Sex-specific Conditions Research Articles

Navigating electronic health record accuracy by examination of sex incongruent conditions

Abstract Objective The increasing reliance on electronic health records (EHRs) for research and clinical care necessitates robust methods for assessing data quality and identifying inconsistencies. To address this need, we develop and apply the incongruence rate (IR) using sex-specific medical conditions. We also characterized participants with incongruent records to better understand the scope and nature of data discrepancies. Materials and Methods In this cross-sectional study, we used the All of Us Research Program’s latest version 7 (v7) EHR data to identify prevalent sex-specific conditions and evaluated the occurrence of incongruent cases, quantified as IR. Results Among the 92 597 males and 152 551 females with condition occurrence data available from All of Us and sex-conformed gender, we identified 167 prevalent sex-specific conditions. Among the 37 537 biological males and 95 499 biological females with these sex-specific conditions, we detected an overall IR of 0.86%. Attempt to include non-cisgender participants result in inflated overall IR. Additionally, a significant proportion of participants with incongruent conditions also presented with conditions congruent to their biological sex, indicating a mix of accurate and erroneous records. These incongruences were not geographically or temporally isolated, suggesting systematic issues in EHR data integrity. Discussion Our findings call attention to the existence of systemic data incongruences in sex-specific conditions and the need for robust validation checks. Extending IR evaluation to non-cisgender participants or non-sex-based conditions remain a challenge. Conclusion The sex condition-specific IR, when applied to adult populations, provides a valuable metric for data quality assessment in EHRs.

Gender Matters: A Multidimensional Approach to Optimizing Cardiovascular Health in Women.

Cardiovascular diseases remaina leading cause of mortality among women, yet they are often underestimated and insufficiently addressed. This narrative review delves into the gender disparities in cardiovascular health, underscoring the critical importance of recognizing and addressing the unique challenges women face. The article explores the pathophysiological differences between men and women, highlighting the role of hormonal factors, such as estrogen and menopause, in conferring cardioprotection or increasing risk. It examines the complexities of diagnosis and assessment, including differences in symptom presentation, diagnostic accuracy, and the challenges of interpreting non-invasive testing in women. The review also highlights the need for tailored risk assessment and prevention strategies, incorporating sex-specific conditions and pregnancy-related factors. It emphasizes the importance of lifestyle modifications and interventions, as well as the potential benefits of personalized treatment approaches, considering gender-specific variations in medication responses and cardiac interventions. Furthermore, the article sheds light on the impact of psychosocial and sociocultural factors, such as gender norms, mental health considerations, and access to healthcare, on women's cardiovascular health. It also addresses the significant gaps and challenges in research, including the historical underrepresentation of women in clinical trials and the lack of sex- and gender-sensitive studies. Finally, the review advocates for a multidisciplinary approach, involving patient-centered care, shared decision-making, and collaboration among policymakers, stakeholders, and healthcare systems. This comprehensive strategy aims to enhance awareness, prevention, diagnosis, and treatment of cardiovascular disease in women, ultimately improving health outcomes and reducing the burden of this often overlooked epidemic.

Differences in presentation, diagnosis and management of heart failure in women. A scientific statement of the Heart Failure Association of the ESC.

Despite the progress in the care of individuals with heart failure (HF), important sex disparities in knowledge and management remain, covering all the aspects of the syndrome, from aetiology and pathophysiology to treatment. Important distinctions in phenotypic presentation are widely known, but the mechanisms behind these differences are only partially defined. The impact of sex-specific conditions in the predisposition to HF has gained progressive interest in the HF community. Under-recruitment of women in large randomized clinical trials has continued in the more recent studies despite epidemiological data no longer reporting any substantial difference in the lifetime risk and prognosis between sexes. Target dose of medications and criteria for device eligibility are derived from studies with a large predominance of men, whereas specific information in women is lacking. The present scientific statement encompasses the whole scenario of available evidence on sex-disparities in HF and aims to define the most challenging and urgent residual gaps in the evidence for the scientific and clinical HF communities.

