Background. Patients with chronic kidney disease (CKD) are at a higher risk of major adverse cardiovascular events (MACE) compared with the general population, but gender differences in this risk,... Show moreBackground. Patients with chronic kidney disease (CKD) are at a higher risk of major adverse cardiovascular events (MACE) compared with the general population, but gender differences in this risk, especially in older adults, are not fully known. We aim to identify gender differences in the risk of MACE in older European CKD patients, and explore factors that may explain these differences.Methods. The European Quality study (EQUAL) is a prospective study on stage 4-5 CKD patients, >= 65 years old, not on dialysis, from Germany, Italy, the Netherlands, Poland, Sweden and the UK. Cox regression and cumulative incidence competing risk curves were used to identify gender differences in MACE risks. Mediation analysis was used to identify variables which may explain risk differences between men and women.Results. A total of 417 men out of 1134 (37%) and 185 women out of 602 women (31%) experienced at least one MACE, over a follow-up period of 5 years. Women had an 18% lower risk of first MACE compared with men (hazard ratio 0.82; 95% confidence interval 0.69-0.97; P =.02), which was attenuated after adjusting for pre-existing cardiometabolic comorbidities and cardiovascular risk factors. There were no significant gender differences in the risk of recurrent MACE or fatal MACE. The risk difference in MACE by gender was larger in patients aged 65-75 years, compared with patients over 75 years.Conclusions. In a cohort of older adults with advanced CKD, women had lower risks of MACE. These risk differences were partially explained by pre-existing cardiometabolic comorbidities and cardiovascular risk factors.[GRAPHICS]. Show less
Context: Cold exposure mobilizes lipids to feed thermogenic processes in organs, including brown adipose tissue (BAT). In rodents, BAT metabolic activity exhibits a diurnal rhythm, which is highest... Show moreContext: Cold exposure mobilizes lipids to feed thermogenic processes in organs, including brown adipose tissue (BAT). In rodents, BAT metabolic activity exhibits a diurnal rhythm, which is highest at the start of the wakeful period. Objective: We investigated whether cold-induced thermogenesis displays diurnal variation in humans and differs between the sexes. Methods: This randomized crossover study included 24 young and lean male (n = 12) and female (n = 12) participants who underwent 2.5-hour personalized cooling using water-perfused mattresses in the morning (7:45 am) and evening (7:45 pm), with 1 day in between. We measured energy expenditure (EE) and supraclavicular skin temperature in response to cold exposure. Results: In males, cold-induced EE was higher in the morning than in the evening (+54% +/- 10% vs +30% +/- 7%; P = 0.05) but did not differ between morning and evening in females (+37% +/- 9% vs +30% +/- 10%; P = 0.42). Only in males, supraclavicular skin temperature upon cold increased more in morning than evening (+0.2 +/- 0.1 degrees C vs -0.2 +/- 0.2 degrees C; P = 0.05). In males, circulating free fatty acid (FFA) levels were increased after morning cold exposure, but not evening (+90% +/- 18% vs +9% +/- 8%; P < 0.001). In females, circulating FFA (+94% +/- 21% vs +20% +/- 5%; P = 0.006), but also triglycerides (+42% +/- 5% vs +29% +/- 4%, P = 0.01) and cholesterol levels (+17% +/- 2% vs 11% +/- 2%; P = 0.05) were more increased after cold exposure in morning than in evening. Conclusion: Cold-induced thermogenesis is higher in morning than evening in males; however, lipid metabolism is more modulated in the morning than the evening in females. Show less
So, P.; Wierdsma, A.I.; Boeijen, C. van; Vermeiren, R.R.J.M.; Mulder, N.C.L. 2021
Adolescents, particularly those with autism spectrum disorders, increasingly use psychiatric emergency services. Such risk is further greater in girls. Available knowledge on young people with... Show moreAdolescents, particularly those with autism spectrum disorders, increasingly use psychiatric emergency services. Such risk is further greater in girls. Available knowledge on young people with autism during crises lacks understanding of gender differences and of differences between typically developing adolescents and adolescents with autism. After psychiatric emergency consultations, we therefore compared the symptomatology and comorbidity of girls and boys with autism, and also to their typically developing male and female counterparts. We used registry data (2009-2017) on 1378 adolescents aged 12-18 years referred for urgent consultation to mobile psychiatric emergency services. This showed an increase in diagnoses of autism spectrum disorder from 7.9% in 2009 to 18.1% in 2016; autistic girls showed a steeper increase than autistic boys. A higher percentage of girls than boys with autism presented with comorbid anxiety disorders and a higher risk of suicide or self-harm, while the persistence of their complaints