What are the features of targeted or system-wide initiatives that affect diversity in health professions trainees? A BEME systematic review: BEME Guide No. 50.

BACKGROUND/PURPOSE: There is interest to increase diversity among health professions trainees. This study aims to determine the features/effects of interventions to promote recruitment/admission of under-represented minority (URM) students to health professions programs. METHODOLOGY: This registered BEME review applied systematic methods to: title/full-text inclusion review, data extraction, and quality assessment (QA). Included studies reported outcomes for interventions designed to increase diversity of health professions education (HPE) programs' recruitment and admissions. RESULTS: Of 7225 studies identified 86 met inclusion criteria. Interventions addressed: admissions (34%), enrichment (19%), outreach (15%), curriculum (3%), and mixed (29%). They were mostly single center (76%), from the United States (81%), in medicine (45%) or dentistry (22%). URM definition was stated in only 24%. The dimension most commonly considered was ethnicity/race (88%). The majority of studies (81%) found positive effects. Heterogeneity precluded meta-analysis. Qualitative analysis identified key features: admissions studies points systems and altered weightings; enrichment studies highlighted academic, application and exam preparation, and workplace exposure. DISCUSSION/CONCLUSIONS: Several intervention types may increase diversity. Limited applicant pools were a rate-limiting feature, suggesting efforts earlier in the continuum are needed to broaden applicant pools. There is a need to examine underlying cultural and external pressures that limit programs' acceptance of initiatives to increase diversity.

Addressing Women's Unmet Health Care Needs in a Canadian Remand Center: Catalyst for Improved Health?

Incarcerated women have a disproportionate burden of infectious and chronic disease, substance disorders, and mental illness. This study explored incarcerated women's health and whether a Women's Health Clinic improved care within this vulnerable population. Retrospective chart reviews and focus groups were conducted. Poor access to care in the community due to competing social needs was described. Barriers to care during incarceration included lack of comprehensive gender-specific services, mistrust of providers, and fragmentation. Of 109 women, high rates of mental illness, partner violence, substance use, sexually transmitted infection (STI), and irregular Pap testing were observed. Pap (15% to 54%, p < .001) and STI (17% to 89%, p < .001) testing rates increased. Fragmentation of care remained at transition points, and further work is needed to improve continuity within corrections and the community.

Access to healthcare services during incarceration among female inmates.

Purpose Incarcerated women have a disproportionate burden of infectious and chronic disease, in addition to substance use disorder and mental health illness, when compared to the general population ( Binswanger et al., 2009 ; Fazel et al., 2006 ; Fuentes, 2013; Kouyoumdjian et al., 2012 ). Women often enter the correctional system in poor health, making incarceration an opportunity to address health issues. The purpose of this paper is to explore the barriers to accessing health services that female inmates face during incarceration, the consequences to their health, and implications for correctional health services delivery. Design/methodology/approach Focus groups were conducted in Canadian correctional center with female inmates. Focus groups explored women's experiences with accessing health services while incarcerated; the impact of access to health services on health during incarceration and in the community; and recommendations for improving access to health services. Thematic analysis was completed using N-vivo 10. Findings The women described multiple barriers to accessing health services that resulted in negative consequences to their health: treatment interruption; health disempowerment; poor mental and physical health; and recidivism into addiction and crime upon release. Women made three important recommendations for correctional health service delivery: provision of comprehensive health entry and exit assessments; improvement of health literacy; and establishment of health support networks. The recommendations were organized into an "Accessing Health Services Resource Manual" for incarcerated women. Originality/value There is a paucity of existing literature examining provision of health services for female inmates. These findings have relevancy for correctional and community health care providers and organizations that provide health services for this vulnerable population.

HIV outcomes at a Canadian remand centre.

Purpose The purpose of this paper is to assess the impact of short-term incarceration on antiretroviral therapy (ART) adherence, virologic suppression, and engagement and retention in community care post-release. Design/methodology/approach A retrospective chart review of patients who attended the human immunodeficiency virus (HIV) Outreach Clinic at a Canadian remand center between September 2007 and December 2011 was carried out. Data extraction included CD4 lymphocyte count, HIV viral load, ART prescription refills, and community engagement and retention during and one-year pre- and post-incarceration. Findings Outpatient engagement increased by 23 percent ( p=0.01), as did ART adherence (55.2-70.7 percent, p=0.01), following incarceration. Retention into community care did not significantly improve following incarceration (22.4 percent pre-incarceration to 25.9 percent post-release, p=0.8). There was a trend toward improved virologic suppression (less than 40 copies/ml; 50-77.8 percent ( p=0.08)) during incarceration and 70. 4 percent sustained this one-year post-incarceration ( p=0.70). Originality/value The impact of short-term incarceration in a Canadian context of universal health coverage has not been previously reported and could have significant implications in optimizing HIV patient outcomes given the large number of HIV-positive patients cycling through short-term remand centers.

