Gender Medizin

Gender Medizin ist eine Disziplin der Humanmedizin, die den Einfluss von biologischem (Sex) und psychosozialem Geschlecht (Gender) gemäß dem bio-psycho-sozialen Modell von Gesundheit und Krankheit berücksichtigt. Ziel ist es, die Lebensqualität über die gesamte Lebensspanne zu erhalten und eine optimale medizinische Versorgung aller Geschlechter zu ermöglichen. Geschichtliche Grundlagen waren die Frauenbewegung der 1960er Jahre und die daraus entstandene Frauen- und Männergesundheitsforschung

Sex-specific-differences in cardiovascular risk in type-1-diabetes : a cross sectional study

Background: Little is known about the impact of sex-specific differences in the management of type 1 diabetes (T1DM). Thus, we evaluated the influence of gender on risk factors, complications, clinical care and adherence in patients with T1DM. Methods: In a cross-sectional study, sex-specific disparities in glycaemic control, cardiovascular risk factors, diabetic complications, concomitant medication use and adherence to treatment recommendations were evaluated in 225 consecutive patients (45.3% women) who were comparable with respect to age, diabetes duration, and body mass index. Results: Although women with T1DM had a higher total cholesterol than men, triglycerides were higher in obese men and males with HbA1c>7% than in their female counterparts. No sex differences were observed in glycaemic control and in micro- or macrovascular complications. However, the subgroup analysis showed that nephropathy was more common in obese men, hyperlipidaemic women and all hypertensive patients, whereas peripheral neuropathy was more common in hyperlipidaemic women. Retinopathy was found more frequently in women with HbA1c>7%, obese men and in both sexes with a long duration of diabetes. The multivariate analysis revealed that microvascular complications were associated with the duration of disease and BMI in both sexes and with hyperlipidaemia in males. The overall adherence to interventions according to the guidelines was higher in men than in women. This adherence was concerned particularly with co-medication in patients diagnosed with hypertension, aspirin prescription in elderly patients and the achievement of target lipid levels following the prescription of statins. Conclusions: Our data showed sex differences in lipids and overweight in patients with T1DM. Although glycaemic control and the frequency of diabetic complications were comparable between the sexes, the overall adherence to guidelines, particularly with respect to the prescription of statins and aspirin, was lower in women than in men

Do women with diabetes need more intensive action for cardiovascular reduction than men with diabetes?

Purpose of Review: This narrative review makes the case for greater efforts to reduce cardiovascular disease (CVD) risk in women with diabetes. Recent Findings: In a recent meta-analysis including five CVOTs of diabetes medications with 46,606 subjects, women (vs men) with type 2 diabetes had a higher relative risk for stroke (RR 1.28; 95% CI 1.09, 1.50) and heart failure (1.30; 1.21, 1.40). Prior studies found higher “within-gender” RR for CVD mortality in women with diabetes although men have an absolute higher risk. Women with prior gestational diabetes mellitus (GDM) have a 2-fold higher CVD risk than the background population. Worse CVD and CVD risk factor management in women, as well as lower female therapy adherence, contribute further to these disparities. Summary: The mechanism behind this excess risk includes biological, hormonal, socioeconomic, clinical, and behavioral factors that still require further investigation. The need for more intensive CVD reduction in women now includes more attention to screening for both incident diabetes and CVD risk factors among high-risk women

Gender Awareness bei Medizinstudierenden der Medizinischen Universität Wien: Eine empirische Analyse von Geschlechtersensibilität und Geschlechterstereotypisierungen

'Gender Awareness' und seine Komponenten 'Gender Sensitivity' und 'Gender Role Ideology' beziehen sich auf ein sensibles, offenes und bewusstes Handeln gegenüber den Bedürfnissen von Patientinnen und Patienten auf biologischer, sozialer und psychologischer Ebene. Gemeinsamkeiten und Unterschiede der Geschlechter sollen berücksichtigt und Geschlechterstereotypisierungen vermieden werden. Mithilfe eines validierten Fragebogens 'Nijmegen Gender Awareness in Medicine' (N-GAMS) wurden die Einstellungen der Studierende im ersten Semester als auch der Studierenden im zwölften Semester an der Medizinischen Universität (MedUni) Wien erhoben. Insgesamt lässt sich eine ausgeprägte Gendersensibilität bei Frauen und Männern in beiden Semestergruppen feststellen. In der vorliegenden Erhebung zeigte sich, dass der Faktor Gender RoleIdeologytowardspatients (Geschlechtersterotypisierungen gegenüber PatientInnen) stärker ausgeprägt war, als der Faktor Gender RoleIdeologytowardsdoctors (Geschlechterstereotypisierungen gegenüber Ärztinnen und Ärzten). Das scheint ein Hinweis darauf zu sein, dass Studierende dem Geschlecht der PatientInnen mehr Einfluss zuschreiben als dem Geschlecht der Ärztinnen und Ärzte.In order to improve the quality of health care for both men and women, awareness of sex and gender in illness and health is essential. Implementation of sex and gender aspects in medical education is therefore needed. The aim of this study is to survey the students’ attitudes to gender and gender stereotyping at the Medical University of Vienna.583 first year medical students and 110 final year medical students completed the validated "Nijmegen Gender Awareness in Medicine" Scale. The questionnaire consists of the subscales gender sensitivity, gender role ideology towards patients and gender role ideology towards doctors. A pronounced sensitivity towards gender issues appeared in both sexes, which is comparable to other international studies. The factor Gender Role Ideology towards Patients was more pronounced than the factor Gender Role Ideology towards Doctors. This seems to be an indication that the students ascribe more influence to the gender of the patient than the gender of the doctors

