Gender Medicine Research Articles

Do Patients Seek Women-Centered Cardiac Care? Patient Experience of an All-Female Multidisciplinary Heart Center for Women.

PurposeCardiovascular disease in women is frequently under-diagnosed and under-treated. Numerous heart centers for women have opened throughout the world to address these disparities; however, there is a paucity of data regarding participants’ perspectives. The current study assesses motivation to participate and perceived benefits in attending a heart center for women (HCW) in Jerusalem, Israel.MethodsThis study utilized qualitative methods to assess patients’ motivation and perceived benefits to attending a women’s heart center, particularly as they relate to gender medicine and single-sex staffing. A random sample of 42 clinic patients were asked to participate in interviews. Inclusionary criteria consisted of previous cardiovascular event, active cardiac symptom or three or more cardiovascular disease risk factors. Exclusionary criteria consisted of pregnancy, type 1 diabetes requiring insulin, psychiatric diagnosis that precluded participation, dementia, or other multidisciplinary clinic participation. Interviews were audio recorded and transcribed verbatim. Qualitative data analysis followed Braun and Clarke’s methodology of thematic analysis.ResultsThe single-sex and gender medicine aspects did not motivate women to attend the HCW, although some participants perceived this as beneficial in retrospect. Women reported that the clinic visit enhanced their knowledge and awareness of issues related to heart disease in women as well as personal health benefits. They reported benefitting from the holistic approach, consideration of their lifestyle, the staff’s expression of concern, personalized attention, common language, and feeling understood.ConclusionThis study describes the patient experience in an all-female HCW, highlighting their motivation for attendance and perceived benefits. While they did not actively seek women-centered care, women reported educational and care provision benefits to their attendance. The care attributes that women identified as beneficial typify the person-centered approach to care. These findings may inform both the design and evaluation of medical care facilities that aim to address the sex and gender disparities in cardiology as well as other medical specialties.

Sex, gender, and the opioid epidemic: Crucial implications for acute care.

The opioid epidemic continues to escalate in the United States, exacerbated significantly by the COVID-19 pandemic. Necessary steps in acute care medicine to expand efforts to combat this epidemic involve increased emergency department engagement of patients with opioid use disorder (OUD) and an incorporation of evolving sex- and gender-based factors that affect this disease presentation and management course. An ever-increasing amount of peer-reviewed, evidence-based literature has shed light on the important biologic and sociocultural variables, specifically sex and gender, which impact OUD trajectory and outcomes. As a collaborative effort of the Sex and Gender in Emergency Medicine (SGEM) Interest Group, a community within the Society for Academic Emergency Medicine (SAEM), we sought to consider, review, and summarize clinically pertinent information as a comprehensive introduction to this topic for the emergency medicine (EM) clinician and educator. A selected overview of current evidence-based data and publications, to include current epidemiologic trends, opioid-based physiology and pathophysiology, as well as opioid use disorder management and outcomes, through a sex- and gender-based lens, was reviewed and included in this summary. Also discussed are implications and recommendations for EM educators seeking insight and resources for continuing, graduate, and/or undergraduate education on this topic. Incorporation of emerging sex- and gender-specific scientific knowledge into clinical context represents a critical link to effective management of the OUD patient in the ED. Similarly, integration of this information into EM education represents an essential step for both sex- and gender-based medicine and opioid-specific training.

The need for preventive nursing care from a gender perspective at Bollate prison. An example: breast cancer.

Breast cancer is prevalent in females, accounting for 25% of the world's cancers. Prevention is strategic, and the nurse is an active part in educational and preventive programs, highlighting how the need for preventive nature is combined with gender medicine. The objective was to investigate the knowledge of breast cancer prevention among inmates of Bollate prison (Milan). 51% (52) adhered; women had an average age of 44 years (SD: 9.8), and 39% (20) were inmates from 1 to 3 years. 93% (48) knew about breast cancer prevention, 43% (26) had undergone specific preventive checkups outside of the prison, and 62% (31) had performed self-palpation. All women felt it was important to implement prevention in the prison environment. A high percentage of female inmates with an educational qualification was observed to be aware of breast cancer prevention and to have undergone screening programs in their lifetime. Emerges the strong willingness of women prisoners to be involved and the educational role of the nurse in the prison setting also from a gender perspective.

