Objective:The aim of this time-trend analysis is to estimate long-term excess mortality and associated cardiovascular risk for abdominal aortic aneurysm (AAA) patients after elective repair while... Show moreObjective:The aim of this time-trend analysis is to estimate long-term excess mortality and associated cardiovascular risk for abdominal aortic aneurysm (AAA) patients after elective repair while addressing the changes in AAA management and patient selection over time.Background:Despite the intensification of endovascular aneurysm repair and cardiovascular risk management, Swedish population data suggest that AAA patients retain a persistently high long-term mortality after elective repair. The question is whether this reflects suboptimal treatment, a changing patient population over time, or a national phenomenon.Methods:Nationwide time-trend analysis including 40,730 patients (87% men) following elective AAA repair between 1995 and 2017. Three timeframes were compared, each reflecting changes in the use of endovascular aneurysm repair and intensification of cardiovascular risk management. Relative survival analyses were used to estimate disease-specific excess mortality. Competing risk of death analysis evaluated the risk of cardiovascular versus noncardiovascular death. Sensitivity analysis evaluated the impact of changes in patient selection over time.Results:Short-term excess mortality significantly improved over time. Long-term excess mortality remained high with a doubled mortality risk for women (relative excess risk=1.87, 95% CI: 1.73-2.02). Excess mortality did not differ between age categories. The risk of cardiovascular versus noncardiovascular death remained similar over time, with a higher risk of cardiovascular death for women. Changes in patient population (ie, older and more comorbid patients in the latter period) marginally impacted excess mortality (2%).Conclusions:Despite changes in AAA care, patients retain a high long-term excess mortality after elective repair with a persistent high cardiovascular mortality risk. In this, a clear sex - but no age - disparity stands out. Show less
Schistosoma mansoni infection may impair genital mucosal antiviral immunity, but immune cell populations have not been well characterized. We characterized mononuclear cells from cervical brushings... Show moreSchistosoma mansoni infection may impair genital mucosal antiviral immunity, but immune cell populations have not been well characterized. We characterized mononuclear cells from cervical brushings of women with and without S mansoni infection. We observed lower frequencies of natural killer T cells and higher frequencies of CD14(+) monocytes in infected women. Show less
Background: It is well recognized that underrepresented and minoritized groups do not have the same career opportunities. However, there are limited data on the range and specifics of potential... Show moreBackground: It is well recognized that underrepresented and minoritized groups do not have the same career opportunities. However, there are limited data on the range and specifics of potential barriers that withhold people in headache medicine and science from reaching their full potential. Moreover, people from different geographical regions often perceive different challenges. We aimed to identify world-wide perceived career barriers and possibilities for promoting equality amongst professionals in the headache fields. Methods: A cross-sectional online survey was conducted among professionals in the field of headache globally. The questions of the survey were aimed at assessing perceived career barriers in four domains: professional recognition, opportunities in scientific societies, clinical practice, and salary and compensation. Perceived mentorship was also assessed. Results: In total 580 responders completed the survey (55.3% women). Gender was the most important perceived barrier in almost all domains. Additionally, country of birth emerged as an important barrier to participation in international scientific societies. Career barriers varied across world regions. Conclusion: It is essential that longstanding and ongoing disparities by gender and country of origin for professionals in the headache field are globally acknowledged and addressed in areas of recruitment, retention, opportunities, mentor- and sponsorships, and advancement. Show less
