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Sperling D. Needs, Experiences, and Hopes for Aging Futures among Older Adults in the LGBTQ Communities: A Qualitative Study in Israel. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:3139-3150. [PMID: 39009741 PMCID: PMC11335906 DOI: 10.1007/s10508-024-02938-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 06/07/2024] [Accepted: 06/09/2024] [Indexed: 07/17/2024]
Abstract
Older lesbian, gay, bisexual, trans, and queer (LGBTQ) individuals tend to live alone, mostly without children and with scarce support from nuclear family members or biological kin. Moreover, traditional resources may not suit their specific end-of-life care needs. While studies have examined these topics in general, they lack focus on end-of-life needs, care, and planning in Israel. Moreover, research on this topic among members of LGBTQ communities is specifically lacking. This study, therefore, aimed at identifying and understanding the attitudes, perceptions, and meanings of older LGBTQ individuals in Israel regarding their needs and challenges, as they age and near end of life. The phenomenological qualitative research methodology was applied, following the interpretive approach. Twenty-one middle-aged and older LGBTQ individuals in Israel, aged ≥ 55, participated in the study. In-depth semi-structured interviews, conducted from November 2020 to April 2021, were audio-recorded, transcribed, and de-identified. Five themes emerged from the interviews: (1) Experiences of loneliness, marginalization, and trauma, and coping through liberation; (2) ageism and exclusion of older adults; (3) elastic and challenging relationships; (4) end of life as reverting into the closet and heteronormativity; and (5) death as a source of generativity and creativity. The study demonstrates that loneliness is an existential experience, exacerbated by the intersectionality of LGBTQ communities. In turn, chosen family members play a minimal role in the end-of-life care of their loved ones. While conveying ambivalence toward social services and housing for the aging, participants in this study expressed fear of being discriminated against and having to re-enter the closet as they age. Ageism and end of life do not represent finality and extinction, yet instead, signify hope and revival. Following Sandberg and Marshall's (2017) concept of queering aging futures, this study refines our understanding of life courses, demonstrating that living and thriving in old age could be positive and desirable. As such, ageism and end of life do not necessarily represent finality and extinction, and may instead signify hope and revival. The unique challenges associated with family and social support of older adults who are LGBTQ members, and their implications on care, deserve further research and are important for practice.
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Affiliation(s)
- Daniel Sperling
- The Cheryl Spencer Department of Nursing, University of Haifa, 199 Aba Khoushy Ave., Mount Carmel, 3498838, Haifa, Israel.
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Goetz TG, Wolk CB. A formative evaluation to inform integration of psychiatric care with other gender-affirming care. BMC PRIMARY CARE 2024; 25:239. [PMID: 38965459 PMCID: PMC11225323 DOI: 10.1186/s12875-024-02472-8] [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: 11/27/2023] [Accepted: 06/10/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Transgender, non-binary, and/or gender expansive (TNG) individuals experience disproportionately high rates of mental illness and unique barriers to accessing psychiatric care. Integrating TNG-specific psychiatric care with other physical health services may improve engagement, but little published literature describes patient and clinician perspectives on such models of care. Here we present a formative evaluation aiming to inform future projects integrating psychiatric care with physical health care for TNG individuals. METHODS In this qualitative pre-implementation study, semi-structured interview guides were developed informed by the Consolidated Framework for Implementation Research to ensure uniform inclusion and sequencing of topics and allow for valid comparison across interviews. We elicited TNG patient (n = 11) and gender-affirming care clinician (n = 10) needs and preferences regarding integrating psychiatric care with other gender-affirming clinical services. We conducted a rapid analysis procedure, yielding a descriptive analysis for each participant group, identifying challenges of and opportunities in offering integrated gender-affirming psychiatric care. RESULTS Participants unanimously preferred integrating psychiatry within primary care instead of siloed service models. All participants preferred that patients have access to direct psychiatry appointments (rather than psychiatrist consultation with care team only) and all gender-affirming care clinicians wanted increased access to psychiatric consultations. The need for flexible, tailored care was emphasized. Facilitators identified included taking insurance, telehealth, clinician TNG-competence, and protecting time for clinicians to collaborate and obtain consultation. CONCLUSIONS This health equity pre-implementation project engaged TNG patients and gender-affirming care clinicians to inform future research exploring integration of mental health care with primary care for the TNG community and suggests utility of such a model of care.
