Gender and age differences in polysomnography findings and sleep complaints of patients referred to a sleep laboratory

Our objective was to examine the effet of gender on the sleep pattern of patients referred to a sleep laboratory. The data (questionnaires and polysomnographic recordings) were collected from a total of 2365 patients (1550 men and 815 women). The polysomnography permits an objective assessment of the sleep pattern. We included only polysomnography exams obtained with no more than one recording system in order to permit normalization of the data. Men had a significantly higher body mass index than women (28.5 ± 4.8 vs 27.7 ± 6.35 kg/m²) and had a significantly higher score on the Epworth Sleepiness Scale (10.8 ± 5.3 vs 9.5 ± 6.0), suggesting daytime sleepiness. Women had a significantly higher sleep latency than men, as well as a higher rapid eye movement (REM) latency. Men spent more time in stages 1 (4.6 ± 4.1 vs 3.9 ± 3.8) and 2 (57.0 ± 10.5 vs 55.2 ± 10.1) of non-REM sleep than women, whereas women spent significantly more time in deep sleep stages (3 and 4) than men (22.6 ± 9.0 vs 19.9 ± 9.0). The apnea/hypopnea and arousal indexes were significantly higher and more frequent in men than in women (31.0 ± 31.5 vs 17.3 ± 19.7). Also, periodic leg movement index did not differ significantly between genders, but rather differed among age groups. We did not find significant differences between genders in the percentage of REM sleep and sleep efficiency. The results of the current study suggest that there are specific gender differences in sleep pattern.

Highly sensitive C-reactive protein and male gender are independently related to the severity of coronary disease in patients with metabolic syndrome and an acute coronary event

Patients with metabolic syndrome are at high-risk for development of atherosclerosis and cardiovascular events. The objective of this study was to examine the major determinants of coronary disease severity, including those coronary risk factors associated with metabolic syndrome, during the early period after an acute coronary episode. We tested the hypothesis that inflammatory markers, especially highly sensitive C-reactive protein (hsCRP), are related to coronary atherosclerosis, in addition to traditional coronary risk factors. Subjects of both genders aged 30 to 75 years (N = 116) were prospectively included if they had suffered a recent acute coronary syndrome (acute myocardial infarction or unstable angina pectoris requiring hospitalization) and if they had metabolic syndrome diagnosed according to the National Cholesterol Education Program/Adult Treatment Panel III. Patients were submitted to a coronary angiography and the burden of atherosclerosis was estimated by the Gensini score. The severity of coronary disease was correlated (Spearman’s or Pearson’s coefficient) with gender (r = 0.291, P = 0.008), age (r = 0.218, P = 0.048), hsCRP (r = 0.256, P = 0.020), ApoB/ApoA ratio (r = 0.233, P = 0.041), and carotid intima-media thickness (r = 0.236, P = 0.041). After multiple linear regression, only male gender (P = 0.046) and hsCRP (P = 0.012) remained independently associated with the Gensini score. In this high-risk population, male gender and high levels of hsCRP, two variables that can be easily obtained, were associated with more extensive coronary disease, identifying patients with the highest potential of developing new coronary events.

Spectral and symbolic analysis of the effect of gender and postural change on cardiac autonomic modulation in healthy elderly subjects

The objective of this study was to use linear and non-linear methods to investigate cardiac autonomic modulation in healthy elderly men and women in response to a postural change from the supine to the standing position. Fourteen men (66.1 ± 3.5 years) and 10 women (65.3 ± 3.3 years) were evaluated. Beat-to-beat heart rate was recorded in the supine and standing positions. Heart rate variability was studied by spectral analysis, including both low (LFnu-cardiac sympathetic modulation (CSM) indicator) and high (HFnu-cardiac vagal modulation (CVM) indicator) frequencies in normalized units as well as the low frequency/high frequency (LF/HF) ratio. Symbolic analysis was performed using the following indexes: 0V% (CSM indicator), 1V% (CSM and CVM indicators), 2LV% (predominantly CVM indicator) and 2ULV% (CVM indicator). Shannon entropy was also calculated. Men presented higher LFnu and LF/HF ratio and lower HFnu and 1V% symbolic index (57.56, 4.14, 40.53, 45.96, respectively) than women (24.60, 0.45, 72.47, 52.69, respectively) in the supine position. Shannon entropy was higher among men (3.53) than among women (3.33) in the standing position, and also increased according to postural change in men (3.25; 3.53). During postural change, the LFnu (24.60; 49.85) and LF/HF ratio (0.45; 1.72) increased, with a concomitant decrease in HFnu (72.47; 47.56) and 2LV% (14.10; 6.95) in women. Women presented increased CSM in response to postural change and had higher CVM and lower CSM than men in the supine position. In conclusion, women in the age range studied presented a more appropriate response to a postural change than men, suggesting that cardiac autonomic modulation may be better preserved in women than in men.

