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Ersoy G, Akrep A, Gönen AÇ, Gölge ZB. Attitudes among physicians towards transgender and gender diverse people in Turkey: Relationship with religiousness, political view and conservatism. SOCIOLOGY OF HEALTH & ILLNESS 2024. [PMID: 39024014 DOI: 10.1111/1467-9566.13809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 05/20/2024] [Indexed: 07/20/2024]
Abstract
According to several recent studies, physicians in various medical branches have some differences in attitudes towards transgender and gender-diverse (TGD) persons based on religious or political beliefs. Our study aims to uncover the attitudes of the general physician community in Turkey, which has a youthful profile, regarding TGD individuals. The attitudes towards transgender individuals scale (ATTI) and the general conservatism scale, along with a form that asks about socio-demographic factors, political beliefs, and level of religion, were administered online to physicians. The ATTI score of physicians (mean = 77.8) is favourable and did not vary among branches. Being female, being close to TGD, having left-wing views, low conservatism and low religious belief scores were associated with positive attitudes towards TGD individuals. The physician profile's moderate religious belief and left-wing views can be interpreted as a country-specific dynamic and did not prevent the approach from being positive. Despite physicians' positive attitude towards TGD individuals on a professional level, there is resistance to contacting them in their daily lives. The possibility of the partial contribution of socially desirable response behaviour to positive scores should not be ignored.
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Affiliation(s)
- Gökhan Ersoy
- Department of Medical Sciences, Institute of Forensic Sciences and Legal Medicine, Istanbul University - Cerrahpaşa, Istanbul, Turkey
| | - Aytunç Akrep
- Department of Medical Sciences, Institute of Forensic Sciences and Legal Medicine, Istanbul University - Cerrahpaşa, Istanbul, Turkey
| | - Anıl Çakır Gönen
- Department of Psychiatry, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Zeynep Belma Gölge
- Department of Social Sciences, Institute of Forensic Sciences and Legal Medicine, Istanbul University - Cerrahpaşa, Istanbul, Turkey
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Ghabrial MA, Ferguson T, Scheim AI, Adams NJ, Khatoon M, Bauer GR. Factors associated with primary healthcare provider access among trans and non-binary immigrants, refugees, and newcomers in Canada. J Migr Health 2024; 10:100241. [PMID: 39040891 PMCID: PMC11261874 DOI: 10.1016/j.jmh.2024.100241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 03/27/2024] [Accepted: 06/23/2024] [Indexed: 07/24/2024] Open
Abstract
Objective Trans and non-binary (TNB) immigrants, refugees, and newcomers (IRN) face intersecting challenges and barriers, including stigma and persecution in countries of origin, and others unique to the Canadian resettlement process. The present study aimed to investigate factors that are associated with having a primary healthcare provider among TNB IRN. Design Trans PULSE Canada was a community-based, national study of health and wellbeing among 2,873 TNB people residing in Canada, aged 14 and older, who were recruited using a multi-mode convenience sampling approach.. The survey asked questions about identity, community, service access, health - and IRN were asked questions specific to immigration/settlement. Results Of the 313 IRN participants who completed the full survey version (age M = 34.1, SE=0.75), 76.4 % had a primary healthcare provider. TNB IRN largely reported being Canadian citizens (59.8 %), gender non-binary or similar (46.9 %), currently living in Ontario (35.5 %), and having immigrated from the United States (32.1 %). Chi-square analyses revealed that having a primary healthcare provider was associated with age, gender identity, citizenship status, region of origin, current location in Canada, length of time since immigrating to Canada, status in gender affirming medical care, and having extended health insurance. With modified Poisson regression, we found that TNB IRN who were non-permanent residents, originating from European, African, and Oceania regions, or living in Quebec and the Prairie provinces were less likely to have a primary healthcare provider. Conclusion Results may inform settlement organizations of the unique needs and barriers of TNB IRN. Schools and LGBTQ+ organizations may better serve this population - especially those originating from highlighted regions, who live in Quebec or the Prairie provinces, and/or are non-permanent residents - by offering programs that connect them to primary healthcare providers who are competent in cross-cultural trans health.
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Affiliation(s)
- Monica A. Ghabrial
- Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Department of Psychology, Algoma University, Brampton, ON, Canada
| | | | - Ayden I. Scheim
- Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
- Unity Health Toronto, Toronto, ON, Canada
| | - Noah J. Adams
- Ontario Institute for Studies in Education, University of Toronto, Toronto, ON, Canada
- Center for Applied Transgender Studies, ON, Canada
- Transgender Professional Association for Transgender Health, ON, Canada
| | - Moomtaz Khatoon
- Salaam Canada, Vancouver, BC, Canada
- PHS Community Services Society, Vancouver, BC, Canada
| | - Greta R. Bauer
- Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Eli Coleman Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, United States
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Jardine L, Edwards C, Janeway H, Krempasky C, Macias‐Konstantopoulos W, Whiteman P, Hsu A. A guide to caring for patients who identify as transgender and gender diverse in the emergency department. J Am Coll Emerg Physicians Open 2024; 5:e13217. [PMID: 38903764 PMCID: PMC11187815 DOI: 10.1002/emp2.13217] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 05/17/2024] [Accepted: 05/23/2024] [Indexed: 06/22/2024] Open
Abstract
Through a review of current research, standards of care, and best practices, this paper serves as a resource for emergency physicians (EPs) caring for persons who identify as transgender and gender diverse (T/GD) in the emergency department (ED). Both patient- and physician-based research have identified existent potential knowledge gaps for EPs caring for T/GD in the ED. T/GD have negative experiences related to their gender identity when seeking emergency medical care and may even delay emergency care for fear of discrimination. Through the lens of cultural humility, this paper aims to address potential knowledge gaps for EPs, identify and reduce barriers to care, highlight gender-affirming hospital policies and protocols, and improve the care and experience of T/GD in the ED.
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Affiliation(s)
- Logan Jardine
- Mount Sinai Beth Israel Department of Emergency MedicineNew YorkNew YorkUSA
| | | | - Hannah Janeway
- White Memorial Medical Center/West Los Angeles VAUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | | | - Wendy Macias‐Konstantopoulos
- Center for Social Justice and Health Equity, Department of Emergency MedicineMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | | | - Antony Hsu
- Department of Emergency MedicineTrinity Health Ann ArborYpsilantiMichiganUSA
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Pastor Bravo MDM, Linander I. Access to healthcare among transgender and non-binary youth in Sweden and Spain: A qualitative analysis and comparison. PLoS One 2024; 19:e0303339. [PMID: 38743711 PMCID: PMC11093328 DOI: 10.1371/journal.pone.0303339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 04/22/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Transgender and non-binary (TGNB) people tend to report worse health than cis people, however, despite an increased need for care, they face several barriers when trying to access healthcare. These barriers might be exacerbated when young age intersects with a trans identity, and so there is a need for studies highlighting the experiences of TGNB youth. AIMS To explore and compare how TGNB youth (15-26 years old) in Sweden and Spain experienced their access to healthcare, in order to shed light on the strengths and limitations of different kinds of healthcare systems and improve healthcare provision and policy development. METHODS This study was based on a qualitative analysis of semi-structured interviews with TGNB youth living in Sweden (n = 16) and Spain (n = 18). Of these, 22 identified as male or transmasculine, six as non-binary, and six as women or transfeminine; 25 had undergone some type of gender-affirming care, and the rest were on the waiting list or undergoing preparatory visits and had not started hormonal treatment. The interviews were analyzed using reflexive thematic analysis. An abductive approach was applied, and the Levesque conceptual framework was used to compare the analyses of each set of materials. RESULTS We present our findings using the structure of the accessibility framework, focusing on approachability, acceptability, availability, affordability, and appropriateness. The conceptualization of accessibility in combination with the concept of cisnormativity illustrates how specific ideals and normative expectations affect access to healthcare for TGNB people across contexts, with most barriers arising from the appropriateness of the services. DISCUSSION Young TGNB people experience barriers to accessing healthcare both in the Spanish and the Swedish contexts. Strategies to reduce these barriers should be framed within the critique of and resistance to cisnormativity and should focus on users with intersecting marginalized identities to promote health equity.
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Affiliation(s)
- María del Mar Pastor Bravo
- Department of Nursing, University of Murcia, Murcia, Spain
- Biomedical Research Institute of Murcia (IMIB) Pascual Parrilla, Murcia, Spain
| | - Ida Linander
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Ravi R, Cheng S, Hutter J, Ibbitson A, Ljubojevich E, Chan Z, Beavers L, Nixon S. A Call to Disrupt Heteronormativity and Cisnormativity in Physical Therapy: Perspectives of 2SLGBTQIPA+ Participants on Future Directions for PT Curricula. Physiother Can 2024; 76:188-196. [PMID: 38725597 PMCID: PMC11078244 DOI: 10.3138/ptc-2022-0019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 07/03/2022] [Accepted: 07/18/2022] [Indexed: 05/12/2024]
Abstract
Purpose To explore the perspectives of individuals with self-reported expertise and/or lived experiences regarding aspects of 2SLGBTQIPA+ health that should be included in pre-licensure physical therapy (PT) curricula across Canada, including how, when, and by whom this content should be delivered. Method We conducted a critical qualitative, cross-sectional study with semi-structured virtual interviews. We analyzed participants' perspectives thematically using the DEPICT method. Results Thirteen participants across Canada with a variety of gender identities and sexual orientations were interviewed. Participants described how transformative change on 2SLGBTQIPA+ issues in PT requires an approach that is based on interrupting heteronormativity and cisnormativity in PT curricula. Participants explained how this could be achieved by (1) emphasizing both historical inequities and present-day considerations for safe and inclusive practice, (2) introducing the content early and integrating it throughout the programme using a variety of large- and small-group sessions, and (3) including 2SLGBTQIPA+ individuals in content delivery and creation. Conclusions This study brings attention to the need for the PT profession to understand how the pervasive social structures of heteronormativity and cisnormativity shape education and practice, and offer strategies for disrupting complicity with these systems of inequality.
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Affiliation(s)
- Roshni Ravi
- From the:
Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Sharon Cheng
- From the:
Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Hutter
- From the:
Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Aaron Ibbitson
- From the:
Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Eric Ljubojevich
- From the:
Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Zachary Chan
- From the:
Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Lindsay Beavers
- From the:
Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Unity Health Toronto, Toronto, Ontario, Canada
| | - Stephanie Nixon
- From the:
Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
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Jecke L, Zepf FD. Delivering transgender-specific knowledge and skills into health and allied health studies and training: a systematic review. Eur Child Adolesc Psychiatry 2024; 33:1327-1354. [PMID: 37115277 PMCID: PMC11098887 DOI: 10.1007/s00787-023-02195-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 03/11/2023] [Indexed: 04/29/2023]
Abstract
Many transgender individuals face inequities, discrimination, and sometimes even a lack of transgender-specific knowledge in health care settings. Educational curricula can address such disparities and help future health professionals to become more knowledgeable, confident, and well-prepared for addressing the needs of transgender individuals. This systematic review aims to summarize current training interventions about care of transgender individuals for health and allied health students, and to analyse the effects of the respective intervention. A total of six databases (Pubmed, MEDLINE, Scopus, Web of Science, Embase and SciSearch) were screened for original articles published between 2017 and June 2021. Search terms and eligibility criteria were pre-specified, and after a structured selection process 21 studies were included into further analysis. Extracted data contained information on general study properties, population, design, program format and outcomes of interest. A narrative synthesis was used to summarize detected results. Study quality was assessed for each individual study. A self-developed 18-item checklist combining criteria of two prior published tools was used to assess overall quality of quantitative studies. For qualitative studies a 10-item checklist by Kmet et al. [HTA Initiat, 2004] was applied. Eligible studies were designed for multiple health or allied health profession students, and varied widely regarding program format, duration, content, and assessed outcomes. Almost all (N = 19) interventions indicated improvements in knowledge, attitude, confidence and comfort levels or practical skills concerning care for transgender clients. Major limitations included the lack of long-term data, validated assessment tools, control groups and comparative studies. Training interventions contribute to prepare future health professionals to deliver competent and sensitive care and which may improve the prospective experienced health care reality of transgender individuals. However, currently there is no common consensus about best practice of education. Additionally, little is known about whether detected effects of training interventions translate into noticeable improvements for transgender clients. Further studies are warranted to assess the direct impact of specific interventions in the light of the respective target populations.
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Affiliation(s)
- L Jecke
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - F D Zepf
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany.
- German Center for Mental Health (DZPG), Site Jena-Magdeburg-Halle, Jena, Germany.
- Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits Underlying Mental Health (C-I-R-C), Jena-Magdeburg-Halle, Jena, Germany.
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Kruse MI, Bigham BL, Phillips SP. A novel online training program for sexual and gender minority health increases allyship in cisgender, heterosexual paramedics. AEM EDUCATION AND TRAINING 2024; 8:e10958. [PMID: 38516255 PMCID: PMC10951873 DOI: 10.1002/aet2.10958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 01/02/2024] [Accepted: 01/18/2024] [Indexed: 03/23/2024]
Abstract
Introduction Sexual and gender minorities (SGM) make up 4% of the Canadian population. Due to existing barriers to care in the community, SGM patients may seek more help and be sicker at presentation to hospital. Paramedics occupy a unique role and can remove or decrease these barriers. There are no existing evaluations of training programs in SGM health for prehospital providers. A training program to develop better allyship in paramedics toward SGM populations was developed and assessed. Methods A 70- to 90-min mandatory, asynchronous, online training module in SGM health in the prehospital environment was developed and delivered via the emergency medical service (EMS) system's learning management system. A before-and-after study of cisgender, heterosexual, frontline paramedics was performed to measure the impact of the training module on the care of SGM patients. The validated Ally Identity Measure (AIM) tool was used to identify success of training and includes subscales of knowledge and skills, openness and support, and oppression awareness. Demographics and satisfaction scores were collected in the posttraining survey. Matched and unmatched pairs of surveys and demographic associations were analyzed using nonparametric statistics. Results Of 609 paramedics, 571 completed the training, and 239 surveys were completed before and 105 (n = 344) surveys after the training; 60 surveys were paired. Overall AIM scores of matched pairs (n = 60) improved by 12% (p < 0.001), with knowledge and skills accounting for most of the increase (21%, p < 0.001). Unmatched pairs (n = 344) were similar in demographics and scores. Rural paramedics also had significantly lower pretraining oppression awareness scores and had lower posttraining AIM scores compared to suburban paramedics (6% difference). Satisfaction scores rated the training as relevant and applicable (87% and 82%, respectively). Conclusions A novel prehospital training program in the care of SGM patients resulted in a statistically significant increase in allyship in cisgender, heterosexual-identified frontline paramedics.
