101
|
Beltz AM, Moser JS. Ovarian hormones: a long overlooked but critical contributor to cognitive brain structures and function. Ann N Y Acad Sci 2020; 1464:156-180. [DOI: 10.1111/nyas.14255] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 08/13/2019] [Accepted: 09/18/2019] [Indexed: 12/23/2022]
Affiliation(s)
- Adriene M. Beltz
- Department of PsychologyUniversity of Michigan Ann Arbor Michigan
| | - Jason S. Moser
- Department of PsychologyMichigan State University East Lansing Michigan
| |
Collapse
|
102
|
Elizabeth Wilcox M, Donnelly JP, Lone NI. Understanding gender disparities in outcomes after sepsis. Intensive Care Med 2020; 46:796-798. [PMID: 32072302 DOI: 10.1007/s00134-020-05961-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 02/05/2020] [Indexed: 02/01/2023]
Affiliation(s)
- M Elizabeth Wilcox
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. .,Division of Respirology, Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, ON, Canada.
| | - John P Donnelly
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA.,Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Nazir I Lone
- Usher Institute, University of Edinburgh, Edinburgh, UK.,Department of Critical Care, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| |
Collapse
|
103
|
Belmonte RL, Corbally MK, Duneau DF, Regan JC. Sexual Dimorphisms in Innate Immunity and Responses to Infection in Drosophila melanogaster. Front Immunol 2020; 10:3075. [PMID: 32076419 PMCID: PMC7006818 DOI: 10.3389/fimmu.2019.03075] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 12/16/2019] [Indexed: 12/20/2022] Open
Abstract
The sexes show profound differences in responses to infection and the development of autoimmunity. Dimorphisms in immune responses are ubiquitous across taxa, from arthropods to vertebrates. Drosophila melanogaster shows strong sex dimorphisms in immune system responses at baseline, upon pathogenic challenge, and over aging. We have performed an exhaustive survey of peer-reviewed literature on Drosophila immunity, and present a database of publications indicating the sex(es) analyzed in each study. While we found a growing interest in the community in adult immunity and in reporting both sexes, the main body of work in this field uses only one sex, or does not stratify by sex. We synthesize evidence for sexually dimorphic responses to bacterial, viral, and fungal infections. Dimorphisms may be mediated by distinct immune compartments, and we review work on sex differences in behavioral, epithelial, cellular, and systemic (fat body-mediated) immunity. Emerging work on sexually dimorphic aging of immune tissues, immune senescence, and inflammation are examined. We consider evolutionary drivers for sex differences in immune investment, highlight the features of Drosophila biology that make it particularly amenable to studies of immune dimorphisms, and discuss areas for future exploration.
Collapse
Affiliation(s)
- Rebecca L. Belmonte
- Institute of Immunology & Infection Research, University of Edinburgh, Edinburgh, United Kingdom
| | - Mary-Kate Corbally
- Institute of Immunology & Infection Research, University of Edinburgh, Edinburgh, United Kingdom
| | - David F. Duneau
- Laboratoire Evolution & Diversite Biologique, UMR5174 EDB, CNRS, Université Toulouse 3 Paul Sabatier, Toulouse, France
| | - Jennifer C. Regan
- Institute of Immunology & Infection Research, University of Edinburgh, Edinburgh, United Kingdom
| |
Collapse
|
104
|
Torondel B, Khan R, Holm Larsen T, White S. Efficacy of the SuperTowel ®: An Alternative Hand-washing Product for Humanitarian Emergencies. Am J Trop Med Hyg 2020; 100:1278-1284. [PMID: 30860009 PMCID: PMC6493919 DOI: 10.4269/ajtmh.18-0860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Handwashing with soap reduces the transmission of diarrheal pathogens, but access to hand-washing facilities, water, and soap in humanitarian emergencies is limited. The SuperTowel® (ST) is a fabric treated with permanent antimicrobial bonding and has been designed as a soap alternative in emergency situations. The aim of this study was to test the efficacy of the ST as a hand-cleaning product. Two sets of laboratory tests, with 16 volunteers in each, were conducted to test the efficacy of different prototypes of the ST. Volunteers pre-contaminated their hands with nonpathogenic Escherichia coli. Comparisons were made between hand cleaning with the ST and handwashing with the reference soap, using a crossover design. Participants also completed a questionnaire about product perceptions. Three of the prototypes of the ST were more efficacious at removing E. coli from pre-contaminated hands than handwashing with soap (mean log10 reduction of 4.11 ± 0.47 for ST1, 3.84 ± 0.61 for ST2, and 3.71 ± 0.67 for ST3 versus 3.01 ± 0.63 for soap [P < 0.001, P = 0.002, and P = 0.005, respectively]). The ST prototypes used less water than handwashing with soap, were well accepted, and were considered preferable in communal settings. The ST has the potential to be a suitable complementary hand-cleaning product for humanitarian emergencies.
Collapse
Affiliation(s)
- Belen Torondel
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rummana Khan
- Department of Microbiology, Kelkar Education Trust's Scientific Research Centre, Mumbai, India
| | | | - Sian White
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
105
|
Blanken AE, Nation DA. Does Gender Influence the Relationship Between High Blood Pressure and Dementia? Highlighting Areas for Further Investigation. J Alzheimers Dis 2020; 78:23-48. [PMID: 32955459 PMCID: PMC8011824 DOI: 10.3233/jad-200245] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Gender differences have been noted in studies linking blood pressure to all-cause dementia, and the two most common forms of dementia: Alzheimer's disease (AD) and vascular dementia (VaD). However, how gender modifies the relationship between blood pressure and dementia remains unclear. OBJECTIVE To review evidence for a gender modifying effect on the link between blood pressure and all-cause dementia. METHODS A systematic review was conducted according to PRISMA guidelines. Sixteen out of 256 reviewed articles met inclusion criteria. RESULTS For women, higher midlife systolic blood pressure (SBP) and hypertension were both associated with greater risk of all-cause dementia, AD, and VaD, in six out of seven studies. Two of these studies reported higher midlife SBP/hypertension were associated with greater risk for all-cause dementia in women, but not men. One study reported higher midlife SBP associated with greater AD risk in women, but not men. However, another study reported that midlife hypertension associated with AD risk in men, but not women. No clear gender differences were reported in the relationship between late-life high blood pressure/hypertension with all-cause dementia or AD. CONCLUSION Studies rarely, and inconsistently, analyzed or reported gender effects. Therefore, interpretation of available evidence regarding the role of gender in blood pressure associated dementia was difficult. Several studies indicated higher midlife SBP was associated with greater risk of all-cause dementia for women, compared to men. Future studies should evaluate women-specific aging processes that occur in midlife when considering the association between blood pressure and dementia risk.
Collapse
Affiliation(s)
- Anna E. Blanken
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Daniel A. Nation
- Department of Psychological Science, University of California Irvine, Irvine, CA, USA
- Institute for Memory Disorders and Neurological Impairments, University of California Irvine, Irvine, CA, USA
| |
Collapse
|
106
|
" Bridging the Gap" Everything that Could Have Been Avoided If We Had Applied Gender Medicine, Pharmacogenetics and Personalized Medicine in the Gender-Omics and Sex-Omics Era. Int J Mol Sci 2019; 21:ijms21010296. [PMID: 31906252 PMCID: PMC6982247 DOI: 10.3390/ijms21010296] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/21/2019] [Accepted: 12/30/2019] [Indexed: 02/06/2023] Open
Abstract
Gender medicine is the first step of personalized medicine and patient-centred care, an essential development to achieve the standard goal of a holistic approach to patients and diseases. By addressing the interrelation and integration of biological markers (i.e., sex) with indicators of psychological/cultural behaviour (i.e., gender), gender medicine represents the crucial assumption for achieving the personalized health-care required in the third millennium. However, ‘sex’ and ‘gender’ are often misused as synonyms, leading to frequent misunderstandings in those who are not deeply involved in the field. Overall, we have to face the evidence that biological, genetic, epigenetic, psycho-social, cultural, and environmental factors mutually interact in defining sex/gender differences, and at the same time in establishing potential unwanted sex/gender disparities. Prioritizing the role of sex/gender in physiological and pathological processes is crucial in terms of efficient prevention, clinical signs’ identification, prognosis definition, and therapy optimization. In this regard, the omics-approach has become a powerful tool to identify sex/gender-specific disease markers, with potential benefits also in terms of socio-psychological wellbeing for each individual, and cost-effectiveness for National Healthcare systems. “Being a male or being a female” is indeed important from a health point of view and it is no longer possible to avoid “sex and gender lens” when approaching patients. Accordingly, personalized healthcare must be based on evidence from targeted research studies aimed at understanding how sex and gender influence health across the entire life span. The rapid development of genetic tools in the molecular medicine approaches and their impact in healthcare is an example of highly specialized applications that have moved from specialists to primary care providers (e.g., pharmacogenetic and pharmacogenomic applications in routine medical practice). Gender medicine needs to follow the same path and become an established medical approach. To face the genetic, molecular and pharmacological bases of the existing sex/gender gap by means of omics approaches will pave the way to the discovery and identification of novel drug-targets/therapeutic protocols, personalized laboratory tests and diagnostic procedures (sex/gender-omics). In this scenario, the aim of the present review is not to simply resume the state-of-the-art in the field, rather an opportunity to gain insights into gender medicine, spanning from molecular up to social and psychological stances. The description and critical discussion of some key selected multidisciplinary topics considered as paradigmatic of sex/gender differences and sex/gender inequalities will allow to draft and design strategies useful to fill the existing gap and move forward.