Gender differences in serum CK-MB mass levels in healthy Braziliansubjects

The creatine kinase-isoenzyme MB (CK-MB) mass assay is one of the laboratory tests used for the diagnosis of myocardial infarction. It is recommended, however, that reference limits should take gender and race into account. In the present study, we analyzed the plasma CK-MB mass and troponin levels of 244 healthy volunteers without a personal history of coronary artery disease and with no chronic diseases, muscular trauma or hypothyroidism, and not taking statins. The tests were performed with commercial kits, CK-MB mass turbo kit and Troponin I turbo kit, using the Immulite 1000 analyzer from Siemens Healthcare Diagnostic. The values were separated according to gender and showed significant differences by the Mann-Whitney test. Mean (± SD) CK-MB mass values were 2.55 ± 1.09 for women (N = 121; age = 41.20 ± 10.13 years) and 3.49 ± 1.41 ng/mL for men (N = 123; age = 38.16 ± 11.12 years). Gender-specific reference values at the 99th percentile level, according to the Medicalc statistical software, were 5.40 ng/mL for women and 7.13 ng/mL for men. The influence of race was not considered because of the high miscegenation of the Brazilian population. The CK-MB values obtained were higher than the 5.10 mg/mL proposed by the manufacturer of the laboratory kit. Therefore, decision limits should be related to population and gender in order to improve the specificity of this diagnostic tool, avoiding misclassification of patients

Effect of gender on training-induced vascular remodeling in SHR

There is accumulating evidence that physical inactivity, associated with the modern sedentary lifestyle, is a major determinant of hypertension. It represents the most important modifiable risk factor for cardiovascular diseases, which are the leading cause of morbidity and mortality for both men and women. In addition to involving sympathetic overactivity that alters hemodynamic parameters, hypertension is accompanied by several abnormalities in the skeletal muscle circulation including vessel rarefaction and increased arteriole wall-to-lumen ratio, which contribute to increased total peripheral resistance. Low-intensity aerobic training is a promising tool for the prevention, treatment and control of high blood pressure, but its efficacy may differ between men and women and between male and female animals. This review focuses on peripheral training-induced adaptations that contribute to a blood pressure-lowering effect, with special attention to differential responses in male and female spontaneously hypertensive rats (SHR). Heart, diaphragm and skeletal muscle arterioles (but not kidney arterioles) undergo eutrophic outward remodeling in trained male SHR, which contributed to a reduction of peripheral resistance and to a pressure fall. In contrast, trained female SHR showed no change in arteriole wall-to-lumen ratio and no pressure fall. On the other hand, training-induced adaptive changes in capillaries and venules (increased density) were similar in male and female SHR, supporting a similar hyperemic response to exercise.

Gender-dependent effects of aging on the kidney

It is well known that the kidney plays an important role in the development of cardiovascular diseases such as hypertension. The normal aging process leads to changes in kidney morphology, hemodynamics and function, which increase the incidence of cardiovascular events in the elderly population. These disturbances are influenced by several factors, including gender. In general, females are protected by the effects of estrogens on the cardiorenal system. Several studies have demonstrated the beneficial effects of estrogens on renal function in the elderly; however, the relationships between androgens and kidney health during one’s lifetime are not well understood. Sex steroids have many complex actions, and the decline in their levels during aging clearly influences kidney function, decreases the renal reserve and facilitates the development of cardiovascular disorders. Therefore, in this review, we discuss the cellular, biochemical, and molecular mechanisms by which sex hormones may influence renal function during the aging process.

