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Rubin MJ, Wakinekona NA, Reilly MA, Canales B, Sparapani R, Dyer M, Kibbe MR, Mansukhani NA. Reporting and analysis of sex in vascular surgery research. J Vasc Surg 2024:S0741-5214(24)01338-7. [PMID: 38901638 DOI: 10.1016/j.jvs.2024.06.021] [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: 12/31/2023] [Revised: 05/20/2024] [Accepted: 06/13/2024] [Indexed: 06/22/2024]
Abstract
OBJECTIVE To examine sex in human vascular surgery research by quantifying the inclusion and analysis of sex-based data in high-impact vascular surgery journals. METHODS A bibliographic review of original articles published in the European Journal of Vascular and Endovascular Surgery, Journal of Vascular Surgery, JVS: Venous and Lymphatic Disorders, Journal of Endovascular Therapy, and Annals of Vascular Surgery from January 1, 2018, to December 31, 2020, and from January 1, 2023, to December 31, 2023, was conducted. Abstracted data included sex-based data analysis, inclusion of sex as a variable in multivariable analysis, inclusion of sex as an independent variable, and a discussion of sex-based results. RESULTS Of the 3762 articles that included human, animal, or cell subjects, 249 (6.6%) did not state sex. Of those 249 articles, 183 included human subjects, 55 included animal subjects, and 11 used cell lines as the subjects. These were removed from analysis as well as the remaining 68 articles with animal subjects. In addition, 23 researched a sex-specific pathology and were removed from analysis. Of the remaining 3422 articles included in our study, 42.3% analyzed sex, 46.9% included sex in multivariable analysis, 4.8% included sex as an independent variable, and 26.6% included a discussion of sex. There were no significant differences in all four sex variables between 2018, 2019, and 2020. Between 2018-2020 and 2023, there were significant increases in all four sex variables. Multicenter studies had significantly higher rates of independent analysis of sex over single-center studies (7.4% vs 3.3%, P < .001). There was no significant difference in independent analysis of sex between U.S.-based and non-U.S.-based studies. Only 191 articles (5.6%) had 90% or greater matching of men and women in their study. CONCLUSIONS Equitable inclusion and analysis of sex is rare in vascular surgery research. Less than 5% of articles included an independent analysis of data by sex, and few studies included males and females equally. Clinical research is the basis for evidence-based medicine; therefore, it is important to strive for equitable inclusion, analysis, and reporting of data to foster generalizability of clinical research to men and women.
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Affiliation(s)
- Micah J Rubin
- Division of Vascular and Endovascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Nalani A Wakinekona
- Division of Vascular and Endovascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Margaret A Reilly
- Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Bethany Canales
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI
| | - Rodney Sparapani
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI
| | - Mitchell Dyer
- Division of Vascular and Endovascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Melina R Kibbe
- Department of Surgery and Biomedical Engineering, University of Virginia School of Medicine, Charlottesville, VA
| | - Neel A Mansukhani
- Division of Vascular and Endovascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI; Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
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Burns KEA, Heels-Ansdell D, Thabane L, Kahn SR, Lauzier F, Mehta S, Ostermann M, Bhuptani P, Crowther MA, Finfer S, Cook DJ. Sex differences in thromboprophylaxis of the critically ill: a secondary analysis of a randomized trial. Can J Anaesth 2023; 70:1008-1018. [PMID: 37310606 DOI: 10.1007/s12630-023-02457-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 06/14/2023] Open
Abstract
PURPOSE Venous thromboembolism (VTE) is a common complication of critical illness. Sex- or gender-based analyses are rarely conducted and their effect on outcomes is unknown. We assessed for an effect modification of thromboprophylaxis (dalteparin or unfractionated heparin [UFH]) by sex on thrombotic (deep venous thrombosis [DVT], pulmonary embolism [PE], VTE) and mortality outcomes in a secondary analysis of the Prophylaxis for Thromboembolism in Critical Care Trial (PROTECT). METHODS We conducted unadjusted analyses using Cox proportional hazards analysis, stratified by centre and admission diagnostic category, including sex, treatment, and an interaction term. Additionally, we performed adjusted analyses and assessed the credibility of our findings. RESULTS Critically ill female (n = 1,614) and male (n = 2,113) participants experienced similar rates of DVT, proximal DVT, PE, any VTE, ICU death, and