To explore variations in postpartum contraception in the United States by race and ethnicity among patients receiving publicly versus privately funded health care. We analyzed Phase 8 (2016-2021) Pregnancy Risk Assessment Monitoring System (PRAMS) data using multivariate logistic regression models with interaction terms to examine relationships between maternal race and ethnicity, health insurance, and postpartum contraceptive use, controlling for maternal age, education, marital status, parity, prepregnancy depression, and whether ever breastfed. Of U.S. birthing individuals, 60.3% had privately funded births and 39.7% had publicly funded births. Tubal sterilization was more common after publicly funded than privately funded births (13.3% versus 7.0%, < 0.001). Among postpartum patients with private insurance, tubal sterilization was more common among Black (10.6%) and Hispanic/Latine (9.6%) than White (6.4%) birthing people. However, with publicly funded insurance, tubal sterilization was less common among Black (12.3%) and Hispanic/Latine (13.7%) than White birthing people (14.6%). After publicly funded births, implant use (8.9% versus 2.8%, < 0.001) and injectable contraception (11.4% versus 2.7%, < 0.001) were more common, whereas reliance on vasectomy was less common (2.1% versus 5.5%, < 0.001) than after privately funded births, for all racial/ethnic groups. Intrauterine device (IUD) use was less common with public than private insurance among Black birthing people (11.9% versus 16.0%, < 0.001). Significant interactions between race and ethnicity and insurance type were observed. Adjusted odds ratios indicated that, compared with private insurance, public insurance was associated with higher odds of tubal sterilization, implant, and injectable use but lower odds of vasectomy for White individuals; higher implant and DMPA use but lower IUD and vasectomy use for Black individuals; and higher tubal sterilization, IUD, and implant use but lower vasectomy use for Hispanic/Latine individuals. Racial and ethnic variation in postpartum contraception use differs for publicly and privately insured births in the United States.

Empirical evidence demonstrating the influence of sex and gender on health has increased dramatically over the last two decades. Yet, the integration of this knowledge into medical school curricula remains limited. To address this gap, we used artificial intelligence (AI) to assess whether clinically relevant sex- and gender-based data were included in a pre-clerkship medical curriculum and develop recommendations for including such data in teaching materials. Utilizing the AI tool Humata.ai, we mapped the content of 26 clinical disciplines within the 2023-2024 Yale School of Medicine pre-clerkship curriculum. We gave the tool two commands: first, identify existing discussions related to sex as a biological variable (SABV) and gender as a social determinant of health, and second, find content areas that could benefit from including such material. Based on a comprehensive analysis of educational materials, we successfully identified that SABV was discussed in 12 of the 26 clinical disciplines. The AI tool also identified significant gaps where data could be included on the influence of SABV on pathophysiology, pharmacology, diagnosis, and treatment. Although our AI commands evaluated both sex and gender content, the tool's output centered on SABV. This study provides one of the first empirical demonstrations of a scalable AI framework for streamlining curricular review and enhancing the integration of clinically relevant content on SABV in medical education. AI-assisted review offers a pathway to transform clinical care by ensuring that future physicians are provided with evidence-based data showing the influence of sex on health.

Recurrent vulvovaginal candidiasis (RVVC) is defined as 3 or more acute symptomatic episodes in a year and affects nearly 138 million women globally. Oteseconazole selectively inhibits fungal cytochrome P51 and has potent activity against and resistant species, including and fluconazole-resistant strains. Over 90% of women randomized to receive oteseconazole in two recently completed global Phase 3 clinical trials (VIOLET trials) did not experience a RVVC episode during these 48-week clinical studies. This observational study was designed to extend these initial findings. A total of 70 eligible women previously randomized to receive oteseconazole were enrolled into an extension study and were followed an additional 48 weeks and monitored for recurrent infections. No additional investigational treatment was administered during the observational period. Of the 70 eligible study participants who received oteseconazole, 85% completed the extension study, and 1/70 (1.4%) experienced a culture-verified recurrent infection during the observational period, weeks 48 to 96. Of the participants initially randomized to receive placebo, 76% completed the study and 3/17 (17.6%) experienced a recurrent infection during the extension study. The proportion of participants who prematurely discontinued the study was lower in the oteseconazole-treated group (16%) compared with the placebo group (29%). During the 48-week extension study, 1.4% of previously randomized subjects experienced a culture-positive recurrence of symptomatic vulvovaginal candidiasis, demonstrating a continued long-term protective effect of oteseconazole.

