Tag: gender

Females ‘Significantly’ More Likely to Experience Long COVID

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A new study published in Current Medical Research and Opinion has revealed that females are “significantly” more likely to suffer from Long COVID than males and will experience substantially different symptoms.

Long COVID is a syndrome in which complications persist more than four weeks after the initial infection of COVID, sometimes for many months.

In a review of studies, researchers observed females with Long COVID are presenting with a variety of symptoms including ear, nose, and throat issues; mood, neurological, skin, gastrointestinal and rheumatological disorders; as well as fatigue.

Male patients, however, were more likely to experience endocrine disorders such as diabetes and kidney disorders.

“Knowledge about fundamental sex differences underpinning the clinical manifestations, disease progression, and health outcomes of COVID is crucial for the identification and rational design of effective therapies and public health interventions that are inclusive of and sensitive to the potential differential treatment needs of both sexes,” the authors explained.

“Differences in immune system function between females and males could be an important driver of sex differences in Long COVID syndrome. Females mount more rapid and robust innate and adaptive immune responses, which can protect them from initial infection and severity. However, this same difference can render females more vulnerable to prolonged autoimmune-related diseases.”

In their review, researchers gathered a total sample size amounting to 1 393 355 unique individuals.

While the number of participants sounds large, only 35 of the 640 634 total articles in the literature provided sex disaggregated data in sufficient details about symptoms and sequalae of COVID disease to understand how females and males experience the disease differently.

The findings showed that, with the initial onset of COVID, female patients were far more likely to experience mood disorders such as depression, ear, nose, and throat symptoms, musculoskeletal pain, and respiratory symptoms. Male patients, on the other hand, were more likely to suffer from renal disorders.

The authors note that this synthesis of the available literature is among the few to break down the specific health conditions that occur as a result of COVID-related illness by sex. Plenty of studies have examined sex differences in hospitalisation, ICU admission, ventilation support, and mortality. But the research on the specific conditions that are caused by the virus, and its long-term damage to the body, have been understudied when it comes to sex.

“Sex differences in outcomes have been reported during previous coronavirus outbreaks,” the authors added. “Therefore, differences in outcomes between females and males infected with SARS-CoV-2 could have been anticipated. Unfortunately, most studies did not evaluate or report granular data by sex, which limited sex-specific clinical insights that may be impacting treatment.” Ideally, sex disaggregated data should be made available even if it was not the researcher’s primary objective, so other interested researchers can use the data to explore important differences between the sexes.

Greater occupational exposure through traditionally female-dominated jobs may may complicate interpretation the COVID sequelae.

Source: EurekAlert!

Oestrogen from Hormone Replacement Therapy Reduces COVID Mortality

Older woman smiling
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A new study in Family Practice reported that receiving oestrogen in the form of hormone replacement therapy within six months of a recorded diagnosis of COVID was associated with a reduction in mortality from the disease.

While men and women are equally susceptible to the infection, men tend to have more severe disease, with higher rates of hospitalisation and mortality. A recent 38-country review of sex differences in COVID found men to have a 1.7 times higher mortality rate than women. Younger women or those with higher oestrogen levels are less likely to experience COVID complications.

Earlier studies have also shown that women have faster and greater immune responses to viral infections. Similar trends has been observed in previous pandemics, including the SARS-CoV (Severe Acute Respiratory Syndrome Corona Virus) and MERS-CoV (Middle East Respiratory Syndrome Corona Virus) outbreaks.

The reason for these sex differences is uncertain. Limited recent observational data suggest that oestrogen may reduce the severity of COVID disease. This study investigated the association between hormone replacement therapy or combined oral contraception use, and the likelihood of death in women with COVID. Researchers investigated combined oral contraception, which contains oestrogen, because some Recent observational data suggests that women taking oral contraceptives have a lower risk of acquiring COVID.

Investigators used a retrospective cohort with medical records from the Oxford-Royal College of General Practitioners Research and Surveillance Centre primary care database. They identified a group of 1 863 478 women over 18 from 465 general practices in England.  There were 5451 COVID cases within the cohort. Hormone replacement therapy was associated with a 22% reduction in all-cause mortality in COVID.

