Gender Diverse Autistic Young Adults: A Mental Health Perspective.

Gender diverse autistic young adults often face mental health challenges which can increase the challenge of obtaining gender-affirming care. Social and communication differences associated with autism compounds the already complex process of navigating a path toward gender affirmation for individuals with these intersecting identities. In this case series of four gender diverse autistic adults, we demonstrate that success in management of their mental health crises was achieved through enlisting family and social support, obtaining effective mental health treatment, and accessing gender-affirming healthcare. These cases selected from two neuropsychiatric outpatient tertiary referral clinics demonstrate that effective mental health treatment supports ultimate success for these individuals in their journeys toward living as the gender with which they identify. We conclude that healthcare practices and treatment recommendations which incorporate internationally recognized standards of care guidelines for gender diverse individuals improve patient outcomes.

Language in the Teaching Operating Room: Expressing Confidence Versus Community.

OBJECTIVE: Previous work has analyzed residency letters of recommendation for agentic and communal language, but this has not been applied to spoken language. Our objective was to analyze intraoperative spoken language by attending and resident surgeons for the use of agentic and communal language. DESIGN: We completed a linguistic inquiry and word count (LIWC) analysis on 16 operating room transcripts (total time 615 minutes) between attendings and resident surgeons for categories associated with agentic and communal speech. Wilcoxon signed rank and Mann-Whitney U tests were used to compare attending versus resident and male versus female speech patterns for word count; "I," clout, and power (agentic categories); and "we," authentic, social (communal categories). SETTING: Midwestern academic university teaching hospital. PARTICIPANTS: Sixteen male (9 attendings, 7 residents) and 16 female (7 attendings, 9 residents) surgeons, from 6 surgical specialties, most commonly from General Surgery. RESULTS: Attending surgeons used more words per minute than residents (40.01 vs 16.92, p < 0.01), were less likely to use "I" (3.18 vs 5.53, p < 0.01), and spoke more language of "clout" (75.82 vs 55.47, p < 0.01). There were no significant differences between attendings and residents in use of analytic speech (23.72 vs 24.67, p = 0.32), "causation" (1.20 vs 1.08, p = 0.72), or "cognitive processing" (10.20 vs 10.54, p = 0.74). Residents used more speech with "emotional tone" (92.91 vs 79.92, p = 0.03), "positive emotion" (4.98 vs 3.86, p = 0.04), more "assent" language (4.89 vs 3.09, p < 0.01), and more "informal" language (9.27 vs 6.77, p < 0.01). There were no gender differences, except for male residents speaking with greater certainty than female residents, although by less than 1% of the total word count. CONCLUSIONS: In the operating room, attending surgeons were more likely to use agentic language compared to resident surgeons based on LIWC analysis. These differences did not depend on gender and likely relate to surgeon experience and confidence, learning versus teaching, and power dynamics.

The Annual Economic Burden of Uterine Fibroids in the United States (2010 Versus 2022): A Comparative Cost-Analysis.

In 2010, the estimated annual cost of uterine fibroids in the United States ranged from 5.9 to 34.4 billion USD. In the past decade, more uterine-sparing and fertility preserving interventions have become available to treat symptomatic fibroids. This comparative cost-analysis aims to evaluate change in societal costs of uterine fibroids in the US between 2010 and 2022 given changing fibroid and obstetric management, population growth, and inflation. A systematic review was conducted to update uterine fibroid, treatment, and obstetric complication prevalence, direct costs of medical and surgical interventions, indirect productivity costs, and obstetric costs attributable to fibroids in 2022. A comparative cost-analysis with paired t-tests was performed using baseline data published in 2010. Percent (%) changes between 2010 and 2022 were reported. NIH research funding for fibroids and other common diseases was compared. All costs were converted to 2023 USD. The number of US women with uterine fibroids increased by 10.6% from 2010 to 2022. Over this period, the economic burden of uterine fibroids increased up to 41.4 billion USD compared to 34.4 billion USD in 2010. Overall costs increased to 42.2 billion USD after incorporating new costs associated with MRgFUS and infertility. Direct costs of medical management decreased while costs of surgical interventions increased as a result of evolving treatment-seeking behavior. Lost work costs continue to account for the largest proportion of the economic burden for fibroids. Cesarean section delivery remains the largest contributor (average 80.0%) to indirect obstetrical costs. Despite the rise in the number of individuals affected by uterine fibroids and its sizable annual cost to society, uterine fibroids research continues to be underfunded.

Impact of new abortion restrictions on people in prison: Estimated number of incarcerated people without abortion access and distance to abortion providers.

