Spinal cerebrospinal fluid (CSF) leak is a disabling and often misdiagnosed condition characterised by CSF hypovolemia. Associated neurological symptoms are diverse and often leave individuals bed-bound due to their orthostatic nature. Prior literature describing the difficulties in diagnosis, treatment, and ongoing impact of CSF leak is, thus far, confined to Europe and North America. This study provides a novel account of lived experiences of spinal CSF leak in Australia and Aotearoa New Zealand (NZ). An online survey exploring symptoms, diagnosis, treatment, and effect on daily life of a person's "first" CSF leak was designed with consumer involvement. Responses were received from May to August 2025. Open-text responses were analysed using thematic analysis. In total, 106 surveys were completed. Over 70 symptoms were reported; the most common were orthostatic headache (95.3%), neck pain (85.8%), and brain fog (79.2%). Most people considered their diagnosis (73.6%) and treatment (65.3%) difficult, underscored by limited clinician awareness and access to care, leaving individuals to self-advocate. Amongst symptomatic participants (73.6%), median EuroQol Visual Analogue Scale score was 40 (interquartile range 25-64; indicating low health-related quality-of-life) and mean Headache Impact Test-6 score was 69 ± 5 (indicating severe impact). Other challenges identified included navigating change to social identity and daily functioning. The spinal CSF leak experience in Australia and NZ is comparable to reports from other high-income countries, highlighting the global need to increase awareness of spinal CSF leak, support timely diagnostic, referral and treatment pathways, and mitigate its impact on quality of life.
The Irritable Bowel Syndrome Severity Scoring System (IBS-SSS) is frequently used to characterize treatment effects in IBS patients. Calculation of a responder rate using IBS-SSS data commonly uses a cut-off value of -50 points. To analyze data from a recently published IBS trial to evaluate whether this cut-off value is appropriate or needs to be revised. Data from 201 patients were used to establish a receiver operating characteristic (ROC) curve for IBS-SSS change data using IBS-Adequate Relief scale data as a binary classifier. The area under the curve (AUC) and its 95% CI for the ROC were determined. Curves plotting accuracy rates and Youden's J index values against changes on the IBS-SSS used as cut-off values were employed to determine an optimal cut-off value. The AUC of the ROC curve was 0.9738 (95% CI from 0.9565 to 0.9912). The curve of accuracy rates had two maxima (-122 and -133 points), while that of the Youden's J index values had only one maximum at -122 points, considered to be the optimal cut-off value. The frequently used -50 points cut-off value might not be optimal for determining clinically meaningful responder rates from IBS-SSS measurements. At least for the IBS-SSS data analyzed in the present study, a change of -122 points appears to be more appropriate. Interpretation of IBS-SSS responder rates from past or future clinical trials should carefully check for the cut-off values applied for their calculation.
Hard-to-control hypertension, comprising uncontrolled and resistant hypertension, is highly prevalent, meaning many patients with hypertension remain at risk of adverse outcomes despite treatment. To discuss the role of managed care in addressing hard-to-control hypertension, AMCP Market Insights virtually convened an expert panel of managed care stakeholders in November 2025. This article provides a qualitative summary of the panel discussion. Key insights were that despite multiple effective, low-cost pharmacotherapy options, a significant proportion of patients have blood pressure above recommended goals because of confounding factors at both the micro and macro levels; and managed care-specific challenges in hard-to-control hypertension include competing organizational priorities, data gaps, and lack of integration of existing resources. Opportunities to advance care in hard-to-control hypertension include focusing on prevention and providing additional patient and clinician support such as with education and enhancing use of digital technologies. Other insights were that top payer priorities in hypertension include reducing cardiovascular events and other complications and meeting quality goals, and that current clinical guidelines and provider input are important elements of payer decision-making. These findings can support informed clinical and coverage decisions, can offer practical actions for payers, and may inform future work.
Sporting events are opportunities for athletes to shine and fans to celebrate. Mass gatherings, including mega sporting events, are linked to substantial communicable disease transmission and requires multi modal, complex preparation and trained response teams. The 2026 FIFA World Cup™ tournament will span 48 teams in three different host countries. This expert commentary aims to review frequently implicated infections and high consequence pathogens; review preparedness strategies for healthcare personnel(HCP), infection prevention and control(IPC) teams, emergency department(ED) and disaster preparedness teams; and emphasize the need for closed loop communication and use of technology. The authors hope this commentary is practically used as a reference for clinicians and public health entities in host cities but also a blueprint for considerations in future sporting events-which are projected to increase.
