Gender-Sexuality Alliance meeting experiences predict weekly variation in hope among LGBTQ+ youth.

Hope is considered a marker of resilience among youth facing oppression, including LGBTQ+ youth. This 8-week weekly diary study among 94 LGBTQ+ youth (ages 14-19; Mage  = 15.91, 46% youth of color, 44% transgender or nonbinary) in 2021 considered whether a youth's meeting-to-meeting experiences in Gender-Sexuality Alliances (GSAs; LGBTQ+ affirming school clubs) predicted subsequent hope from week to week. Youth reported greater hope on days following meetings where they felt more group support, greater advisor responsiveness, and had taken on more leadership responsibilities. Group support and advisor responsiveness were stronger predictors of a youth's hope on days closer to GSA meetings; leadership's effect was stronger when more days had elapsed. Findings suggest how GSAs may cultivate hope among LGBTQ+ youth.

Youth Advocacy Varies in Relation to Adult Advisor Characteristics and Practices in Gender-Sexuality Alliances.

With growing attention to youth's efforts to address sexual and gender diversity issues in Gender-Sexuality Alliances (GSAs), there remains limited research on adult advisors. Do advisor characteristics predict their youth members' advocacy? Among 58 advisors of 38 GSAs, we considered whether advisor attributes predicted greater advocacy by youth in these GSAs (n = 366) over the school year. GSAs varied in youth advocacy over the year. Youth in GSAs whose advisors reported longer years of service, devoted more time to GSA efforts each week, and employed more structure to meetings (to a point, with a curvilinear effect), reported greater relative increases in advocacy over the year (adjusting for initial advocacy and total meetings that year). Relative changes in advocacy were not associated with whether advisors received a stipend, training, or whether GSAs had co-advisors. Continued research should consider how advisors of GSAs and other social justice-oriented groups foster youth advocacy.

Depression, Anxiety, and Interest in Mental Health Resources in School-Based Gender-Sexuality Alliances: Implications for Sexual and Gender Minority Youth Health Promotion.

Schools can be a setting to address mental health needs of sexual and gender minority (SGM) youth. Gender-Sexuality Alliances (GSAs), as extracurricular support groups, provide an existing structure that could be leveraged to reach SGM youth and deliver services. Nevertheless, limited data indicate the prevalence of depression and anxiety among GSA members, how often GSAs discuss mental health, or their receptivity to resources. Participants in the current study were 580 youth (Mage = 15.59; 79% sexual minority, 57% cisgender female; 68% White) and 58 advisors in 38 GSAs purposively sampled across Massachusetts. Youth completed established measures of depression and anxiety; advisors reported how frequently their GSAs discussed mental health; and both reported their interest in mental health materials. Among youth, 70.1% scored above the threshold indicating probable mild depression, and 34.4% scored above the threshold suggesting concerning anxiety. Adjusted odds ratios indicated that the odds of depression and anxiety were higher for SGM members relative to heterosexual and cisgender members, particularly among youth reporting SGM identities that have been underrepresented. GSAs discussed mental health with some frequency over the school year. Youth and advisors expressed strong interest in resources. Findings support the case for developing selective and indicated school-based prevention programming for youth in GSAs to address their mental health needs.

Greater Engagement in Gender-Sexuality Alliances (GSAs) and GSA Characteristics Predict Youth Empowerment and Reduced Mental Health Concerns.

Extracurricular groups can promote healthy development, yet the literature has given limited attention to indirect associations between extracurricular involvement and mental health or to sexual and gender minority youth. Among 580 youth (Mage  = 15.59, range = 10-20 years) and adult advisors in 38 Gender-Sexuality Alliances (GSAs), multilevel structural equation models showed that greater engagement in GSAs over the school year predicted increased perceived peer validation, self-efficacy to promote social justice, and hope (baseline adjusted). Through increased hope, greater engagement indirectly predicted reduced depressive and anxiety symptoms at the year's end (baseline adjusted). GSAs whose members had more mental health discussions and more meetings reported reduced mental health concerns. Findings suggest how groups addressing issues of equity and justice improve members' health.

Myasthenia Gravis and Its Aeromedical Implications.