Intravenous calcitriol normalizes insulin sensitivity in uremic patients

Intravenous calcitriol normalizes insulin sensitivity in uremic patients. Recent studies suggest that secondary hyperparathyroidism and/or vitamin D deficiency are responsible for the insulin resistance in chronic renal failure. We investigated the effect of a 12-week intravenous treatment with 1,25 dihydroxycholecalciferol on glucose metabolism in 10 hemodialysis patients compared with 10 healthy control subjects by the frequently-sampled intravenous glucose tolerance test, analyzed with the minimal model technique. Compared to control subjects, the uremic patients featured elevated levels of parathyroid hormone (432 ± 60 vs. 41 ± 4 ng/liter, P < 0.001), insulin resistance (insulin sensitivity index, SI: 4.9 ± 0.8 vs. 9.5 ± 0.9 MIN-1/(µ/m1), P < 0.002), increased posthepatic insulin delivery (6.48 ± 2.48 vs. 2.73 ± 3.14 nmol/liter in 4 hr, P < 0.001) and a reduced C-peptide fractional clearance (0.033 ± 0.004 vs. 0.085 ± 0.009 min-1, P < 0.0002). Following treatment with 1,25 dihydroxycholecalciferol, the parathyroid hormone levels decreased significantly to 237 ± 30 ng/liter (P < 0.05), the insulin sensitivity index (SI: 9.6 ± 2.2, P < 0.05) reached a value similar to that of control subjects, and posthepatic insulin delivery decreased to 4.63 ± 0.83 nmol/liter in 4 hr (P < 0.01), while all the other parameters remained unchanged. In summary, uremic patients with secondary hyperparathyroidism were found to be severely insulin resistant and hyperinsulinemic. Intravenous vitamin D treatment led to a significant reduction of parathyroid hormone levels and to a complete normalization of insulin sensitivity in the hemodialysis patients. Thus, intravenous 1,25 dihydroxycholecalciferol improves insulin resistance in uremic patients, acting per se or by reducing secondary hyperparathyroidism

Improved usability of the minimal model of insulin sensitivity based on an automated approach and genetic algorithms for parameter estimation. Clin Sci (Lond

A B S T R A C T Minimal model analysis of glucose and insulin data from an IVGTT (intravenous glucose tolerance test) is widely used to estimate insulin sensitivity; however, the use of the model often requires intervention by a trained operator and some problems can occur in the estimation of model parameters. In the present study, a new method for minimal model analysis, termed GAMMOD, was developed based on genetic algorithms for the estimation of model parameters. Such an algorithm does not require the fixing of initial values for the parameters (that may lead to unreliable estimates). Our method also implements an automated weighting scheme not requiring manual intervention of the operator, thus improving the usability of the model. We studied a group of 170 women with a history of previous gestational diabetes. Results obtained by GAMMOD were compared with those obtained by MINMOD (a traditional gradient-based algorithm for minimal model analysis). Insulin sensitivity by GAMMOD was (3.86 + − 0.19) compared with (4.33 + − 0.20) × 10 −4 µ-units · ml −1 · min −1 by MINMOD; glucose effectiveness was 0.0236 + − 0.0005 compared with 0.0229 + − 0.0005 min −1 respectively. The difference in the estimation by the two methods was within the precision expected for such metabolic parameters and is probably of no clinical relevance. Moreover, both the coefficient of variation of the estimated parameters and the error of fit were generally lower in GAMMOD, despite the fact that it does not require manual intervention. In conclusion, the GAMMOD approach for parameter estimation in the minimal model provides a reliable estimation of the model parameters and improves the usability of the model, thus facilitating its further use and application in a clinical context

N-terminal-pro-brain natriuretic peptide is decreased in insulin dependent gestational diabetes mellitus: a prospective cohort trial

