IntroductionThe purpose of this study was to identify the common factors that help and hinder tra... more IntroductionThe purpose of this study was to identify the common factors that help and hinder transgender and nonbinary youth accessing gender‐specific health care in Ireland and to identify how these factors may be perceived differently by young people seeking gender‐affirming care, their parents, and health‐care providers.DesignQualitative investigation utilizing framework analysis (FA).MethodsIn‐depth one–one interviews were conducted with transgender and nonbinary youth (n = 10), parents of youth (n = 10), and gender‐specific health‐care providers (n = 10). Maximum variation and snowball sampling were used to recruit participants across Ireland. An interview guide codesigned with an expert panel of gender‐diverse youth was utilized. Interviews were audio‐recorded and transcribed verbatim. FA was used to code the data and identify key issues and recommendations.ResultsFour themes were derived: (1) “Needing bricks to build” (structural factors); (2) “Enduring and convincing” (diag...
Background: This Clinical Practice Guideline (CPG) for the management of obesity in adults in Ire... more Background: This Clinical Practice Guideline (CPG) for the management of obesity in adults in Ireland, adapted from the Canadian CPG, defines obesity as a complex chronic disease characterised by excess or dysfunctional adiposity that impairs health. The guideline reflects substantial advances in the understanding of the determinants, pathophysiology, assessment, and treatment of obesity. Summary: It shifts the focus of obesity management toward improving patient-centred health outcomes, functional outcomes, and social and economic participation, rather than weight loss alone. It gives recommendations for care that are underpinned by evidence-based principles of chronic disease management; validate patients’ lived experiences; move beyond simplistic approaches of “eat less, move more” and address the root drivers of obesity. Key Messages: People living with obesity face substantial bias and stigma, which contribute to increased morbidity and mortality independent of body weight. Edu...
Introduction: Gastric bypass surgery (RYGB) decreases preference for sweet and fatty foods, but t... more Introduction: Gastric bypass surgery (RYGB) decreases preference for sweet and fatty foods, but the underlying mechanism is not known. This study aimed to investigate the role of the exaggerated satiety gut hormone release on appetitive reward of sweet and fatty taste after RYGB. Method: 13 patients that have undergone previous RYGB surgery (>6 months) and 13 normal weight controls participated in a double-blind placebo-controlled trial comparing the effect of subcutaneous injections of somatostatin analogue (octreotide) which blocks satiety gut hormone responses, and saline (control) on the appetitive reward value of sweet-fat candies. Appetitive reward was measured using the progressive ratio task where participants have to do progressively more work by clicking a mouse button each time to obtain a candy reinforcer. Results: In this ongoing study, 9 RYGB patients and 5 control subjects have already been assessed. There were no statistically significant differences in the median...
Background: Internationally, the demand for gender-affirming care has increased exponentially in ... more Background: Internationally, the demand for gender-affirming care has increased exponentially in recent years. The clinical presentation of those seeking care has changed with an increase in transmasculine and non-binary identities and a decrease in the average age of those seeking care. Healthcare navigation remains complicated for this population and warrants further investigation in light of ongoing changes in the field. This paper presents a protocol for a methodological scoping review that aims to systematically map and synthesise the extent and nature of the peer-reviewed, published academic literature on the instruments used to assess factors relating to healthcare navigation and healthcare access for transgender and non-binary individuals seeking gender-affirming healthcare. Methods: This review will search databases (PsychINFO, CINAHL, Medline, and Embase.) and grey literature sources. In line with the methodological framework for scoping reviews, the following six stages ...
