Inequalities In Health Care Research Articles

European Society of Cardiology: the 2023 Atlas of Cardiovascular Disease Statistics.

This report from the European Society of Cardiology (ESC) Atlas Project updates and expands upon the 2021 report in presenting cardiovascular disease (CVD) statistics for the ESC member countries. This paper examines inequalities in cardiovascular healthcare and outcomes in ESC member countries utilizing mortality and risk factor data from the World Health Organization and the Global Burden of Disease study with additional economic data from the World Bank. Cardiovascular healthcare data were collected by questionnaire circulated to the national cardiac societies of ESC member countries. Statistics pertaining to 2022, or latest available year, are presented. New material in this report includes contemporary estimates of the economic burden of CVD and mortality statistics for a range of CVD phenotypes. CVD accounts for 11% of the EU's total healthcare expenditure. It remains the most common cause of death in ESC member countries with over 3 million deaths per year. Proportionately more deaths from CVD occur in middle-income compared with high-income countries in both females (53% vs. 34%) and males (46% vs. 30%). Between 1990 and 2021, median age-standardized mortality rates (ASMRs) for CVD decreased by median >50% in high-income ESC member countries but in middle-income countries the median decrease was <12%. These inequalities between middle- and high-income ESC member countries likely reflect heterogeneous exposures to a range of environmental, socioeconomic, and clinical risk factors. The 2023 survey suggests that treatment factors may also contribute with middle-income countries reporting lower rates per million of percutaneous coronary intervention (1355 vs. 2330), transcatheter aortic valve implantation (4.0 vs. 153.4) and pacemaker implantation (147.0 vs. 831.9) compared with high-income countries. The ESC Atlas 2023 report shows continuing inequalities in the epidemiology and management of CVD between middle-income and high-income ESC member countries. These inequalities are exemplified by the changes in CVD ASMRs during the last 30 years. In the high-income ESC member countries, ASMRs have been in steep decline during this period but in the middle-income countries declines have been very small. There is now an important need for targeted action to reduce the burden of CVD, particularly in those countries where the burden is greatest.

Lung cancer mortality trends and disparities: A cross-sectional analysis 1999–2020

BackgroundLung cancer remains a leading cause of morbidity and mortality in the United States. Given the importance of epidemiological insight on lung cancer outcomes as the foundation for targeted interventions, we aimed to examine lung cancer death trends in the United States in the recent 22-year period, exploring demographic disparities and yearly mortality shifts. MethodsMortality information was obtained from the CDC Wide-ranging Online Data for Epidemiologic Research database from the years 1999–2020. Demographic information included age, sex, race or ethnicity, and area of residence. We performed log-linear regression models to assess temporal mortality shifts and calculated average annual percentage change (AAPC) and compared age-adjusted mortality rates (AAMR) across demographic subpopulations. ResultsA total of 3,380,830 lung cancer deaths were identified. The AAMR decreased from 55.4 in 1999-31.8 in 2020 (p<0.001). Males (AAMR 57.6) and non-Hispanic (NH) (AAMR 47.5) populations were disproportionately impacted compared to females (AAMR 36.0) and Hispanic (AAMR 19.1) populations, respectively. NH Black populations had the highest AAMR (48.5) despite an overall reduction in lung cancer deaths (AAPC −3.3 %) over the study period. Although non-metropolitan regions were affected by higher mortality rates, the annual decrease in mortality among metropolitan regions (AAPC −2.8 %, p<0.001) was greater compared to non-metropolitan regions (AAPC −1.7 %, p<0.001). Individuals living in the Western US (AAPC −3.4 %, p<0.001) experienced the greatest decline in lung cancer mortality compared to other US census regions. ConclusionsOur findings revealed lung cancer mortality inequalities in the US. By contextualizing these mortality shifts, we provide a larger framework of data-driven initiatives for societal and health policy changes for improving access to care, minimizing healthcare inequalities, and improving outcomes.

Diversity, Equity, and Inclusion Competencies for a Graduate Nursing Program.