Strategies for enhancing the representation of women in clinical trials: an evidence map

BackgroundEquitable sex- and gender-based representation in clinical trials is an essential step to ensuring evidence-based care for women. While multi-institutional actions have led to significant improvements in the inclusion of women in trials, inequity persists in areas like sex-neutral cancers and cardiovascular disease. We sought to identify strategies described or evaluated to boost the inclusion of women in clinical trials.MethodsWe used evidence mapping methodology to examine the breadth of relevant literature. We developed an a priori protocol and followed reporting guidance from the Preferred Reporting Items for Systematic Reviews and Meta-Analysis where applicable. We searched MEDLINE® (via PubMed) and EMBASE (via Elsevier) databases from inception through April 4, 2023, and used standardized procedures incorporating duplication and data verification. We included articles that described strategies to improve the recruitment and retention of women in clinical trials.ResultsWe identified 122 articles describing recruitment and retention strategies for 136 trials (377,595 women). Only one article distinguished between the sex and gender identity of participants, and none defined their use of the terms such as “women” or “female”. The majority of articles (95%) described recruitment for only women, and 64% were conducted in the USA. Ninety-two articles (75%) described strategies in the context of sex-specific conditions (e.g., gynecologic diagnosis). The majority of included articles evaluated a behavioral intervention (52%), with 23% evaluating pharmacologic interventions and 4% invasive interventions. The most common trial phase for reported strategies was during outreach to potential participants (116 articles), followed by intervention delivery (76), enrollment (40), outcomes assessment (21), analysis and interpretation (3), and dissemination (4). We describe specific types of strategies within each of these phases.ConclusionsMost of the existing literature describing strategies to improve the inclusion of women draws from trials for sex-specific conditions and is largely related to outreach to potential participants. There is little information about how and if studies have attempted to proportionally increase the inclusion of women in trials with both men and women or those focused on invasive and pharmacologic interventions. Future work in this area should focus on how to increase the participation of women in mixed-sex studies and on those areas with remaining inequities in trial participation.

Abstract 13595: Sex-Specific Burden of Peripheral Arterial Disease Across the United States: Analysis of the Global Burden of Disease 1990-2019

Background: Peripheral arterial disease is a ubiquitous disease that varies in terms of morbidity and mortality due to biologic sex, including the impact of traditional and non-traditional risk factors and sex-specific conditions that adds complexity and contributes to the existing disparities. Thus, understanding the sex-specific trends of PAD in the United States population is critical for developing targeted interventions. We sought to analyze the burden of PAD in male and female patients across the US from 1990 to 2019. Methods: Using the Global Burden of Disease (GBD) study data from 2019, we performed an analysis of the burden of PAD from 1990-2019, across US states. The GBD defined PAD based on studies that used symptom-based criteria and expressed the burden of PAD as the age-standardized prevalence and disability adjusted life years (DALYs) rates. We additionally estimated the regional relative change in DALYs. Results: In 2019, there were 5.4 million males and 7.1 million females with PAD in the US. Absolute PAD prevalence and DALYs increased in both sexes between 1990 and 2019, figure. The 2019 age-standardized prevalence of PAD (per 100,000) in the US in 2019 was 2,124 (95% Uncertainty Interval (UI): 1905-2354), and 2,302 (95% UI: 2,079-2,522) for females. Between 1990 and 2019, females had higher increase in age-standardized PAD DALYs compared with males (13.8% vs 5.5%). Significant state-level geographic variance was noted in age-standardized prevalence of PAD in both sexes (2-fold difference between lowest and highest state), figure. Conclusion: The burden of PAD is increasing in the US owing to the aging population. The absolute prevalence of PAD is higher in women compared with men in the US. Over the past 3 decades, there has been a more significant increase age-standardized PAD DALYs in women as compared with men. Future studies are needed to investigate and target these disparities.

Effect of Sex and Sex Hormones on SARS-COV-2: A Review Article

When men are exposed to the coronavirus infection (SARS-CoV-2), compared with women, they will suffer from more severe consequences of this disease, leading to a higher death rate. These differences are probably due to sex-specific behaviors, genetic and hormonal factors, and sex differences in biological pathways associated with SARS-CoV-2 infection. Several socio-behavioral factors are involved in pathogenesis in men compared to women. However, sexual-biological differences and their effects on SARS-COV-2 outcomes have received less scholarly attention. Sexual-biological differences between healthy populations and age- and sex-specific conditions such as pregnancy and menopause also play a role. More extensive studies on gender-specific differences and robust analyses are needed to determine how gender can alter the cellular and molecular pathways associated with SARS-CoV-2. This will improve biomarker interpretation and clinical management of SARS-COV-2 patients by facilitating a personalized medicine approach to risk stratification, prevention, and treatment. The present review summarizes the available literature on the proposed molecular and cellular markers associated with SARS-COV-2 infection, their association with health outcomes, and any gender-specific variation reported.

