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Preventive Medicine Nov 2021Cyberbullying is associated with increased risk of suicidal and self-harm behaviors in children and adolescents. However, no review to date has explored factors that...
Cyberbullying is associated with increased risk of suicidal and self-harm behaviors in children and adolescents. However, no review to date has explored factors that exacerbate and mitigate this relationship. This systematic review concerns research on factors that influence the impact of cyberbullying on suicidal and self-harm behaviors. Four bibliographic databases were explored and references in included articles were searched. We identified 727 articles and retained 66 that met inclusion criteria. Research has identified multiple risk factors which have been associated with increased suicide risk in general (mental health problems, substance abuse, loneliness, stress, sexual orientation/gender identity issues and violent behaviors). Others risk factors more specific to cyberbullying were: Autism Spectrum Disorder, Intellectual and Developmental Disorders, obesity, having asthma and severity of cyberbullying. Fewer studies concern protective factors. School connectedness, restrictive style of parenting, parental support, life satisfaction, having a healthy diet, personal skills and having family dinners were associated with less risk of suicidal and self-harm behaviors following cyberbullying. These protective factors suggest prevention strategies to reduce the impacts of cyberbullying by teaching better personal skills, promoting school social connections and proposing family interventions. More research is needed including exploration of the differential impacts of different forms of cyberbullying, and evaluations of the impacts of programs to increase personal skills, improve family relationships and foster school connectedness to reducing suicidal and self-harm behaviors in this vulnerable population.
Topics: Adolescent; Autism Spectrum Disorder; Child; Cyberbullying; Female; Gender Identity; Humans; Male; Parenting; Protective Factors; Risk Factors; Self-Injurious Behavior; Suicidal Ideation
PubMed: 34538376
DOI: 10.1016/j.ypmed.2021.106684 -
Sexual and Reproductive Health Matters 2021Self-administration of quality gender-affirming hormones is one approach to expanding access to hormone therapy for individuals seeking secondary sex characteristics... (Review)
Review
Self-administration of quality gender-affirming hormones is one approach to expanding access to hormone therapy for individuals seeking secondary sex characteristics more aligned with their gender identity or expression and can be empowering when provided within safe, supportive health systems. To inform World Health Organization guidelines on self-care interventions, we systematically reviewed the evidence for self-administration compared to health worker-administration of gender-affirming hormones. We conducted a comprehensive search for peer-reviewed articles and conference abstracts that addressed effectiveness, values and preferences, and cost considerations. Data were extracted in duplicate using standardised forms. Of 3792 unique references, five values and preferences articles were included; no studies met the criteria for the effectiveness or cost reviews. All values and preferences studies focused on self-administration of unprescribed hormones, not prescribed hormones within a supportive health system. Four studies from the U.S. ( = 2), Brazil ( = 1), and the U.K. ( = 1) found that individuals seeking gender-affirming hormone therapy may self-manage due to challenges finding knowledgeable and non-stigmatising health workers, lack of access to appropriate services, exclusion, and discomfort with health workers, cost, and desire for a faster transition. One study from Thailand found health worker perspectives were shaped by restrictive legislation, few transgender-specific services or guidelines, inappropriate communication with health workers, and medical knowledge gaps. There is limited literature on self-administration of gender-affirming hormone therapy. Principles of gender equality and human rights in the delivery of quality gender-affirming hormones are critical to expand access to this important intervention and reduce discrimination based on gender identity.
