Cultural humility training interventions for healthcare students to improve care for gender and sexual minority groups: Protocol for a systematic review and a proposed meta-analysis.

Introduction: To deliver comprehensive and efficient care, it is crucial to understand and address the unique healthcare needs of gender and sexual minority (GSM) groups. Implementing cultural humility training may enhance healthcare students' sensitivity, awareness, and proficiency in serving patients. However, there's a necessity to thoroughly evaluate the impact and effectiveness of these interventions, especially in relation to addressing the distinct healthcare requirements of GSM groups. This protocol describes the steps in conducting a systematic review (SR) to investigate if cultural humility training interventions for medical students enhance care of GSM groups. This SR aims to guide the creation of focused interventions and instructional plans to support fair healthcare delivery for GSM populations. Methods and Analysis: The objective of this SR encompass a comprehensive examination across multiple databases such as PubMed (NCBI), Scopus (Elsevier), Cochrane (Wiley), Web of Science (Clarivate). Using keywords and MeSH phrases, the search method will find relevant research from each database's launch from January 1, 2000, until August 30, 2024, emphasizing English-language publications. To ensure comprehensiveness, reference lists of qualifying papers will be thoroughly reviewed. We shall extract the data and use the appropriate Joanna Briggs Institute (JBI) checklist to evaluate the quality of the included study. By synthesizing the data, the findings will illuminate the value and efficacy of cultural humility training interventions for medical students in enhancing GSM group care. This synthesis will incorporate quantitative studies, to ensure a comprehensive understanding of the interventions' impacts. Ethics and dissemination: Ethics approval is not sought as the review will only synthesize data from published studies. The findings will be presented at conferences and published in peer-reviewed journals. PROSPERO registration number: CRD42024533825 Strengths and limitations of this study:•Our study examines cultural humility training, emphasizing self-reflection and power dynamics, specifically relevant for gender and sexual minority (GSM) groups.•We focus on healthcare students, exploring how early cultural humility training can impact future practice and GSM care.•This is the first systematic review and meta-analysis of cultural humility training for GSM groups, addressing a gap in existing literature.•Our findings aim to inform curriculum and educational policies, addressing a significant need in medical training.•Limiting the review to English-language studies may exclude important research conducted in other languages, potentially missing valuable perspectives and findings that could enhance the understanding of cultural humility training's global applicability.•The review may face challenges in measuring the long-term impact of cultural humility training interventions on healthcare students' competency and attitudes, as existing studies might have a limited follow-up period.

Mental health help-seeking willingness among U.S. college students: A resilience factor associated with many sexual minority identities.

BACKGROUND: For populations with elevated mental health risks such as college students and minority groups, understanding openness to seeking professional help can inform ways to improve service engagement. This study explores help-seeking willingness among U.S. college students by sexual orientation. METHODS: Data were drawn from the 2021 National College Health Assessment (N = 64,079). The main outcome of interest was help-seeking willingness (i.e., reported openness to seeking professional mental health help when needed). A secondary outcome was help-seeking history (i.e., past mental health service utilization). Logistic regression analyses were conducted using R version 4.0.5. RESULTS: Increased help-seeking willingness was detected among students with a help-seeking history, whether within the past 12 months (OR=7.40, 99%CI: 6.78-9.08) or beyond (OR=2.26, 99%CI: 2.11-2.42). Even after controlling for various covariates including help-seeking history, elevated odds of help-seeking willingness persisted for gay (AOR=2.01, 99%CI: 1.63-2.49), bisexual (AOR=1.35, 99%CI: 1.23-1.49), questioning (AOR=1.22, 99%CI: 1.04-1.45), pansexual (AOR=1.31, 99%CI: 1.06-1.63), and queer (AOR=1.78, 99%CI: 1.35-2.38), relative to heterosexual students. CONCLUSIONS: Help-seeking willingness is a mental health resilience factor unique to several sexual minority groups. Examining what yields greater help-seeking willingness for these sexual minority student groups may inform interventions that enable all college students to seek help when they are in distress.

One Health as a potential platform to rescue the neglected fruit trees in Yucatan, Mexico.

