several findings have been highlighted in previous studies with Asian immigrants elsewhere; for example, a study from the perspectives of health care providers in Canada found that the unfamiliarity with Western biomedicine and spiritual beliefs and practices of immigrant women interacted with social stigma in preventing immigrants from accessing care (O’Mahony and Donnelly, 2007). Fancher et al. (2010) reported similar findings regarding stigma, traditional beliefs about medicine, and culture among Vietnamese Americans. Acculturation played a role in changing stigmatizing attitudes as evidenced in intergenerational differences. However, being more Americanized did not equate to being more open, having less stigmatizing attitudes, or being more willing to seek care for mental health issues. Consistent with previous studies (Pedersen and Paves, 2014), we still found some level of stigma among young people aged 18–35, although some components were lessened with an increased level of acculturation. There was also a conflict among the younger generation, in which the need for mental health care was recognized but accessing care was no easier for them than for their parent and grandparent generations. The study’s findings are useful to adapt existing instruments to measure stigma to this population. The findings also have important program implications. One, they can be directly translated into basic supports for local primary and behavioral health care providers. Two, they can also be used to guide and inform the development and evaluation of an intervention and an additional study to validate the findings in other immigrant ethnic groups in the United States. Finally, based on results of the study, we can develop a conceptual framework that describes pathways through which social, cultural, and ecological factors can influence stigma and the ways in which stigma acts as a barrier to accessing mental health care among Vietnamese Americans. The guiding framework then can be validated and applied in future programs aimed to improve mental health care utilization among ethnic minorities.

This updated issue of the professional publication Bulletin of the Slovenian Armed Forces is dedicated to the question of the Slovenian commitment to finding peaceful solutions to conflicts. As Commander­in­Chief of the Defence Forces of the Republic of Slovenia, I find this subject not only necessary but also entirely essential. There are many reasons for this. The historical experience of the Slovenian people has not always been pleasant regarding the preservation of national identity, manifested in the language as well as in the cultural and national tradition. Despite different repressive and denationalising measures taken by many foreign authorities, our ancestors managed to preserve the Slovenian nation through much wisdom, deep national awareness and political skill. The importance of consistent compliance with the provisions of international law in crisis situations, including wars, was seen in 1991. Slovenia won the war, not only in a military sense but also by complying with all legal norms, thus soon becoming recognised as a young European democratic country founded on high legal and moral principles. The lessons of war in 1991 increased the resolve of the Slovenian people for clear rejection of the use of force in finding solutions to any kind of conflict. For this reason, my pleasure at being invited to write about the topic of Slovenian people in the service of peace is that much greater, in part also due to the fact that I spent a large part of my professional life, from 1992 to 2005, working in the United Nations, first as the ambassador of the Republic of Slovenia, later as UN Assistant Secretary­General. In both functions I dealt with peacekeeping operations to a considerable extent. United Nations peacekeeping operations were in full swing at that time and underwent great development on the one hand, but also bitter disappointment and moments of deep doubt on the other. However, they continued to develop to the current extent. The topic of the Bulletin is presented in truly deep, scientific, theoretical and practical ways, from strategic and tactical levels, considering the evolutionary and transformational characteristics of peacekeeping operations, and deriving from historical experience. The most respected authors in the Slovenian professional field have thrown light upon important conceptual changes in the area of peacekeeping operations, which result from numerous factors, in particular from important geopolitical changes in the world. We must not disregard the increasing cooperation of regional organisations in the implementation of peacekeeping operations, which has indirectly brought about a different understanding of the term “peacekeeping operation” and opened technical discussions in the area of terminology as well as in the technical fulfilment of obligations, all the way to the question of the necessity of a preliminary UN mandate. These deficiencies can also be seen in Slovenia and point to the need for conducting a deep technical discussion as soon as possible and unifying the understanding of both the structure of the