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82-681: The Standards of Care for the Health of Transgender and Gender Diverse People ( SOC ) is an international clinical protocol by the World Professional Association for Transgender Health (WPATH) outlining the recommended assessment and treatment for transgender and gender-diverse individuals across the lifespan including social , hormonal , or surgical transition . It often influences clinicians' decisions regarding patients' treatment. While other standards, protocols, and guidelines exist – especially outside

164-437: A causal association does not exist in general. Conversely, it can be (and is in some circumstances) taken by US courts, in an individual case, to justify an inference that a causal association does exist, based upon a balance of probability . The subdiscipline of forensic epidemiology is directed at the investigation of specific causation of disease or injury in individuals or groups of individuals in instances in which causation

246-720: A departure from previous versions, Version 8 draws a conceptual distinction between Adolescents and Children with separate chapters. Continued care and careful assessment of cognitive maturity by qualified mental health professionals is recommended. In contrast to previous versions, there are no absolute requirements for duration of assessments or age to access gender-affirming treatments; rather, individual psychosocial and physical development should be taken into account. Additionally, Chapter 12 and 13 and Appendix D contain further recommendations regarding hormone therapy and surgical treatments in adolescents. Pertaining to prepubescent children only, chapter 7 makes recommendations regarding

328-498: A health system responds to current population health issues but also how a health system can be managed to better respond to future potential population health issues. Examples of organizations that use population-based health management that leverage the work and results of epidemiological practice include Canadian Strategy for Cancer Control, Health Canada Tobacco Control Programs, Rick Hansen Foundation, Canadian Tobacco Control Research Initiative. Each of these organizations uses

410-521: A lesser extent, basic research in the biological sciences. Major areas of epidemiological study include disease causation, transmission , outbreak investigation, disease surveillance , environmental epidemiology , forensic epidemiology , occupational epidemiology , screening , biomonitoring , and comparisons of treatment effects such as in clinical trials . Epidemiologists rely on other scientific disciplines like biology to better understand disease processes, statistics to make efficient use of

492-846: A mastectomy. The seventh version, titled "Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People", was published in 2012 both in the International Journal of Transgenderism and as a standalone document. Included in the guidelines are sections on purpose and use of the WPATH SOC, the global applicability of the WPATH SOC, the difference between gender nonconformity and gender dysphoria, epidemiology , treatment of children, adolescents and adults, mental health , hormone replacement therapy ( masculinizing or feminizing ; HRT), reproductive health, voice and communication therapy, gender-affirming surgery , lifelong preventive and primary care, applicability of

574-787: A population (endemic). The term "epidemiology" appears to have first been used to describe the study of epidemics in 1802 by the Spanish physician Joaquín de Villalba  [ es ] in Epidemiología Española . Epidemiologists also study the interaction of diseases in a population, a condition known as a syndemic . The term epidemiology is now widely applied to cover the description and causation of not only epidemic, infectious disease, but of disease in general, including related conditions. Some examples of topics examined through epidemiology include as high blood pressure, mental illness and obesity . Therefore, this epidemiology

656-520: A population-based health management framework called Life at Risk that combines epidemiological quantitative analysis with demographics, health agency operational research and economics to perform: Applied epidemiology is the practice of using epidemiological methods to protect or improve the health of a population. Applied field epidemiology can include investigating communicable and non-communicable disease outbreaks, mortality and morbidity rates, and nutritional status, among other indicators of health, with

738-422: A prospective study, and confounders are more easily controlled for. However, they are more costly, and there is a greater chance of losing subjects to follow-up based on the long time period over which the cohort is followed. Cohort studies also are limited by the same equation for number of cases as for cohort studies, but, if the base incidence rate in the study population is very low, the number of cases required

820-604: A protocol are seen regularly by research staff to monitor their health and to determine the safety and effectiveness of their treatment. Since 1996, clinical trials conducted are widely expected to conform to and report the information called for in the CONSORT Statement, which provides a framework for designing and reporting protocols. Though tailored to health and medicine, ideas in the CONSORT statement are broadly applicable to other fields where experimental research

902-416: A protocol may refer to the procedural methods of health organizations, commercial laboratories, manufacturing plants, etc. to ensure their activities (e.g., blood testing at a hospital, testing of certified reference materials at a calibration laboratory, and manufacturing of transmission gears at a facility) are consistent to a specific standard, encouraging safe use and accurate results. Finally, in

