Defining malaria risks among forest workers in Aceh, Indonesia: a formative assessment.

BACKGROUND: Following a dramatic decline of malaria cases in Aceh province, geographically-based reactive case detection (RACD) was recently evaluated as a tool to improve surveillance with the goal of malaria elimination. While RACD detected few cases in households surrounding index cases, engaging in forest work was identified as a risk factor for malaria and infections from Plasmodium knowlesi-a non-human primate malaria parasite-were more common than expected. This qualitative formative assessment was conducted to improve understanding of malaria risk from forest work and identify strategies for targeted surveillance among forest workers, including adapting reactive case detection. METHODS: Between June and August, 2016, five focus groups and 18 in-depth interviews with forest workers and key informants were conducted in each of four subdistricts in Aceh Besar and Aceh Jaya districts. Themes included: types of forest activities, mobility of workers, interactions with non-human primates, malaria prevention and treatment-seeking behaviours, and willingness to participate in malaria surveys at forest work sites and using peer-referral. RESULTS: Reported forest activities included mining, logging, and agriculture in the deep forest and along the forest fringe. Forest workers, particularly miners and loggers, described often spending weeks to months at work sites in makeshift housing, rarely utilizing mosquito prevention and, upon fever, self-medicating and seeking care from traditional healers or pharmacies rather than health facilities. Non-human primates are frequently observed near work sites, and most forest work locations are within a day's journey of health clinics. Employers and workers expressed interest in undertaking malaria testing and in participating in survey recruitment by peer-referral and at work sites. CONCLUSIONS: Diverse groups of forest workers in Aceh are potentially exposed to malaria through forest work. Passive surveillance and household-based screening may under-estimate malaria burden due to extended stays in the forest and health-seeking behaviours. Adapting active surveillance to specifically target forest workers through work-site screening and/or peer-referral appears promising for addressing currently undetected infections.

Trans adolescents' perceptions and experiences of their parents' supportive and rejecting behaviors.

Transgender (trans) adolescents consistently report higher rates of adverse mental health outcomes compared to their cisgender peers. Parental support is a recognized adolescent protective factor; however, little is known about the specific parental behaviors that trans adolescents perceive as most or least supportive. To address this gap, we analyzed data from qualitative interviews conducted with an ethnically diverse, urban-based sample of trans adolescents (N = 24; 16-20 years old) to describe (a) the spectrum of specific parental behaviors across 3 categories-rejecting, supportive, and mixed (i.e., simultaneous supportive and rejecting behaviors)-and (b) the perceived psychosocial consequences across these 3 categories of parental behaviors. Qualitative data were gathered through lifeline interviews (i.e., visual representations from birth to present) and photo elicitation (i.e., photographs representing parental support and/or rejection). Supportive behaviors included instances where parents made independent efforts to learn about trans issues or help their child obtain gender-affirming health care. Rejecting behaviors included instances when parents refused to use their child's name or pronouns or failed to show empathy when their child struggled with gender-identity-related challenges. Mixed behaviors included examples when parents expressed support of their child's gender identity, but not of their sexual orientation (or vice versa). Overall, participants reported that rejecting and mixed parental behaviors contributed to a range of psychosocial problems (e.g., depression and suicidal ideation), while supportive behaviors increased positive wellbeing. These findings expand upon descriptions of parental support and rejection within the trans adolescent literature and can help practitioners target specific behaviors for interventions. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Effect of Chronological Age on Pulse Rate Discrimination in Adult Cochlear-Implant Users.

Cochlear-implant (CI) users rely heavily on temporal envelope cues to understand speech. Temporal processing abilities may decline with advancing age in adult CI users. This study investigated the effect of age on the ability to discriminate changes in pulse rate. Twenty CI users aged 23 to 80 years participated in a rate discrimination task. They attempted to discriminate a 35% rate increase from baseline rates of 100, 200, 300, 400, or 500 pulses per second. The stimuli were electrical pulse trains delivered to a single electrode via direct stimulation to an apical (Electrode 20), a middle (Electrode 12), or a basal location (Electrode 4). Electrically evoked compound action potential amplitude growth functions were recorded at each of those electrodes as an estimate of peripheral neural survival. Results showed that temporal pulse rate discrimination performance declined with advancing age at higher stimulation rates (e.g., 500 pulses per second) when compared with lower rates. The age-related changes in temporal pulse rate discrimination at higher stimulation rates persisted after statistical analysis to account for the estimated peripheral contributions from electrically evoked compound action potential amplitude growth functions. These results indicate the potential contributions of central factors to the limitations in temporal pulse rate discrimination ability associated with aging in CI users.