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Affiliation(s)
- Michael I. Kruse
- Department of Family MedicineMcMaster UniversityHamiltonOntarioCanada
| | - Blair L. Bigham
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Susan P. Phillips
- Department of Family MedicineQueen's UniversityKingstonOntarioCanada
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Hepburn S, Buchanan D, Costelloe SJ. Current practice and recommendations for managing transgender patient data in clinical laboratories in the United Kingdom and Republic of Ireland. Ann Clin Biochem 2024; 61:98-106. [PMID: 37542364 DOI: 10.1177/00045632231195484] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Abstract
BACKGROUND Transgender people may avoid seeking medical care due to previous negative experiences and fear of discrimination. Clinical laboratories can contribute to a poor patient experience and clinical outcome when the design and functionality of laboratory information management systems (LIMS) do not consider the needs of transgender patients. This survey aimed to capture current practices in United Kingdom and Republic of Ireland clinical laboratories concerning how transgender patient data and test requests are managed throughout the total testing process. METHODS An anonymous survey was distributed to clinical laboratory professionals in November 2021. Thirty-three questions covered how gender variables are recorded for transgender patients and used to inform gender-specific calculations, test access, and reference intervals (RIs). RESULTS Of the 66 respondents, 70% were based in laboratories in England, with a majority of laboratories having ISO 15189 accreditation and processing 1000-10,000 blood samples daily. Eighty-five percent stated that their LIMS had a single field recording sex or gender information. Forty-three percent did not limit test access based on gender, but 68% did not append RIs for patients with unknown or indeterminate gender. CONCLUSIONS This survey was the first to quantify how clinical laboratories manage sex and gender information and report results for transgender and non-binary patients, and details several key recommendations based on the survey responses.
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Affiliation(s)
- Sophie Hepburn
- Department of Blood Sciences, Raigmore Hospital, Inverness, UK
- Association for Clinical Biochemistry and Laboratory Medicine, Pre-Analytical Phase Special Interest Group, London, UK
| | - Devon Buchanan
- Association for Clinical Biochemistry and Laboratory Medicine, Pre-Analytical Phase Special Interest Group, London, UK
| | - Seán J Costelloe
- Department of Clinical Biochemistry, Synnovis, King's College Hospital, Denmark Hill, London, UK
- Department of Clinical Biochemistry, Cork University Hospital, Wilton, Co. Cork, Republic of Ireland
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Butler K, Vanstone M, Yak A, Veltman A. "Will I be able to be myself? Or will I be forced to lie all the time?": How Trans and Non-Binary Students Balance Professionalism, Authenticity, and Safety in Canadian Medical Programs. PERSPECTIVES ON MEDICAL EDUCATION 2024; 13:119-129. [PMID: 38406648 PMCID: PMC10885831 DOI: 10.5334/pme.1199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/05/2024] [Indexed: 02/27/2024]
Abstract
Introduction Promoting the inclusion of trans and non-binary (TNB) medical trainees is a key step in building an inclusive health workforce well-positioned to provide high-quality healthcare to all patients. Existing data on the experiences of TNB physicians and trainees describe widespread challenges related to prejudice and discrimination, with most trainees concealing their gender identity for fear of discrimination. We aimed to understand how TNB medical students have experienced professionalism and professional identity formation. Methods This was a secondary analysis of data gathered in a constructivist grounded theory study. The authors conducted semi-structured qualitative interviews in 2017 with seven current or recently graduated TNB Canadian medical students. Results and Discussion From medical school application to graduation, TNB medical students reported feeling tensions between meeting expectations of professionalism, being their authentic selves, and seeking to avoid conscious and implicit biases. These tensions played out around issues of disclosure, foregrounding identity through impression management, and responding to identity exemplars. The tension between TNB trainees' desire to bring their whole selves to the practice of medicine and feeling pressured to de-emphasize their gender is ironic when considering the increased call for medical trainees from equity-seeking communities. The most commonly used behavioural frameworks of professionalism were inherited from prior generations and restrict students whose experiences and community-based knowledge are most needed. Demands of professionalism that are incompatible with authentic professional identity development place an inordinate burden on trainees whose identities have been excluded from normative concepts of the professional, including TNB trainees.
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Affiliation(s)
- Kat Butler
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, CA
| | | | | | - Albina Veltman
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, CA
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Eom YJ, Lee H, Choo S, Kim R, Yi H, Kim R, Kim SS. Situational Avoidance and Its Association with Mental Health Among Transgender Adults in South Korea: A Nationwide Cohort Study. LGBT Health 2024; 11:122-130. [PMID: 37831924 DOI: 10.1089/lgbt.2023.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023] Open
Abstract
Purpose: In fear of discrimination or unwanted disclosure of their transgender identity, transgender and nonbinary (TGNB) people may commonly avoid daily activities. We assessed the prevalence of situational avoidance among TGNB people and examined its associations with mental health outcomes. Methods: We analyzed data from a longitudinal survey conducted at baseline (2020) and follow-up (2021) among 268 TGNB people in South Korea. Situational avoidance due to transgender identity within the past 12 months was assessed based on 12 kinds of daily activities (e.g., public bathroom use, job applications, and hospital visits). Past-week depressive symptoms and past 2-week anxiety symptoms were measured with the Center for Epidemiologic Studies-Depression Scale and General Anxiety Disorder Scale, respectively. Results: Of 268 participants, 135 (50.4%) have ever avoided daily activities. The most frequently reported situational avoidance was public bathroom use (32.1%), followed by job applications (24.3%) and hospital visits (12.3%). After adjusting for confounders including baseline depressive symptoms and experience of anti-transgender discrimination, participants with any situational avoidance experience were 1.30 times (95% confidence intervals [CI] = 1.01-1.69) more likely to have anxiety symptoms compared with those without situational avoidance experience. In particular, participants who avoided three or more kinds of daily activities were 1.40 times (95% CI = 1.02-1.93) more likely to have anxiety symptoms than those without any experience of situational avoidance. No association was observed with depressive symptoms. Conclusion: Multilateral interventions including anti-discrimination law enactment are necessary to reduce transphobia and provide support for TGNB people in Korea, thus reducing their fear of participating in daily activities and promoting their mental well-being.
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Affiliation(s)
- Yun-Jung Eom
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea
| | - Hyemin Lee
- Jeju Institute of Public Health & Health Policy, Jeju, South Korea
| | - Sungsub Choo
- Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea
| | - Ranyeong Kim
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea
| | - Horim Yi
- Solidarity for LGBT Human Rights of Korea, Seoul, South Korea
| | - Rockli Kim
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea
- Division of Health Policy and Management, College of Health Science, Korea University, Seoul, South Korea
| | - Seung-Sup Kim
- Department of Environmental Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, South Korea
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Leeies M, Caslake E, Massarella C. Just the facts: transgender and gender diverse identities in emergency medicine. CAN J EMERG MED 2024; 26:10-14. [PMID: 37721696 DOI: 10.1007/s43678-023-00583-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/14/2023] [Indexed: 09/19/2023]
Affiliation(s)
- Murdoch Leeies
- Department of Emergency Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | - Ellie Caslake
- Department of Equity, Access & Participation, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Carys Massarella
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
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Bailey K, Avolio J, Lo L, Gajaria A, Mooney S, Greer K, Martens H, Tami P, Pidduck J, Cunningham J, Munce S, Toulany A. Social and Structural Drivers of Health and Transition to Adult Care. Pediatrics 2024; 153:e2023062275. [PMID: 38084099 DOI: 10.1542/peds.2023-062275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 01/02/2024] Open
Abstract
CONTEXT Youth with chronic health conditions experience challenges during their transition to adult care. Those with marginalized identities likely experience further disparities in care as they navigate structural barriers throughout transition. OBJECTIVES This scoping review aims to identify the social and structural drivers of health (SSDOH) associated with outcomes for youth transitioning to adult care, particularly those who experience structural marginalization, including Black, Indigenous, and 2-spirit, lesbian, gay, bisexual, transgender, queer or questioning, and others youth. DATA SOURCES Medline, Embase, CINAHL, and PsycINFO were searched from earliest available date to May 2022. STUDY SELECTION Two reviewers screened titles and abstracts, followed by full-text. Disagreements were resolved by a third reviewer. Primary research studying the association between SSDOH and transition outcomes were included. DATA EXTRACTION SSDOH were subcategorized as social drivers, structural drivers, and demographic characteristics. Transition outcomes were classified into themes. Associations between SSDOH and outcomes were assessed according to their statistical significance and were categorized into significant (P < .05), nonsignificant (P > .05), and unclear significance. RESULTS 101 studies were included, identifying 12 social drivers (childhood environment, income, education, employment, health literacy, insurance, geographic location, language, immigration, food security, psychosocial stressors, and stigma) and 5 demographic characteristics (race and ethnicity, gender, illness type, illness severity, and comorbidity). No structural drivers were studied. Gender was significantly associated with communication, quality of life, transfer satisfaction, transfer completion, and transfer timing, and race and ethnicity with appointment keeping and transfer completion. LIMITATIONS Studies were heterogeneous and a meta-analysis was not possible. CONCLUSIONS Gender and race and ethnicity are associated with inequities in transition outcomes. Understanding these associations is crucial in informing transition interventions and mitigating health inequities.
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Affiliation(s)
- Katherine Bailey
- Temerty Faculty of Medicine
- Institute of Health Policy, Management and Evaluation
| | | | - Lisha Lo
- Centre for Quality Improvement and Patient Safety
| | - Amy Gajaria
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Margaret and Wallace McCain Centre for Child, Youth, and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sarah Mooney
- Stollery Children's Hospital, Alberta Health Services, Edmonton, Alberta, Canada
- Alberta Strategy for Patient Oriented Research Support Unit
- Faculty of Nursing, Grant MacEwan University, Edmonton, Alberta, Canada
| | - Katelyn Greer
- Alberta Strategy for Patient Oriented Research Support Unit
| | - Heather Martens
- Patient and Community Engagement Research (PaCER) Program, University of Calgary, Calgary, Alberta,Canada
- Alberta Health Services, Edmonton, Alberta, Canada
- KickStand, Mental Health Foundation, Edmonton, Alberta, Canada
| | - Perrine Tami
- Public Health and Preventative Medicine, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Sarah Munce
- Rehabilitation Sciences Institute
- Department of Occupational Science and Occupational Therapy
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Alene Toulany
- Temerty Faculty of Medicine
- Institute of Health Policy, Management and Evaluation
- Department of Pediatrics, Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health and Evaluative Sciences, Sickkids Research Institute, Toronto, Ontario, Canada
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Hughes TL, Bochicchio L, Drabble L, Muntinga M, Jukema JS, Veldhuis CB, Bruck S, Bos H. Health disparities in one of the world's most progressive countries: a scoping review of mental health and substance use among sexual and gender minority people in the Netherlands. BMC Public Health 2023; 23:2533. [PMID: 38110908 PMCID: PMC10729573 DOI: 10.1186/s12889-023-17466-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 12/12/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Evidence from many parts of the world shows that sexual and gender minority (SGM) people have poorer health than their cisgender heterosexual counterparts. Minority stressors, particularly stigma and discrimination, have been identified as major contributors to sexual orientation- and gender identity-related health disparities, particularly negative mental health and behavioral health outcomes. To better understand factors that contribute to these disparities, we conducted a scoping review of SGM mental health and substance use research in the Netherlands-a country with a long-standing reputation as a pioneer in SGM equality. METHODS Using Joanna Briggs Institute guidelines and the PRISMA-ScR protocol, we searched seven databases to identify studies published between 2010 and 2022 that focused on substance use and/or mental health of SGM youth and adults in the Netherlands. RESULTS Although there was some evidence that SGM people in the Netherlands report fewer substance use and mental health concerns than those in less progressive countries, with very few exceptions studies found poorer outcomes among SGM participants than cisgender, heterosexual participants. However, this observation must be considered cautiously given major gaps in the literature. For example, only one study focused exclusively on adult sexual minority women, two focused on older SGM adults, and very little attention was given to nonbinary individuals. Most studies used non-probability samples that were quite homogenous. Many studies, especially those with youth, assessed sexual orientation based on sexual attraction; some studies of adults operationalized SGM status as having a same-sex partner. Importantly, we found no studies that directly assessed associations between structural-level stigma and health outcomes. Studies were mostly focused at the individual level and on health problems; very little attention was given to strengths or resilience. CONCLUSIONS Findings of persistent health disparities-despite the relatively long history of SGM supportive policies in the Netherlands-highlight the need for more research and greater attention to population groups that have been underrepresented. Such research would not only provide guidance on strategies to improve the health of SGM people in the Netherlands, but also in other countries that are seeking to reduce health inequities. Addressing SGM health disparities in the Netherlands and elsewhere is complex and requires a multifaceted approach that addresses individual, interpersonal and structural factors.
