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The relationship between minority stress and biological outcomes: A systematic review.

ABSTRACT: Sexual minority (non-heterosexual) individuals experience higher rates of physical health problems. Minority stress has been the primary explanatory model to account for this disparity. The purpose of this study was to identify in published research empirically established relationships between minority stress processes and biological outcomes and identify avenues for future research. The PubMed database was queried with search terms relevant to minority stress and a comprehensive list of physical and biological outcomes. To be included in the analysis, studies had to examine the relationship between minority stress and a biological outcome among sexual minority individuals. Those meeting inclusion criteria were coded for key variables including methodology used, positive and null results, participant characteristics, and specific minority stress processes and biological outcomes considered. In total, 26 studies met inclusion criteria. Studies tested relationships between specific minority stress processes including prejudice, expectations of prejudice, concealment of sexual orientation, and internalized stigma and multiple biological outcomes, such as overall physical health, immune response, HIV specific outcomes, cardiovascular outcomes, metabolic outcomes, cancer related outcomes, and hormonal outcomes. Studies included both analyses that detected this relationship (42% of analyses) and analyses that did not detect this relationship (58%). There is substantial evidence to support the relationship between minority stress and biological outcomes, yet additional research is needed to identify the measurements and outcomes that have the most rigorous and replicable results.

SUBMITTER: Flentje A

PROVIDER: S-EPMC7430236 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:OBJECTIVES:To assess the current evidence on the effect pre-arrest comorbidity has on survival and neurological outcomes following out-of-hospital cardiac arrest (OHCA). DESIGN:Systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. DATA SOURCES:MEDLINE, Ovid Embase, Scopus, CINAHL, Cochrane Library and MedNar were searched from inception to 31 December 2018. ELIGIBILITY CRITERIA:Studies included if they examined the association between prearrest comorbidity and OHCA survival and neurological outcomes in adult or paediatric populations. DATA EXTRACTION AND SYNTHESIS:Data were extracted from individual studies but not pooled due to heterogeneity. Quality of included studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. RESULTS:This review included 29 observational studies. There were high levels of clinical heterogeneity between studies with regards to patient recruitment, inclusion criteria, outcome measures and statistical methods used which ultimately resulted in a high risk of bias. Comorbidities reported across the studies were diverse, with some studies reporting individual comorbidities while others reported comorbidity burden using tools like the Charlson Comorbidity Index. Generally, prearrest comorbidity was associated with both reduced survival and poorer neurological outcomes following OHCA with 79% (74/94) of all reported adjusted results across 23 studies showing effect estimates suggesting lower survival with 42% (40/94) of these being statistically significant. OHCA survival was particularly reduced in patients with a prior history of diabetes (four out of six studies). However, a prearrest history of myocardial infarction appeared to be associated with increased survival in one of four studies. CONCLUSIONS:Prearrest comorbidity is generally associated with unfavourable OHCA outcomes, however differences between individual studies makes comparisons difficult. Due to the clinical and statistical heterogeneity across the studies, no meta-analysis was conducted. Future studies should follow a more standardised approach to investigating the impact of comorbidity on OHCA outcomes. PROSPERO REGISTRATION NUMBER:CRD42018087578.

Project description:BackgroundThe objective of this systematic review of diverse evidence was to examine the relationship between health system governance and workforce outcomes. Particular attention was paid to how governance mechanisms facilitate change in the workforce to ensure the effective use of all health providers.MethodsIn accordance with standard systematic review procedures, the research team independently screened over 4300 abstracts found in database searches, website searches, and bibliographies. Searches were limited to 2001-2012, included only publications from Canada, the United Kingdom, the Netherlands, New Zealand, Australia, and the United States. Peer- reviewed papers and grey literature were considered. Two reviewers independently rated articles on quality and relevance and classified them into themes identified by the team. One hundred and thirteen articles that discussed both workforce and governance were retained and extracted into narrative summary tables for synthesis.ResultsSix types of governance mechanisms emerged from our analysis. Shared governance, Magnet accreditation, and professional development initiatives were all associated with improved outcomes for the health workforce (e.g., decreased turnover, increased job satisfaction, increased empowerment, etc.). Implementation of quality-focused initiatives was associated with apprehension among providers, but opportunities for provider training on these initiatives increased quality and improved work attitudes. Research on reorganization of healthcare delivery suggests that changing to team-based care is accompanied by stress and concerns about role clarity, that outcomes vary for providers in private versus public organizations, and that co-operative clinics are beneficial for physicians. Funding schemes required a supplementary search to achieve adequate depth and coverage. Those findings are reported elsewhere.ConclusionsThe results of the review show that while there are governance mechanisms that consider workforce impacts, it is not to the extent one might expect given the importance of the workforce for improving patient outcomes. Furthermore, to successfully implement governance mechanisms in this domain, there are key strategies recommended to support change and achieve desired outcomes. The most important of these are: to build trust by clearly articulating the organization's goal; considering the workforce through planning, implementation, and evaluation phases; and providing strong leadership.

Project description:BackgroundThe incidence of severe maternal morbidity is increasing in high-income countries as a consequence, in part, of increased obstetric intervention and increasingly complex medical needs of women who become pregnant. Access to emergency obstetric care means that for the majority of women in these countries, an experience of severe maternal morbidity is unlikely to result in loss of life. However, little is known about the subsequent impact on postnatal psychological health resulting in an evidence gap to support provision of appropriate care for these women. There has recently been increasing recognition that childbirth can be a cause of post-traumatic stress disorder (PTSD). The combination of experiencing a life-threatening complication and its management may culminate in psychological trauma. This systematic review examined the association between women's experience of severe maternal morbidity during labour, at the time of giving birth or within the first week following birth, and PTSD and its symptoms.MethodsRelevant literature was identified through multiple databases, including MEDLINE, PsycINFO, EMBASE, CINAHL, British Nursing Index, Web of Science, Cochrane library and the British Library, using predetermined search strategies. The search terms included "post-traumatic stress disorder", "PTSD", "stress disorders, post-traumatic", "maternal morbidity", "pregnancy complications" "puerperal disorders", "obstetric labo(u)r complication", "postpartum h(a)emorrhage", "eclampsia". Studies identified were categorised according to pre-defined inclusion and exclusion criteria. The quality of included studies was assessed using the relevant CASP appraisal tools.ResultsEleven primary studies met review criteria. Evidence of a relationship between severe maternal morbidity and PTSD/PTSD symptoms was inconsistent and findings varied between studies. Nevertheless, there is some evidence that severe pre-eclampsia is a risk factor for PTSD and its symptoms, an association possibly mediated by other factors such as fetal/neonatal condition.ConclusionsDespite the absence of robust evidence regarding the relationship between severe maternal morbidity and PTSD/PTSD symptoms, it is crucially important that clinicians and policy makers are aware of a potential higher risk of PTSD among women who experience severe morbidity. Further studies are now needed to confirm this risk as well as to understand underlying mechanisms in order to minimise the longer term psychiatric impact of severe maternal morbidity.

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The relationship between minority stress and biological outcomes: A systematic review.

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