TEMA 1
Abstract
Some aspects of glucose homeostasis and energy balance are regulated differently in
males and females. This review discusses the most fundamental gen der differences in
diabetes and obesity, including the prevalence of impaired fasting glucose and impaired
glucose tolerance, the prevalence and incidence of type 2 and type 1 diabetes, as well as
the prevalence of metabolic syndrome and obesity. These gender-specific differences in
glucose homeostasis and energy balance represent a source of factors that should be
studied to develop gender-based therapeutic ave nues for diabetes.
Introduction
Epidemiology is defined as the study of the patterns, causes, and effects of health and
disease in selected populations. It is central to public health and shapes policy decisions
and evidence-based medicine by identifying risk factors for disease and targets for
disease prevention. Increasing evidence suggests that sex and gender affect the
pathophysiology, incidence, prevalence, course, and response to therapy of many
diseases. Sex differences in physiology and disease are of fundamental importance
because they represent gender-related biological factors that might lead to better
prevention and therapy. Some aspects of glucose homeostasis and energy balance are
regulated differently in men and women. This chapter provides an over view of the most
fundamental gender differences in diabetes and obesity. These include the prevalence of
impaired fasting glucose and impaired glucose tolerance, the prevalence and incidence
of type 2 and type 1 diabetes, as well as the prevalence of metabolic syndrome and
obesity. These gender-specific differences in glucose homeostasis and energy balance
represent a source of factors that may lead to the development of gender-based
therapeutic avenues for metabolic disease.
TEMA 2
Cardiovascular disease is the leading cause of morbidity and mortality for womeninthe
Western world, and a major contributor to their illness spectrum in developing countries.
Despite these facts, until recent decades, cardiovas cular disease was considered a man’s
problem. The consequence was that the major evidence base, randomized controlled trials of
cardiovascular diseases and their therapies, were conducted predominantly or exclusively in
middle aged Caucasian men, with results extrapolated (albeit inappropriately) to multiple other
populations. Clinical research related to women’s health involved largely what I have termed
“bikini medicine,” addressing the body systems covered by the bikini bathing suit, i.e., the
breast and the reproductive system. Only in recent decades have we seen attention to broader
aspects of sex-specific medicine, alternately termed gender medicine, and its consequences
have been far reaching. Sex/gender differences entail both those characteristics specific to one
sex and those that differ in prevalence, manifestations, and/or outcomes between the sexes. In
their innovative and comprehensive textbook, “Sex-Specific Analysis of Cardiovascular
Function,” Professors Peter Kerkhof and Virginia Miller pro vide an amazing resource for the
research and clinical adult and pediatric cardiovascular communities. In chapters ranging from
basic cardiovascular physiology, genetics, hormonal status, genomics, proteomics,
metabolomics, biomarkers, biomedical engineering, biostatistics, and the like; to epidemiol
ogy, translational issues, and clinical aspects of a broad spectrum of cardio vascular illnesses,
the recently identified sex/gender differences (as well as similarities) are explored. The
widespread sex differences in cardiovascular structure and function highlight the importance
of consideration of sex as a biologic variable and of sex influences on cardiovascular disease
both in preclinical research and in the planning and analysis of cardiovascular clinical trials.
Although the coronary circulation and coronary heart disease have been the most intensively
studied in the arena of cardiovascular sex-specific medi cine, the editors and their authors
appropriately explore the domains of the cerebral circulation, pulmonary arterial hypertension,
etc.
A woman’s health relates to the health of her family, the health of her community, and thereby
to the health of the nation. Thus, efforts to improve women’s heart health, evidence-based
application of sex-specific preventive, diagnostic, and therapeutic interventions, have the
potential to improve national health status. Advances in the USA offer support to this thesis. In
the early years of sex-specific cardiovascular medicine, and prior to intensive educational and
advocacy campaigns regarding heart disease in women, 1 of 2 USwomendiedofcardiovascular
illness. In 2018, this has decreased to 1 in 4 US women, a stunning accomplishment.
