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  1. Article ; Online: Factors that help and hinder transgender and nonbinary youth accessing gender care in Ireland: A multistakeholder exploration.

    Kearns, Seán / O'Shea, Donal / Neff, Karl

    Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing

    2023  Volume 56, Issue 1, Page(s) 60–75

    Abstract: Introduction: The purpose of this study was to identify the common factors that help and hinder transgender and nonbinary youth accessing gender-specific health care in Ireland and to identify how these factors may be perceived differently by young ... ...

    Abstract Introduction: The purpose of this study was to identify the common factors that help and hinder transgender and nonbinary youth accessing gender-specific health care in Ireland and to identify how these factors may be perceived differently by young people seeking gender-affirming care, their parents, and health-care providers.
    Design: Qualitative investigation utilizing framework analysis (FA).
    Methods: In-depth one-one interviews were conducted with transgender and nonbinary youth (n = 10), parents of youth (n = 10), and gender-specific health-care providers (n = 10). Maximum variation and snowball sampling were used to recruit participants across Ireland. An interview guide codesigned with an expert panel of gender-diverse youth was utilized. Interviews were audio-recorded and transcribed verbatim. FA was used to code the data and identify key issues and recommendations.
    Results: Four themes were derived: (1) "Needing bricks to build" (structural factors); (2) "Enduring and convincing" (diagnostic factors); (3) "Being me, hiding me"; (personal factors); and (4) "It takes a tribe" (interpersonal factors). Each stakeholder group perceived different factors as help or hindrance in accessing care with varying intensities.
    Conclusions: Paramount to the future of gender services in Ireland is the investment of resources for children and young adults. Assessment is likely to remain a component of gender care, but youth recommend distinct revisions to the assessment process. Additional research would be useful in exploring the intersection of neurodiversity and gender as it pertains to health-care navigation. Family and peer support is a strong protective factor and enabler of health-care access among youth.
    Clinical relevance: Access to gender-specific health care remains difficult for transgender and non-binary youth. An understanding of the complexity of this healthcare navigation by healthcare professionals may help to mitigate future negative experiences. This study explores some of the clinical considerations that arise for this population from provider perspectives while elucidating the experiences of youth and parents attempting to access care. Further research is needed on longitudinal outcomes following medical and surgical interventions for transgender youth, including nonbinary identities.
    MeSH term(s) Young Adult ; Child ; Humans ; Adolescent ; Transgender Persons ; Ireland ; Qualitative Research ; Gender Identity ; Health Services Accessibility
    Language English
    Publishing date 2023-05-16
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2008214-9
    ISSN 1547-5069 ; 1527-6546
    ISSN (online) 1547-5069
    ISSN 1527-6546
    DOI 10.1111/jnu.12907
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Instruments used to assess gender-affirming healthcare access: a scoping review protocol.

    Kearns, Seán / Hardie, Philip / O'Shea, Donal / Neff, Karl

    HRB open research

    2023  Volume 6, Page(s) 14

    Abstract: Background:  Internationally, the demand for gender-affirming care has increased exponentially in recent years. The clinical presentation of those seeking care has changed with an increase in transmasculine and non-binary identities and a decrease in ... ...

    Abstract Background:  Internationally, the demand for gender-affirming care has increased exponentially in recent years. The clinical presentation of those seeking care has changed with an increase in transmasculine and non-binary identities and a decrease in the average age of those seeking care. Healthcare navigation remains complicated for this population and warrants further investigation in light of ongoing changes in the field. This paper presents a protocol for a scoping review to map and synthesise the academic and grey literature on instruments used to assess healthcare navigation and access for transgender and non-binary individuals seeking gender-affirming care.
    Methods: This review will search databases (PsychINFO, CINAHL, Medline, and Embase.) and grey literature sources. In line with the methodological framework for scoping reviews, the following six stages will be undertaken: (1) identifying the research question, (2) identifying relevant studies, (3) study selection, (4) charting the data, (5) collating, summarising and reporting results and (6) consultation. The PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation will be utilised and reported. The research team will undertake the study as outlined in this protocol and an expert panel of young transgender and non-binary youth will oversee the project through patient and public involvement.  Conclusions: This scoping review has the potential to inform policy, practice, and future research through enhanced understanding of the complex interplay of factors that impact healthcare navigation for transgender and non-binary people seeking gender-affirming care. The results from this study will inform further research into healthcare navigation considerations generally and will inform a research project entitled "Navigating access to gender care in Ireland-a mixed-method study on the experiences of transgender and non-binary youth".
    Language English
    Publishing date 2023-05-19
    Publishing country Ireland
    Document type Journal Article
    ISSN 2515-4826
    ISSN (online) 2515-4826
    DOI 10.12688/hrbopenres.13689.3
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Transgender and non-binary demographics, referrals, and comorbidities among young Irish adults (2014-2020).

