Are there sex differences in pain? For experimentally delivered somatic stimuli, females have lower thresholds, greater ability to discriminate, higher pain ratings, and less tolerance of noxious stimuli than males. These differences, however, are small, exist only for certain forms of stimulation and are affected by many situational variables such as presence of disease, experimental setting, and even nutritive status. For endogenous pains, women report more multiple pains in more body regions than men. With no obvious underlying rationale, some (...) painful diseases are more prevalent among females, others among males and, for many diseases, symptoms differ between females and males. Sex differences in attitudes exist that affect not only reporting, coping, and responses to treatment, but also measurement and treatment. So many variables are operative, however, that the most striking feature of sex differences in reported pain experience is the apparent overall lack of them. On the other hand, deduction from known biological sex differences suggests that these are powerful sex differences in the operation of pain mechanisms. First, the vaginal canal provides an additional route in women for internal trauma and invasion by pathological agents that puts them at greater risk for developing hyperalgesia in multiple body regions. Second, sex differences in temporal patterns are likely to give rise to sex differences in how pain is and stimuli are interpreted, a situation that could lead to a greater variability and wider range of pains without obvious peripheral pathology among females. Third, sex differences in the actions of sex hormones suggest pain-relevant differences in the operation of many neuroactive agents, opiate and nonopiate systems, nerve growth factor, and the sympathetic system. Thus, while inductive analysis of existing data demonstrate more similarities than differences in pain experience between females and males, deductive analysis suggests important operational sex differences in its production. (shrink)

Sex‐specific transcriptional and epigenomic profiles are detectable in the embryo very soon after fertilization. I propose that in male (XY) and female (XX) pre‐implantation embryos sex chromosomes establish sexually dimorphic interactions with the autosomes, before overt differences become apparent and long before gonadogenesis. Lineage determination restricts expression biases between the sexes, but the epigenetic differences are less constrained and can be perpetuated, accounting for dimorphisms that arise later in life. In this way, sexual identity is registered in the epigenome very (...) early in development. As development progresses, sex‐specific regulatory modules are harbored within shared transcriptional networks that delineate common traits. In reviewing this field, I propose that analyzing the mechanisms for sexual dimorphisms at the molecular and biochemical level and incorporating developmental and environmental factors will lead to a greater understanding of sex differences in health and disease. (shrink)

BACKGROUND: Hallucinations and delusions that complicate Parkinson’s disease could lead to nursing home placement and are linked to increased mortality. Cognitive impairments are typically associated with the presence of hallucinations but there are no data regarding whether such a relationship exists with delusions. OBJECTIVE: We hypothesized that hallucinations would be associated with executive and visuospatial disturbance. An exploratory examination of cognitive correlates of delusions was also completed to address the question of whether they differ from hallucinations. METHODS: 144 PD (...) subjects completed a neuropsychological battery to assess cognition and the SAPS to examine psychosis. Correlational analyses assessed associations between hallucinations and delusions with cognitive domains. RESULTS: 48 subjects reported psychotic symptoms: 25 experienced hallucinations without delusions, 23 had symptoms dominated by delusions. Severity and/or number of hallucination subtypes were significantly correlated with lower scores in language, memory, attention, executive functioning, and visuospatial ability. Correlations with delusions were non-significant. Tests of differences in the size of the correlations between groups revealed a significant relationship between language and visuospatial performance with hallucinations. CONCLUSIONS: Cognitive correlates of hallucinations and delusions appear to be different in PD, suggesting distinct pathogenic mechanisms and possibly anatomical substrates. Hence, delusions may not share the same associations with dementia as hallucinations. Since this is a new finding, further studies will be needed to confirm our results. (shrink)

SummaryThe variability of three behavioural risk factors for heart disease—heavy alcohol and tobacco consumption and physical inactivity—was assessed in an Australian Aboriginal community, where heart disease death rates were high. Prevalence levels were assessed by comparison with those experienced by all adult Australians and by evaluating whether Aboriginal rates were influenced by underlying sociodemographic conditions. Relative risk ratios, odds ratios and logistic regression analysis were used.A total of 159 males and 114 females participated. Compared to all Australians, (...) Aborigines are significantly more likely to drink five or more drinks on a drinking day, to be current smokers, and not to participate in vigorous exercise. In the Aboriginal community, univariate analysis indicates that: the odds of being a heavy drinker are significantly higher for those in unsatisfactory health; odds of being a current smoker are significantly higher for those in unsatisfactory health or unemployed; odds of not participating in vigorous exercise are significantly higher for those in unsatisfactory health, unemployed or without secondary education. Multivariate analysis shows that risk of being a heavy drinker is independently associated with sex, age, and health status; risk of being a current smoker is associated with health and employment status. The risk of not participating in vigorous exercise is significantly related to all sociodemographic variables examined. Reasons for these associations are discussed. (shrink)