IntroductionThere has been a global increase in demand for gender-specific healthcare services an... more IntroductionThere has been a global increase in demand for gender-specific healthcare services and a recognition that healthcare access is complex and convoluted, even in countries with well-developed healthcare services. Despite evidence in Ireland supporting the improvement in physical and mental health following access to gender care, little is known about the local healthcare navigation challenges. Internationally, research focuses primarily on the experience of service users and omits the perspective of other potential key stakeholders. Youth experiences are a particularly seldom-heard group.Methods and analysisThis study will use a sequential exploratory mixed-methods design with a participatory social justice approach. The qualitative phase will explore factors that help and hinder access to gender care for young people in Ireland. This will be explored from multiple stakeholders’ perspectives, namely, young people, caregivers and specialist healthcare providers. Framework an...
Purpose The association between bariatric surgery outcome and depression remains controversial. M... more Purpose The association between bariatric surgery outcome and depression remains controversial. Many patients with depression are not offered bariatric surgery due to concerns that they may have suboptimal outcomes. The aim of this study was to investigate the relationship between baseline World Health Organization-Five Wellbeing Index (WHO-5) and percentage total weight loss (%TWL) in patients after bariatric surgery. Materials and Methods All patients were routinely reviewed by the psychologist and screened with WHO-5. The consultation occurred 3.5 ± 1.6 months before bariatric surgery. Body weight was recorded before and 1 year after surgery. A total of 45 out of 71 (63.3%) patients with complete WHO-5 data were included in the study. Data analysis was carried out with IBM SPSS Statistics (version 27) to determine the correlation between baseline WHO-5 and %TWL in patients having bariatric surgery. Results Overall, 11 males and 34 females were involved with mean age of 47.5 ± 11....
Chronic medical conditions are increasingly common in women of reproductive age. This chapter out... more Chronic medical conditions are increasingly common in women of reproductive age. This chapter outlines some of the chronic diseases that clinicians regularly encounter in preconception care. Given their prevalence, diabetes and thyroid disease receive particular attention. Each section includes a summary of the major points that need to be considered in preconception assessment and how any associated risks can be remediated. Women of reproductive age with chronic conditions are often not asked about their pregnancy intentions, or if asked, with the assumption that they should not become pregnant. Providers must consider their own bias, ask their patients about their desire to have a family, and be prepared to offer patient-centred strategies and referrals for those who choose to become pregnant.
The King's Obesity Staging system was developed to evaluate the effect of obesity treatments ... more The King's Obesity Staging system was developed to evaluate the effect of obesity treatments in multiple physical, psychological and functional domains. In this prospective cohort study, a Northern Irish cohort was scored using the King's Obesity Staging system before and 1 year after bariatric surgery. 71 individuals underwent surgery and 31 (44%) had type 2 diabetes. Bariatric surgery improved each health domain (p < 0.05). A subgroup with type 2 diabetes showed a significantly greater improvement in gonadal disease (polycystic ovarian syndrome and sub-fertility) (p = 0.02), and a trend towards greater improvement in cardiovascular disease (p = 0.07) compared with the non-diabetic subgroup. Half of those with pre-diabetes were normoglycaemic postoperatively (p < 0.05). The King's Obesity Staging system can be used to holistically evaluate the outcomes of bariatric surgery. Patients benefit from bariatric surgery in many ways, but those with diabetes may benefit m...
Objective Transgender and non-binary individuals frequently engage with healthcare services to ob... more Objective Transgender and non-binary individuals frequently engage with healthcare services to obtain gender-affirming care. Little data exist on the experiences of young people accessing gender care. This systematic review and meta-ethnography aimed to identify and synthesise data on youths’ experiences accessing gender-affirming healthcare. Method A systematic review and meta-ethnography focusing on qualitative research on the experiences of transgender and non-binary youth accessing gender care was completed between April-December 2020. The following databases were used: PsychINFO, MEDLINE, EMBASE, and CINAHL. The protocol was registered on PROSPERO, international prospective register of Systematic Reviews (CRD42020139908). Results Ten studies were included in the final review. The sample included participants with diverse gender identities and included the perspective of parents/caregivers. Five dimensions (third-order constructs) were identified and contextualized into the foll...
