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BMC Health Services Research Jul 2021The caregiving's impact on informal carers' quality of life and gender-based stereotypes make older individuals' informal care a complex process for which our knowledge...
BACKGROUND AND PURPOSE
The caregiving's impact on informal carers' quality of life and gender-based stereotypes make older individuals' informal care a complex process for which our knowledge is still limited. The purpose of this review is to identify how gender relates to informal carers' experiences of providing care for people aged 60 years and over with mental and physical health needs by synthesising the available empirical data published between 2000 to 2020.
DESIGN AND METHODS
The systematic method for reviewing and synthesising qualitative data was performed using the PRISMA checklist and ENTREQ statement. The CASP tool was used to examine the quality of the included papers. Thematic synthesis was used as the methodological framework.
RESULTS
This review produced two analytical themes, the impact of gender on the caregivers' labour and negotiating gender identity with self, society, and cultural norms. While informal caregivers share motivators, a linkage between traditional gender stereotypes impacts caregiving burden and coping strategies. Informal carers' experiences entail a constant pursuit of self-agency after acquiring the caregiver role. Cultural values and their intersection with gender appear to influence caregivers' healthy adjustment into their new caregiving identities. The flexibility to move beyond gender boundaries could mediate caregivers' negotiations between self and society on developing their new caregiving identity. Providing intensive informal primary care to older people affects both men's and women's mental and physical health. Gender ideals of the feminine nurturing role further disadvantage women as they determine the caregiving arrangements, the strategies and resources to sustain the caring burden, and the adaptability to experience their new caregiving role positively. Men appear more flexible to debate their hegemonic masculinity and defend their existence in the caregiving role.
CONCLUSION AND IMPLICATIONS
Transgressing gender lines and expanding gender possibilities can ease the caregiving burden and strengthen caregivers coping potentials. Health professionals can empower informal careers to challenge gender binaries and expand gender possibilities by intentionally injecting the language of diversity in caring information and caring processes. The review findings outline a path for research on gender identity development in older people's care.
Topics: Aged; Caregivers; Female; Gender Identity; Humans; Male; Men; Middle Aged; Patient Care; Quality of Life
PubMed: 34301248
DOI: 10.1186/s12913-021-06736-2 -
BMJ Open Jul 2021To systematically review all published and unpublished evidence on the impact of the COVID-19 pandemic on the health and well-being of UK sexual and gender minority...
OBJECTIVE
To systematically review all published and unpublished evidence on the impact of the COVID-19 pandemic on the health and well-being of UK sexual and gender minority (LGBT+; lesbian, gay, bisexual, transgender, non-binary, intersex and queer) people.
METHODS
Any relevant studies with or without comparator were included, with outcomes of: COVID-19 incidence, hospitalisation rates, illness severity, death rates, other health and well-being. Six databases (platforms) were searched-CINAHL Plus (Ovid), Cochrane Central (Cochrane Library), Medline (Ovid), Embase (Ovid), Science Citation Index (Web of Science) and Scopus between 2019 and 2020 in December 2020, using synonyms for sexual and gender minorities and COVID-19 search terms. Data extraction and quality assessment (using the relevant Joanna Briggs checklist) were in duplicate with differences resolved through discussion. Results were tabulated and synthesis was through narrative description.
RESULTS
No published research was found on any outcomes. Eleven grey literature reports found to be of low quality were included, mostly conducted by small LGBT+ charities. Only four had heterosexual/cisgender comparators. Mental health and well-being, health behaviours, safety, social connectedness and access to routine healthcare all showed poorer or worse outcomes than comparators.
CONCLUSIONS
Lack of research gives significant concern, given pre-existing health inequities. Social and structural factors may have contributed to poorer outcomes (mental health, well-being and access to healthcare). Paucity of evidence is driven by lack of routinely collected sexual orientation and gender identity data, possibly resulting from institutional homophobia/transphobia which needs to be addressed. Men are more at risk of serious illness from COVID-19 than women, so using data from trans women and men might have started to answer questions around whether higher rates were due to sex hormone or chromosomal effects. Routine data collection on sexual orientation and gender identity is required to examine the extent to which COVID-19 is widening pre-existing health inequalities.