The intensity and prevalence of viral infections are typically higher in males, whereas disease outcome can be worse for females. Females mount higher innate and adaptive immune responses than males, which can result in faster clearance of viruses, but also contributes to increased development of immunopathology. In response to viral vaccines, females mount higher antibody responses and experience more adverse reactions than males. The efficacy of antiviral drugs at reducing viral load differs between the sexes, and the adverse reactions (...) to antiviral drugs are typically greater in females than males. Several variables should be considered when evaluating male/female differences in responses to viral infection and treatment: these include hormones, genes, and gender‐specific factors related to access to, and compliance with, treatment. Knowledge that the sexes differ in their responses to viruses and to treatments for viral diseases should influence the recommended course of action differently for males and females.Editor's suggested further reading in BioEssays X‐chromosome‐located microRNAs in immunity: Might they explain male/female differences Abstract. (shrink)

Leg rigidity is associated with frequent falls in people with Parkinson’s disease, suggesting a potential role in functional balance and gait impairments. Changes in the neural state due to secondary tasks, e.g., activation maneuvers, can exacerbate rigidity, possibly increasing the risk of falls. However, the subjective interpretation and coarse classification of the standard clinical rigidity scale has prohibited the systematic, objective assessment of resting and activated leg rigidity. The pendulum test is an objective diagnostic method that we hypothesized would (...) be sensitive enough to characterize resting and activated leg rigidity. We recorded kinematic data and electromyographic signals from rectus femoris and biceps femoris during the pendulum test in 15 individuals with PD, spanning a range of leg rigidity severity. From the recorded data of leg swing kinematics, we measured biomechanical outcomes including first swing excursion, first extension peak, number and duration of the oscillations, resting angle, relaxation index, maximum and minimum angular velocity. We examined associations between biomechanical outcomes and clinical leg rigidity score. We evaluated the effect of increasing rigidity through activation maneuvers on biomechanical outcomes. Finally, we assessed whether either biomechanical outcomes or changes in outcomes with activation were associated with a fall history. Our results suggest that the biomechanical assessment of the pendulum test can objectively quantify parkinsonian leg rigidity. We found that the presence of high rigidity during clinical exam significantly impacted biomechanical outcomes, i.e., first extension peak, number of oscillations, relaxation index, and maximum angular velocity. No differences in the effect of activation maneuvers between groups with clinically assessed low rigidity were observed, suggesting that activated rigidity may be independent of resting rigidity and should be scored as independent variables. Moreover, we found that fall history was more common among people whose rigidity was increased with a secondary task, as measured by biomechanical outcomes. We conclude that different mechanisms contributing to resting and activated rigidity may play an important yet unexplored functional role in balance impairments. The pendulum test may contribute to a better understanding of fundamental mechanisms underlying motor symptoms in PD, evaluating the efficacy of treatments, and predicting the risk of falls. (shrink)

Our goal was to explore self‐care practices among men who have sex with men in the context of Mpox in Brazil. This study used qualitative research methods, including interviews and thematic analysis, to collect and analyze data from male participants across the Brazilian territory. The narratives unveil men's perspectives on self‐care, risk reduction, and health beliefs during the Mpox pandemic. Our findings highlight a multifaceted approach to self‐care among men, encompassing hygiene, physical contact management, mask usage, skin lesion vigilance, and (...) adherence to official guidelines. Men's attitudes toward sexual behaviors emphasize the importance of reducing sexual partners, practicing safe sex, and combating misinformation through accurate information dissemination. The development of these behaviors and self‐care practices can be facilitated by nurses guided by Dorothea Orem's Self‐Care Theory, supported by patient‐centered care, with strategies to address and confront the stigma associated with the disease and provide emotional support. Thus, the study underscores the pivotal role of self‐care in mitigating infection risks, especially in the context of emerging infectious diseases. It acknowledges the impact of socio‐cultural factors and healthcare policies on men's preventive measures. However, it also recognizes limitations, such as potential bias due to stigma concerns and a nonrepresentative sample. Ultimately, the research advocates for tailored education, promotion of gender equity, and healthcare empowerment to effectively manage health risks in such contexts. (shrink)

Our understanding of gender carries significant bioethical implications. An errant account of gender-specific disease can lead to overgeneralizations, undergeneralizations, and misdiagnoses. It can also lead to problems in the structure of health-care delivery, the creation of policy, and the development of clinical curricula. In this volume, Cutter argues that gender-specific disease and related bioethical discourses are philosophically integrative. Gender-specific disease is integrative because the descriptive roles of gender, disease, and their relation are inextricably tied to their (...) prescriptive roles within frames of reference. An integrative account of gender-specific disease carries ethical implications because our understanding of gender-specific disease is evaluative, and our evaluations of gender-specific disease entail judgments concerning the praiseworthiness and blameworthiness of a clinical event. Cutter supports a "both/and" emphasis on context and integration in relation to gender-specific disease and bioethical analyses. While the text mainly focuses on gender-specific diseases that affect women, Cutter also includes examples involving men, children, and members of the LGBT community. (shrink)

The evidence favoring sex differences in pain seems compelling (berkley). This commentary considers the role of such factors as anxiety, somatosensory amplification, and coping style in accounting for the differential response to pain in the laboratory and clinic, and emphasizes the need to base evaluation and treatment upon individual reports rather than gender-based stereotypes.

