Associations Between Primary Residence and Mental Health in Global Marginalized Populations

Scholars suggest that marginalized people in non-urban areas experience higher distress levels and fewer psychosocial resources than in urban areas. Researchers have yet to test whether precise proximity to urban centers is associated with mental health for marginalized populations. We recruited 1733 people who reported living in 45 different countries. Participants entered their home locations and completed measures of anxiety, depression, social support, and resilience. Regression and thematic analyses were used to determine what role distance from legislative and urban centers may play in mental health when marginalized people were disaggregated. Greater distance from legislative center predicted higher anxiety and resilience. Greater distance from urban center also predicted more resilience. Thematic analyses yielded five categories (e.g., safety, connection) that further illustrated the impact of geographic location on health. Implications for community mental health are discussed including the need to better understand and further expand resilience in rural areas.

The experiences of support staff in a traumatic brain injury rehabilitation center

PURPOSE

Employee turnover is a major issue for health care organizations. Burnout is a leading contributor to such turnover. Extensive research on burnout has been conducted in health care settings; however, it has primarily been focused on health care professionals ignoring other critical staff. In particular, traumatic brain injury rehabilitation is an area of health care that includes unique challenges and stressors that may contribute to burnout. Brain injury professionals report experiencing high levels of burnout that further increase as they spend more time with patients; however, little is known about the experiences of brain injury paraprofessionals. This study explores the unique experiences of support staff in traumatic brain injury rehabilitation centers.

METHOD

The present study used a grounded theory method to explore the phenomena of burnout, turnover, and job satisfaction from the perspective of paraprofessional support staff in 1 posthospital brain injury rehabilitation center. Support staff participated in the research via small group interviews (N = 4) and survey (N = 11).

RESULTS

The analysis resulted in a grounded theory model, entitled "The Balance model of Rehabilitation Support Work." This model is a framework of risk and protective factors that appeared to influence whether these frontline rehabilitation staff experienced negative outcomes from this often challenging/stressful work environment. The model includes 4 axial-level themes: doing the work, protective factors, risk factors, and imbalance of factors. Within the 4 axial categories are twenty open-coding level categories.

IMPLICATIONS

Implications for traumatic brain injury rehabilitation organizations and areas for future research are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

"There's no real roadmap that I know of": Experiences of transgender and nonbinary graduate students in counseling psychology programs

Minimal research has examined the experiences of transgender and nonbinary (TNB) people in graduate school with no studies to date examining the experiences of TNB students in psychology graduate programs. The purpose of this study was to utilize a critical-ideological paradigm to identify recruitment, retention, and attrition factors for TNB people in counseling psychology (CP) programs with the aim of providing specific recommendations to CP programs. Individual interviews (between 35 and 70 min) were conducted with a sample of 16 TNB graduate students, aged 23-37-years old (M = 26.9, SD = 3.84), in masters (n = 6) and doctoral (n = 10) CP programs. Participants were nonbinary (n = 13) and trans men (n = 3), the majority were White (n = 10), and all were sexual minorities. Participants were recruited online through email listservs and on social media posts on Facebook and Twitter. Reflexive thematic analysis revealed themes related to challenges experienced in CP programs (systemic/structural challenges, interpersonal challenges, individual/internal challenges) and strengths of or recommendations for CP programs (transaffirming resources/policies, supporting TNB competence and expertise, being a TNB accomplice). Several unique subthemes emerged across the seven themes. Findings may be applied by CP programs to more effectively recruit and retain TNB people, and collectively contribute to an increasing number of TNB people within this field. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Social and contextual influences on eating pathology in transgender and nonbinary adults

Eating pathology (EP) is reported at alarmingly high rates among transgender and nonbinary (TNB) people. The present study investigates key associations between experiences that are common in TNB populations and EP. TNB individuals located within the United States (N = 212) who self-identified as currently experiencing disordered eating or an eating disorder were recruited from social media outlets and completed an online survey that included measures of EP, discrimination-based trauma symptoms, internalized transphobia, and gender dysphoria. The average age of participants was just over 27 years old (SD = 6.22) and the majority of participants (68.9%) were nonbinary. Data were analyzed using IBM SPSS version 28 and PROCESS 4.0. Discrimination trauma [β = .27, t(211) = 3.90, p < .001] and internalized transphobia [β = .21, t(211) = 3.03, p = .003] were significant predictors of EP in a multiple regression model. Additionally, internalized transphobia partially mediated the association between discrimination trauma and EP. Findings reinforce the need for trauma-informed and multiculturally competent provision of services for TNB populations presenting with eating concerns. Results also highlight the complex role that previously unexplored variables play in the etiology of EP for TNB populations. Implications and clinical recommendations are discussed.

