bluuebunny/crossref_metadata_2025 huggingface dataset:
Tofacitinib in Ulcerative Colitis: Real-world Evidence From the ENEIDA Registry
Authors: Chaparro María , Garre Ana , Mesonero Francisco , Rodríguez Cristina , Barreiro-de Acosta Manuel , Martínez-Cadilla Jesús , Arroyo María T , Manceñido Noemí , Sierra-Ausín Mónica , Vera-Mendoza Isabel , Casanova María José , Nos Pilar , González-Muñoza Carlos , Martínez Teresa , Boscá-Watts Maia , Calafat Margalida , Busquets David , Girona Eva , Llaó Jordina , Martín-Arranz María Dolores , Piqueras Marta , Ramos Laura , Surís Gerard , Bermejo Fernando , Carbajo Ana Y , Casas-Deza Diego , Fernández-Clotet Agnes , García María J , Ginard Daniel , Gutiérrez-Casbas Ana , Hernández Luis , Lucendo Alfredo J , Márquez Lucía , Merino-Ochoa Olga , Rancel Francisco J , Taxonera Carlos , López Sanromán Antonio , Rubio Saioa , Domènech Eugeni , Gisbert Javier P
Published: July 2020

Aim

To evaluate the effectiveness and safety of tofacitinib in ulcerative colitis [UC] in real life.

Methods

Patients from the prospectively maintained ENEIDA registry and treated with tofacitinib due to active UC were included. Clinical activity and effectiveness were defined based on Partial Mayo Score [PMS]. Short-term response/remission was assessed at Weeks 4, 8, and 16.

Results

A total of 113 patients were included. They were exposed to tofacitinib for a median time of 44 weeks. Response and remission at Week 8 were 60% and 31%, respectively. In multivariate analysis, higher PMS at Week 4 (odds ratio [OR] = 0].2; 95% confidence interval [CI] = 0].1–0.4) was the only variable associated with lower likelihood of achieving remission at Week 8. Higher PMS at Week 4 [OR = 0.5; 95% CI = 0.3–0.7] and higher PMS at Week 8 [OR = 0.2; 95% CI = 0.1–0.5] were associated with lower probability of achieving remission at Week 16. A total of 45 patients [40%] discontinued tofacitinib over time. Higher PMS at Week 8 was the only factor associated with higher tofacitinib discontinuation [hazard ratio = 1.5; 95% CI = 1.3–1.6]. A total of 34 patients had remission at Week 8; of these, 65% had relapsed 52 weeks after achieving remission; the dose was increased to 10 mg/12 h in nine patients, and five of them reached remission again. Seventeen patients had adverse events.

Conclusions

Tofacitinib is effective and safe in UC patients in real practice, even in a highly refractory cohort. A relevant proportion of patients discontinue the drug over time, mainly due to primary failure.
Prevalence and Duration of Gastrointestinal Symptoms Before Diagnosis of Inflammatory Bowel Disease and Predictors of Timely Specialist Review: A Population-Based Study
Authors: Blackwell J , Saxena S , Jayasooriya N , Bottle A , Petersen I , Hotopf M , Alexakis C , Pollok R C
Published: July 2020

Background and Aims

Lack of timely referral and significant waits for specialist review amongst individuals with unresolved gastrointestinal [GI] symptoms can result in delayed diagnosis of inflammatory bowel disease [IBD].

Aims

To determine the frequency and duration of GI symptoms and predictors of timely specialist review before the diagnosis of both Crohn’s disease [CD] and ulcerative colitis [UC].

Methods

This is a case control study of IBD matched 1:4 for age and sex to controls without IBD using the Clinical Practice Research Datalink from 1998 to 2016.

Results

We identified 19 555 cases of IBD and 78 114 controls. One in four cases of IBD reported GI symptoms to their primary care physician more than 6 months before receiving a diagnosis. There was a significant excess prevalence of GI symptoms in each of the 10 years before IBD diagnosis. GI symptoms were reported by 9.6% and 10.4% at 5 years before CD and UC diagnosis respectively compared to 5.8% of controls. Amongst patients later diagnosed with IBD, <50% received specialist review within 18 months from presenting with chronic GI symptoms. Patients with a previous diagnosis of irritable bowel syndrome [IBS] or depression were less likely to receive timely specialist review (IBS: hazard ratio [HR] = 0.77, 95% confidence interval [CI] 0.60–0.99, depression: HR = 0.77, 95% CI 0.60–0.98).

Conclusions

There is an excess of GI symptoms 5 years before diagnosis of IBD compared to the background population, probably attributable to undiagnosed disease. Previous diagnoses of IBS and depression are associated with delays in specialist review. Enhanced pathways are needed to accelerate specialist referral and timely IBD diagnosis.
Association between early treatment hospitals, serum cholesterol level and cardiovascular disease risk in dyslipidemia patients
Authors: Han Kyu-Tae , Kim Seung Ju
Published: July 2020

Background

Studies have shown the importance of managing chronic diseases, such as cardiovascular disease (CVD), at the primary treatment level. Here, we aimed to evaluate the association between medical treatment institutions and health outcomes in patients with dyslipidemia, a major risk of CVD, to provide evidence for increasing chronic disease management at the primary care level in Korea.

