Article Type: Short Communication
Received Date : Septmber 27, 2018
Accepted Date : October 5, 2018
Published Date: October 10, 2018
*Correspondence to: Jose Luis Turabian, Health Center Santa Maria de Benquerencia, Regional Health Service of Castilla la Mancha (SESCAM),
Toledo, Spain, Email: email@example.com
Article Type: Short Communication
Received Date : Septmber 27, 2018
Accepted Date : October 5, 2018
Published Date: October 10, 2018
It tends to be accepted as a proven fact that women are the "most ill sex" in terms of objective health status. But, in reality this is just a hypothesis. Gender differences have been reported in certain health diseases, with higher prevalence in women, as hypertension, kidney diseases, mental and behavioural disorders, psychological alterations and somatic complaints, or nutritional and metabolic diseases, and the susceptibility to smoking and hormonal factors, the role of gender inequality, as well as the molecular mechanisms associated with the physiological phenomena, have been proposed as causes of these differences. However, remain largely obscure the interaction of psychosocial, economic, medical and genetic differences. On the other hand, diagnoses in women are made with greater doubts, despite presenting exactly the same symptoms, than in men; so, could have a gender bias in the diagnoses, and this will finally result in a gender bias in the prevalence. Therefore, both mechanisms -statistical discrimination and discrimination due to personal stereotypes- are self-feeding, may be leading to a higher prevalence of diseases in women, than the real or objective prevalence. It is necessary that the "melody" or hypothesis of the gender differences in prevalence of chronic diseases is structured and balanced with the "harmony" of the data.
KEYWORDS: Gender; General Practice; Epidemiology; Prevalence; Chronic Disease; Morbidity; Symptom reporting.
Chronic diseases are the main causes of the fatal burden of the disease (the number of lives lost due to people dying early) in most age and sex groups [1-4].
The different biological stages in women determine the specific needs and demands of health services. Following these biological stages of the woman, the health needs that health services must respond to are: knowledge and use of contraceptive methods for adequate family planning to avoid unwanted pregnancies and voluntary interruptions of pregnancy, those related to health care of the pregnancy, childbirth and the puerperium, detection and early care of gynaecological cancer and attention to the climacteric .
From a sociological point of view, it has been considered that women perform a worse self-evaluation of health and consult with the doctor with greater probability than men, although the degree to which the differences reported in prevalence and use of health are not known. However, biological or physiological differences, susceptibility to smoking and hormonal factors, have been proposed as causes of increased general susceptibility in women compared to men .
Gender differences have been reported in certain health problems / diseases. So, it has been communicated in hypertension, the prevalence of various kidney diseases, and the progression of established kidney disease. It can be hypothesized sex hormones play a key role in the pathogenesis and the outcome of disease processes, as well as the molecular mechanisms associated with the physiological phenomena necessary to explain the gender differences in renal disorders; however, remain largely obscure the interaction of psychosocial, economic, medical and genetic differences .
In addition, one of the main differences by sex refers to mental and behavioural disorders. Differences by sex occur particularly in the rates of common mental disorders: depression, anxiety, psychological alterations and somatic complaints; these disorders affecting 1 in 3 people occur twice in women than in men. And, moreover, depressive episodes are longer, the recurrences more frequent and with a greater tendency to chronicity in women than among males. Women's greatest impact is due to psychological as well as social and gender factors, as the traditional role of women in societies exposes them to more tensions, while depriving them of the ability to modify their stressful environment, as well as the high rate of domestic and sexual violence, to which women are exposed .
Although it has been described that women have consistently higher prevalence rates of anxiety disorders, less is known about how gender affects age of onset, chronicity, comorbidity, and burden of illness. Women with a lifetime diagnosis of an anxiety disorder are more likely than men to also be diagnosed with another anxiety disorder, bulimia nervosa, and major depressive disorder. Furthermore, anxiety disorders are associated with a greater illness burden in women than in men, particularly among European American women and to some extend also among Hispanic women. These results suggest that anxiety disorders are not only more prevalent but also more disabling in women than in men .
In this scenario it has been reported that the prevalence of depression in women (9%) is almost double that in men (5%). And one third of women (33%) have a chronic pain condition (fibromyalgia, arthritis / rheumatism, back problems and migraines), which can be considered an equivalent of depression / anxiety. The prevalence of depression in individuals with chronic pain conditions is 10%, compared to 5% in those without pain. Women report to having higher rates of chronic pain and depression and heavier pain than men. Consequently, depression and chronic pain conditions represent important sources of disability, especially for women .