Chronotype ontogeny related to gender

Chronotype is an established concept designed to identify distinct phase relationships between the expression of circadian rhythms and external synchronizers in humans. Although it has been widely accepted that chronotype is subjected to ontogenetic modulation, there is no consensus on the interaction between age and gender. This study aimed to determine the relationship between age- and gender-related changes in the morningness-eveningness character in a large sample of people. A total of 14,650 volunteers were asked to complete the Brazilian version of the Horne and Östberg chronotype questionnaire. The data demonstrated that, on average, women were more morning-oriented than men until the age of 30 and there were no significant differences between men and women from 30 to 45 years of age. In contrast to the situation observed until the age of 30, women older than 45 years were more evening-oriented than men. These results suggest that the ontogenetic development of the circadian timekeeping system is more plastic in men, as represented by the larger amplitude of chronotype changes throughout their aging process. The phase delay of adolescence and phase advance of the elderly seem to be phenomena that are more markedly present in men than in women. Thus, our data, for the first time, provide support that sharply opposes the view that there is a single path toward morningness as a function of age, regardless of gender.

Abundant immunohistochemical expression of dopamine D2 receptor and p53 protein in meningiomas: follow-up, relation to gender, age, tumor grade, and recurrence

Meningiomas are common, usually benign tumors, with a high postoperative recurrence rate. However, the genesis and development of these tumors remain controversial. We aimed to investigate the presence and implications of a mutated p53 protein and dopamine D2 receptor in a representative series of meningiomas and to correlate these findings with age, gender, tumor grade, and recurrence. Tumor tissue samples of 157 patients diagnosed with meningioma (37 males and 120 females, mean age 53.6±14.3 years) who underwent surgical resection between 2003 and 2012 at our institution were immunohistochemically evaluated for the presence of p53 protein and dopamine D2 receptor and were followed-up to analyze tumor recurrence or regrowth. Tumors were classified as grades I (n=141, 89.8%), II (n=13, 8.3%), or grade III (n=3, 1.9%). Dopamine D2 receptor and p53 protein expression were positive in 93.6% and 49.7% of the cases, respectively. Neither of the markers showed significant expression differences among different tumor grades or recurrence or regrowth statuses. Our findings highlight the potential role of p53 protein in meningioma development and/or progression. The high positivity of dopamine D2 receptor observed in this study warrants further investigation of the therapeutic potential of dopamine agonists in the evolution of meningiomas.

Gender, race and socioeconomic influence on diagnosis and treatment of thyroid disorders in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Thyroid diseases are common, and use of levothyroxine is increasing worldwide. We investigated the influence of gender, race and socioeconomic status on the diagnosis and treatment of thyroid disorders using data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a multicenter cohort study of civil servants (35-74 years of age) from six Brazilian cities. Diagnosis of thyroid dysfunction was by thyrotropin (TSH), and free thyroxine (FT4) if TSH was altered, and the use of specific medications. Multivariate logistic regression models were constructed using overt hyperthyroidism/hypothyroidism and levothyroxine use as dependent variables and sociodemographic characteristics as independent variables. The frequencies of overt hyper- and hypothyroidism were 0.7 and 7.4%, respectively. Using whites as the reference ethnicity, brown, and black race were protective for overt hypothyroidism (OR=0.76, 95%CI=0.64-0.89, and OR=0.53, 95%CI=0.43-0.67, respectively, and black race was associated with overt hyperthyroidism (OR=1.82, 95%CI=1.06-3.11). Frequency of hypothyroidism treatment was higher in women, browns, highly educated participants and those with high net family incomes. After multivariate adjustment, levothyroxine use was associated with female gender (OR=6.06, 95%CI=3.19-11.49) and high net family income (OR=3.23, 95%CI=1.02-10.23). Frequency of hyperthyroidism treatment was higher in older than in younger individuals. Sociodemographic factors strongly influenced the diagnosis and treatment of thyroid disorders, including the use of levothyroxine.

Innovation Process and Organizational Adoption of Disruptive Innovation: Empirical Evidence from Finnish Bio-Economy Companies.

The thesis aims to build a coherent view and understanding of the innovation process and organizational technology adoption in Finnish bio-economy companies with a focus on innovations of a disruptive nature. Disruptive innovations are exceptional hence in order to create generalizations and a unified view of the subject the perspective is also on less radical innovations. Other interests of the thesis are how ideas are discovered and generated and how the nature of the innovation and size of the company affect the technology adoption and innovation process. The data was collected by interviewing six small and six large Finnish bio-economy companies. The results suggest companies regardless of size consider innovation as a core asset in the competitive markets. Organizations want to be considered innovators and early adopters yet these qualities are limited by certain, mainly resource-based factors. In addition the industry, scalability and Finland’s geographical location when seeking funding provide certain challenges. The innovation process may be considered relatively similar whether the idea or technology stems from an internal or external source suggesting the technology adoption process can in fact be linked to the innovation process theories. Thus the thesis introduces a new theoretical model which based on the results of the study and the theories of technology adoption and innovation process aims on characterizing how ideas and technology from both external and internal sources generate into innovations. The innovation process is in large bio-economy companies most often similar to or a modified version of the stage-gate model, while small companies generally have less structured processes. Nevertheless the more disruptive the innovation, the less it fits in the structured processes. This implies disruptive innovation cannot be put in a certain mould but it is rather processed case-by-case.