The Cross-Cultural Practicum Training Experiences of Asian International Counseling Students

Despite the call to internationalize counseling psychology and calls for improved mentoring to Asian international students enrolled in counseling psychology training programs, there is a dearth of literature to help trainers understand this population’s clinical training experiences. The present study explored the practicum experiences of Asian international students ( N = 10) in counseling psychology programs using the consensual qualitative research method. Data analysis yielded five domains: Learning Outcomes, Challenges, Resources, Behavioral Strategies, and Suggestions. Participants described how they navigated their cross-cultural practicum training in the face of unique challenges and how they adapted, as well as relied on support systems. As our participants reflected on their cross-cultural clinical training experiences, they shared the lessons they learned and provided suggestions for current and future international students, supervisors, and programs. Scholarly and practical implications for this population are discussed.

Determined to improve: An exploration of therapist perspectives about their development

Scholars note that therapist performance is one of many factors that contribute to client treatment outcomes. Given that the performance of therapists matters, researchers have identified several methods and models for improving therapist effectiveness. However, scholars have yet to explore highly effective therapists' perspectives on their motivation to develop, the methods they use, and the impact of their efforts to develop. The present study used a consensual qualitative research (Hill & Knox, 2021) approach to explore dynamics underlying therapist development of expertise. Semistructured interviews were conducted with 12 therapists whose outcome data placed them in the top 25% of clinicians of their respective clinics, according to their supervisors. The researchers reached consensus at each stage of analysis as they organized data into domains, core ideas, and cross-analysis. Domains and corresponding subdomains were: (a) struggle with personal, external, and response to barriers subdomains, (b) therapist characteristics with striving, presence, skills, and values subdomains, and (c) development with early career, formal, feedback, relational, personal/identity subdomains. Implications for practice and areas for future research are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Geographic Distributions of Drag Performers Relative to Urban Centers: Implications for Health

LGB people may become less accessible to health professionals as technology reshapes LGB social connections. Though electronic forms of health promotion are effective, some interventions must be delivered in person. We use GIS to analyze characteristics (e.g., gender identity, depression, and performance involvement) shared by 114 gay, cisgender male drag performers. We used geographic ordinary least squares (OLS) regression to identify spatial relationships based on participant distance from urban centers. Participants lived between 1.73 km (1.07 mi) and 762.77 km (101.14 mi) from the nearest urban center (Mdn = 16.60 km; 10.31 mi). We found a positive correlation between distance from the nearest urban center and performance involvement (R = 0.19, p ≤ 0.05). Results indicate that drag performers are widely disbursed relative to urban centers and that drag involvement provides motivation to travel to gay bars. Health professionals with in person services may use drag shows and related performances to access LGB populations.

A Cotherapy Supervision Approach using Person-Centered Theory with a Gender Fluid Client

The authors discuss their work with a young adult client who identified as gender fluid. The client was a college student in a rural, mid-south town. The authors are two faculty members who worked with the client for a period of 2 years using a cotherapy supervision approach. The counseling approach was affirmative and person-centered. By keeping a focus on the exploration of gender foremost, the clinicians saw an abatement of other symptoms (depression, suicidality, self-harm, disordered eating, low self-confidence, emotion dysregulation, dissociation, and so on) and an improvement in wellness (relationships, emotion regulation, self-concept, assertiveness, appropriate boundary-setting, and so on) over time. The authors offer specific interventions such as collaborative letter writing and the creation of a transition roadmap. They also highlight the advantages and utility of a collaborative, person-centered, consent-based, affirmative approach to therapy with rural transgender and nonbinary clients with complex presenting concerns.

A Qualitative Investigation of the Experiences of People Who Panhandle

U.S. Census data from 2016 indicate that 12.7% of the population may be living in poverty, a total of 40.6 million people. The most visible among this group facing unemployment or underemployment are people who panhandle, characterized by soliciting requests for assistance on street corners or highway exits. If issues of poverty are to be addressed adequately, the characteristics of these populations need to be better understood. In this qualitative study, we sought to understand the experiences of people who panhandle through in-person interviews. Participants included 9 individuals (6 men and 3 women). A consensual qualitative research approach was used to analyze the transcribed interviews resulting in 7 domains. We discuss results in the context of the psychology of working theory. Implications include the integration of social justice and vocational psychology among counseling psychologists working with clients who panhandle.