PROSPERO REGISTRATION NUMBER
CRD42020224304.
Topics: COVID-19; Female; Gender Identity; Humans; Male; Pandemics; SARS-CoV-2; Sexual Behavior; Sexual and Gender Minorities; United Kingdom
PubMed: 34330861
DOI: 10.1136/bmjopen-2021-050092 -
International Journal of Environmental... Sep 2020Extensive research documents the health inequalities LGBTI people experience, however far less is known for people with intersex variation. This paper presents a review...
Extensive research documents the health inequalities LGBTI people experience, however far less is known for people with intersex variation. This paper presents a review of intersex health and healthcare inequalities by evaluating research published from 2012 to 2019. In total 9181 citations were identified with 74 records screened of which 16 were included. A synthesis of results spans nine quantitative, five qualitative and two narrative reviews. Literature was searched in Medline, Web of Science, Cochrane, PsychINFO and CINAHL. People with intersex variance experience a higher incidence of anxiety, depression and psychological distress compared to the general population linked to stigma and discrimination. Progressive healthcare treatment, including support to question normative binaries of sex and gender, aids understand of somatic intersex variance and non-binary gender identity, especially when invasive treatment options are avoided or delayed until individuals are able to self-identify or provide consent to treatment. Findings support rethinking sex and gender to reflect greater diversity within a more nuanced sex-gender spectrum, although gaps in research remain around the general health profile and the healthcare experiences of people with intersex variance. More large-scale research is needed, co-produced with peers who have lived experience of intersex variation to ensure policy, education and healthcare advances with greater inclusivity and ethical accountability.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Australia; Child; Cross-Sectional Studies; Female; Gender Identity; Health; Healthcare Disparities; Humans; Male; Middle Aged; Quality of Life; Sexual and Gender Minorities; Young Adult
PubMed: 32911732
DOI: 10.3390/ijerph17186533 -
Archives of Pathology & Laboratory... Jan 2022Transgender women experience health disparities in all areas of medicine. Within surgical pathology, knowledge gaps relating to the concepts of transgender care exist....
CONTEXT.—
Transgender women experience health disparities in all areas of medicine. Within surgical pathology, knowledge gaps relating to the concepts of transgender care exist. Medical transition for transgender women and transfeminine persons may involve hormone therapy and/or surgery to feminize the body. Understanding the common histologic changes in specimens from feminizing surgeries, as well as other specimens from patients on feminizing hormone therapy, will aid surgical pathologists in providing better care to this unique patient population.
OBJECTIVE.—
To summarize histologic findings in surgical pathology specimens from transgender women taking feminizing hormones.
DATA SOURCES.—
A systematic review of the OVID Medline and PubMed databases was performed to identify all studies describing histologic findings in surgical pathology specimens from transgender women from 1946 to 2019.
CONCLUSIONS.—
Much of the literature to date describing histologic findings in transgender women comes from the examination of genitourinary specimens removed during feminizing surgeries. Common benign changes associated with feminizing hormone therapy include the development of acini and lobules in the breast, testicular tubular changes, and squamous metaplasia of the prostate and urethra. Neoplastic cases include breast adenocarcinoma and fibroepithelial lesions, testicular germ cell tumors, prostatic adenocarcinoma, anal squamous cell carcinoma, pituitary adenomas, and meningiomas. Additional studies assessing the findings in other organ systems as well as population-based studies assessing rates of neoplasia are needed. However, future research relies on engagement within the surgical pathology community as well as collaboration with clinicians and patients to achieve optimal results.
