Healthcare discrimination and treatment adherence among sexual and gender minority individuals living with chronic illness: the mediating effects of anticipated discrimination and depressive symptoms.

Background: Sexual and gender minority (SGM) individuals are at increased risk for an array of chronic illness due to minority stress. Up to 70% of SGM individuals report healthcare discrimination, which may cause additional challenges for SGM people living with chronic illness including avoiding necessary healthcare. The extant literature highlights how healthcare discrimination is associated with depressive symptoms and treatment nonadherence. However, there is limited evidence on the underlying mechanisms between healthcare discrimination and treatment adherence among SGM people living with chronic illness.Methods: Among a sample of SGM individuals living with chronic illness (n = 149) recruited from social media, the current study examined the mediating roles of anticipated discrimination and depressive symptoms on the relation between healthcare discrimination and treatment adherence in a serial mediation model.Results: We found that healthcare discrimination was associated with greater anticipated discrimination, increased depressive symptoms, and, in turn, poorer treatment adherence. Conclusion: These findings highlight the association between minority stress and both depressive symptoms and treatment adherence among SGM individuals living with chronic illness. Addressing institutional discrimination and the consequences of minority stress may improve treatment adherence among SGM individuals living with chronic illness.

Use of intraoperative local field potential spectral analysis to differentiate basal ganglia structures in Parkinson's disease patients.

Identification of brain structures traversed during implantation of deep brain-stimulating (DBS) electrodes into the subthalamic nucleus (STN-DBS) for the treatment of Parkinson's disease (PD) frequently relies on subjective correspondence between kinesthetic response and multiunit activity. However, recent work suggests that local field potentials (LFP) could be used as a more robust signal to objectively differentiate subcortical structures. The goal of this study was to analyze the spectral properties of LFP collected during STN-DBS in order to objectively identify commonly traversed brain regions and improve our understanding of aberrant oscillations in the PD-related pathophysiological cortico-basal ganglia network. In 21 PD patients, LFP were collected and analyzed during STN-DBS implantation surgery. Spectral power for delta-, theta-, alpha-, low-beta-, and high-beta-frequency bands was assessed at multiple depths throughout the subcortical structures traversed on the trajectory to the ventral border of STN. Similar to previous findings, beta-band oscillations had an increased magnitude within the borders of the motor-related area of STN, however, across several subjects, we also observed increased high-beta magnitude within the borders of thalamus. Comparing across all patients using relative power, we observed a gradual increase in the magnitude of both low- and high-beta-frequency bands as the electrode descended from striatum to STN. These results were also compared with frequency bands below beta, and similar trends were observed. Our results suggest that LFP signals recorded during the implantation of a DBS electrode evince distinct oscillatory signatures that distinguish subcortical structures.