Artigos de revistas sobre o tema "Enslaved persons, united states, social conditions"

Abstract In this article we first trace the history of “management,” particularly in the United States, from the plantation to the factory to the corporation, with the intention of understanding and contextualizing “classroom management” in today‘s educational lexicon. To do so, we look at the intertwining history of racial knowledge and the management of enslaved persons; the subsequent development of scientific management; social efficiency educators‘ application of scientific management to education; and conceptions of classroom management in today‘s neoliberal environment, in which education is increasingly positioned as a consumer good subject to individual choice and competitive markets. We further look to examples from post- -colonial Africa to demonstrate the ways in which neocolonial forms of scientific management comingle and entwine with neoliberal policies and procedures. The global phenomenon of scientific management, rife with neoliberalism and racism, is finally examined in the context of (so-called) Culturally Responsive Classroom Management, a neoliberal project that claims to advocate social justice through the process of managing bodies in classrooms.

Seventeenth-century reports of the suffering of European indentured servants and the fact that many were transported to Barbados against their wishes has led to a growing body of transatlantic popular literature, particularly dealing with the Irish. This literature claims the existence of “white slavery” in Barbados and, essentially, argues that the harsh labor conditions and sufferings of indentured servants were as bad as or even worse than that of enslaved Africans. Though not loudly and publicly proclaimed, for some present-day white Barbadians, as for some Irish and Irish-Americans, the “white slavery” narrative stresses a sense of shared victimization; this sentiment then serves to discredit calls for reparations from the descendants of enslaved Africans in the United States and the former British West Indies. This article provides a detailed examination of the sociolegal distinctions between servitude and slavery, and argues that it is misleading, if not erroneous, to apply the term “slave” to Irish and other indentured servants in early Barbados. While not denying the hardships suffered by indentured servants, referring to white servants as slaves deflects the experiences of millions of persons of African birth or descent. We systematically discuss what we believe are the major sociolegal differences and the implications of these differences between indentured servitude and the chattel slavery that uniquely applied to Africans and their descendants.

Abstract Cognitive impairment and dementia continue to threaten the aging population. Although no one is immune, certain groups, namely black older persons, are more likely to have a diagnosis of certain dementias. Because researchers have not found a purely biological reason for this disparity, they have turned to a biopsychosocial model. Specifically, black persons in the United States are more likely to live with social conditions that affect their stress levels which in turn affect physiological regulation leading to conditions that result in higher levels of cognitive impairment or dementia. Here we discuss some of these social conditions such as discrimination, education, and socioeconomic status, and how physiological dysregulation, namely allostatic load that can lead to cognitive impairment and dementia in black persons especially.

This study examines associations between perceived day-to-day age discrimination, positive well-being, and physical health over a 20-year span. Data came from all three waves of the National Survey of Midlife Development in the United States (1995–2014). Generalized structural equation modeling was used to analyze 6,016 observations of 3,102 participants and test associations between age discrimination and (a) psychological well-being and positive affect, and (b) self-rated health, instrumental activities of daily living, and chronic conditions. Associations were also examined between the well-being measures and all three health outcomes. Between-persons and within-persons effects were modeled separately but simultaneously. Both between-persons and within-persons results revealed numerous significant associations between age discrimination and physical health, although results were stronger between-persons. Moreover, hypothesized associations of age discrimination with well-being, and of well-being with physical health, were supported both between- and within-persons. Findings suggest diminished well-being may be one mechanism whereby age discrimination harms health.

Stories matter. They matter to those intent on maintaining structures of power and privilege, and to those being crushed by those structures. In the United States, the space to tell, and to hear, our stories has been expanding. This means that the histories and lived realities of those who have been excluded, particularly people of color, are seeping into mainstream discourse, into the books our children read, the movies and television shows they watch, and the many websites comprising social media. Critical race theory has played a role in this expansion. It insists that we recognize the legitimacy of the stories of those deemed “Other” because they have been erased or distorted beyond recognition in the dominant narrative. 3 Critical race theory has helped ensure that the legacies of genocide and broken treaties, of the cruelties imposed upon enslaved persons, of the forced inclusion and exclusion of those regarded simply as disposable labor, have worked their way into the realm of what can be talked about. Critical race scholars have exposed immigration injustices and called out xenophobia and Islamophobia. All this discomfits those who benefit, or believe they benefit, from the status quo.

e23128 Background: Disparities in minority participation in gynecologic cancer clinical trials is well documented. FDA guidance stipulates geographic informed analyses to reduce barriers to trial participation. We performed a geographical analyses of gynecologic cancer clinical trials in the United States relative to racial distribution and social vulnerability indices to identify areas of increased need. Methods: We performed a cross-sectional analysis of NIH ClinicalTrials.gov by retrieving all trials first posted 1/1/2013 through to 1/10/2024. We searched for ovarian, uterine, cervical, endometrial, vaginal/vulvar and gynecological cancer. We reviewed enrollment criteria to exclude non-gynecological cancers (1643 trials) or non-invasive gynecological conditions (224 trials). We aggregated census data, state-level total population size, percent Non-Hispanic White (NHW), and the FEMA Expected Annual Loss per state as a measure of social vulnerability. Using R statistical software (v 4.3.1), we measured the association between these variables and the number of gynecological trials per 100,000 persons using Pearson’s correlation. Results: We identified 3,428 trials, filtered down to 1,561 invasive cancer trials. The most common trials were ovarian (911, 58.3%) and cervical (438, 28.0%), followed by endometrial (385, 24.6%), uterine (158, 10.1%), vulva-vaginal (78, 4.99%), and 7.62% genetic-based. Texas had the highest number of trials (501) followed by California (454) and New York (427). The state with the highest population-adjusted number of trials was South Dakota (8.57 trials per 100,000 persons), followed by Rhode Island at 8.38 per 100,000 persons. California, Mississippi, and Puerto Rico had the lowest number of trials per 100,000 persons with 1.148, 0.979, 0.466 respectively. States/territories with greater than 4 trials per 100,000 were comprised of populations that were > 50% NHW. The correlation between the state-level percentage of NHW in 2020 and the number of trials per 100,000 persons was p = 0.057 indicating that there was a correlation between Whiteness at the state-level and trial availability. We found that states with higher FEMA expected annual loss had lower numbers of gynecological trials per 100,000 persons (p < 0.001). Conclusions: We found a disparity in the geographical distribution of trials available for gynecological cancers that was correlated with racial disparities and social vulnerability. Efforts to increase decentralization of trials and improve access and availability of gynecologic cancer clinical trials are necessary to increase equity for minority representation in clinical trials at the national level.

Recent scholarship on Mexican Americans in the United States, relying largely on qualitative evidence, sees racism and exploitation as the major explanatory factors in their history. Using representative samples of persons of Mexican origin, we argue that immigration is fundamental to their historical experience. A small, beleaguered community in 1850, the Mexican-origin population grew during the late nineteenth century due to greater security under US jurisdiction. However, immigration between 1900 and 1930 created a Southwest broadly identified with persons of Mexican origin. Economic development in Mexico, restriction of European immigration to the United States, and extreme cross-border wage differentials prompted extensive emigration. Despite low human capital, circular migration, and discrimination, immigrant Mexicans earned substantially higher wages than workers in Mexico or native-born Hispanics in the United States. They followed typical immigrant paths toward urban areas with high wages. Prior to 1930, their marked tendency to repatriate was not “constructed” or compelled by the state or employers, but fit a conventional immigrant strategy. During the Depression, many persons of Mexican origin migrated to Mexico; some were deported or coerced, but others followed this well-established repatriation strategy. The remaining Mexican-origin population, increasingly native born, enjoyed extraordinary socioeconomic gains in the 1940s; upward mobility, their family forms, and rising political activity resembled those of previous immigrant-origin communities. In the same decade, however, the Bracero Program prompted mass illegal immigration and mass deportation, a pattern replicated throughout the late twentieth century. These conditions repeatedly replenished ethnicity and reignited nativism, presenting a challenge not faced by any other immigrant group in US history.

Abstract This paper presents an abbreviated version of an ‘elite’ interview conducted with Madeline Manning-Mims. The 1968 Olympic protest was a pivotal moment in Olympic and American sports history. At the forefront of the protest was the pre-eminent sport sociologist Dr. Harry Edwards. Edwards’ leadership catalyzed the African American boycott of the 1968 Olympics in Mexico City, however, Black female athletes were either silenced or recused themselves from the protest. A series of semi-structured, retrospective interview questions were posed to Manning-Mims to gather her perspectives on the progress that Black American, women Olympic athletes have made in the USA from 1968 to present. Analysis of the ‘expert’ interview with Mims indicated that: 1) the social conditions in the United States that have plagued Black female athletes in 1968 had changed for the better; 2) on the whole Black U.S. athletes in the second millennium have become “commoditized” after the Olympics and gain substantially from their celebrity; and 3) Black female athletes can become enslaved to the economics of their celebrity if they are not careful.

Abstract As of 2019, more than 4 million older adults aged 65+ in the United States are cognitively impaired, including the diagnoses of mild cognitive impairment (MCI) and dementia. Caregivers to these older adults bear significant burden, reflected as high prevalence of chronic stress and mental health problems among the caregiver population. It is thus crucial to understand the wellbeing of the caregiver population to design effective policies. Previous studies have documented survival advantage of dementia caregivers compared to non-caregiving individuals as well as other types of caregivers, namely caregivers to persons with MCI or other types of chronic conditions. However, it remains less clear how the role of social support explains dementia caregiver’s survival advantage. In this paper, we directly compare the level and type of social support between different types of caregivers, and examine to what extent the difference in social support explains the survival and health advantage of dementia caregivers compared to caregivers to persons with MCI, non-cognitive impairment chronic conditions and non-caregiving individuals. We use the 12 waves of the Health and Retirement Study and apply multivariate and survival analysis to calculate difference in age-specific hazard ratios. Our preliminary results show that dementia caregivers tend to secure stronger support from family members than caregivers to persons with MCI. Our results have potential to shed light on the empirical puzzle of healthy caregiver selection effect and have direct implications for designing effective intervention to improve health of the caregiver population.

