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The MeToo-movement challenges the 'culture of silence' regarding sexual harassment (SH). There are few studies regarding this phenomenon in academic settings. The aim of this study was to investigate the relationship between having reported or disclosed SH, on the one hand, and background factors and general health and wellbeing of exposed individuals, types of SH and perpetrator characteristics, on the other hand. A questionnaire sent to all employees and students at a large Swedish university was returned by 33% (N = 2736) and 32% (N = 9677), respectively. This study is based on the 469 employees and 2044 students who affirmed that they had been exposed to SH at the university. Analyses were made by means of chi2 tests and logistic regression. Among employees, 38.8% had disclosed, i.e., talked to someone at the university about their experience, and 17.3% had formally reported, i.e., talked to someone at the university who had the obligation to act on this information. The corresponding figures among students were 11.2% and 4.0%. A higher professional rank was linked to lower disclosing and reporting behavior, although not statistically significantly. Among students, exposure to attempted or completed rape was linked to low rates of disclosing (24.3%) and reporting (8.1%). An asymmetrical power relationship was associated with higher rates of disclosing and reporting; although statistically significant for reporting only among employees, and for disclosing only among students. None of the health-related outcomes were related to disclosing or reporting. The study confirmed a culture of silence regarding SH in the university setting. Several factors were linked to this, which can be associated with gendered and other power relations in society at large and in the academic setting in particular. Similar factors affected employees as well as students, but the culture of silence seemed more pronounced among students.

There is a significant gap in the provision of care for transgender or gender-nonconforming patients. This population experiences a multitude of disparate health outcomes. Studies have demonstrated a clear knowledge gap among ED clinicians regarding the care for transgender or gender-nonconforming patients. A significant number of ED clinicians reported caring for transgender or gender-nonconforming patients during their careers. Currently, many ED clinicians report receiving minimal or no training in the care of transgender or gender-nonconforming patients. This lack of competency contributes to ED care avoidance in this population. This quality improvement project aimed to evaluate the effectiveness of improving clinicians’ knowledge and skills, openness and support, and oppression awareness in transgender or gender-nonconforming patients through a targeted educational intervention. This study included 4 community hospital-based emergency departments. Performance in the domains of knowledge and skill, openness and support, and oppression awareness was measured using the Ally Identity Measure questionnaire and a paired t test analysis of scored results. The intervention for this quality improvement project was a synchronous, in-person education session delivered once in each of the respective hospital-based emergency departments that addressed key components of understanding transgender or gender-nonconforming patient care. These topics include relevant terminology, assessment recommendations, common gender-affirming therapies, and local resources for follow-up. It also incorporated audio/video testimonies of transgender or gender-nonconforming patients and a case study. Improvement was demonstrated in all 3 domains when comparing the pre- and postintervention Ally Identity Measure scores. Knowledge and skills demonstrated the most significant increase from pre- (mean, 25.3) to postintervention (mean, 34.6). Openness and support and oppression awareness demonstrated almost equal improvement when comparing pre- (openness and support mean, 27.0; oppression awareness mean, 16.9) and postintervention performance (openness and support mean, 29.2; oppression awareness mean, 18.4). Transgender or gender-nonconforming patients represent a unique clinical cohort that requires specialized knowledge to provide competent patient care. ED clinicians demonstrated knowledge deficits regarding transgender or gender-nonconforming patient care. These findings support the need for formalized training in the care of transgender or gender-nonconforming patients and its effectiveness in addressing the existing ED clinician education gap.

