Predictors of Healthcare Mistreatment Among Transgender and Gender Diverse Individuals: Are There Different Patterns by Patient Race and Ethnicity?

Using data from the 2015 United States Transgender Survey, this study investigates which patient sociodemographic characteristics and psychosocial risks are associated with likelihood of transgender mistreatment in healthcare and how patterns vary for patients of color. Numerous predictors, including alignment of identity documents, were associated with healthcare mistreatment. Among subgroups of transgender patients of color, psychosocial risks were more consistently significant than sociodemographic characteristics in predicting mistreatment. National and international health organizations are called to enact clear policies that affirm transgender patients and patients of color and establish a commitment to effectively serving these populations within their ethical codes

Maternal Depression and Early Intervention: A Call for an Integration of Services

Depression is a serious disorder with severe and far-reaching consequences. Two decades of observational research have shown robust associations between maternal depression and adverse consequences on offspring (Campbell et al., 2004; Campbell, Matestic, von Stauffenberg, Mohan, & Kirchner, 2007; Campbell, Morgan-Lopez, Cox, & McLoyd, 2009; National Research Council & Institute of Medicine, 2009). Depressive symptoms may pose particular risk to infants and toddlers with neurodevelopmental disabilities, whose long-term outcomes depend heavily on the provision of Early Intervention (EI). EI is most effective with active parental engagement. Maternal depressive symptoms may reduce parental engagement, thereby limiting EI benefits to the child (Gaynes, Gavin & Meltzer –Brody, 2005; O’Hara & Swain, 1996). At present, maternal mental health is not directly addressed in EI. The purpose of this paper is to discuss the literature and significance of maternal depression and apply that evidence to mothers of children with developmental delays and disabilities. We conclude that maternal mental health and well-being is currently insufficiently addressed in the EI population. An increased integration of mental health and EI services is needed to serve the unique needs of families who face an increased risk of stress and depression while coping with their child’s special needs

Behavioral, cognitive, and adaptive development in infants with autism spectrum disorder in the first 2 years of life

BackgroundTo delineate the early progression of autism spectrum disorder (ASD) symptoms, this study investigated developmental characteristics of infants at high familial risk for ASD (HR), and infants at low risk (LR).MethodsParticipants included 210 HR and 98 LR infants across 4 sites with comparable behavioral data at age 6, 12, and 24months assessed in the domains of cognitive development (Mullen Scales of Early Learning), adaptive skills (Vineland Adaptive Behavioral Scales), and early behavioral features of ASD (Autism Observation Scale for Infants). Participants evaluated according to the DSM-IV-TR criteria at 24months and categorized as ASD-positive or ASD-negative were further stratified by empirically derived cutoff scores using the Autism Diagnostic Observation Schedule yielding four groups: HR-ASD-High, HR-ASD-Moderate (HR-ASD-Mod), HR-ASD-Negative (HR-Neg), and LR-ASD-Negative (LR-Neg).ResultsThe four groups demonstrated different developmental trajectories that became increasingly distinct from 6 to 24months across all domains. At 6months, the HR-ASD-High group demonstrated less advanced Gross Motor and Visual Reception skills compared with the LR-Neg group. By 12months, the HR-ASD-High group demonstrated increased behavioral features of ASD and decreased cognitive and adaptive functioning compared to the HR-Neg and LR-Neg groups. By 24months, both the HR-ASD-High and HR-ASD-Moderate groups demonstrated differences from the LR- and HR-Neg groups in all domains.ConclusionsThese findings reveal atypical sensorimotor development at 6months of age which is associated with ASD at 24months in the most severely affected group of infants. Sensorimotor differences precede the unfolding of cognitive and adaptive deficits and behavioral features of autism across the 6- to 24-month interval. The less severely affected group demonstrates later symptom onset, in the second year of life, with initial differences in the social-communication domain.Electronic supplementary materialThe online version of this article (doi:10.1186/s11689-015-9117-6) contains supplementary material, which is available to authorized users

