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PLoS Medicine Jun 2024While there is widespread consensus that sex- and gender-related factors are important for how interventions are designed, implemented, and evaluated, it is not...
BACKGROUND
While there is widespread consensus that sex- and gender-related factors are important for how interventions are designed, implemented, and evaluated, it is not currently known how alcohol treatment research accounts for sex characteristics and/or gender identities and modalities. This methodological systematic review documents and assesses how sex characteristics, gender identities, and gender modalities are operationalized in alcohol treatment intervention research involving youth.
METHODS AND FINDINGS
We searched MEDLINE, Embase, Cochrane Central Registry of Controlled Trials, PsycINFO, CINAHL, LGBT Life, Google Scholar, Web of Science, and grey literature from 2008 to 2023. We included articles that reported genders and/or sexes of participants 30 years of age and under and screened participants using AUDIT, AUDIT-C, or a structured interview using DSM-IV criteria. We limited the inclusion to studies that enrolled participants in alcohol treatment interventions and used a quantitative study design. We provide a narrative overview of the findings. Of 8,019 studies screened for inclusion, 86 articles were included in the review. None of the studies defined, measured, and reported both sex and gender variables accurately. Only 2 studies reported including trans participants. Most of the studies used gender or sex measures as a covariate to control for the effects of sex or gender on the intervention but did not discuss the rationale for or implications of this procedure.
CONCLUSIONS
Our findings identify that the majority of alcohol treatment intervention research with youth conflate sex and gender factors, including terminologically, conceptually, and methodologically. Based on these findings, we recommend future research in this area define and account for a spectrum of gender modalities, identities, and/or sex characteristics throughout the research life cycle, including during study design, data collection, data analysis, and reporting. It is also imperative that sex and gender variables are used expansively to ensure that intersex and trans youth are meaningfully integrated.
TRIAL REGISTRATION
Registration: PROSPERO, registration number: CRD42019119408.
Topics: Humans; Adolescent; Male; Female; Sex Factors; Young Adult; Sexual and Gender Minorities; Alcoholism; Alcohol Drinking; Gender Identity; Adult
PubMed: 38829916
DOI: 10.1371/journal.pmed.1004413 -
Journal of Affective Disorders Jun 2024Many studies have analyzed the association between family cohesion and depression, but there are different views and the results are inconsistent. It is necessary to use... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Many studies have analyzed the association between family cohesion and depression, but there are different views and the results are inconsistent. It is necessary to use meta-analysis to explore the association between family cohesion and depression and its influencing factors.
METHODS
Chinese database (China National Knowledge Infrastructure) and English databases (ERIC, MEDLINE, Web of Science Core Collection, Elsevier SD, PsycINFO, PsycArticles, and ProQuest dissertations and theses) were searched for articles published by November 2023. Measurements of family cohesion and depression, study design, age, gender, cultural background, and sampling year were analyzed as moderators. Meta-analysis was performed using the random effects model in CMA3.0 software.
RESULTS
A total of 71 studies (90,023 participants) were included in this study. The meta-analysis revealed a significant negative correlation between family cohesion and depression (r = -0.31, 95 % CI [-0.35, -0.27]). The association was moderated by measurements of family cohesion and depression, design type, and cultural background, but not by age, gender, or sampling year.
LIMITATIONS
The sample size included in this study is relatively small in European and African cultures, making it challenging to analyze cultural differences in the study results at present comprehensively.
CONCLUSIONS
The findings contribute to the ongoing debate between Social Support Theory and The Circumplex Model, showing that individuals with lower family cohesion tend to experience higher levels of depression.
Topics: Humans; Depression; Gender Identity; Family Relations; Social Support; Culture
PubMed: 38554880
DOI: 10.1016/j.jad.2024.03.138 -
PloS One 2024Transgender and gender diverse (trans) health research has grown rapidly, highlighting the need to characterize the scientific evidence base. We conducted a systematic...
