Suchergebnisse

AbstractThe implementation of the virtual water strategy (VWS) transporting invisible water resources through product scheduling faces resistance due to limited reporting and understanding and the lack of motivation analysis for stakeholders. This study builds a semi‐quantitative Hotelling game model under different scenarios to analyse the influence of preference and material benefits on potential acceptance of VWS with policymakers and stakeholders. Equilibrium analyses of the game show that human preference can be as important as real benefits. With preference differences, it is hard to make all stakeholders accept or reject a VWS approach in achieving optimal results for environment and social welfare. To implement a sustainable VWS mode, modifying preferences through propaganda and education can be effective. The natural play of the game with modified preferences will ultimately favour a holistic VWS approach to responsible management. This model supports the effectiveness of game theory in the implementation of a VWS.

Introduction: Substance use disorder (SUD) is damaging to women's health and quality of life. Appropriate treatment can mitigate the effects and health consequences of SUD, yet many woman face access barriers to such treatment. This research seeks to bridge gaps in the current understanding of access to gender-aware care for women Veterans with SUD and to identify ideal treatment program elements for this population. Methods: We interviewed interdisciplinary providers in Los Angeles Veterans Health Administration facilities ( n = 17; psychiatrists, psychologists, social workers, primary care providers, and nurses) and Veterans ( n = 6), identified using purposive snowball sampling, to characterize key components of a non-residential patient-centred SUD treatment program for women Veterans. A semi-structured interview guide elicited current SUD treatment options for women Veterans, barriers to SUD services, and ideal SUD treatment program components. Mutually agreed-on themes were reached using constant comparison. Results: Analyses revealed five key elements of an ideal SUD treatment program for women Veterans: safety (safe and free from harassment in treatment), flexible scheduling (able to accommodate other work and life responsibilities), resourced (no limit to number of visits, staff able to meet needs of comorbidities, on-site child care, etc.), informed providers (providers with access to a comprehensive resource list and aware of easy referral options), and positive (supportive and not punitive). Discussion: The elements identified as necessary for an optimal outpatient SUD treatment program may guide future implementation efforts. SUD programs may not be viable options for women Veterans if they cannot accommodate multidimensional barriers of health care access.

OBJECTIVE: Given the number of veterans who have experienced military sexual trauma (MST) and the impact of these experiences on veteran health, Veterans Health Administration (VHA) providers frequently communicate with patients about these experiences, either as part of VHA's universal MST screening program or more comprehensive clinical care. The purpose of this study was to understand veterans' perceptions of communication related to MST disclosures with VHA providers. METHOD: We conducted qualitative interviews, including a numeric rating question, with 55 veterans whose medical records indicated recent MST-related interactions with VHA providers. The sample included men and women, with and without histories of MST. We analyzed interview transcripts using matrices and identified themes related to satisfaction with communication. RESULTS: Veterans from all groups reported generally high satisfaction with MST-related communication, although men, as a group, reported a much larger range of satisfaction ratings than women. Key provider-related indicators of satisfaction included providers' communication mechanics and non-specific patient-centered skills and characteristics. One patient-related indicator of lower satisfaction—inherent discomfort discussing MST experiences—was particularly represented among men with MST histories. CONCLUSIONS: These data from veteran patients will be reassuring to providers whose concerns about patient reactions to these conversations may inhibit them from raising this important issue. Understanding variables that promote patient satisfaction with MST disclosure communication is critical for promoting sensitive patient/provider interactions about MST. This ultimately can have important downstream effects on veteran health, allowing veterans to forge satisfying relationships with providers and ultimately facilitate recovery from traumatic experiences.

OBJECTIVE: To increase our understanding about the health beliefs of African-American parents and their daughters towards HPV infection and HPV vaccine acceptance. METHODS: The Health Belief Model was used as a guiding framework. Principles of grounded theory, theoretical sampling and constant comparison analysis were used to qualitatively analyze data generated from personal interviews of African-American parents (n=30) and their 12–17-year-old daughters (n=34). RESULTS: Mothers and daughters perceived low susceptibility to HPV infection and perceived the HPV vaccine as beneficial in protecting against genital warts and cervical cancer. Compared to daughters, parents placed particular emphasis on the vaccine's protection against genital warts. A major HPV vaccine acceptance barrier among parents and daughters was the politicization of the HPV vaccine by government figures. In addition, concerns about unknown side effects, safety, and effectiveness of HPV vaccination emerged. Cues to action varied among parents and daughters, and self-efficacy was higher among parents than daughters. CONCLUSION: Understanding the health beliefs that promote HPV vaccine acceptance, while identifying and addressing beliefs that are barriers among parents and daughters, will assist in the development of appropriate HPV vaccine promotion initiatives for African-American parents and daughters.

