Gender minority stress and diurnal cortisol profiles among transgender and gender diverse people in the United States.

The field of behavioral neuroendocrinology has only begun to explore the lived experiences of transgender and gender diverse (TGD) people exposed to stigma. In light of escalating attacks and legislation targeting TGD people in the United States, it is crucial to examine the physiological pathways through which gender minority stressors become embodied, impact health, and contribute to health inequities. The Trans Resilience and Health Study included baseline data collection from fall 2019 to spring 2020 from a sample of 124 TGD people, reflecting a diversity of gender identities (e.g., trans masculine, trans feminine, and nonbinary) and ages (range = 19-70 years old; M = 34.10), living in Michigan, Nebraska, Oregon, and Tennessee. These analyses examine experiences of gender-related enacted stigma in association with hypothalamic-pituitary-adrenal (HPA)-axis functioning. Among those experiencing the highest levels of enacted stigma, findings show a blunted cortisol awakening response and sluggish daily decline that resulted in elevated concentrations at bedtime compared to those experiencing less enacted stigma. These results of flattened diurnal activity are consistent with an emergent literature on discrimination as a social determinant of potential stress pathophysiology. In contrast, community connectedness was associated with a larger, more dynamic cortisol awakening response. These findings emphasize the importance of incorporating gender-minority stress and resilience measures when studying HPA-axis functioning among TGD people.

Transgender and gender diverse adults' self-reported mental health diagnoses, engagement in mental health services, and perceptions of therapists.

OBJECTIVE: Transgender and gender diverse (TGD) people face various challenges when seeking therapy. Given this, we wanted to understand more about TGD people's perceptions of providers and how these compare to researcher ratings of providers on metrics of affirming practice. METHOD: The sample included 158 TGD adults (Mage = 33.06); 57.6% were in therapy. Participants completed measures about mental health, resilience, and therapy. We systematically coded provider websites and intake forms. RESULTS: Participants in therapy were older, had higher depression, and lower resilience than participants not in therapy. Non-binary/genderqueer participants rated providers as less knowledgeable compared to trans feminine participants. Overall, participants appeared satisfied (71.4% extremely satisfied) and viewed providers as at least moderately knowledgeable (89.1%). Provider coding revealed variation across the markers of affirmation; 66.04% identified a TGD-specialty and only 26.42% shared provider pronouns. Higher frequency of inclusivity (via coding) was related to higher ratings of provider knowledge and more of a focus on gender, however, there was not a significant association with satisfaction. CONCLUSIONS: Providers who engaged in more affirming practices were more knowledgeable compared to those who engaged in fewer affirming practices. This may influence the content of therapy and whether clients feel comfortable discussing gender.

[Inflammation and infection: cellular and biochemical processes]. / Ontsteking en infectie: de cellulaire en biochemische processen.

The terms inflammation and infection are often used interchangeably. Technically this is incorrect. Inflammation is defined as the body's response to a potentially damaging stimulus. Infection involves tissue invasion by microorganisms. An inflammatory reaction will be provoked when infection occurs in an otherwise healthy patient. Inflammation can be recognized clinically by 5 cardinal signs: rubor (redness), calor (warmth), tumor (swelling), dolor (pain), and functio laesa (loss of function). These clinical signs can be explained by the biochemical and cellular processes activated during the inflammatory response. Rubor and calor are the result of local vasodilation. Tumor, dolor and functio laesa result from extravasation of blood plasma, white blood cells, and inflammatory mediators. Pulpitis is an example of inflammation; a periapical abscess is an example of infection.

[A human bite wound caused a severe life threatening infection]. / Een mensenbeet met desastreuze gevolgen.

Within 24 hours after a human bite trauma, a 34-year-old male patient became septic and ended up at an intensive care unit. The combination of a local damage of the skin or mucosa, aggressive micro-organisms, local host factors, and some bad luck resulted in necrotizing fasciitis for this patient. This is a very rapid progressive infection which can spread via fat tissue and the muscle fascia. The occurrence of extensive necrosis releases a lot of cytokines and acute-phase proteins, resulting in a systemic reaction. The consequential vasodilatation makes it necessary for the heart to pump harder in order to maintain the circular volume. The patient will soon become septic and hemodynamically unstable. This can also lead to multiple organ failure with potentially fatal consequences. Because necrotizing fasciitis can be caused by commensal bacteria, even young healthy patients are at risk for this invasive life threatening disease. Early recognition of the clinical manifestations can prevent a fatal outcome.

