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  1. Article ; Online: Gender diversity of clinical practice guideline panels in Australia: important opportunities for progress.

    Carcel, Cheryl / Woodward, Mark

    The Medical journal of Australia

    2023  Volume 218, Issue 2, Page(s) 73–74

    MeSH term(s) Humans ; Evidence-Based Medicine ; Australia
    Language English
    Publishing date 2023-01-10
    Publishing country Australia
    Document type Editorial
    ZDB-ID 186082-3
    ISSN 1326-5377 ; 0025-729X
    ISSN (online) 1326-5377
    ISSN 0025-729X
    DOI 10.5694/mja2.51832
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  2. Article ; Online: Can Dietary Patterns That Support Planetary Health Benefit Population Health?

    Carcel, Cheryl / Bushnell, Cheryl

    Stroke

    2021  Volume 53, Issue 1, Page(s) 164–166

    MeSH term(s) Diet ; Diet, Healthy ; Humans ; Population Health ; Research
    Language English
    Publishing date 2021-12-07
    Publishing country United States
    Document type Editorial ; Comment
    ZDB-ID 80381-9
    ISSN 1524-4628 ; 0039-2499 ; 0749-7954
    ISSN (online) 1524-4628
    ISSN 0039-2499 ; 0749-7954
    DOI 10.1161/STROKEAHA.121.037314
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  3. Article ; Online: Under-Enrollment of Women in Stroke Clinical Trials: What Are the Causes and What Should Be Done About It?

    Carcel, Cheryl / Reeves, Mathew

    Stroke

    2021  Volume 52, Issue 2, Page(s) 452–457

    Abstract: The under-representation of women in clinical trials is a commonly recognized and seemingly intractable problem in many different areas of clinical medicine. Discrepancies in the enrollment of women in clinical trials raises concerns about the ... ...

    Abstract The under-representation of women in clinical trials is a commonly recognized and seemingly intractable problem in many different areas of clinical medicine. Discrepancies in the enrollment of women in clinical trials raises concerns about the generalizability of trial evidence, as well as the potential for reduced access and utilization of new therapies in women. Recent studies confirm that the problem of under-enrollment of women continues to exist in stroke clinical trials, even after accounting for the sex ratio of stroke cases in the underlying population. The origins of these disparities are complex, and there remains a relative dearth of stroke studies that have examined the causes in detail. Although caution should be used when generalizing research findings from studies conducted in other medical conditions including cardiology trials, factors that contribute to lower enrollment in women include the use of specific trial eligibility criteria (eg, older age, presence of specific comorbidities), patient attitudes and beliefs (resulting in less interest and more refusals in women), and potentially implicit biases among study personnel. Beyond a general call to prioritize stroke research in this area, we also recommend the greater use of trial screening logs, the use of qualitative studies to understand patient attitudes and beliefs towards stroke research, avoiding the use of age-based exclusion criteria (eg, >80 years), and increasing the number of women who lead stroke clinical trials.
    MeSH term(s) Bias ; Clinical Trials as Topic ; Female ; Humans ; Male ; Patient Selection ; Sex Factors ; Stroke/therapy
    Language English
    Publishing date 2021-01-25
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80381-9
    ISSN 1524-4628 ; 0039-2499 ; 0749-7954
    ISSN (online) 1524-4628
    ISSN 0039-2499 ; 0749-7954
    DOI 10.1161/STROKEAHA.120.033227
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  4. Article ; Online: Hypertension and mild cognitive impairment: state-of-the-art review.

    Shajahan, Sultana / Peters, Ruth / Carcel, Cheryl / Woodward, Mark / Harris, Katie / Anderson, Craig S

    American journal of hypertension

    2024  

    Abstract: Background: Mid-life hypertension is associated with cognitive decline and dementia in later life. Reducing high blood pressure (BP) with antihypertensive agents is a well-researched strategy to prevent dementia and mild cognitive impairment (MCI). ... ...

    Abstract Background: Mid-life hypertension is associated with cognitive decline and dementia in later life. Reducing high blood pressure (BP) with antihypertensive agents is a well-researched strategy to prevent dementia and mild cognitive impairment (MCI). However, there is still limited direct evidence to support the approach, and particularly for the treatment of the very old and those with existing MCI.
    Methods: This review presents an overview of the current evidence for the relationship between MCI and hypertension, and of the potential pathophysiological mechanisms related to cognitive decline and incidence dementia in relation to aging.
    Results: Although observational data are near consistent in showing an association between mid-life hypertension and MCI and/or dementia, the evidence in relation to hypertension in younger adults and the very old (age >80 years) is much more limited. Most of the commonly available antihypertensive agents appear to provide beneficial effects in reducing the risk dementia, but there is limited evidence to support such treatment in those with existing MCI.
    Conclusions: Further studies are needed to determine the optimal levels of BP control across different age groups, especially in adults with MCI, and which class(es) of antihypertensive agents and duration of treatment best preserve cognitive function in those at risk of, or with established, MCI.
    Language English
    Publishing date 2024-01-12
    Publishing country United States
    Document type Journal Article
    ZDB-ID 639383-4
    ISSN 1941-7225 ; 1879-1905 ; 0895-7061
    ISSN (online) 1941-7225 ; 1879-1905
    ISSN 0895-7061
    DOI 10.1093/ajh/hpae007
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  5. Article: Women's representation in clinical trials of patients with chronic kidney disease.

