Health care needs and barriers to care among the transgender population: a study from western Rajasthan.

BACKGROUND: Transgender people comprise an estimated 0.3-0.5% (25 million) of the global population. The public health agenda focuses on understanding and improving the health and well-being of gender minorities. Transgender (TG) persons often have complex healthcare needs and suffer significant health disparities in multiple arenas. The international literature suggests that this community is at a higher risk of depression, and other mental health problems, including HIV. Many transgender people experience gender dysphoria and seek specific medical needs such as sex reassignment surgeries, implants, hormonal therapies, etc., but are unable to access these services due to financial or social reasons. The objective of this study was to assess the healthcare needs and associated barriers experienced by transgender people in Western Rajasthan. METHODOLOGY: A qualitative study was carried out in which multilevel stakeholder interviews were conducted using interview and focus group discussion guides. Data was analyzed using the qualitative thematic analysis technique. RESULTS: Findings reveal that transgender people have expressed their need to access health services for general health needs, including but not limited to mental health, non-communicable diseases, and infectious diseases. Barriers to healthcare services were identified on 3 levels: health system, social and personal. Health system barriers include policy, accessibility, affordability, and acceptability issues. Social factors such as inadequate housing, education, and job opportunities also play an important role in affecting the individual's health-seeking behavior. The knowledge of healthcare providers in this context was also limited in context of health insurance schemes, package of services available for transgenders and the importance of gender sensitive healthcare. CONCLUSION: Transgender people expressed the need for mental health services, programs targeting nutritional improvement, gender-affirmation procedures besides regular screening of non-communicable diseases as operational for males and females. Levels of barriers have been identified at various levels ranging from absence of targeted policies to individual behavior.

Modified extrinsic tooth stain index and its clinical applicability.

Aim: The first index for the assessment of extrinsic stain was published by Lobene in 1986. Using the Lobene stain index in the field is very cumbersome as well it does not meet the general requirement of an index, i.e., the index is to be simple, rapid, highly reproducible, and sensitive enough to detect small changes in the staining level. Hence, there was a need to develop an alternative index for the same purpose. Hence, the only present study was undertaken to propose a modified stain index with more simplicity and clarity. Materials and Methods: An observational study was carried out among 16-44-year-old participants who had at least six natural teeth and were generally healthy. For the revised index, the criteria and codes for intensity were kept the same as MacPherson Index but the criteria for recording area were modified. The data scoring for each tooth was mentioned in the proposed table and was recorded for each of the surfaces according to the proposed area and intensity codes. Analysis was carried out using SPSS version 21 (IBM, Inc. Virginia, United States). Inferential statistics were performed using the Mann-Whitney U-test. Nonparametric tests were applied following the imposition of a numerical interval scale the same as the Lobene index. Results: No statistically significant difference was appreciated for the area, intensity, and product of area × intensity when compared for measurements recorded by two indices as P > 0.05. Hence, validating the proposed index for the clinical application. Conclusion: The proposed modified index may be advantageous over its conventional counterpart due to its ease of recording and concise scoring and also less complexity in the area to be recorded.