Gender Discordance Research Articles

BARRIERS TO BULGARIAN PRIMARY CARE PHYSICIANS TO ADDRESS AND DISCUSS THE ERECTILE DYSFUNCTION PROBLEM WITH THEIR PATIENTS

Introduction: Several factors play the role of barriers to GP-s and most of them avoid discussing the erectile dysfunction (ED) problem with their patients, even though a part of the patients hope the doctor would initiate such a discussion. Taking into account the relationship of ED with a number of socially significant diseases, these barriers impede the diagnostic process. Objective: To identify possible barriers to Bulgarian primary care physicians to address and discuss the ED problem with their patients. Materials and methods: The opinions of 12 GP-s from the town of Plovdiv, randomly selected, were studied using qualitative research methods, interview with standard open-ended questions, asked by the research investigator. An audio recording was made and transcribed by the interviewer and by two other research investigators. The obtained data are the result of a consensus. Results: Even though the majority of participants point out that doctors do not avoid and should not avoid commenting on problems, related to the sex life of their patients, only one participant declared to always raise this issue before them. Constraining factors (barriers), pointed out by the colleagues, are lack of training in this aspect of health, also lack of training in asking intimate questions, the perception that sex problems of patients are not among "essential" diseases, associated with "survival", refusal of the patient, lack of time, waiting for the patient to raise this issue first and "personal taboos" of the doctor himself. The respondents point that doctors share the same inhibitions as their patients, as they are a part of the same society and are influenced by various cultural factors. Other factors, that play role of a barrier, are patient – physician gender discordance, lack of confidence and lack of experience with the patients with ED, physician personal sexual experience, when doctors do not apply holistic approach and when physicians do not percept ED as a disease. Conclusion: This survey is the first of its kind in Bulgaria. The results of the survey show that a variety of factors, including factors, related to doctor's personality, acts as barriers that impede doctors from proactively asking about and discussing sexuality issues and ED in particular. The overcoming of these barriers would present an opportunity to improve the therapeutic result.

Do you talk to your older patients about sexual health? Health practitioners’ knowledge of, and attitudes towards, management of sexual health among older Australians

Research suggests that older patients want to talk about sexual health, but are reluctant to initiate these discussions with health practitioners. Little is known of the practitioners’ perspectives. The objective of this study was to explore health practitioners’ knowledge of and attitudes towards management of sexual health among older patients. Semi-structured interviews were conducted with 15 general practitioners (GPs) and six practice nurses in rural/metropolitan general practices in March to June 2017 in Victoria, Australia. Most GPs believed it was appropriate to discuss sexual health with older patients but did not routinely do so. Common barriers included age and gender discordance between GP and patient, complexity of patient comorbidities and patient–doctor relationships. Practice nurses identified the limitations of their role as a barrier, although some nurses initiated discussions during health assessments. Health practitioners generally believed the responsibility for initiation of sexual health discussions rested with patients, but understood patients’ reluctance. They saw the need for an intervention to assist in such discussions.

Assessment and Treatment of Gender Dysphoria and Gender Variant Patients: A Primer for Psychiatrists.

Assessment and Treatment of Gender Dysphoria and Gender Variant Patients: A Primer for Psychiatrists.

Smoking among immigrant groups in metropolitan France: prevalence levels, male-to-female ratios and educational gradients

BackgroundAlthough the French population comprises large and diverse immigrant groups, there is little research on smoking disparities by geographical origin. The aim of this study is to investigate in this country smoking among immigrants born in either north Africa, sub-Saharan Africa or French overseas départements.MethodsThe data originate from the 2010 Health Barometer survey representative of metropolitan France. The subsample of 20,211 individuals aged 18–70 years (born either in metropolitan France or in the above-mentioned geographical regions) was analysed using logistic regression.ResultsBoth immigrants from sub-Saharan Africa and immigrants from overseas départements were protected from smoking compared to the reference population, and the former had a distinctive strongly reversed educational gradient in both genders. Returned former settlers from the French colonies in North Africa (repatriates) had the highest smoking levels. Natives from the Maghreb (Maghrebins) showed considerable gender discordance, with men having both a higher prevalence (borderline significance) and a reversed gradient and women having lower prevalence than the reference population.ConclusionImmigrants from regions of the world in stage 1 of the cigarette epidemic had relatively low smoking levels and those from regions in stage 2 had relatively high smoking levels. Some groups had a profile characteristic of late phases of the cigarette epidemic, and others, some of which long-standing residents, seemed to be positioned at its early stages. The situation for Maghrebins reflected the enduring influence of gendered norms post-migration. Based on their educational gradients, immigrants from overseas départements (particularly men) and Maghrebin women may be at risk of losing their particularly low prevalence. Immigrants from sub-Saharan Africa could retain it. In-depth analysis of smoking profiles of immigrants’ groups is essential for a better targeting of smoking prevention and cessation programs.

