Long-Term Follow-Up of Individuals Undergoing Sex-Reassignment Surgery: Somatic Morbidity and Cause of Death

INTRODUCTION:

Studies of mortality and somatic well-being after sex-reassignment surgery (SRS) of transsexual individuals are equivocal. Accordingly, the present study investigated mortality and somatic morbidity using a sample of transsexual individuals who comprised 98% (n = 104) of all surgically reassigned transsexual individuals in Denmark.

AIMS:

To investigate somatic morbidity before and after SRS and cause of death and its relation to somatic morbidity after SRS in Danish individuals who underwent SRS from 1978 through 2010.

METHODS:

Somatic morbidity and mortality in 104 sex-reassigned individuals were identified retrospectively by data from the Danish National Health Register and the Cause of Death Register.

MAIN OUTCOME MEASURES:

Somatic morbidity and cause of death.

RESULTS:

Overall, 19.2% of the sample were registered with somatic morbidity before SRS and 23.1% after SRS (P = not significant). In total, 8.6% had somatic morbidity before and after SRS. The most common diagnostic category was cardiovascular disease, affecting 18 individuals, 9 before and 14 after SRS, and 5 of those 14 who were affected after SRS had cardiovascular disease before and after SRS. Ten individuals died after SRS at an average age of 53.5 ± 7.9 years (male to female) and 53.5 ± 7.3 years (female to male).

CONCLUSION:

Of 98% of all Danish transsexuals who officially underwent SRS from 1978 through 2010, one in three had somatic morbidity and approximately 1 in 10 had died. No significant differences in somatic morbidity or mortality were found between male-to-female and female-to-male individuals. Despite the young average age at death and the relatively larger number of individuals with somatic morbidity, the present study design does not allow for determination of casual relations between, for example, specific types of hormonal or surgical treatment received and somatic morbidity and mortality.

Full article at:   http://goo.gl/5x35ba

By:  Simonsen RK1, Hald GM2, Kristensen E3, Giraldi A3.

• 1Department of Sexology, University Hospital of Copenhagen, Copenhagen, Denmark. Electronic address: rikke.kildevaeld@regionh.dk.
• 2Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
• 3Sexological Clinic, Psychiatric Center Copenhagen, Copenhagen, Denmark. 
• Sex Med. 2016 Mar;4(1):e60-8. doi: 10.1016/j.esxm.2016.01.001.

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Association of Injection Drug Use with Incidence of HIV-Associated Non-AIDS-Related Morbidity by Age, 1995-2014

OBJECTIVE:

Incidence of HIV-associated non-AIDS (HANA) related comorbidities is increasing in HIV-infected individuals. Our objective was to estimate the risk of HANA comorbidity associated with history of injection drug use (IDU), correctly accounting for higher death rates among people who inject drugs (PWID).

DESIGN:

We followed HIV-infected persons aged 25-59 years who enrolled in the Johns Hopkins HIV Clinical Cohort between 1995 and May 2014, from enrollment until HANA comorbidity diagnosis, death, age 60 or administrative censoring.

METHODS:

We compared cumulative incidence ("risk"), by age, of validated diagnoses of HANA comorbidities among HIV-infected PWID and non-IDU; specifically, we considered end-stage renal disease (ESRD), end-stage liver disease (ESLD), myocardial infarction (MI), stroke, and non-AIDS-defining cancer. We used competing risk methods appropriate to account for death, standardized to the marginal distribution of baseline covariates and adjusted for potential differential loss-to-clinic.

RESULTS:

Of 5,490 patients included in this analysis, 37% reported IDU as an HIV transmission risk. By age 55 years, PWID had higher risk of ESLD (risk difference = 6.8, 95% CI: -1.9, 15.5) and ESRD (risk difference = 11.1, 95% CI: 1.2, 21.0) than did non-IDU. Risk of MI and stroke were similar among PWID and non-IDU. Risk of non-AIDS-defining cancer was lower among PWID than among non-IDU (risk difference at 55 years: -4.9, 95% CI: -11.2, 1.3).