Visual Thinking Strategies (VTS) is a structured, evidence-based pedagogical method that has been increasingly embraced in medical education to foster essential clinical competencies such as observation, interpretation, communication and empathy. Originally developed for use in K-12 classrooms, VTS involves a standardised facilitation method centred on three carefully sequenced questions posed in response to a visual artwork. Although deceptively simple in format, effective facilitation of VTS requires extensive training and adherence to specific practices that activate collaborative and critical thinking processes. As interest in arts-based pedagogies grows in medical education, VTS stands out as a method with defined guidelines and demonstrable educational outcomes. However, this paper argues that the expanding adoption of VTS be accompanied by a commitment to fidelity-in how the method is implemented, studied and described in the academic literature. While an increasing number of medical educators are enthusiastically incorporating VTS into their curricula, the literature belies a concerning trend of deviations from the method's core components. These include altered wording of the three core questions, inconsistent naming of the method, facilitation by untrained individuals and inadequate or inaccurate methodological descriptions. Such deviations, even when subtle, can compromise the internal validity of research findings and risk misrepresenting the nature and effectiveness of the intervention. This lack of fidelity could threaten the integrity of educational outcomes and the credibility of arts-based approaches in the broader field of medical education. Compounding the issue, peer reviewers and journal editors may lack sufficient familiarity with VTS to identify these inaccuracies, enabling flawed implementations to persist in the literature. We contend that ensuring fidelity to the original VTS methodology is a shared responsibility across researchers, educators, institutions and scholarly publications. Adherence to the method maintains its pedagogical and scholarly value. To that end, we offer practical recommendations, such as formal VTS facilitator training (with greater accessibility to educators in low-resource settings), accurate reporting standards, peer reviewer education and the cultivation of a community of certified practitioners. As VTS continues to gain traction, we recommend that educators aim for fidelity in its use and study, ensuring that its full potential to enrich clinical education is realised and preserved for future generations of learners.
The small GTPase RAB1 is essential for life. A knockout of RAB1 is not only embryonically lethal, but even triggers cell death in a cultured cell line, underscoring its importance for cellular homeostasis. Previous work has shown that RAB1 plays a key role in protein and membrane trafficking as a player in the ER-to-Golgi trafficking pathway. Here, RAB1 has been shown to interact with COPII vesicles that have left the ER and are arriving at the Golgi. In addition, RAB1 is an essential part of autophagy initiation, where loss of RAB1 leads to defects very early in the pathway. To complicate matters further, there is a non-trivial overlap in phenotype between a Golgi trafficking defect and an autophagy initiation problem, as ATG9A vesicle trafficking and the general importance of the Golgi in autophagy illustrates. Given these hurdles, how would one get a handle on the molecular mechanism of RAB1? In this Punctum, I discuss our recent mapping of a new RAB1 interactome that provides fresh insights into its multifaceted functions.
Across ages and cultures, planning actions adaptively during tool use is a hallmark of human intelligence and a critical factor in human survival and proper function. Previous cross-sectional studies showed that adaptive planning begins in infancy and improves with age and experience. However, little is known about how developmental improvements in adaptive planning occur. Do infants gradually adapt their action planning with one object and then generalize this skill to other objects, or does learning remain tool-specific? Here, we longitudinally tested nine infants in weekly sessions across the age range when tool use is rapidly developing. Infants were presented with a familiar tool (spoon) and three unfamiliar tools (brush, hammer, magnet) with handles pointing to the right or left. For each trial, we scored whether infants used an adaptive radial grip (evidence of action planning) or an inefficient ulnar grip (no evidence of planning). Across several months of testing, every infant gradually learned to use an adaptive radial grip for the spoon, but none showed improvement for the unfamiliar tools. Adaptive planning with the spoon was further limited to self-directed actions (bringing food to their own mouth) rather than other-directed actions (feeding a puppet). Learning was characterized by high variability before stable achievement of an efficient grip. Across all tools, right-pointing handles elicited more radial grips than left-pointing handles. Our findings replicate previous cross-sectional research and provide new insights into the longitudinal progression of adaptive planning during tool use in infancy. Specifically, the development was gradual rather than abrupt, and learning remained highly tool-specific without generalization, emphasizing the critical role of specific and extensive experience with particular tool-action combinations.
