Journal Articles for Teaching

Paying attention to gender and poverty in health research:content and process issues. Piroska Östlin, Gita Sen, & Asha George. Ignoring factors such as socioeconomic class, race and gender leads to biases in both the content and process of research. We use two such factors poverty and gender to illustrate how this occurs. There is a systematic imbalance in medical journals: research into diseases that predominate in the poorest regions of the world is less likely to be published. In addition, the slow recognition of women’s health problems, misdirected and partial approaches to understanding women’s and men’s health, and the dearth of information on how gender interacts with other social determinants continue to limit the content of health research. In the research community these imbalances in content are linked to biases against researchers from poorer regions and women.

Sex of Cells in Cardiovascular Studies Show Bias

November 7, 2011
Reporting of sex as a variable in cardiovascular studies using cultured cells. Taylor, K. E., Vallejo-Giraldo, C., Schaible, N. S., Zakeri, R., & Miller, V. M. Studies often neglect to indicate the sex of cells used. When they do report the sex, it frequently has a male bias.

Sex-Gender Research Sensitivity and Healthcare Disparities

February 19, 2010
Sex-gender research sensitivity and healthcare disparities. Gochfeld, M. Despite advances, sex and gender are not well treated in the biomedical literature. Many studies in which males and females are represented do not address the similarities or differences between sexes, sometimes adjusting for (thereby obscuring) sex differences and sometimes ignoring sex altogether. Women continue to be underrepresented in randomized drug trials, excluded from some by potential reproductive effects, and perhaps frightened from others by IRB-required warnings. Although recognized, sex disparities in treatment, for example, for acute cardiac syndrome, persist.

Gender and Chronic Obstructive Pulmonary Disease

August 2, 2007
Gender and chronic obstructive pulmonary disease: why it matters. Han, M. K., Postma, D., Mannino, D. M., Giardino, N. D., Buist, S., Curtis, J. L., & Martinez, F. J. Gender and chronic obstructive pulmonary disease: why it matters The authors present current knowledge regarding how gender influences the epidemiology, diagnosis, and presentation of COPD in addition to physiologic and psychologic impairments and attempt to offer insight into why these differences might exist and how this may influence therapeutic management. Women may actually be at greater risk of smoking-induced lung function impairment, more severe dyspnea, and poorer health status for the same level of tobacco exposure. Nonsmokers with COPD are also more likely to be female. Men and women may be phenotypically different in their response to tobacco smoke, with men being more prone to an emphysematous phenotype and women an airway predominant phenotype.

Animals Have a Sex, So Should Titles and Methods Sections In Endocrinology Journal

June 1, 2012
Animals have a sex, and so should titles and methods sections of articles in Endocrinology. Blaustein, JD. Beginning with papers submitted as of July 1, 2012, the methods sections of manuscripts submitted to Endocrinology must indicate the sex of animals used, or in the case of primary cells or cultures, the sex of animal from which they were derived. Although not required, authors are also encouraged to identify the sex of cell lines used in cell cultures. If the experiment is of a mixed-sex design, the numbers of males and females should be indicated in the methods. If only one sex of animal was used in an experiment, the title should indicate the sex of animal used.

Sex Bias in Neuroscience and Biomedical Research

January 2011
Sex bias in neuroscience and biomedical research Beery, A. K., & Zucker, I. Female mammals have long been neglected in biomedical research. The NIH mandated enrollment of women in human clinical trials in 1993, but no similar initiatives exist to foster research on female animals. We reviewed sex bias in research on mammals in 10 biological fields for 2009 and their historical precedents. Male bias was evident in 8 disciplines and most prominent in neuroscience, with single-sex studies of male animals outnumbering those of females 5.5 to 1. In the past half-century, male bias in non-human studies has increased while declining in human studies. Studies of both sexes frequently fail to analyze results by sex. The belief that non-human female mammals are intrinsically more variable than males and too troublesome for routine inclusion in research protocols is without foundation.

