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Saunders CL. Using Routine Data to Improve Lesbian, Gay, Bisexual, and Transgender Health. Interact J Med Res 2024; 13:e53311. [PMID: 38691398 DOI: 10.2196/53311] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 02/28/2024] [Accepted: 03/26/2024] [Indexed: 05/03/2024] Open
Abstract
The collection of sexual orientation in routine data, generated either from contacts with health services or in infrastructure data resources designed and collected for policy and research, has improved substantially in the United Kingdom in the last decade. Inclusive measures of gender and transgender status are now also beginning to be collected. This viewpoint considers current data collections, and their strengths and limitations, including accessing data, sample size, measures of sexual orientation and gender, measures of health outcomes, and longitudinal follow-up. The available data are considered within both sociopolitical and biomedical models of health for individuals who are lesbian, gay, bisexual, transgender, queer, or of other identities including nonbinary (LGBTQ+). Although most individual data sets have some methodological limitations, when put together, there is now a real depth of routine data for LGBTQ+ health research. This paper aims to provide a framework for how these data can be used to improve health and health care outcomes. Four practical analysis approaches are introduced-descriptive epidemiology, risk prediction, intervention development, and impact evaluation-and are discussed as frameworks for translating data into research with the potential to improve health.
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Mittertreiner EJ, Ng-Cordell E, McVey AJ, Kerns CM. Research methods at the intersection of gender diversity and autism: A scoping review. Autism 2024:13623613241245595. [PMID: 38661070 DOI: 10.1177/13623613241245595] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
LAY ABSTRACT Research has increasingly focused on the intersection between gender diversity and autism. To better understand this literature, this scoping review systematically searched five databases for peer-reviewed literature on gender diversity and autism published between 2018 and 2023. Included studies (N = 84) were of English language, featured original qualitative or quantitative findings, and examined a psychosocial connection between autism and gender spectra variables. Most studies focused on measuring prevalence of autism among gender-diverse individuals. While the overall study rigor was acceptable, weaknesses in measurement, sample selection, and definition of key terms were noted. Promisingly, studies in this area appear to be shifting away from a pathologizing lens and towards research methods that engage in meaningful collaboration with the autistic, gender-diverse community to investigate how to best enhance the quality of life and wellbeing of this population.
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Affiliation(s)
| | | | - Alana J McVey
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
- Autism Center, Seattle Children's Hospital, Seattle, WA, United States
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Camp J, Morris A, Wilde H, Smith P, Rimes KA. Gender- and Sexuality-Minoritised Adolescents in DBT: A Reflexive Thematic Analysis of Minority-Specific Treatment Targets and Experience. Cogn Behav Therap 2023; 16:s1754470x23000326. [PMID: 38125010 PMCID: PMC7615396 DOI: 10.1017/s1754470x23000326] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Gender- and sexuality-minoritised (GSM) adolescents are at increased risk of self-harm and suicidal behaviours compared to their cisgender and heterosexual peers. This increased risk is thought to be explained in part by exposure to stigma and societal oppression. Dialectical Behaviour Therapy (DBT) is an evidence-based intervention for self-harm and suicidal behaviour that may have advantages for supporting GSM young people in distress. No study has yet sought to understand what GSM-associated difficulties may be important to consider in DBT for adolescents, or the experiences of GSM young people in a standard DBT programme. Therefore, this study aimed to understand the experiences of GSM young people in DBT and what difficulties and dilemmas associated with their gender and sexuality diversity were thought by them to be important to target in DBT. Qualitative interviews were conducted with 14 GSM young people in a comprehensive DBT programme and were analysed using Reflexive Thematic Analysis. The analysis was supported by two further GSM young people who had finished DBT. The findings were split into three overarching themes (Identity, Impact of Others, and Space for Sexual and Gender Identity in DBT), each with themes within. The identity-based theme included "identity confusion and acceptance"; the relationship-based themes included "cis-Heterosexism" and "community connectedness"; and the space within DBT themes included "negotiating focus and targeting in DBT" and "creating safety in DBT". Findings are discussed in relation to implications and recommendations for therapists working with GSM young people within and outside of DBT.
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Affiliation(s)
- J Camp
- Department of Psychology, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London, SE5 8AB
- National & Specialist CAMHS, DBT Service, South London & Maudsley NHS Foundation Trust, Michael Rutter Centre, Maudsley Hospital, London, SE5 8AZ
| | - A Morris
- National & Specialist CAMHS, DBT Service, South London & Maudsley NHS Foundation Trust, Michael Rutter Centre, Maudsley Hospital, London, SE5 8AZ
| | - H Wilde
- National & Specialist CAMHS, DBT Service, South London & Maudsley NHS Foundation Trust, Michael Rutter Centre, Maudsley Hospital, London, SE5 8AZ
| | - P Smith
- Department of Psychology, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London, SE5 8AB
| | - K A Rimes
- Department of Psychology, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London, SE5 8AB
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Britt-Thomas JY, Kridel M, Velez J, Kouame G, Tharrington S, Barrett T, Casanova T. A scoping review of institutional policies and recommendations for trans inpatient mental health care. J Psychiatr Ment Health Nurs 2023; 30:1043-1053. [PMID: 37202857 DOI: 10.1111/jpm.12933] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 01/17/2023] [Revised: 03/30/2023] [Accepted: 05/03/2023] [Indexed: 05/20/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: International guidelines for trans-and-gender-non-conforming (TGNC) exists in outpatient settings. Compared to cisgender and heterosexual people, TGNC individuals are at a higher risk of mental health difficulties and have higher rates of inpatient mental health treatment. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: An international scoping review identifying the lack of guidelines existing for TGNC individuals in inpatient mental health settings. Compared to psychiatrists and psychologists, mental health nursing has the most contact with patients admitted for inpatient psychiatric treatment. The study identifies unaddressed needs in gender affirming policies and outlines preliminary policy recommendations to assist mental health staff in improving TGNC patient quality of care within the United States. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Reforming existing guidelines or creating new guidelines based on the identified themes and gaps to improve the well-being and treatment outcomes of TGNC individuals in inpatient psychiatric settings within the United States. ABSTRACT INTRODUCTION: Access to culturally sensitive care is critical for addressing known mental health disparities among trans-and gender-non-conforming (TGNC) individuals. Although there has been a proliferation of TGNC healthcare guidelines from accrediting bodies, policies have failed to address the needs of TGNC patients in inpatient psychiatric settings. AIM To identify unaddressed needs in policies and policy recommendations for the care of TGNC patients to inform recommendations for change. METHOD A scoping review protocol was developed following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 850 articles were reduced to seven relevant articles with six themes identified via thematic analysis. RESULTS Six themes were identified: lack of consistency in preferred and pronoun use, lack of communication among providers, lack of training in TGNC healthcare, personal bias, lack of formal policies, and housing segregation by sex rather than gender. DISCUSSION The creation of new guidelines or bolstering of existing guidelines to specifically address identified themes and gaps may improve the well-being and treatment outcomes of TGNC individuals in inpatient psychiatric settings. IMPLICATIONS FOR PRACTICE To provide a foundation for future studies to integrate these identified gaps and inform the future development of comprehensive formal policies that generalize TGNC care in inpatient settings.
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Affiliation(s)
- Jessica Y Britt-Thomas
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Matthew Kridel
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Janina Velez
- Clinical Psychology, The Chicago School of Professional Psychology, Washington, DC, USA
| | - Gail Kouame
- Charles M. Baugh Biomedical Library, University of South Alabama, Mobile, Alabama, USA
| | - Shafer Tharrington
- Robert B. Greenblatt, M.D. Library, Augusta University, Augusta, Georgia, USA
| | - Thomas Barrett
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Tracy Casanova
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
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Mahfouda S, Maybery M, Moore J, Perry Y, Strauss P, Zepf F, Lin A. Gender non-conformity in childhood and adolescence and mental health through to adulthood: a longitudinal cohort study, 1995-2018. Psychol Med 2023; 53:7756-7765. [PMID: 37403583 DOI: 10.1017/s0033291723001721] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
BACKGROUND Few studies have examined associations between gender non-conformity (GNC) in childhood or adolescence and mental health outcomes later in life. This study examined associations between (1) GNC and mental health over multiple time points in childhood and adolescence, and (2) GNC in childhood and/or adolescence and mental health in adulthood. METHOD Second generation participants from the Raine Study, a longitudinal cohort from Perth, Western Australia. Data were collected between 1995 and 2018, comprising seven waves: ages 5 (N = 2236), 8 (N = 2140), 10 (N = 2048), 14 (N = 1864), 17 (N = 1726), 22 (N = 1236) and 27 (N = 1190) years. History of GNC, v. absence of this history, was based on responses to item 110 from the Child Behaviour Checklist (CBCL)/Youth Self Report (YSR) ('wishes to be of opposite sex'). The CBCL/YSR were used to measure internalising and externalising symptoms. Items 18 ('deliberate self-harm [DSH] or attempts suicide') and 91 ('talks/thinks about killing self') were used as measures of suicidal ideation (SI) and DSH. For adults, Depression, Anxiety and Stress Subscales and Kessler Psychological Distress Scale assessed mental health. RESULTS Child and adolescent GNC was associated with elevated internalising and externalising behaviours and increased odds of DSH. A history of GNC was also associated with vulnerability for severe psychological distress in adulthood in some symptom scales. CONCLUSION GNC over the child and adolescent period is associated with significant emotional and behavioural difficulties, and psychological distress. A history of GNC in childhood and/or adolescence also predicts poorer mental health in adulthood on multiple symptom domains.