Collapse
|
107
|
Rahman A, Jackson H, Hristov H, Isaacson RS, Saif N, Shetty T, Etingin O, Henchcliffe C, Brinton RD, Mosconi L. Sex and Gender Driven Modifiers of Alzheimer's: The Role for Estrogenic Control Across Age, Race, Medical, and Lifestyle Risks. Front Aging Neurosci 2019; 11:315. [PMID: 31803046 PMCID: PMC6872493 DOI: 10.3389/fnagi.2019.00315] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 10/31/2019] [Indexed: 12/22/2022] Open
Abstract
Research indicates that after advanced age, the major risk factor for late-onset Alzheimer’s disease (AD) is female sex. Out of every three AD patients, two are females with postmenopausal women contributing to over 60% of all those affected. Sex- and gender-related differences in AD have been widely researched and several emerging lines of evidence point to different vulnerabilities that contribute to dementia risk. Among those being considered, it is becoming widely accepted that gonadal steroids contribute to the gender disparity in AD, as evidenced by the “estrogen hypothesis.” This posits that sex hormones, 17β-estradiol in particular, exert a neuroprotective effect by shielding females’ brains from disease development. This theory is further supported by recent findings that the onset of menopause is associated with the emergence of AD-related brain changes in women in contrast to men of the same age. In this review, we discuss genetic, medical, societal, and lifestyle risk factors known to increase AD risk differently between the genders, with a focus on the role of hormonal changes, particularly declines in 17β-estradiol during the menopause transition (MT) as key underlying mechanisms.
Collapse
Affiliation(s)
- Aneela Rahman
- Department of Neurology, Weill Cornell Medicine, Cornell University, New York, NY, United States
| | - Hande Jackson
- Department of Neurology, Weill Cornell Medicine, Cornell University, New York, NY, United States
| | - Hollie Hristov
- Department of Neurology, Weill Cornell Medicine, Cornell University, New York, NY, United States
| | - Richard S Isaacson
- Department of Neurology, Weill Cornell Medicine, Cornell University, New York, NY, United States
| | - Nabeel Saif
- Department of Neurology, Weill Cornell Medicine, Cornell University, New York, NY, United States
| | - Teena Shetty
- Concussion Clinic, Hospital for Special Surgery, New York, NY, United States
| | - Orli Etingin
- Department of Internal Medicine, Weill Cornell Medicine, Cornell University, New York, NY, United States
| | - Claire Henchcliffe
- Department of Neurology, Weill Cornell Medicine, Cornell University, New York, NY, United States
| | - Roberta Diaz Brinton
- Department of Pharmacology, College of Medicine, The University of Arizona, Tucson, AZ, United States.,Department of Neurology, College of Medicine, The University of Arizona, Tucson, AZ, United States
| | - Lisa Mosconi
- Department of Neurology, Weill Cornell Medicine, Cornell University, New York, NY, United States.,Department of Radiology, Weill Cornell Medicine, Cornell University, New York, NY, United States.,Department of Psychiatry, New York University School of Medicine, New York, NY, United States
| |
Collapse
|
108
|
Sledge P. From decision to incision: Ideologies of gender in surgical cancer care. Soc Sci Med 2019; 239:112550. [PMID: 31542648 DOI: 10.1016/j.socscimed.2019.112550] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 09/03/2019] [Accepted: 09/12/2019] [Indexed: 01/06/2023]
Abstract
In this paper, I draw on the narratives of 57 individuals whose gender identities and decisions about their bodies trouble the medical protocols for breast and gynecological cancer care. I focus here on the decision-making process for three groups of elective surgeries: hysterectomy, prophylactic bilateral and contralateral mastectomy, and breast reconstruction. These elective surgeries illustrate places in medical interactions where patients and providers rely on frames of gender to determine whether a given surgery is an appropriate option for cancer prevention or care. These cases also explain how patient experiences of medical interactions are shaped by and thus reproduce ideologies of gender through the bodies of patients. While clinical practice and medical decisions are supposedly determined through the principles of evidence-based medicine and patient-centered care, I show that ideas about gender can actually supersede both medical evidence and patient desires for their bodies in the care of gynecological and breast cancers.
Collapse
|
109
|
Wickham KA, Spriet LL. No longer beeting around the bush: a review of potential sex differences with dietary nitrate supplementation. Appl Physiol Nutr Metab 2019; 44:915-924. [DOI: 10.1139/apnm-2019-0063] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Over the last decade there has been substantial interest in the health and athletic performance benefits associated with acute and chronic dietary nitrate (NO3–) supplementation. Dietary NO3–, commonly found in leafy green and root vegetables, undergoes sequential reduction to nitrite and nitric oxide (NO) via the enterosalivary circulation. Importantly, NO has been shown to elicit a number of biological effects ranging from blood pressure reduction to improved exercise economy and athletic performance. However, a common absence within biological research is the lack of female participants, which is often attributed to the added complexity of hormonal fluctuations throughout the menstrual cycle. Despite mounting evidence supporting significant anthropometric, metabolic, and physiological differences between the sexes, this problem extends to the field of dietary NO3– supplementation where women are underrepresented as research participants. This review examines the existing dietary NO3– supplementation research with regards to dietary NO3– pharmacokinetics, resting blood pressure, exercise economy and performance, and mechanisms of action. It also provides evidence and rationale for potential sex differences in response to dietary NO3– supplementation and future directions for this field of research. Novelty Dietary NO3– supplementation has been shown to have positive impacts on health and athletic performance in generally male populations. However, women are underrepresented in dietary NO3– supplementation research. The present evidence suggests that sex differences exist in response to dietary NO3– supplementation and this review highlights avenues for future research.
Collapse
Affiliation(s)
- Kate A. Wickham
- Faculty of Applied Health Sciences, Brock University, St. Catharines, ON L2S 3A1, Canada
| | - Lawrence L. Spriet
- Human Health & Nutritional Sciences, University of Guelph, Guelph, ON N1G 2W1, Canada
| |
Collapse
|
110
|
Goldstein KM, Duan-Porter W, Alkon A, Olsen MK, Voils CI, Hastings SN. Enrollment and Retention of Men and Women in Health Services Research and Development Trials. Womens Health Issues 2019; 29 Suppl 1:S121-S130. [PMID: 31253236 PMCID: PMC8489188 DOI: 10.1016/j.whi.2019.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 02/26/2019] [Accepted: 03/01/2019] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Sex- and gender-specific science is essential to inform patient-centered, evidence-based care. Developing such evidence requires adequate inclusion of both women and men in trials. We sought to describe study participation of women and men in Department of Veterans Affairs Health Services Research and Development trials. METHODS We identified recent health services research trials from one Health Services Research and Development Center of Innovation and compared the participation of women and men from trial recruitment to study completion. We also calculated the participation to prevalence ratio (PPR) by sex for each trial. RESULTS We included eight trials that started recruitment between 2011 and 2014. Only one study purposefully attempted to boost the recruitment of women. Overall, the PPR for women ranged from 0.2 to 4.5, with seven studies having a PPR of greater than 1, indicating that women participated in these trials at proportions greater than their prevalence in the disease population within the Department of Veterans Affairs. The PPR for men ranged from 0.8 to 1.1. Retention was best with those studies that used administrative data for final outcomes assessment. No studies provided results stratified by sex or conducted analyses to explore treatment effect by sex. CONCLUSIONS At a single site, women participated in Health Services Research and Development trials at similar or greater rates to men without cross-study efforts to enrich the recruitment or retention of women. Adding strategic recruitment approaches could further boost the proportion of women in Department of Veterans Affairs trials and enable adequately powered sex-based analyses.
Collapse
Affiliation(s)
- Karen M Goldstein
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina; Department of Medicine, Duke University Medical Center, Durham, North Carolina.
| | - Wei Duan-Porter
- University of Minnesota Medical School, Minneapolis, Minnesota; Center for Care Delivery & Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - Aviel Alkon
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina; Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Maren K Olsen
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina; Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Corrine I Voils
- Department of Surgery, University of Wisconsin, Madison, Wisconsin; William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
| | - Susan N Hastings
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina; Department of Medicine, Duke University Medical Center, Durham, North Carolina; Geriatric Research, Education, and Clinical Center, Durham VA Medical Center, Durham, North Carolina; Center for the Study of Human Aging and Development, Duke University, Durham, North Carolina
| |
Collapse
|
111
|
Klap R, Humphreys K. Designing Studies for Sex and Gender Analyses: How Research Can Derive Clinically Useful Knowledge for Women's Health. Womens Health Issues 2019; 29 Suppl 1:S12-S14. [DOI: 10.1016/j.whi.2019.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 02/07/2023]
|
112
|
Opinion: Research community needs to better appreciate the value of sex-based research. Proc Natl Acad Sci U S A 2019; 116:7154-7156. [PMID: 30971497 DOI: 10.1073/pnas.1903586116] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
|
113
|
Franconi F, Campesi I, Colombo D, Antonini P. Sex-Gender Variable: Methodological Recommendations for Increasing Scientific Value of Clinical Studies. Cells 2019; 8:E476. [PMID: 31109006 PMCID: PMC6562815 DOI: 10.3390/cells8050476] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/07/2019] [Accepted: 05/09/2019] [Indexed: 02/08/2023] Open
Abstract
There is a clear sex-gender gap in the prevention and occurrence of diseases, and in the outcomes and treatments, which is relevant to women in the majority of cases. Attitudes concerning the enrollment of women in randomized clinical trials have changed over recent years. Despite this change, a gap still exists. This gap is linked to biological factors (sex) and psycho-social, cultural, and environmental factors (gender). These multidimensional, entangled, and interactive factors may influence the pharmacological response. Despite the fact that regulatory authorities recognize the importance of sex and gender, there is a paucity of research focusing on the racial/ethnic, socio-economic, psycho-social, and environmental factors that perpetuate disparities. Research and clinical practice must incorporate all of these factors to arrive at an intersectional and system-scenario perspective. We advocate for scientifically rigorous evaluations of the interplay between sex and gender as key factors in performing clinical trials, which are more adherent to real-life. This review proposes a set of 12 rules to improve clinical research for integrating sex-gender into clinical trials.
