1
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Sapir-Pichhadze R, Oertelt-Prigione S. P3 2: a sex- and gender-sensitive model for evidence-based precision medicine: from knowledge generation to implementation in the field of kidney transplantation. Kidney Int 2023; 103:674-685. [PMID: 36731608 DOI: 10.1016/j.kint.2022.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 12/14/2022] [Accepted: 12/19/2022] [Indexed: 02/01/2023]
Abstract
Precision medicine emerged as a promising approach to identify suitable interventions for individual patients with a particular health concern and at various time points. Technology can enable the acquisition of increasing volumes of clinical and "omics" data at the individual and population levels and support advanced clinical decision making. However, to keep pace with evolving societal realities and developments, it is important to systematically include sex- and gender-specific considerations in the research process, from the acquisition of knowledge to implementation. Building on the foundations of evidence-based medicine and existing precision medicine frameworks, we propose a novel evidence-based precision medicine framework in the form of the P32model, which considers individual sex-related (predictive [P1], preventive [P2], and personalized [P3] medicine) and gender-related (participatory [P4], psychosocial [P5], and percipient [P6] medicine) domains and their intersection with ethnicity, geography, and other demographic and social variables, in addition to population, community, and public dimensions (population-informed [P7], partnered with community [P8], and public-engaging [P9] medicine, respectively). Through its ability to contextualize and reflect on societal realities and developments, our model is expected to promote consideration of diversity, equity, and inclusion principles and, thus, enrich science, increase reproducibility of research, and ensure its social impact.
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Affiliation(s)
- Ruth Sapir-Pichhadze
- Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics, Occupational Health, McGill University, Montreal, Quebec, Canada; Division of Nephrology, Department of Medicine, McGill University, Montreal, Quebec, Canada.
| | - Sabine Oertelt-Prigione
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands; AG10 Sex- and Gender-Sensitive Medicine, Medical Faculty OWL, University of Bielefeld, Bielefeld, Germany.
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2
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Yong-Hing CJ, Gordon PB, Appavoo S, Fitzgerald SR, Seely JM. Addressing Misinformation About the Canadian Breast Screening Guidelines. Can Assoc Radiol J 2022; 74:388-397. [PMID: 36048585 DOI: 10.1177/08465371221120798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Screening mammography has been shown to reduce breast cancer mortality by 41% in screened women ages 40-69 years. There is misinformation about breast screening and the Canadian breast screening guidelines. This can decrease confidence in screening mammography and can lead to suboptimal recommendations. We review some of this misinformation to help radiologists and referring physicians navigate the varied international and provincial guidelines. We address the ages to start and stop breast screening. We explore how these recommendations may vary for specific populations such as patients who are at increased risk, transgender patients and minorities. We identify who would benefit from supplemental screening and review the available supplemental screening modalities including ultrasound, MRI, contrast-enhanced mammography and others. We describe emerging technologies including the potential use of artificial intelligence for breast screening. We provide background on why screening policies vary across the country between provinces and territories. This review is intended to help radiologists and referring physicians understand and navigate the varied international and provincial recommendations and guidelines and make the best recommendations for their patients.
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Affiliation(s)
- Charlotte J Yong-Hing
- Faculty of Medicine, Department of Radiology, 8166University of British Columbia, Vancouver, BC, Canada
| | - Paula B Gordon
- Faculty of Medicine, Department of Radiology, 8166University of British Columbia, Vancouver, BC, Canada
| | - Shushiela Appavoo
- Department of Radiology and Diagnostic Imaging, 3158University of Alberta, Edmonton, AB, Canada
| | - Sabrina R Fitzgerald
- Faculty of Medicine, Department of Radiology, 7938University of Toronto, Toronto, ON, Canada
| | - Jean M Seely
- Faculty of Medicine, Department of Radiology, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Ontario Breast Screening Program, Ottawa, ON, Canada
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3
