RESUMO
Objective To analyze the trends of disease burden of cervical cancer,uterine cancer,and ovarian cancer among Chinese women from 1990 to 2019,and to provide a basis for formulating precise prevention and control measures in China. Methods The global disease burden data in 2019 were used to describe the changes in indicators such as incidence,mortality,years of life lost due to premature mortality(YLL),years lived with disability(YLD),and disability-adjusted life year(DALY) of cervical,uterine,and ovarian cancers in China from 1990 to 2019.Furthermore,the Bayesian age-period-cohort model was adopted to predict the incidence and mortality of the cancers from 2020 to 2030. Results From 1990 to 2019,the incidence rates and mortality of cervical,uterine,and ovarian cancers in Chinese women showed an upward trend,and the age-standardized incidence rate of ovarian cancer increased the most(0.78%).In 2019,the incidence of cervical cancer and uterine cancer concentrated in the women of 55-59 years old,and ovarian cancer mainly occurred in the women of 70-74 years old.The DALY,YLL,and YLD of cervical,uterine,and ovarian cancers all presented varying degrees of growth at all ages.The Bayesian age-period-cohort model predicted that from 2020 to 2030,the incidence and mortality of cervical cancer in China showed a decreasing trend,while those of uterine cancer and ovarian cancer showed an increasing trend.There was no significant change in the age with high incidence of the three cancers. Conclusions From 1990 to 2019,the overall disease burden of cervical,uterine,and ovarian cancers in China increased,while the disease burden of cervical cancer decreased after 2020.It is recommended that the efforts should be doubled for the prevention and control of cervical,uterine,and ovarian cancers.
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Neoplasias Ovarianas , Neoplasias do Colo do Útero , Feminino , Humanos , Pessoa de Meia-Idade , Idoso , Neoplasias do Colo do Útero/epidemiologia , Teorema de Bayes , Neoplasias Ovarianas/epidemiologia , Efeitos Psicossociais da Doença , Genitália , China/epidemiologiaAssuntos
Cirurgia de Readequação Sexual , Pessoas Transgênero , Estados Unidos , Humanos , Medicaid , New York , Genitália/cirurgiaRESUMO
PURPOSE: The cost of gender-affirming surgery (GAS) is an important component of healthcare accessibility for transgender patients. However, GAS is often prohibitively expensive, particularly as there are inconsistencies in insurance coverages. Variability in hospital costs has been documented for other types of nonplastic surgery procedures; however, this analysis has not been done for GAS. To better understand the financial barriers impairing access to equitable transgender care, this study analyzes the distribution of hospitals that perform genital GAS and the associated costs of inpatient genital GAS. METHODS: This is a study of the 2016-2019 National Inpatient Sample database. Transgender patients undergoing genital GAS were identified using International Classification of Diseases, Tenth Revision, diagnosis and procedure codes, and patients undergoing concurrent chest wall GAS were excluded. Descriptive statistics were done on patient sociodemographic variables, hospital characteristics, and hospitalization costs. χ2 test was used to assess for differences between categorical variables and Mood's median test was used to assess for differences between continuous variable medians. RESULTS: A total of 3590 weighted genital GAS encounters were identified. The Western region (50.8%) and Northeast (32.3%) performed the greatest proportion of GAS, compared with the Midwest (9.1%) and the South (8.0%) (P < 0.0001). The most common payment source was private insurance (62.8%), followed by public insurance (27.3%). There were significant differences in the variability of median hospital costs across regions (P < 0.0001). The South and Midwest had the greatest median cost for vaginoplasty ($19,935; interquartile range [IQR], $16,162-$23,561; P = 0.0009), while the West had the greatest median cost for phalloplasty ($26,799; IQR, $19,667-$30,826; P = 0.0152). Across both procedures, the Northeast had the lowest median cost ($11,421; IQR, $9155-$13,165 and $10,055; IQR, $9,013-$10,377, respectively). CONCLUSIONS: There is significant regional variability in the number of GAS procedures performed and their associated hospitalization costs. The identified disparities in insurance coverage present an area of possible future improvement to alleviate the financial burden GAS presents to gender-discordant individuals. The variability in cost suggests a need to evaluate variations in care, leading to cost standardization.