Impact of Patient-Provider Race, Ethnicity, and Gender Concordance on Cancer Screening: Findings from Medical Expenditure Panel Survey.

Background: Racial and ethnic minorities experience lower rates of cancer screening compared with non-Hispanic whites (NHWs). Previous studies evaluating the role of patient-provider race, ethnicity, or gender concordance in cancer screening have been inconclusive.Methods: In a cross-sectional analysis using the Medical Expenditure Panel Survey (MEPS), data from 2003 to 2010 were assessed for associations between patient-provider race, ethnicity, and/or gender concordance and, screening (American Cancer Society guidelines) for breast, cervical, and colorectal cancer. Multivariable logistic analyses were conducted to examine associations of interest.Results: Of the 32,041 patient-provider pairs in our analysis, more than 60% of the patients were NHW, 15% were non-Hispanic black (NHB), and 15% were Hispanic. Overall, patients adherent to cancer screening were more likely to be non-Hispanic, better educated, married, wealthier, and privately insured. Patient-provider gender discordance was associated with lower rates of breast [OR, 0.83; 95% confidence interval (CI), 0.76-0.90], cervical (OR, 0.83; 95% CI, 0.76-0.91), and colorectal cancer (OR, 0.84; 95% CI, 0.79-0.90) screening in all patients. This association was also significant after adjusting for racial and/or ethnic concordance. Conversely, among NHWs and NHBs, patient-provider racial and/or ethnic concordance was not associated with screening. Among Hispanics, patient-provider ethnic discordant pairs had higher breast (58% vs. 52%) and colorectal cancer (45% vs. 39%) screening rates compared with concordant pairs.Conclusions: Patient-provider gender concordance positively affected cancer screening. Patient-provider ethnic concordance was inversely associated with receipt of cancer screening among Hispanics. This counter-intuitive finding requires further study.Impact: Our findings highlight the importance of gender concordance in improving cancer screening rates. Cancer Epidemiol Biomarkers Prev; 26(12); 1804-11. ©2017 AACR.

Cervical Cancer Screening Preferences Among Trans-Masculine Individuals: Patient-Collected Human Papillomavirus Vaginal Swabs Versus Provider-Administered Pap Tests.

Trans-masculine (TM, i.e., persons who have a masculine spectrum gender identity, but were assigned female sex at birth) individuals face disparities in cervical cancer screening rates compared to cisgender women. Some unique barriers to screening in this population are specific to Pap tests. Introduction of self-collected frontal (i.e., vaginal) swabs for human papillomavirus (HPV) testing as a screening strategy may obviate these barriers. This study elucidates cervical cancer screening preferences among TM individuals. TM individuals participated in in-depth interviews (n = 31) and online surveys (n = 32) to explore perceptions and experiences regarding cervical cancer screening, including the acceptability of self-collected frontal HPV swabs for cervical cancer screening compared to provider-administered Pap tests. Provider-collected frontal HPV swab acceptability was also explored. Most TM individuals (94% in-person and 91% online participants) preferred either the self- or provider-collected frontal HPV swab to the Pap test. Participants perceived self- and provider-collected frontal HPV swabs to be less invasive, provoke less gender discordance, and promote a greater sense of agency compared to Pap tests. However, some participants expressed concern about HPV swab accuracy and, regarding the self-collected swab, discomfort about the need to engage with genitals they may not want to acknowledge. Individuals who reported positive provider relationships found Pap tests and provider-collected frontal swabs more acceptable than those who did not. Frontal HPV swabs have the potential to promote regular cervical cancer screening among TM individuals and to narrow screening disparities. Work is ongoing to establish swab accuracy and develop shared decision-making tools.