[Importance of early identification of a deep neck abscess]. / Het belang van tijdige (h)erkenning van een logeabces.

Treatment of odontogenic infections, such as drainage of submucosal abscesses, should be carried out by the dental practitioner. However, when an odontogenic infection deteriorates into a deep neck abscess, treatment should be carried out by the oral maxillofacial surgeon. Based on two cases, this article describes the clinical presentation, course, and necessary treatment of a deep neck abscess. It also points out that timely recognition of the disease is key in treatment. In any case of delay, there is a possibility for fast deterioration by complications, such as airway obstruction, development of descending necrotizing mediastinitis, or sepsis. Oral health practitioners play an important role in early identification of a deep neck abscess. This article proposes recommendations for dentists when to suspect a deep neck infection, which could be useful in quick and adequate referral to an OMF surgeon.

[The dentogenic inflammation, diagnosis, course and treatment]. / De dentogene ontsteking: diagnose, beloop en behandeling.

Inflammation begins as a response of the immune system to an external, harmful stimulus. This stimulus can be chemical, mechanical or bacterial in nature. The inflammatory response is necessary to create optimal conditions for healing. In case of pulpitis, a peri-apical granuloma, peri-coronitis or periodontitis, complaints arise as a result of an inflammatory reaction. With further progression, such as an infiltrate or a submucosal abscess, the bacteria will eventually invade the tissues and develop an infection. Given the high prevalence of dental diseases, oral health care providers are regularly confronted with the consequences of dentogenic inflammation and subsequent infections. Each specific stage of dentogenic inflammation presents symptoms that are important for making the correct diagnosis. This is important in applying the optimal dental, surgical or medical treatment.

Challenging the binary: Gender/sex and the bio-logics of normalcy.

BACKGROUND: We are witnessing renewed debates regarding definitions and boundaries of human gender/sex, where lines of genetics, gonadal hormones, and secondary sex characteristics are drawn to defend strict binary categorizations, with attendant implications for the acceptability and limits of gender identity and diversity. AIMS: Many argue for the need to recognize the entanglement of gender/sex in humans and the myriad ways that gender experience becomes biology; translating this theory into practice in human biology research is essential. Biological anthropology is well poised to contribute to these societal conversations and debates. To do this effectively, a reconsideration of our own conceptions of gender/sex, gender identity, and sexuality is necessary. METHODS: In this article, we discuss biological variation associated with gender/sex and propose ways forward to ensure we are engaging with gender/sex diversity. We base our analysis in the concept of "biological normalcy," which allows consideration of the relationships between statistical distributions and normative views. We address the problematic reliance on binary categories, the utilization of group means to represent typical biologies, and document ways in which binary norms reinforce stigma and inequality regarding gender/sex, gender identity, and sexuality. DISCUSSION AND CONCLUSIONS: We conclude with guidelines and methodological suggestions for how to engage gender/sex and gender identity in research. Our goal is to contribute a framework that all human biologists can use, not just those who work with gender or sexually diverse populations. We hope that in bringing this perspective to bear in human biology, that novel ideas and applications will emerge from within our own discipline.

Biocultural approaches to transgender and gender diverse experience and health: Integrating biomarkers and advancing gender/sex research.

Transgender and gender diverse (TGD) people are increasingly visible in U.S. communities and in national media. With this increased visibility, access to gender affirming healthcare is also on the rise, particularly for urban youth. Political backlash and entrenchment in a gender binary, however, continue to marginalize TGD people, increasing risk for health disparities. The 2016 National Institute of Health recognition of sexual and gender minority people as a health disparities population increases available funding for much-needed research. In this article, we speak to the need for a biocultural human biology of gender/sex diversity by delineating factors that influence physiological functioning, mental health, and physical health of TGD people. We propose that many of these factors can best be investigated with minimally invasively collected biomarker samples (MICBS) and discuss how to integrate MICBS into research inclusive of TGD people. Research use of MICBS among TGD people remains limited, and wider use could enable essential biological and health data to be collected from a population often excluded from research. We provide a broad overview of terminology and current literature, point to key research questions, and address potential challenges researchers might face when aiming to integrate MCIBS in research inclusive of transgender and gender diverse people. We argue that, when used effectively, MICBS can enhance human biologists' ability to empirically measure physiology and health-related outcomes and enable more accurate identification of pathways linking human experience, embodiment, and health.

