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Reading notes, Uncategorized

Saturday afternoon Journal Club.

One of my colleagues emails me papers, and he notes  that JAMA now does these graphically.

Looking around the open access journals this afternoon, there are a couple of highly controversial papers that make the idea of having antidepressants post infarct to prevent cardiac death seem safe and tame.

One is a description of adolescents developing transgender identities in clusters.

Although not all research studies on gender dysphoric adolescents exclude those with adolescent-onset gender dysphoria, it is important to note that most of the studies on adolescents, particularly those about gender dysphoria persistence and desistance rates and outcomes for the use of puberty suppression, cross-sex hormones, and surgery only included subjects whose gender dysphoria began in childhood and subjects with adolescent-onset gender dysphoria would not have met inclusion criteria for these studies. Therefore, most of the research on adolescents with gender dysphoria to date is not generalizable to adolescents experiencing adolescent-onset gender dysphoria and the outcomes for individuals with adolescent-onset gender dysphoria, including persistence and desistence rates and outcomes for treatments, are currently unknown.

The survey asked about gender dysphoria before adolescence: most of the children in the cohort had no symptoms beforehand, while they now had three or four. It is worth noting that about half were injuring themselves, and most had significant issues prior to this transition. The childen thought transition would solve all their problems. But only a minority got better.

The trajectories of the AYAs were not consistent with the narrative of discovering one’s authentic self and then thriving. Specifically, parents reported that, after “coming out,” their children exhibited a worsening of their mental well-being. Additionally, parents noted worsening of the parent-child relationship and observed that their children had narrowed their interests. Although small numbers of AYAs had improvement in mental well-being (12.6%), parent-child relationship (7.4%), grades/academic performance (6.4%), and had broadened their interests and hobbies (5.1%); the most common outcomes were worsened mental well-being (47.2%); worsened parent child relationship (57.3%); unchanged or mixed grades/academic performance (59.1%); and a narrowed range of interests and hobbies (58.1%). One parent describing her child’s trajectory offered, “After announcing she was transgender, my daughter’s depression increased significantly. She became more withdrawn. She stopped participating in activities which she previously enjoyed, stopped participating in family activities, and significantly decreased her interaction with friends. Her symptoms became so severe that she was placed on medication by her physician.”

 

This is qualitative. It is in a moderate impact journal. Watch this space: it may be that we will find that our current approach — often without evidence base — may be harmful. And the physicians and counsellors who allowed such early transitions would be accountable.

The other interesting paper this week is about sitting and screen time. It is bad for adults, and it appears that there is a strong association with adolescents as well.

Overall, there was a slight drop in the prevalence of depressive symptoms for those engaging in 1–2 h of sedentary behavior per day compared to <?1 h/day. This decrease was particularly pronounced among males (Fig. 2). Beyond 1–2 h/day, there was a linear increase in the prevalence of depressive symptoms with increasing sedentary time.

Davy Vancampfort, Brendon Stubbs, Joseph Firth, Tine Van Damme and Ai Koyanagi Sedentary behavior and depressive symptoms among 67,077 adolescents aged 12–15 years from 30 low- and middle-income countries International Journal of Behavioral Nutrition and Physical Activity201815:73 https://doi.org/10.1186/s12966-018-0708-y

Again, you can read the whole article. My suggestion from all this is that it is far beter for kids to run and play than be in front of a screen. Build a tree house instead of buying a tablet. Being old fashioned, yet again, is probably better for you and your children than whatever Apple, Google and Facebook or the rainbow barney creeps in Hollywood are promoting or are using.

Besides, we use enough antidepressants already.

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