CONCLUSIONS:

Not all HANA comorbidities occur with higher incidence in PWID compared to non-IDU. However, higher incidence of ESRD and ESLD among PWID highlights the importance of recognition and management of markers of these comorbidities in early stages among PWID.

Purchase full article at:   http://goo.gl/VVkKG1

By:  Lesko CR1, Moore RD, Tong W, Lau B.

• 1 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 
• School of Medicine, Johns Hopkins University, Baltimore, MD. 
• AIDS. 2016 Mar 16. 

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Uptake of Cervical Cancer Screening and Associated Factors among Women in Rural Uganda: A Cross Sectional Study

Background

In developing countries, inadequate access to effective screening for cervical cancer often contributes to the high morbidity and mortality caused by the disease. The largest burden of this falls mostly on underserved populations in rural areas, where health care access is characterized by transport challenges, ill equipped health facilities, and lack of information access. This study assessed uptake of cervical cancer screening and associated factors among women in rural Uganda.

Methods

This descriptive cross sectional study was carried out in Bugiri and Mayuge districts in eastern Uganda and utilised quantitative data collection methods. Data were collected using a semi-structured questionnaire on cervical cancer screening among females aged between 25 and 49 years who had spent six or more months in the area. Data were entered in Epidata 3.02 and analysed in STATA 12.0 statistical software. Univariate, bivariate and multivariate analyses were performed.

Results

Of the 900 women, only 43 (4.8%) had ever been screened for cervical cancer. Among respondents who were screened, 21 (48.8%) did so because they had been requested by a health worker, 17 (39.5%) had certain signs and symptoms they associated with cervical cancer while 16 (37.2%) did it voluntarily to know their status. Barriers to cervical cancer screening were negative individual perceptions 553 (64.5%) and health facility related challenges 142 (16.6%). Other respondents said they were not aware of the screening service 416 (48.5%). The independent predictors of cervical cancer screening were: being recommended by a health worker [AOR = 87.85, p<0.001], knowing where screening services were offered [AOR = 6.24, p = 0.004], and knowing someone who had ever been screened [AOR = 9.48, p = 0.001].

Conclusion

The prevalence of cervical cancer screening is very low in rural Uganda. Interventions to increase uptake of cervical cancer screening should be implemented so as to improve access to the service in rural areas.

Below:  Suggested measures for increasing uptake of cervical cancer screening services

Full article at:   http://goo.gl/rQQ6D8

By:  

Rawlance Ndejjo, Trasias Mukama, David Musoke

Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda

Angele Musabyimana

Department of Community Health, School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda

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Sexual Life & Dysfunction After Maternal Morbidity: A Systematic Review

Background

Because there is a lack of knowledge on the long-term consequences of maternal morbidity/near miss episodes on women´s sexual life and function we conducted a systematic review with the purpose of identifying the available evidence on any sexual impairment associated with complications from pregnancy and childbirth.

Methods

Systematic review on aspects of women sexual life after any maternal morbidity and/or maternal near miss, during different time periods after delivery. The search was carried out until May 22 ^nd , 2015 including studies published from 1995 to 2015. No language or study design restrictions were applied. Maternal morbidity as exposure was split into general or severe/near miss. Female sexual outcomes evaluated were dyspareunia, Female Sexual Function Index (FSFI) scores and time to resume sexual activity after childbirth. Qualitative syntheses for outcomes were provided whenever possible.

Results

A total of 2,573 studies were initially identified, and 14 were included for analysis after standard selection procedures for systematic review. General morbidity was mainly related to major perineal injury (3 ^rd or 4 ^th degree laceration, 12 studies). A clear pattern for severity evaluation of maternal morbidity could not be distinguished, unless when a maternal near miss concept was used. Women experiencing maternal morbidity had more frequently dyspareunia and resumed sexual activity later, when compared to women without morbidity. There were no differences in FSFI scores between groups. Meta-analysis could not be performed, since included studies were too heterogeneous regarding study design, evaluation of exposure and/or outcome and time span.