    Kearns, Seán / O'Shea, Donal / Neff, Karl

    Irish journal of medical science

    2022  Volume 192, Issue 4, Page(s) 1679–1685

    Abstract: Background: Over the last 6 years, there has been a change in the demographics of people presenting to gender services in Ireland. This is in line with international trends describing a higher number of transgender men (Female-Male, FTM, AFAB) ... ...

    Abstract Background: Over the last 6 years, there has been a change in the demographics of people presenting to gender services in Ireland. This is in line with international trends describing a higher number of transgender men (Female-Male, FTM, AFAB) presenting to gender services as compared to transgender women (Male-Female, MTF, AMAB), and lower ages at referral. Given the changes in demographics, it would be anticipated that clinical needs may have changed. This study describes the demographics of a young Irish sample (participants aged 18-30 years old) and explores the referral pathways and clinical needs of this cohort.
    Methods: The study was performed as a retrospective chart review of 167 charts at The National Gender Service in Ireland over a five-month period.
    Results: Transgender men represented 62.3% of the sample, transgender women 35.3%, and transmasculine/non-binary individuals represented 2.4%. Over two-thirds of participants were on gender affirming hormone therapy or GnRH antagonists and 16.1% had undergone surgical interventions. The median time from referral received to being seen at the clinic was 450 days (481 mean). Mental health comorbidities remain high with 49.1% of youth experiencing depression, a further 15.6% low mood and 26.3% anxiety.
    Conclusion: This is the first study to show increasing referrals of people who were assigned female at birth (AFAB) over assigned male at birth (AMAB) individuals in Ireland, and to document the clinical needs of this cohort. By understanding the changing demographics and clinical needs, we can better plan for care and service improvements.
    MeSH term(s) Adolescent ; Infant, Newborn ; Humans ; Male ; Adult ; Female ; Young Adult ; Transgender Persons/psychology ; Retrospective Studies ; Gender Identity ; Referral and Consultation ; Demography
    Language English
    Publishing date 2022-09-19
    Publishing country Ireland
    Document type Journal Article
    ZDB-ID 390895-1
    ISSN 1863-4362 ; 0021-1265
    ISSN (online) 1863-4362
    ISSN 0021-1265
    DOI 10.1007/s11845-022-03163-y
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Study protocol: navigating access to gender care in Ireland-a mixed-method study on the experiences of transgender and non-binary youth.

    Kearns, Seán / Houghton, Catherine / O'Shea, Donal / Neff, Karl

    BMJ open

    2022  Volume 12, Issue 3, Page(s) e052030

    Abstract: Introduction: There has been a global increase in demand for gender-specific healthcare services and a recognition that healthcare access is complex and convoluted, even in countries with well-developed healthcare services. Despite evidence in Ireland ... ...

    Abstract Introduction: There has been a global increase in demand for gender-specific healthcare services and a recognition that healthcare access is complex and convoluted, even in countries with well-developed healthcare services. Despite evidence in Ireland supporting the improvement in physical and mental health following access to gender care, little is known about the local healthcare navigation challenges. Internationally, research focuses primarily on the experience of service users and omits the perspective of other potential key stakeholders. Youth experiences are a particularly seldom-heard group.
    Methods and analysis: This study will use a sequential exploratory mixed-methods design with a participatory social justice approach. The qualitative phase will explore factors that help and hinder access to gender care for young people in Ireland. This will be explored from multiple stakeholders' perspectives, namely, young people, caregivers and specialist healthcare providers. Framework analysis will be used to identify priorities for action and the qualitative findings used to build a survey tool for the quantitative phase. The quantitative phase will then measure the burden of the identified factors on healthcare navigation across different age categories and gender identities (transmasculine vs transfeminine vs non-binary).
    Ethics and dissemination: This study has been approved by St Vincent's Hospital Research Ethics Committee (RS21-019), University College Dublin Ethics Committee (LS-21-14Kearns-OShea) and the Transgender Equality Network Ireland's Internal Ethics Committee (TIECSK). We aim to disseminate the findings through international conferences, peer-review journals and by utilisation of expert panel members and strategic partners.
    MeSH term(s) Adolescent ; Gender Identity ; Health Services Accessibility ; Humans ; Ireland ; Transgender Persons ; Transsexualism
    Language English
    Publishing date 2022-03-15
    Publishing country England
    Document type Journal Article
    ZDB-ID 2599832-8
    ISSN 2044-6055 ; 2044-6055
    ISSN (online) 2044-6055
    ISSN 2044-6055
    DOI 10.1136/bmjopen-2021-052030
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Experiences of transgender and non-binary youth accessing gender-affirming care: A systematic review and meta-ethnography.

