How the COVID-19 pandemic affects transgender health care in upper-middle-income and high-income countries – A worldwide, cross-sectional survey

Background Since the beginning of the COVID-19 pandemic, access to medical care was restricted for nearly all non-acute medical conditions. Due to their status as a vulnerable social group and the inherent need for transition-related treatments (e.g., hormone treatment), transgender people are assumed to be affected particularly severely by the restrictions caused by the COVID-19 pandemic. This study aims to assess the impact of the COVID-19 pandemic on the health and health care of transgender people. Methods and findings As an ad hoc collaboration between researchers, clinicians, and 23 community organizations, we developed a web-based survey. The survey was translated into 26 languages, and participants were recruited via various social media and LGBTIQ-community sources. Recruitment started in May 2020. We assessed demographical data, physical and mental health problems (e.g., chronic physical conditions), risk factors (e.g., smoking), COVID-19 data (symptoms, contact history, knowledge and concerns about COVID-19), and the influence of the COVID-19 pandemic on access to transgender health care and health-related supplies. To identify factors associated with the experience of restrictions to transgender health care, we conducted multivariate logistic regression analysis. 5267 transgender people from 63 higher-middle income and high-income countries participated in the study. Over 50% of the participants had risk factors for a severe course of a COVID-19 infection and were at a high risk of avoiding testing or treatment of a COVID-19 infection due to the fear of mistreatment or discrimination. Access to transgender health care services was restricted due to the COVID-19 pandemic for 50% of the participants. Male sex assigned at birth and a lower monthly income were significant predictors for the experience of restrictions to health care. 35.0% of the participants reported at least one mental health conditions. Every third participant had suicidal thoughts, and 3.2% have attempted suicide since the beginning of the COVID-19 pandemic. A limitation of the study is that we did not analyze data from low-income countries and access to the internet was necessary to participate. Conclusions Transgender people are assumed to suffer under the severity of the pandemic even more than the general population due to the intersections between their status as a vulnerable social group, their high amount of medical risk factors, and their need for ongoing medical treatment. The COVID-19 pandemic can potentiate these vulnerabilities, add new challenges for transgender individuals, and, therefore, can lead to devastating consequences, like severe physical or mental health issues, self-harming behaviour, and suicidality

How the COVID-19 pandemic affects transgender health care - A cross-sectional online survey in 63 upper-middle-income and high-income countries

Background Due to the COVID-19 pandemic, access to medical care is restricted for nearly all non-acute conditions. Due to their status as a vulnerable social group and the inherent need for transition-related treatments, transgender people are assumed to be affected particularly severely by the restrictions caused by the COVID-19 pandemic. Methods As an ad hoc collaboration between researchers, clinicians and 23 community organizations, we developed a web-based survey in German that was translated into 26 languages. Participants were recruited via community sources, social media channels, and snowball sampling since May 2020. The present sample is based on the data collected until August 9, 2020. We assessed demographical data, health problems, risk factors, COVID-19 data (e.g., contact history), and the influence of the COVID-19 pandemic on access to transgender health care services. To identify factors associated with the experience of restrictions, we conducted multiple logistic regression analysis. Results 5267 transgender people from 63 upper-middle-income and high-income countries participated in the study. Over 50% of the participants had risk factors for a severe course of a COVID-19 infection and were at a high risk of avoiding COVID-19 treatment due to the fear of mistreatment or discrimination. Access to transgender health care services was restricted for 50% of the participants. Male sex assigned at birth and a lower monthly income were significant predictors for the experience of restrictions to health care. 35.0% reported at least one mental health condition and 3.2% have attempted suicide since the beginning of the COVID-19 pandemic. Discussion Transgender people suffer under the severity of the pandemic due to the intersections between their status as a vulnerable social group, their high number of medical risk factors, and their need for ongoing medical treatment. The COVID-19 pandemic can potentiate these vulnerabilities, add new challenges for transgender people, and, therefore, can lead to devastating consequences, like severe physical or mental health issues, self-harming behavior, and suicidality

Chromosome Analysis In The Assessment For Gender Affirmation Process: A Retrospective Study

