Sex Versus Gender-Related Characteristics

Pelletier, Roxanne; Khan, Nadia; Cox, Jafna L.; Daskalopoulou, Stella S.; Eisenberg, Mark J.; Bacon, Simon; Lavoie, Kim; Daskupta, Kaberi; Rabi, Doreen M.; Humphries, Karin H.; Norris, Colleen M.; Thanassoulis, George; Behlouli, Hassan; Pilote, Louise

doi:10.1016/j.jacc.2015.10.067

Cited by 240 publications

(93 citation statements)

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“…Gender is more complex, and can be operationalized along four different constructs: gender roles, gender identity, gender relations and institutionalized gender [6, 28, 31, 32]. Table 1 defines these four constructs, gives examples of key questions that can be asked of each in IRP, and lists measures and methods for use in IRP research [6, 28, 31, 32, 42–44]. …”

Section: Discussionmentioning

confidence: 99%

Why sex and gender matter in implementation research

Tannenbaum

Greaves

Graham

2016

BMC Med Res Methodol

258

243

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BackgroundThere has been a recent swell in activity by health research funding organizations and science journal editors to increase uptake of sex and gender considerations in study design, conduct and reporting in order to ensure that research results apply to everyone. However, examination of the implementation research literature reveals that attention to sex and gender has not yet infiltrated research methods in this field.DiscussionThe rationale for routinely considering sex and gender in implementation research is multifold. Sex and gender are important in decision-making, communication, stakeholder engagement and preferences for the uptake of interventions. Gender roles, gender identity, gender relations, and institutionalized gender influence the way in which an implementation strategy works, for whom, under what circumstances and why. There is emerging evidence that programme theories may operate differently within and across sexes, genders and other intersectional characteristics under various circumstances. Furthermore, without proper study, implementation strategies may inadvertently exploit or ignore, rather than transform thinking about sex and gender-related factors. Techniques are described for measuring and analyzing sex and gender in implementation research using both quantitative and qualitative methods.SummaryThe present paper describes the application of methods for integrating sex and gender in implementation research. Consistently asking critical questions about sex and gender will likely lead to the discovery of positive outcomes, as well as unintended consequences. The result has potential to strengthen both the practice and science of implementation, improve health outcomes and reduce gender inequities.Electronic supplementary materialThe online version of this article (doi:10.1186/s12874-016-0247-7) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Why sex and gender matter in implementation research

Tannenbaum

Greaves

Graham

2016

BMC Med Res Methodol

258

243

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“…Highlighting this is the growing literature that is showing the impact of certain aspects of gender on cardiovascular outcomes, which are independent of sex. 21 These distinctions could also have direct implications for the results of the study by Sullivan et al 7 because there is some suggestion that sex may drive heart disease pathways associated with factors such as abdominal obesity and insulin-resistance, whereas gender my drive heart disease through factors such as psychology distress and acute stress. 22 As such, how much of the sex difference seen could actually be attributable to gender or how much more might gender be able to explain the variability of stress responses?…”

Section: See Accompanying Article On Page 473mentioning

confidence: 99%

The Importance of Sex in the Stress–Heart Disease Relationship and the Potential Contribution of Gender to Future Research

Bacon

2018

ATVB

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We now have numerous studies that have linked increased levels of negative emotions and stress with the development and progression of cardiovascular disease-a relationship that seems to be sex specific in its pattern of outcomes. 1,2 However, the mechanisms of these relationships are still a source of much debate. One of the strongest potential pathways linking acute psychological stress with worse outcomes is through mental stress-induced myocardial ischemia (MSIMI).3 Though there is a large overlap (ca. 70%) in individuals who demonstrate both MSIMI and more common (ie, exercise or pharmacological) stress-induced ischemia, 4 these seem to be distinctly different entities. Firstly, it would seem that more individuals are likely to have MSIMI only than exercise/pharmacological stress-induced ischemia only (20% versus 10%).5 Furthermore, the profiles and potential mechanistic factors of those at risk for MSIMI compared with exercise/pharmacological stress-induced ischemia are different. For example, those individuals who exhibit MSIMI are more likely to be women, have greater microvascular disease, have poorer left ventricular dysfunction, and display endothelial dysfunction, whereas exercise/pharmacological stress-induced ischemia is generally associated with men and those with larger and more diffuse coronary artery plaque. [4][5][6] Though there are sex differences in the rates of presentations of both MSIMI and exercise/pharmacological stress-induced ischemia, both men and women do exhibit both of these forms of ischemia. However, we do not know if the mechanistic factors that underlie these stress-induced ischemia differ by sex; for example, does MSIMI in women differ from MSIMI in men? Understanding these processes can ultimately help in the development of better tailored diagnostic procedures and interventions to treat cardiovascular disease. See accompanying article on page 473The article by Sullivan et al 7 provides some important initial insights into sex differences in the potential mechanisms driving MSIMI. This secondary analysis of 678 (25% women) patients in the MIPS study (Mental Stress Ischemia Mechanisms and Prognosis) evaluated mental stress (public speaking)-induced vascular and hemodynamic responses. The authors found that MSIMI was generally driven by peripheral vasoconstriction in women compared with increased hemodynamic workload in men, results that were independent of exercise/pharmacological stress-induced ischemia. These results suggest that men with MSIMI are effectively cardiac stress reactors, with increased myocardial oxygen demands, and women with MSIMI are more likely to be vascular reactors, with greater endothelial driven increases in vascular resistance (which leads to increased left ventricular afterload and dysfunction).8 However, the article by Sullivan et al does only provide initial insights, and there is a great deal of further information that we need. For example, building a more complex map of MSIMI, to include additional measures of the autonomic nervous system, the...

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“…Women and men are exposed to different occupational hazards (e.g., ergonomic demands and psychosocial stressors), and differ on a wide array of health-related lifestyle behaviours (e.g., exercise, alcohol and tobacco use) 16,17 . Further, gendered psychosocial factors have been found to predict recurrent outcomes in patients with acute coronary syndrome and to moderate patient-perceptions of pain 18,19 . Despite robust evidence, associations between gender, biological sex and health outcomes remain largely neglected in the literature 20 , with potentially life-threatening and costly consequences.…”

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confidence: 99%