scholarly journals Risk of Venous Thromboembolism in Transgender People Undergoing Hormone Feminizing Therapy: A Prevalence Meta-Analysis and Meta-Regression Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Maria Totaro ◽  
Sara Palazzi ◽  
Chiara Castellini ◽  
Antonio Parisi ◽  
Federica D’Amato ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Hormone Therapy ◽  
Estrogen Therapy ◽  
Prevalence Estimate ◽  
Cochrane Library ◽  
Transgender People ◽  
Trans People ◽  
Pooled Prevalence ◽  
Large Heterogeneity ◽  
Meta Regression

BackgroundAlthough venous thromboembolism (VTE) is a recognized side effect of some formulations of estrogen therapy, its impact in transgender people remains uncertain. The aim of this study was to define pooled prevalence estimate and correlates of VTE in Assigned Males at Birth (AMAB) trans people undergoing gender affirming hormone therapy.MethodsA thorough search of MEDLINE, COCHRANE LIBRARY, SCOPUS and WEB OF SCIENCE databases was carried out to identify suitable studies. Quality of the articles was scored using the Assessment Tool for Prevalence Studies. Data were combined using random effects models and the between-study heterogeneity was assessed by the Cochrane’s Q and I2.ResultsThe eighteen studies included gave information about 11,542 AMAB undergoing gender affirming hormone therapy. The pooled prevalence of VTE was 2% (95%CI:1-3%), with a large heterogeneity (I2 = 89.18%, P<0.0001). Trim-and-fill adjustment for publication bias produced a negligible effect on the pooled estimate. At the meta-regression analysis, a higher prevalence of VTE was significantly associated with an older age (S=0.0063; 95%CI:0.0022,0.0104, P=0.0027) and a longer length of estrogen therapy (S=0.0011; 95%CI:0.0006,0.0016, P<0.0001). When, according to the meta-regression results, the analysis was restricted to series with a mean age ≥37.5 years, the prevalence estimate for VTE increased up to 3% (95%CI:0-5%), but with persistence of a large heterogeneity (I2 = 88,2%, P<0.0001); studies on younger participants (<37.5 years) collectively produced a pooled VTE prevalence estimate of 0% (95%CI:0-2%) with no heterogeneity (I2 = 0%, P=0.97). Prevalence estimate for VTE in series with a mean length of estrogen therapy ≥53 months was 1% (95%CI:0-3%), with persistent significant heterogeneity (I2 = 84,8%, P=0.0006); studies on participants subjected to a shorter length of estrogen therapy (<53 months), collectively produced a pooled VTE prevalence estimate of 0% (95%CI:0-3%) with no heterogeneity (I2 = 0%, P=0.76).ConclusionsThe overall rate of VTE in AMAB trans people undergoing gender affirming hormone therapy was 2%. In AMAB population with <37.5 years undergoing estrogen therapy for less than 53 months, the risk of VTE appears to be negligible. Further studies are warranted to assess whether different types and administration routes of estrogen therapy could decrease the VTE risk in AMAB trans people over 37.5 years subjected to long-term therapy.Systematic Review Registration[https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42021229916].

scholarly journals Prevalence of extra-articular manifestations in patients with ankylosing spondylitis: a systematic review and meta-analysis

2013 ◽  
Vol 74 (1) ◽  
pp. 65-73 ◽  
Author(s):  
Carmen Stolwijk ◽  
Astrid van Tubergen ◽  
José Dionisio Castillo-Ortiz ◽  
Annelies Boonen
Keyword(s):  
Ankylosing Spondylitis ◽  
Meta Analysis ◽  
Geographical Area ◽  
Cochrane Library ◽  
Pooled Prevalence ◽  
Prevalence Estimates ◽  
Large Heterogeneity ◽  
Inflammatory Bowel ◽  
Substantial Heterogeneity ◽  
Summary Data