Premenopausal Syndrome and NAFLD: A New Approach Based on Gender Medicine.

Non-alcoholic fatty liver disease (NAFLD) is a multifactorial condition that affects 25% of the world’s population. There is a clear difference in both geographical distribution and sex in childbearing age. These differences are reduced when women become older and senescence begins. The factors that affect the likelihood of developing NAFLD in a premenopausal woman are an imbalance of sex hormones (especially in estradiol and androgen), microbiome dysregulation, insulin resistance, early menarche, the length of time that the woman breastfeeds for and polycystic ovarian syndrome (PCOS). The aim of this review is to identify various physical ailments that may not appear to be serious to young women but that then affect the onset of NAFLD in perimenopause and can degenerate into NASH. These conditions should also be considered in future clinical management, as well as in research opportunities, in order to customize the monitoring and treatment of NAFLD, considering gender medicine for those women who had early metabolic symptoms that were not considered to be significant at the time.

Gender medicine as a tool for implementing the right to health.

The COVID-19 pandemic has increased the interest in the right to health, which represents a relatively new concept brought about by progress in medical science and the evolution of societies. The Italian Constitution, in article 32, states the right to health without specifications about the parameter of sex, assuming that this fundamental right is property of women and men indiscriminately. To assess whether the right to health has actually been achieved in an equal way from the standpoint of sex, and whether a hypothetically "neutral" approach is actually convincing and profitable in this context. This paper analyzes the topic of gender medicine from a scientific and legal perspective, based on current medical literature and its implementation in the Italian and European legal systems. Gender medicine is the only credible response to sex- and gender-based inequalities affecting the right to health, as it provides tools to address persisting inequalities in prevention and treatment, thus pursuing health for all: women and men. The importance of this path was underlined also by the Summit and the Rome Declaration of 21 May 2021, acknowledging that the topic of sex and gender can no longer be overlooked in focusing a correct and equal healthcare approach.

How to Integrate Sex and Gender Medicine into Medical and Allied Health Profession Undergraduate, Graduate, and Post-Graduate Education: Insights from a Rapid Systematic Literature Review and a Thematic Meta-Synthesis.

Sex and gender are concepts that are often misunderstood and misused, being utilized in a biased, preconceived, interchangeable way. Sex and gender medicine is generally overlooked, despite the profound impact of sex and gender on health outcomes. The aims of the present rapid systematic literature review were (i) to assess the extent to which sex- and gender-sensitive topics are covered in medical courses; (ii) to assess the need for and willingness toward integrating/incorporating sex and gender medicine into health-related education; (iii) to identify barriers and facilitators of the process of implementation of sex and gender medicine in medical teaching, mentoring, and training; and (iv) to evaluate the effectiveness of interventional projects targeting curriculum building and improvement for future gender-sensitive physicians. Seven themes were identified by means of a thematic analysis, namely, (i) how much sex- and gender-based medicine is covered by medical courses and integrated into current medical curricula, (ii) the knowledge of sex and gender medicine among medical and allied health profession students, (iii) the need for and willingness toward acquiring sex- and gender-sensitive skills, (iv) how to integrate sex- and gender-based medicine into medical curricula in terms of barriers and facilitators, (v) existing platforms and tools to share knowledge related to sex and gender medicine, (vi) sex- and gender-based medicine aspects in the post-medical education, and (vii) the impact of sex- and gender-sensitive topics integrated into medical curricula. Based on the identified gaps in knowledge, further high-quality, randomized trials with larger samples are urgently warranted to fill these gaps in the field of implementation of gender medicine in educating and training future gender-sensitive physicians.

Hormones and Sex-Specific Medicine in Human Physiopathology.

