Sex and gender matter in health research: addressing health inequities in health research reporting

Social reintegration of cisgender and transgender women post-incarceration in Brazil: policies and challenges

BACKGROUND

Social reintegration relies on the support given to prisoners not only during their reentry into society but also throughout their imprisonment. Our goal was to analyze the expectations reported by cisgender and transgender women returning to society and of the justice and social welfare professionals from the Brazilian prison system.

METHODS

A qualitative analysis using saturation sampling was conducted. The participants were selected through a non-probabilistic sampling technique. Data was collected through semi-structured interviews with professionals involved in the management of the prison system and female former inmates. Interviews were transcribed and analyzed using an open and focused coding process. Textual data was stored, organized, and coded using Atlas software according to emerging themes.

RESULTS

The study involved 15 professionals and 13 female former inmates, five of them identified as transgender women. Among the professionals, the age range went from 38 to 65 years old; they reported a work history in their respective fields, from 10 to 35 years, with an equal distribution across genders. As for the female former inmates, their ages ranged from 24 to 42 years old, and the most reported crime was drug trafficking. Their incarceration time varied from 1 to 8 years. Female inmates were vulnerable to abuse and violence, including physical, sexual, and emotional violence. Women in situations of prior vulnerability faced additional challenges during their sentences. Transgender women were even more neglected and discriminated against by the system. Despite the professionals being aware and concerned about vulnerabilities and the need to improve the reintegration process, in general, they were not sensitive to the gender perspective. There were no specific policies able to support social integration for this public.

CONCLUSIONS

Data showed multifaceted challenges faced by female former inmates within the Brazilian prison system, highlighting the insufficient policies for both cisgender and transgender women. Additionally, the results revealed a lack of sensitivity among professionals regarding gender issues and their particularities in the prison system and social reintegration. These findings emphasize the need for a more comprehensive and intersectional approach that addresses the diverse socio-economic backgrounds of these individuals.

Sex-based tuberculosis mortality in Newfoundland, 1900-1949: Implications for populations in transition

OBJECTIVE

During the second epidemiological transition, tuberculosis (TB) is one disease that declined substantially enough to reduce all-cause mortality. Sex-based differences in TB mortality may reveal an important dimension of population health transitions between the urbanizing and rural regions of Newfoundland.

MATERIALS AND METHODS

For the island of Newfoundland, yearly age-standardized sex-based TB mortality rates were calculated using individual death records from 1900 to 1949 (n = 30 393). Multiple linear regression models predict the relative rates (RR) of sex-based mortality and the absolute difference between males and females while controlling for time and region (the urbanizing Avalon Peninsula or rural Newfoundland). Multiple linear regression models also predict the median age at death from TB while controlling for time, region, and sex to assess if TB was shifting to an older adult disease compared to those typically afflicted in ages 20-44.

RESULTS

Female TB mortality was relatively and absolutely higher than males; additionally, RR and absolute differences between male and female mortality were significantly lower in rural Newfoundland than the Avalon Peninsula. Median age at death for males was significantly higher than females, and differences in median age at death increased over time.

DISCUSSION

The historically high prevalence of TB throughout Newfoundland, including domestic, social, and public health responsibilities of women, likely contributed to increased exposure and transmission, leading to higher observed mortality. Sex-based TB outcomes should be considered in the discussion of the progression of the epidemiological transition as dynamic inequalities that do not necessarily fit contemporary generalizations of sex-based TB epidemiology.

The Influence of Sex and/or Gender on the Occurrence of Colorectal Cancer in the General Population in Developed Countries: A Scoping Review

Objective: Gender as the "sociocultural role of sex" is underrepresented in colorectal cancer incidence studies, potentially resulting in underestimated risk factors' consequences and inequalities men/women. We aim to explore how literature focusing on differences between men and women in the incidence of colorectal cancer interprets these differences: through sex- or gender-related mechanisms, or both? Methods: We conducted a scoping review using PubMed and Google Scholar. We categorized studies based on their definitions of sex and/or gender variables. Results: We reviewed 99 studies, with 7 articles included in the analysis. All observed differences between men and women. Six articles examined colorectal cancer incidence by gender, but only 2 used the term "gender" to define exposure. One article defined its "sex" exposure variable as gender-related mechanisms, and two articles used "sex" and "gender" interchangeably to explain these inequalities. Gender mechanisms frequently manifest through health behaviors. Conclusion: Our results underscore the need for an explicit conceptual framework to disentangle sex and/or gender mechanisms in colorectal cancer incidence. Such understanding would contribute to the reduction and prevention of social health inequalities.

The Association between Caffeine Consumption from Coffee and Tea and Sleep Health in Male and Female Older Adults: A Cross-Sectional Study

Poor sleep health is common in older adults and is associated with negative health outcomes. However, the relationship between caffeine consumption and sleep health at an older age is poorly understood. This study investigated the association between caffeine consumption and sleep health in community-dwelling older males and females in The Netherlands. Cross-sectional analyses were performed using data from 1256 participants aged 61-101 years from the Longitudinal Ageing Study Amsterdam. Self-reported questions assessed sleep disturbances (including sleep latency, continuity, and early awakening), sleep duration, and perceived sleep quality. Caffeine consumption was determined with questions about frequency, quantity, and type of coffee and tea consumption. Logistic and linear regression models were used, controlling for potential confounders, and interaction by sex and age was tested. Caffeine consumption showed significant interactions with sex (p < 0.005) in association with sleep health outcomes. Older females who abstained from caffeine consumption reported more sleep disturbances (β = 0.64 [95%CI 0.13; 1.15]) and had greater odds of short sleep duration (<7 h/day) (OR = 2.26 [95% CI 1.22; 4.20]) compared to those who consumed caffeine. No associations were observed for long sleep duration (>8 h/day) and perceived sleep quality. No associations were observed in older males. Caffeine abstinence was associated with more sleep disturbances and short sleep duration in older females, but not in males. The observed association in older females may reflect reverse causation, suggesting that females may have different motivations for discontinuing caffeine consumption than males.

Trends in the prevalence of intellectual disability among children in Taiwan

BACKGROUND

Intellectual disability (ID) is a major developmental disability. However, data on changes in the prevalence over time at the national level are limited.

METHOD

Using data from the national disability registry, we conducted an ecological study to evaluate the time trends of ID among children in Taiwan. We calculated the prevalence of ID by age, sex and severity, from 2000 to 2011, and assessed the time trends.

RESULTS

During the study period, the overall prevalence of ID in children aged 3-17 years increased from 3.60 to 5.91 per 1000 (β = 0.22, P < 0.001, r2  = 0.97). The prevalence of mild ID (MID, intelligence quotient: 50-69) increased from 1.30 to 3.60 per 1000 (β = 0.21, P < 0.001, r2  = 0.98). However, the prevalence of severe ID (SID, intelligence quotient: <50) was relatively constant, between 2.22 and 2.38 per 1000 (β = 0.01, P = 0.076, r2  = 0.96). Boys had a higher prevalence than girls, and the average boy-to-girl prevalence ratio was 1.42 for MID and 1.31 for SID. The boy-to-girl prevalence ratios of MID and SID decreased over time (β = -0.01, P < 0.001, r2  = 0.99 for MID; β = -0.01, P < 0.001, r2  = 1.00 for SID).

