Competent Health Care Research Articles

Psychological Well-Being in Asian and Asian American University Students: Impacts of Discrimination During the COVID-19 Pandemic

PurposeThe aim of this study is to determine what modifiable behavioral and sociological factors were predictive of psychological distress and suicide risk in Asian and Asian American students, the ethnic group with the highest unmet mental health need in collegiate populations. We also compared these relationships in Fall 2019 to Fall 2020 to better understand how the impact of these factors changed during the COVID-19 pandemic and concurrent increase in Anti-Asian discrimination. MethodsWe used factor analysis to extract a wide range of predictor variables from the Fall 2019 and Fall 2020 American College Health Association's National College Health Assessment III. Next, we used structural equation modeling to identify significant drivers of psychological distress (Kessler-6 scale) and suicidality (Suicide Behavior Questionnaire-Revised scale) in Asian and Asian American students (n = 4,681 in 2019 and 1,672 in 2020). ResultsWhen compared to 2019, experiencing discrimination in 2020 had a substantially larger effect on both psychological distress and suicidality among Asian and Asian American university students. Loneliness and depression were also significant drivers of negative mental health outcomes both years, and their effect magnitudes remained largely unchanged. Being well rested had a protective effect against psychological distress both years. DiscussionDuring the COVID-19 pandemic, discrimination was an important driver of psychological distress and suicidality in Asian and Asian American students. These findings suggest that organizations should enhance culturally competent mental healthcare services, while also working at the systems level to reduce bias and discrimination.

Research Priorities to Support Women Veterans' Reproductive Health and Health Care Within a Learning Health Care System.

Research Priorities to Support Women Veterans' Reproductive Health and Health Care Within a Learning Health Care System.

Posttraumatic Stress Disorder and Breastfeeding Migrant Mothers: A Scoping Review

Introduction:Breastfeeding is highly recommended to promote the physical and mental health of mothers and infants. Unfortunately, migrant mothers face many barriers to their breastfeeding practice and often suffer from posttraumatic stress disorder (PTSD) due to traumatic events during migration and their settlement in the host country. There is a lack of research on the interrelationship of breastfeeding, PTSD, and the migrant status of mothers. This review presents existing research in the field and provides recommendations to improve the breastfeeding practices of migrant women with PTSD.Methods:This scoping review was undertaken in consultation with the patient partners. After searching various databases, 116 articles were found. We reviewed and analyzed five articles that were relevant to migrant mothers, breastfeeding, and PTSD.Findings:Migrant mothers with PTSD face additional breastfeeding barriers in the host countries due to lack of support, pressure to assimilate, racial stigma, inequalities surrounding breastfeeding, lack of culturally sensitive care, language barrier, misinformation, the norm of formula feeding, and stress. Some recommendations include psychosocial interventions, creating private areas to breastfeed in public, reducing pressure for new mothers to return to work, training healthcare workers to be culturally competent, addressing societal stigma, educating migrant mothers on breastfeeding, and offering social support. Also, healthcare workers should take a warm approach, conduct safety assessments, educate themselves on PTSD, notice nonverbal cues, and employ multidisciplinary professionals and interpreters.Conclusions:While research shows that culturally competent healthcare workers, support, and education can aid with PTSD and breastfeeding, future research is needed surrounding the interconnectedness of PTSD, breastfeeding, and migrant mothers. Research on this unique population will allow for better support. Future research should employ patient partners in the development of novel interventions for breastfeeding migrant mothers with PTSD.

Preparedness of final year medical students in caring for lesbian, gay, bisexual, and transgender patients with mental illness.

Lesbian, gay, bisexual, and transgender (LGBT) individuals have a higher prevalence of mental illness compared to the general population. Discriminatory behaviour from mental health care providers impedes access to culturally competent mental health care. Undergraduate psychiatry education plays an important role in adequately preparing medical doctors to care for mental illness in LGBT patients. This study aims to assess the knowledge, attitudes and clinical preparedness of final-year medical students in caring for LGBT patients after completion of their psychiatry rotation. Faculty of health sciences at a large public university in Gauteng. This was a cross-sectional study using an anonymous self-administered questionnaire. The questionnaire comprised demographic data, the lesbian, gay, bisexual, and transgender development of clinical skills scale (LGBT-DOCSS) and questions relating to their subjective knowledge and preparedness in LGBT mental health care. The LGBT-DOCSS is a validated tool consisting of three subscales: basic knowledge, attitudinal awareness, and clinical preparedness. Data from 170 final-year students were used in the analyses. Participants scored within the low range for clinical preparedness and basic knowledge subscales but high in the attitudinal subscale. Gender, sexual orientation and academic background were associated with higher overall scores and higher basic knowledge and attitudinal awareness scores. Final-year medical students were not adequately prepared in caring for LGBT patients with mental illness as indicated by the LGBT-DOCSS. This study identifies a gap in undergraduate psychiatric training in providing culturally competent mental health care for a vulnerable population.