Telemedicine addresses limitations in patient access, health care costs, and time spent by patients for health care visits. However, gender-based differences in patient satisfaction with this method are unclear. Our study aimed to evaluate gender-based differences in patient satisfaction for telemedicine (both video and telephone) and in-person health care visits. Patients were randomly selected to complete a patient satisfaction survey regarding their health care experiences after outpatient medical appointments at a large academic institution. Of 476,777 total respondents, most patients were women (47.5%) and men (37.3%), with fewer patients in the categories transgender, other, or unknown/choose not to disclose (15.2%). Women and men were both satisfied with telemedicine by video or telephone (83.3% women versus 84.5% men rated their visit 5/5) and in-person visits (84.1% women versus 85.7% men rated their visit 5/5). Men and women were nearly equally satisfied with telemedicine and in-person visits, although both genders were slightly less satisfied with telemedicine video visits than in-person visits. The findings indicate that the ongoing integration of telemedicine into clinical practice could serve as a satisfactory alternative to in-person consultations for all patients.

Integrase strand transfer inhibitors (INSTIs) with and without tenofovir alafenamide fumarate (TAF) are recommended in first-line regimens for pregnant people living with human immunodeficiency virus (PWH), with mixed data emerging on pregnancy outcomes and maternal weight gain. This is a retrospective cohort study across two academic medical centers from January 2014 to April 2024. PWH were divided by antiretroviral treatment exposure into INSTI and non-INSTI groups as well as into TAF exposure and nonexposure groups. Maternal and neonatal demographics and outcomes were collected. Continuous variables were analyzed with Student's test, whereas categorical variables were compared using Chi-square and Wilcoxon rank-sum test. -Values of <0.05 were considered significant. Of 401 PWH, 118 PWH received INSTI with TAF regimens; 130 had INSTI without TAF-exposures; 14 had TAF without INSTI-exposure; and 136 had a non-INSTI and non-TAF regimen. INSTI (with TAF)-exposed individuals were older than those without INSTI exposure, but otherwise had similar baseline demographics. In multivariable analysis, TAF exposure (with and without INSTI) was associated with higher odds of undetectable viral load at delivery (aOR: 4.30, 95% confidence interval 2.41-7.65). Neither INSTI- (with and without TAF) nor TAF (with and without INSTI)-exposed individuals had significantly higher odds of PTB. Any TAF exposure also had greater odds of hypertensive disorder of pregnancy at delivery. There were no differences in total maternal weight gain by either INSTI or TAF exposure. Any INSTI exposure did not significantly increase odds of undetectable viral load at delivery. Any TAF exposure was significantly associated with undetectable viral load and hypertensive disorder at delivery.

Stroke is the leading cause of death among women and the third among men. Few studies have explored sex differences in poststroke treatment compliance, and the results are in conflict. Only a few have assessed all recommended drugs, and none have been conducted in France. We evaluated the use of recommended drugs after ischemic stroke in France. This prospective cohort of adult ischemic stroke was conducted from 2019 to 2021 in Aquitaine, southwestern France, using data from the PAPASéPA project, that is, three data sources: the Aquitaine Stroke Observatory (ObA2) matched with the French reimbursement health care system (SNDS), and completed by data. The use of antihypertensive drugs, lipid-lowering drugs, antiplatelet agents, and anticoagulants in the month following hospital discharge was evaluated using logistic regression models. Discontinuation of these drugs 1 year after stroke was estimated using Cox cause-specific models. Of the 822 included patients, 45% were women. Postdischarge use of antihypertensive drugs, antiplatelet agents, and anticoagulants was not sex-dependent (adjusted odds ratio [aOR] of use in women compared with men aOR = 0.95, 95% confidence interval [CI] = [0.64-1.39], aOR = 0.95, 95% CI = [0.67-1.36], and aOR = 1.01, 95% CI = [0.70-1.45], respectively). However, women were less likely to receive lipid-lowering drugs (aOR = 0.69, 95% CI = [0.48-0.99]). Regardless of the drug, the 1-year discontinuation rate did not differ between the sexes. Women were less likely to receive lipid-lowering drugs after an ischemic stroke, but the rate of drug discontinuation did not differ between men and women, regardless of the drug. In postischemic stroke, the prescription of lipid-lowering drugs in women is important for improving their cardiovascular health.

