Voice Therapy For Transgender People

Transrodne osobe su osobe koje osjećaju nesklad između roda s kojim se poistovjećuju i spola u kojem su se rodili. Transrodnost je širok pojam i obuhvaća čitav spektar rodno nenormativnih identiteta. Dva glavna obrasca tranzicije prema drugom spolu, odnosno rodu su: Male-to-Female (MtF) i Female-to-Male (FtM). Transrodne osobe navode da ih njihov glas često “izdaje”, odnosno otkriva njihov biološki rod te predstavlja posljednju prepreku u potpuno uživljavanje u novu rodnu ulogu. Bez obzira na to, često nisu svjesni da se zbog glasa mogu obratiti logopedu. Cilj ovog preglednog rada je dati uvid u poremećaje glasa kod transrodnih osoba, odnosno opisati logopedsku procjenu te terapijske postupke, a sve u svrhu boljeg razumijevanja potreba ovih osoba.Transgender individuals are people who feel an incongruity between their self-identified gender and their birth gender. Transgenderism is a broad term and includes a spectrum of gender-nonconforming identities. The two main patterns of gender transition are Male-to-Female (MtF) and Female-to-Male (FtM).Transgender people often think their voice “betrays” them, i.e. it reveals their biological gender and represents the last obstacle to the individual’s full enjoyment of his/her new gender role. Regardless of this, many transgender individuals are not aware of the fact that they can go to speech and language pathologists (SLP) for therapy. The aim of this review article is to provide insight into the voice disorders of transgender people, i.e. to describe the assessment process and therapy protocols in hope of gaining a better understanding of the needs of this population

State-of-the-art methods for exposure-health studies: Results from the exposome data challenge event

The exposome recognizes that individuals are exposed simultaneously to a multitude of different environmental factors and takes a holistic approach to the discovery of etiological factors for disease. However, challenges arise when trying to quantify the health effects of complex exposure mixtures. Analytical challenges include dealing with high dimensionality, studying the combined effects of these exposures and their interactions, integrating causal pathways, and integrating high-throughput omics layers. To tackle these challenges, the Barcelona Institute for Global Health (ISGlobal) held a data challenge event open to researchers from all over the world and from all expertises. Analysts had a chance to compete and apply state-of-the-art methods on a common partially simulated exposome dataset (based on real case data from the HELIX project) with multiple correlated exposure variables (P > 100 exposure variables) arising from general and personal environments at different time points, biological molecular data (multi-omics: DNA methylation, gene expression, proteins, metabolomics) and multiple clinical phenotypes in 1301 mother–child pairs. Most of the methods presented included feature selection or feature reduction to deal with the high dimensionality of the exposome dataset. Several approaches explicitly searched for combined effects of exposures and/or their interactions using linear index models or response surface methods, including Bayesian methods. Other methods dealt with the multi-omics dataset in mediation analyses using multiple-step approaches. Here we discuss features of the statistical models used and provide the data and codes used, so that analysts have examples of implementation and can learn how to use these methods. Overall, the exposome data challenge presented a unique opportunity for researchers from different disciplines to create and share state-of-the-art analytical methods, setting a new standard for open science in the exposome and environmental health field

WHO Air Quality Guidelines 2021-aiming for healthier air for all: a joint statement by medical, public health, scientific societies and patient representative organisations

[Extract] After years of intensive research and deliberations with experts across the globe, the World Health Organization (WHO) updated its 2005 Global Air Quality Guidelines (AQG) in September 2021 [1, 2]. The new air quality guidelines (WHO AQG) are ambitious and reflect the large impact that air pollution has on global health. They recommend aiming for annual mean concentrations of PM2.5 not exceeding 5 µg/m3 and NO2 not exceeding 10 µg/m3, and the peak season mean 8-hr ozone concentration not exceeding 60 µg/m3 [1]. For reference, the corresponding 2005 WHO guideline values for PM2.5 and NO2 were, respectively, 10 µg/m3 and 40 µg/m3 with no recommendation issued for long-term ozone concentrations [3]. While the guidelines are not legally binding, we hope they will influence air quality policy across the globe for many years to come

Greenspace and cardiovascular health outcomes in UK biobank participants: assessing the environmental and physiological pathways