Determining Risk Factors and Demographic Patterns of Suicide in Tehran Suicide refers to the death of a person that is primarily achieved by self-harm. Today, it is considered one of the major public health issues. One of the important risk factors associated with attempted suicide is social relations. This study is a descriptive and analytical study that aims to identify the suicide rate, the risk factors in suicide, and the methods of suicide. The findings show that there (...) is a significant relationship between suicide and demographic variables that include age, sex, educational level, adherence to religion, and occupation. This research also shows the psychological factors that lead to suicide include depression, addiction, lack of social activities, and mental disorders caused by chronic disease. (shrink)

Vigil's socio-relational framework of sex differences in emotion-expressive behavior has a number of interesting aspects, especially the principal concepts of reciprocity potential and perceived attractiveness and trustworthiness. These are attractive and potentially heuristic ideas. However, some of his arguments and claims are not well grounded in research on early development. Three- to five-year-old children did not show the sex differences in emotion-expressive behavior discussed in the target article. Our data suggest that Vigil may have underestimated the roles of epigenetic and (...) cultural factors in shaping emotion-expressive behavior. (shrink)

The COVID-19 pandemic has caused a global societal, economic, and social upheaval unseen in living memory. There have been substantial cross-national differences in the kinds of policies implemented by political decision-makers to prevent the spread of the virus, to test the population, and to manage infected patients. Among other factors, these policies vary with politicians’ sex: early findings indicate that, on average, female leaders seem more focused on minimizing direct human suffering caused by the SARS-CoV-2 virus, while male leaders (...) implement riskier short-term decisions, possibly aiming to minimize economic disruptions. These sex differences are consistent with broader findings in psychology, reflecting women’s stronger empathy, higher pathogen disgust, health concern, care-taking orientation, and dislike for the suffering of other people—as well as men’s higher risk-taking, Machiavellianism, psychopathy, narcissism, and focus on financial indicators of success and status. This review article contextualizes sex differences in pandemic leadership in an evolutionary framework. Evolution by natural selection is the only known process in nature that organizes organisms into higher degrees of functional order, or counteracts the unavoidable disorder that would otherwise ensue, and is therefore essential for explaining the origins of human sex differences. Differential sexual selection and parental investment between males and females, together with the sexual differentiation of the mammalian brain, drive sex differences in cognition and behavioral dispositions, underlying men’s and women’s leadership styles and decision-making during a global pandemic. According to thesexually dimorphic leadership specialization hypothesis, general psychobehavioral sex differences have been exapted during human evolution to create sexually dimorphic leadership styles. They may be facultatively co-opted by societies and/or followers when facing different kinds of ecological and/or sociopolitical threats, such as disease outbreaks or intergroup aggression. Early evidence indicates that against the invisible viral foe that can bring nations to their knees, the strategic circumspection of empathic feminine health “worriers” may bring more effective and humanitarian outcomes than the devil-may-care incaution of masculine risk-taking “warriors”. (shrink)

Background: Informed consent in clinical research is mandated throughout the world. Both patient subjects and investigators are required to understand and accept the distinction between research and treatment.Aim: To document the extent and to identify factors associated with therapeutic misconception in a population of patient subjects or parent proxies recruited from a variety of multicentre trials .Patients and methods: The study comprised two phases: the development of a questionnaire to assess the quality of informed consent and a survey of (...) patient subjects based on this questionnaire.Results: A total of 303 patient subjects or parent proxies were contacted and 279 questionnaires were analysed. The median age was 49.5 years, sex ratio was 1 and 61% of respondents were professionally active. Overall memorisation of the oral or written communication of informed consent was good , and satisfaction with the process was around 70%. Therapeutic misconception was present in 70% of respondents, who expected to receive better care and ignored the consequence of randomisation and treatment comparisons. This was positively associated with the acuteness and severity of the disease.Conclusion: The authors suggest that the risk of therapeutic misconception be specifically addressed in consent forms as an educational tool for both patients and investigators. (shrink)

