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Ballering AV, Olde Hartman TC, Rosmalen JG. Gender scores in epidemiological research: methods, advantages and implications. THE LANCET REGIONAL HEALTH. EUROPE 2024; 43:100962. [PMID: 38989448 PMCID: PMC11233999 DOI: 10.1016/j.lanepe.2024.100962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/14/2024] [Accepted: 05/30/2024] [Indexed: 07/12/2024]
Abstract
Sex and gender-related factors are strongly associated with patients' illness trajectories, underscoring their essential role in epidemiological research and healthcare. Ignoring sex and gender in research and health inevitably results in inequities between women and men in terms of detection of disease, preventative measures, and effectiveness of treatment. Historical influences, including ideas of female inferiority and conservative notions of women's health only comprising reproductive health, reinforced the perceived irrelevance of sex and gender to health. Currently, these ideas are largely abandoned and epidemiology is becoming increasingly sensitive to sex. Gender-sensitivity, however, is lagging behind. This is potentially due to lacking knowledge and awareness about the relevance of both sex and gender to health and challenges in operationalizing gender in epidemiological research. Here, we thoroughly discuss the relevance of sex and gender to health, and pay special attention to the time, place, and culture-dependent embodiment of gender. We also discuss the operationalization of gender via composite gender scores in epidemiological studies. We argue to move beyond solely using these. Rather we should consider sex and gender in the initial stages of designing a study, to facilitate relevant, reproducible, and person-centric research.
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Affiliation(s)
- Aranka V. Ballering
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands
| | - Tim C. Olde Hartman
- Department of Primary and Community Care, Radboud Institute of Medical Innovation, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Judith G.M. Rosmalen
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands
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Wortmann L, Haarmann L, Yeboah A, Kalbe E. Gender medicine teaching increases medical students' gender awareness: results of a quantitative survey. GMS JOURNAL FOR MEDICAL EDUCATION 2023; 40:Doc45. [PMID: 37560043 PMCID: PMC10407584 DOI: 10.3205/zma001627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 03/31/2023] [Accepted: 04/20/2023] [Indexed: 08/11/2023]
Abstract
Background Knowledge about gender implications of health is insufficiently integrated into university teaching in Germany. Gender awareness represents a key competence to integrate this knowledge into the medical practice. This study is the first survey of the gender awareness of medical students in a cross-sectional design in Germany. Methods From April to July 2021, a quantitative cross-sectional survey in an online format using the "Nijmegen Gender Awareness in Medicine Scale" (2008) was conducted at four German universities (Charité Berlin, Friedrich-Schiller-University Jena, Ludwig-Maximilians-University Munich, and the University of Cologne) with a varied implementation of teaching gender medicine. Students indicated their agreement or disagreement with assumptions and knowledge about the influence of gender in everyday medical practice (gender sensitivity), as well as gender role stereotypes towards patients and physicians (gender role ideology). Results The 750 included participants showed relatively high gender sensitivity and low gender role stereotyping towards patients and physicians. The curricular implementation of gender medicine in the universities showed a significant influence on the students' gender sensitivity, as well as on their gender role stereotyping towards patients. Students who reported having taken classes in gender medicine or stated a definite interest in doing so showed significantly higher levels of gender sensitivity. Cis-males showed significantly lower gender sensitivity and significantly higher gender role stereotyping. Conclusion Implementation of gender medicine in the medical curriculum, attending courses on gender education as well as one's gender and interest have a significant impact on medical students' gender competencies. These results support the need for structural integration of gender medicine in medical education and gender trainings at medical schools in Germany.
