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Journal of Racial and Ethnic Health... Sep 2023This study aims to understand the healthcare experiences of African American women with a fragile X premutation (PM). PM carriers are at risk for fragile X-associated...
This study aims to understand the healthcare experiences of African American women with a fragile X premutation (PM). PM carriers are at risk for fragile X-associated conditions, including primary ovarian insufficiency (FXPOI) and neuropsychiatric disorders (FXAND). There is no racial/ethnic association with carrying a PM, but African American women historically experience barriers receiving quality healthcare in the USA. Obstacles to care may increase mental health conditions like anxiety and depression. Eight African American women with a PM were interviewed to explore disparities in receiving healthcare and to learn about psychosocial experiences during and after their diagnoses. Interviews were transcribed verbatim and independently coded by two researchers. A deductive-inductive approach was used, followed by thematic analysis to determine prominent themes. The average participant age was 52.3 ± 8.60 years, with a mean age at premutation diagnosis of 31 ± 5.95 years. Seven participants had children with FXS. Themes from interviews included healthcare experiences, family dynamics, and emotional/mental health after their diagnosis. Participants reported concerns about not being taken seriously by providers and mistrust of the medical institutions. Within families, participants reported denial, insensitivity, and isolation. Participants reported a high incidence of anxiety and depression. Both are symptoms of FXAND and stresses of systemic racism and sexism. The reported family dynamics around the news of a genetic diagnosis stand apart from other racial cohorts in fragile X research: interventions like family counseling sessions and inclusive support opportunities from national organizations could ease the impacts of a PM for African American women.
PubMed: 37713166
DOI: 10.1007/s40615-023-01792-2 -
Military Medicine Aug 2023Women Veterans of the Persian Gulf War (GW) expanded the military roles they had filled in previous military eras, with some women engaging in direct combat for the...
INTRODUCTION
Women Veterans of the Persian Gulf War (GW) expanded the military roles they had filled in previous military eras, with some women engaging in direct combat for the first time. Many GW service members, including women, had unique combat exposures to hazardous agents during deployment, which might have contributed to the development of chronic health problems. This study aims to understand the experiences of women GW Veterans (GWVs) as it is related to their military service and subsequent health in order to better inform and improve their clinical care.
MATERIALS AND METHODS
We conducted in-depth interviews with 10 women GWVs to understand their experiences and perspectives about how their military service in the Gulf has impacted their lives and health. We used an integrated approach of content analysis and inductive thematic analysis to interpret interview data.
RESULTS
Besides having many of the same war-related exposures as men, women faced additional challenges in a military that was inadequately prepared to accommodate them, and they felt disadvantaged as women within the military and local culture. After service, participants had emergent physical and mental health concerns, which they described as developing into chronic and complex conditions, affecting their relationships and careers. While seeking care and service connection at Veterans Health Administration (VA), women voiced frustration over claim denials and feeling dismissed. They provided suggestions of how VA services could be improved for women and GWVs. Participants found some nonpharmacological approaches for symptom management and coping strategies to be helpful.
CONCLUSIONS
Women in the GW encountered challenges in military and healthcare systems that were inadequately prepared to address their needs. Women faced chronic health conditions common to GWV and voiced the desire to be understood as a cohort with unique needs. There is an ongoing need to expand services within the VA for women GWVs, particularly involving psychosocial support and management of chronic illness. While the small sample size can limit generalizability, the nature of these in-depth, minimally guided interviews provides a rich narrative of the women GWVs in this geographically diverse sample.
Topics: Male; Humans; Female; Gulf War; Military Personnel; Veterans; Delivery of Health Care; Mental Health; Persian Gulf Syndrome
PubMed: 36179086
DOI: 10.1093/milmed/usac283 -
The Journal of Men's Studies Oct 2023Culture and Perspectives on Sexual Assault Policy was a qualitative, focus-group study conducted at four Canadian universities to gather culturally diverse student...
Culture and Perspectives on Sexual Assault Policy was a qualitative, focus-group study conducted at four Canadian universities to gather culturally diverse student perspectives on university sexual violence or sexual assault policies and services. This article highlights two categories of dialectical tension expressed during several male focus groups. The Wrongful Blame Dialectic involved tension between anxieties about wrongful accusations and opposition to victim-blaming. Perceived risk of wrongful accusations was often linked to racism or ethnocentrism. The Male Victim Denial/Recognition Dialectic involved tension between denial and recognition of male sexual victimization. Male participants felt more vulnerable to wrongful accusation than to sexual violence. They felt more likely to be blamed and disbelieved, whether as respondents or complainants.
PubMed: 37693227
DOI: 10.1177/10608265231182100 -
Omega Feb 2024Perinatal loss is a traumatic experience for parents. This research was conducted to evaluate the experiences and needs of parents after perinatal loss. An...
