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While the LGBTQ+ community has been disproportionally impacted by COVID-19 medical complications, little research has considered non-medical impact. We conducted a secondary analyses of USA-based respondents from a global cross-sectional online mixed-methods survey collecting sexual orientation, gender identity, and the perceived stress scale (PSS). Bivariate and multivariate ordinal regression statistics were performed. Fourteen percent (n = 193,14.2%) identified as LGBTQ+. Variables significantly associated with LGBTQ+ included: COVID testing/treatment affordability, canceled activities, stocking food/medications, quitting job, lost income, and inability to procure groceries/cleaning supplies/medications. Adjusting for Hispanic ethnicity and income, BIPOC LGBTQ+ individuals had twice the odds (OR:2.02;95%CI:1.16-3.53) of moderate compared to low PSS scores, and high compared to moderate PSS scores, compared to white non-LGBTQ+ individuals. Adjusting for Hispanic ethnicity, income, age, and education, deaf LGBTQ+ individuals had twice the odds (OR:2.00;95%CI:1.12-3.61) of moderate compared to low PSS scores, and high compared to moderate PSS scores, compared to hearing non-LGBTQ+ individuals. The LBGTQ+ community has increased stress due to COVID-19. Public health interventions must mitigate stress in BIPOC and deaf LGBTQ+ communities, addressing their intersectional experiences.

Introduction There has been increasing attention to—and debate about—best practices related to gender measurement. We add to this conversation by testing whether an approach of providing participants with an extensive list of gender options and then having them self-select into a more limited group of choices (that cohere with the research questions) could be useful. Methods In this study of adults ( N  = 1813), in 2021–2022, we measured gender using a three-part approach: the Gender EXPAND (EXPANsive responsive genDer) approach. Participants were first asked if they identified as transgender. They were then asked their current gender (check all that apply: woman, trans woman, trans feminine, man, trans man, trans masculine, nonbinary or genderqueer, agender, and an option to write in a response). Participants then selected a gender that best fit for them from a limited set of options (transgender, cisgender, nonbinary, unsure). Results We evaluated researcher reclassification from the expanded list of gender options compared to participant self-selection from the limited gender categories. We miscategorized 10.5% of participants when reclassifying their gender from the extensive list of options compared to their self-identification as transgender. We miscategorized 11.2% of participants compared to participants’ self-selection as cisgender, transgender, nonbinary, or unsure. Conclusions Participants generally responded well to the Gender EXPAND approach and our transparency in our explanations for our questions. This approach should be refined to reduce misclassification, potentially through different reclassification processes or modified response categories. Policy Implications Measurement of gender has downstream implications for representation in data, which informs policy. Inadequate measurement can lead to inaccurate data and undercounting of gender diverse individuals and further marginalizes transgender and nonbinary people at a time when stigma and anti-transgender legislation is at an all-time high.

ObjectivesOur objectives were to review the literature to identify frailty instruments in use for transcatheter aortic valve implantation (TAVI) recipients and synthesise prognostic data from these studies, in order to inform clinical management of frail patients undergoing TAVI.MethodsWe systematically reviewed the literature published in 2006 or later. We included studies of patients with aortic stenosis, diagnosed as frail, who underwent a TAVI procedure that reported mortality or clinical outcomes. We categorised the frailty instruments and reported on the prevalence of frailty in each study. We summarised the frequency of clinical outcomes and pooled outcomes from multiple studies. We explored heterogeneity and performed subgroup analysis, where possible. We also used Grading of Recommendations, Assessment, Development and Evaluation (GRADE) to assess the overall certainty of the estimates.ResultsOf 49 included studies, 21 used single-dimension measures to assess frailty, 3 used administrative data-based measures, and 25 used multidimensional measures. Prevalence of frailty ranged from 5.67% to 90.07%. Albumin was the most commonly used single-dimension frailty measure and the Fried or modified Fried phenotype were the most commonly used multidimensional measures. Meta-analyses of studies that used either the Fried or modified Fried phenotype showed a 30-day mortality of 7.86% (95% CI 5.20% to 11.70%) and a 1-year mortality of 26.91% (95% CI 21.50% to 33.11%). The GRADE system suggests very low certainty of the respective estimates.ConclusionsFrailty instruments varied across studies, leading to a wide range of frailty prevalence estimates for TAVI recipients and substantial heterogeneity. The results provide clinicians, patients and healthcare administrators, with potentially useful information on the prognosis of frail patients undergoing TAVI. This review highlights the need for standardisation of frailty measurement to promote consistency.PROSPERO registration numberCRD42018090597.