A Knowledge-Based Assessment of Dermatological Care for Transgender Women.
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ABSTRACT:
SUBMITTER: Sabra JJ
PROVIDER: S-EPMC5938641 | biostudies-literature | 2018
REPOSITORIES: biostudies-literature
Publications
A Knowledge-Based Assessment of Dermatological Care for Transgender Women.
Sabra James J JJ Fang Celestia X CX Kundu Roopal V RV
Transgender health 20180501 1
Dermatologic care plays an important role in the transitioning process for transgender women, with changes occurring to the skin from hormone therapy (HT) and gender affirming procedures. We sought to identify knowledge gaps in a group of transgender women pertaining to both skin and hair changes during the transitioning process. The study was conducted as a cross-sectional survey. Our results demonstrate potential gaps in knowledge that transgender women have regarding HT and gender affirming p ...[more]
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Project description:BACKGROUND:The rapid advancements in health care can make it difficult for general physicians and specialists alike to keep their knowledge up to date. In medicine today, there are deficiencies in the application of knowledge translation (KT) in clinical practice. Some medical procedures are not required, and therefore, no value is added to the patient's care. These unnecessary procedures increase pressures on the health care system's resources, reduce the quality of care, and expose the patients to stress and to other potential risks. KT tools and better access to medical recommendations can lead to improvements in physicians' decision-making processes depending on the patient's specific clinical situation. These tools can provide the physicians with the available options and promote an efficient professional practice. Software for the Evolution of Knowledge in MEDicine (SEKMED) is a technological solution providing access to high-quality evidence, based on just-in-time principles, in the application of medical recommendations for clinical decision-making processes recognized by community members, accreditation bodies, the recommendations from medical specialty societies made available through campaigns such as Choosing Wisely, and different standards or accreditive bodies. OBJECTIVE:The main objective of this protocol is to assess the usefulness of the SEKMED platform used within a real working clinical practice, specifically the Centre intégré de santé et des services sociaux de l'Outaouais in Quebec, Canada. To achieve our main objective, 20 emergency physicians from the Hull and Gatineau Hospitals participate in the project as well as 20 patient care unit physicians from the Hull Hospital. In addition, 10 external students or residents studying family medicine from McGill University will also participate in our study. METHODS:The project is divided into 4 phases: (1) orientation; (2) data synthesis; (3) develop and validate the recommendations; and (4) implement, monitor, and update the recommendations. These phases will enable us to meet our 6 specific research objectives that aim to measure the integration of recommendations in clinical practices, the before and after improvements in practices, the value attributed by physicians to recommendations, the user's platform experience, the educational benefits according to medical students, and the organizational benefits according to stakeholders. The knowledge gained during each phase will be applied on an iterative and continuous basis to all other phases over a period of 2 years. RESULTS:This project was funded in April 2018 by the Fonds de soutien à l'innovation en santé et en services sociaux for 24 months. Ethics approval has been attained, the study began in June 2018, the data collection will be complete at the end of December 2019, and the data analysis will start in winter 2020. Both major city hospitals in the Outaouais region, Quebec, Canada, have agreed to participate in the project. CONCLUSIONS:If results show preliminary efficacy and usability of the system, a large-scale implementation will be conducted. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID):PRR1-10.2196/11754.
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Project description:BackgroundMost pharmacists have not received formal training or education in the provision of care for transgender patients. Nonetheless, pharmacists have the potential to be valuable partners in the care of transgender patients, and a continuing education course might be valuable in addressing this knowledge gap.ObjectiveThe aim of this study was to examine the impact of a three-hour continuing education course in improving the knowledge of pharmacists to provide pharmaceutical care for transgender patients.MethodsA quasi-experimental, one-group pre-test/post-test study design was used to measure the impact of a three-hour continuing pharmacy education course on the knowledge of pharmacists on transgender care. The course was divided into three units: (1) Transgender Patient Care Introduction, (2) General Health Issues of Transgender Patients, and (3) Gender Affirming Hormone Therapy. A total of 68 pharmacists participated in the study, of which 54 completed both the pre- and post-test. An ANOVA was used to compare differences in knowledge in the group before and after the educational intervention.ResultsThe majority of the participating pharmacists were cisgender, heterosexual women who had not received any formal training related to transgender care. Participants demonstrated the largest increase in execution score in the third unit, with a percent improvement of 25.22% (pre-test 45.06%, post-test 70.28%; p<0.001). The average total execution score was 52.15% in the pre-test and 72.89% (p< 0.001) in the post-test.ConclusionsPharmacists benefited from a three-hour continuing education course with an increase in knowledge regarding transgender patient care and hormone therapy for gender affirmation. As this study only evaluated the effect in short term memory, further studies are needed to assess long term impact of the continuing education course on transgender care knowledge.
