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López-Atanes M, Sáenz-Herrero M, Zach N, Lakeberg M, Ugedo A, Fraile-García E, Erkoreka L, Segarra R, Schäfer I, Brand T. Gender sensitivity of the COVID-19 mental health research in Europe: a scoping review. Int J Equity Health 2024; 23:207. [PMID: 39385280 PMCID: PMC11465889 DOI: 10.1186/s12939-024-02286-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 09/23/2024] [Indexed: 10/12/2024] Open
Abstract
BACKGROUND The integration of sex and gender aspects into the research process has been recognized as crucial to the generation of valid data. During the coronavirus pandemic, a great deal of research addressed the mental state of hospital staff, as they constituted a population at risk for infection and distress. However, it is still unknown how the gender dimension was included. We aimed to appraise and measure qualitatively the extent of gender sensitivity. METHODS In this scoping review, we searched MEDLINE, EMBASE, CINAHL PsycINFO and Social Sciences Citation Index (SSCI) from database inception to November 11, 2021. All quantitative studies with primary data published in English, German, or Spanish and based in the European Union were selected. Included studies had to have assessed the mental health of hospital staff using validated psychometric scales for depression, anxiety, PTSD symptoms, distress, suicidal behavior, insomnia, substance abuse or aggressive behavior. Two independent reviewers applied eligibility criteria to each title/abstract reviewed, to the full text of the article, and performed the data extraction. A gender sensitivity assessment tool was developed and validated, consisting of 18 items followed by a final qualitative assessment. Two independent reviewers assessed the gender dimension of each included article. RESULTS Three thousand one hundred twelve studies were identified, of which 72 were included in the analysis. The most common design was cross-sectional (75.0%) and most of them were conducted in Italy (31.9%). Among the results, only one study assessed suicidal behaviors and none substance abuse disorders or aggressive behaviors. Sex and gender were used erroneously in 83.3% of the studies, and only one study described how the gender of the participants was determined. Most articles (71.8%) did not include sex/gender in the literature review and did not discuss sex/gender-related findings with a gender theoretical background (86.1%). In the analysis, 37.5% provided sex/gender disaggregated data, but only 3 studies performed advanced modeling statistics, such as interaction analysis. In the overall assessment, 3 papers were rated as good in terms of gender sensitivity, and the rest as fair (16.7%) and poor (79.2%). Three papers were identified in which gender stereotypes were present in explaining the results. None of the papers analyzed the results of non-binary individuals. CONCLUSIONS Studies on the mental health of hospital staff during the pandemic did not adequately integrate the gender dimension, despite the institutional commitment of the European Union and the gendered effect of the pandemic. In the development of future mental health interventions for this population, the use and generalizability of current evidence should be done cautiously.
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Affiliation(s)
- Mayte López-Atanes
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
- Department of Psychiatry and Psychotherapy of the University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
- University of the Basque Country UPV/EHU, Leioa, Spain.
| | - Margarita Sáenz-Herrero
- University of the Basque Country UPV/EHU, Leioa, Spain
- Cruces University Hospital, Barakaldo, Spain
- Biocruces-Bizkaia Health Research Institute, Barakaldo, Spain
| | - Nele Zach
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Meret Lakeberg
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Asier Ugedo
- Psychiatry Service, Barrualde Galdakao Integratet Health Organization, Galdakao, Spain
| | | | - Leire Erkoreka
- University of the Basque Country UPV/EHU, Leioa, Spain
- Biocruces-Bizkaia Health Research Institute, Barakaldo, Spain
- Psychiatry Service, Barrualde Galdakao Integratet Health Organization, Galdakao, Spain
- CIBERSAM, ISCIII, Madrid, Spain
| | - Rafael Segarra
- University of the Basque Country UPV/EHU, Leioa, Spain
- Cruces University Hospital, Barakaldo, Spain
- Biocruces-Bizkaia Health Research Institute, Barakaldo, Spain
- CIBERSAM, ISCIII, Madrid, Spain
| | - Ingo Schäfer
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Psychiatry and Psychotherapy of the University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tilman Brand
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
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2
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Regensteiner JG, Templeton K. Review of the Influences of Sex Differences on Health and Disease: What Is the Role of Journals? J Bone Joint Surg Am 2024:00004623-990000000-01215. [PMID: 39325861 DOI: 10.2106/jbjs.24.00297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/28/2024]
Abstract
➢ Sex-based differences are understudied, which has potential consequences for the health of everyone.➢ Women's health is particularly affected given a lack of sex-specific data across many disease states.➢ Journals do not consistently require the inclusion of both sexes and the disaggregation of data by sex in cell, animal model, and human studies.➢ Instructions for investigators and journals regarding the inclusion of sex-specific data are found in guidelines such as those by the Sex and Gender Equity in Research (SAGER) group, but these guidelines are underutilized.➢ Consistency in the inclusion of both sexes in studies (except in studies on diseases affecting only 1 sex), as well as in the disaggregation and reporting of results by sex, has the potential to improve health for all people.
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Affiliation(s)
- Judith G Regensteiner
- Ludeman Family Center for Women's Health Research, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado
| | - Kimberly Templeton
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
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3
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Fraser KK, Williams AG, de Silva TTA, Stebbings GK, Backhouse SH. Making competent decisions in sport and exercise science and sports medicine: Preliminary practical guidelines on sex and gender. J Sci Med Sport 2024; 27:281-284. [PMID: 38199919 DOI: 10.1016/j.jsams.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/08/2023] [Accepted: 12/09/2023] [Indexed: 01/12/2024]
Affiliation(s)
- Kotryna K Fraser
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Central Sydney Patyegarang Precinct, Australia.
