HIV-related stigma in health care settings: a survey of service providers in China

We examined how individual and institutional factors in health care settings affected discrimination toward persons with HIV/AIDS. A representative sample of 1101 Chinese service providers was recruited in 2005, including doctors, nurses, and laboratory technicians. Multiple regression models were used to describe associations among identified variables, the relationships with HIV-related personal prejudicial attitudes, and perceived institutional support and discrimination at work. Multivariate analyses revealed that respondents' general view of persons living with HIV/AIDS and their perceived levels of support from their institutions regarding protection procedures were both important predictors for discrimination intent. Perceived institutional support varied according to age, gender, ethnicity, and training background. A better understanding of HIV-related discrimination in health care settings requires consideration of both individual and institutional factors.     

Policies for training and employment of physicians in Mexico 1917-1988

In this article we analyze education and employment policies for medical doctors in Mexico, which have led to a situation characterized by unemployment, under-employment and multiple-employment in urban areas, as well as lack of services in several rural zones. The analysis is divided into four defined periods according to the modes of State participation in health care: 1917-1958 (creation and slow growth of health care institutions); 1959-1967 (growth of scientific medicine); 1968-1979 (crisis period); and 1980-1988 (reform). In each one of these periods the evolution of medical manpower is analysed through the actions of three main actors: the State, the universities and the medical profession. The general conclusion of this historical analysis is that the present imbalance in the medical labor market has derived from a lack of joint planning of supply and demand, where by the educational and health care institutions, could decide together the crucial aspects of the quantity and quality of doctors that the population requires.     

American Geriatrics Society Care of Lesbian,Gay, Bisexual,and Transgender Older Adults Position Statement

There is ample evidence that lesbian, gay, bisexual, and transgender (LGBT) individuals face discrimination in the healthcare setting. Providing high‐quality health care for older LGBT adults will require active steps by organizations, institutions, advocacy groups, and health professionals that create an environment that is free from discrimination. This position statement that the American Geriatrics Society (AGS) Ethics Committee developed addresses the vision of the AGS for the care of LGBT older adults and specific steps that can be taken to ensure that they receive the care that they need.     

医养结合机构建设基本要求与职能设置的研究与实践

本课题组根据多年研究和实践经验,对医养结合的概念和医养结合机构进行了定义、分类和界定,提出对医养结合专业机构实施分级管理以及各级机构建设标准、职能设定、质量控制和等级评定的设想,建议将医养结合专业机构定名为“医养院”,列入国家医疗保健体制内,作为国家正式规范的慢病防治机构。     

Perceived Discrimination and Self-Reported Quality of Care Among Latinos in the United States

BACKGROUND

Given the persistence of health and health-care disparities among Latinos in the United States and evidence that discrimination affects health and health care, an investigation of the relationship between perceived discrimination and quality of health care among Latinos is warranted.

OBJECTIVE

To examine the relationship of perceived discrimination (in general and in regard to doctors and medical personnel) with self-reported quality of health care and doctor-patient communication in a nationally representative Latino population sample.

PARTICIPANTS

Participants were 1,067 Latino adults aged ≥18 years living in the US selected via random-digit dialing. Telephone interviews were conducted in 2008 during Wave 2 of the Pew Hispanic Center/Robert Wood Johnson Foundation Hispanic Healthcare Survey.

RESULTS

US-born Latinos were twice as likely to report general discrimination as foreign born: 0.32 SD versus ?0.23 SD (P?<?0.001) on the Detroit Area Survey (DAS) discrimination scale. Higher DAS discrimination was associated with lower self-reported quality of care in US-born Latinos [OR?=?0.5; 95% CI (0.3, 0.9); P?=?0.009]. For foreign-born Latinos, report of any doctor or medical staff discrimination was associated with lower quality of care [OR?=?0.5; 95% CI (0.3, 0.9); P?=?0.03], but the DAS was not. For US-born Latinos, doctor discrimination and higher DAS were jointly associated with worse doctor-patient communication. For foreign-born Latinos, the effect of discrimination on doctor-patient communication was significantly smaller than that observed in US-born Latinos.

CONCLUSIONS

Given the association between perceived discrimination and quality of care, strategies to address discrimination in health-care settings may lead to improved patient satisfaction with care and possibly to improved treatment outcomes.

     

Implications of pandemic influenza for bioterrorism response.