European journal of applied physiology, Jan 6, 2017
The effect of carbohydrate (CHO), or CHO supplemented with either sodium caseinate protein (CHO-C... more The effect of carbohydrate (CHO), or CHO supplemented with either sodium caseinate protein (CHO-C) or a sodium caseinate protein hydrolysate (CHO-H) on the recovery of skeletal muscle glycogen and anabolic signaling following prolonged aerobic exercise was determined in trained male cyclists [n = 11, mean ± SEM age 28.8 ± 2.3 years; body mass (BM) 75.0 ± 2.3 kg; VO2peak 61.3 ± 1.6 ml kg-1 min-1]. On three separate occasions, participants cycled for 2 h at ~ 70% VO2peak followed by a 4-h recovery period. Isoenergetic drinks were consumed at + 0 and + 2 h of recovery containing either (1) CHO (1.2 g kg -1 BM), (2) CHO-C, or (3) CHO-H (1.04 and 0.16 g kg-1 BM, respectively) in a randomized, double-blind, cross-over design. Muscle biopsies from the vastus lateralis were taken prior to commencement of each trial, and at + 0 and + 4 h of recovery for determination of skeletal muscle glycogen, and intracellular signaling associated with protein synthesis. Despite an augmented insulin respo...
This study examines the effect of Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gas... more This study examines the effect of Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB) on renal function for at least 5 years post-operatively in a tertiary referral center for bariatric surgery. This prospective cohort study of patients undergoing RYGB and LAGB measured renal function, blood pressure, and diabetes status pre-operatively and then 1 and 5 years post-operatively. Renal function was assessed using the Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), and Cockcroft-Gault formulae. Hypertension and diabetes were defined by the European Society of Hypertension and European Society of Cardiology joint guidelines and American Diabetes Association guidelines, respectively. A sub-group who had completed 10 years post-operative follow-up was also included. Estimated glomerular filtration rate (eGFR) increased over 5 years after RYGB (N = 190; 94 ± 2 mL/min/1.73 m(2) to 102 ± 22 mL/min/1.73 m...
IntroductionThe purpose of this study was to identify the common factors that help and hinder tra... more IntroductionThe purpose of this study was to identify the common factors that help and hinder transgender and nonbinary youth accessing gender‐specific health care in Ireland and to identify how these factors may be perceived differently by young people seeking gender‐affirming care, their parents, and health‐care providers.DesignQualitative investigation utilizing framework analysis (FA).MethodsIn‐depth one–one interviews were conducted with transgender and nonbinary youth (n = 10), parents of youth (n = 10), and gender‐specific health‐care providers (n = 10). Maximum variation and snowball sampling were used to recruit participants across Ireland. An interview guide codesigned with an expert panel of gender‐diverse youth was utilized. Interviews were audio‐recorded and transcribed verbatim. FA was used to code the data and identify key issues and recommendations.ResultsFour themes were derived: (1) “Needing bricks to build” (structural factors); (2) “Enduring and convincing” (diag...
Background: This Clinical Practice Guideline (CPG) for the management of obesity in adults in Ire... more Background: This Clinical Practice Guideline (CPG) for the management of obesity in adults in Ireland, adapted from the Canadian CPG, defines obesity as a complex chronic disease characterised by excess or dysfunctional adiposity that impairs health. The guideline reflects substantial advances in the understanding of the determinants, pathophysiology, assessment, and treatment of obesity. Summary: It shifts the focus of obesity management toward improving patient-centred health outcomes, functional outcomes, and social and economic participation, rather than weight loss alone. It gives recommendations for care that are underpinned by evidence-based principles of chronic disease management; validate patients’ lived experiences; move beyond simplistic approaches of “eat less, move more” and address the root drivers of obesity. Key Messages: People living with obesity face substantial bias and stigma, which contribute to increased morbidity and mortality independent of body weight. Edu...