Person-Centered Therapy as Applied to Work With Transgender and Gender Diverse Clients

Scholars continue to call for research-informed treatment approaches for transgender clients. The existing literature directs therapists to learn about unique issues facing transgender individuals and to provide affirming therapy for transgender clients. We offer a person-centered approach to treatment for transgender individuals that integrates current scholarship with person-centered theory and offers specific interventions for use with transgender clients. These theoretical applications and interventions are offered for both interpersonal and intrapersonal work with clients. Following our analysis, we offer future areas of emphasis for treatment and research.

Recommendations from Transgender Healthcare Consumers in Rural Areas

Purpose: Scholars indicate that rates of mental and physical health issues (e.g., substance use, anxiety, depression) may be much higher among transgender individuals relative to the general population. This disparity may be even greater for transgender individuals in rural areas. Clinical researchers suggest using affirmative therapeutic approaches and interventions to address the health concerns of transgender individuals, specifically to connect individuals with the transgender community. However, little is known about the content of information that is shared in transgender communities in rural areas. Method: For this qualitative study, researchers asked transgender individuals in rural areas (n=10) what recommendations they would offer to other transgender individuals in rural areas regarding healthcare access. Results: Results were organized into four domains: Access care, Quality control, Difficulties, and Mentorship. Within these domains, we identified 11 sub-domains: Get physical healthcare, Get mental healthcare, Provider search, Provider vetting, Treatment verification, It will be difficult, Know who you are, Believe in yourself, Move, Connect to community, and Other. Conclusions: We discuss implications of our findings for healthcare provision in rural areas, and we provide recommendations for future research.

Changes in social support over time in a faith-based physical activity intervention

African-American women report higher levels of chronic conditions and church attendance relative to the overall US population. Therefore, efforts have increased over the past decade to design church-based health promotion programs. The present study compared changes in religiosity, religious social support and general social support across time within a church-based physical activity study. In a clustered randomized controlled trial, 31 churches and ∼15 African-American women per church were recruited to participate. Churches were randomized to one of three 10-month programs to promote physical activity: faith-integrated (FI), non-faith integrated (NFI) or self-guided control program (C). Comparisons were made between baseline and 10-month time points to assess differences over time. A significant reduction in general social support was observed across all groups. Private religious practices and religious emotional support received increases in C and FI, respectively. Prior research findings and the current study highlight difficulty in demonstrating strong, unilateral changes in religiosity, social support and health. Additional research is needed to identify more accurate measures of these concepts. Findings from the current study have implications for the role of social support in future church-based health promotion studies.

Exploring the Relationship of Religiosity, Religious Support, and Social Support Among African American Women in a Physical Activity Intervention Program

Religious belief has been linked to a variety of positive mental and physical health outcomes. This exploratory study will address the relationship between religious involvement and social connectedness among African American women. Results from a physical activity intervention research project (N = 465) found that total religious support and social support were significantly negatively correlated with total religiosity, while total general social support was significantly positively correlated with total religious support. Overall, the study indicates that more research is needed on ways to encourage interaction between the positive dimensions of both religiosity and social support to bring about healthy behaviors.

Localization of somatostatin mRNAs in the brain and pancreas of rainbow trout (Oncorhynchus mykiss)

Rainbow trout possess three distinct mRNAs, each encoding a separate precursor: PPSS I, which contains a 14-amino acid sequence at its C-terminus (somatostatin-14) that is highly conserved among vertebrates, as well as two others, PPSS II' and PPSS II", both containing [Tyr(7), Gly(10)]-somatostatin-14 at their C-terminus. In this study, we used RNA template-specific PCR and in situ hybridization to determine the distribution and cellular localization of PPSS mRNAs in the brain and Brockmann body of rainbow trout. PPSS I, PPSS II' and PPSS II" were expressed in the Brockmann body and pituitary; the expression of PPSS mRNAs in the brain was region specific. PPSS I mRNA was expressed in the Brockmann body predominantly by cells other than those that expressed PPSS IIs; however, there were several instances where PPSS I and PPSS IIs were co-expressed within the same cell. Of the PPSS II-expressing cells, many were observed to express both PPSS II' and PPSS II" mRNA; however, some cells expressed only PPSS II' mRNA, while other cells expressed only PPSS II" mRNA. In the brain, PPSS I mRNA was expressed in the optic tectum (OT) and in many hypothalamic nuclei, including the nucleus rotundus (NR), nucleus anterioris hypothalami (NAH), nucleus anterior tuberis (NAT), nucleus lateral tuberis (NLT), as well as in the pituitary (adenohypophysis). PPSS II" mRNA was present in the same regions as PPSS I mRNA; however, PPSS II' mRNA was present primarily in OT, NAT, NLT and adenohypohysis. These results indicate that PPSS mRNAs are expressed differently by different cells, suggesting that cell-specific mechanisms are involved with the control of PPSS expression and that particular biological responses may be associated with a specific SS isoform.

