Search Results (401)

Background/Objectives: Lesbian, gay, bisexual, and transgender (LGBT) cancer survivors face disproportionately high structural and psychosocial barriers to post-diagnosis care. However, heterogeneity within this population remains understudied. This study aimed to characterize healthcare utilization (HCU) barriers among LGBT cancer survivors, assess psychosocial vulnerabilities (discrimination, stress, and social support), and identify survivor subgroups at greatest risk for care disengagement. Methods: Data were drawn from the All of Us Research Program. A sample of 3502 LGBT cancer survivors was analyzed, including lesbian (n = 730), gay (n = 1285), bisexual (n = 1296), and transgender/gender expansive (TGE) (n = 209) individuals. HCU barriers were assessed using 21 binary indicators. Psychosocial measures included the Everyday Discrimination Scale, Perceived Stress Scale, and MOS Social Support Survey. Agglomerative hierarchical cluster analysis identified latent HCU barrier profiles. Differences across clusters and identity groups were assessed using ANOVA and chi-square tests, and multinomial logistic regression examined demographics, socioeconomic, and psychosocial predictors of cluster membership. Results: Three distinct HCU barrier clusters were identified: low (59.7%), moderate (27.8%), and high (12.5%). Bisexual and TGE survivors were disproportionately represented in the high-barrier cluster, which was characterized by widespread cost-related nonadherence, structural delays in care, and higher levels of perceived discrimination and stress. In adjusted models, bisexual identity, lower income, female sex assigned at birth, and higher discrimination and perceived stress were independently associated with increased odds of high-barrier cluster membership. Conclusions: Substantial heterogeneity exists in HCU barriers among LGBT cancer survivors. Bisexual and TGE survivors experience a concentrated burden of structural and psychosocial barriers to survivorship care, highlighting the relevance of targeted, data-driven approaches to reduce access inequities within this population. Full article

Background/Objectives: In England, gay, bisexual, and other men who have sex with men (GBMSM) are eligible for vaccination at NHS sexual health services, including human papillomavirus (HPV), hepatitis A virus (HAV), and hepatitis B virus (HBV) vaccines. However, current research shows limited understanding of the factors influencing vaccination uptake among GBMSM. This study aimed to examine the barriers and facilitators affecting the offer and uptake of these vaccination programmes. Methods: A qualitative interview study following the Person-Based Approach (a systematic method for developing and optimising health interventions) involving GBMSM and sexual health service staff from two regions of England. Purposive sampling aimed to include GBMSM with diverse backgrounds and engagement with sexual health services. Patient and public involvement shaped the study design and interview topic guides. The interviews were recorded, transcribed, and thematically analysed to identify barriers and facilitators which were interpreted using the COM-B model of behaviour change. Results: Twenty GBMSM and eleven staff took part. The findings showed that opportunistic delivery of HPV, HAV, and HBV vaccination within sexual health services is mostly acceptable and feasible for GBMSM and staff, while also highlighting areas for optimization. Despite low knowledge of these viruses and their associated risks, willingness to be vaccinated was high, with healthcare provider recommendations and the convenience of vaccine delivery during routine clinic visits acting as important facilitators. However, the reach of opportunistic models was limited, particularly for individuals underserved by sexual health services or disengaged from GBMSM social networks. System-level barriers such as complex vaccine schedules (particularly when multiple schedules are combined), inconsistent access to vaccination histories, and limited system-level follow-up processes (e.g., automated invites and reminders) were also found to act as obstacles to vaccination uptake and delivery. Conclusions: To improve equitable uptake, sexual health services should explore the feasibility of addressing both individual and structural barriers through additional strategies, including targeted and persuasive communication to increase knowledge, leveraging regular contact with GBMSM to promote uptake, and implementing enhanced approaches to support vaccination completion (e.g., automated prompts or reminders). Full article