| | - Alun G Williams
- Department of Sport and Exercise Sciences, Manchester Metropolitan University Institute of Sport, Manchester Metropolitan University, UK; Institute of Sport, Exercise and Health, University College London, UK; Applied Sports Science Technology and Medicine Research Centre (A-STEM), Faculty of Science and Engineering, Swansea University, UK. https://twitter.com/RugbyGeneStudy
| | - T Thirsha A de Silva
- School of Psychology, Faculty of Humanities and Sciences, Sri Lanka Institute of Information Technology, Sri Lanka. https://twitter.com/Thirsha_deSilva
| | - Georgina K Stebbings
- Department of Sport and Exercise Sciences, Manchester Metropolitan University Institute of Sport, Manchester Metropolitan University, UK. https://twitter.com/stebbina
| | - Susan H Backhouse
- Carnegie School of Sport, Leeds Beckett University, UK. https://twitter.com/Susanbackhouse
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4
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Heidari S, Fernandez DGE, Coates A, Hosseinpoor AR, Asma S, Farrar J, Kenney EM. WHO's adoption of SAGER guidelines and GATHER: setting standards for better science with sex and gender in mind. Lancet 2024; 403:226-228. [PMID: 38134947 DOI: 10.1016/s0140-6736(23)02807-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023]
Affiliation(s)
- Shirin Heidari
- Department of Gender, Rights and Equity, World Health Organization, 1211 Geneva, Switzerland.
| | | | - Anna Coates
- Department of Gender, Rights and Equity, World Health Organization, 1211 Geneva, Switzerland
| | - Ahmad Reza Hosseinpoor
- Division of Data, Analytics and Delivery for Impacts, World Health Organization, 1211 Geneva, Switzerland
| | - Samira Asma
- Division of Data, Analytics and Delivery for Impacts, World Health Organization, 1211 Geneva, Switzerland
| | - Jeremy Farrar
- Science Division, World Health Organization, 1211 Geneva, Switzerland
| | - Erin Maura Kenney
- Department of Gender, Rights and Equity, World Health Organization, 1211 Geneva, Switzerland
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5
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Heidari S, Torreele E, Gülmezoglu AM, Sekalala S, Burke-Shyne N, Chappuis GL. A gender-responsive Pandemic Accord is needed for a healthier, equitable future. Lancet 2023; 402:2176-2179. [PMID: 37802094 DOI: 10.1016/s0140-6736(23)02038-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 10/08/2023]
Affiliation(s)
- Shirin Heidari
- GENDRO, Geneva, Switzerland; Gender Centre, Geneva Graduate Institute, Maison de la Paix, Geneva, Switzerland
| | - Els Torreele
- Independent Research and consultant, Geneva, Switzerland; Institute for Innovation and Public Purpose, University College London, London WC1B 5BP, UK.
| | | | | | - Naomi Burke-Shyne
- Harm Reduction International, London, UK; Global Health Centre, Geneva Graduate Institute, Geneva, Switzerland
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6
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Bennett WL, McRae-Clark AL, Morrow MM. Mechanisms of Career Enhancement at Specialized Centers of Research Excellence (SCORE) on Sex Differences. J Womens Health (Larchmt) 2023; 32:840-842. [PMID: 37585512 PMCID: PMC10457640 DOI: 10.1089/jwh.2023.0371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Affiliation(s)
- Wendy L. Bennett
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aimee L. McRae-Clark
- Department of Psychiatry, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Melissa M.B. Morrow
- School of Health Professions, Center for Health Promotion, Performance, and Rehabilitation Research, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
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George AS, Lopes CA, Vijayasingham L, Mothupi MC, Musizvingoza R, Mishra G, Stevenson J, Remme M. A shared agenda for gender and COVID-19 research: priorities based on broadening engagement in science. BMJ Glob Health 2023; 8:e011315. [PMID: 37217235 PMCID: PMC10230361 DOI: 10.1136/bmjgh-2022-011315] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 04/18/2023] [Indexed: 05/24/2023] Open
Abstract
While the acute and collective crisis from the pandemic is over, an estimated 2.5 million people died from COVID-19 in 2022, tens of millions suffer from long COVID and national economies still reel from multiple deprivations exacerbated by the pandemic. Sex and gender biases deeply mark these evolving experiences of COVID-19, impacting the quality of science and effectiveness of the responses deployed. To galvanise change by strengthening evidence-informed inclusion of sex and gender in COVID-19 practice, we led a virtual collaboration to articulate and prioritise gender and COVID-19 research needs. In addition to standard prioritisation surveys, feminist principles mindful of intersectional power dynamics underpinned how we reviewed research gaps, framed research questions and discussed emergent findings. The collaborative research agenda-setting exercise engaged over 900 participants primarily from low/middle-income countries in varied activities. The top 21 research questions included the importance of the needs of pregnant and lactating women and information systems that enable sex-disaggregated analysis. Gender and intersectional aspects to improving vaccine uptake, access to health services, measures against gender-based violence and integrating gender in health systems were also prioritised. These priorities are shaped by more inclusive ways of working, which are critical for global health as it faces further uncertainties in the aftermath of COVID-19. It remains imperative to address the basics in gender and health (sex-disaggregated data and sex-specific needs) and also advance transformational goals to advance gender justice across health and social policies, including those related to global research.
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Affiliation(s)
- Asha S George
- School of Public Health, University of the Western Cape Faculty of Community and Health Sciences, Cape Town, South Africa
| | - Claudia A Lopes
- United Nations University International Institute for Global Health, Kuala Lumpur, Malaysia
| | - Lavanya Vijayasingham
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Mamothena Carol Mothupi
- School of Public Health, University of the Western Cape Faculty of Community and Health Sciences, Cape Town, South Africa
| | - Ronald Musizvingoza
- United Nations University International Institute for Global Health, Kuala Lumpur, Malaysia
| | - Gita Mishra
- School of Public Health, Centre for Longitudinal and Life Course Studies, University of Queensland, Brisbane, Queensland, Australia
| | - Jacqui Stevenson
- United Nations University International Institute for Global Health, Kuala Lumpur, Malaysia
| | - Michelle Remme
- United Nations University International Institute for Global Health, Kuala Lumpur, Malaysia
- The Global Fund to Fights AIDS, Tuberculosis and Malaria, Geneva, Switzerland
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8
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Batista RCP, Solans-Domènech M, Angulo-Tuesta A. The quality of gender and sex integration in scientific articles resulting from health research funded by the Brazilian Ministry of Health 2004-2016. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2023:1-10. [PMID: 37361267 PMCID: PMC9969035 DOI: 10.1007/s10389-023-01844-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/04/2023] [Indexed: 03/01/2023]
Abstract
Aim Integrating sex and gender into health research is critical to contributing to an ethical and more responsible science to address significant knowledge gaps, resulting in higher-quality evidence for all. Subject and methods Using the Essential Metrics for Assessing Sex and Gender Integration in Health Research Proposals Involving Human Participants, we evaluate the quality of the integration of sex and gender in the 350 scientific articles produced by 144 health studies funded by the Department of Science and Technology of the Brazilian Ministry of Health between 2004 and 2016. Results The results show that clinical research articles are the type of studies that most frequently report on sex differences, while population and public health research articles most frequently report on gender differences. Analysis of the quality of sex and gender integration reveals low levels of qualification in the items of the literature review and research objectives (section 1) and participant recruitment and retention (section 2). However, the data collection tools, data analysis, and knowledge translation (section 3) items were rated as excellent and good. Conclusion Funding agencies and public institutions should recognize the importance of the integration of sex and gender at all stages of the research process, for instance, through awareness and training for researchers and reviewers, clear requirements, and the possibility to use metrics in the evaluations process.