CONCLUSION

The prevalence of ID in Taiwanese children increased from 2000 to 2011 and was largely attributable to increases in MID. Boys had a higher prevalence of ID and were more likely to have MID.

A genderful research world: rapid review, design, and pilot study of an interactive platform for curated sex and gender health research resources

BACKGROUND

Integration of sex and gender into health research is best practice for designing and conducting equitable, rigorous scientific research. Many evidence-based resources exist to support researchers in this endeavour, but such resources often remain underutilized as they are difficult to find, are not publicly accessible, or are specific to a particular research phase, context, or population. The development and evaluation of a repository of resources was deemed important to create an accessible platform for promoting sex- and gender-integration in health research.

METHODS

A rapid review was conducted of critical resources for conducting sex and gender health research. These were integrated into a prototype website design (the Genderful Research World; GRW) that provided an interactive digital landscape for researchers to access these resources. A pilot study evaluated the GRW website for applicability, desirability, and usability with an international sample of 31 health researchers from various disciplines and career stages. Quantitative data from the pilot study was summarized with descriptive statistics. Qualitative data was summarized narratively and used to identify concrete elements for improvement in a second design iteration.

RESULTS

Results of the pilot study revealed that the GRW was considered user friendly and desirable by health researchers and helped them access relevant information. Feedback suggested that providing these resources in a playful way may enhance the experience of the user, particularly given the high 'desirability' scores and that users emphasized the interactive layout as being key to their intention to integrate it into their teaching endeavors. Key feedback from the pilot study (e.g., addition of resources specific to research with transgender populations, revision of website layout) was integrated into the current version of the website: www.genderfulresearchworld.com .

CONCLUSIONS

The present research suggests a utility for a repository of resources for integrating sex and gender considerations into research, and that providing a logical, intuitive means of cataloguing and navigating such resources is critical for usability. The results of this study may inform the development of other novel researcher-directed resource curation efforts to address health equity issues and encourage and support health researchers to integrate a sex and gender perspective in their work.

Sex differences in learning and performing the Go/NoGo tasks

BACKGROUND

The quality of learning and post-learning performances is critical for daily life. The behavioral flexibility is equally important for adapting the changing circumstances. The learning process requires repeated practices, which enhances prompt and proper behavioral responses, in turn, which promotes habits formation as well. Despite the well-documented sex differences in learning and performances, contradictory results were reported. A possible cause might be a systematic analysis due to specific research interests, regardless of the continuity of natural acquisition process. Here, we investigate the potential sex differences in learning, performances and adjustments of habited behaviors with regular and reversal Go/NoGo tasks.

METHODS

Both male and female Sprague-Dawley rats were used in this study. All rats were trained for a regular rodent Go/NoGo task and a subset of rats were trained for a reversal rodent Go/NoGo task, both with strict elimination criteria. The behavioral performance data were stored in PC for off-line analysis. Multiple behavioral indices were analyzed for both passed and retired rats.

RESULTS

The ability of learning the regular the reversal Go/NoGo tasks was similar for both male and female rats, however, the female rats took longer time to master the task principles in later stages for both tasks. In the regular Go/NoGo task, the female rats spent more time on completing the trial in performance optimization phases, which implied female rats were more cautious than male rats. Along with the progression of training, both male and female rats developed Go-preference strategies to perform the regular Go/NoGo task, which induced failure to meet the setting success criteria. The retired male rats exhibited shorter RTs and MTs than the retired female rats after developing Go-preference. Moreover, the time needed to complete the Go trials was significantly prolonged for male rats in the reversal Go/NoGo task.

CONCLUSIONS

Overall, we conclude that distinctive strategies were employed in performing Go/NoGo tasks for both male and female rats. Male rats required less time to stabilize the performance in behavioral optimization phase. In addition, male rats were more accurate in estimating time elapsing. In contrast, female rats took more cautious considerations in performing the task, through which minimal influences were manifested in the reversal version of task.

The quality of gender and sex integration in scientific articles resulting from health research funded by the Brazilian Ministry of Health 2004-2016

Aim

Integrating sex and gender into health research is critical to contributing to an ethical and more responsible science to address significant knowledge gaps, resulting in higher-quality evidence for all.

Subject and methods

Using the Essential Metrics for Assessing Sex and Gender Integration in Health Research Proposals Involving Human Participants, we evaluate the quality of the integration of sex and gender in the 350 scientific articles produced by 144 health studies funded by the Department of Science and Technology of the Brazilian Ministry of Health between 2004 and 2016.

Results

The results show that clinical research articles are the type of studies that most frequently report on sex differences, while population and public health research articles most frequently report on gender differences. Analysis of the quality of sex and gender integration reveals low levels of qualification in the items of the literature review and research objectives (section 1) and participant recruitment and retention (section 2). However, the data collection tools, data analysis, and knowledge translation (section 3) items were rated as excellent and good.

Conclusion

Funding agencies and public institutions should recognize the importance of the integration of sex and gender at all stages of the research process, for instance, through awareness and training for researchers and reviewers, clear requirements, and the possibility to use metrics in the evaluations process.

Health Impacts of High BMI in China: Terrible Present and Future

Temporal trends and future expectations of health effects due to high body mass index (BMI) remain uncertain in China. The trends of high-BMI-related death in China were evaluated and predicted until 2040 using data and methods from the Global Burden of Disease study. The absolute numbers and age-standardized rates of death and disability-adjusted life years (DALYs) were also calculated by age, gender, and cause. From 1990 to 2019, the high-BMI-related death percent, number and rate were all significantly increased in China, and death rate may exceed that globally in the next 10 years. High BMI caused more deaths and DALYs for men than for women, and the gap appeared to increase over time. In 2019, the burden of high BMI among ages 0−14 and 15−19 for children and adolescents were lower than that among adults (>20 years). The most common cause of death associated with high BMI was stroke, followed by ischemic heart disease and hypertensive heart disease. High BMI burden is a significant public health challenges in China. BMI surveillance and evaluation of evidence-based preventive strategies should be immediately initiated in Chinese residents due to the rapid increase in the burden of high BMI.

Gender Disparities Among Editorial Boards of International Urology Journals

BACKGROUND

Gender composition among surgical academic leadership, including academic medical journals, disproportionately favors men and may inadvertently introduce a bias. An understanding of the factors associated with gender representation among urologic journals may aid in prioritizing an equitable balance.

OBJECTIVE

To evaluate female representation on editorial boards of pre-eminent international urologic journals.

DESIGN, SETTING, AND PARTICIPANTS

The names and position descriptions of urologic journal leadership appointees were collected in October 2021. Gender was assessed using gender-api.com or through personal title, as available. Journal characteristics were summarized using SCImago, a bibliometric indicator database extracted from Scopus journal data.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

A multivariate logistic regression analysis was performed to describe associations between SCImago Journal Rank (SJR) quartile and geographic region with female gender representation. Quartile 1 (Q1) was considered the top quartile and Q4 the bottom quartile concordant with journal impact factor.

