bluuebunny/crossref_metadata_2025 huggingface dataset:
(078) The Release of the AUA Testosterone Guidelines Correlate With an Increase in Testosterone Prescriptions Among Urologists
Authors: Sellke N , Sun H , Omil-Lima D , Loeb A , Thirumavalavan N
Published: May 2023

Introduction

There has been a continued increase in total testosterone prescriptions since 2014. The AUA published guidelines regarding the evaluation and treatment of men with testosterone deficiency in 2018. There is a paucity of literature addressing the prescription trends of different specialties during the release of the 2018 Guidelines.

Objective

We aimed to elucidate the testosterone prescription trends overall and of each specialty from 2016 to 2019 as the 2018 AUA testosterone guidelines were released.

Methods

Publicly available data from the Center for Medicare Services (CMS) Part D Prescriber database with regards to testosterone prescriptions across a 4-year span (January 1, 2016-December 31, 2019) were analyzed. Prescribers were categorized into specialties based on their NPI. We analyzed the trends of specialties with over 100 prescribers and prescribers overall using a negative binomial model.

Results

Family practice, internal medicine, urology, endocrinology, nurse practitioners (NPs), physician assistants (PAs), general practice, infectious disease, and emergency medicine (listed in order of descending testosterone prescribers) were the nine specialties with over 100 testosterone prescribers. From 2016 to 2019 each specialty had an increase in the number of prescribers except for emergency medicine which had a 4% decline (Figure 1). Nurse practitioners had the largest relative increase at 118%. The average number of claims increased each year from 2016 to 2019. However, focusing on consecutive years only 2017 and 2018 significantly differ (p=0.015) with urologists having the largest increase in average yearly claims (40 to 43 claims) (Figure 2). NPs and PAs both have an increasing share of the total testosterone claims from 2016 to 2019 (Figure 3).

Conclusions

The number of prescribers and claims for testosterone continued to increase from 2016 to 2019 based on CMS data. Our analysis showed that only 2017 to 2018 had a statistically significant increase in average claims corresponding to the year the AUA guidelines were released. Urologists on average prescribe the most testosterone and had the highest increase in claims per provider in 2018. Additionally, NPs and PAs are prescribing an increasing share of testosterone over the course of our analysis.

Disclosure

No
(098) ERβ Polymorphism (rs1256049; 1082G>A) Association with Male Infertility: A Meta-analysis
Authors: Abbasi K , Irfan M , Arshad A
Published: May 2023

Introduction

In men, estrogen is produced in the testis by Sertoli cell, Leydig cell and germ cells that play an important role in the maturation and capacitation of sperms. The action of estrogen is mediated by two specific Receptors: Estrogen receptors α (ESRα) and Estrogen receptor β (ESRβ). The polymorphisms of the ERβ gene confer a lower sex hormone binding globulin (SHBG) and thus a stronger unbound estrogen effect, which may adversely affect human spermatogenesis. SHBG is involved in both delivering reproductive hormones to target tissues and controlling the concentration of androgens and estrogens in the serum and tissues. Two silent G/A polymorphisms of the ER□ genes i.e., rs1256049 and rs4986938 have been demonstrated. The polymorphism studied at rs1256049 is 1082G>A presented contrary results.

Objective

The study aims to demonstrate the prevalence of Estrogen Receptor Beta (ERβ) polymorphism (1082G>A; rs1256049) in two ethnicities i.e., Asian and Caucasian, and its association with the risk of male infertility.

Methods

The databases PUBMED and NCBI were searched to retrieve case-control studies, published from 2005 to date, regarding ERβ polymorphism and male infertility were selected for this meta-analysis.

Results

A total of 10 case-control studies out of 85articles (6 Asian + 4 Caucasian), including 1613 cases and 1654 controls, determiningERβ polymorphism and male infertility met the inclusion criteria. Significant association (p<0.05) was found between ERβ polymorphism and risk of male infertility on the basis of all four genetic models i.e. Allelic model (A vs G: OR= 1.19, 95% CI [1.00-1.43], I2 = 62%), additive model (AA vs GG: OR= 0.54, 95% CI [0.31-0.94], I2 = 0%), dominant model (AA+AG vs GG: OR= 1.37, 95% CI [1.11-1.69], I2 = 52%) and recessive model (AA vs AG+GG: OR= 0.55, 95% CI [0.32-0.96], I2 = 0%). In case of Caucasian population, this polymorphism is significantly associated with male infertility on the basis of allelic model (A vs G: OR= 2.10, 95% CI [1.31-3.36], I2 = 37%) as well as the dominant model (AA+AG vs GG: OR= 2.70, 95% CI [1.62-4.51], I2 = 72%), whereas in Asian population, it had a significant association on the basis of recessive model (AA vs AG+GG: OR= 0.55, 95% CI [0.31-0.96], I2 = 0%) only.