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Kinitz DJ, Goodyear T, Dromer E, Gesink D, Ferlatte O, Knight R, Salway T. "Conversion Therapy" Experiences in Their Social Contexts: A Qualitative Study of Sexual Orientation and Gender Identity and Expression Change Efforts in Canada. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:441-451. [PMID: 34242106 PMCID: PMC9152241 DOI: 10.1177/07067437211030498] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe in what forms, with whom, where, when, and why Canadians experience sexual orientation and gender identity and expression change efforts (SOGIECE). METHODS This qualitative study is grounded in a transformative paradigm. We conducted semi-structured interviews with a purposive sample of 22 adults recruited from across Canada who have experienced "conversion therapy." Directed content analysis was used, employing deductive and inductive coding approaches, to synthesize the findings and address 5 policy-relevant questions. RESULTS What are SOGIECE? Formal and informal methods of SOGIECE were used, including pharmacologic interventions, denial of gender-affirming care, and coaching to repress sexual orientation and/or gender identity and expression. With whom did SOGIECE occur? Practitioners included religious leaders, licenced health-care professionals (e.g., psychiatrists and psychologists), peers, and family members. Where did SOGIECE occur? SOGIECE occurred in 3 predominant settings: faith-based, health care, and social life. When did SOGIECE occur? SOGIECE rarely occurred over a restricted time frame; often, SOGIECE began while participants were adolescents or young adults and continued multiple years under various forms. Others described SOGIECE as a context in which their life was embedded for many years. Why did people attend SOGIECE? Cisheteronormative social and religious expectations taught participants that being non-cisgender or non-heterosexual was incompatible with living a good and respectable life. CONCLUSIONS SOGIECE are not a circumscribed set of practices. Our study shows that SOGIECE are a larger phenomenon that consists of intentional and explicit change efforts as well as heterosexual- and cisgender-dominant social norms expressed and enforced across a wide range of settings and circumstances. This study provides critical context to inform contemporary social and health policy responses to SOGIECE. Policies should account for the overt, covert, and insidious ways that SOGIECE operate in order to effectively promote safety, equity, and health for sexually diverse and gender-diverse people.
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Affiliation(s)
- David J Kinitz
- Social and Behavioural Health Sciences, Dalla Lana School of Public Health, 7938University of Toronto, Ontario, Canada
| | - Trevor Goodyear
- School of Nursing, 8166The University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
| | - Elisabeth Dromer
- École de Santé Publique de l'5622Université de Montréal, Québec, Canada.,Centre de Recherche en Santé Publique, 5622Université de Montréal et CIUSS du Centre-Sud-de-l'Île-de-Montréal, Québec, Canada
| | - Dionne Gesink
- Dalla Lana School of Public Health, 7938University of Toronto, Ontario, Canada
| | - Olivier Ferlatte
- École de Santé Publique de l'5622Université de Montréal, Québec, Canada.,Centre de Recherche en Santé Publique, 5622Université de Montréal et CIUSS du Centre-Sud-de-l'Île-de-Montréal, Québec, Canada
| | - Rod Knight
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada.,Faculty of Medicine, 8166The University of British Columbia, Vancouver, British Columbia, Canada
| | - Travis Salway
- Faculty of Health Sciences, 1763Simon Fraser University, Burnaby, British Columbia, Canada.,British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
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4
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Ferguson M, Peled M, Saewyc EM. Health and Healthcare Service Use: The Experiences of Runaway Trans Adolescents Compared to their Peers. JOURNAL OF HOMOSEXUALITY 2022; 69:821-835. [PMID: 33891528 DOI: 10.1080/00918369.2021.1892404] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This study is the first trans-inclusive exploration of the relation between running away from home, health, and access to healthcare and supportive figures as a function of gender among adolescents. Secondary data analysis of the 2013 BC Adolescent Health Survey found that trans adolescents were 4.25 times as likely as males, and 3.0 times as likely as females, to have run away. Logistic regressions indicated that runaway adolescents of all genders had greater odds of reporting poor or fair overall health (OR: 2.9) and mental health (OR: 4.5), and of foregoing needed physical (OR: 4.8) and mental health care (OR: 4.5) compared to adolescents who had not run away. The relation between running away and health was exacerbated among trans adolescents. Trans and female youth were also less likely than males to report receiving helpful support. Findings highlight the importance of offering trans-affirming services and care to mitigate harms associated with running away from home.
