Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden

CONTEXT: The treatment for transsexualism is sex reassignment, including hormonal treatment and surgery aimed at making the person's body as congruent with the opposite sex as possible. There is a dearth of long term, follow-up studies after sex reassignment. OBJECTIVE: To estimate mortality, morbidity, and criminal rate after surgical sex reassignment of transsexual persons. DESIGN: A population-based matched cohort study. SETTING: Sweden, 1973-2003. PARTICIPANTS: All 324 sex-reassigned persons (191 male-to-females, 133 female-to-males) in Sweden, 1973-2003. Random population controls (10:1) were matched by birth year and birth sex or reassigned (final) sex, respectively. MAIN OUTCOME MEASURES: Hazard ratios (HR) with 95% confidence intervals (CI) for mortality and psychiatric morbidity were obtained with Cox regression models, which were adjusted for immigrant status and psychiatric morbidity prior to sex reassignment (adjusted HR [aHR]). RESULTS: The overall mortality for sex-reassigned persons was higher during follow-up (aHR 2.8; 95% CI 1.8-4.3) than for controls of the same birth sex, particularly death from suicide (aHR 19.1; 95% CI 5.8-62.9). Sex-reassigned persons also had an increased risk for suicide attempts (aHR 4.9; 95% CI 2.9-8.5) and psychiatric inpatient care (aHR 2.8; 95% CI 2.0-3.9). Comparisons with controls matched on reassigned sex yielded similar results. Female-to-males, but not male-to-females, had a higher risk for criminal convictions than their respective birth sex controls. CONCLUSIONS: Persons with transsexualism, after sex reassignment, have considerably higher risks for mortality, suicidal behaviour, and psychiatric morbidity than the general population. Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism, and should inspire improved psychiatric and somatic care after sex reassignment for this patient group

Топонимы предполагаемого кельтского происхождения в Северной Голландии: huisduinen, texel, den helder, helsdeur

В статье рассматривается возможность обнаружения кельтского субстрата в топонимии нидерландской провинции Северная Голландия. Несмотря на то что присутствие кельтских географических названий в северо-западной части Нидерландов кажется маловероятным, автор предлагает рассматривать местный топоним Huisduinen в контексте других названий, имеющих, по всей видимости, кельтское происхождение, самым репрезентативным из которых является Heusden. Это предположение заставляет более пристально взглянуть и на некоторые другие топонимы региона. В IV в. область лишилась почти всего населения, а в V в. снова была заселена. Учитывая этот факт, можно предполагать, что в это время произошла смена языка — с кельтского на германский, причем следы кельтского субстрата вполне могли сохраниться до наших дней. В тот же период произошли радикальные изменения в ландшафте региона. В предшествующих публикациях автора уже высказывалось предположение о возможном кельтском происхождении средневекового топонима Uxalia. В настоящей статье выдвигается гипотеза о том, что изначально топоним относился к нынешнему острову Тексель, а не к соседнему острову Влиеланд. Автор также предлагает кельтские этимологии для названий Helsdeur и Den Helder. Топоним Helsdeur обозначает наиболее глубокую часть пролива между материковой частью провинции Северная Голландия и островом Тексель. Отсутствие ранних фиксаций этого названия в источниках может быть объяснено его статусом табу-слова. В поддержку такого предположения приводятся типологически релевантные примеры табуирования топонимов мореплавателями.The paper focuses on the probability of the Celtic substratum hypothesis in the toponymy of North Holland. Agreeing that the most north-western tip of the Netherlands is an unlikely place to look for Celtic toponyms, the author suggests that the name Huisduinen relates to the same group of names of which Heusden is the most common representative, and which appears to have a Celtic etymology. Thus making it a tempting task to look at a few other names in the same area. As the area lost most of its population in the 4th century AD and became repopulated in the 5th century, language shift offers a possible scenario for a change from Celtic to Germanic with remnants of a Celtic substratum surviving up to the present day. In the same period, the landscape involved saw radical changes as well. In earlier publications it has been suggested that the medieval name Uxalia may be Celtic. Here it is suggested that this name may originally refer to the present-day island of Texel and not — as it later did — to the neighbouring island of Vlieland. A Celtic etymology is also proposed for the names Helsdeur and Den Helder, which — if accepted — have related etymologies. The name Helsdeur refers to the deepest part of the strait between the mainland of the province North Holland and the island of Texel. The lack of early attestations of this name is explained by suggesting its probable taboo status. This hypothesis is supported by a series of relevant examples of taboo place names in the maritime context

Bilateral pleural effusion and a subsegmental infiltrate due to Chlamydia pneumoniae in a mechanically ventilated patient

A case of Chlamydia pneumoniae infection with bilateral pleural effusion and a subsegmental pulmonary infiltrate in an intubated and mechanically ventilated critically ill patient is described. Diagnosis was made by polymerase chain reaction on both pleural effusion