Article Figures & Tables
Figures
- Figure 1
Flowchart showing the inclusion and exclusion criteria that were applied to the initial sample of 347 Canadian clinical practice guidelines on selected health conditions. A total of 71 text-positive guidelines were categorized as a function of the clinical relevance of the information provided. CMA = Canadian Medical Association, CPG = clinical practice guideline.
Tables
- Table 1: Examples of sex- and gender-related information included in various clinical practice guidelines
Condition Quote from guideline Group Guideline specifically recommends evidence-based diagnostic or management approach for men/women or boys/girls Ischemic heart disease Noninvasive testing not normally recommended for women < 60 years of age or men < 40 years of age with only 1 classical risk factor for angina Canadian Cardiovascular Society41 Stroke Acetylsalicylic acid recommended for reducing the risk of stroke in women only. Stroke unit care is equally beneficial for men and women. Canadian Stroke Best Practices and Standards Working Group42 Diabetes Acetylsalicylic acid recommended for reducing nonfatal myocardial infarction in men but not women without a history of cardiovascular disease Canadian Diabetes Association Clinical Practice Guidelines Expert Committee43 Childhood diabetes Adolescent females with type 1 diabetes should be regularly screened for eating disorders using nonjudgmental questions about weight and body image Canadian Diabetes Association Clinical Practice Guidelines Expert Committee44 Hypertension Recommended target of a healthy body weight (body mass index 18.5-24.9 kg/m2, with a waist circumference < 102 cm for men and < 88 cm for women) Canadian Hypertension Education Program,45-48 Canadian Diabetes Association Clinical Practice Guidelines Expert Committee49 Dyslipidemia Recommend plasma lipid screening in men > 40 years for low high-density lipoprotein (< 1.0 mmol/L) and in women > 50 years for low high-density lipoprotein (< 1.3 mmol/L) Canadian Diabetes Association Clinical Practice Guidelines Expert Committee,50 Canadian Cardiovascular Harmonized National Guidelines Endeavour51 Primary prevention of childhood obesity Educational interventions with a social learning foundation may be more effective with girls, while interventions that change environment to enable physical activity may be more effective with boys Registered Nurses' Association of Ontario52 Low risk drinking guidelines Screen for at-risk drinking in men < 65 years: 5 or more drinks on 1 or more days in the last year. Limit to no more than 3 drinks in any day, 15 per week.
Screen women < 65 years for 4 or more drinks on1 or more days in the last year. Limit to no more than 2 drinks in any day, 10 per week.Collège des médecins du Québec/Éduc'alcool,53 British Columbia Ministry of Health54,55 Guideline acknowledges different laboratory reference values for men/women or boys/girls Heart failure Recommends using World Health Organization definition of anemia: hemoglobin concentration < 130 g/dL for men and < 120 g/dL for women Canadian Cardiovascular Society56 Diabetic nephropathy 4-variable Modification of Diet in Renal Disease equation requires knowledge of the patient's sex for laboratory calculation of the estimated glomerular filtration rate Canadian Diabetes Association Clinical Practice Guidelines Expert Committee57 Asthma Spirometry reference values determined by sex Canadian Thoracic Society58 Guideline mentions epidemiologic or risk factor data only, without recommendations Dyslipidemia Women > 80 years are at increased risk for statin-induced myopathy Canadian Diabetes Association Clinical Practice Guidelines Expert Committee59 Heart failure Female patients are more likely to have nonischemic cardiomyopathy. Making a diagnosis of heart failure in women is considered to be more difficult, because the cardinal triad of edema, fatigue and dyspnea are neither sensitive nor specific manifestations and atypical presentations occur more frequently. Canadian Cardiovascular Society60 Diabetes Thiazolidinediones increase the risk of fracture in older women
Aboriginal women in Canada have a 2 to 3 times higher rate of gestational diabetes than othersCanadian Diabetes Association Clinical Practice Guidelines Expert Committee50 Anxiety disorders Women generally have higher prevalence rates for most anxiety disorders, compared to men Canadian Anxiety Guidelines Initiative Group61 Substance dependence Gender identity and gender expression are risk factors for a substance use disorder owing to widespread marginalization and discrimination Registered Nurses' Association of Ontario62 Colon cancer The risk for devepment of colon cancer is higher in males than in females.
Female sex is associated with more adverse events from colonoscopy, longer duration and incomplete examinations.Cancer Care Ontario63,64 Guideline makes superficial reference to the keywords sex, gender, men/women or boys/girls Coronary artery disease Only 28% of the patients in the trial were women Canadian Cardiovascular Society Heart Failure Management Primary Panel65 Chronic obstructive pulmonary disease Benefits of antibiotic administration on exacerbation rates were significant in 1 study, even after adjustment for sex American College of Chest Physicians/Canadian Thoracic Society66 Pain Pain scale has 6 gender-neutral faces Registered Nurses' Association of Ontario67
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