Conclusions

ERβ polymorphism (rs1256049 is 1082G>A) is linked with a higher risk of male infertility and has a more severe effect on the Caucasian population than on the Asian population.

Disclosure

No
(131) Platelet Rich Plasma: Evaluation of Growth Factor Concentration in Men with ED
Authors: Khodamoradi K , Dullea A , Golan R , Leyba Molina M , Masterson T , Arora H , Ramasamy R
Published: May 2023

Introduction

Platelet Rich Plasma (PRP) is a novel restorative therapy rich in growth factors and cytokines used to target the underlying causes of erectile dysfunction (ED). It is not known, however, if the composition of growth factors in PRP varies between men.

Objective

This study aimed to evaluate PRP growth factor variability among men with ED.

Methods

Whole blood was collected from sixteen men, eight participants with at least a six-month history of ED. The others were the control group, including seven men with Peyronie’s Disease (PD) and one healthy man without sexual dysfunction. PRP was extracted from whole blood using the Arthrex Angel system. A Human Growth Factor Antibody Array for 41 proteins was performed. Using all 16 samples, quantitative detection of GM-CSF, VEGF, and TGF-β were validated by western blot.

Results

From the growth factor array, two growth factors - Granulocyte-Macrophage Colony Stimulating Factor (GM-CSF) and Transforming Growth Factor-beta (TGF-β) - were identified as having a 1.5-fold decrease between the participants and the control. In addition to the shortlisted growth factors, VEGF was selected because androgens can upregulate VEGF production. Other than a weak negative correlation between VEGF expression and age, we found no correlation between growth factor expression for GM-CSF or TGF-β and age, BMI, or comorbidities.

Conclusions

PRP growth factor concentration appears to vary among men with ED. Depending on individual growth factor concentration, PRP treatment for ED may need to be personalized for patients.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Acerus Pharmaceuticals, Boston Scientific, Coloplast, Endo Pharmaceuticals, Empower Pharmacy, Nestle Health, Olympus, Hims, Inc.
(156) CLINiC Score - A Novel Prediction Model of Collagenase Clostridium Histolyticum Outcomes in Men with Peyronie’s Disease
Authors: Anderson N , Green B , Savage J , Brearton K , Ziegelmann M , Helo S , Kohler T , Trost L
Published: May 2023

Introduction

Since the FDA approval of Collagenase Clostridium Histolyticum (CCH), few studies have been able to identify variables which predict curve improvements, with baseline extent of curvature most highly correlated. In addition to extent of baseline curvature, our team has previously identified curve direction and plaque calcification as additional predictive variables. We therefore sought to create an integrated predictive model which incorporated several factors to better estimate anticipated outcomes.

Objective

To report outcomes of a novel scoring system designed to better predict outcomes of men undergoing CCH injections for Peyronie’s disease (PD).

Methods

A prospective database has been maintained of men undergoing CCH injections for PD. Data were reviewed to identify variables predictive of curve improvements in men with isolated curvature as well as among those with key characteristics, including indentations, hourglass deformities, penile tapering, and calcification. A predictive model was subsequently developed to improve correlations between disease factors and subsequent CCH outcomes. The final model (CLINiC Score) assigned points as follows: +1 point for every 10 degrees of curvature (C for Curvature), +5 points for penile narrowing >25% (IN for INdent), +3 points for narrowing 0-25%, -4 points for pure lateral curvatures (L for Lateral), and -2 points for plaque calcification (C for Calcification). Patients were assigned scores based on the CLINiC model, and results were correlated with final curve outcomes.

Results

A total of 476 PD men were included in the current analysis. Baseline variables for the cohort included a mean age of 55.6 yrs (SD 10.9), PD duration 31.9 months (SD 61.4), composite curvature 64.6 degrees (SD 23.9), 47% with indentations, 42% with hourglass deformity, and 17% with calcification. The mean CLINiC score for the cohort was 6.9 (SD 3.4). For the overall cohort, the use of the CLINiC score increased the correlation coefficient from 0.35 to 0.46 (r-squared 0.13 vs 0.21), with a predictive linear formula of 2.1 - 3.2 * CLINiC score. The difference was more pronounced among a subset cohort of men who had pure lateral curvatures, plaque calcification, or narrowing deformity. In comparing the CLINiC predictive model to baseline curve alone, the correlation coefficient increased to 0.54 (r-squared 0.29, p<0.0001) compared to 0.38 (r-squared 0.15, p<0.001). The linear equation to predict curve improvement outcomes using the CLINiC score was 2.2 - 3.5 * total CLINiC score.

Conclusions

Use of a novel scoring system (CLINiC) improves upon baseline curvature alone to predict post-CCH curve improvements, with the difference more pronounced among men with pure lateral curvatures, plaque calcification, and/or narrowing deformities. External validation is warranted.

