Journal articles on the topic 'Discrimination in medical care'
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1
Fiala, Mark Aaron. "Discrimination, medical mistrust, and delaying cancer screenings and other medical care." JCO Oncology Practice 19, no. 11_suppl (November 2023): 159. http://dx.doi.org/10.1200/op.2023.19.11_suppl.159.
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159 Background: Mistrust in the health care system can delay one from seeking needed care and lead to worse health outcomes. For racial/ethnic minorities, medical mistrust may be rooted in past experience of discrimination during clinical encounters. However, few studies have analyzed the relationships between discrimination, medical mistrust, and delaying care, such as cancer screenings. Methods: The study utilized the 2022 Health Information National Trends Survey (HINTS) data, a nationally representative study about knowledge of and attitudes toward cancer- and health-related information. Medical mistrust was assessed by one question “How much do you trust the health care system.” Those reporting “not at all” or “a little” opposed to “somewhat” and “very” were considered to have medical mistrust. Results: Overall, 15% were considered to have medical mistrust. 14% of participants who identified as a racial/ethnic minority reported feeling discriminated against when getting medical care. Participants reporting prior discrimination were 286% (p <0.001) more likely to report medical mistrust after controlling for age, education, income, and race and ethnicity. Interestingly, after controlling for prior discrimination, African American or Black participants were 33% (p = 0.001) less likely to report medical mistrust than their White peers. Overall, 33% of participants reported delaying needed medical care in the past year and 22% reported not being interested in having a cancer screening test in the next year. Participants reporting prior discrimination were 170% (p < 0.001) more likely to report delaying care and those reporting medical mistrust were 83% (p < 0.001) more likely after controlling for age, education, income, race and ethnicity, and insurance coverage. Participants reporting medical mistrust were 37% (p < 0.001) less likely to report being interested in having a cancer screening test after controlling for covariates. There was no independent association between prior discrimination and interest in cancer screenings (p = 0.286). Conclusions: Perceived discrimination during clinical encounters is a mechanism for medical mistrust and medical mistrust is associated with delaying needed care including cancer screenings. Decreasing discrimination may improve trust and reduce disparities in health outcomes.
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Penner, Louis A., John F. Dovidio, Donald Edmondson, Rhonda K. Dailey, Tsveti Markova, Terrance L. Albrecht, and Samuel L. Gaertner. "The Experience of Discrimination and Black-White Health Disparities in Medical Care." Journal of Black Psychology 35, no. 2 (February 9, 2009): 180–203. http://dx.doi.org/10.1177/0095798409333585.
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The current study of Black patients focuses on how discrimination contributes to racial disparities in health. The authors used a longitudinal methodology to study how perceived past discrimination affects reactions to medical interactions and adherence to physician recommendations. In addition, they explored whether these reactions and/or adherence mediate the relationship between discrimination and patients' health. The participants in this study were 156 Black patients of low socioeconomic status at a primary care clinic. Patients completed questionnaires on their current health, past adherence, and perceived past discrimination. Then, they saw a physician and rated their reactions to the visit. Four and 16 weeks later they reported on their adherence to physician recommendations and overall health. Perceived discrimination was significantly and negatively associated with patient health, reactions to the physician, and adherence. Path analyses indicated that adherence mediated the relationship between discrimination and patient health, but patient reactions to the interaction did not.
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Mason, Lawrence. "Medical Discrimination: A Hidden and Non-Neglectable Issue." Science Insights 44, no. 4 (April 30, 2024): 1327–39. http://dx.doi.org/10.15354/si.24.re963.
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Medical discrimination is a pervasive issue that often goes unnoticed or unaddressed in the healthcare system. It occurs when individuals receive differential treatment based on characteristics such as race, gender, sexual orientation, age, or socioeconomic status. This type of discrimination can have serious consequences for patients, including delayed or inadequate care, misdiagnosis, and even harm to their physical and mental health. The impacts of medical discrimination are far-reaching and systemic, perpetuating disparities in health outcomes among marginalized populations. To address this issue effectively, it is crucial for healthcare providers to undergo training on cultural competency and unconscious bias recognition. Additionally, policies must be implemented at both the institutional and governmental levels to ensure equitable access to care for all patients. Ignoring medical discrimination only perpetuates inequalities in the healthcare system and exacerbates disparities in health outcomes.
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Mundy, Lindsey, Suzanne Judd, Olivio Clay, Virginia Howard, Raegan Durant, and Michael Crowe. "CORRELATES OF PHYSICIAN TRUST: DEMOGRAPHIC FACTORS AND EXPERIENCES OF MEDICAL CARE DISCRIMINATION." Innovation in Aging 7, Supplement_1 (December 1, 2023): 1011. http://dx.doi.org/10.1093/geroni/igad104.3248.
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Abstract Lack of trust between older adults and their physicians may decrease adherence to medication or limit disclosure of information to healthcare providers. Trust may be shaped in part by demographic factors as well as previous experiences of discrimination in healthcare. We hypothesized that more experiences of discrimination in a medical care setting would be negatively associated with general physician trust. We used cross-sectional data from a follow-up visit (2013-2016) of the national REasons for Geographic and Racial Differences in Stroke (REGARDS) longitudinal cohort study. Our sample included participants who completed an 11-item general physician trust measure (score range=11-55) and a four-point item about discrimination in medical care settings (n=8,235, age 52-98, 31% Black, 45% men). We examined two sequential linear regression models with trust as the outcome, with the first model including demographic factors and the second adding discrimination in a medical setting. Female gender (β=-0.09, p<.05), Black race (β=-0.03, p<.05), and higher level of education (β=-0.8, p<.05) were each related to lower trust. Higher income (β=0.04, p<.05) and older age (β=0.12, p<.05) were associated with higher trust. Perceived discrimination had a negative association with physician trust (β=-0.14, p<.05) and the relationship between Black race and trust reversed direction and was no longer statistically significant (β=0.20, p=.298) with discrimination in the model. The potential impact of previous discrimination experiences in a medical care setting on physician trust should be considered when providing healthcare services to diverse populations of older adults.
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Ognerubov, Nikolai A., Roman V. Zelepukin, and Irina V. Poddubnaya. "Risk of discrimination against Russian citizens in providing medical care abroad as a health care trend." Journal of Modern Oncology 24, no. 2 (July 15, 2022): 260–63. http://dx.doi.org/10.26442/18151434.2022.2.201706.
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The authors reveal the conditions and factors of health care system development that have emerged to date, indicate their content, and note the role of legal regulation of health care. The influence of aggravation of the international situation is noted, and the resulting risk of national origin discrimination against Russian citizens is addressed. The risk of discrimination against Russian citizens in providing health care abroad is presented as a trend. In this respect, the authors suggest some organizational and human rights measures and directions of support and protection of the rights of Russian citizens.
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Berniker, Jessamyn S. "Legal Implications of Discrimination in Medical Practice." Journal of Law, Medicine & Ethics 28, no. 1 (2000): 85–88. http://dx.doi.org/10.1111/j.1748-720x.2000.tb00322.x.
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Recent medical studies have indicated that medical professionals discriminate in their treatment practices on the basis of race and gender. Among the many concerns stemming from this realization are questions about the possibility of legal actions and the availability of individual compensation for the denial of equal care. By meeting legal evidentiary standards, the recent statistical data pointing to discriminatory trends have created the potential for legal recourse through Title VI of the Civil Rights Act which prohibits recipients of federal funding from treating people differently on the basis of race or national origin.
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Gurel-Headley, Morgan, Mariam Mamisashvili, Sheena CarlLee, Sharon Reece, Christina Chapman, Shashank Kraleti, Jennifer A. Andersen, et al. "Associations between Influenza Vaccination and Health Care Access among Adults in the United States." Vaccines 11, no. 2 (February 11, 2023): 416. http://dx.doi.org/10.3390/vaccines11020416.
