Significant Sex-related Differences Research Articles

Evaluation of Smile Parameters in Nongrowing Subjects Using Photographs

Abstract Introduction An attractive or pleasing smile enhances the acceptance of an individual in the society by improving interpersonal relationships. In this new era of social media, people are more concerned about their smile; hence, smile esthetics has become the primary objective of orthodontic treatment. It is seen that various smile parameters change with age and gender. Aim The aim of the study was to evaluate various smile parameters in nongrowing patients using photographic analysis. Materials and Methods The sample comprised photographs of 50 subjects (8 males, 42 females) taken in natural head position and then divided into two age groups: Group I (25 subjects, aged 18–20 years) and Group II (25 subjects, aged 23–29 years). The various parameters were analyzed using Adobe Photoshop software (version CS 6; Adobe System Inc., California, United States): upper lip and lower lip lengths during rest and smiling, smile index, buccal corridor, upper and lower lip thickness, interlabial gap, incisal display, widest visible maxillary display, and intercommissural width. Results The results showed that lower lip length at rest and smiling, interlabial gap, incisal display, inner commissure width, and widest visible maxillary display were increased, whereas upper lip length both at rest and smiling, upper and lower lip thickness, outer commissure width, smile index, and buccal corridor were decreased with age. Statistically significant sex-related differences were found in upper lip length at rest and lower lip length both at rest and smiling. Conclusion Orthodontic treatment must incorporate various esthetic elements of smile to achieve desirable results.

Trends in stroke outcomes at hospital discharge in first-ever stroke patients: Observations from the Malaysia National Stroke Registry (2009–2017)

BackgroundStroke outcomes could be a quality indicator across the continuum of care and inform stroke management policymaking. However, this topic has rarely to date been studied directly. AimsWe sought to investigate recent trends in stroke outcomes at hospital discharge among first-ever stroke patients. MethodsThis was an analysis of data from the Malaysia National Stroke Registry. Patients aged 18 years or older documented as having a first episode of stroke in the registry were recruited. Subsequently, the comparison of proportions for overall and sex-specific stroke outcomes between years (from 2009 to 2017) was conducted. The primary outcome was modified Rankin Scale score, which was assessed at hospital discharge, and each patient was categorized as follows: 1) functional independence, 2) functional dependence, or 3) death for analysis. ResultsThis study included 9361 first-ever stroke patients. Approximately 36.2% (3369) were discharged in an independence state, 53.1% (4945) experienced functional dependence, and 10.8% (1006) patients died at the time of hospital discharge. The percentage of patients who were discharged independently increased from 23.3% in 2009 to 46.5% in 2017, while that of patients discharged in a disabled state fell from 56.0% in 2009 to 45.6% in 2017. The percentage of death at discharge was reduced from 20.7% in 2009 to 7.8% in 2017. These findings suggest that the proportions of stroke outcomes at hospital discharge have changed significantly over time (p < 0.001), and there was a significant sex-related difference in stroke outcomes at hospital discharge following first stroke episode (p < 0.001). ConclusionsOur data indicate there has been a significant change in stroke outcomes over the past nine years in Malaysia. This information ought to be considered in ongoing efforts of tertiary stroke prevention.

Prevalence of Systemic Arterial Hypertension in Quilombola Communities, State of Sergipe, Brazil.

BackgroundThe quilombolas are groups formed by black ancestry individuals, living in a context of social vulnerability due to low socioeconomic level, which influences health care and the development of chronic diseases.ObjectiveTo assess the prevalence of systemic arterial hypertension and its association with cardiovascular risk factors in the quilombola population in the State of Sergipe, Brazil.MethodsStudy design was cross sectional, involving the administration of a questionnaire to individuals aged ≥ 18 years, in 15 quilombola communities of the State of Sergipe, Brazil. A value of two-sided p < 0.05 was considered statistically significant.ResultssA total of 390 individuals were evaluated, 72.3% of whom were women, with a mean age of 44.7 years. The prevalence of hypertension was 26% (with a confidence interval of 95% [95% CI]: 22-30), with no significant sex-related differences. The age was associated with arterial hypertension (95% CI: 1.03-1.06), systolic (95% CI: 1.04-1.07) and diastolic (IC 95%: 1.01-1.04) arterial hypertension. The level of body mass index was associated with arterial hypertension (95% CI: 1.00-1.11) and diastolic arterial hypertension (95% CI: 1.03-1.17). Economic class was associated with diastolic arterial hypertension (95% CI: 1.22-5.03).ConclusionThe prevalence of arterial hypertension in the quilombola communities was high. Its association with cardiovascular risk factors indicates the need to improve access to healthcare services.

