Gender and Sex Differences in Adipose Tissue.

BackgroundEvidence from clinical research indicates that men and women can differ in response to drug treatment. The knowledge database Janusmed Sex and Gender was developed to illuminate potential sex and gender differences in drug therapy and, therefore, achieve a better patient safety. The database contains non-commercial evidence-based information on drug substances regarding sex and gender aspects in patient treatment. Here, we describe our experiences and reflections from collecting, analyzing, and evaluating the evidence.Janusmed Sex and GenderSubstances have been systematically reviewed and classified in a standardized manner. The classification considers clinically relevant sex and gender differences based on available evidence. Mainly biological sex differences are assessed except for gender differences regarding adverse effects and compliance. Of the 400 substances included in the database, clinically relevant sex differences were found for 20%. Sex-divided data were missing for 22% and no clinically relevant differences were found for more than half of the substances (52%). We noted that pivotal clinical studies often lack sex analyses of efficacy and adverse effects, and post-hoc analyzes are performed instead. Furthermore, most pharmacokinetic analyses use weight correction, but medicines are often prescribed in standard doses. In addition, few studies have sex differences as a primary outcome and some pharmacokinetic analyses are unpublished, which may complicate the classification of evidence.ConclusionsOur work underlines the need of sex and gender analyses, and sex-divided data in drug treatment, to increase the knowledge about these aspects in drug treatment and contribute to a more individualized patient treatment.

Does personality mediate the relationship between sex and environmentalism?

Public health context of women's mental health research

Two highly prevalent pulmonary diseases, lung cancer and chronic obstructive lung disease (COPD), show both sex and gender differences in their presentations and outcomes. Sex differences are defined as biological differences associated with the male vs female genotype, and gender differences are defined as behavioral or social differences that primarily arise because of gender identity. The incidence of both lung cancer and COPD has increased dramatically in women over the past 50 years, and both are associated with chronic pulmonary inflammation. Development of COPD is also a risk factor for lung cancer. In this review, the main differences in lung cancer and COPD biology observed between men and women will be summarized. Potential causative factors will be discussed, including the role of estrogen in promoting pro-growth and inflammatory phenotypes which may contribute to development of both lung cancer and COPD. Response of the innate and adaptive immune system to estrogen is a likely factor in the biology of both lung cancer and COPD. Estrogen available from synthesis by reproductive organs as well as local pulmonary estrogen synthesis may be involved in activating estrogen receptors expressed by multiple cell types in the lung. Estrogenic actions, although more pronounced in women, may also have importance in the biology of lung cancer and COPD in men. Effects of estrogen are also timing and context dependent; the multiple cell types that mediate estrogen action in the lungs may confer both positive and negative effects on disease processes.

In 2001 the Institute of Medicine of the National Academy of Sciences United States published a report, “Exploring the Biological Contributions to Human Health: Does Sex Matter?”, which addressed and highlighted the role of biological sex differences in health and disease, including especially sex differences in non-reproductive areas of the male and female. The report aroused considerable interest and comment and had a significant role in stimulating the generation of a growing body of basic and clinical research on fundamental aspects of sex differences and its role in disease susceptibility, development, and aging. Sex is the most common human polymorphism that affects health and illness through the life cycle. This perspective provides a brief overview of the importance of the critical interlinked interactions of nature (genes and sex hormones) and nurture (environment and experience) on behavior and perception. Differences in gene expression in the male and female appear in the early embryo, before differentiation of the fetal gonads into a testis or ovary, the latter a consequence of the testis-determining SRY gene on the Y chromosome (a developmental switch). Gonadal differentiation results in a striking sex difference in the fetal sex steroid milieu and the phenotypic differences in the internal and external genital tracts that follows. Recent data provide evidence that in addition to the classic brain masculinizing effects of testosterone in the fetus, XX and XY brain cells show different patterns of gene expression even before gonadal differentiation. The functional and structural significance and magnitude of these brain sex differences are uncertain. The X chromosome contains a higher number of genes that have a major role in the development of general cognitive ability. Further, we now know that estrogen formed mainly in extragonadal tissues has an important multifaceted role in boys at puberty and in men.

Using 267 repeated policy questions (962 time points), we examine gender differences in policy choices and how they have changed from the 1960s to the 1980s. The average gender difference in preferences toward policies involving the use of force have consistently been moderately large. Sex differences in opinion toward other policies—regulation and public protection, “compassion” issues, traditional values—have been approximately half as large but they also warrant more attention than in the past. Our analysis suggests that the salience of issues has increased greatly for women, and as a result differences in preferences have increased in ways consistent with the interests of women and the intentions of the women's movement.

