Barreiras no acesso à Atenção Básica pela população LGBTQIA+: uma revisão integrativa / Barriers to access to Primary Care for the LGBTQIA+ population: an integrative review / Barreras de acceso a la Atención Primaria para la población LGBTQIA+: una revisión integradora

Introdução: A população LGBT constitui um grupo cujo acesso à saúde é historicamente limitado e ainda hoje é atravessado por questões complexas que envolvem desde a formação dos profissionais de saúde à própria estrutura organizacional do sistema assistencial. Apesar disso, a literatura científica acerca dos entraves que estes indivíduos enfrentam na Atenção Primária à Saúde (APS), porta de entrada e coordenadora do cuidado, é particularmente escassa. Objetivo: Caracterizar as barreiras envolvidas no acesso da população LGBTQIA+ à APS. Métodos: Trata-se de uma revisão integrativa de estudos científicos selecionados nas plataformas de busca PubMed e Portal Regional da Biblioteca Virtual em Saúde (BVS), sendo utilizados como descritores de busca os termos Minorias Sexuais e de Gênero, LGBTQIA+, APS e Acesso aos Serviços de Saúde. Foram incluídos artigos completos sem restrição de período nos idiomas inglês, português e espanhol. Foram excluídos textos do tipo: revisão bibliográfica; editorial; protocolos de estudo; opinião de especialistas e relato de experiência. Resultados: Foram selecionados 14 artigos, sendo seus conteúdos atribuídos a três eixos de discussão: barreiras físicas/organizacionais, barreiras sociais e barreiras relacionadas à educação/formação dos profissionais da saúde. Conclusões: É essencial expandir as discussões sociais acerca da temática de diversidade sexual e de gênero de modo a desconstruir os preconceitos instituídos; ademais, faz-se fundamental a revisão da estrutura física e organizacional ­ bem como da formação dos profissionais da saúde ­ para criar um ambiente assistencial inclusivo na atenção básica à população LGBTQIA+.

Introduction: The LGBT population is a group whose access to health care has historically been limited and is still crossed by complex issues ranging from the training of health professionals to the very organisational structure of the care system. Despite this, the scientific literature on the obstacles faced by these individuals in Primary Health Care, the gateway and coordinator of care, is particularly scarce. Objective: To characterize the barriers involved in the access of the LGBTQIA+ population to primary care. Methods: This is an integrative review of scientific studies selected from the PubMed and Virtual Health Library (VHL) Regional Portal search platforms, using as search descriptors the terms Sexual and Gender Minorities, LGBTQIA+, Primary Health Care, Health Services Accessibility. Complete articles were included without time restriction, in English, Portuguese and Spanish. Texts such as: literature reviews; editorials; study protocols; expert opinions and experience reports were excluded. Results: The review was composed by the selection of 14 studies, and their contents were assigned to three axes of discussion: physical/organizational barriers, social barriers, barriers related to education/training of health professionals. Conclusions: It is essential to expand the social discussions about the theme of sexual and gender diversity to deconstruct the established prejudices, moreover, it is essential to review the physical and organizational structure ­ as well as the training of health professionals ­ to create an inclusive care environment.

Introducción: La población LGTB es un colectivo cuyo acceso a la atención sanitaria ha estado históricamente limitado y sigue atravesado por complejas cuestiones que van desde la formación de los profesionales sanitarios hasta la propia estructura organizativa del sistema asistencial. A pesar de ello, la literatura científica sobre los obstáculos a los que se enfrentan estas personas en la Atención Primaria de Salud, puerta de entrada y coordinadora de la atención, es especialmente escasa. Objetivo: Caracterizar las barreras que supone el acceso de la población LGBT a la atención primaria. Métodos: Se trata de una revisión integradora de estudios científicos seleccionados de las plataformas de búsqueda PubMed y Portal Regional de la Biblioteca Virtual de Salud (BVS), utilizando como descriptores de búsqueda los términos Minorías Sexuales y de Género, LGBT, Atención Primaria de Salud, Accesibilidad a los Servicios de Salud. Se incluyeron artículos completos sin restriccíon de período, en inglés, portugués y español. Se excluyeron textos como revisiones bibliográficas, editoriales, protocolos de estudio, opiniones de expertos e informes de experiencias. Resultados: El corpus final de artículos se compuso de la selección de 14 artículos, y sus contenidos se asignaron a tres ejes de discusión: barreras físicas/organizativas, barreras sociales, barreras relacionadas con la educación/formación de los profesionales sanitarios. Conclusiones: Es esencial ampliar las discusiones sociales sobre el tema de la diversidad sexual y de género de manera que se deconstruyan los prejuicios institucionales, además, se hace fundamental la revisión de la estructura física y organizacional ­ así como la formación de los profesionales de la salud ­ para crear un ambiente asistencial inclusivo.

