The body matters: Understanding social differences in mental health

This doctoral dissertation illuminates the salience of body image to sociological investigations of mental health. It is argued that concerns over body-appearance evident in America embody a dimension of distress over the physical self that may be appropriately considered a mental health outcome, called body dysphoria. Using cross-sectional data on 1,183 young adults comprising Hispanic, African American, and non-Hispanic white males and females from varying social classes, a valid and reliable measure of body dysphoria is developed and demonstrated to be a distinct dimension of psychological distress. ^ From the standpoint of the sociology of mental health, the social distribution of body dysphoria makes known individual consequences of the stratified arrangements of society based on gender, race/ethnicity, and social class. Results reveal significant social differences in body dysphoria that are both consistent with and contrary to clinical studies attributing eating disorders to white, upper-class females. Body dysphoria is substantially greater among females supporting that unrealistic cultural ideals and standards of body-appearance remain disproportionately targeted at females in the development and presentation of self. Compared to non-Hispanic whites, Hispanics exhibit higher average levels of body dysphoria while African Americans exhibit lower levels of comparable proportion. The question is addressed whether identification with the dominant (white) culture influences distress over body-appearance among racial/ethnic minorities. A small inverse association is revealed between social class origin and body dysphoria suggesting that individuals from lower social class backgrounds are as greatly affected by body image concerns generally presumed to preoccupy upper social classes. ^ The stress process is a widely used theoretical paradigm for explaining structurally driven social differences in mental health outcomes. New evidence is introduced that the stress process may contribute to understanding body image problems. Regression analyses reveal that stress exposure has a significant positive association with body dysphoria that is mediated by varying psychosocial resources. Overall, the stress process explains the effects of social class origin and African American race/ethnicity on body dysphoria but does not account for the larger effects of being female or Hispanic. ^

Subdural electroencephalogram analysis for extracting discriminating measures in epileptogenic data

This dissertation introduces an integrated algorithm for a new application dedicated at discriminating between electrodes leading to a seizure onset and those that do not, using interictal subdural EEG data. The significance of this study is in determining among all of these channels, all containing interictal spikes, why some electrodes eventually lead to seizure while others do not. A first finding in the development process of the algorithm is that these interictal spikes had to be asynchronous and should be located in different regions of the brain, before any consequential interpretations of EEG behavioral patterns are possible. A singular merit of the proposed approach is that even when the EEG data is randomly selected (independent of the onset of seizure), we are able to classify those channels that lead to seizure from those that do not. It is also revealed that the region of ictal activity does not necessarily evolve from the tissue located at the channels that present interictal activity, as commonly believed.^ The study is also significant in terms of correlating clinical features of EEG with the patient's source of ictal activity, which is coming from a specific subset of channels that present interictal activity. The contributions of this dissertation emanate from (a) the choice made on the discriminating parameters used in the implementation, (b) the unique feature space that was used to optimize the delineation process of these two type of electrodes, (c) the development of back-propagation neural network that automated the decision making process, and (d) the establishment of mathematical functions that elicited the reasons for this delineation process. ^

Hand somatosensory sub-cortical sources arehypoactive in migraine interictally: a functionalsource separation analysis

Background: Recent morpho-functional evidences pointed out that abnormalities in the thalamus could play a major role in the expression of migraine neurophysiological and clinical correlates. Whether this phenomenon is primary or secondary to its functional disconnection from the brain stem remains to be determined.Aim: We used a Functional Source Separation algorithmof EEG signal to extract the activity of the different neuronal pools recruited at different latencies along the somatosensory pathway in interictal migraine without aura(MO) patients. Method: Twenty MO patients and 20 healthy volunteers(HV) underwent EEG recording. Four ad-hoc functional constraints, two sub-cortical (FS14 at brain stem andFS16 at thalamic level) and two cortical (FS20 radial andFS22 tangential parietal sources), were used to extract the activity of successive stages of somatosensory information processing in response to the separate left and right median nerve electric stimulation. A band-pass digital filter (450–750 Hz) was applied offline in order to extract high-frequency oscillatory (HFO) activity from the broadband EEG signal. Results: In both stimulated sides, significant reduced subcortical brain stem (FS14) and thalamic (FS16) HFO activations characterized MO patients when compared with HV. No difference emerged in the two cortical HFO activations between two groups. Conclusion: Present results are the first neurophysiological evidence supporting the hypothesis that a functional disconnection of the thalamus from the subcortical monoaminergicsystem may underline the interictal cortical abnormal information processing in migraine. Further studiesare needed to investigate the precise directional connectivity across the entire primary subcortical and cortical somatosensory pathway in interictal MO.

