scholarly journals Principles of Transgender Care for the Primary Care Physician

2020 ◽  
pp. 30-37
Author(s):  
Robert Gotfried
Keyword(s):  
Health Care ◽  
Gender Identity ◽  
Health Care Providers ◽  
Gender Dysphoria ◽  
Mental Health Problems ◽  
Care Physician ◽  
Internal Conflict ◽  
Care Providers ◽  
Transgender People ◽  
Transgender Persons

The term transgender includes people whose gender identity differs from their sex assigned at birth. People identified as male at birth but possess a female gender identity are called transwomen and people identified as female at birth but experience a male gender identity are called transmen. Transgender individuals may also identify outside the binary norm. The prevalence of transgender people who seek medical treatment has dramatically increased in recent years. Transgender individuals have a higher prevalence of mental health problems, suicidality and premature mortality risk versus the general population. However, many transgender persons avoid medical care due to perceived stigma, in conjunction with transgender-specific knowledge deficits among health care providers. Integral to understanding transgender health is the concept of gender dysphoria. This refers to the internal conflict individuals experience due to incongruence between their birth sex and their self-perceived gender. For these individuals, the inconsistency causes significant internal conflict, often to the point that it interferes with functioning. To address gender dysphoria, many transgender people elect to transition to a gender role that is consistent with their gender identity. These individuals opt for medical and/or surgical interventions to do so. Medical therapy incorporates the use of cross-sex hormones to facilitate the acquisition of secondary sexual characteristics consistent with the individual’s internalized identity. Many transgender people choose to undergo gender-confirming surgeries in conjunction with hormonal therapy. Health care is transgender-affirming when it supports the patient’s inherent identity. Educating providers about this population’s unique needs can help reduce health disparities and promote respectful transgender care.

scholarly journals Impact of mental health and addiction NIMHANS ECHO on primary care physicians: study from a rural state of India

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S157-S157
Author(s):  
Shabinabegam A M Sheth ◽  
Bhavya Bairy ◽  
Aurobind Ganesh ◽  
Sumi Jain ◽  
Prabhat Chand ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Health Care Providers ◽  
Mental Health Problems ◽  
Health Problems ◽  
Care Providers ◽  
Primary Health ◽  
Secondary Outcomes

AimsAs per National Mental Health Survey-2015-16, 83 out of 100 people having mental health problems do not have access to care in India. Further, primary health care providers (PCPs) have not been adequately trained in the screening, diagnosis, and initial management of common mental health conditions. There is thus a need to train health care providers at the State level to incorporate mental health into primary health care. In this paper, we report the findings of a collaborative project between the National Institute of Mental Health and Neuro Sciences (NIMHANS) Bangalore India, and the state of Chhattisgarh incorporating mental health into primary care and addressing urban-rural disparities through tele-mentoring.MethodWe assessed the impact of the NIMHANS Extended Community Health Care Outcome (ECHO), an online, blended training program on participants' knowledge and competence (primary outcome) and commitment, satisfaction, and performance (Secondary outcomes) using Moore's evaluation framework. Primary and secondary outcomes were determined through a pre-post evaluation, assessment of trainee participation in the quarterly tele ECHO clinic as well as periodic assignments, respectively.ResultOver ten months of the NIMHANS ECHO program, there was a significant improvement in the participants' knowledge post-ECHO (p < 0.05, t = −3.52). Self-efficacy in diagnosis and management of mental health problems approached significance; p < 0.001. Increased engagement in tele-ECHO sessions was associated with better performance for declarative and procedural knowledge. The attrition rate was low (5 out of 30 dropped out), and satisfaction ratings of the course were high across all fields. The participants reported a 10- fold increase in the number of patients with mental health problems they had seen, following the training. A statistically significant increase in the number of psychotropic drugs prescribed post ECHO with t = −3.295, p = 0.01.ConclusionThe outcomes indicate that the NIMHANS ECHO with high participant commitment is a model with capacity building potential in mental health and addiction for remote and rural areas by leveraging technology. This model has the potential to be expanded to other states in the country in providing mental health care to persons in need of care.

scholarly journals ADVANCE CARE PLANNING AMONG LGBT PEOPLE: AN INTEGRATIVE REVIEW AND ANALYSIS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S181-S182
Author(s):  
Luisa Kcomt ◽  
Kevin M Gorey
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Living Will ◽  
Rapid Review ◽  
Care Planning ◽  
Care Providers ◽  
Advanced Illness ◽  
Transgender People ◽  
Lgbt People ◽  
Healthcare Proxy

