The Operationalisation of Sex and Gender in Quantitative Health–Related Research: A Scoping Review

Current trends in quantitative health research have highlighted the inadequacy of the usual operationalisation of sex and gender, resulting in a growing demand for more nuanced options. This scoping review provides an overview of recent instruments for the operationalisation of sex and gender in health-related research beyond a concept of mutually exclusive binary categories as male or masculine vs. female or feminine. Our search in three databases (Medline, Scopus and Web of Science) returned 9935 matches, of which 170 were included. From these, we identified 77 different instruments. The number and variety of instruments measuring sex and/or gender in quantitative health-related research increased over time. Most of these instruments were developed with a US-American student population. The majority of instruments focused on the assessment of gender based on a binary understanding, while sex or combinations of sex and gender were less frequently measured. Different populations may require the application of different instruments, and various research questions may ask for different dimensions of sex and gender to be studied. Despite the clear interest in the development of novel sex and/or gender instruments, future research needs to focus on new ways of operationalisation that account for their variability and multiple dimensions.German Federal Ministry of Health (BMG)Peer Reviewe

Detection of Gender Differences in Incomplete Revascularization after Coronary Artery Bypass Surgery Varies with Classification Technique

Background. Incomplete revascularization negatively affects survival after coronary artery bypass surgery (CABG). Since gender and classification technique might impact outcome and reporting, we investigated their effect on revascularization patterns and mortality. Methods. A cohort of bypass patients ( = 1545, 23% women) was enrolled prospectively. The degree of revascularization was determined as mathematical difference between affected vessels upon diagnosis and number of grafts or the surgeon's rating on the case file. Results. Although men displayed more triple-vessel disease, they obtained complete revascularization more frequently than women (85% versus 77%, < 0.001). The two calculation methods identified analogous percentages of incompletely revascularized patients, yet there was only a 50% overlap between the two groups. Mathematically, more women, older patients, and patients with NYHA class III/IV appeared incompletely revascularized, while the surgeons identified more patients undergoing technically challenging procedures. Regardless of the definition, incompleteness was a significant risk factor for mortality in both genders (mathematical calculation: HR 2.62, 95% CI 1.76-3.89, < 0.001; surgeon: HR 2.04, 95% CI 1.35-3.89, = 0.001). Conclusions. Given the differences in identification patterns, we advise that the mathematical calculation be performed afterprocedure in all patients regardless of the surgeons' rating to uncover additional subjects at increased risk

The impact of sex and gender on the multidisciplinary management of care for persons with Parkinson's disease

Contains fulltext : 226157.pdf (publisher's version ) (Open Access)7 p

Analysis of sex and gender-specific research reveals a common increase in publications and marked differences between disciplines

Oertelt-Prigione S, Parol R, Krohn S, Preißner R, Regitz-Zagrosek V. Analysis of sex and gender-specific research reveals a common increase in publications and marked differences between disciplines. BMC Medicine. 2010;8(1): 70.© 2010 Oertelt-Prigione et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the CreativeCommons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Severe hepatic encephalopathy in a patient with liver cirrhosis after administration of angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker combination therapy: a case report

<p>Abstract</p> <p>Introduction</p> <p>A combination therapy of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers has been used to control proteinuria, following initial demonstration of its efficacy. However, recently concerns about the safety of this therapy have emerged, prompting several authors to urge for caution in its use. In the following case report, we describe the occurrence of a serious and unexpected adverse drug reaction after administration of a combination of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers to a patient with nephrotic syndrome and liver cirrhosis with severe portal hypertension.</p> <p>Case presentation</p> <p>We administered this combination therapy to a 40-year-old Caucasian man with liver cirrhosis in our Hepatology Clinic, given the concomitant presence of glomerulopathy associated with severe proteinuria. While the administration of one single drug appeared to be well-tolerated, our patient developed severe acute encephalopathy after the addition of the second one. Discontinuation of the therapy led to the disappearance of the side-effect. A tentative rechallenge with the same drug combination led to a second episode of acute severe encephalopathy.</p> <p>Conclusion</p> <p>We speculate that this adverse reaction may be directly related to the effect of angiotensin II on the excretion of blood ammonia. Therefore, we suggest that patients with liver cirrhosis and portal hypertension are at risk of developing clinically relevant encephalopathy when angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker combination therapy is administered, thus indicating the need for a careful clinical follow-up. In addition, the incidence of this serious side-effect should be rigorously evaluated in all patients with liver cirrhosis administered with this common treatment combination.</p

Sex and Gender-Related Differences in COVID-19 Diagnoses and SARS-CoV-2 Testing Practices During the First Wave of the Pandemic:The Dutch Lifelines COVID-19 Cohort Study

Background: Although sex differences are described in Coronavirus Disease 2019 (COVID-19) diagnoses and testing, many studies neglect possible gender-related influences. Additionally, research is often performed in clinical populations, while most COVID-19 patients are not hospitalized. Therefore, we investigated associations between sex and gender-related variables, and COVID-19 diagnoses and testing practices in a large general population cohort during the first wave of the pandemic when testing capacity was limited. Methods: We used data from the Lifelines COVID-19 Cohort (N = 74,722; 60.8% female). We applied bivariate and multiple logistic regression analyses. The outcomes were a COVID-19 diagnosis (confirmed by SARS-CoV-2 PCR testing or physician's clinical diagnosis) and PCR testing. Independent variables included among others participants' sex, age, somatic comorbidities, occupation, and smoking status. Sex-by-comorbidity and sex-by-occupation interaction terms were included to investigate sex differences in associations between the presence of comorbidities or an occupation with COVID-19 diagnoses or testing practices. Results: In bivariate analyses female sex was significantly associated with COVID-19 diagnoses and testing, but significance did not persist in multiple logistic regression analyses. However, a gender-related variable, being a health care worker, was significantly associated with COVID-19 diagnoses (OR = 1.68; 95%CI = 1.30-2.17) and testing (OR = 12.5; 95%CI = 8.55-18.3). Female health care workers were less often diagnosed and tested than male health care workers (ORinteraction = 0.54; 95%CI = 0.32-0.92, ORinteraction = 0.53; 95%CI = 0.29-0.97, respectively). Conclusions: We found no sex differences in COVID-19 diagnoses and testing in the general population. Among health care workers, a male preponderance in COVID-19 diagnoses and testing was observed. This could be explained by more pronounced COVID-19 symptoms in males or by gender inequities