hospital death. In unadjusted analyses, we did not find significant differences in treatment effect favouring males (vs females) treated with dalteparin (vs UFH) for proximal leg DVT, any DVT, or any PE, but found a statistically significant effect (moderate certainty) favouring dalteparin in males for any VTE (males: hazard ratio [HR], 0.71; 95% confidence interval [CI], 0.52 to 0.96 vs females: HR, 1.16; 95% CI, 0.81 to 1.68; P = 0.04). This effect remained after adjustment for baseline characteristics (males: HR, 0.70; 95% CI, 0.52 to 0.96 vs females: HR, 1.17; 95% CI, 0.81 to 1.68; P = 0.04) and weight (males: HR, 0.70; 95% CI, 0.52 to 0.96 vs females: HR, 1.20; 95% CI, 0.83 to 1.73; P = 0.03). We did not identify a significant effect modification by sex on mortality. CONCLUSIONS We found an effect modification by sex of thromboprophylaxis on VTE in critically ill patients that requires confirmation. Our findings highlight the need for sex- and gender-based analyses in acute care research.
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Affiliation(s)
- Karen E A Burns
- Interdepartmental Division of Critical Care, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, Unity Health Toronto-St. Michael's Hospital, 30 Bond Street, 4-045 Donnelly Wing, Toronto, ON, M5B 1W8, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Diane Heels-Ansdell
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, ON, Canada
| | - Susan R Kahn
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Francois Lauzier
- Research Center of the CHU de Québec-Université Laval, Population Health and Optimal Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Quebec City, QC, Canada
| | - Sangeeta Mehta
- Interdepartmental Division of Critical Care, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Mount Sinai Hospital, Toronto, ON, Canada
| | - Marlies Ostermann
- Department of Critical Care and Nephrology, King's College London, Guy's and St Thomas' Hospital, London, UK
| | - Pulkit Bhuptani
- Department of Pharmacy, Unity Health Toronto-St. Michael's Hospital, Toronto, ON, Canada
| | - Mark A Crowther
- St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Simon Finfer
- Clinical Trials Unit, The George Institute, Sydney, NSW, Australia
| | - Deborah J Cook
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
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Commentaries on Viewpoint: Consider iron status when making sex comparisons in human physiology. J Appl Physiol (1985) 2022; 132:703-709. [PMID: 35274549 DOI: 10.1152/japplphysiol.00016.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Sex and gender considerations in implementation interventions to promote shared decision making: A secondary analysis of a Cochrane systematic review. PLoS One 2020; 15:e0240371. [PMID: 33031475 PMCID: PMC7544054 DOI: 10.1371/journal.pone.0240371] [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: 06/24/2020] [Accepted: 09/25/2020] [Indexed: 12/03/2022] Open
Abstract
Background Shared decision making (SDM) in healthcare is an approach in which health professionals support patients in making decisions based on best evidence and their values and preferences. Considering sex and gender in SDM research is necessary to produce precisely-targeted interventions, improve evidence quality and redress health inequities. A first step is correct use of terms. We therefore assessed sex and gender terminology in SDM intervention studies. Materials and methods We performed a secondary analysis of a Cochrane review of SDM interventions. We extracted study characteristics and their use of sex, gender or related terms (mention; number of categories). We assessed correct use of sex and gender terms using three criteria: “non-binary use”, “use of appropriate categories” and “non-interchangeable use of sex and gender”. We computed the proportion of studies that met all, any or no criteria, and explored associations between criteria met and study characteristics. Results Of 87 included studies, 58 (66.7%) mentioned sex and/or gender. The most mentioned related terms were “female” (60.9%) and “male” (59.8%). Of the 58 studies, authors used sex and gender as binary variables respectively in 36 (62%) and in 34 (58.6%) studies. No study met the criterion “non-binary use”. Authors used appropriate categories to describe sex and gender respectively in 28 (48.3%) and in 8 (13.8%) studies. Of the 83 (95.4%) studies in which sex and/or gender, and/or related terms were mentioned, authors used sex and gender non-interchangeably in 16 (19.3%). No study met all three criteria. Criteria met did not vary according to study characteristics (p>.05). Conclusions In SDM implementation studies, sex and gender terms and concepts are in a state of confusion. Our results suggest the urgency of adopting a standardized use of sex and gender terms and concepts before these considerations can be properly integrated into implementation research.