Abstract Lesbian, gay, bisexual, and transgender people (LGBT) with advanced illness need culturally competent advanced care planning (ACP) services but often encounter structural and communication barriers. The aim of this study was to examine the ACP behaviors of LGBT people. An integrative rapid review method was used to search electronic databases for peer reviewed and non-peer reviewed publications between 2010 to 2017. Eight survey instruments comprising 30 prevalence estimates were analyzed. ACP discussions between LGBT people and their primary health care providers were rare, with an overall prevalence of 10%. Transgender people were 50–70% less likely than their LGB counterparts to have a living will or to have appointed a healthcare proxy. These results suggest there is a critical need for greater cultural competency among health care providers serving LGBT populations. Social workers can play a key role in advocacy and social justice for LGBT individuals with advanced illness.

Contested meanings of mental health and well-being among university students

2017 ◽  
Vol 48 (4) ◽  
pp. 453-464 ◽  
Author(s):  
Vinitha Jithoo
Keyword(s):  
Mental Health ◽  
Health Care ◽  
University Students ◽  
Emerging Adults ◽  
Health Care Providers ◽  
Mental Health Problems ◽  
Well Being ◽  
Health Problems ◽  
Care Providers ◽  
Health And Well Being

Emerging adults are an important group not only because their opinions and knowledge will determine future attitudes but also because of the emergence of mental health problems during young adulthood. In order to provide relevant support, academics, health care providers as well as policy makers need to be more cognisant of how emerging adults make meaning of their psycho-social developmental context. The objective of the study was to explore how a cohort of 150 university students made meaning of emotional well-being and mental illness, the causes of mental health problems, the negative connotations associated with mental ill health, help-seeking behaviours, and how culture was used as a lens through which mental well-being was understood. The main findings indicate that students struggle to fully understand these concepts mainly because it is shrouded in mystery and complexity and not engaged with freely because of stigma and stereotypical attitudes, and while culture provides a lens to understand the causes and interventions, emerging adults often adopt a level of scepticism and are beginning to vacillate between tradition and modernity. Emerging adults face many barriers to accessing health care services including limited knowledge and stigma related to services, lack of confidentiality, fear of mistreatment, location of facilities, and the high cost of services. Universities and government should actively engage with research evidence to inform policies and programmes to improve the health and well-being of emerging adults.

Although unseen, chronic pain is real–A phenomenological study

2015 ◽  
Vol 6 (1) ◽  
pp. 33-40 ◽  
Author(s):  
Tapio Ojala ◽  
Arja Häkkinen ◽  
Jaro Karppinen ◽  
Kirsi Sipilä ◽  
Timo Suutama ◽  
...  
Keyword(s):  
Health Care ◽  
Chronic Pain ◽  
Health Care Providers ◽  
Phenomenological Study ◽  
Mental Health Problems ◽  
Holistic Approach ◽  
Spinal Pain ◽  
Underlying Disease ◽  
Pain Patient ◽  
Care Providers

AbstractBackgroundResearch has emphasised the essential role of psychosocial risk factors in chronic pain. In practice, pain is usually verified by identifying its physical cause. In patients without any distinct pathology, pain is easily defined as imaginary pain. The aim of this qualitative study was to explore the invisibility of chronic pain, from the patients’ perspective.MethodsThirty-four participants with chronic pain were interviewed. The mean age of the participants was 48 years, and 19 of them were women. For 21 of the participants, the duration of pain was more than five years, and most of the participants had degenerative spinal pain. The transcribed interviews were analysed using Giorgi’s four-phase phenomenological method.ResultsThe participants’ chronic pain was not necessarily believed by health care providers because of no identified pathology. The usual statements made by health care providers and family members indicated speculation, underrating, and denial of pain. The participants reported experience of feeling that they had been rejected by the health care and social security system, and this feeling had contributed to additional unnecessary mental health problems for the participants.As a result from the interviews, subthemes such as “Being disbelieved”, “Adolescents’ pain is also disbelieved”, “Denying pain”, “Underrating symptoms”, “The pain is in your head”, “Second-class citizen”, “Lazy pain patient”, and “False beliefs demand passivity” were identified.ConclusionsIn health care, pain without any obvious pathology may be considered to be imaginary pain. Despite the recommendations, to see chronic pain as a biopsychosocial experience, chronic pain is still regarded as a symptom of an underlying disease. Although the holistic approach is well known and recommended, it is applied too sparsely in clinical practice.ImplicationsThe Cartesian legacy, keeping the mind and body apart, lives strong in treatment of chronic pain despite recommendations. The biopsychosocial approach seems to be rhetoric.