Higher aerobic physical activity (PA) has been associated with lower psychological distress. However, limited research has examined this association among Latinas of childbearing age, a group disproportionately burdened by higher rates of psychological distress. Therefore, we examined if aerobic PA was associated with psychological distress in Latinas of childbearing age and tested if associations varied by nativity. We used cross-sectional 2012-2018 National Health Interview Survey data on Latinas 18-44 years of age ( = 9,873). Meeting the aerobic PA recommendation (versus less than the recommendation) was classified as ≥150 minutes of moderate-intensity activity per week, ≥75 minutes of vigorous-intensity activity per week, or ≥150 minutes of an equivalent combination of moderate- and vigorous-intensity activity per week. Psychological distress was measured using the Kessler 6 scale and categorized as "none ≤ 6," "moderate = 6-12," and "serious ≥ 13." Multinomial logistic regression models were used to estimate the association between meeting the aerobic PA recommendation and psychological distress. In adjusted models, Latinas meeting the aerobic PA recommendation versus those that did not were significantly less likely to report moderate psychological distress (odds ratio [OR]: 0.82; 95% confidence interval [CI]: 0.71, 0.94). In models stratified by nativity, U.S.-born Latinas meeting the aerobic PA recommendation were significantly less likely to report moderate (OR: 0.71; 95% CI: 0.58, 0.87) and serious psychological distress (OR: 0.67; 95% CI: 0.46, 0.96). Our findings highlight the importance of promoting PA in Latinas of childbearing age and connecting them with mental health resources.

The recent literature highlights how physician and patient gender influence medical care assessment. Gender impacts Press Ganey survey results, a key measure of patient satisfaction. We analyzed 82,195 outpatient visits at Northwell Health (January 01, 2018-January 04, 2019) to assess the role of gender and gender concordance in patient ratings. Inpatient, pediatric, and geriatric encounters were excluded. Five Press Ganey Care Provider questions were reviewed, covering provider concern, shared decision-making (SDM), medication information, confidence, and likelihood of recommendation. Top box scores and abbreviated summary scores were calculated and compared by specialty, physician gender, and patient gender. Male physicians received significantly higher scores in internal medicine subspecialties, primary care, and OB/GYN, whereas female physicians scored higher in surgical specialties. Female patients rated female physicians lower than male physicians in internal medicine subspecialties and OB/GYN but higher in surgical fields. Male patients showed no significant rating differences based on physician gender. Male physicians scored higher on concern, SDM, confidence, and likelihood of recommendation in nonsurgical fields, with female physicians scoring higher on surgical specialties. Our findings suggest that physician gender significantly impacts patient satisfaction scores, with variations by specialty. Expanding this dataset could allow a more nuanced, intersectional analysis in future research.

Clinical practice guidelines (CPGs) play a critical role in shaping medical care and healthcare policies, yet there is growing concern about the lack of diversity in CPG authorship. This systematic review and meta-analysis aim to assess gender, race, and ethnicity representation among authors of CPGs across different medical specialties. To evaluate the representation of women and individuals from minoritized racial and ethnic groups among authors and contributors of CPGs. A comprehensive literature search was conducted in databases including Ovid MEDLINE, Embase.com, Web of Science, Cochrane CENTRAL, and ClinicalTrials.gov from inception to September 2023. Studies focusing on CPG authorship disparities by gender, race, and ethnicity were selected for review. Eligible studies included those that reported data on gender, racial, and ethnic composition among CPG authors. Out of 2,436 articles screened, 20 studies met the inclusion criteria for full-text review and meta-analysis. Data extraction was performed independently by two reviewers, with disagreements resolved through consensus, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A meta-analysis was then conducted using a random-effects model. The primary outcome was the proportion of women and individuals from minoritized racial and ethnic groups among CPG authors. The meta-analysis estimated pooled proportions of women's authorship across the different medical specialties. The 20 included studies covered a total of 36,783 author positions. Women's authorship varied widely across specialties, with an overall pooled proportion of 25.7% (95% Confidence Interval (CI): 21.8%-30.1%). Racial and ethnic data were available in only a few studies, with significant gaps in reporting. The findings indicate persistent gender disparities in CPG authorship, particularly in specialties such as cardiology and gastroenterology. This analysis demonstrated that substantial disparities in gender, race, and ethnicity remain in CPGs' authorship. More inclusive representation is essential to ensure diverse perspectives in shaping healthcare guidelines.

