Special Issue: Examining the Impacts of Social Determinants on HIV Health and Prevention.

Assessing the impact of social determinants of health (SDoH) has become an important part of the holistic view of an individual's health status [...].

Measuring Phases of Employment Decision-Making and the Need for Vocational Services as a Social Determinant of the Health of Employed People Living with HIV.

(1) Background: Secure employment has been recognized as a social determinant of health for people living with HIV (PLHIV), but limited research has been conducted to understand the employment needs and vocational decision-making process of those who are employed. The purpose of this study is to examine the applicability of the client-focused considering-work model to assess the employment outcomes and employment decision-making phases of a sample of employed PLHIV. (2) Methods: This study analyzed data of 244 employed PLHIV who completed National Working Positive Coalition's Employment Needs Survey which included a 20-item Considering Work Scale-Employed version (CWS-Employed) and a single-item Classification of Employment Status Scale (CESS). Factor analysis was used to evaluate the CWS-Employed. Chi-square tests of homogeneity of proportions were conducted to assess the domain-specific needs of individuals in each phase of employment decision-making. (3) Results: Our findings revealed high rates of insecure employment and diverse vocational service needs among research participants. Additionally, the CWS-Employed accurately predicted 71% of the self-reported classification of phases of employment decision-making. (4) Conclusions: When investigating the role of employment as a social determinant of health, more research is needed to better understand the vocational needs and outcomes of PLHIV who are working. Improving the measurement of the phases of employment decision-making is needed to better identify appropriate vocational interventions that can lead to improved employment and related health outcomes for this population.

Validating the client-focused considering work model for people living with HIV and quantifying phases of change of commitment to work.

The primary purpose of this study was to validate the client-focused considering work model and to gain a better understanding of the nature of the relationship among the four domains purported to influence the considering work process (medical, psychosocial, financial/legal and vocational). A second goal of the study was to quantify the relationship between these four domains and the phases of considering work (contemplation, preparation, action, resolution). Structural equation modeling was used to analyze data of 1702 diverse (43% Black, 31% White, 19% Latino 7% other) unemployed respondents who were recruited from AIDS Service Organizations (ASO) and networks across the United States to complete the National Working Positive Vocational Development and Employment Needs Survey (NWPC-VDENS). Overall the results of this study supported the validity of the client-focused considering work model and helped to provide a deeper level of understanding of the relationship among the domains of influence and their contribution to the level of commitment to the considering work process. Implications for Rehabilitation This model enables rehabilitation professionals to consider interventions for clients at different phases (contemplation, preparation, action) of considering work. Rehabilitation professionals are encouraged to provide prevocational services to engage people with HIV in the considering work process. When assisting PLWH within the considering work process, it is important to assess not only medical status but also psychosocial, financial and vocational concerns.

Is any job better than no job? Labor market experiences and depressive symptoms in people living with HIV.

The purpose of this study is to determine the relationship between the psychosocial work environment and labor market experiences (including unemployment) on mental health among adults living with HIV. We used data provided by 538 participants at clinical and community sites across Ontario, Canada. Generalized estimating equation models showed that employment was associated with lower depressive symptoms. For employed participants, adverse psychosocial work conditions, specifically job insecurity, psychological demands, and decision authority were associated with depressive symptoms. For the entire sample, the number of adverse psychosocial work conditions was associated with higher depressive symptoms while participants working in poor quality jobs reported similar levels of depressive symptoms than those who were unemployed or not in the labor force. This study showed that poor quality employment (as assessed by having a high number of adverse psychosocial work exposures) was associated with a similar level of depressive symptoms as unemployment, suggesting that "bad jobs" may not offer the same mental health benefits as "good jobs." Policies to improve employment outcomes should take the quality of employment into account to maximize mental health benefits as better employment may lead to better mental health.

The cognitive and behavioral phenotype of the 16p11.2 deletion in a clinically ascertained population.

BACKGROUND: Deletion of the recurrent ~600 kb BP4-BP5 chromosomal region 16p11.2 has been associated with a wide range of neurodevelopmental outcomes. METHODS: To clarify the phenotype of 16p11.2 deletion, we examined the psychiatric and developmental presentation of predominantly clinically referred individuals, with a particular emphasis on broader autism phenotype characteristics in individuals with recurrent ~600 kb chromosome 16p11.2 deletions. Using an extensive standardized assessment battery across three clinical sites, 85 individuals with the 16p11.2 deletion and 153 familial control subjects were evaluated for symptom presentation and clinical diagnosis. RESULTS: Individuals with the 16p11.2 deletion presented with a high frequency of psychiatric and developmental disorders (>90%). The most commonly diagnosed conditions were developmental coordination disorder, phonologic processing disorder, expressive and receptive language disorders (71% of individuals >3 years old with a speech and language-related disorder), and autism spectrum disorder. Individuals with the 16p11.2 deletion not meeting diagnostic criteria for autism spectrum disorder had a significantly higher prevalence of autism-related characteristics compared with the familial noncarrier control group. Individuals with the 16p11.2 deletion had a range of intellectual ability, but IQ scores were 26 points lower than noncarrier family members on average. CONCLUSIONS: Clinically referred individuals with the 16p11.2 deletion have high rates of psychiatric and developmental disorders and provide a genetically well-defined group to study the emergence of developmental difficulties, particularly associated with the broader autism phenotype.