O (des)cuidado em saúde às pessoas LGBTQIAP+ dispensado por profissionais em unidades básicas de saúde / The (lack of)health care provided to LGBTQIAP+ people by professionals in primary care centers / El (des)cuidado en salud a las personas LGBTQIAP+ dispensado por profesionales en unidades básicas de salud

Objetivo: compreender o cuidado em saúde dispensado às pessoas LGBTQIAP+ por profissionais em Unidades Básicas de Saúde, a partir do referencial teórico da Política Nacional de Saúde LGBT (PNSILGBT) estabelecida pelo Sistema Único de Saúde (SUS). Método: estudo descritivo, com abordagem qualitativa, que entrevistou 12 profissionais de saúde da Atenção Básica. Os dados coletados passaram pela Análise Lexical utilizando-se do software IRAMUTEQ. Resultados: emergiram três categorias temáticas que possibilitaram compreender que os profissionais reconhecem as violências praticadas na assistência a essa população, as barreiras no acesso e as dificuldades enfrentadas por pessoas LGBTQIAP+. Considerações finais: o desconhecimento das políticas e a não percepção das consequências dessas ações para a saúde dessa população remete muito mais ao (des)cuidado do que efetivamente ao cuidado condizente as suas reais necessidades em saúde.

Objective: to understand the health care provided to LGBTQIAP+ people by professionals in Primary Care Centers, based on the theoretical framework of the National LGBT Health Policy (PNSILGBT) established by the Unified Health System (SUS). Method: a descriptive study with a qualitative approach, which interviewed 12 primary care health professionals. The data collected was subjected to Lexical Analysis using the IRAMUTEQ software. Results: Three thematic categories emerged which made it possible to understand that professionals recognize the violence practiced in assisting this population, the barriers to access and the difficulties faced by LGBTQIAP+ people. Final considerations: the lack of knowledge of the policies and the lack of perception of the consequences of these actions for the health of this population leads much more to (lack of)care than to care in line with their real health needs.

Objetivo: comprender el cuidado en salud brindado a las personas LGBTQIAP+ por profesionales en Unidades Básicas de Salud, partiendo del marco teórico de la Política Nacional de Salud LGBT (PNSILGBT) establecida por el Sistema Único de Salud (SUS). Método: estudio descriptivo, con enfoque cualitativo, que entrevistó a 12 profesionales de salud de la Atención Básica. Los datos recogidos fueron analizados mediante Análisis Léxico utilizando el software IRAMUTEQ. Resultados: surgieron tres categorías temáticas que permitieron comprender que los profesionales reconocen las violencias ejercidas en la asistencia a esta población, las barreras en el acceso y las dificultades enfrentadas por personas LGBTQIAP+. Consideraciones finales: el desconocimiento de las políticas y la no percepción de las consecuencias de estas acciones para la salud de esta población reflejan mucho más el (des)cuido que efectivamente el cuidado acorde a sus reales necesidades en salud.

DSD-related attitudes and beliefs held by pediatric endocrinologists and urologists: Insights from the North American disorders/differences of sex development (DSD) clinician survey.

BACKGROUND: Disorders/Differences of Sex Development (DSD) encompass congenital conditions with atypical development of chromosomal, gonadal, or anatomical sex. Due to the rarity and complexity of these conditions, strong evidence for clinical practices is scarce, leading to controversies in management. OBJECTIVE: This study, part of a broader project, examines changes over time in the attitudes and beliefs of DSD healthcare providers, focusing on factors contributing to patients' life satisfaction and the influence of medical specialty, gender, and age. METHODS: Participants included active members of the Pediatric Endocrine Society (PES) and the Societies for Pediatric Urology (SPU) at three time points: 2003-2004 (T1), 2010-2011 (T2), and 2020 (T3). A survey covering predictors of patient life satisfaction, attitudes and beliefs regarding DSD care and outcomes, and participant characteristics was administered. Data were analyzed using descriptive statistics and Generalized Estimating Equations (GEE). RESULTS: Demographics: Participation rates were 56% (PES) and 64.7% (SPU) at T1, 41.1% (PES) and 52.3% (SPU) at T2, and 25.6% (PES) and 51.2% (SPU) at T3. Most participants were male (T1: 70.6%, T2: 61.7%, T3: 70.6%). Factors Affecting Life Satisfaction: Both endocrinologists and urologists ranked "gender identity consistent with assigned sex" as most important. Over time, the endorsement of some factors, such as performing genital surgery at Centers of Excellence, increased, while others, like the influence of prenatal androgen exposure determining gender identity, varied by specialty and gender. Attitudes and Beliefs: Across 18 statements, responses indicated three clusters with strong agreement, moderate agreement, and strong disagreement. Statements on the importance of family background and avoiding gender discordance were consistently endorsed, while those on delaying hypospadias repair until consent were least endorsed. DISCUSSION: The study highlights variability in beliefs about DSD management over time, influenced by specialty, gender, and age. Despite consensus on some care principles, discrepancies remain, particularly regarding the impact of prenatal androgens and the timing of surgical interventions. These findings underscore the need for regular interdisciplinary communication to align clinical practices with evidence-based guidelines and address subjective beliefs. CONCLUSION: The survey illustrates evolving perspectives among DSD healthcare providers, emphasizing the need for continued dialogue and education to bridge gaps between clinical evidence and practice. Collaborative efforts, such as the international I-DSD and the U.S. DSD Translational Research Network, are crucial for advancing patient-centered care in this field.

