[The female urologist in 2022, where are we?]

There are still significant disparities between the sexes even if we are now witnessing a feminization of the urological profession. Women's roles in historically male-dominated services still vary widely based on inherent gender biases. Interventions to minimize the gender gap in urology should not constitute a form of positive discrimination in favor of minorities but on the contrary a form of positive action to eliminate the obstacles present that block the acceptance of women or their promotion. Recognizing the factors responsible for gender disparities remains a key step towards improving equity in still male-dominated fields such as urology.

Differences in the Associations between Body Dissatisfaction and Eating Outcomes by Gender? A Lebanese Population Study

BACKGROUND

The objective of this study was to evaluate the impact of the interaction between body dissatisfaction and gender on eating disorders (restrained eating, binge eating, orthorexia nervosa, and emotional eating) among a sample of Lebanese adults.

METHODS

This cross-sectional study, conducted between January and May 2018, enrolled 811 participants selected randomly from all Lebanese Mohafazat. The mean age of the participants was 27.6±11.8 years. The majority were females (66.5%), had a high level of education (73.2%), and low income (77.9%). This study used the following scales: body dissatisfaction subscale of the Eating Disorder Inventory-second version, binge eating scale, Dutch restrained eating scale, orthorexia nervosa scale (ORTHO-15 scale), emotional eating scale, perceived stress scale, Hamilton Anxiety Rating Scale, and Hamilton Depression Rating Scale.

RESULTS

Body dissatisfaction was positively correlated to restrained eating (r=0.293, P<0.001), emotional eating (r=0.073, P=0.042) and binge eating (r=0.250, P<0.001). The interaction between body dissatisfaction and gender was significantly associated with more restrained eating (Beta=0.01, P<0.001) and orthorexia nervosa (Beta=-0.09, P<0.001), but not with emotional (Beta=-0.43, P=0.103) and binge eating (Beta=-0.08, P=0.358). When stratifying the analysis by gender, the results revealed that higher body dissatisfaction was significantly associated with more restrained eating in both genders, but particularly among women. Body dissatisfaction was significantly associated with higher emotional eating in men only and with higher orthorexia nervosa tendencies and behaviors in females only.

CONCLUSION

The interaction between body dissatisfaction and gender was significantly associated with orthorexia nervosa and restrained eating but not with binge or emotional eating. Higher body dissatisfaction was significantly associated with higher restrained eating, more pronounced in women, while it was significantly associated with higher orthorexia tendencies (lower ORTO-15 scores) in women only. Body dissatisfaction was associated with emotional eating in men only.

[Suicidal behaviors in migrant youths: Male experiences]

OBJECTIVES

Suicide is the second leading cause of death among adolescents. Boys are more affected than girls, although they report fewer suicide attempts and rely less on care. Few studies have examined the experience of suicidal thoughts and behavior among young boys. In order to improve their health care, it is necessary to consider the socio-cultural aspects and the construction of the meaning given by adolescent boys to suicidal behaviors in France.

METHOD

This is a qualitative, complementary and inductive study. All teens included have presented suicidal thoughts in the months preceding the inclusion. The existence of self-mutilation and/or suicidal act is sought but is not included within the criteria of inclusion, the various contexts will enrich the data. Semi-structured interviews are transcribed and analyzed by the Interpretative Phenomenological Analysis.

