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1.
Michael R. Kauth Janelle Marra Zander Keig Jillian C. Shipherd 《Current Sexual Health Reports》2017,9(3):121-127
Purpose of the Review
Health care for transgender veterans in the United States (U.S.) Veterans Health Administration (VHA) is relatively new and for active duty service members (ADSMs) in the military is quite recent. Prevalence of transgender veterans and ADSMs, health conditions, and healthcare provision in VHA and military facilities are reviewed.Recent Findings
There are approximately 134,300 transgender veterans and 15,000 ADSMs. Based on diagnostic codes, more than 5000 transgender veterans receive care in VHA. Transgender veterans experience higher rates of most mental and physical health conditions compared to non-transgender veterans. Comprehensive health care is provided at VHA facilities, except surgical interventions for gender confirmation, and is beginning to be provided in military facilities.Summary
While VHA and military facilities have increased access to health care for transgender veterans and ADSMs, determining outcomes of care is premature. Healthcare delivery efforts alone are unlikely to erase health disparities experienced by this group.2.
Purpose of Review
The goal of this paper is to give current understanding of non-binary/genderqueer identities, non-binary mental health trends and identity development, unique experiences of non-binary individuals, and recommendations for clinicians and researchers.Recent Findings
About one third of individuals who identify as transgender primarily identify as non-binary. Recent studies found that non-binary people are at higher risk for suicide, experience more psychological distress, and experience higher levels of depression and anxiety. New studies on identity development of non-binary individuals provide explicit and fluid understandings of gender identity development outside of male/female, man/woman, and boy/girl.Summary
Overall, little research is focused on non-binary individuals even though non-binary people make up a significant portion of the transgender community and experience even greater negative mental health risks. Non-binary people face several challenges in a society that is structured around binary gender identities. We encourage psychologists to challenge the dominant binary assumption about gender and create environments that include and affirm non-binary individuals.3.
Purpose of Review
Phalloplasty may be performed in patients with acquired or congenital penile insufficiency or transgender individuals who desire phallic construction. Demand for neophallus creation and prosthesis placement has increased in recent years with growing coverage for gender affirming surgery among transgender patients. This report describes consideration of prosthetic implantation in neophallic reconstruction.Recent Findings
Prosthesis implantation in a neophallus requires special consideration regarding avoidance of critical structures, proximal prosthesis anchoring, and distal cushioning in patients without native corpora cavernosa. Neophallus prostheses are associated with increased risk of infection, extrusion, erosion, and device migration relative to standard prostheses, with a high revision rate.Summary
Implanters should have a thorough understanding of neophallic reconstructive technique prior to proceeding with device placement. Current literature on this subject consists predominantly of retrospective reviews and case reports with variable outcome measures. The creation of validated assessment tools will provide more meaningful data to inform provider counseling and patient expectations.4.
Martin Caillet Sarah O’Neill Anne-Frédérique Minsart Fabienne Richard 《Current Sexual Health Reports》2018,10(2):44-49
Purpose of Review
To describe the multidisciplinary approach of the Brussels-based referral center, one of the two centers for women living with female genital mutilation (FGM) in Belgium. This approach is contextualized and compared to the latest literature on the subject.Recent Findings
According to the World Health Organization, women who have undergone FGM should be able to benefit from multidisciplinary care. Clitoral reconstructive surgery appears to be a crucial but controversial element of this holistic treatment; its long-term benefits and role in sexual satisfaction are still the focus of many questions.Summary
Clitoral reconstructive surgery has been reimbursed by Belgian social security since 2014 only in conjunction with multidisciplinary care. In our referral center, the care is provided by a gynecologist, a midwife, a psychotherapist, and a sexologist. Five preoperative consultations are mandatory to obtain the refund. CeMaVie’s first line of treatments is non-surgical therapies.5.
