Tag: gender issues

Categories : Medical Research & TechnologyTags :

Systematic Biases on Race and Gender at Play in Clinical Trials

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Photo by National Cancer Institute on Unsplash

Randomized controlled trials, or RCTs, are believed to be the best way to study the safety and efficacy of new treatments in clinical research. However, a recent study from Michigan State University found that people of colour and white women are significantly underrepresented in RCTs due to systematic biases. 

The study, published in the Journal of Ethnicity in Substance Abuse, reviewed 18 RCTs conducted over the last 15 years that tested treatments for post-traumatic stress and alcohol use disorder. The researchers found that despite women having double the rates of post-traumatic stress and alcohol use disorder than men, and people of colour having worse chronicity than white people, most participants were white (59.5%) and male (about 78%). 

“Because RCTs are the gold standard for treatment studies and drug trials, we rarely ask the important questions about their limitations and failings,” said Nicole Buchanan, co-author of the study and professor in MSU’s Department of Psychology. “For RCTs to meet their full potential, investigators need to fix barriers to inclusion. Increasing representation in RCTs is not simply an issue for equity, but it is also essential to enhancing the quality of our science and meeting the needs of the public that funds these studies through their hard-earned tax dollars.”

The researchers found that the design and implementation of the randomised controlled trials contributed to the lack of representation of people of colour and women. This happened because trials were conducted in areas where white men were the majority demographic group and study samples almost always reflected the demographic makeup where studies occurred. Additionally, those designing the studies seldom acknowledged race or gender differences, meaning they did not intentionally recruit diverse samples.

Furthermore, the journals publishing these studies did not have regulations requiring sample diversity, equity or inclusion as appropriate to the conditions under investigation.

“Marginalized groups have unique experiences from privileged groups, and when marginalised groups are poorly included in research, we remain in the dark about their experiences, insights, needs and strengths,” said Mallet Reid, co-author of the study and doctoral candidate in MSU’s Department of Psychology. “This means that clinicians and researchers may unknowingly remain ignorant to how to attend to the trauma and addiction challenges facing marginalised groups and may unwittingly perpetuate microaggressions against marginalised groups in clinical settings or fail to meet their needs.”

Source: Michigan State University

Categories : COVID GenderTags :

The Pandemic’s Negative Impact on Women in Academic Medicine

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Female scientist in laboratory
Photo by Gustavo Fring from Pexels

Like women in every other sector of the economy, the COVID pandemic has negatively impacted those working in academic medicine according to a commentary which appears in Nature Medicine.

Co-author Anne B. Curtis, MD, professor at the University at Buffalo, laid out the problem: “During the first year of the pandemic, when schools shut down and went to 100% remote learning, we saw that it affected women disproportionately, having to stay home and teach their children while their research languished.”

Even before the COVID pandemic, women in academic medicine were paid less than men in comparable positions, received lower startup funds for laboratory research and were promoted later.

Additionally, they wrote that, compared to men, women have fewer “conventional markers of achievement” in academia, such as principal investigator positions on research grants. Women write fewer grant applications; they have fewer grant renewals; they get lower funding amounts for initial grants; and are first or last author on fewer papers.

The reasons for these are well known, the authors wrote.

“Society expects women to assume the major portion of the burden for child rearing, and women themselves feel an obligation to put family above their own needs, to the detriment of their own career development,” she said. “There still isn’t the sharing of responsibilities in two-career families to mitigate these problems.”

The paper includes a detailed ‘menu’ of proposed solutions. These include providing financial support to hire technicians for two to three years to carry on lab research while women researchers focus on child care at home, or otherwise supporting child care at home so women can continue their lab research.

The paper also proposes slowing down tenure clocks, delaying the tenure decision by two to three years to make up for lost time while women give birth and care for young children.

In addition to such programs, the list includes a category of solutions termed “cultural,” described as creating the cultural expectation that gender equity is a shared responsibility and incorporating those expectations into bonuses and merit raises of institutional leaders. Also included is the need to engage university and hospital boards of trustees to support gender equity.