Slovenian Armed Forces and the broader defence and security system. The introductory and in particular the more theoretical parts of the Bulletin may be taken as important contributions in this regard. Some of the articles offer interesting historical insight into the cooperation of Slovenian men, and later women, in various endeavours for peace launched by individual great powers and international organisations. Although it is difficult to understand the military intervention of European forces on the island Crete in 1897 as a peacekeeping operation, the objective which is still in the forefront of contemporary efforts of the international community in this area was achieved for at least some time. This intervention ensured an armistice between the parties involved in the conflict and enabled a diplomatic solution on the island without unnecessary victims. The confidence that the highest political and military authorities in the Austro­Hungarian Empire had in the 2nd Battalion of the 87th Infantry Regiment from Celje was truly special. This was particularly the case because the military unit was mainly composed of Slovenes, and at the time of deployment in Crete its commander was a Slovene as well. However, we need to emphasise that such thinking is unconventional. By studying the literature on peacekeeping operations we see that such operations were first mentioned around 1919 in connection with peace conferences after the end of World War I and with managing various border issues in Europe, different plebiscites and other situations which, besides political and other diplomatic action, also required the protection of security and were followed by military operations intended for this particular purpose. History tells us much about peacekeeping operations intended to maintain truces. In these operations, coalition forces were deployed to an area in which a truce already existed and had to be maintained among well organised and disciplined armed forces. Today, the status of armed forces is quite different. We have to look at all of history and every aspect of international military engagement which is not armed combat by nature but a military presence with various aspects of employment of military force and the constant readiness and capability of peace forces to defend themselves effectively and be prepared to use weapons to fulfil their mandate. If today we see peacekeeping operations as valid in this respect, it is clear that we have to be familiar with history and evaluate what we can learn from past experience and how we are obliged to consider the present. Of course, we must consider the present. If we look at the status of peacekeeping operations today, we see how important this military activity is for the modern world. I will only dwell upon the United Nations, which from the standpoint of peacekeeping operations is the most important organisation operating today. Approximately 140,000 soldiers participate in peacekeeping operations under the auspices of the United Nations. No other military force has that number of uniformed personnel operating abroad. These people are assigned to eighteen currently active peacekeeping operations, each costing the organisation about seven billion dollars. This is the largest component of the budget of the United Nations. However, this expenditure is small in comparison to other kinds of military deployment outside the UN, to operations which are not peacekeeping operations by nature. Peacekeeping operations have become very multidimensional. The latest such operations, established in Africa (Darfur, Chad, Central African Republic), have been among the most demanding from the very beginning. We can thus conclude that peacekeeping operations are becoming increasingly more complex, which also results in a higher degree of risk. In 2007, 67 members of UN peacekeeping operations lost their lives. Looking at individual operations we see that six people died in Lebanon alone that year. Ever since peacekeeping operations have been in existence, Lebanon has been one of the most dangerous areas. Today, however, it is somewhat outside the sphere of interest. This may be due to the fact that there is a peacekeeping operation active in the area, on account of which a state of relative peace can be better maintained. Peacekeeping operations are both dangerous and multidimensional, multidimensional because they are no longer focused merely on keeping belligerent parties apart. Modern peacekeeping operations include both standard and supplemental functions. Providing a secure environment for political normalisation, humanitarian activity and development is a comprehensive task, requiring the engagement of peacekeeping forces in operations that are far from being common types of military deployment. This raises different questions about the training and competence of peacekeeping forces. We also have to ask ourselves how we can fully consider the lessons learned from previous peacekeeping operations and organise a system of command, particularly in organisations such as the United Nations, while at the same time making sure that national contingents do not lose their identity. There are thus two lines of