Increased rate of pancreatitis in gender diverse and transgender patients on hormone therapy: a case series study.

BACKGROUND: There is limited data on the incidence of gastrointestinal-specific pathology in gender non-conforming (GNC) populations. METHODS: Retrospective analysis of pancreatitis incidence rates in transgender and GNC persons exposed and not exposed to gender-affirming hormone therapy (GAHT). RESULTS: 7 of the 1333 patients on hormone therapy had an incidence of pancreatitis. 0 of the 615 patients with no history of GAHT use developed pancreatitis. Representing a 6.96 (95% CI 2.76 to 848.78) for the development of pancreatitis in patients with exposure to GAHT therapy. CONCLUSION: Clinicians working with GNC individuals should be aware of this possible association.

Genital Tucking Practices in Transgender and Gender Diverse Patients.

Genital tucking (tucking) is the practice of hiding or minimizing the appearance of one's genitals and gonads. We aimed to better understand the prevalence of tucking and its potential effect on behavior and health. An online questionnaire was distributed to adults with a diagnosis of gender dysphoria or gender incongruence (n = 98). The risk of side effects increased with the length of tucking sessions (P = 0.046) with many patients avoiding medical care despite experiencing side effects. Health care providers should empathetically discuss tucking and its potential risks and benefits with transgender and gender diverse patients. Further research is needed to better quantify the potential risks involved with tucking and to assist in developing educational resources.

Development and initial validation of a sexual and gender minority competency-based survey for health service professionals.

Sexual and gender minority (SGM) individuals endure a number of health disparities, such as higher rates of violence, mental health conditions, and medical concerns. These disparities are exacerbated by the fact that SGM individuals face stigmatizing health care provider and system-related experiences. The primary purpose of this study was to quantify health service providers' SGM health competency by developing a measure, namely the Health Care Competency Assessment Form-Sexual and Gender Minority Patients (HCAF-SGM). Further, we examined correlates of SGM health competency based on leading theories of prejudice, primarily the dual process model of prejudice and social identity theory. The study comprised two phases: item development and pilot testing, followed by a primary online survey administration with several health care professionals and training organizations (N = 155). Study findings supported a one-factor HCAF-SGM score, suggesting that health care providers view their competency regarding SGM individuals in a holistic manner, without differentiating between knowledge, attitude, and skill. The measure was found to be negatively associated with right-wing authoritarianism and positively correlated with specific social identities most salient to the topic of SGM health (i.e., health care professional and SGM). The HCAF-SGM shows promise as a reliable and valid assessment of perceived provider health care competency. Implications for SGM health-related measurement, clinical supervision, and training are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Providing Care for Transgender and Gender Diverse Youth.

Transgender and gender diverse youth (TGDY) experience modifiable health disparities and difficulty accessing the physical and mental health care systems. Providers and staff should understand the unique needs of this population and provide affirming spaces where these resilient young people can thrive. In addition to addressing social, setting, and system level barriers to access, providers should consider offering comprehensive gender care because this reduces barriers to medical services and can improve health outcomes. This article educates providers about TGDY, reviews the role of mental health care, and provides an overview of medical interventions for gender affirmation.

Accelerated Thermal Depolymerization of Cyclic Polyphthalaldehyde with a Polymeric Thermoacid Generator.

Thermally triggerable polymer films that degrade at modest temperatures (≈85 °C) are created from a blend of cyclic polyphthalaldehyde (cPPA) and a polymeric thermoacid generator, poly(vinyl tert-butyl carbonate sulfone) (PVtBCS). PVtBCS depolymerizes when heated, generating acid which initiates the depolymerization of cPPA into volatile byproducts. The mass loss onset for 2 wt% PVtBCS/cPPA is 22 °C lower than the onset for neat cPPA alone in dynamic thermogravimetric analysis experiments. Increased concentrations of PVtBCS increase the rate of depolymerization of cPPA. Raman spectroscopy reveals that the monomer, o-phthalaldehyde, is the main depolymerization product of the acid-catalyzed depolymerization of cPPA. The PVtBCS/cPPA blend is a promising material for the design and manufacture of transient electronic packaging and polymers.

Examining the impact of a province-wide physical education policy on secondary students' physical activity as a natural experiment.