Between May and November, 2022, global outbreaks of human monkeypox virus infection have been reported in more than 78 000 people worldwide, predominantly in men who have sex with men. We describe the epidemiological and clinical characteristics of monkeypox virus infection in cisgender (cis) and transgender (trans) women and non-binary individuals assigned female sex at birth to improve identification and understanding of risk factors. International collaborators in geographical locations with high numbers of diagnoses of monkeypox virus infection were approached and invited to contribute data on women and non-binary individuals with confirmed monkeypox virus infection. Contributing centres completed deidentified structured case-report spreadsheets, adapted and developed by participating clinicians, to include variables of interest relevant to women and non-binary individuals assigned female at birth. We describe the epidemiology and clinical course observed in the reported infections. Collaborators reported data for a total of 136 individuals with monkeypox virus infection who presented between May 11 and Oct 4, 2022, across 15 countries. Overall median age was 34 years (IQR 28–40; range 19–84). The cohort comprised 62 trans women, 69 cis women, and five non-binary individuals (who were, because of small numbers, grouped with cis women to form a category of people assigned female at birth for the purpose of comparison). 121 (89%) of 136 individuals reported sex with men. 37 (27%) of all individuals were living with HIV, with a higher proportion among trans women (31 [50%] of 62) than among cis women and non-binary individuals (six [8%] of 74). Sexual transmission was suspected in 55 (89%) trans women (with the remainder having an unknown route of transmission) and 45 (61%) cis women and non-binary individuals; non-sexual routes of transmission (including household and occupational exposures) were reported only in cis women and non-binary individuals. 25 (34%) of 74 cis women and non-binary individuals submitted to the case series were initially misdiagnosed. Overall, among individuals with available data, rash was described in 124 (93%) of 134 individuals and described as anogenital in 95 (74%) of 129 and as vesiculopustular in 105 (87%) of 121. Median number of lesions was ten (IQR 5-24; range 1–200). Mucosal lesions involving the vagina, anus, or oropharynx or eye occurred in 65 (55%) of 119 individuals with available data. Vaginal and anal sex were associated with lesions at those sites. Monkeypox virus DNA was detected by PCR from vaginal swab samples in all 14 samples tested. 17 (13%) individuals were hospitalised, predominantly for bacterial superinfection of lesions and pain management. 33 (24%) individuals were treated with tecovirimat and six (4%) received post-exposure vaccinations. No deaths were reported. The clinical features of monkeypox in women and non-binary individuals were similar to those described in men, including the presence of anal and genital lesions with prominent mucosal involvement. Anatomically, anogenital lesions were reflective of sexual practices: vulvovaginal lesions predominated in cis women and non-binary individuals and anorectal features predominated in trans women. The prevalence of HIV co-infection in the cohort was high. None.

This study aimed to examine the emotional processing of math-related pictures in individuals with math anxiety (MA). Undergraduate participants with low ( n  = 32) and high ( n  = 29) MA assessed math-related pictures, along with pleasant, neutral, and unpleasant pictures, in terms of valence, arousal, and dominance. The high-MA group assessed math-related pictures with lower valence and dominance, and higher arousal, than neutral pictures. Indeed, they emotionally processed the math-related pictures similarly to unpleasant low-arousing images (e.g., pictures of heavily polluted environments). Both groups significantly differed only for the math-related pictures: the high-MA group scored lower in valence and dominance and higher in arousal compared to the low-MA group. These results indicate that math-related pictures are charged emotional cues, which moderately activate the defensive motivational system in individuals with MA. The present study contributes to our understanding of the threatening nature of images depicting math contents embedded in an ecological environment.

Introduction Brazil offers free‐of‐charge antiretroviral therapy (ART) for people living with HIV (PLWH) as well as oral pre‐exposure prophylaxis (PrEP) through its national health system. Adherence to ART and to PrEP is essential to achieving the expected benefits of virologic suppression and prevention of HIV acquisition, respectively. Brazil has experienced worsening social inequalities, exacerbated by the COVID‐19 pandemic, leading to increases in food insecurity especially among vulnerable populations. We explored whether food insecurity mediated the association of socio‐economic status on adherence to ART/PrEP. Methods Adult men who have sex with men (MSM) and transgender and non‐binary persons (TGNB) living in Brazil (May−September/2021) voluntarily participated in a cross‐sectional online study advertised on dating apps and social media. Participants living with HIV reporting ART use and participants with HIV‐negative status reporting daily oral PrEP use were eligible for the analysis. Self‐report of ART adherence was measured by the WebAd‐Q instrument (3‐items/past week) plus a visual analogue scale. Self‐report of PrEP adherence was measured by the number of days the person took PrEP in the past week. The 8‐item Brazilian Scale of Food Insecurity (EBIA) was used to measure food insecurity (higher scores indicate more severe food insecurity). Two structural equation models were used to assess the direct and indirect effects of variables on ART adherence among PLWH and on PrEP adherence among people using PrEP. Results In total, 1230 PLWH were using ART, and 991 individuals with HIV‐negative status were using daily oral PrEP. The median age of PLWH was 37 years (HIV negative: 34 years), most were cismen (98%). More PLWH reported moderate/severe food insecurity (21.7%; HIV negative: 12.9%). Self‐report of ART adherence (measured by WebAd‐Q, past 7 days) was 55.7% (PrEP adherence: 93.3%). In the two models, socio‐economic status had an effect on adherence that was mediated through food insecurity: higher socio‐economic status was associated with lower food insecurity, and higher food insecurity was associated with lower adherence. Conclusions Our findings suggest that the provision of socio‐economic support could help PLWH and people at higher vulnerability to HIV acquisition by improving their adherence to ART or PrEP, and ultimately populations through decreased HIV transmissions.

