Transhealth – how to talk to patients about pronouns

Transgender authors share their experiences of healthcare and the important messages they’d like doctors to know

Two articles published on the bmj aim to help doctors treat patients who request support with their gender identity.

Firstly a practice pointer on how to refer to gender clinic, and secondly a What Your Patient Is Thinking article about trans people’s experiences in the healthcare system.

In this podcast, two of the authors of that patient experience article, Emma-Ben and Reubs, join us to discuss identity, pronouns and what genderqueer means.

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Psychological and emotional concomitants of infertility diagnosis in women with diminished ovarian reserve or anatomical cause of infertility

Fertility and Sterility, Mental health, Volume 108, Issue 1, July 2017

2017 Study Abstract

Objective
To examine the magnitude and predictors of emotional reactions to an infertility diagnosis in two groups of women: those with diminished ovarian reserve (DOR), and those clinically diagnosed with an anatomical cause of infertility (ACI).

Design
Cross-sectional study.

Setting
Academic and private fertility clinics.

Patient(s)
Women diagnosed with DOR (n = 51) and women diagnosed with ACI (n = 51).

Main Outcome Measure(s)

Psychological and emotional concomitants of infertility diagnosis in women with diminished ovarian reserve or anatomical cause of infertility, Fertility and Sterility, Mental health, Volume 108, Issue 1, dx.doi.org/10.1016/j.fertnstert.2017.05.008, July 2017.

Image credit Petras Gagilas.

Fertility Problem Inventory (infertility distress), Rosenberg Self-Esteem Scale, Health Orientation Scale (emotional reactions to receiving a diagnosis).

Result(s)
Women with DOR had statistically significantly higher infertility distress scores than women with ACI and higher scores on subscales assessing distress from social concerns, sexual concerns, and a need for parenthood. In both groups, higher self-esteem was associated with lower infertility distress. Hierarchical multiple regression analyses revealed that for women with DOR and those with ACI lower infertility distress but not self-esteem predicted a more positive emotional reaction toward receiving a fertility diagnosis.

Conclusion(s)
Women diagnosed with DOR have greater infertility distress but similar self-esteem and emotional reactions to their diagnosis compared with women who have an anatomical cause of infertility. These results suggest that for both groups distress surrounding infertility itself may influence the way women respond to learning the cause of their infertility.

Lesbian, gay, bisexual, transgender content on reproductive endocrinology and infertility clinic websites

Fertility and Sterility, Sexuality, Volume 108, Issue 1, July 2017

2017 Study Abstract

Objective
To assess geographical distribution and practice characteristics of fertility clinics inclusive of lesbian, gay, bisexual, and transgender (LGBT) patients.

Design
Cross-sectional analysis.

Main Outcome Measure(s)

Lesbian, gay, bisexual, transgender content on reproductive endocrinology and infertility clinic websites, Fertility and Sterility, Sexuality, Volume 108, Issue 1, dx.doi.org/10.1016/j.fertnstert.2017.05.011, July 2017.

Rainbow flag credit CJF20.

Prevalence and geographical distribution of fertility clinic websites with LGBT-specific content, indicated by keywords and home page cues specific to the LGBT patient population. Assessment of relationship between LGBT-specific content and clinic characteristics, including U.S. region, clinic size, private versus academic setting, and state-mandated fertility insurance coverage.

Result(s)
Of 379 websites analyzed, 201 (53%) contained LGBT content. Clinics with the highest proportion of LGBT website content were in the Northeast (59/82, 72%) and West (63/96, 66%), while the lowest proportion was in the Midwest (29/74, 39%) and South (50/127, 39%). Most frequently used terms included lesbian (72%), LGBT/LGBTQ (69%), and gay (68%), while less used terms included trans/transgender (32%) and bisexual (15%). Larger clinic size was associated with LGBT-specific website content (odds ratio, 4.42; 95% confidence interval, 2.07–9.67). Practice type and state-mandated fertility insurance coverage were not associated with a clinic website having LGBT content.

Conclusion(s)
Over half of Society for Assisted Reproductive Technology member fertility clinics included LGBT content on their websites, yet those in the Midwest and South were significantly less likely to do so. Predictive factors for having LGBT website content included location in northeastern and western regions and increasing clinic size. Further studies are needed to evaluate whether inclusion of LGBT content on clinic websites impacts use of reproductive services by the LGBT patient population.

Plus de transparence dans l’industrie pharmaceutique et des technologies médicales

Belgique, Ministère des Affaires sociales et de la Santé publique, 23/06/2017

BRUXELLES, 23/06/2017– A l’initiative de la ministre des Affaires sociales et de la Santé publique, Maggie De Block, l’obligation de transparence des firmes pharmaceutiques et des technologies médicales est ancrée juridiquement. La décision d’exécution a été publiée au Moniteur belge, aujourd’hui, 23 juin 2017. Les firmes devront rendre publics tous les avantages et primes qu’elles octroient aux associations de patients et aux professionnels et organisations du secteur de la santé. Il s’agit par exemple du soutien à la formation des professionnels de la santé.
En 2015, les transferts de valeurs provenant de l’industrie pharmaceutique s’élevaient à plus de 138 millions d’euros.

