Research shows an overrepresentation of trans people in vulnerable socioeconomic situations, primarily due to experiences of discrimination. At the same time, rural or suburban living areas often ...lack specialized trans-related health care, which a majority of trans people rely on to some extent. Taken together, the lack of both socioeconomic resources and access to trans-related health care can exacerbate health-related distress and impairment for trans people. We illustrate this problem using case vignettes of trans people from rural and suburban areas in (Northern) Germany. They are currently participating in an e-health intervention and randomized controlled trial (RCT) called
, whose case vignettes provided the impetus for the scoping review. The scoping review analyzes the impact of place of residence and its intersection with barriers to accessing trans-related health care. PubMed and Web of Science Data bases were searched for relevant studies using a search strategy related to trans people and remote, rural, or suburban residences. 33 studies were selected after full-text screening and supplemented
reference list checks and study team expertise by 12 articles addressing the living conditions of remotely living trans people and describing requirements for trans-related health care. The literature on trans people living remotely reveals intersections of trans mental health with age, race, gender expression, geographic location, community size, socioeconomic status, discrimination experiences, and attitudes towards health care providers. Several structural health care barriers are identified. The role of health care professionals (HCPs) for remotely living trans people is discussed. There is no need assuming that rural life for trans people is inevitably worse for health and well-being than urban life. Nevertheless, some clear barriers and health disparities exist for trans people in remote settings. Empowering trans groups and diversity-sensitive education of remote communities in private and institutional settings are needed for respectful inclusion of trans people. Facilitating access to trans-related health care, such as through video-based e-health programs with HCPs, can improve both the health and socioeconomic situation of trans people.
Background and aims: Clinical data suggest that the quality of optical diagnoses of colorectal polyps differs markedly among endoscopists. The aim of this study was to develop a computer program that ...was able to differentiate neoplastic from non-neoplastic polyps using unmagnified endoscopic pictures.
Methods: During colonoscopy procedures polyp photographies were performed using the unmagnified high-definition white light and narrow band image mode. All detected polyps (n = 275) were resected and sent to pathology. Histopathological diagnoses served as the ground truth. Machine learning was used in order to generate a computer-assisted optical biopsy (CAOB) approach. In the test phase pictures were presented to CAOB in order to obtain optical diagnoses. Altogether 788 pictures were available (602 for training the machine learning algorithm and 186 for CAOB testing). All test pictures were also presented to two experts in optical polyp characterization. The primary endpoint of the study was the accuracy of CAOB diagnoses in the test phase.
Results: A total of 100 polyps (of these 52% neoplastic) were used in the CAOB test phase. The mean size of test polyps was 4 mm. Accuracy of the CAOB approach was 78.0%. Sensitivity and negative predictive value were 92.3% and 88.2%, respectively. Accuracy obtained by two expert endoscopists was 84.0% and 77.0%. Regarding accuracy of optical diagnoses CAOB predictions did not differ significantly compared to experts (p = .307 and p = 1.000, respectively).
Conclusions: CAOB showed good accuracy on the basis of unmagnified endoscopic pictures. Performance of CAOB predictions did not differ significantly from experts' decisions. The concept of computer assistance for colorectal polyp characterization needs to evolve towards a real-time application prior of being used in a broader set-up.
While romantic infatuation and separation influence psychological and physiological functioning, the hypothalamic-pituitary-adrenal axis with its biomarkers cortisol, dehydroepiandrosterone (DHEA), ...and progesterone central for coping and distress has been scarcely researched in this context. In particular, endocrine hair analyses assumed to be more valid than saliva or blood assessments for studying long-term processes have not yet been conducted in the context of romantic love. Thus, 101 female subjects in phases of infatuation (n = 16), separation (n = 14), long-term relationships (n = 40), and singlehood (n = 31) reported psychological distress and provided 1 cm hair samples for the assessment of long-term integrated cortisol, DHEA, and progesterone over the last month. Separated, infatuated, and single women exhibited higher cortisol levels than those in a long-term relationship (all ps ≤ .031), while self-reported distress was only evident in separated individuals. Further, no group differences for progesterone (p = .602), but higher DHEA levels in the separation (p = .009) and single group (p = .016) compared to the long-term relationship group were detected. This is the first study showing that compared to women in long-term relationships, infatuation, separation, and single groups exhibit higher levels of physiological, but not necessarily self-reported indicators of distress. These findings, albeit on a very small and preliminary sample, are discussed in the context of the stress-buffering effect of relationships, and provide important starting points for bigger, more balanced studies combining multimodal self-report and biological markers in psychological research of romantic love.
•Higher hair cortisol in separation, infatuation, singlehood vs. stable relationship.•Higher hair DHEA only in separation and singlehood vs. stable relationship.•No group difference for progesterone.•Divergence of physiological and self-reported indicators of distress.