communication, one through channels established by international organisations and the other through those established by national systems of armed forces. How to balance this and achieve efficient functioning? How to ensure the operation of different cultures, members and levels of competence in a way that facilitates the success of peacekeeping operations? These are always important questions to consider. In recent years the question of interest has pointed to the complexity of modern peacekeeping operations. Peacekeeping operations are frequently required to facilitate an environment in which elections can be conducted and assist in the establishment of a legal order and institutions to maintain that order. Both tasks are extremely demanding. The establishment of a safe environment for conducting elections in a country with poor communications, with no tradition of elections and with violence linked to every political event, is an extremely difficult task. The establishment of a legal order in areas with no such tradition or adequate infrastructure is even harder. There is often a need to include the civilian police, whose tasks in peacekeeping operations are very demanding. Civilian police have a number of other particularities besides problems connected to the aforementioned multidimensionality. It is necessary to adapt to the local environment in order to facilitate effective police performance. How to facilitate this in an environment such as Haiti, for example, with its difficult past? How to facilitate this in linguistically demanding environments such as East Timor until recently and in other difficult circumstances? These are all extremely demanding tasks. However, there is not much understanding with regard to all the details and problems arising from their implementation. The international political community is often satisfied merely by defining the mandate of a peacekeeping operation. For many people this signifies the solution to the problem, considering that the mandate is defined and that the deployment of forces will occur. However, this is where real problem solving only begins. Only then does it become obvious what little meaning general resolutions of the United Nations Security Council and other acts by which mandates are defined have in the context of actual situations. Therefore, I am of the opinion that we have to take a detailed look at experience from the distant past as well as the present. When speaking of the civilian police we also have to consider the fully human aspects that characterise every peacekeeping operation. Once I spoke to a very experienced leader of civilian police operations about the need to send additional police officers to the mission in Kosovo in the spring, when winter is over and people become more active, which also results in a higher crime rate. He explained that this is not only a problem in the area of this mission but elsewhere in Europe. In spring, the crime rate rises everywhere. Therefore it is difficult to find police officers during this time who are willing to leave their homeland, where they are most needed, and go to a mission area which is just then facing increased needs. I mention this to broaden understanding of the fact that the deployment of peacekeeping forces, both military and civilian police, is not only a matter of mandates and military organisation, but sometimes of the purely elementary questions that accompany social development. I have already mentioned that memory of the past is a very important component of considering present peacekeeping operations. I would like to conclude with another thought. I believe the manner of organising the knowledge of peacekeeping operations is of great importance to all countries, especially those that are new to cooperating in peacekeeping operations. This knowledge cannot be gained from books written at universities, but only from monitoring and carefully analysing the previous experiences of others. It is very important that this knowledge be carefully organised, that these experiences be carefully gathered and analysed, and that a doctrine be developed gradually. This doctrine is required for a country like Slovenia, which is new at conducting peacekeeping operations, to be able to manage well and define its role in international peacekeeping operations properly. To achieve this objective, a new country must cooperate with those countries which have been conducting peacekeeping operations for a long time and therefore have a richer experience. The neighbouring Austria is known to have one of the longest and most interesting systems of experience in peacekeeping operations within the United Nations. Ever since it joined the UN, Austria has been active in numerous activities linked to peacekeeping operations. Its soldiers and the civilian police have participated in a number of peacekeeping operations. Experience gained in this way is of great value, and using this experience is necessary for successful planning of and operating in future peacekeeping operations. The future will be complicated! At one time, when the members of peacekeeping operations numbered approximately 80,000, the United Nations thought that