Sex hormones influence survival of patients with metastatic urothelial carcinoma undergoing immune checkpoint therapy

Introduction Clinical trials investigating efficacy of immune checkpoint inhibitors (ICI) revealed sex-specific divergent outcomes in urothelial cancer (UC), suggesting that sex hormones might play an important role in gender-specific dimorphisms of response upon ICI. However, further clinical investigations are still needed to understand the influence of sex hormones in UC. The aim of this study was to get further insights on the prognostic and predictive value of sex hormone levels in patients with metastatic UC (mUC) who underwent ICI. Material and methods Sex hormone levels of patients with mUC including luteinizing hormone (LH), follicle-stimulating hormone (FSH), LH/FSH ratio, prolactin, testosterone and 17β-estradiol (E2) were evaluated at baseline and during ICI at 6/8 weeks and 12/14 weeks. Results Twenty-eight patients (10 women, 18 men) with a median age of 70 years were included. Metastatic disease was confirmed in 21 patients (75%) after radical cystectomy while seven patients showed mUC at first diagnosis. Twelve patients (42.8%) received first line and 16 patients second line pembrolizumab. The objective response rate (ORR) was 39% (CR in 7%). The median progression-free survival (PFS) and overall survival (OS) was 5.5 and 20 months. Focusing on changes of sex hormone levels during ICI, a significant increase in FSH levels and decrease of the LH/FSH ratio was noticed in responders (p = 0.035), yet without sex-specific significance. When adjusted for sex and treatment line, a significant increase of FSH levels was confirmed in men during second line pembrolizumab. Focusing on baseline levels, LH/FSH ratio was significantly higher in female responders (p = 0.043) compared to non-responders. In women, increased LH levels and LH/FSH ratio were associated with better PFS (p = 0.014 for LH, p = 0.016 for LH/FSH ratio) and OS (p = 0.026 and p = 0.018). In male patients, increased E2 levels were linked with improved PFS (p < 0.001) and OS (p = 0.039). Conclusion Increased LH and LH/FSH values in women as well as high E2 levels in men were significant predictors of better survival. Elevated LH/FSH ratio was predictive of better response to ICI in women. These results show first clinical evidence of the potential role of sex hormones as prognostic and predictive biomarker in mUC. Further prospective analyses are needed to corroborate our findings

The health of women and girls determines the health and well-being of our modern world: A White Paper From the International Council on Women's Health Issues

The International Council on Women's Health Issues (ICOWHI) is an international nonprofit association dedicated to the goal of promoting health, health care, and well-being of women and girls throughout the world through participation, empowerment, advocacy, education, and research. We are a multidisciplinary network of women's health providers, planners, and advocates from all over the globe. We constitute an international professional and lay network of those committed to improving women and girl's health and quality of life. This document provides a description of our organization mission, vision, and commitment to improving the health and well-being of women and girls globally

Support for affirmative actions to increase inclusivity of intersex* persons at an Austrian medical university

Abstract Background Since the ruling handed down by the Austrian Constitutional Court in 2018 intersex variation has been recognized under Austrian law as a “third sex”. In order to ensure that people with intersex variation are not discriminated against based on their group membership affirmative actions (i.e., proactive practices to avert discrimination) can be implemented. The current study explored whether students and employees at an Austrian medical university know about intersex variation. Furthermore, the study investigated what affirmative actions are practiced at the medical university to be inclusive for intersex persons and students’ and employees’ support for such affirmative actions. Methods All students and employees of a medical university in Austria were invited by e-mail to participate at the current study that included a self-constructed knowledge test on intersex variation with ten true-false questions. On five-point Likert scales participants reported for each of twelve listed affirmative actions whether they had seen a certain affirmative action at their university and how important they thought the implementation of an affirmative action was. Finally, participants’ gender, age, sexual orientation, highest level of education, and nationality was assessed. A cluster analysis was performed to determine groups of people with different degrees of support for affirmative actions for intersex persons. Results 220 students (62% cisgender women, 38% cisgender men) and 200 employees (72% cisgender women, 28% cisgender men) participated. Participants responded correctly to three out of ten knowledge test questions. The cluster analysis revealed that participants could be clustered as heterosexual cisgender women (Cluster 1; 55%), heterosexual cisgender men (Cluster 2; 30%), or sexual minority cisgender women and men (Cluster 3; 15%). Sexual minority persons knew more about intersex variation than did heterosexual participants. On average, affirmative actions for the inclusivity of intersex people have not been encountered (M = 1.5, SD = 0.4) at the studied university. Participants, especially those in Cluster 3, believed that the listed actions are moderately important. Conclusions At the medical university many actions should be taken to increase inclusivity for intersex people. Increasing the knowledge of university staff and students concerning intersex might help increase their support for such actions