Food production in solidarity economy: an issue that goes beyond laws

Abstract Food production within the context of solidarity economy is an alternative way to offer employment and income for a significant part of the Brazilian population. The purpose of this study was to carry out a business diagnosis in order to evaluate the facilities, the production process and hygiene practices of seven solidarity economy enterprises located in the city of Novo Hamburgo, Southern Brazil, that work with food production and sales. Visits took place at the enterprises and a check-list was used to record data. Although food production happens in places with space and setting restrictions, it guarantees distinctive foods with aggregate value, where handlers follow the whole process, from raw materials selection to sales. Basic hygiene principles are followed, as they guarantee the production of food with quality, which contributes towards income generation for participating families. Specific laws that apply to the characteristics and needs of small-scale food production must be written in order to regulate solidarity economy enterprises.

Political economy of preferential trade agreement: the case of bilateral asymmetric negotiation

The purpose of this paper is to analyse the political economy of preferential trade agreements based on a sequential non-cooperative Stackelberg political game between a large economy and a small one, in which the political dispute of rival lobby groups defines the unilateral stance of both governments in the first stage; and the Stackelberg "coalition-proof" equilibrium defines the free trade agreement format in the second stage. Finally, a few modifications in the initial game structure are discussed in order to enhance the small economy's negotiation power. The political economy model is applied to FTAA case.

Gender-toiminta osana sotilaallista kriisinhallintaa : rekrytointi, koulutus ja operatiivinen toiminta