BACKGROUND AND OBJECTIVES
Transgender and gender diverse (trans) health research has grown rapidly, highlighting the need to characterize the scientific evidence base. We conducted a systematic review of peer-reviewed research on disease burden and correlates in trans adolescents and adults over a 20-month period to identify knowledge gaps and assess methodological characteristics including measurement of gender identity, community engagement, and study quality.
DATA SOURCES, ELIGIBILITY CRITERIA, AND SYNTHESIS METHODS
We searched seven databases using terms related to (a) transgender populations and (b) health or disease. Eligible studies were in English, French, or Spanish and reported original quantitative data on mental health or substance use conditions, infectious diseases, or non-communicable conditions in at least 25 trans individuals aged 15+. Quality assessment was performed in duplicate on a 10% sample of articles and findings were summarized using narrative synthesis.
RESULTS
The 328 included studies were conducted in 45 countries, with most from North America (54%) and limited research from South Asia (3%), Sub-Saharan Africa (3%), and the Middle East and North Africa (2%). Most studies used cross-sectional designs (73%) and convenience sampling (65%). Only 30% of studies reported any form of community engagement. Mental health and substance use disorders were the most studied area (77% of studies) and non-communicable conditions the least (16%). Available data indicated that trans populations experience high disease burden with considerable heterogeneity within and across settings. Of 39 articles assessed for quality, 80% were rated as fair, 18% as poor, and 3% as good quality.
CONCLUSIONS AND IMPLICATIONS
Geographic, gender-specific, and topical gaps remain in trans health, but we found more research from African countries, with transmasculine people, and on non-communicable conditions than previous syntheses. Areas for growth in trans health research include community engagement, non-binary health, chronic and age-related conditions, and health determinants.
REGISTRATION
PROSPERO CRD42021234043.
Topics: Adult; Adolescent; Humans; Male; Female; Transgender Persons; Cross-Sectional Studies; Gender Identity; Health Status; Cost of Illness; Africa South of the Sahara
PubMed: 38466747
DOI: 10.1371/journal.pone.0299373 -
PloS One 2024Transgender individuals face stigma, discrimination, and other barriers impacting their ability to engage in physical activity (PA). We aim to review current literature...
Transgender individuals face stigma, discrimination, and other barriers impacting their ability to engage in physical activity (PA). We aim to review current literature on PA among transgender individuals. A systemic literature search of research studies from 2010-2023 was conducted. Studies must have reported a measure of PA and gender, be original research, and focus on transgender participants' PA. Rates of PA for transgender individuals were lower compared to cisgender or sexual minority individuals. Transgender women were less likely to engage in PA than other groups. Qualitative results suggest transgender oppression, stigma, discrimination, body image, unwelcoming environments (gyms, locker rooms, swimming pools), and the dichotomous structure of sport contribute to lower rates of PA among transgendered individuals. Disparities in PA for transgender individuals exist. Policy, environment, and system changes are needed to reduce transgender stigma in sport and PA settings. Current legislation is being developed and implemented in the United States regarding the place of transgender individuals in sport and PA. These results should inform public discourse on the topic.
Topics: Humans; Female; United States; Transgender Persons; Transsexualism; Gender Identity; Social Stigma; Exercise
PubMed: 38416705
DOI: 10.1371/journal.pone.0297571 -
Medical Education Online Dec 2024People who identify as lesbian, gay, bisexual, transgender, queer/questioning, intersex, and other sexual/gender minorities (LGBTQ+) may experience discrimination when... (Review)
Review
INTRODUCTION
People who identify as lesbian, gay, bisexual, transgender, queer/questioning, intersex, and other sexual/gender minorities (LGBTQ+) may experience discrimination when seeking healthcare. Medical students should be trained in inclusive and affirming care for LGBTQ+ patients. This narrative literature review explores the landscape of interventions and evaluations related to LGBTQ+ health content taught in medical schools in the USA and suggests strategies for further curriculum development.
