Gender Differences In Disease Research Articles

Editorial: Emerging trends in global women's health—sex and gender differences in disease

Editorial: Emerging trends in global women's health—sex and gender differences in disease

Gender Differences in Disease, Function, and Behavioral Symptoms in Residents with Dementia.

The purpose of this study was to consider gender differences in depressive symptoms, agitation, resistiveness to care, physical function, and use of psychotropic medications in older adults with moderate to severe dementia in nursing homes. Sixty-seven nursing homes and 889 residents from two states were included. The majority of the participants were female (n = 640, 72%) and White (n = 618, 70%) with a mean age of 86.58 years (SD = 10.31). Differences by gender with regard to age, physical function, depressive symptoms, agitation/aggression, and resistiveness to care were tested using multivariate analysis of variance. Older females with moderate to severe dementia present with more depressive symptoms (anxiety, sadness, and somatic complaints) than males. Males present with more aggressive behavior and are more likely to receive anticonvulsants. Caregivers should focus on preventing and managing depressive symptoms including anxiety, sadness, and somatic complaints among older females and aggressive behavior in older males with dementia.

Mental disorders are increasing among children and adolescents in Sweden – a nationwide study with focus on gender differences

IntroductionAn increasing number of young people in Sweden are diagnosed with mental disorders and there appears to be significant gender differences in disease pattern.ObjectiveTo more thoroughly characterize the increase in mental disorders among young people with focus on gender differences.AimTo increase the knowledge of age and sex-specific trends in incidence and prevalence rates of mental disorders among children and adolescents.MethodData on psychiatric diagnoses for the last 10 years were obtained from Swedish national registers held by the National Board of Health and Welfare in Sweden.ResultsNeuropsychiatric, depressive and anxiety disorders have increased markedly among young people the last decade. In addition, men are increasingly diagnosed with substance-related disorders whereas women with borderline personality disorder.ConclusionThe increase in mental disorders among young people is marked and disease affects men and women differently. Because of greater awareness today, some conditions like ADHD are more frequently diagnosed. However, the increase in depressive and anxiety disorders appears genuine and represents an additional challenge.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Caring for women living with HIV: gaps in the evidence

IntroductionIn the management of HIV, women and men generally undergo the same treatment pathway, with gender differences being given limited consideration. This is in spite of accumulating evidence that there are a number of potential differences between women and men which may affect response to treatment, pharmacokinetics, toxicities and coping. There are also notable psychological, behavioural, social and structural factors that may have a unique impact on women living with HIV (WLWH). Despite our increasing knowledge of HIV and advances in treatment, there are significant gaps in the data relating specifically to women. One of the factors contributing to this situation is the under-representation of women in all aspects of HIV clinical research. Furthermore, there are clinical issues unique to women, including gynaecologic and breast diseases, menopause-related factors, contraception and other topics related to women's and sexual health.MethodsUsing scoping review methodology, articles from the literature from 1980 to 2012 were identified using appropriate MeSH headings reflecting the clinical status of WLWH, particularly in the areas of clinical management, sexual health, emotional wellbeing and treatment access. Titles and abstracts were scanned to determine whether they were relevant to non-reproductive health in WLWH, and papers meeting inclusion criteria were reviewed.ResultsThis review summarizes our current knowledge of the clinical status of WLWH, particularly in the areas of clinical management, sexual health, emotional wellbeing and treatment access. It suggests that there are a number of gender differences in disease and treatment outcomes, and distinct women-specific issues, such as menopause and co-morbidities, that pose significant challenges to the care of WLWH.ConclusionsBased on a review of this evidence, outstanding questions and areas where further studies are required to determine gender differences in the efficacy and safety of treatment and other clinical and psychological issues specifically affecting WLWH have been identified. Well-controlled and adequately powered clinical studies are essential to help provide answers to these questions and to contribute to activities aimed at improving the health and wellbeing of WLWH.

Therapeutische Implikationen gender-spezifischer Aspekte von Herzkrankheiten

In cardiovascular diseases e.g. heart failure and coronary artery disease gender differences are evident in etiology, pathophysiology, clinical presentation, prognosis and response to treatment. Diabetes and hypertension are the major risk factors in women. Mechanisms leading to apparent diabetes or its clinical pre-stage are different in women and men and according to this result in different therapeutic implications. Diastolic heart failure is more frequent in women and effects and side effects of important groups of active pharmaceutical substances are, at least to some extent, different. Atrial fibrillation and ventricular arrhythmia differ in frequency of occurrence; drug induced tachycardia with QT interval prolongation is particularly frequent in women. Underlying pathomechanisms responsible for gender differences in pharmacotherapy are on the one hand differences in pharmacokinetic mechanisms. Particularly drugs which are metabolised via cytochrome P 450 CYP 3A pathway show different kinetics in women and men. In addition, important differences are evident in pharmocodynamics caused by effects of sex steroid hormones or products of X-chromosomal genes. The evidence of estrogen and testosterone receptors in cardiomyocytes and the vascular system, interaction of sex steroid hormones with cellular pathways and the role of X-chromosomal genes are the focus of basic research. Interactions of sex steroid hormone receptors with other nuclear receptors e.g. PPARs ("peroxisome proliferator-activated receptors") are another important underlying mechanism. The knowledge of different pharmacokinetic mechanisms has to be taken into consideration in pharmacotherapy of cardiovascular diseases, for example by adjustment of drug dosages in women, necessary in different groups of pharmaceutical substances or in the long run, gender differences in effects and side effects of drugs. In drug development both aspects have to be considered. There is more than one good reason to intensify basic and clinical research and research on health care on gender differences in cardiovascular diseases.

