The matrix metalloproteinases (MMPs) collagenase, gelatinase A (72 kDa gelatinase), stromelysin, and their specific inhibitor TIMP-1 (tissue inhibitor of metalloproteinases), were immunolocalized using specific polyclonal antisera in gingival tissues from 21 patients with chronic inflammatory periodontal disease. Monoclonal antibodies against macrophages (Leu-M5), B cells (Leu-14), helper T cells (OKT4), suppressor T cells (OKT8) and the HLA-DR epitope were also used to identify leukocyte subsets. MMPs were observed in connective tissues at sites that histologically showed signs of remodelling. The number and distribution of positive cells varied widely, however, not only between individual biopsy specimens, but also within the same specimen. The same was true for the composition and distribution of the inflammatory cell infiltrate. Moreover, although there was a positive correlation between the number of MMP-producing cells and the severity of inflammation in some specimens, for others with comparable leukocyte subset scoring the number was reduced and sometimes absent altogether. Cells secreting MMPs were fibroblasts, macrophages and epithelial cells. It was not possible to determine unequivocally whether a MMP-positive cell within the connective tissue was a fibroblast or a macrophage, since the antisera recognise both fibroblast and macrophage MMPs and the different fixation requirements for MMPs (4% paraformaldehyde) and Leu-M5 (acetone) precluded co-localization on the same section. TIMP-1 was immunolocalized within connective tissue cells at sites of tissue remodelling. Our results support the hypothesis that tissue-derived MMPs may be involved in tissue remodelling in periodontal disease and conclusively demonstrate that epithelial cells may be involved as well as connective tissue cells.

Background: Trans children are known to experience challenges in education, in schools under-prepared for trans inclusion. Research on trans people’s mental health has shown an association between experiences of Gender Minority Stress (GMS) and poor mental health, though the GMS framework has not been applied to trans children’s experiences in education. Aims: This article examines trans children’s experiences of GMS in primary and early secondary education (ages 3–13 years old) in UK schools. The study aimed to uncover opportunities for protective action to safeguard trans children’s mental health. Methods: The GMS framework was applied to a rich qualitative dataset drawn from semi-structured interviews with 10 trans children and 30 parents of trans children average age 11 years-old (range 6–16). Data were analyzed through reflexive thematic analysis. Results: The research highlighted the diverse ways in which GMS manifests in primary and secondary education. Trans children in the UK experienced a wide range of trans-specific stressors, putting children under chronic strain. Discussion: Schools need to recognize the range of potential stresses experienced by trans pupils in education. Poor mental health in trans children and adolescents is avoidable, and schools have a duty of care to ensure trans pupils are physically and emotionally safe and welcome at school. Preventative early action to reduce GMS is needed to protect trans children, safeguarding the mental health of vulnerable pupils.

As more trans children find the confidence to make themselves known in our primary and secondary schools, school teachers and administrators look for guidance on how to best support trans pupils. This article synthesises findings from global literature on trans children in primary and secondary education (K1-12 in the US), extracting key themes and conclusions. It then examines the most recent UK school guidance documents on trans inclusion, assessing which lessons and recommendations from global literature are represented. The article highlights existing good practices in visibility and representation and in protection from violence and harassment. Several areas where additional effort is needed are identified, including action on environmental stress and cisnormativity, addressing barriers to school trans-inclusivity and institutional accountability. A number of important shifts are called for: from adaptation on request to pre-emptive change; from accommodation to a rights-based approach; from pathologisation to trans-positivity. Finally, the article raises expectations on what it means to be an ally for trans children in education.

Background: Pediatric gender clinics have a long history of analyzing and scrutinizing parents of trans children. At present, gender services in countries like the UK continue to hold clinical sessions with parents of pre-adolescent transgender children, sometimes extending over many years. Clinician viewpoints dominate the limited existing literature, with little analysis of the perspectives of parents of trans children. Aims: The study aimed to understand the experiences that parents of socially transitioned pre-adolescent trans children have had in UK gender clinics. Methods: Data were drawn from semi-structured qualitative interviews with 30 UK-based parents of socially transitioned trans children – children who socially transitioned, for example, changed pronoun, under the age of eleven. This article analyzed a subset of a wider dataset, focusing on data from 23 parents relating to parental engagement with UK NHS gender clinics before their child reached adolescence. Results: Themes emerging from the dataset included parents feeling under a microscope, and parents finding gender clinic sessions judgemental, intrusive and inappropriate. Interviewees reported clinician discouragement of listening to and validating their children, as well as a lack of emotional support. Discussion: The article presents evidence of continued pathologisation and problematisation of childhood gender diversity in parental engagements with UK children’s gender clinics. It concludes by contrasting current UK practice as described in parental accounts with gender affirmative approaches to supporting parents of trans children.

Objective: This research explored experiences of prepubertal social transition, listening to trans children who were affirmed in childhood, as well as hearing from their parents. Background: Despite being a topic of significant importance, there is limited qualitative literature on parents' or indeed children's experiences of prepubertal social transition and little qualitative research on how childhood rejection or affirmation influences well-being. Method: This study examines qualitative data from 30 parents with experience supporting a trans child to socially transition at average age 7 years (range 3-10 years), alongside data from 10 of the trans children. Data were analyzed through inductive reflexive thematic analysis. Results: The first major theme explored experiences pretransition, with subthemes on children correcting assumptions, becoming distressed, struggling alone, reaching crisis, or growing withdrawn and frustrated. The second major theme examined experiences posttransition, with subthemes on a weight being lifted, validation at school, and well-being. Conclusion: This qualitative research complements existing quantitative evidence on the importance of social transition, with childhood affirmation critical to the happiness and well-being of trans children. Implications: The research has significant relevance for parents of trans children, professionals working with families, and policymakers and legislators influencing policy and practice toward trans children and their families.