The experiences of gender diverse and trans children and youth considering and initiating medical interventions in Canadian gender-affirming speciality clinics

Abstract

Background: Canadian specialty clinics offering gender-affirming care to trans and gender diverse children and youth have observed a significant increase in referrals in recent years, but there is a lack of information about the experiences of young people receiving care. Furthermore, treatment protocols governing access to gender-affirming medical interventions remain a topic of debate.

Aims: This qualitative research aims to develop a deeper understanding of experiences of trans youth seeking and receiving gender-affirming care at Canadian specialty clinics, including their goals in accessing care, feelings about care and medical interventions they have undergone, and whether they have any regrets about these interventions.

Methods: The study uses an adapted Grounded Theory methodology from social determinants of health perspective. Thirty-five trans and gender diverse young people aged 9 to 17?years were recruited to participate in semi-structured interviews through the specialty clinics where they had received or were waiting for gender-affirming medical interventions such as puberty blockers, hormone therapy, and surgery.

Results: Young people felt positively overall about the care they had received and the medical interventions they had undergone, with many recounting an improvement in their well-being since starting care. Most commonly shared frustrations concerned delays in accessing interventions due to clinic waiting lists or treatment protocols. Some youth described unwanted medication side-effects and others said they had questioned their transition trajectory at certain moments in the past, but none regretted their choice to undergo the interventions.

Discussion: The results suggest that trans youth and gender diverse children are benefiting from medical gender-affirming care they receive at specialty clinics, providing valuable insight into their decision-making processes in seeking care and specific interventions. Providers might consider adjusting aspects of treatment protocols (such as age restrictions, puberty stage, or mental health assessments) or applying them on a more flexible, case-by-case basis to reduce barriers to access.     

The effects of spatial configuration on preschoolers' attention strategies,selective attention,and incidental learning

This study investigated the effects of spatial arrangement on preschool children's selective attention and incidental learning. Three‐ and four‐year old children were shown a multi‐coloured box designated as a ‘special place’ containing miniature chairs and models of animals. One category of objects were designated as relevant and one as irrelevant. Relevant items were placed in each of the apparatus' corners, in the middle of its walls, or in two corners and in the middle of two walls. Findings revealed that children shown relevant items in corners demonstrated the greatest number of correct relocations for relevant items while those shown relevant items in the middle of the walls showed the greatest number of correct relocations for irrelevant items. Findings also suggest that for both age groups, the ability to recall relevant items may have been independent of their ability to demonstrate a selective attention strategy. Copyright © 2005 John Wiley & Sons, Ltd.     

Creative potential: assessment issues and the EPoC Battery / Potencial creativo: temas de evaluación y batería EPoC

Abstract

Creative potential can be conceptualized as an ability to produce original ideas that have value in their context. This ability can be measured in three different ways, namely by examining (a) accomplishments or (b) ingredients (abilities and traits) underlying creativity or (c) through contextualized tasks that simulate real-world creative work. The Evaluation of Creative Potential (EPoC) Battery offers a contextualized measure of divergent-exploratory and convergent-integrative thinking processes applied in several content domains (visual art, verbal-literary, social, scientific, maths, music and body movement). The domain specificity of creative ability is represented by a profile of scores. Creative giftedness can be detected using this type of battery. The assessment of creative potential provides an opportunity for identification, orientation, individualized educational programmes and analyses of the effects of creativity training programmes.     

Traumatic stress symptoms following a lower limb amputation in diabetic patients: a longitudinal study

Objective: Limited research has focussed on the development of traumatic stress symptoms following an amputation due to a chronic disease such as Diabetes. This study analysed whether coping strategies, anxiety and depression symptoms, sociodemographic and clinical variables were related to traumatic stress symptoms in a sample of patients who had undergone a lower limb amputation.

Design: A longitudinal design with three assessments, one month (T1), six (T2) and ten months after an amputation surgery (T3), included 144 patients.

Main outcome measures: IES-R, WOC and HADS.

Results: Traumatic stress symptoms were prevalent at T1 (M?=?15.65, SD?=?15.40) and probable PTSD was observed in 13.9% patients. Presence of pain, high level of anxiety symptoms and emotion-focused strategies contributed to traumatic stress symptoms, and the period between T1 and T2, was critical. Six to ten months (Λ?=?0.871, F (2,84) =6.245, p=. 003), after surgery, symptoms tended to decrease 0.122 units (SE?=?0.032, p?=?0.002) per assessment.

Conclusions: Findings raise awareness to the need of urgent identification of traumatic stress symptoms in medically ill patients who underwent a lower limb amputation, given the prevalence of traumatic stress symptoms right after surgery and in the following six months.     

The Alleged Priority of Literal Interpretation

In this article, I argue against a widely accepted model of utterance interpretation, namely the LS model (literality-based serial model), according to which the literal interpretation of an utterance (the proposition literally expressed by that utterance) must be computed before nonliteral interpretations can be entertained. Alleged arguments in favor of this model are shown to be fallacious, counter-examples are provided, and alternative models are sketched.     

Problem-Solving Restructuration: Elimination of Implicit Constraints

A general model of problem-solving processes based on misconception elimination is presented to simulate both impasses and solving processes. The model operates on goal-related rules and a set of constraint rules in the form of “if (state or goal), do not (Action)” for the explicit constraints in the instructions and the implicit constraints that come from misconceptions of legal moves. When impasses occur, a constraint elimination mechanism is applied. Because successive eliminations of implicit constraints enlarge the problem space and have an effect on planning, the model integrates “plan-based” and “constraint-based” approaches to problem-solving behavior. Simulating individual protocols of Tower of Hanoi situations shows that the model, which has a proper set of constraints, predicts a single move with no alternative on about 61% of the movements and that protocols are quite successfully simulated movement by movement. Finally, it is shown that many features of previous models are embedded in the constraint elimination model.