The integration of diversity, equity, and inclusion (DEI) concepts throughout the curriculum is imperative to the preparation of advanced-practice nurses to deliver person-centered care. This article describes the design and evaluation of one institution's faculty-developed DEI competencies for graduate nursing students. A task force of faculty and content experts utilized a modified Delphi approach in the development of DEI-focused competencies related to advanced-level nursing education. A literature review, a faculty survey, and content experts were employed in the modified Delphi approach. Creation of interdisciplinary faculty-lead graduate nursing DEI curricular competencies included an overview, identification of three domains, eight competencies with associated key elements, and a glossary clarifying nine essential DEI terms. The development of DEI competencies for graduate nursing programs is feasible and an important strategy for preparing students with the values and skills to address the ongoing embedded structural inequalities in health care. [J Nurs Educ. 2024;63(X):XXX-XXX.].

A Case of Mauriac Syndrome Caused by Social Inequities in Healthcare: A Call to Action

A Case of Mauriac Syndrome Caused by Social Inequities in Healthcare: A Call to Action

Unit-based Pathways to Reduce InequitieS for familiEs speaking languages other than English (UPRISE).

Health care inequities are common among individuals who speak languages other than English (LOE). Within our PICU, LOE families prefer communication via in-person interpreters (IPI). Spanish-speaking patient families are our largest LOE population; therefore, we sought to increase Spanish IPI utilization for medical updates in the PICU. A quality improvement initiative in a 36-bed PICU included: the addition of a dedicated weekday Spanish-speaking IPI, the creation of communication tools, staff education, optimized identification of LOE families, and development of a language dashboard across multiple Plan, Do, Study, Act cycles. The primary outcome was IPI utilization rates for daily medical updates. Spanish IPI utilization for daily weekday medical updates among 442 Spanish-speaking patient families increased from a median of 39.4% at baseline to a new centerline median of 51.9% during implementation, exhibiting 66.3% (465 of 701) utilization in the final 6 months of implementation. The greatest sustained increases in Spanish IPI utilization occurred after PICU-based IPI implementation, staff education, electronic health record optimization, and a split work week between 2 PICU-based IPIs. This quality improvement initiative increased Spanish IPI utilization for daily weekday medical updates in the PICU across multiple Plan, Do, Study, Act cycles. Future work will adapt these interventions to other languages and other hospital-based units.

Sustainability of specialized healthcare in upper-middle-income economies: Innovations despite constraints

Countries such as Jamaica have had to be largely self-reliant in funding their health-care systems. The success of an early and sustained focus on primary healthcare, coupled with a change in the disease profile from infectious concerns to chronic non-communicable diseases associated with aging, has resulted in a marked rise in healthcare costs. Rapid technological advances in the diagnosis and treatment of many specialized conditions have further increased the cost of care. Funding these health-care costs sustainably is a challenge for Jamaica and other similarly developed economies due to competing demands for scarce funds. In addition to government health-care allocations, sources of sustainable funding from local public-private partnerships, through mechanisms such as philanthropy, may help address, at least in part, this chronic problem. This review examines strategies to create a framework for such funding, as well as proposes specific practical steps for their achievement. The author&amp;rsquo;s motivation to participate in the process of change stems from the stubbornly persistent inequalities of healthcare that people and health-care workers in Jamaica &amp;ndash; and similar lower- and middle-income countries &amp;ndash; routinely cope with. These inequalities must be addressed to truly achieve greater health egalitarianism, social stability, and ultimately, the developed country status they aspire to. The need to think innovatively to achieve this goal is self-evident, given the current inability of governments to achieve this goal.

Ethical challenges in healthcare innovation: A leadership perspective.

Innovation is essential for advancing and sustaining healthcare systems, particularly in hospitals. While innovation offers solutions to challenges such as chronic disease management, access to care, and patient safety, it also introduces significant ethical dilemmas for health leaders. This column explores the broad ethical issues associated with healthcare innovation, focusing on resource allocation, support for diverse healthcare professions, equitable access to care, and the emphasis on technology-based innovations. It highlights the complexities of funding innovation through government, private sector, universities, donors, and the unpaid work of healthcare providers. The column also addresses the disparities in innovation support across different professions and the potential for innovation to exacerbate healthcare inequities. Potential solutions are proposed, including the establishment of interdisciplinary councils, dedicated innovation funds, and public-private partnerships. By prioritizing ethical leadership and balanced innovation strategies, health leaders can ensure that advancements benefit all stakeholders, fostering a more equitable and sustainable healthcare system in Canada.