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Affiliation(s)
- Teddy G Goetz
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA, 19104, USA.
| | - Courtney Benjamin Wolk
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA, 19104, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
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Abstract
BACKGROUND Sexual and gender minorities constitute a rapidly growing part of the older adult population in the United States and may face quality of life (QOL) challenges in older adulthood. Research on quality of life among lesbian, gay, bisexual, transgender, and queer (LGBTQ) older adults has increased dramatically since 2010. Common findings indicate that LGBTQ older adults face challenges related to personal experiences of discrimination, anticipated discrimination in health care settings, and lack of family support. Research designs were primarily nonprobability surveys, with a small number of qualitative designs and surveys using representative probability samples. AIM To identify and summarize research on QOL among LGBTQ older adults conducted in the United States between January 1, 2000 and December 31, 2020. METHOD Four scholarly databases were searched to identify studies addressing QOL in LGBTQ older adult populations. RESULTS The database search produced a total 568 unique results. Of these, 54 research articles were identified that met all inclusion criteria for the review. Appraisal of evidence was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. CONCLUSIONS Care for mental health of LGBTQ older adults should be sensitive to issues including lifetime history of discrimination, anxiety about anticipated discrimination from health care providers, and potential lack of family support. Focus can also be given to common areas of strength, including strengthening nonfamily social networks.
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Affiliation(s)
- Russell Preston
- Russell Preston, MS, RN, University of Rochester School of Nursing, Rochester, NY, USA
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Barringer MN, Savage B. Growing Old in the Bible Belt: Resources for Aging LGBT Adults Living in the South. JOURNAL OF HOMOSEXUALITY 2023; 70:2689-2713. [PMID: 35616426 DOI: 10.1080/00918369.2022.2074333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
There has been an increase in the literature about LGBT older adults in recent years; however, there is a need for further sociological quantitative research examining the impact of geographic region on LGBT aging. Utilizing data from a nationwide survey, this study focuses on the availability of LGBT-specific resources for LGBT aging adults living in the South. We examine the effects of community type and sociodemographics on the availability of LGBT-specific resources as well as the type of resources available. Findings reveal that in the South, community type, having a partner, household income, and education affect the LGBT-specific resources available. Of particular interest, LGBT-affirming faith organizations are identified as the resource most frequently available for LGBT aging adults in this region often referred to as the Bible Belt. Overall, this study sheds light on the LGBT-specific resources that are available to provide social support and help meet the unique needs of LGBT adults aging in the South.
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Affiliation(s)
- M N Barringer
- Department of Sociology, Anthropology, and Social Work, University of North Florida, Jacksonville, Florida, USA
| | - B Savage
- Department of History and Social Sciences, Louisiana Tech University, Ruston, Louisiana, USA
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Cook JM, Cations M, Simiola V, Ellis AE, Bellamy C, Martino S. Comparisons Between Young, Middle-Aged, and Older Adult Sexual and Gender Minority Male Sexual Assault Survivors. Am J Geriatr Psychiatry 2023; 31:833-843. [PMID: 37217371 DOI: 10.1016/j.jagp.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVE This study compared sexual abuse histories and depressive symptoms between younger, middle-aged, and older sexual and gender minority (SGM) male survivors. DESIGN Participants completed a brief, online screener as part of a large comparative effectiveness psychotherapy trial. SETTING SGM males 18 years or older, residing in the U.S. or Canada, were recruited online. PARTICIPANTS This study included younger (aged 18-39; n = 1,435), middle-aged (aged 40-59; n = 546), and older (aged 60+; n = 40) SGM men who reported a history of sexual abuse/assault. MEASUREMENTS Participants were asked about their sexual abuse history, experience of other traumas, symptoms of depression, and past 60-day mental health treatment engagement. RESULTS Older SGM men reported a lower rate of occurrence of adult sexual assault, exposure to other traumas, and depression. However, older and younger groups did not differ on any childhood sexual assault variable, the frequency of or number of attackers for adult sexual assault, the frequency of accidents and other injury traumas, or the occurrence or frequency of mental health treatment. Trauma load, including childhood and adult sexual assault, were more strongly related to current depressive symptoms than age group. CONCLUSION While there were some age-based or cohort differences in the rates of sexual trauma, the clinical response of both groups was similar. Implications for working clinically with middle-aged and older SGM men with untreated sexual assault-related mental health difficulties are discussed, including outreach and availability of gender- and older-inclusive survivor treatment and resources.
