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European Journal of Surgical Oncology :... Oct 2022Although male breast cancer (MBC) is a rare disease, accounting for <1% of all breast cancers, it has significant oncological, survival and psychosocial implications for... (Review)
Review
BACKGROUND
Although male breast cancer (MBC) is a rare disease, accounting for <1% of all breast cancers, it has significant oncological, survival and psychosocial implications for patients. The aim of this study is to assess the latest literature in the diagnosis, management, oncological outcomes, and psychosocial impact of MBC.
METHODS
A systematic literature review was conducted using the PRISMA guidelines (Moher et al., 2009) [1] to explore the management of MBC, with particular focus on investigative imaging, surgical management, oncological outcomes, survival, genetic screening and psychosocial effects. Electronic databases were searched for randomised control trials, cohort studies and case series involving more than 10 patients. Imaging and surgical techniques, local and distant disease recurrence, survival, genetic screening and psychosocial implications in the setting of MBC were assessed.
RESULTS
The search criteria identified 199 articles, of which 59 met the inclusion criteria. This included 39,529 patients, with a mean age of 64.5 years (55-71), and a mean follow-up of 66.3 months (26.2-115). Mastectomy remains the most frequently used surgical technique, with an average of 89.6%. Loco-regional and distant recurrence rate was 10.1% and 21.4% respectively. Disease-free survival (DFS) at 5 and 10 years was 66.8% and 54.5% respectively. Disease-specific survival (DSS) at 5 and 10 years was 87.1% and 67.1% respectively. Overall survival (OS) at 5 and 10 years was 72.7% and 50.7% respectively. Genetic screening was conducted in 38.6% of patients of which 4.8% and 15.8% were found to be BRCA1 and BRCA2 carriers respectively. Psychosocial studies were conducted mainly using questionnaire and interview-based methodology focusing primarily on awareness of breast cancer in men, support available and impact on gender identity.
CONCLUSIONS
This review demonstrates that men present with later stage disease with subsequent impact on survival outcomes. There remains a paucity of high-level evidence and prospective studies are required. There is a need for increasing awareness amongst the public and health care professionals in order to improve outcomes and reduce stigma associated with MBC.
Topics: Humans; Male; Female; Middle Aged; Breast Neoplasms, Male; Mastectomy; Breast Neoplasms; Neoplasm Recurrence, Local; Gender Identity; Disease-Free Survival
PubMed: 35725681
DOI: 10.1016/j.ejso.2022.06.004 -
Academic Medicine : Journal of the... Dec 2022To identify exemplary medical education curricula, operationalized as curricula evaluating knowledge retention and/or clinical skills acquisition, for health care for...
PURPOSE
To identify exemplary medical education curricula, operationalized as curricula evaluating knowledge retention and/or clinical skills acquisition, for health care for sexual and gender minoritized (SGM) individuals and individuals born with a difference in sex development (DSD).
METHOD
The authors conducted a systematic review of the literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches were performed in PubMed/MEDLINE, The Cochrane Library, Web of Science, ERIC, Embase, PsycINFO, and the gray literature to identify studies that (1) pertained to undergraduate and/or graduate medical education, (2) addressed education on health care of SGM/DSD individuals, and (3) assessed knowledge retention and/or clinical skills acquisition in medical trainees. The final searches were run in March 2019 and rerun before final analyses in June and October 2020.
RESULTS
Of 670 full-text articles reviewed, 7 met the inclusion criteria. Five of the 7 studies assessed trainee knowledge retention alone, 1 evaluated clinical skills acquisition alone, and 1 evaluated both outcomes. Studies covered education relevant to transgender health, endocrinology for patients born with DSDs, and HIV primary care. Only 1 study fully mapped to the Association of American Medical Colleges (AAMC) SGM/DSD competency recommendations. Six studies reported institutional funding and development support. No studies described teaching SGM/DSD health care for individuals with multiply minoritized identities or engaging the broader SGM/DSD community in medical education curriculum development and implementation.
CONCLUSIONS
Curriculum development in SGM/DSD health care should target knowledge retention and clinical skills acquisition in line with AAMC competency recommendations. Knowledge and skill sets for responsible and equitable care are those that account for structures of power and oppression and cocreate curricula with people who are SGM and/or born with DSDs.