Conclusion

Investigation of long-term repercussions on women’s sexual life aspects after maternal morbidity has been scarcely performed, however indicating worse outcomes for those experiencing morbidity. Further standardized evaluation of these conditions among maternal morbidity survivors may provide relevant information for clinical follow-up and reproductive planning for women.

Full article at:  http://goo.gl/OXu1fc

By: Carla B. Andreucci¹², Jamile C. Bussadori², Rodolfo C. Pacagnella¹, Doris Chou³,Veronique Filippi⁴, Lale Say³, Jose G. Cecatti^1* and on behalf of the Brazilian COMMAG Study Group and the WHO Maternal Morbidity Working Group

¹Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil

²Federal University of Sao Carlos, Sao Carlos, Brazil

³Reproductive Health Research unit, World Health Organization, Geneva, Switzerland

⁴London School of Hygiene and Tropical Medicine, University of London, London, England, UK

 

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Causes of Hospital Admission among People Living with HIV Worldwide: A Systematic Review & Meta-Analysis

Morbidity associated with HIV infection is poorly characterised, so we aimed to investigate the contribution of different comorbidities to hospital admission and in-hospital mortality in adults and children living with HIV worldwide.

Using a broad search strategy combining terms for hospital admission and HIV infection, we searched MEDLINE via PubMed, Embase, Web of Science, LILACS, AIM, IMEMR and WPIMR from inception to Jan 31, 2015, to identify studies reporting cause of hospital admission in people living with HIV. We focused on data reported after 2007, the period in which access to antiretroviral therapy started to become widespread. We estimated pooled proportions of hospital admissions and deaths per disease category by use of random-effects models. We stratified data by geographical region and age.

We obtained data from 106 cohorts, with reported causes of hospital admission for 313 006 adults and 6182 children living with HIV. 

• For adults, AIDS-related illnesses (25 119 patients, 46%) 
• and bacterial infections (14 034 patients, 31%) were the leading causes of hospital admission. 

These two categories were the most common causes of hospital admission for adults in all geographical regions and the most common causes of mortality. Common region-specific 

• in Africa
• causes of hospital admission included 
• malnutrition and wasting, 
• parasitic infections, and 
• haematological disorders; 
• in Europe
• respiratory disease, 
• psychiatric disorders, 
• renal disorders, 
• cardiovascular disorders, and 
• liver disease; 
• in North America
• haematological disorders 
• in South and Central America
• and respiratory, 
• neurological, 
• digestive and 
• liver-related conditions, 
• viral infections, and 
• drug toxicity. 
• For children, 
• AIDS-related illnesses (783 patients, 27%) and 
• bacterial infections (1190 patients, 41%, 26-56) were the leading causes of hospital admission, 
• followed by malnutrition and wasting, 
• haematological disorders, and, 
• in the African region, malaria. 

Mortality in individuals admitted to hospital was 20% (12,902 deaths) for adults and 14% (10-19, 643 deaths) for children.

This review shows the importance of prompt HIV diagnosis and treatment, and the need to reinforce existing recommendations to provide chemoprophylaxis and vaccination against major preventable infectious diseases to people living with HIV to reduce serious AIDS and non-AIDS morbidity.

Via: http://goo.gl/7YWZKn Purchase full article at: http://goo.gl/qnGZG3

By: Ford N1, Shubber Z2, Meintjes G3, Grinsztejn B4, Eholie S5, Mills EJ6, Davies MA7, Vitoria M8, Penazzato M8, Nsanzimana S9, Frigati L10, O'Brien D11, Ellman T12, Ajose O13, Calmy A14, Doherty M8.

