Family Health Care Research Articles

Diversity, equity, and inclusion: Evolving into belonging, dignity, and justice.

The authors want to invite the integrated care community to reflect with us on an evolutionary shift in how we approach matters of justice and equity: from a diversity, equity, and inclusion (DEI) framework to a perspective that centers the relational concepts of belonging, dignity, and justice (BDJ) for a more just world (Davis, 2021). Our desire to reflect, question, and pivot is inspired by the Ecocycle Planning Model-which I (Deepu George) used to critically frame the Collaborative Family Healthcare Association's (CFHA) history in Part I of the article (George, 2023a) and creatively anticipate our future in Part II (George & Khatri, 2024). In this article, the authors want to focus on the nodes of maturity and creative destruction, as well as the idea of the rigidity trap-to examine our collective energies around the idea of DEI. With CFHA's 30th anniversary upon us, we pause and reflect on not only the benefits of DEI efforts heretofore, but also the pitfalls, to avoid the rigidity trap, which is likely to occur when we embrace tenets of an idea that may no longer serve the values we once aspired to or fail to evolve in favor of the familiar. Considering critiques of the limitations of DEI work in practice and literature, the authors believe a BDJ approach will better inform our growth moving forward. Therefore, the authors want to reflect, honor, and build upon the impact and gains from DEI and adapt them to better serve the needs of all-especially the historically marginalized and underrepresented voices. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

INTERINSTITUTIONAL COLLABORATION FOR THE DEVELOPMENT OF APS, THE EXPERIENCE OF THE UNIVERSITY CONSORTIUM OF HEALTH AND FAMILY MEDICINE

Chile faces the challenge of responding to the complexities in addressing and managing issues arising from the current demographic, epidemiological, social, and cultural profile. The country’s public health policies have followed the guidelines of Alma Ata Primary Health Care (PHC), Renewed PHC, Astana PHC, Universalization of PHC, and have enabled the sustained devel­opment of care networks by implementing a model of comprehensive family and community health care, with a focus on promotion, prevention, and anticipatory management of harm within networks. Throughout these processes, in line with the Mission and Social Responsibility of the University and the Global Consensus on the Social Responsibility of Medical Schools, institu­tions responsible for training health professionals and specialists have played a supportive and facilitating role, with particular emphasis on developing human resources within and through practical experiences and supporting teams in the territorial implementation of health policies. The presented experience aims to share the contributions and lessons learned from an alliance of diverse academic institutions that, through collaboration and the formation of a community of learning and practice, are shaping a process of social innovation, a rhizomatic learning initia­tive, and a good formative practice: the Chilean University Consortium of Family Health and Medicine from 2004 to 2014. Its development, progress, results and projections are analyzed.

PERSON-CENTERED CARE MODEL WITH MULTIMORBIDITY

Multimorbidity is a national and global public health problem that causes a deterioration in people’s health and survival. Health system response is fragmented in several programs with low satisfaction and adherence in patients. Therefore, is advisable to move towards a strategy applying the principles of the Model of Comprehensive Community Health, where the focus ison people, who are activated for their health care. The Ancora Health Innovation Center of the “Universidad Católica” and the Metropolitan Southeast Health Service (SSMSO) carried out a pilot project to implement the Person-Centered Care Model with Multimorbidity (MACEP) aiming to prevent complications and reducing demand at secondary and tertiary care levels. Between 2017 and 2019, 20,642 people were intervened and to evaluate intervention impact they were compared with 32,661 people treated in neighboring not intervened Family Health Care Centers (CESFAM). Significant decreases in the risk of dying and hospitalization were found in the intervened population. Percentage level of MACEP implementation in the seven intervened family health care centers was also evaluated,verifying values from 41 to 100%. The economic evaluation of the pilot project showed higher costs in primary and secondary care, as well as significant savings at the tertiary level, witha net saving in the system total cost. In 2019, the Ministry of Health,drawing on MACEP's experience in the SSMSO, described the Strategy for Person-Centered Comprehensive Care in the Context of Multimorbidity (ECICEP) and began its implementation at the national level. In the case of a public policy that it is still very young,it becomes necessary to deepen the changes that ensure its progress and consolidation.

