Nature journals raise the bar on sex and gender reporting in research

The impact of sex/gender-specific funding and editorial policies on biomedical research outcomes: a cross-national analysis (2000-2021)

Reflecting sex and gender characteristics in biomedical research is critical to improving health outcomes and reducing adverse effects from medical treatments. This study investigates the impact of sex/gender-specific funding policies and journal editorial standards on the integration of sex/gender analysis in biomedical research publications. Using data from the United States, Canada, the United Kingdom, and other countries between 2000 and 2021, we assessed how these policies influenced research output in the fields of medicine and life sciences. Our findings show that countries with progressive funding policies and journals promoting sex/gender-based reporting have significantly improved research quality and publication rates. This highlights the importance of coordinated policy efforts and editorial practices in advancing integrated sex/gender research. We recommend continued global efforts from policymakers, funding bodies, and journals to embed sex/gender perspectives in scientific inquiry, ensuring more effective and equitable biomedical advancements.

Sociodemographic reporting in videomics research: a review of practices in otolaryngology - head and neck surgery

OBJECTIVE

To assess reporting practices of sociodemographic data in Upper Aerodigestive Tract (UAT) videomics research in Otolaryngology-Head and Neck Surgery (OHNS).

STUDY DESIGN

Narrative review.

METHODS

Four online research databases were searched for peer-reviewed articles on videomics and UAT endoscopy in OHNS, published since January 1, 2017. Title and abstract search, followed by a full-text screening was performed. Dataset audit criteria were determined by the MINIMAR reporting standards for patient demographic characteristics, in addition to gender and author affiliations.

RESULTS

Of the 57 studies that were included, 37% reported any sociodemographic information on their dataset. Among these studies, all reported age, most reported sex (86%), two (10%) reported race, and one (5%) reported ethnicity and socioeconomic status. No studies reported gender. Most studies (84%) included at least one female author, and more than half of the studies (53%) had female first/senior authors, with no significant differences in the rate of sociodemographic reporting in studies with and without female authors (any female author: p = 0.2664; first/senior female author: p > 0.9999). Most studies based in the US reported at least one sociodemographic variable (79%), compared to those in Europe (24%) and in Asia (20%) (p = 0.0012). The rates of sociodemographic reporting in journals of different categories were as follows: clinical OHNS: 44%, clinical non-OHNS: 40%, technical: 42%, interdisciplinary: 10%.

CONCLUSIONS

There is prevalent underreporting of sociodemographic information in OHNS videomics research utilizing UAT endoscopy. Routine reporting of sociodemographic information should be implemented for AI-based research to help minimize algorithmic biases that have been previously demonstrated.

LEVEL OF EVIDENCE: 4

Policies on the collection, analysis, and reporting of sex and gender in Australian health and medical research: a mixed methods study

OBJECTIVE

To explore the policies of key organisations in Australian health and medical research on defining, collecting, analysing, and reporting data on sex and gender, and to identify barriers to and facilitators of developing and implementing such policies.

STUDY DESIGN

Mixed methods study: online planning forum; survey of organisations in Australian health and medical research, and internet search for policies defining, collecting, analysing, and reporting data by sex and gender in health and medical research.

SETTING, PARTICIPANTS

Australia, 19 May 2021 (planning forum) to 12 December 2022 (final internet search).

MAIN OUTCOME MEASURES

Relevant webpages and documents classified as dedicated organisation-specific sex and gender policies; policies, guidelines, or statements with broader aims, but including content that met the definition of a sex and gender policy; and references to external policies.

RESULTS

The online planning forum identified 65 relevant organisations in Australian health and medical research; twenty participated in the policy survey. Seven organisations reported at least one relevant policy, and six had plans to develop or implement such policies during the following two years. Barriers to and facilitators of policy development and implementation were identified in the areas of leadership, language and definitions, and knowledge skills and training. The internet search found that 57 of the 65 organisations had some form of sex and gender policy, including all ten peer-reviewed journals and five of ten research funders; twelve organisations, including eight peak body organisations, had published dedicated sex and gender policies on their websites.

