Sex And Gender Research Articles

Early exposure to (hetero)sexism in medical settings: young patients’ experiences with gynaecology

Abstract Background Gynaecology is a highly gendered specialty where gender norms are particularly susceptible to shape patient-provider interactions. Consultations about contraceptive practices, reproductive choices, and sexual activity are fertile settings for the potential confrontation of different sets of gender-related expectations, and the expression of gender-based discrimination, i.e. sexism and heterosexism. We therefore investigated young patients’ first experiences with gynaecological care in Germany with a focus on their experiences of (hetero)sexism. Methods We conducted 15 qualitative interviews with a gender-inclusive sample of patients aged 16-25 who narrated their first consultations and experiences of gynaecological care. We analysed the data thematically. Results Cis-gender heterosexual women composed the majority of the sample; a trans man and two persons who reported being at some point in same-sex relationships were also included. The main reasons for a first consultation were painful periods and contraception. Participants narrated examples of gender-based discrimination, with providers making what was perceived as gender-insensitive, demeaning, or plainly homophobic remarks. Those were particularly present in relation to conversations about the contraceptive pill, with either providers refusing to prescribe it on the account that the patient didn’t have sex or “real sex” (i.e. heterosexual intercourse) or with providers pushing for use of the pill “just in case”, even when patients didn’t need nor want it. Additionally, sexist, unrequited arguments about how the pill could enhance a patient’s breast or skin occurred in several conversations. Conclusions Our study shows clear occurrences of (hetero)sexism on the part of gynaecologists, from demeaning comments to more subtle reminders of sexist gender norms. It highlights the need to implement more patient-centred, gender-sensitive gynaecological practise to support the promotion of respectful care. Key messages • Young patients are exposed to various forms of gender-based discrimination in gynaecological care in Germany, highlighting how entrenched traditional, (hetero)sexist gender norms are among providers. • Promoting more gender-sensitive, respectful care could start with a reflection on consultations around the contraceptive pill, as they often crystallise the manifestation of damaging gender norms.

Sex-Related Differences in the Pathophysiology, Cardiac Imaging, and Clinical Outcomes of Aortic Stenosis: A Narrative Review.

Aortic stenosis (AS) is the most common valvular heart disease in developed countries, and its prevalence is higher in older patients. Clinical studies have shown gender disparity in the pathogenesis and the progression of aortic stenosis. This disparity has led to several overwhelming questions regarding its impact on the clinical outcomes and treatment of the disease and the requirement of personalized sex-specific approaches for its management. Indeed, aortic stenosis differs in the pathophysiological response to pressure overload created by the stenosis in women compared to men, which would translate into differences in cardiac remodeling and clinical outcomes. Several studies have focused on understanding the differences regarding disease progression according to biological gender and have found that sex hormones play a crucial role. Sex hormones affect many metabolic processes, thus activating crucial cell signaling and energy metabolism through mitochondrial activity. Yet, there is still a significant gap in knowledge on how biological sex influences the pathophysiology of AS. In this review, we have discussed studies that point to the role of sex-related physiological differences in the molecular pathways and the clinical presentation of the disease and outcome in women and men. We used the format of narrative review to review and summarize the body of literature without being systematic but with taking great care of considering the most impactful data available to date on the topic, especially randomized trials, metanalyses, and prospective studies and registries when available, as well as experimental studies with rigorous methodological approaches regarding the basic mechanisms and pathophysiology of the disease in women compared to men. The opinion of the authors on a particular issue or finding was expressed when appropriate for clarification.

Exploring the Impact of Sex and Gender in Brain Function: Implications and Considerations.

