Though lesbian, gay, bisexual, transgender and queer (LGBTQ) young adults in the USA experience identity-based adversities, they also develop resilience. Research overemphasizes these young people's ...risks without fully considering their unique social environments. This study documents how LGBTQ young people subjectively and contextually interpret arduous life experiences. Based on 46 LGBTQ young adults aged 19–26 who are either homeless or attending college, we examine how LGBTQ young people with diverse contextual life situations develop understandings of resilience. Findings underscore nuanced processes young people use to reframe their identity-related challenges that enrich their lives in meaningful, resilience-building ways.
We assessed the feasibility of ecological momentary assessment using short message service (SMS) surveying with 150 homeless youth. We found that on average, participants completed 18.8 days of ...texts, but 30% of youth (N = 44) had texting data on 28 or more days. The average number of texts answered per day was 8.49 (of a possible 11). Forty-three percent of days had answers to all 11 texts sent that day, and 69.4% of days had answers to eight or more texts. We found significant differences in response rates by phone type. Seventy-three percent of youth reported that responding to our texts was very easy or somewhat easy and 69% endorsed the response option “just enough,” regarding the number of texts sent per day. The 30-day texting period was deemed “about right” by 74% of youth. Details of using SMS with homeless youth are provided, and results indicate that this data collection technique is feasible with this population.
Posttraumatic stress disorder (PTSD) dramatically increases the risk of both substance use disorder (SUD) and suicide in veterans. Military-related trauma, however, may not be the only or most ...significant trauma experienced by veterans. Trauma exposure is high among those joining the military. This study sought to identify the prevalence of five types of childhood trauma (emotional, physical, and sexual abuse and emotional and physical neglect) and three adult trauma symptom clusters (intrusive thoughts, avoidance, and hyperarousal) among veterans seeking SUD treatment and to clarify the associations between types of trauma and specific symptom clusters. Veterans at three Veterans Affairs (VA) SUD treatment facilities in the Midwest completed surveys at treatment entry (n1 = 195) and at 6-month follow-up (n2 = 138). Measures included the Childhood Trauma Questionnaire-Short Form and the PTSD Checklist, either a military or a civilian version, depending on whether the most traumatic event occurred in or out of the military. The prevalence of childhood trauma was high, ranging from 40.5% experiencing physical abuse down to 22.8% experiencing sexual abuse. At baseline, 60.2% of the military trauma group met criteria for PTSD, compared with 33.9% of the civilian trauma group, a significant difference, χ2(1, N = 195) = 14.46, p < .01. Childhood emotional and physical abuse were moderately associated with intrusion and hyperarousal in the military trauma group, but in the civilian trauma group a broader spectrum of childhood traumas were associated with a broader array of symptom clusters, including avoidance. At follow-up, symptoms improved and were less associated with childhood trauma. These findings illuminate the persistence of effects of childhood trauma and recommend more targeted PTSD treatments.
Abstract
Background
Households are hot spots for severe acute respiratory syndrome coronavirus 2 transmission.
Methods
This prospective study enrolled 100 coronavirus disease 2019 (COVID-19) cases ...and 208 of their household members in North Carolina though October 2020, including 44% who identified as Hispanic or non-White. Households were enrolled a median of 6 days from symptom onset in the index case. Incident secondary cases within the household were detected using quantitative polymerase chain reaction of weekly nasal swabs (days 7, 14, 21) or by seroconversion at day 28.
Results
Excluding 73 household contacts who were PCR-positive at baseline, the secondary attack rate (SAR) among household contacts was 32% (33 of 103; 95% confidence interval CI, 22%–44%). The majority of cases occurred by day 7, with later cases confirmed as household-acquired by viral sequencing. Infected persons in the same household had similar nasopharyngeal viral loads (intraclass correlation coefficient = 0.45; 95% CI, .23–.62). Households with secondary transmission had index cases with a median viral load that was 1.4 log10 higher than those without transmission (P = .03), as well as higher living density (more than 3 persons occupying fewer than 6 rooms; odds ratio, 3.3; 95% CI, 1.02–10.9). Minority households were more likely to experience high living density and had a higher risk of incident infection than did White households (SAR, 51% vs 19%; P = .01).
Conclusions
Household crowding in the context of high-inoculum infections may amplify the spread of COVID-19, potentially contributing to disproportionate impact on communities of color.
Households are hot spots for severe acute respiratory syndrome coronavirus 2 transmission. In the United States, household crowding in the context of high-inoculum infections may amplify the spread of COVID-19, potentially contributing to disproportionate impact on communities of color.
Genome sequencing has been rapidly integrated into clinical research and is currently marketed to health-care practitioners and consumers alike. The volume of sequencing data generated for a single ...individual and the wide range of findings from whole-genome sequencing raise critical questions about the return of results and their potential value for end-users. We conducted a mixed-methods study of 311 sequential participants in the NIH ClinSeq study to assess general preferences and specific attitudes toward learning results. We tested how these variables predicted intentions to receive results within four categories of findings ranging from medically actionable to variants of unknown significance. Two hundred and ninety-four participants indicated a preference to learn their genome sequencing results. Most often, participants cited disease prevention as their reason, including intention to change their lifestyle behaviors. Participants held positive attitudes, strongly perceived social norms and strong intentions to learn results, although there were significant mean differences among four categories of findings (P<0.01). Attitudes and social norms for medically actionable and carrier results were most similar and rated the highest. Participants distinguished among the types and quality of information they may receive, despite strong intentions to learn all results presented. These intentions were motivated by confidence in their ability to use the information to prevent future disease and a belief in the value of even uninterpretable information. It behooves investigators to facilitate participants' desire to learn a range of information from genomic sequencing while promoting realistic expectations for its clinical and personal utility.
