Internet addiction of university students in the Covid-19 process.

This study delves into the intricate dynamics of internet addiction among university students, leveraging a comprehensive quantitative approach to unravel the myriad factors influencing this modern-day malaise. Utilizing logistic regression analysis, this research delineates the predictive significance of Daily Internet Usage Time (DIUT) and Communicative Internet Use Frequency (CIUF) on the propensity for internet addiction, with the analysis substantiating these variables as potent predictors. The model elucidates a significant variance in internet addiction, affirming the complexity of internet addiction as influenced by a constellation of behavioral patterns. Amidst the backdrop of the COVID-19 pandemic's exacerbation of digital dependency, this investigation sheds light on the escalation of internet use to addictive levels, prompted by prolonged isolation and the pivot to online learning platforms. This study underscores the resultant educational and psychological ramifications, highlighting a surge in addiction and its associated detriments such as diminished academic performance, social isolation, and a deterioration in mental health. Comparison of these findings with existing literature reveals a nuanced understanding of internet addiction, characterised by the interaction between individual behaviours and broader socio-economic and psychological contexts, such as the duration of daily internet use and the frequency of communicative internet use. This synthesis argues for a holistic strategy to address internet addiction, emphasizing the need for educational interventions, improving digital literacy and promoting healthy digital habits. By pinpointing the multifaceted nature of internet addiction and its predictors within the university student demographic, this research contributes to the ongoing discourse on digital dependency, proposing a multidisciplinary approach to develop resilient academic environments and support systems. It underscores the urgent need for targeted research to identify predictive factors of internet addiction, thereby enabling the formulation of effective strategies and policies for mitigating its impact on students' academic and psychological well-being. This study not only captures the complexity of internet addiction but also provides critical insights crucial for developing informed educational strategies and interventions in the digital age.

Ambulatory facial feminization surgery: a comparative analysis of outcomes and complications.

BACKGROUND: To date, there are no studies investigating the safety and outcomes of facial feminization surgery (FFS) as an outpatient procedure. This is the first study of its kind analyzing the outcomes of ambulatory FFS based on a comparison of complications, post-operative emergency department or urgent care (ED/UC) visits, and readmissions between patients who underwent FFS with admission versus same-day surgery. METHODS: A retrospective analysis was conducted on all patients who underwent FFS in a single integrated healthcare system. Patient charts were reviewed for operative details, complications, post-operative ED/UC visits, readmission, and demographic factors. Major outcomes including complications, readmissions, and ED/UC visits were compared between groups with same-day discharge and post-operative hospital admission. RESULTS: Of 242 patients included in the study, ED/UC visits were comparable between patients discharged same-day (18.2%) and patients admitted post-operatively (21.6%, p = 0.52). Logistic regression showed no significant difference in the composite outcomes of minor complications, major complications, and readmissions (15.6% for ambulatory versus 19.3% for admission, p = 0.46). Temporary nerve palsy, infection, and hematoma were the most common post-operative complications. However, covariates of a lower face procedure and operative time were shown to have significant differences in the composite complication outcome (p = 0.04 and p = 0.045, respectively). CONCLUSION: Ambulatory FFS is a safe practice with no associated increase in adverse outcomes including complications, ED/UC visits, and readmission when compared to post-operative admission. Adoption of same-day FFS should be considered by high-volume gender health centers to potentially benefit from increased scheduling flexibility and efficiency, increased access to care, and lower healthcare costs.

Are cisnormative surveys adequate to assess sexual well-being in trans men post-genital gender-affirming surgery?