    Kearns, Seán / Kroll, Thilo / O'Shea, Donal / Neff, Karl

    PloS one

    2021  Volume 16, Issue 9, Page(s) e0257194

    Abstract: Objective: Transgender and non-binary individuals frequently engage with healthcare services to obtain gender-affirming care. Little data exist on the experiences of young people accessing gender care. This systematic review and meta-ethnography aimed ... ...

    Abstract Objective: Transgender and non-binary individuals frequently engage with healthcare services to obtain gender-affirming care. Little data exist on the experiences of young people accessing gender care. This systematic review and meta-ethnography aimed to identify and synthesise data on youths' experiences accessing gender-affirming healthcare.
    Method: A systematic review and meta-ethnography focusing on qualitative research on the experiences of transgender and non-binary youth accessing gender care was completed between April-December 2020. The following databases were used: PsychINFO, MEDLINE, EMBASE, and CINAHL. The protocol was registered on PROSPERO, international prospective register of Systematic Reviews (CRD42020139908).
    Results: Ten studies were included in the final review. The sample included participants with diverse gender identities and included the perspective of parents/caregivers. Five dimensions (third-order constructs) were identified and contextualized into the following themes: 1.) Disclosure of gender identity. 2.) The pursuit of care. 3.) The cost of care. 4.) Complex family/caregiver dynamics. 5.) Patient-provider relationships. Each dimension details a complicated set of factors that can impact healthcare navigation and are explained through a new conceptual model titled "The Rainbow Brick Road".
    Conclusion: This synthesis expands understanding into the experience of transgender and non-binary youth accessing gender-affirming healthcare. Ryvicker's behavioural-ecological model of healthcare navigation is discussed in relation to the findings and compared to the authors' conceptual model. This detailed analysis reveals unique insights on healthcare navigation challenges and the traits, resources, and infrastructure needed to overcome these. Importantly, this paper reveals the critical need for more research with non-binary youth and research which includes the population in the design.
    MeSH term(s) Female ; Gender Identity ; Health Services Accessibility ; Humans ; Male ; Transgender Persons/statistics & numerical data ; Transsexualism
    Language English
    Publishing date 2021-09-10
    Publishing country United States
    Document type Journal Article ; Meta-Analysis ; Systematic Review
    ISSN 1932-6203
    ISSN (online) 1932-6203
    DOI 10.1371/journal.pone.0257194
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Innate lymphoid cell (ILC) subsets are enriched in the skin of patients with hidradenitis suppurativa.

    Petrasca, Andreea / Hambly, Roisin / Molloy, Oonagh / Kearns, Sean / Moran, Barry / Smith, Conor M / Hughes, Rosalind / O'Donnell, Margaret / Zaborowski, Alexandra / Winter, Desmond / Fletcher, Jean M / Kirby, Brian / Malara, Anna

    PloS one

    2023  Volume 18, Issue 2, Page(s) e0281688

    Abstract: Hidradenitis suppurativa (HS) is a chronic relapsing inflammatory skin disease manifested as painful inflamed lesions including deep-seated nodules, abscesses and sinus tracts. The exact aetiology of HS is unclear. Recent evidence suggests that immune ... ...

    Abstract Hidradenitis suppurativa (HS) is a chronic relapsing inflammatory skin disease manifested as painful inflamed lesions including deep-seated nodules, abscesses and sinus tracts. The exact aetiology of HS is unclear. Recent evidence suggests that immune dysregulation plays a crucial role in pathogenesis and disease progression. Innate lymphoid cells (ILC) are a recently identified immune cell subset involved in mediating immunity, however their role in HS has not yet been investigated. Three distinct subsets of ILC- ILC1, ILC2 and ILC3 have been described, and these are involved in skin tissue homeostasis and pathologic inflammation associated with autoimmunity and allergic diseases. In this study, we analysed by multiparameter flow cytometry the frequencies of ILC subsets in skin and peripheral blood mononuclear cells (PBMC) of HS patients and compared these to healthy control subjects and psoriasis patients. The absolute numbers of total ILC and subsets thereof were significantly reduced in the blood of HS patients relative to healthy controls. However, when patients were stratified according to treatment, this reduction was no longer observed in patients undergoing anti-TNF treatment. In HS lesional skin the absolute numbers of ILC were significantly increased relative to control skin. Furthermore, the frequencies of total ILC as well as ILC2 and ILC3 were significantly higher in non-lesional than lesional HS skin. This study analysed for the first time the presence of ILC subsets in the blood and skin of HS patients. Our findings suggest that ILC may participate in HS pathogenesis.
    MeSH term(s) Humans ; Immunity, Innate ; Lymphocytes ; Leukocytes, Mononuclear ; Hidradenitis Suppurativa ; Tumor Necrosis Factor Inhibitors ; Inflammation
    Chemical Substances Tumor Necrosis Factor Inhibitors
    Language English
    Publishing date 2023-02-13
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2267670-3
    ISSN 1932-6203 ; 1932-6203
    ISSN (online) 1932-6203
    ISSN 1932-6203
    DOI 10.1371/journal.pone.0281688
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: B-cell-derived transforming growth factor-β may drive the activation of inflammatory macrophages and contribute to scarring in hidradenitis suppurativa.