In this research article, John Hamilton and his co-authors present extensive new research and information gathered since a 2005 publication on the historical evidence of anadromomous fish distribution in the Upper Klamath River watershed. Using historical accounts from early explorers and ethnographers to early-twentieth-century photographs, newspaper accounts, and government reports, the authors provide a more complete record of past salmon migrations. The updated record "substantiate[s] the historical persistence of salmon, their migration characteristics, and the broad population baseline that will be key to future commercial, recreational, and Tribal fisheries in the Klamath River and beyond." During a time when salmon restoration plans are being considered in the region, the historical record can serve as guidance to once again establish diverse and thriving populations.

Objective: The increased life expectancy of people living with HIV has brought about an increase in serodiscordant couples, in which there is risk of HIV transmission. Therefore, interventions that promote sexual health and reduce risk are critical to develop for these couples. Given the disproportionate burden of HIV among populations of color, it is also critical that these interventions are culturally congruent. The EBAN intervention for African American serodiscordant couples recognizes the centrality of culture in shap­ing sexual behaviors and helps couples develop intimacy and positive prevention behaviors. The analytic objective of our study was to examine the knowledge and awareness gained by participants in the intervention.Participants: Participants (n=17) who com­pleted at least half of the eight intervention sessions.Methods: Brief post-implementation semi-structured interviews were conducted be­tween January 1, 2016 and December 31, 2016. Team-based, targeted content analysis focused on knowledge and awareness gains.Results: Participants described learning about sexual health, expanded sexual options, and sexual communication. The "EBAN café," a component that gives couples a menu of options for safer sex behaviors, was particularly popular. Partici­pants also noted the value of learning how to communicate with one another about their sexual health-related concerns and preferences. They appreciated the "cultural stuff" that was infused throughout the ses­sions, including the emphasis on learning from one another as couples.Conclusions: Couples at risk for HIV trans­mission benefit from strengthening skills and knowledge related to healthy sexual­ity. A behavioral intervention that aligns with cultural values and imparts culturally congruent sexual health information appeals to couples who seek ways to enhance their intimacy and sexual options while also re­ducing risk. Ethn Dis. 2020;30(2):269-276; doi:10.18865/ed.30.2.269

Previous research highlights the need to better understand the complex relationships between factors marginalizing Black men who have sex with men and women (MSMW) living with HIV, including HIV stigma, trauma, and hegemonic masculinity. We examined associations between gender role conflict (GRC), trauma, and HIV stigma in Black MSMW living with HIV. 117 participants completed the UCLA Life Adversities Screener (LADS), measures of GRC, and HIV stigma. A multivariate model with age, gender role, and the LADS as predictors of stigma was statistically significant F (4, 110) = 12.81, p < .0001. The LADS was significantly associated with stigma ( b = 11.06, t = 4.17, p < .0001) and moderated by GRC ( b = 12.19, t = 2.25, p < .05); stigma increased significantly at high, but not low GRC. High GRC heightens the relationship between trauma and HIV stigma in Black MSMW. Future research must investigate associations among trauma burden, stigma, and GRC among vulnerable populations.

AIMS: The Veterans Health Administration (VA) promotes evidence-based complementary and integrative health (CIH) therapies as non-pharmacological approaches for chronic pain. We aimed to examine CIH use by gender among veterans with chronic musculoskeletal pain, and variations in gender differences by race/ethnicity and age. METHODS: We conducted secondary analysis of electronic health records provided by all women (n=79,537) and men (n=389,269) veterans age 18–54 with chronic musculoskeletal pain who received VA-provided care between 2010–2013. Using gender-stratified multivariate binary logistic regression, we examined predictors of CIH use, tested a race/ethnicity-by-age interaction term, and conducted pairwise comparisons of predicted probabilities. RESULTS: Among veterans with chronic musculoskeletal pain, more women than men use CIH (36% vs. 26%), with rates ranging from 25%−42% among women and 15%−29% among men, depending on race/ethnicity and age. Among women, patients under age 44 or Hispanic, White, or patients of other race/ethnicities are similarly likely to use CIH; in contrast, Black women, regardless of age, are least likely to use CIH. Among men, White and Black patients, and especially Black men under age 44, are less likely to use CIH than men of Hispanic or other racial/ethnic identities. CONCLUSIONS: Women veteran patients with chronic musculoskeletal pain are more likely than men to use CIH therapies, with variation in CIH use rates by race/ethnicity and age. Tailoring CIH therapy engagement efforts to be sensitive to gender, race/ethnicity, and age could reduce differential CIH use and thereby help to diminish existing health disparities among veterans.