Challenges and Opportunities in Accessing Surgery for Glioblastoma in Low-Middle Income Countries: A Narrative Review.

Glioblastoma: a highly aggressive brain tumor, presents substantial challenges in treatment and management, with surgical intervention playing a pivotal role in improving patient outcomes. Disparities in access to brain tumor surgery arise from a multitude of factors, including socioeconomic status, geographical location, and healthcare resource allocation. Low- and middle-income countries (LMICs) often face significant barriers to accessing surgical services, such as shortages of specialized neurosurgical expertise, limited healthcare infrastructure, and financial constraints. Consequently, glioblastoma patients in LMICs experience delays in diagnosis, suboptimal treatment, and poorer clinical outcomes compared to patients in high-income countries (HICs). The clinical impact of these disparities is profound. Patients in LMICs are more likely to be diagnosed at advanced disease stages, receive less effective treatment, and have lower survival rates than their counterparts in HICs. Additionally, disparities in access to surgical care exacerbate economic and societal burdens, emphasizing the urgent need for targeted interventions and health policy reforms to address healthcare inequities. This review highlights the importance of addressing global disparities in access to brain tumor surgery for glioblastoma through collaborative efforts, policy advocacy, and resource allocation, aiming to improve outcomes and promote equity in surgical care delivery for all glioblastoma patients worldwide.

Communication Practices for Families With Languages Other Than English in US Neonatal Care Units.

The lack of provision of culturally and linguistically appropriate services (CLAS) to families with languages other than English (LOE) is a highly modifiable driver of health care inequities. In a nationally representative sample of level 2 to 4 US NICUs, we examined patterns and predictors of communication practices for families with LOE and ascertained clinical leaders' beliefs about barriers to CLAS provision. We surveyed clinical leaders from 500 randomly selected US NICUs. Responses were weighted by the number of eligible NICUs per region and nonresponse rates. Outcomes included: consistent parental language documentation (≥75% of the time versus <75%) and consistent professional interpreter use (in-person or remote interpretation ≥75% of the time versus <75%). We used logistic regression to examine the associations of predictors (region, hospital characteristics, and the proportion of racial and ethnic minority and families with LOE served) with outcomes. The overall response rate was 34%. A total of 63% of NICUs collected parental language data consistently, and 41% used interpreters consistently. Patterns of interpreter use varied by service hours and type of communication event. Teaching status, highest level of neonatal care, and larger NICU size were associated with consistent language documentation. Only a larger NICU size was associated with consistent interpreter use. Barriers to CLAS provision included untimely access to interpreter services and suboptimal quality of certain interpretation modalities. Implementation guidance, accountability for compliance with existing mandates, and interventions tailored to the NICU context are needed to reduce linguistic disparities.

Integrated behavioral health implementation and chronic disease management inequities: an exploratory study of statewide data

BackgroundPeople with diabetes, vascular disease, and asthma often struggle to maintain stability in their chronic health conditions, particularly those in rural areas, living in poverty, or racially or ethnically minoritized populations. These groups can experience inequities in healthcare, where one group of people has fewer or lower-quality resources than others. Integrating behavioral healthcare services into primary care holds promise in helping the primary care team better manage patients’ conditions, but it involves changing the way care is delivered in a clinic in multiple ways. Some clinics are more successful than others in fully integrating behavioral health models as shown by previous research conducted by our team identifying four patterns of implementation: Low, Structural, Partial, and Strong. Little is known about how this variation in integration may be related to chronic disease management and if IBH could be a strategy to reduce healthcare inequities. This study explores potential relationships between IBH implementation variation and chronic disease management in the context of healthcare inequities.MethodsBuilding on a previously published latent class analysis of 102 primary care clinics in Minnesota, we used multiple regression to establish relationships between IBH latent class and healthcare inequities in chronic disease management, and then structural equation modeling to examine how IBH latent class may moderate those healthcare inequities.ResultsContrary to our hypotheses, and demonstrating the complexity of the research question, clinics with better chronic disease management were more likely to be Low IBH rather than any other level of integration. Strong and Structural IBH clinics demonstrated better chronic disease management as race in the clinic’s location became more White.ConclusionsIBH may result in improved care, though it may not be sufficient to resolve healthcare inequities; it appears that IBH may be more effective when fewer social determinants of health are present. Clinics with Low IBH may not be motivated to engage in this practice change for chronic disease management and may need to be provided other reasons to do so. Larger systemic and policy changes are likely required that specifically target the mechanisms of healthcare inequities.