Influence of environmental colors and long-term sex isolation on zebrafish shoaling behavior

Zebrafish has a complex social behavior and little is known about the role of sexual preference and their environmental social interactions. In this study we investigated the potential influence of environmental colors and shoaling preferences of zebrafish male and female populations, with a focus on visual communication. Males and females were kept for 7 days in gender-isolated tanks, with a specific habitat color for each group: green for males and red for females. After the pre-test period, all the animals were kept separated and 8 noninvasive behavioral tests were conducted in a T-maze, with the application of different visual stimuli. We did not observe any clear influence of environmental coloring on social zebrafish choices. Significant sex-related differences were found in shoaling partner preference (i.e. same sex vs. other sex, one fish vs. three fish) as follows: females showed a tendency to avoid other females and spent more time with males. Male fish did not display a preference between one or three fish stimuli and they shoaled more with another male and less with a potential sexual partner. There was an obvious difference between males and females in responses and selection of shoaling partners.

Sex differences in thigh muscles characteristics: a systematic review

Objective: To determine differences between male and female subjects in the thigh muscles characteristics, separated into architectural (pennation, thickness, and/or fascicle length), mechanical (mass, strength, power, and/or stiffness), neuromuscular (activity) and fatigue aspects, in order to better understand the sex-related differences in the risk of muscle injuries. Methods: A systematic literature search on Pubmed was performed with different keywords: skeletal muscle AND sex characteristics AND muscle contraction, with the following limits: humans and adults (19–44 years old). Studies dealing with hamstring and quadriceps muscles, in physiological condition, and comparison between male and female healthy adult subjects were included. Studies dealing with other skeletal muscles, injuries or physiopathology situation were excluded. Thigh muscular architectural, mechanical, neuromuscular and fatigue characteristics have been analysed to determine differences between male and female subjects. Results: Seventeen studies were included, reporting significant sex-related differences for thigh muscles architecture and mechanical characteristics and muscle fatigue, and especially quadriceps, while for thigh muscles neuromuscular characteristics the results were not consensual, and few information was available regarding hamstring muscles. Conclusions: Sex-related differences in thigh muscles characteristics, and especially quadriceps, have been reported for mechanical characteristics and muscle fatigue, while for neuromuscular characteristics sex-related differences were found to be moderate. Although several macroscopic muscle characteristics have been reported to be different between male and female healthy adult subjects, it is difficult to conclude on its exact relationship with higher muscle injury rates reported in male athletes during international athletics championships.

Atherosclerotic plaque burden evaluated from neck to groin: effect of gender and cardiovascular risk factors.

We explored the impact of gender and cardiovascular risk factors (RF) in the distribution and burden of coronary and extra-coronary atherosclerotic plaques among patients undergoing ECG-gated thoracoabdominal computed tomography angiography (CTA) from the supra-aortic trunks to the femoral arteries. We included a consecutive cohort of patients who underwent ECG-gated thoracoabdominal aortic CTA from the supra-aortic trunks to the pubic symphysis. We evaluated the number of coronary segments with plaques [segment-involvement score (SIS)]; and the extra-coronary atherosclerotic plaque burden, comprising the aorta and supra-aortic trunks, iliofemoral arteries, and visceral arteries (extra-coronary SS). A total of 3400 vascular segments were evaluated in 100 patients (mean age 67.0 ± 12.6 years, 66% male). Seventy-two (72%) patients had evidence of atherosclerosis in the coronary tree (coronary SIS ≥ 1), of which 32% was extensive (coronary SIS > 5). Males had a significantly higher prevalence of coronary SIS ≥ 1 [53 (80%), vs. 19 (56%), p = 0.018], and coronary SIS > 5 [24 (36%) vs. 8 (24%), p = 0.035] than females. Extra-coronary SS was similar between genders (males 10.2 ± 5.8 vs. females 9.7 ± 5.4, p = 0.70), irrespective of the location along the different vascular beds. The number of coronary RF was significantly related to the coronary SIS (p = 0.038), and hypertension and diabetes were consistently related to coronary and extra-coronary plaque burden. In the present study involving analysis of multiple vascular beds from the supra-aortic trunks to the femoral arteries, we identified significant sex-related differences in coronary plaque burden, whereas extra-coronary plaque burden was similar between genders irrespective of the vascular bed assessed.

