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 Questions and Answers on Gender MedicineState of the art, opinions, challenges from the 2nd Italian National Congress on Gender Medicine (Padua, Italy, October 21st-23rd, 2010). In the meeting scientists, clinicians, health economy and organizations experts convened to discuss basic and clinical research devoted to better understand the gender specific issues in clinical management of Chronic Pain, Dementia, Alzheimer Disease, Osteoporosis and Autoimmune Diseases. The meeting was designed to look for an answer to the many questions in Gender Medicine which remain still open. The faculty provided answers to many questions, although some of the unanswered ones are waiting for more satisfying answers. To help the readers, a selection of the presented slides has been endowed in a slide library which is linked to every Q/A group. Gender Medicine is still a book with many pages to be read and understood.
European Society of Gender Health and Medicine
Italian Society of Gender Health and Medicine Italian National Centre for Gender Health and Medicine Fondazione Giovanni Lorenzini Medical Science Foundation CONGRESS SESSIONSDEMENTIA, ALZHEIMER AND DEPRESSION DIABETES AND METABOLIC SYNDROME LONGEVITY AND QUALITY OF LIFEQuestions
Normal ageing, successful ageing, optimal ageing, disability threshold by Giuseppe Paolisso Take home message Genetics plays an important role, but life style is more important in the longevity determination. Questions
Women and Men: the older they grow the less different they become by Graziella Caselli Take home message The recent reduction in the gender gap, which can be seen by analysing the data of the period (1979-2007), is the result of a feminization of male behaviours and not a masculinization of female behaviours. The differences in life expectancy is expected to continue (2065 = w 94,1 m 89,8). Questions
Moli-Sani: a Gender Medicine project in a region-laboratory by Maria Benedetta Donati Take home message Ischemic cardiovascular disease and several forms of tumors (hormone dependent and gastro-intestinal tract) share common mechanisms and risk factors: the common soil hypothesis. To better understand the equilibrium between genetics and environment for CV and cancer disease, an Italian region is transformed in a scientific laboratory. Primary Prevention of Cardio Vascular Disease-CVD is highly based on multivariable risk estimation of CVD risk over the next 10 years. Current risk assessment strategies may inadequately assess CVD risk in many women and younger men. Understanding the lifetime risk for CVD may be very useful in public health education. It is also useful to contextualize gender differences in the family and society. GENDER IN PAINQuestions
Pain pathophysiology and gender by Anna Maria Aloisi Take home message Testosterone and Estradiol, control gonadal function, mood/cognition, sexual behavior, sex response, nociception, motor control. There are sex differences in the neural basis of emotional memories. Estradiol impacts on µ-opioid receptor binding and on responses of µ-opioid receptor-mediated neurotransmission to a stress challenge. Questions
Gender differences in pain perception by Stefania Maggi Take home message Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Despite moderate differences, imaging studies seem to suggest that there is a difference between men and women in the central processing of painful stimuli and/or in the endogenous pain modulating systems. From an anatomical point of view, dementia has obvious implications with regard to the integrity of the nociceptive pathways and on the pain experience. Alzheimer Diseases predominantly affects the neocortex with serious consequences on the motivational and affective aspects of pain response, while the somato-sensory cortex seems to be relatively unaffected by dementia’s histological changes. Questions
Long-term treatment by opioids: is there any gender-linked outcome? by Alessandro Fabrizio Sabato Take home message Breakthrough pain (BTP), in treated patients with chronic pain states is neither well defined nor well understood. Visual analogue scale (VAS) score has been used in evaluating gender related differences in pain before and after opiates treatment. No significant differences seem to be in the measurement of pain between women and men in cancer pain. However both sexes should be included in medication trials in sufficient numbers to detect sex or gender effects. Questions
The impact of symptoms on self-rated health in a gender perspective by Nadia Oprandi et alii Take home message There are no gender differences in self-rated health when health conditions are good. In suffering conditions women’s pain assessment is worse than men’s. It seems that psychological discomfort affects women’s self-rated health more than men’s, but not pain assessment. DEMENTIA, ALZHEIMER AND DEPRESSIONQuestions
Genetic aspects of degenerative dementia by Amalia Bruni Take home message AD is more frequent in women probably because the long survival and the strong reduction of the Estrogen protective effect in menopause. Evolution, course and risk factors are different. The genetic risk is the same for both sexes and, at present, there are not different genes. Subjects affected by degenerative dementia having a familial trait can be genetically studied. Autosomal dominant genes account for both early and late onset forms. Autosomal recessive transmission does exist (it might be not so rare!!!). Many genes interacting each other could modulate susceptibility. Much evidence suggests that epigenetic modification of gene expression can accumulate with age leading to an altered response to stress and to an enhanced susceptibility to diseases. The epigenetic features that regulate gene expression must be better understood. Questions
Biological Basis for the pharmacological treatment of Alzheimer Disease: genetics and gender impact by Stefano Govoni Take home message We will use the old drugs for still several years. Efforts should be made to optimize their use taking also into account pharmacogenetics of metabolizing enzymes and of targets as well as new delivery techniques. Association therapy is another possibility. Several promising randomized controlled trials are ongoing and the increased collaboration between pharmaceutical companies and basic and clinical researchers have the potential to bring us closer to developing an optimum pharmaceutical approach for the treatment of Alzheimer's Disease. Gender differences in AD and in neurodegenerative diseases need to be better explored. A better knowledge of the AD deserves more dedicated studies also from the gender point of view. Questions