Urban greenspace is hypothesised to protect cardiovascular health via multiple mechanistic pathways. These include the environmental pathway, via which greenspace attenuates harmful pollution levels (e.g., air and noise pollution); and the physiological pathway, via which accessible greenspace is hypothesised to increase physical activity. My PhD thesis explored the impact of greenspace on environmental and physiological pathway-specific exposures. I developed pathway-specific exposure models and applied them to participants of a large, adult cohort – UK Biobank (n ~500,000). I estimated residential air pollution exposure via a land-use regression model, with surrounding vegetation cover as a predictor variable to assess the environmental pathway. To assess the physiological pathway, I developed a novel ‘green walkability’ index within a street/path network buffer around participants’ residential addresses. To enhance specificity of greenspace exposure, I assessed greenspace cover surrounding addresses using functional attribute data (e.g., public parks versus private gardens). I conducted survival analyses to examine the associations of greenspace cover surrounding residential addresses with cardiovascular and non-injury mortality, adjusting for relevant individual- and area-level confounders. Integration of vegetation cover into a ‘green walkability’ index did not strengthen effect estimates for physical activity participation in UK Biobank participants when compared to a standard index. I examined the interrelationships of greenspace, air pollution, traffic noise and walkability, and showed that ignoring built environment components related to walkability might result in biased greenspace and physical activity effect estimates. In epidemiological analyses, I showed a protective association across quintiles of surrounding greenspace (100 m circular distance buffer) and non-injury mortality, though not cardiovascular mortality. My thesis points to important policy implications of exposure interrelationships. Greenspace exposure might protect against premature mortality in older adults, though indirect mechanisms (e.g., air flow and walkability of street networks) should be considered, alongside greenspace, to ameliorate specific exposures on the environmental and physiological pathways.Open Acces

Associations of air pollution with COVID-19 positivity, hospitalisations, and mortality: Observational evidence from UK Biobank.

Individual-level studies with adjustment for important COVID-19 risk factors suggest positive associations of long-term air pollution exposure (particulate matter and nitrogen dioxide) with COVID-19 infection, hospitalisations and mortality. The evidence, however, remains limited and mechanisms unclear. We aimed to investigate these associations within UK Biobank, and to examine the role of underlying chronic disease as a potential mechanism. UK Biobank COVID-19 positive laboratory test results were ascertained via Public Health England and general practitioner record linkage, COVID-19 hospitalisations via Hospital Episode Statistics, and COVID-19 mortality via Office for National Statistics mortality records from March-December 2020. We used annual average outdoor air pollution modelled at 2010 residential addresses of UK Biobank participants who resided in England (n = 424,721). We obtained important COVID-19 risk factors from baseline UK Biobank questionnaire responses (2006-2010) and general practitioner record linkage. We used logistic regression models to assess associations of air pollution with COVID-19 outcomes, adjusted for relevant confounders, and conducted sensitivity analyses. We found positive associations of fine particulate matter (PM2.5) and nitrogen dioxide (NO2) with COVID-19 positive test result after adjustment for confounders and COVID-19 risk factors, with odds ratios of 1.05 (95% confidence intervals (CI) = 1.02, 1.08), and 1.05 (95% CI = 1.01, 1.08), respectively. PM 2.5 and NO 2 were positively associated with COVID-19 hospitalisations and deaths in minimally adjusted models, but not in fully adjusted models. No associations for PM10 were found. In analyses with additional adjustment for pre-existing chronic disease, effect estimates were not substantially attenuated, indicating that underlying chronic disease may not fully explain associations. We found some evidence that long-term exposure to PM2.5 and NO2 was associated with a COVID-19 positive test result in UK Biobank, though not with COVID-19 hospitalisations or deaths

Inequalities in Exposure to Nitrogen Dioxide in Parks and Playgrounds in Greater London.

Elevated levels of nitrogen dioxide (NO2) have been associated with adverse health outcomes in children, including reduced lung function and increased rates of asthma. Many parts of London continue to exceed the annual average NO2 concentration of 40 µg/m3 set by the EU directive. Using high-resolution maps of annual average NO2 for 2016 from the London Atmospheric Emissions Inventory and detailed maps of open spaces from Britain's national mapping agency, Ordnance Survey, we estimated average NO2 concentrations for every open space in Greater London and analysed geospatial patterns comparing Inner verses Outer London and the 32 London Boroughs. Across Greater London, 24% of play spaces, 67% of private parks and 27% of public parks had average levels of NO2 that exceeded the EU limit for NO2. Rates of exceedance were higher in Inner London; open spaces in the City of London had the highest average NO2 values among all the London Boroughs. The closest play space for more than 250,000 children (14% of children) under 16 years old in Greater London had NO2 concentrations above the recommended levels. Of these children, 66% (~165,000 children) lived in the most deprived areas of London, as measured by the Index of Multiple Deprivations, where average NO2 concentrations in play spaces were on average 6 µg/m3 higher than for play spaces in the least deprived quintile. More action is needed to reduce NO2 in open spaces to safe levels through pollution reduction and mitigation efforts, as currently, open spaces in Greater London, including play spaces, parks and gardens, still have dangerously high levels of NO2, according to the most recent NO2 map

Green Walkability and Physical Activity in UK Biobank: A Cross-Sectional Analysis of Adults in Greater London.