RESULTS AND LIMITATIONS

A total of 105 urology-focused journals were identified with 5989 total editorial board members, including 877 (14.6%) female, 5112 (85.4%) male, and two nonbinary persons. Female representation differed significantly by journal leadership position, SJR quartile, and geographic region. On the multivariate analysis of overall female representation, Q1 journals had higher odds of female representation than Q2 and Q3 journals, and had no significant difference from Q4 journals. Additionally, compared with Western Europe, North American journals had 78% higher odds while Asiatic journals had 50% lower odds of female representation. This study is limited by the inability to account for outside factors that lead to invitation or acceptance of journal leadership positions.

CONCLUSIONS

Contemporary female leadership at urology journals is about six times less common than male leadership across all journals, although trends in their proportion were noted when assessed by journal quartile and region. Addressing this gender imbalance represents an important step toward achieving gender equity in the field of urology.

PATIENT SUMMARY

In this study, we looked at the gender balance of academic journal leaders who serve as gatekeepers for sharing urologic research with the public. We found that the most prestigious journals and those in western countries tended to have the highest female representation. We hope that these findings help the academic community recognize and improve gender representation.

Prevalence and risk factors of general and abdominal obesity and hypertension in rural and urban residents in Bangladesh: a cross-sectional study

Background

Obesity and hypertension are global health concerns. Both are linked with increased risks of all-cause and cardiovascular mortality. Several early studies reported the prevalence of obesity and hypertension in Bangladeshi adults, but the associated factors in this country population are not clear yet. We aimed to estimate the prevalence and related risk factors of general and abdominal obesity and hypertension in rural and urban adults in Bangladesh.

Methods

In this cross-sectional study, data (n = 1410) was collected on rural (n = 626) and urban (n = 784) adults from eight divisional regions of Bangladesh. Both anthropometric and socio-demographic measurements were recorded in a standardized questionnaire form. General and abdominal obesity were defined based on WHO proposed cut-off values and hypertension was defined by SBP ≥ 140 mmHg and/or, DBP ≥ 90 mmHg and/or, intake of anti-hypertensive drugs at the time of data collection. Multivariable logistic regression analyses were performed to assess the relationship of general and abdominal obesity and hypertension with various factors.

Results

The overall prevalence of general obesity, abdominal obesity and hypertension was 18.2, 41.9 and 30.9%, respectively. The women had a higher prevalence of general obesity (25.2%), abdominal obesity (56.1%) and hypertension (32.3%) compared to the men (12.2, 29.0, and 29.7%, respectively). The prevalence of both general and abdominal obesity was higher in urban participants (21.7 and 46.6%, respectively) than in the rural participants (13.8 and 35.1%, respectively), whereas, the rural participants had a higher prevalence of hypertension (35.1%) compared to the urban participants (27.5%). In geographical region comparison, the prevalence of general and abdominal obesity and hypertension were higher in participants enrolled from Dhaka (30.8%), Khulna (63.6%) and Mymensingh (43.5%) regions, respectively compared to other regions. In regression analysis, increased age, place of residence and less physical activity were positively associated with the increased risk of both types of obesity and hypertension. The analysis also showed a significant positive association between high BMI and an increased risk of hypertension.

Conclusion

This study shows a high prevalence of obesity and hypertension in rural and urban adults. Increased age, inadequate physical activity and place of residence were significant determinants of general and abdominal obesity and hypertension. A comprehensive intervention program focusing on modifiable risk factors such as lifestyles and food habits is needed to increase awareness and prevent the burden of obesity and hypertension in the Bangladeshi population.

Pandemics, past and present: The role of biological anthropology in interdisciplinary pandemic studies

Biological anthropologists are ideally suited for the study of pandemics given their strengths in human biology, health, culture, and behavior, yet pandemics have historically not been a major focus of research. The COVID‐19 pandemic has reinforced the need to understand pandemic causes and unequal consequences at multiple levels. Insights from past pandemics can strengthen the knowledge base and inform the study of current and future pandemics through an anthropological lens. In this paper, we discuss the distinctive social and epidemiological features of pandemics, as well as the ways in which biological anthropologists have previously studied infectious diseases, epidemics, and pandemics. We then review interdisciplinary research on three pandemics–1918 influenza, 2009 influenza, and COVID‐19–focusing on persistent social inequalities in morbidity and mortality related to sex and gender; race, ethnicity, and Indigeneity; and pre‐existing health and disability. Following this review of the current state of pandemic research on these topics, we conclude with a discussion of ways biological anthropologists can contribute to this field moving forward. Biological anthropologists can add rich historical and cross‐cultural depth to the study of pandemics, provide insights into the biosocial complexities of pandemics using the theory of syndemics, investigate the social and health impacts of stress and stigma, and address important methodological and ethical issues. As COVID‐19 is unlikely to be the last global pandemic, stronger involvement of biological anthropology in pandemic studies and public health policy and research is vital.

Awareness of sex and gender dimensions among physicians: the European federation of internal medicine assessment of gender differences in Europe (EFIM-IMAGINE) survey

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.

Gender-related factors and out-of-hospital cardiac arrest incidence in women and men: analysis of a population-based cohort study in the Netherlands

BACKGROUND

The incidence of out-of-hospital cardiac arrest (OHCA) differs consistently between women and men. Besides sex-related (biological) factors, OHCA risk may relate to gender-related (sociocultural) factors. We explored the association of selected gender-related factors with OHCA incidence in women and men.

METHODS

We combined data on emergency medical services-attended OHCA with individual-level data from all women and men aged ≥25 years living in North Holland, the Netherlands. We estimated the associations between employment status, primary earner status, living with children and marital status and the OHCA incidence with Cox proportional hazards models stratified by sex and adjusted for age and socioeconomic status. To determine if metabolic factors explain the associations, we added hypertension, diabetes mellitus and dyslipidaemia to the models. Population attributable fractions (PAF) for all gender-related factors were calculated.

RESULTS

All four gender-related factors were associated with OHCA incidence (eg, unemployed vs employed; HR 1.98, 95% CI 1.67 to 2.35 in women; HR 1.60, 95% CI 1.44 to 1.79 in men). In both sexes, those unemployed, those who are not primary earners, those living without children, and married or divorced individuals had an increased OHCA risk. The PAF ranged from 4.9 to 40.3 in women and from 4.4 to 15.5 in men, with the highest PAF for employment status in both sexes. Metabolic risk factors did not explain the observed associations.

CONCLUSION

Gender-related factors were associated with risk of OHCA and contributed substantially to the OHCA burden at the population level, particularly in women. Employment status contributed most to the OHCA burden.

What is gender awareness in health? A scoping review of the concept, its operationalization, and its relation to health outcomes

Gender awareness emerged in the 1990s and aimed to provide awareness and sympathy toward the needs of women, measuring health-care providers' attitudes toward them and understand if providers possessed the knowledge for appropriate care. According to Miller et al.'s seminal model, gender awareness incorporates three sub-dimensions: gender sensitivity, gender ideology, and knowledge. Gender awareness has the potential to minimize gender bias in health care, improving the ecological validity of research. This scoping review provides an analysis of how gender awareness has been conceptualized, operationalized, and investigated in its relationship with health-related outcomes. A search was conducted on PubMed, PsycINFO, and ERIC. The relevance of 2.589 articles was assessed and 14 empirical studies were selected and included. Difficulties conceptualizing gender awareness were found and gender awareness and gender sensitivity were often presented as interchangeable. Most papers aimed to measure and compare levels of gender awareness among health professionals and the relationship between gender awareness and relevant health-related outcomes was not studied. Drawing upon a critical analysis of our findings, a proposal for a revised gender awareness conceptualization and operationalization is put forth as to inform novel research on its association with gender bias in health and health care.