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Cirurgia de Readequação Sexual , Pessoas Transgênero , Transexualidade , Humanos , Cirurgia de Readequação Sexual/métodos , Hospitalização , Transexualidade/cirurgia , Genitália/cirurgiaRESUMO
Genital cancers are particularly important compared to other cancers because of the psychological impact they have on the individual. This study investigated the complexity in illness and quality of life among female genital cancer patients and determined the effects of these factors on supportive care needs to provide evidential data for the development of nursing intervention strategies to reduce supportive care needs in female genital cancer patients. This cross-sectional study collected data from July 22 to August 17, 2021. The study subjects were 103 female outpatients and inpatients aged 19 years or older who were treated for cervical cancer, endometrial cancer, ovarian cancer, or other female genital cancers such as vulvar cancer and vaginal cancer in a university hospital in Korea. The data were analyzed with t-tests and Scheffé's test using SPSS 26.0. The factors affecting supportive care needs were examined using hierarchical regression. The average age of the subjects was 56.41 (±9.91) years. Cervical cancer was the most common diagnosis at 42.7%, followed by ovarian cancer at 34.0%, and endometrial cancer at 21.4%. The factors affecting supportive care needs included a middle school education or below (ßâ =â 0.21, Pâ =â .028), unemployment (ßâ =â 0.23, Pâ =â .018), complexity in illness (ßâ =â 0.32, Pâ <â .001), and quality of life (ß = -0.68, Pâ <â .001). Developing a strategy for managing the complexity in illness and quality of life caused by various variables including disease stage and type of treatment is necessary to reduce the supportive care needs of female genital cancer patients. Improving their quality of life through effective communication with healthcare providers is essential.
Assuntos
Neoplasias dos Genitais Femininos , Neoplasias Ovarianas , Neoplasias do Colo do Útero , Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Qualidade de Vida/psicologia , Estudos Transversais , Neoplasias dos Genitais Femininos/terapia , Neoplasias dos Genitais Femininos/psicologia , Hospitais Universitários , Neoplasias do Colo do Útero/terapia , Genitália , Inquéritos e Questionários , Necessidades e Demandas de Serviços de SaúdeRESUMO
INTRODUCTION AND HYPOTHESIS: To perform a cost-effectiveness analysis of concurrent posterior repair performed at the time of laparoscopic hysterectomy with sacrocolpopexy over a 7-year time period. We hypothesize it is not cost-effective to perform a posterior colporrhaphy. METHODS: We used TreeAge Pro® to construct a decision model with Markov modeling to compare sacrocolpopexy with and without concurrent posterior repair (SCP and SCP+PR) over a time horizon of 7 years. Outcomes included probability and costs associated with prolapse recurrence, prolapse retreatment, and complications including rectal injury, rectovaginal hematoma requiring reoperation, and postoperative dyspareunia. Cost-effectiveness was defined as an incremental cost-effectiveness ratio (ICER) calculated as ∆ costs /∆ effectiveness and the willingness to pay (WTP) was set at $100,000/QALY. RESULTS: Our model showed that SCP was the dominant strategy, with lower costs (-$ 2681.06) and higher effectiveness (+0.10) compared to SCP+PR over the 7-year period. In two-way sensitivity analyses, we varied the probability of prolapse recurrence after both strategies. Our conclusions would only change if the probability of recurrence after SCP was at least 29.7% higher than after SCP+PR. When varying the probabilities of dyspareunia for both strategies, SCP+PR only became the dominant strategy if the probability of dyspareunia for SCP+PR was lower than the rate of SCP alone. CONCLUSIONS: In this 7-year Markov cost-effectiveness analysis, SCP without concurrent PR was the dominant strategy. SCP+PR costs more with lower effectiveness than SCP alone, due to higher surgical cost of SCP+PR and higher probability of dyspareunia after SCP+PR.
Assuntos
Dispareunia , Prolapso de Órgão Pélvico , Feminino , Humanos , Análise de Custo-Efetividade , Prolapso de Órgão Pélvico/cirurgia , Prolapso de Órgão Pélvico/etiologia , Dispareunia/etiologia , Dispareunia/cirurgia , Histerectomia/efeitos adversos , Genitália , Análise Custo-BenefícioRESUMO
INTRODUCTION: External genitalia gangrene is a well-known uncommon disease; however, mortality remains important. Recent literature focuses on early management. The object of this study was to assess quality of life and disease-specific function, in the medium- and long-term. METHOD: We evaluated retrospectively adult inpatients with external genitalia gangrene who had a surgical debridement between 2010 and 2020 at CHU de Poitiers. Preoperatory FGSI Score was calculated for patients included. In a second phase, surviving patients at 2020 who had agreed to take part in the follow-up were assessed by clinical examination, and asked to complete Short-Form 36 test and two additional disease-specific questionnaire (USP, IIEF5). RESULTS: The patients consisted of 33 men. Mean age was 61.18. Eleven patients (33%) died primarily from external genitalia gangrene. Median FGSI score was 6 (1-13). We were able to reach 11 patients (33%) for secondary clinical revaluation. Time before revaluation was 3months to 8years. All parts of SF-36 were significantly low. Mean USP score was 1.27±2.68/4.54±4.43/0.72±1.84. Nine patients (81%) suffered erectile dysfunction without any sexual intercourse possible. CONCLUSION: Patients with external genitalia gangrene experience severe deterioration of their quality of life. Multidisciplinary healthcare process should systematically be carried out, as so as early screening of vulnerability risks factors, to improve functional outcomes and quality of life.
