Gender Medicine Research Articles

Different Symptoms and Course of Coronary Heart Disease inMenand Women

According to the federal statistical office, cardiovascular disorders are still the leading cause of death in Germany. Chronic ischemic heart disease and acute myocardial infarction are the most important subgroups. In addition to evidence-based and personalized medicine, in recent years gender medicine has been established as an independent research area. Gender differences are evident in the majority of prevalent diseases, including cardiovascular disorders. The following article provides an insight into the diagnostically and therapeutically specific aspects of coronary heart disease in men and women.

Gender Medicine and Pharmacoeconomics: A Narrative Review of the International Literature of the Last 5 Years. A Revision of Evidences about the Relationship Between Gender and Economic Consumption in Health.

The influence of patient gender on the economic impact of health care has increasingly been examined in the recent literature. Gender appears to have an impact on healthcare resource consumption, due to possible differences in the patient's response to a chosen therapeutic management strategy or to a healthcare intervention. The present work is aimed at collecting and reviewing evidences about the relationship between gender and economic consumption in health based on worldwide scientific literature published in the last 5 years. We conducted a narrative review of evidence from an initial pool of 904 articles, selecting information about gender-specific economic impact in any therapeutic area. After title, abstract and full text review, 111 articles were relevant to the paper scope. The reviewed studies seem to be confirming that a difference exists between males and females in the economic implications of healthcare management and that those differences are particularly relevant for cardiovascular and metabolic pathologies. Preliminary evidence suggests overall healthcare costs are slightly higher in females than males, while some specific and non-quantitative items of resource consumption, such as quality of prescriptions, might favour male patients. Results do not allow to clearly claiming an overall cost shift towards males or females, since their polarization varies depending on the considered cost item or event category. Studies suggested the presence of a gender difference in overall healthcare resource consumption and costs. Nevertheless, these aspects still lack thorough examination in literature and further analyses would be required on longer time periods.

Gender Opportunities in Psychosocial Oncology.

So much has happened since the original publication of this chapter. In some ways, the progress made in appreciating the full spectrum of sexual and gender expression has been uneven and in some nations, there has been serious regression and resulting repression. But overall, especially in the industrialized countries, there is much greater awareness of sex and gender and its importance in health and well being. In this updated chapter, we put sex and gender into a historical context that is relevant to psycho-oncology and that openly accepts that society overall, is highly conflicted when it comes to how women and men get the best out of each other, never mind how to best integrate lesbian, gay, bisexual, and transgender (LGBT) communities. With the advent of more tailored treatments and strategic medicine, sex becomes much more important as a variable and this has led to greater scientific requirements to create protocols that integrate sex into all aspects of health from prevention, diagnosis, treatment, survivorship, and death. But we still have a very far way to go. There is a serious dearth of data on sex and gender in science overall and in cancer medicine specifically. Avoidance of discussions of sex and gender in medicine reflects the larger lingering societal discomfort with any discussion that links potential sex and gender differences with superiority. The data shows that there is more intrasexual than intersexual variation in men and women. When speaking about sex and gender the literature reflects that, on average, there are many differences, and although they are small, that when taken together, the impact may be quite robust. Sex and gender differences are relevant to how individuals, couples, and families experience and cope with serious illness; however these important and obvious variables are seldom taken into account when counseling seriously ill patients and their families. Cancer is a complex disease that brings into sharp relief the potential alignments and misalignments in the sexes. In this chapter we have attempted to communicate the imperative for and importance of understanding people under stress within the context of sex and gender. Gender-specific medicine is a very young movement for scientific study but one that has great potential to maximize adaptation and mutual respect at a time when men and women are redefining themselves and adapting to new social realities and challenges.

