Setting the Priorities for LGBT+ Research and Intervention Effort in Malaysia Through Community Voices: A Brief Report.

Internationally, there is a growing acceptance of gender and sexuality diversity and acknowledgment of LGBT + identities as health determinants. However, caution is warranted when applying research and intervention priorities from Global North countries to regions where LGBT + identities remain criminalized. In 2024, Malaysia maintains legal stances persecuting LGBT + individuals and shows no intent to address this human rights issue. This study offers an overview of pivotal issues identified by LGBT + communities in Malaysia that urgently require attention and resolution. Data were employed from a large-scale community-based survey: the KAMI Survey that recruited LGBT + participants in Malaysia in late 2023 and descriptive analyses were conducted on the responses of 637 participants (mean age = 27.75). Results revealed key issues deemed 'very important' to address by participants comprised HIV/AIDS, training for healthcare providers, police mistreatment, and discrimination, with more than 80% reporting each of these. When prompted to select a single issue for urgent resolution, three-fifths (61.0%) prioritized 'criminalizing laws affecting LGBT + individuals'. Echoing prolonged advocacy by local LGBT + community organizations, the author emphasizes the need for collective allyship across stakeholders to develop evidence-based practices and policies to address the concerns articulated in this paper.

Anti-inflammatory effects of phytocannabinoids and terpenes on inflamed Tregs and Th17 cells in vitro.

AIMS: Phytocannabinoids and terpenes from Cannabis sativa have demonstrated limited anti-inflammatory and analgesic effects in several inflammatory conditions. In the current study, we test the hypothesis that phytocannabinoids exert immunomodulatory effects in vitro by decreasing inflammatory cytokine expression and activation. KEY METHODS: CD3/CD28 and lipopolysaccharide activated peripheral blood mononuclear cells (PBMCs) from healthy donors (n = 6) were treated with phytocannabinoid compounds and terpenes in vitro. Flow cytometry was used to determine regulatory T cell (Treg) and T helper 17 (Th17) cell responses to treatments. Cell pellets were harvested for qRT-PCR gene expression analysis of cytokines, cell activation markers, and inflammation-related receptors. Cell culture supernatants were analysed by ELISA to quantify IL-6, TNF-α and IL-10 secretion. MAIN FINDINGS: In an initial screen of 20 µM cannabinoids and terpenes which were coded to blind investigators, cannabigerol (GL4a), caryophyllene oxide (GL5a) and gamma-terpinene (GL6a) significantly reduced cytotoxicity and gene expression levels of IL6, IL10, TNF, TRPV1, CNR1, HTR1A, FOXP3, RORC and NFKΒ1. Tetrahydrocannabinol (GL7a) suppression of T cell activation was associated with downregulation of RORC and NFKΒ1 gene expression and reduced IL-6 (p < 0.0001) and IL10 (p < 0.01) secretion. Cannabidiol (GL1b) significantly suppressed activation of Tregs (p < 0.05) and Th17 cells (p < 0.05) in a follow-on in vitro dose-response study. IL-6 (p < 0.01) and IL-10 (p < 0.01) secretion was significantly reduced with 50 µM cannabidiol. SIGNIFICANCE: The study provides the first evidence that cannabidiol and tetrahydrocannabinol suppress extracellular expression of both anti- and pro-inflammatory cytokines in an in vitro PBMC model of inflammation.

The glue that binds us: The positive relationships between whanaungatanga (belonging), the wellbeing, and identity pride for takatapui who are trans and non-binary.

