To estimate the proportion of US adults who identify as transgender and to compare the demographics of the transgender and nontransgender populations.
We conducted a secondary analysis of data from ...states and territories in the 2014 Behavioral Risk Factor Surveillance System that asked about transgender status. The proportion of adults identified as transgender was calculated from affirmative and negative responses (n = 151 456). We analyzed data with a design-adjusted χ
test. We also explored differences between male-to-female and nontransgender females and female-to-male and nontransgender males.
Transgender individuals made up 0.53% (95% confidence interval = 0.46, 0.61) of the population and were more likely to be non-White (40.0% vs 27.3%) and below the poverty line (26.0% vs 15.5%); as likely to be married (50.5% vs 47.7%), living in a rural area (28.7% vs 22.6%), and employed (54.3% vs 57.7%); and less likely to attend college (35.6% vs 56.6%) compared with nontransgender individuals.
Our findings suggest that the transgender population is a racially diverse population present across US communities. Inequalities in the education and socioeconomic status have negative implications for the health of the transgender population.
Transgender individuals are more likely to experience social and economic barriers to health and health care, and have worse mental health outcomes than cisgender individuals. Our study explores ...variations in mental health among minority genders after controlling for sociodemographic factors.
Multistate data were obtained from the 2014 to 2016 Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System. Data were included from respondents who were asked whether they identified as transgender, and if so, as male-to-female (MTF), female-to-male (FTM), or gender nonconforming. Frequent mental distress (≥14 days in the last month of "not good" mental health) was the primary outcome of interest. Analysis was performed using design-adjusted Chi-square tests and multivariable logistic regression models of frequent mental distress with gender identity as the independent variable of interest.
Of 518,986 respondents, 0.51% identified as transgender. Higher rates of frequent mental distress were found between FTM (24.7% 18.5-32.3) and gender nonconforming populations (25.4% 18.7-33.5), compared with the MTF population (14.2% 10.9-18.3). After controlling for sociodemographic factors, non-transgender female (adjusted odds ratio aOR 1.39 confidence interval, CI 1.32-1.46), FTM (aOR 1.93 CI 1.26-2.95), and gender nonconforming (aOR 2.05 CI 1.20-3.50) identities were associated with increased odds of frequent mental distress compared with non-transgender males.
Our findings suggest differences in the mental health of transgender and non-transgender individuals, and between gender minorities within transgender population. The differences persist after controlling for sociodemographic factors. Our results suggest that considering the spectrum of minority genders within the transgender population may be important in understanding health outcomes.
We undertook a study to assess the associations between barriers to insurance coverage for gender-affirming hormones (either lack of insurance or claim denial) and patterns of hormone use among ...transgender adults.
We used data from the US Transgender Survey, a large national sample of 27,715 transgender adults, collected from August to September 2015. We calculated weighted proportions and performed multivariate logistic regression analyses.
Of 12,037 transgender adults using hormones, 992 (9.17%) were using nonprescription hormones. Among insured respondents, 2,528 (20.81%) reported that their claims were denied. Use of nonprescription hormones was more common among respondents who were uninsured (odds ratio = 2.64; 95% CI, 1.88-3.71;
<.001) or whose claims were denied (odds ratio = 2.53; 95% CI, 1.61-3.97;
<.001). Uninsured respondents were also less likely to be using hormones (odds ratio = 0.37; 95% CI, 0.24-0.56;
<.001).
Lack of insurance coverage for gender-affirming hormones is associated with lower overall odds of hormone use and higher odds of use of nonprescription hormones; such barriers may thus be linked to unmonitored and unsafe medication use, and increase the risks for adverse health outcomes. Ensuring access to hormones can decrease the economic burden transgender people face, and is an important part of harm-reduction strategies.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Amniotic fluid embolism (AFE) is a rare, life threatening obstetric complication, often associated with severe coagulopathy. Induced abortions are extremely safe procedures however complications ...including AFE can occur.
A 29-year-old previously healthy woman, gravida 1 para 0, presented for a scheduled second trimester induced abortion via dilation and evacuation at 22-weeks gestation. The case was complicated by a suspected AFE with associated profound coagulopathy. Viscoelastic point-of-care coagulation analysis was used to successfully and swiftly guide management of her coagulopathy.
AFE can occur in the setting of induced abortion. This case report suggests viscoelastic point-of-care coagulation analyzers may aid in the management of pregnancy-related coagulopathy by providing faster coagulation assessment than laboratory testing, and facilitating timely, targeted management of coagulopathy.
INTRODUCTION:Most surveys use a single question to assess sex. The recommended two-step process asks two questions, sex assigned at birth and current gender identity, which better identifies gender ...minority populations. We use Pap smear data from the Behavioral Risk Factor Surveillance System (BRFSS) to examine the impact of single question sex assessment on natal sex-specific condition data.
