Sex-related Risk Factors Research Articles

Does sex influence the natural history of idiopathic adult-onset dystonia?

BackgroundSeveral earlier studies showed a female predominance in idiopathic adult-onset dystonia (IAOD) affecting the craniocervical area and a male preponderance in limb dystonia. However, sex-related differences may result from bias...

Squamous Cell Carcinoma of the Skin: Epidemiology, Diagnosis, Management, Recurrence and Mortality Rates for the Bulgarian Population

Summary Squamous cell carcinoma of the skin (SCCs) accounts for 20-30% of non-melanoma skin cancers, resulting in 1 million cases in the United States annually. The risk of developing SCCs increases annually, and this process will likely be continued because of the aging population. We investigated 355 patients with histopathologically confirmed SCCs. We rated the age- and sex-related incidence, risk factors, localisation, pathological features, staging systems and treatment, and the recurrence and mortality rates of the tumours. Staging and risk stratification for recurrence and metastases is significant. Most SCCs are successfully treated surgically, with a small subset of carcinomas leading to recurrence, metastasis, and death. Patients with advanced and metastatic disease are often inappropriate for surgical and radiation therapy. We present the first study on squamous cell carcinoma of the skin conducted for the population of the Pleven and Lovech regions of Bulgaria.

Graves' Orbitopathy Models: Valuable Tools for Exploring Pathogenesis and Treatment.

Graves' orbitopathy (GO) is the most common extrathyroidal complication of Graves' disease (GD) and severely affects quality of life. However, its pathogenesis is still poorly understood, and therapeutic options are limited. Animal models are important tools for preclinical research. The animals in some previous models only exhibited symptoms of hyperthyroidism without ocular lesions. With the improvements achieved in modeling methods, some progressive animal models have been established. Immunization of mice with A subunit of the human thyroid stimulating hormone receptor (TSHR) by either adenovirus or plasmid (with electroporation) is widely used and convincing. These models are successful to identify that the gut microbiota influences the occurrence and severity of GD and GO, and sex-related risk factors may be key contributors to the female bias in the occurrence of GO rather than sex itself. Some data provide insight that macrophages and CD8+ T cells may play an important pathogenic role in the early stage of GO. Our team also replicated the time window from GD onset to GO onset and identified a group of CD4+ cytotoxic T cells. In therapeutic exploration, TSHR derived peptides, fingolimod, and rapamycin offer new potential options. Further clinical trials are needed to investigate these drugs. With the increasing use of these animal models and more in-depth studies of the new findings, scientists will gain a clearer understanding of the pathogenesis of GO and identify more treatments for patients.

Impact of Sexual Activity on the Risk of Male Genital Tumors: A Systematic Review of the Literature.

Most cancers are related to lifestyle and environmental risk factors, including smoking, alcohol consumption, dietary habits, and environment (occupational exposures). A growing interest in the association between sexual activity (SA) and the development of different types of tumors in both men and women has been recorded in recent years. The aim of the present systematic review is to describe and critically discuss the current evidence regarding the association between SA and male genital cancers (prostatic, penile, and testicular), and to analyze the different theories and biological mechanisms reported in the literature. A comprehensive bibliographic search in the MEDLINE, Scopus, and Web of Science databases was performed in July 2021. Papers in the English language without chronological restrictions were selected. Retrospective and prospective primary clinical studies, in addition to previous systematic reviews and meta-analyses, were included. A total of 19 studies, including 953,704 patients were selected. Case reports, conference abstracts, and editorial comments were excluded. Men with more than 20 sexual partners in their lifetime, and those reporting more than 21 ejaculations per month, reported a decreased risk of overall and less aggressive prostate cancer (PCa). About 40% of penile cancers (PCs) were HPV-associated, with HPV 16 being the dominant genotype. Data regarding the risk of HPV in circumcised patients are conflicting, although circumcision appears to have a protective role against PC. Viral infections and epididymo-orchitis are among the main sex-related risk factors studied for testicular cancer (TC); however, data in the literature are limited. Testicular trauma can allow the identification of pre-existing TC. SA is closely associated with the development of PC through high-risk HPV transmission; in this context, phimosis appears to be a favoring factor. Sexual behaviors appear to play a significant role in PCa pathogenesis, probably through inflammatory mechanisms; however, protective sexual habits have also been described. A direct correlation between SA and TC has not yet been proven, although infections remain the most studied sex-related factor.

