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Liquidity Facilities Provided to Banks during the Dominican Republic Financial Crisis of 2003
Full text linkAs part of an agreement with the International Monetary Fund (IMF), the Central Bank of the Dominican Republic (CBDR) released a comprehensive document providing an overview of the origins and handling of the 2003 financial crisis. This Archive Note builds on the highlights of that document by discussing primary factors that led to problems within Banco Intercontinental (Baninter), the bank that triggered the crisis; detailing measures the CBDR implemented to mitigate the situation; and addressing the consequences for two other major banks, Banco Mercantil and Bancrédito
Germany: IKB Deutsche Industriebank Emergency Liquidity Program, 2008
Full text linkIn the summer of 2007, IKB Deutsche Industriebank (IKB) faced heavy losses owing to the liquidity support it had provided on commercial paper issued by Rhineland Funding Capital Corporation, its off-balance-sheet vehicle, which held distressed collateralized debt obligations backed by US subprime mortgages. In July 2007, authorities became aware that IKB itself had lost access to liquidity from Deutsche Bank and other funding partners. Publicly owned development bank Kreditanstalt für Wiederaufbau (KfW) held a 38% stake in IKB, exposing it to potentially heavy losses in the event of an IKB failure. KfW, German financial authorities, and German banks pursued a series of intervention measures in 2007 and early 2008, including asset guarantees and capital injections. While implementing intervention measures and negotiating a sale of its stake, KfW provided two liquidity facilities, one in January 2008 and the other in July 2008, allowing IKB to access up to EUR 3 billion of liquidity. Two large American banks and two regional German banks also provided liquidity facilities. KfW ultimately sold its stake in IKB to American private equity firm Lone Star at a significant loss on October 29, 2008. KfW had permitted its liquidity facilities to last until March 2011, but IKB terminated its use of the facilities early in 2010
Disclosure under Regulation 30 of the Securities and Exchange Board of India (Listing Obligations and Disclosure Requirements) Regulations, 2015, as Amended
Full text linkContraceptive Counseling For Transgender & Gender Diverse Patients: Provider Knowledge & Experience
Full text linkMany transgender and gender diverse (TGD) individuals have contraceptive needs. Contraceptive counseling in this population is often nuanced due to the diverse experiences and healthcare goals of TGD individuals. Testosterone therapy is an important component of gender affirming care for some transgender and gender diverse (TGD) individuals. A common misconception among patients and providers is the role of testosterone in pregnancy prevention. Testosterone is not an effective form of contraception due to its inconsistent suppression of ovulation. Previous studies have shown that some patients who use testosterone for contraception do so based on guidance from their healthcare provider. Therefore, this study aimed to evaluate providers’ education, knowledge, experience, and perception regarding contraceptive counseling for TGD patients. By gaining a deeper understanding of providers\u27 current practices and knowledge gaps, this study aims to identify strategies to improve counseling and ensure more accurate contraceptive guidance for TGD patients.The study was granted an exemption from Yale University’s Institutional Review Board. Licensed US healthcare providers with experience providing contraceptive counseling were eligible to complete the study survey. The survey collected provider demographic information, their prior education on providing care for TGD patients, and information about their clinical practice. We assessed (1) contraception-related knowledge, (2) provider confidence providing contraceptive counseling to TGD patients, (3) perceptions of barriers that limited effective contraceptive counseling for TGD patients, and (4) practice behaviors regarding counseling of reproductive health topics. Surveys were collected anonymously through Qualtrics. Participants were recruited through professional networks and email distribution across multiple academic institutions. Forty-seven complete survey responses were collected from providers nationwide. Most respondents were physicians (91.5%) with the majority practicing in the Northeast (37%) and Midwest (39.1%). Diverse gender identity and sexual orientation were represented among respondents, with 32.6% identifying as a sexual or gender minority. Most practiced at academic institutions with resident trainees (76.6%). Respondents varied in the number of TGD patients seen per month, with 59.6% reporting fewer than five, 23.4% seeing five to ten, and 17% seeing more than ten TGD patients per month. Our respondents had a median of 2.5% (IQR 1-8.86%) TGD patients in their practice. Providers who care for significantly higher proportions of TGD patients were more likely to work in non-academic settings (p=0.011), identify as a sexual or gender minority (p\u3c0.001), have received over 11 hours of formal TGD health education (p=0.049), and work in practices with formal staff training on TGD care (p=0.015). Nearly 30% of