Sex and gender are crucial variables in understanding brain development and disease. Biological sex is determined by genetic and hormonal factors, whereas gender is a multidimensional construct shaped by social and cultural influences. The interplay of these factors contributes to sex-specific susceptibilities and disease progression in psychiatric and neurological disorders. However, sex and gender are often considered as a single variable, which can lead to biased data analysis and interpretation. This commentary aims to analyze how sex and gender influence brain structure and function, with implications for personalized medicine, research, and the development of gender-sensitive clinical guidelines. Findings from various studies employing neuroimaging techniques and animal models are discussed, as well as the impact of biological sex, gender, environmental, cultural, and social factors on brain development, organization, and behavior. Evidence suggests that sex differences in brain structure and function are not only genetically determined but arealso influenced by gender-related experiences and societal contexts. Importantly, discrepancies between male and female brains are reduced in gender-equal societies. Preclinical studies play a pivotal role in determining the influence of biological sex, independent of gender, in different disease models. The findings underscore the need to consider both sex and gender in research and clinical practice to avoid biases and promote equitable health outcomes. Moving forward, we advocate for gender-sensitive approaches to be integrated into brain research and in clinical guidelines to achieve personalized and precision medicine.

A retrospective study of sexual minority women’s gendered sexuality: Butch and femme sex at the turn of the 21st century

This study is a retrospective examination of how sexual minority women have experienced their sexuality. The analysis examined a national archival dataset that was collected online in the US and Canada to examine the relationship between gender and sexuality in 1084 sexual minority women in 2003, with a focus on butch and femme identities. It provided an understanding of how gender and sexuality interacted at the turn of the last century when the gender identity landscape differed from that of today. While this study collected data from butch and femme women approximately 20-years ago, the results have implications for how we develop situated understandings of the relationship between gender and sexuality. Findings indicated gendered patterns in sexual preferences and attraction that can shed light on how gender and sexuality have evolved in connection. At the same time, there were no differences in sexual satisfaction, which suggests that the enactment of gendered sexuality (in which attraction is structured by a gender dynamic) was experienced as empowering rather than oppressive. We examine our findings in relation to current scholarship on gendered sexuality to consider how sexuality is constructed and reconstructed across time. The findings support a view of gendered sexuality as a source of pleasure, affirmation, and positive embodiment. We theorize gendered sexuality as functioning to enhance experiences of authenticity and resist heteronormativity. The study holds implications for research on the interaction of gender and sexuality.

Anti-Trans Attacks: Interrogating “Gender” in Politics and Gender Scholarship

This essay considers the rapid uptick in anti-trans legislation that targets transgender girls and women as an occasion to critically interrogate the ways that gender is conceptualized and operationalized in political science (Murib 2022). I argue that the disciplinary tendency to view gender as a single-axis facet of identity that is static and rooted in biology needs to be reconsidered in light of two problems. First, collapsing biological sex and gender naturalizes the gender of non-trans women and men as static, normal, and self-evident; transgender people, in contrast, are locked into perpetual processes of gendering themselves against this biological baseline (Enke 2012). Second, and as a result of this limited view of gender, political scientists face difficulties anticipating, understanding, and addressing recent mobilizations invested in maintaining White, heterosexual, and reproductive families as the cornerstone of what it means to be a proper citizen (Alexander 1994).

Abstract A126: Cancer screening trends in Louisiana’s sexual gender minority population