ISSUE ADDRESSED: This article explores how belonging can enhance well-being for takatapui (a traditional Maori term that embraces all Maori with diverse genders, sexualities and sex characteristics) who are trans and non-binary across a range of contexts. METHODS: We drew data from the 2018 Counting Ourselves, a nationwide community-based survey of trans and non-binary people in Aotearoa (New Zealand) (N = 1178); of which 161 (13.7%) identified as Maori, the Indigenous people of Aotearoa. RESULTS: Based on generalised regression models, feelings of belonging with friends, takatapui communities, Maori communities, and work communities were correlated to higher feelings of life satisfaction, life worthwhileness, and identity pride for takatapui who are trans and non-binary. In Te Ao Maori (the Maori worldview), such concepts of belonging and relationships are collectively known as whanaungatanga. CONCLUSIONS: Our findings affirm whanaungatanga as foundational to well-being among trans Maori people, enabling them to locate themselves within nurturing and supportive networks. SO WHAT?: Whanaungatanga is a key policy agenda, alongside other system-level change, that is needed to buffer takatapui who are trans and non-binary from poverty, stigma, and racism they face. This will require changes to the current policy and practice context. We argue that whanaungatanga, while an important strategy of well-being for trans and non-binary people, must also occur alongside wider system transformations to address transphobia, racism, and cisheteronormativity.

Influence of an Intrinsically Disordered Region on Protein Domains Revealed by NMR-Based Electrostatic Potential Measurements.

Many human proteins possess intrinsically disordered regions containing consecutive aspartate or glutamate residues ("D/E repeats"). Approximately half of them are DNA/RNA-binding proteins. In this study, using nuclear magnetic resonance (NMR) spectroscopy, we investigated the electrostatic properties of D/E repeats and their influence on folded domains within the same protein. Local electrostatic potentials were directly measured for the HMGB1 protein, its isolated D/E repeats, and DNA-binding domains by NMR. The data provide quantitative information about the electrostatic interactions between distinct segments of HMGB1. Due to the interactions between the D/E repeats and the DNA-binding domains, local electrostatic potentials of the DNA-binding domains within the full-length HMGB1 protein were largely negative despite the presence of many positively charged residues. Our NMR data on counterions and electrostatic potentials show that the D/E repeats and DNA have similar electrostatic properties and compete for the DNA-binding domains. The competition promotes dissociation of the protein-DNA complex and influences the molecular behavior of the HMGB1 protein. These effects may be general among the DNA/RNA-binding proteins with D/E repeats.

Mental Healthcare Needs and Experiences of LGBT+ Individuals in Malaysia: Utility, Enablers, and Barriers.

Access to mental healthcare is undoubtedly of major importance for LGBT+ people worldwide, given the high prevalence of mental health difficulties due to minority stress exposures. This study drew mixed-method survey data from the community-based KAMI Survey (n = 696) to examine the enablers, barriers, and unmet needs experiences of LGBT+ individuals in accessing mental healthcare services in Malaysia. First, we present findings from a series of descriptive analyses for sociodemographic differences in unmet needs for mental healthcare, barriers, and satisfaction levels with different types of mental healthcare. Next, we conducted an inductive thematic analysis of open-text comments (n = 273), with relevance drawn to Andersen's Behavioural Model of Healthcare. More than a quarter (29.5%) reported an unmet need for mental healthcare, and some groups (younger, asexual or queer, or participants living in non-major cities) reported higher unmet needs. More than three-fifths (60.5%) reported not knowing where to find culturally safe mental health professionals. The thematic analysis uncovered key contextual (e.g., mental health practitioners' stance, stigma, collaborative client-care) and individual (e.g., positive expectation of mental health services and anticipated stigma) attributes that influence healthcare experiences. Participants also identified resources that facilitate healthcare utilisation, such as affordability, availability of suitable professionals, and geographical considerations. The implications of our findings for the mental healthcare practices in Malaysia were outlined.

An ecological analysis of hope amongst Asian rainbow young people in Aotearoa New Zealand.