INTRODUCTION: For transmasculine spectrum individuals, there is a lack of validated surveys to assess sexual well-being (SWB) post-genital gender-affirming surgery. Currently, either providers are designing their own SWB surveys or surveys designed for cisgender men are being used. OBJECTIVE: This study investigated the applicability of SWB surveys validated for cisgender men to transmasculine spectrum individuals post-genital gender-affirming surgery (TMSX). Recognizing the paucity of validated tools for assessing SWB in transmasculine individuals post-genital gender-affirming surgery (TMSX), we evaluated current surveys for their inclusiveness and relevance to this population. METHODS: Our methodology involved analyzing surveys validated in English-speaking North American cisgender men. We conducted a systematic review, yielding 31 surveys, out of which 12 met our inclusion criteria. These were then assessed against the 10 domains of holistic SWB as identified by Özer et al. Each survey was scored based on its reflection of these domains, thus generating an SWB score. Additionally, we performed a thematic analysis to identify areas needing modification for better applicability to TMSX. RESULTS: Our findings indicate an average SWB score of 5.17 out of 10 across the surveys. The surveys predominantly addressed sexual function, with a marked underrepresentation of domains like quality of life, sexuality, and sexual pleasure. This underscores the tendency of these surveys to focus more on the biological mechanisms of sex, rather than on a nuanced biopsychosocial understanding. Thematic analysis revealed significant gaps, such as the irrelevance of questions about erections and ejaculations for TMSX, and the need for greater emphasis on psychosocial factors. CONCLUSION: Given these gaps and the inadequacy of most cisnormative surveys, we recommend the creation of a novel, validated SWB survey specifically for TMSX. This should be developed in collaboration with a multidisciplinary panel and TMSX community advisory board, ensuring a tool that truly reflects the unique SWB needs of this population.

'I created my own access:' understanding mental healthcare access experiences among LGTBQ + youth who use cannabis in Canada.

In North America, LGBTQ+ youth have high rates of cannabis use and face mental health issues. We conducted a photovoice study to describe the perspectives, needs, and motivations of forty-six LGBTQ+ youth who use cannabis as they access mental healthcare services. Participants' photographs were discussed in individual semi-structured interviews conducted by peer researchers. Following a thematic analysis of the interview transcripts, we first found that, beyond medication, LGBTQ+ youth sought mental health services facilitating introspection to better understand their sexual and gender identities and mental health. Second, participants sought affirming health professionals but often felt judged by providers. Third, access to desired services was often described as uncertain and taxing, which impacted their mental health. Fourth, participants' agency was determined by their experience with mental health services, which translated into resilience to tackle access challenges and cannabis use to mitigate their mental health struggles. Our findings point to the need for mental healthcare delivery that goes beyond medication provision but which in addition foster therapeutic processes based on a holistic understanding of mental health. A trusting dynamic between health professionals and LGBTQ+ youth is imperative to counteract the feelings of stigma experienced by LGBTQ+ youth using cannabis in Canada.

Gender Disparities in Psychological Disturbances and Quality of Life Among Adolescent and Adult Patients with Thalassemia: A Review.

Thalassemia is a chronic disease caused by impaired globin chain synthesis, leading to ineffective erythropoiesis, hemolysis, and chronic anemia. The treatment of patients with thalassemia, including blood transfusion combined with chelation therapy has progressed and improved their survival and prognosis. However, thalassemia-related psychological problems and impaired health-related quality of life (QoL) challenges still exist. Gender is one of the factors that has been suggested, to contribute to the disparities in psychological outcomes. This review article examined the evidence for gender differences in psychological disturbances and QoL in adolescent and adult patients with thalassemia. A non-systematic search of the literature was conducted in PubMed and Google Scholar for English full-text available from 2013 to 2023. We identified 23 studies with a sample size ≥ 100 that examined gender disparities in anxiety, depression, and QoL in adolescent and adult patients with thalassemia (mean prevalence of female = 53.1%; mean age = 28 years). Our review shows that there are gender disparities in psychological distress and QoL in adolescent and adult patients with thalassemia. Statistically significant gender differences were demonstrated in 62% of the psychological and QoL outcomes from 16 studies. Female patients had a higher prevalence of anxiety, depression, and poorer QoL in some studies. However, further studies with sufficient power and design are necessary to confirm the existence of gender disparities in psychological disturbances and QoL outcomes.

MicroRNA in cardiometabolic health and disease: The perspectives of sex, gender and personalised medicine.

BACKGROUND: Personalized medicine represents a novel and integrative approach that focuses on an individual's genetics and epigenetics, precision medicine, lifestyle and exposures as key players of health status and disease phenotypes. METHODS: In this narrative review, we aim to carefully discuss the current knowledge on gender disparities in cardiometabolic diseases, and we consider the sex- specific expression of miRNAs and their role as promising tool in precision medicine. RESULTS: Personalised medicine overcomes the restricted care of patient based on a binomial sex approach, by enriching itself with a holistic and dynamic gender integration. Recognized as a major worldwide health emergency, cardiometabolic disorders continue to rise, impacting on health systems and requiring more effective and targeted strategies. Several sex and gender drivers might affect the onset and progression of cardiometabolic disorders in males and females at multiple levels. In this respect, distinct contribution of genetic and epigenetic mechanisms, molecular and physiological pathways, sex hormones, visceral fat and subcutaneous fat and lifestyle lead to differences in disease burden and outcomes in males and females. CONCLUSIONS: Sex and gender play a pivotal role in precision medicine because the influence the physiology of each individual and the way they interact with environment from intrauterine life.