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Affiliation(s)
| | - Maite Solans-Domènech
- Barcelona – Catalonia, Agency of Health Quality and Assessment of Catalonia (AQuAS), Barcelona, Spain
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9
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Carrillo MJ, Martín U, Bacigalupe A. Gender Inequalities in Publications about COVID-19 in Spain: Authorship and Sex-Disaggregated Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2025. [PMID: 36767391 PMCID: PMC9916323 DOI: 10.3390/ijerph20032025] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
Gender inequalities in biomedical literature have been widely reported in authorship as well as the scarcity of results that are stratified by sex in the studies. We conducted a bibliometric review of articles on COVID-19 published in the main Spanish medical journals between April 2020 and May 2021. The purpose of this study was to analyse differences in authorship order and composition by sex and their evolution over time, as well as the frequency of sex-disaggregated empirical results and its relationship with the author sex in articles on COVID-19 in the main Spanish biomedical journals. We identified 914 articles and 4921 authors, 57.5% men and 42.5% women. Women accounted for 36.7% of first authors and for 33.7% of last authors. Monthly variation in authorship over the course of the pandemic indicates that women were always less likely to publish as first authors. Only 1.0% of the articles broke down empirical results by sex. Disaggregation of results by sex was significantly more frequent when women were first authors and when women were the majority in the authorship. It is important to make gender inequalities visible in scientific dissemination and to promote gender-sensitive research, which can help to reduce gender bias in clinical studies as well as to design public policies for post-pandemic recovery that are more gender-equitable.
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Affiliation(s)
- Marta Jiménez Carrillo
- Social Determinants of Health and Demographic Change, Opik Research Group, University of the Basque Country (UPV/EHU), 48080 Leioa, Spain
- Doctoral Program in Public Health, Department of Preventive Medicine and Public Health, University of the Basque Country (UPV/EHU), 48080 Leioa, Spain
- Department of Sociology and Social Work, University of the Basque Country (UPV/EHU), 48080 Leioa, Spain
| | - Unai Martín
- Social Determinants of Health and Demographic Change, Opik Research Group, University of the Basque Country (UPV/EHU), 48080 Leioa, Spain
- Department of Sociology and Social Work, University of the Basque Country (UPV/EHU), 48080 Leioa, Spain
| | - Amaia Bacigalupe
- Social Determinants of Health and Demographic Change, Opik Research Group, University of the Basque Country (UPV/EHU), 48080 Leioa, Spain
- Department of Sociology and Social Work, University of the Basque Country (UPV/EHU), 48080 Leioa, Spain
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Ponjoan A, Jacques-Aviñó C, Medina-Perucha L, Romero V, Martí-Lluch R, Alves-Cabratosa L, Ramos R, Berenguera A, Garcia-Gil MDM. Axes of social inequities in COVID-19 clinical trials: A systematic review. Front Public Health 2023; 11:1069357. [PMID: 36891333 PMCID: PMC9987589 DOI: 10.3389/fpubh.2023.1069357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 01/16/2023] [Indexed: 02/16/2023] Open
Abstract
Objective The representativeness of participants is crucial to ensure external validity of clinical trials. We focused on the randomized clinical trials which assessed COVID-19 vaccines to assess the reporting of age, sex, gender identity, race, ethnicity, obesity, sexual orientation, and socioeconomic status in the results (description of the participants' characteristics, loss of follow-up, stratification of efficacy and safety results). Methods We searched the following databases for randomized clinical trials published before 1st February 2022: PubMed, Scopus, Web of Science, and Excerpta Medica. We included peer-reviewed articles written in English or Spanish. Four researchers used the Rayyan platform to filter citations, first reading the title and abstract, and then accessing the full text. Articles were excluded if both reviewers agreed, or if a third reviewer decided to discard them. Results Sixty three articles were included, which assessed 20 different vaccines, mainly in phase 2 or 3. When describing the participants' characteristics, all the studies reported sex or gender, 73.0% race, ethnicity, 68.9% age groups, and 22.2% obesity. Only one article described the age of participants lost to follow-up. Efficacy results were stratified by age in 61.9%, sex or gender in 26.9%, race and/or, ethnicity in 9.5%, and obesity in 4.8% of the articles. Safety results were stratified by age in 41.0%, and by sex or gender in 7.9% of the analysis. Reporting of gender identity, sexual orientation or socioeconomic status of participants was rare. Parity was reached in 49.2% of the studies, and sex-specific outcomes were mentioned in 22.9% of the analysis, most of the latter were related to females' health. Conclusions Axes of social inequity other than age and sex were hardly reported in randomized clinical trials that assessed COVID-19 vaccines. This undermines their representativeness and external validity and sustains health inequities.