Experiences With Kidney Transplant Among Undocumented Immigrants in Illinois: A Qualitative Study

Noncitizen, undocumented patients with kidney failure have few treatment options in many states, although Illinois allows for patients to receive a transplant regardless of citizenship status. Little information exists about the experiences of noncitizen patients pursuing kidney transplantation. We sought to understand how access to kidney transplantation affects patients, their family, health care providers, and the health care system. A qualitative study with virtually conducted semistructured interviews. Participants were transplant and immigration stakeholders (physicians, transplant center and community outreach professionals), and patients who have received assistance through the Illinois Transplant Fund (listed for or received transplant; patients could complete the interview with a family member). Interview transcripts were coded using open coding and were analyzed using thematic analysis methods with an inductive approach. We interviewed 36 participants: 13 stakeholders (5 physicians, 4 community outreach stakeholders, and 4 transplant center professionals), 16 patients, and 7 partners. The following seven themes were identified: (1) devastation from kidney failure diagnosis, (2) resource needs for care, (3) communication barriers to care, (4) importance of culturally competent health care providers, (5) negative impacts of policy gaps, (6) new chance at life after transplant, and (7) recommendations for improving care. The patients we interviewed were not representative of noncitizen patients with kidney failure overall or in other states. The stakeholders were also not representative of health care providers because they were generally well informed on kidney failure and immigration issues. Although patients in Illinois can access kidney transplants regardless of citizenship status, access barriers, and health care policy gaps continue to negatively affect patients, families, health care professionals, and the health care system. Necessary changes for promoting equitable care include comprehensive policies to increase access, diversifying the health care workforce, and improving communication with patients. These solutions would benefit patients with kidney failure regardless of citizenship.

Improving comprehensive emergency obstetric and newborn care in Tanzania: A qualitative study

AimThe purpose of this qualitative study was to explore how health care professionals, managers and community members experienced the implementation of a training program in comprehensive emergency obstetric and neonatal care training in rural Tanzania. BackgroundGiven the high rates of maternal and newborn mortality in Tanzania, the government committed to improving maternal health by increasing access to health care; improving reproductive, maternal, newborn health; reducing maternal and neonate mortality; and increasing the number of public health centers with emergency obstetric and neonatal care. To address the gap in emergency obstetric and neonatal care amongst the health workforce, five health care facilities in rural Tanzania participated in a 3-month specialized training program. The training was geared to increase access to skilled deliveries, prevent maternal and neonate deaths, and reduce referrals to district hospitals. MethodsTwenty-four focus group discussions were held with members of Council Health Management Team, Health Facility Management Team, staff who received training, and community members. Data collection and analysis was guided by content analysis and the World Health Organization's availability, accessibility, acceptability, and quality framework. FindingsParticipants reported acquiring necessary skills that enabled them to provide quality and safe obstetric and newborn care. Five themes emerged from the analysis 1) competent and confident health care teams, 2) renewed commitment to teamwork, 3) community confidence and trust in the health team, 4) mentorship as a critical element of success, and 5) enhancing training and practice. These five emerging themes demonstrate enhanced confidence and trust by the community and increased competency of health care teams to support mothers through pregnancy and birth at the health centre. ConclusionThe competencies acquired by health care providers demonstrate an increase in staff commitment and teamwork. There is an increased number of deliveries in health centres, a declining trend of maternal and neonate deaths and referrals to other health centres because the health care providers are capable of competently and confidently providing emergency obstetric and neonatal care services.

The development of accessible and sustainable transgender health education for rural-serving medical providers in Appalachia.