Calling for Sex-Specific Reporting of Trial Results

May 2008
Dispelling the myths: calling for sex-specific reporting of trial results. Hayes, S. N., & Redberg, R. F. The history and myths associated with the exclusion of women from clinical trials are summarized. It is time to recognize that women are complex biological creatures just as are men. All clinical studies should strive to include equal numbers of female and male participants or to at least reflect the prevalence of the condition of interest by sex. Data must also be analyzed and reported by sex.

Sex, Gender, and Health Biotechnology: Points to Consider

July 21, 2009
Sex, gender, and health biotechnology: points to consider. Singh, J. A., Bandewar, S., & Singer, P. A. We propose sex and gender considerations at five critical stages of health biotechnology research and development: priority setting; technology design; clinical trials; commercialization, and health services delivery. Applying a systematic sex and gender framework to five key process stages of health biotechnology research and development could be a first step towards unlocking the opportunities of this promising science for women in the developing world.

Pivotal Articles Regarding Sex and Gender Differences

Groundbreaking articles in various specialty areas which changed our thinking about sex bias in research, education, and standards of care for various health conditions.

Gender Differences in Prevention of Stroke

May 2011
Aspirin is used to prevent ischemic stroke and other types of cardiovascular disease. Seven trials of aspirin focusing on the effectiveness of primary prevention of stroke and other cardiovascular events have been performed, but three of […]

Sex Differences in Zolpidem Clearance and Alcohol Dehydrogenase

September 25, 2016
Alcohol and Aldehyde Dehydrogenases Contribue to Sex-Related Differences in Clearance of Zolpidem in Rats AUTHORS: Peer, C.J., Stronge, J.D., et al Objectives: The recommended zolpidem starting dose was lowered in females (5 mg vs. 10 mg) since side effects were more frequent and severe than those of males; the mechanism underlying sex differences in pharmacokinetics […]

Potentially Lethal Ventricular Arrhythmias and Heart Failure in Arrhythmogenic Right Ventricular Cardiomyopathy: What Are the Differences Between Men and Women?

October 2016
Potentially Lethal Ventricular Arrhythmias and Heart Failure in Arrhythmogenic Right Ventricular Cardiomyopathy What Are the Differences Between Men and Women? Kimura, Y., Noda, T., Otsuka, Y., Wada, M., Nakajima, I., Ishibashi, K., … & Noguchi, T. ABSTRACT: Objectives The aim of this study was to assess sex-related differences in sporadic cases of arrhythmogenic right ventricular cardiomyopathy (ARVC). Background Previous studies have suggested male predominance in ARVC. However, the impact of […]

Long-Term Opioid Therapy Relieves Chronic Pain in Only 20% of Women

October 18, 2015
Sex and Age Differences in Global Pain Status Among Patients Using Opioids Long Term for Chronic Noncancer Pain AUTHORS: LeResche Linda, Saunders Kathleen, Dublin Sascha, Thielke Stephen, Merrill Joseph O., Shortreed Susan M., Campbell Cynthia, and Von Korff Michael R.. Journal of Women’s Health. August 2015, 24(8): 629-635. doi:10.1089/jwh.2015.5222. ABSTRACT Background: The use of chronic opioid […]

Sex Differences in Influenza Vaccine

January 3, 2014
Systems analysis of sex differences reveals an immunosuppressive role for testosterone in the response to influenza vaccination Key Findings: Marked sex differences in immune response to infections and vaccination exist. The reason may be a cluster of genes involved in lipid metabolism that are modulated by testosterone and that correlate with the higher antibody-neutralizing response […]

The Epigenetics of Sex Differences in the Brain

October 14, 2009
The epigenetics of sex differences in the brain. McCarthy, M. M., Auger, A. P., Bale, T. L., De Vries, G. J., Dunn, G. A., Forger, N. G., … & Wilson, M. E. Epigenetic changes in the nervous system are emerging as a critical component of enduring effects induced by early life experience, hormonal exposure, trauma and injury, or learning and memory. Many steroid-induced epigenetic changes are opportunistic and restricted to a single lifespan, but new evidence suggests endocrine-disrupting compounds can exert multigenerational effects. Similarly, maternal diet also induces transgenerational effects, but the impact is sex specific. The study of epigenetics of sex differences is in its earliest stages.

