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J Health Care Poor Underserved ; 32(2): 598-606, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34120960


In response to the COVID-19 pandemic, the Herbert Wertheim College of Medicine's Neighborhood Health Education Learning Program (NeighborhoodHELP) initiated a longitudinal assessment and mitigation of social and health care challenges for a population of approximately 850 underserved households. Here, we describe the needs assessment, ensuing interventions, and lessons learned during this pandemic.

COVID-19/epidemiologia , Determinação de Necessidades de Cuidados de Saúde , Populações Vulneráveis , Adolescente , Adulto , Idoso , Criança , Serviços de Saúde Comunitária , Informação de Saúde ao Consumidor , Feminino , Florida/epidemiologia , Assistência Alimentar , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Área Carente de Assistência Médica , Pessoa de Meia-Idade , Pandemias , Determinantes Sociais da Saúde , Adulto Jovem
South Med J ; 114(1): 17-22, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33398355


OBJECTIVES: Previous negative experiences with the medical community often leave transgender people reluctant to seek medical care. Inadequate teaching and exposure to transgender health during medical training perpetuates the health disparities experienced by this community. Although undergraduate medical education is uniquely positioned to address these disparities, curricular coverage of these topics remains inadequate. METHODS: The second-year clinical skills course at the Florida International University Herbert Wertheim College of Medicine includes a workshop consisting of a 1-hour lecture about the inclusive sexual history, followed by a 1.5-hour small group during which students interview a standardized patient playing the role of a transgender man and participate in a faculty-facilitated debriefing. To evaluate the 2019 workshop, students were provided with an optional, anonymous, pre- and postsession survey consisting of multiple choice and Likert-type questions. RESULTS: After the session, there was a statistically significant increase in students' knowledge of the components of an inclusive sexual history, in the number of students who believed that their medical training had prepared them to effectively provide care for transgender patients, and in the number who reported feeling comfortable taking a sexual history from a patient who identifies as transgender. Most students thought the standardized patient case was realistic and found the postencounter debriefing session helpful in identifying their own strengths and weaknesses. CONCLUSIONS: Our findings suggest that students found this brief, interactive sexual history workshop, which included a lecture and standardized patient case, to be an effective component of their medical training. Although our transgender patient case was acted primarily by cis-gender people, students perceived this as a realistic opportunity to actively explore the nuances of obtaining a history from a transgender patient. In addition, our findings suggest that it is possible to merge teaching on sexual history and transgender health care, which is important in time-limited undergraduate medical education curricula.

Assistência à Saúde Culturalmente Competente/métodos , Anamnese/métodos , Simulação de Paciente , Ensino/normas , Pessoas Transgênero/educação , Assistência à Saúde Culturalmente Competente/estatística & dados numéricos , Educação/métodos , Humanos , Ensino/estatística & dados numéricos , Pessoas Transgênero/psicologia
Fam Med ; 52(7): 523-527, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32640477


BACKGROUND AND OBJECTIVES: Although the subinternship (sub-I) is considered integral in many medical schools' curricula, family medicine does not have standardized course recommendations. Given the variable nature of this clinical experience, this study investigated the potential role of a standardized sub-I curriculum in family medicine. METHODS: Questions about sub-Is were created and data were gathered and analyzed as part of the 2019 Council of Academic Family Medicine's (CAFM) Educational Research Alliance (CERA) survey of family medicine clerkship directors. The survey was distributed via email to 126 US and 16 Canadian recipients between June 19, 2019 and August 2, 2019 through the online program SurveyMonkey. RESULTS: A total of 101 (71.1%) of 142 clerkship directors responded to the survey. Most (84.2%) schools require sub-Is. There was a positive association between students matching into family medicine and having family medicine sub-Is at residency programs (P<.001). There was no relationship between higher family medicine match rates and the presence of family medicine sub-Is at nonresidency sites (P=.48) or having an advanced ambulatory rotation requirement (P=.16). CONCLUSIONS: A sub-I is a way to further expose students to family medicine, and increasing sub-I positions at residency programs may influence the number who pursue the specialty. Creation of a standardized sub-I curriculum presents an opportunity to enhance a critical educational experience in family medicine.

