Narrowing gender differences in procedure use for acute myocardial infarction

OBJECTIVE: To examine age-specific gender differences and trends over time in the management of patients with acute myocardial infarction (AMI). DESIGN: Cross-sectional study of patients admitted with AMI from a community-wide perspective over a 10-year period (1990-1999). SETTING: All hospitals in the Worcester (Mass) metropolitan area (1990 census = 437000). PATIENTS/PARTICIPANTS: We identified 2037 women and 2645 men who were hospitalized in the Worcester metropolitan area with confirmed AMI during six 1-year periods between 1990 and 1999. Four age groups (<55, 55 to 64, 65 to 74 and >or=75 years) of men and women were studied. MEASUREMENTS AND MAIN RESULTS: Use of echocardiography, exercise treadmill testing (ETT), cardiac catheterization, percutaneous coronary interventions (PCI), and coronary artery bypass grafting (CABG) during the index hospitalization was examined in relation to age and gender. Overall, women were less likely to undergo ETT, cardiac catheterization, and CABG than were men, and these trends remained after controlling for potentially confounding factors. Between 1990 and 1999, there was a dramatic decrease in ETT, whereas the use of echocardiography remained unchanged. There were marked increases over time in the use of cardiac catheterization and PCI in women and men. Use of cardiac catheterization and PCI increased to a greater extent in women as compared to men. In patients who underwent cardiac catheterization, rates of coronary revascularization were similar between men and women. CONCLUSIONS: Our data suggest that women and men with AMI are treated differently with respect to use of diagnostic and revascularization procedures. However, gender differences in the use of these diagnostic and interventional approaches have narrowed over time.     

Nurture affects gender differences in spatial abilities

Women remain significantly underrepresented in the science, engineering, and technology workforce. Some have argued that spatial ability differences, which represent the most persistent gender differences in the cognitive literature, are partly responsible for this gap(.) The underlying forces at work shaping the observed spatial ability differences revolve naturally around the relative roles of nature and nurture. Although these forces remain among the most hotly debated in all of the sciences, the evidence for nurture is tenuous, because it is difficult to compare gender differences among biologically similar groups with distinct nurture. In this study, we use a large-scale incentivized experiment with nearly 1,300 participants to show that the gender gap in spatial abilities, measured by time to solve a puzzle, disappears when we move from a patrilineal society to an adjoining matrilineal society. We also show that about one-third of the effect can be explained by differences in education. Given that none of our participants have experience with puzzle solving and that villagers from both societies have the same means of subsistence and shared genetic background, we argue that these results show the role of nurture in the gender gap in cognitive abilities.     

Plasma leptin concentrations: gender differences and associations with metabolic risk factors for cardiovascular disease

Summary The cloning of the obese gene and the characterization of its protein product, leptin, has permitted the study of a new hormone potentially involved in the regulation of adipose tissue mass. The present study examined the gender differences in fasting plasma leptin concentration and its relationship to body fatness, adipose tissue distribution and the metabolic profile in samples of 91 men (mean age ± SD: 37.3 ± 4.8 years) and 48 women (38.5 ± 6.8 years). Plasma leptin concentrations were strongly associated with body fat mass measured by underwater weighing [men: r = 0.80, p < 0.0001; women: r = 0.85, p < 0.0001]. In both genders, plasma leptin levels were also strongly correlated with waist girth as well as cross-sectional areas of abdominal subcutaneous and visceral adipose tissue measured by computed tomography. Women had, on average, plasma leptin concentrations that were three times higher than men. Furthermore, this gender difference remained significant when comparing men and women matched for similar levels of body fat mass. The associations between plasma leptin and lipoprotein concentrations were dependent of adiposity. In both men and women, elevated fasting plasma leptin levels were associated with higher plasma insulin concentrations, but only in women was the association maintained after correction for fat mass. Thus, results of the present study show that women have higher plasma leptin levels compared to men, independent of the concomitant variation in total body fat mass. Furthermore, our results also suggest that, in women, the association between plasma leptin and insulin concentrations is independent of adiposity, a finding which provides further support to the observation that adipose tissue leptin secretion may be upregulated by insulin. [Diabetologia (1997) 40: 1178–1184] Received: 18 February 1997 and in revised form: 28 April 1997     

