This study examined whether frailty mediates the relationship between sexual and gender minority (SGM) status and three types of outpatient healthcare utilization among adults aged 50 and older in the All of Us Research Program (2017-2022). We estimated controlled direct effects of SGM status across generalist, specialist, and mental health visits. Healthcare utilization and SGM status were self-reported, and frailty was measured using a survey-based deficit accumulation index. Both SGM status and frailty were independently associated with increased rates of all outpatient visit types. Regarding mediation, our results suggest that if all participants were robust, SGM adults would still have higher healthcare utilization compared to cisgender heterosexual older adults. This indicates that factors beyond frailty influence patterns of healthcare use in this population and highlights the importance of identifying additional determinants to ensure that older SGM adults receive appropriate and responsive care.
Publications by Year: 2026
2026
OBJECTIVES: Ethnic and racial discrimination stress is a key social determinant of sleep health, yet its day-to-day influence on Mexican-origin adolescents remains underexplored. This study focused on Mexican-origin adolescents and examined the negative effects of daily ethnic and racial discrimination stress on sleep.
METHOD: The analytic sample included 256 Mexican-origin adolescents (48.8% female, 49.7% male, 1.56% non-binary; mean age = 13.50; SD = 1.11; range = 12-16 years old) residing in a suburban area in the United States Midwest. Using multi-level models that disentangle between- and within-person effects, this study assessed daily ethnic and racial discrimination stress and self-reported same-night sleep using a 21-day daily report method. Daily sleep indicators included nighttime duration, onset latency, and quality.
RESULTS: On days when adolescents reported higher levels of discrimination stress, they also reported longer sleep onset latency. At the between-person level, youth who reported higher levels of discrimination stress reported poorer sleep quality. Possible reciprocal dynamics between stress and sleep were tested. Results showed that at the within-person level, sleep behaviors were not associated with next-day racial discrimination. At the between-person level, adolescents who reported higher sleep quality or longer sleep duration the prior night also reported lower levels of next-day discrimination, suggesting that sleep disturbances may be associated with stress experiences.
CONCLUSION: This study highlights the importance of targeted support for Mexican-origin adolescents' sleep health especially on days when they experience ethnic and racial discrimination.
The paraventricular hypothalamus (PVH) controls behavioral and physiologic processes, including appetite, social behavior, autonomic outflow, and pituitary hormone secretion. However, molecular markers for centrally projecting PVH neuron populations remain largely undefined, and a complete census of PVH cell types has not been established. Therefore, we performed extensive single-cell/nucleus RNA sequencing to catalog PVH neuron subtypes and multiplexed error-robust fluorescence in situ hybridization (MERFISH) to map them spatially. Our spatial transcriptomic atlas resolves 26 Sim1+ and 29 GABAergic neuron populations from the PVH and surrounding areas. Additionally, projection-based profiling identified neurons that project to the parabrachial region (PB) and spinal cord, helping to determine PVH populations that regulate satiety and sympathetic nervous system activity, respectively. Notably, activation of PB-projecting PVH neurons expressing Brs3 reduces food intake, and silencing them causes obesity. Together, this atlas contributes high-resolution PVH spatial and circuit-based gene expression profiles, representing a valuable resource for the field of homeostasis.
BACKGROUND: Lower grade gliomas (LGGs) typically affect younger adults and are associated with long-term survival. Treatment-related toxicities, especially neurocognitive and neuroendocrine effects, are a concern. Proton therapy may reduce these risks by minimizing radiation exposure to healthy brain tissue. This study evaluates the safety and efficacy of proton therapy in LGG patients, focusing on neurocognitive, neuroendocrine, and quality-of-life (QOL) outcomes.
METHODS: This single-institution, prospective phase 2 trial enrolled 60 patients with WHO grade 1-2 gliomas or IDH-mutant grade 3 gliomas. Proton therapy was delivered at 54 Gy(RBE) or 59.4 Gy(RBE) by tumor grade. The primary endpoint was progression-free survival (PFS); secondary endpoints included overall survival (OS), neurocognitive and neuroendocrine function, and QOL. Neurocognitive testing occurred at baseline and biennially. QOL was assessed using the FACT-Brain questionnaire. Toxicities were graded per CTCAE v4.0.
RESULTS: With a median follow-up of 7.0 years, 5-year PFS and OS were 79.1% and 85.6%, respectively. PFS was highest in IDH-mutant, 1p/19q co-deleted gliomas (100%) and lowest in IDH-wildtype tumors (62.5%). New neurocognitive deficits occurred in 26% of patients at 5 years. Neuroendocrine dysfunction occurred in 5.3%, with only one case attributed to radiation. QOL declined transiently at 6 months, with 15% showing clinically meaningful decline at 5 years. No late grade 3 toxicities were observed; one case of grade 4 radionecrosis occurred.
CONCLUSIONS: Proton therapy for LGG can offer effective disease control with modest long-term toxicity. These findings support its use as a standard radiation modality and highlight the need for comparative trials with photon therapy.
BACKGROUND: Delirium is a common complication of hospitalization with poor outcomes, but its underlying pathophysiology is poorly understood. We investigated the association of preoperative glial fibrillary acidic protein (GFAP), a biomarker of reactive astrocytosis, with delirium incidence and severity.
METHODS: Data were obtained from the ongoing prospective successful aging after elective surgery (SAGES) study. GFAP was measured in preoperative plasma (n = 529). Postoperative delirium incidence and severity were measured using the confusion assessment method (CAM) and CAM-S (0-19, 19 worst), respectively. A multivariable generalized linear model (GLM) with log link and binary or Poisson error distribution was used to estimate the relative risk of delirium by GFAP quartile scale, and GLM with identity link was used to examine the association of preoperative GFAP and delirium severity.
RESULTS: Overall mean preoperative GFAP value was 289.6 ± 153.3 pg/mL; mean value by quartile (Q) was 148.1 ± 28.6 pg/mL for Q1, 220.5 ± 19.8 pg/mL for Q2, 298.2 ± 28.4 pg/mL for Q3, and 503.4 ± 128.3 pg/mL for Q4. Delirium incidence by GFAP level was 16% in Q1, 24% in Q2, 25% in Q3, and 28% in Q4 (Cochran trend test P-value = 0.031; adjusted P-value = 0.205). Higher GFAP levels (fourth vs. first quartile) were associated with greater risk of incident delirium (adjusted relative risk 1.70, 95% confidence interval [CI]: 1.01-2.86) and greater delirium severity (adjusted mean difference 0.86, 95% CI: 0.004-1.71).
CONCLUSIONS: High preoperative plasma GFAP was associated with increased delirium incidence and severity, suggesting GFAP may serve as a risk marker for delirium. Brain vulnerability in the setting of astrocytosis may contribute to delirium pathophysiology.