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Affiliation(s)
| | | | - Julia Moore
- Perth Children's Hospital, Nedlands, Australia
| | - Yael Perry
- Telethon Kids Institute, Nedlands, Australia
| | | | - Florian Zepf
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
- German Center for Mental Health (DZPG)
- Center for Intervention and Research on adaptive and maladaptive brain Circuits underlying mental health (C-I-R-C), Jena-Magdeburg-Halle, Germany
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Kim S, Xu Z, Forno E, Qin Y, Park HJ, Yue M, Yan Q, Manni ML, Acosta-Pérez E, Canino G, Chen W, Celedón JC. Cis- and trans-eQTM analysis reveals novel epigenetic and transcriptomic immune markers of atopic asthma in airway epithelium. J Allergy Clin Immunol 2023; 152:887-898. [PMID: 37271320 PMCID: PMC10592527 DOI: 10.1016/j.jaci.2023.05.018] [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] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 04/03/2023] [Accepted: 05/02/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Expression quantitative trait methylation (eQTM) analyses uncover associations between DNA methylation markers and gene expression. Most eQTM analyses of complex diseases have focused on cis-eQTM pairs (within 1 megabase). OBJECTIVES This study sought to identify cis- and trans-methylation markers associated with gene expression in airway epithelium from youth with and without atopic asthma. METHODS In this study, the investigators conducted both cis- and trans-eQTM analyses in nasal (airway) epithelial samples from 158 Puerto Rican youth with atopic asthma and 100 control subjects without atopy or asthma. The investigators then attempted to replicate their findings in nasal epithelial samples from 2 studies of children, while also examining whether their results in nasal epithelium overlap with those from an eQTM analysis in white blood cells from the Puerto Rican subjects. RESULTS This study identified 9,108 cis-eQTM pairs and 2,131,500 trans-eQTM pairs. Trans-associations were significantly enriched for transcription factor and microRNA target genes. Furthermore, significant cytosine-phosphate-guanine sites (CpGs) were differentially methylated in atopic asthma and significant genes were enriched for genes differentially expressed in atopic asthma. In this study, 50.7% to 62.6% of cis- and trans-eQTM pairs identified in Puerto Rican youth were replicated in 2 smaller cohorts at false discovery rate-adjusted P < .1. Replicated genes in the trans-eQTM analysis included biologically plausible asthma-susceptibility genes (eg, HDC, NLRP3, ITGAE, CDH26, and CST1) and are enriched in immune pathways. CONCLUSIONS Studying both cis- and trans-epigenetic regulation of airway epithelial gene expression can identify potential causal and regulatory pathways or networks for childhood asthma. Trans-eQTM CpGs may regulate gene expression in airway epithelium through effects on transcription factor and microRNA target genes.
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Affiliation(s)
- Soyeon Kim
- Division of Pediatric Pulmonary Medicine, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa; Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, Pa
| | - Zhongli Xu
- Division of Pediatric Pulmonary Medicine, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa; School of Medicine, Tsinghua University, Beijing, China
| | - Erick Forno
- Division of Pediatric Pulmonary Medicine, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa; Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, Pa
| | - Yidi Qin
- Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, Pa
| | - Hyun Jung Park
- Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, Pa
| | - Molin Yue
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, Pa
| | - Qi Yan
- Department of Obstetrics and Gynecology, Columbia University, New York, NY
| | - Michelle L Manni
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh
| | - Edna Acosta-Pérez
- Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico
| | - Glorisa Canino
- Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico
| | - Wei Chen
- Division of Pediatric Pulmonary Medicine, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa; School of Medicine, Tsinghua University, Beijing, China
| | - Juan C Celedón
- Division of Pediatric Pulmonary Medicine, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa; Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, Pa.
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Cheng PK, Ponnusamy VK, Prakasham K, Huang HI, Chang WT, Huang PC. Exposure and risk assessment of urinary trans, trans-Muconic acid in school-age children in the vicinity of a petrochemical complex in Central Taiwan. Front Public Health 2023; 11:1234823. [PMID: 37732090 PMCID: PMC10507417 DOI: 10.3389/fpubh.2023.1234823] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/17/2023] [Indexed: 09/22/2023] Open
Abstract
School-age children living near large petrochemical factories may be at high risk of exposure to benzene released during manufacturing processes. We aimed to investigate the urinary concentrations of trans, trans-muconic acid (t,t-MA) in school-age children living near a petrochemical complex and to estimate their cumulative risk of benzene exposure. We examined an established cohort (Taiwan Petrochemical Complex Cohort for Children, TPE3C) of school-age children (aged 6-13 years) who lived near large petrochemical factories in central Taiwan between October 2013 and September 2014. The cohort comprised 297 children from five elementary schools, namely S.-C. Branch (n = 63, school A, ~0.9 km), F.-A. (n = 51, school B, ~2.7 km), C.-T. (n = 63, school C, ~5.5 km), M.-L. (n = 54, school D, ~6.9 km), and L.-F. (n = 66, school E, ~8.6 km). We analyzed the urinary t,t-MA levels of each participant and estimated their daily intake of benzene. We also performed multiple regression analysis to investigate potential risk factors for a high urinary t,t-MA level in the study cohort. The median urinary t,t-MA levels and median estimated benzene daily intake of the children from each school were as follows: school A, 64.07 ng/mL, 11.13 μg/kg/day; school B, 61.01 ng/mL, 15.32 μg/kg/day; school C, 59.38 ng/mL, 14.81 μg/kg/day; school D, 42.35 ng/mL, 11.67 μg/kg/day; school E, undetected, 0.14 μg/kg/day. The distance between a school and a petrochemical complex (greater distance: β = -0.26, 95% confidence interval [CI] = -0.52 to 0.00, p = 0.053), and the age of the children (older age: β = -3.44, 95% CI = -5.90 to -1.46, p < 0.001) were identified as potential risk factors. After confounders were adjusted for, the creatinine adjusted urinary t,t-MA levels of the school-age children tended to be lower when the distance between their school and a petrochemical complex was greater.
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Affiliation(s)
- Po-Keng Cheng
- Department of Finance and Cooperative Management, National Taipei University, New Taipei City, Taiwan
| | - Vinoth Kumar Ponnusamy
- Department of Medicinal and Applied Chemistry, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Research Center for Precision Environmental Medicine, and Ph.D. Program in Environmental and Occupational Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Department of Chemistry, National Sun Yat-Sen University, Kaohsiung City, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital (KMUH), Kaohsiung City, Taiwan
| | - Karthikeyan Prakasham
- Research Center for Precision Environmental Medicine, and Ph.D. Program in Environmental and Occupational Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Hsin-I Huang
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Wan-Ting Chang
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Po-Chin Huang
- Research Center for Precision Environmental Medicine, and Ph.D. Program in Environmental and Occupational Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
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Abstract
Background: Despite existing international standards for the prison management of incarcerated trans people, carceral policies across Australian jurisdictions vary in their availability, breadth, and appropriateness. Trans populations in prison represent a vulnerable population, having specific needs surrounding their health, safety, and wellbeing. Prior reviews into Australian carceral policies highlight where contemporary prison practices fall short of meeting those specific needs. Aims/method: A review was conducted on the available carceral policy documents of each Australian correctional service regime, examining their coverage of issues including healthcare access, placement decisions, and classification systems against international standards and prior Australian recommendations. Forty-one relevant policy documents were reviewed against eighteen benchmark recommendations, along with supplementary data. Results: Australian jurisdictions varied widely on the coverage of the reviewed areas. Benchmark attainment ranged from twelve out of eighteen (Victoria and Western Australia) to three out of eighteen (Queensland). The use of administrative segregation was identified as the area in most need of policy reform. No jurisdiction met every benchmark.Conclusions: This review highlights the need for carceral policy reform across Australian jurisdictions in order to meet the unique needs of incarcerated trans people, especially in the areas of administrative segregation and healthcare access. The review also highlights the need for carceral policy reform to bring Australian jurisdictions in line with each other on the management of incarcerated trans people, to reduce disparate outcomes across states and territories.
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Affiliation(s)
- Charlie Winter
- Department of Criminology, Flinders University, Adelaide, South Australia, Australia
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Strock D, Sivesind TE, Dellavalle RP, Mundinger GS. Isotretinoin Use in Transmasculine Patients and Its Implication on Chest Masculinization Surgery: Scoping Review of the Literature. JMIR Dermatol 2023; 6:e45351. [PMID: 37616418 PMCID: PMC10450534 DOI: 10.2196/45351] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 06/29/2023] [Accepted: 07/23/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Acne often worsens in transmasculine patients who are on prolonged testosterone therapy. Isotretinoin is an oral retinoid used in the treatment of severe or refractory cases of acne, but it has the potential to cause delayed wound healing. Transmasculine patients may potentially be prescribed treatment for acne with isotretinoin while also planning to undergo chest masculinization surgery. OBJECTIVE This scoping review aims to determine whether isotretinoin has a negative impact on postoperative healing in transmasculine patients undergoing chest masculinization surgery. METHODS A scoping review was performed using the PubMed and Ovid databases. A total of 16 publications were selected for inclusion. RESULTS Acne tends to peak in transmasculine patients 6 months after initiation of testosterone treatment. Severe cases can be treated with isotretinoin; however, acne may recur once treatment is discontinued, given ongoing hormone therapy. There is little to no evidence in the medical literature regarding perioperative use of isotretinoin specifically among transmasculine patients undergoing chest masculinization surgery. In general, however, recent studies have found no evidence of increased hypertrophic scars or keloids in patients taking isotretinoin. CONCLUSIONS Further studies are required to strengthen the current evidence that suggests that isotretinoin does not need to be discontinued before or after incisional or excisional surgeries, including chest masculinization surgery in transmasculine patients.
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Affiliation(s)
- Daniel Strock
- School of Medicine, Eastern Virginia Medical School, Norfolk, VA, United States
| | - Torunn E Sivesind
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Robert P Dellavalle
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Dermatology Service, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, United States
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Ussher JM, Quinn GP, Perz J. Editorial: Cancer prevention, treatment and survivorship in the LGBTQIA community. Front Oncol 2023; 13:1227911. [PMID: 37496659 PMCID: PMC10368242 DOI: 10.3389/fonc.2023.1227911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 06/30/2023] [Indexed: 07/28/2023] Open
Affiliation(s)
- Jane M. Ussher
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Gwendolyn P. Quinn
- Department of Obstetrics and Gynecology and Population Health, New York University (NYU) Grossman School of Medicine, New York, NY, United States
| | - Janette Perz
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW, Australia
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Rodrigues L, Pinho AR, Carneiro NS, Nogueira C. Trans(gender) journeys: rights and the (non-)recognition of "human". Front Sociol 2023; 8:1172471. [PMID: 37389282 PMCID: PMC10300639 DOI: 10.3389/fsoc.2023.1172471] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/18/2023] [Indexed: 07/01/2023]
Abstract
A human right paradigm has been challenging the biomedical perspectives that tend to be normalized in the Western context concerning the lives of trans people. The aim of this study is to understand how trans people in Portugal and Brazil perceive the (non-)recognition of their socio-cultural, economic and political rights. Specifically, the study intends to know in what extent these perceptions influence the processes of identity (de)construction. For this purpose, 35 semi-structured interviews were conducted with people self-identified as trans, transsexuals and transvestites in Brazil and Portugal. The narratives of the participants were analyzed according to the thematic analysis method and the following six main themes emerged: (i) Who are the rights for; (ii) Types of rights; (iii) Paradigm of distribution of rights; (iv) Local or global rights; (v) Non-recognition of the "human"; and, (vi) Transphobias (and cissexism). The results allowed the knowledge of rights and the non-recognition of the "human" which is the central organizer of the analysis. Among the main conclusions of this study, we emphasize the circumscription of rights to certain international, regional and/or national contexts; the existence of local instead of global rights, since they are influenced by regional and international law, but they depend on the legislation in force in each country; and the way human rights can also be understood as a platform of invisibility and exclusion of other people. Based on a commitment to social transformation, this article also contributes to rethinking the violence that is exercised on trans people as a continuum, whether through 'normalizing devices' by medical contexts, family contexts, public space, or even through internalized transphobia. Social structures produce and sustain transphobias and, simultaneously, are responsible for fighting them by changing the paradigm about the conception of transsexualities.