This suggests that oestrogen may well contribute a protective effect against COVID severity. This may explain why fewer women compared to men have been hospitalised, admitted to ICU, or died due to COVID during the pandemic.

“This study supports the theory that oestrogen may offer some protection against severe COVID,” said Christopher Wilcox, one of the paper’s authors. “We hope that this study can provide reassurance to patients and clinicians that there is no indication to stop hormone replacement therapy because of the pandemic.”

Source: EurekAlert!

Obesity in Women Linked to Increased Fracture Risk

Image source: Pixabay CC0

Women with obesity and overweight, particularly women with high waist circumference, are more susceptible to fractures than those with normal weight, according to new research presented at the European Congress on Obesity (ECO). In men, however, underweight, not overweight, is associated with a greater risk of broken bones.

Obesity has long been thought to help protect against fractures. This is because mechanical loading on bones, which increases with body weight, helps increase bone mineral density, an important determinant of bone strength.

However, recent studies have suggested that the relationship between obesity and fracture risk varies depending on sex, the skeletal site studied and definition of obesity used (body mass index [BMI] vs waist circumference).

To find out more, Dr Anne-Frederique Turcotte, Endocrinology and Nephrology Unit, CHU de Quebec Research Centre, Quebec City, Canada, and colleagues, analysed data from CARTaGENE, a prospective population-based cohort of almost 20 000 individuals aged 40-70 years from Quebec, Canada.

In women, greater waist circumference (WC) was linearly associated with an increased risk of fracture. For each 5cm (two inch) increase in WC, the risk of fracture at any site was 3% higher and the risk of a distal lower limb fracture was 7% higher.  The association between WC and ankle fractures was particularly strong.

In women, greater BMI was associated with a greater risk of distal lower limb fractures. Compared with women with a BMI of 25 kg/m², those with a BMI of 27.5-40 kg/m² showed a greater risk of distal lower limb fractures.  The increase in risk rose linearly from 5% in those with a BMI of 27.5 kg/m², to 40% in those with a BMI of 40 kg/m².

Women with a BMI of 22.5 kg/m² had a 5% lower risk of distal lower limb fractures than those with a BMI of 25 kg/m².

It isn’t known why obesity is associated with a higher risk of fractures in women.  However, most fractures are a result of a fall and falls are more common in people with obesity.  The ankle, unlike the hip and thighbone, is not protected by soft tissue, which could make it more prone to breaking during a fall.

Dr Turcotte added: “Waist circumference was more strongly associated with fractures in women than BMI.  This may be due to visceral fat – fat that is very metabolically active and stored deep within the abdomen, wrapped around the organs – secreting compounds that adversely affect bone strength.

“We also know that people with obesity take longer to stabilise their body, when they trip, for example.  This is particularly pronounced when weight is concentrated at the front of the body, suggesting that individuals with distribution of body fat in the abdominal area may be at higher risk of falling.” 

In men, increases in BMI and WC were not significantly associated with fractures.  However, men with underweight were at higher risk of distal upper limb fractures than those with normal weight.  Men with a BMI ≤17.5 kg/m² were twice as likely to have distal upper limb fracture as men with a BMI of 25 kg/m².

The researchers say a larger number of fractures in men is needed to determine whether this is a true result or whether the pattern for men follows that for women.

The analyses were adjusted for a number of potential confounders: age, menopausal status, ethnicity, marital status, education, income, area of residence, smoking status, alcohol consumption, physical activity level, supplemental calcium and vitamin D intake, history of fracture and comorbidities and medications known to influence fracture risk.

The study authors said: : “Our findings show that the relationship between obesity and fractures is complex and varies by sex. In women, there was a linear relationship between waist circumference and the incidence of fracture at any site and at the distal lower limb, particularly at the ankle.

“Similar results were observed for women with a BMI between 27 and 40 kg/m². In men however, there was no relationship between obesity and the risk of fracture, although a BMI in the underweight range was associated with a higher risk of some fractures.”

Source: EurekAlert!