ObjectivesUveitis, psoriasis and inflammatory bowel disease (IBD) are common extra-articular manifestations (EAM) in patients with ankylosing spondylitis (AS); however, summary data of reported prevalence are lacking. The aim of the present study was to summarise the prevalence of EAMs among patients with AS and to identify underlying factors to explain potential heterogeneity of prevalence.MethodsA systematic literature search was performed (Medline, Embase and Cochrane Library) to identify relevant articles. Risk of bias was assessed and data were extracted. Pooled prevalences were calculated. Potential sources of any observed clinical or methodological heterogeneity in the estimates were explored by subgroup and metaregression analysis.ResultsIn the 156 selected articles, 143 reported the prevalence of uveitis (44 372 patients), 56 of psoriasis (27 626 patients) and 69 of IBD (30 410 patients). Substantial heterogeneity was observed in prevalence estimates among all EAMs (I2=84–95%). The pooled prevalence of uveitis was 25.8% (95% CI 24.1% to 27.6%), and was positively associated in multivariable metaregression with disease duration (β 0.05, 95% CI 0.03 to 0.08) and random selection of patients (β −0.24, 95% CI −0.43 to −0.04). The pooled prevalence of psoriasis was 9.3% (95% CI 8.1% to 10.6%). The pooled prevalence of IBD was 6.8% (95% CI 6.1% to 7.7%) and was positively associated with the percentage of women in the studies (β 0.02, 95% CI 0.00 to 0.03). Geographical area was associated in multivariable metaregressions with prevalence of all EAMs.ConclusionsEAMs are common in patients with AS. The large heterogeneity between studies can be partly explained by differences in clinical as well as methodological characteristics.

scholarly journals The prevalence, risk factors, and prognostic value of venous thromboembolism in ovarian cancer patients receiving chemotherapy: a systematic review and meta-analysis

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Lu Ye ◽  
Li Cai ◽  
Yonghui Fu ◽  
Debao Zhuang ◽  
Xiaoqing Hu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ovarian Cancer ◽  
Venous Thromboembolism ◽  
Publication Bias ◽  
Prognostic Value ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Tumor Diameter ◽  
Funnel Plot ◽  
Pooled Prevalence

Abstract Background Venous thromboembolism (VTE) in ovarian cancer (OC) patients has been widely investigated, but our knowledge on the role of VTE in OC patients receiving chemotherapy is limited. The aim of our study was to investigate the prevalence, risk factors, and prognostic value of chemotherapy-associated VTE in OC. Methods Three databases (PubMed, Embase, and the Cochrane Library) were systematically searched from inception to October 14, 2020. The primary outcome was the prevalence of VTE in OC patients receiving chemotherapy. The risk factors and prognostic value of VTE were the secondary outcomes. The pooled prevalence of VTE was estimated using the generic inverse-variance method. The statistical heterogeneity was evaluated with Cochran’s Q test and I2 statistic. Funnel plot, Begg’s test, and Egger’s test were used to assess the potential publication bias in the meta-analysis. Results A total of eleven observational studies with 4759 OC patients were included. The pooled prevalence of VTE was 9% (95% CI, 0.06–0.12) in OC patients receiving chemotherapy. The results of subgroup analysis and sensitivity analysis were basically consistent with the overall pooled estimate. Multiple significant risk factors associated with VTE were also identified including advanced age, D-dimer > 0.5 mg/mL, and tumor diameter > 10 cm. Only two included studies reported the prognostic value of VTE in OC patients receiving chemotherapy, but with inconsistent results. Funnel plot showed that there existed potential publication bias, which was further verified by statistical test, but the results of the trim-and-fill method showed the pooled estimate kept stable after adding two “missing” studies. Conclusions This current study revealed that the pooled prevalence of chemotherapy-related VTE in OC was approximately 9% in OC patients. Risk factors for chemotherapy-related VTE were also identified which may contribute to targeting potentially preventative measures for VTE in OC.

scholarly journals Adjustment of gender identity and consequences on employment rights

2020 ◽  
Vol 54 (4) ◽  
pp. 1363-1381
Author(s):  
Slobodanka Kovačević-Perić
Keyword(s):  
Human Rights ◽  
Gender Identity ◽  
Hormone Therapy ◽  
Birth Certificate ◽  
Transgender People ◽  
Health Institution ◽  
Medical Interventions ◽  
Work Placement ◽  
Trans People ◽  
Employment Rights