Elective surgical postponements and cancellations adversely affect patient experience, clinical outcomes, and theatre efficiency within the UK NHS. The Postponement and Cancellations in Elective Care study aimed to establish the national incidence and underlying causes of elective surgical postponements at preoperative assessment and cancellations occurring within 24 h of planned surgery. This 7-day prospective service evaluation (November 11-18, 2024) collected data from participating NHS England trusts via an online platform. Preoperative assessment postponements were defined as any factor preventing a patient with a 'to come in' date from undergoing surgery as planned, or preventing preoperative assessment completion as 'good to go' within 2 weeks for those without a 'to come in' date. Cancellations were defined as a decision not to proceed within 24 h of planned surgery. Seventy-eight trusts provided complete incidence data covering 22 573 preoperative assessment appointments and 19 905 planned procedures. The national preoperative assessment postponement incidence was 8.7% (95% confidence interval, 6.9-10.8%), most commonly attributable to further investigation or tests (n=595, 27.2%). The national cancellation incidence was 9.9% (95% confidence interval, 8.7-11.3%), most frequently associated with acute medical conditions (n=515, 23.8%) and list overruns (n=315, 14.5%). The Postponement and Cancellations in Elective Care study provides the first national overview of elective surgical pathway disruption in the UK. Nearly half of postponements were attributable to requirements for additional investigation or specialty review, indicating the importance of earlier optimisation and robust preoperative assessment fit to proceed criteria. Acute medical conditions continue to impact short-notice cancellations. Standardised pathways, improved scheduling, and strengthened perioperative coordination could reduce disruption and improve theatre utilisation.
Discrimination is a psychosocial stressor that, through activation of stress-response pathways, may influence risk of adverse perinatal health outcomes. However, few studies have evaluated the association between discrimination and hypertensive disorders of pregnancy (HDP), and none have explored effect modification by race or paternal support, which may buffer the adverse effects of discrimination. We included 1,847 non-Hispanic Black and White participants from the Maternal and Infant Environmental Health Riskscape (MIEHR) study. Krieger's validated Experiences of Discrimination (EOD) scale was used to assess occurrence (yes/no) and frequency (once, 2-3, ≥ 4 times) of discrimination in nine situations. We created continuous scores representing total situations and frequency and also categorized (0, 1-2, ≥ 3) the situations score. Using electronic health records, we identified participants with HDP (hypertension in pregnancy, preeclampsia, eclampsia, and hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome). We applied log-binomial regression to evaluate associations between experiences of discrimination and HDP, adjusted for maternal age, pre-pregnancy body mass index, income, and race. Analyses were stratified by race and self-reported paternal support (none/a little vs. good/excellent) as potential effect modifiers; due to small numbers, the situation score was dichotomized (0, ≥ 1) for these analyses. HDP occurred in 37.5% (n = 430) of Black and 26.0% (n = 182) of White participants. Compared with participants reporting no discrimination, the adjusted risk ratio (aRR) was 1.13 (95% CI: 0.96, 1.33) and 1.11 (95% CI: 0.94, 1.30) for those reporting discrimination in 1-2 and ≥ 3 situations, respectively. By setting, the strongest associations were observed for discrimination in getting a job (aRR: 1.22; 95% CI: 1.14, 1.43), by police (aRR: 1.21; 95% CI: 1.01, 1.44), and getting medical care (aRR: 1.17; 95% CI: 0.94, 1.44). Stratified analyses revealed the strongest associations between experiencing discrimination and HDP among Black participants and those with lower perceptions of paternal support. We found associations between discrimination and HDP among Black participants, who bear the greatest burden of HDP, as well as a potential buffering effect of paternal support. Future research is needed to investigate associations between discrimination and HDP and evaluate whether enhancing paternal support can mitigate the impact of discrimination on HDP risk.