Sex-related differences in response to zinc pyrithione shampoo vs. non-anti-dandruff shampoo.

Sex-related differences in skin properties may be expected to impact dandruff formation and treatment. A meta-analysis approach was undertaken to investigate potential differences between males and females in response to zinc pyrithione (ZnPT) treatment vs. non-anti-dandruff (AD) shampoo. A separate pooled statistical analysis of ceramide and total protein loss endpoints was also undertaken to assess potential sex-related differences in stratum corneum properties that might influence response to ZnPT vs. non-AD shampoo in subjects with dandruff. The meta-analysis approach included data from 17 half-head, double-blind, randomized studies (N=2088) undertaken in Asia to assess the effectiveness of 1% ZnPT shampoo and/or non-AD shampoo in reducing dandruff severity, as assessed by Total Weighted Head Score Adherent Flake (TWHS-AF) methodology. Treatment duration was 4weeks, with TWHS-AF measured at weekly intervals. Data from an additional three studies (N=143) conducted in Asia were included in the pooled analysis of ceramide levels and protein loss from scalp skin of subjects with dandruff. Response to 1% ZnPT vs. non-AD shampoo was greater in males than in females at all time points; after 4weeks, the between-treatment difference in TWHS-AF was -17.5 (95% confidence interval [CI] -19.5, -15.5) in males and -11.1 (-13.2, -8.9) in females. Sex-related differences were observed between males and females in response to both 1% ZnPT and non-AD shampoos. Males had a stronger response than females to treatment with 1% ZnPT shampoo, while dandruff decreased to a greater extent in females than in males when using non-AD shampoo. Statistically significant sex-related differences in ceramide levels and total protein loss were observed (both P<0.01). Ceramide levels were 0.76 times lower (95% CI 0.60, 0.97) in males than in females, while total protein loss was 1.4 times greater (95% CI 1.1, 1.9) in males than in females. Males show a greater response than females to 1% ZnPT shampoo, while females show a greater response than males to non-AD shampoo. These findings may in part be explained by the sex-related differences observed in stratum corneum properties, which may make males more prone to dandruff than females.

Hemodynamic effects of sex and handedness on the Wisconsin Card Sorting Test: the contradiction between neuroimaging and behavioural results.

This study investigated the potential role of sex and handedness on the performance of a computerised Wisconsin Card Sorting Test (WCST) in healthy participants by applying functional near-infrared spectroscopy (fNIRS). We demonstrated significant (p < 0.05) sex-related differences of hemodynamic response in the prefrontal cortex of 70 healthy participants (female, n = 35 and male, n = 35; right-handed, n = 40 and left-handed, n = 30). In contrast, behavioural results of the WCST do not show sex bias, which is consistent with previous literature. Because of this, we compared ours and sparse previous fNIRS studies on the WCST. We propose that, according to recent studies of neurovascular coupling, this contradiction between neuroimaging and behavioural results may be explained by normal variability in neurovascular dynamics.