Topics: Breast; Female; Hormones; Humans; Male; Pathology, Surgical; Transgender Persons; Transsexualism
PubMed: 33983412
DOI: 10.5858/arpa.2020-0704-RA -
Health & Social Care in the Community Sep 2019Although men have a lower life expectancy than women, and are more susceptible to illness, they have been found to be less likely to engage in health-seeking behaviour....
Although men have a lower life expectancy than women, and are more susceptible to illness, they have been found to be less likely to engage in health-seeking behaviour. Men's Sheds, as a gendered intervention, has been identified as an effective way to engage men in meaningful activity and gain social support from others. However, links between sheds and health and well-being are not well-documented, and evidence is lacking of the potential causal pathways to health generation. This study aims to develop a plausible empirically based causal theory of how Men's Sheds influence the health and well-being of their participants and to set out future research directions to test this theory. Drawing on a scoping review of academic, peer-reviewed journal articles published between 1990 and 2018, potential causal linkages between shed activity and health and well-being outcomes are synthesised into a logic model framework. Sixteen relevant peer-reviewed journal were identified from the academic literature. The data from the articles are predominantly self-reported, and characterised by small sample sizes and/ or low response rates. Further, information is lacking on the demographics of Men's Shed participants and the contexts in which they exist. Most notably, while there is some evidence on the potential mental health and social well-being impacts of shed activities, physical health is less documented. The study shows that there is a lack of reliable and systematic evidence of the potential causal pathways between Men's Shed activities and health and well-being outcomes. In order to address research gaps, further research is required to test and develop the proposed theory and logic model.
Topics: Gender Identity; Health Behavior; Health Promotion; Health Status; Humans; Male; Men's Health; Mental Health; Patient Acceptance of Health Care; Social Support; Socioeconomic Factors
PubMed: 31206945
DOI: 10.1111/hsc.12765 -
Psychoneuroendocrinology Sep 2020Previous studies have examined whether steroid hormone treatment in transgender individuals may affect cognitive function; yet, their limited power does not allow firm... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Previous studies have examined whether steroid hormone treatment in transgender individuals may affect cognitive function; yet, their limited power does not allow firm conclusions to be drawn. We leveraged data from to-date literature aiming to explore the effect of gender-affirming hormone administration on cognitive function in transgender individuals.
METHODS
A search strategy of MEDLINE was developed (through June 1, 2019) using the key terms transgender, hormone therapy and cognitive function. Eligible were (i) cohort studies examining the longitudinal effect of hormone therapy on cognition, and (ii) cross-sectional studies comparing the cognitive function between treated and non-treated individuals. Standardized mean differences (Hedges' g) were pooled using random-effects models. Study quality was evaluated using the Newcastle-Ottawa Scale.
OUTCOMES
Ten studies (seven cohort and three cross-sectional) were eligible representing 234 birth-assigned males (aM) and 150 birth-assigned females (aF). The synthesis of cohort studies (n = 5) for visuospatial ability following hormone treatment showed a statistically significant enhancement among aF (g = 0.55, 95% confidence intervals [CI]: 0.29, 0.82) and an improvement with a trend towards statistical significance among aM (g = 0.28, 95%CI: -0.01, 0.58). By contrast, no adverse effects of hormone administration were shown. No heterogeneity was evident in most meta-analyses.
INTERPRETATION
Current evidence does not support an adverse impact of hormone therapy on cognitive function, whereas a statistically significant enhancing effect on visuospatial ability was shown in aF. New longitudinal studies with longer follow-up should explore the long-term effects of hormone therapy, especially the effects on younger individuals, where there is greater scarcity of data.
Topics: Cognition; Cohort Studies; Cross-Sectional Studies; Female; Gender Dysphoria; Hormone Replacement Therapy; Humans; Male; Sex Reassignment Procedures; Spatial Behavior; Transgender Persons; Transsexualism; Young Adult
PubMed: 32512250
DOI: 10.1016/j.psyneuen.2020.104721 -
The Oncologist Mar 2022Gynecologic cancers standard treatment often requires the removal of some reproductive organs, making fertility preservation a complex challenge. Despite heightened...