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Affiliation(s)
- Max Ferguson
- MAP Centre for Urban Health Solutions, St Michael's Hospital, London, UK
| | - Maya Peled
- McCreary Centre Society, Vancouver, Canada
| | - Elizabeth M Saewyc
- McCreary Centre Society, Vancouver, Canada
- School of Nursing, University of British Columbia, Vancouver, Canada
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5
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MacKinnon KR, Kia H, Rai N, Abramovich A, Cheung JJH. Integrating trans health knowledge through instructional design: preparing learners for a continent - not an island - of primary care with trans people. EDUCATION FOR PRIMARY CARE 2021; 32:198-201. [PMID: 33568022 DOI: 10.1080/14739879.2021.1882885] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In recent years the need to teach primary care providers to better care for transgender and non-binary (trans) patients has garnered significant scholarly and public attention. The alarming why motivating this surge in trans health primary care education has already been firmly established and needs no further comment. Instead, we offer new perspectives on how to do trans health primary care education. From treasured 'trans 101' educational interventions to trans health 'clinical pearls', the prevailing model used to teach primary care learners represents time-limited cultural competency-based education, which we argue creates an isolated education 'island'. In rethinking this approach, we present an introduction to the concepts of knowledge integration and the transfer of learning and apply them to show how trans health knowledge and skills should be structured within existing curricula to support effective learning and application. These instructional design considerations have yet to be extensively explored when teaching primary care learners trans health content and may be critical to building pedagogy that ultimately improves healthcare delivery. We conclude that trans health - and trans patients themselves - must not be treated as an isolated education island of knowledge and practice. Rather, it is the responsibility of educators to design instruction that encourages learners to integrate this knowledge with foundational principles of primary care; building bridges across a continent of primary care practice landscapes in turn.
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Affiliation(s)
| | - Hannah Kia
- School of Social Work, The University of British Columbia
| | - Nanky Rai
- Parkdale Queen West Community Health Centre & Temerty Faculty of Medicine, University of Toronto
| | - Alex Abramovich
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health & Dalla Lana School of Public Health, University of Toronto
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6
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Goldman M, Butler-Foster T, Lapierre D, O'Brien SF, Devor A. Trans people and blood donation. Transfusion 2020; 60:1084-1092. [PMID: 32343438 DOI: 10.1111/trf.15777] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/04/2020] [Accepted: 03/04/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Mindy Goldman
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
| | | | - Don Lapierre
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Sheila F O'Brien
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Aaron Devor
- Sociology Department, University of Victoria, Victoria, British Columbia, Canada
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7
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Le Berre M, Vedel I. [Not Available]. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2020; 66:e115-e118. [PMID: 32273423 PMCID: PMC7145126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Mélanie Le Berre
- Assistante de recherche au Département de médecine de famille de l'Université McGill à Montréal (Québec) et à l'Institut Lady Davis de l'Hôpital général juif Sir Mortimer B. Davis, de même qu'étudiante au doctorat en sciences de la réadaptation à l'Université de Montréal
| | - Isabelle Vedel
- Médecin en santé publique, professeure agrégée au Département de médecine de famille de l'Université McGill, et chercheuse à l'Institut Lady Davis.
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8
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Le Berre M, Vedel I. Diversity considerations in Alzheimer disease and related disorders: How can our national and provincial strategies be inclusive of sexual minorities? CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2020; 66:244-246. [PMID: 32273407 PMCID: PMC7145131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Mélanie Le Berre
- Research assistant in the Department of Family Medicine at McGill University in Montreal, Que, and in the Lady Davis Institute at the Sir Mortimer B. Davis-Jewish General Hospital, and a doctoral student in rehabilitation science at the University of Montreal
| | - Isabelle Vedel
- Public health physician and Associate Professor in the Department of Family Medicine at McGill University and Investigator in the Lady Davis Institute.
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9
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Ahmad T, Lafreniere A, Grynspan D. Incorporating Transition-Affirming Language into Anatomical Pathology Reporting for Gender Affirmation Surgery. Transgend Health 2019; 4:335-338. [PMID: 31754631 PMCID: PMC6868650 DOI: 10.1089/trgh.2019.0026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The use of inclusive terminology in health records continues to be a challenge for transgender, gender-diverse, and nonbinary peoples. When patients access electronic health records, laboratory results, including pathology reports, are among the most frequently viewed items. There has been limited discussion of transgender care within laboratory medicine, despite its role in providing written pathology reports after gender-affirming surgery. Proposal: This group proposes inclusive diagnostic terminology for pathology reporting and puts forward recommendations for procedural descriptions in the pathology report. Finally, we highlight pathological information that should be included in a report that has future cancer screening or diagnostic consequences.
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Affiliation(s)
- Tehmina Ahmad
- Department of Medicine, University of Toronto, Faculty of Medicine, Toronto, Canada
| | - Anthea Lafreniere
- Department of Pathology and Laboratory Medicine, University of Ottawa Faculty of Medicine, Ottawa, Canada
| | - David Grynspan
- Department of Pathology and Laboratory Medicine, Vernon Jubilee Hospital, Vernon, Canada
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