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1.
J Med Humanit ; 2024 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-38753114

RESUMO

Proposed educational outcomes for the health humanities in medical education range from empathy to visual thinking skills to social accountability. This lack of widely agreed-upon high-level curricular goals limits humanities educators' ability to design purposeful curricula toward clear, common ends and threatens justifications for scarce curricular time. We propose a novel approach to the hoped-for outcomes of health humanities training in medical schools, which has the potential to encompass traditional health humanities knowledge, skills, and behaviors while also being concrete and measurable: humanistic practice. Humanistic practice, adapted from the concept of ethical sensitivity, is an intentional process of applying humanities knowledge and skills to a clinical scenario by 1) noticing that the scenario requires humanities knowledge or skills, 2) informing one's clinical and interpersonal strategy and behavior with humanities knowledge or skills, 3) reflecting on the effectiveness of the strategy and behavior, and 4) reorienting to develop new approaches for future practice. The construct of humanistic practice may help address some of the foundational problems in health humanities outcomes research since it transcends the traditional diverse content domains in the health humanities, can link patient and provider experiences, and may bridge the divide among the additive, curative, and intrinsic epistemic positions of humanities to medical education.

2.
BMC Med Educ ; 24(1): 482, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38693525

RESUMO

PURPOSE: To characterize current lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI +) health-related undergraduate medical education (UME) curricular content and associated changes since a 2011 study and to determine the frequency and extent of institutional instruction in 17 LGBTQI + health-related topics, strategies for increasing LGBTQI + health-related content, and faculty development opportunities. METHOD: Deans of medical education (or equivalent) at 214 allopathic or osteopathic medical schools in Canada and the United States were invited to complete a 36-question, Web-based questionnaire between June 2021 and September 2022. The main outcome measured was reported hours of LGBTQI + health-related curricular content. RESULTS: Of 214 schools, 100 (46.7%) responded, of which 85 (85.0%) fully completed the questionnaire. Compared to 5 median hours dedicated to LGBTQI + health-related in a 2011 study, the 2022 median reported time was 11 h (interquartile range [IQR], 6-16 h, p < 0.0001). Two UME institutions (2.4%; 95% CI, 0.0%-5.8%) reported 0 h during the pre-clerkship phase; 21 institutions (24.7%; CI, 15.5%-33.9%) reported 0 h during the clerkship phase; and 1 institution (1.2%; CI, 0%-3.5%) reported 0 h across the curriculum. Median US allopathic clerkship hours were significantly different from US osteopathic clerkship hours (4 h [IQR, 1-6 h] versus 0 h [IQR, 0-0 h]; p = 0.01). Suggested strategies to increase content included more curricular material focusing on LGBTQI + health and health disparities at 55 schools (64.7%; CI, 54.6%-74.9%), more faculty willing and able to teach LGBTQI + -related content at 49 schools (57.7%; CI, 47.1%-68.2%), and more evidence-based research on LGBTQI + health and health disparities at 24 schools (28.2%; CI, 18.7%-37.8%). CONCLUSION: Compared to a 2011 study, the median reported time dedicated to LGBTQI + health-related topics in 2022 increased across US and Canadian UME institutions, but the breadth, efficacy, or quality of instruction continued to vary substantially. Despite the increased hours, this still falls short of the number of hours based on recommended LGBTQI + health competencies from the Association of American Medical Colleges. While most deans of medical education reported their institutions' coverage of LGBTQI + health as 'fair,' 'good,' or 'very good,' there continues to be a call from UME leadership to increase curricular content. This requires dedicated training for faculty and students.


Assuntos
Currículo , Educação de Graduação em Medicina , Minorias Sexuais e de Gênero , Humanos , Canadá , Estados Unidos , Educação de Graduação em Medicina/normas , Inquéritos e Questionários , Masculino , Feminino
3.
Community Ment Health J ; 60(5): 885-897, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38431704

RESUMO

Individuals with psychiatric illness believe that voting is important. However, these individuals have lower rates of voting when compared to the general population. A survey of psychiatrically hospitalized adult patients was conducted to assess perceptions of and barriers to voting in patients with psychiatric illness. Data from 113 surveys was analyzed. A majority of survey participants agreed that they cared about voting, that their vote made a difference, and that their vote was important. 74% of individuals reported previously experiencing at least one barrier when exercising their right to vote. The most commonly experienced barriers reported were not having enough information to make an informed choice, not knowing where to vote, not having transportation, and not being registered to vote. Individuals who encountered a higher number of barriers in the past had a higher chance of encountering barriers more often. In conclusion, a high percentage of individuals with mental illness severe enough to warrant hospitalization have experienced barriers to voting, with many experiencing multiple barriers. Reduction of these barriers is important, as voting and the resultant public policies can directly affect this population's mental health and access to both mental and physical healthcare services.