Impact of patient-provider race/ethnicity and gender concordance on cancer screening: Findings from medical expenditure panel survey.

1547 Background: Racial/ethnic minority groups experience lower rates of cancer screening compared to non-Hispanic (NH) whites. Previous studies evaluating the role of patient-provider race/ethnicity and gender concordance in cancer screening have been inconclusive. Methods: We conducted a cross-sectional study of 18,690 patient-provider pairs using the 2003-2010 Medical Expenditure Panel Survey (MEPS) data. We assessed association between patient-provider race/ethnicity and gender concordance and, screening adherence for breast, cervical, and colorectal cancer using American Cancer Society guidelines. Separate multivariable logistic regression adjusting for demographics, self-reported health and MEPS survey year were conducted to examine relationships of interest. Results: Seventy percent of patients were NH-white, 15% were NH-black and 15% were Hispanic. Patients adherent to cancer screening were more likely to be non-Hispanic, better educated, married, wealthier, and privately insured. Among NH-black and NH-whites, patient-provider racial/ethnic concordance was not associated with screening adherence. Among Hispanics, patient-provider racial/ethnic discordant pairs had higher colorectal cancer screening rates as compared to concordant pairs (OR 1.48; 95% CI 1.28-1.71). This association was significant even on adjusting for gender concordance and survey language (English vs. Spanish). Conversely, patient-provider gender discordance was associated with lower rates of breast (OR 0.81; 95% CI 0.74-0.89), cervical (OR 0.79; 95% CI 0.72-0.87) and colorectal cancer (OR 0.86; 95% CI 0.80-0.93) screening adherence in all patients. This association was also significant on restricting analysis to racial/ethnic concordant pairs. Conclusions: Patient-provider gender concordance positively impacts adherence to cancer screening and this finding may guide future interventions. Patient-provider racial/ethnic concordance is not associated with screening adherence among whites and blacks but Hispanic patients seen by Hispanic providers have lower colorectal cancer screening rates. This counter-intuitive finding requires further study.

Gender differences in the transmission of risk for antisocial behavior problems across generations.

Previous studies have shown that children of alcohol use disorder (AUD) parents are more likely to develop alcohol problems as well as antisocial and other behavior problems. The purpose of this study was to examine gender discordance in the effect of early maternal and paternal influences on antisocial behaviors of boys and girls, as well as the environmental factors that moderate the parental effects. Specifically, we examined the effects of childhood and adulthood antisocial behavior of the parents on offspring antisocial behavior as young adults. We also examined whether mothers’ and fathers’ drinking problems when offspring were young children (6–8 years) affected offspring antisocial behavior as young adults (18–21 years). We evaluated 655 children from 339 families in the Michigan Longitudinal Study (MLS), a prospective study of AUD and non-AUD families. Path models were constructed in order to test for the parental contributions to offspring outcomes. We found that both mothers’ and fathers’ antisocial behavior contributed to the children’s young adult antisocial behavior. Only mothers’ drinking problems while their children were little had a significant effect on their sons’ later drinking, but not on their daughters’. These different parental effects suggest that maternal and paternal influences may be mediated by different mechanisms.

Current Challenges in the Management of LGBT Suicide

Current Challenges in the Management of LGBT Suicide

Risk of Anal Cancer in People Living with HIV: Addressing Anal Health in the HIV Primary Care Setting

Anal health and anal cancer are rarely addressed in HIV primary care. We sought to understand factors that impeded or promoted addressing anal health in HIV primary care from providers' perspectives. In this exploratory study, HIV primary care providers from the Mid-South region of the United States participated in brief individual interviews. We analyzed transcribed data to identify barriers and facilitators to addressing anal health. Our study sample included five physicians and four nurse practitioners. The data revealed a number of barriers such as perception of patient embarrassment, provider embarrassment, external issues such as time constraints, demand of other priorities, lack of anal complaints, lack of resources, and gender discordance. Facilitators included awareness, advantageous circumstances, and the patient-provider relationship. Anal health education should be prioritized for HIV primary care providers. Preventive health visits should be considered to mitigate time constraints, demands for other priorities, and unequal gender opportunities.