    Smith, Conor M / Hambly, Roisin / Gatault, Solene / Iglesias-Martinez, Luis F / Kearns, Sean / Rea, Helen / Marasigan, Vivien / Lynam-Loane, Kate / Kirthi, Shivashini / Hughes, Rosalind / Fletcher, Jean M / Kolch, Walter / Kirby, Brian

    The British journal of dermatology

    2023  Volume 188, Issue 2, Page(s) 290–310

    MeSH term(s) Humans ; Hidradenitis Suppurativa ; Cicatrix ; Transforming Growth Factor beta ; Macrophages ; Transforming Growth Factors
    Chemical Substances Transforming Growth Factor beta ; Transforming Growth Factors (76057-06-2)
    Language English
    Publishing date 2023-02-09
    Publishing country England
    Document type Journal Article
    ZDB-ID 80076-4
    ISSN 1365-2133 ; 0007-0963
    ISSN (online) 1365-2133
    ISSN 0007-0963
    DOI 10.1093/bjd/ljac048
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: B-cell and complement signature in severe hidradenitis suppurativa that does not respond to adalimumab.

    Hambly, Roisin / Gatault, Solene / Smith, Conor M / Iglesias-Martinez, Luis F / Kearns, Sean / Rea, Helen / Marasigan, Vivien / Lynam-Loane, Kate / Kirthi, Shivashini / Hughes, Rosalind / Fletcher, Jean M / Kolch, Walter / Kirby, Brian

    The British journal of dermatology

    2023  Volume 188, Issue 1, Page(s) 52–63

    Abstract: Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder with significant morbidity. The pathogenesis remains incompletely understood although immune dysregulation plays an important role. It is challenging to treat and ... ...

    Abstract Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder with significant morbidity. The pathogenesis remains incompletely understood although immune dysregulation plays an important role. It is challenging to treat and approximately 50% of patients respond clinically to adalimumab, the only licensed treatment.
    Objectives: To examine differences between lesional and nonlesional HS skin at baseline using bulk RNA sequencing, and to compare the transcriptome in the skin before and after 12 weeks of treatment with adalimumab. To examine transcriptomic differences between adalimumab responders and nonresponders using Hidradenitis Suppurativa Clinical Response and the International Hidradenitis Suppurativa Severity Score System (IHS4); and to compare transcriptomic differences based on disease severity (Hurley stage and IHS4).
    Methods: We completed bulk RNA sequencing on lesional and nonlesional skin samples of patients before and after 12 weeks of treatment with adalimumab.
    Results: Baseline differentially expressed genes and pathways between lesional and nonlesional skin highlighted chemokines and antimicrobial peptides produced by keratinocytes; B-cell function; T-cell-receptor, interleukin-17 and nuclear factor-κB signalling; and T-helper-cell differentiation. Transcriptomic differences were identified in lesional skin at baseline, between subsequent responders and nonresponders. Patients with severe HS who did not respond to adalimumab had enriched complement and B-cell activation pathways at baseline. In addition, logistic regression identified CCL28 in baseline lesional HS skin as a potential biomarker of treatment response.
    Conclusions: This highlights the potential for targeting B-cell and complement pathways in HS treatment and the potential of stratifying patients at baseline to the most suitable treatment based on the skin transcriptome. CCL28 has not previously been identified in HS skin and has potential clinical relevance due to its antimicrobial function and homing of B and T cells at epithelial surfaces. Our results provide data to inform future translational and clinical studies on therapeutics in HS.
    MeSH term(s) Humans ; Adalimumab/therapeutic use ; Hidradenitis Suppurativa/drug therapy ; Signal Transduction ; Transcriptome ; Severity of Illness Index
    Chemical Substances Adalimumab (FYS6T7F842)
    Language English
    Publishing date 2023-01-24
    Publishing country England
    Document type Journal Article
    ZDB-ID 80076-4
    ISSN 1365-2133 ; 0007-0963
    ISSN (online) 1365-2133
    ISSN 0007-0963
    DOI 10.1093/bjd/ljac007
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: At the outer part of the active site in Trypanosoma cruzi glucokinase: The role of phenylalanine 337.