Regional hospital improves efficiency with co-generation retrofit

Feasibility analysis of the co-generation retrofit of the Red Deer Regional Hospital pointed to a reasonable payback of capital cost and increased efficiency in operation of the facility. Budget restrictions nearly stopped the project from proceeding. Innovative construction procedures proposed by the Facility Management Group, in particular, Mr Keith Metcalfe, Director of Maintenance, allowed a worthwhile project to reach successful completion. We feel that this model can perhaps be used by similar facilities in the future to achieve their energy efficiency goals.

HMO financial arrangements with rural physicians

The growth of managed care in general suggests that a substantially larger number of rural primary care physicians will be asked to enter into risk-bearing contracts with Health Maintenance Organizations (HMOs) in the near future. This article describes the different types of payment and risk-sharing arrangements that exist between HMOs and primary care physicians and presents survey data relating to their prevalence in rural areas. Also, it describes in detail the payment arrangements used by four HMOs that contract with rural primary care physicians. The concluding discussion highlights policy issues regarding risk-sharing arrangements that are especially pertinent in rural settings.

Taking health status into account when setting capitation rates: a comparison of risk-adjustment methods

OBJECTIVE

To compare performance of different health status measures for risk-adjusting capitation rates.

DESIGN

Cross-sectional study. Health status measures derived from 1 year were used to predict resources for that year and the next.

SETTING

Group-network health maintenance organization in Minnesota.

PARTICIPANTS

Sample of 18- to 64-year-old (n=3825) and elderly (aged > or = 65 years; n=1955) members enrolled in a network-model health maintenance organization in Minnesota.

MAIN OUTCOME MEASURES

Total expenditures in the year concurrent with the health status survey (July 1991 through June 1992) and total expenditures in the year following the survey (July 1992 through June 1993).

RESULTS

Capitation adjustment based on demographic measures performed least well. Both self-reported health status measures and diagnoses predicted future expenditures twice as well as demographics. When predicting costs for groups of patients rather than individuals, the demographic model worked well for average groups but tended to overpredict healthier groups and underpredict sicker groups. Ambulatory Care Groups based on diagnoses performed better than self-reported health status both in the retrospective models and across healthier and sicker groups.

CONCLUSIONS

Without risk adjustment, capitation rates are likely to overpay or underpay physicians for certain patient groups. It is possible to improve prediction using health status measures for risk adjustment. When selection bias is suspected and administrative data are available, we recommend a risk-adjustment method based on diagnostic information. If diagnostic data are not available, we recommend a system based on simple self-reported measures, such as chronic conditions, rather than complex functional status measures.

Health care report cards: what about consumers' perspectives?

Though the report card style is seen by many as a way to create better-informed consumers, very little is actually known about how consumers will respond to health care report cards. Report cards are only one of many factors that influence health care decision making. Much consumer-oriented effort and fine-tuning will be required to make report cards effective. Using the approach called "social marketing" as a framework, specific examples are used to outline some ideas for more intensive pursuit of consumers' perspectives in the design and distribution of report cards.

Topical clindamycin treatment of acne. Clinical, surface lipid composition, and quantitative surface microbiology response

A double-blind study has been conducted to examine the effect of topical 1% clindamycin hydrochloride hydrate in a hydroalcoholic vehicle as compared to the effect of the vehicle alone. Fourteen patients applied clindamycin or vehicle alone twice daily for eight weeks. Free fatty acid surface lipid percentages, quantitative bacterial counts, and clinical response were assessed every two weeks. A significant reduction (88%) in the percentage of free fatty acids in the surface lipids was seen in the clindamycin-treated group and not in the vehicle-treated group. There was no significant change in the surface microflora. Despite the short duration of treatment, objective clinical improvement was seen in three of nine treated patients, while none was observed in the placebo-treated patients.

