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Arnoldussen M, de Rooy FBB, de Vries ALC, van der Miesen AIR, Popma A, Steensma TD. Demographics and gender-related measures in younger and older adolescents presenting to a gender service. Eur Child Adolesc Psychiatry 2023; 32:2537-2546. [PMID: 36370316 PMCID: PMC10682114 DOI: 10.1007/s00787-022-02082-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 09/10/2022] [Indexed: 11/13/2022]
Abstract
Transgender adolescents may present to gender identity specialty services earlier or later in adolescence. The aim of this study was to examine whether, 'younger' and 'older' presenters could be identified in a large cohort of transgender adolescents and if differences exist between the two groups. The study sample consisted of 1487 adolescents (506 birth-assigned males, 981 birth-assigned females) referred between 2000 and 2018. The distribution of age at intake was evaluated. Demographic, diagnostic, and treatment characteristics, the Recalled Childhood Gender Identity/Gender Role Questionnaire (RCGI) to measure childhood gender nonconformity and the Body Image Scale (BIS) to measure body image were collected. Based on a stem-and-leaf plot and a histogram, two groups were identified: adolescents presenting at ≤ 13.9 years ('younger presenters') and adolescents presenting at 14 years or older ('older presenters'). The sex ratio was more extreme in the group of older presenters favoring birth-assigned females (Χ2(1, N = 1487) = 19.69, p < 0.001). Furthermore, more adolescents from the younger presenting group lived with both biological parents (Χ2(1, N = 1427) = 24.78, p < 0.001), were diagnosed with gender dysphoria and started with medical gender-affirming treatment (Χ2(1, N = 1404) = 4.60, p = 0.032 and Χ2(1, N = 1487) = 29.16, p < 0.001). Younger presenters showed more gender nonconformity in childhood (β 0.315, p < 0.001, 95% CI 0.224-0.407). Older presenters were more dissatisfied with various aspects of their bodies (p < 0.001). The differences between older and younger presenting adolescents suggest that there may be different developmental pathways in adolescents that lead to seeking gender-affirming medical care and argues for more tailored care.
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Affiliation(s)
- Marijn Arnoldussen
- Department of Child and Adolescent Psychiatry, Center of Expertise On Gender Dysphoria, Amsterdam Medical Centers, Location VU, Amsterdam, The Netherlands.
| | - Frédérique B B de Rooy
- Department of Child and Adolescent Psychiatry, Center of Expertise On Gender Dysphoria, Amsterdam Medical Centers, Location VU, Amsterdam, The Netherlands
| | - Annelou L C de Vries
- Department of Child and Adolescent Psychiatry, Center of Expertise On Gender Dysphoria, Amsterdam Medical Centers, Location VU, Amsterdam, The Netherlands
| | - Anna I R van der Miesen
- Department of Child and Adolescent Psychiatry, Center of Expertise On Gender Dysphoria, Amsterdam Medical Centers, Location VU, Amsterdam, The Netherlands
| | - Arne Popma
- Department of Child and Adolescent Psychiatry, Center of Expertise On Gender Dysphoria, Amsterdam Medical Centers, Location VU, Amsterdam, The Netherlands
| | - Thomas D Steensma
- Department of Child and Adolescent Psychiatry, Center of Expertise On Gender Dysphoria, Amsterdam Medical Centers, Location VU, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam Medical Centers, Location VU, Amsterdam, The Netherlands
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Vrouenraets LJJJ, de Vries ALC, Arnoldussen M, Hannema SE, Lindauer RJL, de Vries MC, Hein IM. Medical decision-making competence regarding puberty suppression: perceptions of transgender adolescents, their parents and clinicians. Eur Child Adolesc Psychiatry 2023; 32:2343-2361. [PMID: 36115898 PMCID: PMC10576681 DOI: 10.1007/s00787-022-02076-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 08/31/2022] [Indexed: 11/30/2022]
Abstract
