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Bragazzi NL, Khabbache H, Ouazizi K, Ait Ali D, El Ghouat H, El Alami L, Atwan H, Tuma R, Dickman N, Farah R, Khamisy-Farah R. Key Learnings and Perspectives of a Newly Implemented Sex-and Gender-Based Medicine Modular Course Integrated into the First-Year Medical School Curriculum: A Mixed-Method Survey. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2024; 15:685-693. [PMID: 39050118 PMCID: PMC11268626 DOI: 10.2147/amep.s447843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 07/04/2024] [Indexed: 07/27/2024]
Abstract
Purpose Sex and Gender-Based Medicine (SGBM) addresses the influence of sex and gender on health and healthcare, emphasizing personalized care. Integrating SGBM into medical education is challenging. This study examines the implementation of an SGBM course in an Israeli university during the first year of the medical school. Methods The course integrated lectures, group work, online gender studies resources, workshops, teacher training, and essential literature. The curriculum spanned pre-clinical and clinical aspects, featuring seven 90-minute sessions. Surveys assessed course structure, content, and lecturers using a 5-point Likert scale and qualitative feedback. Quantitative analysis involved descriptive statistics, and thematic analysis was used for qualitative data. Results Of the 84 students surveyed, 35 (41.7%) responded to the first part, and 30 (35.7%) to the second. The SGBM course received high satisfaction with an average score of 3.63, surpassing other first-year courses (average 3.21). Students appreciated the supportive academic atmosphere (mean score 4.20) and diverse teaching methods (mean score 4.03), while the development of feminist thinking was less appreciated (average score 3.49). Lecturers received high ratings (average score 4.33). Qualitative feedback highlighted the value of group work, the significance of the subject matter, and the helpfulness of supplementary videos. Students requested more content on contemporary issues like gender transition and patient perspectives. The feminist medicine aspect was contentious, with students seeking better gender balance and scientific evidence. Conclusion Introducing SGBM into the first-year curriculum yielded positive results with high student satisfaction for content and lecturers. An expanded course module is planned, to be assessed at the end of the next academic year.
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Affiliation(s)
- Nicola Luigi Bragazzi
- Human Nutrition Unit (HNU), Department of Food and Drugs University of Parma, Parma, Italy
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON, Canada
- Postgraduate School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- United Nations Educational, Scientific and Cultural Organization (UNESCO) Chair, Health Anthropology Biosphere and Healing Systems, University of Genoa, Genoa, Italy
| | - Hicham Khabbache
- Director of the UNESCO Chair “Lifelong Learning Observatory” (UNESCO/UMSBA), Fez, Morocco
| | - Khalid Ouazizi
- Department of Psychology, Faculty of Arts and Human Sciences Fès-Saïss, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Driss Ait Ali
- Department of Psychology, Faculty of Arts and Human Sciences Fès-Saïss, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Hanane El Ghouat
- Department of Psychology, Faculty of Arts and Human Sciences Fès-Saïss, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Laila El Alami
- Department of Psychology, Faculty of Arts and Human Sciences Fès-Saïss, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Hisham Atwan
- Department of Internal Medicine, Kaplan Medical Centre, Hebrew University, Rehovot, Israel
| | - Ruba Tuma
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Galilee, Israel
- Clalit Health Services, Akko, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Nomy Dickman
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Raymond Farah
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
- Department of Internal Medicine B, Ziv Medical Center, Safed, Israel
| | - Rola Khamisy-Farah
- Clalit Health Services, Akko, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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Schluchter H, Kaczmarczyk G, Seeland U. Virologists' Sex- and Gender-Based Medical Knowledge of COVID-19 Affects Quality of Students' Education. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:118-125. [PMID: 36895822 PMCID: PMC9989519 DOI: 10.1089/whr.2022.0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 03/08/2023]
Abstract
Background A sex- and gender-based approach to medical education is important to develop new knowledge and to improve quality of and equality within health care. Results of a systematic survey showed a lack of sex- and gender-based medical education at German medical faculties. The global severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) pandemic is affecting people from diverse backgrounds differently, and the reciprocal interactions between biological sex and sociocultural gender aspects with regard to coronavirus disease 2019 (COVID-19) necessitate an intersectional research approach and transfer to medical education. Methods This descriptive-phenomenological qualitative online survey focused on the sex and gender knowledge of faculty staff and the status of implementation in medical education and research at departments of virology and immunology at German university hospitals. It comprised 16 questions generated by an expert consortium based on published research data. In the fall of 2021, 36 leading virologists were invited to participate anonymously in this survey. Results The response rate was 44%. Most experts deemed sex and gender knowledge as not that important or not important. Almost half the lecturers supported a sex- and gender-based research design and sex-disaggregated analysis of animal study data. Biological sex differences and gender aspects regarding SARS-CoV-2 were at least occasionally addressed upon a student's request. Conclusion Virologists attributed only minor importance to sex and gender knowledge, despite scientific evidence of sex and gender differences in the field of virology, immunology, and COVID-19 in particular. This knowledge is not systematically implemented in the curriculum, but rather only occasionally passed on to medical students.
