The impact of sex differences on 3-year outcomes of patients with non-ST-segment elevation myocardial infarction after successful stent implantation according to symptom-to-balloon time

BACKGROUND

Because no data are available, we compared the 3-year outcomes of patients with non-ST-elevation myocardial infarction (NSTEMI) based on sex and symptom-to-balloon time (SBT).

METHODS

This study included 4910 patients who were divided into two groups based on SBT: SBT <48 h (n = 3,293, 67.1%) and SBT ≥48 h (n = 1,617, 32.9%). The primary outcome was all-cause death during the 3-year follow-up period. The secondary outcome was major adverse cardiac events (MACE), defined as all-cause death, recurrent myocardial infarction, or repeat coronary revascularization.

RESULTS

After adjustment, the in-hospital mortality rates for males and females in the SBT <48 h and SBT ≥48 h groups were similar. During a 3-year follow-up period, females in the SBT <48 h group had significantly higher rates of all-cause death (adjusted hazard ratio [aHR], 1.482; P = 0.006), cardiac death (CD, aHR, 1.617; P = 0.009), and MACE (aHR, 1.268; P = 0.024) than those males in the same groups. Females and males in the SBT ≥48 h group did not differ significantly in the primary and secondary outcomes. In males, the rates of all-cause death (P = 0.008) and CD (P = 0.024) were significantly higher in the SBT ≥48 h group than in the SBT <48 h group.

CONCLUSIONS

This study has identified a higher 3-year mortality rate in female patients with NSTEMI and SBT <48 h compared to their male counterparts. As such, a more preventive approach may be required to reduce mortality in these female patients.

Gender Difference of Blood Pressure Control Rate and Clinical Prognosis in Patients With Resistant Hypertension: Real-World Observation Study

BACKGROUND

There are several differences in the clinical course of hypertension due to the biological and social differences between men and women. Resistant hypertension is an advanced disease state, and significant gender difference could be expected, but much has not been revealed yet. The purpose of this study was to compare gender differences on the current status of blood pressure (BP) control and clinical prognosis in patients with resistant hypertension.

METHODS

This is a multicenter, retrospective cohort study using common data model databases of 3 tertiary hospitals in Korea. Total 4,926 patients with resistant hypertension were selected from January 2017 to December 2018. Occurrence of dialysis, heart failure (HF) hospitalization, myocardial infarction, stroke, dementia or all-cause mortality was followed up for 3 years.

RESULTS

Male patients with resistant hypertension were younger but had a higher cardiovascular risk than female patients. Prevalence of left ventricular hypertrophy and proteinuria was higher in men than in women. On-treatment diastolic BP was lower in women than in men and target BP achievement rate was higher in women than in men. During 3 years, the incidence of dialysis and myocardial infarction was higher in men, and the incidence of stroke and dementia was higher in women. After adjustment, male sex was an independent risk factor for HF hospitalization, myocardial infarction, and all-cause death.

CONCLUSION

In resistant hypertension, men were younger than women, but end-organ damage was more common and the risk of cardiovascular event was higher. More intensive cardiovascular prevention strategies may be required in male patients with resistant hypertension.

[Oxytocin and vasopressin: sexual differences and clinical implications]

Oxytocin and vasopressin share a similar chemical structure but have different functions. Both hormones are produced in different brain areas, are transported through the hypophyseal portal system, pass to the anterior hypophysis, and released to reach their target organs. These hormones also act as neuromodulators, where its receptors are found in the lateral septum, the middle amygdala, the hippocampus, the hypothalamus, and the brain stem. These brain structures regulate socio-sexual behaviors in vertebrates. Moreover, the oxytocinergic and the vasopressin systems are sexually different. The sexual steroids promote oxytocin release and the oxytocin receptor synthesis, as well as promoting or inhibiting vasopressin release and its receptor genetic transcription. Both neuropeptides are involved in social recognition, male-female pair bonding, aggression, and cognition. Furthermore, the disruption or malfunctioning of the oxytocin and vasopressin systems adds to the causes of some psychiatric disorders like depression, schizophrenia, autism, and borderline personality.

Sexual Activity and Physical Tenderness in Older Adults: Prevalence and Associated Characteristics From a Belgian Study

BACKGROUND

Despite the World Health Organization calling for sexuality to be recognized as an aspect of well-being, no studies have explored sexual activity and physical tenderness in older adults aged ≥ 75 years in Belgium or those aged ≥ 85 years worldwide.