over time was rated lower. Adolescents with autism experienced more severe impairment in overall functioning, while being diagnosed less often with comorbid disorders as compared to typically developing adolescents. Outpatient care for autistic youth should include easy access to specialized professionals to help young people with autism cope with the challenges of adolescence.Lay abstractAmong adolescents seen for psychiatric emergency consultation, the percentage of adolescents with autism is increasing over the years. This applies even more to girls than to boys. We collected data of 1378 adolescents aged 12-18 years who were seen for urgent consultation by mobile psychiatric emergency services in the Netherlands. Among these, there were 64 autistic girls and 125 autistic boys. We wanted to know more about differences in problems between autistic and typical developing adolescents in crisis, both to prevent crisis and to improve services. The percentage of adolescents with autism increased over the years studied. Autistic adolescents experienced more severe impairment in functioning compared to typically developing adolescents. Compared to other adolescents, both boys and girls on the autism spectrum were diagnosed less frequently with mood disorders, behavioral disorders, relational problems, and abuse. Autistic girls had a higher suicide risk and suffered more often from anxiety disorders than autistic boys, while autistic boys had a longer history of problems. Outpatient care for children with autism should include easy access to specialized professionals who aim to reduce anxiety and help young people with autism to cope with the challenges of adolescence. Because possibly signs were missed during the emergency consultation, we recommend that as part of the routine procedure in crisis situations adolescents with autism are asked about mood and behavioral problems explicitly, as well as about negative life events. Show less
Items of the Resistance to Peer Influence Questionnaire (RPIQ) have a tree-based structure. On each item, individuals first choose whether a less versus more peer-resistant group best describes... Show moreItems of the Resistance to Peer Influence Questionnaire (RPIQ) have a tree-based structure. On each item, individuals first choose whether a less versus more peer-resistant group best describes them; they then indicate whether it is “Really true” versus “Sort of true” that they belong to the chosen group. Using tree-based item response theory, we show that RPIQ items tap three dimensions: A Resistance to Peer Influence (RPI) dimension and two Response Polarization dimensions. We then reveal subgroup differences on these dimensions. That is, adolescents with mild-to-borderline intellectual disability, compared with typically developing adolescents, are less RPI and more polarized in their responses. Also, girls, compared with boys, are more RPI, and, when high RPI, more polarized in their responses. Together, these results indicate that a tree-based modeling approach yields a more sensitive measure of individuals’ RPI as well as their tendency to respond more or less extremely. Show less
Spruijt, A.M.; Dekker, M.C.; Ziermans, T.B.; Swaab, H. 2019
Previous studies showed that the mineralocorticoid receptor (MR) is needed for behavioral flexibility in a fear conditioning paradigm. Female mice with forebrain-specific deletion of the MR gene ... Show morePrevious studies showed that the mineralocorticoid receptor (MR) is needed for behavioral flexibility in a fear conditioning paradigm. Female mice with forebrain-specific deletion of the MR gene (MRCaMKCre) were unable to show extinction of contextual fear, and could not discriminate between cue and context fear unlike control mice. In the present study, male and female (MRCaMKCre) mice and control littermates were used to study sex-specific fear conditioning, memory performance and extinction. The fear conditioning paradigm assessed both context- and cue-related fear within one experimental procedure. We observed that at the end of the conditioning all mice acquired the fear-motivated response. During the first minutes of the memory test, both male and female MRCaMKCre mice remembered and feared the context more than the control mice. Furthermore, female MRCaMKCre mice were not able to extinguish this memory even on the second day of memory testing. The female mutants also could not discriminate between cue (more freezing) and context periods (less freezing). In contrast, male MRCaMKCre mice and the controls showed extinction and were capable to discriminate, although the MRCaMKCre mice needed more time before they started extinction. These findings further support the relevance of MR for behavioral flexibility and extinction of fear-motivated behavior. In conclusion, the loss of MR in the forebrain results in large differences in emotional and cognitive behaviors between female and male mice, which suggests a role of this receptor in the female prevalence of stress- and anxiety-regulated disorders. Show less
