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BACKGROUND: Transgender medicine is an emergent subfield with clearly identified educational gaps. AIMS: This manuscript evaluates a gender-affirming healthcare curriculum for second-year medical (M2) students. METHODS: Students received a survey assessing Gender Identity Competency in terms of skills, knowledge and attitudes regarding transgender and gender non-conforming (TGNC) issues. The authors administered the survey before and after the delivery of the curriculum. The curriculum included five online modules, a quiz, a 3-hour case-based workshop and a 2-hour interactive patient-provider panel. RESULTS: Approximately 60% of M2 students (n=77) completed both preassessments and postassessments. The following showed a statistically significant improvement from preassessment to postassessment: student Gender Identity Competency, t(76) = -11.07, p<0.001; skills, t(76) = -15.22, p<0.001; and self-reported knowledge, t(76) = -4.36, p<0.001. Negative attitudes did not differ (p=0.378). Interest in TGNC issues beyond healthcare settings did not change (p=0.334). M2 students reported a significant change in experience role-playing chosen pronouns in a clinical setting, t(76) = -8.95, p<0.001. CONCLUSIONS: The curriculum improved students' gender-affirming medical competency, knowledge and skills. The development of a sustained, longitudinal curriculum is recommended in addition to the continuing education of faculty to reinforce this expanding knowledge and skills base and to address discomfort working with this population.
Assuntos
Atitude Frente a Saúde , Competência Clínica , Currículo , Educação de Graduação em Medicina/métodos , Saúde das Minorias/educação , Pessoas Transgênero , Adulto , Competência Cultural , Assistência à Saúde Culturalmente Competente , Feminino , Disforia de Gênero , Disparidades em Assistência à Saúde , Hormônios/uso terapêutico , Humanos , Masculino , Saúde Mental , Procedimentos de Readequação Sexual , Adulto JovemRESUMO
OBJECTIVE: Posttraumatic stress disorder (PTSD) is one of the most prevalent mental health diagnoses for veterans. Previous research as well as the minority stress model and transgenerational trauma theories, suggest that race may be associated with PTSD, particularly in veterans. The current study examined whether there were racial differences in symptomology in a sample of combat veterans with PTSD (global and symptom cluster-specific). METHODS: Data were collected from male veterans who identified as non-Hispanic Caucasian or non-Hispanic African American (N = 413). Participants completed the Posttraumatic Stress Disorder Checklist- Military version (PCL-M). The PCL-M items were split into four symptom clusters to align with the DSM-5: Re-experiencing, Avoidance, Numbing, and Hyperarousal. It was hypothesized that African American veterans would report more severe global PTSD symptoms and higher levels of hypervigilance. RESULTS: Findings indicated global PTSD symptoms and three of the four symptom clusters did not differ, although the symptom cluster of Re-experiencing was found to be higher for African Americans compared to Caucasians. CONCLUSIONS: It may be helpful for researchers to broaden their methods of assessing PTSD symptomology, such as to examine specific PTSD symptom clusters, especially when assessing differences by race.
RESUMO
Posttraumatic stress disorder (PTSD) is one of the most prevalent mental health diagnoses for veterans. Group therapy can be an effective and efficient means of treating PTSD, yet the literature exploring treatment outcomes for racial minorities is mixed and limited. The present study was an evaluation across racial groups of the PTSD Recovery Program, a manualized group therapy implemented at a Veterans Affairs hospital. Data were collected from male veterans (N = 450) who identified as non-Hispanic White or non-Hispanic African American and participated in a 10-week, combat-related, group therapy program between 2010 and 2014. Participants completed the Posttraumatic Stress Disorder Checklist-Military version (PCL-M) measure at pre-treatment and post-treatment. The Program led to a statistically significant reduction in PCL-M scores (Cohen's d = .64). Symptom reduction occurred regardless of race, with no racial differences in improvement. Racial and ethnic composition of groups was not related to outcomes. The Program was effective regardless of veteran group or provider. Results imply that the PTSD Recovery Program is an effective first-line option to treating non-Hispanic White and non-Hispanic African American veterans with PTSD. Future research should continue to explore the associations between group characteristics and treatment outcomes.
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Although considerable research has been carried out on family caregivers of individuals with various types of disabilities, spinal cord injury (SCI) caregivers have received considerably less attention in terms of research, especially in regions such as Latin America. This study examined the relationship between health-related quality of life (HRQOL) in individuals with SCI and their family caregiver's mental health in Neiva, Colombia. Thirty-four individuals with SCI and their primary caregivers (34 dyads; n=68) from the Foundation for the Integral Development of People with Disabilities in Neiva, Colombia, were included in this study. Individuals with SCI completed eight subscales of the SF-36 that assessed HRQOL. Five aspects of caregiver mental health were assessed, including burden (Zarit Burden Interview), satisfaction with life (Satisfaction with Life Scale), depression (Patient Health Questionnaire-9), self-esteem (Rosenberg Self-Esteem Scale), and anxiety (State Trait Anxiety Inventory). A series of multiple regressions uncovered strong associations among the HRQOL of individuals with SCI and various aspects of caregiver mental health. In these regressions, patient physical functioning and pain were independently related to caregiver burden; patient pain and general health were independently related to caregiver satisfaction with life; and patient pain was independently related to caregiver anxiety. HRQOL in individuals with SCI was robustly related to their caregiver's mental health, suggesting that the two sets of variables are closely linked. These findings suggest that caregiver mental health should be a central part of SCI rehabilitation interventions, especially in Latin America.