Gender incongruence in Denmark, a quantitative assessment

INTRODUCTION

The number of persons with gender incongruence referred to health care is increasing, but national data on the incidence of gender incongruence are lacking. The aim of this study was to quantify the development in number of individuals with gender incongruence over time and to estimate the national incidence in Denmark.

MATERIAL AND METHODS

Historical descriptive cohort study. Individuals older than 18 years with legal sex-change in their person registration number were achieved from Statistics Denmark, and the National Health Register provided data on contact diagnoses related to gender-identity conditions. By combining these two data sources, we made estimates on incidence and incidence rates for individuals with gender incongruence in Denmark through a 41-year period 1980-2020.

RESULTS

Through 1980-2020, the annual number of legal sex-changes increased in individuals assigned female at birth from 5 to approximately 170 and among individuals assigned male at birth from 10 to approximately 150. The cumulative number of legal sex-changes at the end of 2019 was 1275 assigned female at birth and 1422 assigned male at birth and 66% of the legal sex-changes were in individuals below 30 years. Correspondingly, the annual number of contacts with the healthcare system due for gender-identity-related conditions increased from 30 during 1990-1999 to around 500 in 2017 (both genders combined), with a 10-fold increase from 2010 to 2017.

CONCLUSIONS

The number of legal sex-changes and healthcare contacts due to gender-identity-related diagnoses increased substantially over the last 40 years with a more than 10-fold increase during the last decade. This calls for research on possible explanations for this increase, for research on the short-term and long-term health consequences of hormonal and surgical treatment regimens and for ensuring adequate healthcare facilities.

Multi-Photochromic Molecules Based on Dihydroazulene Units

Multi-photochromic systems incorporating individually addressable switching units are attractive for development of advanced data storage devices. Here, we present the synthesis and properties of a selection of such molecular systems incorporating the dihydroazulene/vinylheptafulvene (DHA/VHF) photo-/thermoswitch. The influence of the linker (meta-phenylene vs. azulene-1,3-diyl vs. thiophene-2,5-diyl) separating two DHA units on the switching properties was investigated. An azulene-1,3-diyl spacer largely inhibited both the DHA-to-VHF photoisomerizations and the thermal VHF-to-DHA back-reactions; the latter occurred ten times slower than for the related compound with a meta-phenylene spacer. A DHA trimer containing three DHA units around a central benzene ring was found to undergo stepwise DHA-to-VHF photoisomerizations, whereas the thermal back-reactions occurred at similar rates for the three VHF entities. A meta-phenylene-bridged DHA dimer was subjected to further structural modifications at position C-1 of each DHA, having strong implications for the switching events, and synthetic steps for further functionalizations at position C-7 of each DHA were investigated. Finally, the molecular structure (from X-ray crystallographic analysis) between the meta-phenylene-bridged DHA dimer and Cu^I is presented.

Pharmacokinetics and Safety of Intravenous, Intravesical, Rectal, Transdermal, and Vaginal Melatonin in Healthy Female Volunteers: A Cross-Over Study

INTRODUCTION

We aimed to investigate the pharmacokinetic properties and safety of melatonin administered by alternative routes of administration.

METHODS

This study employed a cross-over design in healthy female volunteers. Twenty-five milligrams of melatonin was administered intravenously, intravesically, rectally, transdermally, and vaginally. Blood samples were collected at specified time points up to 24 h following intravenous, intravesical, rectal, and vaginal administration, and up to 48 h following transdermal administration. Plasma melatonin concentrations were determined by radioimmunoassay. Sedation was evaluated by a simple reaction-time test, and sleepiness was assessed by the Karolinska Sleepiness Scale. Adverse events were registered for each route of administration.

RESULTS

Ten participants were included. We documented a mean (SD) time to maximal concentration of 51 (29) min for intravesical, 24 (20) min for rectal, 21 (8) h for transdermal, and 147 (56) min for vaginal administration. The mean (SD) elimination half-life was 47 (6) min for intravenous, 58 (7) min for intravesical, 60 (18) min for rectal, 14.6 (11.1) h for transdermal, and 129 (17) min for vaginal administration. The mean (SD) bioavailability was 3.6 (1.9)% for intravesical, 36.0 (28.6)% for rectal, 10.0 (5.7)% for transdermal, and 97.8 (31.7)% for vaginal administration. No significant changes in reaction times were observed following administration of melatonin by any of the administration routes. Increased tiredness was documented following transdermal administration only. No serious adverse effects were documented.

CONCLUSION

Rectally and vaginally administered melatonin may serve as relevant alternatives to standard oral melatonin therapy. Transdermal delivery of melatonin displayed an extended absorption and can be applied if prolonged effects are intended. Intravesical administration displayed, as expected, a very limited bioavailability. Melatonin administered by these routes of administration was safe.

Patient-reported outcome measures for inguinal hernia repair are insufficiently validated: a systematic review

PURPOSE

To systematically assess the validity of patient-reported outcome measures (PROMs) for patients undergoing inguinal hernia repair.

DATA SOURCES

A systematic review was performed according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guideline for systematic reviews of PROMs. PubMed, EMBASE and PsycINFO were consulted.

STUDY SELECTION

Only studies explicitly aimed at validation of PROMs specific for patients with inguinal hernia were included.

