[Evaluation of bone health in transgender people. Position of the Argentine Osteoporosis Society]. / Valoración de la densidad mineral ósea en personas transgénero. Posicionamiento de la Sociedad Argentina de Osteoporosis.

The Argentine Osteoporosis Society convened renowned specialists in the care of transgender people to prepare the first local position on the evaluation of bone health in this population. Law 26.743 on "Gender Identity" recognize all identities and guarantees free care throughout the health system. The impact of different gender affirmation treatments on bone mass has been topic of international debate. To date the evidence remains limited and different societies have issued suggestions and recommendations. For this reason, we believe it is relevant to mention our experience, capturing through this document a series of suggestions to be used in medical care.

La Sociedad Argentina de Osteoporosis convocó a especialistas reconocidos en la atención de personas transgénero para la elaboración del primer posicionamiento local sobre la evaluación de la salud ósea en esta población. La ley 26.743 de "Identidad de género" reconoce todas las identidades y garantiza su atención de manera gratuita en el sistema de salud. El impacto de los diferentes tratamientos de afirmación de género sobre la masa ósea ha sido tópico de debate internacional. Hasta la fecha la evidencia sigue siendo limitada y diferentes sociedades han emitido sugerencias y recomendaciones. Por tal motivo, creemos relevante mencionar nuestra experiencia plasmando mediante este documento una serie de sugerencias para ser utilizadas en la atención médica.

Valoración de la densidad mineral ósea en personas transgénero posicionamiento de la Sociedad Argentina de Osteoporosis / Evaluation of bone health in transgender people. Position of the Argentine Osteoporosis Society

Resumen La Sociedad Argentina de Osteoporosis convocó a especialistas reconocidos en la atención de personas transgénero para la elaboración del primer posiciona miento local sobre la evaluación de la salud ósea en esta población. La ley 26.743 de "Identidad de género" reco noce todas las identidades y garantiza su atención de manera gratuita en el sistema de salud. El impacto de los diferentes tratamientos de afirmación de género sobre la masa ósea ha sido tópico de debate internacional. Hasta la fecha la evidencia sigue siendo limitada y diferentes sociedades han emitido sugerencias y recomendaciones. Por tal motivo, creemos relevante mencionar nuestra experiencia plasmando mediante este documento una serie de sugerencias para ser utilizadas en la atención médica.

Abstract The Argentine Osteoporosis Society convened renowned specialists in the care of transgender people to prepare the first local position on the evaluation of bone health in this population. Law 26.743 on "Gender Identity" recognize all identities and guarantees free care throughout the health system. The impact of different gender affirmation treatments on bone mass has been topic of international debate. To date the evidence remains limited and different societies have issued suggestions and recommendations. For this reason, we believe it is relevant to mention our experience, capturing through this document a series of suggestions to be used in medical care.

An overview of international regulatory frameworks for mesenchymal stromal cell-based medicinal products: From laboratory to patient.

Human mesenchymal stromal cells (hMSCs) are emerging as one of the most important cell types in advanced therapies and regenerative medicine due to their great therapeutic potential. The development of hMSC-based products focuses on the use of hMSCs as biological active substances, and they are considered medicinal products by the primary health agencies worldwide. Due to their regulatory status, the development of hMSC-based products is regulated by specific criteria that range from the design phase, nonclinical studies, clinical studies, to the final registration and approval. Patients should only be administered hMSC-based products within the framework of a clinical trial or after the product has obtained marketing authorization; in both cases, authorization by health authorities is usually required. Considering the above, this paper describes the current general regulatory requirements for hMSC-based products, by jurisdiction, to be implemented throughout their entire development process. These measures may provide support for researchers from both public and private entities and academia to optimize the development of these products and their subsequent marketing, thereby improving access to them by patients.

Adults with Housing Insecurity Have Worse Access to Primary and Preventive Care.

