Development of competencies for the use of bedside ultrasound for assessment and cannulation of hemodialysis vascular access.

Use of ultrasound for hemodialysis vascular access assessment and real-time cannulation requires specialized training. In order to obtain basic hand-eye coordination, theoretical sessions on ultrasound use, as well as practical sessions using phantom models are recommended prior to its use in the clinical setting with patients. New users of this technology need to consider that all competencies can be achieved with daily use of ultrasound at the bedside. It takes approximately 500 guided cannulations to achieve the highest level of competency described above.

A randomized controlled trial to evaluate a structural intervention to promote the female condom in New York state.

We conducted a structural intervention to promote the female condom (FC), comparing 44 agencies randomized to a Minimal Intervention (MI) [developing action plans for promotion and free access] or an Enhanced Intervention (EI) [with the addition of counselor training]. Intervention effects were evaluated via surveys with agency directors, counselors and clients at baseline and 12 months. Agency-level outcomes of the FC did not differ between the two interventions at follow-up. Counselors in the EI showed significantly greater gains in FC knowledge and positive attitudes, although there was no difference in the proportion of clients counseled on the FC, which significantly increased in both conditions. There was a greater increase in intention to use the FC among clients in EI agencies. Intervention effects were stronger in medical agencies. Findings suggest that making subsidized FCs available and assisting agencies to formulate action plans led to increased FC promotion. Limitations and implications for future research and intervention efforts are discussed.

Homelessness among lesbian, gay, and bisexual youth: implications for subsequent internalizing and externalizing symptoms.

Although lesbian, gay, and bisexual (LGB) youth with a history of homelessness (running away or being evicted from their homes by parents) report more psychological symptoms than homeless heterosexual peers, it is unclear whether symptoms are due to homelessness, given the absence of a non-homeless comparison group. This study longitudinally investigates whether LGB youth with a history of homelessness report more subsequent psychological symptoms than non-homeless LGB youth and examines potential mediators of any such relationships. Of the 156 LGB youth interviewed (49% female; 78% non-White), 48% reported past homeless experiences. Homelessness was associated with subsequent symptoms of anxiety, depression, conduct problems, and substance abuse and to changes in symptoms over time even after controlling for childhood sexual abuse and early development of sexual orientation. Stressful life events, negative social relationships, and social support from friends mediated the relationships between homelessness and symptomatology. These findings suggest the need for interventions to reduce stress and enhance social support among LGB youth with a history of homelessness in order to reduce psychological symptoms.

Risk Factors for Homelessness Among Lesbian, Gay, and Bisexual Youths: A Developmental Milestone Approach.

Lesbian, gay, and bisexual (LGB) youths are over-represented in the homeless population. To examine why some LGB youths become homeless, this report compares homeless and non-homeless LGB youths. Of the 156 LGB youths, 48% reported ever being homeless (i.e., running away or being evicted from home). Results indicate that sexual orientation awareness and the initiation of sexual behavior occurred earlier in homeless than in non-homeless LGB youths and predated the first homeless episode. Substance use was more frequent and first occurred at an earlier age in homeless as compared to non-homeless LGB youths; however, substance use occurred subsequent to first homelessness. Childhood sexual abuse was associated with homelessness; and, early sexual orientation development was related to homelessness among youths without a history of sexual abuse. Findings suggest that interventions should help youths cope with their unfolding sexual orientation and work to prevent or address the consequences of sexual abuse.

Cigarette smoking as a coping strategy: negative implications for subsequent psychological distress among lesbian, gay, and bisexual youths.

OBJECTIVE: The heightened risk of cigarette smoking found among lesbian, gay, and bisexual (LGB) youths may be because smoking serves as a coping strategy used to adapt to the greater stress experienced by LGB youths. The current report examines whether smoking moderates the relation between stress and subsequent psychological distress, and whether alternative coping resources (i.e., social support) moderate the relation between smoking and subsequent distress. METHOD: An ethnically diverse sample of 156 LGB youths was followed longitudinally for 1 year. RESULTS: Significant interactions demonstrated that smoking amplified the association between stress and subsequent anxious distress, depressive distress, and conduct problems. Both friend and family support buffered the association between smoking and subsequent distress. CONCLUSIONS: Smoking has negative implications for the distress of LGB youths, especially those reporting high levels of stress or few supports. Interventions and supportive services for LGB youths should incorporate smoking cessation to maximally alleviate distress.