Topics: Cost-Benefit Analysis; Female; Gender Identity; Hormones; Humans; Male; Transgender Persons; Transsexualism
PubMed: 35312467
DOI: 10.1080/26410397.2022.2045066 -
Social Work in Health Care 2023Individuals within the Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ) community who are diagnosed with cancer experience inequitable treatment in healthcare... (Review)
Review
Individuals within the Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ) community who are diagnosed with cancer experience inequitable treatment in healthcare systems worldwide, resulting in dissatisfaction, communication challenges with healthcare providers, and a deep sense of disappointment. Stigma, discrimination, and perceived homophobia further heighten the risk of psychological and attitudinal disorders, including depression and suicidal tendencies, among LGBTQ cancer patients. To comprehensively assess the discrimination faced by LGBTQ cancer patients and gain deeper insights into their needs and experiences, we conducted a systematic review following PRISMA guidelines. We searched for relevant articles using specific keywords in reputable databases such as PubMed, Google Scholar, and PsycINFO. We rigorously evaluated article quality using the CASP (Critical Appraisal Skills Programme) checklist. From a total of 75 eligible studies, we carefully selected 14 studies, specifically examining LGBTQ cancer patients who were currently undergoing or had previously undergone cancer treatment. The studies revealed various factors, including unmet needs related to anxiety and depression, instances of discrimination, disparities in care, and inadequate support systems. A majority of patients expressed dissatisfaction with their cancer care and continued to encounter discrimination and disparities throughout their treatment journeys. Consequently, this led to heightened levels of anxiety, stress, depression, and negative perceptions of healthcare providers. Based on these findings, we recommend providing specialized training to social workers and healthcare providers. This training will equip them with the necessary skills and knowledge to deliver culturally sensitive care tailored to the unique needs of LGBTQ cancer patients. By addressing discrimination, reducing disparities, and fostering an inclusive environment, healthcare professionals can strive to ensure that LGBTQ cancer patients receive the care they deserve.
Topics: Female; Humans; Transgender Persons; Sexual and Gender Minorities; Sexual Behavior; Gender Identity; Social Stigma; Neoplasms
PubMed: 37338823
DOI: 10.1080/00981389.2023.2226182 -
Journal of Advanced Nursing Apr 2024To inform efforts to integrate gender and race into moral distress research, the review investigates if and how gender and racial analyses have been incorporated in such... (Meta-Analysis)
Meta-Analysis Review
AIM
To inform efforts to integrate gender and race into moral distress research, the review investigates if and how gender and racial analyses have been incorporated in such research.
DESIGN
Scoping review.
METHODS
The PRISMA (Preferred Reporting Items for Systematic and Meta-Analysis) Extension for Scoping Reviews was adopted.
DATA SOURCES
Systematic literature search was conducted through PubMed, CINAHL and Web of Science databases. Boolean operators were used to identify moral distress literature which included gender and/or race data and published between 2012 and 2022.
RESULTS
After screening and full-text review, 73 articles reporting on original moral distress research were included. Analysis was conducted on how gender and race were incorporated in research and interpretation of moral distress experiences among healthcare professionals.
IMPACT
This study found that while there is an upward trend in including gender and race-disaggregated data in moral distress research, over half of such research did not conduct in-depth analysis of such data. Others only highlighted differential experiences such as moral distress levels of women vis-à-vis men. Only about 20% of publications interrogated how experiences of moral distress differed and/or explored factors behind their findings.
CONCLUSION
There is a need to not only collect disaggregated data in moral distress research but also engage this data through gender and race-based analysis. Particularly, we highlight the need for intersectional analysis, which can elucidate how social identities and categories (such as gender and race) and structural inequalities (such as those sustained by sexism and racism) interact to influence moral experiences.
IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE
Moral distress as experienced by healthcare professionals is increasingly recognized as an important area of research with significant policy implications in the healthcare sector. This study offers insights for nuanced and targeted policy approaches.
PATIENT OR PUBLIC CONTRIBUTION
No patient or public contribution.
Topics: Male; Humans; Female; Gender Identity; Health Personnel; Morals; Stress, Psychological
PubMed: 37849045
DOI: 10.1111/jan.15901 -
JAMA Network Open Sep 2021Women represent two-thirds of patients with Alzheimer disease (AD), and sex differences might affect results of randomized clinical trials (RCTs). However, little... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Women represent two-thirds of patients with Alzheimer disease (AD), and sex differences might affect results of randomized clinical trials (RCTs). However, little information exists on differences in sex as reported in RCTs for AD.