CONCLUSION

Most of the organisations included in our study had policies regarding the integration of sex and gender in health and medical research. The implementation and evaluation of these policies is necessary to ensure that consideration of sex and gender is adequate during all stages of the research process.

The Role of Journals in Reporting Sex and Gender-Based Outcomes: Should We Adopt Guidelines, and What Else Can We Do to Improve Reporting?

➤ Sex and gender are inconsistently reported in musculoskeletal research. A panel of journal editors and other interested parties who participated in The Journal of Bone and Joint Surgery Sex and Gender Reporting in Musculoskeletal Research Symposium met in 2023 to help define the roles of journals and other stakeholders in addressing this issue.➤ This report summarizes the resulting recommendations and presents several different ways in which orthopaedic journals may elect to introduce to their readers, reviewers, and authors the importance of considering sex and gender in orthopaedic research.➤ Many current sex and gender-related funding agency mandates as well as the Sex and Gender Equity in Research (SAGER) guidelines are most readily applied to prospective research and/or randomized controlled trials.➤ The panel was supportive of endorsing SAGER or a similar set of guidelines as a tool that can help authors to consider the most effective means of evaluating the influences of sex and gender within the context of orthopaedic research.➤ Engaging readers, reviewers, and authors on multiple fronts, with purpose and intention, is likely the most important approach to increase awareness and to enhance the quality of evidence utilized to support clinical decisions in orthopaedic surgery.

A life-course approach to tackling noncommunicable diseases in women

Women's health has been critically underserved by a failure to look beyond women's sexual and reproductive systems to adequately consider their broader health needs. In almost every country in the world, noncommunicable diseases are the leading causes of death for women. Among these, cardiovascular disease (including heart disease and stroke) and cancer are the major causes of mortality. Risks for these conditions exist at each stage of women's lives, but recognition of the unique needs of women for the prevention and management of noncommunicable diseases is relatively recent and still emerging. Once they are diagnosed, treatments for these diseases are often costly and noncurative. Therefore, we call for a strategic, innovative life-course approach to identifying disease triggers and instigating cost-effective measures to minimize exposure in a timely manner. Prohibitive barriers to implementing this holistic approach to women's health exist in both the social arena and the medical arena. Recognizing these impediments and implementing practical approaches to surmounting them is a rational approach to advancing health equity for women, with ultimate benefits for society as a whole.

Sex and gender in health research: intersectionality matters

Research policies aiming to integrate sex and gender in scientific studies are receiving increased attention in academia. Incorporating these policies into health research is essential for improving targeted and equitable healthcare outcomes, by considering both disparities and similarities between individuals relating to sex and gender. Although these efforts are both urgent and critical, only an intersectional approach, which considers broad and multidimensional aspects of an individual's identity, can provide a complete understanding of the factors that impact health. In this commentary, we emphasize that it is crucial to examine how sex and gender intersect with factors such as culture, ethnicity, minority status, and socioeconomic conditions to influence health outcomes. To approach health equity, we must consider disparities linked to both biological and environmental factors, in order to facilitate evidence-based health interventions with tangible impact.

[Sex-specific differences in gastroenterological diseases]

Diseases of the gastrointestinal tract present with substantial sex differences that have a potential impact on patient outcome. This fact is not sufficiently addressed either in basic research or in clinical studies. For example, most animal studies utilize male animals. Despite differences in incidence, sex may affect complication rates, prognosis, or therapeutic response. The incidence of gastrointestinal cancers is frequently higher in males, but this observation cannot solely rely on a distinct risk behaviour. Here, differences in immune response and p53 signalling may be factors responsible for this finding. Nevertheless, taking sex differences into account and improving our understanding of relevant mechanisms is crucial and will most likely have a substantial impact on disease outcome. This overview aims to highlight sex differences in the context of various gastroenterological diseases, primarily to enhance awareness. Attention to sex-specific differences is essential to improve individualized treatment.