Abstract As of 2022, 21 states have fully legalized cannabis, 23 legalize for medical use only, and 6 states prohibit cannabis use entirely. While previous research has associated discrete aspects of state cannabis regulation with individual outcomes, little is known about the administrative rules most relevant to older persons. We previously have observed how the progressive approach to legalization across the United States, which includes flexible regulation on legal access, medical program eligibility and qualifying conditions, potency limits, care giver autonomy and others has corresponded with increased accessibility and use of cannabis among Americans over 65 years old. In this study, we source data on seven distinct state regulations pertaining to older persons and measured each on a scale reflecting permissiveness relevant to access and use. We used individual item measures to construct aggregated scores of state policies and charted changes within and among these seven state policies from 2016 to 2022. This research advances scientific understanding by capturing finite distinctions among state regulatory approaches most likely to impact older persons and offering reliable time-varying measures to be included in multi-level model formulations.

Obesity has become the second leading cause of death following smoking in the United States and is considered to have reached epidemic proportions over the past decade. It is estimated that almost two thirds of the U.S. population are overweight or obese. Obesity is also a contributor to a number of secondary disabling conditions such as coronary heart disease, type 2 diabetes, respiratory dysfunction, and musculoskeletal disorders. The psychosocial, medical and vocational implications for persons who are obese are becoming an increasing important area for rehabilitation counselors. Discrimination in employment, social situations, education, and the medical community is well documented. These issues in addition to mental health and vocational counseling strategies are discussed in this article.

South Africans with albinism are among the most marginalised and vulnerable citizens yet very little attention is paid to protecting them from human rights violations. There have been several calls by people with albinism in South Africa to be classified as disabled. The question of whether albinism is classified as a disability or not is a controversial legal one, which does not always have a straightforward answer. A literature search indicates that in South Africa no comprehensive and analytical study has been carried out on the subject of albinism and disability, whereas this has already been addressed in court cases in the United States of America. This paper anticipates addressing this gap within a legal perspective. The objective of such an analysis is to understand the construction of disability under the Employment Equity Act in order to shed light on whether people with albinism qualify for the protection, which is afforded to people with disabilities in the work place. Foreign case law and international human rights law could shed new light on this longstanding grey area or stimulate the development of novel legal analytical strategies. This paper reviews the nature of disability claims in the workplace on grounds of albinism in the United States context, including factors contributing to disability claims; assessing the degree of impairment and the guidelines in assessing albinism related disability. Prior to this discussion, the paper explores the current working definition of disability in South Africa, which stems from the IMATU case, which relied significantly on a foreign precedent; the Sutton v United Airlines case as there was no indigenous precedent in South Africa to fall back on. It will be argued that the Sutton v United Airlines decision, referred to in the IMATU case is based on an insufficiently inclusive definition of disability. Specific cases that relied on the Sutton v United Airlines decision as a persuasive authority in determining whether albinism is a disability or not, will also be examined. While the United States of America has struck down the decision in the Sutton v United Airlines and amended its legislation to include a broader and less restrictive definition of disability, which includes present as well as past conditions and a subjective component of perceived disability, the South African definition of disability still remains narrow and less inclusive. The United States of America's amended legislation does not contain an exhaustive definition of disability; rather, an equality-based framework was chosen which considers changing biomedical, social and technological developments. This new definition highlights the fact that the emphasis must be on whether discrimination occurred rather than adherence to a strict definition of disability. Such a framework of disability includes a socio-political aspect, which places emphasis on human dignity, respect and the right to equality. Against this background, the comparative analysis raises specific issues that deserve attention, in particular that the unique disadvantages and negative stereotyping suffered by people with albinism should be recognised as unlawful conduct against people with disabilities as defined by legislation. Put differently, the discussion calls for a broader approach to viewing disability, which includes both a social and a human rights perspective. In taking the position that albinism related discrimination is socially constructed, the article also explores the mandate of the Convention on the Rights of Persons with Disabilities in as far as it relates to the social construction of disability. The paper argues that the Convention on the Rights of Persons with Disabilities affords a direction for an analysis of the discrimination faced by persons with albinism.

The increase in the scope of international collaborative medical research involving human subjects is raising the problem of whether and how to maintain Western ethical standards when research is conducted in countries with very different social and ethical values. Existing international ethical guidelines for research largely reflect Western concepts of human rights, focusing on the bioethical principles of respect for persons, beneficence, and justice. However, in countries and societies where these values are understood differently or are not expressed in local cultures and institutions, it may be impossible or of no practical value to insert them into the research setting.In the United States, individual informed consent is considered ethically imperative for research involving human subjects. However, this imperative may be difficult to instill in societies that define persons by their relations to others, and important decisions are commonly made by heads of households or group leaders rather than by individuals. The baseline economic and health care conditions in foreign communities may also create ethical conflicts.

Purpose Smoking and at-risk drinking are each associated with lower primary care utilization, but the influence of their co-occurrence is not known. The current study compared associations of endorsement of one behavior vs endorsement of both with primary care utilization. Design Cross-sectional telephone survey. Setting All United States and Territories. Subjects 246 801 adults aged 18–64. Measures The outcome was endorsement of attending a past-year primary care visit. Predictor variables included drinking and smoking status examined individually and combined. Analysis Multivariable logistic regressions, adjusted for socio-demographics and number of chronic health conditions. Results The odds of attending a past-year primary care visit were 24% lower for persons who drank at risk levels compared to the odds of persons who did not drink and 36% lower for persons who smoked vs those who did not smoke. Among persons who endorsed at least one risk behavior, the odds of attending a past-year primary care visit were 25–35% lower for those who engaged in multiple behaviors compared to the odds of persons who engaged in one behavior. Conclusion Substance use screening and intervention services in primary care may not be reaching individuals with the greatest need for services. Proactive outreach and identification of primary care utilization barriers are needed, with special consideration of those with co-occurring substance use.

This article presents the application of a theatrical technique—Playback Theatre, which was developed in the United States during the 1970s—to social intervention, as a narrative and listening space that confers value and dignity upon the person and the unique and distinct individual experiences that facilitate their social and relational integration. This art of being oneself, as the author states, uses the oral tradition and spontaneous and creative communication of psychodrama and combines them with theatrical expression. This technique has been shown to be pertinent to both community social work and support groups for persons in problematic situations. The aim of this is to celebrate some specific moment of their lives, as individuals or as a community, and to define strategies for improving living conditions or resolving or alleviating conflicts. It is also used to assess the achievements of the proposed objectives, to strengthen the motivation to change and to transform existing relationships into collaborative ones. This is possible not only owing to the participation of persons, but also to the assumption of different roles that can permit the overcoming of certain traumatic events.In addition to support groups, it is used for the training and supervision of social work professionals. The theatrical technique in question allows them to assume roles as diverse as narrator, audience or actor, whether simultaneously or successively. Taking the role of «performer» or guide to the theatrical action requires prior preparation in order for the group of participants to be able to pool their individualities and their emotions and reflect on them. The participatory methodology that Playback Theatre proposes is important in community social work and is posed in a new and transformative key.

Abstract Weather radar is now widely viewed by the general public in the United States via television, computers/tablets, and smartphones. Anyone can consult near-real-time maps and animations of weather radar data when weather conditions are a factor. However, the usefulness of weather radar data for each user depends on a complex interaction of factors. There have been few studies providing conceptual arguments and empirical data to better understand what the most important factors are and to comprehend patterns of public weather radar use across the United States. The first part of this research provides a basic conceptual framework for research investigating the usefulness of weather radar displays as a source of weather information and as a decision aid. The second part aims to uncover several factors that influence the perceived usefulness rating of the National Weather Service (NWS) website’s weather radar display at both national and regional levels using variables gathered from the 2014 NWS customer satisfaction survey alongside relevant geographic and climatological variables. Data analyses include spatial clustering and ordinal regression utilized within a generalized linear model methodology. Overall, respondents who are more familiar with the NWS and their products, as well as those who indicate they are more likely to take action based on information provided by the NWS, are more likely to find the NWS radar display useful. Geographically, the NWS radar display is most useful to persons residing in the southern United States. Lightning is the most important hazard associated with higher radar usefulness ratings.

Abstract Adult day centers (ADCs) in the United States represent a vital, but commonly overlooked, resource for dementia care among community-dwelling older adults. However, the severity of dementia in ADC users, their medical complexity, the supports offered to them, and health outcomes associated with adult day services among persons living with dementia is poorly understood. This is in part due to a lack of standardized data collection in this industry. In this symposium, we present the most current research on these issues, as well as strategies to improve data collection across ADCs to strengthen care. The symposium begins with analysis of data from the state of California that identifies patterns of chronic conditions in ADC users with dementia that are associated with emergency department visits and hospitalizations. We then examine data from the Centers for Disease Control, comparing dementia specialized ADCs and their participants to non-specializing ADCs. We compare the extent to which states with ADC programs require collection of patient centered reported outcomes on persons with dementia. Finally, we explore an innovative collaboration between researchers and community partners to simplify data collection in these centers. Our findings suggest that persons with dementia in ADCs are an extremely complex population and that some ADCs are better suited than others to meet their extensive needs. Additional patient-centered data collection can be supported with widely available software, and has the potential to demonstrate the effectiveness of ADCs, aid in program development, and help leverage funding opportunities.