Neglected and underutilized species of plants (NUS) have been identified by the Food and Agriculture Organization as valuable resources for fighting poverty, hunger and malnutrition as they can help make agricultural production systems more sustainable and resilient. Adaptation of NUS to changing environments over several millennia has rendered most of these plants resistant to pests and climate change. In this paper, we explore the potential values of some of the Mayan fruit trees justifying conservation efforts in their native habitats. Our research was primarily based on a scoping review using Google Scholar. We considered articles published in English, Spanish and Portuguese. Our review rendered two sets of articles including those focusing on the nutritional and medicinal properties of NUS and their products, and those focusing on their uses in traditional medicine. Both sets of papers strongly support arguments for conservation of NUS. Additionally, our scoping review expands and includes a case study on the conservation of NUS, highlighting the critical role of civil society on how it can spearhead rescue efforts of botanical resources through the creation of what is possibly the first arboretum of its kind in the Americas. Among the project's key selling points was not only the rescue of an important component of Yucatan's cultural heritage but its nutritional value as well as its potential medicinal properties. Our paper is not prescriptive on how to preserve or even commercially exploit NUS. It is intended as a thought-provoking piece on the potential of a One Health approach as a multisectoral platform to support conservation efforts, while stimulating greater interest in the subject and encouraging more action from the academic and pharmaceutical sectors as well as civil society.

Language barriers and healthcare access: a qualitative study in the Volta Region of Ghana.

BACKGROUND: The study explores the language barriers between two language minority populations and healthcare professionals in the Volta Region of Ghana. METHODS: An interpretive description with a qualitative approach to data collection and analysis was used. This study was carried out in the Tafi-Atome and Avatime-Vane communities, the Hohoe Municipal Hospital and the Margaret Marquart Catholic Hospital in the Kpando Municipality. In all, 46 respondents comprising 19 purposively sampled community members (patients) from the two selected communities and 27 conveniently sampled healthcare professionals from the two health facilities were interviewed. The face-to-face in-depth interviews were audio-recorded, transcribed and thematically analysed. RESULTS: The study revealed a barrier in language use between healthcare professionals and patients from the two language minority communities. While healthcare professionals preferred to use English, Akan and Ewe, the patients, on the other hand, preferred their native languages, which are Sideme and Tegbor. The services of unqualified interpreters were utilised by both healthcare professionals and patients. Study participants were aware of these challenges, which prevented the patients from receiving optimum healthcare services, and the healthcare workers from delivering client-centred healthcare services. CONCLUSIONS: The presence of communication challenges emanating from language barriers between healthcare professionals and patients should be considered as a key hindrance to the attainment of the Sustainable Development Goal Three (SDG3), which aims to promote health and well-being at all ages. Therefore, stakeholders in the healthcare delivery system in Ghana need to prioritize stronger communication and translation practices and policies.

A qualitative study exploring experiences of racial minority stress in pharmacy education and practice.

Background: Despite 49.1% of registered pharmacists in the UK being from a Black, Asian and Minority Ethnic (BAME) background, senior management roles within pharmacy are dominated by white males. People from BAME communities may experience minority stress which contributes to a professional attainment gap compared with non-BAME colleagues. Minority stress describes additional stressors, such as unconscious bias, micro-aggression and racial minority stress, experienced by minoritized people to adhere to the social norms of the majority. There is little evidence describing experiences of minority stress in pharmacy practice and education. The aim was to explore experiences of racial minority stress in pharmacy education and practice. Methods: A convenience sample of pharmacy students and pharmacists were recruited via email and social media posts to volunteer to take part in interviews and focus groups. A topic guide was used to explore experiences of unconscious bias, microaggressions and racial minority stress in education and practice. Interviews and focus groups were transcribed verbatim and inductively analysed using thematic analysis underpinned by a phenomenological approach. Ethical approval was granted from Newcastle University (5340/2020, 2430/2593). Results: Forty-five participants were recruited. Six focus groups and sixteen one-to-one semi-structured interviews were conducted. The sample was varied, with 56% (n = 25) students and 33% (n = 15) registered pharmacists from community, hospital, primary care, academia and an additional 11% (n = 5) still in foundation training in these sectors. The sample include diversity of racial identities, including 40% (n = 18) South Asian, 27% (n = 12) White, 15% (n = 7) Black, 7% (n = 3) Chinese and Arab mixed, 2% (n = 1) and 2% (n = 1) Not disclosed. Three themes were identified - Theme 1) Experiences of racial minority stress, Theme 2) Making sense of racial minority stress, and Theme 3) Responding to racial minority stress. Participants characteristics (for example skin colour, dialect, religious dress) made them feel susceptible to judgement, racist comments and microaggressions in education and practice. Participants required time to interpret, understand and make sense of incidents of racial minority stress. Responses to stressors included 'ignoring ignorance' and using a 'professional identity' to mask feelings. However, malicious comments and actions from other pharmacy staff were responded to differently to experiences from patients. Participants reported poor self-confidence to challenge racist behaviours in the workplace. Conclusions: The aim of this study was to explore experiences of racial minority stress in pharmacy education and practice. This study shows dealing with microaggression, racial minority stress and judgement in pharmacy education and practice is a burden experienced by people from BAME backgrounds. These experiences could contribute to the professional attainment gap in pharmacy, as making sense of these experiences is an additional burden pharmacists and trainees must bear in comparison to people from non-BAME backgrounds. Further work is needed to explore interventions to reduce minority stress in pharmacy practice and education to reduce the attainment gap across the sector.

