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Talia AJ, Busuttil NA, Kendal AR, Brown R. Gender differences in foot and ankle sporting injuries: A systematic literature review. Foot (Edinb) 2024; 60:102122. [PMID: 39121692 DOI: 10.1016/j.foot.2024.102122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND In response to the all-time high of female sports participation, there has been increasing scientific discourse and media interest in women's sporting injuries in recent years. In gender comparable sports the rate of foot and ankle injury for women is higher than for men. There are intrinsic and extrinsic factors which may explain this difference. METHODS A systematic literature search was performed according to the PRISMA guidelines of PubMed, Ovid EMBASE and OVID MEDLINE. Relevant key terms were used to narrow the scope of the search prior to screening. Case reports, review articles, paediatric patients, non foot and ankle injuries and combat sports were excluded. We used dual author, two pass screening to arrive at final included studies. RESULTS 2510 articles were screened after duplicate exclusion. 104 were included in this literature review. We identified lack of reporting gender difference in the literature.We identified that females have higher frequency and severity of injury. We provide an overview of our current understanding of ankle ligament complex injuries, stress fractures, ostochondral lesions of the talus and Achilles tendon rupture. We expand on the evidence of two codes of football, soccer and Australian rules, as a "case study" of how injury patterns differ between genders in the same sport. We identify gender specific characteristics including severity, types of injury, predisposing risk factors, anatomy, endocrinology and biomechanics associated with injuries. Finally, we examine the effect of level of competition on female injury patterns. CONCLUSIONS There is a lack of scientific reporting of gender differences of foot and ankle injuries. Female athletes suffer foot and ankle injuries at higher rates and with greater severity compared to males. This is an under-reported, yet important area of orthopaedics and sports medicine to understand, and hence reduce the injury burden for female athletes.
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Affiliation(s)
- Adrian J Talia
- Department of Foot & Ankle Surgery, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK; Department of Orthopaedic Surgery, Western Health, Footscray Hospital, Gordon Street, Footscray, VIC 3011, Australia; Melbourne Orthopaedic Group, 33 The Avenue, Windsor, VIC 3181, Australia.
| | - Nicholas A Busuttil
- Institute for Health and Sport, Victoria University, Melbourne, Australia; Performance Science, Research and Innovation, The Movement Institute, Melbourne, Australia.
| | - Adrian R Kendal
- Department of Foot & Ankle Surgery, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK; The Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK.
| | - Rick Brown
- Department of Foot & Ankle Surgery, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK.
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Granton D, Rodrigues M, Raparelli V, Honarmand K, Agarwal A, Friedrich JO, Perna B, Spaggiari R, Fortunato V, Risdonne G, Kho M, VanderKaay S, Chaudhuri D, Gomez-Builes C, D'Aragon F, Wiseman D, Lau VI, Lin C, Reid J, Trivedi V, Prakash V, Belley-Cote E, Al Mandhari M, Thabane L, Pilote L, Burns KEA. Sex and gender-based analysis and diversity metric reporting in acute care trials published in high-impact journals: a systematic review. BMJ Open 2024; 14:e081118. [PMID: 38719297 PMCID: PMC11103199 DOI: 10.1136/bmjopen-2023-081118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/23/2024] [Indexed: 05/22/2024] Open
Abstract
OBJECTIVE To characterise sex and gender-based analysis (SGBA) and diversity metric reporting, representation of female/women participants in acute care trials and temporal changes in reporting before and after publication of the 2016 Sex and Gender Equity in Research guideline. DESIGN Systematic review. DATA SOURCES We searched MEDLINE for trials published in five leading medical journals in 2014, 2018 and 2020. STUDY SELECTION Trials that enrolled acutely ill adults, compared two or more interventions and reported at least one clinical outcome. DATA ABSTRACTION AND SYNTHESIS 4 reviewers screened citations and 22 reviewers abstracted data, in duplicate. We compared reporting differences between intensive care unit (ICU) and cardiology trials. RESULTS We included 88 trials (75 (85.2%) ICU and 13 (14.8%) cardiology) (n=111 428; 38 140 (34.2%) females/women). Of 23 (26.1%) trials that reported an SGBA, most used a forest plot (22 (95.7%)), were prespecified (21 (91.3%)) and reported a sex-by-intervention interaction with a significance test (19 (82.6%)). Discordant sex and gender terminology were found between headings and subheadings within baseline characteristics tables (17/32 (53.1%)) and between baseline characteristics tables and SGBA (4/23 (17.4%)). Only 25 acute care trials (28.4%) reported race or ethnicity. Participants were predominantly white (78.8%) and male/men (65.8%). No trial reported gendered-social factors. SGBA reporting and female/women representation did not improve temporally. Compared with ICU trials, cardiology trials reported significantly more SGBA (15/75 (20%) vs 8/13 (61.5%) p=0.005). CONCLUSIONS Acute care trials in leading medical journals infrequently included SGBA, female/women and non-white trial participants, reported race or ethnicity and never reported gender-related factors. Substantial opportunity exists to improve SGBA and diversity metric reporting and recruitment of female/women participants in acute care trials. PROSPERO REGISTRATION NUMBER CRD42022282565.
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Affiliation(s)
- David Granton
- Department of Medicine and Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
| | - Myanca Rodrigues
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Valeria Raparelli
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- University Center for Studies on Gender Medicine, University of Ferrara, Ferrara, Italy
| | - Kimia Honarmand
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Division of Critical Care, Mackenzie Health, Vaughan, Ontario, Canada
| | - Arnav Agarwal
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jan O Friedrich
- Department of Medicine and Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
- Critical Care and Medicine Departments, Unity Health Toronto, Toronto, Ontario, Canada
| | - Benedetta Perna
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Riccardo Spaggiari
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Valeria Fortunato
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Gianluca Risdonne
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Michelle Kho
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
- Physiotherapy Department, Research Institute of St. Joe's Hamilton, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Sandra VanderKaay
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Dipayan Chaudhuri
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Carolina Gomez-Builes
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Frédérick D'Aragon
- Department of Anesthesiology, Universite de Sherbrooke, Sherbrooke, Quebec, Canada
- Centre de Recherche du Centre Hospitalier, Universite de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Daniel Wiseman
- Departments of Medicine and Critical Care Medicine, McGill University, Montreal, Quebec, Canada
| | - Vincent Issac Lau
- Department of Critical Care Medicine, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
| | - Celina Lin
- Department of Medicine, Division of Physical Medicine & Rehabilitation, McMaster University, Hamilton, Ontario, Canada
| | - Julie Reid
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Vatsal Trivedi
- Department of Medicine and Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Varuna Prakash
- Department of Medicine and Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
| | - Emilie Belley-Cote
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, Divisions of Cardiology and Critical Care, McMaster University, Hamilton, Ontario, Canada
| | - Maha Al Mandhari
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Louise Pilote
- Department of Medicine, McGill University, Montreal, Quebec, Canada
- Department of Medicine, Research Institute of the McGill University Health Centre, Montreal, Ontario, Canada
| | - Karen E A Burns
- Department of Medicine and Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Critical Care and Medicine Departments, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Fuster-Casanovas A, Miró Catalina Q, Vidal-Alaball J, Escalé-Besa A, Carrión C. eHealth in the Management of Depressive Episodes in Catalonia's Primary Care From 2017 to 2022: Retrospective Observational Study. JMIR Ment Health 2024; 11:e52816. [PMID: 38236631 PMCID: PMC10835588 DOI: 10.2196/52816] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 12/12/2023] [Accepted: 12/28/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND The reasons for mental health consultations are becoming increasingly relevant in primary care. The Catalan health care system is undergoing a process of digital transformation, where eHealth is becoming increasingly relevant in routine clinical practice. OBJECTIVE This study aimed to analyze the approach to depressive episodes and the role of eHealth in the Catalan health care system from 2017 to 2022. METHODS A retrospective observational study was conducted on diagnostic codes related to depressive episodes and mood disorders between 2017 and 2022 using data from the Catalan Institute of Health. The sociodemographic evolution and prevalence of depression and mood disorders in Catalonia were analyzed between 2017 and 2022. Sociodemographic variables were analyzed using absolute frequency and percentage. The prevalence of depressive episodes was calculated, highlighting the year-to-year changes. The use of eHealth for related consultations was assessed by comparing the percentages of eHealth and face-to-face consultations. A comparison of sociodemographic variables based on attendance type was conducted. Additionally, a logistic regression model was used to explore factors influencing face-to-face attendance. The analysis used R software (version 4.2.1), with all differences examined using 95% CIs. RESULTS From 2017 to 2022, there was an 86.6% increase in the prevalence of depression and mood disorders, with women consistently more affected (20,950/31,197, 67.2% in 2017 and 22,078/33,169, 66.6% in 2022). In 2022, a significant rise in depression diagnoses was observed in rural areas (difference 0.71%, 95% CI 0.04%-1.43%), contrasting with a significant decrease in urban settings (difference -0.7%, 95% CI -1.35% to -0.05%). There was a significant increase in antidepressant use in 2022 compared to 2017 (difference 2.4%, 95% CI 1.87%-3.06%) and the proportion of eHealth visits rose from 4.34% (1240/28,561) in 2017 to 26.3% (8501/32,267) in 2022. Logistic regression analysis indicated that men (odds ratio [OR] 1.06, 95% CI 1.04-1.09) and younger individuals had a higher likelihood of eHealth consultations in 2022. Furthermore, individuals using eHealth consultations were more likely to use antidepressants (OR 1.54, 95% CI 1.50-1.57) and anxiolytics (OR 1.06, 95% CI 1.03-1.09). CONCLUSIONS The prevalence of depression in Catalonia has significantly increased in the last 6 years, likely influenced by the COVID-19 pandemic. Despite ongoing digital transformation since 2011, eHealth usage remained limited as of 2017. During the lockdown period, eHealth accounted for nearly half of all health care consultations, representing a quarter of consultations by 2022. In the immediate aftermath of the COVID-19 pandemic, emerging evidence suggests a significant role of eHealth in managing depression-related consultations, along with an apparent likelihood of patients being prescribed antidepressants and anxiolytics. Further research is needed to understand the long-term impact of eHealth on diagnostic practices and medication use.
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Affiliation(s)
- Aïna Fuster-Casanovas
- eHealth Lab Research Group, School of Health Sciences and eHealth Centre, Universitat Oberta de Catalunya, Barcelona, Spain
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
| | - Queralt Miró Catalina
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
- Health Promotion in Rural Areas Research Group, Gerència d'Atenció Primària i a la Comunitat de Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
| | - Josep Vidal-Alaball
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
- Health Promotion in Rural Areas Research Group, Gerència d'Atenció Primària i a la Comunitat de Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
- Faculty of Medicine, University of Vic-Central, University of Catalonia, Vic, Spain
| | - Anna Escalé-Besa
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
- Health Promotion in Rural Areas Research Group, Gerència d'Atenció Primària i a la Comunitat de Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
- Faculty of Medicine, University of Vic-Central, University of Catalonia, Vic, Spain
| | - Carme Carrión
- eHealth Lab Research Group, School of Health Sciences and eHealth Centre, Universitat Oberta de Catalunya, Barcelona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion, Barcelona, Spain
- School of Medicine, Universitat de Girona, Girona, Spain
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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: 3] [Impact Index Per Article: 1.5] [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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Biskup E, Marra AM, Ambrosino I, Barbagelata E, Basili S, de Graaf J, Gonzalvez-Gasch A, Kaaja R, Karlafti E, Lotan D, Kautzky-Willer A, Perticone M, Politi C, Schenck-Gustafsson K, Vilas-Boas A, Roeters van Lennep J, Gans EA, Regitz-Zagrosek V, Pilote L, Proietti M, Raparelli V. Awareness of sex and gender dimensions among physicians: the European federation of internal medicine assessment of gender differences in Europe (EFIM-IMAGINE) survey. Intern Emerg Med 2022; 17:1395-1404. [PMID: 35604515 PMCID: PMC9352607 DOI: 10.1007/s11739-022-02951-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 02/15/2022] [Indexed: 11/28/2022]
Abstract
Sociocultural gender is a complex construct encompassing different aspects of individuals' life, whereas sex refers to biological factors. These terms are often misused, although they impact differently on individuals' health. Recognizing the role of sex and gender on health status is fundamental in the pursuit of a personalized medicine. Aim of the current study was to investigate the awareness in approaching clinical and research questions on the impact of sex and gender on health among European internists. Clinicians affiliated with the European Federation of Internal Medicine from 33 countries participated to the study on a voluntary basis between January 1st, 2018 and July 31st, 2019. Internists' awareness and knowledge on sex and gender issues in clinical medicine were measured by an online anonymized 7-item survey. A total of 1323 European internists responded to the survey of which 57% were women, mostly young or middle-aged (78%), and practicing in public general medicine services (74.5%). The majority (79%) recognized that sex and gender are not interchangeable terms, though a wide discrepancy exists on what clinicians think sex and gender concepts incorporate. Biological sex and sociocultural gender were recognized as determinants of health mainly in cardiovascular and autoimmune/rheumatic diseases. Up to 80% of respondents acknowledged the low participation of female individuals in trials and more than 60% the lack of sex-specific clinical guidelines. Internists also express the willingness of getting more knowledge on the impact of sex and gender in cerebrovascular/cognitive and inflammatory bowel diseases. Biological sex and sociocultural gender are factors influencing health and disease. Although awareness and knowledge remain suboptimal across European internists, most acknowledge the underrepresentation of female subjects in trials, the lack of sex-specific guidelines and the need of being more informed on sex and gender-based differences in diseases.
