Gender Affirming Graft Only Vaginoplasty.

OBJECTIVE: To describe our technique for performing gender affirming graft only vaginoplasty. METHODS: In graft only vaginoplasty, penile skin is used only for the external genitals, and the entire vaginal canal is created from a full thickness skin graft. The inner scrotum is excised and used as a skin graft to line the vaginal canal. The outer scrotum is left in place then moved medially to form the labia majora. The penile skin and Dartos fascia are incised dorsally and ventrally then advanced to the posterior perineum to become the labia minora. The glans clitoris is constructed from a W-shaped dorsally-based portion of the glans penis, and the clitoral hood is constructed from the distal 2-3 cm of penile shaft skin. The posterior wall of the introitus is formed from a posterior perineal flap. RESULTS: The patient presented here is a 26-year-old transgender woman with marked and sustained gender incongruence. She is circumcised, has typical penile length, scrotal contents are normal, and all hair has been removed on the scrotum and perineum. She underwent graft only vaginoplasty, as shown in the accompanying video. CONCLUSION: Gender affirming graft only vaginoplasty allows for construction of the vaginal canal from a full thickness skin graft, and construction of external genitals from penile and scrotal skin. Advantages of this approach include availability of more tissue for construction of the external genitals and an external skin to graft anastomosis. The procedure is modified slightly when the patient has a small scrotum, short penis, or is uncircumcised.

Genital Gender Affirming Surgery.

Genital gender affirming surgery is an effective treatment for gender dysphoria in transgender individuals. Optimization of medical and mental health conditions, including coordination with a patient's entire care team, is essential. Feminizing procedures include vaginoplasty (creation of female genitalia with a vaginal canal) and vulvoplasty (creation of female genitalia with a short or absent vaginal canal). Masculinizing procedures include metoidioplasty (construction of male genitals via local tissue rearrangement) and phalloplasty (creation of a phallus from extra-genital tissue). We aim to provide an overview of genital gender affirming surgery for providers who are interested in learning more about genital gender affirming surgery.

Transrectal Ultrasound MRI-Fusion Biopsy of Perirectal Mass.

This case report describes the novel use of ultrasound-guided MRI-fusion biopsy to sample an extraluminal perirectal mass. This is a 64-year-old man with a history of pT3N2b mucinous adenocarcinoma of the right colon with metastatic disease to the mesocolic lymph nodes. Two years after initial resection he was found on restaging CT to have a mass measuring ∼4.0 × 4.8 cm superior to the seminal vesicles. Fluorodeoxyglucose (FDG)-positron emission tomography (PET) showed a moderately FDG avid soft tissue mass interposed between the prostate and the rectum. Multiparametric MRI revealed a 6.2 × 4.6 × 2.8 cm heterogeneous lobulated T2 hyperintense mass with enhancement just superior to the seminal vesicles. This mass was unable to be viewed using sigmoidoscopy. Using UroNAV technology, we were able to biopsy the mass in the clinic setting. Biopsy was confirmed as recurrent mucinous adenocarcinoma.

Tobacco crop substitution: pilot effort in China.

In China, approximately 20 million farmers produce the world's largest share of tobacco. Showing that income from crop substitution can exceed that from tobacco growth is essential to persuading farm families to stop planting tobacco, grown abundantly in Yunnan Province. In the Yuxi Municipality, collaborators from the Yuxi Bureau of Agriculture and the University of California at Los Angeles School of Public Health initiated a tobacco crop substitution project. At 3 sites, 458 farm families volunteered to participate in a new, for-profit cooperative model. This project successfully identified an approach engaging farmers in cooperatives to substitute food crops for tobacco, thereby increasing farmers' annual income between 21% and 110% per acre.

Improving reproductive health knowledge in rural China--a web-based strategy.

In China, one of the major problems in upgrading rural health services is the difficulty of communicating between the rural and urban areas. Enabling local agencies to access the Internet in resource-poor areas can provide an efficient means of diffusing current training and information and will have far-reaching policy implications. To test the feasibility of using the Internet to deliver needed health information to the countryside, the UCLA School of Public Health and the Institute of Health Studies of Kunming Medical College (IHS-KMC) collaborated in an experimental website project to improve the quality of reproductive health services to promote women's health in three rural counties of Yunnan. The project involved the county government and the Bureau of Public Health, the Bureau of Family Planning; the Bureau of Education, Women's Federation, and the Maternal and Child Health Station targeting village health workers and teachers; women's cadres. Three counties, matched on socioeconomic status, participated in the study and were randomized to receive three programs. Nanhua County received computer skill training and logistic support including a planning workshop for information diffusion. Mouding County received computers only. Dayao, the control county, did not receive the full program until the conclusion of the project. The study demonstrated that the use of a website to disseminate health information in remote rural areas is not only feasible but that it also will be enthusiastically adopted by local health workers and interested parties. Moreover, the knowledge was diffused from the primary population of village doctors, family planning workers, women's cadres, and teachers to the secondary population of villagers and students.

