Understanding the role of sex hormones in cancer for the transgender community.

Sex hormones are crucial for the body's development and function. Therefore, many transgender people seek hormone therapy as part of their transition. However, sex hormones modulate cancer risk. Studying sex hormones in cisgender and transgender populations will improve our knowledge of their biological role in cancer and reduce health disparities.

Attitudes of transgender men and non-binary people to cervical screening: a cross-sectional mixed-methods study in the UK.

BACKGROUND: Transgender men and non-binary people assigned female at birth (TMNB) who have not had surgery to remove the cervix are recommended to undertake cervical screening with the same frequency as cisgender women, but evidence suggests that TMNB have lower odds of lifetime and up-to-date cervical screening uptake. AIM: To understand the attitudes towards and preferences for cervical screening among UK-based TMNB. DESIGN AND SETTING: Cross-sectional survey of TMNB at an NHS gender identity clinic (GIC) and an NHS sexual health service specialising in care of transgender people. METHOD: Recruitment was via email invitations to patients of the GIC and sexual health service. Inclusion criteria were: female sex assigned at birth; transgender man, masculine, or non-binary gender identity; aged ≥18 years; and UK resident. Quantitative results were analysed using descriptive statistics, and free-text comments were analysed thematically. RESULTS: In total there were 137 participants; 80% identified as transmasculine,18% as non-binary, and the remaining participants reported other noncisgender identities. Sixty-four participants (47%) were eligible for cervical screening and 37 (58%) of those had been screened. Only 34 (53%) of those eligible felt they had sufficient information about cervical screening. Just over half (n = 71/134, 53%) stated they would like the option to self-swab for high-risk human papillomavirus. Only half (n = 68/134, 51%) of participants were in favour of an automatic invitation for cervical screening. Thematic analysis identified a number of additional barriers to and facilitators of screening. CONCLUSION: TMNB have identified numerous potential areas for change that may improve cervical screening uptake and patient experience.

Medical students' awareness of health issues, attitudes, and confidence about caring for lesbian, gay, bisexual and transgender patients: a cross-sectional survey.

BACKGROUND: Lesbian, gay, bisexual and transgender (LGBT) patients have an increased incidence of a range of health problems, and face many barriers to accessing healthcare. Our research aimed to explore the awareness of health issues and attitudes of medical students towards LGBT patients' health including barriers to health services, their attitudes towards inclusion of LGBT content in the curriculum and their confidence with providing care for their LGBT patients in the future. METHODS: Medical students were recruited to take part in a cross-sectional survey. We used a 28-item survey to explore views about the undergraduate medical curriculum. RESULTS: 252 surveys were analysed from 776 eligible participants. Attitudes towards LGBT patients were positive but awareness and confidence with respect to LGBT patients were variable. Confidence discussing sexual orientation with a patient significantly increased with year of study but confidence discussing patient gender identity did not. The majority of participants (n = 160; 69%) had not received specific training on LGBT health needs, and 85% (n = 197) wanted to receive more training. CONCLUSIONS: Increasing the amount of LGBT teaching in undergraduate medical curricula could help to increase the quality of doctor-patient interactions, to facilitate patients' disclosure of sexual orientation and gender identity in healthcare and increase the quality of healthcare.

Patient sexual orientation and gender identity disclosure.

BACKGROUND: In the UK, 2.3% of men and 1.6% of women identify as lesbian, gay or bisexual (LGB). Of the UK population, 1% are estimated to identify as transgender (T). Of the LGB population, 46% do not disclose their sexual orientation to health care professionals (HCPs) and 18% of transgender patients avoid health care altogether. Non-disclosure of sexual orientation and/or gender identity contributes to worse health outcomes for LGBT patients. OBJECTIVES: This study aimed to explore medical students' perceptions of the barriers to health care for LGBT patients and the importance of patient disclosure of sexual orientation or gender identity. METHODS: Focus groups included medical students across five year-groups from a medical school in the South East of England. Discussions followed a pre-approved topic guide with a primary and co-facilitator present. Focus groups were audio-recorded, transcribed verbatim and the data underwent framework analysis. RESULTS: Forty-five undergraduate medical students participated (40% of whom were non-heterosexual). Most participants believed that the incorrect use of pronouns and discrimination would be a cause for non-disclosure of gender identity and sexual orientation to HCPs. Several participants thought it was more important to know a patient's gender identity than sexual orientation. Many participants felt that collecting sexual orientation information on healthcare registration forms is acceptable. DISCUSSION: More education regarding LGBT health needs and ways to encourage patient disclosure of sexual orientation or gender identity should be included in the undergraduate medical school curricula to increase the competency of future doctors when interacting with LGBT patients.

