Sex Differences In Rates Research Articles

Sex Differences in Pediatric Bipolar Disorder

To explore sex differences in pediatric bipolar disorder in terms of subtype and severity of depressive and manic symptomatology. Participants were 760 youth (aged 5-17 years) and their legal guardians. Participants were part of a larger outpatient assessment protocol enriched for bipolar disorder. Youth were assessed for DSM-IV diagnoses using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Epidemiologic Version. Their presenting mood state was determined using the Young Mania Rating Scale and the Children's Depression Rating Scale-Revised. The study was conducted from January 1996 to February 2003. 387 youth (51%) met DSM-IV criteria for diagnoses of bipolar spectrum disorders. Results showed no sex differences in rates of bipolar spectrum disorders or any of the bipolar subtypes. Sex differences were found with regard to presenting mood states: boys presented with higher rates of manic mood, and girls presented with higher rates of depressed mood. Older children were also more likely than younger children to exhibit higher levels of depressed mood. There were no age differences in levels of manic mood. This study highlights how bipolar disorder can manifest itself differently among girls and boys despite equivalent rates of diagnosis. It is important for clinicians to consider the full range of mood states in order to accurately diagnose and treat children. Future research is needed to assess the roles that genetics, puberty, cognitive styles, and environmental factors play in the expression of mania and depression in girls and boys over the course of their development.

Sex difference in rates of lactic acidosis with HAART

Sex difference in rates of lactic acidosis with HAART

Sex difference in rates of lactic acidosis with HAART

Sex difference in rates of lactic acidosis with HAART

Sex differences in inappropriate prescribing among elderly veterans

Previous studies have suggested that older women may be more likely than older men to receive potentially inappropriate prescriptions. A better understanding of sex differences in inappropriate prescribing can help inform the development of effective interventions. This study was conducted to assess sex differences in rates of inappropriate prescribing before and after accounting for potentially appropriate indications and to examine sex differences in predictors of inappropriate drug use. This was a retrospective cohort study of administrative data from the national Veterans Health Administration (VA). Participants were veterans aged >or=65 years who had >or=1 patient visit at VA outpatient facilities in fiscal year 1999 (FY99) and 2000 (FY00). The main outcome measure was the diagnosis-adjusted prevalence of 33 potentially inappropriate medications as judged by the Beers criteria in FY00: overall, by individual drug, and in 3 categories grouped by potential indication ("always avoid," "rarely appropriate," and "some indications"). The study population included 965,756 patients (946,641 men and 19,115 women). Women were more likely than men to receive inappropriate medications overall and in all 3 categories, even after accounting for diagnoses that may have justified the prescription. Women were more likely to receive 16 of the 33 medications (analgesics, psychotropic drugs, and anticholinergic agents), and men were more likely to receive 3 of the 33. After controlling for sociodemographic characteristics, number of medications, and care characteristics, women remained more likely to receive inappropriate drugs. Receipt of geriatric care was equally protective for men and women, although only a small proportion received this care. Psychiatric comorbidity was associated with inappropriate prescribing for men but not for women. Analgesic, psychotropic, and anticholinergic medications that should be avoided contributed to higher rates of inappropriate drug use among older women than among older men. Targeted efforts to avoid these medications in older women may help reduce overall rates of inappropriate prescribing. Sex-stratified reporting of quality indicators that assess inappropriate prescribing among community-dwelling elders would help monitor the effectiveness of improvement efforts.

Sex differences in rates of territory joining and inheritance in a cooperatively breeding cichlid fish

In social groups, subordinates may gain dominant breeding status either by inheriting the top position in their current group or by dispersing to join a new group. The pathway to breeder status is likely to vary between males and females as a result of sex differences in the costs of dispersal and inbreeding. We report results from a field study conducted to explore sex differences in the rates of territory joining and inheritance in a cooperatively breeding cichlid, Neolamprologus pulcher. We experimentally created 34 breeding vacancies and investigated the effects of breeder removal on the degree of cooperative behaviour and how changes in status influenced reproductive physiology. We found that 71% of male vacancies were filled by joiners (incoming fish, not previously members of the group) entering the territory. In contrast, only 15% of female vacancies were filled by joiners entering the group from elsewhere. Helpers increased their frequency of cooperative behaviour following the removal of a female breeder, but not following removal of a male breeder. Our results suggest that female breeder vacancies are typically filled by subordinate helpers who inherit from within the group and that male breeder vacancies are commonly filled by joining individuals (existing breeders or former helpers from other groups). Male social status and gonadal investment were positively correlated. This study represents one of the first experimental attempts to examine sexual differences in the pathway to breeding status in a cooperatively breeding species.

