Physical and psychosocial challenges of people with gender dysphoria: a content analysis study

BACKGROUND

The mismatch between the gender experienced by a person and the gender attributed to him/her leads to gender dysphoria. It seems that people's perception of gender dysphoria is affected by individual, cultural, and sociological factors and these factors affect different aspects of their biological, psychological, and social health. To this end, this qualitative study aimed to identify the physical, psychological, and social challenges of people with gender dysphoria referring to the Department of forensic medicine in Iran.

METHODS

This qualitative study was conducted using conventional content analysis on 9 individuals who were selected through purposive sampling. A total of 16 interviews were conducted with 9 participants. Each interview lasted 60-90 min. The participants' gender dysphoria was confirmed by the Department of forensic medicine. The data were collected through face-to-face semi-structured interviews with the participants.

RESULTS

The data revealed 3 main categories and 10 subcategories. The main categories were living in agony, confusion, and social concerns. The subcategories were annoying physical characteristics, mental suffering, disturbing sexual changes, concerns about public reaction, helplessness, surrender, the final solution, retreating to isolation, stressful family conditions, and lack of public recognition.

CONCLUSION

The findings showed that people with gender dysphoria suffer from some problems including living in agony, confusion, and social concerns. Each of these problems is associated with several challenges. It seems that most of the challenges faced by people with gender dysphoria are caused by unawareness of their conditions by the family and the public, which in turn is caused by the failure of related organizations and experts in this field to provide adequate information about the conditions of these people. Thus, the findings of the present study can have some implications for resolving the challenges faced by people with gender dysphoria.

Oropharyngeal microbiome composition as a possible diagnostic marker for true psychosis in a forensic psychiatric setting: A narrative literature review and an opinion

The malingered psychosis has increasingly occurred over the past few years due to the tendency towards care in the community and the closures of long-stay psychiatric institutions. Thus, it is required to identify malingered psychosis to reach accurate forensic assessments and inhibit misuse of restricted healthcare resources and miscarriages of justice. Despite the fact that some practical psychometric tools and strategies have been proposed for diagnosing true psychosis over the past decades, the differentiation between true psychosis and malingered psychosis is still sometimes challenging. Accordingly, it seems crucial to identify innovative and reliable diagnostic alternatives. Hence, the present article summarizes a collection of evidence that can be used by researchers to improve future assessment of oropharyngeal microbiome composition as a feasible diagnostic marker for true psychosis in a forensic psychiatric setting.

Parenting styles, maladaptive coping styles, and disturbed eating attitudes and behaviors: a multiple mediation analysis in patients with feeding and eating disorders

Background

Although preliminary studies support the roles of unhealthy parenting styles and maladaptive coping styles in increasing rates of disturbed eating attitudes and behaviors (EAB) and clinically significant feeding and eating disorders (FED), underlying mechanisms have not been well-recognized. This study aims to investigate the factors associated with disturbed EAB and the mediating roles of overcompensation and avoidance coping styles in the relationship between different types of parenting styles and disturbed EAB among patients with FED.

Methods

A total of 102 patients with FED in Zahedan, Iran, participating in this cross-sectional study (from April to March 2022) completed a sociodemographic information form and self-report measures of parenting styles, maladaptive coping styles, and EAB. Model 4 of Hayes' PROCESS macro in SPSS was employed to identify and explain the mechanism or process that underlies an observed relationship between study variables.

Results

The results showed that authoritarian parenting style, overcompensation and avoidance coping styles, and female gender might be related to disturbed EAB. The overall hypothesis that overcompensation and avoidance coping styles mediated the effect of fathers' and mothers' authoritarian parenting styles on disturbed EAB was also supported.

Conclusions

Our findings highlighted the necessity of evaluating particular unhealthy parenting styles and maladaptive coping styles as the important possible risk factors in the development and maintenance of higher level of disturbance in EAB among patients with FED. However, more research is needed to explore individual, family, and peer risk factors for disturbed EAB among these patients.

The Effect of Sense of Failure and Alexithymia on Perceived Temptation in Substance Users

Considering the importance of perceived level of temptation on treatment programs in substance users and the role of cognitive aspects, this study was conducted to investigate the effect of sense of failure and alexithymia on perceived temptation. Materials and Methods: In this study, the effect of sense of failure and alexithymia on the perceived temptation in substance users in Saravan [south of IR. Iran] was investigated. In this cross-sectional descriptive study, 270 addicts living in addiction treatment centers in Saravan in the first four months of 2018 were selected by convenience sampling method. The Defeat Scale, the Alexithymia Scale, and the Drug Perceived Temptation Questionnaire-20 were used to assess variables. SPSS software version 22, Pearson correlation test and multiple regression were used to analyze the data. Results: The results showed that there is a relationship between inactivity, sense of loser and satisfaction with temptation [r = 0.32, 0.51, - 0.46]. There is also a significant relationship between alexithymia, difficulty in identifying emotions, difficulty in describing emotions and objective thinking with temptation [r = 0.60, 0.51, 0.48, 0.30]. Based on regression analysis, alexithymia [R2 = 0.37] and sense of failure [R2 = 0.32] can negatively predict temptation. Based on the results of the study, considering the sense of failure, alexithymia, and receiving appropriate care can play an important role in reducing perceived temptation.