Contextualising mental health: interdisciplinary contributions to a new model for tackling social differences and inequalities in mental healthcare

ABSTRACT Many classical approaches in the area of phenomenological pscyhopathology focus on structures of lived experience of mental illness and overlook the role social context plays in the formation of lived experiences. The paper addresses this issue and contributes to recent research which has pointed out that there is a need for an approach to mental health which investigates the role of context in shaping lived experiences. We propose a conception of contextuality (or situatedness) which we develop in terms of two main characteristics: intersectionality and social relationality of the human condition. We take context to be shaped by social interdependence and by the intersection of multiple factors including gender, race, ethnicity, class, socio-economic status and power relations. We develop this analysis in relation to substance misuse, refer to, and compare, certain case studies and perspectives from Brazil to illustrate our approach which can, however, be applied to other areas of mental health. We suggest that the proposed contextual approach is crucial for an in-depth understanding of psychopathology from a phenomenological perspective and in relation to contemporary ethico-political issues concerning social differences and inequalities in mental health.

Fibromyalgia Diagnosis and Treatment Receipt in the U.S. Military Health System.

Meta-analytic findings and clinical practice guidance recommend pharmacological (e.g., pregabalin, duloxetine, and milnacipran) and non-pharmacological (e.g., exercise and sleep hygiene) interventions to reduce symptoms and improve quality of life in people living with fibromyalgia. However, some of these therapies may lack robust evidence as to their efficacy, have side effects that may outweigh benefits, or carry risks. Although the annual prevalence of fibromyalgia in active duty service members was estimated to be 0.015% in 2018, the likelihood of receiving a fibromyalgia diagnosis was 9 times greater in patients assigned female than male and twice as common in non-Hispanic Black than White service members. Therefore, the primary goal of this retrospective study is to examine co-occurring conditions and pain-management care receipt in the 3 months before and 3 months after fibromyalgia diagnosis in active duty service members from 2015 to 2022. Medical record information from active duty service members who received a fibromyalgia diagnosis between 2015 and 2022 in the U.S. Military Health System was included in the analyses. Bivariate analyses evaluated inequities in co-occurring diagnoses (abdominal and pelvic pain, insomnia, psychiatric conditions, and migraines), health care (acupuncture and dry needling, biofeedback and other muscle relaxation, chiropractic and osteopathic treatments, exercise classes and activities, massage therapy, behavioral health care, other physical interventions, physical therapy, self-care management, and transcutaneous electrical nerve stimulation), and prescription receipt (anxiolytics, gabapentinoids, muscle relaxants, non-opioid pain medication, opioids, selective serotonin and norepinephrine inhibitors, and tramadol) across race and ethnicity and assigned sex. Pairwise comparisons were made using a false discovery rate adjusted P value. Overall, 13,663 service members received a fibromyalgia diagnosis during the study period. Approximately 52% received a follow-up visit within 3 months of index diagnosis. Most service members received a co-occurring psychiatric diagnosis (35%), followed by insomnia (24%), migraines (20%), and abdominal and pelvic pain diagnoses (19%) fibromyalgia diagnosis. At least half received exercise classes and activities (52%), behavioral health care (52%), or physical therapy (50%). Less commonly received therapies included other physical interventions (41%), chiropractic/osteopathic care (40%), massage therapy (40%), transcutaneous electrical nerve stimulation (33%), self-care education (29%), biofeedback and other muscle relaxation therapies (22%), and acupuncture or dry needling (14%). The most common prescriptions received were non-opioid pain medications (72%), followed by muscle relaxers (44%), opioids (32%), anxiolytics (31%), gabapentinoids (26%), serotonin-norepinephrine reuptake inhibitor (21%), selective serotonin reuptake inhibitors (20%), and tramadol (15%). There were many inequities identified across outcomes. Overall, service members diagnosed with fibromyalgia received variable guideline-congruent health care within the 3 months before and after fibromyalgia diagnosis. Almost 1 in 3 service members received an opioid prescription, which has been explicitly recommended against use in guidelines. Pairwise comparisons indicated unwarranted variation across assigned sex and race and ethnicity in both co-occurring health conditions and care receipt. Underlying reasons for health and health care inequities can be multisourced and modifiable. It is unclear whether the U.S. Military Health System has consolidated patient resources to support patients living with fibromyalgia and if so, the extent to which such resources are accessible and known to patients and their clinicians.

