Sex differences in cardiovascular disease (CVD) mortality have been attributed to differences in pathophysiology between men and women and to disparities in CVD management that disproportionately affect women compared to men. Similarly, there has been investigation of differences in the prevalence and presentation of insomnia attributable to sex. Few studies have examined how sex and insomnia interact to influence CVD outcomes, however. In this review, we summarize the literature on sex-specific differences in the prevalence and presentation of insomnia as well as existing research regarding the relationship between insomnia and CVD outcomes as it pertains to sex. Research to date indicate that women are more likely to have insomnia than men, and there appear to be differential associations in the relation between insomnia and CVD by sex. We posit potential mechanisms of the relationship between sex, insomnia and CVD, discuss gaps in the existing literature, and provide commentary on future research needed in this area. Unraveling the complex relations between sex, insomnia, and CVD may help to explain sex-specific differences in CVD, and identify sex-specific strategies for promotion of cardiovascular health. Throughout this review, terms “men” and “women” are used as they are in the source literature, which does not differentiate between sex and gender. The implications of this are also discussed.
Over the past 3 decades, significant strides have been made in the field of sleep medicine for women. The impact of sex and gender on sleep health and sleep disorders received little attention in the early 1990s, but driven by policies ensuring inclusion of women in medical research, more recent studies have identified sex differences in sleep and investigated gender differences in sleep disorders. Nevertheless, disparities remain: diagnosis of sleep disorders, such as obstructive sleep apnea, narcolepsy, and rapid eye movement (REM) sleep behavior disorder are often delayed and underdiagnosed in women. Future research should continue to examine how biological sex and identity across the gender spectrum influence sleep health and sleep disorders, allowing for more personalized health care for all patients.
Changes in vision can have significant impact on health and quality of life. Differences between women and men have been identified in the incidence of several eye conditions. Some of these differences are a result of the greater longevity of women. However, the eye, like other organs, is susceptible to the impacts of inflammation and sex steroids. Conditions, such as thyroid eye disease, optic neuritis, and dry eye disease are related to autoimmune or inflammatory conditions and are, thus, more common among women. Idiopathic intracranial hypertension occurs disproportionately in women of childbearing age; the etiology of this condition appears to be related to both inflammatory and sex hormone fluctuations.
COVID-19 displays a sex-biased behavior with a higher rate of intensity and mortality in men. In that sense, COVID-19 deflects-off the typical trend of many viral infections which are characterized by a higher rate of intensity and prevalence in males, yet a higher female mortality rate. Severity and mortality rates of COVID-19 are associated with several underlying diseases, which exhibit significant self-sufficient male-biased dimorphism, thus are at times hypothesized to be the ones responsible to tilt mortality balance toward higher men death in COVID-19. Yet, similar comorbidities prevail in other viral infections, raising curiosity to what makes COVID-19 unique? The answer may lay in the involvement of renin-angiotensin system and ACE2 receptor in COVID-19 progression, 2 players which are significant contributors to the fatality of COVID-19. A structured difference is evident in the expression and function of RAS and ACE2 between the sexes, presumably tipping over mortality rate tendency toward male-risk factor.
Introduction: Structural and functional abnormalities of coronary microvasculature, referred to as coronary microvascular dysfunction (CMD), have been implicated in a wide range of cardiovascular diseases and have gained growing attention in patients with chest pain with no obstructive coronary artery disease, especially in females. The central mechanisms of coronary vasomotion abnormalities encompass enhanced coronary vasoconstrictive reactivity (ie, coronary spasm), reduced endothelium-dependent and -independent coronary vasodilator capacities, and increased coronary microvascular resistance. The 2 major endothelium-derived relaxing factors, nitric oxide (NO) and endothelium-dependent hyperpolarization (EDH) factors, modulate vascular tone in a distinct vessel size–dependent manner; NO mainly mediates vasodilatation of relatively large, conduit vessels, while EDH factors in small resistance vessels. Endothelium-dependent hyperpolarization–mediated vasodilatation is more prominent in female resistance arteries, where estrogens exert beneficial effects on endothelium-dependent vasodilatation via multiple mechanisms. In the clinical settings, therapeutic approaches targeting NO are disappointing for the treatment of various cardiovascular diseases, where endothelial dysfunction and CMD are substantially involved. Significance: In this review, we will discuss the current knowledge on the pathophysiology and molecular mechanisms of endothelial function and coronary vasomotion abnormalities from bench to bedside, with a special reference to gender differences. Results: Recent experimental and clinical studies have demonstrated distinct gender differences in endothelial function and coronary vasomotion abnormalities with major clinical implications. Moreover, recent landmark clinical trials regarding the management of stable coronary artery disease have questioned the benefit of percutaneous coronary intervention, supporting the importance of the coronary microvascular physiology. Conclusion: Further characterization and a better understanding of the gender differences in basic vascular biology as well as those in cardiovascular diseases are indispensable to improve health care and patient outcomes in cardiovascular medicine.