The 1918-1919 influenza pandemic (Spanish flu) had catastrophic effects upon urban populations in the United States. Large numbers of frightened, critically ill people overwhelmed health care providers. Mortuaries and cemeteries were severely strained by rapid accumulation of corpses of flu victims. Understanding of the outbreak's extent and effectiveness of containment measures was obscured by the swiftness of the disease and an inadequate health reporting system. Epidemic controls such as closing public gathering places elicited both community support and resistance, and fear of contagion incited social and ethnic tensions. Review of this infamous outbreak is intended to advance discussions among health professionals and policymakers about an effective medical and public health response to bioterrorism, an infectious disease crisis of increasing likelihood. Elements of an adequate response include building capacity to care for mass casualties, providing emergency burials that respect social mores, properly characterizing the outbreak, earning public confidence in epidemic containment measures, protecting against social discrimination, and fairly allocating health resources.     

Understanding HIV-related stigma and discrimination in a "blameless" population.

HIV-related stigma and discrimination are major barriers to the successful control of HIV. Stigma is associated with the disease as well as the behaviors that lead to infection. A qualitative study was conducted to identify the reasons, sources, and types of HIV-related stigma prevalent in rural China. Eighty in-depth interviews were conducted with people living with HIV/AIDS, their family members, health care providers, and uninfected villagers. Stigmatizing behaviors were primarily associated with fear of HIV rather than with the route of infection. Uninfected villagers were the main source of discrimination, with health workers and family members also holding some stigmatizing attitudes. A primary concern for HIV-positive villagers was protecting their families, especially their children, from discrimination. Secondary stigma also extended to un- infected members of the same village. The results have been used to develop an intervention to reduce fear of casual transmission and stigma in these communities.     

What high-risk women are telling us about access to primary and reproductive health care and HIV prevention services.

Focus group discussions on barriers to health care and attitudes toward family planning, reproductive health services, and condom use were conducted with 63 women at high risk for HIV due to their own injection drug use, sex with injection drug users, sex industry work, or a history of multiple sexually transmitted diseases. Barriers identified include the high cost of health care, perceived poor quality of care and experiences of discrimination and stigmatization, geographic accessibility, fear of legal/social services punitive actions, misperceptions about the efficacy of birth control methods and condom usage, lack of sterilization services, and lack of male involvement. Where possible, findings from the focus groups are supported with quantitative survey data from a sample of high-risk women (n = 723). Recommendations are made for improving care for high-risk women.     

Provider perceptions of stigma and discrimination experienced by adolescents and young adults with pHiV while accessing sexual and reproductive health care

Historically, children with perinatally-acquired HIV (PHIV) were viewed as the “innocent victims” as their HIV infection was not acquired through sexual/drug related means. Today, adolescents with PHIV are surviving into young adulthood and are engaging in developmentally expected behaviors such as establishing intimate, sexual relationships. Like other youth, those living with PHIV often need to access sexual and reproductive health (SRH) services. Previous research has documented stigma and discrimination experienced by adult women living with HIV as they try to access SRH care. However, little is known about the experiences of stigma and discrimination encountered by the maturing adolescents and young adults (AYA) with PHIV when accessing services. HIV health care providers (HHCPs) who frequently care for this population are in a unique position to learn about and understand the stigma and discrimination experienced by their patients in formal service settings. HHCPs (n?=?57, 28 medical and 29 social service providers) were recruited using snowball sampling, and completed an online survey based on patient-shared experiences of stigma and discrimination when accessing SRH-related health care and social services. Thirty-eight percent (22/57) of providers reported that their patients with PHIV had shared encounters of stigma or discrimination when accessing SRH services. Coded open-ended provider comments indicated that AYA patients experienced challenges with providers who were unfamiliar with PHIV and expressed surprise that someone with PHIV was still alive. Analyses also revealed prejudicial attitudes towards women with HIV. Patients reported being counseled to terminate their pregnancy and lectured about their “poor choices.” As AYA with PHIV transition out of pediatric and adolescent care, it is important for providers to simultaneously help them navigate care in other health settings, as well as educate adult health care providers about possible misconceptions of caring for individuals with PHIV.     

Health institutions and physicians' self-care

OBJECTIVE: To analyze how self-care of health workers is influenced by their professional training and institutional setting. MATERIAL AND METHODS: This study took place from March 2000 to February 2001 in a health center, a general hospital, and a health research institute. Qualitative in-depth interviews were used to collect data. Four in-depth interviews were conducted among physicians at the study sites: two to primary care physicians and two to secondary care physicians. RESULTS: Study findings show that physicians face barriers to self-care. Secondary care physicians were particularly affected by long work journeys and multiemployment. The main difficulties were associated with stress, nutrition, rest, and recreational activities. Physicians did not regularly have medical check-ups and would often simply consult with their colleagues in "hallway checkups" when they were afflicted by an illness. The physicians coincided in their recommendation that the health institutions should develop policies, programs, guidelines, and facilities to promote self-care among health workers. CONCLUSIONS: Health institutions are not designed or organized to promote self-care among their personnel. In the case of secondary care physicians, the organizational structure often prevents them from engaging in healthy activities. The English version of this paper is available at: http://www.insp.mx/salud/index.html.     