Abstract Cancer screenings in Louisiana (LA) have been consistently lower than the national average. Sexual and gender minorities (SGM) are more likely to be non-compliant with cancer screening guidelines and consistently do not meet cancer screening recommendations. This study compares compliance to cervical, breast, and colorectal cancer (CRC) screening guidelines over time between SGM and the non-SGM population in LA. Data were obtained from the LA 2014, 2016, 2018, 2020, and 2022 Behavioral Risk Factor Surveillance System (BRFSS). The sample was divided into gay (including lesbian, gay, bisexual, or other sexual orientation other than straight) and straight. Three primary outcomes of interest were used to measure breast, cervical, and CRC cancer screening adherence based on the U.S. Preventive Services Task Force (USPSTF) screening recommendation at the time of each survey. Descriptive analysis and chi-square tests were conducted using sample weights. CRC had the lowest compliance rate in the entire population and across sexual orientation groups. Twenty-five percent of both populations had never received any CRC screening test. Comparatively, 3.6% of straight and 5.3% of gay populations had never received a mammogram while 6.6% of straight and 13.6% of the population had never received a pap smear. Significant improvements in compliance to breast, cervical, and CRC cancer screenings guidelines was observed among those who identified as straight over the survey years until 2020. Decreases in screening compliance were observed in this population from 2020 to 2022, likely due to the effects of the COVID pandemic. Screening compliance in those who identified as gay showed more variation over time in all three cancers. Screening compliance for CRC and cervical cancer were at its highest in 2016, declined to its lowest point in 2020, but increased in 2022. In 2016, there was a significant decline in breast cancer screening compliance in this population to the lowest ever observed in both groups. The initial increases in colorectal and cervical cancer screening observed from 2014 to 2016 among the gay population may be attributed to significant decreases in uninsured rates following the passage of the Affordable Care Act. Additionally, this population saw increased access to the private insurance market following the Obergefell decision and the Marriage Equality Act of 2015, which extended employer-sponsored coverage to same-sex couples. While breast cancer screenings declined from 2014-2016 in the gay population, there was a sharp increase from 2016 to 2018, which aligns with the 2016 expansion of Medicaid in Louisiana. Despite increases in access to insurance coverage, SGM individuals report being in fair or poor health and having negative experiences with healthcare providers at higher rates than their non-SGM counterparts. More research is needed to understand the healthcare landscape and experiences of SGM Louisianans. This will help to inform targeted interventions to increase screenings and improve cancer outcomes among this population. Citation Format: Bilikisu Elewonibi, Carleigh Baudoin, Ashely Fenton. Cancer screening trends in Louisiana’s sexual gender minority population [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A126.

A Retrospective Study of Sexual Minority Women’s Gendered Sexuality: Butch and Femme Sex at the Turn of the 21st Century

This study is a retrospective examination of how sexual minority women have experienced their sexuality. The analysis examined a national archival dataset that was collected online in the US and Canada to examine the relationship between gender and sexuality in 1084 sexual minority women in 2003, with a focus on butch and femme identities. It provided an understanding of how gender and sexuality interacted at the turn of the last century when the gender identity landscape differed from that of today. While this study collected data from butch and femme women approximately 20-years ago, the results have implications for how we develop situated understandings of the relationship between gender and sexuality. Findings indicated gendered patterns in sexual preferences and attraction that can shed light on how gender and sexuality have evolved in connection. At the same time, there were no differences in sexual satisfaction, which suggests that the enactment of gendered sexuality (in which attraction is structured by a gender dynamic) was experienced as empowering rather than oppressive. We examine our findings in relation to current scholarship on gendered sexuality to consider how sexuality is constructed and reconstructed across time. The findings support a view of gendered sexuality as a source of pleasure, affirmation, and positive embodiment. We theorize gendered sexuality as functioning to enhance experiences of authenticity and resist heteronormativity. The study holds implications for research on the interaction of gender and sexuality.

Recommendations for the Application of Sex and Gender Medicine in Preclinical, Epidemiological and Clinical Research.

Gender medicine studies how health status and diseases differ between men and women in terms of prevention, therapeutic approach, prognosis, and psychological and social impact. Sex and gender analyses have been demonstrated to improve science, contributing to achieving real appropriateness and equity in the cure for each person. Therefore, it is fundamental to consider, both in preclinical and clinical research, the different clinical and biological features associated with sex and/or gender, where sex differences are mainly influenced by biological determinants and gender ones by socio-cultural and economic matters. This article was developed to provide knowledge and methodological tools for the development of studies/research protocols in which sex and gender should be taken into account.