Cardiovascular disease prevention and therapy in women with Type 2 diabetes.

Cardiovascular disease (CVD) is the leading cause of death among men and women, although women are usually underdiagnosed and experience a delay in diagnosis. This also occurs in women with type 2 diabetes mellitus, despite the fact that diabetes is recognized as a major cardiovascular risk factor. Several factors influence the gap between diagnosis and treatment of cardiovascular disease in women: lack of perception of cardiovascular risk, effects of sex-related risk factors and the action of drugs in women. Women with Type 2 diabetes mellitus are more likely to be assigned a lower CVD risk category and to receive lifestyle counseling as well as less intensive CVD therapy compared with men. The present narrative review aims to analyze the risk of CVD in women with Type 2 diabetes mellitus and whether there is a difference between men and women in the efficacy of SGLT-2 inhibitors, new hypoglycemic drugs.

Association between Anemia and Stroke in Females: A Nationwide, Population-Based Cohort Study in Taiwan.

Optimal stroke prevention strategies for women should take into account specific sex-related stroke risk factors. Anemia is a common medical condition in females, particularly in women of reproductive age. This study investigated whether anemia is an independent risk factor for stroke in females in a population-based cohort study. We investigated newly diagnosed anemic female patients with no history of central nervous system disease, psychiatric disorders, traumatic brain injury, major operations or hemorrhagic diseases identified from the Taiwan National Health Insurance Research Database. Non-anemic matched controls (1:1) were selected based on a propensity score estimated using a logistic regression model that included demographic characteristics and comorbidities. A competing risk analysis was applied to estimate the stroke risk in anemic patients compared to that of their matched controls. In our study, the adjusted sub-distribution hazard ratios (aSHRs) of overall, hemorrhagic and ischemic stroke in anemic female patients aged <50 years were 1.35 (95% confidence interval (CI): 1.19–1.52, p < 0.001), 1.31 (95% CI, 1.09-1.56, p < 0.003), and 1.35 (95% CI, 1.15–1.58, p < 0.001), respectively, compared to non-anemic female controls. However, a positive association between anemia and stroke was not found for those aged ≥50 years. Similar results were observed when the follow-up age was limited to 50 years to reduce the potential effects of menopause on stroke. In conclusion, the present population-based cohort study found that anemia is a potential risk factor for overall, hemorrhagic and ischemic stroke in females of reproductive age.

Invited Commentary

Invited Commentary

Severity of Presentation, Not Sex, Increases Risk of Surgery for Infective Endocarditis

Cardiac surgery for infective endocarditis (IE) is associated with substantial short- and long-term mortality, and female sex seems to be associated with even worse outcomes. The aim of our study was to analyze the impact of sex on 30-day and long-term mortality and to identify sex-related risk factors in IE patients requiring cardiac surgery. Relevant clinical data of all consecutive 305 patients undergoing cardiac surgery for IE between 2009 and 2016 were extracted from our institutional database and retrospectively analyzed. Infective endocarditis was defined according to the recent modified Duke criteria and surgery indicated in compliance with current European Society of Cardiology guidelines. Sex-related postoperative outcomes including 30-day and 1-year mortality were recorded. Univariate and multivariable analysis was performed to identify potential sex-dependent risk factors. In all, 229 male patients (75.1%) and 76 female patients (24.9%) underwent surgery for IE. Female patients showed significantly more mitral valve infection (52.6% versus 33.6%, p= 0.003), and Staphylococcus aureus as causative microorganisms was diagnosed in 44.7% of female patients compared with 24.5% of male patients (p= 0.001). Female sex was associated with a higher 30-day mortality (18.4% versus 8.3%, p= 0.014) and 1-year mortality (46.1% versus 27.1%, p= 0.002). Multivariable analysis revealed not female sex, but European System for Cardiac Operative Risk Evaluation II score, reexploration for bleeding, and postoperative acute kidney injury as independent risk factors for 30-day mortality and preoperative dialysis for 1-year mortality, respectively. In this study, female sex was associated with more severe manifestations of IE and significantly higher 30-day and 1-year mortality. After multivariable analysis, not female sex, but the underlying comorbidities seem to determine clinical outcomes.

