Gender and sex bias in prevention and clinical treatment of women's chronic pain: hypotheses of a curriculum development.
Ontology highlight
ABSTRACT:
SUBMITTER: Moretti C
PROVIDER: S-EPMC10407111 | biostudies-literature | 2023
REPOSITORIES: biostudies-literature
Publications
Gender and sex bias in prevention and clinical treatment of women's chronic pain: hypotheses of a curriculum development.
Moretti Chiara C De Luca Enrico E D'Apice Clelia C Artioli Giovanna G Sarli Leopoldo L Bonacaro Antonio A
Frontiers in medicine 20230725
This discursive paper focuses on undergraduate medical education's role in tackling gender bias in clinical practice, specifically preventing and managing from a non-biomedical perspective chronic pain in women. A preliminary web search of medical schools' curricula was performed to identify programs content related to gender bias in pain management. The web search included 10 universities' websites selected from the top 10 rankings QS Universities Rankings 2022 for medical schools. Additionally ...[more]
Similar Datasets
Project description:In the pursuit of mental and physical health, effective pain management stands as a cornerstone. Here, we examine a potential sex bias in pain management. Leveraging insights from psychological research showing that females' pain is stereotypically judged as less intense than males' pain, we hypothesize that there may be tangible differences in pain management decisions based on patients' sex. Our investigation spans emergency department (ED) datasets from two countries, including discharge notes of patients arriving with pain complaints (N = 21,851). Across these datasets, a consistent sex disparity emerges. Female patients are less likely to be prescribed pain-relief medications compared to males, and this disparity persists even after adjusting for patients' reported pain scores and numerous patient, physician, and ED variables. This disparity extends across medical practitioners, with both male and female physicians prescribing less pain-relief medications to females than to males. Additional analyses reveal that female patients' pain scores are 10% less likely to be recorded by nurses, and female patients spend an additional 30 min in the ED compared to male patients. A controlled experiment employing clinical vignettes reinforces our hypothesis, showing that nurses (N = 109) judge pain of female patients to be less intense than that of males. We argue that the findings reflect an undertreatment of female patients' pain. We discuss the troubling societal and medical implications of females' pain being overlooked and call for policy interventions to ensure equal pain treatment.
| S-EPMC11331074 | biostudies-literature
Project description:Background: In the last 3 years, the National Institutes of Health (NIH) declared advancement of understanding the role sex as a biological variable has in research a priority. The burden now falls on educators and clinicians to translate into clinical practice the ensuing body of evidence for sex as a biological variable that clearly shows the effect of sex/gender on disease diagnosis and management. The 2018 Sex and Gender Health Education Summit (SGHE) organized an interdisciplinary and interprofessional workshop to (1) analyze common clinical scenarios highlighting the nuances of sex- and gender-based medicine (SGBM) in presentation, diagnosis, or management of illness; (2) utilize valid educational and assessment tools for a multiprofessional audience; and (3) brainstorm standardized learning objectives that integrate both. Materials and Methods: We describe the iterative process used to create these scenarios, as well as an interprofessional forum to develop standardized SGBM case-based objectives. Results: A total of 170 health education professionals representing 137 schools of Medicine, Dentistry, Pharmacy, Public Health, Nursing, Physical, and Occupational Therapy participated in this workshop. After attending the workshop, participants reported a significant increase in comfort level with using diverse educational modalities in the instruction of health profession learners. Recurrent themes included case-based learning, use of sex-neutral cases, simulation, and standardized patient scenarios for educational modalities; and self-assessment, peer assessment, and review of clinical documentation as used assessment tools. Materials created for the workshop included teaching SGBM case scenarios, methods of assessment, and sample standardized objectives. Conclusion: The SGHE Summit provided an interdisciplinary forum to create educational tools and materials for SABV instruction that may be applied to a diverse audience.
