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Housing insecurity is a critical issue within Southern Nevada. However, little is known about the housing-insecurity-related needs of LGBTQIA+ Southern Nevadans. The aim of this study was to identify strategies to address housing insecurity among this vulnerable community. Utilizing community-based participatory research and concept mapping, the most salient solutions were identified and prioritized at a Community Housing Forum. This Forum brought together stakeholders with expertise in housing or who work with the LGBTQIA+ community. The most important identified solutions consistently emphasized the criticality of culturally competent mental health services; the need for affordable housing options; and various social and environmental factors. There is a continued need for research and collaboration among organizations and providers to better serve LGBTQIA+ individuals experiencing housing insecurity. Additional research is needed to determine the efficacy of the identified solutions and to inform the development of context-specific and broadly applicable strategies to address housing insecurity within this community.

Objectives: To test the psychometric properties of several dementia care-related scales among Latinos in the US., Design: We leveraged secondary baseline data from a one-arm mHealth trial on dementia caregiver support. We included 100 responses for caregiver-focused scales and 88 responses for care recipient-focused scales. Scales included the Neuropsychiatric Inventory Questionnaire Severity and Distress scales, six-item Zarit Burden Inventory, Ten-item Center for Epidemiologic Studies Depression Scale, Geriatric Depression Inventory, Quality of Life in Alzheimer's Disease, and Single-item Satisfaction With Life Scale. We calculated concurrent validity using Pearson and Spearman correlations and expected correlations amongst all variables in line with the Stress Process Framework. We calculated internal consistency reliability using Cronbach's alpha., Results: All concurrent validity correlations followed the expected directionality, with 19/21 inter-scale correlations in the total sample reaching statistical significance (p<0.05), and 17/21 reaching at least a low correlation (0.3). Cronbach's alpha ranged from 0.832 to 0.879 in all scales in the total sample., Conclusion: The English and Spanish caregiver-administered scales tested in this manuscript have good psychometric properties., Clinical Implications: The dementia care-related scales are now appropriately available for use among US Latinos in research and clinical contexts., Competing Interests: Disclosure statement: The authors declare that they have no conflict of interest.

Purpose: This study aimed to conduct a moderated mediation analysis to understand further the complex pathways through which structural stigma in the form of transgender sports bans was associated with suicidal ideation and behaviors among sexual and gender minority (SGM) adults. Methods: A cross-sectional survey of 1033 adults who identified as SGM from across the 50 U.S. states and Washington, DC was conducted between January 28 and February 7, 2022. Distal discrimination distress was the mediation variable; individual resilience and social resources were the moderation variables. Familiarity with transgender sports bans represented structural stigma. The conditional process analysis was applied to build a moderated mediation model. Both conditional direct and indirect effects were computed by estimated coefficients. All models were based on linear regression. Results: Our final model explained nearly half (46%) of the variation in suicidal ideation and behaviors between those SGM adults familiar and those not familiar with transgender sports bans. Social resources significantly moderated the conditional indirect effect of distal discrimination distress (adjusted estimate = -0.23; 95% confidence interval = -0.37 to -0.08). Conclusion: Both discrimination distress and social resources influenced the association between structural stigma as measured by familiarity with transgender sports bans and suicidal ideation and behaviors among SGM adults. Findings support the need for future research examining the pathway between structural stigma and suicidal ideation and behaviors among SGM adults and how minority stress, social safety, and other constructs shape this pathway.

As the health care and well-being of sexual and gender minority (SGM; i.e., lesbian, gay, bisexual, and/or transgender or gender non-binary) people in the United States receive federal and local-level attention, SGM older adults and caregivers continue to be left out of important health policy and care conversations. The current article describes policy issues and affirmative strategies related to inclusive care practices among SGM older adults and caregivers. In addition to the broader policies considered related to health and well-being, we include a discussion of local-level policy strategies to mitigate discrimination and promote inclusive care for SGM older adults and caregivers. [ Journal of Gerontological Nursing, 48 (12), 6-15.].

