The “kaleidoscope” of factors influencing urban adolescent pregnancy in Baltimore, Maryland

Existing intervention and prevention efforts for adolescent pregnancy focus primarily on individual-level approaches; however, there is an emerging expectation to include a more contextually based social-ecological approach. This approach is salient in urban communities like Baltimore, Maryland, with one of the nation’s highest adolescent pregnancy and birth rates. Poverty, community violence, and compromised school systems further complicate the precursors and consequences of adolescent pregnancy. In this mixed methods study, we conducted interviews with key informants (n = 16) from community-based organizations, health departments, foundations, the public school system, clinics, and the faith community who worked with youth in Baltimore to gain a more comprehensive perspective on factors affecting adolescent pregnancy. Interviews were digitally recorded, transcribed verbatim, and analyzed using the constant comparative method. Geographic maps of select socio-demographic variables were created to examine the community context. Results highlighted contributing multi-level factors that emerged across the social-ecological model. Key informants described community- (e.g., environment, community norms, public policy; “Teen pregnancy is norm in many communities”), interpersonal- (e.g., peer social norms; “If you don’t perceive that you have a whole lot of options, you might just kind-of do what everybody else does”), and intrapersonal-level (e.g., specific developmental phase, self-esteem; “You need somebody to love and somebody to love you back”) influences on adolescent pregnancy and birth. GIS maps further illustrated disparities in adolescent birth rates, poverty level, and available community resources. Key informants recommended institutional and structural changes in the community, such as improving sexuality education and school-based health centers and increasing inter-organizational collaboration. These findings underscore the importance of considering creative community partnerships that address key social determinants of reproductive health in developing interventions to address adolescent pregnancy

Factors Influencing Health Care Access Perceptions and Care-seeking Behaviors of Immigrant Latino Sexual Minority Men and Transgender Individuals: Baseline Findings from the HOLA Intervention Study

Little is known about immigrant Latino sexual minorities’ health seeking behaviors. This study examined factors associated with perceptions of access and actual care behaviors among this population in North Carolina. Methods: A community-based participatory research partnership recruited 180 Latino sexual minority men and transgender individuals within preexisting social networks to participate in a sexual health intervention. Mixed-effects logistic regression models and GIS mapping examined factors influencing health care access perceptions and use of services (HIV testing and routine check-ups). Results: Results indicate that perceptions of access and actual care behaviors are low and affected by individual and structural factors, including: years living in NC, reported poor general health, perceptions of discrimination, micro-, meso-, and macro-level barriers, and residence in a Medically Underserved Area. Discussion: To improve Latino sexual minority health, focus must be placed on multiple levels, including: individual characteristics (e.g., demographics), clinic factors (e.g., provider competence and clinic environment), and structural factors (e.g., discrimination)

Individual and structural factors influencing HIV care linkage and engagement: Perceived barriers and solutions among HIV-positive persons

To meet the National HIV/AIDS Strategy’s goals of reducing and preventing HIV transmission, understanding factors that shape HIV-positive persons’ care-seeking behaviors is critical. Accordingly, this study examined factors that affect HIV care linkage and engagement. Six focus groups were conducted with 33 HIV-positive persons living in North Carolina. A variety of factors influenced care behaviors, including: structural and policy factors, relationship with HIV care systems, and individuals’ personal characteristics. Participants also provided solutions for addressing specific factors to care. Improving clinical services and utilizing context-specific strategies can help facilitate greater care linkage and engagement