Studies examining quality of life outcomes have shown that Autistic people experience lower scores across domains (e.g., physical, psychological) compared to other groups, with their lowest scores consistently reported in social functioning. However, to date, little is known about different adult life experiences that Autistic adults have beyond the typically tested outcome of living independently in the community, which may not be a desired outcome culturally for all Autistic people, particularly outcomes that could lead to improved social functioning, like being in relationships. Survey data were collected from a nationally representative sample of 272 U.S. residents with autism. Respondents were asked about secondary school transition activities, support, and later life experiences of moving into their own home, falling in love, getting married, pregnancy, becoming a caregiver, and being arrested. Logistic regression results indicated goal setting and psychological empowerment were significant predictors of all adult life experience outcomes tested, and autonomy/decision-making predicted moving into one's own home and falling in love. Social skills predicted both falling in love, getting married, and being arrested. For support, the number of people supporting the Autistic youth was related to increased odds of falling in love. While transition programs are typically focused on furthering education and employment success in later life, skills taught to students to support those outcomes also relate to a broader range of life experiences for Autistic youth and adults. Programs to support Autistic students and youth should include, at a minimum, activities that build goal setting and psychological empowerment skills in hopes that Autistic adults can experience a fulfilling life of their choosing.
We assessed the proportion of patients with biochemical recurrence (BCR), the occurrence of BCR in risk groups according to prostate-specific antigen doubling time (PSA-DT), and clinical outcomes in risk groups. Retrospective observational study of patients with non-metastatic prostate cancer (PC) (n = 26,755) in the US using the Optum® PC electronic medical record database. Primary outcomes were the proportion of patients with BCR in prior radical prostatectomy (RP) or radiation therapy (RT) cohorts. Secondary outcomes included association between baseline characteristics and time to BCR, BCR risk group (high-risk: PSA-DT <12 months; low-risk: PSA-DT ≥12 months), and time from BCR to metastasis and castration-resistant PC (CRPC). BCR occurred in 19.7% of patients after RP and 8.8% after RT. Among high-risk BCR patients (n = 523) in the RP cohort, 19.3% developed metastasis, 14.5% developed CRPC, and 14.1% died. In contrast, among low-risk BCR patients (n = 1,356), rates were 10.2%, 7.0%, and 6.6%, respectively. In the RT cohort, 25.9% of the high-risk BCR patients (n = 498) developed metastasis, 21.5% developed CRPC, and 19.7% died, compared with 16.4%, 9.0%, and 16.4% among low-risk patients (n = 122), respectively. PSA and PSA-DT are key predictors of BCR. Outcomes are worse among high-risk BCR patients with short PSA-DT. This study looked at medical records from men who were treated for early-stage prostate cancer with surgery or radiation therapy. After treatment, some men showed a rise in their PSA levels in blood tests. This rise can be a sign that some cancer cells may still be present. We found that about 15 in every 100 men experience a rise in PSA levels after treatment, most often within 2 years. We also found that both the PSA level and how quickly it increases over time are important. A faster rise in PSA levels was linked to a higher chance of the cancer coming back and to poorer outcomes. Measuring how quickly PSA levels double over time can help doctors choose the most appropriate treatment to slow down or prevent the cancer from getting worse.
The aim of this study was to examine the community participation levels (frequency and involvement) of children with Down syndrome (DS) and the restrictive and supportive factors affecting their participation levels and compare them with typically developing (TD) children. This cross-sectional study included parents of 70 children (35 with DS; 35 TD children) aged 8-17 years. Parents of all children completed the community module of the Participation and Environment Measure for Children and Youth, which is used to assess participation and environmental factors in the community. Children with DS participated less frequently (organizations, groups, clubs, or leadership activities and out-of-school classes and lessons) and less involved (getting together with children, organizations, groups, clubs, or leadership activities and out-of-school classes and lessons) in community activities compared to TD children, and parents of children with DS were less satisfied with their children's participation in community activities. Children with DS faced more barriers (the physical layout, the sensory quality and weather conditions) and had insufficient resources (information and supplies) compared to their TD peers in the community. After adjusting for the child's age, parental education level and average income, the group (DS vs. TD) had an independent effect on frequency, involvement and desire for change. Children with DS are negatively affected in terms of community participation (both) compared to TD children. Beyond sociodemographic factors, being a child with DS may reduce community participation (both). The community environmental factors were influential for the community participation of children with DS. Community participation of children with DS can be increased through environmental regulations.