OBJECTIVE: Housing insecurity has been linked to high-risk behaviors and chronic disease, although less is known about the pathways leading to poor health. We sought to determine whether housing insecurity is associated with access to preventive and primary care. METHODS: We conducted weighted univariate, bivariate, and multivariate analyses by using 2011 to 2015 Behavioral Risk factor Surveillance Survey data (N = 228,131 adults). The independent variable was housing insecurity derived from the question on worry about paying rent or mortgage. The outcome measures were health services utilization (no usual source of care, no routine checkup in the past 1 year, and delayed medical care due to cost), self-rated health (number of days reported physical, mental health not good, and poor overall health), and number of chronic diseases (0, 1, 2 or more). The covariates included age, sex, race/ethnicity, income, level of education, marital status, and number of children in the family. We also adjusted for state fixed effects and survey year. We performed χ2 tests and binary logistic regressions on categorical variables and ran t tests and estimated linear regression models on continuous variables. Multinomial logistic regressions were estimated for the number of chronic diseases. RESULTS: Of the 228,131 adults in the study sample, 28,704 adults reported housing insecurity. We found that those with housing insecurity were more likely to forgo routine check-ups and lack usual sources of care. Low-income individuals, minorities, the unmarried, and middle-aged adults were more likely to report housing insecurity. CONCLUSION: Housing insecurity is associated with worse access to preventive and primary care. Interventions to enhance access for these patients should be developed and studied.

Finding the Value in 'Value' Designation: Evidence and Opportunity in the United States.

PURPOSE: Centers of Excellence (COE) designations have been used to distinguish high-quality facilities. Originally based on quality metrics alone, published evidence failed to consistently show improvements in measurable quality markers. COE development has since shifted to a value-based framework incorporating cost of care, providing greater transparency. This study evaluated the patient outcomes of such value-designated facilities certified under one of the larger U.S. commercial provider networks. DESIGN: Retrospective, observational study using 2009-2013 commercial administrative claims data. METHODOLOGY: Analysis included 33,827 adults (≥18 years) who received spine surgery at value-designated (n=6,141, 22%) vs. other facilities (n=27,686, 78%). Multivariate regression models were used to compare 90-day episodic costs and quality outcomes, adjusted for patient characteristics and comorbidities. RESULTS: Adjusted episodic cost per surgery was lower in value-designated facilities by $3,157 (16%) for lumbar discectomy/decompression, $6,784 (19%) for cervical simple fusion, and $11,134 (18%) for lumbar simple fusion (all P<.05). Adjusted complication rate was lower (1.5% vs. 2.0%; P<.05) at value-designated facilities, while other quality measures were similar. Value-designated facilities tended to be large, in metropolitan areas, affiliated with medical schools, and performed more surgical procedures and provided more nursing hours. CONCLUSIONS: To our knowledge, this is the first large-scale study evaluating value-designated COE. Value-designated COE programs represent an advance over a cost- or quality-alone designation in the ability to identify facilities with lower costs and equal or better quality outcomes. Value designation offers patients transparency for selecting care providers. Future efforts should continue to refine quality criteria used in designations to distinguish patient outcomes.

Bridging the Distance in the Caribbean: Telemedicine as a means to build capacity for care in paediatric cancer and blood disorders.

Over the past 50 years, survival for children in high-income countries has increased from 30% to over 80%, compared to 10-30% in low and middle income countries (LMIC). Given this gap in survival, established paediatric cancer treatment centres, such as The Hospital for Sick Children (SickKids) are well positioned to share clinical expertise. Through the SickKids Centre for Global Child Health, the SickKids-Caribbean Initiative (SCI) was launched in March 2013 to improve the outcomes and quality of life for children with cancer and blood disorders in the Caribbean. The six participating Caribbean countries are among those defined by the United Nations as Small Island Developing States, due to their small size, remote location and limited accessibility. Telemedicine presents an opportunity to increase their accessibility to health care services and has been used by SCI to facilitate two series of interprofessional rounds. Case Consultation Review Rounds are a forum for learning about diagnostic work-up, management challenges and treatment recommendations for these diseases. To date, 54 cases have been reviewed by SickKids staff, of which 35 have been presented in monthly rounds. Patient Care Education Rounds provide nurses and other staff with the knowledge base needed to safely care for children and adolescents receiving treatment. Five of these rounds have taken place to date, with over 200 attendees. Utilized by SCI for both clinical and non-clinical meetings, telemedicine has enhanced opportunities for collaboration within the Caribbean region. By building capacity and nurturing expert knowledge through education, SCI hopes to contribute to closing the gap in childhood survival between high and low-resource settings.

Comparison of compostable bags and aerated bins with conventional storage systems to collect the organic fraction of municipal solid waste from homes. a Catalonia case study.

