The aim of GESTURE is to provide and develop gender-specific tools to improve the health of both men and women via education, research and patient care.
One of the examples of the multidimensional research within GESTURE is the CREW consortium (2.4 MEuro, grant from the Netherlands Heart Foundation).
The participating PIs work both on a clinical level (J. Roeters van Lennep, E. Steegers, J. Roos Hesselink, J. Laven), as well as on an epidemiological (H. Boersma) and fundamental / translational (A. Maassen van den Brink) level. Within CREW, we collaborate with all other Dutch UMCs and the Queen of Hearts consortium (also a grant from the Dutch Heart Foundation). Our team consists of internists, cardiologists, vascular surgeons, gynecologists, hematologists, urologists and pharmacists as clinical Leading Investigators, epidemiologists and statisticians as Leading Investigators at population level and endocrinologists and pharmacologists as fundamental / translational Leading Investigators. Further collaborations exist with, e.g., Lund University (Sweden), Charité Berlin (Germany), University of Oslo (Norway), Birmingham University (UK), University of Chicago (USA), Cinvestav-Coapa (Mexico) and University of Calgary (Canada).
The importance of gender-specific medical education has been recognized by the minister of Health. According to her directives for medical education, the Ba and MSc programs at all medical faculties in the Netherlands have to provide measurable gender-specific content. Dr. A. Maassen van den Brink en Dr. J.E. Roeters van Lennep have been assigned as senior advisors for the Desiderius school to implement these measures at Erasmus MC.
In collaboration with the Desiderius School, the Ba and MSc program are screened for the gender-specific content of medical education wherever this is relevant. The aim of our ACE is to certify that gender is an integral part of the Erasmus medical curriculum.
Rather than promoting special (optional) courses on gender our incentive is to entwine within the existing medical education to show that gender is an integral part of healthcare and research instead of a separate entity. In PhD education COEUR, Moll Med and NIHES have courses and research seminars with gender-specific medicine as topic. Including the international NIHES 3-day Womens's Health Course with highest evaluation scores of all NIHES courses. Also this summer we will have a joint collaboration between Erasmus Summer Program and ZonMw on Womens Health.
Opportunities for our ACE are educating teachers about how and where to incorporate gender in their education in a meaningful manner. In collaboration with the Desiderius school workshops will be organized. These will be also available for teachers outside the Erasmus MC.
Societal Relevance to Research, Education and Patient Care
Both Principle Investigators (PI) of GESTURE are authors of the National Knowledge Agenda on Gender and Health, which now serves as a guideline for the minister of Health to provide future funding by ZonMW and to set priorities in medical research. Apart from the research, both PI are active members of the National Alliance for Gender and Health, which is involved in many societal as well as economic (e.g., the development of business cases) initiatives to promote gender-specific health.
The establishment of the ACE GESTURE would clearly inforce the visibility of our network. Together with prof. W.W. v.d. Broek, a member of our ACE, the PI are responsible for the gender-specific component in the medical curriculum of the Erasmus MC. Besides the medical curriculum, the yearly NIHES course on Women's Health (receiving the highest ratings among these courses) is organized by members of our ACE (J. Roeters van Lennep, M. Kavousi, O. Franco, J. Duvekot). Several members of our team are involved in medical guideline committees, where they are able to put emphasis on a gender-specific approach. (J Laven, J Roeters van Lennep in "Cardiovascular risk management after reproductive disorders", M.Kruip "Diagnostiek, preventie en behandeling van veneuze trombo-embolie en secundaire preventie van arteriële trombose" J.Roos-Hesselink "ESC Guidelines on the management ofcardiovascular diseases during pregnancy"). Several of our members are closely involved with patient organizations such as Stichting HELLP syndroom (JD, JRvL), Stichting PCOS Nederland (JL), Nederlandse Vereniging van Hoofdpijn Patiënten (AMvdB)and the HartenVaatgroep (JRH,JRVL,ER)
Viability of Research, Education and Patient Care
We have monthly research meetings with our PI's and their groups, where scientific presentations (often by PhD students) are used to exchange scientific knowledge and to improve its quality by receiving comments from other members.
This has already resulted in obtaining a major grant from the Netherlands Heart Foundation, where our member Prof. H. Boersma is one of the two leading coordinators and many GESTURE PI's are involved. Because of this grant, 4 extra PhD students are now working on gender-specific health in the Erasmus MC. Several PhD students who obtained their PhD degree in the Erasmus MC supervised by GESTURE members are now internationally active. Further, members of GESTURE do have international PhD students, as well as postdoctoral fellows, e.g. funded by the International Headache Society.
May 2018 the ACE had a first congres with the Dutch Society for Gender and Health where both PI's are board members, in Rotterdam. The leading investigators are also members of the Gender working group of the Dutch Society of Cardiology. Together with the Gender working group, we are working on the first Dutch consensus on microvascular disease. One of the PI's was part of two consensus papers of the European Headache Federation on migraine, contraception and stroke.