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Affiliation(s)
- Laura Wortmann
- Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Medizinische Psychologie, Neuropsychologie und Gender Studies, Cologne, Germany
| | - Lena Haarmann
- Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Medizinische Psychologie, Neuropsychologie und Gender Studies, Cologne, Germany
| | | | - Elke Kalbe
- Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Medizinische Psychologie, Neuropsychologie und Gender Studies, Cologne, Germany
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3
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Palermo TM, Davis KD, Bouhassira D, Hurley RW, Katz JD, Keefe FJ, Schatman M, Turk DC, Yarnitsky D. Promoting inclusion, diversity and equity in pain science. Eur J Pain 2023; 27:451-456. [PMID: 36815603 DOI: 10.1002/ejp.2087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 01/29/2023] [Indexed: 02/24/2023]
Affiliation(s)
- Tonya M Palermo
- Department of Anesthesiology & Pain Medicine, University of Washington, Washington, USA
| | - Karen D Davis
- Department of Surgery and Institute of Medical Science, Krembil Brain Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Didier Bouhassira
- Inserm U987, APHP, UVSQ, Paris-Saclay University, Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Robert W Hurley
- Department of Anesthesiology, Neurobiology and Anatomy, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Joel D Katz
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, North, USA
| | - Michael Schatman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine and Division of Medical Ethics, NYU Grossman School of Medicine, New York, New York, USA
| | - Dennis C Turk
- Department of Anesthesiology & Pain Medicine, University of Washington, Washington, USA
| | - David Yarnitsky
- Department of Neurology, Rambam Medical Center, and Laboratory of Clinical Neurophysiology, Technion Faculty of Medicine, Haifa, Israel
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Palermo TM, Davis KD, Bouhassira D, Hurley RW, Katz JD, Keefe FJ, Schatman ME, Turk DC, Yarnitsky D. Promoting Inclusion, Diversity, and Equity in Pain Science. J Pain Res 2023; 16:301-306. [PMID: 36756205 PMCID: PMC9901522 DOI: 10.2147/jpr.s401985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 02/04/2023] Open
Affiliation(s)
- Tonya M Palermo
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington, USA,Correspondence: Tonya M Palermo, PhD, Department of Anesthesiology & Pain Medicine, University of Washington, P.O. Box 5371, M/S BC-3, Seattle Children’s Research Institute, Seattle, WA98145-5005, USA, E-mail address:
| | - Karen Deborah Davis
- Department of Surgery and Institute of Medical Science, Krembil Brain Institute, University Health Network; University of Toronto, Toronto, Ontario, Canada
| | - Didier Bouhassira
- Inserm U987, APHP, UVSQ, Paris-Saclay University, Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Robert W Hurley
- Department of Anesthesiology, Neurobiology and Anatomy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Joel D Katz
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Michael E Schatman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, New York, USA,Department of Population Health − Division of Medical Ethics, NYU Grossman School of Medicine, New York, New York, USA
| | - Dennis C Turk
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington, USA
| | - David Yarnitsky
- Department of Neurology, Rambam Medical Center, and Laboratory of Clinical Neurophysiology, Technion Faculty of Medicine, Haifa, Israel
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Palermo TM, Davis KD, Bouhassira D, Hurley RW, Katz JD, Keefe FJ, Schatman M, Turk DC, Yarnitsky D. Promoting inclusion, diversity, and equity in pain science. Pain 2023; 164:217-220. [PMID: 36626235 PMCID: PMC9833109 DOI: 10.1097/j.pain.0000000000002847] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Tonya M. Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United States
| | - Karen Deborah Davis
- Division of Brain, Imaging, and Behaviour, Krembil Brain Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery and Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Didier Bouhassira
- Inserm U987, APHP, UVSQ, Paris-Saclay University, Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Robert W. Hurley
- Department of Anesthesiology, and Department of Neurobiology and Anatomy, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Joel D. Katz
- Department of Psychology, York University, Toronto, ON, Canada
| | - Francis J. Keefe
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY, United States
| | - Michael Schatman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY, United States
- Department of Population Health, Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, United States
| | - Dennis C. Turk
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United States
| | - David Yarnitsky
- Department of Neurology, Rambam Medical Center, and Laboratory of Clinical Neurophysiology, Technion Faculty of Medicine, Haifa, Israel
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Promoting Inclusion, Diversity, and Equity in Pain Science. THE JOURNAL OF PAIN 2023; 24:187-191. [PMID: 36463026 DOI: 10.1016/j.jpain.2022.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 11/15/2022] [Indexed: 12/02/2022]
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Palermo TM, Davis KD, Bouhassira D, Hurley RW, Katz JD, Keefe FJ, Schatman M, Turk DC, Yarnitsky D. Promoting Inclusion, Diversity, and Equity in Pain Science. Clin J Pain 2023; 39:55-59. [PMID: 36650601 PMCID: PMC9844988 DOI: 10.1097/ajp.0000000000001094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 12/20/2022] [Indexed: 01/19/2023]
Affiliation(s)
- Tonya M. Palermo
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington
| | - Karen Deborah Davis
- Department of Surgery and Institute of Medical Science, Krembil Brain Institute, University Health Network; University of Toronto, Toronto, Ontario, Canada
| | - Didier Bouhassira
- Inserm U987, APHP, UVSQ, Paris-Saclay University, Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Robert W. Hurley
- Department of Anesthesiology, Neurobiology and Anatomy, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Joel D. Katz
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Francis J. Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Michael Schatman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, New York
- Division of Medical Ethics, Department of Population Health NYU Grossman School of Medicine, New York, New York
| | - Dennis C. Turk
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington
| | - David Yarnitsky
- Department of Neurology, Rambam Medical Center, and Laboratory of Clinical Neurophysiology, Technion Faculty of Medicine, Haifa, Israel
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Promoting inclusion, diversity, and equity in pain science. Pain Rep 2023; 8:e1063. [PMID: 36699995 PMCID: PMC9845008 DOI: 10.1097/pr9.0000000000001063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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Palermo TM, Davis KD, Bouhassira D, Hurley RW, Katz JD, Keefe FJ, Schatman M, Turk DC, Yarnitsky D. Promoting Inclusion, Diversity, and Equity in Pain Science. PAIN MEDICINE 2023; 24:105-109. [PMID: 36622210 PMCID: PMC9890303 DOI: 10.1093/pm/pnac204] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 12/13/2022] [Indexed: 01/10/2023]
Affiliation(s)
- Tonya M Palermo
- Corresponding author: Tonya M. Palermo, Department of Anesthesiology and Pain Medicine, University of Washington, Seattle Children’s Research Institute, M/S BC-3, P.O. Box 5371, Seattle, WA 98145-5005, USA.
