Intersectionality in Clinical Medicine: The Need for a Conceptual Framework

Intersectionality has become a significant intellectual approach for those thinking about the ways that race, gender, and other social identities converge in order to create unique forms of oppression. Although the initial work on intersectionality addressed the unique position of black women relative to both black men and white women, the concept has since been expanded to address a range of social identities. Here we consider how to apply some of the theoretical tools provided by intersectionality to the clinical context. We begin with a brief discussion of intersectionality and how it might be useful in a clinical context. We then discuss two clinical scenarios that highlight how we think considering intersectionality could lead to more successful patient–clinician interactions. Finally, we extrapolate general strategies for applying intersectionality to the clinical context before considering objections and replies.     

Towards an evidence‐base for student wellbeing and mental health: Definitions,developmental transitions and data sets

Against a background of huge changes in the world of university and college students since the turn of the millennium, together with a multitude of reports on student mental health/wellbeing, this article argues that the field of student mental health is hampered by the imprecise use of terms, a rush to action by universities in the absence of a robust evidence‐base, and a lack of overall coordination and collaboration in the collection and use of data. In response, we argue for clearer and more consistent use of definitions of, as well as differentiations between, student wellbeing and mental health, for a longitudinal approach to the student body that captures their developmental transitions to and through university, and a strategic and systematic approach to the use of bona fide measures in the collection of data on wellbeing and on the process of outcomes in embedded university counselling services. Such a coordinated approach will provide the necessary evidence‐base upon which to develop and deliver appropriate support and interventions to underpin and enhance the quality of students’ lives and learning while at university or college.     

On the dark side of work: a longitudinal analysis using self-determination theory

As the nature of work has changed in recent decades, employees are increasingly exposed to psychological demands in the workplace, which have associated consequences for employees, organizations, and society. Using self-determination theory, this study examined the dark side of work, in which frustration of basic psychological needs is associated with higher levels of work-related stress. In this model, work-related stress is associated with higher levels of somatic symptom burden, which in turn is associated with higher levels of emotional exhaustion, turnover intention, and absenteeism. Results of a longitudinal analysis using data from four time points over 15 months supported these predictions. Taken together, this study advances the literature towards an understanding of the (potential) detrimental impact that need-thwarting work contexts can have on employee wellness and work-related outcomes.     

Thirdhand smoke beliefs and behaviors among healthcare professionals

Thirdhand smoke (THS) refers to tobacco smoke contaminants and by-products that remain in the environment after a cigarette is extinguished. The purpose of this study was to assess beliefs and behaviors regarding THS among healthcare professionals, and to examine associations among smoking attitudes/beliefs, provider demographics, and THS beliefs and behaviors. Healthcare professionals (N = 204) at a comprehensive cancer center and affiliated general hospital in a northeastern urban area completed online questionnaires. About one third of the respondents had heard of THS before completing the survey, and more than two thirds of the sample believed that THS issues do not receive enough attention. Being female, likelihood of discussing THS with others, endorsing the belief that smoking affects the quality of parenting, and support for government action towards smoking bans were significantly associated with providers’ belief that THS is harmful. Endorsing the belief that smoking affects the quality of parenting and belief that THS is harmful were significantly associated with the likelihood of discussing THS with others. Findings shed light on THS beliefs and behaviors of healthcare providers (a group of individuals that could be trained to educate and advise patients about THS) and inform recommendations for new tobacco policies and clinical guidelines for best practices in tobacco control and prevention.     

Virtual voices: social support and stigma in postnatal mental illness Internet forums

Many women with postnatal mental illness do not get the treatment they need and this is often because stigma prevents disclosure. The purpose of this study was to explore online social support for postnatal mental illness, how women experience stigma and potential disadvantages of using Internet forums. Interviews were conducted with fifteen participants who had suffered postnatal mental illness and had used forums. Systematic thematic analysis identified common themes in relation to social support, stigma and disadvantages of using forums. Most women felt they benefited from visiting forums by developing a shared understanding and discourse about their illness. Findings suggest future research should investigate if women benefit from using online social support provided by forums, if use challenges stigma and further explore potential concerns about using forums.     

