"It's like having a superpower": Reclaiming creativity and the intersectional experiences of trans young adults of color.

Trans young adults of color experience systemic harm that contributes to negative health outcomes and hinders their ability to live freely. The present study used a grounded theory qualitative methodology rooted in a critical-ideological paradigm to understand the intersections of racial and gender oppression. Trans young adults of color from across the United States (N = 15; ages 20-29; majority racial identities: Asian, Black, and multiracial; majority gender identities: nonbinary and transmasculine) participated in a semistructured interview. Analyses identified a six-category empirical framework explaining major dimensions and processes of intersectional experiences of trans people of color. The core category, Reclaiming Creativity, reflected how trans communities of color use creativity to build their identities and communities beyond intersectional oppressive societal norms and imagine a better, more liberated world. The remaining five categories were Creating and Recreating Identity, Experiencing Discrimination and Its Impacts on Wellness, Surviving Oppression and Compromising Authentic Self, Embracing Identity Strengths, and Finding Liberation. They provided insights into the role of creativity within the intersectional experiences of trans young adults of color. In doing so, they provided directions to address structural injustice, pursue liberation, and allow creativity to flourish. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Discomfort in LGBT Community and Psychological Wellbeing for LGBT Asian Americans: The Moderating Role of Racial/Ethnic Identity Importance.

While past research has examined the deleterious effects of racism on Asian Americans, fewer studies have investigated lesbian, gay, bisexual, and transgender (LGBT) Asian Americans' unique experiences of oppression and unbelonging within the broader LGBT community. Guided by intersectionality and minority stress theoretical frameworks, the present study examined the effect of discomfort due to one's race/ethnicity within the LBGT community on psychological wellbeing in a national sample of 480 LGBT Asian Americans from the Social Justice Sexuality Project. The moderating role of how important one considered their race/ethnicity to their identity was also examined. Regression analyses revealed that greater discomfort due to one's race/ethnicity within the LGBT community was associated with reduced psychological wellbeing for LGBT Asian Americans who viewed their racial/ethnic identity as moderately or highly important, whereas this association was not significant for LGBT Asian Americans who considered their racial/ethnic identity as less important. These findings highlight the necessity of examining the role of racial/ethnic discomfort in relation to LGBT Asian Americans' psychological wellbeing, as well as the extent to which LGBT Asian Americans consider their race/ethnicity as important.

An intersectional investigation of Asian American men's muscularity-oriented disordered eating: Associations with gendered racism and masculine norms.

Grounded in an intersectional framework, the present study investigated the extent to which racism, gendered racism, and conformity to masculine norms are associated with Asian American men's muscularity-oriented disordered eating. The study also examined if ethnic identity moderated the association between both forms of racism and muscularity-oriented disordered eating. 220 Asian American men completed an online cross-sectional survey that contained the study questionnaires. Hierarchical regression analyses were conducted to examine the associations between our predictor variables and muscularity-oriented disordered eating. Gendered racism, conformity to the masculine norms of playboy, heterosexual presentation and self-reliance were positively associated with muscularity-oriented disordered eating, whereas conformity to power over women was negatively associated. Racism and the remaining masculine norms were not associated with muscularity-oriented disordered eating. Ethnic identity did not moderate the association between either form of racism and muscularity-oriented disordered eating. Given that gendered racism was positively associated with muscularity-oriented disordered eating whereas racism was not, researchers and practitioners may consider prioritizing intersectionality in their understanding of Asian American men's eating pathology. Results emphasize the importance of examining both race and gender in conceptualizing Asian American men's muscularity-oriented disordered eating.Data Availability Statement: Data for this study are available upon request from the first author.

A novel digital approach to describe real world outcomes among patients with constipation.