Family Supportive Supervisor Behaviors Moderate Associations between Work Stress and Exhaustion: Testing the Job Demands&ndash;Resources Model in Academic Staff at an Austrian Medical University

The time-intensive work of publishing in scientific journals is an important indicator of job performance that is given much weight during promotion procedures for academic positions. The current study applied the job demands&ndash;resources model and analyzed whether family supportive supervisor behaviors (FSSB) moderated associations between work stress and feelings of exhaustion as a job resource and whether feelings of exhaustion ultimately mediated the link between work stress and academic employees&rsquo; publication activity. The current online cross-sectional questionnaire study was conducted in 133 academic employees (65.4% women, 34.6% men; Mage = 41.9, SD = 10.1) at an Austrian medical university and assessed employees&rsquo; numbers of publications, H-index, work stress, feelings of exhaustion, FSSB, and work&ndash;family services used. Manifest path models revealed that FSSB moderated the link between experiencing high levels of work stress and strong feelings of exhaustion, especially in employees who had at least one child below the age of 18. Part-time employment was most strongly linked with lower numbers of publications and lower H-index levels. The finding that FSSB acted as a job resource mostly for employees with at least one child below 18 underlines the fact that FSSB is different from other forms of supervisor support. The current study supports recommendations to increase the amount of work&ndash;family services and to change organizational norms to be supportive of the successful management of family and work obligations

All employees benefit: arguments that help increase support for affirmative action in academic careers

Abstract The goal of affirmative action programs is to establish equal opportunities for women and men. Past research has focused on one type of affirmative action, namely quotas, and found that the implementation of quotas is often met by a backlash from employees. The current study adds to the literature by investigating fairness and importance perceptions of career development programs offered only to women at Austrian universities or the Austrian Science Fund. Using the model of attitudes toward affirmative action programs the current experimental study tested whether providing participants with information about the benefits (gain-message condition) or costs (loss-message condition) of the implementation of affirmative action programs influenced participants’ perceptions of affirmative action programs. In the current online study, the 510 participants (52.5% cisgender women and 47.5% cisgender men; M age = 29.5, SD = 9.5) from German-speaking countries in Europe gave on average higher fairness and importance ratings to career development programs offered to all employees than to such programs offered specifically to women. Men in the gain-message condition and loss-message condition gave higher fairness ratings to affirmative action programs than did men in the control condition (i.e., men who read a text that gave no justification for the implementation of affirmative action programs). Men in the gain-message condition also gave higher importance ratings to affirmative action programs than did men in the control condition. Women were not influenced in their ratings by the justification of the implementation of affirmative action programs. Nevertheless, women’s perceptions of affirmative action programs were more favorable than men’s. When implementing affirmative action programs in organizations, providing information that explains why affirmative action is needed and how all employees benefit therefrom can increase support from men who, as seen from past research, are known to be most opposed to affirmative action

Gender differences and similarities in medical students’ experiences of mistreatment by various groups of perpetrators