Context and issues: Rural regions in Southeastern USA are predominantly under-resourced and have poorer health outcomes compared to national averages. People living in rural Appalachia with intersectional identities often have limited choices in providers along with other systemic barriers to obtaining good health care. Barriers to competent and safe health care disproportionately impact people who are marginalized because of their identity. For transgender patients in South Central Appalachia, intersectional identities constitute barriers to receiving competent health care and increase the risk of poorer health outcomes. Literature indicates providers nationally receive on average between 45 minutes and 5 hours of training on transgender healthcare provision, which may exacerbate poor care experiences in South Central Appalachia. The present study aimed to develop and implement a training program for rural-serving medical residents in primary care in South Central Appalachia. A six-stage pilot development study is described. Lessons learned: This project developed a cultural competency training for rural-serving medical providers specific to transgender health needs. The Kern Model was utilized to structure the development of this training. Data from clinic stakeholders, resident liaisons, and transgender community members were utilized throughout phases of development. Two major themes arose from planning with these key stakeholders: accessibility/reusability of the material and usefulness of the material to the residents. Stakeholders were asked to identify areas of competency that would be beneficial for their practices and what baseline information would be necessary for all participants to know. Trainings were a hybrid of virtual and live delivery to pivot in response to space allocations at each clinic and to allow residents who were on hospital rotations to attend. An educational consultant was utilized to inform the best style of training design to meet the stated pedagogical goals. Previous studies have indicated that medical providers receive limited training on transgender health needs. However, there is also literature suggesting differences in general medical education due to resource competition. Therefore, developing sustainable, accessible, and useful medical education is imperative. The inclusion of resident and community member feedback in the content creation of this project allowed customization to community and resident needs. Stakeholder input on the pedagogy of this project was also imperative due to physical space constraints with social distancing guidelines. This training highlights the value in engaging virtual curricula, as it allows optimal accessibility for rural clinics. This project aimed to develop a training specific for South Central Appalachian providers that was informed by transgender people in the region and tailored specifically for regional providers based on stakeholder input. The resulting training may be an invaluable tool for future medical providers in a rural-serving region that is medically, educationally under-resourced and experiences inflated intersectional discrimination at systemic and interpersonal levels.

Primary healthcare competencies needed in the management of person-centred integrated care for chronic illness and multimorbidity: Results of a scoping review

BackgroundChronic disease management is important in primary care. Disease management programmes focus primarily on the respective diseases. The occurrence of multimorbidity and social problems is addressed to a limited extent. Person-centred integrated care (PC-IC) is an alternative approach, putting the patient at the centre of care. This asks for additional competencies for healthcare professionals involved in the execution of PC-IC. In this scoping review we researched which competencies are necessary for healthcare professionals working in collaborative teams where the focus lies within the concept of PC-IC. We also explored how these competencies can be acquired.MethodsSix literature databases and grey literature were searched for guidelines and peer-reviewed articles on chronic illness and multimorbidity in primary care. A data synthesis was carried out resulting in an overview of the competencies that healthcare professionals need to deliver PC-IC.ResultsFour guidelines and 21 studies were included and four core competencies could be derived through the synthesis: 1. interprofessional communication, 2, interprofessional collaborative teamwork, 3. leadership and 4. patient-centred communication. Included papers mostly lack a clear description of the competencies in terms of knowledge, skills and attitudes which are necessary for a PC-IC approach and on how these competencies can be acquired.ConclusionThis review provides insight on competencies necessary to provide PC-IC within primary care. Research is needed in more depth on core concepts of these competencies which will then benefit educational programmes to ensure that healthcare professionals in primary care are better equipped to deliver PC-IC for patients with chronic illness and multimorbidity.

Abstract 5533: Providing culturally responsible health care to Pacific Islander communities: The creation of a cultural competency training for healthcare professionals

