‘Vrouwen, alcohol en ambiguïteit’[translated from Dutch to English] as 'Women, alcohol and ambivalence'

In welke stad je ’s avonds ook rondwandelt, overal zie je jonge mensen uitgaan, plezier maken en drinken. In de latere uurtjes levert deze mix van jongeren en alcohol vaak dronken en zelfs alarmerende taferelen op. Vrouwen gaan op zo’n momenten op zoek naar het soms wankele evenwicht tussen plezier en controle. "The practices and aesthetics of young women drinking and getting drunk provoke an array of responses. Influenced by psychoanalytic theory, this article explores the negotiation of ambivalent drinking identities centred around ideas of ‘correct’ gendered practices and imaginations, based upon empirical research in Reading (UK) and Groningen (the Netherlands?". (Please note this is not a direct translation of the above abstract)

Health professionals’ identified barriers to trans healthcare: a qualitative interview study

Background: Trans people face multiple barriers within healthcare. Primary care practitioners are key to trans healthcare but they often lack training in, and understanding of trans identities, and healthcare options. Few studies have examined health professionals’ understanding of the barriers that exist in healthcare for trans people. Aim: To map out barriers to providing good quality healthcare to trans and gender diverse people and ways to address them. Design and setting: A qualitative interview study involving 20 health professionals working with trans and gender diverse people. Method: Participants were recruited through purposive and snowball sampling. Data were generated using semi-structured qualitative interviews. A thematic analysis involved coding and categorising data using Nvivo software and further conceptual analysis in which developing themes were identified. Results: The study identified four barrier domains to good quality care for trans and gender diverse people: structural (related to lack of guidelines, long waiting times, shortage of specialist centres), educational (based on lack of training on trans health), cultural and social (reflecting negative attitudes towards trans people) and technical (related to information systems and technology). Conclusion: There is an urgent need to address the barriers trans and gender diverse people face in healthcare. Structural level solutions include health policy, professional education and standards; at the practice level, GPs can act as potential drivers of change in addressing the cultural and technical barriers to better meet the needs of their trans and gender diverse patients

Implementation of patient-reported outcome measures for gender-affirming care worldwide

Importance Gender-affirming care is a key clinical area that can benefit from implementation of patient-reported outcome measures (PROMs). Identifying barriers to and enablers of PROM implementation is needed to develop an evidence-based implementation strategy. Objective To identify (1) PROMs previously implemented for gender-affirming care and constructs measured, (2) how patients completed PROMs and how results were reported and used, and (3) barriers to and enablers of PROM implementation. Evidence Review In this systematic review, PubMed, Embase, MEDLINE, PsycINFO, CINAHL, and Web of Science were searched from inception to October 25, 2021, and updated on December 16, 2022. Gray literature was searched through gray literature database, online search engine, and targeted website searching. Inclusion criteria were (1) original articles of (2) a formally developed PROM or ad hoc instrument administered for gender-affirming care to (3) patients accessing gender-affirming care. The Critical Appraisal Skills Programme tool was used to evaluate quality of included studies. This review was registered on PROSPERO (CRD42021233080). Findings In total, 286 studies were included, representing 85 395 transgender and nonbinary patients from more than 30 countries. A total of 205 different PROMs were used in gender-affirming care. No studies described using an implementation science theory, model, or framework to support PROM deployment. Key barriers to PROM implementation included issues with evidence strength and quality of the PROM, engaging participants, and PROM complexity. Key enablers of PROM implementation included using PROMs validated for gender-affirming care, implementing PROMs able to be deployed online or in person, implementing PROMs that are shorter and reduce patient burden, engaging key stakeholders and participants as part of developing an implementation plan, and organizational climate. Conclusions and Relevance In this systematic review of barriers to and enablers of PROM implementation in gender-affirming care, PROM implementation was inconsistent and did not follow evidence-based approaches in implementation science. There was also a lack of patient input in creating implementation strategies, suggesting a need for patient-centered approaches to PROM implementation. Frameworks created from these results can be used to develop evidence-based PROM implementation initiatives for gender-affirming care and have potential generalizability for other clinical areas interested in implementing PROMs

The importance of clinician, patient and researcher collaborations in Alport syndrome