BACKGROUND: The purpose of this paper is to examine the impact of a province-wide physical education (PE) policy on secondary school students' moderate to vigorous physical activity (MVPA). METHODS: Policy: In fall 2008, Manitoba expanded a policy requiring a PE credit for students in grades 11 and 12 for the first time in Canada. The PE curriculum requires grades 11 and 12 students to complete a minimum of 55 h (50% of course hours) of MVPA (e.g., ≥30 min/day of MVPA on ≥5 days a week) during a 5-month semester to achieve the course credit. STUDY DESIGNS: A natural experimental study was designed using two sub-studies: 1) quasi-experimental controlled pre-post analysis of self-reported MVPA data obtained from census data in intervention and comparison [Prince Edward Island (PEI)] provinces in 2008 (n = 33,619 in Manitoba and n = 2258 in PEI) and 2012 (n = 41,169 in Manitoba and n = 4942 in PEI); and, 2) annual objectively measured MVPA in cohorts of secondary students in intervention (n = 447) and comparison (Alberta; n = 224) provinces over 4 years (2008 to 2012). ANALYSIS: In Study 1, two logistic regressions were conducted to model the odds that students accumulated: i) ≥30 min/day of MVPA, and ii) met Canada's national recommendation of ≥60 min/day of MVPA, in Manitoba versus PEI after adjusting for grade, sex, and BMI. In Study 2, a mixed effects model was used to assess students' minutes of MVPA per day per semester in Manitoba and Alberta, adjusting for age, sex, BMI, school location and school SES. RESULTS: In Study 1, no significant differences were observed in students achieving ≥30 (OR:1.13, 95% CI:0.92, 1.39) or ≥60 min/day of MVPA (OR:0.92, 95% CI: 0.78, 1.07) from baseline to follow-up between Manitoba and PEI. In Study 2, no significant policy effect on students' MVPA trajectories from baseline to last follow-up were observed between Manitoba and Alberta overall (-1.52, 95% CI:-3.47, 0.42), or by covariates. CONCLUSIONS: The Manitoba policy mandating PE in grades 11 and 12 had no effect on student MVPA overall or by key student or school characteristics. However, the effect of the PE policy may be underestimated due to the use of a nonrandomized research design and lack of data assessing the extent of policy implementation across schools. Nevertheless, findings can provide evidence about policy features that may improve the PE policy in Manitoba and inform future PE policies in other jurisdictions.

Low-Ceiling-Temperature Polymer Microcapsules with Hydrophobic Payloads via Rapid Emulsion-Solvent Evaporation.

We report a microencapsulation procedure based on rapid solvent evaporation to prepare microcapsules with hydrophobic core materials and low-ceiling-temperature polymer shell wall of cyclic poly(phthalaldehyde) (cPPA). We use and compare microfluidic and bulk emulsions. In both methods, rapid solvent evaporation following emulsification resulted in kinetically trapped core-shell microcapsules, whereas slow evaporation resulted in acorn morphology. Through the systematic variation of encapsulation parameters, we found that polymer-to-core weight ratios higher than 1 and polymer concentrations higher than 4.5 wt % in the oil phase were required to obtain a core-shell structure. This microencapsulation procedure enabled the fabrication of microcapsules with high core loading, controlled size, morphology, and stability. This procedure is versatile, allowing for the encapsulation of other hydrophobic core materials, i.e., mineral oil and organotin catalyst, or using an alternative low-ceiling-temperature polymer shell wall, poly(vinyl tert-butyl carbonate sulfone).

Base-Triggered Degradation of Poly(vinyl ester sulfone)s with Tunable Sensitivity.

A series of poly(vinyl ester sulfone)s are synthesized and are found to rapidly degrade in the presence of base. Solution phase NMR indicates that the sensitivity of these polymers to base depends on the identity of the ester functional group of the polymers. From most to least sensitive these are poly(vinyl chloroacetate sulfone) > poly(vinyl acetate sulfone) > poly(vinyl benzoate sulfone) > poly(vinyl pivalate sulfone). Significantly, these polymers were more reactive to base than the aliphatic poly(1-hexene sulfone). Additionally, degradation of these polymers in bulk occurs rapidly with exposure to aqueous solutions of base. The polymers are stable in water and possess good barrier properties; films of 30 µm thickness allow on average <1% crossover of dye over 7 days. Based on the data collected, poly(vinyl ester sulfone) polymers are promising for use in microcapsules, in particular, for applications where sustained or staged release would benefit from a series of different microcapsule compositions.

Common Questions About Pneumonia in Nursing Home Residents.

Pneumonia in older adults residing in nursing homes can be challenging to diagnose and treat. Pneumococcal and influenza immunizations decrease the risk of pneumonia and are recommended for all nursing home patients. Older adults with pneumonia may not display classic signs and symptoms of infection, although most have at least one respiratory symptom. Suspicion of pneumonia is heightened if pulse oximetry measurements are low. The diagnosis of pneumonia is confirmed by chest radiography. To determine whether treatment is necessary and where treatment should occur, the patient's overall prognosis should be considered. If treatment is to occur, antibiotics should be administered as soon as possible for a duration of five to eight days; however, treatment may be extended in the absence of clinical resolution or in the presence of Pseudomonas aeruginosa. Oral antibiotics may be administered in the nursing home, whereas hospitalized patients should initially receive intravenous antibiotics and transition to oral antibiotics after clinical improvement. Antibiotic regimens for patients treated in the nursing home include a respiratory fluoroquinolone, or a beta-lactam antibiotic with a macrolide. Hospitalized patients may receive the same regimens, although several other oral and intravenous options are acceptable. Patients' prognosis can be accurately estimated using the SOAR score (which uses systolic blood pressure, oxygenation, age, and respiratory rate).