Hypophosphatasia: Validation and expansion of the clinical nosology for children from 25 years experience with 173 pediatric patients

Hypophosphatasia (HPP) is caused by loss-of-function mutation(s) within the gene TNSALP that encodes the “tissue-nonspecific” isoenzyme of alkaline phosphatase (TNSALP). In HPP, inorganic pyrophosphate, an inhibitor of mineralization and substrate for TNSALP, accumulates extracellularly often leading to rickets or osteomalacia and tooth loss, and sometimes to craniosynostosis and calcium crystal arthropathies. HPP's remarkably broad-ranging expressivity spans stillbirth from profound skeletal hypomineralization to adult-onset dental problems or arthropathies without bone disease, which is largely explained by autosomal recessive versus autosomal dominant transmission from among several hundred, usually missense, TNSALP mutations. For clinical purposes, this expressivity has been codified according to absence or presence of skeletal disease and then patient age at presentation and diagnosis. Pediatric patients are reported principally with “odonto”, “childhood”, “infantile”, or “perinatal” HPP. However, this nosology has not been tested using a cohort of patients, and the ranges of the clinical and laboratory findings have not been defined and contrasted among these patient groups.To evaluate the extant nosology for HPP in children, we assessed our 25years experience with 173 pediatric HPP patients. Data were exclusively from inpatient studies. The childhood form of HPP was further designated “mild” or “severe”. Here, we focused on demographic, clinical, and dual-energy X-ray absorptiometry parameters compared to data from healthy American children.The 173-patient cohort comprised 64 individuals with odonto HPP, 38 with mild childhood HPP, 58 with severe childhood HPP, and 13 with infantile HPP. None was a survivor of perinatal HPP. TNSALP analysis revealed a mutation(s) in all 105 probands tested. Thirteen mutations were unique. Most patients represented autosomal dominant inheritance of HPP. Mutant allele dosage generally indicated the disorder's severity. Gender discordance was found for severe childhood HPP; 42 boys versus 16 girls (p=0.006), perhaps reflecting parental concern about stature and strength. Key disease parameters (e.g., height, weight, numbers of teeth lost prematurely, grip strength, spine and hip bone mineral density) were increasingly compromised as HPP was designated more severe. Although data overlapped successively between the four patient groups, body size (height and weight) differed significantly.Thus, our expanded nosology for HPP in children organizes the disorder's broad-ranging expressivity and should improve understanding of HPP presentation, natural history, complications, and prognosis.

Provider and interpreter preferences among Somali women in a primary care setting.

Somali people are among the largest refugee populations to resettle in North America and Europe over the past 2 decades, and health disparities are well documented, including barriers to effective navigation of primary health care systems. Patient-provider gender discordance has been described as a barrier to health-seeking behaviors and effective communication by Somali women in past qualitative work. The objective of this study was to elucidate provider and interpreter preferences during clinical encounters according to gender and race among Somali women in the United States. Fifty Somali women empanelled to a large primary care practice completed pictorial surveys to elucidate preferences of Somali women for providers of different genders and race for different components of the clinical examination using a Likert-type scale. We found that Somali women generally preferred a female provider for conducting the physical examination, particularly for the pelvic, breast, and abdominal examinations. Likewise, Somali women strongly preferred female interpreters to be present during the physical examination. There was no stated preference for patient-provider racial concordance. These findings have implications for structural health care changes aimed at delivering culturally sensitive and effective primary care to Somali patients.

Defining the influence of gender discordance on survival following live donor liver transplantation

Defining the influence of gender discordance on survival following live donor liver transplantation

Do gender differences affect the doctor-patient interaction during consultations in general practice? Results from the INTERMEDE study.