The gender identity of every person represents an integral part of their personality and belong to one of the basic aspects of self-definition, dignity and freedom. A certain number of people do not identify themselves with the sex allotted to them at birth, a problem arising regarding their inner comprehension of gender (self-defining), which does not correlate to the sex. Those people are called trans people. In this paper, the author examines the position of trans people i.e. individuals of different gender identity through the prism of the realization and protection in the field of labour rights and the rights arising from employment. Trans people belong to one of the most vulnerable (most discriminated) groups within society - discrimination is most evident in case of seeking a work placement and during employment, while the key performers are the state and its institutions. It could be said that conditioning and interdependence between the legal procedure of adjustment of gender identity and medical interventions, leave the legal and life status of a transgender person in "vacuum", which leads to the situation of gender identity being the grounds for further transphobia and discrimination of transgender people in all the aspects of human rights realization. However, in the procedure of further adjustment of gender identity, a transgender person can be registered in the birth certificate register, they can change their personal documents only based on the certificate of a health institution that they have been through a psychological check-up and a year-long hormone therapy prescribed by an endocrinologist. In practice, such regulations put "on hold" the personal status of a transgender person, which leads to the discrimination of transgender people based on gender identity, especially in the phase of transition, when the changes are visible but non-compliant with the sex verified in personal documents. Therefore, it is crucial that, instead of partial amendments to certain laws, an umbrella law (lex specialis) be adopted - Law on Gender identity

Abstract MP65: Transgender Adolescents Have High Prevalence Of Atherosclerotic Cardiovascular Disease Risk Factors Before And After Taking Hormone Therapy For 1 Year

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Ambur M Staab ◽  
Amy M Cizik ◽  
Nicole L Mihalopoulos
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Hormone Therapy ◽  
Disease Risk ◽  
Estrogen Therapy ◽  
The United States ◽  
Normal Weight ◽  
Atherosclerotic Cardiovascular Disease ◽  
Transgender People ◽  
Ascvd Risk

Introduction: The United States has a growing population of transgender adolescents aged 12-21y presenting for medical transition via gender affirming hormone therapy (HT). Transgender people do not identify with their sex assigned at birth while cisgender people do. HT involves estrogen for trans females, those who identify as female, and testosterone for trans males, those who identify as male. Initiation of HT is beginning in adolescence and is a lifelong commitment for many transgender individuals. Little is known about how HT affects ASCVD risk factors in transgender adolescents. Studies of cisgender adults show cardioprotective effects of estrogen, and an estimated 37% of normal-weight cis gender adolescents have at least 1 ASCVD risk factor; but little investigation exists for transgender people, especially adolescents. Although some studies involving the transgender population have reproducible results, few include adolescents and comparison to acceptable ASCVD risk factor profiles. Guidelines for transgender health recommend laboratory assessment before starting HT and annually. This study expands on current knowledge and informs clinical practice by comparing ASCVD risk biomarkers of transgender adolescents taking HT to acceptable clinical values for adolescents. Hypothesis: Estrogen therapy for trans females will ameliorate ASCVD risk factors while testosterone therapy for trans males will worsen ASCVD risk factors. Methods: Retrospective chart review identified 300 transgender patients receiving HT at an academic adolescent medicine gender clinic. Of those 300, 50 trans female and 50 trans male were randomly selected for evaluation of ASCVD risk parameters at baseline and 1 year after initiating HT. ASCVD risk factors were compared to the International Diabetes Federation guidelines for metabolic syndrome. Parameters included lipids, glucose, and blood pressure. BMI ≥30 was used as proxy for obesity. Results: At baseline, at least one abnormal value was found for 50% (n=25, of these 5 had obesity) of trans females and 66% (n=33, of these 13 had obesity) of trans males. At 1 year, at least one abnormal value was found for 30% (n=15) of trans females and 70% (n=35) of trans males. At baseline, 50% (n=25) of trans females and 82% (n=41) of trans males, and at 1 year 20% (n=10) of trans females and 48% (24) of trans males had all parameters measured. Paired t-tests (α=.05) showed no significant change in ASCVD risk factors for trans females, and significant decrease in HDL and significant increase in BMI for trans males after 1 year of HT. Conclusions: The prevalence of having at least 1 ASCVD risk factor is greater among transgender adolescents than normal weight cisgender adolescents. HT may worsen HDL and BMI for trans males. We recommend baseline parameters for all and follow up and lab surveillance for patients with abnormal baseline parameters.

scholarly journals Mapping evidence on the effects of gender-affirming hormone therapy on the hard and soft tissues of the craniofacial complex in transgender people: a protocol for a scoping review

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
M. F. Van den Bosch ◽  
C. M. Wiepjes ◽  
M. Den Heijer ◽  
L. J. Schoonmade ◽  
R. E. G. Jonkman ◽  
...  
Keyword(s):  
Systematic Review ◽  
Scoping Review ◽  
Soft Tissues ◽  
Grey Literature ◽  
Cochrane Library ◽  
Sex Characteristics ◽  
Transgender People ◽  
Link Type ◽  
Scoping Reviews ◽  
Craniofacial Complex