Methods

We used National Health Insurance Sampling cohort data, of which 37 506 patients were newly diagnosed with dyslipidemia during 2009–14. CVD risk and changes in serum cholesterol level after dyslipidemia diagnosis were outcome variable examined. A generalized estimating equation model was used to identify associations between initial medical institution, CVD risk and changes in serum cholesterol levels. The Cox proportional-hazard ratio was used to assess the association between initial medical institutions and detailed CVD risk. Subgroup analyses were conducted to assess CVD risk following treatment with prescription medication.

Results

Our analyses demonstrate that CVD risk was lower at primary care-level community health centers and clinics compared to tertiary hospitals, with a statistically significant difference observed in clinics. Ischemic heart disease was lower at community health centers and clinics. However, all medical institution types were associated with significantly lower serum cholesterol levels compared to the baseline.

Conclusions

Management of patients with dyslipidemia at primary care institutions was associated with reduced CVD risk and decreased serum cholesterol levels. Therefore, policymakers should strengthen the quality of healthcare at primary care institutions and educate patients that these institutions are appropriate for managing chronic disease.
Trends in active commuting to school from 2003 to 2017 among children and adolescents from Germany: the MoMo Study
Authors: Reimers Anne K , Marzi Isabel , Schmidt Steffen C E , Niessner Claudia , Oriwol Doris , Worth Annette , Woll Alexander
Published: July 2020

Background

Inactivity in children and adolescents is a global issue requiring interventions that target different domains of physical activity, such as active transport. The aim of this study was to assess the prevalence, historical trends and socio-demographic correlates of active commuting to school (ACS) in a nationwide sample of girls and boys from Germany.

Methods

Data of commuting behaviour and socio-demographic factors were collected, covering three measurement points from 2003 to 2017. The MoMo Study derived its data from a representative sample of children and adolescents aged 4–17 years who answered a questionnaire (N = 11 387). Statistically significant differences between Baseline, Wave 1 and Wave 2 were determined via 95% confidence intervals (CIs) for complex samples.

Results

Overall, ACS decreased from 84.4% at the first measurement point to 78.3% in the third measurement point. The proportion of cases in which children opted for passive modes of commuting increased predominantly in those aged 4–5 years, in children with a low-to-medium socio-economic status, and in children residing in small- or medium-sized towns. No gender differences were found in active commuting. The results of multinomial logistic regression identified age, migration background and residential area as correlates of walking for boys. For girls, the likelihood of walking, cycling and taking public transport instead of opting for motorized transport increased with age.

Conclusions

Intervention programmes to increase active transport in children and adolescents should target different age groups and also consider parental influence in determining the child’s choice of transport mode.
First insights into the phylogeography and demographic history of the common hermit crab Pagurus bernhardus (Linnaeus, 1758) (Decapoda: Anomura: Paguridae) across the Eastern Atlantic and North Sea
Authors: Rossel Sven , Deli Temim , Raupach Michael J
Published: July 2020

The common hermit crab Pagurus bernhardus (Linnaeus, 1758) is an abundant and ecologically important benthic crustacean in the northeastern Atlantic Ocean. While this species has been intensively studied in terms of its ecology, physiology, behavior, and larval development, knowledge about its population structure and demographic history is still lacking. We examined, for the first time, the genetic variability of P. bernhardus by analyzing two mitochondrial gene fragments (CO1 and 16S) from more than 150 specimens collected from various locations from the Iberian Peninsula to Norway. Our results provide evidence for a significant genetic structure according to the sampled regions for both genetic markers. Furthermore, a comprehensive demographic history reconstruction, mainly based on neutrality tests and a Bayesian Skyline Plot (CO1), revealed a recent demographic expansion of P. bernhardus that preceded the Last Glacial Maximum. Such pattern of retrieved demographic trend could have been likely a successive process to historical contraction of the species into potential climate refugia within the surveyed geographic spectrum.
Coming of age: morphometric variation in the hand skeletons of juvenile and adult Lesser Treeshrews (Scandentia: Tupaiidae: Tupaia minor Günther, 1876)
Authors: Woodman Neal , Miller-Murthy Ananth , Olson Link E , Sargis Eric J
Published: July 2020