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Project description:ImportanceTransgender, gender nonbinary, and genderqueer people are at increased risk for negative health outcomes, and medical school education is currently lacking on inclusion of these topics. However, there is little evidence of an association of clinician knowledge with the health of transgender people.ObjectiveTo evaluate the associations of patients' perceptions of clinician knowledge with self-rated health and severe psychological distress among transgender people.Design, setting, and participantsIn this cross-sectional study, a secondary data analysis of the 2015 US Transgender Survey (a survey of transgender, gender nonbinary, and genderqueer adults conducted across 50 states) Washington, DC, US territories, and US military bases in 2015 was performed. Data were analyzed from February to November 2022.ExposuresPatients' perception of their clinician's knowledge about transgender health care.Main outcomes and measuresSelf-rated health, dichotomized as poor or fair vs excellent, very good, or good, and severe psychological distress (scoring a validated threshold of ≥13 on the Kessler Psychological Distress Scale).ResultsThe sample included a total of 27 715 respondents (9238 transgender women [33.3%; 55.1% weighted; 95% CI, 53.4%-56.7%], 22 658 non-Hispanic White individuals [81.8%; 65.6% weighted; 95% CI, 63.7%-67.5%], and 4085 individuals aged 45-64 years [14.7%; 33.8% weighted; 95% CI, 32.0%-35.5%]). Of 23 318 individuals who answered questions regarding their perceptions of their clinicians' level of knowledge, 5732 (24.6%) reported their clinician knows almost everything about transgender care, 4083 (17.5%) reported their clinician knows most things, 3446 (14.8%) reported their clinician knows some things, 2680 (11.5%) reported their clinician knows almost nothing, and 7337 (31.5%) reported they were unsure. Nearly 1 in 4 transgender adults (5612 of 23 557 individuals [23.8%]) reported having to teach their clinician about transgender people. In total, 3955 respondents (19.4%; 20.8% weighted; 95% CI, 19.2%-22.6%) reported fair or poor self-rated health and 7392 (36.9%; 28.4% weighted, 95% CI, 26.9%-30.1%) met the criteria for severe psychological distress. After adjusting for covariates, compared with individuals who reported their clinician knows almost everything about transgender care, exposure to clinicians with lower perceived levels of knowledge about transgender care was associated with significantly higher odds of fair or poor self-rated health (adjusted odds ratio [aOR] for knowing almost nothing, 2.63; 95% CI, 1.76-3.94; aOR for unsure, 1.81; 95% CI, 1.28-2.56) and severe psychological distress (aOR for knowing almost nothing, 2.33; 95% CI, 1.61-3.37; aOR for unsure, 1.37; 95% CI, 1.05-1.79). Respondents who had to teach a clinician about transgender people had higher odds of reporting fair or poor self-rated health (aOR, 1.67; 95% CI, 1.31-2.13) and severe psychological distress (aOR, 1.49; 95% CI, 1.21-1.83) compared with those who did not.Conclusion and relevanceThe findings of this cross-sectional study suggest that there is an association between perceived clinician knowledge about transgender people and self-rated health and psychological distress among transgender people. These results highlight the importance of integration and enhancement of transgender health in medical education curriculum as a necessary intervention to improve the health of transgender people.