Psychological experiences of Druze women with breast cancer.

The purpose of this study was to explore the experiences of Druze women who were diagnosed with breast cancer. Semi-structured interviews were conducted with nine Druze women. Inductive thematic analysis was used to analyze the data and three themes were generated. The first was "cancer discourse": participants utilized codeswitching and medical jargon in their rhetoric, in a manner that seemed to imply difficulty to speak directly about their experiences. The second was "self-image": the cancer and its treatments seem to have had an impact on participants' body image and overall sense of femininity. The third was "coping": sense and meaning-making as well as faith and family were identified as major coping mechanisms. Findings suggest a need for cultural competence in psychological interventions for breast cancer survivors.

Living and dying between cultural traditions in African & Caribbean Heritage families: a constructivist grounded theory.

BACKGROUND: Ethnic differences influence end-of-life health behaviours and use of palliative care services. Use of formal Advance care planning is not common in minority ethnic heritage communities. Older adults expect and trust their children to be their decision makers at the end of life. The study aim was to construct a theory of the dynamics that underpin end-of-life conversations within families of African and Caribbean heritage. This is a voice not well represented in the current debate on improving end-of-life outcomes. METHODS: Using Charmaz's constructivist grounded theory approach, a purposive sample of elders, adult-children, and grandchildren of African and Caribbean Heritage were recruited. In-person and online focus groups were conducted and analysed using an inductive, reflexive comparative analysis process. Initial and axial coding facilitated the creation of categories, these categories were abstracted to constructs and used in theory construction. RESULTS: Elders (n = 4), adult-children (n = 14), and adult grandchildren (n = 3) took part in 5 focus groups. A grounded theory of living and dying between cultural traditions in African and Caribbean heritage families was created. The constructs are (a) Preparing for death but not for dying (b) Complexity in traditions crosses oceans (c) Living and dying between cultures and traditions (d) There is culture, gender and there is personality (e) Watching the death of another prompts conversations. (f) An experience of Hysteresis. DISCUSSION: African and Caribbean cultures celebrate preparation for after-death processes resulting in early exposure to and opportunities for discussion of these processes. Migration results in reforming of people's habitus/ world views shaped by a mixing of cultures. Being in different geographical places impacts generational learning-by-watching of the dying process and related decision making. CONCLUSIONS: Recognising the impact of migration on the roles of different family members and the exposure of those family members to previous dying experiences is important. This can provide a more empathetic and insightful approach to partnership working between health care professionals and patients and families of minority ethic heritage facing serious illness. A public health approach focusing on enabling adult-children to have better end of life conversations with their parents can inform the development of culturally competent palliative care.

Summer undergraduate biomedical research program for underrepresented minority students in a rural, low-income state.

Introduction: Diversity can enhance the agenda and quality of biomedical research, but a dearth of underrepresented minorities and women serve as biomedical researchers. The study purpose was to examine the impact of the a summer undergraduate research program on self-efficacy in research, scientific communication, and leadership as well as scientific identity, valuing objectives of the scientific community, and intent to pursue a biomedical research career. Methods: Underrepresented minority and female undergraduate students participated in a mentored research experience in a rural, low-income state. Results: Students' self-efficacy in research, scientific communication, and leadership as well as scientific identity, valuing objectives of the scientific community, and intent to pursue a biomedical research career increased post-program compared to pre-program. Conclusion: This study supports implementation of a biomedical summer undergraduate research program for URM and women in a poor, rural, settings.