Sex differences in the prevalence of genetic mutations in FTD and ALS: A meta-analysis.

To conduct a meta-analysis that investigates sex differences in the prevalence of mutations in the 3 most common genes that cause amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD)-chromosome 9 open reading frame 72 (C9orf72), progranulin (GRN), or microtubule-associated protein tau (MAPT)-in patients clinically diagnosed with these conditions. MEDLINE, EMBASE, and PsycINFO databases were searched (inception to June 30, 2016). Studies of patients with FTD or ALS that reported the number of men and women with and without mutations of interest were selected. Female to male pooled risk ratios (RR) and 95% confidence intervals (CI) for each mutation were calculated using random-effects models. Thirty-two articles reporting 12,784 patients with ALS (including 1,244 C9orf72 mutation carriers) revealed a higher prevalence of female patients with C9orf72-related ALS (RR 1.16, 95% CI 1.04-1.29). Twenty-three articles reporting 5,320 patients with FTD (including 488 C9orf72 mutation carriers) revealed no sex differences in C9orf72-related FTD (RR 0.95, 95% CI 0.81-1.12). Thirty-six articles reporting 3,857 patients with FTD (including 369 GRN mutation carriers) revealed a higher prevalence of female patients with GRN-related FTD (RR 1.33, 95% CI 1.09-1.62). Finally, 21 articles reporting 2,377 patients with FTD (including 215 MAPT mutation carriers) revealed no sex difference in MAPT-related FTD (RR 1.21, 95% CI 0.95-1.55). Higher female prevalence of C9orf72 hexanucleotide repeat expansions in ALS and GRN mutations in FTD suggest that sex-related risk factors might moderate C9orf72 and GRN-mediated phenotypic expression.

Risk Factors for Serogroup C Meningococcal Disease during Outbreak among Men who Have Sex with Men, New York City, New York, USA.

Risk factors for illness during a serogroup C meningococcal disease outbreak among men who have sex with men in New York City, New York, USA, in 2012–2013 included methamphetamine and cocaine use and sexually transmitted infections. Outbreak investigations should consider routinely capturing information regarding drug use and sex-related risk factors.

Sex differences in epidemiology and risk factors of acute coronary syndrome in Chinese patients with type 2 diabetes: a long-term prospective cohort study.

ObjectiveDiabetic patients with acute coronary syndrome (ACS) are at higher risk of poor outcome than are non-diabetic patients with ACS. Few studies have focused on sex-related ACS incidence, ACS-related mortality or risk factors to affects sex specific ACS in Chinese with Type 2 diabetes mellitus (T2DM). Based on a hospital-based cohort of Chinese patients with T2DM, we aimed to investigate whether there was sex difference in ACS or ACS-related mortality or risk factors of ACS.MethodsTotally 2,135 Hong Kong Chinese with T2DM were recruited during 1994-1996 and followed up until August 2012. We systematically analyzed sex-related ACS incidence and ACS-related mortality and risk factors with χ2-squared test, descriptive statistics and survival analysis.ResultsRegular follow-up was completed in 2,105 subjects (98.6%), with a median period of 14.53 years. The occurrence of ACS was recorded among 414 patients (19.7%) and ACS-related death among 104 patients (4.9%). ACS incidences increased with age in both men and women, and men had a higher prevalence of ACS than women across different age categories and different follow-up periods (log rank χ2=20.32, P<0.001). The transition of ACS incidences from slow to rapid increase were about 5 years earlier in men (at 51-55 years) than in women (55-60 years). Among ACS patients, cumulative ACS-related mortalities was similar between men and women (log rank χ2=0.063, P=0.802). Besides age and albuminuria, different profiles of risk factors accounted for the occurrence of ACS between men and women.ConclusionsOur findings demonstrated sex differences in ACS incidence and risk factors, but not in ACS-related mortality in Chinese patients withT2DM. These findings suggest that screening and prevention campaigns should be optimized for men and women, which may help to identify diabetic patients at higher risk of coronary heart disease.