OBJECTIVE
To assess the ratio of females to males and the reporting of sex-stratified data in large pharmaceutical RCTs for AD.
DATA SOURCES
A search for pharmaceutical RCTs for AD was conducted on September 4, 2019, using ClinicalTrials.gov with the key word Alzheimer disease, and articles related to those trials were identified using the PubMed, Scopus, and Google Scholar databases. Searches were conducted between September 4 and October 31, 2019, and between April 15 and May 31, 2020.
STUDY SELECTION
Controlled RCTs that had more than 100 participants and tested the efficacy of drugs or herbal extracts were included. Of 1047 RCTs identified, 409 were published and therefore screened. A total of 77 articles were included in the final analysis, including 56 primary articles on AD, 13 secondary articles on AD, and 8 articles on mild cognitive impairment.
DATA EXTRACTION AND SYNTHESIS
The location and date of publication; number, sex, and age of patients enrolled; disease severity; experimental or approved status of the drug; and whether the study included a sex-stratified analysis in the protocol, methods, or results were extracted by 1 reviewer for each article, and the meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Data were analyzed using a mixed-effects model.
MAIN OUTCOMES AND MEASURES
The mean proportion of women enrolled in the trials and the associations between prespecified variables were analyzed. The proportion of articles that included sex-stratified results and the temporal trends in the reporting of these results were also studied.
RESULTS
In this review of 56 RCTs for AD involving 39 575 participants, 23 348 women (59.0%) were included. The mean (SD) proportion of women in RCTs of approved drugs was 67.3% (6.9%), and in RCTs of experimental drugs was 57.9% (5.9%). The proportion of women in RCTs of experimental drugs was significantly lower than the proportion of women in the general population with AD in the US (62.1%; difference, -4.56% [95% CI, -6.29% to -2.87%]; P < .001) and Europe (68.2%; difference, -10.67% [95% CI, -12.39% to -8.97%]; P < .001). Trials of approved drugs had a higher probability of including women than trials of experimental drugs (odds ratio [OR], 1.26; 95% CI, 1.05-1.52; P = .02). Both the severity of AD at baseline and the trial location were associated with the probability of women being enrolled in trials (severity: OR, 0.98; 95% CI, 0.97-1.00; P = .02; location in Europe: OR, 1.26; 95% CI, 1.05-1.52; P = .01; location in North America: OR, 0.81; 95% CI, 0.71-0.93; P = .002). Only 7 articles (12.5%) reported sex-stratified results, with an increasing temporal trend (R, 0.30; 95% CI, 0.05-0.59; P = .03).
CONCLUSIONS AND RELEVANCE
In this systematic review and meta-analysis, the proportion of women in RCTs for AD, although higher than the proportion of men, was significantly lower than that in the general population. Only a small proportion of trials reported sex-stratified results. These findings support strategies to improve diversity in enrollment and data reporting in RCTs for AD.
Topics: Alzheimer Disease; Europe; Female; Gender Identity; Humans; Male; Patient Selection; Randomized Controlled Trials as Topic; Severity of Illness Index; United States
PubMed: 34515784
DOI: 10.1001/jamanetworkopen.2021.24124 -
The Journal of Sexual Medicine Apr 2016A systematic review and meta-analysis was conducted to evaluate how various definitions of transgender affect prevalence estimates. (Review)
Review
INTRODUCTION
A systematic review and meta-analysis was conducted to evaluate how various definitions of transgender affect prevalence estimates.
AIMS
To evaluate the epidemiology of transgender and examine how various definitions of transgender affect prevalence estimates and to compare findings across studies that used different methodologies, in different countries, and over different periods.