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Few studies have investigated the relationship between influenza vaccination and health care access. Furthermore, despite the well-documented disparities in vaccine coverage for communities of color, few studies have examined how experiences of discrimination may influence vaccine uptake. To fill this gap in the literature, this study examined associations between 5-year influenza vaccination rates and sociodemographic characteristics, health care access, and racial discrimination. Age, race/ethnicity, education, health care coverage, primary care provider, no medical care due to cost, and routine doctor checkups were significant correlates of 5-year influenza vaccination. In contrast to previous studies, discrimination scores were not a significant correlate of regular influenza vaccination. Respondents who reported forgoing care due to cost were less likely to report vaccination every year out of the last 5 years compared to all of the less frequent categories combined, demonstrating a more complex association between sometimes not being able to afford medical care and influenza vaccination. Future research should examine the relationship between influenza vaccination uptake, racial discrimination, and forgone care due to cost to enhance resources and messaging for influenza vaccination uptake.
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Ali Khan, Waqas, and Qaisar Abbas. "Transgender Discrimination in the Binary Gender Paradigm: An Analysis of Exclusionary Practices in Healthcare." Journal of Asian Development Studies 13, no. 2 (May 28, 2024): 181–87. http://dx.doi.org/10.62345/jads.2024.13.2.15.
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This research focuses on the widespread discrimination against transgender individuals within the healthcare industry resulting from a deeply rooted binary gender system. It seeks to gauge how much they are discriminated against, identify particular forms of discrimination by medical practitioners, and evaluate healthcare providers' understanding gaps about transgender health needs. The investigation assumes that in healthcare facilities, transgender people receive substantial discrimination treatment; doctors carry out discriminatory actions as well as health facilitators or hospital administration know little about what is required for the wellbeing of such patients. The quantitative study involved 344 transgender individuals from 36 districts of Punjab. To find out the rates and types of discrimination as well as knowledge gaps among the data was subjected to chi-square tests, one-way ANOVA, and regression analysis. Results of chi-square tests revealed a significant relation between transgender identity and multiple discriminations such as postponements in treatment (χ² = 43.62, p < 0.001), denial of care (χ² = 67.21, p < 0.001), as well as financial discrimination (χ² = 138.23, p < 0.001). This research adds to existing knowledge about transgender health by showing how these individuals are discriminated against regularly and why educational as well as policy reforms in medical facilities should be implemented as a matter of urgency.
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Smith, DeAnna Y., and Alexus Roane. "Child Removal Fears and Black Mothers’ Medical Decision-Making." Contexts 22, no. 1 (February 2023): 18–23. http://dx.doi.org/10.1177/15365042221142834.
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Konnoth, Craig. "Mental Health Parity Arguments for Accessing Gender Affirmation Surgery." American Journal of Law & Medicine 49, no. 2-3 (July 2023): 386–95. http://dx.doi.org/10.1017/amj.2023.39.
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AbstractMany insurers exclude coverage for transgender individuals. Litigation challenging these exclusions has increased. Most of these cases successfully advance equality claims by arguing that trans exclusions discriminate based on sex. That is, procedures performed on patients for reasons unrelated to gender affirming care are being denied to transgender individuals. There are, however, limitations to this argument. First, some courts may construe care narrowly and hold that some procedures are unique to gender affirming care that have no analog in other contexts. Second, a court that is hostile to the sex discrimination argument might hold that the denial does not arise from sex discrimination, but rather, because of the kind of diagnosis at issue. Further, the sex discrimination argument might force transgender individuals into making claims based on a binarized gender identity which may not conform with their lived experience.Claims based on the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) can address these shortcomings. This Act prohibits insurers from discriminating against mental health diagnoses—for example, procedures that insurers cover because of medical or surgical diagnoses should also be covered if indicated for mental health diagnoses. Gender dysphoria is a recognized mental health diagnosis. Transgender individuals seeking gender affirming care arising from gender dysphoria can thus claim that exclusions of coverage violate the MHPAEA. Some transgender individuals might raise concerns that such an approach would lead to increased medicalization of trans identity. However, an MHPAEA claim would only appear in cases where a transgender individual is voluntarily submitting themselves to medical assistance in order to advance their own autonomy.
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Gonzales, Kelly L., William E. Lambert, Rongwei Fu, Michelle Jacob, and Anna K. Harding. "Perceived Racial Discrimination in Health Care, Completion of Standard Diabetes Services, and Diabetes Control Among a Sample of American Indian Women." Diabetes Educator 40, no. 6 (September 23, 2014): 747–55. http://dx.doi.org/10.1177/0145721714551422.
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Purpose The purpose of this study is to examine perceived experiences of racial discrimination (perceived discrimination) in health care and its associations with completing standards of care for diabetes management and diabetes control. Methods This cross-sectional study included 200 adult American Indian (AI) women with type 2 diabetes from 4 health care facilities located on tribal reservations in the Pacific Northwest. Participants completed a survey, and medical records were abstracted. Logistic regression was completed to assess associations. Results Sixty-seven percent of AI women reported discrimination during their lifetime of health care. After adjusting for patient characteristics, perceived discrimination was significantly associated with lower rates of dental exam; checks for blood pressure, creatinine, and total cholesterol; and pneumococcal vaccination. The association between perceived discrimination and total number of diabetes services completed was not statistically significant. Perceived discrimination was associated with having A1C values above target levels for diabetes control in unadjusted and adjusted models, but no association was observed for blood pressure or total cholesterol. Conclusions In our sample of AI women with diabetes, two-thirds reported experiencing racial discrimination in their health care experience. Those reporting perceived discrimination completed fewer diabetes services and therefore may be at increased risk for comorbidities of diabetes. This finding supports the continued need for culturally responsive health care and programs of diabetes education to recognize perceived discrimination and its potential to impact success in self-management and services utilization.
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Wang, Wanbo, Donne Will, and Fuzhou Wang. "Medical Equity: The Eventual Goal of Health Care." Science Insights 44, no. 4 (April 30, 2024): 1341–52. http://dx.doi.org/10.15354/si.24.re969.
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Medical equity is the fundamental principle that all individuals should have equal access to high-quality healthcare services, regardless of their race, ethnicity, gender, socioeconomic status, or geographic location. Achieving medical equity is essential for improving health outcomes and reducing disparities in healthcare delivery. This goal requires addressing systemic barriers such as discrimination, stigma, and lack of access to resources that prevent marginalized populations from receiving appropriate care. Implementing policies and programs that promote medical equity will help ensure that everyone has the opportunity to lead a healthy life. By prioritizing equity in healthcare delivery, we can work towards creating a more just and inclusive society where every individual has the opportunity to achieve optimal health and well-being.
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Mihalache, Adrian Sorin, and Leon Zăgrean. "Compassion vs. empathy. Necessary distinctions in approaching medical care." Romanian Medical Journal 68, no. 3 (September 30, 2021): 354–67. http://dx.doi.org/10.37897/rmj.2021.3.5.
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The incidence of the fatigue caused by medical care brings to attention the emotional reactions to suffering and their possible effects on caregivers. In this study, we shall discuss empathy and compassion. Linguistic analyses and psychological evaluations fail to differentiate between empathy and compassion. We shall therefore make an inventory of the contribution of neuroscientific studies that we consider important. We shall present some research and clinical studies that support the discrimination between compassion and empathy, at the psycho-behavioral level, in terms of vagal and cerebral patterns and in terms of the effects that these emotional states have at the psycho-emotional level. Unlike the interventions aimed at empathic training, cultivating compassion among caregivers produces beneficial effects, decreasing fatigue and increasing resilience. We believe that the differences found between compassion and empathy support the replacement of the phrase “compassion fatigue”, widely used today, with “empathic distress”. We consider the prophylactic and therapeutic capitalization of compassion in health care, by developing training programs to cultivate compassion for specialized staff for patients, to avoid fatigue (empathic distress) and to improve the emotional, humanistic dimension of the doctor-patient relationship, both urgent and necessary.
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Brusca, Rebeccah M., Catherine E. Simpson, Sarina K. Sahetya, Zeba Noorain, Varshitha Tanykonda, R. Scott Stephens, Dale M. Needham, and David N. Hager. "Performance of Critical Care Outcome Prediction Models in an Intermediate Care Unit." Journal of Intensive Care Medicine 35, no. 12 (October 21, 2019): 1529–35. http://dx.doi.org/10.1177/0885066619882675.