Transgender and gender-expansive (TGE) communities face persistent health inequities that are reproduced through everyday administrative and clinical encounters across care systems. A feedback-focused lens can clarify how those inequities are generated and sustained. Objective: To identify and validate feedback loops that create policy exposure and institutional gatekeeping in TGE healthcare and to surface leverage points to stabilize their continuity of care. Methods: Two facilitated, Zoom-based Group Model Building (GMB) sessions were conducted in March 2021 with eight TGE participants (mean age 38 years; range 22–63; transfeminine and transmasculine identities; multiracial, White, and SWANA racial identities) recruited through a Lesbian Gay Bisexual and Transgender (LGBT) community center, followed by a participant member-checking session to validate loop structure, causal direction, and interpretive accuracy. Analysis focused explicitly on identifying reinforcing and balancing feedback structures, rather than isolated barriers, to explain how policy exposure and institutional gatekeeping are generated over time. Results: Participants co-constructed a nine-variable Causal Loop Diagram (CLD) with six feedback structures, four reinforcing and two balancing that interact dynamically to amplify or dampen policy exposure, institutional gatekeeping, and continuity of care, which were organized across structural, institutional/clinical, and individual/community tiers. Reinforcing dynamics linked structural stigma, exclusion from formal employment, institutionalized provider bias, and enacted stigma to degraded care experience, increased trauma and distrust, and disrupted continuity, manifesting as policy exposure (e.g., coverage volatility, denials) and gatekeeping (e.g., discretionary documentation, referral hurdles). Community-based supports and peer/elder navigation functioned as balancing loops that reduced trauma, improved continuity and encounters, and, over time, dampened provider bias. A salient theme was the visibility/invisibility paradox: symbolic inclusion without workflow redesign can inadvertently increase exposure and reinforce harmful loops. Full article

Existing research highlights that Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ+) teachers are often exposed to additional stressors in schools which adversely affect their mental health. Some mitigate the effects of these stressors by separating their personal and professional identities while others choose to integrate their identities so that they can be authentic, advance social justice in school contexts or be visible and vocal role models. Less is known about the experiences of pre-service teachers who are undertaking teacher preparation programmes. This systematic literature review presents the results of 20 published papers which represent the global experiences of both pre-service teachers and serving teachers. The findings highlight identity management, experiences of discrimination, agency and lack of confidence of teacher educators. Two new frameworks are presented that lay the foundations for embedding LGBTQ+ inclusion and proposed mandatory elements of curricula for initial teacher training. This systematic literature review has been informed by the following research questions RQ1. What are the experiences of LGBTQ+ pre-service teachers? RQ2. How do LGBTQ+ pre-service teachers negotiate their identities? RQ3. How do LGBTQ+ pre-service teachers disrupt hetero/cis-normative cultures in schools? RQ4: How well does the teacher education programme prepare pre-service teachers for teaching LGBTQ+ inclusive education? Full article

The 2S LGBTQIA+ (Two-Spirit, Lesbian, Gay, Bisexual, Trans, Queer and/or Questioning, Intersex, Asexual, and additional sexually and gender-diverse self-identities) population often faces barriers to care in the context of cervical cancer screening. With the shift from primary cervical cytology (Papanicolaou test) to primary human papillomavirus (HPV)-DNA testing, it is crucial to examine these populations’ healthcare needs. An intersectionality framework with an anti-oppressive lens is needed to restructure a healthcare system whose systems have traditionally erased the care needs of diverse populations through colonial, racialized, and cis-heteronormative practices. Barriers to cervical screening in 2S LGBTQIA+ populations include stigma, discrimination, limited provider guidance and understanding, and high rates of physical, sexual, and medical trauma. Self-sampling for HPV is a less invasive alternative to traditional Pap tests with a high rate of acceptability. The option to self-sample may increase participation in cervical screening based on improved privacy, comfort, and feelings of empowerment. Organizational, psychosocial, and physical recommendations for practice are shared to create a welcoming environment that reflects the diversity of populations in all aspects of healthcare. Affirmative care aims to make clients feel safe and accommodated by prioritizing dignity and respect as essential elements of eliminating cervical cancer in 2S LGBTQIA+ populations. Full article

