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Using an intersectionality-based approach to evaluate mental health services use among gay, bisexual and other men who have sex with men in Montreal, Toronto and Vancouver
- Ivan Marbaniang, Erica E. M. Moodie, Eric Latimer, Shayna Skakoon-Sparling, Trevor A. Hart, Daniel Grace, David M. Moore, Nathan J. Lachowsky, Jody Jollimore, Gilles Lambert, Terri Zhang, Milada Dvorakova, Joseph Cox, Engage Team Members
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- Journal:
- Epidemiology and Psychiatric Sciences / Volume 33 / 2024
- Published online by Cambridge University Press:
- 05 March 2024, e10
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Aims
To cope with homonegativity-generated stress, gay, bisexual and other men who have sex with men (GBM) use more mental health services (MHS) compared with heterosexual men. Most previous research on MHS among GBM uses data from largely white HIV-negative samples. Using an intersectionality-based approach, we evaluated the concomitant impact of racialization and HIV stigma on MHS use among GBM, through the mediating role of perceived discrimination (PD).
MethodsWe used baseline data from 2371 GBM enrolled in the Engage cohort study, collected between 2017 and 2019, in Montreal, Toronto and Vancouver, using respondent-driven sampling. The exposure was GBM groups: Group 1 (n = 1376): white HIV-negative; Group 2 (n = 327): white living with HIV; Group 3 (n = 577): racialized as non-white HIV-negative; Group 4 (n = 91): racialized as non-white living with HIV. The mediator was interpersonal PD scores measured using the Everyday Discrimination Scale (5-item version). The outcome was MHS use (yes/no) in the prior 6 months. We fit a three-way decomposition of causal mediation effects utilizing the imputation method for natural effect models. We obtained odds ratios (ORs) for pure direct effect (PDE, unmediated effect), pure indirect effect (PIE, mediated effect), mediated interaction effect (MIE, effect due to interaction between the exposure and mediator) and total effect (TE, overall effect). Analyses controlled for age, chronic mental health condition, Canadian citizenship, being cisgender and city of enrolment.
ResultsMean PD scores were highest for racialized HIV-negative GBM (10.3, SD: 5.0) and lowest for white HIV-negative GBM (8.4, SD: 3.9). MHS use was highest in white GBM living with HIV (GBMHIV) (40.4%) and lowest in racialized HIV-negative GBM (26.9%). Compared with white HIV-negative GBM, white GBMHIV had higher TE (OR: 1.71; 95% CI: 1.27, 2.29) and PDE (OR: 1.68; 95% CI: 1.27, 2.24), and racialized HIV-negative GBM had higher PIE (OR: 1.09; 95% CI: 1.02, 1.17). Effects for racialized GBMHIV did not significantly differ from those of white HIV-negative GBM. MIEs across all groups were comparable.
ConclusionsHigher MHS use was observed among white GBMHIV compared with white HIV-negative GBM. PD positively mediated MHS use only among racialized HIV-negative GBM. MHS may need to take into account the intersecting impact of homonegativity, racism and HIV stigma on the mental health of GBM.
56 Stereological Densities of Neuronal Tau Inclusions in Corticobasal Degeneration are Anatomically Distinct in PPA vs bvFTD
- Grace Minogue, Allegra Kawles, Antonia Zouridakis, Rachel Keszycki, Christina Coventry, Nathan Gill, Hui Zhang, Emily Rogalski, Sandra Weintraub, Qinwen Mao, Margaret Flanagan, Rudolph Castellani, M-Marsel Mesulam, Changiz Geula, Tamar Gefen
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, p. 262
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Objective:
Primary progressive aphasia (PPA) is a dementia syndrome characterized early in its course by gradual dissolution of language and is associated with asymmetric atrophy in the language-dominant hemisphere (usually left). In contrast, behavioral variant frontotemporal dementia (bvFTD) is a dementia syndrome characterized by a progressive early decline in personality and comportment and is associated with relatively symmetric or rightward predominant bifrontal atrophy. This study analyzed the regional and hemispheric distributions of neuronal tau inclusions of the corticobasal degeneration variant of FTLD-tau pathology (FTLD-CBD) in individuals with PPA or bvFTD. The goal was to establish clinicopathologic concordance between FTLD-CBD and behavioral/comportmental vs aphasic dementia syndromes.