RESULTS

Ten adolescents between 14 and 20 years old were included in the study. Three axes of experience emerge: the relationship to oneself, the relationship to the other, the relationship to death. Some themes are common to experiences of both boys and girls, others are more specific to the boys' experience. The inner struggle, testing one's limits and an isolating unspeakable are thus common, highlighting the difficulty for adolescents to mentalize and verbalize emotions and feelings. Difficulties in connecting with others, and feelings of loneliness and isolation, are at the core of the participants' experience. However, the experience of boys appears specific in the difficulty to represent the irreversibility of death which can lead to suicidal behavior without direct intentionality. The narrative of suicidal acts, in its formulation, is quite different from that of young girls. One can assume that the difficulty of expressing suffering could lead young boys to develop a discourse that overshadows the question of their death, or in contrast magnifies it in a rewarding stage from which they pride themselves. The fear of being isolated or rejected seems almost insurmountable for the boys interviewed. The fear of the judgment of peers or the family is mixed with the imperative to face the problem by oneself and reinforces the feeling of isolation in a retroactive loop. The story of the suicidal act can take a positive and enriching tone in the participant's stories. This only applies to adolescents with a history of suicidal gesture. The experience of acting out and its consequences seems to be integrated by the adolescent as elements which participate to a certain extent to the construction of their identity. This ameliorative feature can be compared to the hegemonic social models of masculinity. The sociological notion of gender identity makes it possible to think of this construction in a dynamic way and to propose adaptations of the caregivers' attitude during the first interviews with a suicidal teenager. During the first meetings, the caregiver should explore the adolescent's representations of the suicidal crisis in a neutral, self-interested, and unbiased way, including when the representations are disturbing or shocking for the caregiver. For example, when the patient values or glorifies suicidal behavior or when care is experienced as a sign of weakness and vulnerability. Respect of these proposals can indeed support weakened narcissistic foundations and favor encounter and alliance. This can only be done with the conviction that these representations are not frozen, but in construction, and that they can be secondarily mobilized in the therapeutic relationship. For that purpose, a work of elaboration on the representations of the masculinity will be able to lead the young person to reconsider his perception of care and suicidal behaviors. Reflexivity on the part of the caregiver about his own representations of masculinity seems necessary.

CONCLUSION

Therapeutic management must explore and respect the adolescent's representations of masculinity and then mobilize them to bring the young person to reconsider his perception of care and suicidal behavior.

[Exercise-Associated Hyponatremia in Endurance Performance]

Exercise-Associated Hyponatremia in Endurance Performance Abstract. Exercise-associated hyponatremia is defined as a plasma sodium concentration of <135 mmol/l and was first described by Timothy Noakes at the Comrades Marathon in South Africa in the mid-1980s. A decrease in plasma sodium <135 mmol/l occurs with excessive fluid intake. Risk factors include long to very long endurance performance, extreme climatic conditions, female gender and competitions in the USA. Regarding its prevalence by sport, exercise-associated hyponatraemia tends to occur while swimming and running, but rarely when cycling. While mild exercise-associated hyponatremia does not lead to clinical symptoms, severe hyponatremia due to cerebral edema can lead to neurological deficits and even death. The best prevention of exercise-associated hyponatremia is the reduction of fluid intake during exercise.

Donor characteristics do not influence transfusion-related acute lung injury incidence in a secondary analysis of two case-control studies

OBJECTIVE

To investigate the relation between donor characteristics and TRALI incidence.

BACKGROUND

Transfusion-related acute lung injury (TRALI) is a potentially fatal complication of transfusion. In pre-clinical studies and several clinical studies, TRALI has been related to loss of product quality during red blood cell (RBC) storage, called the "storage lesion". Donor characteristics, as for example age, genetics and life style choices influence this "storage lesion". We hypothesized that donor sex, age and blood type is related to TRALI incidence.

METHODS/MATERIALS

We performed a secondary analysis of two cohort studies, designed to identify TRALI risk factors by matching TRALI patients to transfused controls. We obtained donor sex, age and blood type from the Dutch Blood Bank Sanquin and investigated TRALI incidence in patients who were exposed to a certain donor characteristic. We used Kruskal-Wallis testing to compare the number of transfused products and Chi² testing to compare proportions of TRALI patients and transfused control.

RESULTS

After implementation of the male-donor only plasma strategy, patients received more transfusion products from male donors. However, we did not detect a relation between TRALI incidence and donor sex. Both TRALI patients and transfused controls received mainly products from donors over 41 years old, but donor age did not influence TRALI risk. Donor blood type, the transfusion of blood type-compatible and blood type-matched products also had no influence on TRALI incidence.

CONCLUSION

We conclude that in two cohorts of TRALI patients, donor age, donor sex and donor blood type are unrelated to TRALI.

Temporal trends in clinical characteristics and management according to sex in patients with cardiogenic shock after acute myocardial infarction: The FAST-MI programme

BACKGROUND

Cardiogenic shock (CS) complicating acute myocardial infarction (AMI) occurs more frequently in women, but little is known about its potential specificities according to sex.

AIMS

To analyse the incidence, management and 1-year mortality of CS according to sex using the FAST-MI programme.

METHODS

The FAST-MI programme consists of four nationwide French surveys carried out 5 years apart from 1995 to 2010, including consecutive patients with AMI over a 1-month period, and with a 1-year follow-up.