The impact of health disparities on peripheral vascular access outcomes in hospitalized patients: an observational study

BackgroundPlacement of peripheral intravenous catheters (PIVC) is a routine procedure in hospital settings. The primary objective is to explore the relationship between healthcare inequities and PIVC outcomes.MethodsThis study was a multicenter, observational analysis of adults with PIVC access established in the emergency department requiring inpatient admission between January 1st, 2021, and January 31st, 2023, in metro Detroit, Michigan, United States. Epidemiological, demographic, therapeutic, clinical, and outcomes data were collected. Health disparities were defined by the National Institute on Minority Health and Health Disparities. The primary outcome was the proportion of PIVC dwell time to hospitalization length of stay, expressed as the proportion of dwell time (hours) to hospital stay (hours) x 100%. Multivariable linear regression and a machine learning model were used for variable selection. Subsequently, a multivariate linear regression analysis was utilized to adjust for confounders and best estimate the true effect of each variable.ResultsBetween January 1st, 2021, and January 31st, 2023, our study analyzed 144,524 ED encounters, with an average patient age of 65.7 years and 53.4% female. Racial demographics showed 67.2% White, and 27.0% Black, with the remaining identifying as Asian, American Indian Alaska Native, or other races. The median proportion of PIVC dwell time to hospital length of stay was 0.88, with individuals identifying as Asian having the highest ratio (0.94) and Black individuals the lowest (0.82). Black females had a median dwell time to stay ratio of 0.76, significantly lower than White males at 0.93 (p < 0.001). After controlling for confounder variables, a multivariable linear regression demonstrated that Black males and White males had a 10.0% and 19.6% greater proportion of dwell to stay, respectively, compared to Black females (p < 0.001).ConclusionsBlack females face the highest risk of compromised PIVC functionality, resulting in approximately one full day of less reliable PIVC access than White males. To comprehensively address and rectify these disparities, further research is imperative to improve understanding of the clinical impact of healthcare inequities on PIVC access. Moreover, it is essential to formulate effective strategies to mitigate these disparities and ensure equitable healthcare outcomes for all individuals.

Income Elasticity of Demand for Healthcare and Change Over Time: Across the Income Groups in India

The study computes the income elasticity of out-of-pocket healthcare expenditures (OOPEs) of Indian households across the income groups. Using data from the National Sample Survey Organization for the 71st (2014) and 75th (2018) rounds, a log-linear model with splines estimates the elasticity of healthcare expenditure across different income segments. The analysis controls for demographic variables and employs dual deflation to adjust for price changes. The elasticity magnitude depends upon the marginal propensity to OOPE (MP-OOPE), which is inconsistent across the income groups. The random MP-OOPE is due to the non-linear relationship between income and healthcare expenditure. The data revealed increased income (proxied by household consumption expenditure) and decreased average OOPE in wave 2. Despite this, households in the bottom income bracket experience a rise in elasticity, and those at the top observe reduced elasticity in wave 2. The income group-wise MP-OOPE suggests uncertain healthcare demand patterns and evidence of widening healthcare inequality. Poorer households either face low-magnitude inelastic healthcare demand, leaving their healthcare needs unmet, or experience high-magnitude inelastic demand, leading to financial hardship. Policies should aim to reduce out-of-pocket healthcare expenses for vulnerable groups. Expanding public-funded risk pooling mechanisms like Pradhan Mantri Jan Arogya Yojana would be crucial in addressing this issue.