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Affiliation(s)
- Ewelina Biskup
- Division of Internal Medicine, University Hospital of Basel, Basel, Switzerland
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Alberto M Marra
- Department of Translational Medical Sciences, "Federico II" University of Naples, Naples, Italy
- Center for Pulmonary Hypertension, Thoraxklinic, University Hospital Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | | | - Elena Barbagelata
- Department of Internal Medicine, Lavagna Hospital ASL 4 Chiavarese, Genoa, Italy
| | - Stefania Basili
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Jacqueline de Graaf
- Radboud University Medical Centre, Radboud Health Academy - division of PGME, Nijmegen, Netherlands
| | | | - Risto Kaaja
- Internal Medicine, University of Turku, Turku, Finland
| | - Eleni Karlafti
- 1st Propedeutic Clinic of Internal Medicine, AHEPA University Hospital of Thessaloniki, Thessaloniki, Greece
| | - Dor Lotan
- Division of Cardiology, Columbia University Irving Medical Center, New York, USA
| | - Alexandra Kautzky-Willer
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Internal MedicineIII, Medical University Vienna, Vienna, Austria
- Gender Institute, Gars am Kamp, Austria
| | - Maria Perticone
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Cecilia Politi
- Internal Medicine, "F. Veneziale" Hospital, Isernia, Italy
| | - Karin Schenck-Gustafsson
- Centre for Gender Medicine, Department of Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Andreia Vilas-Boas
- Internal Medicine, Hospital da Luz Arrábida, Vila Nova de Gaia, Portugal
| | | | - Emma A Gans
- Department of Internal Medicine, Leiden University Medical Center, Leiden, Netherlands
| | - Vera Regitz-Zagrosek
- Charité, University Medicine Berlin, DZHK, Berlin, Germany
- University of Zurich, Zurich, Switzerland
| | - Louise Pilote
- Division of Clinical Epidemiology and General Internal Medicine, McGill University Health Centre Research Institute, Montreal, Canada
| | - Marco Proietti
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Valeria Raparelli
- Department of Translational Medicine, University of Ferrara, Via dei Borsari 46, 44121, Ferrara, Italy.
- University Center for Studies On Gender Medicine, University of Ferrara, Ferrara, Italy.
- Faculty of Nursing, University of Alberta, Edmonton, Canada.
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Becher E, Oertelt-Prigione S. History and development of sex- and gender sensitive medicine (SGSM). INTERNATIONAL REVIEW OF NEUROBIOLOGY 2022; 164:1-25. [PMID: 36038201 DOI: 10.1016/bs.irn.2022.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Sex- and gender-sensitive medicine has evolved from a feminist approach into an innovative cross-cutting approach to doing medicine. In the present chapter we define what sex and gender are in the context of biomedical research and describe the history of the development of this scientific approach. Looking back at crucial events in the U.S.A., Canada and Europe, we will outline how a structural framework has been established, ready to be filled with clinical and applied knowledge and to change the practice of medicine for decades to come.
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Affiliation(s)
- Eva Becher
- Sex- and Gender-Sensitive Medicine Unit, Medical Faculty OWL, Bielefeld University, Bielefeld, Germany
| | - Sabine Oertelt-Prigione
- Sex- and Gender-Sensitive Medicine Unit, Medical Faculty OWL, Bielefeld University, Bielefeld, Germany; Gender Unit, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Netherlands.
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Colineaux H, Soulier A, Lepage B, Kelly-Irving M. Considering sex and gender in Epidemiology: a challenge beyond terminology. From conceptual analysis to methodological strategies. Biol Sex Differ 2022; 13:23. [PMID: 35550193 PMCID: PMC9103114 DOI: 10.1186/s13293-022-00430-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 04/21/2022] [Indexed: 11/22/2022] Open
Abstract
Background Epidemiologists need tools to measure effects of gender, a complex concept originating in the social sciences which is not easily operationalized in the discipline. Our aim is to clarify useful concepts, measures, paths, effects, and analytical strategies to explore mechanisms of health difference between men and women. Methods We reviewed concepts to clarify their definitions and limitations for their translation into usable measures in Epidemiology. Then we conducted methodological research using a causal framework to propose methodologically appropriate strategies for measuring sex and gender effects in health. Results (1) Concepts and measures. We define gender as a set of norms prescribed to individuals according to their attributed-at-birth sex. Gender pressure creates a systemic gap, at population level, in behaviors, activities, experiences, etc., between men and women. A pragmatic individual measure of gender would correspond to the level at which an individual complies with a set of elements constituting femininity or masculinity in a given population, place and time. (2) Main analytical strategy. Defining and measuring gender are not sufficient to distinguish the effects of sex and gender on a health outcome. We should also think in terms of mechanisms, i.e., how the variables are linked together, to define appropriate analytical strategies. A causal framework can help us to conceptualize “sex” as a “parent” of a gender or gendered variable. This implies that we cannot interpret sex effects as sexed mechanisms, and that we can explore gendered mechanisms of sex-differences by mediation analyses. (3) Alternative strategy. Gender could also be directly examined as a mechanism, rather than through a variable representing its realization in the individual, by approaching it as an interaction between sex and social environment. Conclusions Both analytical strategies have limitations relative to the impossibility of reducing a complex concept to a single or a few measures, and of capturing the entire effect of the phenomenon of gender. However, these strategies could lead to more accurate analyses of the mechanisms underlying health differences between men and women. A pragmatic individual measure of individual gender would correspond to the level at which an individual complies with a set of elements constituting femininity or masculinity in a given population, place and time Comparing outcomes by sex and gender is not sufficient, and even misleading, to understand the mechanisms underlying biological and health differences between men and women Causal analysis framework is a powerful tool for refining hypotheses and identifying the effects that can and should be estimated to meet the objectives Gender could also be measured at the populational-level as an interaction between sex and environment, which would be more compatible with the sociological concept of gender
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Affiliation(s)
- Hélène Colineaux
- EQUITY Team,, CERPOP, INSERM, Batiment E, 1er Etage, 37 Allées Jules Guesde, 31062, Toulouse, France.
| | | | - Benoit Lepage
- EQUITY Team,, CERPOP, INSERM, Batiment E, 1er Etage, 37 Allées Jules Guesde, 31062, Toulouse, France.,Epidemiology Department, CHU Toulouse, 37 Allées Jules Guesde, 31062, Toulouse, France.,Biostatistic Department, Toulouse III University, 37 Allées Jules Guesde, 31062, Toulouse, France
| | - Michelle Kelly-Irving
- EQUITY Team,, CERPOP, INSERM, Batiment E, 1er Etage, 37 Allées Jules Guesde, 31062, Toulouse, France
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Hallam L, Vassallo A, Pinho-Gomes AC, Carcel C, Woodward M. Does Journal Content in the Field of Women's Health Represent Women's Burden of Disease? A Review of Publications in 2010 and 2020. J Womens Health (Larchmt) 2022; 31:611-619. [PMID: 35333604 PMCID: PMC9133969 DOI: 10.1089/jwh.2021.0425] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background: Historically, women's health has focused on reproductive health. However, noncommunicable and communicable diseases comprise much of the burden of disease in women. Methods: A quantitative analysis of the main health content of articles published in six women's health journals (WHJ) and five general medical journals (GMJ) in 2010 and 2020 was conducted to categorize the main medical area topics of published articles and the life stage under study. Findings were compared with the leading causes of disease in women according to the Global Burden of Disease (GBD) study. Results: There were 1483 articles eligible for analysis. In total, in WHJ, 44% of topics were reproductive health, increasing from 36% in 2010 to 49% in 2020, which was similar to GMJ. Noncommunicable disease was the next most addressed topic, with cancer being the major disease area covered. When compared with the GBD study, major disease areas such as infectious disease, cardiovascular disease, and musculoskeletal disorders were underrepresented as topics in women's health publications. Most articles that focused on a particular life stage were on pregnancy or the reproductive years, with very few articles on menopause. Conclusion: Women's health publishing remains largely focused on reproductive health topics, with few articles on many of the major causes of morbidity and mortality in women. Journals, researchers, funders, and research priority setters should embrace a broader view of women's health to effectively cover content that reflects the broad range of health issues impacting women across the life span.
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Affiliation(s)
- Laura Hallam
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Amy Vassallo
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Ana-Catarina Pinho-Gomes
- The George Institute for Global Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Cheryl Carcel
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,Sydney School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Mark Woodward
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,The George Institute for Global Health, School of Public Health, Imperial College London, London, United Kingdom
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9
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van Hagen LJ, Muntinga M, Appelman Y, Verdonk P. Sex- and gender-sensitive public health research: an analysis of research proposals in a research institute in the Netherlands. Women Health 2020; 61:109-119. [PMID: 33073744 DOI: 10.1080/03630242.2020.1834056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Taking sex and gender into account in public health research is essential to optimize methodological procedures, bridge the gender gap in public health knowledge, and advance gender equality. The aim of this study was to evaluate the current status of sex and gender considerations in public health research proposals in a Dutch research institute. We screened a random sample of 38 proposals submitted for review to the institute's science committee between 2011 and 2016. Using the Canadian Institutes of Health Research' Gender and Health Institute criteria for gender-sensitive research and qualitative content analysis, we assessed if, and how sex and gender were considered throughout the proposals (background, research aim, design, data collection, and analysis). Our results show that in general, both sex and gender were poorly considered. Gender was insufficiently taken into account throughout most proposals. When sex was mentioned in a proposal, its consideration was often inconsistent and fragmented. Finally, we identified common methodological pitfalls. We recommend that public health curricula and funding bodies increase their focus on implementing sex and gender in public health research, for instance through quality criteria, training programs for researchers and reviewers, and capacity building initiatives.
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Affiliation(s)
- Lisanne Jeannine van Hagen
- Amsterdam UMC-VUmc, Department of Medical Humanities, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Maaike Muntinga
- Amsterdam UMC-VUmc, Department of Medical Humanities, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC-VUmc, Amsterdam, The Netherlands
| | - Petra Verdonk
- Amsterdam UMC-VUmc, Department of Medical Humanities, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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10
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An opportunity for patient-centered care: Results from a secondary analysis of sex- and gender-based data in mobile health trials for chronic medical conditions. Maturitas 2020; 138:1-7. [PMID: 32631583 DOI: 10.1016/j.maturitas.2020.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/27/2020] [Accepted: 05/06/2020] [Indexed: 01/12/2023]
Abstract
Traditional medical practice has suffered from male bias, which can lead to sub-optimal treatment options for female patients and increase the incidence of severe side-effects in this population. Mobile health applications, mHealth apps, represent one essential component of the shift towards consumer-centered self-administered individualized health. To prevent sex-specific bias it is important that trials consider sex and gender when developing mHealth apps. We evaluated the inclusion and reporting of sex and gender at all levels in mHealth randomized controlled trials (RCTs). To this end, we conducted a secondary analysis of a large study database addressing the effectiveness of app interventions on clinical outcomes in patients with chronic medical conditions. We followed the 5 steps described in the framework by Arksey and O'Malley and the guidelines of the PRISMA-ScR. Of the 72 app-based RCTs which reported information about sex overall, 62 included individuals of both sexes. The concept of gender was not addressed in any of the studies. The consideration of sex aspects in the design, execution and reporting of mHealth RCTs was minimal or absent. To adequately address the health and preventative needs of the mHealth user population, sex and gender should be systematically included in the research, development and evaluation of mHealth applications.
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11
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Gianakos AL, George N, Merklein M, Chambers L, Ferkel R, DiGiovanni C, Kennedy JG. Foot and Ankle Related Sex-Specific Analysis Within High-Impact Journals. Foot Ankle Int 2020; 41:356-363. [PMID: 31855079 DOI: 10.1177/1071100719894530] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The impact of patient sex on the prevalence of foot and ankle injuries has been established. Reporting of differences on treatment outcomes is lacking. The purpose of this study was to identify trends in sex-specific outcomes across high-impact journals over a 5-year time period. METHODS Two independent investigators reviewed journal issues published during 2 calendar years (2011 and 2016) in the 5 highest-impact orthopedic foot and ankle/sports subspecialty journals (Foot & Ankle International [FAI], Foot and Ankle Surgery [FAS], American Journal of Sports Medicine [AJSM], Arthroscopy, and Knee Surgery, Sports Traumatology, Arthroscopy [KSSTA]). Studies were stratified into those that involved sex-specific analysis (SSA), where sex was a variable in a multifactorial statistical model, and those that only reported sex as a demographic characteristic or utilized sex-matched cohorts. RESULTS A total of 473 studies evaluating a total of 273 128 patients met criteria. An average of 43.9% (119 967 patients) of the population were female. Only 16.7% (79/473) of studies included sex as variable in a statistical model. Thirteen percent (25/193) and 19.3% (54/280) of studies reported SSA in 2011 and 2016, respectively. FAI was the only journal demonstrating a significant improvement of reporting SSA from 2011 to 2016 (P < .002). Thirty percent (24/79) of studies that performed SSA demonstrated significant differences between male and female outcomes. CONCLUSION Reporting of SSA in the orthopedic literature continued to be lacking. Only 16.7% of all articles evaluated in 2011 and 2016 performed SSA, with 30% of this subset reporting a statistically significant difference in outcomes. LEVEL OF EVIDENCE Level III, comparative study.