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Background: Intermediate care units (IMCUs) are heterogeneous in design and operation, which makes comparative effectiveness studies challenging. A generalizable outcome prediction model could improve such comparisons. However, little is known about the performance of critical care outcome prediction models in the intermediate care setting. The purpose of this study is to evaluate the performance of the Acute Physiology and Chronic Health Evaluation version II (APACHE II), Simplified Acute Physiology Score version II (SAPS II) and version 3 (SAPS 3), and Mortality Probability Model version III (MPM0III) in patients admitted to a well-characterized IMCU. Materials and Methods: In the IMCU of an academic medical center (July to December 2012), the discrimination and calibration of each outcome prediction model were evaluated using the area under the receiver–operating characteristic and Hosmer-Lemeshow goodness-of-fit test, respectively. Standardized mortality ratios (SMRs) were also calculated. Results: The cohort included data from 628 unique IMCU admissions with an inpatient mortality rate of 8.3%. All models exhibited good discrimination, but only the SAPS II and MPM0III were well calibrated. While the APACHE II and SAPS 3 both markedly overestimated mortality, the SMR for the SAPS II and MPM0III were 0.91 and 0.91, respectively. Conclusions: The SAPS II and MPM0III exhibited good discrimination and calibration, with slight overestimation of mortality. Each model should be further evaluated in multicenter studies of patients in the intermediate care setting.
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Charron, Marilou, Katie Saulnier, Nicole Palmour, Hortense Gallois, and Yann Joly. "Intersex Stigma and Discrimination: Effects on Patient-Centred Care and Medical Communication." Canadian Journal of Bioethics 5, no. 2 (2022): 16. http://dx.doi.org/10.7202/1089782ar.
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Casagrande, Sarah Stark, Tiffany L. Gary, Thomas A. LaVeist, Darrell J. Gaskin, and Lisa A. Cooper. "Perceived Discrimination and Adherence to Medical Care in a Racially Integrated Community." Journal of General Internal Medicine 22, no. 3 (January 27, 2007): 389–95. http://dx.doi.org/10.1007/s11606-006-0057-4.
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Rosenbaum, Sara. "Insurance Discrimination on the Basis of Health Status: An Overview of Discrimination Practices, Federal Law, and Federal Reform Options." Journal of Law, Medicine & Ethics 37, S2 (2009): 101–20. http://dx.doi.org/10.1111/j.1748-720x.2009.00423.x.
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This is an important time to focus on the question of insurance discrimination based on health status. The nation once again is poised to embark on a major health care reform debate. Even as the number of uninsured stands at some 45 million persons, millions more may be poised to lose coverage during the worst economic downturn in generations. In addition, a large number of persons may be seriously under-insured, with coverage falling significantly below the cost of necessary health care. In recent years, the proportion of insured persons who are underinsured has grown by 60% since 2003, reaching an estimated 25 million persons in 2007. Health care costs experienced by insured persons now account for more than 75% of all personal bankruptcies related to medical care. Underlying these figures is a national approach to health care financing for the non-elderly that effectively increases the odds that those who are in poor health status will be uninsured or underinsured.
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Thapa, Raksha, E. Van Teijlingen, P. Regmi, and V. Heaslip. "Uptake of Health Services by People from the Dalit Community." Journal of BP Koirala Institute of Health Sciences 1, no. 2 (December 20, 2018): 1–6. http://dx.doi.org/10.3126/jbpkihs.v1i2.22072.
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Studies and reports on uptake of health services in Nepal and other low-income countries often focus on limitations due to physical factors, such as travel distance to health facility, or lack of medical facilities or electricity at the health care centre or focus on resources, such as lack of service providers, or lack of appropriately trained staff.
In this editorial article, we highlight the importance of discrimination as a reason for people not seeking available health care. Discrimination is particularly a barrier to service usage among the most deprived people in society, such as the Dalit community in Nepal and South Asia more generally. We discuss the caste-based discrimination in Nepal and its effects on health outcomes of those groups who experience such discrimination.
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Misek, Ryan. "The Injustice of Categorical Exclusions during Triage." National Catholic Bioethics Quarterly 22, no. 3 (2022): 495–507. http://dx.doi.org/10.5840/ncbq202222345.
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Triage situations and other occurrences in which rationing of medical care is necessary require careful distribution of medical equipment, services, or resources. However, the evolution of triage has failed to eliminate certain biases in the standards of care, particularly for groups already facing societal disenfranchisement and discrimination. This article explores the use of triage calculators and other systems of rationing care, their implicit biases, and how to avoid allowing those biases to influence care.
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Miller, Robert J. H., Danielle Southern, Stephen B. Wilton, Matthew T. James, Bryan Har, Greg Schnell, Sean van Diepen, and Andrew D. M. Grant. "Comparative Prognostic Accuracy of Risk Prediction Models for Cardiogenic Shock." Journal of Intensive Care Medicine 35, no. 12 (October 14, 2019): 1513–19. http://dx.doi.org/10.1177/0885066619878125.
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Objectives: Despite advances in medical therapy, reperfusion, and mechanical support, cardiogenic shock remains associated with excess morbidity and mortality. Accurate risk stratification may improve patient management. We compared the accuracy of established risk scores for cardiogenic shock. Methods: Patients admitted to tertiary care center cardiac care units in the province of Alberta in 2015 were assessed for cardiogenic shock. The Acute Physiology and Chronic Health Evaluation-II (APACHE-II), CardShock, intra-aortic balloon pump (IABP) Shock II, and sepsis-related organ failure assessment (SOFA) risk scores were compared. Receiver operating characteristic curves were used to assess discrimination of in-hospital mortality and compared using DeLong’s method. Calibration was assessed using the Hosmer-Lemeshow goodness-of-fit test. Results: The study included 3021 patients, among whom 510 (16.9%) had cardiogenic shock. Patients with cardiogenic shock had longer median hospital stays (median 11.0 vs 4.1 days, P < .001) and were more likely to die (29.0% vs 2.5%, P < .001). All risk scores were adequately calibrated for predicting hospital morality except for the APACHE-II score (Hosmer-Lemeshow P < .001). Discrimination of in-hospital mortality with the APACHE-II (area under the curve [AUC]: 0.72, 95% confidence interval [CI]: 0.66-0.76) and IABP-Shock II (AUC: 0.73, 95% CI: 0.68-0.77) scores were similar, while the CardShock (AUC: 0.76, 95% CI: 0.72-0.81) and SOFA (AUC: 0.76, 95%CI: 0.72-0.81) scores had better discrimination for predicting in-hospital mortality. Conclusions: In a real-world population of patients with cardiogenic shock, existing risk scores had modest prognostic accuracy, with no clear superior score. Further investigation is required to improve the discriminative abilities of existing models or establish novel methods.
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Soomro, Munawar Hussain. "BARRIERS TO TRANSGENDER HEALTH CARE IN PAKISTAN." Gomal Journal of Medical Sciences 16, no. 2 (June 30, 2018): 33–34. http://dx.doi.org/10.46903/gjms/16.02.1869.