Sex and Gender in Medical Literature

Oertelt-Prigione S. Sex and Gender in Medical Literature. In: Oertelt-Prigione S, Regitz-Zagrosek V, eds. Sex and Gender Aspects in Clinical Medicine. London: Springer; 2012: 9-15

The use of pre- and postoperative variables as predictors for gender differences in the mortality after coronary bypass surgery

Weibliche Übermortalität nach aortokoronarer Bypass-Operation (CABG) ist in zahlreichen Studien beschrieben worden, dennoch können die identifizierten Erklärungsansätze diese Geschlechterunterschiede nur begrenzt aufklären. Vor allem die Wichtigkeit psychosozialer Variablen und ihr potentieller prädiktiver Wert ist hierzulande limitiert erforscht worden. Methoden Im Rahmen der dargestellten Studien wurden prä- intra- und postoperative Variablen, die zur Erklärung und potentiellen Prädiktion von schlechten Outcomes und Übermortalität herangezogen werden könnten, untersucht. Ein Kollektiv von 1559 Patienten und Patientinnen, die sich einer CABG unterzogen, wurden für die Studie rekrutiert. Mortalitätsprädiktoren und die Rolle von inkompletter Revaskularisierung als kausaler Faktor wurden mittels univariater Analysen und folglich mittels multivariater Cox-Analysen untersucht. Die Identifikation von Prädiktoren für präoperative Depressivität wurde mittels fünf unabhängiger multipler logistischer Modelle untersucht. Ergebnisse Unsere Studien bestätigte die Rolle von weiblichem Geschlecht als unabhängiger und nicht modifizierbarer Risikofaktor für erhöhte Sterblichkeit nach CABG (HR = 2.91, 95% CI 1.70 - 4.96, P< 0.001). Ausgehend von diesem Punkt konnten außerdem selbsteingeschätzte körperliche Funktionalität, geringes postoperatives Herzzeitvolumen, respiratorische Insuffizienz und die Notwendigkeit postoperativer Reanimation als Prädiktoren identifiziert werden. Weiterhin stellte sich inkomplette Revaskularisierung als ein wichtiger Mortalitätsprädiktor heraus, der signifikant mit weiblichem Geschlecht korrelierte (HR=2.617, 95%CI 1.760 - 3.890; P < 0.001). Schließlich konnten Ruhe- und Belastungsdyspnoe, Zustand nach Myokardinfarkt, Präsenz von Komorbiditäten und Therapie mit Beruhigungsmitteln als prädiktive Merkmale zur Vorhersage von präoperativer Depressivität identifiziert werden. Schlussfolgerungen Die dargestellten Ergebnisse ermöglichen die Identifikation mehrerer potentieller Interventionsmomente im Rahmen des versorgungstechnischen Kontinuums von Bypass-Patientinnen und –Patienten. Ausgehend von unseren Analysen wären die akkurate Befragung zur Erkennung von präoperativer Depressivität und die standardisierte Abfragung der selbsteingeschätzten körperlichen Funktionalität zu empfehlen. Weiterhin sollten bildgebende Verfahren zur korrekten Einstufung der Gefäßkrankheit vor allem für Frauen optimiert werden, um letztendlich auch eine adäquate präoperative Einschätzung ihrer Herzfunktion zu gewährleisten.Female excessive mortality after coronary bypass graft surgery (CABG) has been widely reported, yet explanatory approaches are insufficient to fully explain this gender difference. Especially the impact of psychosocial variables and their potential predictive value has been seldom investigated. Methods The presented studies investigated the role of pre- intra- and postoperative variables as potential explanatory and causal factors for the female excess in post-CABG mortality. A cohort of 1559 CABG patients were recruited for the present study. Predictors of mortality and the role of incomplete revascularization as a possible cause were investigated by univariate and following multivariate Cox analyses. Predictors for preoperative depression were examined using five independent multiple logistic models. Results Our studies confirmed the role of female gender as an independent and non- modifiable risk factor for excessive mortality after CABG (HR = 2.91, 95% CI 1.70 - 4.96, P< 0.001). Starting with this finding we also identified self- reported physical functioning, low postoperative cardiac output, respiratory insufficiency and postoperative reanimation as additional predictors. Furthermore, we established the role of incomplete revascularization as a relevant predictor of mortality that significantly correlates with female gender (HR=2.617, 95%CI 1.760 - 3.890; P < 0.001). Finally, we were able to identify dyspnea at rest and on exertion, history of comorbidities and specifically myocardial infarction, as well as ongoing therapy with tranquilizers as predictors of preoperative depression. Conclusions The presented results allowed for the identification of several potential intervention targets in the context of the management and care of patients undergoing CABG surgery. We would advise the thorough investigation of potential preoperative depression as well as the standardized survey of self- reported physical functioning. Furthermore, we recommend the development of improved visual diagnostic protocols to correctly classify vessel disease, especially in women, in order to guarantee an adequate preoperative evaluation of their cardiac function