BOOK REVIEW

O'Connor V, Kovacs G, editors. Obstetrics, Gynecology, and Women's Health. 681 pages, illustrated. Cambridge, UK: Cambridge University Press, 2003. ISBN 0-521-81893-1 hardback. Price: GBP 35.00, USD 45.00. The editors and most of the 61 other contributors to this brand-new textbook of obstetrics and gynecology come from Australia. I do not know whether this explains its novel features, but the overall impression is refreshing. Thematically, all of the traditional headlines are present, but emphasis is shifting and some new sections have been added. Whereas breast conditions in most gynecologic curricula are limited to breast feeding and mastitis, subheadings on ‘breast concerns’, ‘breast screening’, and ‘breast problems’ appear in different other chapters. In addition, there are 12 pages on breast cancer in the chapter on pre-cancer and cancer. The first part of the book is called ‘Women's health', starting with excellent advice on history taking and gynecologic examination, including examination of the pregnant uterus, not to forget the breasts. Prescription covers six pages, followed by a well-balanced discussion on the pros and contras of screening, to end with an example of how to search PubMed for evidence to help solve a given clinical problem. Ethics, minority group women (with lesbian women as one), lifestyle, body image, sexuality, abuse, and sexual assault are described in other chapters, all worthy of study. The succeeding parts follow the woman's life cycle from early (i.e. fetal, childhood, and adolescent) life through the reproductive years (including obstetrics, sexual health, subfertility, hormonal problems, and pelvic pain), the middle years (wherein menstrual problems, the menopause, pelvic floor disorders, stress urinary incontinence, pre-cancer, and cancer are covered) to the older years, where you will find osteoporosis, Alzheimer's disease, more on urinary incontinence and other conditions. Each part starts with a description of the normal, healthy situation (‘the well woman’) to continue with the various ailments. Legal issues pertaining to teenage sexuality are discussed with references to UK and Australian decisions and laws. Statistics are also mainly drawn from UK and Australian populations. The final part covers surgery including complications and adverse events, short notes on gender differences in disease, and some useful points for those who want to do research. There are chapter references and a list of abbreviations at the end, the latter covering four pages, and of course the alphabetical index. Layout is superb, tabulations and drawn illustrations are didactic. Colored photographs are presented collectively at the end of some of the sections. It is probably impossible to produce a volume of this size free of errors or inconsistencies. I found ‘caput succedaneum’ illustrated in drawings of skull bones on page 257, giving me the false impression that it is a moulding of the parietal bone instead of a swelling of the soft parts between bone and periosteum. For active management of the third stage of labor (page 263), the choice is between syntometrine and syntocinon, which are both brand names. Textbooks should preferably use generic product names. The proper name of syntocinon, oxytocin, is used on the following page. Syntometrine, a mixture of oxytocin and methyl ergometrine, is no longer in use in Denmark, Norway, and Sweden and may therefore confuse students from Scandinavia. In Table 8.5 on page 284, it is claimed that the incidence of post term pregnancy in Australia (>42 weeks) is 0.4%, which is hard to believe. In the same tabulation, birth weight less than the 3rd percentile and greater than the 97th percentile for gestational age are both said to be 2.5%, which defies logic, unless they use a foreign scale for comparison. Finally, one of the great pastimes of oncologists is to devise new classification systems for the various types of cancer. Whereas in olden days, we used to say dysplasia and carcinoma in situ of the cervix, the students are now burdened with the Papanicolaou/UK and the Bethesda terminologies, to which are added a special Australian category (pages 558–9), hopefully for the benefit of patients, but certainly not for students. The comments in the preceding paragraph are trifles. The overall impression is that of a timely, well-written and edited, textbook of obstetrics and gynecology, unreservedly to be recommended for students.

Gender differences in disease specific functional status following CABG Mukesh Garg, Brent Bliven, Phil Jones, John Spertus. Mid America Heart Institute, Kansas City, MO, University of Missouri - Kansas City, MO

Gender differences in disease specific functional status following CABG Mukesh Garg, Brent Bliven, Phil Jones, John Spertus. Mid America Heart Institute, Kansas City, MO, University of Missouri - Kansas City, MO