Introduction: Gender-affirming hormone therapy (GAHT) for transgender women utilizes estrogen and an anti-androgen like cyproterone acetate (CPA) which can both lead to hyperprolactinemia. Although mild prolactin elevations are common, the development of prolactinomas in transgender women on GAHT is rare. Case: A 23-year-old trans-woman on self-purchased estradiol hemihydrate (17β-estradiol) 4 mg and CPA 12.5 mg daily for GAHT presented with galactorrhea. Investigations revealed markedly elevated prolactin at 2,369 mIU/L and elevated estradiol at 848 pmol/L. A pituitary magnetic resonance imaging (MRI) identified a 0.4 × 0.5 cm microprolactinoma. She declined clinical advice to reduce her medication dose and continued on the same treatment. In the subsequent year, her peak prolactin was 1,383 mIU/L, and a repeat MRI showed the microprolactinoma remained stable. She continues to be on close clinical monitoring. Transgender females experience approximately a fourfold higher rate of developing prolactinomas. The patient’s choice to persist with GAHT reflects the challenges in managing gender dysphoria alongside medical complications. A recent paper by BJ Nolan et al. suggests using prolactin levels exceeding 2,000–3,000 mIU/L to guide further investigations including a pituitary MRI to rule out a prolactinoma. In most cases, the serum prolactin levels will return to the normal range with a reduction or discontinuation of the GAHT. Normalization of prolactin levels have been reported after gonadectomy and CPA cessation in transgender females on GAHT, which suggests that CPA usage may be associated with higher risk of hyperprolactinemia compared to estrogen therapy. Conclusion This case highlights that GAHT can lead to development of prolactinomas. Prolactin monitoring and MRI investigations should be reserved for symptomatic patients, and for those with significantly elevated or increasing prolactin levels. While treatment using dopamine agonists have been reported, this case demonstrates that conservative management and close monitoring can be a viable approach for structurally stable microprolactinomas.
Female ; Prolactinoma ; Transgender Persons

BACKGROUND: Infertility is a burdensome, often overlooked condition. This study aimed to investigate the global distribution and trends in the burden of infertility from 1990 to 2021. METHODS: We obtained data on the prevalence and years lived with disability (YLDs) related to infertility from the Global Burden of Disease 2021 study and evaluated them by calculating the estimated annual percentage change in age-standardized rates. We investigated the relationship between sociodemographic index (SDI) and the burden of infertility on the global, regional, and national levels. RESULTS: In 2021, there were 143,261,562 female and 55,481,380 male infertility cases worldwide, respectively. In China, female and male infertility cases accounted for 23.59% and 21.47% of the global totals, reaching 33,795,944 and 11,909,889, respectively. Compared with 2019, the global number of female and male infertility cases increased by 5,286,227 in females and 2,017,271 in males. In contrast, China saw a decline in both female and male infertility cases, with reductions of 698,735 and 154,591, respectively. From 1990 to 2021, the age-standardized prevalence rate (ASPR) and age-standardized YLDs rate (ASYR) for female infertility both increased by 0.59% annually, whereas these two corresponding indicators for male infertility increased by 0.50% annually worldwide. The burden of female infertility was consistently higher than that of male infertility and demonstrated a faster rate of increase. East Asia had the highest ASPR and ASYR for female infertility, whereas Eastern Europe had the highest metrics for male infertility. A horizontal S-shaped association was observed between the SDI and ASPR and ASYR of infertility, with a rapid decline in the infertility burden when the SDI exceeded 0.7. CONCLUSIONS The global burden of infertility has increased over the years, with a higher burden on women and underdeveloped regions. These findings emphasize the need to prioritize healthcare for patients with infertility to address the rising burden.
Humans ; Female ; Male ; Global Burden of Disease ; Prevalence ; Infertility/epidemiology* ; Adult ; Infertility, Male/epidemiology* ; Persons with Disabilities/statistics & numerical data* ; Middle Aged ; Infertility, Female/epidemiology* ; China/epidemiology* ; Disability-Adjusted Life Years