    Pinho-Gomes, Ana-Catarina / Carcel, Cheryl / Woodward, Mark / Hockham, Carinna

    Clinical kidney journal

    2023  Volume 16, Issue 9, Page(s) 1457–1464

    Abstract: Background: Sex and gender differences in chronic kidney disease (CKD), including epidemiology and response to treatment, remain poorly understood. This study aimed to investigate how women are represented in CKD clinical trials and whether sex- and ... ...

    Abstract Background: Sex and gender differences in chronic kidney disease (CKD), including epidemiology and response to treatment, remain poorly understood. This study aimed to investigate how women are represented in CKD clinical trials and whether sex- and gender-disaggregated outcomes were reported.
    Methods: Clinical trials on CKD were identified from ClinicalTrials.gov. Randomised, phase 3/4 trials with ≥100 participants were selected to quantify women's representation among participants by computing the participation:prevalence ratio (PPR) and investigating whether sex-disaggregated analyses had been performed.
    Results: In total, 192 CKD trials registered on ClinicalTrials.gov and published between 1995 and 2022 were included. Overall, women accounted for 66 875 (45%) of the 147 136 participants. Women's participation in clinical trials was lower than their representation in the underlying CKD population globally (55%). The PPR was 0.75 (95% confidence interval 0.72-0.78), with no significant variation irrespective of mean age, CKD stage, dialysis, location, type of intervention or funding agency. A total of 39 (20%) trials reported sex-disaggregated efficacy outcomes and none reported sex-disaggregated safety outcomes.
    Conclusion: Women's participation in CKD clinical trials was lower than their representation in the underlying CKD population. Sex-disaggregated efficacy and safety outcomes were rarely reported. Improving women's enrolment into clinical trials is crucial to enable sex- and gender-disaggregated analysis and thus identify potential differences in treatment response between women and men.
    Language English
    Publishing date 2023-02-02
    Publishing country England
    Document type Journal Article
    ZDB-ID 2655800-2
    ISSN 2048-8513 ; 2048-8505
    ISSN (online) 2048-8513
    ISSN 2048-8505
    DOI 10.1093/ckj/sfad018
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  6. Article ; Online: Differences in the pre-hospital management of women and men with stroke by emergency medical services in New South Wales.

    Wang, Xia / Carcel, Cheryl / Woodward, Mark

    The Medical journal of Australia

    2022  Volume 218, Issue 2, Page(s) 96

    MeSH term(s) Male ; Humans ; Female ; New South Wales ; Emergency Medical Services ; Stroke/therapy ; Hospitals
    Language English
    Publishing date 2022-12-10
    Publishing country Australia
    Document type Letter ; Comment
    ZDB-ID 186082-3
    ISSN 1326-5377 ; 0025-729X
    ISSN (online) 1326-5377
    ISSN 0025-729X
    DOI 10.5694/mja2.51809
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  7. Article ; Online: Author response: Sex differences in treatment and outcome after stroke: Pooled analysis including 19,000 participants.

    Carcel, Cheryl / Woodward, Mark

    Neurology

    2020  Volume 95, Issue 21, Page(s) 987

    MeSH term(s) Female ; Humans ; Male ; Sex Characteristics ; Sex Factors ; Stroke/therapy ; Treatment Outcome
    Language English
    Publishing date 2020-11-23
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 207147-2
    ISSN 1526-632X ; 0028-3878
    ISSN (online) 1526-632X
    ISSN 0028-3878
    DOI 10.1212/WNL.0000000000011042
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    Zs.MO 374: Show issues

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  8. Article ; Online: Blood Pressure and Stroke: A Review of Sex- and Ethnic/Racial-Specific Attributes to the Epidemiology, Pathophysiology, and Management of Raised Blood Pressure.

    Wang, Xia / Carcel, Cheryl / Woodward, Mark / Schutte, Aletta E

    Stroke

    2022  Volume 53, Issue 4, Page(s) 1114–1133

    Abstract: Raised blood pressure (BP) is the leading cause of death and disability worldwide, and its particular strong association with stroke is well established. Although systolic BP increases with age in both sexes, raised BP is more prevalent in males in early ...

