Barriers to oral health care for transgender and gender nonbinary populations.

BACKGROUND: Despite health disparities and barriers to medical care being well documented in the literature, transgender and gender nonbinary (TGNB) people's experiences and expectations with regard to oral health care remain understudied. The authors examined gender identity-related factors influencing experiences in the dental setting, aspects of subjective oral health, and avoidance of oral health care. METHODS: One-hundred eighteen TGNB people aged 13 through 70 years completed a 32-item questionnaire designed for this study. Data analysis relied on descriptive methods and bivariate comparisons using a conventional P < .05 statistical significance criterion. Qualitative description analysis was used to identify emerging themes from responses to an open-ended question. RESULTS: One-third of participants reported misgendering (that is, had been addressed by their incorrect name and pronouns in the dental setting). Although refusal of oral health care was rare in this sample of TGNB participants, more than one-half felt that their usual source of oral health care was not equipped to provide gender-appropriate care. Participants' avoidance due to gender identity was significantly associated with measures of self-reported suboptimal oral health. Common themes related to participants' oral health care experiences included gender insensitivity, awkward interactions, avoidance of care, and lack of gender-affirming providers. CONCLUSIONS: Discrepancies between TGNB patients' expectations and actual experiences suggest that their needs are often unmet in the dental setting, possibly contributing to gender identity-associated dental avoidance and oral health disparities. PRACTICAL IMPLICATIONS: Although these results need to be verified in larger and more diverse samples, they provide actionable information for improvement to this population's oral health and management.

Longitudinal Changes in Depression Symptoms and Glycemia in Adults With Type 1 Diabetes.

OBJECTIVE: This study assessed longitudinal change in depression symptoms over ≥4 years in adults with type 1 diabetes and examined the association between change in depression symptom status and glycemia. RESEARCH DESIGN AND METHODS: Adults in the T1D Exchange registry with HbA1c and Patient Health Questionnaire (PHQ-8) at 1 year (baseline) and 5 years post-enrollment (follow-up; n = 2,744, mean age, 42 years; 57% female, 92% white; mean HbA1c, 7.6% [58 mmol/mol]) were included. Depression status was defined as Persistent Elevated Depression Symptoms (EDS) (EDS at baseline and follow-up), Resolved EDS (EDS at baseline, no EDS at follow-up), New Onset EDS (no EDS at baseline, EDS at follow-up), and Not Depressed (no EDS at baseline or follow-up). RESULTS: Overall, 131 (5%) had Persistent EDS, 122 (4%) had Resolved EDS, 168 (6%) had New Onset EDS, and 2,323 (85%) were Not Depressed. Of those with EDS (PHQ ≥ 10) at baseline, 53% had EDS at follow-up; of those not depressed at baseline, 7% had EDS at follow-up. An increase in PHQ-8 was associated with an increase in HbA1c (P < 0.001). Although HbA1c increased in all groups, the increase was less in the Resolved EDS and Not Depressed groups (P = 0.001). Persistent EDS and New Onset EDS groups were more likely to experience diabetic ketoacidosis (DKA) (P < 0.001). CONCLUSIONS: T1D Exchange registry data provide evidence for relationships over time between persistently, and newly developing EDSs and worsening glycemic control, and suggest relationships between depression symptoms and the occurrence of severe hypoglycemia and DKA. Successful treatment of depression symptoms may lead to better long-term diabetes outcomes.

Contemporary Demographic, Treatment, and Geographic Distribution Patterns for Disorders of Sex Development.

This study aimed to describe the demographic characteristics, hospital utilizations, patterns of inpatient surgical management, and the overall state/regional variation in surgery rate among patients with disorders of sex development (DSD). We analyzed the Nationwide Inpatient Sample from 2001 to 2012 for patients younger than 21 years. DSD-related diagnoses and procedures were identified via International Classification of Diseases, Ninth Revision (ICD-9) codes. We identified a total of 43,968 DSD-related admissions. Of these, 73.4% of the admissions were designated as female and 642 (1.9%) were inpatient surgical admissions. Among neonates, less than 1% underwent any type of genital surgery. Nonsurgical admissions were associated with longer length of stay and higher cost. There was no significant regional variation in the rate of DSD surgeries, but we observed higher concentrations of DSD surgeries in states associated with tertiary referral centers.