Medical student clinical cultural awareness in cancer care of sexual gender minority patients

ObjectiveHealth disparities in lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+), or sexual and gender minority (SGM) people are known. SGM people have higher cancer risk, but lower rates of screenings, resulting in a higher likelihood of late-stage disease. This study evaluates medical students’ clinical cultural awareness in cancer care of SGM patients to identify gaps in education. MethodsThis was a cross-sectional survey distributed to medical students at a academic center. There were 38 questions on demographics, attitudes, and knowledge of SGM topics. Descriptive statistics were used for demographic information and stratified analyses assessed responses by demographic subgroups. ResultsThere were 238 responses from 1145 students (response rate = 20.7 %). Of the responders, 91.2 % and 79 % were comfortable treating lesbian, gay, bisexual (LGB) and transgender patients respectively. Only 28.6 % and 21.8 % were confident treating LGB and transgender patients respectively after taking the survey. 91.2 % of students were interested receiving education regarding SGM health needs. ConclusionWhile most medical students are comfortable treating LGBTQ+ patients, most are not confident in their knowledge. This difference is most profound in knowledge of transgender patients. Practice implicationsSchools must provide more education in SGM topics to improve student knowledge to produce competent providers.

Differences between males and females in infectious diseases notifications in the EU/EEA, 2012 to 2021.

BackgroundThere are differences between males and females for most diseases both for exposure and course of illness, including outcome. These differences can be related to biological sex or gender i.e. socio-cultural factors that may impact exposure and healthcare access.AimWe aimed to quantify differences between males and females in infectious disease notifications in Europe and identify countries with these differences significantly different from the European Union and European Economic Area (EU/EEA) average.MethodsNotifiable infectious disease surveillance data are reported by EU/EEA countries to ECDC. We retrieved surveillance data for 2012-2021. Using a cut-off median of annual disability-adjusted life years above 1 per 100,000 population, we included 16 infectious diseases. We calculated median male proportion and interquartile range by disease, year, country and age group and used boxplots to identify outliers.ResultsFor campylobacteriosis, acute hepatitis B, Legionnaires' disease, malaria and HIV and AIDS, all countries had male proportion above 50%. Most countries had a male proportion below 50% for pertussis (25/28 countries), STEC infection (21/28 countries) and Chlamydia trachomatis infection (16/24 countries). Chlamydia trachomatis infection and listeriosis showed the greatest dispersion of male proportion across age groups. Most outliers were countries reporting few cases.ConclusionWe observed important differences in male proportion across infectious disease notifications in EU/EEA countries. For some diseases with high male proportions in all countries, such as HIV and hepatitis B, behaviours play a role in disease transmission. Screening offered to specific populations may explain differences across countries for example for C. trachomatis infection.

The Association of Stigma, School, and Family Factors with Patterns of Substance Use Among LGBTQ Youth.

Polysubstance use is associated with myriad short- and long-term health outcomes. Although prior research has documented differences in polysubstance use between lesbian, gay, bisexual, transgender, queer/questioning, and other sexual and gender minoritized (LGBTQ +) youth and their heterosexual/cisgender counterparts, as well as between subgroups of LGBTQ + youth, it is unknown how personal, family, and school factors are associated with substance use patterns among LGBTQ + youth. Using a large, national sample of 9646 LGBTQ + youth ages 13-17, we used latent class analysis to examine patterns of alcohol, tobacco, and marijuana use and to determine whether personal, family, and school factors predict class membership. We identified five classes of substance use: polysubstance use, polysubstance experimentation, dual alcohol and cannabis, alcohol, and no use. Greater depression and LGBTQ + victimization, and an ability to be oneself at school, were associated with greater odds of membership in the polysubstance use class, while higher levels of family connection and having a Gender Sexuality Alliance (GSA) at school were associated with lower odds of membership in the polysubstance use class. Our analysis also revealed sociodemographic differences in class membership. These findings highlight potential mechanisms for intervention to reduce polysubstance use among LGBTQ + youth.

Correction of Paulina Banaszkiewicz (2022). Biological sex and psychological gender differences in the experience and expression of romantic jealousy

Correction of Paulina Banaszkiewicz (2022). Biological sex and psychological gender differences in the experience and expression of romantic jealousy

Age, Race, Sex and Cardiorespiratory Fitness: Implications for Prevention and Management of Cardiometabolic Disease in Individuals with Diabetes Mellitus.