Key and relevant publications of the last five years
- Prick BW, Jansen AJ, Steegers EA, Hop WC, Essink-Bot ML, Uyl-de Groot CA, Akerboom BM, van Alphen M, Bloemenkamp KW, Boers KE, Bremer HA, Kwee A, van Loon AJ, Metz GC, Papatsonis DN, van der Post JA, Porath MM, Rijnders RJ, Roumen FJ, Scheepers HC, Schippers DH, Schuitemaker NW, Stigter RH, Woiski MD, Mol BW, van Rhenen DJ, Duvekot JJ. Transfusion policy after severe postpartum haemorrhage: a randomised non-inferiority trial. BJOG. 2014 Jul;121(8):1005-14. doi: 10.1111/1471-0528.12531. Epub 2014 Jan 10
- Visser JA, Schipper I, Laven JS, Themmen AP. Anti-Müllerian hormone: an ovarian reserve marker in primary ovarian insufficiency. Nat Rev Endocrinol. 2012 Jan 10;8(6):331-41.
- Franco OH, Chowdhury R, Troup J, Voortman T, Kunutsor S, Kavousi M, Oliver-Williams C, Muka T. Association between use of plant-based therapies and menopausal symptoms: a systematic review and meta-analysis. JAMA. 2016 (accepted for publication)
- van Hagen IM, Roos-Hesselink JW, Ruys TP, Merz WM, Goland S, Gabriel H, Lelonek M, Trojnarska O, Al Mahmeed WA, Balint HO, Ashour Z, Baumgartner H, Boersma E, Johnson MR, Hall R; ROPAC Investigators and the EURObservational Research Programme (EORP) Team*. Pregnancy in Women With a Mechanical Heart Valve: Data of the European Society of Cardiology Registry of Pregnancy and Cardiac Disease (ROPAC). Circulation. 2015 Jul 14;132(2):132-42
- Hammiche F, Laven JS, Twigt JM, Boellaard WP, Steegers EA, Steegers-Theunissen RP. Body mass index and central adiposity are associated with sperm quality in men of subfertile couples. Hum Reprod. 2012 Aug;27(8):2365-72.
- Ibrahimi K, van Oosterhout WPJ, van Dorp W, Danser AHJ, Garrelds IM, Kushner SA, Lesaffre EM, Terwindt GM, Ferrari MD, van den Meiracker AH, MaassenVanDenBrink A. Reduced trigeminovascular cyclicity in patients with menstrually related migraine. Neurology, 2015;84:125-31
- Jaspers L, Daan NM, van Dijk GM, Gazibara T, Muka T, Wen KX, Meun C, Zillikens MC, Roeters van Lennep JE, Roos-Hesselink JW, Laan E, Rees M, Laven JS, Franco OH, Kavousi M. Health in middle-aged and elderly women: A conceptual framework for healthy menopause. Maturitas. 2015 May;81(1):93-8. doi: 10.1016/j.maturitas.2015.02.010. Epub 2015 Mar 6. Review.
- Leening MJ, Ferket BS, Steyerberg EW, Kavousi M, Deckers JW, Nieboer D, Heeringa J, Portegies ML, Hofman A, Ikram MA, Hunink MG, Franco OH, Stricker BH, Witteman JC, Roos-Hesselink JW, Sex differences in lifetime risk and first manifestation of cardiovascular disease: prospective population based cohort study. BMJ. 2014 Nov 17;349:g5992. doi: 10.1136/bmj.g5992.
- Arabkhani B, Heuvelman HJ, Bogers AJ, Mokhles MM, Roos-Hesselink JW,Takkenberg JJ. Does pregnancy influence the durability of human aortic valve substitutes? J Am Coll Cardiol. 2012 Nov 6;60(19):1991-2
- Daan NMP , T. Muka , M.P.H. Koster , J.E. Roeters van Lennep , C.B. Lambalk , J.S.E. Laven , C.G.K.M. Fauser, C. Meun , Y. B. de Rijke , E. Boersma, O.H. Franco, M. Kavousi , B.C.J.M. Fauser Cardiovascular risk in women with premature ovarian insufficiency compared to premenopausal women at middle age. Journal of Clinical Endocrinology & Metabolism, Accepted
PhD theses of the last five years
- C. Stoof. Effects and outcome of hemostatic treatment in bleeding disorders
- K. Verdonk: Preeclampsia, the renin-angiotensin-aldosterone system and beyond (2015)
- L. van Houten: The Role of Ovarian Factors in the Regulation of Metabolism (2014)
- K. Ibrahimi: Microvasculature, the Trigeminal System and Migraine; a focus on female sex hormones (2015)
- M. Kavousi: Subclinical Measures of Atherosclerosis: Genetics and Cardiovascular Risk Prediction (2013)
- S. Labruijere: Neurovascular Pharmacology of Migraine; epigenetics and sex hormones (2014)
- S. Lie Fong. Clinical applications of serum anti-Müllerian hormone (2012)
- Y. Louwers: Polycystic Ovary Syndrome: from phenotype to genotype (2014)
- H. Heuvelman. Aortic Stenosis in Adults: natural history, treatment and outcome
- M. Hoedjes. Maternal quality of life, lifestyle, and interventions after complicated pregnancies(2011)