Brain Sex Depends on Sex Differences in Other Body Parts

August 15, 2015
Sex differences in the brain: a whole body perspective Authors: Geert J. de Vries* and Nancy G. Forger Abstract Most writing on sexual differentiation of the mammalian brain (including our own) considers just two organs: the gonads and the brain. This perspective, which leaves out all other body parts, misleads us in several ways. First, […]

Nerve Block for Prevention of Hot Flashes

August 2014
Effects of stellate ganglion block on vasomotor symptoms: findings from a randomized controlled clinical trial in postmenopausal women Walega, David R. MD1; Rubin, Leah H. PhD2; Banuvar, Suzanne MPA3; Shulman, Lee P. MD3; Maki, Pauline M. PhD2,4 Abstract Objective Uncontrolled intervention studies, including studies involving breast cancer survivors, have demonstrated improvements in vasomotor symptoms […]

MI Chest Pain Differs by Sex

February 22/29, 2012
Association of Age and Sex With Myocardial Infarction Symptom Presentation and In-Hospital Mortality Key Findings: Proportion of MI patients who presented without chest pain was significantly higher for women than men (42.0% vs 30.7%) There was a significant interaction between age and sex with chest pain at presentation, with a larger sex difference in younger […]

Gendered Response to Depression

October 2013
The Experience of Symptoms of Depression in Men vs Women Analysis of the National Comorbidity Survey Replication Lisa A. Martin, PhD; Harold W. Neighbors, PhD; Derek M. Griffith, Abstract Excerpt: Until now, women have been diagnosed with depression twice as often as men. However, men reported higher rates of anger attacks/aggression, substance abuse, and risk taking compared with women. Analyses using the scale that included alternative, male-type symptoms of depression found that a higher proportion of men (26.3%) than women (21.9%) (P = .007) met criteria for depression. Analyses using the scale that included alternative and traditional depression symptoms found that men and women met criteria for depression in equal proportions: 30.6% of men and 33.3% of women (P = .57).

Exercise Stress Testing in Women

2010
Exercise stress testing in women: going back to the basics.  Kohli, P., & Gulati, M.  The purpose of this article is to review the literature regarding exercise stress testing in women, with a focus beyond ST-segment depression alone. It addition to interpretation of ECG changes with exercise, evaluation of exercise capacity, chronotropic index, heart rate (HR) recovery (HRR), blood pressure response, and Duke Treadmill Score (DTS) can be used to enhance the utility of exercise testing. The diagnostic and prognostic value of these non-ECG variables in women is reviewed.

Necessity of Gender Medicine

March 21, 2013
Gender medicine: a task for the third millennium. Baggio G, Corsini A, Floreani A, Giannini S, Zagonel V. Gender-specific medicine is the study of how diseases differ between men and women in terms of prevention, clinical signs, therapeutic approach, prognosis, psychological and social impact. It is a neglected dimension of medicine. In this review, authors point out some major issues in five enormous fields of medicine: cardiovascular diseases (CVDs), pharmacology, oncology, liver diseases and osteoporosis.

Clinical Implications of Sex Analyses in Studies

June 16, 2003
Expanding the frontiers of women’s health research–US style. Pinn, VW. Research on women’s health and sex and gender factors is providing the data with which to better arm the physician for possible variation in approaches to better approaches, drug dosages, or diagnostic practices not only for women but also men. the new knowledge is creating new challenges to ensure that future physicians possess a full understanding of how to provide gender-appropriate care.

Progress of Sex, Race, and Ethnicity in Clinical Trials

March 15, 2011
Inclusion, analysis, and reporting of sex and race/ethnicity in clinical trials: have we made progress? Geller, S. E., Koch, A., Pellettieri, B., & Carnes, M. (2011). . Journal of Women’s Health, 20(3), 315-320. The National Institutes of Health (NIH) Revitalization Act of 1993 requires that NIH-funded clinical trials include women and minorities as participants; other federal agencies have adopted similar guidelines. The objective of this study is to determine the current level of compliance with these guidelines for the inclusion, analysis, and reporting of sex and race/ethnicity in federally funded randomized controlled trials (RCTs) and to compare the current level of compliance with that from 2004, which was reported previously.