Exploring parity in female authorship of pharmacoepidemiology articles: A case study of the Canadian Network for Observational Drug Effect Studies and its citing articles

PURPOSE

The Canadian Network for Observational Drug Effect Studies (CNODES) studies the benefits and risks of post-market drugs and evaluates its research mobilization efforts for accountability, demonstrating value, and learning. As part of these evaluation efforts, and acknowledging gender disparity in authorship across many academic disciplines, CNODES examined the relationship between gender and authorship in its own journal articles and the literature citing them.

METHODS

CNODES articles (published 2012-2017) and all citing articles were identified and extracted using Scopus. Scopus author IDs were used to extract full names and a web service (www.genderapi.com) was used to estimate gender, converting all probabilities <80% to "indeterminate." T-tests and visualizations were used to compare the proportion of females between CNODES and the citing literature.

RESULTS

Twenty-eight CNODES articles and 463 citing articles were identified. The mean number of authors per article was 9.5 in CNODES articles and 5.7 in the citing literature. CNODES articles had a female authorship rate of 36%, compared to 29% in the citing literature (7% difference, 95% CI: [1%, 13%]). There were no female authors in 14% of CNODES articles versus 36% of the citing literature. Women were first authors in 25% and corresponding authors in 14% of CNODES articles.

CONCLUSIONS

This analysis provides a benchmark and method to monitor progress in female parity in pharmacoepidemiology authorship. Further work is needed to determine and address barriers and facilitators to women's recruitment and advancement in the field of pharmacoepidemiology.

A qualitative exploration of how gender and relationship shape family caregivers' experiences across the Alzheimer's disease trajectory

Caregiving experiences are not static. They change across the disease trajectory and care continuum. However, it is not clear how caregiver gender or relationship type is related to evolving caregiver experiences over time. This qualitative study informed by constructivist grounded theory and framework analysis explored the experiences over time of men and women who were adult children and spousal caregivers to persons with Alzheimer's disease. Forty spousal (10 husbands and 10 wives) and adult children (10 sons and 10 daughters) caregivers to persons with Alzheimer's disease were interviewed using a semi-structured interview guide. Our findings suggest the experiences of caregiving, examined through a gender and relationship type lens, are complex and variable. The caregiving experience was not related to gender or relationship type alone, but often to a combination of the two. For instance, spousal caregivers did not immediately accept the diagnosis, with wives being more optimistic than husbands about a slow progression of the disease. Adult children caregivers were concerned about the ways the caregiving role would impact their personal and career obligations and sought ways to mitigate the changes to their daily lives. Sons and husband caregivers largely utilized home and community health services to assist with personal care tasks, whereas daughters and wives utilized the same services to allow them to complete other caregiving tasks (e.g., housekeeping). Recognition of the complex inter-relationships among gender and relationship type on caregiving experiences supports the need for family-centered interventions. This article also extends sex and gender research as it highlights that an in-depth understanding of the caregiving experience cannot be understood by gender alone and relationship type must also be considered.

Sex/Gender-Differences in the Health Effects of Environmental Noise Exposure on Hypertension and Ischemic Heart Disease-A Systematic Review

Previous studies have demonstrated cardiovascular health effects of environmental noise exposure, partly showing different effect estimates for males and females. This cannot be explained by biological differences between males and females alone. It is assumed that health outcomes and exposure patterns also depend on gender, determined by social, economic, and cultural factors in society. This systematic review evaluated the current state of how sex/gender is integrated in studies on environmental noise associated with hypertension, blood pressure, and ischemic heart diseases. A systematic literature search was conducted in three different databases, identifying thirty studies published between 1 January 2000 and 2 February 2020. Effects varied, with no consistent findings for both males and females. All studies used a binary operationalization of sex/gender, assuming static differences between males and females. The differentiation between biological and social dimensions of sex/gender was not present in any of the studies and the terms “sex” and “gender” were used interchangeably. However, biological and social dimensions of sex/gender were unconsciously taken up in the discussion of the results. Integrating sex/gender-theoretical concepts into future studies offers great potential to increase the validity of research findings, thus making them more useful for prevention efforts, health promotion, and health care.

Sex Differences in Supplement Intake in Recreational Endurance Runners-Results from the NURMI Study (Step 2)

It has been well-documented that female and male athletes differ in many physiological and psychological characteristics related to endurance performance. This sex-based difference appears to be associated with their nutritional demands including the patterns of supplement intake. However, there is a paucity of research addressing the sex differences in supplement intake amongst distance runners. The present study aimed to investigate and compare supplement intake between female and male distance runners (10 km, half-marathon, (ultra-)marathon) and the potential associations with diet type and race distance. A total of 317 runners participated in an online survey, and 220 distance runners (127 females and 93 males) made up the final sample after a multi-stage data clearance. Participants were also assigned to dietary (omnivorous, vegetarian, vegan) and race distance (10-km, half-marathon, marathon/ultra-marathon) subgroups. Sociodemographic characteristics and the patterns of supplement intake including type, frequency, dosage, and brands were collected using a questionnaire. One-way ANOVA and logistic regression were used for data analysis. A total of 54.3% of female runners and 47.3% male runners reported consuming supplements regularly. The frequency of supplement intake was similar between females and males (generally or across dietary and distance subgroups). There was no significant relationship for sex alone or sex interactions with diet type and race distance on supplement intake (p < 0.05). However, a non-significant higher intake of vitamin and mineral (but not CHO/protein) supplements was reported by vegan and vegetarian (but not by omnivorous) females compared to their male counterparts. In summary, despite the reported findings, sex could not be considered as a strong modulator of supplement intake among different groups of endurance runners.

Patients' understanding, management practices, and challenges regarding hypertension: A qualitative study among hypertensive women in a rural Bangladesh

Background

Hypertension, as one of the main predisposing factors of many non-communicable diseases, is generally underdiagnosed among women with a significant uncontrolled rate. This study explores the understanding, management practice and challenges related to hypertension among hypertensive women in rural Bangladesh.

Methods

A qualitative study was conducted among hypertensive rural women at Kumarkhali Upazilla, Kushtia, Bangladesh, using purposive and snowball sampling technique. Data was collected through in-depth interviews among twenty-three hypertensive women until they reached saturation. Data were analyzed thematically.

Results

Findings of the study found that a small number of participants perceived the symptoms, risk factors, management and treatment of hypertension based on biomedical understanding. Also, their awareness level and adherence to preventive practices reflected a significant gap between biomedical preventive practices and local practices. A substantial number of participants preferred home management and alternative treatment for hypertension over the medication adherence and hospital treatment. This investigation revealed that poor socio-economic conditions, such as financial insufficiency, and, gender-based negligence impacted women's perception of and practice for hypertension and resulted in risky hypertension management behaviors.