For AI policy, there are significant differences between Europe and the United States. The General Data Protection Regulation, which applies not only to European Union companies but also to all American companies with European customers, is more protective than health insurance portability and accountability act for individual health data. Its Article 22 stipulates that citizens cannot be submitted to medical decisions generated by an automated source.
Cystic fibrosis (CF) is an autosomal recessive genetic disease caused by mutations in the cystic fibrosis transmembrane conductance regulation (CFTR) anion channel. Loss of CFTR protein and/or function disrupts chloride, bicarbonate, and fluid transport and also impacts epithelial sodium transport. Such altered ion and fluid transport produces mucus obstruction, inflammation, pulmonary infection, and damage to multiple organs. Although an autosomal disease, it is apparent that gender differences in life expectancy and quality of life do exist. Conventionally established therapies have treated the downstream sequelae of CFTR dysfunction and have led to a steady increase in life expectancy. Physicians now have access to medications that treat the basic defect in CF, in the form of CFTR modulators. These drugs target the trafficking and/or function of CFTR to improve clinical outcomes for patients. This review summarizes the science behind CFTR modulators and shows how these drugs have dramatically changed how patients with CF are treated. Surprisingly, although the drug target(s) are identical in males and females, CF females seem to display a greater improvement than their male counterparts.
Humans have devised machines to replace computation by individuals since ancient times: The abacus predated the written Hindu–Arabic numeral system by centuries. We owe a quantum leap in the development of machines to help problem solve to the British mathematician Charles Babbage who built what he called the Difference Engine in the mid-19th century. But the Turing formula created in 1936 is the foundation for the modern computer; it produced printed symbols on paper tape that listed a series of logical instructions. Three decades later, Olivetti manufactured the first mass-marketed desktop computer (1964), and by 1981, IBM had developed the first personal computer. Computing machines have become more and more powerful, culminating recently in Google’s claim that it had achieved quantum supremacy in developing a system that can complete a task in 200 seconds that it would take the most powerful type of classical computer available 10 000 years to achieve. In short, we are in a period of human history in which we are creating more and more powerful and complex machines potentially capable of duplicating human intelligence and indeed surpassing/expanding its power. We are solidly in the age of artificial intelligence (AI). Increasing interest in the development of AI and its application to human health at all levels makes a roundtable discussion by experts a valuable project for publication in our journal, Gender and the Genome , the official journal of the Foundation for Gender-Specific Medicine and the International Society of Gender Medicine.
Blood products are indicated for a plethora of conditions in several settings, with a variety of products available for transfusion, from highly processed specific components to whole blood. Matching the donor product to the recipient is crucial in avoiding serious transfusion reactions, with the extent of matching depending on the physiological need, setting, and product. There are important factors related to sex and gender differences in donated blood products, adverse reactions to those products, interplay with underlying pathology, as well as sociocultural differences in the collection. This article will review key sex- and gender-specific research related to the use of blood products with an emphasis on the acute care setting.
Sleep disordered breathing (SDB) is a common, yet under-recognized and undertreated condition in pregnancy. Sleep disordered breathing is associated with pregnancy complications including preeclampsia, gestational diabetes, preterm birth, as well as severe maternal morbidity and mortality. The identification of risk factors for SDB in pregnancy may improve screening, diagnosis, and treatment of SDB prior to the onset of pregnancy complications. The goal of this study was to determine whether fetal sex increases risk of SDB in pregnancy. A cohort of singleton (N = 991) pregnant women were recruited within 24 to 48 hours of delivery and answered questions regarding SDB symptoms by questionnaire. Women who reported frequent loud snoring at least 3 times a week were considered to have SDB. Hospital records were reviewed to extract information on fetal sex and pregnancy complications including preeclampsia, pregnancy-induced hypertension, gestational diabetes, preterm delivery, and low birth weight. Women carrying male fetuses were significantly more likely to have SDB (β = .37, P = .01, OR: 1.45 [95% CI: 1.09-1.94]). Fetal sex was associated with increased risk of hypertensive disorders of pregnancy (defined as preeclampsia and/or pregnancy-induced hypertension) among women with SDB in pregnancy (β = .41, P = .02, OR: 1.51 [95% CI: 1.08-2.11]). Fetal sex did not increase risk of preterm birth, low birth weight, or gestational diabetes among women with SDB in pregnancy. Women carrying male fetuses were approximately 1.5 times more likely to report SDB in pregnancy compared to women carrying female fetuses, and women with pregnancy-onset SDB carrying male fetuses were 1.5 times more likely to have hypertensive disorders of pregnancy compared to women with SDB carrying female fetuses. Confirmation of fetal sex as a risk factor may, with other risk factors, play a role in identifying women at highest risk of SDB complications in pregnancy.
