Dtsch Arztebl Int
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Gender identity disorders (GID) can appear even in early infancy with a variable degree of severity. Their prevalence in childhood and adolescence is below 1%. GID are often associated with emotional and behavioral problems as well as a high rate of psychiatric comorbidity. Their clinical course is highly variable. There is controversy at present over theoretical explanations of the causes of GID and over treatment approaches, particularly with respect to early hormonal intervention strategies. ⋯ The types of modulating influences that are known from the fields of developmental psychology and family dynamics have therapeutic implications for GID. As children with GID only rarely go on to have permanent transsexualism, irreversible physical interventions are clearly not indicated until after the individual's psychosexual development ist complete. The identity-creating experiences of this phase of development should not be restricted by the use of LHRH analogues that prevent puberty.
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The aim of the international Reduction of Atherothrombosis for Continued Health (REACH) registry was to identify prospectively characteristics, risk factors, treatments, and cardiovascular event rates in stable outpatients with atherothrombotic disease, as well as in asymptomatic patients with risk factors for atherothrombotic disease. ⋯ The traditional risk factors are common in patients with coronary heart disease, cerebrovascular disease (stroke and/or transient ischemic attack), or peripheral arterial occlusive disease. Many patients with these conditions or associated risk factors are not treated according to current guidelines. This may explain, at least in part, the high rates of cardiovascular events observed after one year.