nothing more could be done, and a larger number of members was unthinkable. Today the number of members is significantly larger, development will most likely still continue and conditions will become even more demanding. I do not wish to forecast events which have not yet taken place. However, I would like to strongly emphasise that the history of peacekeeping operations is not over yet and that the future will be full of risks and challenges. I would also again like to stress the importance of this issue of the Bulletin of the Slovenian Armed Forces, which is entering a new decade, and express my pleasure at being able to note down a few thoughts. Let me particularly emphasise that as Commander­in­Chief of the Slovenian Defence Forces I will continue to devote special attention to achievements in the area of cooperation in peacekeeping operations in the future, having a special interest in these experiences. I thank the authors of the articles of this important issue of the Bulletin for their scientific and professional contributions – and I greatly respect those who have already done important work in the name of the Republic of Slovenia with the Slovenian flag on their shoulders, with the hope that they continue to fulfil their obligations in accordance with the rules.

A few days ago, in August 2013, a Cochrane Database Systemic Review reported that the existing limited evidence to date on the effect of Mediterranean diet (MD) on primary prevention of cardiovascular disease (CVD), suggests some favorable effects on risk factors; however, the reduction of CVD event rates was not mentioned [1]. The review included 11 trials (15 papers, 52,044 participants); 7 trials described the intervention as a MD. Clinical events were reported in only one trial [Women's Health Initiative (WHI) 48,835 postmenopausal women with an intervention not described as a MD but increased fruit and vegetable and cereal intake], where no statistically significant effects of the intervention were seen on fatal and non-fatal endpoints during the 8 years of its duration [1]. Since the WHI study was huge and had a great weight in the analysis, it eliminated any other beneficial effect on CVD incidence from other studies. Moreover, in this study the diet used as an intervention was not MD. On April 2013 the results of the Prevención con Dieta Mediterránea (PREDIMED), a multicenter trial from Spain, were published in New England Journal of Medicine [2]. The study included a total of 7,447 persons (aged 55-80 years) with no CVD at baseline. These were randomized to 1 of 3 diets: a MD supplemented with extra-virgin olive oil, a MD supplemented with mixed nuts or a control diet (advice to reduce dietary fat) [2]. An interim analysis terminated the trial prematurely at 4.8 years. The primary endpoint was the rate of major CVD (myocardial infarction, stroke, or CVD death). The multivariable-adjusted hazard ratios were 0.70 (95% confidence interval [CI], 0.54 to 0.92) and 0.72 (95% CI, 0.54 to 0.96) for the group assigned to a MD with extravirgin olive oil and the group assigned to a MD with nuts, respectively, vs. the control group [2]. No diet-related adverse effects were reported [2]. Moreover, a post hoc analysis of PREDIMED that will be published in September 2013, in the American Journal of Clinical Nutrition, suggests that one of the mechanisms by which MD, particularly if supplemented with virgin olive oil, can exert health benefits is through changes in the transcriptomic response of genes related to CVD risk [3]. These results of the PREDIMED trial confirm that changes in diet can have beneficial effects on CVD risk. However, the study was criticized for mainly 3 reasons. One is that in MD the dietary pattern as an entity is rather more important than the inclusion or avoidance of specific nutrients [4]. Second there were low (in absolute terms) primary composite CVD outcome rates (3.8% and 3.4% in the intervention groups vs. 4.4% in the control group) and a minor absolute risk difference (range 0.6 to 1%), thus limiting the importance of the study findings [5]. Furthermore there were statistically significant differences in baseline characteristics between the groups: men (+5.7%), obese persons (+4.7%), diuretic use (+3.5%), and oral hypoglycaemic use (+3.2%) in the control group than in the intervention group [5]. And third there was a complete lack of policy implications [6]. The PREDIMED trial was neither a pure test of a Mediterranean-style diet nor a pure test of extra- virgin olive oil or nuts. All the above make the interpretation of the PREDIMED trial similarly difficult to that of the Lyon Diet Heart Study [7], which tested provision of a margarine rich in alpha-linolenic acid on top of brief advice to consume a MD in high CVD risk patients with astonishing results [7]. Policymakers [8] and Great Scientific Organizations, like Mayo Clinic [9], already recommend consumption of a Mediterranean-style diet on the basis of a body of evidence from observational and interventional studies, in antithesis to the findings of the Cochrane Database Systemic Review [1]. On the other hand, the policy implications of the PREDIMED trial related primarily to the