Article Commentary: Sex- and Gender-Based Medicine: The Need for Precise Terminology

As our knowledge of sex- and gender-based medicine (SGBM) continues to grow, attention to precision in the use of related terminology is critical. Unfortunately, the terms sex and gender are often used interchangeably and incorrectly, both within and outside of the typical binary construct. On behalf of the Sex and Gender Women's Health Collaborative (SGWHC), a national organization whose mission is the integration of SGBM into research, health professions education, and clinical practice, our objective was to develop recommendations for the accurate use of SGBM terminology in research and clinical practice across medical specialties and across health professions. In addition, we reviewed the origins and evolution of SGBM terminology and described terms used when referring to individuals outside the typical binary categorization of sex and gender. Standardization and precision in the use of sex and gender terminology will lead to a greater understanding and appropriate translation of sex and gender evidence to patient care along with an accurate assessment of the impact sex and gender have on patient outcomes. In addition, it is critical to acknowledge that SGBM terminology will continue to evolve and become more precise as our knowledge of sex and gender differences in health and disease progresses.

Introduction: Philosophy of Sex and Gender in Gender Medicine

Introduction: Philosophy of Sex and Gender in Gender Medicine

The Sex and Gender Intersection in Chronic Periodontitis.

Periodontitis, a complex polymicrobial inflammatory disease, is a public health burden affecting more than 100 million people and being partially responsible for tooth loss. Interestingly, periodontitis has a documented higher prevalence in men as compared to women signifying a possible sex/gender entanglement in the disease pathogenesis. Although relevant evidence has treated sex/gender in a simplistic dichotomous manner, periodontitis may represent a complex inflammatory disease model, in which sex biology may interfere with gender social and behavioral constructs affecting disease clinical phenotype. Even when it became clear that experimental oral health research needed to incorporate gender (and/or sex) framework in the hypothesis, researchers overwhelmingly ignored it unless the research question was directly related to reproductive system or sex-specific cancer. With the recognition of gender medicine as an independent field of research, this study challenged the current notion regarding sex/gender roles in periodontal disease. We aimed to develop the methodological and analytical framework with the recognition of sex/gender as important determinants of disease pathogenesis that require special attention. First, we aim to present relevant sex biologic evidence to understand the plausibility of the epidemiologic data. In periodontitis pathogenesis, sex dimorphism has been implicated in the disease etiology possibly affecting the bacterial component and the host immune response both in the innate and adaptive levels. With the clear distinction between sex and gender, gender oral health disparities have been explained by socioeconomic factors, cultural attitudes as well as access to preventive and regular care. Economic inequality and hardship for women have resulted in limited access to oral care. As a result, gender emerged as a complex socioeconomic and behavioral factor influencing oral health outcomes. Taken together, as disease phenotypic presentation is a multifactorial product of biology, behavior and the environment, sex dimorphism in immunity as well as gender socio-behavioral construct might play a role in the above model. Therefore, this paper will provide the conceptual framework and principles intergrading sex and gender within periodontal research in a complex biologic and socio-behavioral dimension.

Sex and Gender Representations of Myocardial Infarction in German Medical Books

Abstract Mandatory teaching of sex- and gender-specific medicine (SGSM) is an essential tool to prepare future physicians for clinical care. Textbooks still play an important role for physician tra...

The Gender Lens: Development of a learning aid to introduce gender medicine.

Background and aim: Gender medicine takes into account biological and social differences between men and women in terms of prevalence and course of disease, diagnosis and therapy. Medical students should be made aware of this in the early stages of medical education. However, there is hardly any teaching material currently available. This article presents the adaption and first use of the German “Gender Lens,” a tool to introduce gender medicine to medical students. Method: The original Canadian ”Gender Lens Tool” was translated into German, tested by (n=5) teachers and adapted based on current scientific concepts. The instrument was applied and evaluated using qualitative methods in a student focus group (n=4). It was then piloted in a cohort of fourth-semester students (n=247) in a seminar addressing gender medicine. These experiences were evaluated using quantitative methods.Results: The German translation of the Gender Lens offers students a framework with which to analyze sex and gender differences in terms of the “prevalence, diagnosis, course, therapy and prevention” of a specific disease. Furthermore, it enables a refined search for causes such as “biological disposition, attitudes and behaviors, family and social networks, occupational and material circumstances and experiences with the health care system.” Recommendations were received from the student groups regarding teaching methods. Male and female fourth-semester students agreed that the Gender Lens is useful as an introduction to gender medicine. Discussion: Initial experiences with the Gender Lens adapted for the German curriculum suggest that such a learning aid can contribute to raising awareness of gender medicine in medical students.