Disclosure

No
(250) Male Physicians as Patients: Is Fertility an Issue?
Authors: Parikh N , Alom M , Ahmed M , Robinson M , Mcgriff S , Olive E , Helo S
Published: May 2023

Introduction

Physicians may be subjected to grueling work hours, sleep deprivation, and a stressful work environment during their prime reproductive years. While attention to fertility among female physicians has garnered interest in recent years, little is known about the fertility of their male colleagues.

Objective

In this study we sought to compare semen parameters of male physicians presenting for a fertility evaluation compared to their non-physician counterparts.

Methods

Upon IRB approval, a retrospective review of all hospital employed individuals (or their partners) who underwent a semen analysis between 2013-2019 was performed. Post-vasectomy semen analysis patients were excluded. Baseline patient demographics including age, comorbidities, occupation, and BMI were recorded. Normal semen parameters were defined by the World Health Organization 2010 criteria. A comparison analysis of semen analysis parameters, baseline characteristics, and comorbidities was conducted with a significant p-value defined as <0.05.

Results

Of the 169 physicians and 438 non-physicians identified, physicians were more likely to have a lower BMI (median 25.8 vs. 28.0, p<0.0001) when compared to their non-physician counterparts. Physicians were less likely to have ADHD, depression, obstructive sleep apnea, malignancy, alcohol abuse, and history of smoking (p<0.05). Physicians had better semen parameters including pH, concentration, motility, volume, and morphology (p<0.05), with a greater sperm concentration (68.4 vs. 52.2 million/mL, p<0.0001) and higher total motile sperm count (125 vs. 86.4 million, p<0.0001) compared to non-physicians. However, male physicians were more likely to be older at time of semen analysis (33.8 versus 32.7 years, p<0.05), more likely to utilize assisted reproductive technology (IVF and IUI, p=0.0277), have older female partners (p=0.0053), and have older female partners at time of delivery (p=0.0124).

Conclusions

In this study we report, for the first time, semen parameters of physicians compared to non-physicians. Physicians had a significantly higher total motile sperm count and sperm concentration; however, they were older at time of semen analysis, more likely to utilize ART, and more likely to have older female partners. While physicians may be healthier, this may indicate increased difficulty achieving pregnancy. Patient care is directly impacted by the health and safety provided to their physicians. As the paradigm in the medical field shifts from caring only for our patients to caring for ourselves, fertility amongst male physicians warrants further investigation.

Disclosure

No
(426) Peyronie’s Disease Treatment Pathways in the TriNetX Global Database
Authors: Ebbott D , Prebay Z , Li M , Chung P
Published: May 2023

Introduction

Peyronie’s disease (PD) is a fibrosing condition which commonly leads to penile pain, curvature, plaque development, change in penile shape, and sexual dysfunction. Urologists will benefit from understanding the utilization of the most common treatment pathways followed in practice.

Objective

To identify the pathways of treatment between pentoxifylline, injection therapy, penile plication, plaque excision with/without grafting (PEG), and penile prosthesis in the treatment of PD.

Methods

TriNetX is a research network of real-time data from 58 Healthcare Organizations globally. We queried the network for adult men with Peyronie’s disease and interventions from 2002-2022. Patients were identified based on the International Classification of Disease Tenth Edition (ICD-10) code for Peyronie’s disease (N48.6). Interventions were identified using Current Procedural Terminology (CPT) codes for injection therapy (54200), penile plication (54360), plaque excision +/− grafting (PEG) (54110, 54111, 54112), and penile implant (54400, 54401, 54405). Use of oral pentoxifylline (8013) was identifiable using RxNorm Concept Unique Identifier, part of the Unified Medical Language System. The analysis was run on June 16, 2022.

Results

There were 45,944 cases of PD within the database with a mean age of 62 +/− 13 years. The cohort identified as 73% white, 8% black, and 18% race unknown. Figure 1 shows the cases by treatments and pathways. The most common management was no treatment in 69.5% of cases (n=31,912). A single medical or surgical therapy was used in 79.6% of patients who received treatment (n=11,166). Of single medical therapy cases, pentoxifylline (60.0%, n=4,541) was the more commonly used medical treatment followed by injection therapy (40.0%, n=3,033), while penile plication was the most frequently utilized surgical therapy (54.2%, n=1,946) followed by penile prosthesis (30.6%, n=1,100), PEG (15.2%, n=546). Patients required multiple therapies 20.4% of the time (n=2,866). Of patients requiring multiple therapies, a progression of medical to surgical treatment occurred in 20.4% (n=584).

Conclusions

PD was predominantly managed without any intervention, followed by medical therapy, and then surgery. Surgical therapy occurred less frequently after medical treatment suggesting that few patients are interested or require a stepwise approach to PD.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific and Coloplast.
(489) Comparison of Penile Prostheses Outcomes in Veterans with Peyronie’s Disease: A Single-Center Analysis
Authors: Handing G , Park B , Patel S , Jones J , Srikishen N , Khera M
Published: May 2023

Introduction

Peyronie’s disease (PD) causes erectile dysfunction (ED) in at least 40% of cases. ED refractory to medical and injection therapy can be treated with implantable penile prosthesis, which may also address the penile deformities. However, prosthesis surgery has significant associated morbidity-including erosive disease and infection-and frequently requires explant or revision. Data for Veterans Affairs (VA) patients with PD is limited, especially with respect to penile prosthesis placement. More information is needed for proper counseling and perioperative planning in this high-risk population.