AIM

To assess the prevalence and predictors of sexual activity and physical tenderness in a sample of older adults.

METHODS

Using data from a Belgian cross-sectional study on sexual violence (UN-MENAMAIS), information on sexual activity, physical tenderness, and associated characteristics was collected during structured face-to-face interviews with older adults living in the community, assisted living facilities, or nursing homes. Cluster random probability sampling with a random route-finding approach was used to select the participants.

OUTCOMES

Current sexual activity and physical tenderness in the previous 12 months, sociodemographic characteristics, chronological age, subjective age, number of sexual partners, sexual satisfaction, attitudes toward sexuality in later life, quality of life, and lifetime sexual victimisation.

RESULTS

Among the 511 participants included, 50.3% were in a relationship, mainly living with their partner; 31.3% indicated they were sexually active; and 47.3% of sexually inactive participants reported having experienced forms of physical tenderness in the previous 12 months. Sexual activity was associated with the presence of a partner, satisfaction with sexual life, permissive attitudes regarding sexuality in later life, a younger age, and a lack of disability. Physical tenderness was associated with the presence of a partner, community residency, and permissive attitudes regarding sexuality in later life.

CLINICAL IMPLICATIONS

Raising awareness among the general population, healthcare professionals, and older adults about sexuality in later life could contribute to ending this taboo and should therefore be a priority for society.

STRENGTHS AND LIMITATIONS

Our study fills a gap in the literature regarding sexual activity and physical tenderness in older adults aged ≥ 70 years, including respondents aged up to 99 years. Additionally, we explored different forms of sexual expression beyond intercourse, and face-to-face interviews contributed to the quality of the collected data. The main limitation of this study was the sample size, although the findings were similar to recent statistical indicators in Belgium.

CONCLUSION

One in 3 older adults aged ≥ 70 years living in Belgium are sexually active. These findings provide an opportunity to inform the general public and older adults about later life sexuality and to educate healthcare professionals about aging sexuality to increase discussions and avoid assumptions of asexuality in later life. Cismaru-Inescu A, Hahaut B, Adam S et al. Sexual Activity and Physical Tenderness in Older Adults: Prevalence and Associated Characteristics From a Belgian Study. J Sex Med 2022;19:569-580.

Mind the Gap: An Analysis of Physical Therapist Earnings in the United States by Male/Female Sex

OBJECTIVE

Earnings discrepancies between male and female health and medical professionals are well documented. The purpose of this study was to examine the distribution of physical therapist earnings using a quartile regression approach to determine the nature of the gender-based differences in earnings between male and female physical therapists in the United States, with "gender" as defined by the dataset as being male or female.

METHODS

This observational study used data from the 2014 to 2018 American Community Survey 5-year public use microdata file. The file contained 12,123 physical therapist cases weighted to an estimate of the physical therapist active workforce of 238,221 (95% CI = 232,587 to 243,855). To analyze the influence of gender on earnings, a multivariable quantile regression approach was used in which physical therapist earnings were the dependent variable and the variables representing the geographic distribution, social characteristics, and employment characteristics were the independent variables.

RESULTS

In 2018 dollars, the average annual earnings of a physical therapist were $73,444.98 (95% CI = $72,498.19 to $74,391.11), with a median value of $71,735.09. Differences in male and female earnings were evident in both the unadjusted bivariable and in the adjusted values produced by the quartile regression. The ratios of female-to-male earnings at each quartile were 0.89, 0.90, and 0.89. When age of the earner is accounted for, male physical therapists earned more than female therapists in both the 30-to-54-year age group and the ≥55-year age group. In the youngest age group of earners under 30 years of age, the differences were substantially smaller.

CONCLUSIONS

Gender differences in income persist across the distribution of earnings, resulting in female physical therapists earning approximately 10% less than their male counterparts. The differences are most distinct as physical therapists advance in their careers.

IMPACT

The etiology of the earnings gap is unknown, but gender equity has not been achieved yet for physical therapy.