Background: Structural stigma in the form of discriminatory laws and policies impacts the mental health of sexual and gender minorities, especially with regard to suicidality. However, this relationship could be moderated by resilience. The past two years has brought anti-SGM legislation, particularly transgender sports bans, at the state level in the United States into focus. This study aims to understand if the relationship between familiarity with transgender sports bans (proposed or enacted) and suicidality was moderated by individual or community resilience., Methods: This was a cross-sectional study of survey data collected from a national sample of 1033 SGM adults in the United States between 28 January and 7 February 2022. Univariate and multivariate moderation analyses were used., Results: In the univariate analyses and the final model, community resilience moderated the relationship between structural stigma and suicidality ( p = 0.0002); however, individual resilience did not ( p = 0.0664)., Conclusion: Interventions to bolster community resilience may attenuate the negative mental health impacts of structural stigma and are warranted, along with concerted efforts to minimize structural stigma in the form of discriminatory laws and policies targeting people who are SGM.

Three models of recalled childhood gender nonconformity (GNC) and maltreatment are proposed to explain disparities in current psychological distress and lifetime suicidality among sexual minority individuals, using a United States probability sample of cisgender lesbian/gay ( n = 701), bisexual ( n = 606), and other (e.g., queer, n = 182) adults. Indirect effects indicated that lesbian/gay individuals were more likely than bisexual individuals to experience maltreatment and suicidal ideation as childhood GNC increased. Other indirect effects found that bisexual individuals reported more psychological distress and greater likelihood of lifetime suicidal ideation and attempts than lesbian/gay individuals as maltreatment increased. The direct effects of sexual orientation were stronger than the indirect effects via maltreatment or GNC, with bisexual individuals reporting more maltreatment, distress, and suicidality than lesbian/gay individuals. Significant findings for individuals with other identities were similar to those of bisexual individuals. Adjusted findings were comparable for women and men. The findings indicated that sexual minority individuals reported experiences consistent with sexual minority stress during early developmental periods, before being aware of their sexual orientation. It is necessary to understand the early lived experiences of sexual minority individuals, differences between lesbian/gay and bisexual individuals in those experiences, and their implications for adaptation.

Background: Discriminatory laws and policies are a form of structural stigma that is associated with increased suicidality among sexual and gender minority (SGM) people. Unfortunately, in the United States, there has been an increase in state-level discriminatory laws and policies targeting SGM people in 2021 and 2022, particularly, transgender sports bans. The purpose of this study was to (1) determine if familiarity with transgender sports bans was associated with suicidality among SGM adults; and (2) determine if interpersonal stigma and/or individual stigma mediated this association., Methods: This was a cross-sectional study of data collected from a national sample of 1033 SGM adults in the United States between 28 January and 7 February 2022. Univariate and serial mediator models were used in this analysis., Results: The increased suicidality was associated with familiarity with state-level transgender sports bans among SGM adults ( p -value = 0.0150). Even after interpersonal and individual stigma mediated this relationship, the association between suicidality and familiarity with state-level transgender sports bans remained ( p -value = 0.0106)., Conclusion: State-level transgender sports bans appear to exacerbate existing disparities in mental health, especially for individuals who are familiar with the bans. They directly discriminate against people who are transgender and indirectly stigmatize the broader SGM community.

