Tag Archive for: women’s health

Same Disease, Different Risks & Symptoms: Cardiovascular Disease in Women

Authors: Nabilah Gulamhusein: Libin Cardiovascular Institute & Cumming School of Medicine, University of Calgary; Elaha Niazi: Libin Cardiovascular Institute & Cumming School of Medicine, University of Calgary; Smriti Juriasingani: Cumming School of Medicine, University of Calgary 

Editors: Romina Garcia de leon & Shayda Swann (Blog Co-coordinators).

 

Cardiovascular disease is the leading cause of death among women worldwide, and in fact, women are more likely to die from a heart attack than men. This often surprises women and their care providers because cardiovascular disease has traditionally been considered a male-dominated disease. Deaths due to cardiovascular disease have declined in the last 50 years in men, but have risen in women, especially in younger women. It is increasingly apparent that there are both sex-based (related to biological attributes) and gender-based (related to socially constructed identities, expression, roles, and behaviors) differences in cardiovascular risk factors, as well as the development and progression of cardiovascular diseases. Though we have made great gains in improving men’s heart health, women remain under-researched, under-diagnosed, under-treated, and under-supported; consequently, many women are unaware of their cardiovascular disease risk. 

 

Though many consider cardiovascular disease only a disease of older women, it affects women at all life stages. Reproductive-aged women have been developing increasingly disadvantageous cardiovascular disease risk profiles, including obesity, physical inactivity, an unhealthy diet, and stress; these factors appear to have a larger impact on women than men. While these are certainly important considerations in cardiovascular disease risk for young women, it is time to adopt a broader understanding of female-specific risk factors.

 

In addition to traditional risk factors, female-specific and female-predominant factors contribute to cardiovascular risk. Conditions related to fertility, such as polycystic ovarian syndrome and menstrual irregularities, have been associated with an increased cardiovascular disease risk. In addition, certain pregnancy complications can increase heart disease risk, including gestational hypertension and diabetes. It is critical that women have the opportunity for informed discussions with healthcare providers to mitigate reproductive and pregnancy-related risks. There is also a multitude of medical conditions disproportionately impacting women that result in increased cardiovascular risk. These include depression, diabetes, hypertension, autoimmune diseases, and chronic kidney disease. Awareness of these important female-specific and female-predominant risk factors can empower women in making heart-healthy choices. 

 

There is no question, however, that as a woman ages, cardiovascular risk increases considerably due to changes in the heart and blood vessels. The timing of the onset of menopause, as well as perimenopause (when the transition to menopause begins, but before a final menstrual period), may influence a woman’s cardiovascular risk. Premature menopause (before age 40) and early menopause (before age 45) are significantly associated with increased cardiovascular risk. Additionally, cardiovascular disease risk commonly increases after menopause, which is attributed to changes in hormone levels (e.g., estrogens).

 

Early heart attack symptoms are missed in more than 50% of women and therefore, it is important to recognize that women may have different symptoms compared to men during a heart attack. While women experience symptoms such as sharp chest pain, they may also have aching sensations across the back and stomach, pain in the jaw, neck or arm, shortness of breath, abnormally excessive sweating, nausea, indigestion, and extreme fatigue. Unlike men, women are more likely to present with three or more symptoms in addition to chest pain when having a heart attack. Being informed and spreading the word about heart disease symptoms in women is the first step towards protecting the women in our lives. 

 

Knowing that women have unique cardiovascular risk factors and subtle symptoms can be overwhelming, however, heart disease is largely preventable. First, following Canada’s 24-hour movement guidelines, including getting 150 minutes of moderate to vigorous physical activity per week, reducing sedentary time, and getting enough good quality sleep is recommended for a healthy lifestyle. Research shows that consuming 7-10 servings of fruits and vegetables every day, while limiting processed foods, sugar and salt are key ways to reduce cardiovascular risk. It is also important for women to have regular check-ups with their healthcare providers and take their medications as prescribed. Finally, living free from commercial tobacco and vaping while reducing alcohol intake and actively managing stress can also be beneficial.  

 

To learn about women’s cardiovascular health, including risk factors, symptoms, treatment, and support, you can participate in Wear Red Canada or visit WearRedCanada.ca! Wear Red Canada is run by volunteers across the country, including healthcare providers, scientists, and people with lived experience. Wear Red Canada Day is celebrated annually on February 13th to raise awareness about women’s heart and vascular health. Each year, you are invited to attend presentations by leading experts, join the Wear Red Canada Movement Challenge, and visit local landmarks that will light up RED in support of women’s heart health. On February 13, wear RED and join us on social media to share selfies or pictures of your participation in these events with the hashtag #HerHeartMatters and tag @WearRedCanada to share this important message. By starting conversations about women’s cardiovascular health and getting informed, we can increase awareness and improve the health of the women in our lives.

 

 

 

 

Behind the Science: Moving the Microscopic Lens to Marginalized Populations

Interviewee: Emmanuela Ojukwu (RN, PhD), Assistant Professor of Nursing, University of British Columbia. Authors/Editors: Romina Garcia de leon, Shayda Swann (Blog Co-coordinators).

Published: November 18th, 2022

Could you briefly explain your career trajectory from a Registered Nurse to now an Assistant Professor?