Objective

The aim of this study is to compare outcomes and revision rates in Veteran patients with and without PD after primary penile prosthesis implantation.

Methods

A retrospective cohort study of the xxx VA Medical Center Informatics and Computing Infrastructure database was performed. Veterans who underwent penile prosthesis surgery between January 2013 and February 2022 were identified and included in the study. Patient factors including age, race, procedure type, and relevant comorbidities were collected. Patients with and without history of PD were identified and separated into two cohorts and patient factors of these two groups were compared using chi-square and Fisher’s exact tests. Freedom from revision was analyzed using Cox regression and hazard ratios.

Results

A total of 229 patients underwent penile prosthesis placement with at least 4 months follow-up. 24 patients (10.48%) with history of PD were identified. The mean age at prosthesis placement of PD patients was younger than that of non-PD patients (61.3 vs 65.0 respectively, p=0.0358). Rear tip extender length was longer in the PD cohort than the non-PD cohort (3.02 cm vs 2.32 cm respectively, p=0.0313). Operative time was shorter in patients with PD than in patients without PD (91 minutes vs 111 minutes respectively, p=0.0409). Prosthesis type, hospital stay, and post-operative complication rates were not significantly different between groups. PD was not associated with significantly increased risk of prosthesis revision or removal (p>0.05). No patients in the PD cohort experienced infection or erosion; two explants were performed for component migration and supersonic transporter deformity respectively.

Conclusions

Veterans with PD undergoing prosthesis placement have similar revision rates and explant rates as compared to veterans without PD. Additionally, penile prosthesis implantation for men with PD is associated with low morbidity and similar complication rates compared to men without PD undergoing prosthesis placement for erectile dysfunction.

Disclosure

No
(527) The Unprecedented Number of Google Searches for Vasectomy Following the Overturning of Roe Versus Wade
Authors: Sellke N , Tay K , Sun H , Tatem A , Thirumavalavan N
Published: May 2023

Introduction

On June 24, 2022, the United States Supreme Court overturned the landmark 1973 Roe v. Wade decision. This removed constitutional protection for women seeking abortions and introduced uncertainty for couples desiring reproductive autonomy. Currently, each state’s laws determine specific protections or bans for abortion. As a result, many individuals are investigating alternate forms of family planning such as vasectomy.

Objective

We aimed to characterize the public interest in vasectomy since the overturning of Roe v. Wade and elucidate whether interest varies based on state.

Methods

We extracted relative search volumes from Google Trends (July 2017 to July 2022) for the keyword “vasectomy”. We compared the relative rates of Google searches for the two weeks preceding and following the Supreme Court decision date of June 24, 2022. The mean rates were compared using a Welch t-test. Lastly, we assessed geographic variations in public interest after the decision by extracting the relative search data separated by state from Google Trends.

Results

Google searches peaked on June 25, 2022. This was the highest rate of Google searches for vasectomy within the past five years and was about four-fold higher than the average rate over that time (25.9%). There are two other prominent spikes: one on May 4, 2022 to about 60% of the highest rate, and another on May 16, 2019 to about 55% (Figure 1). In the two weeks following the Supreme Court announcement, there was a higher rate of searches for vasectomy (47.3%) compared to searches two weeks prior (17.2%) (P<0.05). Utah was the state with the most Google searches for vasectomy. Idaho, Texas, and North Dakota were the next most common states. The four regions with the lowest search rate were the District of Columbia, Massachusetts, New Jersey, and New York (Figure 2).

Conclusions

The overturning of Roe v. Wade corresponds with the highest increase in Google searches for vasectomy in the past 5 years with a significant increase in searches the days following. In addition, the two previous spikes in vasectomy searches corresponded to events that threatened access to abortion. The spike in searches in May 2022 happened on the same day the draft of the Supreme Court’s decision on Roe v. Wade was leaked to the public. The spike in May 2019 correlates with the passing of a strict anti-abortion law in Alabama which received national attention. Interestingly, states with the highest rates of searches are also states with laws banning abortion in place. States with the lowest rates appear to be states with laws in place to protect access to abortion. Urologists should be aware of the unprecedented increase in public interest in vasectomy as it relates to a potential flux of patients seeking counseling for this procedure.