Paternalism and Competent Patient Choice in the Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People

In 2016 physicians in Ontario will be granted the authority to refer patients with gender dysphoria for sex reassignment surgery. In order to be granted this authority physicians must be trained in the World Professional Association for Transgender Health’s Standards of Care, which outlines healthcare procedures for the treatment of gender dysphoria and provides background information concerning transgender health. The Standards of Care require that patients undergo a process of 12 months of continuous living in a gender role that is congruent with their gender identity prior to being given access to sex reassignment surgery. While this requirement can sometimes be helpful it can also cause more harm than benefit. This paper argues that the requirement is strongly paternalistic in its current form and should no longer be mandatory in most cases.

Health-related quality of life and determinant factors in celiac disease: a population-based analysis of adult patients in Spain

Background: Celiac disease (CD) has a negative impact on the health-related quality of life (HRQL) of affected patients. Although HRQL and its determinants have been examined in Spanish CD patients specifically recruited in hospital settings, these aspects of CD have not been assessed among the general Spanish population. Methods: An observational, cross-sectional study of a non-randomized, representative sample of adult celiac patients throughout all of Spain's Autonomous Regions. Subjects were recruited through celiac patient associations. A Spanish version of the self-administered Celiac Disease-Quality of Life (CD-QOL) questionnaire was used. Determinant factors of HRQL were assessed with the aid of multivariate analysis to control for confounding factors. Results: We analyzed the responses provided by 1,230 patients, 1,092 (89.2%) of whom were women. The overall mean value for the CD-QOL index was 56.3 ± 18.27 points. The dimension that obtained the most points was dysphoria, with 81.3 ± 19.56 points, followed by limitations with 52.3 ± 23.43 points; health problems, with 51.6 ± 26.08 points, and inadequate treatment, with 36.1 ± 21.18 points. Patient age and sex, along with time to diagnosis, and length of time on a gluten-free diet were all independent determinant factors of certain dimensions of HRQL: women aged 31 to 40 expressed poorer HRQL while time to diagnosis and length of time on a gluten-free diet were determinant factors for better HRQL scores. Conclusions: The HRQL level of adult Spanish celiac subjects is moderate, improving with the length of time patients remain on a gluten-free diet.

Depresión en pacientes con epilepsia: Revisión sistemática de la literatura

Esta revisión sistemática de la literatura tuvo como objetivo investigar sobre la depresión en personas con epilepsia en la última década (2005-2015), enfocándose en identificar en el paciente con epilepsia: características sociodemográficas, prevalencia de la depresión, tipos de intervención para el manejo de la depresión, factores asociados con la aparición y el mantenimiento de la depresión y por último, identificar las tendencias en investigación en el estudio de la depresión en pacientes con epilepsia. Se revisaron 103 artículos publicados entre 2005 y 2015 en bases de datos especializadas. Los resultados revelaron que la prevalencia de depresión en pacientes con epilepsia es diversa y oscila en un rango amplio entre 3 y 70 %, por otro lado, que las principales características sociodemográficas asociadas a la depresión está el ser mujer, tener un estado civil soltero y tener una edad comprendida entre los 25 y los 45 años. A esto se añade, que los tratamientos conformados por terapia psicológica y fármacos, son la mejor opción para garantizar la eficacia en los resultados del manejo de la depresión en los pacientes con epilepsia. Con respecto a los factores asociados a la aparición de la depresión en pacientes con epilepsia, se identificaron causas tanto neurobiológicas como psicosociales, asimismo los factores principales asociados al mantenimiento fueron una percepción de baja calidad de vida y una baja auto-eficacia. Y finalmente los tipos de investigación más comunes son de tipo aplicado, de carácter descriptivo, transversales y de medición cuantitativa.

¡Porque ni putas, ni peluqueras, ni nada… somos ciudadanas!’: Reflexiones sobre ciudadanía desde un grupo trans en la ciudad de Bogotá

‘¡Porque ni putas, ni peluqueras, ni nada… somos ciudadanas!’. Se pregunta por cómo se puede entender la ciudadanía desde las acciones comunitarias que llevaron a cabo un grupo de mujeres trans en la ciudad de Bogotá . Según informes nacionales y a nivel Latinoamérica son las mujeres trans pertenecientes al sector LGBT las que dijeron sentir, en mayor número, vulnerados sus derechos entorno a trabajo, salud y educación en la capital del país en comparación a la población LGB. La causa de tal vulneración pareció coincidir con su identidad de género, por ejemplo, al no poder encontrar trabajo por las expresiones de género que utilizaban. Por ende era necesario abordar cómo se entiende la ciudadanía desde corporalidades que no han tenido un óptimo acceso a la ciudad teniendo como referencia sus experiencias personales. Siendo el tránsito un proceso que se hace a lo largo del tiempo.