Cohort effects on gender differences in alcohol dependence

Aims The present study investigated the presence of cohort effects on gender differences in the course, severity and symptomatology of DSM‐III‐R alcohol dependence in a community‐based sample. Design A comparison of substance‐related variables among men and women divided into two groups based on the median birth year of the sample was conducted. Participants Participants were 468 men and 132 women with life‐time alcohol dependence, the vast majority of whom were born between 1941 and 1960. Measurements Substance use and DSM‐III‐R substance use disorders were assessed by a structured interview administered in person. Findings Individuals born after 1951 had higher rates of alcohol dependence. Among individuals with alcohol dependence, those born after 1951 had an earlier onset and longer duration of alcohol‐related problems. Significant interactions indicated that these effects were stronger for women than men. Conclusions Risk for alcohol dependence appears to be rising in younger generations, and particularly for younger women, making them an important target group for prevention and treatment programs.     

HIV testing among youth in a high-risk city: prevalence,predictors, and gender differences

While HIV is prevalent among adolescents and young adults, testing levels remain low and little is known about gender differences in HIV testing. The objectives of this study were to describe the prevalence of past-year HIV testing and evaluate associations between HIV testing and individual- and partner-level factors by gender among heterosexually experienced youth (15–24 years) in Baltimore, Maryland (N = 352). Past-year HIV testing was prevalent (60.1%) and differed by gender (69.4% among women vs. 49.6% among men, p = 0.005). For women, African-American race (AOR 3.09) and recent older partner by ≤2 years (AOR 4.04) were significantly associated with testing. Among men, only African-American race was associated with testing (OR 4.23), with no patterns identified based on risk behavior or perceived partner risk. HIV testing among adolescent and young adults was prevalent in this highly affected urban area. Findings emphasize the value of a gender lens, and provide direction for optimizing engagement in HIV testing.     

Excited to death: different ways to lose your neurones

The selective loss of neurones in a range of neurodegenerative diseases is widely thought to involve the process of excitotoxicity, in which glutamate-mediated neuronal killing is elaborated through the excessive stimulation of cell-surface receptors. Every such disease exhibits a distinct regional and subregional pattern of neuronal loss, so processes must be locally triggered to different extents to account for this. We have studied several mechanisms which could lead to excitotoxic glutamate pathophysiology and compared them indifferent diseases. Our data suggest that glutamate can reach toxic extracellular levels in Alzheimer disease by malfunctions in cellular transporters, and that the toxicity may be exacerbated by continued glutamatere lease from presynaptic neurones acting on hypersensitive postsynaptic receptors. Thus the excitotoxicity is direct. In contrast, alcoholic brain damage arises in regions where GABA-mediated inhibition is deficient, and fails properly to dampen trans-synaptic excitation. Thus the excitotoxicity is indirect. A variety of such mechanisms is possible, which may combine in different ways. This revised version was published online in July 2006 with corrections to the Cover Date.     

Gender differences in COVID-19 attitudes and behavior: Panel evidence from eight countries

The initial public health response to the breakout of COVID-19 required fundamental changes in individual behavior, such as isolation at home or wearing masks. The effectiveness of these policies hinges on generalized public obedience. Yet, people’s level of compliance may depend on their beliefs regarding the pandemic. We use original data from two waves of a survey conducted in March and April 2020 in eight Organisation for Economic Co-operation and Development countries (n = 21,649) to study gender differences in COVID-19−related beliefs and behaviors. We show that women are more likely to perceive COVID-19 as a very serious health problem, to agree with restraining public policy measures, and to comply with them. Gender differences in attitudes and behavior are sizable in all countries. They are accounted for neither by sociodemographic and employment characteristics nor by psychological and behavioral factors. They are only partially mitigated for individuals who cohabit or have direct exposure to the virus. We show that our results are not due to differential social desirability bias. This evidence has important implications for public health policies and communication on COVID-19, which may need to be gender based, and it unveils a domain of gender differences: behavioral changes in response to a new risk.