Assuntos
Pacientes Internados , Transtornos Mentais , Política , Humanos , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Pacientes Internados/psicologia , Inquéritos e Questionários , Poder Psicológico , Idoso , Adulto Jovem , Votação
4.
Ann Behav Med ; 57(12): 1024-1031, 2023 11 16.
Artigo em Inglês | MEDLINE | ID: mdl-37616560

RESUMO

BACKGROUND: Intersex individuals experience poor health due, in part, to healthcare avoidance. Nonconsensual intersex surgery may contribute to medical mistrust and avoidance among intersex populations. PURPOSE: The purpose of this study was to explore the relationship between nonconsensual surgery and healthcare avoidance among intersex populations and to examine if medical mistrust mediates this relationship. METHODS: Data for this cross-sectional study were collected in 2018 and analyzed in 2022. Participants completed a survey collecting information on demographics, medical mistrust, history of nonconsensual surgery, and history of postponing healthcare. One hundred nine participants with valid responses to all regression model variables were included in the study. Multivariable logistic regression models controlling for age, race, and income, examined the relationship between nonconsensual surgery and postponing preventive and emergency healthcare. Mediation analyses of cross-sectional data examined whether medical mistrust mediated the relationship between nonconsensual surgery and postponing preventive and emergency healthcare. RESULTS: Mean medical mistrust score was 2.8 (range = 1-4; standard deviation = 0.8), 49.7% of participants had nonconsensual surgery in their lifetime, 45.9% postponed emergency healthcare, and 61.5% postponed preventive healthcare in their lifetime. Nonconsensual surgery was associated with increased odds of delaying preventive (adjusted odds ratio [AOR] = 4.17; confidence interval [CI] = 1.76-9.88; p = .016) and emergency healthcare (AOR = 4.26; CI = 1.71-10.59; p = .002). Medical mistrust mediated the relationship between nonconsensual surgery and delaying preventive (indirect effect = 1.78; CI = 1.16-3.67) and emergency healthcare (indirect effect = 1.66; CI = 1.04-3.30). CONCLUSIONS: Nonconsensual surgery contributed to healthcare avoidance in this intersex population by increasing medical mistrust. To decrease healthcare avoidance, intersex health promotion interventions should restrict nonconsensual surgery and build trust through trauma-informed care.


Many intersex people experience nonconsensual surgery during childhood to alter their genitalia and other anatomy. Some intersex people who have experienced nonconsensual surgery develop subsequent mistrust in medical providers and avoidance of healthcare. The purpose of this study was to understand the relationship between nonconsensual surgery and delay in emergency and preventive healthcare among intersex adults. Additionally, this study aimed to understand whether mistrust in medical providers mediates the relationship between nonconsensual surgery and delaying emergency and preventive healthcare. This study found that ever having nonconsensual surgery was positively associated with delaying both emergency and preventive healthcare among intersex adults. Additionally, this study found that increased mistrust in medical providers mediated the relationship between nonconsensual surgery and delaying emergency and preventive healthcare. Interventions aimed at improving the healthcare engagement of intersex adults may focus on building trust between intersex patients and healthcare providers and restricting nonconsensual intersex surgeries.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Confiança , Adulto , Humanos , Estudos Transversais , Inquéritos e Questionários , Recusa do Paciente ao Tratamento
5.
Psychiatr Serv ; 74(12): 1291-1293, 2023 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-37287229

RESUMO

The American Medical Association adopted a resolution in June 2022 recognizing voting as a social determinant of health. As psychiatric professionals and trainees with experience in civic health, the authors argue that psychiatrists must consider the relationship between voting and mental health as part of care delivery. People with psychiatric illness can experience unique barriers to voting and garner mental health benefits from civic engagement. Provider-led activities to promote voting are accessible and simple. Given the benefits of voting, and the availability of interventions to foster voter engagement, psychiatrists have an obligation to promote voting access among their patients.