Assuntos
Gangrena de Fournier , Gangrena , Adulto , Masculino , Humanos , Pessoa de Meia-Idade , Gangrena/complicações , Gangrena de Fournier/diagnóstico , Gangrena de Fournier/cirurgia , Estudos Retrospectivos , Qualidade de Vida , GenitáliaRESUMO
OBJECTIVE: To assess the incidence of genital pain in patients with urethral stricture and examine the impact of urethroplasty. Genital pain is a common and challenging urological condition and potentially associated with urethral stricture. METHODS: From 2011-2019, patients were offered enrollment in a prospective single-center study assessing patient-reported genital pain pre- and 6-months posturethroplasty. Genital pain was assessed with the question, "Do you experience genital (scrotum or penis) pain?" answered on a five-point scale ["Never" (1), "Occasionally" (2), "Sometimes" (3), "Most of the Time" (4) or "All of the Time" (5)]. Responses of 3, 4, or 5 were considered clinically significant. Wilcoxon signed-rank test was used to compare pre- and postoperative states and logistic regression was used to evaluate the association between genital pain and clinical variables. RESULTS: Of the 387 patients completing enrollment, 36.4% (141/387) reported genital pain preoperatively. Patients with panurethral stricture reported higher rates (57.1%) of pain (Odds Ratio 2.93, 95%CI 1.32-6.50; P = .008). Posturethroplasty, pain scores improved with an incidence of 14.2% (P < .0001). In patients reporting preoperative pain, 88.7% (125/141) experienced improvement, 8.5% were unchanged and 2.8% reported worsening pain. On logistic regression, patients with penile strictures (O.R. 0.24, 95%CI 0.06-0.91; P = .04), hypospadias (O.R. 0.14, 95%CI 0.02-0.88; P = .04), and staged reconstruction (O.R. 0.22, 95%CI 0.05-0.90; P = .04) were less likely to report improvement. CONCLUSION: Genital pain is common in patients with urethral stricture and improves in the majority of patients undergoing urethroplasty but less so in patients with penile strictures, hypospadias and staged reconstruction.
Assuntos
Hipospadia , Estreitamento Uretral , Masculino , Humanos , Estreitamento Uretral/epidemiologia , Estreitamento Uretral/cirurgia , Estreitamento Uretral/complicações , Hipospadia/complicações , Hipospadia/cirurgia , Estudos Prospectivos , Constrição Patológica/epidemiologia , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Incidência , Uretra/cirurgia , Dor/cirurgia , Genitália , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Estudos RetrospectivosRESUMO
Este artigo reflete sobre os modos como a cisnormatividade, conceito impulsionado pelos transfeminismos, tem auxiliado na composição da psicologia de maneira histórica. Ao elaborar uma crítica sobre como a violência de gênero está expressivamente presente no território brasileiro, discute-se como tem sido pensada a saúde mental, esfera que, uma vez inserida nesse contexto mais amplo, está sendo convocada a produzir saídas criativas em relação aos sujeitos que são alvo de discriminações transfóbicas. Na busca de deslocar o olhar do indivíduo para o social, foi realizado um estudo bibliográfico para investigar os diferentes impactos que a cisnormatividade opera em nossos currículos psicológicos, gerando efeitos na prática e na própria profissão. A aposta está em reconhecer outras epistemologias como projetos éticos e políticos a uma psicologia contemporânea, e a contribuição transfeminista a "outra" clínica. É nesse sentido que este trabalho se destina a pensar um modo de cuidado que esteja baseado na singularidade, mas que, ao mesmo tempo, seja capaz de dedicar alguma atenção ao paradigma normativo que nos guia como terapeutas.(AU)
This article reflects on the ways that cisnormativity, a concept boosted by transfeminisms, has played a historical role in the composition of psychology. Elaborating a criticism on how gender violence is expressively present in the Brazilian territory, we discuss how mental health is conceived, a sphere that, inserted in this wider context, is invited to create creative solutions related to the subjects who are the target of transphobic discrimination. Trying to shift the focus from the individual to the collective, a bibliographical study was conducted to recognize the different impacts that cisnormativity has in our psychological curriculums, having effects on the practice and on the profession itself. The goal is to recognize other epistemologies as ethical and political projects for contemporary psychology and the transfeminist contribution to "another" clinic. It is in this sense that this work aims to think about a form of care that is based on singularity, but that can also pay attention to the normative paradigm that guides us as therapists.(AU)