Evaluation of a web-based intervention for improving HIV/AIDS knowledge in rural Yunnan, China.

OBJECTIVE: To improve HIV/AIDS knowledge among villagers and students in remote rural counties of Yunnan, China. DESIGN: The University of California at Los Angeles School of Public Health and the Institute of Health Sciences of Kunming Medical College, with the assistance of local health and community agencies, initiated a web-based intervention project. Nanhua county received computers, training on accessing the website, and ongoing logistic support for diffusing information to their village colleagues. Mouding county received computers only, and Dayao county received neither. METHODS: Health workers in the two experimental counties were encouraged to disseminate the information from the website to villagers and students. Health knowledge was queried by cross-sectional surveys before and after implementation of the intervention. RESULTS: Health workers, villagers and students in Nanhua experienced the greatest increase in knowledge of HIV/AIDS and sexually transmitted infections, and Dayao the lowest. The improved knowledge was substantial in many, but not all areas (e.g. hepatitis B transmission) assessed. CONCLUSION: Web-based education is an effective method to increase health knowledge in rural China. Ongoing logistic support is essential for success.

Reproductive health indicators for China's rural areas.

We report community-based development of reproductive health indicators for China's rural areas. To generate these indicators, we sequenced two participatory techniques known as nominal group process and Delphi survey methodology. Nominal group process entailed grassroots reproductive health workers' generating indicators, followed by refinement and prioritization of these indicators through a consensus-building Delphi process among nationally and internationally known reproductive health experts. Major criteria for the indicators were practicality, feasibility, and measurability within China's rural areas. We explain the importance of establishing these indicators for application in rural China and other developing countries as a complement to the World Health Organization's reproductive health indicators for global monitoring; present the identified indicators; and describe lessons learned from field testing in low-, middle-, and high-income counties of China's countryside.

Diffusion of HIV/AIDS knowledge, positive attitudes, and behaviors through training of health professionals in China.

A study evaluated a training-of-trainers strategy to update HIV/AIDS knowledge and improve attitudes and behavior among health professionals and the public. A survey was carried out among health workers and villagers. An initial workshop was given to 55 staff from several health institutions. Trainees were provided limited funds to conduct secondary workshops at local levels. They were requested to diffuse knowledge to patients during routine health visits. A follow-up survey was conducted 18 months later in counties in which workshops were not held. Knowledge, attitudes, and behavior were compared both at the baseline and follow-up surveys, and before and after the intervention. Nearly 95% (94.8%, or 13,782) of health workers in Fuyang Prefecture were trained secondarily at local levels. Knowledge was significantly higher in intervention (88.5-99.8%) compared with nonintervention (37.4-53.7%) counties, and after intervention (22.2-66.6%), respectively (p < .01). Attitudes toward people with HIV/AIDS improved significantly in intervention counties. Condom use during last sexual intercourse increased from 11.0% to 33.5% in health workers (p < .01) and from 8.7% to 18.5% among villagers (p <.01). The strategy wascost effective for improving knowledge and attitudes and promoting condom use.

Community-based trial to prevent drug use among youths in Yunnan, China.

OBJECTIVES: This study evaluated a community-based program in China to prevent initiation of drug use in young men. METHODS: Similar intervention and control areas were selected. Village leaders, teachers, and women and youth leaders were recruited to participate in the program. Community activities were organized and intervention activities in schools were implemented. Incidence of new drug users was estimated. RESULTS: There was a 2.7-fold greater reduction in drug use initiation in the intervention area (1.59% vs 0.60%). Reduction was highest among males aged 15 to 19, single men, illiterate men, and the Jingpo minority. HIV/AIDS knowledge and attitudes and recognition of drug problems were all significantly better in the intervention area. CONCLUSIONS: Community-based intervention programs to prevent drug use can be successful in rural areas of China.