Need to Prioritize Education of the Public Regarding Stroke Symptoms and Faster Activation of the 9-1-1 System: Findings from the Florida–Puerto Rico CReSD Stroke Registry

Objective: Demographic differences (race/ethnicity/sex) in 9-1-1 emergency medical services (EMS) access and utilization have been reported for various time-dependent critical illnesses along with associated outcome disparities. However, data are lacking with respect to measuring the various components of time taken to reach definitive care facilities following the onset of acute stroke symptoms (i.e., stroke onset to 9-1-1 call, EMS response, time on-scene, transport interval) and particularly with respect to any differences across ethnicities and sex. Therefore, the specific aim of this study was to measure the various time intervals elapsing following the first symptom onset (FSO) from an acute stroke until stroke hospital arrival (SHA) and to delineate any race/ethnic/sex-related differences among any of those measurements.Methods: The Florida-Puerto Rico Stroke Registry (FLPRSR) is an on-going, voluntary stroke registry of hospitals participating in the Get with the Guidelines-Stroke initiative. The study population included patients treated at Florida hospitals participating in the FLPRSR between 2010 and 2014 who had called 9-1-1 and were managed and transported by EMS. In total, 10,481 patients (16% black, 8% Hispanic, 74% white) had complete data-sets that included birthdate/year, sex, ethnic background, date/hour/minute of FSO and date/hour/minute of EMS response, scene arrival, and SHA.Results: Median time from FSO to SHA was 339 minutes (interquartile range [IQR] of 284–442), 301 of which constituted the time elapsed from FSO to the 9-1-1 call (IQR =249–392) versus only 10 from 9-1-1 call to EMS arrival (IQR =7–14), 14 on-scene (IQR =11–18) and 12 for transport to SHA (IQR =8–19). The FSO to 9-1-1 call interval, being by far the longest interval, was longest among whites and blacks (302 minutes for both) versus 291 for Hispanics (p = 0.01). However, this 11-minute difference was not deemed clinically-significant. There were neither significant sex-related differences nor any racial/ethnic/sex differences in the relatively short EMS-related intervals.Conclusions: Following acute stroke onset, time elapsed for EMS response and transport is relatively short compared to the lengthy intervals elapsing between symptom onset and 9-1-1 system activation, regardless of demographics. Exploration of innovative strategies to improve public education regarding stroke symptoms and immediate 9-1-1 system activation are strongly recommended.

Specificity: A Phenotypic Comparison of Communication-Relevant Domains Between Youth With Down Syndrome and Fragile X Syndrome.

Despite the shared presence of an intellectual disability (ID), there is a growing literature documenting important phenotypic differences between Down syndrome (DS) and fragile X syndrome (FXS). These conclusions, however, are based on a synthesis across studies, each of which typically includes only measures of a limited number of constructs, and with differing participant characteristics. Firmer conclusions regarding specific phenotypes require a single comprehensive multi-domain assessment of participants with the syndrome groups being well matched on chronological age (CA) and cognitive functioning. The current study was designed to fill this gap by assessing several important cognitive and behavioral domains relevant to communication, such as: structural language skills, false belief understanding, as well as pragmatics and behavioral difficulties, in 30 adolescents of both sexes with DS and 39 males with FXS, matched on CA and nonverbal (NV) cognition. After statistically controlling for NV cognition, we did not find significant syndrome differences in expressive and receptive structural language or false belief understanding. In contrast, participants with DS displayed less stereotyped language and fewer behavioral difficulties compared to males with FXS. Within-syndrome associations among the targeted domains are described. Finally, females with DS were less impaired than males with DS in almost all structural language domains, whereas no significant sex-related differences were observed in NV cognition, false belief understanding, pragmatics, or behavior. Clinical and methodological implications of the findings are discussed.

Demographic and Clinical Characteristics of Completed Suicides in Mexico City 2014-2015.

Objective: To analyze sex differences in demographic and clinical characteristics of individuals who died by suicide in Mexico City.Method: Statistical analysis of residents of Mexico City whose cause of death was suicide, during two years period from January 2014 to December 2015, with a coroner's report. Suicide mortality rates were calculated by age, sex, and location within the city. The Chi-squared test was used to assess statistical differences.Results: From January 2014 to December 2015, 990 residents of Mexico City died by suicide (men: 78.28%, women: 21.72%). Among males, the highest mortality rates were among the groups of 20–24 and 75–79 years old, whereas in women, the group with the highest mortality rate was 15 to 19 years old. 74% of the sample used hanging as suicide method. However, men had higher rates of a positive result in the toxicology test (40%) (p < 0.05). There was no concordance between male and female suicide by city jurisdictions.Conclusion: Our results provide evidence that the characteristics of Mexico City's residents who committed suicide had significant sex-related differences, including where they used to live. Understanding the contributory factors associated with completed suicide is essential for the development of effective preventive strategies.