Fluidity models in ancient Greece and current practices of sex assignment

Disorders of sexual differentiation such as androgen insensitivity and gonadal dysgenesis can involve an intrinsic fluidity at different levels, from the anatomical and biological to the social (gender) that must be considered in the context of social constraints. Sex assignment models based on George Engel’s biopsychosocial aspects model of biology accept fluidity of gender as a central concept and therefore help establish expectations within the uncertainty of sex assignment and anticipate potential changes. The biology underlying the fluidity inherent to these disorders should be presented to parents at diagnosis, an approach that the gender medicine field should embrace as good practice. Greek mythology provides many accepted archetypes of change, and the ancient Greek appreciation of metamorphosis can be used as context with these patients. Our goal is to inform expertise and optimal approaches, knowing that this fluidity may eventually necessitate sex reassignment. Physicians should provide sex assignment education based on different components of sexual differentiation, prepare parents for future hormone-triggered changes in their children, and establish a sex-assignment algorithm.

Sex Differences in Patient Satisfaction With Outpatient Obstetrics/Gynecology Care [14G

INTRODUCTION: Sex differences in medicine are discussed in medical and lay literature. Female physicians receive lower compensation and are less likely to be promoted compared to males. Reimbursement may now include results of patient questionnaires which is concerning given the paucity of literature demonstrating validity in quality of care assessment. Obstetrics/Gynecology is especially subject to the impact of sex differences as discussing reproductive organs is inherently intimate. We hypothesize sex differences exist in patient evaluation of outpatient Obstetrics/Gynecology care measured by patient satisfaction surveys. METHODS: We analyzed 909 Press-Ganey patient satisfaction surveys linked to outpatient Obstetrics/Gynecology visits at Stanford Hospitals and Clinics (March 2013-June 2014). Likelihood to Recommend Physician (LTR) was rated on a 5-point scale and, due to its frequency distribution, was evaluated as receiving a 5 compared to 1-4 rating. Patient-physician demographic concordance was evaluated using chi-square tests. Office, Access, and Physician Assessments were generated from correlated PG questions and confirmed using factor analysis. Models to understand LTR controlling for patient, physician, and care environment characteristics were analyzed using generalized estimating equations (GEE), clustered by physician. RESULTS: Age and race concordance increased LTR (p=.01 and p < .0001, respectively) while sex concordance decreased LTR (p=.03). After controlling for patient, physician, and care environment characteristics, female physicians show a 49% decrease in odds of receiving a top LTR score (p=.003). CONCLUSION: Analysis of 909 patient satisfaction surveys demonstrates male Obstetricians/Gynecologists are rated higher than females in multivariate analysis, supporting our hypothesis that sex differences exist in patient evaluation and contrary to patient self-reported data.

Characterization of the human aqueous humour proteome: A comparison of the genders

Aqueous humour (AH) is an important biologic fluid that maintains normal intraocular pressure and contains proteins that regulate the homeostasis of ocular tissues. Any alterations in the protein compositions are correlated to the pathogenesis of various ocular disorders. In recent years, gender-based medicine has emerged as an important research focus considering the prevalence of certain diseases, which are higher in a particular sex. Nevertheless, the inter-gender variations in the AH proteome are unknown. Therefore, this study endeavoured to characterize the AH proteome to assess the differences between genders. Thirty AH samples of patients who underwent cataract surgery were categorized according to their gender. Label-free quantitative discovery mass spectrometry-based proteomics strategy was employed to characterize the AH proteome. A total of 147 proteins were identified with a false discovery rate of less than 1% and only the top 10 major AH proteins make up almost 90% of the total identified proteins. A large number of proteins identified were correlated to defence, immune and inflammatory mechanisms, and response to wounding. Four proteins were found to be differentially abundant between the genders, comprising SERPINF1, SERPINA3, SERPING1 and PTGDS. The findings emerging from our study provide the first insight into the gender-based proteome differences in the AH and also highlight the importance in considering potential sex-dependent changes in the proteome of ocular pathologies in future studies employing the AH.