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984-402: A random sample from the original population at risk. This has as a consequence that the control group can contain people with the disease under study when the disease has a high attack rate in a population. A major drawback for case control studies is that, in order to be considered to be statistically significant, the minimum number of cases required at the 95% confidence interval is related to

1066-420: A regulatory agency. When it is known during the experiment which data was negative there are often reasons to rationalize why that data shouldn't be included. Positive data are rarely rationalized the same way. Epidemiology Epidemiology is the study and analysis of the distribution (who, when, and where), patterns and determinants of health and disease conditions in a defined population . It

1148-520: A section distinguishing between cases of gender dysphoria and non-conformity for children and adolescents, as well as recommended treatment paths for each. A systematic review into international guidelines for management of gender dysphoria and gender incongruence in children and adolescents published as part of the Cass Review in 2024 stated WPATH SOC 7 lacked "developmental rigour and transparency". The eighth version, titled "Standards of Care for

1230-538: A specific laboratory may incorporate or reference standard operating procedures (SOP) governing general practices required by the laboratory. A protocol may also reference applicable laws and regulations that are applicable to the procedures described. Formal protocols typically require approval by one or more individuals—including for example a laboratory directory, study director, and/or independent ethics committee —before they are implemented for general use. Clearly defined protocols are also required by research funded by

1312-445: A unique disease process different from any other individual ("the unique disease principle"), considering uniqueness of the exposome (a totality of endogenous and exogenous / environmental exposures) and its unique influence on molecular pathologic process in each individual. Studies to examine the relationship between an exposure and molecular pathologic signature of disease (particularly cancer ) became increasingly common throughout

1394-468: A year prior to hormones. These critiques developed into a trans-led Advocacy and Liaison committee, marking the first time trans people were officially and actively consulted regarding their treatment. The 5th version, published in 1998, was titled the "Standards of Care for Gender Identity Disorders" to be consistent with the DSM-III. It recommended but did not require psychotherapy and stated that while GID

1476-399: Is a core component, that is unified with management science to provide efficient and effective health care and health guidance to a population. This task requires the forward-looking ability of modern risk management approaches that transform health risk factors, incidence, prevalence and mortality statistics (derived from epidemiological analysis) into management metrics that not only guide how

1558-485: Is a cornerstone of public health , and shapes policy decisions and evidence-based practice by identifying risk factors for disease and targets for preventive healthcare . Epidemiologists help with study design, collection, and statistical analysis of data, amend interpretation and dissemination of results (including peer review and occasional systematic review ). Epidemiology has helped develop methodology used in clinical research , public health studies, and, to

1640-428: Is based upon how the pattern of the disease causes change in the function of human beings. The Greek physician Hippocrates , taught by Democritus, was known as the father of medicine , sought a logic to sickness; he is the first person known to have examined the relationships between the occurrence of disease and environmental influences. Hippocrates believed sickness of the human body to be caused by an imbalance of

1722-479: Is beyond the domain of the science of epidemiology. Epidemiology has its limits at the point where an inference is made that the relationship between an agent and a disease is causal (general causation) and where the magnitude of excess risk attributed to the agent has been determined; that is, epidemiology addresses whether an agent can cause disease, not whether an agent did cause a specific plaintiff's disease. In United States law, epidemiology alone cannot prove that

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1804-483: Is disputed or is unclear, for presentation in legal settings. Epidemiological practice and the results of epidemiological analysis make a significant contribution to emerging population-based health management frameworks. Population-based health management encompasses the ability to: Modern population-based health management is complex, requiring a multiple set of skills (medical, political, technological, mathematical, etc.) of which epidemiological practice and analysis

1886-537: Is famous for his investigations into the causes of the 19th-century cholera epidemics, and is also known as the father of (modern) Epidemiology. He began with noticing the significantly higher death rates in two areas supplied by Southwark Company. His identification of the Broad Street pump as the cause of the Soho epidemic is considered the classic example of epidemiology. Snow used chlorine in an attempt to clean

1968-401: Is impossible or unethical. A good clinical protocol ensures that blinding is as effective as possible within ethical and practical constrains. During the course of an experiment, a participant becomes unblinded if they deduce or otherwise obtain information that has been masked to them. Unblinding that occurs before the conclusion of a study is a source of experimental error, as the bias that