What makes advance care planning discussion so difficult? A systematic review of the factors of advance care planning in healthcare settings.

Existing systematic reviews related to advance care planning (ACP) largely focus on specific groups and intervention efficacy or are limited to contextual factors. This research aims to identify the modifiable factors perceived by different users of ACP in healthcare settings and inform healthcare professionals about the factors affecting ACP practice. Five English-language databases (ProQuest, PubMed, CINAHL Plus, Scopus, and Medline) and two Chinese-language databases (CNKI and NCL) were searched up to November 2022. Empirical research identifying factors related to ACP in healthcare settings was included. ACP is defined as a discussion process on future end-of-life care. Thematic synthesis was performed on all included studies. A total of 1871 unique articles were screened; the full texts of 193 were assessed by 4 reviewers, and 45 articles were included for analysis. Twenty-two (54%) studies were qualitative, 15 (33%) were quantitative, and 6 (13%) used mixed methods. Foci varied from 28 (62%) studies on a single subject group (either patient, family, or physician), 11 (25%) on 2 subject groups (either patient and family or patient and healthcare professional), and 6 (13%) covered 3 subject groups (patient, family, and healthcare professional). Among the 17 studies involving more than 1 subject group, only 2 adopted a dyadic lens in analysis. Complex interwoven factors were categorized into (1) intrapersonal factors, (2) interpersonal factors, and (3) socio-environmental factors, with a total of 11 themes: personal belief, emotions, the burden on others, timing, responsiveness, relationship, family dynamics, experience, person taking the lead, culture, and support. Patients, families, and healthcare professionals are the essential stakeholders of ACP in healthcare settings. Factors are interweaved among the intrapersonal, interpersonal, and socio-environmental dimensions. Research is warranted to examine the dynamic interactions of the 3 essential stakeholders from a multidimensional perspective, and the mechanism of the interweaving of factors.

Factors influencing adoption of sexual and reproductive health intervention for adolescents in Ebonyi, Nigeria.

School and Community-embedded reproductive health interventions have been implemented in developing countries, with evidence that they led to improved sexual and reproductive health among adolescents. However, this type of intervention is rarely evaluated for its potential adoption and use. This study evaluated the constraints and enablers of the adoption of a school and community-embedded intervention that used community engagement, capacity building, partnerships and collaborations to deliver sexual and reproductive health services to adolescents. The intervention was implemented between 2019 and 2021 in six local government areas in Ebonyi State. The results on adoption presented here were collected four months into the mid-phase of the project, targeting adolescents, parents, adult family members, healthcare providers, local authorities, and community members. Sixteen in-depth interviews were conducted with policymakers, 14 with health service providers and 18 Focus Group Discussions (FGDs) with parents, community leaders and adolescents who were part of the implementation process. The coding reliability approach, a type of thematic data analysis was used, that involves early theme development and the identification of evidence for the themes. The adoption of school and community-embedded reproductive health intervention was strong among stakeholders at the early stages of the implementation process. Multi-stakeholder involvement and its multi-component approach made the intervention appealing, thereby enabling its adoption. However, at the later stage, the adoption was constrained by beliefs and norms about sexual and reproductive health (SRH) and the non-incentivisation of stakeholders who acted as advocates at the community level. The sustainability of the intervention may be threatened by the non-incentivisation of stakeholders and the irregular supply of materials and tools to facilitate SRH advocacy at the community level. The inclusive community-embedded reproductive health intervention was adopted by stakeholders because of the enablers which include timely stakeholder engagement. However, for it to be sustainable, implementers must address the non-incentivising of community-level advocates which serve as constraints.

Fear of childbirth among pregnant women: A concept analysis.

To clarify the concept of fear of childbirth among pregnant women and to examine its current measure tools. Fear of childbirth is a psychological symptom, prevalent among pregnant women, which negatively impacts women's health and well-being. It has become an increasingly concerning issue in perinatal mental health. However, due to its poor conceptualization, it presents difficulty in conducting reliable assessments and identifying risk factors. The Walker and Avant approach to concept analysis guided this review. Six bibliographic databases were systematically searched for published research from their inception date to May 2023. Additional records were identified by manually searching the reference lists of relevant studies. Quantitative and qualitative studies investigating fear of childbirth in pregnant women were included. Three critical attributes have been identified: cognitive impairments, affective disorders and somatic symptoms. Antecedents include perceived a real or anticipated threat of pregnancy or its outcomes, low perceived self-coping ability and unmet social support needs. Consequences include processing and avoiding behaviours. This study also identified the dimensions of fear of childbirth, including 6 primary categories and 14 subcategories. The content of five scales was analysed and none covered all domains. The current analysis provides healthcare providers with a more comprehensive framework to assess and identify fear of childbirth. Further research is needed to develop a suitable instrument that covers all the attributes and dimensions of this concept and assesses its severity. This conceptual analysis provides a comprehensive insight into the phenomenon of fear of childbirth. This will help family members, healthcare providers and policymakers to identify the psychological needs of pregnant women and improve the quality of antenatal care. Not applicable as no new data were generated.

Cultural food practices and sources of nutrition information among pregnant and postpartum migrant women from low- and middle-income countries residing in high income countries: A systematic review.

Women in low- and middle-income countries (LMICs) may engage in a range of cultural food practices during pregnancy, including restricting or avoiding foods high in protein and iron, and foods rich in vitamins and minerals. While research has explored the cultural food practices of pregnant women in LMICs, there is less understanding of the continued cultural food practices of women who migrate to high-income countries and then become pregnant. This systematic review explores the existing research on cultural food practices and sources of nutrition information among pregnant and postpartum migrant women from LMICs, residing in high-income countries. A systematic search was conducted in April 2024 across Global Health, CINAHL, and MEDLINE, published in English, with no date restrictions. Eligible studies included those focused on pregnant and postpartum women who had migrated from LMICs to high-income countries. Studies were excluded if they comprised of non-immigrant women or did not involve LMIC participants. Screened were studies for eligibility, data were extracted, and study quality was assessed. In total, 17 studies comprising qualitative (n = 10) and quantitative (n = 7) approaches were included. In 14 studies participants adhered to cultural food practices, wherein certain nutritious foods were restricted during pregnancy or the postpartum period; three studies noted limited adherence due to support, acculturation, and access to traditional foods. Most studies (n = 10) reported traditional "hot" and "cold" food beliefs during pregnancy and postpartum, aiming to maintain humoral balance for maternal and child health and to prevent miscarriage. Nutrition advice was sought from family members, friends, relatives, healthcare providers, and media sources, with a preference for advice from family members in their home countries. There is a need for culturally appropriate nutrition education resources to guide pregnant migrants through healthy and harmful cultural food practices and overall nutrition during this crucial period. (PROSPERO Registration: CRD42023409990).

Child life specialist services, practice, and utilization across health care: a scoping review.

The objective of this review was to map the available evidence regarding the scope of child life specialist services, practice, and utilization. The concept of child life services began in 1922 and emerged as the child life specialist services specialty in the United States in the 1970s and 1980s. Child life specialists are members of multidisciplinary health care system teams who prioritize the developmental needs of pediatric patients to support and improve patient and family health care experiences. Evidence of the effectiveness of child life specialist services and the utilization of those services is often incorporated in multidisciplinary research reports and thus overlooked. All quantitative, qualitative, and mixed methods research study reports and systematic reviews investigating child life specialist services, practice, and utilization in health care systems were included. This review was guided by the JBI methodology for scoping reviews and a published a priori protocol. CINAHL (EBSCOhost), MEDLINE (PubMed), Scopus, and PsycINFO (APA) were searched for evidence published from January 1980 to August 2022. Research publications about child life specialist services, practice, and utilization have increased dramatically over the past decade, with more than 50% of studies published in the past 5 years. Although the first authors of the majority of the research publications were physicians, these multidisciplinary author teams depicted child life specialist services in a variety of roles, including co-investigators, interventionists, and research subjects. The 105 full-text publications reviewed were from 9 countries, plus 1 publication that surveyed people across Europe. The contexts spanned a wide scope of clinical settings and medical subspecialties, but primarily in hospitals and health centers, and to a lesser extent, in ambulatory clinics and communities. A wide variety of child life specialist services were described across these settings. Mapping the research can help delineate the barriers and facilitators to child life specialist services in health care systems. This scoping review provides evidence of the global diffusion of child life specialist services across health care system settings, with recent increases in research publications involving child life specialist services.

Poverty proofing healthcare: A qualitative study of barriers to accessing healthcare for low-income families with children in northern England.

Poverty impacts negatively on children's health and future life chances. Access to the UK's National Health Service (NHS) is based on clinical need rather than the ability to pay but horizontal inequities in access exist. Children North East, a charity supporting children experiencing poverty, are working with partners to reduce the impacts of poverty on NHS access. This collaborative study aimed to understand barriers to healthcare access faced by families living on low incomes to validate and support further development of a Poverty Proofing© healthcare tool. Twenty-four parents and eight Voluntary Community Social Enterprise sector staff participated in qualitative interviews or focus groups. Data were analysed thematically, and three main themes were identified as impacting access to healthcare: hidden costs, securing appointments and developing relationships with healthcare providers. We conclude that low-income families experience both financial and other barriers to accessing NHS healthcare and that these barriers are exacerbated for low-income families living in remote/rural areas.

Psychometric Evaluation of a Tablet-Based Tool to Detect Mild Cognitive Impairment in Older Adults: Mixed Methods Study.

With the rapid aging of the global population, the prevalence of mild cognitive impairment (MCI) and dementia is anticipated to surge worldwide. MCI serves as an intermediary stage between normal aging and dementia, necessitating more sensitive and effective screening tools for early identification and intervention. The BrainFx SCREEN is a novel digital tool designed to assess cognitive impairment. This study evaluated its efficacy as a screening tool for MCI in primary care settings, particularly in the context of an aging population and the growing integration of digital health solutions. The primary objective was to assess the validity, reliability, and applicability of the BrainFx SCREEN (hereafter, the SCREEN) for MCI screening in a primary care context. We conducted an exploratory study comparing the SCREEN with an established screening tool, the Quick Mild Cognitive Impairment (Qmci) screen. A concurrent mixed methods, prospective study using a quasi-experimental design was conducted with 147 participants from 5 primary care Family Health Teams (FHTs; characterized by multidisciplinary practice and capitated funding) across southwestern Ontario, Canada. Participants included health care practitioners, patients, and FHT administrative executives. Individuals aged ≥55 years with no history of MCI or diagnosis of dementia rostered in a participating FHT were eligible to participate. Participants were screened using both the SCREEN and Qmci. The study also incorporated the Geriatric Anxiety Scale-10 to assess general anxiety levels at each cognitive screening. The SCREEN's scoring was compared against that of the Qmci and the clinical judgment of health care professionals. Statistical analyses included sensitivity, specificity, internal consistency, and test-retest reliability assessments. The study found that the SCREEN's longer administration time and complex scoring algorithm, which is proprietary and unavailable for independent analysis, presented challenges. Its internal consistency, indicated by a Cronbach α of 0.63, was below the acceptable threshold. The test-retest reliability also showed limitations, with moderate intraclass correlation coefficient (0.54) and inadequate κ (0.15) values. Sensitivity and specificity were consistent (63.25% and 74.07%, respectively) between cross-tabulation and discrepant analysis. In addition, the study faced limitations due to its demographic skew (96/147, 65.3% female, well-educated participants), the absence of a comprehensive gold standard for MCI diagnosis, and financial constraints limiting the inclusion of confirmatory neuropsychological testing. The SCREEN, in its current form, does not meet the necessary criteria for an optimal MCI screening tool in primary care settings, primarily due to its longer administration time and lower reliability. As the number of digital health technologies increases and evolves, further testing and refinement of tools such as the SCREEN are essential to ensure their efficacy and reliability in real-world clinical settings. This study advocates for continued research in this rapidly advancing field to better serve the aging population. RR2-10.2196/25520.

Experiences of Adult Siblings of Individuals With an Intellectual Disability and Pervasive Support Needs

Siblings are important in the lives of individuals with an intellectual disability and pervasive support needs; however, adults’ experiences of the things they do with or for their siblings with pervasive support needs remain underexplored. This study examined positive and challenging aspects of their roles related to their siblings. An online questionnaire was completed by 55 adults whose siblings had pervasive support needs. An inductive approach was used to thematically analyze open-ended questions about their experiences. The respondents described rewarding experiences of being with their siblings, combined with a sense of care and responsibility, and noted how their experiences were affected by their siblings’ support needs. “Being of service” was experienced as both rewarding and as a demanding responsibility. Collaboration with family members and health care professionals was another overarching theme. Our findings highlighted the valuable mutual contributions of siblings in each other’s life when one of them has pervasive support needs. Understanding adults’ experiences relating to their siblings who have pervasive support needs enables service providers to facilitate their contact and support. In addition, these findings can provide input for government agencies and organizations that provide support for people with disabilities by increasing awareness about siblings’ perspectives.

'They don't know what to do with our children': Experiences and views on feeding and swallowing from parents of children who use long-term ventilation.

Increasing use of paediatric long-term ventilation (LTV) has been reported around the world over the last two decades and it is anticipated that use of this medical intervention will continue to grow. Research has shown that children who use LTV have risk factors for feeding and swallowing difficulties which result in long-term reliance on non-oral feeding methods. This Patient and Public Involvement (PPI) activity explored experiences of parents of children with LTV on their children's feeding and swallowing journeys. Individual and group interviews with seven parents were conducted. Interview data was then analysed using content analysis. Families discussed a range of themes including impacts on their family, facilitators and barriers to feeding and swallowing journeys, speech and language therapy (SLT) support, their family's healthcare journey in relation to quality of life and future directions for research. This study highlighted potential key areas to explore when identifying ways to improve SLT care and research in feeding and swallowing for children who use LTV.

Beyond the brink: Unraveling the opioid crisis and its profound impacts

This paper examines the long-standing and severe public health crisis, the opioid epidemic in the United States, which has been worsening since the mid-1990s. In contrast to previous research, it investigates the broader impacts of this epidemic, particularly on family members and healthcare systems. Using a comprehensive dataset spanning from 1998 to 2010, the study analyzes opioid use at the three-digit ZIP code level, utilizing data from the Drug Enforcement Agency (DEA) and individual-level data from the Health and Retirement Study (HRS) in a two-way fixed effect model. The findings reveal significant negative effects on family caregivers, notably adult children, due to the opioid epidemic. Additionally, opioid exposure is associated with increased healthcare utilization, including home health care and hospital use. This research contributes to a deeper understanding of the multifaceted consequences of the opioid epidemic.