This article highlights the participation of the USSR in solving the international problem of refugees and displaced persons in the post-war period; shows the attitude of the Soviet government to the policy of repatriation of Soviet citizens to their homeland, reveals the participation of the USSR in international organizations on the issue of refugees and displaced persons (UNRRA, IRO, UN) at the final stage of the Second World War and after its end, the ways of interaction of the allied countries on these world platforms are fixed. To study the activities of the USSR in the development of the principles of repatriation policy, as well as to resolve the problems of refugees and displaced persons, such methods as historicism, objectivity, as well as the method of comparative analysis together with a comprehensive analysis of documents were used. Based on the present research, we can conclude that the Soviet Union conducted active foreign policy activities to achieve the main goals of the repatriation policy, establishing international cooperation and protecting the interests of its citizens. The bulk of Soviet people who found themselves in difficult conditions of the post-war period were forced to lead their lives in camps for displaced persons, awaiting the decision of the authorities regarding their fate. Despite the active assistance to the return of refugees and social protection from the Soviet Union, the generous amount of the repatriates were tested in filtration camps, especially military ones, in order to identify traitors. In addition, the solution of the problem was complicated by the ardent anti-Soviet propaganda in camps for refugees and displaced persons by representatives of the United Kingdom and the United States, which was gaining momentum in connection with the beginning of the implementation of the means of conducting the cold War.

Since the outbreak of the novel coronavirus (covid-19) pandemic from China in 2019, it has left the world leaders in great confusing due to its fast-paced propagation and spread that has left infected a world population of over Eleven Million persons with over five hundred and thirty four thousand deaths and counting with the United States of America, Brazil, Russia, India and Peru in the lead on these death toll. The pandemic whose increased mortality rate is targeted at ‘aged’ citizens, patients with low immunology as well as patients with chronic diseases and underlying health conditions. Study models covid-19 pandemic via a susceptible-infect-remove actor-based graph, with covid-19 virus as the innovation diffused within the social graph. We measure the rich connective patterns of the actor-based graph, and explore personal feats as they influence other nodes to adopt or reject an innovation. Results shows current triggers (lifting of inter-intra state migration bans) and shocks (exposure to covid-19 by migrants) will lead to late widespread majority adoption of 23.8-percent. At this, the death toll will climb from between 4.43-to-5.61-percent to over 12%.

The purpose of the study is to determine the prospects for improving the special system of compensation for harm caused to the employee’s health as a result of accidents at work and occupational diseases in Russia based on the experience of legal regulation and development of such a system in the United States. The choice of the United States is determined by the specifics of regulation and the use of special systems for compensation for industrial damage in this country, which combines the best practices in this field in the world, as well as experimental approaches. The author substantiates the thesis about the compensatory nature of compulsory insurance for the industrial harm risks. It is noted that the national legislator should implement the approach in which the list of legally significant circumstances established for receiving insurance payments under this type of insurance includes only the fact of harm, its size and the fact of the origin of harm from the sphere of production or from industrial (professional) risks. In case of loss of earning capacity, it is important to adhere to a single method of assessing harm to health in terms of lost earnings (income), based either on the loss of ability to work, or on the projected or actual losses of the injured person, which is customary when applying depreciation methods, future losses and actual losses in the United States. At the same time, the method of future or actual losses in the future can be used in Russia for the injured persons returning to work. It is determined that it is advisable to compensate for industrial harm in terms of expenses for medical, social and professional rehabilitation of the injured person, which will free the judicial practice from disputes regarding the validity of providing specific types of assistance and care, as well as the need for them for the injured person.

On February 20, 1990, in Sullivan v Zebley, the Supreme Court of the United States struck down the Social Security Administration's criteria for determining eligibility of children with disabilities for Supplemental Security Income (SSI). This dramatic decision held that the existing regulations for the program discriminated against children, because children were required to meet a stricter standard than adults who applied for SSI. This decision overturned the current rules and procedures for the determination of access to a major federal benefits program and, in most states, to additional benefits through assured Medicaid eligibility. The Court also mandated that the Social Security Administration make changes that will significantly alter and liberalize access for children. Because many pediatricians may be unaware of the issues and the potential advantages for children in their care, we summarize below some of the pertinent background and implications of this landmark decision. BACKGROUND AND DESCRIPTION The Supplemental Security Income Program of the Social Security Administration, enacted by Congress in 1972, provides an income supplement to lower income disabled Americans, both children and adults. Persons older than 18 years of age who have a health problem that causes major disability and prevents participation in substantial gainful activity may receive cash benefits as part of a social policy effort that began in the Roosevelt era of the 1930s, although specific disability programs did not begin until the 1960s. Children also may receive cash benefits under certain similar conditions. The SSI program was designed primarily as a social benefit program to improve the financial standing of aged, blind, and disabled individuals, but it also brings automatic eligibility for Medicaid for individuals who qualify for SSI in 31 states and the District of Columbia.

Abstract Significantly more than half of people living with HIV in the United States are over age 50 and at least half of that number are over 70 years old. Advances in antiretroviral treatments continue to extend the lifespan of people with HIV. However, people aging with HIV, particularly those diagnosed earlier in the epidemic, known as “long term survivors” are likely to face a myriad of challenges: clinical, psychosocial, financial, and logistical. Aging with HIV is a complex mix of long-term treatment effects, early onset of general aging, comorbidities and other confounding factors including mental health and psycho-social factors that affect quality of life. Older persons living with HIV have experienced tremendous loss, stigma and discrimination, including within the healthcare system. Now, renewed losses amplified by the emergence of multiple comorbidities including cardiovascular and metabolic disease, HIV associated neurocognitive disease, other neurological disability, diminished bone health and frailty and other conditions can impair quality of life significantly. A review of the common comorbidities experienced by people aging with HIV and the intersection with social isolation, stigma and loss will be presented. Strength based, holistic care that focuses on resilience, and includes advocacy, social networks and care coordination delivered by nurses and nurse practitioners as part of a collaborative inter-professional education program at the Association of Nurses in AIDS Care to address the unique challenges experienced by PLWH will be described.

Background Young people with genetic conditions often face challenges coping with their health condition. It can be difficult for them to meet someone with a similar condition, which is important for reinforcement of chronic illness management recommendations. Social media is used by 97% of young people in the United States and may provide those with these disorders a space for emotional expression and support. However, there is a scarcity of literature related to the use of social media among adolescents with genetic conditions as an indicator of their perception regarding their own condition. Objective The purpose of this pilot study was to obtain preliminary data to assess and understand social media use by young people with connective tissue disorders and determine whether they use social media to connect with patients with similar conditions or whether they would be interested in doing so. Methods We undertook a pilot study of selected connective tissue disorders occurring in young people between the ages of 11 and 25 years, including Marfan syndrome; Ehlers-Danlos syndrome subtypes classical, classical-like, cardiac-valvular, and vascular; Beals congenital contractual arachnodactyly; and Alport hereditary nephritis. The study took place within one pediatric clinical system. Patients were identified through electronic medical record search and International Classification of Diseases, Ninth Revision, coding at a Midwest university–based clinical system. Study subjects completed a short survey describing their experiences with their connective tissue disorders, their means of self-expression, their existing network of persons to communicate with, and their use of social media. Data analysis included nominal and bivariate regressions to compare social media use in relation to age. Results Our 31 participants (42% response rate) were 55% female (17/31) and their average age was 18 years (SD 5). All participants used social media and there were no statistically significant differences between social media use and age. The majority of participants (25/30, 83%) reported that they never used social media to discuss their condition (P=.09), and only 17% (5/30) knew someone online with a similar condition (P=.50). Most participants (19/30, 63%) said they would communicate with someone with a similar disorder (P=.64). Conclusions We found that young individuals with connective tissue disorders use at least one type of social media. A majority did not use social media to discuss their condition or know someone online with a similar condition. However, many persons were interested in finding others similarly affected. Social media could serve as a platform for young people with connective tissue disorders to connect. Peer support is important in disease management and adolescent development. Future studies should aim at understanding social media use among young people with connective tissue disorders and helping them connect with other people who have similar conditions.

This study was designed to examine national trends and evaluate social determinants of health that were associated with the provision of dental services in emergency rooms in the United States between 2007 and 2014. A pooled cross-sectional database of emergency department (ED) visits combined the 2007–2014 waves of the Nationwide Emergency Department Sample. A total of 3,761,958 ED visits with dental conditions were extracted and the principal diagnosis was identified. A series of modified Poisson regression models were used to assess the relationship between patient sociodemographic factors and hospital characteristics, and the likelihood of visiting the ED for a nontraumatic dental reason. Unadjusted descriptive results indicated that there was no apparent increase in the percentage of patients who visited an ED with nontraumatic dental conditions (NTDCs) between 2007 and 2014. The greatest users of EDs for NTDCs were among those who were uninsured and Medicaid beneficiaries relative to persons privately insured. ED visitors were more likely to reside in lower socioeconomic areas (when compared with visitors in the top quartile of the income distribution). Patients in all other age groups were more likely to seek care in an ED for NTDCs relative to those 65 years of age or older. Multiple strategies are required to reduce the use of EDs for routine dental care. This approach will require an interprofessional dialogue and solutions that reduce barriers to receiving dental care.

Contemporary world events are demonstrating the need to embrace and further develop tele-health options for assessment and delivery of biopsychosocial healthcare services. This is now possible, given advances in communication technologies allowing virtual connections of medical personnel with constituents, as well as necessary, in light of recent challenges posed by infectious conditions and growing needs for travel restrictions, social distancing, and isolation of large portions of populations. Moreover, the opportunity to virtually connect with persons through ubiquitous computer-based and handheld communication devices allows comprehensive care provision to include underserved areas, where restricted, walk-in access to brick-and-mortar establishments has long been recognized as a limiting factor in healthcare. This review examines evolving approaches of tele-healthcare, with a specific focus on telemedicine as a bridge between traditional, in-person approaches to diagnose and treat medical conditions and new healthcare opportunities developing to meet changing societal needs. The three purposes of the review are: discuss background information, with a brief look at policy and procedure guiding applications of tele-techniques in healthcare practices; identify relevant scientific studies to show the breadth of new evidence-based research for telemedicine practices; and, discuss challenges for the further development of telemedicine as healthcare systems in the United States evolve to meet current and projected healthcare needs.

