Exploring Perceived Discrimination Among LGBT Individuals in Turkey in Education,Employment, and Health Care: Results of an Online Survey

This article explores the discrimination practices encountered by lesbian, gay, bisexual, and transgender (LGBT) individuals in education, income, employment, and health care in Turkey. Limited quantitative data on LGBT individuals are available in Turkey. This study collected data from 2,875 LGBT individuals through a Web-based survey. The findings suggest that LGBT individuals report perceived direct and indirect discrimination in accessing education, employment, and health care. In a country where LGBT rights are not yet recognized and antidiscrimination legislation covering sexual orientation and gender identity is still nonexistent, findings demonstrate perceived discrimination of LGBTs rarely turns into a legal complaint. Even when they do, most LGBTs in our sample report that they did not feel that the justice system addressed their grievances.     

Creating Welcoming Spaces for Lesbian,Gay, Bisexual,and Transgender (LGBT) Patients: An Evaluation of the Health Care Environment

ABSTRACT

Health outcomes are affected by patient, provider, and environmental factors. Previous studies have evaluated patient-level factors; few focusing on environment. Safe clinical spaces are important for lesbian, gay, bisexual, and transgender (LGBT) communities. This study evaluates current models of LGBT health care delivery, identifies strengths and weaknesses, and makes recommendations for LGBT spaces. Models are divided into LGBT-specific and LGBT-embedded care delivery. Advantages to both models exist, and they provide LGBT patients different options of healthcare. Yet certain commonalities must be met: a clean and confidential system. Once met, LGBT-competent environments and providers can advocate for appropriate care for LGBT communities, creating environments where they would want to seek care.     

A qualitative study of innovations implemented to improve transition of care from maternity to child and family health (CFH) services in Australia

BackgroundThe transition of care (ToC) from maternity services, particularly from midwifery care to child and family health (CFH) nursing services, is a critical time in the support of women as they transition into early parenting. However significant issues in service provision exist, particularly meeting the needs of women with social and emotional health risk factors. These include insufficient resources, poor communication and information transfer, limited interface between private and public health systems and tension around role boundaries. In response some services are implementing strategies to improve the transition of care from maternity to CFH services.AimThis paper describes a range of innovations developed to improve transition of care between maternity and child and family health services and identifies the characteristics common to all innovations.MethodsData reported were collected in phase three of a mixed methods study investigating the feasibility of implementing a national approach to child and family health services in Australia (CHoRUS study). Data were collected from 33 professionals including midwives, child and family health nurses, allied health staff and managers, at seven sites across four Australian states. Data were analysed thematically, guided by Braun and Clarke's six-step process of thematic analysis.FindingsThe range of innovations implemented included those which addressed; information sharing, the efficient use of funding and resources, development of new roles to improve co-ordination of care, the co-location of services and working together. Four of the seven sites implemented innovations that specifically targeted families with additional needs. Successful implementation was dependent on the preliminary work undertaken which required professionals and/or organisations to work collaboratively.ConclusionImproving the transition of care requires co-ordination and collaboration to ensure families are adequately supported. Collaboration between professionals and services facilitated innovative practice and was core to successful change.     

Patterns of Mental Health Care Utilization Among Sexual Orientation Minority Groups

Prior studies of the utilization of mental health professionals by sexual minority populations have relied on data that are now dated or not nationally representative. These studies have also provided mixed findings regarding gender differences in the utilization of mental health professionals among sexual minority individuals. Using data from the 2013–2015 National Health Interview Surveys, this study investigates (1) how sexual minority individuals compare to heterosexual participants in their utilization of mental health professionals; and (2) gender differences in that utilization. The results indicate sexual minority individuals utilize mental health care professionals at higher rates than heterosexual individuals even after controlling for measures of mental health and other demographic characteristics; this is true for both men and women. However, gender moderates the sexual minority effect on utilization rates. Sexual minority men utilize mental health professionals at a high rate, such that their utilization rates are similar to sexual minority women, contrary to the gender gap seen among heterosexuals.     