Down Syndrome Disintegrative Disorder: New-Onset Autistic Regression, Dementia, and Insomnia in Older Children and Adolescents With Down Syndrome.

Over a 10-year period in a Down syndrome Clinic, 11 children and adolescents were encountered with a history of new-onset (8) or worsening (3) autistic characteristics. Ten of the 11 (91%) had cognitive decline to a dementia-like state and 9 of the 11 (82%) new-onset insomnia. The mean age at which symptoms developed was 11.4 years (standard deviation = 3.6 years; range 5-14 years), an older age than usual for autistic regression in Down syndrome. Ten of 11 cases (91%) had elevated ("positive") thyroperoxidase antibody titers compared to only 5 of 21 (23%) age-matched control subjects with Down syndrome (P < .001). At follow-up at a mean age of 20.7 years (standard deviation = 3.9 years), 8 of the 11 (73%) were at least somewhat better. Down syndrome disintegrative disorder seems an appropriate name for this newly recognized clinical association, which may be due to autoimmunity.

Trastorno desintegrativo en el síndrome de Down ¿un nuevo cuadro diagnóstico? / No disponible

Los autores de este reciente trabajo describen un complejo cuadro que aparece raramente en el síndrome de Down, para el que proponen el término 'trastorno desintegrativo en el síndrome de Down'. Se caracterizaría en esencia por la aparición de: 1) una regresión de tipo autista en un niño con síndrome de Down que hasta entonces había tenido un desarrollo conductual y lingüístico normales, dentro de su síndrome, 2) declive cognitivo hacia un estado de demencia, 3) insomnio, 4) aparición a edades mayores de las que suelen ocurrir en la típica regresión autista del síndrome de Down, 5) quizá, signos de autoinmunidad tiroidea. El llamado trastorno desintegrativo infantil forma parte de un grupo más amplio denominado: 'Trastornos generalizados del desarrollo' (DSM-IV R). Se caracteriza por el desarrollo de autismo y de deterioro cognitivo en un niño hasta entonces normal, y que aparece a una edad superior a la que suele aparecer en la típica regresión autista. Para hacer este diagnóstico, debe haber pasado por lo menos 2 años con un desarrollo normal, apareciendo después la regresión autista; esta regresión debe ocurrir antes de los 10 años de edad y no debe ser explicada por ningún otro diagnóstico en ese niño. Como tal, el trastorno desintegrativo es una enfermedad rara. Lo que se presenta en este trabajo es un análisis de 11 casos observados en una Clínica especializada en el síndrome de Down (Duke University Medical Center, Durham, USA) a lo largo de 10 años (2002-2012), cuya descripción se aproxima al diagnóstico antes definido como trastorno desintegrativo infantil, pero con unas características propias que inducen a los autores a proponer una nueva entidad patológica que definen como trastorno desintegrativo en el (o propio del) síndrome de Down. Para entrar en este diagnóstico, los pacientes tenían que presentar regresión autista de acuerdo con los requisitos diagnósticos de DSM-IV R, y tener una edad superior a la que se considera propia de la regresión autista en el síndrome de Down (5 años o más). En todos los casos se pidió a los padres una historia del declive cognitivo hacia un estado del tipo de la demencia (desarrollo cognitivo, desarrollo del lenguaje, desarrollo de motricidad gruesa; desarrollo de habilidades de la vida cotidiana). Se les pidió los registros escolares y muestras del trabajo escolar antes y después del inicio del declive cognitivo, para comprobar el deterioro del niño. También se les pidió la historia del insomnio. En una segunda y posteriores visitas se les volvió a pedir historias detalladas del declive cognitivo y de nuevos síntomas autistas, para confirmar lo ya informado. Seles realizaron pruebas de seropositividad a la tiroperoxidasa (AU)

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