Prevalence and sex-related risk factors of premarital pregnancy and reproductive tract infections among female undergraduates in Wuhan, China.

In China, more and more female college students engage in premarital sex. Few seek reproductive health services, increasing their risk for unintended pregnancy and reproductive tract infections (RTIs). The present study aims to explore the prevalence and sex-related risk factors of premarital pregnancy and RTIs among female undergraduates in China. A total of 4769 females were recruited using randomized cluster sampling and anonymously completed questionnaires. Of the 4,769 females, 863 (18.1%) reported ever having sexual intercourse, 17.5% of which had become pregnant, and 22.7% had contracted RTIs. Younger age or not using a condom at first sex and having multiple sex partners contributed to premarital pregnancy. Majoring in arts, being from less-developed regions of China, having multiple partners, and self-reported pregnancy contributed to RTIs. Findings suggest importance of sexual health education among undergraduates, especially women from less-developed regions of China and/or majoring in arts.

Comparison of Landing Biomechanics Between Male and Female Dancers and Athletes, Part 1

Background: The incidence of anterior cruciate ligament (ACL) injuries among dancers is much lower than among team sport athletes, and no clear disparity between sexes has been reported in the dance population. Although numerous studies have observed differences in landing biomechanics of the lower extremity between male and female team sport athletes, there is currently little research examining the landing biomechanics of male and female dancers and none comparing athletes to dancers. Comparing the landing biomechanics within these populations may help explain the lower overall ACL injury rates and lack of sex disparity. Hypothesis: The purpose was to compare the effects of sex and group (dancer vs team sport athlete) on single-legged drop-landing biomechanics. The primary hypothesis was that female dancers would perform a drop-landing task without demonstrating typical sex-related risk factors associated with ACL injuries. A secondary hypothesis was that female team sport athletes would display typical ACL risk factors during the same task. Study Design: Controlled laboratory study. Methods: Kinematics and kinetics were recorded as 40 elite modern and ballet dancers (20 men and 20 women) and 40 team sport athletes (20 men and 20 women) performed single-legged drop landings from a 30-cm platform. Joint kinematics and kinetics were compared between groups and sexes with a group-by-sex multivariate analysis of variance (MANOVA) followed by pairwise t tests. Results: Dancers of both sexes and male team sport athletes landed similarly in terms of frontal-plane knee alignment, whereas female team sport athletes landed with a significantly greater peak knee valgus (P = .007). Female dancers were found to have a lower hip adduction torque than those of the other 3 groups (P = .003). Dancers (male and female) exhibited a lower trunk side flexion (P = .002) and lower trunk forward flexion (P = .032) compared with team sport athletes. Conclusion: In executing a 30-cm drop landing, female team sport athletes displayed a greater knee valgus than did the other 3 groups. Dancers exhibited better trunk stability than did athletes. Clinical Relevance: These biomechanical findings may provide insight into the cause of the epidemiological differences in ACL injuries between dancers and athletes and the lack of a sex disparity within dancers.