Women, lipids, and atherosclerotic cardiovascular disease: a call to action from the European Atherosclerosis Society.

Cardiovascular disease is the leading cause of death in women and men globally, with most due to atherosclerotic cardiovascular disease (ASCVD). Despite progress during the last 30 years, ASCVD mortality is now increasing, with the fastest relative increase in middle-aged women. Missed or delayed diagnosis and undertreatment do not fully explain this burden of disease. Sex-specific factors, such as hypertensive disorders of pregnancy, premature menopause (especially primary ovarian insufficiency), and polycystic ovary syndrome are also relevant, with good evidence that these are associated with greater cardiovascular risk. This position statement from the European Atherosclerosis Society focuses on these factors, as well as sex-specific effects on lipids, including lipoprotein(a), over the life course in women which impact ASCVD risk. Women are also disproportionately impacted (in relative terms) by diabetes, chronic kidney disease, and auto-immune inflammatory disease. All these effects are compounded by sociocultural components related to gender. This panel stresses the need to identify and treat modifiable cardiovascular risk factors earlier in women, especially for those at risk due to sex-specific conditions, to reduce the unacceptably high burden of ASCVD in women.

Physical medicine & rehabilitation residents' perspectives on women's musculoskeletal health.

Women are either disproportionately or uniquely affected by certain musculoskeletal conditions but have limited access to providers of sex-specific musculoskeletal care. Few physical medicine & rehabilitation (PM&R) residencies offer women's musculoskeletal health training, and it is unknown whether PM&R residents feel prepared to care for women's musculoskeletal health concerns. To examine PM&R residents' perspectives and experiences in women's musculoskeletal health. Cross-sectional survey developed through clinical expertise and consistent with sports medicine guidelines. Electronic survey sent to all accredited PM&R residency programs within the United States, distributed through program coordinators and resident representatives. PM&R residents. Not applicable. The primary outcome was residents' perspective of comfort with women's musculoskeletal health. Secondary outcomes were exposure to formal education on women's musculoskeletal health topics, exposure to various learning formats for these topics; and residents' perspectives on desire for further education, access to field-specific mentors, and interest in incorporating women's musculoskeletal health into future practice. Two hundred eighty-eight responses were included for analysis (20% response rate, 55% female sex residents). Only 19% of residents self-reported feeling comfortable providing care for women's musculoskeletal health conditions. Comfort did not significantly differ by postgraduate year, program region, or sex. However, with regression modeling, the number of topics learned formally in their curriculum had an increased odds of residents self-reporting comfort (odds ratio [OR] 1.18, confidence interval [CI] 1.08-1.30, adjusted p value .01). The majority of residents viewed learning women's musculoskeletal health as important (94%) and requested more exposure to the field (89%). Many PM&R residents do not feel comfortable in caring for women's musculoskeletal health conditions despite their interest in the field. To improve health care access for patients seeking care for these sex-predominant or sex-specific conditions, residency programs may want to consider increasing exposure to women's musculoskeletal health for residents.

