The intersection of race, sexual orientation, socioeconomic status, trans identity, and mental health outcomes

The present study examined patterns in trans individuals’ multiple identities and mental health outcomes. Cluster 1 (socioeconomic and racial privilege; n = 239) was characterized by individuals who identified as trans women or cross-dressers, lesbian, bisexual, or questioning; had associates degrees; reported household incomes of $60,000 or more a year; and were non-Latino White. Cluster 2 (educational privilege; n = 191) was characterized by individuals who identified as trans men or genderqueer, gay, or queer; had a bachelor’s degree; reported household incomes of$10,000 or less a year; and were people of color. There was a pattern of individuals in Cluster 1 who identified with two privileged identities (identifying as White and having higher household incomes), whereas individuals in Cluster 2 identified only formal education as a privilege. Individuals in Cluster 2 reported statistically significant levels of anxiety. Implications of these results for future research and clinical practice are examined.Accepted manuscrip

Timing of antiretroviral therapy in Cambodian hospital after diagnosis of tuberculosis: impact of revised WHO guidelines

OBJECTIVE: To determine if implementation of 2010 World Health Organization (WHO) guidelines on antiretroviral therapy (ART) initiation reduced delay from tuberculosis diagnosis to initiation of ART in a Cambodian urban hospital. METHODS: A retrospective cohort study was conducted in a nongovernmental hospital in Phnom Penh that followed new WHO guidelines in patients with human immunodeficiency virus (HIV) and tuberculosis. All ART-naïve, HIV-positive patients initiated on antituberculosis treatment over the 18 months before and after guideline implementation were included. A competing risk regression model was used. FINDINGS: After implementation of the 2010 WHO guidelines, 190 HIV-positive patients with tuberculosis were identified: 53% males; median age, 38 years; median baseline CD4+ T-lymphocyte (CD4+ cell) count, 43 cells/µL. Before implementation, 262 patients were identified; 56% males; median age, 36 years; median baseline CD4+ cell count, 59 cells/µL. With baseline CD4+ cell counts ≤ 50 cells/µL, median delay to ART declined from 5.8 weeks (interquartile range, IQR: 3.7–9.0) before to 3.0 weeks (IQR: 2.1–4.4) after implementation (P < 0.001); with baseline CD4+ cell counts > 50 cells/µL, delay dropped from 7.0 (IQR: 5.3–11.3) to 3.6 (IQR: 2.9–5.3) weeks (P < 0.001). The probability of ART initiation within 4 and 8 weeks after tuberculosis diagnosis rose from 23% and 65%, respectively, before implementation, to 62% and 90% after implementation. A non-significant increase in 6-month retention and antiretroviral substitution was seen after implementation. CONCLUSION: Implementation of 2010 WHO recommendations in a routine clinical setting shortens delay to ART. Larger studies with longer follow-up are needed to assess impact on patient outcomes

Reviewing media literacy intervention studies for validity

This study is an examination of validity in published articles that have provided tests of the effectiveness of media literacy interventions. We identified 88 published tests of media literacy interventions then analyzed their content using five coding variables that indicated the degree to which authors of those studies established basic validity. We first conducted a meaning analysis to identify the definitions that authors of those studies presented for media literacy. Then we used those definitions to determine the extent to which those authors provided a complete (content validity) and accurate (face validity) operationalization in the design of their measures

The association between overall health, psychological distress, and occupational heat stress among a large national cohort of 40,913 Thai workers

BACKGROUND Occupational heat stress is a well-known problem, particularly in tropical countries, affecting workers, health and well-being. There are very few recent studies that have reported on the effect of heat stress on mental health, or overall health in workers, although socioeconomic development and rapid urbanization in tropical developing countries like Thailand create working conditions in which heat stress is likely. OBJECTIVE This study is aimed at identifying the relationship between self-reported heat stress and psychological distress, and overall health status in Thai workers. RESULTS 18% of our large national cohort (>40,000 subjects) often works under heat stress conditions and males are exposed to heat stress more often than females. Furthermore, working under heat stress conditions is associated with both worse overall health and psychological distress (adjusted odds ratios ranging from 1.49 to 1.84). CONCLUSIONS This association between occupational heat stress and worse health needs more public health attention and further development on occupational health interventions as climate change increases Thailand's temperatures.This study was supported by the International Collaborative Research Grants Scheme with joint grants from the Wellcome Trust UK (GR0587MA) and the Australian NHMRC (268055)

The role of the lateral prefrontal cortex and anterior cingulate in stimulus–response association reversals

Many complex tasks require us to flexibly switch between behavioral rules, associations, and strategies. The prefrontal cerebral cortex is thought to be critical to the performance of such behaviors, although the relative contribution of different components of this structure and associated subcortical regions are not fully understood. We used functional magnetic resonance imaging to measure brain activity during a simple task which required repeated reversals of a rule linking a colored cue and a left/right motor response. Each trial comprised three discrete events separated by variable delay periods. A colored cue instructed which response was to be executed, followed by a go signal which told the subject to execute the response and a feedback instruction which indicated whether to ‘‘hold’’ or ‘‘f lip’’ the rule linking the colored cue and response. The design allowed us to determine which brain regions were recruited by the specific demands of preparing a rule contingent motor response, executing such a response, evaluating the significance of the feedback, and reconfiguring stimulus–response (SR) associations. The results indicate that an increase in neural activity occurs within the anterior cingulate gyrus under conditions in which SR associations are labile. In contrast, lateral frontal regions are activated by unlikely/unexpected perceptual events regardless of their significance for behavior. A network of subcortical structures, including the mediodorsal nucleus of the thalamus and striatum were the only regions showing activity that was exclusively correlated with the neurocognitive demands of reversing SR associations. We conclude that lateral frontal regions act to evaluate the behavioral significance of perceptual events, whereas medial frontal–thalamic circuits are involved in monitoring and reconfiguring SR associations when necessary