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Project description:We investigated health, economic, and social disparities among transgender adults (transgender women, men, and nonbinary) aged 18 years and older. Using population-based data from the Washington State Behavioral Risk Factor Surveillance System (WA-BRFSS), we pooled 2016 through 2019 data (n = 47,894). We estimated weighted distributions and prevalence by gender identity for background characteristics, economic, social and health indicators. We performed regressions of these indicators on gender identity, including transgender versus cisgender adults and transgender nonbinary adults compared to cisgender adults, followed by subgroup analyses: transgender women and men compared to each cisgender group and to one another, adjusting for covariates. Compared to cisgender adults, transgender adults overall were significantly younger and lower income with less education; more likely single with fewer children; and had several elevated health risks, including poor physical and mental health, and higher rates of chronic conditions and disability. Alternatively, transgender men and women had higher rates of flu vaccination than cisgender men. Between transgender subgroups, transgender men and transgender nonbinary adults were younger than transgender women; transgender men were significantly less likely married or partnered than transgender women; and, transgender women were more likely to live alone than nonbinary respondents. This is one of the first population-based studies to examine both between and within subgroup disparities among cisgender, transgender binary, and transgender nonbinary adults, revealing patterns of inequities across subgroups. More research understanding the mechanisms of these disparities and the development of targeted interventions is needed to address the unique needs of subgroups of transgender people.
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Project description:Gender is one of the main variables that influence the distribution of local knowledge. We carried out a literature review concerning local mycological knowledge, paying special attention to data concerning women's knowledge and comparative gender data. We found that unique features of local mycological knowledge allow people to successfully manage mushrooms. Women are involved in every stage of mushroom utilization from collection to processing and marketing. Local mycological knowledge includes the use mushrooms as food, medicine, and recreational objects as well as an aid to seasonal household economies. In many regions of the world, women are often the main mushroom collectors and possess a vast knowledge about mushroom taxonomy, biology, and ecology. Local experts play a vital role in the transmission of local mycological knowledge. Women participate in the diffusion of this knowledge as well as in its enrichment through innovation. Female mushroom collectors appreciate their mycological knowledge and pursue strategies and organization to reproduce it in their communities. Women mushroom gatherers are conscious of their knowledge, value its contribution in their subsistence systems, and proudly incorporate it in their cultural identity.
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Project description:BackgroundSelf-care during pregnancy is a crucial topic to be discussed due to its effects on both the mother and fetus. In Sri Lanka, specifically regarding self-care with over-the-counter (OTC) medicines, usage among the pregnant population is scarce.ObjectiveThis study assessed knowledge, attitudes, and practices (KAP) on self-care with OTC medicine usage among pregnant women attending maternity clinics in the Colombo Medical Officer of Health (MOH) areas, Sri Lanka.MethodA cross-sectional study was conducted among 399 pregnant women enrolled through simple random sampling using a self-administered questionnaire. Data were collected on knowledge, attitudes, practices, and sociodemographic characteristics. SPSS version 27 was used for descriptive statistical analysis.ResultsThere were satisfactory levels of KAP on self-care with OTC medicines identified among participants. The Mean ± SD for knowledge was 4.38 ± 0.873, and for attitude and practice, 27.56 ± 3.752 and 20.35 ± 4.235, respectively. Significant positive linear correlation between knowledge and attitude (r = 0.375, p < 0.001), attitude and practice (r = 0.518, p < 0.001), and knowledge and practice (r = 0.224, p < 0.001) were observed. It refers to participants with higher levels of knowledge being more likely to exhibit certain attitudes and engage in good practice regarding self-care. However, 93% of the participants had a wrong intention that any medicine could be used at any stage of pregnancy, and 26.3% of the participants didn't know that the medications taken during pregnancy could impact the fetus. Surprisingly, 87% had misperceived that antibiotics can be purchased as OTC medicines. Additionally, the majority of the participants (96%) believed that they could use old prescriptions to purchase medicines during pregnancy.ConclusionGreater awareness regarding self-care with OTC medication usage is suggested to be provided during pregnancy.