MP21-10 SEX BIAS IN CONTEMPORARY CLINICAL DRUG TRIALS IN UROLOGY

You have accessJournal of UrologyCME1 Apr 2023MP21-10 SEX BIAS IN CONTEMPORARY CLINICAL DRUG TRIALS IN UROLOGY Andres Guillen Lozoya, Candace Granberg, Vidit Sharma, Patricio Gargollo, and Kevin Koo Andres Guillen LozoyaAndres Guillen Lozoya More articles by this author , Candace GranbergCandace Granberg More articles by this author , Vidit SharmaVidit Sharma More articles by this author , Patricio GargolloPatricio Gargollo More articles by this author , and Kevin KooKevin Koo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003246.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Despite federal policies to foster equal representation of female and male participants, sex bias remains common in clinical trial enrollment, leading to underrepresentation of women among trial participants. The extent of sex bias in clinical trials in urology is not well characterized. This study aimed to evaluate enrollment rates by sex for clinical trials leading to new drug approvals in urology. METHODS: We retrospectively reviewed the US Food and Drug Administration database for new drug approvals for urological indications from 2016 through 2021. Published trials that supported these approvals were analyzed to determine enrollment rates of female participants. The sample was grouped and analyzed by demographic and clinical variables. To assess sex bias, we defined a “sex-matching ratio” as the proportion of female to male trial enrollees, where a ratio of 1.0 would indicate equal numbers of women and men. A ratio ≥0.9 was considered “optimal” based on prior published studies. RESULTS: Of a total of 20 trials supporting novel drugs in urology, 6 were excluded due to sex-specific conditions, leaving a total of 14 trials that enrolled 10,875 female and male participants. The clinical indications in the trials included urinary tract infection (4 trials, 29%), urothelial carcinoma (4 trials, 29%), renal cell carcinoma (1 trial,7%), and overactive bladder (1 trial, 7%). Women accounted for 43% of the total sample and had significantly less enrollment in trials for cancer indications; women were only 26% of enrollees in urothelial and renal cancer trials vs 45% in non-cancer trials (p<0.001). Five trials (36%) enrolled more women than men overall; however, the participants in these majority-women trials (3,215) only comprised 30% of total enrolled sample. In terms of sex bias, 7 of the trials (50%) achieved an optimal sex-matching ratio ≥0.9. Among the other 7 trials with suboptimal sex-matching ratios, 1 trial had a ratio of 0.75, while the remaining 6 trials had ratios <0.5 (range 0.26-0.42), indicating that women accounted for less than half the number of men in these trials. The total enrollees in the 7 trials with suboptimal sex-matching ratios was 6,728; of these, women (1,962) accounted for just 29% of the sample. CONCLUSIONS: Sex bias is common in contemporary clinical trials for new drugs in urology. In half the trials with the strongest sex bias, women accounted for just 29% of the study population. Renewed efforts are urgently needed to ensure inclusive drug trials in urology. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e289 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andres Guillen Lozoya More articles by this author Candace Granberg More articles by this author Vidit Sharma More articles by this author Patricio Gargollo More articles by this author Kevin Koo More articles by this author Expand All Advertisement PDF downloadLoading ...

PAEAN: PAIN IN AGING, EDUCATIONAL ASSESSMENT OF NEED: OPIOID DIAGNOSES AND IMPACTS ON PAIN DIAGNOSIS IN OLDER ADULTS

Abstract Pain is prevalent in older adults of both genders but more so in women. The extent to which this is impacted by opioids is not well established. We sought to evaluate common pain diagnoses among older adults noting whether the pattern of female preponderance holds across all conditions and whether opioids might impact this. Utilizing the 2017 Medicare 5% standard analytical claim sample we examined the rate of pain condition diagnoses in older females and males with or without opioid-related diagnoses. We have previously reported that low back pain and opioid diagnosis coding rates interact in older adults, we here expand this finding. We established a condition definition file for opioid use, not including overdose-related codes. We segmented the older adult Medicare part B claims file into those with and those without opioid diagnoses, separated by CMS-coded gender. Diagnostic rates of the 100 most common pain diagnoses in each of the subpopulations showed low back pain was the most prevalent pain diagnosis regardless of gender or opioid diagnosis status. Chest pain unspecified, neck pain, and abdominal pain unspecified, were also highly prevalent. All pain conditions were diagnosed at higher rates in the opioid subpopulation. Few diagnoses were more common in males, these included sex-specific conditions, diabetic neuropathy, and vascular claudication. Although pain conditions are common in older adults, diagnosis rates are elevated in those with opioid diagnoses. This impacts the educational needs of geriatricians, and other healthcare providers, and may indicate needs for more research in pain and aging.

Improving Data-Driven Methods to Identify and Categorize Transgender Individuals by Gender in Insurance Claims Data.