Promoting lifestyle changes in patients with prediabetes from African-Caribbean backgrounds in the United Kingdom.

OBJECTIVES: Diabetes is a non-communicable disease where the patient's glucose level in the blood is too high. Diabetes is prevalent among ethnic minority groups in the United Kingdom (UK). Type 2 diabetes is a major cause of premature mortality in England. Unfortunately, the lifestyle of these minority groups has become a barrier to diabetes healthcare treatment. The timely intervention of programmes targeting risk factors associated with diabetes may reduce the prevalence of diabetes among these ethnic minority groups. This review critically explores and identifies barriers that hinder specific African-Caribbean groups from accessing diabetes healthcare and how nurses can promote lifestyle changes in patients with prediabetes from African-Caribbean backgrounds. DESIGN: An extended literature review (ELR). The process consisted of a search of key databases and other nursing and public health journal articles with the keywords defined in this extended review (prediabetes, diabetes, lifestyle of Afro-Caribbean). Thematic analysis is then applied from a socio-cultural theoretical lens to interpret the selected articles for the review. RESULTS: Three main barriers were identified: (a) the strong adherence to traditional diets, (b) a wrong perception about diet management and (c) 'Western medication' as a key barrier that hinders effective diabetes management in ethnic minorities, including the African-Caribbean in the UK. CONCLUSION: To address these barriers, it is important for policymakers to prioritise well-tailored interventions for African-Caribbean groups as well as support healthcare providers with the requisite capacity to provide care.

Intersectionality as a tool for clinical ethics consultation in mental healthcare.

Bioethics increasingly recognizes the impact of discriminatory practices based on social categories such as race, gender, sexual orientation or ability on clinical practice. Accordingly, major bioethics associations have stressed that identifying and countering structural discrimination in clinical ethics consultations is a professional obligation of clinical ethics consultants. Yet, it is still unclear how clinical ethics consultants can fulfill this obligation. More specifically, clinical ethics needs both theoretical tools to analyze and practical strategies to address structural discrimination within clinical ethics consultations. Intersectionality, a concept developed in Black feminist scholarship, is increasingly considered in bioethical theory. It stresses how social structures and practices determine social positions of privilege and disadvantage in multiple, mutually co-constitutive systems of oppression. This article aims to investigate how intersectionality can contribute to addressing structural discrimination in clinical ethics consultations with a particular focus on mental healthcare. To this end, we critically review existing approaches for clinical ethics consultants to address structural racism in clinical ethics consultations and extend them by intersectional considerations. We argue that intersectionality is a suitable tool to address structural discrimination within clinical ethics consultations and show that it can be practically implemented in two complementary ways: 1) as an analytic approach and 2) as a critical practice.

The Impact of Comorbidities among Ethnic Minorities on COVID-19 Severity and Mortality in Canada and the USA: A Scoping Review.

(1) Current literature on ethnic minorities, comorbidities, and COVID-19 tends to investigate these factors separately, leaving gaps in our understanding about their interactions. Our review seeks to identify a relationship between ethnicity, comorbidities, and severe COVID-19 outcomes (ICU admission and mortality). We hope to enhance our understanding of the various factors that exacerbate COVID-19 severity and mortality in ethnic minorities in Canada and the USA. (2) All articles were received from PubMed, Scopus, CINAHL, and Ovid EMBASE from November 2020 to June 2022. Included articles contain information regarding comorbidities among ethnic minorities in relation to COVID-19 severity and mortality. (3) A total of 59 articles were included that examined various ethnic groups, including Black/African American, Asian, Hispanic, White/Caucasian, and Indigenous people. We found that the most examined comorbidities were diabetes, hypertension, obesity, and chronic kidney disease. A total of 76.9% of the articles (40 out of 52) found a significant association between different races and COVID-19 mortality, whereas 21.2% of the articles (11 out of 52) did not. (4) COVID-19 ICU admissions and mortality affect various ethnic groups differently, with Black patients generally having the most adverse outcomes. These outcomes may also interact with sex and age, though more research is needed assessing these variables together with ethnicity.