To determine the safety of a fully functioning shared care model (SCM) in hepatopancreatobiliary surgery through evaluating outcomes in pancreaticoduodenectomy.
SCMs, where a team of surgeons share ...in care delivery and resource utilization, represent a surgeon-level opportunity to improve system efficiency and peer support, but concerns around clinical safety remain, especially in complex elective surgery.
Patients who underwent pancreaticoduodenectomy between 2016-2020 were included. Adoption of shared care was demonstrated by analyzing shared care measures including the number of surgeons encountered by patients during their care cycle, proportion of patients with different consenting versus primary operating surgeon (POS), and the proportion of patients who met their POS on the day of surgery. Outcomes including 30-day mortality, readmission, unplanned reoperation, sepsis, and length of stay (LOS) were collected from the institution's National Surgical Quality Improvement Program (NSQIP) database and compared to peer hospitals contributing to the pancreatectomy-specific NSQIP collaborative.
Of the 174 patients included, a median of three surgeons were involved throughout the patients' care cycle, 69.0% of patients had different consenting versus POS, and 57.5% met their POS on the day of surgery. Major outcomes including mortality (1.1%), sepsis (5.2%), and reoperation (7.5%) were comparable between the study group and NSQIP peer hospitals. LOS (10 d) was higher in place of lower readmission (13.2%) in the study group compared to peer hospitals.
SCMs are feasible in complex elective surgery without compromising patient outcomes, and wider adoption may be encouraged.
The abuse of opioid and methamphetamine is a public health crisis in the United States, particularly in rural areas where injection drug use is common. This systematic review of rural injection drug ...use synthesized the research on injection of opioids and methamphetamine use and assessed the similarity of their research findings to the field of rural injection drug use in the United States. A citation network analysis was used to support the assessment of research similarity and provided a visualization of the field. This citation network analysis exposed a gap in the literature revealing that the state of research may not be fully applicable to the field in its entirety in the United States. In summary, this review provides a representative overview of the state of research in the field of injection drug use. Future research should conduct studies on rural drug use in areas of the country not represented in this review.
While many homeless youth use cell phones to stay socially connected, and maintaining positive social ties can contribute to pathways out of homelessness, little is known about how using cell phones ...for data collection can improve these young people's lives. We conducted baseline and follow-up interviews with 150 homeless youth as well as provided them with a cell phone for 30days to gather daily data using short message service (SMS) surveying. This paper examines youths' opinions about study participation and how they used the cell phone. Results revealed that youth liked participating in the study because the SMS texting portion, for example, made them feel that someone still cared about them, prompted them to self-reflect on their life, and allowed them to make a difference (e.g. educating the public about homelessness). Despite numerous benefits of study participation, improvements that youth discussed for future studies included changing the format of our text questions to allow for explanations and the use of higher quality phones. In terms of study phone usage, youth reported using the phone to schedule appointments, contact employers, and to keep in touch with family and friends. Finally, we highlight ways in which cell phones via SMS could be used with homeless youth to provide informational resources along with educational and employment opportunities, all of which are important intervention strategies in improving life situations for this population.
•We examine homeless youths' interpretations of their roles as study participants.•Used cell phones to collect daily data using short message service (SMS)•Participation resulted in youth feeling productive and contributing to society.•SMS with homeless youth holds enormous potential as an intervention tool.
We employ a social stress framework, which examines the influence of multiple stressors (e.g., physical abuse, foster care placement) on an individual's ability to function (e.g., mental well‐being), ...to longitudinally examine the effects of stressful life events on mental health and the role of the social environment in this process among 150 homeless youth. Results revealed that numerous stressors, such as physical abuse and running away from home more frequently, were associated with greater depressive symptoms and elevated anxiety. Having mentors and family and friends from home that youth can rely on resulted in more positive social support, which subsequently lowered the risk for depressive symptoms and anxiety at wave 2.
Little is known about the location and consistency of sleeping arrangements among youth experiencing homelessness (YEH) and how this is linked to their well-being. This study addresses this gap using ...ecological momentary assessment (EMA) via short message service (SMS) surveying with 150 YEH over 30 days, to examine how various sleeping arrangements are associated with depression, marijuana use, support received, and service utilization. Results revealed that the average number of consecutive days youth stayed at any particular location varied considerably. Youth who stayed more frequently with a friend/partner or in a transitional living facility (TLF) reported fewer days of being depressed, whereas staying with a friend/partner was associated with using marijuana more frequently. Finally, youth staying with a friend/partner, stranger, or TLF reported using services on fewer days. Because sleeping arrangements change almost daily, on average, this has important public health implications for agencies finding permanent housing for YEH.
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