Exploring the utilization of end-of-life documentation among an online sample of sexual- and gender-minority individuals in the United States

ABSTRACT

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) persons often receive end-of-life care incongruent with wishes. Evidence with heterosexual samples supports associations among end-of-life documentation (do not resuscitate [DNR] orders, durable power of attorney for health care orders [DPOAH], living wills [LW]), and care consistent with wishes. However, little is known about the knowledge, attitudes, and willingness regarding utilization of these documents among LGBTQ persons. Of 107 participants, most had heard of each document (95% DNR, 91% DPOAH, 97% LW), but had not procured them (26% DNR, 50% DPOAH, 51% LW). Answers above 4 on a 5-point Likert scale indicated willingness to pursue these documents and belief documents would be enforced. However, approximately one-third of respondents believed documents would be enforced more for heterosexual persons than themselves. This result indicates sexuality or gender minority-related stigma may be a barrier to document utilization. Future research, policies, and guidelines should address these concerns.     

Success of University Student Volunteers in Obtaining Consent for Reviewing Private Health Information for Emergency Research

This study aimed to determine the success of university student volunteers in obtaining consent from parents to allow review of their child’s personal health information (PHI) for emergency research screening. This study also aimed to examine the variables associated with successful consent. This was a prospective cross-sectional study conducted at a pediatric emergency department (ED). University students, who functioned as delegates of the health information custodian, approached parents for consent. Of 2,506 parents, 1,852 (73.9%) provided consent to allow review of their child’s PHI for research screening. Variables associated with successful consent were high (≥12 months) versus low (<12 months) volunteer experience (OR = 2.0), research related (vs. unrelated) to the child’s chief complaint (OR = 2.0), child treated regularly by specialists at the study institution (OR = 1.7), and ED presentation mid-week vs. weekend (OR = 1.7) and morning vs. evening presentation (OR = 1.4). When approached by a university student volunteer, about 25% of parents declined to have their child’s PHI reviewed for research screening. This model of obtaining consent may put some emergency research at risk for selection bias. Variables that increase the odds of successful consent can be considered in program design to improve the effectiveness of this model.     

Bringing the Citizen Back In: Supporting Decentralisation in Fragile States ‐ A View from Burundi

While, in theory, decentralisation offers many benefits, empirical evidence of these benefits remains limited. Drawing on fieldwork conducted in Burundi in 2011, this article argues that the current donor emphasis on institution‐building alone proves insufficient. Evidence is presented to show that current support, while consolidating the authority of local political elites, reinforces political and horizontal inequalities, thereby paving the way for further disaffection and conflict. Reflecting back to the initial aims of the process, a re‐orientation is proposed, moving the focus of support beyond elite state actors and institutions and bringing citizens back into the process of state building and transformation.     

HOTEL DEMAND BEFORE,DURING, AND AFTER SPORTS EVENTS: EVIDENCE FROM CHARLOTTE,NORTH CAROLINA

This paper uses daily hotel occupancy data to examine the effects of a wide variety of political and sporting events on the hotel room market of Charlotte, North Carolina from 2005 to 2014. Two political conventions and NASCAR auto races are associated with large increases in hotel occupancy, prices, and revenue, but many other events have no discernable effect on Charlotte's hotel market. The results also indicate that occupancy effects before or after most events are modest at best. Back‐of‐the‐envelope calculations show incremental hotel‐tax receipts fall short of the debt service incurred in constructing and maintaining the city's sports venues. (JEL H71, Z23, Z28)     

Talking about Work: School Students’ Views on their Paid Employment

Seventy 15‐year‐old students in rural and urban Scottish schools, who had previously answered questionnaires about the extent of their part‐time employment, were interviewed. Work appears to be the norm in their communities, 79 per cent having worked and most of the others anticipating working before leaving school. Although the interviewees’ accounts of their jobs give some support to those who argue that most of the paid employment school students undertake is routine and boring, it was also found that most of the young workers found their work satisfying and believed that their experience of working helped to prepare them for adult life. It is proposed that research on the meaning of employment for school students should be extended and that the self‐report techniques currently employed might be supplemented by observational studies. © 2006 The Author(s). Copyright © 2005 National Children's Bureau.     

Bridging the Organizational Divide: A Comparative Institutional Analysis of United States and International Humanitarian Service Delivery Structures

Hurricane Katrina, which devastated the New Orleans, Louisiana metropolitan area in August 2005, made many United States citizens more aware of how their national government undertakes its humanitarian relief responsibilities. Many learned for the first time, for example, that the federal government is a secondary responder and attends to natural disasters only when states and localities request such support and assistance. That U.S. framework and the international relief implementation structure are remarkably similar. This paper compares and contrasts these two aid implementation approaches with an eye to clarifying their similarities and differences and to identifying how each might better be understood for the future to secure improved coordination and more effective outcomes.

Preventing Tragedy in Canada? Risk and Responsibility in Government Discourses about Alcohol Consumption and Pregnancy

The feminist analysis presented in this article interrogates the fundamental assumptions that informed the first document produced by the Canadian government about alcohol consumption during pregnancy. Our analysis shows that constructions of risk and responsibility are rooted in neoliberal principles. We argue that such ideas can reinforce a problematic notion of individualization that is at the core of the neoliberal state—one that devalues a sense of social responsibility for the public good and contributes to a highly moralized pregnancy discourse that encourages the widespread surveillance of women’s reproductive bodies and behaviors.     

The Sexual Health of Transgender Men: A Scoping Review

There is a general paucity of research concerning the sexual health of transgender individuals, and most existing research focuses on transgender women. A scoping review concerning the sexual health of transgender men was conducted to identify gaps in the literature and to highlight opportunities for future research and intervention. A comprehensive search of seven databases was conducted. The Joanna Briggs Institute Reviewers’ Manual was used as a framework. Some 7,485 articles were initially identified using a search strategy applied to seven online databases: 54 articles were identified as relevant to the research questions and reviewed in detail; of those, 33 were included in the final analysis. Studies were conceptualized into four broad themes: sexual behaviors, sexual identity, sexual pleasure and sexual function, and transactional sex. Besides an overall lack of research, existing studies were often characterized by small convenience samples that do not allow for generalization to the larger population of transgender men. Significant gaps in the literature regarding sexual coercion, sexual and intimate partner violence, and relationship quality and functioning among transgender men exist. There is a need to improve the scope and depth of research examining the sexual health of this population, especially concerning sexual risk behaviors and structural barriers to sexual health care access.     

“We Became Sceptics”: Fear and Media Hype in General Public Narrative on the Advent of Pandemic Influenza

In this article, we examine the apparent resistance of publics to messages regarding pandemic influenza. The 2009 H1N1 pandemic was addressed through media: governments used print, broadcast, and digital media to advise publics to enact hygiene practices and comply with social isolation; news media took up the pandemic as a lead story. Publics, however, rated the pandemic as not serious, even before it was widely known that it was mild for most. This problem is presently constructed as complacency: where individuals are seen to lack appropriate motivation to avoid risk. We combine perspectives on media reflexivity on the part of audiences with general public interviews and focus groups in Australia and the UK, to offer an alternative explanation for complacency. Publics endorse public health advice, but are skeptical of pandemic risk communication. They exhibit critical awareness of outbreak narrative and concomitant emotions, such as fear, which are coded into media stories. We, therefore, challenge the view that publics are complacent. Instead, governments must navigate an emerging terrain of ramified and critical media consumption to shape effective risk communication in time of global health emergency.