Collapse
Affiliation(s)
- Flavia Franconi
- Laboratory of Sex-gender Medicine, National Institute of Biostructures and Biosystems, 07100 Sassari, Italy.
| | - Ilaria Campesi
- Laboratory of Sex-gender Medicine, National Institute of Biostructures and Biosystems, 07100 Sassari, Italy.
- Dipartimento di Scienze Biomediche, Università degli Studi di Sassari, 07100 Sassari, Italy.
| | - Delia Colombo
- Value and Access Head, Novartis Italia, 21040 Origgio, Italy.
| | | |
Collapse
|
114
|
Lawson McLean A. Publication trends in transcranial magnetic stimulation: a 30-year panorama. Brain Stimul 2019; 12:619-627. [DOI: 10.1016/j.brs.2019.01.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 01/02/2019] [Accepted: 01/07/2019] [Indexed: 01/11/2023] Open
|
115
|
Regensteiner JG, Libby AM, Huxley R, Clayton JA. Integrating sex and gender considerations in research: educating the scientific workforce. Lancet Diabetes Endocrinol 2019; 7:248-250. [PMID: 30744946 DOI: 10.1016/s2213-8587(19)30038-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 01/31/2019] [Accepted: 02/01/2019] [Indexed: 01/12/2023]
Affiliation(s)
- Judith G Regensteiner
- Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO 80045, USA; Center for Women's Health Research, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO 80045, USA.
| | - Anne M Libby
- Department of Emergency Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO 80045, USA; Center for Women's Health Research, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Rachel Huxley
- College of Science, Health and Engineering and Research Centre for Cardiovascular Biology and Disease, La Trobe University, Melbourne, VIC, Australia
| | - Janine Austin Clayton
- Office of Research on Women's Health, National Institutes of Health, Bethesda, MD, USA
| |
Collapse
|
116
|
Thande NK, Wang M, Curlin K, Dalvie N, Mazure CM. The Influence of Sex and Gender on Health: How Much Is Being Taught in Medical School Curricula? J Womens Health (Larchmt) 2019; 28:1748-1754. [PMID: 30864888 DOI: 10.1089/jwh.2018.7229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Sex is a biological variable linked to our chromosomal complement, while gender refers to one's personal identification as influenced by social, cultural, and personal experience. Both sex and gender and their interactions influence health outcomes. Although this is increasingly clear, we have not yet ensured that the next generation of physicians and physician-scientists is being taught the empirical findings necessary to understand these relationships. We assert that medical schools must incorporate these data into didactics throughout an integrated curriculum. Materials and Methods: This study evaluates a medical curriculum for sex- and gender-based content and provides recommendations for establishing and integrating pertinent sex and gender medicine didactics. Trained first-and second-year medical students audited 548 lectures and workshops to determine sex- and gender-based content. Results: Less than 25% of all sessions raised the topic of sex or gender influences on physiology and pathophysiology or the experience of the patient in the health care environment. Only 8.1% of all sessions included an in-depth discussion of sex or gender differences, and these discussions predominantly focused on basic physiology and prevalence and/or incidence of disease, and not on available data on sex- and gender-specific influences on diagnosis, treatment, prognosis, and drug effects. The didactics that included data on sex or gender influences were largely in lectures rather than small group sessions, which are important for the development of critical clinical reasoning skills. Conclusions: A survey-based audit of medical school curricula can inform recommendations for improving the inclusion of data on sex- and gender-based content.
Collapse
Affiliation(s)
- Njeri K Thande
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | | | | | - Carolyn M Mazure
- Department of Psychiatry, Women's Health Research at Yale, Yale School of Medicine, New Haven, Connecticut
| |
Collapse
|
117
|
Zhang YW, Cheng YC. Challenge and Prospect of Traditional Chinese Medicine in Depression Treatment. Front Neurosci 2019; 13:190. [PMID: 30890916 PMCID: PMC6411815 DOI: 10.3389/fnins.2019.00190] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 02/18/2019] [Indexed: 12/26/2022] Open
Abstract
Current medication for depression is inadequate and far from ideal. Development of novel antidepressant drugs is a pressing task. The discovery of ketamine and related agents represents a new era in drug discovery for the rapid treatment of depression. Due to potential neurotoxicity, short-lasting efficacy, the limitation of a single target approach, and a limited role in depression prevention of these agents, additional approaches or drugs that exert synergy and compatibility, with the rapid-acting agents are required for better treatment of depression. Traditional Chinese Medicine (TCM) is a systems medicine and its clinical experience and integrated theory for diagnosis and treatment provides an alternative method of novel drug discovery in depression treatment. In TCM, there are numerous claimed effective antidepressant formulas, but comprehensive research and evidence-based clinical studies are required for their acceptance as a treatment. In this essay, we review current attempts in the discovery of new agents, TCM drug formulation, and TCM treatment of depression, and discuss the challenges and opportunities of TCM in the new era of antidepressant discovery. TCM could provide an important resource in the discovery of novel agents, assistance of the rapid-acting antidepressants, development of new agents for female patients, and the prevention of depression at its early stages. The study of depression in conjunction with TCM therefore not only provides an opportunity to scientifically evaluate the benefits and risks of TCM, but also accelerates the development of novel antidepressant agents by combining the principle of modern molecular medicine with the ideas of empirical systems medicine.
Collapse
Affiliation(s)
- Yuan-Wei Zhang
- School of Life Sciences, Guangzhou University, Guangzhou, China.,Department of Pharmacology, School of Medicine, Yale University, New Haven, CT, United States
| | - Yung-Chi Cheng
- Department of Pharmacology, School of Medicine, Yale University, New Haven, CT, United States
| |
Collapse
|
118
|
Abstract
PURPOSE OF REVIEW Inflammation has emerged as an important biological process in the development of many age-related diseases that occur at different frequencies in men and women. The aim of this review was to examine the current evidence linking stress and sleep with inflammation with a focus on sex differences. RECENT FINDINGS Psychosocial stress that occurs either acutely or chronically is associated with elevated levels of systemic inflammation. While not as robust, insufficient sleep, particularly sleep disturbances, appears to be associated with higher levels of inflammatory activity as well. In several contexts, associations of stress and insufficient sleep with inflammation appear stronger in women than in men. However, this should be interpreted with caution as few studies test for sex differences. Stress and poor sleep often predict elevations in systemic inflammation. While there is some evidence that these associations are stronger in women, findings are largely mixed and more systematic investigations of sex differences in future studies are warranted.
Collapse
|
119
|
Ghare MI, Chandrasekhar J, Mehran R, Ng V, Grines C, Lansky A. Sex Disparities in Cardiovascular Device Evaluations. JACC Cardiovasc Interv 2019; 12:301-308. [DOI: 10.1016/j.jcin.2018.10.048] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 09/30/2018] [Accepted: 10/04/2018] [Indexed: 01/12/2023]
|
120
|
Saunders S, Hammond C, Thomas R. Exploring Gender-Related Experiences of Cancer Survivors Through Creative Arts: A Scoping Review. QUALITATIVE HEALTH RESEARCH 2019; 29:135-148. [PMID: 29732960 DOI: 10.1177/1049732318771870] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Negative health consequences of cancer and its treatments are multifaceted. Research suggests numerous psychosocial benefits may be gained by cancer survivors who engage in arts-based practices. To grasp the breadth of this literature, we undertook a scoping review exploring the intersection between arts-based practices, gender, and cancer. Three databases were searched according to the following criteria: (a) participants older than 18 years, (b) use of arts-based practices, (c) explore cancer survivorship, and (d) gender-based analysis component. A total of 1,109 studies were identified and 11 met inclusion criteria. Themes extracted illustrate four transformative moments related to gender identities postcancer diagnosis: (a) fostering reflection after a cancer diagnosis, (b) constructing new narratives of gender postcancer, (c) navigating gender norms in search of support for new identities, and (d) interrogation of perceived gender norms. Findings demonstrate potential contributions of arts-based practices in shaping cancer-related gender identities. Future research should investigate these experiences across a wider population.
Collapse
|
121
|
Karp NA, Reavey N. Sex bias in preclinical research and an exploration of how to change the status quo. Br J Pharmacol 2018; 176:4107-4118. [PMID: 30418665 DOI: 10.1111/bph.14539] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/18/2018] [Accepted: 10/28/2018] [Indexed: 01/16/2023] Open
Abstract
There has been a revolution within clinical trials to include females in the research pipeline. However, there has been limited change in the preclinical arena; yet the research here lays the ground work for the subsequent clinical trials. Sex bias has been highlighted as one of the contributing factors to the poor translation and replicability issues undermining preclinical research. There have been multiple calls for action, and the funders of biomedical research are actively pushing the inclusion of sex as a biological variable. Here, we consider the current standard practice within the preclinical research setting, why there is a movement to include females and why the imbalance exists. We explore organizational change theory as a tool to shape strategies needed at an individual and institute level to change the status quo. The ultimate goal is to create a scientific environment in which our preclinical research automatically implements sex-sensitive approaches. LINKED ARTICLES: This article is part of a themed section on The Importance of Sex Differences in Pharmacology Research. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v176.21/issuetoc.