| S-EPMC6919237 | biostudies-literature
Project description:OBJECTIVE: Women's health knowledge and skills are important for physicians, but training is often inadequate. The objective of this project was to develop, implement, and evaluate a women's health curriculum for an internal medicine residency program. METHODS: After assessing institutional factors, we developed a curriculum for a multidisciplinary clinical rotation with a web-based tutorial. We recruited faculty from several specialties relevant to the care of women to precept for the rotation and/or to provide teaching materials for the tutorial. RESULTS: The curriculum for the 1-month rotation covered most of the recommended women's health topics. Internal medicine residents worked in a variety of clinical settings and were assigned to a web-based tutorial and a pretest and posttest. A statistically significant increase was seen in participants' mean posttest (71.7%) versus pretest (61.1%) scores (difference, 10.7%; 95% confidence interval [CI]: 4.7-16.6; P = .0009). No difference was seen in controls' mean posttest (56.5%) versus pretest (57.2%) scores (difference, -0.7%; 95% CI: -12.1-10.7; P = .9). Mean rotation evaluation responses ranged from 7.09 to 7.45 on a 9-point scale. The majority (93%) of survey respondents agreed that the rotation increased their skills in caring for women, and all agreed the program was well organized and that it increased their awareness of women's health issues. CONCLUSION: A women's health curriculum using a web-based tutorial with a multidisciplinary clinical rotation can be successfully implemented in an internal medicine residency. The curriculum satisfied women's health training requirements, was associated with improvements in learning outcomes, and may be a model for women's health education.
| S-EPMC2951780 | biostudies-other
Project description:Importance:Previous studies demonstrate sex bias in surgical research. Female participants and investigators are underrepresented in surgical scientific research. Objectives:To describe the distribution of male and female authors in 5 general-interest surgery journals, assess the association of author gender with sex bias, and explore whether investigators benefit from performing sex-inclusion research. Design, Setting, and Participants:For this bibliometric analysis, data were abstracted from 1921 original, peer-reviewed articles published from January 1, 2011, through December 31, 2012, in Annals of Surgery, American Journal of Surgery, JAMA Surgery, The Journal of Surgical Research, and Surgery. Excluded articles pertained to a sex-specific disease or did not report the number of study participants. An additional 119 articles contained gender-ambiguous author names and were omitted. Data were analyzed from April to June 2017. Main Outcomes and Measures:Male and female first and senior authors, number of female and male participants in each study, surgical specialty, and number of citations received per article. Results:Of the 3604 authors of 1802 articles included in this study, 2791 first and senior authors (77.4%) were male and 813 (22.6%) were female. The prevalence of male and female authors was consistent across all 5 journals and among clinical and basic science research. Articles by female authors included a higher median number of female study participants compared with their male counterparts (27.5 vs 16.0; P = .01), but sex matched the inclusion of participants less frequently (36% vs 45%; P = .001). No sex-based differences occurred between male and female authors in reporting, statistical analysis, and discussion of the data or in the number of citations received. Compared with studies that did not report, analyze, or discuss data by sex, studies that performed sex-specific data reporting yielded a mean of 2.8 more citations (95% CI, 1.2-4.4; P = .001); those that performed statistical analysis, a mean of 3.5 more citations (95% CI, 1.8-5.1; P = .001); and those that discussed the data, a mean of 2.6 more citations (95% CI, 0.7-4.5; P = .001). Articles with a higher percentage of sex matching of participants also received more citations, with an increase of 1 citation per 4.8% (95% CI, 2.0%-7.7%; P = .001) increase in percentage of sex matching. Conclusions and Relevance:Sex bias in surgical research is prevalent among male and female authors; however, female authors included proportionally more female participants in their studies compared with male authors. Notably, studies that addressed sex bias were rewarded by the scientific community with increased citations of their published work.