Sex differences in the rate of fatigue development and recovery

BackgroundMany musculoskeltal injuries in the workplace have been attributed to the repetitive loading of muscle and soft tissues. It is not disputed that muscular fatigue is a risk factor for musculoskeltal injury, however the disparity between gender with respect to muscular fatigability and rate of recovery is not well understood. Current health and safety guidelines do not account for sex differences in fatiguability and may be predisposing one gender to greater risk. The purpose of this study was to quantify the sex differences in fatigue development and recovery rate of lower and upper body musculature after repeated bouts of sustained isometric contractions.MethodsTwenty-seven healthy males (n = 12) and females (n = 15) underwent bilateral localized fatigue of either the knee extensors (male: n = 8; female: n = 8), elbow flexors (male: n = 8; female: n = 10), or both muscle groups. The fatigue protocol consisted of ten 30-second sub-maximal isometric contractions. The changes in maximum voluntary contraction (MVC), electrically evoked twitches, and motor unit activation (MUA) were assessed along with the ability to control the sustained contractions (SLP) during the fatigue protocol using a mixed four-factor repeated measures ANOVA (gender × side × muscle × time) design with significance set at p < 0.05.ResultsThere was a significant loss of MVC, MUA, and evoked twitch amplitude from pre- to post-fatigue in both the arms and legs. Males had greater relative loss of isometric force, a higher rate of fatigue development, and were less capable of maintaining the fatiguing contractions in the legs when compared to the females.ConclusionThe nature of the induced fatigue was a combination of central and peripheral fatigue that did not fully recover over a 45-minute period. The results appear to reflect sex differences that are peripheral, and partially support the muscle mass hypothesis for explaining differences in muscular fatigue.

Do Sex Inequalities Extend to Rapid Access Chest Pain Clinics (RACPCs)?

Background: Sex differences in rates of referral, investigation, and outcomes have been reported in relation to coronary heart disease. Few have examined this for patients referred by primary care to rapid access chest pain clinics (RACPC), the objective of the current study. Methods: Data were collected on patients referred to a RACPC at a district general hospital in the northwest of England from January 2001 to May 2003. Sex differences relating to history, investigation, and subsequent referrals were examined using logistic regression (men to women) adjusting for age quartiles. Results: Over 29 months, 2039 patients were referred to the RACPC; 48% (987 of 2039) were women and mean age was similar in women (55.8, standard deviation [SD] 11.3, range 18–88 years) and men (53.1, SD 12.09, range 18–83 years). More men (23.1%) smoked than women (17.5%) (odds ratio [OR] adjusted age 1.31, 95% confidence interval [CI] 1.05–1.64, P = 0.02). Positive exercise tolerance tests (Bruce protocol) were observed for 10.8% (107 of 987) women and 17.1% (180 of 1052) men (OR adjusted age 1.95, 95% CI 1.49–2.54, P = 0.001), of whom 143 were known to have been referred for angiography (44.8% women, 52.8% men, OR adjusted age 1.41, 95% CI 0.86–2.31, P = 0.18). Older people were less likely to have had angiography (OR adjusted sex 0.74, 95% CI 0.57–0.96, P = 0.02). Conclusions: Similar numbers of men and women were referred for rapid access chest pain assessment, but fewer women had positive tests. The higher rate of possibly unnecessary tests in women has cost implications and may increase patient anxiety. No sex differences were found for referral for angiography, but older people were less likely to receive investigation after positive exercise tests. Future analysis will consider sex and age differences for medical and surgical management and outcomes among this cohort.

P1227 Sex differences in rate of thrombolysis in acute ST-elevation myocardial infarction is caused by longer delay times in women

Sex differences in rate of thrombolysis in acute ST-evation myocardial infarction is caused by longer delay times in women.