METHODS:We analyzed data among people eligible for Pap smears in the 2014-2016 BRFSS (n= 294,171). In 2014-2015 “sex” was determined by interviewersʼ perception with “clarification if necessary;” in 2016 respondents were asked, “Are you male or female?” “Females” were asked about Paps. Transgender status was determined by asking “Do you consider yourself to be transgender?” We analyzed the “sex” and transgender status of respondents that were and were not asked about Paps using design-adjusted chi-square tests.
RESULTS:Half of transmen (48.7%), compared to two-thirds (69.8%) of ciswomen, were asked whether they ever had a Pap (p-value <0.001). Sex was coded “male” for 31.8% (24.9-43.0%) of transmen. Pap data was not collected for any individuals coded as “male”. Among transmen labeled “female” there was no difference in those asked about Paps (71.4%) compared to ciswomen (69.8%, p-value=0.709). Of those who were asked, 17.5% of transmen had never had a pap compared to 6.8% of ciswomen (p-value <0.001).
CONCLUSION:Transmen are less likely to be asked about, or to have had, a Pap than ciswomen. With a single sex question, surveys fail to capture natal sex-specific conditions accurately in gender minority populations.
Provoked vestibulodynia, the most common form of vulvodynia (unexplained pain of the vulva), is a prevalent, idiopathic pain disorder associated with a history of recurrent candidiasis (yeast ...infections). It is characterized by vulvar allodynia (painful hypersensitivity to touch) and hyperinnervation. We tested whether repeated, localized exposure of the vulva to a common fungal pathogen can lead to the development of chronic pain. A subset of female mice subjected to recurrent Candida albicans infection developed mechanical allodynia localized to the vulva. The mice with allodynia also exhibited hyperinnervation with peptidergic nociceptor and sympathetic fibers (as indicated by increased protein gene product 9.5, calcitonin gene-related peptide, and vesicular monoamine transporter 2 immunoreactivity in the vaginal epithelium). Long-lasting behavioral allodynia in a subset of mice was also observed after a single, extended Candida infection, as well as after repeated vulvar (but not hind paw) inflammation induced with zymosan, a mixture of fungal antigens. The hypersensitivity and hyperinnervation were both present at least 3 weeks after the resolution of infection and inflammation. Our data show that infection can cause persistent pain long after its resolution and that recurrent yeast infection replicates important features of human provoked vulvodynia in the mouse.
Transgender and gender diverse (TGD) people experience health disparities, and many avoid necessary medical care because of fears of discrimination or mistreatment. Disparate care is further ...compounded by limited understanding of gender-affirming hormone therapy (GAHT) and gender-affirming surgery among the medical community. Specific to radiology, TGD patients report more negative imaging experiences than negative general health encounters, highlighting the need for guidance and best practices for inclusive imaging care. A patient's imaging journey provides numerous opportunities for improvement. Inclusive practice in a radiology department starts with ordering and scheduling the examination, facilitated by staff education on appropriate use of a patient's chosen name, gender identity, and pronouns. Contemporary electronic health record systems have the capacity for recording detailed sexual orientation and gender identity data, but staff must be trained to solicit and use this information. A welcoming environment can help TGD patients to feel safe during the imaging experience and may include institutional nondiscrimination policies, gender-neutral signage, and all-gender single-user dressing rooms and bathrooms. Image acquisition should be performed using trauma-informed and patient-centered care. Finally, radiologists should be aware of reporting considerations for TGD patients, such as avoiding the use of gender in reports when it is not medically relevant and using precise, respectful language for findings related to GAHT and gender-affirming surgical procedures. As a field, radiology has a range of opportunities for improving care delivery for TGD patients, and the authors summarize recommended best practices. See the invited commentary by Stowell in this issue.
RSNA, 2023 Quiz questions for this article are available in the supplemental material.
Regulations regarding bathroom use by transgender people affect youth across the United States. This study examines youth opinions on bathroom use regulations. Data were obtained from MyVoice, a ...weekly text messaging survey of youth aged 14-24 years. Youth were recruited nationally at community events and online; Southeast Michigan was overrepresented. Mixed methods analysis was performed using grounded theory methodology. The majority of respondents (n = 683) were white (71.4%) and had education beyond high school (56.5%). Most (79%) stated that bathroom use by transgender people should not be restricted, rationalizing: 1) bathroom use is private and should be a personal decision; 2) choosing bathrooms is a matter of equality, freedom, and human rights; 3) transgender people are not sexual perpetrators; and 4) forcing transgender people to use particular bathrooms puts them at risk. Contrary to the current policy in many schools, respondents do not support restrictions on bathroom use by transgender people.
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