A prodigious increment of scientific evidence in both preclinical and clinical studies is narrowing a major gap in knowledge regarding sex-specific biological responses observed in numerous branches of clinical practices. Some paradigmatic examples include neurodegenerative and mental disorders, immune-related disorders such as pathogenic infections and autoimmune diseases, oncologic conditions, and cardiovascular morbidities. The male-to-female proportion in a population is expressed as sex ratio and varies eminently with respect to the pathophysiology, natural history, incidence, prevalence, and mortality rates. The factors that determine this scenario incorporate both sex-associated biological differences and gender-dependent sociocultural issues. A broad narrative review focused on the current knowledge about the role of hormone regulation in gender medicine and gender peculiarities across key clinical areas is provided. Sex differences in immune response, cardiovascular diseases, neurological disorders, cancer, and COVID-19 are some of the hints reported. Moreover, gender implications in occupational health and health policy are offered to support the need for more personalized clinical medicine and public health approaches to achieve an ameliorated quality of life of patients and better outcomes in population health.

Gender and Sex-Related Differences in Normal Tissue Effects Induced by Platinum Compounds.

Gender medicine in the field of oncology is an under-researched area, despite the existing evidence towards gender-dependent response to therapy and treatment-induced adverse effects. Oncological treatment aims to fulfil its main goal of achieving high tumour control by also protecting normal tissue from acute or chronic damage. Chemotherapy is an important component of cancer treatment, with a large number of drugs being currently in clinical use. Cisplatin is one of the most commonly employed chemotherapeutic agents, used either as a sole drug or in combination with other agents. Cisplatin-induced toxicities are well documented, and they include nephrotoxicity, neurotoxicity, gastrointestinal toxicity, ototoxicity, just to name the most frequent ones. Some of these toxicities have short-term sequelae, while others are irreversible. Furthermore, research showed that there is a strong gender-dependent aspect of side effects caused by the administration of cisplatin. While evidence towards sex differences in animal models is substantial, clinical studies considering sex/gender as a variable factor are limited. This work summarises the current knowledge on sex/gender-related side effects induced by platinum compounds and highlights the gaps in research that require more attention to open new therapeutic possibilities and preventative measures to alleviate normal tissue toxicity and increase patients’ quality of life in both males and females.

Gender sensitivity and stereotypes in medical university students: An Italian cross-sectional study.

Gender medicine is crucial to reduce health inequalities. Knowledge about students' attitudes and beliefs regarding men, women and gender is important to improve gender medicine courses. The aim of this study is to evaluate gender stereotypes and its predictors in Italian medical students. We performed an online cross-sectional study among students from the University of Turin. We used the validated Nijmegen Gender Awareness Scale in Medicine scale to explore gender sensitivity and stereotypes. Multivariable logistic regression model was performed to explore potential predictors of gender awareness. We enrolled 430 students. Female sex, a better knowledge on gender medicine and having had a tutor aware of gender issues are associated with higher gender sensitivity. Older age, a better knowledge on gender medicine and having had a tutor sensitive to gender issues were predictors of more stereotyped opinions towards patients. Having had a tutor aware of gender medicine, male sex and older age were associated with more stereotypes towards doctors. Italian students have high gender sensitivity and low gender stereotypes. Age, higher knowledge of gender medicine and having had a tutor that considered gender were associated with higher gender stereotypes. Focusing on gender awareness in medical schools can contribute to a better care.

Past, present and future of gender medicine in Russia and worldwide

<h3></h3> Гендерная медицина — это новый раздел медицины, который изучает дифференцированный подход к диагностике, лечению и профилактике болезней у женщин и мужчин и способствует его внедрению. Зарождение гендерной медицины связано с международным движением за женское здоровье, которое появилось на фоне второй волны феминизма, ее важной основой является включение женщин в клинические исследования, сбор гендер-акцентных данных и обеспечение безопасности лекарств. Катастрофа с талидомидом существенно повлияла на исключение женщин детородного возраста из участия в клинических испытаниях. В СССР, а затем и в Российской Федерации никогда не было прямого запроса на гендерную медицину, а также запрета на участие женщин в клинических испытаниях лекарств. В то же время не было условий для тестирования новых лекарств на лицах женского пола, отсутствовал гендерный подход в целом. В результате женщин не удовлетворял уровень оказываемой медицинской помощи. Данные, полученные из разных социально значимых сфер медицины, не оставляют сомнения в существовании потребности в гендерном подходе в медицине в мире и в частности в России.