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Affiliation(s)
- Helena Schluchter
- Department of Anesthesiology and Intensive Care, Klinik Floridsdorf, Vienna, Austria
- German Society for Gender-Specific Medicine, Berlin, Germany
| | - Gabriele Kaczmarczyk
- German Society for Gender-Specific Medicine, Berlin, Germany
- German Medical Women's Association (Deutscher Ärztinnenbund), Berlin, Germany
| | - Ute Seeland
- German Society for Gender-Specific Medicine, Berlin, Germany
- Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitaetsmedizin Berlin, Berlin, Germany
- *Address correspondence to: Ute Seeland, PD Dr. med., Institute of Social Medicine, Epidemiology and Health Economics Charité – Universitaetsmedizin Berlin, Luisenstr. 57, Berlin 10117, Germany,
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Darici D, Schneider AYD, Missler M, Pfleiderer B. Are stereotypes in decline? The portrayal of female anatomy in e-learning. ANATOMICAL SCIENCES EDUCATION 2022. [PMID: 35844161 DOI: 10.1002/ase.2211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/06/2022] [Accepted: 07/10/2022] [Indexed: 06/15/2023]
Abstract
Sex and gender bias in anatomy learning materials are considered a "hidden obstacle" to gender equity in medical curricula. The purpose of this study was to investigate whether quantitative sex and gender biases do exist in popular anatomy e-learning platforms and compare the results with those found in contemporary textbooks and atlases. A systematic content-analysis was performed on N = 3767 images published from 2008 to 2021 in which sex/gender could be identified by considering technical aspects of illustration and various intersectional categories. E-learning platforms took into account an appropriate representation of the female body and presented even more females (n = 932/1412; 66%), more frequently from a ventral/anterior (χ2 = 26, P < 0.001) and whole-body perspective (χ2 = 27, P < 0.001). This was in contrast to German anatomy books, where the results pointed to a significant sex and gender bias. For example, all books assessed underrepresented females (n = 707/2355; 30%) and placed them in stereotypical sex-specific context (χ2 = 348, P < 0.001), showing them more often from a caudal/inferior (χ2 = 99, P < 0.001) and internal (χ2 = 132, P < 0.001) perspective. Altogether, the visual representation of sex and gender in anatomical curricula is still biased and the stereotypical perceptions of human anatomy seem to be a global issue. However, the increasing use of electronic learning platforms, which gradually replace traditional books is changing the way the male and female body is depicted, which might offer new opportunities for reducing stereotypes in anatomy education.