Towards the end of obtaining my Bachelor of Science Degree in Nursing, I knew that I wanted to pursue a career in women’s health. As my journey progressed, I would eventually get accepted to a PhD program where I had the opportunity to work with a professor who was internationally recognized, with a track record of success in improving minority women’s health with a focus on social determinants of health. The decision to focus on HIV came during my RN experiences at a Perinatal HIV clinic for vulnerable populations, wherein I observed birthing parents living with HIV, to be lost to follow-up to their own care but continually engaged in their infant’s care, postpartum. Possibly due to maternal instincts, but the focus on their infants and not themselves was very apparent. This spurred the idea for what would eventually become my dissertation. So, I wanted to see what factors deterred them from engaging in their own care or factors that motivated them to go in (for those that did). Also, as a natural empath – sometimes to a fault – I would find myself really vested in their care, particularly, for the marginalized women, e.g, new immigrants/refugees, racialized populations, homeless. Most of the patients who were lost were within these categories, so it was important to note the possible intersections in their marginalized identities, which were causing their suboptimal engagement in treatment and possible impediments to their overall wellbeing. When I applied to UBC, I definitely wanted to continue with HIV research, although, I realize that HIV rates here compared to the US are relatively less, but it’s still present. And, as there is currently no treatment that completely eliminates the virus, the likelihood of transmission and/or increasing morbidity and mortality,is significantly reduced with effective treatment/management. I remain vested in this topic as a researcher, and would describe my work as focusing on health equity and social determinants of health for vulnerable populations, marginalized by race, sex, gender, disabilities such as HIV, and other psychosocial vulnerabilities.

Why did you choose to study marginalized populations and sexual health?

Asides from being such an empath, I think that I’ve had my own lived experiences of discrimination within the healthcare setting, both as a patient and a healthcare provider. I, sometimes, find that there are “sexual and reproductive health stereotypes” that follow “black women” and these often go before them upon their arrival to any hospital/clinical setting. As a patient, I can count times this has been the case for me; and not until I divulge my profession in healthcare do I get treated any differently. As a provider, the discrimination can stem from patients or colleagues with preconceived, underrated expectations of racialized peoples’ performances, and hence a lack of trust in their abilities as providers, and also unequal (or mostly, subdued) access to and opportunities for growth and development within their various units. All of these experiences, and their impacts on wellbeing demonstrate a critical need for research with and for persons on both sides of the table. By doing this work with and for patients who may fit within these identity brackets, especially for topics that could be stigmatizing such as sexually transmitted infections and HIV, I hope to amplify their voices and create an awareness of their situations. I hope that in creating such an awareness of the existing disparities and inequities; and with the development of interventions, put in place by healthcare providers, public health officers, and even the government; that there might be opportunities to rebuild some of the trust which may have seemed lost in the system, by these communities.

How does Women’s Health specifically intersect with your work at the moment?

Women’s health is at the center of everything I do in my research. A lot of my work focuses on the sexual and reproductive health of women. I currently have two ongoing studies; one, examining the impacts of COVID-19 on quality of life for African, Caribbean, and Black women living with HIV in BC; and another exploring the impacts of racism, sexism, and psychosocial vulnerabilities on access to care services for African, Caribbean, and Black women living with HIV. While I have a special interest for racialized women, I do not shy away from work focusing on the psychosocial and sociostructural factors influencing equitable care for all women. Merely existing in a patriarchal world as a woman can interfere with several aspects of wellbeing. The impacts of other layers of marginalization can have very lasting, detrimental effects on the lives of persons who fit within these identity brackets. Examining the impacts of these intersecting, underprivileged identities and unpacking the various layers and layers of vulnerabilities that surface, is at the core of my research. So in essence, the makeup of a woman’s sexual and reproductive health, and how that interferes with and/or allows them to exist inclusively in a very patriarchal system is of importance to me.

What impact do you hope to see with your work years from now?

I’m hoping that knowledge generated from my work can have lasting positive impacts in the way that care is modified/adjusted for the affected populations. Not surprisingly, there isn’t a lot of data on marginalized populations when it comes to women’s reproductive health, whether it’s rates of maternal mortality or anything else, in Canada. I’m hoping that my research can contribute to bridging those gaps and generating these data, so that researchers, community leaders, healthcare providers, the government, and others in positions of power may be alerted to these situations and help to effect change. We know that these issues exist but the paucity of data and research in this area limits the opportunities for interventions that are culturally-sensitive and -safe. I hope that my research in the short run, can be a “call to action” and in the long run can lead to sustainable “actions for change” for enhancing women’s equitable health.

Where can people find your work?

My email, usually, is the best way to contact me, at emmanuela.ojukwu@ubc.ca.

Behind the Science: Designing for Pregnancy After Loss, With and Through Technology

Interviewee: Kamala Payyapilly Thiruvenkatanathan, PhD candidate, Pennsylvania State University. Authors/Editors: Romina Garcia de leon, Shayda Swann (Blog Co-coordinator).

Published: October 21tst 2022. 

Could you briefly explain your research?

My research is situated at the intersection of women’s health and technology with a specific focus on pregnancy after loss. There has been a rising emphasis on designing technology for women’s health and this has led to the growth of the FemTech industry. FemTech is an abbreviation for “Female Technology” and is inclusive of a plethora of women’s health systems ranging from menstrual and fertility trackers to smart wearables that track women’s intimate health data to artificial intelligence based diagnostic devices. Among women’s health issues addressed, there has been an increasing focus on the pregnant body as a site of research and intervention. And yet, the pregnant and the maternal body are used interchangeably, neglecting a common but an unpleasant outcome of pregnancy loss and the associated felt experiences of women navigating pregnancy after loss. Pregnancy loss which encompasses miscarriage and stillbirth is incredibly common and approximately 80% of women get pregnant again after loss. However, their pregnancy journey is never the same given the physical and the emotional trauma they experienced during pregnancy loss. Attending to the rising interest in designing interventions for pregnancy and maternal health, alongside the ongoing call to question the stigmatization of women’s bodies, my research centers a common but tabooed experience of pregnancy after loss.