Emission of herbivore elicitor-induced sesquiterpenes is regulated by stomatal aperture in maize (Zea mays) seedlings.

Maize seedlings emit sesquiterpenes during the day in response to insect herbivory. Parasitoids and predators use induced volatile blends to find their hosts or prey. To investigate the diurnal regulation of biosynthesis and emission of induced sesquiterpenes, we applied linolenoyl-L-glutamine (LG) to maize seedlings in the morning or evening using a cut-stem assay and tracked farnesene emission, in planta accumulation, as well as transcript levels of farnesyl pyrophosphate synthase 3 (ZmFPPS3) and terpene synthase10 (ZmTPS10) throughout the following day. Independent of time of day of LG treatment, maximum transcript levels of ZmFPPS3 and ZmTPS10 occurred within 3-4 h after elicitor application. The similarity between the patterns of farnesene emission and in planta accumulation in light-exposed seedlings in both time courses suggested unobstructed emission in the light. After evening induction, farnesene biosynthesis increased dramatically during early morning hours. Contrary to light-exposed seedlings dark-kept seedlings retained the majority of the synthesized farnesene. Two treatments to reduce stomatal aperture, dark exposure at midday, and abscisic acid treatment before daybreak, resulted in significantly reduced amounts of emitted and significantly increased amounts of in planta accumulating farnesene. Our results suggest that stomata not only play an important role in gas exchange for primary metabolism but also for indirect plant defences.

Social cognition and brain morphology: implications for developmental brain dysfunction.

The social-cognitive deficits associated with several neurodevelopmental and neuropsychiatric disorders have been linked to structural and functional brain anomalies. Given the recent appreciation for quantitative approaches to behavior, in this study we examined the brain-behavior links in social cognition in healthy young adults from a quantitative approach. Twenty-two participants were administered quantitative measures of social cognition, including the social responsiveness scale (SRS), the empathizing questionnaire (EQ) and the systemizing questionnaire (SQ). Participants underwent a structural, 3-T magnetic resonance imaging (MRI) procedure that yielded both volumetric (voxel count) and asymmetry indices. Model fitting with backward elimination revealed that a combination of cortical, limbic and striatal regions accounted for significant variance in social behavior and cognitive styles that are typically associated with neurodevelopmental and neuropsychiatric disorders. Specifically, as caudate and amygdala volumes deviate from the typical R > L asymmetry, and cortical gray matter becomes more R > L asymmetrical, overall SRS and Emotion Recognition scores increase. Social Avoidance was explained by a combination of cortical gray matter, pallidum (rightward asymmetry) and caudate (deviation from rightward asymmetry). Rightward asymmetry of the pallidum was the sole predictor of Interpersonal Relationships and Repetitive Mannerisms. Increased D-scores on the EQ-SQ, an indication of greater systemizing relative to empathizing, was also explained by deviation from the typical R > L asymmetry of the caudate.These findings extend the brain-behavior links observed in neurodevelopmental disorders to the normal distribution of traits in a healthy sample.

The role of parental cognitive, behavioral, and motor profiles in clinical variability in individuals with chromosome 16p11.2 deletions.

