Acute Alcohol Co‐Ingestion and Hospital‐Treated Deliberate Self‐Poisoning: Is There an Effect on Subsequent Self‐Harm?

The aim of this study was to determine the relationship between alcohol co‐ingestion in an index deliberate self‐poisoning (DSP) episode with repeated DSP and subsequent suicide. A retrospective cohort study was conducted involving 5,669 consecutive index presentations to a toxicology service following DSP between January 1, 1996, and October 31, 2010. Records were probabilistically matched to National Coronial Information System data to identify subsequent suicide. Index DSPs were categorized on co‐ingestion of alcohol, and primary outcomes analyzed were repetition of any DSP, rates of repeated DSP, time to first repeat DSP, and subsequent suicide. Co‐ingestion of alcohol occurred in 35.9% of index admissions. There was no difference between those who co‐ingested alcohol (ALC+) and those who did not co‐ingest alcohol (ALC?) in terms of proportion of repeat DSP, number of DSP events, or time to first repeat DSP event. Forty‐one (1.0%) cases were probabilistically matched to a suicide death; there was no difference in the proportion of suicide between ALC+ and ALC? at 1 or 3 years. There was no significant relationship between the co‐ingestion of alcohol in an index DSP and subsequent repeated DSP or suicide. Clinically, this highlights the importance of mental health assessment of patients that present after DSP, irrespective of alcohol co‐ingestion at the time of event.     

Comparing implicit and explicit attitudes of gay,straight, and non-monosexual groups toward transmen and transwomen

Background: Transphobia studies have typically relied on self-report measures from heterosexual samples. However, there is evidence suggesting the need to use indirect measures and to explore transphobia among other populations. Aims: This study examined how explicit and implicit attitudes toward transwomen and transmen differ between people of different sexual orientations. Methods: Cisgender participants (N = 265) completed measures of explicit feelings toward transmen and transwomen, as well as Implicit Association Tests (IAT) for each group. Comparisons were made between 54 gay, 79 straight, and 132 non-monosexual (asexual, bisexual, pansexual) individuals. Results: An interaction was found between measurement type (explicit, implicit) and sexual orientation (straight, gay, non-monosexual). With regard to transmen, gay respondents’ explicit and implicit scores diverged such that they explicitly reported lower bias than their straight counterparts, but their Transmen-IAT showed an implicit preference for biological men over transmen. For attitudes toward transwomen, implicit measurement scores were consistently negative and did not differ by group. Gay participants also reported positive explicit attitudes toward transwomen, similar to non-monosexual people. Discussion: Overall, findings show that gay people tend to report positive attitudes toward transgender people explicitly, but tend to have implicit bias against both transmen and transwomen. Future studies need to explore the origins of these biases and how they relate to the complex interplay of sex, gender, and sexual orientation.     

How to be a Normativist about the Nature of Belief

According to the normativist, it is built into the nature of belief itself that beliefs are subject to a certain set of norms. I argue here that only a normativist account can explain certain non‐normative facts about what it takes to have the capacity for belief. But this way of defending normativism places an explanatory burden on any normativist account that an account on which a truth norm is explanatorily fundamental simply cannot discharge. I develop an alternative account that can achieve explanatory adequacy where this sort of truth privileging account falls short.     

HPA-Axis Activation as a Key Moderator of Childhood Trauma Exposure and Adolescent Mental Health

Individual differences in a child’s sensitivity to stress may influence whether youth exposed to trauma develop symptoms of psychopathology. We examined the interaction between HPA-axis reactivity to an acute stressor and exposure to different types of childhood trauma as predictors of mental health symptoms in a sample of youth. Youth (n?=?121, ages 9–16; 47% female) completed a standardized stress task, including 5 post-stress salivary cortisol samples. Parents also completed the Child Behavior Checklist as a measure of child internalizing and externalizing symptoms in the past month, and completed the Early Trauma Inventory (ETI) as a measure of their child’s trauma exposure. More emotional abuse and non-intentional trauma were associated with greater internalizing symptoms. Youth exposed to physical abuse who demonstrated slower HPA-axis reactivity had elevated internalizing and externalizing symptoms. Youth exposed to emotional abuse or non-intentional traumatic events who demonstrated faster HPA-axis reactivity had elevated internalizing and externalizing symptoms. Profiles of exaggerated or attenuated HPA-axis reactivity to acute stress may be risk factors for psychopathology in children facing different stressful social environments.     

Implementing a Virtual Health Telemedicine Program in a Community Setting

Aurora Health Care in eastern Wisconsin has a clinical genetics program driven by genetic counselors in the cancer/adult and prenatal genetics settings. In 2015, the workforce shortage of genetic counselors left us with 4 open positions for genetic counselors that we were unable to fill. We explored many models of alternative service delivery, and determined virtual health (VH) via telemedicine to be the best option for our system. Historically, telemedicine technologies have been used to provide access to healthcare services to patients in remote areas. We, however, were struggling to find genetics counselors to staff both our remote clinics and urban clinics. To solve this problem, we recruited genetic counselors from across the country to work remotely from their current home or home office utilizing VH to staff our clinics. We then created clinical workflows and an implementation process of virtual health for 9 prenatal and cancer clinics across the eastern Wisconsin footprint of our healthcare system over the course of 12 months. Here we provide our experience and process in establishing a VH program in order to help other institutions that have been affected by the workforce shortage of clinical genetics professionals.