Rainbow research tends to prioritise gender and sexuality experiences over the racialised experiences of Asian rainbow young people. Informed by an intersectional lens, we employed a hope-based ecological framework to examine how multiple overlapping axes of oppression (e.g. cisgenderism, heterosexism and racism) shape the aspirations of these youth. We drew on the voices of Asian participants from the 2021 Aotearoa New Zealand Identify Survey, who had responded to an open-text question on their hopes for rainbow young people (n = 217; age range = 14 to 26). The content analysis identified seven prominent categories of hope across three ecological levels (macro exo and meso). These categories were societies: 1) break away from cisheterosexist expectations; 2) confront racism and intersection with cisheterosexism; 3) promote rainbow-inclusive education; 4) ban sexual orientation and gender identity change efforts; 5) improve access to culturally safe health care; 6) dismantle white-dominated rainbow spaces; and 7) provide more rainbow-inclusive family support. These hopes were constructed amidst the desire to challenge unacceptance and exclusion by the wider society for not adhering to white cisheterosexist expectations. The study provides critical insights for community organisations, education settings, and government to consider in addressing the diverse needs of Asian rainbow young people.

The "standard story" of anti-Maori talk in Pae Ora (Healthy Futures) Bill submissions.

AIM: To review some common patterns of race talk in a sample of submissions made to the Pae Ora (Healthy Futures) Bill. This bill proposed a structural reform of the health system in Aotearoa New Zealand to address long-standing health inequities experienced by Maori, the Indigenous peoples, and other priority populations. METHOD: In a sample of 3,000 individual submissions made in late 2021, we found 2,536 explicit references to race. Utilising the "standard story" frame of Pakeha/non-Maori race talk, five longer submissions that inferred that the Pae Ora bill was "racist" were analysed in detail. RESULTS: Many "standard story" race discourses were identified in the Pae Ora submissions. Three derived discourses included in this paper are: Pakeha as norm (monoculturalism or not seeing Pakeha as a culture), equality and the "Treaty" (equality for all to access healthcare), and one people (we are all New Zealanders). Sources such as the Waitangi Tribunal Wai 2575 Hauora report were drawn on to provide alternative discourses. CONCLUSION: Identifying Pakeha standard story discourses enables learning about language patterns systems draw on, and the development of tools and procedures to improve equity for Maori and eliminate institutional racism.

Uptake, experiences and barriers to cervical screening for trans and non-binary people in Aotearoa New Zealand.

Little is known about experiences and barriers for trans and non-binary (TGNB) people eligible for cervical screening in Aotearoa New Zealand. AIMS: To identify uptake, barriers and reasons for delaying cervical cancer screening among TGNB people in Aotearoa. MATERIALS AND METHODS: The 2018 Counting Ourselves data on TGNB people assigned female at birth aged 20-69 years who had ever had sex, were analysed to report on experiences of those who were eligible for cervical screening (n = 318). Participants answered questions about whether they had taken part in cervical screening and reasons behind any delays in receiving the test. RESULTS: Trans men were more likely than non-binary participants to report that they did not require cervical screening or were unsure if they needed it. For those who had delayed cervical screening, 30% did so due to feeling worried about how they would be treated as a trans or non-binary person and 35% due to another reason. Other reasons for delay related to general and gender-related discomfort, previous traumatic experiences, anxiety or fear of the test and pain. Material barriers to access included cost and lack of information. CONCLUSIONS: The current cervical screening program in Aotearoa does not consider the needs of TGNB people, leading to delayed and reduced uptake of cervical screening. Health providers require education on the reasons TGNB people delay or avoid cervical screening in order to provide appropriate information and affirmative healthcare environments. The human papillomavirus self-swab may address some of the existing barriers.

Sexual Orientation and Gender Identity Change Efforts for Young People in New Zealand: Demographics, Types of Suggesters, and Associations with Mental Health.