Introduction: The sustained global epidemic of Human Immunodeficiency Virus (HIV) necessitates comprehensive, region-specific surveillance to inform public health policy. This 30-year retrospective observational cohort study delineated the epidemiological patterns, transmission dynamics, treatment efficacy, and long-term clinical outcomes of HIV infection in Oman to strategically align preventative and therapeutic programs with Oman’s Vision 2040 framework. Methods: We analyzed the clinical and epidemiological data of 429 confirmed HIV-positive patients with a minimum follow-up period of six months, registered at a secondary care facility in North Batinah, Oman, between January 1995 and December 2024. Predictors of mortality were rigorously assessed utilizing Kaplan–Meier survival analysis and Cox proportional hazards regression models. Continuous variables were evaluated using independent sample t-tests or Mann–Whitney U tests, while categorical variables employed chi-square or Fisher’s exact tests. Results: The cohort exhibited a male predominance (70.6%) with a mean age at diagnosis of 32.8 years (SD ± 12.17). Heterosexual contact constituted the predominant mode of acquisition (56%), followed by bisexual (17%) and homosexual (12%) contacts. Although 67.1% of patients presented with early, asymptomatic disease (WHO Stage 1), opportunistic infections were evident in 28.1% of the cohort, with recurrent sepsis (8.4%) and bacterial pneumonia (3.5%) being the most frequent complications. The WHO clinical stage at presentation was confirmed as a highly significant predictor of survival (p < 0.0001). Stage 1 patients achieved excellent long-term prognosis (approximately 75% survival beyond 30 years), markedly contrasting with Stage 4 patients, whose survival declined sharply (median survival of approximately 8 years, and only 10–15% surviving past 20 years). The tenofovir/emtricitabine/efavirenz regimen showed superior efficacy, achieving 75% survival at 30 years, relative to zidovudine-based regimens, which showed significantly poorer performance (15–20% survival at 20 years). Conclusions: This investigation substantiates the shift toward predominant heterosexual transmission and emphasizes the critical prognostic significance of the clinical stage at diagnosis. Optimal long-term survival mandates prompt diagnosis, timely initiation of contemporary antiretroviral therapies, and sustained viral suppression. These findings offer crucial evidence to strengthen HIV prevention and treatment programs within Oman. Full article

Plant seed number depends on ovule number initiated within the carpels, and it serves as a primary factor shaping fruit yield. Pomegranate trees exhibit bisexual flowers and functional male flowers. Pomegranate have anatropous ovules which are bitegmic and crassinucellate. Bisexual flowers possess the fertile pistil, while functional male flowers have abnormally developed ovules, a small ovary with few chambers, and a short style. The formation of functional male flowers is due to abnormal and stagnant development of ovule integument. Ovule number directly determines the yield of pomegranate seeds. Recent studies have highlighted the molecular mechanisms through which ovule-related genes regulate pomegranate ovule development. Pomegranate PgCRC and PgINO genes positively regulate the increase in the number of ovules, and PgBEL1 to synergistically regulate seed development. PgAGL11 (the SEEDSTICK orthologous gene) promotes ovule development in transgenic Arabidopsis. PgSEP protein can bridge interactions among PgBEL1, PgSTK and PgAG, which regulate ovule development. At the level of post-transcriptional regulation, PgmiRNA167, PgmiRNA164 and PgmiRNA160 are differentially expressed during pomegranate flower development, and PgmiR166a interacts with its target genes to affect ovule development. This review summarizes the key regulators of ovule development and their molecular pathways, integrating these interactions into a model that describes pomegranate ovule development. Full article

The psyllid genus Cacopsylla comprises mainly bisexually reproducing species; however, some members of this genus exhibit a unisexual mode of reproduction. Using an integrative approach that combines molecular and cytogenetic methods, as well as Wolbachia screening, we conducted a comprehensive study of the Palaearctic species C. ledi. We show that this species uses various reproductive strategies (bisexual and parthenogenetic) across its distribution range. Our findings indicate that the bisexual mode of reproduction has emerged at least twice in the evolutionary history of C. ledi. Bisexual populations in southern Fennoscandia are of ancestral origin, whereas the bisexual mode of reproduction observed in northern Fennoscandia represents a recent secondary transition from parthenogenesis. We report that in the first case, parthenogenetic and bisexual lineages can be easily distinguished not only cytogenetically but also by DNA barcoding, while in the second case, “bisexual” individuals share DNA barcodes with parthenogenetic ones. A comprehensive Wolbachia screening (1140 specimens across the entire distribution range) revealed Wolbachia infection in every specimen of C. ledi, indicating a significant role of the endosymbiont in the biology and evolution of this species. Full article

Background: Men who have sex with men (MSM) in Brazil remain disproportionately affected by HIV. Combination prevention strategies, including Pre-Exposure Prophylaxis (PrEP), are critical, yet adherence remains a challenge. This study aimed to identify factors associated with the simultaneous practice of condomless anal sex and non-use of PrEP among Brazilian MSM. Methods: A national cross-sectional study was conducted in 2020 via an online questionnaire disseminated on social media and dating apps. The outcome was defined as reporting condomless anal sex and no PrEP use in the previous year. Bivariate and multivariate logistic regression analyses were performed. Results: Among 1357 MSM participants, a high proportion (69.4%) reported condomless anal sex without PrEP use. Factors significantly associated with this behavior included being younger (18–28 years; AOR: 2.59), identifying as homosexual (AOR: 6.04), bisexual (AOR: 5.30), or pansexual (AOR: 8.67), having a steady partner (AOR: 4.57), engaging primarily in receptive or insertive anal sex, and having a prior STI diagnosis (AOR: 1.49). Conclusions: The confluence of condomless sex and PrEP non-use reveals a significant vulnerability profile among young MSM in Brazil, even within steady relationships. These findings highlight the originality of examining this combined behavioral outcome and underscore the urgent need for targeted, culturally sensitive prevention strategies that address risk perception and enhance PrEP uptake to meet the UNAIDS 2030 goals. Full article