Since the breakout of COVID-19, most countries have advised or required restrictive measures such as isolation at home or wearing face masks, in an attempt to contain the spread of the pandemic, limit pressure on their national health system, and reduce the death counts (1). These rules have been shown to reduce both the individual risk of infection and the likelihood of contaminating others (2, 3). In particular, the main route for the spread of COVID-19—airborne transmission—is largely reduced by wearing face masks: 78,000 fewer infections in Italy in a month and 66,000 fewer in New York City over a 3-wk period (4). Yet, restrictive measures also generate economic and psychological costs (5). Ultimately, the effectiveness of these public health policies hinges on generalized public obedience.Women have been found to agree (6) and comply more with existing rules in other domains (7, 8). In this study, we ask whether they are also more likely to adopt the rapid behavioral changes required to address the challenge posed by COVID-19, and for what reason. Using original data from two waves of a nationally representative panel survey conducted in eight Organisation for Economic Co-operation and Development countries, we analyze gender differences both in behavior—namely, compliance with the new public health rules—and in attitudes toward the virus—the assessment of how dangerous it is and which policy measures should be adopted to combat it.A striking feature of the pandemic is that many more men than women are dying of COVID-19 (9–14). An array of factors have been speculated to account for this gender gap, including differences in biology (15–17), preexisting conditions, occupations (18), smoking, and propensity to seek health care (13). Our study investigates the role of a behavioral factor which may be equally important but has received much less attention: compliance with public policy rules.Our survey data (19) cover Australia (n = 2,010), Austria (n = 2,000), France (n = 4,036), Germany (n = 3,501), Italy (n = 1,997), New Zealand (n = 1,997), the United Kingdom (n = 2,012), and the United States (n = 4,096), for a total of 21,649 respondents. All these countries have high income per capita and advanced health systems, allowing us to pool their data in a common analysis, but they were affected very differently by the pandemic, increasing the external validity of our results. The United States, United Kingdom, and Italy are among the countries with the highest COVID-19 mortality in the world, while Australia and New Zealand each had fewer than 200 deaths (20) attributed to the pandemic by May 31, 2020.The first wave of the survey was administered between March 16 and March 30, soon after the pandemic reached the countries we study. In this period, most of these countries were beginning to implement lockdowns and stay-at-home orders (SI Appendix, Table S1 reports the lockdown date for each country). The second wave was administered between April 15 and April 20. First-wave respondents were contacted again for the second wave. Those who failed to respond were replaced by new people. In each wave, respondents were asked how serious they expected the health consequences of COVID-19 to be in their country and whether they agreed with several public policy measures discussed or already implemented, such as closing schools; closing nonessential businesses, economic activities, and institutions; stopping public transportation; prohibiting meetings of two or more people; imposing quarantine on people entering the country; closing borders; and mandating the use of face masks in public places. Respondents were also asked to report their current level of compliance with several COVID-19−related health and social distancing rules, such as wearing face masks, washing hands, coughing into one’s elbow, stopping hugging or greeting, keeping physical distance from others, staying at home, avoiding crowded places, and stopping meeting friends. Finally, the survey collected a wide range of sociodemographic and attitudinal factors.     