2050-499: Is in the term inference . Correlation, or at least association between two variables, is a necessary but not sufficient criterion for the inference that one variable causes the other. Epidemiologists use gathered data and a broad range of biomedical and psychosocial theories in an iterative way to generate or expand theory, to test hypotheses, and to make educated, informed assertions about which relationships are causal, and about exactly how they are causal. Epidemiologists emphasize that

2132-418: Is increasing recognition that a wide range of modern data sources, many not originating from healthcare or epidemiology, can be used for epidemiological study. Such digital epidemiology can include data from internet searching, mobile phone records and retail sales of drugs. Epidemiologists employ a range of study designs from the observational to experimental and generally categorized as descriptive (involving

2214-404: Is reduced by  1 ⁄ 2 . Although epidemiology is sometimes viewed as a collection of statistical tools used to elucidate the associations of exposures to health outcomes, a deeper understanding of this science is that of discovering causal relationships. " Correlation does not imply causation " is a common theme for much of the epidemiological literature. For epidemiologists, the key

2296-521: Is typically determined using DNA from peripheral blood leukocytes. Since the 2000s, genome-wide association studies (GWAS) have been commonly performed to identify genetic risk factors for many diseases and health conditions. While most molecular epidemiology studies are still using conventional disease diagnosis and classification systems, it is increasingly recognized that disease progression represents inherently heterogeneous processes differing from person to person. Conceptually, each individual has

2378-439: Is used to describe the intersection of Host , Agent , and Environment in analyzing an outbreak. Case-series may refer to the qualitative study of the experience of a single patient, or small group of patients with a similar diagnosis, or to a statistical factor with the potential to produce illness with periods when they are unexposed. The former type of study is purely descriptive and cannot be used to make inferences about

2460-499: Is used. Protocols will often address: Best practice recommends publishing the protocol of the review before initiating it to reduce the risk of unplanned research duplication and to enable transparency, and consistency between methodology and protocol. A protocol may require blinding to avoid bias. A blind can be imposed on any participant of an experiment, including subjects, researchers, technicians, data analysts, and evaluators. In some cases, while blinding would be useful, it

2542-470: The National Institutes of Health . In a clinical trial , the protocol is carefully designed to safeguard the health of the participants as well as answer specific research questions. A protocol describes what types of people may participate in the trial; the schedule of tests, procedures, medications, and dosages; and the length of the study. While in a clinical trial, participants following

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2624-567: The Republican chairwoman Lisa McClain of the U.S. Congress Subcommittee on Health Care and Financial Services announced that it started an investigation and requested documents and information from the HHS related to its interactions with WPATH. The guidelines became a focus of controversy during the debate over the Scottish government's Gender Recognition Reform Bill in 2022. Opponents of

2706-622: The Standards of Care were published as standalone documents by the Harry Benjamin International Gender Dysphoria Association. However, the third version was also published as a 1985 reprint in the journal Archives of Sexual Behavior . In the 1990's, WPATH was struggling to operate due to criticisms of their SOC in the trans community such as the requirement of the real life test , where patients had to socially transition for up to

2788-500: The US Department of Health and Human Services (HHS), this provision was removed in the final release. Despite the criticism, transgender youths wishing to be treated are still required to undergo a "comprehensive diagnostic assessment". In a statement by a spokesperson for the HHS, they explained that Assistant Secretary Levine "shared her view with her staff that publishing the proposed lower ages for gender transition surgeries

2870-476: The " one cause – one effect " understanding is a simplistic mis-belief. Most outcomes, whether disease or death, are caused by a chain or web consisting of many component causes. Causes can be distinguished as necessary, sufficient or probabilistic conditions. If a necessary condition can be identified and controlled (e.g., antibodies to a disease agent, energy in an injury), the harmful outcome can be avoided (Robertson, 2015). One tool regularly used to conceptualize

2952-459: The "who, what, where and when of health-related state occurrence". However, analytical observations deal more with the 'how' of a health-related event. Experimental epidemiology contains three case types: randomized controlled trials (often used for a new medicine or drug testing), field trials (conducted on those at a high risk of contracting a disease), and community trials (research on social originating diseases). The term 'epidemiologic triad'

