Citations

ABSTRACT Background Experiencing weight stigmatization is linked to maladaptive eating, poorer mental health, and increased risk of weight gain, potentially impacting metabolic bariatric surgery (MBS) outcomes. This meta‐analysis aimed to synthesize patient experiences of weight stigmatization before and after MBS and to examine the association of presurgical weight stigma on postsurgical weight loss. Methods This preregistered study followed PRISMA guidelines. Six databases were searched through March 2025; eligible studies included published articles and dissertations/theses available in English that quantitatively measured presurgical weight stigma among MBS samples and included relevant outcomes. Meta‐analyses utilized random effects models with change scores converted to Hedge's g and associations between presurgical experienced weight stigma and post‐MBS weight change converted to coefficient r . Results Forty‐one studies were included, with 36 reporting on experienced weight stigma change pre‐ to post‐MBS and 10 studies reporting on the relationship between pre‐MBS experienced weight stigma and post‐MBS weight loss. Conclusions Results revealed weight stigmatization decreased substantially after MBS (6–12 months, g = 1.28; 13–24 months, g = 1.16; 25–36 months, g = 1.26). Presurgical weight stigma was not associated with weight loss post‐surgery ( r = 0.05). Findings are limited by minimal studies reporting on longer term relationships between baseline stigma, post‐MBS weight loss, and additional health outcomes.

Background: Despite recent advances in cleft care, Vietnam continues to have extensive involvement from international nongovernmental organizations (NGOs), creating a fragmented system with limited coordination. This project seeks to establish a baseline understanding of Vietnam’s cleft care landscape, including major international NGOs and their collaborations with local partners, costs and insurance coverage, and patterns applicable to other low- and middle-income countries with NGO-supported cleft care. Methods: We conducted a mixed-methods study using literature review and semi-structured interviews with surgeons, hospital administrators, and NGO representatives (n = 7). Sources included PubMed, targeted Google searches, and government regulations on NGO involvement, cleft care costs, and insurance policies. Results: Vietnam partners with 17 international NGOs that operate through 3 distinct but complementary models: vertical, horizontal, and diagonal models. These collaborations offer financial support, infrastructure, technology investment, and research development, leading to higher surgical volume, more timely access to care, and implementation of standardized multidisciplinary cleft services in Vietnam. National insurance provides broad coverage but requires a complex referral process with limited benefits for secondary cleft services. Limited awareness of insurance benefits and mistrust of local care further discourage the use of national health insurance. Conclusions: Improving access to comprehensive cleft services in Vietnam requires streamlining insurance referral pathways and decentralizing advanced cleft services to regional centers to ensure continuity of care. Aligning NGO activities with national policies is essential to building a coordinated and sustainable cleft care system in Vietnam and in other low- and middle-income countries with strong insurance frameworks and significant NGO involvement.

Abstract Mild traumatic brain injury (mTBI) commonly induces transient acute (APTH) or persistent (PPTH) post-traumatic headache (PTH) that often resembles migraine. As orexin B sensitizes male but not female murine, nonhuman primate, and human dorsal root ganglion neurons and supradural orexin B/orexin receptor 2 (OX2R) signaling elicits migraine-like pain in naïve male, but not female, mice we explored possible sexually dimorphic contributions of orexin B/OX2R to PTH. In mice of both sexes, mTBI-induced transient cephalic allodynia, a surrogate measure of APTH. After APTH resolution, allodynia was reinstated by exposure to normally innocuous stress or by inhalational delivery of a subthreshold concentration of umbellulone, a TRPA1 agonist, suggesting the expression of PPTH. In contrast to these nonselective stimuli, subthreshold supradural orexin B induced PPTH only in male mTBI mice. Intranasal delivery of a CRISPR/Cas9 plasmid to edit trigeminal OX2R expression prevented APTH and development of PPTH selectively in male mTBI mice. Daily oral suvorexant, a dual orexin receptor antagonist (DORA), beginning immediately after mTBI, prevented APTH as well as PPTH. Critically, starting suvorexant treatment after resolution of APTH also prevented stress- or umbellulone-induced PPTH. EEG/EMG-defined sleep architecture or immobility-defined sleep was not disrupted in this mTBI model suggesting that suvorexant benefits are unlikely related to sleep modulation. Our findings reveal a male-specific mechanism of PTH maintained by orexin B/OX2R signaling and suggest that approved DORAs may be beneficial in treating APTH and preventing transition to PPTH in men. Importantly, DORAs may also be effective in men with established PPTH.

Abstract Purpose This study evaluates associations with suicidal ideation (SI) of impact of work on personal relationships (IWPR), self-valuation (SV), and imposter phenomenon and compares the SI point prevalence in physicians vs other workers. Method This study used American Medical Association Physician Professional Data to sample US physicians across different specialties between November 2020-March 2021. Of 7360 survey respondents, 6497 (88.3%) completed the SI question. A probability-based sample included 2508 nonphysician individuals from the US population employed at the time of survey administration, with 2501 workers (99.7%) completing the SI item. Logistic regression was used to evaluate the associations of occupational distress factors, including IWPR, SV, imposter phenomenon, and other factors, with SI before and after adjusting for depression and compare the risk of SI among physicians with other US workers. Results The study included 6497 physicians and 2501 workers in other fields. Adjusting for sex, age, relationship status, parenting status, and depression, each 1-point higher IWPR score (range, 0-10) was associated with 10% increased SI odds (odds ratio [OR], 1.10; 95% confidence interval [CI], 1.05-1.15). Adjusting for the same variables, each 1-point higher SV score (range, 0-10) was associated with 10% lower SI odds (OR, 0.90; 95% CI, 0.85-0.95). The association between imposter phenomenon scores (range, 4-20) and SI was not statistically significant (OR, 1.03; 95% CI, 0.99-1.08). The unadjusted 1-year SI point prevalence was 6.6% (95% CI, 6.0%-7.4%) in physicians vs 5.6% (95% CI, 4.7%-6.6%) among workers in other fields (P = .09). In a multivariable model, workers in other fields with a bachelor’s or master’s degree had lower SI odds compared with physicians (OR, 0.64; 95% CI, 0.46-0.87). Conclusions IWPR and low SV are associated with SI among physicians, independent of depression. Development and evaluation of interventions designed to mitigate these factors in physicians may be warranted.

Transgender and gender-diverse (TGD) people comprise approximately 0.9% of adults in the United States; among them, 18% to 50% of TGD adults surveyed report being parents. Younger generations of Americans are more likely to identify as TGD, and also more likely to desire children than previous generations of TGD individuals surveyed. Despite this, TGD parents are often underrepresented in literature on parenting experiences of lesbian, gay, bisexual, transgender, and queer (LGBTQ+) parents. TGD parents experience significant mental health, physical health, and socioeconomic disparities due to gender minority stressors, and numerous barriers to reproductive care and affirming mental health care. This article presents an overview of the current literature on TGD parents, psychosocial outcomes for children of TGD parents, common clinical issues that may arise in treatment, and strategies for supporting TGD families to build resilience.