SPARC: a matricellular regulator of tumorigenesis

Although many clinical studies have found a correlation of SPARC expression with malignant progression and patient survival, the mechanisms for SPARC function in tumorigenesis and metastasis remain elusive. The activity of SPARC is context- and cell-type-dependent, which is highlighted by the fact that SPARC has shown seemingly contradictory effects on tumor progression in both clinical correlative studies and in animal models. The capacity of SPARC to dictate tumorigenic phenotype has been attributed to its effects on the bioavailability and signaling of integrins and growth factors/chemokines. These molecular pathways contribute to many physiological events affecting malignant progression, including extracellular matrix remodeling, angiogenesis, immune modulation and metastasis. Given that SPARC is credited with such varied activities, this review presents a comprehensive account of the divergent effects of SPARC in human cancers and mouse models, as well as a description of the potential mechanisms by which SPARC mediates these effects. We aim to provide insight into how a matricellular protein such as SPARC might generate paradoxical, yet relevant, tumor outcomes in order to unify an apparently incongruent collection of scientific literature

Behavioral, cognitive, and adaptive development in infants with autism spectrum disorder in the first 2 years of life

BACKGROUND: To delineate the early progression of autism spectrum disorder (ASD) symptoms, this study investigated developmental characteristics of infants at high familial risk for ASD (HR), and infants at low risk (LR). METHODS: Participants included 210 HR and 98 LR infants across 4 sites with comparable behavioral data at age 6, 12, and 24 months assessed in the domains of cognitive development (Mullen Scales of Early Learning), adaptive skills (Vineland Adaptive Behavioral Scales), and early behavioral features of ASD (Autism Observation Scale for Infants). Participants evaluated according to the DSM-IV-TR criteria at 24 months and categorized as ASD-positive or ASD-negative were further stratified by empirically derived cutoff scores using the Autism Diagnostic Observation Schedule yielding four groups: HR-ASD-High, HR-ASD-Moderate (HR-ASD-Mod), HR-ASD-Negative (HR-Neg), and LR-ASD-Negative (LR-Neg). RESULTS: The four groups demonstrated different developmental trajectories that became increasingly distinct from 6 to 24 months across all domains. At 6 months, the HR-ASD-High group demonstrated less advanced Gross Motor and Visual Reception skills compared with the LR-Neg group. By 12 months, the HR-ASD-High group demonstrated increased behavioral features of ASD and decreased cognitive and adaptive functioning compared to the HR-Neg and LR-Neg groups. By 24 months, both the HR-ASD-High and HR-ASD-Moderate groups demonstrated differences from the LR- and HR-Neg groups in all domains. CONCLUSIONS: These findings reveal atypical sensorimotor development at 6 months of age which is associated with ASD at 24 months in the most severely affected group of infants. Sensorimotor differences precede the unfolding of cognitive and adaptive deficits and behavioral features of autism across the 6- to 24-month interval. The less severely affected group demonstrates later symptom onset, in the second year of life, with initial differences in the social-communication domain. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s11689-015-9117-6) contains supplementary material, which is available to authorized users

Early Communicaiton Development in Infants at High and Low Genetic Risk for Autism Spectrum Disorders: An Examination of Communication Spontaneity

Thesis (Ph.D.)--University of Washington, 2013Social communication impairment is one of the key diagnostic features of ASD, with communication deficits being the earliest symptom reported by most parents of children with ASD (Filipek et al., 1999; Landa & Garrett-Meyer, 2006). From differences in babble (Trevarthen & Daniel, 2005; Yirmiya, et al., 2006) and gesture inventories (Landa et al., 2007; Wetherby et al., 1998) to delayed onset or atypical development of verbal language (Luyster, 2009) and social-communication deficits (Landa et al., 2007; Wetherby, 1998; Zwaigenbaum, 2005), children with ASD present with a unique profile of early communication behaviors. One aspect of early communication development that has received limited attention is communication spontaneity (CS). CS has been conceptualized as the level of environmental support required for a child to initiate a communication act (Carter, Hotchkis & Cassar, 1996). While CS has been discussed as an important aspect of communication, additional research is needed to better understand CS's nature (i.e., how CS changes over time) and relevance (i.e., relationship to other developmental domains) in typically developing children as well as children with developmental disabilities such as ASD. Given the limitations of retrospective report, prospective studies are necessary to determine if early risk signs are related to later development of ASD or broader autism phenotype (BAP) features. The purpose of the present study was to examine CS in a cohort of infants at high and low genetic risk for ASD at 12 and 24 month of age.. Results indicated that CS is associated with existing measures of language and social communication. A specific component of CS which captures how a child responds to direct communication prompts (CS-SP-Direct Prompts), was found to be particularly associated with outcomes, including ADOS diagnostic group and symptom severity. In contrast, children's CS during Free Play conditions or in response to non-social prompts was not significantly related to ASD outcomes. These findings suggest that previous discussions of potential differences in CS may be better conceptualized as differences in Social Prompt Responsiveness. At 12 months of age, CS-SP-Direct Prompts differentiated ASD from NonASD children and uniquely predicted both diagnostic group and ASD symptom severity. CS-SP-Direct Prompts may also be associated with the broader autism phenotype, though differences may not become clear until 24 months of age in high risk (HR), NonASD siblings. Results from the present study suggest that structured measurement of Social Prompt Responsiveness is possible and may contribute important information regarding a child's social-communication development, particularly in monitoring infants at high genetic risk for ASD. Findings also provide support for the social salience framework of ASD and its application to early communication development

