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Are there gender differences in objective and subjective sleep measures? A study of insomniacs and healthy controls.

It is well known that insomnia is more frequent in women than in men throughout all age groups. In this respect insomnia resembles other psychiatric disorders that occur more frequently in women such as anxiety and depressive disorders. Since insomnia is frequently a symptom of anxiety and depression, it remains an open question whether the comorbidity with psychiatric disorders fully explains the gender differences in the prevalence of insomnia or whether gender influences sleep independently from psychiatric conditions. We analyzed sleep measures of patients diagnosed with a primary insomnia (n=86) and of an age- and sex-matched healthy control group (n=86) by polysomnography; additionally, subjective rating scales were available for 70 patients and 54 controls matched for mean age and sex ratio. Surprisingly, none of the sleep continuity measures (sleep duration, sleep efficiency, arousal index, and wake%), nor slow wave or REM sleep % showed significant gender differences in both insomniacs and healthy controls. Also, subjective estimates of sleep quality were comparable in both sexes. As expected, insomniacs strongly differed from the control group in all subjective measures of sleep. Polysomnography showed significantly reduced sleep duration and efficiency, increased arousal index, and slightly, but significantly, less REM sleep in the insomniacs as compared to the healthy controls. These studies indicate that gender seems to have, if any, relatively little influence on sleep per se. We hypothesize that the clear gender differences in the prevalence of insomnia are caused predominantly by gender differences in the prevalence of anxiety and depression. Primary insomnia may be, at least in a part of the cases, a subclinical or subthreshold form of anxiety or depression.

Adolescent↗

Gender differences in Axis I comorbidity among depressed outpatients.

OBJECTIVE: The aim of our study was to assess gender differences in Axis I comorbidity in patients with a primary diagnosis of Major Depressive Disorder (MDD), as well as gender differences in age of onset of MDD. METHODS: The presence of MDD, including age of onset, and of comorbid Axis I disorders were assessed in 396 depressed outpatients. RESULTS: Women were significantly more likely than men to meet criteria for comorbid bulimia nervosa and for simple phobia, while men were significantly more likely than women to meet criteria for lifetime history of alcohol abuse/dependence and other substance abuse/dependence. No other significant gender differences in those comorbid Axis I disorders examined were observed. In addition, the age of onset of the first episode of MDD was significantly lower in women than in men. CONCLUSIONS: Our findings are consistent with those of previous studies showing a greater prevalence of alcohol and substance abuse and dependence in men and of eating disorders in women.

Adolescent↗

A gender difference in visual-spatial ability in 4-year-old children: effects on performance of a kinesthetic acuity task.

Eighty 4-year-old children (40 boys and 40 girls) were tested on a kinesthetic acuity test (KAT), half in the presence of extra visual-spatial cues and half in the absence of these cues. All subjects were also tested on a three-dimensional block design test, a measure of visual-spatial ability. It was found that for both sexes KAT performance in the presence of the extra cues was superior to performance in their absence. In the presence of the cues boys performed significantly better than girls but when the extra cues were absent, the gender difference disappeared. There was a significant gender difference in performance on the block design test and a strong correlation between block design and KAT (with extra cues) performance for both sexes. When KAT cues were reduced, this correlation was substantially reduced. The results indicated that the gender difference in KAT performance found previously in the presence of extra visual-spatial cues was due to differential use of these cues rather than to a gender difference in kinesthetic acuity.

Attention↗

Gender differences in caregiving: fact or artifact?

This study applies meta-analysis techniques to the results of 14 descriptive studies of gender differences in caregiving to determine the size and significance of gender differences in caregiving stressors (level of elder impairment and level and type of task involvement) and in caregiver burden. There were essentially no significant gender differences in functional impairment of the frail care recipient, total caregiver involvement in care, or in money management tasks. Female caregivers were more likely to carry out personal care and household tasks and more likely to report greater burden. Given the relatively small size of the effects found, we conclude that future research should focus on the part that gender-role explanations play in assigning meaning to caregiving behaviors.

Caregivers↗

Gender differences in depression in primary care.