Age- and Sex-related Risk Factors for Influenza-associated Mortality in the United States Between 1997–2007

Limited information on age- and sex-specific estimates of influenza-associated death with different underlying causes is currently available. We regressed weekly age- and sex-specific US mortality outcomes underlying several causes between 1997 and 2007 to incidence proxies for influenza A/H3N2, A/H1N1, and B that combine data on influenza-like illness consultations and respiratory specimen testing, adjusting for seasonal baselines and time trends. Adults older than 75 years of age had the highest average annual rate of influenza-associated mortality, with 141.15 deaths per 100,000 people (95% confidence interval (CI): 118.3, 163.9), whereas children under 18 had the lowest average mortality rate, with 0.41 deaths per 100,000 people (95% CI: 0.23, 0.60). In addition to respiratory and circulatory causes, mortality with underlying cancer, diabetes, renal disease, and Alzheimer disease had a contribution from influenza in adult age groups, whereas mortality with underlying septicemia had a contribution from influenza in children. For adults, within several age groups and for several underlying causes, the rate of influenza-associated mortality was somewhat higher in men than in women. Of note, in men 50-64 years of age, our estimate for the average annual rate of influenza-associated cancer mortality per 100,000 persons (1.90, 95% CI: 1.20, 2.62) is similar to the corresponding rate of influenza-associated respiratory deaths (1.81, 95% CI: 1.42, 2.21). Age, sex, and underlying health conditions should be considered when planning influenza vaccination and treatment strategies.

P1-S5.29 Relationship between incident bacterial vaginosis, gonorrhoea and chlamydial infection among women attending a sexually transmitted disease clinic

BackgroundInteractions between bacterial vaginosis (BV) and inflammatory sexually transmitted infections, such as gonorrhoea and chlamydial infection, are not well understood. Furthermore, evidence regarding the sexual transmission of BV is equivocal.MethodsWe...

Analysis of 1040 cases of canine aggression in a referral practice in Spain

A retrospective study was designed to assess the prevalence and clinical presentation of canine aggression problems in a referral practice in Spain. One thousand forty canine aggression cases seen at the Animal Behavior Clinic (Barcelona School of Veterinary Medicine) were analyzed. Each aggression problem was characterized according to 7 predefined diagnostic categories. Breed and sex-related risk factors were calculated by comparing the aggressive dogs to a control population. Aggression problems were the most common behavior complaint (52.28% of all canine behavior cases). Owner-directed aggression was the most frequent of the aggression complaints (38.55%), followed by aggression towards other dogs (34.85%) and unfamiliar people (21.95%). A mean of 1.4 diagnoses of aggression per dog were established. Social conflict aggression towards family members was the most common diagnostic category (35.34%). Sixty nine per cent of aggressive dogs were males and 31% were females, from which only 11 and 12 percent were neutered respectively. Two breeds, the English cocker spaniel and the Catalan sheepdog, presented a particularly high risk for aggression in the studied population.

Sero-prevalence of Hepatitis B Surface Antigen (HBsAg), in Sexually Transmitted Disease Patients

Aim: To determine the sero-prevalence of hepatitis B surface antigen (HBsAg), in sexually transmitted diseases(STD) patients and to determine the sex-related risk factors associated with HBsAg Patients and Methods: A descriptive study was performed at the University of Benin Teaching Hospital, on 155 (79males and 76 females) between the ages of 24 and 63years (mean age 35±2.4 years ).Patients were consecutively selected from all adults attending the STD clinic. A questionnaire was administered to each patient, in order to ascertain the possible risk factors, for the transmission of HBsAg, with STDs as the main risk factor. The sex-related factors included a history of multiple partners in the past 6 months, a history of a number of episodes of STDs, history of heterosexual exposure to partners at risk, for example prostitutes; a history of symptoms of an STD at the commencement of the study. Sera were screened for HBsAg, using a rapid chromatographic immuno-assay. Results: The number of HBsAg positives was 14.1%(males 5.1% and females 9%).The sex-related risk factors identified were a history of exposure to partners at risk; a history of HIV antibody; a history of clinical symptoms of an STD at the commencement of the study. Conclusion: The HBsAg sero-prevalence rate of 14.1% is high. The study showed that exposure to sex-related risk factors are liable for the high prevalence of HBsAg observed. In order to curb the further spread of the hepatitis B virus, we recommend prompt treatment of STDs; avoidance of people at risk of STDs; cost effective HBsAg screening and public health education based on the epidemiology of sex-related HBsAg acquisition. Key Words: HbsAg, Seroprevalence, STD Patients. Journal of College of Medicine 2005: 9(2): 107-109

