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      Integrating the Health of Socially Vulnerable Populations into Residency Programs.

      , , , ,  
      Canadian Journal of General Internal Medicine
      Dougmar Publishing Group, Inc.

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          Abstract

          In Canada, growing disparities in health disproportionally affect socially vulnerable populations. The Royal College of Physician and Surgeons of Canada has attempted to incorporate health equity for socially vulnerable populations within the competency training objectives set forth for internal medicine (IM) residents. However, trainee exposure to these populations beyond inpatient contact in tertiary care hospitals has not traditionally been a requirement of IM training. At the University of Calgary, we have developed a four-week clinical rotation that aims to expose residents to social determinants for socially vulnerable populations. To our knowledge this is the first clinical rotation within an IM program in Canada dedicated to exposing and educating residents on the broader care of socially vulnerable populations. Our goal is to train internists and subspecialists to gain the empathy, skills, and knowledge to better provide care for socially vulnerable populations and to advocate for health equity, throughout their careers. Résumé Au Canada, les disparités croissantes de santé affectent de manière disproportionnée les populations socialement vulnérables. Le Collège royal des médecins et chirurgiens du Canada a tenté d'intégrer l'équité en santé pour les populations socialement vulnérables dans les objectifs de formation aux compétences énoncés pour les résidents en médecine interne (GI). Toutefois, l'exposition des stagiaires à ces populations au-delà des contacts avec les patients hospitalisés dans les hôpitaux de soins tertiaires n'a pas toujours été une exigence de la formation en GI. À l'Université de Calgary, nous avons mis au point une rotation clinique de quatre semaines qui vise à exposer les résidents aux déterminants sociaux des populations socialement vulnérables. À notre connaissance, il s'agit de la première rotation clinique au sein d'un programme de GI au Canada consacré à l'exposition et à l'éducation des résidents sur les soins plus larges des populations socialement vulnérables. Notre objectif est de former des internistes et des sous-spécialités pour acquérir l'empathie, les compétences et les connaissances pour mieux fournir des soins aux populations socialement vulnérables et pour plaider en faveur de l'équité en santé, tout au long de leur carrière.    

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          Most cited references23

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          Family rejection as a predictor of negative health outcomes in white and Latino lesbian, gay, and bisexual young adults.

          We examined specific family rejecting reactions to sexual orientation and gender expression during adolescence as predictors of current health problems in a sample of lesbian, gay, and bisexual young adults. On the basis of previously collected in-depth interviews, we developed quantitative scales to assess retrospectively in young adults the frequency of parental and caregiver reactions to a lesbian, gay, or bisexual sexual orientation during adolescence. Our survey instrument also included measures of 9 negative health indicators, including mental health, substance abuse, and sexual risk. The survey was administered to a sample of 224 white and Latino self-identified lesbian, gay, and bisexual young adults, aged 21 to 25, recruited through diverse venues and organizations. Participants completed self-report questionnaires by using either computer-assisted or pencil-and-paper surveys. Higher rates of family rejection were significantly associated with poorer health outcomes. On the basis of odds ratios, lesbian, gay, and bisexual young adults who reported higher levels of family rejection during adolescence were 8.4 times more likely to report having attempted suicide, 5.9 times more likely to report high levels of depression, 3.4 times more likely to use illegal drugs, and 3.4 times more likely to report having engaged in unprotected sexual intercourse compared with peers from families that reported no or low levels of family rejection. Latino men reported the highest number of negative family reactions to their sexual orientation in adolescence. This study establishes a clear link between specific parental and caregiver rejecting behaviors and negative health problems in young lesbian, gay, and bisexual adults. Providers who serve this population should assess and help educate families about the impact of rejecting behaviors. Counseling families, providing anticipatory guidance, and referring families for counseling and support can help make a critical difference in helping decrease risk and increasing well-being for lesbian, gay, and bisexual youth.
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            Association between household food insecurity and annual health care costs.

            Household food insecurity, a measure of income-related problems of food access, is growing in Canada and is tightly linked to poorer health status. We examined the association between household food insecurity status and annual health care costs.
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              The health and housing in transition study: a longitudinal study of the health of homeless and vulnerably housed adults in three Canadian cities.

              While substantial research has demonstrated the poor health status of homeless populations, the health status of vulnerably housed individuals is largely unknown. Furthermore, few longitudinal studies have assessed the impact of housing transitions on health. The health and housing in transition (HHiT) study is a prospective cohort study that aims to track the health and housing status of a representative sample of homeless and vulnerably housed single adults in three Canadian cities (Toronto, Ottawa, and Vancouver). This paper discusses the HHiT study methodological recruitment strategies and follow-up procedures, including a discussion of the limitations and challenges experienced to date. Participants (n = 1,192) were randomly selected at shelters, meal programmes, community health centres, drop-in centres, rooming houses, and single-room occupancy hotels from January to December 2009 and are being re-interviewed every 12 months for a 2-year period. At baseline, over 85% of participants reported having at least one chronic health condition, and over 50% reported being diagnosed with a mental health problem. Our findings suggest that, regardless of housing status, participants had extremely poor overall health.
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                Author and article information

                Journal
                Canadian Journal of General Internal Medicine
                Can Journ Gen Int Med
                Dougmar Publishing Group, Inc.
                2369-1778
                1911-1606
                March 05 2018
                March 05 2018
                : 13
                : 1
                Article
                10.22374/cjgim.v13i1.225
                004916c7-f3b2-4653-b7b9-2d43eec18674
                © 2018

                Copyright of articles published in all DPG titles is retained by the author. The author grants DPG the rights to publish the article and identify itself as the original publisher. The author grants DPG exclusive commercial rights to the article. The author grants any non-commercial third party the rights to use the article freely provided original author(s) and citation details are cited. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc/4.0/


                General medicine,Geriatric medicine,Neurology,Internal medicine
                General medicine, Geriatric medicine, Neurology, Internal medicine

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