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"Sex factors in disease"
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Autism and gender : from refrigerator mothers to computer geeks
\"The reasons behind the increase in autism diagnoses have become hotly contested in the media as well as within the medical, scholarly, and autistic communities. Jordynn Jack suggests the proliferating number of discussions point to autism as a rhetorical phenomenon that engenders attempts to persuade through arguments, appeals to emotions, and representational strategies. In Autism and Gender: From Refrigerator Mothers to Computer Geeks, Jack focuses on the ways gender influences popular discussion and understanding of autism's causes and effects. She identifies gendered theories like the \"refrigerator mother\" theory, for example, which blames emotionally distant mothers for autism, and the \"extreme male brain\" theory, which links autism to the modes of systematic thinking found in male computer geeks. Jack's analysis reveals how people employ such highly gendered theories to craft rhetorical narratives around stock characters--fix-it dads, heroic mother warriors rescuing children from autism--that advocate for ends beyond the story itself while also allowing the storyteller to gain authority, understand the disorder, and take part in debates. Autism and Gender reveals the ways we build narratives around controversial topics while offering new insights into the ways rhetorical inquiry can and does contribute to conversations about gender and disability\"-- Provided by publisher.
Book
Predictive accuracy of the Framingham coronary risk score in British men:prospective cohort study
Abstract Objective To establish the predictive accuracy of the Framingham risk score for coronary heart disease in a representative British population. Design Prospective cohort study. Setting 24 towns in the United Kingdom. Participants 6643 British men aged 40-59 years and free from cardiovascular disease at entry into the British regional heart study. Main outcome measures Comparison of observed 10 year coronary heart disease mortality and event rates with predicted rates for each individual, using the relevant Framingham risk equation. Results Of 6643 men, 2.8% (95% confidence interval 2.4% to 3.2%) died from coronary heart disease compared with 4.1% predicted (relative overestimation 47%, P < 0.0001). A fatal or non-fatal coronary heart disease event occurred in 10.2% (9.5% to 10.9%) of the men compared with 16.0% predicted (relative overestimation 57%, P < 0.0001). These relative degrees of overestimation were similar at all levels of coronary heart disease risk, so that overestimation of absolute risk was greatest for those at highest risk. A simple adjustment provided an improved level of accuracy. In a “high risk score” approach, most cases occur in the low risk group. In this case, 84% of the deaths from coronary heart disease and non-fatal events occurred in the 93% of men classified at low risk (< 30% in 10 years) by the Framingham score. Conclusion Guidelines for the primary prevention of coronary heart disease advocate offering preventive measures to individuals at high risk. Currently recommended risk scoring methods derived from the Framingham study significantly overestimate the absolute coronary risk assigned to individuals in the United Kingdom.
Journal Article
Health and gender : resilience and vulnerability factors for women's health in the contemporary society
This book presents a concise and comprehensive overview of the most important protective and risk factors for women's health, and reviews the main areas of medical science from a gender perspective. Numerous scientific experiments and studies have shown how gender differences significantly affect the clinical presentation of physical and mental health disorders as well as responses to treatments. This text highlights these issues, while at the same time reflecting on the practical implications of the theoretical knowledge presented. It also examines the organization of social and health services, which should increasingly take into account the specificities related to gender differences and where equality is based on truly embracing these differences. The final part provides insights into the experiences and testimonies collected by the authors of the book. Written by a multidisciplinary team of medical, psychosocial and humanities professionals, this book is of interest to health professionals and medical students. -- Provided by publisher.