Calculation and evaluation of angle of acetabular anteversion in normal healthy Indian population

Studies have been carried out regarding the acetabular and femoral anteversion in patients with developmental dysplasia of hip. However, definitive criteria/measurements regarding the normal angle of acetabular anteversion in asymptomatic patients is lacking. In our study, angle of anteversion of the acetabulum was determined by use of computed tomography in 200 asymptomatic Indian adults. The overall normal anteversion of the acetabulum was found to be 16.43+6 0 (mean + standard deviation) with no significant sex related difference. Slight age related increase in the angle of acetabular anteversion was observed.

Vitamin D Levels of Out-Patients in Lithuania: Deficiency and Hypervitaminosis.

Aim: Data on the prevalence of vitamin D deficiency in Lithuania are scarce. The aim was to assess the reserves of vitamin D in different age groups of out-patients, regarding the season of the year. Methods: Data on serum 25-hydroxyvitamin D (25(OH)D) levels from blood tests made in 2012–2014 were obtained from one laboratory, and a retrospective cross-sectional analysis was performed. Results: A total of 9581 subjects were included. The mean age of the participants was 33 ± 23 years. The mean levels of vitamin D were higher in males than in females (p < 0.001). The highest mean 25(OH)D levels were in 0–9-year-old group, the lowest were in the 10–19-year-old group and in the group of participants that were 70 years and older (p < 0.001). The lowest vitamin D status was found in January, February, March, and April. The highest status was found in August and September. Overall, vitamin D deficiency, sufficiency, and hypervitaminosis were detected in 67%, 21%, and 12% of cases, respectively. Most cases with hypervitaminosis were in the group of children up to 2 years of age. Conclusion: Vitamin D status demonstrated clear seasonality. Significant sex-related differences of vitamin D statuses were also determined. Vitamin D deficiency was very prevalent in almost all age groups. Young children (aged up to 2 years) are of special interest for further research involving other types of 25(OH)D assays, such as those based on high-performance liquid chromatography (HPLC), since the real prevalence of “true” vitamin D hypervitaminosis in Lithuania’s children is still to be determined.

Longitudinal relations of mental health and motivation among elite student-athletes across a condensed season: Plausible influence of academic and athletic schedule

ObjectivesThis study characterised mental health, motivation, and their interrelations among 38 elite student-athletes over a 13-week season, while monitoring and considering the influence of their athletic and academic schedules. DesignLongitudinal. MethodElectronically-administered questionnaires measured total mood disturbance and depressive symptoms (weekly), sleep quality and trait anxiety (monthly), and motivation, basic needs satisfaction and motivational climate (weeks one and 13). ResultsThirty-seven percent of athletes reported scores indicative of mild-to-moderate depression, 32% were poor sleepers, and 8% were high trait anxious. These outcomes significantly improved over time, whereas the motivation-related variables remained stable. The athletes were predominantly intrinsically motivated, and reported high satisfaction of basic psychological needs. Task climate exceeded its ego counterpart. There were no significant sex-related differences for any mental health outcome at week one; however, autonomy and relatedness were significantly higher among females. ConclusionsCollectively, these findings suggest that psychological monitoring of student-athletes, particularly over intense athletic and academic periods, is a powerful tool for identifying potential mental health and/or motivation-related issues that may influence performance and well-being.

Hematology and erythrocyte osmotic fragility of the Franquet's fruit bat (Epomops franqueti).

