Mental health and gender transitioning among hijra individuals: a qualitative approach using the minority stress model.

This study used the minority stress model to explore experiences of gender transitioning among hijra (trans woman) individuals in Mumbai, India. It used a qualitative life history calendar approach to examine transitioning as a critical life experience in a chronological manner. Twenty hijra-identified persons were recruited using purposive snowball sampling and interviewed at a community-based organisation. Data were analysed using thematic analysis. Participants reported diverse experiences living as hijra and shared perspectives on transitioning. Most participants identified to undergo transitioning at their own will. Many cited biological families as a factor that restricted or delayed transitioning, while gharana (congregation of hijras) and gurus were listed as sources of support. Participants also differed in the reasons given for transitioning, expectations, types of practices, and issues of access and support. Transitioning was described as an integral part of their experiences as hijra and developing a congruent self. Implications of the study include the need to engage communities in determining their needs and social support, provide holistic transitioning services at public hospitals, and develop technical and cultural sensitivity training for health professionals.

Noninvasive markers of liver fibrosis: on-treatment changes of serum markers predict the outcome of antifibrotic therapy.

AIM: The utility of noninvasive serum markers to longitudinally monitor liver fibrosis is not established. METHODS: A total of 70 patients with chronic hepatitis C who had previously failed antiviral therapy were randomized to receive pegylated interferon with or without silymarin for 24 months. Enhanced Liver Fibrosis (ELF) tests (hyularonic acid, terminal peptide of procollagen III, tissue inhibitor of matrix metaloproteinase-1) were performed on patient sera obtained before, during and at the end of the study (0, 12, 24 months) and liver histology obtained before and at the end of the study. RESULTS: At 24 months, absolute changes in Ishak fibrosis stage and ELF ranged from -4 to +4 and from -2.41 to +2.68, respectively. Absolute changes in ELF at 12 months were significantly associated with changes in both ELF and histology at 24 months. A model combining both baseline ELF and change of ELF at 12 months could predict the 24-month ELF (R=0.609, P<1×10), a decrease in ELF at 24 months [area under the curve (AUC): 0.80-0.85] and an increase in ELF at 24 months (AUC: 0.81-0.85). Furthermore, a model combining both baseline histologic stage and ELF together with the change of ELF at 12 months could predict 24-month histology (R=0.601, P<1×10, AUC: 0.88-0.92), histologic fibrosis regression (AUC: 0.81-0.84) and progression (AUC: 0.86-0.91). CONCLUSION: Our observations suggest that a change in the serum marker ELF predicts changes in liver fibrosis over a longer period. These data support the use of ELF as a surrogate marker of liver fibrosis evolution in monitoring antifibrotic treatments, thus permitting 'response-guided' therapy by the early identification of patients who will benefit from prolonged treatment.