Purpose: Prior algorithms enabled the identification and gender categorization of transgender people in insurance claims databases in which sex and gender are not simultaneously captured. However, these methods have been unable to categorize the gender of a large proportion of their samples. We improve upon these methods to identify the gender of a larger proportion of transgender people in insurance claims data. Methods: Using 2001-2019 Optum's Clinformatics® Data Mart insurance claims data, we adapted prior algorithms by combining diagnosis, procedure, and pharmacy claims to (1) identify a transgender sample; and (2) stratify the sample by gender category (trans feminine and nonbinary [TFN], trans masculine and nonbinary [TMN], unclassified). We used logistic regression to estimate the burden of 13 chronic health conditions, controlling for gender category, age, race/ethnicity, enrollment length, and census region. Results: We identified 38,598 unique transgender people, comprising 50% [n = 19,252] TMN, 26% (n = 10,040) TFN, and 24% (n = 9306) unclassified individuals. In adjusted models, relative to TMN people, TFN people had significantly higher odds of most chronic health conditions, including HIV, atherosclerotic cardiovascular disorder, myocardial infarction, alcohol use disorder, and drug use disorder. Notably, TMN individuals had significantly higher odds of post-traumatic stress disorder and depression than TFN individuals. Conclusion: By combining complex administrative claims-based algorithms, we identified the largest U.S.-based sample of transgender individuals and inferred the gender of >75% of the sample. Adjusted models extend prior research documenting key health disparities by gender category. These methods may enable researchers to explore rare and sex-specific conditions in hard-to-reach transgender populations.

Determining the Sex Assigned at Birth of Transgender and Nonbinary Populations in Administrative Claims Databases Utilizing Diagnostic and Procedure Codes.

Widespread conflation of sex assigned at birth and gender has hindered the identification of transgender and nonbinary people in large datasets. The study objective was to develop a method of determining the sex assigned at birth of transgender and nonbinary patients utilizing sex-specific diagnostic and procedural codes, for future use in administrative claims databases, with a goal of expanding the available datasets for exploring sex-specific conditions among transgender and nonbinary people. Authors reviewed indexes of International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes, and medical record data from a single institution's gender-affirming clinics. Sex-specific ICD and CPT codes were identified through author review and consultation with subject experts. Patient's sex assigned at birth determined by chart review, as a gold standard, was compared with sex assigned at birth determined by querying their electronic health records for natal sex-specific codes. Sex-specific codes correctly identified 53.5% (n=364) of transgender and nonbinary patients assigned female sex at birth, and 17.3% (n=108) of those assigned male sex at birth. Codes were 95.7% and 98.3% specific for assigned female and male sex at birth, respectively. ICD and CPT codes can be used to specifically determine the sex assigned at birth in databases where this information is not recorded. This methodology has novel potential for use in exploring sex-specific conditions among transgender and nonbinary patients in administrative claims data.

Reference Gene Selection for Normalizing Gene Expression in Ips Sexdentatus (Coleoptera: Curculionidae: Scolytinae) Under Different Experimental Conditions.

Ips sexdentatus (Coleoptera: Curculionidae: Scolytinae) is one of the most destructive and economically important forest pests. A better understanding of molecular mechanisms underlying its adaptation to toxic host compounds may unleash the potential for future management of this pest. Gene expression studies could be considered as one of the key experimental approaches for such purposes. A suitable reference gene selection is fundamental for quantitative gene expression analysis and functional genomics studies in I. sexdentatus. Twelve commonly used reference genes in Coleopterans were screened under different experimental conditions to obtain accurate and reliable normalization of gene expression data. The majority of the 12 reference genes showed a relatively stable expression pattern among developmental stages, tissue-specific, and sex-specific stages; however, some variabilities were observed during varied temperature incubation. Under developmental conditions, the Tubulin beta-1 chain (β-Tubulin) was the most stable reference gene, followed by translation elongation factor (eEF2) and ribosomal protein S3 (RPS3). In sex-specific conditions, RPS3, β-Tubulin, and eEF2 were the most stable reference genes. In contrast, different sets of genes were shown higher stability in terms of expression under tissue-specific conditions, i.e., RPS3 and eEF2 in head tissue, V-ATPase-A and eEF2 in the fat body, V-ATPase-A and eEF2 in the gut. Under varied temperatures, β-Tubulin and V-ATPase-A were most stable, whereas ubiquitin (UbiQ) and V-ATPase-A displayed the highest expression stability after Juvenile Hormone III treatment. The findings were validated further using real-time quantitative reverse transcription PCR (RT-qPCR)-based target gene expression analysis. Nevertheless, the present study delivers a catalog of reference genes under varied experimental conditions for the coleopteran forest pest I. sexdentatus and paves the way for future gene expression and functional genomic studies on this species.

