QueerVIEW: Protocol for a Technology-Mediated Qualitative Photo Elicitation Study With Sexual and Gender Minority Youth in Ontario, Canada

Background:The experiences of resilience and intersectionality in the lives of contemporary sexual and gender minority youth (SGMY) are important to explore. SGMY face unique experiences of discrimination in both online and offline environments, yet simultaneously build community and seek support in innovative ways. SGMY who identify as transgender, trans, or gender nonconforming and have experiences with child welfare, homelessness, or immigration have been particularly understudied. A qualitative exploration that leverages technology may derive new understanding of the negotiations of risk, resilience, and identity intersections that impact the well-being of vulnerable SGMY. Objective:The objectives of the QueerVIEW study were to (1) enhance understanding of SGMY identities, both online and offline, (2) identify experiences of intersectionality among culturally, regionally, and racially diverse SGMY in Ontario, Canada, (3) explore online and offline sources of resilience for SGMY, and (4) develop and apply a virtual photo elicitation methodological approach. Methods:This is the first study to pilot a completely virtual approach to a photo elicitation investigation with youth, including data collection, recruitment, interviewing, and analysis. Recruited through social media, SGMY completed a brief screening survey, submitted 10 to 15 digital photos, and then participated in an individual semistructured interview that focused on their photos and related life experiences. Online data collection methods were employed through encrypted online file transfer and secure online interviews. Data is being analyzed using a constructivist grounded theory approach, with six coders participating in structured online meetings that triangulated photo, video, and textual data. Results:Data collection with 30 participants has been completed and analyses are underway. SGMY expressed appreciation for the photo elicitation and online design of the study and many reported experiencing an emotional catharsis from participating in this process. It is anticipated that results will form a model of how participants work toward integrating their online and offline experiences and identities into developing a sense of themselves as resilient. Conclusions:This protocol presents an innovative, technology-enabled qualitative study that completely digitized a popular arts-based methodology—photo elicitation—that has potential utility for contemporary research with marginalized populations. The research design and triangulated analyses can generate more nuanced conceptualizations of SGMY identities and resilience than more traditional approaches. Considerations for conducting online research may be useful for other qualitative research. International Registered Report Identifier (IRRID):DERR1-10.2196/2054

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p<0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (<1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (<1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

Critical reflections and reflexivity on responding to the needs of LGBTQ+ youth in a global pandemic

The global community has been significantly impacted by the COVID-19 global pandemic. LGBTQ+ (i.e., lesbian, gay, bisexual, transgender, queer, etc.) youth may face increased stressors amidst the pandemic given their significant mental and sexual health disparities, pervasive rejection - including quarantining in homes with heightened risk of abuse and victimization, and a lack of access to essential resources. Responsive supports are needed at this time for vulnerable LGBTQ+ youth, particularly tailored mental health supports. This critical reflexive paper will highlight, as qualitative social work researchers and practitioners, the swift response to the needs of vulnerable LGBTQ+ youth across Canada during this pandemic. We provide a transparent account of how we have utilized critical reflexivity, cultivated through qualitative research, to support LGBTQ+ youth. This article will elucidate the importance of critical reflexivity in effectively transitioning essential offline mental health services for LGBTQ+ youth to a technology-mediated mental health affirmative intervention. The aim of this paper is to provide qualitative researchers and practitioners practical direction through important insights gleaned by supporting marginalized LGBTQ+ youth during particularly trying times such as a global pandemic