Male Sex and Ageing are Independent Risk Factors for Sarcopenia Stage in Patients With Chronic Kidney Disease Not Yet on Dialysis.

BACKGROUND: The risk of sarcopenia in older adults with chronic kidney disease (CKD) not yet on dialysis is controversial. The aims of this study were to investigate the association among sarcopenia, diabetes and predialysis CKD and evaluate the impact of gender and ageing on the risk of sarcopenia statuses in older patients with predialysis CKD. METHODS: The participants aged ≥60 years old were recruited from the community of New Taipei City, Taiwan. Handgrip strength, appendicular skeletal muscle mass and the 6-m walk were measured. The diagnosis of sarcopenia was established based on the consensus of Asian Sarcopenia Working Group 2019. These older adults were categorised into G1, G2 and G3-5 according to the guidelines of Kidney Disease Improving Global Outcomes (KDIGO) after calculating the estimated glomerular filtration rate by the Modification of Diet in Renal Disease equation. The Chi-square test and ANOVA were used to estimate the difference of categorical and continuous variables, respectively. Polytomous logistic regression was employed to assess the odds ratio (OR) and 95% confidence intervals (CIs) of the sarcopenia status and sarcopenia-associated risk factors in the predialysis CKD patients. All tests were two-sided, and p < 0.05 was defined as statistical significance. RESULTS: Among the 3648 older adults (mean age: 71.9 ± 6.07 years), including 1701 males and 1947 females, 870 (23.9%), 94 (2.58%) and 48 (1.32%) had possible sarcopenia, sarcopenia and severe sarcopenia, respectively. After adjustment, the risk for possible sarcopenia, sarcopenia and severe sarcopenia significantly increased with ageing (OR = 1.11, 1.10 and 1.23; 95% CI = 1.10-1.13, 1.07-1.15 and 1.18-1.30, respectively) and male gender (OR = 2.26, 20.3 and 25.4; 95% CI = 1.87-2.73, 11.5-36.0 and 11.3-57.2, respectively). Compared with KDIGO G1, no significant association between KDIGO G3-5 and the statuses of sarcopenia was observed (OR = 0.97, 0.88 and 0.91; 95% CI = 0.75-1.26, 0.43-1.78 and 0.37-2.27, p = 0.821, 0.718, 0.838, for possible sarcopenia, sarcopenia and severe sarcopenia, respectively). Ageing and male gender indicated a significant risk for higher sarcopenia status in older patients with predialysis CKD (0.027-fold/year and 0.284-fold, respectively) (p < 0.0001). CONCLUSIONS: This study illuminated the importance of the male sex and the ageing process on the risk of sarcopenia progression in patients with predialysis CKD. Early clinical screening and aggressive treatment for the prevention of higher sarcopenia status in advanced older male adults with predialysis CKD are recommended.

The Swedish sleep apnea registry (SESAR) cohort - "Real world data" on a national level.

INTRODUCTION: The Swedish Sleep Apnea Registry (SESAR) collects clinical data from individual obstructive sleep apnea (OSA) patients since 2010. SESAR has recently been integrated with additional national healthcare data. The current analysis presents the SESAR structure and representative clinical data of a national sleep apnea cohort. METHODS: Clinical data from unselected patients with a diagnosis of OSA are submitted to the SESAR registry. 48 sleep centers report data from diagnosis, treatment starts with Continuous Positive Airway Pressure (CPAP), oral devices (OD), and Upper Airway Surgery (UAS). Data from follow-up are included. SESAR is linked to mandatory national healthcare data (mortality, comorbidities, procedures, prescriptions) and diagnosis-specific quality registries (e.g. stroke, heart failure, diabetes) within the DISCOVERY project. RESULTS: 83,404 OSA patients have been reported during the diagnostic workup (age 55.4 ± 14.1 years, BMI 30.8 ± 6.5 kg/m2, AHI 25.8 ± 21.6n/h, respectively). At least one cardiometabolic and respiratory comorbidity is recognized in 57 % of female and 53 % of male OSA patients with a linear increase across OSA severity. In 54,468, 7,797, and 390 patients, start of CPAP, OD or UAS treatment is reported, respectively. OD patients have 4 units lower BMI and 10 units lower AHI compared to patients started on CPAP. UAS patients are characterized by 10 years lower age. The degree of daytime sleepiness is comparable between treatment groups with mean Epworth Sleepiness Scale Scores between 9 and 10. CONCLUSION: SESAR is introduced as a large national registry of OSA patients. SESAR provides a useful tool to highlight OSA management and to perform relevant outcome research.