TEMA 3
Queer Embodiment: Monstrosity, Medical Violence, and Intersex Experience is a book about
intersex experience written by an intersex person. It is not, like most books about intersex
experience written by intersex people— of which there are very few to begin with— an
autobiography, at least not in any straightforward sense. It draws on work in critical theory,
queer theory, feminist philosophy, and science and technology studies. It does so because
these fields have helped me more adequately understand and theorize the fraught experience
that is being an intersex person in this contemporary moment in North America. In other words,
the intellectual work done by this book is also work that felt personally necessary in order begin
to grasp who and what I am. This means that Queer Embodiment is centrally preoc cupied with
the question of intersex ontology: what is it to be intersex? T his is no easy question to answer,
at least not for me: I have found that being intersex is complicatedly comprised of how modern
and contempo rary medical and scientific epistemologies have interpreted and diagnosed
intersex conditions; how intersex activists have contested those definitions; how certain
intellectuals have interrogated intersexuality to make broader points about contemporary
understandings of pathology, queerness, sexed embodiment, and technoscientific methods of
somatic normalization; and how actually existing intersex people have fought for and theorized
ways of being in the world. Because of this, the book is an amalgam of genres and methods:
part autobiography, part theory, part medical genealogy. I think of it as a monstrous
assemblage, a hybrid project that has had to reject concepts of disciplinary purity and propriety
to explore phenomena that trouble some of our most basic taxonomic and classificatory
distinctions: male and female, the pathological and the healthy, the normal and the abnormal,
the biological and the technological. I was at a conference in September 2017 where a
presenter with an intersex condition responded to an audience question about the genetic
inher itability of such conditions with the quip that intersex “is just a word.” I understood them
to mean that intersex is a deliberate human invention that expeditiously unites a large variety
of congenital quirks of sexed being under a big tent (so if you want to know about genetic
inheritability, you should just ask about a specific condition). While I was sympathetic to their
call for specificity, I bristled at their claim. Intersex is a word, yes, but it is not “just a word.” No
word is. One of the things this book does is trace the work that certain words (like intersex,
hermaphrodite, male, female) do: their material impacts, the ways they function in the
translation of embodied experience, and the integral role they play in shifting, transforming,
gener ating, and dismantling technoscientific knowledges and practices, as well as
communities and consortiums of people negotiating these knowledges and practices.
TEMA 4
Abstract
Sex/gender-specific differences in the respira tory system begin with intrauterine lung
development and continue throughout child hood and adulthood. Sex/gender affects the
incidence, treatment, and prognosis of various respiratory diseases, but there are not many
studies focusing on sex differences in respira tory physiology and pulmonary disease. In this
chapter, we discuss sex/gender differences in respiratory diseases, with a focus on chronic
obstructive pulmonary disease, asthma, non tuberculous mycobacterial pulmonary dis ease,
and pulmonary arterial hypertension.
Introduction
Sex/gender influences the onset, treatment, and prognosis of respiratory diseases. The
majority of information and knowledge we currently have about respiratory diseases is based
on studies conducted primarily with male partici pants [1]. “Sex” distinguishes between male
and female, beginning with biological differences determined by sex and is characterized by
varia tions in sex hormones. These biological differ ences, along with various social and
environmental influences, contribute to differences in the occur rence and prognosis of
respiratory diseases between males and females. In addition to bio logical sex differences,
“gender,” which refers to the expression of masculinity and femininity in a specific sociocultural
context, affects social activities and occupational differences between men and women and
impacts the onset and prognosis of diseases. Although there have not been many studies on
sex/gender-specific differences in respiratory diseases, it is under stood that both biological
sex and gender dif ferences affect these diseases. In this chapter, we explore sex/gender-
specific differences in respiratory diseases, focusing on chronic obstructive pulmonary
disease (COPD), asthma, nontuberculous mycobacterial pulmonary disease, and pulmonary
arterial hypertension.
TEMA 5
Medical and social care of transgender persons require complicated, multidisci plinary efforts
with complex strategies and many unknowns. The biology of gender identity, gender dysphoria,
and gender incongruence is still incompletely under stood. The best medical practice options
are often based upon retrospective or empirical studies rather than upon controlled,
randomized, double-blind trials common to most other areas of medicine. Even hormone
therapy for transgender individuals is commonly based upon the strategies used for estrogen
replacement in menopausal women or testosterone in hypogonadal men—treatment
modalities whose goals differ from those of gender affirming hormone therapy in transgender
individuals. As a result, treatment may lack consistent standards of care required to ensure an
acceptable transition in hormone levels using the best available therapeutic options. To make
things even more complex, in addition to hormone therapy, transgender persons have a mul
titude of coincident needs—medical, surgical, educational, social, and legal—all of which
must be addressed. In planning this volume, we attempted to address as many of these needs
as possible. We have engaged a multidisciplinary group of experts and asked them to provide
recommendations and advice based upon the best available evidence. Clearly, the important
and compelling field of transgender medicine will continue to evolve and the next edition of this
text (if and when it comes) may look very different. So, in the meantime, we hope that the reader
will find this text a useful guide for safe and efficient care of transgender persons. We are
grateful to all contributors who embraced this project with immense enthusiasm and to our
students who keep asking good questions and demanding evidence-based answers. Most
importantly, we are indebted to those transgender persons from whom we continue to learn
daily and with whom we are proud to share their accomplishments.