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he term “transgender” refers to a spectrum of individuals who express gender in ways that deviate from the gender binary. It includes transsexuals, crossdressers and others.1,2 In Pakistan, the state of being a transgender presents a serious challenge to the traditionally established binary systems of nature/culture, man/woman, masculinity/ femininity and sex/gender. Even transgender community were given their identity as citizens of Pakistan in year 2009.3 Whereas the transgender persons suffer significant health disparities.4,5 Real or perceived stigma and discrimination within biomedicine and the health care provision in general may impact transgender people’s desire and ability to access appropriate care. The situation of the community is worse because they are left ignored and isolated without the survival facilities, education, employment opportunities, identity crisis or even the conformity from the dominant social class.3 National health services of Pakistan should include rigorous determination in the health care system to provide adequate care for transgender in the country. There is need to know the mechanism through the knowledge and biases of medical work force across the spectrum of medical training with regard to transgender health care. With these studies we can validate and propose potential solutions to address the identified gaps. Whereas the situation in other developing countries including those belonging to African and Asian regions is not good. In developed countries the situation is found to be much better. However, reported data shows that transgender people even in developed world face various kinds of discrimination especially in health care situations. The federal government of USA does not have laws specifically for protecting transgender people from discrimination in employment, housing, healthcare, and adoption. U.S. President Barack Obama had issued an executive order prohibiting discrimination against transgender people in employment by the federal government and its contractors. While in Pakistan there was no specific law for the transgender, however, a Senate committee had approved a bill in December 2017 for full legal protection to transgender people. It will provide a relief to transgender people for their health care and other facilities. Further, National Assembly of Pakistan approved the final Bill as Act called the Transgender Person (Protection of Rights) Act, 2018 on 18 May 2018.6 There is need to assess the perceptions and knowledge of the heath care provider workforce to provide medical care to transgender. Barriers may include fear of stigma associated with providing transgender medical care. Barriers may also include bias in the structure of clinics, forms, and electronic medical record systems in addition to gaps in knowledge and bias among support staff. Identification of solutions to the gaps is needed, which are not solely a lack of knowledge. The degree to which third party payer policy impedes access needs to be determined. Determination of change needed to overcome the financial barrier to care is also required. It is necessary to evaluate other barriers including societal stigma, mental health issue among patients, and socioeconomic issues. Finally evaluation of strategies to overcome these barriers is a must to address the matter.
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Kantor, Olga, Ruth Lederman, Naomi Ko, Haley Gagnon, Tsion Fikre, Daniel A. Gundersen, Anna C. Revette, et al. "Associations of social determinants of health with avoidance of information, treatment receipt, and physician mistrust for women with breast cancer." Journal of Clinical Oncology 42, no. 16_suppl (June 1, 2024): 1507. http://dx.doi.org/10.1200/jco.2024.42.16_suppl.1507.
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1507 Background: Social determinants of health (SDoH) are key factors contributing to breast cancer disparities but are difficult to measure. We surveyed a diverse population of women with breast cancer to identify SDoH and demographic measures associated with avoiding information, treatment receipt, and physician mistrust. Methods: During 2018-2020, we interviewed 297 women (60% White, 25% Black, 15% Hispanic) with a history of breast cancer treated at three academic institutions. We used multivariable regression to assess the associations of SDoH, demographics, and related factors (social support, discrimination in daily life and within healthcare, education, financial strain, faith, age, birth country, race and ethnicity, marital status) with three outcomes: (1) avoiding information about cancer, (2) lack of initiation of recommended treatments, and (3) physician mistrust. For each model, we included factors statistically significant (p<0.05) in unadjusted analyses. Results: Overall, 79 participants (26.6%) reported avoiding information about cancer. Age <40, discrimination (treated with less courtesy or as if dishonest), and financial strain (worry about medical bills, uninsured status) were all significantly associated with avoiding information (p<0.05 for all). In multivariable analyses, discrimination in daily life (OR 3.37, 95% CI 1.40-8.10 for being treated as if dishonest) and age (OR 3.36 for age <40 compared to >60) were associated with avoiding information. Twenty-two participants (7.4%) reported not initiating at least one recommended treatment. Discrimination in daily life and in healthcare were both significantly associated with treatment receipt, as was financial strain (all p<0.01). In multivariable analyses, discrimination (OR 3.51, 95% CI 1.05-11.76 for being treated as if dishonest) and worrying about medical bills (OR 3.53, 95% CI 1.40-8.93) were associated with lack of treatment initiation. Twelve participants (4.0%) reported not trusting physician’s judgements about medical care. Discrimination in daily life and in health care and insurance status were significantly associated with physician mistrust (both p<0.05). Multivariable analysis found that discrimination in both daily life and in health care (OR 5.95, 95% CI 1.40-25.3 for being treated with less courtesy in daily life, and OR 12.79, 95% CI 2.49-65.6 for reporting being treated as dishonest in health care setting) were associated with mistrust. Race and ethnicity were not significantly associated with any of the outcome measures in unadjusted or adjusted analyses (all p>0.05). Conclusions: SDoH measures and not race were associated with lack of engagement and trust within the health care system, with experiences of discrimination and financial strain associated with avoiding information, not initiating treatments, and physician mistrust.
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Muller, Carly, Canon Brodar, Kaitlyn E. Brodar, Kenneth Goodman, and Jeffrey P. Brosco. "Medical Student Choices Regarding Ventilator Allocation for People With Disabilities." Intellectual and Developmental Disabilities 59, no. 6 (November 23, 2021): 441–45. http://dx.doi.org/10.1352/1934-9556-59.6.441.
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Abstract In the COVID-19 pandemic, concerns exist that ventilator triage policies may lead to discrimination against people with disabilities. This study evaluates whether preclinical medical students demonstrate bias towards people with disabilities during an educational ventilator-allocation exercise. Written student responses to a triage simulation activity were analyzed to describe ventilator priority rankings and to identify themes regarding disability. Disability status was not cited as a reason to withhold a ventilator. Key themes observed in ventilator triage decisions included life expectancy, comorbidities, and social worth. Although disability discrimination has historically been perpetuated by health care professionals, it is encouraging that preclinical medical students did not demonstrate explicit bias against people with disabilities in ventilator triage scenarios.
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Li, Chien-Ching, Alicia Matthews, and XinQi Dong. "Psychological Distress Among Older LGBT and Non-LGBT Asian Americans: The Influence of Minority Stress." Innovation in Aging 4, Supplement_1 (December 1, 2020): 624. http://dx.doi.org/10.1093/geroni/igaa057.2125.
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Abstract Emerging data from epidemiological studies have confirmed elevated prevalence rates for mental health conditions among the lesbian, gay, bisexual and transgender (LGBT) populations. An estimated 2.8% of Asian Americans identify as LGBT and 26% of Asian LGBT are 40 years or older. This study analyzed the California Health Interview Survey to examine differences in psychological distress between LGBT and non-LGBT older Asian Americans, and further evaluated the role of discrimination in medical care and intimate violence on psychological distress. Regression results showed older LGBT Asians had a higher psychological distress score compared to non-LGBT Asians. After adjusting for discrimination or violence, this association no longer existed. Experiencing discrimination in medical care and intimate violence were associated with higher levels of psychological stress. This study increases our knowledge of mental health among older Asian LGBT, enhancing our ability to design culturally-targeted and trauma-informed psychosocial interventions to improve outcomes in this population.
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Jinabhai, Champak C., Hoosen M. Coovadia, and Salim S. Abdool-Karim. "Socio-Medical Indicators of Health in South Africa." International Journal of Health Services 16, no. 1 (January 1986): 163–78. http://dx.doi.org/10.2190/jtnm-2d1h-8tk8-63dv.
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Socio-medical indicators developed by WHO for monitoring progress towards Health-for-All have been adapted to reveal, clearly and objectively, the devastating impact of state planning based on an outmoded immoral and unscientific philosophy of race superiority in South Africa on the health of the disenfranchised majority within the context of social and economic discrimination; Health policy indicators confirm that the government is committed to three options (Bantustans, A New Constitution, and A Health Services Facilities Plan) all of which are inconsistent with the attainment of Health-for-All; Social and economic indicators reveal gross disparities between African, Coloured, Indian, and White living and working conditions; Provision of health care indicators show the overwhelming dominance of high technology curative medical care consuming about 97 percent of the health budget with only minor shifts towards community-based comprehensive care; and Health status indicators illustrate the close nexus between privilege, dispossession and disease with Whites falling prey to health problems related to affluence and lifestyle, while Africans, Coloureds, and Indians suffer from disease due to poverty. All four categories of the indicator system reveal discrepancies which exist between Black and White, rich and poor, urban and rural. To achieve the social goal of Health-for-All requires a greater measure of political commitment from the state. We conclude that it is debatable whether a system which maintains race discrimination and exploitation can in fact be adapted to provide Health-for-All.