Conclusion

Based on the study, formulation of a comprehensive health education program for creating awareness, provisioning of significant interventions services related to hypertensive care are needed. Further intensive research is needed at the community-level to manage this chronic disease.

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Lack of awareness and underestimation of hypertension is prevalent more than a quarter of the adult world population.

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Knowledge gap about symptoms, risk factors, and management practices of hypertension are predominant among participants.

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Study participants prefer the self-management practices of hypertension without taking medication.

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Financial hardship, forgetfulness in taking medication, anxiety, and stigmas create challenges to manage hypertension.

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Comprehensive, integrated and structured intervention programs should be develop to control hypertension.

A scoping review of female drowning: an underexplored issue in five high-income countries

BACKGROUND

Drowning is a significant public health issue, with females accounting for one third of global drowning deaths. The rate of female drowning has not decreased within high-income countries and presentations to hospital have increased. This scoping review aimed to explore adult female unintentional drowning, including risk factors, clinical treatment and outcomes of females hospitalised for drowning.

METHODS

A systematic search of the literature following the PRISMA-ScR framework was undertaken. The databases OVID MEDLINE, Embase, CINAHL, OVID Emcare, Web of Science, Informit and Scopus were accessed. Study locations of focus were Australia, Canada, New Zealand, the United Kingdom, and the United States. Studies from January 2003 to April 2019 were included. The quality of evidence of included studies was assessed using GRADE guidelines.

RESULTS

The final search results included 14 studies from Australia (n = 4), Canada (n = 1), New Zealand (n = 1), United States (n = 6), United Kingdom (n = 1), and one study reporting data from both Australia and United States. Nine studies reported risk factors for female drowning including age, with the proportion of female drowning incidence increasing with age. Although females are now engaging in risk-taking behaviours associated with drowning that are similar to males, such as consuming alcohol and swimming in unsafe locations, their exposure to risky situations and ways they assess risk, differ. Females are more likely to drown from accidental entry into water, such as in a vehicle during a flood or fall into water. This review found no evidence on the clinical treatment provided to females in hospital after a drowning incident, and only a small number of studies reported the clinical outcomes of females, with inconsistent results (some studies reported better and some no difference in clinical outcomes among females).

CONCLUSION

Adult females are a group vulnerable to drowning, that have lacked attention. There was no single study found which focused solely on female drowning. There is a need for further research to explore female risk factors, the clinical treatment and outcomes of females hospitalised for drowning. This will not only save the lives of females, but also contribute to an overall reduction in drowning.

Endocrine disrupting chemicals and metabolic disorders in the liver: What if we also looked at the female side?

Endocrine disrupting chemicals (EDCs) are linked to the worldwide epidemic incidence of metabolic disorders and fatty liver diseases, which affects quality of life and represents a high economic cost to society. Energy homeostasis exhibits strong sexual dimorphic traits, and metabolic organs respond to EDCs depending on sex, such as the liver, which orchestrates both drug elimination and glucose and lipid metabolism. In addition, fatty liver diseases show a strong sexual bias, which in part could also originate from sex differences observed in gut microbiota. The aim of this review is to highlight significant differences in endocrine and metabolic aspects of the liver, between males and females throughout development and into adulthood. It is also to illustrate how the male and female liver differently cope with exposure to various EDCs such as bisphenols, phthalates and persistent organic chemicals in order to draw attention to the need to include both sexes in experimental studies. Interesting data come from analyses of the composition and diversity of the gut microbiota in males exposed to the mentioned EDCs showing significant correlations with hepatic lipid accumulation and metabolic disorders but information on females is lacking or incomplete. As industrialization increases, the list of anthropogenic chemicals to which humans will be exposed will also likely increase. In addition to strengthening existing regulations, encouraging populations to protect themselves and promoting the substitution of harmful chemicals with safe products, innovative strategies based on sex differences in the gut microbiota and in the gut-liver axis could be optimistic outlook.

Methods for prospectively incorporating gender into health sciences research

Numerous studies have demonstrated that sex (a biological variable) and gender (a psychosocial construct) impact health and have discussed the mechanisms that may explain these relationships. Funding agencies have called for all health researchers to incorporate sex and gender into their studies; however, the way forward has been unclear to many, particularly due to the varied definition of gender. We argue that just as there is no standardized definition of gender, there can be no standardized measurement thereof. However, numerous measurable gender-related variables may influence individual or population-level health through various pathways. The initial question should guide the selection of specific gender-related variables based on their relevance to the study, to prospectively incorporate gender into research. We outline various methods to provide clarification on how to incorporate gender into the design of prospective clinical and epidemiological studies as well as methods for statistical analysis.

Non-alcoholic Fatty Liver Disease as a Canonical Example of Metabolic Inflammatory-Based Liver Disease Showing a Sex-Specific Prevalence: Relevance of Estrogen Signaling

There is extensive evidence supporting the interplay between metabolism and immune response, that have evolved in close relationship, sharing regulatory molecules and signaling systems, to support biological functions. Nowadays, the disruption of this interaction in the context of obesity and overnutrition underlies the increasing incidence of many inflammatory-based metabolic diseases, even in a sex-specific fashion. During evolution, the interplay between metabolism and reproduction has reached a degree of complexity particularly high in female mammals, likely to ensure reproduction only under favorable conditions. Several factors may account for differences in the incidence and progression of inflammatory-based metabolic diseases between females and males, thus contributing to age-related disease development and difference in life expectancy between the two sexes. Among these factors, estrogens, acting mainly through Estrogen Receptors (ERs), have been reported to regulate several metabolic pathways and inflammatory processes particularly in the liver, the metabolic organ showing the highest degree of sexual dimorphism. This review aims to investigate on the interaction between metabolism and inflammation in the liver, focusing on the relevance of estrogen signaling in counteracting the development and progression of non-alcoholic fatty liver disease (NAFLD), a canonical example of metabolic inflammatory-based liver disease showing a sex-specific prevalence. Understanding the role of estrogens/ERs in the regulation of hepatic metabolism and inflammation may provide the basis for the development of sex-specific therapeutic strategies for the management of such an inflammatory-based metabolic disease and its cardio-metabolic consequences.

Readmission rates following heart failure: a scoping review of sex and gender based considerations

Background

Although hospital readmission for heart failure (HF) is an issue for both men and women, little is known about differences in readmission rates by sex. Consequently, strategies to optimize readmission reduction programs and care strategies for women and men remain unclear. Our study aims were: (1) to identify studies examining readmission rates according to sex, and (2) to provide a qualitative overview of possible considerations for the impact of sex or gender.

Methods

We conducted a scoping review using the Arksey and O’Malley framework to include full text articles published between 2002 and 2017 drawn from multiple databases (MEDLINE, EMBASE), grey literature (i.e. National Technical information, Duck Duck Go), and expert consultation. Eligible articles included an index heart failure episode, readmission rates, and sex/gender-based analysis.