Understanding day-to-day variations in symptoms and medication management can be important in describing patient centered outcomes for people with constipation. Patient Generated Health Data (PGHD) from digital devices is a potential solution, but its utility as a tool for describing experiences of people with frequent constipation is unknown. We conducted a virtual, 16-week prospective study of individuals with frequent constipation from an online wellness platform that connects mobile consumer digital devices including wearable monitors capable of passively collecting steps, sleep, and heart rate data. Participants wore a Fitbit monitoring device for the study duration and were administered daily and monthly surveys assessing constipation symptom severity and medication usage. A set of 38 predetermined day-level behavioral activity metrics were computed from minute-level data streams for steps, sleep and heart rate. Mixed effects regression models were used to compare activity metrics between constipation status (irregular or constipated vs. regular day), medication use (medication day vs. non-medication day) and the interaction of medication day with irregular or constipation days, as well as to model likelihood to treat with constipation medications based on daily self-reported symptom severity. Correction for multiple comparisons was performed with the Benjamini-Hochberg procedure for false discovery rate. This study analyzed 1540 enrolled participants with completed daily surveys (mean age 36.6 sd 10.0, 72.8% female, 88.8% Caucasian). Of those, 1293 completed all monthly surveys and 756 had sufficient Fitbit data density for analysis of activity metrics. At a daily-level, 22 of the 38 activity metrics were significantly associated with bowel movement or medication treatment patterns for constipation. Participants were measured to have fewer steps on irregular days compared to regular days (-200 steps, 95% CI [-280, -120]), longer periods of inactivity on constipated days (9.1 min, 95% CI [5.2, 12.9]), reduced total sleep time on irregular and constipated days (-2.4 min, 95% CI [-4.3, -0.4] and -4.0 min, 95% CI [-6.5, -1.4], respectively). Participants reported greater severity of symptoms for bloating, hard stool, difficulty passing, and painful bowel movements on irregular, constipation and medication days compared to regular days with no medication. Interaction analysis of medication days with irregular or constipation days observed small increases in severity compared to non-medication days. Participants were 4.3% (95% CI 3.2, 5.3) more likely to treat with medication on constipated days versus regular. No significant increase in likelihood was observed for irregular days. Daily likelihood to treat increased for each 1-point change in symptom severity of bloating (2.4%, 95% CI [2.0, 2.7]), inability to pass (2.2%, 95% CI [1.4, 3.0]) and incomplete bowel movements (1.3%, 95% CI [0.9, 1.7]). This is the first large scale virtual prospective study describing the association between passively collected PGHD and constipation symptoms and severity at a day-to-day granularity level. Constipation status, irregular or constipated, was associated with a number of activity metrics in steps and sleep, and likelihood to treat with medication increased with increasing severity for a number of constipation symptoms. Given the small magnitude of effect, further research is needed to understand the clinical relevance of these results. PGHD may be useful as a tool for describing real world patient centered experiences for people with constipation.

Characterizing COVID-19 and Influenza Illnesses in the Real World via Person-Generated Health Data.

The fight against COVID-19 is hindered by similarly presenting viral infections that may confound detection and monitoring. We examined person-generated health data (PGHD), consisting of survey and commercial wearable data from individuals' everyday lives, for 230 people who reported a COVID-19 diagnosis between March 30, 2020, and April 27, 2020 (n = 41 with wearable data). Compared with self-reported diagnosed flu cases from the same time frame (n = 426, 85 with wearable data) or pre-pandemic (n = 6,270, 1,265 with wearable data), COVID-19 patients reported a distinct symptom constellation that lasted longer (median of 12 versus 9 and 7 days, respectively) and peaked later after illness onset. Wearable data showed significant changes in daily steps and prevalence of anomalous resting heart rate measurements, of similar magnitudes for both the flu and COVID-19 cohorts. Our findings highlight the need to include flu comparator arms when evaluating PGHD applications aimed to be highly specific for COVID-19.

Continuous Digital Assessment for Weight Loss Surgery Patients.