Major depression etiopathogenesis is related to a wide variety of genetics, demographic and psychosocial factors, as well as to environmental factors. The objective of this study is to analyze sociodemographic and environmental variables that are related to the prevalence of depression through correlation analysis and to develop a regression model that explains the behavior of this disease from an ecological perspective. This is an ecological, retrospective, cross-sectional study. The target population was 1,148,430 individuals over the age of (...) 16 who were registered in Aragon (Spain) during 2010, with electronic medical records in the community’s primary health care centers. The spatial unit was the Basic Health Area (BHA). The dependent variable was the diagnosis of Depression and the ecological independent variables were: Demographic variables (gender and age), population distribution, typology of the entity, population structure by sex and age, by nationality, by education, by work, by salary, by marital status, structure of the household by number of members, and state of the buildings. The results show moderate and positive correlations appear with higher rates of depression in areas having a higher femininity index, higher population density, areas with a higher unemployment rate and higher average salary. The results of the linear regression show that aging +75 and rural entities act as protective factors for depression, while urban areas and deficient buildings act as risk factors. In conclusion, the ecological methodology may be a useful tool which, together with the statistical epidemiological analysis, can help in the political decision making process. (shrink)

Cardiovascular disease is the leading cause of death of women in the United States, yet cardiovascular research is disproportionately conducted using male human subjects and male animal models. This article deploys Katrina Hutchison’s (2019) analysis of gender disparity in clinical trials as a moral aggregation problem to address the problem of underrepresentation of women in cardiovascular research. I identify cost concerns, convenience, pregnancy, and negligence as potential reasons for the underrepresentation of women in CVD research. Finally, I suggest that (...) multilevel strategies will be needed to eliminate sex disparity in CVD research and improve patient care. (shrink)

Recent research has shown that psychological risk factors play an important role in the pathogenesis of cardiovascular diseases. The so-called coronary prone behaviour pattern predominates, an important part of which is the Type A behaviour pattern. This is characterized by a marked ambition, a constant feeling of being under pressure, due to latent aggression and to a striving to dominate. For cerebrovascular diseases the so-called pressured pattern as a risk factor has been found to be typical which is comparable (...) to the Type A behaviour. Psychological risk factors and their components are not equally important for different vascular diseases. Besides the explanation of the question as to how far psychological processes really are involved in the development of vascular diseases, the research on psychological risk factors serves as a foundation for psychosomatic theories. (shrink)

BackgroundSexual minority (SM) older adults experience mental health disparities. Psychiatric disorders and neuropsychiatric symptoms (NPS) are risk factors for cognitive decline. Although older people in same-sex (SSR) compared to mixed-sex relationships (MSR) perform more poorly on cognitive screening tests, prior studies found no differences in rates of dementia diagnosis or neuropsychological profiles. We sought to explore the role of NPS on neurocognitive outcomes for SM populations. We compared cognitive performance and structural brain parameters of older adults in SSR and (...) MSR.MethodsData were originally collected at Alzheimer's Disease Research Centers (ADRCs). Inclusion criteria were: age of 55+ years, a study partner identified as a spouse/partner, and availability of T1-MRI brain volumes/thickness. Participants were labeled as either SSR or MSR based on their/their co-participant's reported sex. We identified 1,073 participants (1,037 MSR−555 cognitively unimpaired [CU]; 36 SSR−23 CU) with structural MRI data, Mini-Mental State Exam (MMSE), and Neuropsychiatric Inventory Questionnaire (NPI-Q) scores. A subset of the overall sample completed comprehensive neuropsychological assessment (n = 939; 908 MSR−494 CU; 31 SSR−22 CU). Covariates included in statistical models were age, sex, education, total intracranial volume, and apolipoprotein E genotype.ResultsMultivariate general linear models showed significant diagnosis-by-relationship interaction effects on the left parahippocampal gyrus volume. After stratification by relationship group, only cognitively impaired (CI) MSR had significantly smaller left parahippocampal volumes than MSR-CU. The SSR group showed better episodic memory performance. Severity of neuropsychiatric symptoms was negatively associated with volume/thickness of bilateral fronto-temporal areas and with MMSE scores, predominantly in the MSR group.ConclusionIn our study, MSR participants presented with a more compromised cognitive profile than SSR participants. MSR-CI participants showed significantly smaller left medio-temporal volumes, a neural signature of AD. Neuropsychiatric symptoms predicted smaller fronto-temporal volumes in the MSR more consistently than in the SSR group. These findings may be due to unexplored protective factors against cognitive decline in SM elders. Indeed, social support has been proposed as a protective factor warranting future investigation. (shrink)