The separation of biowaste at home is key to improving, facilitating and reducing the operational costs of the treatment of organic municipal waste. The conventional method of collecting such waste and separating it at home is usually done by using a sealed bin with a plastic bag. The use of modern compostable bags is starting to be implemented in some European countries. These compostable bags are made of biodegradable polymers, often from renewable sources. In addition to compostable bags, a new model of bin is also promoted that has a perforated surface that, together with the compostable bag, makes the so-called "aerated system". In this study, different combinations of home collection systems have been systematically studied in the laboratory and at home. The results obtained quantitatively demonstrate that the aerated bin and compostable bag system combination is effective at improving the collection of biowaste without significant gaseous emissions and preparing the organic waste for further composting as concluded from the respiration indices. In terms of weight loss, temperature, gas emissions, respiration index and organic matter reduction, the best results were achieved with the aerated system. At the same time, a qualitative study of bin and bag combinations was carried in 100 homes in which more than 80% of the families participating preferred the aerated system.

Standardization of terminology for episodes of hematopoietic stem cell patient transplant care.

The nomenclature describing hematopoietic stem cell transplantation has evolved, adding precision and definition in research and regulation. The lack of coordination and standardization in terminology has left some gaps in the definition of episodes of clinical care. These voids have caused particular problems in contracting for payment and billing for services rendered. The purpose of this report is to propose definitions for cell products, cell infusions, and transplantation episodes.

An overview of American Indians and Alaska Natives in the context of Social Security and Supplemental Security Income.

This article examines the economic security of the American Indian and Alaska Native (AIAN) population by exploring AIAN receipt of Social Security benefits and Supplemental Security Income (SSI). This analysis uses data from the 2005-2009 American Community Survey Public Use Microdata Sample, which provides a larger AIAN sample size than many other sources, thereby enabling more reliable estimates. We find that adult AIANs are less likely to receive Social Security benefits and more likely to receive SSI than are adults in the total population. In both programs, median benefit amounts are lower for AIAN recipients than for recipients in the total population.

Benefits of self-monitoring blood glucose in the management of new-onset Type 2 diabetes mellitus: the St Carlos Study, a prospective randomized clinic-based interventional study with parallel groups.

BACKGROUND: Intensive treatment of patients with Type 2 diabetes mellitus (T2DM) from the moment of diagnosis facilitates ß-cell recovery. Self-monitoring of blood glucose (SMBG)-based educational and pharmacological intervention may be better than conventional HbA1c algorithms in the treatment of newly diagnosed T2DM. METHODS: Newly diagnosed T2DM patients were randomized to either an SMBG-based intervention or an HbA1c-based control group (n = 99 and 62, respectively) and were followed for 1 year. RESULTS: Higher rates of diabetes regression (HbA1c < 6% on metformin alone) and remission (HbA1c between 6.0% and 6.4%) were achieved in the intervention compared with the control group (39% vs 5% (P < 0.001) and 37% vs 30% (P < 0.01), respectively). Furthermore, significantly greater reductions in median HbA1c (6.6% to 6.1%; P < 0.05) and body mass index (29.6-27.9 kg/m(2) ; P < 0.001) were seen in the intervention over the 1 year of therapy. The percentage of patients achieving a lifestyle score >12 was significantly greater in the SMBG compared with the control group (38.4% vs 9.7% respectively; P < 0.001). An inverse correlation was observed between SMBG and HbA1c levels (P < 0.04). CONCLUSIONS: The results indicate that SMBG-based structured educational and pharmacological programs empower patients to achieve nutritional and physical activity goals, and encourage physicians and patients to use SMBG to optimize therapy. We believe that the concept of intensive treatment of T2DM patients should be modified; instead of referring to the type of treatment (insulin use), the term should reflect the intensity with which we work to reach glucose objectives.

Translation and validation of the Spanish version of the "Echelle de Satisfaction des Besoins Psychologiques" in the sports context.

The aim of the present research was to translate and to analyze the psychometric properties of the Spanish version of the Satisfaction of Psychological Needs Scale, using a sample of 284 athletes (204 male and 78 female). Results of the confirmatory factor analysis confirmed the correlated three-factor structure of the scale. Furthermore, the results showed evidence of convergence validity with the Basic Psychological Needs in Exercise Scale. The predictive validity was tested using a structural equation model in which task orientation climate predicted the three basic psychological needs and these, in turn, intrinsic motivation. Likewise, we documented evidence of reliability, analyzed as internal consistency and temporal stability. Results partially support the use of the Spanish version of the scale in sports.