IMPORTANCE: Most disorders caused by copy number variants (CNVs) display significant clinical variability, often referred to as incomplete penetrance and variable expressivity. Genetic and environmental sources of this variability are not well understood. OBJECTIVES: To investigate the contributors to phenotypic variability in probands with CNVs involving the same genomic region; to measure the effect size for de novo mutation events; and to explore the contribution of familial background to resulting cognitive, behavioral, and motor performance outcomes in probands with de novo CNVs. DESIGN, SETTING, AND PARTICIPANTS: Family-based study design with a volunteer sample of 56 individuals with de novo 16p11.2 deletions and their noncarrier parents and siblings from the Simons Variation in Individuals Project. MAIN OUTCOMES AND MEASURES: We used linear mixed-model analysis to measure effect size and intraclass correlation to determine the influence of family background for a de novo CNV on quantitative traits representing the following 3 neurodevelopmental domains: cognitive ability (Full-Scale IQ), social behavior (Social Responsiveness Scale), and neuromotor performance (Purdue Pegboard Test). We included an anthropometric trait, body mass index, for comparison. RESULTS: A significant deleterious effect of the 16p11.2 deletion was demonstrated across all domains. Relative to the biparental mean, the effect sizes were -1.7 SD for cognitive ability, 2.2 SD for social behavior, and -1.3 SD for neuromotor performance (P < .001). Despite large deleterious effects, significant positive correlations between parents and probands were preserved for the Full-Scale IQ (0.42 [P = .03]), the verbal IQ (0.53 [P = .004]), and the Social Responsiveness Scale (0.52 [P = .009]) scores. We also observed a 1-SD increase in the body mass index of probands compared with siblings, with an intraclass correlation of 0.40 (P = .07). CONCLUSIONS AND RELEVANCE: Analysis of families with de novo CNVs provides the least confounded estimate of the effect size of the 16p11.2 deletion on heritable, quantitative traits and demonstrates a 1- to 2-SD effect across all neurodevelopmental dimensions. Significant parent-proband correlations indicate that family background contributes to the phenotypic variability seen in this and perhaps other CNV disorders and may have implications for counseling families regarding their children's developmental and psychiatric prognoses. Use of biparental mean scores rather than general population mean scores may be more relevant to examine the effect of a mutation or any other cause of trait variation on a neurodevelopmental outcome and possibly on systems of diagnosis and trait ascertainment for developmental disorders.

Social cognition, face processing, and oxytocin receptor single nucleotide polymorphisms in typically developing children.

Recent research has provided evidence of a link between behavioral measures of social cognition (SC) and neural and genetic correlates. Differences in face processing and variations in the oxytocin receptor (OXTR) gene have been associated with SC deficits and autism spectrum disorder (ASD) traits. Much work has examined the qualitative differences between those with ASD and typically developing (TD) individuals, but very little has been done to quantify the natural variation in ASD-like traits in the typical population. The present study examines this variation in TD children using a multidimensional perspective involving behavior assessment, neural electroencephalogram (EEG) testing, and OXTR genotyping. Children completed a series of neurocognitive assessments, provided saliva samples for sequencing, and completed a face processing task while connected to an EEG. No clear pattern emerged for EEG covariates or genotypes for individual OXTR single nucleotide polymorphisms (SNPs). However, SNPs rs2254298 and rs53576 consistently interacted such that the AG/GG allele combination of these SNPs was associated with poorer performance on neurocognitive measures. These results suggest that neither SNP in isolation is risk-conferring, but rather that the combination of rs2254298(A/G) and rs53576(G/G) confers a deleterious effect on SC across several neurocognitive measures.

Adaptive and maladaptive correlates of repetitive behavior and restricted interests in persons with down syndrome and developmentally-matched typical children: a two-year longitudinal sequential design.

We examined the course of repetitive behavior and restricted interests (RBRI) in children with and without Down syndrome (DS) over a two-year time period. Forty-two typically-developing children and 43 persons with DS represented two mental age (MA) levels: "younger" 2-4 years; "older" 5-11 years. For typically developing younger children some aspects of RBRI increased from Time 1 to Time 2. In older children, these aspects remained stable or decreased over the two-year period. For participants with DS, RBRI remained stable or increased over time. Time 1 RBRI predicted Time 2 adaptive behavior (measured by the Vineland Scales) in typically developing children, whereas for participants with DS, Time 1 RBRI predicted poor adaptive outcome (Child Behavior Checklist) at Time 2. The results add to the body of literature examining the adaptive and maladaptive nature of repetitive behavior.

Examining the role of vocational rehabilitation on access to care and public health outcomes for people living with HIV/AIDS.

PURPOSE: The purpose of this study is to examine the role of vocational rehabilitation services in contributing to the goals of the National HIV/AIDS strategy. Three key research questions are addressed: (a) What is the relationship among factors associated with the use of vocational rehabilitation services for people living with HIV/AIDS? (b) Are the factors associated with use of vocational rehabilitation also associated with access to health care, supplemental employment services and reduced risk of HIV transmission? and (c) What unique role does use of vocational rehabilitation services play in access to health care and HIV prevention? METHOD: Survey research methods were used to collect data from a broad sample of volunteer respondents who represented diverse racial (37% Black, 37% White, 18% Latino, 7% other), gender (65% male, 34% female, 1% transgender) and sexual orientation (48% heterosexual, 44% gay, 8% bisexual) backgrounds. RESULTS: The fit of the final structural equation model was good (root mean square error of approximation = 0.055), with 90% upper bound of 0.058, Comparative Fit Index = 0.953, TLI = 0.945). Standardized effects with bootstrap confidence intervals are reported. CONCLUSIONS: Overall, the findings support the hypothesis that vocational rehabilitation services can play an important role in health and prevention strategies outlined in the National HIV/AIDS strategy.