The risk of recurrence after discontinuation of anticoagulation for a combined oral contraceptive (COC)-associated venous thromboembolism (VTE) is unclear. Therefore, we conducted a systematic... Show moreThe risk of recurrence after discontinuation of anticoagulation for a combined oral contraceptive (COC)-associated venous thromboembolism (VTE) is unclear. Therefore, we conducted a systematic review and meta-analysis to estimate the incidence of recurrent VTE among women with COC-associated VTE, unprovoked VTE and to compare the incidence of recurrent VTE between the two groups. The Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Embase Classic +Embase and Medline ALL to July 2020 and citations from included studies were searched. Randomized controlled trials, prospective cohort studies and meta-analyses of these study types were selected. The analysis was conducted by random-effects model. Nineteen studies were identified including 1537 women [5828 person-years (PY)] with COC-associated VTE and 1974 women (7798 PY) with unprovoked VTE. Studies were at low risk of bias. The incidence rate of VTE recurrence was 1.22/100 PY [95% confidence interval (CI) 0.92-1.62, I-2 = 6%] in women with COC-associated VTE, 3.89/100 PY (95% CI 2.93-5.17, I-2 = 74%) in women with unprovoked VTE and the unadjusted incidence rate ratio was 0.34 (95% CI 0.26-0.46, I-2 = 3%). The recurrence risk in women after COC-associated VTE is low and lower than after an unprovoked VTE. Show less
Objective: To assess validity of ICHD-3 diagnostic criteria for menstrual migraine.Methods: We performed a longitudinal E-diary study in premenopausal women with migraine. Menstrual migraine... Show moreObjective: To assess validity of ICHD-3 diagnostic criteria for menstrual migraine.Methods: We performed a longitudinal E-diary study in premenopausal women with migraine. Menstrual migraine diagnosis was self-reported at baseline, and verified according to diary based ICHD-3 criteria and a previous proposed statistical model. Validity of self-reported menstrual migraine was compared to diary based diagnosis and statistical diagnosis. Test-retest reliability and concordance between both methods were determined. Clinical characteristics of perimenstrual and non-perimenstrual migraine attacks were compared in women with and without menstrual migraine.Results: We included 607 women. Both women who did and women who did not self-report to suffer from menstrual migraine fulfilled ICHD-3 criteria in the E-diary in two thirds of cases. Pure menstrual migraine was extremely rare (<1%). Concordance between statistical and diary based diagnosis was minimal (kappa = 0.28, 95% CI:0.23-0.33). Women diagnosed with menstrual migraine showed 37-50% longer attack duration and increased triptan intake (OR 1.19-1.22, p<0.001) during perimenstrual attacks.Conclusion: Self-reported menstrual migraine diagnosis has extremely poor accuracy. Two thirds of women suffer from menstrual migraine, independent of self-reports. Pure menstrual migraine is rare. Women with menstrual migraine have longer attack duration and increased triptan intake during perimenstrual attacks, in contrast to women without menstrual migraine. Prospective headache (E-)diaries are required for a menstrual migraine diagnosis, also in clinical practice. Show less
Wiegers, H.M.G.; Knijp, J.; Es, N. van; Coppens, M.; Moll, S.; Klok, F.A.; Middeldorp, S. 2022
Background The risk of recurrence after a venous thromboembolism (VTE) related to estrogen-containing contraceptives is a key driver to guide anticoagulant treatment decisions. Objective To... Show moreBackground The risk of recurrence after a venous thromboembolism (VTE) related to estrogen-containing contraceptives is a key driver to guide anticoagulant treatment decisions. Objective To estimate the incidence rate of recurrent VTE after discontinuation of anticoagulant treatment in women with a first episode of VTE related to estrogen-containing contraceptives. Methods Embase, MEDLINE, and the CENTRAL were searched from 1 January 2008 to 27 May 2021 for prospective and retrospective studies reporting on recurrence after a first VTE related to estrogen-containing contraceptives. Risk of bias was assessed using QUIPS tool. Recurrence rates per 100 patient-years were pooled using Knapp-Hartung random-effects meta-analysis. Incidence rates were reported separately based on study follow-up duration (<= 1 year, 1-5 years, and >5 years) and for several subgroups. Results A total of 4,120 studies were identified, of which 14 were included. The pooled recurrence rate was 1.57 (95%-CI: 1.10-2.23; I-2 = 82%) per 100 patient-years. Recurrence rates per 100 patient-years were 2.73 (95%-CI: 0.00-3643; I-2 = 80%) for studies with <= 1 year follow-up, 1.35 (95%-CI: 0.68-2.68; I-2 = 44%) for studies with 1-5 years follow-up, and 1.42 (95%-CI: 0.84-2.42; I-2 = 78%) for studies with >5 years follow-up. Conclusion Among women with VTE associated with estrogen-containing contraceptives, the risk of recurrence after stopping anticoagulation is low, which favors short-term anticoagulation. Large prospective studies on VTE recurrence rates and risk factors after stopping short-term anticoagulants are needed. Show less