Abstract Older adults, the largest segment of the US rural population, face significant disparities in health and healthcare compared to their non-rural peers, including more chronic health conditions, financial challenges, and social isolation. They have limited access to healthcare and social services for prevention, management and treatment of chronic conditions. Age-Friendly Care-PA, a partnership between Primary Health Network and Penn State College of Nursing, aims to reduce these disparities in care and services for rural older adults through co-designing their Geriatric Workforce Enhancement Program. Age-Friendly Health Systems, an initiative of the John A Hartford Foundation and the Institute for Healthcare Improvement, in partnership with the American Hospital Association and the Catholic Health Association of the United States, equips providers, older adults, and their care partners with the support necessary to address What Matters, Medication, Mentation, and Mobility. This symposium describes how the 4Ms are integrated into clinician training and competencies, older adult education, operations, care delivery, and quality improvement. Year two outcome data will be shared. Drs. Hupcey and Fick will provide an overview of the project and its reach. Dr. Berish will describe the process of engaging stakeholders in co-developing our 4M metrics and the data generated. Jenny Knecht, CRNP, will describe a pilot study to extend the reach and acceptability of telehealth to hard-to-reach older persons. Finally, Dr. Garrow will detail a new initiative focused on equity in care. Our discussant, Dr. Terry Fulmer will lead a discussion of this work as well as next steps and policy implications.

Abstract There has been significant discourse surrounding the widespread system failures within healthcare during COVID-19. Older, frailer, and poorer persons across the United States have been the most impacted by the pandemic. Given this, our FlourishCare team, received funding through the COVID Cares Act, as part of our Geriatric Workforce Enhancement Program (GWEP) grant, to create innovative programming for individuals that were the most impacted by the pandemic. Remote patient monitoring (RPM) is one intervention been shown as an effective way to assist persons in managing their conditions. Patients from our Optimal Aging Clinic were identified as struggling with hypertension, diabetes and/or COPD. Interprofessional teams of nursing and social work learners were assigned to work with patients. The kits contain all of the necessary technology and a virtual app platform that allows a patient to check their heart rate, blood pressure, oxygen levels, and glucose levels. This information was then disseminated to the team coordinating the patient’s care. The sample was mostly female (88%), African American (64%) and retired (70%). The mean age was 60 (SD=4), and 40% had less than a high school diploma. After 3 months in the program, we saw a significant improvement across all determinants of health, with a particular overall change in access to health services and individual health behaviors. This study showed the importance of providing patients with access to technology and the support of an interprofessional team can improve patient outcomes, lead to improvements in individual health behaviors and improve health literacy.

Abstract Background and Objectives Conversion therapies to minimize same-sex attractions are classified as a dangerous practice by numerous scientific institutions in the United States. These practices may contribute to poor long-term psychosocial health, thereby interrupting processes of healthy aging. Few studies have examined psychosocial differences between persons with and without prior experiences of conversion therapy. We assessed associations between prior conversion therapy experiences and psychosocial health among midlife and older men who have sex with men (MSM; age 40+ years). Research Design and Methods Participants included a multicity sample of MSM (N = 1,156) enrolled in the Multicenter AIDS Cohort Study who completed health surveys (2016–2019) as part of their biannual study visits. Using multivariable regressions, we investigated the associations of prior conversion therapy with current depressive symptoms, internalized homophobia, post-traumatic stress, and cumulative psychosocial conditions. Using a trait-level measure (e.g., life purpose and perseverance), we tested whether resilience moderated these associations. Results The full sample was predominantly non-Hispanic white with a mean age of 62.6 years. Fifteen percent of men (n = 171/1,156) reported prior conversion therapy. In multivariable models, men exposed to conversion therapy were more likely to have depressive symptoms and above-average internalized homophobia. Men exposed to conversion therapy had 2–2.5 times the odds of reporting 1 and ≥2 psychosocial conditions, respectively, compared with those who reported 0 conditions. Resilience did not moderate these associations. Discussion and Implications Conversion therapies are nonaffirming social stressors for MSM and may compromise critical psychosocial aspects of healthy aging among MSM.

Binary rubrics are used to differentiate between living and non-living, animal and plant, vertebrate and invertebrate, mammalian and non-mammalian, as well as male and female organisms. While this approach helps in classifying the vast majority of the target population, we must remember that these frameworks are man-made. Many human beings may be born with phenotypic, karyotypic, gonadal and/or genital characteristics that “do not fit typical binary notion of male or female bodies”.1 Such births may as frequently as once in every 50 births, though 1 and 2 per 1,000 live births require, and/or receive “corrective” genital surgery.2 Intersex conditions are defined in various ways. Ambiguous genitalia and atypical genitalia occur if genetic and hormonal development are disturbed, and genital differentiation is hampered. A more inclusive term, difference of sexual development (DSD) uses karyotyping to classify such conditions. Types of DSDS include 46XX and 46XY sex chromosome DSD, XX and XY sex reversal, and ovotesticular disorders.3 Though frequently confused with transgender persons, and those with non-heterosexual orientation, persons with DSD are different from these. Hence, distinct advocacy for DSD needs to be carried out. As United Nations Human Rights states, “intersex children and adults are often stigmatized and subjected to multiple human rights violations, including violations of their rights to health and physical integrity, to be free from torture and ill-treatment, and to equality and non-discrimination.” 1 While South Asian countries have progressive legislation for transgender rights, awareness about the unique challenges faced by intersex people is lacking.4 Considering the near ubiquitous presence of endocrine disruptor chemicals in our environment, it may be prudent to expect, and prepare for, and increase in the incidence of differences of sexual differentiation.5 The case of persistent Mullerian duct syndrome, published6 in the current issue of the Journal of Pakistan Medical Association, should serve as a stimulus to enhance awareness and advocacy of this, as well as other DSD. Apart from ensuring accurate and appropriate diagnosis, one must focus on person sensitive communication, psychological support and social modulation.7 We commend the authors6 for their work in the field of DSD. Much more needs to be done, however. Policy makers, planners, members of the public, and persons living with DSD should work collectively to ensure that persons living with DSD should get their rightful place under the sun. Continues...

Background It is estimated that 70% of all deaths each year in the United States are due to chronic conditions. Cardiovascular disease (CVD), a chronic condition, is the leading cause of death in ethnic and racial minority males. It has been identified as the second most common cause of death in persons with HIV. By the year 2030, it is estimated that 78% of persons with HIV will be diagnosed with CVD. Objective We propose the first technology-based virtual environment intervention to address behavioral, modifiable risk factors associated with cardiovascular and metabolic comorbidities in sexual-minority men of color with HIV. Methods This study will be guided using social cognitive theory and the Technology Acceptance Model. A sequential, mixed method, waitlist controlled randomized control feasibility trial will be conducted. Aim 1 is to qualitatively explore perceptions of cardiovascular risk in 15 participants. Aim 2 is to conduct a waitlist controlled comparison to test if a virtual environment is feasible and acceptable for CVD prevention, based on web-based, self-assessed, behavioral, and psychosocial outcomes in 80 sexual-minority men of color with HIV. Results The study was approved by the New York University Institutional Review Board in 2019, University of Texas Health Science Center at Houston in 2020, and by the Yale University Institutional Review Board in February 2022. As of April 2022, aim 1 data collection is 87% completed. We expect to complete data collection for aim 1 by April 30, 2022. Recruitment for aim 2 will begin mid-May 2022. Conclusions This study will be the first online virtual environment intervention for CVD prevention in sexual-minority men of color with HIV. We anticipate that the intervention will be beneficial for CVD prevention education and building peer social supports, resulting in change or modification over time in risk behaviors for CVD. Trial Registration ClinicalTrials.gov NCT05242952; https://clinicaltrials.gov/ct2/show/NCT05242952 International Registered Report Identifier (IRRID) PRR1-10.2196/38348

Abstract Cerebral Palsy (CP) is the most common pediatric-onset physical disability, with an estimated prevalence ranging from 2.6-3.1 cases per 1,000 live births in the United States. There is a lack of clinical follow-up for individuals with CP after they transition from pediatric to adult primary care, and insufficient surveillance to track patients with CP longitudinally. Despite the shortage of research to examine the natural history of CP and chronic disease trajectories in this population, a range of secondary conditions arise at an accelerated rate as compared to the adult population without CP, prompting the widespread notion and clinical hypothesis that patients with CP are prone to accelerated aging. These factors further worsen functional status and quality of life, as well as lead to decreased independence. Despite the well-established interrelationships between physical and mental health disorders in the non-CP older adult population, the extent to which, mechanisms underlying, and time course associated with the development of these chronic conditions among adults living with CP has received little empirical attention. The proposed course will build upon our ongoing work by highlighting new findings from three centers doing research pertaining to aging with CP, and will cover novel mechanisms of musculoskeletal pathophysiology in CP, risk factors of and unique CVD profiles among adults with CP, and new findings related to health trajectory differences of adults with CP from clinical and population-representative cohorts. We will also provide insights into the pathophysiologic mechanisms linking early frailty and long-term health outcomes among persons with CP.

Background The COVID-19 epidemic in the United States is widespread, with more than 200,000 deaths reported as of September 23, 2020. While ecological studies show higher burdens of COVID-19 mortality in areas with higher rates of poverty, little is known about social determinants of COVID-19 mortality at the individual level. Methods and findings We estimated the proportions of COVID-19 deaths by age, sex, race/ethnicity, and comorbid conditions using their reported univariate proportions among COVID-19 deaths and correlations among these variables in the general population from the 2017–2018 National Health and Nutrition Examination Survey (NHANES). We used these proportions to randomly sample individuals from NHANES. We analyzed the distributions of COVID-19 deaths by race/ethnicity, income, education level, and veteran status. We analyzed the association of these characteristics with mortality by logistic regression. Summary demographics of deaths include mean age 71.6 years, 45.9% female, and 45.1% non-Hispanic white. We found that disproportionate deaths occurred among individuals with nonwhite race/ethnicity (54.8% of deaths, 95% CI 49.0%–59.6%, p < 0.001), individuals with income below the median (67.5%, 95% CI 63.4%–71.5%, p < 0.001), individuals with less than a high school level of education (25.6%, 95% CI 23.4% –27.9%, p < 0.001), and veterans (19.5%, 95% CI 15.8%–23.4%, p < 0.001). Except for veteran status, these characteristics are significantly associated with COVID-19 mortality in multiple logistic regression. Limitations include the lack of institutionalized people in the sample (e.g., nursing home residents and incarcerated persons), the need to use comorbidity data collected from outside the US, and the assumption of the same correlations among variables for the noninstitutionalized population and COVID-19 decedents. Conclusions Substantial inequalities in COVID-19 mortality are likely, with disproportionate burdens falling on those who are of racial/ethnic minorities, are poor, have less education, and are veterans. Healthcare systems must ensure adequate access to these groups. Public health measures should specifically reach these groups, and data on social determinants should be systematically collected from people with COVID-19.