The association between gender and industry payments to minimally invasive surgeons.

BACKGROUND: It is unknown if there are differential industry payments to surgeons based on gender. This study aims to examine differences by gender for industry relations with minimally invasive surgeons, using speakers at the SAGES Annual Meeting as a proxy for key thought leaders in minimally invasive surgery. METHODS: We queried the Open Payments Database for payments made to US speakers from the 2023 SAGES meeting. All payments from the prior fiscal year prior were collected. The National Provider Identity (NPI) Registry was cross-referenced to determine surgeon's self-reported gender. Industry sponsors were analyzed based on differences in payments made. RESULTS: A total of 305 speakers were assessed, with 175 (57.4%) males and 130 (42.6%) females. Of the 305 speakers, 246 were listed in the OPD. There were 145/175 (82.8%) males who were received general payments, compared to 101/130 (77.6%) females (p = 0.326). The total amount of industry payments was $2,894,287 for males and $1,539,481 for females. Median payments were 2.8X higher for males ($4657, IQR $422-$15,798) than females ($1651, IQR $299-$9005) (p = 0.05). CONCLUSIONS: Despite efforts to decrease gender bias in surgery, there remains a significant and substantial difference in payments towards male and female surgeons via industry relationships. This has potential downstream effects on career development, consulting and research opportunities, and development of new devices.

Breaking Barriers: Ensuring Gender Neutral Care on Short Term Surgical Missions.

INTRODUCTION: Gender discrimination is prevalent worldwide in medical and surgical care. In the setting of short-term surgical missions (STSMs) conducted to address the global burden of surgical disease, patient selection raises ethical considerations regarding equitable distribution of limited clinical resources. The goal of this study was to examine if equitable distribution of operative care between male and female patients occurs in STSMs. METHODS: The International Surgical Health Initiative (ISHI) is a US based nonprofit, nongovernmental organization. Records from surgical missions to Ghana (2014-2023) and Sierra Leone (2013-2023) were analyzed to evaluate for gender equity in inguinal hernia repairs, the most common procedure performed. A control group was created from a literature review inclusive of all studies of inguinal hernia repairs that included over 500 patients and patient gender. RESULTS: The review of 26 studies, representing 3,239,043 patients, demonstrated a gender distribution of 13% female. In Sierra Leone 246 inguinal hernia repairs were performed between 2013 and 2023. 28 (11.4%) of the hernia repairs were in females, which was not significantly different from the control group (P = 0.45). In Ghana 150 inguinal hernia repairs were performed between 2014 and 2023. 12 (8%) of the hernia repairs were in females. This was not significantly different from the control group (P = 0.07). CONCLUSIONS: This is the first study investigating the gender equity conducted within the context of humanitarian surgical outreach. Equitable patient selection is a paramount consideration in STSMs, particularly to address gender-related disparities in surgical care.

Patterns and trends in melanoma mortality in Spain (1999-2022).

AIM: To examine melanoma mortality trends in Spanish Autonomous Communities from 1999 to 2022, focusing on gender and age differences. METHODS: Data from the National Statistics Institute were used to calculate age-standardized mortality rates (ASMRs). Joinpoint regression identified trend changes. RESULTS: Melanoma mortality varied significantly by region, gender, and age. Eastern Spain had higher male mortality, while western regions had lower rates. Asturias had higher female mortality, with lower rates in Andalusia, Extremadura, and Castilla-La Mancha. Men generally exhibited higher ASMRs than women, with variations across regions. While ASMRs remained stable in most areas, Madrid experienced a notable decline (AAPC: - 1.3%). A national trend reversal occurred in 2014 (AAPC: - 1.3%). For individuals aged 45-74 years, Catalonia saw a significant decrease (AAPC: - 1.1%, p < 0.05), whereas Andalusia experienced an increase (APC: 2.1% since 2007). Nationally, ASMRs for this age group declined (AAPC: - 0.7%). Among those aged 75 years and over, ASMRs varied considerably, with increases observed in Andalusia and Aragon. Nationally, male ASMRs rose (AAPC: 1.6% per year), while female rates were stable. Regional disparities were evident, with higher female mortality in the Balearic Islands and fluctuating rates in the Community of Madrid (an increase followed by a decrease after 2015). The gender gap in mortality varied across regions, with some areas showing a narrowing gap and others widening disparities. CONCLUSION: Continuous monitoring of melanoma mortality, especially among men and older adults, is crucial. Public health efforts should address regional disparities, improve early detection, and enhance treatment access to optimize outcomes nationwide.