J Immigr Minor Health ; 22(2): 421-425, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31620965


In 2016, the NeighborhoodHELP mobile health centers (MHCs) started to provide free long acting reversible contraception (LARC) for uninsured patients who lacked access due to cost. All female patients with appointments from May 1st, 2016 through April 30th, 2017 were identified. LARC uptake rate, as well as demographics for patients aged 15-44 who underwent LARC insertion versus those who did not, were determined. Of the 520 female patients seen on the MHCs during the study period, 170 were of reproductive age. Seventeen (10%) patients opted for LARC; 100 % of these patients spoke Spanish or English and 82 % identified as White and Hispanic/Latino. Results show a 10% LARC uptake, which is slightly above the national rate, but lower than rates in other studies in which cost barriers were removed. Further investigation into barriers influencing LARC uptake in our patient population is warranted.

Serviços de Planejamento Familiar , Contracepção Reversível de Longo Prazo , Unidades Móveis de Saúde , Adolescente , Adulto , Anticoncepcionais Femininos , Registros Eletrônicos de Saúde , Feminino , Florida , Acesso aos Serviços de Saúde , Humanos , Pessoa de Meia-Idade , Projetos Piloto , Determinantes Sociais da Saúde , Adulto Jovem
Ann Epidemiol ; 28(2): 119-134, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29439782


PURPOSE: To describe the use of multilevel models (MLMs) in evaluating the influence of contextual factors on HIV/AIDS, sexually transmitted infections (STIs), and risky sexual behavior (RSB) in sub-Saharan Africa. METHODS: Ten databases were searched through May 29, 2016. Two reviewers completed screening and full-text review. Studies examining the influence of contextual factors on HIV/AIDS, STIs, and RSB and using MLMs for analysis were included. The Quality Assessment Tool for Quantitative Studies was used to evaluate study quality. RESULTS: A total of 118 studies met inclusion criteria. Seventy-four studies focused on HIV/AIDS-related topics; 46 focused on RSB. No studies related to STIs other than HIV/AIDS met the eligibility criteria. Of five studies examining HIV serostatus and community socioeconomic factors, three found an association between poverty and measures of inequality and increased HIV prevalence. Among studies examining RSB, associations were found with numerous contextual factors, including poverty, education, and gender norms. CONCLUSIONS: Studies using MLMs indicate that several contextual factors, including community measures of socioeconomic status and educational attainment, are associated with a number of outcomes related to HIV/AIDS and RSB. Future studies using MLMs should focus on contextual-level interventions to strengthen the evidence base for causality.

Infecções por HIV/epidemiologia , Assunção de Riscos , Comportamento Sexual , Doenças Sexualmente Transmissíveis/epidemiologia , Determinantes Sociais da Saúde , África ao Sul do Saara/epidemiologia , Feminino , Humanos , Masculino , Análise Multinível , Pobreza , Fatores Socioeconômicos
Am J Prev Med ; 51(3): 373-83, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27130864


CONTEXT: Some parents believe human papillomavirus (HPV) vaccination increases the chance of risky sexual behaviors among adolescents. This review summarizes the evidence available on adolescent girls and women engaging in risky sexual activity following HPV vaccination. EVIDENCE ACQUISITION: Systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted in 2014 and updated in 2015. Literature was searched for articles published between 2004 and 2015 in MEDLINE, PsycInfo, CINAHL, Cochrane Database, Web of Science, and EMBASE without language limits. Studies were screened according to predefined inclusion and exclusion criteria. Methodologic quality of the included articles was assessed. EVIDENCE SYNTHESIS: The search resulted in 21 articles to be included in the review, with 527,475 participants. Included studies were conducted in 12 different countries using experimental and observational study designs. The review included data on girls aged as young as 11 years to women aged 40 years. Studies measured changes in sexual behaviors using a variety of outcomes, including age at sexual debut; risky sexual behaviors; use of condoms and contraception; and clinical indicators such as rates of sexually transmitted infections, HIV, and pregnancy terminations. Available data showed either no association between vaccination status and the outcomes of interest or a positive association between safer sexual behaviors, such as condom use and receipt of HPV vaccination. Methodologic quality of all but one study was moderate or weak. CONCLUSIONS: This review did not find sufficient evidence to support compensatory sexual risk behaviors following HPV vaccination among adolescent girls or women.

Vacinas contra Papillomavirus/administração & dosagem , Assunção de Riscos , Doenças Sexualmente Transmissíveis/epidemiologia , Vacinação/psicologia , Feminino , Saúde Global , Humanos , Infecções por Papillomavirus/prevenção & controle , Sexo Seguro , Comportamento Sexual