• 1Department of HIV/AIDS, WHO, Geneva, Switzerland; Centre for Infectious Disease Epidemiology and Research, University of Cape Town, South Africa. Electronic address: fordn@who.int.
• 2Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
• 3Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
• 4Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Ministry of Health, Brazil.
• 5Unit of Infectious and Tropical Diseases, Treichville University Teaching Hospital, Abidjan, Côte d'Ivoire.
• 6Global Evaluative Sciences, Vancouver, BC, Canada.
• 7Centre for Infectious Disease Epidemiology and Research, University of Cape Town, South Africa.
• 8Department of HIV/AIDS, WHO, Geneva, Switzerland.
• 9Rwanda Biomedical Center, Institute of HIV Disease Prevention and Control, Kigali, Rwanda; Swiss Tropical and Public Health Research Institute and Basel Institute for Clinical Epidemiology and Biostatistics, University of Basel, Switzerland.
• 10Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Division of Paediatric Infectious Diseases, University of Stellenbosch, Cape Town, South Africa.
• 11Manson Unit, Médecins Sans Frontières, London, UK; Department of Medicine and Infectious Diseases, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia.
• 12South Africa Medical Unit, Médecins Sans Frontières, Cape Town, South Africa.
• 13Clinton Health Access Initiative, Boston, MA, USA.
• 14HIV/AIDS Unit, Infectious Disease Service, Geneva University Hospital, Geneva, Switzerland. 

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Hospitalisation Rates & Associated Factors in Community-Based Cohorts of HIV-Infected & -Uninfected Gay & Bisexual Men

There is evidence that HIV-positive patients are suffering from a greater burden of morbidity as they age due to nonAIDS-related complications. To date it has been difficult to determine what part of this excess risk is due to the health effects of HIV, its treatment or to lifestyle factors common to gay and bisexual men (GBM). We calculated overall and cause-specific hospitalisation rates and risk factors for hospitalisations in HIV-negative and HIV-positive cohorts of GBM and compare these with rates in the general male population.

We conducted a record linkage study, linking two cohorts of HIV-negative (n = 1325) and HIV-positive (n = 557) GBM recruited in Sydney, New South Wales (NSW), Australia with the NSW hospital discharge data register. We compared rates of hospitalisation in the two cohorts and risk factors for hospitalisation using random-effects Poisson regression methods. Hospitalisation rates for each cohort were further compared with those in the general male population using indirect standardisation.

We observed 2,032 hospitalisations in the HIV-negative cohort during 13,016 person-years (PYs) and 2,130 hospitalisations in the HIV-positive cohort during 5,571 PYs. HIV-positive individuals had an increased risk of hospitalisation compared with the HIV-negative individuals and the general population. Hospitalisation rates were lower in the HIV-negative cohort compared with the general population. The primary causes of hospitalisation differed between groups.

HIV-positive GBM continue to experience excess morbidity compared with HIV-negative GBM men and the general population. HIV-negative GBM had lower morbidity compared with the general male population suggesting that GBM identity does not confer excess risk.

Via:  http://ht.ly/SBtvQ Purchase full article at: http://goo.gl/hH6CMu

By: Moore CL1, Grulich AE1, Prestage G1,2, Gidding HF3, Jin F1, Mao L4, Petoumenos K1, Zablotska IB1, Poynten IM1, Law MG1, Amin J1.

• 1The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
• 2Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Vic., Australia.
• 3School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia.
• 4Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia.

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Self-Reported Postpartum Morbidity: Prevalence and Determinants among Women in Marrakesh, Morocco

Below:  Women’s reported postpartum morbidities

The self-reported postpartum morbidity prevalence was 13.1 % while haemorrhage, pregnancy-induced hypertension and fever were the main complications: 71.92 %; 12.18 % and 10.64 % respectively.

According to the multiple logistic regression model, the illiteracy among women and the number of pregnancies greater than 3 determine independently this morbidity (OR = 1.24; CI 95 %: 1.09–1.54; and OR = 1.69; CI 95 %:1.04–2.70 respectively).

Reducing female illiteracy and fertility will help the fight against postpartum maternal morbidity, which is critical to the wellbeing of women and their infants.

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