What got you interested in this research?

As a human, I seek fulfillment in making a positive impact in the lives of the underserved, those who are truly in need. At a young age, I was not aware of a career that allowed me to embrace my personal value of wanting to serve the underserved. Parking it aside, I decided to step into a typical, professional career journey that would eventually fetch me a job. Before setting foot into my doctoral path, I was a trained computer science engineer, with my understanding of technology limited to its functionality. I considered my ability to comprehend technology’s inner workings as my strength. A few years later, during my attempt to make a career detour in search of fulfillment, I was introduced to the domain of Human Computer Interaction (HCI). I always had a passion for design and HCI revealed ways through which I could combine my technological strength with that of design. More importantly, HCI rekindled my yearning to help those in need, by exposing me to the world of humanistic research. Reflecting on my personal values and my positionality as a woman led to the pursuit of research on women’s health, acknowledging women’s lived bodily experiences. My stumbling upon the world of FemTech by chance also enabled ways to reinforce my ability to comprehend (and perhaps design) technology. My observations along with a critical reflection of my personal values, of wanting to design for the margins, motivated me to design for the neglected felt experiences of women navigating pregnancy after loss, with and through technology.

What impact do you hope to see with this work years from now?

The ultimate goal of my research is to bring to the forefront the lived bodily experiences of women navigating pregnancy after loss. Discussing pregnancy loss and pregnancy after loss continues to be a taboo. I hope for my research to contribute to the emancipatory research agenda within women’s health in HCI, bringing to the fore a stigmatized and yet common experience of pregnancy loss. Additionally, as a part of my research process, I aim to design with women that could lead to concrete design implications on tangible FemTech systems that employ emerging technologies to support the unique needs of women experiencing pregnancy after loss. Ultimately, I hope for my work to contribute to the de-stigmatization of pregnancy loss and reimagining the pregnant body, considering unique unheard experiences of women navigating pregnancy after loss. 

 Can you tell us about any barriers you’ve faced advocating for women’s health in the human-computer interaction field? 

Despite a growing trend in HCI towards experience, embodied interactions, and leisure technologies, some topics related to the body, such as women’s health and human sexuality, remain to be a taboo. Given the taboos associated with designing for women’s bodies, it takes extra efforts and often an activist stance, to invoke discussions related to the need to design considering women’s embodied, lived experiences. Additionally, with the emergence of women’s health technologies, there is a need to understand how technology conditions women’s bodies and generate implications towards designing better women’s health technologies. However, as a woman, my own subjectivity and positionality often meddles with my interpretation and critique of women’s health technologies and it often gets challenging to convey the same in an acceptable form, to the research community.

What is the best way for people to learn more about your work?

You can find more about my work on my website. 

 

Oral Contraceptives and Emotions: How Progestin can Influence Mood and Socio-Emotional Cognition

Author: Minhal Mussawar, University of Saskatchewan | Editors: Romina Garcia de leon, Shayda Swann  (Blog Coordinators) 

Published: September 23rd, 2022

Oral contraceptives are one of the most commonly chosen forms of contraception in Canada. Reasons for this include high therapeutic value and status as a cheap and accessible form of contraceptive, but also for their health benefits, such as managing dysmenorrhea, premenstrual syndrome and reducing the risk of ovarian cancer. Hence, they represent a cost-effective way of mitigating and treating many health conditions. Unfortunately, they also come with a number of negative side effects, including nausea, headaches and cramping, and can increase the risk of cardiovascular conditions in some users. Moreover, the likelihood of developing serious complications, such as venous thromboembolisms, can vary depending on whether an individual is taking a combined or progestin-only pill, meaning that certain patient populations may fare better on one type of pill than another. Another health condition that may be influenced by oral contraceptive type is breast cancer, where women who use high-dose estrogen pills are at a higher risk of developing breast cancer than those who use lower doses.

Evidently, there is plenty of research regarding the physiological effects of oral contraceptives on its users. In an age where female participants are being studied more and the scientific community has acknowledged its history of favouring male participants in the past, this type of research has become paramount as it represents a push towards sex inclusivity in literature that was previously non-existent.

Yet, while progress has been made with respect to studying the physical effects of oral contraceptives, less can be said about their cognitive and psychological effects. One study reported mood differences associated with the use of combined oral contraceptives, and another noted differential effects on verbal memory based on whether participants were in the active pill phase (pills that contained the active ingredients of estradiol and progestin) of their birth control or the inactive phase (“placebo” pills). However, aside from generalised research on the effects of combined pills, few studies have assessed the extent birth control can impact a person’s cognitive functioning. Even fewer have separated the effects of ethinyl estradiol and progestin (the two active ingredients in all combined oral contraceptives) and independently studied their effects. Our study aimed to address this issue; we wanted to see how one component of the combined oral contraceptive pill – progestin androgenicity – can affect various cognitive and emotional parameters.

Progestin androgenicity refers to the extent to which a progestin is structurally related to the androgenic hormone testosterone; progestins with high levels of androgenicity tend to bind to testosterone receptors in the body with a higher affinity than their anti-androgenic counterparts. This, unsurprisingly, leads to more androgenic side effects when taking the pill. For our study, we first looked at the existing literature on progestin type and cognitive differences. We found a few papers that suggested users who took oral contraceptives with androgenic progestins performed worse on verbal memory tasks than those who took anti-androgenic contraceptives. Other research suggested that individuals who took oral contraceptives with androgenic progestins performed better on visuospatial and socio-emotional tasks.