Participants and Methods:Seven participants were clinically diagnosed with PPA and 6 were diagnosed with bvFTD. All had FTLD-CBD as the principal neuropathologic diagnosis at postmortem study. Sections from the following cortical regions were stained immunohistochemically with AT-8 to visualize neuronal tau inclusions: bilateral middle frontal gyrus (MFG), inferior parietal lobule (IPL), superior temporal gyrus (STG); and unilateral occipital cortex (OCC). Bilateral anterior temporal lobes (ATL) were analyzed in PPA cases only. Unbiased stereological analysis was performed to compare regional and hemispheric distributions between and within PPA vs. bvFTD groups.
Results:Overall neocortical (MFG+STG+IPL) tau densities were significantly greater in the PPA group compared to the bvFTD group (p<0.05). Within the bvFTD group, the highest densities of tau inclusions were observed in the right MFG (mean=6,871.17; SD=3,220). In the PPA group, highest densities were observed in the left ATL (mean=9,901.81; SD=6,871). There was leftward hemispheric asymmetry of tau inclusions in IPL, STG and ATL which trended towards significance in the latter (p=0.083). Cortical distributions were symmetric or rightward predominant within the bvFTD group. Occipital cortex was devoid of inclusions.
Conclusions:Preliminary stereological findings of FTLD-CBD tau inclusions suggest that the distributions of pathologic tau are different across two distinct clinical dementia phenotypes. The presence of left-sided neuronal tau inclusions in PPA is concordant with the aphasic phenotype whereas symmetric and frontal-predominant densities in bvFTD are consistent with comportmental dysfunction.
Examining the operationalizability of findings from homicide investigations
- R. Nathan, R. Caplan, M. Gill-Mullarkey
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S883-S884
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Introduction
Investigations into health and social care services offered to people who have died by suicide or who have committed a homicide have the potential to facilitate improvements in future practice. Such improvements are, however, dependent on the operationalizability of the recommendations of these investigations. Operationalizability in this context means the potential of the recommendations to alter the thinking/actions of practitioners involved in the areas of practice to which the recommendations relate. Critically, the proposed learning must make sense to practitioners in a multiplicity of single instance episodes of practice when the future is unknown. Although common content themes identified by investigations have been reported, no study has yet specifically examined how the framing of recommendations in investigation reports affects their operationalizability.
ObjectivesPrimary objective: to pilot a novel approach to the thematic analysis of investigations into serious incidents which focuses on the operationalizability of recommendations for day-to-day practice. Secondary objective: to explore the operationalizability of the specific recommendations arising from a recent UK review of child homicides.
MethodsA publicly available UK national review of child homicides by parents under social care services was subjected to a two-stage thematic analysis (firstly, to identify the types of thinking/acting that were scrutinised; and secondly to characterise the ways in which these thoughts/actions were appraised). The frame of reference for the thematic analysis was that of a practitioner involved in typical instances of practice where there is uncertainty about outcomes (i.e. real-life practice).
ResultsStage 1 - Four types of thinking/acting were identified: (i) information gathering, (ii) interpretation, (iii) judgement formation, and (iv) decision to act (figure 1).Stage 2 - The thoughts/actions were appraised according to three key themes: (a) occurrence of thoughts/actions at a pivotal moment, (b) erroneousness of thoughts/actions, and (c) thoroughness of thoughts/actions.
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ConclusionsWith regard to the specific report analysed, the recommendations were found to have differing degrees of operationalizability. For instance, examples of ‘erroneous thinking/acting’ were more readily applicable to future practice (since they can be operationalised in terms of general principles). However, the notion of ‘pivotal moments’ is less useful, since the labelling of moments as ‘pivotal’ is dependent on a knowledge of the outcome and therefore would not have been readily identified contemporaneously in these cases (or, by extension in future similar cases prior to any serious incident). This pilot demonstrates that the novel approach used is a feasible way to examine not just the content, but also the utility, of investigation recommendations.