Breaking the bamboo ceiling and de-bunking the model minority myth.

Leadership roles must incorporate representation from all involved individuals for the resulting decision-making process to reflect the interests and expertise of a diverse organization. Many resources have rightly focused on developing historically underrepresented racial and ethnic (HURE) leaders. Though numbers of Black and Hispanic dental school deans have increased, more work is needed for these and other HURE groups such as American Indians. Asians are not classified as HURE. As an aggregated group they have robust presence in the dental workforce in North America, the United Kingdom and Australia. The assumption is they are fine, so the group is ignored. Previous research indicates Asians are almost invisible in leadership roles in dentistry, and while the "Glass Ceiling" phenomenon for women persists, Asian women face even greater obstacles to leadership. This paper explores cultural factors contributing to the "Bamboo Ceiling", such as Confucian values emphasizing collectivism and deference to authority. It examines challenges faced by Asian women at the intersection of gender and race. The impact of the "Model Minority Myth" compounds these challenges, leading to overlooking diverse needs. The importance of dispelling these harmful myths is underscored. This paper provides strategies to combat them, urging proactive efforts from minorities and management. By shedding light on the "Bamboo Ceiling" and the "Model Minority Myth", this paper aims to reassess existing norms, current policies and procedures pertaining to equitable representation and leadership opportunities for Asian women in academic dentistry, community oral health, research, and in dental corporations.

Trends in Suspected Opioid Drug Overdose Events in Emergency Medical Service Encounters in South Carolina, 2019-2022.

OBJECTIVES: The number of drug overdoses and drug-related deaths has increased across the United States in recent years. Reports of suspected opioid drug overdoses identified through emergency medical services (EMS) are valuable sources of information for shaping the public health response to drug overdoses. The objective of this study was to describe trends in the number of EMS-reported suspected opioid drug overdose events in South Carolina from 2019 through 2022. METHODS: We included reports of suspected opioid drug overdoses if they met the definition of nonfatal opioid overdose syndrome in our analysis. We analyzed statewide data reported from EMS agencies to biospatial, Inc, from January 2019 through December 2022 to understand demographic trends for a statewide overdose and response program in South Carolina. RESULTS: In 2022, a total of 11 078 suspected opioid drug overdose events, or 216.4 per 100 000 South Carolina residents, were reported by EMS. During the 4-year study period, the number of EMS-reported suspected opioid drug overdoses increased by 82%, with African American people experiencing a 133% increase and White people experiencing a 68% increase. The number of opioid overdoses increased among all age groups during the study period. Approximately 84% of opioid overdoses were reported in urban counties, but rural counties had a higher number of opioid overdose reports per capita than urban counties. CONCLUSIONS: Monitoring trends in suspected opioid drug overdoses allows decision makers to adjust resources and programs for overdose response and is essential for local coordinated response. Continued monitoring of trends is needed for an equitable response to prevent opioid drug overdoses.

International Migration and Cardiovascular Health: Unraveling the Disease Burden Among Migrants to North America and Europe.

Europe and North America are the 2 largest recipients of international migrants from low-resource regions in the world. Here, large differences in cardiovascular disease (CVD) morbidity and death exist between migrants and the host populations. This review discusses the CVD burden and its most important contributors among the largest migrant groups in Europe and North America as well as the consequences of migration to high-income countries on CVD diagnosis and therapy. The available evidence indicates that migrants in Europe and North America generally have a higher CVD risk compared with the host populations. Cardiometabolic, behavioral, and psychosocial factors are important contributors to their increased CVD risk. However, despite these common denominators, there are important ethnic differences in the propensity to develop CVD that relate to pre- and postmigration factors, such as socioeconomic status, cultural factors, lifestyle, psychosocial stress, access to health care and health care usage. Some of these pre- and postmigration environmental factors may interact with genetic (epigenetics) and microbial factors, which further influence their CVD risk. The limited number of prospective cohorts and clinical trials in migrant populations remains an important culprit for better understanding pathophysiological mechanism driving health differences and for developing ethnic-specific CVD risk prediction and care. Only by improved understanding of the complex interaction among human biology, migration-related factors, and sociocultural determinants of health influencing CVD risk will we be able to mitigate these differences and truly make inclusive personalized treatment possible.