Background and Objectives: We examined the health disparities of older adults (age 50 and older) in California at the intersection of sexual identity and Latinx ethnicity, by comparing the prevalence of health outcomes of 4 groups: LGB (lesbian, gay, and bisexual) Latinx, straight Latinx, LGB non-Latinx, and straight non-Latinx older adults., Research Design and Methods: Data were from the 2015-2016 California Health Interview Survey. Multivariable logistic regressions tested differences among the 4 groups and the effect of covariates on prevalence of mental and physical health outcomes. We compared LGB and straight people within the same ethnic groups and Latinx and non-Latinx people within the same sexual identity groups to understand the intersectional effect of Latinx ethnicity and LGB identity., Results: Tests by sexual identity showed that among Latinx older adults, more LGB than non-LGB people experienced serious psychological distress. Among non-Latinx older adults, there were no health disparities due to sexual identity. Tests by Latinx ethnicity showed that among LGB older adults, more Latinx than non-Latinx people were obese. Among straight people, more Latinx than non-Latinx older people had poor health, diabetes, and obesity., Discussion and Implications: The compounded effect of Latinx and LGB identity on psychological distress is notable. However, most health disparities were among straight older adults, between Latinx and non-Latinx people, indicating that Latinx, not sexual identity, nor their intersection, was most influential. Given the importance of sociodemographic factors on health outcomes, programs targeting LGB older adults should take a comprehensive approach to understand their experiences as ethnic minorities., (© The Author(s) 2020. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The aim of this study was to investigate the detailed mechanisms of hepatotoxicity induced by cadmium telluride quantum dots (CdTe-QDs) in BALB/c mice after intravenous injection. The study investigated oxidative stress, apoptosis, and effects on mitochondria as potential mechanistic events to elucidate the observed hepatotoxicity. Oxidative stress in the liver, induced by CdTe-QD exposure, was demonstrated by depletion of total glutathione, an increase in superoxide dismutase activity, and changes in the gene expression of several oxidative stress-related biomarkers. Furthermore, CdTe-QD treatment led to apoptosis in the liver via both intrinsic and extrinsic apoptotic pathways. Effects on mitochondria were evidenced by the enlargement and increase in the number of mitochondria in hepatocytes of treated mice. CdTe-QDs also caused changes in the levels and gene expression of electron transport chain enzymes, depletion of ATP, and an increase in the level of the peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α), a regulator of mitochondrial biogenesis. The findings from this study suggest that CdTe-QDs-induced hepatotoxicity might have originated from mitochondrial effects which resulted in oxidative stress and apoptosis in the liver cells. This study provides insight into the biological effects of CdT-QDs at the tissue level and the detailed mechanisms of their toxicity in animals. The study also provides important data for bridging the gap between in vitro and in vivo testing and risk assessment of these NPs.

Quantum dots (QDs) are engineered nanoparticles (NPs) of semiconductor structure that possess unique optical and electronic properties and are widely used in biomedical applications; however, their risks are not entirely understood. This study investigated the tissue distribution and toxic effects of cadmium telluride quantum dots (CdTe-QDs) in male BALB/c mice for up to 1 week after single-dose intravenous injections. CdTe-QDs were detected in the blood, lung, heart, liver, spleen, kidney, testis and brain. Most CdTe-QDs accumulated in the liver, followed by the spleen and kidney. At high doses, exposure to CdTe-QDs resulted in mild dehydration, lethargy, ruffled fur, hunched posture, and body weight loss. Histological analysis of the tissues, upon highest dose exposures, revealed hepatic hemorrhage and necrotic areas in the spleen. The sera of mice treated with high doses of CdTe-QDs showed significant increases in alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin levels, as well as a reduction in albumin. CdTe-QD exposure also led to a reduced number of platelets and elevated total white blood cell counts, including monocytes and neutrophils, serum amyloid A, and several pro-inflammatory cytokines. These results demonstrated that the liver is the main target of CdTe-QDs and that exposure to CdTe-QDs leads to hepatic and splenic injury, as well as systemic effects, in mice. By contrast, cadmium chloride (CdCl 2 ), at an equivalent concentration of cadmium, appeared to have a different pharmacokinetic pattern from that of CdTe-QDs, having minimal effects on the aforementioned parameters, suggesting that cadmium alone cannot fully explain the toxicity of CdTe-QDs.