The coming-out process of young lesbian and bisexual women: are there butch/femme differences in sexual identity development?

Research on lesbian and bisexual women has documented various biological and behavioral differences between butch and femme women. However, little research has examined whether differences exist in sexual identity development (i.e., the coming-out process). The present study examined longitudinally potential butch/femme differences in sexual identity formation and integration among an ethnically diverse sample of 76 self-identified lesbian and bisexual young women (ages 14-21 years). A composite measure of butch/femme identity classified 43% as butch and 51% as femme. Initial comparisons found butch/femme differences in sexual identity (i.e., nearly all butches identified as lesbian, but about half of femmes identified as bisexual), suggesting the need to examine this confound. Comparisons of lesbian butches, lesbian femmes, and bisexual femmes found that lesbian butches and femmes generally did not differ on sexual identity formation, but they differed from bisexual femmes. Lesbian butches and femmes had sexual behaviors and a cognitive sexual orientation that were more centered on women than those of bisexual femmes. With respect to sexual identity integration, lesbian butches were involved in more gay social activities, were more comfortable with others knowing about their homosexuality, and were more certain, comfortable, and accepting of their sexual identity than were bisexual femmes. Fewer differences were found between lesbian femmes and bisexual femmes or between lesbian butches and lesbian femmes. The findings suggest that sexual identity formation does not differ between butch or femme women, but differences are linked to sexual identity as lesbian or bisexual. Further, the findings that lesbian femmes sometimes differed from lesbian butches and at other times from bisexual femmes on sexual identity integration suggest that neither sexual identity nor butch/femme alone may explain sexual identity integration. Research examining the intersection between sexual identity and butch/ femme is needed.

Disclosure of sexual orientation and subsequent substance use and abuse among lesbian, gay, and bisexual youths: critical role of disclosure reactions.

Research on whether disclosure of sexual orientation promotes lower substance use among lesbian, gay, and bisexual (LGB) individuals has been inconsistent. One reason for this may be that disclosure results in accepting and rejecting reactions. The current report longitudinally examines whether the types of reactions to disclosure are associated with substance use and abuse among 156 LGB youths (ages 14-21). Neither the number of disclosures nor the numbers of accepting or neutral disclosure reactions were associated with substance use or abuse. However, the number of rejecting reactions to disclosure was associated with current and subsequent alcohol, cigarette, and marijuana use, even after controlling for demographic factors, social desirability, and emotional distress. Further, accepting reactions were found to moderate or protect youths from the negative role of rejecting reactions on alcohol use, but not other substances. This research indicates that, rather than disclosure per se, it is the number of accepting and rejecting reactions in response to disclosure that are critical to understanding substance use among LGB youths. Further, the results suggest that to be maximally effective, substance use prevention and treatment efforts should address rejecting reactions. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

Predicting different patterns of sexual identity development over time among lesbian, gay, and bisexual youths: a cluster analytic approach.

Recent research has suggested that the sexual identity development of lesbian, gay, and bisexual (LGB) youths may not follow a single pattern, but may follow a variety of pathways. Although some research documenting variability in identity development exists, unclear are the potential individual and social contexts that predict these different patterns, as well as the contexts that predict changes in identity integration over time. This report longitudinally examined these issues in an ethnically diverse sample of 156 LGB youths (ages 14-21) in New York City. Cluster analytic techniques identified two patterns of sexual identity formation (i.e., early and more recent), and three patterns of sexual identity integration (i.e., high, middling, and low). Gender and sexual abuse were found to predict identity formation; and, gay-related stress, social support, negative social relationships, sexual orientation, sexual identity, and gender were found to predict patterns of sexual identity integration and changes in integration over 1 year. These findings document different patterns of sexual identity development and identify potential contextual barriers and facilitating factors that may be used to develop interventions to promote healthy LGB identity development.