Perinatal loss is a traumatic experience for parents. This research was conducted to evaluate the experiences and needs of parents after perinatal loss. An interpretative phenomenological study was carried out between January 2021 and July 2022 with 6 parental pairs (12 people in total, 6 mothers and 6 fathers) who experienced a perinatal loss. Participants were reached by snowball sampling method. Data were collected using semi-structured audio recording interviews that were transcribed and analyzed using thematic analysis. The themes of this study were determined as "attributing meaning to loss", "fragmented parenting roles and expectations", "changing relationships", "expectations from healthcare professionals", and "emotional responses". Five sub-themes were created from the emotional responses theme which included. These are sadness and pain, denial, anger, guilt and fear. In the study, it was concluded that the experience of perinatal loss may have negative consequences on the psychological health of the parents. Therefore, specific, professional, adequate nursing support and continuity of support are needed to help parents cope with perinatal losses.
PubMed: 38356333
DOI: 10.1177/00302228241234381 -
Health Care Analysis : HCA : Journal of... Dec 2023Rising health insurance costs and the cost of living crisis are likely leading to an increase in unpaid health insurance bills in many countries. In Switzerland, a...
Rising health insurance costs and the cost of living crisis are likely leading to an increase in unpaid health insurance bills in many countries. In Switzerland, a particularly drastic measure to sanction defaulting insurance payers is employed. Since 2012, Swiss cantons - who have to cover most of the bills of defaulting payers - are allowed by federal law to blacklist them and to restrict their access to medical care to emergencies.In our paper, we briefly describe blacklisting in the context of the Swiss healthcare system before we examine the ethical issues involved in light of what is known about its social and health impacts. We found no evidence that blacklisting serves as an effective way of recovering unpaid health insurance contributions or of strengthening solidarity within the health insurance system. Furthermore, the ambiguous definitions of what constitutes an emergency treatment and the incompatibility of the denial of medical care with the obligation to provide professional assistance complicate the implementation of blacklists and expose care providers to enormous pressure.Therefore, we conclude that blacklists and the (partial) denial of medical care not only pose profound ethical problems but are also unsuitable for fulfilling the purpose for which they were introduced.
Topics: Humans; Insurance, Health; Delivery of Health Care; Costs and Cost Analysis; Switzerland
PubMed: 37498417
DOI: 10.1007/s10728-023-00464-w -
Journal of the Medical Library... Jul 2023For over a millennium, libraries and library workers have advanced the knowledge of human science by building, preserving, and sharing collections and research....
For over a millennium, libraries and library workers have advanced the knowledge of human science by building, preserving, and sharing collections and research. Historically, libraries have also aligned their institutional responsibilities to adhere to and support the values and virtues of oppressive and colonial practices. Library history has shown the mistreatments and denials of information access of marginalized groups. The history of libraries in the health and medical sciences reveals how these institutions and their workers have preserved and circulated research studies perpetuating racial science. This commentary highlights how such institutions shape and contribute to racial science in the field of medicine. By exploring the history of medicine through this lens, we examine how such institutions have been complicit in upholding racial science. We explore historical documents and archival collections that have been collected and preserved, particularly records and data of vulnerable groups, to advance the knowledge and understanding of the human body through the ideology of racial science. We argue that health and medical sciences librarians need to critically interrogate the racism in medical libraries and its history and address how health misinformation is common even in scholarly publications.
Topics: Humans; Archives; Communication; Librarians; Libraries; Libraries, Medical; Medicine; Racism; Diversity, Equity, Inclusion
PubMed: 37483359
DOI: 10.5195/jmla.2023.1728 -
Psychological Trauma : Theory,... Jul 2024Peritraumatic dissociation (PD) and coping strategies (CS) around the time of trauma are significant predictors of acute and long-term posttraumatic symptomatology...
OBJECTIVE
Peritraumatic dissociation (PD) and coping strategies (CS) around the time of trauma are significant predictors of acute and long-term posttraumatic symptomatology (PTS), but it is unclear how they relate to each other. The aim of this study was to examine their association using a nationwide, representative sample following the September 11 attacks in the United States ( = 3,134).
METHOD
We used exploratory and confirmatory network analyses to estimate reliable associations between PD and CS, as well as looking at those variables as predictors of PTS at 2, 6, and 12 months after the attack.
RESULTS
Analyses showed that: (a) PD formed 3 factors (alterations of consciousness, depersonalization, and compartmentalization) distinct from coping strategies; (b) PD related only to some CS; (c) coping through denial had a particularly strong link to alterations of consciousness among adults. Both altered consciousness and denial predicted PTS significantly 2, 6, and 12 months after the attack, with altered consciousness being the stronger predictor (and a better predictor of PTS than other types of PD). For teens, the only significant link between PD and CS was for compartmentalization and substance abuse.