Uninterrupted prolonged ethanol oxidation as a main pathogenetic factor of alcoholic liver damage: evidence from a new liquid diet animal model

ABSTRACT— Marked fatty infiltration and degenerative or mild inflammatory changes including eosinophilic cytoplasmic degeneration in centrilobular cells and focal inflammatory changes with cell necrosis were observed in livers of rats maintained for 12 weeks on a nutritionally adequate and balanced liquid ethanol diet. The animals continuously oxidized ethanol due to the supplementation of the diet with a low dose of 4-methylpyrazole (4-MP, an alcohol dehydrogenase inhibitor), that decreased ethanol elimination by about 20%. In other, equicalorically pair-fed groups of rats receiving (a) a similar ethanol-containing liquid diet without 4-MP or (b) a diet with 4-MP and 20% less ethanol, only a few minor changes were seen. The liver histology of rats pair-fed a control diet with a 4 times higher doses of 4-MP was completely normal. The results indicate that the prolonged imbalance of hepatic metabolism due to the uninterrupted oxidation of ethanol is a crucial factor in the development of alcoholic liver injury.     

Survival and trends of occurrence of left ventricular hypertrophy,gender differences, 1967-92: The Reykjavik Study

OBJECTIVE: We estimated the prevalence, incidence and risk factors of left ventricular hypertrophy (LVH) in a prospective cohort study of 26 489 participants. MATERIAL AND METHODS: The LVH was defined as Minnesota Code 310 on electrocardiogram (ECG). Everyone with this code at first visit was defined as a prevalence case and those who developed it between subsequent visits were incidence cases. The comparison cohort were all other participants in the Reykjavik Study stages I-V. RESULTS: A total of 297 men and 49 women were found to have LVH of 3.2% and 0.5%, respectively. The incidence was 25 per 1000 per year amongst men and six per 1000 per year amongst women. Prevalence in both genders increased with increasing age. Risk factors at the time of diagnosis were systolic blood pressure [odds ratio (OR) per mmHg 1.02; 95% confidence interval (CI): 1.01-1.03], age (OR per year 1.04; 95% CI: 1.02-1.05), silent myocardial infarction (MI) (OR 3.18; 95% CI: 1.39-7.27) and ST-T changes (OR 3.06; 95% CI: 2.14-4.38) amongst men and systolic blood pressure and age for women with similar odds ratio. Predictive factors for acquiring LVH were systolic blood pressure [incidence ratio (IR) 1.01; 95% CI: 1.01-1.02] and angina with ECG changes (IR 2.33; 95% CI: 1.08-5.02) amongst men and systolic blood pressure amongst women (IR 1.03; 95% CI: 1.01-1.04). The risk for coronary mortality was significantly increased amongst women with hypertrophy [hazard ratio (HR) 3.07; 95% CI: 1.5-6.31] and their total survival was poorer with increasing time from diagnosis of LVH (HR 2.17; 95% CI: 1.36-3.48). CONCLUSIONS: We conclude that the presence of LVH and its appearance is associated with age and increased blood pressure amongst both genders. Women with LVH have poorer survival than other women and they are at threefold risk of dying of ischaemic heart disease.     

Gender differences in giving blood: a review of the literature

Background

An overview of European blood donors shows that the distribution of men and women donors is similar in many countries, with Italy being an exception in that women account for only 30% of donors. Gender medicine is a key issue in this context, even though gender studies are very limited in the transfusion field, whether considered broadly or with specific regards to the selection, management and retention of donors. It, therefore, seemed important to compare the presence of women among blood donors in different European countries and examine the roles that gender is reported to play in the donation of blood in order to identify possible implications for communication with and management of the donor.

Methods

To determine the proportion of women among donors in European countries, data were collected from annual reports or documents available on the websites of national associations; furthermore, all papers related to giving blood published in the five main journals in the sector (Transfusion, Vox Sanguinis, Transfusion and Apheresis Science, Transfusion Medicine, Blood Transfusion) were considered; about 80 publications were selected and the gender variable was examined.

Results

The published studies showed that gender plays key roles in the motivation to give blood (women being more altruistic, men being more individualistic) and in adverse reactions, which was a particularly critical problem leading to fewer women become regular donors. A few aspects specific to the management of donors in Italy also emerged.