Does the Spiritual Values/Religion Subscale of the Self-Description Questionnaire III Function Differentially Across Heterosexual and Non-Heterosexual Young Adults? A Measurement Invariance Study

We evaluated the dimensionality and measurement invariance of the Spiritual Values/Religion (SVR) subscale from the Self-Description Questionnaire III across heterosexual and non-heterosexual young adults. We found a one-factor model provided adequate fit to the data for each group, with the SVR items exhibiting configural, metric, and scalar invariance across the two groups. Given that we established measurement invariance, we examined the latent mean difference on the construct and found the heterosexual group reported significantly higher levels of spiritual value/ religion than the non-heterosexual group. Our results provided empirical support for the theorized factor structure of the SVR items and the use of the SVR subscale across heterosexual and non-heterosexual young adults, making the scale a viable option for researchers studying religiosity in these specific subpopulations

The Intersection of Race, Sexual Orientation, Socioeconomic Status, Trans Identity, and Mental Health Outcomes

The present study examined patterns in trans individuals’ multiple identities and mental health outcomes. Cluster 1 (socioeconomic and racial privilege; n = 239) was characterized by individuals who identified as trans women or crossdressers, lesbian, bisexual, or questioning; had associates degrees; reported household incomes of $60,000 or more a year; and were non-Latino White. Cluster 2 (educational privilege; n = 191) was characterized by individuals who identified as trans men or genderqueer, gay, or queer; had a bachelor’s degree; reported household incomes of$10,000 or less a year; and were people of color. There was a pattern of individuals in Cluster 1 who identified with two privileged identities (identifying as White and having higher household incomes), whereas individuals in Cluster 2 identified only formal education as a privilege. Individuals in Cluster 2 reported statistically significant levels of anxiety. Implications of these results for future research and clinical practice are examined

Functional characterization of ADP ribosyl cyclase signaling pathways in the renal microcirculation

Due to its role in the regulation of salt and water balance, the kidney is thought to be the primary organ involved in arterial blood pressure regulation. The mechanisms governing contraction of renal resistance arteries/arterioles are incompletely understood, however. The purpose of my dissertation was to investigate the importance of a novel signaling pathway involving the enzyme ADP ribosyl (ADPR) cyclase in the regulation of calcium (Ca2+) signaling in afferent arterioles and regulation of renal vascular resistance. Physiological measurements of renal blood flow (RBF) were performed on anesthetized rats before, during, and after pharmacological blockade of ADPR cyclase and its downstream target, the ryanodine receptors (RyR). Inhibition of ADPR cyclase under basal conditions resulted in a significant increase in RBF, and impairment of ADPR cyclase or RyR function attenuated RBF responses to the vasoconstrictors angiotensin II (Ang II), norepinephrine (NE), and endothelin-1 (ET-1) by 30-50%. Further analysis revealed that ADPR cyclase and RyR contribute to vasoconstrictor responses induced by either ET receptor, ETA or ETB. Measurements of cytosolic Ca2+ concentration ([Ca2+]i) in isolated rat afferent arterioles revealed that the second messenger nicotinic acid adenine dinucleotide phosphate (NAADP) participated in the actions of NE and ET-1. [Ca2+]i transients produced by either agonist were diminished by at least 50% in the presence of disruption of lysosomal Ca2+ or NAADP receptor inhibition. Real time quantitative RT-PCR studies on isolated mouse preglomerular resistance arterioles determined mRNA expression of ADPR cyclase family members CD38 and CD157. Genetic knockout of CD38 resulted in attenuated RBF responses to Ang II, NE, and ET-1. Pharmacological blockade of ADPR in CD38-/- animals resulted in no significant attenuation of Ang II-induced renal vasoconstriction, suggesting that CD38 functions as the predominant ADPR cyclase. Overall, these studies provide evidence for the physiological function of ADPR cyclase, its second messengers, and downstream effectors in the regulation of renal hemodynamics. Further investigation of this pathway in the renal vasculature will result in a deeper understanding of renal hemodynamics

Cost driver analysis of statin expenditure on Australia’s pharmaceutical benefits scheme

The Australian Pharmaceutical Benefits Scheme (PBS) provides universal access to subsidised medicines. In 2013, statins as a class had the highest expenditure on the PBS. To assess the influence of policies and drivers affecting PBS statin utilisation and expenditure between 1992 and 2013. Analyses conducted from 1992 to 2013 and over three distinct time periods, including monthly expenditure/prescription, annual utilisation (calculated as Defined Daily Doses/1000 inhabitants/day) and statin strengths dispensed. The major driver of increased PBS expenditure for statins was increased volumes. After adjusting for inflation, the average PBS expenditure on statin prescriptions was the major negative driver. Other influential drivers included the increased use of newer statins and increased strength of statins dispensed. Whilst the inflation-adjusted reimbursed price of statins decreased, increased utilisation, including increased use of patented statins, increased total statin expenditure. Successful measures adopted by other countries could be applied to Australia to decrease total medicines expenditure