Predictors of mood or anxiety problems among transgender individuals seeking hormone therapy.

BACKGROUND: Mental health needs of transgender individuals can be complex with individual, social, and medical factors impacting symptoms. This study examines predictors of mood or anxiety problems among transgender individuals seeking hormone therapy (HT). METHODS: A retrospective chart review was conducted at 2 clinics providing gender-affirming HT. Cross-sectional data from initial patient encounters (N = 311) were used in this study. Bivariate correlations and multiple logistic regression analyses were carried out. RESULTS: Transgender women (TW) were 2.2 times more likely to have mood or anxiety problems while transgender men (TM) were 2.6 times more likely as the number of medical comorbidities increased. For both TW and TM, White race significantly increased the likelihood of mood or anxiety problems. Neither previous nor current HT were associated with mood or anxiety problems for TW and TM. However, receiving multiple gender-affirming procedures decreased the likelihood of mood or anxiety problems for TM. CONCLUSIONS: Gender-affirming care and addressing comorbidities can be important aspects of mental health needs for transgender individuals.

The majority of transgender men and women reported 1 or more chronic health conditions. These health conditions were associated with transgender individuals being more likely to have a mood or anxiety problem. Currently receiving or previously receiving hormonal therapy was not associated with mood or anxiety problems for transgender men or women, but having received 1 or multiple gender-affirming procedures was associated with a decrease in likelihood of having a mood or anxiety problem for transgender men. White race also was associated with increased likelihood of having a mood or anxiety problem for transgender men and women. These results highlight the need for primary care physicians to take a comprehensive approach when dealing with the mental health needs of transgender patients by ensuring that general health care needs are met while receiving gender-affirming care.

Barriers and facilitators of family rules and routines during pediatric cancer treatment.

OBJECTIVE: Pediatric nurses work closely with families of children with new cancer diagnoses and can provide essential supports to promote coping and adjustment. This cross-sectional qualitative study aimed to gather caregiver perspectives on barriers and facilitators to adaptive family functioning during the early phases of cancer treatment, with a focus on family rules and routines. METHODS: Caregivers (N = 44) of a child diagnosed with cancer and receiving active treatment completed a semi-structured interview about their engagement in family rules and routines. Time since diagnosis was abstracted from the medical record. A multi-pass inductive coding strategy was utilized to extract themes identifying caregiver-reported facilitators and barriers to maintaining consistent family rules and routines during the first year of pediatric treatment. RESULTS: Caregivers identified three primary contexts that presented barriers and facilitators to engagement in family rules and routines: the hospital setting (n = 40), the family system (n = 36), and the broader social and community setting (n = 26). Caregivers reported barriers primarily related to the demands of their child's treatment, additional caregiving needs, and needing to prioritize basic daily tasks (e.g., food, rest, household needs). Caregivers reported that different networks of support across contexts facilitated family rules and routines by expanding caregiver capacity in distinctive ways. CONCLUSIONS: Findings provided insight into the importance of having multiple networks of support to extend caregiving capacity in the context of cancer treatment demands. PRACTICE IMPLICATIONS: Providing nurses with training to facilitate problem-solving skills in the context of competing demands may provide a new avenue of clinical intervention at the bedside.

Family rules, routines, and caregiver distress during the first year of pediatric cancer treatment.

OBJECTIVE: A new diagnosis of pediatric cancer may disrupt family functioning. The current study aimed to describe changes in family rules and routines during the first year of pediatric cancer treatment, and to explore associations with demographics, illness factors, and caregiver distress. METHODS: This exploratory mixed-methods, cross-sectional study examined 44 primary caregivers of youth in treatment for a new cancer diagnosis in 2019 and 2020, before the onset of the COVID-19 pandemic. Caregivers completed validated questionnaires assessing demographic and child illness characteristics, psychosocial distress, and cancer-related stressors, and participated in a semi-structured interview about family rules and routines. RESULTS: Caregivers reported changes in bedtime, mealtime, and school routines, relaxed behavioral expectations and rules around screen time, and new rules and routines around treatment, medications, and infection control. Caregivers with elevated levels of psychosocial distress reported more changed routines than caregivers with low levels of psychosocial distress. Caregivers who endorsed more cancer-related stressors reported more new rules and routines than those who reported fewer cancer-related stressors. Demographic and illness factors were not significantly associated with the number of changed, new, or stable family rules and routines. CONCLUSIONS: Families may relax rules and routines during the first several months of diagnosis, and this may be related to side effects of treatment and limited caregiver capacity. The long-term impact of changes in family rules and routines during cancer treatment warrants further study given that accommodating parenting strategies have been associated with adverse short- and long-term child health and behavior outcomes.