Physical inactivity and poor cardiorespiratory fitness (CRF) are strongly associated with type 2 diabetes (DM2) and all-cause and cardiovascular morbidity and mortality. Incorporating physical activity promotion in the management of DM2 has been a pivotal approach modulating the underlying pathophysiology of DM2 of increased insulin resistance, endothelial dysfunction, and abnormal mitochondrial function. Although CRF is considered a modifiable risk factor, certain immutable aspects such as age, race, and gender impact CRF status and is the focus of this review. Results show that diabetes has often been considered a disease of premature aging manifested by early onset of macro and microvascular deterioration with underlying negative impact on CRF and influencing next generation. Certain races such as Native Americans and African Americans show reduced baseline CRF and decreased gain in CRF in randomized trials. Moreover, multiple biological gender differences translate to lower baseline CRF and muted responsivity to exercise in women with increased morbidity and mortality. Although factors such as age, race, and sex may not have major impacts on CRF their influence should be considered with the aim of optimizing precision medicine.

Understanding moderators of consent regarding the sharing of supermarket shopping data in ALSPAC.

Introduction & BackgroundShopping data is a valuable resource, offering insights into consumer behaviour and health. In recent years, there has been a growing interest in using shopping data for the purposes of health research. However, little is known about the characteristics of those who are willing to share their shopping data with researchers. Objectives & ApproachThis study aims to investigate the factors that influence individuals' decisions to consent to sharing their shopping data for research purposes. We will leverage data from a cohort study – the Avon Longitudinal Study of Parents and Children (ALSPAC) – to address this question. We will draw upon the responses of a 2018 survey, which asked ALSPAC participants about their use of supermarket loyalty cards, their perceived acceptability of sharing this data with ALSPAC, and their perspectives on potential privacy concerns. Of the 4,462 respondents, 65.4% indicated ownership of at least one major UK supermarket or store loyalty card. Among these, 88.4% expressed a potential willingness to share this data with ALSPAC for research purposes. In the present day – around 2023 – participants have explicitly either granted or withheld consent for the sharing of this data. Our analysis approach will consider factors such as biological gender, ethnicity, education, employment, socioeconomic status, and anxiety as potential moderators to the consent process. We plan to employ a mix of standard statistical methods to analyse sampling biases in the dataset, including regression modelling and correlation tests. Relevance to Digital FootprintsOur study will contribute to the growing body of literature on data linkage between cohort studies and digital footprints datasets. ResultsThe findings from this study will offer valuable insights into the factors influencing participants' consent decisions regarding data sharing. We will contribute to ongoing discussions about privacy and the ethical use of digital footprints data, informing the development of more inclusive consent processes in this field. Conclusions & ImplicationsThis study will inform consent practices in the realm of digital footprints, identifying and addressing potential barriers to consent, and contributing to the ongoing discourse on the responsible and ethical use of shopping data.

Come for the Tobacco, Stay for the Flavor: Flavored Cigarillo-Use Trajectories Among Young Adult Sexual Gender Minority Women.