How can health systems approach reducing health inequalities? An in-depth qualitative case study in the UK

BackgroundAddressing socioeconomic inequalities in health and healthcare, and reducing avoidable hospital admissions requires integrated strategy and complex intervention across health systems. However, the understanding of how to create effective systems to reduce socio-economic inequalities in health and healthcare is limited. The aim was to explore and develop a system’s level understanding of how local areas address health inequalities with a focus on avoidable emergency admissions.MethodsIn-depth case study using qualitative investigation (documentary analysis and key informant interviews) in an urban UK local authority. Interviewees were identified using snowball sampling. Documents were retrieved via key informants and web searches of relevant organisations. Interviews and documents were analysed independently based on a thematic analysis approach.ResultsInterviews (n = 14) with wide representation from local authority (n = 8), NHS (n = 5) and voluntary, community and social enterprise (VCSE) sector (n = 1) with 75 documents (including from NHS, local authority, VCSE) were included. Cross-referenced themes were understanding the local context, facilitators of how to tackle health inequalities: the assets, and emerging risks and concerns. Addressing health inequalities in avoidable admissions per se was not often explicitly linked by either the interviews or documents and is not yet embedded into practice. However, a strong coherent strategic integrated population health management plan with a system’s approach to reducing health inequalities was evident as was collective action and involving people, with links to a “strong third sector”. Challenges reported include structural barriers and threats, the analysis and accessibility of data as well as ongoing pressures on the health and care system.ConclusionWe provide an in-depth exploration of how a local area is working to address health and care inequalities. Key elements of this system’s working include fostering strategic coherence, cross-agency working, and community-asset based approaches. Areas requiring action included data sharing challenges across organisations and analytical capacity to assist endeavours to reduce health and care inequalities. Other areas were around the resilience of the system including the recruitment and retention of the workforce. More action is required to embed reducing health inequalities in avoidable admissions explicitly in local areas with inaction risking widening the health gap.

Pandemic Times and Health Care Exclusion: Attitudes Toward Health Care Exclusion of Undocumented Immigrants.

Most of the 11 million undocumented immigrants living in the United States are excluded from government healthcare programs. Yet, healthcare inequities pose significant dangers to all members of society during a pandemic. This project explores to what extent undocumented immigrants, in the context of a pandemic, can be seen as deserving of access to government healthcare programs. The first survey experiment explores whether work ethic can affect perceptions of undocumented immigrants as deserving of government healthcare programs. The second survey experiment tests to what extent appeals to fairness and self-interest, during a pandemic, shape healthcare deservingness attitudes. The results show that respondents view undocumented immigrants as less deserving of healthcare than citizens, even when undocumented immigrants have a solid work history. The second survey experiment, however, shows that appeals to fairness and self-interest trigger substantial increases in support for undocumented immigrants, both among Republicans and Democrats. The results suggest that while undocumented immigrants are seen as less deserving of access, appeals to fairness and self-interest can trigger increased support.

What attributes of digital devices are important to clinicians in rehabilitation? A cross-cultural best-worst scaling study

BackgroundDigital interventions are becoming increasingly popular in rehabilitation. Understanding of device features which impact clinician adoption and satisfaction is limited. Research in the field should be conducted across diverse settings to ensure digital interventions do not exacerbate healthcare inequities. ObjectiveThis study aimed to understand rehabilitation clinicians’ preferences regarding device attributes and included a cross-cultural comparison. Materials and MethodsChoice experiment methodology (best-worst scaling) was used to survey rehabilitation clinicians across Australia and Brazil. Participants completed 10 best-worst questions, choosing the most and least important device attributes from subsets of 31 attributes in a partially balanced block design. Results were analysed using multinomial models by country and latent class. Attribute preference scores (PS) were scaled to 0–100 (least to most important). ResultsA total of 122 clinicians from Brazil and 104 clinicians from Australia completed the survey. Most respondents were physiotherapists (83%) working with neurological populations (51%) in the private/self-employed sector (51%) who had experience using rehabilitation devices (87%). Despite preference heterogeneity across country and work sector (public/not-for-profit versus private/self-employed/other), clinicians consistently prioritised patient outcomes (PS 100.0, 95%CI: 86.2–100.0), patient engagement (PS 93.9, 95%CI: 80.6–94.2), usability (PS 81.3, 95%CI: 68.8–82.5), research evidence (PS 80.4, 95%CI: 68.1–81.7) and risk (PS 75.7, 95%CI: 63.8–77.3). In Australia, clinicians favoured device attributes which facilitate increased therapy dosage (PS 79.2, 95%CI: 62.6–81.1) and encourage patient independent practice (PS 66.8, 95%CI: 52.0–69.2). In Brazil, clinicians preferred attributes enabling device use for providing clinical data (PS 67.6, 95%CI: 51.8–70.9) and conducting clinical assessments (PS 65.6, 95%CI: 50.2–68.8). ConclusionClinicians prioritise patients’ needs and practical application over technical aspects of digital rehabilitation devices. Contextual factors shape clinician preferences rather than individual clinician characteristics. Future device design and research should consider preferences and influences, involving diverse stakeholders to account for context-driven variations across cultures and healthcare settings.