Dimensions, content and validation of the fear of AIDS schedule in health professionals

We examined the structure of the Fear of AIDS Schedule (FAIDSS) in a sample of 134 health care workers. Factor analysis indicated that there were five discrete dimension of fear of AIDS: fears of loss of control, of sex, of HIV infection through blood and illness, of death and medical interventions, and of contact with outsiders. These dimensions had low to moderate intercorrelations. The dimensions of fear of HIV infection through blood or illness, was significantly correlated with desired personal social distance from people with AIDS, and this dimension along with fear of death and medical interventions were correlated with desired public social distance. Fear of infection through blood and illness were predictors of both desired personal social distance and public social distance from people with HIV infection. The data suggest greater discrimination of AIDS fears with greater closeness of interaction with people with HIV disease, and that these dimensions of the FAIDSS are both reliable and valid measures of AIDS fears.     

Needlestick injuries in an era of HIV: technical and personal aspects

Hospitals are workplaces in which HIV has double significance. Needlestick accidents link patients, healthcare workers and cleaning staff through the risk of occupational exposure to HIV. Additionally, concern over needlestick injuries may embody HIV stigma, discrimination and fear. This paper draws on qualitative research from a one-year case study at a large, private South African healthcare company that runs a number of hospitals across the country. Issues surrounding needlestick injuries were discussed with hospital managers, union members, infection-control nurses, health and safety representatives, HIV/AIDS counsellors, and general nursing staff. Needlestick injuries presented a complex set of technical and personal concerns. The research shows that cost-management, human rights, health and safety procedures, stigma and discrimination, and the quality of patient care are all relevant to needlestick injuries in an era of HIV. Participants' concerns focused on: establishing safety procedures, the cost and efficacy of waste disposal systems, access to post-exposure prophylaxis, legal implications, and baseline HIV tests following needlestick injuries. The last topic revealed numerous other issues, including the possibility of health workers 'legitimising' sexually acquired HIV infection by passing it off as an occupational accident. Healthcare facilities should ensure procedures that minimise occupational exposure to HIV and that minimise infection risk in the event of accidents. We propose that hospitals ought to directly encourage staff to learn their HIV status and seek disease management when needed. Likewise, better approaches to dealing with HIV stigma and discrimination are needed, especially to dispel myths of good and bad ways of contracting HIV.     

AIDS: who will care at home?

This study examined a program to educate providers of home health care about AIDS. A U.S. Public Health Service-funded program PROJECT Tec-HI, was designed to train family members, friends, and homemaker/home health aides to care for AIDS patients. Students had classroom and clinical learning opportunities. Pre- and posttesting of five AIDS-related items embedded in a scale of general health care knowledge suggested differential learning of AIDS content. Students with experience caring for AIDS patients completed the curriculum significantly more often. The greater the level of students' knowledge on pretest the more likely they were to complete PROJECT Tec-HI. Results suggested that even persons willing to learn about AIDS are not immune to fears that preclude their ability to learn about the disease. This study suggests that AIDS educators must help students deal with their levels of fear in order to prepare quality care givers for AIDS patients.     

2017-2019年云南省医疗卫生机构性病防治工作质量控制结果分析

目的对云南省医疗卫生机构开展性病防治工作的质量控制落实情况进行评价,了解其工作开展情况及存在问题,以进一步提高本省性病防治工作质量。方法对2017-2019年省级抽查的医疗卫生机构性病防治工作质量控制结果进行整理分析。结果 2017-2019年,省级共抽查124家性病诊疗机构和97家仅开展梅毒筛查的非性病诊疗机构,其中性病诊疗机构质控指标10项,质控合格率为100%,仅开展梅毒筛查的非性病诊疗机构质控指标6项,质控合格率为97.9%,性病诊疗机构和仅开展梅毒筛查的非性病诊疗机构,质控总体得分分别从2017年的87.5分和86.7分,提高到2019年的88.5分和95.2分,但部分机构存在实验室室内质控合格率、人员理论考试合格率、疑似梅毒患者成功转介率及实验室检测项目不达标的情况,不同类型医疗机构中,疾控/皮防的质控得分最高,其次是综合医院,私立机构和乡镇卫生院得分相对较低。结论云南省医疗卫生机构性病防治工作质量总体良好,但仍需加强实验室能力建设、人员培训以及疑似梅毒患者的追踪管理等工作,质量控制工作重心可以向基层医疗卫生机构适当倾斜。     