The aim of the study was to ascertain whether disagreement between GPs and patients on advice given on nutrition, exercise and weight loss is related to patient-doctor gender discordance. Our hypothesis is that a patient interacting with a physician of the same gender may perceive more social proximity, notably on health care beliefs and may be more inclined to trust them. The analysis used the Intermede project's quantitative data collected via mirrored questionnaires at the end of the consultation. Multilevel logistic regressions were carried out to explore associations between patient-doctor gender discordance and their disagreement on advice given during the consultation adjusted on patients' and physicians' characteristics. The sample consists of 585 eligible patients and 27 GPs. Disagreement on advice given on nutrition was observed less often for female concordant dyads: OR = 0.25 (95% CI = 0.08-0.78), and for female doctors-male patients dyads: OR = 0.24 (95% CI = 0.07-0.84), taking the male concordant dyads as reference. For advice given on exercise, disagreement was found less often for female concordant dyads OR = 0.38 (95% CI = 0.15-0.98) and an interdoctor effect was found (P < 0.05). For advice given on weight loss, the probability of disagreement was significantly increased (OR: 2.87 95% CI = 1.29-6.41) when consultations consisted of female patient and male GP. Patient-doctor gender concordance/discordance is associated with their agreement/disagreement on advice given during the consultation. Physicians need to be conscious that their own demographic characteristics and perceptions might influence the quality of prevention counseling delivered to their patients.

Incidence and zygosity of twin births following transfers using a single fresh or frozen embryo.

Are all twin births following single embryo transfer (SET) monozygotic? Between 1 in 10 and in 1 in 5 twins born after SET are the result of a concurrent natural conception. The twinning rate after SET is higher than following natural conception. Most studies of twins following SET have incorrectly assumed monozygosity or have not been able to assess the zygosity. This study is a retrospective cohort study assessing the gender discordance of all live born twins following fresh or frozen SET. A total of 4701 patients in a large private IVF unit who gave birth following SET with a fresh or frozen embryo with complete follow-up. Of 137 viable twins at the 7-week ultrasound, 109 were delivered as twins. Gender discordance and Weinberg's differential rule were used to estimate dizygosity. Twin rates were compared for fresh and frozen transfers by insemination method and transfer day. The overall live twin birth rate was 2.3% (109/4701). Based on the 7-week scan, 2 of the twins were monochorionic monoamniotic, 62 were monochorionic diamniotic and 45 were dichorionic diamniotic. There were a total of 12 gender discordant twins (11%), 7 from the Day 2/3 transfers and 5 from Day 5 transfers. Nine of the 12 discordant twins were from natural cycle frozen embryo transfers, the remaining 3 were from fresh cycles. LIMITATIONS, REASONS FOR CAUTION; To assess gender discordance only live born twins were studied. DNA fingerprinting of twins is a more accurate way to assess zygosity than measuring gender discordance. Same sex twins in this study are not necessarily monozygotic and the dizygotic rate in this study may therefore be higher. This rate was estimated using Weinberg's differential rule. As many as 1 in 5 twins born after SET may be the result of a concurrent natural conception. Couples therefore need to be counselled regarding the relative benefits and risks of intercourse in assisted reproduction technology cycles where spontaneous conception is possible. None. Not applicable.

Female donor to male recipient gender discordance results in inferior graft survival: a prospective study of 1,042 liver transplants

The influence of donor-recipient gender mismatch on outcomes after liver transplantation (LT) is controversial. The aim of this study was to evaluate the effect of donor and recipient gender discordance on graft survival. All patients who underwent primary LT from 1994-2012 at a single-center were identified prospectively. Clinico-demographic data were collected at the time of LT and last follow-up. Gender match included both male donor to male recipient (MM) and female donor to female recipient (FF), while gender mismatch included female donor to male recipient (FM) and male donor to female recipient (MF). Survival curves for graft survival were generated using Kaplan-Meier method and compared by log-rank test. Unadjusted and multivariate adjusted COX regression analyzing graft survival at up to 10 years post-transplant was performed. A total of 1,042 subjects fulfilled the criteria. Graft survival in patients receiving a donor-recipient gender match was better than those receiving a gender mismatch (P = 0.047). Female-to-male transplants had the worst graft survival of all combinations (P < 0.001); this difference was maintained in multivariate regression after adjustment for recipient and donor variables (hazards ratio 2.09, P = 0.013). Female-to-male liver transplants are associated with a statistically significant poorer graft survival as compared with other donor-recipient gender groups.

The LGBT Casebookedited by LevounisPetros, M.D., M.A.,DrescherJack, M.D., and BarberMary, M.D. Washington, DC, American Psychiatric Publishing, 2012, 324 pp., $62.00 (paper).