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Affiliation(s)
- Arianna L Gianakos
- Department of Orthopaedic Surgery, Robert Wood Johnson Barnabas Health-Jersey City Medical Center, Jersey City, NJ, USA
| | - Nicole George
- Department of Orthopaedic Surgery, Aultman Hospital, Canton, OH, USA
| | - Meghan Merklein
- Department of Orthopaedic Surgery, Robert Wood Johnson Barnabas Health-Jersey City Medical Center, Jersey City, NJ, USA
| | - Lori Chambers
- Department of Orthopaedic Surgery, Robert Wood Johnson Barnabas Health-Jersey City Medical Center, Jersey City, NJ, USA
| | - Richard Ferkel
- Department of Orthopaedic Surgery, Southern California Orthopedic Institute, Van Nuys, CA, USA
| | | | - John G Kennedy
- Department of Orthopaedic Surgery, New York University, New York, NY, USA
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12
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Sex and gender inclusion, analysis, and reporting in anaesthesia research. Br J Anaesth 2020; 124:e43-e49. [PMID: 31924347 DOI: 10.1016/j.bja.2019.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/03/2019] [Accepted: 12/02/2019] [Indexed: 01/11/2023] Open
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13
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Biskup E, Martinkova J, Ferretti MT. Gender medicine: Towards a gender-specific treatment of neuropsychiatric disorders. HANDBOOK OF CLINICAL NEUROLOGY 2020; 175:437-448. [PMID: 33008542 DOI: 10.1016/b978-0-444-64123-6.00029-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Sex and gender are increasingly recognized as major influencing factors in disorders across all medical specialties. Even though there is ample evidence of sex and gender differences in neuropsychiatric disorders, a sex and gender-differentiated approach has not yet been sufficiently applied to diagnostics and management. Therefore, there is an urgent need to establish general recommendations and guidelines toward precision and sex/gender medicine, with regard to dosage, tolerability, interactions and side effects, sensitivity of diagnostic tests, and distinct treatment strategies. This chapter illustrates the current knowledge about sex and gender aspects in neuropsychiatric disorders, providing a base not only to assist the clinician in the handling of specific pathologic entities, but also to sensitize medical practitioners to consider sex and gender in clinical decision-making. As such, the chapter is a call to action to physicians and researchers to produce more sex- and gender-stratified evidence, leading to an acceleration of guideline development. Such novel guidelines will provide a base for medical education, of both medical students and specialists, as well as a reference point for practitioners, toward precision medicine.
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Affiliation(s)
- Ewelina Biskup
- Women's Brain Project, Guntershausen (TG), Switzerland; Shanghai University of Medicine and Health Sciences, College of Clinical Medicine, Shanghai, China.
| | - Julie Martinkova
- Women's Brain Project, Guntershausen (TG), Switzerland; Memory Clinic, Department of Neurology, Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic
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14
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Ramirez FD, Hibbert B. Letter by Ramirez and Hibbert Regarding Article, "Consideration of Sex Differences in Design and Reporting of Experimental Arterial Pathology Studies: A Statement From the Arteriosclerosis, Thrombosis, and Vascular Biology Council". Arterioscler Thromb Vasc Biol 2019; 38:e99-e100. [PMID: 29793995 DOI: 10.1161/atvbaha.118.310942] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- F Daniel Ramirez
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
| | - Benjamin Hibbert
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
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15
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Carcel C, Woodward M, Balicki G, Koroneos GL, Sousa DAD, Cordonnier C, Lukaszyk C, Thompson K, Wang X, Davies L, Bassi M, Anderson CS, Peters SAE, Sandset EC. Trends in recruitment of women and reporting of sex differences in large-scale published randomized controlled trials in stroke. Int J Stroke 2019; 14:931-938. [DOI: 10.1177/1747493019851292] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Understanding of sex differences, especially in terms of the influence of sex on therapeutic interventions, can lead to improved treatment and management for all. Aim We examined temporal and regional trends in female participation and the reporting of sex differences in stroke randomized controlled trials. Methods Randomized controlled trials from 1990 to 2018 were identified from ClinicalTrials.gov, using keywords “stroke” and “cerebrovascular accidents.” Studies were selected if they enrolled ≥100 participants, included both sexes and were published trials (identified using PubMed, Google Scholar, and Scopus). Results Of 1700 stroke randomized controlled trials identified, 277 were published and eligible for analysis. Overall, these randomized controlled trials enrolled only 40% females, and in the past 10 years, this percentage barely changed, peaking at 41% in 2008–2009 and 2012–2013. North American randomized controlled trials recruited the most women, at 43%, and Asia the lowest, at 40%. Among the 277 randomized controlled trials, 101 (36%) reported results according to sex, of which 91 (33%) were pre-specified analyses. The increasing trend in the number of studies reporting sex-differentiated results from 2008 to 2018 merely paralleled the increase in the number of papers published during the same time period. North American randomized controlled trials most often reported sex-specific results (42%), and Australia and Europe least often (31%). Conclusion Little progress has been made in the inclusion of females and the reporting of sex in stroke randomized controlled trials. This highlights the need for key stakeholders, such as funders and journal editors, to provide clear guidance and effective implementation strategies to researchers in the scientific reporting of sex.
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Affiliation(s)
- Cheryl Carcel
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Sydney School of Public Health, Sydney Medical School, The University of Sydney, New South Wales, Australia
| | - Mark Woodward
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, University of Oxford, Oxford, UK
- Department of Epidemiology, Johns Hopkins University, Baltimore MD, USA
| | - Grace Balicki
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Diana Aguiar de Sousa
- Department of Neurosciences and Mental Health (Neurology), Hospital Santa Maria/CHLN, University of Lisbon, Lisbon, Portugal
| | - Charlotte Cordonnier
- Department of Neurology, Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, University of Lille, F-59000 Lille, France
| | - Caroline Lukaszyk
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Kelly Thompson
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Xia Wang
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Leo Davies
- Sydney School of Public Health, Sydney Medical School, The University of Sydney, New South Wales, Australia
| | - Meenakshi Bassi
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Craig S Anderson
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute China at Peking University Health Science Center, Beijing, China
| | - Sanne AE Peters
- The George Institute for Global Health, University of Oxford, Oxford, UK
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Else Charlotte Sandset
- Department of Neurology, Oslo University Hospital, Oslo, Norway
- Department of Research and Development, The Norwegian Air Ambulance Foundation, Oslo, Norway
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16
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Day S, Wu W, Mason R, Rochon PA. Measuring the data gap: inclusion of sex and gender reporting in diabetes research. Res Integr Peer Rev 2019; 4:9. [PMID: 31080635 PMCID: PMC6503434 DOI: 10.1186/s41073-019-0068-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 03/27/2019] [Indexed: 01/11/2023] Open
Abstract
Background Important sex and gender differences have been found in research on diabetes complications and treatment. Reporting on whether and how sex and gender impact research findings is crucial for developing tailored diabetes care strategies. To analyze the extent to which this information is available in current diabetes research, we examined original investigations on diabetes for the integration of sex and gender in study reporting. Methods We examined original investigations on diabetes published between January 1 and December 31, 2015, in the top five general medicine journals and top five diabetes-specific journals (by 2015 impact factor). Data were extracted on sex and gender integration across seven article sections: title, abstract, introduction, methods, results, discussion, and limitations. Results We identified 155 original investigations on diabetes, including 115 randomized controlled trials (RCTs) and 40 observational studies. Sex and gender were rarely incorporated in article titles, abstracts and introductions. Most methods sections did not describe plans for sex/gender analyses; 47 (30.3%) articles described plans to control for sex/gender in the analysis and 12 (7.7%) described plans to stratify results by sex/gender. While most articles (151, 97.4%) reported the sex/gender of study participants, only 10 (6.5%) of all articles reported all study outcomes separately by sex/gender. Discussion of sex-related issues was incorporated into 21 (13.5%) original investigations; however, just 1 (0.6%) discussed gender-related issues. Comparison by journal type (general medicine vs. diabetes specific) yielded only minor differences from the overall integration results. In contrast, RCTs performed more poorly on multiple sex/gender assessment metrics compared to observational studies. Conclusions Sex and gender are poorly integrated in current diabetes original investigations, suggesting that substantial improvements in sex and gender data reporting are needed to inform the evidence to support sex- and gender-specific diabetes care.
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Affiliation(s)
- Suzanne Day
- 1Women's Xchange, Women's College Hospital, 76 Grenville Street, Toronto, Ontario M5S 1B2 Canada.,2Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, 130 Mason Farm Road, 2nd Floor, Campus Box #7030, Chapel Hill, NC 27599-7030 USA
| | - Wei Wu
- 3Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, Ontario M5S 1B2 Canada
| | - Robin Mason
- 1Women's Xchange, Women's College Hospital, 76 Grenville Street, Toronto, Ontario M5S 1B2 Canada.,3Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, Ontario M5S 1B2 Canada.,4Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M7 Canada
| | - Paula A Rochon
- 1Women's Xchange, Women's College Hospital, 76 Grenville Street, Toronto, Ontario M5S 1B2 Canada.,3Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, Ontario M5S 1B2 Canada.,5Department of Medicine, University of Toronto, 1 King's College Circle, Toronto, Ontario M5S 1A8 Canada
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17
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Kautzky-Willer A, von Euler M, Oertelt-Prigione S. Editorial: Sex and Gender Aspects in Diabetes. Front Endocrinol (Lausanne) 2019; 10:813. [PMID: 32010058 PMCID: PMC6977595 DOI: 10.3389/fendo.2019.00813] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 11/06/2019] [Indexed: 12/25/2022] Open
Affiliation(s)
- Alexandra Kautzky-Willer
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- *Correspondence: Alexandra Kautzky-Willer
| | - Mia von Euler
- Departments of Clinical Science and Education, Södersjukhuset and Medicine, Karolinska Institutet, Solna, Sweden
- Department of Clinical Pharmacology, Karolinska University Hospital, Huddinge, Sweden
| | - Sabine Oertelt-Prigione
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Netherlands
- Institute of Legal and Forensic Medicine, Charité-Universitätsmedizin, Berlin, Germany
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18
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Sex-Specific Considerations in Guidelines Generation and Application. Can J Cardiol 2018; 35:598-605. [PMID: 30910247 DOI: 10.1016/j.cjca.2018.11.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/11/2018] [Accepted: 11/14/2018] [Indexed: 12/14/2022] Open
Abstract
New knowledge about male-female differences in pathophysiology, diagnosis, and treatment is shifting the practice of medicine from a one-size-fits all approach to a more individualized process that considers sex-specific interventions at the point of care. In this article, we review how clinical practice guideline committees can incorporate a structured framework to determine whether sex-specific assessments of the quality of the evidence or the particular recommendations should be made. The process can be operationalized by societies who author clinical practice guidelines by developing formal policies to approach biological sex in a systematic way, and by ensuring that writing committees include an individual who will champion the formal appraisal of the literature for associations between sex and the outcomes of interest. Ongoing challenges are discussed, and solutions are provided for how to disaggregate the evidence, how to assess bias, how to improve search strategies, and what to do when the data are insufficient to make sex-specific recommendations. Application of sex-specific recommendations will involve routinely asking whether the presentation, diagnostic workup, or management might change for each patient if they were the opposite sex.
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19
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Dave S, Dodge JL, Terrault NA, Sarkar M. Racial and Ethnic Differences in Graft Loss Among Female Liver Transplant Recipients. Transplant Proc 2018; 50:1413-1423. [PMID: 29880364 DOI: 10.1016/j.transproceed.2018.02.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 01/29/2018] [Accepted: 02/17/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Racial differences in post-liver transplantation (LT) outcomes are identified in predominantly male cohorts. Despite known sex differences in a spectrum of liver-related outcomes, it is not known how race influences graft outcomes in women. METHODS Using the Scientific Registry of Transplant Recipients, we examined race and ethnicity and graft loss (death or retransplant) in women transplanted from 2002 to 2012. Covariates included recipient and donor characteristics, socioeconomics, and medical comorbidities. RESULTS The eligible cohort (n = 15,860) included 11,051 Caucasians, 2171 Hispanics, 1876 African Americans (AAs), and 762 Asian women with median follow-up of 3.1 years. Five-year graft survival was lower in AA women (60%) compared with Caucasians (71%), Hispanics (70%), and Asians (73%) (P < .001). Graft loss was 45% higher among AA women <40 years at transplant compared with AA women aged 50 to 59 (hazard ratio 1.45, 95% confidence interval 1.17-1.81) and aged 60 to 69 years (hazard ratio 1.33, 95% confidence interval 1.03-1.71), and risk increased after age 60 among Caucasians (P < .001 for race-age interactions). Increased graft loss among young AA women was limited to the first 2 years post-LT (P = .002). CONCLUSION Younger AA women are at particularly high risk for graft loss, which predominates in the first 2 years post-LT. Prospective studies of immunosuppression adherence and pharmacokinetics, particularly in relation to patient age, may help to explain the mechanisms underlying the higher rates of graft loss in younger AA women.