Results

The search generated 5887 articles, of which 746 underwent full abstract text consideration for eligibility. Of 164 eligible articles, 34 studies addressed the primary outcome, 103 studies considered sex differences as a secondary outcome and 25 studies stratified data for sex. Good inter-rater agreement was reached: 83% title/abstract; 88% full text; kappa: 0.69 (95%CI: 0.53–0.85). Twelve of 34 studies reported higher heart failure readmission rates for men and six studies reported higher heart failure readmission rates for women. Using non composite endpoints, five studies reported higher HF readmission rates for men compared to three studies reporting higher HF readmission rates for women. Overall, there was heterogeneity between studies when examined by sex, but one observation emerged that was related to the timing of readmissions. Readmission rates for men were higher when follow-up duration was longer than 1 year. Women were more likely to experience higher readmission rates than men when time to event was less than 1 year.

Conclusions

Future studies should consider different time horizons in their designs and avoid the use of composite measures, such as readmission rates combined with mortality, which are highly skewed by sex. Co-interventions and targeted post-discharge approaches with attention to sex would be of benefit to the HF patient population.

A Scoping Review of Literature on Sex and Gender Differences Among Dementia Spousal Caregivers

BACKGROUND AND OBJECTIVES

Sex and gender differences among dementia spousal caregivers have been investigated, but never systematically reviewed or synthesized. A synthesis of findings can help facilitate specificity in practice and in health policy development. As a first step towards such a synthesis, this scoping review reports the available evidence, identifies research gaps, and suggests possible directions for future research.

RESEARCH DESIGN AND METHODS

A scoping review methodology was used to identify articles, and to chart and analyze data. Systematic searches for published, empirical studies, with an explicit goal or hypothesis related to sex or gender differences were conducted in seven databases.

RESULTS

Sixty-one studies met inclusion criteria. Most (n = 45) were quantitative, cross-sectional studies. Caregivers included in the studies were generally 61-70 years old, Caucasian, middle-class, and highly educated. The most extensively investigated differences are: depression, burden, objective physical health, and informal supports.

DISCUSSION AND IMPLICATIONS

This scoping review is the first to summarize and critique the research on sex and gender differences that are specific to dementia spousal caregivers. The review can be used by researchers to make decisions regarding future systematic reviews and primary studies. To further strengthen the evidence base, future studies may benefit from including more caregivers of ethnic minorities, using more qualitative, longitudinal, or experimental designs, and focusing on variables needed to inform caregiving models and theories. Overall, this scoping review contributes to furthering gender-sensitive practices and policies that are better tailored to the specific needs of this population.

Impacts of considering sex and gender during intervention studies in occupational health: Researchers' perspectives

The aim of this article is to examine the impacts of incorporating sex and gender (s/g) analysis in integrated knowledge translation (iKT) initiatives in the field of ergonomics and occupational health. The article presents findings based on a retrospective analysis of twelve intervention-research (IR) studies, including a thematic content analysis of in-depth interviews conducted with 15 researchers involved in these IRs. The findings offer an overview of various categories of impacts, such as changes in partners' views, in workplace settings and conditions, in practices and policies, and in economic outcomes. In these types of IR, health effects measurement is not the main objective, and direct health outcomes are difficult to assess. Explicitly talking about sex/gender led more often to system-level changes but less often to workplace-level changes, compared to interventions where sex/gender was not identified as a specific object of the intervention.

Evaluating a Tool to Support the Integration of Gender in Programs to Promote Men's Health

Men's disproportionate rate of suicide and substance use has been linked to problematic conformity to traditional masculine ideals. Mental health promotion interventions directed toward men should address the gender-specific needs of men; yet, no tools exist to provide such guidance. To address this need, the Check-Mate tool was developed as part of a global evaluation of the Movember Foundation's Social Innovators Challenge (SIC). The tool provides an initial set of evidence-based guidelines for incorporating gender-related influences in men's mental health promotion programs. This article describes the development of Check-Mate and an evaluation of its usability and usefulness. Using a qualitative descriptive approach, semistructured interviews were conducted with the leads for eight of the SIC projects; they used the tool for these. Data were analyzed using conventional content analysis. Overall, project leads found the tool user-friendly. Identified strengths of Check-Mate included its practicality, adaptability, usefulness for priming thinking on gender sensitization, and value in guiding program planning and implementation. With respect to limitations, project leads explained that the complexity of men's mental health promotion programming may limit applicability of some or all approaches included in Check-Mate. They also expressed concern about how using Check-Mate might reinforce hegemonic masculine ideals. It was suggested that examples illustrating the use of Check-Mate would be a helpful accompaniment to the tool. Findings indicate that Check-Mate is a useful guide in men's mental health promotion programming. In addition to future testing of the tool in different settings, links between the tool's approaches and program outcomes should be explored.

Subjective social status and inequalities in depressive symptoms: a gender-specific decomposition analysis for South Africa

Background

Inequalities in mental health are a notable and well documented policy concern in many countries, including South Africa. Individuals’ perception of their position in the social hierarchy is strongly and negatively related to their mental health, whilst the global burden of poor mental health is greater amongst women. This paper offers a first glimpse of the factors that shape gender-based health inequalities across subjective social status.

Methods

This study employs the cross-sectional 2014 South African Social Attitudes Survey (SASAS). The prevalence of depressive symptoms is measured with the aid of the CES-D 8-item scale, with analyses disaggregated by gender. Concentration indices (CI) are used to measure inequalities in depressive symptoms related to subjective social status. The study applies the Wagstaff decomposition to determine the factors that contribute to these gender-based inequalities.

Results

More than 26% of the study sample had depressive symptoms (95% CI 24.92–28.07). The prevalence of depressive symptoms is significantly more pronounced in females (28.46% versus 24.38%; p = 0.011). The concentration index for depressive symptoms is − 0.276 (95% CI -0.341 – − 0.211), showing large inequalities across subjective social status. The observed SSS-related inequality in depressive symptoms however is higher for males (CI = -0.304) when compared to females (CI = -0.240) (p = 0.056). The most important contributor to SSS-related inequalities in depressive symptoms, at 61%, is subjective social status itself (contributing 82% in females versus 44% in males). Other variables that make large contributions to the inequalities in depressive symptoms at 11% each are race (contributing 2% in females versus 25% in males) and childhood conflict (contributing 17% in females versus 4% in males).

Conclusion

Policy makers should target a reduction in the positive contribution of SSS to depression via the implementation of programmes that improve social welfare. Given the much greater contribution to inequalities among females, these policies should target women. Policies that protect children and especially the girl child from conflict can also be useful in reducing inequalities in depression related to subjective social status during adulthood. Overall, there is need for a multi-sectoral approach to address these inequalities.

Work-related traumatic brain injury: A brief report on workers perspective on job and health and safety training, supervision, and injury preventability

BACKGROUND

Although work-related injuries are on the decline, rates of work-related traumatic brain injury (wrTBI) continue to rise. As even mild wrTBI can result in cognitive, behavioural, and functional impairments that can last for months and even years, injury prevention is a primary research focus. Administrative claims data have provided valuable insights into the mechanisms that cause wrTBI; however, data from the perspective of injured workers on wrTBI prevention is limited.

OBJECTIVE

Our study aimed to better understand the factors that precipitate wrTBI, as perceived by injured workers.

METHODS

We recruited 101 injured workers from a neurology services clinic with a province-wide catchment area in a large, urban teaching hospital and studied perceived preventability of these injuries from the injured workers' perspective.

