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Tong IL. Diversity of Authorship in Clinical Practice Guidelines- Not There Yet. J Womens Health (Larchmt) 2024. [PMID: 38842431 DOI: 10.1089/jwh.2024.0489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024] Open
Affiliation(s)
- Iris L Tong
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Program in Liberal Medical Education, Brown University, Providence, Rhode Island, USA
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2
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Bellamy JL, Goodrich ER, Sabatini FM, Mounce SD, Ovadia SA, Kolin DA, Odum SM, Cohen-Rosenblum A, Landy DC. Systematic Review of Gender and Sex Terminology Use in Arthroplasty Research: There Is Room for Improvement. J Arthroplasty 2024:S0883-5403(24)00436-4. [PMID: 38734326 DOI: 10.1016/j.arth.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND There is increasing appreciation of the distinction between gender and sex as well as the importance of accurately reporting these constructs. Given recent attention regarding transgender and gender nonconforming (TGNC) and intersex identities, it is more necessary than ever to understand how to describe these identities in research. This study sought to investigate the use of gender- and sex-based terminology in arthroplasty research. METHODS The 5 leading orthopaedic journals publishing arthroplasty research were reviewed to identify the first twenty primary clinical research articles on an arthroplasty topic published after January 1, 2022. Use of gender- or sex-based terminology, whether use was discriminate, and whether stratification or adjustment based on gender or sex was performed, were recorded. RESULTS There were 98 of 100 articles that measured a construct of gender or sex. Of these, 15 articles used gender-based terminology, 45 used sex-based terminology, and 38 used a combination of gender- and sex-based terminology. Of the 38 articles using a combination of terminology, none did so discriminately. All articles presented gender and sex as binary variables, and 2 attempted to explicitly define how gender or sex were defined. Of the 98 articles, 31 used these variables for statistical adjustments, though only 6 reported stratified results. CONCLUSIONS Arthroplasty articles infrequently describe how gender or sex was measured, and frequently use this terminology interchangeably. Additionally, these articles rarely offer more than 2 options for capturing variation in sex and gender. Future research should be more precise in the treatment of these variables to improve the quality of results and ensure findings are patient-centered and inclusive.
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Affiliation(s)
- Jaime L Bellamy
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Ezra R Goodrich
- Department of Orthopaedic Surgery, Henry Ford Health, Detroit, Michigan
| | | | - Samuel D Mounce
- Department of Orthopaedic Surgery, University of Kentucky, Lexington, Kentucky
| | - Steven A Ovadia
- Division of Plastic Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - David A Kolin
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Susan M Odum
- OrthoCarolina Research Institute, Charlotte, North Carolina
| | - Anna Cohen-Rosenblum
- Department of Orthopaedic Surgery, Louisiana State University, New Orleans, Louisiana
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3
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Gulamhusein N, Turino Miranda K, Dumanski SM, González Bedat MC, Ulasi I, Conjeevaram A, Ahmed SB. Sex- and Gender-Based Reporting in Antihypertensive Medication Literature Informing Hypertension Guidelines. J Am Heart Assoc 2024; 13:e030613. [PMID: 38420762 PMCID: PMC10944031 DOI: 10.1161/jaha.123.030613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 10/18/2023] [Indexed: 03/02/2024]
Abstract
BACKGROUND Hypertension is the leading modifiable cardiovascular risk factor with recognized sex- and gender-based differences. We assessed the incorporation of sex and gender reporting in the antihypertensive medication literature informing hypertension guidelines. METHODS AND RESULTS Literature cited in the International Society of Hypertension (2020), European Society of Cardiology/European Society of Hypertension (2018), American College of Cardiology/American Heart Association (2017), Latin American Society of Hypertension (2017), Pan-African Society of Cardiology (2020), and Hypertension Canada (2020) guidelines was systematically reviewed. Observational studies, randomized controlled trials, and systematic reviews involving antihypertensive medications were included. Studies with participants of a single sex, guidelines, and commentaries were excluded. Data on study participation-to-prevalence ratio by sex, analysis of baseline demographics and study outcomes by sex, and stratification of adverse events by sex were extracted. Of 1659 unique citations, 331 studies met inclusion criteria. Of those, 81% reported the sex of participants, and 22% reported a male-to-female participation-to-prevalence ratio of 0.8 to 1.2. Three percent of studies stratified baseline characteristics by sex, and 20% considered sex during analysis through statistical adjustment or stratification. Although 32% of studies reported adverse events, only 0.6% stratified adverse events by sex. Most (58%) studies reporting sex/gender used sex and gender terms interchangeably. CONCLUSIONS Incorporation of sex- and gender-based considerations in study population, analysis, or reporting of results and adverse events is not common in the antihypertensive medication literature informing international hypertension guidelines. Greater attention to sex- and gender-based factors in research is required to optimally inform management of hypertension.
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Affiliation(s)
- Nabilah Gulamhusein
- Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Libin Cardiovascular InstituteUniversity of CalgaryCalgaryAlbertaCanada
| | - Keila Turino Miranda
- Department of Kinesiology and Physical EducationMcGill UniversityMontrealQuebecCanada
| | - Sandra M. Dumanski
- Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Libin Cardiovascular InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Alberta Kidney Disease NetworkCalgaryAlbertaCanada
- O’Brien Institute for Public HealthCalgaryAlbertaCanada
| | | | | | | | - Sofia B. Ahmed
- Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Alberta Kidney Disease NetworkCalgaryAlbertaCanada
- Faculty of Medicine and DentistryUniversity of AlbertaEdmontonAlbertaCanada
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4
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Norris CM, Mullen KA, Foulds HJ, Jaffer S, Nerenberg K, Gulati M, Parast N, Tegg N, Gonsalves CA, Grewal J, Hart D, Levinsson AL, Mulvagh SL. The Canadian Women's Heart Health Alliance ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women - Chapter 7: Sex, Gender, and the Social Determinants of Health. CJC Open 2024; 6:205-219. [PMID: 38487069 PMCID: PMC10935698 DOI: 10.1016/j.cjco.2023.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/31/2023] [Indexed: 03/17/2024] Open
Abstract
Women vs men have major differences in terms of risk-factor profiles, social and environmental factors, clinical presentation, diagnosis, and treatment of cardiovascular disease. Women are more likely than men to experience health issues that are complex and multifactorial, often relating to disparities in access to care, risk-factor prevalence, sex-based biological differences, gender-related factors, and sociocultural factors. Furthermore, awareness of the intersectional nature and relationship of sociocultural determinants of health, including sex and gender factors, that influence access to care and health outcomes for women with cardiovascular disease remains elusive. This review summarizes literature that reports on under-recognized sex- and gender-related risk factors that intersect with psychosocial, economic, and cultural factors in the diagnosis, treatment, and outcomes of women's cardiovascular health.
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Affiliation(s)
- Colleen M. Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Kerri-Anne Mullen
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Heather J.A. Foulds
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Shahin Jaffer
- Department of Medicine/Community Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kara Nerenberg
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Martha Gulati
- Barbra Streisand Women’s Heart Centre, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Nazli Parast
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Nicole Tegg
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | | | - Jasmine Grewal
- Department of Medicine/Community Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Donna Hart
- Canadian Women’s Heart Health Alliance, Ottawa, Ontario, Canada
| | | | - Sharon L. Mulvagh
- Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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González Ramos AM, Serrano-Gemes G. Does Sex Matter to the Biomedical Approach in Clinical Practice Guidelines (CPGs)?: A Systematic Review of Methodology Documents Used in the Spanish National Health System. Healthcare (Basel) 2023; 12:74. [PMID: 38200979 PMCID: PMC10778633 DOI: 10.3390/healthcare12010074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/23/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024] Open
Abstract
Sex and gender are important variables in health, although their incorporation in medicine has been very slow. If research is sensitive and yields fruitful sex and gender evidence, these results should be included in the guidelines for clinical practices. However, literature claims that clinical practice guidelines devote very little space to these categories. The present systematic review addresses the relevance of sex and gender dimensions through methodology documents for the development of clinical practice guidelines based on three sources: the AGREE Reporting Checklist, the GRADE Handbook, and the Spanish GuíaSalud NHS Clinical Guideline Program. Findings suggest that neglecting sex and gender issues in the biomedical approach may lead to continuing to ignore relevant evidence on biological and social dimensions that do indeed influence people's health and diseases.
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Affiliation(s)
- Ana M. González Ramos
- Institute for Advanced Social Studies (IESA), The Spanish National Research Council (CSIC), 14004 Córdoba, Spain
| | - Gema Serrano-Gemes
- Department of Nursing and Physiotherapy, Ponferrada University Campus, University of León, 24401 Ponferrada, Spain;
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Peters SAE, Woodward M. A roadmap for sex- and gender-disaggregated health research. BMC Med 2023; 21:354. [PMID: 37704983 PMCID: PMC10500779 DOI: 10.1186/s12916-023-03060-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/30/2023] [Indexed: 09/15/2023] Open
Abstract
Sex and gender are fundamental aspects of health and wellbeing. Yet many research studies fail to consider sex or gender differences, and even when they do this is often limited to merely cataloguing such differences in the makeup of study populations. The evidence on sex and gender differences is thus incomplete in most areas of medicine. This article presents a roadmap for the systematic conduct of sex- and gender-disaggregated health research. We distinguish three phases: the exploration of sex and gender differences in disease risk, presentation, diagnosis, treatment, and outcomes; explaining any found differences by revealing the underlying mechanisms; and translation of the implications of such differences to policy and practice. For each phase, we provide critical methodological considerations and practical examples are provided, taken primarily from the field of cardiovascular disease. We also discuss key overarching themes and terminology that are at the essence of any study evaluating the relevance of sex and gender in health. Here, we limit ourselves to binary sex and gender in order to produce a coherent, succinct narrative. Further disaggregation by sex and gender separately and which recognises intersex, non-binary, and gender-diverse identities, as well as other aspects of intersectionality, can build on this basic minimum level of disaggregation. We envision that uptake of this roadmap, together with wider policy and educational activities, will aid researchers to systematically explore and explain relevant sex and gender differences in health and will aid educators, clinicians, and policymakers to translate the outcomes of research in the most effective and meaningful way, for the benefit of all.
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Affiliation(s)
- Sanne A E Peters
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.
- School of Public Health, The George Institute for Global Health, Imperial College London, London, UK.
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.
| | - Mark Woodward
- School of Public Health, The George Institute for Global Health, Imperial College London, London, UK
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
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Chan V, Estrella MJ, Hanafy S, Colclough Z, Joyce JM, Babineau J, Colantonio A. Equity considerations in clinical practice guidelines for traumatic brain injury and homelessness: a systematic review. EClinicalMedicine 2023; 63:102152. [PMID: 37662521 PMCID: PMC10474365 DOI: 10.1016/j.eclinm.2023.102152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 09/05/2023] Open
Abstract
Background Clinical practice guidelines (CPGs) predominantly prioritise treatment and cost-effectiveness, which encourages a universal approach that may not address the circumstances of disadvantaged groups. We aimed to advance equity and quality of care for individuals experiencing homelessness and traumatic brain injury (TBI) by assessing the extent to which homelessness and TBI are integrated in CPGs for TBI and CPGs for homelessness, respectively, and the extent to which equity, including consideration of disadvantaged populations and the PROGRESS-Plus framework, is considered in these CPGs. Methods For this systematic review, CPGs for TBI or homelessness were identified from electronic databases (MEDLINE, Embase, CINAHL, PsycINFO), targeted websites, Google Search, and reference lists of eligible CPGs on November 16, 2021 and March 16, 2023. The proportion of CPGs that integrated evidence regarding TBI and homelessness was identified and qualitative content analysis was conducted to understand how homelessness is integrated in CPGs for TBI and vice versa. Equity assessment tools were utilised to understand the extent to which equity was considered in these CPGs. This review is registered with PROSPERO (CRD42021287696). Findings Fifty-eight CPGs for TBI and two CPGs for homelessness met inclusion criteria. Only three CPGs for TBI integrated evidence regarding homelessness by recognizing the prevalence of TBI in individuals experiencing homelessness and identifying housing as a consideration in the assessment and management of TBI. The two CPGs for homelessness acknowledged TBI as prevalent and recognised individuals experiencing TBI and homelessness as a disadvantaged population that should be prioritised in guideline development. Equity was rarely considered in the content and development of CPGs for TBI. Interpretation Considerations for equity in CPGs for homelessness and TBI are lacking. To ensure that CPGs reflect and address the needs of individuals experiencing homelessness and TBI, we have identified several guideline development priorities. Namely, there is a need to integrate evidence regarding homelessness and TBI in CPGs for TBI and CPGs for homelessness, respectively and engage disadvantaged populations in all stages of guideline development. Further, this review highlights an urgent need to conduct research focused on and with disadvantaged populations. Funding Canada Research Chairs Program (2019-00019) and the Ontario Ministry of Health and Long-Term Care (Grant #725A).