Kansainväliset sotilaalliset kriisinhallintaoperaatiot ovat muuttuneet yhä vaativammiksi, ja kriisinhallinnan tehtäväkenttä on laajentunut ja monipuolistunut. Operaatioalueella olevilta kriisinhallintahenkilöiltä odotetaan yhä enemmän kykyä yhteistyöhön kaikkien toimijoiden kanssa yhteiskunnan vakauden ja turvallisuuden palauttamiseksi ja säilyttämiseksi. Yhdistyneiden kansakuntien päätöslauselman 1325 ”Naiset, rauha ja turvallisuus” täytäntöönpanolla halutaankin hyödyttää koko yhteiskunnan vakautta ja kehitystä. Suomen kansallisen toimintaohjelman ja Pääesikunnan normin mukaan Suomi tukee naisten kouluttautumista kohti vaativimpia tehtäviä ja esittää naisia kansainvälisiin johtotehtäviin. Suomi varmistaa, että kaikilla kriisinhallintatehtäviin lähtevillä on ihmisoikeus- ja tasa-arvokysymysten asiantuntemus sekä kyky tehdä yhteistyötä sisällyttämällä YK:n päätöslauselma 1325, kansainvälinen oikeus, kansainvälinen humanitaarinen oikeus sekä ihmisoikeusvelvoitteet kaikkeen kriisinhallintakoulutukseen. Suomi sisällyttää gender-näkökulman osak-si kriisinhallintajoukkojen operatiivista toimintaa huomioimalla gender-näkökulman operaatioiden suunnittelussa, toimeenpanossa ja raportoinnissa YK:n päätöslauselman 1325 ja operaatiokohtaisten määräysten mukaisesti. Tutkielman tarkoituksena oli tutkia puolustusvoimien virassa olevien naisupseerien motiiveja hakeutua kriisinhallintatehtäviin, naisten osallistumisen vaikutuksia kriisinhallintaoperaatioihin sekä gender-näkökulman huomioimista koulutuksessa ja kriisinhallintajoukon operatiivisessa toiminnassa. Tutkimusongelmana oli vähäinen aiempi tiedon määrä Suomen kansallisessa toimintaohjelmassa ja Pääesikunnassa määritetyn gender-toiminnan toteutumisesta. Päätutkimuskysymyksen avulla pyrittiinkin selvittämään, miten gender-toiminta on toteutu-nut sotilaallisen kriisinhallinnan rekrytoinnissa, koulutuksessa ja operatiivisessa toiminnassa. Tutkimusstrategiana sovellettiin monimenetelmäistä tiedonkeruutapaa määrällisen ja laadullisen aineiston saamiseksi. Tutkimusmenetelminä käytettiin survey-tutkimusta ja sisällönanalyysiä, joiden avulla pyrittiin kuvaamaan naisupseerien, operaatioista kotiutuneiden rauhanturvaajien sekä Afganistanin kriisinhallintaoperaatiossa (ISAF) palvelleiden SKJA:n komentajien ja naisupseerien käsityksiä, mielipiteitä ja asenteita tutkittavasta aiheesta. Tutkielman empiirinen osuus perustuu naisupseereille suunnattuun kyselyyn sekä SKJA:n komentajien ja naisupseerien sähköpostihaastatteluun. Tutkielmassa hyödynnettiin lisäksi Porin prikaatin kotiutuneille rauhanturvaajille teettämän tasa-arvokyselyn tuloksia. Tutkielman tuloksena ilmeni, että naisrauhanturvaajien kriisinhallintatehtäviin osallistumisen vaikutuksista merkittävimpiä olivat yhteyden saaminen paikalliseen naisväestöön. Myös miesten ja naisten työskentely yhdessä samoissa tehtävissä nähtiin tärkeänä esimerkkinä sukupuolten tasa-arvosta. Sukupuolen liiallinen korostaminen nähtiin haitalliseksi, ja tehtävän vaatimukset tuleekin asettaa tehtävässä tarvittavien ominaisuuksien, tietojen ja taitojen mukaisesti. Positiivisten vaikutusten saavuttamiseksi naisten määrän kriisinhallintatehtävissä tulisi kasvaa nykyisestä, mutta sen ei tule olla itseisarvo. Merkittävimmät naisupseerien kriisinhallintatehtäviin hakeutumattomuuden syyt olivat perheen perustamiseen liittyvät sosiaaliset syyt. Kriisinhallintatehtäviin hakeutumisen motivaatiota kasvattavista tekijöistä tärkeimpiä olivat ammattitaidon ja itsensä kehittäminen. Gender-koulutuksen osalta ilmeni, että Suomessa annetaan gender-peruskoulutus mutta operaatioalueella ei täydennyskoulutusta annettu. Gender-näkökulman huomioon ottaminen kriisinhallintajoukon operatiivisessa suunnittelussa, toimeenpanossa ja raportoinnissa ei myöskään tulosten perusteella toteutunut. Tutkielman johtopäätöksenä todetaan, että naisupseerit ovat pääosin halukkaita palvelemaan kriisinhallintatehtävissä, vaikka osallistuminen onkin henkilömäärältään vähäistä. Naisten mahdollisuuteen hakeutua kriisinhallintatehtäviin voidaan vaikuttaa laatimalla urasuunnitelma varhaisemmassa vaiheessa ja lisäämällä naisupseereille kohdennettua tietoa kriisinhallintatehtävistä. Kriisinhallintatehtäviin halukkaita naisia on enemmän kuin näyttäisi olevan mahdollista irrottaa kotimaan tehtävistä. Gender-koulutuksen todettiin olevan liian yleisellä tasolla eikä sitä kyetty konkreettisesti huomioimaan ja soveltamaan joukon operatiivisessa toiminnassa. Koulutuksen pääpainon tulisikin olla operatiivisessa vaikuttavuudessa osana kaikkea koulutusta. Gender-näkökulma tulisi saada integroitua osaksi kaikkea kriisinhallintajoukon toimintaa operaation vaikuttavuuden ja tavoitteiden täyttymisen näkökulmaa. Operaation tavoitteita asetettaessa tulisi muistaa, että kriisinhallintaoperaatioilla pyritään kokonaisvaltaisesti turvallisuusympäristön parantamiseen ja normaaliyhteiskunnan toimintojen ja palvelujen palauttamiseen. Gender-toiminnan kehittämisessä tärkeää onkin ymmärtää sen vaikutus ja kytkeminen nimenomaan paikallisväestön eri ihmisryhmien huomioimiseen ja tasavertaisuuteen ihmisoikeuksien näkökulmasta. Tutkielman tulosten mukaan kehityskohteita gender-toiminnan parantamiseksi on olemassa, ja mikäli kriisinhallintaoperaatioiden vaikuttavuutta halutaan tehostaa, näyttäisi siihen myös olevan keinoja.