IMED Lectures 1-10

What are the top causes of burden for women?

Asthma, anxiety disorders, back pain , dementia

What is the most important determinant of health?

Age - accumulation of molecular and cellular damage over time, exposure to external risks and disadvantages to access healthcare

WHO key facts on age

The proportion of the world's population over 60 years old is set to double by 2050, in 2050 80% of older people will be living in low-middle income countries

What happens in the absence of the SRY gene

Other genes on the chromosome are expressed (WNT4 and FOXL2) and differentiation of cells in the embryonic gonad form the ovary

Example of child burial

3 year old female on a bed of ochre with grave goods and DNA analysis showed she belonged to an unknown human lineage

Clinical stages of pubic hair development in females

1) preadolescent, 2) sparse, long, pigmented hair along the labia, 3) Spread of coarser, darker, curly hair across pubis, 4) Abundant adult type hair, limited to labia area, 5) Spread of pubic hair to form inverse triangle; spread medial surface of upper thigh

Evidence that the onset of puberty is not initiated by the gonad

1930s animal experiment - they removed ovaries from immature ovulate and when transplanted to adult animals they did ovulate. So hormonal signalling tells the gonad what to do.

Info about GnRH neurons

They originate from the nose structures during foetal development and are scattered around the hypothalamus

What is the cause and consequence of not enough iron

By increased loss, demand or decreased intake, absorption leads to deficiency which can have adverse health outcomes

What is Type I clitoridectomy?

Removal of the clitoral hood with or without removal of the clitoris

What is the WHO definition of health

a state of complete physical, mental and social wellbeing and not merely the absence of disease of infirmity

What are some ways to measure health

Child mortality, health expenditure per capita, burden of disease

How does gender influence experience of healthcare

Unequal power relationships, social norms decrease women's education and paid employment, exclusive focus on women's reproductive role, potential or actual experience of sexual violence

What are the top causes of burden for men?

Asthma, Suicide, Coronary heart disease

Factors that influence healthy ageing

Environment, healthy behaviours, supportive physical and social environment

What was special about COVID in terms of health data?

It was the 3rd leading cause of death in 2022, the first time in more than 50 years that an infectious disease had been top 5 leading causes of death in Australia. Chronic conditions contributed to 90% of death each year.

What are the 4 priority areas for WA women's health

Chronic conditions and healthy ageing; health and wellbeing impacts of gender-based violence; maternal, reproductive and sexual health; mental health and wellbeing

Biological sex =

Reproductive organs and their functions, determined by interplay of chromosomes, genes and hormones

Gender =

Socially or culturally determined traits, characteristics or expectations of being masculine or feminine.

What were the historical views of sex and gender

Legal recognition of sex based on genital anatomy and often surgical/hormonal interventions to assign a child with ambiguous genitalia to a category would occur.

What's a recent australian law on sex and gender?

Australian humans rights commission 2021 - unless there is medical necessity, irreversible intersex procedures should not be done on a child without consent

Early experiment on sex determination

Alfred Jost removed the gonads to foetal rabbits and femaleness was the default outcome

What is a karyotype

Number and visual appearance of chromosomes. Humans have 22 pairs of autosomes and 1 pair of sex chromosomes

What happens in the presence of the SRY gene for gonadal sex

It is expressed on the Y chromosome and it tells embryonic gonad to start forming a testis by differentiation into sertolis cells

Describe the formation of external and internal genetalia for a man

In the fetal testis presence of AMH results in inhibition of the female duct system and presence of Testosterone leads to development of the male duct system and conversion into 5aDHT by 5a reductase leading to development of male external genetalia

Why do variations in sex development occur?

Genetic mutations that interfere with formation of the gonad or genetic mutation that interferes with action of hormones (receptors or amount)

Explain the result of 5 alpha reductase deficiency (Guevedoces)

A mutation in gene coding for 5a reductase means T cannot convert to 5aDHT so there is a regression of female duct system (due to AMH) and stimulation of male duct system (due to T) but no development of external male genetalia so male infants are born with female or ambiguous external genetalia - masclinisation occurs at puberty

Explain the result of complete androgen insensitivity syndrome

Genetic mutation that results in the inability of cells to recognize and respond to T. So there is regression of female duct system (due to AMH), absence of male duct system (due to lack of T action) and female external genetalia (due to lack of 5aDHT). Genetically male due to SRY gene but phenotypically female.

Explain the result of classic congenital adrenal hyperplasia

Mutation in gene coding for 21 hydrolase enzymes involved in cortisol and aldosterone production which leads to excess androgen synthesis. Increase in circulating androgens leads to masculinization of female infants and ambiguous genetalia

How many missing women are there?