LGBT Health in the Midlands: A Rural/Urban Comparison of Basic Health Indicators

Research into the health and wellbeing of rural lesbian, gay, bisexual, and transgender (LGBT) populations is limited. A community-based participatory research (CBPR) approach was used to develop an online survey for LGBT Nebraskans. The 770 participants replied to an array of questions on social determinants of health and basic health outcomes. Only significant differences in having health insurance were found between urban and rural participants. Social determinants of health were explored. Results of this study suggest that regional culture may be more salient to health for lesbian, gay, bisexual, and transgender persons living in the Midwest than rural or urban residence.     

Health Needs and Experiences of a LGBT Population in Georgia and South Carolina

ABSTRACT

The 2016 Municipal Equality Index rated Augusta, the largest city in the Central Savannah River Area (CSRA), as one of the least lesbian, gay, bisexual, and transgender (LGBT) friendly cities in America. To understand the context of our region in relation to LGBT wellness, we conducted the first LGBT health needs assessment of the CSRA, assessing physical and mental health status and health care needs and experiences in the community. Participants (N = 436) were recruited using venue and snowball sampling and completed an anonymous online survey. Overall, the health problems experienced (i.e., obesity, depression) were not uniformly experienced across sexual orientation and gender identity; some groups experienced significantly higher rates of these conditions than others. Similarly, transgender individuals in particular reported higher rates of negative experiences with health care providers. Regional and national dissemination of these findings is critical to reducing health disparities and improving wellness of our local LGBT community.     

Staying in the Hood: Black Lesbian and Transgender Women and Identity Management in North Philadelphia

ABSTRACT

The concept Don’t Ask, Don’t Tell regarding Black LGBT sexuality in Black communities has been an acceptable form of identity management for Black LGBT people. In other words, Black LGBT people are accepted as long as they are not vocal about their sexuality. However, this is changing with the issue of gay marriage, which is creating a space where Black LGBT people are more open about their gender identity and sexuality in heterosexual Black spaces. This new form of openness allows Black LGBT people to “stay in” their communities, as opposed to coming out. In this article I examine how Black LGBT women in North Philadelphia stay in their communities: being politically active regarding LGBT issues, disengaging from LGBT issues, passing, and educating straight Black people about issues affecting the Black LGBT community. I conclude with implications of staying in and intersectionality among Black heterosexual and LGBT women fighting for social change.     

“Coming Out” of Prison: An Exploratory Study of LGBT Elders in the Criminal Justice System

ABSTRACT

This two-phase qualitative study explores the experiences of 10 formerly incarcerated LGBT elders’ experiences prior to, during, and after release from prison. A core theme of self and the social mirror emerged from the data that represented LGBT elders ongoing coming-out process of unearthing their “true selves” despite managing multiple stigmatized identities or social locations, such as being LGBT, elderly, HIV positive, formerly incarcerated, and a racial/ethnic minority. These findings further our awareness of an overlooked population of LGBT who are older and involved in the criminal justice system. Recommendations that incorporate suggestions from formerly incarcerated LGBT elders for services and policy reform are presented.     

Lesbian, gay, bisexual, and transgender (LGBT) physicians' experiences in the workplace

Little is known about the experiences of lesbian, gay, bisexual, and transgender (LGBT) physicians in the workplace. There is little formal education in medical school about LGBT issues, and some heterosexual physicians have negative attitudes about caring for LGBT patients or working with LGBT coworkers, setting the stage for an exclusive and unwelcoming workplace. The current study used an online survey to assess a convenience sample of 427 LGBT physicians from a database of a national LGBT healthcare organization, as well as a snowball sample generated from the members of the database. Although rates of discriminatory behaviors had decreased since earlier reports, 10% reported that they were denied referrals from heterosexual colleagues, 15% had been harassed by a colleague, 22% had been socially ostracized, 65% had heard derogatory comments about LGBT individuals, 34% had witnessed discriminatory care of an LGBT patient, 36% had witnessed disrespect toward an LGBT patient's partner, and 27% had witnessed discriminatory treatment of an LGBT coworker. Few had received any formal education on LGBT issues in medical school or residency. It appears that medical schools and health care workplaces continue to ignore LGBT issues and operate in discriminatory fashion far too often.     