Hazard and risk assessment of a nanoparticulate cerium oxide-based diesel fuel additive - a case study.

Envirox is a scientifically and commercially proven diesel fuel combustion catalyst based on nanoparticulate cerium oxide and has been demonstrated to reduce fuel consumption, greenhouse gas emissions (CO(2)), and particulate emissions when added to diesel at levels of 5 mg/L. Studies have confirmed the adverse effects of particulates on respiratory and cardiac health, and while the use of Envirox contributes to a reduction in the particulate content in the air, it is necessary to demonstrate that the addition of Envirox does not alter the intrinsic toxicity of particles emitted in the exhaust. The purpose of this study was to evaluate the safety in use of Envirox by addressing the classical risk paradigm. Hazard assessment has been addressed by examining a range of in vitro cell and cell-free endpoints to assess the toxicity of cerium oxide nanoparticles as well as particulates emitted from engines using Envirox. Exposure assessment has taken data from modeling studies and from airborne monitoring sites in London and Newcastle adjacent to routes where vehicles using Envirox passed. Data have demonstrated that for the exposure levels measured, the estimated internal dose for a referential human in a chronic exposure situation is much lower than the no-observed-effect level (NOEL) in the in vitro toxicity studies. Exposure to nano-size cerium oxide as a result of the addition of Envirox to diesel fuel at the current levels of exposure in ambient air is therefore unlikely to lead to pulmonary oxidative stress and inflammation, which are the precursors for respiratory and cardiac health problems.

Hispanics, Social Security, and Supplemental Security Income.

The U.S. Census Bureau reports that Hispanics are the country's largest and fastest growing minority, representing about 14.4 percent of the population in 2005 (Census Bureau 2006b). By 2050, Hispanics will account for an estimated 24.4 percent of the population--or 1 in every 4 persons in the United States (Census Bureau 2004, Table 1 a). The Hispanic population tends to be younger than the overall population and currently represents a relatively small but growing fraction of the Social Security beneficiary population. The representation of Hispanics in the Supplemental Security Income (SSI) program, however, approximates that of their representation in the overall population. This article compares the Hispanic population with the overall population along several dimensions, with a particular focus on the Social Security beneficiary and SSI recipient populations. Data are drawn mainly from the 2005 Public Use Microdata Sample of the American Community Survey (ACS PUMS), a relatively new data source with a rich set of economic and demographic variables. Fully implemented nationwide for the first time in 2005, the ACS became the largest household survey in the United States with a sample of almost 3 million addresses. The analysis using the ACS finds that the Hispanic population is significantly different from the general population, particularly in the areas of age distribution, educational attainment, and economic well-being. Compared with the general population, the Hispanic segment is younger and is characterized by lower levels of educational attainment and a higher rate of poverty. The Hispanic Social Security beneficiary population also differs significantly from the general beneficiary population in the same areas. In contrast, the Hispanic and general SSI populations are more comparable with regard to age and economic status and differ significantly only with regard to education.

Social security: a program and policy history.

