Right ventricular peak systolic longitudinal strain is a sensitive marker for right ventricular deterioration in adult patients with tetralogy of Fallot

The aim of this study was to evaluate the feasibility of right ventricular (RV) longitudinal peak systolic strain (LPSS) assessment for the follow-up of adult patients with corrected tetralogy of Fallot (TOF). Adult patients (n = 18) with corrected TOF underwent echocardiography and CMR twice with a time interval of 4.2 ± 1.7 years. RV performance was derived from CMR, and included RV volumes and ejection fraction (EF). LPSS was calculated globally (GLPSS) and in the RV free wall (LPSS FW), with echocardiographic speckle-tracking strain-analysis. Baseline (G)LPSS values were compared between patients and healthy controls; the relation between (G)LPSS and CMR parameters was evaluated and the changes in (G)LPSS and CMR parameters during follow-up were compared. GLPSS and LPSS FW were significantly reduced in patients as compared to controls (−14.9 ± 0.7% vs. −21.6 ± 0.9% and −15.5 ± 0.9% vs. −22.7 ± 1.5%, P < 0.01). Moderate agreement between LPSS and CMR parameters was observed. RV EF remained unchanged during follow-up, whereas GLPSS and LPSS FW demonstrated a significant reduction. RVEF showed a 1% increase, whereas GLPSS decreased by 14%, and LPSS FW by 27%. RV LPSS is reduced in TOF patients as compared to controls; during follow-up RV EF remained unchanged whereas LPSS decreased suggesting that RV LPSS may be a sensitive marker to detect early deterioration in RV performance

Making the invisible visible: a systematic review of sexual minority women’s health in Southern Africa

Background: Over the past two decades research on sexual and gender minority (lesbian, gay, bisexual and transgender; LGBT) health has highlighted substantial health disparities based on sexual orientation and gender identity in many parts of the world. We systematically reviewed the literature on sexual minority women’s (SMW) health in Southern Africa, with the objective of identifying existing evidence and pointing out knowledge gaps around the health of this vulnerable group in this region. Methods: A systematic review of publications in English, French, Portuguese or German, indexed in PubMed or MEDLINE between the years 2000 and 2015, following PRISMA guidelines. Additional studies were identified by searching bibliographies of identified studies. Search terms included (Lesbian OR bisexual OR “women who have sex with women”), (HIV OR depression OR “substance use” OR “substance abuse” OR “mental health” OR suicide OR anxiety OR cancer), and geographical specification. All empirical studies that used quantitative or qualitative methods, which contributed to evidence for SMW’s health in one, a few or all of the countries, were included. Theoretical and review articles were excluded. Data were extracted independently by 2 researchers using predefined data fields, which included a risk of bias/quality assessment. Results: Of 315 hits, 9 articles were selected for review and a further 6 were identified through bibliography searches. Most studies were conducted with small sample sizes in South Africa and focused on sexual health. SMW included in the studies were racially and socio-economically heterogeneous. Studies focused predominately on young populations, and highlighted substance use and violence as key health issues for SMW in Southern Africa. Conclusions: Although there are large gaps in the literature, the review highlighted substantial sexual-orientationrelated health disparities among women in Southern Africa. The findings have important implications for public health policy and research, highlighting the lack of population-level evidence on the one hand, and the impact of criminalizing laws around homosexuality on the other hand

Being lesbian – does the doctor need to know?: A qualitative study about the significance of disclosure in general practice

Lesbian women make up a sexual minority within a heteronormative society where homosexuality becomes invisible and inferior. Minority stress is the excess stress individuals from stigmatized social categories experience because of their minority position. Stress may influence health and identity. It is not the burden of stress itself that determines its influence on health and identity, but how the individual copes with the stress. Existing research indicates that having a lesbian orientation may be especially challenging in encounters with health care professionals. Consequently, we wanted to explore how minority stress may be experienced by lesbian women in Norway today, and what strategies they employ to cope successfully with these situations. We wanted particularly to learn how minority stress comes into play within the health care system. The objective of this thesis is to develop knowledge that may be applied as a foundation for quality care and improved health for lesbian women, with a special relevance for general practice. We have accomplished three sub-studies based on experiences of lesbian women to illuminate the following issues: 1) What does it mean to lesbian women that the general practitioner is aware of their sexual orientation? 2) What kind of experiences related to sexual orientation do Norwegian lesbian women report from encounters with health care professionals? 3) Which strategies do lesbian women use to cope with challenges related to sexual orientation in their every-day lives? In sub-study I we conducted a focus group interview with lesbian women focusing on when and why it may be important to inform the general practitioner about their sexual orientation. We gathered data in the form of web based histories for substudies II and III. The empirical data consisted of 128 histories about concrete experiences in health care encounters where the lesbian orientation was of importance (II), and 64 histories about successful coping experiences related to the lesbian orientation (III). Data were analyzed with systematic text condensation in all three sub-studies. The analysis was data-driven and supported by theories of heteronormativity (I and II) and salutogenesis and coping (III). The analysis in sub-study I demonstrated that informing the general practitioner about the lesbian orientation may be important in order to be able to be oneself and communicate freely, and it may be relevant for the medical problem at hand. The experiences of the participants constitute a foundation for knowledge about how doctors may support the coming-out process of lesbian women. Sub-study II presents a wide range of experiences among lesbian women encountering health care professionals. The analysis concludes that for health care professionals a persistent awareness that not all patients are heterosexual, a positive attitude to lesbian orientation, and knowledge about lesbian-specific health matters, are required to offer health care services of high quality to lesbian patients. The challenges described by the participants in sub-study III concerned the question of whether or not disclose the lesbian orientation, how to disclose, how to handle derogatory remarks or actions, and how to face homo-negativity within family and other significant relations. Positive coping experiences comprised openness about the lesbian orientation, the way disclosure was carried out, and to maintain dignity when prejudice was encountered. Dignity could be maintained by demanding respect or arguing for rights, or by boosting thoughts and feelings that it is good to be lesbian. The analysis demonstrates that lesbian self-confidence – a personal conviction that a lesbian orientation is equally good and natural as a heterosexual orientation – may be a prerequisite for the positive coping strategies. The thesis presents these main findings: Lesbian women must continually deal with how to appear. Disclosure competency may improve lesbian women’s coping of minority stress related to openness. Lesbian women must continually receive and process reactions from the surroundings. Dignity may be maintained in all situations by sustaining and communicating lesbian self-confidence. Even in Norway 2012 do lesbian women experience minority stress that calls for coping strategies. Lesbian self-confidence may strengthen resilience against minority stress

Dimensions of Sexual Orientation and the Prevalence of Mood and Anxiety Disorders in the United States

Objectives. We used data from a nationally representative sample to examine the associations among 3 dimensions of sexual orientation (identity, attraction, and behavior), lifetime and past-year mood and anxiety disorders, and sex