Bongaarts and Guilmoto = 121 millions in 2010, mostly china and india

How do we define missing women

Abortions, early childhood death, reproductive years death. Increase in death in late 70s due to invention of ultrasound technologies.

What mix of factors increases sex-selective abortions

Son preference, lower fertility, sex determination technologies (Ultrasound, blood test, sperm sorting)

What is the sex ratio across india and china?

104-7 boys per 100 girls but boys are at higher risk of dying in the first few years of life than girls due to higher T levels

Why do some parents prefer boys over girls?

Money (the dowry system) also it's the other way round in china, men are more likely to work and earn, continue the family name, men remain in the family and women are more likely/able to bring shame to the family by becoming pregnant.

When is sex-selective abortion most likely to occur?

After the 1st/2nd child

What is the consequence of differential stopping behaviour on women's health?

Since child-bearing will occur until a son is born, girls are more likely to have more siblings and limited resources

What is the consequence of shorter birth spacing due to pressure to have a son quickly on health?

Increased maternal death, low birth weight, prematurity, infant mortality - not recommended to have less than 2 years between birth and conception.

What are the three ways to define death?

Legal (irreversible cessation of all function of the brain), Religious, medical (legally brain dead)

What is archaeology?

The study of old things - human history using evidence

Who are the marginalised dead?

Where we have evidence past people were treated worse than others in terms of mortuary practice or where personal bias today makes us assume things so we misinterpret evidence from the past

Example of the lozoyo child

40,000 year old site in spain and small bonfires were found around a neanderthal child's grave - they were not marginalised

Oldest known example of cremation

Mungo lady 26,000 years ago who was burned, broken up, burned a second time and covered with ochre

Initial interpretations of the 'Lady of Vix' who was buried with grave good and no weapons

AS the transvestite priestess, honorary male or ritual specialist. Only in 1990 was it argued she was just a high-status female

How would you know a burual was for a deviant?

Burial position, grave goods

What is the difference between language and speech?

Language is communication of thoughts and feelings through a system of signals, such as voice sounds, gestures or symbols whereas speech is the act of expressing/describing thoughts by articulation of words

What are the two aspects of language

Production (thought-sentence-sound) and comprehension (sounds-words-sentence-meaning)

When does early auditory development occur?

0-3 months. Capacity to store and record sequences of auditory events. Evidence they prefer the language resembling the speech of their mother

What are the stages of early articulation

0-3m = cries, 3-6m = cooing, 6-9m = babble, 8m onwards = first words, 18m onwards = sentences

Gender differences in language development

Girls are more advantaged until 4 years old. Studies show girls use more parts of the brain while processing language

Factors that affect learning and behaviour

Biological, socio-cognitive, family and society, media, gender-typing

What should schools do to prevent negative effects of sexualised images

Education promoting positive body image, building social media literacy skills and enhancing help-seeking for body image concerns

What should young mental health service providers do to prevent negative affects of sexualised images

National and clinical guidelines to assist in building knowledge and skills related to body image, sexualised images, and social media.

What should social media companies do to prevent negative affects of sexualised images

Be held accountable for how platforms proliferate sexualisation of females, change algorithms, change in policies

Puberty =

the physiological, morphological and behavioural changes that occur in a growing individual during the transformation from a juvenile to a fertile adult

What are the 5 clinical stages of breast development?

1) Preadolescent, 2) Breast bud stage - increase in areolar area, 3) increase in breast tissue and pigmentation, 4) Areoloar and papilla form secondary mound above the level o the breast, 5) Mature stage; erect papilla projecting above areolar

Ovarian changes during puberty

Volume increases linearly from birth in relation to child's growth, change due to continuous recruitment and atresia follicles, follicles stimulated by gonadotrophins to secrete estrogen, ovulation rare until late puberty

What is an anovulatory cycle?

A cycle where there is no ovulation, common at puberty

What are the different tanner stages of puberty with GnRH

Tanner 1 - pulsatile secretion of LH occurs in nocturnal times, Tenner 2/3 - LH pulses become higher and then also smaller pulses are occurring outside of nocturnal stages, Tenner V - more insistent pulsatile secretion through both daylight and night hours

What initiates increased GnRH pulsatility

Leptin, a product of the obese gene and hormone produced by adipose cells, acts on the hypothalamus and leptin levels rise and modulate GnRH secretion via kisspeptin

What is the critical body fat hypothesis

Inhibition of GnRH pulse generator when body weight due to fat is < or equal to 20%

What is kisspeptin

Neuropoptide in the hypothalamus critical for switching on GnRH pulsatility. At puberty sensitivity of kisspeptin to estradial is released and inhibition of kisspeptin is disgarded.