Exploring Gender Diversity in Canadian Surgical Residency Leadership.

OBJECTIVE: Studies in the United States demonstrate a low proportion of cisgender women in medical leadership. No research exists about the prevalence of transgender people in medical leadership. The objective of this study was to evaluate gender representation within Canadian surgical training leadership. DESIGN: This study represents a survey based exploratory analysis and literature review. Associations between gender and leadership position, surgical subspecialty, years in practice and leadership role, province of work, and age were calculated using Chi squared goodness of fit and independence tests. SETTING: The study was based out of the University of British Columbia in Vancouver and included all Canadian surgical training programs. PARTICIPANTS: Participants were identified using the Canadian Resident Matching Service and program websites. All prospective respondents (359) were emailed an encrypted survey link. RESULTS: The survey response rate was 65/359 responses (18%). The overall gender distribution was cis men (n = 36, 56.5%), cis women (n = 26, 40%), nonbinary (n = 1, 1.5%), agender (n = 1, 1.5%) and nonresponse (n = 1, 1.5%). Sixty-three percent of program directors were cis men, 33% were cis women and 4% were agender. Sixty-seven percent of associate program directors were cis women and 33% were cis men. Sixty-five percent of division leads were cis men, 29% were cis women, and 6% were nonbinary. There were more cis women in general surgery leadership than expected (df = 1, N = 20, x2 = 11.05, p ≤ 0.001). No statistically significant associations between gender identity/modality, leadership role, province, or age were found using chi squared tests. CONCLUSIONS: Cis men continue to outnumber all others in surgical training leadership. More cis women than expected work in general surgery training leadership. However, these findings must be interpreted with caution considering the low survey response rate and the greater proportion of cis women respondents compared to cis women surgeons. There is a marked absence of binary-identified trans people in surgical training leadership in Canada, however a small number of nonbinary and agender people are present.

Differences in Primary Total Shoulder Arthroplasty Volume, Reimbursement, Practice Styles, and Patient Populations Based on Surgeon Gender: A Temporal Analysis.

BACKGROUND: Orthopedic surgery has previously been shown to have a shortage of female physicians and a gender pay gap. However, this has not been thoroughly evaluated in the setting of shoulder surgery. The primary purpose of this study was to evaluate differences in total shoulder arthroplasty (TSA) volume, reimbursement, surgeon billing practices, and patient populations between male and female surgeons from 2013 to 2021. METHODS: The Medicare Physician and Other Practitioners database, a publicly available dataset that includes 100% of services billed to Medicare Part B was utilized. The database was queried for all billing episodes of Current Procedural Terminology (CPT) code 23472, which encompasses both anatomic and reverse primary TSA. Procedural volume, average inflation-adjusted reimbursement per TSA, physician billing information, and the patient demographics of each surgeon who performed TSAs were collected. Welch's t-test and Kruskal-Wallis were utilized to compare male and female surgeons each year between 2013 and 2021. RESULTS: Between 2013 and 2021, the proportion of TSAs performed by female surgeons nationally increased from 1.8% to 2.9% (+1.1%). This increase was greatest in the Northeast (2.0% to 6.1%), while a decrease was seen in the Midwest (1.9% to 1.6%). In 2021, there was no significant difference between male and female surgeons in the average inflation-adjusted reimbursement per TSA ($1,144.00 vs $1,143.00, p=0.792) and the average number of TSAs performed per surgeon (26.6 vs 23.1, p=0.105). Female TSA surgeons, on average, had less Medicare beneficiaries (348 vs 462, p<0.001), performed fewer annual services (1,817 vs 3,630, p<0.001), and performed fewer unique services (60 vs 76, p<0.001) compared to male surgeons. A higher proportion of female surgeon's patient populations were non-White (24% vs 22%, p=0.028), female (61% vs 59%, p=0.001), and dual enrolled Medicare-Medicaid patients (13% vs 10%, p<0.001). However, there was no difference in the average patient complexity between male and female TSA surgeons based on hierarchical condition category (HCC) score (1.0783 vs 1.0732, p=0.228). CONCLUSION: Female representation within TSA surgery is increasing nationally, with the greatest representation in the Northeast and West and the lowest representation in the South and Midwest. Although female TSA surgeons perform a similar number of TSAs, receive comparable reimbursement per TSA, and have a similarly complex patient population as their male counterparts, they perform significantly fewer total and unique billable services annually. Additionally, female TSA surgeons tend to see more non-White, women, and dual Medicare-Medicaid enrolled patients.

Gender Parity Among Vascular Surgeons: Progress and Attrition.