Back to table of contents Previous article Next article Communications and UpdatesFull AccessThe LGBT CasebookLawrence Hartmann, M.D.Lawrence HartmannSearch for more papers by this author, M.D.Published Online:1 Nov 2012https://doi.org/10.1176/appi.ajp.2012.12060819AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail edited by LevounisPetros, M.D., M.A.,DrescherJack, M.D., and BarberMary, M.D. Washington, DC, American Psychiatric Publishing, 2012, 324 pp., $62.00 (paper).Casebooks need not be dull. This timely and sensible book seems to me to be a model of what a casebook should be. It is clear without being simple. It is relatively brief. It embodies good listening to patients. It is scientifically up-to-date and well written and edited. It provides reasonably detailed and thoughtful examples across a solid group of major psychiatric diagnoses—as well as across a few psychiatric and social categories other than diagnoses—and examples of integrated, educated, and helpful biopsychosocial consideration and treatment of people.I recommend this book to all psychiatrists, young and old, and to our mental health colleagues and students, particularly, but not limited to, those who are actively or might potentially work with LGBT (lesbian, gay, bisexual, and transgender) patients or clients. The scope and teaching power of this book are wider than its focus on LGBT issues, and it helps us all to consider how psychiatry and mental health care have changed in recent decades and will continue to change in the future.Many readers may also want to read further discussion of these issues in the American Academy of Child and Adolescent Psychiatry “Practice Parameter on Gay, Lesbian or Bisexual Sexual Orientation, Gender-Nonconformity, and Gender Discordance in Children and Adolescents,” which is available online.Although organized predominantly around DSM-IV categories, this book will remain relevant with publication of DSM-5. Following a foreword and preface, there are preliminary chapters titled “What’s In Your Closet?, “Coming Out,” “From Outlaws to In-Laws,” “LGBT Parenting,” and “Sexual Identity in Patient-Therapist Relationships.” The book consists of specific short, chapter-long case studies on attention deficit hyperactivity disorder, substance dependence, schizophrenia, major depressive disorder, dysthymic disorder, bipolar disorder, panic disorder, obsessive-compulsive disorder, posttraumatic stress disorder, generalized anxiety disorder, adjustment disorder, and borderline personality disorder. Also addressed are parent-child relational problems, partner relational problems, bereavement, occupational problems, identity problems, religious/spiritual problems, acculturation problems, and phase-of-life problems. A brief glossary is included as well.Many of the book’s authors consider both medication and psychotherapy, and many of the psychotherapies demonstrated have realistic and eclectic components, including dynamic psychotherapy. Some attention is also given to the “neater” psychotherapies preferred by researchers, such as cognitive-behavioral therapy, interpersonal psychotherapy, dialectical behavioral therapy, exposure and response therapy, and supervised community treatment. If there is a second edition, the editors could usefully add a chapter on alcohol misuse (since the chapter on substance abuse is specific to methamphetamines), a chapter on minor depressive disorder, and a chapter on the vicissitudes of Internet use.The contributing authors are knowledgeable of—and most are also attentive to—the contexts and meanings of various discomforts and disorders. Most of the authors are sensitive to diversity and try not to view issues in terms of extremes, which is tempting when defining boundaries (e.g., what is meant by “gay or straight”). However, assumptions of clear boundaries and categories do creep in from time to time, for example, when “coming out” is referred to as something that happens more or less once and for all, and solidly. Self-acceptance and synthesis are, in my view, healthy, but the accepted and synthesized self is complex. In one discussion, it is suggested that sexuality can be defined within four neat patient-therapist boxes (i.e., gay-gay, gay-straight, straight-gay, and straight-straight), rather than allowing for inevitable complex shades of gray or bisexual categories.There is also a startling first sentence. It is the first sentence in the whole book, in the Foreword (and thus perhaps not edited by the book’s editors): “People in the LGBT community are just like everyone else.” Like, yes; just like, no. If that were true, this book would not have been written. The challenge that this good book meets is to deal thoughtfully and respectfully with LGBT people, who are very much like non-LGBT people but also have important differences.Dr. Hartmann is a retired Professor of Psychiatry at Harvard Medical School, Cambridge, Mass.The author reports no financial relationships with commercial interests. FiguresReferencesCited byDetailsCited byNone Volume 169Issue 11 November 2012Pages 1216-1216 Metrics PDF download History Accepted 1 July 2012 Published online 1 November 2012 Published in print 1 November 2012