Culter alburnus (topmouth culter, TC) is extensively distributed in various rivers and lakes in China. As a widely adaptive fish species, they have significant economic value and special ecological roles. Intergeneric hybridization is a pivotal strategy for generating novel hybrid lineages and species. In a previous study, we obtained an improved bisexual hybrid culter, BTBTF₁, derived from the hybrid lineage of Megalobrama amblycephala (blunt snout bream, BSB, 2n = 48, ♀) × Culter alburnus (2n = 48, ♂). In this study, we established an improved hybrid culter lineage by the self-crossing of BTBTF₁ and evaluated the biological characteristics regarding cytology, morphology, and genetics. DNA content and chromosome analyses confirmed that BTBTF₁-F₂ was a diploid lineage (2n = 48), with morphological traits exhibiting intermediate values between parental species, except for significantly TC-biased full-length-to-body length (FL/BL) and body length-to-head length (BL/HL) ratios (p < 0.05). ITS sequencing analysis revealed that BTBTF₁-F₂ inherited ITS1 sequences from BSB and TC. The global methylation level in BTBTF₁-F₂ was substantially reduced compared to progenitors, characterized by elevated full and diminished hemimethylation states. Transcriptomic analysis identified 7877 differentially expressed genes (DEGs), displaying 9.05%/8.30% maternal (BSB)-dominant and 17.01%/18.95% paternal (TC)-dominant expression patterns in BTBTF₁ and F₂. Remarkable intergenerational similarity in phenotypic and molecular profiles, coupled with bidirectional inheritance of progenitor characteristics, confirmed BTBTF₁-F₂ as a genetically stable allodiploid lineage. Remarkably, methylation patterns, and DEG expression collectively demonstrated significant TC-oriented bias (p < 0.05). This study reports a novel stabilized allodiploid culter lineage after a comprehensive assessment at cytology, morphology, and genetic levels, and provides new insights into genetic bias in hybrid progeny. Full article

The Artemia exhibit broad environmental adaptability and distinct reproductive modes, making them ideal for studying stress tolerance. Solar UV-B radiation poses a threat to aquatic organisms; however, for Artemia—a key aquatic organism characterized by a wide altitudinal distribution range and unique reproductive modes—it remains unclear how their UV-B resistance varies with altitudinal gradients, developmental stages, and reproductive modes. Here, we evaluated six Artemia species/lineages (three bisexual species, three parthenogenetic lineages) from 113 to 4700 m altitude across three developmental stages (embryo, nauplius, adult) under gradient UV-B doses. Key results: (1) UV-B resistance showed a dose-dependent positive correlation with altitude, especially under high-dose UV-B (6.4 kJ·m⁻², R² = 0.72, p < 0.01); (2) Adults had the highest resistance, while nauplii were the most vulnerable; (3) Bisexual species had 41–57% higher adult survival rates than parthenogenetic lineages at similar altitudes, but parthenogenetic lineages showed higher embryo relative hatching rates. These findings clarify the adaptive traits of Artemia in response to UV-B stress. Full article

A pair of connected flowers preserved in a mid-Cretaceous (early Cenomanian) Myanmar amber is described and named Antiquigemina pilosa Wang and Li gen. et sp. nov. Antiquigemina pilosa has bisexual flowers with a calyx of at least 3 sepals, a corolla of 5 petals, a whorl of at least 4 stamens and a tricarpellate pistil with a semi-inferior ovary. The differences in style divergence and calyx presence between paired flowers indicate different developmental stages. Considering that differentiated calyx and corolla and pentamery of corolla are features frequently observed in core eudicots, we propose treating Antiquigemina pilosa, which has a pentamerous perianth and differentiated sepals and petals, as an earlier representative of core eudicots. Antiquigemina pilosa provides first-hand evidence for the early diversification of core eudicots. Full article