Factors influencing attrition in 35 Alzheimer’s Disease Centers across the USA: a longitudinal examination of the National Alzheimer’s Coordinating Center’s Uniform Data Set

Objective: A lack of understanding of the causes of attrition in longitudinal studies of older adults may lead to higher attrition rates and bias longitudinal study results. In longitudinal epidemiological studies of Alzheimer’s disease and related dementias, high rates of attrition may cause a systematic underestimation of dementia prevalence and skew the characterization of the disease. This can compromise the generalizability of the study results and any inferences based on the surviving sample may grossly misrepresent the importance of the risk factors for dementia. The National Institute on Aging outlined a National Strategy for Recruitment and Participation in Alzheimer’s Disease Clinical Research to address this problem, providing evidence of the magnitude of this problem. Method: To explore predictors of attrition, this study examined the National Alzheimer’s Coordinating Center ( NACC ) Uniform Data Set, a repository of observations of older adults spanning 11 years, using survival analysis. Four samples were examined: the full sample ( n = 30,433 ) , the alive subsample excluding those who died ( n = 24,231 ) , the MRI sample [participants with complete MRI data ( n = 1104 ) ] , and the alive MRI subsample [participants with MRI data excluding those who died (n = 947 ) ] . Results: Worsening cognitive impairment, neuropsychiatric symptoms, and difficulty with functional activities predicted attrition, as did lower hippocampal volume in the MRI subsample. Questionable co-participant reliability and an informant other than a spouse also increased risk of attrition. Discussion: Special considerations exist in recruiting and retaining older adults in longitudinal studies, and results of baseline psychological, functional, and cognitive functioning should be used to identify targeted retention strategies

Predictors of healthcare mistreatment among transgender and gender diverse individuals: Are there different patterns by patient race and ethnicity?

Using data from the 2015 United States Transgender Survey, this study investigates which patient sociodemographic characteristics and psychosocial risks are associated with likelihood of transgender mistreatment in healthcare and how patterns vary for patients of color. Numerous predictors, including alignment of identity documents, were associated with healthcare mistreatment. Among subgroups of transgender patients of color, psychosocial risks were more consistently significant than sociodemographic characteristics in predicting mistreatment. National and international health organizations are called to enact clear policies that affirm transgender patients and patients of color and establish a commitment to effectively serving these populations within their ethical codes

Group A Streptococcus Vaccine Targeting the Erythrogenic Toxins SpeA and SpeB Is Safe and Immunogenic in Rabbits and Does Not Induce Antibodies Associated with Autoimmunity

Group A streptococcus (GAS) is a global pathogen associated with significant morbidity and mortality for which there is currently no licensed vaccine. Vaccine development has been slow, mostly due to safety concerns regarding streptococcal antigens associated with autoimmunity and related complications. For a GAS vaccine to be safe, it must be ensured that the antigens used in the vaccine do not elicit an antibody response that can cross-react with host tissues. In this study, we evaluated the safety of our GAS vaccine candidate called VaxiStrep in New Zealand White rabbits. VaxiStrep is a recombinant fusion protein comprised of streptococcal pyrogenic exotoxin A (SpeA) and exotoxin B (SpeB), also known as erythrogenic toxins, adsorbed to an aluminum adjuvant. The vaccine elicited a robust immune response against the two toxins in the rabbits without any adverse events or toxicity. No signs of autoimmune pathology were detected in the rabbits’ brains, hearts, and kidneys via immunohistochemistry, and serum antibodies did not cross-react with cardiac or neuronal tissue proteins associated with rheumatic heart disease or Sydenham chorea (SC). This study further confirms that VaxiStrep does not elicit autoantibodies and is safe to be tested in a first-in-human trial