INTRODUCTION: Improving representation of women in medicine and surgery has been tempered by higher rates of attrition from residencies and from academic medicine among women compared to men. The attrition of women from the practicing vascular surgery workforce has not been studied. METHODS: We utilized the Center for Medicare and Medicaid Services' Doctors and Clinicians database to study vascular surgery employment patterns from 2015 to 2022. We examined gender balance within the workforce and attrition rates among male and female vascular surgeons. We utilized a logistic regression to calculate the odds of attrition by gender. RESULTS: The percentage of female vascular surgeons grew from 11% to 16% between 2015 and 2022, with each graduating class since 2005 having between 20% and 38% women. Yet, female surgeons were 2.05 (95% confidence interval: 1.36-3.08) times more likely to leave practice than their male counterparts when controlling for graduation year and practice in academic medicine. CONCLUSIONS: The proportion of women in vascular surgery is increasing as more women graduate into the specialty. Despite increasing representation, women are more likely than men to leave the workforce.

Gender differences in the management and outcomes of acute coronary syndrome in Indians: a systematic review and meta-analysis.

BACKGROUND: Gender differences in acute coronary syndrome (ACS) outcomes have been noted in global data, which however did not analyse Indian data. No prior systematic review and meta-analysis (SRM) has addressed this important aspect of gender bias in Indian women with ACS. Hence this SRM aimed to address this knowledge gap. METHODS: Electronic databases were searched for studies in ACS comparing cardiovascular disease presentation, treatment received and outcomes in women and men from India. Primary outcomes were to evaluate gender-differences in 30-day death and major adverse cardiovascular events (MACE). Secondary outcomes were to evaluate gender-differences in presentation, management and mortality. The SRM is registered with PROSPERO (CRD42023477286). RESULTS: From initially screened 3753 articles, data from 9 studies (61,185 patients) were analyzed. Women with ACS had higher prevalence of diabetes [Odds ratio (OR) 1.65(95%CI:1.33-2.04);P<0.001;I2=95%] and hypertension [OR2.06(95%CI:1.88-2.25);P<0.001;I2=42%]. Smoking was significantly lower in women [OR 0.05(95%CI:0.03-0.07);P<0.001;I2=87%]. Non-ST elevation myocardial infarction (NSTEMI) was significantly higher in women [OR 1.92(95%CI:1.66-2.21);P<0.001;I2=0%]. Diagnostic angiography [OR 0.64(95%CI:0.56-0.74);P<0.001;I2=46%] and percutaneous coronary interventions [OR0.71(95%CI:0.55-0.92);P=0.01;I2=92%] were significantly lower in women. Women had significantly higher 30-day mortality [Hazard ratio (HR)2.26(95%CI:2.01-2.55);P<0.001;I2=6%], 1-year mortality [HR2.41(95%CI:1.89-3.07);P<0.001;I2=53%], in-hospital death [HR1.88(95%CI:1.19-2.96);P=0.007;I2=92%], stroke [HR 1.84 (95%CI:1.34-2.52);P<0.001;I2=0%] and MACE outcomes [OR 2.05 (95%CI:1.78-2.35);P<0.001]. Use of aspirin, clopidogrel, beta-blockers and nitrates were significantly lower in women. CONCLUSION: Our study highlights worse outcomes in Indian women with ACS. Higher burden of diabetes and hypertension, decreased used of PCI and lesser aggressive pharmacotherapy may be some of the contributing factors.

Penile Inversion Vaginoplasty: An Evolving Technique.

Penile inversion vaginoplasty (PIV) is the most common surgical technique used in "gender-affirming bottom surgery." During this process, penile tissue is used to create a functional neo-vagina, allowing the individual to experience a more aligned physical manifestation of their "gender" identity. In this technical note, we describe the steps and nuances used by the senior author to ensure reliable aesthetic and functional outcomes, contributing to the overall well-being and satisfaction of transgender patients.

Expectations and Experienced Outcomes Regarding Gender-Affirming Surgeries: A Pilot Study.

Purpose: This study aimed to explore in what ways the preoperative expectations of transgender individuals regarding gender-affirming surgery (GAS) align with experienced postoperative outcomes and, subsequently, how these expectations can best be managed to support optimal outcomes. Methods: In the parent study, interviews were conducted to understand the health care experiences of a group of trans individuals that had or wanted to have gender-affirming surgical care. In this secondary analysis, we focused specifically on the individuals' expectations and experiences about the gender-affirming procedures they desired or underwent. Recruitment occurred from August 2018 to October 2018 at the Amsterdam University Medical Center (VUmc) in the Netherlands. Axial coding and theory-informed thematic analysis were used to assess preoperative expectations and postoperative. Results: The data regarding expectations related to GAS (ncodes=273) and postoperative experienced outcomes (ncodes=292) yielded a total of four themes-(1) Procedure, recovery, and functional results; (2) Esthetic outcomes of GAS; (3) Improved body image in relation to one's gender role; and (4) Increased psychosocial and sexual wellbeing at large in relation to one's gender role. Each of the four themes were divided into two subthemes: (1) expectations, and (2) experienced outcomes. Conclusion: Better understanding, education, and support in the decision-making process of trans individuals seeking gender-affirming surgical care is needed to manage expectations and overall outcomes of GAS procedures.