3034-441: The 1960s, few countries offered safe, legal medical options and many criminalized cross-gender behaviors or mandated unproven psychiatric treatments. In response to this problem, the Harry Benjamin International Gender Dysphoria Association (now known as the World Professional Association for Transgender Health ) authored one of the earliest sets of clinical guidelines for the express purpose of ensuring "lasting personal comfort with

3116-515: The 2000s. However, the use of molecular pathology in epidemiology posed unique challenges, including lack of research guidelines and standardized statistical methodologies, and paucity of interdisciplinary experts and training programs. Furthermore, the concept of disease heterogeneity appears to conflict with the long-standing premise in epidemiology that individuals with the same disease name have similar etiologies and disease processes. To resolve these issues and advance population health science in

3198-504: The 2010s. By 2012, it was recognized that many pathogens' evolution is rapid enough to be highly relevant to epidemiology, and that therefore much could be gained from an interdisciplinary approach to infectious disease integrating epidemiology and molecular evolution to "inform control strategies, or even patient treatment." Modern epidemiological studies can use advanced statistics and machine learning to create predictive models as well as to define treatment effects. There

3280-465: The Health of Transgender and Gender Diverse People", was published in 2022. It gives recommendations for health professionals in eighteen chapters. The guidelines were developed by a multidisciplinary committee of experts, building on previous versions and using the Delphi method . Version 8 is the first one to include a chapter on adolescent care separate from that on the care of children. This version of

3362-560: The OR, a RR greater than 1 shows association, where the conclusion can be read "those with the exposure were more likely to develop the disease." Prospective studies have many benefits over case control studies. The RR is a more powerful effect measure than the OR, as the OR is just an estimation of the RR, since true incidence cannot be calculated in a case control study where subjects are selected based on disease status. Temporality can be established in

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3444-479: The United States ;– the WPATH SOC is the most widespread protocol used by professionals working with transgender or gender-variant people. Version 8 of the WPATH SOC, the latest version, was released online on September 15, 2022. Prior to the advent of the first SOC, there was no semblance of consensus on psychiatric, psychological, medical, and surgical requirements or procedures. Before

3526-484: The WPATH SOC to people living in institutional environments, and applicability of the WPATH SOC to people with disorders of sex development . The seventh version also includes acknowledgements of the ever-evolving language used to describe and treat transsexual, transgender, and gender non-conforming individuals. There is an emphasis placed on the idea that identifying with these labels does not inherently qualify someone as disordered, and that treatment should be focused on

3608-402: The alleviation of any suffering caused by gender dysphoria. They make a stance against the "deprivation of civil and human rights" on the grounds of someone's gender identity. This version, much like its predecessor requires referrals for surgical procedures based on set criteria, but notes the importance of informed consent and listening to the wishes of the patient. The seventh version includes

3690-407: The assessment of data covering time, place, and person), analytic (aiming to further examine known associations or hypothesized relationships), and experimental (a term often equated with clinical or community trials of treatments and other interventions). In observational studies, nature is allowed to "take its course", as epidemiologists observe from the sidelines. Conversely, in experimental studies,

3772-811: The bill highlighted the chapter on eunuchs , which proposes eunuch be considered a gender identity, and criticised NHS Scotland 's association with WPATH. NHS England commissioned the Cass Review to create guidelines for transgender people in England. A systematic review into international guidelines published as part of the review was published in 2024 and stated that WPATH SOC 8 lacked "developmental rigour and transparency". NHS England in March 2024 updated their guidelines and stated that for children and adolescents they do not follow WPATH 8. Issues specific to certain demographics, including adults, children, and adolescents, are described in chapters 5–11 of version 8. In

3854-414: The case control study. However, the point estimate generated is the relative risk (RR), which is the probability of disease for a person in the exposed group, P e  =  A  / ( A  +  B ) over the probability of disease for a person in the unexposed group, P u  =  C  / ( C  +  D ), i.e. RR  =  P e  /  P u . As with

3936-429: The causation of the disease. Case-control studies are usually faster and more cost-effective than cohort studies but are sensitive to bias (such as recall bias and selection bias ). The main challenge is to identify the appropriate control group; the distribution of exposure among the control group should be representative of the distribution in the population that gave rise to the cases. This can be achieved by drawing

4018-427: The cause-and-effect hypothesis and none can be required sine qua non ." Epidemiological studies can only go to prove that an agent could have caused, but not that it did cause, an effect in any particular case: Epidemiology is concerned with the incidence of disease in populations and does not address the question of the cause of an individual's disease. This question, sometimes referred to as specific causation,