According to international transgender care guidelines, transgender adolescents should have medical decision-making competence (MDC) to start puberty suppression (PS) and halt endogenous pubertal development. However, MDC is a debated concept in adolescent transgender care and little is known about the transgender adolescents', their parents', and clinicians' perspectives on this. Increasing our understanding of these perspectives can improve transgender adolescent care. A qualitative interview study with adolescents attending two Dutch gender identity clinics (eight transgender adolescents who proceeded to gender-affirming hormones after PS, and six adolescents who discontinued PS) and 12 of their parents, and focus groups with ten clinicians was conducted. From thematic analysis, three themes emerged regarding transgender adolescents' MDC to start PS: (1) challenges when assessing MDC, (2) aspects that are considered when assessing MDC, and (3) MDC's relevance. The four criteria one needs to fulfill to have MDC-understanding, appreciating, reasoning, communicating a choice-were all, to a greater or lesser extent, mentioned by most participants, just as MDC being relative to a specific decision and context. Interestingly, most adolescents, parents and clinicians find understanding and appreciating PS and its consequences important for MDC. Nevertheless, most state that the adolescents did not fully understand and appreciate PS and its consequences, but were nonetheless able to decide about PS. Parents' support of their child was considered essential in the decision-making process. Clinicians find MDC difficult to assess and put into practice in a uniform way. Dissemination of knowledge about MDC to start PS would help to adequately support adolescents, parents and clinicians in the decision-making process.
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Affiliation(s)
- Lieke Josephina Jeanne Johanna Vrouenraets
- Department of Medical Psychology, Willem Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands.
- Department of Medical Ethics and Health Law, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Annelou L C de Vries
- Department of Child and Adolescent Psychiatry, Emma Children's Hospital, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands
| | - Marijn Arnoldussen
- Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands
| | - Sabine E Hannema
- Department of Paediatric Endocrinology, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands
- Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Ramón J L Lindauer
- Department of Child and Adolescent Psychiatry, Amsterdam University Medical Centers, Location AMC, University of Amsterdam and Levvel, Amsterdam, The Netherlands
| | - Martine C de Vries
- Department of Medical Ethics and Health Law, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
- Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Irma M Hein
- Department of Child and Adolescent Psychiatry, Amsterdam University Medical Centers, Location AMC, University of Amsterdam and Levvel, Amsterdam, The Netherlands
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Arnoldussen M. Rosalind Franklin Society Proudly Announces the 2022 Award Recipient for LGBT Health. LGBT Health 2023; 10:411. [PMID: 37672209 DOI: 10.1089/lgbt.2023.29010.rfs2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023] Open
Affiliation(s)
- Marijn Arnoldussen
- Center of Expertise on Gender Dysphoria Amsterdam Medical Center, Vrije Universiteit Amsterdam, The Netherlands
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Arnoldussen M, Hooijman EC, Kreukels BP, de Vries AL. Association between pre-treatment IQ and educational achievement after gender-affirming treatment including puberty suppression in transgender adolescents. Clin Child Psychol Psychiatry 2022; 27:1069-1076. [PMID: 35638479 PMCID: PMC9574895 DOI: 10.1177/13591045221091652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Concerns exist regarding effects of puberty suppression on neurodevelopment. Intelligence is strongly correlated with educational achievement in the general population. This study aimed to examine the association between pre-treatment intelligence and educational achievement after gender-affirming treatment including puberty suppression in transgender adolescents to contribute to the emerging understanding of the effect that gender-affirming treatment including puberty suppression may have on cognitive development. METHODS IQ was measured in 72 adolescents (45 trans boys, 27 trans girls) at clinical entry (mean age 12.78 years), educational achievement was evaluated after gender-affirming treatment (mean age 20.40 years). RESULTS IQ pre-treatment and educational achievement post-treatment were positively associated (Nagelkerke R = 0.71). DISCUSSION The association between IQ pre-treatment and educational achievement post-treatment in transgender adolescents who received gender-affirming medical treatment including puberty suppression appears to be similar to the general population. This may reflect that gender-affirming medical treatment including puberty suppression does not negatively affect the association between IQ and educational achievement.