Human ; Health Promotion ; Persons

OBJECTIVE: To explore the current status and changing trends of the disease burden of traumatic brain injury (TBI) in China from 1990 to 2023, and to quantitatively assess the impact of different influencing factors on this disease burden, thereby providing references for the prevention of TBI. METHODS: Based on the 2023 Global Burden of Disease Study (GBD), indicators including incidence and years lived with disability (YLDs) were used to analyze the status and changing trends of TBI disease burden in China from 1990 to 2023. Additionally, the decomposition method established by Gupta was adopted to quantify the effects of population growth, population aging, age-specific incidence rate, and disease severity on YLDs. RESULTS: From 1990 to 2023, the age-standardized incidence rate and YLDs rate of TBI in China showed an overall upward trend, with a significant downward trend between 2015 and 2020, followed by a resumption of upward trend after 2020. The disease burden of TBI in males was higher than that in females, with a larger increase amplitude. The elderly population had higher TBI incidence rate and YLDs rate, also with a larger upward amplitude. Falls were the main cause of TBI in China, and the changing trend of the disease burden caused by falls was consistent with the overall trend of TBI disease burden; meanwhile, the elderly population bore a relatively high disease burden from falls. Taking 1990 as the baseline, the growth rates of YLDs in males and females in 2023 were 101.54% and 101.40%, respectively. For males, the proportions of YLDs growth attributed to population growth, population aging, age-specific incidence rate, and disease severity were 26.91%, 49.62%, 37.74%, and -12.73%, respectively; for females, the corresponding proportions were 28.85%, 57.69%, 27.65%, and -12.79%. CONCLUSION From 1990 to 2023, population aging had a significant impact on the disease burden of TBI in China. Strengthening the prevention and control of falls and paying close attention to males and the elderly population should be the key focuses of TBI prevention and control work in China in the future.
Humans ; Brain Injuries, Traumatic/epidemiology* ; China/epidemiology* ; Male ; Female ; Incidence ; Middle Aged ; Aged ; Adult ; Cost of Illness ; Adolescent ; Young Adult ; Persons with Disabilities/statistics & numerical data* ; Child ; Global Burden of Disease ; Disability-Adjusted Life Years ; Child, Preschool ; Infant ; Aged, 80 and over

OBJECTIVES: To investigate the effect of age-friendly social and family care environment on the long-term care (LTC) services for the disabled elderly people. METHODS: A questionnaire-based survey was conducted among disabled elderly people in three cities of Zhejiang province from June to August 2022, involving 311 subjects from Ningbo city (LTC service insurance pilot site, insured group) and 542 subjects from Hangzhou and Quzhou cities (uninsured group). The service provisions, including ensuring daily activities, preventive healthcare, and satisfying spiritual comfort, were compared among the groups. The family friendly care environment was evaluated with the Family Function Scale and assistance of daily activities, financial support and emotional comfort. The social friendly care environment was measured with the revised WHO recommended age-friendly city environmental framework, including accessibility guarantee environment, information dissemination environment, social participant environment, and life security environment. After controlling for covariates such as sociodemographic, elderly care status, and health risk characteristics, the impact of environment on the effectiveness of service provision of LTC insurance was explored by multiple logistic regression analysis. The mediating and moderating effects were tested to explore the role of age-friendly care environment. A fixed effects model was used to test the service provision effects of LTC insurance policy. RESULTS: Disabled elderly with LTC insurance had a higher proportion of their preventive health care and spiritual comfort needs met. Additionally, a multifactorial analysis found a significant positive association between LTC insurance and meeting the spiritual comfort needs. Compared with insured group (Ningbo city), disabled elderly people in Hangzhou urban area (OR=0.45, 95%CI:0.27-0.74, P<0.01) and Quzhou rural area (OR=0.21, 95%CI:0.12-0.37, P<0.01) were more likely to feel unsatisfied with spiritual comfort. The results of mediation analysis showed that the scores of accessibility guarantee environment (OR=1.22, 95%CI:1.02-1.45, P<0.05), information dissemination environment (OR=1.19, 95%CI:1.02-1.39, P<0.05), and social participation environment (OR=1.40, 95%CI:1.17-1.67, P<0.01) in a socially friendly care environment were positively correlated with the satisfaction rate of mental comfort services. The results of the moderation effect analysis indicated that a socially friendly care environment (OR=1.46, 95%CI:1.16-1.84, P<0.01) could compensate for the difference in effectiveness between insured (Ningbo) and uninsured (Hangzhou and Quzhou) areas of LTC insurance. A fixed effect model confirmed the policy chain of LTC insurance policy-social friendly care environment-mental health service satisfaction. CONCLUSIONS The implementation of LTC insurance has improved service accessibility, making disabled elderly people feel "seen and valued", and generating psychological and spiritual satisfaction. Accelerating the establishment and improvement of the LTC insurance system requires systematic design, especially emphasizing the supportive role of a socially friendly care environment, and promoting it in urban and rural areas according to the local conditions.
Humans ; Aged ; Persons with Disabilities ; Surveys and Questionnaires ; Long-Term Care ; Female ; Male ; China ; Social Environment ; Middle Aged ; Aged, 80 and over