Assessment of Current Trends in Demographic and Clinical Characteristics of Male Patients with Rheumatoid Arthritis: A Retrospective Study

Introduction: Role of gender in development of an autoimmune dysfunction in Rheumatoid Arthritis (RA) is very complex and therefore novel concept of gender medicine has come into limelight. Aim: To assess current trends in demographic and clinical characteristics of male patients with RA. Materials and Methods: This retrospective study was conducted among patients with RA attending Outpatient Department of Rheumatology at Santokba Durlabhji Memorial Hospital cum medical Research Institute, Jaipur and Centre for Arthritis and Autoimmune Rheumatic Disorders, Jaipur, Rajasthan, India, during April 2015 to April 2021. Men who qualified the European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) criteria for RA were included in this study. The medical records of patients were reviewed for collecting demographic and clinical characteristics, disease activity, disease duration, deformities, extra articular manifestations, and co-morbid illness. Results: A total of 179 men were enrolled, and the mean age was 45.3±11.1 years. The majority of patients had severe disease with more than two years of disease duration. Subcutaneous nodule (27.8%) was most frequently observed extra-articular manifestations. Rheumatoid factor positivity and cyclic citrullinated peptide were prevalent in 107 and 110 patients, respectively. Osteoporosis (21.1%) and hypertension (19.2%) were the most common comorbidities and majority of patients reported wrist deformities. Conclusion: Overall observations indicate the presence of subcutaneous nodule as the common extra-articular manifestation with more than 2 years of disease duration, osteoporosis and hypertension as the most common co-morbidities; and high prevalence of wrist deformities in male patients with RA.

The Relationship Between Applicant Gender and Internal Medicine Residency Interview Scores.

Gender inequity is widespread in academic medicine, including in the promotion, academic recognition, and compensation of female faculty. To assess whether these inequities extend to the GME intern selection process, this study examines differences in the interview scores assigned to male and female applicants at one large internal medicine residency program. Subjects include 1399 applicants who completed 3099 interviews for internship positions for the Brigham and Women's Hospital internal medicine residency in Electronic Residency Application Service (ERAS) cycles 2015-2016, 2017-2018, 2018-2019, and 2019-2020. Unadjusted and multivariable linear regressions were used to assess the simultaneous effect of applicant gender, interviewer gender, and applicant academic characteristics on pre-interview, post-interview, and change in interview scores. Our analysis included 3027 interviews (97.7%) of 1359 applicants (97.1%). There were no statistically significant differences in the interview scores assigned to female versus male applicants. This was true across pre-interview scores (difference = 0.03, P = .61), post-interview scores (difference = 0.00, P = .98), and change in interview scores (difference = 0.01, P = .24) as well as when adjusting for the baseline academic characteristics of both male and female applicants. This was also true when analyzing individual application years, individual residency tracks, and accounting for the gender of the faculty interviewers. The findings do not support the presence of gender inequity in the interview scores assigned to male and female applicants included in this study.

Gender-specific side effects of chemotherapy in pancreatic cancer patients.

Pancreatic carcinoma incidence showed a significant increase in men over the last few years and the prognosis remains poor. Patients are treated with different pharmacological plans with no evidence about gender-specific adverse effects. We aimed to investigate differences in the incidence of chemotherapy side effects in the treatment of pancreatic cancer, to provide insights toward a personalized assistance based in individual needs. The sample population is composed of 207 patients. Regression model highlighted the predictive role of female gender for alopecia, constipation, hand-foot syndrome, and epigastric pain. Also, considering single therapeutic schemes, gender differences have been reported. Moreover, evaluating the effect of age, a general reduced risk of toxicity has been reported in younger patients. To personalize chemotherapy and increase patient survival rate and life quality during the therapy, gender medicine and pharmacology studies are recommended.