Development of AACAP Practice Parameters for Gender Nonconformity and Gender Discordance in Children and Adolescents

The American Academy of Child and Adolescent Psychiatry (AACAP) is preparing a publication, Practice Parameter on Gay, Lesbian or Bisexual Sexual Orientation, Gender-Nonconformity, and Gender Discordance in Children and Adolescents. This article discusses the development of the part of the parameter related to gender nonconformity and gender discordance and describes the practice parameter preparation process,rationale, key scientific evidence, and methodology. Also discussed are terminology considerations, related clinical issues and practice skills, and overall organization of information including influences on gender development, gender role behavior, gender nonconformity and gender discordance, and their relationship to the development of sexual orientation.

Pattern of fractures across pediatric age groups: analysis of individual and lifestyle factors

BackgroundKnowledge of the epidemiology of children's fractures is essential to develop preventive strategies. The aim of this study was to analyze the individual/lifestyle determinants of fractures across pediatric age groups.MethodsA cross-sectional study was performed in the first six months of 2008 through questionnaire on a sample of children from an outpatient clinic for pediatric fractures. Differences in gender, anatomic site, circumstances and location of fracture occurrence, behavioural lifestyle, and calcium intake were investigated among three different age classes (pre-school children, school children, and adolescents).ResultsThe sample consisted of 382 subjects (2-14 years of age) sustaining a fracture after low or moderate trauma. Males were at a higher risk of fractures than females; greater than two-thirds of injuries occurred after low-energy trauma and the upper limb was more frequently involved. With increasing age, the male/female ratio and time spent in sports participation increased (p < 0.001), while calcium intake and time spent in sedentary behaviors decreased (p < 0.001 and < 0.003, respectively). Gender discordance existed in pre-school children with respect to the anatomic location, and in school children and adolescents with respect to the dynamics. In the adolescent group, males were more physically active and also more sedentary than females. Fractures most frequently occurred in homes (41.6%), followed by playgrounds and footpaths (26.2%), sports facilities (18.3%), and educational facilities (13.9%), with gender differences existing only in adolescence. Twenty-three percent of the subjects sustained one or more fractures in the past. The percentage of recurrent fractures increased with age (p = 0.001), with a similar trend in both genders.ConclusionsGender differences were shown in the prevalence of injuries, characteristics, and circumstances across ages. These differences may be explained by the related changes in behaviors, together with attending different places. Individual and lifestyle factors can in part explain the variability in the occurrence of fractures and can also address targeted preventive strategies.

Management of Female Sexual Problems: Perceived Barriers, Practice Patterns, and Confidence among Primary Care Physicians and Gynecologists

Although approximately 40% of women report female sexual problems--and particularly sexual desire disorders, there are numerous practical, professional, and personal barriers to their diagnosis and management by treating clinicians. To identify practice patterns, perceptions, and barriers to the diagnosis and management of female sexual problems among U.S. practicing primary care physicians (PCPs) and obstetrician/gynecologists (OB/GYNs). A random sample of practicing U.S. PCPs and OB/GYNs were sent a case-vignette survey by e-mail and fax. Response to the survey was considered consent. A regression model was analyzed to assess predictors of confidence. Frequency and variability in diagnostic tests ordered and treatment recommendations provided for a patient with diminished sexual desire. Percent of physicians who reported they were confident in treating hypoactive sexual desire disorder (HSDD) and percent who reported significant barriers to initiating a dialogue about sexual health with female patients. A total of 505 responses were analyzed (8.8% response rate). Of respondents, 21% of OB/GYNs and 38% of PCPs stated they were not at all confident in treating HSDD. The majority of physicians would order a thyroid panel (PCP = 63%, OB/GYN = 53%) to assess a patient's diminished desire and recommended counseling and stress management to treat a patient with sexual complaints (PCP = 48%, OB/GYN = 54%). Regression results identified time constraints, the perceived lack of effective therapies, perceptions regarding patient-physician gender discordance, years in practice, number of patients seen per week, and perceptions regarding continuing medical education and practice experience as significant and independent predictors of confidence in treating HSDD patients.