Articles: health.
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Since 2020, there has been a significant cultural and political backlash in the USA to growing acceptance of gender diversity and gender-affirming care. Legislative attacks, particularly targeting gender-affirming care access for transgender and gender diverse youth, have occurred in a media environment rife with misinformation and disinformation. Even in states where a ban is not enacted, we have seen significant harm caused by such misinformation and disinformation, to transgender and gender diverse patients, their families, and clinicians who provide this important and much needed care, in the form of clinic closures and disruption of services. In this hostile sociopolitical environment, we present strategies for health care organizations and workers to continue to provide this lifesaving care thoughtfully, to safeguard the protections currently in place, and to continue to advocate for patients, families, and health care staff.
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Physicians within the family medicine workforce are the most diverse compared to other medical specialties in both primarily clinical and academic settings. Family physicians also provide care to the most diverse patients and communities across the United States. ⋯ Yet many practicing and teaching physicians are unaware of their colleagues' scholarly DEIA work, which aims to elucidate inequities and barriers to optimal care and, importantly, to educate on ways physicians and learners can recognize and address specific needs of patients and communities marginalized by health care policies and practices. In collaboration with editors from several family medicine journals, the authors move beyond the traditional editorial space to share recent practice-changing and innovative articles, adding voice and momentum to improve DEIA efforts in all spaces where the practice and teaching of family medicine exists.
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Behavioral health care access is inadequate and new primary care-based strategies are needed to meet the rising demand. Behavioral health integration (BHI) models, such as collaborative care (CoCM) or the primary care behavioral health (PCBH) model, are often touted as actionable and sustainable solutions. The intent of such models is to bring behavioral health expertise into medical settings with the aims of improving outcomes, increasing treatment capacity, and reducing stigma. ⋯ Recent encouraging developments include technical assistance opportunities for MBC implementation and emerging payment models that emphasize MBC. However, concerns remain surrounding the limitations of existing MBC billing codes. Ultimately, with continued advocacy and thoughtful policy decision-making, MBC has the potential to be a solution to the current behavioral health crisis.
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Nationally representative studies have shown that lesbian, gay, and bisexual adults have higher levels of substance use than heterosexual adults. In the military, substance use is often associated with adverse mental health outcomes and is often comorbid with other mental health conditions and adverse or harmful behaviors. Few military studies to date have comprehensively examined the relationship between sexual orientation, mental health, and substance use. ⋯ Substance use in the military was more likely among sexual minority individuals compared to heterosexual individuals. These findings reflect the patterns of substance use seen in the general population. Increased levels of psychological distress were associated with both the lesbian, gay, and bisexual population in this study and self-reported substance use behaviors. Further investigation of health disparities by sexual orientation may inform more efficacious treatment and prevention programs.