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Affiliation(s)
- Anna Ponjoan
- Grup en Salut Vascular de Girona (ISV-Girona), Institut Universitari d'Investigació en Atenció Primària (IDIAPJGol), Girona, Spain.,Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta (IDIBGI), Girona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Constanza Jacques-Aviñó
- Universitat Autònoma de Barcelona, Bellaterra, Spain.,Institut Universitari d'Investigació en Atenció Primària (IDIAPJGol), Barcelona, Spain
| | - Laura Medina-Perucha
- Universitat Autònoma de Barcelona, Bellaterra, Spain.,Institut Universitari d'Investigació en Atenció Primària (IDIAPJGol), Barcelona, Spain
| | - Victor Romero
- Servicio Canario de la Salud, Santa Cruz de Tenerife, Spain
| | - Ruth Martí-Lluch
- Grup en Salut Vascular de Girona (ISV-Girona), Institut Universitari d'Investigació en Atenció Primària (IDIAPJGol), Girona, Spain.,Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta (IDIBGI), Girona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Lia Alves-Cabratosa
- Grup en Salut Vascular de Girona (ISV-Girona), Institut Universitari d'Investigació en Atenció Primària (IDIAPJGol), Girona, Spain
| | - Rafel Ramos
- Grup en Salut Vascular de Girona (ISV-Girona), Institut Universitari d'Investigació en Atenció Primària (IDIAPJGol), Girona, Spain.,Department of Medical Sciences, School of Medicine, Universitat de Girona, Girona, Spain
| | - Anna Berenguera
- Institut Universitari d'Investigació en Atenció Primària (IDIAPJGol), Barcelona, Spain.,Department of Nursing, Universitat de Girona, Girona, Spain
| | - María Del Mar Garcia-Gil
- Grup en Salut Vascular de Girona (ISV-Girona), Institut Universitari d'Investigació en Atenció Primària (IDIAPJGol), Girona, Spain
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Vijayasingham L, Heidari S, Munro J, Omer S, MacDonald N. Resolving sex and gender bias in COVID-19 vaccines R&D and beyond. Hum Vaccin Immunother 2022; 18:2035142. [PMID: 35143380 PMCID: PMC9009935 DOI: 10.1080/21645515.2022.2035142] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The influence of sex and gender in immune response and vaccine outcomes is established in many disease areas, including in COVID-19. Yet, there are notable gaps in the consideration of sex and gender in the analysis and reporting of COVID-19 vaccines clinical trial data. The push for stronger sex and gender integration in vaccines science should be championed by all researchers and stakeholders across the R&D and access ecosystem - not just gender experts. This requires joint action on the tactical framing of customized value propositions (based on stakeholder motivations), the stronger enforcement of existing regulation, tools, and commitments, and aligning the overall agenda to parallel calls on intersectionality, equity diversity and inclusion.
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Affiliation(s)
- Lavanya Vijayasingham
- Gender and Health Hub, United Nations University- International Institute for Global Health, Kuala Lumpur, Malaysia
- CONTACT Lavanya Vijayasingham Gender and Health Hub, United Nations University- International Institute for Global Health, UKM Medical Centre, Jalan Yaacob Latif, 56000 Kuala Lumpur, Malaysia
| | - Shirin Heidari
- GENDRO, Geneva, Switzerland
- Global Health Centre, Graduate Institute of International and Development Studies, Geneva, Switzerland
| | - Jean Munro
- Gender Equality, GAVI Vaccine Alliance, Geneva, Switzerland
| | - Saad Omer
- Yale Institute for Global Health, Yale University, New Haven, CT, USA
| | - Noni MacDonald
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
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Pak J, Lund JL, Keil A, Westreich D, Stürmer T, Wohl D, Farel C, Drummond MB, Webster-Clark M. A systematic review of whether COVID-19 randomized controlled trials reported on demographic and clinical characteristics. Pharmacoepidemiol Drug Saf 2022; 31:1219-1227. [PMID: 35996832 PMCID: PMC9538362 DOI: 10.1002/pds.5533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 06/18/2022] [Accepted: 08/19/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE We aim to assess the reporting of key patient-level demographic and clinical characteristics among COVID-19 related randomized controlled trials (RCTs). METHODS We queried English-language articles from PubMed, Web of Science, clinicaltrials.gov, and the CDC library of gray literature databases using keywords of "coronavirus," "covid," "clinical trial" and "randomized controlled trial" from January 2020 to June 2021. From the search, we conducted an initial review to rule-out duplicate entries, identify those that met inclusion criteria (i.e., had results), and exclude those that did not meet the definition of an RCT. Lastly, we abstracted the demographic and clinical characteristics reported on within each RCT. RESULTS From the initial 43 627 manuscripts, our final eligible manuscripts consisted of 149 RCTs described in 137 articles. Most of the RCTs (113/149) studied potential treatments, while fewer studied vaccines (29), prophylaxis strategies (5), and interventions to prevent transmission among those infected (2). Study populations ranged from 10 to 38 206 participants (median = 100, IQR: 60-300). All 149 RCTs reported on age, 147 on sex, 50 on race, and 110 on the prevalence of at least one comorbidity. No RCTs reported on income, urban versus rural residence, or other indicators of socioeconomic status (SES). CONCLUSIONS Limited reporting on race and other markers of SES make it difficult to draw conclusions about specific external target populations without making strong assumptions that treatment effects are homogenous. These findings highlight the need for more robust reporting on the clinical and demographic profiles of patients enrolled in COVID-19 related RCTs.