On the other hand, given that several studies have found the gender difference in depression to be rooted in psychosocial forces and others have shown the difference to be due to a gender difference in somatic depression , the gender difference in the prevalence of depression can result from the higher prevalence among women of a specific phenotype of somatic depression .
Although, as we say, typically, women are diagnosed with depression twice as often as men, and their disease follows a more chronic course, also comorbid anxiety is more prevalent in women, whereas comorbid alcohol abuse is a major concern in men. Suicide rates for men are between three and five times higher compared with women. So, there are different symptom profiles in men and women, but it is difficult to define a gender-specific symptom profile. Socially mediated gender roles have a significant impact on psychosocial factors associated with risk, sickness behaviour and coping strategies. In general, too little attention has been paid to the definition and handling of depression and the gender-related requirements it makes on the healthcare system.
Definitely, it is not known why the most common mental disorders, anxiety and depression, are more prevalent among women then men. The gender difference in the prevalence of the common mental disorders is not explained by differences between men and women in the number or type of social roles occupied . It has been defined "psychosocial malaise" as a suffering that, because it can not be deciphered and expressed in words, appears as mental suffering, pain or somatic symptoms -Including gynaecological symptoms in women- without organic cause, and which are more frequent in women. So, the term "malaise syndrome" in women encompasses a complex set of diverse symptoms. They include nonspecific and general symptoms, psychological disorders and biosocial influences in women who consult the health services [14-17].
On the other hand, regarding endocrine, nutritional and metabolic diseases, in most populations the prevalence of obesity is greater in women than in men; however, the magnitude of the difference between the sexes varies significantly by country. It must be considered the role of gender inequality in explaining these disparities. So, the patterning of obesity across countries is gendered. However, the association between global measures of gender inequality and the sex gap in obesity is dependent on the measure used .
In summary, it can be said that there is a gender effect in the diagnoses and consequently in the prevalence. It has been emphasized that diagnoses in women are made with greater doubts, despite presenting exactly the same symptoms, than in men. It has been reported that this may be due, on the one hand, to "statistical discrimination" according to which doctors use previous data on the prevalence of the disease to help determine the certainty of a diagnosis, or on the other hand, doctors behave differently for men and women due to stereotypes or personal prejudices. In this sense, it has been published that this gender effect can not be explained by the doctors' previous notions about the probabilities of the disease (prevalence of the disease), so that this possible gender effect, with the consequent discrimination in the diagnoses, is due to the stereotypes personal .
In any case, it can be inferred that if there is a gender bias in the diagnoses, this will finally result in a gender bias in the prevalence. Therefore, both mechanisms-statistical discrimination "and discrimination due to personal stereotypes are self-feeding, and finally the communicated prevalence in women could be less than real or objective prevalence. However, some studies have reported that, taken as a whole, the apparently accepted notion of women as "most ill sex" in terms of objective health status, is not supported by data. There are no clear global differences in the prevalence of chronic diseases between women and men in the family medicine consultation. The interaction of psychosocial, economic, medical and genetic differences results in fewer differences in the prevalence of chronic diseases than expected. It could be hypothesized that some of these differences are due to psychosocial and gender factors that lead to greater use of early detection tests (breast and cervix, especially), greater susceptibility to smoking and hormonal factors in women and certain behaviours (tobacco, alcohol) predominant in men .
In short, are there differences in prevalence of chronic diseases described by gender, and in that case, what are they due to? Further research is needed to investigate the prevalence, diagnostic process, and mechanisms that underpin the gendered nature of diseases. Different disease prevention, diagnostic and treatment approaches may be needed across gender groups. And, consequently, the knowledge of these differences can allow prioritizing certain medical care decisions, especially, in family medicine level of care.
Hypotheses have a horizontal component, they are like the "melody" in music; they express a complete scientific (or "musical") idea; they have an important cultural base; it's the easiest thing to remember, the essence of the song and what makes it recognizable. On the contrary, facts are like the "harmony": they are eminently vertical. Like the harmony in music, the scientific facts fulfil the function of accompaniment, framework and base of the melodies; it results in the organization of scientific data (or simultaneous sounds in music). It is about achieving an adequate balance between melody and harmony, between hypotheses and facts that allow making science and medicine functional. This balance has to do with the structure of medicine. Everything is a matter of balance.
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