Morphometric analyses of the manus skeleton have proven useful in understanding species limits and morphological divergence among tupaiid treeshrews (Scandentia: Tupaiidae). Specimens in these studies are typically limited to mature individuals with fully erupted permanent dentition, which eliminates potentially confounding variation attributable to age, but also can exclude rare taxa and small island populations that are poorly represented in systematic collections. To determine the real limits associated with including immature animals in such studies, we used multivariate analyses to study sexual and age variation of the manus skeleton in two allopatric populations of the Lesser Treeshrew (Tupaia minor Günther, 1876) from the Malay Peninsula and from Borneo that we treated as separate samples. Individuals were aged using dental eruption of the permanent dentition. We also recorded the degree of epiphyseal fusion of the bones of the manus based on x-rays of study skins. We then tested our ability to distinguish the two populations using a series of discriminant function analyses of hand measurements from samples that included varying proportions of immature individuals and adults. We found no evidence of sexual dimorphism in hand proportions, permitting us to combine females and males in our samples. Epiphyseal fusion of the metacarpals and phalanges typically occurs by the time the third molars have completely erupted, and fusion of the distal epiphyses of the radius and ulna typically occurs by the time the permanent fourth premolars are in place. There is occasional asynchrony between dental age and epiphyseal fusion. In both populations, the hands of most infants and subadults provide morphometric values within the range of variation of adults, although they are typically distributed in the lower part of the adult range and have the potential to bias the sample toward lower mean size. The inclusion of infants and subadults when attempting to discriminate between two taxa generally results in lower rates of correct classifications, although the rates increase as the sample of immature individuals is limited to older subadults. As a general rule, we recommend that specimens of infants and subadults continue to be excluded from analyses when exploring taxonomic boundaries among treeshrews. In cases of extremely small sample sizes of adults, however, older subadults—in which the permanent third premolars are erupting or in place—can be used with appropriate caution.
A complex regulating pattern induced by the effects of predation and parasites on root vole (Microtus oeconomus) populations during the breeding season
Authors: Shang Guozhen , Yang Yuangang , Zhu Yahui , Wu Xueqing , Cao Yifan , Wu Yan , Bian Jianghui
Published: July 2020

Predators and parasites have synergistic effects on the phenotype of the species they share as prey and host. Experimental studies that incorporate the interactions between predation and parasitism are, however, scarce in small-mammal populations. Our previous work has shown that the combined effects of predation and coccidian infection reduce overwinter survival and population density in root voles (Microtus oeconomus). Here, we examined the separate and combined effects of these two drivers on the population growth of root voles during the breeding season. We carried out a two-level factorial experiment, in which we manipulated predator exclusion and the removal of parasites in enclosures and measured survival, fecal corticosterone metabolite (FCM) concentration, recruitment, and population density. An expected synergistic effect of predators and parasites on vole population was not found, due to no effect of parasites on FCM level and recruitment rate during the period of the experiment. Instead, we found phase-related effects of predation on demography. Predation reduced the survival rate of voles in spring, which was intensified by parasite infection. Predation risk reduced recruitment rate in early summer by elevating FCM levels. Consequently, both direct and indirect effects of predation lowered population density during the experimental period. In addition, for populations free of predators, the peak density that occurred in early autumn elevated FCM level of adult voles, which reduced recruitment rates and halted population growth. Moreover, predation, parasites, and density affected the quality of the offspring. Our study suggests that multiple regulation processes influence population fluctuations during the breeding season. We conclude that a population experiencing stress acts as a common interface through which interactions between intrinsic and extrinsic factors can be important determinants of fluctuations. We propose a new hypothesis of integrative stress effects to explain small-mammal population fluctuations.
Pulsed radiation therapy for the treatment of newly diagnosed glioblastoma
Authors: Almahariq Muayad F , Quinn Thomas J , Arden Jessica D , Roskos P T , Wilson George D , Marples Brian , Grills Inga S , Chen Peter Y , Krauss Daniel J , Chinnaiyan Prakash , Dilworth Joshua T
Published: July 2020

Background

Pulsed radiation therapy (PRT) has shown effective tumor control and superior normal-tissue sparing ability compared with standard radiotherapy (SRT) in preclinical models and retrospective clinical series. This is the first prospective trial to investigate PRT in the treatment of patients with newly diagnosed glioblastoma (GBM).

Methods

This is a single-arm, prospective study. Patients with newly diagnosed GBM underwent surgery, followed by 60 Gy of PRT with concurrent temozolomide (TMZ). Each day, a 2-Gy fraction was divided into ten 0.2-Gy pulses, separated by 3-minute intervals. Patients received maintenance TMZ. Neurocognitive function (NCF) and quality of life (QoL) were monitored for 2 years using the Hopkins Verbal Learning Test‒Revised and the European Organisation for Research and Treatment of Cancer QLQ-C30 QoL questionnaire. Change in NCF was evaluated based on a minimal clinically important difference (MCID) threshold of 0.5 standard deviation.

Results

Twenty patients were enrolled with a median follow-up of 21 months. Median age was 60 years. Forty percent underwent subtotal resection, and 60% underwent gross total resection. One patient had an isocitrate dehydrogenase (IDH)–mutated tumor. Median progression-free survival (PFS) and overall survival (OS) were 10.7 and 20.9 months, respectively. In a post-hoc comparison, median OS for the prospective cohort was longer, compared with a matched cohort receiving SRT (20.9 vs 14 mo, P = 0.042). There was no decline in QoL, and changes in NCF scores did not meet the threshold of an MCID.