Abstract Cultural competency is the ability to respectfully engage, understand, and communicate through conscientious interaction, enabling effective work and meaningful relationships in cross-cultural situations. Cultural competency recognizes the importance for organizations of participants’ diverse social and cultural values, beliefs, and behaviors, and has gained attention because it can bridge health perspectives, understanding, and respect between health professionals and patients. There remains a need for cultural competency in healthcare as disparities persist across the U.S. in racial and ethnic minority groups who experience worse health outcomes and lower healthcare quality than the general public. Therefore, a cultural competency training curriculum was created using various resources to improve interactions between Pacific Islander patients and healthcare professionals. This training helps to reduce racial/ethnic disparities in healthcare by encouraging mutual understanding and improving patient satisfaction, adherence to medical instructions, and overall health outcomes by highlighting patient-centered care as a result of utilizing components of cultural competency. To improve patient experiences in Hawai’i, healthcare professionals need the tools to better interact with patients from different cultures, such as Pacific Islanders. This training provides healthcare professionals with culturally-based content for improving cultural competence techniques for interacting with Pacific Island patients. This training was pilot tested with key stakeholders from community organizations and Cancer Center faculty/staff. Local health clinics, providers, and practices will have the opportunity to participate in this training through a Zoom-based electronic training format and be provided with three continuing medical education credits. The initial delivery of the training was intended for in-person sessions; however, a virtual format was adapted due to the COVID-19 pandemic and subsequent social distancing regulations. Healthcare providers are provided pre-training resources, a pre- and post-test, and a course evaluation to determine the validity of training objectives. To date, two Federally Qualified Health Centers have been provided the training, n=60, as well as one Cancer Health Equity Partnerships’ Scientific Workshop, n=40. For attendees, the analysis of correct responses from the pretest to post-test showed a significant improvement on 6 of the 12 questions. Respondents also agreed that the training resources aligned with the course objectives. Improved patient interactions from this training can help support better patient outcomes, adherence to medical advice regarding cancer screenings, and many other aspects of improving health equity for Pacific Islanders. Citation Format: Mark Lee Willingham Jr., Kevin Cassel, Angela Sy, Munirih Taafaki, Tressa P. Diaz, Angelina G. Mummert. Providing culturally responsible health care to Pacific Islander communities: The creation of a cultural competency training for healthcare professionals. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5533.

Socio-medical aspects of the problem of the development of inclusion in modern Russian society: cross-sectional study

BACKGROUND: The study of the socio-medical aspects of the problem of the development of inclusion in modern Russian society is needed urgently. On the one hand, this is due to the growth in the number of people with disabilities, the need to improve the level and quality of care, and on the other hand, due to the insufficient level of readiness of the healthcare system and the social protection of the population to provide effective, comprehensive assistance to persons with disabilities.
 OBJECTIVE: The purpose of the study was to identify the main problems and difficulties faced by young people with disabilities in obtaining necessary medical and social assistance.
 MATERIALS AND METHODS: This article presents the results of a survey of young people with disabilities living in the Stavropol Territory. The study involved 195 young people aged 18 to 30 years. The study was conducted from September to October 2022. The main method of research was a questionnaire survey compiled using Google Forms.
 RESULTS: The leading conditions for ensuring the inclusion of persons with disabilities are: ensuring the availability of health services, education, the level of social support and assistance, the opportunity to participate actively in the cultural and social aspect of modern society, and participating in adapted physical culture and sports. The research indicates an insufficient level of development of the socio-medical rehabilitation potential of persons with disabilities and the presence of socio-medical barriers that prevent the active inclusion of disabled people in the life of modern society. Persons with disabilities and their family members face the following problems: the insufficient level of development of an accessible architectural environment; the low level of material and technical provision of services and innovations in the field of social rehabilitation; the unavailability of specialists for inclusive interaction; the lack of objective and accessible information about modern methods of treatment and rehabilitation; the system of socio-psychological assistance; and support after reaching adulthood.
 CONCLUSION: The leading directions to improve the effectiveness of social policy in the development of inclusive interaction are: the creation of resource centers for the comprehensive support of persons with disabilities and their family members; the improvement of organizational and legal mechanisms for supporting the public organizations of disabled people and their family members; inclusive volunteering activities aimed at the active inclusion of persons with disabilities in the modern society life; and improving the professional competence of healthcare and social protection specialists working in the field of ensuring inclusive interaction with persons with disabilities.

‘If you didn't chart it, you didn't do it’: a retrospective chart review of errors omission in endoscopy care

Background: Patients put themselves in the care of a competent healthcare team. Missed nursing care is a universal phenomemon, and endoscopy is no exception. Although endoscopic procedures for the diagnosis and treatment of gastrointestinal diseases are usually minimally invasive, highest standards of nursing care and documentation are to be ensured for patient safety. Aim: This study aimed to identify and quantify the type and frequency of nursing care that was documented. Methods: A descriptive retrospective chart review was conducted after formal approval and ethics clearance at a tertiary hospital. Documentation on the nurses' records (n=717) for the period January to December 2019 that met the sampling criteria were audited for a full range of nursing care activities during endoscopy. Data was extracted using a validated (CVI 0.87-1), reliable (Kappa 0.83; ICC 0.98) data abstraction form. Data were analysed using descriptive statistics. Results: Of 47 care activities in each of 717 records, 41.5% were undocumented. More care went undocumented in the intra-procedure (56.1%) and post-procedure (54.2%) periods than the pre-procedure period (15.4%). The proportion of each activity going undocumented ranged widely from 0% to 100%. Conclusion: The findings demonstrate that many aspects of care related to endoscopy were not documented and thus likely omitted. Proper care and documentation can help identify and mitigate any harm to patients.