Disclosure

No
(540) Aesthetic Penile Augmentation Procedures: A Comprehensive and Current Perspective
Authors: Xing M , Hou S , Raheem O
Published: May 2023

Introduction

Society has perpetuated the misconception that penis shape and size are a marker of masculinity and sexual ability. Unfortunately, many men experience small penis anxiety syndrome (SPS), a body dysmorphic disorder in which a patient believes their penis to be small even when it is clinically average in length and girth. In these situations, patients who have received proper psychological evaluation may choose to pursue clinical procedures to augment their penis. There is a lack of consensus on current approaches for aesthetic penile augmentation in patients with small penis anxiety. As cosmetic surgery becomes more widely accepted, management of SPS may present a challenge for urologists.

Objective

We aim to provide a updated review of aesthetic penile augmentation procedures that are available for physicians to discuss with this unique patient population. Our review focuses on procedures and techniques that have been of interest in the scientific literature over the last five years.

Methods

A PubMed literature review was performed to identify articles published between 2015-2021 on penile aesthetic augmentation procedures. Relevant prospective studies, retrospective studies, and systematic reviews were included, while abstracts and opinion papers were excluded. Search terms included “penis”, “penile,” “augmentation,” “enhancement,” “aesthetic,” “girth,” and “length.”

Results

After thorough psychological counseling, patients with small penis syndrome may choose to undergo penile augmentation. Augmentation procedures range from invasive to non-invasive. Surgical solutions include grafts and flaps, suspensory ligament release, and suprapubic lipectomy. Minimally invasive solutions include injections of fillers (hyaluronic acid, polylactic acid, and polymethyl methacrylate). Noninvasive solutions include external devices such as vacuum pumps and traction devices.

Conclusions

In the current climate, aesthetic penile augmentation is becoming a desirable option for many patients but remains clinically controversial. While there are a multitude of treatment options with varying degrees of invasiveness, there is no standardized recommendation for patients who are pursuing penile enhancement. Our review of the literature summarizes recent and relevant studies and demonstrates the need for further research and consensus on penile augmentation procedures.

Disclosure

No
Improved Wisdom Tooth Diagnosis Can Reduce Dental Disease and Nonbattle Injuries
Authors: Mendoza Andres M , Rodenas Yann J , Eidson Brittany K
Published: May 2023

Introduction

Wisdom teeth are a frequent cause for dental disease and nonbattle injuries (D-DNBIs) during expeditionary deployments. Improved diagnosis and timely treatment before deployment can reduce the need to evacuate a D-DNBI while in a theater. This study proposed key identifiers to diagnose wisdom teeth as Dental Readiness Classification (DRC) 3.

Materials and Methods

This study was a retrospective chart review conducted to measure concurrence among Army dentists when assigning DRC for wisdom teeth. This study also recorded demographic data and physical findings among the observed patients. Concurrence, or inter-rater reliability, was measured using Cohen’s kappa (κ).

Results

A Cohen’s κ of 0.04 suggested that there was no concurrence among Army dental providers in the diagnosis of wisdom teeth. The study concluded that caries and pericoronitis accounted for 37% and 13% of class 3 nondeployable troops, respectively. Forty-one percent of tobacco users had caries. Fifty-eight percent of the population was diagnosed as DRC 3.

Conclusions

This study proposed DRC 3 criteria for wisdom teeth and measured concurrence among dental providers’ diagnoses. Dental Readiness Classification 3 criteria include caries, pericoronitis, infection, and pathology. A Cohen’s κ of 0.04 indicated there was a lack of concurrence in examining dentists compared to the DRC 3 criteria. Caries and pericoronitis were the most frequent diagnoses for third molars. Early diagnosis and treatment of these key identifiers can help reduce a significant source of D-DNBIs in the deployed environment.
Faith, Local Actors, and the Localization of International Humanitarian Response
Authors: Wilkinson Olivia
Published: May 2023

The localization agenda has recently been a dominant debate in the international humanitarian system. While many projects and programs have been launched to “localize” humanitarian response, that is, shift power and resources to local rather than international actors, there is only scant evidence of progress in this regard. This chapter argues that one barrier to progress is the “functional secularism” of the humanitarian system and the way that manifests as the exclusion of people’s religious beliefs and practices to the detriment of humanitarian responses worldwide. In particular, local faith actors are potentially powerful partners and already significant implementers of humanitarian response. International humanitarians can consider equitable partnerships with local faith actors as part of the process of dismantling structures of power that will lead to more successful localization.
Protest Waves in Latin America
Authors: Almeida Paul
Published: May 2023

This chapter examines the basic dynamics of protest waves in Latin America—periods of widespread popular mobilization by multiple sectors across the national territory. Protest waves are relatively rate events, but when they do erupt, they result in profound social change as recently witnessed in Chile, Colombia, Ecuador, Honduras, and Panama. Special attention is given to the facilitating conditions associated with the outbreak of protest cycles. These conditions include elaborate organizational infrastructures, political liberalization, economic threats, repressive threats, and unifying frames. Some of the most common outcomes of protest waves are considered in terms of repression, political reforms, electoral success, radicalization, and revolution.
Social Movements and Globalization in Latin America
Authors: Burridge Daniel , Markoff John
Published: May 2023