Sex and gender in infection and immunity: addressing the bottlenecks from basic science to public health and clinical applications

Although sex and gender are recognized as major determinants of health and immunity, their role is rarely considered in clinical practice and public health. We identified six bottlenecks preventing the inclusion of sex and gender considerations from basic science to clinical practice, precision medicine and public health policies. (i) A terminology-related bottleneck, linked to the definitions of sex and gender themselves, and the lack of consensus on how to evaluate gender. (ii) A data-related bottleneck, due to gaps in sex-disaggregated data, data on trans/non-binary people and gender identity. (iii) A translational bottleneck, limited by animal models and the underrepresentation of gender minorities in biomedical studies. (iv) A statistical bottleneck, with inappropriate statistical analyses and results interpretation. (v) An ethical bottleneck posed by the underrepresentation of pregnant people and gender minorities in clinical studies. (vi) A structural bottleneck, as systemic bias and discriminations affect not only academic research but also decision makers. We specify guidelines for researchers, scientific journals, funding agencies and academic institutions to address these bottlenecks. Following such guidelines will support the development of more efficient and equitable care strategies for all.

Are we moving the dial? Canadian health research funding trends for women's health, 2S/LGBTQ + health, sex, or gender considerations

BACKGROUND

Sex and gender impacts health outcomes and disease risk throughout life. The health of women and members of the Two-Spirit, Lesbian, Gay, Bisexual, Transgender, Queer or Questioning (2S/LGBTQ +) community is often compromised as they experience delays in diagnosis. Distinct knowledge gaps in the health of these populations have prompted funding agencies to mandate incorporation of sex and gender into research. Sex- and gender-informed research perspectives and methodology increases rigor, promotes discovery, and expands the relevance of health research. Thus, the Canadian Institutes of Health Research (CIHR) implemented a sex and gender-based analysis (SGBA) framework recommending the inclusion of SGBA in project proposals in 2010 and then mandating the incorporation of SGBA into grant proposals in 2019. To examine whether this mandate resulted in increased mention of sex or gender in funded research abstracts, we searched the publicly available database of grant abstracts funded by CIHR to analyze the percentage of abstracts that mentioned sex or gender of the population to be studied in the funded research. To better understand broader health equity issues we also examined whether the funded grant abstracts mentioned either female-specific health research or research within the 2S/LGBTQ + community.

RESULTS

We categorized a total of 8,964 Project and Operating grant abstracts awarded from 2009 to 2020 based on their study of female-specific or a 2S/LGBTQ + populations or their mention of sex or gender. Overall, under 3% of grant abstracts funded by CIHR explicitly mentioned sex and/or gender, as 1.94% of grant abstracts mentioned sex, and 0.66% mentioned gender. As one of the goals of SGBA is to inform on health equity and understudied populations with respect to SGBA, we also found that 5.92% of grant abstracts mentioned female-specific outcomes, and 0.35% of grant abstracts focused on the 2S/LGBTQ + community.

CONCLUSIONS

Although there was an increased number of funded grants with abstracts that mentioned sex and 2S/LGBTQ + health across time, these increases were less than 2% between 2009 and 2020. The percentage of funded grants with abstracts mentioning female-specific health or gender differences did not change significantly over time. The percentage of funding dollars allocated to grants in which the abstracts mentioned sex or gender also did not change substantially from 2009 to 2020, with grant abstracts mentioning sex or female-specific research increasing by 1.26% and 3.47%, respectively, funding allocated to research mentioning gender decreasing by 0.49% and no change for 2S/LGBTQ +-specific health. Our findings suggest more work needs to be done to ensure the public can evaluate what populations will be examined with the funded research with respect to sex and gender to advance awareness and health equity in research.

A Call to Action for Improving LGBTQIA2S+ Inclusive Policies and Practices in Educating Science and Medical Professionals

Based on Nature's novel sex and gender guidelines, we share a call to action to enact policy changes in medical and scientific education. We conducted a literature search of current policies and practices affecting sex and gender minorities. Our work indicated a scarcity of guidelines and curricula dedicated to standardizing LGBTQIA2S+ topics. Educational policies must be enacted to ensure that sex and gender guidelines are implemented across all institutions as it impacts the future of healthcare and science. It is essential that sex and gender considerations be mandated topics in both medical and scientific education.

Call to Action: Prioritizing the Use of Inclusive, Nonstigmatizing Language in Scientific Communications

The language we use in our scientific communications can either empower or stigmatize the people we study and care for. Clinical Infectious Diseases is committed to prioritizing the use of inclusive, nonstigmatizing language in published manuscripts. We hereby call upon submitting authors, reviewers, and editors to do the same.