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Affiliation(s)
- S Dave
- Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - J L Dodge
- Department of Surgery, Division of Transplant, University of California-San Francisco, San Francisco, California, USA
| | - N A Terrault
- Division of Gastroenterology and Hepatology, University of California-San Francisco, San Francisco, California, USA; Department of Surgery, Division of Transplant, University of California-San Francisco, San Francisco, California, USA
| | - M Sarkar
- Division of Gastroenterology and Hepatology, University of California-San Francisco, San Francisco, California, USA.
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Schiebinger L, Klinge I. Gendered Innovation in Health and Medicine. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1065:643-654. [PMID: 30051412 DOI: 10.1007/978-3-319-77932-4_39] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Excellence in research requires careful attention to sex and gender analysis. The Gendered Innovations project, initiated in 2009, develops state-of-the-art methods of sex and gender analysis for basic and applied research. This chapter reviews recent developments in cardiovascular disease for (1) analyzing sex, (2) analyzing gender, and (3) policy initiatives.
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Affiliation(s)
| | - Ineke Klinge
- Horizon 2020 Advisory Group for Gender, European Commission, Brussels, Belgium
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21
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One and a half million medical papers reveal a link between author gender and attention to gender and sex analysis. Nat Hum Behav 2017; 1:791-796. [DOI: 10.1038/s41562-017-0235-x] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 09/27/2017] [Indexed: 11/09/2022]
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22
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Welch V, Doull M, Yoganathan M, Jull J, Boscoe M, Coen SE, Marshall Z, Pardo JP, Pederson A, Petkovic J, Puil L, Quinlan L, Shea B, Rader T, Runnels V, Tudiver S. Reporting of sex and gender in randomized controlled trials in Canada: a cross-sectional methods study. Res Integr Peer Rev 2017; 2:15. [PMID: 29451565 PMCID: PMC5803639 DOI: 10.1186/s41073-017-0039-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 06/26/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Accurate reporting on sex and gender in health research is integral to ensuring that health interventions are safe and effective. In Canada and internationally, governments, research organizations, journal editors, and health agencies have called for more inclusive research, provision of sex-disaggregated data, and the integration of sex and gender analysis throughout the research process. Sex and gender analysis is generally defined as an approach for considering how and why different subpopulations (e.g., of diverse genders, ages, and social locations) may experience health conditions and interventions in different or similar ways.The objective of this study was to assess the extent and nature of reporting about sex and/or gender, including whether sex and gender analysis (SGA) was carried out in a sample of Canadian randomized controlled trials (RCTs) with human participants. METHODS We searched MEDLINE from 01 January 2013 to 23 July 2014 using a validated filter for identification of RCTs, combined with terms related to Canada. Two reviewers screened the search results to identify the first 100 RCTs that were either identified in the trial publication as funded by a Canadian organization or which had a first or last author based in Canada. Data were independently extracted by two people from 10% of the RCTs during an initial training period; once agreement was reached on this sample, the remainder of the data extraction was completed by one person and verified by a second. RESULTS The search yielded 1433 records. We screened 256 records to identify 100 RCTs which met our eligibility criteria. The median sample size of the RCTs was 107 participants (range 12-6085). While 98% of studies described the demographic composition of their participants by sex, only 6% conducted a subgroup analysis across sex and 4% reported sex-disaggregated data. No article defined "sex" and/or "gender." No publication carried out a comprehensive sex and gender analysis. CONCLUSIONS Findings highlight poor uptake of sex and gender considerations in the Canadian RCT context and underscore the need for better articulated guidance on sex and gender analysis to improve reporting of evidence, inform policy development, and guide future research.
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Affiliation(s)
- V. Welch
- Bruyère Research Institute, Bruyère Continuing Care, 304b-85 Primrose Avenue, Ottawa, Ontario K1R 6 M1 Canada
- University of Ottawa, Ontario, Canada
| | - M. Doull
- School of Nursing, University of British Columbia, T223-2211 Wesbrook Mall, Vancouver, British Columbia V6T 2B5 Canada
| | - M. Yoganathan
- Bruyère Research Institute, Bruyère Continuing Care, 304b-85 Primrose Avenue, Ottawa, Ontario K1R 6 M1 Canada
| | - J. Jull
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario Canada
| | - M. Boscoe
- Research Sex/gender, Health Equity, Primary Care Consultant, 906 Bowron Court, North Vancouver, BC V7H 2S7 Canada
| | - S. E. Coen
- Department of Geography and Planning, Queen’s University, Mackintosh-Corry Hall, Kingston, Ontario K7L 3 N6 Canada
| | - Z. Marshall
- Renison University College, University of Waterloo, 240 Westmount Road North, Waterloo, Ontario N2L 3G4 Canada
| | - J. Pardo Pardo
- Cochrane Musculoskeletal, University of Ottawa, Ottawa Hospital Research Institute, The Ottawa Hospital, General Campus, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada
| | - A. Pederson
- B.C. Women’s Hospital + Health Centre, E305, 4500 Oak Street, Vancouver, BC V6H 3E1 Canada
| | - J. Petkovic
- Bruyère Research Institute, Bruyère Continuing Care, 304b-85 Primrose Avenue, Ottawa, Ontario K1R 6 M1 Canada
- University of Ottawa, Ontario, Canada
| | - L. Puil
- Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia, 2176 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada
| | - L. Quinlan
- Bruyère Research Institute, Bruyère Continuing Care, 304b-85 Primrose Avenue, Ottawa, Ontario K1R 6 M1 Canada
| | - B. Shea
- Bruyère Research Institute, Bruyère Continuing Care, 304b-85 Primrose Avenue, Ottawa, Ontario K1R 6 M1 Canada
- University of Ottawa, Ontario, Canada
| | - T. Rader
- Canadian Agency for Drugs and Technology in Health, 865 Carling Ave, Ottawa, Ontario Canada
| | - V. Runnels
- Globalization and Health Equity Research Unit, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, 850 Peter Morand Crescent, Ottawa, Ontario K1G 5Z3 Canada
| | - S. Tudiver
- Gender and Health Consultant, 161 Northwestern Avenue, Ottawa, Ontario K1Y 0 M1 Canada
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Day S, Mason R, Tannenbaum C, Rochon PA. Essential metrics for assessing sex & gender integration in health research proposals involving human participants. PLoS One 2017; 12:e0182812. [PMID: 28854192 PMCID: PMC5576646 DOI: 10.1371/journal.pone.0182812] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 07/25/2017] [Indexed: 01/11/2023] Open
Abstract
Integrating sex and gender in health research is essential to produce the best possible evidence to inform health care. Comprehensive integration of sex and gender requires considering these variables from the very beginning of the research process, starting at the proposal stage. To promote excellence in sex and gender integration, we have developed a set of metrics to assess the quality of sex and gender integration in research proposals. These metrics are designed to assist both researchers in developing proposals and reviewers in making funding decisions. We developed this tool through an iterative three-stage method involving 1) review of existing sex and gender integration resources and initial metrics design, 2) expert review and feedback via anonymous online survey (Likert scale and open-ended questions), and 3) analysis of feedback data and collective revision of the metrics. We received feedback on the initial metrics draft from 20 reviewers with expertise in conducting sex- and/or gender-based health research. The majority of reviewers responded positively to questions regarding the utility, clarity and completeness of the metrics, and all reviewers provided responses to open-ended questions about suggestions for improvements. Coding and analysis of responses identified three domains for improvement: clarifying terminology, refining content, and broadening applicability. Based on this analysis we revised the metrics into the Essential Metrics for Assessing Sex and Gender Integration in Health Research Proposals Involving Human Participants, which outlines criteria for excellence within each proposal component and provides illustrative examples to support implementation. By enhancing the quality of sex and gender integration in proposals, the metrics will help to foster comprehensive, meaningful integration of sex and gender throughout each stage of the research process, resulting in better quality evidence to inform health care for all.
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Affiliation(s)
- Suzanne Day
- Women’s Xchange, Women’s College Hospital, Toronto, Ontario, Canada
- * E-mail:
| | - Robin Mason
- Women’s Xchange, Women’s College Hospital, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Cara Tannenbaum
- Institute of Gender and Health, Canadian Institutes of Health Research, Montreal, Quebec, Canada
| | - Paula A. Rochon
- Women’s Xchange, Women’s College Hospital, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Ioannidou E. The Sex and Gender Intersection in Chronic Periodontitis. Front Public Health 2017; 5:189. [PMID: 28824898 PMCID: PMC5543279 DOI: 10.3389/fpubh.2017.00189] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 07/11/2017] [Indexed: 12/30/2022] Open
Abstract
Periodontitis, a complex polymicrobial inflammatory disease, is a public health burden affecting more than 100 million people and being partially responsible for tooth loss. Interestingly, periodontitis has a documented higher prevalence in men as compared to women signifying a possible sex/gender entanglement in the disease pathogenesis. Although relevant evidence has treated sex/gender in a simplistic dichotomous manner, periodontitis may represent a complex inflammatory disease model, in which sex biology may interfere with gender social and behavioral constructs affecting disease clinical phenotype. Even when it became clear that experimental oral health research needed to incorporate gender (and/or sex) framework in the hypothesis, researchers overwhelmingly ignored it unless the research question was directly related to reproductive system or sex-specific cancer. With the recognition of gender medicine as an independent field of research, this study challenged the current notion regarding sex/gender roles in periodontal disease. We aimed to develop the methodological and analytical framework with the recognition of sex/gender as important determinants of disease pathogenesis that require special attention. First, we aim to present relevant sex biologic evidence to understand the plausibility of the epidemiologic data. In periodontitis pathogenesis, sex dimorphism has been implicated in the disease etiology possibly affecting the bacterial component and the host immune response both in the innate and adaptive levels. With the clear distinction between sex and gender, gender oral health disparities have been explained by socioeconomic factors, cultural attitudes as well as access to preventive and regular care. Economic inequality and hardship for women have resulted in limited access to oral care. As a result, gender emerged as a complex socioeconomic and behavioral factor influencing oral health outcomes. Taken together, as disease phenotypic presentation is a multifactorial product of biology, behavior and the environment, sex dimorphism in immunity as well as gender socio-behavioral construct might play a role in the above model. Therefore, this paper will provide the conceptual framework and principles intergrading sex and gender within periodontal research in a complex biologic and socio-behavioral dimension.
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Hubertsson J, Turkiewicz A, Petersson IF, Englund M. Understanding Occupation, Sick Leave, and Disability Pension Due to Knee and Hip Osteoarthritis From a Sex Perspective. Arthritis Care Res (Hoboken) 2017; 69:226-233. [PMID: 27110664 DOI: 10.1002/acr.22909] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 02/10/2016] [Accepted: 04/05/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To investigate the association between occupation and risk for sick leave or disability pension due to knee or hip osteoarthritis (OA) from a sex perspective. METHODS We conducted a population-based study including residents ages 40-70 years in the Skåne region, Sweden (2007) and working in the included job sectors (n = 165,179). We retrieved data on cause-specific sick leave and disability pension (2007-2012) and linked to individual information on occupation and education (2007). Occupations were classified into job sectors. We calculated sex-specific, age-adjusted odds ratios (ORs) of sick leave and disability pension due to OA in traditionally female-dominated job sectors (health care, child care, and cleaning) and traditionally male-dominated job sectors (construction, farming, metal work, or transportation) compared to business and administration. RESULTS Of all eligible subjects, 2,445 had sick leave or disability pension due to knee or hip OA. Adjusted for age, the risk of sick leave due to knee OA was increased for women working in health care, with an OR of 3.3 (95% confidence interval [95% CI] 2.6-4.2), child care OR 2.9 (95% CI 2.2-3.8), and cleaning OR 3.0 (95% CI 2.2-4.1), as was the risk for disability pension. The risk was increased also for persons working in occupations with higher educational requirements. The risk was similarly increased in male-dominated sectors. In female-dominated job sectors the risk of sick leave and disability pension due to knee OA, but not hip OA, was higher than that for other musculoskeletal diseases. CONCLUSION Traditionally female-dominated occupational sectors are associated with an increased risk of sick leave and disability pension due to knee OA.