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Affiliation(s)
- Vincy Chan
- KITE Research Institute-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Maria Jennifer Estrella
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Sara Hanafy
- KITE Research Institute-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Zoe Colclough
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Julie Michele Joyce
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Jessica Babineau
- Library and Information Services, University Health Network, Toronto, ON, Canada
- The Institute for Education Research, University Health Network, Toronto, ON, Canada
| | - Angela Colantonio
- KITE Research Institute-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
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Lacasse A, Nguena Nguefack HL, Page G, Choinière M, Samb OM, Katz J, Ménard N, Vissandjée B, Zerriouh M. Sex and gender differences in healthcare utilisation trajectories: a cohort study among Quebec workers living with chronic pain. BMJ Open 2023; 13:e070509. [PMID: 37518085 PMCID: PMC10387645 DOI: 10.1136/bmjopen-2022-070509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
OBJECTIVES Chronic pain (CP) is a poorly recognised and frequently inadequately treated condition affecting one in five adults. Reflecting on sociodemographic disparities as barriers to CP care in Canada was recently established as a federal priority. The objective of this study was to assess sex and gender differences in healthcare utilisation trajectories among workers living with CP. DESIGN Retrospective cohort study. PARTICIPANTS This study was conducted using the TorSaDE Cohort which links the 2007-2016 Canadian Community Health Surveys and Quebec administrative databases (longitudinal claims). Among 2955 workers living with CP, the annual number of healthcare contacts was computed during the 3 years after survey completion. OUTCOME Group-based trajectory modelling was used to identify subgroups of individuals with similar patterns of healthcare utilisation over time (healthcare utilisation trajectories). RESULTS Across the study population, three distinct 3-year healthcare utilisation trajectories were found: (1) low healthcare users (59.9%), (2) moderate healthcare users (33.6%) and (3) heavy healthcare users (6.4%). Sex and gender differences were found in the number of distinct trajectories and the stability of the number of healthcare contacts over time. Multivariable analysis revealed that independent of other sociodemographic characteristics and severity of health condition, sex-but not gender-was associated with the heavy healthcare utilisation longitudinal trajectory (with females showing a greater likelihood; OR 2.6, 95% CI 1.6 to 4.1). CONCLUSIONS Our results underline the importance of assessing sex-based disparities in help-seeking behaviours, access to healthcare and resource utilisation among persons living with CP.
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Affiliation(s)
- Anaïs Lacasse
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
- Chronic Pain Epidemiology Laboratory, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | - Hermine Lore Nguena Nguefack
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
- Chronic Pain Epidemiology Laboratory, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | - G Page
- Research Center, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Manon Choinière
- Research Center, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Oumar Mallé Samb
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | - Joel Katz
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Nancy Ménard
- Chronic Pain Epidemiology Laboratory, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | - Bilkis Vissandjée
- Faculty of Nursing and Public Health Research Institute (CReSP), Université de Montréal, Montreal, Quebec, Canada
- SHERPA Research Centre, Montreal, Quebec, Canada
| | - Meriem Zerriouh
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
- Chronic Pain Epidemiology Laboratory, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
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Naghipour A, Gemander M, Becher E, Oertelt-Prigione S. Consideration of sex and gender in European clinical practice guidelines in internal medicine: a systematic review protocol. BMJ Open 2023; 13:e071388. [PMID: 37263698 DOI: 10.1136/bmjopen-2022-071388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
INTRODUCTION Clinical practice guidelines (CPGs) are a powerful instrument to ensure evidence-based practice in clinical diagnostics and disease management. As knowledge about the impact of sex and gender on health and disease is emerging, the need for its transfer into clinical practice is becoming more urgent. However, a systematic evaluation of the incorporation of sex-related and gender-related knowledge into CPGs in Europe is currently not available. This systematic review will fill this gap. We will analyse the operationalisation of sex and gender in internal medicine CPGs in Europe and the translation of this information into tailored recommendations. The results will offer a baseline assessment to inform prospective sex-sensitive and gender-sensitive guideline development. METHODS AND ANALYSIS CPGs published by European internal medicine guidelines will be analysed according to a pre-established analysis framework. CPGs will be identified by a two-step approach, that is, through direct contact with the organisations and by a PubMed search, to ensure capture of all relevant guidelines. Prespecified keywords will be employed to identify the representation of sex-related and gender-related content throughout the CPGs. Structured data will be collected through machine-assisted text mining. Identified texts will then be manually reviewed by two independent coders using a specifically developed checklist. ETHICS AND DISSEMINATION This study does not require approval by an ethics board. It will provide an overview of sex and gender considerations in European CPGs in the field of internal medicine regarding the time frame 2012-2022.
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Affiliation(s)
- Awa Naghipour
- Department of Sex and Gender Sensitive Medicine, Bielefeld University, Bielefeld, Germany
| | - Marcel Gemander
- Bielefeld Center for Data Science, Bielefeld University, Bielefeld, Germany
| | - Eva Becher
- Department of Sex and Gender Sensitive Medicine, Bielefeld University, Bielefeld, Germany
| | - Sabine Oertelt-Prigione
- Department of Sex and Gender Sensitive Medicine, Bielefeld University, Bielefeld, Germany
- Department of Primary and Transmural Care, Radboud Universiteit Nijmegen, Nijmegen, The Netherlands
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Sapir-Pichhadze R, Oertelt-Prigione S. P3 2: a sex- and gender-sensitive model for evidence-based precision medicine: from knowledge generation to implementation in the field of kidney transplantation. Kidney Int 2023; 103:674-685. [PMID: 36731608 DOI: 10.1016/j.kint.2022.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 12/14/2022] [Accepted: 12/19/2022] [Indexed: 02/01/2023]
Abstract
Precision medicine emerged as a promising approach to identify suitable interventions for individual patients with a particular health concern and at various time points. Technology can enable the acquisition of increasing volumes of clinical and "omics" data at the individual and population levels and support advanced clinical decision making. However, to keep pace with evolving societal realities and developments, it is important to systematically include sex- and gender-specific considerations in the research process, from the acquisition of knowledge to implementation. Building on the foundations of evidence-based medicine and existing precision medicine frameworks, we propose a novel evidence-based precision medicine framework in the form of the P32model, which considers individual sex-related (predictive [P1], preventive [P2], and personalized [P3] medicine) and gender-related (participatory [P4], psychosocial [P5], and percipient [P6] medicine) domains and their intersection with ethnicity, geography, and other demographic and social variables, in addition to population, community, and public dimensions (population-informed [P7], partnered with community [P8], and public-engaging [P9] medicine, respectively). Through its ability to contextualize and reflect on societal realities and developments, our model is expected to promote consideration of diversity, equity, and inclusion principles and, thus, enrich science, increase reproducibility of research, and ensure its social impact.
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Affiliation(s)
- Ruth Sapir-Pichhadze
- Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics, Occupational Health, McGill University, Montreal, Quebec, Canada; Division of Nephrology, Department of Medicine, McGill University, Montreal, Quebec, Canada.
| | - Sabine Oertelt-Prigione
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands; AG10 Sex- and Gender-Sensitive Medicine, Medical Faculty OWL, University of Bielefeld, Bielefeld, Germany.
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11
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Zhang M, Fergusson DA, Sharma R, Khoo C, Mendelson AA, McDonald B, Macala KF, Sharma N, Gill SE, Fiest KM, Lehmann C, Shorr R, Jahandideh F, Bourque SL, Liaw PC, Fox-Robichaud A, Lalu MM. Sex-based analysis of treatment responses in animal models of sepsis: a preclinical systematic review protocol. Syst Rev 2023; 12:50. [PMID: 36945012 PMCID: PMC10029211 DOI: 10.1186/s13643-023-02189-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 02/06/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND The importance of investigating sex- and gender-dependent differences has been recently emphasized by major funding agencies. Notably, the influence of biological sex on clinical outcomes in sepsis is unclear, and observational studies suffer from the effect of confounding factors. The controlled experimental environment afforded by preclinical studies allows for clarification and mechanistic evaluation of sex-dependent differences. We propose a systematic review to assess the impact of biological sex on baseline responses to disease induction as well as treatment responses in animal models of sepsis. Given the lack of guidance surrounding sex-based analyses in preclinical systematic reviews, careful consideration of various factors is needed to understand how best to conduct analyses and communicate findings. METHODS MEDLINE and Embase will be searched (2011-present) to identify preclinical studies of sepsis in which any intervention was administered and sex-stratified data reported. The primary outcome will be mortality. Secondary outcomes will include organ dysfunction, bacterial load, and IL-6 levels. Study selection will be conducted independently and in duplicate by two reviewers. Data extraction will be conducted by one reviewer and audited by a second independent reviewer. Data extracted from included studies will be pooled, and meta-analysis will be conducted using random effects modeling. Primary analyses will be stratified by animal age and will assess the impact of sex at the following time points: pre-intervention, in response to treatment, and post-intervention. Risk of bias will be assessed using the SYRCLE's risk-of-bias tool. Illustrative examples of potential methods to analyze sex-based differences are provided in this protocol. DISCUSSION Our systematic review will summarize the current state of knowledge on sex-dependent differences in sepsis. This will identify current knowledge gaps that future studies can address. Finally, this review will provide a framework for sex-based analysis in future preclinical systematic reviews. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022367726.
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Affiliation(s)
- MengQi Zhang
- Faculty of Medicine, University of Ottawa, 451 Smyth Rd #2044, Ottawa, ON, K1H 8M5, Canada
- Clinical Epidemiology Program, Blueprint Translational Group, Ottawa Hospital Research Institute, 501 Smyth Box 511, Ottawa, ON, K1H 8L6, Canada
| | - Dean A Fergusson
- Faculty of Medicine, University of Ottawa, 451 Smyth Rd #2044, Ottawa, ON, K1H 8M5, Canada.
- Clinical Epidemiology Program, Blueprint Translational Group, Ottawa Hospital Research Institute, 501 Smyth Box 511, Ottawa, ON, K1H 8L6, Canada.
| | - Rahul Sharma
- Faculty of Medicine, University of Ottawa, 451 Smyth Rd #2044, Ottawa, ON, K1H 8M5, Canada
| | - Ciel Khoo
- Clinical Epidemiology Program, Blueprint Translational Group, Ottawa Hospital Research Institute, 501 Smyth Box 511, Ottawa, ON, K1H 8L6, Canada
| | - Asher A Mendelson
- Department of Internal Medicine, Section of Critical Care Medicine, Rady Faculty of Health Sciences, University of Manitoba, 820 Sherbrook Street, Winnipeg, MB, R3A 1R9, Canada
| | - Braedon McDonald
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
- Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Kimberly F Macala
- Department of Critical Care Medicine, Royal Alexandra Hospital, University of Alberta, 2-214 Clinical Science Building, 8440-112Th Street, Edmonton, AB, T6G 2B7, Canada
| | - Neha Sharma
- Department of Medical Sciences and Thrombosis and Atherosclerosis Research Institute, McMaster University, 237 Barton St East, Hamilton, ON, L8L 2X2, Canada
| | - Sean E Gill
- Centre for Critical Illness Research, Lawson Health Research Institutes, Victoria Research Labs, A6-134, 800 Commissioners Road Ease, London, ON, N6A 5W9, Canada
- Division of Respirology, Department of Medicine, Western University, London, ON, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Christian Lehmann
- Department of Anesthesia, Pain Management and Perioperative Medicine, II Health Sciences Centre, 5850 College Street, Halifax, NS, B3H 1X5, Canada
| | - Risa Shorr
- Learning Services, The Ottawa Hospital, Ottawa, ON, Canada
| | - Forough Jahandideh
- Clinical Epidemiology Program, Blueprint Translational Group, Ottawa Hospital Research Institute, 501 Smyth Box 511, Ottawa, ON, K1H 8L6, Canada
- Department of Anesthesiology & Pain Medicine, Katz Group Centre for Pharmacy and Health Research, University of Alberta, 3-020H, Edmonton, AB, T6G 2E1, Canada
| | - Stephane L Bourque
- Department of Anesthesiology & Pain Medicine, Katz Group Centre for Pharmacy and Health Research, University of Alberta, 3-020H, Edmonton, AB, T6G 2E1, Canada
| | - Patricia C Liaw
- Department of Medicine and Thrombosis and Atherosclerosis Research Institute, McMaster University and Hamilton Health Sciences, 237 Barton St East, Hamilton, ON, L8L 2X2, Canada
| | - Alison Fox-Robichaud
- Department of Medicine and Thrombosis and Atherosclerosis Research Institute, McMaster University and Hamilton Health Sciences, 237 Barton St East, Hamilton, ON, L8L 2X2, Canada
| | - Manoj M Lalu
- Clinical Epidemiology Program, Blueprint Translational Group, Ottawa Hospital Research Institute, 501 Smyth Box 511, Ottawa, ON, K1H 8L6, Canada.