Disclosure of InterestNone Declared
Blue justice: A review of emerging scholarship and resistance movements
- Jessica L. Blythe, David A. Gill, Joachim Claudet, Nathan J. Bennett, Georgina G. Gurney, Jacopo A. Baggio, Natalie C. Ban, Miranda L. Bernard, Victor Brun, Emily S. Darling, Antonio Di Franco, Graham Epstein, Phil Franks, Rebecca Horan, Stacy D. Jupiter, Jacqueline Lau, Natali Lazzari, Shauna L. Mahajan, Sangeeta Mangubhai, Josheena Naggea, Rachel A. Turner, Noelia Zafra-Calvo
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- Journal:
- Cambridge Prisms: Coastal Futures / Volume 1 / 2023
- Published online by Cambridge University Press:
- 26 January 2023, e15
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The term “blue justice” was coined in 2018 during the 3rd World Small-Scale Fisheries Congress. Since then, academic engagement with the concept has grown rapidly. This article reviews 5 years of blue justice scholarship and synthesizes some of the key perspectives, developments, and gaps. We then connect this literature to wider relevant debates by reviewing two key areas of research – first on blue injustices and second on grassroots resistance to these injustices. Much of the early scholarship on blue justice focused on injustices experienced by small-scale fishers in the context of the blue economy. In contrast, more recent writing and the empirical cases reviewed here suggest that intersecting forms of oppression render certain coastal individuals and groups vulnerable to blue injustices. These developments signal an expansion of the blue justice literature to a broader set of affected groups and underlying causes of injustice. Our review also suggests that while grassroots resistance efforts led by coastal communities have successfully stopped unfair exposure to environmental harms, preserved their livelihoods and ways of life, defended their culture and customary rights, renegotiated power distributions, and proposed alternative futures, these efforts have been underemphasized in the blue justice scholarship, and from marine and coastal literature more broadly. We conclude with some suggestions for understanding and supporting blue justice now and into the future.
Out of the frying pan and into the fire: effects of volcanic heat and other stressors on the conservation of a critically endangered plant in Hawai‘i
- Nathan S Gill, Jeffery K Stallman, Linda Pratt, Jennifer Lewicki, Tamar Elias, Patricia A Nadeau, Stephanie Yelenik
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- Journal:
- Environmental Conservation / Volume 50 / Issue 2 / June 2023
- Published online by Cambridge University Press:
- 06 January 2023, pp. 108-115
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Loss of local biodiversity resulting from abrupt environmental change is a significant environmental problem throughout the world. Extinctions of plants are particularly important yet are often overlooked. Drawing from a case in Hawai‘i, a global hotspot for plant and other extinctions, we demonstrate an effort to better understand and determine priorities for the management of an endangered plant (‘Ihi makole or Portulaca sclerocarpa) in the face of rapid and extreme environmental change. Volcanic heat emissions and biological invasions have anecdotally been suggested as possible threats to the species. We integrated P. sclerocarpa outplanting with efforts to collect geological and ecological data to gauge the role of elevated soil temperatures and invasive grasses in driving P. sclerocarpa mortality and population decline. We measured soil temperature, soil depth, surrounding cover and P. sclerocarpa survivorship over three decades. The abundance of wild P. sclerocarpa decreased by 99.7% from the 1990s to 2021. Only 51% of outplantings persisted through 3–4 years. Binomial regression and structural equation modelling revealed that, among the variables we analysed, high soil temperatures were most strongly associated with population decline. Finding the niche where soil temperatures are low enough to allow P. sclerocarpa survival but high enough to limit other agents of P. sclerocarpa mortality may be necessary to increase population growth of this species.
A global threats overview for Numeniini populations: synthesising expert knowledge for a group of declining migratory birds
- JAMES W. PEARCE-HIGGINS, DANIEL J. BROWN, DAVID J. T. DOUGLAS, JOSÉ A. ALVES, MARIAGRAZIA BELLIO, PIERRICK BOCHER, GRAEME M. BUCHANAN, ROB P. CLAY, JESSE CONKLIN, NICOLA CROCKFORD, PETER DANN, JAANUS ELTS, CHRISTIAN FRIIS, RICHARD A. FULLER, JENNIFER A. GILL, KEN GOSBELL, JAMES A. JOHNSON, ROCIO MARQUEZ-FERRANDO, JOSE A. MASERO, DAVID S. MELVILLE, SPIKE MILLINGTON, CLIVE MINTON, TAEJ MUNDKUR, ERICA NOL, HANNES PEHLAK, THEUNIS PIERSMA, FRÉDÉRIC ROBIN, DANNY I. ROGERS, DANIEL R. RUTHRAUFF, NATHAN R. SENNER, JUNID N. SHAH, ROB D. SHELDON, SERGEJ A. SOLOVIEV, PAVEL S. TOMKOVICH, YVONNE I. VERKUIL
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- Journal:
- Bird Conservation International / Volume 27 / Issue 1 / March 2017
- Published online by Cambridge University Press:
- 01 March 2017, pp. 6-34