Introduction: Gastric bypass surgery (RYGB) decreases preference for sweet and fatty foods, but t... more Introduction: Gastric bypass surgery (RYGB) decreases preference for sweet and fatty foods, but the underlying mechanism is not known. This study aimed to investigate the role of the exaggerated satiety gut hormone release on appetitive reward of sweet and fatty taste after RYGB. Method: 13 patients that have undergone previous RYGB surgery (>6 months) and 13 normal weight controls participated in a double-blind placebo-controlled trial comparing the effect of subcutaneous injections of somatostatin analogue (octreotide) which blocks satiety gut hormone responses, and saline (control) on the appetitive reward value of sweet-fat candies. Appetitive reward was measured using the progressive ratio task where participants have to do progressively more work by clicking a mouse button each time to obtain a candy reinforcer. Results: In this ongoing study, 9 RYGB patients and 5 control subjects have already been assessed. There were no statistically significant differences in the median...
Background: Internationally, the demand for gender-affirming care has increased exponentially in ... more Background: Internationally, the demand for gender-affirming care has increased exponentially in recent years. The clinical presentation of those seeking care has changed with an increase in transmasculine and non-binary identities and a decrease in the average age of those seeking care. Healthcare navigation remains complicated for this population and warrants further investigation in light of ongoing changes in the field. This paper presents a protocol for a methodological scoping review that aims to systematically map and synthesise the extent and nature of the peer-reviewed, published academic literature on the instruments used to assess factors relating to healthcare navigation and healthcare access for transgender and non-binary individuals seeking gender-affirming healthcare. Methods: This review will search databases (PsychINFO, CINAHL, Medline, and Embase.) and grey literature sources. In line with the methodological framework for scoping reviews, the following six stages ...
IntroductionThere has been a global increase in demand for gender-specific healthcare services an... more IntroductionThere has been a global increase in demand for gender-specific healthcare services and a recognition that healthcare access is complex and convoluted, even in countries with well-developed healthcare services. Despite evidence in Ireland supporting the improvement in physical and mental health following access to gender care, little is known about the local healthcare navigation challenges. Internationally, research focuses primarily on the experience of service users and omits the perspective of other potential key stakeholders. Youth experiences are a particularly seldom-heard group.Methods and analysisThis study will use a sequential exploratory mixed-methods design with a participatory social justice approach. The qualitative phase will explore factors that help and hinder access to gender care for young people in Ireland. This will be explored from multiple stakeholders’ perspectives, namely, young people, caregivers and specialist healthcare providers. Framework an...
Purpose The association between bariatric surgery outcome and depression remains controversial. M... more Purpose The association between bariatric surgery outcome and depression remains controversial. Many patients with depression are not offered bariatric surgery due to concerns that they may have suboptimal outcomes. The aim of this study was to investigate the relationship between baseline World Health Organization-Five Wellbeing Index (WHO-5) and percentage total weight loss (%TWL) in patients after bariatric surgery. Materials and Methods All patients were routinely reviewed by the psychologist and screened with WHO-5. The consultation occurred 3.5 ± 1.6 months before bariatric surgery. Body weight was recorded before and 1 year after surgery. A total of 45 out of 71 (63.3%) patients with complete WHO-5 data were included in the study. Data analysis was carried out with IBM SPSS Statistics (version 27) to determine the correlation between baseline WHO-5 and %TWL in patients having bariatric surgery. Results Overall, 11 males and 34 females were involved with mean age of 47.5 ± 11....
Chronic medical conditions are increasingly common in women of reproductive age. This chapter out... more Chronic medical conditions are increasingly common in women of reproductive age. This chapter outlines some of the chronic diseases that clinicians regularly encounter in preconception care. Given their prevalence, diabetes and thyroid disease receive particular attention. Each section includes a summary of the major points that need to be considered in preconception assessment and how any associated risks can be remediated. Women of reproductive age with chronic conditions are often not asked about their pregnancy intentions, or if asked, with the assumption that they should not become pregnant. Providers must consider their own bias, ask their patients about their desire to have a family, and be prepared to offer patient-centred strategies and referrals for those who choose to become pregnant.
