Gender-specific Diagnosis Research Articles

Sex-specific roles of hippocampal microRNAs in stress vulnerability and resilience

Contrary to intuition, most individuals are resilient to psychological trauma and only a minority is vulnerable. Men and women are known to respond differently to trauma exposure, however, mechanisms underlying the relationship between sex differences and trauma resilience and vulnerability are not yet fully understood. Taking advantage of the Behavioral Profiling approach, which enables differentiating between ‘affected’ and ‘unaffected’ individuals, we examined sex-associated differences in stress exposure effects on hippocampal expression of selected stress-related GABA-A receptor targeting miRNAs. Levels of the miRNA-144 and miRNA-33 were measured in male and female affected (vulnerable, e.g., higher freezing time) and unaffected (resilient) rats. In male rats, increased levels of miRNA-144 and miRNA-33 were observed in the dorsal dentate gyrus (dDG) and ventral dentate gyrus (vDG) respectively, of stress-exposed but unaffected animals. In females, we observed an increased expression of miRNA-144 and miRNA-33 in the ventral cornu ammonis 1 (vCA1) of affected animals. Accordingly, we inhibited miRNAs expression selectively in hippocampal subregions using oligonucleotides containing locked nucleic acid bases, to examine the miRNAs’ causal contribution to either vulnerability or resilience to stress in each sex. Inhibition of miRNA-144 in dDG and miRNA-33 in vDG in males resulted in an increased prevalence of vulnerable animals, while inhibition of miRNA-144 and miRNA-33 in vCA1 in females increased the proportion of resilient animals. The current findings reveal a critical sex-associated difference in the role of miRNAs in stress vulnerability and resilience. This novel understanding of sex-associated epigenetic involvement in the mechanism of stress-related psychopathologies may help improve gender-specific diagnosis and effective treatment.

Deep learning identifies robust gender differences in functional brain organization and their dissociable links to clinical symptoms in autism.

Autism spectrum disorder (ASD) is a highly heterogeneous disorder that affects nearly 1 in 189 females and 1 in 42 males. However, the neurobiological basis of gender differences in ASD is poorly understood, as most studies have neglected females and used methods ill-suited to capture such differences. To identify robust functional brain organisation markers that distinguish between females and males with ASD and predict symptom severity. We leveraged multiple neuroimaging cohorts (ASD n = 773) and developed a novel spatiotemporal deep neural network (stDNN), which uses spatiotemporal convolution on functional magnetic resonance imaging data to distinguish between groups. stDNN achieved consistently high classification accuracy in distinguishing between females and males with ASD. Notably, stDNN trained to distinguish between females and males with ASD could not distinguish between neurotypical females and males, suggesting that there are gender differences in the functional brain organisation in ASD that differ from normative gender differences. Brain features associated with motor, language and visuospatial attentional systems reliably distinguished between females and males with ASD. Crucially, these results were observed in a large multisite cohort and replicated in a fully independent cohort. Furthermore, brain features associated with the motor network's primary motor cortex node predicted the severity of restricted/repetitive behaviours in females but not in males with ASD. Our replicable findings reveal that the brains of females and males with ASD are functionally organised differently, contributing to their clinical symptoms in distinct ways. They inform the development of gender-specific diagnoses and treatment strategies for ASD, and ultimately advance precision psychiatry.

A Machine Learning-Based Investigation of Gender-Specific Prognosis of Lung Cancers.

Background and Objective: Primary lung cancer is a lethal and rapidly-developing cancer type and is one of the most leading causes of cancer deaths. Materials and Methods: Statistical methods such as Cox regression are usually used to detect the prognosis factors of a disease. This study investigated survival prediction using machine learning algorithms. The clinical data of 28,458 patients with primary lung cancers were collected from the Surveillance, Epidemiology, and End Results (SEER) database. Results: This study indicated that the survival rate of women with primary lung cancer was often higher than that of men (p < 0.001). Seven popular machine learning algorithms were utilized to evaluate one-year, three-year, and five-year survival prediction The two classifiers extreme gradient boosting (XGB) and logistic regression (LR) achieved the best prediction accuracies. The importance variable of the trained XGB models suggested that surgical removal (feature “Surgery”) made the largest contribution to the one-year survival prediction models, while the metastatic status (feature “N” stage) of the regional lymph nodes was the most important contributor to three-year and five-year survival prediction. The female patients’ three-year prognosis model achieved a prediction accuracy of 0.8297 on the independent future samples, while the male model only achieved the accuracy 0.7329. Conclusions: This data suggested that male patients may have more complicated factors in lung cancer than females, and it is necessary to develop gender-specific diagnosis and prognosis models.

Long-term outcomes in treated males with anorexia nervosa and bulimia nervosa-A prospective, gender-matched study.