Exploring Women's Reasons for Choosing Home Birth with the Help of Their Untrained Family Members: A Qualitative Research.

Home births with the help of untrained family members continue to be women's preference in Indonesia. However, the practice has received very little attention. The purpose of this study was to explore women's reasons for choosing home births with the help of their untrained family members. This study used an exploratory-descriptive qualitative research approach and was conducted from April 2020 to March 2021 in Riau Province, Indonesia. A total of 22 respondents determined by data saturation was recruited using purposive and snowball samplings. The respondents consisted of 12 women who had at least one planned home birth with the help of their untrained family members, and 10 untrained relatives who had an experience in intentionally assisting their family member's home birth. Data were collected through semi-structured telephone interviews. Nvivo version 11 software was used for data analysis using the Graneheim and Lundman's content analysis. 13 categories and 4 themes emerged. The themes were living with fallacious beliefs in unassisted home childbirths, feeling of socially alienated from the surrounding communities, dealing with limited access to healthcare services, and escaping from childbirth-related stressors. Home birth with the help of untrained family members takes place because of not only limited access to healthcare services, but also women's personal beliefs, values, and needs. Designing culturally sensitive health education, ensuring culturally competent healthcare workers and services, overcoming healthcare access barriers, and improving the community's pregnancy and childbirth literacies are fundamental in reducing unassisted home births and promoting facility childbirths.

Features of the formation of health care competence of school students in physical education lessons

The purpose of the work: to analyze the current state of the formation of health-preserving competence in physical education lessons in general secondary education institutions. Methodology: analysis and generalization of methodological, psychological-pedagogical and educational-methodical literature, which gave an opportunity to study the peculiarities of the formation of health-preserving competence in physical education lessons. Scientific novelty: the article examines modern approaches to the formation of health-preserving competence of schoolchildren in physical education lessons.
 Conclusions: at the current stage of the country's development, the issue of student youth's health occupies a prominent place in the education and upbringing of the younger generation. The main reasons for this situation are a lack of physical activity, which in turn negatively affects the physical development and health of schoolchildren. Currently, general secondary education institutions do not fully solve the problem of meeting the biological need of schoolchildren to move. Physical education lessons at school compensate for only 15% of the need for children's bodies to be physically active. The formation of health-preserving competence of schoolchildren is a purposeful process of forming a positive motivational and value orientation towards a healthy lifestyle, students' mastery of knowledge, skills to conduct health-preserving activities, experience of health-preserving; development of personal qualities, which is carried out by means of health-saving technologies, taking into account the specifics of the functioning of school institutions.

Legislative regulation as a component of the formation of healthcare competences of the adults in the USA

The article presents the author's work on the legislative regulation of the formation of healthcare competencies of the adult population in the USA. It has been studied that US lawmakers attach great importance to the outlined problem, which is determined by the large number of legislative acts and the diversity of their direction. The work presents relevant legislative documents and defines their essence. The analysis of the laws adopted by the US Congress on the health care of the adult population made it possible to distinguish 4 directions: Educational component; Improving the activity of medical provision; Support and preservation of personal health; Development of a network of health facilities and sports clubs. The methodological basis of the research is a complex search, analysis, synthesis of regulatory documents and the legal framework of the USA; justification of leading principles and functions; formation of generalized conclusions, identification of rational and practically valuable material. Therefore, the purpose of the article is to analyze the laws adopted by the US Senate and House of Representatives regarding the formation of healthcare competencies of the adult population and borrowing positive experience regarding the possibility of further application in the legislative acts of Ukraine. It is concluded that recognition of the need to ensure the formation of healthcare competencies of the adult population in the USA is being actively resolved at the legislative level. Legal initiatives set out in normative acts on the formation of healthcare competencies of the adult population are aimed at supporting and improving the level of health of the individual, the family, and as a result, ensuring the prosperity of the state in general. We have identified 4 main areas of activity of the US Congress regarding the healthcare of the adult population. We consider it appropriate to borrow the positive experience of the possibility of further application of the main directions in legislative acts and state programs of Ukraine.