UV responses in Native Hawaiians and Pacific Islanders, and Asians residing in Hawai'i and in Maryland.

BACKGROUND: UV exposure causes a wide range of skin damage including cutaneous melanoma. The mechanisms of cellular and molecular damage, as well as those of erythemal and pigmentation responses to UV exposure, have largely been studied in the White population. METHODS: This study systematically investigates responses to UV exposure in the Native Hawaiian and Pacific Islander (NHPI) and Asian populations living in Hawai'i (A/HI) as well as in Asians living in Maryland (A/MD). RESULTS: Our analyses indicate that the NHPI population is less sensitive to UV exposure than the A/HI population. Comparisons between the two Asian groups suggest that, despite slightly but not statistically different baseline constitutive pigmentation (pre-UV exposure), the A/HI and A/MD had similar UV sensitivity, measured as minimal erythemal dose (MED). However, the A/MD population had higher levels of oxyhemoglobin at doses of 2.0, 2.8 and 4.0 MED. Unexpectedly, the A/MD subjects retained higher levels of pigmentation 2 weeks post-UV exposure. CONCLUSION: This study provides insight into UV responses of the inhabitants of Hawai'i and shows that such responses are statistically significant for relatively small samples of NHPI and for A/HI and A/MD.

Are comic books an effective way to engage nonmajors in learning and appreciating science?

Comic books employ a complex interplay of text and images that gives them the potential to effectively convey concepts and motivate student engagement. This makes comics an appealing option for educators trying to improve science literacy about pressing societal issues involving science and technology. Here, we report results from the first systematic assessment of how a science comic book can affect student learning and attitudes about biology. We used pre- and postinstruction instruments to measure students' attitudes about biology, attitudes about comics, and content knowledge about evolution before and after using the science comic book Optical Allusions in their classes. On the preinstruction instrument, nonmajors reported the lowest scores on the content test and attitude surveys relative to the other groups. However, on the postinstruction instrument, nonmajors' content scores and attitudes showed a statistically significant improvement after using the comic book, particularly among those with lower content knowledge at the start of the semester. The improvement in attitudes about biology was correlated to attitudes about comics, suggesting that the comic may have played a role in engaging and shaping student attitudes in a positive way.

Analysis of candidate genes and hypertension in African American adults.

OBJECTIVE: We investigated the associations between hypertension status and the genotypes of four single nucleotide polymorphism (SNP) sites in four hypertension-related genes (Angiotensinogen [AGT], Angiotensin I Converting Enzyme [ACE], Angiotensinogen II receptor, subtype 1 [AGTR1], and Alpha 1-Antichymotrypsin [ACT or SERPINA3]), in an African American sample. METHODS: DNA from 628 participants of the Carolina African American Twin Study of Aging project, a population-based study of African American adult twins, was genotyped using SNPs shown to be associated with hypertension in other studies. RESULTS: The ACE SNP (ACE4 or A-240T) was associated with hypertension (P = .047 in a generalized estimating equations alternating logistics regression model that included age, body mass index, sex, and education. The analysis indicated a protective effect of the TT genotype (odds ratio [OR] 1.59, 95% confidence interval [CI] 1.03-2.48, P = .04) and of the AT genotype (OR 1.91, 95% CI 1.01-3.62, P = .047) compared with the AA genotype. DISCUSSION: These results extend previous findings of associations of various polymorphisms of ACE to hypertension and support the association of hypertension to the A allele of ACE4. The potential for this polymorphism to alter expression by its position in the gene's promoter region suggests that future studies of altered ACE protein activity are warranted.

Workplace discrimination and HIV/AIDS: the national EEOC ADA research project.

This article utilizes data from the Equal Employment Opportunity Commission's Integrated Mission System database to document the levels of employment discrimination involving individuals with HIV/AIDS. The researchers explore the theory that the nature of HIV/AIDS related employment discrimination is rooted in deeper stigmatization than discrimination against other disability groups. Researchers compare and contrast key demographic characteristics of Charging Parties and Respondents involved in HIV/AIDS related allegations of discrimination and their proportion of EEOC merit resolutions to those of persons with other physical, sensory, and neurological impairments. Findings indicate that, in contrast to the general disability group, HIV/AIDS was more likely to be male, ethnic minorities, between the ages of 25-44, in white collar jobs, in the South and West and to work for businesses with 15 to 100 employees. Additionally, the allegations in HIV/AIDS were more likely to receive merit resolution from the EEOC by a large difference of ten percent.