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Affiliation(s)
- Joan M Cook
- Department of Psychiatry (JMC, CB, SM), Yale School of Medicine, New Haven, CT.
| | - Monica Cations
- College of Education (MC), Psychology and Social Work, Flinders University, Adelaide SA, Australia
| | - Vanessa Simiola
- Kaiser Permanente (VS), Center for Integrated Health Care Research, Honolulu, HI
| | - Amy E Ellis
- Nova Southeastern University (AEE), Trauma Resolution & Integration Program, Fort Lauderdale, FL
| | - Chyrell Bellamy
- Department of Psychiatry (JMC, CB, SM), Yale School of Medicine, New Haven, CT
| | - Steve Martino
- Department of Psychiatry (JMC, CB, SM), Yale School of Medicine, New Haven, CT; VA Connecticut Healthcare System, Psychology Service (SM), West Haven, CT
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Yu B, Feng C, Yang X, Wang Z, Zou H, Jia P, Yang S. Roles of Social Capital in the Association Between Internalized Homophobia and Condomless Sex Among Men Who Have Sex With Men in Southwest China: A Four-Way Decomposition. Int J Public Health 2023; 68:1605202. [PMID: 36743343 PMCID: PMC9894890 DOI: 10.3389/ijph.2023.1605202] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 01/10/2023] [Indexed: 01/21/2023] Open
Abstract
Objectives: This study examined whether social capital (SC) mediated the association between internalized homophobia (IH) and condomless sex among men who have sex with men (MSM), with the interaction of SC and IH considered. Methods: A cross-sectional study was conducted between November 2018 and April 2019 in Sichuan Province, China. A total of 540 participants were recruited to investigate their IH, SC, and condomless sex. A four-way decomposition of causal mediation analysis was used to test SC's roles in the association between IH and condomless sex. Results: Condomless sex was prevalent (46.7%) among the participants, which was significantly associated with IH [odds ratio (OR) = 1.70] and SC (OR = 0.55). A direct effect [excess risk ratio (RR = 0.32)] and an indirect effect (excess RR = 0.16) of SC were found to be significant in the association between IH and condomless sex. Heterogeneities in effects were observed when taking the SC's domains (e.g., individual and family-based SC) as mediators. SC's effects were significant only in the homosexual subgroup. Conclusion: IH-based intervention with consideration of SC can be tailored to MSM to decrease condomless sex and curb the spread of HIV, especially for the homosexual subgroup.
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Affiliation(s)
- Bin Yu
- Institute for Disaster Management and Reconstruction, Sichuan University-The Hong Kong Polytechnic University, Chengdu, China,West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China,Sichuan Research Center of Sexual Sociology and Sex Education, Chengdu, China
| | - Chuanteng Feng
- Institute for Disaster Management and Reconstruction, Sichuan University-The Hong Kong Polytechnic University, Chengdu, China,West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Xue Yang
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Zixin Wang
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Peng Jia
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, China,International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China
| | - Shujuan Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China,International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China,Department of Health Management Center, Clinical Medical College and Affiliated Hospital, Chengdu University, Chengdu, China,*Correspondence: Shujuan Yang,
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Abrams LM, Look K, Imhoff L. The importance of providing gender-affirming care in pharmacy practice. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 6:100135. [PMID: 35909713 PMCID: PMC9335925 DOI: 10.1016/j.rcsop.2022.100135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/07/2022] [Accepted: 04/07/2022] [Indexed: 12/05/2022] Open
Abstract
Transgender and gender diverse (TGD) individuals face bias and discrimination across many health care settings including pharmacy. While there is evidence of successful interventions to increase provider awareness of the needs of TGD individuals in medicine, nursing, and social work, little work has been done by the pharmacy profession to recognize and meet the needs of this population. This commentary examines the gaps in pharmacy practice and pharmacy research with regards to the needs of TGD individuals and looks at allied health fields for potential solutions that can be adapted by the pharmacy profession. We first examine the social pressures that TGD individuals face in multiple social contexts and describe how bias and discrimination spill over into their interactions with providers and health care systems. Solutions for improving pharmacy practice research's ability to identify TGD individuals and their needs follows as a measure that will lead to solutions for improving pharmacy practice. A discussion of TGD individuals' responses to actual and perceived discrimination by pharmacists is discussed next, and why their avoidance of pharmacy care can be problematic to their health. The remainder of the paper focuses on how pharmacy education can train future pharmacists to provide inclusive care to TGD individuals, and how interprofessional education and continuing education can enhance future and practicing pharmacists' ability to provide high quality care to TGD individuals.