Reflecting on the Importance of Family Building and Fertility Preservation: Transgender People's Experiences with Starting Gender-Affirming Treatment as an Adolescent.

Purpose: We aimed to investigate how adults, who started gender-affirming hormone treatment during adolescence, reflect on their reproductive decisions. Methods: We recruited transgender and gender-diverse (TGD) people who visited our gender identity clinic and commenced medical treatment in adolescence at least 9 years ago. We collected data through an online survey. Results: The cohort consisted of 89 participants (66 TGD people assigned female at birth (AFAB) and 23 TGD people assigned male at birth (AMAB) with a mean age of 32.4 years (range 25.5-51.2) at the time of study, and 15.6 years (range 11.5-20.6) at the start of medical treatment. All participants initiated medical treatment before 2014, when laws requiring sterilization for legal gender recognition were still in place, and only 30% of participants reported to have received information about fertility preservation, which none of them pursued. In addition, 96% of participants underwent gonadectomy and thus became permanently infertile, which was troublesome for 27%. With today's knowledge, 44% of TGD people AFAB and 35% of TGD people born AMAB would pursue fertility preservation. The percentage of participants with a (future) desire for children increased from 34% at the start of medical treatment (at adolescent age) to 56% at the time of this study (at adult age), of whom 23% had currently started a family. Conclusion: It is important to inform transgender adolescents about the effect of medical treatment on fertility and the options for fertility preservation since many may develop a desire for (biological) children when they reach adulthood.

Depressive and Anxiety Symptoms Were More Common for Transgender Individuals Whose Gender-Affirming Surgeries Were Cancelled or Delayed Due to COVID-19: A Global Cross-Sectional Study.

Gender-affirming surgeries, which have well-established mental health benefits, were cancelled and delayed for transgender people worldwide during the COVID-19 crisis. Of 253 scheduled gender-affirming surgeries among transgender adults across 35 countries in late 2020, 27% (n=69) reported that the COVID-19 crisis limited their access to gender-affirming surgery (i.e., cancelled, postponed indefinitely, or rescheduled). In adjusted models, respondents with reduced access to surgeries were somewhat more likely to screen positive for depressive or anxiety symptoms, whereas those who maintained access were more likely to report higher levels of happiness. Our findings illustrate the transgender-specific harms of the COVID-19 crisis on gender-affirming surgeries and mental health.

Gender Differences in Self-Description: A Linguistic Analysis of Orthopedic Surgery Residency Application Personal Statements.

OBJECTIVE: The purpose of this study is to assess differences in language characteristics in personal statements written by male and female applicants to an orthopedic surgery residency program. DESIGN: This is a blinded retrospective analysis of personal statements from all applicants to an orthopedic surgery residency training program during 1 application cycle. Language characteristics were analyzed using a linguistic analysis software. This software evaluated 19 variables, including word count, 4 summary language variables (analytical thinking, clout, authenticity, and emotional tone), and 14 additional word categories. SETTING: Our study took place at [institution]. PARTICIPANTS: All applications submitted during the 2018-2019 residency application cycle were analyzed. 889 applicants were included in the study based on exclusion criteria, which omitted the 5 applicants who ultimately matched at our institution, as well as non-US citizens. RESULTS: Word count was not statistically significant between groups. Amongst the summary language variables, authenticity was higher in female applicants (p = 0.0142). Of the selected word categories, males averaged a higher score in certainty (p = 0.0418), while females averaged higher scores in curiosity (p = 0.0102), perception (p = 0.0486), and attention (p = 0.0293). CONCLUSIONS: Subtle differences exist in the language characteristics of personal statements written by male and female applicants to orthopedic surgery residency. The implications of our findings would be strengthened by new data on specific language characteristics and communication skills most desired by orthopedic program directors. Lastly, as evaluation metrics for residency applications continue to change, personal statements may assume an even more important role.

Temporal Trends in Racial and Gender Disparities of Early Onset Colorectal Cancer in the United States: An Analysis of the CDC WONDER Database.