Este artículo reflexiona sobre las formas en que la cisnormatividad, un concepto impulsado por los transfeminismos, ha tenido un papel en la composición de la psicología de manera histórica. Al elaborar una crítica sobre como la violencia de género está expresamente presente en el territorio brasileño, se discute cómo se ha pensado la salud mental, dominio que, una vez insertado en este contexto más amplio, es convocado a producir soluciones creativas con relación a los sujetos que son objeto de discriminación transfóbica. Al desviar el enfoque del individuo hacia lo social, se realizó un estudio bibliográfico para investigar los diferentes impactos que tiene la cisnormatividad en nuestros planes de estudios psicológicos, generando efectos en la práctica y en la propia profesión. El foco está en reconocer otras epistemologías como proyectos éticos y políticos para la psicología contemporánea y la contribución transfeminista a una "otra" clínica. En este sentido, este trabajo pretende pensar en una forma de cuidado que se basa en la singularidad, al mismo tiempo que sea capaz de dedicar cierta atención al paradigma normativo que a nosotras nos guía como terapeutas.(AU)
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Humanos , Masculino , Feminino , Psicologia , Feminismo , Sexismo , Hospitais , Ansiedade , Preconceito , Psiquiatria , Psicanálise , Psicologia Social , Desenvolvimento Psicossexual , Religião , Reprodução , Fenômenos Fisiológicos Reprodutivos e Urinários , Ciência , Autoimagem , Sexo , Comportamento Sexual , Delitos Sexuais , Ajustamento Social , Mudança Social , Justiça Social , Problemas Sociais , Terapêutica , Transexualidade , Travestilidade , Comportamento e Mecanismos Comportamentais , Biologia , Imagem Corporal , Adaptação Psicológica , Caracteres Sexuais , Direitos Civis , Diversidade Cultural , Sexualidade , Discurso , Heterossexualidade , Desumanização , Agressão , Grupos Raciais , Desenvolvimento Sexual , Direitos Sexuais e Reprodutivos , Saúde de Gênero , Assistência à Saúde Mental , Existencialismo , Feminilidade , Masculinidade , Procedimentos de Readequação Sexual , Cirurgia de Readequação Sexual , Saúde Sexual , Homofobia , Pessoas Transgênero , Normas Sociais , Comportamento de Busca de Ajuda , Disforia de Gênero , Minorias Sexuais e de Gênero , Construção Social do Gênero , Pessoas Cisgênero , Binarismo de Gênero , Androcentrismo , Estereotipagem de Gênero , Estudos de Gênero , Liberdade , Respeito , Angústia Psicológica , Empoderamento , Pessoas Intersexuais , Intervenção Psicossocial , Equidade de Gênero , Papel de Gênero , Genitália , Minorias Desiguais em Saúde e Populações Vulneráveis , Cidadania , Culpa , Ódio , Hostilidade , Crise de Identidade , Individuação , MoralRESUMO
Gender affirming surgery (GAS) has important impacts for people with gender incongruence (GI), both physically and socially. As the societal acceptance of gender diversity spreads, the number of individuals with GI who wish to be identified as the gender of their choice is increasing. Indeed, many elderly people who have lived a long time with GI now wish to undergo GAS, but face greater surgical risks due to greater burdens of underlying medical conditions. Generally, vaginoplasty is performed for transwomen; however, this surgery is time-consuming and involves heavy bleeding, and thus, should be avoided in elderly people. A less invasive technique is needed. In this article, we describe a new, less invasive genital feminizing surgical technique for transwomen with reports from two clinical cases. We present this novel technique as a safe, aesthetic, and cost-effective option for gender-affirming surgery for transwomen.
Assuntos
Cirurgia de Readequação Sexual , Pessoas Transgênero , Feminino , Humanos , Idoso , Análise Custo-Benefício , Cirurgia de Readequação Sexual/métodos , Estética , GenitáliaRESUMO
Nitrate (NO3) toxicity is a serious global issue that results in impairment of physiological systems of our body. The present study aimed to investigate the effects of different concentration of NaNO3 (10, 100, 500 and 1000 mg/kg bw) on the male reproductive system, liver, kidney and pancreas. Adult male Wistar rats were divided into five groups of five animals each (n = 5). The first group served as controls. The second, third, fourth and fifth groups of rat were orally intubated with 10, 100, 500 and 1000 mg/kg bw of NaNO3 for 52 days. After the treatment period, the rats were sacrificed and NO3 induced alterations on selected organs were assessed. There was a dose dependent decrease in sperm motility, serum concentration of testosterone, body weight and organ weight, and increase in abnormal sperm morphology in the NaNO3 treated groups compared with the controls. Further, histological analysis confirmed that NO3 induced toxicity. Shrunken seminiferous tubules and loss of spermatids in testes, shrinkage of acinar cells of the pancreas, sinusoidal congestion and necrosis in the liver, atrophy of glomeruli and congestion of renal tubules of the kidney were the histological alterations observed in rats treated with100 and 500 mg/kg NaNO3. However, 100% mortality was observed in rats treated with 1000 mg/kg NaNO3. The present study clearly demonstrated the toxic effects of NaNO3 on both the reproductive system and other organs of the body. The study might inform human studies; where in the chances of male infertility may be more a problem for individuals in areas with NO3-rich ground water.