Promethazine hydrochloride reduces children's agitation during ocular examination for trauma

Examination and intervention are always the causes of agitation, anxiety, and fear in children's lives. This study aimed to investigate the effectiveness of promethazine hydrochloride in reducing children's agitation during the ocular examination for trauma. In this interventional-clinical trial study, a total of 62 children referred to Al-Zahra Ophthalmology Hospital in Zahedan, Iran, were evaluated in two matched groups (case (n = 31) and control (n = 31)) for an initial examination of ocular trauma. Finally, the intervention was performed (giving placebo or promethazine hydrochloride cough syrup 20 minutes before the initial ocular examination at 0.5 mg/kg), and the demographic information form and researcher-made questionnaire modeled on the Cohen-Mansfield Agitation Inventory (CMAI) were completed. The obtained results revealed that the mean scores of physical/aggressive behaviors (p ˂ 0.001), physical/nonaggressive behaviors (p = 0.013), verbal/aggressive behaviors (p ˂ 0.001), and hiding behaviors (p ˂ 0.001) were significantly lower in the promethazine hydrochloride-receiving group than the placebo group. These findings demonstrated that promethazine hydrochloride cough syrup facilitated the examination among the pediatric patients who suffered from traumatic ocular injuries. However, further studies in this field need to be carried out through randomized controlled trials.

Prevalence of Domestic Violence Against Women Undergoing Methadone Maintenance Therapy Programs and its Related Risk Factors

Background

This study aimed to investigate the prevalence of domestic violence (DV) against women who are undergoing methadone maintenance therapy (MMT) and its related risk factors.

Methods

This case-control study was conducted on 195 women who were under MMT and a control group consisting of 195 women who were not under it in the city of Zahedan from 22 May to 1 December 2019. Data were collected using a questionnaire for the measurement of violence against women and a sociodemographic questionnaire. In order to analyze the data, the t test, analysis of variance (ANOVA), Pearson's correlation, and multiple regression analysis were used.

Findings

In the case group, 67.2% of participants had experienced DV during the past year. In the control group, the prevalence was 78.5%. The rate of more than one occasion of DV was significantly higher in the group who were under MMT (P<0.05). The most common type of violence was mental abuse. Physical, sexual, and economic abuses were in the next ranks. Important predictors of DV, in order of importance, were: the women's low educational level, smoking, income level, and polygamy (P<0.05).

Conclusion

MMT is not a risk factor for DV. It seems that the rate of DV against women in Zahedan is very high. The prevalence of recurrent DV in women under MMT was higher than in the general population.

A narrative review of research on healthcare staff’s burnout during the COVID-19 pandemic

Background

During the 2019 coronavirus disease (COVID-19) pandemic, burnout emerges as a critical health problem that might involve workers in many occupations, particularly healthcare personnel. Although burnout syndrome is not necessarily proved to be nosologic, it yields serious physical, mental, and social outcomes. However, it is essential to provide practical strategies and effective instruments for people so that they can adapt to such highly stressful conditions.

Objectives

The present review was conducted to explore preliminary evidence for nature, treatment, and prevention of burnout among healthcare workers during the COVID-19 pandemic.

Methods

Related English literatures published from the beginning of January 2020 to the end of September 2020 were searched in PubMed, Web of Science, Scopus, and Google scholar databases. “Burnout,” “COVID-19,” “healthcare workers,” “medical staff,” and “pandemic” constituted the search terms. A narrative technique was implemented for material synthesis and creating a compelling and cohesive story.

Results

Final results provided the burnout history and its major effects, causes, and prevalence among healthcare workers. Also, some strategies were listed to be employed by hospital medical staff and organizations to deal with the COVID-19 pandemic.

Conclusions

Recent evidence demonstrated that healthcare staff could gain significant benefits from interventions to modify burnout syndrome, especially from organization-directed interventions. So, health policymakers and practitioners should adopt such interventions and develop context-specific approaches promoting a healthy workplace and averting burnout during the COVID-19 crisis.