Collapse
Affiliation(s)
- Natasha A Karp
- Quantitative Biology, Discovery Sciences, IMED Biotech Unit, AstraZeneca, Cambridge, UK
| | - Neil Reavey
- Council for Science and Animal Welfare, AstraZeneca, Cambridge, UK.,Drug Safety and Metabolism, IMED Biotech Unit, AstraZeneca, Cambridge, UK
| |
Collapse
|
122
|
Stephenson ED, Farzal Z, Kilpatrick LA, Senior BA, Zanation AM. Sex bias in basic science and translational otolaryngology research. Laryngoscope 2018; 129:613-618. [PMID: 30408174 DOI: 10.1002/lary.27498] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 07/07/2018] [Accepted: 07/16/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Recent studies revealed sex bias in surgical research. Although many diseases exhibit sex-based clinically relevant differences, otolaryngology research has not been evaluated for sex reporting and sex-based analysis. We postulate that a similar bias is prevalent in otolaryngology literature. STUDY DESIGN Literature review. METHODS Articles published from 2016 to 2017 in The Laryngoscope, Otolaryngology-Head and Neck Surgery, and JAMA Otolaryngology-Head and Neck Surgery were reviewed. Articles with animal subjects, human subject cells, or commercial cell lines were included. Data collected included study type, cell/animal sex, and sex-based data analysis. RESULTS One hundred forty-four basic/translational research articles were identified. Sixty-nine (47.9%) of those lacked sex reporting. Of 75 studies that reported sex, 22 (29.3%) included both sexes, and 11 (14.7%) analyzed data by sex. One hundred five (72.9%) used animal subjects, of which 54 (51.9%) lacked sex breakdown. Among animal studies, 48/105 included only one sex, and three articles analyzed data by sex. Fifty-four studies used commercial cell lines (N = 23) or human/animal subject cells (N = 31). Among cell groups, 28/54 (51.9%) were of unknown sex, and seven were single sex. Eight (14.8%) studies included data analysis by sex. Domestic studies exhibited a lower rate of sex reporting in both animal and cell studies, and a lower rate of sex-based analysis in cell studies. CONCLUSIONS Sex may influence outcomes significantly but is underreported and underanalyzed in basic/translational otolaryngology research. Because this research frequently lays the groundwork for clinical trials and standards of care, future research must address these sex-based discrepancies. LEVEL OF EVIDENCE NA Laryngoscope, 129:613-618, 2019.
Collapse
Affiliation(s)
- Elizabeth D Stephenson
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Zainab Farzal
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Lauren A Kilpatrick
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Brent A Senior
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Adam M Zanation
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| |
Collapse
|
123
|
de Abreu MS, Friend AJ, Demin KA, Amstislavskaya TG, Bao W, Kalueff AV. Zebrafish models: do we have valid paradigms for depression? J Pharmacol Toxicol Methods 2018; 94:16-22. [DOI: 10.1016/j.vascn.2018.07.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 06/12/2018] [Accepted: 07/16/2018] [Indexed: 11/26/2022]
|
124
|
Volgin AD, Yakovlev OA, Demin KA, de Abreu MS, Alekseeva PA, Friend AJ, Lakstygal AM, Amstislavskaya TG, Bao W, Song C, Kalueff AV. Zebrafish models for personalized psychiatry: Insights from individual, strain and sex differences, and modeling gene x environment interactions. J Neurosci Res 2018; 97:402-413. [PMID: 30320468 DOI: 10.1002/jnr.24337] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 08/16/2018] [Accepted: 09/17/2018] [Indexed: 12/30/2022]
Abstract
Currently becoming widely recognized, personalized psychiatry focuses on unique physiological and genetic profiles of patients to best tailor their therapy. However, the role of individual differences, as well as genetic and environmental factors, in human psychiatric disorders remains poorly understood. Animal experimental models are a valuable tool to improve our understanding of disease pathophysiology and its molecular mechanisms. Due to high reproduction capability, fully sequenced genome, easy gene editing, and high genetic and physiological homology with humans, zebrafish (Danio rerio) are emerging as a novel powerful model in biomedicine. Mounting evidence supports zebrafish as a useful model organism in CNS research. Robustly expressed in these fish, individual, strain, and sex differences shape their CNS responses to genetic, environmental, and pharmacological manipulations. Here, we discuss zebrafish as a promising complementary translational tool to further advance patient-centered personalized psychiatry.
Collapse
Affiliation(s)
- Andrey D Volgin
- Almazov National Medical Research Centre, Ministry of Healthcare of Russian Federation, St. Petersburg, Russia.,Institute of Translational Biomedicine, St. Petersburg State University, St. Petersburg, Russia.,Military Medical Academy, St Petersburg, Russia
| | - Oleg A Yakovlev
- Almazov National Medical Research Centre, Ministry of Healthcare of Russian Federation, St. Petersburg, Russia.,Institute of Translational Biomedicine, St. Petersburg State University, St. Petersburg, Russia.,Military Medical Academy, St Petersburg, Russia
| | - Konstantin A Demin
- Almazov National Medical Research Centre, Ministry of Healthcare of Russian Federation, St. Petersburg, Russia.,Institute of Translational Biomedicine, St. Petersburg State University, St. Petersburg, Russia
| | - Murilo S de Abreu
- Bioscience Institute, University of Passo Fundo (UPF), Passo Fundo, Brazil.,Postgraduate Program in Pharmacology, Federal University of Santa Maria, Santa Maria, Brazil
| | - Polina A Alekseeva
- Almazov National Medical Research Centre, Ministry of Healthcare of Russian Federation, St. Petersburg, Russia
| | - Ashton J Friend
- Tulane University School of Science and Engineering, New Orleans, Louisiana
| | - Anton M Lakstygal
- Almazov National Medical Research Centre, Ministry of Healthcare of Russian Federation, St. Petersburg, Russia.,Institute of Translational Biomedicine, St. Petersburg State University, St. Petersburg, Russia
| | - Tamara G Amstislavskaya
- Laboratory of Translational Biopsychiatry, Scientific Research Institute of Physiology and Basic Medicine, Novosibirsk, Russia
| | - Wandong Bao
- School of Pharmacy, Southwest University, Chongqing, China
| | - Cai Song
- Research Institute of Marine Drugs and Nutrition, Guangdong Ocean University, Zhanjiang, China
| | - Allan V Kalueff
- School of Pharmacy, Southwest University, Chongqing, China.,Ural Federal University, Ekaterinburg, Russia.,ZENEREI Research Center, Slidell, Louisiana.,Institute of Experimental Medicine, Almazov National Medical Research Centre, Ministry of Healthcare of Russian Federation, St. Petersburg, Russia.,Granov Russian Scientific Center of Radiology and Surgical Technologies, Ministry of Healthcare of Russian Federation, St. Petersburg, Russia.,Scientific Research Institute of Physiology and Basic Medicine, Novosibirsk, Russia.,Laboratory of Biological Psychiatry, Institute of Translational Biomedicine, St. Petersburg State University, St. Petersburg, Russia
| |
Collapse
|
125
|
Jain N, Cottingham MD, Fisher JA. Disadvantaged, Outnumbered, and Discouraged: Women's Experiences as Healthy Volunteers in U.S. Phase I Trials. CRITICAL PUBLIC HEALTH 2018; 30:141-152. [PMID: 32123487 DOI: 10.1080/09581596.2018.1529861] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
While enormous strides have been made in the representation of women in clinical trials, the percentage of women enrolling in Phase I trials still remains low, which both raises public health concerns about the safety of new drugs and social justice concerns regarding their inclusion in research. As part of a longitudinal study of healthy volunteers in the United States, our inquiry aimed to examine impediments to women enrolling in Phase I trials as well as their experiences participating in these studies at residential research clinics. We analyzed 111 semi-structured interviews conducted with 47 women who had enrolled in at least one Phase I trial. Our study indicates that women face discrimination during all stages of their participation in Phase I trials from their ability to qualify for studies, the treatment they receive in the clinic facilities, and a lack of social support. Specifically, we found that (1) study designs disadvantage participants of childbearing potential, (2) women feel vulnerable in the clinic space when outnumbered by men, and (3) heterosexual women are often discouraged from participation by their husbands or significant others. Placing these findings within the scholarly literature on barriers to women's clinical trial participation, we argue that diverse strategies attending both to physiological and social factors are needed to combat inequalities in U.S. Phase I trial participation.
Collapse
Affiliation(s)
- Nupur Jain
- The Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA,
| | | | - Jill A Fisher
- Department of Social Medicine and Center for Bioethics, University of North Carolina at Chapel Hill, USA
| |
Collapse
|
126
|
Ruggieri A, Gagliardi MC, Anticoli S. Sex-Dependent Outcome of Hepatitis B and C Viruses Infections: Synergy of Sex Hormones and Immune Responses? Front Immunol 2018; 9:2302. [PMID: 30349537 PMCID: PMC6186821 DOI: 10.3389/fimmu.2018.02302] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 09/17/2018] [Indexed: 01/19/2023] Open
Abstract
Hepatitis B virus (HBV) and hepatitis C virus (HCV) are hepatotropic viruses that differ in their genomic content, life cycle and molecular prognosis. HBV and HCV establish chronic lifespan infections that can evolve to fibrosis, cirrhosis and hepatocellular carcinoma (HCC). This malignant liver cancer affects more commonly male patients than females, with a male-to-female incidence ratio of <Capword>2</Capword>:1 up to 7:1. Sex significantly contributes to shape the immune responses, contributing to differences in the pathogenesis of infectious diseases, in males and females patients. Females usually develop more intense innate, humoral and cellular immune responses to viral infections and to vaccination compared to male subjects. Sex hormones, in turn, differentially affect the immune responses to viruses, by specific binding to the hormone receptors expressed on the immune cells. In general, estrogens have immune-stimulating effect, while androgens are immune-suppressing. However, sex hormones, such as androgen, can also directly interact with HBV genome integrated into the cell nucleus and activate transcription of HBV oncoproteins. On the other side, estradiol and estrogen receptors protect liver cells from inflammatory damage, apoptosis and oxidative stress, which contribute to fibrosis and malignant transformation preceding HCC. In HCV-associated cirrhosis and HCC the decreased expression of estrogen receptor alfa (ERα) in male patients may explain the worse outcome of HCV infection in men than in women. The synergistic action of male and female sex hormones and of immune responses, together with viral factors contribute to the mechanism of sex/gender disparity in the outcome and progression of hepatitis viruses infection.