Adolescent Sex Differences in Response to a Mindfulness Intervention: A Call for Research

Research on mindfulness interventions with adolescents has burgeoned over the last ten years, and findings have demonstrated increases in overall emotional wellbeing post-intervention. However, little is known about the sex differences in response to mindfulness interventions in this age group. In the present study we examine sex differences in outcomes of physiological stress markers during the Trier Social Stress Test (TSST) and emotional wellbeing measures before and after a mindfulness intervention (N?=?15) with 10 female and 5 male adolescents. Additionally, we examine sex differences in course engagement and post-intervention use of mindfulness skills during the TSST. Overall, we found some evidence that females were more engaged than males in the class and also reported less stress post-intervention. We conclude by strongly encouraging future research in this area to more clearly elucidate the different ways in which adolescent males and females engage and respond to mindfulness interventions.     

The Perceived Value and Impact of the Transference of a U.S. Model of Accreditation to National Christian Schools in Latin America

This study uses mixed methodology of the convergent design to examine stakeholder perceptions toward a transferred model of accreditation for national Christian schools in Latin America. Parents, teachers, and leaders from five accredited schools participated in an accreditation survey. One parent, teacher, and leader from each of the five accredited schools were selected for a semi-structured interview. Survey results were very positive toward the accreditation, but there were significant statistical differences in the perceptions of the stakeholder groups. Interview results were also very positive with five themes that were confirmed by all participants. Stakeholders acknowledged that the transferred model was appropriate for the region, but the model needed to be further contextualized.     

Examining the relation between adolescent social anxiety,adolescent delinquency (abstention), and emerging adulthood relationship quality

Background and Objectives: Social anxiety symptoms and delinquency are two prevalent manifestations of problem behavior during adolescence and both are related to negative interpersonal relationships in adolescence and emerging adulthood. This study examined the relation between social anxiety and delinquency in adolescence and the interplay between adolescent social anxiety and delinquency on perceived relationship quality in emerging adulthood. Design and Methods: In a 10-year long prospective study (T1, n = 923; T2, n = 727; Mage T1 = 12; 49% female), we examined competing hypotheses using regression analyses: the protective perspective, which suggests social anxiety protects against delinquency; and the co-occurring perspective, which suggests social anxiety and delinquency co-occur leading to increased negative interpersonal outcomes. Results: In adolescence, the relation between social anxiety and delinquency was consistent with the protective perspective. In emerging adulthood, consistent with the co-occurring perspective, ever-delinquents (but not delinquency abstainers) with higher social anxiety reported less perceived best friend, mother, and father support compared to delinquents with lower social anxiety. There was no interaction between anxiety and delinquency in predicting perceived conflict. Conclusion: This study highlights the importance of examining the relation between social anxiety and delinquency with regards to different interpersonal outcomes.     

Gesture as representational action: A paper about function

A great deal of attention has recently been paid to gesture and its effects on thinking and learning. It is well established that the hand movements that accompany speech are an integral part of communication, ubiquitous across cultures, and a unique feature of human behavior. In an attempt to understand this intriguing phenomenon, researchers have focused on pinpointing the mechanisms that underlie gesture production. One proposal––that gesture arises from simulated action (Hostetter & Alibali Psychonomic Bulletin & Review, 15, 495–514, 2008)––has opened up discussions about action, gesture, and the relation between the two. However, there is another side to understanding a phenomenon and that is to understand its function. A phenomenon’s function is its purpose rather than its precipitating cause––the why rather than the how. This paper sets forth a theoretical framework for exploring why gesture serves the functions that it does, and reviews where the current literature fits, and fails to fit, this proposal. Our framework proposes that whether or not gesture is simulated action in terms of its mechanism––it is clearly not reducible to action in terms of its function. Most notably, because gestures are abstracted representations and are not actions tied to particular events and objects, they can play a powerful role in thinking and learning beyond the particular, specifically, in supporting generalization and transfer of knowledge.