Geopolitical Considerations for Working with Medically Complex Patients: A Case Illustration.

Becoming culturally competent healthcare providers depends on the ability of practitioners to acquire knowledge, awareness, and skills related to other cultures. In building these areas of competence, it is essential to consider geopolitical factors that may influence health and health-seeking behaviors, particularly when working with immigrant populations. When care is sought, they are likely to experience significant barriers to effective care, including lack of providers who speak their language and failure of practitioners to integrate cultural beliefs into treatment plans. This is further complicated by the presence of geopolitical issues, including immigration status, war/conflict in the patient's country of origin, and/or human rights violations. The current study uses a sample case of a Burmese-speaking, Myanmar national to illustrate a culturally informed approach to the assessment of neurobehavioral changes within complex geopolitical circumstances. The sample represents an amalgam of several patients, designed to represent common presentations, sociodemographic situations, and concerns that arise during the neuropsychological assessment process. Description of relevant case information including background, clinical observations, and performance on testing is provided. Awareness of the impact of these life experiences not only has the potential to deepen our understanding of our patients but also results in a more holistic, accurate, and culturally competent conceptualization of their physical and mental health needs.

Analysis of Psychiatric Symptoms and Suicide Risk Among Younger Adults in China by Gender Identity and Sexual Orientation

Younger adults in China who are transgender and gender nonconforming (TGNC) and lesbian, gay, and bisexual (LGB) experience high levels of minority stress (eg, stigma and bullying) and adverse mental health symptoms. However, there is a lack of research documenting mental health disparities compared with their cisgender and heterosexual peers. Studies that disaggregate TGNC and LGB individuals and are conducted in nonmetropolitan regions are also needed. To examine whether younger adult students' psychiatric symptoms and suicide risk vary by sexual orientation and gender identity and identify risk factors within LGB younger adults and TGNC younger adults. This cross-sectional study surveyed students at 63 universities in Jilin Province, China, between October 24 and November 18, 2021. Analyses were completed May 6, 2022. Gender identity (TGNC vs cisgender) and sexual orientation (LGB vs heterosexual). Psychiatric outcomes included depression, anxiety, traumatic stress, and nonsuicidal self-injury (NSSI), which were measured by the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Trauma Screening Questionnaire, and self-reported NSSI behaviors. The Suicide Behaviors Questionnaire-Revised was used to assess suicide risk. The analytic sample included 89 342 younger adults (mean [SD] age, 19.60 [1.75] years), including 51 438 assigned female at birth and 37 904 assigned male at birth. The sample included 2352 individuals who were TGNC, 6501 who were cisgender LGB, and 80 489 who were cisgender heterosexual. Compared with their cisgender heterosexual peers, TGNC and LGB younger adults were more likely to experience increased psychiatric symptoms across categories and suicide risk, as well as more severe forms of symptoms. In particular, overall suicide risk was 43.03% among TGNC individuals, 36.21% among LGB individuals, and 11.70% among cisgender heterosexual younger adults. Controlling for demographic variables and compared with cisgender heterosexual peers, TGNC young adults had higher odds of suicide risk (adjusted odds ratio, 5.38; 95% CI, 4.94-5.86; P < .001) and of past-year NSSI (adjusted odds ratio, 6.55; 95% CI, 5.87-7.30; P < .001). Separate within-group analyses for LGB and TGNC younger adults highlighted the vulnerability of bisexual women and gender nonbinary groups, as well as the relevance of minority stress-related risk factors, including peer bullying and assault and loneliness. This study noted disparities of mental health issues among LGB, transgender, or queer or questioning younger adults in China and suggests a high urgency to address psychological health and prevent suicide in this population. Targeted public health initiatives may be needed to reduce stigma and discrimination, train competent health care professionals, and create affirmative mental health policies and systems of care.