Discussion

Gender seems to play an important role in the aspects studied and does, therefore, merit further consideration in relation to strategies to recruit donors and the management of critical events during donation.     

Gender differences in the etiology of heart failure: A systematic review

Background

Heart failure (HF) is an increasing problem for the aging population, specifically among women. The etiology of HF influences both the selection and outcome of the treatment. There are variations between genders in morbidity and mortality in different studies, possibly reflecting etiology. The objective of this study was to examine the strength of evidence available for gender differences in the etiology of chronic heart failure.

Methods

Computer-assisted searches from 1980–2009 for gender differences in the etiology of heart failure were performed (Medline, EMBASE and PubMed). From 2347 abstracts reviewed based on inclusion criteria, 35 original articles were chosen for review. Data extraction was based on observational studies (prospective/retrospective cohort or cross sectional) with a mean follow up of 3 months. There was no interrater variability between the 2 reviewers on data-extraction.

Results

Ventricular systolic dysfunction being more associated with male sex, but female sex was more reported to be associated with preserved left ventricular function. Ischemic etiology and associated coronary heart disease were strongly correlated with male sex. The risk for HF was dramatically more elevated for women with systolic hypertension but the association for diabetes mellitus as the etiology of HF was somewhat equal between males and females.

Conclusions

One of the limitations in reaching conclusions about gender differences in cardiovascular disease is that many major clinical trials do not include a gender analysis nor they are powered to do so as women are under-represented in most of the HF studies. The need remains for a well designed prospective study of sufficient numbers of male and female patients with and without heart failure and analyzing etiology and risk factors based on the sex differences.     

Pathophysiology of alcoholic brain damage: synergistic effects of ethanol,thiamine deficiency and alcoholic liver disease

Chronic alcoholism results in brain damage and dysfunction leading to a constellation of neuropsychiatric symptoms including cognitive dysfunction, the Wernicke-Korsakoff Syndrome, alcoholic cerebellar degeneration and alcoholic dementia. That these clinically-defined entities result from independent pathophysiologic mechanisms is unlikely. Alcohol and its metabolite acetaldehyde are directly neurotoxic. Alcoholics are thiamine deficient as a result of poor diet, gatrointestinal disorders and liver disease. In addition, both alcohol and acetaldehyde have direct toxic effects on thiamine-related enzymes in liver and brain. Alcoholics frequently develope severe liver disease and liver diseaseper se results in altered thiamine homeostasis, in cognitive dysfunction and in neuropathologic damage to astrocytes. The latter may result in the loss of neuron-astrocytic trafficking of neuroactive amino acids and thiamine esters, essential to CNS function. The present review article proposes mechanisms whereby the effects of alcohol, thiamine deficiency and liver disease combine synergistically to contribute to the phenomena of cognitive dysfunction and alcoholic brain damage.     

超敏C反应蛋白与老年高血压患者合并颈动脉斑块稳定性的关系及其性别差异

目的观察血清超敏C反应蛋白(hsCRP)水平与老年高血压患者颈动脉斑块及其稳定性的相关性,以及是否有性别差异。方法 "老年高血压降压治疗长期随访研究"的研究对象中,172例70岁以上的高血压患者行颈动脉超声检查,以内膜中层厚度(IMT)1.3mm诊断动脉粥样斑块形成;根据有无斑块及斑块回声的特点分为无斑块组、稳定斑块组(扁平斑块和硬斑块)和易损斑块组(软斑块和溃疡型斑块)。同时测定hsCRP、血脂、血清肌酐、尿酸。结果颈动脉斑块组(n=131)血清hsCRP为(3.2±2.5)mg/L,显著高于无斑块组〔(2.0±1.8)mg/L,n=41,P=0.005〕。对危险因素进行logistic回归分析显示,只有血清hsCRP水平是发生颈动脉斑块的危险因素(RR=1.299,95%CI=1.052～1.604,P=0.015)。进一步分析显示易损斑块组血清hsCRP为(4.2±2.5)mg/L,显著高于稳定斑块组〔(2.5±2.2)mg/L〕和无斑块组(P0.001)。后两组之间血清hsCRP则无显著差异(P=0.278)。分别分析男性和女性血清hsCRP与颈动脉斑块的关系,易损斑块组的血清hsCRP均显著高于稳定斑块组和无斑块组(P0.05)。结论血清hsCRP水平与老年高血压患者颈动脉斑块的发生及其稳定性相关,易损斑块者的血清hsCRP显著高于无斑块者和稳定斑块者;并且这种相关性在70岁以上的男性和女性老年高血压患者中都存在,未观察到性别差异。     