Based on this research, we anticipated that individuals taking highly androgenic progestins would yield higher and more accurate scores on social-emotional cognition (emotion recognition and rejection sensitivity) relative to non-androgenic progestin users. Our findings aligned with this hypothesis, as we found that androgenic progestin users were better at recognising negative emotions such as facial expressions of sadness, fear and disgust. Interestingly enough, androgenic users also reported feeling significantly more stressed when measuring their mood on a visual analogue scale compared to anti-androgenic users. Overall, these results indicate that highly androgenic progestins may have a negative psychological effect on users versus anti-androgenic users.

 

 

                                                                

Figure 1. Progestin androgenicity effects on mean stress scores on the Visual Analogue Scale (standard error bars shown). Androgenic users reported feeling significantly more stressed throughout the lab session.

 

Figure 2. Average rate of correct identification (%) for sadness on the Emotion Recognition Task (standard error bars shown). Androgenic users were significantly more accurate at identifying sadness compared to anti-androgenic users.

These findings are consistent with previous research on androgenic hormones and socio-emotional cognition; studies have found correlations between social threat identification and testosterone. Additionally, anti-androgenic progestins have historically been used to treat negative mood in premenstrual syndrome; this makes the association between negative mood and androgenic progestins expected.

So how do we interpret these findings on a larger scale? Well, there are two key implications that arise from this study, the first of which comes from the association between negative mood and androgenic progestin use. As noted earlier, oral contraceptives with anti-androgenic progestins can be used to treat negative mood symptoms in premenstrual syndrome. With this in mind, it may be worth considering progestin androgenicity when prescribing oral contraceptives to this patient population, as well to patients who may be at risk or have a history of depression and anxiety as androgenic progestins could potentially exacerbate any negative thoughts they may have. The second implication comes from how oral contraceptives are viewed in general. Since they are  very common drugs, it can be easy to underestimate their effects, as a result, people who may consider using them may not appreciate how much of an impact they may have on their socio-emotional functioning. In fact, it is not uncommon to hear about people “just going on birth control” once they become sexually active, and while implementing contraceptive measures ought to be encouraged, those who are considering using them should still be informed about their potential side effects. The same goes for people who expect their partners to start oral contraceptives.

This research represents the tip of the iceberg when it comes to studying the psychological effects of oral contraceptives. There are a multitude of other factors at play that should also be considered in light of this study; for example, ethinyl estradiol dose can induce its own effects on users, independent of progestin type. This is also something that we hope to look into further with our research, where our next steps involve assessing the role estrogen plays on the same parameters. We look forward to seeing the results and hope it can help elucidate the role each hormone can play.  

 

Behind the Science: Promoting Women’s Mental HealthThrough Social Interventions

Authors: Romina Garicia de leon and Negin Nia, Women’s Health Blog Coordinators | Interviewee: Dr. Saima Hirani, Ph.D., University of British Columbia

Published: September 9th, 2022 

Can you please tell us a bit about your career trajectory as a registered nurse, and now Assistant Professor of Nursing?

I’m an internationally educated nurse. I completed my Bachelors of Science and Master of Science in Nursing from The Aga Khan University in Pakistan. I began  my nursing career as an intensive care unit and cardiac intensive care unit nurse in Pakistan, which involved a lot of technical, high tech, critical care.

I then came to Canada and completed my PhD in Nursing with a focus on mental health at the University of Alberta. After PhD, I went back to Pakistan and worked as an Assistant Professor in the Aga Khan University. In 2019, I joined University of British Columbia (UBC) as a postdoctoral research fellow and currently, I am Assistant Professor,  at UBC,  School of Nursing.

What got you interested in Mental health Nursing? 

After I started working in the ICU, I got some experience with mental health nursing and I got to work with a variety of women, some of whom were incarcerated, survivors of sexual assault or domestic violence. This got me interested in mental health, and many of my teachers recommended me to enter the field.  In 2007, I joined a multidisciplinary research project as a co-investigator that aimed to promote mental health and empowerment in women. My master’s thesis was also part of that larger project. By the time I came to Canada for my PhD, it was very clear that I wanted to focus on women’s health and mental health specifically. My PhD focused on development and testing of social support intervention for women’s resilience and quality of life. My program of research mainly focuses on mental health promotion of individuals including women who live in socioeconomic disadvantaged settings. 

You recently published a paper on COVID-19 and its effects on mental health. Can you elaborate on that study? 

So that was a team that I was working with during my postdoctoral work. Dr. Emily Jenkins led this work which was about the impact of COVID-19 on Canadian Mental Health. The first findings that we published showed  an anticipated change in mental health issues among the population, and especially women experienced more mental health issues than men, globally. COVID-19 has affected women badly, as we all know there are some social issues at play. For example, many working women were also taking care of kids at home so there is a double burden. Sex differences were also observed for employment losses i.e. women’s employment has been affected more than men.There’s actually a layer of complexity into women’s well being and in turn the well being of the families and the children. 

You touched a bit on this, but why is women’s health important to you?

Women’s Health has been very close to me for a long time. This passion started when I was a master’s student 15 years ago. I actually joined a multidisciplinary research team back in Pakistan, and it was made up of nurses, psychologists, and psychiatrists. The team’s goal was to develop and test economic skill building and life skill interventions for women, and that’s where my masters thesis came from. So I actually developed and tested that lifestyle building intervention and tested it for feasibility. Intervention development is not an easy task, I went through a lot  of literature, and interviewed several women who were living in some more vulnerable conditions, and some low socio economic communities. I would go to the urban slum areas of Karachi, Pakistan to work with these women. I learnt a lot from these women, it was a life changing experience for me. That was what laid the foundation for my work. After 15 years, I’m still very passionate about that work. 