4100-504: The coordinated, standardized work of many participants. Additionally, any associated laboratory testing and experiment must be done in a way that is both ethically sound and results can be replicated by others using the same methods and equipment. As such, rigorous and vetted testing and experimental protocols are required. In fact, such predefined protocols are an essential component of Good Laboratory Practice (GLP) and Good Clinical Practice (GCP) regulations. Protocols written for use by

4182-445: The data and draw appropriate conclusions, social sciences to better understand proximate and distal causes, and engineering for exposure assessment . Epidemiology , literally meaning "the study of what is upon the people", is derived from Greek epi  'upon, among' demos  'people, district' and logos  'study, word, discourse', suggesting that it applies only to human populations. However,

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4264-497: The disease to the cases in the series. A prospective study would involve following the case series over time to evaluate the disease's natural history. The latter type, more formally described as self-controlled case-series studies, divide individual patient follow-up time into exposed and unexposed periods and use fixed-effects Poisson regression processes to compare the incidence rate of a given outcome between exposed and unexposed periods. This technique has been extensively used in

4346-612: The epidemiologist is the one in control of all of the factors entering a certain case study. Epidemiological studies are aimed, where possible, at revealing unbiased relationships between exposures such as alcohol or smoking, biological agents , stress , or chemicals to mortality or morbidity . The identification of causal relationships between these exposures and outcomes is an important aspect of epidemiology. Modern epidemiologists use informatics and infodemiology as tools. Observational studies have two components, descriptive and analytical. Descriptive observations pertain to

4428-771: The era of molecular precision medicine , "molecular pathology" and "epidemiology" was integrated to create a new interdisciplinary field of " molecular pathological epidemiology " (MPE), defined as "epidemiology of molecular pathology and heterogeneity of disease". In MPE, investigators analyze the relationships between (A) environmental, dietary, lifestyle and genetic factors; (B) alterations in cellular or extracellular molecules; and (C) evolution and progression of disease. A better understanding of heterogeneity of disease pathogenesis will further contribute to elucidate etiologies of disease. The MPE approach can be applied to not only neoplastic diseases but also non-neoplastic diseases. The concept and paradigm of MPE have become widespread in

4510-571: The field and advanced methods to study cancer, a disease with patterns and mode of occurrences that could not be suitably studied with the methods developed for epidemics of infectious diseases. Geography pathology eventually combined with infectious disease epidemiology to make the field that is epidemiology today. Another breakthrough was the 1954 publication of the results of a British Doctors Study , led by Richard Doll and Austin Bradford Hill , which lent very strong statistical support to

4592-592: The field of social science, a protocol may also refer to a "descriptive record" of observed events or a "sequence of behavior" of one or more organisms, recorded during or immediately after an activity (e.g., how an infant reacts to certain stimuli or how gorillas behave in natural habitat) to better identify "consistent patterns and cause-effect relationships." These protocols may take the form of hand-written journals or electronically documented media, including video and audio capture. Various fields of science, such as environmental science and clinical research, require

4674-405: The four humors (black bile, yellow bile, blood, and phlegm). The cure to the sickness was to remove or add the humor in question to balance the body. This belief led to the application of bloodletting and dieting in medicine. He coined the terms endemic (for diseases usually found in some places but not in others) and epidemic (for diseases that are seen at some times but not others). In

4756-513: The gendered self in order to maximize overall psychological well-being and self-fulfillment." The WPATH SOC are periodically updated and revised. The eighth and latest version was released on September 15, 2022. Previous versions were released in 1979 (1st), 1980 (2nd), 1981 (3rd), 1990 (4th), 1998 (5th), 2001 (6th), and 2012 (7th). The first four versions of the Standards of Care were titled Standards of Care: The Hormonal and Surgical Sex Reassignment of Gender Dysphoric Persons . The first version

4838-458: The general population of patients with that disease. These types of studies, in which an astute clinician identifies an unusual feature of a disease or a patient's history, may lead to a formulation of a new hypothesis. Using the data from the series, analytic studies could be done to investigate possible causal factors. These can include case-control studies or prospective studies. A case-control study would involve matching comparable controls without