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Affiliation(s)
- Marijn Arnoldussen
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Evelien C Hooijman
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Baudewijntje Pc Kreukels
- Department of Medical Psychology, Center of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdams, Netherlands
| | - Annelou Lc de Vries
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Van Mello N, De Nie I, Asseler J, Arnoldussen M, Steensma T, Den Heijer M, De Vries A, Huirne J. P-506 Reflecting on the Importance of Family Building and Fertility Preservation: Transgender People’s Experiences with Starting Gender-affirming Treatment as Adolescent. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
To investigate how adults of reproductive age (± 30 years), who started gender-affirming treatment during adolescence, reflect on their reproductive wishes.
Summary answer
Views regarding fertility and family building change over time, which may be related with reduced levels of gender dysphoria, matured intellectual and emotional cognitions.
What is known already
Within the last two decades, gender-affirming care for transgender youth has become widely available. One of the topical debates in adolescent transgender care concerns the difficulty of making decisions regarding fertility at an early age, since medical treatment for gender dysphoria negatively affects reproductive function. In transgender adolescents, data on the potential change in wishes and desires regarding fertility, family building and the importance of biological parenthood, when coming of reproductive age, are lacking. Hereby, the long-term consequences of acquired infertility in transgender adolescents who have now reached adulthood remain still unknown.
Study design, size, duration
This was a questionnaire study. Gender diverse adolescents who presented between 1989 and 2000 and started medical transition, were recruited for participation. As well as gender diverse adolescents who commenced medical treatment with gonadotropin-releasing hormone agonist (GnRHa) prior to gender affirming hormone treatment (GAHT), at least 9 years ago. 89 participants were eligible for inclusion in the study cohort.
Participants/materials, setting, methods
Data were collected through an online survey, and a subsequent telephonic interview to validate the provided answers in the survey. The fertility questionnaire focused on different themes, such as fertility counseling at initiation of medical treatment, decision-making about fertility preservation, current feelings about infertility, and a potential desire to have children.
Main results and the role of chance
The cohort consisted of 89 participants, among whom 66 trans masculine and 23 trans feminine people. Participants had a mean age of 32.4 years (SD 6.6, range 25.5-51.2) at time of the study, and 15.6 years (SD 2.2, range 11.5-20.6) at time of start of medical treatment. Since all participants initiated medical treatment before 2014, at that time laws requiring sterilization for legal gender recognition were still in place. Only 30% of participants received information about the options for fertility preservation, and none of them pursued fertility preservation. In addition, 96% of participants underwent gonadectomy and thus became permanently infertile. 27% of participants found becoming infertile troublesome, and 21% stated that they were not able to make decisions regarding fertility and future family building during adolescence. With today’s knowledge, 14% of trans masculine and 17% of trans feminine people would not have chosen to undergo gonadectomy. In addition, 44% of trans masculine and 35% of trans feminine people would pursue fertility preservation. The percentage of participants with a (future) desire for children changed from 34% at start of medical treatment to 56% at time of this study, of whom 23% had already started a family.
Limitations, reasons for caution
Since the participants reflect on a period in time in which fertility counseling was not offered on a structural basis and preservation options were not widely available, results of this study may not be fully translatable to current practice.
Wider implications of the findings
Transgender adolescents should be counselled on fertility and the options for fertility preservation, even in the absence of a desire for children upon initiation of treatment. Views on future family building might change over time, fertility counseling should be repeated at each step of the transition.