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Affiliation(s)
- Dogus Darici
- Institute of Anatomy and Molecular Neurobiology, Westfälische Wilhelms-University, Münster, Germany
| | | | - Markus Missler
- Institute of Anatomy and Molecular Neurobiology, Westfälische Wilhelms-University, Münster, Germany
| | - Bettina Pfleiderer
- Radiology Clinic, Medical Faculty, Westfälische Wilhelms-University, Münster, Germany
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How to Integrate Sex and Gender Medicine into Medical and Allied Health Profession Undergraduate, Graduate, and Post-Graduate Education: Insights from a Rapid Systematic Literature Review and a Thematic Meta-Synthesis. J Pers Med 2022; 12:jpm12040612. [PMID: 35455728 PMCID: PMC9026631 DOI: 10.3390/jpm12040612] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/08/2022] [Accepted: 04/08/2022] [Indexed: 12/10/2022] Open
Abstract
Sex and gender are concepts that are often misunderstood and misused, being utilized in a biased, preconceived, interchangeable way. Sex and gender medicine is generally overlooked, despite the profound impact of sex and gender on health outcomes. The aims of the present rapid systematic literature review were (i) to assess the extent to which sex- and gender-sensitive topics are covered in medical courses; (ii) to assess the need for and willingness toward integrating/incorporating sex and gender medicine into health-related education; (iii) to identify barriers and facilitators of the process of implementation of sex and gender medicine in medical teaching, mentoring, and training; and (iv) to evaluate the effectiveness of interventional projects targeting curriculum building and improvement for future gender-sensitive physicians. Seven themes were identified by means of a thematic analysis, namely, (i) how much sex- and gender-based medicine is covered by medical courses and integrated into current medical curricula, (ii) the knowledge of sex and gender medicine among medical and allied health profession students, (iii) the need for and willingness toward acquiring sex- and gender-sensitive skills, (iv) how to integrate sex- and gender-based medicine into medical curricula in terms of barriers and facilitators, (v) existing platforms and tools to share knowledge related to sex and gender medicine, (vi) sex- and gender-based medicine aspects in the post-medical education, and (vii) the impact of sex- and gender-sensitive topics integrated into medical curricula. Based on the identified gaps in knowledge, further high-quality, randomized trials with larger samples are urgently warranted to fill these gaps in the field of implementation of gender medicine in educating and training future gender-sensitive physicians.
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Clever K, Richter C, Meyer G. Current approaches to the integration of sex- and gender-specific medicine in teaching: a qualitative expert survey. GMS JOURNAL FOR MEDICAL EDUCATION 2020; 37:Doc26. [PMID: 32328528 PMCID: PMC7171350 DOI: 10.3205/zma001319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 10/08/2019] [Accepted: 10/14/2019] [Indexed: 06/02/2023]
Abstract
Aim: Although criteria and recommendations for the successful integration of sex- and gender-sensitive aspects in medical teaching have already been published, only a few medical faculties in Germany have conducted the systematic integration of sex- and gender-sensitive medicine. The aim of this expert survey, therefore, was to describe the current approaches to the integration of sex- and gender-sensitive medicine in teaching in the sense of Good Practice. Method: Between April and June 2018, guided interviews were conducted with nine experts in the field of sex- and gender-sensitive medicine. Each of the experts had had experience of implementing sex- and gender-sensitive medicine at their universities. The expert interviews were then evaluated by means of quality content analysis, and frequency analyses were carried out. Results: Aspects of sex- and gender-sensitive medicine were integrated both longitudinally and selectively into the compulsory curriculum or elective fields of various medical, health and nursing science courses. In the opinion of the experts, medical studies should promote the students' gender sensitivity and in particular impart knowledge about the psychosocial and biological aspects of sex- and gender-related differences and sex- and gender-sensitive communication. For the methodological implementation of the integrated contents, didactic resources were partly adapted or developed. The players in the implementation process were confronted with various challenges, e.g. the involvement of the lecturers, the perception of sex- and gender-sensitive medicine as a women's theme as well as ensuring the sustainable integration of sex- and gender-sensitive medicine, which is also structurally anchored in the faculty. Aspects of the curricular integration (e.g. evidence-basing, relevance in examinations) and the structural anchoring (e.g. central organization, staff availability) were mentioned i.a. as being crucial for success. A combination of top-down and bottom-up processes, e.g. by involving the faculty management but also by supporting student initiatives, was described as conducive to success. Conclusion: The depicted approaches to the integration of sex- and gender-sensitive teaching contents give insight as to how sex- and gender-sensitive medicine can be integrated into the curricula. The interviews with the experts point to current themes related to sex- and gender-sensitive medicine and didactic resources. Moreover, it becomes clear which challenges are to be expected for the integration of sex- and gender-sensitive medicine in teaching and how these can be addressed. Particularly the involvement of the faculty's lecturers but also the sustainable integration and continual quality assurance of sex- and gender-sensitive contents present challenges of a crucial nature.