RESULTS

Key findings were that nearly 80% of injuries were perceived as preventable, and nearly 25% and 50% of workers reported that they did not receive job and health and safety training, respectively. Less than half of all workers reported being regularly supervised, and of those who were supervised, approximately two-thirds reported that supervision was adequate. Moreover, 84% and 77% reported they were advised to rest and take time-off after the injury, respectively.

CONCLUSIONS

Our study is the first to show that the vast majority of injured workers consider their wrTBI to be preventable. In addition, we found that training and supervision are two areas that can be targeted by wrTBI prevention strategies. Our study provides valuable and unique perspectives to consider when designing wrTBI prevention initiatives.

Self-management and blood pressure control in China: a community-based multicentre cross-sectional study

OBJECTIVES

This study explored the relationship between self-management and blood pressure (BP) control in China.

DESIGN

A cross-sectional study.

SETTING

Eight community health centres from four cities in the Northeast (Shenyang), Northwest (Xi'an), Southwest (Chengdu) and South (Changsha) of China.

PARTICIPANTS

A total of 873 adults with hypertension, including 360 men and 513 women. Hypertension was defined as systolic BP ≥140 mm Hg and/or diastolic BP ≥90 mm Hg.

OUTCOME MEASUREMENTS

BP control was the primary outcome variable. This was categorised as good control if individuals with hypertension reduced their BP to <140/90 mm Hg, otherwise, it was categorised as poor control. Secondary outcomes included self-management, defined as: (1) context or condition-specific factors or physical/social environments (eg, age, sex, marital status, education, personal income and health insurance) and (2) process or knowledge/beliefs, self-regulation skills/abilities and social facilitation (eg, treatment, diet, exercise and risk factor management). Data were analysed using logistic regression models using SPSS V.20.

RESULTS

A total of 67.1% (n=586) participants had poor BP control. Limited outpatient care benefits in mainly rural residents (OR 2.26, 95% CI 1.06 to 4.81) and longer disease duration (OR 1.03, 95% CI 1.01 to 1.04) were associated with poor BP control. Self-management practices reduced the odds of having poor BP control (OR 0.98, 95% CI 0.97 to 0.99).

CONCLUSIONS

The individual and family self-management theory can serve as an effective theory for understanding the key contexts, processes and outcomes essential for BP control in China. Future research should evaluate the effect of a self-management intervention (eg, self-monitoring, medication adherence, regular and routine doctor visits, and social supports) for BP control in China using a multisite cluster randomised controlled trial. Sex and gender difference, cost and patient-reported outcomes should also be examined.

Exploring Gender-Related Experiences of Cancer Survivors Through Creative Arts: A Scoping Review

Negative health consequences of cancer and its treatments are multifaceted. Research suggests numerous psychosocial benefits may be gained by cancer survivors who engage in arts-based practices. To grasp the breadth of this literature, we undertook a scoping review exploring the intersection between arts-based practices, gender, and cancer. Three databases were searched according to the following criteria: (a) participants older than 18 years, (b) use of arts-based practices, (c) explore cancer survivorship, and (d) gender-based analysis component. A total of 1,109 studies were identified and 11 met inclusion criteria. Themes extracted illustrate four transformative moments related to gender identities postcancer diagnosis: (a) fostering reflection after a cancer diagnosis, (b) constructing new narratives of gender postcancer, (c) navigating gender norms in search of support for new identities, and (d) interrogation of perceived gender norms. Findings demonstrate potential contributions of arts-based practices in shaping cancer-related gender identities. Future research should investigate these experiences across a wider population.

Sex bias in basic science and translational otolaryngology research

OBJECTIVES/HYPOTHESIS

Recent studies revealed sex bias in surgical research. Although many diseases exhibit sex-based clinically relevant differences, otolaryngology research has not been evaluated for sex reporting and sex-based analysis. We postulate that a similar bias is prevalent in otolaryngology literature.

STUDY DESIGN

Literature review.

METHODS

Articles published from 2016 to 2017 in The Laryngoscope, Otolaryngology-Head and Neck Surgery, and JAMA Otolaryngology-Head and Neck Surgery were reviewed. Articles with animal subjects, human subject cells, or commercial cell lines were included. Data collected included study type, cell/animal sex, and sex-based data analysis.

RESULTS

One hundred forty-four basic/translational research articles were identified. Sixty-nine (47.9%) of those lacked sex reporting. Of 75 studies that reported sex, 22 (29.3%) included both sexes, and 11 (14.7%) analyzed data by sex. One hundred five (72.9%) used animal subjects, of which 54 (51.9%) lacked sex breakdown. Among animal studies, 48/105 included only one sex, and three articles analyzed data by sex. Fifty-four studies used commercial cell lines (N = 23) or human/animal subject cells (N = 31). Among cell groups, 28/54 (51.9%) were of unknown sex, and seven were single sex. Eight (14.8%) studies included data analysis by sex. Domestic studies exhibited a lower rate of sex reporting in both animal and cell studies, and a lower rate of sex-based analysis in cell studies.

CONCLUSIONS

Sex may influence outcomes significantly but is underreported and underanalyzed in basic/translational otolaryngology research. Because this research frequently lays the groundwork for clinical trials and standards of care, future research must address these sex-based discrepancies.

LEVEL OF EVIDENCE

NA Laryngoscope, 129:613-618, 2019.

The odd couple: using biomedical and intersectional approaches to address health inequities

Background: Better understanding and addressing health inequities is a growing global priority.

Objective: In this paper, we contribute to the literature examining complex relationships between biological and social dimensions in the field of health inequalities. Specifically, we explore the potential of intersectionality to advance current approaches to socio-biological entwinements.

Design: We provide a brief overview of current approaches to combining both biological and social factors in a single study, and then investigate the contributions of an intersectional framework to such work.

Results: We offer a number of concrete examples of how intersectionality has been used empirically to bring both biological and social factors together in the areas of HIV, post-traumatic stress disorder, female genital circumcision/mutilation/cutting, and cardiovascular disease.

Conclusion: We argue that an intersectional approach can further research that integrates biological and social aspects of human lives and human health and ultimately generate better and more precise evidence for effective policies and practices aimed at tackling health inequities.

Beyond sex and gender difference in funding and reporting of health research

BACKGROUND

Understanding sex and gender in health research can improve the quality of scholarship and enhance health outcomes. Funding agencies and academic journals are two key gatekeepers of knowledge production and dissemination, including whether and how sex/gender is incorporated into health research. Though attention has been paid to key issues and practices in accounting for sex/gender in health funding agencies and academic journals, to date, there has been no systematic analysis documenting whether and how agencies and journals require attention to sex/gender, what conceptual explanations and practical guidance are given for such inclusion, and whether existing practices reflect the reality that sex/gender cannot be separated from other axes of inequality.

METHODS

Our research systematically examines official statements about sex/gender inclusion from 45 national-level funding agencies that fund health research across 36 countries (covering the regions of the EU and associated countries, North America, and Australia) and from ten top-ranking general health (the top five in "science" and the top five in "social science") and ten sex- and/or gender-related health journals. We explore the extent to which agencies and journals require inclusion of sex/gender considerations and to what extent existing strategies reflect state of the art understandings of sex/gender, including intersectional perspectives.