BACKGROUND: Myasthenia gravis is an autoimmune condition where antibodies form against the acetylcholine receptors at the neuromuscular junction, eventually causing damage to the motor end plate. The clinical features include muscle fatigability as well as ocular, bulbar, and limb weakness, which can have implications on the role of a pilot or air traffic controller. This retrospective study reviewed the United Kingdom Civil Aviation Authority (UK CAA) experience of myasthenia gravis. METHODS: A search of the United Kingdom Civil Aviation Authority medical records database from 1990 to 2016 identified 11 individuals with a diagnosis of myasthenia gravis. Data were extracted for the class of medical certificate, age at diagnosis, symptoms, acetylcholine receptor antibody status, treatment, the time from diagnosis to loss of medical certification, and the reasons for loss of certification. RESULTS: There were two Class 1 certificate holders (for professional flying) and six Class 2 certificate holders (for private pilot flying) and three air traffic controllers. The mean and median ages at diagnosis were 53 and 57 yr, respectively, with a range of 28-67 yr. The mean and median intervals from diagnosis to loss of certification were 22 and 11 mo, respectively, with a range of 0 to 108 mo. CONCLUSION: The aeromedical implications of myasthenia gravis, including complications, types of treatment, and functional impact, are considered. A policy for medical certification following a diagnosis of myasthenia gravis is proposed.Jagathesan T, O'Brien MD. Myasthenia gravis and its aeromedical implications. Aerosp Med Hum Perform. 2017; 88(1):30-33.

Lesson of the month 1: Post-malaria neurological syndromes.

There are three neurological syndromes that may follow -malarial infection after recovery and at a time when the patient is aparasitaemic. An acute disseminated encephalopathy; a cerebellar syndrome; and an acute demyelinating polyneuropathy. This paper reports a 42-year-old male patient who developed encephalopathy.

The Aeromedical Implications of Parkinson's Disease.

BACKGROUND: Parkinson's disease is a progressive neurodegenerative disorder which is encountered in the pilot population and has clinical features that can impact on the flying role. This retrospective study reviewed the United Kingdom Civil Aviation Authority (UK CAA) experience of Parkinson's disease. The aeromedical implications of the condition are discussed and the UK CAA policy for the certificatory assessment of pilots with Parkinson's disease is described. METHODS: A search of the UK CAA medical records database from 1990 to 2015 identified 34 pilots with a diagnosis of Parkinson's disease. Data was extracted for the class of medical certificate, time from first symptoms to diagnosis, age at diagnosis, the time from diagnosis to loss of certification and the reasons for loss of certification. RESULTS: Of 15 professional (Class 1) and 19 private (Class 2) pilots, the mean time from onset of symptoms to diagnosis was 36 and 19 mo, respectively. The mean ages at diagnosis were 55 and 59 yr, respectively. The mean interval from diagnosis to loss of certification was 21 (0-93) and 37 (0-84) mo, respectively. The reasons for loss of certification are considered. CONCLUSION: In the UK, pilots diagnosed with Parkinson's disease may be granted medical certification depending on their functional ability and the side effect profile of medication. The aeromedical implications of Parkinson's disease and the UK CAA policy for the certification of pilots with Parkinson's disease are discussed.

Transient global amnesia and its aeromedical implications.

INTRODUCTION: Transient global amnesia (TGA) is an episode of severe anterograde amnesia of sudden onset, characteristically lasting 4 to 6 h. Patients become disorientated in time and place, but not in person. Automated motor tasks are preserved; however, the retention of new information is impaired, with clear implications to a pilot's fitness to fly. This study examines the United Kingdom Civil Aviation Authority (UK CAA) experience of pilots with TGA and compares it to the medical literature. METHODS: The UK CAA medical records database was searched for subjects who had reported a history of TGA between the years 1990 and 2010. Subject age and gender, the frequency and duration of episodes, the follow-up period, precipitants, and associated features were recorded. A literature search for papers with similar information was undertaken. RESULTS: The UK CAA database showed 29 subjects who had held a UK CAA medical certificate with a history of TGA. There were 28 male individuals and 1 female. The mean age was 59 yr. The mean follow-up period was 3.4 yr. The average duration of an episode was 2.8 h. Activity, stress, or exposure to cold water were reported as possible precipitants by 16 subjects (55%). There were 6 subjects (21%) who had a history of migraine and 10 (34%) who had a history of hypertension. From the literature, 10 papers were reviewed and compared to our study group. DISCUSSION: The aeromedical implications of TGA, including its etiology, associations, misdiagnosis, and recurrence risk are considered. A policy for the certification of pilots following TGA is proposed.

Contraception for women taking antiepileptic drugs.

Antiepileptic drugs (AEDs) that induce hepatic enzyme activity may alter the metabolism of most hormonal methods of contraception, and this may affect their contraceptive efficacy. There is also the potential for the hormonal method to affect the AED. Women may also be prescribed AEDs to treat conditions other than epilepsy, such as chronic pain and migraine. These effects should be considered in the choice of both the treatment of the epilepsy and the choice of contraceptive method. This review considers these interactions and offers advice about their management.

Contraception for women with epilepsy.

Antiepileptic drugs that induce hepatic enzyme activity may alter the metabolism of most hormonal methods of contraception, and this affects the contraceptive regime. This effect should be considered in the choice of both the treatment of the epilepsy and the choice of contraceptive method. This review considers these interactions and offers advice about their management.