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Room B307, 1053 Carling Avenue, Mail Stop 249, Ottawa, ON, K1Y 4E9, Canada.
- Regenerative Medicine Program, Ottawa Hospital Research Institute, 501 Smyth Box 511, Ottawa, ON, K1H 8L6, Canada.
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Parker LA, Moreno-Garijo A, Chilet-Rosell E, Lorente F, Lumbreras B. Gender Differences in the Impact of Recommendations on Diagnostic Imaging Tests: A Retrospective Study 2007-2021. Life (Basel) 2023; 13:life13020289. [PMID: 36836646 PMCID: PMC9965980 DOI: 10.3390/life13020289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023] Open
Abstract
(1) Background: The frequency of imaging tests grew exponentially in recent years. This increase may differ according to a patient's sex, age, or socioeconomic status. We aim to analyze the impact of the Council Directive 2013/59/Euratom to control exposure to radiation for men and women and explore the impact of patients' age and socioeconomic status; (2) Methods: The retrospective observational study that includes a catchment population of 234,424. We included data of CT, mammography, radiography (conventional radiography and fluoroscopy) and nuclear medicine between 2007-2021. We estimated the associated radiation effective dose per test according using previously published evidence. We calculated a deprivation index according to the postcode of their residence. We divided the study in 2007-2013, 2014-2019 and 2020-2021 (the pandemic period). (3) Results: There was an increase in the number of imaging tests received by men and women after 2013 (p < 0.001), and this increase was higher in women than in men. The frequency of imaging tests decreased during the pandemic period (2020-2021), but the frequency of CT and nuclear medicine tests increased even during these years (p < 0.001) and thus, the overall effective mean dose. Women and men living in the least deprived areas had a higher frequency of imaging test than those living in the most deprived areas. (4) Conclusions: The largest increase in the number of imaging tests is due to CTs, which account for the higher amount of effective dose. The difference in the increase of imaging tests carried out in men and women and according to the socioeconomic status could reflect different management strategies and barriers to access in clinical practice. Given the low impact of the available recommendations on the population exposure to radiation and the performance of high-dose procedures such as CT, deserve special attention when it comes to justification and optimization, especially in women.
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Affiliation(s)
- Lucy A. Parker
- Department of Public Health, University Miguel Hernández de Elche, 03550 Alicante, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Andrea Moreno-Garijo
- Faculty of Pharmacy, University Miguel Hernández de Elche, 03550 Alicante, Spain
| | - Elisa Chilet-Rosell
- Department of Public Health, University Miguel Hernández de Elche, 03550 Alicante, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Fermina Lorente
- Radiology Department, University Hospital of San Juan de Alicante, Sant Joan d’Alacant, 03550 Alicante, Spain
| | - Blanca Lumbreras
- Department of Public Health, University Miguel Hernández de Elche, 03550 Alicante, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-965-919510
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Chan V, Estrella MJ, Babineau J, Colantonio A. A systematic review protocol for assessing equity in clinical practice guidelines for traumatic brain injury and homelessness. Front Med (Lausanne) 2022; 9:815660. [PMID: 35935774 PMCID: PMC9353519 DOI: 10.3389/fmed.2022.815660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 06/29/2022] [Indexed: 12/03/2022] Open
Abstract
Background When used optimally, clinical practice guidelines (CPGs) can reduce inappropriate variations in practice, improve application of research to practice, and enhance the quality of healthcare. However, a common criticism, despite its potential, is the lack of consideration for equity and disadvantaged populations. Objectives This protocol is for a systematic review of CPGs for traumatic brain injury (TBI) and homelessness that aims to assess (1) the extent to which evidence regarding TBI and homelessness is integrated in CPGs for homelessness and TBI, respectively, and (2) equity considerations in CPGs for TBI and homelessness. Methods and analysis The methodology for this review is guided by the PRISMA-P, validated search filters for CPGs, and methodological guides to searching systematic reviews and gray literature. CPGs will be identified from (a) databases for peer-reviewed literature (MEDLINE, Embase, CINAHL, and PsycInfo), (b) targeted websites and Google Search for gray literature, and (c) reference lists of peer-reviewed and gray literature that meet the eligibility criteria. Searching for gray literature, including from guideline-specific resources, is a critical component of this review and is considered an efficient approach to identifying CPGs, given the low precision of searching peer-reviewed databases. Two independent reviewers will screen all articles based on pre-determined eligibility criteria. A narrative synthesis will be conducted to identify the proportion of CPGs that integrate evidence about TBI and homelessness and how TBI and homelessness is or is not integrated in CPGs. Quality appraisal will take the form of an equity assessment of CPGs and will be completed independently by two reviewers. Conclusion This protocol outlines the methodology for a systematic review of CPGs for TBI and homelessness. The resulting systematic review from this protocol will form an evidence-based foundation to advance CPGs for individuals with lived experience of TBI and homelessness. Systematic review registration identifier: CRD42021287696.
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Affiliation(s)
- Vincy Chan
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- *Correspondence: Vincy Chan
| | - Maria Jennifer Estrella
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Jessica Babineau
- Library and Information Services, University Health Network, Toronto, ON, Canada
- The Institute for Education Research, University Health Network, Toronto, ON, Canada
| | - Angela Colantonio
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
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Hall M, Krishnanandan VA, Cheung MC, Coburn NG, Haas B, Chan KKW, Raphael MJ. An Evaluation of Sex- and Gender-Based Analyses in Oncology Clinical Trials. J Natl Cancer Inst 2022; 114:1186-1191. [PMID: 35477781 PMCID: PMC9360459 DOI: 10.1093/jnci/djac092] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 02/17/2022] [Accepted: 04/21/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The objective of this study was to evaluate whether sex- and gender-based analyses and proper sex- and gender-terminology were used in oncology trials leading to regulatory drug approval. METHODS The Food and Drug Administration (FDA) Hematology/Oncology Approvals and Safety Notifications page was used to identify all anti-cancer therapies that received FDA approval between 2012 and 2019. The trials used to support FDA-drug approval were collected along with all available supplemental tables and study protocols. Documents were reviewed to determine if there was a plan to analyze results according to sex and gender and to determine if consistent sex and gender terminology were used. RESULTS 128 randomized-controlled trials were identified corresponding to a cancer medicine which received FDA-approval. No study specified how sex and gender were collected or analyzed. No study reported any information on the gender of participants. Sex and gender terminology was used inconsistently at least once in 76% (97/128) of studies. Among the 102 trials for non-sex-specific cancer sites, 89% (91/102) presented disaggregated survival outcome data by sex. No study presented disaggregated toxicity data by sex or gender. CONCLUSION The majority of pivotal clinical trials in oncology fail to account for the important distinction between sex and gender and conflate sex and gender terminology. More rigor in designing clinical trials to include sex and gender based analyses and more care in using sex and gender terms in the cancer literature is needed. These efforts are essential to improve the reproducibility, generalizability, and inclusiveness of cancer research.
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Affiliation(s)
- Mathew Hall
- Department of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vaishali A Krishnanandan
- Division of Hematology/Medical Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Matthew C Cheung
- Division of Hematology/Medical Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Natalie G Coburn
- Department of General Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Barbara Haas
- Department of General Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kelvin K W Chan
- Division of Hematology/Medical Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Canadian Centre of Applied Research in Cancer Control, Canada
| | - Michael J Raphael
- Division of Hematology/Medical Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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15
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Deom Tardif A, Gogovor A, Guay-Bélanger S, Audet D, Parent N, Gaudreau A, Remy-Lamarche D, Vigneault L, Ngueta G, Bilodeau A, Légaré F. Integration of sex and gender in a continuing professional development course on diabetes and depression: a mixed methods feasibility study. BMJ Open 2022; 12:e050890. [PMID: 35459660 PMCID: PMC9036429 DOI: 10.1136/bmjopen-2021-050890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Assess the feasibility and impact of a continuous professional development (CPD) course on type 2 diabetes and depression on health professionals' intention to include sex and gender considerations in patient care. DESIGN AND SETTING In collaboration with CPD organisations and patient-partners, we conducted a mixed-methods feasibility controlled trial with postintervention measures in three Canadian provinces. PARTICIPANTS Of 178 eligible health professionals, 127 completed questionnaires and 67 participated in semistructured group discussions. INTERVENTION AND COMPARATOR An interactive 1 hour CPD course, codesigned with patient-partners, on diabetes and depression that included sex and gender considerations (innovation) was compared with a similar course that did not include them (comparator). OUTCOMES Feasibility of recruitment and retention of CPD organisations and patient-partners throughout the study; adherence to planned activities; health professionals' intention to include sex and gender considerations in patient care as measured by the CPD-Reaction questionnaire; and barriers and facilitators using the Theoretical Domains Framework. RESULTS All recruited CPD organisations and patient-partners remained engaged throughout the study. All planned CPD courses occurred. Overall, 71% of eligible health professionals participated (63% under 44 years old; 79.5% women; 67.7% practising in French; 66.9% practising in Quebec; 78.8% in urban practice). After training, mean intention scores for the innovation (n=49) and control groups (n=78) were 5.65±0.19 and 5.19±0.15, respectively. Mean difference was -0.47 (CI -0.95 to 0.01; p=0.06). Adjusted for age, gender and practice settings, mean difference was -0.57 (CI -1.09 to -0.05; p=0.03). We identified eight theoretical domains related to barriers and six related to facilitators for providing sex-adapted and gender-adapted diabetes and depression care. CONCLUSIONS CPD training on diabetes and depression that includes sex and gender considerations is feasible and, compared with CPD training that does not, may prompt health professionals to modify their care. Addressing identified barriers and facilitators could increase intention. TRIAL REGISTRATION NUMBER NCT03928132 with ClinicalTrials.gov; Post-results.