What is the importance of carbohydrates

for cognitive function, blood sugar, fibre for the gut and heart, energy

What is the importance of protein

chemical reactions, muscle contraction support, hormones, DNA regulation and transport

What is the importance of fat/lipids

Help brain development/function, a structural component of cells, support vitamin absorption and energy source

What are micronutrients?

include vitamins & minerals are essential for maintaining health but are needed in smaller quantities than macronutrients

4 types of micronutrients

Water soluble vitamins,
Fat soluble vitamins,
Microminerals,
Trace minerals

What is iron as a metal and micronutrient

The most abundant transition metal (maybe why we evolved to need it) and a trace mineral/micromineral required by all living things

What are iron's functions in humans

Oxygen transport and storage, cellular and mitochondrial respiration, immune function, cell growth

Amounts of iron in the body

200mg in RBCs, 100mg in liver, 500mg in macrophages, 500mg in mitochondria

Recommended iron intake daily

boys - 11mg, girls - 15mg, males- 8mg, females - 18mg

What are the two types of iron in the diet

Heam (efficient, in animal products), non-haem (needs to be changed to DMT-1 and is vegetarian sources)

How is iron transported across enterocytes

Haem is mobilised by haem oxygenase and taken into the labile iron pool. The iron will then be transport straight across to the basolateral membrane for entry into circulation or stored as ferretin

Describe iron transport into circulation

Exported into the bloodstream via ferroportin then picked up by transferrin for transport around the body through circulation

What happens when there's too much iron in the diet

Often due to genetic disorder, leads to excessive production of ROS which is highly toxic and has adverse health outcomes

What is hemochromatosis

a condition where ferraportin is much bigger and iron is led straight through to circulation rather than localised

What are the 4 examples for the reasons for iron deficiency

Menstrual blood loss/exercise, pregnancy iron demand, vegetarian diet, genetics

What is the definition of iron deficiency

Iron loss exceeds absorption over time which results in decreased body iron levels

What are the three stages of severity for iron deficiency

Iron depletion (iDNA), then if that's left untreated to iron-deficient erythropoiesis (iDNA) then iron-deficient anaemia (IDA) where there are fewer RBCs

Other definitions of iron deficiency

Standard Australian medical practice (Ferritin < 30 uG/L);
WHO (Ferritin < 15 uG/L);
Research involving iron deficiency (varies significantly)

Top 5 impacts of iron deficiency

Fatigue
Exhaustion
Brain Fog
Muscle Weakness
Shortness of breath

What are the two types of modern treatment for iron deficiency

Oral iron therapy which increase iron 40-80% but restoration can take months and intravenous iron therapy which increases iron 200-400% instantly but can have negatives and is expensive

From 2000 to 2022 how much has prison populations increased by

the global female prison population increased by 59 percent, while male prisoner numbers increased by around 22% and the general population growth was only 29.5 per cent

From 2009 to 2019 the total australian adult prison population grew by

47 per cent, constituting a 45 per cent increase for males and a 64 per cent increase for females

What percentage of women imprisoned in WA are aboriginal

51.3%, 21x overrepresentation

Name the 4 metropolitan prisons in WA and what they're like

Boronia - most women have short sentences, will leave prison on a daily basis and they can have their children with them.
Melaleuca - Very big and newest. Where women go where they have not be sentenced yet, very secure.
Wandoo - small therapeutic prison, specialised treatment for women with alcohol and drug problems.
Bandyup - Biggest prison for women, maximum security

What is meant by criminalised women

Women who were being subjected to several areas of deprivation and victims of various forms of abuse, which led them into the criminal legal system

What are the 5 steps of the pre-imprisonment cycle of harm

1 Adverse childhood experience
2. homelessness and unsafe accommodation
3. harming relationships - drug use - early motherhood
Criminality
4. Interactions with the system
5. Prison

What are some post prison plans and needs

accommodation, support, holistic approach for transitional period so they can reconnect, need jobs and mentoring

What is the definition of female genital mutilation

comprises all procedures involving partial or total removal of
the female external genitalia or other injury to the female genital organs whether for cultural or other non-therapeutic reasons - WHO 2008

What are the 4 types of FGC

Type I - Clitoridectomy
Type II - Excision
Type III - Infibulation
Type IV - