Inequalities In Health Care Research Articles

A Genomic Revolution: Advancing Health and Knowledge in Latin America

Editorial: Pioneering Genetics and Genomics Research for Regional Progress As we enter the second year of the Genetics and Clinical Genomics Journal, there is much anticipation for the future of this field in the region. It’s remarkable to see how far we’ve come in such a short time. This journal was born from a vision to bring together the best of genetics and genomics research and make a meaningful impact on healthcare and education in our region. That vision is becoming a reality, thanks to the incredible contributions of our authors and the support of our readers. This issue features an impressive selection of articles that highlight the power of genomic research to transform lives. Our Case Reports section includes stories of rare and complex conditions where genetics has played a critical role: In Hypotonic syndrome as a manifestation of an ultra-rare disease caused by a novel de novo variant in the PLA2G6 gene, we see the intricate process of solving a diagnostic mystery and its profound implications for patient care. De novo variant in the COL1A1 gene associated with an orphan genetic disease: Type I osteogenesis imperfecta sheds light on a rare condition that challenges both families and clinicians but also presents opportunities for targeted treatments. De novo genetic variant in Epileptic Encephalopathy: The importance of specific diagnosis highlights how pinpointing a genetic cause can lead to more effective therapeutic strategies. Finally, Detection of a genetic variant in Apert syndrome examines a condition that, while rare, has significant developmental and therapeutic implications. Our Review Articles, Literature review and Advances and perspectives on genetic pathologies in the 21st century, provide valuable overviews of current trends and emerging possibilities, serving as essential guides for anyone engaged in genetic research or clinical practice. Why This Matters Genetics and genomics are no longer rare disciplines they’re reshaping how we understand health and disease. In our region, this knowledge has the potential to address long-standing healthcare inequities, ensuring that advances in precision medicine benefit all communities, not just a select few. Equally exciting is the role genetics can play in education. Training the next generation of healthcare providers and researchers to harness the power of genomics is essential. By investing in education, we’re laying the groundwork for a future where genomic medicine is fully integrated into everyday practice. This journal is a testament to what’s possible when we work together—scientists, clinicians, educators, and policymakers. It’s an invitation to keep pushing boundaries, asking tough questions, and finding answers that matter. Thank you for joining us on this journey. I hope you find this issue inspiring, thought-provoking, and a reminder of the incredible potential within genetics and genomics to create a healthier, more equitable world.

The impact of game play on dementia knowledge: A student evaluation of the Dementia Inequalities Game.

Background: People with dementia and carers can face many barriers, or inequalities, in accessing a diagnosis or care. These barriers are unjust and can be addressed by the right interventions, to ensure that everyone receives equitable access to diagnosis and care. A lack of knowledge about dementia in the health and social care workforce is a recognised barrier. The Dementia Inequalities Game was co-produced with people with personal, professional, and voluntary sector experiences of dementia, and offers an educational tool to educate people about dementia and associated inequalities and overcome this knowledge gap in the current and future (in training) workforce. Aims: The aim of this study was to assess the impact of playing the co-produced Dementia Inequalities Game on knowledge about dementia and associated inequalities in health care, allied health professional, nursing and psychology students.Methods: We conducted 11 game play workshops as part of regular teaching in undergraduate and postgraduate courses in psychology, nursing, occupational therapy, physiotherapy, orthoptics, and radiography at one University in the North of England. Students did not have to partake in the workshops. Participating students completed a brief before and after knowledge questionnaire about dementia and inequalities. Paired samples t-tests were used to compare ratings of knowledge of dementia and associated inequalities before and after game play.Findings: Three-hundred-and-eighteen students took part in the workshops, with 312 fully completed questionnaires. The largest cohort of students (49%) were studying for a degree in nursing. Playing the game significantly increased knowledge about dementia (p < .001) and dementia inequalities (p < .001).Implications: Playing the Dementia Inequalities Game is an effective tool to improve knowledge about dementia and associated inequalities in health care and psychology students. Using the game as an educational and sociable intervention in health and social care professionals is a next avenue to test.

Stigma and lack of access to quality healthcare in the transgender population.

More than 1.6 million US adults identify as transgender (that is, a gender different than the one traditionally associated with the biologic sex assigned to them at birth). These patients suffer from healthcare inequity and lack of access to healthcare, causing a public health crisis. This article seeks to raise awareness of this issue and encourage clinicians and healthcare systems to make meaningful changes to reduce healthcare stigma for transgender patients.

Development of an evidence- and consensus-based Digital Healthcare Equity Framework.

To develop an evidence- and consensus-based Digital Healthcare Equity Framework (the Framework) that guides users in intentionally considering equity in healthcare solutions that involve digital technologies. We conducted an environmental scan including a scoping review of the literature and key informant interviews with health equity and digital healthcare technology thought leaders and convened a technical expert panel (TEP). We grouped similar concepts from the scoping review and key informant interviews, synthesized them into several primary domains and subdomains, and presented the composite list of domains and subdomains to the TEP for their input. From those, we derived the following domains for the Framework: (1) Patient and Community Characteristics, (2) Health System Characteristics, and (3) Health Information Technology Characteristics. We structured the Framework around the following 5 phases of the digital healthcare lifecycle: planning, development, acquisition, implementation/maintenance, and monitoring/improvement/equity assessment. The proposed Framework is designed to specify the aspects that need to be considered in a systematic and intentional approach to ensure digital healthcare solutions improve, and not exacerbate, healthcare inequities. The proposed Framework serves as a tool to help users and other stakeholders assess whether their healthcare solutions that involve digital technologies are equitable at every phase of the digital healthcare lifecycle.

Artificial intelligence-generated feedback on social signals in patient-provider communication: technical performance, feedback usability, and impact.

Implicit bias perpetuates health care inequities and manifests in patient-provider interactions, particularly nonverbal social cues like dominance. We investigated the use of artificial intelligence (AI) for automated communication assessment and feedback during primary care visits to raise clinician awareness of bias in patient interactions. (1) Assessed the technical performance of our AI models by building a machine-learning pipeline that automatically detects social signals in patient-provider interactions from 145 primary care visits. (2) Engaged 24 clinicians to design usable AI-generated communication feedback for their workflow. (3) Evaluated the impact of our AI-based approach in a prospective cohort of 108 primary care visits. Findings demonstrate the feasibility of AI models to identify social signals, such as dominance, warmth, engagement, and interactivity, in nonverbal patient-provider communication. Although engaged clinicians preferred feedback delivered in personalized dashboards, they found nonverbal cues difficult to interpret, motivating social signals as an alternative feedback mechanism. Impact evaluation demonstrated fairness in all AI models with better generalizability of provider dominance, provider engagement, and patient warmth. Stronger clinician implicit race bias was associated with less provider dominance and warmth. Although clinicians expressed overall interest in our AI approach, they recommended improvements to enhance acceptability, feasibility, and implementation in telehealth and medical education contexts. Findings demonstrate promise for AI-driven communication assessment and feedback systems focused on social signals. Future work should improve the performance of this approach, personalize models, and contextualize feedback, and investigate system implementation in educational workflows. This work exemplifies a systematic, multistage approach for evaluating AI tools designed to raise clinician awareness of implicit bias and promote patient-centered, equitable health care interactions.

Impact of the COVID-19 pandemic on the HIV care continuum and associated factors in middle-income countries: A mixed-methods systematic review.

The HIV care continuum during the COVID-19 era faced specific challenges. The pandemic, affecting the delivery of HIV care, exacerbated existing healthcare inequities and vulnerabilities in middle-income countries with limited financial resources. This study aims to set the stage for the systematic review, focusing on the impact of COVID-19 on HIV care in middle-income countries with a focus on barriers and facilitators. A systematic search of relevant literature, including electronic databases and manual assessment of references, was done. The review included quantitative, qualitative and mixed-methods studies conducted in middle-income countries, with no age or gender restrictions. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for reporting the results. In the course of our systematic review, a comprehensive examination of the pertinent literature published between 2020 and 2024 yielded a total of 76 studies. This adverse impact was prominently attributed to an amalgamation of factors intrinsically associated with pandemic-induced restrictions, fear of contracting the COVID-19 and fear of disclosing HIV status. Moreover, an emergent theme observed in select studies underscored the enduring trend of HIV treatment continuity, which was facilitated by the burgeoning utilization of telemedicine within this context. The pandemic negatively affected income and increased vulnerability to HIV across all phases of the HIV care continuum, except for viral suppression. Prevention measures, such as pre-exposure prophylaxis (PrEP), were compromised, leading to increased risky behaviours and compromised mental health among people living with HIV. HIV testing and diagnosis faced challenges, with reduced access and frequency, particularly among key populations. The pandemic also disrupted linkage and retention in care, especially in urban areas, exacerbating barriers to accessing necessary HIV treatment. Additionally, this review highlights the complex and multifaceted landscape of the pandemic's impact on HIV medical appointments, adherence and treatment engagement, with various barriers identified, including fear of COVID-19, economic constraints and disruptions in healthcare services. The coexistence of pandemics has had negative effects on the HIV care continuum, with restrictions on services, an increase in care gaps and a break in the transmission chain in middle-income countries.

Beyond Tuskegee: A contemporary qualitative assessment of barriers to research participation among Black women.

Health care inequities have partially contributed to the existing racial gaps in health. Despite having lower incidence rates of breast cancer, Black women have a 41% higher mortality rate than White women. Black individuals remain underrepresented in research. Diversity in research is paramount to the improvement of clinical care practices and subgroup-specific guidelines. Black women from various community venues across geographic regions of the United States were invited via email, online fliers, social media platforms, and word of mouth to participate in focus groups. Six online focus groups of six to 10 Black women aged 25-65 years (N=38) with and without a history of cancer were conducted with an in-depth semistructured discussion guide. Most participants were college educated (32 of 38; 84.2%), aged 50 years or older (31 of 38; 81.6%), and had an annual income of $50,000 or more (26 of 38; 68.4%). Several barriers to research participation were identified. They included a lack of empathy and respect in health care settings, apprehension regarding the sharing of personal information, mistrust of medical research, and logistical/technical barriers. Alternatively, building individual and community trust and communicating the value of conducting research beneficial to the Black community were viewed as facilitators to research participation. Successful engagement of Black women in research requires the acknowledgment and consideration of the numerous barriers that affect their ability to participate. Black women are more inclined to participate in research when the research team is knowledgeable, has experience within their communities, and engages trusted community partners. Additionally, the research must be meaningful and impactful to future generations of Black women.

Cancer Clinical Trial Participation: A Qualitative Study of Black/African American Communities' and Patient/Survivors' Recommendations.

Black/African Americans experience a disproportionate cancer burden and mortality rates. Racial/ethnic variation in cancer burden reflects systemic and healthcare inequities, cancer risk factors, and heredity and genomic diversity. Multiple systemic, socio-cultural, economic, and individual factors also contribute to disproportionately low Black/African American participation in cancer clinical trials. The Participatory Action for Access to Clinical Trials project utilized a community-based participatory research (CBPR) approach inclusive of Black/African American community-based organizations (CBOs), Henry Ford Health (HFH), and the University of Michigan Urban Research Center. The project aims were to understand Black/African Americans' behavioral intentions to participate in cancer clinical trials and to obtain recommendations for improving participation. Audio-recorded focus group data were transcribed, coded, and searches were conducted to identify themes and subthemes. Representative text was extracted from the transcripts. Six community focus group discussions (70 participants) and six HFH patient/survivor focus group discussions (29 participants) were completed. General themes related to trial participation were identified including: 1) systemic issues related to racism, health disparities, and trust in government, health systems, and clinical research; 2) firsthand experiences with healthcare and health systems; 3) perceived and experienced advantages and disadvantages of clinical trial participation; and 4) recruitment procedures and personal decision-making processes. Specific recommendations on how to address barriers were obtained. CBPR is effective in bringing communities equitably to the table. To build trust, health systems must provide opportunities for patients and communities to jointly identify factors affecting cancer clinical trial participation, implement recommendations, and address health disparities.

Racial health disparities in the United States

Abstract Disparities between Black and White Americans in health care coverage and health outcomes are pervasive in the United States. In this paper, we describe the evolution of the market-based approach to health insurance and health care delivery in the United States and its implications for racial disparities. First, we discuss the history of the United States’ predominantly private health insurance system. Second, we illustrate the persistence and pervasiveness of disparities through three present-day epidemics: maternal mortality, opioid use, and Covid-19. Through the epidemic case studies, we highlight the systemic roots of racial inequality in health care. Finally, we conclude with a brief discussion of potential policy approaches for reducing disparities in the health care system.

Healthcare inequity arising from unequal response to need in the older (45+ years) population of India: Analysis of nationally representative data

Given the large and growing number of older (45+ years) people in India, inequitable access to healthcare in this population would slow global progress toward universal health coverage. We used a 2017-18 nationally representative sample of this population (n = 53,687) to estimate healthcare inequality and inequity by economic status. We used an extensive battery of indicators in nine health domains, plus age and sex, to adjust for need. We measured economic status by monthly per capita consumption expenditure and used a concentration index to measure inequalities in probabilities of any doctor visit and any hospitalisation within 12 months. We decomposed inequality with a regression method that allowed for economic and urban/rural heterogeneity in partial associations between healthcare and both need and non-need covariates. We used the associations achieved by the richest fifth of urban dwellers to predict a need-justified distribution of healthcare and compared the actual distribution with that benchmark to identify inequity. We found pro-rich inequalities in doctor visits and hospitalisations, which were driven by use of private healthcare. Adjustment for the greater need of poorer individuals revealed pro-rich inequity that exceeded inequality by about 65% and 39% for doctor visits and hospitalisations, respectively. These adjustments would have been substantially smaller, and inequity underestimated, without allowing for use-need heterogeneity, which accounted for 11% of the inequity in doctor visits and was 373% of inequity in hospitalisations. Targeting service coverage on poorer and rural groups, and increasing their access to private providers, would both reduce inequity and raise average coverage in the older population of India.

Geographical health inequalities in India: the impact of the COVID-19 pandemic on healthcare access and healthcare inequality

PurposeWith an emphasis on spatial health disparities, this study examines how COVID-19 has affected healthcare access and inequality in India. The study developed the Healthcare Access Index (HAI) and Healthcare Inequality Index (HII) to assess the pandemic’s effects on healthcare. The study addresses spatial health disparities in healthcare access and inequality, filling gaps in the literature. The final aim of the study is to offer policy suggestions to lessen healthcare inequities in India, particularly in the context of COVID-19.Design/methodology/approachThe study incorporates secondary data from publicly accessible databases such as the National Family Health Survey, Niti-Ayog and Indian Census databases and employs a quantitative research design. The impact of the COVID-19 pandemic on healthcare access and healthcare inequality in India is examined using the HAI and the HII. The five dimensions of healthcare access – availability, accessibility, accommodation, cost and acceptability – were used in developing the HAI. The study uses a panel data analysis methodology to examine the HAI and HII scores for 19 states over the pre-COVID-19 (2015) and post-COVID-19 (2020) periods. In order to investigate the connection between healthcare access, healthcare inequality and the COVID-19 pandemic, the analysis employs statistical tests such as descriptive statistics, correlation analysis, factor analysis and visualization analysis.FindingsAccording to the study, COVID-19 impacted healthcare access and inequality in India, with notable regional inequalities between states. The pandemic has increased healthcare disparities by widening the gap between states with high and low HII ratings. Healthcare access is closely tied to healthcare inequality, with lower levels of access being associated with more significant levels of inequality. The report advises governmental initiatives to lessen healthcare disparities in India, such as raising healthcare spending, strengthening healthcare services in underperforming states and enhancing healthcare infrastructure.Practical implicationsFor Indian healthcare authorities and practitioners, the study has significant ramifications. In light of the COVID-19 pandemic, there has been a main focus on addressing geographic gaps in healthcare access and inequality. The report suggests upgrading transportation infrastructure, lowering out-of-pocket costs, increasing health insurance coverage and enhancing healthcare infrastructure and services in underperforming states. The HAI and the HII are tools that policymakers can use to identify states needing immediate attention and appropriately spend resources. These doable recommendations provide a framework for lowering healthcare disparities in India and enhancing healthcare outcomes for all communities.Originality/valueThe study’s originality resides in establishing the HAI and HII indices, using panel data analysis and assessing healthcare inequality regarding geographic disparities. Policy choices targeted at lowering healthcare disparities and enhancing healthcare outcomes for all people in India can be informed by the study’s practical consequences.

Social justice as nursing resistance: a foucauldian discourse analysis within emergency departments.

Social justice is consistently upheld as a central value within the nursing profession, yet there are persistent inconsistencies in how this construct is conceptualized, further compounded by a lack of empirical inquiry into how nurses enact social justice in everyday practice. In the current context in which structural inequities are perpetuated throughout the health care system, and the emergency department in particular, it is crucial to understand how nurses understand and enact social justice as a disciplinary commitment. This research examines how nurses' talk and institutional texts discursively construct social justice within the institutional context of the emergency department, and how such discourses shape the enactment of social justice within nursing practice. Guided by Iris Marion Young's theorizing of distributive and systemic social justice paradigms, this Foucauldian discourse analysis draws on emergency department nurses' talk (N = 25 interviews) and institutional documents (N = 27) as key texts that visibilize dominant and excluded discourses of social justice within the institutional context of the emergency department, and implications for how social justice is enacted through nursing practices. This analysis identified one overarching discursive pattern, in which social justice was discursively constructed through a hegemonic distributive paradigm, yet also resisted through nurses' conceptualization and enactment of a systemic social justice paradigm that facilitated their recognition and remediation of inequities. This central discursive pattern is explored through three exemplars of nurses' enactment of social justice as resistance: triage, harm reduction, and care planning. Findings from this analysis demonstrate that while a hegemonic distributive paradigm has dominated conceptualizations of social justice within nursing, a re-construction of social justice through a systemic paradigm may guide nurses in enacting practices that remediate inequities in health and health care.

IMPACTO DA PNEUMONIA NA MORTALIDADE INFANTIL: ANÁLISE HOSPITALAR NO ESTADO DA BAHIA

Introduction: Pneumonia is a severe respiratory infection, often caused by bacteria, viruses, or fungi, that primarily affects the lungs and can impair gas exchange, leading to respiratory difficulties. In Brazil, pneumonia presents a significant public health challenge, with a particular impact on children under five years of age. This issue is especially evident in the state of Bahia, where the infant mortality rate due to pneumonia is one of the highest in the country. The causes of this high mortality are linked to a combination of factors such as lack of access to adequate medical care, low vaccination coverage, poor living conditions, overcrowded homes, and insufficient air quality. Objectives: The main objective of this study is to analyze the impact of pneumonia on infant mortality in the state of Bahia, focusing on hospital data analysis between 2020 and 2024. The research aims to identify the epidemiological trends of the disease, understand the associated risk factors, and encourage the implementation of public policies to reduce infant mortality caused by pneumonia. Justification: This research is relevant to public health because it highlights the persistent high rates of infant mortality due to pneumonia, a critical issue in socially vulnerable areas. The study contributes to understanding the social, economic, and healthcare access factors affecting the child population in Bahia, providing essential data for more effective public health policies. Methodology: The study is of an epidemiological nature, using a quantitative approach. Data were collected from records of pediatric pneumonia cases provided by the Health Department of the State of Bahia (SESAB) and DATASUS, covering the period from 2020 to 2024. Data on incidence, mortality, demographic characteristics (age, sex, race/ethnicity), and regional conditions were analyzed. The analysis was performed using descriptive statistics and techniques such as calculating mortality rates and identifying risk factors. Results and Discussion: The data revealed that between January 2020 and September 2024, there were 295 deaths due to pneumonia in children in Bahia. The highest mortality was observed in the age groups under 1 year (33.6%) and 1 to 4 years (37.3%), indicating extreme vulnerability of these age groups to the disease. Additionally, pneumonia mortality was higher among children of mixed-race (parda) background (76.3%), reflecting socioeconomic and healthcare access inequalities, particularly in peripheral and rural areas. A slight predominance of deaths among girls was also observed, though the gender difference was small (2.37%). Conclusion: This study highlights the social and regional inequalities contributing to high infant mortality from pneumonia in Bahia, emphasizing the difficulties in accessing healthcare services in more vulnerable areas. The analysis revealed that children under 5 years of age, especially those under 1 year old, are the most affected. To reduce these rates, it is urgent to implement public policies focused on improving healthcare access, expanding vaccination coverage, and strengthening living conditions in the most underserved areas of Bahia.

Inequality in Reproductive Health Care and Medical Research Knowledge in The Welkin by Lucy Kirkwood

Inequality in Reproductive Health Care and Medical Research Knowledge in The Welkin by Lucy Kirkwood

Abstract 4147614: Prevalence and Impact of Stroke In Young (18-44 Years) ACHD-Related Admissions by Median Household Income Quartiles: A 2019 National Inpatient Sample Analysis

Background: The risk of stroke in Adult Congenital Heart Disease (ACHD) is well established. However, the prevalence and impact of stroke in young ACHD-related admissions stratified by median household income remain underexplored. Methods: The National Inpatient Sample (2019) was utilized to identify the rate of stroke admissions among young (18-44 years) ACHD patients. We also evaluated comorbidities and outcomes (all-cause mortality [ACM], length of stay [LOS], disposition,&amp;charges) based on the median household income quartiles and compared two cohorts of lowest (0-25th percentile) and highest (75-100thpercentile) median household income (LMHI vs HMHI). Results: Of 41950 young (18-44 years) ACHD patients, 5360 patients had stroke (12.8%). Patients in the LMHI group were relatively older (median age 36 years vs 35 years) and had a greater proportion of males (53.8% vs 46.0%) when compared to patients in the HMHI group. Patients admitted with stroke were of greater proportion in the LMHI group (13.2% vs 12.1%) compared to the HMHI group. Comorbidities like alcohol abuse (4.7% vs. 2.3%), depression (9.8% vs. 7.0%), hypertension (13.0% vs. 5.6%), obesity (21.2% vs. 18%), drug abuse (12.3% vs 4.2%), and tobacco use disorder (30.4% vs 11.2%) were higher for LMHI when compared to HMHI. Regarding in-hospital outcomes, ACM (3.7 vs. 1.9%) and discharge to home (71.6 vs. 66.5) were higher with HMHI, whereas the LMHI cohort demonstrated fewer routine discharges, higher transfers to other facilities, and prolonged LOS (5 vs. 3 days, p&lt;0.001). When adjusted for confounders, there were statistically higher odds of AIS in ACHD patients from the LMHI group vs. the HMHI group [aOR 1.33; 1.02-1.74; p=0.045]. However, no association of income quartile with overall stroke risk was observed. Conclusion: The prevalence of stroke is significantly higher in the LMHI group. When controlled for confounders, there was a higher risk of AIS without any impact on overall stroke. Furthermore, the lowermost income quartile was associated with fewer routine dispositions, and frequent transfers can further adversely increase healthcare inequalities and healthcare costs.

The Missing Voices, an exploration of what healthcare-related research would matter to Global Ethnic Majority Women in Aberdeenshire, Scotland

Abstract Introduction In multicultural communities, such as the UK, published evidence has indicated that patients from marginalised backgrounds experience healthcare inequality and inequity with regards to accessibility and safety.1 The lack of appropriate ethnic representation in healthcare-related research, has been identified as a potential causation of some of these disparities and poorer health outcomes.2,3 The focus of this project was the marginalised communities identified by the NIHR to have poorer health outcomes, such as Global Ethnic Majority (GEM) women. Aim To explore what healthcare research matters to marginalised communities with a focus on lived and perceived experiences on access to healthcare for GEM women in Aberdeen city and Aberdeenshire, Scotland. Methods This pilot project captured real world data through an inclusive community engagement approach of reaching within rather than reaching out. A framework of 5Cs (Connect, Collaborate, Consult, Co-create and Circulate) was used to establish a diverse panel of ten GEM women. All panel members had a passion for equality and wellbeing as well as diverse lived experiences. The method used to establish the panel is presented elsewhere. Based on a review of literature, open-ended, flexible, thought-provoking questions for the discussions were developed and circulated to all panel members for approval. These questions were used to guide both in-person and virtual open discussions with aforementioned stakeholders to capture narratives and perspectives around barriers and facilitators to equitable healthcare access in the area. As the public members were research partners and not participants, no ethical approval was required as advised by a professor of pharmacy research and the school’s ethics convenor. The project had three main objectives. This submission will only report on objective three that aimed to Identify and prioritise research questions relating to equitable access to healthcare and the needs of marginalised minority ethnic communities. Results The objective was met. A list of emergent themes from the pre-panel questions and a list of panel-approved research questions were devised with a focus on access to healthcare. The emergent themes were around accessibility and equity of maternal/reproductive healthcare, lack of early screening for high-risk GEM groups and culturally appropriate approaches to mental healthcare. Solution focused recommendations included the design of an inclusive healthcare curriculum, compulsory EDI and cultural competency training for healthcare professionals who practice in diverse communities, additional screening programmes tailored to specific GEM groups based on prevalence and risk factors and the development of localised culturally appropriate and inclusive community programmes, especially for those who support new immigrants. Mistrust and lack of inclusive language were mentioned as potential barriers to participating in research. Discussion / Conclusion This pilot offered the historically under-represented and usually silent communities an equal voice within a trusting and collaborative environment. Over ten years after the enaction of the UK Equality Act (2010) inequity in healthcare access and poor outcomes are still evident. The outcomes of this small pilot study highlight that GEM-specific projects should be driven by that community.

MSphere of Influence: Venturing outside the biology canon with sex and gender.

Victoria Prieto-Echagüe works in the field of signaling by primary cilia, adipogenesis, and obesity. In this mShpere of Influence article, she reflects on how gender studies, feminism, and societal movements such as #metoo may inform all areas of biomedical and health research. She describes how they inspired her to incorporate sex as a biological variable (SABV) principle to her research exploring sex-specific mechanisms in obesity and metabolic diseases and argues that incorporating SABV is crucial for advancing precision medicine and addressing healthcare inequities.

Measuring attitudes towards ethnic minority patients: the revalidated REMP-3 instrument for graduate healthcare practitioners

ObjectiveMeasuring intercultural attitudes can aid in understanding and addressing persistent inequities in healthcare. Instead of creating new instruments, several sources call for a more rigorous revalidation of existing instruments towards a more broad population. As an example of such an existing instrument, the EMP-3 (Ethnic Minority Patients) focuses on the attitudes of physicians towards ethnic minority patients. Starting from a robust theoretical underpinning and a rigorous methodological setup, the present study revalidates the EMP-3 instrument for physicians towards the REMP-3 instrument for graduate healthcare practitioners.MethodsWe assessed the reliability and validity of the old EMP-3, which we then updated to a new REMP-3 instrument. We used structural equation modeling to model the framework of intercultural effectiveness on two waves of independent data, N2021 = 368 and N2022 = 390. Within this framework, we tested the new REMP-3 instrument as an operationalization of intercultural attitudes. We conducted a confirmatory factor analysis on the first wave, after which we made adaptations to the original EMP-3 instrument to obtain a new REMP-3 instrument. The new REMP-3 instrument was then cross-validated using the data of the second wave.ResultsThe new REMP-3 instrument is a psychometric upgrade compared to the EMP-3. The REMP-3 now has a cross-validated structure, with three subscale dimensions (i.e., task perception, background perception and the perceived need to communicate) and an overarching higher-order, full-scale dimension. Both the subscales as well as the full instrument show acceptable to good internal consistency reliability, with a reduced number of items from eighteen to ten. As theoretically predicted, the REMP-3 also functions as a measure of intercultural attitudes in an intercultural competence framework.ConclusionUltimately, the REMP-3 instrument can contribute to more equity in healthcare by concisely and reliably assessing and monitoring attitudes in healthcare practitioners. This attitude assessment represents the potential of learning new skills and knowledge to address interactions with ethnic minority patients, which is especially useful during training situations like an internship.