Conclusions

Treatment of newly diagnosed GBM with PRT is feasible and produces promising effectiveness while maintaining neurocognitive function and QoL. Validation of our results in a larger prospective trial warrants consideration.
Turkey’s Foreign Policy in the Middle East
Authors: Hintz Lisel
Published: July 2020

This chapter provides an overview of Turkey’s foreign policy toward the Middle East from the collapse of the Ottoman Empire to the present day. Its thematic focus includes institutional legacies of imperial rule, Cold War alliance dynamics, ethnic and religious/sectarian politics, and strategies of economic development. It suggests that an analytical focus on identity contestation between competing versions of Turkishness—Republican Nationalism and Ottoman Islamism—that prescribe very different foreign policy orientations helps to explain the dramatic shift toward a highly activist role in the Middle East in the mid-2000s. Applying this conceptual framework, the discussion highlights the key influential factors and inflection points shaping bilateral ties with the most prominent states, including Iran, Saudi Arabia, Israel, and Syria, as well as non-state actors, including various Kurdish and Palestinian entities.
The Evolution of Conventional Political Participation in Turkey
Authors: Kalaycıoğlu Ersin
Published: July 2020

This chapter provides an explanatory framework of conventional political participation in Turkey. One core institution of democracy that seems to have withstood, to some extent, all the erosive influences upon it in Turkish politics has been the elections. Voters seem to be highly inclined to vote even when the standards of fairness of elections suffered in the last few years. Populist authoritarian practices of the 2010s in Turkey seem not to have diminished the importance of competitive elections, while the voter turnout continued to stay very high at over 80 percent in most elections, which is unprecedented among European, North American, and East Asian countries. At the same time, other forms of political participation, including contacting authorities and campaigning remain low. A comparative study of conventional political participation since the 1970s, promises to provide us insight into the nature of conventional participation in Turkish politics. Using statistical analyses, data collected through the Turkish Election Studies and International Social Survey Program annual surveys are analyzed to chart the evolution of different forms of political participation and the role of sociopolitical, cultural, and economic factors in shaping these forms. Survey research conducted since the 1970s indicate that under the influence of changing political opportunity structure and increasing political resources, not only voting turnout but also campaign related activism, mass–elite contacts, and participation in discussions to solve social, communal problems have also increased in the last four decades in Turkey.
The Political Economy of Environmental Policymaking in TurkeyA Vicious Cycle
Authors: Adaman Fikret , Akbulut Bengi , Arsel Murat
Published: July 2020

This chapter analyzes the political economy of the environment in Turkey by developing an analytical framework to shed light on the nature and workings of the environmental policy design and implementation process. It makes three main arguments: (a) the Turkish state continues to favor growth over the environment (with a recent focus on the trifecta of construction, energy, and extractive sectors) so as to establish its hegemony in a Gramscian sense; (b) with the current polarization in ideological and cultural domains as well as increasing authoritarianism, the conflation of environmental politics with other types of politics (such as ethnicity) induces the incumbent government to perceive environmental activism representing an ideological opposition and therefore to take a hostile and uncompromising position against environmental demands; and (c) the combination of these two factors is pernicious to the development of a democratic relationship between state and society, resulting in the titular vicious cycle that undermines the effective implementation of environmental policy in Turkey. Breaking this cycle and making environmental policymaking and implementation more effective would require radical structural changes.
The Transnational Mobilization of the Alevis of TurkeyFrom Invisibility to the Struggle for Equality
Authors: Lord Ceren
Published: July 2020

This chapter examines the emergence and dynamics of the transnational Alevi movement since the 1990s in both Turkey and Western Europe. As a social movement, it asserts the distinction of Alevi identity from Sunni Islam and seeks official recognition and equal citizenship rights in Turkey and Europe where a large number of Alevis live. Accordingly, the chapter first provides an overview of the debates on who the Alevis are and what Alevism is, as the contestation around definition shapes the factions and alignments within the Alevi movement. It then outlines the institutional context within which the Alevi movement emerged, tracing the influence of the Ottoman legacy on nation-state building and how these dynamics shaped the strategies adopted by competing factions within the state together with their evolution over time. Finally, it discusses the mobilization of the Alevi movement from the 1990s onward, its politics of recognition, factionalism, party political engagement, and key challenges. While prospects for gaining recognition and equal citizenship rights will grow more elusive with deepening authoritarianism of the Turkish state and sectarianism in the AKP era, the achievements of the transnational movement in Western Europe stand to shape the future of Alevism.
Autonomy
Authors: Wheeler Michael
Published: July 2020