Urban greenspace provides opportunities for outdoor exercise and may increase physical activity, with accompanying health benefits. Areas suitable for walking (walkability) are also associated with increased physical activity, but interactions with greenspace are poorly understood. We investigated associations of walkability and green walkability with physical activity in an urban adult cohort. We used cross-sectional data from Greater London UK Biobank participants (n = 57,726) and assessed walkability along roads and footpaths within 1000 m of their residential addresses. Additionally, we assessed green walkability by integrating trees and low-lying vegetation into the walkability index. Physical activity outcomes included self-reported and accelerometer-measured physical activity and active transport. We assessed associations using log-linear, logistic and linear regression models, adjusted for individual- and area-level confounders. Higher green walkability was associated with favourable International Physical Activity Questionnaire responses and achievement of weekly UK government physical activity guideline recommendations. Participants living in the highest versus lowest quintile of green walkability participated in 2.41 min (95% confidence intervals: 0.22, 4.60) additional minutes of moderate-and-vigorous physical activity per day. Higher walkability and green walkability scores were also associated with choosing active transport modes such as walking and cycling. Our green walkability approach demonstrates the utility in accounting for walkability and greenspace simultaneously to understand the role of the built environment on physical activity

Association between Noise and Cardiovascular Disease in a Nationwide U.S. Prospective Cohort Study of Women Followed from 1988 to 2018.

BACKGROUND: Long-term noise exposure is associated with cardiovascular disease (CVD), including acute cardiovascular events such as myocardial infarction and stroke. However, longitudinal cohort studies in the U.S. of long-term noise and CVD are almost exclusively from Europe and few modeled nighttime noise, when an individual is likely at home or asleep, separately from daytime noise. We aimed to examine the prospective association of outdoor long-term nighttime and daytime noise from anthropogenic sources with incident CVD using a U.S.-based, nationwide cohort of women. METHODS: We linked L50 nighttime and L50 daytime anthropogenic modeled noise estimates from a U.S. National Parks Service model (L50: sound pressure levels exceeded 50 percent of the time) to geocoded residential addresses of 114,116 participants in the Nurses Health Study. We used time-varying Cox proportional hazards models to estimate risk of incident CVD, coronary heart disease (CHD), and stroke associated with long-term average (14-y measurement period) noise exposure, adjusted for potential individual- and area-level confounders and CVD risk factors (1988-2018; biennial residential address updates; monthly CVD updates). We assessed effect modification by population density, region, air pollution, vegetation cover, and neighborhood socioeconomic status, and explored mediation by self-reported average nightly sleep duration. RESULTS: Over 2,548,927 person-years, there were 10,331 incident CVD events. In fully adjusted models, the hazard ratios for each interquartile range increase in L50 nighttime noise (3.67 dBA) and L50 daytime noise (4.35 dBA), respectively, were 1.04 (95% CI: 1.02, 1.06) and 1.04 (95% CI: 1.02, 1.07). Associations for total energy-equivalent noise level (Leq) measures were stronger than for the anthropogenic statistical L50 noise measures. Similar associations were observed for CHD and stroke. Interaction analyses suggested that associations of L50 nighttime and L50 daytime noise with CVD did not differ by prespecified effect modifiers. We found no evidence that inadequate sleep (<5 h/night) mediated associations of L50 nighttime noise and CVD. DISCUSSION: Outdoor L50 anthropogenic nighttime and daytime noise at the residential address was associated with a small increase in CVD risk in a cohort of adult female nurses. https://doi.org/10.1289/EHP12906

Minute level smartphone derived exposure to greenness and consumer wearable derived physical activity in a cohort of US women.

BACKGROUND: Inconsistent results have been found in the literature on associations of greenness, or vegetation quantity, and physical activity. However, few studies have assessed associations between mobility-based greenness and physical activity from mobile health data from smartphone and wearable devices with fine spatial and temporal resolution. METHODS: We assessed mobility-based greenness exposure and wearable accelerometer data from participants in the US-based prospective Nurses Health Study 3 cohort Mobile Health (mHealth) Substudy (2018-2020). We recruited 500 female participants with instructions to wear devices over four 7-day sampling periods equally spaced throughout the year. After restriction criteria there were 337 participants (mean age 36 years) with n = 639,364 unique observations. Normalized Difference Vegetation Index (NDVI) data were derived from 30 m x 30 m Landsat-8 imagery and spatially joined to GPS points recorded every 10 min. Fitbit proprietary algorithms provided physical activity summarized as mean number of steps per minute, which we averaged during the 10-min period following a GPS-based greenness exposure assessment. We utilized Generalized Additive Mixed Models to examine associations (every 10 min) between greenness and physical activity adjusting for neighborhood and individual socioeconomic status, Census region, season, neighborhood walkability, daily mean temperature and precipitation. We assessed effect modification through stratification and interaction models and conducted sensitivity analyses. RESULTS: Mean 10-min step count averaged 7.0 steps (SD 14.9) and greenness (NDVI) averaged 0.3 (SD 0.2). Contrary to our hypotheses, higher greenness exposure was associated non-linearly with lower mean steps per minute after adjusting for confounders. We observed statistically significant effect modification by Census region and season. DISCUSSION: We utilized objective physical activity data at fine temporal and spatial scales to present novel estimates of the association between mobility-based greenness and step count. We found higher levels of greenness were inversely associated with steps per minute