| S-EPMC5875386 | biostudies-literature
Project description:Women's health in physical therapy has historically focused on sexual and reproductive health. The biological and social constructs of sex and gender, respectively, are determinants of health, including pathophysiology of disease and therapeutic outcomes, and an expansion of the concept of "women's health" is warranted. This Perspective explores the role of sex and gender as key determinants of women's and girls' health and highlights the factors pertinent to physical therapist practice. The Scale for the Assessment for Narrative Review Articles (SANRA), a 6-point assessment to evaluate the quality of narrative reviews, was used a priori and consulted throughout. Across the lifespan, sex- and gender-based health disparities exist. These include sex-based disparities in maternal-fetal outcomes linking female fetal sex to maternal hypertensive disorders of pregnancy, along with a sex-based female advantage in birth outcomes and the emergence of gender differences in motor development. A complex interplay of biological and socially influenced factors contributes to an increased care burden for women throughout adulthood and specific risks for the development of cardiovascular and pelvic floor conditions, decreased function, and increased disability. Sex- and gender-disaggregated data are lacking in outcomes literature. A sex- and gender-informed approach in physical therapy, including analyzing data by sex and gender, may better meet the needs of patients and better prepare physical therapist professionals to contribute to women's health across the lifespan. Success will take coordinated effort involving many stakeholders within and adjacent to the physical therapist community. The influence of sex and gender are lifelong determinants of health, making them critically important to consider in physical therapist practice, education, research, advocacy, and policy. In women's health, focusing on sexual and reproductive health is limiting and insufficient.
| S-EPMC11523629 | biostudies-literature
Project description:Women's health care has evolved significantly since it was first acknowledged as an integral part of internal medicine training more than two decades ago. To update and clarify core competencies in sex- and gender-based women's health for general internists, the Society of General Internal Medicine (SGIM) Women and Medicine Commission prepared the following Position Paper, approved by the SGIM council in 2023. Competencies were developed using several sources, including the 2021 Accreditation Council for Graduate Medical Education Program Requirements for Internal Medicine and the 2023 American Board of Internal Medicine Certification Examination Blueprint. These competencies are relevant to the care of patients who identify as women, as well as gender-diverse individuals to whom these principles apply. They align with pivotal advances in women's health and acknowledge the changing context of patients' lives, reaffirming the role of general internal medicine physicians in providing comprehensive care to women.
| S-EPMC10117249 | biostudies-literature
Project description:Existing evidence indicates sex-related differences in Prescription Opioid Use Disorder (OUD) in Chronic Non-Cancer Pain (CNCP). However to date, there is scant evidence for other socioeconomic factors in these differences. Our aim was to enquire about the influence of gender and drug copayment of OUD narratives by the text mining analysis. A prospective mixed-methods study was designed and performed at Pain Unit (PU) including 238 real world patients with CNCP divided in controls (n = 206) and OUD cases (n = 32) due to DSM-5 diagnosis Variables related to pain, sleep, mental and health status were collected in together with sex and gender interaction, in pain status, along 30-45 min face-to-face interviews. Sex differences were observed due to women's significantly older ages, with a stronger impact on mental health, and an even stronger one for the OUD women. Globally, OUD cases were more unemployed vs the CNCP controls, and on a significantly higher median opioid daily dose of 90 [100] mg/day. Although OUD participants did more social activities, they tended to use less vocabulary to express themselves regardless of their sex, gender role or economic status. In contrast, the CNCP participants presented more differences driven by their incomes, with "limited" being the most discriminating word for those on low income, followed by "less" and "help". Here, the most significant word of CNCP women was "husband", followed by "tasks". In contrast, gender reproductive roles shared similarities in both sexes, being one of the most discriminatory words "help". The data show that OUD patients seem to have a marked influence of OUD on poorer lexicon and simpler narrative, together with a significant impact of socioeconomic factors on the CNCP narratives. The conclusion suggests to extend the research to better understand the effect of sex, gender and socioeconomic status in CNCP especially on OUD women's health.