Influence of baseline QTc on sotalol-induced prolongation of ventricular repolarization in men and women

The extent of sotalol-induced QTc prolongation on the electrocardiogram, is variable among subjects and influenced by sex. However, the influence of baseline QTc on the extent of drug-induced QTc prolongation remains unclear. This was studied around peak plasma concentration in a large cohort of 376 healthy male and 614 healthy female subjects who received 80 mg of sotalol orally. Baseline QTc was 379±16ms in men and 393±15ms in women (p<0.0001). The change in QTc from baseline was highly variable among both sexes and was greater in women than in men (26.5±13.2 vs.13.0±10.8ms; <0.0001). The slope of the regression line between QTc on sotalol and baseline QTc did not significantly differ from unity in men and in women indicating that the extent of QTc prolongation with sotalol was not influenced by baseline QTc. Assessing QTc after administration of an I_Kr blocker may be more important than measuring a baseline QTc.

Patient satisfaction with medication therapy adherence clinic services in a district hospital: a cross-sectional study

Background:

Patient satisfaction is one of the essential indicators for assessing the quality of healthcare services being delivered, including pharmacy ambulatory care service, as it determines the practicability and sustainability of the service provided. As such, pharmaceutical care services provided during medication therapy adherence clinic (MTAC) sessions need to be assessed to maximise its effectiveness and benefits to the patients.

Objective:

This study aimed to assess the association between patient satisfaction and socio-demographic characteristics, as well as the predictors for patient satisfaction.

Methods:

This was a cross-sectional study conducted at the medical outpatient department in Hospital Port Dickson from January until October 2019. Convenience sampling method was used to recruit potential study participants. Patient satisfaction was measured using Validated Patient Satisfaction with Pharmacist Services Questionnaire (PSPSQ2.0), consisted of quality of care and interpersonal relationship between pharmacist and patient domains. Descriptive data were presented as mean and standard deviation or numbers and percentages, while Independent Sample t-test, ANOVA and post-hoc analysis, and multiple linear regression were used for inferential data analysis.

Results:

There were 37 (25%) diabetes MTAC, 36 (24.3%) respiratory MTAC, and 75 (50.7%) warfarin MTAC patients recruited. On average, the mean overall satisfaction score was 3.30(SD=0.43). The mean satisfaction score in the interpersonal relationship domain [3.35(SD=0.44)] was higher than the quality of care domain [3.26(SD=0.45)]. There was a significant association between gender, education level, and patient satisfaction towards pharmaceutical care service (p<0.05). Gender and education level statistically predicted respondents’ satisfaction with MTAC services (p<0.001).

Conclusions:

The overall patient satisfaction towards MTAC services in this setting was high. Gender and education level were significant predictors for patient satisfaction. These findings could potentially contribute to the planning of MTAC services in the future.

Polypharmacy among older Brazilians: prevalence, factors associated, and sociodemographic disparities (ELSI-Brazil)

Background:

Polypharmacy has become an increasingly public health issue as population age and novel drugs are developed. Yet, evidence on low- and middle-income countries (LMIC) is still scarce.

Objective:

This work aims to estimate the prevalence of polypharmacy among Brazilians aged 50 and over, and investigate associated factors.

Methods:

A cross-sectional study was conducted using data from the baseline assessment of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), a nationally representative study of persons aged 50 years and older (n=9,412). Univariate and bivariate analyses described the sample. Robust Poisson regression was used to estimate prevalence ratios and predict probabilities of polypharmacy.

Results:

Prevalence of polypharmacy was estimated at 13.5% among older adults in Brazil. Important disparities were observed in regard to gender (16.1% among women and 10.5% among men), race (16.0% among whites and 10.1% among blacks) and geographic region (ranging from 5.1% in the North to 18.7% in the South). The multivariate analysis showed that polypharmacy is associated with various sociodemographic/individual factors (age, gender, race, education, region, health status, body mass index) as well as with several variables of healthcare access/utilization (number of visits, same physician, provider’s knowledge of patient’s medications, gate-keeper, and difficulty managing own medication). Overall, the more utilization of health services, the higher the probability of polypharmacy, after adjusting for all other model covariates.

Conclusions:

Polypharmacy prevalence is relatively low in Brazil, compared to European countries. After controlling for variables of healthcare need and demographic characteristics, there is still substantial residual variance in polypharmacy prevalence. Policies to identify inappropriate prescribing and reduce regional discrepancies are necessary.