Although the full and lasting impact of the coronavirus disease 2019 (COVID-19) outbreak is yet to be determined, there is evidence that sex and gender play a significant role in determining patient outcomes across the globe. This roundtable discussion is a transcript of a seminar held by several representatives from Johns Hopkins University on the impact of the global pandemic on women’s health and well-being. They reported on the various pathophysiological aspects of the disease, as well as the social and financial consequences of this global pandemic. Looking at COVID-19 through a sex and gender lens highlights the vulnerabilities and inequalities of people of different genders, races, and socioeconomic conditions, and how care providers can better respond to those differences.
New mammalian mothers undergo an increase in their maternal responsiveness with the birth of their infants. Associated with changes in responsiveness are how attracted mothers are to infant cues, mothers’ affective state, and their cognitive and executive function. In comparison to nonmothers, new mothers are more attracted to infant odors and are more easily alerted to their vocalizations; they undergo a reduction in withdrawal behaviors and anxiety, but increased lability. Their maternal sensitivity (human or licking intensity, rat) is associated with higher levels of attention and working memory. Maternal responsiveness and these associated behaviors are associated with large shifts in maternal hormones across parturition. Changes in expression of neuropeptides and neurotransmitters are affected by mothers’ prior experiences, including their very early experiences in their families of origin. The present review describes the regulation of mothering and associated behaviors by the neurotransmitters, oxytocin, dopamine, and serotonin, in a rat model and in humans. Emphasis is then given to studies that focus on the role of genes and what we know about their expression in the functioning of these 3 neurochemical systems in new mothers. Studies of early experience, genetics, and human mothering show gene-by-environment interplays (interactions) for a number of DNA single-nucleotide polymorphism within both the oxytocin and serotonin systems, where associations between mothers’ early experiences and mothering/affect depend on mothers’ genotype. Studies also show associations between different dopamine genes and many aspects of both mothering and maternal affect. Where known, we also discuss evidence that the relation between early experience and mothering is often an indirect one, mediated through an effect of experience on mothers’ affect or executive function. In many cases, mothers’ genetic profile moderates these relations. Finally, preliminary evidence suggests a role of epigenetic mechanisms in these processes.
Summary of the Symposium of Sex and Gender in Physiology and Pharmacology Held at the Royal Swedish Academy of Sciences in Stockholm, October 2018
Semen quality plays a pivotal role in maintaining healthy fertilizing ability of spermatozoa. Male infertility is a rising global problem with an increasing declining in male semen quality among men living in Africa, Europe, North American, and Asia. Though the sperm acquire proactive mechanisms during spermatogenesis and their epididymal maturation, they still remain viable for toxic insult. Declining semen quality is a major contributor to infertility. Studies have postulated that different factors, such as exposure to pesticides, industrial chemicals, heavy metals, obesity, alcoholism, tobacco smoking, sedentary lifestyles, poor nutrient intake, oxidative stress, physiological factors, genetic factors can influence male fertility. Routine semen analysis and assays for sperm chromatin integrity are the most widely utilized and best studied adjunctive diagnostics in male infertility. Over the years, scientists have developed different treatment options for male infertility. Male infertility with known etiology can be treated successfully, but other causes like genetic factors require pragmatic approaches. This article summarizes protective mechanisms of spermatogenesis, causes, diagnosis, and both modern and traditional treatment approaches of male infertility. Further, this article highlights present issues and direction for future exploration of the male infertility problem.
In this selective review, emerging literature linking biological sex, sociocultural gender, and sexual orientation to stress hormone functioning and multisystemic physiological dysregulations are summarized. Beyond sex as a binary biological variable, continuums of sex hormones, gender roles, gender identity, and sexual orientation each uniquely help delineate pathways and mechanisms linked to stress-related disease trajectories. This implicates glucocorticoid functioning and allostatic load, the “wear and tear” of chronic stress in synergy with unhealthy behaviors. Clinical considerations are also discussed for the field of gender medicine.