    Abstract Raised blood pressure (BP) is the leading cause of death and disability worldwide, and its particular strong association with stroke is well established. Although systolic BP increases with age in both sexes, raised BP is more prevalent in males in early adulthood, overtaken by females at middle age, consistently across all ethnicities/races. However, there are clear regional differences on when females overtake males. Higher BP among males is observed until the seventh decade of life in high-income countries, compared with almost 3 decades earlier in low- and middle-income countries. Females and males tend to have different cardiovascular disease risk profiles, and many lifestyles also influence BP and cardiovascular disease in a sex-specific manner. Although no hypertension guidelines distinguish between sexes in BP thresholds to define or treat hypertension, observational evidence suggests that in terms of stroke risk, females would benefit from lower BP thresholds to the magnitude of 10 to 20 mm Hg. More randomized evidence is needed to determine if females have greater cardiovascular benefits from lowering BP and whether optimal BP is lower in females. Since 1990, the number of people with hypertension worldwide has doubled, with most of the increase occurring in low- and-middle-income countries where the greatest population growth was also seen. Sub-Saharan Africa, Oceania, and South Asia have the lowest detection, treatment, and control rates. High BP has a more significant effect on the burden of stroke among Black and Asian individuals than Whites, possibly attributable to differences in lifestyle, socioeconomic status, and health system resources. Although pharmacological therapy is recommended differently in local guidelines, recommendations on lifestyle modification are often very similar (salt restriction, increased potassium intake, reducing weight and alcohol, smoking cessation). This overall enhanced understanding of the sex- and ethnic/racial-specific attributes to BP motivates further scientific discovery to develop more effective prevention and treatment strategies to prevent stroke in high-risk populations.
    MeSH term(s) Adult ; Blood Pressure ; Cardiovascular Diseases/complications ; Female ; Humans ; Hypertension/complications ; Hypertension/epidemiology ; Hypertension/therapy ; Male ; Middle Aged ; Racial Groups ; Stroke/complications ; Stroke/epidemiology ; Stroke/therapy
    Language English
    Publishing date 2022-03-28
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Review
    ZDB-ID 80381-9
    ISSN 1524-4628 ; 0039-2499 ; 0749-7954
    ISSN (online) 1524-4628
    ISSN 0039-2499 ; 0749-7954
    DOI 10.1161/STROKEAHA.121.035852
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  9. Article ; Online: A life-course approach to tackling noncommunicable diseases in women.

    Carcel, Cheryl / Haupt, Sue / Arnott, Clare / Yap, Mei Ling / Henry, Amanda / Hirst, Jane E / Woodward, Mark / Norton, Robyn

    Nature medicine

    2024  Volume 30, Issue 1, Page(s) 51–60

    Abstract: Women's health has been critically underserved by a failure to look beyond women's sexual and reproductive systems to adequately consider their broader health needs. In almost every country in the world, noncommunicable diseases are the leading causes of ...

    Abstract Women's health has been critically underserved by a failure to look beyond women's sexual and reproductive systems to adequately consider their broader health needs. In almost every country in the world, noncommunicable diseases are the leading causes of death for women. Among these, cardiovascular disease (including heart disease and stroke) and cancer are the major causes of mortality. Risks for these conditions exist at each stage of women's lives, but recognition of the unique needs of women for the prevention and management of noncommunicable diseases is relatively recent and still emerging. Once they are diagnosed, treatments for these diseases are often costly and noncurative. Therefore, we call for a strategic, innovative life-course approach to identifying disease triggers and instigating cost-effective measures to minimize exposure in a timely manner. Prohibitive barriers to implementing this holistic approach to women's health exist in both the social arena and the medical arena. Recognizing these impediments and implementing practical approaches to surmounting them is a rational approach to advancing health equity for women, with ultimate benefits for society as a whole.
    MeSH term(s) Female ; Humans ; Cardiovascular Diseases/epidemiology ; Cardiovascular Diseases/prevention & control ; Noncommunicable Diseases/epidemiology ; Noncommunicable Diseases/prevention & control ; Women's Health ; Neoplasms/epidemiology ; Neoplasms/prevention & control
    Language English
    Publishing date 2024-01-19
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1220066-9
    ISSN 1546-170X ; 1078-8956
    ISSN (online) 1546-170X
    ISSN 1078-8956
    DOI 10.1038/s41591-023-02738-1
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  10. Article ; Online: Sex and gender in health research: updating policy to reflect evidence.

    Wainer, Zoe / Carcel, Cheryl

    The Medical journal of Australia

    2019  Volume 212, Issue 2, Page(s) 57–62.e1

    MeSH term(s) Australia ; Biomedical Research ; Europe ; Female ; Gender Identity ; Health Policy ; Humans ; Male ; North America ; Sex Factors
    Language English
    Publishing date 2019-11-24
    Publishing country Australia
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 186082-3
    ISSN 1326-5377 ; 0025-729X
    ISSN (online) 1326-5377
    ISSN 0025-729X
    DOI 10.5694/mja2.50426
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