Trial registration number
na
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Affiliation(s)
- N Van Mello
- Amsterdam UMC, Obstetrics and gynaecology- Center of Expertise on Gender Dysphoria , Amsterdam, The Netherlands
| | - I De Nie
- Amsterdam UMC, Department of Endocrinology , Amsterdam, The Netherlands
| | - J Asseler
- Amsterdam UMC, Obstetrics and gynaecology- Center of Expertise on Gender Dysphoria , Amsterdam, The Netherlands
| | - M Arnoldussen
- Amsterdam UMC, Department of Child and Adolescent Psychiatry , Amsterdam, The Netherlands
| | - T Steensma
- Amsterdam UMC, Department of Medical Psychology , Amsterdam, The Netherlands
| | - M Den Heijer
- Amsterdam UMC, Department of Endocrinology , Amsterdam, The Netherlands
| | - A De Vries
- Amsterdam UMC, Department of Child and Adolescent Psychiatry , Amsterdam, The Netherlands
| | - J Huirne
- Amsterdam UMC, Obstetrics and gynaecology , Amsterdam, The Netherlands
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Arnoldussen M, van der Miesen AIR, Elzinga WS, Alberse AME, Popma A, Steensma TD, de Vries ALC. Self-Perception of Transgender Adolescents after Gender-Affirming Treatment: A Follow-Up Study into Young Adulthood. LGBT Health 2022; 9:238-246. [PMID: 35475663 DOI: 10.1089/lgbt.2020.0494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose: Early medical treatment for transgender adolescents should contribute to healthy psychological development, including the development of positive self-perception. However, at present, there are no longitudinal studies that have examined whether current treatment approaches meet this expectation. Therefore, the aim of this single-arm retrospective study was to examine transgender adolescents' self-perception changes over the course of irreversible medical gender-affirming treatment. Method: The total study sample consisted of 70 adolescents (49 trans men and 21 trans women). Self-perception was assessed before the start of gender-affirming hormone treatment (mean age = 14.65, standard deviation (SD) = 2.08) and at least 6 months after gender-affirming surgeries (mean age = 20.70, SD = 1.49) by Self-Perception Profile for Adolescents (SPPA). The SPPA is a self-report measure that examines self-perception on seven different domains: Scholastic competence, social acceptance, athletic competence, physical appearance, behavioral conduct, close friendship, and global self-worth. Multilevel modeling (random intercepts model) was conducted to determine the effect of time for all domains of self-perception. Results: It was found that the domains of physical appearance and global self-worth improved significantly over the course of treatment. No domain worsened significantly over the course of treatment. The domains of scholastic competence, social acceptance, athletic competence, and close friendship remained stable over time. Conclusion: This study provides the first suggestive evidence that irreversible gender-affirming treatment for adolescents could contribute to the development of a more positive self-perception.
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Affiliation(s)
- Marijn Arnoldussen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, de Boelelaan 1117, Amsterdam, Netherlands
| | - Anna I R van der Miesen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, de Boelelaan 1117, Amsterdam, Netherlands
| | - Wieteke S Elzinga
- GGZ-Noord-Holland-Noord, Division Triversum, Centre for Child and Adolescent Psychiatry, Heiloo, the Netherlands
| | - Anne-Marie E Alberse
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, de Boelelaan 1117, Amsterdam, Netherlands
| | - Arne Popma
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, de Boelelaan 1117, Amsterdam, Netherlands
| | - Thomas D Steensma
- Department of Medical Psychology, Center of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Annelou L C de Vries
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, de Boelelaan 1117, Amsterdam, Netherlands
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Arnoldussen M, Steensma TD, Popma A, van der Miesen AIR, Twisk JWR, de Vries ALC. Correction to: Re-evaluation of the Dutch approach: are recently referred transgender youth different compared to earlier referrals? Eur Child Adolesc Psychiatry 2022; 31:843. [PMID: 33330953 PMCID: PMC9172768 DOI: 10.1007/s00787-020-01691-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Marijn Arnoldussen
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
| | - Thomas D. Steensma
- grid.12380.380000 0004 1754 9227Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Arne Popma