RESULTS

Among the 10,610 patients included in the surveys, the incidence of CS was 4.8% in men and 8.2% in women (P<0.001). Absolute incidence of CS decreased from 1995 to 2010 in both sexes. Mean age in patients with CS tended to decrease in men (from 72±12 to 69±13 years) and to increase in women (from 78±10 to 80±9 years). One-year mortality decreased significantly in men (from 70% in 1995 to 48% in 2010) and in women (from 81% to 54%). Using Cox multivariable analysis, female sex was not an independent correlate of 1-year mortality [hazard ratio (HR): 0.98, 95% confidence interval (CI): 0.78-1.22]. Early use of percutaneous coronary intervention was, however, an independent predictor of 1-year survival in women (HR: 0.55, 95% CI: 0.37-0.81), but showed only a non-significant trend in men (HR: 0.85, 95% CI: 0.61-1.19).

CONCLUSIONS

The incidence of CS-AMI has decreased in both men and women, but remains higher in women. One-year mortality has significantly decreased for both men and women, and the role of early percutaneous coronary intervention as a potential mediator of decreased mortality seems greater in women than in men.

[Schizotypal Personality Questionnaire-Brief - Likert format: Factor structure analysis in general population in France]

INTRODUCTION

The main objective of the study was to explore the factorial structure of the French version of the Schizotypal Personality Questionnaire-Brief (SPQ-B) in a Likert format, in a representative sample of the general population. In addition, differences in the dimensional scores of schizotypy according to gender and age were analyzed. As the study in the general population of schizotypal traits and its determinants has been recently proposed as a way toward the understanding of aetiology and pathophysiology of schizophrenia, consistent self-report tools are crucial to measure psychometric schizotypy. A shorter version of the widely used Schizotypal Personality Questionnaire (SPQ-Brief) has been extensively investigated in different countries, particularly in samples of students or clinical adolescents, and more recently, a few studies used a Likert-type scale format which allows partial endorsement of items and reduces the risk of defensive answers.

METHOD

A sample of 233 subjects representative of the adult population from an urban area near Paris (Créteil) was recruited using the "itinerary method". They completed the French version of the SPQ-B with a 5-point Likert-type response format (1=completely disagree; 5=completely agree). We examined the dimensional structure of the French version of the SPQ-B with a Principal Components Analysis (PCA) followed by a promax rotation. Factor selection was based on Eigenvalues over 1.0 (Kaiser's criterion), Cattell's Scree-plot test, and interpretability of the factors. Items with loadings greater than 0.4 were retained for each dimension. The internal consistency estimate of the dimensions was calculated with Cronbach's α. In order to study the influence of age and gender, we carried out a simple linear regression with the subscales as dependent variables.

RESULTS

Our sample was composed of 131 women (mean age=52.5±18.2 years) and 102 men (mean age=53±18.1 years). SPQ-B Likert total scores ranged from 22 to 84 points (mean=43.6±13). Factor analysis resulted in a 3-factor solution that explained 47.7% of the variance. Factor 1 (disorganized; 10 items) included items related to "odd behavior", "odd speech", as well as "social anxiety", one item of "constricted affect" and one item of "ideas of reference". Factor 2 (interpersonal; 7 items) included items related to "no close friends", "constricted affect", and three of the items of "suspiciousness". Factor 3 (cognitive-perceptual; 5 items) included items related to "ideas of reference", "magical thinking", "unusual perceptual experiences" and one item of "suspiciousness". Coefficient α for the three subscales and total scale were respectively 0.81, 0.81, 0.77 and 0.88. We found no differences in total schizotypy and the three dimensions scores according to age and sex.

CONCLUSION

Factor analysis of the French version of the SPQ-B in a Likert format confirmed the three-factor structure of schizotypy. We found a pure cognitive perceptual dimension including the most representative positive features. As expected, "Suspiciousness" subscale is included in both positive and negative dimensions, but mainly in the negative dimension. Surprisingly, "social anxiety" subscale is included in the disorganized dimension in our analysis. The SPQ-B in a Likert format demonstrated good internal reliability for both total and subscales scores. Unlike previous published results, we did not find any influence of age or gender on schizotypal dimensions.