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Affiliation(s)
- Jenny Hubertsson
- Lund University, and Skåne University Hospital, Epidemiology and Register Centre South, Lund, Sweden
| | | | - Ingemar F Petersson
- Lund University, and Skåne University Hospital, Epidemiology and Register Centre South, Lund, Sweden
| | - Martin Englund
- Lund University, Skåne University Hospital, Epidemiology and Register Centre South, Lund, Sweden, and Boston University School of Medicine, Boston, Massachusetts
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26
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van der Meij E, Bouwsma EVA, van den Heuvel B, Bonjer HJ, Anema JR, Huirne JAF. Using e-health in perioperative care: a survey study investigating shortcomings in current perioperative care and possible future solutions. BMC Surg 2017; 17:61. [PMID: 28535763 PMCID: PMC5442686 DOI: 10.1186/s12893-017-0254-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 05/07/2017] [Indexed: 11/18/2022] Open
Abstract
Background An e-health care program has previously shown to have a positive effect on return to work, quality of life and pain in patients who underwent gynaecological surgery. Plausibly, providing the care program to a population undergoing other types of surgery will be beneficial as well. The objectives of this study are to evaluate patients’ opinions, needs and preferences regarding the information and guidance supplied to patients during the perioperative period, to investigate whether e-health may be of assistance and to explore if gender specific needs exist. Methods A questionnaire was sent to all patients between 18 and 75 years (n = 362), who underwent various forms of abdominal surgery between August 2013 to September 2014 in a university hospital in the Netherlands. The questionnaire contained questions about the current situation in perioperative care and questions about patients’ preferences in an e-health care program. Gender differences were evaluated. Results Two hundred seven participants (57.2%) completed the survey. The majority of the participants were relatively satisfied with the perioperative care they received (68.6%). Most reported shortcomings in perioperative care concerning the supply of information regarding the resumption of activities and guidance during the recovery course. An e-health care program was expected to be of added value in perioperative care by 78% of the participants; a website was reported as most useful. In particular practical functions on a website focusing on the preparation to surgery and monitoring after surgery were appraised to be highly valuable. Overall, women had slightly more needs for extra information and support during the perioperative course than men. Conclusions In abdominal surgery, there is a need for an e-health care program, which should focus mainly on the supply of information about the resumption of activities as well as guidance in the postoperative course.
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Affiliation(s)
- Eva van der Meij
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands. .,Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands.
| | - Esther V A Bouwsma
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.,Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands
| | | | - H Jaap Bonjer
- Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Johannes R Anema
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Judith A F Huirne
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.,Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands
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27
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Cooke M, Waite N, Cook K, Milne E, Chang F, McCarthy L, Sproule B. Incorporating sex, gender and vulnerable populations in a large multisite health research programme: The Ontario Pharmacy Evidence Network as a case study. Health Res Policy Syst 2017; 15:20. [PMID: 28320403 PMCID: PMC5360067 DOI: 10.1186/s12961-017-0182-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 02/16/2017] [Indexed: 11/10/2022] Open
Abstract
Background Funders now frequently require that sex and gender be considered in research programmes, but provide little guidance about how this can be accomplished, especially in large research programmes. The purpose of this study is to present and evaluate a model for promoting sex- and gender-based analysis (SGBA) in a large health service research programme, the Ontario Pharmacy Evidence Network (OPEN). Methods A mixed method study incorporating (1) team members’ critical reflection, (2) surveys (n = 37) and interviews (n = 23) at programme midpoint, and (3) an end-of-study survey in 2016 with OPEN research project teams (n = 6). Results Incorporating gender and vulnerable populations (GVP) as a cross-cutting theme, with a dedicated team and resources to promote GVP research across the programme, was effective and well received. Team members felt their knowledge was improved, and the programme produced several sex- and gender-related research outputs. Not all resources were well used, however, and better communication of the purposes and roles of the team could increase effectiveness. Conclusions The experience of OPEN suggests that dedicating resources for sex and gender research can be effective in promoting SGBA research, but that research programmes should also focus on communicating the importance of SGBA to their members. Electronic supplementary material The online version of this article (doi:10.1186/s12961-017-0182-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Martin Cooke
- Department of Sociology and Legal Studies, University of Waterloo, 200 University Drive W, Waterloo, ON, N2L 3G1, Canada. .,School of Public Health and Health Systems, University of Waterloo, 200 University Drive W, Waterloo, ON, N2L 3G1, Canada.
| | - Nancy Waite
- School of Pharmacy, University of Waterloo, 200 University Drive W, Waterloo, ON, N2L 3G1, Canada
| | - Katie Cook
- Psychology Department, Wilfrid Laurier University, 75 University Avenue West, Waterloo, ON, N2L 3C5, Canada
| | - Emily Milne
- Department of Sociology, MacEwan University, 10700 104th Ave NW, Edmonton, AB, T5J 4S2, Canada
| | - Feng Chang
- School of Pharmacy, University of Waterloo, 200 University Drive W, Waterloo, ON, N2L 3G1, Canada
| | - Lisa McCarthy
- Women's College Research Institute at Women's College Hospital, 76 Grenville St., Toronto, ON, M5S 1B2, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St., Toronto, ON, M5S 3M2, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, 500 University Ave., Toronto, ON, M5G 1V7, Canada
| | - Beth Sproule
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St., Toronto, ON, M5S 3M2, Canada.,Centre for Addiction and Mental Health, 101 Queen St. W., Toronto, ON, M6J 1H4, Canada
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28
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Tannenbaum C, Clow B, Haworth-Brockman M, Voss P. Sex and gender considerations in Canadian clinical practice guidelines: a systematic review. CMAJ Open 2017; 5:E66-E73. [PMID: 28401121 PMCID: PMC5378537 DOI: 10.9778/cmajo.20160051] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The importance of sex and gender in the diagnosis and management of health conditions is well established, but the extent to which this evidence is integrated into clinical practice guidelines remains unknown. We aimed to determine the proportion of Canadian clinical practice guidelines that integrate evidence on sex and gender considerations. METHODS We searched the Canadian Medical Association's CPG Infobase, PubMed, all provincial/territorial websites and websites of professional organizations for English- and French-language Canadian clinical practice guidelines published between January 2013 and June 2015 on selected conditions identified as priorities by policy-makers and practitioners. Citations and text were searched electronically using keyword terms related to sex and gender. Three investigators independently analyzed and categorized the content of text-positive clinical practice guidelines based on clinical relevance for practitioners. RESULTS Of the 118 clinical practice guidelines that met the inclusion criteria, 79 (66.9%) were text-positive for sex and/or gender keywords; 8 (10%) of the 79 used the keywords only in relation to pregnancy. Of the remaining 71 guidelines, 25 (35%) contained sex-related diagnostic or management recommendations. An additional 5 (7%) contained recommendations for sex-specific laboratory reference values, 29 (41%) referred to differences in epidemiologic features or risk factors only, and 12 (17%) contained nonrelevant mentions of search keywords. Twenty-five (35%) of the text-positive guidelines used the terms "sex" and/or "gender" correctly. INTERPRETATION Recommendations related to sex and gender are inconsistently reported in Canadian clinical practice guidelines. Guidelines such as the Sex and Gender Equity in Research guidelines may help inform the meaningful inclusion of sex and gender evidence in the development of clinical practice guidelines.
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Affiliation(s)
- Cara Tannenbaum
- Faculties of Medicine and Pharmacy (Tannenbaum), Université de Montréal; Centre de Recherche (Tannenbaum), Institut universitaire de Gériatrie de Montréal, Université de Montréal; Institute of Gender and Health (Tannenbaum, Voss), Canadian Institutes of Health Research, Montréal, Que.; Barbara Clow Consulting (Clow); Department of History (Clow), Faculty of Graduate Studies, Dalhousie University, Halifax, NS; Department of Sociology (Haworth-Brockman), Faculty of Arts, University of Winnipeg; Rady Faculty of Health Sciences (Haworth-Brockman), National Collaborating Centre for Infectious Diseases, University of Manitoba, Winnipeg, Man
| | - Barbara Clow
- Faculties of Medicine and Pharmacy (Tannenbaum), Université de Montréal; Centre de Recherche (Tannenbaum), Institut universitaire de Gériatrie de Montréal, Université de Montréal; Institute of Gender and Health (Tannenbaum, Voss), Canadian Institutes of Health Research, Montréal, Que.; Barbara Clow Consulting (Clow); Department of History (Clow), Faculty of Graduate Studies, Dalhousie University, Halifax, NS; Department of Sociology (Haworth-Brockman), Faculty of Arts, University of Winnipeg; Rady Faculty of Health Sciences (Haworth-Brockman), National Collaborating Centre for Infectious Diseases, University of Manitoba, Winnipeg, Man
| | - Margaret Haworth-Brockman
- Faculties of Medicine and Pharmacy (Tannenbaum), Université de Montréal; Centre de Recherche (Tannenbaum), Institut universitaire de Gériatrie de Montréal, Université de Montréal; Institute of Gender and Health (Tannenbaum, Voss), Canadian Institutes of Health Research, Montréal, Que.; Barbara Clow Consulting (Clow); Department of History (Clow), Faculty of Graduate Studies, Dalhousie University, Halifax, NS; Department of Sociology (Haworth-Brockman), Faculty of Arts, University of Winnipeg; Rady Faculty of Health Sciences (Haworth-Brockman), National Collaborating Centre for Infectious Diseases, University of Manitoba, Winnipeg, Man
| | - Patrice Voss
- Faculties of Medicine and Pharmacy (Tannenbaum), Université de Montréal; Centre de Recherche (Tannenbaum), Institut universitaire de Gériatrie de Montréal, Université de Montréal; Institute of Gender and Health (Tannenbaum, Voss), Canadian Institutes of Health Research, Montréal, Que.; Barbara Clow Consulting (Clow); Department of History (Clow), Faculty of Graduate Studies, Dalhousie University, Halifax, NS; Department of Sociology (Haworth-Brockman), Faculty of Arts, University of Winnipeg; Rady Faculty of Health Sciences (Haworth-Brockman), National Collaborating Centre for Infectious Diseases, University of Manitoba, Winnipeg, Man
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McCarthy L, Milne E, Waite N, Cooke M, Cook K, Chang F, Sproule BA. Sex and gender-based analysis in pharmacy practice research: A scoping review. Res Social Adm Pharm 2016; 13:1045-1054. [PMID: 27908657 DOI: 10.1016/j.sapharm.2016.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 09/22/2016] [Accepted: 11/18/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Recognizing the potential effect of sex and gender on health outcomes, there is a shift toward conducting sex and gender-based analysis (SGBA) within health research. However, little is known about the extent to which SGBA has been incorporated into pharmacy practice research. OBJECTIVES To understand the extent to which SGBA is included in pharmacy practice research. METHOD Scoping review of English-language studies identified through MEDLINE, Embase, International Pharmacy Abstracts (IPA), and CINAHL (inception to Jan 2014). Two raters independently screened citations to identify titles and abstracts that included key words related to sex or gender and studies that could be categorized as pharmacy practice research. One author extracted data from included studies related to study design, population, intervention/exposure and outcomes, with results reviewed by another. All authors reviewed eligible articles to categorize them based on a previously-developed typology, and to assess four criteria: 1) the inclusion of sex or gender in research objectives, 2) the depth of sex/gender analysis incorporated into study designs and reporting, 3) the inclusion of sex or gender considerations in interpretation of study results, 4) the intentional and accurate use of sex/gender language. RESULTS Of 458 unique search results, only six articles met the inclusion criteria. Two of these six publications included sex/gender considerations in a model consistent with sex/gender based analysis as described by Hammarström. Three of the six studies inaccurately applied sex and gender terminology, whereas the two studies that featured sex or gender in their primary research question did use these terms appropriately. CONCLUSION Despite increasing attention on the need for considering sex and gender, there was a paucity of pharmacy practice research publications that conducted SGBA. This presents an opportunity to explore sex, gender and intersectionality when pursuing studies that explore the impact of pharmacists interventions on patient outcomes.
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Affiliation(s)
- Lisa McCarthy
- Women's College Research Institute at Women's College Hospital, 76 Grenville Street, Toronto, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, Ontario, Canada.
| | - Emily Milne
- School of Pharmacy, University of Waterloo, 10 Victoria Street, Kitchener, Ontario, Canada
| | - Nancy Waite
- School of Pharmacy, University of Waterloo, 10 Victoria Street, Kitchener, Ontario, Canada
| | - Martin Cooke
- School of Pharmacy, University of Waterloo, 10 Victoria Street, Kitchener, Ontario, Canada; Department of Sociology & Legal Studies, University of Waterloo, 200 University Avenue E, Waterloo, Ontario, Canada; School of Public Health and Health Systems, University of Waterloo, 200 University Avenue E, Waterloo, Ontario, Canada
| | - Katie Cook
- School of Pharmacy, University of Waterloo, 10 Victoria Street, Kitchener, Ontario, Canada
| | - Feng Chang
- School of Pharmacy, University of Waterloo, 10 Victoria Street, Kitchener, Ontario, Canada
| | - Beth A Sproule
- Women's College Research Institute at Women's College Hospital, 76 Grenville Street, Toronto, Canada; Centre for Addiction and Mental Health, 1001 Queen Street, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, Canada
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30
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Day S, Mason R, Lagosky S, Rochon PA. Integrating and evaluating sex and gender in health research. Health Res Policy Syst 2016; 14:75. [PMID: 27724961 PMCID: PMC5057373 DOI: 10.1186/s12961-016-0147-7] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 09/22/2016] [Indexed: 11/10/2022] Open
Abstract
Both sex (biological factors) and gender (socio-cultural factors) shape health. To produce the best possible health research evidence, it is essential to integrate sex and gender considerations throughout the research process. Despite growing recognition of the importance of these factors, progress towards sex and gender integration as standard practice has been both slow and uneven in health research. In this commentary, we examine the challenges of integrating sex and gender from the research perspective, as well as strategies that can be used by researchers, funders and journal editors to address these challenges. Barriers to the integration of sex and gender in health research include problems with inconsistent terminology, difficulties in applying the concepts of sex and gender, failure to recognise the impact of sex and gender, and challenges with data collection and datasets. We analyse these barriers as strategic points of intervention for improving the integration of sex and gender at all stages of the research process. To assess the relative success of these strategies in any given study, researchers, funders and journal editors would benefit from a tool to evaluate the quality of sex and gender integration in order to establish benchmarks in research excellence. These assessment tools are needed now amidst growing institutional recognition that both sex and gender are necessary elements for advancing the quality and utility of health research evidence.