We conducted a survey about recent surgical procedures on a large connected population and requested each individual's permission to access data from commercial wearable devices they may have been wearing around the time of the procedure. For subcohorts of 66-118 patients who reported having a weight loss procedure and who had dense Fitbit data around their procedure date, we examined several daily measures of behavior and physiology in the 12 weeks leading up to and the 12 weeks following their procedures. We found that the weeks following weight loss operations were associated with fewer daily total steps, smaller proportions of the day spent walking, lower resting and 95th percentile heart rates, more total sleep time, and greater sleep efficiency. We demonstrate that consumer-grade activity trackers can capture behavioral and physiological changes resulting from weight loss surgery and these devices have the potential to be used to develop measures of patients' postoperative recovery that are convenient, sensitive, scalable, individualized, and continuous.

The pandemic of 1918 and the heart disease epidemic in middle-aged men and women in the United States.

Members of birth cohorts who were alive in 1918 and survived the influenza pandemic were likely to have been "primed" for heart disease in later life. We examine the hypothesis that the twentieth-century heart disease epidemic was a cohort effect reflecting the changing susceptibility composition of the population.We estimated heart disease death rates by single years of age for cohorts born in 1860-1949. We prepared age-specific rates for calendar years 1900-2016, as well as age-standardized cohort and calendar year rates.Males born in 1880-1919 contributed 90 per cent to 100 per cent of all heart disease deaths among males aged 40-64 from 1940 to 1959, when the heart disease epidemic was at its peak. There was no heart disease epidemic among females aged 40-64. Death from heart disease in females tends to occur at older ages.Cigarette smoking, unemployment, and other factors may have played a role in the heart disease epidemic in men and would have interacted with injury from influenza, but our results suggest that having been alive at the time of the 1918 influenza pandemic probably played an important role.

Genetic epidemiology of cardiometabolic risk factors and their clustering patterns in Mexican American children and adolescents: the SAFARI Study.

Pediatric metabolic syndrome (MS) and its cardiometabolic components (MSCs) have become increasingly prevalent, yet little is known about the genetics underlying MS risk in children. We examined the prevalence and genetics of MS-related traits among 670 non-diabetic Mexican American (MA) children and adolescents, aged 6-17 years (49 % female), who were participants in the San Antonio Family Assessment of Metabolic Risk Indicators in Youth study. These children are offspring or biological relatives of adult participants from three well-established Mexican American family studies in San Antonio, TX, at increased risk of type 2 diabetes. MS was defined as ≥3 abnormalities among 6 MSC measures: waist circumference, systolic and/or diastolic blood pressure, fasting insulin, triglycerides, HDL-cholesterol, and fasting and/or 2-h OGTT glucose. Genetic analyses of MS, number of MSCs (MSC-N), MS factors, and bivariate MS traits were performed. Overweight/obesity (53 %), pre-diabetes (13 %), acanthosis nigricans (33 %), and MS (19 %) were strikingly prevalent, as were MS components, including abdominal adiposity (32 %) and low HDL-cholesterol (32 %). Factor analysis of MS traits yielded three constructs: adipo-insulin-lipid, blood pressure, and glucose factors, and their factor scores were highly heritable. MS itself exhibited 68 % heritability. MSC-N showed strong positive genetic correlations with obesity, insulin resistance, inflammation, and acanthosis nigricans, and negative genetic correlation with physical fitness. MS trait pairs exhibited strong genetic and/or environmental correlations. These findings highlight the complex genetic architecture of MS/MSCs in MA children, and underscore the need for early screening and intervention to prevent chronic sequelae in this vulnerable pediatric population.

Motor vehicle driver death and high state maximum speed limits: 1991-1993.

