An Integrated Behavioral Model of Healthcare Utilization among Transgender and Gender-Nonconforming Adults

Transgender and gender-nonconforming (TGNC) individuals in the United States experience significant marginalization due to stigma enacted at the structural, interpersonal, and individual levels. As a result, this population has reported increased behavioral and physical health needs, as well as unique barriers to healthcare. Moreover, TGNC individuals have reported greater experiences of childhood abuse compared to cisgender individuals. The cumulative experiences of stigma-related stressors and adverse childhood experiences put this population at risk for the development of mental and physical health problems, increasing need for health services. However, TGNC individuals have reported being denied medical care and postponing seeking care due to fear of discrimination, which may increase complications and severity of illness, and result in increased hospitalizations and healthcare costs. Utilizing the Andersen Behavioral Model of Health Services Use and Theory of Planned Behavior, the current study examined robust associations among stigma-related stressors, adverse childhood experiences, personal and physician-related enabling factors, mental, behavioral, and physical health needs, and healthcare utilization, intention, and delay among an online convenience sample of 109 TGNC adults in the United States. A series of multivariate and mediational analyses were conducted to determine the connections among predisposing factors, enabling resources, needs, health beliefs, and healthcare intention, delay, and behavior. Although predisposing factors were not directly associated with healthcare behavior, they were directly associated with healthcare delay. Moreover, mediation analyses indicated an indirect effect of victimization and adverse childhood events to decreased healthcare utilization and increased delay through mental health needs, internalized stigma, negative personal beliefs, perceived TGNC-inclusivity of healthcare providers, and finally, behavioral intention. Thus, the present study illuminated a possible cascade of detrimental effects that are initiated by stigma-related stress and adverse childhood experiences through enabling resources, needs, and beliefs, that ultimately are associated with healthcare utilization intent, behavior, and delay. These findings highlight the need to address both TGNC individuals’ timely use of care, and the quality of care they receive. It is imperative that future research takes a multi-level approach by creating and testing evidence-based interventions to improve both healthcare providers’ competency, as well as for TGNC individuals’ ability to coping with stressors

FAMILY NEEDS, CAREGIVER BURDEN, AND MENTAL HEALTH: CAREGIVERS OF INDIVIDUALS WITH VARIOUS NEUROLOGICAL CONDITIONS FROM COLOMBIA AND MEXICO

This cross-sectional study examined differences in family needs (informational, social, financial, health, and household support), caregiver mental health (depression, satisfaction with life, vitality, social functioning, and emotional role limitations), and caregiver burden (personal life, guilt, and psychological) among caregivers of individuals with traumatic brain injury, spinal cord injury, multiple sclerosis, and dementia from cities in Colombia and Mexico (N = 343). The study also examined the connections among family needs, caregiver mental health, and caregiver burden in the combined sample of caregivers of individuals with neurological conditions. Many significant differences were identified among groups, and implications are discussed. Family needs, caregiver mental health, and burden were all robustly associated with each other, with financial and social support needs, depression, and burden-personal life and guilt emerging as particularly important. Clinicians should focus on helping caregivers meet financial and social support needs in order to positively influence caregiver burden and mental health

Copy number variants as modifiers of breast cancer risk for BRCA1/BRCA2 pathogenic variant carriers

The risk of germline copy number variants (CNVs) in BRCA1 and BRCA2 pathogenic variant carriers in breast cancer is assessed, with CNVs overlapping SULT1A1 decreasing breast cancer risk in BRCA1 carriers.The contribution of germline copy number variants (CNVs) to risk of developing cancer in individuals with pathogenic BRCA1 or BRCA2 variants remains relatively unknown. We conducted the largest genome-wide analysis of CNVs in 15,342 BRCA1 and 10,740 BRCA2 pathogenic variant carriers. We used these results to prioritise a candidate breast cancer risk-modifier gene for laboratory analysis and biological validation. Notably, the HR for deletions in BRCA1 suggested an elevated breast cancer risk estimate (hazard ratio (HR) = 1.21), 95% confidence interval (95% CI = 1.09-1.35) compared with non-CNV pathogenic variants. In contrast, deletions overlapping SULT1A1 suggested a decreased breast cancer risk (HR = 0.73, 95% CI 0.59-0.91) in BRCA1 pathogenic variant carriers. Functional analyses of SULT1A1 showed that reduced mRNA expression in pathogenic BRCA1 variant cells was associated with reduced cellular proliferation and reduced DNA damage after treatment with DNA damaging agents. These data provide evidence that deleterious variants in BRCA1 plus SULT1A1 deletions contribute to variable breast cancer risk in BRCA1 carriers.Peer reviewe

Uproar on Campus: Student Protests in the Vietnam War Era

The Vietnam War was one of the most polarizing events in United States history. Protesters angered by a decade of controversial policy decisions in Vietnam opposed what they believed to be an unfair and corrupt political system waging an unpopular war. As the antiwar movement began to gain momentum in the late 1960s and early 1970s, college students took leading roles, protesting not only against the war, but also against conventional forms of authority and social norms. Student protesters embraced a philosophy of free love, and peace and justice for all that had its roots in the radical counterculture movement that started in the early 1960s. The Vietnam War opened an ideological rift between Americans. The radical ideas of student protesters, and the antiwar movement more broadly, met opposition from the US government, as well as from supporters of the war. Americans on both side of this divide banded together to print and distribute materials across the country in the hopes of gaining support and recognition for their respective causes. The artifacts in this exhibit are drawn from the Radical Pamphlets Collection housed in Gettysburg College’s Musselman Library. These artifacts have been selected to provide a taste of what it might have been like to be a college student during the Vietnam War era

Isotope ratios of H, C, and O in CO2 and H2O of the Martian atmosphere

Stable isotope ratios of H, C, and O are powerful indicators of a wide variety of planetary geophysical processes, and for Mars they reveal the record of loss of its atmosphere and subsequent interactions with its surface such as carbonate formation. We report in situ measurements of the isotopic ratios of D/H and O-18/O-16 in water and C-13/C-12, O-18/O-16, O-17/O-16, and (CO)-C-13-O-18/(CO)-C-12-O-16 in carbon dioxide, made in the martian atmosphere at Gale Crater from the Curiosity rover using the Sample Analysis at Mars (SAM)'s tunable laser spectrometer (TLS). Comparison between our measurements in the modern atmosphere and those of martian meteorites such as ALH 84001 implies that the martian reservoirs of CO2 and H2O were largely established similar to 4 billion years ago, but that atmospheric loss or surface interaction may be still ongoing