[Risk of intensive practice in sportswomen]

Risk of intensive practice in sportswomen. Intensive sports practice in women exposes to specific risks, depending on the sport, such as the athlete triad, the increased risk of stress fracture, and lastly the perineal dysfunction. Risk factor screening including the relativ energy deficiency in sport, the sub clinical menstrual disturbances and a special vigilance ahead of perineal constrained sports help preserve the sportswoman's health. The search for performance and the intensive practice do not exclude that the sportswoman can integrate the pregnancy project into her life, with several adaptations in intensity, duration and frequency of sessions to promote maternity without maternal or fetal risk, and a calm recovery in the post-partum period. Sharing the information with the sportswoman and her environment is essential to reassure and to implement a comprehensive prevention strategy with her.

[Asthma and allergy: what about the differences between men and women?]

Asthma and allergy: what about the differences between men and women? Allergic asthma is a chronic pulmonary disease characterized by bronchial hyper responsiveness, hyper production of mucus and remodeling of the airways. Asthma, which often begins before the age of 5, is the most common chronic disease in children and affects approximately 10% of the population in affluent societies. As it is the case for many allergic diseases, asthma affects men and women differently. In childhood, pathology is more common in boys, but this trend reverses at puberty, suggesting a regulation by sex hormones. In this review, we summarize the current knowledge on how sex hormones impact allergic inflammation and particularly describe the protective actions of androgens on the development and function of key immune cell subsets involved in allergic responses.

Gender, age, and pharmacists' job satisfaction

A comprehensive literature review was conducted on the concept of job satisfaction in the pharmacist workforce field and the facets it comprises, as well as its measurement, aiming to (i) review the nature, mechanisms, and importance of job satisfaction in the context of the pharmacist workforce, (ii) survey some of the most salient facets that configure job satisfaction, and (iii) discuss validity and measurement issues pertaining to it.

Although female pharmacists generally hold less appealing jobs, earn lower wages and salaries, and are promoted less frequently than their male counterparts, they report higher levels of job satisfaction. Age has a U-shape effect on job satisfaction, with middle-age pharmacists less satisfied than both younger and older practitioners. Workload, stress, advancement opportunities, job security, autonomy, fairness in the workplace, supervisors, coworkers, flexibility, and job atmosphere are facets contributing to pharmacists’ job satisfaction. Finally, discrepancy exists among researchers in measuring job satisfaction as a single global indicator or as a composite measure derived from indices of satisfaction with key aspects of a job.

Understanding the mechanisms that affect pharmacists’ job satisfaction is important to employers in their pursuit to respond to practitioners’ needs, decrease turnover, and increase productivity. As pharmacists’ response to work-related conditions and experiences depends on gender and age, a unique set of rewards and incentives may not be universally effective. Additional research into the dynamics of the forces shaping pharmacists’ perceptions, opinions, and attitudes is needed in order to design and implement policies that allocate human resources more efficiently within the various pharmacy settings.

Sex-specific differences in risk factors for in-hospital mortality and complications in patients with acute coronary syndromes : An observational cohort study

BACKGROUND

The goal of this observational cohort study was to examine gender-specific differences in the incidence of acute coronary syndrome (ACS), in-hospital complications and mortality.

METHODS

A cohort of 1550 patients with the primary diagnosis of ACS were enrolled in the study over a period of 4 years. The in-hospital mortality and complications were analyzed as the main outcome measures.

RESULTS

Women were significantly older compared to men (71 ± 11 years vs. 64 ± 12 years, p < 0.001) and had higher in-hospital mortality and complications due to this age difference. The prevalence of smoking was lower while hypertension and history of angina pectoris was more frequent in women, independent of age. Percutaneous transluminal coronary angioplasty (PTCA) with or without stenting as well as coronary catheterization significantly reduced in-hospital mortality and complications while thrombolytic therapy was associated with a 3.3 times increased mortality odds ratio (OR, p = 0.01). Other significant predictors of in-hospital mortality were in-hospital complications (OR 25, p < 0.001) and ST segment elevation myocardial infarction (STEMI, OR 4.5, p < 0.001).

CONCLUSIONS

Women differed from men in terms of ACS clinical characteristics, treatment, invasive procedures and survival outcome and some of these effects were age-related. The future emphasis should be based on the prevention of modifiable risk factors and identification of subgroups of female patients that could benefit from more aggressive therapeutic strategies.