This is a post-peer-review, pre-copyedit version of an article published in Pediatric Nephrology. The final authenticated version is available online at: https://doi.org/10.1007/s00467-019-04241-7Alport syndrome (AS) is caused by mutations in the genes COL4A3, COL4A4 or COL4A5 and is characterised by progressive glomerular disease, sensorineural hearing loss and ocular defects. Occurring in less than 1:5000, AS is rare genetic disorder but still accounts for >1% of the prevalent population receiving renal replacement therapy. There is also increasing awareness about the risk of chronic kidney disease in individuals with heterozygous mutations in AS genes. The mainstay of current therapy is the use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers, yet potential new therapies are now entering clinical trials. The 2017 International Workshop on Alport Syndrome in Glasgow was a preconference workshop ahead of the 50th anniversary meeting of the European Society for Pediatric Nephrology. It focussed on updates in clinical practice, genetics, basic science and also incorporated patient perspectives. More than 80 international experts including clinicians, geneticists, researchers from academia and industry, and patient representatives took part in panel discussions and breakout groups. This report summarises the workshop proceedings and the relevant contemporary literature. It highlights the unique clinician, patient and researcher collaborations achieved by regular engagement between the groups

The Rise and Fall of ‘Girlsdrinkdiaries.com’: Dilemmas and Opportunities When Creating Online Forums to Investigate Health Behaviour

This paper explores the potential dilemmas and opportunities for setting up online discussion forums when undertaking research on health-related behaviour. It draws on the setting up of a website called ‘girlsdrinkdiaries.com’ which sought to understand young women's relationship(s) with alcohol and their feelings about drinking and drunkenness. I reflect on how the use of virtual space may allow for more liberated and ‘free’ talk about sensitive topics in health, yet at the same time may create a voyeuristic and potentially abusive environment. In doing so, I explore the ultimate demise of the website and therefore the potential problems of utilising online methods. I suggest that researchers need to carefully mitigate and negotiate harm when considering such methods, whilst also acknowledging how participants themselves resist and negotiate risk in virtual places

What Does it Mean for Young Women to get Drunk? A Kleinian Perspective on Young Women’s Relationship with Alcohol

On a cold December night in 2008, I was returning from a night out. For the most part it had been like any other ordinary night; Reading is a large town in the South East of the UK with a bustling night-time economy comprising several hundred well-known bars and nightclubs like Revolutions and JD Wetherspoons, where the usual heady ingredients of dancing, crowds, music, chatter, encounters, fights and drunkenness regularly occur. I had spent the night in the police station ‘observing’ all this from the setting of a CCTV room. This research, which was a qualitative study on young women’s relationship(s) with alcohol in the UK and the Netherlands, felt timely: young women appear to be at the centre of a number of anxieties and concerns about drinking, drunkenness and debauchery on city centre streets at the weekend. Indeed, the persistent and dogged media coverage of ‘young women’ as a troublesome group is both commonplace and relentless, particularly in the UK (Day et al. 2004; Measham and Østergaard 2009; Jayne et al. 2011). At the police station, I had entered into familiar conversations: do British women drink too much? How much is too much? Do European women (and men) have ‘better’, or more sophisticated, ways of drinking? Should bars be open all night? And so on

How does reorganisation in child and adolescent mental health services affect access to services? An observational study of two services in England.

BackgroundChild and Adolescent Mental Health Services (CAMHS) in England are making significant changes to improve access and effectiveness. This 'transformation' variously involves easier access to services through a Single Point of Access (SPA), more integrated services within CAMHS and enhanced co-provision across education and third sector or non-profit organisations.MethodsA mixed-methods observational study was conducted to explore the process and impact of transformation over four years in two services. Ethnographic observations and in-depth interviews were conducted and Electronic Patient Records with over one million contacts analysed. Difference-in-differences analysis with propensity score matching to estimate the causal impact of the transformation on patient access was utilised.OutcomesSpend and staffing increased across both CAMHS. The SPA had growing rates of self-referral and new care pathways were seeing patients according to expected degree of psychopathology. Third sector partners were providing increasing numbers of low-intensity interventions. Although the majority of staff were supportive of the changes, the process of transformation led to service tensions. In the first year after transformation there was no change in the rate of new patients accessing services or new spells (episodes of care) in the services. However, by year three, the number of new patients accessing CAMHS was 19% higher (Incidence Rate Ratio: 1·19, CI: 1·16, 1·21) and the rate of new spells was 12% higher (Incidence Rate Ratio: 1·12, CI: 1·05, 1·20).InterpretationTransformation investment, both financial and intellectual, can help to increase access to CAMHS in England, but time is needed to realise the benefits of reorganisation