Varicella zoster virus transmission in youth during incarceration.

Purpose - Facility-based Varicella zoster virus (VZV) transmission is reported in a Canadian youth offender correctional centre (YOCC). Transmission occurred from an immunocompetent youth offender (YO) with localized Herpes zoster to another immunocompetent single dose vaccinated YO, resulting in Varicella zoster (VZ) breakthrough disease. The purpose of this paper is to identify infection prevention and control (IPAC) measures utilized in this setting. Design/methodology/approach - A retrospective chart and immunization record review was conducted for two VZV cases and 27 exposed YO contacts in order to obtain demographic, clinical and immunization data. Descriptive data analysis was performed. Findings - All VZV cases and exposed contacts were male with an average age of 14.2 and 15.6 years for cases and contacts, respectively. Both cases shared the same living unit in the YOCC. There were 28 identified YO contacts, of whom 70 percent were single dose vaccinated with univalent vaccine, followed by 22 percent with a previous history of Varicella disease. All cases and contacts were born in Canada. No foreign-born populations were involved with this event. Infection control measures included additional precaution management, enhanced surveillance and environmental cleaning. As such, no hospitalizations or post-exposure immunizations were required. Originality/value - This report highlights the role that VZ breakthrough disease could play in fueling an outbreak in a high-risk environment without rapid recognition and implementation of preventative measures. It also underscores the importance of IPAC presence and public health immunization programs within correctional centers to avoid infectious disease threats.

Assessment of HIV Knowledge in Correctional Facility Health Care Workers: A Pilot Study of an Educational Intervention.

HIV rates are disproportionately higher in the incarcerated compared to the general population. Unfortunately, HIV sero-positive inmates report perceived discrimination and missed antiretroviral doses. Correctional facility nursing competency in HIV management may mitigate these concerns. Using validated knowledge instruments, the authors measured baseline HIV knowledge in correctional facility nurses from 3 correctional facilities in Alberta, Canada, and quantified changes after a targeted educational workshop. Basic HIV knowledge increased significantly, whereas perceived need for further HIV education significantly decreased postintervention. This study demonstrates that correctional facility nurses may not receive ideal HIV education during employment and that targeted HIV workshops can significantly increase knowledge and confidence when caring for affected individuals.

The Impact of Homelessness and Incarceration on Women's Health.

Female inmates have multiple challenges during incarceration and as they transition into the community including: barriers to accessing health care within correctional facilities, poor transitional preparation preceding release, and inadequate continuity of health care after release. This qualitative study explored the health-seeking experiences and the health and housing needs of female inmates. Four focus groups were conducted in a remand facility in Canada. Women described poor health at entry to the correctional system and viewed incarceration as a means to access health care services. Transition back into the community represented a crossroad that was dependent on the stability of housing status. These findings support gender-sensitive health and housing programs to reduce addictions, recidivism, and poor health among this vulnerable population.

Assessment of linezolid efficacy, safety and tolerability in the treatment of tuberculosis: A retrospective case review.

Linezolid is a potentially effective drug for the treatment of patients with drug-resistant tuberculosis. Among 13 patients treated for tuberculosis with linezolid in the present study, nine had treatment success and four remain on treatment. Adverse effects occurred in 11 (85%) patients, of whom three discontinued treatment because of adverse effects. The present study adds to the growing evidence supporting the efficacy of linezolid for tuberculosis, although treatment remains complicated by adverse effects.

Le linézolide est un médicament qui peut être efficace dans le traitement de patients atteints d'une tuberculose résistant aux médicaments. Dans la présente étude, chez 13 patients traités au linézolide contre la tuberculose, neuf ont vu leur traitement réussir et quatre sont toujours en traitement. Des effets indésirables se sont manifestés chez 11 (85 %) patients, dont trois ont arrêté le traitement pour cette raison. La présente étude s'ajoute aux données croissantes étayant l'efficacité du linézolide pour soigner la tuberculose, même si le traitement demeure compliqué par des effets indésirables.