There is growing recognition of the importance of sex and gender differences within falls literature, but the characterization of such literature is uncertain. The aim of this scoping review was to (1) map the nature and extent of falls literature examining sex or gender differences among older adults, and (2) identify gaps and opportunities for further research and practice. We used a scoping review methodology. Eligible studies included participants with a mean age of 60 years and study aims specifying falls and either sex or gender concepts. MEDLINE, Embase, CINAHL, Ageline, and Psychinfo databases were searched from inception to March 2, 2022. Records were screened and charted by six independent reviewers. Descriptive and narrative reports were generated. A total of 15,266 records were screened and 74 studies were included. Most studies reported on sex and gender differences in fall risk factors (n = 52, 70%), incidence/prevalence (n = 26, 35%), fall consequences (n = 22, 30%), and fall characteristics (n = 15, 20%). The majority of studies (n = 70, 95%) found significant sex or gender differences in relation to falls, with 39 (53%) identifying significant sex differences and 31 (42%) identifying significant gender differences. However, only three (4%) studies defined sex or gender concepts and only nine (12%) studies used sex or gender terms appropriately. Fifty-six (76%) studies had more female participants than males. Four (5%) were intervention studies. Studies did not report falls in line with guidelines nor use common fall definitions. Sex and gender differences are commonly reported in falls literature. It is critical for future research to use sex and gender terms appropriately and include similar sample sizes across all genders and sexes. In addition, there is a need to examine more gender-diverse populations and to develop interventions to prevent falls that address sex and gender differences among older adults.

Sex and gender differences in schizophrenic psychoses

Alcohol use disorder (AUD) and chronic pain are frequently comorbid conditions. This review aims to communicate recent research describing the bidirectional effects of pain experience and alcohol use, while focusing on sex and gender differences at this intersection with an emphasis on translational research. Most pain syndromes affect people assigned female at birth (AFAB). Although people assigned male at birth (AMAB) typically drink more than AFABs, AFABs progress to AUD more quickly and experience more alcohol-related comorbidities. In the preclinical setting, different alcohol models highlight sex differences in the escalation of alcohol drinking, while a state of alcohol dependence appears to produce sex-specific alterations in withdrawal-induced pain- and anxiety-like behaviors. Preclinical and clinical studies are accelerating in order to elucidate important sex differences in both chronic pain and AUD. A better understanding of the physiological mechanisms underlying pain and AUD will support the discovery of more effective, potentially sex-specific, therapeutic options for these devastating co-morbid conditions.

Pain is a leading public health problem in the United States, with an annual economic burden of more than $630 billion, and is one of the most common reasons that individuals seek emergency department (ED) care. There is a paucity of data regarding sex differences in the assessment and treatment of acute and chronic pain conditions in the ED. The Academic Emergency Medicine consensus conference convened in Dallas, Texas, in May 2014 to develop a research agenda to address this issue among others related to sex differences in the ED. Prior to the conference, experts and stakeholders from emergency medicine and the pain research field reviewed the current literature and identified eight candidate priority areas. At the conference, these eight areas were reviewed and all eight were ratified using a nominal group technique to build consensus. These priority areas were: 1) gender differences in the pharmacological and nonpharmacological interventions for pain, including differences in opioid tolerance, side effects, or misuse; 2) gender differences in pain severity perceptions, clinically meaningful differences in acute pain, and pain treatment preferences; 3) gender differences in pain outcomes of ED patients across the life span; 4) gender differences in the relationship between acute pain and acute psychological responses; 5) the influence of physician-patient gender differences and characteristics on the assessment and treatment of pain; 6) gender differences in the influence of acute stress and chronic stress on acute pain responses; 7) gender differences in biological mechanisms and molecular pathways mediating acute pain in ED populations; and 8) gender differences in biological mechanisms and molecular pathways mediating chronic pain development after trauma, stress, or acute illness exposure. These areas represent priority areas for future scientific inquiry, and gaining understanding in these will be essential to improving our understanding of sex and gender differences in the assessment and treatment of pain conditions in emergency care settings.