This chapter assesses the concept of the autonomous AI—AI that is self-governing. Unease regarding autonomous AI is most vividly expressed in the vision of an artificial superintelligence whose self-generated goals and interests diverge radically from those of humankind, and which thus places humankind’s well-being—and maybe even their survival—at risk. As such, the chapter examines the conditions that would need to be met by an intelligent machine in order for that machine to exhibit the kind of autonomy that is operative in this dystopian scenario. However, there is arguably a more pressing concern regarding a different class of AI systems, those that are autonomous in only the milder sense that—in their domains of operation—humans are ceding, or will cede, some significant degree of control to them. Systems of this kind include self-driving cars and autonomous weapons systems. The chapter then evaluates whether these already-in-the-world autonomous AI systems are a genuine cause for concern. A key issue here concerns the properties of so-called deep learning networks.
A Human-Centered Approach to AI Ethics
Authors: Chrisley Ron
Published: July 2020

This chapter explores a human-centered approach to AI and robot ethics. It demonstrates how a human-centered approach can resolve some problems in AI and robot ethics that arise from the fact that AI systems and robots have cognitive states, and yet have no welfare, and are not responsible. In particular, the approach allows that violence toward robots can be wrong even if robots cannot be harmed. More importantly, the approach encourages people to shift away from designing robots as if they were human ethical deliberators. Ultimately, the cognitive states of AI systems and robots may have a role to play in the proper ethical analysis of situations involving them, even if it is not by virtue of conferring welfare or responsibilities on those systems or robots.
Automating Origination
Authors: Slater Avery
Published: July 2020

This chapter highlights historic and contemporary efforts to engineer artificial intelligence (AI) capable of producing artifacts previously associated with the creative arts. While creativity and artistic origination have historically been tied to art’s social value, AI art has recently begun to sell for high prices, and the promise of automating artistic production heralds new sectors of economic profit. Yet AI creativity also highlights the changing status of human innovation, origination, and newness in ways that deserve careful thought. The chapter then explores how future research in the field of computational creativity might benefit from a more robust appreciation for the uniquely nonhuman qualities of AI’s creativity, rather than its ability to imitate the human. AI’s exponentially intensifying capabilities raise meaningful and urgent questions of how to relate to a technology that, in many meaningful senses, invents itself. As automation, origination, and creativity cross-pollinate in unknowable ways, an intelligence both truly other and yet still conversant with human categories emerges. Thinking from the perspective of the humanities can help one negotiate this unprecedented challenge.
Ethics of Artificial Intelligence in Transport
Authors: Walker Smith Bryant
Published: July 2020

This chapter highlights key ethical issues in the use of artificial intelligence in transport by using automated driving as an example. These issues include the tension between technological solutions and policy solutions; the consequences of safety expectations; the complex choice between human authority and computer authority; and power dynamics among individuals, governments, and companies. In 2017 and 2018, the U.S. Congress considered automated driving legislation that was generally supported by many of the larger automated-driving developers. However, this automated-driving legislation failed to pass because of a lack of trust in technologies and institutions. Trustworthiness is much more of an ethical question. Automated vehicles will not be driven by individuals or even by computers; they will be driven by companies acting through their human and machine agents. An essential issue for this field—and for artificial intelligence generally—is how the companies that develop and deploy these technologies should earn people’s trust.
“Fair Notice” in the Age of AI
Authors: Brennan-Marquez Kiel
Published: July 2020

This chapter examines the concept of “fair notice,” both in the abstract and as it operates in U.S. constitutional doctrine. Fair notice is paramount to the rule of law. The maxim has ancient roots: people ought to know, in advance, what the law demands of them. As such, fair notice will be among the key concepts for regulating the scope and role of artificial intelligence (AI) in the legal system. AI—like its junior sibling, machine learning—unleashes a historically novel possibility: decision-making tools that are at once powerfully accurate and inscrutable to their human stewards and subjects. To determine when the use of AI-based (or AI-assisted) decision-making tools are consistent with the requirements of fair notice, a sharper account of the principle’s contours is needed. The chapter then develops a tripartite model of fair notice, inspired by the problems and opportunities of AI. It argues that lack of fair notice is used interchangeably to describe three distinct properties: notice of inputs, notice of outputs, and notice of input-output functionality. Disentangling these forms of notice, and deciding which matter in which contexts, will be crucial to the proper governance of AI.
Indigenous American/Two-Spirit Mental Health
Authors: Bird Naomi , Robinson Margaret
Published: July 2020

While many Indigenous languages have terms for individuals who combine masculinity with femininity in some way, Indigenous gender minority people have increasingly come to self-identify using the pan-Indigenous term “two-spirit.” This chapter examines key factors shaping the mental wellness of two-spirit people, such as the negative impact of residential and boarding school incarceration, and highlights available data on anxiety, depression, posttraumatic stress disorder, suicidality, and substance use. Reducing the mental health disparities that two-spirit people face is made more challenging by the lack of culturally informed and supportive health services. The authors describe factors that may buffer the minority stressors that lead to negative mental health outcomes and may increase wellness. The chapter concludes with a discussion of promising directions for future research.
Mental Health of Sexual and Gender Minority Immigrants and Refugees
Authors: Lee Edward Ou Jin , Kahn Sarilee , Alessi Edward J. , Leon Abelardo
Published: July 2020