Future habitat loss and extinctions driven by land-use change in biodiversity hotspots under four scenarios of climate-change mitigation.

Numerous species have been pushed into extinction as an increasing portion of Earth's land surface has been appropriated for human enterprise. In the future, global biodiversity will be affected by both climate change and land-use change, the latter of which is currently the primary driver of species extinctions. How societies address climate change will critically affect biodiversity because climate-change mitigation policies will reduce direct climate-change impacts; however, these policies will influence land-use decisions, which could have negative impacts on habitat for a substantial number of species. We assessed the potential impact future climate policy could have on the loss of habitable area in biodiversity hotspots due to associated land-use changes. We estimated past extinctions from historical land-use changes (1500-2005) based on the global gridded land-use data used for the Intergovernmental Panel on Climate Change Fifth Assessment Report and habitat extent and species data for each hotspot. We then estimated potential extinctions due to future land-use changes under alternative climate-change scenarios (2005-2100). Future land-use changes are projected to reduce natural vegetative cover by 26-58% in the hotspots. As a consequence, the number of additional species extinctions, relative to those already incurred between 1500 and 2005, due to land-use change by 2100 across all hotspots ranged from about 220 to 21000 (0.2% to 16%), depending on the climate-change mitigation scenario and biological factors such as the slope of the species-area relationship and the contribution of wood harvest to extinctions. These estimates of potential future extinctions were driven by land-use change only and likely would have been higher if the direct effects of climate change had been considered. Future extinctions could potentially be reduced by incorporating habitat preservation into scenario development to reduce projected future land-use changes in hotspots or by lessening the impact of future land-use activities on biodiversity within hotspots.

La Futura Pérdida de Hábitat y Extinciones Causados por el Cambio en el Uso de Suelo en los Puntos Clave de Biodiversidad bajo Cuatro Escenarios de Mitigación de Cambio Climático Resumen Se ha llevado a numerosas especies a la extinción conforme una porción creciente de la superficie terrestre ha sido adueñada por actividades humanas. En el futuro, la biodiversidad global se verá afectada tanto por el cambio climático como por el cambio en el uso de suelo, de los cuales el último es actualmente el principal conductor de la extinción de especies. La manera en que las sociedades aborden el cambio climático afectará críticamente a la biodiversidad ya que las políticas de mitigación de cambio climático reducirán directamente los impactos del cambio climático; sin embargo, estas políticas influenciarán las decisiones de uso de suelo, lo que podría tener impactos negativos sobre el hábitat de numerosas especies. Evaluamos el impacto potencial que podrían tener las futuras políticas de clima sobre la pérdida del área habitable en los puntos clave de biodiversidad debido al cambio asociado en el uso de suelo. Estimamos las extinciones pasadas a partir de cambios históricos en el uso de suelo (1500 - 2005) con base en la extensión del hábitat, los datos de especies para cada punto clave, y la cuadrícula global de datos sobre uso de suelo, la cual fue utilizada para el Reporte de la Quinta Evaluación del Panel Intergubernamental sobre Cambio Climático. Después estimamos las extinciones potenciales causadas por futuros cambios en el uso de suelo bajo escenarios alternativos de cambio climático (2005 - 2100). El número de extinciones de especies adicionales, en relación con aquellas ya provocadas entre 1500 y 2005, causadas por el cambio en el uso de suelo para 2100 en todos los puntos clave, varió aproximadamente de 220 a 21, 000 (0.2% a 16%), dependiendo del escenario de mitigación de cambio climático y factores biológicos, como la pendiente de la relación especies-área y la contribución de la tala a las extinciones. Estas estimaciones de las extinciones potenciales en el futuro fueron causadas solamente por el cambio en el uso de suelo y probablemente habrían sido más altas si se hubiesen considerado los efectos directos del cambio climático. Las extinciones futuras podrían reducirse potencialmente al incorporar la preservación del hábitat al desarrollo del escenario para reducir los futuros cambios en el uso de suelo en los puntos clave o al disminuir el impacto de las futuras actividades de uso de suelo sobre la biodiversidad dentro de los puntos clave.

A National Survey on Depression, Internalized Homophobia, College Religiosity, and Climate of Acceptance on College Campuses for Sexual Minority Adults.