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Affiliation(s)
- Tonda L Hughes
- School of Nursing, Department of Psychiatry, Columbia University Irving Medical School, Center for Sexual and Gender Minority Health Research, 560 West 168 Street, New York, NY, USA.
| | - Lauren Bochicchio
- Columbia University School of Nursing Center for Sexual and Gender Minority Health Research, 560 West 168th Street, New York, NY, USA
| | - Laurie Drabble
- College of Health and Human Sciences, San Jose State University, One Washington Square, San Jose, CA, USA
| | - Maaike Muntinga
- Department of Ethics, Law and Humanities, Amsterdam UMC location VUmc, De Boelelaan 1118, Amsterdam, 1081 HZ, Netherlands
| | - Jan S Jukema
- School of Health, Saxion University of Applied Sciences, M. H. Tromplaan 28, Enschede, 7513 AB, Netherlands
| | - Cindy B Veldhuis
- Departments of Medical Social Sciences, Psychology, Psychiatry, and Obstetrics & Gynecology, Northwestern University, 625 N. Michigan Ave., 14th Floor, Chicago, IL, USA
| | - Sunčica Bruck
- Kohnstamm Instituut, Keizer Karelplein 1, Amstelveen, 1185 HL, Netherlands
| | - Henny Bos
- Research Institute Child Development and Education, Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, 1012 WX, Netherlands
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Campbell J, Nathoo A, Chard S, Messenger D, Walker M, Bartels SA. Lesbian, gay, bisexual, transgender and or queer patient experiences in Canadian primary care and emergency departments: a literature review. CULTURE, HEALTH & SEXUALITY 2023; 25:1707-1724. [PMID: 36794329 DOI: 10.1080/13691058.2023.2176548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/31/2023] [Indexed: 06/18/2023]
Abstract
This literature review synthesises existing evidence and offers a thematic analysis of primary care and emergency department experiences of lesbian, gay, bisexual, transgender, queer and/or any other sexual or gender minority (LGBTQ+) individuals in Canada. Articles detailing first-person primary or emergency care experiences of LGBTQ + patients were included from EMBASE, MEDLINE, PsycINFO and CINHAL. Studies published before 2011, focused on the COVID-19 pandemic, unavailable in English, non-Canadian, specific to other healthcare settings, and/or only discussing healthcare provider experiences were excluded. Critical appraisal was performed following title/abstract screening and full-text review by three reviewers. Of sixteen articles, half were classified as general LGBTQ + experiences and half as trans-specific experiences. Three overarching themes were identified: discomfort/disclosure concerns, lack of positive space signalling, and lack of healthcare provider knowledge. Heteronormative assumptions were a key theme among general LGBTQ + experiences. Trans-specific themes included barriers to accessing care, the need for self-advocacy, care avoidance, and disrespectful communication. Only one study reported positive interactions. LGBTQ + patients continue to have negative experiences within Canadian primary and emergency care - at the provider level and due to system constraints. Increasing culturally competent care, healthcare provider knowledge, positive space signals, and decreasing barriers to care can improve LGBTQ + experiences.
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Affiliation(s)
- Jenn Campbell
- School of Medicine, Queen's University, Kingston, ON, Canada
| | - Aisha Nathoo
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Sidonie Chard
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - David Messenger
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada
| | - Melanie Walker
- School of Medicine, Queen's University, Kingston, ON, Canada
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada
| | - Susan A Bartels
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada
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15
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Thomas SD, King R, Murphy M, Dempsey M. Demographic factors associated with healthcare avoidance and delay in the transgender population: Findings from a systematic review. DIALOGUES IN HEALTH 2023; 3:100159. [PMID: 38515802 PMCID: PMC10954025 DOI: 10.1016/j.dialog.2023.100159] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/02/2023] [Accepted: 11/09/2023] [Indexed: 03/23/2024]
Abstract
Purpose Healthcare avoidance and delay (HAD) in the transgender population has been well documented, and research has explored a range of associated factors that help to identify those most at risk of HAD. This review addresses a gap in the research by synthesizing research exploring associations between HAD and demographic factors. Methods A systematic search of literature published at any time up to December 2021 was conducted, using five databases (EBSCO, EMBASE, PubMed, Scopus, and Web of Science) and manually searching reference lists of included studies. After exclusion of duplicates, 608 unique records were subjected to double screening. Papers reporting statistical analyses of HAD in association with any sociodemographic variables were included in this review. Papers consisted of nineteen cross-sectional studies. Narrative synthesis was used to address findings. Results Nineteen studies met inclusion criteria, exploring HAD in association with a wide range of demographic factors, including sex and gender, social transition factors, age, race and ethnicity, socioeconomic factors, veteran status, education, sexuality, relationship status, citizenship, place of residence, and state demographics. Findings identified intra-community demographic risk factors, with consistent evidence for increased HAD among transmasculine, and younger, participants. Lower income and higher educational attainment were also associated with increased HAD, while remaining areas had weak or little evidence for association with HAD. Conclusion This review expands knowledge in this area by highlighting demographic factors associated with increased HAD in research literature, and exploring how these may be further investigated to address substantial gaps in the body of research.
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Affiliation(s)
- Siobhan D. Thomas
- School of Applied Psychology, University College Cork, Cork Enterprise Centre, North Mall, Cork, Ireland
| | - Robert King
- School of Applied Psychology, University College Cork, Cork Enterprise Centre, North Mall, Cork, Ireland
| | - Mike Murphy
- School of Applied Psychology, University College Cork, Cork Enterprise Centre, North Mall, Cork, Ireland
| | - Maria Dempsey
- School of Applied Psychology, University College Cork, Cork Enterprise Centre, North Mall, Cork, Ireland
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Rosser BS, Weideman BC, Rider GN, Jatoi A, Ecklund AM, Wheldon CW, Talley KM, Kulasingam S, Smith MK, Jacobs DR, Mitteldorf D, West W, Alley R, Ross MW. Sexual and Gender Minority Invisibility in Cancer Studies: A Call for Effective Recruitment Methods to Address Cancer Disparities. J Clin Oncol 2023; 41:5093-5098. [PMID: 37725780 PMCID: PMC10666979 DOI: 10.1200/jco.23.00655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/09/2023] [Accepted: 07/14/2023] [Indexed: 09/21/2023] Open
Abstract
#LGBTQ+ people with cancer are invisibilized: A call for #intersectional cancer research (link here) #healthequity
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Affiliation(s)
- B.R. Simon Rosser
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Ben C.D. Weideman
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - G. Nic Rider
- Department of Family Medicine and Community Health, Institute for Sexual and Gender Health, University of Minnesota Medical School, Minneapolis, MN
| | - Aminah Jatoi
- Department of Oncology, Mayo Clinic, Rochester, MN
| | - Alexandra M. Ecklund
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Christopher W. Wheldon
- Department of Social and Behavioural Sciences, College of Public Health, Temple University, Philadelphia, PA
| | - Kristine M.C. Talley
- Adult and Geriatric Health, University of Minnesota School of Nursing, Minneapolis, MN
| | - Shalini Kulasingam
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - M. Kumi Smith
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - David R. Jacobs
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | | | - William West
- Department of Writing Studies, University of Minnesota, Minneapolis, MN
| | - Rhea Alley
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Michael W. Ross
- Department of Family Medicine and Community Health, Institute for Sexual and Gender Health, University of Minnesota Medical School, Minneapolis, MN
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17
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Primeau CA, Philpott HT, Vader K, Unger J, Le CY, Birmingham TB, MacDermid JC. Students' attitudes, beliefs and perceptions surrounding 2SLGBTQIA + health education and inclusiveness in Canadian physiotherapy programs. BMC Public Health 2023; 23:1661. [PMID: 37644532 PMCID: PMC10466852 DOI: 10.1186/s12889-023-16554-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 08/17/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Patients who identify as 2SLGBTQIA + report negative experiences with physiotherapy. The objectives were to evaluate student attitudes, beliefs and perceptions related to 2SLGBTQIA + health education and working with individuals who identify as 2SLGBTQIA + in entry-level physiotherapy programs in Canada and to evaluate physiotherapy program inclusiveness towards 2SLGBTQIA + persons. METHODS We completed a nationwide, cross-sectional survey of physiotherapy students from Canadian institutions. We recruited students via email and social media from August-December 2021. Frequency results are presented with percentages. Logistic regression models (odds ratios [OR], 95%CI) were used to evaluate associations between demographics and training hours with feelings of preparedness and perceived program 2SLGBTQIA + inclusiveness. RESULTS We obtained 150 survey responses (mean age = 25 years [range = 20 to 37]) from students where 35 (23%) self-identified as 2SLGBTQIA + . While most students (≥ 95%) showed positive attitudes towards working with 2SLGBTQIA + patients, only 20 students (13%) believed their physiotherapy program provided sufficient knowledge about 2SLGBTQIA + health and inclusiveness. Students believed more 2SLGBTQIA + training is needed (n = 137; 92%), believed training should be mandatory (n = 141; 94%) and were willing to engage in more training (n = 138; 92%). Around half believed their physiotherapy program (n = 80, 54%) and clinical placements (n = 75, 50%) were 2SLGBTQIA + -inclusive and their program instructors (n = 69, 46%) and clinical instructors (n = 47, 31%) used sex/gender-inclusive language. Discrimination towards 2SLGBTQIA + persons was witnessed 56 times by students and most (n = 136; 91%) reported at least one barrier to confronting these behaviours. Older students (OR = 0.89 [0.79 to 0.99]), individuals assigned female at birth (OR = 0.34 [0.15 to 0.77]), and students self-identifying as 2SLGBTQIA + (OR = 0.38 [0.15 to 0.94]) were less likely to believe their program was 2SLGBTQIA + inclusive. Older students (OR = 0.85 [0.76 to 0.94]) and 2SLGBTQIA + students (OR = 0.42 [0.23 to 0.76]) felt the same about their placements. Students who reported > 10 h of 2SLGBTQIA + training were more likely to believe their program was inclusive (OR = 3.18 [1.66 to 6.09]). CONCLUSIONS Entry-level physiotherapy students in Canada show positive attitudes towards working with 2SLGBTQIA + persons but believe exposure to 2SLGBTQIA + health and inclusiveness is insufficient in their physiotherapy programs. This suggests greater attention dedicated to 2SLGBTQIA + health would be valued.
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Affiliation(s)
- Codie A Primeau
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada.
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, Western University, London, ON, Canada.
- School of Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, ON, Canada.
- Bone and Joint Institute, Western University, London, ON, Canada.
| | - Holly T Philpott
- School of Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, ON, Canada
- Bone and Joint Institute, Western University, London, ON, Canada
| | - Kyle Vader
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Janelle Unger
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada
- School of Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Christina Y Le
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Trevor B Birmingham
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada
- School of Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, ON, Canada
- Bone and Joint Institute, Western University, London, ON, Canada
| | - Joy C MacDermid
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada
- School of Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, ON, Canada
- Bone and Joint Institute, Western University, London, ON, Canada
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Burcheri A, Coutin A, Bigham BL, Kruse MI, Lien K, Lim R, MacCormick H, Morris J, Ng V, Primiani N, Odorizzi S, Poirier V, Upadhye S, Primavesi R. Exploring a case for education about sexual and gender minorities in postgraduate emergency medicine training: forming recommendations for change. Postgrad Med 2023; 135:623-632. [PMID: 37310186 DOI: 10.1080/00325481.2023.2225329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/12/2023] [Indexed: 06/14/2023]
Abstract
Social medicine and health advocacy curricula are known to be uncommon in postgraduate medical education. As justice movements work to unveil the systemic barriers experienced by sexual and gender minority (SGM) populations, it is imperative that the emergency medicine (EM) community progress in its efforts to provide equitable, accessible, and competent care for these vulnerable groups. Given the paucity of literature on this subject in the context of EM in Canada, this commentary borrows evidence from other specialties across North America. Trainees across specialties and of all stages are caring for an increasing number of SGM patients. Lack of education at all levels of training is identified as a significant barrier to adequately caring for these populations, thereby precipitating significant health disparities. Cultural competency is often mistakenly attributed to a willingness to treat rather than the provision of quality care. However, positive attitudes do not necessarily correlate with trainee knowledge. Barriers to creating and implementing culturally competent curricula are plentiful, yet facilitating policies and resources are rare. While international bodies continuously publish position statements and calls to action, concrete change is seldom made. The scarcity of SGM curricula can be attributed to the universal absence of formal acknowledgment of SGM health as a required competency by accreditation boards and professional membership associations. This commentary synthesizes hand-picked literature in an attempt to inform healthcare professionals on their journey toward developing culturally competent postgraduate medical education. By thematically organizing evidence into a stepwise approach, the goal of this article is to borrow ideas across medical and surgical specialties to inform the creation of recommendations and make a case for an SGM curriculum for EM programs in Canada.