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Mansukhani NA, Yoon DY, Teter KA, Stubbs VC, Helenowski IB, Woodruff TK, Kibbe MR. Determining If Sex Bias Exists in Human Surgical Clinical Research. JAMA Surg 2017; 151:1022-1030. [PMID: 27551816 DOI: 10.1001/jamasurg.2016.2032] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Importance Sex is a variable that is poorly controlled for in clinical research. Objectives To determine if sex bias exists in human surgical clinical research, to determine if data are reported and analyzed using sex as an independent variable, and to identify specialties in which the greatest and least sex biases exist. Design, Setting, and Participants For this bibliometric analysis, data were abstracted from 1303 original peer-reviewed articles published from January 1, 2011, through December 31, 2012, in 5 surgery journals. Main Outcomes and Measures Study type, location, number and sex of participants, degree of sex matching of included participants, and inclusion of sex-based reporting, statistical analysis, and discussion of data. Results Of 2347 articles reviewed, 1668 (71.1%) included human participants. After excluding 365 articles, 1303 remained: 17 (1.3%) included males only, 41 (3.1%) included females only, 1020 (78.3%) included males and females, and 225 (17.3%) did not document the sex of the participants. Although female participants represent more than 50% (n = 57 688 606) of the total number (115 377 213) included, considerable variability existed with the number of male (46 111 818), female (58 805 665), and unspecified (10 459 730) participants included among the journals, between US domestic and international studies, and between single vs multicenter studies. For articles included in the study, 38.1% (497 of 1303) reported these data by sex, 33.2% (432 of 1303) analyzed these data by sex, and 22.9% (299 of 1303) included a discussion of sex-based results. Sex matching of the included participants in the research overall was poor, with 45.2% (589 of 1303) of the studies matching the inclusion of both sexes by 50%. During analysis of the different surgical specialties, a wide variation in sex-based inclusion, matching, and data reporting existed, with colorectal surgery having the best matching of male and female participants and cardiac surgery having the worst. Conclusions and Relevance Sex bias exists in human surgical clinical research. Few studies included men and women equally, less than one-third performed data analysis by sex, and there was wide variation in inclusion and matching of the sexes among the specialties and the journals reviewed. Because clinical research is the foundation for evidence-based medicine, it is imperative that this disparity be addressed so that therapies benefit both sexes.