OBJECTIVE: To measure the association between motor vehicle crash (MVC) driver death and high state maximum speed limits. METHODS: This study used a case-control design and assessed driver deaths from three major types of MVCs: non-collision; collision with motor vehicles in transit; and collision with stationary objects. The study period was 1991-1993. For each type of crash, case subject populations of fatally injured drivers were obtained from the U.S. Department of Transportation Fatality Analysis Reporting System. Four control subject populations, each associated with a different cause of death, were obtained from a U.S. national death certificate database (the causes of death were unintentional poisoning, non-Hodgkin lymphoma, drowning, and diabetes mellitus). Subjects were considered exposed if the state in which they crashed (for cases) or died (for controls) had a maximum speed limit greater than 55 mph. Each of the three case subject populations was compared against each of the four control subject populations. Odds ratios (ORs) were adjusted for age and gender. RESULTS: For non-collision driver death, ORs ranged from 3.06 to 6.56, depending on the year and control group; all the ORs were significant. For collision with motor vehicles in transit driver death, ORs ranged from 1.12 to 2.22; all the ORs were significant. For collision with stationary objects driver death, ORs ranged from 0.87 to 1.83. CONCLUSIONS: There was a moderately strong and significant association between non-collision driver death and high state maximum speed limits. For collision with motor vehicles in transit driver death, the association was somewhat milder but still consistent. For collision with stationary objects driver death, the presence of an association was unclear. During 1991-1993, the effects of high state maximum speed limits may have been different for different types of MVCs.

Synthesis of 5-hydroxy-2,3,4,5-tetrahydro-[1H]-2-benzazepin-4-ones: selective antagonists of muscarinic (M3) receptors.

Two approaches to tetrahydro-[1H]-2-benzazepin-4-ones of interest as potentially selective, muscarinic (M(3)) receptor antagonists have been developed. Base promoted addition of 2-(tert-butoxycarbonylamino)methyl-1,3-dithiane with 2-(tert-butyldimethylsiloxymethyl)benzyl chloride gave the corresponding 2,2-dialkylated 1,3-dithiane which was taken through to the dithiane derivative of the parent 2,3,4,5-tetrahydro-[1H]-2-benzazepin-4-one by desilylation, oxidation and cyclisation via a reductive amination. After conversion into the N-tert-butyloxycarbonyl, N-toluene p-sulfonyl and N-benzyl derivatives , hydrolysis of the dithiane gave the N-protected tetrahydro-[1H]-2-benzazepin-4-ones . However, preliminary attempts to convert these into 5-cycloalkyl-5-hydroxy derivatives were not successful. In the second approach, ring-closing metathesis was used to prepare 2,3-dihydro-[1H]-2-benzazepines which were hydroxylated and oxidized to give the required 5-hydroxy-2,3,4,5-tetrahydro-[1H]-2-benzazepin-4-ones. Following preliminary studies, ring-closing metathesis of the dienyl N-(2-nitrophenyl)sulfonamide gave the dihydrobenzazepine which was converted into the 2-butyl-5-cyclobutyl-5-hydroxytetrahydrobenzazepin-4-one by hydroxylation and N-deprotection followed by N-alkylation via reductive amination, and oxidation. This chemistry was then used to prepare the 2-[(N-arylmethyl)aminoalkyl analogues , , and . N-Acylation followed by amide reduction using the borane-tetrahydrofuran complex was also used to achieve N-alkylation of dihydrobenzazepines and this approach was used to prepare the 5-cyclopentyl-5-hydroxy-2,3,4,5-tetrahydro-[1H]-2-benzazepin-4-one and the 5-cyclobutyl-8-fluoro-5-hydroxy-2,3,4,5-tetrahydro-[1H]-2-benzazepin-4-one . The structures of 2-tert-butyloxycarbonyl-4,4-propylenedithio-2,3,4,5-tetrahydro-[1H]-2-benzazepine and (4RS,5SR)-2-butyl-5-cyclobutyl-4,5-dihydroxy-2,3,4,5-tetrahydro-[1H]-2-benzazepine were confirmed by X-ray diffraction. The racemic 5-cycloalkyl-5-hydroxy-2,3,4,5-tetrahydro-[1H]-2-benzazepin-4-ones were screened for muscarinic receptor antagonism. For M(3) receptors from guinea pig ileum, these compounds had log(10)K(B) values of up to 7.2 with selectivities over M(2) receptors from guinea pig left atria of approximately 40.

A cohort study of tuberculosis and influenza mortality in the twentieth century.