Postoperative complications of Goel-Harms C1-C2 screw-rod fixation technique for C1-C2 instability after C2 nerve sacrifice, a prospective study over two years follow up

BackgroundAtlantoaxial instability is mainly caused by trauma. C2 nerve is usually needed to be sacrificed for adequate exposure of the lateral mass and screw insertion. ObjectivesThis study aimed to investigate the clinical outcome of postoperative complications of C1 and C2 screw-rod fixation using the Goel-Harms technique for C1-C2 instability after sacrificing the C2 nerve root. MethodsAmongst forty patients with C1-C2 pathology, twenty-seven cases were enrolled into the study, then variables, including age, sex, primary pathology, operation duration, postoperative pain, paresthesia, anesthesia, and other specific conditions, were documented. Data analyzed by an expert biostatistician. p-value < 0.05 was considered significant. ResultsRegardless of gender, the most postoperative adverse effect was occipital anesthesia (81.5%). Most of the patients (63%) had both occipital pain and anesthesia one-month post-surgery. At 3- and 6-months post-surgery, occipital pain and anesthesia were seen in 40.7% and 14.8%, respectively. ConclusionThe most common postoperative adverse effect of C2 nerve root scarification after C1-C2 fixation is occipital anesthesia followed by occipital paresthesia and pain, which are reduced in severity over time.

Sex differences in heart failure

The overall lifetime risk of heart failure (HF) is similar between men and women, however, there are marked sex differences in the landscape of this condition that are both important and under-recognized. Men are predisposed to HF with reduced ejection fraction (HFrEF), whereas women predominate in HF with preserved ejection fraction (HFpEF). Sex differences are also notable in the penetrance of genetic cardiomyopathies, risk factors, e.g. breast cancer which may be associated with cancer treatment-induced cardiomyopathy, as well as sex-specific conditions such as peripartum cardiomyopathy (PPCM). This review outlines the key sex differences with respect to clinical characteristics, pathophysiology, and therapeutic responses to HF treatments. Finally, we address important differences in the prognosis of HF. A central hypothesis is that the higher risk of HFrEF in men compared to women may be attributable to their predisposition to macrovascular coronary artery disease and myocardial infarction, whereas coronary microvascular dysfunction/endothelial inflammation has been postulated to play a key role in HFpEF and maybe the common link among HF syndromes that women are predisposed to Takotsubo cardiomyopathy, PPCM, and breast cancer radiotherapy-induced cardiomyopathy. Under-pinning current sex disparities in HF, there is a paucity of women recruited to HF clinical trials (20-25% of cohorts) and thus treatment guidelines are predominantly based on male-derived data. Large gaps in knowledge exist in sex-specific mechanisms, optimal drug doses for women and sex-specific criteria for device therapy.

Impact of Sex Assessment Methodology on Natal Sex-Specific Condition Data: Pap Smears and Transmen [38G

INTRODUCTION: Most surveys use a single question to assess sex. The recommended two-step process asks two questions, sex assigned at birth and current gender identity, which better identifies gender minority populations. We use Pap smear data from the Behavioral Risk Factor Surveillance System (BRFSS) to examine the impact of single question sex assessment on natal sex-specific condition data. METHODS: We analyzed data among people eligible for Pap smears in the 2014-2016 BRFSS (n= 294,171). In 2014-2015 “sex” was determined by interviewers' perception with “clarification if necessary;” in 2016 respondents were asked, “Are you male or female?” “Females” were asked about Paps. Transgender status was determined by asking “Do you consider yourself to be transgender?” We analyzed the “sex” and transgender status of respondents that were and were not asked about Paps using design-adjusted chi-square tests. RESULTS: Half of transmen (48.7%), compared to two-thirds (69.8%) of ciswomen, were asked whether they ever had a Pap (p-value <0.001). Sex was coded “male” for 31.8% (24.9-43.0%) of transmen. Pap data was not collected for any individuals coded as “male”. Among transmen labeled “female” there was no difference in those asked about Paps (71.4%) compared to ciswomen (69.8%, p-value=0.709). Of those who were asked, 17.5% of transmen had never had a pap compared to 6.8% of ciswomen (p-value <0.001). CONCLUSION: Transmen are less likely to be asked about, or to have had, a Pap than ciswomen. With a single sex question, surveys fail to capture natal sex-specific conditions accurately in gender minority populations.