| S-EPMC11918440 | biostudies-literature
Project description:BACKGROUND: Chronic pelvic pain (CPP) accounts for 10% of gynecologic visits and is a common complaint in university-based and community resident clinics. Resident education about CPP has been inconsistent, and review of the limited literature shows predominantly negative perceptions of patients with CPP. Current literature lacks information regarding obstetrics-gynecology residents' attitudes and acquired knowledge regarding CPP. OBJECTIVE: This targeted needs assessment aims to identify regional obstetrics-gynecology resident attitudes and self-perceived knowledge regarding chronic pelvic pain in order to better address potential educational barriers and look toward placing a greater emphasis on this area in resident training. METHODS: We conducted a focus group of obstetrics-gynecology residents to identify major themes regarding attitudes about CPP. This informed the development of a survey administered to university-based and community-based obstetrics-gynecology residents (N = 57) in the Colorado part of the Western Mountain Region. Cronbach α was calculated to determine reliability for each theme, and descriptive statistics were calculated for each theme. Independent samples t tests assessed differences between training levels and between university and community training sites. RESULTS: Survey response rate was 72% (41 of 57). Residents consistently reported feeling overwhelmed by CPP patients, perceived a lack of time to see these patients, and indicated a desire to learn more in this area, but they varied in chosen learning methods. No significant differences were found between levels of training or training sites. CONCLUSIONS: Most obstetrics-gynecology residents surveyed believe they are inadequately prepared to address the needs of women presenting with CPP.
| S-EPMC3963792 | biostudies-other
Project description:Historically, biomedical research has been led by and focused on men. The recent introduction of Artificial Intelligence (AI) in this area has further proven this practice to be discriminatory for other sexes and genders, more noticeably for women. To move towards a fair AI development, it is essential to include sex and gender diversity both in research practices and in the workplace. In this context, the Bioinfo4women (B4W) program of the Barcelona Supercomputing Center (i) promotes the participation of women scientists by improving their visibility, (ii) fosters international collaborations between institutions and programs and (iii) advances research on sex and gender bias in AI and health. In this article, we discuss methodology and results of a series of conferences, titled “Sex and Gender Bias in Artificial Intelligence and Health, organized by B4W and La Caixa Foundation from March to June 2021 in Barcelona, Spain. The series consisted of nine hybrid events, composed of keynote sessions and seminars open to the general audience, and two working groups with invited experts from different professional backgrounds (academic fields such as biology, engineering, and sociology, as well as NGOs, journalists, lawyers, policymakers, industry). Based on this awareness-raising action, we distilled key recommendations to facilitate the inclusion of sex and gender perspective into public policies, educational programs, industry, and biomedical research, among other sectors, and help overcome sex and gender biases in AI and health.
| S-EPMC10512182 | biostudies-literature
Project description:ObjectivesChronic pain (CP) is a poorly recognised and frequently inadequately treated condition affecting one in five adults. Reflecting on sociodemographic disparities as barriers to CP care in Canada was recently established as a federal priority. The objective of this study was to assess sex and gender differences in healthcare utilisation trajectories among workers living with CP.DesignRetrospective cohort study.ParticipantsThis study was conducted using the TorSaDE Cohort which links the 2007-2016 Canadian Community Health Surveys and Quebec administrative databases (longitudinal claims). Among 2955 workers living with CP, the annual number of healthcare contacts was computed during the 3 years after survey completion.OutcomeGroup-based trajectory modelling was used to identify subgroups of individuals with similar patterns of healthcare utilisation over time (healthcare utilisation trajectories).ResultsAcross the study population, three distinct 3-year healthcare utilisation trajectories were found: (1) low healthcare users (59.9%), (2) moderate healthcare users (33.6%) and (3) heavy healthcare users (6.4%). Sex and gender differences were found in the number of distinct trajectories and the stability of the number of healthcare contacts over time. Multivariable analysis revealed that independent of other sociodemographic characteristics and severity of health condition, sex-but not gender-was associated with the heavy healthcare utilisation longitudinal trajectory (with females showing a greater likelihood; OR 2.6, 95% CI 1.6 to 4.1).ConclusionsOur results underline the importance of assessing sex-based disparities in help-seeking behaviours, access to healthcare and resource utilisation among persons living with CP.
| S-EPMC10387645 | biostudies-literature