Collapse
Affiliation(s)
- Anna Ruggieri
- Center for Gender Specific Medicine, Istituto Superiore di Sanità, Rome, Italy
| | | | - Simona Anticoli
- Center for Gender Specific Medicine, Istituto Superiore di Sanità, Rome, Italy
| |
Collapse
|
127
|
Abstract
The underrepresentation of female subjects in animal research has gained attention in recent years, and new NIH guidelines aim to address this problem early, at the grant proposal stage. Many researchers believe that use of females will hamper research because of the need for increased sample sizes, and increased costs. Here I review empirical research across multiple rodent species and traits that demonstrates that females are not more variable than males, and that for most traits, female estrous cyclicity need not be considered. I present statistical simulations illustrating how factorial designs can reduce the need for additional research subjects, and discuss cultural issues around the inclusion of male and female subjects in research.
Collapse
Affiliation(s)
- Annaliese K. Beery
- Department of Psychology, Department of Biology, Neuroscience Program, Smith College, Northampton, MA, USA
- Neuroscience and Behavior Graduate Program, University of Massachusetts, Amherst, MA, USA
| |
Collapse
|
128
|
Bjørnnes AK, Parry M, Leegaard M, Ayala AP, Lenton E, Harvey P, McFetridge-Durdle J, McGillion MH, Price J, Stinson J, Watt-Watson J. Self-Management of Cardiac Pain in Women: A Meta-Summary of the Qualitative Literature. QUALITATIVE HEALTH RESEARCH 2018; 28:1769-1787. [PMID: 29916769 DOI: 10.1177/1049732318780683] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Symptom recognition and self-management is instrumental in reducing the number of deaths related to coronary artery disease (CAD) in women. The purpose of this study was to synthesize qualitative research evidence on the self-management of cardiac pain and associated symptoms in women. Seven databases were systematically searched, and the concepts of the Individual and Family Self-Management Theory were used as the framework for data extraction and analysis. Search strategies yielded 22,402 citations, from which 35 qualitative studies were included in a final meta-summary, comprising data from 769 participants, including 437 (57%) women. The available literature focused cardiac pain self-management from a binary sex and gender perspective. Ethnicity was indicated in 19 (54%) studies. Results support individualized intervention strategies that promote goal setting and action planning, management of physical and emotional responses, and social facilitation provided through social support.
Collapse
Affiliation(s)
- Ann Kristin Bjørnnes
- 1 University of Toronto, Toronto, Ontario, Canada
- 2 Oslo Metropolitan University, Oslo, Norway
| | - Monica Parry
- 1 University of Toronto, Toronto, Ontario, Canada
| | | | | | - Erica Lenton
- 1 University of Toronto, Toronto, Ontario, Canada
| | - Paula Harvey
- 3 Women's College Hospital, Toronto, Ontario, Canada
| | | | | | | | - Jennifer Stinson
- 1 University of Toronto, Toronto, Ontario, Canada
- 6 The Hospital for Sick Children, Toronto, Ontario, Canada
| | | |
Collapse
|
129
|
Hilderbrand ER, Lasek AW. Studying Sex Differences in Animal Models of Addiction: An Emphasis on Alcohol-Related Behaviors. ACS Chem Neurosci 2018; 9:1907-1916. [PMID: 29227676 DOI: 10.1021/acschemneuro.7b00449] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Animal models are essential for understanding the biological factors that contribute to drug and alcohol addiction and discovering new pharmacotherapies to treat these disorders. Alcohol (ethanol) is the most commonly abused drug in the world, and as the prevalence of alcohol use disorder (AUD) increases, so does the need for effective pharmacotherapies. In particular, treatments with high efficacy in the growing number of female AUD sufferers are needed. Female animals remain underrepresented in biomedical research and sex differences in the brain's response to alcohol are poorly understood. To help bridge the gender gap in addiction research, this Review discusses strategies that researchers can use to examine sex differences in the context of several common animal models of AUD. Self-administration, two-bottle choice, drinking in the dark, and conditioned place preference are discussed, with a focus on the role of estrogen as a mediator of sex differences in alcohol-related behaviors.
Collapse
|
130
|
Xu Y, Jin C, Qiao S, Wu Y, Yan H, Dou K, Xu B, Yang J, Yang Y. A Comparison of Transradial and Transfemoral Percutaneous Coronary Intervention in Chinese Women Based on a Propensity Score Analysis. Korean Circ J 2018; 48:719-727. [PMID: 30073810 PMCID: PMC6072662 DOI: 10.4070/kcj.2018.0040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/22/2018] [Accepted: 04/04/2018] [Indexed: 01/27/2023] Open
Abstract
Background and Objectives Over the past decades, transradial approach for percutaneous coronary intervention (PCI) has been increasingly adopted in clinical practice. Women represent a large population who will possibly benefit from PCI, but they are often under-represented in clinical studies. Therefore, the role of TRI in women remains to be further defined. This study sought to compare safety and efficacy for transradial intervention (TRI) and transfemoral intervention (TFI) in women undergoing PCI in China. Methods The study population consisted of 5,067 women undergoing PCI at Fuwai Hospital, Beijing, China between 2006 and 2011 (TRI: n=4,105, TFI: n=962). Incidence rates of clinical outcomes during hospitalization and at 1-year follow-up were compared between TRI and TFI. In order to minimize potential biases, a 1:1 propensity score matching (PSM) was performed. A total of 899 pairs were matched. Results Baseline and procedural characteristics were well-balanced between TRI and TFI groups after controlling for confounders using PSM. TRI was associated with reduced major post-PCI bleeding (odds ratio [OR], 0.64; 95% confidence interval [CI], 0.54–0.76; p<0.001) and access site complications (OR, 0.67; 95% CI, 0.61–0.74; p<0.001) after PSM. There was no statistical differences in the incidence rates of major adverse cardiac events (a composite of cardiac death, myocardial infarction, and target vessel revascularization) both during hospitalization and at 1-year follow-up (p>0.05). Conclusions In this propensity score-based analysis of TRI versus TFI in Chinese women, TRI showed advantages of safety and feasibility over TFI. A wider adoption of TRI in women has the potential to improve outcomes in treatment of coronary artery diseases.
Collapse
Affiliation(s)
- Yi Xu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chen Jin
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shubin Qiao
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yongjian Wu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongbing Yan
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kefei Dou
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Xu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingang Yang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuejin Yang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| |
Collapse
|
131
|
Roy-O’Reilly M, McCullough LD. Age and Sex Are Critical Factors in Ischemic Stroke Pathology. Endocrinology 2018; 159:3120-3131. [PMID: 30010821 PMCID: PMC6963709 DOI: 10.1210/en.2018-00465] [Citation(s) in RCA: 208] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 07/04/2018] [Indexed: 02/06/2023]
Abstract
Ischemic stroke is a devastating brain injury resulting in high mortality and substantial loss of function. Understanding the pathophysiology of ischemic stroke risk, mortality, and functional loss is critical to the development of new therapies. Age and sex have a complex and interactive effect on ischemic stroke risk and pathophysiology. Aging is the strongest nonmodifiable risk factor for ischemic stroke, and aged stroke patients have higher mortality and morbidity and poorer functional recovery than their young counterparts. Importantly, patient age modifies the influence of patient sex in ischemic stroke. Early in life, the burden of ischemic stroke is higher in men, but stroke becomes more common and debilitating for women in elderly populations. The profound effects of sex and age on clinical ischemic stroke are mirrored in the results of experimental in vivo and in vitro studies. Here, we review current knowledge on the influence of age and sex in the incidence, mortality, and functional outcome of ischemic stroke in clinical populations. We also discuss the experimental evidence for sex and age differences in stroke pathophysiology and how a better understanding of these biological variables can improve clinical care and enhance development of novel therapies.