Osteoporosis in Men is Often Overlooked

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Osteoporosis in men is often overlooked by health care professionals, found the authors of a review published in The Lancet Diabetes and Endocrinology. There is a desperate need for raising awareness of the condition in men to help improve outcomes for patients, the authors said.

Women are generally at higher risk of developing osteoporosis, as their bone density declines more rapidly than men at an earlier age, especially post-menopause. In most populations, men have larger and stronger bone and joint surfaces, so they can be overlooked when diagnosing the condition.

Reviewing available data on the condition in men, researchers found that they are generally diagnosed later, comply with treatment less and present to hospital in older ages than women. With fatality rates from hospitalisations with fragility fractures, like a broken hip, being higher than women.

The review’s author, Dr Tatiane Vilaca, said: “Generally diagnosis of osteoporosis happens when a patient presents at hospital with some kind of fragility fracture in older age, for example falling from standing height, and breaking a hip, wrist or spine.

“Research suggests men hospitalised with hip fractures tend to be older than women, which could be because the condition develops more slowly in men. As older people are usually slightly frailer, with poorer states of overall health, this could explain the slightly higher levels of disability and mortality associated in men with osteoporosis who are hospitalised following a fracture.”

The review found that although there is a lack of research about which treatment options are most effective in men, diagnosis and treatment options are effective.

The team believe further research specifically tailored to osteoporosis in male patients will help improve current diagnosis systems, helping clinicians with earlier diagnosis, and a focus on education for patients will support compliance with drug treatment programs, all improving outcomes for men living with osteoporosis.

Dr. Richard Eastell, Professor of Bone Metabolism at the Department of Oncology and Metabolism, said: “As women make up larger numbers of people living with osteoporosis, the data we have on the progression of the condition in men is currently not as robust. This updated review shows that further studies of male patients could help improve current diagnosis systems, as well as resources for the education of primary care clinicians and the general public on the early warning signs of osteoporosis in men.”

Dr. Vilaca added: “Despite the current gap in knowledge, men can still easily be screened for osteoporosis at their general practitioner surgery.

“Anyone with a family history of osteoporosis, broken bones, or fractures, those with acute back pain or a loss of height should be encouraged to have a check-up.

“These are all early warning signs of the condition in both men and women, and early preventative treatment is the best way to ensure a slower disease progression and longer, healthier life without a fracture.”

Source: University of Sheffield

Hypertension Risk for Women After Sexual Assault or Harassment

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A new study has found that women who have experienced sexual assault or harassment are at higher long-term risk of developing hypertension than women who have not.

The study appears in the Journal of the American Heart Association.

In the US, nearly 43% of women aged 20 and older have hypertension. Defined as a blood pressure of 130/80mmHg or higher, hypertension is a major risk factor for cardiovascular disease – the number one killer of women, causing one in three deaths each year.

“We know that experiences of sexual violence in the form of sexual assault and workplace sexual harassment are common, and that women are disproportionately victims of such violence, with 13–44% of women reporting sexual assault and up to 80% of women reporting workplace sexual harassment,” said study author Rebecca B. Lawn, PhD. “However, exposure to sexual violence is not widely recognized as a contributor to women’s cardiovascular health. We felt it was important to investigate the relationship among common forms of sexual violence with the risk of developing hypertension. These links could help in the early identification of factors that influence women’s long-term cardiovascular health.”

In this study, researchers analysed data over the course of seven years beginning with a 2008 follow-up of the Nurses’ Health Study II, an ongoing cohort study of US women. The 2008 follow-up measured the incidence of sexual violence and other trauma exposure, as well as post-traumatic stress disorder (PTSD) and symptoms of depression, among a subset of 54 703 of the study’s original participants.

From that subset, Lawn and colleagues analysed data for 33 127 women (95% non-Hispanic white women; average age of 53 years at the beginning of the 2008 follow-up) who had no history of hypertension or had not taken medication for high blood pressure as of the start of the 2008 follow-up.

The analyses found:

  • At the seven-year follow-up in 2015, about 1 in 5 (nearly 7100) of the women self-reported they had developed hypertension, validated with medical records.
  • Sexual assault and workplace sexual harassment were common, with lifetime prevalence of 23% for sexual assault and 12% for workplace sexual harassment; 6% of women reported experiencing both.