The purpose of this research was to identify how young adult sexual gender minority (SGM) women who use cigarillos may respond to cigar flavor restrictions. Young adults aged 21-28 years in the United States who currently use cigarillos were recruited between October 2020 and April 2021 to participate in an online survey. Due to high prevalence of cigarillo use among individuals who identify as sexual and/or gender minority (SGM) women, their (n = 192) flavored tobacco-use behaviors and anticipated responses to cigarillo flavor restrictions were compared to cisgender heterosexual (CisHet) women (n = 110). Logistic regression was used to model cigarillo cessation and product-switching behaviors (flavored and unflavored). SGM women were significantly less likely to report the use of flavor at the initiation of cigarillo use (61.7% vs. 86.1%) but were no different in current flavor use compared to CisHet women, with more than 80% of all women using any flavor. SGM women were 2.36 times as likely to say they would discontinue using cigarillos if flavors were unavailable. Among those who would continue using cigarillos, SGM women were 4.53 times as likely to endorse switching to an unflavored tobacco product but had the same likelihood of saying they would switch to flavored product compared to CisHet women. Flavor restriction policies may not reduce the initiation of cigarillos among SGM women and may elicit differential cigarillo use and tobacco product substitution by SGM identity. Flavor restriction policies should be coupled with targeted cessation resources to address potential remaining disparities. SGM US women have a unique cigarillo-use trajectory. These women are more likely to initiate cigarillos without flavor and then later integrate it into their behavior. National cigar flavor restrictions are expected to have a greater impact decreasing cigarillo initiation among CisHet women and decreasing current cigarillo use among SGM women. However, for those who would continue using unflavored cigarillos, SGM women may remain at risk for nicotine dependence due to increased product substitution. SGM women should be prioritized for cessation resources to reduce tobacco-use disparities leading up to and following the implementation of cigar flavor restrictions.

Complicating critical discussions in gender sexuality alliances: Youth desire for intersectional conversations and the experience of fragmentation.

Gender sexuality alliances (GSAs) represent consciousness-raisings that hold potential for critical consciousness development in youth. In this study, we focus on critical reflection-the understanding that oppression is structured and maintained by human action. We engage intersectionality as our analytical framework and analyze both student interview data (n = 38) and advisor closed-ended and open-ended survey data (n = 58) to examine: (1) the nature/content of critically reflective discussions in GSAs and (2) how advisors support critically reflective discussions in GSAs and their role in these discussions. Our findings suggest that (1) conversations centering race and its intersections with other socio-structural axes occur, albeit infrequently; (2) youth recognize and understand the concept of intersectionality in nuanced ways, desire to have critical intersectional conversations, and experience fragmentation from conversations around race, sexuality, and gender if they are situated at privileged locations on those axes; and (3) students want advisors to engage in critically reflective discussions in GSAs. The findings suggest that interventions and programming are needed that could cultivate advisors' and youth leaders' skills in facilitating intersectional dialogues for critical reflection among members.

OUTCOMES OF OUT HOSPITAL CARDIAC ARREST: SEX DISPARITIES IN OUR REGION

Abstract Background The incidence of out of hospital cardiac arrest (OHCA) differs consistently between women and men.Besides sex related factors, OHCA risk may relate to gender related factors.Although previous studies regarding sex difference outcomes after OHCA yielded conflicting results, from some researches it seems that women have less shockable initial rhythm than men and they have worse survival. Methods We considered 5524 consecutively OHCA survivors resuscitated from emergency medical System (EMS) or bystander In two city of Emilia Romagna: Piacenza (3452 ) and Bologna (2072) from January 2009 to December 2019 and we evaluated the outcomes, considering sex and gender disparities. Results Out of 5524 patients, who experienced OHCA, 3340 (60%) were males with average age 70,6 ±14 years and 2184 (40%) females with average age of 78,9 ±13 years (p<0,001).Overall survival rate was 8% .In our population we observed as initial rhythm of cardiac arrest : 3057 (57%) asystole, 1070 (22%) ventricular fibrillation (VF) and 998 (21%) pulseless electrical activity (PEA) with sex disparities.In fact we have found : 1695 asystole (51%), 840 FV (25%), 583 pea (17%) in men and 1362 asistolia (62%), 230 fv (11%), 415 pea (19%)in women. Asystole was more frequently in females (62 f vs 51m %, p<0.001), whilst VF in males (25 vs 11%, p<0.001).Furthermore considering sex disparities, survival was better in males 299 (9%) than in females 115 (5%), p<0.001. Conclusions In our population OHCA was more frequent in males in line with previous published data. However, females affected by OHCA are older, tend to present more frequently with non–shockable rhythms and show worse outcome. It’s unknown if these data are related to sex biological differences or gender disparities . Further data will be necessary to explain this challenge.