Assuntos
Nitratos , Motilidade dos Espermatozoides , Animais , Genitália , Humanos , Rim , Fígado , Masculino , Nitratos/toxicidade , Tamanho do Órgão , Pâncreas , Ratos , Ratos Wistar , Sêmen , Contagem de Espermatozoides , Espermatozoides , Testículo , TestosteronaRESUMO
Importance: Genital gender-affirming surgery (GAS) is safe and offers substantial benefits to patients. Geographic accessibility and high out-of-pocket (OOP) costs reportedly hinder access; however, to date, this has not been thoroughly investigated at the national level. Objective: To estimate OOP and total costs for GAS among commercially insured beneficiaries and assess whether costs differed between surgical procedures conducted in and outside the patient's state of residence. Design, Setting, and Participants: This cross-sectional study used previously collected insurance data from the MarketScan Commercial Database (129 million patients) from January 1, 2007, to December 31, 2019. Vaginoplasties and phalloplasties were identified using diagnosis and procedure codes among patients aged 18 to 64 years. Out-of-state surgical procedures were identified based on residence at enrollment and place of service of the surgery. Data analysis took place from July 1 to September 31, 2021. Exposures: Vaginoplasty and phalloplasty. Main Outcomes and Measures: The main outcomes were differences in OOP and total costs by out-of-state designation, census region, age, and insurance type for surgical procedures, estimated using multivariable linear regression models. Results: The study included 771 patients who underwent GAS. A total of 609 underwent vaginoplasty, of whom 249 (41%) underwent surgery in their state of residence (mean [SD] age, 38.7 [13.1] years) and 340 (56%) underwent surgery outside their state (mean [SD] age, 38.1 [13.0] years), and 162 underwent phalloplasty, of whom 66 (41%) underwent surgery in their state of residence (mean [SD] age, of 39.7 [11.6] years) and 81 (50%) underwent surgery outside their state (mean [SD] age, 35.8 [10.9] years); 20 vaginoplasties (3%) and 15 phalloplasties (9%) could not be classified as in or out of state owing to missing data about the facility or residence. Procedures outside the state were associated with 49% (95% CI, 19%-85%) higher OOP costs compared with procedures done in the state of residence. Conclusions and Relevance: In this cross-sectional study, 56% of patients who underwent vaginoplasty and 50% of patients who underwent phalloplasty underwent the procedure outside their state of residence. Patients who underwent these procedures outside their state also experienced higher OOP costs than did those who underwent these procedures in their state. Improving geographic access and understanding patient preferences for surgical care may help reduce the cost burden for those planning to undergo GAS.
Assuntos
Gastos em Saúde , Cirurgia de Readequação Sexual , Adulto , Criança , Estudos Transversais , Feminino , Genitália , Humanos , Estudos RetrospectivosRESUMO
OBJECTIVE: The objective was to perform a cost-effectiveness analysis of posterior repair performed at the time of sacrocolpopexy (SCP). METHODS: We used TreeAge Pro to construct a decision model comparing laparoscopic hysterectomy with SCP with and without concurrent posterior repair (SCP and SCP + PR). Using a time horizon of 1 year, we modeled prolapse recurrence, prolapse retreatment, and complications, including rectal injury, rectovaginal hematoma requiring surgical take-back, and postoperative dyspareunia. Costs included index surgery, surgical retreatment, and complications. We modeled effectiveness as quality-adjusted life years (QALYs). Cost-effectiveness was defined using the incremental cost-effectiveness ratio and willingness to pay of $100,000/QALY. Sensitivity analyses were performed. RESULTS: Sacrocolpopexy was the dominant strategy with a cost of $65,714 and an effectiveness of 0.84. It was cost-effective at willingness to pay threshold less than $100,000/QALY. The SCP + PR costs more ($75,063) with lower effectiveness (0.83). The effectiveness of the 2 strategies was similar, differing only by 0.01 QALY, which is less than the minimally important difference for utilities. Tornado plots showed CEA results were most influenced by the cost of SCP, cost of SCP + PR, and probability of dyspareunia after SCP. In 1-way sensitivity analyses, the model outcome would change only if the cost of SCP was increased by 12.8% or if the cost of SCP + PR decreased by 14.5%. For dyspareunia, our model would only change if the probability of dyspareunia after SCP alone was 75.9% (base case, 18.6%), whereas the probability of dyspareunia after SCP + PR was 26.8%. CONCLUSION: In this cost-effectiveness analysis, SCP without concurrent PR was the dominant strategy.
Assuntos
Dispareunia , Análise Custo-Benefício , Dispareunia/etiologia , Feminino , Genitália , Humanos , Masculino , Prolapso , Anos de Vida Ajustados por Qualidade de VidaRESUMO
BACKGROUND: Screening for genital inflammation can reveal asymptomatic cases of sexually transmitted infections (STIs) and bacterial vaginosis (BV), useful in settings where only syndromic management is available. This study aimed to estimate the incremental cost of screening using a new cytokine biomarker rapid test and determine the budget impact of providing this service in primary health facilities in South Africa. METHODS: Costs of adding genital inflammation screening to existing family planning services were estimated for women (15-49 years) attending 3 different family planning clinics in US $2016. The predicted unit cost per patient screened from a provider's perspective was calculated using bottom-up and top-down approaches and was used to analyze the budget impact of scaling up and providing this service in primary health facilities countrywide. Univariate sensitivity analyses tested the robustness of the findings. RESULTS: The incremental cost per woman screened for genital inflammation ranged between US $3.19 and US $4.79. The scaled-up costs ranged between US $7,245,775 and US $22,212,636 countrywide, annually. This was based on the number of women of reproductive age currently seeking contraceptive care at all primary health care facilities, as a proxy for those most susceptible to asymptomatic STIs/BV. The cost estimates were sensitive to changes in personnel costs, utilization rate, and population coverage rates. CONCLUSIONS: This screening tool is likely to increase case detection, contributing to better STI/BV management and control, in addition to reducing women's risk of HIV acquisition. The incremental cost estimates could make implementation affordable.