General medical care and the education of internists in university hospitals. An evaluation of the teaching hospital general medicine group practice program

Fifteen general internal medicine group practices in university teaching hospitals were studied to evaluate their primary care services and education. Data were collected over 9 months from physicians, patients, and medical records, and by observation. All institutions had closed their general medical clinics. Many patients being treated in group practices were very sick; 57% had hypertension; 21% were diabetic; and 45% could not work. Most were satisfied with their care. Care for acute problems from a health care provider in the practice was available quickly; regular physicians were harder to see. House staff and faculty spent little time in the practices. Few practices used teams; most used traditional attending and house staff models. Practice physicians could not easily determine when patients were seen in the institution's emergency department or were hospitalized. Quality of care standards were not uniformly met. Finally, the structure of academic centers appeared to inhibit the practices' performance, suggesting a need for further appraisal of relationships between university hospitals and their ambulatory care units.     

Health benefits of Practical Approach to Lung health (PAL) experienced by patients with chronic respiratory diseases – Results from PAL pilot project in primary health care setting in Kerala,India

Government of Kerala state had implemented a pilot project of the World Health Organisation recommended Practical Approach to Lung health (PAL) strategy, with an intention to improve the quality of diagnosis, treatment and management of common chronic respiratory diseases (CRD) in primary health care settings. The current study was done as a part of implementation of PAL pilot project and was intended to assess the benefits of PAL for the individual patients with CRDs accessing services from primary health institutions. Exit interviews were conducted at the baseline and for impact assessment after six months of pilot project by interviewing patients with CRD attending primary health institutions implementing PAL and control institutions. A total of 94 and 100 CRD patients were interviewed at baseline and after six months in the PAL implementing institutions, and 88 and 96 CRD patients were interviewed at the control institutions. Reduction in number of medical consultation, hospital admissions and exacerbations among CRD patients were 5.03, 3.20 and 2.24 times higher in PAL implementing institutions as compared to the control institutions. PAL pilot project in India implemented in an area with a reasonably sound primary health care system has proved that it might be beneficial for the patients with CRD as it reduces frequency of exacerbations, hospital visits and frequency of medical consultations.     

Association Between Prior Experiences of Discrimination and Patients’ Attitudes Towards Health Care Providers Collecting Information About Race and Ethnicity

BACKGROUND  Previously, we reported a high level of comfort among Californians for collecting race/ethnicity information by health care providers (HCPs). However, minorities were less comfortable providing race/ethnicity information and were more worried than non-Hispanic whites about the potential misuse of this information. OBJECTIVE  To determine if perceived experiences of discrimination (both in general and in medical care) were associated with comfort providing race/ethnicity information, and conversely, to worry about providing the information. DESIGN AND PARTICIPANTS  Telephone survey of 480 Californians, including 101 whites, 98 Asians, 173 Hispanics, 82 blacks, and 26 multiracial individuals. MEASUREMENTS  Comfort level giving HCPs information about race/ethnicity (measured on a 1–10 scale, with text anchors of “very uncomfortable” at 1 and “very comfortable” at 10), worry that the information could be used to discriminate against patients, and worry that the information could be used to find undocumented immigrants. Worry was measured using a four-point Likert scale- not worried at all, a little worried, somewhat worried, and very worried. Respondents were also asked about perceived discrimination in general and perceived discrimination in medical care. RESULTS  Compared to whites, Hispanics (Beta-coefficient (BC) = -1.16, SE = 0.51) and Mandarin/Cantonese-speaking Asians (BC = -1.40, SE = 0.65) reported significantly less comfort giving HCPs information about their race/ethnicity, while blacks (BC = 0.70, SE = 0.16), Hispanics (BC = 0.91, SE = 0.18), and multiracial individuals (BC = 0.63, SE = 0.24) were significantly more worried that race/ethnicity information could be used to discriminate against them. Adjusting for perceived experiences of discrimination in general and in medical care partially explained the higher discomfort and worry among minorities. CONCLUSIONS  Perceived experiences of discrimination are associated with greater discomfort and worry about providing race/ethnicity data. Health care institutions should consider how they can address the public’s concerns about possible misuses of data.     

RX FOR HEALTH CARE COSTS:

The literature on addictions treatment cost offsets suggests that resolving addictive disorders in the general medical setting will drive down the demand for health care, promote more efficient use of care by both patients and their families, and preserve scarce resources that can be deployed more wisely elsewhere. The demand to reduce waste and trim health care expenditures challenges the historic gulf between general medical practice and the management of addictive behaviors. An example of an addiction treatment technology developed in medical settings for use by medical personnel, brief intervention , is reviewed, with reference to its cost-saving potential under health care reform.