Accumulating evidence pinpoints sex differences in stroke incidence, etiology and outcome. Therefore, more understanding of the sex-specific mechanisms that lead to ischemic stroke and aggravation... Show moreAccumulating evidence pinpoints sex differences in stroke incidence, etiology and outcome. Therefore, more understanding of the sex-specific mechanisms that lead to ischemic stroke and aggravation of secondary damage after stroke is needed. Our current mechanistic understanding of cerebral ischemia states that endothelial quiescence in neurovascular units (NVUs) is a major physiological parameter affecting the cellular response to neuron, astrocyte and vascular smooth muscle cell (VSMC) injury. Although a hallmark of the response to injury in these cells is transcriptional activation, noncoding RNAs such as microRNAs exhibit cell-type and context dependent regulation of gene expression at the post-transcriptional level. This review assesses whether sex-specific microRNA expression (either derived from X-chromosome loci following incomplete X-chromosome inactivation or regulated by estrogen in their biogenesis) in these cells controls NVU quiescence, and as such, could differentiate stroke pathophysiology in women compared to men. Their adverse expression was found to decrease tight junction affinity in endothelial cells and activate VSMC proliferation, while their regulation of paracrine astrocyte signaling was shown to neutralize sex-specific apoptotic pathways in neurons. As such, these microRNAs have cell type-specific functions in astrocytes and vascular cells which act on one another, thereby affecting the cell viability of neurons. Furthermore, these microRNAs display actual and potential clinical implications as diagnostic and prognostic biomarkers in ischemic stroke and in predicting therapeutic response to antiplatelet therapy. In conclusion, this review improves the current mechanistic understanding of the molecular mechanisms leading to ischemic stroke in women and highlights the clinical promise of sex-specific microRNAs as novel diagnostic biomarkers for (silent) ischemic stroke. Show less
Objectives This research aimed to provide a deeper insight into the gender-specific barriers to smoking cessation and gender-specific preferences for interventions in primary care, in order to... Show moreObjectives This research aimed to provide a deeper insight into the gender-specific barriers to smoking cessation and gender-specific preferences for interventions in primary care, in order to contribute to better aligned cessation care for women. Design Qualitative study using focus groups. Setting Regularly smoking female and male adults were recruited from four different general practices in The Hague (The Netherlands). Participants A total of 11 women and nine men participated. Participants included were regular smokers with a minimum age of 18 and sufficient command of the Dutch language, who were willing to talk about smoking cessation. Inclusion ended when saturation was reached for both women and men. Participants were selected by means of purposeful sampling, whereby looking at age, educational level and experience with quitting. Results The main barriers to smoking cessation in women were psychological factors, such as emotion and stress, compared with environmental factors in men. Women indicated they were in need of support and positivity, and both women and men expressed the desire for assistance without judgement. Contrary to men, women were not drawn to restrictions and (dis)incentives. Conclusion When counselling smokers, in women the focus should be on perceived internal problems, as opposed to more external obstacles in men. Contrary to men, female smokers seem to prefer non-coercive interventions, such as a group intervention offering support and positivity. Future research should focus on these gender differences, and how they could improve treatment in primary care. Show less