Prof Curtis said that the paper aims to highlight the persistence of these gender differences persist and that global phenomena like the pandemic only worsen them.

“As much as we would like to think that gender differences in career development no longer exist, they do, and they adversely affect women more than men,” she said. “Understanding these issues and implementing solutions are the best ways to minimise potentially adverse effects on women’s careers.”

As the pandemic and its associated restrictions ease, Prof Curtis warned, “The situation is improving now that schools are open, but the next pandemic may only be a mutation away.”

Source: Buffalo University

Categories : Gender Pain ManagementTags :

Both Genders Rate Pain of Female Patients as Lower

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Woman clutching her belly in pain. Photo by Andrea Piacquadio from Pexels.

In a recent study, researchers found that a patient’s pain responses may be perceived differently by others based on their gender.

The study was published in The Journal of Pain, with the co-author being Elizabeth Losin, assistant professor of psychology and director of the Social and Cultural Neuroscience lab at the University of Miami. A previous study showed that men are seen as more stoic and women as more emotional in expression of pain.

In the first of two experiments in the study, 50 participants viewed videos of male and female patients complaining of shoulder pain as they performed a series of range of motion exercises using their injured and uninjured shoulders. These videos came from a database that contains videos of actual shoulder injury patients, each with a different level of pain, as well as the patients’ self-reported discomfort levels on shoulder movement.

According to Prof Losin, this study is more applicable to patients in a clinical setting.
“One of the advantages of using these videos of patients who are actually experiencing pain from an injury is that we have the patients’ ratings of their own pain,” she explained. “We had a ground truth to work with, which we can’t have if it’s a stimulus with an actor pretending to be in pain.”

The patients’ facial expressions were also analysed through the Facial Action Coding System (FACS)—a system for describing all visible facial movements. The researchers created an objective score of the intensity of the patients’ pain facial expressions derived from the FACS values, providing a second ground truth.

The study participants were asked to gauge the amount of pain they thought the patients in the videos experienced on a scale from zero, labeled as “absolutely no pain,” to 100, labeled as “worst pain possible.”

For the second experiment, the first experiment was replicated with 200 participants, who were asked to complete the Gender Role Expectation of Pain questionnaire, which measures gender-related stereotypes about pain sensitivity, the endurance of pain, and willingness to report pain.

The participants also reported the amount of medication and psychotherapy they would prescribe to each patient, and which of these they believed be a more effective treatment for that patient.

The researchers analysed the participants’ perceptions relative to the two ground truth pain measures, Prof Losin explained. That is because bias could be defined as different ratings for male and female patients despite the same level of responses.

Overall, the study found that female patients were perceived to be in less pain than the male patients who reported, and exhibited, the same intensity of pain. Additional analyses using participants’ responses to the questionnaire about gender-related pain stereotypes allowed researchers to conclude that these perceptions were partially explained by these stereotypes. 

“If the stereotype is to think women are more expressive than men, perhaps ‘overly’ expressive, then the tendency will be to discount women’s pain behaviors,” Prof Losin said. “The flip side of this stereotype is that men are perceived to be stoic, so when a man makes an intense pain facial expression, you think, ‘Oh my, he must be dying!’ The result of this gender stereotype about pain expression is that each unit of increased pain expression from a man is thought to represent a higher increase in his pain experience than that same increase in pain expression by a woman.”

Additionally, the researchers found that psychotherapy was also selected over medication for a higher proportion of female than male patients. The participants’ gender did not influence pain estimation, with both male and female participants perceiving women’s pain to be less intense.

Prof Losin said the study was motivated by literature showing that women received less treatment for pain and waited longer.

“There’s a pretty wide literature showing demographic differences in pain report, the prevalence of clinical pain conditions, and then also a demographic difference in pain treatments,” Losin pointed out. “These differences manifest as disparities because it seems that some people are getting undertreated for their pain based on their demographics.”

