Partnership and the Politics of Care: Advocates' Role in Passing and Implementing California's Law to Extend Foster Care

This report traces the history of the California's Fostering Connections to Success Act legislation from its introduction in the California State Assembly, through its passage and signing, and ultimately to its innovative and extensive implementation planning process. The report aims to document the California experience, highlighting its successes and challenges, so that other states may benefit, potentially smoothing the legislative and implementation processes there. Beyond telling the story of extended care, this report also focuses on two other issues. The first is the strong role played by a group of stakeholders (e.g., advocates, foundations, county administrators) in passing this bill and seeing it through implementation planning. We find that their central involvement was a result of their own desire to see the policy through to implementation, the limited capacity of state government agencies to implement such complex legislation, and the willingness of foundations to help fund implementation planning. The second is the degree to which research evidence was used in both the legislative and implementation planning phases. Our findings about use of evidence indicate that for research to be effective in shaping legislative decisions, it needs to be more timely and geared to policymakers' concerns. In particular, research on specific state-level contexts is greatly valued. For legislation that concerns sympathetic populations, testimonial or discursive evidence can be just as effective with legislators as research evidence. Moreover, in times of budgetary constraint, research evidence about cost effectiveness may be as important as research evidence about program or policy effectiveness

Evaluating the Health Effects of Micro Health Insurance Placement: Evidence from Bangladesh

We examine the impact of micro health insurance placement on health awareness, healthcare utilization and health status of microcredit members in rural Bangladesh, using data from 329 households in the operating areas of Grameen Bank. The results are based on econometric analysis conditioned on placement of the scheme, and show that placement has a positive association with all of the outcomes. The results are statistically significant for health awareness and healthcare utilization, but not for heath status. Our study makes an important contribution to the literature as it provides evidence on the impact of MHI on a broad set of health outcomes.Microcredit, Micro Health Insurance, Grameen Bank, Bangladesh

Occupational Injustice and the Right to Play: A Systematic Review of Accessible Playgrounds for Children with Disabilities

Background: Playgrounds facilitate important opportunities for growth and development during childhood. These experiences are not afforded to children with disabilities due to environmental and societal barriers despite ADA regulations. The objective of this systematic review is to dentify and synthesize existing research on the relationship between key areas of development and accessible play settings for children aged 3-12 with disabilities, and provide occupational therapy practitioners (OTPs) with a body of evidence to inform evidence-based interventions and utilize in advocating for occupational justice. Methods: The following databases were searched on January 30, 2021: Academic Search Complete/EBSCO, CINAHL/EBSCO, Education Research Complete/EBSCO, ERIC, OTSeeker, and PubMed. Study Selection and Data Collection: This systematic review was conducted using PRISMA guidelines. Included studies were peer-reviewed, included children with disabilities aged 3-12, in an accessible play setting, and had outcomes related to areas of childhood development. Validated tools were used to determine risk of bias and quality of evidence. Results: Nine articles met inclusion criteria. This included one Level IIIB matched case-control study, four Level IV cross-sectional studies, three Level V qualitative studies, and one mixed-methods study with both Level IV and Level V evidence. Social participation, play participation, and motor skill development were negatively impacted in 8 of 9 studies despite playgrounds being labeled accessible. Conclusion: Children with disabilities have decreased engagement in activities that provide opportunities for play, social participation, and motor skill development. OTPs should address occupational injustice in the playground setting through developing programs to combat stigma, engaging in policy and playground design, and conducting longitudinal cohort studies. Through addressing play accessibility, OTPs could significantly reduce instances of play inequity. Creating interdisciplinary teams to address accessible playground design locally would allow OTPs the opportunity to make a lasting impact for the children in their community

Love-bombing: A Narcissistic Approach to Relationship Formation

The current study examined the relationship between attachment style, self-esteem, and narcissism as they pertain to behavioral tendencies, termed love-bombing behaviors, among a sample of young adult millennials. Love-bombing was identified as the presence of excessive communication at the beginning of a romantic relationship in order to obtain power and control over another’s life as a means of narcissistic self-enhancement. Millennials have shown a drastic increase in narcissism compared to generations prior, and the need for psychological services on college campuses has also increased. This study sought to establish empirical evidence for the presence of love-bombing behaviors amongst millennials as a gateway for further research to address the problem facing young adult relationships today. The sample consisted of 484 college students from a large southern university who ranged in age from 18 to 30. Results indicated that love-bombing was positively correlated with narcissistic tendencies and insecure attachment styles (lack of trust or value in self and others), and negatively associated with self-esteem. Secure attachment was a positive indicator of love-bombing behaviors. Lastly, love-bombing was also associated with more text and media usage within romantic relationships. In conclusion, love-bombing was found to be a logical and potentially necessary strategy for romantic relationships among individuals with high displays of narcissism and low levels of self-esteem. This is the first study to empirically examine love-bombing behaviors; thus, future research should address the impact that these behaviors may have on young adult relationships. The potential for negative psychological impact on both love-bombers and the subject of their attacks are discussed

Association of Central Arterial Stiffness and Pressure Pulsatility with Mild Cognitive Impairment and Dementia: The Atherosclerosis Risk in Communities Study-Neurocognitive Study (ARIC-NCS)

The association of central arterial stiffness and pressure pulsatility with mild cognitive impairment and dementia is not well characterized in the population-based setting