We report on the long-term outcome of males compared to females treated for anorexia nervosa (AN) or bulimia nervosa (BN). A total of 119 males with AN and 60 males with BN were reassessed 5.8 ± 4.6 and 7.5 ± 5.9 years (respectively) after treatment and compared to matched female patients. At follow-up, males with AN had a higher body weight than females. For AN, remission rates (40% males vs. 41% females) did not differ at follow-up. And at follow-up, more males (34%) than females (19%) had an eating disorder not otherwise specified (ED-NOS; p < .01). At follow-up of AN, there was no binge-eating disorder (BED) and obesity was rare. For BN, remission rates (44% males vs. 50% females) and frequency of AN, BN, BED and ED-NOS did not differ at follow-up. Males with AN scored lower than females at follow-up on most subscales of the Eating Disorder Inventory (EDI) and on somatization, obsessive-compulsive symptoms, and depression (Brief Symptom Inventory). Males with BN scored lower than females with BN on perfectionism and higher on interpersonal distrust (EDI) at follow-up. Results from the scarce literature on males with ED are inconclusive regarding longer term outcome. In the present study, males with AN showed a slightly better outcome than females. In BN, outcome was about the same in males and females. According to our study, existing treatment is equally effective in both males and females. Additional research on the need of gender-specific diagnosis and therapy is required.

Validation of SHI Claims Data Exemplified by Gender-specific Diagnoses

Aim: Use of statutory health insurance (SHI) data in health services research is increasing steadily and questions of validity are gaining importance. Using gender-specific diagnosis as an example, the aim of this study was to estimate the prevalence of implausible diagnosis and demonstrate an internal validation strategy. Method: The analysis is based on the SHI data from Baden-Württemberg for 2012. Subject of validation are gender-specific outpatient diagnoses that mismatch with the gender of the insured. To uncover this implausibility, it is necessary to clarify whether the diagnosis or the gender is wrong. The validation criteria used were the presence of further gender-specific diagnoses, the presence of gender-specific settlement items, the specialization of the physician in charge and the gender assignment of the first name of the insured. To review the quality of the validation, it was verified if the gender was changed during the following year. Results: Around 5.1% of all diagnoses were gender-specific and there was a mismatch between diagnosis and gender in 0.04% of these cases. All validation criteria were useful to sort out implausibility, whereas the last one was the most effective. Only 14% remained unsolved. From the total of 1 145 insured with implausible gender-specific diagnoses, one year later 128 had a new gender (in the data). 119 of these cases were rightly classified as insured with wrong gender and 9 cases were in the unsolved group. This confirms that the validation works well. Conclusion: Implausibility in SHI data is relatively small and can be solved with appropriate validation criteria. When validating SHI data, it is advisable to question all data used critically, to use multiple validation criteria instead of just one and to abandon the idea that reality and the associated data conform to standardized norms. Keeping these aspects in mind, analysis of SHI data is a good starting point for research in health services.

Women and the DSM-5: A Clinician's Response to the Question of Invisibility

Diagnosis of psychiatric conditions is a topic that is currently receiving significant attention in light of the release of the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders in 2013. The process of the revisions is complex and involves political, social, and economic influences, all of which are amplified in an evolving corporate health care system in the United States. Of particular concern in the development of the revised nosology is the representation of gender-specific diagnoses and course specifiers to reflect the distinct manifestations of the psychiatric symptoms of women. Based on a growing body of psychobiological evidence related to gender differences in symptom manifestation, gender specific diagnoses remain palpably absent from the taxonomy. This article explores the issue of invisibility of women-specific diagnosis from the perspective of a women's health advanced practice nurse.

Prospects for the classification of mental disorders in women

Many mental disorders show marked gender differences as regards prevalence, symptomatology, risk factors or course. Other disorders do per definition only occur in women – e.g. premenstrual dysphoric disorder (PMDD) – or are markedly influenced by female specific factors such as hormonal changes over the life cycle or during reproductive processes. Current classification systems have tried to take into account these gender aspects, but some problems will certainly have to be discussed again with the next revisions of the ICD and DSM. As regards gender differences in prevalence and symptomatology questions of gender bias in diagnostic instruments and diagnostic criteria will have to be readdressed. New findings from unselected epidemiological samples, which were analysed by gender, will have to be taken into account as well as new findings from research into gender specific personality traits, which can influence the symptomatology of mental disorders. Decisions will have to be taken whether to revise existing diagnostic criteria and provide alternative diagnostic thresholds for men and women or even to develop alternative criteria sets in certain disorders, or rather to enhance the gender neutrality of criteria. A further question to be addressed will be that of gender specific diagnoses versus diagnostic specifiers. In the whole discussion two main aims of classification should be given priority: the research aim of identifying genuine entities with a common aetiology, which means we should be able to identify specific diagnostic entities with descriptive, construct, and predictive validity quite independently of the influences of gender; and the clinical aim to improve treatment and care for men and women, which often means to offer gender-specific approaches.