Many of the federal and state programs that provide income security to U.S. families have their roots in the Social Security Act (the Act) of 1935. This Act provided for unemployment insurance, old-age insurance, and means-tested welfare programs. The Great Depression was clearly a catalyst for the Social Security Act of 1935, and some of its provisions--notably the means-tested programs--were intended to offer immediate relief to families. However, the old-age insurance program-the precursor to today's Old-Age, Survivors, and Disability Insurance, or Social Security, program-was not designed specifically to deal with the economic crisis of that era. Indeed, monthly benefit payments, under the original Act, were not scheduled to begin until 1942. In addition, from the beginning, the Social Security program has embodied social insurance principles that were widely discussed even before the onset of the Great Depression. The first four decades of the Social Security program were, in general, ones of expansion. In fact, the program was expanded even before it became truly operational. In 1939, amendments added child, spouse, and survivor benefits to the retirement benefits authorized by the 1935 Act. Those amendments also allowed for monthly benefits to begin in 1940. Although the program was not changed substantially during the war years and the initial postwar period, the 1950s were a transformational decade in the program's history: benefit amounts were increased substantially, coverage under the program became close to universal, and a new disability insurance benefit was offered. The 1960s witnessed additional growth in Social Security, but the most important development in social insurance occurred in health insurance, with the creation of the Medicare program in 1965. Legislative actions in the 1970s had profound effects on the Social Security program and, indeed, set the stage for many of today's reform debates. Large benefit increases, a new benefit formula that was erroneously generous, and other changes in the early 1970s created a situation in which annual program costs, as a share of gross domestic product, increased during a 12-year period from about 3 percent to 5 percent. In 1977, amendments to the Act corrected the flawed benefit formula and made other changes in the financing of the system to shore up the program. Thus, the 1970s represent a watershed in the program's history-program growth gave way to increasing concerns about the program's finances. Those concerns were reflected in the amendments to the Act in 1983, which were the last major changes to the program. These amendments, based largely on recommendations from a commission chaired by Alan Greenspan, adjusted benefits and taxes to address pressing near-term financing problems faced by the system. Although the Greenspan Commission focused to a large extent on short-range issues, the resulting reforms have generated large surpluses in the program and the buildup of a substantial trust fund. However, the looming retirement of the baby boomers and several other demographic factors will, according to projections, result in the exhaustion of the trust fund by 2042.

Comparing replacement rates under private and federal retirement systems.

One measure of the adequacy of retirement income is replacement rate - the percentage of pre-retirement salary that is available to a worker in retirement. This article compares salary replacement rates for private-sector employees of medium and large private establishments with those for federal employees under the Civil Service Retirement System and the Federal Employees Retirement System. Because there is no standard benefit formula to represent the variety of formulas available in the private sector, a composite defined benefit formula was developed using the characteristics of plans summarized in the Bureau of Labor Statistics Medium and Large Employer Plan Survey. The resulting "typical" private-sector defined benefit plan, with an accompanying defined contribution plan, was then compared with the two federal systems. The Civil Service Retirement System (CSRS) is a stand-alone defined benefit plan whose participants are not covered by Social Security. Until passage of the 1983 Amendments to Social Security Act, it was the only retirement plan for most federal civilian employees. Provisions of the 1983 Amendments were designed to restore long-term financial stability to the Social Security trust funds. One provision created the Federal Employees Retirement System (FERS), which covers federal employees hired after 1983. It was one of the provisions designed to restore long-term financial stability to the Social Security trust funds. FERS employees contribute to and are covered by Social Security. FERS, which is a defined benefit plan, also includes a basic benefit and a 401(k)-type plan known as the Thrift Savings Plan (TSP). To compare how retirees would fare under the three different retirement systems, benefits of employees retiring at age 65 with 35 years of service were calculated using hypothetical workers with steady earnings. Workers were classified according to a percentage of the average wage in the economy: low earners (45 percent), average earners (100 percent) high earners (160 percent), and maximum earners (earnings at the taxable maximum amount). Overall, this analysis found that: Excluding Social Security benefits and TSP and defined contribution annuities, CSRS retirees have a higher pre-retirement salary replacement rate than either FERS or private-sector retirees. Private-sector retirees, however, have higher replacement rate than their FERS counterparts. Including Social Security benefits but not TSP and defined contribution plan annuities, CSRS retirees who are maximum earners have a higher pre-retirement salary replacement rate (despite receiving no Social Security benefits) than FERS retirees with the same earnings. Private-sector retirees in all earnings categories have a higher replacement rate than federal retirees with the same earnings. Including Social Security and TSP and defined contribution plan annuities, private-sector retirees in all earnings categories have a higher replacement rate than federal retirees, but their rate is close to that of FERS retirees. The rate is higher for FERS retirees than for CSRS retirees in all earnings categories. This analysis shows that replacement creates could exceed 100 percent for FERS employees who contribute who contribute 6 percent of earnings to the TSP over full working career. Private-sector replacement rates were quite similar for those with both a defined benefit and a defined contribution pension plan. Social Security replacement rates make up the highest proportion of benefits for th private sector's lowest income quartile group. The replacement rate for 401(k) plans and the TSP account for a higher proportion of benefits than does Social Security for all other income groups, assuming the absence of a defined benefit plan.