Background
With increasing pressure on health care resources, it is necessary to demonstrate that new treatments are both effective and cost effective.Objective
The purpose of this study was to assess the cost effectiveness of pimecrolimus (Elidel) compared to usual therapy in the treatment of both adults and children with atopic eczema in Canada.Methods
Analysis was performed using a decision model which estimated the incremental cost per quality adjusted life year (QALY) gained from both a societal and health care perspective.Results
For children, Elidel leads an incremental cost per QALY of $38,000 from a societal perspective. For adults, the incremental cost per QALY was $35,000.Conclusion
Elidel will lead to an overall increase in costs but with an improvement in clinical outcomes. The cost effectiveness ratios for Elidel were consistently below $50,000 per QALY gained. Given previous funding decisions in Canada, Elidel may be considered a cost-effective use of health care resources.6.
Purpose of Review
Sexual and gender minority (SGM) populations, including lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals, continue to experience significant health and healthcare disparities. One mechanism proposed to address these disparities is improving the education of healthcare professionals. This narrative review summarizes recent trends specifically in medical education related to LGBTQ/SGM populations and highlights examples of curricular innovations.Recent Findings
Efforts are described in all levels of medical education. The predominant contributions to literature include documenting the current state of education and patient care, including further defining gaps. There are many reports of educational efforts in various institutions, with reports of outcomes mostly in the domain of activity acceptability and learner self-efficacy. Interventions have been developed by both faculty and learners with broad acceptability and perceived value.Summary
Existing publications continue to point out needed research in LGBTQ/SGM medical education. We also identify areas for additional innovation efforts.7.
K. Herberger K. Heyer K. Protz A. Mayer J. Dissemond S. Debus T. Wild J. Schmitt M. Augustin Konsensusgruppe 《Der Hautarzt; Zeitschrift für Dermatologie, Venerologie, und verwandte Gebiete》2017,68(11):896-911
Background
Standards in the assessment and documentation of disease processes are the basis of guideline-based care. For the treatment of chronic wounds, especially leg ulcers, no approved parameters are available.Objectives
Against this background, our aim was to develop standards for the documentation of leg ulcer in routine care. This article presents the recommendations for the classification and characteristics of the variables.Materials and methods
The development of the documentation standard was based on a systematic literature research and was performed in a Delphi-based consensus process. The national consensus process included meetings as well as web-based questionnaires. The Consensus Group is coordinated by the German Center for Health Services Research in Dermatology (CVderm).Results
The documentation standards and their variables for leg ulcer routine care were developed in seven meetings of the consensus group. The consensus group consists of 38 delegates of wound care societies, health insurances, wound networks and associations.Discussion
For each variable, recommended in routine care, a distinct response scheme (defined set of variable characteristics) was defined. As a next step, a structured implementation process is required, which was part of the resolutions of the consensus group.8.
Background
While skin cancer incidence is rising throughout Europe, general practitioners (GP) feel unsure about their ability to diagnose skin malignancies.Objectives
To evaluate whether the GP has sufficient validated clinical decision aids and tools for the examination of potentially malignant skin lesions.Methods
We conducted a review searching Medline and the Cochrane Library. In addition, reference lists and personal archives were examined. Outcome measures were sensitivity and specificity but also the advantages and disadvantages of different clinical decision aids and tools.Results
No clinical decision aids or tools for the examination of non-pigmented lesions are available. Clinical decision aids and tools for the examination of pigmented lesions have mostly been studied in secondary care and, in primary care, randomised clinical trials comparing the additional value of a clinical decision aid or tools to care are scarce.Conclusion
Sufficiently validated clinical decision aids and tools for the examination of potentially malignant skin lesions are lacking in general practice. The clinical decision aids and tools available in primary care need to be studied.9.