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Affiliation(s)
- Alèxe Deom Tardif
- VITAM Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, Quebec, Canada
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
| | - Amédé Gogovor
- VITAM Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
| | - Sabrina Guay-Bélanger
- VITAM Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, Quebec, Canada
| | - Denis Audet
- University Family Medicine Group Saint-François-d'Assise, Quebec, Quebec, Canada
| | - Nicole Parent
- Direction de la formation professionnelle, Médecins francophones du Canada, Montreal, Quebec, Canada
| | - André Gaudreau
- Patient Partner, Université Laval, Quebec, Quebec, Canada
| | | | - Luc Vigneault
- VITAM Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, Quebec, Canada
- Patient Partner, CAP Rétablissement, Quebec, Quebec, Canada
| | - Gérard Ngueta
- VITAM Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, Quebec, Canada
| | - André Bilodeau
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - France Légaré
- VITAM Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
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16
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Gogovor A, Zomahoun HTV, Ekanmian G, Adisso ÉL, Deom Tardif A, Khadhraoui L, Rheault N, Moher D, Légaré F. Sex and gender considerations in reporting guidelines for health research: a systematic review. Biol Sex Differ 2021; 12:62. [PMID: 34801060 PMCID: PMC8605583 DOI: 10.1186/s13293-021-00404-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 10/26/2021] [Indexed: 01/12/2023] Open
Abstract
Background Despite growing recognition of the importance of sex and gender considerations in health research, they are rarely integrated into research design and reporting. We sought to assess the integration of sex, as a biological attribute, and gender, as a socially constructed identity, in published reporting guidelines. Methods We conducted a systematic review of published reporting guidelines listed on the EQUATOR website (www.equator-nework.org) from inception until December 2018. We selected all reporting guidelines (original and extensions) listed in the EQUATOR library. We used EndNote Citation Software to build a database of the statements of each guideline identified as a "full bibliographic reference" and retrieved the full texts. Reviewers independently extracted the data on use of sex and gender terms from the checklist/abstract/main text of guidelines. Data were analyzed using descriptive statistics and narrative synthesis. Results A total of 407 reporting guidelines were included; they were published between 1995 and 2018. Of the 407 guidelines, 235 (57.7%) mentioned at least one of the sex- and gender-related words. In the checklist of the reporting guidelines (n = 363), “sex” and “gender” were mentioned in 50 (13.8%) and 40 (11%), respectively. Only one reporting guideline met our criteria (nonbinary, appropriate categorization, and non-interchangeability) for correct use of sex and gender concepts. Trends in the use of "sex" and "gender" in the checklists showed that the use of “sex” only started in 2003, while “gender” has been in use since 1996. Conclusions We assessed the integration of sex and gender in reporting guidelines based on the use of sex- and gender-related words. Our findings showed a low use and integration of sex and gender concepts and their incorrect use. Authors of reporting guidelines should reduce this gap for a better use of research knowledge. Trial registration PROSPERO no. CRD42019136491. Supplementary Information The online version contains supplementary material available at 10.1186/s13293-021-00404-0. Omission of sex and gender considerations is a recurring deficiency in research design and reporting Integration of sex and gender considerations in health research reporting guidelines is very low Three criteria were used to assess correct use of sex and gender concepts Only one reporting guideline met the three criteria A call to action is made to address these deficiencies
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Affiliation(s)
- Amédé Gogovor
- Quebec SPOR-SUPPORT Unit, Quebec City, QC, Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec City, QC, Canada.,Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC, Canada.,VITAM-Centre de Recherche en Santé Durable, Pavillon Landry-Poulin, 2525, Chemin de la Canardière, Quebec, QC, G1J 0A4, Canada
| | - Hervé Tchala Vignon Zomahoun
- Quebec SPOR-SUPPORT Unit, Quebec City, QC, Canada.,VITAM-Centre de Recherche en Santé Durable, Pavillon Landry-Poulin, 2525, Chemin de la Canardière, Quebec, QC, G1J 0A4, Canada
| | - Giraud Ekanmian
- Quebec SPOR-SUPPORT Unit, Quebec City, QC, Canada.,VITAM-Centre de Recherche en Santé Durable, Pavillon Landry-Poulin, 2525, Chemin de la Canardière, Quebec, QC, G1J 0A4, Canada
| | - Évèhouénou Lionel Adisso
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec City, QC, Canada.,VITAM-Centre de Recherche en Santé Durable, Pavillon Landry-Poulin, 2525, Chemin de la Canardière, Quebec, QC, G1J 0A4, Canada
| | - Alèxe Deom Tardif
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec City, QC, Canada.,VITAM-Centre de Recherche en Santé Durable, Pavillon Landry-Poulin, 2525, Chemin de la Canardière, Quebec, QC, G1J 0A4, Canada
| | - Lobna Khadhraoui
- Quebec SPOR-SUPPORT Unit, Quebec City, QC, Canada.,VITAM-Centre de Recherche en Santé Durable, Pavillon Landry-Poulin, 2525, Chemin de la Canardière, Quebec, QC, G1J 0A4, Canada
| | - Nathalie Rheault
- Quebec SPOR-SUPPORT Unit, Quebec City, QC, Canada.,VITAM-Centre de Recherche en Santé Durable, Pavillon Landry-Poulin, 2525, Chemin de la Canardière, Quebec, QC, G1J 0A4, Canada
| | - David Moher
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.,Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, General Campus, Centre for Practice Changing Research Building, 501 Smyth Road, PO Box 201B, Ottawa, ON, K1H 8L6, Canada
| | - France Légaré
- Quebec SPOR-SUPPORT Unit, Quebec City, QC, Canada. .,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec City, QC, Canada. .,Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC, Canada. .,VITAM-Centre de Recherche en Santé Durable, Pavillon Landry-Poulin, 2525, Chemin de la Canardière, Quebec, QC, G1J 0A4, Canada.
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Anderson NN, Gagliardi AR. Medical student exposure to women's health concepts and practices: a content analysis of curriculum at Canadian medical schools. BMC MEDICAL EDUCATION 2021; 21:435. [PMID: 34407817 PMCID: PMC8371837 DOI: 10.1186/s12909-021-02873-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 08/04/2021] [Indexed: 05/12/2023]
Abstract
BACKGROUND Women's health (WH) includes a broad array of concerns and challenges that affect health across the lifespan. Considerable research shows that women continue to experience disparities in access to and quality of care. Apart from surveys of medical trainees and faculty, little research and none in Canada examined medical curriculum for WH. This study assessed how Canadian medical schools integrate WH in their curriculum. METHODS We used deductive and summative content analysis to describe instances and the nature of WH topics in program and course descriptions that were publicly-available on web sites of Canadian medical schools. We reported results using summary statistics and text examples. We employed a framework, tested in our prior research, that included mention of women's health principles and practices relevant to any health concern or condition including factors (e.g. sex, gender, social determinants) that influence health, and access to or quality of care. RESULTS We retrieved 1459 documents from 16 medical schools (median 49.5, range 16 to 301). Few mentioned WH (125, 8.6 %), and the quantity of mentions varied by school (range 0.0-37.5 %). Pre-clerkship course documents more frequently mentioned WH (61/374, 17.3 %, chi square 43.2, p < 0.00001) compared with clerkship course documents (58/1067, 5.4 %). Core course documents more frequently mentioned WH (72/542, 13.3 %, chi square 29.0, p < 0.00001) compared with elective course documents WH (47/899, 5.2 %). Overall, documents more frequently referred to the WH domain of social determinants of health (88, 70.4 %). Few documents addressed women's health (21, 16.8 %), sex or gender (19, 15.2 %), other considerations (15.2 %) or principles/components of women's health (2, 1.6 %). Most documents that mentioned WH provided little detail about what those concepts referred to or how to optimize WH. CONCLUSIONS Based on program and course descriptions, WH may not be well-integrated at Canadian medical schools, and future physicians may not be consistently exposed to the full breadth of WH. This reveals opportunities for enhancing WH in the medical curriculum. Future research is needed to engage stakeholders including women in developing, implementing and evaluating competencies and corresponding curriculum that reflect the full range of WH concepts and practices.
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Affiliation(s)
- Natalie N Anderson
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street. 13EN-228, M5G2C4, Toronto, Canada
| | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street. 13EN-228, M5G2C4, Toronto, Canada.
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18
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Zhang MQ, Macala KF, Fox-Robichaud A, Mendelson AA, Lalu MM. Sex- and Gender-Dependent Differences in Clinical and Preclinical Sepsis. Shock 2021; 56:178-187. [PMID: 33399356 DOI: 10.1097/shk.0000000000001717] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT In this mini-review we provide an overview of sex- and gender-dependent issues in both clinical and preclinical sepsis. The increasing recognition for the need to account for sex and gender in biomedical research brings a unique set of challenges and requires researchers to adopt best practices when conducting and communicating sex- and gender-based research. This may be of particular importance in sepsis, given the potential contribution of sex bias in the failures of translational sepsis research in adults and neonates. Clinical evidence of sex-dependent differences in sepsis is equivocal. Since clinical studies are limited to observational data and confounded by a multitude of factors, preclinical studies provide a unique opportunity to investigate sex differences in a controlled, experimental environment. Numerous preclinical studies have suggested that females may experience favorable outcomes in comparison with males. The underlying mechanistic evidence for sex-dependent differences in sepsis and other models of shock (e.g., trauma-hemorrhage) largely centers around the beneficial effects of estrogen. Other mechanisms such as the immunosuppressive role of testosterone and X-linked mosaicism are also thought to contribute to observed sex- and gender-dependent differences in sepsis. Significant knowledge gaps still exist in this field. Future investigations can address these gaps through careful consideration of sex and gender in clinical studies, and the use of clinically accurate preclinical models that reflect sex differences. A better understanding of sex-and gender-dependent differences may serve to increase translational research success.
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Affiliation(s)
- Meng Qi Zhang
- Clinical Epidemiology Program, Blueprint Translational Group, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada K1H 8M5
| | - Kimberly F Macala
- Departments of Critical Care Medicine and Anesthesiology and Pain Medicine, Royal Alexandra Hospital, University of Alberta, Edmonton, AB, Canada
| | - Alison Fox-Robichaud
- Department of Medicine and Thrombosis and Atherosclerosis Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Asher A Mendelson
- Section of Critical Care Medicine, Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Manoj M Lalu
- Clinical Epidemiology Program, Blueprint Translational Group, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada
- Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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19
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The Effects of Biological Sex on Sepsis Treatments in Animal Models: A Systematic Review and a Narrative Elaboration on Sex- and Gender-Dependent Differences in Sepsis. Crit Care Explor 2021; 3:e0433. [PMID: 34151276 PMCID: PMC8205191 DOI: 10.1097/cce.0000000000000433] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Preclinical studies provide an opportunity to evaluate the relationship between sex and sepsis, and investigate underlying mechanisms in a controlled experimental environment. The objective of our systematic review was to assess the impact of biological sex on treatment response to fluid and antibiotic therapy in animal models of sepsis. Furthermore, we provide a narrative elaboration of sex-dependent differences in preclinical models of sepsis. DATA SOURCES MEDLINE and Embase were searched from inception to March 16, 2020. STUDY SELECTION All studies reporting sex-stratified data comparing antibiotics and/or fluid resuscitation with a placebo or no treatment arm in an in vivo model of sepsis were included. DATA EXTRACTION Outcomes of interest were mortality (primary) and organ dysfunction (secondary). Risk of bias was assessed. Study selection and data extraction were conducted independently and in duplicate. DATA SYNTHESIS The systematic search returned 2,649 unique studies, and two met inclusion criteria. Both studies used cecal ligation and puncture models with imipenem/cilastatin antibiotics. No eligible studies investigated fluids. In one study, antibiotic therapy significantly reduced mortality in male, but not female, animals. The other study reported no sex differences in organ dysfunction. Both studies were deemed to be at a high overall risk of bias. CONCLUSIONS There is a remarkable and concerning paucity of data investigating sex-dependent differences in fluid and antibiotic therapy for the treatment of sepsis in animal models. This may reflect poor awareness of the importance of investigating sex-dependent differences. Our discussion therefore expands on general concepts of sex and gender in biomedical research and sex-dependent differences in key areas of sepsis research such as the cardiovascular system, immunometabolism, the microbiome, and epigenetics. Finally, we discuss current clinical knowledge, the potential for reverse translation, and directions for future studies. REGISTRATION PROSPERO CRD42020192738.
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Lindsay S, Kolne K, Barker DJ, Colantonio A, Stinson J, Moll S, Thomson N. Exploration of Gender-Sensitive Care in Vocational Rehabilitation Providers Working With Youth With Disabilities: Codevelopment of an Educational Simulation. JMIR Form Res 2021; 5:e23568. [PMID: 33720023 PMCID: PMC8075068 DOI: 10.2196/23568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 10/15/2020] [Accepted: 01/17/2021] [Indexed: 12/02/2022] Open
Abstract
Background Although research shows that there is a need for gender-specific vocational support to help youth with disabilities find employment, health care providers often report needing more training in this area. Currently, there are no existing educational simulations of gender-sensitive care within vocational rehabilitation for clinicians who provide care to youth with disabilities. Therefore, developing further educational tools that address gender-sensitive care could help them enhance the care they provide while optimizing patient outcomes. Objective This study aims to codevelop an educational simulation and identify issues relevant to providing gender-sensitive care within the context of vocational rehabilitation for youth with disabilities. Methods We used a qualitative co-design approach with a purposive sampling strategy that involved focus group discussions and journal reflections to understand and address issues relevant to gender-sensitive care within vocational rehabilitation for those working with youth with disabilities. A total of 10 rehabilitation providers participated in two sessions (5 participants per session) to design the web-based simulation tool. The sessions (2.5 hours each) were audio recorded, transcribed, and analyzed thematically. Results Two main themes arose from our analysis of codeveloping a simulation focusing on gender-sensitive care. The first theme involved the relevance of gender within clinical practice; responses varied from hesitance to acknowledging but not talking about it to those who incorporated gender into their practice. The second theme focused on creating a comfortable and safe space to enable gender-sensitive care (ie, included patient-centered care, effective communication and rapport building, appropriate language and pronoun use, respecting gender identity, awareness of stereotypes, and responding to therapeutic ruptures). Conclusions Our web-based gender-sensitive care simulation that addressed vocational rehabilitation among youth with disabilities was cocreated with clinicians. The simulation highlights many issues relevant to clinical practice and has potential as an educational tool for those working with young people with disabilities.