OBJECTIVES

This study investigates the impact of the COVID-19 pandemic on social service accessibility for persons with disabilities in the Philippines, with a focus on disability related opportunity costs and out-of-pocket expenses.

A mixed-methods approach was employed, combining both qualitative and quantitative data collection techniques. Focus group discussions (FGDs) and interviews were conducted to gather qualitative insights, while quantitative analysis, utilizing one-sample t-tests, was used to assess the impact of the pandemic on key areas such as income, access to essential goods, employment, healthcare, mental health, and social support.

Using a mixed-methods approach, data were collected from 141 participants. Qualitative insights highlighted that 89% of participants reported negative effects on daily living conditions due to rising costs and limited access to necessities. Parents of children with disabilities indicated that early childhood care and development services were adversely affected by school closures, and transitioning to online learning posed significant barriers, with 62% lacking access to training and resources. While many participants had access to healthcare, lockdowns exacerbated disability-related opportunity costs, complicating access to routine care. Quantitative data findings were analyzed through one-sample t-tests to assess the impact of COVID-19 on various aspects of daily life, including income, access to essential goods, employment status, healthcare access, mental health, and social support. Findings revealed significant challenges, with an average income decrease rating of 7.39, reflecting substantial financial loss. Ratings for access to essential goods and healthcare services also averaged 7.39, while employment status was rated at 7.82, indicating instability. Mental health impacts averaged 7.13, and social support was rated at 7.42, underscoring inadequacies during this crisis.

Overall, the study emphasizes the urgent need for targeted interventions and inclusive responses in emergency planning to mitigate the pandemic's disproportionate impact on this marginalized group in the Philippines.

BACKGROUND: The health needs of the transgender population have not been well understood and have been an interest when it comes to research. There were several reported cases of breast cancer, specifically in male-to-female (MtF) transgenders or those who were born genotypic male but addressed themselves psychosocially as females. The characteristics, risk factors, and recommendations METHODS: In this study, three independent reviewers conducted literature searches using various online databases for all types of studies in relation to breast cancer occurrences in MtF transgenders in adult patients during the publication timeline of 2016–2022. Studies were excluded if RESULTS: A total of 14 articles were included and categorized in which quality assessment for risk of bias was done accordingly. Most of the studies were case reports, case series, and literature reviews making the overall quality poor. Most of the MtF transgenders were diagnosed with breast cancer at a median age of 58.9 years. The use of cross-sex hormones for at least 5 years by a transgender women may contribute the most to the risk of developing breast cancer. Other possible risk factors include a family history of breast cancer and obesity with body mass index (BMI) >35. The level of risk of developing breast cancer is still uncertain, but chronic hormonal use may increase one’s risk. CONCLUSION Due to the poor quality of the studies included, it is not possible at this time to quantify the risk of breast cancer among MtF transgenders. However, long-term use of cross-sex hormones (estrogen and/or progesterone) may be a contributing factor, but more large-scale studies are needed to establish the relationship. Most studies recommend mammography as the screening diagnostic modality at the age of 50 and older, with significant risk factors as identified annually or biennially. These recommendations still vary and are not yet well established by strong evidence due to various limitations, one of which is the uncertainty of the size of the MtF transgender population. Hence, further investigations are warranted and this study aims to uplift the recognition of breast cancer risk among the MtF transgenders.
Human ; Breast Neoplasms ; Transgender Persons

