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A key priority of transgender health research is the evaluation of long-term effects of gender affirmation treatment. Thus, accurate assessment of treatment receipt is critical. The data for this analysis came from an electronic medical records (EMR) based cohort of transgender individuals. A subset of cohort members were also asked to complete a self-administered survey. Information from the EMR was compared with survey responses to assess the extent of agreement regarding transmasculine (TM)/transfeminine (TF) status, hormone therapy receipt, and type of surgery performed. Logistic regression models were used to assess whether participant characteristics were associated with disagreement between data sources. Agreement between EMR and survey-derived information was high regarding TM/TF status (99%) and hormone therapy receipt (97%). Lower agreement was observed for chest reconstruction surgery (72%) and genital reconstruction surgery (84%). Using survey responses as the “gold standard”, both chest and genital reconstruction surgeries had high specificity (95 and 93%, respectively), but the corresponding sensitivities were low (49 and 68%, respectively). A lower proportion of TM had concordant results for chest reconstruction surgery (64% versus 79% for TF) while genital reconstruction surgery concordance was lower among TF (79% versus 89% for TM). For both surgery types, agreement was highest among the youngest participants. Our findings offer assurance that EMR-based data appropriately classify cohort participants with respect to their TM/TF status or hormone therapy receipt. However, current EMR data may not capture the complete history of gender affirmation surgeries. This information is useful in future studies of outcomes related to gender affirming therapy. [ABSTRACT FROM AUTHOR]

Objective: (s): To examine recent trends in preterm birth (PTB) and its clinical subtypes by maternal race/ethnicity among singleton births.Study Design: Kaiser Permanente Southern California electronic health records (EHR) for all singleton births between 2009-2020 (n=427,698) were used to examine PTB trends and their subtypes (spontaneous [SPTB] and iatrogenic [IPTB]). Data on preterm labor triage extracted from EHRs using Natural Language Processing (NLP) were used to define PTB subtypes. Maternal race/ethnicity was categorized as non-Hispanic (NH) White, NH-Black, Hispanic, and NH-Asian/Pacific Islander. Multiple logistic regression was used to quantify the linear trend for PTB and its subtypes. Racial/ethnic trends were further examined by considering statistical interactions and stratifications.Results: From 2009 to 2020, the overall PTB rate decreased by 9.12% (from 8.04% to 7.31%; p<.001). Rates decreased by 19.29% among NH-Whites (from 7.23% to 5.83%, p<.001), 6.15% among Hispanics (from 7.82% to 7.34%; p=.036), and 12.60% among NH-Asian/Pacific Islanders (from 8.90% to 7.78%; p<.001) whereas a non-significantly increased PTB rate (8.45%) was observed among NH-Blacks (from 9.91% to 10.75%; p=.103). Between 2009 and 2020, overall SPTB rates decreased by 28.85% (from 5.75% to 4.09%; p<.001). However, overall IPTB rates increased by 40.45% (from 2.29% to 3.22%; p<.001). SPTB rates decreased by 34.73% among NH-Whites (from 5.44% to 3.55%, p<.001), 19.75% among NH-Blacks (from 6.82% to 5.47%, p<.001), 22.96% among Hispanics (from 5.55% to 4.28%, p<.001), and 28.19% among NH-Asian/Pacific Islanders (from 6.50% to 4.67%, p<.001). IPTB rates increased by 52.42% among NH-Whites (from 1.88% to 2.61%, p<.001), 107.89% among NH-Blacks (from 3.18% to 6.13%, p<.001), 46.88% among Hispanics (from 2.29% to 3.26%, p<.001), and 42.21% among NH-Asian/Pacific Islanders (from 2.45% to 3.44%, p<.001).Conclusions: The overall PTB rate decreased over time and was driven by a decrease in the SPTB rate. There is racial/ethnic variability in rates of SPTB and IPTB. The observed increase in IPTB among all racial and ethnic groups, especially NH-Blacks is disconcerting and needs further investigation. [ABSTRACT FROM AUTHOR]

Objective To examine the association between exposures to perinatal factors and autism spectrum disorders (ASD). Study Design A retrospective cohort study of ASD among children born in Kaiser Permanente Southern California hospitals between 1991 and 2009 (n = 594,638). Medical records were used to determine exposure to perinatal (antepartum and intrapartum) complications. ASD was diagnosed using DSM-IV criteria. Multivariable Cox regression was used to estimate hazard ratios (HRs). Result Children with ASD were more likely to be exposed to perinatal complications (HR = 1.15, 95% confidence interval [CI]: 1.09-1.21) than neurotypical children. Children exposed to antepartum (HR = 1.22, 95% CI: 1.10-1.36) and intrapartum (HR = 1.10, 95% CI: 1.04-1.17) complications were at increased risk of ASD. The risk was even greater when both antepartum and intrapartum conditions were present (HR = 1.44, 95% CI: 1.26-1.63). Conclusion Exposure to antepartum or intrapartum complications increases the risk of ASD in the offspring. Therefore, pregnancy complications may help identify children who could benefit from early screening and intervention for this common neuro-developmental condition. [ABSTRACT FROM AUTHOR]

Objective The risk of infection in infants of mothers with chorioamnionitis (CAM) may be lower than previously reported. This study's objective was to determine the incidence of intrapartum fever (IPF) and culture-positive early-onset bacterial neonatal infection (CPEOI) in the late preterm and term infants of mothers with or without CAM and to assess interhospital variation in neonatal infection management. Study Design This retrospective cohort study included mothers and newborns delivered at ≥35 weeks gestation at Kaiser Permanente Southern California Hospitals in 2010 (n = 31,112). Electronic medical and laboratory records from 13 medical centers were examined for maternal temperature, intrapartum, and neonatal antibiotic treatment. Rates for IPF, CAM, and CPEOI were estimated. Rates for starting neonatal antibiotics were calculated. Results The incidence of IPF was 9% and CAM 4%. The overall rate for CPEOI was 0.61 / 1,000 (95% confidence interval [CI] 0.34, 0.89/1,000). The rate of CPEOI was 4.0/1,000 (95% CI 0.50, 7.5/1,000) in infants born to mothers with CAM. The rate of beginning antibiotics for infants born to mothers with CAM ranged from 7 to 76% between nurseries. Conclusion The rate of CPEOI in infants born to mothers with CAM is lower than previously reported. There is heterogeneity in initiation of neonatal antibiotics by neonatologists. [ABSTRACT FROM AUTHOR]