Commonly used isotonic arthroscopic irrigation fluids, such as normal saline or lactated Ringer's, were initially formulated for intravenous administration so they do not replicate the physiologic properties of healthy synovial fluid. Synovial fluid plays an important role in regulating joint homeostasis such that even transient disruptions in its composition and physiology can be detrimental. Previous studies suggest that hyperosmolar solutions may be a promising alternative to traditional isotonic fluids. This manuscript sought to systematically review and synthesize previously published basic science, translational, and clinical studies on the use of hyperosmolar arthroscopic irrigation fluids to delineate the optimal fluid for clinical use. A systematic literature search of MEDLINE/PubMed and Embase databases was performed in accordance with Preferred Reporting Items for Systemic Reviews and Meta-analyses (PRISMA) guidelines. The search phrases were: ("cartilage" AND "hyperosmolar"); ("arthroscopy" OR "arthroscopic" AND "hyperosmolar"). The titles, abstracts, and full texts were screened for studies on hyperosmolar solutions and articular cartilage. Study quality was assessed, and relevant data were collected. A meta-analysis was not performed due to study heterogeneity. A risk of bias assessment was performed on the included translational and clinical studies. There were 10 basic science studies, 2 studies performed in translational animal models, and 2 clinical studies included in this review. Of the basic science studies, 7 utilized a mechanical injury model. The translational studies were carried out in the canine shoulder and equine stifle (knee) joint. Clinical studies were performed in the shoulder and knee. Multiple basic science, translational, and clinical studies highlight the short-term safety, cost-effectiveness, and potential benefits associated with use of hyperosmolar solutions for arthroscopic irrigation. Further work is needed to develop and validate the ideal formulation for a hyperosmolar irrigation solution with proven long-term benefits for patients undergoing arthroscopic surgeries.

A sex- and gender-informed perspective increases rigor, promotes discovery, and expands the relevance of biomedical research. In the current era of accountability to present data for males and females, thoughtful and deliberate methodology can improve study design and inference in sex and gender differences research. We address issues of motivation, subject selection, sample size, data collection, analysis, and interpretation, considering implications for basic, clinical, and population research. In particular, we focus on methods to test sex/gender differences as effect modification or interaction, and discuss why some inferences from sex-stratified data should be viewed with caution. Without careful methodology, the pursuit of sex difference research, despite a mandate from funding agencies, will result in a literature of contradiction. However, given the historic lack of attention to sex differences, the absence of evidence for sex differences is not necessarily evidence of the absence of sex differences. Thoughtfully conceived and conducted sex and gender differences research is needed to drive scientific and therapeutic discovery for all sexes and genders.

Based on the publication records of journal articles indexed in the Web of Science Social Sciences Citation Index, our analysis examines the underlying factors influencing the usage of ‘sex differences’ over ‘gender differences’ in Titles and Author Keywords. Our search query identified 16,362 articles published in 1971–2021 that use either of the phrases and have at least one of their Research Areas belonging to the Social Sciences. In concurrence with earlier research, we find a substantial shift towards using ‘gender’ in the 1980s. However, for records published after 1992, the Publication Year has a negligible aggregate impact on the likelihood of ‘gender’ over ‘sex’, although meaningful trend differences occur across subsets defined by article-level disciplinary associations. Using the available publication meta-data (Publication Year, Research Area, Publication Journal) as well as the results of topic modelling (LDA) on Titles and Abstracts, we implement multi-level regression modelling to demonstrate that the likelihood of referring to ‘gender’ rather than ‘sex’ is strongly influenced by article-level disciplinary associations and their topical classification. We find that Psychology articles, by far the most numerous, exhibit a lower propensity to use ‘gender’ than all the other Social Sciences, especially when collaborating with Life Sciences & Biomedicine.

The chapter reports evidence to suggest that children’s singing is characterised by both sex and gender differences. Sex differences are evidenced in the relative size of the vocal anatomy and physiology, with boys tending to have slightly larger vocal instruments compared to girls throughout childhood. Gender differences are evidenced in the ways that such sex differences are reflected in the socio-cultural shaping of children’s developing vocal behaviours over time. Girls tend to be relatively more accomplished in their singing than boys at an earlier age in Western cultures, but there are also diverse cultural examples (such as in the UK, Afghanistan and South Africa) where there are strong traditions of accomplished boys’ singing. For both sexes, highly skilled singing is more likely to be evidenced where selected children participate in an extensive programme of singing development, such as offered by the Cathedral choirs in the UK since the first millennium. Within the chapter, gender similarities and differences are illustrated by data from three longitudinal studies, one in Italy and two in England, including an ongoing evaluation of the English National Singing Programme Sing Up. In the latter study, data analyses based on the sung products of approximately 10,000 individual children indicate that those with successful experience of the programme – both girls and boys – tend to be significantly more developed in their singing competency than those outside the programme. However, gender differences persist in both groups in favour of girls, although these are mediated by age and experience. When questioned about their attitudes to singing, clear gender differences also emerged, with girls tending to be more positive than boys, although again with age as a mediating factor, with younger children of both sexes generally more positive than older children. Nevertheless, the potential benefit of appropriate educational experience in addressing these general trends is evidenced by examples of individual schools where boys are at least as successful as their female peers, and demonstrate equally positive attitudes to singing.

Gender differences and disparities in all-cause and coronary heart disease mortality: Epidemiological aspects