Gender medicine: a cross-sectional survey on knowledge and curriculum among Italian medical students

Abstract Introduction Gender and sex are important predictors of many attitudes and behaviours that have an impact on health and disease. Gender medicine is then a fundamental approach for better quality of care in Europe. Few information is available on Italian medical students and their knowledge about gender medicine. Our study aimed to investigate knowledge about gender medicine in a sample of Italian medical students in order to identify specific knowledge gaps and improve Medicine degree curricula. Methods In 2020, an online cross-sectional survey was conducted on 430 medical students of the University of Turin, Italy. Participants filled out a questionnaire consisting of 29 items concerning the areas of knowledge and attitudes regarding gender medicine. Multivariable logistic regression model was performed to explore potential predictors of knowledge among students. Results More than 60% of the students knew the correct definition of gender medicine and around 90% of them knew the difference between sex and gender. In total, 58.16% of female students had a good level of knowledge, significantly more than male students (37,5%; p &amp;lt; 0.001); female students also showed a higher mean score compared to male students (respectively 17.96±2.75 vs 16.59±3.20, p &amp;lt; 0.001). Using a multivariate linear regression model, with level of knowledge about gender medicine used as a continuous variable, we found that being female was the only potential predictor of high consideration of gender medicine in patient management. Conclusions The results indicate that students have a good knowledge and high regard for gender medicine. Female students seem more aware of the importance of gender medicine and areas of improvement can be identified. Future European physicians must consider gender medicine in order to encourage a patient-tailored approach and to reduce gender gap still existent in current practice. Key messages Gender medicine is a fundamental approach to improve quality of care and to reduce gender gap among European patients. Medical students should be more aware and trained about gender and sex differences during clinical practice in order to encourage a patient-tailored medicine.

Are 2020’s medical students still suffering from gender stereotypes? An Italian study

Abstract Background Gender medicine is crucial to reduce health inequalities in Europe. Knowledge about medical students' attitudes and beliefs regarding sex and gender is important to improve gender medicine courses. The aim of this study is to evaluate gender awareness and its predictors in Italian medical students. Methods During 2020, we performed a cross-sectional study among medical students from the University of Turin, Italy. We used the validated Nijmegen Gender Awareness Scale in Medicine (N-GAMS) to investigate gender sensitivity (GS) and gender role ideology towards patients (GRIP) or doctors (GRID). Multivariable logistic regression model was performed to explore potential predictors of gender awareness. Results Globally, 430 participants completed the survey (68.4% were females). The 62.5% of male students had a poor knowledge of gender medicine. GRID score significantly differs between males and females (1.64±0.68 vs 1.51±0.49; p = 0.028). Males had lower GS scores (coefB -0.96, p &amp;lt; 0.05), while students who had a better knowledge on gender medicine (coefB 0.14, p &amp;lt; 0.05) and those who have received good example from tutors (coefB 0.14, p &amp;lt; 0.05) were more gender-sensitive. Older age (coefB 0.04, p &amp;lt; 0.05), a better knowledge on gender medicine (coefB 0.12, p &amp;lt; 0.05) and having had a tutor sensitive to gender issues (coefB 0.13, p &amp;lt; 0.05) were predictors of more stereotyped opinions towards patients. Having had a tutor aware of gender medicine (coefB 0.03, p &amp;lt; 0.05), male sex (coefB 0.12, p &amp;lt; 0.05) and older age (coefB 0.03, p &amp;lt; 0.05) were associated with more stereotypes towards doctors. Conclusions Gender stereotypes are still common. During university courses and practical training more attention must be paid to explain that stereotyped gender differences are not scientifically proven and they do not contribute to provide better care. Therefore, the implementation of gender specific teaching throughout elective courses should be seriously considered. Key messages Receiving more knowledge and more attention about gender medicine during university education was associated with higher gender stereotypes in our sample of medical students. Interventions in European university education are needed to make gender medicine education more effective in order to reduce gender stereotypes and contribute to better care.