Child Sleep and Parent Depressive Symptoms

Objectives Parent distress and child sleep problems have been associated in earlier research. The present study expands on past research on parent depressive symptoms and their child\u27s sleep. This study examines the relation between parents who screen positive for depressive symptoms and their perception of their child\u27s sleep. Methods Three hundred sixty-nine English-speaking parents of children ages 3 to 5 years (n = 134) or 6 to 11 years (n = 235) met this study\u27s inclusion criteria within the Southwestern Ohio Ambulatory Research Network (response rate 90%). The validated scales used were the RAND Depression Screener (DS), the Wisconsin Abbreviated Children\u27s Sleep Habits Questionnaire (WCSHQ), and the Jenkins Sleep Questionnaire. Multiple logistic regression was used to determine adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for associations with the WCSHQ. Results In total, 74.3% of the study children were White, 82.4% of respondents were the child\u27s mother, 75.1% had at least some college education, and 54.4% reported an annual income of \u3c$50,000. In total, 54.4% of children were male and 53.8% had public health insurance. Approximately one-fourth of parents had a positive DS and nearly one-third reported sleep problems. Adjusting for child\u27s age and other factors, we found that parents with a positive (vs negative) DS had AOR 2.42 (95% CI 1.38-4.24) for higher WCSHQ scores. Children ages 3 to 5 years (vs 6-11 years) had AOR 2.48 (95% CI 1.56-3.95) for higher WCSHQ scores. Conclusions Parents with a positive DS were more likely to report sleep problems in their children after adjusting for the child\u27s age. These findings from a diverse sample of US Midwestern families at primary care venues corroborate previous research

Wait times for publicly funded addiction and problem gambling treatment agencies in Ontario, Canada

Abstract Background This study describes the definitions of wait times and intake processes used by drug and problem gambling treatment agencies in Ontario, Canada, as well as the various strategies employed to ameliorate client backlog. Methods An online survey was developed and distributed to 203 publicly-funded, provincial substance use and problem gambling treatment agencies from June to August, 2011. All aspects of the intake process were covered in the survey. Results Based on 139 responses, six different wait time periods were identified. Additional analyses were completed by type of service offered. Suggestions for effective interventions to shorten wait times and recommendations for future research are provided. Conclusion The results of this study highlight a need for standardized definitions of wait times across substance use and problem gambling treatment services

Child Sleep and Parent Depressive Symptoms

Objectives Parent distress and child sleep problems have been associated in earlier research. The present study expands on past research on parent depressive symptoms and their child\u27s sleep. This study examines the relation between parents who screen positive for depressive symptoms and their perception of their child\u27s sleep. Methods Three hundred sixty-nine English-speaking parents of children ages 3 to 5 years (n = 134) or 6 to 11 years (n = 235) met this study\u27s inclusion criteria within the Southwestern Ohio Ambulatory Research Network (response rate 90%). The validated scales used were the RAND Depression Screener (DS), the Wisconsin Abbreviated Children\u27s Sleep Habits Questionnaire (WCSHQ), and the Jenkins Sleep Questionnaire. Multiple logistic regression was used to determine adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for associations with the WCSHQ. Results In total, 74.3% of the study children were White, 82.4% of respondents were the child\u27s mother, 75.1% had at least some college education, and 54.4% reported an annual income of \u3c$50,000. In total, 54.4% of children were male and 53.8% had public health insurance. Approximately one-fourth of parents had a positive DS and nearly one-third reported sleep problems. Adjusting for child\u27s age and other factors, we found that parents with a positive (vs negative) DS had AOR 2.42 (95% CI 1.38-4.24) for higher WCSHQ scores. Children ages 3 to 5 years (vs 6-11 years) had AOR 2.48 (95% CI 1.56-3.95) for higher WCSHQ scores. Conclusions Parents with a positive DS were more likely to report sleep problems in their children after adjusting for the child\u27s age. These findings from a diverse sample of US Midwestern families at primary care venues corroborate previous research

Towards an integrative self: a digital photo elicitation study of resilience among key marginalized populations of sexual and gender minority youth