Discussing the Indispensable Gender Perspective in Medical Research Through the Lenses of Biological Sex, Gender, and Intersectionality

<p>由性別醫學所帶動、在醫學研究中增加性別分析的趨勢，在國際上與臺灣都受到極大的重視。使用性別分析來進行研究，即是在研究的每一個階段中，以生理性別(sex)、社會性別(gender)和交織性(intersectionality)分析來進行檢視研究設計中的性別盲點，亦即以「性別化創新」的概念來進行醫學研究。運用性別分析可以幫助我們檢討過去被視為理所當然的「預設值」。從性別的視角出發，讓我們可以看見更多其他的受壓迫主體和身體經驗，修正過去以預設值為醫學研究的基礎，增進各個性別主體的福祉。</p> <p> </p><p>The trend of incorporating gender analysis in medical research, driven by gender medicine, has garnered considerable attention both internationally and in Taiwan. Conducting research with gender analysis involves examining each phase of the research through the lenses of biological sex, gender, and intersectionality, to identify blind spots in research designs. This approach, referred to as gendered innovation, utilizes gender analysis to reassess what have traditionally been considered default assumptions. Adopting a gender perspective, we can acknowledge more of the oppressed individuals and bodily experiences, rectify past assumptions used as the foundation for medical research, and enhance the well-being of individuals across all genders.</p> <p> </p>

Survival analysis after stereotactic ablative radiotherapy for early stage non-small cell lung cancer: a single-institution cohort study

BackgroundStereotactic ablative radiotherapy (SABR) is the standard treatment for medically inoperable early-stage non-small cell lung cancer (ES-NSCLC), but which patients benefit from stereotactic radiotherapy is unclear. The aim of this study was to analyze prognostic factors for early mortality.MethodsFrom August 2010 to 2022, 617 patients with medically inoperable, peripheral or central ES-NSCLC were treated with SABR at our institution. We retrospectively evaluated the data from 172 consecutive patients treated from 2018 to 2020 to analyze the prognostic factors associated with overall survival (OS). The biological effective dose was > 100 Gy10 in all patients, and 60 Gy was applied in 3–5 fractions for a gross tumor volume (GTV) + 3 mm margin when the tumor diameter was < 1 cm; 30–33 Gy was delivered in one fraction. Real-time tumor tracking or an internal target volume approach was applied in 96% and 4% of cases, respectively. In uni- and multivariate analysis, a Cox model was used for the following variables: ventilation parameter FEV1, histology, age, T stage, central vs. peripheral site, gender, pretreatment PET, biologically effective dose (BED), and age-adjusted Charlson comorbidity index (AACCI).ResultsThe median OS was 35.3 months. In univariate analysis, no correlation was found between OS and ventilation parameters, histology, PET, or centrality. Tumor diameter, biological effective dose, gender, and AACCI met the criteria for inclusion in the multivariate analysis. The multivariate model showed that males (HR 1.51, 95% CI 1.01–2.28; p = 0.05) and AACCI > 5 (HR 1.56, 95% CI 1.06–2.31; p = 0.026) were significant negative prognostic factors of OS. However, the analysis of OS showed that the significant effect of AACCI > 5 was achieved only after 3 years (3-year OS 37% vs. 56%, p = 0.021), whereas the OS in one year was similar (1-year OS 83% vs. 86%, p = 0.58).ConclusionSABR of ES-NSCLC with precise image guidance is feasible for all medically inoperable patients with reasonable performance status. Early deaths were rare in our real-life cohort, and OS is clearly higher than would have been expected after best supportive care.

Inhabiting Adamancy: Contributions Toward a Queer Feminist Theology

This article seeks to demonstrate that the myth of creation, written in Genesis, originates in the history of the different technologies of power. Judaism, in the myth of origin, established a hermeneutic with ontological status on the creation of man. This has severely affected the theological work of sex–gender diversity groups, including feminist and queer theology. Since the myth of origin has been one of the foundational narratives of the history of Christianity, it is the theological matrix where the binary oppositions are constructed: man-woman in which a cis-heteropatriarchal theology of the texts is articulated.