OBJECTIVES: To determine gender differences in the frequency and manifestation of depression in primary care. STUDY DESIGN: PRIME-MD, a new assessment tool, was tested in 1000 patients as an aid to diagnose depression in primary care patients. Answers to a self-assessment questionnaire completed by patients determined whether physicians administered the mood module in the Clinician Evaluation Guide to diagnose depression. Functional status was assessed with the Medical Outcomes Study Short Form (SF-20). RESULTS: More women than men were diagnosed as having a mood disorder (31% vs 19%; p < 0.01), and an antidepressant was newly prescribed only for women (p < 0.001). There were no gender differences in physician ratings of patients' health, but women rated their health significantly more poorly than did men. Similarly, functional impairment scores were significantly lower in women than in men. CONCLUSIONS: Women are much more likely than men to have depressive disorders, and when these disorders are diagnosed, to receive a prescription for antidepressant medication. Further research is needed to determine why women seem to suffer disproportionately from symptoms of depression and signs of functional impairment.

Antidepressive Agents↗

Gender differences in anxiety disorders and anxiety symptoms in adolescents.

Gender differences in anxiety were examined in a large sample of adolescents that included 1,079 who had never met criteria for any disorder, 95 who had recovered from an anxiety disorder, and 47 who had a current anxiety disorder. Participants were examined on a wide array of psychosocial measures. There was a preponderance of females among current and recovered anxiety disorder cases, but not among those who had never experienced an anxiety disorder. The female preponderance emerges early in life, and retrospective data indicate that at age 6, females are already twice as likely to have experienced an anxiety disorder than are males. Psychosocial variables that were correlated with both anxiety and gender were identified. Statistically controlling for these variables did not eliminate the gender differences in prevalence or anxiety symptom means.

Adolescent↗

Gender differences in the management and outcome of patients with acute coronary artery disease.

STUDY OBJECTIVE: s: To compare the clinical management and health outcomes of men and women after admission with acute coronary syndromes, after adjusting for disease severity, sociodemographic, and cardiac risk factors. DESIGN: Prospective national survey of acute cardiac admissions followed up by mailed patient questionnaire two to three years after initial admission. SETTING: Random sample of 94 district general hospitals in the UK. PATIENTS: 1064 patients under 70 years old recruited between April 1995 and November 1996. MAIN RESULTS: Of the 1064 patients recruited, 126 (11.8%) died before follow up. Of the 938 survivors, 719 (76.7%) completed a follow up questionnaire. There were no gender differences in the use of cardiac investigations during the index admission or follow up period. However, male patients with hypertension were more likely to undergo rehabilitation compared with female hypertensive patients (OR 2.01, 95% CI 0.85 to 4.72). Men were also more likely to undergo coronary artery bypass grafting (CABG) than women (OR 1.90, 95%CI 1.21 to 3.00), but there was no gender difference in the use of revascularisation overall (p=0.14). An indirect indication that the gender differences in CABG were not attributable to bias was provided by the lack of gender differences in health outcomes, which implies that patients received the care they needed. CONCLUSIONS: Despite the extensive international literature referring to a gender bias in favour of men with coronary heart disease, this national survey found no gender differences in the use of investigations or in revascularisation overall. However, the criteria used for selecting percutaneous transluminal coronary angioplasty compared with CABG requires further investigation as does the use of rehabilitation. It is unclear whether the clinical decisions to provide these procedures are made solely on the basis of clinical need.

Acute Disease↗

Identifying the relationship among mental status, functional independence and mobility level in Turkish institutionalized elderly: gender differences.

The purpose of this study was to examine gender differences in older people living at a rest home in terms of functional independence, mental status and mobility level and to describe the relationship among the three outcome variables. One hundred and thirty-three elderly people (60 women, 73 men), aged 65 years and above were included in the study. The average age was 75.3 +/- 6.7 years (range, 65-90 years). Mental status was assessed using the Hodkinson Mental Test (HMT). Functional independence was measured using Functional Independence Measurement (FIM). Mobility level was evaluated using the Rivermead Mobility Index (RMI). Elderly women had lower scores regarding all the outcome variables when compared to older men. The older men had higher cognitive performance than women. In addition, women were at low level of mobility and depended upon the daily living activities (p < 0.05). Both genders showed a significant negative correlation between mental status and functional independence or mobility level, while the correlation between functional independence and mobility level was significantly positive. The data showed that mental impairment decreases both functional status and mobility level of the institutionalized elderly people. Gender difference was found to be an important factor affecting the outcome variables of the study.