Collapse
Affiliation(s)
- Meaghan Roy-O’Reilly
- Department of Neurology, University of Texas Health Science Center, Houston, Texas
| | - Louise D McCullough
- Department of Neurology, University of Texas Health Science Center, Houston, Texas
- Correspondence: Louise D. McCullough, MD, PhD, Department of Neurology, University of Texas Health Science Center, 6431 Fannin Street, Houston, Texas 77030. E-mail:
| |
Collapse
|
132
|
Stephenson ED, Farzal Z, Zanation AM, Senior BA. Sex bias in rhinology research. Int Forum Allergy Rhinol 2018; 8:1469-1475. [PMID: 30028087 DOI: 10.1002/alr.22179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/07/2018] [Accepted: 06/14/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND Analysis of general surgery literature has revealed noteworthy sex bias and underreporting. Our objective was to determine the prevalence of sex bias and underreporting in rhinology. METHODS All articles in 2016 issues of Rhinology, the American Journal of Rhinology and Allergy (AJRA), and the International Forum of Allergy and Rhinology (IFAR) were reviewed. Of 369 articles, 248 met inclusion criteria. Excluded studies were cadaveric, meta-analysis/review, and editorial. Data collected included study type, demographics, and sex-based statistical analysis. RESULTS There were 202 clinical and 46 basic science/translational studies. From 188 of 202 clinical studies with known sex, 1 included participants of a single sex. Sex matching >50% (SM50 ) was found in 81.9%, and 55.9% performed sex-based statistical analysis. Domestic clinical studies performed sex-based analysis more frequently than international (54.9% vs 44.4%) and exhibited a higher rate of SM50 (84.5% vs 80.3%), though these differences were not statistically significant. For basic/translational studies, 54.5% (24/44) provided sex breakdown. Among these, 29.2% included 1 sex, and 8.3% performed sex-based analysis. Of 10 using animals, 70.0% utilized 1 sex. The remaining 30.0% did not report sex. None of 4 cell line studies reported cell sex. Less than half (46.2%) of domestic and 56.3% of international studies reported sex breakdown; 7.7% of domestic and 3.0% of international studies performed sex-based analysis. CONCLUSION Although sex may impact outcomes, research without sex reporting and analysis is prevalent, particularly among basic science/translational studies. Future research must account for sex in demographics and analysis to best inform evidence-based clinical guidelines.
Collapse
Affiliation(s)
- Elizabeth D Stephenson
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Zainab Farzal
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Adam M Zanation
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Brent A Senior
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| |
Collapse
|
133
|
Hupfeld KE, Vaillancourt DE, Seidler RD. Genetic markers of dopaminergic transmission predict performance for older males but not females. Neurobiol Aging 2018; 66:180.e11-180.e21. [PMID: 29525179 PMCID: PMC5924602 DOI: 10.1016/j.neurobiolaging.2018.02.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 01/08/2018] [Accepted: 02/06/2018] [Indexed: 10/18/2022]
Abstract
Mobility and memory declines with aging can limit independence. Several single-nucleotide polymorphisms have been associated with cognitive performance, but studies investigating motor function are scant. We examined 4 single-nucleotide polymorphisms involved in dopaminergic metabolism: BDNF (Val66Met), DRD3 (Ser9Gly), DBH (C>T), and COMT (Val158Met) for their relationship to motor and cognitive function in healthy older adults (n = 4605 and n = 7331) who participated in the U.S. Health and Retirement Study. Individuals with genotypes associated with reduced dopamine metabolism exhibited poorer balance and memory. We found the most pronounced effects in the oldest participants (aged 85+ years), supporting the notion that age-related declines in dopamine availability contribute to magnified genotype effects with advancing age. Moreover, males demonstrated stronger associations than did females between a number of beneficial dopamine alleles and cognitive scores, suggesting that sex differences in dopaminergic transmission interact with genotype to influence performance. These findings point to common genetic variants related to dopaminergic metabolism that characterizes individual differences in motor and cognitive function in older adults.
Collapse
Affiliation(s)
- Kathleen E Hupfeld
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA.
| | - David E Vaillancourt
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA; Center for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville, FL, USA; Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Rachael D Seidler
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA; School of Kinesiology, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
134
|
Ellis SE, Collado-Torres L, Jaffe A, Leek JT. Improving the value of public RNA-seq expression data by phenotype prediction. Nucleic Acids Res 2018; 46:e54. [PMID: 29514223 PMCID: PMC5961118 DOI: 10.1093/nar/gky102] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 02/01/2018] [Accepted: 02/15/2018] [Indexed: 12/26/2022] Open
Abstract
Publicly available genomic data are a valuable resource for studying normal human variation and disease, but these data are often not well labeled or annotated. The lack of phenotype information for public genomic data severely limits their utility for addressing targeted biological questions. We develop an in silico phenotyping approach for predicting critical missing annotation directly from genomic measurements using well-annotated genomic and phenotypic data produced by consortia like TCGA and GTEx as training data. We apply in silico phenotyping to a set of 70 000 RNA-seq samples we recently processed on a common pipeline as part of the recount2 project. We use gene expression data to build and evaluate predictors for both biological phenotypes (sex, tissue, sample source) and experimental conditions (sequencing strategy). We demonstrate how these predictions can be used to study cross-sample properties of public genomic data, select genomic projects with specific characteristics, and perform downstream analyses using predicted phenotypes. The methods to perform phenotype prediction are available in the phenopredict R package and the predictions for recount2 are available from the recount R package. With data and phenotype information available for 70,000 human samples, expression data is available for use on a scale that was not previously feasible.
Collapse
Affiliation(s)
- Shannon E Ellis
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, USA
- Center for Computational Biology, Johns Hopkins University, USA
| | - Leonardo Collado-Torres
- Center for Computational Biology, Johns Hopkins University, USA
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, USA
| | - Andrew Jaffe
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, USA
- Center for Computational Biology, Johns Hopkins University, USA
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, USA
| | - Jeffrey T Leek
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, USA
- Center for Computational Biology, Johns Hopkins University, USA
| |
Collapse
|
135
|
Gerhard DM, Duman RS. Rapid-Acting Antidepressants: Mechanistic Insights and Future Directions. Curr Behav Neurosci Rep 2018; 5:36-47. [PMID: 30034992 PMCID: PMC6051539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE OF REVIEW Ketamine produces rapid (within hours) antidepressant actions, even in patients considered treatment resistant, and even shows promise for suicidal ideation. Here, we review current research on the molecular and cellular mechanisms of ketamine and other novel rapid-acting antidepressants, and briefly explore gender differences in the pathophysiology and treatment of MDD. RECENT FINDINGS Ketamine, an NMDA receptor antagonist, increases BDNF release and synaptic connectivity, opposing the deficits caused by chronic stress and depression. Efforts are focused on the development of novel rapid agents that produce similar synaptic and rapid antidepressant actions, but without the side effects of ketamine. The impact of gender on the response to ketamine and other rapid-acting antidepressants is in early stages of investigation. SUMMARY The discovery that ketamine produces rapid therapeutic actions for depression and suicidal ideation represents a major breakthrough and much needed alternative to currently available medications. However, novel fast acting agents with fewer side effects are needed, as well as elucidation of the efficacy of these rapid-acting antidepressants for depression in women.
Collapse
Affiliation(s)
- Danielle M Gerhard
- Department of Psychiatry, Laboratory of Molecular Psychiatry, Yale University School of Medicine, New Haven, CT 06508, USA
| | - Ronald S Duman
- Department of Psychiatry, Laboratory of Molecular Psychiatry, Yale University School of Medicine, New Haven, CT 06508, USA
| |
Collapse
|
136
|
|
137
|
Nawroth J, Rogal J, Weiss M, Brucker SY, Loskill P. Organ-on-a-Chip Systems for Women's Health Applications. Adv Healthc Mater 2018; 7. [PMID: 28985032 DOI: 10.1002/adhm.201700550] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 06/30/2017] [Indexed: 12/19/2022]
Abstract
Biomedical research, for a long time, has paid little attention to the influence of sex in many areas of study, ranging from molecular and cellular biology to animal models and clinical studies on human subjects. Many studies solely rely on male cells/tissues/animals/humans, although there are profound differences in male and female physiology, which can significantly impact disease mechanisms, toxicity of compounds, and efficacy of pharmaceuticals. In vitro systems have been traditionally very limited in their capacity to recapitulate female-specific physiology and anatomy such as dynamic sex-hormone levels and the complex interdependencies of female reproductive tract organs. However, the advent of microphysiological organ-on-a-chip systems, which attempt to recreate the 3D structure and function of human organs, now gives researchers the opportunity to integrate cells and tissues from a variety of individuals. Moreover, adding a dynamic flow environment allows mimicking endocrine signaling during the menstrual cycle and pregnancy, as well as providing a controlled microfluidic environment for pharmacokinetic modeling. This review gives an introduction into preclinical and clinical research on women's health and discusses where organ-on-a-chip systems are already utilized or have the potential to deliver new insights and enable entirely new types of studies.
Collapse
Affiliation(s)
| | - Julia Rogal
- Department of Cell and Tissue Engineering; Fraunhofer Institute for Interfacial Engineering and Biotechnology IGB; Nobelstrasse 12 70569 Stuttgart Germany
| | - Martin Weiss
- Department of Gynecology and Obstetrics; University Medicine Tübingen; Calwerstrasse 7 72076 Tübingen Germany
| | - Sara Y. Brucker
- Department of Gynecology and Obstetrics; University Medicine Tübingen; Calwerstrasse 7 72076 Tübingen Germany
| | - Peter Loskill
- Department of Cell and Tissue Engineering; Fraunhofer Institute for Interfacial Engineering and Biotechnology IGB; Nobelstrasse 12 70569 Stuttgart Germany
| |
Collapse
|
138
|
de Souza Santos R, Frank AP, Clegg DJ. The impact of sex and sex hormones on cell function. Steroids 2017; 128:72-74. [PMID: 29104097 DOI: 10.1016/j.steroids.2017.10.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 10/20/2017] [Accepted: 10/30/2017] [Indexed: 11/23/2022]
Abstract
The influence of sex on cellular function and metabolism is often ill defined in many human and animal studies. The National Institute of Health (NIH) recognized this gap in scientific knowledge and mandated that sex be factored into the design and data analysis of all cell culture and animal studies. Therefore, it is critical to understand how to incorporate sex in pre-clinical and clinical research. Here, we discuss how the sexual identify of cells influences experimental responses in cell culture and we highlight the importance of the culture media and its constituents to the function of cells. We further discuss the importance of understanding the influence and interactions between sex hormones and sex chromosomes. A deeper understanding of how sex chromosomes and sex hormones function as variables in complex biological systems may lead to better, more personalized medical therapies.