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The Numeniini is a tribe of 13 wader species (Scolopacidae, Charadriiformes) of which seven are Near Threatened or globally threatened, including two Critically Endangered. To help inform conservation management and policy responses, we present the results of an expert assessment of the threats that members of this taxonomic group face across migratory flyways. Most threats are increasing in intensity, particularly in non-breeding areas, where habitat loss resulting from residential and commercial development, aquaculture, mining, transport, disturbance, problematic invasive species, pollution and climate change were regarded as having the greatest detrimental impact. Fewer threats (mining, disturbance, problematic native species and climate change) were identified as widely affecting breeding areas. Numeniini populations face the greatest number of non-breeding threats in the East Asian-Australasian Flyway, especially those associated with coastal reclamation; related threats were also identified across the Central and Atlantic Americas, and East Atlantic flyways. Threats on the breeding grounds were greatest in Central and Atlantic Americas, East Atlantic and West Asian flyways. Three priority actions were associated with monitoring and research: to monitor breeding population trends (which for species breeding in remote areas may best be achieved through surveys at key non-breeding sites), to deploy tracking technologies to identify migratory connectivity, and to monitor land-cover change across breeding and non-breeding areas. Two priority actions were focused on conservation and policy responses: to identify and effectively protect key non-breeding sites across all flyways (particularly in the East Asian- Australasian Flyway), and to implement successful conservation interventions at a sufficient scale across human-dominated landscapes for species’ recovery to be achieved. If implemented urgently, these measures in combination have the potential to alter the current population declines of many Numeniini species and provide a template for the conservation of other groups of threatened species.
Contributors
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- By Tod C. Aeby, Melanie D. Altizer, Ronan A. Bakker, Meghann E. Batten, Anita K. Blanchard, Brian Bond, Megan A. Brady, Saweda A. Bright, Ellen L. Brock, Amy Brown, Ashley Carroll, Jori S. Carter, Frances Casey, Weldon Chafe, David Chelmow, Jessica M. Ciaburri, Stephen A. Cohen, Adrianne M. Colton, PonJola Coney, Jennifer A. Cross, Julie Zemaitis DeCesare, Layson L. Denney, Megan L. Evans, Nicole S. Fanning, Tanaz R. Ferzandi, Katie P. Friday, Nancy D. Gaba, Rajiv B. Gala, Andrew Galffy, Adrienne L. Gentry, Edward J. Gill, Philippe Girerd, Meredith Gray, Amy Hempel, Audra Jolyn Hill, Chris J. Hong, Kathryn A. Houston, Patricia S. Huguelet, Warner K. Huh, Jordan Hylton, Christine R. Isaacs, Alison F. Jacoby, Isaiah M. Johnson, Nicole W. Karjane, Emily E. Landers, Susan M. Lanni, Eduardo Lara-Torre, Lee A. Learman, Nikola Alexander Letham, Rachel K. Love, Richard Scott Lucidi, Elisabeth McGaw, Kimberly Woods McMorrow, Christopher A. Manipula, Kirk J. Matthews, Michelle Meglin, Megan Metcalf, Sarah H. Milton, Gaby Moawad, Christopher Morosky, Lindsay H. Morrell, Elizabeth L. Munter, Erin L. Murata, Amanda B. Murchison, Nguyet A. Nguyen, Nan G. O’Connell, Tony Ogburn, K. Nathan Parthasarathy, Thomas C. Peng, Ashley Peterson, Sarah Peterson, John G. Pierce, Amber Price, Heidi J. Purcell, Ronald M. Ramus, Nicole Calloway Rankins, Fidelma B. Rigby, Amanda H. Ritter, Barbara L. Robinson, Danielle Roncari, Lisa Rubinsak, Jennifer Salcedo, Mary T. Sale, Peter F. Schnatz, John W. Seeds, Kathryn Shaia, Karen Shelton, Megan M. Shine, Haller J. Smith, Roger P. Smith, Nancy A. Sokkary, Reni A. Soon, Aparna Sridhar, Lilja Stefansson, Laurie S. Swaim, Chemen M. Tate, Hong-Thao Thieu, Meredith S. Thomas, L. Chesney Thompson, Tiffany Tonismae, Angela M. Tran, Breanna Walker, Alan G. Waxman, C. Nathan Webb, Valerie L. Williams, Sarah B. Wilson, Elizabeth M. Yoselevsky, Amy E. Young
- Edited by David Chelmow, Virginia Commonwealth University, Christine R. Isaacs, Virginia Commonwealth University, Ashley Carroll, Virginia Commonwealth University
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- Book:
- Acute Care and Emergency Gynecology
- Published online:
- 05 November 2014
- Print publication:
- 30 October 2014, pp ix-xiv
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Pharmacological treatments for neuropsychiatric symptoms of dementia in long-term care: a systematic review
- Dallas P. Seitz, Sudeep S. Gill, Nathan Herrmann, Sarah Brisbin, Mark J. Rapoport, Jenna Rines, Kimberley Wilson, Ken Le Clair, David K. Conn
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- Journal:
- International Psychogeriatrics / Volume 25 / Issue 2 / February 2013
- Published online by Cambridge University Press:
- 19 October 2012, pp. 185-203
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Background: Medications are frequently prescribed for neuropsychiatric symptoms (NPS) associated with dementia, although information on the efficacy and safety of medications for NPS specifically in long-term care (LTC) settings is limited. The objective of this study was to provide a current review of the efficacy and safety of pharmacological treatments for NPS in LTC.