Book
COVID-19 and Sex Differences: Mechanisms and Biomarkers
Men are consistently overrepresented in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and coronavirus disease 2019 (COVID-19) severe outcomes, including higher fatality rates. These differences are likely due to gender-specific behaviors, genetic and hormonal factors, and sex differences in biological pathways related to SARS-CoV-2 infection. Several social, behavioral, and comorbid factors are implicated in the generally worse outcomes in men compared with women. Underlying biological sex differences and their effects on COVID-19 outcomes, however, have received less attention. The present review summarizes the available literature regarding proposed molecular and cellular markers of COVID-19 infection, their associations with health outcomes, and any reported modification by sex. Biological sex differences characterized by such biomarkers exist within healthy populations and also differ with age- and sex-specific conditions, such as pregnancy and menopause. In the context of COVID-19, descriptive biomarker levels are often reported by sex, but data pertaining to the effect of patient sex on the relationship between biomarkers and COVID-19 disease severity/outcomes are scarce. Such biomarkers may offer plausible explanations for the worse COVID-19 outcomes seen in men. There is the need for larger studies with sex-specific reporting and robust analyses to elucidate how sex modifies cellular and molecular pathways associated with SARS-CoV-2. This will improve interpretation of biomarkers and clinical management of COVID-19 patients by facilitating a personalized medical approach to risk stratification, prevention, and treatment.
Journal Article
Cumulative Risk, Age at Onset, and Sex-Specific Differences for Developing End-Stage Renal Disease in Young Patients With Type 1 Diabetes: A Nationwide Population-Based Cohort Study
This study aimed to estimate the current cumulative risk of end-stage renal disease (ESRD) due to diabetic nephropathy in a large, nationwide, population-based prospective type 1 diabetes cohort and specifically study the effects of sex and age at onset.
In Sweden, all incident cases of type 1 diabetes aged 0-14 years and 15-34 years are recorded in validated research registers since 1977 and 1983, respectively. These registers were linked to the Swedish Renal Registry, which, since 1991, collects data on patients who receive active uremia treatment. Patients with > or =13 years duration of type 1 diabetes were included (n = 11,681).
During a median time of follow-up of 20 years, 127 patients had developed ESRD due to diabetic nephropathy. The cumulative incidence at 30 years of type 1 diabetes duration was low, with a male predominance (4.1% [95% CI 3.1-5.3] vs. 2.5% [1.7-3.5]). In both male and female subjects, onset of type 1 diabetes before 10 years of age was associated with the lowest risk of developing ESRD. The highest risk of ESRD was found in male subjects diagnosed at age 20-34 years (hazard ratio 3.0 [95% CI 1.5-5.7]). In female subjects with onset at age 20-34 years, the risk was similar to patients' diagnosed before age 10 years.
The cumulative incidence of ESRD is exceptionally low in young type 1 diabetic patients in Sweden. There is a striking difference in risk for male compared with female patients. The different patterns of risk by age at onset and sex suggest a role for puberty and sex hormones.
Journal Article
Sexual dimorphism in cardiometabolic health: the role of adipose tissue, muscle and liver
Obesity is associated with many adverse health effects, such as an increased cardiometabolic risk. Despite higher adiposity for a given BMI, premenopausal women are at lower risk of cardiometabolic disease than men of the same age. This cardiometabolic advantage in women seems to disappear after the menopause or when type 2 diabetes mellitus develops. Sexual dimorphism in substrate supply and utilization, deposition of excess lipids and mobilization of stored lipids in various key metabolic organs (such as adipose tissue, skeletal muscle and the liver) are associated with differences in tissue-specific insulin sensitivity and cardiometabolic risk profiles between men and women. Moreover, lifestyle-related factors and epigenetic and genetic mechanisms seem to affect metabolic complications and disease risk in a sex-specific manner. This Review provides insight into sexual dimorphism in adipose tissue distribution, adipose tissue, skeletal muscle and liver substrate metabolism and tissue-specific insulin sensitivity in humans, as well as the underlying mechanisms, and addresses the effect of these sex differences on cardiometabolic health. Additionally, this Review highlights the implications of sexual dimorphism in the pathophysiology of obesity-related cardiometabolic risk for the development of sex-specific prevention and treatment strategies.This Review provides insight into sexual dimorphism in adipose tissue distribution and substrate metabolism in adipose tissue, skeletal muscle and liver, as well as the underlying mechanisms. The effects of these sex differences on cardiometabolic health are outlined and the potential for developing sex-specific prevention and treatment strategies is discussed.