Assuntos
Transtornos Mentais , Psiquiatria , Estados Unidos , Humanos , Transtornos Mentais/terapia , Saúde Mental , Política
6.
7.
Community Ment Health J ; 59(3): 498-506, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-36315332

RESUMO

Individuals with mental illness often face barriers to voting. One of the primary barriers is not being registered to vote. This paper describes voter support activities (VSAs) provided to hospitalized adults on the acute inpatient psychiatric units at Pennsylvania Psychiatric Institute. During the six weeks preceding the 2020 general election, adult inpatients were offered six VSAs and an optional survey examining previous voting behaviors and barriers encountered to voting. VSAs included checking voter registration status and polling location, completing a paper or electronic voter registration application, and requesting a mail-in ballot. Of 189 patients approached, 119 individuals participated in the survey and 60 individuals utilized at least one VSA. This project demonstrates that VSAs are a welcome and feasible resource for psychiatrically hospitalized adults. Psychiatric providers can serve an important role in promoting access to voting-related activities for their patients.


Assuntos
Equidade em Saúde , Transtornos Mentais , Adulto , Humanos , Pacientes Internados , Política , Transtornos Mentais/terapia , Pennsylvania
8.
Pediatr Ann ; 50(9): e359-e365, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34542337

RESUMO

Throughout the history of Western culture, sex has been reflected as a binary rule, with this binary system affecting self-expression, lifestyle choices, and health outcomes of everyone, but especially those with intersex traits. "Intersex" (or differences of sex development) is an umbrella term used to describe a wide range of natural variations in genitalia, gonads, and chromosome patterns that do not fit typical binary notions of male or female bodies. Currently, people who identify as intersex or as having intersex traits are not provided with the appropriate care needed for their wellbeing. Intersex health care has undergone a great deal of change in the last century, led by intersex leaders and advocates. Clinician advocates have also played a vital role. This article will focus on this history of intersex health care evolution, the role of clinician advocacy, and suggestions for how clinicians can become advocates for improving intersex health care. [Pediatr Ann. 2021;50(9):e359-e365.].


Assuntos
Atenção à Saúde/tendências , Transtornos do Desenvolvimento Sexual , Transtornos do Desenvolvimento Sexual/diagnóstico , Transtornos do Desenvolvimento Sexual/terapia , Feminino , Gônadas/anatomia & histologia , Humanos , Masculino , Defesa do Paciente , Papel do Médico
9.
LGBT Health ; 8(7): 439-443, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34191611

RESUMO

Historically, the majority of differences in sex development or intersex trait (dsd/I)-specific medical care has been provided by pediatric clinicians, leading to a dearth of adult clinicians qualified to care for this vulnerable population, and pediatricians reticent to transition patients to adult care. Recent changes in routine care of children and infants with dsd/I, including reconsidering the role of early genital surgeries, highlight the critical need to address the gaps in adult dsd/I health care. In this perspective, we describe three key educational and research approaches that can be implemented to build competency to care for adults with dsd/I and improve care across the lifespan.


Assuntos
Transtornos do Desenvolvimento Sexual , Adulto , Criança , Atenção à Saúde , Transtornos do Desenvolvimento Sexual/terapia , Humanos , Lactente , Desenvolvimento Sexual
11.
J ECT ; 37(1): 64-66, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-32881782

RESUMO

ABSTRACT: There is very limited information regarding the effectiveness of electroconvulsive therapy (ECT) as a treatment for major depressive disorder in transgender patients. This population is also at risk for comorbid conditions, such as posttraumatic stress disorder and substance use that could impact the outcome of ECT. We report our experience with the use of ECT in this population. Clinical and response characteristics of 7 consecutive cases are described in this series. All patients had multiple psychiatric diagnoses and were refractory to pharmacologic intervention. Pretreatment Beck Depression Inventory-II scores were 45.5 ± 3.2 SEM and posttreatment scores were 21.2 ± 6.4 [P < 0.01]. Suicidality scores reduced by greater than 60%, whereas remission of depression was obtained for 2 of 7, and 4 of 7 showed greater than 50% reduction in depression scores. Treatments were tolerated well using conventional treatment procedures. This case series suggests that ECT can be effective for depressed transgender patients with multiple clinical comorbidities.