Collapse
Affiliation(s)
- Roberta de Souza Santos
- Biomedical Research Department, Diabetes and Obesity Research Division, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
| | - Aaron P Frank
- Biomedical Research Department, Diabetes and Obesity Research Division, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
| | - Deborah J Clegg
- Biomedical Research Department, Diabetes and Obesity Research Division, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
| |
Collapse
|
139
|
Parry M, Bjørnnes AK, Clarke H, Cooper L, Gordon A, Harvey P, Lalloo C, Leegaard M, LeFort S, McFetridge-Durdle J, McGillion M, O’Keefe-McCarthy S, Price J, Stinson J, Victor JC, Watt-Watson J. Self-management of cardiac pain in women: an evidence map. BMJ Open 2017; 7:e018549. [PMID: 29175891 PMCID: PMC5719283 DOI: 10.1136/bmjopen-2017-018549] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 10/10/2017] [Accepted: 11/02/2017] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To describe the current evidence related to the self-management of cardiac pain in women using the process and methodology of evidence mapping. DESIGN AND SETTING Literature search for studies that describe the self-management of cardiac pain in women greater than 18 years of age, managed in community, primary care or outpatient settings, published in English or a Scandinavian language between 1 January 1990 and 24 June 2016 using AMED, CINAHL, ERIC, EMBASE, MEDLINE, Proquest, PsychInfo, the Cochrane Library, Scopus, Swemed+, Web of Science, the Clinical Trials Registry, International Register of Controlled Trials, MetaRegister of Controlled Trials, theses and dissertations, published conference abstracts and relevant websites using GreyNet International, ISI proceedings, BIOSIS and Conference papers index. Two independent reviewers screened using predefined eligibility criteria. Included articles were classified according to study design, pain category, publication year, sample size, per cent women and mean age. INTERVENTIONS Self-management interventions for cardiac pain or non-intervention studies that described views and perspectives of women who self-managed cardiac pain. PRIMARY AND SECONDARY OUTCOMES MEASURES Outcomes included those related to knowledge, self-efficacy, function and health-related quality of life. RESULTS The literature search identified 5940 unique articles, of which 220 were included in the evidence map. Only 22% (n=49) were intervention studies. Sixty-nine per cent (n=151) of the studies described cardiac pain related to obstructive coronary artery disease (CAD), 2% (n=5) non-obstructive CAD and 15% (n=34) postpercutaneous coronary intervention/cardiac surgery. Most were published after 2000, the median sample size was 90 with 25%-100% women and the mean age was 63 years. CONCLUSIONS Our evidence map suggests that while much is known about the differing presentations of obstructive cardiac pain in middle-aged women, little research focused on young and old women, non-obstructive cardiac pain or self-management interventions to assist women to manage cardiac pain. PROSPERO REGISTRATION NUMBER CRD42016042806.
Collapse
Affiliation(s)
- Monica Parry
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Ann Kristin Bjørnnes
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Institute of Nursing and Health Promotion, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Hance Clarke
- Pain Research Unit, University Health Network, Toronto, Ontario, Canada
| | - Lynn Cooper
- Canadian Pain Coalition, Toronto, Ontario, Canada
| | - Allan Gordon
- Wasser Pain Management Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Paula Harvey
- Department of Medicine, Women’s College Hospital, Toronto, Ontario, Canada
- Women’s College Hospital, Women’s College Research Institute, Toronto, Ontario, Canada
| | - Chitra Lalloo
- Hosp Sick Children, The Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Marit Leegaard
- Institute of Nursing and Health Promotion, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Sandra LeFort
- School of Nursing, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | | | | | - Sheila O’Keefe-McCarthy
- Department of Nursing, Faculty of Applied Sciences, BrockUniversity, Toronto, Ontario, Canada
| | - Jennifer Price
- Women’s College Hospital, Women’s College Research Institute, Toronto, Ontario, Canada
| | - Jennifer Stinson
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Hosp Sick Children, The Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - J Charles Victor
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Judy Watt-Watson
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
140
|
Manfredini R, Fabbian F. Pulmonary embolism, mortality, 'weekend effect' and gender: what do we know? Future Cardiol 2017; 14:9-13. [PMID: 29168648 DOI: 10.2217/fca-2017-0077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Roberto Manfredini
- Clinica Medica Unit, Department of Medical Sciences, Faculty of Medicine, Pharmacy & Prevention, University of Ferrara, Ferrara, Italy
| | - Fabio Fabbian
- Clinica Medica Unit, Department of Medical Sciences, Faculty of Medicine, Pharmacy & Prevention, University of Ferrara, Ferrara, Italy
| |
Collapse
|
141
|
McHugh RK, Votaw VR, Sugarman DE, Greenfield SF. Sex and gender differences in substance use disorders. Clin Psychol Rev 2017; 66:12-23. [PMID: 29174306 DOI: 10.1016/j.cpr.2017.10.012] [Citation(s) in RCA: 478] [Impact Index Per Article: 68.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 10/26/2017] [Accepted: 10/30/2017] [Indexed: 12/18/2022]
Abstract
The gender gap in substance use disorders (SUDs), characterized by greater prevalence in men, is narrowing, highlighting the importance of understanding sex and gender differences in SUD etiology and maintenance. In this critical review, we provide an overview of sex/gender differences in the biology, epidemiology and treatment of SUDs. Biological sex differences are evident across an array of systems, including brain structure and function, endocrine function, and metabolic function. Gender (i.e., environmentally and socioculturally defined roles for men and women) also contributes to the initiation and course of substance use and SUDs. Adverse medical, psychiatric, and functional consequences associated with SUDs are often more severe in women. However, men and women do not substantively differ with respect to SUD treatment outcomes. Although several trends are beginning to emerge in the literature, findings on sex and gender differences in SUDs are complicated by the interacting contributions of biological and environmental factors. Future research is needed to further elucidate sex and gender differences, especially focusing on hormonal factors in SUD course and treatment outcomes; research translating findings between animal and human models; and gender differences in understudied populations, such as those with co-occurring psychiatric disorders and gender-specific populations, such as pregnant women.
Collapse
Affiliation(s)
- R Kathryn McHugh
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States; Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA 02155, United States.
| | - Victoria R Votaw
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States
| | - Dawn E Sugarman
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States; Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA 02155, United States
| | - Shelly F Greenfield
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States; Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA 02155, United States
| |
Collapse
|
142
|
Oxytocin receptor gene polymorphisms, attachment, and PTSD: Results from the National Health and Resilience in Veterans Study. J Psychiatr Res 2017; 94:139-147. [PMID: 28715704 PMCID: PMC5605420 DOI: 10.1016/j.jpsychires.2017.07.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 06/23/2017] [Accepted: 07/07/2017] [Indexed: 01/08/2023]
Abstract
The human oxytocin system is implicated in social behavior and stress recovery. Polymorphisms in the oxytocin receptor gene (OXTR) may interact with attachment style to predict stress-related psychopathology like posttraumatic stress disorder (PTSD). The objective of this study was to examine independent and interactive effects of the OXTR single nucleotide polymorphism (SNP) rs53576, which has been associated with stress reactivity, support-seeking, and PTSD in prior studies, and attachment style on risk for PTSD in a nationally representative sample of 2163 European-American (EA) U.S. military veterans who participated in two independent waves of the National Health and Resilience in Veterans Study (NHRVS). Results revealed that insecure attachment style [adjusted odds ratio (OR) = 4.29; p < 0.001] and the interaction of rs53576 and attachment style (OR = 2.58, p = 0.02) were associated with probable lifetime PTSD. Among individuals with the minor A allele, the prevalence of probable PTSD was significantly higher among those with an insecure attachment style (23.9%) than those with a secure attachment style (2.0%), equivalent to an adjusted OR of 10.7. We attempted to replicate these findings by utilizing dense marker data from a genome-wide association study of 2215 high-risk civilians; one OXTR variant, though not rs53576, was associated with PTSD. Exploratory analyses in the veteran sample revealed that the interaction between this variant and attachment style predicting probable PTSD approached statistical significance. Results indicate that polymorphisms in the OXTR gene and attachment style may contribute to vulnerability to PTSD in U.S. military veterans.
Collapse
|
143
|
|
144
|
Bangasser DA, Wicks B, Waxler DE, Eck SR. Touchscreen Sustained Attention Task (SAT) for Rats. J Vis Exp 2017. [PMID: 28994786 DOI: 10.3791/56219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Sustained attention is the ability to monitor intermittent and unpredictable events over a prolonged period of time. This attentional process subserves other aspects of cognition and is disrupted in certain neurodevelopmental, neuropsychiatric, and neurodegenerative disorders. Thus, it is clinically important to identify mechanisms that impair and improve sustained attention. Such mechanisms are often first discovered using rodent models. Therefore, several behavior procedures for testing aspects of sustained attention have been developed for rodents. One, first described by McGaughy and Sarter (1995), called the sustained attention task (SAT), trains rats to distinguish between signal (i.e., brief light presentation) and non-signal trials. The signals are short and thus require careful attention to be perceived. Attentional demands can be increased further by introducing a distractor (e.g., flashing houselight). We have modified this task for touchscreen operant chambers, which are configured with a touchscreen on one wall that can present stimuli and record responses. Here we detail our protocol for SAT in touchscreen chambers. Additionally, we present standard measures of performance in male and female Sprague-Dawley rats. Comparable performance on this task in both sexes highlights its use for attention studies, especially as more researchers are including female rodents in their experimental design. Moreover, the easy implementation of SAT for the increasingly popular touchscreen chambers increases its utility.