The Michigan Peer-to-Peer Depression Awareness Program: School-Based Prevention to Address Depression Among Teens.

OBJECTIVE: The Peer-to-Peer Depression Awareness Program (P2P) is a school-based program that aims to decrease mental illness and promote well-being among students by empowering high school students as both learners and educators. Specific goals include improving the school climate around mental health, directing students to resources, and encouraging help-seeking behavior. METHODS: In the 2015-2016 academic year, 121 students across 10 high schools organized into teams and were trained to develop and implement peer-to-peer depression awareness campaigns. Outcomes were assessed via pre- and posttest questionnaires. RESULTS: A total of 878 students completed questionnaires. Outcomes demonstrated improved knowledge and attitudes toward depression, increased confidence in identifying and referring peers with depression, improved help-seeking intentions, and reduced stigma. CONCLUSIONS: The P2P program increased depression literacy through the use of youth-designed and youth-implemented depression awareness and outreach activities, which may ultimately result in earlier detection of depression and in fewer depression sequelae.

Perceptions of Nursing Students Regarding Usage of Art Therapy in Mental Health.

BACKGROUND: The purpose of this study was to explore the perceptions of baccalaureate nursing students regarding the use of art therapy to promote a therapeutic relationship and communication with mental health patients. A literature review revealed a lack of research on this topic. METHOD: This was a qualitative study using principles of thematic analysis. RESULTS: Major themes found in the study included: Nursing Students' Initial Experiences With Mental Health Patients, Nursing Students' Observations of Mental Health Patients, and Nursing Students' and Mental Health Patients' Responses to Art Therapy. CONCLUSION: The intentional use of art therapy should be integrated into undergraduate nursing education. Further research should be conducted to determine whether art therapy is useful with students in other settings. In addition, innovations using art therapy in nursing education should be studied. [J Nurs Educ. 2017;56(10):605-610.].

A model of sexual risk behaviors among young gay and bisexual men: longitudinal associations of mental health, substance abuse, sexual abuse, and the coming-out process.

Sexual risk behaviors of young gay and bisexual men must be understood within the context of other health concerns (e.g., anxiety, substance abuse), population specific factors (i.e., the coming-out process and gay-related stress), childhood sexual abuse, and other theoretical factors (e.g., safer-sex intentions). The current report proposes and longitudinally examines a model of risk factors for subsequent sexual risk behaviors among young gay and bisexual men in New York City. As hypothesized, more negative attitudes toward homosexuality, more substance abuse symptoms, and poorer intentions for safer sex were directly associated with a greater likelihood of unprotected anal sex over the following year. Furthermore, lower self-esteem, more anxious symptoms, and childhood sexual abuse were related to more unprotected anal sex indirectly through more sexual partners, sexual encounters, and substance abuse symptoms. These findings suggest that interventions targeting sexual risk behaviors of young gay and bisexual men may be more effective if they also address mental health concerns and aspects of the coming-out process.

Sexual identity development among gay, lesbian, and bisexual youths: consistency and change over time.

A longitudinal report of 156 gay, lesbian, and bisexual youths examined changes in sexual identity over time. Fifty-seven percent of the youths remained consistently self-identified as gay/lesbian, 18% transited from bisexual to gay/lesbian, and 15% consistently identified as bisexual over time. Although youths who consistently identified as gay/lesbian did not differ from other youths on time since experiencing sexual developmental milestones, they reported current sexual orientation and sexual behaviors that were more same-sex centered and they scored higher on aspects of the identity integration process (e.g., more certain, comfortable, and accepting of their same-sex sexuality, more involved in gay-related social activities, more possessing of positive attitudes toward homosexuality, and more comfortable with others knowing about their sexuality) than youths who transited to a gay/lesbian identity and youths who consistently identified as bisexual. Contrary to the hypothesis that females are more sexually fluid than males, female youths were less likely to change identities than male youths. The finding that youths who transited to a gay/lesbian identity differed from consistently gay/lesbian youths suggests that identity integration continues after the adoption of a gay/lesbian sexual identity.