Quantitation and characterization of soluble immune complexes precipitated from sera by polyethylene glycol (PEG)

Polyethylene glycol (PEG) was used to isolate immune complexes from sera. Complexes were then quantified and partially characterized by a variety of immunological techniques. Complexes were detected in rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), Felty's syndrome and vasculitis, but not in polymyositis, scleroderma or Behçets syndrome. The level of immune complexes correlated with disease activity in SLE and RA patients. Rheumatoid factors and anti-DNA antibodies were enriched by PEG precipitation of RA and SLE sera, respectively, thus these antibodies appeared to be present in the form of soluble immune complexes. Immune complexes usually contained all three immunoglobulin classes, IgG, IgM and IgA. Complexes from RA patients were generally larger and often contained Clq, while C3 was found almost exclusively in SLE complexes which also tended to be smaller. Such compositional differences may one day explain the differences in clinical manifestations of various immune complex-mediated diseases.

Control of proximal tubule fluid reabsorption in experimental glomerulonephritis

We have recently shown that in the early autologous phase of nephrotoxic serum nephritis (NSN) single nephron glomerular filtration rate is unchanged from values in normal hydropenic control rats, but that single nephron filtration fraction and efferent arteriolar oncotic pressure (piE) are reduced because of a marked reduction in the glomerular capillary ultrafiltration coefficient. The present study was undertaken to examine the influence of this decline in piE as well as the other known determinants of peritubular capillary fluid exchange on absolute proximal fluid reabsorption (APR) in NSN. The findings indicate that APR and proximal fractional reabsorption are reduced significantly in NSN, relative to values in a separate group of age and weight-matched normal hydropenic control rats studied concurrently. In addition to the measured decline in piE, efferent arteriolar plasma flow (Qe) and peritubular capillary hydraulic pressure (Pc) were found to increase significantly, while interstitial oncotic pressure, estimated from hilar lymph, was not significantly different from values in control rats. Using a mathematical model of peritubular capillary fluid uptake we found that, assuming that the capillary permeability-surface area product and interstitial hydraulic pressure are unchanged in NSN, the observed changes in piE and Pc are sufficient to offset the effect of the increase in QE, yielding a calculated reduction in APR of approximately 4 nl/min, in excellent agreement with the observed mean decline of 4.1 nl/min. These findings suggest that control of APR in NSN is mediated by the same factors that regulate APR under normal physiological conditions, namely, the imbalance of forces governing peritubular capillary uptake of isotonic reabsorbate.

Determinants of glomerular filtration in experimental glomerulonephritis in the rat

Pressures and flows were measured in surface glomerular capillaries, efferent arterioles, and proximal tubules of 22 Wistar rats in the early autologous phase of nephrotoxic serum nephritis (NSN). Linear deposits of rabbit and rat IgG and C3 component of complement were demonstrated in glomerular capillary walls by immunofluorescence microscopy. Light microscopy revealed diffuse proliferative glomerulonephritis, and proteinuria was present. Although whole kidney and single nephron glomerular filtration rate (GFR) in NSN (0.8 plus or minus 0.04 SE2 ml/min and 2 plus or minus 2 nl/min, respectively) remained unchanged from values in 16 weight-matched NORMAL HYDROPENIC control rats (0.8 plus or minus 0.08 and 28 plus or minus 2), important alterations in glomerular dynamics were noted. Mean transcapillary hydraulic pressure difference (deltaP) averaged 41 plus or minus 1 mm Hg in NSN versus 32 plus or minus 1 in controls (P LESS THAN 0.005). Oncotic pressures at the afferent (piA) end of the glomerular capillary were similar in both groups ( 16 mm /g) but increased much less by the efferent end (piE) in NSN (to 29 plus or minus 1 mm Hg) than in controls (33 plus or minus 1, P less than 0.025). Hence, equality between deltaP and piE, denoting filtration pressure equilibrium, obtained in control but not in NSN rats. While glomerular plasma flow rate was slightly higher in NSN (88 plus or minus 8 nl/min) than in controls (76 plus or minus 6, P greater than 0.2), the failure to achieve filtration equilibrium in NSN rats was primarily the consequence of a marked fall in the glomerular capillary ultrafiltration coefficient, Kf, to a mean value of 0.03 nl/(s times mm Hg), considerably lower than that found recently for the normal rat, 0.08 nl/(s times mm Hg). Thus, despite extensive glomerular injury, evidenced morphologically and by the low Kf, GFR remained normal. This maintenance of GFR resulted primarily from increases in deltaP, which tended to increase the net driving force for filtration, and thereby compensate for the reduction in Kf.