We reviewed period and cohort mortality for tuberculosis and influenza and pneumonia over the twentieth century and data on the roles of influenza and tuberculosis as underlying and contributory causes of death. As would be consistent with long-term trends, each cohort had lower tuberculosis mortality but there was no decisive downturn in age specific tuberculosis mortality for any male cohort until after 1945. Tuberculosis mortality among females fell steadily from cohort to cohort as well as within each cohort. In every cohort born from around 1890 to around 1930, tuberculosis mortality was higher among women than among men at ages under 30, suggesting that prevalence in women was also higher, but death rates of females crossed under those of males at about age 30. Tuberculosis death rates rose more for males than females around 1918; however, any unusual increase that could be attributable to the 1918 influenza pandemic must have been brief. Contrary to expectations in the medical community, tuberculosis mortality did not rise following the 1918 influenza pandemic. Some portion of the rise in death rates around 1918 may have been associated with the influenza, but a comparison of the increase in male tuberculosis mortality during and after World War II, when there was no influenza pandemic, with male mortality in a similar period during and after World War I suggests that any excess in tuberculosis mortality among males in both periods may have been due to wartime mobilization rather than influenza.

Causes for discharge of military working dogs from service: 268 cases (2000-2004).

OBJECTIVE: To determine causes for discharge of military working dogs (MWDs) from service. DESIGN: Retrospective case series. ANIMALS: 268 MWDs. PROCEDURES: Records of all MWDs approved for discharge from December 2000 through November 2004 were evaluated for cause of discharge. RESULTS: 23 dogs had been obtained through the Department of Defense breeding program but had failed to meet prepurchase or certification standards. The remaining 245 (120 German Shepherd Dogs, 100 Belgian Malinois, and 25 dogs of other breeds) had been purchased as adults or obtained through the breeding program and had passed prepurchase and certification standards. Eighty-five of the 245 (34.7%) adult dogs were 1 to < 5 years old at discharge, and 160 (65.3%) were >or= 5 years old at discharge. The proportion of adult dogs < 5 years old at discharge that were German Shepherd Dogs (69.4%) was significantly greater than the proportion of adult dogs >or= 5 years old at discharge that were German Shepherd Dogs (38.1%). Within the subgroup of dogs >or= 5 years old at discharge, median age at discharge for the German Shepherd Dogs (8.59 years) was significantly less than median age at discharge for the Belgian Malinois (10.61 years). For adult dogs < 5 years old at discharge, the most common cause for discharge was behavioral problems (82.3%). CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that longevity of service for MWDs may be influenced by breed differences and that selection criteria should be evaluated to reduce behavior-related discharge from service.

A quantitative trait locus (QTL) on chromosome 6q influences birth weight in two independent family studies.

Low birth weight is an important cause of infant mortality and morbidity worldwide. Birth weight has been shown to be inversely correlated with adult complex diseases such as obesity, type-2 diabetes and cardiovascular disease. However, little is known about the genetic factors influencing variation in birth weight and its association with diseases that occur in later life. We, therefore, have performed a genome-wide search to identify genes that influence birth weight in Mexican-Americans using the data from the San Antonio Family Birth Weight Study participants (n=840). Heritability of birth weight was estimated as 72.0+/-8.4% (P<0.0001) after adjusting for the effects of sex and term. Multipoint linkage analysis yielded the strongest evidence for linkage of birth weight (LOD=3.7) between the markers D6S1053 and D6S1031 on chromosome 6q. This finding has been replicated (LOD=2.3) in an independent European-American population. Together, these findings provide substantial evidence (LOD(adj)=4.3) for a major locus influencing variation in birth weight. This region harbors positional candidate genes such as chorionic gonadotropin, alpha chain; collagen, type XIX, alpha-1; and protein-tyrosine phosphatase, type 4A, 1 that may play a role in fetal growth and development. In addition, potential evidence for linkage (LOD>or=1.2) was found on chromosomes 1q, 2q, 3q, 4q, 9p, 19p and 19q with LODs ranging from 1.3 to 2.7. Thus, we have found strong evidence for a major gene on chromosome 6q that influences variation in birth weight in both Mexican- and European-Americans.