Abstract Background Gender-affirming hormone (GAH) therapy aims to support the transition of transgender people to their gender identity. GAHs can induce changes in their secondary sex characteristics such as the development of breasts in transgender females and increased muscle mass in transgender males. The face and its surrounding tissues also have an important role in gender confirmation. The aim of this scoping review is to systematically map the available evidence in order to provide an overview of the effects of GAH therapy on the hard and soft tissues of the craniofacial complex in transgender people. Methods/design The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA) extension for Scoping Reviews was consulted for reporting this protocol. The methods were based on the Arksey and O’Malley’s framework and the Reviewer’s Manual of the Joanna Briggs Institute for conducting scoping reviews. Ten transgender people were involved in the development of the primary research question through short interviews. The eligibility criteria were defined for transgender people undergoing GAH therapy and for quantitative and qualitative outcomes on the hard and soft tissues of the craniofacial complex. Eligible sources of evidence include observational, experimental, qualitative, and mixed method studies. No exclusion criteria will be applied for the language of publication and the setting. To identify eligible sources of evidence, we will conduct searches from inception onwards in PubMed, Embase.com, the Cochrane Library, Web of Science Core Collection, Scopus, CINAHL, LIVIVO, and various grey literature sources such as Google Scholar. Two reviewers will independently select eligible studies in these information sources and will subsequently conduct data extraction. The same operators will chart, categorize, and summarize the extracted data. A narrative summary of findings will be conducted. Frequency counts of quantitative and qualitative data on items such as concepts, populations, interventions, and other characteristics of the eligible sources will be given. Where possible, these items will be mapped descriptively. Discussion We chose the scoping review over the systematic review approach, because the research questions are broad-spectrum and the literature is expected to be widely scattered. No systematic review has previously assessed this topic. Identifying knowledge gaps in this area and summarizing and disseminating research findings are important for a wide spectrum of stakeholders, in particular, for transgender people who want to undergo additional interventions such as plastic or orthognathic surgery or orthodontics. Systematic review registration This protocol was registered in the Open Science Framework: https://osf.io/e3qj6

scholarly journals The Rheumatology Drugs for COVID-19 Management: Which and When?

2021 ◽  
Vol 10 (4) ◽  
pp. 783
Author(s):  
Fabiola Atzeni ◽  
Ignazio Francesco Masala ◽  
Javier Rodríguez-Carrio ◽  
Roberto Ríos-Garcés ◽  
Elisabetta Gerratana ◽  
...  
Keyword(s):  
English Language ◽  
Multidisciplinary Approach ◽  
Intravenous Immunoglobulins ◽  
Cochrane Library ◽  
Immunomodulatory Drugs ◽  
Antiviral Therapies ◽  
Tnf Α ◽  
Large Heterogeneity ◽  
Necrosis Factor ◽  
Game Changer

Introduction: While waiting for the development of specific antiviral therapies and vaccines to effectively neutralize the SARS-CoV2, a relevant therapeutic strategy is to counteract the hyperinflammatory status, characterized by an increase mainly of interleukin (IL)-1β, IL-2, IL-6, IL-7, IL-8, and tumor necrosis factor (TNF)-α, which hallmarks the most severe clinical cases. ‘Repurposing’ immunomodulatory drugs and applying clinical management approved for rheumatic diseases represents a game-changer option. In this article, we will review the drugs that have indication in patients with COVID-19, including corticosteroids, antimalarials, anti-TNF, anti-IL-1, anti-IL-6, baricitinib, intravenous immunoglobulins, and colchicine. The PubMed, Medline, and Cochrane Library databases were searched for English-language papers concerning COVID-19 treatment published between January 2020 and October 2020. Results were summarized as a narrative review due to large heterogeneity among studies. In the absence of specific treatments, the use of immunomodulatory drugs could be advisable in severe COVID-19 patients, but clinical outcomes are still suboptimal. An early detection and treatment of the complications combined with a multidisciplinary approach could allow a better recovery of these patients.

scholarly journals The prevalence of diabetes in Afghanistan: a systematic review and meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sohail Akhtar ◽  
Jamal Abdul Nasir ◽  
Amara Javed ◽  
Mariyam Saleem ◽  
Sundas Sajjad ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Methodological Quality ◽  
Meta Analysis ◽  
Population Based ◽  
Included Study ◽  
Cochrane Library ◽  
Or Education ◽  
Meta Regression