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Affiliation(s)
- Liliana Rodrigues
- Center for Psychology at the University of Porto, Faculty of Psychology and Educational Sciences of University of Porto, Porto, Portugal
| | - Ana R. Pinho
- Center for Psychology at the University of Porto, Faculty of Psychology and Educational Sciences of University of Porto, Porto, Portugal
| | | | - Conceição Nogueira
- Center for Psychology at the University of Porto, Faculty of Psychology and Educational Sciences of University of Porto, Porto, Portugal
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Collet S, Kiyar M, Martens K, Vangeneugden J, Simpson VG, Guillamon A, Mueller SC, T'Sjoen G. Gender minority stress in transgender people: a major role for social network. J Sex Med 2023; 20:905-917. [PMID: 37102304 DOI: 10.1093/jsxmed/qdad043] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 01/30/2023] [Accepted: 03/06/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Gender minority individuals, on average, experience higher rates of mental health problems. Mounting work suggests that gender minority stress (GMS) contributes to mental health outcomes in transgender/gender-nonconforming individuals. AIM We assessed whether GMS decreased in transgender people after initiating gender-affirming hormone therapy (GAHT), and we identified social predictors and hormonal associations for GMS at 2 time points. METHODS GMS was surveyed through self-report questionnaires tapping into proximal and distal stressors and coping constructs following the minority stress framework. Eighty-five transgender persons wishing to undertake hormonal interventions were assessed prospectively at start of GAHT and after 7.7 ± 3.5 months (mean ± SD). Sixty-five cisgender persons served as a control group. OUTCOMES (1) Proximal stressors were surveyed by the Beck Depression Inventory II, State-Trait Anxiety Inventory, Scale for Suicide Ideation, Suicidal Thoughts/Attempts, Stigma Consciousness Questionnaire, and Perceived Stress Scale; (2) distal stressors by the Everyday Discrimination Scale; and (3) coping constructs by the Resilience Scale, social network, social standing, and Marlowe Crowne Social Desirability Scale. RESULTS Transgender people experienced higher rates of proximal stressors (Beck Depression Inventory II, State-Trait Anxiety Inventory, Scale for Suicide Ideation, Suicidal Thoughts/Attempts, Perceived Stress Scale) and had lower protective factors (social standing) prior to and during GAHT than cisgender people. Social network and resilience were lower in transgender people relative to cisgender peers only at baseline. Prospectively, decreasing trait anxiety was observed in transgender people. Social factors were adequate predictors of multiple GMS constructs. Specifically, a major role for social network emerged. As for hormonal associations, only serum estradiol levels in transgender women with GAHT were negatively associated with trait anxiety and suicidal thoughts/attempts but positively with resilience and social desirability. CLINICAL IMPLICATIONS Stimulating a social environment supportive of diverse identities, particularly by investing in social networks as a resource for resilience, is likely to alleviate GMS. STRENGTHS AND LIMITATIONS Longer duration of interventions with sex steroid treatment, with continued resilience-enhancing strategies, is needed to observe further alleviation of GMS in transgender persons. Also, objective and subjective GMS identification with heteronormative attitudes and beliefs should be surveyed for good measure when assessing GMS. CONCLUSION Transgender people experienced more GMS throughout study visits than cisgender people did. With a relatively short period of GAHT, some significant changes in and predictors for experienced GMS emerged.
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Affiliation(s)
- Sarah Collet
- Department of Endocrinology, Ghent University Hospital, 9000, Ghent, Belgium
| | - Meltem Kiyar
- Department of Experimental Clinical and Health Psychology, Ghent University, 9000, Ghent, Belgium
| | - Klara Martens
- Department of Endocrinology, Ghent University Hospital, 9000, Ghent, Belgium
| | - Jolien Vangeneugden
- Department of Endocrinology, Ghent University Hospital, 9000, Ghent, Belgium
| | - Victoria G Simpson
- Department of Clinical Psychology and Psychotherapy, University of Bonn, 53113, Bonn, Germany
| | - Antonio Guillamon
- Departamento de Psicobiología, Facultad de Psicología, Universidad Nacional de Educación a Distancia, 28040, Madrid, Spain
| | - Sven C Mueller
- Department of Experimental Clinical and Health Psychology, Ghent University, 9000, Ghent, Belgium
| | - Guy T'Sjoen
- Department of Endocrinology, Center for Sexology and Gender, Ghent University Hospital, 9000, Ghent, Belgium
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Chu J, Zhang C, Yan M, Zhang H, Ge T. TRD-YOLO: A Real-Time, High-Performance Small Traffic Sign Detection Algorithm. Sensors (Basel) 2023; 23:3871. [PMID: 37112213 PMCID: PMC10145582 DOI: 10.3390/s23083871] [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] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/25/2023] [Accepted: 03/27/2023] [Indexed: 06/19/2023]
Abstract
Traffic sign detection is an important part of environment-aware technology and has great potential in the field of intelligent transportation. In recent years, deep learning has been widely used in the field of traffic sign detection, achieving excellent performance. Due to the complex traffic environment, recognizing and detecting traffic signs is still a challenging project. In this paper, a model with global feature extraction capabilities and a multi-branch lightweight detection head is proposed to increase the detection accuracy of small traffic signs. First, a global feature extraction module is proposed to enhance the ability of extracting features and capturing the correlation within the features through self-attention mechanism. Second, a new, lightweight parallel decoupled detection head is proposed to suppress redundant features and separate the output of the regression task from the classification task. Finally, we employ a series of data enhancements to enrich the context of the dataset and improve the robustness of the network. We conducted a large number of experiments to verify the effectiveness of the proposed algorithm. The accuracy of the proposed algorithm is 86.3%, the recall is 82.1%, the mAP@0.5 is 86.5% and the mAP@0.5:0.95 is 65.6% in TT100K dataset, while the number of frames transmitted per second is stable at 73, which meets the requirement of real-time detection.
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Affiliation(s)
- Jinqi Chu
- School of Electronic and Information Engineering, Nanjing University of Information Science and Technology, Nanjing 210044, China
| | - Chuang Zhang
- School of Electronic and Information Engineering, Nanjing University of Information Science and Technology, Nanjing 210044, China
- Jiangsu Key Laboratory of Meteorological Observation and Information Processing, Nanjing 210044, China
| | - Mengmeng Yan
- School of Electronic and Information Engineering, Nanjing University of Information Science and Technology, Nanjing 210044, China
| | - Haichao Zhang
- School of Electronic and Information Engineering, Nanjing University of Information Science and Technology, Nanjing 210044, China
| | - Tao Ge
- School of Electronic and Information Engineering, Nanjing University of Information Science and Technology, Nanjing 210044, China
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14
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Paganelli L, Morel-Journel N, Carnicelli D, Ruffion A, Boucher F, Maucort-Boulch D, Paparel P, Terrier M, Neuville P. Determining the outcomes of urethral construction in phalloplasty. BJU Int 2023; 131:357-366. [PMID: 36221955 DOI: 10.1111/bju.15915] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the surgical and functional outcomes of urethral reconstruction associated with phalloplasty, depending on the surgical techniques and patient history. MATERIALS AND METHODS We conducted a single-centre retrospective study including 89 patients who underwent phalloplasty with urethral reconstruction between 2007 and 2018. Patients included were trans-male patients undergoing gender-affirming surgery and cis-male patients undergoing penile reconstruction after trauma, congenital malformation, or cancer. Urethral reconstructions were performed by free flap or skin graft (total or thin). Secondary urethroplasty may include direct vision urethrotomy, excision-anastomosis, or augmentation urethroplasty (skin graft, buccal mucosa graft). Patient demographics, medical history, peri- and postoperative data were collected from patient files. Functional results were evaluated using individual questionnaires. RESULTS The mean (±sd) follow-up duration was 5.5 (±3.7) years. No significant difference was found for total urethral complication rate (fistula and/or stricture) according to type of urethral construction (70.9% for free flap urethra vs 73.5% for skin graft urethra; P = 0.911), nor according to the patient's grounds for surgery (72.7% for cis-male vs 71.8% for trans-male patients; P = 1). A total of 36 patients (40.5%) answered the functional questionnaire, of whom 80.5% reported usually voiding while standing and 47.5% were comfortable with urinating in public. CONCLUSIONS Urethral construction in phalloplasty is associated with a high complication and revision rate regardless of the type of urethral reconstruction. Voiding in a standing position is generally possible but should not conceal feeble functional results.
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Affiliation(s)
- Léna Paganelli
- Department of Urology, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite Cedex, France
| | - Nicolas Morel-Journel
- Department of Urology, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite Cedex, France
| | - Damien Carnicelli
- Department of Urology, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite Cedex, France
| | - Alain Ruffion
- Department of Urology, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite Cedex, France.,Lyon Est and Lyon Sud Medical School, Claude Bernard University Lyon 1, Lyon, France
| | - Fabien Boucher
- Department of Plastic and Reconstructive Surgery, Hospices Civils de Lyon, Hôpital de la Croix Rousse, Lyon, France
| | - Delphine Maucort-Boulch
- Lyon Est and Lyon Sud Medical School, Claude Bernard University Lyon 1, Lyon, France.,Department of Biostatistics, Hospices Civils de Lyon, Lyon, France
| | - Philippe Paparel
- Department of Urology, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite Cedex, France.,Lyon Est and Lyon Sud Medical School, Claude Bernard University Lyon 1, Lyon, France
| | - Manon Terrier
- Department of Urology, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite Cedex, France
| | - Paul Neuville
- Department of Urology, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite Cedex, France.,Lyon Est and Lyon Sud Medical School, Claude Bernard University Lyon 1, Lyon, France
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15
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Horton C. Institutional cisnormativity and educational injustice: Trans children's experiences in primary and early secondary education in the UK. Br J Educ Psychol 2023; 93:73-90. [PMID: 36082674 PMCID: PMC10087670 DOI: 10.1111/bjep.12540] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 07/22/2022] [Accepted: 07/29/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Transgender children are known to face a wide range of barriers, difficulties and injustices at school. Few studies have focused on the educational experiences of trans pupils who socially transition at or before primary school, with no such studies in the UK. AIMS To learn about the at-school experiences of transgender children who socially transitioned at or before primary school in the UK, listening to children's and parental accounts of navigating cisnormativity in UK primary and early secondary education. SAMPLE The primary sample included 30 parents whose children had socially transitioned under the age of 11 in the UK. This sample was complemented with data directly from 10 of these trans children. The primary sample was accessed through six trans positive parenting groups in the UK, supplemented through snowball sampling. METHODS Semi-structured interviews produced a rich and detailed qualitative data set, that was analysed through inductive thematic analysis. RESULTS Three major themes are presented, highlighting experiences of (i) institutional cisnormativity in UK schools, (ii) a failure to protect trans children and (iii) evidence of educational injustice. The results demonstrate how institutional cisnormativity leaves trans pupils in unsafe educational environments, contributing to school drop-out and trauma. CONCLUSIONS Cisnormative attitudes normalize injustice, making it acceptable for trans children to lose access to education, or to experience trauma in school. Educators, schools and school leaders need to take action to protect trans children in our schools.
