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Purpose of review Transgender individuals experience unique health disparities but are the subject of little focused health research. This manuscript reviews current literature on transgender medical and mental health outcomes and proposes research priorities to address knowledge gaps. Recent findings Published research in transgender healthcare consists primarily of case reports, retrospective and crosssectional studies, involving largely European settings. Challenges to US-based transgender health research include a diverse population where no single center has sufficient patient base to conduct clinical research with statistical rigor. Treatment regimens are heterogeneous and warrant study for best practices. Current research suggests increased mortality and depression in transgender individuals not receiving optimal care, and possibly a modest increase in cardiovascular risk related to hormone therapy. Current evidence does not support concerns for hormone-related malignancy risk. Summary The priorities for transgender medical outcomes research should be to determine health disparities and comorbid health conditions over the life span, along with the effects of mental health, medical, and surgical interventions on morbidity and mortality. Specific outcomes of interest based on frequency in the literature, potential severity of outcome, and patient-centered interest, include affective disorders, cardiovascular disease, malignancies, fertility, and time dose-related responses of specific interventions.

Purpose: To determine the difference of Body Mass Index (BMI), the prevalence of overweight and obesity, and their predictors among residents of different urbanization levels in China. Methods: A stratified, multistage, random cluster sampling method was used to select a representative sample aged 18-60 years in metropolitan, prefecture, and rural areas in 4 provinces and Beijing City in China. A total of 6,159 residents were interviewed. Multiple logistic regression was used to evaluate the association between urbanization levels and the prevalence of overweight/obesity adjusted for sociodemographic characteristics and lifestyle factors. Findings: The prevalence of overweight and obesity was 21.0% and 2.5%, respectively. Compared to metropolitan residents (BMI = 22.76 ± 3.20 kg/m2), rural and prefecture residents had a higher BMI, 23.17 ± 3.49 kg/m2 (P <001) and 23.06 ± 3.31 kg/m2 (P =.004), respectively. Multiple logistic regression showed that, compared to the rural residents, those in prefecture and metropolitan areas were less likely to be overweight and obese (OR = 0.80 [95% CI: 0.68-0.94] and OR = 0.68 [95% CI: 0.57-0.80], respectively). The prevalence of overweight/obesity was higher in males (OR = 1.68 [95% CI: 1.43-1.97]) and patients with noncommunicable chronic diseases (NCD; OR = 2.50 [95% CI: 2.16-2.89]). Less frequency of physical activity was associated with a higher prevalence of overweight/obesity (OR: 0.85, [95% CI: 0.74, 0.97]). Conclusions: The rural population had an increased prevalence of overweight/obesity compared to both the prefecture and metropolitan populations. Male gender, older age, and NCD were positively associated with the prevalence of overweight/obesity. Policies are urgently needed to combat the overweight and obesity challenge in rural China.

The purpose of this study was to develop an Attribution of Racial/Ethnic Health Disparities (AREHD) scale. A convenience sample of undergraduate college students (n = 423) at four Midwestern universities was recruited to respond to the survey. A pilot test with undergraduate students (n = 23) found the survey had good acceptability and readability level (SMOG = 11th grade). Using exploratory factor analysis we found the two a priori subscales were confirmed: individual responsibility and social determinants. Internal reliabilities of the subscales were: individual responsibility (alpha = 0.87) and social determinants (alpha = 0.90). Test-retest stability reliabilities were: individual responsibility (r = 0.72) and social determinants (r = 0.69). The AREHD subscales are satisfactory for assessing college student's AREHD.

Purpose: The purposes of this study were to translate current knowledge regarding cardiovascular risk factors, screening, and prevention to a disparate population of women and to ascertain the cardiovascular health status and risk factors in a sample of minority and underserved Appalachian women.Data sources: Demographic data were collected from a voluntary sample of women from a disparate population living in Appalachian Tennessee. A coronary risk profile recorded family health history, personal health history, and lifestyle habits affecting risk for cardiovascular disease. Physiologic measurements included body mass index, blood pressure, fasting glucose, cholesterol levels, ankle brachial index, and carotid artery stenosis.Conclusions: Women in Appalachia Tennessee from a disparate population have high risks for heart disease and stroke. This is a critical time to address any modifiable risk factors and aggressively treat underlying cardiovascular diseases such as hypertension and hypercholesterolemia.Implications for practice: Nurse practitioners (NPs) often provide primary care to women who may not be aware of their cardiovascular risks or actual disease. NPs can ensure that their practice incorporates primary and secondary cardiovascular prevention through screening, individual health education, and aggressive evidence-based treatment plans for women.