- grid.12380.380000 0004 1754 9227Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Anna I. R. van der Miesen
- grid.12380.380000 0004 1754 9227Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Jos W. R. Twisk
- grid.12380.380000 0004 1754 9227Department of Epidemiology and Biostatics, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Annelou L. C. de Vries
- grid.12380.380000 0004 1754 9227Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
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Vrouenraets LJ, de Vries MC, Hein IM, Arnoldussen M, Hannema SE, de Vries AL. Perceptions on the function of puberty suppression of transgender adolescents who continued or discontinued treatment, their parents, and clinicians. Int J Transgend Health 2021; 23:428-441. [PMID: 36324881 PMCID: PMC9621271 DOI: 10.1080/26895269.2021.1974324] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Purpose: Treatment of transgender adolescents with puberty suppression (PS) was developed to provide time for exploration before pursuing gender affirming medical treatment (GAMT) with irreversible effects. It may also result in a more satisfactory physical outcome for those who continue with GAMT. Despite being the current first choice treatment, little research has examined the function of PS from the perspectives of transgender adolescents, their parents, and clinicians. Insight into the perceived functions of PS will help to adequately support adolescents in their decision-making process and give them the care they need. Methods: Qualitative study using interviews with eight transgender adolescents who proceeded with GAMT after PS ("continuers"), six adolescents who discontinued PS ("discontinuers") and 12 parents, and focus groups with ten clinicians. Results: All informants considered inhibition of development of secondary sex characteristics an important function of PS. Most continuers saw PS as the first step of GAMT. Nevertheless, some were glad that the effects were reversible even if they didn't expect to change their minds. Some discontinuers did experience PS as an expanded diagnostic phase. One continuer used the time on PS to get used to living in the affirmed gender role, and several parents found the time helpful to adapt to their child's new gender role. PS provided clinicians more time for diagnostic assessment. Conclusions: Adolescents, parents and clinicians do not all report the same functions of PS. Although international guidelines emphasize providing time for exploration of gender identity as an important reason for PS, many adolescents nowadays seem to have clear ideas about their gender identity and treatment wishes, and experience PS as the first step of GAMT. For some discontinuers however, PS offered a valued period of exploration. Guidelines could be modified to provide more customized care, taking adolescents' and parents' ideas about the functions of PS into account.
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Affiliation(s)
- Lieke J.J.J. Vrouenraets
- LUMC Curium-Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Oegstgeest, The Netherlands
- Department of Medical Ethics and Health Law, Leiden University Medical Center, Leiden, The Netherlands
| | - Martine C. de Vries
- Department of Medical Ethics and Health Law, Leiden University Medical Center, Leiden, The Netherlands
| | - Irma M. Hein
- Department of Child and Adolescent Psychiatry, Amsterdam University Medical Centers, Location AMC, University of Amsterdam and Levvel, Amsterdam, The Netherlands
| | - Marijn Arnoldussen
- Department of Child and Adolescent Psychiatry, Amsterdam University Medical Centers, Location VUmc, VU Universiteit, Amsterdam, The Netherlands
| | - Sabine E. Hannema
- Department of Paediatric Endocrinology, Amsterdam University Medical Centers, Location VUmc, VU Universiteit, Amsterdam, the Netherlands
- Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Annelou L.C. de Vries
- Department of Child and Adolescent Psychiatry, Amsterdam University Medical Centers, Location VUmc, VU Universiteit, Amsterdam, The Netherlands