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16
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Bourne A, Amos N, Donovan C, Carman M, Parsons M, Lusby S, Lyons A, Hill AO. Naming and Recognition of Intimate Partner Violence and Family of Origin Violence Among LGBTQ Communities in Australia. J Interpers Violence 2023; 38:4589-4615. [PMID: 36036557 DOI: 10.1177/08862605221119722] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Dominant framings of intimate partner violence (IPV) construct the experience as one where a cisgender man enacts violence against a cisgender woman. While often the case, this framing obfuscates the experiences of people who identify as lesbian, gay, bisexual, transgender diverse, or queer (LGBTQ) and may challenge their ability to conceive of their relationship-based experiences as abusive or violent. The extent to which hostile experiences from family of origin violence (FOV) members are conceived or named as violence is also unclear. A large, online, national survey of LGBTQ adults separately assessed experiences of IPV and FOV in two ways: a direct question relating to abuse from a partner/s or family member/s, and a second question (asked irrespective of the previous answer) which sought to establish experience of a nuanced list of abusive acts that can constitute violence (including emotional abuse, LGBTQ-specific forms of violence, and enforced social isolation). Following comparison of responses, multiple regression analyses were performed to assess variation by demographic characteristics. Among the full sample of 6,835 individuals, when asked directly, 30.93% (n = 2,108) of participants indicated that they had ever experienced FOV and 41.73% (n = 2,846) indicated that they had ever experienced IPV. However, when asked about experiences of FOV using the second nuanced question, 43.18% (n = 2,675) responded in ways that indicated that they had ever experienced FOV and 60.71% (n = 3,716) with respect to IPV. The recognition of violence, as indicated by responses to the direct question varied by numerous characteristics, including age, gender, and educational attainment. These findings indicate some LGBTQ people may struggle to recognize or name their family or relationship experiences as abusive or violent, which may complicate their ability or willingness to access professional support. More expansive framings, policies, and responses to IPV and FOV are required.
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Affiliation(s)
- Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
- Kirby Insitute, UNSW Sydney, Australia
| | - Natalie Amos
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | | | - Marina Carman
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Matthew Parsons
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Stephanie Lusby
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Anthony Lyons
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Adam O Hill
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
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17
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Shields L, Stovall T, Colby H. Increasing Inclusivity and Reducing Reactance During Provider-Patient Interactions. Med Decis Making 2023; 43:478-486. [PMID: 36825755 DOI: 10.1177/0272989x231156430] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
BACKGROUND Significant health disparities exist for trans and gender-nonconforming patients, in part caused by a reduced likelihood of seeking health care due to experienced discrimination in health care settings. Increasing inclusivity in patient-provider interactions can decrease barriers to care seeking for these patients, but such advice to providers must be simple to implement and account for potential backlash among certain patient subgroups. METHODS In 3 studies, we use online samples to experimentally test patient reactions to 2 methods of provider inclusivity signaling: verbal sharing of the provider's pronouns and request for the patient's pronouns (a method frequently suggested in the literature) and the provider wearing a pin indicating their pronouns without verbal sharing or requesting that the patient share their pronouns. RESULTS Study 1 finds that political orientation significantly moderated the effect of pronoun request on patient satisfaction with the visit, P = .003; satisfaction with the doctor, P = .003; and willingness to return to the provider, P = .007, with politically liberal participants being more satisfied and more likely to return when pronouns were requested and politically conservative participants less satisfied and less likely to return. Study 2 replicated these findings and demonstrated that such backlash among conservative participants did not occur when inclusivity was indicated via the provider wearing a pin indicating their pronouns. Study 3 showed that while pronoun pins may be subtle enough to not cause backlash, they are noticed by the target community and increase satisfaction and willingness to return among participants who identify as trans, nonbinary, and genderqueer. LIMITATIONS These studies were hypothetical scenario studies run online rather than field studies. CONCLUSIONS These results suggest that recommendations for increasing inclusivity should account for potential negative impacts on the practice from more politically conservative patients and that more subtle methods of indicating an inclusive health care environment are likely to be more implementable for practitioners in the field while still positively affecting the target population. HIGHLIGHTS Increasing inclusivity in health care settings by verbally sharing and requesting pronouns can cause backlash and aggression among politically conservative patients.More subtle methods of inclusivity signaling such as providers wearing pins sharing their own pronouns do not have this type of backlash effect and increase satisfaction and willingness to return among non-cisgender patients.Recommendations for increasing inclusivity in health care settings should consider negative reactions from other patient subgroups to ensure recommendations are those providers are likely to be willing and able to implement long term.
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Affiliation(s)
- Lillianna Shields
- Kelley School of Business, Indiana University, Indianapolis, IN, USA
| | - Tony Stovall
- Kelley School of Business, Indiana University, Indianapolis, IN, USA
| | - Helen Colby
- Kelley School of Business, Indiana University, Indianapolis, IN, USA
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18
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Reinhardt R, Hirzel K, Link G, Eisler SA, Hägele T, Parson MAH, Burke JE, Hausser A, Leonard TA. PKD autoinhibition in trans regulates activation loop autophosphorylation in cis. Proc Natl Acad Sci U S A 2023; 120:e2212909120. [PMID: 36745811 DOI: 10.1073/pnas.2212909120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Phosphorylation is a ubiquitous mechanism by which signals are transduced in cells. Protein kinases, enzymes that catalyze the phosphotransfer reaction are, themselves, often regulated by phosphorylation. Paradoxically, however, a substantial fraction of more than 500 human protein kinases are capable of catalyzing their own activation loop phosphorylation. Commonly, these kinases perform this autophosphorylation reaction in trans, whereby transient dimerization leads to the mutual phosphorylation of the activation loop of the opposing protomer. In this study, we demonstrate that protein kinase D (PKD) is regulated by the inverse mechanism of dimerization-mediated trans-autoinhibition, followed by activation loop autophosphorylation in cis. We show that PKD forms a stable face-to-face homodimer that is incapable of either autophosphorylation or substrate phosphorylation. Dissociation of this trans-autoinhibited dimer results in activation loop autophosphorylation, which occurs exclusively in cis. Phosphorylation serves to increase PKD activity and prevent trans-autoinhibition, thereby switching PKD on. Our findings not only reveal the mechanism of PKD regulation but also have profound implications for the regulation of many other eukaryotic kinases.
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19
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Ramsay A, Safer JD. Update in Adult Transgender Medicine. Annu Rev Med 2023; 74:117-124. [PMID: 36322979 DOI: 10.1146/annurev-med-020222-121106] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Transgender people often face barriers in health care due to lack of access to care, lack of knowledgeable healthcare professionals, discrimination, and gaps in medical and mental health research. Existing research on transgender health has focused heavily on mental health, HIV/AIDS, sexually transmitted diseases/infections, and substance abuse. Gender-affirming hormone therapy and/or surgery allows for some alignment of biology and gender identity. Gender-affirming care may offer quality-of-life benefits, which may outweigh modest concerns related to exogenous hormone therapy. The Endocrine Society treatment guidelines were revised in 2017, and this article reviews recent data that might inform a future guideline revision. Future longitudinal research is needed to close the gap in knowledge in the field of transgender medicine.
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Affiliation(s)
- Alyxandra Ramsay
- Mount Sinai Center for Transgender Medicine and Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA; ,
| | - Joshua D Safer
- Mount Sinai Center for Transgender Medicine and Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA; ,
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20
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López-Sáez MÁ, Angulo-Brunet A, Platero LR, Bochicchio V, Lecuona O. Attitudes towards Trans Men and Women in Spain: An Adaptation of the ATTMW Scale. Int J Environ Res Public Health 2023; 20:1872. [PMID: 36767239 PMCID: PMC9914429 DOI: 10.3390/ijerph20031872] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/15/2023] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
This article presents the results of the adaptation and validation of the Attitudes Toward Trans Men and Women (ATTMW) scale-a measure capable of detecting transphobic positions towards trans men and women-in the Spanish context. A total of 310 prospective teachers from different stages of education participated in the study on its adaptation. In order to provide quantitative evidence of validity, confirmatory factor analysis and regression analysis with different constructs and sociodemographic variables were carried out. Internal consistency reliability was adequate. The study demonstrated that the ATTMW is a psychometrically sound instrument for the assessment of attitudes towards trans people, especially with items that categorize trans women and men as second-class people.
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Affiliation(s)
| | - Ariadna Angulo-Brunet
- Faculty of Psychology and Education Sciences, Universitat Oberta de Catalunya, 08018 Barcelona, Spain
| | - Lucas R. Platero
- Department of Psychology, Rey Juan Carlos University, 28922 Alcorcón, Spain
| | - Vincenzo Bochicchio
- Department of Humanistic Studies, University of Calabria, 87036 Arcavacata, Italy
| | - Oscar Lecuona
- Department of Psychology, Rey Juan Carlos University, 28922 Alcorcón, Spain
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21
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Rivera-Custodio JJ, Soto-Sanchez AV, Alvarado-Cardona EO, Moreta-Ávila F, Silva-Reteguis J, Velez-Perez E, Jiménez-Ricaurte C, Rivera-Segarra E, Rodríguez-Madera SL, Ramos-Pibernus A. Recommendations from Latinx Trans and Non-Binary Individuals to Promote Cancer Prevention in Puerto Rico and Florida. Int J Environ Res Public Health 2023; 20:1213. [PMID: 36673968 PMCID: PMC9859014 DOI: 10.3390/ijerph20021213] [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] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
Latinx trans and non-binary individuals (LTNB) face increased cancer-related health disparities. Studies evidence how barriers at the individual, provider and organizational levels drive cancer disparities among LTNB individuals. These barriers increase the emotional discomfort associated with testing and disengagement from cancer prevention efforts. Moreover, there are no guidelines or interventions that address cancer prevention specifically among LTNB individuals. There is a need to develop interventions informed by the LTNB communities to promote cancer prevention and screening. The study aims to describe the recommendations provided by LTNB individuals to foster cancer screening and prevention in the communities residing in Puerto Rico and Florida. We conducted two online focus groups with a total of 15 LTNB participants. Participants were recruited using non-probabilistic purposive sampling. We used rapid-qualitative analysis for data interpretation. Findings are gathered in three main themes: (1) recommendations for promoting cancer prevention screening among providers; (2) specific recommendations to promote cancer screening among LTBN individuals; and (3) recommendations on delivery formats to foster cancer prevention. These results evidence the need and feasibility of developing community informed tailored interventions targeting cancer screening and preventative care to reduce cancer-related health disparities among the LTNB population.