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Infecções Sexualmente Transmissíveis , Vaginose Bacteriana , Biomarcadores , Citocinas , Feminino , Genitália , Humanos , Programas de Rastreamento , Testes Imediatos , Infecções Sexualmente Transmissíveis/diagnóstico , Infecções Sexualmente Transmissíveis/epidemiologia , Vaginose Bacteriana/diagnósticoRESUMO
Provision of optimum healthcare for infants with atypical genitalia requires a clear understanding of the occurrence of this condition. The objective of this study was to determine the prevalence of atypical genitalia and its initial management. A prospective, electronic survey of clinicians within managed clinical networks in Scotland was undertaken between 2013 and 2019. Notification from clinicians was sought for term neonates requiring specialist input for atypical genitalia. Additional information was also sought from the 4 regional genetics laboratories that provided details for neonates who had an urgent karyotype performed for atypical genitalia or sex determination. In total, the study identified 171 term infants who required some investigation for atypical genitalia in the neonatal period, providing a birth prevalence of 1:1,881 term births. Of the 171 infants, 97 (57%) had specialist input over the first 3 months of life, providing a birth prevalence of 1:3,318 term births that received specialist input for atypical genitalia. A total of 92 of these 97 cases had complete 3-month follow-up data, 62 (67%) presented within 24 h of birth, and age at presentation ranged from birth to 28 days. Age at sex assignment ranged from birth to 14 days, and in 63 cases (68%), sex assignment occurred at birth. Thus, the birth prevalence of a case of atypical genitalia where sex assignment was reported to be delayed beyond birth was estimated at 1:11,097 births. In 1 case sex was re-assigned at 3 months. Atypical genitalia requiring specialist input within the first month of life are rare in term newborns, and in only a third of these cases, sex assignment is delayed beyond birth. This study provides new clinical benchmarks for comparing and improving the delivery of care in centres that manage these conditions.
Assuntos
Transtornos do Desenvolvimento Sexual , Transtornos do Desenvolvimento Sexual/epidemiologia , Transtornos do Desenvolvimento Sexual/genética , Transtornos do Desenvolvimento Sexual/terapia , Genitália , Humanos , Lactente , Recém-Nascido , Prevalência , Estudos Prospectivos , Análise para Determinação do SexoRESUMO
Laristania beyarslani sp. nov., a new species of Phycitinae (Pyralidae) from Turkey, is described herein, and compared with other known species of the genus Laristania Amsel, 1951. The distribution area of all Laristania species and assessment on the morphology of some species are presented. Habitus, male and female genitalia of the new species are illustrated. The male genitalia of all species in the genus are compared. Besides, photos of adult, male and female genitalia of L. taftanella (Amsel, 1954), and adult and male genitalia of L. aspergella (Ragonot, 1887) are provided.
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Lepidópteros , Mariposas , Aves Canoras , Distribuição Animal , Animais , Feminino , Genitália , Masculino , TurquiaRESUMO
INTRODUCTION: Left untreated, sexually transmitted and genital infections (henceforth STIs) in pregnancy can lead to serious adverse outcomes for mother and child. Papua New Guinea (PNG) has among the highest prevalence of curable STIs including syphilis, chlamydia, gonorrhoea, trichomoniasis and bacterial vaginosis, and high neonatal mortality rates. Diagnosis and treatment of these STIs in PNG rely on syndromic management. Advances in STI diagnostics through point-of-care (PoC) testing using GeneXpert technology hold promise for resource-constrained countries such as PNG. This paper describes the planned economic evaluation of a cluster-randomised cross-over trial comparing antenatal PoC testing and immediate treatment of curable STIs with standard antenatal care in two provinces in PNG. METHODS AND ANALYSIS: Cost-effectiveness of the PoC intervention compared with standard antenatal care will be assessed prospectively over the trial period (2017-2021) from societal and provider perspectives. Incremental cost-effectiveness ratios will be calculated for the primary health outcome, a composite measure of the proportion of either preterm birth and/or low birth weight; for life years saved; for disability-adjusted life years averted; and for non-health benefits (financial risk protection and improved health equity). Scenario analyses will be conducted to identify scale-up options, and budget impact analysis will be undertaken to understand short-term financial impacts of intervention adoption on the national budget. Deterministic and probabilistic sensitivity analysis will be conducted to account for uncertainty in key model inputs. ETHICS AND DISSEMINATION: This study has ethical approval from the Institutional Review Board of the PNG Institute of Medical Research; the Medical Research Advisory Committee of the PNG National Department of Health; the Human Research Ethics Committee of the University of New South Wales; and the Research Ethics Committee of the London School of Hygiene and Tropical Medicine. Findings will be disseminated through national stakeholder meetings, conferences, peer-reviewed publications and policy briefs. TRIAL REGISTRATION NUMBER: ISRCTN37134032.
