Search Results for: Transgender – Competenze e ruoli del medico di medicina generale

Presidente consiglio comunale e medico sulla Nave della Salute

Opere, video e installazioni negli ospedali sono benefici per i pazienti. Cultura e medicina alleate contro i tumori, ma non solo

A Torino. Anelli, ‘medici siano messi in condizione di lavorare’. Balzanelli, ‘urge riforma per potenziare sistema d’emergenza’

Test clinici la promuovono. L’esperto: ‘Mai come sostitutivo del medico’

Isolò la Sars nel 2003. Lezione su accesso a cure e prevenzione

Objective
We identified factors associated with hepatitis C virus (HCV) testing in the previous 6 months in people who inject drugs (PWID) according to gender.

Design
COSINUS (Cohorte pour l’évaluation des facteurs Structurels et Individuels de l’USage de drogues) is a multisite longitudinal cohort study conducted between June 2016 and May 2019.

Setting
Harm reduction facilities in two French cities (Marseille and Bordeaux).

Participants
Eligibility criteria were as follows: 18 years of age or older, French speaking, regular use of illegal drugs or of prescribed medication, having injected at least once in the previous month and being able to provide informed consent to participate. We selected data for 298 participants (624 observations).

Primary outcome
Self-reporting HCV testing in the previous 6 months. Gender was defined as self-identifying as a woman, man or transgender person.

Results
Seventy-nine per cent (n=235) of the sample were men, and 63% (n=189) reported HCV testing in the previous 6 months. Our results suggest that men recently incarcerated (OR (95% CI): 3.26 (1.31, 8.12), p=0.011), those regularly attending harm reduction facilities (OR (95% CI): 2.49 (1.47, 4.22), p=0.001), and those with lifetime attempted suicide (OR (95% CI): 2.07 (1.08, 3.95), p=0.028) were more likely to have been tested for HCV in the previous 6 months, whereas older men were less likely (OR (95% CI): 0.46 (0.24, 0.89), p=0.022). Women who had slept in the street (OR (95% CI): 3.95 (1.12, 13.89), p=0.032) were more likely to have been tested for HCV in the previous 6 months, whereas those employed (OR (95% CI): 0.31 (0.12, 0.83), p=0.019) and those with lifetime attempted suicide (OR (95% CI): 0.39 (0.16, 0.97), p=0.044) were less likely.

Conclusion
Our results highlight the importance of improving current harm reduction facilities for PWID by adapting them to women’s needs and paying special attention to women’s mental health. Furthermore, in the context of primary care, improving provider training and reducing injection-related stigma may improve HCV testing uptake in older men and employed women.

Objective
Despite increasing incidence of genital gender-affirming surgery (GGAS), there is no systematic method of evaluating patient perspectives. The objective of this study is to elucidate transgender and non-binary patient perspectives on gender-affirming phalloplasty/metoidioplasty via structured focus groups and determine convergent themes as the first step towards the development of a GGAS patient-reported outcome measure.

Design
We conducted a systematic qualitative study using a thematic content analysis of four focus groups from April 2021 to April 2022 comprising 8 patients undergoing phalloplasty/metoidioplasty and 10 patients post-phalloplasty/metoidioplasty. Focus groups were hosted virtually and recorded and transcribed. Discussions were guided by participant input and focused on goals, experiences, outcomes, satisfaction, and quality of life.

Setting
This volunteer but purposive sample of patients was recruited directly in clinic, via email, and via social media at NYU Langone Health (primary site), Callen-Lorde Community Health Center (New York, New York, USA) and the San Francisco Community Health Center.

Participants
We conducted focus groups with 18 patients before/after undergoing gender-affirming phalloplasty/metoidioplasty.

Primary and secondary outcome measurements and statistical analysis
Transcripts were uploaded into ATLAS.ti, a qualitative data analysis software that facilitates coding for thematic content analysis. We performed deductive and inductive coding to identify the themes that were clustered into overarching domains.

Results
The mean duration of focus groups was 81.5 min. Seven themes and 19 subthemes were constructed. The major themes were (1) goals, expectations, and priorities before/after surgery; (2) sexual function; (3) urinary function; (4) peer support; (5) decision-making; (6) mental health and quality of life; and (7) gender dysphoria. Of the major themes, those determined before the study included themes 1–3 and 6–7. Limitations include small sample size and bias in patient selection.

Conclusions
We conducted focus groups with 18 patients before/after undergoing gender-affirming phalloplasty/metoidioplasty. Mental health, quality of life, functional, and aesthetic outcomes are all critical to patients. Phalloplasty/metoidioplasty impact numerous aspects of patients’ lives. Experiential components of the surgical process, mental health, and quality of life are important metrics to consider in addition to functional and aesthetic outcomes.