A thematic analysis of how men and women post 56 years, unwind from work during their free time.

BACKGROUND: Recent research indicates that as men age, their tendency to ruminate about work decreases, while ruminating remains high in women, which poses an increased risk for impaired health among older women. OBJECTIVE: This study explored gender differences/similarities in the process of unwinding from work in men and women aged between 56-65 years. METHODS: Semi-structured qualitative interviews were conducted online with eight men and eight women, recruited from a UK leading organization that provides health care solutions between May and June 2022. Participants were asked about their job role and responsibilities, their leisure time activities, how they unwind post work, and their experiences of thinking about work related thoughts outside of work. Transcripts were analyzed using an inductive analysis. RESULTS: Three superordinate themes were identified that underpinned their ability to unwind: 'Work style', 'Creating work-life balance' and 'Switching off from one's responsibilities'. Women reported a more perfectionist approach, they set high standards for themselves, were worried about making mistakes, and demonstrated, if in a supervisory role, a more nurturing and holistic approach to their colleagues/subordinates, while men, were more focused on task completion. Most women, but not men, also described difficulties in psychologically switching off from work, and stated they could only truly relax outside the home, when they are away from household activities. CONCLUSION: The study provides nuanced insights into the experiences of unwinding from work, and the findings suggest the need for person-centric approaches in developing interventions to help workers over 56 years to psychologically disengage from work.

Affirming Care for LGBTQ+ Patients.

The lesbian, gay, bisexual, transgender, and queer(LGBTQ +) community is a marginalized minority group who continues to face and experience significant discrimination, prejudice, stigma, oppression, and abuse in various societal domains including health care. The older adult LGBTQ + community is an especially vulnerable group as they have unique minority stressors attributed to intersectional identities of age, ableism, ethnicity, and employment, among other factors. It is critical for health care providers to recognize and mitigate disproportionate care by engaging in strategies that promote inclusion and affirmation of their sexual orientation and gender identity. The biopsychosocial, cultural, and spiritual framework is a useful tool to care for this community in a holistic and compassionate way.

Gender-Based Heat Map Images of Campus Walking Settings: A Reflection of Lived Experience.

Fear of crime can influence our view of and experience with the world around us. This can be problematic for individuals seeking physical activity, including from walk commuting. Prior work shows fear is especially evident among women, who report fear of rape and sexual abuse by men as a primary concern. We present the results of a cross-sectional survey (n = 571) where participants were shown images from college campus (n = 4 campuses) depicting different lighting (daytime, nighttime), and entrapment levels (high, low; i.e., able to easily escape if needed, with high entrapment being difficult and low being easy), and using the Qualtrics heat map tool, selected features that stood out to them most. Data were segregated by gender and analyzed to determine similarity of heat maps for the same base image. Heat map images were analyzed using canonical correlation (Rc) to determine the relationship between the two groups; dispersion testing to decipher spatial uniformity within the images; the Structural Similarity Index (SSIM) to characterize the nature of image patterns differences; and, the Breslow-Day Test to specify pattern locations within images. Several heat map images are also presented in the results. Overall, female and male participants appear to "see" different things when imagining walk-commuting (as seen by poor Rc values) and the nature of what they were looking at were different (as seen by poor SSIM values). Female participants tended to focus on areas outside the walking path, such as bushes and dark areas, whereas men's focus was on the path ahead [χ2(1) = 4.29, p = 0.04]. Furthermore, women were more likely to select areas outside the walking path during high entrapment settings [χ2(1) = 15.49, p < 0.001] and at nighttime [χ2(1) = 4.98, p = 0.02]. Our study demonstrates point-of-view differences in female-male walking space assessments. Viewing walking safety through the lens of lived experience could be productive for holistic community walking safety.

Diet Pattern Analysis in Alzheimer's Disease Implicates Gender Differences in Folate-B12-Homocysteine Axis on Cognitive Outcomes.