Abstract Background Mistreatment of medical students during medical education is a widespread concern. Studies have shown that medical students report the most mistreatment compared to students of other study programs and that the prevalence of mistreatment peaks during clinical training. For this reason, a study was conducted to assess prevalence of mistreatment among medical students committed by various groups of people. The focus was to identify whether gender was associated with the experience of mistreatment. Additionally, students’ perception of university climate for reporting sexual harassment was assessed. Method In the study 88 medical students (45 women, 43 men) participated. A modified version of the Questionnaire on Student Abuse was used to assess students’ experience of various types of mistreatment and associated distress during medical education. To explore factors that could be associated with this experience the organizational climate for reporting sexual harassment was assessed with the Psychological Climate for Sexual Harassment. Result The most often cited perpetrators of mistreatment were strangers (79.5%), friends (75.0%) and university staff (68.2%). Strangers mostly committed psychological mistreatment and sexual harassment, whereas friends additionally engaged in physical mistreatment of medical students. The most common form of mistreatment conducted by university staff was humiliation of students. These kinds of psychological mistreatment were reported to be distressing (43%). Gender differences were found in the prevalence of mistreatment. Women experienced more sexual harassment and humiliation than did men. On the other hand, men experienced more physical mistreatment than did women. Women reported experiencing more distress from mistreatment experiences than did men and also more often reported being mistreated by university staff than did men. Women perceived a greater risk in reporting sexual harassment to the organization than did men. Conclusion Mistreatment of female and male students should be focused on using a gender perspective because types of mistreatment can differ by gender. Additionally, interventions should include the societal level as there was a high prevalence of mistreatment perpetrated by strangers. Also the issue of trust in the university needs to be addressed and the organization is called on to visibly demonstrate that it represents and protects its students as well as its staff

Parenthood does not explain the gender difference in clinical position in academic medicine among Swedish, Dutch and Austrian physicians

Studies have continuously shown that fewer women than men achieve leadership positions in academic medicine. In the current study we explored gender differences in clinical position among academic physicians at three university hospitals, each in a different European country. These countries, Sweden, the Netherlands and Austria, differ in terms of gender equality. We analyzed whether the number of children, working hours or publications could explain gender differences in physicians' clinical position. In this cross-sectional questionnaire study 1333 (54% female) physicians participated. Physicians were asked about their gender, age, number of children, working hours and clinical position. We used structural equation models to explore the influence of gender on the physicians' clinical position in each of the three countries. We explored whether the association between gender and clinical position could be explained by number of children, working hours or publication activity. The analyses revealed that at all three university hospitals gender influenced clinical position. These gender differences in clinical position could be partly explained by gender differences in publication activity. Female physicians as compared to male physicians were likely to publish fewer articles, and in turn these lower publication numbers were associated with lower clinical positions. The number of children or working hours did not explain gender differences in publication activity or clinical position. Therefore, factors other than unequal allocation of household labor, such as the academic working environment, may still disproportionately disadvantage women's progress, even at universities in countries with high rates of gender equality such as Sweden

Sex differences in disease presentation, surgical and oncological outcome of liver resection for primary and metastatic liver tumors-A retrospective multicenter study.

BackgroundSex differences are becoming of rising interest in many fields of medicine. It remains unknown whether sex has a role in postoperative and long-term outcome after hepatic resection (HR). The aim of this study was to investigate sex differences in disease presentation, surgical and oncological outcome after curative HR.MethodsRetrospective analysis of 1010 patients who underwent HR between 2005 and 2018 at two tertiary hospitals in Austria. Demographics and survival data were obtained from a prospectively maintained database. Univariate analysis was used to identify sex differences for the entire cohort and for sub-cohorts. Disease-free- and overall survival was assessed by the Kaplan-Meier estimate and results were compared by log-rank tests.Results436 females and 574 males were analyzed. Women were younger (pConclusionThis study delivers new insights on the impact of sex differences in liver surgery. Despite the fact that male patients have a higher incidence of preoperative morbidities, we did not observe specific disparities in terms of immediate postoperative as well as long term oncological outcome between sexes