BACKGROUND
Gynecologic cancers standard treatment often requires the removal of some reproductive organs, making fertility preservation a complex challenge. Despite heightened oncofertility awareness, knowledge about fertility attitudes and decisions of young patients with gynecologic cancer is scarce. The aim of this systematic review was to highlight what is currently known about knowledge, attitudes, and decisions about fertility, fertility preservation, and parenthood among these patients.
METHODS
Peer-reviewed journals published in English were searched in PubMed, Web of Science and EMBASE from January 1, 2000 to July 1, 2020. Childbearing, fertility, fertility preservation, pregnancy, and parenthood attitudes/decisions after gynecologic cancer from women's perspective were evaluated.
RESULTS
A total of 13 studies comprised the review. Most of the women valued fertility preservation procedures that could be regarded as a means to restore fertility. A unique feature identified was that fertility preservation was seen also as a way to restore gender identity perceived to be lost or threatened during diagnosis and treatment. Fertility counseling was suboptimal, with wide variability among studies reviewed. Comparisons between gynecologic cancers and other cancer types about fertility counseling rates were inconclusive. The potential negative impact of impaired fertility on patients' mental health and quality of life was also documented.
CONCLUSIONS
Fertility and parenthood were important matters in patients' lives, with the majority of patients expressing positive attitudes toward future childbearing. Results confirm that the inclusion of patients with gynecologic cancer in research studies focusing on this topic still remains low. Additionally, the provision of fertility counseling and referral by health professionals is still suboptimal.
Topics: Female; Fertility; Fertility Preservation; Gender Identity; Genital Neoplasms, Female; Humans; Male; Pregnancy; Quality of Life
PubMed: 35274725
DOI: 10.1093/oncolo/oyab051 -
International Journal For Equity in... Oct 2020Gender as a social construct contributes to determine who migrates and which migration-related risks and opportunities emerge in all phases of the migration trajectory....
BACKGROUND
Gender as a social construct contributes to determine who migrates and which migration-related risks and opportunities emerge in all phases of the migration trajectory. Simultaneously, migration influences the individual as well as societal definition and perception of gender roles. An explicit gender perspective in migration-related epidemiological research can contribute to adequately analyse and interpret the health of migrants. This systematic review gives a comprehensive overview on how gender has been conceptualised, operationalised and measured in social epidemiologic studies aiming to assess the influence of gender on health among migrants.
METHODS
We searched PubMed, Embase, CINAHL, the Cochrane Library, EconLit and PsycINFO and conducted backward reference searching. Reviewers independently selected studies, extracted data and conducted the quality assessment. Eligible studies actively aimed to understand, identify or explain the influence of gender on migrants' health, whereby the role of gender can encompass a variety of mechanisms, processes or states of differentiation, discrimination and/or inequality.
RESULTS
Almost all of the 43 studies were cross-sectional and focussed on health outcomes in the post-migration phase. The most common theme of research was the health of male migrants in the US, and in particular of men who have sex with men (MSM). All studies treated gender as a binary variable (men vs. women), without discussing additional types of gender identities. A minority of studies differentiated clearly between sex and gender. Gender was mostly operationalised through attitudes toward gender roles and gender-based discrimination, experienced at the individual level. Community and societal level gender measures capturing structural gender determinants were underrepresented.
CONCLUSIONS
The intersections of migration and gender suggested synergistic effects on health that only become visible when considering those two social determinants together. Future research needs to embrace a multilevel and non-binary understanding of gender and reflect on the influence of gender in the different phases of the migration journey.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42019124698 .
Topics: Cross-Sectional Studies; Epidemiology; Female; Gender Identity; Health Status; Humans; Male; Transients and Migrants
PubMed: 33054755
DOI: 10.1186/s12939-020-01289-y -
PloS One 2020To explore the scope, range, and nature of the existing literature on Mexican women who remain behind in their communities of origin while their partners migrate abroad.