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Affiliation(s)
| | - Dustin Y Yoon
- Department of Surgery, Northwestern University, Chicago, Illinois
| | | | - Vanessa C Stubbs
- Department of Surgery, Northwestern University, Chicago, Illinois
| | | | - Teresa K Woodruff
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois3Women's Health Research Institute, Northwestern University, Chicago, Illinois
| | - Melina R Kibbe
- Department of Surgery, Northwestern University, Chicago, Illinois3Women's Health Research Institute, Northwestern University, Chicago, Illinois4Editor, JAMA Surgery5now with Department of Surgery, University of North Carolina at Chapel Hill
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Dias SP, Brouwer MC, Bijlsma MW, van der Ende A, van de Beek D. Sex-based differences in adults with community-acquired bacterial meningitis: a prospective cohort study. Clin Microbiol Infect 2016; 23:121.e9-121.e15. [PMID: 27816734 DOI: 10.1016/j.cmi.2016.10.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 10/22/2016] [Accepted: 10/23/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To investigate sex-based differences in clinical features, causative pathogens, outcome and treatment of adult community-acquired meningitis. METHODS From January 2006 to July 2014, we prospectively investigated sex-based differences in clinical features, causative pathogens, outcome and treatment of adult community-acquired meningitis in a nationwide cohort study in the Netherlands. Sex was analysed along with known predictors of unfavourable outcome using logistic regression. RESULTS We evaluated 1412 episodes of meningitis, 707 (50%) in men. Men more often presented with a history of remote head injury (41/667 (6%) versus 14/658 (2%) women, p 0.0002) or alcoholism (61/652 (9%) versus 21/660 (3%) women, p <0.0001). Neck stiffness was less common in men (453/651 (70%) versus 524/671 (78%) women, p 0.0004). Despite greater illness severity, women were less likely to receive treatment in an intensive care unit (odds ratio (OR) 0.72, 95% CI 0.58-0.89, p 0.003) or mechanical ventilation (OR 0.67, 95% CI 0.54-0.85, p 0.001). Women exhibited higher serum inflammatory parameters than men (median C-reactive protein 211 versus 171, p 0.0001; median erythrocyte sedimentation rate 48 versus 33, p <0.0001). Corticosteroids improved prognosis in both sexes, but absolute risk reduction was higher in women (20% versus 15%, p 0.001), although we found no significant interaction between sex and dexamethasone (p 0.38). In the multivariable analysis, male sex was an independent predictor of unfavourable outcome (OR 1.34, 95% CI 1.03-1.75, p 0.03) and death (OR 1.47, 95% CI 1.04-2.07, p 0.03). CONCLUSIONS Our findings show sex-based differences in adults with community-acquired bacterial meningitis. Male sex is an independent risk factor for adverse outcome. It is possible that sex-based differences in immune reaction could determine a distinct response to corticosteroids.
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Affiliation(s)
- S P Dias
- Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands; Department of Neurology, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - M C Brouwer
- Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - M W Bijlsma
- Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - A van der Ende
- Department of Medical Microbiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands; The Netherlands Reference Laboratory for Bacterial Meningitis, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - D van de Beek
- Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands.
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McGregor AJ, Hasnain M, Sandberg K, Morrison MF, Berlin M, Trott J. How to study the impact of sex and gender in medical research: a review of resources. Biol Sex Differ 2016; 7:46. [PMID: 27785348 PMCID: PMC5073798 DOI: 10.1186/s13293-016-0099-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
There is a growing appreciation by the biomedical community that studying the impact of sex and gender on health, aging, and disease will lead to improvements in human health. Sex- and gender-based comparisons can inform research on disease mechanisms and the development of new therapeutics as well as enhance scientific rigor and reproducibility. This review will assist basic researchers, clinical investigators, as well as epidemiologists, population, and social scientists by providing an annotated bibliography of currently available resource tools on how to consider sex and gender as independent variables in research design and methodology. These resources will assist investigators applying for funding from the National Institutes of Health since all grant applicants will be required (as of January 25, 2016) to address the role of sex as a biological variable in vertebrate animal and human studies.