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Affiliation(s)
- Adam Burcheri
- Department of Psychology, Concordia University, Montreal, QC, Canada
| | - Alexandre Coutin
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Blair L Bigham
- Department of Emergency Medicine, McMaster University, Hamilton, ON, Canada
| | - Michael I Kruse
- Department of Family Medicine, Queen's University, Kingston, ON, Canada
| | - Kelly Lien
- Departments of Emergency Medicine and Family Medicine, Western University, London, ON, Canada
| | - Rodrick Lim
- Department of Pediatrics and Medicine, Western University, London, ON, Canada
| | - Hilary MacCormick
- Departments of Anesthesia, Pain Management, & Perioperative Medicine, Women's & Obstetric Anesthesia, IWK Health Centre, Dalhousie University, Halifax, NS, Canada
| | - Judy Morris
- Departments of Family Medicine and Emergency Medicine, Université de Montréal, Montreal, QC, Canada
| | - Victor Ng
- Division of Emergency Medicine, Western University, London, ON, Canada
| | - Nadia Primiani
- Department of Emergency Medicine, University of Toronto, Toronto, ON, Canada
| | - Scott Odorizzi
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Vincent Poirier
- Department of Emergency Medicine, McGill University, Montreal, QC, Canada
| | - Suneel Upadhye
- Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Robert Primavesi
- Department of Emergency Medicine, McGill University, Montreal, QC, Canada
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Lee CH, Santos CD, Brown T, Ashworth H, Lewis JJ. Trauma-Informed Care for Acute Care Settings: A Novel Simulation Training for Medical Students. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2023; 19:11327. [PMID: 37520013 PMCID: PMC10376910 DOI: 10.15766/mep_2374-8265.11327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 04/11/2023] [Indexed: 08/01/2023]
Abstract
Introduction Physicians often care for patients who have experienced traumatic events including abuse, discrimination, and violence. Trauma-informed care (TIC) is a framework that recognizes the prevalence of trauma, promotes patient empowerment, and minimizes retraumatization. There are limited education curricula on how to apply TIC to acute care settings, with simulation-based training presenting a novel educational tool for this aim. Methods Students participated in a didactic on TIC principles and its applications in acute care settings. Learners participated in three simulation cases where they performed physical exams and gathered history on patients with urgent medical needs related to intimate partner violence, transgender health, and health care discrimination. Debriefing followed each simulation. Results Seventeen medical students participated across four sessions. The sessions were evaluated with pre- and postparticipation surveys, including Likert scales and free-response questions. After participation, individuals' self-assessed confidence improved across multiple domains, including identifying situations for trauma screenings, inquiring about trauma, and responding as a bystander. Learners also felt more familiar with TIC-specific history taking and physical exam skills. Finally, simulation was perceived as a beneficial educational tool. All findings were statistically significant (p ≤ .01). Discussion Our simulation-based training enabled students to practice conversations and interventions related to trauma. This novel training represents a feasible and effective means for teaching TIC for acute care settings, including in the emergency department and in-patient settings. Development and evaluation were supported by the Society for Academic Emergency Medicine.
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Affiliation(s)
| | | | - Taylor Brown
- Second-Year Resident, Department of Emergency Medicine, Beth Israel Deaconess Medical Center
| | - Henry Ashworth
- First-Year Resident, Department of Emergency Medicine, Highland Hospital, Alameda Health System
| | - Jason J. Lewis
- Assistant Professor, Department of Emergency Medicine, Beth Israel Deaconess Medical Center
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20
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Primeau CA, Philpott HT, Vader K, Unger J, Le CY, Birmingham TB, MacDermid JC. Knowledge, behaviours, and training related to 2SLGBTQIA+ health education amongst entry-level physiotherapy students in Canada: results of a nationwide, cross-sectional survey. BMC MEDICAL EDUCATION 2023; 23:519. [PMID: 37468895 DOI: 10.1186/s12909-023-04499-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 07/04/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Individuals who identify as 2SLGBTQIA+ report worse health outcomes than heterosexual/cisgender counterparts, in part due to poor experiences with healthcare professionals. This may stem from inadequate 2SLGBTQIA+ health and inclusiveness training in health professional student education. The purpose of the study was to evaluate knowledge, behaviours, and training related to 2SLGBTQIA+ health education and inclusiveness for entry-level physiotherapy students in Canada. METHODS We conducted a nationwide, cross-sectional survey with physiotherapy students from accredited Canadian physiotherapy programs. We administered the survey through Qualtrics and recruited students through targeted recruitment emails and social media posts on Twitter and Instagram between August and December 2021. Survey responses are reported as frequencies (percentage). We also completed multivariable logistic regressions to evaluate associations among question responses related to working with 2SLGBTQIA+ individuals (i.e., communication, feeling prepared and assessment competency). Covariates included training hours (< 10/10 + hours) and 2SLGBTQIA+ identity (yes/no). RESULTS A total of 150 students responded to the survey, with 35 (23%) identifying as 2SLGBTQIA+ . Many students felt confident in communicating effectively with clients who identify as 2SLGBTQIA+ (69%). However, only half (47%) felt comfortable assessing clients who identify as 2SLGBTQIA+ . Routine practice of inclusive behaviours such as using pronouns, considering identities are fluid and a patient's gender identity and/or sexual orientation may shift from one visit to the next, and considering trauma-informed care practices were reported from less than half of the students (< 45%). Around 29% of students reported no 2SLGBTQIA+ training in their physiotherapy program, while 47% reported 0-10 hours, and 24% reported 10 + hours of training. Students with 10 + hours of training had 92% higher odds of feeling competent in assessing 2SLGBTQIA+ clients, compared to those with < 10 hours of training. CONCLUSIONS Entry-level physiotherapy students in Canada show a lack of understanding and awareness for 2SLGBTQIA+ health and inclusive behaviours which can meaningfully impact patient experience. Students report feeling incompetent when working with 2SLGBTQIA+ patients, which may be associated with lack of 2SLGBTQIA+ training in their programs. Greater efforts and attention towards increasing 2SLGBTQIA+ health education and inclusivity in Canadian entry-level physiotherapy programs is critically needed.
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Affiliation(s)
- Codie A Primeau
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada.
- School of Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, ON, Canada.
- Bone and Joint Institute, Western University, London, ON, Canada.
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, Western University, London, ON, N6A 3K7, Canada.
| | - Holly T Philpott
- School of Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, ON, Canada
- Bone and Joint Institute, Western University, London, ON, Canada
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, Western University, London, ON, N6A 3K7, Canada
| | - Kyle Vader
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Janelle Unger
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada
- School of Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Christina Y Le
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Trevor B Birmingham
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada
- School of Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, ON, Canada
- Bone and Joint Institute, Western University, London, ON, Canada
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, Western University, London, ON, N6A 3K7, Canada
| | - Joy C MacDermid
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada
- School of Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, ON, Canada
- Bone and Joint Institute, Western University, London, ON, Canada
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21
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McSky KZ, Lin AL, Tanski ME. Transgender and Gender Nonbinary Patient Experiences in the Emergency Department: A Regional Study. Transgend Health 2023; 8:238-245. [PMID: 37342472 PMCID: PMC10278006 DOI: 10.1089/trgh.2021.0040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose Transgender people experience discrimination in health care, including reports of avoiding or delaying emergency department (ED) care due to prior negative experiences, fear of discrimination, poor accommodations, and inappropriate staff behavior. Emergency physicians receive minimal training on transgender care. This study sought to understand the experience of transgender patients when visiting EDs in the Portland metro area, and the knowledge and training experience of Oregon Health & Science University (OHSU) ED staff. Methods Two populations were examined via survey: (1) Transgender people who accessed, or felt they should access, ED care in Portland, Oregon, in the past 5 years; and (2) OHSU ED patient-facing staff. Data were analyzed to identify trends in ED experiences, and predictors of positive experiences. Potential relationships between self-reported proficiency in transgender care and formal training experience, professional role, and duration of practice were also assessed. Results Of the predictors assessed, only the opportunity to provide pronouns at check-in was associated with better perceived experiences (p<0.01). The differences between reported best and worst ED experiences were significant in all domains of perceived experiences but one (p<0.01). ED providers who had formal training were more likely to rate themselves as proficient (p<0.01). There was no relationship found between self-reported proficiency and length of practice. Conclusion This study demonstrated that there are significant differences between reported best and worst ED experiences by transgender patients, and thus areas for ED improvement. It is our recommendation that EDs provide the opportunity for patients to supply their pronouns, and offer trainings in transgender health care for employees.
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Affiliation(s)
- Kysa Z. McSky
- Emergency Medicine Residency, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Amber L. Lin
- Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Mary E. Tanski
- Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon, USA
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22
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Shires DA, Kcomt L, Kattari L, Liroff M, Lee R. Emergency Clinicians' Comfort Levels in Caring for Transgender Patients. Transgend Health 2023; 8:246-253. [PMID: 37342475 PMCID: PMC10278018 DOI: 10.1089/trgh.2021.0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective Transgender individuals report negative experiences in emergency department settings, but little is known about emergency clinicians' barriers to treating transgender patients. The purpose of this study was to explore emergency clinicians' experiences with transgender patients to better understand their comfort with caring for this population. Methods We conducted a cross-sectional survey of emergency clinicians in an integrated health system in the Midwest. To assess the relationship between each independent variable and the outcome variables (i.e., comfort level generally and comfort level asking transgender patients about their body parts specifically), Mann-Whitney U test or Kruskal-Wallis analysis of variance was conducted for categorical independent variables and Pearson correlations were conducted for continuous independent variables. Results Most participants (90.1%) were comfortable caring for transgender patients, whereas two-thirds (67.9%) were comfortable asking transgender patients about body parts. Although none of the independent variables was associated with increased clinician comfort level caring for transgender patients in general, White clinicians and those who were unsure how to ask patients about their gender identity or transgender-specific care they had received were less comfortable asking about body parts. Conclusion Having skills to communicate with transgender patients was associated with emergency clinicians' comfort levels. In addition to offering traditional classroom-based didactics about transgender health care, providing opportunities for clinical rotations that allow clinicians-in-training to treat, and perhaps more importantly, learn from transgender patients will likely be higher yield in bolstering clinician confidence in serving this patient population.
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Affiliation(s)
- Deirdre A. Shires
- School of Social Work, Michigan State University, East Lansing, Michigan, USA
| | - Luisa Kcomt
- School of Social Work, Wayne State University, Detroit, Michigan, USA
| | - Leonardo Kattari
- School of Social Work, Michigan State University, East Lansing, Michigan, USA
| | - Meghan Liroff
- Department of Emergency Medicine, and Henry Ford Health System, Detroit, Michigan, USA
| | - Rachel Lee
- Department of Family Medicine, Henry Ford Health System, Detroit, Michigan, USA
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Knudson GA, Feldman J, Neira P, Fraser L. Closing the gap in education: Raising medical professionals' knowledge and attitudes in transgender health. Best Pract Res Clin Obstet Gynaecol 2023; 89:102339. [PMID: 37295317 DOI: 10.1016/j.bpobgyn.2023.102339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/19/2023] [Accepted: 04/08/2023] [Indexed: 06/12/2023]
Abstract
Transgender and gender diverse (TGD) health is a rapidly evolving, underserviced, and underresearched healthcare field. This chapter will provide a brief review of the research in TGD health and medical education and offer further areas of research and curriculum design.
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Huttunen A. “I had to teach my own doctor what this was about”: Information sharing barriers and information evaluation of Finnish transgender people. LIBRARY & INFORMATION SCIENCE RESEARCH 2023. [DOI: 10.1016/j.lisr.2023.101235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
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Schultz TR, Zoucha R, Sekula K, Abrams BAD. Emergency care for youth who experience suicidality and identify as LGBTQ. Public Health Nurs 2023; 40:243-249. [PMID: 36519928 DOI: 10.1111/phn.13162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/01/2022] [Accepted: 11/27/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Suicide is a leading cause of death in children; youth who identify as LGBTQ+ are at an exponentially higher risk of suicide. The purpose of this study was to explore the lived experiences of youth who identify as LGBTQ+ and sought emergency care for suicidality as adolescents. METHODS Hermeneutics phenomenology is the research method used in this study. Youth who identify as LGBTQ+ and sought emergency treatment for suicidality when they were adolescents were recruited; fifteen youth enrolled. Individuals ranged in age from 20 to 25 years. Participants described their gender identity as male, female, non-binary, transgender female, and their sexual orientation as: female, demisexual, bisexual, gay, homosexual, lesbian, queer, asexual, and transgender. RESULTS This study establishes that youth who identify as LGBTQ+ seeking emergency care for suicidality value: coping and control, acceptance from others and self, communicating with me about me, and moving beyond danger and distress. Lack of psychological safety-from the emic perspective-emerged as a critical finding. CONCLUSION This research has strong implications for public health, policy, and research. Future research must seek to understand ways in which psychological safety is assessed in healthcare if we are to more deeply understand and effectively address the impact on health equity.
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Affiliation(s)
- Theresa Ryan Schultz
- Children's National Hospital, Director of Nursing, Emergency Medicine and Trauma Center, Washington, DC
| | - Rick Zoucha
- School of Nursing, Duquesne University, Pittsburgh, Pennsylvania
| | - Kathleen Sekula
- School of Nursing, Duquesne University, Pittsburgh, Pennsylvania
| | - Bishop Allyson D Abrams
- Pastor of Empowerment Liberation Cathedral, President of Empowerment Justice Center, Bowie, Maryland
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Albar M, Koziarz A, McMahon E, Chan C, Liu K. Timing of testosterone discontinuation and assisted reproductive technology outcomes in transgender patients: a cohort study. F S Rep 2023; 4:55-60. [PMID: 36959967 PMCID: PMC10028470 DOI: 10.1016/j.xfre.2023.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/12/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023] Open
Abstract
Objective To determine if there is an association between the timing of testosterone discontinuation and assisted reproductive technology (ART) outcomes. Design Retrospectivse cohort study. Setting Single academic center. Patients We included consecutive transgender patients seeking fertility preservation between October 2019 and April 2021. Patients who identified as transgender on androgens for >1 month on presentation were included. Interventions None. Main outcome measures A linear regression model was used to evaluate the effect of testosterone discontinuation duration on the number of mature oocytes retrieved. Results Eighteen patients (mean age 27.7 [SD 5.2] years, mean body mass index 27.3 [SD 4.6] kg/m2, mean antimüllerian hormone 27.2 [SD 11.8], median antral follicle count 20 [interquartile range (IQR) 14-32]) were included in the analysis. No patient underwent transition-related surgery (eg, oophorectomy, hysterectomy). None of the patients were previously pregnant. Mean time o,n testosterone was 44 (SD 29.6) months. The median time off testosterone until the start of ovarian stimulation was 7.7 weeks (IQR 4.3-20.7). All patients underwent oocyte cryopreservation except one who had embryo cryopreservation. The median total number of oocytes was 11 (IQR 7-14). The median number of mature oocytes was 7.5 (IQR 5-12) oocytes. The univariate regression model evaluating the duration of time off testosterone before ART demonstrated no significant association with the outcome of mature oocytes (regression coefficient, 0.19; 95% confidence interval, -0.13 to 0.50). Conclusion In a retrospective analysis of transgender patients recently on testosterone undergoing ART, no association was detected between the timing of testosterone cessation and the number of mature oocytes.