The King's Obesity Staging system was developed to evaluate the effect of obesity treatments ... more The King's Obesity Staging system was developed to evaluate the effect of obesity treatments in multiple physical, psychological and functional domains. In this prospective cohort study, a Northern Irish cohort was scored using the King's Obesity Staging system before and 1 year after bariatric surgery. 71 individuals underwent surgery and 31 (44%) had type 2 diabetes. Bariatric surgery improved each health domain (p < 0.05). A subgroup with type 2 diabetes showed a significantly greater improvement in gonadal disease (polycystic ovarian syndrome and sub-fertility) (p = 0.02), and a trend towards greater improvement in cardiovascular disease (p = 0.07) compared with the non-diabetic subgroup. Half of those with pre-diabetes were normoglycaemic postoperatively (p < 0.05). The King's Obesity Staging system can be used to holistically evaluate the outcomes of bariatric surgery. Patients benefit from bariatric surgery in many ways, but those with diabetes may benefit m...
Objective Transgender and non-binary individuals frequently engage with healthcare services to ob... more Objective Transgender and non-binary individuals frequently engage with healthcare services to obtain gender-affirming care. Little data exist on the experiences of young people accessing gender care. This systematic review and meta-ethnography aimed to identify and synthesise data on youths’ experiences accessing gender-affirming healthcare. Method A systematic review and meta-ethnography focusing on qualitative research on the experiences of transgender and non-binary youth accessing gender care was completed between April-December 2020. The following databases were used: PsychINFO, MEDLINE, EMBASE, and CINAHL. The protocol was registered on PROSPERO, international prospective register of Systematic Reviews (CRD42020139908). Results Ten studies were included in the final review. The sample included participants with diverse gender identities and included the perspective of parents/caregivers. Five dimensions (third-order constructs) were identified and contextualized into the foll...
European journal of applied physiology, Jan 6, 2017
The effect of carbohydrate (CHO), or CHO supplemented with either sodium caseinate protein (CHO-C... more The effect of carbohydrate (CHO), or CHO supplemented with either sodium caseinate protein (CHO-C) or a sodium caseinate protein hydrolysate (CHO-H) on the recovery of skeletal muscle glycogen and anabolic signaling following prolonged aerobic exercise was determined in trained male cyclists [n = 11, mean ± SEM age 28.8 ± 2.3 years; body mass (BM) 75.0 ± 2.3 kg; VO2peak 61.3 ± 1.6 ml kg-1 min-1]. On three separate occasions, participants cycled for 2 h at ~ 70% VO2peak followed by a 4-h recovery period. Isoenergetic drinks were consumed at + 0 and + 2 h of recovery containing either (1) CHO (1.2 g kg -1 BM), (2) CHO-C, or (3) CHO-H (1.04 and 0.16 g kg-1 BM, respectively) in a randomized, double-blind, cross-over design. Muscle biopsies from the vastus lateralis were taken prior to commencement of each trial, and at + 0 and + 4 h of recovery for determination of skeletal muscle glycogen, and intracellular signaling associated with protein synthesis. Despite an augmented insulin respo...
This study examines the effect of Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gas... more This study examines the effect of Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB) on renal function for at least 5 years post-operatively in a tertiary referral center for bariatric surgery. This prospective cohort study of patients undergoing RYGB and LAGB measured renal function, blood pressure, and diabetes status pre-operatively and then 1 and 5 years post-operatively. Renal function was assessed using the Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), and Cockcroft-Gault formulae. Hypertension and diabetes were defined by the European Society of Hypertension and European Society of Cardiology joint guidelines and American Diabetes Association guidelines, respectively. A sub-group who had completed 10 years post-operative follow-up was also included. Estimated glomerular filtration rate (eGFR) increased over 5 years after RYGB (N = 190; 94 ± 2 mL/min/1.73 m(2) to 102 ± 22 mL/min/1.73 m...
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