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Project description: Not available
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Project description:PurposeLittle has been reported from population-based surveys on the characteristics of transgender persons living with HIV. Using Medical Monitoring Project (MMP) data, we describe the characteristics of HIV-infected transgender women and examine their care and treatment needs.MethodsWe used combined data from the 2009 to 2011 cycles of MMP, an HIV surveillance system designed to produce nationally representative estimates of the characteristics of HIV-infected adults receiving medical care in the United States, to compare demographic, behavioral, and clinical characteristics, and met and unmet needs for supportive services of transgender women with those of non-transgender persons using Rao-Scott chi-square tests.ResultsAn estimated 1.3% of HIV-infected persons receiving care in the United States self-identified as transgender women. Transgender women were socioeconomically more marginalized than non-transgender men and women. We found no differences between transgender women and non-transgender men and women in the percentages prescribed antiretroviral therapy (ART). However, a significantly lower percentage of transgender women compared to non-transgender men had 100% ART dose adherence (78.4% vs. 87.4%) and durable viral suppression (50.8% vs. 61.4%). Higher percentages of transgender women needed supportive services. No differences were observed in receipt of most of supportive services, but transgender women had higher unmet needs than non-transgender men for basic services such as food and housing.ConclusionWe found little difference between transgender women and non-transgender persons in regards to receipt of care, treatment, and most of supportive services. However, the noted disparities in durable viral suppression and unmet needs for basic services should be explored further.
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Project description:IntroductionTurner syndrome (TS) is associated with distinct manifestations in women and girls including short stature, cardiac abnormalities, premature ovarian failure as well as dermatological features, including lymphedema, keloids, onychodystrophy, and acne. Although many dermatological concerns present during the first few decades of life, the overwhelming majority of respondents are not provided with dermatology referrals at diagnosis.MethodsThis cross-sectional study utilized an author designed survey to assess self-reported dermatological manifestations, dermatology referral experience, common therapies for select dermatological conditions, as well as a validated 10-question Dermatology Life Quality Index (DLQI) to assess quality-of-life impact in women and girls with Turner syndrome.ResultsIn our cohort, 64% (n = 149) had been referred to a dermatologist at some point in their life time. The majority of individuals self-identified their dermatological concern (79.6%) and were referred after a dermatological concern had already occurred (90.2%). The most common dermatological findings reported were xerosis cutis (78.7%), lymphedema (73%), and more than 20 acquired melanocytic nevi (70%). The overall mean DLQI score was 3.52, indicative of a small effect on the patient's life. Onychodystrophy, history of skin biopsy, and lymphedema were statistically significant to have a higher impact on quality of life.DiscussionOur data reveal that skin conditions are highly prevalent in the TS population during the early decades of life and affirm utilizing these conditions in the TS diagnostic process, as well as emphasize the need for specialized dermatology referrals to address the detrimental impacts related to skin concerns on quality of life.
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Project description:BACKGROUND:In Argentina, HIV prevalence among transgender women (TGW) has been reported at 34%. The stigma is one of the most important factors limiting their access to healthcare services. The aims of this study were to compare different HIV testing methodologies, to determine the factors associated with HIV diagnosis and to determine the feasibility of a home-based HIV testing service for TGW. METHODS:A multidisciplinary team performed home-based HIV testing interventions in four cities of Argentina. Participants self-identified as TGW, older than 14 years and with a negative or unknown HIV status. Blood samples were screened by two rapid tests (RT), one based on antibodies (Determine™ HIV-1/2) and the other on antigen and antibodies (Determine™ HIV-1/2 Combo), and the subsequent blood processing via 4th generation ELISA (VIDAS HIV DUO). All reactive samples were confirmed with a viral load (VL). We compared the results of both RT with the ELISA. Samples were pooled in groups of 6 and a VL (Abbott Real Time) performed to identify acute HIV infections. Factors associated with HIV infection were evaluated with multivariate logistic regression analysis. RESULTS:A total of 260 TGW were tested, 51 tested positive (HIV prevalence 19.6%). There were no discordant results between both RTs nor between RTs and 4th generation ELISA, therefore the correlation was 100%. The VL identified 2 additional positive samples. The final analytic sample for positive cases consisted of 53 TGW. In the multivariate analysis, factors associated with a positive HIV result were history of other sexually transmitted infections (STIs) and not being previously tested for HIV. TGW tested for the first time were at 4 times greater risk of being HIV positive compared to those that were tested previously. CONCLUSIONS:A multidisciplinary home-based HIV testing service among TGW is feasible and effective to detect cases of HIV infection. The testing algorithm should start with an RT followed by molecular diagnosis. The history of STIs and never having been tested for HIV were the factors associated with HIV-positive results and should determine efforts to reach this population. Home-based testing reaches individuals that were not tested before and who have more risk of acquiring HIV.
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