Ambivalent messages: Adolescents’ perspectives on pregnancy and birth

Purpose To examine, from a youth’s perspective, adolescent pregnancy and parenting in Baltimore, Maryland, a city with high rates of adolescent pregnancy. Methods Six gender-stratified focus groups with 13- to 19-year-olds (4 female and 2 male groups; n = 47). We recorded focus groups, transcribed them verbatim, and analyzed them using the constant comparison method. Participants completed questionnaires to collect demographic and behavioral information. Results Results fit into a social-ecological framework. Individual (e.g., contraceptive use behaviors, religion), interpersonal (e.g., peer norms, maintaining male partners), and community (e.g., clinic factors, perceptions of community) level influences on adolescent pregnancy emerged. Participants discussed contradictory messages that were often gendered in their expectations; for instance, women were responsible for not getting pregnant and raising children. Adolescents expressed beliefs both against (e.g., challenging to complete school) and supporting early childrearing (e.g., religion). Recommendations for addressing the different influences included mentors, education, and community resources. Conclusions Adolescents’ perspectives and values regarding pregnancy and parenting may not mirror traditional and expected norms for pregnancy and requirements for raising a child. These findings challenge the framing of existing interventions as they may not accurately reflect adolescents' values regarding pregnancy and parenting, and thus may need to be modified to highlight positive attitudes toward contraception and postponing pregnancy

Creating and implementing a biodiversity recording app for teaching and research in environmental studies

This case study reports on the development of a bespoke mobile recording app for collating records of biodiversity sightings on a University campus. This innovative project was achieved through a multi-disciplinary partnership of staff and students. It is hoped that the app itself will benefit lecturers by streamlining data collection during teaching and learning activities, whilst engaging students and highlighting the wealth of diversity available on campu

Health Vulnerability Model for Latinx Sexual and Gender Minorities: Typologies with Socioeconomic Stability, Health Care Access, and Social Characteristics Indicators

Vulnerability can undermine positive health outcomes and challenge healthcare services access. However, to date, vulnerable populations research has been limited by overly broad definitions, lack of clear indicators, and failure to explore subtypes of vulnerability. Informed by literature and theory, this analysis used a specific operationalization of health vulnerability to identify typologies among a sample of Latinx sexual and gender minorities. We analyzed baseline data from Latinx sexual and gender minorities (N = 186) recruited for a community-based HIV intervention. We performed latent class analysis to operationalize vulnerability using eight socioeconomic stability, health care access, and social characteristics indicators. We identified three typologies of vulnerability from our sample: Low Education and High Social Support (63.4% of sample), High Education and Year-round Employment (18.8%), and High Education and High Discrimination (17.7%). Using specific indicators produced more nuanced vulnerability typologies which, after further testing, can assist in informing tailored health promotion interventions

Transitioning HIV-infected adolescents to adult care at 14 clinics across the United States: Using adolescent and adult providers’ insights to create multi-level solutions to address transition barriers

HIV-infected adolescents have disproportionately low rates of care retention and viral suppression. Approximately half disengage from care while transitioning to adult clinics, in part due to fragmented care systems and lack of streamlined protocols. We conducted 58 qualitative interviews with social service and health care providers across 14 Adolescent Trials Network clinics (n=28) and 20 adult clinics that receive transitioning adolescents (n=30) from August 2015 – June 2016. We used the constant comparative approach to examine processes, barriers, and facilitators of adult care transition. Transition barriers coalesced around three levels. Structural: insurance eligibility, transportation, and HIV-related stigma; Clinical: inter-clinic communication, differences in care cultures, and resource/personnel limitations; and Individual: adolescents’ transition readiness and developmental capacity. Staff-initiated solutions (e.g., grant-funded transportation) were often unsustainable and applied individual-level solutions to structural-level barriers. Comprehensive initiatives, which develop collaborative policies and protocols that support providers’ ability to match the solution and barrier level (i.e., structural-to-structural), are sorely needed. These initiatives should also support local systematic planning to facilitate inter-clinic structures and communication. Such approaches will help HIV-infected adolescents transition to adult care and improve long-term health outcomes

A phase II study of laser interstitial thermal therapy combined with doxorubicin in patients with recurrent glioblastoma