Objective: To summarize emergency transport cases related to bamboo shoot activities treated at a single center and review the relevant literature. Methods: We retrospectively reviewed cases presented to a hospital in Japan from April 2015 to June 2025 involving bamboo shoot harvesting-related incidents. The collected data included patient sex, age, month of consultation, clinical history, diagnosis, and outcomes. Additionally, literature searches were conducted using Ichushi, PubMed, and general Internet sources to identify related case reports and studies. Results: Nine patients (six males and three females) aged 63-80 years (mean: 71.6 years) were included. Six patients sustained injuries from falls or slips while harvesting bamboo shoots, and three experienced cardiopulmonary arrest (CPA) during the activity. All patients with CPA died, whereas those with traumatic injuries survived. A literature review revealed a wide variety of incidents related to bamboo shoot harvesting, including: getting lost in forests, animal attacks, parasitic and tick-borne infections, exertion-induced endogenous illnesses, harvesting-related trauma, allergic reactions following consumption, and postprandial ileus. Conclusion: Emergency medical conditions related to bamboo shoot harvesting predominantly affect older males and often involve trauma from falls or slips. Notably, the literature also indicates a wide spectrum of possible emergencies related to this seasonal activity.
Pregnant women face increased risks from influenza complications, underscoring the importance of vaccination. This study evaluated knowledge and attitudes about influenza vaccination and self-reported vaccination rates among pregnant women in Split-Dalmatia County, Croatia. A cross-sectional study was conducted from March to July 2020 in primary healthcare gynecological clinics in Split, Croatia. A convenience sample of pregnant women completed an anonymous 33-question survey after providing informed consent. Data were analyzed with a chi-square test, Fisher's exact test, or Kruskal-Wallis test, as appropriate. Among 323 participants, only 10 (3.2%) received the influenza vaccine during pregnancy. Most respondents (96.3%) reported that healthcare providers did not offer them influenza vaccine. Insufficient knowledge about influenza vaccination was observed, with a median score of 38.46 (IQR = 23.08-53.85) out of 100. Higher education was significantly associated with better knowledge about influenza vaccination (P = 0.006), while age was not (P = 0.441). The primary reason cited for not getting vaccinated was a lack of information about the influenza vaccine (n = 144, 46%). Media sources such as radio, television, and the Internet were the most common sources of vaccine information (n = 89, 40%), while only a small fraction (n = 15, 6.7%) received information from their gynecologist. Low self-reported vaccination rates among pregnant women in Split-Dalmatia County were primarily due to insufficient awareness and inadequate information from healthcare professionals. Improved education and proactive vaccine promotion by healthcare providers are critical to addressing this gap.
The areas covered represent a personal selection in the field. Asthma is defined in this manuscript as a clinical syndrome of wheeze, breathlessness and chest tightness, sometimes with excess cough. No assumptions are made about underlying pathology, and asthma thus becomes a clinical description, not a diagnosis. The areas covered include the need never to forget the importance of getting the basics right, including correct diagnosis and appropriate management; most children with asthma do not need biologics. Recent advances in preschool wheeze are covered next, especially the beginnings of phenotype-driven treatment, and the difficult issue of understanding non-eosinophilic wheezing. It is becoming clearer that infection likely plays a big role, but management is very difficult with no evidence base. We are now coming to realize the importance of phenotyping acute asthma attacks; one size does not fit all, but whereas many are eosinophilic, some are infection driven and are non-eosinophilic, especially in the preschool years. A phenotypic approach may allow us to reduce the burden of repeated oral corticosteroid bursts. Furthermore, we need to move beyond mere cell counting to assessing functional status. We are increasingly appreciating the importance of replacing short-acting β-2 agonist reliever therapy with combined inhaled corticosteroid and a fast acting short- and especially long-acting β-2 agonists. Finally, the use of biologicals in severe asthma is discussed. The possibility that early use of biologics may induce remission or even cure asthma.