Topics: Humans; Clinical Competence; Curriculum; Sexual and Gender Minorities; Gender Identity; Minority Health
PubMed: 35703197
DOI: 10.1097/ACM.0000000000004768 -
AIDS Patient Care and STDs Jun 2022HIV pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV; however, PrEP use among transgender individuals remains low. We conducted a systematic review...
HIV pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV; however, PrEP use among transgender individuals remains low. We conducted a systematic review to identify barriers and facilitators to PrEP uptake, adherence, and persistence among transgender individuals in the United States. We conducted a literature search in PubMed and CINAHL databases in March 2021 and followed PRISMA guidelines. Studies were eligible if they were published in a peer-reviewed journal and reported interest, uptake, adherence, and/or persistence of PrEP use among transgender individuals. Articles that did not disaggregate results for transgender participants were excluded. Data from included articles were coded using content analysis and narratively synthesized using a framework matrix. We screened 254 unique articles published after US Food and Drug Administration approval of PrEP, and 33 articles were included in the review. Five themes were identified in the literature, including (1) PrEP concentrations were lower among individuals taking feminizing hormones, but the difference did not appear clinically significant; (2) concerns regarding interactions between gender-affirming hormone therapy and PrEP remain a large barrier; (3) PrEP initiation may facilitate increased self-advocacy and self-acceptance; (4) lack of trust in medical institutions impacts PrEP uptake; and (5) social networks have a significant influence on PrEP knowledge, interest, and adherence. Additional research is needed involving transgender men and nonbinary persons, and efforts to improve PrEP persistence among the transgender community are needed. Training health care providers to provide inclusive and affirming care is perhaps one of the strongest areas for intervention to increase PrEP uptake and persistence.
Topics: Anti-HIV Agents; HIV Infections; Homosexuality, Male; Humans; Male; Pre-Exposure Prophylaxis; Transgender Persons; Transsexualism; United States
PubMed: 35687813
DOI: 10.1089/apc.2021.0236 -
Seminars in Arthritis and Rheumatism Aug 2022Existing patient-reported outcome measures (PROMs) in rheumatoid arthritis (RA) may be limited in their applicability to populations that are at risk for inequities. We...
Validation studies of rheumatoid arthritis patient-reported outcome measures in populations at risk for inequity: A systematic review and analysis using the OMERACT summary of measurement properties equity table.
BACKGROUND
Existing patient-reported outcome measures (PROMs) in rheumatoid arthritis (RA) may be limited in their applicability to populations that are at risk for inequities. We conducted a systematic review to identify and rate evidence in the validation studies for PROMs in populations at risk for inequity.
METHODS
A systematic review of MEDLINE and EMBASE was completed. The search strategy was developed to identify measurement property studies for PROMs of interest (selected pain, disease activity, global evaluation and quality of life scales) in patients with RA. We identified experimental, observational, and qualitative studies reporting analysis of feasibility, construct validity and discriminant ability metrics for populations at risk for inequity by various factors including race, ethnicity, culture or language; employment status; sex and gender identity; education level; socioeconomic status; social support; age; health literacy and disability. These were rated based on the OMERACT Summary of Measurement Properties Equity table.
RESULTS
From 19,786 titles and abstracts screened, we identified 14 unique studies reporting validation metrics for pain (n = 3), DAS28-ESR or DAS28-CRP (n = 2), ACR20 (n = 1), patient global assessment (n = 2), EQ5D (n = 4), and PROMIS® (n = 3) by race (n = 10 studies), age (n = 6 studies), sex (n = 5 studies), education level (n = 2 studies), and disability, literacy, employment status, social support level and socioeconomic status (n = 1 study each). Five studies reported on feasibility, 12 reported construct validity metrics, and 4 studies reported on discriminant validity metrics. All studies by culture or language were rated as having good measurement property metrics. There was limited assessment of measurement property metrics for other populations at risk for inequity.
CONCLUSION
Our study highlights important gaps in patient representation in rheumatology research for accepted outcome measures. New outcome measures being developed for research purposes and clinical practice should ensure and report representation of patients from populations at risk for inequities in the testing of metrics of feasibility, construct validity and discriminant ability metrics.