respondents had no TGD health education during their medical training. However, 46.8% reported 1-5 hours of formal education on TGD health during training. Providers practicing less than 10 years reported statistically more TGD health education during training than more experienced providers (p\u3c0.002). Most respondents (91.5%) had additional TGD health education since completing their medical education, most frequently from colleagues (80.9%), medical journals or publications (72.3%), professional meetings or conferences (66%), and TGD patients (63.8%). Overall contraceptive-related knowledge was high– with respondents averaging 5.89 (SD=0.983) correct responses to the 7 knowledge-assessment questions. Providers who saw five or more TGD patients per month had significantly higher cumulative knowledge scores (mean=6.47, SD=0.772) than providers with fewer TGD patients (mean=5.5, SD=0.923); p\u3c0.001. There was no significant difference in cumulative knowledge score by provider education, years in practice, practice environment, or identity. Despite respondents’ high knowledge scores, 27.6% lacked confidence in their ability to counsel TGD patients on their contraceptive options and 34% lacked confidence in their ability educate patients on testosterone’s impact on reproductive potential. Significantly higher confidence was associated with providers who saw five or more TGD patients each month (p\u3c0.001), identified as a sexual or gender minority (p=0.033), or used diverse educational resources to learn more about TGD healthcare (p\u3c0.001). Providers most frequently reported TGD patients not seeking gynecologic care as a barrier to providing contraceptive counseling (72.4%). Compared to their cisgender patients, 14.9% of providers were less likely to discuss fertility desires and family planning goals and 6.4% were less likely to discuss contraceptive options with TGD patients. Our national survey results suggest a shift in medical training to include more TGD health education, however significant gaps still exist. Our study found that providers who care for a higher number of TGD patients had significantly greater knowledge scores and confidence in counseling. Therefore, increasing exposure to TGD patients during clinical training is key to preparing the next generation of providers to deliver informed and inclusive care. Additionally, our study highlighted significant barriers to contraceptive counseling for TGD patients, including a lack of provider confidence, disparities in provider practices, and the common belief that TGD patients are reluctant to seek gynecologic care. Therefore, practices should develop a gender inclusive environment with appropriate materials and staff training to improve TGD patients’ comfort in seeking care and increase opportunities to provide contraceptive counseling
Men Take Care Of Each Other”: Evaluation Of A Community-Based Model For Pre-Exposure Prophylaxis Services Among Male Bar Patrons In Rural South Africa
Full text linkLow engagement with HIV services persists among young men with harmful alcohol use in South Africa. We previously piloted a rural community-based HIV service delivery model to engage this key population. In the initial study, male nurses visited alcohol-serving venues to provide HIV testing and pre-exposure prophylaxis (PrEP) services. From November 1 to December 30, 2021, we conducted interviews with 17 of 34 male pilot participants to evaluate program barriers, facilitators, and suggestions. All Interviewees were satisfied with HIV testing and PrEP services. Participants overcame testing avoidance through peer influence and enhanced privacy. Barriers for PrEP initiation were stigma (PrEP mistaken for HIV treatment) and complacency towards HIV, while facilitators included desire to mitigate alcohol-associated risks, social support, and comfort with male community nurses. Most participants self-reported good adherence due to daily routines, nurse follow-ups, and social support, with lapses due to travel and alcohol use. Post-pilot, only three participants transferred to clinics to continue PrEP due to inconvenient access, unwelcoming environment, and stigma of clinic attendance. All participants wanted to restart community-based PrEP due to convenience, preference for male nurses, and avoidance of stigma. A few participants reported privacy concerns regarding peer-pressure to disclose test results and pills or home visits being mistaken for HIV treatment. Future suggestions included school/church visits, unmarked vehicles, nurse assistance with facilitated PrEP disclosure, patient ambassadors, and injectable PrEP. Community-based PrEP services using male nurses at alcohol-serving venues can reach men who otherwise would not engage in HIV services
Exposure To Parental Depression And Mental Health In Adulthood: The Importance Of Timing
No full textChildren exposed to maternal symptoms of depression and anxiety are at increased risk of socioemotional and behavioral problems in childhood. However, few studies have examined how the developmental timing of exposure to maternal and paternal depression from pregnancy onwards influences objective measures of mental health in adulthood. This study sought to examine how the timing of parental depression from pregnancy to early adulthood affects risk for offspring mental illness.