Medical assistance in dying (MAiD) became a legal end-of-life option on December 10, 2015, in Québec, and on June 17, 2016, in the rest of Canada. Since its legalization, there has been a steady increase in the number of MAiD requests and provisions. Across permissive jurisdictions, Québec now has the highest rate of assisted death. Despite the growing use of MAiD, research examining the factors driving this increase remains limited and fragmented. Existing studies offer partial and sometimes contradictory explanations, with little integration of legal, institutional, societal, and individual dimensions. Further research is needed to better understand the determinants of MAiD requests and practices, particularly in the Canadian and Québec contexts. This research aims to understand the factors influencing changes in MAiD requests and administrations in Québec by examining laws, practices, societal perspectives, organization of care and services, and individual characteristics of those requesting MAiD, as well as their interrelationships. We present the protocol developed by the Consortium interdisciplinaire de recherche sur l'aide médicale à mourir, an interdisciplinary research consortium, including an international advisory committee, set up for this research. The design of this protocol is multimethods and convergent mixed methods, including (1) an international cross-thematical approach with 4 main research methods (a scoping review, key informant interviews, focus groups with health care professionals, and a population-based survey) chosen to partially answer research questions across the entire study and to compare with other jurisdictions and (2) 11 theme-specific methods (including community forums, media coverage analysis, comparative legal analyses, case studies of triads, individual interviews, and system mapping) to enrich and complement findings from the cross-thematical approach. When this 3-year funded study started in July 2024, several research methods not requiring ethics committee approval (because no human participants were involved) were initiated, including scoping and systematic reviews, media coverage analysis, and comparative legal analyses. By August 2025, interviews with key informants were completed, and analyses took place in September. Concurrently, other subteams started data collection (focus groups December 2025) or are getting ready to seek ethics approval for their protocols and data collection processes involving human participants: case studies of triads, individual interviews, and community forums. Findings from the international cross-thematical approach and theme-specific methods will provide a comprehensive understanding of the factors influencing the use of MAiD in Québec. This study has strengths, including the use of a specific theoretical framework, a variety of complementary methods, and an integrated knowledge mobilization strategy. As for its limitations, we foresee challenges with the comparison of jurisdictions in terms of language, culture, and legal systems, as well as access to data about MAiD cases, since reporting systems may differ between jurisdictions. DERR1-10.2196/83549.
The recent push by the United States to mine the international seabed for critical minerals, such as manganese and cobalt, has been met with widespread calls to quickly enact international regulations for deep seabed mining. Indeed, criticism of the pace at which the International Seabed Authority (ISA) is developing mining regulations has intensified. However, scientists have been calling for more time to better understand the risks of deep seabed mining, as current knowledge gaps render robust environmental management untenable. Casting the situation as a race creates a false sense of urgency that distracts from the higher goal of getting the regulations right.
BackgroundResearch indicates a significant overlap between transgender and gender-diverse (TGD) and autistic identities. This intersectional population has higher risks of mental health challenges and worse mental health outcomes than individuals with just one of the two identities. Limited research focuses on adults at this intersection and their care access needs. To better characterize this population in the Canadian context, this study examines the population referred to Canada's largest publicly funded adult gender-related care clinic and compares demographic and diagnostic characteristics between those with and without a pre-existing autism diagnosis.MethodsThe data come from the medical records of 1,843 adults referred to the Gender Identity Clinic (GIC) at the Centre for Addiction and Mental Health in Toronto, Canada, between January 2020 and March 2025. The prevalence of autism diagnosis prior to entering the clinic was calculated. Average age, sex-assigned-at-birth composition, prevalence of gender dysphoria diagnoses and of additional mental health and neurodevelopmental diagnoses were compared between autistic and non-autistic groups. Changes across time in the number of autistic individuals referred to the GIC were analyzed.ResultsApproximately 6.3% of adults referred to GIC had a diagnosis of autism. The autistic and non-autistic groups had no difference in average age. The groups had no differences in sex-assigned-at-birth distribution. Autistic adults had greater rates of gender dysphoria. Autistic adults had higher rates of each category of mental health and neurodevelopmental diagnoses examined.ConclusionsThis study is a first step in developing a holistic understanding of the experiences of autistic TGD adults seeking clinical gender-related care in the Canadian context, providing a starting point to addressing needs and barriers to care for this population, as well as insight into the substantial mental health challenges experienced by this population. Characterizing the population of autistic adults visiting a large gender-care service in CanadaPlain Language SummaryMany transgender and gender-diverse (TGD) individuals