Previous work has consistently shown a higher prevalence of obesity based on body mass index (BMI) among lesbian women and, more recently, also among bisexual women. New recommendations on defining clinical obesity suggest the inclusion of other physical health measures related to physiological health and/or physical limitations. Therefore, the purpose of this study is to examine sexual identity-based differences in clinical obesity among women using updated definitions. 2001-2016 National Health and Nutrition Examination Survey data were analyzed in 2024 to 2025. Body mass index, metabolic biomarkers, and physical functioning were used to estimate prevalence of clinical obesity for each sexual identity group (heterosexual = 11,054; lesbian/gay = 171; bisexual = 464; something else = 94; "not sure" = 289). Logistic regression models were fit to assess sexual identity-based differences in clinical obesity. Covariates included age, race/ethnicity, income, education, and relationship status. With metabolic biomarkers, there was no statistically significant difference in prevalence of clinical obesity between lesbian/gay and heterosexual women. With physical functioning only, prevalence was higher among lesbian/gay than heterosexual women (OR range: 2.0-2.5). Bisexual women consistently had higher prevalence of clinical obesity than heterosexual women (OR range: 1.2-2.1) across all definitions. There were no other sexual identity-based differences in clinical obesity. Based on updated recommendations, physical functioning may better capture clinical obesity among lesbian/gay and bisexual than heterosexual women with BMI ≥30 kg/m than metabolic biomarkers. However, bisexual women continued to have higher risk for clinical obesity, and additional work is needed to better understand the factors that contribute to this disparity.

Obesity is a common comorbidity among women of childbearing age. With increasing obesity, more females are considering bariatric surgery (BS) as a form of weight loss. The effect of successful bariatric surgery (sBS) on maternal cardiovascular outcomes remains to be elucidated. Patients were extracted from the National Inpatient Sample database. We mainly stratified patients into two groups-BS candidates and sBS. We matched patients by age, race, and cardiovascular risk factors using propensity-score matching. The primary outcome was a composite and defined as major adverse cardiovascular events (MACE). Secondary outcomes included preeclampsia, gestational diabetes, and extended length of hospital stay (eLOS). The study also evaluated two other groups of interest-patients that had BS with outcomes other than success (oBS) and any patient with a history of BS. Of 5,892 patients with BS, 2,966 patients had sBS. 115,490 patients were BS candidates. BS candidate patients had increased MACE relative to sBS patients. Additionally, they had higher rates of preeclampsia, gestational diabetes, and eLOS relative to BS candidate patients, even after matching. oBS patients also had decreased rates of MACE, heart failure, preeclampsia, gestational diabetes, and eLOS compared with BS candidates after matching. Lastly, to further demonstrate the beneficial effects of BS, patients with a history of BS had similar outcomes, including improved MACE, compared with patients without BS. sBS was associated with a reduction in MACE. The significant reduction in MACE highlights the importance of considering BS as an option if conventional weight loss measures fail.

