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Purpose – To examine potential sex differences among American Indian and Alaska Native peoples (AIANs) in diabetes prevalence, comorbidities, healthcare utilization, and treatment costs within the Indian Health Services (IHS).

Methodology/Approach – Data were drawn from the IHS Improving Healthcare Delivery Data Project with 437,608 persons in our analytical sample. We described sex and age differences in diabetes, comorbidities, healthcare utilization, and treatment costs among the adults with diabetes. We evaluated the statistical differences between men and women using confidence intervals calculated at the 95% level, with nonoverlapping confidence intervals indicating statistical significance.

Findings – The prevalence of diabetes among females was somewhat higher than that of males (10.82 vs 9.16%, respectively, p < 0.05). Among adults with diabetes, males had statistically higher prevalence of hypertension, cardiovascular disease, and substance use disorders and fewer mental health disorders compared to females. Although males had overall lower average cost of services than females, males had higher utilization for hospital inpatient services than females, and females used more outpatient services.

Research limitations/implications – We are limited to one fiscal year of data and thus cannot predict the influence of healthcare utilization patterns on the overall health of this population. Although a large sample, the findings are only generalizable to the active users of the participating IHS Service Units.

Originality/Value of Paper – This study fills a major gap in our knowledge of sex differences in diabetes prevalence, comorbidities, healthcare utilization, and treatment costs among AIANs. Differences in the comorbidities that characterized the AIAN adult males and females with diabetes in this sample have important implications for mortality and cost of care. Diabetes management that addresses such gender-specific comorbidities, particularly substance use disorders among men and mental health disorders among women, promises to reduce these comorbidities and related complications.

One of the consequences of the democratization of higher education in the United States is the explosion of institutions that have arisen to meet mass demand, and the stratification of those institutions based on the populations they serve. The Ivy League, the “public ivy” flagship state universities, and a cadre of elite small private liberal arts colleges are the basis for the institutionalized myths that inform public perception of what colleges or universities are, even though these schools account for an ever-shrinking fraction of American higher education experiences. The growth in schools serving primarily “nontraditional” students – that is, anything except in-person residential undergraduate liberal arts for at-least-middle-class white eighteen-year-olds with certain test scores coming directly from a college-preparatory high school program – has created a legitimacy paradox within the higher education sector. Democratization has created a need for different types of institutions, but the quest for legitimacy within the higher education sector drives isomorphic change and fuels mission creep, pulling schools away from their original nontraditional constituencies. In order to effectively serve nontraditional students, schools must explore other sectors outside of higher education where there is potential for creating programmatic and/or institutional legitimacy, including the business sector, specific professional sectors, and social/cultural milieu. The intentional development of multiliminality, where institutions draw legitimacy from multiple overlapping environmental sectors simultaneously, offers one response which helps anchor colleges and universities in their missions and helps maintain the access promised by the democratization of higher education.

Self-employment placements can provide an opportunity to experience the real-life world of the entrepreneur within an educational context but their implementation is rare. Here we describe a full sandwich year placement scheme at the University of Huddersfield – the Enterprise Placement Year (EPY). Details of the EPY are provided including academic requirements, application procedures and the learning opportunities provided. There are a growing number of EPY alumni continuing the development of their business idea or starting up a new business in their final year or after graduation and three examples are provided. In addition to increasing numbers of sustaining businesses, there is evidence of improved academic success with a greater than average percentage of ‘good degrees’ obtained. Regular changes to the delivery of the programme have been made as a result of ongoing evaluation. These are reported here with recommendations for other universities considering offering such a programme and suggestions for future research.

Purpose – This chapter reflects on the importance of being reflexive as a socio-legal researcher whilst seeking to address the practicalities, challenges and methods of being reflexive during the research process. The chapter demonstrates ‘doing it’ by reporting on the use of an internal dialogue of the researcher’s feelings and choices during research encounters to reflect on the status of insider knowledge in the interview process. It also charts the unexpected emotional reactions of participants, and in doing so, highlights the challenges of reflection in and on everyday practice as a physiotherapist.

Methodology/Approach – The research reported here was an empirical ethics study using in-depth interviews and the voice-centred relational method as practical means of doing and being reflexive.

Findings – The chapter sheds light on the role of emotion in the research process, the author’s emotional position as researcher and the unexpected emotional reactions of participants.

Originality/Value – The chapter presents a practical method of reflexivity in qualitative research and considers the personal and ethical issues that arise during the research process from the competing perspectives of both insider and researcher. The key lesson learnt is the importance of reflecting on ethically important, and at times uncomfortable, moments in the research process so that other researchers can learn about the ‘how to’ of reflexivity and reflexive writing.

While there are a number of diversity programs centered on advanced science, technology, engineering, and mathematics (STEM) initiatives at colleges and universities throughout the country, the Chicago Area Health and Medical Careers Program (CAHMCP) is unique because of combination of the longevity of the program, its healthcare focus, its affiliation over the years with multiple institutions, and the scale of its impact. CAHMCP is a pipeline program focused on identifying and recruiting students at any point in their academic development, providing educational programming, and supporting them until they are medical professionals.

Over the course of its nearly 40-year history, CAHMCP has recruited participants as early as elementary school and advised them until they were established in their careers. With its combination of personalized mentoring, classroom teaching, and community healthcare engagement, CAHMCP has succeeded in identifying the needs of the community and its young people. Beyond helping students enhance their academic profile over time, CAHMCP helps youth develop as community leaders. Giving back to the community has been a core principle of the program, so as they are matured, CAHMCP alumni have given back to the program as well as influencing broader healthcare and medical education initiatives. This chapter discusses the unique nature of the CAHMCP program and its successes.

This chapter focuses on the orientation towards the medical profession shown by 18-year-old Sardinian students who were asked to write in an essay how they imagined their future. Interest in the medical profession opens up interesting views on what this path may represent for young people given the current general climate of work uncertainty. This chapter focuses on students’ career narratives and, in particular, on their perceived difficulties in accessing medical studies and on the reasons this profession appears so attractive to them. Medicine is, in fact, constructed as a solid, gendered professional path, with a clear vocation career-wise, and it is kept safe from the increasing uncertainty of the labour market. Further, a career in medicine is easy to imagine because there are several medical TV series. Third, the concept of medicine is embedded with positive values and care-centred attitudes, and it therefore ‘sounds good’. The specific ways in which these orientations are gendered are discussed.

The public healthcare system faces challenges and limitations regarding the supply and delivery of healthcare services. The private healthcare system is expensive and only affordable for some. Due to the increasing population, developing countries face a greater degree of demand–supply mismatch. The existing healthcare services in developing countries need to be more sustainable due to high out-of-pocket expenditures and low-income levels. The research design used in this chapter is a case study approach based on qualitative data. The study focuses on two objectives: (1) to have a detailed understanding of the nature of healthcare cooperatives in Spain and their contribution to meeting healthcare requirements; and (2) to make suggestions and recommendations for an improved and sustainable healthcare cooperative for developing countries. Inspired by the healthcare cooperative model of Spain and keeping in mind the ground reality of the lack of healthcare facilities and services accessible and affordable in developing countries, the authors have developed a conceptual framework with the foundation of an insurance cooperative. The Spain Model is sustainable for developing countries as it serves the interest of all income brackets, not leaving the low-income population behind. Concepts like cooperative worker insurance embedded in the model can ensure that the beneficiaries receive timely and good quality health services at an affordable price. It empowers individuals by allowing them to make small amounts of investments as premiums to secure a hopeful future for a healthy life.