Declining sex differences in mortality from lung cancer in high-income nations.

After decades of widening, the difference in mortality from lung cancer between men and women has begun to narrow in recent years. Recognizing that the increase in smoking among women relative to men is the proximate cause of the changing sex difference in rates of lung cancer, I analyzed two approaches to identify the more distant sources of the changes. A gender-equality argument suggests that the difference is related to the more general equalization of women's and men's work and family roles, which also encourages the adoption of harmful behaviors such as smoking by women. An alternative explanation suggests that the convergence in mortality from lung cancer among men and women is the byproduct of a lag in the adoption, diffusion, and abatement of smoking by women. Using mortality data on 21 nations from 1955 to 1996, an analysis of logged rates of men's and women's lung cancer mortality and the logged ratio of the rates demonstrated little relationship between the sex difference and gender equality. However, I found a strong and consistent relationship between the sex difference and the stage of diffusion of the use of cigarettes.

Race and sex differences in the refusal of cardiac catheterization among elderly patients hospitalized with acute myocardial infarction

Background Prior studies have reported race and sex differences in cardiac catheterization use after acute myocardial infarction (AMI). It is unclear whether race or sex differences in procedure refusal may contribute to this difference. We sought to determine whether cardiac catheterization refusal rates differ by patient race or sex. Methods We evaluated medical records of 74,745 Medicare beneficiaries hospitalized for AMI between January 1994 and February 1996 to ascertain refusal of cardiac catheterization during hospitalization. Patient race and sex were evaluated for their association with cardiac catheterization refusal adjusting for patient, physician, and hospital characteristics. Results The cardiac catheterization refusal rate in the overall cohort was 2.92% (95% CI 2.80%-3.04%). Race and sex differences in cardiac catheterization were observed after multivariate adjustment, with white women (odds ratio [OR] 1.28), black men (OR 1.34), and black women (OR 1.37) more likely to refuse cardiac catheterization than white men (OR 1.00). Relative differences in refusal were associated with only modest absolute differences in risk-standardized rates of cardiac catheterization refusal; rates were lowest for white men (2.55%), and higher for white women (3.21%), black men (3.36%), and black women (3.38%, P <.001 for global comparison). Conclusions Patient race and sex were associated with cardiac catheterization refusal among elderly patients hospitalized with AMI. However, absolute race and sex differences in rates of procedure refusal were small, suggesting that race and sex differences in cardiac catheterization refusal provide only a partial explanation of observed differences in cardiac procedure use. (Am Heart J 2002;144:1052-6.)

Gender differences in aging: cognition, emotions, and neuroimaging studies

Gender and aging moderate brain-behavior relationships. Advances in neuroscience enable integration of neurobehavioral, neuroanatomic, and neurophysiology measures. Here we present neurobehavioral studies thai examine cognitive and emotion processing in healthy men and women and highlight the effects of sex differences and aqinq. Neuroanatomic studies with maqnetic resonance imaging (MRI) indicate that the progressive decrease in brain volume affects froniotemporal brain regions in men more than in Vi/omen, Functional imaging methods suggest sex differences in rate of blood flow, pattern of glucose metabolism, and receptor activity. The role of ovarian hormones is important in elucidating the observed relationships. A life span perspective on gender differences through the integration of available methodologies will advance understanding healthy people and the effects of brain disorders.

Sex differences in access to coronary revascularization after cardiac catheterization: importance of detailed clinical data.