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Affiliation(s)
- Mohammad Albar
- Department of Obstetrics and Gynaecology, University of King Abdulaziz, Jeddah, Saudi Arabia
| | - Alex Koziarz
- Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Eileen McMahon
- Hannam Fertility Centre, Toronto, Ontario, Canada
- Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada
| | - Crystal Chan
- Markham Fertility Centre, Toronto, Ontario, Canada
| | - Kimberly Liu
- Mount Sinai Fertility, Toronto, Ontario, Canada
- Reprint requests: Kimberly Liu, M.D., M.S.L., Division of Reproductive Endocrinology and Infertility, Mount Sinai Fertility, University of Toronto, 250 Dundas Street West, Suite 700, Ontario, Canada.
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Bartels SA, MacKenzie M, Douglas SL, Collier A, Pritchard J, Purkey E, Messenger D, Walker M. Emergency department care experiences among members of equity-deserving groups: quantitative results from a cross-sectional mixed methods study. BMC Emerg Med 2023; 23:21. [PMID: 36809981 PMCID: PMC9942657 DOI: 10.1186/s12873-023-00792-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 02/15/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Emergency departments (EDs) serve an integral role in healthcare, particularly for vulnerable populations. However, marginalized groups often report negative ED experiences, including stigmatizing attitudes and behaviours. We engaged with historically marginalized patients to better understand their ED care experiences. METHOD Participants were invited to complete an anonymous mixed-methods survey about a previous ED experience. We analysed quantitative data including controls and equity-deserving groups (EDGs) - those who self-identified as: (a) Indigenous; (b) having a disability; (c) experiencing mental health issues; (d) a person who uses substances; (e) a sexual and gender minority; (f) a visible minority; (g) experiencing violence; and/or (h) facing homelessness - to identify differences in their perspectives. Differences between EDGs and controls were calculated with chi squared tests, geometric means with confidence ellipses, and the Kruskal-Wallis H test. RESULTS We collected a total of 2114 surveys from 1973 unique participants, 949 controls and 994 who identified as equity-deserving. Members of EDGs were more likely to attribute negative feelings to their ED experience (p < 0.001), to indicate that their identity impacted the care received (p < 0.001), and that they felt disrespected and/or judged while in the ED (p < 0.001). Members of EDGs were also more likely to indicate that they had little control over healthcare decisions (p < 0.001) and that it was more important to be treated with kindness/respect than to receive the best possible care (p < 0.001). CONCLUSION Members of EDGs were more likely to report negative ED care experiences. Equity-deserving individuals felt judged and disrespected by ED staff and felt disempowered to make decisions about their care. Next steps will include contextualizing findings using participants' qualitative data and identifying how to improve ED care experiences among EDGs to make it more inclusive and better able to meet their healthcare needs.
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Affiliation(s)
- Susan A Bartels
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada. .,Department of Public Health Sciences, Queen's University, Kingston, ON, Canada.
| | - Meredith MacKenzie
- Department of Family Medicine, Queen's University, Kingston, ON, Canada.,Street Health Centre, part of Kingston Community Health Centres, Kingston, ON, Canada
| | - Stuart L Douglas
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada.,Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - Amanda Collier
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada
| | - Jodie Pritchard
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada
| | - Eva Purkey
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada.,Department of Family Medicine, Queen's University, Kingston, ON, Canada
| | - David Messenger
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada.,Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - Melanie Walker
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada.,Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
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Brown C, Marnie C, Peters MDJ. Barriers and enablers to culturally safe care for trans and gender-diverse people in hospital emergency departments: a scoping review protocol. JBI Evid Synth 2023:02174543-990000000-00132. [PMID: 36735278 DOI: 10.11124/jbies-22-00262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The objective of this review is to identify barriers and enablers to the provision and accessibility of culturally safe care to trans and gender-diverse patients in the emergency department. INTRODUCTION Emergency departments have a unique role in creating patient experiences that influence positive or negative health outcomes. It is vital that emergency departments provide equitable experiences for all patients regardless of gender. Culturally safe care aims to support inclusive, effective, and appropriate care for trans and gender-diverse patients. Identifying the reported barriers and enablers to culturally safe care for trans and gender-diverse people in emergency departments will support knowledge users to advocate for and implement improvements to care. INCLUSION CRITERIA This review will consider studies that describe barriers and enablers of accessing culturally safe care in emergency departments reported by trans and gender-diverse people, their families/loved ones, as well as health care workers involved in the provision of care. English-language published and gray literature sources from January 1, 2000, to the present from all countries will be eligible. METHODS The review will follow the JBI methodology for scoping reviews and be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. Database searches of MEDLINE, Emcare, Embase, ScienceDirect, PsycINFO, Web of Science, Scopus, Google Scholar, and ProQuest will be undertaken. Data will be presented in tabular format or graphs, with an accompanying narrative summary.
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Affiliation(s)
- Chantal Brown
- Rosemary Bryant AO Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Casey Marnie
- Rosemary Bryant AO Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia.,National Policy Research Unit, Australian Nursing and Midwifery Federation (Federal Office), Adelaide, SA, Australia
| | - Micah D J Peters
- Rosemary Bryant AO Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia.,National Policy Research Unit, Australian Nursing and Midwifery Federation (Federal Office), Adelaide, SA, Australia.,Adelaide Nursing School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia.,The Centre for Evidence-based Practice South Australia (CEPSA): A JBI Centre of Excellence
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Kawsar M, Linander I. “It’s a patient safety issue” A qualitative study with care professionals on their experiences of meeting trans people in obstetric and gynaecological care. SEXUAL & REPRODUCTIVE HEALTHCARE 2022; 34:100786. [DOI: 10.1016/j.srhc.2022.100786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 09/10/2022] [Accepted: 09/21/2022] [Indexed: 11/27/2022]
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30
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Petrey LN, Noonan EJ, Weingartner LA. Gender Diverse Representation in Patient Simulation: A Scoping Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:S107-S116. [PMID: 35947464 DOI: 10.1097/acm.0000000000004926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Despite recent advocacy for transgender and nonbinary (TGNB) health competencies in medical education, there is little guidance on how to represent diverse gender identities for clinical skills training. Published literature is one of few resources available to inform educators' decisions, so this study aims to summarize how medical education scholarship portrays TGNB identities in patient simulation. METHOD This scoping review used PRISMA guidelines with search strings encompassing diverse gender identities and patient simulation. This search was completed in July 2021, and all years of publication were included. The authors completed a 3-tiered review to identify relevant studies and then extracted data to summarize how TGNB patients were portrayed and training outcomes. RESULTS After screening 194 total articles, 44 studies met the criteria for full review. Of these, 22 studies involved TGNB simulated patient cases. Within these, 15 (68%) reported the specific gender identities represented in the patient case, revealing mostly binary transgender identities. Sixteen studies (73%) reported the gender identities of all actors who portrayed the patient. The identities of all patients and actors matched in only 10 articles (45%), indicating that most programs portray TGNB identities with cisgender or unspecified standardized patients. Nearly all studies reported desirable learner outcomes. Several noted the advantage of authenticity in recruiting TGNB actors and the need to achieve more accurate representation of TGNB patients. CONCLUSIONS Educators are increasingly representing TGNB identities in clinical skills training. These results show a lack of nonbinary representation and discrepancies between TGNB patient cases and standardized patient identities. These data also suggest that simulation programs need and desire better recruitment strategies within TGNB communities. Because TGNB communities are not a monolith, reporting out and analyzing gender identities of simulation cases and people hired to portray TGNB patients helps ensure that TGNB care is taught effectively and respectfully.
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Affiliation(s)
- Luca N Petrey
- L.N. Petrey is a fourth-year medical student, University of Louisville School of Medicine, Louisville, Kentucky; ORCID: http://orcid.org/0000-0002-8406-9181
| | - Emily J Noonan
- E.J. Noonan is assistant professor, Undergraduate Medical Education, University of Louisville School of Medicine, Louisville, Kentucky; ORCID: http://orcid.org/0000-0002-7361-8229
| | - Laura A Weingartner
- L.A. Weingartner is assistant professor, Undergraduate Medical Education, University of Louisville School of Medicine, Louisville, Kentucky; ORCID: http://orcid.org/0000-0003-0820-3980
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Hoge MA, Vanderploeg J, Paris M, Lang JM, Olezeski C. Emergency Department Use by Children and Youth with Mental Health Conditions: A Health Equity Agenda. Community Ment Health J 2022; 58:1225-1239. [PMID: 35038073 PMCID: PMC8762987 DOI: 10.1007/s10597-022-00937-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 12/26/2021] [Indexed: 11/22/2022]
Abstract
There are growing concerns regarding the referral of children and youth with mental health conditions to emergency departments (EDs). These focus on upward trends in utilization, uncertainty about benefits and negative effects of ED visits, and inequities surrounding this form of care. A review was conducted to identify and describe available types of data on ED use. The authors' interpretation of the literature is that it offers compelling evidence that children and youth in the U.S. are being sent to EDs for mental health conditions at increasing rates for reasons frequently judged as clinically inappropriate. As a major health inequity, it is infrequent that such children and youth are seen in EDs by a behavioral health professional or receive evidence-based assessment or treatment, even though they are kept in EDs far longer than those seen for reasons unrelated to mental health. The rate of increase in these referrals to EDs appears much greater for African American and Latinx children and youth than White children and is increasing for the publicly insured and uninsured while decreasing for the privately insured. A comprehensive set of strategies are recommended for improving healthcare quality and health equity. A fact sheet is provided for use by advocates in pressing this agenda.
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Affiliation(s)
- Michael A. Hoge
- grid.47100.320000000419368710Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
| | - Jeffrey Vanderploeg
- grid.47100.320000000419368710Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
- grid.475976.eChild Health and Development Institute, Farmington, CT USA
- grid.208078.50000000419370394Department of Psychiatry, UConn Health, Farmington, CT USA
| | - Manuel Paris
- grid.47100.320000000419368710Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
| | - Jason M. Lang
- grid.47100.320000000419368710Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
- grid.475976.eChild Health and Development Institute, Farmington, CT USA
- grid.208078.50000000419370394Department of Psychiatry, UConn Health, Farmington, CT USA
| | - Christy Olezeski
- grid.47100.320000000419368710Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
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Coleman E, Radix AE, Bouman WP, Brown GR, de Vries ALC, Deutsch MB, Ettner R, Fraser L, Goodman M, Green J, Hancock AB, Johnson TW, Karasic DH, Knudson GA, Leibowitz SF, Meyer-Bahlburg HFL, Monstrey SJ, Motmans J, Nahata L, Nieder TO, Reisner SL, Richards C, Schechter LS, Tangpricha V, Tishelman AC, Van Trotsenburg MAA, Winter S, Ducheny K, Adams NJ, Adrián TM, Allen LR, Azul D, Bagga H, Başar K, Bathory DS, Belinky JJ, Berg DR, Berli JU, Bluebond-Langner RO, Bouman MB, Bowers ML, Brassard PJ, Byrne J, Capitán L, Cargill CJ, Carswell JM, Chang SC, Chelvakumar G, Corneil T, Dalke KB, De Cuypere G, de Vries E, Den Heijer M, Devor AH, Dhejne C, D'Marco A, Edmiston EK, Edwards-Leeper L, Ehrbar R, Ehrensaft D, Eisfeld J, Elaut E, Erickson-Schroth L, Feldman JL, Fisher AD, Garcia MM, Gijs L, Green SE, Hall BP, Hardy TLD, Irwig MS, Jacobs LA, Janssen AC, Johnson K, Klink DT, Kreukels BPC, Kuper LE, Kvach EJ, Malouf MA, Massey R, Mazur T, McLachlan C, Morrison SD, Mosser SW, Neira PM, Nygren U, Oates JM, Obedin-Maliver J, Pagkalos G, Patton J, Phanuphak N, Rachlin K, Reed T, Rider GN, Ristori J, Robbins-Cherry S, Roberts SA, Rodriguez-Wallberg KA, Rosenthal SM, Sabir K, Safer JD, Scheim AI, Seal LJ, Sehoole TJ, Spencer K, St Amand C, Steensma TD, Strang JF, Taylor GB, Tilleman K, T'Sjoen GG, Vala LN, Van Mello NM, Veale JF, Vencill JA, Vincent B, Wesp LM, West MA, Arcelus J. Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2022; 23:S1-S259. [PMID: 36238954 PMCID: PMC9553112 DOI: 10.1080/26895269.2022.2100644] [Citation(s) in RCA: 609] [Impact Index Per Article: 304.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8. Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment. Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings. Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health. Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for the treatment of people experiencing gender incongruence. As in all previous versions of the SOC, the criteria set forth in this document for gender-affirming medical interventions are clinical guidelines; individual health care professionals and programs may modify these in consultation with the TGD person.