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Affiliation(s)
- Alyson J McGregor
- Division of Sex and Gender in Emergency Medicine, Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI USA
| | - Memoona Hasnain
- Department of Family Medicine, College of Medicine, University of Illinois at Chicago, Chicago, IL USA
| | - Kathryn Sandberg
- Center for the Study of Sex Differences in Health, Aging and Disease, Georgetown University Medical Center, Washington, DC, USA
| | - Mary F Morrison
- Department of Psychiatry, Temple University School of Medicine, Philadelphia, PA USA ; Department of Internal Medicine, Temple University School of Medicine, Philadelphia, PA USA
| | - Michelle Berlin
- Center for Women's Health, Oregon Health & Science University, Portland, OR USA
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Eifert S, Guethoff S, Kaczmarek I, Beiras-Fernandez A, Seeland U, Gulbins H, Seeburger J, Deutsch O, Jungwirth B, Katsari E, Dohmen P, Pfannmueller B, Hultgren R, Schade I, Kublickiene K, Mohr FW, Gansera B. Applying the Gender Lens to Risk Factors and Outcome after Adult Cardiac Surgery. VISZERALMEDIZIN 2015; 30:99-106. [PMID: 26288584 PMCID: PMC4513818 DOI: 10.1159/000362344] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background Applying the gender lens to risk factors and outcome after adult cardiac surgery is of major clinical interest, as the inclusion of sex and gender in research design and analysis may guarantee more comprehensive cardiovascular science and may consecutively result in a more effective surgical treatment as well as cost savings in cardiac surgery. Methods We have reviewed classical cardiovascular risk factors (diabetes, arterial hypertension, hyperlipidemia, smoking) according to a gender-based approach. Furthermore, we have examined comorbidities such as depression, renal insufficiency, and hormonal influences in regard to gender. Gender-sensitive economic aspects have been evaluated, surgical outcome has been analyzed, and cardiovascular research has been considered from a gender perspective. Results The influence of typical risk factors and outcome after cardiac surgery has been evaluated from a gender perspective, and the gender-specific distribution of these risk factors is reported on. The named comorbidities are listed. Economic aspects demonstrated a gender gap. Outcome after coronary and valvular surgeries as well as after heart transplantation are displayed in this regard. Results after postoperative use of intra-aortic balloon pump are shown. Gender-related aspects of clinical and biomedical cardiosurgical research are reported. Conclusions Female gender has become an independent risk factor of survival after the majority of cardiosurgical procedures. Severely impaired left ventricular ejection fraction independently predicts survival in men, whereas age does in females.
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Affiliation(s)
- Sandra Eifert
- Klinik für Herzchirurgie, Herzzentrum Leipzig, Universität Leipzig, Frankfurt/M., Germany
| | - Sonja Guethoff
- Klinik für Herzchirurgie, Ludwig-Maximilians-Universität München, Frankfurt/M., Germany
| | - Ingo Kaczmarek
- Klinik für Herzchirurgie, Ludwig-Maximilians-Universität München, Frankfurt/M., Germany
| | - Andres Beiras-Fernandez
- Klinik für Thorax-, Herz- und Thorakale Gefäßchirurgie, Goethe-Universität, Frankfurt/M., Germany
| | - Ute Seeland
- Institut für Geschlechterforschung in der Medizin (GiM), Charité - Universitätsmedizin, Campus Mitte, Berlin, Germany
| | - Helmut Gulbins
- Klinik und Poliklinik für Herz- und Gefäßchirurgie, Universitäres Herzzentrum Hamburg, Germany
| | - Jörg Seeburger
- Klinik für Herzchirurgie, Herzzentrum Leipzig, Universität Leipzig, Frankfurt/M., Germany
| | - Oliver Deutsch
- Klinik für Herzchirurgie, Klinikum Bogenhausen, Städtisches Klinikum München, Germany
| | | | - Elpiniki Katsari
- Klinik für Herz-, Thorax- und Gefäßchirurgie, Herz- und Diabeteszentrum Karlsburg, Germany
| | - Pascal Dohmen
- Klinik für Herzchirurgie, Herzzentrum Leipzig, Universität Leipzig, Frankfurt/M., Germany
| | - Bettina Pfannmueller
- Klinik für Herzchirurgie, Herzzentrum Leipzig, Universität Leipzig, Frankfurt/M., Germany
| | - Rebecka Hultgren
- Center for Gender Medicine, Karolinska Institute, Stockholm, Sweden, Germany
| | - Ina Schade
- Klinik und Poliklinik für Thorax-, Herz- und Thorakale Gefäßchirurgie, Universitätsklinikum Würzburg, Germany
| | | | - Friedrich W Mohr
- Klinik für Herzchirurgie, Herzzentrum Leipzig, Universität Leipzig, Frankfurt/M., Germany
| | - Brigitte Gansera
- Klinik für Herzchirurgie, Klinikum Bogenhausen, Städtisches Klinikum München, Germany