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Affiliation(s)
- Suzanne Day
- Women’s Xchange, Women’s College Research Institute, Women’s College Hospital, 76 Grenville Street, Toronto, Ontario M5S 1B2 Canada
| | - Robin Mason
- Women’s Xchange, Women’s College Research Institute, Women’s College Hospital, 76 Grenville Street, Toronto, Ontario M5S 1B2 Canada
- Dalla Lana School of Public Health and Department of Psychiatry, University of Toronto, 27 King’s College Circle, Toronto, Ontario M5S 1A1 Canada
| | - Stephanie Lagosky
- Women’s Xchange, Women’s College Research Institute, Women’s College Hospital, 76 Grenville Street, Toronto, Ontario M5S 1B2 Canada
| | - Paula A. Rochon
- Women’s Xchange, Women’s College Research Institute, Women’s College Hospital, 76 Grenville Street, Toronto, Ontario M5S 1B2 Canada
- Department of Medicine, University of Toronto, 27 King’s College Circle, Toronto, M5S 1A1 Ontario Canada
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Ovseiko PV, Greenhalgh T, Adam P, Grant J, Hinrichs-Krapels S, Graham KE, Valentine PA, Sued O, Boukhris OF, Al Olaqi NM, Al Rahbi IS, Dowd AM, Bice S, Heiden TL, Fischer MD, Dopson S, Norton R, Pollitt A, Wooding S, Balling GV, Jakobsen U, Kuhlmann E, Klinge I, Pololi LH, Jagsi R, Smith HL, Etzkowitz H, Nielsen MW, Carrion C, Solans-Domènech M, Vizcaino E, Naing L, Cheok QHN, Eckelmann B, Simuyemba MC, Msiska T, Declich G, Edmunds LD, Kiparoglou V, Buchan AMJ, Williamson C, Lord GM, Channon KM, Surender R, Buchan AM. A global call for action to include gender in research impact assessment. Health Res Policy Syst 2016; 14:50. [PMID: 27432056 PMCID: PMC4950803 DOI: 10.1186/s12961-016-0126-z] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 06/24/2016] [Indexed: 11/21/2022] Open
Abstract
Global investment in biomedical research has grown significantly over the last decades, reaching approximately a quarter of a trillion US dollars in 2010. However, not all of this investment is distributed evenly by gender. It follows, arguably, that scarce research resources may not be optimally invested (by either not supporting the best science or by failing to investigate topics that benefit women and men equitably). Women across the world tend to be significantly underrepresented in research both as researchers and research participants, receive less research funding, and appear less frequently than men as authors on research publications. There is also some evidence that women are relatively disadvantaged as the beneficiaries of research, in terms of its health, societal and economic impacts. Historical gender biases may have created a path dependency that means that the research system and the impacts of research are biased towards male researchers and male beneficiaries, making it inherently difficult (though not impossible) to eliminate gender bias. In this commentary, we – a group of scholars and practitioners from Africa, America, Asia and Europe – argue that gender-sensitive research impact assessment could become a force for good in moving science policy and practice towards gender equity. Research impact assessment is the multidisciplinary field of scientific inquiry that examines the research process to maximise scientific, societal and economic returns on investment in research. It encompasses many theoretical and methodological approaches that can be used to investigate gender bias and recommend actions for change to maximise research impact. We offer a set of recommendations to research funders, research institutions and research evaluators who conduct impact assessment on how to include and strengthen analysis of gender equity in research impact assessment and issue a global call for action.
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Affiliation(s)
- Pavel V Ovseiko
- Medical Sciences Division, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom.
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Woodstock Road, Oxford, OX2 6GG, United Kingdom
| | - Paula Adam
- Agency for Health Quality and Assessment of Catalonia (AQuAS), Carrer de Roc Boronat, 81, ES-08005, Barcelona, Spain
| | - Jonathan Grant
- The Policy Institute, King's College London, Strand Campus, London, WC2R 2LS, United Kingdom
| | - Saba Hinrichs-Krapels
- The Policy Institute, King's College London, Strand Campus, London, WC2R 2LS, United Kingdom
| | - Kathryn E Graham
- Alberta Innovates - Health Solutions, 10104-103 Avenue NW, Edmonton, AB, T5J 4A7, Canada
| | - Pamela A Valentine
- Alberta Innovates - Health Solutions, 10104-103 Avenue NW, Edmonton, AB, T5J 4A7, Canada
| | - Omar Sued
- Fundación Huésped, Pasaje A. Peluffo 3932 (C1202ABB), Buenos Aires, Argentina
| | | | | | - Idrees S Al Rahbi
- Department of Studies and Planning, The Research Council, P.O. Box 1422, Al Azaiba, 130, Oman
| | - Anne-Maree Dowd
- Commonwealth Scientific and Industrial Research Organisation, P.O. Box 883, Kenmore, Brisbane, 4069, Australia
| | - Sara Bice
- Melbourne School of Government, The University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Tamika L Heiden
- School of Population Health, University of Western Australia, Perth, WA, 6009, Australia.,Knowledge Translation Australia Pty Ltd., Melbourne, Victoria, Australia
| | - Michael D Fischer
- Faculty of Business and Economics, University of Melbourne, 198 Berkeley Street, Parkville, Victoria, 3010, Australia.,Saïd Business School, University of Oxford, Park End Street, Oxford, OX1 1HR, United Kingdom
| | - Sue Dopson
- Saïd Business School, University of Oxford, Park End Street, Oxford, OX1 1HR, United Kingdom
| | - Robyn Norton
- The George Institute for Global Health, University of Oxford, 34 Broad Street, Oxford, OX1 3BD, United Kingdom.,The George Institute for Global Health, University of Sydney, P.O. Box M201, Missenden Road, Sydney, NSW 2050, Australia
| | - Alexandra Pollitt
- The Policy Institute, King's College London, Strand Campus, London, WC2R 2LS, United Kingdom
| | - Steven Wooding
- RAND Europe, Westbrook Centre, Milton Road, Cambridge, CB4 1YG, United Kingdom
| | - Gert V Balling
- Novo Nordisk Foundation, Tuborg Havnevej 19, DK-2900, Hellerup, Denmark
| | - Ulla Jakobsen
- Lundbeck Foundation, Scherfigsvej 7, DK-2100, Copenhagen, Denmark
| | - Ellen Kuhlmann
- Institute for Economics, Labour and Culture, Goethe-University Frankfurt, Senckenberganlage 31, 60325, Frankfurt am Main, Germany.,Medical Management Centre, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Tomtebodavaegen 18a, 171 77, Stockholm, Sweden
| | - Ineke Klinge
- Horizon 2020 Advisory Group for Gender, European Commission, Brussels, Belgium
| | - Linda H Pololi
- National Initiative on Gender, Culture and Leadership in Medicine: C-Change, Brandeis University Women's Studies Research Center, 415 South Street, MS 079, Waltham, MA, 02454, United States of America
| | - Reshma Jagsi
- Department of Radiation Oncology, Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, 48109, United States of America
| | - Helen Lawton Smith
- Department of Management, Birkbeck, University of London, Malet Street, London, WC1E 7HX, United Kingdom
| | - Henry Etzkowitz
- Department of Management, Birkbeck, University of London, Malet Street, London, WC1E 7HX, United Kingdom.,International Triple Helix Institute, 1520 Sand Hill Road, A210, Palo Alto, CA, 94304, United States of America
| | - Mathias W Nielsen
- Gendered Innovations, History Department, Stanford University, 450 Serra Mall, Stanford, CA, 94305, United States of America
| | - Carme Carrion
- Agency for Health Quality and Assessment of Catalonia (AQuAS), Carrer de Roc Boronat, 81, ES-08005, Barcelona, Spain.,Health Sciences Department, Universitat Oberta de Catalunya, Av. Tibidabo 39-43, ES-08035, Barcelona, Spain
| | - Maite Solans-Domènech
- Agency for Health Quality and Assessment of Catalonia (AQuAS), Carrer de Roc Boronat, 81, ES-08005, Barcelona, Spain
| | - Esther Vizcaino
- Agency for Health Quality and Assessment of Catalonia (AQuAS), Carrer de Roc Boronat, 81, ES-08005, Barcelona, Spain
| | - Lin Naing
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Jalan Tungku Link, Gadong, BE1410, Brunei Darussalam
| | - Quentin H N Cheok
- Faculty of Integrated Technologies, Universiti Brunei Darussalam, Jalan Tungku Link, Gadong, BE1410, Brunei Darussalam
| | - Baerbel Eckelmann
- QS Intelligence Unit, Quacquarelli Symonds Ltd, 4 Heathgate, Agincourt Rd, London, NW3 2NT, United Kingdom
| | - Moses C Simuyemba
- Department of Public Health, School of Medicine, University of Zambia, Nationalist Rd, Lusaka, Zambia
| | - Temwa Msiska
- Research Support Centre, College of Medicine, University of Malawi, P.O. Box 360, Chichiri, Blantyre 3, Malawi
| | - Giovanna Declich
- Assembly of Women for Development and the Struggle against Social Exclusion (ASDO), via Guido Reni 56, 00196, Rome, Italy
| | - Laurel D Edmunds
- Medical Sciences Division, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom
| | - Vasiliki Kiparoglou
- NIHR Oxford Biomedical Research Centre, Joint Research Office, Churchill Hospital, Oxford, OX3 7LE, United Kingdom.,Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom
| | - Alison M J Buchan
- Department of Physiology, University of Toronto, 1 King's College Circle, Toronto, Ontario, M5S 1A8, Canada
| | - Catherine Williamson
- Women's Health Academic Centre, King's College London, Guy's Hospital, London, SE1 1UL, United Kingdom.,NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, Guy's Hospital, London, SE1 9RT, United Kingdom.,Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London, SE1 9RT, United Kingdom
| | - Graham M Lord
- NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, Guy's Hospital, London, SE1 9RT, United Kingdom.,Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London, SE1 9RT, United Kingdom.,MRC Centre for Transplantation, King's College London, Guys' Hospital, London, SE1 9RT, United Kingdom
| | - Keith M Channon
- Medical Sciences Division, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom.,NIHR Oxford Biomedical Research Centre, Joint Research Office, Churchill Hospital, Oxford, OX3 7LE, United Kingdom.,Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom
| | - Rebecca Surender
- Department of Social Policy and Intervention, University of Oxford, Barnett House, 32-37 Wellington Square, Oxford, OX1 2ER, United Kingdom.,Institute of Social and Economic Research, Rhodes University, P.O. Box 94, Grahamstown, 6140, South Africa
| | - Alastair M Buchan
- Medical Sciences Division, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom.,NIHR Oxford Biomedical Research Centre, Joint Research Office, Churchill Hospital, Oxford, OX3 7LE, United Kingdom.,Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom
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Simonsen SE, Digre KB, Ralls B, Mukundente V, Davis FA, Rickard S, Tavake-Pasi F, Napia EE, Aiono H, Chirpich M, Stark LA, Sunada G, Keen K, Johnston L, Frost CJ, Varner MW, Alder SC. A gender-based approach to developing a healthy lifestyle and healthy weight intervention for diverse Utah women. EVALUATION AND PROGRAM PLANNING 2015; 51:8-16. [PMID: 25559947 DOI: 10.1016/j.evalprogplan.2014.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Utah women from some cultural minority groups have higher overweight/obesity rates than the overall population. We utilized a gender-based mixed methods approach to learn about the underlying social, cultural and gender issues that contribute to the increased obesity risk among these women and to inform intervention development. A literature review and analysis of Utah's Behavioral Risk Factor Surveillance System data informed the development of a focus group guide. Focus groups were conducted with five groups of women: African immigrants from Burundi and Rwanda, African Americans, American Indians/Alaskan Natives, Hispanics/Latinas, and Pacific Islanders. Six common themes emerged: (1) health is multidimensional and interventions must address health in this manner; (2) limited resources and time influence health behaviors; (3) norms about healthy weight vary, with certain communities showing more preference to heavier women; (4) women and men have important but different influences on healthy lifestyle practices within households; (5) women have an influential role on the health of families; and (6) opportunities exist within each group to improve health. Seeking insights from these five groups of women helped to identify common and distinct cultural and gender themes related to obesity, which can be used to help elucidate core obesity determinants.