Gender-related differences in β-adrenergic receptor-mediated cardiac remodeling

Cardiac remodeling is the pathological basis of various cardiovascular diseases. In this study, we found gender-related differences in β-adrenergic receptor (AR)-mediated pathological cardiac remodeling. Cardiac remodeling model was established by subcutaneous injection of isoprenaline (ISO) for 14 days. Heart rate (HR), mean arterial pressure (MAP), and echocardiography were obtained on 7th and 14th days during ISO administration. Myocardial cross-sectional area and the ratio of heart mass to tibia length (HM/TL) were detected to assess cardiac hypertrophy. Picro-Sirius red staining (picric acid + Sirius red F3B) was used to evaluate cardiac fibrosis. Myocardial capillary density was assessed by immunohistochemistry for von Willebrand factor. Further, real-time PCR was used to measure the expression of β1-AR and β2-AR. Results showed that ISO induced cardiac remodeling, the extent of which was different between female and male mice. The extent of increase in cardiac wall thickness, myocardial cross-sectional area, and collagen deposition in females was less than that in males. However, no gender-related difference was observed in HR, MAP, cardiac function, and myocardial capillary density. The distinctive decrease of β2-AR expression, rather than a decrease of β1-AR expression, seemed to result in gender-related differences in cardiac remodeling.

[Negative prognostic impact of female gender on oncological outcomes following radical cystectomy]

OBJECTIVE

To confirm gender specific differences in pathologic factors and survival rates of urothelial bladder cancer patients treated with radical cystectomy.

PATIENTS AND METHODS

We conducted a retrospective monocentric study on 701 patients treated with radical cystectomy and pelvic lymphadenectomy for muscle invasive bladder cancer. Impact of gender on recurrence rate, specific and non-specific mortality rate were evaluated using Cox regression models in univariate and multivariate analysis.

RESULTS

We collected data on 553 males (78.9%) and 148 females (21.1%) between 1998 and 2011. Both groups were comparable at inclusion regarding age, pathologic stage, nodal status and lymphovascular invasion. Mean follow-up time was 45 months (interquartile 23-73) and by that time, 163 patients (23.3%) had recurrence of their tumor and 127 (18.1%) died from their disease. In multivariable Cox regression analyses, female gender was independently associated with disease recurrence (RR: 1.73; 95% CI 1.22-2.47; P=0.02) and cancer-specific mortality (RR=2.50, 95% CI=1.71-3.68; P<0.001).

CONCLUSION

We confirmed female gender to be an independent negative prognosis factor for patients following a radical cystectomy and lymphadenectomy for an invasive muscle bladder cancer.

[Women and acute coronary syndrome with ST elevation: Excess mortality related to longer delays and spontaneous coronary dissection]

The outcome of patients with ST elevation acute coronary syndrome (ACS) has been increasingly improving in the general population over the past few decades. However, detailed analysis of the results show that the reduction in mortality rates is higher in males compared to their female counterparts. The excess mortality rate observed in women, though sometimes questioned, has been widely reported in the literature. The higher mortality rate observed in women with ST elevation ACS can be explained by the presence of aggravating clinical factors such as older age, a higher percentage of diabetics, and a higher frequency of cardiogenic shock. Other factors pertaining to patient management seem to negatively impact the outcome. These factors include a lower use of reperfusion strategies, longer time to treatment mainly as a result of diagnostic uncertainty with respect to a disease, which is believed to affect principally the male gender. The doubts that female patients themselves and their families have about the nature of their symptoms are also present in the medical environment but cease to exist in the catheterization laboratory. This is illustrated in the first clinical case that we present here. Coronary reperfusion is the cornerstone of the therapeutic management of MI. In this context, bleeding complications associated with the implemented treatments can also result in an increased mortality rate in this more vulnerable population. When all the factors likely to influence the prognosis are taken into account, excess mortality seems to persist in women, especially in younger patients. As described in the second clinical case, a distinct physio-pathological factor, more frequent in women, could account for this higher mortality rate. Indeed, spontaneous coronary dissection and intramural hematoma are not always easy to diagnose and may not be adequately managed by reperfusion treatments. In addition, these coronary reperfusion strategies are probably not adapted to this type of ACS. It is, therefore, very important to identify them by angiography coupled with intra-coronary imaging examination when necessary and to carry out further research to adjust our PCI techniques to this pathology.