Cette obligation de transparence est inspirée de la loi américaine « Physician Payments Sunshine provision » de 2010, mieux connue sous le nom de «Sunshine Act». Elle est inscrite dans le Pacte d’avenir pour le patient avec l’industrie pharmaceutique et le Pacte des Technologies médicales. La ministre De Block a conclu ces pactes avec les secteurs concernés, respectivement le 27 juillet 2015 et le 5 octobre 2016, dans l’intérêt du patient.

Les deux secteurs ont déjà pris des initiatives dans le passé pour communiquer ce type de données. La ministre De Block fixe maintenant cette obligation de transparence légalement et l’étend à l’ensemble des acteurs des soins de santé. La ministre De Block :

« Le citoyen a le droit de savoir si l’industrie pharmaceutique ou celle des technologies médicales ont un lien avec un prestataire de soins, et si c’est le cas, ce que comprend ce lien. »

Publication
Les citoyens peuvent consulter tous les transferts de valeur de manière simple sur le site internet betransparent.be. Ils sont classés par professionnel de la santé, par organisation de la santé, par association de patients et par entreprise.

L’ensemble des transferts de valeurs octroyés pendant l’année calendrier 2017 devront être rendus publics au plus tard le 30 juin 2018. Les firmes devront communiquer ces données chaque année. A côté de ces infos, les données suivantes seront également mentionnées : les investissements en Recherche & Développement, les frais de séjour lors de congrès scientifiques, les rémunérations de consultance, le soutien financier apporté aux associations de patients, etc.

Gestion
Le site sera géré par beTransparent.be, qui regroupe l’ensemble des acteurs concernés. L’agence fédérale des médicaments et des produits de santé (afmps) est chargée de la supervision des activités de beTransparent.be et du respect de la législation.

En Savoir Plus

Toxic Cocktail

How chemical pollution is poisoning our brains

In her latest book, Professor Barbara Demeneix explains how exposure to endocrine disrupting chemicals is resulting in reduced IQ levels in children and higher rates of Autism Spectrum Disorder (ASD). The author also explains the approaches needed to reduce exposure to today’s toxic cocktails.

The EDCs that interfere with the thyroid hormone are resulting in falling child IQ and contributing to rocketing rates of Autism Spectrum Disorder (ASD).

Barbara Demeneix

  • Presents evidence, derived from a wide spectrum of scientific and epidemiological studies, that many of these chemicals are interfering with one of our bodies’ most essential regulators of brain development: thyroid hormone.
  • Offers number of recommendations for individuals to apply in their day-to-day life and suggest actions that should be taken at the regulatory level.
  • Goes through the main catalogue of chemicals that can interfere with thyroid hormone production and action.
  • Tells the personal story of how the author became aware of these problems.
  • Simply presented ways to decrease your individual chemical load to protect yourself and unborn children.
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Endocrine Disruptors

While 91 people per day die of opioid overdose…

Are drug policies at times exactly the opposite from what science-based policies would look like ?

“We have an opioid epidemic that looks like it’s going to be deadlier than AIDS, but the criminal justice system handles drug addiction in almost exactly opposite of what neuroscience and other behavioral sciences would suggest,”

said Keith Humphreys, a professor of psychiatry and behavioral sciences and one of the leaders of the Stanford Neurosciences Institute’s Neurochoice Big Idea initiative.

Summary

With 1 in 8 deaths globally due to the use of tobacco, alcohol, and other drugs, the director-general of the World Health Organization recently called for more scientifically informed public policies regarding addiction.

In the United States, where an average of 91 people per day die of opioid overdose, a presidential task force is to present, on 27 June, policy recommendations to combat opioid addiction, although the House of Representatives passed an Affordable Care Act repeal bill that would withdraw health insurance from two million people with addictions.

Despite these urgent challenges, research on the brain and its interactions with the environment, which can help policymakers advance more effective and humane policies than some traditional approaches to addiction, has only occasionally been applied in public policy.

Sources and Press Releases

60 MiNueTs : Toxic Money

UCSF Program on Reproductive Health and the Environment, 2017

The University of California San Francisco (UCSF) Program on Reproductive Health and the Environment (PRHE)’s mission is to create a healthier environment for human reproduction and development through advancing scientific inquiry, clinical care and health policies that prevent exposures to harmful chemicals in our environment.