Moving forward, Prof Losin and her fellow researchers hope this study is a step in identifying and addressing gender disparities in health care.

Prof Losin said that even medically trained people are subject to such biases. “Critically, our results demonstrate that these gender biases are not necessarily accurate. Women are not necessarily more expressive than men, and thus their pain expression should not be discounted.”

Source: Medical Xpress

Journal information: Lanlan Zhang et al, Gender Biases in Estimation of Others’ Pain, The Journal of Pain (2021). DOI: 10.1016/j.jpain.2021.03.001

Categories : Gender Injury & TraumaTags :

Social Plus Biological Factors Increase Knee Injuries Among Female Athletes

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Writing in the British Medical Journal, scientists have argued that the study of knee injuries in female athletes is too focused on biological factors and not enough on social factors.

It is said that female athletes experience anterior cruciate ligament (ACL) injury, at a rate three to six times higher than their male counterparts.The ACL is one of the key ligaments that helps to stabilise the knee joint. This can be a career-ending injury, and occurs most often in sports involving sudden changes of direction such as basketball.

The authors of the paper argued that much of the focus still falls on biological and hormonal factors, with little attention paid to how sex-based factors are affected by the social concept of gender and how they could influence each other.

They suggested that gendered experiences are relevant in shaping female sport participation as well as disparities in injury outcomes. They demonstrated that, over a lifetime, gendered expectations of physical abilities (eg ‘throw like a girl’), to inequitable access to funding, training, and facilities for women’s sport (eg disparities in access to weight training).

Lastly, the authors suggested there may also be differences between post-injury rehabilitation for men and women recovering from an ACL injury. These social and environmental factors play a much bigger role in how sports injuries occur than once thought, they said, urging that there should be much more weight given to these issues.

Dr Sheree Bekker from the Department for Health at the University of Bath (UK) explained: “We wanted to unpack the biases and assumptions that we were seeing in research into and practice around sports injuries in girls and women. Specifically, we wanted to challenge the increasingly pervasive idea that this is simply a problem for girls/women because they are inherently prone to injury just because of their female biology. Approaching ACL injury prevention and management from a strictly biological view can propagate sexism in sport with detrimental consequences for girls and women.”

Dr Joanne Parsons from the University of Manitoba (Canada) added: “Over 20 years of research focussed on biological traits has failed to decrease the ACL injury rate in girls and women. To make a difference, we need to approach the problem in a different way. The recent challenges that the NCAA women’s teams faced with access to adequate training equipment is a perfect example of why we have to include society’s influence when talking about injury risk for girls/women.”

Paper co-author Dr Stephanie Coen of the University of Nottingham said: “By extending the focus from individual bodies and biology to the gendered environments contextualizing ACL injury, our approach identifies new opportunities to intervene and achieve better outcomes for girls and women, with implications beyond athletes. As childhood and youth physical activity levels influence those in adulthood, the sequelae of ACL injury can be lifelong and particularly concerning for girls and women who already participate in physical activity at lower rates than boys and men. There is a wider health equity issue at stake.”

Source: Medical Xpress

Journal information: Joanne L Parsons et al, Anterior cruciate ligament injury: towards a gendered environmental approach, British Journal of Sports Medicine (2021). DOI: 10.1136/bjsports-2020-103173

Categories : Gender Substance UseTags :

Alcoholic Liver Disease Is ‘Astronomical’ in Young Women

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Image by ds_30 from Pixabay

Rates of alcoholic liver disease are skyrocketing in young women, doctors in the US have warned. Much of it has to do with added pressures on women in the pandemic.

Alcoholic liver disease — including milder fatty liver and the permanent scarring of cirrhosis, as well as alcoholic hepatitis — are up 30% over the last year at the University of Michigan’s health system, said Dr Jessica Mellinger, a liver specialist there. Severe liver disease and cirrhosis can see survival rates as low as 10%.

