The impact of the economic downturn on environmental health services and professionals in North Carolina.

The objective of the authors' study was to examine the impact of the economic recession on the environmental health profession between budget year (BY) 2006-2007 and BY 2010-2011 in the following areas: (1) environmental health department fees for services; (2) changes in staffing levels, benefits, or pay; (3) changes in staff responsibilities; and (4) the impact to the private environmental sector compared to public environmental health professionals. Data were summarized from the following surveys: North Carolina Environmental Health Supervisors Association Fee and Economic Surveys; University of North Carolina Chapel Hill School of Government Current Salary Index; and a created online survey of private-sector environmental professionals. Total fees in the public sector for services have risen for most environmental health departments, but not enough to offset budget reductions. All of the counties that participated in the survey either have reduced staff, pay, or benefits due to budget cuts, and some counties utilized staff in other areas through cross-training. The private environmental sector also reduced staff in response to a reduced workload. Public sector employers may have difficulties retaining existing employees and recruiting new employees over the long-term in the current economic climate.

Disforia de género en niños y controversias en su tratamiento: dos concepciones distintas sobre la identidad de género / Disforia de gênero em crianças e controvérsias em seu tratamento: duas concepções diferentes sobre a identidade de gênero / Gender Dysphoria in Children and Controversies about its Treatment: Two Different Conceptions of Gender Identity

Resumen La disforia de género es una marcada incongruencia entre el sexo que se siente o expresa y el que se asigna al nacer, asociada a un malestar clínicamente significativo o deterioro en lo social, que puede darse en niños, adolescentes y adultos. En relación con los pacientes pediátricos, no existe actualmente consenso sobre su tratamiento, así como tampoco evidencia que apoye claramente un enfoque por sobre otro. En la literatura se describen principalmente tres tipos de abordaje en niños preadolescentes: modelo terapéutico, watchful waiting (espera atenta) y modelo afirmativo. En este trabajo se realiza una breve revisión de la literatura existente sobre la disforia de género, se describen los distintos abordajes en niños y se analizan las visiones antropológicas que los sustentan. Plantearemos que existen al menos dos modos de entender la identidad de género, lo que ha dado lugar, en gran medida, a las controversias en los tratamientos propuestos. Por ello, resulta de gran importancia comprender los supuestos antropológicos en que se fundamentan estos modelos, ya que a cada uno de ellos subyacen diferentes maneras de entender la relación sexo-género en la persona y, por tanto, el rol de la corporalidad y de la autoconsciencia en la identidad de género.

Abstract Gender dysphoria is a marked mismatch between the sex felt or expressed by an individual and that assigned to them at birth. It is associated with clinically significant discomfort or social impairment and can occur in children, adolescents, and adults. The literature mainly describes three approaches for preadolescents: therapeutic model, watchful waiting, and gender affirmative model. However, there is currently no consensus on its treatment nor any evidence that favors one approach over another. This paper provides a brief review of the existing literature on gender dysphoria, explains various approaches for children, and discusses the anthropological views behind them. We argue that at least two ways of understanding gender identity have given rise to disagreements over the proposed treatments. It is quite important to comprehend the anthropological assumptions on which these models are based since they underlie different conceptions of the person's sex-gender relationship and, therefore, the role of corporality and self-awareness in gender identity.

Resumo A disforia de gênero é uma marcada incongruência entre o sexo que se sente ou expressa e o que é designado ao nascer, associada a um malestar clinicamente significativo ou a uma deterioração no âmbito social, que pode ocorrer em crianças, adolescentes e adultos. Quanto aos pacientes pediátricos, não existe atualmente consenso em seu tratamento nem evidência que apoie com clareza uma abordagem sobre outro. Na literatura, são descritos três tipos de abordagem em crianças pré-adolescentes: modelo terapêutico, watchful waiting (observação vigilante) e modelo afirmativo. Neste trabalho, é realizada uma breve revisão da literatura sobre a disforia de gênero, são descritas as diferentes abordagens em crianças e são analisadas as visões antropológicas que as justificam. É provável que haja, pelo menos, dois modos de entender a identidade gênero, o que abre espaço a controvérsias nos tratamentos propostos. Por isso, é de grande importância compreender os pressupostos antropológicos nos quais esses modelos estão fundamentados, já que a cada um deles subjazem diferentes maneiras de entender a relação sexo-gênero na pessoa e, portanto, o papel da corporeidade e da autoconsciência na identidade de gênero.

Hepatitis C virus.

Hepatitis C virus is a common blood-borne pathogen that is now declining as a new infection in the population. However, women and men who were infected 2 to 3 decades ago are now developing liver damage. To prevent further damage, treatment with IFN and ribavirin is available. Because of adverse events, this treatment requires close supervision over 6 to 12 months, which is often provided by a clinic nurse in collaboration with the physician and pharmacist. Educational outreach to the public and health care providers may help identify patients earlier and promote screening of high-risk groups.

Gene expression patterns that correlate with hepatitis C and early progression to fibrosis in liver transplant recipients.

BACKGROUND & AIMS: Liver transplant recipients infected with hepatitis C virus (HCV) develop recurrent hepatitis soon after transplantation and, in some cases, progress to fibrosis within the first 2 years. Our goals were to identify molecular processes influencing the liver disease progression and to find potential gene markers of early fibrosis. METHODS: We performed gene expression profiling on serial liver biopsy specimens obtained from 13 (11 infected and 2 uninfected) transplant recipients within the first year after transplantation at 0, 3, 6, and 12 months. The data were compared with clinical observations and with a gene expression database obtained for 55 nontransplant HCV-infected and uninfected liver samples. RESULTS: We identified several specific gene expression patterns. The first pattern was unique for the transplant recipients regardless of their infection status. The corresponding genes encoded stress response proteins and blood proteins involved in coagulation that were differentially expressed in response to posttransplantation graft recovery. The second pattern was specific to HCV-infected samples and included up-regulation of genes encoding components of the interferon-mediated antiviral response and immune system (antigen presentation, cytotoxic response). This up-regulation pattern was absent or suppressed in the patients who developed early fibrosis, indicating that the disease progression might result from an impaired liver response to infection. Finally, we identified gene expression patterns that were specific for 12-month biopsy specimens in all 4 HCV-infected patients who developed early fibrosis. CONCLUSIONS: The identified gene expression patterns may prove useful for diagnostic and prognostic applications in HCV-infected patients, including predicting early progression to fibrosis.