Penerapan Terapi Minum Teh Hijau Dalam Mengontrol Tekanan Darah Pada Penderita Hipertensi Pada Keluarga Ibu A di Kelurahan Bambu Apus RT 14 RW 03 Kecamatan Cipayung Jakarta Timur

Hypertension is a condition in which blood pressure rises chronically (long term) and has the potential to cause extreme illness or death to the individual. Individuals who are diagnosed as suffering from hypertension if there is an indication that the systolic blood pressure is greater than 140 mmHg and the diastolic blood pressure is less than 90, which is more, if treatment is not carried out intensively and treatment can also be carried out early, can have a high risk of causing degenerative disease, namely retinopathy. , thickening of the heart wall, kidney damage, coronary heart disease, rupture of blood vessels, stroke, can also result in sudden death. The family has an important role in efforts to improve health and reduce the risk of disease in society because the family is the smallest unit in society, the role of the family is very important in every aspect of family health care, for this reason the family plays a role in determining the type of care needed by the family. Family nurses have a role, namely helping families to solve health problems by increasing the family's ability to carry out health care functions and tasks. Based on data, one effort to lower blood pressure is by giving green tea (Camelia sinensis). Tea has the main properties that come from the polyphenols contained in it.

Self- and Proxy-Completion of Quality of Life Assessment in Dementia Care: A Review of Reviews

Background and Purpose:Quality of life (QOL) assessment invites the perspectives of people living with dementia to be shared with family caregivers and healthcare providers. A review of reviews was conducted to describe synthesized evidence (i.e., from other reviews) regarding self- and proxy-reports of QOL for this population.Methods:Searches were conducted in four databases. The 25 included articles addressed self- or proxy-rated patient-reported outcome measures, focused on any type of dementia, and were a review or synthesis published in English.Results:Individuals with dementia are largely able to self-report QOL. Proxy-reports are incongruent with self-reports due to various factors, including the proxy-patient relationship and perspective of measurement.Conclusion:When assessing QOL for people with dementia, self-reports are preferred to proxy-reports; however, a combination is recommended.

Abstract 02: Contributions of Social Determinants of Health to Premature Cardiovascular Mortality in the US General Population

Introduction: Quantifying the contributions of 8 social determinants of health (SDOH) to US population-level premature cardiovascular disease (CVD) mortality will aid in developing and implementing strategies to reduce the burden of CVD mortality for diverse populations. Hypothesis: Levels of unfavorable SDOH are more common in Black and Hispanic adults in the US and contribute to a higher proportion of US population-level premature CVD mortality compared with White adults. Methods: We included 48170 participants aged 20-74 years from the National Health and Nutrition Examination Survey 1999-2018, linked to the National Death Index for cause-specific mortality follow-up through December 31, 2019. Premature CVD mortality was defined as death before age 75 with underlying ICD-10 codes for heart disease or stroke. SDOH included employment, family income-poverty ratio, food security, education, healthcare access, insurance status, home ownership, and marital status. We estimated average population attributable fractions to quantify the contribution of each SDOH to premature CVD mortality by self-reported race/ethnicity. Models controlled for age, sex, and survey year. Results: Combined SDOH accounted for >50% of US population-level premature CVD mortality among US adults (Figure). Among Black adults, SDOH accounted for 64.2% of premature CVD mortality, which was larger than that for Hispanic (58.4%) and White (55.0%) adults. Unemployment was generally the SDOH most strongly associated with premature CVD mortality, with PAFs (95% confidence intervals) ranging from 14.7% (7.3-22.0%) among White adults to 20.8% (7.7-33.9%) among Black adults. Low family income-poverty ratio contributed an additional 27.3% of premature CVD mortality in Black adults. Conclusion: SDOH account for >50% of premature CVD deaths in US adults but contributions differ by race/ethnicity. Interventions targeting SDOH may simultaneously reduce premature CVD mortality among all adults while addressing associated disparities.

Healthcare Burden and Resource Utilization After Pediatric Acute Respiratory Distress Syndrome: A Secondary Analysis of the Collaborative Pediatric Critical Care Research Network Acute Respiratory Distress Syndrome Study.