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Affiliation(s)
- Joyce Pak
- Department of Epidemiology, UNC Gillings School of Global Public health, University of North Carolina at Chapel Hill, USA
| | - Jennifer L. Lund
- Department of Epidemiology, UNC Gillings School of Global Public health, University of North Carolina at Chapel Hill, USA
| | - Alexander Keil
- Department of Epidemiology, UNC Gillings School of Global Public health, University of North Carolina at Chapel Hill, USA
| | - Daniel Westreich
- Department of Epidemiology, UNC Gillings School of Global Public health, University of North Carolina at Chapel Hill, USA
| | - Til Stürmer
- Department of Epidemiology, UNC Gillings School of Global Public health, University of North Carolina at Chapel Hill, USA
| | - David Wohl
- Department of Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, USA
| | - Claire Farel
- Department of Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, USA
| | - M. Bradley Drummond
- Department of Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, USA
| | - Michael Webster-Clark
- Department of Epidemiology, UNC Gillings School of Global Public health, University of North Carolina at Chapel Hill, USA
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Manca TA, Sadarangani M, Halperin SA, Langley JM, McClymont E, MacDonald SE, Top KA. Vaccine regulation should require and enforce the inclusion of pregnant and breastfeeding women in prelicensure clinical trials. Hum Vaccin Immunother 2022; 18:2104019. [PMID: 35880903 DOI: 10.1080/21645515.2022.2104019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Exclusion of pregnant and breastfeeding women from the pivotal randomized controlled trials for COVID-19 vaccines that led to emergency regulatory approval created gaps in data needed for vaccine policy, healthcare provider recommendations, and women's decisions about vaccination. We argue that such knowledge gaps increase potential for vaccine hesitancy and misinformation relating to the health of women and infants, and that these gaps in evidence are avoidable. Over several decades, ethical and scientific guidance, scholarship, and advocacy in favor of pregnant and breastfeeding women's participation in clinical development of vaccines has accumulated. Guidance on how to include pregnant and breastfeeding women in vaccine trials ethically and safely predates the COVID-19 pandemic but has yet to be routinely incorporated in vaccine development. We highlight the important role regulatory authorities could play in requiring that pregnant and breastfeeding women be eligible as volunteer participants in prelicensure vaccine trials for products that are expected to be used in this population. Inclusion of pregnant and breastfeeding populations in clinical trials leading to market approval or emergency use authorization should be undertaken early or concurrently at the time of trials in the general population.
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Affiliation(s)
- Terra A Manca
- Canadian Center for Vaccinology, IWK Health, Nova Scotia Health and Dalhousie University, Halifax, Canada.,Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Scott A Halperin
- Canadian Center for Vaccinology, IWK Health, Nova Scotia Health and Dalhousie University, Halifax, Canada.,Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Joanne M Langley
- Canadian Center for Vaccinology, IWK Health, Nova Scotia Health and Dalhousie University, Halifax, Canada
| | - Elisabeth McClymont
- Department of Pediatrics, University of British Columbia, Vancouver, Canada.,Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada
| | - Shannon E MacDonald
- Faculty of Nursing, University of Alberta, Edmonton, Canada.,School of Public health, University of Alberta, Edmonton, Canada
| | - Karina A Top
- Canadian Center for Vaccinology, IWK Health, Nova Scotia Health and Dalhousie University, Halifax, Canada.,Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Canada
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14
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McDougal L, Dehingia N, Cheung WW, Dixit A, Raj A. COVID-19 burden, author affiliation and women's well-being: A bibliometric analysis of COVID-19 related publications including focus on low- and middle-income countries. EClinicalMedicine 2022; 52:101606. [PMID: 35936025 PMCID: PMC9347236 DOI: 10.1016/j.eclinm.2022.101606] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 12/28/2022] Open
Abstract
Background Published literature documents tremendous gender inequities in the social, economic and health effects of the COVID-19 pandemic, but less evidence has come from low- and middle-income countries (LMICs) and even less from LMIC-based authors. We examine whether a) COVID-19 burden and b) LMIC-based authorship were associated with academic publications related to COVID-19 and women's well-being in LMICs. Methods We reviewed academic articles on COVID-19 and women's well-being in LMICs published between February 2020 and May 2021 (n=1076 articles), using six electronic databases (PubMed, Web of Science, PsycInfo, EconLit, RePeC, NBER). Multilevel, mixed effects linear regressions assessed the relationships between each of our independent variables - a) COVID-19 burden (cases/100 population, deaths/100 population, deaths/cases) and b) author's country of primary affiliation, with publications related to COVID-19 and women's well-being, both overall and stratified by country income group. Findings Eight-eight percent of articles had lead and/or senior authors affiliated with in-country institutions. Linear mixed effect models indicate that COVID-19 cases and case fatality ratios in a country were significantly and positively associated with the number of publications related to COVID-19 and women's well-being, though these relationships were significant only in upper-middle income group countries in stratified analyses. LMIC lead and senior authorship were also significantly and positively associated with our outcome, after adjusting for COVID-19 burden. Interpretation While the majority of COVID-19 research examining women's well-being in LMICs in the first year and a half of the pandemic included country-affiliated author leadership, there were important gaps in representation. Findings highlight the importance of LMIC-based scholars to build local and gendered research in crises. Funding Bill and Melinda Gates Foundation (INV-018007).
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Affiliation(s)
- Lotus McDougal
- Center on Gender Equity and Health, Department of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego. 9500 Gilman Dr, La Jolla, CA 92093, United States
| | - Nabamallika Dehingia
- Center on Gender Equity and Health, Department of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego. 9500 Gilman Dr, La Jolla, CA 92093, United States
| | - Wendy Wei Cheung
- Center on Gender Equity and Health, Department of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego. 9500 Gilman Dr, La Jolla, CA 92093, United States
| | - Anvita Dixit
- Center on Gender Equity and Health, Department of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego. 9500 Gilman Dr, La Jolla, CA 92093, United States
| | - Anita Raj
- Center on Gender Equity and Health, Department of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego. 9500 Gilman Dr, La Jolla, CA 92093, United States
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15
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Heidari S. Gender perspective in COVID-19. SESPAS Report 2022. GACETA SANITARIA 2022; 36 Suppl 1:S26-S29. [PMID: 35781144 PMCID: PMC9244841 DOI: 10.1016/j.gaceta.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/04/2021] [Accepted: 10/10/2021] [Indexed: 11/28/2022]
Abstract
We failed to adequately launch a gender transformative response to COVID-19 pandemic, data by sex on a variety of indicators for most countries are hard to find. Some symptoms reported as common of COVID-19 infection, are more prominent in men, while others are more prominent in women, one cannot with certainty exclude that some of the differences observed could be due to gender bias in the management of cases in health services. The gender implications of the pandemic reach wide and far. Inequalities can be further aggravated as sex and gender intersect with other axes of inequality. The SAGER guidelines exemplify an effort to improve reporting of sex and gender dimensions and encouraging researchers to integrate these aspects in the research design. these observations and emerging evidence about the persistent gender-blind approach to COVID-19 is a wake-up call to change course. National Gender Equality Institutions can be central in ensuring gender matters are considered in government responses. COVID-19 pandemic is an opportunity to reverse the trend and take action to apply an intersectional feminist approach to global health that enables a just and equal world where everyone's health and wellbeing matter.