Parents who experienced maltreatment in childhood may be at an increased risk of presenting abusive or neglectful behavior toward their own children. Research suggests reoccurring patterns of abuse and neglect across generations, but the factors that influence these behavioral patterns are complex and poorly understood. Although abusive or neglectful parenting styles undoubtedly are strongly influenced by social factors (ie, “nurture”), there might be underlying biological components to perpetuating behavioral patterns (ie, “nature”). Importantly, nature and nurture are known to interact in shaping developmental outcomes, and as such should not be considered in isolation. In this review, we examine the evidence regarding the inheritance of abusive and/or neglectful parenting behavior using a transdisciplinary approach. We integrate knowledge of the social and biological science fields on the continuance of abusive and neglectful behavior, as well as the methodological challenges that complicate the interpretation of existing research. Finally, we stress the importance of considering contextual factors of both social and biological research findings concerning the intergenerational inheritance of child abuse and neglect and discuss the potential for early social intervention to disrupt harmful intergenerational patterns.
The number of information technology (IT) jobs is increasing dramatically in Iraq. This has produced an increased need for IT graduates than before. On the other hand, most IT and computer science (CS) departments in private universities are seeing small numbers of females in their courses. This indicates that these private universities have failed in attracting a sufficient percentage of female students. In this article, we explore the gender gap in IT and CS departments at 3 private universities: Tishk, Cihan, and Bayan, using 3 data sets related to the 2017 to 2018 academic year. The research design is descriptive and primary data were collected using personal observations made by the authors over the past 2 years. By analyzing these data sets, we can discover important issues such as students’ diversity in computing departments. For example, we find that a gender gap does not clearly exist in the IT department of Tishk University, while it’s more obvious in CS departments of Bayan and Cihan Universities. This finding implies that there is a need for some initiatives to attract women to IT and CS departments and to more investigate the gender gap in computing within the higher education level. These findings may also be relevant to the computing programs at other large public universities.
The number of forcibly displaced people has been steadily increasing over the last decades. Women represent a large proportion of this population. Due to gender roles, duties of care, educational and economic imbalances, their experiences during flight and relocation differ from those of men and children. The currently available information about their specific health-related needs and barriers to access is scarce. We sought to explore the specific needs of the female refugee population employing a user-centered perspective. Rather than focusing on provider-designed interventions, we aimed at defining what female refugees want and need and which priorities they define themselves. We searched PubMed, Medline, EMBASE, Cochrane Library, and Scopus to identify publications that explored the unique experiences of female refugees between January 1, 2008 and June 30, 2018. Publications needed to address the health needs of refugees, asylum seekers, or displaced individuals, include at least 50% women in their study and employ a user-centered perspective. A framework of themes was identified and applied to all publications. We identified 1945 publications of which 13 could be included in the present review. Twelve of these publications employed qualitative and/or innovative methodology. We identified 5 broad categories of health-related needs (immediate health care, communication, cultural/spiritual, social, and economic). The identified publications described the need for complex, coordinated approaches. Concerted action providing information and culturally sensitive care, while supporting language acquisition and economic empowerment is essential to improve the health status of female refugees. Transformative interventions need to address multiple axes of unequal access for female refugees to improve their overall health.
Psychological stress, a subjective perception of an adverse environmental change, is a hallmark of modern society. Although psychological stress has previously been established as a risk factor for cardiovascular disease (CVD), it is unclear whether stress influences cardiovascular risk differently in men versus women. Gender disparities exist in the prevalence of stress as well as in the prevalence and prognosis of CVD; therefore, associations between stress and CVD risk and mortality may vary by sex. The purpose of this review was to summarize the evidence from recent and landmark studies on gender differences in the associations of stress with CVD risk factors and end points and to highlight clinical and public health implications as well as future research directions in this field. Taken together, research to date indicates that while stress is associated with poorer cardiovascular health metrics in both men and women, the influence of stress on measures of glucose regulation and dyslipidemia and on overall CVD risk may be stronger among women. However, men may be more susceptible to the influence of stress on body adiposity, blood pressure, and CVD mortality. In terms of behavioral risk factors for CVD, associations between stress and diet quantity and quality appear to be stronger among women, but the influence of stress on sedentary behaviors and sleep may be stronger among men. Given that gender disparities exist in the prevalence of overall and different types of stress (eg, financial stress, caregiving stress, and occupational stress), future studies should decipher the potential differential associations between types of stress and cardiovascular risk among men and women to identify vulnerable populations and develop targeted interventions.