Background and purpose Migraine is recognized as a vascular risk factor, especially in women. Presumably, migraine, stroke and cardiovascular events share pathophysiological mechanisms. Self... Show moreBackground and purpose Migraine is recognized as a vascular risk factor, especially in women. Presumably, migraine, stroke and cardiovascular events share pathophysiological mechanisms. Self-reported cold extremities were investigated as a marker for vascular dysfunction in migraine. Secondly, it was hypothesized that suffering from cold extremities affects sleep quality, possibly exacerbating migraine attack frequency.Methods In this case-control study, a random sample of 1084 migraine patients and 348 controls (aged 22-65 years) from the LUMINA migraine cohort were asked to complete questionnaires concerning cold extremities, sleep quality and migraine.Results A total of 594 migraine patients and 199 controls completed the questionnaires. In women, thermal discomfort and cold extremities (TDCE) were more often reported by migraineurs versus controls (odds ratio 2.3, 95% confidence interval 1.4-3.7; P < 0.001), but not significantly so in men (odds ratio 2.5, 95% confidence interval 0.9-6.9; P = 0.09). There was no difference in TDCE comparing migraine with or without aura. Female migraineurs who reported TDCE had higher attack frequencies compared to female migraineurs without TDCE (4 vs. 3 attacks per month; P = 0.003). The association between TDCE and attack frequency was mediated by the presence of difficulty initiating sleep (P = 0.02).Conclusion Women with migraine more often reported cold extremities compared with controls, possibly indicating a sex-specific vascular vulnerability. Female migraineurs with cold extremities had higher attack frequencies, partly resulting from sleep disturbances. Future studies need to demonstrate whether cold extremities in female migraineurs are a predictor for cardiovascular and cerebrovascular events. Show less
Rhun, E. le; Weller, M.; Niclou, S.P.; Short, S.; Piil, K.; Boele, F.; ... ; EANO Women Neuro-Oncology Comm 2020
Background. Women represent an increasing proportion of the overall workforce in medicine but are underrepresented in leadership roles.Methods. To explore gender inequalities and challenges in... Show moreBackground. Women represent an increasing proportion of the overall workforce in medicine but are underrepresented in leadership roles.Methods. To explore gender inequalities and challenges in career opportunities, a web-based survey was conducted among the membership of the European Association of Neuro-Oncology and the Brain Tumor Group of the European Organisation for Research and Treatment of Cancer.Results. A total of 228 colleagues responded to the survey: 129 women (median age 45 years; range, 25-66 years)and 99 men (median age 48 years; range, 24-81 years); 153 participants (67%) were married and 157 participants(69%) had at least 1 child. Women less often declared being married (60% vs 77%, P =.007) or having a child (63%vs 77%, P =.024). Men more frequently had a full-time position (88% vs 75%, P =.036). Women and men both perceived an underrepresentation of women in leadership positions. Half of participants agreed that the most important challenges for women are leading a team and obtaining a faculty position. Fewer women than men would accept such a position (42% vs 56%). The main reasons were limited time for career and an inappropriate work and life balance. Women specifically cited negative discrimination, limited opportunities, and lack of self-confidence.Discrimination of women at work was perceived by 64% of women vs 47% of men (P =.003).Conclusion. Women are perceived as experiencing more difficulties in acquiring a leadership position. Personal preferences may account for an underrepresentation of women in leadership positions, but perceived gender inequalities extend beyond disparities of access to leadership. Show less
Gebhard, C.; Maredziak, M.; Messerli, M.; Buechel, R.R.; Lin, F.; Gransar, H.; ... ; Kaufmann, P.A. 2020
Aims There are significant sex-specific differences in left ventricular ejection fraction (LVEF), with a higher LVEF being observed in women. We sought to assess the clinical relevance of an... Show moreAims There are significant sex-specific differences in left ventricular ejection fraction (LVEF), with a higher LVEF being observed in women. We sought to assess the clinical relevance of an increased LVEF in women and men.Methods and results A total of 4632 patients from the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) registry (44.8% women; mean age 58.7 +/- 13.2 years in men and 59.5 +/- 13.3 years in women, P = 0.05), in whom LVEF was measured by cardiac computed tomography, were categorized according to LVEF (low <55%, normal 55-65%, and high >65%). The prevalence of high LVEF was similar in both sexes (33.5% in women and 32.5% in men, P = 0.46). After 6 years of follow-up, no difference in mortality was observed in patients with high LVEF in the overall cohort (P = 0.41). When data were stratified by sex, women with high LVEF died more often from any cause as compared to women with normal LVEF (8.6% vs. 7.1%, log rank P = 0.032), while an opposite trend was observed in men (5.8% vs. 6.8% in normal LVEF, log rank P = 0.89). Accordingly, a first order interaction term of male sex and high LVEF was significant (hazard ratios 0.63, 95% confidence intervals 0.41-0.98, P = 0.043) in a Cox regression model of all-cause mortality adjusted for age, cardiovascular risk factors, and severity of coronary artery disease (CAD).Conclusion Increased LVEF is highly prevalent in patients referred for evaluation of CAD and is associated with an increased risk of death in women, but not in men. Differentiating between normal and hyperdynamic left ventricles might improve risk stratification in women with CAD. Show less