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Affiliation(s)
- Sally Lindsay
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Kendall Kolne
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Donna J Barker
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Angela Colantonio
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Jennifer Stinson
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.,Hospital for Sick Children, Toronto, ON, Canada
| | - Sandra Moll
- School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada
| | - Nicole Thomson
- Centre for Addiction and Mental Health, Toronto, ON, Canada
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21
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López-Vilella R, Marqués-Sulé E, Laymito Quispe RDP, Sánchez-Lázaro I, Donoso Trenado V, Martínez Dolz L, Almenar Bonet L. The Female Sex Confers Different Prognosis in Heart Failure: Same Mortality but More Readmissions. Front Cardiovasc Med 2021; 8:618398. [PMID: 33748194 PMCID: PMC7973030 DOI: 10.3389/fcvm.2021.618398] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/10/2021] [Indexed: 12/20/2022] Open
Abstract
Introduction: Heart failure (HF) is a major cause of morbimortality both in men and women. Differences between sex in etiopathogenesis, response to treatment, and quality of care have been found in patients with HF. Females are usually under-represented in clinical trials and there is no solid evidence demonstrating the influence of sex in the prognostic of chronic HF. The primary objective of this study was to analyse the differences in mortality and probability of hospital readmission between males and females with HF. The secondary objective was to compare mortality and probability of hospital readmission by ejection fraction (reduced vs. preserved). Methods: Patients with decompensated HF that were consecutively admitted to a Cardiology Service of a tertiary hospital for 4 years were recruited. De novo HF, death during hospitalization, programmed admissions and those patients with moderate left ventricular ejection fraction (LVEF) (40-50%) were discarded. Finally, 1,291 patients were included. Clinical profiles, clinical history, functional status, treatment at admission, first blood analysis performed, readmissions and mortality at follow-up were analyzed and compared. All patients underwent an echocardiographic study at admission. HF with reduced ejection fraction (HFrEF) was considered when left ventricular ejection fraction (LVEF) was <40%, whilst HF with preserved ejection fraction (HFpEF) was considered when LVEF was ≥50%. Results: 716 participants were male (55%). Basal characteristics showed differences in some outcomes. No differences were found in probability of survival among patients with decompensated HF by sex and ejection fraction (p = 0.25), whereas there was a clear tend to a major survival in females with HFrEF (p < 0.1). Females presented more readmissions when compared to males, independently from the LVEF (females = 33.5% vs. males = 26.8%; p = 0.009). Adjusted multivariate analysis showed no association between sex and mortality (HR = 0.97, IC 95% = 0.73-1.30, p = 0.86), although there was association between female sex and probability of readmission (OR = 1.37, IC 95% = 1.04-1.82, p = 0.02). Conclusions: Sex does not influence mid-term mortality in patients admitted for decompensated HF. Nevertheless, probability of readmission is higher in females independently from LVEF. Thus, it should be considered whether healthcare may be different depending on sex, and a more personalized and frequent care may be recommended in females.
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Affiliation(s)
- Raquel López-Vilella
- Heart Failure and Transplant Unit, La Fe University and Polytechnic Hospital, Valencia, Spain.,Cardiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | | | - Rocío Del Pilar Laymito Quispe
- Heart Failure and Transplant Unit, La Fe University and Polytechnic Hospital, Valencia, Spain.,Cardiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Ignacio Sánchez-Lázaro
- Heart Failure and Transplant Unit, La Fe University and Polytechnic Hospital, Valencia, Spain.,Cardiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, CIBERCV, Valencia, Spain
| | - Víctor Donoso Trenado
- Heart Failure and Transplant Unit, La Fe University and Polytechnic Hospital, Valencia, Spain.,Cardiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Luis Martínez Dolz
- Cardiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, CIBERCV, Valencia, Spain
| | - Luis Almenar Bonet
- Heart Failure and Transplant Unit, La Fe University and Polytechnic Hospital, Valencia, Spain.,Cardiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, CIBERCV, Valencia, Spain.,Department of Medicine, University of Valencia, Valencia, Spain
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22
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Williams A, Lyeo JS, Geffros S, Mouriopoulos A. The integration of sex and gender considerations in health policymaking: a scoping review. Int J Equity Health 2021; 20:69. [PMID: 33653362 PMCID: PMC7923641 DOI: 10.1186/s12939-021-01411-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 02/17/2021] [Indexed: 01/11/2023] Open
Abstract
While the terms 'sex' and 'gender' represent distinct concepts, their influence may intersect as important determinants of health. Despite their influence in shaping individual health outcomes, there is often inaccuracy and inconsistency in the degree to which sex and gender considerations are integrated in the health policymaking process. This primary aim of this paper is to fill the gap in the current understanding of how sex and gender considerations are integrated in this process. A scoping review methodology was used with the objective of assessing the extent to which sex and gender were considered inclusively and comprehensively in established examples of health policy planning and development. One hundred seventy-five documents from the academic and grey literature were found to meet the inclusion criteria for this scoping review. The authors charted the data from these publications, assessing the ways in which sex and gender were incorporated in their policy development process. Five key findings were ascertained from this review: (1) the terms sex and gender are often used interchangeably; (2) the terms sex and gender are often used with a limited and binary scope; (3) the most inclusive and comprehensive documents included transgender and gender diverse populations; (4) there are significant variations in the degree of inclusivity and comprehensivity of these documents based on geographic distribution; and (5) documents published within the last 5 years were more inclusive than older documents. This paper concludes with an acknowledgment of the limitations of the study design, a summary of the findings, future research directions, and implications for policymakers.
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23
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Rathbone T, Truong C, Haldenby H, Riazi S, Kendall M, Cimek T, Macedo LG. Sex and gender considerations in low back pain clinical practice guidelines: a scoping review. BMJ Open Sport Exerc Med 2020; 6:e000972. [PMID: 33437498 PMCID: PMC7780542 DOI: 10.1136/bmjsem-2020-000972] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2020] [Indexed: 12/26/2022] Open
Abstract
Objective The purpose of this scoping review is to determine if and how sex and gender have been incorporated into low back pain (LBP) clinical practice guidelines (CPG), and if sex and gender terms have been used properly. Methods CPGs were searched on MEDLINE, Embase, NICE, TRIP and PEDro from 2010 to 2020. The inclusion criteria were English language, CGPs within physiotherapy scope of practice and for adult population with LBP of any type or duration. Three pairs of independent reviewers screened titles, abstracts and full texts. Guidelines were searched for sex/gender-related terms and recommendations were extracted. The AGREE II (Appraisal of Guidelines for Research and Evaluation II) was used to evaluate the quality of the CPGs. Results Thirty-six CPGs were included, of which 15 were test-positive for sex or gender terms. Only 33% (n=5) of CPGs incorporated sex or gender into diagnostic or management recommendations. Sixty percent of guidelines (n=9) only referenced sex or gender in relation to epidemiology, risk factors or prognostic data, and made no specific recommendations. Overall, there was no observable relationship between guideline quality and likeliness of integrating sex or gender terms. The majority of guidelines used sex and gender terms interchangeably, and no guidelines defined sex or gender. Conclusion CPGs did not consistently consider sex and gender differences in assessment, diagnosis or treatment of LBP. When it was considered, sex and gender terms were used interchangeably, and considerations were primarily regarding pregnancy. Researchers should consider the importance of including sex-based and/or gender-based recommendations into future LBP CPGs.
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Affiliation(s)
- Tori Rathbone
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Catherine Truong
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Haley Haldenby
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Sara Riazi
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Mara Kendall
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Tayler Cimek
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Luciana G Macedo
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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24
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Tong I, Griffin B, Trott J, Romano M, Stein AB, Madsen TE. The Proportion of Women Authors and the Inclusion of Sex and Gender Content Among the American College of Cardiology Clinical Practice Guidelines, 2008-2018. J Womens Health (Larchmt) 2020; 30:1616-1625. [PMID: 33252297 DOI: 10.1089/jwh.2020.8454] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background: Sex and gender, two important factors affecting health care, should be routinely taken into consideration in clinical practice. Members of the Sex and Gender Health Collaborative Scholarship Committee reviewed clinical guidelines published by the American College of Cardiology (ACC) from 2008 to 2018 to determine if the number of women authors on the writing committee influenced the presence of sex- and gender-specific content and recommendations in each guideline. Methods: We reviewed 33 ACC clinical guidelines from 2008 to 2018 and determined the number of women authors on the writing committee for each guideline. We then reviewed each guideline to identify specific content on sex and/or gender differences as it pertained to the guideline's subject cardiac condition. Results: The median proportion of women authors among the 33 ACC guidelines was 22.2% (interquartile range 4.4-81.1). Only two guidelines (6%) had writing committees with >50% women authors. Overall, 25 of 33 guidelines (75.8%) contained sex and gender content; however, the depth and detail of the sex and gender content varied widely among guidelines. The proportion of women authors was not associated with the presence of sex- and gender-specific content. Conclusions: Our findings demonstrate continued gender disparities in authorship, and changes should be made to increase the inclusion of women in clinical practice guideline writing committees. We propose selecting a sex and gender champion for guideline writing committees and/or including a specific section on sex- and gender-related content in each guideline to ensure inclusion of sex- and gender-specific recommendations in clinical guidelines.
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Affiliation(s)
- Iris Tong
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Brooke Griffin
- Department of Pharmacy, Midwestern University Chicago College of Pharmacy, Downers Grove, Illinois, USA
| | - Justina Trott
- Department of Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Mary Romano
- Division of Adolescent Medicine and Young Adult Health, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Amy Buros Stein
- Office of Research and Sponsored Programs, Midwestern University Chicago College of Pharmacy Downers Grove, Illinois, USA
| | - Tracy E Madsen
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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25
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Lindsay S, Kolne K. The training needs for gender-sensitive care in a pediatric rehabilitation hospital: a qualitative study. BMC MEDICAL EDUCATION 2020; 20:468. [PMID: 33238977 PMCID: PMC7690145 DOI: 10.1186/s12909-020-02384-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 11/19/2020] [Indexed: 05/26/2023]
Abstract
BACKGROUND Gender is an important social determinant of health; however, clinicians often lack training in how to provide gender-sensitive care. Offering appropriate and relevant training could help to address some gender-based health inequalities. Our objective was to identify and describe the training needs for gender-sensitive care among pediatric rehabilitation healthcare providers. METHODS This study used an interpretive descriptive qualitative design to conduct interviews with 23 pediatric rehabilitation healthcare providers (19 women, 3 men, 1 transgender man), from a pediatric rehabilitation hospital in a large urban center, in Ontario, Canada from a range of disciplines. Interviews were transcribed verbatim and analyzed using an open-coding inductive thematic analysis. RESULTS Our analysis revealed the following themes: [1] lack of knowledge about gender-sensitive care and the need for more training; [2] content of the desired training (i.e., gender differences, effective communication and how to practice gender-sensitive care) and [3] delivery method of the training. CONCLUSIONS Enhanced gender-sensitive training for healthcare providers is required for optimizing patient outcomes and addressing gender-based health inequalities. Educators in pediatric rehabilitation should consider developing gender-sensitive care training that is embedded within post-graduate education and also continuing education within hospitals and community care centers.