Although some studies suggest that access to cardiac procedures may differ by sex, others have found no evidence of gender bias in cardiac care. To study rates of percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery in men and women after cardiac catheterization. Cohort study with prospective data collection. Alberta, Canada. Persons undergoing cardiac catheterization between 1 January 1995 and 31 December 1998 (n = 21 816). The occurrence of revascularization procedures (PCI or CABG) in the year after cardiac catheterization was measured. Unadjusted revascularization rates, partially adjusted rates (adjusted for clinical variables available in most databases, including administrative databases), and fully adjusted rates (additionally adjusted for extent of coronary artery disease and ejection fraction) were also evaluated. The unadjusted relative risk was 0.67 (95% CI, 0.65 to 0.71) for the end point of any revascularization in women relative to men. The relative risk increased to 0.69 (CI, 0.66 to 0.72) with partial adjustment and to 0.98 (CI, 0.94 to 1.03) with full adjustment, indicating equivalent access to revascularization for men and women. For PCI, the corresponding relative risks were 0.77 (CI, 0.73 to 0.82), 0.84 (CI, 0.80 to 0.89), and 1.02 (CI, 0.96 to 1.08). For CABG surgery, the relative risks were 0.54 (CI, 0.51 to 0.58), 0.51 (CI, 0.48 to 0.55), and 0.93 (CI, 0.87 to 1.01). In Alberta, Canada, clinical variables fully explain sex differences in rates of revascularization after cardiac catheterization, and misleading conclusions would arise without full adjustment for clinical differences between men and women. Extreme caution is needed in interpreting reports on access to care that use sparsely detailed clinical data sources.

Al Ain community survey of psychiatric morbidity: II. Sex differences in the prevalence of depressive disorders

Aim: To examine sex differences in the prevalence of depressive disorders in an Arab community. Methods: One thousand three hundred and ninety-four subjects ( n=1394) were systematically sampled from the general population in Al-Ain city, United Arab Emirates. All subjects were interviewed and assessed with the modified version of the Composite International Diagnostic Interview (CIDI) and a specially designed socio–demographic questionnaire. The lifetime male and female prevalence rates were estimated. Multivariate logistic regression of various socio–demographic variables was carried out to assess independent risk factors for depression. Statistical significance of sex differences in rates of depression by various socio–demographic groups were also assessed. Results: The lifetime rates in males and females were 2.8 and 10.3%, respectively. F:M ratio found in this study is highest reported ratio in the literature. Sex, life events, chronic difficulties and to a certain extent age were found to be risk factors for depression in the studied community. The prevalence rates of depression were higher in females in all above categories but such differences reached statistical significance in age category before 55, regardless of marital status, when the number of children is four or more and among those exposed to recent life events and chronic difficulties. Females were found to to be more exposed to chronic life difficulties but only depressed females were significantly more subjected to recent life events. Conclusion: Sex differences in depression is a robust finding but more studies are needed to explain the high F:M ratio found in this survey.

Sex Differences in Rates of Hip and Knee Replacement

Osteoarthritis, the leading cause of long-term disability, is more prevalent in women than in men. Previous studies have suggested that women receive

Variable Expression of the Autism Broader Phenotype: Findings from Extended Pedigrees

Factors influencing the rate, form, and severity of phenotypic expression among relatives of autistic probands are examined. Family history data on 3095 first- and second-degree relatives and cousins from 149 families with a child with autism and 36 families with a child with Down syndrome are studied. The results provide further evidence of an increased risk among autism relatives for the broadly defined autism phenotype. Of proband characteristics, severity of autism and obstetric optimality were confirmed as being related to familial loading for probands with speech. There was little variation in loading among probands lacking speech. The type of phenotypic profile reported in relatives appeared little influenced by characteristics of the relative or the proband, except for variation by degree of relative, parental status of relative, and perhaps proband's birth optimality score. Phenotypic rates among parents suggested reduced fitness for the severest and more communication-related forms of expression but not for the more mild and social forms of expression. Patterns of expression within the families did not support a simple X-linked nor an imprinted X-linked mode of inheritance. The basis for sex differences in rates of expression is discussed.

Growth in utero and during childhood among women who develop coronary heart disease: longitudinal study

Objective: To examine whether women who develop coronary heart disease have different patterns of fetal and childhood growth from men in the same cohort who develop the disease.Design: Follow up...

Asthma Hospitalization Trends in California, 1983-1996

Annual asthma hospitalization rates were calculated for California's ethnically diverse population from 1983 through 1996. Trends were examined for four race/ethnicity groups: Hispanics, African-Americans, non-Hispanic Caucasians, and Asians/Pacific Islanders. The overall rate decreased by 30% during the time period. African-Americans had the highest rate, more that three times greater than the rate for Caucasians. Among children, the rates for Caucasians decreased by one-third, while rates increased for Hispanics and Asians. The rate for African-American children remained generally constant and was four times higher than the rate for Caucasians. Data from 1996 were assessed for repeat admissions, age and sex differences in rates, costs, and progress toward national goals.