Physical diseases among homeless people: Gender differences and comparisons with the general population

To study morbidity amongst homeless men and women by comparing prevalence of hospital care for somatic diseases and injuries with a control group of men and women from the general population. A cohort of 1,364 men and 340 women were documented as homeless in 1996. Comparisons are made concerning hospital care for somatic diseases and injuries (1996-2002) among 3,750 men and 1,250 women from the general population. The relative risk (RR) for homeless men and women of being hospitalised was double that of the men and women in the controls (1.93 and 1.96 respectively). Homeless women had a slightly, not significant, increased risk compared to homeless men (RR 1.10). Younger homeless women had a significant higher risk. Among diagnostic categories, the highest prevalence was found among homeless men in the diagnosis group injury/poisoning (22%). The highest risk was found for skin diseases (RR 36.96) and concerned homeless women. There were a number of gender specific diagnoses, where risks were considerably elevated, such as diseases of the genital organs, viral hepatitis, and poisoning for homeless women, and cerebrovascular diseases, diseases of the liver, and concussion for homeless men. Homeless people had twice the risk of being hospitalised for physical diseases compared to the general population. Younger women were particularly at risk compared to homeless men and to women in the controls. There were a number of gender specific diagnoses that are important to take into account when planning services for homeless people.

Gender Disparity in Analgesic Treatment of Emergency Department Patients with Acute Abdominal Pain

Oligoanalgesia for acute abdominal pain historically has been attributed to the provider's fear of masking serious underlying pathology. The authors assessed whether a gender disparity exists in the administration of analgesia for acute abdominal pain. This was a prospective cohort study of consecutive nonpregnant adults with acute nontraumatic abdominal pain of less than 72 hours' duration who presented to an urban emergency department (ED) from April 5, 2004, to January 4, 2005. The main outcome measures were analgesia administration and time to analgesic treatment. Standard comparative statistics were used. Of the 981 patients enrolled (mean age +/- standard deviation [SD] 41 +/- 17 years; 65% female), 62% received any analgesic treatment. Men and women had similar mean pain scores, but women were less likely to receive any analgesia (60% vs. 67%, difference 7%, 95% confidence interval [CI] = 1.1% to 13.6%) and less likely to receive opiates (45% vs. 56%, difference 11%, 95% CI = 4.1% to 17.1%). These differences persisted when gender-specific diagnoses were excluded (47% vs. 56%, difference 9%, 95% CI = 2.5% to 16.2%). After controlling for age, race, triage class, and pain score, women were still 13% to 25% less likely than men to receive opioid analgesia. There was no gender difference in the receipt of nonopioid analgesia. Women waited longer to receive their analgesia (median time 65 minutes vs. 49 minutes, difference 16 minutes, 95% CI = 3.5 to 33 minutes). Gender bias is a possible explanation for oligoanalgesia in women who present to the ED with acute abdominal pain. Standardized protocols for analgesic administration may ameliorate this discrepancy.

The effects of gender-specific diagnosis on men's and women's response to infertility

To determine if differences could be distinguished between men's and women's emotional response to infertility based on the assignment of a gender-specific diagnosis.Gender-specific diagnoses were examined in relation to stigma, perception of loss, role failure, and self-esteem, using structured interviews.Tertiary clinical care in private practice settings.Thirty-six self-selected volunteer couples undergoing infertility treatment.Stigma, perception of loss, role failure, and lowered self-esteem emerged from content analysis of structured interview data.No differences were found among women in their emotional response to infertility regardless of whether a female or male infertility factor was present, whereas men with a male factor experienced more negative emotional response to infertility than men without a male factor.Although both women and men are affected by infertility, their emotional response is significantly influenced by a gender-specific diagnosis. Men's response to infertility closely approximates that of women if the infertility has been attributed to a male factor but differs considerably if a male factor is not found.

The effects of gender-specific diagnosis on men’s and women’s response to infertility

To determine if differences could be distinguished between men’s and women’s emotional response to infertility based on the assignment of a gender-specific diagnosis. Gender-specific diagnoses were examined in relation to stigma, perception of loss, role failure, and self-esteem, using structured interviews. Tertiary clinical care in private practice settings. Thirty-six self-selected volunteer couples undergoing infertility treatment. Stigma, perception of loss, role failure, and lowered self-esteem emerged from content analysis of structured interview data. No differences were found among women in their emotional response to infertility regardless of whether a female or male infertility factor was present, whereas men with a male factor experienced more negative emotional response to infertility than men without a male factor. Although both women and men are affected by infertility, their emotional response is significantly influenced by a gender-specific diagnosis. Men’s response to infertility closely approximates that of women if the infertility has been attributed to a male factor but differs considerably if a male factor is not found.