Socioeconomic inequalities and mental health problems in children and adolescents: A systematic review

Objective To update the "Endocrine Treatment of Transsexual Persons: An Endocrine Society Clinical Practice Guideline," published by the Endocrine Society in 2009. Participants The participants include an Endocrine Society-appointed task force of nine experts, a methodologist, and a medical writer. Evidence This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation approach to describe the strength of recommendations and the quality of evidence. The task force commissioned two systematic reviews and used the best available evidence from other published systematic reviews and individual studies. Consensus process Group meetings, conference calls, and e-mail communications enabled consensus. Endocrine Society committees, members and cosponsoring organizations reviewed and commented on preliminary drafts of the guidelines. Conclusion Gender affirmation is multidisciplinary treatment in which endocrinologists play an important role. Gender-dysphoric/gender-incongruent persons seek and/or are referred to endocrinologists to develop the physical characteristics of the affirmed gender. They require a safe and effective hormone regimen that will (1) suppress endogenous sex hormone secretion determined by the person's genetic/gonadal sex and (2) maintain sex hormone levels within the normal range for the person's affirmed gender. Hormone treatment is not recommended for prepubertal gender-dysphoric/gender-incongruent persons. Those clinicians who recommend gender-affirming endocrine treatments-appropriately trained diagnosing clinicians (required), a mental health provider for adolescents (required) and mental health professional for adults (recommended)-should be knowledgeable about the diagnostic criteria and criteria for gender-affirming treatment, have sufficient training and experience in assessing psychopathology, and be willing to participate in the ongoing care throughout the endocrine transition. We recommend treating gender-dysphoric/gender-incongruent adolescents who have entered puberty at Tanner Stage G2/B2 by suppression with gonadotropin-releasing hormone agonists. Clinicians may add gender-affirming hormones after a multidisciplinary team has confirmed the persistence of gender dysphoria/gender incongruence and sufficient mental capacity to give informed consent to this partially irreversible treatment. Most adolescents have this capacity by age 16 years old. We recognize that there may be compelling reasons to initiate sex hormone treatment prior to age 16 years, although there is minimal published experience treating prior to 13.5 to 14 years of age. For the care of peripubertal youths and older adolescents, we recommend that an expert multidisciplinary team comprised of medical professionals and mental health professionals manage this treatment. The treating physician must confirm the criteria for treatment used by the referring mental health practitioner and collaborate with them in decisions about gender-affirming surgery in older adolescents. For adult gender-dysphoric/gender-incongruent persons, the treating clinicians (collectively) should have expertise in transgender-specific diagnostic criteria, mental health, primary care, hormone treatment, and surgery, as needed by the patient. We suggest maintaining physiologic levels of gender-appropriate hormones and monitoring for known risks and complications. When high doses of sex steroids are required to suppress endogenous sex steroids and/or in advanced age, clinicians may consider surgically removing natal gonads along with reducing sex steroid treatment. Clinicians should monitor both transgender males (female to male) and transgender females (male to female) for reproductive organ cancer risk when surgical removal is incomplete. Additionally, clinicians should persistently monitor adverse effects of sex steroids. For gender-affirming surgeries in adults, the treating physician must collaborate with and confirm the criteria for treatment used by the referring physician. Clinicians should avoid harming individuals (via hormone treatment) who have conditions other than gender dysphoria/gender incongruence and who may not benefit from the physical changes associated with this treatment.