METHODS
PubMed, ERIC, and Education Research Complete databases were systematically searched for peer-reviewed articles on LGBTQ+ health in medical student education in the USA published between 1 January 2011-6 February 2023. Articles were screened for eligibility and data was abstracted from all eligible articles. Data abstraction included the type of intervention or evaluation, sample population and size, and key outcomes.
RESULTS
One hundred thirty-four articles met inclusion criteria and were reviewed. This includes 6 (4.5%) that evaluate existing curriculum, 77 (57.5%) study the impact of curriculum components and interventions, 36 (26.9%) evaluate student knowledge and learning experiences, and 15 (11.2%) describe the development of broad learning objectives and curriculum. Eight studies identified student knowledge gaps related to gender identity and affirming care and these topics were covered in 34 curriculum interventions.
CONCLUSION
Medical student education is important to address health disparities faced by the LGBTQ+ community, and has been an increasingly studied topic in the USA. A variety of curriculum interventions at single institutions show promise in enhancing student knowledge and training in LGBTQ+ health. Despite this, multiple studies indicate that students report inadequate education on certain topics with limitations in their knowledge and preparedness to care for LGBTQ+ patients, particularly transgender and gender diverse patients. Additional integration of LGBTQ+ curriculum content in areas of perceived deficits could help better prepare future physicians to care for LGBTQ+ patients and populations.
Topics: Humans; Male; Female; United States; Students, Medical; Gender Identity; Sexual and Gender Minorities; Curriculum; Health Education
PubMed: 38359164
DOI: 10.1080/10872981.2024.2312716 -
European Journal of Endocrinology Feb 2024Hormone therapy in transgender people might be associated with an increased risk of cardiovascular disease (CVD). We aimed to investigate whether the risk of CVD is... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Hormone therapy in transgender people might be associated with an increased risk of cardiovascular disease (CVD). We aimed to investigate whether the risk of CVD is increased in transgender people compared with people of the same birth sex.
DESIGN AND METHODS
PubMed, Cochrane, Embase, and Google Scholar were searched until July 2022. Studies evaluating cardiovascular events in transgender women or men were included. Primary outcomes were stroke, myocardial infarction (MI), and venous thromboembolism (VTE). The risk for transgender women versus cisgender men and for transgender men versus cisgender women was analysed through random-effects meta-analysis.
RESULTS
Twenty-two studies involving 19 893 transgender women, 14 840 transgender men, 371 547 cisgender men, and 434 700 cisgender women were included. The meta-analysis included 10 studies (79% of transgender women and 76% of transgender men). In transgender women, incidence of stroke was 1.8%, which is 1.3 (95% confidence interval [CI], 1.0-1.8) times higher than in cisgender men. Incidence of MI was 1.2%, with a pooled relative risk of 1.0 (95% CI, 0.8-1.2). Venous thromboembolism incidence was 1.6%, which is 2.2 (95% CI, 1.1-4.5) times higher. Stroke occurred in 0.8% of transgender men, which is 1.3 (95% CI, 1.0-1.6) times higher compared with cisgender women. Incidence of MI was 0.6%, with a pooled relative risk of 1.7 (95% CI, 0.8-3.6). For VTE, this was 0.7%, being 1.4 (95% CI, 1.0-2.0) times higher.
CONCLUSIONS
Transgender people have a 40% higher risk of CVD compared with cisgender people of the same birth sex. This emphasizes the importance of cardiovascular risk management. Future studies should assess the potential influence of socio-economic and lifestyle factors.
Topics: Male; Humans; Female; Transgender Persons; Cardiovascular Diseases; Venous Thromboembolism; Transsexualism; Myocardial Infarction; Stroke
PubMed: 38302717
DOI: 10.1093/ejendo/lvad170 -
Human Reproduction Update May 2024Polycystic ovary syndrome (PCOS) is a common and distressing endocrine disorder associated with lower quality of life, subfertility, diabetes, cardiovascular disease,... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Polycystic ovary syndrome (PCOS) is a common and distressing endocrine disorder associated with lower quality of life, subfertility, diabetes, cardiovascular disease, depression, anxiety, and eating disorders. PCOS characteristics, its comorbidities, and its treatment can potentially influence sexual function. However, studies on sexual function in women with PCOS are limited and contradictory.