Objective: Gender dysphoria refers to the experienced discomfort related to the incongruence between gender identity and the sex assigned at birth. Current treatment approach for this clinical condition is gender affirmation procedures. International guidelines about gender affirmation do not recommend routine genetic evaluation. In Turkey, provision of health insurance for medical expenses incurred by these procedures requires genetic consultation which frequently involves chromosome analysis (karyotyping). However, the contribution of routine chromosome analysis to the assessment and management of gender dysphoria is not established. This study aims to mess the results of chromosome analysis and its effect on the management of gender dysphoria. Method: The completed chromosome analysis results and observational records of 217 individuals among a total of 281 evaluated for gender affirmation in the psychiatry polyclinic were investigated retrospectively. Results: The chromosome analysis results of 213 (98.2 %) of the 217 individuals investigated were congruent with the sex assigned at birth. Variations were found in the karyotypes of 4 individuals with female sex assigned at birth, only 1 of whom had been diagnosed with a disorder of sex development. In the other cases, however, chromosome analysis did not affect the diagnosis or the clinical intervention. Conclusion: Finding that routine chromosome analysis during the assessment for gender affirmation process rarely affected the clinical diagnosis and the treatment was consistent with the reports of previous studies and supported the recommendation that chromosome analysis should be carried out only in cases where history, physical examination and the required imaging investigations suggested a disorder sex development.WoSScopu

Resilience in Individuals with Gender Dysphoria: Association with Perceived Social Support and Discrimination

Objective: Psychological distress associated with discrimination is proposed to have an indirect effect on the development of mental disorders, through its negative influence on individual's cognitive, affective and social coping strategies. The aim of this study was to investigate the association between resilience, perceived social support, and perceived discrimination in individuals with gender dysphoria. Method: Individuals with gender dysphoria were assessed with Turkish validated forms of Resilience Scale for Adults (RSA), Multidimensional Scale of Perceived Social Support (MSPSS), Perceived Discrimination Scale (PDS), and Beck Depression Inventory (BDI). Diagnoses of mental disorders, history of suicide attempt and non-suicidal self injury were assessed with clinical interviews. Self-report forms were used to obtain demographic information and gender transition related features. Results: Participants' (n = 116, 88 trans men) median age was 25. Significantly low RSA scores, indicating poor resilience, were obtained in participants with lifetime (59.5 %) and present (27.6 %) diagnosis of any mental disorder, history of suicide attempt (23.3 %). There was significant direct correlation between RSA and MSPSS scores, inverse correlation with BDI and personal PDS scores, but not with group PDS. Regression analysis revealed that only friends domain score in MSPSS predicted better resilience, whereas personal perceived discrimination score predicted poor resilience. Conclusion: Findings support the association between poor resilience and vulnerability to mental and behavioral problems in individuals with gender dysphoria. The associations reveal the significance of addressing discrimination and assisting individuals with gender dysphoria in developing strategies to obtain peer support in providing mental health services.WoSScopusTr-Dizi

Effects of Acute and Chronic Electroconvulsive Shocks on Glycogen Synthase Kinase 3[beta] Level and Phosphorylation in Mice

WOS: 000330362600012PubMed: 23807397Objectives Glycogen synthase kinase 3 beta (GSK-3 beta) is recently proposed as a novel target in the treatment of mood disorders. Recent evidence has suggested that acute and chronic administration of antidepressants led to inhibition of GSK-3 beta via phosphorylation of Serine9 residue. Acute electroconvulsive shock (ECS) has been reported to increase GSK-3 beta phosphorylation transiently. In this study, the changes in the level of GSK-3 beta and its phoshorylated form (phospho-Ser9-GSK-3 beta) following chronic ECS (cECS) were investigated in mice. Methods Mice were given daily ECS via bilateral corneal electrodes for 10 consecutive days in the chronic group and a single ECS in the acute group. Electrodes were applied without stimulation in corresponding sham groups. Immunoblotting for GSK-3 beta and phospho-Ser9-GSK-3 beta was performed with the frontal cortex and hippocampus samples, extracted 10 minutes after single ECS, and 24 hours after the last ECS in the chronic group. The optical densities of the bands obtained were compared between the active treatment and sham groups for each condition separately. Results The level of phospho-Ser9-GSK-3 beta was not different following chronic ECS, but significantly higher following acute ECS, compared with the corresponding sham group, in the hippocampus and frontal cortex. The level of GSK-3 beta was similar to sham following both acute and chronic ECS, in both regions. Conclusions The transient increase in GSK-3 beta phosphorylation observed following acute ECS in the mice hippocampus and frontal cortex was not found to persist 24 hours following chronic ECS. The mechanism of action of ECS does not seem to involve persistent change in the level and phosphorylation of GSK-3 beta.Scientific and Technological Research Council of Turkey (TUBITAK)Turkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK) [SBAG-HD-18-105S012]; Hacettepe University (Scientific Research and Development Office)Hacettepe University [04D10101004]; Brain Research Society (Turkey)This study was financially supported by the Scientific and Technological Research Council of Turkey (TUBITAK, grant no. SBAG-HD-18-105S012), Hacettepe University (Scientific Research and Development Office, grant number: 04D10101004), Brain Research Society (Turkey, 2004 Project Support Award)