The Effect of Topical Substance-P Plus Insulin-like Growth Factor-1 (IGF-1) on Epithelial Healing After Photorefractive Keratectomy in Rabbits

Purpose

To determine whether topical Substance-P (SP) plus insulin-like growth factor-1 (IGF-1) can improve corneal healing after photorefractive surface ablation in a rabbit.

Methods

After a 9.0-mm corneal de-epithelialization using a combination of chemical (18% alcohol) and mechanical debridement, excimer photorefractive surface ablation was performed bilaterally in eight rabbits (16 eyes) with an 8.0-mm ablation zone and 70-μm depth. The right eye was treated with SP (250 μg/mL) and IGF-1 (25 ng/mL) in hyaluronic acid, one drop twice a day, and the other eye treated with only hyaluronic acid. The epithelial healing process was documented photographically twice a day until healing was complete. Six rabbits were sacrificed 6 weeks after photorefractive keratectomy (PRK) and corneas examined histologically.

Results

Seven of eight rabbit eyes treated with SP/IGF-1 healed in a shorter time than the untreated eye. For rabbit #6, both eyes healed at the same time. The average healing time (total time until wound closure) for the treated eyes was 99 hours, while the average healing time for the untreated eyes was 170 hours (P = 0.0490). A persistent epithelial defect was found in two of the nontreated eyes but none in the treated eyes. Corneal pathology showed some degree of epithelial separation in the central corneal wound in three out of six nontreated eyes and in just the treated eye of rabbit #6.

Conclusion

Topical SP plus IGF-1 increases the epithelial healing rate after PRK. There may have been beneficial effects upon cell adhesion as well.

Translational Relevance

Better and faster healing.

L-carnosine as an adjuvant to fluvoxamine in treatment of obsessive compulsive disorder: A randomized double-blind study

BACKGROUND

Dysregulation of glutamate is implicated in the pathogenesis of obsessive-compulsive disorder (OCD). Consistently, glutamate-modulating agents, such as riluzole and memantine have been used in OCD treatment. Previous research has identified some neuroprotective role for L-carnosine potentially via its modulatory effect on glutamate. Here, we assessed the efficacy of L-carnosine as adjuvant to fluvoxamine in OCD treatment.

METHODS

Forty-four patients diagnosed with moderate to severe OCD were recruited in a randomized double-blind trial. Patients received either L-carnosine or placebo as adjuvant to fluvoxamine for 10 weeks. The Yale- Brown Obsessive Compulsive Scale (Y-BOCS) was used for assessing the severity of symptoms at baseline and at weeks 4, 8, and 10.

RESULTS

General linear model repeated measure showed significant effects for Time × Treatment interaction on total Y-BOCS [F (2.10, 88.42) = 8.66, p < 0.001], obsession [F (1.88, 79.34) = 4.96, p = 0.01] and compulsion [F (1.88, 79.11) = 4.57, p = 0.01]. At week 10, the change from baseline in Y-BOCS scores was 8.86 ± 2.89 (mean ± SD) in the L-carnosine group compared to 5.86 ± 2.88 in the placebo group.

CONCLUSION

L-carnosine results in significant reduction of obsessive-compulsive symptoms when used as an adjuvant to fluvoxamine.

Trichloridothallium(III) Complexes with Bipyridine Derivatives: From Structure to Luminescence Properties

Several new thallium(iii) complexes, [Tl(4,4′-dmbpy)Cl3(DMSO)]·H2O (1), [Tl(4,4′-dtbpy)Cl3(DMSO)] (2), [Tl(5,5′-dmbpy)Cl3(DMSO)]·(5,5′-dmbpy) (3), and [Tl(6-mbpy)Cl3(DMSO)] (4) (4,4′-dmbpy = 4,4′-dimethyl-2,2′-bipyridine, 4,4′-dtbpy = 4,4′-ditert-butyl-2,2′-bipyridine, 5,5′-dmbpy = 5,5′-dimethyl-2,2′-bipyridine, and 6-mbpy = 6-methyl-2,2′-bipyridine) were prepared from the reaction of TlCl3 with the mentioned ligands in DMSO. The four complexes were fully characterised and their structures were determined by X-ray diffraction. These complexes have a bidendate nitrogenous ligand, a DMSO molecule, and three chloride anions (in the facial position) attached to a TlIII metal centre in a distorted octahedral environment. The stability of the complexes in DMSO is evident by a 203,205Tl–1H spin–spin coupling, determined by 1H NMR spectroscopy. Interestingly, six bond hydrogen–thallium coupling was observed with a coupling constant of 6JTlH = 20 Hz. The absorption and emission spectra of the complexes were investigated. These studies revealed that upon coordination to TlIII, the luminescent intensity is increased in comparison with the related unbound ligands.