BACKGROUND: The mortality rates of early-onset colorectal cancer (EOCRC) have surged globally over the past two decades. While the underlying reasons remain largely unknown, understanding its epidemiology is crucial to address this escalating trend. This study aimed to identify disparities potentially influencing these rates, enhancing risk assessment tools, and highlighting areas necessitating further research. METHODS: Using the CDC Wide-Ranging Online Data for Epidemiologic Research (WONDER) database, this study assessed EOCRC mortality data from 2012 to 2020. Individuals under 50 years who succumbed to EOCRC were identified through the International Classification of Diseases, Tenth Revision (ICD-10) codes. Data interpretation and representation were performed using R 4.2.2 software. RESULTS: Between 2012 and 2020, EOCRC mortality rates fluctuated marginally between 1.7 and 1.8 per 100,000. Male mortality rates increased from 1.9 to 2.0 per 100,000, while female rates varied between 1.5 and 1.6 per 100,000. Significant variations were observed across age groups, with the 40-49 years category experiencing an increase from 6.34 (2012) to 6.94 (2020) per 100,000. Racial category-based data revealed the highest mortality rates among African Americans. Geographically, Mississippi and Alabama exhibited elevated mortality rates. Age-adjusted mortality rate (AAMR) assessments indicated a marked decline for both genders from 2012 to 2020, with consistently higher rates for men. CONCLUSION: The findings highlight the evolving landscape of EOCRC mortality, revealing significant gender, age, and racial disparities. These results underscore the urgent need for tailored health strategies and intensified research efforts targeting these disparities.

Breast care considerations for transgender and gender-diverse patients.

Transgender and gender-diverse (TGD) persons represent a small but growing population in the United States. Accessing inclusive, equitable, and evidence-based healthcare remains a challenge for this patient population. Many TGD persons seek gender-affirming care, including gender-affirming hormonal therapy (GAHT) and gender-affirming surgery (GAS), to help ameliorate the physical and mental aspects of their gender incongruence. Both GAHT and GAS induce clinically important histopathologic and anatomic changes in breast tissue. Consequently, breast care in TGD persons has become an increasingly recognized topic of importance in gender-affirming care. However, there remains a scarce but growing base of literature specifically addressing the unique healthcare needs of breast care in TGD patients. This article will review how to establish trusting patient-provider relationships for TGD patients, gender inclusivity in breast clinics and imaging centers, the influence of GAHT and GAS on breast tissue, breast cancer screening recommendations and barriers, and breast cancer risk and treatment considerations in TGD persons.

Women Experience Higher Rates of Mortality Following Thoracic Endovascular Aneurysm Repair.

OBJECTIVES: Thoracic endovascular aortic repair (TEVAR) and complex endovascular thoraco-abdominal aneurysm repair (cEVAR) has been increasingly adopted in the treatment of thoracic and thoracoabdominal aorta aneurysms, offering a less invasive approach for patients with appropriate anatomy. Women usually present with smaller aortic diameter. However, they usually have greater aneurysm growth rates. How sex can affect postoperative and short-term outcomes after TEVAR is not well reported. The aim of this study was to assess outcomes in female versus male patients undergoing TEVAR for treatment of thoracic and thoracoabdominal aneurysms in a Medicare-linked database. METHODS: We retrospectively reviewed patients undergoing TEVAR for thoracic and thoracoabdominal aneurysm repair in the Vascular Quality Initiative (VQI) Vascular Implant Surveillance and Interventional Outcomes Network (VISION) database from 2003 to 2018. Patients were divided into males and females. Patients presented with ruptured aneurysm were excluded from the analysis. Postoperative outcomes included in-hospital stroke, myocardial infarction (MI), spinal cord ischemia, and 30-day mortality. One-year outcomes included mortality, aneurysmal rupture, and reintervention. Postoperative outcomes were assessed using multivariable logistic regression analysis and one-year outcomes were evaluated using Kaplan Meier Survival and Cox regression analyses. RESULTS: A total of 3,058 males and 1,843 females were available for the analysis. Female patients had smaller median aortic diameter, were more likely to be black, with chronic obstructive pulmonary disease, and chronic kidney disease, and to be symptomatic on presentation. Male patients were more likely to be on preoperative medications such as aspirin, beta-blockers, angiotensin-converting enzyme inhibitors, P2Y12 antagonists, and anticoagulants. After adjusting for potential confounders, female gender was associated with double the risk of in-hospital stroke (OR: 2.3, 95%CI ((1.5-3.7), P<0.001) and 80% increase in 30-day mortality (OR: 1.8, 95%CI (1.3-2.6), P=0.001). At one year, female gender was associated with a higher risk of mortality (HR: 1.2, 95%CI (1.05-1.4), P=0.011). There was a trend towards higher risk of reintervention (HR: 1.2, 95%CI (0.97-1.6), P=0.079). CONCLUSIONS: Mortality after TEVAR seems to be higher in female patients at 30 days and up to one year of follow-up. Female patients also face a two times higher risk of in-hospital stroke. Future studies with a larger female population should aim to identify and potentially ameliorate the factors associated with these unfavorable outcomes in females.