Assuntos
Nascimento Prematuro , Infecções Sexualmente Transmissíveis , Criança , Análise Custo-Benefício , Feminino , Genitália , Humanos , Recém-Nascido , Papua Nova Guiné/epidemiologia , Testes Imediatos , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Infecções Sexualmente Transmissíveis/diagnóstico , Infecções Sexualmente Transmissíveis/tratamento farmacológicoRESUMO
BACKGROUND: Adults and children report genital oedema but prevalence is unknown. Pre-registration nurse training rarely includes genital oedema and postgraduate training opportunities are rare. AIM: To identify the education needs of health professionals regarding management of genital oedema. METHOD: An electronic survey was cascaded to health professionals through relevant professional groups and social media. FINDINGS: Of 149 UK respondents, most manage patients with genital oedema but only 2% felt current training was sufficient. Of 138 responding regarding supplemental training, only a half had completed genital oedema specific education, usually of 1-4 hours' duration. Confidence in knowledge was up to 22.5% higher in those with genital oedema education, even accounting for years of experience. The most common top three individual needs were compression, contemporary surgical and medical management and patient assessment. Educational resources are needed and both offline and online formats were suggested; collaborative events with urology/pelvic health are essential. CONCLUSION: Health professionals working in lymphoedema care have (unmet) specific education needs regarding genital oedema management. The desire for both offline and online resources reflects the necessity of accessing learning at a distance and on an 'as needed' basis.
Assuntos
Edema , Educação em Enfermagem , Genitália , Avaliação das Necessidades , Tratamento Conservador/enfermagem , Edema/enfermagem , Educação em Enfermagem/organização & administração , Humanos , Inquéritos e Questionários , Reino UnidoRESUMO
Ethyl(dimethyl)(tetradecyl)ammonium ethyl sulfate, used in laundry detergents, shampoos, and body soaps, is classified by the Japanese Chemical Substances Control Law as a priority assessment chemical substance for environmental effects. However, its toxicity data for human health are insufficient. This study evaluated this chemical under the Safety Examination of Existing Chemicals and Safety Programmes of the Ministry of Health, Labour and Welfare (MHLW). The MHLW conducted bacterial reverse mutation (Ames test), in vitro chromosomal aberration, and combined repeated-dose and reproductive/developmental toxicity screening tests. We performed a screening assessment of ethyl(dimethyl)(tetradecyl)ammonium ethyl sulfate for human health. The chemical showed a negative reaction in the Ames test and a positive reaction in the in vitro chromosomal aberration test with metabolic activation in rats. The combined repeated-dose and reproductive/developmental toxicity screening test showed significantly decreased food consumption at 50 mg/kg body weight/day, but no reproductive and developmental toxicity was observed. The no-observed-effect level of 15 mg/kg/day was obtained as a screening value. Therefore, this chemical was classified as hazard class 3, with a derived-no-effect level of 0.025 mg/kg/day. The results of this study will be useful for risk assessment of groups of structurally similar alkyl quaternary ammonium surfactants.