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Gunawan S, Broeke CT, Ven PVD, Arnoldussen M, Kaspers G, Mostert S. Parental Experiences with Chemotherapy-Induced Alopecia among Childhood Cancer Patients in Indonesia. Asian Pac J Cancer Prev 2017; 17:1717-23. [PMID: 27221843 DOI: 10.7314/apjcp.2016.17.4.1717] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study assessed parental experiences with chemotherapy-induced alopecia among children with cancer treated at an Indonesian academic hospital. MATERIALS AND METHODS Fifty parents of childhood cancer patients were interviewed using semi-structured questionnaires. RESULTS The moment that hair fell out was the moment that parents (84%) had to admit their child had cancer. Alopecia was a traumatizing painful experience (46%). Active strategies to hide alopecia, mainly hats, were used by 66% of children, while 34% never covered their bald head. If money had not been an issue, 40% would use another strategy. Alopecia made children limit outdoor daily activities (78%) and engagement with others (60%). Significantly more children from high-educated (95%) than low-educated (60%) parents received sympathy from other people (P=0.012). Significantly more Christian (29%) than Muslim (0%) families confirmed that alopecia lowered the quality of life (P=0.046). Most parents (82%) had no prior plans about alopecia management, yet for significantly more girls (26%) than boys (0%) such plans existed (P=0.044). Parents received most information about alopecia from other parents (66%). Parents (92%) needed more alopecia education from doctors. Of all school-attending children, 53% were bullied and 47% did not want to attend school due to alopecia. Significantly more high-educated than low-educated families received pity from teachers and pupils (94% vs. 0%, P=0.004), and acceptance by pupils (81% vs. 0%, P=0.021). CONCLUSIONS Alopecia is a severe, far-stretching side-effect of chemotherapy with physical, psychological and social consequences for children and parents. Parents should be better informed about occurrence and impact of alopecia. Extra attention is required to facilitate children's return to school. Health- care providers should facilitate optimal supportive care through open dialogue and provision of educational materials for parents, children and their community.
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Affiliation(s)
- Stefanus Gunawan
- Department of Pediatrics, Kandou Hospital, Manado, Indonesia, E-mail :
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Yasmin-Karim S, Moreau M, Kumar R, Makrigiorgos GM, Hanlon J, Arnoldussen M, Hempstead J, Celli J, Ngwa W. SU-G-TeP3-05: In Vitro Demonstration of Endothelial Dose Enhancement Due to Gold Nanoparticles During Low-Voltage Radiotherapy. Med Phys 2016. [DOI: 10.1118/1.4957085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Oumano M, Ngwa W, Celli J, Arnoldussen M, Hanlon J, Hempstead J, Petrovic L. TU-H-CAMPUS-TeP3-01: Gold Nanoparticle-Enhanced Radiation Therapy in In Vitro A549 Lung Carcinoma: Studies in Both Traditional Monolayer and Three Dimensional Cell Culture Models. Med Phys 2016. [DOI: 10.1118/1.4957704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Gunawan S, Arnoldussen M, Gordijn MS, Sitaresmi MN, van de Ven PM, Ten Broeke CAM, Veerman AJP, Mantik M, Kaspers GJL, Mostert S. Comparing Health-Care Providers' Perspectives on Complementary and Alternative Medicine in Childhood Cancer Between Netherlands and Indonesia. Pediatr Blood Cancer 2016; 63:118-23. [PMID: 26274831 DOI: 10.1002/pbc.25689] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 07/02/2015] [Indexed: 01/09/2023]
Abstract
BACKGROUND Use of complementary and alternative medicine (CAM) is common among patients with childhood cancer. Health-care providers (HCP) should address this need properly. Geographical and cultural differences seem likely. This study explores perspectives on CAM of HCP involved in the care of children with cancer in Netherlands and Indonesia. Health beliefs, components of CAM, encouraging or discouraging CAM, and knowledge about CAM were assessed. PROCEDURE We conducted a cross-sectional study using semi-structured questionnaires at a Dutch and Indonesian academic hospital. RESULTS A total of 342 HCP participated: 119 Dutch (response rate 80%) and 223 Indonesian (response rate 87%). Chemotherapy can cure cancer according to more Dutch than Indonesian HCP (87% vs. 53% respectively, P < 0.001). Combination of chemotherapy and CAM is the best way to cure cancer according to more Indonesian than Dutch HCP (45% vs. 25%, P < 0.001). Dutch and Indonesian HCP recommend and discourage CAM use differently. Most Dutch (77%) and Indonesian HCP (84%) consider their knowledge about CAM to be inadequate (P = ns). Fewer Dutch doctors than other HCP want to learn more about CAM (51% vs. 76%, P = 0.007), whereas there is no significant difference in eagerness to learn about CAM between Indonesian doctors (64%) and other HCP (72%). CONCLUSIONS Indonesian HCP have more positive views about CAM than their Dutch colleagues. Both Dutch and Indonesian HCP consider their knowledge about CAM to be inadequate. Therefore, education programs about CAM tailored to the needs of HCP are recommended, knowing that CAM is used frequently.
