Combined hysterectomy and mastectomy surgery for transgender patients in an integrated health care setting

Background: Hysterectomy and mastectomy surgery for gender affirmation have traditionally been performed as separate surgeries. Our institution offers these surgeries as a single combined procedure, typically with same-day discharge. Decreasing the number of times patients need to have surgery may reduce barriers to care by limiting surgical and hospital stay events. Our primary objective was to describe the perioperative experience of transgender patients who underwent combined hysterectomy and mastectomy surgery.

Methods: This retrospective case series assessed patients who underwent combined hysterectomy and mastectomy surgery between 2013 and 2015 in an integrated health care setting in the United States. Chart reviews were performed for outcomes of interest, which included operative and postoperative complications.

Results: We identified 25 patients who underwent a combined hysterectomy and mastectomy for the indication of gender transition. Preoperative patient characteristics included a median age of 31, with a median BMI of 25. Ninety-two percent of the patients were on testosterone therapy at the time of surgery. A total of 76% and 24% of patients had laparoscopic and vaginal hysterectomies, respectively. Intraoperatively, the average blood loss was 104 mL, and there were no complications. Eighty percent of patients were discharged on the same day. Postoperatively, 92% of patients experienced no major complications. One patient received a uterine artery embolization and blood transfusion for postoperative intraabdominal bleeding, and one patient presented 9 weeks after surgery with partial vaginal cuff dehiscence requiring a cuff revision. There were no re-admissions within six months of surgery. There were no major mastectomy-related complications.

Conclusions: Combined surgeries are feasible and reduce the number of surgical events and hospital stays. There were no complications that could be attributed to undergoing two procedures as a single incident.     

Intergenerational Continuity in Qualities of the Parent–Child Relationship: Mediating and Moderating Mechanisms

Intergenerational continuity in parenting quality has been demonstrated but the mechanisms underlying this continuity are less understood. This study investigated whether the offspring personality and years of education mediate the continuity in qualities of the parent–child relationship and whether offspring personality moderates this association. The sample comprised 1308 Finnish offspring (G2; 62% female) and their mothers (G1). G1 (Mean age?=?37.7) reported self-perceived qualities of the parent–child relationship in terms of emotional warmth and acceptance towards G2 aged 3–18 years in 1980. Thirty-two years later, once having become parents themselves, G2 (Mean age?=?42.9) self-rated their own qualities of the parent–child relationship towards their children using the same scales. Between these follow-ups, G2 self-rated their personality (consisting of temperament and character traits) using the Temperament and Character Inventory and reported years of education. Results indicated that G2 character traits—Self-directedness and Cooperativeness—partially mediated the intergenerational continuity in self-perceived emotional warmth and explained 16% of this association. No mediating role of G2 temperament traits was found (all ps?>?.240). Character traits accounted for the indirect association better than education in a multiple mediator model. Moreover, no moderating role of either temperament or character traits was found (all ps?≥?.064). Study findings show that warm and accepting qualities of the parent–child relationship in childhood are related to offspring character traits that reflect personality maturity in adulthood, which in turn would predict their own positive parent–child relationship later in life.     

Sluggish cognitive tempo in children and adolescents with higher functioning autism spectrum disorders: Social impairments and internalizing symptoms

Sluggish cognitive tempo (SCT) was introduced in 1980s in the field of attention deficit hyperactivity disorder (ADHD). Studies indicate that symptoms of SCT are separate from symptoms of ADHD and independently associated with multiple domains of functioning in clinical groups and in typical development. We assessed whether similar pattern would apply to higher functioning autism spectrum disorders (ASD). Children with higher functioning ASD (N = 55; 5?15 years) were divided into the ASD+High SCT (n = 17), the ASD+Medium SCT (n = 18) and the ASD+Low SCT (n = 20) groups based on parent‐rated daydreaming and slowness on the Five to Fifteen questionnaire (FTF). The groups were compared on SCT‐related impairments found in previous studies: social skills, academic functioning, psychiatric symptoms, and processing speed. Assessment methods were the FTF, the Development and Well‐Being Assessment, and the Coding subtest of the WISC‐III. The ADHD symptoms were statistically controlled due to the overlap between SCT and ADHD. The ASD+High SCT and ASD+Medium SCT groups were significantly more likely to have the most pronounced social impairments, and the ASD+High SCT group had significantly higher rate of internalizing disorders compared to the ASD+Low SCT group. Our results suggest that children with higher functioning ASD and high or medium levels of SCT symptoms could be at higher risk for psychosocial impairments than children with higher functioning ASD with low levels of SCT symptoms. Co‐occurring ADHD symptoms do not explain the finding. Recognizing SCT symptoms in higher functioning ASD would be important to targeting preventive support.     

Associations of Youth and Adulthood Body-Mass Index and Waist-Hip Ratio with Attachment Styles and Dimensions

The current cross-sectional study examined whether body-mass index (BMI) and waist-hip ratio are associated with adult attachment. Participants were 1,570 men and women participating in Cardiovascular Risk in Young Finns study. BMI was measured in youth and in adulthood and waist-hip ratio in adulthood. A single measure of attachment style was conducted when participants were aged 24–39 years. In age and sex adjusted models, youth BMI (Beta = .066, p = .008), adulthood BMI (Beta = .069, p = .007) and waist-hip ratio (Beta = .082, p = .016) were associated with fearful attachment. The associations remained significant when education and relationship status were adjusted for. Age adjusted association between adulthood waist-hip ratio and preoccupied attachment was found in men (Beta = .132, p = .002). The association was not essentially changed by additionally adjusting for education and relationship status, and including fearful attachment in the model. Furthermore, associations for attachment dimensions were also found. These results suggest that in addition to previously reported negative effects of higher BMI on physical health, higher BMI might have negative associations with psychological functioning as well. Furthermore, our results imply that physical appearance might be associated with attachment style in adulthood.     