Trend Analysis of Medical Publications About LGBT Persons: 1950–2007

Although there are currently at least 6 million lesbian, gay, bisexual, and transgender (LGBT) persons in the United States, there are no prior studies analyzing how this group is represented in the medical literature. An examination of published LGBT topics over a 57-year period was performed using OvidSP. A total of 21,728 publications was analyzed for topic using information from the title, keywords, subject headings, and abstracts. Several trends became apparent. The largest proportion of LGBT publications (31.78%) was devoted to HIV/AIDS and other sexually transmitted infections (STIs), yet there was an overall lack of emphasis on general health topics or common causes of mortality. Further analysis showed that if publications on HIV/AIDS or STIs addressed sexual orientation, they were more likely to be about LGBT persons than heterosexuals. Overall, the volume and range of medical publications on LGBT persons may not be reflective of the health care needs of this population.     

城乡差异、就医惯性与老年人卫生服务利用

现有对城乡老年人卫生服务利用不公平的研究多忽略了长期的城乡差异所导致的隐性的农村老年人就医惯性的存在。本研究在控制了收入、医疗保障和就医可及性等因素的条件下,发现就医惯性的存在;并运用集中指数分解法发现,卫生服务的利用存在不公平,偏向于富人,而就医惯性在两种卫生服务利用中的贡献度分别为12%和5%。这种城乡固定差异造成了农村老年人在身体健康、心理健康和自我照料能力上都显著地低于城市老年人。     

Primary Care Providers’ Attitudes,Practices, and Knowledge in Treating LGBTQ Communities

ABSTRACT

Cultural competency in lesbian, gay, bisexual, transgender, and queer (LGBTQ) health care has been found to be lacking within various medical specialties, but no studies have compared competency among primary care providers. The authors compared 127 primary care providers’ cultural competency regarding LGBTQ health using a survey that assessed providers’ attitudes, practices, and knowledge. Overall, 78.0% of respondents agreed that they were comfortable treating LGBTQ patients. Yet many providers did not feel well informed on specific LGBTQ health needs (70.1%), on clinical management of LGBTQ care (74.8%), nor on referring patients with LGBTQ issues (78.7%). Overall accuracy on LGBTQ knowledge questions was 51.0%. This study revealed a lack of cultural competency and much need for improvement as primary care providers endorsed negative attitudes, biases, inconsistencies in clinical practice, and deficiencies in medical knowledge in specialty-specific ways. There is a need for greater LGBTQ-specific education to increase providers’ comfortability and competency in the needs, management, and referrals within LGBTQ health care.     

Factors affecting rural women's utilisation of continuum of care services in remote or isolated villages or Pakistan – A mixed-methods study

IntroductionAn effective continuum of care for pregnancy and childbirth connects women and girls with essential reproductive and maternity care services. This study aimed to estimate the continuum of care utilisation rate of women who lived in remote and isolated regions of Pakistan and explored factors that influence women's utilisation of reproductive and maternity care services.MethodsA mixed-methods study was conducted in five rural villages of Sindh, Pakistan. A cross-sectional survey with 669 women who gave birth between July 2010 and September 2014 investigated women's maternity-care service utilisation during pregnancy, childbirth, and in the postpartum period. In-depth interviews with 15 women explored their maternity-care experiences with health providers.ResultsOnly 6.4% of 669 women participants reported to have completed the continuum of care for their last pregnancy. Skilled birth attendants, including health professionals, were used by 56.1% for antenatal care, 40.8% for both antenatal and childbirth, 22.3% for antenatal, childbirth and postnatal, and only 6.4% reported using all pregnancy-related and postpartum services. Limited knowledge about affordable health services, poor health literacy, and access to health services was associated with women's fragmented utilisation of maternity care. A lack of respectful maternity-care was also identified as a major barrier to women's utilisation of primary health care facilities, especially for childbirth.ConclusionThe existing primary health structure in Pakistan provides a good foundation to deliver continuity of care services; however, health services utilisation for reproductive and maternity care remains suboptimal in women who live in geographically remote regions of Pakistan.     