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Affiliation(s)
- E Coleman
- Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - A E Radix
- Callen-Lorde Community Health Center, New York, NY, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - W P Bouman
- Nottingham Centre for Transgender Health, Nottingham, UK
- School of Medicine, University of Nottingham, Nottingham, UK
| | - G R Brown
- James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
- James H. Quillen VAMC, Johnson City, TN, USA
| | - A L C de Vries
- Department of Child and Adolescent Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M B Deutsch
- Department of Family & Community Medicine, University of California-San Francisco, San Francisco, CA, USA
- UCSF Gender Affirming Health Program, San Francisco, CA, USA
| | - R Ettner
- New Health Foundation Worldwide, Evanston, IL, USA
- Weiss Memorial Hospital, Chicago, IL, USA
| | - L Fraser
- Independent Practice, San Francisco, CA, USA
| | - M Goodman
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - J Green
- Independent Scholar, Vancouver, WA, USA
| | - A B Hancock
- The George Washington University, Washington, DC, USA
| | - T W Johnson
- Department of Anthropology, California State University, Chico, CA, USA
| | - D H Karasic
- University of California San Francisco, San Francisco, CA, USA
- Independent Practice at dankarasic.com
| | - G A Knudson
- University of British Columbia, Vancouver, Canada
- Vancouver Coastal Health, Vancouver, Canada
| | - S F Leibowitz
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - H F L Meyer-Bahlburg
- New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Columbia University, New York, NY, USA
| | | | - J Motmans
- Transgender Infopunt, Ghent University Hospital, Gent, Belgium
- Centre for Research on Culture and Gender, Ghent University, Gent, Belgium
| | - L Nahata
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
- Endocrinology and Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - T O Nieder
- University Medical Center Hamburg-Eppendorf, Interdisciplinary Transgender Health Care Center Hamburg, Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, Hamburg, Germany
| | - S L Reisner
- Harvard Medical School, Boston, MA, USA
- Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - C Richards
- Regents University London, UK
- Tavistock and Portman NHS Foundation Trust, London, UK
| | | | - V Tangpricha
- Division of Endocrinology, Metabolism & Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Atlanta VA Medical Center, Decatur, GA, USA
| | - A C Tishelman
- Boston College, Department of Psychology and Neuroscience, Chestnut Hill, MA, USA
| | - M A A Van Trotsenburg
- Bureau GenderPRO, Vienna, Austria
- University Hospital Lilienfeld-St. Pölten, St. Pölten, Austria
| | - S Winter
- School of Population Health, Curtin University, Perth, WA, Australia
| | - K Ducheny
- Howard Brown Health, Chicago, IL, USA
| | - N J Adams
- University of Toronto, Ontario Institute for Studies in Education, Toronto, Canada
- Transgender Professional Association for Transgender Health (TPATH)
| | - T M Adrián
- Asamblea Nacional de Venezuela, Caracas, Venezuela
- Diverlex Diversidad e Igualdad a Través de la Ley, Caracas, Venezuela
| | - L R Allen
- University of Nevada, Las Vegas, NV, USA
| | - D Azul
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - H Bagga
- Monash Health Gender Clinic, Melbourne, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
| | - K Başar
- Department of Psychiatry, Hacettepe University, Ankara, Turkey
| | - D S Bathory
- Independent Practice at Bathory International PLLC, Winston-Salem, NC, USA
| | - J J Belinky
- Durand Hospital, Guemes Clinic and Urological Center, Buenos Aires, Argentina
| | - D R Berg
- National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - J U Berli
- Oregon Health & Science University, Portland, OR, USA
| | - R O Bluebond-Langner
- NYU Langone Health, New York, NY, USA
- Hansjörg Wyss Department of Plastic Surgery, New York, NY, USA
| | - M-B Bouman
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Plastic Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - M L Bowers
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mills-Peninsula Medical Center, Burlingame, CA, USA
| | - P J Brassard
- GrS Montreal, Complexe CMC, Montreal, Quebec, Canada
- Université de Montreal, Quebec, Canada
| | - J Byrne
- University of Waikato/Te Whare Wānanga o Waikato, Hamilton/Kirikiriroa, New Zealand/Aotearoa
| | - L Capitán
- The Facialteam Group, Marbella International Hospital, Marbella, Spain
| | | | - J M Carswell
- Harvard Medical School, Boston, MA, USA
- Boston's Children's Hospital, Boston, MA, USA
| | - S C Chang
- Independent Practice, Oakland, CA, USA
| | - G Chelvakumar
- Nationwide Children's Hospital, Columbus, OH, USA
- The Ohio State University, College of Medicine, Columbus, OH, USA
| | - T Corneil
- School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada
| | - K B Dalke
- Penn State Health, PA, USA
- Penn State College of Medicine, Hershey, PA, USA
| | - G De Cuypere
- Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
| | - E de Vries
- Nelson Mandela University, Gqeberha, South Africa
- University of Cape Town, Cape Town, South Africa
| | - M Den Heijer
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Endocrinology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - A H Devor
- University of Victoria, Victoria, BC, Canada
| | - C Dhejne
- ANOVA, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - A D'Marco
- UCTRANS-United Caribbean Trans Network, Nassau, The Bahamas
- D M A R C O Organization, Nassau, The Bahamas
| | - E K Edmiston
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - L Edwards-Leeper
- Pacific University, Hillsboro, OR, USA
- Independent Practice, Beaverton, OR, USA
| | - R Ehrbar
- Whitman Walker Health, Washington, DC, USA
- Independent Practice, Maryland, USA
| | - D Ehrensaft
- University of California San Francisco, San Francisco, CA, USA
| | - J Eisfeld
- Transvisie, Utrecht, The Netherlands
| | - E Elaut
- Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
- Department of Clinical Experimental and Health Psychology, Ghent University, Gent, Belgium
| | - L Erickson-Schroth
- The Jed Foundation, New York, NY, USA
- Hetrick-Martin Institute, New York, NY, USA
| | - J L Feldman
- Institute for Sexual and Gender Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - A D Fisher
- Andrology, Women Endocrinology and Gender Incongruence, Careggi University Hospital, Florence, Italy
| | - M M Garcia
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Departments of Urology and Anatomy, University of California San Francisco, San Francisco, CA, USA
| | - L Gijs
- Institute of Family and Sexuality Studies, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | | | - B P Hall
- Duke University Medical Center, Durham, NC, USA
- Duke Adult Gender Medicine Clinic, Durham, NC, USA
| | - T L D Hardy
- Alberta Health Services, Edmonton, Alberta, Canada
- MacEwan University, Edmonton, Alberta, Canada
| | - M S Irwig
- Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - A C Janssen
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - K Johnson
- RMIT University, Melbourne, Australia
- University of Brighton, Brighton, UK
| | - D T Klink
- Department of Pediatrics, Division of Pediatric Endocrinology, Ghent University Hospital, Gent, Belgium
- Division of Pediatric Endocrinology and Diabetes, ZNA Queen Paola Children's Hospital, Antwerp, Belgium
| | - B P C Kreukels
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - L E Kuper
- Department of Psychiatry, Southwestern Medical Center, University of Texas, Dallas, TX, USA
- Department of Endocrinology, Children's Health, Dallas, TX, USA
| | - E J Kvach
- Denver Health, Denver, CO, USA
- University of Colorado School of Medicine, Aurora, CO, USA
| | - M A Malouf
- Malouf Counseling and Consulting, Baltimore, MD, USA
| | - R Massey
- WPATH Global Education Institute
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - T Mazur
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- John R. Oishei Children's Hospital, Buffalo, NY, USA
| | - C McLachlan
- Professional Association for Transgender Health, South Africa
- Gender DynamiX, Cape Town, South Africa
| | - S D Morrison
- Division of Plastic Surgery, Seattle Children's Hospital, Seattle, WA, USA
- Division of Plastic Surgery, Department of Surgery, University of Washington Medical Center, Seattle, WA, USA
| | - S W Mosser
- Gender Confirmation Center, San Francisco, CA, USA
- Saint Francis Memorial Hospital, San Francisco, CA, USA
| | - P M Neira
- Johns Hopkins Center for Transgender Health, Baltimore, MD, USA
- Johns Hopkins Medicine Office of Diversity, Inclusion and Health Equity, Baltimore, MD, USA
| | - U Nygren
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Speech and Language Pathology, Medical Unit, Karolinska University Hospital, Stockholm, Sweden
| | - J M Oates
- La Trobe University, Melbourne, Australia
- Melbourne Voice Analysis Centre, East Melbourne, Australia
| | - J Obedin-Maliver
- Stanford University School of Medicine, Department of Obstetrics and Gynecology, Palo Alto, CA, USA
- Department of Epidemiology and Population Health, Stanford, CA, USA
| | - G Pagkalos
- Independent PracticeThessaloniki, Greece
- Military Community Mental Health Center, 424 General Military Training Hospital, Thessaloniki, Greece
| | - J Patton
- Talkspace, New York, NY, USA
- CytiPsychological LLC, San Diego, CA, USA
| | - N Phanuphak
- Institute of HIV Research and Innovation, Bangkok, Thailand
| | - K Rachlin
- Independent Practice, New York, NY, USA
| | - T Reed
- Gender Identity Research and Education Society, Leatherhead, UK
| | - G N Rider
- National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - J Ristori
- Andrology, Women Endocrinology and Gender Incongruence, Careggi University Hospital, Florence, Italy
| | | | - S A Roberts
- Harvard Medical School, Boston, MA, USA
- Division of Endocrinology, Boston's Children's Hospital, Boston, MA, USA
| | - K A Rodriguez-Wallberg
- Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - S M Rosenthal
- Division of Pediatric Endocrinology, UCSF, San Francisco, CA, USA
- UCSF Child and Adolescent Gender Center
| | - K Sabir
- FtM Phoenix Group, Krasnodar Krai, Russia
| | - J D Safer
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mount Sinai Center for Transgender Medicine and Surgery, New York, NY, USA
| | - A I Scheim
- Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, Ontario, Canada
| | - L J Seal
- Tavistock and Portman NHS Foundation Trust, London, UK
- St George's University Hospitals NHS Foundation Trust, London, UK
| | | | - K Spencer
- National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - C St Amand
- University of Houston, Houston, TX, USA
- Mayo Clinic, Rochester, MN, USA
| | - T D Steensma
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - J F Strang
- Children's National Hospital, Washington, DC, USA
- George Washington University School of Medicine, Washington, DC, USA
| | - G B Taylor
- Atrium Health Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Charlotte, NC, USA
| | - K Tilleman
- Department for Reproductive Medicine, Ghent University Hospital, Gent, Belgium
| | - G G T'Sjoen
- Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
- Department of Endocrinology, Ghent University Hospital, Gent, Belgium
| | - L N Vala
- Independent Practice, Campbell, CA, USA
| | - N M Van Mello
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - J F Veale
- School of Psychology, University of Waikato/Te Whare Wānanga o Waikato, Hamilton/Kirikiriroa, New Zealand/Aotearoa
| | - J A Vencill
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - B Vincent
- Trans Learning Partnership at https://spectra-london.org.uk/trans-learning-partnership, UK
| | - L M Wesp
- College of Nursing, University of Wisconsin MilwaukeeMilwaukee, WI, USA
- Health Connections Inc., Glendale, WI, USA
| | - M A West
- North Memorial Health Hospital, Robbinsdale, MN, USA
- University of Minnesota, Minneapolis, MN, USA
| | - J Arcelus
- School of Medicine, University of Nottingham, Nottingham, UK
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
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Warner RL, Crandall M. Sex Disparities in Trauma Care-Why Are the Women Waiting? JAMA Surg 2022; 157:617. [PMID: 35583900 DOI: 10.1001/jamasurg.2022.1551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Rachel L Warner
- Division of Acute Care Surgery, Department of Surgery, University of Florida College of Medicine Jacksonville, Jacksonville
| | - Marie Crandall
- Division of Acute Care Surgery, Department of Surgery, University of Florida College of Medicine Jacksonville, Jacksonville
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Cooper RL, Ramesh A, Radix AE, Reuben JS, Juarez PD, Holder CL, Belton AS, Brown KY, Mena LA, Matthews-Juarez P. Affirming and Inclusive Care Training for Medical Students and Residents to Reducing Health Disparities Experienced by Sexual and Gender Minorities: A Systematic Review. Transgend Health 2022. [PMID: 37525832 PMCID: PMC10387161 DOI: 10.1089/trgh.2021.0148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Purpose Providing inclusive and comprehensive gender-affirming care is critical to reducing health disparities (gaps in care) experienced by sexual and gender minorities (SGM). Currently, little is known about how medical students and residents are being trained to address the health needs of SGM persons or of the most effective methods. Methods We conducted a systematic review of the research literature from 2000 to 2020 on the effectiveness of teaching medical students and residents on knowledge, attitudes, and skills in addressing the health of SGM persons and the strength of the research sample, design, and methods used. Results We identified a total of 36 articles that assessed the impact of medical student and resident education on knowledge, comfort, attitudes, confidence, and skills in working with SGM patients. All studies utilized quasi-experimental designs, and found efficacious results. No study examined the impact of training on patient outcomes. Conclusion Future studies will need to be powered and designed to assess the impact of training on patient outcomes.
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Affiliation(s)
- Robert Lyle Cooper
- Department of Family and Community Medicine, Cancer Biology, Neuroscience & Pharmacology, Meharry Medical College, Nashville, Tennessee, USA
| | - Aramandla Ramesh
- Department of Biochemistry, Cancer Biology, Neuroscience & Pharmacology, Meharry Medical College, Nashville, Tennessee, USA
- National Center for Medical Education Development and Research, Meharry Medical College, Nashville, Tennessee, USA
| | - Asa E. Radix
- Callen-Lorde Community Health Center in New York, New York, New York, USA
| | - Jayne S. Reuben
- Department of Biomedical Sciences, Texas Agricultural and Mechanical University College of Dentistry, Dallas, Texas, USA
| | - Paul D. Juarez
- Department of Family and Community Medicine, Cancer Biology, Neuroscience & Pharmacology, Meharry Medical College, Nashville, Tennessee, USA
- National Center for Medical Education Development and Research, Meharry Medical College, Nashville, Tennessee, USA
| | - Cheryl L. Holder
- Department of Family Medicine at Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Allyson S. Belton
- Satcher Health Leadership Institute at Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Katherine Y. Brown
- Department of Family and Community Medicine, Cancer Biology, Neuroscience & Pharmacology, Meharry Medical College, Nashville, Tennessee, USA
- National Center for Medical Education Development and Research, Meharry Medical College, Nashville, Tennessee, USA
| | - Leandro A. Mena
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Patricia Matthews-Juarez
- Department of Family and Community Medicine, Cancer Biology, Neuroscience & Pharmacology, Meharry Medical College, Nashville, Tennessee, USA
- National Center for Medical Education Development and Research, Meharry Medical College, Nashville, Tennessee, USA
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Schultz TR, Zoucha R, Sekula LK. The intersection between youth who identify as LGBTQ+ and emergency care for suicidality: an integrative review. J Pediatr Nurs 2022; 63:e82-e94. [PMID: 34756491 DOI: 10.1016/j.pedn.2021.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/22/2021] [Accepted: 10/13/2021] [Indexed: 10/20/2022]
Abstract
PROBLEM Suicide is a leading cause of death in children. Sexual minority youth are greater than three times more likely to attempt suicide than their cisgender heterosexual peers. ELIGIBILITY CRITERIA Empirical and theoretical literature were evaluated through the integrative review process using the Whittemore-Knafl integrative review model (2005). Studies were included when they addressed LGBTQ+ youth seeking emergency care for suicidality. SAMPLE The final sample included a mix of 13 qualitative, quantitative, and mixed methods studies published in peer-review journals between 2011 and 2020. These articles were located in journals found through a database search, including Medline EBSCO, Health Source/Nursing Academic Education, SportDiscus, ERIC EBSCO, Academic Search Elite, Social Services Abstracts, Sociological Abstracts, APA Psych Info, Embase, and CINAHL. RESULTS Thirteen studies included individuals 5 to 26 years of age; ten studies included individuals > 11 years old. The analysis and synthesis of coded and grouped data resulted in four themes: 1) affirmation/acceptance, 2) strength, 3) approach/intervention, and 4) safety/psychological distress. CONCLUSIONS Research study methods, design, setting, and quality varied. This integrative review has established that youth who identify as LGBTQ+ and are seeking emergency care for suicidality, value: acceptance, safety, strength, and approach/intervention. IMPLICATIONS There are strong implications for research, healthcare policy, and pediatric nursing practice. Future research is needed to explore the unique values, beliefs, and experiences of youth who identify as LGBTQ+ seeking emergency/crisis care for suicidality.