This chapter aims to provide a critical review of the literature that addresses the ways in which sexual and gender minorities (SGMs) with migration experience navigate mental health issues. There has been a recent growth in public interest and scholarship in Canada and the United States about the realities of SGMs with migration experience. However, there are scholarly debates and tensions in relation to how key terms related to sexuality, gender, and migration have been mobilized within this field of knowledge. This chapter thus aims to map out the ways in which knowledge about SGMs with migration experience has been categorized through migrant status, race, and ethnicity. In addition, this chapter provides a synthesis of the latest research findings on the relationship between this population and mental health issues. This chapter also critically reflects on various policy and practice implications of these findings and considers future directions for content, theories, and methodologies of research about this population.
Transgender Mental Health
Authors: Kuper Laura E. , Bismar Danna , Ryan Whit
Published: July 2020

Research on transgender mental health has dramatically increased over the past decade. While initial studies were limited to small clinic-based or geographically limited convenience samples, larger internet and multi-clinic samples as well as increasing inclusion of gender identity questions in regional, national, and probability-based surveys have started to open new avenues for research. Broadly, disparities appear to exist across a broad range of mental health symptoms and diagnoses. However, significant variations exist across studies and intersectional and integrative approaches have started to shed light on some of these variations. This chapter provides an overview of studies examining the prevalence of mental health–related conditions within transgender samples followed by a synthesis of risk and protective factors that appear to underlie mental health disparities. Approaches to conceptualizing and measuring the size of the transgender population, ethical considerations, and implications and future directions are also discussed.
Gender Nonbinary Mental Health
Authors: Dickey Lore M.
Published: July 2020

In this chapter the author explores the mental health of those with nonbinary gender identities and focuses on the issues they face. The author defines nonbinary identities and discusses how these identities are different than people who have binary identities. There is a summary of the extant psychological literature focusing on people with nonbinary identities. Attention is also brought to how racial and ethnic minority individuals, including Native American people, conceptualize nonbinary identities. The chapter ends with information about the lack of attention to the Global South and the need for additional research and training in the mental health of those with nonbinary identities.
Intersex Mental Health
Authors: Roen Katrina , Lundberg Tove
Published: July 2020

This chapter takes a critical psychology approach to reviewing research on psychological distress among people with variations of sex characteristics. The focus is on depathologizing emotional distress and developing affirming and empowering approaches to healthcare. Affirming approaches to psychosocial healthcare can be undertaken by health professionals who have enough knowledge about intersex, diverse sex development, or variations of sex characteristics to be able to support positive adaptation to bodily variation and facilitate non-stigmatizing talk about the experience of living with a diagnosis. There is room for significant development here, particularly research addressing psychosocial well-being in ways that are non-medicalized and culturally relevant in diverse global regions.
Mental Health for Asexual Individuals
Authors: Rothblum Esther D.
Published: July 2020

The present chapter focuses on the mental health of individuals who identify as asexual, defined as not having feelings of sexual attraction for other people. It focuses on population-based studies of the prevalence of asexuality and demographic characteristics of asexual respondents in these surveys. The author describes the stigma of asexual identity as perceived by asexual individuals and by society, as well as the advantages that asexual individuals cite. The author also reviews how low sexual desire is described in the current Diagnostic and Statistical Manual of Mental Disorders. The chapter reviews the (scant) literature on asexual mental health and ends with some implications for future research.
History of Gender Identity and Mental Health
Authors: Dickey Lore M.
Published: July 2020

In the past fifty years, gender identity has been closely linked to mental health. This is due, in part, to the classification of gender identity disorder and gender dysphoria being listed as mental health disorders in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. This chapter focuses on the history of the intersection of gender identity and mental health. The author explores first the history addressing the intersection of gender identity and mental health and then evidence-based research exploring this intersection. This includes the ways that mental health has and continues to impact transgender people. The author examines co-occurring mental health concerns such as depression, anxiety, substance abuse, and bipolar disorder as well as the ways that race and ethnicity complicate these disparities. Finally, the author addresses the future directions in the areas of research, clinical practice, and training.
Mental Health for Sexual and Gender Minority Polyamorous and Consensually Non-monogamous Individuals
Authors: Pallotta-Chiarolli Maria
Published: July 2020

This chapter covers four areas. First, the author introduces, defines, and briefly describes how sexual and gender minority (SGM) polyamorous and consensually non-monogamous (poly/CNM) individuals, families, and communities have been researched in mental health studies. Second, the author reviews the available evidence-based research on poly/CNM SGMs and mental health, and mental health service provision. Third, the author reviews absences and erasures in research pertaining to the mental health of poly/CNM SGMs, particularly in relation to whether an intersectional lens has been applied in service provision such as in relation to age and to racial and ethnic minorities. In the final section, the author identifies and proposes future directions in the content and methodologies of research on poly/CNM SGM mental health, and recommendations for more effective mental health service provision.
HIV/AIDS and Mental Health among Sexual and Gender Minority Populations
Authors: Silvestrini Molly , Hoff Colleen C. , Witkovic Y. Darin , Madriles Crystal
Published: July 2020