OBJECTIVE AND RATIONALE
The aim was to perform a systematic review of the published literature on sexual function in women with PCOS and assess the quality of the research and certainty of outcomes, to inform the 2023 International Guidelines for the Assessment and Management of PCOS.
SEARCH METHODS
Eight electronic databases were searched until 1 June 2023. Studies reporting on sexual function using validated sexuality questionnaires or visual analogue scales (VAS) in PCOS populations were included. Random-effects models were used for meta-analysis comparing PCOS and non-PCOS groups with Hedges' g as the standardized mean difference. Study quality and certainty of outcomes were assessed by risk of bias assessments and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) method according to Cochrane. Funnel plots were visually inspected for publication bias.
OUTCOMES
There were 32 articles included, of which 28 used validated questionnaires and four used VAS. Pooled Female Sexual Function Index (FSFI) scores in random-effects models showed worse sexual function across most subdomains in women with PCOS, including arousal (Hedges's g [Hg] [95% CI] = -0.35 [-0.53, -0.17], I2 = 82%, P < 0.001), lubrication (Hg [95% CI] = -0.54 [-0.79, -0.30], I2 = 90%, P < 0.001), orgasm (Hg [95% CI] = -0.37 [-0.56, -0.19], I2 = 83%, P < 0.001), and pain (Hg [95% CI] = -0.36 [-0.59, -0.13] I2 = 90%, P < 0.001), as well as total sexual function (Hg [95% CI] = -0.75 [-1.37, -0.12], I2 = 98%, P = 0.02) and sexual satisfaction (Hg [95% CI] = -0.31 [-0.45, -0.18], I2 = 68%, P < 0.001). Sensitivity and subgroup analyses based on fertility status and body mass index (BMI) did not alter the direction or significance of the results. Meta-analysis on the VAS studies demonstrated the negative impact of excess body hair on sexuality, lower sexual attractiveness, and lower sexual satisfaction in women with PCOS compared to controls, with no differences in the perceived importance of a satisfying sex life. No studies assessed sexual distress. GRADE assessments showed low certainty across all outcomes.
WIDER IMPLICATIONS
Psychosexual function appears to be impaired in those with PCOS, but there is a lack of evidence on the related distress scores, which are required to meet the criteria for psychosexual dysfunction. Health care professionals should discuss sexual function and distress and be aware of the multifactorial influences on sexual function in PCOS. Future research needs to assess both psychosexual function and distress to aid in understanding the degree of psychosexual dysfunction in PCOS. Finally, more diverse populations (e.g. non-heterosexual and more ethnically diverse groups) should be included in future studies and the efficacy of treatments for sexual dysfunction should also be assessed (e.g. lifestyle and pharmacological interventions).
Topics: Humans; Polycystic Ovary Syndrome; Female; Sexual Dysfunction, Physiological; Sexual Behavior; Quality of Life
PubMed: 38237144
DOI: 10.1093/humupd/dmad034 -
The European Journal of General Practice Dec 2024Transgender and nonbinary (TNB) people face barriers to primary care, which remains the main entry point for accessing gender-affirming healthcare in the UK. (Review)
Review
BACKGROUND
Transgender and nonbinary (TNB) people face barriers to primary care, which remains the main entry point for accessing gender-affirming healthcare in the UK.
OBJECTIVES
This systematic review aims to summarise the evidence regarding TNB people's experiences of primary care to inform improvements in service and patient outcomes.
METHODS
This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. A systematic literature search was conducted across articles from 2005 to April 2023 across Ovid Medline, Ovid Embase and PsychInfo using established keywords relating to gender identity, primary care and experiences. Qualitative data were thematically analysed and quantitative data were compiled using a descriptive narrative.