Sexual orientation and gender identity change efforts (SOGICE) are harmful practices, yet who suggests them to young people and what impacts are associated with these suggestions have received limited attention in the literature. The present study explored whether certain suggesters, and the frequency of categories of suggesters (including religious leaders, family members, and health professionals), were associated with suicidality and non-suicidal self-injury (NSSI). The study also explored whether particular demographics of young people were more likely to report SOGICE experiences. Data were collected through an online survey of New Zealand gender- and sexuality-diverse youth. The sample (n = 3948) had an age range of 14-26 (mean age = 18.96), and approximately half (52.4%) were transgender or gender-diverse. Odds of suicidality and NSSI were highest when religious leaders suggested SOGICE and when more than one type of suggester was reported. SOGICE was more likely to be reported by transgender and gender-diverse youth, statutory care- and homelessness-experienced youth, and young people reporting current material deprivation. Implications for targeted mental health services and education for young people and the community are discussed.

Unmet need for gender-affirming care as a social determinant of mental health inequities for transgender youth in Aotearoa/New Zealand.

BACKGROUND: Past studies have demonstrated better mental health and well-being among transgender youth who had accessed gender-affirming care. However, few existing studies have assessed unmet need for gender-affirming care as a social determinant of mental health inequities. METHODS: Data on unmet need for gender-affirming care, distress and suicidality were analysed from the 2018 Counting Ourselves nationwide community-based survey of transgender people in Aotearoa/New Zealand. Associations between unmet need for gender-affirming care and mental health indicators were tested for transgender youth within the sample (aged 14-26 years; n = 608; Mage = 20.5). RESULTS: Transgender youth reported unmet needs ranging from 42% for gender-affirming hormone to 100% for feminizing surgeries and voice surgeries. Overall unmet need for gender-affirming care was associated with worse mental health. Trans men with an unmet need for chest reconstruction (84%) scored an average of 7.13 points higher on the K10 Psychological Distress Scale relative to those whose need had been met. Participants reporting unmet need for hormones (42%) had twice the odds (adjusted odds ratios = 2.01; CI = 1.02-3.98) of having attempted suicide in the last 12 months. CONCLUSIONS: Dismantling barriers to accessing gender-affirming care could play a crucial role in reducing mental health inequities faced by transgender youth.

PrEP awareness and protective barrier negotiation among transgender people attracted to men in Aotearoa New Zealand.

INTRODUCTION: Internationally, trans women are disproportionately impacted by HIV, encounter specific barriers navigating safer sex and face inequities accessing HIV prevention, including pre-exposure prophylaxis (PrEP). Aotearoa/New Zealand (hereafter Aotearoa) was one of the first countries internationally to publicly fund PrEP in 2018, including for trans people. However, few data exist on PrEP awareness or sexual negotiation among trans populations to guide implementation. We present the first Aotearoa data on trans people's ability to negotiate barrier protection and awareness of PrEP efficacy and availability. METHODS: We used data from a large, diverse community-based nationwide survey of trans (including non-binary) people in Aotearoa: Counting Ourselves (N = 1178) conducted from 21 June to 30 September 2018. Generalized regression analyses were carried out among participants who have had sex (n = 704; Mage = 32.5) to identify associations between demographic factors (age, gender and sexual attraction, ethnicity, income, education qualification and current sex work involvement) and the Trans-Specific Barrier Negotiation Self-Efficacy (T-Barrier) Scale and PrEP awareness. RESULTS: The mean value of a 40-point T-Barrier Scale was 33.45 (SD: 6.89), suggesting a relatively high perceived ability among our participants to negotiate protective barrier usages in different situations. Asian participants scored 3.46 points lower compared to Pakeha (White) participants, and trans women attracted to men (cisgender and/or trans men) scored 2.40 points higher than trans women not attracted to men. Three-fifths (59.7%) were aware that PrEP reduced HIV risks and did not prevent sexually transmitted infections (STI) transmission, and only two-fifths (40.2%) knew PrEP was publicly funded for trans people. In multivariate models, we found participants who were older, trans women or those with lower education qualifications were less likely to have increased levels of PrEP awareness. CONCLUSIONS: Participants attracted to men have a higher potential need for PrEP and were more likely to report PrEP awareness and that they could negotiate protective barrier usage. However, trans women and those with lower educational qualifications reported lower levels of PrEP awareness. More trans-competent sexual health education, drawing on the newly released PrEP guidelines, is needed to promote the benefits of PrEP in the Aotearoa HIV epidemic context, particularly for trans women.