BACKGROUND & AIMS: Low plasma B12 and folate levels or hyperhomocysteinemia are related to cognitive impairment. This study explores the relationships among diet pattern, blood folate-B12-homocysteine levels, and cognition measurement in Alzheimer's disease (AD) while exploring whether a gender effect may exist. METHODS: This cross-sectional study enrolled 592 AD patients (246 males, 346 females) and the demographic data, blood biochemical profiles, Mini-Mental State Examination (MMSE), and a Food Frequency Questionnaire (FFQ) for quantitative assessment of dietary frequency were collected. Structural Equation Modeling (SEM) was employed to explore the associations among dietary patterns, blood profiles, and cognition. A least absolute shrinkage and selection operator regression model, stratified by gender, was constructed to analyze the weighting of possible confounders. RESULTS: Higher MMSE scores were related to higher frequencies of coffee/tea and higher educational levels, body mass index, and younger age. The SEM model revealed a direct influence of dietary frequencies (skimmed milk, thin pork, coffee/tea) and blood profiles (homocysteine, B12, and folate) on cognitive outcomes. At the same time, the influence of dietary pattern on cognition was not mediated by folate-B12-homocysteine levels. In males, a direct influence on the MMSE is attributed to B12, while in females, homocysteine is considered a more critical factor. CONCLUSIONS: Dietary patterns and blood profiles are both associated with cognitive domains in AD, and there are gender differences in the associations of dietary patterns and the levels of B12 and homocysteine. To enhance the quality of dietary care and nutritional status for individuals with dementia, our study results still require future validations with multi-center and longitudinal studies.

Predictive models for perceived convenience of accessing outdoor activities among elderly with physical disabilities in rural China.

BACKGROUND: The elderly, especially those with physical disabilities, often encounter barriers that prevent them from accessing outdoor activities. Their perceptions of the convenience of accessing outdoor activities may be influenced by various factors including their health, the social context, and/or planned behavior. This study aimed to develop predictive models that identify the principal determinants of perceived convenience among this demographic, and it also examined the disparities observed between genders. METHODS: This was a cross-sectional survey of 1216 community-dwelling older people with physical disabilities in rural China. Grounded on the rehabilitation concepts and the theory of planned behavior, structural equation models integrated health and social behavior factors were constructed to predict perceived convenience of accessing outdoor activities. The standardized coefficients explained the contributions of various factors to the variance. RESULTS: The final structural models demonstrated good fit for both female and male participants. Perceptions of the convenience of accessing outdoor activities among both women and men were directly impacted by their physical functioning and their intention to participate, and indirectly by medical expenditure, subjective norms, pain, and role limitation in emotional interactions. Positive mental health was more influential for women, while men were more influenced by subjective norms. CONCLUSIONS: Structural equation models have effectively predicted the self-reported convenience of accessing outdoor activities, underscoring the importance of functional and behavioral rehabilitation. Furthermore, gender-sensitive rehabilitation programs are advised to promote engagement in outdoor activities among elderly individuals with physical disabilities.

Evaluation of nurses' and midwives' knowledge and attitudes towards recognizing violence against women.

The study was cross-sectional research that surveyed 410 nurses and midwives from March 2020 to March 2021 in Turkey. The aim of this study was to evaluate the knowledge and attitudes of nurses and midwives towards recognizing violence against women. The "Scale for Nurses' and Midwives' Recognition of the Symptoms of Violence against Women" were used. The average total scale score was 20.3 ± 3.2. The score of participants who are receiving postgraduate education, working in the field of gynaecology and obstetrics, and considering intervention as a professional responsibility when encountering a woman who has experienced violence was found to be significantly higher than the other groups (p<.05). It is important for midwives and nurses to be aware of signs of violence to identify violence against women. Providing education to midwives and nurses regarding signs of violence against women will contribute to the recognition, prevention, and awareness of violence.

L'étude était une recherche transversale qui a enquêté sur 410 infirmières et sages-femmes de mars 2020 à mars 2021 en Turquie. L'objectif de cette étude est d'évaluer les connaissances et les attitudes des infirmières et des sages-femmes envers la reconnaissance de la violence contre les femmes. L'échelle de reconnaissance des symptômes de la violence contre les femmes des infirmières et des sages-femmes a été utilisée. Le score moyen total de l'échelle était de 20,3 ± 3,2. Le score des participants qui suivent une formation de troisième cycle, travaillant dans le domaine de la gynécologie et de l'obstétrique, et considérant l'intervention comme une responsabilité professionnelle lorsqu'ils rencontrent une femme victime de violence s'est avéré significativement plus élevé que les autres groupes (p<.001). Il est important que les sages-femmes et les infirmières soient conscientes des signes de violence pour identifier la violence contre les femmes. Fournir une éducation aux sages-femmes et aux infirmières concernant les signes de violence contre les femmes contribuera à la reconnaissance, à la prévention et à la sensibilisation à la violence.