In this prospective cohort study using data from the Avon Longitudinal Study of Parents and Children (ALSPAC), a British birth cohort, we utilized distributed lag models (DLM) to calculate the cumulative effect of parental depressive symptoms across time on multiple mental health outcomes, adjusted for confounders related to parental socioeconomic status and antenatal characteristics. Using DLM, we also generated a time-response curve to visualize changes in the weight of association between each longitudinal measure of parental depressive symptoms from pregnancy to young adulthood and offspring self-reported symptoms of mental illness in adulthood. We then applied the related distributed lag interaction model (DLIM) to test if offspring sex modifies the relationship between parental depression and offspring mental health outcomes. Parental depressive symptoms were assessed 10-12 times from pregnancy to 21 years using the Edinburgh Postnatal Depression Scale (EPDS). Outcomes included symptoms related to depression at 27, anxiety at 25, psychotic disorders at 24, and alcohol use disorder (AUD) at 22. Participants with mental health outcomes and parental depressive symptoms measured at least once over time were included. As a supplemental analysis, we analyzed the effects of parental anxiety symptoms, as assessed using the Crown-Crisp Experiential Index (CCEI) anxiety subscale from pregnancy to 6 years of age (representing all available measures), on the same four mental health outcomes.
Between 3,342 and 3,795 participants (2086-2506 [62.4%-66.0%] female) were included. Adults exposed to a one point increase in EPDS scores across development were more likely to experience clinically concerning symptoms of depression (maternal: adjusted odds ratio [aOR] , 2·598; 95% CI, 2·101-3·191; P \u3c 0·001; paternal: aOR, 2·292; 95% CI, 1·722 -3·052; P \u3c 0·001), anxiety (maternal: aOR, 2·821; 95% CI, 2·262-3·517; P \u3c 0·001; paternal: aOR, 2·170; 95% CI, 1·627-2·894; P \u3c 0·001), and psychosis (maternal: aOR, 2·040; 95% CI, 1·377-3·022; P \u3c 0·001; paternal: aOR, 1·766; 95% CI, 1·034-3·018; P = 0·037). Parental depressive symptoms were not associated with problematic alcohol use. We found no evidence that offspring sex modifies the effects of parental depressive symptoms on any of the outcomes studied. Parental depressive symptoms were associated with adult symptoms of depression and anxiety for most time points. However, maternal effects emerged during pregnancy, whereas paternal effects were first detected in early childhood. Only maternal depressive symptoms during pregnancy were significantly associated with psychotic experiences.
In this study, we found that both timing and chronicity of parental depression influenced offspring adult mental health in a large, longitudinal birth cohort. The presence of maternal effects only in pregnancy is consistent with the ‘fetal origins’ hypothesis. Interventions that reduce cumulative exposure to parental depression may improve the mental health of the next generation
Maternal Prenatal Anxiety And Child Epigenetic Aging: A Longitudinal Analysis From Childhood To Mid-Adolescence
Full text linkThe developmental origins of health and disease posits that in utero exposures and early life experiences increases susceptibility to a host of pathologies. Maternal psychopathology, specifically maternal prenatal anxiety, has been studied as an in utero stressor that can affect childhood development and epigenetic aging. In the current study, we analyzed the longitudinal effects of maternal prenatal anxiety on epigenetic aging, assessed sex-specific effects, and tested the contribution of cellular heterogeneity to these findings. Using the longitudinal Basal Influences on Baby Development (BIBO) cohort, we performed a mixed model for repeated measures to determine how prenatal and postnatal anxiety (State-Trait Anxiety Inventory) affect epigenetic aging according to the Pediatric-Buccal-Epigenetic (PedBE) clock at 6-, 10-, and 14-years across 146 individuals and 392 methylomes. For secondary analyses we assessed Tanner stages of puberty at the 10-year timepoint and performed cell-type deconvolution analysis to examine the contribution of puberty and biosample cell heterogeneity, respectively, to our primary findings. Despite no differences in chronological age, females had higher PedBE age compared to males at all three timepoints. In males, but not females, increasing prenatal STAI scores was associated with increased PedBE age. However, no significant association emerged between postnatal anxiety and PedBE aging in either males or females. We found no differences in proportion of epithelial cells across males and females at any timepoint. While males at the 10-year timepoint had higher Tanner scores than females, there were no associations between pubertal development and PedBE-derived epigenetic aging. These findings highlight the importance of the prenatal environment on developmental processes, including epigenetic aging. Future work should probe the biological and social processes that explain why maternal prenatal anxiety affects epigenetic aging in a sex-specific manner. Our results underscore the need for improved behavioral health interventions to pregnant individuals, which has implications for both their health and their developing child