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Johnson J, Sharman Z, Vissandjée B, Stewart DE. Does a change in health research funding policy related to the integration of sex and gender have an impact? PLoS One 2014; 9:e99900. [PMID: 24964040 PMCID: PMC4070905 DOI: 10.1371/journal.pone.0099900] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 05/19/2014] [Indexed: 12/28/2022] Open
Abstract
We analyzed the impact of a requirement introduced in December 2010 that all applicants to the Canadian Institutes of Health Research indicate whether their research designs accounted for sex or gender. We aimed to inform research policy by understanding the extent to which applicants across health research disciplines accounted for sex and gender. We conducted a descriptive statistical analysis to identify trends in application data from three research funding competitions (December 2010, June 2011, and December 2011) (N = 1459). We also conducted a qualitative thematic analysis of applicants' responses. Here we show that the proportion of applicants responding affirmatively to the questions on sex and gender increased over time (48% in December 2011, compared to 26% in December 2010). Biomedical researchers were least likely to report accounting for sex and gender. Analysis by discipline-specific peer review panel showed variation in the likelihood that a given panel will fund grants with a stated focus on sex or gender. These findings suggest that mandatory questions are one way of encouraging the uptake of sex and gender in health research, yet there remain persistent disparities across disciplines. These disparities represent opportunities for policy intervention by health research funders.
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Affiliation(s)
- Joy Johnson
- CIHR Institute of Gender and Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Zena Sharman
- CIHR Institute of Gender and Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bilkis Vissandjée
- Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada
| | - Donna E. Stewart
- University of Toronto and University Health Network, Toronto, Ontario, Canada
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Bird CE, Sharman Z. Gender-based analysis is essential to improving women's health and health care. Womens Health Issues 2014; 24:e163-4. [PMID: 24529744 DOI: 10.1016/j.whi.2013.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 11/21/2013] [Indexed: 11/24/2022]
Affiliation(s)
| | - Zena Sharman
- CIHR Institute of Gender and Health, Vancouver, British Columbia, Canada
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Intra-individual reaction time variability in mild cognitive impairment and Alzheimer's disease: gender, processing load and speed factors. PLoS One 2013; 8:e65712. [PMID: 23762413 PMCID: PMC3677873 DOI: 10.1371/journal.pone.0065712] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Accepted: 04/28/2013] [Indexed: 12/13/2022] Open
Abstract
Compared to cognitively healthy ageing (CH), intra-individual variability in reaction time (IIVRT), a behavioural marker of neurological integrity, is commonly reported to increase in both Alzheimer’s disease (AD) and mild cognitive impairment (MCI). It varies in MCI with respect to whether it represents the pro-dromal stages of dementia or not; being greatest in those most likely to convert. Abnormal IIVRT in MCI therefore represents a potential measure of underlying functional integrity that may serve to differentiate MCI from CH and to help identify those patients for whom MCI is the result of a progressive pathological process. As the clinical approach to MCI is increasingly stratified with respect to gender, we investigated whether this factor could influence study outcome. The influence of RTSPEED and processing load upon IIVRT was also examined. Under low processing load conditions, IIVRT was significantly increased in both MCI and AD compared to CH. However, correcting for an individual’s processing speed abolished this effect in MCI but not in AD, indicating that the increased IIVRT in MCI and AD may result from different factors. In MCI but not in CH, IIVRT was significantly greater for females. Increasing task processing load by adding distracting information, although increasing overall IIVRT, failed to improve the differentiation between CH and both MCI and AD, and in MCI resulted in a reduction in the influence of gender upon study outcome. The outcome of studies investigating IIVRT in MCI and AD compared to CH therefore appear influenced by the gender of the participants, by task-related processing load and processing speed.
