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    Stigma, reproductive and mental health among transgender and gender diverse individuals

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    BackgroundTransgender and gender diverse (TGD) individuals are exposed to widespread stigma since they break gender norms dictating that all individuals should identify, look and behave according to binary gender expectations determined by the sex they were assigned at birth. The positioning of TGD individuals as abnormal and inferior is used to marginalize and control them, diminishing their access to resources and autonomy. The stress that stigma entails harms their mental health, causing important health discrepancies. On a structural level stigma against TGD individuals is present in discriminatory laws, policies and negative population attitudes that systematically disadvantage them or fail to protect their rights. This includes legislation that enforces mandatory sterilization before legal gender recognition can be approved. It remains unclear how legislation and population attitudes affect European TGD individuals health care encounters and ability to build a family. Moreso, the health care needs of gestational TGD individuals require further exploration.AimThe broader aim of this thesis was to explore how structural stigma affects health care seeking behaviors, health care encounters and the ability of TGD individuals to build a family and sustain their mental health as parents. A secondary aim was to deepen the understanding of gender dysphoria, stigma exposure, mental health concerns and health care needs among gestational TGD individuals to support law reforms and improve the mental health and quality of care for TGD individuals.MethodsThis thesis includes four studies involving quantitative and qualitative methodologies. Studies I and II are qualitative. They explored the experiences of TGD individuals who have undergone pregnancy and childbirth in Sweden after mandatory sterilization was removed from the law on legal gender recognition. The studies used inductive thematic content analysis based on face-to-face interviews.Studies III and IV are cross sectional. They mainly used multilevel logistic regression to assess the association between country level structural stigma and individual outcomes among TGD individuals living in Europe. These studies relied on a composite index, measuring structural stigma at the country level based on legislation and population attitudes. Two large scale cross-European surveys on discrimination provided the individual level data.ResultsStudy I: Health care providers in gender-affirming, antenatal and obstetrical care were perceived to regard pregnancy and masculinity as incompatible. Participants were systematically marginalized in reproductive health care, experienced microaggressions, and a lack of knowledge. They took the lead to ensure that their health needs were met. Former sterilization regulations compromised trust and expectations on health care providers, limiting disclosure. The quality of care was inconsistent.Study II: The ability to sustain gender congruence during pregnancy was central to participants. Gender norms, gender dysphoria and the coming out process affected family planning. Pregnancy and masculinity could be reconciled by renegotiating the feminine connotations of pregnancy, accessing gender- affirming treatment, dissociating from the pregnant body and hiding the pregnancy. Peer interactions contributed to resilience. Body changes and interpersonal stigma strained participants mental health, making it harder to handle microaggressions and claim their gender identity.Study III: Country-level structural stigma varied greatly across countries in Europe and was negatively associated with access to gender-affirming care and positively associated with gender identity concealment in health care. Gender identity concealment was associated with a lower exposure to discrimination in health care in lower and higher structural stigma countries.Study IV: Parenthood prevalence among TGD individuals in Europe was 8.3%. There was no statistically significant association between country-level structural stigma and parenthood. Biological parenthood was twice as common among participants AMAB than AFAB. The odds ratio of biological parenthood differed according to gender identity. Parenthood status and structural stigma did not predict depressive symptoms.ConclusionsStructural and interpersonal stigma affect trust in health care providers, limiting disclosure of clinically relevant information and access to gender-affirming care. Structural stigma marginalize gestational TGD individuals in reproductive health care, exposing them to health risks. Health professionals are at risk of conflating legal and medical boundaries when making decisions. To support health equity policy makers should eliminate structural stigma against TGD individuals. Meanwhile clinicians can empower TGD individuals who wish to undergo pregnancy by supporting their gender congruence and mental health. Further research is needed to assess the influence of structural stigma on TGD family building and parental health.List of scientific papersI. Falck, F., Frisén, L., Dhejne, C., & Armuand, G. (2021). Undergoing pregnancy and childbirth as trans masculine in Sweden: experiencing and dealing with structural discrimination, gender norms and microaggressions in antenatal care, delivery and gender clinics. International journal of transgender health. 22(1-2), 42-53. https://doi.org/10.1080/26895269.2020.1845905II. Falck, F. A. O. K., Dhejne, C. M. U., Frisén, L. M. M., & Armuand, G. M. (2024). Subjective Experiences of Pregnancy, Delivery, and Nursing in Transgender Men and Non-Binary Individuals: A Qualitative Analysis of Gender and Mental Health Concerns. Archives of sexual behavior. 53(5), 1981-2002. https://doi.org/10.1007/s10508-023-02787-0III. Falck, F., & Bränstrom, R. (2023). The significance of structural stigma towards transgender people in health care encounters across Europe: Health care access, gender identity disclosure, and discrimination in health care as a function of national legislation and public attitudes. BMC public health. 23(1), 1031. https://doi.org/10.1186/s12889-023-15856-9IV. Falck, F., Smart, B. D., Frisen, L., & Bränstrom, R. (2025). Structural stigma, parenthood patterns and depressive symptoms among transgender and gender diverse individuals across 30 countries in Europe. International journal of transgender health. 1-17. https://doi.org/10.1080/26895269.2025.2537879</p