are autistic. They are more likely to have mental health problems but have a harder time getting mental health care. We wanted to know how common it was for the people coming to get gender care services at a large gender related clinic to have an autism diagnosis, and how those with an autism diagnosis were the same or different than other people at the clinic. We collected data from the medical records of 1,843 adults who had been referred to the Gender Identity Clinic at a large hospital in Toronto, Canada between January 2020 and March 2025. We examined the number of adults in the population who had a recorded diagnosis of autism at the point of intake, and compared the autistic and non-autistic groups in terms of: average age, sex-assigned-at-birth makeup, the rates of participants with a diagnosis of gender dysphoria, and other mental health or neurodevelopmental diagnoses. We also looked at the rates of adults with an autism diagnosis accessing care at the clinic across time. The researchers found that about 6.3% of the sample had a diagnosis of autism upon referral to the clinic. The autistic and non-autistic groups had no differences in average age. The sex-assigned-at-birth makeup of the two groups was equal. The autistic group was more likely to have higher rates of gender dysphoria and of mental health diagnoses than the non-autistic group. This study highlights the mental health difficulties experienced by this population, urging researchers, clinicians, families, and self-advocates to work toward removing the barriers experienced by this population in accessing care. La recherche indique un chevauchement important entre l’identité transgenre et l’identité de genres multiples (TGD), d’une part, et les identités autistiques, d’autre part. La population occupant cette intersection présente des risques plus élevés de problèmes de santé mentale et subit des conséquences plus graves sur le plan de la santé mentale que les personnes ne présentant qu’une seule de ces deux identités. Peu de projets de recherche sont menés sur les besoins en matière d’accès aux soins des adultes occupant cette intersection. Afin de mieux caractériser cette population dans le contexte canadien, cette étude évalue la population orientée vers la plus grande clinique de soins liés aux identités de genre destinés aux adultes financée par le secteur public au Canada. De plus, elle compare les caractéristiques démographiques et diagnostiques des personnes ayant reçu un diagnostic d’autisme préexistant à celles n’en ayant pas. Les données proviennent des dossiers médicaux de 1 843 adultes orientés vers la Clinique de l’identité du genre (CIG) du Centre de toxicomanie et de santé mentale (CAMH) de Toronto, au Canada, de janvier 2020 à mars 2025. La prévalence du diagnostic d’autisme avant l’arrivée à la clinique a été calculée. L’âge moyen, la répartition du sexe attribué à la naissance, la prévalence des diagnostics de dysphorie de genre, d’autres problèmes de santé mentale et de troubles neurodéveloppementaux dans les groupes de personnes autistes et non autistes ont fait l’objet de comparaisons. L’évolution du nombre de personnes autistes orientées vers le GIC au fil du temps a été analysée. Environ 6,3% des adultes orientés vers le GIC avaient un diagnostic d’autisme préexistant. Les groupes de personnes autistes et non autistes ne présentaient aucune différence pour ce qui est de l’âge moyen. Les groupes ne présentaient aucune différence au chapitre de la répartition du sexe attribué à la naissance. Les adultes autistes présentaient des taux plus élevés de dysphorie de genre. Les adultes autistes présentaient des taux plus élevés de chacune des catégories diagnostiques de problèmes de santé mentale et de troubles neurodéveloppementaux évaluées. Cette étude constitue la première étape de la compréhension holistique des expériences des adultes autistes ayant une identité transgenre et une identité de genres multiples qui cherchent à obtenir des soins cliniques liés à l’identité de genre au Canada. Cela fournit un point de départ pour répondre aux besoins et surmonter les obstacles en matière de soins offerts à cette population, ainsi qu’un aperçu des problèmes de santé mentale importants auxquels fait face cette population.
This study explores the influence of experiencing one, two or more stressful life events (SLE) in the past year in associations with adolescent sleep and depression symptomatology in the short and long term in the context of coping. Participants were 2323 Hispanic (44.1%), non-Hispanic Black (30.5%), non-Hispanic White (8.6%), and non-Hispanic Asian (16.7%) eighth graders (51.1% female) from 24 public middle schools in southeast Texas in 2019. Multivariate linear and logistic regressions for the depression and sleep outcomes, respectively, were conducted while controlling for clustering in schools. Findings indicated that experiencing two or more SLEs (compared to one or none) was associated with worse adjustment in the short and longer term. Problem-focused coping was concurrently associated with better adjustment but heightened the association between aggregated SLEs and depressive symptoms over time. Avoidant coping was not associated with adjustment longitudinally but, in the short term, it was associated with higher depressive symptoms and exacerbated the association between SLEs and depressive symptomatology. Avoidant coping was also associated with better odds of getting adequate sleep when no SLEs were experienced but conditioned the negative association between experiencing one SLE and worse sleep. Lastly, emotion-focused coping was associated with poorer adjustment both in the short and longer term and exacerbated the negative association between SLEs on short-term adjustment. These findings add incrementally to the literature on adolescent coping with SLEs during a time when researchers and practitioners are grappling with how best to address the increased stress and deteriorating mental health of adolescents.