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Schulte PA, Pandalai S, Wulsin V, Chun H. Interaction of occupational and personal risk factors in workforce health and safety. Am J Public Health 2011; 102:434-48. [PMID: 22021293 DOI: 10.2105/ajph.2011.300249] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Most diseases, injuries, and other health conditions experienced by working people are multifactorial, especially as the workforce ages. Evidence supporting the role of work and personal risk factors in the health of working people is frequently underused in developing interventions. Achieving a longer, healthy working life requires a comprehensive preventive approach. To help develop such an approach, we evaluated the influence of both occupational and personal risk factors on workforce health. We present 32 examples illustrating 4 combinatorial models of occupational hazards and personal risk factors (genetics, age, gender, chronic disease, obesity, smoking, alcohol use, prescription drug use). Models that address occupational and personal risk factors and their interactions can improve our understanding of health hazards and guide research and interventions.
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Affiliation(s)
- Paul A Schulte
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH 45226, USA.
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Sims ST, Stefanick ML, Kronenberg F, Sachedina NA, Schiebinger L. Gendered innovations: a new approach for nursing science. Biol Res Nurs 2010; 12:156-61. [PMID: 20798156 DOI: 10.1177/1099800410375108] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Considerable sex and gender bias has been recognized within the field of medicine. Investigators have used sex and gender analysis to reevaluate studies and outcomes and generate new perspectives and new questions regarding differential diagnoses and treatments of men and women. Sex and gender analysis acts as an experimental control to provide critical scientific rigor; researchers who ignore it risk ignoring a possible source of error in past, current, and future science. In this article, the authors introduce some tools of sex and gender analysis and illustrate the concept of gendered innovations by demonstrating through examples how this type of analysis has profoundly enhanced human knowledge in health and disease. The authors also provide recommendations for incorporating the concepts of sex and gender analysis into nursing education and research.
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Affiliation(s)
- Stacy T Sims
- Stanford Prevention Research Center, Stanford School of Medicine, Stanford, CA, USA.
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14
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Nieuwenhoven L, Klinge I. Scientific Excellence in Applying Sex- and Gender-Sensitive Methods in Biomedical and Health Research. J Womens Health (Larchmt) 2010; 19:313-21. [DOI: 10.1089/jwh.2008.1156] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Linda Nieuwenhoven
- School for Public Health and Primary Care (Caphri), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- National Institute for Health Development, Budapest, Hungary
| | - Ineke Klinge
- School for Public Health and Primary Care (Caphri), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Centre for Gender and Diversity, Maastricht University, Maastricht, The Netherlands
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15
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Johnson JL, Greaves L, Repta R. Better science with sex and gender: Facilitating the use of a sex and gender-based analysis in health research. Int J Equity Health 2009; 8:14. [PMID: 19419579 PMCID: PMC2689237 DOI: 10.1186/1475-9276-8-14] [Citation(s) in RCA: 279] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Accepted: 05/06/2009] [Indexed: 01/01/2023] Open
Abstract
Much work has been done to promote sex and gender-based analyses in health research and to think critically about the influence of sex and gender on health behaviours and outcomes. However, despite this increased attention on sex and gender, there remain obstacles to effectively applying and measuring these concepts in health research. Some health researchers continue to ignore the concepts of sex and gender or incorrectly conflate their meanings. We report on a primer that was developed by the authors to help researchers understand and use the concepts of sex and gender in their work. We provide detailed definitions of sex and gender, discuss a sex and gender-based analysis (SGBA), and suggest three approaches for incorporating sex and gender in health research at various stages of the research process. We discuss our knowledge translation process and share some of the challenges we faced in disseminating our primer with key stakeholders. In conclusion, we stress the need for continued attention to sex and gender in health research.
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Affiliation(s)
- Joy L Johnson
- NEXUS, School of Nursing, University of British Columbia, Vancouver, Canada.
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