<p>Abstract</p> <p>Background</p> <p>N-terminal-pro-brain natriuretic peptide (NT-proBNP) is elevated in gestational hypertension and preeclampsia. This trial aimed to generate data for gestational diabetes mellitus patients, who are at risk to develop these complications.</p> <p>Methods</p> <p>We have measured NT-proBNP in 223 otherwise healthy women between gestational week 24 and 32 referred to the outpatient diabetes unit in a cross-sectional study.</p> <p>Results</p> <p>88 control subjects, 45 patients with indication for medical nutrition therapy (MNT) alone and 90 patients who required insulin therapy were included. Groups of women were comparable regarding gestational week. Body mass index before pregnancy and at blood draw was significantly higher in subjects with insulin dependent gestational diabetes mellitus compared to MNT controlled gestational diabetes mellitus. NT-proBNP was significantly lower in patients with insulin dependent gestational diabetes mellitus (35 ± 25 pg/ml) compared to controls (53 ± 43 pg/ml, p = 0.012).</p> <p>Conclusions</p> <p>NT-proBNP is within the reference range of normal subjects in women with gestational diabetes mellitus. Differences in body mass index, changes in glomerular filtration rate and haemodynamics may explain lower NT-proBNP concentrations in insulin dependent gestational diabetes mellitus. A false negative interpretation needs to be considered in these women.</p

Development of a new occupational balance-questionnaire: incorporating the perspectives of patients and healthy people in the design of a self-reported occupational balance outcome instrument

BACKGROUND: Self-reported outcome instruments in health research have become increasingly important over the last decades. Occupational therapy interventions often focus on occupational balance. However, instruments to measure occupational balance are scarce. The aim of the study was therefore to develop a generic self-reported outcome instrument to assess occupational balance based on the experiences of patients and healthy people including an examination of its psychometric properties. METHODS: We conducted a qualitative analysis of the life stories of 90 people with and without chronic autoimmune diseases to identify components of occupational balance. Based on these components, the Occupational Balance-Questionnaire (OB-Quest) was developed. Construct validity and internal consistency of the OB-Quest were examined in quantitative data. We used Rasch analyses to determine overall fit of the items to the Rasch model, person separation index and potential differential item functioning. Dimensionality testing was conducted by the use of t-tests and Cronbach’s alpha. RESULTS: The following components emerged from the qualitative analyses: challenging and relaxing activities, activities with acknowledgement by the individual and by the sociocultural context, impact of health condition on activities, involvement in stressful activities and fewer stressing activities, rest and sleep, variety of activities, adaptation of activities according to changed living conditions and activities intended to care for oneself and for others. Based on these, the seven items of the questionnaire (OB-Quest) were developed. 251 people (132 with rheumatoid arthritis, 43 with systematic lupus erythematous and 76 healthy) filled in the OB-Quest. Dimensionality testing indicated multidimensionality of the questionnaire (t = 0.58, and 1.66 after item reduction, non-significant). The item on the component rest and sleep showed differential item functioning (health condition and age). Person separation index was 0.51. Cronbach’s alpha changed from 0.38 to 0.57 after deleting two items. CONCLUSIONS: This questionnaire includes new items addressing components of occupational balance meaningful to patients and healthy people which have not been measured so far. The reduction of two items of the OB-Quest showed improved internal consistency. The multidimensionality of the questionnaire indicates the need for a summary of several components into subscales

Initial evidence for the link between activities and health: associations between a balance of activities, functioning and serum levels of cytokines and C-reactive protein

AbstractGrowing evidence shows interrelations of psychological factors, neurological and immunological processes. Therefore, constructs like a balance of activities, the so called “occupational balance”, could also have biological correlates. The aim of this study was to investigate potential associations between occupational balance, functioning, cytokines and C-reactive protein (CRP) in patients suffering from a chronic inflammatory disease like rheumatoid arthritis (RA) and healthy people. Moreover, we wanted to explore potential differences in gender and employment status.A descriptive study in patients with RA and healthy people was conducted using the Occupational Balance-Questionnaire (OB-Quest) and the Short-Form 36 Health Survey (SF-36). Serum levels of cytokines, such as interleukin 6 (IL-6) and 8 (IL-8), interferon alpha (INFα), tumour necrosis factor alpha (TNFα), rheumatoid factor (RF) and of CRP were measured. Descriptive statistics, as well as Mann-Whitney U tests and Spearmen's rank correlation coefficients (rs) were calculated.One-hundred-thirty-two patients with RA and 76 healthy people participated. Occupational balance was associated with functioning, cytokines and CRP. The strongest associations were identified in the unemployed healthy-people sample with cytokines and CRP being within the normal range. For example, the OB-Quest item challenging activities was associated with IL-8 (rs=−0.63, p=0.04) and the SF-36 sub-scale bodily pain was associated with IFNα (rs=−0.69, p=0.02). The items rest and sleep (rs=−0.71, p=0.01) and variety of different activities (rs=−0.74, p<0.01) correlated with the SF-36 sub-scale social functioning. Employed and unemployed people differed in their age and CRP levels. Additionally, gender differences were found in two OB-Quest items in that fewer women were able to adapt their activities to changing living conditions and fewer men were overstressed. In conclusion, we found preliminary biological evidence for the link between occupation and health in that the concepts encompassed in the construct of occupational balance were associated with functioning, cytokines and CRP