Interaction of Nature and Nurture on Behavior and Perception

MAY 12, 2004
To an understanding of the biology of sex and gender differences:“an idea whose time has come”. Grumbach, M. M. Sex is the most common human polymorphism that affects health and illness through the life cycle. This perspective provides a brief overview of the importance of the critical interlinked interactions of nature (genes and sex hormones) and nurture (environment and experience) on behavior and perception. Differences in gene expression in the male and female appear in the early embryo, before differentiation of the fetal gonads into a testis or ovary. Gonadal differentiation results in a striking sex difference in the fetal sex steroid milieu and the phenotypic differences in the internal and external genital tracts that follows. Recent data provide evidence that in addition to the classic brain masculinizing effects of testosterone in the fetus, XX and XY brain cells show different patterns of gene expression even before gonadal differentiation. The X chromosome contains a higher number of genes that have a major role in the development of general cognitive ability. Further, we now know that estrogen formed mainly in extragonadal tissues has an important multifaceted role in boys at puberty and in men.

Women’s Health: An Evolving Mosaic

December 25, 2001
Women’s health: an evolving mosaic. Karney, P. Women’s health was described as “a patchwork quilt with gaps” in 1992. Since 1992, there have been increasing amounts of women’s health research, teaching, and new clinical initiatives at the interface between disciplines, extending throughout the life span. There are sex and gender differences between men and women in many domains.

Sex Differences in Coronary Artery Disease

August 2007
New insights into ischemic heart disease in women. Bellasi, A., Raggi, P., Merz, C. B., & Shaw, L. J.  Coronary artery disease is different in women than in men in its pathogenesis, symptoms, and prognosis. Compared with men, women have: as great a prevalence of coronary disease, at least in their older years; a higher death rate from coronary disease; worse outcomes after acute coronary events; different pathophysiologic mechanisms of coronary disease; different presentations and risk factors. Screening tests also differ in efficacy in men and women.

Mortality in Elderly Patients After Hip Fractures

January 20, 2011
Early and late mortality in elderly patients after hip fracture: a cohort study using administrative health databases in the Lazio region, Italy.Castronuovo, E., Pezzotti, P., Franzo, A., Di Lallo, D., & Guasticchi, G. Both clinical and organizational factors of acute care are associated with the risk of early mortality. As time passes, some of these factors tend to become less important while older age, male gender, the presence of cognitive problems and the presence of other comorbidities remain significant.

Aspirin for the Primary Prevention of Cardiovascular Events in Women and Men

January 18, 2006
Aspirin for the primary prevention of cardiovascular events in women and men: a sex-specific meta-analysis of randomized controlled trials. Berger, J. S., Roncaglioni, M. C., Avanzini, F., Pangrazzi, I., Tognoni, G., & Brown, D. L.  For women and men, aspirin therapy reduced the risk of a composite of cardiovascular events due to its effect on reducing the risk of ischemic stroke in women and MI in men. Aspirin significantly increased the risk of bleeding to a similar degree among women and men.

Aspirin for the Primary Prevention of Cardiovascular Events in Women and Men Update

March 17, 2009
Aspirin for the primary prevention of cardiovascular events: an update of the evidence for the US Preventive Services Task Force. Wolff, T., Miller, T., & Ko, S. Aspirin reduces the risk for myocardial infarction in men and strokes in women. Aspirin use increases the risk for serious bleeding events. CLINICAL GUIDELINES

Sex Differences in Pharmacokinetics and Pharmacodynamics of Anti-Hypertensive Drugs

November 17, 2011
Sex-related differences in pharmacokinetics and pharmacodynamics of anti-hypertensive drugs. Ueno, K., & Sato, H. Sex-specific differences in pharmacokinetics and pharmacodynamics have been reported to have important clinical consequences. In this review, some representative sex-specific differences in absorption and transporters (that is, P-glycoprotein (P-gp)), metabolic processes (that is, those that involve cytochrome P450 (CYP)), clearance (Cl) processes (for example, renal excretion or other pharmacokinetic parameters) and involvement of sex hormones (that is, estrogen and testosterone) in the regulation of some metabolic enzymes are introduced for each of the following categories of anti-hypertensive drugs: calcium-channel blockers, angiotensin-receptor blockers and angiotensin-converting enzyme inhibitors, diuretic agents, and β-adrenergic-receptor blockers (β-blockers). In many cases, female sex is a risk factor for adverse effects or attenuated clinical responses because of lower Cl, smaller distribution volumes, higher activity of some metabolic enzymes (especially hepatic CYP3A4), or presence of sex hormones.