supplemental foods [2] and not MD itself, thus, we probably have to go both back and elsewhere to find evidence base for the benefits of MD and if these are related in any degree to blood pressure (BP) reduction. The Seven Countries Study showed that the risk and rates of heart attack and stroke both at the population and at the individual level were directly and independently related to the level of serum total cholesterol (TC). It demonstrated that the association between TC level and coronary heart disease (CHD) risk from 5 to 40 years follow-up is found consistently across different cultures [10,11]. The Seven Countries Study started in 1958 in former Yugoslavia. In total, 12,763 men, 40–59 years of age, were enrolled as 16 cohorts, in 7 countries, in 4 regions of the world (United States, Northern Europe, Southern Europe, Japan); 1 cohort is in the United States, 2 cohorts in Finland, 1 in the Netherlands, 3 in Italy, 5 in the former Yugoslavia (two in Croatia, and three in Serbia), 2 in Greece (1 in Crete and 1 in Corfu), and 2 in Japan [10]. The Seven Countries Study has continued, with high levels of participation, for more than 50 years.􀀁The initial and objective data on CVD health in relation to the MD originated from the Seven Countries Study [10]. CHD deaths in the United States and Northern Europe greatly exceeded those in Southern Europe, even when controlled for age, TC and BP levels, smoking, physical activity, and weight [12]. After further investigation, the importance of the eating pattern characterized as the MD became clear [12,13]. What exactly is meant by "Mediterranean diet" today, and its benefits, is detailed by other researches during the last 20 years [14,15]. During the 90's, for the first time, the concept of a food pyramid and the need for an adherence to MD score were born [14-16]. As a result of the Seven Countries Study, the MD has been popularized as a "healthy" diet. Nevertheless, it has not replaced the "prudent" diet commonly prescribed to coronary patients [17]. The Crete cohort of the Seven Countries Study had the lowest rates of deaths from CVD [10]; even the 25 year mortality was lower than others (for example vs. the Italian cohort) [18]. This was attributed to the entire lifestyle of Cretans including a variation of MD, the Cretan-type MD. Many investigators during the last 20 years would rather refer to the Cretan-type MD rather than plain MD, which is a rather abstract definition [19-22]. The 40 years’ CVD mortality in the Corfu cohort showed that participants also benefited from the long-term adoption of a nutritional pattern (close to the Cretan-type) of MD, the presence of physical activity, optimism, and a positive psychological profile [23]. During the last 15 years, and before the economic crisis, Greeks adopted a more western way of life. Nevertheless, several aspects of the traditional Greek way of life and diet, suggest that a relatively high consumption of vegetables and fruits or olive oil and bread, remained well-established among large segments of the Greek population, and may explain why a population with a few healthy habits still enjoys one of the longer life expectancies among the 16 cohorts of the Seven Country Study 40 years after its initiation [23]. The Working Group on Epidemiology and Prevention of the European Society of Cardiology (ESC) coordinated in 2003 information from 12 European cohort studies, including 205,000 persons, and assessed the 10-year CVD mortality rates. This gave birth to the SCORE (Systematic Coronary Risk Estimation) project [24]. The European Society of Cardiology encouraged the creation of local SCORES for each country, based on the original SCORE and local data. Indeed the HellenicSCORE (equations and charts) present the calibration of the risk by age group and sex, based on mortality data, as reported by the National Statistical Services of Greece and prevalence data regarding smoking, TC and BP levels, as reported by the ATTICA study [25]. This was very successfully tested in the ATTEMPT Study [26]. The predicated rates of CVD were verified in a survival study with a nearly 4-year follow-up in patients with metabolic syndrome and randomization to intensive versus moderate risk factor treatment [27]. In the meantime the MD score (MedDietScore) was developed, according to the adherence to MD [28].􀀁The weekly consumption of the following 9 food groups: non-refined cereals(whole grain bread and pasta, brown rice, etc.), fruits, vegetables, legumes, potatoes, fish, meat and meat products, poultry, full fat dairy products (like cheese, yoghurt, milk), as well asolibe oil and alcohol intake, were included [28]. The inclusion of dietary evaluation (MedDietScore), as well as other sociodemographic and anthropometric characteristics, increases the accuracy and reduces estimating bias of CVD risk prediction models [29]. Thus, we have a country adjusted integrated system that can predict CVD risk. It was clear, during the use of HellenicSCORE and MedDietScore, that a better adherence to MD was related to a lower CVD risk. On the contrary, aging, central fat, hypertension (HTN), diabetes, inflammation, low social status and abstinence from a MD seem to