"Being Trans Intersects with My Cultural Identity": Social Determinants of Mental Health Among Asian Transgender People.

Purpose: While studies on the relationship between social determinants and mental health among transgender people in Asia are increasing, there is a paucity of research on Asian transgender people living in Western countries. This study aimed to examine how social positions (gender, ethnicity, and migrant status) and social determinants of mental health were inter-related for Asian transgender people in Aotearoa/New Zealand. Methods: We analyzed both quantitative and qualitative data from Asian participants (n=49) who responded to the 2018 Counting Ourselves: Aotearoa New Zealand Trans and Non-Binary Health Survey. Results: Overall, 35% reported a very high psychological distress level. There were high levels of unmet needs for gender-affirming care, and participants reported a range of negative experiences at health care settings. About two-fifths had been discriminated because of their transgender (42%) or Asian (39%) identities. Fewer than half of participants felt that their family members were supportive of them being transgender (44%), and most reported they had supportive friends (73%). More than two-thirds of participants (68%) had a strong sense of belongingness to the transgender community and 35% reported this for the Asian community. Qualitative findings revealed specific challenges that participants experienced; these included barriers to accessing health care due to their migrant status and language barriers, influences of Asian cultures on mental health experiences, and rejection by family and people in Asian communities. Conclusion: Our study provides evidence for health care providers, researchers, and policy makers to employ a culturally appropriate lens to improve knowledge about the intersectional experiences of being Asian and transgender.

"I teach them. I have no choice": experiences of primary care among transgender people in Aotearoa New Zealand.

AIM: This study aims to report primary care experiences among transgender people in Aotearoa New Zealand based on quantitative and qualitative data from a nationwide community-based survey of transgender people. METHODS: Subsamples with a usual general practitioner were employed from the 2018 Counting Ourselves Survey (n=871) and the 2018/19 New Zealand Health Survey to assess inequities between these samples in primary care experiences and barriers. Guided by Andersen's Behavioural Model of healthcare access, we conducted a content analysis on comments from Counting Ourselves participants (n=153) to identify themes about issues of concern for transgender people when accessing primary care. RESULTS: Transgender participants had greater risk of feeling no confidence in their GPs (Mdifference=0.22; Cohen's d=0.39), reporting barriers accessing primary care due to cost (38.4% vs 17.4%; RR=2.21), and transport issues (13.5% vs 3.0%; RR=4.58) compared to the general population. Content analysis uncovered how transgender people's primary care experiences are shaped by healthcare environments, predisposing characteristics, and enabling resources. CONCLUSION: Our findings indicate ways to ensure primary care services are inclusive so that all transgender people feel welcome. This requires all primary healthcare professionals to demonstrate core trans-specific cultural safety when providing healthcare to transgender patients.

Subclinical infection occurs frequently following low dose exposure to prions by blood transfusion.

Infectious prion diseases have very long incubation periods, and the role that subclinical infections play in transmission, persistence and re-emergence of these diseases is unclear. In this study, we used a well-established model of vCJD (sheep experimentally infected with bovine spongiform encephalopathy, BSE) to determine the prevalence of subclinical infection following exposure by blood transfusion from infected donors. Many recipient sheep survived for years post-transfusion with no clinical signs and no disease-associated PrP (PrPSc) found in post mortem tissue samples by conventional tests. Using a sensitive protein misfolding cyclic amplification assay (PMCA), we found that the majority of these sheep had detectable PrPSc in lymph node samples, at levels approximately 105-106 times lower than in equivalent samples from clinically positive sheep. Further testing revealed the presence of PrPSc in other tissues, including brain, but not in blood samples. The results demonstrate that subclinical infection is a frequent outcome of low dose prion infection by a clinically relevant route for humans (blood transfusion). The long term persistence of low levels of infection has important implications for prion disease control and the risks of re-emergent infections in both humans and animals.