The route by which liver disease develops varies according to the individual, although obesity, genetics and underlying health conditions play a role. Moderate consumption of alcohol, a glass or two of wine daily, is unlikely to contribute to it.

However, Dr Mellinger says that along with her colleagues, she has seen alcohol consumption edging upward, to a bottle of wine per day which results in increased risk of serious liver disease.

Since the beginning of the pandemic, no data on overall increases in serious alcoholic liver disease has yet been compiled by The Centers for Disease Control and Prevention. But, Dr Mellinger said, “in my conversations with my colleagues at other institutions, everybody is saying the same thing: ‘Yep, it’s astronomical. It’s just gone off the charts.’ “

The age demographic is also changing. “We’re seeing kids in their late 20s and early 30s with a disease that we previously thought was kind of exclusive to middle age,” she said.

The pressures of the COVID pandemic are partly to blame, and in many cases the extra burden is falling on women – who are already more susceptible to alcohol because they have a smaller water volume to distribute alcohol into and their bodies do less ‘first pass’ metabolism of alcohol in the stomach. Popular culture and advertising also encourages women to drink.

Psychological factors such as eating disorders and trauma from sexual abuse also fuel the disease.

“Whether this is early life sexual trauma or they are in a recent or ongoing abusive relationship, we see this link very, very closely,” said psychiatrist Dr Scott Winder, a clinical associate professor at the University of Michigan who treats liver disease patients. “Just the sheer amount of trauma is really, really tragic.”

The lack of overlap between the various fields in this complex relationship results in what he calls a “tragic gap”.

“The cultures of hepatology and the cultures of psychology and psychiatry are very disparate; we see patients very differently,” so physicians aren’t coordinating care, even when they should, he said.

Advanced liver disease may leave no other recourse than a liver transplant.
“Unfortunately, transplantation is finite,” said Dr Haripriya Maddur, a hepatologist at Northwestern University. “There aren’t enough organs to go around. What it unfortunately means is that many of these young people may not survive, and die very young — in their 20s and 30s. It’s horrific.”

Some people such as Jessica Duena, a teacher who was diagnosed with alcoholic hepatitis at 34, and was hospitalised several times following the death of her boyfriend from heroin, have managed to turn the disease around and are encouraging others to do the same. 

She wrote about her long-held secret in the Louisville Courier-Journal: “I’m Jessica, I’m the 2019 Kentucky State Teacher of the Year, I’m an alcoholic and I’ve been suffering in silence for years.”

She received hundreds of responses, mostly women like herself who were in similar circumstances.

“What I’ve noticed is quite a few of the women, typically, they were either educators, they were moms or they happened to be nurses or attorneys,” Duenas said. They poured their hearts out about the crushing and constant stress of kids, work and home life.

They also complained of the pressures outside the home. “Imagine being a teacher who gets evaluated on how your students do, given the situation today,” Duenas says. “I mean, that makes me want to drink for them, you know — like that’s a terrible pressure to be under.”

Duenas has started writing about the stories of such people who reach out to her on her website, www.bottomlesstosober.com.

Source: NPR

Categories : GenderTags :

Article Highlights Lack of Healthcare’s Anaemia Support for Women

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An article entitled  “The misogyny of iron deficiency”, published today in Anesthesia addresses the history of anaemia and how women’s health has often been overlooked.

The article was written by researchers from The University of Western Australia and University College London coincides with International Women’s Day. Sex differences in haemoglobin begins in puberty due to the effects of menstruation on iron stores and also varies by age, and can be affected by factors such as smoking and pregnancy.

Team lead Professor Toby Richards, Lawrence-Brown Chair in Vascular Surgery at UWA, is calling for greater recognition and equality for women’s health. He said that one in three women would need to take iron supplements at some point in their life.

“Our figures show that up to 18 percent of women who appear fit and healthy are actually deficient in iron, with heavy menstrual bleeding the most common cause. Symptoms reported by women range from fatigue to brain fog, hair loss and eating ice,” Prof Richards said.