Compared to women with no history of sexual assault or harassment, women who reported having experienced both had the greatest increased hypertension risk (21%), followed women who reported experiencing workplace sexual harassment (15%) and an women who reported experiencing sexual assault (11%).

“We did not find any association of increased risk for hypertension among women who had a history of other types of trauma and who did not experience sexual violence, suggesting that increased hypertension risk does not appear to be associated with all trauma exposure,” Dr Lawn said. “Our finding that experiencing both sexual assault and workplace sexual harassment had the highest risk of hypertension underscores the potential compounding effects of multiple sexual violence exposures on women’s long-term cardiovascular health.”

Dr Lawn observed screening for partner violence by primary care clinicians is becoming more common, sexual violence overall is not recognised as a risk factor among women for developing cardiovascular disease.

“These results suggest that screening for a broader range of experiences of sexual violence in routine health care, including sexual harassment in the workplace, as well as verbal harassment or assault, and being aware of and treating potential cardiovascular health consequences may be beneficial for women’s long-term health,” she said. “Reducing sexual violence against women, which is important in its own right, may also provide a strategy for improving women’s lifetime cardiovascular health.”

There are several limitations to the study, including memory biases in recall of sexual violence. The sexual assault and harassment had no measures of severity or timing. Most of the women in the study were white women in the nursing field, limiting generalisability.

“We hope future studies will examine these questions with more detailed information on sexual and other forms of violence. These questions need to be investigated in more diverse groups of people of various ages, races and ethnic backgrounds and gender,” Dr Lawn said. “Although women are disproportionately victims of sexual violence, men are also victims and the physical health implications of experiences of sexual violence against men warrants further investigation.”

Source: American Heart Association

Grip Strength is an Important Health Marker in Older Women

Source: CDC

Researchers have found that greater grip strength in older women reduces mortality risk, regardless of weight change, suggesting that mobility and strength support should have more focus than weight loss in this group.

Grip strength and short physical performance battery (SPPB) are measures of physical functioning. Grip strength assesses strength of grip alone, whereas SPPB is a cumulative score considering three components: balance test, timed walk, and chair stands. 

Previous studies have shown a link between increased grip strength and lower all-cause mortality. SPPB considers timed walk, balance test, and chair stands, and is associated with CVD risk in older women. However, studies of the effects of weight loss on grip strength which evaluated participants before and after weight loss interventions have shown inconsistent results.

In a study published in the Journal of the American Geriatrics Society, researchers followed 5039 older women for an average of 5.4 years. They found that loss of 5% or more body weight was associated with a 66% higher risk of dying. However, there was no association of weight gain with mortality.

The researchers also found that higher grip strength and better lower extremity functioning were associated with lower risks of death during follow-up, regardless of weight change.

“Our findings support increasing efforts to improve mobility and muscle strength in older women and less focus on long-term weight loss in this population,” said lead author Lisa Underland, DO, of Children’s Hospital at Montefiore. 

Source: Wiley

Prunes Also Protect Bone Health in Men

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New research published in the Journal of Food and Medicine reports that daily prunes consumption protects bone health in men over 50. This study is the first of its kind to examine the beneficial prune effect on bones in men. 

Some 2 million men are estimated to be battling osteoporosis and another 16.1 million men have osteopenia, or low bone mass. Despite these numbers, bone disease in men is often overlooked.

“We’ve already seen significant evidence that prunes have a positive effect on bone health in women, so it’s particularly exciting to find that prunes can also play a beneficial role in men’s bone health. We look forward to continuing to study the ‘prune effect’ on bone and other health outcomes in men,” said lead researcher Professor Shirin Hooshmand at San Diego State University.

In this study, 57 healthy men aged 50-79 years old were randomised to either consume 100 grams of prunes every day or no prunes for twelve months. After a year, the prune consumers showed significant decreases in biomarkers of bone breakdown, while no changes were observed in the control group. The study authors also reported the men who ate prunes showed improvements in bone geometry indicating greater bone strength.