Collapse
Affiliation(s)
- Debra A Bangasser
- Psychology Department, Temple University; Neuroscience Program, Temple University;
| | | | | | | |
Collapse
|
145
|
Age-related language lateralization assessed by fMRI: The effects of sex and handedness. Brain Res 2017; 1674:20-35. [PMID: 28830770 DOI: 10.1016/j.brainres.2017.08.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 08/14/2017] [Accepted: 08/16/2017] [Indexed: 11/21/2022]
Abstract
Previous studies focusing on the relationship between lateralization of language function and age suffer from lack of a balanced distribution of age and handedness among participants, especially in the extremes of age. This limits our understanding of the influence of these factors on lateralization of language circuitry. The hemispheric asymmetry reduction in older adults (HAROLD) model suggests that under similar circumstances, involvement in cognitive processes of prefrontal (and potentially other) cortical areas tends to be less lateralized with age. In this study, we aimed to investigate the link between age, gender, and language lateralization in a large group of healthy participants with a relatively even distribution of age and handedness in order to further test the HAROLD model. 99 healthy men (33 left-handed; age range 18-74years) and 125 women (44 left-handed; age range 19-76) were recruited. All participants underwent fMRI at 3T with a semantic decision and a verb generation tasks and received a battery of linguistic tests. Lateralization indexes (LI) were calculated for each participant based on fMRI results for each task separately. LIs were found to be significantly decreasing with age only in right-handed men and only in temporo-parietal cortical area. LIs did not change with age in other brain regions or in left-handed subjects. Our results do not support the HAROLD model and suggest a potentially different relationship between aging and lateralization of language functions.
Collapse
|
146
|
Segarra I, Modamio P, Fernández C, Mariño EL. Sex-Divergent Clinical Outcomes and Precision Medicine: An Important New Role for Institutional Review Boards and Research Ethics Committees. Front Pharmacol 2017; 8:488. [PMID: 28785221 PMCID: PMC5519571 DOI: 10.3389/fphar.2017.00488] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 07/10/2017] [Indexed: 12/22/2022] Open
Abstract
The efforts toward individualized medicine have constantly increased in an attempt to improve treatment options. These efforts have led to the development of small molecules which target specific molecular pathways involved in cancer progression. We have reviewed preclinical studies of sunitinib that incorporate sex as a covariate to explore possible sex-based differences in pharmacokinetics and drug–drug interactions (DDI) to attempt a relationship with published clinical outputs. We observed that covariate sex is lacking in most clinical outcome reports and suggest a series of ethic-based proposals to improve research activities and identify relevant different sex outcomes. We propose a deeper integration of preclinical, clinical, and translational research addressing statistical and clinical significance jointly; to embed specific sex-divergent endpoints to evaluate possible gender differences objectively during all stages of research; to pay greater attention to sex-divergent outcomes in polypharmacy scenarios, DDI and bioequivalence studies; the clear reporting of preclinical and clinical findings regarding sex-divergent outcomes; as well as to encourage the active role of scientists and the pharmaceutical industry to foster a new scientific culture through their research programs, practice, and participation in editorial boards and Institutional Ethics Review Boards (IRBs) and Research Ethics Committees (RECs). We establish the IRB/REC as the centerpiece for the implementation of these proposals. We suggest the expansion of its competence to follow up clinical trials to ensure that sex differences are addressed and recognized; to engage in data monitoring committees to improve clinical research cooperation and ethically address those potential clinical outcome differences between male and female patients to analyze their social and clinical implications in research and healthcare policies.
Collapse
Affiliation(s)
- Ignacio Segarra
- Clinical Pharmacy and Pharmacotherapy Unit, Department of Pharmacy and Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of BarcelonaBarcelona, Spain
| | - Pilar Modamio
- Clinical Pharmacy and Pharmacotherapy Unit, Department of Pharmacy and Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of BarcelonaBarcelona, Spain
| | - Cecilia Fernández
- Clinical Pharmacy and Pharmacotherapy Unit, Department of Pharmacy and Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of BarcelonaBarcelona, Spain
| | - Eduardo L Mariño
- Clinical Pharmacy and Pharmacotherapy Unit, Department of Pharmacy and Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of BarcelonaBarcelona, Spain
| |
Collapse
|
147
|
Sex and gender differences in chronic kidney disease: progression to end-stage renal disease and haemodialysis. Clin Sci (Lond) 2017; 130:1147-63. [PMID: 27252402 DOI: 10.1042/cs20160047] [Citation(s) in RCA: 149] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 03/29/2016] [Indexed: 01/04/2023]
Abstract
Sex and gender differences are of fundamental importance in most diseases, including chronic kidney disease (CKD). Men and women with CKD differ with regard to the underlying pathophysiology of the disease and its complications, present different symptoms and signs, respond differently to therapy and tolerate/cope with the disease differently. Yet an approach using gender in the prevention and treatment of CKD, implementation of clinical practice guidelines and in research has been largely neglected. The present review highlights some sex- and gender-specific evidence in the field of CKD, starting with a critical appraisal of the lack of inclusion of women in randomized clinical trials in nephrology, and thereafter revisits sex/gender differences in kidney pathophysiology, kidney disease progression, outcomes and management of haemodialysis care. In each case we critically consider whether apparent discrepancies are likely to be explained by biological or psycho-socioeconomic factors. In some cases (a few), these findings have resulted in the discovery of disease pathways and/or therapeutic opportunities for improvement. In most cases, they have been reported as merely anecdotal findings. The aim of the present review is to expose some of the stimulating hypotheses arising from these observations as a preamble for stricter approaches using gender for the prevention and treatment of CKD and its complications.
Collapse
|
148
|
Kentner AC, Grace SL. Between mind and heart: Sex-based cognitive bias in cardiovascular disease treatment. Front Neuroendocrinol 2017; 45:18-24. [PMID: 28232227 DOI: 10.1016/j.yfrne.2017.02.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 02/14/2017] [Accepted: 02/16/2017] [Indexed: 01/01/2023]
Abstract
Given that both men and women experience cardiovascular disease (CVD), a common misconception is that they have similar risk factors and clinical presentation, receive comparable treatment, and have equivalent clinical outcomes; in reality differences are observed between men and women for each of these endpoints. Moreover, these differences occur as a function of both gender and sex. A review of the literature reveals widespread bias in the selection of research subjects based on these factors, in addition to implicit patient and provider biases that impede the access of women to recommended primary and secondary CVD management. In this perspective, we identify strategies to eliminate such biases and improve women's access to CVD treatments to ensure their care is consistent with current guidelines.
Collapse
Affiliation(s)
- Amanda C Kentner
- Massachusetts College of Pharmacy and Health Sciences, Health Psychology Program, Boston, MA, United States.
| | - Sherry L Grace
- York University, School of Kinesiology and Health Science, Toronto, Ontario, Canada; University Health Network, Toronto General Hospital Research Institute, Peter Munk Cardiac Centre, Toronto, Ontario, Canada; University of Toronto, Faculty of Medicine, Toronto, Ontario, Canada
| |
Collapse
|
149
|
Jahn I, Börnhorst C, Günther F, Brand T. Examples of sex/gender sensitivity in epidemiological research: results of an evaluation of original articles published in JECH 2006-2014. Health Res Policy Syst 2017; 15:11. [PMID: 28202078 PMCID: PMC5312447 DOI: 10.1186/s12961-017-0174-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 01/30/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND During the last decades, sex and gender biases have been identified in various areas of biomedical and public health research, leading to compromised validity of research findings. As a response, methodological requirements were developed but these are rarely translated into research practice. The aim of this study is to provide good practice examples of sex/gender sensitive health research. METHODS We conducted a systematic search of research articles published in JECH between 2006 and 2014. An instrument was constructed to evaluate sex/gender sensitivity in four stages of the research process (background, study design, statistical analysis, discussion). RESULTS In total, 37 articles covering diverse topics were included. Thereof, 22 were evaluated as good practice example in at least one stage; two articles achieved highest ratings across all stages. Good examples of the background referred to available knowledge on sex/gender differences and sex/gender informed theoretical frameworks. Related to the study design, good examples calculated sample sizes to be able to detect sex/gender differences, selected sex/gender sensitive outcome/exposure indicators, or chose different cut-off values for male and female participants. Good examples of statistical analyses used interaction terms with sex/gender or different shapes of the estimated relationship for men and women. Examples of good discussions interpreted their findings related to social and biological explanatory models or questioned the statistical methods used to detect sex/gender differences. CONCLUSIONS The identified good practice examples may inspire researchers to critically reflect on the relevance of sex/gender issues of their studies and help them to translate methodological recommendations of sex/gender sensitivity into research practice.
Collapse
Affiliation(s)
- Ingeborg Jahn
- Department Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Achterstr. 30, 28359 Bremen, Germany
| | - Claudia Börnhorst
- Department Biometry and Data Management, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Achterstr. 30, 28359 Bremen, Germany
| | - Frauke Günther
- Department Biometry and Data Management, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Achterstr. 30, 28359 Bremen, Germany
| | - Tilman Brand
- Department Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Achterstr. 30, 28359 Bremen, Germany
| |
Collapse
|
150
|
Picillo M, Nicoletti A, Fetoni V, Garavaglia B, Barone P, Pellecchia MT. The relevance of gender in Parkinson’s disease: a review. J Neurol 2017; 264:1583-1607. [DOI: 10.1007/s00415-016-8384-9] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 12/21/2016] [Accepted: 12/22/2016] [Indexed: 10/20/2022]
|