Sociodemographic and Clinical Characteristics Associated With Veterans’ Digital Needs

Telehealth can expand access to care, but digital needs present barriers for some patients. To investigate sociodemographic and clinical associations of digital needs among veterans. This quality improvement study used data collected between July 2021 and September 2023 from Assessing Circumstances and Offering Resources for Needs (ACORN), a Department of Veterans Affairs (VA) initiative to systematically screen for, comprehensively assess, and address social risks and social needs. Eligible participants were veterans screened for social risks and social needs during routine care at 12 outpatient clinics, 3 emergency departments, and 1 inpatient unit across 14 VA medical centers. Data analysis occurred between October 2023 and January 2024. The ACORN screening tool was administered by clinical staff. Veterans were considered positive for a digital need if they reported no smartphone or computer, no access to affordable and reliable internet, running out of minutes and/or data before the end of the month, and/or requested help setting up a video telehealth visit. Among 6419 veterans screened (mean [SD] age, 67.6 [15.9] years; 716 female [11.2%]; 1740 Black or African American [27.1%]; 202 Hispanic or Latino [3.1%]; 4125 White [64.3%]), 2740 (42.7%) reported 1 or more digital needs. Adjusting for sociodemographic and clinical characteristics, the adjusted prevalence (AP) of lacking a device among veterans aged 80 years or older was 30.8% (95% CI, 27.9%-33.7%), 17.9% (95% CI, 16.5%-19.2%) among veterans aged 65 to 79 years, 9.9% (95% CI, 8.2%-11.6%) among veterans aged 50 to 64 years, 3.4% (95% CI, 2.1%-4.6%) among veterans aged 18 to 49 years, 17.6% (95% CI, 16.7%-18.6%) for males, and 7.9% (95% CI, 5.5%-10.3%) for females. AP of lacking affordable or reliable internet was 25.3% (95% CI, 22.6%-27.9%) among veterans aged 80 years or older, 15.0% (95% CI, 12.1%-18.0%) among veterans aged 18 to 49 years, 31.1% (95% CI, 28.9%-33.4%) for Black or African American veterans, 32.1% (95% CI, 25.2%-39.0%) for veterans belonging to other racial groups (ie, American Indian or Alaska Native, Asian, Native Hawaiian or Other Pacific Islander, as well as those with more than 1 race captured in their medical record), and 19.4% (95% CI, 18.2%-20.6%) for White veterans. Veterans with dementia were at higher risk of lacking a device (adjusted relative risk [aRR], 1.21; 95% CI, 1.00-1.48). Veterans with high medical complexity were at higher risk of lacking internet (aRR, 1.26; 95% CI, 1.11-1.42). Veterans with dementia (aRR, 1.58; 95% CI, 1.24-2.01) or substance use disorder (aRR, 1.22; 95% CI, 1.00-1.49) were more likely to want help scheduling a telehealth visit than those without. In this quality improvement study of veterans screened for social risks and social needs, there were substantial disparities in digital needs. These findings suggest that routine screening is important to understand patients' digital access barriers and connect patients with telehealth resources to address inequities in health care.

Health and Social Care Inequalities During the First Wave of COVID-19 in Italy; Comment on "Experiences and Implications of the First Wave of the COVID-19 Emergency in Italy: A Social Science Perspective".

The impact of COVID-19 on the Italian population is well-known and has been deeply analysed under the clinical and epidemiological perspectives where the majority of the studies focused on the beginning of the first wave (March-May 2020). However, there is a need for analysing this complex phenomenon integrating the clinical side with the economic and social lens to better understand implications of a pandemic for populations. In their paper Masino and Enria focused the attention on four specific perspectives: health system reaction to the pandemic, inequalities in the work world, social care from the elderly point of view and the government communication challenges. In this commentary, I take these different perspectives trying to outline how they have been explored and analysed during these three years after their publication.