The article refers to the educational electronic service provided in libraries by volunteer instructors, who help users, mostly those unemployed and elderly, to master computer literacy, work with the Internet , and search for information, especially concerning the labor market. Launched at the Chicago Public Library, in which, under the conditions of manifestation of the so-called phenomenon of library axiom, volunteers act as digital social workers, the CyberNavigator program has become one of the most sought-after and contributed to reducing the digital inequality in this megalopolis. Having familiarized with the American practice in the fi eld of library volunteering, during an educational trip to the United States, Polish specialists, studying foreign experience in the organization of modern volunteering to increase the level of its development in their country, decided to adopt a new service addressed to persons with diffi culties in accessing to information and communication technologies (ICT). To do this, they created and implemented a pilot project called “Information for Citizens — Cyber-Navigators in Libraries”. Its main objective was to introduce a system of continuous electronic training for persons with diffi culties in accessing to ICT by implementing a specifi c service of “cyber-navigators” in libraries. The authors of the project strived to implement digital and media training in libraries, both for those users “delimited by the digit” and for librarians to develop various forms of lessons for visitors like that (trai nings, instructions, consultations, etc.). The authors also wanted to identify the needs in the fi eld of users’ digital training and to attract volunteers in professional library activities, basing on the experience of American libraries and taking into account the Polish realities. The idea of cyber-navigation appeared to be so timely and fruitful, that the libraries have included this informal educational service in their list of permanent ones.

Background: Despite the considerable increase in computer and internet use over the past two decades, few studies have examined socioeconomic, demographic, and health characteristics associated with computer and internet use in the United States. Community-level differences in computer and internet use and associated disparities in health and mor tality indicators have not been analyzed. This study examines these associations at the individual and community level using national census, health, and mortality data. Methods: We analyzed data from the 2017 American Community Survey (ACS) Micro-data Sample, the 2013-2017 ACS Summary File, 2013-2017 National Vital Statistics System, and 2019 County Health Rankings and Roadmaps. Health and socioeconomic characteristics associated with broadband internet and computer use among adults aged ≥18 were modeled by logistic regression (N=2,385,595). Results: In 2017, 89.7% of Asian/Pacific Islanders (APIs) had broadband internet service, compared with 66.0% of American Indians/Alaska Natives (AIANs), 77.2% of Blacks/African-Americans, 78.8% of Hispanics, and 83.5% of non-Hispanic Whites. APIs (97.4%) were more likely than other racial/ethnic groups to own or use a computer (including smartphones), while AIANs (80.3%) were less likely. Socioeconomic gradients in internet and computer use were marked. Those below the poverty level and with less than a high school education reported 18 and 15 percentage points lower rates of internet and computer use respectively. Compared to metropolitan areas, nonmetropolitan areas had lower internet access (80.3% vs. 69.7%) and computer use (88.4% vs. 80.5%). Rural areas and small urban towns had the lowest level of internet and computer use. Risks of disabilities and lack of health insurance were greater among persons with lower broadband internet and computer access. Communities with low internet and computer use had seven years shorter life expectancy than communities with high use and were at increased risks of mortality from various chronic conditions, poor health, mental distress, hospitalization, smoking, obesity, and physical inactivity. Conclusions and Implications for Translation: Significant socioeconomic and racial/ethnic disparities in internet and computer use and associated health inequalities exist in the US. Closing the social divide in internet and computer use can positively impact individual empowerment, educational attainment, economic growth, community development, access to health care and health-related information, and health promotions efforts. Key words: • Digital divide • broadband internet • computer use • disability • health insurance • causespecific mortality • morbidity • health behaviors Copyright © 2020 Singh et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial (CC BY-NC 4.0) License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial.

Background Despite the efficacy of treatment and severity of symptoms, medication adherence by many with bipolar disorder (BD) is variable at best. This poses a significant challenge for BD care management. Objective For this study, we set out to identify psychosocial and psychiatric predictors of medication adherence with BD. Methods Using microtargeted social media advertising, we recruited an international sample of young and older adults with BD living in North America (Canada and the United States), Western Europe (eg, United Kingdom and Ireland), Australia and New Zealand (N=92). On average, participants were 55.35 (SD 9.65; range 22-73) years of age, had been diagnosed with BD 14.25 (SD 11.14; range 1-46) years ago, and were currently prescribed 2.40 (SD 1.28; range 0-6) psychotropic medications. Participants completed questionnaires online including the Morisky Medication Adherence Scale. Results Medication adherence did not significantly differ across BD subtypes, country of residence, or prescription of lithium versus other mood stabilizers (eg, anticonvulsants). Path analyses indicate that alcohol misuse and subjective or perceived cognitive failures are direct predictors of medication adherence. BD symptoms, psychological well-being, and the number of comorbid psychiatric conditions emerged as indirect predictors of medication adherence via perceived cognitive failures. Conclusions Alcohol misuse did not predict perceived cognitive failures. Nor did age predict medication adherence or cognitive failures. This is noteworthy given the 51-year age range of participants. That is, persons in their 20s with BD reported similar levels of medication adherence and perceived cognitive failures as those in their 60s. This suggests that perceived cognitive loss is a facet of adult life with BD, in contrast to the assumption that accelerated cognitive aging with BD begins in midlife.

Background Brief intervention is a critical method for identifying patients with problematic substance use in primary care settings and for motivating them to consider treatment options. However, despite considerable evidence of delay discounting in patients with substance use disorders, most brief advice by physicians focuses on the long-term negative medical consequences, which may not be the best way to motivate patients to seek treatment information. Objective Identification of the specific symptoms that most motivate individuals to seek treatment information may offer insights for further improving brief interventions. To this end, we used anonymized internet search engine data to investigate which medical conditions and symptoms preceded searches for 12-step meeting locators and general 12-step information. Methods We extracted all queries made by people in the United States on the Bing search engine from November 2016 to July 2017. These queries were filtered for those who mentioned seeking Alcoholics Anonymous (AA) or Narcotics Anonymous (NA); in addition, queries that contained a medical symptom or condition or a synonym thereof were analyzed. We identified medical symptoms and conditions that predicted searches for seeking treatment at different time lags. Specifically, symptom queries were first determined to be significantly predictive of subsequent 12-step queries if the probability of querying a medical symptom by those who later sought information about the 12-step program exceeded the probability of that same query being made by a comparison group of all other Bing users in the United States. Second, we examined symptom queries preceding queries on the 12-step program at time lags of 0-7 days, 7-14 days, and 14-30 days, where the probability of asking about a medical symptom was greater in the 30-day time window preceding 12-step program information-seeking as compared to all previous times that the symptom was queried. Results In our sample of 11,784 persons, we found 10 medical symptoms that predicted AA information seeking and 9 symptoms that predicted NA information seeking. Of these symptoms, a substantial number could be categorized as nonsevere in nature. Moreover, when medical symptom persistence was examined across a 1-month time period, a substantial number of nonsevere, yet persistent, symptoms were identified. Conclusions Our results suggest that many common or nonsevere medical symptoms and conditions motivate subsequent interest in AA and NA programs. In addition to highlighting severe long-term consequences, brief interventions could be restructured to highlight how increasing substance misuse can worsen discomfort from common medical symptoms in the short term, as well as how these worsening symptoms could exacerbate social embarrassment or decrease physical attractiveness.

Abstract Declining mortality rates and an aging population have contributed to increasing rates of multimorbidity (≥2 chronic conditions) in the United States. Obesity is an important risk factor for the development of chronic diseases. We evaluated the association between obesity and multimorbidity, and how the prevalence of concomitant obesity has changed over time. We used data from 8,883 individuals aged ≥60 years with data on body mass index (BMI) and self-reported comorbidities from the National Health and Nutrition Examination Surveys 2005-2014. Logistic regression was used to quantify the association between BMI categories (&lt;18.5, 18.5-24.9, 25-29.9, ≥30 kg/m2) and multimorbidity (yes/no). Change in proportions of obesity coexisting with multimorbidity by year was tested through linear regression. All analysis used NHANES survey design and weighting to be representative of the US population. The overall proportion of individuals with concomitant multimorbidity and obesity was 75%. As compared to a normal BMI (18.5-24.9 kg/m2), older adults with obesity (BMI ≥30 kg/m2) had higher odds of multimorbidity (OR 1.78, 95% CI 1.49,2.12). Persons with obesity had higher odds of decline in physical (1.41 [1.06,1.88]), basic (1.56 [1.13,2.15]), and instrumental activities of daily living (OR 1.58 [1.03,2.40]). The proportion of individuals with obesity and multimorbidity increased over time, but did not reach significance (β = 0.008, p=0.051). These results emphasize the role of obesity as a contributing factor to the burden of multimorbidity among older adults and underscore the importance of identifying and addressing obesity and multimorbidity via interventions to decrease obesity prevalence.