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Key Words
- Sex, Gender, Sex-differences, gender bias, COVID-19, Disease outbreaks analysis, Disease outbreak statistics and numerical data
- Sexo, género, diferencias de sexo, sesgo de género, COVID-19, análisis de brotes de enfermedades, estadísticas de brotes de enfermedades y datos numéricos
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Affiliation(s)
- Shirin Heidari
- GENDRO, Geneva, Switzerland; Global Health Centre, Graduate Institute of International and Development Studies, Geneva, Switzerland.
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16
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de Vries ST, Starokozhko V, Schellens IMM, Wijnans L, Enzmann H, Cavaleri M, Mol PGM. Attention for sex in COVID-19 trials: a review of regulatory dossiers. BMJ Glob Health 2022; 7:bmjgh-2021-008173. [PMID: 35304352 PMCID: PMC8935005 DOI: 10.1136/bmjgh-2021-008173] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/08/2022] [Indexed: 12/13/2022] Open
Abstract
An under-representation of women and a lack of sex-specific analyses in COVID-19 trials has been suggested. However, the higher number of men than women who are severely affected by COVID-19 and the restricted information in scientific publications may have biased these suggestions. Therefore, we evaluated sex proportionality and sex-specific efficacy and safety data in trials of COVID-19 treatments and vaccines using both publicly available regulatory documents and confidential documents used by regulators in their review of medicinal products. Included were two treatments (ie, remdesivir and dexamethasone) and four vaccines (ie, BNT162b2 mRNA (BioNTech/Pfizer), mRNA-1273 (Moderna), ChAdOx1-S (AstraZeneca) and Ad26.COV2-S (Janssen)) that received marketing authorisation by the European Commission at the time of the study conduct. An under-representation of women was shown in three of the nine data sets for one treatment (ie, remdesivir), but the proportion of women included was representative in each of the data sets for the other five products. This indicates that there is no structural under-representation of women in the COVID-19 trials. Currently, sex-specific efficacy data are available for five of the six assessed products and sex-specific safety data are available for half of the products only. It is important that this information will also be made available for the other products. There are only small differences in efficacy and safety between men and women which are likely to be of limited clinical relevance. Sex-specific efficacy information can generally be found in the publicly available regulatory documents other than the Summary of Product Characteristics, for which more awareness might be required.
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Affiliation(s)
- Sieta T de Vries
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Dutch Medicines Evaluation Board, Utrecht, The Netherlands
| | - Viktoriia Starokozhko
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Dutch Medicines Evaluation Board, Utrecht, The Netherlands
| | | | | | - Harald Enzmann
- Committee for Medicinal Products for Human Use, European Medicines Agency (EMA), Amsterdam, The Netherlands.,Bundesinstitut für Arzneimittel und Medizinprodukte, Bonn, Germany
| | - Marco Cavaleri
- European Medicines Agency (EMA), Amsterdam, The Netherlands
| | - Peter G M Mol
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands .,Dutch Medicines Evaluation Board, Utrecht, The Netherlands.,Scientific Advice Working Party, European Medicines Agency (EMA), Amsterdam, The Netherlands
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17
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Hussain M, Fatima M, Muhammad Iqbal S, Asif M, Saadullah M, Kashif-Ur-Rehman, Mukhtar I, Ahmad Khan I, Parveen S, Fayyaz T, Shabbir N, Kanwal A, Shaukat S, Fatima M, Ikram N, Majeed A, Parveen F, Tariq M, Barkat MQ, Zeng LH, Wu X. COVID-19 vaccine trials and sex-disaggregated data. Expert Rev Vaccines 2022; 21:285-288. [PMID: 34894982 PMCID: PMC8726001 DOI: 10.1080/14760584.2022.2015331] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 12/03/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Musaddique Hussain
- Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Mehwish Fatima
- Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Shahid Muhammad Iqbal
- Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Muhammad Asif
- Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Malik Saadullah
- Department of Pharmaceutical Chemistry, Government College University, Faisalabad, Pakistan
| | - Kashif-Ur-Rehman
- Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Imran Mukhtar
- Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Imran Ahmad Khan
- Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Sajida Parveen
- Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Tehreem Fayyaz
- Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Najia Shabbir
- Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Aisha Kanwal
- Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Saira Shaukat
- Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Mobeen Fatima
- Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Nadia Ikram
- Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Abdul Majeed
- Faculty of Pharmacy, Bahauddin Zakariya University, MultanPakistan
| | - Farzana Parveen
- Faculty of Pharmacy, Bahauddin Zakariya University, MultanPakistan
| | | | - Muhammad Qasim Barkat
- Department of Pharmacology, School of Medicine, Zhejiang University, Hangzhou City, China
| | - Ling-Hui Zeng
- Department of Pharmacology, Zhejiang University City College, Hangzhou, China
| | - Ximei Wu
- Department of Pharmacology, School of Medicine, Zhejiang University, Hangzhou City, China
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18
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Garcia LP. Equidade de sexo e gênero na pesquisa e na publicação científica: as diretrizes SAGER e suas listas de verificação. REVISTA BRASILEIRA DE SAÚDE OCUPACIONAL 2022. [DOI: 10.1590/2317-6369nt122pt2022v47e21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Resumo Diferenças de sexo e gênero são elementos importantes para se considerar na pesquisa e na publicação científica. Diversos esforços têm sido empreendidos no meio científico para incorporar as dimensões sexo e gênero em todo o ciclo da pesquisa, especialmente na área da Saúde. As diretrizes sobre Equidade de Sexo e Gênero na Pesquisa (Sex and Gender Equity in Research - SAGER) dedicam-se a guiar autores na preparação dos manuscritos, mas também são úteis para editores e revisores de periódicos, bem como para avaliadores das agências de fomento, buscando promover a integração de sexo e gênero na pesquisa, em diversas disciplinas. Para facilitar a adesão às diretrizes SAGER e encorajar uma abordagem mais sistemática no relato dessas variáveis na pesquisa, foram desenvolvidas duas listas de checagem: uma para estudos com participantes humanos e outra para os demais estudos (ciência aplicada, biologia celular etc.). Esta nota apresenta as versões em português dessas listas e destaca sua relevância para o aprimoramento do relato das pesquisas comunicadas nos periódicos, como prática de integridade científica.