Indiana University-Purdue University Indianapolis (IUPUI) / Hispanic patients receive disparate pain care compared to non-Hispanic White (NHW) patients. Healthcare providers’ ethnic bias may be one reason for pain disparities. This investigation sought to determine the influence of Hispanic ethnicity and ethnic bias on chronic pain management decisions. During an online experiment, 97 medical students made pain assessment and opioid treatment decisions for Hispanic and NHW virtual human patients with chronic pain. They also completed explicit and implicit measures of ethnic bias. Individual-level analyses found that 31% and 36% of participants demonstrated large effect sizes (dz>.50), indicating that patient ethnicity strongly influenced their pain assessment and opioid treatment decisions, respectively. At the group level of analysis, participants’ decisions did not differ significantly between NHW and Hispanic patients (all p values >.05). Participants did not report significant explicit ethnic bias (t[96]=1.88, p=.06; dz=.19; Hispanic mean rating=77.6[SD=18.7]; NHW mean rating=75.2[SD=19.4]) but demonstrated a small-to-moderate implicit preference for NHWs relative to Hispanics (Mean=.31[SD=.41]). Patient ethnicity and implicit ethnic bias had an interactive effect on opioid treatment decisions (F[1, 95]=5.15, p<.05, generalized eta squared =.02); however, the direction of the effect was not as hypothesized. Participants with higher implicit ethnic bias gave significantly higher opioid ratings to Hispanics relative to NHWs (p=.05), whereas participants with lower bias gave marginally higher opioid ratings to NHWs relative to Hispanics (p=.20). Participants with higher vs. lower implicit ethnic bias differed only in their treatment ratings for NHW patients, such that participants with lower bias gave significantly higher opioid ratings to NHW patients than did participants with higher bias (p<.05). This investigation found that approximately one-third of participants made significantly different chronic pain management decisions for Hispanic vs. NHW patients. Participants’ implicit ethnic bias interacted with their opioid treatment decisions but not as expected. Future investigations should measure healthcare providers’ stereotypes about Hispanic patients with pain as this may better predict their pain decisions.

Indiana University-Purdue University Indianapolis (IUPUI) / Chronic pain is a common and costly health condition for children. Previous studies have documented racial and gender disparities in pain care for adults, with women and racial minorities receiving poorer pain assessment and treatment. Providers contribute to these disparities when their pain-related decision-making systematically varies across patient demographic groups. Little is known about racial and gender disparities in children with chronic pain, or the extent to which providers contribute to these disparities. In a sample of 129 medical students (henceforth referred to as ‘providers’), Virtual Human (VH) methodology and a pain-related version of the Implicit Association Test (IAT) were used to assess the effects of patient race/gender and provider implicit racial/gender attitudes on providers’ pain assessment and treatment decisions for children with chronic pain. Findings indicated that, in the context of abdominal pain, providers rated Black patients as more distressed (mean difference [MD]=2.33, p<.01, SE=.71, 95% CI=.92, 3.73) and as experiencing more pain-related interference in daily activities (MD=3.14, p<.01, SE=.76, 95% CI=1.63, 4.64) compared to White patients. Providers were also more likely to recommended opioids for Black patients’ pain compared to White patients (MD=2.41, p<.01, SE=.58, 95% CI=1.05, 3.76). Female patients were also perceived to be more distressed by their pain (MD=2.14, p<.01, SE=.79, 95% CI=.58, 3.70), however they there were no differences in treatment recommendations based on patient gender (all ps>.05). The sample reported implicit attitudes that men and Black Americans were more pain-tolerant than their demographic counterparts; however, pain assessment and treatment decisions were not related to these implicit attitudes. This study represents a critical step in research on pain-related disparities in pediatric pain. Future studies are needed to further elucidate specific paths through which the pain experience and consequent treatment differ across racial and gender groups.

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Distributive justice is a bioethical principle concerned with the fair distribution of resources and benefits in society. In the context of orthopaedic surgery management, distributive justice is an important consideration in ensuring that all patients have equal access to the resources and care in the treatment of their injuries. The literature well documents demographic and socioeconomic factors in the allocation of elective orthopaedic surgeries, but unfortunately a similar analysis is lacking when it comes to orthopaedic trauma surgeries. This study examines fundamental philosophical perspectives that underly healthcare delivery specifically pertaining to orthopaedic trauma. In doing so, the influence of race, socioeconomic status, insurance status and other factors on access to care and allocation of resources are described. Findings for various orthopaedic trauma surgery cases suggest decreased allotment to those of black race, lower socioeconomic, educational, and non-insurance status. Although the reason is multifactorial and complex, I suggest a shift in focus to the equity and fair distribution of surgical resources by considering the role of population health, understanding multidisciplinary interactions, improving research methodology, and community partnership. / Urban Bioethics