Healthcare Experiences and Needs of Consensually Non-Monogamous People: Results From a Focus Group Study.

BACKGROUND: Individuals engaged in consensual non-monogamy (CNM) face broad and potentially harmful experiences of sexual stigma in society, yet no published empirical literature has examined the experiences of this population within the healthcare system. AIM: The present investigation sought to explore positive and negative experiences of CNM individuals within the healthcare system, as well as specific needs of these patients regarding inclusive healthcare practices. METHODS: 20 CNM-identified adults from a non-profit organization serving CNM individuals completed a brief survey and participated in 1 of 3 focus groups of 70 minutes duration centered on their healthcare needs and experiences. OUTCOMES: CNM patients report challenges in addressing their healthcare needs related to lack of provider knowledge, inadequate preventative screenings, and stigmatizing behaviors that impact their health and trust in the healthcare system. CLINICAL IMPLICATIONS: Healthcare providers must monitor and work to avoid assumptions and pathologization of individuals who engage in CNM, creating an open, accepting environment to work collaboratively with CNM individuals to meet their unique sexual health needs. STRENGTH & LIMITATIONS: Although the present sample is diverse with respect to sexual and gender identity and socioeconomic status, it may not represent the experiences of CNM individuals outside of the midwestern United States and those who do not identify as polyamorous. CONCLUSION: CNM individuals frequently experience sexual stigma in interactions with the healthcare system that interferes with receipt of sensitive, medically accurate care relevant to their unique needs and experiences. Vaughan MD, Jones P, Taylor BA, et al. Healthcare Experiences and Needs of Consensually Non-Monogamous People: Results From a Focus Group Study. J Sex Med 2019;16:42-51.

Susceptibility to aflatoxin B1-related primary hepatocellular carcinoma in mice and humans.

The genetic basis of disease susceptibility can be studied by several means, including research on animal models and epidemiological investigations in humans. The two methods are infrequently used simultaneously, but their joint use may overcome the disadvantages of either method alone. We used both approaches in an attempt to understand the genetic basis of aflatoxin B(1) (AFB(1))-related susceptibility to hepatocellular carcinoma (HCC). Ingestion of AFB(1) is a major risk factor for HCC in many areas of the world where HCC is common. Whether humans vary in their ability to detoxify the active intermediate metabolite of AFB(1), AFB(1)-exo-8,9-epoxide, is not certain but may explain why all exposed individuals do not develop HCC. To determine whether human variability in detoxification may exist, in a study of 231 HCC cases and 256 controls, we genotyped eleven loci in two families of AFB(1) detoxification genes; the glutathione S-transferases (GSTs) and the epoxide hydrolases (EPHX). After adjustment for multiple comparisons, only one polymorphism in the epoxide hydrolase family 2 locus remained significantly associated with HCC (odds ratio = 2.06, 95% confidence interval = 1.13-3.12). To determine whether additional susceptibility loci exist, we developed a mouse model system to examine AFB(1)-induced HCC. Susceptibility of 7-day-old mice from two common inbred strains (C57BL/6J, DBA/2J) was assessed. DBA/2J animals were 3-fold more sensitive to AFB(1)-induced HCC and significantly more sensitive to AFB(1) acute toxicity than were C57BL/6J animals. Analysis of the xenobiotic metabolizing genes in the two strains revealed single nucleotide polymorphisms in three genes, Gsta4, Gstt1, and Ephx1. Although the GSTT1 and EPHX1 loci did not appear to be related to HCC in the total population of the human study, a polymorphism in GSTA4 was significantly related to risk in the male subset. The mouse model also demonstrated that absent or compromised p53 was not necessary for the development of carcinogenesis. These results indicate that the comparison of results from human studies and the AFB(1)-susceptible mouse model may provide new insights into hepatocarcinogenesis.