Supporting Transgender and Nonbinary Residents.

Transgender and gender nonbinary (TGNB) individuals experience challenges while applying for and completing residency, although limited research exists. An academic panel reviewed best practices for residency programs who interview and match TGNB residents. Program leadership should identify and utilize the affirming name and pronouns for all applicants, not ask gender identity during an interview unless self-disclosed, and ensure that health insurance covers transition care. Programs should proactively educate all residents, faculty, and staff on knowledge gaps regarding transgender health regardless of the presence of TGNB residents. Future studies are necessary regarding experiences of TGNB residents to investigate their specific needs.

Perspectives of female medical faculty in Ethiopia on a leadership fellowship program.

OBJECTIVES: This study aims to evaluate a leadership fellowship program through perspectives of Ethiopian women medical faculty participants. METHODS: An intensive two-week leadership development fellowship was designed for women faculty from Ethiopian medical schools and conducted from 2011-2015 at the University of Wisconsin-School of Medicine and Public Health in Madison, Wisconsin. Nine Ethiopian women working in early- or mid-level academic positions were selected. Semi-structured interviews were conducted with the fellows. Transcripts were reviewed through qualitative analysis to assess the perceived impact of the training on their careers. Three male academic leaders were interviewed to solicit feedback on the program. RESULTS: Eight of 9 fellows were interviewed. Themes describing the benefits of the fellowship included: increased awareness of gender inequities; enhanced motivation for career advancement; increased personal confidence; and improved leadership skills. Fellows provided suggestions for future training and scaling up efforts to promote gender equity. Male leaders described the benefits of men promoting gender equity within academic health centers. CONCLUSIONS: This paper provides evidence that targeted brief training programs can enhance women's motivation and skills to become effective leaders in academic medicine in Ethiopia. Promoting gender equity in academic medicine is an important strategy to address health workforce shortages and to provide professional role models for female students in the health professions.

Family Medicine in Ethiopia: Lessons from a Global Collaboration.

BACKGROUND: Building the capacity of local health systems to provide high-quality, self-sustaining medical education and health care is the central purpose for many global health partnerships (GHPs). Since 2001, our global partner consortium collaborated to establish Family Medicine in Ethiopia; the first Ethiopian family physicians graduated in February 2016. METHODS: The authors, representing the primary Ethiopian, Canadian, and American partners in the GHP, identified obstacles, accomplishments, opportunities, errors, and observations from the years preceding residency launch and the first 3 years of the residency. RESULTS: Common themes were identified through personal reflection and presented as lessons to guide future GHPs. LESSON 1: Promote Family Medicine as a distinct specialty. LESSON 2: Avoid gaps, conflict, and redundancy in partner priorities and activities. LESSON 3: Building relationships takes time and shared experiences. LESSON 4: Communicate frequently to create opportunities for success. LESSON 5: Engage local leaders to build sustainable, long-lasting programs from the beginning of the partnership. CONCLUSIONS: GHPs can benefit individual participants, their organizations, and their communities served. Engaging with numerous partners may also result in challenges-conflicting expectations, misinterpretations, and duplication or gaps in efforts. The lessons discussed in this article may be used to inform GHP planning and interactions to maximize benefits and minimize mishaps.

Gender and Sexual Health: Same-Sex Relationships.

A transformation in legal and cultural attitudes toward same-sex relationships is under way nationwide. As same-sex marriage has become legal, the unique social and medicolegal issues faced by individuals in same-sex relationships are evolving rapidly. National organizations have published recommendations for making clinical environments more inclusive of lesbian, gay, bisexual, and queer (LGBQ) individuals and their families. Medical issues for patients in same-sex relationships include a higher risk of HIV infection for men who have sex with men (a majority of new cases of HIV infection occur within relationships), higher rates of obesity among women who have sex with women, and disproportionately high rates of mental health issues and alcohol and drug use. Screening and prevention strategies for reducing these risks include cancer and infectious disease screening, immunization for human papillomavirus, and preexposure prophylaxis for HIV. More LGBQ individuals are becoming parents. Clinicians can assist patients in this process by being aware of local resources for adoption, assisted reproductive techniques, and parenting.

Preexposure Prophylaxis (PrEP) for HIV Prevention: The Primary Care Perspective.