Preclinical models in the study of sex differences.

The biology of sex differences deals with the study of the disparities between females and males and the related biological mechanisms. Gender medicine focuses on the impact of gender and sex on human physiology, pathophysiology and clinical features of diseases that are common to women and men. The term gender refers to a complex interrelation and integration of sex-as a biological and functional determinant-and psychological and cultural behaviours (due to ethnical, social or religious background). The attention to the impact of gender differences on the pathophysiology and, therefore, on the clinical management of the most common diseases, such as cardiovascular diseases (CVD), neurodegenerative disorders, immune and autoimmune diseases as well as several tumours, is in fact often neglected. Hence, studies covering different fields of investigation and including sex differences in the pathogenesis, in diagnostic and prognostic criteria as well as in response to therapy appear mandatory. However, prerequisites for this development are preclinical studies, including invitro and invivo approaches. They represent the first step in the development of a drug or in the comprehension of the pathogenetic mechanisms of diseases, in turn a necessary step for the development of new or more appropriate therapeutic strategies. However, sex differences are still poorly considered and the great majority of preclinical studies do not take into account the relevance of such disparities. In this review, we describe the state of the art of these studies and provide some paradigmatic examples of key fields of investigation, such as oncology, neurology and CVD, where preclinical models should be improved.

Gender Medicine – the heart and mind of the latest findings in our collection from Clinical Science

Gender Medicine focuses on the impact of gender on human physiology, pathophysiology, and clinical features of diseases. Men and women may have different experiences of the same disease and the pathophysiology of disease may also vary as a function of genetics, epidemiology and biological sex/gender. Translating molecular bioscience and experimental research into medical insights, the journal Clinical Science offers multi-disciplinary coverage and clinical perspectives to advance human health. Together with leaders in the field of gender medicine, we have put together a special themed collection of the journal focusing on this often neglected dimension of medicine.

As precision medicine becomes more important, is it finally time for increased emphasis on gender medicine?

Gender medicine is the topic of this issue of The Biochemist. In 2014, Francis Collins, Director of the National Institutes of Health (NIH), and Janine Clayton, Director of the Office of Research on Women's Health (ORWH) at NIH, announced that NIH would begin requiring all preclinical grant proposals to address sex as a biological variable1. The ORWH was set up in 1990 with the specific mandate to promote the inclusion of women and minority individuals in all clinical trials going forward2. Similar guidelines are imposed by the European Commission and the Canadian Institutes of Health Research.

更年期女性のうつ病の姿とジェンダー医学としての臨床的対応(シンポジウム, 第35回日本女性心身医学会学術集会報告)

更年期女性のうつ病の姿とジェンダー医学としての臨床的対応(シンポジウム, 第35回日本女性心身医学会学術集会報告)

Ethnic Differences in Risk Factors for Obesity among Adults in California, the United States

