Standards of Care for the Health of Transgender and Gender Diverse People, Version 8.

Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8. Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment. Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings. Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health. Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for the treatment of people experiencing gender incongruence. As in all previous versions of the SOC, the criteria set forth in this document for gender-affirming medical interventions are clinical guidelines; individual health care professionals and programs may modify these in consultation with the TGD person.

Use of temporary and semipermanent enrichment objects by five chimpanzees.

At the Chimpanzee and Human Communication Institute, caregivers provide the 5 chimpanzees who reside there with many different forms of social, food, habitat, and object enrichment. In this study, we examined the chimpanzees' use of both semipermanent and temporary objects. Semipermanent objects included cargo nets, climbing structures, a treat mound, and other objects that were present at the chimpanzees' enclosure throughout the duration of this study. Each day, 50 temporary objects were placed in the chimpanzees' outdoor enclosure or indoor exercise rooms. Frequency of use was examined in 2 conditions: rotated and same. In the rotated condition, temporary objects were replaced with different temporary objects after 3 hr. In the same condition, temporary objects were presented for the entire day. Focal and scan sampling were used to record the chimpanzees' use of enrichment objects. Observers collected focal sample data to record the chimpanzees' initial reaction to objects when entering the indoor exercise rooms, outdoor enclosures, or both at 9:00 a.m. and 1.00 p.m. A total of 35 hr of focal data and 156 hr of scan data were collected over an 8-week period. Temporary object rotation increased the overall frequency of temporary object use both in the initial 15 min of focal sample data and during the following 6 hr of scan sample data for 4 of the chimpanzees. All of these chimpanzees used both semipermanent and temporary objects throughout the day. Each chimpanzee's pattern of use was unique. The results of this study emphasize the importance of temporary object rotation and presentation of both temporary and semipermanent objects to captive chimpanzee environments.

[Epidemiology of malignant neoplasms of the upper respiratory tract and oral cavity in the Bydgoszcz region]. / Epidemiologia nowotworów zlosliwych górnych dróg oddechowych i jamy ustnej w województwie bydgoskim.

The authors performed epidemiological analysis of malignant neoplasms of the nose, paranasal sinuses, throat, tongue, larynx and salivary glands in Bydgoszcz area. All the patients were treated in the Otolaryngological Clinic of Medical Academy in Bydgoszcz. Patient's sex, age, profession, living and environmental conditions as well as histopathological diagnosis were taken into analysis. The data were referred to various regions of Bydgoszcz province, which were elucidated on the basis of microclimate conditions, industry, soil conditions, density of the forest area, and cultivated agriculture plants. Correlations between occurrence of oral cavity and the upper respiratory tract malignant neoplasms and living conditions as well as kind of profession in different parts of Bydgoszcz province were estimated.

[Malignant neoplasms of the tongue and tonsil-glossal angle from material obtained in the otolaryngology clinic in Bydgoszcz in the years 1981-1994]. / Nowotwory zlosliwe jezyka i kata migdalkowo-jezykowego w materiale Kliniki Otolaryngologii w Bydgoszczy w latach 1981-1994.

In the period 1981-1994 in the ENT Department, University School of Medical Sciences in Bydgoszcz, 102 patients with malignant neoplasms of the tongue and the tonsillo-glossal angle were treated. The most common group comprised patients diagnosed with "planoepithelial carcinoma" (94 persons). The number of patients with tongue malignancies increased every year. Similarly, increasing of the neoplastic grade was observed. The majority of patients underwent surgery and, in the next step, radiotherapy. We preferred a total tumor excision involving half of the tongue. Often we had to extend surgery to resection of the lateral part of throat and, in situation of extreme penetration of neoplasms, we removed the bottom of oral cavity. We concluded that in patients with malignant neoplasms of the tongue, planoepithelial carcinoma is present in more than 90 percent of cases. The tumors are diagnosed in the late period. On initiation of treatment half of the patients were presenting with T2 tumors. We confirmed infiltration of the tonsillo-glossal angle in half of the patients. Five years survival without tumor recurrence in our material was 26.47%.

[Parotid neoplasms from material in the Bydgoszcz otolaryngologic clinics in the years 1980-1994]. / Guzy nowotworowe slinianek przyusznych w materiale bydgoskiej Kliniki Otolaryngologii w latach 1980-1994.

During the years 1980-1994 159 patients with parotid tumors were treated in ENT Clinic in Bydgoszcz. 26.4% (42 patients) of tumors were malignant. The main surgical procedures were the removal of tumor, partial parotidectomy, total conservative parotidectomy and total radical parotidectomy. In malignant tumor cases the radiotherapy followed the surgery.