Several hundred thousand intellectually talented 12-to 13-year-olds have been tested nationwide over the past 16 years with the mathematics and verbal sections of the Scholastic Aptitude Test (SAT). Although no sex differences in verbal ability have been found, there have been consistent sex differences favoring males in mathematical reasoning ability, as measured by the mathematics section of the SAT (SAT-M). These differences are most pronounced at the highest levels of mathematical reasoning, they are stable over time, and they are observed (...) in other countries as well. The sex difference in mathematical reasoning ability can predict subsequent sex differences in achievement in mathematics and science and is therefore of practical importance. To date a primarily environmental explanation for the difference in ability has not received support from the numerous studies conducted over many years by the staff of Study of Mathematically Precocious Youth (SMPY) and others. We have studied some of the classical environmental hypotheses: attitudes toward mathematics, perceived usefulness of mathematics, confidence, expectations/ encouragement from parents and others, sex-typing, and differential course-taking. In addition, several physiological correlates of extremely high mathematical reasoning ability have been identified (left-handedness, allergies, myopia, and perhaps bilateral representation of cognitive functions and prenatal hormonal exposure). It is therefore proposed that the sex difference in SAT-M scores among intellectually talented students, which may be related to greater male variability, results from both environmental and biological factors. (shrink)

Cardiovascular disease is the leading cause of death of women in the United States, yet cardiovascular research is disproportionately conducted using male human subjects and male animal models. This article deploys Katrina Hutchison’s (2019) analysis of gender disparity in clinical trials as a moral aggregation problem to address the problem of underrepresentation of women in cardiovascular research. I identify cost concerns, convenience, pregnancy, and negligence as potential reasons for the underrepresentation of women in CVD research. Finally, I suggest that (...) multilevel strategies will be needed to eliminate sex disparity in CVD research and improve patient care. (shrink)

Background: We previously showed, by means of an online-based survey, that the belief of being infected by coronavirus disease 2019 acted as a nocebo and predicted higher perception of symptoms similar to COVID-19 symptoms. However, there is little known about the psychological mechanisms that give rise to beliefs such as certainty of being infected by COVID-19, and this was investigated in the present study.Objective: Using the same data from the previous online survey with the same research team, we further (...) investigated whether certainty of being infected by COVID-19 is associated with age, sex, health anxiety, and/or personality traits.Methods: Respondents filled out an online survey with 57 questions about symptoms similar to COVID-19, certainty of being infected by COVID-19, anxiety, stress, health anxiety, and personality dimensions.Results: Higher levels of conscientiousness and health anxiety were independently associated with certainty of being infected by COVID-19. The model predicted 29% of the variance in certainty of being infected by COVID-19.Conclusion: Being conscientious and worried about health issues were associated with the belief of being infected by COVID-19. Such finding may have implications for health care personnel who provide COVID-19 testing or consulting services to general population, as individuals high in these traits may over-report COVID-like symptoms. Theoretically, these findings point to psychological factors that may increase nocebo and possibly placebo effects. Clinically, the findings suggest that individuals high in conscientiousness and health anxiety may be more likely to over-report their bodily experiences. (shrink)

The relation between testosterone levels and aggressive behavior is well established. From an evolutionary viewpoint, testosterone can explain at least part of the sex differences found in aggressive behavior. This explanation, however, is mediated by factors such as prenatal testosterone levels and basal levels of cortisol. Especially regarding sex differences in aggression during adolescence, these mediators have great influence. Based on developmental brain structure research we argue that sex differences in aggression have a pre-pubertal origin and are maintained during (...) adolescence. Evidence of prenatal, adolescent, and adult levels of testosterone in relation to aggression taken together, support Archer's argument for sexual selection as the driver of sex differences in aggression. (shrink)

Sex is a fundamentally important biological variable. Recent years have seen significant progress in the integration of sex in many aspects of basic and clinical research, including analyses of sex differences in brain function. Significant advances in the technology available for studying the endocrine and nervous systems are now coupled with a more sophisticated awareness of the interconnections of these two communication systems of the body. A thorough understanding of the current knowledge, conceptual approaches, methodological capabilities, and challenges is a (...) prerequisite to continued progress in research and therapeutics in this interdisciplinary area. Sex Differences in the Brain provides scientists with the basic tools for investigating sex differences in brain and behavior and insight into areas where important progress in understanding physiologically relevant sex differences has already been made. This book was edited and co-authored by members of the Isis Fund Network on Sex, Gender, Drugs and the Brain, sponsored by the Society for Womens Health Research. The book is arranged in three parts. The first part of the book introduces the study of sex differences in the brain, with an overview of how the brain, stress systems, and pharmacogenetics differ in males and females and how this information is important for the study of behavior and neurobiology of both genders. The second part presents examples of sex differences in neurobiology and behavior from both basic and clinical research perspectives, covering both humans and nonhuman animals. The final part discusses sex differences in the neurobiology of disease and neurological disorders. For interested individuals as well as those who are considering conducting research at the intersections of endocrinology, neuroscience, and other areas of biomedicine, the study of sex differences offers exciting and challenging questions and perspectives. This book is intended as a guide and resource for clinicians, scientists, and students. (shrink)