And the way I think about it is, there are the two main reasons women’s health is important. The first and foremost is, women’s health is directly linked with the children and families health, which is the cornerstone of a family’s overall health. Working in different contexts  of Pakistan and Canada, I learnt that  in general women and mothers play the same roles across countries. There are some universal gender roles attached to women, therefore, women’s mental health is directly associated with their children’s wellbeing.  To pay attention to women’s health and well being is to make children’s lives better and create healthier families. 

And the second reason to focus on women’s health is the high prevalence and high risk of developing certain health challenges among women, as women experience unique healthcare issues more than men. Such as reproductive health issues, violence and abuse, depression and anxiety. These issues are more prevalent globally, and not only in low and middle income women. Moreover, women don’t just experience higher prevalence to diseases but more barriers in accessing  health care than men. Some women may lack economic independence in certain countries, meaning no or lack of education opportunities, or unemployment. If women don’t have the freedom to decide for themselves, this creates a large barrier to reach out for help and support.  Mostly, I’ve seen these issues come up in Pakistan, when women get married. A lot  of attention goes to their families and children, leading them to overlook their own health. So I think this realization and awareness drove the focus of my research, and to empower women, and help them prioritize their health. 

Where can people go to learn more about the work that you do? 

I have  twitter @HiraniSaima and people can look at my Google Scholar or PubMed. 

 

Using the Power of Sex Differences in Research: What a difference 10 years Did Not Make

Authors: Rebecca Rechlin, BSc Behavioural Neuroscience; Tallinn Splinter, BSc Biology, University of British Columbia | Editors: Negin Nia, Romina Garcia de leon  (Blog Coordinators).

Published: August 26th, 2022.

Females have been overlooked in health research for decades, and despite 10 years of advancements and improvements in knowledge, this has still not changed significantly.  Historically, there has been a long-standing bias of using males predominantly in scientific research instead of females, and as male and female health differ, this has led to health disparities for both males and females. Biological differences between females and males exist in diseases, such as in disease progression, symptomatology, and drug efficacy in many neurological and physiological diseases.

The study of these sex differences is essential for the understanding and advancement of disease treatment and precision medicine. For example women have double the risk for adverse drug reactions compared to men, which may in part be due to incorrect dosing (for instance despite both men and women being recommended the same dose for acetaminophen, an active ingredient in Tylenol, women break down the drug 60% slower than men). The biomedical and clinical research community is beginning to make corrections for these inequalities by issuing mandates for including females in clinical trials (such as by the NIH in 1993), and frameworks from funding agencies to address sex and gender in upcoming research (CIHR: Sex and Gender based Analysis (SGBA)) in 2010, and NIH: Sex As a Biological Variable (SABV) in 2016), however, there is still a long way to go to reach equality. Despite these mandates and increased approving attitudes towards these policies, the literature shows very little improvement in the analysis or examination of any potential sex differences.

Our study aimed to investigate whether and how possible sex differences were being investigated in neuroscience and psychiatry research. We looked at over 3,000 neuroscience and psychiatry studies in 2009 and in 2019 to see whether researchers were including both sexes in their studies. We found that only 53% of these studies actually included both males and females, and only 16.5% of these used an equal number of males and females throughout their study. Of the papers that used both sexes only 6% actually analyzed sex as a discovery variable. We found that the majority (60%) of the papers that used both sexes did not do any analysis by sex. This is concerning, as this means that we will lose out on important scientific discoveries if researchers are failing to embrace the power of studying potential sex differences. 

 

Figure 1: An infographic depicting the change in percentages of total papers sampled reporting studies in 2009 and 2019 that used both sexes, a single sex, omitted sex, papers reporting studies that used an optimal design or analyses for the discovery of possible sex differences irrespective of discipline. Reprinted with permission from Rechlin et al. 2022

It is important to note that biology sex and gender are two different things, and neither one is binary. Sex refers to the biological and physiological attributes of females and males, whereas gender is a psychosocial construct that includes one’s gender identity, and the norms and expectations set out by society. In our analysis we focused on studies using males and females (or sex) in rodents, humans and in research using cell lines, but the study of gender differences is also important to study and examine in regards to disease and treatments.

However studying sex differences, while important is not the only path towards equitable findings and discoveries in both men and women’s health research. With that in mind we found that although 27% of all studies in 2019 were conducted in males, only 3% were in females only! That means there were 9x more studies in males than in females! This greater focus on male health likely contributes to the health disparity and contributes to the historical male bias in assuming females and males are the same. Single sex studies are still essential for the discovery of sex-specific diseases/conditions such as prostate cancer in males and cervical conditions in females. Females specific factors, such as pregnancy and menopause, contribute to health outcomes and disease risk. For example, depression has a higher prevalence in women than men, and the risk of depression is largely increased during perimenopause and during the postpartum period.

So what can we do to improve these disparities? For starters, researchers need to actually analyze their data by using sex as a factor (or discovery variable). This essentially means including sex as one of the independent variables of the study (and not just controlling for it), allowing for the discovery of potential sex differences. It is also important for researchers to use a balanced and consistent study design, meaning they need to use both males and females consistently and in relatively equal numbers throughout their study. And even if they don’t find any sex differences, then the paper should make that statement with supporting statistics and a table to show the means and variation of the dependent variables by sex. This information of no sex differences is just as important as the discovery of them.