经皮冠状动脉介入治疗的3 049例男性和1 878例女性老年患者的临床特征及其性别差异

目的：观察确诊为冠心病并行经皮冠状动脉介入治疗（PCI）的老年患者的临床特征,分析冠心病危险因素在不同性别人群中的差异以及不同性别患者PCI预后的差异。方法本研究回顾性地分析自2008年7月至2012年11月在沈阳军区总医院年龄＞65岁确诊为冠心病并行PCI治疗的患者4927例,按性别分为两组,其中男性3049例,女性1878例,统计其临床特征、冠状动脉造影及PCI结果、围术期抗栓治疗药物及其他心血管药物的使用情况、院内主要心脑血管不良事件（MACCE）的发生情况,分析总结两组患者各自的特点及差异。结果冠心病危险因素中,男性患者吸烟比例和肾功能不全的发病率较女性高（51.5% vs 15.3%,P＜0.01;22.1% vs 15.3%,P＜0.01）;而女性患者体质量指数[（24.8±4.4） vs （24.5±3.7）kg/m2,P＜0.05]和发病年龄更高[（72.6±4.8） vs （72.2±5.4）岁,P＜0.01],患有高血压、糖尿病的患者比例也较男性高（70.5%vs 60.8%,P＜0.01;32.2%vs 24.9%,P＜0.01）。两组术后MACCE发生率差异无统计学意义,但女性死亡率高于男性（0.6% vs 0.1%,P＜0.01）。结论在接受PCI的人群中,老年女性较男性拥有更多的冠心病危险因素,且PCI预后也较男性差。     

Attenuated neural response to emotional cues in cocaine-dependence: a preliminary analysis of gender differences

Background: Cocaine users often report a loss of arousal for nondrug-related stimuli, which may contribute to their response to drug-related rewards. However, little is known about users’ neural reactivity to emotional nondrug-related stimuli and the potential influence of gender. Objectives: Test the hypotheses that cocaine-dependent individuals have an attenuated neural response to arousing stimuli relative to controls and that this difference is amplified in women. Methods: The brain response to typically arousing positive and negative images as well as neutral images from the International Affective Picture System was measured in 40 individuals (20 non-treatment seeking cocaine-dependent and 20 age- and gender-matched control participants; 50% of whom were women). Images were displayed for 4 s each in blocks of five across two 270-second runs. General linear models assessed within and between group activation differences for the emotional images. Results: Cocaine-dependent individuals had a significantly lower response to typically arousing positive and negative images than controls, with attenuated neural activity present in the medial prefrontal cortex (mPFC) and anterior cingulate cortex (ACC). Analyses by gender revealed less mPFC/ACC activation among female users, but not males, for both positive and negative images. Conclusion: The dampened neural response to typically arousing stimuli among cocaine-dependent polydrug users suggests decreased salience processing for nondrug stimuli, particularly among female users. This decreased responding is consistent with data from other substance using populations and suggests that this may be a general feature of addiction. Amplifying the neural response to naturally arousing nondrug-related reinforcers may present an opportunity for unique behavioral and brain stimulation therapies.