Cerebral venous sinus thrombosis ( CVST) results from occlusion of cerebral venous sinuses, usually resulting in hemorrhagic infarction. It is a rare type of stroke affecting 3-5 per million people, often due to hypercoagulable states from clotting factor abnormalities or diseases like cancers, autoimmune and collagen vascular disease. Headache, visual changes, changes in sensorium, focal neurologic signs, seizures, and coma are some of the symptoms.

The role of exogenous estrogen in developing CVST among transgenders has not been reported frequently in literature. We report a 26-year-old transgender female who presented with throbbing headache after four years of exogenous high dose parenteral and oral estrogen. Magnetic resonance venography findings showed dural sinus thrombosis involving the left internal jugular vein, left sigmoid sinus, left transverse sinus, straight sinus, torcula and posterior aspect of the superior sagittal sinus. Patient was treated with topiramate, steroids and anticoagulants. Patient symptoms improved and was subsequently sent with home medications edoxaban. This case underscores the importance of monitoring the use of hormonal therapy in transgender individuals.

This report is an example of a rare cause of thrombosis secondary to self-administration of parenteral and oral estrogen. Prompt diagnosis in this patient resulted in the prevention of a catastrophic event like a major stroke, highlighting the importance of vigilance in managing hormone therapy. Increasing awareness about transgender issues can improve health and reduce inequities in this population. Cerebral venous sinus thrombosis ( CVST) results from occlusion of cerebral venous sinuses, usually resulting in hemorrhagic infarction. It is a rare type of stroke affecting 3-5 per million people, often due to hypercoagulable states from clotting factor abnormalities or diseases like cancers, autoimmune and collagen vascular disease. Headache, visual changes, changes in sensorium, focal neurologic signs, seizures, and coma are some of the symptoms.

The role of exogenous estrogen in developing CVST among transgenders has not been reported frequently in literature. We report a 26-year-old transgender female who presented with headache after 4 years of exogenous high dose parenteral and oral estrogen. Magnetic resonance venography findings showed dural sinus thrombosis involving the left internal jugular vein, left sigmoid sinus, left transverse sinus, straight sinus, torcula and posterior aspect of the superior sagittal sinus. Patient was treated with topiramate, steroids and anticoagulants. Patient symptoms improved and was subsequently sent home on edoxaban. This case underscores the importance of monitoring hormonal therapy in transgender individuals.

This report is an example of a rare cause of thrombosis secondary to self-administration of parenteral and oral estrogen. Prompt diagnosis in this patient resulted in the prevention of a catastrophic event like a major stroke, highlighting the importance of vigilance in managing hormone therapy. Increasing awareness about transgender issues can improve health and reduce inequities in this population.