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Affiliation(s)
| | - Kevin Look
- University of Wisconsin-Madison, United States of America
| | - Lisa Imhoff
- University of Wisconsin-Madison, United States of America
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Benoit ID, Kordrostami E, Foreman J. Senior sexual and gender minorities’ perception of healthcare services: A phenomenological approach. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2021. [DOI: 10.1080/20479700.2020.1724437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Ilgım Dara Benoit
- Department of Marketing and Supply Chain Management, Walker College of Business, Appalachian State University, Boone, NC, USA
| | - Elika Kordrostami
- Marketing and Business Information System, Rowan University, Glassboro, NJ, USA
| | - Jeff Foreman
- Department of Marketing and Supply Chain Management, Walker College of Business, Appalachian State University, Boone, NC, USA
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Loeb AJ, Wardell D, Johnson CM. Coping and healthcare utilization in LGBTQ older adults: A systematic review. Geriatr Nurs 2021; 42:833-842. [PMID: 34090228 DOI: 10.1016/j.gerinurse.2021.04.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/17/2021] [Accepted: 04/20/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE This systematic review was conducted to identify, synthesize, and elucidate the coping mechanisms described by aging lesbian, gay, bisexual, transgender, and queer (LGBTQ) adults (60+) when utilizing healthcare. METHODS A comprehensive literature search was conducted in Embase and Ovid databases to identify studies of aging LGBTQ adults using coping mechanisms during healthcare utilization. Qualitative and quantitative studies published in English between 1969 and 2020 were included and assessed with COREQ, STROBE Statement, and CASP instruments. RESULTS Of 227 articles identified, six were included in the review. The final synthesis revealed that coping mechanisms were associated with social support, social network size, provider competency, and disclosure management. Frequency of appointments varied when seeking healthcare, and one study indicated delay in treatment. CONCLUSION This systematic review highlights various coping mechanisms associated with healthcare utilization and supports the need to develop research uniquely focused on aging LGBTQ adults.
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Affiliation(s)
- Aaron J Loeb
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, 6901 Bertner Ave., Houston, TX 77030, United States.
| | - Diane Wardell
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, 6901 Bertner Ave., Houston, TX 77030, United States
| | - Constance M Johnson
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, 6901 Bertner Ave., Houston, TX 77030, United States
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Lim G, Waling A, Lyons A, Pepping CA, Brooks A, Bourne A. The experiences of lesbian, gay and bisexual people accessing mental health crisis support helplines in Australia. PSYCHOLOGY & SEXUALITY 2021. [DOI: 10.1080/19419899.2021.1904274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Gene Lim
- Australian Research Centre in Sex, Health & Society, La Trobe University, Melbourne, Australia
- School of Social Sciences, Monash University, Melbourne, Australia
| | - Andrea Waling
- Australian Research Centre in Sex, Health & Society, La Trobe University, Melbourne, Australia
| | - Anthony Lyons
- Australian Research Centre in Sex, Health & Society, La Trobe University, Melbourne, Australia
| | | | - Anna Brooks
- Lifeline Research Foundation, Canberra, Australia
| | - Adam Bourne
- Australian Research Centre in Sex, Health & Society, La Trobe University, Melbourne, Australia
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Gamble RM, Taylor SS, Huggins AD, Ehrenfeld JM. Trans-specific Geriatric Health Assessment (TGHA): An inclusive clinical guideline for the geriatric transgender patient in a primary care setting. Maturitas 2019; 132:70-75. [PMID: 31883667 DOI: 10.1016/j.maturitas.2019.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 12/05/2019] [Indexed: 01/07/2023]
Abstract
There is a growing concern in the field of geriatric medicine that transgender health is often overlooked and under-reported. Not only does this impact the health and safety of the aging transgender community, but it also often influences the ability of physicians to provide high-quality evidence-based care. This article reviews the current knowledge base for geriatric transgender health and aims to organize evidence-based clinical recommendations for the primary care provider. Our proposed guideline, the Trans-specific Geriatric Health Assessment (TGHA), highlights areas of current clinical practice that do not address the geriatric transgender experience and modifies them to include trans-specific clinical recommendations found in the literature. The TGHA emphasizes topics such as cognitive function, vision and hearing, gait and stability, nutrition, sleep, functional/social status, urogenital health, psychiatric health, hormone replacement therapy, cancer screening, disease prevention and advanced care planning. Our review also addresses the limitations of certain clinical topics and where there is significant need for supportive research.
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Affiliation(s)
- Reid M Gamble
- Program for LGBTQ Health, Vanderbilt University Medical Center, Nashville, TN, USA; College of Osteopathic Medicine, Kansas City University of Medicine and Biosciences, Kansas City, USA
| | - Shayne S Taylor
- Program for LGBTQ Health, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Adam D Huggins
- Program for LGBTQ Health, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jesse M Ehrenfeld
- Program for LGBTQ Health, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA; Senior Associate Dean, Medical College of Wisconsin, USA.
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