In the United States, although the gaps in health insurance coverage by sexual orientation have been closing since the implementation of the Affordable Care Act and legalization of same-sex marriage, the LGB group (i.e., lesbian, gay, bisexual) continues to report healthcare utilization and access inequities such as more delayed or unmet care. The extant research has often examined healthcare utilization and access inequities due to affordability (e.g., out-of-pocket costs). However, healthcare utilization and access inequities are only partially explained by cost reasons; there are non-cost reasons that have not been adequately empirically examined. The present study innovatively includes discrimination structural variables to understand how social structure is associated with healthcare utilization and access inequities of LGB people. It focuses on two routine health services—regular check-ups and prescription medications—for LGB people who have chronic diseases. Additionally, sexual orientation may intersect with sex assigned at birth (sex, hereafter, i.e., male, female) to impact healthcare utilization and access inequities. The current study applies quantitative intersectional analysis to understand healthcare utilization and access inequities from a sexual orientation and sex intersectional lens and for easier and clearer interpretations of intersectional results and more actionable policy implications for inter-categorical groups. Using the 2023 National Health Interview Survey (weighted N = 136,231,053), we conducted quantitative intersectional analysis for logistic regression using complex survey data. First, we fit a series of logistic regression models with sexual orientation–sex interactions for routine healthcare utilization and access outcomes, adjusting for covariates. Second, we calculated average marginal predictions for inter-categorical groups by interacting sexual orientation and sex and other covariates. Third, we computed risk ratios of average marginal predictions for all the covariates. Lastly, we examined the interaction of inter-categorical groups/sexual orientation and structural variables. Our results show that experiencing a higher level of discrimination is positively associated with underutilization of regular check-ups and lower access to prescription medications, and this effect is stronger for LGB people. Further, LGB women are least likely to utilize regular check-ups and LGB men are least likely to access prescription medications among the inter-categorical groups. Highlighting structural issues of healthcare utilization and access offers new evidence on healthcare utilization and access inequities that can inform policies for raising awareness of and addressing structural issues. The intersectional analyses suggest that relevant policies target LGB women and LGB men. Full article

Sex workers were disproportionately affected by the COVID-19 pandemic due to precarious working conditions. This cross-sectional study was conducted in 2022 among 264 sex workers in Chiang Mai, Thailand, during the transition to the endemic phase, to evaluate their COVID-19 knowledge and preventive practices. Face-to-face interviews were used. Descriptive statistics were used to describe sample characteristics. Factors associated with knowledge and preventive practices were identified using the Mann–Whitney U test or Kruskal–Wallis test as appropriate. Independent factors associated with preventive practices were assessed through linear regression. The median scores for knowledge and preventive practices were 10 (interquartile range (IQR) = 9–10) and 5 (IQR = 3–5), respectively. In univariate analysis, females scored higher in knowledge than males. For preventive practices, females vs. males, older vs. younger, heterosexual vs. homosexual/bisexual, longer vs. shorter career, worked in massage parlors vs. pubs/bars, and having child vs. none showed higher rates. In multivariate analysis, being male (β = −1.87; 95%CI; −0.87 to −0.88) and single (β = −1.15; 95%CI; −2.28 to −0.02) were independent predictors of lower rates of preventive practices. Despite having good knowledge, certain groups of sex workers’ COVID-19 preventive behaviors remain inadequate, emphasizing the need for targeted interventions to enhance pandemic preparedness. Full article

Background/Objectives: Secondary syphilis typically presents with a non-pruritic maculopapular rash. However, vesicular and bullous manifestations are exceedingly rare in adults and may mimic autoimmune blistering diseases. The objective of this report is to describe atypical presentation of secondary syphilis with predominant vesiculobullous lesions and to emphasize the importance of including syphilis in the differential diagnosis of blistering skin diseases. Methods: We describe the case of a 46-year-old bisexual man with syphilis of unknown duration who presented with recurrent polymorphic skin eruptions, predominantly bullous and vesicular in nature. Clinical examination, serologic testing, and histopathologic evaluation were performed to establish the diagnosis. Results: Serologic tests confirmed active syphilis infection. A brief review of similar reported cases was conducted to highlight the clinical variability of vesiculobullous syphilis. Conclusions: Atypical vesiculobullous presentations of secondary syphilis pose significant diagnostic challenges and may be mistaken for autoimmune blistering disorders. Clinicians should maintain a high index of suspicion for syphilis in patients with polymorphic or blistering eruptions, particularly in those with risk factors for sexually transmitted infections. Awareness of these uncommon manifestations can facilitate timely diagnosis and appropriate treatment. Full article