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Affiliation(s)
- Leila Posenato Garcia
- Fundação Jorge Duprat Figueiredo de Segurança e Medicina do Trabalho (Fundacentro), Brasil
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19
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Thompson K, Vassallo A, Finfer S, Woodward M. Renewed rationale for sex- and gender-disaggregated research: A COVID-19 commentary review. WOMEN'S HEALTH 2022; 18:17455065221076738. [PMID: 35107040 PMCID: PMC8814978 DOI: 10.1177/17455065221076738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The COVID-19 pandemic provides a contemporaneous illustration of the need to consider sex and gender in research. Using surveillance, treatment and vaccine research examples, in this commentary review, we highlight opportunities for innovation in sex- and gender-sensitive and transformative health and medical research.
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Affiliation(s)
- Kelly Thompson
- The George Institute for Global Health, University of New South Wales (UNSW), Newtown, NSW, Australia
| | - Amy Vassallo
- The George Institute for Global Health, University of New South Wales (UNSW), Newtown, NSW, Australia
| | - Simon Finfer
- The George Institute for Global Health, University of New South Wales (UNSW), Newtown, NSW, Australia
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
| | - Mark Woodward
- The George Institute for Global Health, University of New South Wales (UNSW), Newtown, NSW, Australia
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
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20
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Peters SAE, Babor TF, Norton RN, Clayton JA, Ovseiko PV, Tannenbaum C, Heidari S. Fifth anniversary of the Sex And Gender Equity in Research (SAGER) guidelines: taking stock and looking ahead. BMJ Glob Health 2021; 6:bmjgh-2021-007853. [PMID: 34815246 PMCID: PMC8611433 DOI: 10.1136/bmjgh-2021-007853] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/08/2021] [Indexed: 01/12/2023] Open
Affiliation(s)
- Sanne A E Peters
- The George Institute for Global Health, Imperial College London, London, UK .,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Thomas F Babor
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Robyn N Norton
- The George Institute for Global Health, Imperial College London, London, UK.,The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Janine A Clayton
- Office of Research on Women's Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Pavel V Ovseiko
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Cara Tannenbaum
- Canadian Institutes of Health Research, Institute of Gender and Health, Universite de Montreal, Montreal, Quebec, Canada
| | - Shirin Heidari
- GENDRO, Geneva, Switzerland.,Global Health Center, Graduate Institute of International and Development Studies, Geneva, Switzerland
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21
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Heidari S, Palmer-Ross A, Goodman T. A Systematic Review of the Sex and Gender Reporting in COVID-19 Clinical Trials. Vaccines (Basel) 2021; 9:1322. [PMID: 34835253 PMCID: PMC8622702 DOI: 10.3390/vaccines9111322] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/02/2021] [Accepted: 11/09/2021] [Indexed: 01/12/2023] Open
Abstract
Sex and gender have implications for COVID-19 vaccine efficacy and adverse effects from the vaccine. As vaccination is one of the key responses to the COVID-19 pandemic, it is vital that sex and gender differences be acknowledged, measured, and analysed in clinical research. Here, we systematically review published COVID-19 vaccine trials, both interventional and observational, to assess the quality of reporting of sex and gender. Of the 75 clinical trials on COVID-19 vaccines included in this review, only 24% presented their main outcome data disaggregated by sex, and only 13% included any discussion of the implications of their study for women and men. Considering the sex differences in adverse events after vaccination, and the gendered aspects of vaccine hesitancy, these oversights in clinical research on vaccines have implications for recovery from the COVID-19 pandemic and for wider public health.
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Affiliation(s)
- Shirin Heidari
- Gender Equity and Human Rights, World Health Organisation, 1211 Geneva, Switzerland
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22
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Vassallo A, Shajahan S, Harris K, Hallam L, Hockham C, Womersley K, Woodward M, Sheel M. Sex and Gender in COVID-19 Vaccine Research: Substantial Evidence Gaps Remain. Front Glob Womens Health 2021; 2:761511. [PMID: 34816252 PMCID: PMC8593988 DOI: 10.3389/fgwh.2021.761511] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/08/2021] [Indexed: 12/22/2022] Open
Abstract
Since the start of the COVID-19 pandemic there has been a global call for sex/gender-disaggregated data to be made available, which has uncovered important findings about COVID-19 testing, incidence, severity, hospitalisations, and deaths. This mini review scopes the evidence base for efficacy, effectiveness, and safety of COVID-19 vaccines from both experimental and observational research, and asks whether (1) women and men were equally recruited and represented in vaccine research, (2) the outcomes of studies were presented or analysed by sex and/or gender, and (3) there is evidence of sex and/or gender differences in outcomes. Following a PubMed search, 41 articles were eligible for inclusion, including seven randomised controlled trials (RCTs), 11 cohort studies, eight cross-sectional surveys, eight routine surveillance studies, and seven case series. Overall, the RCTs contained equal representation of women and men; however, the observational studies contained a higher percentage of women. Of 10 studies with efficacy data, only three (30%) presented sex/gender-disaggregated results. Safety data was included in 35 studies and only 12 (34%) of these presented data by sex/gender. For those that did present disaggregated data, overall, the majority of participants reporting adverse events were women. There is a paucity of reporting and analysis of COVID-19 vaccine data by sex/gender. Research should be designed in a gender-sensitive way to present and, where possible analyse, data by sex/gender to ensure that there is a robust and specific evidence base of efficacy and safety data to assist in building public confidence and promote high vaccine coverage.