    Carey, Shane M / Kearns, Sean P / Millington, Matthew E / Buechner, Gregory S / Alvarez, Beda E / Daneshian, Leily / Abiskaroon, Brendan / Chruszcz, Maksymilian / D'Antonio, Edward L

    Biochimie

    2023  Volume 218, Page(s) 8–19

    Abstract: The hole mutagenesis approach was used to interrogate the importance of F337 in Trypanosoma cruzi glucokinase (TcGlcK) in order to understand the complete set of binding interactions that are made by d-glucosamine analogue inhibitors containing aromatic ... ...

    Abstract The hole mutagenesis approach was used to interrogate the importance of F337 in Trypanosoma cruzi glucokinase (TcGlcK) in order to understand the complete set of binding interactions that are made by d-glucosamine analogue inhibitors containing aromatic tail groups that can extend to the outer part of the active site. An interesting inhibitor of this analogue class includes 2-N-carboxybenzyl-2-deoxy-d-glucosamine (CBZ-GlcN), which exhibits strong TcGlcK binding with a K
    MeSH term(s) Humans ; Trypanosoma cruzi ; Glucokinase/chemistry ; Glucokinase/metabolism ; Catalytic Domain ; Phenylalanine ; Artificial Intelligence ; Models, Molecular ; Chagas Disease ; Glucosamine ; Binding Sites ; Crystallography, X-Ray
    Chemical Substances Glucokinase (EC 2.7.1.2) ; Phenylalanine (47E5O17Y3R) ; Glucosamine (N08U5BOQ1K)
    Language English
    Publishing date 2023-09-22
    Publishing country France
    Document type Journal Article
    ZDB-ID 120345-9
    ISSN 1638-6183 ; 0300-9084
    ISSN (online) 1638-6183
    ISSN 0300-9084
    DOI 10.1016/j.biochi.2023.09.014
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  10. Article ; Online: Reduced adiponectin levels in patients with COVID-19 acute respiratory failure: A case-control study.

    Kearns, Sean M / Ahern, Katelyn W / Patrie, James T / Horton, William B / Harris, Thurl E / Kadl, Alexandra

    Physiological reports

    2021  Volume 9, Issue 7, Page(s) e14843

    Abstract: Hypoadiponectinemia is speculated to play a key role in the relationship between obesity and COVID-19 respiratory failure. However, only one study has examined adiponectin levels in COVID-19 patients, and none have investigated adiponectin levels ... ...

    Abstract Hypoadiponectinemia is speculated to play a key role in the relationship between obesity and COVID-19 respiratory failure. However, only one study has examined adiponectin levels in COVID-19 patients, and none have investigated adiponectin levels strictly in patients with acute respiratory failure. In this study, we performed a retrospective case-control study of adipokine levels in patients with acute respiratory failure caused by either COVID-19 or other viral/bacterial source. All patients with COVID-19 respiratory failure in the University of Virginia Biorepository and Tissue Research database were included. We also selected patients with non-COVID-19 infectious respiratory failure from the same biorepository to serve as a comparison cohort. Plasma adipokine levels were measured on three occasions during the first 72 hours of hospitalization. Twelve patients with COVID-19 respiratory failure and 17 patients with other infectious respiratory failure were studied. Adiponectin levels were significantly lower in patients with COVID-19 respiratory failure, even after adjustment for age, sex, BMI, and other covariates. In conclusion, adiponectin levels appear to be reduced in COVID-19 respiratory failure. Larger studies are needed to confirm this report.
    MeSH term(s) Adiponectin/blood ; Aged ; Biomarkers/blood ; COVID-19/blood ; COVID-19/diagnosis ; Databases, Factual ; Down-Regulation ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Time Factors
    Chemical Substances ADIPOQ protein, human ; Adiponectin ; Biomarkers
    Language English
    Publishing date 2021-04-27
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 2724325-4
    ISSN 2051-817X ; 2051-817X
    ISSN (online) 2051-817X
    ISSN 2051-817X
    DOI 10.14814/phy2.14843
    Database MEDical Literature Analysis and Retrieval System OnLINE

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