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Affiliation(s)
| | - Rick Zoucha
- Duquesne University, 600 Forbes Avenue, 527 Fisher Hall, Pittsburgh, PA 15202, USA
| | - L Kathleen Sekula
- Duquesne University, 600 Forbes Avenue, 527 Fisher Hall, Pittsburgh, PA 15202, USA
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Varcoe C, Browne AJ, Bungay V, Perrin N, Wilson E, Wathen CN, Byres D, Roberta Price E. Through An Equity Lens: Illuminating The Relationships Among Social Inequities, Stigma And Discrimination, And Patient Experiences of Emergency Health Care. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2022; 52:246-260. [PMID: 35098791 PMCID: PMC8894974 DOI: 10.1177/00207314221075515] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
People who experience the greatest social inequities often have poor experiences in emergency departments (EDs) so that they are deterred from seeking care, leave without care complete, receive inadequate care, and/or return repeatedly for unresolved problems. However, efforts to measure and monitor experiences of care rarely capture the experiences of people facing the greatest inequities, experiences of discrimination, or relationships among these variables. This analysis examined how patients' experiences, including self-reported ratings of care, experiences of discrimination, and repeat visits vary with social and economic circumstances. Every consecutive person presenting to three diverse EDs was invited if/when they were able to consent; 2424 provided demographic and contact information; and 1692 (70%) completed the survey. Latent class analysis (LCA) using sociodemographic variables: age, gender, financial strain, employment, housing stability, English as first language, born in Canada, and Indigenous identity, indicated a six-class solution. Classes differed significantly on having regular access to primary care, reasons for the visit, and acuity. Classes also differed on self-reported discrimination every day and during their ED visit, ratings of ED care, and number of ED visits within the past six months. ED care can be improved through attention to how intersecting forms of structural disadvantage and inequities affect patient experiences.
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Affiliation(s)
- Colleen Varcoe
- 120487University of British Columbia (UBC), Vancouver BC, Canada
| | - Annette J Browne
- 120487University of British Columbia (UBC), Vancouver BC, Canada
| | - Vicky Bungay
- 120487University of British Columbia (UBC), Vancouver BC, Canada
| | - Nancy Perrin
- 1466Johns Hopkins University, Baltimore, Maryland, USA
| | - Erin Wilson
- 6727University of Northern British Columbia (UNBC), Prince George, British Columbia, Canada
| | | | - David Byres
- Provincial Health Services Authority, Vancouver, British Columbia, Canada
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Sequeira GM, Boyer T, Coulter RWS, Miller E, Kahn NF, Ray KN. Healthcare Experiences of Gender Diverse Youth Across Clinical Settings. J Pediatr 2022; 240:251-255. [PMID: 34536494 PMCID: PMC8712353 DOI: 10.1016/j.jpeds.2021.08.089] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/25/2021] [Accepted: 08/31/2021] [Indexed: 01/03/2023]
Abstract
We explored gender diverse youth's experiences seeking and receiving gender-affirming care in various health system locations. Results provide evidence for system-, clinic-, and provider-level improvements to promote the development of affirming environments and to improve health outcomes for gender diverse youth.
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Affiliation(s)
- Gina M. Sequeira
- University of Washington, Seattle, Washington,Seattle Children’s Hospital, Seattle, Washington
| | - Taylor Boyer
- VA Pittsburgh Health System, Pittsburgh, Pennsylvania
| | - Robert W. S. Coulter
- University of Pittsburgh, Pittsburgh, Pennsylvania,UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Elizabeth Miller
- University of Pittsburgh, Pittsburgh, Pennsylvania,UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Kristin N. Ray
- University of Pittsburgh, Pittsburgh, Pennsylvania,UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
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Thompson-Blum DN, Coleman TA, Phillips NE, Richardson S, Travers R, Coulombe S, Wilson C, Woodford M, Cameron R, Davis C. Experiences of Transgender Participants in Emergency Departments: Findings from the OutLook Study. Transgend Health 2021; 6:358-368. [PMID: 34993307 PMCID: PMC8664106 DOI: 10.1089/trgh.2020.0112] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Even in cases of medical emergency, mistreatment and negative experiences in life or in medical settings can deter trans patients from seeking necessary care. The purpose of this study was to identify factors associated with trans persons' emergency department (ED) avoidance in the mixed urban-rural Region of Waterloo, Ontario, Canada. Methods: The OutLook Study was a community-based partnership that created an online, cross-sectional questionnaire for lesbian, gay, bisexual, transgender, and other sexual and gender minority community members. Participants in this analysis were 16 years of age or older, lived, worked, or attended school in Waterloo Region, and identified as trans (n=112). Binary logistic regression was used to test associations between sociodemographic, resilience, and risk variables, and ED avoidance. Sociodemographic variables statistically significant at p<0.05 at the bivariate level were included as controls to explore different combinations of resilience and risk factor in multivariable models. Results: Participants reporting complete or partially complete medical transitions were more likely to report ED avoidance, compared to those who had not initiated medical transition. Elevated transphobia was associated with greater likelihood of avoidance. However, increasing levels of social support decreased the likelihood of avoidance. In multivariable models, social support, support from a special person, and transphobia were always significant, regardless of controlled variables. Conclusion: Transphobia-enacted in the contexts of everyday life and health care-can deter patients from seeking care. Patient-centered care requires careful attention to trans identity and health needs, especially in emergency settings. In the absence of structural changes, providers can take steps to mitigate the erasure and discrimination trans patients experience and anticipate when accessing EDs.
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Affiliation(s)
| | - Todd A. Coleman
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Canada
| | | | - Sean Richardson
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Canada
| | - Robb Travers
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Canada
| | - Simon Coulombe
- Department of Psychology and Wilfrid Laurier University, Waterloo, Canada
| | - Ciann Wilson
- Department of Psychology and Wilfrid Laurier University, Waterloo, Canada
| | - Michael Woodford
- Faculty of Social Work, Wilfrid Laurier University, Kitchener, Canada
| | - Ruth Cameron
- Department of Psychology and Wilfrid Laurier University, Waterloo, Canada
| | - Charlie Davis
- Department of Psychology and Wilfrid Laurier University, Waterloo, Canada
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Kruse MI, Voloshin D, Wan M, Clarizio A, Bigham BL, Upadhye S. Care of Sexual and Gender Minorities in the Emergency Department: A Scoping Review. Ann Emerg Med 2021; 79:196-212. [PMID: 34785088 DOI: 10.1016/j.annemergmed.2021.09.422] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/03/2021] [Accepted: 09/10/2021] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE This scoping review was conducted to collate and summarize the published research literature addressing sexual and gender minority care in the emergency department (ED). METHODS Using PRISMA-ScR criteria, an electronic search was conducted of CINAHL, Embase, Ovid Medline, and Web of Science for all studies that were published after 1995 involving sexual and gender minorities, throughout all life stages, presenting to an ED. We excluded non-US and Canadian studies and editorials. Titles and abstracts were screened, and full-text review was performed independently with 4 reviewers. Abstraction focused on study design, demographics, and outcomes, and the resulting data were analyzed using an ad hoc iterative thematic analysis. RESULTS We found 972 unique articles and excluded 743 after title and abstract screening. The remaining 229 articles underwent full-text review, and 160 articles were included. Themes identified were HIV in sexual and gender minorities (n=61), population health (n=46), provider training (n=29), ED avoidance or barriers (n=23), ED use (n=21), and sexual orientation/gender identity information collection (n=9). CONCLUSION The current literature encompassing ED sexual and gender minority care cluster into 6 themes. There are considerable gaps to be addressed in optimizing culturally competent and equitable care in the ED for this population. Future research to address these gaps should include substantial patient stakeholder engagement in all aspects of the research process to ensure patient-focused outcomes congruent with sexual and gender minority values and preferences.
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Affiliation(s)
- Michael I Kruse
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada.
| | - Daniel Voloshin
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Melissa Wan
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada
| | - Alexandra Clarizio
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Blair L Bigham
- Division of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA
| | - Suneel Upadhye
- Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada
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40
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Du Mont J, Kosa SD, Abavi R, Kia H, Macdonald S. Toward Affirming Care: An Initial Evaluation of a Sexual Violence Treatment Network's Capacity for Addressing the Needs of Trans Sexual Assault Survivors. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP12436-NP12455. [PMID: 31789091 PMCID: PMC8581708 DOI: 10.1177/0886260519889943] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
There is a global call to action to improve transgender (trans) health to achieve health equity for people of all gender identities. Trans persons experience high rates of sexual assault and have historically had limited or no access to health care that meets their needs. As an initial step in addressing this, we evaluated a sexual assault treatment network's capacity for addressing the needs of trans sexual assault survivors. Working with an Advisory Group comprising trans community members and their allies who have expertise in trans health, a short online questionnaire was developed and distributed to the program leaders of Ontario's 35 hospital-based Sexual Assault/Domestic Violence Centres (SA/DVTCs). A total of 27 program leaders completed the questionnaire for a response rate of 77%. The majority of respondents reported that their program collaborates with trans-positive services within their community (70.4%). However, only two in five (40.7%) program leaders indicated that the patient bill of rights at their hospital included a statement pledging nondiscrimination on the basis of gender, gender identity, and/or gender expression. All (100%) program leaders felt that the nurses and physicians working within their programs would benefit from (further) training in the care of trans persons who have been sexually assaulted. This study represents an important step in a research program aimed at enhancing Ontario SA/DVTCs' response to trans persons.
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Affiliation(s)
- Janice Du Mont
- Women’s College Hospital, Toronto, Ontario, Canada
- University of Toronto, Ontario, Canada
| | - Sarah D. Kosa
- Ontario Network of Sexual Assault/Domestic Violence Treatment Centres, Toronto, Canada
| | | | - Hannah Kia
- Women’s College Hospital, Toronto, Ontario, Canada
| | - Sheila Macdonald
- Ontario Network of Sexual Assault/Domestic Violence Treatment Centres, Toronto, Canada
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Bauer GR, Pacaud D, Couch R, Metzger DL, Gale L, Gotovac S, Mokashi A, Feder S, Raiche J, Speechley KN, Temple Newhook J, Ghosh S, Sansfaçon AP, Susset F, Lawson ML. Transgender Youth Referred to Clinics for Gender-Affirming Medical Care in Canada. Pediatrics 2021; 148:peds.2020-047266. [PMID: 34620727 DOI: 10.1542/peds.2020-047266] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Referrals of transgender and gender-diverse (trans) youth to medical clinics for gender-affirming care have increased. We described characteristics of trans youth in Canada at first referral visit. METHODS Baseline clinical and survey data (2017-2019) were collected for Trans Youth CAN!, a 10-clinic prospective cohort of n = 174 pubertal and postpubertal youth <16 years with gender dysphoria, referred for hormonal suppression or hormone therapy, and 160 linked parent-participants. Measures assessed health, demographics, and visit outcome. RESULTS Of youth, 137 were transmasculine (assigned female) and 37 transfeminine (assigned male); 69.0% were aged 14 to 15, 18.8% Indigenous, 6.6% visible minorities, 25.7% from immigrant families, and 27.1% low income. Most (66.0%) were gender-aware before age 12. Only 58.1% of transfeminine youth lived in their gender full-time versus 90.1% of transmasculine (P < .001). Although transmasculine youth were more likely than transfeminine youth to report depressive symptoms (21.2% vs 10.8%; P = .03) and anxiety (66.1% vs 33.3%; P < .001), suicidality was similarly high overall (past-year ideation: 34.5%, attempts: 16.8%). All were in school; 62.0% reported strong parental gender support, with parents the most common support persons (91.9%). Two-thirds of families reported external gender-related stressors. Youth had met with a range of providers (68.5% with a family physician). At clinic visit, 62.4% were prescribed hormonal suppression or hormone therapy, most commonly depot leuprolide acetate. CONCLUSIONS Trans youth in Canada attending clinics for hormonal suppression or gender-affirming hormones were generally healthy but with depression, anxiety, and support needs.