Invalidation Experiences Among Non-Binary Adolescents.

Mental health disparities among transgender adolescents are well documented and have generally been attributed to minority stress. However, significantly less is known about the minority stress experiences of non-binary adolescents or those who do not identify as exclusively male or female. This study qualitatively explored the unique ways that non-binary adolescents experience minority stress and how it influences their mental health and well-being. Lifeline methodology and photo elicitation were used to interview 14 ethnically diverse non-binary adolescents between the ages of 16 and 20, residing in New York City (NYC) and the San Franscicso Bay Area (SFBA). We present participants' experiences using a novel construct of invalidation, defined as the refusal to accept one's identity as real or true. Our findings indicate that invalidation is conceptually distinct from the established minority stressor of "non-affirmation." Non-binary adolescents experienced myriad forms of invalidation within multiple social contexts, which contributed to negative affective and cognitive processes, including confusion, self-doubt, rumination, and internalized shame. For many participants, the cumulative stressors related to invalidation contributed to poor mental health outcomes. Data from this study suggest that identity invalidation is a unique form of minority stress that may especially affect non-binary individuals, with significant implications for their social and emotional well-being.

Social Ecological Correlates of Polyvictimization among a National Sample of Transgender, Genderqueer, and Cisgender Sexual Minority Adolescents.

Polyvictimization is a common experience for youth in the United States, with 20% nationally experiencing five or more different forms of victimization in the last year. Utilizing a large, national convenience sample of sexual and gender minority adolescents (N = 1177, 14-19 years old), the current study aimed to (a) generate the first estimates of last year polyvictimization (including nine victimization subtypes) for transgender, genderqueer, and cisgender (i.e., assigned birth sex aligns with gender identity) sexual minority adolescents and (b) identify social ecological correlates of last year polyvictimization. The study utilized an online survey advertised through Facebook and community organizations across the United States. Approximately, 40% of participants experienced ten or more different forms of victimization in the last year and were classified as polyvictims. A significantly higher percentage of transgender female (63.4%), transgender male (48.9%), genderqueer assigned male at birth (71.5%) and genderqueer assigned female at birth (49.5%) were polyvictimized in comparison to cisgender sexual minority males (33.0%). Polyvictimization rates for cisgender sexual minority females (35.1%) were not significantly different from male counterparts (33.0%). Several significant risk factors for polyvictimization were identified: genderqueer identity for participants assigned male at birth and higher-levels of posttraumatic stress, family-level microaggressions, and peer rejection. The manuscript concludes with recommendations for future research including the exploration of factors (e.g., lack of community support, gender-role policing) associated with higher polyvictimization rates for genderqueer adolescents. Additionally, professionals (e.g., foster care, homeless shelters, schools) require new tools to assess for polyvictimization among sexual and gender minority adolescents.

Laparoendoscopic single site orchiopexy.

We report a laparoendoscopic single site orchiopexy in a 2-year-old boy with a right nonpalpable testis. Diagnostic laparoscopy using a 5-mm port revealed a right intraabdominal testis. The 5-mm port site was extended to accommodate the smallest commercially available triport, and orchiopexy was performed. The operative time was 55 minutes, and the estimated blood loss was minimal. There were no complications, and surgical and cosmetic results were excellent. Laparoendoscopic single site surgery is a feasible technique for orchiopexy of the nonpalpable testis.

Pediatric single-port-access nephrectomy for a multicystic, dysplastic kidney.

Major urologic surgery via a single port has emerged as the latest progression in laparoscopy and robotics. While current literature highlights the single-port approach to the surgical treatment of cholecystitis, appendicitis and varicoceles, this technique has never been employed to perform a nephrectomy on a child. We herein report a case of a pediatric patient who underwent nephrectomy via single-port-access.

Management of obstructing fungal pyelonephritis in infants.

This case report and literature review suggest that infants with renal obstruction due to Candida albicans pyelonephritis often require drainage, in addition to systemic antifungal agents, to treat the infection.