Amplification is the primary mode of gene-by-sex interaction in complex human traits

Sex differences in complex traits are suspected to be in part due to widespread gene-by-sex interactions (GxSex), but empirical evidence has been elusive. Here, we infer the mixture of ways in which polygenic effects on physiological traits covary between males and females. We find that GxSex is pervasive but acts primarily through systematic sex differences in the magnitude of many genetic effects ("amplification") rather than in the identity of causal variants. Amplification patterns account for sex differences in trait variance. In some cases, testosterone may mediate amplification. Finally, we develop a population-genetic test linking GxSex to contemporary natural selection and find evidence of sexually antagonistic selection on variants affecting testosterone levels. Our results suggest that amplification of polygenic effects is a common mode of GxSex that may contribute to sex differences and fuel their evolution.

Sex and gender reporting in Australian health and medical research publications

OBJECTIVE

This study aimed to determine how sex and gender are being incorporated into Australian medical research publications and if this is influenced by journals endorsing the International Committee of Medical Journal Editors (ICMJE) guidelines, which contain criteria for sex and gender reporting.

METHODS

Analysis of original research articles published in Australia's top 10 medical journals in 2020.

RESULTS

From the 10 leading journals, 1,136 articles were eligible for analysis, including 990 human participant populations. Sex and/or gender were reported for 873 (88.2%) human populations, with 480 using conflicting terminology. Only 14 (1.6%) described how sex and gender were determined. The primary outcome, or key aim, was stratified by sex and/or gender for 249 (29.2%) participant groups and the influence of sex and/or gender on the results was discussed for only 171 (17.3%). There was no significant association between endorsement of the ICMJE guidelines and adherence to any sex and gender criteria.

CONCLUSIONS

Sex and gender are poorly incorporated into Australian medical research publications and was not improved by journals endorsing the ICMJE guidelines.

IMPLICATIONS FOR PUBLIC HEALTH

Reporting and analysis of sex and gender data in health research in Australian medical journals requires improvement, for better health for all.

Parity, paradigms, and possibilities: a constructive approach to advancing women's equality

Prompted by the midpoint assessments of achievement of the United Nations Sustainable Development Goal 5 (SDG5), this article considers the pattern of progress toward women's equality and how theory and practice can be harnessed to accelerate necessary further advance. It applies Kuhn's analysis of scientific paradigm shift as an explanatory framework and draws on a cross-section of the literature on women's equality to illustrate signs of shift in the current paradigm, notably the movement away from numerical parity conceptualization and measurement to the evolution and interrogation of more nuanced notions of equality and its operationalization in various social spheres. It is proposed that this movement is propelled primarily by a method involving four inter-related elements-awareness, belief, communication, and design (a-b-c-d)-each of which is described and illustrated by examples from social science research, development organization data, and the media. Limitations and implications for future research and applied activity are discussed and the constructive orientation to the contribution of diverse responses to an increasingly complex understanding of equality identified as an important takeaway from this analysis. The approach is offered as an accessible interpretive and practical framework for more consciously advancing a paradigm shift in women's equality coherent with the SDGs.

Sex-specific morphs: the genetics and evolution of intra-sexual variation

Sex-specific morphs exhibit discrete phenotypes, often including many disparate traits, that are observed in only one sex. These morphs have evolved independently in many different animals and are often associated with alternative mating strategies. The remarkable diversity of sex-specific morphs offers unique opportunities to understand the genetic basis of complex phenotypes, as the distinct nature of many morphs makes it easier to both categorize and compare genomes than for continuous traits. Sex-specific morphs also expand the study of sexual dimorphism beyond traditional bimodal comparisons of male and female averages, as they allow for a more expansive range of sexualization. Although ecological and endocrinological studies of sex-specific morphs have been advancing for some time, genomic and transcriptomic studies of morphs are far more recent. These studies reveal not only many different paths to the evolution of sex-specific morphs but also many commonalities, such as the role of sex-determining genes and hormone signalling in morph development, and the mixing of male and female traits within some morphs.