Context: The rates of appendiceal rupture and negative appendectomy in children remain high despite efforts to reduce them. Both outcomes are used as measures of hospital quality. Little is known about the factors that influence these rates., Objective: To investigate the association between hospital- and patient-level characteristics and the rates of appendiceal rupture and negative appendectomy in children., Design, Setting, and Patients: Retrospective review using the Pediatric Health Information System database containing information on 24,411 appendectomies performed on children aged 5 to 17 years at 36 pediatric hospitals in the United States between 1997 and 2002., Main Outcome Measures: Rates of negative appendectomy and appendiceal rupture; the odds ratio (OR) of negative appendectomy and appendiceal rupture by hospital, patient age, race, and health insurance status, and hospital fiscal year and appendectomy volume. Negative appendectomy rate was defined as the number of patients with appendectomy but without appendicitis divided by the total number of appendectomies., Results: The median negative appendectomy rate was 3.06% (range, 1%-12%) and the median appendiceal rupture rate was 35.08% (range, 22%-62%). The adjusted OR for appendiceal rupture was higher in Asian children (1.66; 95% confidence interval [CI], 1.24-2.23) and black children (1.13; 95% CI, 1.01-1.30) compared with white children. Children without health insurance and children with public insurance had increased odds of appendiceal rupture compared with children who had private health insurance (adjusted OR, 1.36; 95% CI, 1.22-1.53 for self-insured; adjusted OR, 1.48; 95% CI, 1.34-1.64 for public insurance). No correlation existed between negative appendectomy rate and race, health insurance status, or hospital appendiceal rupture rate. The negative appendectomy rate improved as the hospital appendectomy volume increased., Conclusion: The rate of appendiceal rupture in school-aged children was associated with race and health insurance status and not with negative appendectomy rate and therefore is more likely to be associated with prehospitalization factors such as access to care, quality of care, and patient or physician education.

Background/purpose: To improve clinical results and resource utilization in the care of appendicitis in children, the authors examined the current practice and outcomes of 30 pediatric hospitals., Methods: The Pediatric Health Information System (PHIS) database consists of comparative data from 30 free-standing Children's hospitals. The study population of 3,393 children was derived from the database by selecting the "Diagnosis Related Group Code" for appendicitis (APRDRGv12 164), ages 0 to 17 years, using discharges between October 1, 1999 and September 30, 2000. Data are expressed as the range and median for individual hospital outcomes., Results: The nonpositive appendectomy rate ranged from 0 to 17% at the 30 hospitals (median, 2.6%). Ruptured appendicitis varied from 20% to 76% (median, 36.5%). The median length of stay (LOS) for nonruptured appendicitis was 2 days (range, 1.4 to 3.1 days), ruptured appendicitis varied from 4.4 to 11 days (median, 6 days). The median readmission rate within 14 days was 4.3% (0 to 10%). Laparoscopic appendectomy varied from 0 to 95% in the 30 hospitals (mean, 31%) The LOS did not vary significantly in laparoscopic versus open for nonruptured (2.3 v 2.0 days) or ruptured appendicitis (5.5 v 6.2 days). Days on antibiotics for ruptured appendicitis ranged from 4.6 to 7.9 days (median, 5.9 days) Children receiving any study varied from 18% to 89% (median, 69%). Ultrasound scan and computed tomography (CT) were comparable in both nonruptured (13% ultrasound scan v 14%) and ruptured appendicitis (14% ultrasound scan v 21% CT)., Conclusions: Significant variability in practice patterns and resource utilization exists in the management of acute appendicitis in pediatric hospitals. Clinical outcomes could be improved by collaborative initiatives to adopt evidence-based best practices., (Copyright 2003, Elsevier Science (USA). All rights reserved.)

To survive in today's competitive market, children's hospitals must make informed decisions on cost reduction and resource optimization, while maintaining the highest quality of care. The Pediatric Health Information System (PHIS) is designed to assist children's hospitals and physicians in making these types of decisions. PHIS is a detailed comparative database that gives participating hospitals and clinicians the ability to assess and improve the resources required for patient care. PHIS data are used to compare hospital performance against clinical guidelines for the purpose of identifying opportunities that can lead to quality improvement and development of clinical benchmarks among peers. There is broad interest in the use of guidelines for clinical benchmarking because of rising health care costs, increasing demand for care, and more expensive technologies. PHIS continues to be an invaluable tool in assisting hospitals in their everyday efforts to improve efficacy and performance., (Copyright 2002 by W.B. Saunders Company)