Gender equity in medical journals in Korea and this issue

The recommendations by the International Committee of Medical Journal Editors (ICMJE) provide clear guidelines on the selection, description, and representation of study participants. The guidelines emphasize including representative populations in all study types and, at the very least, providing descriptive data for age, sex, ethnicity, and other relevant demographic variables [1]. As of April 7, 2023, there are 280 medical journals in Korea, of which 55 are indexed in the Science Citation Index Expanded (SCIE). It is necessary to investigate the extent to which the 55 SCIE-indexed medical journals in Korea adhere to and implement the ICMJE guidelines on gender equity in their publications. This evaluation involves checking for explicit sex/gender distinctions in the articles and, when missing, seeking justifications and sex/gender-specific interpretations.

The sample included all SCIE-indexed journals published by member organizations of the Korean Association of Medical Journal Editors as of April 7, 2023. The websites of the 55 journals were visited to check for ICMJE guideline adherence. From journals stating that they follow these guidelines, one original article was selected and examined for sex/gender distinction. Cases where sex/gender-differentiated descriptions were not applicable were excluded. The variables included data reflecting sex/gender differences, reasons given when no sex/gender distinction was made, and the interpretation of sex/gender data (Dataset 1). Of the 55 journals, one did not have a statement regarding the ICMJE recommendations and was excluded from the study, leaving 54 for analysis. Table 1 displays the primary results.

As Table 1 indicates, out of 38 articles, excluding 16 that were not applicable, nine (23.7%) did not distinguish participants according to sex or gender, 18 (47.4%) did not provide a sex/gender interpretation, and 11 (29.0%) included both sexes/genders and offered a sex/gender-based interpretation. Despite journals’ stated adherence to the ICMJE guidelines, the rate of incorporating sex/gender differentiation and interpretation was only 29.0%.

No existing studies on the adequacy of descriptions of sex/gender differences in Korean medical journals were found in KoreaMed (https://koreamed.org/) or PubMed (https://pubmed.ncbi.nlm.nih.gov/), making it challenging to compare this study's results with those of prior research. The present investigation was limited to 55 journals, a fraction of Korea's total 280 medical journals. Only one article was sampled from each journal, representing a minuscule portion of the total annual publications in Korean medical journals. Despite the small sample size, the findings offer insights into how articles published in Korean medical journals describe sex/gender differences. Future research could benefit from randomly sampling a larger number of journals and articles, comparing older and more recent articles to observe trends, and dividing the number of cases in the analysis method for comparative purposes.

The Ewha Medical Journal is published by the Ewha Womans University College of Medicine, to which only women are admitted. This unique role of training women leaders in the medical field should also be reflected in the Ewha Medical Journal’s gender equity policy. I will continue to do my best to promote gender equity in human population studies during my editorship, as I announced in the previous editorial emphasizing diversity, equity, and inclusivity [2].

In this issue, Dr. In-Jeong Cho’s review entitled “Sex differences in pharmacotherapy for heart failure [3]” examines the impact of sex on heart failure medication outcomes, highlighting distinct drug responses and side effects between men and women. It underscores the importance of increasing women's participation in clinical trials and developing research methods for sex differences. This topic is essential for precision medicine, aiming to tailor treatments to individual biological and genetic characteristics. The review advocates for a more personalized and inclusive approach to heart failure pharmacotherapy, focusing on the crucial impact of sex-related differences.

To provide the guidelines of gender-equity in scholarly publishing for Korean researchers and editors, two Korean translations are included in this issue. One is the “Sex and Gender Equity in Research: rationale for the SAGER guidelines and recommended use: a Korean translation [4],” the other is “The Sex and Gender Equity in Research (SAGER) guidelines: implementation and checklist development: a Korean translation [5].” The SAGER guidelines and checklist were made by the European Association of Science Editors Gender Policy Committee. Both guidelines and checklist were translated by the members of the Korean Council of Science Editors. Under the help of the Korean Council of Science Editors and the European Association of Science Editors Gender Policy Committee, those two translations can be published in the Ewha Medical Journal. It is one of merits of Korean/English journal to be able to publish translated version with importance.

A special article by Drs. Eun Mee Kim, President of the Ewha Womans University and Young-Ju Oh from the Korea National Diplomatic Academy was invited as a secondary publication, entitled "Sustaining Peace on the Korean Peninsula and the role of international organizations [6].” Dr. Kim has served as the 17^th President of the university since March 2021. This special article recommended that the Republic of Korea (South Korea) focus on building a solid team of experts in Korean Peninsula affairs and increasing the number of Koreans in critical positions within various United Nations agencies. These efforts will improve engagement with the Democratic People’s Republic of Korea (North Korea). Peace between South and North Korea is essential for the Korean Peninsula and the world. Understanding the dynamics of international relations and their impact on peace between South and North Korea can provide physicians and other health professionals with a broader perspective on the region. Human interaction and exchange could lead to medical challenges in both territories, including the spread of infectious diseases like malaria, tuberculosis, and hepatitis. Addressing the healthcare needs of the North Korean population may require substantial human resources and a significant budget. The medical implications of increased human exchange between the North and South are additional issues that physicians and the South Korean government need to explore.

Dr. Ja Hye Kim's review entitled "Overview of Endocrine Tumor Syndromes Manifesting as Adrenal Tumors" covers adrenal tumor incidence and the clinical features that need to be addressed to improve patient care through early detection, effective management, and targeted treatment [7]. Multiple types of adrenal tumors are clearly presented, providing up-to-date information on this topic for endocrinologists and general physicians.

There are two original articles in this issue: one is to examine the frequency of sleep disorders and the level of sleep quality, as well as their relationship with health-related quality of life in cancer patients in Turkey [8]; the other is to observe the differential expression of exosomal miRNAs in blood and urine [9]. Cancer patients exhibited moderate average sleep quality scores, with over half of them demonstrating poor sleep patterns. Sleep disorders significantly impacted their health-related quality of life. Therefore, to improve the sleep quality of cancer patients, medical care is recommended, including the early detection and social support. In the expression study of exoxomal miRNAs, there was no significant difference in total reads between blood and urine exosomes. It is the study of healthy adults so that the results can be groundwork for the identification of potential biomarkers derived from blood and urinary exosomes.

The year 2024 marks my second year as editor of the Ewha Medical Journal. While I proposed several development strategies in the previous editorial, it remains to be seen whether these objectives will be achieved. Nevertheless, with the backing of the publisher and the support of the editorial board members, I am committed to advancing the mission and scope of the journal. Our goal is to publish the highest-quality research and information at the intersection of biomedical science, clinical practice, and medical education.