Topics: Arthritis, Rheumatoid; Female; Gender Identity; Humans; Male; Pain; Patient Reported Outcome Measures; Quality of Life; Risk Factors
PubMed: 35640489
DOI: 10.1016/j.semarthrit.2022.152029 -
Journal of Homosexuality Oct 2023Sexual and gender minorities (SGM) constitute vulnerable groups in many countries. Thus, they might be affected to a different extent than heterosexual and cisgender...
Sexual and gender minorities (SGM) constitute vulnerable groups in many countries. Thus, they might be affected to a different extent than heterosexual and cisgender individuals by the Coronavirus pandemic. This systematic review aimed to summarize the state of international research on the mental and physical health-related as well as socioeconomic effects of the Coronavirus pandemic on SGM individuals. Following the PRISMA protocol, we identified 35 publications, including different article formats. We considered minority stress theory and intersectionality in synthesizing the reviewed literature. Our key finding implicates that both minority- and pandemic-specific adversities have increased the vulnerabilities of SGM individuals during the Coronavirus pandemic. Minority-specific stressors include discrimination experiences, poorer mental and physical health, and fewer socioeconomic resources. Pandemic-specific challenges such as the deferral and delay of medication or school closing have exposed certain SGM subgroups (transgender individuals, young SGM) to particularly high risk. Moreover, the reviewed evidence suggests distinctive interactive effects of minority-specific stressors with pandemic-specific challenges (e.g., being forced to stay close to rejecting others during lockdown periods). A significant share of the included literature was US-based, while research from other countries remained scarce. The specific mechanisms still deserve to be better understood to protect SGM in future crises, especially during pandemics.
Topics: Humans; Sexual and Gender Minorities; Pandemics; Coronavirus; Sexual Behavior; Transgender Persons; Gender Identity
PubMed: 35576127
DOI: 10.1080/00918369.2022.2074335 -
Manifestations and Reinforcement of Heteronormativity in the Workplace: A Systematic Scoping Review.Journal of Homosexuality Oct 2023This scoping review systematizes the evidence available to date on the manifestations of heteronormativity in the workplace. The reviewed literature shows that, at an...
This scoping review systematizes the evidence available to date on the manifestations of heteronormativity in the workplace. The reviewed literature shows that, at an organizational level, heteronormativity is reproduced in the configuration of space, organizational policies, and the monitoring of their accomplishment by leaders. At an interpersonal level, employees interact with others based on heterosexual presumptions, they reward what is aligned with heteronormativity, and censor what is not. Finally, individuals acting of their own volition may perform their gender in ways that strengthen the presumption of heterosexuality and communicate heteronormativity alignment. This review offers suggestions for future research in the field of heteronormativity in the workplace and includes theoretical and practical implications for the creation of inclusive organizations.
Topics: Humans; Sexual and Gender Minorities; Heterosexuality; Gender Identity; Workplace
PubMed: 35576124
DOI: 10.1080/00918369.2022.2074334 -
Journal of Homosexuality Sep 2023Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals are at a higher risk of mental illness when compared to their heterosexual and cisgender counterparts....
Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals are at a higher risk of mental illness when compared to their heterosexual and cisgender counterparts. Most research emanates from Western countries, with a paucity of studies in the Arab world. We systematically reviewed studies assessing the mental health of LGBTQ individuals who live in the Arab world or are of Arab descent. Of 261 articles, seven were eligible for analysis. Depression was the most common psychiatric disorder. Suicidal ideations and attempts were frequent in trans women. Post-traumatic stress disorder was also common, with the majority of precipitating traumatic events being related to sexual orientation and/or gender identity. Societal and familial stressors in the Arab culture are major contributors to the increased vulnerability of the LGBTQ community to mental health challenges. Further research is of utmost need while taking into consideration the Arab socio-cultural context.