RESULTS

The research highlights the following: (a) there is no consistency in whether sex/gender are mentioned in funding and publishing guidelines; (b) there is wide variation in how sex/gender are conceptualized and how researchers are asked to address the inclusion/exclusion of sex/gender in research; (c) funding agencies tend to prioritize male/female equality in research teams and funding outcomes over considerations of sex/gender in research content and knowledge production; and (d) with very few exceptions, agency and journal criteria fail to recognize the complexity of sex/gender, including the intersection of sex/gender with other key factors that shape health.

CONCLUSIONS

The conceptualization and integration of sex/gender needs to better capture the interacting and complex factors that shape health-an imperative that can be informed by an intersectional approach. This can strengthen current efforts to advance scientific excellence in the production and reporting of research. We provide recommendations and supporting questions to strengthen consideration of sex/gender in policies and practices of health journals and funding agencies.

Sex bias in rhinology research

BACKGROUND

Analysis of general surgery literature has revealed noteworthy sex bias and underreporting. Our objective was to determine the prevalence of sex bias and underreporting in rhinology.

METHODS

All articles in 2016 issues of Rhinology, the American Journal of Rhinology and Allergy (AJRA), and the International Forum of Allergy and Rhinology (IFAR) were reviewed. Of 369 articles, 248 met inclusion criteria. Excluded studies were cadaveric, meta-analysis/review, and editorial. Data collected included study type, demographics, and sex-based statistical analysis.

RESULTS

There were 202 clinical and 46 basic science/translational studies. From 188 of 202 clinical studies with known sex, 1 included participants of a single sex. Sex matching >50% (SM₅₀ ) was found in 81.9%, and 55.9% performed sex-based statistical analysis. Domestic clinical studies performed sex-based analysis more frequently than international (54.9% vs 44.4%) and exhibited a higher rate of SM₅₀ (84.5% vs 80.3%), though these differences were not statistically significant. For basic/translational studies, 54.5% (24/44) provided sex breakdown. Among these, 29.2% included 1 sex, and 8.3% performed sex-based analysis. Of 10 using animals, 70.0% utilized 1 sex. The remaining 30.0% did not report sex. None of 4 cell line studies reported cell sex. Less than half (46.2%) of domestic and 56.3% of international studies reported sex breakdown; 7.7% of domestic and 3.0% of international studies performed sex-based analysis.

CONCLUSION

Although sex may impact outcomes, research without sex reporting and analysis is prevalent, particularly among basic science/translational studies. Future research must account for sex in demographics and analysis to best inform evidence-based clinical guidelines.

Uncovering the hidden impacts of inequality on mental health: a global study

Women are nearly twice as likely as men to suffer from mental illness. This gender disparity in depressive disorders may relate to social inequalities and living standards across nations. Currently, these disparities were not reflected at the level of health policies. This study utilized global data for depressive disorders and socioeconomic data from the United Nations' World Bank databases and Global Burden of Disease database to demonstrate the correlation between social inequality and gender disparities in mental health. This study investigated the association among the ratio of female to male depressive disorder rates, gross domestic product, the GINI Index, and the gender inequality index for 122 countries. The research yielded some major findings. First, there exists a significant correlation between gender inequality and gender disparities in mental health. Second, the GINI index is significantly associated with male-but not female-depressive disorder rates. Third, gender disparities in depressive disorders are associated with a country's wealth. These findings can help to inform society, policy-makers, and clinicians to improve the overall health level globally.

Self-management of cardiac pain in women: an evidence map

OBJECTIVE

To describe the current evidence related to the self-management of cardiac pain in women using the process and methodology of evidence mapping.

DESIGN AND SETTING

Literature search for studies that describe the self-management of cardiac pain in women greater than 18 years of age, managed in community, primary care or outpatient settings, published in English or a Scandinavian language between 1 January 1990 and 24 June 2016 using AMED, CINAHL, ERIC, EMBASE, MEDLINE, Proquest, PsychInfo, the Cochrane Library, Scopus, Swemed+, Web of Science, the Clinical Trials Registry, International Register of Controlled Trials, MetaRegister of Controlled Trials, theses and dissertations, published conference abstracts and relevant websites using GreyNet International, ISI proceedings, BIOSIS and Conference papers index. Two independent reviewers screened using predefined eligibility criteria. Included articles were classified according to study design, pain category, publication year, sample size, per cent women and mean age.

INTERVENTIONS

Self-management interventions for cardiac pain or non-intervention studies that described views and perspectives of women who self-managed cardiac pain.

PRIMARY AND SECONDARY OUTCOMES MEASURES

Outcomes included those related to knowledge, self-efficacy, function and health-related quality of life.

RESULTS

The literature search identified 5940 unique articles, of which 220 were included in the evidence map. Only 22% (n=49) were intervention studies. Sixty-nine per cent (n=151) of the studies described cardiac pain related to obstructive coronary artery disease (CAD), 2% (n=5) non-obstructive CAD and 15% (n=34) postpercutaneous coronary intervention/cardiac surgery. Most were published after 2000, the median sample size was 90 with 25%-100% women and the mean age was 63 years.

CONCLUSIONS

Our evidence map suggests that while much is known about the differing presentations of obstructive cardiac pain in middle-aged women, little research focused on young and old women, non-obstructive cardiac pain or self-management interventions to assist women to manage cardiac pain.

PROSPERO REGISTRATION NUMBER

CRD42016042806.

Sedentary time in older men and women: an international consensus statement and research priorities

Sedentary time is a modifiable determinant of poor health, and in older adults, reducing sedentary time may be an important first step in adopting and maintaining a more active lifestyle. The primary purpose of this consensus statement is to provide an integrated perspective on current knowledge and expert opinion pertaining to sedentary behaviour in older adults on the topics of measurement, associations with health outcomes, and interventions. A secondary yet equally important purpose is to suggest priorities for future research and knowledge translation based on gaps identified. A five-step Delphi consensus process was used. Experts in the area of sedentary behaviour and older adults (n=15) participated in three surveys, an in-person consensus meeting, and a validation process. The surveys specifically probed measurement, health outcomes, interventions, and research priorities. The meeting was informed by a literature review and conference symposium, and it was used to create statements on each of the areas addressed in this document. Knowledge users (n=3) also participated in the consensus meeting. Statements were then sent to the experts for validation. It was agreed that self-report tools need to be developed for understanding the context in which sedentary time is accumulated. For health outcomes, it was agreed that the focus of sedentary time research in older adults needs to include geriatric-relevant health outcomes, that there is insufficient evidence to quantify the dose–response relationship, that there is a lack of evidence on sedentary time from older adults in assisted facilities, and that evidence on the association between sedentary time and sleep is lacking. For interventions, research is needed to assess the impact that reducing sedentary time, or breaking up prolonged bouts of sedentary time has on geriatric-relevant health outcomes. Research priorities listed for each of these areas should be considered by researchers and funding agencies.

This consensus statement has been endorsed by the following societies: Academy of Geriatric Physical Therapy, Exercise & Sports Science Australia, Canadian Centre for Activity and Aging, Society of Behavioral Medicine, and the National Centre for Sport and Exercise Medicine.