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Vahlne Westerhäll, Lotta. "Equality Within Medical Care – Discrimination of Elderly With Covid-19 in Residential Homes." Scandinavian studies in law, no. 2022 68 (March 31, 2022): 271–86. http://dx.doi.org/10.53292/92887d87.f919ee7e.
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English, Sara. "Caring for the Stonewall Generation: Assessment of Staff Training for Transgender Persons Living in Long Term Care." Innovation in Aging 5, Supplement_1 (December 1, 2021): 862. http://dx.doi.org/10.1093/geroni/igab046.3147.
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Abstract Transgender persons who came of age in the late 1960s are considered LGBTQ+ elders - The Stonewall Generation. These persons experience unique bio-psychosocial challenges, often complicated by a history of a lack of access to good medical care and social supports. Discrimination and bias can influence the provision of care and the protection of privacy for transgender or gender non-conforming persons. Staff training is essential to provide ethical care for aging trans persons who require residential care. This presentation examines current staff training modules of 100 Long Term Care (LTC) facilities, assessing training needs to provide affirming, culturally competent, and ethical care for sexual and gender minorities. Keywords: cultural competence; Long Term Care; staff training; transgender
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Meihubers, Sandra, Phillip Godwin, and Arie Rotem. "Blood-borne virus-related discrimination in dental services." Australian Health Review 21, no. 3 (1998): 92. http://dx.doi.org/10.1071/ah980092.
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While the risk of infection through occupational exposure to blood-borne viruses isa major concern of dental health care workers, the National HIV/AIDS Strategy and many health, AIDS and discrimination-related agencies have identified discrimination related to HIV/AIDS as a priority area for action. In 1995 the Commonwealth Department of Health and Family Services selected the School of Medical Education at the University of New South Wales to conduct a national project to reduce discrimination related to blood-borne viruses within dental services(Godwin, Meihubers & Rotem 1997). This paper provides an overview of the study and its major findings.The study focused on quality of care issues which may cause or manifest discrimination. Key stakeholders were invited to review policies, procedures,organisational arrangements and other systemic issues which influence the quality of oral health services to populations within selected geographical regions.
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Aqsa, Mehak, Nida Shoaib, Sameera Ali Rizvi, Manisha Juriasinghani, and Muhammad Ismail Khan. "Mental Health Challenges due to Health Care Discrimination among Transgender Youth: A Selective Review." National Journal of Health Sciences 9, no. 2 (June 28, 2024): 121–30. http://dx.doi.org/10.21089/njhs.92.0121.
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Abstract: Background: Transgender youth face various difficulties including mental health due to discrimination in healthcare settings because of their gender orientation. This review investigates the mental health of transgender youth and health care discrimination leading to inadequate health care. Materials and Methods: The study complied with the latest publications using PRISMA reporting guidelines. For the selective review, 19 articles were selected over the last five years (between 2017 and 2022) which were primarily focused on mental health challenges and lack of health care due to health care discrimination among transgender youth. The study included publications at a global level, citing the global articles first, followed by Asia. The study only took into account biological and/or non-biological factors for the young transgender community, including both male and female factors. Result: All 19 articles confirmed the positive significance of the Mental Health of the transgender youth community due to discrimination meanwhile, 08 articles mainly indicated about lack of healthcare or unfair healthcare in settings due to being transgender along with mental health concerns. This review identified the differences in mental health and discrimination that the transgender population faces. Conclusion: As a reform, lower levels of depression and suicidality have been associated with social transition and having access to gender-affirming medical treatment. However, policies affecting this young transgender minority, who experience mental and social prejudice, must be changed. Multilevel intervention should also be advocated to address both of these severe issues. Keywords: Mental health, Transgender youth, Health care discrimination, Gender-affirming, Sexual assault, Stigma.
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Van Dijcke, Hannah. "Pregnant Transgender People: What to Expect from the Court of Justice of the European Union's Jurisprudence on Pregnancy Discrimination." Michigan Journal of Gender & Law, no. 29.1 (2022): 179. http://dx.doi.org/10.36641/mjgl.29.1.pregnant.
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Pregnant transgender people’s experiences vary: they may identify as male or non-binary and may seek gender-affirming medical care to different degrees. This variety in gender identities and bodies puts additional pressure on CJEU’s pregnancy discrimination case law—a case law that is, as this Article argues, already flawed. Building on a critique of the CJEU’s decision in Dekker, this Article discusses three alternative approaches to addressing pregnancy discrimination in EU law. The first two approaches are different ways of construing pregnancy discrimination as sex discrimination. First, the Article discusses a gender-stereotyping approach to direct sex discrimination, and, second, an indirect sex discrimination analysis. The third approach is to introduce a separate provision on pregnancy discrimination in EU legislation. This Article argues that this third approach provides the fullest protection for all types of pregnancy discrimination—including the pregnancy discrimination that pregnant transgender people experience.
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Mathew, Satheesh. "The Invisible Culture of Discrimination." Timeless Mahatma 12, no. 1 (November 22, 2019): 23–24. http://dx.doi.org/10.38192/12.1.13.
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A recent ITV news item featured Radhakrishna Shanbag, a senior surgeon with over 20 years of service in the NHS, being asked, ‘Please can I have a white doctor for my operation?’, by one his patient’s 1 . Any form of racism is both painful and upsetting, however to a dedicated professional it throws a much greater challenge. To remain professional, composed and objective in the face of adversity, is ingrained in medical training. One is also expected to provide the very best of care ‘free from all bias’ at all times to all comers. As in this case, professionals have no choice but to swallow the insults and provide alternatives to get the best possible outcome, suppressing the impact on self-worth and devastating emotional trauma.
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Polonsky, Michael Jay, Ahmed Shahriar Ferdous, Andre M. N. Renzaho, Neil Waters, and Zoe McQuilten. "Factors Leading to Health Care Exclusion Among African Refugees in Australia: The Case of Blood Donation." Journal of Public Policy & Marketing 37, no. 2 (November 2018): 306–26. http://dx.doi.org/10.1177/0743915618813115.
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Developed countries that accept refugees are obligated, under the UN Convention for Refugees, to integrate refugees into host communities, with inclusion in the health system being pivotal. Integration programs can be difficult though, because many refugees’ home countries have different health systems, lower health literacy, and different expectations of health services. Country health system differences require cultural adaptation of host country services when designing targeted, inclusive health care programs. Using a sample of 317 Australian-based African refugees, the authors examine how refugees’ acculturation, perceptions of discrimination, past behavior, objective knowledge, and medical mistrust affect their health inclusion, depending on their blood donation intentions. The results indicate that perceived discrimination and objective blood donation knowledge directly affect donation intentions. Perceived discrimination mediates the relationships between acculturation and intentions and between medical mistrust and donation intentions, and objective knowledge mediates the relationship between past behavior and donation intentions. The authors offer recommendations to policy makers designing social inclusion programs and health service providers designing and delivering targeted initiatives, to better facilitate refugee participation in host country health systems.
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Chikamoto, Yosuke, and Dara Vazin. "College Students’ Perceptions Regarding Medical Waivers for Wellness Incentives Under the Affordable Care Act." Californian Journal of Health Promotion 14, no. 3 (December 1, 2016): 58–63. http://dx.doi.org/10.32398/cjhp.v14i3.2068.
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Background and Purpose: The use of health-contingent financial incentives in promoting employee wellness is controversial because of potential discrimination against those who could not reach certain health goals due to health factors. To protect consumers from such discrimination, the Affordable Care Act (ACA) requests protective mechanisms; however clear and detailed guidelines for the medical waivers have yet to be developed. This study aimed to identify college students’ opinions about employee wellness programs where monetary incentives are given for those whose Body Mass Index falls into the normal range with particular attention to medical waivers. Methods: A cross-sectional survey study was conducted with participants consisting of a convenience sample of 58 college students in California. Results: Some scenarios were considered more legitimate for waivers than others (pregnancy, 67.3%; chronic back pain; 43.1%; broken leg, 38%; and steroid use; 34.5%). The non-medical reason of "trying to lose weight" was also considered legitimate by 21% of respondents. Responses varied by participants’ gender and their own weight status. Conclusion: College students did not view all scenarios as legitimate reasons for medical waivers. These findings call for physicians to develop a list of legitimate reasons for medical waivers, and for physician preparedness in discussing these issues with patients.