Abstract Background The aim of this paper is to investigate the prevalence of diabetes and its associated risk factors in Afghanistan through a systematic review and meta–analysis. Methods A comprehensive literature search was conducted using EMBASE, PubMed, Web of Sciences, Google Scholar and the Cochrane library, carried out from inception to April 312,020, without language restriction. Meta–analysis was performed using DerSimonian and Laird random-effects models with inverse variance weighting. The existence of publication bias was initially assessed by visual inspection of a funnel plot and then tested by the Egger regression test. Subgroup analyses and meta-regression were used to explore potential sources of heterogeneity. This systematic review was reported by following the PRISMA guidelines and the methodological quality of each included study was evaluated using the STROBE guidelines. Results Out of 64 potentially relevant studies, only 06 studies fulfilled the inclusion criteria and were considered for meta-analysis. The pooled prevalence of diabetes in the general population based on population-based studies were 12.13% (95% CI: 8.86–16.24%), based on a pooled sample of 7071 individuals. Results of univariate meta-regression analysis revealed that the prevalence of diabetes increased with mean age, hypertension and obesity. There was no significant association between sex (male vs female), smoking, the methodological quality of included articles or education (illiterate vs literate) and the prevalence of diabetes. Conclusions This meta-analysis reports the 12.13% prevalence of diabetes in Afghanistan,with the highest prevalence in Kandahar and the lowest in Balkh province. The main risk factors include increasing age, obesity and hypertension. Community-based care and preventive training programmes are recommended. Trial registration This review was registered on PROSPERO (registration number CRD42020172624).

scholarly journals Intestinal parasitic infections and associated factors among pregnant women in Ethiopia: a systematic review and meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zelalem Animaw ◽  
Addisu Melese ◽  
Habtamu Demelash ◽  
Girma Seyoum ◽  
Abiy Abebe
Keyword(s):  
Pregnant Women ◽  
Associated Factors ◽  
Intestinal Parasites ◽  
Meta Analysis ◽  
Morbidity And Mortality ◽  
Cochrane Library ◽  
Stool Examination ◽  
Parasitic Infections ◽  
Intestinal Parasitic Infections ◽  
Pooled Prevalence

Abstract Background Intestinal parasitic infections (IPIs) are public health problems widely distributed in the world and cause significant morbidity and mortality; many of which occur among women of reproductive age. IPIs caused by helminthes and protozoan parasites are common among pregnant women. Data on the national pooled prevalence of intestinal parasites and associated factors during pregnancy is not documented well in Ethiopia. This review aims at summarizing evidences on the burden of IPIs and associated factors among pregnant women in Ethiopia. Methods Published and unpublished studies were thoroughly searched at MEDLINE/PubMed, EMBASE, Google Scholar, CINAHL, Cochrane library and Science Direct. In addition, repositories of Addis Ababa, Gondar and Jimma Universities were searched. Eligible studies were selected following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline. The pooled prevalence of intestinal parasites and summary odds ratios (ORs) were determined with 95 % confidence intervals (CI). Sub-groups analyses were done based on study region, types of parasites, methods of stool examination and study setting. The statistical analyses were performed using STATA version 14.0 software. Results Among 168 retrieved studies, 31 studies with a total population of 12,118 pregnant women were included. The estimated pooled prevalence of IPIs among pregnant women in Ethiopia was 27.32 % (95 % CI: 20.61, 33.87 %). In the subgroup analysis, Oromia and Amhara regions had the highest prevalence with a 29.78 % (95 % CI: 15.97, 43.60) and 29.63 % (95 % CI: 15.37, 43.89); respectively. In addition, studies conducted in the community showed higher prevalence than institution based studies (49.93 % Vs 24.84 %; respectively). The most prevalent type of intestinal parasite identified were Hookworm followed by Ascaris lumbricoides with a pooled prevalence of 11.2 and 10.34 %, respectively. In our analysis; residence, being bare footed, lack of hand washing habit and eating uncooked/raw vegetables were significantly associated with IPIs among pregnant women in Ethiopia. Conclusions Prevalence of IPIs during pregnancy is relatively high in Ethiopia. Poor hygienic practices were identified as risk factors. Based on our finding, targeted preventive measures shall be considered so as to prevent morbidity and mortality due to IPIs.

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