Sexual minority persons have an increased risk for negative mental health outcomes in adulthood. This seems to largely be due to experiences of stigma in social settings. This study sought to understand the relationship between attending a religiously conservative college, internalized homophobia (a measure of sexual stigma), and depressive symptoms for sexual minority adults. Sexual minority adult participants (n = 384) from across the U.S. were recruited and completed a Web-based, anonymous survey. A mediation model predicting depression through college religious conservatism, college acceptance of sexual minority identities, and internalized homophobia was tested using path analysis. Results revealed an indirect effect of increased religious conservatism of a college predicted higher depression through lower college acceptance and higher internalized homophobia. Implications for the mental health of sexual minority adults and future research are examined.

(+)-Morphine and (-)-morphine stereoselectively attenuate the (-)-morphine-produced tail-flick inhibition via the naloxone-sensitive sigma receptor in the ventral periaqueductal gray of the rat.

We have previously demonstrated that (+)-morphine and (-)-morphine pretreated spinally for 45 min stereoselectively attenuates the tail-flick inhibition produced by (-)-morphine given spinally in the mouse. The present study is then undertaken to determine if the same phenomenon observed in the mouse spinal cord can also take place in the ventral periaqueductal gray of the rat. Pretreatment with (+)-morphine for 45 min at 0.3 to 3.3 fmol dose-dependently attenuated the tail-flick inhibition produced by (-)-morphine (9 nmol) given into the ventral periaqueductal gray. Likewise, pretreatment with (-)-morphine for 45 min at a higher dose (3-900 pmol), which given alone did not affect the baseline tail-flick latency, also dose-dependently attenuated the tail-flick inhibition produced by (-)-morphine. Thus, (+)-morphine is approximately 270,000-fold more potent than (-)-morphine in attenuating the (-)-morphine-produced tail-flick inhibition. The attenuation of the (-)-morphine-produced tail-flick inhibition induced by (+)-morphine or (-)-morphine was dose-dependently reversed by (+)-naloxone (27.5 to 110 pmol) pretreatment for 50 min given into the ventral periaqueductal gray. Pretreatment with the sigma receptor antagonist BD1047 (N-[2-(3,4-dichlorophenyl)ethyl]-N-methyl-2-(dimethylamino)ethylamine dihydrobromide) (11-45 nmol) for 45 min given into the ventral periaqueductal gray also reversed dose-dependently the attenuation of the (-)-morphine-produced tail-flick inhibition induced by (+)-morphine or (-)-morphine, indicating that the effects are mediated by the activation of the sigma receptors. Since (+)-morphine, (-)-morphine and (+)-naloxone do not have any affinity for the naloxone-inaccessible sigma receptors, we therefore propose that (+)-morphine and (-)-morphine attenuate the (-)-morphine-produced tail-flick inhibition via the activation of the naloxone-sensitive sigma receptor originally proposed by Tsao and Su [Tsao, L.T., Su, T.P., 1997. Naloxone-sensitive, haloperidol-sensitive, [(3)H](+)-SKF-1047-binding protein partially purified from rat liver and rat brain membranes: an opioid/sigma receptor. Synapse 25, 117-124].

Functional analysis of sirtuin genes in multiple Plasmodium falciparum strains.

Plasmodium falciparum, the causative agent of severe human malaria, employs antigenic variation to avoid host immunity. Antigenic variation is achieved by transcriptional switching amongst polymorphic var genes, enforced by epigenetic modification of chromatin. The histone-modifying 'sirtuin' enzymes PfSir2a and PfSir2b have been implicated in this process. Disparate patterns of var expression have been reported in patient isolates as well as in cultured strains. We examined var expression in three commonly used laboratory strains (3D7, NF54 and FCR-3) in parallel. NF54 parasites express significantly lower levels of var genes compared to 3D7, despite the fact that 3D7 was originally a clone of the NF54 strain. To investigate whether this was linked to the expression of sirtuins, genetic disruption of both sirtuins was attempted in all three strains. No dramatic changes in var gene expression occurred in NF54 or FCR-3 following PfSir2b disruption, contrasting with previous observations in 3D7. In 3D7, complementation of the PfSir2a genetic disruption resulted in a significant decrease in previously-elevated var gene expression levels, but with the continued expression of multiple var genes. Finally, rearranged chromosomes were observed in the 3D7 PfSir2a knockout line. Our results focus on the potential for parasite genetic background to contribute to sirtuin function in regulating virulence gene expression and suggest a potential role for sirtuins in maintaining genome integrity.