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Affiliation(s)
- Sara E Simonsen
- University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT 84018, United States.
| | - Kathleen B Digre
- University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT 84018, United States.
| | - Brenda Ralls
- Utah Department of Health, PO Box 142107, 288 North 1460 West, Salt Lake City, UT 84114-2107, United States; Community Faces of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, United States.
| | - Valentine Mukundente
- Community Faces of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, United States; Best of Africa, 6379 Thor Way, West Valley City, UT 84128, United States.
| | - France A Davis
- Community Faces of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, United States; Calvary Baptist Church, 1090 South State Street, Salt Lake City, UT 84111, United States.
| | - Sylvia Rickard
- Community Faces of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, United States; Hispanic Health Care Task Force, PO Box 58654, Salt Lake City, UT 84158, United States.
| | - Fahina Tavake-Pasi
- Community Faces of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, United States; National Tongan American Society, 3007 South West Temple, Building H, Salt Lake City, UT 84115, United States.
| | - Eru Ed Napia
- Community Faces of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, United States; Urban Indian Center, 120 West 1300 South, Salt Lake City, UT 84115, United States.
| | - Heather Aiono
- University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT 84018, United States; Community Faces of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, United States.
| | - Meghan Chirpich
- University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT 84018, United States; Community Faces of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, United States.
| | - Louisa A Stark
- University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT 84018, United States; Community Faces of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, United States.
| | - Grant Sunada
- Utah Department of Health, PO Box 142107, 288 North 1460 West, Salt Lake City, UT 84114-2107, United States; Community Faces of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, United States.
| | - Kassy Keen
- University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT 84018, United States.
| | - Leanne Johnston
- University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT 84018, United States.
| | - Caren J Frost
- University of Utah College of Social Work, 395 South 1500 East, Room 101, Salt Lake City, UT 84112, United States.
| | - Michael W Varner
- University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT 84018, United States.
| | - Stephen C Alder
- University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT 84018, United States; Community Faces of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, United States.
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Gahagan J, Gray K, Whynacht A. Sex and gender matter in health research: addressing health inequities in health research reporting. Int J Equity Health 2015; 14:12. [PMID: 25637131 PMCID: PMC4320818 DOI: 10.1186/s12939-015-0144-4] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 01/20/2015] [Indexed: 11/10/2022] Open
Abstract
Attention to the concepts of 'sex' and 'gender' is increasingly being recognized as contributing to better science through an augmented understanding of how these factors impact on health inequities and related health outcomes. However, the ongoing lack of conceptual clarity in how sex and gender constructs are used in both the design and reporting of health research studies remains problematic. Conceptual clarity among members of the health research community is central to ensuring the appropriate use of these concepts in a manner that can advance our understanding of the sex- and gender-based health implications of our research findings. During the past twenty-five years much progress has been made in reducing both sex and gender disparities in clinical research and, to a significant albeit lesser extent, in basic science research. Why, then, does there remain a lack of uptake of sex- and gender-specific reporting of health research findings in many health research journals? This question, we argue, has significant health equity implications across all pillars of health research, from biomedical and clinical research, through to health systems and population health.
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Affiliation(s)
- Jacqueline Gahagan
- Gender & Health Promotion Studies Unit (GAHPS Unit), Head, Health Promotion Division, Dalhousie University, Halifax, NS, Canada.
| | - Kimberly Gray
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Ardath Whynacht
- Department of Sociology, Mount Allison University, Sackville, NB, Canada.
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Legato M. Untying the gordian knot: what we do and don't know about gender-specific medicine-keynote address for the 2014 Academic Emergency Medicine Consensus Conference. Acad Emerg Med 2014; 21:1320-4. [PMID: 25491705 DOI: 10.1111/acem.12533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 07/31/2014] [Accepted: 08/05/2014] [Indexed: 12/30/2022]
Abstract
Over the past two decades, a burgeoning interest in women's health, the direct consequence of the feminist movement, has inspired a worldwide interest in the differences between the normal function of men and women and their unique experiences of the same illnesses. The scope and significance of what we have discovered and continue to find has fundamentally changed the way we prevent, diagnose, and treat diseases. Important questions remain, however, and deserve specific investigation and analysis.
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Gleissner C. [How does gender influence oral health?]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2014; 57:1099-106. [PMID: 25106081 DOI: 10.1007/s00103-014-2018-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Most oral diseases show gender-specific differences in prevalence. This is true for common diseases such as caries and periodontitis, which are considered the main causes of tooth loss, affecting women more often than men. Furthermore, other diseases, e.g. temporomandibular joint dysfunction, malignant oral tumours, and several diseases of the oral mucosa show differing incidences between men and women. This is confirmed by empirical evidence from studies in Germany and other European countries, the USA, and emerging nations in Amercia and Southeast Asia. The present article aims to summarize gender-specific knowledge on oral health and present perspectives for future research. The main focus is on tooth loss and edentulism, a key measure of oral health, and their main causes, i.e. caries and periodontitis.
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Affiliation(s)
- C Gleissner
- Poliklinik für Zahnerhaltungskunde, Universitätsmedizin Mainz, Mainz, Deutschland,
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36
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Jahn I, Gansefort D, Kindler-Röhrborn A, Pfleiderer B. Geschlechtersensible Forschung in Epidemiologie und Medizin: Wie kann das erreicht werden? Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2014; 57:1038-46. [DOI: 10.1007/s00103-014-2010-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Johnson J, Sharman Z, Vissandjée B, Stewart DE. Does a change in health research funding policy related to the integration of sex and gender have an impact? PLoS One 2014; 9:e99900. [PMID: 24964040 PMCID: PMC4070905 DOI: 10.1371/journal.pone.0099900] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 05/19/2014] [Indexed: 12/28/2022] Open
Abstract
We analyzed the impact of a requirement introduced in December 2010 that all applicants to the Canadian Institutes of Health Research indicate whether their research designs accounted for sex or gender. We aimed to inform research policy by understanding the extent to which applicants across health research disciplines accounted for sex and gender. We conducted a descriptive statistical analysis to identify trends in application data from three research funding competitions (December 2010, June 2011, and December 2011) (N = 1459). We also conducted a qualitative thematic analysis of applicants' responses. Here we show that the proportion of applicants responding affirmatively to the questions on sex and gender increased over time (48% in December 2011, compared to 26% in December 2010). Biomedical researchers were least likely to report accounting for sex and gender. Analysis by discipline-specific peer review panel showed variation in the likelihood that a given panel will fund grants with a stated focus on sex or gender. These findings suggest that mandatory questions are one way of encouraging the uptake of sex and gender in health research, yet there remain persistent disparities across disciplines. These disparities represent opportunities for policy intervention by health research funders.
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Affiliation(s)
- Joy Johnson
- CIHR Institute of Gender and Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Zena Sharman
- CIHR Institute of Gender and Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bilkis Vissandjée
- Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada
| | - Donna E. Stewart
- University of Toronto and University Health Network, Toronto, Ontario, Canada
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Impact of gender and age on risk factor distribution and health perception: evaluation in a prospective population with heart disease. J Public Health (Oxf) 2014. [DOI: 10.1007/s10389-013-0609-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Oertelt-Prigione S, Gohlke BO, Dunkel M, Preissner R, Regitz-Zagrosek V. GenderMedDB: an interactive database of sex and gender-specific medical literature. Biol Sex Differ 2014; 5:7. [PMID: 24904731 PMCID: PMC4047004 DOI: 10.1186/2042-6410-5-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 05/09/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Searches for sex and gender-specific publications are complicated by the absence of a specific algorithm within search engines and by the lack of adequate archives to collect the retrieved results. We previously addressed this issue by initiating the first systematic archive of medical literature containing sex and/or gender-specific analyses. This initial collection has now been greatly enlarged and re-organized as a free user-friendly database with multiple functions: GenderMedDB (http://gendermeddb.charite.de). DESCRIPTION GenderMedDB retrieves the included publications from the PubMed database. Manuscripts containing sex and/or gender-specific analysis are continuously screened and the relevant findings organized systematically into disciplines and diseases. Publications are furthermore classified by research type, subject and participant numbers. More than 11,000 abstracts are currently included in the database, after screening more than 40,000 publications. The main functions of the database include searches by publication data or content analysis based on pre-defined classifications. In addition, registrants are enabled to upload relevant publications, access descriptive publication statistics and interact in an open user forum. CONCLUSIONS Overall, GenderMedDB offers the advantages of a discipline-specific search engine as well as the functions of a participative tool for the gender medicine community.
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Affiliation(s)
- Sabine Oertelt-Prigione
- Institute of Gender in Medicine, Charité-Universitätsmedizin Berlin, Hessische Str. 3/4, Berlin 10117, Germany ; German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Björn-Oliver Gohlke
- Structural Bioinformatics Group, Charité-Universitätsmedizin Berlin, Berlin 13125, Germany ; German Cancer Consortium (DKTK), Heidelberg 69120, Germany
| | - Mathias Dunkel
- Structural Bioinformatics Group, Charité-Universitätsmedizin Berlin, Berlin 13125, Germany
| | - Robert Preissner
- Structural Bioinformatics Group, Charité-Universitätsmedizin Berlin, Berlin 13125, Germany
| | - Vera Regitz-Zagrosek
- Institute of Gender in Medicine, Charité-Universitätsmedizin Berlin, Hessische Str. 3/4, Berlin 10117, Germany ; German Center for Cardiovascular Research (DZHK), Berlin, Germany ; Center for Cardiovascular Research (CCR), Charité-Universitätsmedizin Berlin, Berlin 10115, Germany
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Strobl R, Müller M, Thorand B, Linkohr B, Autenrieth CS, Peters A, Grill E. Men benefit more from midlife leisure-time physical activity than women regarding the development of late-life disability--results of the KORA-Age study. Prev Med 2014; 62:8-13. [PMID: 24502847 DOI: 10.1016/j.ypmed.2014.01.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 01/13/2014] [Accepted: 01/27/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Encouraging physical activity is an important public health measure to reduce disability prevalence in the aged. The aims of this study were to determine the association between midlife physical activity and late-life disability and to investigate gender-specific differences. METHOD This data originates from the KORA-Age cohort, a follow-up in 2008 of the MONICA (Multinational Monitoring of Trends and Determinants in Cardiovascular Diseases)/KORA (Cooperative Health Research in the Region of Augsburg) S1-S4 surveys (1984-2001) situated in Augsburg, a city in Southern Germany. We applied a multivariable hurdle model to investigate the association of physical activity and disability. RESULTS We analysed 3333 persons with a mean follow-up of 18±5.5 years. Using hurdle models, moderate activity and high activity had a protective effect on the occurrence of disability (OR (odds ratio)=0.80 and 0.73), but not on severity (i.e. number of limitations). We observed a strong gender-specific difference in this association, with men benefitting more from exercise. CONCLUSION Elevated physical activity reduces the risk of becoming disabled and postpones the onset of disability by several years, but we could not show an effect on the severity of disability. In addition, men seem to benefit more from leisure-time physical activity than women.
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Affiliation(s)
- Ralf Strobl
- Institute for Medical Information Processing, Biometrics and Epidemiology (IBE), Ludwig-Maximilians-Universität München, Munich, Germany; German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität München, Munich, Germany.
| | - Martin Müller
- Institute for Medical Information Processing, Biometrics and Epidemiology (IBE), Ludwig-Maximilians-Universität München, Munich, Germany; German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Barbara Thorand
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Birgit Linkohr
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Christine S Autenrieth
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany; Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Annette Peters
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Eva Grill
- Institute for Medical Information Processing, Biometrics and Epidemiology (IBE), Ludwig-Maximilians-Universität München, Munich, Germany; German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität München, Munich, Germany
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Oertelt-Prigione S, Klinger C, Rau B. Perceived Relevance of Gender-Specific Differences in Gastrointestinal Medicine and Surgery: Results of a Survey. VISZERALMEDIZIN 2014; 30:108-13. [PMID: 26286374 PMCID: PMC4513801 DOI: 10.1159/000360742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background The recognition of the relevance of sex and gender differences in medicine has significantly increased in the last 20 years. Nonetheless, the implementation of these aspects into clinical practice still remains to be attained. In particular, while sex differences – which refer to biological attributes – are widely accepted, gender concepts – which include sociocultural and psychological properties – are frequently treated with diffidence. Methods In December 2012 and January 2013, all members of the German Society for General and Abdominal Surgery (DGAV) were invited to participate in an online-based survey to determine the relevance and incorporation of sex and gender aspects in gastrointestinal medicine and surgery. Results 493 (13.4%) of the 3,689 members of the DGAV participated in the survey. More than 50% of the participants reported including sex and gender aspects into consultation, diagnosis, and management at least occasionally. However, 44% reported no knowledge of the formal definition of ‘gender medicine’, suggesting potential differences in the perception of the notion of gender. Conclusion The participants of the survey demonstrated vast knowledge about sex differences, while gender attributes were generally neglected. Since gender features are critically relevant for prevention as well as during medical consultation, we suggest this area as a potential target for further training initiatives.