Background Hematological parameters are vital diagnostic tools for understanding health dynamics of humans and animals. Franquet's fruit bat (Epomops franqueti) is host to several parasites such as protozoa, bacteria, viruses and mites. Yet, studies exploring the values of its blood components with interest for research or food purposes are scarce. Thus, this study was carried out to investigate the hematological values of the adult E. franqueti. Methods Seventeen (nine female and eight male) apparently healthy adult E. franqueti were captured from their roosting colony. Blood samples were collected for determination of erythrocyte indices [red blood cell count (RBC), packed cell volume (PCV), hemoglobin (Hb) concentration, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC)] and leukocyte indices [total white blood cell counts (WBC), lymphocytes, eosinophil, monocytes, neutrophil count and erythrocytes osmotic fragility]. Results There were no significant (p≥0.05) sex-related differences in RBC, PCV, Hb concentration, MCV, MCH, MCHC and total and differential WBC of E. franqueti. Erythrocyte osmotic fragility was significantly higher in female than in male E. franqueti at 0.1% NaCl. Conclusions These considerations are critical in establishing reference ranges of blood parameters for E. franqueti and may provide insight to why they serve as reservoir hosts for several microorganisms.

Forensic age assessment by 3.0T MRI of the knee: proposal of a new MRI classification of ossification stages.

To explore the possibility of determining majority via a morphology-based examination of the epiphyseal-diaphyseal fusion by 3.0T magnetic resonance imaging (MRI), a prospective cross-sectional study developing and applying a new stage classification was conducted. 344 male and 350 female volunteers of German nationality between the ages of 12-24 years were scanned between May 2013 and June 2015. A 3.0T MRIscanner was used, acquiring a T1-weighted (T1-w) turbo spin-echo sequence (TSE) and a T2-weighted (T2-w) TSE sequence with fat suppression byspectral pre-saturation with inversion recovery (SPIR). The gathered information was sifted and a five-stage classification was formulatedas a hypothesis. The images were then assessed using this classification. The relevant statistics were defined, the intra- and interobserver agreements were determined, and the differences between the sexes were analysed. The application of the new classification made it possible to correctly assess majority in both sexes by the examination of the epiphyses of the knee joint. The intra- and interobserver agreement levels were very good (κ > 0.80). The Mann-Whitney-U Test implied significant sex-related differences for most stages. Applying the presented MRI classification, it is possible to determine the completion of the 18th year of life in either sex by 3.0T MRI of the knee joint. • Based on prospective referential data a new MRI classification was formulated. • The setting allows assessment of the age of an individual's skeletal development. • The classification scheme allows the reliable determination of majority in both sexes. • The staging shows a high reproducibility for instructed and trained professional personnel. • The proposed classification is likely to be adaptable to other long bone epiphyses.

Association of Gastrocnemius Muscle Stiffness With Passive Ankle Joint Stiffness and Sex-Related Difference in the Joint Stiffness.

Passive ankle joint stiffness is affected by all structures located within and over the joint, and is greater in men than in women. Localized muscle stiffness can be assessed by ultrasound shear wave elastography, and muscle architecture such as fascicle length and pennation angle can be measured by B-mode ultrasonography. Thus, the authors assessed localized muscle stiffness of the medial gastrocnemius (MG) with consideration of individual variability in the muscle architecture, and examined the association of the muscle stiffness with passive ankle joint stiffness and the sex-related difference in the joint stiffness. Localized muscle stiffness of the MG in 16 men and 17 women was assessed at 10° and 20° plantar flexion, neutral anatomical position, and 10° and 20° dorsiflexion. Fascicle length and pennation angle of the MG were measured at these joint positions. Passive ankle joint stiffness was determined by the ankle joint angle-torque relationship. Localized MG muscle stiffness was not significantly correlated with passive ankle joint stiffness, and did not show significant sex-related difference, even when considering the muscle architecture. This finding suggests that muscle stiffness of the MG would not be a prominent factor in determining passive ankle joint stiffness and the sex-related difference in the joint stiffness.

Constructing three emotion knowledge tests from the invariant measurement approach.