Journal Article
Sex differences in anxiety and depression: circuits and mechanisms
Epidemiological sex differences in anxiety disorders and major depression are well characterized. Yet the circuits and mechanisms that contribute to these differences are understudied, because preclinical studies have historically excluded female rodents. This oversight is beginning to be addressed, and recent studies that include male and female rodents are identifying sex differences in neurobiological processes that underlie features of these disorders, including conflict anxiety, fear processing, arousal, social avoidance, learned helplessness and anhedonia. These findings allow us to conceptualize various types of sex differences in the brain, which in turn have broader implications for considering sex as a biological variable. Importantly, comparing the sexes could aid in the discovery of novel therapeutics.Male-only studies predominate preclinical research on anxiety and depression. In this Review, Bangasser and Cuarenta discuss how, since the inclusion of female subjects, new mechanisms have been identified that underlie vulnerability to these disorders, and that reveal novel targets for treatments.
Journal Article
Sex disparities matter in cancer development and therapy
Curing cancer through precision medicine is the paramount aim of the new wave of molecular and genomic therapies. Currently, whether patients with non-reproductive cancers are male or female according to their sex chromosomes is not adequately considered in patient standard of care. This is a matter of consequence because there is growing evidence that these cancer types generally initiate earlier and are associated with higher overall incidence and rates of death in males compared with females. Gender, in contrast to sex, refers to a chosen sexual identity. Hazardous lifestyle choices (notably tobacco smoking) differ in prevalence between genders, aligned with disproportionate cancer risk. These add to underlying genetic predisposition and influences of sex steroid hormones. Together, these factors affect metabolism, immunity and inflammation, and ultimately the fidelity of the genetic code. To accurately understand how human defences against cancer erode, it is crucial to establish the influence of sex. Our Perspective highlights evidence from basic and translational research indicating that including genetic sex considerations in treatments for patients with cancer will improve outcomes. It is now time to adopt the challenge of overhauling cancer medicine based on optimized treatment strategies for females and males.This Perspective highlights the evidence from basic and translational research that genetic sex influences multiple factors that can contribute to cancer development and treatment responses, and suggests that including genetic sex considerations in treatments for patients with cancer will improve outcomes.
Journal Article
Sex differences in movement disorders
In a range of neurological conditions, including movement disorders, sex-related differences are emerging not only in brain anatomy and function, but also in pathogenesis, clinical features and response to treatment. In Parkinson disease (PD), for example, oestrogens can influence the severity of motor symptoms, whereas elevation of androgens can exacerbate tic disorders. Nevertheless, the real impact of sex differences in movement disorders remains under-recognized. In this article, we provide an up-to-date review of sex-related differences in PD and the most common hyperkinetic movement disorders, namely, essential tremor, dystonia, Huntington disease and other chorea syndromes, and Tourette syndrome and other chronic tic disorders. We highlight the most relevant clinical aspects of movement disorders that differ between men and women. Increased recognition of these differences and their impact on patient care could aid the development of tailored approaches to the management of movement disorders and enable the optimization of preclinical research and clinical studies.Sex-based differences in demographics, clinical features and therapeutic response are emerging in a range of neurological diseases, including movement disorders. The authors review current knowledge of sex-related differences in Parkinson disease, essential tremor, dystonia, Huntington disease and chronic tic disorders.
Journal Article
Gender, Health, and History in Modern East Asia
This groundbreaking volume captures and analyzes the exhilarating and at times disorienting experience when scientists, government officials, educators, and the general public in East Asia tried to come to terms with the introduction of Western biological and medical sciences to the region. The nexus of gender and health is a compelling theme, for this is an area in which private lives and personal characteristics encounter the interventions of public policies. The nine empirically based studies by scholars of history of medicine, sociology, anthropology, and STS (science, technology, and society), spanning Japan, Korea, China, Taiwan, and Hong Kong from the 1870s to the present, demonstrate just how tightly concerns with gender and health have been woven into the enterprise of modernization and nation-building throughout the long twentieth century. The concepts of “gender\" and “health\" have become so commonly used that one might overlook that they are actually complicated notions with vexed histories even in their native contexts. Transposing such terminologies into another historical or geographical dimension is fraught with problems, and what makes the East Asian cases in this volume particularly illuminating is that they present concepts of gender and health in motion. The studies show how individuals and societies made sense of modern scientific discourses on diseases, body, sex, and reproduction, redefining existing terms in the process and adopting novel ideas to face new challenges and demands.
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