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Sexual and gender minority youth (SGMY) experience unique challenges related to identity and disclosure, and cope in vibrant ways. Qualitative research has not yet fulsomely explored the risk, resilience, and identity intersections that impact vulnerable SGMY wellbeing. Methods: This digital photo-elicitation study (QueerView) recruited thirty SGMY (aged 14-29) from priority populations that had one or more of the following experiences:  trans and gender diverse, homelessness, child welfare, and immigration. From submission of fifteen photos representing resilience and a semi-structured interview via web conferencing, constructivist grounded theory was utilized for multimodal analysis of photos, interview video, and interview transcript. Triangulation, an audit trail, and member checking were employed to support trustworthiness. Results: A visual model emerged showing how participants work towards an integrative self, with themes of reflecting and knowing, discrimination and intersectional challenges, connecting, performing, curating, coping, (re)defining and (re)creating, growing and being. Sub-themes of the impact of family dynamic and values, mental health and trauma, and the cathartic benefit from advocacy and leadership offered insight. Participant images were captured in a digital gallery. Conclusions: QueerView animates the complex lives of multiply marginalized SGMY and their intersectional strengths and challenges while demonstrating the utility of a digital multimodal approach.Dr. Craig is the Canada Research Chair (CRC) in Sexual and Gender Minority Youth (CRC-2020-00310). This project is funded by a Partnership Grant from the Social Sciences and Humanities Research Council of Canada [SSHRC #895-2018-1000]; the John R. Evans Leaders Fund of the Canada Foundation for Innovation [CFI Grant #37651]; and an International Doctoral Cluster (IDC) Grant from the University of Toronto. Dr. Eaton is supported by a salary award from the Ontario HIV Treatment Network (OHTN)

AFFIRM Online: Utilising an Affirmative Cognitive–Behavioural Digital Intervention to Improve Mental Health, Access, and Engagement among LGBTQA+ Youth and Young Adults

Digital mental health interventions may enable access to care for LGBTQA+ youth and young adults that face significant threats to their wellbeing. This study describes the preliminary efficacy of AFFIRM Online, an eight-session manualised affirmative cognitive behavioural group intervention delivered synchronously. Participants (Mage = 21.17; SD = 4.52) had a range of sexual (e.g., queer, lesbian, pansexual) and gender (e.g., non-binary, transgender, cisgender woman) identities. Compared to a waitlist control (n = 50), AFFIRM Online participants (n = 46) experienced significantly reduced depression (b = −5.30, p = 0.005, d = 0.60) and improved appraisal of stress as a challenge (b = 0.51, p = 0.005, d = 0.60) and having the resources to meet those challenges (b = 0.27, p = 0.059, d = 0.39) as well active coping (b = 0.36, p = 0.012, d = 0.54), emotional support (b = 0.38, p = 0.017, d = 0.51), instrumental support (b = 0.58, p d = 0.77), positive framing (b = 0.34, p = 0.046, d = 0.42), and planning (b = 0.41, p = 0.024, d = 0.49). Participants reported high acceptability. This study highlights the potential of digital interventions to impact LGBTQA+ youth mental health and explores the feasibility of digital mental health to support access and engagement of youth with a range of identities and needs (e.g., pandemic, lack of transportation, rural locations). Findings have implications for the design and delivery of digital interventions for marginalised youth and young adults.This research was funded by the Social Sciences and Humanities Research Council of Canada, grant number 895-2018-1000 and by the Public Health Agency of Canada, grant number 1718-HQ-000697. S.L.C. receives salary support from a Canada Research Chair

The burden of gestational diabetes mellitus in Jamaican women with a family history of autosomal dominant type 2 diabetes La carga de la diabetes mellitus gestacional en mujeres de Jamaica con antecedentes familiares de diabetes autosómica dominante tipo 2