Many transgender and gender diverse (TGD) people use the internet to find ways out of isolation, network, and share information on health-related topics. Thus, e-health services could reduce the ...health burden of TGD people and facilitate access to health care. Following the PRISMA guidelines, we conducted a systematic review on e-health approaches that could improve trans health care (i.e., services directly for TGD people or training programs for health care professionals, HCPs) and their effectiveness, acceptability, and feasibility. We searched PubMed, Web of Science, and PubPsych databases for publications from January 2000 to June 2021 with final updates before publication. The systematic review identified e-health services across 27 studies from 8 different countries. Few studies evaluated e-health services exclusively for TGD people. However, use of an e-health service was found to be effective and beneficial: TGD people improved in health-related outcomes, and HCPs improved in professional expertise. Service users find e-health services helpful and easy to integrate into their daily lives. Recommendations for further development of e-health services in trans health care are provided. In the future, given the rapidly evolving e-health research and care field, new treatment approaches for TGD people should be subject to ongoing evaluation and development.
IntroductionLiving in an area with no or deficient structures for trans health care is disadvantageous for trans people. By providing an internet-based health care programme, i²TransHealth aims at ...reducing structural disadvantages for trans people living in areas lacking specialised care. The e-health intervention consists of video consultations and a 1:1 chat with a study therapist. Additionally, the i²TransHealth network cooperates with physicians, who especially offer crisis intervention close to the participants’ place of residence. The aim of this study is to evaluate the (cost-)effectiveness of the internet-based health care programme for trans people compared with a control (waiting) group. The following research questions will be examined with a sample of 163 trans people: Does a 4-month treatment with the i²TransHealth internet-based health care programme improve patient-reported health-outcomes? Is i²TransHealth cost-effective compared with standard care from a societal or health care payers’ perspective? Does the participation in and support by i²TransHealth lead to an increase of trans-related expertise in the physician network?Methods and analysisIn a randomised controlled trial, the outcomes of an internet-based health care programme for trans people will be investigated. In the intervention group, participants are invited to use i²TransHealth for 4 months. Participants allocated to the control group will be able to start with their transition-related care after 4 months of study participation. The primary outcome measure is defined as the reduction of psychosomatic symptoms, as assessed by the Brief Symptom Inventory-18, 4 months after using the i²TransHealth programme. Participants in both groups will undergo an assessment at baseline and 4 months after using i²TransHealth.Ethics and disseminationPositive ethical approval was obtained from the Hamburg Medical Association (PV7131). The results will be disseminated to service users and their families via media, to health care professionals via professional training and meetings and to researchers via conferences and publications.Trial registration number NCT04290286.Protocol version22 December 2021 (V.1.0)
For the treatment of intestinal tumors by oral administration of drugs, the mucus layer of the intestine represents a barrier, but also a target possibility for drug. The use of nanoparticular drug ...delivery systems is an important tool to improve the transport and accumulation of the drug on the target side. Therefore, specific in vitro test systems to simulate the conditions of an intestine tumor are necessary for the screening and efficiency testing of potential new nanoparticular drug delivery systems. Here, we introduce a microfluidic 3D intestine tumor spheroid model, which allows to test functionalized nanoparticles and their ability to adsorb onto and permeate over a mucus layer under dynamic conditions. More specifically, the model consists of a 3D tumor spheroid with a mucus layer and microvilli on the surface, which is placed into a microfluidic chip system. The system incorporates a fluid flow, which is an important factor in nanoparticle residence time and uptake. To test the microfluidic 3D intestine tumor spheroid model, two different nanoparticle systems surfaces-coated with Carbopol® or Pluronic® F127 were produced to test the adsorption and permeation over the mucus layer. The data showed obvious adsorptive and permeable properties of uncoated and surface-coated nanoparticles in the static and dynamic system. The 3D intestine tumor spheroid model has the potential to significantly advance the preclinical development of new drugs like nanoparticles.
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Iron complexes bound by redox-active pyridine dialdimine (PDAI) ligands catalyze the cycloaddition of two terminal alkynes and one cyanamide. The reaction is both chemo- and regioselective, as only ...4,6-disubstituted 2-aminopyridine products are formed in moderate to high yields. Isolation of an iron azametallacycle (4) suggests that catalyst deactivation occurs with a large excess of cyanamide over longer reaction times. Fe-catalyzed cycloaddition allowed for a straightforward synthesis of a variety of aminopyridines, including known estrogen receptor ligands.
A Ni-catalyzed (4 + 2) cycloaddition of bicyclic 3-azetidinones and alkynes was developed to access indolizidine and quinolizidine alkaloids. A key element was the development of a diazomethylation ...procedure that allows the efficient synthesis of bicyclic azetidinones from pyroglutamic and 6-oxopiperidine-2-carboxylic acid. A ligand screening led to improved regioselectivity and enantiopurity during the Ni-catalyzed (4 + 2) cycloaddition. This straightforward methodology was leveraged to synthesize (+)-ipalbidine, (+)-septicine, (+)-seco-antofine, and (+)-7-methoxy-julandine.
A Ni-catalyzed (4 + 2) cycloaddition of alkynes and azetidinones toward piperidinones was used as key reaction in the enantioselective synthesis of naturally occurring indolizidine alkaloids. The ...reaction benefits from the use of an easily accessible azetidinone as an advanced and divergent intermediate to build the indolizidine core. This methodology has been applied in the total syntheses of (+)-septicine, (+)-ipalbidine, and (+)-seco-antofine to illustrate the applicability of the general approach.
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