[Ten-year evolution in non-small-cell lung cancer according to sex. Results of the KBP-2010-CPHG study by the College of General Hospital Respiratory Physicians]

INTRODUCTION

Comparison by sex and presenting features between 2000 and 2010 of the characteristics of new cases of non-small-cell lung cancer (NSCLC).

METHODS

Observational KBP-2010-CPHG study similar to KBP-2000-CPHG. Both studies were promoted by the French College of General Hospital Respiratory Physicians (CPHG). KBP-2010-CPHG collected data for 6083 NSCLC diagnosed between January 1st and December 31st, 2010, and followed in the respiratory departments of 119 French general hospitals.

RESULTS

In 2010, 24.4 % of the patients were women (16 % in 2000, p<0.0001). Compared to men, women were more commonly non-smokers (34.2 vs 4.7 %) or lighter consumers (37.2 vs 43.7 pack per years) (p<0.0001). Their tumours (mostly adenocarcinoma: 64.6 vs 48.7 %, p<0.0001) were more frequently diagnosed at stage IV (62.4 vs 56.9 %, p=0.0008). EGFR mutation research was more frequently performed (48.5 vs 31.0 %, p<0.0001) and positive (20.6 vs 5.2 %, p<0.0001) in women than men. Their treatment more frequently included targeted therapy (13.4 vs 5.7 %, p<0.0001). Compared to 2000, the percentage of non-smokers increased in men (4.7 vs 2.5 %, p<0.0001) while remaining stable in women (36.1 vs 34.2 %, p=0.32). The percentage of adenocarcinomas increased, particularly in men (48.7 vs 31.5 %, p<0.0001).

CONCLUSIONS

The percentage of women with NSCLC has increased in 10years in France. In 2010, the main gender differences persist, but have decreased with the increasing proportion of non-smokers and adenocarcinomas in men. Various hypotheses to explain these changes are discussed.

[Acute myocardial infarction in women. Initial characteristics, management and early outcome. The FAST-MI registry]

AIM

To assess gender differences in characteristics, management, and hospital outcomes in patients participating in the French FAST-MI 2010 registry.

POPULATION

Three thousand and seventy-nine patients hospitalised for ST-elevation (STEMI) or non-ST-elevation (NSTEMI) myocardial infarction in 213 French centres during a 1-month period at the end of 2010.

RESULTS

Women account for 27% of the population and more frequently present with NSTEMI. They are 9 years older than men on average, although 25% of women with STEMI are less than 60 years of age. Management of STEMI is similar, after adjustment for baseline characteristics. However, fewer women are treated with primary percutaneous coronary angioplasty. In NSTEMI, although use of coronary angiography is similar, fewer women get treated with angioplasty. Most medications are used in a similar way in men and women, except thienopyridines, with fewer women receive prasugrel. After adjustment, in-hospital mortality is similar for men and women.

CONCLUSION

Myocardial infarction is not specific to men: one out of four patients admitted for myocardial infarction is a woman. Initial management is rather similar for men and women, after taking into account differences in baseline characteristics. Percutaneous coronary angioplasty, however, remains less frequently used in women. In-hospital complications have become rarer and do not differ according to sex.

[Characteristics of Dupuytren's disease in women. A study of 67 cases]

OBJECTIVES

The aim of this study was to identify the clinical differences of the Dupuytren's disease in gender. Testosterone induces an increase of the Dupuytren's fibroblast proliferation via androgen's receptors. Testosterone rate increases during pregnancy and menopausis. We also reached a link between this factors and the clinical aspects of Dupuytren' disease in the women of our study.

METHODS

This retrospective, comparative study was about all women and a randomized number of men, who underwent surgery for Dupuytren' disease between 1980 and 2010. We analysed all the epidemiologic and clinical data, the surgery procedures and the complications. Pre- and postoperative measurements of the extension lack of all the joints were performed with a manual goniometer. Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was used to evaluate the patients function. This specific data of women were reached.

RESULTS

Sixty-seven women and 69 men were compared. The complex regional pain syndrome was significantly more common in women and the correction of the proximal interphalangeal joint was significantly lower in women. Recurrence rate and mean follow up were not statistically different. Mean DASH score was higher in women. We have not found any association between menopausis, pregnancy and the average age at presentation of the disease, the recurrence rate or the extension rate.

CONCLUSIONS

The prognosis of the Dupuytren's disease is worse in women than in men. Other studies are necessary to reach the link between the testosterone and the clinical history of the disease in women.