/pdf/endocrine-treatment-of-gender-dysphoric-gender-incongruent-frgsgoxe8w.pdf

Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline

European Resuscitation Council Guidelines for Resuscitation 2015

This book includes detailed information on many of the factors surrounding injuries--the man-made systems and products involved, the groups at greatest risk, and effective ways to protect people from injuries. The circumstances under which injuries occur, the etiologic agents, and the characteristics of the people involved are examined. Chapter 2 summarizes the importance of injuries in relation to other prominent health problems. Subsequent chapters describe injury mortality and, in cases where good population-based studies are available, nonfatal injuries. The analyses in Chapters 3-15 are primarily of injury deaths during 1977-1979, the most recent years for which detailed mortality data were available in mid-1983 for deaths other than those related to motor vehicles. Most of these data were collected by the U.S. Department of Health and Human Services, National Center for Health Statistics (NCHS). Chapters 16-20 summarize data on deaths from motor vehicle-related injuries. Most of these detailed data were obtained from the U.S. Department of Transportation, National Highway Traffic Safety Administration (NHTSA). Data from the 1980 census provided denominators for the rates throughout the book, except for trendline calculations which were based on interpolations between census years. The purpose of this book is to improve understanding of the nature and magnitude of the injury problem in the United States. Although it includes some discussion of ameliorative approaches, there is no comprehensive coverage of injury research, theory, or prevention, since these have been comprehensively discussed elsewhere. This book is a thorough documentation of the injury problem. Most of the information presented is new, the product of analyses not previously published in any form.

https://link.springer.com/content/pdf/10.2307%2F3342319.pdf

The injury fact book

Objective: The aim was to formulate practice guidelines for endocrine treatment oftranssexual persons. Evidence: This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe the strength of recommendations and the quality of evidence, which was low or very low. Consensus Process: Committees and members of The Endocrine Society, European Society of Endocrinology, European Society for Paediatric Endocrinology, Lawson Wilkins Pediatric Endocrine Society, and World Professional Association for Transgender Health commented on preliminary drafts of these guidelines. Conclusions: Transsexual persons seeking to develop the physical characteristics of the desired gender require a safe, effective hormone regimen that will 1) suppress endogenous hormone secretion determined by the person’s genetic/biologic sex and 2) maintain sex hormone levels within the normal range for the person’s desired gender. A mental health professional ...

/pdf/endocrine-treatment-of-transsexual-persons-an-endocrine-2qlptvdf9y.pdf

Endocrine Treatment of Transsexual Persons: An Endocrine Society Clinical Practice Guideline

Objective. We describe the frequency and patterns of injury affecting 96 359 children between 0 and 10 years old and living in Alberta, Canada. Design. This population-based, longitudinal study involved children born in the 3 fiscal years of April 1, 1985 to March 31, 1988, recruited before age 1, and who remained in the study until at least age 5. We used the International Classification of Diseases, Ninth Revision, Clinical Modification chapter-17 diagnostic codes provided by physicians. Codes were grouped into 17 categories; injury episodes were calculated, and age- and gender-specific incidence rates for each category were calculated. The age, pattern, times of greatest risk, and the effect of gender on the type and incidence of injury were determined. Setting. Health care administrative data were obtained from all fee-for-service health care venues in Alberta between April 1, 1985 and March 31, 1998 providing services to children registered with the Alberta Health Care Insurance Plan and otherwise meeting entrance criteria. Results. Nearly 84% of children received care for an injury during the study period, and in any given year ∼21% of the population studied had at least 1 injury. Repeat injury was common (73%), and boys were more likely than girls to be injured and to have repeat injury. The most common injuries were dislocations and sprains, open wounds, and superficial injuries and contusions. Burns, poisoning, intracranial injury, and foreign bodies were the next most common, and fractures were least common. Approximately 10% of injuries were multiple-category injuries. Rates varied greatly by injury category, age, and gender. Hospitalization rates varied in a similar manner and commonly accounted for ∼10% of all services. Males were most likely to have an injury, and aboriginal children or children who had received welfare at some time were at greatest risk. Conclusions. Administrative data can be used to estimate the incidence of injury in a pediatric population. Distinct patterns of injury occur at different ages. Recurrent injury is common. Almost identical proportions of injury (46%) are treated in emergency departments and physicians’ offices.

Patterns of injury in children: a population-based approach.