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Affiliation(s)
| | - Ana V. Soto-Sanchez
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce 00732, Puerto Rico
| | | | | | | | - Erik Velez-Perez
- School of Public Health, Ponce Health Sciences University, Ponce 00732, Puerto Rico
| | - Coral Jiménez-Ricaurte
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce 00732, Puerto Rico
| | - Eliut Rivera-Segarra
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce 00732, Puerto Rico
| | | | - Alixida Ramos-Pibernus
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce 00732, Puerto Rico
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22
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Kichler R. "What Has Kept Me Alive": Transgender Communities and Support. J Homosex 2022; 69:2463-2482. [PMID: 34264806 DOI: 10.1080/00918369.2021.1943277] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Transgender (trans) people in the United States experience staggering marginalization. To survive, trans people turn to their communities for support. In this study, I use in-depth interviews with 10 trans people living in "Townsville" to explore the social support trans and LGBTQ communities provide to trans members. What types of support are available? How does this support enable survival? How do differences in communities influence support? I found four types of support: emotional, institutional, bodily, and financial. The focus and composition of communities determined the types of support provided, and communities were divided based on gender and class. By concentrating on the contexts in which support occurs, my study adds to trans studies and sexualities scholarship concerned with how local trans and LGBTQ communities are experienced.
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23
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Matthews C. "I feel the mind enlarging itself": Anne Lister's gendered reading practices. J Lesbian Stud 2022; 26:367-381. [PMID: 36369937 DOI: 10.1080/10894160.2022.2125142] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
This article argues for the usefulness of deploying a trans lens to examine the diaries of Anne Lister (1791-1840). The author contends that a trans reading may expand possibilities for critical analysis of Lister's gender practices within the context of early-nineteenth-century white, upper-class Halifax society, in addition to existing labels such as "lesbian" and "queer." Examples to illustrate these possibilities are drawn from Lister's reading habits, facilitated by some initial quantitative analysis of Lister's own indexing practices. The article concludes that Lister structures their literary life to enable them to trans certain gender practices, and to fashion a livable gendered existence amidst the competing pressures of class, nationhood, financial security, self-determination, and sexual desire.
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Neri J, Iudici A, Faccio E. Mental health practitioners' narratives about gender transition and the role of diagnosis: A qualitative study in the Italian context. Health Soc Care Community 2022; 30:e2678-e2689. [PMID: 35016261 DOI: 10.1111/hsc.13711] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 11/29/2021] [Accepted: 12/17/2021] [Indexed: 06/14/2023]
Abstract
In many European Countries, a diagnosis is needed to access the gender transition process, which has sparked debate about whether gender variance should be equated with a psychodiagnosis. This study explores mental health practitioners' perspectives about the implications of using the diagnosis for gatekeeping purposes. Semi-structured interviews were conducted with 11 Italian mental health specialists. The personal positions and interpretative repertoires emerging from the interviews centred on three thematic areas: the diagnosis, the practitioner's role, and the clinical relationship. In relation to the development of health promotion policies, findings underscore the importance of exercising reflexivity, adhering to theory and national and/or international guidelines, and analysing people's needs to ensure that the clinical setting is an affirmative space, especially for non-binary people.
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Affiliation(s)
- Jessica Neri
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padua, Padua, Italy
| | - Antonio Iudici
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padua, Padua, Italy
| | - Elena Faccio
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padua, Padua, Italy
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Abstract
This paper contemplates two notions that I have been exploring in relation to the frontier between subjects and collectives. The first is what I call homo-nationalis, the subject formed by and along the organizing principles of nationalism. This subject, I argue, reflects the ideology and reality of the nation-state. It is animated by its imaginaries and unsettled by its fragilities in the deepest psychological sense. The second is what I call the trans-subject. I use this notion inspired by, and wishing to extend the sense of, transing as it pertains to trans-gendering to other categories of subjecthood, aiming to capture the subject's potential to re-form the precepts of subjectivity as it is prescribed for them. I engage these two notions as I reflect on my (countertransference) experience while working with an individual moving across various collective-social frontiers in the process of a religious conversion.
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Durocher K, Caxaj CS. Gender Binaries in Nursing: A Critical Shift to Postgenderism. Nurs Womens Health 2022; 26:262-268. [PMID: 35777491 DOI: 10.1016/j.nwh.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 04/13/2022] [Accepted: 05/01/2022] [Indexed: 10/17/2022]
Abstract
Gender binaries refer to grouping systems that label individuals as male or female. Societal shifts in what defines gender have evolved over the past decade; however, nursing practice remains grounded in these traditional gender binaries. The negative impacts of these practices, specifically in reproductive care, are detrimental for individuals who do not identify within traditional gender binaries. Gender binaries and stereotypes persist because of the prevalence of attitudes; nursing education development; and biases within care areas-specifically, reproductive care-because of issues such as gendered theories and language. Nurses can play a role in enhancing inclusivity by encouraging reflective practice, implementing gender-informed concepts into curricula, and encouraging the use of a postgenderism lens in policy and practice. Improvements in these areas can help foster health care access and safety.
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Goldberg AE, McCormick N, Matsuno E, Virginia H, Beemyn G. Transgender Graduate Students: Considerations, Tensions, and Decisions in Choosing a Graduate Program. J Homosex 2022; 69:1549-1575. [PMID: 33900153 DOI: 10.1080/00918369.2021.1919476] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This study explored how 30 trans graduate students made decisions regarding graduate school. Specifically, it examined how the students chose their graduate program and, secondarily, how they chose their field, what led them to apply to graduate school, and their outness during the application process. In selecting a program, participants considered contextual and personal factors that encompassed commonly cited academic and pragmatic circumstances (e.g., reputation; cost) and factors salient to their gender identity, including state and university climate. Participants identified a number of tensions in choosing a program (e.g., whether to prioritize academic factors over program climate)-although some could not prioritize program climate because their field (e.g., STEM) was not LGBTQ savvy. In applying to graduate school, participants weighed the benefits of being out as trans (e.g., authenticity; finding a "good fit") and risks (e.g., discrimination). Findings have implications for higher education administrators, career counselors, clinicians, and researchers.
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Affiliation(s)
- Abbie E Goldberg
- Department of Psychology, Clark University, Worcester, Massachusetts, USA
| | - Nora McCormick
- Department of Psychology, Clark University, Worcester, Massachusetts, USA
| | - Em Matsuno
- Department of Psychology, Palo Alto University, Palo Alto, California, USA
| | - Haylie Virginia
- Department of Psychology, Clark University, Worcester, Massachusetts, USA
| | - Genny Beemyn
- The Stonewall Center, Crampton Hall, Amherst, Massachusetts, USA
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Bhatt N, Cannella J, Gentile JP. Gender-affirming Care for Transgender Patients. Innov Clin Neurosci 2022; 19:23-32. [PMID: 35958971 PMCID: PMC9341318] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual, plus (LGBTQIA+ or LGBTQ+) individuals face a wide array of health disparities both within and separate from the healthcare system. Transgender patients are subject to microaggressions, misgendering, and harassment from providers, medical staff, and fellow patients. These patients experience drastic disparities in suicidality, depression, anxiety, substance use, malignancy, sexually transmitted disease (STD), and victimization of violence. Providers have the opportunity to intervene and positively impact patient experiences through gender-affirming care, but they first require an adequate knowledge base and understanding of the importance of sensitive and inclusive care. Seemingly small interventions, such as listing one's own pronouns, using gender-neutral language, validating and affirming patients, and utilizing appropriate mental and physical health screenings, can lead to significant impacts on the patient experience, health outcomes, and quality of life. This article will discuss some of the most common disparities and obstacles faced by transgender patients and will argue the paramount role of the provider in establishing gender-affirming care and some high-impact avenues which the provider, regardless of specialty, may pursue when caring for these patients.
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Affiliation(s)
- Nita Bhatt
- Dr. Bhatt is Associate Director of Medical Student Education and Associate Professor in the Department of Psychiatry at Wright State University in Dayton, Ohio
| | - Jesse Cannella
- Mr. Cannella is a medical student at Wright State University Boonshoft School of Medicine in Dayton, Ohio
| | - Julie P Gentile
- Dr. Gentile is Professor and Chair of the Department of Psychiatry at Wright State University in Dayton, Ohio
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Abstract
Trans and non-binary (TNB) people face mental health disparities, likely due to discrimination. This study aims to explore the types of discrimination that TNB people report and the corresponding coping strategies. A sample of 85 TNB adults between the ages of 18 and 46 years old completed two surveys a day for 30 days reporting discrimination, coping, and emotional state. The types of discriminatory events were grouped into four categories: rejection, active transphobia, microaggressions, and community-level transphobia. A total of 3240 discriminatory events were reported, with the most frequent types reported being misgendering and other microaggressions. Results from linear regressions found individuals who experienced rejection were less likely to use support-based coping strategies, while individuals who experienced multiple events were more likely to report marijuana use. These findings should encourage researchers and practitioners to pay attention to discrimination when intervening on mental health with people who identify as TNB.
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Affiliation(s)
- Natalia Truszczynski
- Department of Counseling and Human Development Services, University of Georgia, Athens, Georgia, USA
| | - Anneliese A Singh
- Department of Counseling and Human Development Services, University of Georgia, Athens, Georgia, USA
| | - Nathan Hansen
- Department of Health Promotion and Behavior, University of Georgia, Athens, Georgia, USA
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30
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Forsberg H, Eliason MJ. Healthcare Providers' Pregnancy Prevention Counseling of Trans and Non-Binary Assigned Female at Birth (TNB/AFAB) Patients. J Homosex 2022; 69:356-383. [PMID: 32960736 DOI: 10.1080/00918369.2020.1819713] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Transgender and non-binary people assigned female at birth (TNB/AFAB) have unintended pregnancies, but there is a dearth of information about effective pregnancy prevention care for this population. This needs assessment study aimed at discerning pregnancy prevention care best practices involved interviews of 20 healthcare providers solicited for experience providing pregnancy counseling with this group. Findings were organized via the ecological model, revealing four layers of themes. 1) Social structural level themes related to the gender binary system and other forms of oppression (racism, sexism, heterosexism); 2) the systems level theme related to access to and barriers to care; 3) provider level themes included lack of formal education, need to provide trauma-informed care, and provider discomfort or assumptions; and 4) patient-level themes included the fact that patients do not usually raise issues related to contraception and that TNB/AFAB patients have unique contraception needs. Implications of the findings are discussed.