predict CVD events within a 5-year period; actual data from the ATTICA study [30]. All these put the adoption of MD at a high position among CVD risk factors, for good and for bad, according to the degree of adoption (MedDietScore). However, does MD affect the level of BP? Is HTN one of the factors to increase CVD risk if the adherence to MD (MedDietScore) is low? There is some evidence on this issue. It has been suggested by a review on the dietary influences on BP that there is more than enough evidence from observational and clinical studies that diets low in saturated fats and sodium and rich in fruits, vegetables, and fiber, with adequate amounts of potassium, calcium, and magnesium, are effective in the prevention and treatment of HTN alone or as an adjunct to pharmacologic therapy [31]. Such dietary combinations are provided by the MD [31]. The association of adherence to the MD with the incidence of HTN was evaluated among 9,408 men and women enrolled in a dynamic Spanish prospective cohort (SUN) study during 1999- 2005 [32]. The adherence to MD was associated with reduced mean values of systolic BP [moderate adherence, -2.4 mm Hg (95% CI: -4.0, -0.8); high adherence, -3.1 mm Hg (95% CI: -5.4, -0.8)] and diastolic BP [moderate adherence, - 1.3 mm Hg (95% CI: -2.5, -0.1); high adherence, -1.9 mm Hg (95% CI: -3.6, -0.1)] after 6 years of follow-up [32]. These results suggest that adhering to a Mediterranean-type diet could contribute to the prevention of age-related increase in BP [32]. In the ATTICA Study the mean value of the MedDiet Score was 25.5 (±3) for men and 27 (±3) for women (p<0.001). The prevalence of HTN was 36.6% in men and 23.7% in women (p<0.001) [33]. Diet score was 23.5±6.4 in hypertensive and 26.8±6.6 in normotensive individuals (p<0.001). The sensitivity of defining people with HTN was higher than for any other CVD risk factor, suggesting that the adoption of MD reduces the risk for HTN [33]. In an elderly population of Cyprus, another Mediterranean Country, 60% of men and 58% of women have HTN, along with other classical CVD risk factors [34]. A 10-unit increase in the MedDietScore was associated with 21% lower odds of having one additional risk factor, including HTN, in women (p< 0.001) and with 14% lower odds in men (p=0.05) [34]. The results of the CARDIO2000 study [35] point out that the adoption of MD by physically active subjects seems to significantly reduce the coronary heart disease (CHD) events and prevent, just about, the one-third of acute CHD syndromes, in controlled subjects with HTN [35]. This supports the idea that MD combined with physical activity provides substantial protection from acute coronary events in patients with HTN [35]. Other data from the SUN Study also [36] suggest that there is an inverse relationship between fruit and vegetable consumption and the prevalence of nonpreviously diagnosed HTN in a Mediterranean population with a very high intake of both fat (paradoxically) and plantderived foods [36]. There was a 77 % reduction in the prevalence of HTN for those with the higher consumption of both fruit and vegetables compared with those at the lower quintiles of both food groups [36]. This inverse relationship was also evident when considering BP as a continuous variable, with a mean systolic BP and diastolic BP of 2.2 mmHg lower for those with the highest consumption of fruit and vegetables compared with those with the lowest intake [36]. The study concludes that in a Mediterranean population, with an elevated fat consumption, a high fruit and vegetable intake is inversely associated with BP levels [36]. From the same (SUN) study it was reported that there is an inverse association between fiber or fruit/vegetable consumption and weight gain, thus emphasizing the importance of replacing some dietary compounds by such foods and fiber-rich products, which may help to avoid weight gain [37]. This brinks about the issue of MD and obesity, mainly central, which is the key clinical manifestation of metabolic syndrome (MetS); this includes HTN. Data suggest that the prevalence of MetS has dramatically increased during the recent years, especially in Western Countries and South East Asia [38]. More than one third (35 %) of adults in the U.S. could be characterized as having the MetS, which translates to nearly 84 million U.S. adults affected by MetS [38]. Unfortunately the prevalence of MetS in Mediterranean Countries is high (one forth of the adult population), although definitely lower than that in U.S. [39,40]. It has been shown by prospective cohort studies, cross-sectional studies and clinical trials that adherence to the MD was associated with reduced risk of the MetS and its individual components also, in particular waist circumference, triglycerides levels, low density lipoprotein cholesterol (HDL-C), BP levels and glucose metabolism [38,41]. These effects of MD increase life expectancy in patients with MetS [42]. On the other hand, Mediterranean countries, such as Greece, have experienced a rapid social-economic change in the last 15 years and recently an economic crisis; both having negative impacts on healthy eating. These community changes affect nutritional habits and