Gulf War veterans' health: medical evaluation of a U.S. cohort.

BACKGROUND: United States military personnel reported various symptoms after deployment to the Persian Gulf during the 1991 Gulf War. However, the symptoms' long-term prevalence and association with deployment remain controversial. OBJECTIVE: To assess and compare the prevalence of selected medical conditions in a national cohort of deployed and nondeployed Gulf War veterans who were evaluated by direct medical and teledermatologic examinations. DESIGN: A cross-sectional prevalence study performed 10 years after the 1991 Gulf War. SETTING: Veterans were examined at 1 of 16 Veterans Affairs medical centers. PARTICIPANTS: Deployed (n = 1061) and nondeployed (n = 1128) veterans of the 1991 Gulf War. MEASUREMENTS: Primary outcome measures included fibromyalgia, the chronic fatigue syndrome, dermatologic conditions, dyspepsia, physical health-related quality of life (Short Form-36 [SF-36]), hypertension, obstructive lung disease, arthralgias, and peripheral neuropathy. RESULTS: Of 12 conditions, only 4 conditions were more prevalent among deployed than nondeployed veterans: fibromyalgia (deployed, 2.0%; nondeployed, 1.2%; odds ratio, 2.32 [95% CI, 1.02 to 5.27]); the chronic fatigue syndrome (deployed, 1.6%; nondeployed 0.1%; odds ratio, 40.6 [CI, 10.2 to 161]); dermatologic conditions (deployed, 34.6%; nondeployed, 26.8%; odds ratio, 1.38 [CI, 1.06 to 1.80]), and dyspepsia (deployed, 9.1%; nondeployed, 6.0%; odds ratio, 1.87 [CI, 1.16 to 2.99]). The mean physical component summary score of the SF-36 for deployed and nondeployed veterans was 49.3 and 50.8, respectively. LIMITATIONS: Relatively low participation rates introduce potential participation bias, and deployment-related illnesses that resolved before the research examination could not, by design, be detected. CONCLUSIONS: Ten years after the Gulf War, the physical health of deployed and nondeployed veterans is similar. However, Gulf War deployment is associated with an increased risk for fibromyalgia, the chronic fatigue syndrome, skin conditions, dyspepsia, and a clinically insignificant decrease in the SF-36 physical component score.

Spouses of Persian Gulf War I veterans: medical evaluation of a U.S. cohort.

Ten years after the 1991 Persian Gulf War (GW I), a comprehensive evaluation of a national cohort of deployed veterans (DV) demonstrated a higher prevalence of several medical conditions, in comparison to a similarly identified cohort of nondeployed veterans (NDV). The present study determined the prevalence of medical conditions among nonveteran spouses of these GW I DV and NDV. A cohort of 490 spouses of GW I DV and 537 spouses of GW I NDV underwent comprehensive face-to-face examinations. No significant differences in health were detected except that spouses of DV were less likely to have one or more of a group of six common skin conditions. We conclude that, 10 years after GW I, the general physical health of spouses of GW I DV is similar to that of spouses of NDV.

The salvage of aneurysmal fistulae utilizing a modified buttonhole cannulation technique and multiple cannulators.

We describe the St Michael's Hospital (SMH) modified buttonhole (BH) cannulation technique as a method that offers a solution for fistulae with aneurysmal dilatation due to repetitive cannulation in a restricted area. This is a prospective cohort study of 14 chronic hemodialysis (HD) patients with problematic fistulae (marked aneurysmal formation and thinning of the overlying skin, bleeding during treatment, and prolonged hemostasis post-HD) because of repetitive, localized cannulation. Each patient was followed for 12 months. The protocol was as follows: creation of tunnel tracks by 1 to 3 experienced cannulators per patient, using sharp needles. After the tunnel tracks were established and cannulation was easily achieved with dull needles, additional cannulators were incorporated with the guidance of a mentor. Bleeding from cannulation sites during dialysis ceased within 2 weeks and skin damage resolved within 6 months in all patients. Hemostasis time postdialysis decreased from 24 to 15 min. Cannulation pain scores decreased significantly. Access flows and dynamic venous pressure measurements remained unchanged. No interventions were required to maintain access patency. In 2 cases, the aneurysms became much less evident. Complications included one episode of septic arthritis and one contact dermatitis. A third patient developed acute bacterial endocarditis 9 months following completion of her follow-up. The SMH modified BH cannulation technique can salvage problematic fistulae, prevent further damage, and induce healing of the skin in the areas of repetitive cannulation. This technique can be successfully achieved by multiple cannulators in a busy full-care HD unit.