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Affiliation(s)
- Hannah Forsberg
- Department of Health Education, San Francisco State University, San Francisco, California, USA
| | - Michele J Eliason
- Department of Health Education, San Francisco State University, San Francisco, California, USA
- San Francisco State University, San Francisco, California, USA
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Ha T, Kaiser C, Myong S, Wu B, Xiao J. Next generation single-molecule techniques: Imaging, labeling, and manipulation in vitro and in cellulo. Mol Cell 2022; 82:304-314. [PMID: 35063098 DOI: 10.1016/j.molcel.2021.12.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/14/2021] [Accepted: 12/14/2021] [Indexed: 12/24/2022]
Abstract
Owing to their unique abilities to manipulate, label, and image individual molecules in vitro and in cellulo, single-molecule techniques provide previously unattainable access to elementary biological processes. In imaging, single-molecule fluorescence resonance energy transfer (smFRET) and protein-induced fluorescence enhancement in vitro can report on conformational changes and molecular interactions, single-molecule pull-down (SiMPull) can capture and analyze the composition and function of native protein complexes, and single-molecule tracking (SMT) in live cells reveals cellular structures and dynamics. In labeling, the abilities to specifically label genomic loci, mRNA, and nascent polypeptides in cells have uncovered chromosome organization and dynamics, transcription and translation dynamics, and gene expression regulation. In manipulation, optical tweezers, integration of single-molecule fluorescence with force measurements, and single-molecule force probes in live cells have transformed our mechanistic understanding of diverse biological processes, ranging from protein folding, nucleic acids-protein interactions to cell surface receptor function.
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Affiliation(s)
- Taekjip Ha
- Department of Biophysics and Biophysical Chemistry, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA; Department of Biophysics, Johns Hopkins University, Baltimore, MD 21218, USA; Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA; Howard Hughes Medical Institute, Baltimore, MD 21205, USA.
| | - Christian Kaiser
- Department of Biology, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Sua Myong
- Department of Biophysics, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Bin Wu
- Department of Biophysics and Biophysical Chemistry, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Jie Xiao
- Department of Biophysics and Biophysical Chemistry, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
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MacKinnon KR, Kia H, Lacombe-Duncan A. Examining TikTok's Potential for Community-Engaged Digital Knowledge Mobilization With Equity-Seeking Groups. J Med Internet Res 2021; 23:e30315. [PMID: 34889739 PMCID: PMC8704107 DOI: 10.2196/30315] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/30/2021] [Accepted: 11/02/2021] [Indexed: 01/30/2023] Open
Abstract
Social media is increasingly being leveraged by researchers to engage in public debates and rapidly disseminate research results to health care providers, health care users, policy makers, educators, and the general public. This paper contributes to the growing literature on the use of social media for digital knowledge mobilization, drawing particular attention to TikTok and its unique potential for collaborative knowledge mobilization with underserved communities who experience barriers to health care and health inequities (eg, equity-seeking groups). Setting the TikTok platform apart from other social media are the unique audiovisual video editing tools, together with an impactful algorithm, that make knowledge dissemination and exchange with large global audiences possible. As an example, we will discuss digital knowledge mobilization with trans and nonbinary (trans) communities, a population that experiences barriers to health care and is engaged in significant peer-to-peer health information sharing on the web. To demonstrate, analytics data from 13 selected TikTok videos on the topic of research on gender-affirming medicine (eg, hormonal therapy and surgeries) are presented to illustrate how knowledge is disseminated within the trans community via TikTok. Considerations for researchers planning to use TikTok for digital knowledge mobilization and other related community engagement with equity-seeking groups are also discussed. These include the limitations of TikTok analytics data for measuring knowledge mobilization, population-specific concerns related to community safety on social media, the spread of disinformation, barriers to internet access, and commercialization and intellectual property issues. This paper concludes that TikTok is an innovative social media platform that presents possibilities for achieving transformative, community-engaged knowledge mobilization among researchers, underserved health care users, and their health care providers, all of whom are necessary to achieve better health care and population health outcomes.
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Affiliation(s)
| | - Hannah Kia
- School of Social Work, The University of British Columbia, Vancouver, BC, Canada
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Tate CC. Is lesbian identity obsolete? Some (limited) answers and further questions from a unique philology of human behavioral science perspective. J Lesbian Stud 2021; 26:199-215. [PMID: 34806544 DOI: 10.1080/10894160.2021.2000561] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Many scholarly disciplines focusing exclusively on human behavior can and do approach philology in some form in the conduct of their analyses, especially implicitly. "Philology" is generally understood to mean a study of oral and written records, particularly in their original form to determine either their authenticity and/or their original meaning-especially at the time of their development and delivery. This present article sketches a philology of human behavioral science perspective to make explicit what is largely implicit in the conduct of the science (most notably in psychological science) to answer the provocative question of this special issue ("Is lesbian identity obsolete?"). From this new perspective, I ask and answer (to the extent possible) three interrelated questions about the current or future obsolescence of the concept "lesbian identity." The first question is whether lesbian identity like predecessor terms for the larger concept will become obsolete in the future. A second question is whether lesbian identity should become obsolete based on its potentially less inclusive meaning-either (a) from the origin terms that comprise it or (b) in comparison to other terms in the lexicon at present. A third question concerns whether lesbian identity may wane now (at the time of this writing) and then wax again in the future (some decade[s] later from this writing).
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Bower-Brown S, Zadeh S. "I guess the trans identity goes with other minority identities": An intersectional exploration of the experiences of trans and non-binary parents living in the UK. Int J Transgend Health 2021; 22:101-112. [PMID: 34806080 PMCID: PMC8040685 DOI: 10.1080/26895269.2020.1835598] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Background: Research on trans and non-binary parents has identified challenges in integrating parenting and gender identities, and in navigating stigmatizing environments. Studies have also highlighted the unique experience of transmasculine pregnancy and its violation of cisheteronormative ideals, yet little is known about either the experiences of trans and non-binary parents who have used diverse routes to parenthood or their experiences beyond the transition to parenthood. Research on the way in which gender intersects with other identity categories to shape the experiences of trans and non-binary parents is also lacking. Aims: This study aimed to explore the experiences of trans and non-binary parents in the UK within different parenting spaces both during and after the transition to parenthood, using an intersectional framework. Methods: Eleven semi-structured interviews were conducted with trans and non-binary parents and analyzed according to the principles of thematic analysis. Results: Three main themes were identified, reflecting participants' experiences within the "highly normative world" of parenting, and the strategies of "being a pragmatic parent" and "being a pioneering parent" used to navigate this. Discussion: The findings of this study highlight the usefulness of an intersectional approach for research on this topic. Findings also evidence a need for inclusive, and queer, parenting spaces for trans and non-binary parents, so that parents and children can enjoy the benefits of trans parenting.
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Affiliation(s)
| | - Sophie Zadeh
- Thomas Coram Research Unit, University College London Institute of Education, London, UK
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35
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Sherwood J, Lankiewicz E, Castellanos E, O'Connor N, Theron L, Restar A. Assessing inclusion of trans people in HIV national strategic plans: a review of 60 high HIV prevalence countries. J Int AIDS Soc 2021; 24:e25837. [PMID: 34761871 PMCID: PMC8582022 DOI: 10.1002/jia2.25837] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/13/2021] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Trans people are disproportionately impacted by HIV yet have not been adequately prioritized in national HIV responses or policy documents. This review aims to understand the extent of meaningful inclusion of trans people in national strategic plans (NSPs) for HIV/AIDS as an essential step in ensuring that HIV policy aligns with epidemiologic data, and trans-specific programming is funded, implemented and sustained. METHODS HIV NSPs from 60 countries, across five global regions, were assessed for the level of inclusion of trans populations between January and March 2021. The most recently available NSP for each country, published after 2011, was obtained through publicly accessible online sources or through researcher networks. Data were manually extracted from NSPs using a framework of indicators focusing on trans inclusion in these five major sections of NSPs: (1) narratives; (2) epidemiological data; (3) monitoring and evaluation (M&E) indicators and targets; (4) activities; and (5) budgets. RESULTS AND DISCUSSION Within all reviewed NSPs, 65.0% (39/60) mentioned trans people in at least one of the five key sections but only 8.3% (5/60) included trans people in all five key sections. Trans people were more commonly mentioned in the background/narratives of NSPs (61.7%, 37/60) but less commonly included NSP activities (38.3%, 23/60), in M&E indicators and targets (23.7%, 14/60), in epidemiological data (20.0% 12/60), and in NSP budgets (13.3%, 8/60). Countries in the Asia and Pacific region most frequently included trans people in all five key sections (38%, 5/13), while no countries in Eastern and Southern Africa included trans people in all NSP sections. CONCLUSIONS This analysis finds substantial gaps in the inclusion of trans populations in NSPs globally. Results highlight the pressing need for states, technical partners, and international funders to engage with trans communities to improve trans-inclusion in all key sections of NSPs. Trans inclusion in NSPs is an essential step towards reaching the populations most at risk of HIV and ultimately achieving country-level epidemic control.
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Affiliation(s)
- Jennifer Sherwood
- Public Policy OfficeamfARFoundation for AIDS ResearchWashingtonDCUSA
| | - Elise Lankiewicz
- Public Policy OfficeamfARFoundation for AIDS ResearchWashingtonDCUSA
| | | | | | | | - Arjee Restar
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
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Toze M, Westwood S, Hafford-Letchfield T. Social support and unmet needs among older trans and gender non-conforming people during the COVID-19 'lockdown' in the UK. Int J Transgend Health 2021; 24:305-319. [PMID: 37519914 PMCID: PMC10373604 DOI: 10.1080/26895269.2021.1977210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Background Previous research has suggested that older trans and gender non-conforming (TGNC) people may face particular challenges related to stigma, social exclusion and discrimination in later life. However, direct data on social support and needs in older TGNC population both internationally and within the UK is limited due to the small, dispersed nature of this population, and the absence of specific data collection on aging TGNC populations. During the UK COVID-19 lockdown in summer 2020, older people and those with long-term health conditions were advised to adopt particular precautions. Aims This study aimed to explore older TGNC people's social support networks, key concerns and unmet needs during the COVID-19 'lockdown'. Methods A UK cross-sectional survey of LGBT + people aged 60+ (n = 375) was undertaken during the lockdown. This paper analyses responses from the subset (n = 38) of TGNC participants. Results The majority of TGNC respondents described diverse social networks, often centered around friends and non-kin social networks, although partners and adult children were also significant for some. In most cases, those with existing strong networks continued to maintain social connections during lockdown, albeit with some regrets about loss of activities and face-to-face connection. However, a minority of respondents had experienced greater challenges prior to lockdown, and may have been at increased vulnerability during the pandemic, for example indicating that they had no-one to call on for practical support in an emergency. When asked about unmet needs and challenges, social isolation was repeatedly raised as the most frequent concern. Several respondents also mentioned issues specifically affecting TGNC communities, including access to gender affirming care and a perceived rise in social intolerance. Conclusions Health and social care providers should be aware of the diversity of support networks within TGNC communities. There may also be benefits in community sector interventions to help older TGNC build and maintain strong social networks.