ABSTRACT The public controversy over sex‐based differentials in insurance pricing makes heavy use of terms like ‘fairness’ and ‘discrimination’; in particular, both sides argue that their position is the one dictated by considerations of fairness. Appeal to a basic principle of distributive justice shows that these differentials are not fair. Nevertheless, there is a substantial ethical argument to be made for the industry's status quo, based on the liberty of the low‐risk insurees. The paper considers an alternative reform proposal, with (...) a qualitatively different freedom cost; seven factors are then identified as useful in evaluating the trade‐off between the freedom and justice at stake in any questionable insurance classification variable. A brief concluding section attempts to generalise this analysis to provide a broad framework for the analysis of other discrimination issues. (shrink)

Why do the two sexes have different lifespans and rates of aging? Two hypotheses based on asymmetric inheritance of sex chromosomes (“unguarded X”) or mitochondrial genomes (“mother's curse”) explain sex differences in lifespan as sex‐specific maladaptation leading to increased mortality in the shorter‐lived sex. While asymmetric inheritance hypotheses equate long life with high fitness, considerable empirical evidence suggests that sexes resolve the fundamental tradeoff between reproduction and survival differently resulting in sex‐specific optima for lifespan. However, selection for sex‐specific values in (...) life‐history traits is constrained by intersexual genetic correlations resulting in intra‐locus sexual conflict over optimal lifespan. The available data suggest that the evolution of sexual dimorphism only partially resolves these conflicts. Sexual conflict over optimal trait values, which has been demonstrated in model organisms and in humans, is likely to play a key role in shaping the evolution of lifespan, as well as in maintaining genetic variation for sex‐specific diseases. (shrink)

I argue that ductal carcinoma in situ (DCIS), the tumor most commonly diagnosed by breast mammography, cannot be confidently classified as cancer, that is, as pathological. This is because there may not be dysfunction present in DCIS—as I argue based on its high prevalence and the small amount of risk it conveys—and thus DCIS may not count as a disease by dysfunction-requiring approaches, such as Boorse’s biostatistical theory and Wakefield’s harmful dysfunction account. Patients should decide about treatment for DCIS (...) based on the risks it poses and the risks and benefits of treatment, not on its disease status. (shrink)

In describing and explaining the sexes, medicine and science participated in the delineation of what was "feminine" and what was "masculine" in the Middle Ages. Hildegard of Bingen and Albertus Magnus, among others, writing about gynecology, the human constitution, fetal development, or the naturalistic dimensions of divine Creation, became increasingly interested in issues surrounding reproduction and sexuality. Did women as well as men produce procreative seed? How did the physiology of the sexes influence their healthy states and their susceptibility to (...) disease? Who derived more pleasure from sexual intercourse, men or women? The answers to such questions created a network of flexible concepts which did not endorse a single model of male-female relations, but did affect views on the health consequences of sexual abstinence for women and men and on the allocation of responsibility for infertility - problems with much social and religious significance in the Middle Ages. Sometimes at odds with, and sometimes in accord with other forces in medieval society, medicine and natural philosophy helped to construct a set of notions that divided significant portions of the world - from the behavior of animals to the operations of astrological signs - into "masculine" and "feminine." Even cases that seemed to exist outside the definitions of this duality, for example, hermaphrodite features or homosexual behavior, were brought under control by the application of gendered labels, such as "masculine women.". (shrink)

Should we use human germline genome modification only when serious diseases are involved? This belief is the underlying factor in the article written by Kleiderman, Ravitsky and Knoppers to which I now respond. In my opinion, the answer to this question should be negative. In this paper, I attempt to show that there are no good reasons to think that this technology should be limited to serious diseases once it is sufficiently proven to be safe and efficient. In fact, opting (...) otherwise would negatively harm human beings’ right to the highest standard of health that unmodified embryos could promote. Therefore, the issue should not be so much to define adequately what a serious disease is, but rather to elucidate whether this concept should play any role beyond the context of preimplantation genetic testing. This paper argues that we should not accept the similarity between technologies such as PGT and HGGM because they face different challenges and offer totally different possibilities. Therefore, we are in urgent need to build a completely new ethical architecture that covers the application of germline editing in human embryos. As a part of that process, a much deeper debate on the necessity of distinguishing different disease types is required. (shrink)

Sex is determined by non‐Mendelian genetic elements overriding the sex factors carried by the heterochromosomes in some species of terrestrial isopods. A bacterium Wolbachia and a non‐bacterial feminizing factor (f) can both force chromosomal males of Armadillidium vulgare to become phenotypic functional females. The f factor is believed to be a genetic element derived from the Wolbachia genome that becomes inserted into the host nuclear genome. The feminizing factors can be considered to be selfish genetic elements because they (...) bias their host's sex ratio to increase their own transmission. New sex‐determining genes are selected (genes resisting the feminizing effects, or the transmission of feminizing elements) as a consequence of the conflict between these elements and the rest of the host's genome. These events drive the sex‐determining mechanisms to evolve, and may explain the polymorphism of sex factors and the poor differentiation of the heterochromosomes in isopods. (shrink)