4920-471: The general recommendations for content of the letters of readiness. An important change in the eligibility criteria for GAH allowed providers to prescribe hormones even if patients had not undergone the "Real Life Test" or psychotherapy if it was for harm reduction purposes. A notable change in version six separated the eligibility and readiness criteria for top and bottom surgery allowing some patients, particularly individuals assigned female at birth, to receive

5002-575: The link between tobacco smoking and lung cancer . In the late 20th century, with the advancement of biomedical sciences, a number of molecular markers in blood, other biospecimens and environment were identified as predictors of development or risk of a certain disease. Epidemiology research to examine the relationship between these biomarkers analyzed at the molecular level and disease was broadly named " molecular epidemiology ". Specifically, " genetic epidemiology " has been used for epidemiology of germline genetic variation and disease. Genetic variation

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5084-403: The main etiological work that brought forward the concept. His concepts were still being considered in analysing SARS outbreak by WHO in 2004 in the context of traditional Chinese medicine. Another pioneer, Thomas Sydenham (1624–1689), was the first to distinguish the fevers of Londoners in the later 1600s. His theories on cures of fevers met with much resistance from traditional physicians at

5166-448: The middle of the 16th century, a doctor from Verona named Girolamo Fracastoro was the first to propose a theory that the very small, unseeable, particles that cause disease were alive. They were considered to be able to spread by air, multiply by themselves and to be destroyable by fire. In this way he refuted Galen 's miasma theory (poison gas in sick people). In 1543 he wrote a book De contagione et contagiosis morbis , in which he

5248-506: The multicausality associated with disease is the causal pie model . In 1965, Austin Bradford Hill proposed a series of considerations to help assess evidence of causation, which have come to be commonly known as the " Bradford Hill criteria ". In contrast to the explicit intentions of their author, Hill's considerations are now sometimes taught as a checklist to be implemented for assessing causality. Hill himself said "None of my nine viewpoints can bring indisputable evidence for or against

5330-417: The odds of exposure in the cases (A/C) to the odds of exposure in the controls (B/D), i.e. OR = (AD/BC). If the OR is significantly greater than 1, then the conclusion is "those with the disease are more likely to have been exposed", whereas if it is close to 1 then the exposure and disease are not likely associated. If the OR is far less than one, then this suggests that the exposure is a protective factor in

5412-498: The odds ratio by the equation: where N is the ratio of cases to controls. As the odds ratio approaches 1, the number of cases required for statistical significance grows towards infinity; rendering case-control studies all but useless for low odds ratios. For instance, for an odds ratio of 1.5 and cases = controls, the table shown above would look like this: For an odds ratio of 1.1: Cohort studies select subjects based on their exposure status. The study subjects should be at risk of

5494-414: The outcome under investigation at the beginning of the cohort study; this usually means that they should be disease free when the cohort study starts. The cohort is followed through time to assess their later outcome status. An example of a cohort study would be the investigation of a cohort of smokers and non-smokers over time to estimate the incidence of lung cancer. The same 2×2 table is constructed as with

5576-400: The prevailing Miasma Theory of the time, a model of disease in which poor air quality was blamed for illness. This was used to rationalize high rates of infection in impoverished areas instead of addressing the underlying issues of poor nutrition and sanitation, and was proven false by his work. Other pioneers include Danish physician Peter Anton Schleisner , who in 1849 related his work on

5658-640: The prevention of the epidemic of neonatal tetanus on the Vestmanna Islands in Iceland . Another important pioneer was Hungarian physician Ignaz Semmelweis , who in 1847 brought down infant mortality at a Vienna hospital by instituting a disinfection procedure. His findings were published in 1850, but his work was ill-received by his colleagues, who discontinued the procedure. Disinfection did not become widely practiced until British surgeon Joseph Lister 'discovered' antiseptics in 1865 in light of

5740-463: The protocol gives no specific age limits for treatments, emphasizing the need to decide individually for each patient. It was criticized for suggesting that young people may come to believe they are transgender through social influence. An earlier draft would have required several years of transgender identity before an adolescent could begin treatment. After criticism from transgender advocates, as well as from staff of Assistant Secretary for Health of

5822-402: The same population that gave rise to the cases. The case-control study looks back through time at potential exposures that both groups (cases and controls) may have encountered. A 2×2 table is constructed, displaying exposed cases (A), exposed controls (B), unexposed cases (C) and unexposed controls (D). The statistic generated to measure association is the odds ratio (OR), which is the ratio of