Circulation, Ahead of Print. Pulmonary embolism is a common cause of cardiovascular-associated morbidity and mortality. Although pulmonary embolism affects individuals from all demographics, the incidence of pulmonary embolism is higher among people from certain racial groups, reproductive-age women compared with age-matched men, and transgender people taking estrogen hormones. Furthermore, disparities may exist in the diagnosis or management strategies of pulmonary embolism associated with race, ethnicity, sex, or socioeconomic status, which may correlate with poorer downstream outcomes, including recurrent pulmonary embolism, chronic thromboembolic pulmonary hypertension, or short- or long-term mortality. This scientific statement summarizes disparities in diagnosis, treatment strategies, and outcomes related to pulmonary embolism, and reviews approaches to create equitable pulmonary embolism care and address the knowledge gaps in the literature.

Patologica la crescita delle università telematiche

L’idea di un gruppo di laureandi in Medicina all’Università delle Marche

Introduction
Gender-affirming care (GAC) includes interventions aimed at supporting an individual’s gender identity. Canada is experiencing an increase in referrals for GAC, higher than any other health service; therefore, there is a need for a systematic approach to health outcome measurement to effectively evaluate care. This review aims to analyse health outcome measurement in Canadian GAC, focusing on what is measured, how it is measured and associated barriers and enablers.

Methods
A comprehensive search was conducted in MEDLINE, Embase, PsycINFO, Scopus and CINAHL, up to 26 December 2023. Inclusion criteria were original articles involving transgender or gender-diverse (TGD) patients receiving gender-affirming care in Canada.

Results
A total of 4649 articles were identified with 64 included, representing 6561 TGD patients. Most studies were conducted in Ontario (52%), British Columbia (19%) and Quebec (11%). The most common forms of GAC provided were hormonal (36%) and surgical (27%). Barriers to outcome measurement include that most studies (61%) did not use patient-reported outcome measures (PROMs). When PROMs were used, most did not capture gender-related constructs (eg, gender dysphoria). Barriers to accessing care included stigma, discrimination, lack of clinician knowledge, geographic, socioeconomic and institutional barriers.

Conclusion
This review reveals gaps in outcome measurement for GAC, particularly underutilisation of PROMs and inconsistent outcome measurement and reporting. There is a need to systematically implement PROMs, including those measuring gender-related constructs, to promote patient-centred care. This review provides evidence-based recommendations for improving health outcomes for TGD individuals in Canada.

This Viewpoint discusses Tennessee’s ban on gender-affirming care for transgender youth and how the US Supreme Court’s decision on the constitutionality of this law could have potential implications for state regulation of medical practice.

L’omaggio del piccolo Roberto all’ospedale del cuore di Massa

Ingresso di giovani camici bianchi rafforza l’assistenza

Objectives
This study aimed to explore the role of occupational physicians (OPs) in supporting transgender and gender-diverse (TGD) workers during gender transition and return to work (RTW) following gender-affirming (medical) interventions.

Design
We conducted a qualitative study (ONZ-2023-0026) using focus groups.

Setting
This study involved OPs in Belgium.

Participants
Two semistructured focus group interviews were held with 19 OPs working in occupational health services in Belgium in May and November 2023. Purposeful sampling was used, which included OPs with at least 2 years of seniority and experience with TGD people or inclusive company culture. Participants were predominantly white and cisgender, with varying levels of seniority and sectoral coverage.

Methods
Qualitative data was thematically analysed using Braun and Clarke to find patterned meaning.

Results
The analysis created four themes: (1) ‘What is the right professional attitude?: You never get a second chance to make a good first impression’ discusses the aspects of professional attitude alongside ethical considerations; (2) ‘Controlled open-mindedness’ entails values and views of gender in light of medicine, the individual worker, organisations and society; (3) ‘The balance game: “Fingerspitzengefühl” (intuitive flair or instinct) without treating’ and (4) ‘Being gender-bombarded: the need for OP-tailored training and best practices’. These themes highlighted the limited knowledge and experience of OPs regarding gender-affirming care (GAC) and their need for additional training. Participants struggled to find the best gender-inclusive professional approach to support TGD workers as well as employers and require ‘best practices’. Implementing overarching legislative frameworks can help OPs and companies create an inclusive work environment considering the differences in occupational sectors and company culture. RTW policies should focus on abilities without medicalisation and stigmatisation and involve multiple stakeholders.

Conclusions
Occupational medicine can be crucial in improving the health and well-being of TGD workers. However, with the ageing workforce, gender diversity poses new ‘hidden’ challenges for sick leave management, RTW and sensitive health surveillance. Multidisciplinary training with stakeholders and GAC professionals can enhance occupational practice and equip future OPs with the necessary competencies and confidence.

Fnomceo, ‘le pari opportunità sono la priorità del nuovo Comitato centrale’