There is a profound paradox in modern medical knowledge production: The more we know, the more we know that we (still) do not know. Nowhere is this more visible than in diagnostics and early detection of disease. As we identify ever more markers, predictors, precursors, and risk factors of disease ever earlier, we realize that we need knowledge about whether they develop into something experienced by the person and threatening to the person’s health. This study investigates how (...) advancements in science and technology alter one type of uncertainty, i.e., temporal uncertainty of disease diagnosis. As diagnosis is related to anamnesis and prognosis it identifies how uncertainties in all these fields are interconnected. In particular, the study finds that uncertainty in disease diagnosis has become more subject to prognostic uncertainty because diagnosis is more connected to technologically detected indicators and less closely connected to manifest and experienced disease. These temporal uncertainties pose basic epistemological and ethical challenges as they can result in overdiagnosis, overtreatment, unnecessary anxiety and fear, useless and even harmful diagnostic odysseys, as well as vast opportunity costs. The point is not to stop our quest for knowledge about disease but to encourage real diagnostic improvements that help more people in ever better manner as early as possible. To do so, we need to pay careful attention to specific types of temporal uncertainty in modern diagnostics. (shrink)

The argument of berkley for the existence sex differences in pain is based on biological factors. We suggest that the psychological evidence for such differences is more substantial.

In many species of reptiles, sex is determined at fertilization by zygotic sex chromosome composition. In other species, including all crocodilians, most turtles and some lizards, sex is determined by temperature during the earlier stages of gonadal differentiation. The effects of exogenous estrogens, antiestrogens and aromatase inhibitors at different temperatures have unambiguously demonstrated the involvement of estrogens in sexual differentiation of the gonads. Aromatase is the enzyme that converts androgens to estrogens. Gonadal aromatase activity is well correlated with gonadal structure. (...) It increases exponentially in differentiating ovaries, whereas it remains low in differentiating testes. Moreover, there is a high correlation between the thermosensitive periods for both ovary differentiation and increase in aromatase activity. We suggest that a thermosensitive factor intervenes, directly or indirectly, in the transcriptional regulation of the aromatase gene in reptiles with temperature‐dependent sex determination. (shrink)

Current advances in assisted reproductive technologies aim to promote the health and well-being of future children. They offer the possibility to select embryos with the greatest potential of being born healthy (eg, preimplantation genetic testing) and may someday correct faulty genes responsible for heritable diseases in the embryo (eg, human germline genome modification (HGGM)). Most laws and policy statements surrounding HGGM refer to the notion of ‘serious’ as a core criterion in determining what genetic diseases should be targeted by these (...) technologies. Yet, this notion remains vague and poorly defined, rendering its application challenging and decision making subjective and arbitrary. By way of background, we begin by briefly presenting two conceptual approaches to ‘health’ and ‘disease’: objectivism (ie, based on biological facts) and constructivism (ie, based on human values). The basic challenge under both is sorting out whether and to what extent social and environmental factors have a role in helping to define what qualifies as a ‘serious’ disease beyond the medical criteria. We then focus on how a human rights framework (eg, right to science and right to the highest attainable health) could integrate the concepts of objectivism and constructivism so as to provide guidance for a more actionable consideration of ‘serious’. Ultimately, it could be argued that a human rights framework, by way of its legally binding nature and its globally accepted norms and values, provides a more universal foundation for discussions of the ethical, legal and social implications of emerging or disruptive technologies. (shrink)

Sex differences in mortality rates stem from genetic, physiological, behavioral, and social causes that are best understood when integrated in an evolutionary life history framework. This paper investigates the Male-to-Female Mortality Ratio (M:F MR) from external and internal causes and across contexts to illustrate how sex differences shaped by sexual selection interact with the environment to yield a pattern with some consistency, but also with expected variations due to socioeconomic and other factors.

Multiple drug resistant strains of HIV and continuing difficulties with vaccine development highlight the importance of psychologi- cal interventions which aim to in uence the psychosocial and emo- tional factors empirically demonstrated to be significant predictors of immunity, illness progression and AIDS mortality in seropositive persons. Such data have profound implications for psychological interventions designed to modify psychosocial factors predictive of enhanced risk of exposure to HIV as well as the neuroendocrine and immune mechanisms mediating the impact of (...) such factors on disease progression. Many of these factors can be construed as unconscious mental ones, and psychoanalytic self-psychology may be a useful framework for conceptualizing psychic and immune de- fence as well as bodily and self-integration in HIV infection. Al- though further prospective studies and cross-cultural validation of research are necessary, existing data suggest that psychoanalytic insights may be useful both in therapeutic interventions and evaluative research which would require an underlying epistemology of the complementarity of mind and matter. (shrink)