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Affiliation(s)
- Stefanus Gunawan
- Department of Pediatric Oncology-Hematology, Prof. Dr. RD Kandou Hospital, Manado, Indonesia
| | - Marijn Arnoldussen
- Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, the Netherlands
| | - Maartje S Gordijn
- Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, the Netherlands
| | - Mei N Sitaresmi
- Department of Pediatrics, Dr. Sardjito Hospital, Gadjah Mada University, Yogyakarta, Indonesia
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
| | - Chloé A M Ten Broeke
- Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, the Netherlands
| | - Anjo J P Veerman
- Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, the Netherlands
| | - Max Mantik
- Department of Pediatric Oncology-Hematology, Prof. Dr. RD Kandou Hospital, Manado, Indonesia
| | - Gertjan J L Kaspers
- Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, the Netherlands
| | - Saskia Mostert
- Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, the Netherlands
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Brivio D, Zygmanski P, Arnoldussen M, Hanlon J, Chell E, Sajo E, Makrigiorgos GM, Ngwa W. Kilovoltage radiosurgery with gold nanoparticles for neovascular age-related macular degeneration (AMD): a Monte Carlo evaluation. Phys Med Biol 2015; 60:9203-13. [PMID: 26576672 DOI: 10.1088/0031-9155/60/24/9203] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This work uses Monte Carlo radiation transport simulation to assess the potential benefits of gold nanoparticles (AuNP) in the treatment of neovascular age-related macular degeneration with stereotactic radiosurgery. Clinically, a 100 kVp x-ray beam of 4 mm diameter is aimed at the macula to deliver an ablative dose in a single fraction. In the transport model, AuNP accumulated at the bottom of the macula are targeted with a source representative of the clinical beam in order to provide enhanced dose to the diseased macular endothelial cells. It is observed that, because of the AuNP, the dose to the endothelial cells can be significantly enhanced, allowing for greater sparing of optic nerve, retina and other neighboring healthy tissue. For 20 nm diameter AuNP concentration of 32 mg g(-1), which has been shown to be achievable in vivo, a dose enhancement ratio (DER) of 1.97 was found to be possible, which could potentially be increased through appropriate optimization of beam quality and/or AuNP targeting. A significant enhancement in dose is seen in the vicinity of the AuNP layer within 30 μm, peaked at the AuNP-tissue interface. Different angular tilting of the 4 mm beam results in a similar enhancement. The DER inside and in the penumbra of the 4 mm irradiation-field are almost the same while the actual delivered dose is more than one order of magnitude lower outside the field leading to normal tissue sparing. The prescribed dose to macular endothelial cells can be delivered using almost half of the radiation allowing reduction of dose to the neighboring organs such as retina/optic nerve by 49% when compared to a treatment without AuNP.
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Affiliation(s)
- D Brivio
- Brigham and Woman's Hospital, Harvard Medical School, Boston, MA, USA. Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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Chell E, Arnoldussen M. MO-EE-A3-04: Motion Management for a Novel Ophthalmic Stereotactic Radiosurgical Device. Med Phys 2009. [DOI: 10.1118/1.3182262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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