Lesbian, gay, bisexual, transgender and queer (LGBTQ+) menopause: Literature review, knowledge gaps and research agenda.

There is growing interest in menopause discrimination in healthcare, the workplace and beyond. However, there is a dearth of research on lesbian, gay, bisexual, transgender and queer (LGBTQ+) experiences of the menopause. This article reports on a scoping review of the recent literature which identified a very limited number of articles and a wide range of knowledge gaps. This is discussed in relation to LGBTQ+ wider health, healthcare and workplace inequalities, and heteronormative and cisnormative conceptualisations of the menopause. A research agenda is proposed. Research should: be intersectional; differentiate between LGBTQ+ sub-groups; aim to understand how menopause experiences impact and are impacted by minority sexuality/gender identities; and examine how menopause healthcare and workplace support can be LGBTQ+ inclusive. Such research is urgently needed to ensure that LGBTQ+ people are fully included in menopause justice discussions and solutions.

Are protected characteristics associated with mental health care inequalities in the adult UK general population? a cross-sectional study.

This study investigates the association between protected characteristics and inequalities in mental health care in the UK. Multinomial regression was used to model the association between protected characteristics and self-reported distress. Data was extracted from waves 6-10 (2014-2019) of the UK Household Longitudinal Study. Two risk categories were constructed: "undiagnosed distress" referred to a General Health Questionnaire-12 (GHQ-12) score above "caseness" along with no history of mental health diagnosis; "diagnosis without self-report symptoms" referred to a GHQ-12 score consistently below "caseness" within the study time frame but having received a mental health diagnosis. Compared to people without a disability, people with a disability are at considerably greater risk of both undiagnosed distress (Relative risk ratios (RRR) 2.76; Confidence Interval (CI): 2.55, 2.99) and diagnosis without self-reported symptoms (RRR 3.61; CI: 2.80, 4.66). Likewise, women were more likely than men to report undiagnosed distress (RRR = 1.49; CI: 1.38,1.61) or a diagnosis without self-reported symptoms (RRR = 1.38; CI: 1.08, 1.76. Lesbian, gay, and bisexual people are at greater risk of undiagnosed distress compared with heterosexual people (RRR 1.42; CI: 1.19, 1.70). Adults aged 16-24 years were at greatest risk compared to all other age groups. People from a minority ethnic background had a reduced risk of diagnosis without self-report symptoms compared with people from a White ethnic background (RRR 0.34; CI: 0.20, 0.61). Education, employment and income variables moderated some of these associations. This is the first study to examine diagnosis without self-report symptoms alongside undiagnosed distress. Findings suggest that addressing inequality in mental health care requires increased understanding of the needs and strengths within different groups and to provide appropriate forms of social, medical or psychosocial intervention rather than a singular focus on increasing detection, diagnosis and treatment. People with a disability appear to be at greatest disadvantage, requiring greater attention in policy and practice.

Social justice in Canadian nursing professional documents: A Foucauldian discourse analysis.

Social justice is widely advanced as a central nursing value, and yet conceptual understandings of social justice remain inconsistent and vague. Further, despite persistently articulated commitments to upholding social justice, the profession of nursing has been implicated in perpetuating inequities in health and health care. In this context, it is essential to establish both conceptual clarity and tangible guidance for nurses in enacting practices to advance social justice-particularly through regulatory, education and accreditation documents that shape the nursing profession. This Foucauldian discourse analysis examines how social justice is discursively positioned within nursing professional documents in Canada, and illustrates that social justice was largely discursively excluded from these texts. Where social justice discourses were invoked, we identified that four central discursive patterns obscured and de-centred this nursing value: (i) Vague language undermined professional commitments to social justice; (ii) Constructions of knowledge and awareness de-emphasized practice; (iii) Individualism discourses minimized institutional/professional responsibility; and (iv) Aspirational language obscured present action. Extending from this analysis, we contend that the nursing profession must re-examine how social justice is understood and articulated, and call for a re-conceptualization of social justice grounded in nursing practice toward remediating inequities in health and health care.