Nursing students' knowledge regarding sexuality, sex, and gender diversity in a multicenter study.

Introduction: Sexuality is an integral part of development and personality, and is important in healthcare. Nurses are among the most representative healthcare professionals. For holistic and inclusive nursing care practice and to improve equality, human rights, well-being, and health of individuals, the curricula of nursing courses must integrate broad knowledge about sexuality and its diversity. This study aimed to identify and analyze nursing students' knowledge of sexuality, sex, and gender diversity. The present study was part of a multicenter study conducted in Europe. Methods: Questionnaires were administered in three nursing schools to assess nursing students' knowledge (n = 75). Data processing was performed using Excel® software version 20 and IRaMuTeQ (R Interface pour les Analysis Multidimensionnelles de Textes et de Questionnaires) 0.7 alpha 2, allowing organization by category and subsequent thematic analysis using content analysis. Results: The textual corpus "Nursing students' knowledge about sexuality in its diversity," was divided into two sub-corpus: "Students' perception of sexuality" and "Students' perception of gender identity," originating Class 6 "Eroticism" (14.23%) and Classes 4 "Sexual Orientation" (16.07%) and 3 "Heteronormative" (16.07%), the latter with greater proximity to each other and consequently to Class 6. Similarly, Classes 1 "Gender" (20.36%) and 5 "Cisgender" (12.14%) also presented a greater interrelationship between themselves and consecutively with Class 2 "Gender Identity" (15.36%). Discussion: The analyses revealed that though nursing students possessed knowledge about sexuality and its diversity, this knowledge was elementary and did not reveal a sustained appropriation of concepts related to sexuality, sexual orientation, and gender diversity. For some questions, the absence of students' answers were noteworthy, and may be associated with their personal reservation in expressing themselves on this sensitive and intimate theme. To ensure diversity, inclusivity, and impartiality in nursing practice, it is imperative to change the curriculum plans of nursing courses to address the theme of sexuality during the training process of nurses in Europe.

Understanding the interplay of occupational, public health, and climate-related risks for informal workers: A new framework with findings from Zimbabwe and India.

Globally, there are 2 billion 'informal' workers, who lack access to social protection while facing profound health risks and socioeconomic exclusions. The informal economy has generated most jobs in Low and Middle-Income Countries (LMICs), but few studies have explored informal workers' complex health vulnerabilities, including in the face of climate change. This paper will discuss recent action-research in Indore (India), Harare, and Masvingo (Zimbabwe) with informal workers like vendors, waste-pickers, and urban farmers. We conducted qualitative interviews (N = 110 in India), focus group discussions (N = 207 in Zimbabwe), and a quantitative survey (N = 418 in Zimbabwe). Many informal workers live in informal settlements ('slums'), and we highlight the interrelated health risks at their homes and workplaces. We explore how climate-related threats-including heatwaves, drought, and floods-negatively affect informal workers' health and livelihoods. These challenges often have gender-inequitable impacts. We also analyse workers' individual and collective responses. We propose a comprehensive framework to reveal the drivers of health in the informal economy, and we complement this holistic approach with a new research agenda. Our framework highlights the socioeconomic, environmental, and political determinants of informal workers' health. We argue that informal workers may face difficult trade-offs, due to competing priorities in the face of climate change and other risks. Future interventions will need to recognise informal workers' array of risks and co-develop multifaceted solutions, thereby helping to avoid such impossible choices. We recommend holistic initiatives to foster health and climate resilience, as well as participatory action-research partnerships and qualitative, intersectional data-collection with informal workers.

Tenuifolin improves learning and memory by regulating long-term potentiation and dendritic structure of hippocampal CA1 area in healthy female mice but not male mice.