CONCLUSION
PD and CS were related in adults and contributed independently to later PTS. Future research should evaluate longitudinally the interactions between specific types of PD and CS. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Topics: Humans; Adaptation, Psychological; Dissociative Disorders; Female; Adult; Male; Adolescent; Young Adult; Stress Disorders, Post-Traumatic; Middle Aged; September 11 Terrorist Attacks; United States; Denial, Psychological; Coping Skills
PubMed: 36326654
DOI: 10.1037/tra0001403 -
American Journal of Rhinology & Allergy Jul 2024Obtaining insurance approval is a necessary component of healthcare in the United States and denials of these claims have been estimated to result in a loss of 3% to 5%...
BACKGROUND
Obtaining insurance approval is a necessary component of healthcare in the United States and denials of these claims have been estimated to result in a loss of 3% to 5% of revenue.
OBJECTIVE
Examine the trends in insurance denials for rhinological procedures.
METHODS
A retrospective review of deidentified financial data of patients who were treated by participating physicians across 3 institutions from January 1, 2021, to June 30, 2023. The data was queried for rhinological and non-rhinological procedures via CPT codes. Cumulative insurance denials were calculated and stratified by procedure and insurance type. Write-offs were dollar amounts associated with final denials.
RESULTS
A sample of 102,984 procedures and visits revealed a final denial rate between 2.2% and 2.9% across institutions ( = .72). The top three rhinological procedures for final write-offs were: nasal endoscopy (16.24%, $111,836.87), nasal debridement or polypectomy (6.48%, $79,457.51), and destruction of intranasal lesion (2.11%, $56,932.20). The write-off percentage for each procedure was highest among commercial insurance payers as opposed to Medicare or Medicaid.
CONCLUSION
Final denial rates of rhinology procedures ranged between 2% and 3%. Common procedures such as nasal endoscopy and nasal debridement are among the highest written-off procedures. Insurance denials can lead to notable revenue loss. Rhinology practices must continue to remain knowledgeable of the changes and effects of insurance reimbursement on their practice.
Topics: Humans; United States; Retrospective Studies; Otolaryngology; Medicare; Endoscopy; Insurance, Health; Medicaid
PubMed: 38544439
DOI: 10.1177/19458924241242856 -
ANS. Advances in Nursing ScienceThe Ri Majel (Marshallese) migrants of Washington State have endured health inequities and unique laws dictating their access to health care once they arrive to the...
The Ri Majel (Marshallese) migrants of Washington State have endured health inequities and unique laws dictating their access to health care once they arrive to the United States. These health inequities can be seen to be a result of historical trauma and militarization of their islands. The research question was an inquiry regarding access to health care for the Ri Majel in Washington State. We first provide detailed historical data in the background to contextualize our research inquiry. We interviewed 12 people and using manifest content analysis found 2 main themes regarding the health of the Ri Majel: (1) health care access and inequity and (2) historical trauma and embodiment. Health care access was impeded by (1) ongoing effects of radiation, (2) repeated denial of services, (3) lack of health care and insurance, (4) lack of language interpretation during health care visits, and (5) poverty. Historical trauma and embodiment were evidenced by these findings: (1) illness and early mortality; (2) provider lack of knowledge and understanding of the Ri Majel; (3) structural discrimination; (4) feelings of sadness and despair; (5) shyness and humility; and (6) a sense of "cannot/will not" and fatalism. Our findings demonstrate the need to examine structural factors when assessing health inequities and a need to understand and mitigate the effects of historical trauma enacted by structural racism, violence, and colonialism. Strategies to mitigate the embodiment of historical trauma require further investigation.
Topics: Humans; United States; Washington; Health Services Accessibility; Language
PubMed: 36094285
DOI: 10.1097/ANS.0000000000000456 -
The International Journal of... Dec 2023Here the author draws on Theodor Fontane's 1895 novel to consider the links between Freud's paper "The Uncanny" and his elaboration of the trauma of sexuality and the...
Here the author draws on Theodor Fontane's 1895 novel to consider the links between Freud's paper "The Uncanny" and his elaboration of the trauma of sexuality and the après-coup. Conceptualizing trauma in contemporary clinical theory inevitably draws on the theory of the après-coup: the blow that is inflicted on the psyche when the impact of the early event is retranscribed at a later date. The author considers the trauma that Effi experiences, not the catastrophic trauma of death or assault but the deceptive trauma, is disguised as an unparalleled opportunity for Effi. Her story highlights the trauma of sexuality and the incestuous Oedipal dimension. In the cruel economy of incestuous exchange across the generations Effi, in what she experiences as dreary incarceration, is left isolated with her libidinal yearnings. Arguing that Effi as a seventeen-year-old girl is drawn into the incestuous world of her parents and the mother's suitor Innstetten, the author describes how the trauma involving the denial of her sexuality leads to her being ostracized and facing psychic death. Captured in the deferred maternal desire, Effi unknowingly becomes part of a system of incestuous exchange. This is a trauma that is only known in the après-coup.
Topics: Female; Humans; Adolescent; Freudian Theory; Sexual Behavior; Sexuality
PubMed: 38127485
DOI: 10.1080/00207578.2023.2228881