Activities of Daily Living↗

A developmental examination of gender differences in brain engagement during evaluation of threat.

BACKGROUND: Females appear to be more sensitive and responsive to social cues, including threat signals, than are males. Recent theoretical models suggest that developmental changes in brain functioning play important roles in the emergence of such gender differences. METHODS: We used functional magnetic resonance imaging to examine developmental and gender differences in activation of neural structures thought to mediate attention to emotional faces depicting varying degrees of threat. Analyses focused on the orbitofrontal cortex, amygdala, and anterior cingulate cortex during the evaluation of threat conveyed by faces. Healthy adolescents (n = 17; 53% male) and adults (n = 17; 53% male) were scanned while they rated how threatening pictures of neutral and emotional (angry, fearful, or happy) faces appeared. RESULTS: Results indicate significant interactions among age, gender, and face type for activation during explicit threat monitoring. In particular, adult women activated orbitofrontal cortex and amygdala selectively to unambiguous threat (angry) cues, while adult men showed a less discriminating pattern of activation. No gender differences were evident for adolescents, who as a group resembled adult males. CONCLUSIONS: These findings suggest that there are gender differences in patterns of neural responses to emotional faces that are not fully apparent until adulthood.

Adolescent↗

Gender differences in insulin action after a single bout of exercise.

Effects of a single exercise bout on insulin action were compared in men (n = 10) and women (n = 10). On an exercise day, subjects cycled for 90 min at 85% lactate threshold, whereas on a rest (control) day, they remained semirecumbent. The period of exercise, or rest, was followed by a 3-h hyperinsulinemic-euglycemic clamp (30 mU.m(-2).min(-1)) and indirect calorimetry. Glucose kinetics were measured isotopically by using an infusion of [6,6-2H2]glucose. Glucose infusion rate (GIR) during the clamp on the rest day was not different between the genders. However, GIR on the exercise day was significantly lower in men compared with women (P = 0.01). This was mainly due to a significantly lower glucose rate of disappearance in men compared with women (P = 0.05), whereas no differences were observed in the endogenous glucose rate of appearance. Nonprotein respiratory quotient (NPRQ) increased significantly during the clamp from preclamp measurements in men and women on the rest day (P < 0.01). Exercise abolished the increase in NPRQ seen during the clamp on the rest day and tended to decrease NPRQ in men. Our results indicate the following: 1) exercise abolishes the usual increase in NPRQ observed during a hyperinsulinemic-euglycemic clamp in both genders, 2) men exhibit relatively lower whole body insulin action in the 3-4 h after exercise compared with women, and 3) gender differences in insulin action may be explained by a lower glucose rate of disappearance in the men after acute exercise. Together, these data imply gender differences in insulin action postexercise exist in peripheral tissues and not in liver.

Adult↗

Gender differences on the mental rotations test: a factor analysis.

The purpose of the present study was to examine possible gender differences in strategy when completing the mental rotations test. Two experiments examined gender differences and the factor structure on outcomes that can be obtained on this test. Experiment 1 involved large groups testing and Experiment 2 used small groups. Factor analytic results in both experiments generally supported the notion that items with one wrong and one blank response or one correct and one blank reflect reluctance to guess, whereas one correct and one wrong or two wrong answers reflect propensity to guess. Even though the factor structure was the same in males and females, the data provided mitigated support for the hypothesis that males have a higher propensity to guess and females show a greater reluctance to guess. Findings are discussed in terms of their implications for the interpretation of gender differences on the MRT.

Adolescent↗

Are there gender differences in DSM-IV personality disorders?