Assuntos
Genitália/efeitos dos fármacos , Compostos de Amônio Quaternário/toxicidade , Animais , Linhagem Celular , Cricetinae , Relação Dose-Resposta a Droga , Ingestão de Alimentos , Feminino , Masculino , Testes de Mutagenicidade , Nível de Efeito Adverso não Observado , Tamanho do Órgão/efeitos dos fármacos , Ratos , Ratos Sprague-DawleyRESUMO
BACKGROUND: Persistent genital arousal disorder (PGAD), a condition of unwanted, unremitting sensations of genital arousal, is associated with a significant, negative psychosocial impact that may include emotional lability, catastrophization, and suicidal ideation. Despite being first reported in 2001, PGAD remains poorly understood. AIM: To characterize this complex condition more accurately, review the epidemiology and pathophysiology, and provide new nomenclature and guidance for evidence-based management. METHODS: A panel of experts reviewed pertinent literature, discussed research and clinical experience, and used a modified Delphi method to reach consensus concerning nomenclature, etiology, and associated factors. Levels of evidence and grades of recommendation were assigned for diagnosis and treatment. OUTCOMES: The nomenclature of PGAD was broadened to include genito-pelvic dysesthesia (GPD), and a new biopsychosocial diagnostic and treatment algorithm for PGAD/GPD was developed. RESULTS: The panel recognized that the term PGAD does not fully characterize the constellation of GPD symptoms experienced by patients. Therefore, the more inclusive term PGAD/GPD was adopted, which maintains the primacy of the distressing arousal symptoms and acknowledges associated bothersome GPD. While there are diverse biopsychosocial contributors, there is a common underlying neurologic basis attributable to spontaneous intense activity of the genito-pelvic region represented in the somatosensory cortex and its projections. A process of care diagnostic and treatment strategy was developed to guide the clinician, whenever possible, by localizing the symptoms as originating in any of five regions: (i) end organ, (ii) pelvis/perineum, (iii) cauda equina, (iv) spinal cord, and (v) brain. Psychological treatment strategies were considered critical and should be performed in conjunction with medical strategies. Pharmaceutical interventions may be used based on their site and mechanism of action to reduce patients' symptoms and the associated bother and distress. CLINICAL IMPLICATIONS: The process of care for PGAD/GPD uses a personalized, biopsychosocial approach for diagnosis and treatment. STRENGTHS AND LIMITATIONS: Strengths and Limitations: Strengths include characterization of the condition by consensus, analysis, and recommendation of a new nomenclature and a rational basis for diagnosis and treatment. Future investigations into etiology and treatment outcomes are recommended. The main limitations are the dearth of knowledge concerning this condition and that the current literature consists primarily of case reports and expert opinion. CONCLUSION: We provide, for the first time, an expert consensus review of the epidemiology and pathophysiology and the development of a new nomenclature and rational algorithm for management of this extremely distressing sexual health condition that may be more prevalent than previously recognized. Goldstein I, Komisaruk BR, Pukall CF, et al. International Society for the Study of Women's Sexual Health (ISSWSH) Review of Epidemiology and Pathophysiology, and a Consensus Nomenclature and Process of Care for the Management of Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia (PGAD/GPD). J Sex Med 2021;18:665-697.
Assuntos
Disfunções Sexuais Psicogênicas , Saúde Sexual , Nível de Alerta , Consenso , Feminino , Genitália , Humanos , Parestesia , PelveRESUMO
BACKGROUND: To date, a comprehensive state-by-state assessment of transgender transition-related health care coverage for gender-affirming hormone therapy (GAHT) and genital gender-affirming surgery (GAS) has not been reported. AIMS: The aims of this study were 1) to verify which U.S. states' Medicaid systems do/do not cover GAHT and GAS; 2) to assess the ease/difficulty for patients to determine whether GAHT and GAS are Medicaid-covered benefits; and 3) to understand possible state-related predictors of Medicaid coverage for gender-affirming care. METHODS: We reviewed the official Medicaid Handbook and website for all 51 states (+D.C.) and 5 territories to confirm whether GAHT and GAS are covered benefits. When indeterminate, we called the Medicaid office in each state, and for many, Medicaid managed care organizations (MCOs), and individual in-state providers, to confirm coverage. We recorded our experiences, number of, and duration of phone calls to confirm coverage. OUTCOMES: The main outcome was a definitive answer from the state/territory's Medicaid program or MCOs regarding whether GAHT and GAS are/are not covered benefits. Secondary outcome measures included responses we received and the total number/duration of phone calls necessary to confirm coverage. RESULTS: Only 12 of 51 states and 0 of 5 territories featured their policy regarding coverage for GAHT in their Medicaid Handbook/webpages. We confirmed that 34 of 51 state Medicaid programs do cover GAHT, whereas 9 of 51 states' and 2 of 5 territories' do not. We could not confirm coverage of GAHT in 8 of 51 states and 3 of 5 territories. Only 26 of 51 states and 0 of 5 territories featured their policy regarding coverage for GAS in their Medicaid Handbook/webpages. We confirmed that 25 of 51 state Medicaid programs do cover GAS, whereas 22 of 51 states' and 3 of 5 territories' do not. We could not confirm coverage of GAS in 4 of 51 states and 2 of 5 territories. Up to 12 calls, lasting up to 125 minutes, were required to confirm coverage for GAHT/GAS. CLINICAL IMPLICATIONS: Our findings indicate that important health care access barriers/disparities exist today and warrant improvement. STRENGTHS & LIMITATIONS: To our knowledge, this is the most comprehensive assessment of transgender transition-related health care coverage. Limitations include possible bias, as it could be that we were more persistent than actual patients would be to determine service coverage, and a lack of specificity regarding which specific hormone formulations or procedures are/are not covered. CONCLUSION: Our findings show that only 34 of 51 (67%) states' Medicaid programs include GAHT and 25 of 51 (49%) include GAS as covered benefits. Our experience suggests that the process to confirm coverage can be especially time-consuming and frustrating for patients. Zaliznyak M, Jung EE, Bresee C, et al. Which U.S. States' Medicaid Programs Provide Coverage for Gender-Affirming Hormone Therapy and Genital Gender-Affirming Surgery for Transgender Patients?: A State-by-State Review, and a Study Detailing the Patient Experience to Confirm Coverage of Service. J Sex Med 2021;18:410-422.