Trans clients are frequently doubted, misunderstood, infantilised and judged by professionals, and this book presents an approach that ensures psychological wellbeing and trust is built between counsellor and client. This person-centred, affirmative approach is based around unlearning assumptions about gender and destabilising professionals' ideas of 'knowing better' than, and judging the client, so that they can forge a relationship and connection that is on an equal footing. The book explores a range of topics such as the overlap of gender diversity and autism, sex and sexuality, intersectionality, unconscious bias and reflective practice. Essential reading for professionals that want to support trans people's mental health and social wellbeing.

Written by experienced clinicians and edited by Vanderbilt Program for LGBTI Health faculty, this book contains up-to-date expertise from physicians renowned for their work in LGBT health. This important text fills an informational void about the practical health needs of LGBT patients in both the primary care and specialty settings remains, and serves as a guide for LGBT preventive and specialty medicine that can be utilized within undergraduate medical education, residency training, and medical practice. Beginning with a short review of LGBT populations and health disparities, it largely focuses on the application and implementation of LGBT best practices within all realms of medical care. In addition, the book offers recommendations for the integration of LGBT health into systems-based practice by addressing intake forms and electronic health records, as well as evidence-based emerging concerns in LGBT health. This is a must-have volume for medical students, residents, and practicing physicians from all medical specialties.

The Pocket Guide to LGBTQ Mental Health is a down-to-earth, informative, and affirming manual for mental health clinicians working with patients of diverse gender and sexual identities. In recent years, people have begun to grapple with these issues in a healthier, more public way, and mental health practitioners must be prepared to meet their patients with the knowledge, understanding, and grasp of the context in which patients live their lives. The editors have brought their specialized knowledge to the project and, along with contributors who are experts in the field of LGBTQ mental health, have created a book of uncommon empathy. The volume's structure is simple, consistent, and effective, with 10 chapters covering lesbian, gay, bisexual, transgender, queer, questioning, intersex, asexual, pansexual, and allied individuals. Some chapters overlap because some people identify with more than one of these identities. The writers have drawn on both the scientific literature and their own clinical experience to create a volume that is informative, practical, and easy to read. The book possesses an abundance of useful features: • All diagnostic and treatment discussions are based on the latest information found in DSM-5.• Each chapter includes straightforward, real-world, and evidence-based answers to \"Questions Well-Meaning People Ask\" -- essentially, \"What would patients, their friends, their parents, their physicians like to know about being X, Y, or Z?\"• A special section in each chapter addresses themes that may emerge during therapy, preparing the clinician to identify and respond sensitively and knowledgeably to issues that may become salient as counseling progresses.• Each chapter concludes with \"Five Take-Home Points, \" a handy summary of the most important information, allowing the reader to identify essential material and consolidate learning.• An extensive collection of resources is included, helping the reader to locate more information on reliable websites and from other authoritative sources. Written in a conversational style that will appeal to patients and families, as well as clinicians, the Pocket Guide to LGBTQ Mental Health explores the psychological and cultural context for each gender or sexual identity in a comprehensive, realistic, and affirming way.

This guide shows how to sensitively treat and care for transgender patients in healthcare settings. Distilling cutting edge research into practical advice, it covers everything from referral procedures to respectful language and insights on the wider social and ethical issues experienced by this growing client group.