“Globalization” refers to the growing web of economic, political, and cultural processes that connect people across national borders. In Latin America in the 1990s and beyond, the policies of globalized neoliberal capitalism coincided with regional democratization, new technologies of communication, and changing ideas on the Left to both generate varied grievances and facilitate varied forms of resistance. Harms were especially pronounced for the historically marginalized—precariously employed workers, rural people, women, and indigenous communities—who often took the lead in the social movement activism enabled by democratic circumstances and who were often joined by such other social categories as students and the middle classes. In so doing, these movements established new connections across borders that linked local, national, and transnational analyses and practices. The movements, therefore, were not only responding to the harms of injurious globalizing processes but were themselves globalizing actors who forged alternative global visions. Our analysis draws on world-system perspectives, the political sociology of social movements, and analyses of Latin American cultures of opposition and activism.
Identity in Latin American Social Movements
Authors: Fontana Lorenza B.
Published: May 2023

This chapter reconstructs the origins of identity as a key concept in socio-political analysis and illustrates the role it has played both in making sense of social and political transformations as well as in influencing the very processes of collective mobilization in Latin America. It begins by analysing the shift from class to identity in the narrative on social struggle since the 1980s and the main feature that distinguish identity movements compared to other social movements. The second part of the chapter focuses on some of the main Latin American identity movements, namely: indigenous, feminist, and LGBT movements. In the conclusions, I provide some ideas around the limitations as well as potential developments of identity-based theories of social mobilization.
Social Movements and Modes of Institutionalization
Authors: Lavalle Adrian Gurza , Szwako José
Published: May 2023

This chapter discusses the influence of social movements on public policy through an examination of modes of institutionalization. Due to the prevalence of approaches which posit a rigid divide between civil society and the state, the role of social movements in institutionalization has been insufficiently analyzed. In dialogue with historical institutionalism and both discursive and pragmatic policy approaches, the chapter casts new light on how institutionalization varies according to the object that is to be institutionalized. Based on an extensive literature review on Latin America, it focuses on four modes: programmatic, positional, symbolic, and practical. The programmatic mode refers to a form of institutionalization of public policies and institutional arenas that emerges from the projects and programs of militants and social movements organizations. The positional mode can be understood as a form of institutionalization in which official positions within the state apparatus are linked to social movements and occupied by activists. The symbolic mode concerns the internalization of symbolic and cognitive categories of social actors by the state, through its bureaucracies. Once these categories become part of the language of the state, they affect the way policies classify and organize the social world. Finally, the practical mode of institutionalization refers to what are often understood as “merely technical” aspects or “minor details” of public policy but are in reality policy instruments whose origins often lie in the interaction between authorities and movements.
Legal Mobilization
Authors: Ruibal Alba
Published: May 2023

Over the past two decades, the use of law and courts has become part of the repertoire of collective action by social movements in Latin America. After democratic transitions, the rights discourse set out to permeate political claims, social actors started framing their grievances and goals in terms of legal and constitutional rights, and constitutional and judicial reforms brought about new legal opportunities for social actors in different Latin American countries. In this setting, legal mobilization became part of social movements’ work and strategies, and movements started to have a relevant role in constitutional politics. This chapter presents an account of the main processes and events in the recent history of the interaction between social movements and the judicial system across the region. It analyzes the role of social movements in the creation of new legal opportunities, through their influence in constitutional conventions and judicial reform processes. It also examines some of the main developments in the relationship of social actors with the court system, including progressive judicialization as well as counter-legal mobilization. Finally, it addresses multi-level processes of legal mobilization, by pointing out the importance of international litigation and subnational legal mobilization and the impact of federalism.
Strengths and Blind Spots of Digital Activism in Latin America
Authors: Treré Emiliano , Harlow Summer
Published: May 2023

Through a critical meta-analysis of the literature, this chapter assesses the actors, tools, and theories that constitute digital activism research in Latin America. First, the chapter highlights the strengths of this research in the region, casting light on the diversity, nuance, and richness of case studies, technologies, and conceptual lenses that have been explored. Then, it points out its blind spots and challenges, including: the trend towards fragmentation; the propensity to adopt conceptual lenses from the Global North; the underdevelopment of South–North and North–South dialogue; the tendency to provide limited analyses focused on just one medium; the application of ahistorical approaches that disregard the legacy of previous protest events; the limitations of emerging computational methods; and the emergence of digital agnosticism and a general uncritical stance towards digital platforms. All these factors, it is argued, hinder a more unified, region-wide understanding of digital activism. Second, the chapter illustrates the complexities of digital activism using case studies of Guatemala and Mexico. The contribution concludes by providing future directions and areas of study in need of further scrutiny.
Social Movements and Capitalist Models of Development in Latin America
Authors: Rossi Federico M.
Published: May 2023