HIV/AIDS is a disease that significantly affects the health outcomes of sexual and gender minorities (SGMs) and the LGBTQ community globally. HIV is frequently associated with mental health issues among many vulnerable populations, such as depression, anxiety, stigma, substance abuse, and discrimination. In addition, risk factors for HIV acquisition often include mental health problems, lack of social support, and experiences of stigma and discrimination. This chapter focuses on the history of HIV/AIDS, current HIV health disparities in SGM communities in the United States and globally, mental health among HIV-positive vulnerable and understudied populations, and future directions for the improvement of HIV prevention programs and mental health interventions. Understudied populations include women who have sex with women, transgender men, and SGM belonging to racial and ethnic minority groups. This chapter aims to summarize the interaction of HIV/AIDS and mental health over the past two decades in order to demonstrate the importance of this subject in current research.
Stigma and Sexual and Gender Minority Mental Health
Authors: DiPlacido Joanne , Fallahi Carolyn R.
Published: July 2020

Minority stress and stigma among LGBTQ individuals as a result of oppression from discrimination, heterosexism, and homonegativity has consistently led to poorer mental health outcomes. This chapter outlines the research linking minority stress and stigma to mental health. The authors review Hatzenbuehler’s mediational framework to understand the underlying mechanisms to explain why minority stress predicts psychiatric distress. The authors also discuss the role of intersectionality on mental health, recognizing that many LGBTQ individuals deal with multiple oppressions due to not only their sexual orientation or gender identity or expression but also race and ethnicity. This chapter covers minority stress and stigma among more vulnerable populations at higher risk of mental distress, such as transgender, older, and bisexual communities and those living in the Global South. The authors discuss how coping and social support can buffer the negative mental health effects of minority stress and stigma. Methodological issues and future directions are reviewed and suggestions for prevention and treatment interventions are offered.
Anxiety Disorders among Sexual and Gender Minority Populations
Authors: Weiss Brandon J. , Owens Raymond Bethany
Published: July 2020

Rates of anxiety disorders are significantly elevated among sexual and gender minorities. In this chapter, the minority stress model is discussed as a framework for conceptualizing anxiety among sexual and gender minorities, and the authors review the literature on the relationships between specific minority stressors and symptoms. The authors examine prevalence rates of anxiety disorders among sexual minorities and gender minorities, separately and in comparison to heterosexual and cisgender individuals. Also reviewed is the literature on anxiety disorders among sexual and gender minorities with a racial or ethnic minority status. Current assessment and treatment approaches are identified and reviewed. Finally, limitations to the current literature base are discussed and recommendations are provided for future studies.
Authentic Education for Meaningful Work: Beyond “Career Management Skills”
Authors: Sultana Ronald G.
Published: July 2020

This chapter focuses on work education in education settings and explores how it can be conceptualized so that it contributes to flourishing and well-being. The chapter first provides an overview of recent developments in “career learning” worldwide, noting the increasing importance that it has been given as a contributor to enhanced competitivity in knowledge-based economies. The chapter notes that the centrality of work in the curriculum is justified because “meaningful work” maintains its importance as the hallmark of a flourishing life. Much of the work that is available in neoliberal economies, however, is increasingly the cause of distress, hardship, exploitation, and abuse. A case is made for an authentic work education programme that helps participants understand the nature of meaningful work, to aspire to it, and to decode the causes that frustrate access to it. It is argued that, as with all truly educational enterprises, authentic work education should provide the intellectual tools and encourage the moral resolve to imagine more socially just and fulfilling ways of living together and to gain a measure of individual and collective control over the forces that shape lives.
Assessing PTSD Symptoms
Authors: Bovin Michelle J. , Weathers Frank W.
Published: July 2020

Posttraumatic stress disorder (PTSD) is a serious and prevalent mental health disorder that poses significant challenges for accurate assessment and diagnosis. This chapter describes some of the most widely used PTSD assessment tools for adult trauma survivors, including structured interviews, self-report measures, and biologically based methods, with an eye toward updates reflecting the new Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) PTSD criteria.  It also discusses several key issues in PTSD assessment, including identifying an index traumatic event for symptom inquiry, linking symptoms to the index event, assessing for the new dissociative subtype, and detecting exaggerated symptom reporting.  The chapter concludes with a brief discussion of future directions for research on PTSD assessment.
Risk and Resilience Factors for Traumatic Stress Disorders
Authors: Park Crystal L. , Pless Kaiser Anica , Finkelstein-Fox Lucy , Spiro Avron , Schuster Wachen Jennifer
Published: July 2020