An international study of public contact with people who have an intellectual disability.

BACKGROUND: People with intellectual disability (ID) are often socially isolated, and many experience stigma and discrimination. Increased contact with the general public is thought to overcome prejudices. This large-scale international study had three main aims: to determine the type and frequency of contact that the general public has with people with ID; to identify the personal characteristics of those who have greater contact; and to examine the public's level of comfort at the prospect of having contact with people with ID. METHOD: Self-completed online questionnaires were administered to nationally representative panels of respondents in 17 countries; totally 24 504 persons. Multivariate analyses were used to identify respondents more likely to have had frequent personal contact with persons with ID from those with infrequent or no contact and those respondents who were most comfortable at meeting a person with ID. RESULTS: Internationally around one in four of the general population reports having frequent personal contact with people who have an ID although this varied from 7% in Japan to 46% in Panama. The principal forms of contact were through friendships, neighbours or extended family members. Over all countries, volunteering and engagement with Special Olympics were the two main predictors of frequent personal contact followed by employment in the education, health or social care field, being a parent of children under 18 years, playing sports and being employed. People who reported frequent personal contact were also more comfortable at meeting a person with ID. CONCLUSIONS: This international dataset provides a baseline against which public contact can be compared across countries and changes monitored over time. The findings suggest ways in which greater contact can be promoted and making the public more comfortable at meeting people with ID.

[The importance of triage in dental trauma. De differences between the hospital and dental practice]. / Het belang van triage bij tandletsel: de verschillen tussen het ziekenhuis en de tandartspraktijk.

In dental trauma, the first thought is often: 'Where is that tooth?' And, of course, it is certainly true that fast repositioning is beneficial for the prognosis of the tooth. Nevertheless, it is extremely important to focus on the condition of the patient before focussing on the treatment. A structured approach is mandatory for optimal diagnosis and treatment. This includes possible concomitant injuries such as neurotrauma. The principle of initial screening of the severity of the injury is called triage. There is a clear difference in the severity of injuries of patients with dental trauma presenting themselves in hospital or the dental practice. In hospital there are protocols for primary care; these principles can be applied in the dental practice as well.

[Acute respiratory distress in a frail older patient: spontaneous tooth aspiration]. / Acute ademnood bij een kwetsbare oudere: spontane aspiratie van een gebitselement.

A 68-year-old man presented at the emergency room with acute difficulty breathing. On account of recent subarachnoidal haemorrhage the patient was a resident of a care facility, and was also being treated for acute bronchitis there. Radiographic imaging of the lungs revealed a tooth with crown and pontic to have been inhaled. The tooth was surgically removed. After 3 weeks in the intensive care unit, the patient died of aspiration pneumonia. Spontaneous tooth aspiration is rare, yet it can have fatal consequences in vulnerable older patients. Aspiration of a foreign body may lead to injury and infection of the trachea and lungs. In order to determine the correct diagnosis in patients with acute respiratory distress, adequate and targeted diagnostics is essential; especially in older patients with multimorbidity and polypharmacy. Sarcopenia, dysphagia, a decrease in functional chewing units and decreased sensation of the palate increase the risk of choking in patients. In addition, dysphagia and poor oral health are known to be strongly associated with aspiration pneumonia. Healthcare providers should pay more attention to oral health in frail older patients.

[The optimal approach to severe facial trauma following a horse's kick]. / Optimale behandeling van ernstig aangezichtstrauma na trap van paard.

A 15-year-old girl was brought to the emergency department of a hospital by ambulance with extensive facial trauma following a horse's kick. The considerable impact resulted in a combination of injuries to the bone, teeth and soft tissue. Following the transfer from the ambulance, the AE physician immediately consulted an oral and maxillofacial surgeon. Consequently, the patient could be brought to the operating theatre almost straight after stabilisation. There, the oral and maxillofacial surgeon first repositioned her teeth in anatomical position, followed by repositioning and fixation of the mandibular fracture. Next, the teeth in the upper front were stabilised with an acid-etch composite splint and the lip was reconstructed.