there is a tendency to abandon the traditional healthy MD [43]. However, if we continue to try at the elementary school level, things might be better than they look. A study aiming to examine the long-term effects of the "Cretan Health and Nutrition Education Program" on BP, examined several parameters: BP, dietary, anthropometrical and physical activity data nearly 10 years after the original study (at baseline year 1992-1993, and follow-up examination at year 2001-2002) [44]. The findings of the study revealed that the increase over the 10- year period in systolic BP and diastolic BP was higher in the control group than in the MD intervention group (P=0.003 and P<0.001 respectively). These facts are encouraging, indicating favorable changes in BP, micronutrients intake, body mass index (BMI) and physical activity over a 10-year period and 4 years after program's cessation [44]. We just have to keep trying to establish MD at an early age. In brief, MD reduces CVD risk and this action could be at least in part attributed to the reduction of BP and MetS. Given that the complete adoption of MD is practically impossible, a high degree of adherence is desirable. This could substantially reduce adverse CVD events as well as the incidence of acute coronary syndromes, by one third, If combined with a high level of physical activity. A high adherence to MD also reduces the prevalence of MetS, a part of which is HTN, and diminishes its clinical consequences, improving life expectancy. It is more effective if MD is adopted early in life.

If screening had been a drug, it would have been withdrawn from the market. Thus, which country will be first to stop mammography screening? (Peter C. Gøtzsche) 1This issue of RBMFC addresses the subject of medical ethics, the backbone that should guide both the demands in health services and health technologies provision, as well as the practice of family and community physicians. As a stimulus for reflection, the Debate section tackles the “Preventive mandatory mammography” policy in Uruguay, while in the Section Essays, Jamoulle and Gomez discuss the concept of quaternary prevention: action that aims to offer ethically acceptable alternatives to patients in order to prevent the excess of medical interventions.2 Despite considerable technological and social transformations that directly affect people’s health, ethics in medicine continues to morally shape health problems and health policy decisions with implications for patients, physicians and health institutions.In a practical analytical and easy to understand guidance for health professionals, Gillon3 discusses the four principles and scope of medical ethics: autonomy, beneficence, non-maleficence and justice. The latter encompasses the distributive justice, individual right justice and legal justice. These four principles provide a baseline for dialogue across different cultures, religious beliefs and political positions, as these principles are considered to be prima facie: a duty which is compulsory on all occasions unless it is in conflict with equal or stronger duties.4 Thus, based on these four principles that underlie ethics in medicine and consequently the application of the quaternary prevention, cancer screening programme will be critically analysed as a preventative strategy.Screening programmes entails the use of an initial selective tool or a sieve phase (i.e. mammography) to separate asymptomatic persons within the target population, that will need to undergo a classificatory or diagnostic phase - which involves a ‘gold standard’ for defining a disease (i.e. anatomopathology) – to finally offer patients a definitive preventive treatment for the condition screened.5 Since this type of intervention is performed on healthy individuals, the ethical requirements in the cases of screening programmes are very high, because the risks of damage are not balanced against real suffering (a clinically manifested disease), but are anchored in a potential future of illness and death. In this case, the principle of non-maleficence (do not harm) prevails over the principle of beneficence (the desire to promote the patients’ wellbeing), since asymptomatic persons, who perceive themselves as healthy, may have their health perception shaken indefinitely due to a biomedical intervention. The most often cited damages in the literature are psychological (due to the uncertainties of false positives, false assurance of false negatives, and borderline conditions that require a closer monitoring such as Cervical Intraepithelial Neoplasia - CIN I, II, III), as well as the physical consequences resulting from treatment itself, such as impotence or urinary incontinence, in the case of screening and treatment of prostate cancer.Since in the screening and/or health check ups the intervention is usually a ‘mirage-guided’ or ‘probability-guided’, it can result in ‘damage without the potential benefits’,6 as in the case of invasive procedures (to clarify ‘images’ or ‘positive’ exam results produced in the selective or sieving phase) which can result in complications, but the biopsy turnout to be normal. For instance, colonoscopy, laparoscopy, biopsies (liver, kidney, prostate), in