Polygala tenuifolia Wild is an ancient traditional Chinese medicine. Its main component, tenuifolin (TEN), has been proven to improve cognitive impairment caused by neurodegenerative diseases and ovariectomy. However, there was hardly any pharmacological research about TEN and its potential gender differences. Considering the reduction of TEN on learning and memory dysfunction in ovariectomized animals, therefore, we focused on the impact of TEN in different mice genders in the current study. Spontaneous alternation behavior (SAB), light-dark discrimination, and Morris water maze (MWM) tests were used to evaluate the mice's learning and memory abilities. The field excitatory postsynaptic potential (fEPSP) of the hippocampal CA1 region was recorded using an electrophysiological method, and the morphology of the dendritic structure was examined using Golgi staining. In the behavioral experiments, TEN improved the correct rate in female mice in the SAB test, the correct rate in the light-dark discrimination test, and the number of crossing platforms in the MWM test. Additionally, TEN reduced the latency of female mice rather than male mice in light-dark discrimination and MWM tests. Moreover, TEN could significantly increase the slope of fEPSP in hippocampal Schaffer-CA1 and enhance the total length and the number of intersections of dendrites in the hippocampal CA1 area in female mice but not in male mice. Collectively, the results of the current study showed that TEN improved learning and memory by regulating long-term potentiation (LTP) and dendritic structure of hippocampal CA1 area in female mice but not in males. These findings would help to explore the improvement mechanism of TEN on cognition and expand the knowledge of the potential therapeutic value of TEN in the treatment of cognitive impairment.

A Holistic Framework for the Evaluation of Kidney Function in a Gender-Diverse Landscape.

The most commonly used equations to estimate glomerular filtration rate incorporate a binary male-female sex coefficient, which has important implications for the care of transgender, gender-diverse, and nonbinary (TGD) people. Whether "sex assigned at birth" or a binary "gender identity" is most appropriate for the computation of estimated glomerular filtration rate (eGFR) is unknown. Furthermore, the use of gender-affirming hormone therapy (GAHT) for the development of physical changes to align TGD people with their affirmed gender is increasingly common, and may result in changes in serum creatinine and cystatin C, the biomarkers commonly used to estimate glomerular filtration rate. The paucity of current literature evaluating chronic kidney disease (CKD) prevalence and outcomes in TGD individuals on GAHT makes it difficult to assess any effects of GAHT on kidney function. Whether alterations in serum creatinine reflect changes in glomerular filtration rate or simply changes in muscle mass is unknown. Therefore, we propose a holistic framework to evaluate kidney function in TGD people. The framework focuses on kidney disease prevalence, risk factors, sex hormones, eGFR, other kidney function assessment tools, and the mitigation of health inequities in TGD people.

Institution-Wide Retreats Foster Organizational Learning and Action at a Comprehensive Cancer Center.

Providing safe and informed healthcare for sexual and gender minority (SGM) individuals with cancer is stymied by the lack of sexual orientation and gender identity (SOGI) data reliably available in health records and by insufficient training for staff. Approaches that support institutional learning, especially around sensitive topics, are essential for hospitals seeking to improve practices impacting patient safety and research. We engineered annual institutional retreats to identify and unify stakeholders, promote awareness of gaps and needs, identify initiatives, minimize redundant projects, and coordinate efforts that promote improvements in SGM cancer care, education, and research. The 2022 and 2023 retreats employed a 4-h hybrid format allowing virtual and in-person engagement. Retreat organizers facilitated small-group discussions for brainstorming among participants. We performed descriptive statistics from retreat evaluations. The retreats engaged 104 attendees from distinct departments and roles. Participants expressed robust satisfaction, commending the retreat organization and content quality. Notably, the first retreat yielded leadership endorsement and funding for a Quality Improvement pilot to standardize SOGI data collection and clinical staff training. The second retreat provided a platform for updates on focused efforts across the institution and for receiving direction regarding national best practices for SGM care and research. We report the processes and outcomes of institution-wide retreats, which served as a platform for identifying gaps in organizational healthcare practices and research for SGM individuals with cancer. The strategies described herein may be readily scaled at other cancer hospitals seeking to learn and enact system-wide practice changes that support the needs of SGM patients and families.

Provider Perspectives on Multi-level Barriers and Facilitators to PrEP Access Among Latinx Sexual and Gender Minorities.