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Witteveen, Esther, Luuk Wieske, Juultje Sommers, Jan-Jaap Spijkstra, Monique C. de Waard, Henrik Endeman, Saskia Rijkenberg, et al. "Early Prediction of Intensive Care Unit–Acquired Weakness: A Multicenter External Validation Study." Journal of Intensive Care Medicine 35, no. 6 (May 1, 2018): 595–605. http://dx.doi.org/10.1177/0885066618771001.
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Objectives: An early diagnosis of intensive care unit–acquired weakness (ICU-AW) is often not possible due to impaired consciousness. To avoid a diagnostic delay, we previously developed a prediction model, based on single-center data from 212 patients (development cohort), to predict ICU-AW at 2 days after ICU admission. The objective of this study was to investigate the external validity of the original prediction model in a new, multicenter cohort and, if necessary, to update the model. Methods: Newly admitted ICU patients who were mechanically ventilated at 48 hours after ICU admission were included. Predictors were prospectively recorded, and the outcome ICU-AW was defined by an average Medical Research Council score <4. In the validation cohort, consisting of 349 patients, we analyzed performance of the original prediction model by assessment of calibration and discrimination. Additionally, we updated the model in this validation cohort. Finally, we evaluated a new prediction model based on all patients of the development and validation cohort. Results: Of 349 analyzed patients in the validation cohort, 190 (54%) developed ICU-AW. Both model calibration and discrimination of the original model were poor in the validation cohort. The area under the receiver operating characteristics curve (AUC-ROC) was 0.60 (95% confidence interval [CI]: 0.54-0.66). Model updating methods improved calibration but not discrimination. The new prediction model, based on all patients of the development and validation cohort (total of 536 patients) had a fair discrimination, AUC-ROC: 0.70 (95% CI: 0.66-0.75). Conclusions: The previously developed prediction model for ICU-AW showed poor performance in a new independent multicenter validation cohort. Model updating methods improved calibration but not discrimination. The newly derived prediction model showed fair discrimination. This indicates that early prediction of ICU-AW is still challenging and needs further attention.
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Penner, Louis A., Irene V. Blair, Terrance L. Albrecht, and John F. Dovidio. "Reducing Racial Health Care Disparities." Policy Insights from the Behavioral and Brain Sciences 1, no. 1 (October 2014): 204–12. http://dx.doi.org/10.1177/2372732214548430.
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Large health disparities persist between Black and White Americans. The social psychology of intergroup relations suggests some solutions to health care disparities due to racial bias. Three paths can lead from racial bias to poorer health among Black Americans. First is the already well-documented physical and psychological toll of being a target of persistent discrimination. Second, implicit bias can affect physicians’ perceptions and decisions, creating racial disparities in medical treatments, although evidence is mixed. The third path describes a less direct route: Physicians’ implicit racial bias negatively affects communication and the patient–provider relationship, resulting in racial disparities in the outcomes of medical interactions. Strong evidence shows that physician implicit bias negatively affects Black patients’ reactions to medical interactions, and there is good circumstantial evidence that these reactions affect health outcomes of the interactions. Solutions focused on the physician, the patient, and the health care delivery system; all agree that trying to ignore patients’ race or to change physicians’ implicit racial attitudes will not be effective and may actually be counterproductive. Instead, solutions can minimize the impact of racial bias on medical decisions and on patient–provider relationships.
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Kim, Yoon Hee, Bo Hyun Kim, Joonki Kim, Bokyoung Jung, and Sangyoung Bae. "Item difficulty index, discrimination index, and reliability of the 26 health professions licensing examinations in 2022, Korea: a psychometric study." Journal of Educational Evaluation for Health Professions 20 (November 22, 2023): 31. http://dx.doi.org/10.3352/jeehp.2023.20.31.
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Purpose: This study presents item analysis results of the 26 health personnel licensing examinations managed by the Korea Health Personnel Licensing Examination Institute (KHPLEI) in 2022.Methods: The item difficulty index, item discrimination index, and reliability were calculated. The item discrimination index was calculated using a discrimination index based on the upper and lower 27% rule and the item-total correlation.Results: Out of 468,352 total examinees, 418,887 (89.4%) passed. The pass rates ranged from 27.3% for health educators level 1 to 97.1% for oriental medical doctors. Most examinations had a high average difficulty index, albeit to varying degrees, ranging from 61.3% for prosthetists and orthotists to 83.9% for care workers. The average discrimination index based on the upper and lower 27% rule ranged from 0.17 for oriental medical doctors to 0.38 for radiological technologists. The average item-total correlation ranged from 0.20 for oriental medical doctors to 0.38 for radiological technologists. The Cronbach α, as a measure of reliability, ranged from 0.872 for health educators-level 3 to 0.978 for medical technologists. The correlation coefficient between the average difficulty index and average discrimination index was -0.2452 (P=0.1557), that between the average difficulty index and the average item-total correlation was 0.3502 (P=0.0392), and that between the average discrimination index and the average item-total correlation was 0.7944 (P<0.0001).Conclusion: This technical report presents the item analysis results and reliability of the recent examinations by the KHPLEI, demonstrating an acceptable range of difficulty index and discrimination index values, as well as good reliability.
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Skowron, Adam, Alicja Jankowska, and Janusz Sytnik-Czetwertyński. "Ethical issues in medical treatment of homeless patients in Poland. A preliminary study." Journal of Education, Health and Sport 13, no. 2 (December 12, 2022): 68–74. http://dx.doi.org/10.12775/jehs.2023.13.02.009.
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The article presents some of the most important ethical aspects in the medical care of a homeless patient. Hygiene, access to medicines and information, the problem of social discrimination are analysed. The article concludes with a short reflection on the expected ethical attitude of a doctor towards a homeless patient.
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Lee, Hak-Seung, and Chang-Woo Lee. "Gender in Medical Training and Academic Medicine." Korean Medical Education Review 15, no. 1 (February 28, 2013): 54–58. http://dx.doi.org/10.17496/kmer.2013.15.1.054.
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There has been an increase in the number of female doctors worldwide. Women now represent half of all medical students, with almost the same numbers of men and women becoming physicians. There is a pool of talented women in our midst, and it is our responsibility as leaders to find those individuals and groom them for progress. However, residency training and academic education still resemble the historical model when there were few women in medicine. Gender differences in medical specialty choices can cause a maldistribution of doctors by specialty and geographical area, which could cause significant problems at the national health care system level. Major challenges facing female physicians include gender discrimination and sexual harassment, and work/family conflicts. Women are largely under-represented in academic medicine and experience discrimination in the academic environments. Recent issues about related to the “feminization of medicine” raise important questions forabout how academic medicine deals with gender issues. To better accommodate the needs of female doctors and ensure that they will have successful careers, structural and cultural changes to medical educations are needed.
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Goh, Hyo Jung, and Geum Hee Jeong. "Sexual Discrimination towards Female Nurses in the Male Dominated Hospital Environment." Korean Journal of Women Health Nursing 5, no. 3 (November 28, 1999): 265–76. http://dx.doi.org/10.4069/kjwhn.1999.5.3.265.
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Female nurses in Korea have historically experienced discrimination on the basis of their gender as part of the traditional society views on woman and as a result of the male dominated hospital environments. This discrimination may interfere with the ability of female nurses to promote the health of their patients. To better understand this bias, we collected and analyzed 16 cases of alleged sexual discrimination reported by female nurses with more than 5 years work experience. The cases were classified into 10 subjects and further into 4 categories: personnel administration, daily working environment, female gender bias, and health care delivery. There were 7 cases (11.3%) of unjust personnel changes consisting of demotion(1), termination(4), and reallocation of position(3). Twenty three (37.1%) of cases related to problems in the daily workplace including biases in communication between female nurses and male physicians(12), daily work(8), and responsibility for adverse outcomes(3). We noted 17 cases (27.4%) of female gender bias as reported by female nurses(7), female physicians(7), and female patients(3). Lastly, there were 15 (24.3%) cases of problems with health care delivery due to sexual discrimination, including enrollment in the health care system(4),and decisions regarding medical care(4). These results suggest that sexual discrimination towards women is pervasive in the Korea hospitals, not only towards female nurses but also towards female physicians and patients. More discriminatory practices in a timely fashion such that better nursing care can be provided to patients and their families.