    Going Beyond Counting First Authors in Author Co-citation Analysis

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    The present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed

    Variations on the Author

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    “Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship

    Appropriate Similarity Measures for Author Cocitation Analysis

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    We provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis

    Dispelling the Myths Behind First-author Citation Counts

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    We conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more sophisticated methods

    Author Index

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    koamabayili/VECTRON-author-checklist: VECTRON author checklist

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    We have done our best to complete the author checklist relating to the use of animals in the hut study. Note that the objective for the hut study was to evaluate the IRS treatment applications for residual efficacy against Anopheles mosquitoes, including the local An. coluzzii mosquito population. Cows were only used to attract mosquitoes into the huts and no tests were carried out directly on the cows. The author checklist is intended for use with studies where experiments are carried out on animals, which is why we have had such difficulty in completing this for the hut study, as many of the questions do not relate to how the cows were used

    Author Under Sail The Imagination of Jack London, 1893-1902

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    In Author Under Sail, Jay Williams offers the first complete literary biography of Jack London as a professional writer engaged in the labor of writing. It examines the authorial imagination in London's work, the use of imagination in both his fiction and nonfiction, and the ways he defined imagination in the creative process in his business dealings with his publishers, editors, and agents. In this first volume of a two-volume biography, Williams traverses the years 1893 to 1902, from London's "Story of a Typhoon" to The People of the Abyss. The Jack London who emerges in the pages of Author Under Sail is a writer whose partnership with publishers, most notably his productive alliance with George Brett of Macmillan, was one of the most formative in American literary history. London pioneered many author models during the heyday of realism and naturalism, blurring the boundaries of these popular genres by focusing on absorption and theatricality and the representation of the seen and unseen. London created an impassioned, sincere, and extremely personal realism unlike that of other American writers of the time. Author Under Sail is a literary tour de force that reveals the full range of London as writer, creative citizen, and entrepreneur at the same time it sheds light on the maverick side of machine-age literature.Intro -- Title Page -- Copyright Page -- Dedication -- Contents -- Acknowledgments -- Introduction -- 1. Spirit Truth -- 2. From Absorption to Theatricality and Back Again -- 3. "I Will Build a New Present" -- 4. Sons as Authors -- 5. Fathers as Publishers -- 6. The Daughter as Author -- 7. Lovers as Authors -- 8. At Sea with the Family -- 9. Yellow News, Yellow Stories -- 10. The Return Home -- Notes -- Bibliography -- Index -- About Jay WilliamsIn Author Under Sail, Jay Williams offers the first complete literary biography of Jack London as a professional writer engaged in the labor of writing. It examines the authorial imagination in London's work, the use of imagination in both his fiction and nonfiction, and the ways he defined imagination in the creative process in his business dealings with his publishers, editors, and agents. In this first volume of a two-volume biography, Williams traverses the years 1893 to 1902, from London's "Story of a Typhoon" to The People of the Abyss. The Jack London who emerges in the pages of Author Under Sail is a writer whose partnership with publishers, most notably his productive alliance with George Brett of Macmillan, was one of the most formative in American literary history. London pioneered many author models during the heyday of realism and naturalism, blurring the boundaries of these popular genres by focusing on absorption and theatricality and the representation of the seen and unseen. London created an impassioned, sincere, and extremely personal realism unlike that of other American writers of the time. Author Under Sail is a literary tour de force that reveals the full range of London as writer, creative citizen, and entrepreneur at the same time it sheds light on the maverick side of machine-age literature.Description based on publisher supplied metadata and other sources.Electronic reproduction. Ann Arbor, Michigan : ProQuest Ebook Central, YYYY. Available via World Wide Web. Access may be limited to ProQuest Ebook Central affiliated libraries
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