Abstract Artificial Intelligence (AI) holds the unique potential to capture older adult functional and behavioral diversity and improve geriatric care. Yet a gap exists between new technologies and the real-world needs of their target populations. Currently in the United States, three Collaboratories support novel AI projects in Aging Research. As the Stakeholder Engagement Core of the Johns Hopkins AI Collaboratory, in this poster, we share early lessons of forming a ‘Council’ of stakeholders – a group with the charge of informing pilot AI projects longitudinally. The Council was envisioned to include 10-15 persons: older adults, caregivers, and clinicians. We adopted different outreach techniques for clinicians versus non-clinicians; leveraged existing relationships with affiliated Memory and Social Clinics; individually approached community dwelling older adults and caregivers including homebound older adults and older adults with disabilities; and reached out to clinicians and advocates known to be committed to geriatric care. We developed plain language materials and explained the meaning of ’AI’ and ’Stakeholder Engagement’. Five out of 5 outreached clinicians, and 10 out of 20 older adults/caregivers agreed to serve on the Council. Many older adults on our Council had difficulty using their email and computer and required support. Several caregivers declined due to high caregiving demands and many older adults with multiple chronic conditions declined due to high personal needs; all reiterated their interest in the topic area despite declining participation. Future novel-technology projects should ensure inclusion of diverse stakeholders; incorporating a flexible plan of engaging high-needs older adults and caregivers is required.

Guaranteeing the availability of European labour markets constituted a very important element of the Polish foreign policy during the negotiation of conditions under which Poland would become a member of the European Union. At the time of the Polish accession, Poles as citizens of United Europe gained the right to take up legal work in other Member States. This opportunity was taken by Polish young people – “thirdgeneration emigrants” tempted by better earnings and prospects for the future. The proposed text is an attempt to capture migrants’ reality in the context of adaptative difficulties experienced by migrants with regard to globalisation-related transformations and the construct of a global teenager. The research results were obtained from two research projects carried out: (1) a research project carried out under the promotional grant in the years 2008-2012 (National Center for Science in Krakow – NN 106 348 140 (grant manager: Prof. Magdalena Piorunek, PhD) under the title: ‘Polish emigration and reemigration as an experience. Sociological and pedagogical aspect’, the results of which have been published in: Kozielska J., (2014) Post-accession migration. The theoretical and empirical context. Social support. The research sample in the quantitative analysis consisted of 174 persons who emigrated for at least one year and stayed in Poland for at least 6 months from the time of their return to the time of the research. The sample was targeted, and the target group consisted of return emigrants who emigrated during the pre-accession period and decided to stay in a European state rather than a “traditional” country of migration like the United States of America. The quantitative research was supplemented with a qualitative analysis of texts derived from hermeneutic methods, which included online forums (created by and for emigrants, both those who are still abroad and those who are planning to return or have already returned to Poland) and blogs containing fragments of emigrants’ biographies; (2) a research project carried out in London and Scotland under the POSTDOC scholarship of the Adam Mickiewicz University “Unique Graduate = Opportunities. An increase in the didactic potential of the Adam Mickiewicz University through proinnovative education in English, interdisciplinariness, e-learning, investment in human resources” under the title: ‘Transnational biographical counselling. A paradigm of qualitative research. An in-depth interview – 15 families with children (aged between 3 and 13 years) (2015-2017)’.

Abstract COVID-19 has adversely impacted the well-being of informal caregivers (CG) due to infection risk, changes to the home environment, and changes to resource availability. CG of persons living with dementia (PLWD) may be especially vulnerable due to the intensity of care provided. We compared CG activities and well-being among CG who did and did not care for PLWD during COVID-19. We conducted an anonymous online survey from April 2020-present. Respondents self-identified as 18+ years and CG to a child or adult with mental health or medical conditions. CG answered questions regarding hours of care provision and caregiving activities, and completed measures of CG burden (Zarit Burden Inventory-4), loneliness (UCLA Loneliness Scale), depressive symptoms (Patient Health Questionnaire), and anxiety (Generalized Anxiety Disorder-2). Of the 258 respondents within the United States, 86 cared for PLWD (33%; 88% female; 56±12 years) while 172 did not (66%; 87% female; 49±14 years). Compared to non-dementia CGs, more CGs of PLWD provided 40+ hours of caregiving/week (36% vs. 49%, p&lt;.05), performed more caregiving activities (8.5 vs. 10.5, p&lt;.01), and assisted with more activities of daily living (55% vs. 73%, p&lt;.01). Compared to non-dementia CG, more dementia CG reported CG burden (53% vs. 67%; p&lt;.05) and loneliness (7.3 vs. 9.1, p&lt;.05). No differences in depressive symptoms or anxiety were found. Results suggest that existing needs of CG of PLWD may be exacerbated by the stressors and concerns of the pandemic, necessitating higher levels of support.

The peculiarities of the manifestation of the food crisis in Ukraine in times of war are investigated and the foreign experience and the experience of international organizations and political institutions in overcoming it are analyzed. The analysis is based on the concept of food security developed by the UN, which defines it as sustainable physical and economic access to sufficient, safe, and nutritious food. It also uses the comprehensive approach with four pillars of food security: food availability, access, utilization, and stability. In the context of the study of food security in Ukraine, two areas for analysis are identified: a decrease in the availability of food for the population and a violation of nutritional stability; a decrease in the economic access of the population to food and essential goods. The article focuses on the issue of economic access to food for vulnerable groups of the population (including internally displaced persons and people living near the demarcation line, and in the occupied and liberated territories), compares the incomes of households of internally displaced persons in Ukraine at different moments since the beginning of the full-scale invasion of russia in February 2022, and presents the results of the assessment of the population's food needs in Ukraine. The prevalence of food insecurity and the ongoing fight against it at the international level have made it possible to develop clear mechanisms to overcome it. Based on numerous studies and taking into account the experience of countries where the food crisis was caused by natural disasters or the impact of climate factors and states whose territories became the arena of military conflicts, in the context of finding ways to overcome the food crisis, the author examines the comprehensive approach of the Food and Agriculture Organization of the United Nations to achieving food security in crisis conditions, which combines two areas: Sustainable development of rural areas and stimulation of agriculture; development and implementation of targeted programs to provide direct access to food for vulnerable groups. The areas of the comprehensive approach of the Food and Agriculture Organization of the United Nations are defined as complementary and aimed at reinforcing each other's positive results. Moreover, the article analyzes the European Union's approach to rural development in the Common Agricultural Policy, which provides for the definition of two equally important directions: support and stimulation of the agricultural sector; strengthening the social, environmental, and economic sustainability of rural areas in the context of overcoming the risks inherent in this type of territory.

The United Declaration of Human Rights (UDHR) proclaims that “all human beings are born free and equal in dignity and rights, are endowed with reason and conscience and should act towards one another in a spirit of brotherhood (Article 1),” and are “entitled to all the rights and freedoms outlined in (said) Declaration, without distinction of any kind, such as race, color, sex, language, religion, political or other opinions, national or social origin, property, birth or another status. (Article 2)” This formal declaration is supposed to be a simple institutionalization of a generally recognized realism – those human beings are born with inherent dignity, from which fundamental basic human rights flow and which provides reasonable justification for fostering justice and equality despite each person’s individuality. It is an affirmation that amidst personal and cultural divergences, human beings are called upon to respect each other primarily on account of their shared humanity, and not based on wealth, power, educational background, race, gender, and other social clusters – to treat each other fairly without discrimination. However, while the aforementioned international convention narrates a chronicle filled with beautiful social expectations, reality may be chanting a different narrative. Across different epochs, stories of horrifying violations of human rights have reverberated throughout the world. The infamous holocaust during the 2nd World War, the genocide of the Tutsis in Rwanda, and the martial law defilements during the Marcos regime in the Philippines are just some of the many horrific instances of human rights violations that have shocked humanity. One of the more prominent reasons for the occurrence of different human rights violations is deleterious discrimination – the arrogant sense of superiority that some assert over others, the conceited belief of being entitled with a guaranteed place atop the zenith of societal hierarchies at the detriment of those who do not share the same shade, nook or status. To address these discriminatory leanings of different cultures and States and provide international legal frameworks for ensuring that basic human rights are genuinely protected and promoted, the United Nations (U.N.) was created. To realize the objectives for its establishment, sundry international conventions have been crafted, negotiated, issued, and implemented. In the area of human rights protection, the primordial international convention is the UDHR. Two social groups that suffer from significant discrimination as to their capacity to properly enjoy and exercise basic human rights are refugees and stateless persons, which are governed by the 1951 United Nations Convention Relating to the Status of Refugees, and its 1967 Protocol, and the 1954 Convention Relating to Status of Stateless Persons, respectively. Because of their conditions and contextual situations, they are very vulnerable to being discriminated against and abused. This humanitarian crisis has been haunting the worldfor decades already and has also been knocking at the doorsteps of the Philippines in recent times, whose presence in the country has been rapid. Unfortunately, very few are aware of their existence, much less care about the predicaments and struggles of refugees and stateless persons worldwide and in the Philippines. It is in this context that the researcher is proposing the integration of international law on human rights, particularly that which relates to the protection of refugees and stateless persons, in the curriculum of higher education institutions (HEIs) in the Philippines.ReferencesAssociation of Southeast Asian Nations (2022). The Regional Comprehensive Economic Partnership, https://asean.org/?static_post=rcep-regional-comprehensive -economic-partnershipCommission on Higher Education (2012). Policy-Standard to Enhance Quality Assurance (QA) in Philippine Higher Education through an Outcomes-Based and Typology-Based QA. CHED Memorandum No. 46 series 2012. https://ched.gov.ph/wpcontent/uploads/2017/10/CMO-No.46-s2012.pdfCommission on Higher Education (2013). General Education Curriculum: Holistic Understandings, Intellectual and Civic Competencies. 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The article proves that law is an effective means of regulation only in the rule of law. The rule of law underpins the work of the United Nations and other international organizations, as well as the political institutions of modern developed nations. It is shown that the concept of “rule of law” is lexically close to one of the basic elements of the positivist doctrine of law in the form of the concept of “rule of law”, which led to the identification of these concepts. It is substantiated that the Ukrainian vision of the rule of law is not limited to legislation as one of its forms, but also includes other social regulators, including morals, traditions, customs, etc., which are legitimized by society and conditioned with historically achieved cultural level. It is confirmed that justice is one of the basic principles of the law, decisive in defining it as a regulator of social relations, one of the universal dimensions of the law. It is proved that justice is considered as a property of the law, expressed, in particular, in the equal legal scale of behavior and in the proportionality of legal responsibility for the offense. In the field of the law enforcement, justice is manifested, in particular, in the equality of all before the law, the conformity of crime and punishment, the goals of the legislator and the means chosen to achieve them. In the article, that right, comes forward as effective means of adjusting only in the conditions of supremacy of thelaw. Principle of supremacy of right is the basis of activity of United Nations and other international organizations, and also political institutes of the modern developed states. It has been shown that a pan-European understanding of the concepts studied takes into account the main aspects of the concept of “rule of law”: all persons, whether public or private, must be bound by law and have the right to enjoy it. It is shown that modern society has developed an effective mechanism for ensuring the rule of law, which includes: the existence of the basic law of the country – the Constitution or its equivalent; clear and consistent system of legislation; institutions of justice, administration and security, which have the means and capabilities to ensure the application of legislation; legal culture. In the absence of equal law for all, the progressive development of society is impossible. Where there are groups above the law, as well as the practice of selective application of the law, incentives for development disappear. It is substantiated that the rule of law should be identified and implemented at the stage of law enforcement and the first step towards this is to increase the role of law as the main and primary regulator of public relations.