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Sabbah, Mohammad Yasser. "Health Care System Structure in the State of Israel." Journal of Medical Science 88, no. 1 (March 28, 2019): 39–46. http://dx.doi.org/10.20883/jms.332.
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The health care system in the State of Israel consists of two sectors - the public sector, which includes government-owned hospitals and medical institutes. The public health sector includes the community health system, health funds, family medicine, the general care system and the mental health care system. The second sector is the private sector, which includes private hospitals and medical institutes. Both sectors are supervised by the Israeli Ministry of Health, which is the supreme governmental authority through which it implements its policy in the entire health system in Israel. The law provides and guarantees medical insurance for every resident of Israel, the right to receive medical treatment, the prohibition of discrimination, informed consent to medical treatment, the right to receive an additional medical opinion, the dignity and privacy of the patient and the right to attend. Health funds in Israel were established before the State of Israel was established. The ideological concept of the health funds was based on the principle of equality and mutual assistance.
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Gomez, Scarlett Lin, Felisa A. Gonzales, Salma Shariff-Marco, Laura A. Dwyer, and Amani Nuru-Jeter. "Discrimination and quality of life among breast cancer survivors." Journal of Clinical Oncology 34, no. 3_suppl (January 20, 2016): 250. http://dx.doi.org/10.1200/jco.2016.34.3_suppl.250.
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250 Background: We examined the role of race/ethnicity, education, and medical discrimination on global and breast cancer-specific (BCS) quality of life (QoL). Methods: Telephone interviews were administered to 536 Asian, Black, Hispanic and White women identified through the Greater Bay Area Cancer Registry who were aged 20+ when diagnosed with a first invasive primary breast cancer between 2006 and 2009. Women reported perceptions of discriminatory experiences while receiving breast cancer care. QoL was assessed with a single item asking about global QoL over the past 4 weeks ( “excellent” vs “less than excellent”) and a summary score for the 6-item breast cancer subscale of the FACT-B (higher scores indicated more concerns (or worse QoL)). Race/ethnicity and education were combined into an 8-category variable (4 race/ethnic groups x 2 education groups). Psychometric analyses was used to create a summed medical discrimination score using 7 items that comprised a single factor, and split into tertiles to indicate no, low, and moderate/high levels of discrimination. Main effects for race/ethnicity x education and medical discrimination were identified using logistic and linear regression models. Adjusted analyses controlled for age, marital status, health insurance, stage, histology, and tumor size. Results: In adjusted analyses, disparities across combined race/ethnicity x education groups were observed for global QoL (Wald χ2(7) = 23.32, p < 0.01) but not for BCS QoL (F= 0.78, p= 0.60). Black and Asian women reported lower global QoL than college-educated White women. Medical discrimination was related to global (Wald χ2(2) = 6.98, p= 0.03) and BCS QoL (F= 6.14, p< 0.01). Women reporting moderate/high levels of medical discrimination had significantly lower odds of excellent QoL (OR= 0.416, p< 0.01) and more breast cancer concerns (β= 1.19, t= 3.50, p< 0.001) than women reporting no discrimination. Conclusions: Medical discrimination was associated with lower global and BCS QoL. More research is needed to identify specific factors at the individual, provider, and organizational levels that contribute to perceptions of medical discrimination so that they can be addressed and QoL can be improved for breast cancer patients.
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López-Cevallos, Daniel F., S. Marie Harvey, and Jocelyn T. Warren. "Medical Mistrust, Perceived Discrimination, and Satisfaction With Health Care Among Young-Adult Rural Latinos." Journal of Rural Health 30, no. 4 (February 27, 2014): 344–51. http://dx.doi.org/10.1111/jrh.12063.
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Berch, V. V. "Somatic rights and medical law: issues of protecting dignity and autonomy." Analytical and Comparative Jurisprudence, no. 5 (November 17, 2023): 92–95. http://dx.doi.org/10.24144/2788-6018.2023.05.13.
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It is noted that somatic rights, which define human rights to the inviolability of the physical body and medical autonomy, are gaining increasing importance in the modern world. The protection and enforcement of these rights are becoming urgent challenges because they determine the way in which health care is provided and received.
It has been established that somatic rights are defined as human rights to the inviolability of the physical body and the right to control it. These rights include the right to privacy of medical information, the right to freely choose medical procedures, as well as the right to confidentiality and protection from any form of medical discrimination. Somatic rights are an important aspect of general human rights and ensure that individuals can make their own decisions about their physical health and medical procedures.
It is emphasized that medical law recognizes the right of a person to freedom of choice of medical procedures and treatment, as well as the right to refuse medical intervention. This is related to a person's right to control his physical body and make decisions about it. It also provides protection against any form of medical discrimination based on gender, age, race, religion or other characteristics, which contributes to the observance of the principle of equal opportunities and respect for somatic rights in all areas of medical practice.
It is emphasized that reproductive rights include the right to freely choose the number of children, intervals between births, as well as the right to access information and services related to reproductive health. They allow a person to make decisions about their reproductive future according to their own values and beliefs. Medical law includes norms and principles that regulate medical practice, relationships between medical professionals and patients, and also ensure compliance with ethical standards in the medical field.
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Munyaneza, Yvonne, and Euphemia Mbali Mhlongo. "Medical Xenophobia: The Voices of Women Refugees in Durban, Kwazulu-Natal, South Africa." Global Journal of Health Science 11, no. 13 (November 3, 2019): 25. http://dx.doi.org/10.5539/gjhs.v11n13p25.
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BACKGROUND: Women refugees are mostly affected due to their specific needs for reproductive health services. In their attempt to utilize reproductive health care services, women refugees face medical xenophobia by the health care professionals. Upon their arrival in South Africa, refugee women do not undergo any screening, and this exposes them to health risks making them more prone to all different types of diseases, as many of them are survivors of rape and other acts of sexual violence.
OBJECTIVE: The aim of the study was to describe the voices of women refugees regarding reproductive health services in public health institutions in Durban KwaZulu-Natal
METHODS: A qualitative, descriptive design was used. Data was collected through face-to-face interviews with eight women refugees living in Durban, KwaZulu-Natal. Thematic content analysis guided the study.
RESULTS: Two main themes emerged from the data: negative experiences/challenges, and positive experiences. The negative experiences included medical xenophobia and discrimination, language barrier, unprofessionalism, failure to obtain consent and lack of confidentiality, ill-treatment, financial challenges, internalised fear, religious and cultural domination, the shortage of staff and overcrowding of public hospitals. The positive experiences included positive care and treatment.
CONCLUSION: The study concluded that discrimination and medical xenophobia remain a challenge for women refugees seeking reproductive health services in public health institutions in Durban, KwaZulu-Natal.
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Herscovici, Romana, James Mirocha, Jed Salomon, Noel B. Merz, Bojan Cercek, and Michael Goldfarb. "Sex differences in crude mortality rates and predictive value of intensive care unit-based scores when applied to the cardiac intensive care unit." European Heart Journal: Acute Cardiovascular Care 9, no. 8 (August 27, 2019): 966–74. http://dx.doi.org/10.1177/2048872619872129.