Social movements are crucial actors in producing transformations in society. One important dimension in this regard is certainly capitalism. The goal of this chapter is to analyze social movement dynamics across the capitalist models of development that predominated in Latin America from independence from colonial rule until the early twenty-first century. This is done through the lens of a political economy of social movements, understood as the substantive and theoretical recoupling of the political and economic spheres in the relational study of social movements and capitalist dynamics. If an economically determinist approach is avoided and the North Atlantic mainstream narrative is decentered, a political economy of social movements reveals multiple struggles for the expansion of the socio-political arena and the resistance to this expansion with plutocratic retrenchment periods that contract that arena. In Latin America there has been an enormous development of research since the 1980s linked to protest and the transformations of capitalism. However, this accumulated research has not yet been systematized into models of development to understand the impact of capitalism on social movements, and even less so, the role played by social movements and protests in economic change.
Multiple Paradigms for Understanding a Mobilized Region
Authors: Rossi Federico M.
Published: May 2023

The field of social movement studies in Latin America has gradually consolidated into a subdiscipline since the re-democratization of most of the region in the 1980s. The reinstatement of academic freedom, the return of some scholars from exile, and the political relevance of social movements and protests since re-democratization have put this area of research at the core of numerous studies. The question of how to understand the struggles that have defined Latin American history since independence has led to very intense theoretical debate that has developed alternative explanations for the comprehension of social movements. In Latin America, social movement studies as a subdiscipline has been characterized by a great diversity of theoretical approaches and a pragmatic combination of perspectives in empirical studies. As a general overview of the main Latin American output on social movement studies, this introductory chapter presents the contributions in this book under the five sections that structure this volume: first, the theoretical perspectives developed in or applied to social movements in Latin America; second, the main macro-dynamics and processes and the role of social movements from the mid-nineteenth to the early twenty-first century; third, a review of the main social movements in Latin America; fourth, an analysis of the ideational and strategic dimensions of movements; and fifth, an exploration of the interaction of movements with (formal and informal) institutional politics.
Financing and Reframing Universal Social Protection in Africa
Authors: van Vrede Brenton
Published: May 2023

Societies naturally organize themselves to care for one another, either at a family or community level. These social transfers are normal in any society. Governments have the ability to formalize these transfers and share the burden and benefits across society as a whole through fair and transparent administrative arrangements. When viewed from this perspective, we no longer question whether social protection is affordable or sustainable or whether it will cause dependency. Instead, the debate should center around how much of the social protection system should be formal versus informal. This is normally dependent on the level of social solidarity within society. Development can also be chaotic and the development of social protection systems can often be fragmented. Care needs to be taken to ensure that tax and transfer systems reduce inequality and do not themselves become a source of inequality.
Transforming Social Protection in South Africa
Authors: Taylor Viviene
Published: May 2023

This chapter provides an analysis of social policy transformation in South Africa’s post-apartheid, post-independent era after 1994 over a 20-year period until 2014. Using social protection as the lens, it highlights that while the policy intentions over the period were transformative, there was, and still is, a disjuncture in the administration and implementation of policy that constrains the fulfillment of social and economic rights derived from the Constitution. The role and place of social assistance (primarily in the form of cash grants) and social policy in broader processes of transformation and innovation in South Africa inform the analysis. Among the issues raised is that of navigating social policy change in a fluid, neoliberal global economic system in which terms of trade and development are predetermined. In addition, the context of neoliberal globalization and its consequences for social policy interventions by national governments is a focus. It is particularly difficult to mitigate the negative impacts and address the roots of inequities, especially in South Africa, when the terms of national social development are shaped by transnational processes.
Welfare State Administration and the East Asian Welfare Regime
Authors: Aspalter Christian
Published: May 2023

The main subject of this chapter is the real-typical side of comparative welfare regime analysis. Welfare state systems from Singapore, South Korea, Mainland China, Taiwan, Hong Kong, and Japan are examined from a close distance, focusing on their in-depth institutional particularities. When looking at East Asian welfare state systems, it is useful to apply an ideal-typical (Weberian) method especially when looking at larger international and historical developments, while other methods of applying real types are also highly beneficial for welfare state analysis in comparative perspective. When applying the real-typical method, in particular, the relative weaknesses and strengths of various welfare subsystems come into sharper view, as seen in this chapter’s review of specific welfare state systems in Asia. Important insights are gained about the extent to which incentive structures of each social security system increase or decrease effectiveness and efficiency of the overall welfare state system in place.
Social Policy Administration in the Canadian Federation
Authors: Graefe Peter
Published: May 2023