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Affiliation(s)
- Greta R Bauer
- Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | | | - Robert Couch
- Division of Pediatric Endocrinology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Canada
| | - Daniel L Metzger
- Division of Endocrinology, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, Canada
| | | | - Sandra Gotovac
- Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Arati Mokashi
- Department of Pediatrics, Division of Endocrinology, Dalhousie University and IWK Health Centre, Halifax, Nova Scotia, Canada
| | | | - Joe Raiche
- Foothills Medical Centre, Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Kathy Nixon Speechley
- Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | | | - Shuvo Ghosh
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Canada
| | | | | | - Margaret L Lawson
- Endocrinology and Metabolism, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
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Berliant M, Odorizzi S, Leppard J. Out of the closet and into the waiting room: improving care of 2SLGBTQIA+ patients in the emergency department. CAN J EMERG MED 2021; 23:733-736. [PMID: 34709585 DOI: 10.1007/s43678-021-00202-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 09/22/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Maria Berliant
- Faculty of Medicine, Department of Emergency Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.
| | - Scott Odorizzi
- Faculty of Medicine, Department of Emergency Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Jennifer Leppard
- Faculty of Medicine, Department of Emergency Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
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Vigny-Pau M, Pang N, Alkhenaini H, Abramovich A. Suicidality and non-suicidal self-injury among transgender populations: A systematic review. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2021. [DOI: 10.1080/19359705.2021.1955195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Myriam Vigny-Pau
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Nelson Pang
- Institute of Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Hamad Alkhenaini
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Alex Abramovich
- Institute of Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Allison MK, Marshall SA, Stewart G, Joiner M, Nash C, Stewart MK. Experiences of Transgender and Gender Nonbinary Patients in the Emergency Department and Recommendations for Health Care Policy, Education, and Practice. J Emerg Med 2021; 61:396-405. [PMID: 34176685 PMCID: PMC8627922 DOI: 10.1016/j.jemermed.2021.04.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 03/25/2021] [Accepted: 04/26/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Transgender and gender nonbinary (trans/NB) individuals face many barriers to accessing health care in the United States due to systemic and clinician discrimination. Such experiences can lead to avoidance or delays in seeking care. These issues are relevant for emergency department (ED) clinicians and staff because trans/NB patients may use the ED in times of crisis. OBJECTIVES The purpose of this study was to qualitatively explore experiences of trans/NB individuals accessing health care in the ED and provide recommendations for improvements. METHODS This study involved semi-structured qualitative interviews with nine trans/NB individuals living in Arkansas about their experiences when visiting local EDs. RESULTS Interviews revealed four main themes: 1) system and structural issues; 2) interactions with clinicians/staff influence care received; 3) perceptions of clinician knowledge and education about trans/NB health; and 4) impact on future health and health care access. Participants recommended education for current and future ED clinicians and staff to improve knowledge of best practices for trans/NB health care. Recommendations were also made to improve ED policy for inclusive and affirming intake processes, intake forms, and electronic health record (EHR) documentation, including documentation and use of patients' chosen name and pronouns. CONCLUSION The negative experiences and discrimination reported by trans/NB patients in ED visits underscores the importance of improving ED clinician knowledge of gender-affirming care practices, ED intake policies and practices, and EHR documentation in EDs.
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Affiliation(s)
- M Kathryn Allison
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansa.
| | - S Alexandra Marshall
- Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Gray Stewart
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Melissa Joiner
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Creshelle Nash
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - M Kathryn Stewart
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Guethlein N, Grahlow M, Lewis CA, Bork S, Habel U, Derntl B. Healthcare for Trans*gender People in Germany: Gaps, Challenges, and Perspectives. Front Neurosci 2021; 15:718335. [PMID: 34557067 PMCID: PMC8452951 DOI: 10.3389/fnins.2021.718335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/11/2021] [Indexed: 11/13/2022] Open
Abstract
People whose gender does not correspond to the binary gender system, i.e., trans∗gender people, face two main problems when it comes to healthcare in Germany: (1) They often suffer from general psychiatric comorbidities as well as specific and significant mental distress due to gender dysphoria, and (2) the German healthcare system lacks sufficiently educated and clinically experienced medical personnel who are able to provide specialized healthcare. Aside from transition, it often is extremely difficult for trans∗gender people to get access to and be integrated into the medical system. Stigmatization and pathologization in treatment are widespread, as are long waiting times for specialized healthcare providers who are often only accessible to those trans∗gender people willing to travel long distances. Frequently, trans∗gender people face further difficulties and barriers after transition, as some healthcare professionals fail to provide suitable care (e.g., gynecological consultation for transmen). The ICD-11 German Modification (ICD-11-GM), which should be routinely used by 2022, implements a depathologization of trans∗gender people in the medical system. This paper compares the issues related to health and healthcare of trans∗gender people in Germany with those in other European countries. We review the care offered by specialized centers with regard to treatment of and support for trans∗gender people. We conclude with specific proposals that may contribute to establish an improved, up-to-date, gender-sensitive healthcare system.
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Affiliation(s)
- Nora Guethlein
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Melina Grahlow
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
- Graduate Training Centre of Neuroscience, University of Tübingen, Tübingen, Germany
| | - Carolin A. Lewis
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
- Emotion Neuroimaging Lab, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- International Max Planck Research School on Neuroscience of Communication: Function, Structure, and Plasticity, Leipzig, Germany
| | - Stephan Bork
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Ute Habel
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
- Institute of Neuroscience and Medicine, JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Jülich, Germany
| | - Birgit Derntl
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
- LEAD Graduate School and Research Network, University of Tübingen, Tübingen, Germany
- International Max Planck Research School for Cognitive and Systems Neuroscience, University of Tübingen, Tübingen, Germany
- TübingenNeuroCampus, University of Tübingen, Tübingen, Germany
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Squires LR, Bilash T, Kamen CS, Garland SN. Psychosocial Needs and Experiences of Transgender and Gender Diverse People with Cancer: A Scoping Review and Recommendations for Improved Research and Care. LGBT Health 2021; 9:8-17. [PMID: 34495755 DOI: 10.1089/lgbt.2021.0072] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The psychosocial needs and experiences of transgender and gender diverse (TGD) people is an understudied area of oncology research. In response to calls to action from past researchers, we conducted a scoping review, which included published and gray literature. From the included articles, the following key themes were identified: (1) lack of coordination between gender-affirming care and cancer care; (2) impact of cancer care on gender affirmation; (3) navigating gendered assumptions; (4) variation in providers' understanding of the needs of TGD patients; and (5) lack of TGD-specific cancer resources. Following this review, we consulted 18 key stakeholders with TGD-relevant personal and/or professional experience to gain further insight into issues that were not encompassed by the original themes. Based on these themes and stakeholder feedback, we offer recommendations for future research and clinical practice to increase awareness of the psychosocial needs of TGD people who have been diagnosed with cancer and to improve patient care.
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Affiliation(s)
- Lauren R Squires
- Department of Psychology, Faculty of Science, Memorial University, St. John's, Newfoundland, Canada
| | | | - Charles S Kamen
- Cancer Control Unit, Department of Surgery, University of Rochester, Rochester, New York, USA
| | - Sheila N Garland
- Department of Psychology, Faculty of Science, Memorial University, St. John's, Newfoundland, Canada.,Discipline of Oncology, Faculty of Medicine, Memorial University, St. John's, Newfoundland, Canada
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Trans-affirming care: An integrative review and concept analysis. Int J Nurs Stud 2021; 123:104047. [PMID: 34454333 DOI: 10.1016/j.ijnurstu.2021.104047] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 05/23/2021] [Accepted: 07/17/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Contemporary healthcare exists within a cisnormative landscape which underpins the erasure of trans persons in healthcare, health research, and health education, and results in negative experiences and poorer outcomes. Further, nurses report feeling inadequately prepared to provide affirming care to trans patients, with little guidance available to inform their practice. OBJECTIVE To explore the conceptual understanding of trans-affirming care as it pertains to nursing, and to provide recommendations for trans-affirming nursing care at the systemic, organizational, and individual level. METHODS A systematic search of the literature was completed using standard review processes. Two reviewers independently applied a two-step study selection procedure to identify eligible citations. Walker and Avant's concept analysis method was used to analyze the extracted data to determine antecedents, defining attributes, empirical referents, and consequences. RESULTS Of the 5914 studies, 136 met criteria, representing a variety of clinical settings. The antecedents identified were depathologization of gender variance and cultural humility. The defining attributes were patient-led care, trans-affirming culture, and trans-competent providers. The consequences were improved psychological and physical health outcomes. CONCLUSIONS Trans persons and communities are becoming more visible in society, as are their testimonials about their substandard treatment within healthcare systems. Nurses need to respond to these health inequities with self-reflection, advocacy, and education. At the center of this work is the concept of trans-affirming care, which is a philosophy of care specific to trans persons. Tweetable abstract: This article offers an evidence-informed definition of trans-affirming care and recommendations for how it can be operationalized by nurses.
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Lien K, Vujcic B, Ng V. Attitudes, behaviour, and comfort of Canadian emergency medicine residents and physicians in caring for 2SLGBTQI+ patients. CAN J EMERG MED 2021; 23:617-625. [PMID: 34363194 DOI: 10.1007/s43678-021-00160-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/05/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Physicians working in the emergency department (ED) will interact with two-spirited, lesbian, gay, bisexual, transgender, queer/questioning and intersex (2SLGBTQI+) persons as colleagues and patients. These patients have unique healthcare needs and encounter negative experiences when seeking medical care, leading to poorer health outcomes and inequities. This study aims to explore the attitudes, behaviour, and comfort of Canadian emergency medicine (EM) physicians in caring for 2SLGBTQI+ patients. METHODS An anonymous survey was distributed to EM staff physicians and residents through the Canadian Association of Emergency Physicians (CAEP) network and social media channels. Demographic information was collected, and participants were asked about their comfort, current knowledge, and desire to gain new knowledge in caring for 2SLGBTQI+ patients. Personal perceptions and practice patterns in treating cisgender heterosexual (cis-het) and 2SLGBTQI+ patients were analysed using five-point Likert scales. Residents were asked additional questions regarding availability of learning experiences during training. RESULTS 266 surveys were included in the final analysis consisting of 229 (86%) staff physicians and 37 (14%) residents. 97% (n = 258) of all respondents believed 2SLGBTQI+ patients deserve the same quality care from medical institutions as other patients. Further, 83% (n = 221) respondents agreed that they would like to increase their knowledge in taking care of 2SLGBTQI+ patients, while 34% (n = 91) agreed that performing physical examinations on transgender or intersex patients was more challenging than on cis-het patients. Among resident respondents, 46% indicated a lack of didactic teaching devoted to 2SLGBTQI+ care during residency (n = 17/37), while 38% encountered discrimination towards 2SLGBTQI+ patients, with most comments from senior faculty and nursing staff. CONCLUSIONS This study suggests that Canadian EM physicians feel that 2SLGBTQI+ patients deserve equitable care when compared to cis-het patients. Future work should focus on educational needs and curricular enhancements in residency programs and continuing professional development for physicians to improve care for 2SLGBTQI+ patients in the ED.
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Affiliation(s)
- Kelly Lien
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
- Division of Emergency Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
| | - Branka Vujcic
- Division of Emergency Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Victor Ng
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Division of Emergency Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- The College of Family Physicians of Canada, Toronto, ON, Canada
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Burton WN, Schultz AB, Quinn C. Demographics, Preventive Services Compliance, Health, and Healthcare Experiences of Lesbian, Gay, and Bisexual Employed Adults. J Occup Environ Med 2021; 63:696-705. [PMID: 34397661 DOI: 10.1097/jom.0000000000002231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study examined demographics, health risks and conditions, preventive services, and health care experiences of lesbian, gay, bisexual, transgender, or questioning (LGBTQ) adults who are employed in the United States. METHODS Male and female gay, lesbian, or bisexual employees (N = 1191) from seven companies participated in an online survey. RESULTS Differences were observed in the characteristics of gays, lesbians, and bisexuals on a number of demographic, health, and preventive services measures. Differences were also seen compared to previous studies about LGBTQ adults in the general population. CONCLUSIONS Employers have a vested interest in making sure their employees have access to quality health care that addresses their unique needs. There is much room for improvement in this area, since a large percentage of respondents reported negative health care experiences, avoiding or postponing care, and difficulty finding an LGBTQ-experienced healthcare provider.
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Affiliation(s)
- Wayne N Burton
- Department of Environmental and Occupational Sciences, University of Illinois at Chicago, 715 Mckinley Lane, Hinsdale, Chicago, Illinois 60521 (Dr Burton); Global Health Management Research Core, NCRC, 1600 Huron Parkway, Building 520, 2nd Floor, Ann Arbor, Michigan 48109 (Dr Schultz); Included Health, 22 W 15th St, New York, New York 10011 (Quinn)
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Davis CE, Johnson CW, Flanagan A, Silk W. “We’re all in an abusive relationship with the health-care system”: Collective memories of transgender health care. THE CANADIAN JOURNAL OF HUMAN SEXUALITY 2021. [DOI: 10.3138/cjhs.2021-0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Collective memory work allows participants to recall, examine, and analyze their memories and experiences within a broader cultural context to see how their individual experiences link to collective, shared experiences of similar and/or different groups. This study utilized collective memory work to engage six trans participants in an examination of their individual experiences with health care. During a four-hour focus group, participants engaged in this process of discourse analysis and came to collective agreements about the meaning of their stories, the intentions of the author, and the intentions of others in their shared lived experience. In this paper, we will provide a thorough and rich description of the participants’ memories and their collective analysis, which highlights the interconnection between perceptions of oneself and their experiences with the health-care system. Our analysis revealed participants felt they had a toxic relationship with the health-care system. In particular, they discussed how health-care professionals left trans people tremulously asking for services, uncertain if they would receive care, what the quality of the care would be, and whether they would be treated respectfully. When discussing positive health-care experiences, participants highlighted when fears and anxieties were not realized, but all instances reflected some inappropriate actions. The results from this study will contribute to research on trans health care by providing a nuanced understanding of how health-care experiences impact trans communities collectively, as well as the ways in which health practices can be improved.
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Affiliation(s)
- Charlie E. Davis
- Wilfred Laurier University – Psychology, Waterloo, Ontario, Canada
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