Minority Stress,Parenting Styles,and Mental Health in Brazilian Homosexual Men

ABSTRACT

Homosexual men are constantly exposed to prejudice and violence in Brazil. The aim of this study was to investigate the relationship between minority stress, parenting styles, and indicators of mental health problems in a sample of homosexual men. Method: quantitative, cross-sectional, correlational, and retrospective design. Participants were 101 Brazilian men who selfidentified as homosexuals, aged between 18 and 55 years. Results: concealing sexual identity was a predictor of depression and stress. Parental responsiveness was associated with a lower incidence of enacted stigma and depression. Conclusions: the mental health of homosexual men can be negatively affected by the need to conceal their sexual orientation. Parental responsiveness is a protective factor in terms of experiencing enacted stigma and depression. The results found in the study may be useful for counselors and social workers who are working with LGBT people and their families.     

老年人口长期护理需求及影响因素分析--基于上海调查数据的实证分析

老年人长期护理问题已经成为当前我国重要的社会问题之一。文章基于上海市28个社区的调查数据,利用相关定量模型,实证分析上海老年人对护理服务的需求、满意情况及其影响因素。研究发现：不仅老年人健康状况、长期护理费用对老年人口长期护理需求有显著影响,更为重要的是长期护理的资源供给情况已经成为制约老年长期护理发展的关键因素。明确老年人口长期护理服务的责任主体,建立以老年护理需求为导向的评估体系,构建政府主导、社会多元主体参与的长期护理服务体系成为应对人口老龄化风险的有效路径。     

Is the Lack of Specific Lesbian,Gay, Bisexual,Transgender and Queer/Questioning (LGBTQ) Health Care Education in Medical School a Cause for Concern? Evidence From a Survey of Knowledge and Practice Among UK Medical Students

Lesbian, gay, bisexual, transgender and queer/questioning (LGBTQ) people frequently report negative health care encounters. Medical professionals may inadequately manage LGBTQ persons’ health if they have not received training in this area. An anonymous survey measuring efficacy in health situations among LGBTQ persons was answered by 166 medical students across all years of a UK university. Results show that 84.9% of participants reported a lack of LGBTQ health care education, with deficits in confidence clarifying unfamiliar sexual and gender terms, deciding the ward in which to nurse transgender patients, finding support resources, and discussing domestic abuse with LGBTQ patients. Most participants reported that they would not clarify gender pronouns or ask about gender or sexual identity in mental health or reproductive health settings. Participants reported infrequently observing doctors making similar inquiries. Participants held positive attitudes toward LGBTQ patients, with attitude scores positively correlating with LGBTQ terminology knowledge scores (r_s = 0.5052, p < .01). Addressing gender identity and sexuality issues within medical curricula may remove barriers to accessing health care and improve encounters for LGBTQ patients.     

老年地产开发与“集约化”老年照顾的创新模式

中国老龄社会的来临与老年社会问题的凸显,迫切需要实施更加多元且有效的老年社会政策。本文以“老年照顾”为核心理念的“老年主题社区”的开发,本着提供“集约化”服务的理念,探索了老年主题社区开发中如何创新设计理念、服务理念和政策措施,以真正实现规模化、低成本的老年照顾与老年服务有效供给机制。     

农村留守老人社区照料模式构建及可行性研究

随着人口老龄化及人口迁移的频繁,农村留守老人的照料问题日益凸显。文章通过分析农村现有养老保障制度的缺陷,构建了农村留守老人社区照料服务模式并进行了可行性分析,认为农村社区服务建设应该充分用现有制度和资源,通过完善政策和组织管理制度、广泛争取社会资源才能解决当前农村留守老人服务资源短缺的现实,进而促进农村社区服务的专业化和农村服务产业健康发展。     

政府支出对医疗服务健康公平影响的比较和启示

医疗服务公平和人民的健康是各国卫生系统向其国家居民提供医疗服务所应实现的两个重要目标。但以英美日为例的发达国家根据世界卫生统计年鉴中的医疗服务公平性排名确有明显差距,因此,高收入和高政府医疗卫生支出与医疗卫生服务公平和健康公平性并没有必然关系。本文通过比较分析美日英国的政府间医疗卫生支出责任划分的结构发现高政府医疗卫生支出比例是提高医疗服务筹资公平性的前提,中央承担社会医疗保险责任是实现医疗服务筹资公平性的保证,政府特别是中央政府出资的长期护理有助于提高国民健康水平,地方政府的参与更有助于提高一国医疗系统机构数量特别是医院的数量。