Transphobia rather than education predicts provider knowledge of transgender health care

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/148342/1/medu13796.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/148342/2/medu13796_am.pd

Optimal selection of streetlighting projects in the City of Jerusalem

This study deals with the development and application of a methodology which permits optimal planning of an urban streetlighting system. It presents for the first time -- to the best of the authors' knowledge -- a procedure for the quantitative estimation of the utility accruing from street-lighting. The multivariable utility function divided by the installation cost of lighting for each street yields an efficiency coefficient for a given lighting project. The rank order of these coefficients, listed in descending order, shows the marginal utility of each project realized. An optimization model based on an integer programming algorithm was employed because it permits periodical (for example, annual) selection of a set of indivisible projects to be realized during a given period so as to derive maximum economic and social utility, subject to budgetary and technological constraints. The first part of the methodological derivation yields the utility function of the lighting system for each street. The components of the function, some of which represent subjective assessments, were identified by the Delphi method, which permits derivation of subjective values for groups of interviewees whose assessments may reasonably be assumed to be crucial in determining the relative values of the objectives used in the utility function. The optimization process was carried out using the IBM MPS X (an integer programming algorithm). The selection process was extended and deepened so as to render it sensitive to benefit from economies of scale and external economies. The conventional practice, whereby residents have no say in the planning of the lighting system in their city, was abandoned. Residents' value judgements concerning the relative importance of the objectives to be served by the lighting system were incorporated into the planning process.

Discrimination and Delayed Health Care Among Transgender Women and Men: Implications for Improving Medical Education and Health Care Delivery.

BACKGROUND: The transgender community experiences health care discrimination and approximately 1 in 4 transgender people were denied equal treatment in health care settings. Discrimination is one of the many factors significantly associated with health care utilization and delayed care. OBJECTIVES: We assessed factors associated with delayed medical care due to discrimination among transgender patients, and evaluated the relationship between perceived provider knowledge and delayed care using Anderson\u27s behavioral model of health services utilization. RESEARCH DESIGN: Multivariable logistic regression analysis was used to test whether predisposing, enabling, and health system factors were associated with delaying needed care for transgender women and transgender men. SUBJECTS: A sample of 3486 transgender participants who took part in the National Transgender Discrimination Survey in 2008 and 2009. MEASURES: Predisposing, enabling, and health system environment factors, and delayed needed health care. RESULTS: Overall, 30.8% of transgender participants delayed or did not seek needed health care due to discrimination. Respondents who had to teach health care providers about transgender people were 4 times more likely to delay needed health care due to discrimination. CONCLUSIONS: Transgender patients who need to teach their providers about transgender people are significantly more likely to postpone or not seek needed care. Systemic changes in provider education and training, along with health care system adaptations to ensure appropriate, safe, and respectful care, are necessary to close the knowledge and treatment gaps and prevent delayed care with its ensuing long-term health implications

Discrimination and Delayed Health Care Among Transgender Women and Men: Implications for Improving Medical Education and Health Care Delivery

BACKGROUND: The transgender community experiences health care discrimination and approximately 1 in 4 transgender people were denied equal treatment in health care settings. Discrimination is one of the many factors significantly associated with health care utilization and delayed care. OBJECTIVES: We assessed factors associated with delayed medical care due to discrimination among transgender patients, and evaluated the relationship between perceived provider knowledge and delayed care using Anderson\u27s behavioral model of health services utilization. RESEARCH DESIGN: Multivariable logistic regression analysis was used to test whether predisposing, enabling, and health system factors were associated with delaying needed care for transgender women and transgender men. SUBJECTS: A sample of 3486 transgender participants who took part in the National Transgender Discrimination Survey in 2008 and 2009. MEASURES: Predisposing, enabling, and health system environment factors, and delayed needed health care. RESULTS: Overall, 30.8% of transgender participants delayed or did not seek needed health care due to discrimination. Respondents who had to teach health care providers about transgender people were 4 times more likely to delay needed health care due to discrimination. CONCLUSIONS: Transgender patients who need to teach their providers about transgender people are significantly more likely to postpone or not seek needed care. Systemic changes in provider education and training, along with health care system adaptations to ensure appropriate, safe, and respectful care, are necessary to close the knowledge and treatment gaps and prevent delayed care with its ensuing long-term health implications

Potentilla recta L. (BR0000010927274)

Belgium Herbarium image of Meise Botanic Garden

Primary care clinicians\u27 willingness to care for transgender patients

Transgender patients report negative experiences in health care settings, but little is known about clinicians\u27 willingness to see transgender patients. We surveyed 308 primary care clinicians in an integrated Midwest health system and 53% responded. Most respondents were willing to provide routine care to transgender patients (85.7%) and Papanicolaou (Pap) tests (78.6%) to transgender men. Willingness to provide routine care decreased with age; willingness to provide Pap tests was higher among family physicians, those who had met a transgender person, and those with lower transphobia. Medical education should address professional and personal factors related to caring for the transgender population to increase access

Transphobia Rather Than Education Predicts Provider Knowledge of Transgender Health Care

PURPOSE: Transgender and gender diverse (TGD) patients face significant hurdles in accessing affirming, knowledgeable care. Lack of provider knowledge presents a substantial barrier to both primary and transition-related care and may deter patients from seeking health care. Little is known about factors that affect provider knowledge or whether exposure to TGD health content during training is associated with improved knowledge among providers. Using the TGD Healthcare Knowledge Scale, this study aimed to determine whether prior education on TGD health predicts clinicians\u27 current knowledge regarding health care for TGD patients. METHODS: An online survey examining exposure to TGD content and knowledge of TGD health care was distributed to all primary care providers in an integrated health care system in the Midwestern United States. Multivariable linear regression was used to predict provider knowledge, controlling for demographics, transphobia and other potential confounders. RESULTS: The response rate was 57.3% (n = 223). The mean knowledge score was 7.41 (SD = 1.31) on a 10-point scale. Almost half (48.4%, n = 108) had no formal education on TGD health care, yet half (49.7%, n = 111) of providers reported previously caring for at least one transgender patient. In regression analysis, provider knowledge of TGD health care was associated with transphobia (β = -0.377, 95% CI = -0.559 to -0.194, p \u3c 0.001), but not with hours of formal education (β = -0.027, 95% CI = -0.077 to 0.023, p = 0.292) or informal education (β = -0.012, 95% CI = -0.033 to 0.009, p = 0.259). CONCLUSIONS: Increasing hours of education related to TGD health care may not be sufficient to improve providers\u27 competence in care for TGD individuals. Transphobia may be a barrier to learning that needs to be addressed. Broader efforts to address transphobia in society in general, and in medical education in particular, may be required to improve the quality of medical care for TGD patients