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Affiliation(s)
- Katharina Clever
- Martin Luther University Halle-Wittenberg, Medical Faculty, Institute of Health and Nursing Science, Halle (Saale), Germany
| | - Cynthia Richter
- Martin Luther University Halle-Wittenberg, Medical Faculty, Institute of Health and Nursing Science, Halle (Saale), Germany
| | - Gabriele Meyer
- Martin Luther University Halle-Wittenberg, Medical Faculty, Institute of Health and Nursing Science, Halle (Saale), Germany
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Buil-Cosiales P, Gómez-García C, Cos X, Franch-Nadal J, Vlacho B, Millaruelo J. Escaso conocimiento entre los profesionales sanitarios sobre las diferencias de género en la asociación entre la diabetes tipo 2 y la enfermedad cardiovascular. Semergen 2020; 46:90-100. [DOI: 10.1016/j.semerg.2019.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 10/03/2019] [Accepted: 10/06/2019] [Indexed: 11/28/2022]
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Siller H, Tauber G, Hochleitner M. Does diversity go beyond sex and gender? Gender as social category of diversity training in health profession education - a scoping review. GMS JOURNAL FOR MEDICAL EDUCATION 2020; 37:Doc25. [PMID: 32328527 PMCID: PMC7171361 DOI: 10.3205/zma001318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 04/09/2019] [Accepted: 05/28/2019] [Indexed: 05/03/2023]
Abstract
Background: Sex and gender are social categories of diversity. Diversity can be perceived with an intersectional framework as it demonstrates the intersecting categories that might contribute to oppression, inequality, power and privilege. This article focused on what aspects were considered in diversity training programmes for health professions and the role of sex/gender in this context. Method: This scoping review focuses on the social categories mentioned in diversity education of health professionals. Articles on diversity training for health professionals were searched for in the Web of Science database using the keywords gender, diversity, training, education and health professions. Twelve articles were finally included in this review. Thematic analysis was employed to summarise information deduced from articles. Findings: Gaps in the aspects included in diversity training were identified. Findings show that culture was mostly discussed, whereas sex/gender and lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI) were focused on only to a minor extent. Cultural diversity training includes self-reflection on one's own culture, whereas a comparable tool for sex/gender and LGBTQI is missing. Additionally, other social categories of diversity, such as disability or age, are largely absent. Conclusion: Diversity should be incorporated in its full breadth in health profession education and not fragmented. Additionally, other social categories such as gender might benefit from including self-reflection on these categories in addition to reflecting on the role of power and privilege in order to increase self-awareness for diversity. In this way, othering of the population might be prevented and healthcare can be improved for all.
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Affiliation(s)
- Heidi Siller
- Medical University of Innsbruck, Gender Medicine Unit, Innsbruck, Austria
- *To whom correspondence should be addressed: Heidi Siller, Medical University of Innsbruck, Gender Medicine Unit, Innrain 66, A-6020 Innsbruck, Austria, phone: +43 (0)512 504 25714, Fax: +43 (0)512 504 25719, E-mail:
| | - Gloria Tauber
- Medical University of Innsbruck, Gender Medicine Unit, Innsbruck, Austria
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Schluchter H, Nauman AT, Ludwig S, Regitz-Zagrosek V, Seeland U. Quantitative and Qualitative Analysis on Sex and Gender in Preparatory Material for National Medical Examination in Germany and the United States. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2020; 7:2382120519894253. [PMID: 32363236 PMCID: PMC7180954 DOI: 10.1177/2382120519894253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 10/29/2019] [Indexed: 06/11/2023]
Abstract
BACKGROUND Sex- and gender-based medicine (SGBM) should be a mandatory part of medical education. We compared the quantity and quality of sex- and gender-related content of e-learning materials commonly used by German and American medical students while preparing for national medical examinations. METHODS Quantitative, line-by-line analysis of the preparatory materials AMBOSS 2017 and USMLE Step 1 Lecture Notes (2017) by KAPLAN MEDICAL was performed between April and October 2017. Subjects were allocated to one of the three main fields: clinical subjects, behavioral and social science, and pharmacology. Qualitative analysis comprised binary categorization into sex- and gender-based aspects and qualification with respect to the presence of a pathophysiological explanation for the sex or gender difference. RESULTS In relation to the total content of AMBOSS and KAPLAN, the sex- and gender-based share of the clinical subjects content was 26.8% (±8.2) in AMBOSS and 21.1% (±10.2) in KAPLAN. The number of sex- and gender-based aspects in the behavioral and social science learning material differed significantly for AMBOSS and KAPLAN (4.4% ± 3.1% vs 10.7% ± 7.5%; P = .044). Most of the sex- and gender-related content covered sex differences. Most learning cards and texts did not include a detailed pathophysiological explanation for sex- or gender-based aspects. The knowledge provided in the preparatory documents represents only a small part of facts that are already known about sex and gender differences. CONCLUSIONS The preparatory materials focused almost exclusively on biological sex differences and the sociocultural dimension in particular is underrepresented. A lot more evidence-based facts are known and should be integrated into the materials to reflect the importance of SGBM as an integral component of patient-centered medicine.