High frequency stimulation of the ventrolateral and mediodorsal thalamic nuclei: Differential effects on impulsive action

Ventrolateral thalamic nucleus stimulation is a frequently applied clinical procedure to control disabling tremor. Its motor effects are largely established now, but the cognitive effects are largely unknown and are currently under investigation. Here, we performed a detailed investigation of the effects of electrical stimulation at high frequency (130 Hz) and various amplitude (0, 1, 3, 30, 150) of the VL thalamic nucleus in a rat model on specific cognitive functions, using a reaction time task, and compared to DBS of the mediodorsal thalamic nucleus (MD) to evaluate the specificity of the site of stimulation. The involvement of the MD thalamic nucleus in cognitive functions has already been established. In addition, we mapped the effect of VL and MD thalamic nuclei DBS on the neuronal activity of the mPFC using c-Fos immunohistochemistry to investigate the neural pathways underlying the behavioural effects. Results show l that DBS of the VL and MD thalamic nuclei had no significant effects on reaction time and motor time. DBS of the VL thalamic nucleus induced no significant effect on premature responding, whereas DBS of the MD thalamic nucleus increased this. In addition, MD and VL thalamic nuclei DBS significantly increased the number of c-Fos-immunoreactive cells in the prelimbic cortex as compared to control animals. In the infralimbic cortex, the number of c-Fos-immunoreactive cells was signifcantly higher following MD thalamic nucleus DBS as compared to the other groups. These findings support that the VL thalamic nuclei is not involved in impulsive action. However, DBS of the MD thalamic nucleus induced specific changes in cognitive parameters, which further establishes its involvement in behavioral functions.. This behavioral effect is mediated by a circuit involving specific prefrontal cortical areas. © 2009 OMU All rights reserved.Link_to_subscribed_fulltex

Comparison of Resorbable Mesh (Poly L-Lactide/Glycolic Acid) and Porous Polyethylene in Orbital Floor Fractures in an Experimental Model.

Resorbable mesh and porous polyethylene are frequently used alloplastic materials for the treatment of the orbital blowout fractures. The literature lacks reports comparing their long-term effects on experimental models

Comparison of Resorbable Mesh (Poly L-Lactide/Glycolic Acid) and Porous Polyethylene in Orbital Floor Fractures in an Experimental Model

Background: Resorbable mesh and porous polyethylene are frequently used alloplastic materials for the treatment of the orbital blowout fractures. The literature lacks reports comparing their long-term effects on experimental models. Objective: Our aim was to radiologically and histologically evaluate the effectiveness and safety of porous polyethylene and resorbable mesh in a rabbit orbital blowout fracture model. Methods: Twelve New Zealand white rabbits (24 orbits) were randomized to 4 groups. In group 1, only orbital floor dissection was done. In group 2, following orbital floor dissection, a 10-mm defect was created without any extra procedure. In group 3, following a 10-mm defect creation, a 12-mm-round cut porous polyethylene was placed on the defect. In group 4, following a 10-mm defect creation, a 12-mm-round cut resorbable mesh was placed on the defect. Computed tomographic analysis was performed during follow-up period. Orbital floors were evaluated histologically at month 6. Results: No clinical complications were observed during follow-up period. In radiological evaluation, there was no statistically significant difference between groups regarding bone formation. In histological evaluation, the connective tissue was denser, and organized and better bone formation was observed in group 3 and 4 when compared with other groups. Conclusion: Although no significant radiological changes were present, porous polyethylene and resorbable mesh performed better histologically. They were effective and well tolerated for reconstruction of the isolated orbital floor defects