Topics: Humans; Female; Male; Sexual and Gender Minorities; Mental Health; Gender Identity; Arabs; Sexual Behavior; Transgender Persons
PubMed: 35499284
DOI: 10.1080/00918369.2022.2060624 -
International Journal of Environmental... Apr 2022The objective of this systematic review is to make an inventory of the representations of the professionals of specialized institutions on the sexuality of persons with... (Review)
Review
The objective of this systematic review is to make an inventory of the representations of the professionals of specialized institutions on the sexuality of persons with intellectual disabilities. The scientific studies were identified according to the PRISMA protocol using 18 databases, with keywords on sexuality and parenthood. Studies were reviewed through a methodological assessment and then a thematic analysis. Twenty-four studies were reviewed and three themes were identified: professionals' representations of gender, sexuality, and consent; professionals' perceptions of their role in supporting people's sexual lives; and the ways in which professionals construct representations of people's sexual lives. This corpus highlights deep paradoxes in the representations of professionals concerning the socio-affective needs and sexuality of people with intellectual disabilities, creating what we could define as a "system of incompatibility" and leading to difficulties in positioning. Support is still too random and subject to control logics in the name of protecting users, who are perceived as vulnerable. Training and new ways of teamwork appear to be central to supporting the evolution of the representations and practices of professionals. Future research anchored in practices and involving users as well as professionals is necessary to better understand the paradoxical aspects of professionals' representations and to draw alternative ways of constructing these representations.
Topics: Gender Identity; Humans; Intellectual Disability; Persons with Mental Disabilities; Sexual Behavior; Sexuality
PubMed: 35457641
DOI: 10.3390/ijerph19084771 -
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 -
JAMA Pediatrics May 2022Sexual orientation and gender identity change efforts (SOGICE), also called conversion therapy, is a discredited practice attempting to convert lesbian, gay, bisexual,...
IMPORTANCE
Sexual orientation and gender identity change efforts (SOGICE), also called conversion therapy, is a discredited practice attempting to convert lesbian, gay, bisexual, transgender, queer, or questioning (LGBTQ) individuals to be heterosexual and/or cisgender.
OBJECTIVES
To identify and synthesize evidence on the humanistic and economic consequences of SOGICE among LGBTQ youths in the US.
DESIGN, SETTING, AND PARTICIPANTS
This study, conducted from December 1, 2020, to February 15, 2021, included a systematic literature review and economic evaluation. The literature review analyzed published evidence on SOGICE among LGBTQ individuals of any age. The economic model evaluated the use of SOGICE vs no intervention, affirmative therapy vs no intervention, and affirmative therapy vs SOGICE to estimate the costs and adverse outcomes for each scenario and to assess the overall US economic burden of SOGICE. Published literature and public sources were used to estimate the number of LGBTQ youths exposed to SOGICE, the types of therapy received, and the associated adverse events (anxiety, severe psychological distress, depression, alcohol or substance abuse, suicide attempts, and fatalities).
EXPOSURES
SOGICE (licensed or religion-based practitioners) or affirmative therapy (licensed practitioners).
MAIN OUTCOMES AND MEASURES
Total incremental costs and quality-adjusted life-years (QALYs) vs no intervention and total economic burden of SOGICE.
RESULTS
Among 28 published studies, which included 190 695 LGBTQ individuals, 12% (range, 7%-23%) of youths experienced SOGICE, initiated at a mean age of 25 years (range, 5-58 years), with a mean (SD) duration of 26 (29) months. At least 2 types of SOGICE were administered to 43% of recipients. Relative to LGBTQ individuals who did not undergo SOGICE, recipients experienced serious psychological distress (47% vs 34%), depression (65% vs 27%), substance abuse (67% vs 50%), and attempted suicide (58% vs 39%). In the economic analysis, over a lifetime horizon with a 3% annual discount rate, the base-case model estimated additional $97 985 lifetime costs per individual, with SOGICE associated with 1.61 QALYs lost vs no intervention; affirmative therapy yielded cost savings of $40 329 with 0.93 QALYs gained vs no intervention. With an estimated 508 892 youths at risk for SOGICE in 2021, the total annual cost of SOGICE is estimated at $650.16 million (2021 US dollars), with associated harms totaling an economic burden of $9.23 billion.
CONCLUSIONS AND RELEVANCE
This economic evaluation study suggests that there is a high economic burden and high societal costs associated with SOGICE and identifies additional research questions regarding the roles of private and public funding in supporting this harmful practice.
Topics: Adolescent; Adult; Bisexuality; Female; Financial Stress; Gender Identity; Humans; Male; Sexual Behavior; Sexual and Gender Minorities; United States
PubMed: 35254391
DOI: 10.1001/jamapediatrics.2022.0042