Sex differences in the prevalence and detection of depressive and anxiety disorders in general health care settings: report from the World Health Organization Collaborative Study on Psychological Problems in General Health Care.

Understanding the relevance of biological and social factors to sex differences in the prevalence and detection of depressive and anxiety disorders has been impaired by the lack of standardized research methods across cultures. Prevalence rates of depressive and anxiety disorders were assessed using a 2-stage design from 26,969 patients attending for primary care in 15 centers from 4 continents. Logistic regression analysis was used to examine sex differences in prevalence and detection across centers. Odds ratios for women compared with men of current depression (1.60; 95% confidence interval [CI], 1.37-1.86) and agoraphobia or panic (1.63; 95% CI, 1.18-2.20) were consistent across centers. The odds ratio for generalized anxiety varied among centers: 3 groups of centers were identified with odds ratios of 0.46 (95% CI, 0.27-0.78), 1.34 (95% CI, 1.08-1.66), and 3.09 (95% CI, 1.60-5.89). There was no sex difference in the detection of depressive and anxiety disorders by physicians across centers. The absence of a sex-by-center effect for current depression and agoraphobia or panic disorder is consistent with biological and psychosocial factors, either interacting or working alone, that have a similar final effect across cultures. It does not support the idea that sex differences in prevalence are caused by local psychosocial factors that vary from country to country. The variation in the odds ratio for generalized anxiety disorder offers some support to the idea that there are local differences between the centers contributing to the sex difference in rates. Patients' sex does not appear to affect the likelihood of current depression and anxiety being detected by primary care physicians.

What happens to depressed men? Application of the Stirling County criteria.

In a recent issue of the Harvard Review of Psychiatry, results from the Stirling County Study showed that the prevalence and incidence rates of depression were similar in men and women when "gender-fair" criteria were used and help-seeking was not required. We attempted to replicate these findings by applying the criteria for depression from the Stirling County Study to two national and six international epidemiologic surveys conducted in the 1980s and 1990s. Depression was defined as dysphoric mood and disturbances of sleep, appetite, and energy, with at least a mild degree of impairment. The rates of depression were computed using this algorithm with data from the US Epidemiologic Catchment Area Study, conducted in the 1980s, the US National Comorbidity Survey, conducted in the 1990s, and independent community surveys from Canada, Puerto Rico, France, Taiwan, Korea, and New Zealand. For the US studies, these rates were recalculated after persons seeking treatment were removed from the analyses, where such data were available. Using Stirling County Study criteria, the lifetime prevalence rate of depression remains approximately twice as high in women as in men cross-nationally, except in Puerto Rico. Excluding help-seeking as a criterion and controlling for birth cohort do not change the findings. The Stirling County findings on absence of a sex difference in rates of depression using "gender-fair" criteria may be due to methodological variance in the collection of data, sample size, or the social and/or genetic uniqueness of the Atlantic Canadian community.

General practitioners and young suicides: a preventive role for primary care.

The suicide rate in young men, but not young women, is rising. One possible route to suicide prevention is through general practice but recent evidence suggests that young suicides are not likely to attend GP surgeries prior to death. We carried out a retrospective examination of general practice contacts by a 2-year sample of suicides under 35 years of age in the 12 health districts of Greater Manchester. In the 61 young suicides who were known to attend a GP in the three months before death, we recorded (a) the number of consultations each week in the three months before suicide; (b) sex differences in rates of and reasons for consultation; (c) frequency of recorded risk assessment at the last GP visit before suicide. The number of GP visits increased significantly before death. A monthly increase was more evident in males, but the increase in the week before death was more marked in females. There was no sex difference in the rate of GP visits before suicide; both sexes were most likely to attend for psychological reasons. Significant suicide risk had been noted at none of the final GP visits. There remains a potential role for GPs in preventing suicides by young people of both sexes. The recent increase in suicide by young males does not appear to be related to a lower rate of GP attendance before death. Future training of GPs in this area should focus on risk assessment.