To describe family healthcare burden and health resource utilization in pediatric survivors of acute respiratory distress syndrome (ARDS) at 3 and 9 months. Secondary analysis of a prospective multisite cohort study. Eight academic PICUs in the United States (2019-2020). Critically ill children with ARDS and follow-up survey data collected at 3 and/or 9 months after the event. None. We evaluated family healthcare burden, a measure of healthcare provided by families at home, and child health resource use including medication use and emergency department (ED) and hospital readmissions during the initial 3- and 9-month post-ARDS using proxy-report. Using multivariable logistic regression, we evaluated patient characteristics associated with family healthcare burden at 3 months. Of 109 eligible patients, 74 (68%) and 63 patients (58%) had follow-up at 3- and 9-month post-ARDS. At 3 months, 46 families (62%) reported healthcare burden including (22%) with unmet care coordination needs. At 9 months, 33 families (52%) reported healthcare burden including 10 families (16%) with unmet care coordination needs. At month 3, 61 patients (82%) required prescription medications, 13 patients (18%) had ED visits and 16 patients (22%) required hospital readmission. At month 9, 41 patients (65%) required prescription medications, 19 patients (30%) had ED visits, and 16 (25%) required hospital readmission were reported. Medication use was associated with family healthcare burden at both 3 and 9 months. In a multivariable analysis, preillness functional status and chronic conditions were associated with healthcare burden at month 3 but illness characteristics were not. Pediatric ARDS survivors report high rates of healthcare burden and health resource utilization at 3- and 9-month post-ARDS. Future studies should assess the impact of improved care coordination to simplify care (e.g., medication management) and improve family burden.

(250) A Case Study with an Egyptian Transgender Woman's Transitioning Phases

Abstract Introduction Transgender individuals face numerous challenges in their journey to affirm their gender identity. In Egypt, transgender individuals face additional challenges due to social and legal constraints. This case study aims to provide an in-depth look at the transitioning phases of an Egyptian transgender woman, including the challenges she faced and the support she received. Objective The objective of this study is to investigate the transitioning phases of an Egyptian transgender woman in her thirties, including demographic history, social and legal constraints, past traumas, psychiatric management, medical and surgical procedures, and outcome. Methods This study will use a case study approach, focusing on a single Egyptian transgender woman. Data will be collected from interviews with the participant, as well as with her family members, friends, and healthcare providers. The interviews will cover topics such as demographic history, social and legal constraints, traumas, psychiatric management, medical and surgical procedures, and outcome. Written consent was acquired from the participant, her family and all involved parties. Conflict of Interest: the author declares that he was the psychotherapist for the participant before, during and after the transition, the psychotherapy was ended 4 years ago Results The data collected from the interviews will be analyzed using thematic analysis to identify common themes and patterns related to the participant’s transitioning phases. The analysis will focus on the challenges faced by the participant, as well as the support she received from her family, friends, and healthcare providers. Conclusions This case study aims to provide valuable insights into the transitioning phases of an Egyptian transgender woman. By identifying the challenges faced by the participant and the support she received, this research can inform the development of strategies for improving the health and well-being of transgender individuals in Egypt. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: rakhawy hospital for mental health.

Don Bloch nomination letter.

Don Bloch nomination letter.

Contemplating on the end of integrated care-part II: Living the questions to foster adaptability.

This article extends the use of the ecocycle planning framework to describe challenges ahead for the integrated care and Collaborative Family Healthcare Association (CFHA). The authors make the case that to remain agile and adaptable, there are contextual, ecological, and moral challenges that integrated care and CFHA should keep in the forefront as they navigate the future of an inequitable health care system that is morphing at a rapid pace. These influences include but are not limited to challenges of social determinants of health, artificial intelligence, generational differences in technology among older and younger populations, the moral issue of poverty, challenges to retain an integrated care workforce, and rethinking development of evidence-based supported treatments for integrated care. (PsycInfo Database Record (c) 2024 APA, all rights reserved).