In 2022, 12.5% of women ages 18+ in the United States reported past-month binge drinking. Some studies indicate that excessive drinking is associated with lower rates of mammogram screening, but information by racial/ethnic group is lacking. We explored the relationship between binge drinking and mammogram and Pap test use among Asian, Black, Hispanic, and White women. We used 7 years of National Health Interview Survey data reported between 2003 and 2018. Samples included women ages 21-64 without a hysterectomy who reported Pap test data (N = 52,621) and women ages 40-64 with or without a hysterectomy who reported mammogram data (N = 40,635). Using relative risk regression analysis, we tested the relationship between binge drinking, defined as having had four or more drinks on one or more days during the past year, and mammogram and Pap test screenings for the total samples and the four racial/ethnic groups. White women reported the highest rates of binge drinking, followed by Hispanic, Black, and Asian American women. Contrary to our expectations, binge drinking was associated with a slightly higher relative risk of mammogram utilization among White women (RR = 1.02, 95% CI = 1.02-1.02). Among Black women, binge drinking was associated with a lower relative risk (RR = 0.98, 95% CI = 0.97-0.98). For Pap test utilization, binge drinking was associated with a slightly lower relative risk among Black women (RR = 0.99, 95% CI = 0.99-0.99), and Hispanic women (RR = 0.99, 95% CI = 0.99-0.99), and a slightly higher relative risk among Asian women (RR = 1.05, 95% CI = 1.03-1.08) and White women (RR = 1.00, 95% CI = 1.00-1.00). Binge drinking bears little relationship to mammogram or Pap test use. Results suggest that reducing socioeconomic disparities will increase cancer screening.

The goal in selecting these recent articles was to help identify literature that may change the clinical practice of women's health for practitioners in the primary care setting. Articles were identified by reviewing the high-impact medical and women's health journals, national guidelines, ACP JournalWise, and NEJM Journal Watch. In this Clinical Update, we selected recent publications relevant to the cardiovascular health of women.

Among breast cancer (BC) survivors, type 2 diabetes (DM) is associated with 40% increased BC mortality. Black and Latina BC survivors have worse BC mortality and are more likely to have DM. We aimed to assess the association of race/ethnicity with adherence to DM self-management behaviors (SMBs), medication beliefs, and control in BC survivors. We recruited Stages 0-III BC survivors ≥55 years with DM taking ≥1 DM medication. Adherence to DM SMBs and medication beliefs were assessed with validated questionnaires. Hemoglobin A1c (A1c) was measured at recruitment to assess DM control. We evaluated the relationship between race/ethnicity and SMBs, medication beliefs, and DM control with univariate analyses and multivariable regression. Of 194 participants, median age was 67 years (interquartile range [IQR] = 60-72), median A1c was 7.4% (IQR = 6.4-7.9), 27% self-identified as non-Hispanic Black, 41% as non-Hispanic White (NHW), 18% as Latina, and 14% as other/unknown race (not Latina). Race/ethnicity was not significantly associated with adherence to most DM SMBs. In multivariate analyses, non-White race/ethnicity was significantly associated with poorly controlled DM and higher concerns about DM medications, and Black race had a significant association with lower belief of necessity of DM medications compared with NHWs. Race/ethnicity was not associated with DM SMBs in BC survivors, but non-White participants had greater concerns about DM medications and poorer DM control. Future studies exploring differences in DM medication beliefs could inform interventions that can improve DM care among minority BC survivors.

Reproductive health, including abortion care, is a critical component of undergraduate medical education (UME) that is inconsistently included in UME. The objective of this study is to investigate the association between the inclusion of abortion and contraception topics in UME curricula overall and state-level abortion restrictions. A national cross-sectional survey of medical students was conducted from August 2022 to June 2023 using the American Medical Student Association Reproductive Medical Education Survey. Students reported whether abortion, contraception, options counseling, and values clarification were included in their schools' preclinical and clinical curricula. State-level abortion laws as of July 2024 were categorized as banned, banned before 12 weeks, banned after 12 weeks, or unrestricted. Logistic regression was used to evaluate the association between state law and inclusion of each curricular topic. Responses were received from 101 of 190 U.S. medical schools (53%) in 41 states. Preclinical coverage was 63.4% for abortion, 82.2% for contraception, 52.5% for options counseling, and 47.5% for values clarification. Clinical coverage was 53.5% for abortion, 61.4% for contraception, 56.4% for options counseling, and 44.6% for values clarification. While there was no association between state-level abortion restrictions and inclusion of abortion in preclinical curricula, schools in unrestricted states were more likely than those in banned states to include clinical education on abortion (OR: 2.83; 95% CI: 1.04-8.20) and values clarification (OR: 2.98; 95% CI: 1.08-8.91). Inclusion of reproductive health topics in UME remains limited, and our findings are the first to indicate that a decrease in clinical abortion education is seen in states with state-level abortion bans. All medical schools must strive to include contraception and abortion education to ensure a workforce trained to meet the community's health needs.