Until recently there have been few primary care office-based strategies to reduce the transmission of HIV. In May 2014 the Centers for Disease Control and Prevention published updated practice guidelines recommending the use of preexposure prophylaxis (PrEP) with daily oral dosing of tenofovir/emtricitabine to help prevent HIV infection in high-risk individuals (strength of recommendation, A). Knowledge of PrEP among primary care providers is low, however, and this intervention is likely reaching only a small fraction of eligible patients. PrEP is recommended for certain injection drug users, nonmonogamous men who have sex with men, heterosexual women who have sex with men who have sex with men or injection drug users, and those in HIV serodiscordant relationships. Providers should obtain baseline laboratory values and provide initial counseling before prescribing PrEP. Regular office visits are necessary to ensure adherence, provide ongoing counseling, and monitor for side effects, including nausea, abdominal pain, headache, and, less commonly, increased creatinine. Guidelines and toolkits have been developed to assist in incorporating PrEP into primary care practice. PrEP is gaining widespread acceptance and has become a crucial tool in the fight to stop the spread of HIV.

PROMOTING GENDER EQUITY AT THE COLLEGE OF HEALTH SCIENCES, ADDIS ABABA UNIVERSITY, ETHIOPIA.

BACKGROUND: Ethiopia faces a dire shortage of human resources to meet the health care needs of its population of more than 90 million people. The government has implemented programs to expand the health care workforce, of which women are a growing and crucial component. Universities are working to identify and address gender inequity to help recruit and retain women. OBJECTIVE: This paper describes and analyzes a multi-institution grant-funded program to promote gender equity at Addis Ababa University-College of Health Sciences (AAU-CHS) in Ethiopia. METHODS: The primary intervention was to provide intensive short-term fellowships to mid-level female faculty to facilitate their promotion into leadership positions. Secondary interventions included a series of gender equity meetings with students, residents and staff to elicit bottom-up concerns and recommendations for future action, as well as conducting a gender climate survey of female students and staff External consultants assisted with program implementation, monitoring and evaluation of the program. RESULTS: Initial outcomes demonstrate promising career advancement of women who participated in the fellowships. A comprehensive gender equity action plan was developed based upon results from the survey and meeting recommendations. This plan is being implemented by AAU-CHS faculty and administration. CONCLUSION: This program has been an initial success and may serve as a template for others who are working to promote gender equity.

A Brief Clinical Update on Hepatitis C--The Essentials.

Infection with the hepatitis C virus (HCV) is a common cause of cirrhosis and liver failure and the most common indication for liver transplant in the United States. Based on the prevalence of HCV infection at 1.3% of the US population, there are an estimated 74,000 people living with HCV infection in the state of Wisconsin, the majority of whom are undiagnosed. HCV infections in Wisconsin have increased, reflecting the increasing use of intravenous heroin in the state. This review discusses up-to-date guidelines for screening, diagnosis, and treatment of HCV. New direct-acting antiviral medications have revolutionized the treatment of HCV with significantly improved outcomes. High cost and limited availability of these medications present challenges in overall management of HCV.

Glatiramer acetate immune system augmentation for peripheral nerve regeneration in rat crushed sciatic nerve model.

BACKGROUND: Protective antiself response to nervous system injury has been reported to be mediated by a T-cell subpopulation that can recognize self-antigens. Immune cells have been shown to play a role in the regulation of motor neuron survival after a peripheral nerve injury. The objective of the present study was to evaluate the effects of immune system augmentation with use of the antigen glatiramer acetate, which is known to affect T-cell immunity, on peripheral nerve regeneration. METHODS: Wild-type and nude-type (T-cell-deficient) rats underwent crush injury of the sciatic nerve. Three and six weeks after the injury, the sciatic nerve was examined, both functionally (on the basis of footprint analysis and the tibialis anterior muscle response and weight) and histologically (on the basis of axon count). RESULTS: Significantly greater muscle responses were measured after three weeks in the group of wild-type rats that were treated with glatiramer acetate (control limb:injured limb ratio, 0.05 for the glatiramer acetate group [n = 9], compared with 0.51 for the saline solution group [n = 8]; p < 0.05). Higher axon counts were also found in this group (control limb:injured limb ratio, -0.07 for the glatiramer acetate group [n = 10], compared with 0.29 for the saline solution group [n = 8]; p < 0.05). The nude-type rats showed no response to the intervention after three weeks but showed a delayed response after six weeks. A second dose of glatiramer acetate, delivered forty-eight hours after the injury, did not result in an improved response as compared with the control groups. CONCLUSIONS: We found that a single treatment with glatiramer acetate resulted in accelerated functional and histological recovery after sciatic nerve crush injury. The role of T-cell immunity in the mechanism of glatiramer acetate was suggested by the partial and late response found in the T-cell-deficient rats.