For funding agencies, one solution is to have funding dedicated specifically for SABV and SGBA proposals and not as a supplement to regular funding. More training modules from funders or scholarly organizations with an SABV focus may help, however, enticing researchers to explore the influence of sex and gender in their data may be a more fruitful approach. If journals, especially those with higher visibility, adopt calls for papers using sex and gender-based analyses this may serve as a catalyst to ensure more researchers consider possible sex differences and further promote the notion that this research is important to publish. Since we published our paper – Nature journals have committed to ensuring sex and gender are considered in their study design, by requiring authors to state how and why sex/gender was considered, or to state why it was not. If implemented as intended, this is a good first step to increase the amount of studies considering sex and gender in their analysis, and may be a great leap towards fixing these health disparities. 

 

Behind the Science: New Ways of Investigating Ovarian Cancer Prevention


Interviewee: Alex Lukey, PhD, University of British Columbia, School of Population and Public Health. Authors/Editors: Negin Nia & Romina Garcia de leon (Blog Co-coordinators).

Published: August 12th, 2022.

Alex Lukey, a previous Women’s Health Research Cluster (WHRC), Blog Co-coordinator is speaking to us about her work on ovarian cancer prevention. Lukey is working on preventing ovarian cancer using big data and machine learning. Read more to find out about her work and how she got into the women’s health field.

Could you please tell us about your current research?

The lab that I work in studies ovarian cancer, specifically the prevention aspect. So, the project that I am going to be working on focuses on using the big datasets that are in BC to try and predict ovarian cancer. This is to possibly make recommendations in a clinical setting regarding prevention efforts. 

My supervisor, Dr. Gillian Hanley, works around opportunistic salpingectomy. In the last 10 years or so the research found that a lot of ovarian cancers start on the fallopian tube rather than the actual ovaries. So, about 10 years ago a team in BC started doing opportunistic salpingectomies. This means if someone goes into another gynecological surgery, and they are done having kids (or don’t want any), they can have their fallopian tubes taken out by choice, at the same time.

We now have studies that show that removing the fallopian tubes is effective at preventing the most common and deadly form of ovarian cancer. My PhD will be looking at this and seeing if we can take this a step further by possibly targeting people who are at higher risk. I am also going to be doing qualitative research because it is a big decision to undergo surgery and to make that decision as a patient – but this is why the research is needed.

What sparked your interest to pursue this work?

I have always been interested in women’s health research. My Master’s in nursing at UBC Okanagan focused on improving heart failure self-care through gamified education which so my PhD work is pretty different, but even back in nursing school I volunteered at the Options for Sexual Health Clinic. So, I have always been interested in making women’s health research more equitable because there are so many big gaps.

Before my PhD I was working with Dr. Hanley on a project that was looking at hormone replacement therapy on a grant I was awarded called the CIHR Women’s Health Clinical Mentorship Grant. After that, I decided to keep working with Dr. Hanley as my PhD supervisor because she’s a fantastic researcher and her lab focused on my interests of ovarian cancer and population-based data. I knew I wanted to work in big datasets for my PhD because there are many opportunities to translate research into provincial, national and even international knowledge and answer important research questions. 

How do you hope this research will impact the women’s health field?

For me, the most tangible impact would be that we are allowing patients to make that decision regarding preventing ovarian cancer around their own bodies and health. Before we can offer salpingectomy at a greater scale for preventing ovarian cancer though more work needs to be done. This is totally an individual decision, but I want people to be able to take their health into their own hands.

The cancer survival rate has not really moved much in the last 30 years. There have been better treatments and drugs coming out. But the five year survival rate of ovarian cancer is still less than 50 per cent which is pretty abysmal. This also affects a lot of people on the younger side, in their 50 or 60’s. It’s a very deadly and devastating disease and often has major long term health impacts for those who do survive. Survivors can have their quality of life impacted through things like sexual dysfunction, bowel dysfunction, and continuing pain just to name a fewy. So, we are just trying to help prevent ovarian cancer from happening in the first place.

Did any of this tie into the work you did with the WHRC as a Blog Co-coordinator?

I definitely would say that, when I was a blog coordinator it was a really great experience to learn about a lot of different research areas. It was also really cool to see what other people were working on. I learned about so many impressive research projects going on in women’s health. And it’s really exciting to see so many really motivated researchers out thereIn research, you often have to just pick your little area and kind of stay focused on that. But I think it was really exciting to see how many different areas are being addressed even just in BC and Canada.

Is there anything else you are currently working on?

I am still helping out with the trainee research presentation for the WHRC. We just had one in June and we will likely have another in September. I love hearing about more research being done in the field of women’s health and it is an opportunity for trainees ranging from undergrad to post-doc to showcase their work and practice presenting. So, if anyone wants to participate in that, then they can reach out to me.

Where can people find you and your work?

I’d be happy to connect on Twitter so I can be found at @AlexandraLukey there for any questions. If people are more interested in the research aspect of things feel free to email me alukey@mail.ubc.ca

Behind the Science: Health Access of Indigenous Women


Interviewee: Chelsey Perry, M.S.c, Simon Fraser University, Authors/Editors: Negin Nia & Romina Garcia de leon (Blog Co-coordinators)

Published: July 15th, 2022

This week the WHRC spoke to Chelsey Perry, who is focusing her master’s work and research with the Centre for Gender and Sexual Health Equity (CGSHE) to examine social and structural factors that influence health access of Indigenous women, Two-Spirit and gender-diverse people. Perry has been working on several projects aiming to make a change in a colonial health system, and to amplify Indigenous voices. Read more about their work below.

Could you please tell us about the work that you do with the Centre for Gender and Sexual Health Equity?

I started my master’s degree at SFU last year and before that I started working on some projects in the summer at the CGSHE. They were about decolonizing Indigenous research methodologies and creating training for researchers who want to get involved in Indigenous research with the CGSHE and Vancouver Coastal Health. 