Is the Provision of Physical Education to Senior-Years Students Associated With Greater Physical Activity Levels? Insight Into a Province-Wide Policy.

OBJECTIVES: The purpose of this study was to determine if participation in physical education (PE) was associated with increased moderate-to-vigorous physical activity (MVPA) levels in adolescents. METHODS: This was a cross sectional study comparing MVPA levels in senior-years students-grade 11 and 12-enrolled in high school PE during the semester data were collected compared with those not enrolled in PE in that same semester. The primary outcome measure was daily MVPA measured by accelerometry. The primary exposure was participation in PE. RESULTS: Among the 508 adolescents (16.9 ± 0.8 yrs, 49% female, n = 338 exposed to PE) studied, no differences in MVPA (47.0 ± 25.8 vs. 43.9 ± 25.0 mins/day, P = .25) or sedentary time (540.2 ± 94.7 vs. 550.2 ± 79.4 mins/day, P = .79) were noted between students enrolled in PE compared with students not enrolled in PE. Participation in PE was associated with a greater odds of achieving >60 minutes of MVPA daily (OR: 1.69; 95% CI: 1.04-2.75). This association was stronger among boys (OR: 2.4; 95% CI: 1.2-4.8) than girls (OR: 1.17; 95% CI: 0.5-2.7). CONCLUSION: Enrollment in PE in grade 11 or 12 is associated with modestly higher levels of MVPA and an increased likelihood of meeting PA guidelines among students in grades 11 and 12, particularly among boys.

Phenylalanine detection using matrix assisted pulsed laser evaporation of molecularly imprinted amphiphilic block copolymer films.

Matrix assisted pulsed laser evaporation was used to deposit molecularly imprinted polymer films of an amphiphilic block copolymer imprinted with an amino acid. This method avoids the need for a common solvent for host and template, and permits fabrication of layers with controlled thicknesses in the nanometer range. Polystyrene-block-polyethylene oxide copolymer and phenylalanine template were co-deposited onto surface plasmon resonance (SPR) sensors from a water/toluene emulsion. FTIR confirmed removal and reintroduction of phenylalanine, and SPR measurements were used for quantitative analysis. A binding ratio of more than 10 was obtained for phenylalanine on imprinted sensors vs. the non-imprinted control surfaces of the same polymer, and a detection limit of 0.5 mM phenylalanine was established. Exposure of sensors to alanine, glutamine, tryptophan, and tyrosine demonstrated that the sensors were highly specific.

VItamin D supplementation in infants, children, and adolescents.

Vitamin D deficiency in children can have adverse health consequences, such as growth failure and rickets. In 2008,the American Academy of Pediatrics increased its recommended daily intake of vitamin D in infants, children, and adolescents to 400 IU. Infants who are breastfed and children and adolescents who consume less than 1 L of vitamin D-fortified milk per day will likely need supplementation to reach 400 IU of vitamin D per day. This recommendation is based on expert opinion and recent clinical trials measuring biomarkers of vitamin D status. It is also based on the precedent of preventing and treating rickets with 400 IU of vitamin D. In addition to dietary sources, exposure to ultraviolet B sunlight provides children and adults with additional vitamin D. Although the American Academy of Pediatrics recommends keeping infants out of direct sunlight, decreased sunlight exposure may increase children's risk of vitamin D deficiency. No randomized controlled trials assessing patient-oriented outcomes have been performed on universal vitamin D supplementation. However, vitamin D may reduce the risk of certain infections and chronic diseases. Physicians should help parents choose the appropriate vitamin D supplement for their child.

Management of cardiovascular risk in the peri-menopausal woman: a consensus statement of European cardiologists and gynaecologists.

Cardiovascular risk is poorly managed in women, especially during the menopausal transition when susceptibility to cardiovascular events increases. Clear gender differences exist in the epidemiology, symptoms, diagnosis, progression, prognosis, and management of cardiovascular risk. Key risk factors that need to be controlled in the peri-menopausal woman are hypertension, dyslipidaemia, obesity, and other components of the metabolic syndrome, with the avoidance and careful control of diabetes. Hypertension is a particularly powerful risk factor and lowering of blood pressure is pivotal. Hormone replacement therapy is acknowledged as the gold standard for the alleviation of the distressing vasomotor symptoms of the menopause, but the findings of the Women's Health Initiative (WHI) study generated concern for the detrimental effect on cardiovascular events. Thus, hormone replacement therapy cannot be recommended for the prevention of cardiovascular disease. Whether the findings of WHI in older post-menopausal women can be applied to younger peri-menopausal women is unknown. It is increasingly recognized that hormone therapy is inappropriate for older post-menopausal women no longer displaying menopausal symptoms. Both gynaecologists and cardiovascular physicians have an important role to play in identifying peri-menopausal women at risk of cardiovascular morbidity and mortality and should work as a team to identify and manage risk factors such as hypertension.