Medicine in Unplanned Mass Gatherings: A Qualitative Study of Health-Care Providers’ Response and Recommendations to Beirut’s Protests

2021 ◽  
pp. 1-5
Author(s):  
Farah Yassine ◽  
Samer Bou Karroum ◽  
Reem Amine ◽  
Majid Chammas ◽  
Hassan Dehaini ◽  
...  
Keyword(s):  
Health Care ◽  
Qualitative Study ◽  
Health Care System ◽  
Health Care Providers ◽  
Mental Health Problems ◽  
Health Care Provision ◽  
Care Provision ◽  
Care Providers ◽  
Mass Gatherings ◽  
Care System

Abstract Objective: This study aims at exploring the dynamics of health-care provision during recent unplanned public mass gatherings in Beirut, and how the health-care system adapts to mass movements in protests. Methods: A qualitative study was conducted using semi-structured interviews with 12 health-care providers who volunteered at medical tents set during protests in Beirut, Lebanon. Responses were transcribed and coded. Results: Three themes were noted: preparedness and logistics, encountered cases, and participants’ proposed recommendations. In terms of preparedness and logistics, participants lacked knowledge of field medicine protocols and an organizational structure. They faced difficulties in securing equipment and advertising their services. Most encountered cases were physical injuries rather than mental health problems. The participants proposed both short-term recommendations, including advice on how to boost care provided, and long-term recommendations on structuring the health-care system to be better prepared. Conclusions: On-site health-care provision during unplanned mass gatherings is a vital need. We recommend forming a task force of health-care workers from various fields led by the Ministry of Public Health in every respective country to plan protocols, train personnel, and secure resources beforehand.

Mental Health Practices of Ontario Family Physicians: A Study Using Qualitative Methodology

1997 ◽  
Vol 42 (9) ◽  
pp. 943-949 ◽  
Author(s):  
MA Craven ◽  
M Cohen ◽  
D Campbell ◽  
J Williams ◽  
Nick Kates
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Mental Health Care ◽  
Health Care Providers ◽  
Mental Health Problems ◽  
Family Physicians ◽  
Health Problems ◽  
Care Providers ◽  
Mental Health Care Providers

Objective: To obtain descriptions of how family physicians detect and manage mental health problems commonly encountered in their practices and how they function in their role as mental health care providers. Also, to elicit their perceptions of barriers to the delivery of optimal mental health care. Method: Focus groups with standardized questions were used to elicit descriptive data, opinions, attitudes, and terminology. Convenience samples of 10 to 12 physicians were chosen in each of Ontario's 7 health care planning regions, with a mixture of rural, urban, and university settings. Discussions were audiotaped, transcribed, analyzed, and recurring themes were extracted. Results: Family physicians' descriptions of the range of problems commonly encountered and their detection and management highlight the unique nature of mental health care in the primary care setting. The realities of family medicine, the undifferentiated nature of presenting problems, the long-term physician–patient relationship, and the frequent overlap of physical and mental health problems dictate an approach to diagnosis and treatment that differs from mental health care delivery in other settings. Difficulties in the relationship with local psychiatric services—accessing psychiatric care (especially for emergencies), poor communication with mental health care providers, and cumbersome intake procedures of many mental health services—were consistently identified as barriers to the delivery of optimal mental health care. Conclusions: This study confirms the importance of the family physician in the detection and management of mental health problems. It offers insights into how family physicians function in their role as mental health care providers and how they deal with diagnostic and management challenges that are specific to primary care. It also identifies barriers to the optimal delivery of mental health care in the primary care setting, including difficulties at the clinical interface between psychiatry and family medicine. Further studies are needed to explore these issues in greater depth.

Getting to the Heart of the Matter: Nursing Assessment and Intervention with Battered Women in Psychiatric Mental Health Settings

1995 ◽  
Vol 1 (2) ◽  
pp. 48-54
Author(s):  
Nancy Fishwick
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Battered Women ◽  
Health Care Providers ◽  
Mental Health Problems ◽  
Abusive Relationships ◽  
Care Providers ◽  
Physical And Mental Health ◽  
Nursing Assessment ◽  
Mental Health Settings

The consequences of abusive relationships are reflected in the physical and psychologic distress for which women seek assistance from health care providers. Although the physical and mental health problems from the abuse are addressed and treated, the heart of the matter— the abuse at home— goes unattended Women often leave the health care setting as isolated and uninformed about options as when they came in. Mental health settings offer important opportunities for psychiatric nurses to identify and intervene with women in abusive relationships. Whether encounters are relatively brief or occur over an extended period of time, important interactions can take place. The nurse's response to women in abusive relationships is one component of a unified community-wide response that is needed to prevent violence and abuse in the home. (J Am Psychiatr Nurses Assoc [1995]. 1, 48–54)

scholarly journals Patients’ Perspectives and Advice on How to Discuss Sexual Orientation, Gender Identity, and Sexual Health in Oncology Clinics