Although pre-exposure prophylaxis (PrEP) is a highly effective HIV prevention intervention, inequities in access remain among Latinx sexual and gender minorities (LSGM). There is also a gap in the PrEP literature regarding providers' perspective on access inequities. This qualitative case study sought to explore barriers and facilitators to PrEP engagement in a community-based integrated health center primarily serving Latinx populations in Northern California. We conducted in-depth, semi-structured interviews with providers (9/15) involved in PrEP services and engaged in a constructivist grounded theory analysis consisting of memoing, coding, and identifying salient themes. Three participants worked as medical providers, three as outreach staff, and one each in planning, education, and research. The analysis surfaced four themes: geopolitical differences, culture as barrier, clinic as context, and patient strengths and needs. Participants referenced a lack of resources to promote PrEP, as well as the difficulties of working within an institution that still struggles with cultural and organizational mores that deprioritize sexual health. Another barrier is related to sexual health being positioned outside of patients' immediate needs owing to structural barriers, including poverty, documentation status, and education. Participants, however, observed that peer-based models, which emboldened their decision-making processes, were conducive to better access to PrEP, as well as allowing them to build stronger community ties. These data underscore the need for interventions to help reduce sexual stigma, promote peer support, and ameliorate structural barriers to sexual healthcare among LSGM.

Psychosocial predictors of the innate immune response to influenza vaccination.

Experimental activation of the innate immune system has contributed significantly to both our understanding of how psychological factors influence immune function as well as how immune activity influences the brain and behavior. The annual influenza vaccine can be used to interrogate the effects of mild immune stimulation on day-to-day changes in psychological processes in human subjects that range across the lifespan and in both clinical and non-clinical populations. Yet, the immune response to the influenza vaccine in the days immediately following its administration are not well characterized. The present study describes changes in inflammatory and antiviral gene expression within circulating immune cells, plasma cytokines, and C-reactive protein (CRP) following receipt of the flu vaccine, and further reports the association between several common behavioral health factors and the acute immune response. Participants were 65 adults (mean age 18.81 ± 1.03 years; 66.2% female) who provided a blood sample immediately before and then 24 h after receiving the vaccine. A subsample also provided additional blood samples at 48 and 72 h. Plasma was assayed for CRP, IL-6, IL-10, IL-8, TNF-α, and IFN-γ, and peripheral blood mononuclear cell RNA was sequenced for evidence of change in expression of an a priori set of type 1 interferon (IFN) and inflammatory response genes (INFLAM). Plasma cytokines, CRP, and IFN response genes increased 24 h after vaccination, all ps < .001. The increase in IFN gene expression correlated with the observed increase in plasma cytokines and CRP, p < .0001. The immune response to influenza vaccination at 24-hours was moderated by anxiety symptoms, BMI, being female, sleep, and history of influenza vaccination. These factors and their associations with common immune challenges may be useful in studies interrogating the origins of immune dysregulation. The annual influenza vaccine is an accessible and reliable exogenous activator of both circulating and transcriptional markers of innate immune reactivity, with sensitivity to behavioral health factors relevant for psychoneuroimmunology research.

Dietary Supplement Use in Transmasculine People: Results of an Online Survey of Volunteer Adults.

INTRODUCTION: Health inequities and disparities in nutrition research exist among transmasculine people. A dearth of evidence on dietary supplement use and motivations exist, partially due to constrained collection of sex and gender identity in national surveys. OBJECTIVE: We sought to investigate common motivations and use of dietary supplements in a voluntary survey of transmasculine people. METHODS: A total of 48 participants completed an online survey detailing dietary supplement use, motivations, and demographic information. RESULTS: 64.5 and 90.0% of participants reported use of 1+ dietary supplement within the past 30-days and during some point in their lifetime, respectively. Top reported product types used included multivitamins (52%), melatonin (52%), vitamin D (46%), vitamin C (35%), fish oil (33%), B-vitamins or B-complex (31%), iron (29%), green tea (29%), biotin (25%), cranberry (23%), zinc (23%), protein powder (23%), probiotics (23%), and calcium (21%). There was no relationship between the number of supplements reported and participant age, BMI, income, or mastectomy status (p > 0.05). Participants reported top motivations being for "improving my overall health" (60.4%), "maintaining health" (54.2%), to "supplement my diet due to not getting enough from food"(41.7%), "mental health" (39.6%), and to "prevent colds, boost immune system" (33.3%). CONCLUSION: Transmasculine people in our study reported a high use of dietary supplements. Differences in the types of products and number of products used, as well as specific motivations for use likely exist within this subpopulation, however, future nationally-representative longitudinal studies are needed to fully elucidate these patterns and for informing evidence-based nutrition guidance.