Quest’articolo indaga il rapporto tra affronto verbale, genere e agentività legale nella Bologna della prima età moderna. Per molto tempo gli studiosi hanno trascurato di considerare l’impegno... Show moreQuest’articolo indaga il rapporto tra affronto verbale, genere e agentività legale nella Bologna della prima età moderna. Per molto tempo gli studiosi hanno trascurato di considerare l’impegno delle donne nell’attività criminale, o ne hanno sottolineato la distinzione. In tale contesto l’insulto è spesso stato caratterizzato una forma criminale tipicamente femminile e considerato in rapporto all’incapacità delle donne di agire in altri ambiti sociali, economici e politici della vita. Il presente studio intende sottoporre a meditazione critica tale assunto, esaminando il linguaggio e la pratica dell’affronto verbale quale discorso deviante attraverso il casellario giudiziario del Tribunale del Torrone, la corte penale di Bologna nella prima età moderna. Mentre tale fonte conferma l’esistenza di un lessico altamente sessista degli insulti, si sostiene che l’insulto maschile e femminile non vadano trattati distintamente, dal momento che i protagonisti maschili e quelle femminili attinsero a un ampio spettro di convenzioni e pratiche culturali condivise che vale la pena di esplorare. Show less
Why did some European countries choose migrant labour to expand their labour force in the decades that followed World War II, while others opted for measures to expand female employment via welfare... Show moreWhy did some European countries choose migrant labour to expand their labour force in the decades that followed World War II, while others opted for measures to expand female employment via welfare expansion? The paper argues that gender norms and the political strength of the left were important structuring factors in these choices. Female employment required a substantial expansion of state intervention (e.g. childcare; paid maternity leave). Meanwhile, migrant recruitment required minimal public investments, at least in the short term, and preserved traditional gender roles. Using the contrasting cases of Sweden and Switzerland, the article argues that the combination of a weak left (labour unions and social democratic parties) and conservative gender norms fostered the massive expansion of foreign labour and a late development of female labour force participation in Switzerland. In contrast, more progressive gender norms and a strong labour movement put an early end to guest worker programmes in Sweden, and paved the way for policies to promote female labour force participation. Show less
This paper explores women’s entrepreneurial activities in the Oman and Qatar in light of the state attention given to promoting entrepreneurship in the region over the past decade. In the Gulf Arab... Show moreThis paper explores women’s entrepreneurial activities in the Oman and Qatar in light of the state attention given to promoting entrepreneurship in the region over the past decade. In the Gulf Arab countries, like in many rapidly developing economies, neoliberal growth discourse abounds. Along with this, the promotion of entrepreneurship and embrace of individual enterprise is paramount. Despite the dominance of the state in political and economic spaces, Gulf governments have embraced the rhetoric of the market and entrepreneurship. Drawing from semi-structured interviews, focus groups, and participant observation conducted between 2011 and 2015, this paper examines this phenomenon. In a region stereotyped with weak gender development outcomes, female entrepreneurship is largely cast as a positive development aimed at liberating and empowering women through individual enterprise. In contrast, this paper finds that the same forces that are meant to empower women often reproduce or reinforce certain gender norms while introducing new forms of dependency. Gulf female entrepreneurs confront competing tensions within three intersecting political economy logics: the structural logic of the economy, the logic of development narratives, and the logic of socio-economic organisation. Show less
Mutsert, R. de; Gast, K.; Widya, R.; Koning, E. de; Jazet, I.; Lamb, H.; ... ; Heijer, M. den 2018