Race and Gender Differences in Correlates of Death Anxiety Among Elderly in the United States

BACKGROUND

Death anxiety among elderly is a major public health concern. Few studies, however, have been conducted on factors associated with death anxiety.

OBJECTIVES

This study investigated race and gender differences in psychosocial correlates of death anxiety among elderly in the US.

MATERIALS AND METHODS

With a cross-sectional design, we used data of the Religion, Aging, and Health survey. 1,074 White and Black elderly (age > 65 years, 615 women, 359 men) were entered to this study. Demographic (age, gender, and race), socio-economic (family income, perceived financial difficulty), health (number of chronic medical conditions and self-rated health), and psychological (perceived control over life) factors were measured. Death anxiety was measured using four items. We used linear regressions to determine factors associated with death anxiety based on race and gender.

RESULTS

Although race and gender did not have main effects on death anxiety (P > 0.05), they altered correlates of death anxiety. Age was a predictor of death anxiety among women (B = 0.165, P = 0.002) but not men (B = 0.082, P = 0.196). Self-rated health was associated with death anxiety among Whites (B = - 0.120, P = 0.050) but not Blacks (B = - 0.077, P = 0.268). Total family income was only associated with death anxiety among White men.

CONCLUSIONS

Demographic, socio-economic, health, and psychological determinants of death anxiety in United States differ based on race, gender, and their intersection. Findings advocate that geriatric psychiatrists and gerontologists who wish to reduce death anxiety among elderly people may need to tailor their interventions to race and gender.

Associations of gender and age groups on the knowledge and use of drug information resources by American pharmacists

Objective

To explore knowledge and use of drug information resources by pharmacists and identify patterns influenced by gender and age-group classification.

Methods

A survey questionnaire was mailed nationwide to 1,000 practitioners working in community (n = 500) and hospital (n = 500) settings who answer drug information questions as part of their expected job responsibilities. Responses pertaining to drug information resource use and knowledge of different types of drug-related queries, resource media preferences, and perceived adequacy of resources maintained in the pharmacy were analyzed by gender and age group. The t statistic was used to test for significant differences of means and percentages between genders and between age groups. Descriptive statistics were used to characterize other findings.

Results

Gender and age group classification influenced patterns of knowledge and use of drug information resources by pharmacists. They also affected pharmacists’ perceptions of the most common types of questions prompting them to consult a drug information reference, as well as the resources consulted. Micromedex, exclusively available in electronic format, was the most commonly consulted resource overall by pharmacists. Lexi-Comp Online was the leading choice by women, preferred over Micromedex, but was not one of the top two resources selected by men.

Conclusions

This study successfully identified the influence of gender and age-group classification in assessing drug information resource knowledge and use of general and specific types of drug-related queries.

Gender difference in the prodromal symptoms of first-episode schizophrenia

To investigate the gender difference of early symptoms appearing before the onset of the psychotic symptoms in patients with first-episode schizophrenia, we reviewed the medical records of 63 patients (38 males, 25 females), who were hospitalized for first-episode schizophrenia. The frequency and duration of prodromal and psychotic symptoms, Clinical Global Impression scale scores, Global Assessment of Functioning (GAF) scale scores at admission, and other clinical characteristics were recorded for all patients. Overall, the most common prodromal symptoms were attenuated positive symptoms (89%), followed by mood symptoms (86%). Negative symptoms were the most common in male patients (97.4%), whereas attenuated positive symptoms were the most common in female patients (84%). Male patients demonstrated more frequent negative, cognitive, and obsessive-compulsive symptoms than female patients did and also showed a tendency of having negative symptoms for the longer period. Correlational analysis showed a significant negative correlation between the duration of negative symptoms and GAF scores at admission in male patients. Our findings suggest that different patterns of prodromal symptoms between male and female begin before the onset of the psychosis. Further prospective studies should be needed.

Excess female child mortality in the developing world during the 1970s and 1980s

"How did...excess female child mortality evolve from the 1970s to the 1980s, during a period when mortality declined significantly? Is there a relationship between the intensity of the phenomenon and levels of mortality or certain social development indicators? These are some of the questions which the article discusses on the basis of reliable and comparable data taken from approximately 60 [developing] countries."