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Affiliation(s)
- Michael Toze
- Lincoln Medical School, University of Lincoln, Lincoln, UK
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Abstract
Despite the growing population of youth identifying with a transgender or nonbinary gender identity, research on gender-diverse individuals' educational outcomes is limited. This study takes advantage of the first nationally representative, population-based data set that includes measures of gender identity and educational outcomes: the High School Longitudinal study of 2009. Using minority stress and structural symbolic interactionist frameworks, we examine the association between gender identity and high school and college educational outcomes. We compare the educational outcomes of gender-diverse youth-binary transgender, nonbinary, and gender unsure-with those of cisgender youth, and also examine differences within the gender-diverse population. Given the strong link between minority stress and educational experiences among gender-diverse youth, we examine differences in outcomes before and after accounting for school belonging and emotional distress. We also account for individuals' social-structural location, arguing that social positionality shapes both gender identity and educational outcomes. Results indicate important differences in educational outcomes within the gender-diverse population: Whereas binary transgender and gender-unsure youth exhibit educational disadvantage, relative to cisgender youth, nonbinary youth do not. The gender-unsure disadvantage remains even after accounting for differences in social-structural location and social-psychological factors associated with minority stress.
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Ussher JM, Hawkey A, Perz J, Liamputtong P, Sekar J, Marjadi B, Schmied V, Dune T, Brook E. Gender affirmation and social exclusion amongst trans women of color in Australia. Int J Transgend Health 2021; 23:79-96. [PMID: 35403115 PMCID: PMC8986236 DOI: 10.1080/26895269.2021.1947432] [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] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
INTRODUCTION Transgender (trans) women of color navigate the intersected identity frames of gender, race, social class and sexuality, whilst facing multiple layers of stigma, discrimination and violence during and following gender affirmation. However, little is known about the ways in which trans women of color negotiate gender affirmation, in the context of the risk of social exclusion and violence. AIM This article discusses the experience and construction of gender transitioning and gender affirmation for trans women of color living in Australia, associated with the risk of social exclusion or violence. METHOD In-depth interviews and photovoice were conducted with 31 trans women of color, analyzed through theoretical thematic analysis informed by intersectionality theory. RESULTS The following themes were identifed: 1) 'Gender affirmation: A bittersweet experience', with three subthemes: 'Self-empowerment is tempered by family rejection', 'Migration facilitates gender affirmation' and 'Gender affirmation and social support'; 2) 'Being a trans woman of color', subthemes: 'Bodily agency and passing', 'Femininity as pleasure and cultural self-expression', and 'Resisting archetypal White hetero-femininity'; 3) 'Hormones, surgical intervention and navigating the health system'. CONCLUSION Gender transitioning and gender affirmation involved the intersection of gender, cultural, social class and sexual identities, accomplished through personal agency and with the support of significant others. To ensure that policy and support services meet the needs of trans women of color, it is critical that the voices of such multiply-marginalized women are at the center of leadership, program and policy development.
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Affiliation(s)
- Jane M. Ussher
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith South, Australia
| | - Alexandra Hawkey
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith South, Australia
| | - Janette Perz
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith South, Australia
| | - Pranee Liamputtong
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith South, Australia
| | - Jessica Sekar
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith South, Australia
| | - Brahmaputra Marjadi
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith South, Australia
| | - Virginia Schmied
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith South, Australia
| | - Tinashe Dune
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith South, Australia
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Rogers MM. Exploring the Domestic Abuse Narratives of Trans and Nonbinary People and the Role of Cisgenderism in Identity Abuse, Misgendering, and Pathologizing. Violence Against Women 2021; 27:2187-2207. [PMID: 34448660 PMCID: PMC8404723 DOI: 10.1177/1077801220971368] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Drawing on data from two empirical studies, this article employs cisgenderism as a conceptual tool to explore trans people’s experiences of domestic violence and abuse (DVA). Distinct modes of cisgenderism are analyzed. These are identity abuse, microaggressions, misgendering, and pathologizing practices. Qualitative data were collected via semistructured interviews (n = 24). Two inclusion criteria were used for this secondary analysis requiring participants to self-identify as trans or nonbinary and have experience of DVA. The findings illuminate the extent of cisgenderism as underpinning experiences of DVA. The article ends with a call for further theoretical and empirical research in this regard.
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Low WYJ, Tai JCJ. Response to: integrating trans health knowledge through instructional design. Educ Prim Care 2021; 33:127. [PMID: 34424148 DOI: 10.1080/14739879.2021.1968320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Opening with a reflection on lesbian invisibility, "Lesbian Vitality: A Provocation" challenges the idea of lesbian erasure, particularly when it is used in relationship to transgender people. Arguing for a multiplicity of lesbian identities and spaces for capacious lesbian formations, the author draws from the history of the periodical Sinister Wisdom and her experiences editing it to call for lesbian vitality as an alternative to erasure and as a focus for lesbian and queer women's community-making and cultural production.
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Markovic L, McDermott DT, Stefanac S, Seiler-Ramadas R, Iabloncsik D, Smith L, Yang L, Kirchheiner K, Crevenna R, Grabovac I. Experiences and Interactions with the Healthcare System in Transgender and Non-Binary Patients in Austria: An Exploratory Cross-Sectional Study. Int J Environ Res Public Health 2021; 18:ijerph18136895. [PMID: 34199049 PMCID: PMC8297154 DOI: 10.3390/ijerph18136895] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/15/2021] [Accepted: 06/24/2021] [Indexed: 11/16/2022]
Abstract
Medical care of transgender and non-binary (TNB) patients if often a complex interdisciplinary effort involving a variety of healthcare workers (HCWs) and services. Physicians not only act as gatekeepers to routine or transitioning therapies but are also HCWs with the most intimate and time-intensive patient interaction, which influences TNB patients' experiences and health behaviors and healthcare utilization. The aim of this study was to investigate the physician-patient relationship in a sample of TNB individuals within the Austrian healthcare system, and explore its associations with sociodemographic, health-, and identity-related characteristics. A cross-sectional study utilizing an 56-item online questionnaire, including the Patient-Doctor Relationship Questionnaire 9 (PDRQ-9), was carried out between June and October 2020. The study involved TNB individuals 18 or older, residing in Austria, and previously or currently undergoing medical transition. In total, 91 participants took part, of whom 33.0% and 25.3% self-identified as trans men and trans women, respectively, and 41.8% as non-binary. Among participants, 82.7% reported being in the process of medical transitioning, 58.1% perceived physicians as the most problematic HCWs, and 60.5% stated having never or rarely been taken seriously in medical settings. Non-binary participants showed significantly lower PDRQ-9 scores, reflecting a worse patient-physician relationship compared to trans male participants. TNB patients in Austria often report negative experiences based on their gender identity. Physicians should be aware of these interactions and reflect potentially harmful behavioral patterns in order to establish unbiased and trustful relations.
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Affiliation(s)
- Lovro Markovic
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, 1090 Vienna, Austria; (L.M.); (R.S.-R.); (D.I.); (I.G.)
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, 1090 Vienna, Austria;
| | - Daragh T. McDermott
- NTU Psychology, School of Social Sciences, Nottingham Trent University, Nottingham NG1 4FQ, UK;
| | - Sinisa Stefanac
- Institute of Outcomes Research, Centre for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, 1090 Vienna, Austria
- Correspondence:
| | - Radhika Seiler-Ramadas
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, 1090 Vienna, Austria; (L.M.); (R.S.-R.); (D.I.); (I.G.)
| | - Darina Iabloncsik
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, 1090 Vienna, Austria; (L.M.); (R.S.-R.); (D.I.); (I.G.)
| | - Lee Smith
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge CB1 1PT, UK;
| | - Lin Yang
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB T2S 3C3, Canada;
- Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Kathrin Kirchheiner
- Department of Radiation Oncology, Medical University of Vienna, 1090 Vienna, Austria;
| | - Richard Crevenna
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, 1090 Vienna, Austria;
| | - Igor Grabovac
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, 1090 Vienna, Austria; (L.M.); (R.S.-R.); (D.I.); (I.G.)
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Jones BA, Bowe M, McNamara N, Guerin E, Carter T. Exploring the mental health experiences of young trans and gender diverse people during the Covid-19 pandemic. Int J Transgend Health 2021; 24:292-304. [PMID: 37519915 PMCID: PMC10373615 DOI: 10.1080/26895269.2021.1890301] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Background Both anxiety and depression have been identified as negative health outcomes associated with the distressing nature of the Covid-19 pandemic, especially among young people. Within this age demographic, trans and gender diverse people may be particularly vulnerable to pandemic-related mental health outcomes, such as anxiety and depression, due to the social challenges, gender dissonance, and poor mental health they experience. Furthermore, the social distancing measures impose several unique social and help-seeking challenges which may further contribute to the worsening of mental health. While there has been acknowledgment that vulnerable populations may be disproportionally affected by the pandemic, the experiences of trans and gender diverse youth have received very little empirical attention. Aims To explore the mental health impact of Covid-19 on the lives of young trans and gender diverse people in the UK. Method In total, 243 people took part in an online survey between May and July in 2020. Eighty-two people were removed due to providing insufficient data. The analyzed dataset therefore comprised of 161 respondents ranging from 16 to 25 years (M = 20; SD = 2.68). Participants were asked how social distancing measures had impact on their social lives, mental health and access to health services. They were also asked to complete validated measures of anxiety and depression. Results This study found that those who experienced a greater impact of the Covid-19 outbreak and its associated social distancing measures, reported poorer mental health. Lack of social support, negative interpersonal interactions, unsupportive and non-affirming living environments and the inability to access mental health support and gender-affirming interventions were all factors that were associated with poor mental health. Conclusion The findings provide specific direction for the tailoring of mental health service delivery to this population, noting the need for private, safe spaces in which young people can feel supported and have their gender identity affirmed.
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Affiliation(s)
- Bethany A. Jones
- Department of Psychology, Nottingham Trent University, Nottingham, UK
| | - Mhairi Bowe
- Department of Psychology, Nottingham Trent University, Nottingham, UK
| | - Niamh McNamara
- Department of Psychology, Nottingham Trent University, Nottingham, UK
| | - Ella Guerin
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Tim Carter
- School of Health Sciences, University of Nottingham, Nottingham, UK
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Abstract
BACKGROUND Many transgender (trans) parents experience challenges related to their mental health, which can affect and impact on their experiences of parenting, however there is scant research on how Australian trans parents contextualize and experience their mental health, the support they receive for it, and impacts within the family context. AIMS The present study aims to address these gaps in the literature, through examining how Australian trans parents contextualize and experience issues around their mental health, and their experience of formal and informal support for their mental health? METHODS This study aimed to explore these experiences, through a qualitative research design using online open-ended survey data and one-on-one interviews, with 66 trans parents, aged 24-67 years old. Data was analyzed using thematic analysis. RESULTS Many participants reported significant challenges in relation to their mental health: such as depression, anxiety, and suicidal ideation, which reportedly made parenting challenging. However, participants reported that gender affirmation as well as family and social support had a positive impact on their mental health. The majority of participants reported feeling they had to educate their therapist, that they were pigeon-holed by their gender identity or, had concerns about confidentiality. However, some participants expressed positive interactions with therapists, particularly therapists specializing in, or knowledgeable of, trans health. CONCLUSION The results reinforced the need for mental health professionals and associated services to be competent in treating trans parents and reiterated the positive impact of family and social support, as well as support for gender affirmation, on the mental health of trans parents and their ability to parent.