Barriers to Possessing Gender-Concordant Identity Documents are Associated with Transgender and Nonbinary People's Mental Health in Aotearoa/New Zealand.

Purpose: This study sought to expand on previous scholarship focused on gender-concordant identity documents (IDs) as a social determinant of health. We examined the association between barriers to legal gender recognition and the mental health of transgender and nonbinary people in Aotearoa/New Zealand. Methods: We used data from a 2018 nationwide community-based survey of trans and nonbinary people in Aotearoa (N = 818). Variables of investigation included: gender-concordant IDs, mental health (past-month psychological distress, past-year nonsuicidal self-injury, past-year suicidality) and barriers to changing gender markers on a birth certificate or passport. Associations between gender-concordant IDs and mental health were determined using generalized linear regression models. Results: In total, 34.8% reported the correct name on all of their IDs. The proportion with the correct gender marker on both birth certificates and passports was 16.0%. Participants with gender-concordant IDs were more likely to be older, have higher levels of income and education, and have had genital reconstruction. In addition, 68.7% of participants reported experiencing at least one barrier to changing gender markers on their IDs, and these participants had significantly higher average points of psychological distress scores (b = 2.39) and greater odds of suicidal ideation (odds ratio = 2.02) than those with gender-concordant IDs, after adjusting for sociodemographic variables. Conclusion: We present novel findings on higher levels of mental health problems among trans and nonbinary people who faced barriers in trying to obtain gender-concordant IDs compared with those with gender-concordant IDs. Removing barriers to legal gender recognition may be an effective way to improve mental health.

Supportive interactions with primary care doctors are associated with better mental health among transgender people: results of a nationwide survey in Aotearoa/New Zealand.

BACKGROUND: Past research has established that transgender people experience significant disparities in mental health outcomes and healthcare dissatisfaction compared with cisgender people, but more research is needed on how supportive healthcare interactions relate to the mental health of transgender people. OBJECTIVES: The 2 main aims of our analyses were: (i) to establish the most common negative experiences in healthcare and the most common supportive experiences specifically with primary care doctors for transgender people; and (ii) to examine the association of supportive experiences with mental health variables after controlling for demographic factors. METHODS: Data from the 2018 Counting Ourselves nationwide survey of transgender people were analysed using regression modelling. The 948 participants with a primary care doctor or general practitioner were included in analyses. Participants were aged 14-83 years old (mean 30.20). RESULTS: The most common supportive experiences involved primary care doctors treating transgender people equitably, with competence, and with respect. Participants with more negative healthcare experiences had higher psychological distress as well as higher likelihood of reporting nonsuicidal self-injury and suicidality. Conversely, participants with more experiences of supportive primary care doctors had lower psychological distress and were less likely to have attempted suicide in the past 12 months. CONCLUSION: When transgender people receive supportive care from their primary care providers they experience better mental health, despite ongoing negative healthcare experiences. Future research is needed to confirm ways of supporting positive trajectories of mental health for transgender people but these findings demonstrate the importance of positive aspects of care.

Variation in coded frailty syndromes in secondary care administrative data: an international retrospective exploratory study.