Developing an Ethical Model of Care for People with a Variation of Sex Development in Switzerland

Abstract Background What constitutes best practice in the area of intersex, renamed Disorders/differences of sex development (DSD/dsd) or even variations of sex development (VDS) after the “Chicago consensus”? What kind of model of care would meet the requirements of an ethical management of intersex/dsd/VDS? Methods In 2005, we launched an interdisciplinary SHS and gender medicine project to improve the standards of care for persons with intersex/dsd/VDS. Abroad, this project, initiated in Lausanne, has sometimes been called the “Swiss Model”. It includes the development of an interdisciplinary team, based at the University hospital CHUV, who takes care of persons born with intersex/dsd/VDS and also teaches an ethical model of care to students at the Medical School of the University of Lausanne. The “Swiss Model” is centered on the children's fundamental rights to bodily integrity, self-determination and genital autonomy. We describe our 10 years' experience, the reasons, goals and development modalities of our team and model of care. Results We have developed a medical ethics “from below” to overcome the lack of ethical recommendations, as it was the case until 2012 in Switzerland. During this period of time, genital surgeries and other non-vital medical treatments have been postponed until the child could fully participate in the medical decisions and give one's informed assent or consent. Only one family did not follow our recommendations. Conclusions The Lausanne experience testifies to the possibility of changing the so-called Johns Hopkins paradigm in actual practice. The model of care we have implemented can define best practice as it is scientifically grounded, medically reasonable, and ethically consistent.

Sex and gender specific health topics in medical student learners: pulse check eight years later

BackgroundAn essential component of patient-centered, individualized medicine is considering how sex and gender affect mechanisms of health and disease.ObjectivesTo assess medical students’ current knowledge of sex and gender specific health (SGSH) concepts compared to results from the same survey in 2012 to better inform development of curricular materials for medical education.MethodsA previously designed survey tool, which assessed current knowledge of sex and gender-based medicine of medical students, was emailed to all Mayo Clinic Alix School of Medicine (MCASOM) students on Minnesota, Arizona, and Florida campuses in 2020. Descriptive and qualitative thematic results were compared to the same survey administered in 2012 to students enrolled in MCASOM. Changes in the inclusion of SGSH topics were assessed over the eight years.ResultsOne hundred and one of 365 (27.7% response rate) surveys were returned with 2:1 female to male respondents with representation from all 4 years. The definitions of the terms “sex” and “gender” were correctly identified by most respondents (93.1%). However, only 36% (12/33) of questions related to other medical knowledge on SGSH topics had more than a 50% correct response rate. More than half of the students reported that SGSH topics were included in Gynecology, Cardiology, Pediatrics, and Immunology. SGSH topics were reported as not being routinely covered in Neurology and Nephrology, although more students said they were in 2020 then 2012. Sixty-two percent of students favored increasing SGSH in the current curriculum.ConclusionsMedical students appear to understand the definition of and importance of SGSH in education. While some improvements in coverage by subject matter and topic area appear to have occurred as reported by medical students, opportunity remains to more fully integrate SGSH concepts in medical school curricula.

Genetics, sex, and gender.

This review aims to give an overview of what has been discovered so far and what still needs to be analyzed about how sex and gender affect the disease development. These two terms are often confused and indifferently used. In principle, the term "sex" refers to biological differences between males and females, specifically reproductive organs and their functions, while the term "gender" refers to the social context in which people live and which contributes to a subjective sexual identity, masculine or feminine. This dichotomy, however, is not so rigid and both sex and gender influence different aspects of human health, such as brain, health and aging and drug treatment and pharmacokinetics. In particular, we want to focus on genetic differences between men and women: indeed, the expression of the genes mapped on X chromosome or Y chromosome and all epigenetic interactions affect the diseases development. Finally, we will briefly outline sex and gender differences in clinical manifestations of three neurological diseases: Alzheimer's disease, Parkinson's disease, and obsessive compulsive disorder. In the era of personalized medicine, we must not forget the importance of gender medicine to promote personalized care for any kind of patients.