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Affiliation(s)
- Helena Schluchter
- Institute of Gender in Medicine (GiM), Charité—Universitätsmedizin Berlin, Germany
| | - Ahmad T Nauman
- Institute of Gender in Medicine (GiM), Charité—Universitätsmedizin Berlin, Germany
| | - Sabine Ludwig
- Institute of Medical Sociology and Rehabilitation, Charité—Universitätsmedizin Berlin, Germany
| | - Vera Regitz-Zagrosek
- Institute of Gender in Medicine (GiM), Charité—Universitätsmedizin Berlin, Germany
- Center for Cardiovascular Research (CCR), Charité—Universitätsmedizin Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
| | - Ute Seeland
- Institute of Gender in Medicine (GiM), Charité—Universitätsmedizin Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
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Park SM, Kim N, Paik HY. Experiences with a graduate course on sex and gender medicine in Korea. JOURNAL OF EDUCATIONAL EVALUATION FOR HEALTH PROFESSIONS 2018; 15:13. [PMID: 29724091 PMCID: PMC6004513 DOI: 10.3352/jeehp.2018.15.13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 05/04/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Seon Mee Park
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Nayoung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Gendered Innovation Center, Seoul, Korea
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Marra AM, Biskup E, Raparelli V. The Internal Medicine and Assessment of Gender Differences in Europe (IMAGINE): The new European Federation of Internal Medicine initiative on sex and gender medicine. Eur J Intern Med 2018; 51:e30-e32. [PMID: 29422375 DOI: 10.1016/j.ejim.2018.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 01/31/2018] [Accepted: 02/02/2018] [Indexed: 02/06/2023]
Affiliation(s)
| | - Ewelina Biskup
- Shanghai University of Medicine and Health Sciences, Shanghai, People's Republic of China; Department of Internal Medicine, University Hospital Basel, Switzerland
| | - Valeria Raparelli
- Experimental Medicine Department, Sapienza - University of Rome, Rome, Italy; McGill University Health Centre Research Institute, Centre for Outcomes Research and Evaluation (CORE), Montreal, Canada
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Abstract
Gender medicine is concerned with the question of why diseases are expressed differently in the genders. It takes differences between men and women into account, which are often neglected by traditional medicine. Sex differences can also be found in cardiovascular diseases; therefore, risk factors for cardiovascular diseases have a different significance depending on the sex. Diabetic diseases tend to promote the occurrence of coronary heart disease (CHD) more strongly in women than in men. Myocardial infarctions affect women 10 years later than men and young women are often treated too late, possibly because myocardial infarction is consider to be a "male disease". The number of cases of coronary syndrome is significantly increasing, particularly in young women. Some of the diseases which predominantly occur in women are takotsubo cardiomyopathy, microcirculation disorders and spontaneous coronary artery dissection. Pharmacological treatment of CHD is principally the same in men and women but attention must be paid to differences in the pharmacokinetics of important drugs. Coronary dilatation has comparable effects in both men and women but more complications occur in women. Cardiac failure with impaired left ventricular systolic function affects more men than women in the Western world but the opposite is true for cardiac failure with preserved left ventricular ejection fraction. Hypertrophic and dilatative cardiomyopathies are more frequent in men. Many of the drugs used to treat cardiac failure have different actions in men and women. Too little attention is paid to the pharmacokinetics and pharmacodynamics in women when testing active agents; however, awareness of the differences that need to be considered is growing.