Background
Psoriasis is a multifactorial disease involving both genetic predisposition and external triggers, resulting in epidermal and immune dysfunctions. Regardless of the severity of the disease, patients require additional basic topical treatment with emollients. Basic skin care products are well known for their role in moisture retention and symptom control in psoriasis, yet patients underuse them. Dry skin and cutaneous inflammation are associated with an impaired epidermal barrier function. This breakdown of the skin barrier causes the release of proinflammatory mediators that exaggerate inflammation.Objectives
to provide recommendations for the use of emollients (including ceramides, urea, keratolytic agents, zinc salts, niacinamide), thermal water and skin care products in psoriasis.Methods
A review of the current literature from 2000 to 2012 using Medline and Ovid was performed by a working group of five European Dermatologists with clinical and research experience in psoriasis.Results
Either alone or used adjunctively, basic topical therapy can restore and protect skin barrier function, increase remission times between flare-ups and enhance the effects of pharmaceutical therapy.Conclusion
We provide physicians with a tool to assist them in implementing basic skin care in an integrated disease management approach.10.
Background
Psoriasis is a chronic skin disorder which negatively impacts a patient’s quality of life (QoL).Arecently published assessment tool, PsoDisk, has been proposed to evaluate patient’s QoL.Objective
The aim of this study was to test PsoDisk as a QoL assessment tool in psoriatic patients undergoing treatment with adalimumab.Methods
A retrospective, monocentric study, including patients who completed at least 48 weeks of both adalimumab therapy and PsoDisk assessment. PASI was assessed by the physician whereas the PsoDisk test was self-performed by the patient. Both were evaluated at each control visit throughout the study-period in order to detect changes in disease severity and the impact of quality of life, respectively.Results
In total, we evaluated 31 patients selected from our database. At baseline, all aspects of patients’ psycho-emotional and social lives were impaired. PASI score reduction correlated with a PsoDisk score decrease (r = 0.97; p = 0.02), reflecting an overall improvement of patient’s QoL.Conclusion
PsoDisk was found to be easy to administer and intuitive for interpreting clinical results.11.
Background
Chronic spontaneous urticaria (CSU) is a skin disease characterised by wheal appearance, swelling, itching, and painful skin. Omalizumab has been used for CSU treatment demonstrating good efficacy.Objectives
To investigate the efficacy and safety of omalizumab treatment in CSU patients in real-life practice.Materials & methods
A retrospective analysis was performed on 38 patients suffering from CSU who received 300 mg of omalizumab every four weeks.Results
After omalizumab treatment, 68.4% of patients showed a complete response (UAS7 = 0). All the patients were able to stop treatment with corticosteroids, cyclosporine, and anti-leukotrienes, and only 39.5% of patients remained on anti-histamines. Omalizumab treatment led to a 96% and 65% decrease in emergency room and primary health care visits, respectively, as well as a reduction in the direct costs associated with the disease. No omalizumab-related adverse events were reported.Conclusion
Omalizumab exhibits good efficacy in alleviating the symptoms of CSU, leads to a decrease in concomitant medication use, restores patients’ quality of life, and has economic benefits by reducing disease-related health care costs.12.
Sarah C. Krzastek J. Tyler RosemanII Ryan P. Smith Raymond A. Costabile 《Current Sexual Health Reports》2018,10(4):333-338
Introduction
Scrotal reconstruction may be required in any setting where the patient sustains loss of a large area of scrotal or penile skin, as in repair of scrotal lymphedema and the adult acquired buried penis. Massive scrotal lymphedema and adult acquired buried penis are two conditions closely linked to obesity and are largely refractory to non-operative management. The demand for surgical repair of these conditions is increasing.Purpose of Review
The aim of this article is to provide an overview of the preoperative considerations, surgical techniques, and postoperative outcomes in the repair of scrotal lymphedema and adult buried penis.Recent Findings
Scrotal lymphedema and adult buried penis are associated with significant medical comorbidities and can cause sexual and urinary dysfunction. Surgical repair requires a multidisciplinary approach. Skin grafts are often required. There is no consensus regarding optimal postoperative management of these surgical wounds. Consideration should be given to extended duration chemical prophylaxis of thromboembolic events. Though complications are common, patient quality of life is significantly improved following repair.Summary
The demand for surgical repairs of scrotal lymphedema and adult buried penis are increasing. Though patients have significant comorbidities and surgical repair may be complex, patient outcomes are good and quality of life can be greatly improved.13.