Digital Health Interventions for Cancer Prevention Among Racial and Ethnic Minority Groups in the United States: A Scoping Review.

OBJECTIVE: The COVID-19 pandemic abruptly accelerated the use of digital health for cancer care. Previously, researchers identified a variety of digital health interventions for cancer prevention. The purpose of the present scoping review was to identify digital health interventions for cancer prevention designed for racial/ethnic minority groups. METHODS: The scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews and was guided by the Arksey and O'Malley methodological framework. A search of PubMed, Ovid MEDLINE, and CINAHL for peer-reviewed research articles published from database inception to August 21, 2023, was conducted. Peer-reviewed studies published in English that employed digital health interventions for cancer prevention, that were conducted among racial/ethnic minority groups, and that were conducted in the United States were included. Also included were cancer prevention interventions for people who did not have cancer, people who did have cancer, and cancer survivors. Excluded were interventions that included non-Hispanic White individuals, interventions performed outside the United States, interventions that combined face-to-face methods with digital strategies, and interventions that did not clearly include digital health. Articles that focused on technologies for collecting and transmitting health data (e.g., remote patient monitoring) without an explicit tie-in to cancer prevention intervention outcomes were also excluded. RESULTS: Following screening, eight articles met the eligibility criteria. Six of the articles were published prior to the COVID-19 pandemic, and two were published during it. The digital health interventions for cancer prevention in racial/ethnic minority groups included screening (n = 5), emotional support and education (n = 1), human papillomavirus vaccination (n = 1), and education and treatment (n = 1). A consistently measured outcome was intervention efficacy. Four authors explicitly stated that theories or theoretical constructs were employed to guide intervention development. Also, no interventions were created using novel devices such as emerging technologies. CONCLUSIONS: We identified several notable gaps regarding digital health for cancer prevention among racial/ethnic minority groups. Addressing these gaps may help guide continued innovation in the use of digital health for cancer prevention among racial/ethnic minority groups.

A presença dos grupos minoritários na universidade: uma revisão de literatura / Presence of minority groups at university: A literature review / La presencia de grupos minoritarios en la universidad: una revisión de la literatura

Resumo Vinculado ao projeto de pesquisa «Qual universidade salesiana para os jovens de hoje?: ouvindo a voz dos alunos¼, parceria entre instituições salesianas da América Latina, o artigo é fruto de um mapeamento de produções realizadas em bases de dados do Brasil, que busca a discussão, a escrita e os olhares que foram produzidos, no período de 2018 a 2021, em pesquisas acadêmicas cuja a temática está voltada aos grupos minoritários que estudam em instituições de ensino superior. O artigo evidencia que ao problematizar os grupos minoritários no ensino superior, as discussões, os debates e os enfrentamentos para a construção de um espaço de diálogo, autonomia e respeito são fatores sempre presentes, pois são elementos de um posicionamento político que busca a qualidade do acesso e da permanência.

Abstract (analytical) Linked to the research Project «What salesian university for today's youth?: Listening to the voices of its students¼, a partnership between Salesian institutions in Latin America, the article is the result of a mapping of productions carried out in databases in Brazil, which seeks the discussion, writing and views that were produced, from 2018 to 2021, in academic research whose theme is focused on minority groups studying in higher education institutions. The article shows that when problematizing minority groups in higher education, discussions, debates and confrontations for the construction of a space for dialogue, autonomy and respect are always present factors, as they are elements of a political position that seeks the quality of the access and permanence.

Resumen (analítico) Vinculado al proyecto de investigación «¿Qué universidad salesiana para los jóvenes de hoy?: escuchando las voces de sus estudiantes¼, una asociación entre instituciones salesianas de América Latina, el artículo es el resultado de un mapeo de producciones realizadas en bases de datos de Brasil, que busca la discusión, la escritura y las miradas que se han producido, en el período de 2018 a 2021, en investigaciones académicas cuyo tema está dirigido a los grupos minoritarios que estudian en instituciones de educación superior. El artículo evidencia que, al problematizar los grupos minoritarios en la educación superior, las discusiones, los debates y los enfrentamientos para la construcción de un espacio de diálogo, autonomía y respeto son factores siempre presentes, ya que son elementos de una posición política que busca la calidad del acceso y la permanencia.