The United States has the highest maternal mortality rate of any high resource country, and it is the only country outside of Afghanistan and Sudan where the rate is rising. The rate of pregnancy-related mortality in the US increased from 7.2 pregnancy-related deaths per 100,000 live births per year in 1987 to 17.2 in 2017. In Arizona, almost half of all pregnancy-associated deaths in 2016-2018 or three out of five deaths were related to mental health conditions or substance use disorder, and 98% of those deaths were deemed preventable with 48.5% of deaths having a good chance to prevent the death. Over 40% of these deaths were accidents or unintentional overdoses. Social determinants of health, system, and community factors have increasingly been acknowledged as contributing factors to the increasing rate of poor maternal health outcomes nationally, yet few states have been able to comprehensively address these issues due to fragmented health and public health systems of care, as well as severe workforce shortages. The State of Arizona launched a series of initiatives beginning or enhanced in 2019 to improve maternal health outcomes for persons of reproductive age in the State, including a grant-funded initiative to strengthen Arizona’s Maternal Mortality Review Committee and to fund prevention efforts. In 2020, maternal mental health was spotlighted by stakeholders as a crisis related to the COVID-19 pandemic. A maternal mental health task force was appointed by the state legislature and funded through a federal grant to bring statewide stakeholders together to identify gaps in care for the perinatal population, improve statewide data on maternal mortality, and to form a statewide action plan to promote and execute innovation in maternal health service delivery including recommendations to the state government for providers and facilities, regulatory and state policy, payers, law enforcement, other systems, public health, and communities. While the effort to improve perinatal care statewide has legislative and grant-funded support, the input from individuals with lived experience, healthcare professionals specializing in serving this population, and our community health workers such as peer support professionals, patient advocates, and BIPOC advocacy organizations have been the key to our momentum and successes. Ultimately, a legion of volunteers (primarily mothers) across the state have co-designed improvements that truly meet the needs in close partnership with the state department of health and state medicaid agency. Through community and provider participation, workforce development initiatives, compassionate and informed leadership, change management, and policy making, we have developed a comprehensive strategy to expand access to better care across the continuum of providers and facilities involved in perinatal care outcomes in our state. What we’ve learned and achieved through our evolving statewide efforts will contribute to the efforts of others in communities globally who are working to reduce adverse maternal health outcomes. Lessons learned and best practices in capacity building and sustainability will be shared.

Rehabilitation is defined as “a set of interventions designed to optimize functioning and reduce disability in individuals with health conditions in interaction with their environment”. Anybody may need rehabilitation at some point in their lives, following an injury, surgery, disease or illness, or because their functioning has declined with age. Some examples of rehabilitation include Speech and language training to improve a person’s communication after a brain injury; physical exercise training to improve muscle strength, voluntary movements and balance in persons with stroke or Parkinson disease; modifying an older person’s home environment to improve their safety and independence at home and to reduce their risk of falls; educating a person with heart disease on how to exercise safely; preparing a person with an amputation to be able to use a prosthetic and making, fitting and refitting the prosthesis; positioning and splinting techniques to assist with skin healing, reduce swelling, and to regain movement after burn surgery; prescribing medicine to reduce spasticity for a child with cerebral palsy; psychological therapies for a person with emotional distress following a spinal cord injury; Social skills training for persons with schizophrenia, autism spectrum disorders or disorders of intellectual disability. training a person with vision loss in the use of a white cane; and working with a patient in intensive care to improve their breathing, prevent complications and speed their recovery after critical illness. Rehabilitation is an essential part of universal health coverage along with the promotion of good health, prevention of disease, treatment and palliative care. Rehabilitation helps a child, adult or older person to be as independent as possible in everyday activities and enables participation in education, work, recreation and meaningful life roles such as taking care of family. Globally, an estimated 2.4 billion people are currently living with a health condition that may benefit from rehabilitation. With changes taking place in the health and characteristics of the population worldwide, this estimated need for rehabilitation is only going to increase in the coming years. People are living longer, with the number of people over 60 years of age predicted to double by 2050, and more people are living with chronic diseases such as diabetes, stroke and cancer. At the same time, the ongoing incidence of injury and child developmental conditions (such as cerebral palsy) persist. These health conditions can impact an individual’s functioning and are linked to increased levels of disability, for which rehabilitation can be beneficial. In many parts of the world, this increasing need for rehabilitation is going largely unmet. More than half of people living in low- and middle-income countries who require rehabilitation services do not receive them. The need for rehabilitation worldwide is predicted to increase due to changes in the health and characteristics of the population. For example, people are living longer, but with more chronic disease and disability. Currently, the need for rehabilitation is largely unmet. In some low- and middle-income countries, more than 50% of people do not receive the rehabilitation services they require. Emergencies including conflicts, disasters and outbreaks create enormous surges in rehabilitation needs while also disrupting rehabilitation services. Rehabilitation is an important part of universal health coverage and is a key strategy for achieving Sustainable Development Goal 3 – “Ensure healthy lives and promote well-being for all at all ages”. In this case study, an in-depth review of the situation of the rehabilitation centre practicum at Bostson, United States of America, is, highlighting important contributions that this research/practicum conducted by a student of the Department of Social Sciences Education, of the Catholic University of Ghana, Fiapre-Sunyani, could make to this important field of rehabilitation research in the next two decades.

BackgroundSystemic sclerosis (SSc) severely limits one’s ability to participate in paid employment, which may threaten an individual’s economic, social, physical, or mental well-being. No programs and very little resources exist to help people with SSc remain in the work force despite the high prevalence of work disability. The few programs that do exist were developed for persons with other rheumatic conditions. One evidence-based program, Making it WorkTM(MIW), has the potential to be adapted to meet the specific work related problems faced by people with SSc.ObjectivesThis study identified challenges in the work environment and supports received or desired by persons with SSc as a preliminary step to identify adaptations that could make the MIWTMmore relevant to people with SSc.MethodsParticipants were recruited through virtual communication from the National Scleroderma Foundation and word of mouth to participate in one 2-hour virtual focus group. Participants were>18 years of age, currently employed or stopped work in the past 5 years, United States residents, English-speaking, and self-reported a diagnosis of SSc and that SSc affected their work ability. Participants were first asked about difficulties working with SSc. The facilitator created a list of challenges based on initial discussion, then participants identified the top five most important challenges according to their experience. Participants were then asked about supports received or desired to help maintain employment. Focus group notes and transcripts were analyzed to determine challenges and supports that must be addressed in an employment intervention for people with SSc.ResultsThe sample included 14 participants (85.7% women, mean age 48.8±10.1 years, mean disease duration 7.7±7.4 years; 78.6% had diffuse SSc). 71.4% had college degrees and 71.4% were employed full time. 42.9% described their jobs as having mostly mental demands while 35.7% had both physical and mental demands. Important challenges prioritized by the most participants were: 1) challenges with physical tasks, particularly related to hand use [11, 78.6%] –“My hands are pretty messed up; typing is a challenge”; 2) fatigue [9, 64.3%]-“When you say fatigue, people are like, “Well, go take a power nap,” but that’s not what it is. I could sleep 12-hours and still be exhausted”;3) mental and emotional health, related to coping with how the unpredictability of SSc affects the body, identity, and employment [8, 57.1%]-“This disease does not just knock us down one time or challenge us on one level. It’s like one body system after another.”“You have to deal with the issues of your self-esteem, feeling like you’re different than everybody else, mourning that loss of ability or career or work ethic that you had prior to your diagnosis”Participants identified a variety of individualized strategies that enabled them to overcome challenges with SSc at work, including ways to plan ahead, adaptive equipment, and strategies to adapt job tasks. However, participants emphasized that in order to use these tools, it is most helpful to: 1) have the knowledge and advocacy skills to know what to ask for; 2) feel confident that asking for support or accommodations in the workplace will lead to a beneficial change; and 3) be able to problem solve with others (e.g., clinicians, work-related program, therapists, support group).ConclusionThis study identified the prominent barriers and supports to employment from the perspectives of patients with SSc. While there is some overlap with issues reported by persons with other rheumatic conditions, there are also SSc-specific concerns. This information will be used to adapt the MIWTMintervention, and warrants further consideration for how to incorporate better supports in healthcare, workplaces, and vocational counseling for people with SSc.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