This study examined gender differences in DSM-IV personality disorders (PD) in outpatients. Structured diagnostic interviews were reliably administered to a consecutive series of 145 outpatients with a primary axis I diagnosis of binge eating disorder (BED). To further reduce variability due to heterogeneity of axis I, a subgroup of 75 patients with co-occurring major depressive disorder (MDD) was retested for gender differences. Overall, the proportion of males (34.4%) and females (27.4%) diagnosed with any PD did not significantly differ. Specific PD diagnoses were not differentially distributed by gender in the overall study group of patients with BED or in the subgroup of patients with BED and MDD, except for antisocial PD in males.

Adult↗

Gender differences in mate selection preferences: a test of the parental investment model.

Evolutionary-related hypotheses about gender differences in mate selection preferences were derived from Triver's parental investment model, which contends that women are more likely than men to seek a mate who possesses nonphysical characteristics that maximize the survival or reproductive prospects of their offspring, and were examined in a meta-analysis of mate selection research (questionnaire studies, analyses of personal advertisements). As predicted, women accorded more weight than men to socioeconomic status, ambitiousness, character, and intelligence, and the largest gender differences were observed for cues to resource acquisition (status, ambitiousness). Also as predicted, gender differences were not found in preferences for characteristics unrelated to progeny survival (sense of humor, "personality"). Where valid comparisons could be made, the findings were generally invariant across generations, cultures, and research paradigms.

Female↗

Gender differences in tumor-induced anorectic feeding pattern in Fischer-344 rats.

Gender differences of feeding pattern in normal male and female rats are well recognized. Differences in gender-related feeding patterns have also been established following a variety of experimental manipulations, such as hypothalamic lesions, nicotine infusion, and total parenteral nutrition administration. Anorexia is a common feature during tumor growth. The present study examined whether the feeding indices constituting the feeding patterns differed with the development of cancer anorexia in male and female rats. Sixteen male and 15 female Fischer-344 rats had their food intake (FI) and feeding indices, meal number (MN) and meal size (MZ), continuously measured by a computerized rat eater meter. Viable methylcholanthrene (MCA) sarcoma cells (10(6)) were inoculated subcutaneously in 10 male (M-TB) and 8 female (F-TB) Fischer rats, while the rest were controls and received an equal volume of vehicle. Tumor-bearing (TB) rats became anorectic by Day 18, when the weight of the tumor was approximately 8% of the total body weight (BW). A notable decrease in BW was observed in both M-TB and F-TB. A decrease in FI resulted from different feeding indices between male and female rats. In male rats, lower FI was due to a decrease in both MN and MZ. In female rats, lower FI was solely due to a decrease in MN. The data show that gender differences in feeding patterns, which are an external manifestation of biochemical changes in the brain, occur following development of cancer-related anorexia suggesting that besides other factors, cancer anorexia is also influenced by sex-related hormones.

Animals↗

Gender differences in clinical outcome after coronary stenting.

OBJECTIVE: The purpose of this study was to determine the effect of gender differences in the clinical outcome of women and men submitted to coronary stenting at our institution. BACKGROUND: Studies regarding gender differences in outcome after invasive coronary interventions have revealed conflicting data regarding risk for complications. Some studies have pointed to female gender as a predictor of mortality and complications after those procedures. To our knowledge no such evaluation has been performed in our country. METHODS: We reviewed the medical records, cardiac catheterization and procedural data of 205 men and 122 women referred to our section that underwent coronary stenting at the Cardiovascular Center of Puerto Rico and the Caribbean from July 1, 1998 to March 30, 1999. The clinical and procedural characteristics and the immediate procedure-related complications were analyzed. Clinical events during the six-month period after the procedure were evaluated in patients that returned for follow-up to the section. Student's t-test or Mann-Whitney-Wilcoxon, when appropriate, was used to compare continuous data. The chi-square test or Fisher's exact test, was employed to compare categorical data. RESULTS: The initial procedural success and the frequency of early complications were comparable to those informed in the medical literature and not statistically significant between genders. The only statistically significant gender differences in outcome occurred in men who had higher re-hospitalization and re-intervention rates in the six-month period after the procedure. A lower mean ejection fraction and higher previous history of myocardial infarction and cigarette smoking in this group could have been related to the higher complication rate. CONCLUSION: Although the sample examined is small, its findings point to the need of a larger prospective study to further explore the possibility that the previously reported differences in outcome in men and women submitted to interventional procedures would have a stronger relation to clinical factors than to the direct effect of gender.