Little attention has been given to differences in obesity risk factors by racial/ethnic groups. Using data from the 2011-2012 California Health Interview Survey, we examined differences in risk factors for obesity among Whites, Latinos, Asians, and African Americans among 42,935 adults (24.8% obese). Estimates were weighted to ensure an unbiased representation of the Californian population. Multiple logistic and linear regression analyses were used to examine the differences in risk factors for obesity. Large ethnic disparities were found in obesity prevalence: Whites (22.0%), Latinos (33.6%), African Americans (36.1%), and Asians (9.8%). Differences in risk factors for obesity were also observed: Whites (gender, age, physical activity, smoking, arthritis, and diabetes medicine intake), Latinos (age, arthritis, and diabetes medicine intake), Asians (age, binge drinking, arthritis, and diabetes medicine intake), and African Americans (gender, physical activity, smoking, binge drinking, and diabetes medicine intake). Females were more likely to be obese among African Americans (odds ratio (OR) = 1.43, 95% confidence interval (CI) = 1.05–1.94), but less likely among Whites (OR = 0.80, 95% CI = 0.74–0.87). Race/ethnicity should be considered in developing obesity prevention strategies.

The ethical implications of the medical community’s failure to differentiate sex- and gender-based medicine from women’s health

The ethical implications of the medical community’s failure to differentiate sex- and gender-based medicine from women’s health

Implementation and sex-specific analysis of students' attitudes toward a longitudinal, gender-specific medical curriculum - a pilot study.

Gender medicine has gained importance over the past 20 years. Nevertheless, the scientific findings concerning gender- and sex-specific patient care have not been sufficiently integrated into the education of physicians. It was therefore our aim, against initial resistance in our school, to integrate clinically relevant aspects of gender medicine into the existing medical curriculum. This paper describes the implementation process of a lecture-based interdisciplinary, longitudinal, basic gender curriculum and evaluates students' attitudes in relation to sex and semester level. The curriculum encompasses 15 lecture sessions scheduled in years 1 through 5 of the medical curriculum at Ulm University, Germany. Prospectively gathered evaluation data of two cross-sectional analyses of this basic curriculum in the first and fifth semesters are analyzed by sex. More than 80% of the students have registered for this new curriculum. Evaluation data show a predominantly positive (75.5%) student response; however, only about half of those surveyed indicated that they had learned new material or judged the content on gender to be relevant to their practice of medicine. Students at a more advanced semester level (88.2% vs. 55.2%) and male participants more than female participants (36.7% vs. 62.4%) showed lower acceptance. It was possible to integrate gender issues into the existing medical student curriculum. Despite the overall positive rating, our evaluation data identified the aspects of rejection and resistance in some students, particularly male and more advanced students. Further studies on the development of student attitudes toward gender issues are needed.

The Spanish Influenza Pandemic of 1918–1919: Perspectives From the Iberian Peninsula and the Americas

Situating Iberian Peninsula as key point of connection between Europe and Americas, both epidemiologically and discursively, The Spanish Influenza Pandemic of 1918-1919 sheds new light on what World Health Organization described as the single most devastating infectious disease outbreak ever recorded. The essays in this volume elucidate specific aspects of pandemic that have received minimal attention until now, including social control, gender, class, religion, national identity, and military medicine's reactions to pandemic and relationship with civilian medicine. While World War I, as authors point out, is context for these discussions, experiences of 1918-19 remain persistently relevant to contemporary life, particularly in view of events such as 2009 H1N1 swine flu pandemic and Ebola outbreak of 2014. Contributors: Catherine Belling, Josep Bernabeu-Mestre, Liane Maria Bertucci, Ryan A. Davis, Esteban Domingo, Magda Fahrni, Hernan Feldman, Pilar Leon-Sanz, Maria Luisa Lima, Maria de Fatima Nunes, Mercedes Pascual Artiaga, Maria-Isabel Porras-Gallo, Anny Jackeline Torres Silveira, Jose Manuel Sobral, Paulo Silveira e Sousa, Christiane Maria Cruz de Souza. Maria-Isabel Porras-Gallo is professor of history of science in Medical Faculty of Ciudad Real at University of Castilla-La Mancha (Spain). Ryan A. Davis is assistant professor in Department of Languages, Literatures, and Cultures at Illinois State University.

Consideration of Sex Differences in Medicine to Improve Health Care and Patient Outcomes

Consideration of Sex Differences in Medicine to Improve Health Care and Patient Outcomes