2020 ◽  
Vol 37 (12) ◽  
pp. 1053-1061
Author(s):  
Elizabeth Cathcart-Rake ◽  
Jennifer O’Connor ◽  
Jennifer L. Ridgeway ◽  
Carmen Radecki Breitkopf ◽  
Judith S. Kaur ◽  
...  
Keyword(s):  
Health Care ◽  
Sexual Orientation ◽  
Gender Identity ◽  
Sexual Health ◽  
Health Care Provider ◽  
Health Care Providers ◽  
Care Provider ◽  
Care Providers ◽  
Female Doctor ◽  
Transition Clinic

Objective: This study sought to understand the patients’ perspective of what contributes to an absence of discussions of sexual orientation (SO), gender identity (GI), and sexual health in cancer care. Methods: Patients were recruited from oncology, gynecology, and a gender transition clinic to participate in semistructured interviews, which were analyzed with qualitative methods. Results: A total of 25 patients were interviewed, shedding light on 2 themes. The first was that these conversations are important but infrequent. One patient explained, “…. we know people who have had sex changes…[they] would have appreciated that question.” In response to whether sexual health was ever brought up, one patient responded, “No doctor ever has.” Patients described unaddressed issues: “There have been times, you know, we’ve wondered if it was okay to make love.” The second theme consisted of 4 pragmatic, patient-provided points to facilitate discussions: (1) implementation of a scale of 1 to 10 (with 10 being comfortable) to first gauge patients’ comfort in talking about SO, GI, and sexual health; (2) having the health-care provider explore the topic again over-time; (3) making sure the health-care provider is comfortable, as such comfort appears to enhance the patient’s comfort (“I have a doctor here, a female doctor, who just matter of fact will ask if I get erections and so on because of the medication she’s giving me);” and (4) eliminating euphemisms (one patient stated, “I don’t know what you mean by ‘sexual health’.”). Conclusion: Oncology health-care providers have a unique opportunity and responsibility to address SO, GI, and sexual health.

scholarly journals The primary health care of transgender adults

Sexual Health ◽  
2017 ◽  
Vol 14 (5) ◽  
pp. 477 ◽  
Author(s):  
Stuart Aitken
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Disparity ◽  
Gender Dysphoria ◽  
Well Being ◽  
Primary Care Providers ◽  
Transition Services ◽  
Care Providers ◽  
Transgender People ◽  
Significant Health

Gender dysphoria is associated with significant health disparity. Gender services perform specialised activities such as diagnosis, endocrine management and liaison with surgical services. Although providing these specialised transition services appears to be safe and improves well-being, significant health disparity remains. Engaging primary care providers is an important part of any strategy to improve the health care of transgender people. The relationships between gender dysphoria and a range of primary care issues such as mental health, cardiovascular disease and cancer are explored.

scholarly journals Prevalence of depression and its associated factors among the doctors working in a private medical college, Trichy- a cross sectional study

2020 ◽  
Vol 7 (11) ◽  
pp. 4410
Author(s):  
Sathasivam Ponnan ◽  
N. Mareeswaran ◽  
Thalha . ◽  
T. Tamizhan
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Health Care Providers ◽  
Mental Health Problems ◽  
Cross Sectional Study ◽  
Care Providers ◽  
Sectional Study ◽  
Cross Sectional ◽  
Tertiary Teaching ◽  
Study Participants

Background: Stress is one among the leading health problem throughout the world. Stress due to family problems and work related are often encountered. Among the various professionals, health care providers are found to be more depressed than others. This study was conducted with an objective to study the socio demographic characters of the study participants, to study the depression status of the study participants and to study the association between various factors and depression.Methods: This descriptive cross sectional study done among the doctors working in a tertiary teaching hospital. A total of 150 participants were included in this study. Simple random sampling method was used to identify the study participants.Results: Around 76% of the participants belongs to the age group of 20-30 years of age. 71.3% of the study population were junior residents. Nearly 64% were found to be depressed among which 8% were found to be on severely depressed. Statistical significant association was found between factors like designation and time spending with family with depression.Conclusions: Since stress and burnout became the leading mental health problems, and health care providers posing as a vulnerable group by virtue of their profession. Hence behavioral therapy sessions and stress management programs are to be conducted frequently to screen as well to relieve from the mental health issues. 

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