METHODS
PubMed, EMBASE, and Medline were searched to identify studies reporting prevalence estimates of transgender in a population. All studies were grouped based on the case definition applied to the numerator. Summary estimates were derived using a random-effects model for total prevalence of transgender and for male-to-female and female-to-male subgroups. Overall and stratum-specific meta-prevalence estimates (mPs) and 95% confidence intervals (CIs) were accompanied by tests for heterogeneity and meta-regressions to assess sources of heterogeneity.
MAIN OUTCOME MEASURES
The main outcome measure was population prevalence of transgender. Secondary outcomes included gender-specific prevalence estimates for male-to-female and female to male subgroups.
RESULTS
Thirty-two studies met the inclusion criteria for systematic review. Of those, 27 studies provided necessary data for a meta-analysis. Overall mP estimates per 100,000 population were 9.2 (95% CI = 4.9-13.6) for surgical or hormonal gender affirmation therapy and 6.8 (95% CI = 4.6-9.1) for transgender-related diagnoses. Of studies assessing self-reported transgender identity, the mP was 871 (95% CI = 519-1,224); however, this result was influenced by a single outlier study. After removal of that study, the mP changed to 355 (95% CI = 144-566). Significant heterogeneity was observed in most analyses.
CONCLUSION
The empirical literature on the prevalence of transgender highlights the importance of adhering to specific case definitions because the results can range by orders of magnitude. Standardized and routine collection of data on transgender status and gender identity is recommended.
Topics: Adult; Concept Formation; Female; Humans; Male; Outcome Assessment, Health Care; Prevalence; Terminology as Topic; Transgender Persons; Transsexualism
PubMed: 27045261
DOI: 10.1016/j.jsxm.2016.02.001 -
Journal of Sex Research 2013This article reviews research on psychosocial and health outcomes associated with peer victimization related to adolescent sexual orientation and gender identity or... (Review)
Review
This article reviews research on psychosocial and health outcomes associated with peer victimization related to adolescent sexual orientation and gender identity or expression. Using four electronic databases and supplementary methods, we identified 39 relevant studies. These studies were published between 1995 and 2012 and conducted in 12 different countries. The studies were diverse in terms of their approaches to sampling participants, assessing participants' sexual orientation, operationalizing peer victimization, and with regard to the psychosocial and health outcomes studied in relation to peer victimization. Despite the methodological diversity across studies, there is fairly strong evidence that peer victimization related to sexual orientation and gender identity or expression is associated with a diminished sense of school belonging and higher levels of depressive symptoms; findings regarding the relationship between peer victimization and suicidality have been more mixed. Peer victimization related to sexual orientation and gender identity or expression is also associated with disruptions in educational trajectories, traumatic stress, and alcohol and substance use. Recommendations for future research and interventions are discussed.
Topics: Adolescent; Adolescent Development; Bullying; Crime Victims; Gender Identity; Humans; Peer Group; Sexual Behavior
PubMed: 23480074
DOI: 10.1080/00224499.2012.750639 -
Archives of Sexual Behavior May 2023Adolescents are particularly vulnerable to poor sexual health outcomes such as sexually transmitted diseases, sexually transmitted infections, human immunodeficiency... (Review)
Review
Adolescents are particularly vulnerable to poor sexual health outcomes such as sexually transmitted diseases, sexually transmitted infections, human immunodeficiency virus, and unintended pregnancy. While school-based sexual health education (SBSHE) can address adolescents' needs, they are often insufficient. Hence, their perception of SBSHE should be explored to improve current education. This review aims to consolidate the available evidence on perceptions, experiences, and needs of adolescents about SBSHE. Six electronic databases were searched from their inception date till June 2022. The included studies were assessed using the method of the Critical Appraisal Skills Program tool, and findings were meta-synthesized using Sandelowski and Barroso (2007). This review was registered via the International Prospective Register of Systematic Reviews. Overall, 51 studies were included, and three themes were identified: (1) teachings of SBSHE and its impact, (2) adolescents' preferred approach to SBSHE, and (3) importance of engaging and safe SBSHE. In conclusion, adolescents had mixed reactions toward SBSHE. They expressed the need for inclusivity (gender identity and racial, ethnic, and cultural groups). Having a "safe space," well-trained educators, and interactive approaches were important and hence should also be considered. More qualitative studies from different geographical regions are needed. Diverse topics (e.g., mutual consent, sexual abuse, and violence) should also be discussed. The use of multiple educators (e.g., schoolteachers, specialist teachers, and peers) should also be deliberated in future SBSHE research. Findings from this review should be triangulated by evaluating the perceptions of various stakeholders (e.g., educators, adolescents, and SBSHE administrators).
