Outcomes of Gender Affirming Voice Training: A Comparison of Hybrid and Individual Training Modules.

PURPOSE: Gender affirming voice training supports individuals as they explore and develop a healthy voice that feels congruent with their gender and sense of self. Although gender affirming voice training is increasingly available, there is no research comparing individual versus hybrid training outcomes in the existing literature. METHOD: A retrospective chart review was performed on trans women and/or nonbinary individuals who attended either individual or hybrid (group and individual training) gender affirming voice and communication training at St. Michael's Hospital in Toronto between 2012 and 2019. Participant demographics, self-reported goal achievement, attendance, pre/post-Trans Woman Voice Questionnaire (TWVQ) scores, and pre/postspeaking fundamental frequency (SFF) were compared between individual and hybrid training participants. Multiple logistic regression analysis was performed to determine factors that could predict self-reported goal achievement. RESULTS: Sixty-two trans women and/or nonbinary individuals who attended either individual (n = 43) or hybrid (n = 19) gender affirming voice and communication training were included in the study. Hybrid participants had a significantly higher goal achievement rate and therapy adherence rate compared with individual participants (74% vs. 21%; 84% vs. 28%, respectively). Both training models resulted in significant elevation of SFF and reduction of TWVQ scores. Inflection range did not change significantly for either training formats. Multiple logistic regression showed that hybrid training was a positive predictor for goal achievement (odds ratio = 2.2, 95% confidence interval [0.3, 4.1]). CONCLUSIONS: Although clients in individual and hybrid gender affirming voice and communication training achieved significant pitch elevation and lower TWVQ scores, hybrid participants demonstrated significantly higher goal achievement and therapy adherence. This study suggests that hybrid training may provide a valuable support system that improves therapy success in this client population.

Prospective pilot study of Floseal® for the treatment of anterior epistaxis in patients with hereditary hemorrhagic telangiectasia (HHT).

BACKGROUND: Epistaxis is the most common symptom of hereditary hemorrhagic telangiectasia (HHT), affecting more than 98% of adults with HHT, with significant impact on quality of life. Floseal® has been shown to be effective for the management of anterior epistaxis, but has yet to be thoroughly evaluated in this population. Our goal was to evaluate the efficacy of Floseal® for managing acute anterior epistaxis in patients with HHT. METHODS: A pilot prospective clinical trial was conducted at two tertiary referral centres, St. Michael's Hospital, Toronto, Canada and The Ottawa Hospital, Ottawa, Canada. All patients with HHT presenting with acute anterior epistaxis to the two study centres, who enrolled in the study, received Floseal® treatment. The primary outcome measures were achievement of hemostasis and changes in the Epistaxis Severity Score (ESS) between baseline and one-month follow up. Secondary outcome measure included clinical assessment of the nasal cavity. RESULTS: Seven patients were included in the final analysis. All patients underwent treatment of anterior epistaxis with Floseal® and achieved control of epistaxis within 15-min post-application. Application of Floseal® was well tolerated, with patients reporting a pain score of 3 ± 3.13 out of 10. There was no statistically significant difference noted in ESS scores pre-treatment and one-month follow up, 6.27 ± 2.42 vs. 4.50 ± 2.44, p = 0.179. There was a significant improvement clinically on exam of the nasal cavity between baseline and at one-month follow up, indicated by a decrease in the clinical assessment score, 17.29 ± 7.70 vs. 9.57 ± 7.81 (p = 0.0088). CONCLUSIONS: Patients with HHT presenting with acute epistaxis were able to achieve hemostasis with one application of Floseal®, with the procedure being very well tolerated with minimal pain. Although there was no significant change in ESS scores, clinical assessment of the nasal cavity revealed significant improvement at one-month follow up post treatment with Floseal®. TRIAL REGISTRATION: This multi-centered prospective clinical trial was registered with ClinicalTrials.gov ( NCT02638012 ). Registered on December 22, 2015.

Community-based screening for cardiovascular risk using a novel mHealth tool in rural Kenya.

BACKGROUND: An increasing burden of cardiovascular disease (CVD) in low-resource settings demands innovative public health approaches. OBJECTIVES: To design and test a novel mHealth tool for use by community health workers (CHWs) to identify individuals at high CVD risk who would benefit from education and/or pharmacologic interventions. METHODS: We designed and implemented a novel two-way mobile phone application, "AFYACHAT," to rapidly screen for CVD risk in rural Kenya. AFYACHAT collects and stores SMS text message data entered by a CHW on a subject's age, sex, smoking, diabetes, and systolic blood pressure, and returns as SMS text message the category of 10-year CVD risk: "GREEN" (<10% 10 year risk of cardiovascular event), "YELLOW" (10 to <20%), "orange"(20 to <30%), or "RED" (≥30%). CHWs were equipped and trained to use an automated blood pressure device and the mHealth tool. RESULTS: Five CHWs screened 2,865 subjects in remote rural communities in Kenya over a 22 month period (2015-17). The median age of subjects was 50 (IQR 43 to 60) and 1581 (55%) were female. Point prevalence of hypertension (systolic blood pressure>140mmHg), diabetes, and tobacco use were 23%, 3.2%, and 22%, respectively. Overall, the 10-year risk of CVD among patients was <10% in 2778 (97%) patients, 10 to <20% in 65 (2.3%), 20 to <30% in 12 (0.4%), and ≥30% in 10 (0.2%). CONCLUSION: We have developed a mHealth tool that can be used by CHWs to screen for CVD risk factors, demonstrating proof-of-concept in rural Kenya.