[Dental trauma: an overview]. / Tandletsel: een overzicht.

It is estimated that, in the Netherlands, 20-30% of 18-year-olds have suffered some form of dental trauma. A third of them must bear the consequences for the rest of their lives. Adequate care and treatment can make a difference and considerably improve the prognosis of a traumatised tooth. Knowledge about the various types of injuries, forms the basis of optimal treatment. Based on the literature currently available, this article provides an overview of the ways in which details in clinical research can be helpful in more effectively estimating the risk of losing teeth and thus in determining treatment options, in such a way that they are immediately applicable in daily practice.

Sexual orientation, disclosure, and cardiovascular stress reactivity.

Stigma may strain the heart health of lesbian, gay, and bisexual (LGB) individuals. To date, however, LGB-related differences in cardiovascular diagnosis, risk factors, and basal biomarkers are inconsistently reported. Using a laboratory-based stress paradigm, the current study assessed whether cardiovascular stress reactivity differs as a function of sexual orientation and disclosure status ("coming out") in a sample of healthy young LGB and heterosexual adults. Eighty-seven participants aged 18-45 (M = 24.61 ± 0.61 SE) identifying as LGB and heterosexual (47%) were exposed to the Trier Social Stress Test, a well-validated laboratory stressor involving public speaking and mental arithmetic. Throughout a two-hour session, ambulatory recordings for heart rate and blood pressure were collected. Self-report questionnaires were also administered to assess psychosocial and demographic variables. Gay/bisexual men showed higher heart rate and lesbian/bisexual women showed marginally higher mean arterial blood pressure in response to a stressor, compared to sex- and age-matched heterosexuals. No significant differences emerged when comparing LGB individuals who had completely disclosed and those that had not completely disclosed their sexual orientation to family and friends. Compared to heterosexuals, heart rate is higher among gay/bisexual men and blood pressure is marginally higher among lesbian/bisexual women when exposed to a laboratory-based stressor. These preliminary findings contribute to small literature on sexual orientation differences in stress reactive biomarkers that requires further exploration. Lay abstract In response to stress exposure in a laboratory, gay/bisexual men showed higher heart rate than heterosexual men. By contrast, lesbian/bisexual showed a non-significant tendency towards higher blood pressure than heterosexual women. These preliminary findings suggest that the heart health of LGB individuals might be strained by stigma exposure.

The CODATwins Project: The Current Status and Recent Findings of COllaborative Project of Development of Anthropometrical Measures in Twins.

The COllaborative project of Development of Anthropometrical measures in Twins (CODATwins) project is a large international collaborative effort to analyze individual-level phenotype data from twins in multiple cohorts from different environments. The main objective is to study factors that modify genetic and environmental variation of height, body mass index (BMI, kg/m2) and size at birth, and additionally to address other research questions such as long-term consequences of birth size. The project started in 2013 and is open to all twin projects in the world having height and weight measures on twins with information on zygosity. Thus far, 54 twin projects from 24 countries have provided individual-level data. The CODATwins database includes 489,981 twin individuals (228,635 complete twin pairs). Since many twin cohorts have collected longitudinal data, there is a total of 1,049,785 height and weight observations. For many cohorts, we also have information on birth weight and length, own smoking behavior and own or parental education. We found that the heritability estimates of height and BMI systematically changed from infancy to old age. Remarkably, only minor differences in the heritability estimates were found across cultural-geographic regions, measurement time and birth cohort for height and BMI. In addition to genetic epidemiological studies, we looked at associations of height and BMI with education, birth weight and smoking status. Within-family analyses examined differences within same-sex and opposite-sex dizygotic twins in birth size and later development. The CODATwins project demonstrates the feasibility and value of international collaboration to address gene-by-exposure interactions that require large sample sizes and address the effects of different exposures across time, geographical regions and socioeconomic status.

Sensitive Health Topics With Underserved Patient Populations: Methodological Considerations for Online Focus Group Discussions.