TEMA 6
Teenagers usually have a wide range of interests that oscillate constantly and give rise to an
instability that sometimes leads them up the omnipotent fantasy path, which makes them feel
capable of doing everything sometimes and full of anguish other times — the natural fruit of
their constantly mutable priorities. This continuous and contradictory movement is a
remarkable pattern in adolescence. Such a process happens with teenagers in general, but
those having excessively high IQs tend to face stronger anguish crises. To mitigate anguish and
in an aim to protect themselves, teenagers look for role models and follow their idols’ path: the
awakening of their own “selves”, which is far away from them, is a tempting invitation to
constant changes and frequent exchange of positions. This stage, opposed to the evolutionary
stage toward maturity, which, instead of changes, has a decreasing range of their abilities as
the common denominator. When they reach the young adult stage, their sense of responsibility
leads them to evaluate their old interests and increasingly adjust to a new sense of life. These
matters — only sketched here — make one think how improper it is to make a vocational choice
in this age band, or better, in this stage of life. In developed countries, such a choice is made
later; sometimes by the time Brazilian students, for instance, graduate. A resource commonly
used is to insert an intermediate course to allow students to make more mature choices in a
culturally neutral environment. We had such courses in Brazil in the past, and I don’t know why
they have been discontinued. Brazilian teenagers then attended general subject matter classes
which allowed them to broaden their cultural knowledge while their range of abilities naturally
narrowed down and their omnipotent childlike fantasies were gradually abandoned: their
career choice was made in a more realistic way. We all should employ our efforts to bring that
model back.
However, in the meantime, the Millans should multiply in order to advise these young people
and mitigate their anguish. In this scenario full of anxieties triggered by uncertainties, the
surveys mentioned in this book were carried out. “Man is an eternal apprentice, and pain is his
master”. A former young man, or, who knows, an “eternal young man”, although already
matured by life difficulties, waived, or at least postponed, an academic goal. And then, “clear”
from college influences created by a teacher-student relationship, he could, with smooth
tranquility, deal with the vicissitudes teenagers, or late teenagers, go through along their
educational path as health care professionals. For the last twenty years, he has been
performing such tasks with intelligence, probity and modesty, and obtaining such magnificent
results that the Psychological Counseling Group of the School of Medicine of the University of
São Paulo (GRAPAL) has become a national reference. Such work is nothing but the natural fruit
of a generous professional attitude. The experience acquired over these long years by providing
psychological assistance to medical students, has added to the author’s natural gifts and has
resulted in a survey strictly correct from the scientific viewpoint, which is unique in several
aspects, appropriately deep for the importance of the issue and, moreover, brave enough to
deal with a problem, which to the majority of medical psychology experts is the most intricate
one in that discipline: the medical career choice! With the advice of Professor Doctor
Raymundo Soares de Azevedo Neto, who is a quality seal, Millan prepared his doctorate
dissertation, now transformed into this valuable scientific compendium, which is now
published in order to fill a gap in this area by approaching the matter of gender in the medical
career choice.
I am honored and grateful for being given this opportunity and I am going to analyze this work in
some of its fundamental aspects: Copyright © 2009. Nova Science Publishers, Incorporated.
All rights reserved.
• Methodology: I should focus only on the methodology used. Escaping from the prominent
sectarianism in psychological sciences, particularly the psychiatry-related ones, where the
quantitative methodology nearly always prevails over the qualitative methodology, the author
has elected to use both of them. And he appropriately does not explain the use of the qualitative
methodology. Both methodologies have a clear scientific nature, one in the numerical sense
and the other in the clinical sense. It is time to abandon the “fashionable” exclusive use of
Scales to the detriment of Schools: if we do not redefine what Science is, we will keep on
improperly using and evaluating clinical criteria, underestimating it: the Cartesian time is long
over! If we fail to approach an individual as an indivisible whole, we may revert to past decades
and keep on using the rancid dichotomy methods used in Wundt’s psychometric age: we would
annul the WHO Magna Session held on April 14, 1948 and go back to the archaic sense of
health.
• I give myself the right to warn younger researchers: the pendulum of history is inexorable. If,
in order to be read, a work has to be published in impact journals, its future publications will be
faster and virtual, and all researches will find their space. The more they are read, the more they
have impact on the public. The impact is to be generated by the research, not by the publishing
media. The world is globalized! Internet sites are available to everyone, democratically.
• Escaping a little from the methodology, I should say a couple of words about the sampling:
restricted, uniform and appropriate; conclusions are referred to as valid for this group only. The
work makes way for confrontation with other investigations related to different populations
from different schools, in several educational stages, including postgraduate ones. The author
calls our attention to all of this. And this is very important, because if a research equivocally
concludes that some matter was exhausted, this research is dead: it yields no more fruit!
• Women in Medicine: what a fascinating chapter! Not only for its serious and competent
bibliographic survey, but also for the question raised at the end: Women doctors: are they a
threat? The purpose of this work is not to analyze the matter in detail, particularly because it is
the product of a Doctoral Dissertation submitted to the obligatory questioning made by an
Examining Committee. We all know that the Dissertation, most of the time, is not the best work
of the researcher. As such, the Dissertation is fastened, locked and restricted exclusively to the
Title given to it. It does not allow further divagations, save in the discussion chapter, where, even
so, it should be carefully explained, without the freedom that authors give themselves, where
they are allowed to freely and fully express their thoughts, their general or hypothetical ideas.
