The impact of sex and gender on adaptation to space: executive summary.

This review article is a compendium of six individual manuscripts, a Commentary, and an Executive Summary. This body of work is entitled "The Impact of Sex and Gender on Adaptation to Space" and was developed in response to a recommendation from the 2011 National Academy of Sciences Decadal Survey, "Recapturing a Future for Space Exploration: Life and Physical Sciences for a New Era," which emphasized the need to fully understand sex and gender differences in space. To ensure the health and safety of male and female astronauts during long-duration space missions, it is imperative to examine and understand the influences that sex and gender have on physiological and psychological changes that occur during spaceflight. In this collection of manuscripts, six workgroups investigated and summarized the current body of published and unpublished human and animal research performed to date related to sex- and gender-based differences in the areas of cardiovascular, immunological, sensorimotor, musculoskeletal, reproductive, and behavioral adaptations to human spaceflight. Each workgroup consisted of scientists and clinicians from academia, the National Aeronautics and Space Administration (NASA), and other federal agencies and was co-chaired by one representative from NASA and one from the external scientific community. The workgroups met via telephone and e-mail over 6 months to review literature and data from space- and ground-based studies to identify sex and gender factors affecting crew health. In particular, the Life Sciences Data Archive and the Lifetime Surveillance of Astronaut Health were extensively mined. The groups identified certain sex-related differences that impact the risks and the optimal medical care required by space-faring women and men. It represents innovative research in sex and gender-based biology that impacts those individuals that are at the forefront of space exploration.

Proceedings from the scientific symposium: Sex differences in cardiovascular disease and implications for therapies.

UNLABELLED: A consortium of investigator-thought leaders was convened at the Heart Institute at Cedars-Sinai Medical Center and produced the following summary points: POINT 1: Important sex differences exist in cardiovascular disease (CVD) that affect disease initiation, diagnosis, and treatment. IMPLICATION: Research that acknowledges these differences is needed to optimize outcomes in women and men. POINT 2: Atherosclerosis is qualitatively and quantitatively different in women and men; women demonstrate more plaque erosion and more diffuse plaque with less focal artery lumen intrusion. IMPLICATION: Evaluation of CVD strategies that include devices should be used to explore differing anatomical shapes and surfaces as well as differing drug coating and eluting strategies. POINT 3: Bone marrow progenitor cells (PCs) engraft differently based on the sex of the donor cell and the sex of the recipient. IMPLICATION: PC therapeutic studies need to consider the sex of cells of the source and the recipient. POINT 4: Women have a greater risk of venous but not arterial thrombosis compared with men, as well as more bleeding complications related to anticoagulant treatment. Several genes coding for proteins involved in hemostasis are regulated by sex hormones. IMPLICATIONS: Research should be aimed at evaluation of sex-based differences in response to anticoagulation based on genotype. POINT 5: Women and men can have differences in pharmacological response. IMPLICATION: Sex-specific pharmacogenomic studies should be included in pharmacological development. POINT 6: CVD progression results from an imbalance of cell injury and repair in part due to insufficient PC repair, which is affected by sex differences, where females have higher circulating levels of PCs with greater rates of tissue repair. IMPLICATION: CVD regenerative strategies should be directed at learning to deliver cells that shift the recipient balance from injury toward repair. CVD repair strategies should ideally be tested first in females to have the best chance of success for proof-of-concept.

From earth to Mars: sex differences and their implications for musculoskeletal health.

Historically, most diagnostic and treatment modalities have been based on a male model. Osteoporosis is one of the few diseases in which there has been sex-based research and treatment bias in favor of women. As such, it is not known whether treatments developed for women will be efficacious for men. Similarly, scientists are just beginning to research whether sex-based differences in musculoskeletal health exist with extended space travel. Both women and men lose muscle and bone with extended space travel, but the low numbers of female astronauts combined with a lack of discrete data make it challenging to accurately pinpoint sex-based differences. More data collection is needed to ensure that the musculoskeletal health of astronauts is better managed both on earth and in space.

Complementary and alternative medicine and physical activity for menopausal symptoms.

Forty percent of all menopausal women seek medical attention to alleviate symptoms of menopause, a natural physiologic process. Severe symptoms and an overall decrease in quality of life have prompted many women to demand additional information and treatment. Although menopausal hormone therapy has been the standard, increasing evidence suggests that women are looking to complementary and alternative therapies for management and treatment of menopausal symptoms. Modalities such as physical activity, diet supplements, body work, and mind-body techniques are often used without evaluation or treatment by conventional health care providers. Many of these treatments may present varying risks and contraindications. Consequently, there is a great need for ongoing education and research to ensure alternative therapy use is not only effective, but also safe. This paper provides a systematic review of current complementary and alternative modalities and of physical activity used in the management and treatment of menopausal symptoms.

Severity of menopausal symptoms and use of both conventional and complementary/alternative therapies.

OBJECTIVE: To describe the prevalence and correlates of using conventional therapies, complementary and alternative therapies, or a combination of both types of therapies for menopausal symptoms and to examine the association between severity of symptoms and type of therapy use. DESIGN: Data on 2,602 women aged 45 years or older were gathered through a cross-sectional telephone survey conducted in Florida, Minnesota, and Tennessee during 1997 and 1998 using the Behavioral Risk Factor Surveillance System. Participants were asked a series of questions about their menopausal status, menopausal symptoms, healthcare provider selection in relation to menopause, and therapies used for menopausal symptoms. RESULTS: Of the eight menopausal symptoms assessed, the highest prevalence estimates were reported for hot flashes (62.9%), night sweats (48.3%), and trouble sleeping (41.1%). The average number of symptoms (range 0-8) was 3.10 (SD +/- 2.25) and, for women reporting symptoms, the average symptom severity score (range 1-24) was 6.78 (SD +/-4.63). About 45% of the women had not consulted with a healthcare provider for treatment of menopausal symptoms or for medical conditions related to menopause even though only 16.3% did not report any of the symptoms included in the survey. Forty-six percent of the women used complementary/alternative therapy either alone or in combination with conventional therapies. Age-adjusted average symptom severity scores were significantly higher among women who had undergone a hysterectomy, with removal of the ovaries (7.73; 95% CI 7.33,8.12) or without (7.60; 95% CI 7.16,8.05), than among women who experienced a natural menopause (6.42; 95% CI 6.14,6.71). Average severity scores were significantly higher among women who used both conventional and complementary/alternative therapies in relation to menopause (8.61; 95% CI 8.26,8.96) than among women who used only conventional therapies (7.09; 95% CI 6.67,7.50). This statistically significant association persisted when adjusted for age, education, income, race/ethnicity, state of residence, and menopausal category. CONCLUSIONS: In this sample, 46% of the women used complementary/alternative therapy either alone or in combination with conventional therapies, whereas a third of the women did not use any therapy in relation to menopause. Although causal inferences cannot be made, the menopausal symptom severity score was significantly higher among women who reported using a combination of conventional and complementary/alternative therapies than among women who used only conventional therapy, only complementary/alternative, or no therapy.

Reentry into clinical practice: challenges and strategies.

Women and men who reenter clinical practice after a period of clinical inactivity often face personal, professional, and institutional obstacles. Although many associations and academic medical institutions realize the critical importance of retaining and promoting highly qualified individuals, it is equally important for health care professionals to have the opportunity to return to a successful professional career following extended clinical inactivity. Here we provide a review of factors that may contribute to clinical inactivity, discuss challenges associated with the reentry process, describe current reentry efforts, and propose recommendations for future directions.