Historically, research has focused on osteoporosis and bone health in women, already indicating a favorable bone response to prunes specifically among postmenopausal women. Several studies have suggested that eating 50 to 100 grams of prunes everyday could lead to increased bone mass and decreased bone breakdown. Moreover, a recent case study earlier this year reported that total bone mineral density increased in a postmenopausal woman with osteopenia after she consumed 50 grams of prunes daily for 16 months.

“Bone health is not just a concern for women. Men need to think about how to protect their bones as well,” said Leslie Bonci, MPH, RDN and consultant with the California Prune Board. “Prunes are a shelf-stable and nutrient-packed food that provide a preventive, proactive, palatable option for men to optimize their bone health.”

While San Diego State University’s newest research is an exciting addition to existing prune-focused literature, more work on the effect of prunes on human bone health is currently underway. An upcoming study from Pennsylvania State University examines how consuming different amounts of prunes affects health outcomes in postmenopausal women over a one-year period. The study not only explores the impact of prunes on bone health, but it will also look at the prune-effect on inflammation and gut health.

Source: PR Newswire

Older Women Struggle More with Daily Activities

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Older women are more likely to struggle with both regular daily tasks and mobility activities, according to new analysis of longitudinal cohort studies.

However, the researchers say disparities in ability to perform daily tasks have been steadily decreasing as the socioeconomic gap between the sexes has decreased.  

The international study, published in The Lancet Healthy Longevity, uses data from more than 27 000 men and 34 000 women aged 50 to 100, born between 1895 and 1960, to examine sex differences in daily activity and mobility limitations. Researchers at UCL and the National Institute of Health and Medical Research (INSERM) in France drew on four large longitudinal studies, covering 14 countries*.

Women were more found to be more likely than men to be limited in their ‘functional capacity’ (both tasks and mobility) as they get older. From age 75, women were also more likely to have three or more mobility issues (such as going up a flight of stairs) or limitations with more complex daily tasks (eg managing money) compared to men who were more likely to have just one or two. At age 85 years, the prevalence of three or more mobility limitations was 10% higher in women than in men.

Lead author, Mikaela Bloomberg, UCL PhD candidate, explained: “Our study of over 60,000 participants born between 1895 and 1960 provides new insights on functional limitations and sex differences.

“We found that women are more likely to be limited than men in carrying out daily tasks from age 70, while we observed women were more likely to be limited in mobility activities from age 50 onward.

“This is an important observation because mobility limitations can precede other more severe limitations and targeting these gaps at middle age could be one way to reduce sex differences in limitations at older ages.”

Historical socioeconomic differences between men and women in areas such as education and entrance to the labour force may partly explain these differences, as women are disproportionately exposed to associated health risks that can lead to disability.

“It appears that gender inequalities in the ability to carry out daily tasks at older age are decreasing over time and this could be explained by the fact that women have better access to education and are more likely to enter the paid labour force in recent generations,” said Bloomberg.

“And although reductions in socioeconomic inequalities may be associated with smaller disparities in simple daily tasks, we did not see the same reductions in sex disparities for mobility after accounting for socioeconomic factors. This might be partly due to sex differences in body composition such as body mass and skeletal muscle index but more research is needed to identify other factors.”

Co-author Dr Séverine Sabia added: “Developing targeted prevention policies to preserve independent living and quality of life for older adults requires an understanding of drivers of sex differences in functional limitations.

“Our study indicates improvements in socioeconomic conditions for women could play an important role in reducing these sex differences. Findings also highlight the importance of early prevention to tackle sex differences in mobility that may trigger sex differences in disability at older age.”

Source: University College London

Is That A Girl’s Voice or A Boy’s?

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Researchers have found that it is possible to distinguish a girl’s voice from a boy’s from as young as five years old, but identification requires the listener to perceive the size of the speaker, providing a clue to their likely age. 

Perceiving gender in children’s voices is of special interest to researchers, because in children, a girl’s voice and a boy’s are very similar before the age of puberty. Adult male and female voices are fairly easy to distinguish due to acoustic differences.

With children, gender perception is much more complicated because gender differences in speech may emerge before sex-related anatomical differences between speakers. This suggests listeners may need to consider speaker age when guessing speaker gender and the perception of gender may depend on acoustic information besides anatomical differences between boys and girls.