Pivotal WISE Study Delineates Sex Differences in Ischemic Cardiac Disease

February 2006
Insights from the NHLBI-Sponsored Women’s Ischemia Syndrome Evaluation (WISE) Study: Part I: gender differences in traditional and novel risk factors, symptom evaluation, and gender-optimized diagnostic strategies. Shaw, L. J., Merz, C. N. B., Pepine, C. J., Reis, S. E., Bittner, V., Kelsey, S. F., … & Rogers, W. J. The 2006 WISE Study (Women’s Ischemia Syndrome Evaluation), sponsored by the NHLBI, is arguably one of the most significant, pivotal studies which opened our eyes to sex differences in ischemic cardiac disease, which is commonly MI with Non Obstructive Coronary Arteries (MINOCA) in women. It pleads for education of clinicians on sex differences in not only symptoms (more likely to be fatigue, nausea, and jaw pain), but also in risk markers (high-sensitivity CRP), cardiac testing results (stress echocardiography), SPECT cardiac imaging (single-photon emission computed tomographic imaging), and treatment programs.

The Importance of Women’s Health Research IOM Report

2010
Women’s Health Research: Progress, Pitfalls, and Promise: Institute of Medicine of the National Academies. Smith Taylor, J.  Even though slightly over half of the U.S. population is female, medical research historically has neglected the health needs of women. However, over the past two decades, there have been major changes in government support of women’s health research–in policies, regulations, and the organization of research efforts. To assess the impact of these changes, Congress directed the Department of Health and Human Services (HHS) to ask the IOM to examine what has been learned from that research and how well it has been put into practice as well as communicated to both providers and women.

Journals

Sex and Gender Differences

Biology of Sex Differences

Biology of Sex Differences considers manuscripts on all aspects of the effects of sex on biology and disease. Sex has profound effects on physiology and the susceptibility to disease. The function of cells and organs depends on their sex, determined by the interplay among the genome and biological and social environments. The study of sex differences is a discipline in itself, with its own concepts and methods that apply across tissues. Biology of Sex Differences is the official journal of the Organization for the Study of Sex Differences, and a publication of the Society for Women’s Health Research.

Gender and the Genome

Gender and the Genome is a peer reviewed, open access journal that provides evidence-based original research, reviews, perspectives, and commentaries that illuminate the impact of biological sex on technology and its effects on human life. The journal is the official journal of the Foundation for Gender-Specific Medicine, the International Society for Gender-Specific Medicine, and the Israeli Society for Gender-and Sex Conscious Medicine. The Journal’s international editorial board is comprised of the most forward-thinking leaders in gender-specific medicine to engage the community of molecular biologists, engineers, ethicists, anthropologists, and legal experts in a dialogue about the nature and implications of 21st century technology.

Women’s Health with Gender Included

Journal of Women’s Health

The Journal of Women’s Health is the primary source of information for meeting the challenges of providing optimal health care for women throughout their lifespan. The Journal delivers cutting-edge advancements in diagnostic procedures, therapeutic protocols for the management of diseases, and innovative research in gender-based biology that impacts patient care and treatment.

Women’s Health Issues

Women’s Health Issues (WHI) is a peer-reviewed, bimonthly, multidisciplinary journal that publishes research and review manuscripts related to women’s health care and policy. As the official journal of the Jacobs Institute of Women’s Health, it is dedicated to improving the health and health care of all women throughout the lifespan and in diverse communities. The journal seeks to inform health services researchers, health care and public health professionals, social scientists, policymakers, and others concerned with women’s health.