Ethics in women's health: A pathway to gender equity

The differences between women’s and men’s experiences of health and illness are well known. Gender-specific medicine needs to restore equilibrium in order to understand the different clinical signs, diagnostic procedures, and therapeutic needs of diseases in men and women. This new dimension of medicine needs investment in research and health policy. If health professionals and healthcare organizations do not systematically take gender differences into account, inequities may arise and endure. Most discussions of gender involving an ethical perspective begin with the argument that women and men should be regarded as being of equal moral value. Where there are no relevant differences between them, then fairness and justice dictate that they should be treated equally, but if differences in needs exist, service planning should take this into account. Under these circumstances, equity as well as equality should be a guiding principle. The promotion of greater equality between men and women has also become a crucial issue in the bioethical debate, even if there is some confusion about the meaning of equality in this context, and especially of how this can be obtained. Biological differences cannot be removed, but their potentially harmful effects can be mitigated through social policies that take them properly into account, and through health research, policies and projects that give due attention to gender considerations and promote gender equity between women and men

A sex and gender perspective in medicine: a new mandatory challenge for human health

Abstrac

Maternal longevity is associated with lower infant mortality

OBJECTIVE Referring to the multidisciplinary and multipurpose survey AKeA2, and focusing on family genealogy data on centenarian women and controls, this paper aims to verify the hypothesis that maternal longevity is associated with lower infant mortality in offspring, after having controlled for fertility characteristics, familial longevity and some contextual variables. METHODS The association between the longevity of a mother and her children's infant mortality level was assessed using a multivariate Poisson Regression Model with robust estimates, which is suitable for estimating consistently and efficiently the relative risk when binary data are used. RESULTS Our results show an association between longevity and infant mortality among the children of the Sardinians who survived to become centenarians. Infant mortality is significantly lower for children belonging to a mother born and living in Sassari and Oristano than Nuoro, close to each other and both located on the Western coast.</br

Metabolic Syndrome and All-Cause and Cardiovascular Mortality in an Italian Elderly Population: The Progetto Veneto Anziani (Pro.V.A.) Study

OBJECTIVE—The purpose of this study was to explore the association of metabolic syndrome and each of its components with all-cause and cardiovascular mortality in a general Italian elderly population

Poor Physical Performance Predicts Future Onset of Depression in Elderly People: Pro.V.A. Longitudinal Study

Background: Reduced physical performance is predictive of deleterious outcomes in older adults. Data considering objective physical performance and incident depression is sparse. Objective: We investigated whether objective physical performance can predict incident depression among non-depressed older adults during a 4-year study. Design: longitudinal. Methods: From 3,099 older individuals initially enrolled in the Progetto Veneto Anziani study, 970 participants without depression at baseline were included (mean age 72.5 years, 54.6% females). Physical performance measures included the Short Physical Performance Battery (SPPB), 4m gait speed, five times sit-to-stand test, leg extension and flexion, handgrip strength, and 6-Minute Walking Test (6MWT), categorized in gender-specific tertiles. Depression was classified based on the Geriatric Depression Scale (GDS) and a diagnosis from a geriatric psychiatrist. Area under the curve (AUC) and logistic regression analyses were conducted. Results: At baseline, participants developing depression during follow-up (n = 207) scored significantly worse across all physical performance measures than those who did not develop depression. The AUC and predictive power for each physical performance test was similar for all the tests assessed. In logistic regression analysis, after adjusting for 14 potential confounders, worse physical performance across all tests increased the risk of depression. The lowest tertile of the SPPB were at notable odds of developing depression (OR = 1.79; 95%CI: 1.18-2.71). The association between poor physical performance and depression was typically stronger in women than in men, except for 4m gait speed. Limitations: no gold standard used for depression diagnosis; oxidative stress and inflammatory markers were not included; high rate of missing data at follow-up. Conclusion: Low physical performance appears to be an independent predictor of depression over a 4.4-year follow-up in our sample of elderly people

Vitamin D and Physical Performance in Elderly Subjects: The Pro.V.A Study

Background The role of Vitamin D in musculoskeletal functionality among elderly people is still controversial. We investigated the association between serum 25-hydroxyvitamin D (25OHD) levels and physical performance in older adults. Methods 2694 community-dwelling elderly women and men from the Progetto Veneto Anziani (Pro.V.A.) were included. Physical performances were assessed by: tandem test, 5 timed chair stands (TCS), gait speed, 6-minute walking (6 mW) distance, handgrip strength, and quadriceps strength. For each test, separate general linear models and loess plots were obtained in both genders, in relation to serum 25OHD concentrations, controlling for several potential confounders. Results Linear associations with 25OHD levels were observed for TCS, gait speed, 6 mW test and handgrip strength, but not for tandem test and quadriceps strength. After adjusting for potential confounders, linear associations with 25OHD levels were still evident for the 6 mW distance in both genders (p = .0002 in women; <.0001 in men), for TCS in women (p = .004) and for gait speed (p = .0006) and handgrip strength (p = .03) in men. In loess analyses, performance in TCS in women, in gait speed and handgrip strength in men and in 6 mW in both genders, improved with increasing levels of 25OHD, with most of the improvements occurring for 25OHD levels from 20 to 100 nmol/L. Conclusion lower 25OHD levels are associated with a worse coordination and weaker strength (TCS) in women, a slower walking time and a lower upper limb strength in men, and a weaker aerobic capacity (6 mW) in both genders. For optimal physical performances, 25OHD concentrations of 100 nmol/L appear to be more advantageous in elderly men and women, and Vitamin D supplementation should be encouraged to maintain their 25OHD levels as high as this threshold

Gender-Related Approach to Kidney Cancer Management: Moving Forward

Men are more frequently diagnosed with kidney cancer than women, with a more aggressive histology, larger tumors, a higher grade and stage, and worse oncological outcomes. Smoking habits and sex steroid hormones seem to have a possible role in explaining these gender disparities. Moreover, the expression of genes involved in tumor growth and immune response in kidney cancer varies between men and women, having an impact on the gender-related response to oncological therapy, such as anti-angiogenic drugs and immunotherapy. Recent advances have been made in our understanding of the molecular and genetic mechanisms involved in kidney cancer, which could partially explain the gender differences, and they are summarized in this paper. However, other key mechanisms, which fully clarify the striking clinical gender-related differences observed in kidney cancer, are not completely understood at present. We reviewed and summarized the most relevant publications about the relationship between gender and kidney cancer. Efforts should be made to progress in bench and clinical research on gender-related signatures and disparities, and their impact on the clinical management of kidney cancer