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Affiliation(s)
- Rosie Charter
- Translational Health Research Institute, Western Sydney University, Penrith, Australia
| | - Jane Ussher
- Translational Health Research Institute, Western Sydney University, Penrith, Australia
| | - Janette Perz
- Translational Health Research Institute, Western Sydney University, Penrith, Australia
| | - Kerry Robinson
- School of Social Sciences, Western Sydney University, Penrith, Australia
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Abstract
LGBTQ+ youth experience health disparities compared with heterosexual and cisgender youth. Community-based, positive youth development organizations are an important resource to support and affirm LGBTQ+ youth. This study aimed to identify the opportunities and challenges in supporting LGBTQ+ youth within 4-H. The study took place in one state in the United States within a 4-H program and employed qualitative, community-based methods using SWOT (strengths, weaknesses, opportunities, threats) analyses and focus groups of 4-H staff, support staff, volunteers, and youth participants. The majority of participants were White and middle class with direct connections to the 4-H program. Thematic analyses were conducted by multiple analysts until consensus was reached. Challenges and opportunities emerged in 3 themes: (a) organizational climate; (b) policies and procedures; and (c) training, education, and resources. Two additional themes included opportunities only: (a) community engagement and (b) youth-specific resources. This study has important implications for the 4-H program, rural community practice, and research, including strategies to improve LGBTQ+ inclusivity through education, programs and policies, hiring, and community partnerships. Additionally, this study highlights the opportunity and unique positionality of the 4-H program to amplify youth voices in the creation of youth-specific resources.
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Affiliation(s)
- Joseph J Rand
- Extension Center for Youth Development, University of Minnesota
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Horton C. Thriving or Surviving? Raising Our Ambition for Trans Children in Primary and Secondary Schools. Front Sociol 2020; 5:67. [PMID: 33869473 PMCID: PMC8022833 DOI: 10.3389/fsoc.2020.00067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 07/27/2020] [Indexed: 05/14/2023]
Abstract
As more trans children find the confidence to make themselves known in our primary and secondary schools, school teachers and administrators look for guidance on how to best support trans pupils. This article synthesises findings from global literature on trans children in primary and secondary education (K1-12 in the US), extracting key themes and conclusions. It then examines the most recent UK school guidance documents on trans inclusion, assessing which lessons and recommendations from global literature are represented. The article highlights existing good practices in visibility and representation and in protection from violence and harassment. Several areas where additional effort is needed are identified, including action on environmental stress and cisnormativity, addressing barriers to school trans-inclusivity and institutional accountability. A number of important shifts are called for: from adaptation on request to pre-emptive change; from accommodation to a rights-based approach; from pathologisation to trans-positivity. Finally, the article raises expectations on what it means to be an ally for trans children in education.
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Affiliation(s)
- Cal Horton
- Education Department, Goldsmiths University, London, United Kingdom
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Willis P, Dobbs C, Evans E, Raithby M, Bishop JA. Reluctant educators and self-advocates: Older trans adults' experiences of health-care services and practitioners in seeking gender-affirming services. Health Expect 2020; 23:1231-1240. [PMID: 32677100 PMCID: PMC7696140 DOI: 10.1111/hex.13104] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 06/23/2020] [Accepted: 06/25/2020] [Indexed: 11/30/2022] Open
Abstract
Background Trans‐identifying individuals experience unique barriers and challenges in negotiating health‐care systems due to the cisnormative attitudes and practices which obstruct the receipt of trans‐inclusive care. To date, there has been little exploration of older trans consumers’ experiences of contemporary health‐care services when seeking to transition medically in later life. Objectives Qualitative findings are presented from a study of trans ageing and trans‐related health and social care needs in Wales, UK (2016‐18). The objectives are to (1) examine supportive and obstructive points of interaction with health‐care professionals, and (2) identify key learning messages for improving trans‐related health care from the perspectives of trans‐identifying adults in later life. Design Trans‐identifying participants self‐selected to take part in two interviews—a life‐history interview and a semi‐structured interview. Interview data were analysed thematically using the framework method approach. Setting and participants This paper focuses on the accounts of 19 participants (50‐74 years of age) who identified as trans and were seeking to transition medically in mid‐ to later life. Results Findings indicate how older trans patients are positioned as reluctant educators for GPs in primary care settings and illustrate the transphobic practices and cisnormative assumptions encountered across health‐care interactions and systems that impede their journey of transitioning in later life. Discussion and conclusions Messages from this study speak to the importance of improving professionals’ knowledge of gender identity diversity across the life course and making changes at a systemic level in redressing cisnormative assumptions and systems that reinforce inequities on the basis of gender identity.
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Affiliation(s)
- Paul Willis
- School for Policy Studies, University of Bristol, Bristol, UK
| | - Christine Dobbs
- Centre for Innovative Ageing, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Elizabeth Evans
- Centre for Innovative Ageing, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Michele Raithby
- Centre for Innovative Ageing, College of Human and Health Sciences, Swansea University, Swansea, UK
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Van Hout MC, Kewley S, Hillis A. Contemporary transgender health experience and health situation in prisons: A scoping review of extant published literature (2000-2019). Int J Transgend Health 2020; 21:258-306. [PMID: 34993510 PMCID: PMC8726645 DOI: 10.1080/26895269.2020.1772937] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Background: Many jurisdictions globally have no specific prison policy to guide prison management and prison staff in relation to the special needs of lesbian, gay, bisexual and transgender (LGBT) prisoners despite the United Nations for the Treatment of Prisoners Standard Minimum Rules and the updated 2017 Yogyakarta Principles on the Application of International Human Rights Law in relation to Sexual Orientation and Gender Identity. Within LGBT prison groups, transgender people represent a key special population with distinct needs and rights, with incarceration rates greater than that of the general population, and who experience unique vulnerabilities in prisons. Aims/Method: A scoping review was conducted of extant information on the transgender prison situation, their unique health needs and outcomes in contemporary prison settings. Fifty-nine publications were charted and thematically analyzed. Results: Five key themes emerged: Transgender definition and terminology used in prison publications; Prison housing and classification systems; Conduct of correctional staff toward incarcerated transgender people; Gender affirmation, health experiences and situational health risks of incarcerated transgender people; and Transgender access to gender-related healthcare in prison. Conclusions: The review highlights the need for practical prison based measures in the form of increased advocacy, awareness raising, desensitization of high level prison management, prison staff and prison healthcare providers, and clinical and cultural competence institutional training on transgender patient care. The review underscores the need to uphold the existing international mandates to take measures to protect incarcerated transgender people from violence and stigmatization without restricting rights, and provide adequate gender sensitive and gender affirming healthcare, including hormone therapy and gender reassignment.
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Affiliation(s)
- Marie Claire Van Hout
- Faculty of Health, Public Health Institute, Liverpool John Moores University, Liverpool, UK
| | - Stephanie Kewley
- Faculty of Health, School of Psychology, Liverpool John Moores University, Liverpool, UK
| | - Alyson Hillis
- Faculty of Health, Public Health Institute, Liverpool John Moores University, Liverpool, UK
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Kirlew MI, Lord H, Weber J. Exploring health and social care professionals' initial perceptions of caring for trans patients. Nurs Stand 2020; 35:e11383. [PMID: 32363844 DOI: 10.7748/ns.2020.e11383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2019] [Indexed: 11/09/2022]
Abstract
AIM To investigate the initial perceptions that health and social care professionals have when caring for trans patients. METHOD This was a qualitative study that involved semi-structured interviews with five participants in one geographical area as a snapshot study. The research transcripts were analysed, and themes were identified and examined. FINDINGS The main themes identified from the interviews with participants were: discrimination; lack of understanding of the trans body and gender identity; confusion around terminology; cultural perceptions and attitudes towards trans people; professionalism; the need for trans awareness training; and social recognition for trans staff members. CONCLUSION The findings of this study suggest there is a need to develop trans awareness training for staff working in areas of practice that are likely to provide care for trans people, such as acute care, emergency departments and mental health services. This could improve health outcomes for trans people and increase the likelihood of them accessing health and social care services in the future.
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Affiliation(s)
| | - Helen Lord
- School of Health and Midwifery, University of Bolton, Bolton, Greater Manchester, England
| | - Joey Weber
- School of Health and Wellbeing, University of Bolton, Bolton, Greater Manchester, England
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Abstract
Background: A surgical readiness assessment is a major step in the medical journey of trans people seeking gender-affirming surgery. Much of the peer-reviewed literature surrounding surgical readiness assessments emphasizes the perspectives of academics and clinicians, leaving the voices of trans and gender diverse patients largely unheard. Aims: This paper foregrounds patient experiences with surgery readiness assessments to discuss the tensions, challenges and opportunities they generate. Methods: We conducted a thematic analysis of 35 in-depth interviews with trans people who accessed or were seeking to access gender-affirming surgery in British Columbia. Results: We developed three main themes to capture participants' narratives of their surgical assessment experiences. The first, assessments as gatekeeping, explores the stories of people who described their assessments as outdated and even discriminatory processes. The second, assessments as a barrier to care, discusses the informational missteps, bureaucratic regulations, economic issues, and geographic concerns that made assessments difficult to access. The third, assessments as useful, includes positive stories about assessments that often involved feeling supported by an assessor and feeling prepared for the next steps. Discussion: These narratives demonstrate how much variation exists among people's experiences of readiness assessments for gender-affirming surgery. No matter how their actual assessment turned out, many participants approached their appointments with a great deal of anxiety and trepidation. We attributed this stress was to challenges ranging from lengthy wait times, arbitrary medical gatekeeping, a lack of access to knowledgeable and supportive providers, unclear or changing administrative processes, and insufficient communication. To address these challenges, it is crucial for the medical system to create more accessible pathways with centralized, up-to-date information for people trying to access assessments. Patients are best served by multi-disciplinary gender-affirming teams that provide individualized care.
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Affiliation(s)
| | - Margaret MacAulay
- School of Nursing, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Monica Shannon
- School of Nursing, The University of British Columbia, Vancouver, British Columbia, Canada
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