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Affiliation(s)
- V Regitz-Zagrosek
- Institut für Geschlechterforschung in der Medizin (GiM), Charité - Universitätsmedizin Berlin, Hessische Str. 3-4, 10115, Berlin, Deutschland. .,Center Cardiovascular Research (CCR), Charité - Universitätsmedizin Berlin, Berlin, Deutschland. .,Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Partner Berlin, Berlin, Deutschland.
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Regitz-Zagrosek V. Unsettled Issues and Future Directions for Research on Cardiovascular Diseases in Women. Korean Circ J 2018; 48:792-812. [PMID: 30146804 DOI: 10.4070/kcj.2018.0249] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 08/07/2018] [Indexed: 02/06/2023] Open
Abstract
Biological sex (being female or male) significantly influences the course of disease. This simple fact must be considered in all cardiovascular diagnosis and therapy. However, major gaps in knowledge about and awareness of cardiovascular disease in women still impede the implementation of sex-specific strategies. Among the gaps are a lack of understanding of the pathophysiology of women-biased coronary artery disease syndromes (spasms, dissections, Takotsubo syndrome), sex differences in cardiomyopathies and heart failure, a higher prevalence of cardiomyopathies with sarcomeric mutations in men, a higher prevalence of heart failure with preserved ejection fraction in women, and sex-specific disease mechanisms, as well as sex differences in sudden cardiac arrest and long QT syndrome. Basic research strategies must do more to include female-specific aspects of disease such as the genetic imbalance of 2 versus one X chromosome and the effects of sex hormones. Drug therapy in women also needs more attention. Furthermore, pregnancy-associated cardiovascular disease must be considered a potential risk factor in women, including pregnancy-related coronary artery dissection, preeclampsia, and peripartum cardiomyopathy. Finally, the sociocultural dimension of gender should be included in research efforts. The organization of gender medicine must be established as a cross-sectional discipline but also as a centered structure with its own research resources, methods, and questions.
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Affiliation(s)
- Vera Regitz-Zagrosek
- CHARITÉ Universitätsmedizin Berlin, Institute of Gender in Medicine and CCR, and DZHK (partner site Berlin), Berlin, Germany.
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En route to precision medicine through the integration of biological sex into pharmacogenomics. Clin Sci (Lond) 2017; 131:329-342. [PMID: 28159880 DOI: 10.1042/cs20160379] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 10/15/2016] [Accepted: 11/07/2016] [Indexed: 12/14/2022]
Abstract
Frequently, pharmacomechanisms are not fully elucidated. Therefore, drug use is linked to an elevated interindividual diversity of effects, whether therapeutic or adverse, and the role of biological sex has as yet unrecognized and underestimated consequences. A pharmacogenomic approach could contribute towards the development of an adapted therapy for each male and female patient, considering also other fundamental features, such as age and ethnicity. This would represent a crucial step towards precision medicine and could be translated into clinical routine. In the present review, we consider recent results from pharmacogenomics and the role of sex in studies that are relevant to cardiovascular therapy. We focus on genome-wide analyses, because they have obvious advantages compared with targeted single-candidate gene studies. For instance, genome-wide approaches do not necessarily depend on prior knowledge of precise molecular mechanisms of drug action. Such studies can lead to findings that can be classified into three categories: first, effects occurring in the pharmacokinetic properties of the drug, e.g. through metabolic and transporter differences; second, a pharmacodynamic or drug target-related effect; and last diverse adverse effects. We conclude that the interaction of sex with genetic determinants of drug response has barely been tested in large, unbiased, pharmacogenomic studies. We put forward the theory that, to contribute towards the realization of precision medicine, it will be necessary to incorporate sex into pharmacogenomics.
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