On the other hand, I am also working on projects with the SHAWNA (Sexual Health & HIV/AIDS: Longitudinal Women’s Needs Assessment) and AESHA (An Evaluation of Sex Workers Health Access) cohorts housed at CGSHE. In these projects we have pulled the Indigenous data from those two cohorts to specifically look at Indigenous women, Two-Spirit and gender diverse people’s experiences throughout the COVID 19 pandemic.This was to make sure that we are accurately and appropriately looking at the data from an Indigenous lens. And, also to inform on social and structural inequities during the course of the pandemic. 

My work specifically focuses on access to routine health care for Indigenous women, and gender-diverse people during the pandemic. But, also how Indigenous communities have come together and how that’s impacted access to health services among Indigenous women, Two-Spirit and gender diverse people.

And how does this tie into your master’s thesis?

My master’s work is nested within a larger project called the Amplify project at CGSHE, which looks at equitable and culturally safe sexual and reproductive health services among Indigenous women, Two-Spirit and gender-diverse people. This is where my master’s work and my research work are really intertwined. My master’s research focuses on that access to routine health care, access to sexual reproductive, and health services. But I also do work on other projects for the Amplify project and the AESHA cohort as well. 

What got you interested in this type of research in the field of women’s health?

I have always been interested in health research because of my family experiences and just wanting to make change in a colonial health system. There is a lot of room to bridge gaps between a colonial health system and Indigenous ways of knowing. I have mixed Nisga’a, Haida, Scottish and French ancestry and I’m a member of the Nisga’a First Nation – and I think my varying identities can bring a unique perspective to this work.

I also believe that it is so important to be amplifying Indigenous voices to inform actionable change — and I want to be a part of supporting change. And I really wanted to work with the supervisors I’m working with, because they have all been doing excellent work within this field and really inspire me. 

What are some long-term goals for your research?

In my thesis research, each objective is tied to the calls to action and recommendations from the Truth and Reconciliation, In Plain Sight, and the Inquiry into Missing and Murdered Indigenous Women and Girls reports. So, this research addresses calls to action and recommendations from these reports to look at gaps within health outcomes between Indigenous and non-Indigenous peoples as well as social and structural factors that impact Indigenous women, Two-Spirit and gender diverse peoples health.

I hope this research will support policy changes to address the urgent need for culturally safe care and anti racism legislation, here in BC, but also broader in Canada, too. And to address health gaps that are caused by social and structural inequities.

Where can people find you and your work?

People can learn more about me and my work @chelseyllperry on Twitter and on LinkedIn.

Mastectomy, Then and Now: The Cases of Frances Burney and Marie-Claude Belzile


Author: Heather Meek, Ph.D., Associate Professor of English Studies, University of Montreal | Editors: Negin Nia & Romina Garcia de leon (Blog Co-coordinators)

Published: July 1st, 2022

Mastectomy and Women’s Health

Frances Burney (1752-1840) and Marie-Claude Belzile (1987-2020), separated in time by two hundred years, can be aligned to the extent that they both underwent mastectomies and felt the impulse to share their stories in writing. Burney’s 20-page letter, written in 1812, and addressed to her sister Esther, and Belzile’s essay Penser le sein féministe, published in 2019, offer accounts of breast surgery written from the perspective of the sufferer. Despite their historical distance from each other, and the significant differences in the virulence of their illnesses and the technical particularities of their treatments, reading Burney’s letter alongside Belzile’s essay reveals, strikingly, how certain aspects of the experience of mastectomy have remained consistent over time. 

Belzile’s text draws out the latent political potential of Burney’s account as it moves beyond the personal into larger contemporary feminist and LGBTQAI+ contexts and explores the politics of breast reconstruction. Both works serve as testaments to the importance of patient narratives to the history of women’s health, especially as explorations of the complexities of women’s relationships to their post-surgical bodies and appraisals of institutionalized medical practices and rituals. Burney’s and Belzile’s narratives depict medical encounters that exceed an ethos of biomedical conquest as they capture remarkable encounters with bodily variation and death.

Burney and Belzile’s Point of View

Burney and Belzile both grapple with physical and psychic loss as they contemplate the prospect of surgery and the fate of their breasts. Anticipating what she believed would be a tumour excision, Burney confesses to her feelings of “dread & repugnance, from a thousand reasons besides the pain”. She gestures implicitly to what it meant to lose a breast, which in this period was understood as a material entity integral to the life of the female body, and as a powerful symbol of maternal tenderness, feminine beauty, and sexual pleasure. 

Belzile acknowledges explicitly such multivalent cultural meanings of the breast and brings them into the current moment, explaining that hypersexualized breasts are, rather puzzlingly, displayed everywhere even as they are viewed as objects to be “concealed from male onlookers, revealed only in intimacy”*. She at once denounces and transcends such patriarchal notions as she mourns, in a way uniquely her own, the loss of her own breasts, remembering how she was forced to “think about the future of my chest in the urgency of a few weeks” when she received her cancer diagnosis. 

 While Burney’s account predates the consolidation of a distinct medical profession, and Belzile’s case is situated in our current age of rapid medical innovation, both authors offer critical accounts of entrenched rituals and systems that silence, objectify, or disregard female patients. Burney is unprepared when “seven men in black” enter her operating room, when her face is covered in a semi-transparent veil, and when she learns, for the first time, mere minutes before the surgeons begin the excision, that her entire right breast will be removed. 

 One might assume that such astonishing details are relics of Burney’s period, but Belzile describes not being listened to by her surgical team, which she fortuitously discovered had planned to insert, during her operation, tissue expanders to make possible an eventual reconstruction which she had made adamantly clear she did not want. She presents this not as a rarity but as a systemic problem – as one among many instances of breast cancer patients’ choices being discounted or trivialized.  