OBJECTIVE
To explore the scope, range, and nature of the existing literature on Mexican women who remain behind in their communities of origin while their partners migrate abroad.
DESIGN
A scoping review informed by an intersectionality framework was conducted over four months, January-April 2020.
DATA SOURCES
The electronic databases Medline, PsyINFO, Global Health, CINAHL, Gender Studies Database, Dissertations & Theses Global, LILACS, IBECS, and Sociological Abstracts were searched.
REVIEW METHODS
Articles were included if they focused on Mexican women who remain behind across transnational spaces. Two independent reviewers screened and selected articles. Data were analyzed and synthesized using descriptive statistics for quantitative data and content analysis for qualitative data.
RESULTS
A total of 19 articles were included for analysis; within those, the methods used included quantitative (n = 5), qualitative (n = 11), mixed methods (n = 2), and intervention (n = 1). Most studies lacked a theoretical framework (n = 10); the majority were empirical published studies (n = 11), and most used interviews (n = 12) and surveys (n = 6) to collect data. All of the articles studied cis-heterosexual Mexican women. Major areas identified were 1) research context, 2) gender roles, and 3) women's health.
CONCLUSION
Implications for practice and future research are discussed.
Topics: Culture; Family; Female; Gender Identity; Humans; Loneliness; Mental Health; Mexico; Socioeconomic Factors; Spouses; Transients and Migrants; Women; Women's Health
PubMed: 32925976
DOI: 10.1371/journal.pone.0238525 -
Health and Quality of Life Outcomes Aug 2020Several reports have demonstrated varying results on the quality of life (QoL) of the transgender population. Therefore, the aim of this study was to conduct a... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Several reports have demonstrated varying results on the quality of life (QoL) of the transgender population. Therefore, the aim of this study was to conduct a systematic review and meta-analysis about the quality of life (QoL) of individuals during the post transsexual surgery period.
METHODS
We searched major biomedical electronic databases, including Scopus, Google Scholar, Psychological Information Database (PsycInfo), Web of Science, PubMed, Excerpta Medica dataBASE (EMBASE), and ProQuest, for all relevant literature published in English up to December 2019. The included papers required to be cross sectional studies that reported quality of life in people with transsexuality post surgery. After selecting eligible studies, 2 authors extracted data of each study independently and resolved any inconsistency by consensus with the third reviewer. The risk of bias was assessed by 2 independent research experts by the Newcastle-Ottawa Scale (NOS).
RESULTS
In this study, out of 497 articles extracted from the initial investigation, 8 articles with 1099 patients were ultimately selected for meta-analysis. The pooled mean of quality of life in transsexual individuals was obtained to be 70.45 (95%CI 55.87-85.03) and 59.17 (95%CI 48.59-69.74), based on World Health Organization Quality of Life (WHOQoL-BREF) and The 36-item short form of the Medical Outcomes Study questionnaire (SF36), respectively. Also, the results of the subgroup analysis for the weighted mean quality of life in male to female and female to male showed that the mean quality of life in female to male was 57.54 (95%CI 42.24-72.84) and it was 62.47 (95%CI 45.94-79.00) in male to female, based on SF36 questionnaire. Moreover, the weighted mean quality of life in female to male was 69.99 (95%CI 43.76, 96.23) and it was 70.65 (95%CI 53.11, 88.19) in male to female, based on WHOQoL-BREF questionnaire.
CONCLUSION
The results of this systematic review may support the approaches to transsexuality that facilitates sex reassignment. In this review, the means of quality of life after surgery were not compared to the means of quality of life before surgery or even before hormonal therapy which was due to inadequate number of primary studies.
Topics: Cross-Sectional Studies; Female; Humans; Male; Quality of Life; Sex Reassignment Procedures; Surveys and Questionnaires; Transsexualism
PubMed: 32746856
DOI: 10.1186/s12955-020-01510-0