Background
Melanocytic tumours which colonise basal cell carcinomas (BCC) may be considered as either lentigo maligna (LM) (in situ) or invasive melanomas.Objectives
To highlight the diagnostic approach and long-term prognosis of LM which colonises BCC.Materials and methods
Using Satter et al.’s classification, we identified a case of BCC colonised by LM and reviewed similar cases in the literature with long-term follow-up.Results
In the absence of melanocytic extension beyond the lamina propria of theBCCcompartment, mixed tumours may be considered as LM colonising the BCC, allowing for less invasive surgery. The absence of long-term relapse in our short series supports this diagnosis, rather than invasive melanomas.Conclusion
Our case report, review of the literature, and series follow-up illustrate the most recent assessment of melanocytic/BCC tumours, and guide the physician and the pathologist in their recognition and classification, thus allowing them to make the most appropriate therapeutic decisions.14.
Annarita?Panebianco Francesca?Sampogna Maria?Luisa?Iemboli Luciano?Sobrino Elisabetta?Andreoli Valeria?Antinone Cinzia?Mazzanti Damiano?Abeni
Background
The psychosocial impact of skin conditions is usually evaluated in research settings.Objectives
To define predictors that can be used by dermatologists to refer patients for psychological consultation or psychotherapy using a simple screening instrument.Materials & Methods
A questionnaire to evaluate possible anxiety and depression (12-item General Health Questionnaire [GHQ-12]) was routinely used over a period of two months in an Italian dermatological reference centre.Results
Of 651 patients, 508 (78%) completed the GHQ-12. Of the total sample, 35.2% scored 4 or more (psychological consultation suggested), and 15.7% scored 7 or more (psychological consultation recommended). Probable depression or anxiety was more frequent in women than in men, in patients born in foreign countries, and in patients with leg ulcers, pemphigoid, and psoriasis.Conclusion
Our results indicate that a simple instrument may be useful for dermatologists to detect patients at risk of psychological problems and subsequently refer them for psychological consultation.15.
Won?Joo?Kwon Joo?Yeon?Ko Young?Suck?Ro Myung?Hwa?Kim Byung?Soo?Kim Hye?One?Kim Jae?Hui?Nam Ga-Young?Lee Mi?Youn?Park Sang?Wook?Son Jun?Mo?Yang Dong?Hun?Lee Ai?Young?Lee Jun?Young?Lee Sung?Eun?Chang Hae?Young?Choi Eun?Joo?Park
Background
A comparison between responses to allergens based on the TRUE Test® (TT) and IQ® Chamber (IQC) in Europeans has been previously reported, however, no such study has been performed in Asians.Objectives
To compare allergen responses using the TT and IQC (using the Korean standard series) in order to gather more information regarding the positive response rates for each allergen and the clinical value of IQC.Materials & methods
Suspected contact dermatitis patients were enrolled and tested with 18 allergens using the TT and IQC.Results
The test was performed in 214 patients. Simultaneous positive results for both tests were recorded in 242 cases (positive concordance rate: 66.7%). IQC yielded more positive results. Allergens with a high positive concordance rate were nickel sulphate (82.1%), thimerosal (78.6%), and p-phenylenediamine (73.3%). IQC mostly showed similar or higher positive rates than TT, with high concordance.Conclusions
We recommend the IQC method as a screening test in patients with suspected contact dermatitis. To compensate for possible false positive results, careful history taking and a different patch test should be performed when appropriate.16.