Mass Sars-Cov-2 In A State Correctional System During The Pandemic
Full text linkMass screening has been shown to be more efficient in identifying infections in correctional facilities compared to symptom-based screening, but little is known about the impact of systematic mass screening on timely isolation of infectious cases over the course of the entire pandemic. Between March 2020 and May 2023, the Connecticut Department of Correction (CT DOC) performed a multifaceted SARS-CoV-2 testing strategy for its incarcerated population, which included RT-PCR for mass screening, as well as rapid antigen testing for contact tracing, symptom-based screening, and other miscellaneous reasons. Testing data reveals that mass screening identified 48% of all positive results, whereas contact tracing and symptom-based screening captured 31% and 1%, respectively. In order to ascertain the impact of mass screening on SARS-CoV-2 detection and transmission, resident housing data was used to approximate the movement of individuals into isolation after testing positive for SARS-CoV-2. Through a linear difference-in-difference model, mass screening is estimated to have prevented 877 exposure-days to susceptible cell- and cellblock-mates for each index case who tested positive. This evaluation suggests that a systematic mass screening program is compatible with timely identification and isolation of infectious cases, with some operational limitations to controlling a respiratory pandemic within a vulnerable congregate setting
Exploring The Journey To Heart Failure Diagnosis In Uganda
Full text linkThis study sought to explore the healthcare journeys of patients recently diagnosed with heart failure (HF) in Uganda. Using a semi-structured guide developed in collaboration with Ugandan colleagues, we conducted in-depth interviews with 19 patients diagnosed with HF within the past three months across four regional referral hospitals in Uganda. Interviews were conducted in the participant’s preferred language (English, Luganda, Lugbara, Lugisu, or Swahili) using trained research assistants (RAs) and were recorded, transcribed verbatim, and thematically analyzed using the socioecological framework (SEM) to capture individual, interpersonal, community, and systemic-level barriers to HF care.Findings revealed a total of 11 themes spread across various levels of the SEM – Individual-level themes included a Lack of Health Awareness, Misconceptions about Illness, Personal Faith, Impact on Daily Life, and Comorbidities. Interpersonal-level themes included Social, Emotional, and Financial Support Systems, and Sociocultural Beliefs about Illness. Community level themes included Healthcare Access and Systematic Challenges, as well as Traditional Medicine Use. Societal themes included Financial Burdens and Patient Recommendations. Overall, findings revealed that patients had little to no awareness of HF prior to diagnosis, misattributing early symptoms to aging, environmental exposures, or infectious disease. Cultural beliefs provided alternative explanations of supernatural causes, further delaying care by prompting patients to seek traditional healers and/or delay allopathic care. 3 Patients often only sought biomedical care when symptoms significantly impacted income-generating activities. Participants were frequently met with misdiagnoses at initial points of medical contact, where they were often treated for asthma, tuberculosis, malaria, or peptic ulcer disease. When patients finally reached referral hospitals capable of HF diagnosis, they experienced additional delays due to long wait times, medication stockouts, unsafe conditions, and financial barriers due to high cost of consultation fees, diagnostic services, and medications. This study highlights the complex interplay of individual, interpersonal, communal, and societal elements that illustrate the delayed diagnostic journeys of HF patients in Uganda. These findings underscore the need for improved HF awareness campaigns, targeted health worker training at primary healthcare centers, financial assistance programs for diagnostic services, and integration of HF management into Uganda’s existing non-communicable disease (NCD) initiatives