Online focus group discussions provide an anonymous environment to assess sensitive, health-related experiences that may be difficult to discuss utilizing traditional face-to-face modalities, particularly for marginalized populations such as female-to-male trans masculine (TM) transgender individuals. This article reviews the history, advantages, and disadvantages of online focus groups, with an emphasis for research about sensitive issues with stigmatized, rare, and/or geographically dispersed patient populations. The article then evaluates the success of online focus group discussions as a case study using data from four asynchronous online focus groups conducted between September 2015 and February 2016 that explored topics related to sexual health care access with U.S. TM adults ( N = 29). The rationale for selecting an asynchronous online methodology is described along with the unique methodological considerations that emerged in developing the study protocol. We conclude by sharing lessons learned, including innovations for maximizing participant engagement and comfort to elicit rich qualitative data.

[Needle breakage during local anaesthesia]. / Naaldbreuk tijdens het geven van lokale anesthesie.

Two patients were referred to a maxillofacial surgeon in connection with the occurrence of needle breakage during local anaesthesia. In the first case, of a 67-year-old woman, it concerned a needle breakage after giving mandibular block anaesthesia. The needle could be removed quite easily under local anaesthesia. The second case concerned a less cooperative patient of 8 years old with whom needle breakage occurred after infiltration anaesthesia in the mucobuccal fold of the maxilla with the so-called QuickSleeper 5, needle breakage. After exact localisation by means of cone beam computerised tomography, the 9 mm size needle was removed under general anaesthesia with some difficulty.

[Maxillary osteonecrosis after denosumab treatment]. / Verlies van de bovenkaak door denosumab.

A 58-year-old patient with a history of intravenous use of denosumab was referred to the department of oral and maxillofacial surgery with inadequate recovery after a series of extractions. During physical and radiological examination, several sites of exposed necrotic bone with purulent discharge were seen, and the maxilla appeared fractured at the level of Le Fort 1. Treatment consisted of intravenous administration of antibiotics with consecutive sequestrectomy of the maxilla under general anaesthesia. While Medication Related Osteonecrosis of the Jaw (MRONJ) is most commonly seen in patients treated with bisphosphonates, in the past decade, it has become apparent that other types of medication, most notably denosumab, can cause comparable disorders. Treatment of MRONJ strongly depends on the stage the disease is in. In patients with a history of denosumab or bisphosphonate use (administered either intravenously or orally in combination with corticosteroids), abnormal radiological findings, or developing osteonecrosis, referral to a department of oral and maxillofacial surgery is recommended.

[Ocular complications of local anaesthesia in dentistry]. / Oculaire bijwerkingen van lokale anesthesie in de tandheelkunde.

An estimated 1 in 1,000 local anaesthetic injections in the maxilla or the mandible lead to unwanted effects on the ipsilateral eye. We have seen a case with diplopia and lateral rectus palsy following bimaxillary anaesthesia. A systematic literature review of reports on this type of complication resulted in a total of 144 documented cases published between 1936 and 2016. The most frequently reported symptoms included diplopia (72%), partial or full ophthalmoplegia (26%), ptosis (22%), mydriasis (18%), amaurosis (13%) and orbital pain (12%). This type of complication is best understood by pathophysiological hypotheses that include intra-arterial injection, intravenous injection, autonomic dysregulation, or deep injection and diffusion. If ocular symptoms appear after local intraoral anaesthesia, the patient should be reassured. In the case of diplopia, the eye should be covered with a gauze dressing, and the patient should be instructed about associated safety risks. If symptoms persist or when vision deteriorates, referral to an ophthalmologist is advisable.

[The impact of fireworks: the context of facial trauma]. / De impact van vuurwerk: achtergronden van het aangezichtsletsel.

In the Netherlands the general public can legally use fireworks on New Year's Eve. Despite the fact that the public is well aware of the dangers of fireworks, fireworks accidents occur in which the victims suffer a variety of injuries. In addition to burns, injuries to fingers and/or hands are most common. However, injuries to the eye, which can also involve facial trauma, frequently occur as well. Trauma mainly occurs as a result of the destructive effects of the wave of pressure released by the explosion. The best preventive measure would be to prohibit the use of fireworks by amateurs. Until such time, people should be advised to wear protective fireworks glasses when outside so that damage to the eyes from legal fireworks at least can be prevented.