Re: “Pro-choice missteps drove voters away,” by Joshua Whitfield, Nov. 15 Opinion. In this discourse, we delve into the complex issues surrounding reproductive rights and the role of pro-choice voters. For many pro-choice Catholics, including myself, reproductive rights entail the right to healthcare that may involve an abortion in specific circumstances. When a woman's life is at risk or a fetus is non-viable or has already died within her body, she should be able to make this decision with her doctor alone, as this is not the purview of the government.

Navigating the Controversial Terrain of Reproductive Rights

Pro-choice and the Right to Healthcare

For pro-choice advocates, the right to healthcare is of utmost importance. It encompasses the ability to make decisions regarding one's body and reproductive health. In certain situations, such as when a woman's life is in danger or a fetus is not viable, the choice to have an abortion should be left to the individual in consultation with her doctor. This perspective emphasizes the autonomy and agency of women in matters related to their health.There are valid reasons for this stance. Women often face unique challenges and circumstances that require individualized care. By allowing them to make decisions in collaboration with their doctors, we respect their rights and well-being. It is a matter of personal choice and should not be dictated by external forces.

Florida Surgeon General's Advice and Its Implications

Florida Surgeon General Dr. Joseph Ladapo's advice to stop adding fluoride to the water supply has sparked a debate. While Robert F. Kennedy Jr. contends that fluoride should not be in our water, the actual basis for his concern remains unclear. When the author moved to Hawaii at 15 and had no cavities initially but developed multiple cavities within three years despite no change in oral hygiene, it raises questions about the role of fluoride.This incident highlights the need for evidence-based decisions. Just because there is a claim does not mean it is valid. We must carefully consider the potential impacts and rely on scientific research to make informed choices about such matters.

Minimizing Trump's Victory and Its Consequences

The constant PolitiFact checks on President-elect Donald Trump and the tendency to minimize his victory raise concerns. A strong majority in the country desires a stronger economy, reduced food prices, energy independence, safer neighborhoods, and a secure border. We should give a new administration a fair chance and avoid downplaying their achievements.It is important to recognize the significance of the election and the potential for positive change. By focusing on the issues that matter to the people, we can work towards a better future.

Limits on Immigration and the Promise of Liberty

Erickson's claim that the promise to the huddled masses is no longer available raises important questions. By looking at the statistics, we can see that the world's population has grown significantly while the U.S. population has also increased. However, there must be limits to immigration to ensure that the country can handle the influx and provide resources and opportunities.The promise of liberty still exists for limited and legal entry. We need to find a balance between welcoming those in need and protecting the interests of the nation.

Paying for Health Care and the Need for Reform

As a retired physician and health-care policy nerd, the author has witnessed the challenges and complexities of the healthcare system. While privatization of health care has been touted as a solution, it has often led to disaster and increased costs.Medicare for all and private insurance for those who can afford it offer a more viable approach. By providing quality care for all at a reasonable cost, we can ensure that everyone has access to the healthcare they need. It is time to reevaluate our healthcare policies and work towards a more sustainable system.

Discrediting Our Schools and the Role of Christianity

The concern over public school teachers teaching Bible stories is valid. Not all teachers are qualified or have the appropriate beliefs and education to do so. Moreover, reducing archetypal stories to cartoon series in children's minds undermines the depth and significance of these teachings.If the curriculum is truly good, it should not require bribes to be used. Discrediting our public schools in this way is contrary to Christian values and undermines the educational system that serves our children.

Appendix B provides a comprehensive summary of the results from each of the 13 papers included in this review. These papers explore various aspects related to tics and healthcare, shedding light on important themes and issues.

Unveiling the Challenges in Tics Healthcare

Descriptive Characteristics of Included Papers

The study selection process is depicted in the PRISMA diagram (Fig. 1). The included studies employed different methodologies - qualitative (n = 2), quantitative (n = 7), or mixed (n = 4). Quantitative and mixed studies used surveys, while qualitative studies used interviews or focus groups. A summary of these studies can be found in Appendix B.All 73 countries represented in the studies have their unique findings. Caregivers formed the largest participant pool (33%), followed by healthcare professionals (HCPs - 32%), medical students (17%), and people with tics (10%). Males dominated among HCPs (60%−80%) and people with tics (65%−85%), while caregivers (52%−93%) and medical students (69%) were mostly female. More details on participant demographics are in Appendix B, along with a distribution graph in Appendix D.The publication dates of the included papers range from 1992 to 2023, with nine papers published in the last 10 years (see Appendix B and D).

Summary of Results

Need for Education and Effective ImplementationAll papers emphasized the need for greater professional education in tic disorders across all countries. HCPs interviewed by Rodin et al. [42] highlighted the inadequacy of training on tics.Impact of Limited KnowledgeKnowledge of tics was explored in various aspects. Most HCPs scored between 60 and 80% on tic understanding, lower than for other disorders. Comparisons between care sectors showed no significant difference in HCP knowledge compared to medical students, but knowledge varied among clinical occupations. A significant gap existed between good knowledge scores and low confidence in understanding tics due to limited training opportunities.When young people and caregivers perceived HCPs' sufficient tic knowledge, they felt more confident about their diagnoses. In Uganda, secondary care HCPs were eager to learn more about tics. In Saudi Arabia and the USA, primary and secondary care HCPs wanted to learn about HRT.Secondary care HCPs focused more on treating comorbidities, and MDS members endorsed this. Neurologists and psychiatrists were more likely to manage comorbidities than offer tic-related advice.Limited Support and Unclear Referral ProcessUp to 86% of neurologists offered tic-living advice, but caregivers received limited information. People with tics and caregivers felt unsupported in primary care, leading to dissatisfaction and increased healthcare usage. Primary care HCPs had a limited understanding of treatment options and often prescribed medication. However, 69% of MDS members preferred behavioural interventions as the first-line treatment.Secondary care referrals were necessary due to limited primary care support. Primary care clinicians had limited knowledge of referral sources and often faced rejection.Misinterpretation, Misdiagnosis, and StigmaPrimary and secondary care HCPs underestimated tic prevalence. Tics were often misinterpreted as other disorders. In the UK, GPs were unsure about tic diagnoses. Vocal tics were more likely to be misinterpreted. There were differences in beliefs about tic severity and premotor urges among HCPs.Patients and families felt that HCPs trivialized tic symptoms, and some parents had misconceptions. HCPs also acknowledged tic-related stigma. In Uganda, cultural beliefs affected healthcare seeking. In the UK, parents felt responsible for their child's behavior.Communication between Healthcare Professionals and FamiliesFour studies explored this. Only 45% of secondary care HCPs valued parent input in decisions. 76% of parents preferred collective decision-making. Overuse of clinical language hindered family understanding and relationship development. However, families appreciated GPs who showed compassion and kept them updated.