Health risk factors among detained adolescent females

To identify the prevalence of health risk factors among a sample of detained adolescent females and determine whether there are racial/ethnic differences. A cross-sectional survey of 197 adolescent females (aged 14 to 18 years) recruited within eight detention facilities. Thirty-five measures, comprising four domains, were assessed. Domains were sex-related risk factors, violence-related risk factors, selected mental health issues, and substance abuse behaviors. Measures were collected using audio-computer-assisted self-interviewing. A biological assessment for the presence of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis was also conducted. Several health risk factors were especially prominent. Mean age of sexual debut was 13 years. The mean number of sex partners (lifetime) was 8.8. Twenty percent tested positive for an STD, and 32.2% had ever been pregnant. Of those reporting sexual activity, 33.9% had not used any form of contraception in the past 2 months and about 40% reported having recent sex with a casual partner. More than 40% reported that a friend had been beaten, attacked, or hurt by others in the past year. More than one half had witnessed violence (past year) and nearly 30% had ever belonged to a gang. Forty percent had thought about committing suicide in the past 2 months, with 35% informing someone of their intent, and 25% attempting suicide. Recent use of illegal substances was common. Correlations between the four domains were significant (p < 0.03), but weak. With some notable exceptions (STD prevalence, trading sex for money, witnessing violence), no difference was found between minority and nonminority adolescents with respect to risk factors. After creating an index of all the risk factors, a normal distribution was obtained (mean number of factors, 10.3; standard deviation, 5.0). Preventive medicine programs for adolescent females within detention facilities are warranted. Our evidence suggests that health risk behaviors in this population may be quite diverse; therefore, these programs should be broad in scope and that depth of the programs should vary as a function of risk level.

Characteristics of Sites and Morphology of the stomach cancer incidents in Jejudo, 2000

Objectives: The aim of this study is to describe the distribution of sites and morphologic findings of the stomach cancer in Jejudo.Methods: From the Jejudo Regional Cancer Registry databases, the subjects were constructed by condition of the incidents of stomach cancer in 2000 among Jejudo residents. The databases also supplied the individual information of the topology and morphology on subjects.Results: The order of ranks in the topology and morphology of stomach cancer was nearly same as that of Korea Central Cancer Registry databases, which represented the nationwide condition of cancer incidence. However, there were some differences in dominant site and morphology between men and women.Conclusions: The results showed that the occurring mechanism of stomach cancer would not be different between Jejudo and other area of Korea. But some further studies to evaluate sex-related risk factors of stomach cancer should be necessary near future.

Oral contraceptives intake may be inversely correlated with varicose veins and chronic venous insufficiency

SummaryAim: Determination of lifestyle and sex related risk factors that contribute to higher prevalence of varicose veins (VV) and chronic venous insufficiency (CVI) in women and establishment of a possible link between reported exposure to oral contraceptives (OC) and prevalence of VV and CVI. Methods: The Warsaw Brodno Venous Population Survey was a cross-sectional study, conducted on a group of 2530 women. On the basis of a targeted questionnaire, medical records and clinical investigation, sex, and lifestyle related risk factors were identified. Results: In women the prevalence of VV was 15.9% and of CVI (C1-C6) 40.15%. Open ulceration and healed ulceration were diagnosed in 0.51% and 0.75%, respectively. Analysis of lifestyle and job related risk factors for VV showed OR = 0.52 for sitting and OR = 1.56 for vertical lifestyle, and for CVI for office workers OR = 0.53 versus physical workers OR = 1.88. Women taking ever oral contraceptives and those who took them for more than 5 years had a decreased risk of CVI: OR = 0.44 and OR = 0.36 respectively. For VV risk OC intake demonstrated OR = 0.30 and OR = 0.27, respectively. Conclusions: Oral contraception may be inversely correlated with the prevalence of varicose veins and chronic venous insufficiency, although the reasons for this finding require further elucidation. We have confirmed that vertical life style and physical work, pregnancy, family history of varicose veins increase the risk of VV and CVI.