Cardiac Surgical Procedures↗

Gender differences in worry and associated cognitive-behavioral variables.

Research has shown that there is a significant gender difference in the worry report of women and men, with women often reporting more worry than men. The present study investigated this phenomenon by looking at gender differences in cognitive variables associated with worry; namely, intolerance of uncertainty, negative problem orientation, positive beliefs about worry, and cognitive avoidance. The sample consisted of 217 female and 100 male university students who completed six questionnaires assessing worry and associated cognitive variables. Women reported more worry than men on two measures of the tendency to worry, as well as more worries about lack of confidence issues. Women also reported a more negative problem orientation and engaging in more thought suppression, a type of cognitive avoidance. Thought suppression and negative orientation were found to make a significant contribution to the prediction of worry scores. Moreover, when both variables were controlled, the significant prediction of gender to worry disappeared. Hypotheses accounting for gender differences in thought suppression and negative problem orientation are discussed.

Adolescent↗

Gender differences in depression: the role of personality factors.

The goal of the study was to determine the association between gender and the Big Five personality factors, and to identify the role of personality factors in the association between gender and depression among adults in the United States. Data were drawn from the Midlife Development in the United States Survey (N=3032). Multivariate analysis of variance (MANOVA) was used to examine gender differences on the Big Five personality factors (i.e. agreeableness, neuroticism, openness to experience, extraversion, and conscientiousness). Multivariate logistic regression analyses were conducted to examine the relation between gender and depression, and to test whether this association is moderated by neuroticism. Levels of neuroticism, agreeableness, extraversion, and conscientiousness were significantly higher among females than among males; in contrast, level of openness to experience was significantly higher among males. Female gender was associated with increased odds of experiencing depression. Results showed that neuroticism played a significant contributory role in the relationship between being female and major depression, though the role of gender remained statistically significant after adjustment. These data suggest that gender differences in personality factors, specifically neuroticism, may play a key role in the well-documented gender difference in depression. Our findings indicate that neuroticism may moderate the association between female gender and increased risk of depression among adults. These findings require replication using longitudinal data.

Adult↗

Atrial fibrillation in elderly patients after coronary artery bypass grafting; gender differences in outcome.

OBJECTIVES: To evaluate gender-related differences in preoperative risk factors, hospital events, especially atrial fibrillation (AF), and length of stay in elderly patients undergoing isolated coronary artery bypass grafting (CABG). DESIGN: Prospectively collected data from consecutive patients undergoing isolated CABG in Tampere University Hospital between May 1999 and November 2000, in total 1131 patients. RESULT: We analysed 621 patients 65 years and older of whom 401 (65%) were male. When evaluating gender differences we found that the women were older (73 vs. 71 yrs, p<0.001) and significantly more often had hypertension (66% vs. 49%, p<0.001) and chronic heart insufficiency (11% vs. 4%, p=0.001). The NYHA classification of the women was worse (3.4 vs. 3.1, p<0.001) and in the angiographic data they had left main stenosis more often (31% vs. 21%, p=0.005) than the men. The women needed longer hospitalisation (19 vs. 15 days, p<0.001). There was no difference in the prevalence of postoperative AF between the genders, but in spite of that women had more postoperative strokes (6% vs. 3%, p=0.028) and also other major complications (29% vs. 19%, p=0.004) than the men. The 30-day mortality was higher in the female group (8% vs. 5%, p=0.06). We analysed preoperative risk factors and found that the females had a 1.6-fold risk for postoperative major complication after adjustment for age and other risk factors. In a logistic regression analysis age and the number of anastomoses emerged as independent predictors of AF in males, but in females we could not find any predictor for postoperative AF. CONCLUSIONS: The women are older and have more comorbidities and risk factors at the time of CABG. They also have more postoperative complications, but not a significantly higher mortality. Importantly, the excess of morbidity remains after adjustment for age and underlying risk factors. There is no gender difference in the incidence of postoperative AF in the elderly population. However, it seems to occur independent of age in the women only.

Age Factors↗