PD04-08 URINARY INCONTINENCE AND QUALITY OF LIFE: A PRINCIPAL COMPONENT ANALYSIS OF THE STANFORD WSDM OBSERVATIONAL LOWER URINARY TRACT SYMPTOM (LUTS) COHORT

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence: Therapy I (PD04)1 Sep 2021PD04-08 URINARY INCONTINENCE AND QUALITY OF LIFE: A PRINCIPAL COMPONENT ANALYSIS OF THE STANFORD WSDM OBSERVATIONAL LOWER URINARY TRACT SYMPTOM (LUTS) COHORT Chen Shenhar, Abdelrahman S. Abdalla, Stefanie van Uem, Ashu Mohammad, Bertha H. Chen, Elizabeth A. Kidd, and Amy D. Dobberfuhl Chen ShenharChen Shenhar More articles by this author , Abdelrahman S. AbdallaAbdelrahman S. Abdalla More articles by this author , Stefanie van UemStefanie van Uem More articles by this author , Ashu MohammadAshu Mohammad More articles by this author , Bertha H. ChenBertha H. Chen More articles by this author , Elizabeth A. KiddElizabeth A. Kidd More articles by this author , and Amy D. DobberfuhlAmy D. Dobberfuhl More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001968.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urinary incontinence (UI) is included in the ICIQ FLUTS / MLUTS questionnaires, but not in the AUASI. Our aim was to study the effect of UI on quality of life (QOL) in females and males using principal component analysis. METHODS: Subjects were prospectively enrolled into the Stanford WSDM observational LUTS cohort from a functional urology clinic and answered questionnaires. Data were analyzed in SAS using principal component analysis (PCA) to identify LUTS domain groups. Eigenvalues over 1 were retained. Multivariate logistic regression was performed using the gender specific principal components to ascertain the effect of LUTS domains on the outcome AUASI QOL. RESULTS: A total of 304 patients (178 female, 126 male) were enrolled. Mean age was 58±17 years. 540 clinic visits occurred between May 2019 and November 2020. Response rates were 93% (500/540) for AUASI, and 91% (490/540) for ICIQ. For the AUASI, unsupervised PCA identified the principal components as either voiding phase or storage dysfunction. While for the ICIQ questionnaires, unsupervised PCA identified voiding, storage and incontinence as the dominant LUTS domains. In females, maximum likelihood estimates for the effect of LUTS on QOL were significant for all components of the ICIQ FLUTS (incontinence p<0.0001, voiding p<0.0001, storage p=0.008) and for the storage component of the AUASI (p=0.004). In males, maximum likelihood estimates were significant for the incontinence (p=0.024) and storage (p=0.027) components of the ICIQ MLUTS, as well as the voiding (p=0.018) and storage (p=0.006) components of the AUASI. Given the significance of UI on QOL, which is not ascertained by the AUASI, predicted probabilities of QOL were plotted using the incontinence PCA component scores, while holding the other component domains constant. This identified the inflection point for significant UI as AUASI QOL 5 or 6 in women, whereas UI in men was adversely associated as a driving component of worse QOL for men reporting AUASI QOL 4, 5 or 6 (Figure 1). CONCLUSIONS: UI is a significant driver of QOL and potentially under ascertained in men given the absence of a UI specific item in the AUASI. Men need to be queried for the presence of UI, as UI appears to be a significant driver of worse QOL. Source of Funding: NIH 1L30DK115056-01, Stanford Women's Health and Sex Differences in Medicine (WSDM) Seed Grant © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e52-e53 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Chen Shenhar More articles by this author Abdelrahman S. Abdalla More articles by this author Stefanie van Uem More articles by this author Ashu Mohammad More articles by this author Bertha H. Chen More articles by this author Elizabeth A. Kidd More articles by this author Amy D. Dobberfuhl More articles by this author Expand All Advertisement Loading ...