Methods: We searched MEDLINE, EMBASE, PsychINFO, and the Cochrane Library for randomized controlled trials comparing medications with either placebo or other interventions in LTC. Study quality was described using the Cochrane collaboration risk of bias tool. The efficacy of medications was evaluated using NPS symptom rating scales. Safety was evaluated through rates of trial withdrawals, trial withdrawals due to adverse events, and mortality.
Results: A total of 29 studies met inclusion criteria. The most common medications evaluated in studies were atypical antipsychotics (N = 15), typical antipsychotics (N = 7), anticonvulsants (N = 4), and cholinesterase inhibitors (N = 3). Statistically significant improvements in NPS were noted in some studies evaluating risperidone, olanzapine, and single studies of aripiprazole, carbamazepine, estrogen, cyproterone, propranolol, and prazosin. Study quality was difficult to rate in many cases due to incomplete reporting of details. Some studies reported higher rates of trial withdrawals, adverse events, and mortality associated with medications.
Conclusions: We conclude that there is limited evidence to support the use of some atypical antipsychotics and other medications for NPS in LTC populations. However, the generally modest efficacy and risks of adverse events highlight the need for the development of safe and effective pharmacological and non-pharmacological interventions for this population.
Potential Role of Active Surveillance in the Control of a Hospital-Wide Outbreak of Carbapenem-Resistant Klebsiella pneumoniae Infection
- Debby Ben-David, Yasmin Maor, Nathan Keller, Gili Regev-Yochay, Ilana Tal, Dalit Shachar, Amir Zlotkin, Gill Smollan, Galia Rahav
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 31 / Issue 6 / June 2010
- Published online by Cambridge University Press:
- 02 January 2015, pp. 620-626
- Print publication:
- June 2010
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Background.
The recent emergence of carbapenem resistance among Enterobacteriaceae is a major threat for hospitalized patients, and effective strategies are needed.
Objective.To assess the effect of an intensified intervention, which included active surveillance, on the incidence of infection with carbapenem-resistant Klebsiella pneumoniae.
Setting.Sheba Medical Center, a 1,600-bed tertiary care teaching hospital in Tel Hashomer, Israel.
Design.Quasi-experimental study.
Methods.The medical records of all the patients who acquired a carbapenem-resistant K. pneumoniae infection during 2006 were reviewed. An intensified intervention was initiated in May 2007. In addition to contact precautions, active surveillance was initiated in high-risk units. The incidence of clinical carbapenem-resistant K. pneumoniae infection over time was measured, and interrupted time-series analysis was performed.
Results.The incidence of clinical carbapenem-resistant K. pneumoniae infection increased 6.42-fold from the first quarter of 2006 up to the initiation of the intervention. In 2006, of the 120 patients whose clinical microbiologic culture results were positive for carbapenem-resistant K. pneumoniae, 67 (56%) developed a nosocomial infection. During the intervention period, the rate of carbapenem-resistant K. pneumoniae rectal colonization was 9%. Of the 390 patients with carbapenem-resistant K. pneumoniae colonization or infection, 204 (52%) were identified by screening cultures. There were a total of 12,391 days of contact precautions, and of these, 4,713 (38%) were added as a result of active surveillance. After initiation of infection control measures, we observed a significant decrease in the incidence of carbapenem-resistant K. pneumoniae infection.
Conclusions.The use of active surveillance and contact precautions, as part of a multifactorial intervention, may be an effective strategy to decrease rates of nosocomial transmission of carbapenem-resistant K. pneumoniae colonization or infection.