Sex differences in the psychopharmacological treatment of depression

Although a number of studies have observed that females respond better to serotonergic antidepressants than males and that postmenopausal females have a diminished response to antidepressants compared with younger females, there are also studies that conflict with both of these findings, making any generalizations regarding sex differences difficult to make. Sex variance in antidepressant efficacy and pharmacokinetics profiles have been attributed to sex-based physiological differences, behavioral differences, related disorders, and sex-specific conditions, including pregnancy and menopause. This paper will review the history and current research on sex effects of antidepressant treatment.

Sex-Specific Conditions, Gender, and Evaluation Using the AMA Guides

Abstract Concerns about potential sex and gender bias during impairment and disability evaluations have been raised; this article reviews ways in which sex and gender contribute to the unique presentation, manifestations, treatment, and functional outcome of medical conditions and how these differences can be appropriately addressed using the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition. Sex differences are objective and are based on biochemical and biological factors; gender refers to cultural attitudes that are learned and vary by culture, history, and ethnicity. The AMA Guides acknowledges individual variations and advocates a flexible approach: Physicians can choose among sections of the AMA Guides those best suited to account for individual and sex differences. The AMA Guides does not advocate different evaluation of medical conditions based on sex, except for sex-specific disorders (eg, unique male or female reproductive organs). The health care system is striving to eliminate gender and sex bias, and impairment and disability are following by attempting to eliminate bias by offering individualized assessments of how impairment affects the injured organ, use of unique rating methods to fully characterize the impairment, use of rating ranges to account for individual variability and sex, and by ascribing equal values to gender-ascribed activities of daily living.

Sex Differences Research, Precision Medicine, and the Future of Women's Health

The National Institutes of Health's (NIH) commitment to improving health outcomes for women and men through rigorous science has been compromised by the lack of basic science evidence obtained from female animals. To correct this limitation, in June 2015 the NIH announced expectations that “sex,” as a biological variable, be included into research design and analysis in studies of vertebrate animals and humans (NOT-OD-15-102). Scientists must take the responsibility to implement this directive. However, in doing so, there is a risk that attention could be restricted to only studies of direct comparison between female/women and male/men. By contrast, understanding how sex influences health and disease needs to take a programmatic approach that includes the study of sex-specific conditions. A programmatic approach will assure the advancement of knowledge to improve women's health.

Polycystic Ovary Syndrome: An Opportunity to Reduce the Incidence and Burden of Ischemic Heart Disease among Young Women?

Background: Over the past 40 years, the magnitude of improvements in cardiovascular (CV) mortality has been greater for men than for women. Most concerning is the high rate of mortality in young women who experience ischemic heart disease (IHD). Since IHD is largely preventable, it is imperative that researchers identify the age- and sex-specific conditions that contribute to IHD. In doing so, the possibility arises for tailored or targeted primary and secondary prevention strategies. One sex-specific condition that may contribute to the disease burden of IHD is polycystic ovary syndrome (PCOS), which affects between 7% and 18% of women of reproductive age. Pathognomonic features of PCOS include anovulation, hyperandrogenism, and/or polycystic ovaries on ultrasound assessment; dyslipidemia, insulin resistance and obesity, known risk factors for IHD, are also common. Indeed, many studies consistently demonstrate that PCOS worsens women’s risk profiles for CV disease, particularly when risk factors can persist beyond menopause. Recent meta-analyses of mechanistic studies have suggested that PCOS increases CV risks through inflammatory, endothelial, and coagulation alterations. However, it is unclear if PCOS contributes to IHD among younger women. Furthermore, the presence of these intermediate risk factors does not necessarily translate into poor CV outcomes. This literature review outlines how current evidence about the effect of PCOS on CV outcomes is inconclusive because of the challenges associated with diagnosing PCOS during and after midlife, the confounding effect of obesity on the manifestations and sequelae of PCOS, and the relatively low incidence of IHD among women under 65 years of age. Purpose: We are planning a study that aims to resolve some of the inconsistencies and gaps in knowledge about the association between PCOS and clinically significant IHD. Our proposed study will address the research question: Are women with premature IHD more likely than controls to have had signs of PCOS during their reproductive lives? The case-control design, comparing the prevalence of putative PCOS among women with known acute coronary syndromes (ACS) with that among women without ACS, is novel. Implications: The findings from this study may identify which young women would derive the most benefit from early screening, to reduce the incidence and burden of CV disease and to help formulate primary and secondary prevention strategies.