ABSTRACT
Background The societal discourse concerning gender(diversity) is changing rapidly and this trickles down to our consultation rooms. Most requests for gender-affirming medical care (GAMC) are well-considered and evidently necessary. In more complex presentations, however, challenges may arise. Aim To provide insight into clinical challenges in decision-making regarding GAMC. Method Discussing relevant literature by means of a clinical vignette. Results Dilemmas may arise in assessing competence to give consent to treatment. In differential diagnosis, it may be challenging to discern the interaction between gender incongruence and co-occurring mental conditions. Conclusion It is unethical to prima facie deny access to GAMC to those presenting with co-occurring mental health concerns and/or challenges in decision-making capacity. For this population, specialist care and comprehensive deliberation are indicated. To arrive at good care and decision-making, sufficient knowledge and sensitivity among, and cooperation with other mental health services is indispensable.
Subject(s)
Mental Health Services , Patient Care , Humans , Mental Health , Referral and ConsultationABSTRACT
In May 1990 491 persons living next to a metallurgical plant in Braubach were examined concerning the concentration of heavy metal in the blood. On account of a modification of the plant, the blood-lead concentration of these persons was, in comparison with former examinations, significantly decreased. Subjects with vocationally exposed relatives showed enhance values. This is probably caused by the penetration of pollutants into the domestic sphere. Contamination of blood by different heavy metals could not be ascertained. Examined hemapaetic parameters were not affected. In scopes with minor lead concentrations in blood indications have proved that the lead pipes of the drinking-water pipe system engendered the contamination. At present further internal neurological and psychological examinations are being performed.
Subject(s)
Lead Poisoning/blood , Lead Poisoning/prevention & control , Lead/pharmacokinetics , Mass Screening , Occupational Diseases/chemically induced , Occupational Diseases/prevention & control , Adolescent , Adult , Child , Environmental Exposure , Female , Germany , Humans , Male , Occupational Diseases/bloodABSTRACT
The Office of Public Health in the Rhine-Lahn-district offered information meetings about AIDS-prävention to 51 local kindergartens. 36 of them were interested. The following article describes how to organize a sequence of such meetings. A basic conception is introduced which can help to reduce the staff's fear and insecurity when they have to decide about admission of HIV-infected children.
Subject(s)
Acquired Immunodeficiency Syndrome/transmission , Health Education/methods , Social Environment , Teaching , Acquired Immunodeficiency Syndrome/prevention & control , Child , Child, Preschool , HumansABSTRACT
Within the framework of the school examination of fourth-formes in 1988, 997 children of the primary schools in the Rhein-Lahn district were examined by the Board of Health of Lahnstein. Nearly every 5th child had to be referred to established specialists because of suspicious diagnoses. Primarily this was a matter of pathological skeleton findings. About 20% of the children were overweight. About 75% of the pupils complied with our request to show us their vaccination certificates. After a part of them had been revaccinated, complete vaccination status was available in three quarter of the children. The significance of medical examination in school is underlined by the great number of children with medical problems. First of the area of the spinal column is alarmingly high. The health-political significance results from the possibility of an early prevention of degenerative diseases of the spinal column.