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Affiliation(s)
- Amy Vassallo
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Sultana Shajahan
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Katie Harris
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Laura Hallam
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Carinna Hockham
- The George Institute for Global Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Kate Womersley
- The George Institute for Global Health, School of Public Health, Imperial College London, London, United Kingdom
- University of Edinburgh, NHS Lothian, Edinburgh, United Kingdom
| | - Mark Woodward
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- The George Institute for Global Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Meru Sheel
- National Centre for Epidemiology and Population Health, Research School of Population Health, ANU College of Health and Medicine, Australian National University, Canberra, ACT, Australia
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23
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Young SL, Bethancourt HJ, Ritter ZR, Frongillo EA. The Individual Water Insecurity Experiences (IWISE) Scale: reliability, equivalence and validity of an individual-level measure of water security. BMJ Glob Health 2021; 6:bmjgh-2021-006460. [PMID: 34615660 PMCID: PMC8493920 DOI: 10.1136/bmjgh-2021-006460] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/09/2021] [Indexed: 02/07/2023] Open
Abstract
Objective The lack of a validated and cross-culturally equivalent scale for measuring individual-level water insecurity has prevented identification of those most vulnerable to it. Therefore, we developed the 12-item Individual Water InSecurity Experiences (IWISE) Scale to comparably measure individual experiences with access, use, and stability (reliability) of water. Here, we examine the reliability, cross-country equivalence, and cross-country and within-country validity of the scale in a cross-sectional sample. Methods IWISE items were implemented by the Gallup World Poll among nationally representative samples of 43 970 adults (>15 y) in 31 low-income and middle-income countries (LMICs). Internal consistency was assessed with Cronbach’s alpha. Equivalence was tested using multigroup confirmatory factor analysis (MGCFA), the alignment method, and item response theory. Cross-country validity was assessed by regressing mean national IWISE scores on measures of economic, social, and water infrastructure development. Within-country validity was tested with logistic regression models of dissatisfaction with local water quality by IWISE score and regressing individual IWISE scores on per capita household income and difficulty getting by on current income. Findings Internal consistency was high; Cronbach’s alpha was ≥0.89 in all countries. Goodness-of-fit statistics from MGCFA, the proportion of equivalent item thresholds and loadings in the alignment models, and Rasch output indicated equivalence across countries. Validity across countries was also established; country mean IWISE scores were negatively associated with gross domestic product and percentage of the population with access to basic water services, but positively associated with fertility rate. Validity within countries was also demonstrated; individuals’ IWISE scores were positively associated with greater odds of dissatisfaction with water quality and negatively associated with lower financial standing. Conclusions The IWISE Scale provides an equivalent measure of individual experiences with water access and use across LMICs. It will be useful for establishing and tracking changes in the prevalence of water insecurity and identifying groups who have been ‘left behind’.
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Affiliation(s)
- Sera L Young
- Anthropology, Northwestern University, Evanston, Illinois, USA .,Institute for Policy Research, Northwestern University, Evanston, IL, USA
| | | | | | - Edward A Frongillo
- Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, USA
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24
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Heidari S, Durrheim DN, Faden R, Kochhar S, MacDonald N, Olayinka F, Goodman TS. Time for action: towards an intersectional gender approach to COVID-19 vaccine development and deployment that leaves no one behind. BMJ Glob Health 2021; 6:e006854. [PMID: 34389628 PMCID: PMC8366282 DOI: 10.1136/bmjgh-2021-006854] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 07/23/2021] [Indexed: 12/29/2022] Open
Affiliation(s)
- Shirin Heidari
- Gender, Equity and Human Rights Unit, World Health Organization, Geneva, Switzerland
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - David N Durrheim
- Public Health Medicine, University of Newcastle, Newcastle, New South Wales, Australia
- Member of WHO Strategic Advisory Group of Experts (SAGE) COVID-19 Vaccines Working Group, Geneva, Geneva, Switzerland
| | - Ruth Faden
- Member of WHO Strategic Advisory Group of Experts (SAGE) COVID-19 Vaccines Working Group, Geneva, Geneva, Switzerland
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sonali Kochhar
- Member of WHO Strategic Advisory Group of Experts (SAGE) COVID-19 Vaccines Working Group, Geneva, Geneva, Switzerland
- Global Health, Global Healthcare Consulting, New Delhi, India
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Noni MacDonald
- Member of WHO Strategic Advisory Group of Experts (SAGE) COVID-19 Vaccines Working Group, Geneva, Geneva, Switzerland
- Department of Pediatrics, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
- Member WHO Strategic Advisory Group of Experts (SAGE), Geneva, Switzerland
| | - Folake Olayinka
- Member of WHO Strategic Advisory Group of Experts (SAGE) COVID-19 Vaccines Working Group, Geneva, Geneva, Switzerland
- Member WHO Strategic Advisory Group of Experts (SAGE), Geneva, Switzerland
- Public Health Institute/STAR, Washington, DC, USA
| | - Tracey S Goodman
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
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Campesi I, Racagni G, Franconi F. Just a Reflection: Does Drug Repurposing Perpetuate Sex-Gender Bias in the Safety Profile? Pharmaceuticals (Basel) 2021; 14:730. [PMID: 34451827 PMCID: PMC8402096 DOI: 10.3390/ph14080730] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 02/08/2023] Open
Abstract
Vaccines constitute a strategy to reduce the burden of COVID-19, but the treatment of COVID-19 is still a challenge. The lack of approved drugs for severe COVID-19 makes repurposing or repositioning of approved drugs a relevant approach because it occurs at lower costs and in a shorter time. Most preclinical and clinical tests, including safety and pharmacokinetic profiles, were already performed. However, infective and inflammatory diseases such as COVID-19 are linked with hypoalbuminemia and downregulation of both phase I and phase II drug-metabolizing enzymes and transporters, which can occur in modifications of pharmacokinetics and consequentially of safety profiles. This appears to occur in a sex- and gender-specific way because of the sex and gender differences present in the immune system and inflammation, which, in turn, reflect on pharmacokinetic parameters. Therefore, to make better decisions about drug dosage regimens and to increases the safety profile in patients suffering from infective and inflammatory diseases such as COVID-19, it is urgently needed to study repurposing or repositioning drugs in men and in women paying attention to pharmacokinetics, especially for those drugs that are previously scarcely evaluated in women.
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Affiliation(s)
- Ilaria Campesi
- Department of Biomedical Science, University of Sassari, 07100 Sassari, Italy
- National Laboratory of Pharmacology and Gender Medicine, National Institute of Biostructure and Biosystem, 07100 Sassari, Italy;
| | - Giorgio Racagni
- Department of Pharmacological and Biomolecular Sciences, University of Milan, 20133 Milan, Italy;
| | - Flavia Franconi
- National Laboratory of Pharmacology and Gender Medicine, National Institute of Biostructure and Biosystem, 07100 Sassari, Italy;
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