Iron deficiency was a particular problem for women involved in fitness or sport with up to one in five athletes affected, he added.

“Issues with a women’s menstrual cycle and particularly heavy periods are surprisingly common and often not recognized with more than half also suffering iron deficiency.

“It’s so common it’s hiding in plain sight and both are under-diagnosed issues in women’s health. Unfortunately, there has been a dogma to accept these as ‘in the normal range’ for women,” said Prof Richards.

Prof Richards’ team also recently surveyed two groups of women, including 68 triathletes and 181 students, at UWA’s recent Orientation Day.

The women completed a simple questionnaire about previous iron status, menstrual blood loss, diet and motherhood. They were then tested for anaemia. Of the 181 women tested 14.5% were anaemic and most were unaware.

“This is alarming that so many apparently fit and healthy women are actually anemic, which may impact on their physical and mental health,” said Prof Richards.

He said many women simply coped with constant tiredness among a host of other symptoms, without addressing the root cause.

“We want to raise awareness of these conditions and help women recognize the signs and symptoms, in order to get the treatment that their body needs to improve their health and welfare.”

Source: News-Medical.Net

Categories : Cardiovascular Disease GenderTags :

Women are Less Likely to Undergo Critical Heart Surgery

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A scientific presentation at the 57th Annual Meeting of The Society of Thoracic Surgeons revealed that women are less likely to have a coronary artery bypass grafting (CABG) using guideline-recommended approaches, possibly resulting in worse post-surgery outcomes.

CABG is a major surgical operation involves bypassing atheromatous blockages in a patient’s coronary arteries with venous or arterial conduits harvested from elsewhere in the patient’s body.

Dr Oliver Jawitz and colleagues from Duke and The Johns Hopkins University School of Medicine used the STS Adult Cardiac Surgery Database (containing records of nearly all CABG procedures done in the US), and identified adult patients from 2011 to 2019 who underwent first-time isolated CABG, along with detailed demographic, clinical and procedural data.

The association between female sex and three different CABG surgical techniques from US and European guidelines was investigated. Grafting of the left internal mammary artery to the left anterior descending artery, complete revascularisation, and multiarterial grafting have been linked to better short and/or long-term outcomes. Despite this, the results indicated that women were 14%-22% less likely than men to undergo CABG procedures with these revascularisation strategies.

“With these findings, we did in fact see less aggressive treatment strategies with women,” said Dr Jawitz. “It is clear that sex disparities exist in all aspects of care for patients with coronary artery disease (CAD), including diagnosis, referral for treatment, and now, in surgical approaches to CABG. We must ensure that female patients undergoing CABG are receiving evidence-based, guideline-concordant techniques.”

The results are in accordance with an overall neglect of heart disease treatment in women. Women are much more likely than men to have non-typical symptoms of heart disease which are also subtler, such as abdominal pain and fatigue, as well as having their own particular set of risk of factors. This is compounded by women being underrepresented in cardiac disease study cohorts.

Women’s health historically focused on mother and child, and breast cancer. As such, the period from symptom onset to diagnosis and treatment is longer, allowing the disease to progress and worsen outcomes. This is also reflected by fewer women being referred for beneficial treatments such as CABG. 


“Delayed diagnosis of CAD in women leads to late initiation of key behavioral and pharmacologic interventions for minimizing heart disease risk, as well as delayed referral for invasive diagnostic and therapeutic procedures, including surgical revascularisation with CABG,” said Dr Jawitz. “This often means that by the time female patients undergo these procedures, they have more severe disease than males, as well as a greater number of comorbidities, which leads to worse outcomes.

“Now that we have identified specific differences in surgical approaches to CABG between females and males, we must further elucidate how these differences result in disparate outcomes such as increased mortality, readmissions, and complications,” he concluded. “These findings will help inform the development of sex-specific guidelines for the diagnosis and management of cardiovascular disease.”

Source: News-Medical.Net