which those procedures may end up producing complications (intestinal perforation, anaesthesia complications, major artery perforation, sepsis) with the potential to scale up into hospital readmission, with stress for patients and families and/or an even worse scenario: patients’ death with a benign finding. Therefore, screening programmes intrinsically carry the potential to convert healthy people into sick individuals at the population level, and consequently are highly iatrogenic and could be summarized as follows: “For many are called, but few are chosen…,” but many will need to suffer for to very few be cured.This is particularly true in the case of breast cancer screening with mammography, which renders physiopathologically insignificant cancers (overdiagnosis) exposing previously healthy women to significant damages due to radiotherapy. Gotzsche et al.7 highlighted important risks of adverse effects as consequence of radiotherapy, such as heart failure (27%) from circulatory cardiac damage and/or induction of lung cancer (78%). Furthermore, a recently published systematic review in the British Medical Journal8 on the adverse effects of cancer screening, found that only a third of randomized controlled clinical trials was concerned in measuring and controlling for potential harms of screening intervention. This article is very important because it has a direct effect upon the practice of health professionals, who cannot address security parameters on cancer screening interventions with their patients, since there is an information selection bias that emphasizes only the positive aspects of screening, for lack of controlling and monitoring of potential harms in most screening clinical trials.From an ethical stance, this context of uncertainty undermines the patients’ autonomy, creating false empowerment, since women do not have a more complete view on the potential harms and benefits of breast cancer screening programmes.9 To truly empower women and strengthen their autonomy for deciding upon interventions that directly affect their health, there is a need for information to be more transparent and also to reveal potential harms of the interventions. Moreover, the language used for the dissemination of information should be neutral, of simple understanding, culturally accessible, so that the users of the health system can better decide about their own health.3From the perspective of public health, distributive ethic justice, and limited healthcare budget - that any health system faces - screening programmes diverts financial resources - which should primarily be allocated to the treatment and care of sick individuals - towards healthy people, with the potential to produce new real patients, due to the damage of the interventions on healthy bodies, generating more costs to the health system and society in general.Fortunately, screening programmes are increasingly losing their strength, especially in Europe. For instance, the Swiss Medical Board10 found no scientific rational for the maintenance of breast screening programmes in light of current available scientific evidence. In Denmark, the rate of mortality attributable to breast cancer have not reduced due to the implementation of systematic breast cancer screening programme with mammography over 17 years follow up,11 however, it has produced an overdiagnosis rate of 33%.12 Similar trends in mortality over the last 30 years were also observed in the United States,13 as well as in Canada, the accumulated 25 years monitoring of the effects of breast cancer screening, did not render reduction in mortality from breast cancer, but resulted in 22% of overdiagnosis.14 Thus, to Peter C. Gotzsche,1 one of the world ‘s leading authorities on the subject, the best method we have to reduce the occurrence of breast cancer is to stop screening with mammography.From an ethical and scientific point of view,10 screening programmes should be discontinued or restricted to high-risk groups or very specific situations, and the focus of prevention should be redirected towards interventions on early-symptomatic patients, since breast cancer treatment has improved considerably in recent decades, and this is likely to be the responsible for improving the quality of life of affected women.1 The Canadian Task Force15 on preventive health care in their last update (2011) regarded as weak recommendation the breast cancer screening with mammography every 2-3 years in age group 50-69 years-old, because they considered the evidence for screening only of moderate quality. The Brazilian Ministry of Health16 also acted correctly in limiting the financial incentives for breast cancer screening for the age group 50-69 years.Therefore, ‘there is nothing wrong saying no to mammography’,9 because when acting upon asymptomatic healthy people, the principle of non-maleficence should override the principle of beneficence. Thus, the challenge left for family and community doctors is to individualize each case in this ‘sea of uncertainty’, sharing with their patients the often hidden potential harms attributed to cancer screening in order to operationalize in daily practice the concept of quaternary prevention.