Summary
Aim
The aim of this study is to evaluate the effect of haemophilia disease severity and potential intermediaries on body mass index (BMI) in patients with hemophilia.
Methods
A secondary analysis of a cross-sectional study eighty-eight adults with haemophilia was undertaken.
Results
On bivariate analysis, persons with severe haemophilia had 9.8% lower BMI (95% CI −17.1, −3.0) than persons with non-severe hemophilia. The effect of haemophilia severity on BMI varied significantly by HIV status. Among HIV positive subjects, haemophilia severity was not associated with BMI (+5.0%, 95% CI −22.4, 41.9). Among HIV negative subjects, severe haemophilia was associated with 15.1% lower BMI (95% CI, −23.6, −5.7). Older (>41 years) HIV negative subjects with severe haemophilia had a BMI that was 24.8% lower (95% CI −39.1, −7.0) than those with non-severe haemophilia. No statistically significant association was detected between BMI and severe versus non-severe haemophilia for younger HIV negative subjects. Although joint disease, as measured by the WFH joint score, did not influence the association between haemophilia disease severity and BMI, adjustment for the atrophy component of the WFH score reduced the association between haemophilia severity and BMI by 39.1–69.9%. This suggested that muscle atrophy mediated at least part of the relationship between haemophilia severity and BMI.
Conclusion
Haemophilia disease severity is associated with BMI and appears to be mediated by muscle atrophy of surrounding joints. This association appears to be possibly modified by HIV status and age.
A US federal court recently ruled against requiring health insurers to cover HIV pre-exposure prophylaxis (PrEP) under the Affordable Care Act. For every 10% decrease in PrEP coverage resulting from this ruling among US men who have sex with men, we estimate an additional 1,140 HIV infections in the following year in that population.
Purpose of review
Transgender and gender-diverse (TGD) youth experience a discordance between their binary sex assigned at birth and gender identity. All TGD youth benefit from compassionate care delivered by clinicians who are informed in matters of gender diversity. Some of TGD youth experience clinically significant distress, termed gender dysphoria (GD), and may benefit from additional psychological support and medical treatments. Discrimination and stigma fuel minority stress in TGD youth and thus many struggle with mental health and psychosocial functioning. This review summarizes the current state of research on TGD youth and essential medical treatments for gender dysphoria. These concepts are highly relevant in the current sociopolitical climate. Pediatric providers of all disciplines are stakeholders in the care of TGD youth and should be aware of updates in this field.
Recent findings
Children who express gender-diverse identities continue to express these identities into adolescence. Medical treatments for GD have a positive effect on mental health, suicidality, psychosocial functioning, and body satisfaction. The overwhelming majority of TGD youth with gender dysphoria who receive medical aspects of gender affirming care continue these treatments into early adulthood. Political targeting and legal interference into social inclusion for TGD youth and medical treatments for GD are rooted in scientific misinformation and have negative impacts on their well being.
Summary
All youth-serving health professionals are likely to care for TGD youth. To provide optimal care, these professionals should remain apprised of best practices and understand basic principles of medical treatments for GD.
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