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Affiliation(s)
- Sally Lindsay
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital & Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada.
| | - Kendall Kolne
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital & Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
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26
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Forcadell Drago E, Dalmau Llorca MR, Aguilar Martín C, Ferreira-González I, Hernández Rojas Z, Gonçalves AQ, López-Pablo C. Impact of Implementing a Dyslipidemia Management Guideline on Cholesterol Control for Secondary Prevention of Ischemic Heart Disease in Primary Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8590. [PMID: 33228008 PMCID: PMC7699273 DOI: 10.3390/ijerph17228590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 11/17/2022]
Abstract
Cardiovascular diseases (CVD) are the main cause of death worldwide. The control of CVD risk factors, such as dyslipidemia, reduces their mortality rate. Nonetheless, fewer than 50% of patients with ischemic heart disease (IHD) have good cholesterol control. Our objective is to assess whether the level of participation of general practitioners (GPs) in activities to implement a dyslipidemia management guideline, and the characteristics of the patient and physician are associated with cholesterol control in IHD patients. We undertook a quasi-experimental, uncontrolled, before-and-after study of 1151 patients. The intervention was carried out during 2010 and 2011, and consisted of a face-to-face training and online course phase (Phase 1), and another of face-to-face feedback (Phase 2). The main outcome variable was the low-density lipoprotein cholesterol (LDL-C) control, whereby values of <100 mg/dL (2.6 mmol/L) were set as a good level of control, according to the recommendations of the guidelines in force in 2009. After Phase 1, 6.7% more patients demonstrated good cholesterol control. With respect to patient characteristics, being female and being older were found to be risk factors of poor control. Being diabetic and having suffered a stroke were protective factors. Of the GPs' characteristics, being tutor in a teaching center for GP residents and having completed the online course were found to be protective factors. We concluded that cholesterol control in IHD patients was influenced by the type of training activity undertook by physicians during the implementation of the GPC, and patient and physician characteristics. We highlight that if we apply the recent targets of the European guideline, which establish a lower level of LDL-C control, the percentage of good control could be worse than the observed in this study.
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Affiliation(s)
- Emma Forcadell Drago
- Equip d’Atenció Primària Tortosa Oest, Institut Català de la Salut, 43500 Tortosa, Tarragona, Spain;
- Programa de Doctorat en Medicina, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain;
- Unitat de Suport a la Recerca Terres de l’Ebre, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 43500 Tortosa, Tarragona, Spain; (Z.H.R.); (A.Q.G.)
- GAVINA Research Group, 43500 Tortosa, Tarragona, Spain
| | - Maria Rosa Dalmau Llorca
- Unitat de Suport a la Recerca Terres de l’Ebre, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 43500 Tortosa, Tarragona, Spain; (Z.H.R.); (A.Q.G.)
- GAVINA Research Group, 43500 Tortosa, Tarragona, Spain
- Equip d’Atenció Primària Tortosa Est, Institut Català de la Salut, 43500 Tortosa, Tarragona, Spain
- Programa de Doctorat de Biomedicina, Universitat Rovira i Virgili, 43201 Reus, Spain
| | - Carina Aguilar Martín
- Unitat de Suport a la Recerca Terres de l’Ebre, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 43500 Tortosa, Tarragona, Spain; (Z.H.R.); (A.Q.G.)
- GAVINA Research Group, 43500 Tortosa, Tarragona, Spain
- Unitat d’Avaluació, Direcció d’Atenció Primària Terres de l’Ebre, Institut Català de la Salut, 43500 Tortosa, Tarragona, Spain
| | - Ignacio Ferreira-González
- Programa de Doctorat en Medicina, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain;
- Departament de Cardiologia, Vall d’Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Zojaina Hernández Rojas
- Unitat de Suport a la Recerca Terres de l’Ebre, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 43500 Tortosa, Tarragona, Spain; (Z.H.R.); (A.Q.G.)
- GAVINA Research Group, 43500 Tortosa, Tarragona, Spain
- Equip d’Atenció Primària Tortosa Est, Institut Català de la Salut, 43500 Tortosa, Tarragona, Spain
- Programa de Doctorat de Biomedicina, Universitat Rovira i Virgili, 43201 Reus, Spain
| | - Alessandra Queiroga Gonçalves
- Unitat de Suport a la Recerca Terres de l’Ebre, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 43500 Tortosa, Tarragona, Spain; (Z.H.R.); (A.Q.G.)
- GAVINA Research Group, 43500 Tortosa, Tarragona, Spain
- Unitat Docent de Medicina de Família i Comunitària Tortosa-Terres de L’Ebre, Institut Català de la Salut, 43500 Tortosa, Tarragona, Spain
| | - Carlos López-Pablo
- Departament de Patologia, Hospital de Tortosa Verge de la Cinta, Institut Català de la Salut, 43500 Tortosa, Tarragona, Spain;
- Institut d’Investigació Sanitària Pere Virgili (IISPV), 43500 Tortosa, Tarragona, Spain
- Departament d’Infermeria, Campus Terres de l’Ebre, Universitat Rovira i Virgili, 43500 Tortosa, Tarragona, Spain
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27
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Machluf Y, Chaiter Y, Tal O. Gender medicine: Lessons from COVID-19 and other medical conditions for designing health policy. World J Clin Cases 2020; 8:3645-3668. [PMID: 32953842 PMCID: PMC7479575 DOI: 10.12998/wjcc.v8.i17.3645] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/29/2020] [Accepted: 08/12/2020] [Indexed: 02/05/2023] Open
Abstract
Gender-specific differences in the prevalence, incidence, comorbidities, prognosis, severity, risk factors, drug-related aspects and outcomes of various medical conditions are well documented. We present a literature review on the extent to which research in this field has developed over the years, and reveal gaps in gender-sensitive awareness between the clinical portrayal and the translation into gender-specific treatment regimens, guidelines and into gender-oriented preventive strategies and health policies. Subsequently, through the lens of gender, we describe these domains in detail for four selected medical conditions: Asthma, obesity and overweight, chronic kidney disease and coronavirus disease 2019. As some of the key gender differences become more apparent during adolescence, we focus on this developmental stage. Finally, we propose a model which is based on three influential issues: (1) Investigating gender-specific medical profiles of related health conditions, rather than a single disease; (2) The dynamics of gender disparities across developmental stages; and (3) An integrative approach which takes into account additional risk factors (ethnicity, socio-demographic variables, minorities, lifestyle habits etc.). Increasing the awareness of gender-specific medicine in daily practice and in tailored guidelines, already among adolescents, may reduce inequities, facilitate the prediction of future trends and properly address the characteristics and needs of certain subpopulations within each gender.
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Affiliation(s)
- Yossy Machluf
- Shamir Research Institute, University of Haifa, Kazerin 1290000, Israel
| | - Yoram Chaiter
- The Israeli Center for Emerging Technologies in Hospitals and Hospital-based Health Technology Assessment, Shamir (Assaf Harofeh) Medical Center, Zerifin 7030100, Israel
| | - Orna Tal
- The Israeli Center for Emerging Technologies in Hospitals and Hospital-based Health Technology Assessment, Shamir (Assaf Harofeh) Medical Center, Zerifin 7030100, Israel
- Shamir (Assaf Harofeh) Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Zerifin 7030100, Israel
- Department of Management, Program of Public Health and Health System Administration, Bar Ilan University, Ramat Gan 5290002, Israel
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28
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Affiliation(s)
- Ewelina Biskup
- Department of Advanced Biomedical Sciences, Federico II University of Naples.,Shanghai University of Medicine and Health Sciences, School of Clinical Medicine, Shanghai, China
| | - Valeria Raparelli
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Tiffany I Leung
- Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands
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29
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Norris CM, Tannenbaum C, Pilote L, Wong G, Cantor WJ, McMurtry MS. Systematic Incorporation of Sex-Specific Information Into Clinical Practice Guidelines for the Management of ST -Segment-Elevation Myocardial Infarction: Feasibility and Outcomes. J Am Heart Assoc 2020; 8:e011597. [PMID: 30929545 PMCID: PMC6509726 DOI: 10.1161/jaha.118.011597] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background Clinical practice guideline ( CPG ) developers have yet to endorse a consistent and systematic approach for considering sex-specific cardiovascular information in CPG s. This article describes an initiative led by the Canadian Cardiovascular Society to determine the feasibility and outcomes of a structured process for considering sex in a CPG for the management of ST-segment-elevation myocardial infarction. Methods and Results A sex and gender champion was appointed to the guideline development committee. The feasibility of tailoring the CPG to sex was ascertained by recording (1) the male-female distribution of the study population, (2) the adequacy of sex-specific representation in each study using the participation/prevalence ratio, and (3) whether data were disaggregated by sex. The outcome was to determine whether recommendations for CPG s based on an assessment of the evidence should differ by sex. In total, 175 studies were included. The mean percentage of female participants reported in the studies was 24.5% ( SD : 6.6%; minimum: 0%; maximum: 51%). The mean participation/prevalence ratio was 0.62 ( SD : 0.16; minimum: 0.00; maximum: 1.19). Eighteen (10.2%) studies disaggregated the data by sex. Based on the participation/prevalence ratio and the sex-specific analyses presented, only 1 study provided adequate evidence to confidently inform the applicability of the CPG recommendations to male and female patients. Conclusions Implementing a systematic process for critically appraising sex-specific evidence for CPG s was straightforward and feasible. Inadequate enrollment and reporting by sex hindered comprehensive sex-specific assessment of the quality of evidence and strength of recommendations for a CPG on the management of ST-segment-elevation myocardial infarction.
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Affiliation(s)
- Colleen M Norris
- 1 Faculty of Nursing University of Alberta Edmonton Alberta Canada.,2 Heart and Stroke Strategic Clinical Network Alberta Health Services Edmonton Alberta Canada.,3 Division of Cardiology Faculty of Medicine University of Alberta Edmonton Alberta Canada
| | - Cara Tannenbaum
- 4 Institute of Gender and Health Canadian Institutes of Health Research Montreal Canada
| | - Louise Pilote
- 5 Divisions of General Internal Medicine and Clinical Epidemiology McGill University Health Centre Montreal Quebec Canada
| | - Graham Wong
- 6 Division of Cardiology Faculty of Medicine University of British Columbia Vancouver British Columbia Canada
| | | | - Micheal S McMurtry
- 3 Division of Cardiology Faculty of Medicine University of Alberta Edmonton Alberta Canada
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30
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Hoang-Kim A, Parpia C, Freitas C, Austin PC, Ross HJ, Wijeysundera HC, Tu K, Mak S, Farkouh ME, Sun LY, Schull MJ, Mason R, Lee DS, Rochon PA. Readmission rates following heart failure: a scoping review of sex and gender based considerations. BMC Cardiovasc Disord 2020; 20:223. [PMID: 32408892 PMCID: PMC7222562 DOI: 10.1186/s12872-020-01422-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 03/09/2020] [Indexed: 12/23/2022] Open
Abstract
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.