Factors Influencing Graduate Program Choice Among Undergraduate Women

Context: Despite equal enrollment proportions in MD and PhD programs, there are fewer women than men in MD-PhD programs and academic medicine. Factors important in degree program selection, including the perception of gender disparities, among undergraduate students were characterized. Methods: In 2017, pre-health students at four public North Carolina universities were invited to participate in an online survey regarding career plans, decision factors, and perceptions of gender disparities in MD, PhD and MD-PhD pathways. The authors characterized factors important to program selection, and evaluated the association of intended graduate program with perceived gender disparities using Fisher’s exact tests. Results: Among the n=186 female survey participants, most were white (54%) and intended MD, PhD, and/or MD-PhD programs (52%). Sixty percent had heard of MD-PhD programs, over half had no research experience, and half were considering but uncertain about pursuing a research career. The most common factors influencing degree program choice were perceived competitiveness as an applicant, desired future work environment, and desire for patient interaction. Twenty-five percent of students considering MD, PhD, and MD-PhD programs stated that perceived gender disparities during training for those degrees will influence their choice of program, however intended degree was not statistically associated with perceived gender disparities. Discussion: Perceived gender disparities may influence choice of graduate training program but are not among the top factors. Perceived competitiveness as an applicant is an important career consideration among undergraduate women. Strategies to increase awareness of MD-PhD programs, to encourage women to consider all training paths for which they are qualified are needed. Keywords: Education, Graduate; Sexism; Career Choice; Biomedical Research/education; Female What is known: Though men and women are nearly equally represented in MD-only and PhD-only programs, women are underrepresented in MD-PhD programs, which train physician-scientists. Prior studies have shown gender is not associated with rates of attrition from MD-PhD programs or differences in academic preparation, research interest, or research experience, suggesting enrollment differences by gender may be due to fewer women applying to MD-PhD programs. Gender parity in the physician-scientist workforce is critical to equitably serving a diverse patient population. What this study adds: This study is the first to examine the role of gender disparities in the career choices of undergraduate women. Given the moderate familiarity with MD-PhD training and lack of research experience among respondents, increased awareness of MD-PhD programs and expanded research opportunities may help undergraduates make informed career choices. This may increase women MD-PhD applicants, creating a more balanced physician-scientist workforce to address the needs of patients from all backgrounds

“No One Can Make that Choice for You”: Exploring Power in the Sexual Narratives of Black Collegians

Power is enacted to oppress others, pursue wellness, or resist oppression. For Black people, societal and relational oppression influences racialized and gendered expressions of power within sexual encounters. The current study analyzed power dynamics within Black university students’ first and most recent sexual encounters. Using narrative inquiry within a critical paradigm, five narrative strategies were identified within participants’ interviews: 1) Offering a Peek into Powerlessness, 2) Detailing Disempowerment, 3) Privileging Stereotypical Power, 4) Reclaiming Power, and 5) Emphasizing Empowered Sex. Racialized, gendered sexual socialization among Black students is discussed. Counseling considerations to increase sexual wellness for Black people are explored

meQTL Mapping in the Genoa Study Reveals Genetic Determinants of DNA Methylation in African Americans

Identifying genetic variants that are associated with variation in DNA methylation, an analysis commonly referred to as methylation quantitative trait locus (meQTL) mapping, is an important first step towards understanding the genetic architecture underlying epigenetic variation. Most existing meQTL mapping studies have focused on individuals of European ancestry and are underrepresented in other populations, with a particular absence of large studies in populations with African ancestry. We fill this critical knowledge gap by performing a large-scale cis-meQTL mapping study in 961 African Americans from the Genetic Epidemiology Network of Arteriopathy (GENOA) study. We identify a total of 4,565,687 cis-acting meQTLs in 320,965 meCpGs. We find that 45% of meCpGs harbor multiple independent meQTLs, suggesting potential polygenic genetic architecture underlying methylation variation. A large percentage of the cis-meQTLs also colocalize with cis-expression QTLs (eQTLs) in the same population. Importantly, the identified cis-meQTLs explain a substantial proportion (median = 24.6%) of methylation variation. In addition, the cis-meQTL associated CpG sites mediate a substantial proportion (median = 24.9%) of SNP effects underlying gene expression. Overall, our results represent an important step toward revealing the co-regulation of methylation and gene expression, facilitating the functional interpretation of epigenetic and gene regulation underlying common diseases in African Americans

Associations of NINJ2 sequence variants with incident ischemic stroke in the Cohorts for Heart and Aging in Genomic Epidemiology (CHARGE) consortium

Background<p></p> Stroke, the leading neurologic cause of death and disability, has a substantial genetic component. We previously conducted a genome-wide association study (GWAS) in four prospective studies from the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) consortium and demonstrated that sequence variants near the NINJ2 gene are associated with incident ischemic stroke. Here, we sought to fine-map functional variants in the region and evaluate the contribution of rare variants to ischemic stroke risk.<p></p> Methods and Results<p></p> We sequenced 196 kb around NINJ2 on chromosome 12p13 among 3,986 European ancestry participants, including 475 ischemic stroke cases, from the Atherosclerosis Risk in Communities Study, Cardiovascular Health Study, and Framingham Heart Study. Meta-analyses of single-variant tests for 425 common variants (minor allele frequency [MAF] ≥ 1%) confirmed the original GWAS results and identified an independent intronic variant, rs34166160 (MAF = 0.012), most significantly associated with incident ischemic stroke (HR = 1.80, p = 0.0003). Aggregating 278 putatively-functional variants with MAF≤ 1% using count statistics, we observed a nominally statistically significant association, with the burden of rare NINJ2 variants contributing to decreased ischemic stroke incidence (HR = 0.81; p = 0.026).<p></p> Conclusion<p></p> Common and rare variants in the NINJ2 region were nominally associated with incident ischemic stroke among a subset of CHARGE participants. Allelic heterogeneity at this locus, caused by multiple rare, low frequency, and common variants with disparate effects on risk, may explain the difficulties in replicating the original GWAS results. Additional studies that take into account the complex allelic architecture at this locus are needed to confirm these findings