The Conflict Between Trade Policy and Environmental Policy in Agriculture

Environmental Economics and Policy, International Relations/Trade,

Endocrinology of Transgender Medicine

Gender-affirming treatment of transgender people requires a multidisciplinary approach in which endocrinologists play a crucial role. The aim of this paper is to review recent data on hormonal treatment of this population and its effect on physical, psychological, and mental health. The Endocrine Society guidelines for transgender women include estrogens in combination with androgen-lowering medications. Feminizing treatment with estrogens and antiandrogens has desired physical changes, such as enhanced breast growth, reduction of facial and body hair growth, and fat redistribution in a female pattern. Possible side effects should be discussed with patients, particularly those at risk for venous thromboembolism. The Endocrine Society guidelines for transgender men include testosterone therapy for virilization with deepening of the voice, cessation of menses, and increases of muscle mass and facial and body hair. Owing to the lack of evidence, treatment of gender nonbinary people should be individualized. Young people may receive pubertal suspension, consisting of GnRH analogs, later followed by sex steroids. Options for fertility preservation should be discussed before any hormonal intervention. Morbidity and cardiovascular risk with cross-sex hormones is unchanged among transgender men and unclear among transgender women. Sex steroid-related malignancies can occur but are rare. Mental health problems such as depression and anxiety have been found to reduce considerably following hormonal treatment. Future studies should aim to explore the long-term outcome of hormonal treatment in transgender people and provide evidence as to the effect of gender-affirming treatment in the nonbinary population

Ergodic problems and periodic homogenization for fully nonlinear equations in half-space type domains with Neumann boundary conditions

We study periodic homogenization problems for second-order pde in half-space type domains with Neumann boundary conditions. In particular, we are interested in "singular problems" for which it is necessary to determine both the homogenized equation and boundary conditions. We provide new results for fully nonlinear equations and boundary conditions. Our results extend previous work of Tanaka in the linear, periodic setting in half-spaces parallel to the axes of the periodicity, and of Arisawa in a rather restrictive nonlinear periodic framework. The key step in our analysis is the study of associated ergodic problems in domains with similar structure

Les déterminants des politiques provinciales au Canada : Une synthèse des études comparatives

Cet article est un bilan des écrits ayant pour objet l’analyse comparative des politiques publiques dans les dix provinces canadiennes. Le bilan est fait en deux temps. D’abord, nous caractérisons le choix des politiques gouvernementales étudiées (la variable dépendante) en fonction de quatre critères : le secteur d’intervention, le point de vue, le type d’observation et la forme de l’activité gouvernementale. Ensuite, nous regardons plus attentivement le choix des facteurs explicatifs (les variables indépendantes) en nous attardant à la pertinence des arguments donnés par les écoles de la convergence et du « Politics Matters ».This article is a review of the studies on provincial public policies in a comparative perspective. We first caracterise the choice of government policies (the dependent variable) using four criteria: the sector of intervention, the point of view, the type of observation, and the form of government activity. Then we direct our attention to the choice of explanatory factors (the independent variables) looking at the relevance of the arguments presented by two approaches: the "Convergence Approach" and the "Politics Matters Approach"

Douleur hallucinée, douleur non perçue dans la psychose

International audienceIn the psychosis, perceptions, sensations and the subjective experience of pain can be altered, and sometimes completely suppressed. Some schizophrenie patients mutilate themselfs and seem te feel no pain or use sensory excitation to struggle against angst that terrify themselfs (sink a pointed object, blind to the sun, etc.) Other schizophrenies patients have terrifies expériences in wich they hallucinate very intense pain against which they tried to struggle. These pathological functioning modes will be presented from a clinical observation.Dans la psychose, les perceptions, les sensations et le vécu subjectif de la douleur peuvent être altérés, voire complètement supprimés. Des patients mutilent certaines parties de leur corps sans douleur apparente, ou encore utilisent des sources d'excitation sensorielle pour lutter contre des angoisses qui les terrifient (s'enfoncer un objet pointu, s'aveu-gler au soleil, etc.) Inversement, certains patients schizophrènes hallucinent des expériences terrifiantes (créent hallucinatoire-ment des douleurs très intenses) contre lesquelles ils essaient de lutter. Ces modalités de fonctionnements pathologiques seront présentées à partir d'exemples cliniques

Endocrine treatment of aging transgender people

High quality empirical data assessing morbidity and mortality and cancer incidence among transgender people are almost non-existent. Sex hormone treatment of conditions in older non-transgender people might as yet be taken as the best available analogy to hormone administration to aging transgender persons. Testosterone administration to transgender men carries little risk with regard to cardiovascular disease and cancer. A dose adaptation may be needed in men with a high hematocrit or cardiac insufficiency. In transgender men, even after breast ablation, breast cancer may occur in residual mammary tissue. Treatment with estrogens (specifically oral ethinylestradiol) of transgender women, particularly in combination with progestins, carries a significant relative risk of developing cardiovascular disease (almost a twofold incidence compared to the general population). The dose of estrogens may have to be reduced with aging. A change from oral to probably safer transdermal estrogens must be considered. Though rare, tumors of the breasts, prostate, meninges and pituitary have been encountered. Based upon the available expertise, initiation of cross-sex hormone treatment in elderly subjects is without disproportionate risks