Rethinking the Hispanic paradox: death rates and life expectancy for US non-Hispanic White and Hispanic populations.

OBJECTIVES: We examined the "Hispanic paradox," whereby persons of Hispanic origin seemed to experience lower mortality than the non-Hispanic White population. This paradox coincided with a change from the classification of deaths and population by Spanish surname to the use of Hispanic-origin questions in the census and vital statistics. METHODS: To estimate US Hispanic and non-Hispanic White mortality, we applied a familiar relation between death rates for population subgroups to Hispanic and non-Hispanic White population death rates. We calculated age-specific death rates for the Hispanic population and the non-Hispanic White population and computed life tables for each. Result. For Texas between 1980 (surname) and 1990 (origin), the change in Hispanic deaths in persons aged 65 years or older was only half as great as the change in population size, implying a relative omission of 15% to 20% of deaths. By a different approach, the life tables for the US Hispanic and non-Hispanic White populations pointed to a similar omission. CONCLUSIONS: There is no "Hispanic paradox." The Hispanic paradox described in past research derives from inconsistencies in counts of Hispanic-origin deaths and populations.

Variation in life expectancy during the twentieth century in the United States.

The National Center for Health Statistics (NCHS) reports life expectancy at birth (LE) for each year in the United States. Censal year estimates of LE use complete life tables. From 1900 through 1947, LEs for intercensal years were interpolated from decennial life tables and annual crude death rates. Since 1948, estimates have been computed from annual life tables. A substantial drop in variation in LE occurred in the 1940s. To evaluate these methods and examine variation without artifacts of different methods, we estimated a consistent series of both annual abridged life tables and LEs from official NCHS age-specific death rates and also LEs using the interpolation method for 1900-1998. Interpolated LEs are several times as variable as life table estimates, about 2 times as variable before 1940 and about 6.5 times as variable after 1950. Estimates of LE from annual life tables are better measures than those based on the mixed methods detailed in NCHS reports. Estimates from life tables show that the impact of the 1918 influenza pandemic on LE was much smaller than indicated by official statistics. We conclude that NCHS should report official estimates of intercensal LE for 1900-1948 computed from life tables in place of the existing LEs that were computed by interpolation.

Reconciling heart disease mortality and ICD codes.

This study uses 61 years of death certificates for Bexar County, Texas, uniformly coded under ICD 9, to describe the transition in heart disease mortality from 1935-1995. We find that life expectancy for persons dying with heart diseases increased throughout this period, with clear differences in rates of increase for males and females, associated with acute ischemic heart disease. Our data point to an epidemic of AIHD in the 1950s and 1960s, which is now abating. Findings are less clear for chronic ischemic heart disease, while other major heart diseases cannot be traced with any confidence owing to changes over time in the emphasis accorded particular causes. Our findings suggest caution with respect to the socioeconomic analysis of heart disease mortality data, particularly where the instability of the coding conventions has been most acute.

Sex and ethnic differences in hip fracture-related mortality in Texas, 1990 through 1998.

Hip fracture, the most serious complication of osteoporosis, is associated with considerable morbidity and mortality. Knowledge of hip fracture-related mortality rates by age, sex, and ethnicity as well as temporal changes in mortality are important for health planners to implement programs aimed at awareness and prevention of hip fractures. This study determines adjusted death rates in Texas by age, sex, and ethnic group from 1990 through 1998 and describes trends in mortality during the 9-year period. Upward trends in mortality were observed for both sexes in whites and blacks. Hispanics showed trends toward decreasing mortality rates. The highest mortality rates were observed in whites, predominantly in persons 80 years and older. Furthermore, rates in men by ethnic group consistently exceeded those in women. As the population ages, hip fractures are becoming a major public health problem in Texas that will likely increase unless fall prevention strategies and treatment of osteoporosis in elderly people are improved.