Dilemmas Encountered by Small and Medium-sized Orthopedic Medical Device Manufacturing Companies in Healthcare Reform Based on a Supply Chain Perspective: Taking a Manufacturer in Jiangsu Province as an Example

As China’s healthcare reform progresses, the medical device industry is receiving significant attention as an essential part of the healthcare delivery system. Current research on the supply and management of medical devices in the context of healthcare reform mainly focuses on the downstream of the supply chain to innovate the management model of orthopedic consumables in hospitals and realize competent healthcare. However, only a few studies have focused on medical device manufacturers upstream of the supply chain and proposed measures to improve supply chain performance. This paper takes a medium-sized customer medical device manufacturer in China as a case study. This study analyzes the problems revealed in its supply chain operation through literature research, case study analysis, and fieldwork. It proposes countermeasures for the continuous improvement of the industry against the background of healthcare reform. The study found that small and medium-sized medical device manufacturers were not using management information systems adequately and were suffering from the impact of healthcare reform by sticking to their old distribution models. For long-term growth, these small and medium-sized medical companies should focus on research and development, cater to market needs, integrate downstream distributors, and work with hospitals to establish a more transparent and efficient healthcare supply chain.

Towards a national pharmaceutical strategy in Lebanon: Ensuring access to quality and safe medications for all

Introduction: Lebanon is facing challenges affecting the whole health sector, including access to medications. Lebanon has only proposed very few short-term national pharmaceutical strategic solutions. Previous reform attempts targeting the pharmaceutical sector, could not protect it from the crises and their detrimental consequences on patient and population health. Purpose: This document unveils the critical elements that should be addressed in the planned National Pharmaceutical Sector Strategy (NPS) being developed by the Order of Pharmacists of Lebanon (OPL) in consultation with the concerned stakeholders. Method: Strategic goals were proposed for adoption and implementation by the competent authorities based on consultations, situational assessments, and gap analyses. The objectives and an implementation plan were developed based on the available resources and policy dialogue, respectively. Conclusion: The National Pharmaceutical Strategy would help the Lebanese authorities/policy-makers, aided by competent healthcare professionals, develop and implement a time-bound roadmap to attain a nation with access to quality and safe medications for the whole population. Implementing this strategy would require the commitment of decision-makers, the accountability of involved parties, innovation in finding solutions, close collaboration between stakeholders, and lengthy efforts to attain the stated vision.

Our Patients Need Empathy Training across Healthcare Professions

Vulnerable populations are those who experience disparity at a disproportionate rate. For this article, specific vulnerable populations of interest include people who experience intellectual or developmental disorders, mental illness, or substance misuse. Vulnerable populations are some of the most stigmatized populations in our society. Research shows that vulnerable populations receive less empathic care than general health care populations, resulting in reduced quality of care and disparities in health outcomes. Empathy, a necessary health care competency, is associated with improved patient outcomes, enhanced job satisfaction, and increased retention and resilience across health care professions. However, there is no current standard for how empathy is taught, assessed, or sustained. Even when empathy education is implemented in healthcare professions curricula, research has demonstrated that it appears to erode with experience and time. In addition, the COVID-19 pandemic has exacerbated inequities in health care systems, with consequences for both patients and providers. There is an urgent need to develop efficacious training in empathy across health care professions to foster and sustain a robust workforce and improve health care experiences and outcomes.

Racial and Ethnic Differences in the Use of Regional Anesthesia for Patients Undergoing Total Knee Arthroplasty

BackgroundThere is an increasing body of evidence that suggests racial and ethnic disparities exist in medical care. In the field of anesthesiology, few studies have investigated the association of race and ethnicity with the provision of regional anesthesia for patients undergoing total knee arthroplasty. This analysis queried a large national surgical database to determine whether there were racial or ethnic differences in the administration of peripheral nerve blocks for patients undergoing total knee arthroplasty. MethodsIn this retrospective cohort study, data were collected from a large national database during the years 2017-2019. Multivariable logistic regressions were used to measure the association of race and ethnicity with utilization of regional anesthesia. The participants for the study were patients 18 years or older undergoing total knee arthroplasty. ResultsOur primary finding was that among patients undergoing total knee arthroplasty, Black patients had lower odds (adjusted odds ratio [aOR]: 0.93, 99% confidence interval [CI]: 0.89-0.98) of receiving regional anesthesia than White patients. Also, Hispanic patients had lower odds (aOR: 0.88, 99% CI: 0.83-0.94) of receiving regional anesthesia than non-Hispanic patients. Native Hawaiian/Pacific Islander patients had increased odds (aOR: 2.04, 99% CI: 1.66-2.51) of receiving regional anesthesia. ConclusionThis study demonstrated that there might be racial and ethnic differences in the provision of regional anesthesia for patients undergoing total knee arthroplasty. These differences underscore the need for more studies aimed at equitable access to high quality and culturally competent health care.