DATA EXTRACTION

Data regarding measurement properties of PROMs were extracted from the included studies. Each study was critically assessed for methodological quality and each PROM was evaluated for sufficient measurement properties.

RESULTS OF DATA SYNTHESIS

We included 15 studies, covering 11 different PROMs. The Carolinas Comfort Scale was the most frequently investigated PROM, being covered in five of the included publications. The included PROMs were evaluated according to nine different measurement properties, of which internal consistency and construct validity were the most frequently assessed. Evidence regarding content validity and structural validity was universally inadequate, according to the criteria for good measurement properties, as defined by the COSMIN.

CONCLUSION

Based on the current evidence, it is not possible to formulate recommendations for application of PROMs for patients undergoing inguinal hernia repair. Further validation of the included PROMs is necessary especially regarding content validity and structural validity.

Patient-Reported Outcome Measures for Patients Undergoing Inguinal Hernia Repair

There are many ways to determine the success of an inguinal hernia operation. Traditional measures are hernia recurrence, neuralgia, mesh infection, or rather the absence of these complications. While these traditional measures obviously have their merits, alternative outcomes are emerging, and researchers and clinicians are gaining an increasing interest in patient-reported outcomes and patient reported outcome measures (PROMs). PROMs are patient questionnaires concerning quality of life, chronic pain, disability, or other subjects that are best assessed by the patients. PROMs come in two different forms: generic and condition specific. The generic PROMs concern general symptoms and issues, while the condition-specific PROMs target patients with a certain condition. Inguinal hernia-specific PROMs typically address issues like mesh-related symptoms, groin pain, sexual dysfunction, etc. Clinical measurement instruments such as PROMs should be carefully validated according to standardized guidelines to ensure their psychometric measurement properties. Unfortunately, this type of evidence is often lacking when it comes to inguinal hernia-specific PROMs. In this review, we explain why PROMs are useful for patients with inguinal hernia and why one should use inguinal hernia-specific PROMs as opposed to the generic ones. We address the importance of population-specific validation and explain what type of evidence is lacking. Last, we discuss the future prospects of using PROMs for patients with inguinal hernia.

[Sex reassignment surgery in Denmark]

This review summarises the knowledge of sex reassignment surgery in Denmark. Sex reassignment surgery aims at confirming a transgender person's gender identity and can consist of surgery on breasts, genitals, thyroid cartilage, vocal cords as well as facial and body contours. In Denmark, most procedures are performed at a highly specialised level after referral to Center for Gender Identity. Some choose to get procedures performed abroad. Depending on the surgical procedure additional surgery can be necessary, however, patient satisfaction is generally high. Surgery has been shown to increase patients' quality of life and decrease gender dysphoria.

Outcome Measures in Gender-Confirming Chest Surgery: A Systematic Scoping Review

BACKGROUND

The aim of this scoping review was to provide an overview of outcome measures in gender-confirming chest surgery.

METHODS

A comprehensive literature search was performed in PubMed, EMBASE, CINAHL, PsycINFO, Scopus and the Cochrane Library to find studies evaluating gender-confirming chest surgery in a non-cis gender population. The systematic scoping review followed the PRISMA extension for scoping reviews. Data were charted for outcome measures including complications, reoperations, revision surgery, aesthetic outcome and patient-reported outcome measures.

RESULTS

Our search yielded 849 records, which were screened on title, abstract and full text. Of these, 47 were included in the review. Feminising gender-confirming chest surgery was evaluated in 11 studies, and masculinising gender-confirming chest surgery was evaluated in 39 studies. Clinician-reported outcome categories were used in 40 studies and included complications, reoperation, revision surgery and aesthetic outcome. Categories of patient-reported outcomes were used in 29 studies and included aesthetic outcome, functional outcome and mental health parameters. The summary of outcome domains and classifications showed that there are large variations in outcome evaluation between studies. Although several studies reported on similar outcome categories, there was a high level of heterogeneity of domains and classifications of outcomes.

CONCLUSIONS

Evaluation of outcomes in gender-confirming chest surgery showed large variations in reporting, and further streamlining of reporting is therefore required to be able to compare surgical outcomes between studies.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Expression and regulation of an interferon-alpha-inducible membrane protein p106 on human hematopoietic cells

p106 is a human membrane protein of 106 kD previously shown to be inducible by interferon-alpha (IFN-alpha) on Daudi cells. To investigate the role of p106 further, its distribution and inducibility within hematopoietic cells was studied. Multiparameter flow cytometry (FCM) analysis showed that p106 expression was restricted to B cells and monocytes, and in both cell lineages acquired at a late stage of differentiation. Thus, p106 was found on mature B lymphocytes and monocytes in peripheral blood and on a variety of freshly isolated leukemic cells of B and myeloid origin as well as on a variety of cultured B-cell lines. In contrast, no expression was found on T lymphocytes, natural killer (NK) cells or granulocytes. p106 expression could be further induced by IFN-alpha on monocytes and Daudi cells, and this capacity was shown to be selective for IFN-alpha, since no other cytokines tested induced p106. Moreover, IFN-alpha therapy of chronic myeloid leukemia (CML) and hairy cell leukemia (HCL) patients lead to a clearcut induction of p106 on such malignant cells. The distribution of p106 could suggest that it represents an activation antigen. Further studies, including cloning of p106 cDNA, are needed to determine the function of p106.