Background: Although gender plays an important role in health, most healthcare providers lack knowledge in providing gender-sensitive care. Offering gender-sensitivity training for healthcare providers can help to address gender-based health inequalities. Method: A mixed-methods systematic review of gender-sensitivity training programmes or interventions for healthcare providers was undertaken to assess their outcomes and to document areas for future research. Comprehensive searches of seven international databases were conducted for peer-reviewed literature published between 1998 and 2018. Eligible studies included at least one outcome related to gender-sensitivity training for healthcare providers. Results: Twenty-nine studies met the inclusion criteria. Fourteen studies focused on gender-sensitivity in reducing gender bias towards men and women, and 15 studies focused on addressing the needs of lesbian, gay, bisexual and transgender (LGBT) patients. Thirty-seven percent of studies showed a significant improvement in gender-related knowledge, attitudes or practice after the training. Multiple training methods were used to teach gender-sensitive care. Common content of the training included learning sex/gender terminology, understanding gender issues and inequalities in health, stigma and discrimination and communication skills. The duration and frequency of interventions ranged considerably. Sex differences in training outcomes also occurred among the learners. Conclusion: Review findings highlight that although gender-sensitivity training for healthcare providers is increasing, there is insufficient evidence to determine its effectiveness. Additional, more rigorously designed studies are needed to assess the long-term implications on learner behaviours and practices, especially across a wide variety of healthcare providers.
The aim of this study was to examine the association between grades of neck pain severity and health-related quality of life (HRQoL), using a populationbased, cross-sectional mailed survey. The literature suggests that physical and mental HRQoL is worse for individuals with neck pain compared to those without neck pain. However, the strength of the association varies across studies. Discrepancies in study results may be attributed to the use of different definitions and measures of neck pain and differences in the selection of covariates used as control variables in the analyses. The Saskatchewan Health and Back Pain Survey was mailed to 2,184 randomly selected Saskatchewan adults of whom 1,131 returned the questionnaire. Neck pain was measured with the Chronic Pain Questionnaire and categorized into four increasing grades of severity. We measured HRQoL with the SF-36 Health Survey and computed the physical and mental component summary scores. We built separate multiple linear regression models to examine the association between grades of neck pain and physical and mental summary scores while controlling for sociodemographic, general health and comorbidity covariates. Our crude analysis suggests that a gradient exists between the severity of neck pain and HRQoL. Compared to individuals without neck pain, those with Grades III-IV neck pain have significantly lower physical (mean difference = -13.9/100; 95% CI = -16.4, -11.3) and mental (mean difference = -10.8/100; 95% CI = -13.6, -8.1) HRQoL. Controlling for covariates greatly reduced the strength of association between neck pain and physical HRQoL and accounted for the observed association between neck pain and mental HRQoL. In the comorbidity model, the strength of association between Grades III-IV neck pain and PCS decreased by more than 50% (mean difference = -4.5/ 100; 95% CI = -6.9, -2.0). In the final PCS model, Grades III-IV neck pain coefficients changed only slightly from the comorbidity model (mean difference = -4.4/ 100; 95% CI = -6.9, -1.9). This suggests that comorbid conditions account for most of the association between neck pain and PCS score. It was concluded that prevalent neck pain is weakly associated with physical HRQoL, and that it is not associated with mental HRQoL. Our crosssectional analysis suggests that most of the observed association between prevalent neck pain and HRQoL is attributable to comorbidities.
Background The world is faced with a chronic shortage of health workers, and the World Health Organization (WHO) has estimated a global shortage of 7.2 million health workers resulting in large gaps in service provision for people with disability. The magnitude of the unmet needs, especially within musculoskeletal conditions, is not well established as global data on health work resources are scarce. Methods We conducted an international, cross-sectional survey of all 193 United Nation member countries and seven dependencies to describe the global chiropractic workforce in terms of the availability (numbers and where they are practising), quality (education and licensing), accessibility (entry and reimbursement), and acceptability (scope of practice and legal rights). An electronic survey was issued to contact persons of constituent member associations of the World Federation of Chiropractic (WFC). In addition, data were collected from government websites, personal communication and internet searches. Data were analysed using descriptive statistics. Worldwide density maps of the distribution of numbers of chiropractors and providers of chiropractic education were graphically presented. Results Information was available from 90 countries in which at least one chiropractor was present. The total number of chiropractors worldwide was 103,469. The number of chiropractors per country ranged from 1 to 77,000 (median = 10; IQR = [4–113]). Chiropractic education was offered in 48 institutions in 19 countries. Direct access to chiropractic services was available in 81 (90%) countries, and services were partially or fully covered by government and/or private health schemes in 46 (51.1%) countries. The practice of chiropractic was legally recognized in 68 (75.6%) of the 90 countries. It was explicitly illegal in 12 (13.3%) countries. Conclusion We have provided information about the global chiropractic workforce. The profession is represented in 90 countries, but the distribution of chiropractors and chiropractic educational institutions, and governing legislations and regulations largely favour high-income countries. There is a large under-representation in low- and middle-income countries in terms of provision of services, education and legislative and regulatory frameworks, and the available data from these countries are limited. Electronic supplementary material The online version of this article (10.1186/s12998-019-0255-x) contains supplementary material, which is available to authorized users.
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