PRHE is housed within the Department of Obstetrics, Gynecology and Reproductive Sciences, in the UCSF School of Medicine, one of the nation’s most prestigious medical schools. The Department is renowned for promoting cutting-edge reproductive science research, extending the frontiers of multidisciplinary women’s health care and professional education, advocating for women’s health at local, state and national levels, and engaging community involvement.

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Age at Menopause : Do Chemical Exposures Play a Role ?

Environmental Health Perspectives, Charles W. Schmidt, June 2017

With its associated hot flashes, mood swings, and insomnia, menopause can be a challenging period in a woman’s life. But as much as it marks the end of her childbearing years, menopause—and more specifically the age at which it occurs—can also reflect on a woman’s overall health. An older age at menopause typically reflects good health overall, whereas early menopause—generally defined as occurring before age 40—can reflect poorer health and a greater likelihood of premature mortality.

Now, experts are taking a closer look at how environmental exposures may influence age at menopause and whether exposure-induced changes in menopausal timing put women at greater risk of associated health problems. These are early days in the field, but recent research suggesting a link between potential endocrine-disrupting compounds (EDCs) and early menopause has raised concerns over how exposures might accelerate hormonal processes involved in female aging.

“We know that going through menopause early increases the risk of osteoporosis, heart disease, and other disorders,
so the long-term health implications of early menopause are considerable.”

says Natalia Grindler, a reproductive and endocrinology fellow at the University of Colorado’s Advanced Reproductive Medicine Division.

There is still much to be learned about the toxicology underlying changes in age at menopause, and isolating chemical effects from the other varied influences that govern when a woman’s reproductive years come to an end is challenging. Nevertheless, this area of study provides a new window on population-level effects from chemical exposures that could have wide-ranging consequences.

continue reading Age at Menopause : Do Chemical Exposures Play a Role ? on Environmental Health Perspectives, by Charles W. Schmidt, 12 June 2017.

Includes:

  • Mechanisms of Menopause
  • Variations on Normal
  • Assessing the Evidence
  • A Search for Mechanisms

Download the full PDFImage credit © V. Benakis.

The Toxins that Threatens our Brains

UCSF Program on Reproductive Health and the Environment, 2017

The University of California San Francisco (UCSF) Program on Reproductive Health and the Environment (PRHE)’s mission is to create a healthier environment for human reproduction and development through advancing scientific inquiry, clinical care and health policies that prevent exposures to harmful chemicals in our environment.

PRHE is housed within the Department of Obstetrics, Gynecology and Reproductive Sciences, in the UCSF School of Medicine, one of the nation’s most prestigious medical schools. The Department is renowned for promoting cutting-edge reproductive science research, extending the frontiers of multidisciplinary women’s health care and professional education, advocating for women’s health at local, state and national levels, and engaging community involvement.

More Information

The Florence Statement on Triclosan and Triclocarban

More than 200 scientists outline a broad range of concerns for triclosan and triclocarban and call for reduced use worldwide

Two ingredients used in thousands of products to kill bacteria, fungi and viruses linger in the environment and pose a risk to human health, according to a statement released today by more than 200 scientists and health professionals.

The scientists say the possible benefits in most uses of triclosan and triclocarban – used in some soaps, toothpastes, detergents, paints, carpets – are not worth the risk.

SUMMARY

“Triclosan and triclocarban have been permitted for years without definitive proof they’re providing benefits.”

Avery Lindeman, Green Policy Institute

The Florence Statement on Triclosan and Triclocarban documents a consensus of more than 200 scientists and medical professionals on the hazards of and lack of demonstrated benefit from common uses of triclosan and triclocarban.

These chemicals may be used in thousands of personal care and consumer products as well as in building materials. Based on extensive peer-reviewed research, this statement concludes that triclosan and triclocarban are environmentally persistent endocrine disruptors that bioaccumulate in and are toxic to aquatic and other organisms. Evidence of other hazards to humans and ecosystems from triclosan and triclocarban is presented along with recommendations intended to prevent future harm from triclosan, triclocarban, and antimicrobial substances with similar properties and effects.

Because antimicrobials can have unintended adverse health and environmental impacts, they should only be used when they provide an evidence-based health benefit. Greater transparency is needed in product formulations, and before an antimicrobial is incorporated into a product, the long-term health and ecological impacts should be evaluated.

Sources, Studies, Press Releases

  • The Florence Statement on Triclosan and Triclocarban, Environ Health Perspect; DOI:10.1289/EHP1788, JUNE 2017.
  • Patterns, Variability, and Predictors of Urinary Triclosan Concentrations during Pregnancy and Childhood, Environ. Sci. Technol., DOI: 10.1021/acs.est.7b00325, May 18, 2017
  • Hundreds of scientists call for caution on anti-microbial chemical use, EHN, June 20, 2017.
  • Hygiene leaves kids with loads of triclosan, EHN, June 1, 2017.
  • Image credit Mike Mozart.