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Background: Limited data exists regarding sex differences in outcome and predictive accuracy of intensive care unit-based scoring systems when applied to cardiac intensive care unit patients. Methods: We reviewed medical records of patients admitted to cardiac intensive care unit from 1 January 2011–31 December 2016. Sex differences in mortality rates and the performance of intensive care unit-based scoring systems in predicting in-hospital mortality were analyzed. Calibration was assessed by the Hosmer-Lemeshow test and locally weighted scatterplot smoothing curves. Discrimination was assessed using the c statistic and receiver-operating characteristic curve. Results: Among 6963 patients, 2713 (39%) were women. Overall in-hospital and cardiac intensive care unit mortality rates were similar in women and men (9.1% vs 9.4%, p=0.67 and 5.9% vs 6%, p=0.88, respectively) and in age and major diagnosis subgroups. Of the scoring systems, Acute Physiology and Chronic Health Evaluation III and Sequential Organ Failure Assessment had poor calibration (Hosmer-Lemeshow p value <0.001), while Simplified Acute Physiology Score II performed better (Hosmer-Lemeshow p value 0.09), in both women and men. All scores had good discrimination (C statistics >0.8). In the subgroups of acute myocardial infarction and heart failure patients, all scores had good calibration (Hosmer-Lemeshow p>0.001) and discrimination (C statistic >0.8) while in diagnosis subgroups with highest mortality, the calibration varied among scores and by sex, and discrimination was poor. Conclusions: No sex differences in mortality were seen in cardiac intensive care unit patients. The mortality predictive value of intensive care unit-based scores is limited in both sexes and variable among different subgroups of diagnoses.
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Tsang, Eileen Yuk-ha. "Gay Sex Workers in China’s Medical Care System: The Queer Body with Necropolitics and Stigma." International Journal of Environmental Research and Public Health 17, no. 21 (November 5, 2020): 8188. http://dx.doi.org/10.3390/ijerph17218188.
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The struggles of China’s gay sex workers—men who sell sex to other men—illustrate how the multi-layered stigma that they experience acts as a form of necropolitical power and an instrument of the state’s discrimination against gay sex workers who are living with HIV. One unintended side effect of this state power is the subsequent reluctance by medical professionals to care for gay sex workers who are living with HIV, and discrimination from Chinese government officers. Data obtained from 28 gay sex workers who are living with HIV provide evidence that the necropower of stigma is routinely exercised upon the bodies of gay sex workers. This article examines how the necropolitics of social death and state-sanctioned stigma are manifested throughout China’s health system, discouraging gay sex workers from receiving health care. This process uses biopolitical surveillance measures as most of gay sex workers come from rural China and do not enjoy urban hukou, thus are excluded from the medical health care system in urban China. Public health priorities demand that the cultured scripts of gendered Chinese citizenship must reevaluate the marking of the body of gay sex workers as a non-entity, a non-human and socially “dead body.”
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Butt, Leslie. "A "Shortage of Women": Gender and Medical Care in the Highlands of Irian Jaya, Indonesia." Culture 14, no. 1 (November 5, 2021): 29–38. http://dx.doi.org/10.7202/1083258ar.
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This paper describes two distinct features ofthe Irian Jaya highlands: local practices that may contribute to gender imbalances of up to 250 menfor every 100 women; and regional health care policy and practice. Ideally, medical care and local needs complement one another, but the demographics of the region belie primary health care mandates to improve the well-being of all. Healing programmes appear more responsive to Indonesian development agendas than to community needs. This paper suggests that missionaries and medical staff do intervene, notably in events surrounding childbirth, but tend not to address the issue of long-term discrimination against women. The flexible nature of the concept "health" within primary health care allows women to fall into the void between policy and local practice.
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Mwiti, Kirimi, Dennis Magu, Opondo Everisto, Joseph Mutai, and Angeline Chepchirchir. "Medical Appointment Adherence and Challenges Encountered by HIV Infected Children at Kenyatta National Hospital, Kenya." Journal of Health, Medicine and Nursing 10, no. 1 (April 2, 2024): 57–65. http://dx.doi.org/10.47604/jhmn.2447.
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Purpose: The goal of this study was to determine the adherence and challenges to scheduled medical appointment on HIV care services among HIV positive children aged 18 months to nine years undergoing treatment at Kenyatta National Hospital, Kenya at six months interval
Methodology: The study design was prospective cohort study design consisting of 221 caregivers and their HIV infected children. Consecutive sampling method was used, in which potential participants were sought out on a daily basis until we had contacted all the eligible individuals and enroled them.This research was undertaken from March, 2017 to November, 2018. The study participants each was followed for period of one year. Pretested questionnaire was used for collecting data together with review of standardized clinical notes on challenges and adherence to scheduled medical appointments. Data was analyzed using statistical package for the Social Sciences (SPSS) Version 20. The descriptive statistics were done and data was presented in frequency tables. Ethical approval no P688/09/2016) was obtained.
Findings: It was observed that adherence to scheduled medical appointment among children infected with HIV ranged from 77% to 81.9% at 6 and 12 months respectively. This study found an average of 20% of children infected with HIV are at high risk of adverse outcomes related to non-adherence to planned medical appointments. The observed difference on adherence was associated with financial constrain, perceived stigma and discrimination, long distance and long waiting period in the medical HIV clinic.
Unique Contribution to Theory, Practice and Policy: Targeted intervention aimed at addressing measures to reduce children missing attendance of scheduled medical appointment is vital. The health care providers may address measures to reduce children missing attendance of scheduled medical appointment by reducing waiting time in the clinic and reducing the number of scheduled medical appointments. This study adds to the pool of knowledge that stigma and discrimination, long waiting time in the clinic and the number of scheduled medical appointments has influence on adherence to appointments. The attendance of scheduled medical appointment should be enhanced in the policies by Ministry of health and HIV health care providers focusing on reducing waiting time, mitigating stigma and discrimination.
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Hanes, Douglas, and Sean Clouston. "DOES SELF-REPORTED DISCRIMINATION INCREASE AS COGNITION DECLINES?" Innovation in Aging 7, Supplement_1 (December 1, 2023): 837–38. http://dx.doi.org/10.1093/geroni/igad104.2701.
Full textAbstract:
Abstract Progressing cognitive decline causes limitations on daily life and emotional changes, including increased aggression, agitation, and restlessness that might occasion greater scrutiny, limitations, discrimination, and disrespect due to a combination of care-provision and ageism. While there are a number of studies of discrimination as a cause of cognitive decline, there are no studies of how real and perceived discrimination during cognitive decline might affect the aging person and their caregivers. This study analyzes whether people currently experiencing cognitive decline report greater frequency of discrimination. Using the Health and Retirement Study (HRS; 2006–18; N = 37,059), we used multilevel ordered logistic regression to test the role of changes in cognitive performance in predicting self-reported frequency of six forms of discrimination, adjusting for age, socioeconomic, and demographic covariates. We found that lower cognitive scores were associated with increased discrimination frequency in three forms of treatment: less respect (β=-0.010; p=0.022), being treated as “not smart” (β=-0.026; p< 0.001), and worse medical treatment (β=-0.014; p=0.027) though no differences were evident in service quality (β=-0.002, p=0.736), evidence of being threatened (β=-0.11, p=0.069), or having people report being afraid of you (β=-0.004, p=0.455). Results suggest that perceptions of discrimination could emerge as a result of declining cognitive performance and highlight the need for greater sensitivity to discrimination among older adults in both everyday and medical settings. Further investigation will enable us to distinguish between experienced discrimination due to changes in treatment versus ageism.
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Levytska, Yuliia. "MEDICAL CARE FOR PRISONERS IN THE CONTEXT OF HIV TREATMENT AND PREVENTION." Scientific Journal of Polonia University 51, no. 2 (June 14, 2022): 257–61. http://dx.doi.org/10.23856/5130.
Full textAbstract:
The article examines the general aspects of medical care for prisoners with HIV/AIDS as stated in international standards and Ukrainian legislation. Attention is paid to the prohibition of discrimination and stigmatisation of prisoners in the context of medical care. The reports of the Ukrainian Parliament Commissioner for Human Rights during monitoring visits to penitentiary institutions were analysed. Data released by international organisations demonstrate the high prevalence of HIV among prisoners. The existence of such disease often causes violations of prisoners’ rights, including access to health care. During the survey, common problems, related to medical care, faced by detainees in the penitentiary system, were identified. Among these problems, the inability to receive antiretroviral therapy that should be used to treat HIV is recognised as the most significant. It was concluded that international standards, despite their implementation in national legislation, have not been successfully applied in practice.