| | - Karen Deborah Davis
- Department of Surgery and Institute of Medical Science, Krembil Brain Institute, University Health Network, University of Toronto, Toronto, ON, United States; Editor-in-Chief, Pain
| | - Didier Bouhassira
- Inserm U987, APHP, UVSQ, Paris-Saclay University, Ambroise Pare Hospital, Boulogne-Billancourt, France; Editor-in-Chief, European Journal of Pain
| | - Robert W Hurley
- Department of Anesthesiology, Neurobiology and Anatomy, Wake Forest University School of Medicine, Winston-Salem, NC, United States; Editor-in-Chief, Pain Medicine
| | - Joel D Katz
- Department of Psychology, York University, Toronto, ON, Canada; Editor-in-Chief, Canadian Journal of Pain
| | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States; Former Editor-in-Chief, Pain
| | - Michael Schatman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY, United States; Editor-in-Chief, Journal of Pain Research,Department of Population Health—Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, United States
| | - Dennis C Turk
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United States; Editor-in-Chief, Journal of Pain,Editor-in-Chief, Clinical Journal of Pain
| | - David Yarnitsky
- Department of Neurology, Rambam Medical Center, and Laboratory of Clinical Neurophysiology, Technion Faculty of Medicine, Haifa, Israel; Editor-in-Chief, Pain Reports
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Palermo TM, Davis KD, Bouhassira D, Hurley RW, Katz JD, Keefe FJ, Schatman M, Turk DC, Yarnitsky D. Promoting inclusion, diversity, and equity in pain science. Can J Pain 2023; 7:2161272. [PMID: 36874230 PMCID: PMC9980601 DOI: 10.1080/24740527.2022.2161272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Tonya M Palermo
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Karen Deborah Davis
- Department of Surgery and Institute of Medical Science, Krembil Brain Institute, University Health Network; University of Toronto, Toronto, Ontario, Canada
| | - Didier Bouhassira
- Inserm U987, APHP, UVSQ, Paris-Saclay University, Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Robert W Hurley
- Department of Anesthesiology, Neurobiology and Anatomy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Joel D Katz
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington, USADepartment of Neurology, Rambam Medical Center, and Laboratory of Clinical Neurophysiology, Technion Faculty of Medicine, Haifa, Israel
| | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Michael Schatman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, New York, USA.,Department of Population Health-Division of Medical Ethics, NYU Grossman School of Medicine, New York, New York, USA
| | - Dennis C Turk
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington, USADepartment of Neurology, Rambam Medical Center, and Laboratory of Clinical Neurophysiology, Technion Faculty of Medicine, Haifa, Israel
| | - David Yarnitsky
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington, USA.,Department of Neurology, Rambam Medical Center, and Laboratory of Clinical Neurophysiology, Technion Faculty of Medicine, Haifa, Israel
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van den Hurk L, Hiltner S, Oertelt-Prigione S. Operationalization and Reporting Practices in Manuscripts Addressing Gender Differences in Biomedical Research: A Cross-Sectional Bibliographical Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14299. [PMID: 36361177 PMCID: PMC9653596 DOI: 10.3390/ijerph192114299] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 06/16/2023]
Abstract
Historically, authors in the biomedical field have often conflated the terms sex and gender in their research significantly limiting the reproducibility of the reported results. In the present study, we investigated current reporting practices around gender in biomedical publications that claim the identification of "gender differences". Our systematic research identified 1117 articles for the year 2019. After random selection of 400 publications and application of inclusion criteria, 302 articles were included for analysis. Using a systematic evaluation grid, we assessed the provided methodological detail in the operationalization of gender and the provision of gender-related information throughout the manuscript. Of the 302 articles, 69 (23%) solely addressed biological sex. The remaining articles investigated gender, yet only 15 (6.5%) offered reproducible information about the operationalization of the gender dimension studied. Followingly, these manuscripts also provided more detailed gender-specific background, analyses and discussions compared to the ones not detailing the operationalization of gender. Overall, our study demonstrated persistent inadequacies in the conceptual understanding and methodological operationalization of gender in the biomedical field. Methodological rigor correlated with more nuanced and informative reporting, highlighting the need for appropriate training to increase output quality and reproducibility in the field.
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Affiliation(s)
- Lori van den Hurk
- Department of Primary and Community Care, Radboud University Medical Center, 6500HB Nijmegen, The Netherlands
| | - Sarah Hiltner
- Department of Primary and Community Care, Radboud University Medical Center, 6500HB Nijmegen, The Netherlands
| | - Sabine Oertelt-Prigione
- Department of Primary and Community Care, Radboud University Medical Center, 6500HB Nijmegen, The Netherlands
- AG10 Sex- and Gender-Sensitive Medicine, Medical Faculty OWL, University of Bielefeld, 33615 Bielefeld, Germany
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