Psychological Distress Following Suicidality Among Gay, Lesbian, and Bisexual Youths: Role of Social Relationships.

Longitudinal relations between past suicidality and subsequent changes in psychological distress at follow-up were examined among gay, lesbian, and bisexual (GLB) youths, as were psychosocial factors (e.g., self-esteem, social support, negative social relationships) that might mediate or moderate this relation. Past suicide attempters were found to have higher levels of depressive symptoms, anxious symptoms, and conduct problems at a later time than youths who neither attempted nor ideated. Psychosocial factors failed to mediate this relation. The interaction among past suicidality, social support, and negative relationships was associated with subsequent changes in all three psychological distress indicators six months later. Specifically, high levels of support (either from family or friends) or negative relationships were found to predict increased psychological distress among those with a history of suicide attempts, but not among youths without a history of suicidality. The findings suggest that GLB youths who attempt suicide continue to have elevated levels of psychological distress long after their attempt and they highlight the importance of social relationships in the youths' psychological distress at follow-up.

Gay-related stress and emotional distress among gay, lesbian, and bisexual youths: a longitudinal examination.

The longitudinal relations between gay-related stress (i.e., gay-related stressful events, negative attitudes toward homosexuality, and discomfort with homosexuality) and emotional distress (i.e., anxious symptoms, depressive symptoms, and conduct problems) were examined at 3 assessment periods (baseline, 6 months, and 12 months) among 140 gay, lesbian, and bisexual (GLB) youths. Although some findings were consistent with the hypothesis that stress would be associated with subsequent distress among GLB youths, the larger number of nonsignificant relations and the presence of relations between distress and subsequent gay-related stress indicate that the hypothesis was unsupported. The authors discuss the potential reasons for the lack of hypothesized relations and offer suggestions for future research.

Predictors of substance use over time among gay, lesbian, and bisexual youths: an examination of three hypotheses.

Gay, lesbian, and bisexual (GLB) youths report elevated levels of substance use relative to heterosexual youths, but reasons for this disparity have received scant attention. This report longitudinally examined three hypothesized explanations for cigarette, alcohol, and marijuana use among 156 GLB youths. Counter to two hypotheses, neither a history of childhood sexual abuse nor recent experiences of gay-related stressful life events were associated with increased substance use over time. However, the hypothesis concerning the coming-out process was supported by significant nonlinear associations of involvement in gay-related (recreational and social) activities with changes in alcohol use at 12 months and changes in marijuana use at 6 months and 12 months. Specifically, as involvement in gay-related activities increased, alcohol and marijuana use was found to initially increase, but then, substance use declined as involvement in gay-related activities continued to increase. These findings offer a potential explanation for high levels of substance use among GLB youths and suggest potential areas for intervention to prevent or decrease substance use among these youths.

Ethnic/racial differences in the coming-out process of lesbian, gay, and bisexual youths: a comparison of sexual identity development over time.

This longitudinal report of 145 lesbian, gay, and bisexual (LGB) youths examined ethnic/racial differences in the coming-out process. No significant differences emerged in sexual developmental milestones, sexual orientation, sexual behavior, or sexual identity. However, Black youths reported involvement in fewer gay-related social activities, reported less comfort with others knowing their sexual identity, and disclosed that identity to fewer people than did White youths. Latino youths disclosed to fewer people than did White youths. Analyses of change indicated Black youths had greater increases in positive attitudes toward homosexuality and in certainty in their sexual identity over time than did White youths. These findings support the authors' hypothesis that cultural factors do not impede the formation of identity but may delay identity integration.