Topics: Pregnancy; Humans; Male; Female; Adolescent; Gender Identity; Sex Education; Sexually Transmitted Diseases; Sexual Behavior
PubMed: 36581711
DOI: 10.1007/s10508-022-02504-3 -
Current HIV/AIDS Reports Aug 2023Sexual and gender minority (SGM) individuals are diagnosed with HIV at disproportionate rates, and hazardous alcohol use can increase their HIV risk. This review... (Review)
Review
PURPOSE OF REVIEW
Sexual and gender minority (SGM) individuals are diagnosed with HIV at disproportionate rates, and hazardous alcohol use can increase their HIV risk. This review assessed the state of the literature examining interventions for addressing alcohol use and sexual HIV risk behaviors among SGM individuals.
RECENT FINDINGS
Fourteen manuscripts from 2012 to 2022 tested interventions that address both alcohol use and HIV risk behaviors among SGM populations, with only 7 randomized controlled trials (RCTs). Virtually all the interventions targeted men who have sex with men, with none focused on transgender populations or cisgender women. While they demonstrated some evidence of effectiveness in reducing alcohol use and/or sexual risk, the outcomes varied widely between studies. More research is needed that tests interventions in this area, particularly for transgender individuals. The use of larger-scale RCTs with diverse populations and standardized outcome measures are needed to strengthen the evidence base.
Topics: Male; Female; Humans; HIV Infections; Sexual and Gender Minorities; Sexual Behavior; Alcohol Drinking; Transgender Persons; Gender Identity
PubMed: 37225923
DOI: 10.1007/s11904-023-00660-2 -
European Journal of Pain (London,... Oct 2012Gender role refers to the culturally and socially constructed meanings that describe how women and men should behave in certain situations according to feminine and... (Meta-Analysis)
Meta-Analysis Review
Gender role refers to the culturally and socially constructed meanings that describe how women and men should behave in certain situations according to feminine and masculine roles learned throughout life. The aim of this meta-analysis was to evaluate the relationship between gender role and experimental pain responses in healthy human participants. We searched computerized databases for studies published between January 1950 and May 2011 that had measured gender role in healthy human adults and pain response to noxious stimuli. Studies were entered into a meta-analysis if they calculated a correlation coefficient (r) for gender role and experimental pain. Searches yielded 4465 'hits' and 13 studies were eligible for review. Sample sizes were 67-235 participants and the proportion of female participants was 45-67%. Eight types of gender role instrument were used. Meta-analysis of six studies (406 men and 539 women) found a significant positive correlation between masculine and feminine personality traits and pain threshold and tolerance, with a small effect size (r = 0.17, p = 0.01). Meta-analysis of four studies (263 men and 297 women) found a significant negative correlation between gender stereotypes specific to pain and pain threshold and tolerance, with a moderate effect size (r = -0.41, p < 0.001). In conclusion, individuals who considered themselves more masculine and less sensitive to pain than the typical man showed higher pain thresholds and tolerances. Gender stereotypes specific to pain scales showed stronger associations with sex differences in pain sensitivity response than masculine and feminine personality trait scales.
Topics: Adolescent; Adult; Culture; Female; Femininity; Gender Identity; Humans; Male; Masculinity; Pain; Pain Measurement; Pain Threshold; Personality; Sex Factors; Stereotyping
PubMed: 22434689
DOI: 10.1002/j.1532-2149.2012.00121.x