For many years, institutional psychiatry was a major tool in the suppression of political dissent. Moreover, it appears painfully clear that, while the worst excesses of the past have mostly disappeared, the problem is not limited to the pages of history. What is more, the revelations of the worst of these abuses (and the concomitant rectification of many of them) may, paradoxically, have created the false illusion that all the major problems attendant to questions of institutional treatment and conditions in these nations have been solved. This is decidedly not so.Remarkably, the issue of the human rights of persons with mental disabilities had been ignored for decades by the international agencies vested with the protection of human rights on a global scale. Within the legal literature, it appears that the first time disability rights were conceptualized as a human rights issue was as recently as 1993 when, in a groundbreaking article, Eric Rosenthal and Leonard Rubenstein first applied international human rights principles to the institutionalization of people with mental disabilities.For people with mental disabilities, in particular, the development of human rights protections may be even more significant than for people with other disabilities. Like people with other disabilities, people with mental disabilities face degradation, stigmatization, and discrimination throughout the world today. But unlike people with other disabilities, many people with mental disabilities are routinely confined, against their will, in institutions, and deprived of their freedom, dignity, and basic human rights. People with mental disabilities who are fortunate enough to live outside of institutions often remain imprisoned by the social isolation they experience, often from their own families. They are not included in educational programs, and they face attitudinal barriers to employment because they have not received the education and training needed to obtain employment or because of discrimination based on unsubstantiated fears and prejudice. Only recently have disability discrimination laws and policies in the United States and elsewhere focused on changing such attitudes and promoting the integration of people with disabilities into our schools, neighborhoods, and workplaces.The question remains, however: to what extent has institutional, state-sponsored psychiatry been used as a tool of political suppression, and what are the implications of this pattern and practice? After an Introductory section (Part I), I discuss, in Part II, the first revelations of the dehumanization inflicted on persons with mental disabilities, primarily (but not exclusively) in Soviet Bloc nations. In Part III, I discuss developments after these revelations were publicized. In Part IV, I weigh the extent to which the post-revelation reforms have been effective and meaningful. In Part V, I explain the meanings of sanism and pretextuality, and discuss how they relate to the topic at hand. Then, in Part VI, I raise questions that have not yet been answered, and that, I believe, should help set the research agendas of those thinking about these important issues.

The growing interest in migration issues in the EU has not affected the analysis of African migrants. The focus is on social and political issues, while the economic issues studied are primarily related to the assessment of the reasons for the arrival of Africans in the EU, the trajectory of their movement, as well as the scale of remittances to their homeland and the conditions for their return back to Africa. The article focuses on the main features of African migrants’ economic activity in the EU. Instead of the traditional consideration of only one or several diasporas in a single country or a generalized analysis of the entire EU, we compare the specifics of immigrants from different African countries in the 4 largest EU member states (including the UK, which left the integration project in 2020). Our article begins with a review of studies that contain information on the economic activities of migrants from African countries. Then, based on data from Eurostat and national statistics from Germany, France, Italy and the UK, the role of people from Africa in these countries population is shown. The reasons for the differences between these four countries in the dynamics and structure of immigration from Africa are explained. Statistics of refugees, naturalized persons over the past 10 years, foreign citizens and residents with migration past are considered. France is the leader in the number of migrants, mainly due to people from French-speaking countries of North and West Africa. Italy stands out because it is targeted by many illegal migrant routes due to its geographical proximity to this region. The UK has become a target mainly for residents of former British colonies who are quite successful in naturalization in the United Kingdom (therefore, there are as many Africans without local passports in the UK as in Germany – 0.6 million). Further, it is shown that the key factor for taking a particular economic position in society is the status of migrants, their education also plays an important role (although Africans often work in places where a lower level of qualification is required than they have), as well as language barriers. There are big gender differences. At the end of the article we make conclusions about the problems of African migrants’ adaptation, although the EU countries cannot refuse to employ migrants in unattractive jobs in any case.

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.

The number of studies on specific deterrence is not large. Some data on this subject can be found in other studies aimed e.g. at evalution of effectiveness of diffrent penal measures, or analysis of criminal careers. One of the reasons of this lack of interest in specific deterrence is a belief, rather common today and particularly marked in the 1960s, that punishment not only fails to deter the convicted person from futher offenses but – quite the contrary - increases the probability of his futher criminal carrer. Another reason is probably the great difficulty in distinguishing for research purposes of the impact of specific deterrence from the other effects of punishment. Unfortunately, a statement made by J. Gibbs over twenty years ago still remains valid: there is no theory of specific deterrence, and the hypotheses concerning specific deterrence are vague and difficult to verify empirically. During the last twenty years, there was a progress in the methodology of research into specific deterrence. New success criteria were introduced into the assessment of deterrent effect of punishment, and the method of random field experiment was used. Researchers started to compare the effect of punishment with the effects of escaning punishment, instead of limiting themselves to comparisons of relative effectiveness of some penalties as opposed to some other ones. The progress was less marked in the formation of the theory of specific deterrence. It consists in attempts, on the one hand, at a new conceptualization of the problem of deterrence, and on the other hand, at integrating the deterrence hypothesis with other theoretical approaches. The paper consists of seven parts. The Introduction (I) contains analysis of the notion of specific deterrence, the criteria to distinguish between specific and general deterrence, tvpes of deterrence. Also discussed have the recent attempts at a new conceptualization of tne problem of deterrence through inclusion into that notion of not only the “direct costs of legal sanctions” but also “indirect costs”, or through the use of another criterion to distinguish between specific and general deterrence. Chapter II contains a brief discussion of early studies on specific deterrence; the findings have been discussed and numerous methodological flaws pointed out. The conclusion from those studies (that severe penalties involve a higher recidivism rate than lenient penalties) was generally seen as a prove that punishment has no specific deterrent effect on the futher behaviour of convicted persons. This conclusion was unjustified, though. And that for several reasons. The discussed studies often failed to distinguish between the mechanism of deterrence and the other effects of punishment. They also failed to solve the problem of selection bias in sentencing where specific types of penalties are imposed on specific categories of offenders; the difference between such groups of convicted persons is that even before the imposition of penalty, the probability of their relapse into crime was different. The studies examined but a marginal effectiveness of some penalties as compared to some other ones. What they overlooked, instead, was that the growth in recidivism rate cannot be estimated which would have taken place were no criminal penalties at all imposed on offenders. Chapter III discusses the findings of studies which tested two opposing hypotheses; i.e. that punishment either deters offenders (deterrence hypothesis) or amplifies offendling (amplification hypothesis). Both the conception of deterrence and that of labeling involve too one-sided and simplified an approach to the impact of punishment on the further conduct of offenders as they ignore the possibility of effects other than the anticipated ones. This was reflected in these studies in which the researches posed instead of posing questions in the categories of “whether” (does punishment deter? does pinishment amplify affending?), instead of trying to define the conditions of emergence of each of those two effects. Analyzed in few studies only were mediating psycho-social processes between punisment and the punished pefsons’ further conduct. The findings of different studies are often inconsistent. Some seem to confirm the amplification hypothesis although researchers sometimes stress that this effect is not stable Other findings point to the effect of deterrence. Still other studies showed that: punishment seems do not influence a pefson’s further criminal career. Finally, some of the latest findings also indicate the possibility of amplifijing offending under some conditions and of deterring effect on offending - under some other circumstances. Chapter IV discusses the implications of the criminal careers approach for methodology of studies on specific deterrence. What is particularly worthy of attention here is: 1) departure from the use of a sole success criterion in the evaluation of deterrent effect of punishment, and an attempt at grasping the impact of punishment on different dimensions of criminality such as the length of criminal career or fraquency of offenses; 2) investigation of the impact of punishment at different stages of a person’s criminal career. The success criterion where success means a person’s abstention from further offenses is replaced with the before and after comparison criterion where the intensity of a person’s criminal career before and after punishment is compared; this replacement is of a great importance in studies of effectiveness of penal measures imposed on chronic offnders. As suggested by the findings, certain penalties may in cessation of delinquency at the initial stage of the criminal career (on the occasion of the first and possibly also the second contact with the police). At further stages of that career, a decrease in the intensity of delinquency of the persons convicted is possible. Chapter V discusses attempts at including the hypothesis of specific deterrence into the economic model of delinquent behawior, and studies carried out by economists. According to some economists, specific deterrence can be included into the theory of rational choice provided it is treated as a special case of general deterrence. In tlis approach, the experience of a sanction becomes a factor influencing the anticipated sanctions. Chapter VI is devoted to discussion of the results of a series of rondom field experiments conducted in selected cities of the United States. The purpose was to evaluate the effectiveness of arrest as compared to other reactions to violence against a spouse (nearly all victims in the study were women). The obtained results were not uniform: in some experiments, deterrent effect of arrest was found out, while the rest showed an amplifying effect of arrest on the arrested person’s further violence against his spouse. The authors explain this divergence of results with a different impact of arrest on different types of persons. Thus the results suggest that arrest has a deterrent effect on permanently employed suspects; instead, suspects without a regular job tended to use violence more often after the arrest incident. The last Chapter (VII) recapitulates the findings. They show that it was a premature decision to reject the hyphothesis of specific deterrence. Punishment has a different impact on different persons: in some situations it results in amplication of offending; in some other ones, it deters a person from further offenses; and in still other situations it seems not to have any effect at all on furter offending. The findings point to a great importance in this respect of the first contacts with the law enforcement agencies. Moreover, the differentiated effect of punishment seems to depend on the offender’s age, sex, and attitude towards risk, and also on his permanent employment. It should be stressed that many studies use a broader definition of punishment, not limited to the penalties imposed by court. Some researchers treat even a person’s contact with the police as punishment; others believe that this function is performed by arrest. These different working definitions of punishment make it difficult to interpret the findings that relate to absolute deterrence, that is assessment of the effects of imposing punishment as compared to those of escaping punishment. Nearly all studies dealt with recidivism and, first and foremost, the effectiveness of punishment in reducing a person’s further delinquency. To a slight extent only did they try to define the meaning of punishment for those punished, their subjective estimations of probability and severity of punishment. For this reason, interpretation of the findings in the categories of stating whether punishment has a deterrent effect is not always justified.