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Affiliation(s)
- Sabine Oertelt-Prigione
- Institut für Geschlechterforschung in der Medizin (GiM), Charité - Universitätsmedizin, Campus Mitte, Germany
| | - Carsten Klinger
- StuDoQ - Studien-, Dokumentations- und Qualitätszentrum, Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie, Germany
| | - Beate Rau
- Klinik für Allgemein-, Viszeral-, Gefäß- und Thoraxchirurgie, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
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Shen HN, Wang WC, Lu CL, Li CY. Effects of gender on severity, management and outcome in acute biliary pancreatitis. PLoS One 2013; 8:e57504. [PMID: 23469006 PMCID: PMC3585306 DOI: 10.1371/journal.pone.0057504] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 01/22/2013] [Indexed: 12/28/2022] Open
Abstract
Background We conducted a population-based cross-sectional study to examine gender differences in severity, management, and outcome among patients with acute biliary pancreatitis (ABP) because available data are insufficient and conflicting. Methods We analyzed 13,110 patients (50.6% male) with first-attack ABP from Taiwan’s National Health Insurance Research Database between 2000 and 2009. The primary outcome was hospital mortality. Secondary outcomes included the development of severe ABP and the provision of treatment measures. Gender difference was assessed using multivariable analyses with generalized estimating equations models. Results The odds of gastrointestinal bleeding (adjusted odds ratio [aOR] 1.44, 95% confidence interval [CI] 1.18–1.76) and local complication (aOR 1.38, 95% CI 1.05–1.82) were 44% and 38% higher in men than in women, respectively. Compared with women, men had 24% higher odds of receiving total parenteral nutrition (aOR 1.24, 95% CI 1.00–1.52), but had 18% and 41% lower odds of receiving cholecystectomy (aOR 0.82, 95% CI 0.72–0.93) and hemodialysis (aOR 0.59, 95% CI 0.42–0.83), respectively. Hospital mortality was higher in men than in women (1.8% vs. 1.1%, p = 0.001). After adjustment for potential confounders, men had 81% higher odds of in-hospital death than women (aOR 1.81, 95% CI 1.15–2.86). Among patients with severe ABP, hospital mortality was 11.0% and 7.5% in men and women (p<0.001), respectively. The adjusted odds of death remained higher in men than in women with severe ABP (aOR 1.72, 95% CI 1.10–2.68). Conclusions Gender is an important determinant of outcome in patients with ABP and may affect their treatment measures.
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Affiliation(s)
- Hsiu-Nien Shen
- Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan, Taiwan
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wen-Ching Wang
- Department of General Surgery, Chi Mei Medical Center, Tainan, Taiwan
| | - Chin-Li Lu
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Public Health, China Medical University, Taichung, Taiwan
- * E-mail:
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Branković I, Verdonk P, Klinge I. Applying a gender lens on human papillomavirus infection: cervical cancer screening, HPV DNA testing, and HPV vaccination. Int J Equity Health 2013. [PMID: 23394214 DOI: 10.1186/1475-9276-1214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Our aim is to provide a state-of-the-art overview of knowledge on sex (biological) and gender (sociocultural) aspects of Human papillomavirus (HPV) and cervical cancer for educational purposes. Considerable disparities exist in cervical cancer incidences between different subgroups of women. We provide an outline on the crucial issues and debates based on the recent literature published in leading gender medicine journals. Intersectionality was applied in order to help categorise the knowledge. METHODS Key terms (HPV, cervical cancer) were screened in Gender Medicine, Journal of Women's Health and Women & Health from January 2005-June 2012. Additional searches were conducted for topics insufficiently mentioned, such as HPV vaccination of boys. In total, 71 publications were included (56 original papers, four reviews, six reports, three commentaries, one editorial and one policy statement). RESULTS Research reveals complexity in the way various subgroups of women adhere to cervical screening. Less educated women, older women, uninsured women, homeless women, migrant women facing language barriers, women who have sex with women and obese women participate in Pap smears less frequently. A series of barriers can act to impede decisions to vaccinate against HPV. CONCLUSIONS Both male and female controlled preventive methods and treatment measures should be developed in order to tackle HPV infection and different strategies are needed for different subgroups. A substantial discussion and research on alternative methods of prevention was and is lacking. In future research, sex and gender aspects of HPV-related diseases of boys and men as well as subgroup differences in HPV risk need to be addressed.
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Affiliation(s)
- Ivan Branković
- Institute for Public Health Genomics, Department of Genetics and Cell Biology, FHML, School CAPHRI, Maastricht University, PO Box 616, MD 6200, Maastricht, The Netherlands.
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Branković I, Verdonk P, Klinge I. Applying a gender lens on human papillomavirus infection: cervical cancer screening, HPV DNA testing, and HPV vaccination. Int J Equity Health 2013; 12:14. [PMID: 23394214 PMCID: PMC3598235 DOI: 10.1186/1475-9276-12-14] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Accepted: 01/29/2013] [Indexed: 02/08/2023] Open
Abstract
Background Our aim is to provide a state-of-the-art overview of knowledge on sex (biological) and gender (sociocultural) aspects of Human papillomavirus (HPV) and cervical cancer for educational purposes. Considerable disparities exist in cervical cancer incidences between different subgroups of women. We provide an outline on the crucial issues and debates based on the recent literature published in leading gender medicine journals. Intersectionality was applied in order to help categorise the knowledge. Methods Key terms (HPV, cervical cancer) were screened in Gender Medicine, Journal of Women’s Health and Women & Health from January 2005-June 2012. Additional searches were conducted for topics insufficiently mentioned, such as HPV vaccination of boys. In total, 71 publications were included (56 original papers, four reviews, six reports, three commentaries, one editorial and one policy statement). Results Research reveals complexity in the way various subgroups of women adhere to cervical screening. Less educated women, older women, uninsured women, homeless women, migrant women facing language barriers, women who have sex with women and obese women participate in Pap smears less frequently. A series of barriers can act to impede decisions to vaccinate against HPV. Conclusions Both male and female controlled preventive methods and treatment measures should be developed in order to tackle HPV infection and different strategies are needed for different subgroups. A substantial discussion and research on alternative methods of prevention was and is lacking. In future research, sex and gender aspects of HPV-related diseases of boys and men as well as subgroup differences in HPV risk need to be addressed.
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Affiliation(s)
- Ivan Branković
- Institute for Public Health Genomics, Department of Genetics and Cell Biology, FHML, School CAPHRI, Maastricht University, PO Box 616, MD 6200, Maastricht, The Netherlands.
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Abbasi A, Corpeleijn E, Meijer E, Postmus D, Gansevoort RT, Gans ROB, Struck J, Hillege HL, Stolk RP, Navis G, Bakker SJL. Sex differences in the association between plasma copeptin and incident type 2 diabetes: the Prevention of Renal and Vascular Endstage Disease (PREVEND) study. Diabetologia 2012; 55:1963-70. [PMID: 22526609 DOI: 10.1007/s00125-012-2545-x] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 03/12/2012] [Indexed: 12/18/2022]
Abstract
AIMS/HYPOTHESIS Vasopressin plays a role in osmoregulation, glucose homeostasis and inflammation. Therefore, plasma copeptin, the stable C-terminal portion of the precursor of vasopressin, has strong potential as a biomarker for the cardiometabolic syndrome and diabetes. Previous results were contradictory, which may be explained by differences between men and women in responsiveness of the vasopressin system. The aim of this study was to evaluate the usefulness of copeptin for prediction of future type 2 diabetes in men and women separately. METHODS From the Prevention of Renal and Vascular Endstage Disease (PREVEND) study, 4,063 women and 3,909 men without diabetes at baseline were included. A total of 208 women and 288 men developed diabetes during a median follow-up of 7.7 years. RESULTS In multivariable-adjusted models, we observed a stronger association of copeptin with risk of future diabetes in women (OR 1.49 [95% CI 1.24, 1.79]) than in men (OR 1.01 [95% CI 0.85, 1.19]) (p (interaction) < 0.01). The addition of copeptin to the Data from the Epidemiological Study on the Insulin Resistance Syndrome (DESIR) clinical model improved the discriminative value (C-statistic,+0.007, p = 0.02) and reclassification (integrated discrimination improvement [IDI] = 0.004, p < 0.01) in women. However, we observed no improvement in men. The additive value of copeptin in women was maintained when other independent predictors, such as glucose, high sensitivity C-reactive protein (hs-CRP) and 24 h urinary albumin excretion (UAE), were included in the model. CONCLUSIONS/INTERPRETATION The association of plasma copeptin with the risk of developing diabetes was stronger in women than in men. Plasma copeptin alone, and along with existing biomarkers (glucose, hs-CRP and UAE), significantly improved the risk prediction for diabetes in women.
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Affiliation(s)
- A Abbasi
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB Groningen, the Netherlands.
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Weiss B. The intersection of neurotoxicology and endocrine disruption. Neurotoxicology 2012; 33:1410-1419. [PMID: 22659293 DOI: 10.1016/j.neuro.2012.05.014] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Revised: 05/22/2012] [Accepted: 05/23/2012] [Indexed: 11/27/2022]
Abstract
Endocrine disruption, the guiding theme of the 27th International Neurotoxicology Conference, merged into the neurotoxicology agenda largely because hormones help steer the process of brain development. Although the disruption motif first attracted public health attention because of reproductive anomalies in both wildlife and humans, the neurobehavioral implications had been planted decades earlier. They stemmed from the principle that sex differences in behavior are primarily the outcomes of differences in how the brain is sexually differentiated during early development by gonadal hormones (the Organizational Hypothesis). We also now understand that environmental chemicals are capable of altering these underlying events and processes. Among those chemicals, the group labeled as endocrine disrupting chemicals (EDCs) offers the clearest evidence of such selectivity, a consequence of their actions on the endogenous sex steroids, androgens and estrogens. Two EDCs in particular offer useful and intriguing examples. One is phthalate esters. The other is bisphenol A. Both agents are used extensively in plastics manufacture, and are pervasive in the environment. Both are produced in immense quantities. Both are found in almost all humans. Phthalates are considered to function in essence as anti-androgens, while bisphenol A is labeled as an estrogen. Their associations with brain sexual differentiation are reviewed and further questions noted. Both EDCs produce a wider spectrum of health effects, however, than would be extrapolated simply from their properties as anti-androgens and estrogens. Obesity is one example. Further complicating their assessment as health risks are questions about nonmonotonic dose-response functions and about transgenerational effects incurred via epigenetic mechanisms. All these facets of endocrine disruption are pieces of a puzzle that challenge neurotoxicologists for solutions.
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Affiliation(s)
- Bernard Weiss
- Department of Environmental Medicine, University of Rochester, School of Medicine and Dentistry, Rochester, NY 14642, United States.
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Abstract
The women's movement rose to prominence decades ago, but women continue to be discriminated against in their encounters with medicine, as both patients and practitioners. How should bioethics think about this state of affairs?
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Abstract
The immune system and its orchestrated response are affected by a multitude of endogenous and exogenous factors, modulators and challenges. One of the most frequent differences described in the immune response is its vigor and activity in females compared to males, leading to the consequent increase in autoimmune conditions seen in the female population as well as differences in the immune response to pathogens and viruses. The following review summarizes our present knowledge on sex differences in the immune response, detailing the hormonal and genetic effects that have been proposed as explanatory mechanisms. Sexual hormones, mostly estrogen but also progesterone and testosterone, affect immune cells quantitatively and qualitatively. Relevant research has focused on the impact of hormones on cytokine production by the different effector cells, as well as impact on immunoglobulin production by B lymphocytes and activity of granulocytes and NK cells. The biological aspects are complemented by research data on the possible modulatory role of the X chromosome. In addition to biological differences, the frequently neglected role of gender as an immunomodulator is introduced and explored. Gender affects all areas of human life and consequently affects the different steps of an immune response. Exposure to various types of antigens, access to health promotion programs and health care, as well as prioritization of health needs and household resource allocation all affect the different response of females and males to immunologic challenges.
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Sex differences in the morphological failure patterns following hip resurfacing arthroplasty. BMC Med 2011; 9:113. [PMID: 21992554 PMCID: PMC3204242 DOI: 10.1186/1741-7015-9-113] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Accepted: 10/13/2011] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Metal-on-metal hybrid hip resurfacing arthroplasty (with a cementless acetabular component and a cemented femoral component) is offered as an alternative to traditional total hip arthroplasty for the young and active adult with advanced osteoarthritis. Although it has been suggested that women are less appropriate candidates for metal-on-metal arthroplasty, the mechanisms of prosthesis failure has not been fully explained. While specific failure patterns, particularly osteonecrosis and delayed type hypersensitivity reactions have been suggested to be specifically linked to the sex of the patient, we wished to examine the potential influence of sex, clinical diagnosis, age of the patient and the size of the femoral component on morphological failure patterns in a large cohort of retrieved specimens following aseptic failure of hip resurfacing arthroplasty. METHODS Femoral remnants retrieved from 173 hips with known patient's sex were morphologically analyzed for the cause of failure. The results were compared with the control group of the remaining 31 failures from patients of unknown sex. The odds ratios (OR) and 95% confidence intervals (CI) of the following morphologically defined variables were calculated using logistic regression analysis: periprosthetic fractures (n=133), osteonecrosis (n=151), the presence of excessive intraosseous lymphocyte infiltration (n=11), and interface hyperosteoidosis (n=30). Logistic regression analysis was performed both unadjusted and after adjustment for sex, age, the size of the femoral component, and preoperative clinical diagnosis. RESULTS Femoral remnants from female patients had a smaller OR for fracture (adjusted OR: 0.29, 95% CI 0.11, 0.80, P for difference=0.02) and for the presence of osteonecrosis (adjusted OR: 0.16, 95% CI 0.04, 0.63, P for difference=0.01). However, women had a higher OR for both the presence of excessive intraosseous lymphocyte infiltration (adjusted OR: 10.22, 95% CI 0.79, 132.57, P for difference=0.08) and interface hyperosteoidosis (adjusted OR: 4.19, 95% CI 1.14, 15.38, P for difference=0.03). CONCLUSIONS Within the limitations of this study, we demonstrated substantial sex differences in distinct failure patterns of metal-on-metal hip resurfacing. Recognition of pathogenically distinct failure modes will enable further stratification of risk factors for certain failure mechanisms and thus affect future therapeutic options for selected patient groups.
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