OBJECTIVES: Challenges with manual methodologies to identify frailty, have led to enthusiasm for utilising large-scale administrative data, particularly standardised diagnostic codes. However, concerns have been raised regarding coding reliability and variability. We aimed to quantify variation in coding frailty syndromes within standardised diagnostic code fields of an international dataset. SETTING: Pooled data from 37 hospitals in 10 countries from 2010 to 2014. PARTICIPANTS: Patients ≥75 years with admission of >24 hours (N=1 404 671 patient episodes). PRIMARY AND SECONDARY OUTCOME MEASURES: Frailty syndrome groups were coded in all standardised diagnostic fields by creation of a binary flag if the relevant diagnosis was present in the 12 months leading to index admission. Volume and percentages of coded frailty syndrome groups by age, gender, year and country were tabulated, and trend analysis provided in line charts. Descriptive statistics including mean, range, and coefficient of variation (CV) were calculated. Relationship to in-hospital mortality, hospital readmission and length of stay were visualised as bar charts. RESULTS: The top four contributors were UK, US, Norway and Australia, which accounted for 75.4% of the volume of admissions. There were 553 595 (39.4%) patient episodes with at least one frailty syndrome group coded. The two most frequently coded frailty syndrome groups were 'Falls and Fractures' (N=3 36 087; 23.9%) and 'Delirium and Dementia' (N=221 072; 15.7%), with the lowest CV. Trend analysis revealed some coding instability over the frailty syndrome groups from 2010 to 2014. The four countries with the lowest CV for coded frailty syndrome groups were Belgium, Australia, USA and UK. There was up to twofold, fourfold and twofold variation difference for outcomes of length of stay, 30-day readmission and inpatient mortality, respectively, across the countries. CONCLUSIONS: Variation in coding frequency for frailty syndromes in standardised diagnostic fields are quantified and described. Recommendations are made to account for this variation when producing risk prediction models.

Mental health of people of diverse genders and sexualities in Aotearoa/New Zealand: Findings from the New Zealand Mental Health Monitor.

ISSUES ADDRESSED: To examine the mental health inequities, and social exclusion and isolation and protective factor differences between people of diverse genders and sexualities (lesbian/gay, bisexual, gender diverse and takatapui) and cisgender and heterosexual people in Aotearoa/New Zealand. METHODS: We employed data from the pooled probability sample of 2016 and 2018 New Zealand Mental Health Monitor. The sample comprised of 2938 people at least 15 years old, of which 93 had diverse gender and sexuality identities. Generalised linear models were used to test for differences in mental health (current and lifetime mental distress, depression, anxiety, self-harm and suicide), social exclusion and isolation, and friend and family support for people of diverse genders and sexualities. We also conducted exploratory linear regression analyses to examine whether mental health difficulties were associated with social exclusion and isolation and friend/family support. RESULTS: People of diverse genders and sexualities had high rates of mental health difficulties across all variables we examined. For example, people identifying as diverse genders and sexualities had three times the risk of considering self-harm and suicide than their cisgender and heterosexual counterparts (22% vs 5%; RR = 3.12). People of diverse genders and sexualities also scored an average of 6.08 points higher on the 27-point PHQ-9 depression scale when they had experienced social isolation, and 4.01 points higher when they experienced social exclusion. CONCLUSION: Our results are consistent with current literature on the large mental health inequities faced by people of diverse genders and sexualities. SO WHAT?: Policy makers and health care providers in Aotearoa/New Zealand should consider the negative mental health consequences of social exclusion and isolation for people of diverse genders and sexualities.

Stratification of Patients with Diabetes Using Continuous Glucose Monitoring Profiles and Machine Learning.

Background. Continuous glucose monitoring (CGM) offers an opportunity for patients with diabetes to modify their lifestyle to better manage their condition and for clinicians to provide personalized healthcare and lifestyle advice. However, analytic tools are needed to standardize and analyze the rich data that emerge from CGM devices. This would allow glucotypes of patients to be identified to aid clinical decision-making.Methods. In this paper, we develop an analysis pipeline for CGM data and apply it to 148 diabetic patients with a total of 8632 days of follow up. The pipeline projects CGM data to a lower-dimensional space of features representing centrality, spread, size, and duration of glycemic excursions and the circadian cycle. We then use principal components analysis and k-means to cluster patients' records into one of four glucotypes and analyze cluster membership using multinomial logistic regression.Results. Glucotypes differ in the degree of control, amount of time spent in range, and on the presence and timing of hyper- and hypoglycemia. Patients on the program had statistically significant improvements in their glucose levels.Conclusions. This pipeline provides a fast automatic function to label raw CGM data without manual input.