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Affiliation(s)
| | | | - Cassandra Freitas
- Peter Munk Cardiac Centre of University Health Network, Toronto, Canada
| | - Peter C Austin
- ICES, Toronto, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Heather J Ross
- Peter Munk Cardiac Centre of University Health Network, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada.,Ted Rogers Centre for Heart Research, Toronto, Canada
| | - Harindra C Wijeysundera
- ICES, Toronto, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada.,Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Karen Tu
- Faculty of Medicine, University of Toronto, Toronto, Canada.,North York General Hospital, Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Susanna Mak
- Faculty of Medicine, University of Toronto, Toronto, Canada.,Sinai Health System, Toronto, Canada
| | - Michael E Farkouh
- Peter Munk Cardiac Centre of University Health Network, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Louise Y Sun
- ICES, Toronto, Canada.,Division of Cardiac Anesthesiology, University of Ottawa Heart Institute, Ottawa, Canada
| | - Michael J Schull
- ICES, Toronto, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada.,Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Robin Mason
- Women's College Research Institute, Toronto, Canada
| | - Douglas S Lee
- Peter Munk Cardiac Centre of University Health Network, Toronto, Canada. .,ICES, Toronto, Canada. .,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. .,Faculty of Medicine, University of Toronto, Toronto, Canada. .,Ted Rogers Centre for Heart Research, Toronto, Canada.
| | - Paula A Rochon
- Women's College Research Institute, Toronto, Canada.,ICES, Toronto, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
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Norris CM, Yip CY, Nerenberg KA, Jaffer S, Grewal J, Levinsson AL, Mulvagh SL. Introducing the Canadian Women's Heart Health Alliance ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Diseases in Women. CJC Open 2020; 2:145-150. [PMID: 32462128 PMCID: PMC7242496 DOI: 10.1016/j.cjco.2020.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 02/02/2020] [Indexed: 12/12/2022] Open
Abstract
Despite a global understanding that indicators and outcomes of cardiovascular disease (CVD) are known to differ between men and women, uptake of the recognition of sex and gender influences on the clinical care of women has been slow or absent. The Canadian Women’s Heart Health Alliance (CWHHA) was established as a network of experts and advocates to develop and disseminate evidence-informed strategies to transform clinical practice and augment collaborative action on women’s cardiovascular health in Canada. As an initial project, the CWHHA membership undertook an environmental scan of CVD in women in Canada from which a scientific statement could be developed to summarize critical sex- and gender-specific issues in CVD. This comprehensive review of the evidence focused on the sex- and gender-specific differences in comorbidity, risk factors, disease awareness, presentation, diagnosis, and treatment across the entire spectrum of CVD. In the process of creating the review, it was recognized that the team of CWHHA experts had also assembled an expansive collection of original research articles that were synthesized into detailed chapters reporting on the present state of the evidence unique to each cardiovascular condition in women. This work comprises an “ATLAS” on the epidemiology, diagnosis, and management of CVD in women. The overall goal of the ATLAS is to create a living document that will help clinicians and the public recognize the unique aspects of women’s heart health care and provide policy makers with information they need to ensure equitable care for women with CVD.
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Affiliation(s)
- Colleen M. Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
- Corresponding author: Dr Colleen M. Norris, Faculty of Nursing, 3rd Floor ECHA, University of Alberta, Edmonton, Alberta T6G 1C9, Canada,. Tel.: +1-780-492-0784; fax: +1-780-492-2551.
| | - Cindy Y.Y. Yip
- Heart and Stroke Foundation of Canada, Toronto, Ontario, Canada
| | - Kara A. Nerenberg
- Department of Medicine/Division of General Internal Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shahin Jaffer
- Department of Medicine/Community Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jasmine Grewal
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anna L.E. Levinsson
- Montréal Heart Institute, Beaulieu-Saucier Université de Montréal Pharmacogenomics Centre, Faculty of Medicine, Université de Montréal, Montréal, Quebec, Canada
| | - Sharon L. Mulvagh
- Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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Gogovor A, Zomahoun HTV, Ben Charif A, McLean RKD, Moher D, Milat A, Wolfenden L, Prévost K, Aubin E, Rochon P, Ekanmian G, Sawadogo J, Rheault N, Légaré F. Essential items for reporting of scaling studies of health interventions (SUCCEED): protocol for a systematic review and Delphi process. Syst Rev 2020; 9:11. [PMID: 31926555 PMCID: PMC6954577 DOI: 10.1186/s13643-019-1258-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 12/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The lack of a reporting guideline for scaling of evidence-based practices (EBPs) studies has prompted the registration of the Standards for reporting studies assessing the impact of scaling strategies of EBPs (SUCCEED) with EQUATOR Network. The development of SUCCEED will be guided by the following main steps recommended for developing health research reporting guidelines. METHODS Executive Committee. We established a committee composed of members of the core research team and of an advisory group. Systematic review. The protocol was registered with the Open Science Framework on 29 November 2019 (https://osf.io/vcwfx/). We will include reporting guidelines or other reports that may include items relevant to studies assessing the impact of scaling strategies. We will search the following electronic databases: EMBASE, PsycINFO, Cochrane Library, CINAHL, Web of Science, from inception. In addition, we will systematically search websites of EQUATOR and other relevant organizations. Experts in the field of reporting guidelines will also be contacted. Study selection and data extraction will be conducted independently by two reviewers. A narrative analysis will be conducted to compile a list of items for the Delphi exercise. CONSENSUS PROCESS We will invite panelists with expertise in: development of relevant reporting guidelines, methodologists, content experts, patient/member of the public, implementers, journal editors, and funders. We anticipated that three rounds of web-based Delphi consensus will be needed for an acceptable degree of agreement. We will use a 9-point scale (1 = extremely irrelevant to 9 = extremely relevant). Participants' response will be categorized as irrelevant (1-3), equivocal (4-6) and relevant (7-9). For each item, the consensus is reached if at least 80% of the participants' votes fall within the same category. The list of items from the final round will be discussed at face-to-face consensus meeting. Guideline validation. Participants will be authors of scaling studies. We will collect quantitative (questionnaire) and qualitative (semi-structured interview) data. Descriptive analyses will be conducted on quantitative data and constant comparative techniques on qualitative data. DISCUSSION Essential items for reporting scaling studies will contribute to better reporting of scaling studies and facilitate the transparency and scaling of evidence-based health interventions.
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Affiliation(s)
- Amédé Gogovor
- Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Quebec, Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Canada
- Centre de recherche sur les soins et les services de première ligne de l’Université Laval, Pavillon Landry-Poulin, 2525, Chemin de la Canardière, Quebec, QC G1J 0A4 Canada
| | - Hervé Tchala Vignon Zomahoun
- Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Canada
- Centre de recherche sur les soins et les services de première ligne de l’Université Laval, Pavillon Landry-Poulin, 2525, Chemin de la Canardière, Quebec, QC G1J 0A4 Canada
| | - Ali Ben Charif
- Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Quebec, Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Canada
- Centre de recherche sur les soins et les services de première ligne de l’Université Laval, Pavillon Landry-Poulin, 2525, Chemin de la Canardière, Quebec, QC G1J 0A4 Canada
| | - Robert K. D. McLean
- International Development Research Centre, PO BOX 8500, Ottawa, Ontario K1G 3H9 Canada
- Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505 South Africa
| | - David Moher
- School of Epidemiology and Public Health, University Research Chair in Systematic Reviews, Ottawa, Canada
- Ottawa Methods Centre, Ottawa Hospital Research Institute, The Ottawa Hospital, General Campus, Centre for Practice Changing Research Building, 501 Smyth Road, PO BOX 201B, Ottawa, Ontario K1H 8L6 Canada
| | - Andrew Milat
- Centre for Epidemiology, NSW Ministry of Health, Australia, LMB 961, North Sydney, 2059 Australia
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Edward Ford Building (A27) Fisher Road, Sydney, NSW 2006 Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Locked Bag 10, Wallsend, NSW 2287 Australia
| | - Karina Prévost
- Centre de recherche sur les soins et les services de première ligne de l’Université Laval, Pavillon Landry-Poulin, 2525, Chemin de la Canardière, Quebec, QC G1J 0A4 Canada
- Patient partner, Quebec, Canada
| | - Emmanuelle Aubin
- Centre de recherche sur les soins et les services de première ligne de l’Université Laval, Pavillon Landry-Poulin, 2525, Chemin de la Canardière, Quebec, QC G1J 0A4 Canada
- Patient partner, Quebec, Canada
| | - Paula Rochon
- Women’s College Research Institute, Women’s College Hospital, University of Toronto, 76 Grenville Street, Toronto, Ontario M5S 1B2 Canada
| | - Giraud Ekanmian
- Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Quebec, Canada
- Centre de recherche sur les soins et les services de première ligne de l’Université Laval, Pavillon Landry-Poulin, 2525, Chemin de la Canardière, Quebec, QC G1J 0A4 Canada
| | - Jasmine Sawadogo
- Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Quebec, Canada
- Centre de recherche sur les soins et les services de première ligne de l’Université Laval, Pavillon Landry-Poulin, 2525, Chemin de la Canardière, Quebec, QC G1J 0A4 Canada
| | - Nathalie Rheault
- Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Quebec, Canada
- Centre de recherche sur les soins et les services de première ligne de l’Université Laval, Pavillon Landry-Poulin, 2525, Chemin de la Canardière, Quebec, QC G1J 0A4 Canada
| | - France Légaré
- Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Quebec, Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Canada
- Centre de recherche sur les soins et les services de première ligne de l’Université Laval, Pavillon Landry-Poulin, 2525, Chemin de la Canardière, Quebec, QC G1J 0A4 Canada
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Biskup E, Martinkova J, Ferretti MT. Gender medicine: Towards a gender-specific treatment of neuropsychiatric disorders. HANDBOOK OF CLINICAL NEUROLOGY 2020; 175:437-448. [PMID: 33008542 DOI: 10.1016/b978-0-444-64123-6.00029-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Sex and gender are increasingly recognized as major influencing factors in disorders across all medical specialties. Even though there is ample evidence of sex and gender differences in neuropsychiatric disorders, a sex and gender-differentiated approach has not yet been sufficiently applied to diagnostics and management. Therefore, there is an urgent need to establish general recommendations and guidelines toward precision and sex/gender medicine, with regard to dosage, tolerability, interactions and side effects, sensitivity of diagnostic tests, and distinct treatment strategies. This chapter illustrates the current knowledge about sex and gender aspects in neuropsychiatric disorders, providing a base not only to assist the clinician in the handling of specific pathologic entities, but also to sensitize medical practitioners to consider sex and gender in clinical decision-making. As such, the chapter is a call to action to physicians and researchers to produce more sex- and gender-stratified evidence, leading to an acceleration of guideline development. Such novel guidelines will provide a base for medical education, of both medical students and specialists, as well as a reference point for practitioners, toward precision medicine.
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Affiliation(s)
- Ewelina Biskup
- Women's Brain Project, Guntershausen (TG), Switzerland; Shanghai University of Medicine and Health Sciences, College of Clinical Medicine, Shanghai, China.
| | - Julie Martinkova
- Women's Brain Project, Guntershausen (TG), Switzerland; Memory Clinic, Department of Neurology, Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic
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Cavanagh A. When i say … gender. MEDICAL EDUCATION 2019; 53:1176-1177. [PMID: 31667863 DOI: 10.1111/medu.13963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 08/21/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Alice Cavanagh
- Health Policy PhD Program, McMaster University, Hamilton, Ontario, Canada
- Michael G DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
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Ling S, Mangaoil R, Cleverley K, Sproule B, Puts M. A systematic review of sex differences in treatment outcomes among people with opioid use disorder receiving buprenorphine maintenance versus other treatment conditions. Drug Alcohol Depend 2019; 197:168-182. [PMID: 30831429 DOI: 10.1016/j.drugalcdep.2019.02.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 01/19/2019] [Accepted: 02/07/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Opioid use disorder is a major health concern in North America. Currently, buprenorphine is one of the most common pharmacological interventions used to treat opioid use disorder. Despite increasing prevalence of opioid use disorder among females, little is known about sex considerations in relation to treatment with buprenorphine. METHODS CINAHL, PsycINFO, EMBASE, PubMed/MEDLINE and Cochrane Central were searched for randomized controlled trials examining buprenorphine maintenance versus other medication-assisted treatment, placebo, or withdrawal management to determine if there were any sex differences in treatment outcomes reported. RESULTS This review included 25 studies and found that only 52% included information related to sex differences in treatment outcomes or discussed any sex considerations in their studies. Of the 6,466 patients represented by these studies, only 26% were female. Of the studies conducting sex-specific analyses, seven studies examined treatment retention, five examined opioid use, two examined other substance use and one examined sexual risk behaviours. However, due to mixed findings, small sample sizes, and inability to conduct meta-analyses, no conclusive statements can be made about sex differences in these outcomes. None of the studies described sex differences in quality of life, legal involvement or mental and physical health. CONCLUSIONS Low numbers of females have been included in randomized controlled trials examining buprenorphine compared to males. While sex differences in treatment outcomes were identified in this review, further research is needed in order to add to these findings. Future studies should include greater numbers of female participants and conduct sex-specific analyses.
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Affiliation(s)
- Sara Ling
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON, Canada, M5T 1P8; Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, ON, Canada, M6J 1H4.
| | - Remar Mangaoil
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON, Canada, M5T 1P8; Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, ON, Canada, M6J 1H4.
| | - Kristin Cleverley
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON, Canada, M5T 1P8; Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, ON, Canada, M6J 1H4.
| | - Beth Sproule
- Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, ON, Canada, M6J 1H4; Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, Canada, M5S 3M2.