In the Journal of the Acoustical Society of America, researchers reported developing a database of speech samples from children ages five to 18 to answer two questions: What types of changes occur in children’s voices as they become adults, and how do listeners adjust to the enormous variability in acoustic patterns across speakers?

Listeners assess a speaker’s gender, age, height, and other physical characteristics based primarily on the speaker’s voice pitch and on the resonance (formant frequencies) of their voice.

“Resonance is related to speaker height — think violin versus cello — and is a reliable indicator of overall body size,” said co-author Santiago Barreda, from the University of California, Davis. “Apart from these basic cues, there are other more subtle cues related to behaviour and the way a person ‘chooses’ to speak, rather than strictly depending on the speaker’s anatomy.”
When co-authors Barreda and Peter Assmann presented listeners with both syllables and sentences from different speakers, gender identification improved for sentences. They said this supports the stylistic elements of speech that highlight gender differences and are better conveyed in sentences.

They made two other important findings. First, listeners can reliably identify the gender of individual children as young as five.

“This is well before there are any anatomical differences between speakers and before there are any reliable differences in pitch or resonance,” said Barreda. “Based on this, we conclude that when the gender of individual children can be readily identified, it is because of differences in their behavior, in their manner of speaking, rather than because of their anatomy.”

Second, they found identification of gender of speakers must take place along with the identification of age and likely physical size.

“Essentially, there is too much uncertainty in the speech signal to treat age, gender, and size as independent decisions,” he said. “One way to resolve this is to consider, for example, what do 11-year-old boys sound like, rather than what do males sound like and what do 11-year-olds sound like, as if these were independent questions.”

Their findings suggest that “perception of gender can depend on subtle cues based on behaviour and not anatomy,” said Barreda. “In other words, gender information in speech can be largely based on performance rather than on physical differences between male and female speakers. If gendered speech followed necessarily from speaker anatomy, there would be no basis to reliably identify the gender of little girls and boys.”

This study supports the notion that gender (as opposed to sex) is largely performative in nature, which has long been argued on theoretical grounds.

Source: American Institute of Physics

Gaps and Gender Differences in Diabetes Management

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A new study from the University of Eastern Finland revealed there are gaps and gender differences in diabetes management. Type 2 diabetes is often accompanied by elevated cholesterol levels, but many patients do not receive appropriate cholesterol-lowering treatment, according to the study, which appears in Scientific Reports.

Type 2 diabetes is a major risk factor of cardiovascular diseases, such as coronary artery disease and heart failure, as well as premature death. To prevent or at least delay complications, regular health care visits and good control of blood glucose, low-density lipoprotein cholesterol (LDL-C) and other risk factors are needed.

The present study shows that LDL-C control and statin prescriptions remain suboptimal in clinical practice – despite guidelines that consistently recommend treating elevated LDL-C with statins at moderate- to high-intensity. The study drew on electronic health records of 8592 type 2 diabetes patients between 2012 and 2017.

Analysing LDL-C values over time, researchers identified four groups with different trajectories. Most patients (86%) had relatively stable LDL-C values at moderate levels and only a few patients showed a significant increase (3%) or decrease (4%) during the follow-up. However, the second-largest group (8%) consisted of patients with alarmingly “high-stable” LDL-C levels at around 3.9 mmol/L.  

The “high-stable” LDL-C group had the lowest proportions of patients on moderate- and high-intensity treatment as well as any statin treatment. The proportion of patients receiving any statin treatment even decreased from 42% to 27% among men, and from 34% to 23% among women between 2012 and 2017.

“We observed significant gender differences in care processes and outcomes,” said Laura Inglin, Early Stage Researcher, University of Eastern Finland. “In all the trajectory groups, women had significantly higher average LDL-C levels and received any statin treatment and high-intensity treatment less frequently than men.”

Significant differences were seen in terms of longitudinal care processes, outcomes, and treatments, pointing out gaps in current diabetes management. Efforts to control LDL-C should be increased – especially in patients with continuously elevated levels – by initiating and intensifying statin treatment earlier and re-initiating the treatment after discontinuation if possible.

Source: University of Eastern Finland