Mazen?Kurban Savo?Bou?Zeineddine Lamiaa?Hamie Remi?Safi Ossama?Abbas Abdul?Ghani?Kibbi Fadi?Bitar Georges?Nemer
Background
Cardio-facio-cutaneous syndrome (CFC), Noonan syndrome (NS), and Costello syndrome are a group of diseases that belong to the RASopathies. The syndromes share clinical features making diagnosis a challenge.Objectives
To investigate the phenotype and genotype of a 10-year-old Iraqi girl with overlapping features of CFC, NS, and Costello syndromes, with additional features of ectodermal dysplasia.Materials & methods
DNA was examined by exome sequencing and protein expression by immunohistochemistry.Results
Exome sequencing identified a mutation in the SOS1 gene and a de novo deletion in the FOXI2 gene whichwas neither present in the international databases, nor in 400 chromosomes from the same population. Based on immunohistochemical staining, FOXI2was identified in the basal cell layer of the skin and overlapped with the expression of P63, a major player in ectodermal dysplasia.Conclusion
We therefore suggest screening for FOXI2 mutation in the setting of ectodermal features that are not associated with genes known to contribute to ectodermal dysplasia.17.
Caroline?Schell Ramona?Schleich Florian?Walker Amir?S.?Yazdi Holger?Lerche Martin?R?cken Detlef?Axmann Kamran?Ghoreschi
Background
Restless legs syndrome (RLS) is characterized by unpleasant sensations in the legs and an uncontrollable urge to move them in order to gain relief. Higher frequencies of RLS have been reported in systemic lupus, multiple sclerosis, rheumatoid arthritis and atopic dermatitis.Objectives
Since the disease-related stress present in psoriasis is similar to the stress of those diseases, we aimed to study the frequency of RLS in a German cohort of patients with psoriasis.Methods
300 patients with psoriasis and 300 healthy controls were evaluated for RLS symptoms in this study.Results
While 17% (n = 51) of patients with psoriasis reported symptoms of RLS, only 4% (n = 12) of individuals without psoriasis suffered from RLS symptoms (95% confidence interval: 0.08–0.18, p<0.01). In patients with psoriasis and RLS the average RLS score was 16.0 ± 9.2 whereas individuals with RLS in the control group had an average RLS score of 13.5 ± 7.1.Conclusions
Our findings indicate an increased frequency of RLS in patients with psoriasis, suggesting screening patients with psoriasis for the presence of RLS as a well-treatable co-morbidity.18.
Richard Green 《Current Sexual Health Reports》2017,9(2):79-83
Purpose of Review
Review evidence in the controversial management of prepubertal gender dysphoric children where some clinicians and parents advocate transition to live as a child of the non-natal sex.Recent Findings
Earlier reports, primarily of males, demonstrated that most cross-gender behaving children, with what was called Gender Identity Disorder, matured into gay or lesbian adults, and only a small minority were transgender. However, recent practice by some clinicians advocates gender transition for prepubertal children believed to be sufficiently gender dysphoric to live as the non-natal sex. Can the subgroups be distinguished for this decision to be made? Can clinical judgment result in short term and longer term benefit to those who transition? Are there risks to facilitating gender transition as well as efforts to promote more comfort with natal sex?Summary
Many unknowns pervade the advocacy of transitioning prepubertal gender dysphoric children and the advocacy of promoting more comfort with natal sex. Complex research designs will help answer these questions.19.
Amy L. Gower G. Nic Rider Barbara J. McMorris Marla E. Eisenberg 《Current Sexual Health Reports》2018,10(4):246-254
Purpose of Review
This paper examines recent research on bullying victimization among lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth to identify critical issues and advocate for future research priorities.Recent Findings
Recent studies have begun to document the importance of bullying in general, and bias-based bullying (rooted in stigma) in particular, on the health and well-being of this vulnerable subgroup of adolescents, as well as drivers of disparities. Current research demonstrates the importance of multiple, overlapping identities, key difference among LGBTQ youth, and the role of protective factors for youth who are the targets of bullying.Summary
Researchers, clinicians, and those working with and on behalf of LGBTQ youth must measure and acknowledge the multiple reasons for which LGBTQ youth are the targets of bullying. Intervention and prevention efforts should focus on improving the supportiveness of the climates within which LGBTQ youth live.20.