Comparison of esophageal, rectal, axillary, bladder, tympanic, and pulmonary artery temperatures in children

The gradient between temperatures measured at different body sites is not constant; one factor which will change this gradient is rapid changes in body temperature. Measurement of this gradient was done in patients undergoing rapid changes in body temperature to establish the best site to measure temperature and to compare two brands of commercial tympanic thermometers. A total of 228 sets of temperatures were measured from probes in the oesophagus, rectum, and axilla and from two brands of tympanic thermometer and compared with pulmonary artery (PA) temperature in 18 adults during cardiac surgery. Measurements from the oesophageal site was closest to PA readings (mean difference 0.0 ± 0.5°C) compared with IVAC tympanic thermometer (mean difference −0.3 ± 0.5°C), Genius tympanic thermometer (mean difference −0.4 ± 0.5°C), axillary (mean difference 0.2 ± 1.0dgC) and rectal (mean difference −0.4 ± 1,0°C) readings. When data during cooling were analysed separately, all sites had similar gradients from PA except for rectal, which was larger. On rewarming, oesophageal readings were closest to PA readings; tympanic readings were closer to PA than were rectal or axillary readings. Readings from the two brands of tympanic thermometer were equivalent. Oesophageal temperature is more accurate and will reflect rapid changes in body temperature better than tympanic, axillary, or rectal temperature. When oesophageal temperature cannot be measured, tympanic temperature done by a trained operator should become the reading of choice.

/pdf/oesophageal-rectal-axillary-tympanic-and-pulmonary-artery-2qlgxxkiom.pdf

Oesophageal, rectal, axillary, tympanic and pulmonary artery temperatures during cardiac surgery

Spontaneous integrin expression on CD4+, CD8+ and CD19+ lymphocytes at 6 months was significantly lower in breastfed than formula-fed infants (p < 0.05). In another study of 59 formula-fed and 64 breastfed 12-month-old children blast transformation and cytokine production by lymphocytes, and T cell changes were measured before and after measles-mumps-rubella vaccination (MMR). Before vaccination, lymphocytes of breastfed children had lower levels of blast transformation without antigen (p < 0.001), with tetanus toxoid (p < 0.02) or Candida (p < 0.04), and lower interferon-gamma production (p < 0.03). Fourteen days after the live viral vaccination, only the breastfed children had increased production of interferon-gamma (p < 0.02) and increased percentages of CD56+ (p < 0.022) and CD8+ cells (p < 0.004). These findings are consistent with a Th1 type response by breastfed children, not evident in formula-fed children. Feeding mode has an important long-term immunomodulating effect on infants beyond weaning.

Differential modulation of the immune response by breast- or formula-feeding of infants

The aim of this study was to examine bone mineral density and serum 25-hydroxy vitamin D in relation to disease activity in children newly diagnosed with IBD. In a cross-sectional analytic study, 60 children newly diagnosed with IBD (39 with Crohn’s disease [CD], mean age 12.2 ± 2.1 years; and 21 with ulcerative colitis [UC], mean age 12.4 ± 3.7 years) were recruited. Fifty-six age- and sex-matched children without IBD were invited as controls (mean age 11.3 ± 4.2 years). Serum 25-hydroxy vitamin D for patients and controls was measured at diagnosis. Patients’ adjusted lumbar spine bone mineral density (BMD) z scores were measured. Activity indices for both CD and UC were calculated. The serum level of 25-hydroxy vitamin D was significantly lower in children with IBD compared to the control group (P = 0.04). BMD was significantly lower in patients with CD compared to those with UC (P = 0.039). There was no correlation between vitamin D levels, BMD z scores or disease activity indices for both CD and UC. Serum vitamin D level is significantly lower in children with newly diagnosed IBD compared to those without. However, vitamin D levels are not affected by disease severity. It seems that BMD status may not be affected by vitamin D levels or disease severity in this cohort. Larger prospective controlled studies are needed to confirm these findings.

Donald W. Spady

Papers

Patterns of injury in children: a population-based approach.

Comparison of esophageal, rectal, axillary, bladder, tympanic, and pulmonary artery temperatures in children

Oesophageal, rectal, axillary, tympanic and pulmonary artery temperatures during cardiac surgery

Differential modulation of the immune response by breast- or formula-feeding of infants

Bone Mineral Density, Vitamin D, and Disease Activity in Children Newly Diagnosed with Inflammatory Bowel Disease