Objective To compare the functional status of diabetic patients with and without nephropathy and identify the items that diabetic patients with nephropathy are more likely to develop dysfunction than diabetic patients without nephropathy based on the international classification of functioning,disability and health rehabilitation set(ICF-RS).Methods A cross-sectional study was conducted.A total of 320 diabetic patients hospitalized in Guangdong Provincial Hospital of Chinese Medicine from August 2021 to February 2022 were selected and assigned into a group with nephropathy and a group without nephropathy.The general characteristics,clinical examination,and laboratory findings were compared by the t test,rank sum test,and Chi-squared test.The functional status of the patients was compared between the two groups by the t test based on the ICF-RS.Logistic regression was employed to control interferential factors between the two groups and identify the association between nephropathy and ICF-RS problematic items among diabetic patients.Results The diabetic patients with nephropathy had more problematic items in ICF-RS(P<0.001),the body function dimension(P=0.003),the activity dimension(P<0.001),and the participation dimension(P<0.001)than those without nephropathy.Moreover,the diabetic patients with nephropathy experienced severer problems in 5 body function items(energy and drive functions,sleep functions,sexual functions,exercise tolerance functions,and muscle power functions),10 activity items(transferring oneself,walking,moving around using equipment,moving around,washing oneself,caring for body parts,toileting,dressing,doing housework,and looking after one's health),and 4 participation items(using transportation,assisting others,basic interpersonal interactions,and recreation and leisure)(all P<0.05).The Logistic regression results showed that compared with the diabetic patients without nephropathy,the diabetic patients with nephropathy were more likely to develop problems in energy and drive functions(aOR=4.35,95%CI=1.28-14.79,P=0.019),emotional functions(aOR=1.88,95%CI=1.06-3.34,P=0.031),sexual functions(aOR=3.39,95%CI=1.82-6.34,P<0.001),moving around(aOR=3.11,95%CI=1.76-5.52,P<0.001),doing housework(aOR=17.48,95%CI=3.57-85.60,P<0.001),looking after one's health(aOR=1.97,95%CI=1.13-3.43,P=0.017),using transportation(aOR=2.59,95%CI=1.38-4.88,P=0.003),and recreation and leisure(aOR=2.52,95%CI=1.46-4.35,P<0.001).Conclusion Compared with the diabetic patients without nephropathy,the patients with nephropathy suffer more ICF-RS problematic items and are more likely to develop dysfunction in certain items in all the three dimensions.
Humans ; Disability Evaluation ; Cross-Sectional Studies ; Functional Status ; Disabled Persons/rehabilitation* ; Kidney Diseases ; Diabetes Mellitus ; Activities of Daily Living

PURPOSE: To systematically review the risk of permanent disability related to road traffic injuries (RTIs) and to determine the implications for future research regarding permanent impairment following road traffic crashes. METHODS: We conducted this systematic review according to the preferred reporting items for systematic reviews and meta-analysis statement. An extended search of the literature was carried out in 4 major electronic databases for scientific research papers published from January 1980 to February 2020. Two teams include 2 reviewers each, screened independently the titles/abstracts, and after that, reviewed the full text of the included studies. The quality of the studies was assessed using the strengthening the reporting of observational studies in epidemiology (STROBE) checklist. A third reviewer was assessed any discrepancy and all data of included studies were extracted. Finally, the data were systematically analyzed, and the related data were interpreted. RESULTS: Five out of 16 studies were evaluated as high-quality according to the STROBE checklist. Fifteen studies ranked the initial injuries according to the abbreviated injury scale 2005. Five studies reported the total risk of permanent medical impairment following RTIs which varied from 2% to 23% for car occupants and 2.8% to 46% for cyclists. Seven studies reported the risk of permanent medical impairment of the different body regions. Eleven studies stated the most common body region to develop permanent impairment, of which 6 studies demonstrated that injuries of the cervical spine and neck were at the highest risk of becoming permanent injured. CONCLUSION The finding of this review revealed the necessity of providing a globally validated method to evaluate permanent medical impairment following RTIs across the world. This would facilitate decision-making about traffic injuries and efficient management to reduce the financial and psychological burdens for individuals and communities.
Humans ; Accidents, Traffic ; Disabled Persons ; Abbreviated Injury Scale ; Databases, Factual ; Wounds and Injuries/etiology*