Subsistence crop deficit and family structure in Sub-Saharan Africa

The author seeks to provide demographic explanations for the current food crisis in Sub-Saharan Africa. "In the present paper, we will consider the possibility that one of these [explanations] may lie in the way African families are structured, particularly in countries that are still in the first stage of the demographic transition. More specifically, we will examine the following two assumptions: the effects which the rural-urban migration...has on food production may be amplified by the way family labour is divided between the sexes and the different age groups; [and] lower mortality increases the size of the kin group, while rural-urban migration decreases the proportion of family members engaged in agricultural production, thus perturbing the distribution and consumption of subsistence foods."

[Sex differential in life expectancy at birth in Japan: (2) trends in sex differential in life expectancy at birth from 1920 to 1990]

Sex differentials in life expectancy at birth in Japan are analyzed for the period 1920 to 1990. The results show that there was a general increase in differences in mortality by sex over time. "The sex differential in age-specific death rate in 0-4 year age group (particularly age 0) explained most of the sex differential in life expectancy at birth before 1947. After 1950, the age group of 60-79 played a major role in the sex differential in life expectancy at birth. It is noteworthy that female mortality exceeded male mortality in age groups of 2-41 before 1930. Consequently, excess of female mortality reduced the sex differential in life expectancy at birth at that period. As for the sex differential in mortality rates by causes of death, tuberculosis, pregnancy and childbirth related disease exerted a great influence...before 1940. Recently, malignant neoplasms, heart diseases, cerebrovascular diseases, and accidents [have] become leading contributors to the sex differentials in life expectancy at birth." (SUMMARY IN ENG)

Forecast of labour force in Poland to the year 2020: methodology and results

"In 1995 the Labour Statistics Division of the Central Statistical Office (CSO) started methodological work on the preparation of a forecast of the labour force in Poland to the year 2020.... Variant ¿intermediate' assumes a slow reconstruction of the economic activity of population from the level of the period 1978-88 (census 1978 and census 1988). The main part of this ¿reconstruction' will take place in the years 1995-2010. The greatest anticipated changes concern youths (18-24 years), persons of immobility age (males 45-64 years and females 45-59 years) and the first groups of the retirement age. Variant ¿maximum' assumes that the anticipated ¿reconstruction' labour force participation rate will be faster (compared with variant ¿intermediate')."

Sex differentials in old-age mortality

"This article examines levels and trends of sex differentials in life expectancy at older ages for 29 developed countries. Significant sex differentials in life expectancy among the elderly have been found--but no common trend among countries.... The article concludes that it is necessary to draw more attention to old-age mortality, and to sex differentials in particular, since the size and relative weight of the elderly segment of the population continues to grow. Also, it seems to be necessary to include specific goals for old-age mortality in national health strategies aimed at reducing overall mortality and narrowing inequalities between social groups."

The uprooting of people, migration, and labor force experiences: Ecuador 1982 and 1990

"Moving beyond traditional theories of migration, this paper considers how actual economic, socio-political, and natural events impacted uprooting of people in Ecuador since the 1950s. Major eras of economic growth and economic devolution are represented by Census data for 1982 and 1990. Through these, individual labor force experiences of migrants and stayers, and gender differentials within each group, are considered. Uprooting of people persists forty to fifty years after events initiating its occurrence, and differentially impacts each population group. Gender differentials are noticeably significant among occupational sectors of employment, less so for economic sectors. Predominance and continual growth of informal activities also is apparent, a trend which impacts women more strongly." (SUMMARY IN GER)

Mortality patterns among elderly American Jews

"Mortality studies of ethnic and religious subgroups within a nation are of interest as they provide indicators of health differentials that may result from differences in life style and risk-factor exposures. The mortality experience of North American Jews has been documented over many years and is of particular interest because of the unusual pattern that has been observed, a crossover from relatively low rates at younger ages to relatively high rates at older ages. This study examines mortality in 1979-81 among more than 100,000 Medicare enrollees who held 22 surnames common among American Jews. The findings substantiate those of a recent mortality study of a Canadian Jewish population which indicated more rapid improvement in life expectancy among elderly Jewish than non-Jewish males, and a lessening of the relative disadvantage of elderly Jewish women."