International comparison of Cloninger’s temperament dimensions

Cloninger’s Tridimensional Personality Questionnaire (TPQ) and Temperament and Character Inventory (TCI) have been developed to measure the following temperament dimensions: novelty seeking (NS), harm avoidance (HA), reward dependence (RD) and persistence (P). We used our previous Finnish normative study of the TPQ and TCI (Miettunen et al., 2004) to estimate correction coefficients to convert TPQ scales to comparable TCI scales. Our aim was to compare these corrected temperament dimension scores across 20 countries adjusting for study sample differences in age and gender. In all, some variations were found in these temperament scores between countries. Differences were especially apparent between the Asian and the Western countries. By far the lowest mean score of the RD was in Japan (11.2 vs. 15.4 for other countries; effect size Cohen’s d = −5.74; z-test p < 0.001) and the highest mean score in P was in USA (5.5 vs. 4.4; d = 4.24, p = 0.001). Some of the findings could be explained by sample differences (e.g. age and education); while some may reflect real differences in the ways which personality is related to cultural factors, such as individualism/collectivism. These differences should be considered when interpreting studies with data on TPQ/TCI from different countries.     

Personality traits and perceptions of organisational justice

This study examined the association between five‐factor model personality traits and perceptions of organisational justice. The sample for the study comprised 903 participants (35–50 years old; 523 women) studied in 2007 and 2012. Measures used were the Neuroticism, Extraversion, Openness, Five‐Factor Inventory questionnaire and the short organisational justice measure. The results showed that high neuroticism was associated with low distributive, procedural and interactional justice. Furthermore, high agreeableness was associated with high procedural and interactional justice and high openness with high distributive justice. This study suggests that neuroticism, agreeableness and openness are involved in perceptions of organisational justice and that personality should be considered in research and in practices at the workplace.     

The psychophysiology of James Bond: phasic emotional responses to violent video game events

The authors examined emotional valence- and arousal-related phasic psychophysiological responses to different violent events in the first-person shooter video game "James Bond 007: NightFire" among 36 young adults. Event-related changes in zygomaticus major, corrugator supercilii, and orbicularis oculi electromyographic (EMG) activity and skin conductance level (SCL) were recorded, and the participants rated their emotions and the trait psychoticism based on the Psychoticism dimension of the Eysenck Personality Questionnaire--Revised, Short Form. Wounding and killing the opponent elicited an increase in SCL and a decrease in zygomatic and orbicularis oculi EMG activity. The decrease in zygomatic and orbicularis oculi activity was less pronounced among high Psychoticism scorers compared with low Psychoticism scorers. The wounding and death of the player's own character (James Bond) elicited an increase in SCL and zygomatic and orbicularis oculi EMG activity and a decrease in corrugator activity. Instead of joy resulting from victory and success, wounding and killing the opponent may elicit high-arousal negative affect (anxiety), with high Psychoticism scorers experiencing less anxiety than low Psychoticism scorers. Although counterintuitive, the wounding and death of the player's own character may increase some aspect of positive emotion.     

Insecure adult attachment style and depressive symptoms: Implications for parental perceptions of infant temperament

The current study tested associations between parental depressive symptoms, adult attachment styles, and perceptions of infant temperament among 319 mother–infant and 173 father–infant dyads. Depressive symptoms and insecure attachment style among the mothers and/or fathers were associated with perceptions of the infant as temperamentally more negatively and/or less positively tuned. Multivariate analyses of depressive symptoms and attachment styles with perceived temperament suggest that depressive symptoms and perceived temperament remain significantly associated, while the associations between attachment styles and perceived temperament, in most instances, were reduced to nonsignificance. We also tested whether secure attachment among the parents buffered any negatively and/or positively tuned depression‐related perceptions, but found no supporting evidence. Even though the study results await replication in longitudinal designs, they nevertheless underline the significance of parental depressive information processing in the perceiving of infant temperament. ©2004 Michigan Association for Infant Mental Health.     

Type A behaviour and school achievement

Type A behaviour related to school achievement was studied in 1640 randomly selected 12-, 15-, and 18-year-old subjects. Type A behaviour was both self-assessed by the subjects and evaluated by their mothers. Results indicated that school achievement was not related to the global score of Type A behaviour but correlated with three Type A dimensions, i.e. positively with Responsible Hard-driving and Leadership Competitiveness, and negatively with Aggressive Competitiveness. It has previously been shown that hard-driving correlates with a high level of somatic CHD risk factors, while leadership competition is a protective factor, i.e. it is associated with a low level of somatic CHD risk. So, school achievement differentiated adjusted and maladjusted Type A competitors, but not individuals with high and low somatic CHD risk. The results were manifest for boys and girls and for all age groups. Moreover, it was shown that the results were obtained independently of the methods used.     

Temperament and migration patterns in Finland

Migration is a central determinant of population dynamics and structure. We examined whether three major temperament traits--sociability, emotionality, and activity--predicted migration propensity, selective urban-rural migration, and migration distance in a 9-year prospective study in Finland. The participants were Finnish women and men (N= 1,733) ages 15 to 30 years at baseline. The home municipality's position on the urban-rural continuum was assessed on the basis of the municipality's population density. We found that high sociability predicted migration to urban areas and longer migration distances. High activity increased general migration propensity (including migration to both urban and rural areas). High emotionality increased the likelihood of leaving the home municipality and decreased migration distances, but was not associated with selective urban-rural migration. These data suggest that temperament predicts the self-selection of environments on a demographic scale and may be relevant in understanding population dynamics.