Dementia, Alzheimer, and Depression in elderly: gender differences by Renzo Rozzini Take home message The psycho-geriatric people (dementia and depression) are mainly women. Depressed women are more than men, under treatment and for longer time. Clinical outcome are similar (60% responder). Depressed women have more psychotic symptoms and more disability. Diagnosis of dementia in women is defined later than in men. Treatment is similar, but longer in women. Dementia is a longer-lasting disease in women. More care-givers are requested for women with dementia. Questions
Genetic (APOE, CYP19) and non genetic factors interact in the onset of Alzheimer Disease in Women by Rosa Maria Corbo et alii Take home message Gender is a relevant AD risk determinant and there is evidence for a higher prevalence of AD in women, but it is unclear whether this is due to the longer life expectancy of women or to biological gender-specific risk factors for the disease. The higher prevalence of AD in women cannot be simply explained by differences in survival between men and women but it has a biological basis: APOE gene, as well as combined effects of CYP19, rs4646 genotypes, and parity status are under evaluation. Questions
Gender differences of Adverse Drug Reactions - ADRs related to psychotropic drug: a survey from Italy, France and Spain by P. D'Incau et alii Take home message Women represent the majority of patients who are prescribed antipsychotics, antidepressants, anxiolytics and hypnotics, as consequence they are more at risk of developing adverse effects. DIABETES AND METABOLIC SYNDROMEQuestions
Natural history of diabetes mellitus and gender differences by Antonio Tiengo Take home message Abdominal obesity, dyslipidemia, oxaditive stress, hypercoability, hypertension; disparity of treatment, abrogation of sex differences due to estrogen action on endothelium increase vulnerability to hypertension and dyslipidemia. Can all these factors contribute to higher cardiovascular diseases in women with diabetes? Unadjusted and age-adjusted summary odds ratio show a trend or significant differences by sex, whereas multiple-adjusted results (for age, hypertension, total cholesterol level and smoking) show no difference by sex. Questions
Metabolic syndrome: gender differences by Giuseppe Schillaci Take home message There are gender differences in MS in several aspects, e.g. LV hypertrophy; high aortic pulse wave velocity in hypertension; carotid thickness; diabetes and CHD mortality Despite a number of weaknesses and inconsistencies, the metabolic syndrome remains a useful tool for risk stratification, especially in the subjects at low cardiovascular risk. Questions
Gender Medicine: what about physical exercise? by Paolo Moghetti Take home message There are no gender specific recommendation by the American College of Sport and the American Heart Association. Aerobic was slightly better than Resistance exercise , and frankly better than no exercise for improving physical health status in diabetes patients. No exercise was superior to resistance or combined exercise for improving mental health status. Well-being was unchanged by intervention. Recommended Frequency: Physical activity: At least 3-4 times per week (every day is better); Duration: 30 – 60 min per session. Intensity 50-70% of heart rate reserve; Type: Aerobic. Questions
Peripheral arterial disease deletes female gender protective effect on cardiovascular events in type 2 diabetes mellitus by Franco Cavalot et alii Take home message In type 2 diabetes mellitus a) severe PAD affects men and women in 2/3 ratio; b) severe PAD affects women at an older age; c) smoking habit is - like in the non diabetic population - a strong risk factor for PAD in both genders; d) severe PAD confers a 3 fold increased risk for cardiovascular events, all-cause and cardiovascular mortality in both genders compared to their respective controls; e) when PAD is present, the rate of cardiovascular events, all-cause and cardiovascular mortality in women become similar or even worse compared to those of men; f) in men with type 2 diabetes mellitus, smoking habit is the principal risk factor for PAD, present in practically all patients, while the other risk factors are similar to those of controls without PAD; g) in women with type 2 diabetes mellitus, the main risk factor is diabetes itself (long disease duration, bad glycemic control, frequent insulin treatment) and atherogenous dyslipidemia (low HDL cholesterol, high triglycerides); h) PAD prevention is based on smoking cessation, adequate glycemic control, anti-platelet therapy and aggressive treatment of dyslipidemia. OSTEOPOROSIS AND CHRONIC REHUMATIC DISEASEQuestions
Osteoprosis treatment in man and woman by Sandro Giannini Take home message From the anatomical point of view, position and extent of bone loss in men and women are different. Differences in the outcomes by drugs treatment in women and men should be expected and better studied. Vitamin D relative deficiency, that is important in elderly women in Italy, can decrease the drugs effect. Questions
Systemic Autoimmune Disease and gender by Claudio Vitali Take home message Data from the epidemiology of autoimmune diseases (AID) support a variable female predominance in most conditions. The human immune system exhibits sexual dimorphism and basic immune responses differ between females and males in terms of antibody production and cellular responses. Sex hormones were first suggested for inducing female susceptibility to AID due to their effects on cytokine production, B cell maturation, homing of lymphocytes and antigen presentation. X chromosome provides a survival advantage to women in the face of pathogenic insult, but it can also enhance the susceptibility of them to autoimmunity. X chromosome may, in fact, have a role in shaping autoimmune responses and inducing a breakdown of self tolerance. The persistence of fetal genetic material (termed fetal microchimerism) may induce autoimmunity in women, but previous observations in Systemic Sclerosis patients were not confirmed. GENDER DIFFERENCES IN THE RESPONSE TO ANTICOAGULANTSQuestions
Gender differences in the response to oral anticoagulant drugs by Giulia Ogliari et alii Take home message Average Dsens is higher in females than in males. Women present a lower average number of INR relevations in range. Women may require more frequent monitoring of INR and may present a higher risk of hemorrhagic and thrombotic events. |
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