This chapter provides a survey of the institutional context for social policy renewal in Canada. It begins with a brief sketch of how social policy makers identified new social risks in the early 2000s, and the main policy instruments that they developed in response. The chapter then considers how development of these instruments nevertheless had to engage with long-standing constitutional barriers to central government involvement in social policy, as well as the legacy of earlier intergovernmental institutions that worked around those barriers. Finally, the chapter describes and evaluates the new intergovernmental institutional “workarounds” developed when implementing social policy renewal, including recent developments in mental health and early childhood development.
Enabling Social Policy Innovation
Authors: Moulton Stephanie , Sandfort Jodi R. , Merrick Weston
Published: May 2023

Public sector innovation is often driven by leaders and organizations to address complex, “wicked” problems, shifting and increasing citizen expectations, and new levels of political and economic insecurity. This chapter provides an overview of recent approaches to fostering social policy innovation in North America. Recent trends, including co-production, behavioral science, and implementation science, tend to focus on either technical or managerial innovation. Yet integrating the two holds more promise, as it is often necessary to address both the core programmatic technology and the organizational or field context. We conclude by exploring the potential of design-based research and pragmatic experiments as approaches that enable scholars to support innovation more holistically within the social sector.
Front-line Workers and the Creation of Administrative Data
Authors: Hetling Andrea , Saunders Correne
Published: May 2023

Public agencies generate administrative data as part of their routine management of programs and services. The growth of big data analytics and open government has led to a great increase in the popularity of administrative data among policy researchers. Partnerships with public administrators are necessary and important in enabling researchers both to access and understand the data. Little consideration has been given, however, to front-line workers, like caseworkers and eligibility workers, as key stakeholders in the production and understanding of administrative data. Street-level organization research offers an applicable theoretical framework based on the roles of front-line workers in implementing policy and delivering services. By connecting this framework to administrative data, this chapter offers suggestions to include front-line workers as research partners and thus strengthen the quality and use of administrative data in evaluations.
Standardized Educational Assessments
Authors: Rivas Axel
Published: May 2023

In the last 25 years, Latin America became a region overwhelmed with standardized educational assessments. Standardized assessments point to a major change in the governance of education systems, not only because they enter as policy inputs for decision-making, but also because they rise to the status of high-stakes standardized assessments where rankings on outcomes are published so that parents can make informed decisions regarding school choice. The first assessment systems emerged in almost all Latin American countries during the nineties. Then, some countries introduced high-stakes assessments with publication of rankings and economic incentives for schools. The third wave of reforms seems to point toward a “reasonable convergence” among countries, with greater institutional capacity to assess schools. This chapter reviews developments in this area of public administration through a proposed typology of standardized assessment models and a comparison of different systemic-change theories in education. Decisions regarding types of assessment require re-envisioning the institutional, curricular, and pedagogical design of educational systems.
The Hidden Impact of Conditional Cash Transfer Programs on State Capacity
Authors: Cecchini Simone
Published: May 2023

State-run conditional cash transfer (CCT) programs have made a significant contribution to poverty reduction in many Latin American and Caribbean countries. CCTs also have had a less-discussed impact, which has been to foster management and technical changes in social policy that are gradually supplanting the clientelistic approaches typical of the past. This chapter discusses key management and technical innovations and their programmatic impact on state capacity in the social protection sector. Although approaches differ between countries, CCTs have tended to be established through laws or decrees and supported by solid institutional frameworks. In addition, CCTs typically have made use of modern information systems for selecting, registering, and paying program participants; and many have introduced a culture of impact evaluation in the social policy field. The effects of this management and technical revolution will be felt for a long time to come.
Afrikaner Nationalism and White Politics, 1910–1948
Authors: Grundlingh Albert
Published: May 2023

This chapter unpacks the dynamics of Afrikaner nationalism during the first half of the twentieth century. It includes dimensions such as the historiography of Afrikaner nationalism, the ways in which the movement was mobilized, gender relations, the reification of history, and the manner in which events impinged on developments. The trajectory of Afrikaner nationalism was not a simple, linear process, but several inter-Afrikaner tensions had to be negotiated. It finally points out that at the time of the watershed election of 1948, apartheid was not necessarily a fixed concept and its implications only emerged later.
Water, Earth, and Fire
Authors: Jue GUO , Sturm Camilla
Published: May 2023

This chapter introduces the material evidence of the making of riverine communities in the Greater Jiang Han Region in prehistoric central-southern China and their uniquely emplaced social dynamics of collaborating with both the landscape and with one another. By focusing on two types of material remains—hydraulic “landmarks” and special classes of pottery—at the Shijiahe site complex in the Jiang Han Basin that brought together people and place, this chapter demonstrates how these communities integrated the natural and the social through collective activities of place-making and ritualized practices of community building. The chapter argues that these activities all foreground a common set of social values of shared labor, community participation, and an intimate connection to the landscape that persisted through millennia in this region. Ultimately, the chapter advocates shifting attention to the deep-time pattern of living in the Jiang Han region at the local level and seriously considering the alternative path of social development—characterized by heterarchy rather than hierarchy—that was emplaced in the co-evolving socio-natural landscape and integral to the long-term social resilience of the Jiang Han riverine communities.