BackgroundPsychological constructionist models like the Conceptual Act Theory (CAT) postulate that complex states such as emotions are composed of basic psychological ingredients that are more clearly respected by the brain than basic emotions. The objective of this study was the construction and initial validation of Emotion Knowledge measures from the CAT frame by means of an invariant measurement approach, the Rasch Model (RM). Psychological distance theory was used to inform item generation.MethodsThree EK tests—emotion vocabulary (EV), close emotional situations (CES) and far emotional situations (FES)—were constructed and tested with the RM in a community sample of 100 females and 100 males (age range: 18–65), both separately and conjointly.ResultsIt was corroborated that data-RM fit was sufficient. Then, the effect of type of test and emotion on Rasch-modelled item difficulty was tested. Significant effects of emotion on EK item difficulty were found, but the only statistically significant difference was that between “happiness” and the remaining emotions; neither type of test, nor interaction effects on EK item difficulty were statistically significant. The testing of gender differences was carried out after corroborating that differential item functioning (DIF) would not be a plausible alternative hypothesis for the results. No statistically significant sex-related differences were found out in EV, CES, FES, or total EK. However, the sign of d indicate that female participants were consistently better than male ones, a result that will be of interest for future meta-analyses.DiscussionThe three EK tests are ready to be used as components of a higher-level measurement process.

Contemporary Determinants of Delayed Benchmark Timelines in Acute Myocardial Infarction in Men and Women

Treatment delays in patients with acute myocardial infarction (AMI) are related to increased morbidity and mortality. Hence, identifying determinants of delay may help reduce time to treatment. Importantly, limited data suggest that there may be sex-related disparities in benchmark timelines. Although guidelines advocate the use of the first medical contact (FMC) rather than hospital admission as the moment from which delays to treatment should be monitored, the latter is still often used for quality purposes. We aimed to identify factors associated with treatment delays, with an emphasis on sex-related disparities. We reviewed data on 3,658 patients with AMI from 2 contemporary, consecutive multicenter surveys. Measured delays were FMC-to-electrocardiogram >10 minutes in ST-elevation MI (STEMI) and non-STEMI, FMC-to-primary percutaneous coronary intervention >90 minutes in STEMI, and invasive angiography >72 hours after admission in non-STEMI patients. Timely electrocardiogram was performed in 48% of patients with STEMI and in 39.8% of non-STEMI patients without significant sex-related differences. Independent determinants of delay included atypical chest pain (CP) and presentation during daytime. In patients with STEMI, 37.5% had primary percutaneous coronary intervention in less than 90 minutes without significant sex-related disparities. Independent determinants of delay included atypical CP, night presentation, and diabetes. In non-STEMI patients, independent determinants of delayed invasive approach were female sex, age >75 years, atypical CP, and renal failure. In conclusion, significant treatment delays in patients with AMI are still frequent in contemporary practice, highlighting the need for improvement and guidelines implementation. Predictors of delay identified in our study may facilitate targeting of interventions to improve adherence to guidelines.

Prevalence and Characterization of Thyroid Hemiagenesis in Japan: The Fukushima Health Management Survey.

Background: Thyroid hemiagenesis is a rare congenital variant characterized by the lack of development of one thyroid lobe with no clinical manifestations.Methods: This study was performed to determine the prevalence and characteristics of thyroid hemiagenesis in a normal Japanese population. This cross-sectional study was performed from October 9, 2011, to April 30, 2015. In total, 299,908 children and young adults in the Fukushima Health Management Survey were examined to determine the presence of thyroid agenesis or hemiagenesis. Thyroid width, thickness, and length were measured in 292,452 of these subjects.Results: Thyroid agenesis was diagnosed in 13 subjects, and hemiagenesis was detected in 67 subjects (0.02%; 22.3/100,000 individuals). Although there was no significant sex-related difference (p = 0.067), the female:male ratio was 1.67:1.00. Females were significantly dominant in right hemiagenesis, while there was no difference in left hemiagenesis between males and females. The thyroid volumes at the 2.5th and 97.5th percentiles for age and body surface area were determined for each sex. Multivariate regression analysis showed that a large hemithyroid volume was independently associated with the presence of contralateral hemiagenesis (p < 0.001).Conclusion: The prevalence of thyroid hemiagenesis in the present study is in agreement with that reported in other countries. The prevalence of right hemiagenesis was higher in females, and the larger contralateral lobe in patients with rather than without hemiagenesis may have been caused by a compensatory feedback mechanism to prevent hypothyroidism. In addition, the prevalence of hemiagenesis, especially right hemiagenesis, may be affected by sex-related factors similar to those in patients with an ectopic thyroid gland.