RESULTS
Following eligibility criteria, 16 articles were included in this review. This review identified both facilitators and limitations and barriers experienced by TNB people related to primary care provider knowledge; the patient-provider relationship, and healthcare settings. Quantitative findings reported up to 54.4% of participants were uncomfortable discussing TNB issues with their physician. Overall findings suggest TNB people face discrimination on a systemic level utilising primary care services, though positive healthcare encounters at a local level were reported. Participants expressed a desire for primary care-led gender-affirming healthcare services, with involvement from local TNB communities.
CONCLUSION
This review demonstrates TNB people's mixed experiences of primary care alongside their recommendations for service improvement. This is the first systematically reviewed evidence on the topic, emphasising the need for clinicians and policymakers to centre the voices of the TNB community in service design and improvement.
Topics: Male; Adult; Female; Humans; Gender Identity; Transgender Persons; Gender-Affirming Care; Health Facilities; Primary Health Care
PubMed: 38197305
DOI: 10.1080/13814788.2023.2296571 -
Archives of Sexual Behavior Apr 2024Sexual and gender minority stress is associated with negative physical and mental health outcomes, such as hypertension and depression. Expanding on previous reviews of...
Sexual and gender minority stress is associated with negative physical and mental health outcomes, such as hypertension and depression. Expanding on previous reviews of the literature on cross-sectional and long-term prospective associations between sexual and gender minority stress and health outcomes, the current systematic review synthesizes the evidence on how everyday sexual and gender minority stress relates to momentary changes in health. The findings of 53 experience sampling studies published between 2007 and 2022 suggest that daily and momentary within-persons fluctuations in minority stressors are associated with cognitive-emotional (e.g., affect, suicidality), behavioral (e.g., substance use), social (e.g., relationship satisfaction), and physical health outcomes (e.g., somatic symptoms). These findings suggest that sexual and gender minority stress is a dynamic process that can vary within individuals over time and significantly impact everyday mental and physical health. We discuss the implications of these findings for minority stress theory, LGBTQ+ health research, LGBTQ+ affirming therapy, and prevention initiatives. The current experience sampling literature is limited by a lack of attention to gender minority stress and a focus on a limited range of health outcomes. Methodological and theoretical considerations for future experience sampling research are discussed in light of these limitations.
Topics: Humans; Cross-Sectional Studies; Ecological Momentary Assessment; Sexual and Gender Minorities; Sexual Behavior; Minority Groups; Gender Identity
PubMed: 38172351
DOI: 10.1007/s10508-023-02779-0 -
Journal of Psychopathology and Clinical... Jan 2024Although researchers seek to understand psychological phenomena in a population, quantitative research studies are conducted in smaller samples meant to represent the...
Although researchers seek to understand psychological phenomena in a population, quantitative research studies are conducted in smaller samples meant to represent the larger population of interest. This systematic review and quantitative synthesis considers reporting of sociodemographic characteristics and sample composition in the Journal of Abnormal Psychology (now the Journal of Psychopathology and Clinical Science) over the past 3 decades. Across k = 1,244 empirical studies, there were high and increasing rates of reporting of participant age/developmental stage and sex/gender, low but increasing reporting of socioeconomic status/income, and moderate and stable reporting of educational attainment. Rates of reporting of sexual orientation remained low and reporting of gender identity was essentially nonexistent. There were low to moderate but increasing rates of reporting of participant race and ethnicity. Approximately three-quarters of participants in studies over the past 3 decades were White, while the proportion of participants who were Asian, Black or African American, American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander, or Hispanic/Latino was much lower. Approximately two-thirds of participants were female, with this proportion increasing over time. There were also notable differences in the proportion of study participants as a function of race and sex/gender for different forms of psychopathology. Basic science and theoretical psychopathology research must include sociodemographically diverse samples that are representative of and generalizable to the larger human population, while seeking to decrease stigma of psychopathology and increase mental health equity. Recommendations are made to increase sociodemographic diversity in psychopathology research and the scientific review/publication process. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Topics: Humans; Female; Male; Gender Identity; Psychopathology; Academic Success; Alaska; Mental Disorders
PubMed: 38147053
DOI: 10.1037/abn0000871