OBJECTIVES: To determine if Jamaican women of African descent with a family history of early onset autosomal dominant type 2 diabetes have greater odds of developing gestational diabetes mellitus (GDM) than those without a family history of the disease. METHODS: A comparative study was conducted of two groups of pregnant Jamaican women: the first with a family history of early onset autosomal dominant type 2 diabetes; the second with no history of the disease. Incidence, odds for developing GDM, and metabolic profiles in first and second trimesters were assessed using SPSS 11.5 (SPSS Inc., Chicago, Illinois, United States). RESULTS: The incidence of GDM was 12.0 % in women with a family history of early onset autosomal dominant type 2 diabetes and 1.5% in women without a family history of the disease (P < 0.05). Women with a family history were nine times more likely to develop GDM than those without a family history of diabetes (95% confidence interval: 5.00-16.38, P < 0.0001). CONCLUSION: Family history of early onset autosomal dominant type 2 diabetes appears to increase susceptibility to GDM in Jamaican women. Pregnant women of any age with family history of early onset autosomal type 2 diabetes should be screened for GDM.<br>OBJETIVOS: Determinar si las mujeres jamaicanas de ascendencia africana con antecedentes familiares de inicio temprano de diabetes autosómica dominante tipo 2 tienen mayor probabilidad de desarrollar diabetes mellitus gestacional (DMG) que las que no tienen esos antecedentes familiares. MÉTODOS: Se realizó un estudio comparativo con dos grupos de mujeres jamaicanas embarazadas: el primero con mujeres que tenían antecedentes familiares de inicio temprano de diabetes autosómica dominante tipo 2 y el segundo con mujeres sin antecedentes familiares de esa enfermedad. Se empleó el programa SPSS v. 11.5 (SPSS Inc., Chicago, Illinois, Estados Unidos de América) para analizar los resultados y calcular la incidencia, la probabilidad de desarrollar DMG y los perfiles metabólicos en el primer y el segundo trimestres de gestación. RESULTADOS: La incidencia de DMG fue de 12,0% en las mujeres con antecedentes familiares de inicio temprano de diabetes autosómica dominante tipo 2 y de 1,5% en las mujeres sin antecedentes familiares de esa enfermedad (P < 0,05). Las mujeres del primer grupo tuvieron nueve veces más probabilidades de desarrollar DMG que las del segundo grupo (intervalo de confianza de 95%: 5,00 a 16,38; P < 0,0001). CONCLUSIÓN: Los antecedentes familiares de inicio temprano de diabetes autosómica dominante tipo 2 aumentaron la predisposición a sufrir DMG en mujeres jamaicanas. Las mujeres embarazadas con antecedentes familiares de inicio temprano de diabetes autosómica tipo 2 deben someterse a pruebas de tamizaje para DMG, independientemente de su edad

Generating unbiased estimates of burrowing seabird populations

Maximising survey efficiency can help reduce the tradeoff between spending limited conservation resources on identifying population changes and responding to those changes through management. Burrow-nesting seabirds are particularly challenging to survey because nests cannot be counted directly. We evaluated a stratified random survey design for generating unbiased population estimates simultaneously for four petrel species nesting on Macquarie Island, Australia, where the survey cue, burrow entrances, is similar for all species. We also compared the use of design-based and model-based analyses for minimising uncertainty in estimates. We recorded 2845 Antarctic prion burrows, 306 white-headed petrel burrows and two blue petrel burrows while distance-sampling along 154 km of transects. For blue petrels and grey petrels, we completed nocturnal searches along a further 71 km and searched 249 km of tracks during follow-up ground searches. We failed to generate unbiased population estimates for two rare and localised species, blue and grey petrels, from our stratified random survey. Only for the most widespread and abundant species, Antarctic prion, did the estimate have reasonable power to detect a rapid population change. Model-based analyses of the stratified random survey data did not improve upon traditional design-based analyses in terms of uncertainty in population estimates, but they did provide useful spatial representation of current populations. Models that used the targeted survey data did not reflect current population sizes and distributions of the two rare and localised species. We found that when species ecologies, distributions and abundances vary, a multi-method approach to surveys is needed. Species with low abundance that occur patchily across large islands are likely to be best estimated using targeted surveys, whereas widespread and abundant species can be accurately and precisely estimated from randomised surveys using informative model-based analyses.</p