OBJECTIVES: This study aimed to estimate the annual number of incarcerated pregnant people in state and federal prisons needing an abortion. STUDY DESIGN: We used 2021 Bureau of Justice Statistics data and prior studies' findings to estimate the number of pregnant incarcerated people, then calculated state-specific abortion ratios to determine the number potentially needing an abortion. RESULTS: Of 638 pregnant people incarcerated in prisons annually, 110 would be expected to need an abortion, including 55 in states where abortion is currently banned or restricted. CONCLUSIONS: Under Dobbs, many incarcerated pregnant people will be forced to continue unwanted pregnancies to term.

How teaching surgeons communicate: An analysis of intraoperative discourse among male and female surgeons.

BACKGROUND: Our objective was to compare the use of agentic ("I") and communal ("we") spoken intraoperative discourse between male and female attending and resident surgeons. METHODS: We analyzed transcripts involving attending and resident surgeons from 5 specialties at a single Midwestern academic teaching hospital. We adapted and expanded Grebelsky-Lichtman's codes, assessed rater agreement, and systematically coded transcripts for agentic and communal terms. Differences between genders and roles were evaluated using Mann-Whitney U tests. RESULTS: In the operating room, attendings used significantly more Action Demands, Rationality, Collective Speech, Passive Speech, Nurturing Speech, and Degree Modifiers. Conversely, residents used significantly more Assertive Speech, and Display Solution. Attendings were also more likely to use Action Demands combined with Passive Speech. No significant gender differences were found in any categories. CONCLUSIONS: Language use in the OR is more closely associated with professional role rather than gender and may reflect underlying power dynamics and the nature of the surgical teaching environment.

A scoping review of global COVID-19 vaccine hesitancy among pregnant persons.

Uptake of the COVID-19 vaccine among pregnant persons is lower than the general population. This scoping review explored pregnant people's attitudes towards the COVID-19 vaccine, reasons for vaccine hesitancy, and whether attitudes about COVID-19 vaccines differ by country of origin. A scoping review was conducted across PubMed, Embase, CINHAL, and Scopus. Inclusion criteria were articles published in English from 2019-2022 focused on attitudes towards COVID-19 vaccination among pregnant persons. Data analysis was done via the 5Cs framework for vaccine hesitancy: Constraints, Complacency, Calculation, Confidence, and Collective Responsibility. 44 articles were extracted. A lack of confidence in vaccine safety was the most prevalent theme of hesitancy among pregnant persons. This was largely driven by a lack of access to information about the vaccine as well as mistrust of the vaccine and medical professionals. Meanwhile, vaccine acceptance was mostly driven by a desire to protect themselves and their loved ones. Overall, COVID-19 vaccine hesitancy among pregnant persons continues to be high. Vaccine hesitancy is primarily driven by fear of the unknown side effects of the vaccine on pregnant persons and their fetuses along with a lack of information and medical mistrust. Some differences can be seen between high income and low- and middle-income countries regarding vaccine hesitancy, showing that a single solution cannot be applied to all who are vaccine hesitant. General strategies, however, can be utilized to reduce vaccine hesitancy, including advocating for inclusion of pregnant persons in clinical trials and incorporating consistent COVID-19 vaccine counseling during prenatal appointments.

Trends in Matriculation from Neurological Surgery Training Programs into Academic Versus Private Practice.

OBJECTIVE: A career in academic neurosurgery is an arduous endeavor. Specific factors influencing physician practice preferences remain unclear. This study analyzes data from the American Association of Neurological Surgeons membership identifying the impact of several demographic and educational characteristics influencing neurosurgical career choices centered on academia, private practice, or a combination in the United States. METHODS: A list of all current neurosurgeons was obtained from the American Association of Neurological Surgeons membership, and information on physician characteristics was collected via internet searches and institutional databases. The practice type of all neurosurgeons considered in this study were categorized as follows: private practice, academic, or a combination of private practice and academic, termed privademic. These data were subsequently correlated to race, gender, current age, training at a top 40 National Institutes of Health-funded medical school or residency program, and current practice. RESULTS: The median age of private practice and academic neurosurgeons was 58.18 and 53.61 years, respectively (P < 0.001). Age was significantly associated with practicing in an academic setting (odds ratio 0.96), with younger neurosurgeons pursuing careers in academia. Data indicated a positive and statistically significant contribution of female gender (P < 0.001) and training at a top-40 National Institutes of Health-funded institution to practicing in an academic setting (P < 0.01). CONCLUSIONS: Neurosurgery as a field has grown significantly over the past century. The authors recommend that future efforts seek to diversify the neurosurgical workforce by considering practice setting, demographic characteristics, and educational background.