MP02-13 EFFECTS OF GENDER AND AGE ON LOWER URINARY TRACT SYMPTOMS (LUTS): INSIGHTS FROM THE STANFORD WSDM OBSERVATIONAL LUTS COHORT

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Non-neurogenic Voiding Dysfunction I (MP02)1 Sep 2021MP02-13 EFFECTS OF GENDER AND AGE ON LOWER URINARY TRACT SYMPTOMS (LUTS): INSIGHTS FROM THE STANFORD WSDM OBSERVATIONAL LUTS COHORT Chen Shenhar, Petah Tikva Israel, Stefanie van Uem, Abdelrahman S. Abdalla, Ashu Mohammad, Bertha H. Chen, Elizabeth A. Kidd, and Amy D. Dobberfuhl Chen ShenharChen Shenhar More articles by this author , Petah Tikva IsraelPetah Tikva Israel More articles by this author , Stefanie van UemStefanie van Uem More articles by this author , Abdelrahman S. AbdallaAbdelrahman S. Abdalla More articles by this author , Ashu MohammadAshu Mohammad More articles by this author , Bertha H. ChenBertha H. Chen More articles by this author , Elizabeth A. KiddElizabeth A. Kidd More articles by this author , and Amy D. DobberfuhlAmy D. Dobberfuhl More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001963.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To describe how specific items in the AUASI and the ICIQ FLUTS / MLUTS differ based on gender and age, in a patient population seeking care for LUTS. METHODS: Subjects were prospectively enrolled into the Stanford WSDM observational LUTS cohort from a functional urology clinic and answered questionnaires. Data were analyzed in SAS using logistic regression to model effects of gender and age on LUTS and quality of life. RESULTS: A total of 304 patients (178 female, 126 male) were enrolled. Mean age was 58±17 years. 540 clinic visits occurred between May 2019 and November 2020. Response rates were 93% (500/540) for AUASI, and 91% (490/540) for ICIQ. A logistic regression model by gender, adjusted for age (Figure 1), demonstrated a greater number of women with urgency using both instruments (AUASI OR 2.27, 95% CI 1.55-3.33; ICIQ OR 2.25, 95% CI 1.42-3.56). Women reported more voiding symptoms than men, including straining (AUASI OR 1.70, 95% CI 1.10-2.62; ICIQ OR 1.79, 95% CI 1.04-3.06). Incontinence was only represented by the ICIQ, where women reported more incontinence than men (ICIQ stress urinary incontinence (UI) OR 6.14, 95% CI 2.55-14.77; ICIQ unaware UI OR 2.18, 95% CI 1.03-4.62; ICIQ sleep UI OR 1.99, 95% CI 1.02-3.90; ICIQ urge UI OR 1.94, 95% CI 1.16-3.26). After adjusting for gender (Figure 2), nocturia was more likely to occur in older patients captured by the ICIQ (ICIQ nocturia OR 1.13, 95% CI 1.01-1.26). Urgency and urge UI occurred more in older subjects in the ICIQ domain for urgency (ICIQ urgency OR 1.16, 95% CI 1.02-1.32; ICIQ urge UI OR 1.23, 95% CI 1.06-1.43). Younger subjects were more likely to report hesitancy (ICIQ OR 0.74, 95% CI 0.65-0.84) and straining (AUASI OR 0.75, 95% CI 0.67-0.84; ICIQ OR 0.82, 95% CI 0.71-0.94). CONCLUSIONS: The AUASI and the ICIQ FLUTS / MLUTS differ based on sex and age in a patient population seeking care for LUTS. The ICIQ questionnaires capture symptom specific bother and incontinence. Further research is needed to better classify gender and age specific impact on LUTS outcomes not captured by the AUASI. Source of Funding: NIH 1L30DK115056-01, Stanford Women's Health and Sex Differences in Medicine (WSDM) Seed Grant © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e16-e17 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Chen Shenhar More articles by this author Petah Tikva Israel More articles by this author Stefanie van Uem More articles by this author Abdelrahman S. Abdalla More articles by this author Ashu Mohammad More articles by this author Bertha H. Chen More articles by this author Elizabeth A. Kidd More articles by this author Amy D. Dobberfuhl More articles by this author Expand All Advertisement Loading ...