Barriers to Mental Health Care Identified by Sexual and Gender Minority Individuals in Georgia and South Carolina.

OBJECTIVE: Geographic location can affect access to appropriate, affirming mental health care for sexual and gender minority (SGM) individuals, especially for those living in rural settings. Minimal research has examined barriers to mental health care for SGM communities in the southeastern United States. The objective of this study was to identify and characterize perceived barriers to obtaining mental health care for SGM individuals living in an underserved geographic area. METHODS: Drawing from a health needs survey of SGM communities in Georgia and South Carolina, 62 participants provided qualitative responses describing barriers they encountered to accessing mental health care when needed in the previous year. Four coders used a grounded theory approach to identify themes and summarize the data. RESULTS: Three themes of barriers to care emerged: personal resource barriers, personal intrinsic factors, and healthcare system barriers. Participants described barriers that can inhibit access to mental health care regardless of one's sexual orientation or gender identity, such as finances or lack of knowledge about services, but several of the identified barriers intersect with SGM-related stigma or may be magnified by participants' location in an underserved region of the southeastern United States. CONCLUSIONS: SGM individuals living in Georgia and South Carolina endorsed several barriers to receiving mental health services. Personal resource and intrinsic barriers were the most common, but healthcare system barriers were present as well. Some participants described simultaneously encountering multiple barriers, illustrating that these factors can interact in complex ways to affect SGM individuals' mental health help seeking.

Efficacy of Various Facial Protective Equipment for Infection Control in a Healthcare Setting.

INTRODUCTION: The coronavirus 2019 (COVID-19) pandemic has reinforced the importance of facial protection against droplet transmission of diseases. Healthcare workers wear personal protection equipment (PPE), including face shields and masks. Plastic face shields may have advantages over regular medical masks. Although many designs of face shields exist, there is a paucity of evidence regarding the efficacy of shield designs against droplet transmissions. There is even less published evidence comparing various face shields. Due to the urgency of the pandemic and the health and safety of healthcare workers, we aimed to study the efficacy of various face shields against droplet transmission. METHODS: We simulated droplet transmission via coughing using a heavy-duty chemical spray bottle filled with fluorescein. A standard-adult sized mannequin head was used. The mannequin head wore various face shields and was positioned to face the spray bottle at either a 0°, 45°, or 90° angle. The spray bottle was positioned at and sprayed from 30 centimeters (cm), 60 cm, or 90 cm away from the head. These steps were repeated for all face shields used. Control was a mannequin that wore no PPE. A basic mask was also tested. We collected data for particle count, total area of particle distribution, average particle size, and percentage area covered by particles. We analyzed percent covered by particles using a repeated measures mixed-model regression with Tukey-Kramer pairwise comparison. RESULTS: We used least square means to estimate the percentage area covered by particles. Wearing PPE regardless of the design reduced particle transmission to the mannequin compared to the control. The LCG mask had the lowest square means of 0.06 of all face-shield designs analyzed. Tukey-Kramer pairwise comparison showed that all PPEs had a decrease in particle contamination compared to the control. LCG shield was found to have the least contamination compared to all other masks (P < 0.05). CONCLUSION: Results suggest the importance of wearing a protective covering against droplet transmission. The LCG shield was found to decrease facial contamination by droplets the most of any tested protective equipment.