Can mammalian mothers adaptively control the sex of their offspring? The influential Trivers-Willard hypothesis proposes that when maternal condition increases the fitness of sons more than that of daughters, the proportion of sons produced should increase with maternal condition. Studies of mammals, however, often fail to support this hypothesis. This article highlights recent advances, including studies on the assumptions of the TWH and physiological mechanisms for sex-ratio manipulation. Particular emphasis is placed on how factors such as paternal quality, maternal (...) reproductive costs and environmental conditions experienced by mothers early in life can mask/alter the expected relationship between maternal condition and offspring sex ratio or lead to apparent support for the TWH. While there is growing evidence that sex ratio around conception may be maternally and paternally manipulated, a challenge for future studies on sex allocation is to integrate how multiple and potentially opposite selective pressures affect offspring sex ratio. The relationship between offspring sex and maternal condition lies at the heart of one of the most controversial hypotheses in evolutionary biology. This review highlights recent findings on the Trivers-Willard hypothesis with particular emphasis on factors which may mask the relationship of interest or falsely demonstrate it. (shrink)

Sexual selection provides an adequate partial explanation for the difference in means between the distributions, but fails to explain the difference in variance, that is, the overrepresentation of both boys with outstanding mathematical reasoning ability and boys with mental retardation. Other genetic factors are probably at work. While spatial ability is correlated with OMRA, so are other cognitive abilities. OMRA is not reducible to spatial ability; hence selection for navigational skill is unlikely to be the only mechanism by which (...) males have gained an advantage in OMRA. (shrink)

Using Australian records of human births for the first six decades of the twentieth century, the proportions of male and female births are studied in relation to the mother's age, the father's age, the parents' ages in combination, and certain other factors. The principal data used relate to the years 1931–55, during which over 3 million children were born, yet even so the significant features are not easy to discern.

In The Biopsychosocial Model of Health and Disease, Derek Bolton and Grant Gillett argue that a defensible updated version of the biopsychosocial model requires a metaphysically adequate account of disease causation that can accommodate biological, psychological, and social factors. This present paper offers a philosophical critique of their account of biopsychosocial causation. I argue that their account relies on claims about the normativity and the semantic content of biological information that are metaphysically contentious. Moreover, I suggest that (...) these claims are unnecessary for a defence of biopsychosocial causation, as the roles of multiple and diverse factors in disease causation can be readily accommodated by a more widely accepted and less metaphysically contentious account of causation. I then raise the more general concern that they are misdiagnosing the problem with the traditional version of the biopsychosocial model. The challenge when developing an explanatorily valuable version of the biopsychosocial model, I argue, is not so much providing an adequate account of biopsychosocial causation, but providing an adequate account of causal selection. Finally, I consider how this problem may be solved to arrive at a more explanatorily valuable and clinically useful version of the biopsychosocial model. (shrink)

Researchers from the Universities of Oxford, Nairobi, and Manitoba are collaborating on a project to develop an HIV vaccine based on the immunological protection mechanisms found in commercial sex workers from the Majengo slum in Nairobi. This group consists of educationally and economically disadvantaged women who resort to commercial sex work for a living. A clinic was established in the slum to study sexually transmitted diseases, which now includes HIV/AIDS. The clinic serves as a research facility for the collaborating researchers (...) who have been using the women's blood, cervical, vaginal, and saliva samples for the ongoing studies. The clinic runs two HIV-integrated activities: HIV research and HIV care and treatment. For HIV negative participants, samples are collected and used for research and care after they give informed consent. (shrink)

Obesity is characterized by the accumulation of an excessive amount of fat mass in the adipose tissue, subcutaneous, or inside certain organs. The risk does not lie so much in the amount of fat accumulated as in its distribution. Abdominal obesity is an important risk factor for cardiovascular diseases, diabetes, and cancer, having an important role in the so-called metabolic syndrome. Therefore, it is necessary to prevent, detect, and appropriately treat obesity. The diagnosis is based on anthropometric indices that have (...) been associated with adiposity and its distribution. Indices themselves, or a combination of some of them, conform to a big picture with different values to establish risk. Anthropometric indices can be used for risk identification, intervention, or impact evaluation on nutritional status or health; therefore, they will be called anthropometric health indicators. We have found 17 AHIs that can be obtained or estimated from 3D human shapes, being a noninvasive alternative compared to X-ray-based systems, and more accessible than high-cost equipment. A literature review has been conducted to analyze the following information for each indicator: definition; main calculation or obtaining methods used; health aspects associated with the indicator ; criteria to classify the population by means of percentiles or cutoff points, and based on variables such as sex, age, ethnicity, or geographic area, and limitations. (shrink)

Male superiority in mathematical ability (along with female superiority in verbal fluency) may reflect the operation of an X-Y homologous gene (the right-shift-factor) influencing the relative rates of development of the cerebral hemispheres. Alleles at the locus on the Y chromosome will be selected at a later mean age than alleles on the X, and only by females.