The Idealized Female Body

Both Burney and Belzile refuse to elevate an idealized, supposedly ‘whole’ female body, forcing their readers to come face-to-face with the physical realities of mastectomy. Burney, whose 20-minute operation took place before the advent of anesthetic, describes how “the dreadful steel was plunged into the breast – cutting through veins – arteries – flesh – nerves” . Evoking her own bilateral mastectomy, Belzile celebrates the altered realities of women’s bodies, and affirms that “a flat chest is a chest that exists”. Belzile’s essay and Burney’s letter resonate with Audre Lorde’s lyrical embrace, in her Cancer Journals (1980), of a vocal coterie of one-breasted women.

A final link between Burney’s and Belzile’s accounts is found in the way they resist triumphant narratives of the sort Susan Sontag scrutinizes in her foundational essay Illness as Metaphor (1978) – ones in which medical cure is “the great destination,” ‘survivor’ and ‘military’ metaphors of illness flourish, and the realities of mortality are averted. Burney, even as she assures her sister of her “perfect recovery”, maintains that she is traumatized by this “terrible business” whose recollection is “painful”. She thus refuses a comfortable return to her previous self. Belzile’s raw recognition of the departure of her “before body” is described, paradoxically, in poetic and exultant prose as she insists that a woman can reclaim her “body, welcoming with compassion its history, its scars, and its transformations”. This optimism does not, however, preclude a recognition of what Lorde calls our temporary status “upon this earth”. The specter of death looms, since, as her reader knows, Belzile’s cancer is incurable and will eventually consume her. 

Transcending historical boundaries and speaking to each other across centuries, Belzile and Burney, together, provide stunning images of flat and one-breasted chests, brave recollections of bodily violation and transformation, and extraordinarily honest confrontations with mortality.  

*All quotations in this essay from Belzile’s Penser le sein féministe were translated into English by Heather Meek.

Behind the Science: Racializied Women’s Physical Pain Dismissal


Interviewee: Negin Nia, B.A., M.J., University of British Columbia, Author/Editor: Romina Garcia de leon (Blog Co-coordinator).

Published: June 17th, 2022

In this week’s Behind the Science, we highlight work done by our current Blog Co-Coordinator at the Women’s Health Research Cluster (WHRC), Negin Nia. She is a recent Master’s graduate from the UBC School of Journalism who specialized in public health. Negin’s final research project in the program sought to examine the intersection between women’s physical pain, race, and treatment in North America’s hospitals and beyond.

Negin did not only complete a literature review but also released an audio documentary covering the lived experiences of racialized women. Her podcast was recently awarded the 2022 Radio Television Digital News Foundation JJ Richards Award. Read more about her project and the lived experience that drove this work. 

Can you please tell me about the work you have done during your Master of Journalism degree? 

For the last year in my program, I decided to focus my journalism specialization on health reporting. This work was driven by my lived experience but also because I believe health impacts every aspect of our lives. 

I did my final research project, which was a combination of a literature review, and an audio documentary on women’s physical pain, race and treatment. There is a lot of research that shows that women, especially racialized women, experience a heightened degree of discrimination, stigma and dismissal of their physical pain because of stereotypes and biases. This is particularly striking as women already experience more chronic pain than men. 

So, the audio documentary explores the lived experiences of many women, including my own story surrounding physical pain, race and accessing treatment across North America’s health care systems. And then the final literature review was more of a deep dive into why this is happening. It included the research in the statistics, whereas the audio documentary was more testimony with facts — they complement each other well.

What led you to pursue this work in the field of health? 

Back in 2020, I had to undergo open-heart surgery for a benign heart condition that I have had my whole life. The situation caught me by surprise because I was an outwardly healthy, 22-year-old. But I had been having a lot of heart palpitations during that year and the doctors kept telling me it was just my anxiety. 

Finally, I got referred to a cardiologist who took such great care of me and took my pain seriously. He scheduled me for an MRI, which is an uncommon test to run for my condition. Usually, it’s an echo scan. The MRI showed more than the echo scan did, that my heart condition had all of a sudden become severe with no explanation. I underwent surgery as soon as possible. 

That experience was super scary and shocking, but I have come out of it a lot stronger — it taught me so much. And just being in the hospital that week, and talking to other people who have been dealing with chronic health issues, really opened up my eyes to the disproportionate dismissal that women, people of color, and non-binary folk face in the healthcare system. 

Do you incorporate the knowledge you gained from your undergraduate degree into what you do now? 

I did my undergraduate degree at UBC in political science and law, and it taught me how to develop my writing skills. I also focused a lot on health policy during my degree. I originally wanted to become a lawyer, but after I started writing for the school newspaper, I realized that I love writing and journalism. 

That degree equipped me for a lot of what I’m doing now in my work at the WHRC, and it also gave me the skills to pursue my master’s degree and the work that has come from it. 

What are your next steps, and long-term goals? 

I’m very interested in pursuing work that’s meaningful, similar to what I did in my podcast. I enjoyed the aspect of sharing stories and highlighting the voices of marginalized and racialized groups — which is my passion. I think that it’s really important to do something you’re passionate about because it shines through your work. 

I’m also currently working at the Women’s Health Research cluster as a Blog Co-Coordinator, which has been amazing because it’s so enriching. Every week when we post blogs, there’s a new topic and I’m constantly learning about women’s health issues and people doing amazing work in the health field. 

How can people reach you and know more about your work?

My Twitter handle is @_neginnia. My podcast is titled “Let’s Talk About: Women’s Physical Pain, Race & Treatment,” and you can find it on Spotify.