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON, Canada, M5T 1P8.
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Sex-Specific Considerations in Guidelines Generation and Application. Can J Cardiol 2018; 35:598-605. [PMID: 30910247 DOI: 10.1016/j.cjca.2018.11.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/11/2018] [Accepted: 11/14/2018] [Indexed: 12/14/2022] Open
Abstract
New knowledge about male-female differences in pathophysiology, diagnosis, and treatment is shifting the practice of medicine from a one-size-fits all approach to a more individualized process that considers sex-specific interventions at the point of care. In this article, we review how clinical practice guideline committees can incorporate a structured framework to determine whether sex-specific assessments of the quality of the evidence or the particular recommendations should be made. The process can be operationalized by societies who author clinical practice guidelines by developing formal policies to approach biological sex in a systematic way, and by ensuring that writing committees include an individual who will champion the formal appraisal of the literature for associations between sex and the outcomes of interest. Ongoing challenges are discussed, and solutions are provided for how to disaggregate the evidence, how to assess bias, how to improve search strategies, and what to do when the data are insufficient to make sex-specific recommendations. Application of sex-specific recommendations will involve routinely asking whether the presentation, diagnostic workup, or management might change for each patient if they were the opposite sex.
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Légaré F, Lee-Gosselin H, Borduas F, Monette C, Bilodeau A, Tanguay D, Stacey D, Gagnon MP, Roch G, Dogba MJ, Bussières A, Tremblay MC, Bélanger AP, Jose C, Desroches S, Robitaille H, Blair L, Rhugenda SM. Approaches to considering sex and gender in continuous professional development for health and social care professionals: An emerging paradigm. MEDICAL TEACHER 2018; 40:875-879. [PMID: 30058455 DOI: 10.1080/0142159x.2018.1483579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Consideration of sex and gender in research and clinical practice is necessary to redress health inequities and reduce knowledge gaps. As all health professionals must maintain and update their skills throughout their career, developing innovative continuing professional education programs that integrate sex and gender issues holds great promise for reducing these gaps. This article proposes new approaches to partnership, team development, pedagogical theory, content development, evaluation and data management that will advance the integration of sex and gender in continuing professional development (CPD). Our perspectives build on an intersectoral and interprofessional research team that includes several perspectives, including those of CPD, health systems, knowledge translation and sex and gender.
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Affiliation(s)
- France Légaré
- a Université Laval Primary Care Research Centre (CERSSPL-UL) , Quebec City , QC , Canada
- b Faculty of Medicine , Université Laval , Quebec City , QC , Canada
| | - Hélène Lee-Gosselin
- c Institute for Women, Societies, Equality and Equity , Université Laval , Quebec City , QC , Canada
| | | | - Céline Monette
- d Médecins Francophone du Canada , Montreal , QC , Canada
| | | | - Dominique Tanguay
- c Institute for Women, Societies, Equality and Equity , Université Laval , Quebec City , QC , Canada
| | - Dawn Stacey
- f School of Nursing Faculty of Health Sciences , University of Ottawa , Ottawa , ON , Canada
- g Ottawa Hospital Research Institute , Ottawa , ON , Canada
| | | | - Geneviève Roch
- h Faculty of Nursing , Université Laval , Quebec City , QC , Canada
- i CHU de Québec, Université Laval Research Centre , Quebec City , QC , Canada
| | - Maman Joyce Dogba
- a Université Laval Primary Care Research Centre (CERSSPL-UL) , Quebec City , QC , Canada
- b Faculty of Medicine , Université Laval , Quebec City , QC , Canada
| | - André Bussières
- j Faculty of Medicine , McGill University , Montreal , QC , Canada
| | | | | | - Caroline Jose
- l Department of Family Medicine , University of Sherbrooke , Moncton , NB , Canada
- m Maritimes SPOR Support Unit , Moncton , NB , Canada
| | - Sophie Desroches
- n Institute of Nutrition and Functional Foods , School of Nutrition , Université Laval , Quebec City , QC , Canada
| | - Hubert Robitaille
- a Université Laval Primary Care Research Centre (CERSSPL-UL) , Quebec City , QC , Canada
| | - Louisa Blair
- a Université Laval Primary Care Research Centre (CERSSPL-UL) , Quebec City , QC , Canada
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Bjørnnes AK, Parry M, Leegaard M, Ayala AP, Lenton E, Harvey P, McFetridge-Durdle J, McGillion MH, Price J, Stinson J, Watt-Watson J. Self-Management of Cardiac Pain in Women: A Meta-Summary of the Qualitative Literature. QUALITATIVE HEALTH RESEARCH 2018; 28:1769-1787. [PMID: 29916769 DOI: 10.1177/1049732318780683] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Symptom recognition and self-management is instrumental in reducing the number of deaths related to coronary artery disease (CAD) in women. The purpose of this study was to synthesize qualitative research evidence on the self-management of cardiac pain and associated symptoms in women. Seven databases were systematically searched, and the concepts of the Individual and Family Self-Management Theory were used as the framework for data extraction and analysis. Search strategies yielded 22,402 citations, from which 35 qualitative studies were included in a final meta-summary, comprising data from 769 participants, including 437 (57%) women. The available literature focused cardiac pain self-management from a binary sex and gender perspective. Ethnicity was indicated in 19 (54%) studies. Results support individualized intervention strategies that promote goal setting and action planning, management of physical and emotional responses, and social facilitation provided through social support.
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Affiliation(s)
- Ann Kristin Bjørnnes
- 1 University of Toronto, Toronto, Ontario, Canada
- 2 Oslo Metropolitan University, Oslo, Norway
| | - Monica Parry
- 1 University of Toronto, Toronto, Ontario, Canada
| | | | | | - Erica Lenton
- 1 University of Toronto, Toronto, Ontario, Canada
| | - Paula Harvey
- 3 Women's College Hospital, Toronto, Ontario, Canada
| | | | | | | | - Jennifer Stinson
- 1 University of Toronto, Toronto, Ontario, Canada
- 6 The Hospital for Sick Children, Toronto, Ontario, Canada
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Tannenbaum C, van Hoof K. Effectiveness of online learning on health researcher capacity to appropriately integrate sex, gender, or both in grant proposals. Biol Sex Differ 2018; 9:39. [PMID: 30157942 PMCID: PMC6114804 DOI: 10.1186/s13293-018-0197-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 08/15/2018] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND To describe the effectiveness of online learning to augment academic capacity to consider sex and gender in the conduct of basic science, clinical research, and population health studies. METHOD The analysis compares pre- and post-test scores from 1441 individuals who completed the Canadian Institutes of Health Research Institute of Gender and Health's interactive e-learning modules between February 2016 and May 2017. The tests measured knowledge, self-efficacy, and self-reported intent to change behavior for three competencies: (1) the ability to appropriately define and distinguish between sex-related versus gender-related variables, (2) the application of methods for integrating sex and gender, and (3) the critical appraisal of sex and gender integration in the design, methods, and analysis plan of research proposals and publications. RESULTS Of the 543 individuals who completed the basic science module, 62% demonstrated improved knowledge, and 86% increased self-efficacy across all competencies. Gains in knowledge and self-efficacy also occurred among 84% and 77% of completers of the human data collection module (n = 463) and among 73% and 82% of those who completed the secondary data analysis module (n = 435). In aggregate, 95% of participants reported an intent to change their behavior with respect to sex and gender in health research. CONCLUSIONS Interactive online learning combined with feedback and self-assessment results in improved knowledge and self-efficacy for integrating sex and gender in health research.
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Affiliation(s)
- Cara Tannenbaum
- Institute of Gender and Health, Canadian Institutes of Health Research, 4545 Queen Mary Road, Montreal, Quebec, H3W 1W5, Canada.
- Faculties of Medicine and Pharmacy, Université de Montréal, Montreal, Canada.
| | - Krystle van Hoof
- Institute of Gender and Health, Canadian Institutes of Health Research, 4545 Queen Mary Road, Montreal, Quebec, H3W 1W5, Canada
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Petkovic J, Trawin J, Dewidar O, Yoganathan M, Tugwell P, Welch V. Sex/gender reporting and analysis in Campbell and Cochrane systematic reviews: a cross-sectional methods study. Syst Rev 2018; 7:113. [PMID: 30068380 PMCID: PMC6090880 DOI: 10.1186/s13643-018-0778-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 07/17/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The importance of sex and gender considerations in research is being increasingly recognized. Evidence indicates that sex and gender can influence intervention effectiveness. We assessed the extent to which sex/gender is reported and analyzed in Campbell and Cochrane systematic reviews. METHODS We screened all the systematic reviews in the Campbell Library (n = 137) and a sample of systematic reviews from 2016 to 2017 in the Cochrane Library (n = 674). We documented the frequency of sex/gender terms used in each section of the reviews. RESULTS We excluded 5 Cochrane reviews because they were withdrawn or published and updated within the same time period as well as 4 Campbell reviews and 114 Cochrane reviews which only included studies focused on a single sex. Our analysis includes 133 Campbell reviews and 555 Cochrane reviews. We assessed reporting of sex/gender considerations for each section of the systematic review (Abstract, Background, Methods, Results, Discussion). In the methods section, 83% of Cochrane reviews (95% CI 80-86%) and 51% of Campbell reviews (95% CI 42-59%) reported on sex/gender. In the results section, less than 30% of reviews reported on sex/gender. Of these, 37% (95% CI 29-45%) of Campbell and 75% (95% CI 68-82%) of Cochrane reviews provided a descriptive report of sex/gender and 63% (95% CI 55-71%) of Campbell reviews and 25% (95% CI 18-32%) of Cochrane reviews reported analytic approaches for exploring sex/gender, such as subgroup analyses, exploring heterogeneity, or presenting disaggregated data by sex/gender. CONCLUSION Our study indicates that sex/gender reporting in Campbell and Cochrane reviews is inadequate.
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Affiliation(s)
- Jennifer Petkovic
- Bruyère Research Institute, 85 Primrose Ave, Ottawa, Ontario, K1N 6M1, Canada.
| | - Jessica Trawin
- Bruyère Research Institute, 85 Primrose Ave, Ottawa, Ontario, K1N 6M1, Canada
| | - Omar Dewidar
- Bruyère Research Institute, 85 Primrose Ave, Ottawa, Ontario, K1N 6M1, Canada
| | - Manosila Yoganathan
- Bruyère Research Institute, 85 Primrose Ave, Ottawa, Ontario, K1N 6M1, Canada
| | - Peter Tugwell
- Ottawa Hospital Research Institute, Centre for Practice-Changing Research, Mailbox 201B, The Ottawa Hospital - General Campus, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada.,Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, K1Y 4E9, Canada.,University of Ottawa, School of Epidemiology and Public Health, Ottawa, K1H 8M5, Canada
| | - Vivian Welch
- Bruyère Research Institute, 85 Primrose Ave, Ottawa, Ontario, K1N 6M1, Canada
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Tannenbaum C, Day D. Age and sex in drug development and testing for adults. Pharmacol Res 2017; 121:83-93. [PMID: 28455265 DOI: 10.1016/j.phrs.2017.04.027] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 03/24/2017] [Accepted: 04/24/2017] [Indexed: 01/11/2023]
Abstract
Individualization of drug therapy requires that the right drug be administered at the correct dose to patients who are likely to achieve the highest benefit and lowest risk. Female sex and age comprise two important risk factors for altered drug exposure and response. This review summarizes the current state of science for considering age and sex-related factors along the drug development pipeline, from cell culture and animal research through all phases of clinical trials in humans. A set of recommendations is provided to improve standards for integrating age and sex into the study design, analysis, and reporting of pre-clinical and clinical assessment of new molecular entities and biologics in adults.
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Affiliation(s)
- Cara Tannenbaum
- Institute of Gender and Health, Canadian Institutes of Health Research, Canada; Medicine and Pharmacy, Université de Montreal, Centre de recherche, Institut universitaire de gériatrie de Montréal (CRIUGM), 4565 Chemin Queen-Mary, Montréal, Québec H3W 1W5, Canada.
| | - Danielle Day
- Fractyl Laboratories, 17 Hartwell Ave, Lexington, MA 02421, USA
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