This chapter provides an overview of risk and protective factors that may account for posttraumatic responses. In addition to considering risk and protective factors for posttraumatic stress disorder (PTSD), the chapter examines processes of resilience to trauma and stressors, as well as outcomes such as posttraumatic growth. Emphasis is placed on the necessity of a life-span developmental framework for studying trauma and its effects and the importance of longitudinal data for understanding how these processes unfold over both micro and macro intervals of time. A brief survey of methodological approaches for assessing longitudinal change is presented, followed by suggestions for future research.
Young Children with Down Syndrome: Mother-Child Dyadic Relationships
Authors: Hauser-Cram Penny , Woodman Ashley C. , Gilmore Linda
Published: July 2020

This chapter is focused on the mother-child dyadic relationship in families where a young child has Down syndrome. Because mothers enter into a relationship with a child within a particular context, a sociocultural perspective on parenting a child with Down syndrome promotes a deeper understanding of interaction in the mother-child dyad. Both the role of the family system, including positive parenting, and the contributions of the child’s attributes, especially temperament, are considered. Specific literature on the mother-child dyad is discussed, including maternal language input, the role of maternal directives during structured and unstructured tasks, and studies on autonomy-supportive parenting. Suggestions for future research include developing studies that focus on maternal strengths as well as conducting investigations that recognize the importance of the sociocultural context in which mother-child dyadic relationships are developed.
Economic and Policy Issues for Wind-Resistant Construction
Authors: Simmons Kevin M.
Published: July 2020

This chapter summarizes recent research first on the policy prescription of building codes designed with wind engineering principles, then on research concerning how markets for wind-enhanced construction offers other channels for increased resilience. Florida’s statewide building code was enacted after Hurricane Andrew; it was the first statewide building code designed for wind. But non-synoptic systems, such as tornadoes, also cause high levels of damage, so the city of Moore, Oklahoma, adopted a code to address that threat. The first purpose of this chapter is to conduct an analysis of the cost-effectiveness of these codes. An examination of other states that may also justify stronger codes follows. Finally, the chapter reviews research on how real estate markets value voluntary mitigation. Using markets for above-code construction provides opportunities to increase resilience in states where stronger building codes are not adopted.
Incomplete Commodification in American Law
Authors: Ram Natalie
Published: July 2020

This chapter discusses the incomplete commodification of human body parts in American law. In the main, American law bars payments for human body parts and tissue to be used in clinical care. However, this prohibition on payments does not reach all human body products. Rather, federal law sets out an explicit list of covered organs, and courts have interpreted that list strictly. Despite strong demand for body products and the traditional American preference for markets in general, myriad body products are procured in partial, though incomplete, markets. On one hand, when market mechanisms are putatively prohibited, markets have nonetheless crept in at some—but not all—stages of the process of transferring tissue from the donor to the recipient. On the other hand, when markets are not prohibited, they nonetheless do not develop fully. The chapter explores this juxtaposition of law and norms in the American setting. It also suggests one reason for the incomplete commodification of body products such as sperm, eggs, and blood: a preoccupation and discomfort with the role of women in markets rather than at home. That is, when it comes to body products, women are deemed to participate primarily for reasons of love, not money.
Regulation of Professionals and Facilities in the United States
Authors: Buck Isaac D.
Published: July 2020

This chapter covers the regulation of healthcare professionals and facilities in the United States. In the midst of an era of great policy uncertainty, the quality of healthcare in the United States is regulated by a number of different actors and rules. This chapter seeks to summarize the types of regulation that govern American healthcare professionals and institutions while providing an overview for comparison with European counterparts. After summarizing the general themes of quality regulation in the United States, the first part of the chapter covers the regulation of professionals—including the self-regulatory state-based system, the government certification regime, and the reimbursement-based voluntary system. The second part of the chapter focuses on the regulation of healthcare institutions, focused primarily on government accreditation and reimbursement-based regulation. In addition to summarizing the basic structure of healthcare regulation for professionals and institutions, new developments and challenges in American health law and policy will be highlighted throughout the chapter.
The Right to Avoid Procreation and the Regulation of Pregnancy
Authors: Sepper Elizabeth
Published: July 2020

This chapter considers the right to avoid procreation and the regulation of pregnancy from an American perspective. In the United States, the right to avoid procreation finds protection in constitutional and statutory law. The Supreme Court’s decisions to recognize contraception and abortion as constitutional rights have permitted generations of women a measure of reproductive freedom. However, the constitutionalization of contraception, and abortion in particular, has brought to the fore deeper contestation about the moral (and legal) status of the fetus, women’s place in society, and the meaning of motherhood. These same issues play out in decisions about the protection and regulation of women during their pregnancies. Within the framework of Supreme Court precedent, the fifty states have adopted varying approaches to the right to abortion. The trend, however, has inclined toward greater restrictions in a growing number of states. At the same time, the current Court seems likely to dilute or reject the right to abortion, with consequences for contraception, protections for pregnant women at work, and criminal intervention during pregnancy.