Assuntos
Transtorno Depressivo Maior/terapia , Eletroconvulsoterapia/métodos , Pessoas Transgênero/psicologia , Adolescente , Adulto , Comorbidade , Feminino , Humanos , Masculino , Pennsylvania , Estudos Retrospectivos
12.
PLoS One ; 15(10): e0240088, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33035248

RESUMO

OBJECTIVES: To describe the health of intersex adults (people with differences of sex development) in the U.S. using community-based research methods. METHODS: In July-September 2018, we conducted a national health study of intersex adults aged 18 and older in the U.S., using a survey hosted on Qualtrics. The study describes the physical and mental health experiences of intersex adults, including differences by age (18 to 39 vs. 40 and older). Questions were derived from national (Behavioral Risk Factor Surveillance System) and intersex-related health studies. RESULTS: A non-probability sample of 198 intersex adults completed the survey over three months. Over 43% of participants rated their physical health as fair/poor and 53% reported fair/poor mental health. Prevalent health diagnoses included depression, anxiety, arthritis, and hypertension, with significant differences by age. Nearly a third reported difficulty with everyday tasks and over half reported serious difficulties with cognitive tasks. CONCLUSIONS: To our knowledge, this is the first national study of intersex adults in the U.S. Greater understanding of intersex health over the life course is essential. Findings highlight the need for longitudinal studies and further examination of potential health disparities experienced by intersex populations.


Assuntos
Transtornos do Desenvolvimento Sexual/psicologia , Nível de Saúde , Saúde Mental , Adolescente , Adulto , Idoso , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/patologia , Depressão/epidemiologia , Depressão/patologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Estados Unidos/epidemiologia , Adulto Jovem
13.
Curr Psychiatry Rep ; 18(6): 59, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27091646

RESUMO

Depression and anxiety during pregnancy are common, and patients and providers are faced with complex decisions regarding various treatment modalities. A structured discussion of the risks and benefits of options with the patient and her support team is recommended to facilitate the decision-making process. This clinically focused review, with emphasis on the last 3 years of published study data, evaluates the major risk categories of medication treatments, namely pregnancy loss, physical malformations, growth impairment, behavioral teratogenicity, and neonatal toxicity. Nonpharmacological treatment options, including neuromodulation and psychotherapy, are also briefly reviewed. Specific recommendations, drawn from the literature and the authors' clinical experience, are also offered to help guide the clinician in decision-making.


Assuntos
Ansiedade/terapia , Tomada de Decisões , Depressão/terapia , Complicações na Gravidez/psicologia , Complicações na Gravidez/terapia , Transtornos de Ansiedade/terapia , Transtorno Depressivo/terapia , Feminino , Humanos , Gravidez , Medição de Risco
14.
Horm Res Paediatr ; 85(3): 158-80, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26820577

RESUMO

The goal of this update regarding the diagnosis and care of persons with disorders of sex development (DSDs) is to address changes in the clinical approach since the 2005 Consensus Conference, since knowledge and viewpoints change. An effort was made to include representatives from a broad perspective including support and advocacy groups. The goal of patient care is focused upon the best possible quality of life (QoL). The field of DSD is continuously developing. An update on the clinical evaluation of infants and older individuals with ambiguous genitalia including perceptions regarding male or female assignment is discussed. Topics include biochemical and genetic assessment, the risk of germ cell tumor development, approaches to psychosocial and psychosexual well-being and an update on support groups. Open and on-going communication with patients and parents must involve full disclosure, with the recognition that, while DSD conditions are life-long, enhancement of the best possible outcome improves QoL. The evolution of diagnosis and care continues, while it is still impossible to predict gender development in an individual case with certainty. Such decisions and decisions regarding surgery during infancy that alters external genital anatomy or removes germ cells continue to carry risk.


Assuntos
Transtornos do Desenvolvimento Sexual , Qualidade de Vida , Desenvolvimento Sexual , Transtornos do Desenvolvimento Sexual/diagnóstico , Transtornos do Desenvolvimento Sexual/epidemiologia , Transtornos do Desenvolvimento Sexual/fisiopatologia , Transtornos do Desenvolvimento Sexual/terapia , Feminino , Humanos , Masculino
15.
Horm Res Paediatr ; 85(2): 112-8, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26727471

RESUMO

BACKGROUND: Societal changes are increasingly moving the conceptualization of gender from a set of binary categories towards a bimodal continuum, which along with the cautious conclusions resulting from the 2005 Consensus Conference influences gender-related clinical work with patients with disorders of sex development. OBJECTIVE: This article provides an update of these developments over the past decade along with an overview of pertinent new data. CONCLUSION: Considerably more research is needed on larger sample sizes with systematic long-term follow-up to ground the emerging trends in clinical management of the highly diverse disorders of sex development syndromes in a solid empirical basis.


Assuntos
Transtornos do Desenvolvimento Sexual , Identidade de Gênero , Feminino , Humanos , Masculino , Procedimentos de Readequação Sexual
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