Survival following Staphylococcus aureus bloodstream infection: A prospective multinational cohort study assessing the impact of place of care.

BACKGROUND: Staphylococcus aureus bloodstream infection (SAB) is a common, life-threatening infection with a high mortality. Survival can be improved by implementing quality of care bundles in hospitals. We previously observed marked differences in mortality between hospitals and now assessed whether mortality could serve as a valid and easy to implement quality of care outcome measure. METHODS: We conducted a prospective observational study between January 2013 and April 2015 on consecutive, adult patients with SAB from 11 tertiary care centers in Germany, South Korea, Spain, Taiwan, and the United Kingdom. Factors associated with mortality at 90 days were analyzed by Cox proportional hazards regression and flexible parametric models. RESULTS: 1851 patients with a median age of 66 years (64% male) were analyzed. Crude 90-day mortality differed significantly between hospitals (range 23-39%). Significant variation between centers was observed for methicillin-resistant S. aureus, community-acquisition, infective foci, as well as measures of comorbidities, and severity of disease. In multivariable analysis, factors independently associated with mortality at 90 days were age, nosocomial acquisition, unknown infective focus, pneumonia, Charlson comorbidity index, SOFA score, and study center. The risk of death varied over time differently for each infective focus. Crude mortality differed markedly from adjusted mortality. DISCUSSION: We observed significant differences in adjusted mortality between hospitals, suggesting differences in quality of care. However, mortality is strongly influenced by patient mix and thus, crude mortality is not a suitable quality indicator.

A new perspective of the structural complexity of HCMV-specific T-cell responses.

BACKGROUND: In studies exploring the effects of HCMV infection on immune system aging ('immunosenescence'), after organ transplantation or in other settings, HCMV-specific T-cell responses are often assessed with respect to purportedly 'immunodominant' protein subunits. However, the response structure in terms of recognized antigens and response hierarchies (architecture) is not well understood and actual correlates of immune protection are not known. METHODS: We explored the distribution of T-cell response sizes and dominance hierarchies as well as response breadth in 33 HCMV responders with respect to >200 HCMV proteins. RESULTS: At the individual responder level HCMV-specific T-cell responses were generally arranged in clear dominance hierarchies; interestingly, the number of proteins recognized by an individual correlated closely with the size of their biggest response. Target-specificity varied considerably between donors and across hierarchy levels with the presence, size, and hierarchy position of responses to purportedly 'immunodominant' targets being unpredictable. CONCLUSIONS: Predicting protective immunity based on isolated HCMV subunit-specific T-cell responses is questionable in light of the complex architecture of the overall response. Our findings have important implications for T-cell monitoring, intervention strategies, as well as the application of animal models to the understanding of human infection.

Correlates of research effort in carnivores: body size, range size and diet matter.

Given the budgetary restrictions on scientific research and the increasing need to better inform conservation actions, it is important to identify the patterns and causes of biases in research effort. We combine bibliometric information from a literature review of almost 16,500 peer-reviewed publications on a well-known group of 286 species, the Order Carnivora, with global datasets on species' life history and ecological traits to explore patterns in research effort. Our study explores how species' characteristics influenced the degree to which they were studied (measured as the number of publications). We identified a wide variation in intensity of research effort at both Family and Species levels, with some of the least studied being those which may need protection in future. Our findings hint at the complex role of human perspectives in setting research agendas. We found that better-studied species tended to be large-bodied and have a large geographic range whilst omnivory had a negative relationship with research effort. IUCN threat status did not exhibit a strong relationship with research effort which suggests that the conservation needs of individual species are not major drivers of research interest. This work is the first to use a combination of bibliometric analysis and biological data to quantify and interpret gaps in research knowledge across an entire Order. Our results could be combined with other resources, such as Biodiversity Action Plans, to prioritise and co-ordinate future research effort, whilst our methods can be applied across many scientific disciplines to describe knowledge gaps.