5904-456: The study of adverse reactions to vaccination and has been shown in some circumstances to provide statistical power comparable to that available in cohort studies. Case-control studies select subjects based on their disease status. It is a retrospective study. A group of individuals that are disease positive (the "case" group) is compared with a group of disease negative individuals (the "control" group). The control group should ideally come from

5986-921: The support of children and their families throughout gender exploration and potential social transitions. Non-binary individuals are included for the first time in chapter 8. The guidelines recommend that medical treatment and social support be made available to non-binary people in individualized combinations, for example providing medical interventions without social transition or gender-affirming surgery without hormone therapy. The chapter additionally notes unique experiences of discrimination, minority stress, and difficulty accessing gender-affirming medical treatment among non-binary people, which healthcare providers should take into consideration. Recommendations for treatments, including medical and social aspects of gender transition as well as mental health, as are given in Chapters 12–18. Clinical protocol Similarly,

6068-439: The term is widely used in studies of zoological populations (veterinary epidemiology), although the term " epizoology " is available, and it has also been applied to studies of plant populations (botanical or plant disease epidemiology ). The distinction between "epidemic" and "endemic" was first drawn by Hippocrates , to distinguish between diseases that are "visited upon" a population (epidemic) from those that "reside within"

6150-716: The time. He was not able to find the initial cause of the smallpox fever he researched and treated. John Graunt , a haberdasher and amateur statistician, published Natural and Political Observations ... upon the Bills of Mortality in 1662. In it, he analysed the mortality rolls in London before the Great Plague , presented one of the first life tables , and reported time trends for many diseases, new and old. He provided statistical evidence for many theories on disease, and also refuted some widespread ideas on them. John Snow

6232-413: The water and removed the handle; this ended the outbreak. This has been perceived as a major event in the history of public health and regarded as the founding event of the science of epidemiology, having helped shape public health policies around the world. However, Snow's research and preventive measures to avoid further outbreaks were not fully accepted or put into practice until after his death due to

6314-637: The work of Louis Pasteur . In the early 20th century, mathematical methods were introduced into epidemiology by Ronald Ross , Janet Lane-Claypon , Anderson Gray McKendrick , and others. In a parallel development during the 1920s, German-Swiss pathologist Max Askanazy and others founded the International Society for Geographical Pathology to systematically investigate the geographical pathology of cancer and other non-infectious diseases across populations in different regions. After World War II, Richard Doll and other non-pathologists joined

6396-423: Was a mental disorder, that was not a license for stigma. The sixth version was published in 2001 and offered more flexibility and individualized care but continued to use the phrase "gender identity disorder". At the same time transgender people increasingly complained of having to "jump through hoops". SOC 6 also did not include significant changes to the tasks mental health professionals were required to take or in

6478-424: Was eliminated by blinding is re-introduced. Unblinding is common in blind experiments, and must be measured and reported. Reporting guidelines recommend that all studies assess and report unblinding. In practice, very few studies assess unblinding. An experimenter may have latitude defining procedures for blinding and controls but may be required to justify those choices if the results are published or submitted to

6560-470: Was not supported by science or research, and could lead to an onslaught of attacks on the transgender community." In July 2024, the Biden administration said they opposed gender-affirming surgery for transgender minors, but also said they would continue to support gender-affirming care for minors and would continue to oppose bans on such treatments, including continuing to oppose bans on surgeries. In August 2024,

6642-477: Was released in 1979 and revisions were made in 1980, 1981, and 1990. These revisions were relatively minor, with the text staying mostly the same between versions. These versions of the SOC followed the gatekeeping model laid out by Harry Benjamin, where clinicians set strict eligibility requirements, requiring evaluations from separate mental health professionals and compulsory psychotherapy. The first four versions of

6724-668: Was the first to promote personal and environmental hygiene to prevent disease. The development of a sufficiently powerful microscope by Antonie van Leeuwenhoek in 1675 provided visual evidence of living particles consistent with a germ theory of disease . During the Ming dynasty , Wu Youke (1582–1652) developed the idea that some diseases were caused by transmissible agents, which he called Li Qi (戾气 or pestilential factors) when he observed various epidemics rage around him between 1641 and 1644. His book Wen Yi Lun (瘟疫论, Treatise on Pestilence/Treatise of Epidemic Diseases) can be regarded as

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