BACKGROUND: The blood-brain barrier (BBB) is a major limiting factor for drug delivery in brain tumors. Laser interstitial thermal therapy (LITT) disrupts the peritumoral BBB. In this study, we examine survival in patients with recurrent glioblastoma (GBM) treated with LITT followed by low-dose doxorubicin, a potent anti-neoplastic drug with poor BBB permeability. METHODS: Forty-one patients with recurrent GBM were enrolled; thirty patients were evaluable. Participants underwent LITT followed by 6 weekly doxorubicin treatments starting within one week (Early Arm) or at 6-8 weeks (Late Arm) after LITT. The overall survival (OS), local progression-free survival (PFS), and any PFS were compared to historical controls treated with bevacizumab salvage therapy ( RESULTS: The Late Arm and all patients (Early Arm + Late Arm) demonstrated significant improvement in OS compared to historical controls treated with bevacizumab ( CONCLUSIONS: Low-dose doxorubicin given after LITT is well tolerated and correlated with higher OS compared to historical controls treated with bevacizumab or LITT with standard salvage chemotherapy. A larger study is needed to further characterize survival and progression patterns

Biomarker-driven phenotyping in Parkinson's disease: A translational missing link in disease-modifying clinical trials

Past clinical trials of putative neuroprotective therapies have targeted PD as a single pathogenic disease entity. From an Oslerian clinicopathological perspective, the wide complexity of PD converges into Lewy bodies and justifies a reductionist approach to PD: A single-mechanism therapy can affect most of those sharing the classic pathological hallmark. From a systems-biology perspective, PD is a group of disorders that, while related by sharing the feature of nigral dopamine-neuron degeneration, exhibit unique genetic, biological, and molecular abnormalities, which probably respond differentially to a given therapeutic approach, particularly for strategies aimed at neuroprotection. Under this model, only biomarker-defined, homogenous subtypes of PD are likely to respond optimally to therapies proven to affect the biological processes within each subtype. Therefore, we suggest that precision medicine applied to PD requires a reevaluation of the biomarker-discovery effort. This effort is currently centered on correlating biological measures to clinical features of PD and on identifying factors that predict whether various prodromal states will convert into the classical movement disorder. We suggest, instead, that subtyping of PD requires the reverse view, where abnormal biological signals (i.e., biomarkers), rather than clinical definitions, are used to define disease phenotypes. Successful development of disease-modifying strategies will depend on how relevant the specific biological processes addressed by an intervention are to the pathogenetic mechanisms in the subgroup of targeted patients. This precision-medicine approach will likely yield smaller, but well-defined, subsets of PD amenable to successful neuroprotection.Fil: Espay, Alberto J.. University of Cincinnati; Estados UnidosFil: Schwarzschild, Michael A.. Massachusetts General Hospital; Estados UnidosFil: Tanner, Caroline M.. University of California; Estados UnidosFil: Fernandez, Hubert H.. Cleveland Clinic; Estados UnidosFil: Simon, David K.. Harvard Medical School; Estados UnidosFil: Leverenz, James B.. Cleveland Clinic; Estados UnidosFil: Merola, Aristide. University of Cincinnati; Estados UnidosFil: Chen Plotkin, Alice. University of Pennsylvania; Estados UnidosFil: Brundin, Patrik. Van Andel Research Institute. Center for Neurodegenerative Science; Estados UnidosFil: Kauffman, Marcelo Andres. Universidad Austral; Argentina. Universidad Austral. Facultad de Ciencias Biomédicas. Instituto de Investigaciones en Medicina Traslacional. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigaciones en Medicina Traslacional; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; ArgentinaFil: Erro, Roberto. Universita di Verona; Italia. University College London; Reino UnidoFil: Kieburtz, Karl. University of Rochester Medical Center; Estados UnidosFil: Woo, Daniel. University of Cincinnati; Estados UnidosFil: Macklin, Eric A.. Massachusetts General Hospital; Estados UnidosFil: Standaert, David G.. University of Alabama at Birmingahm; Estados UnidosFil: Lang, Anthony E.. University of Toronto; Canad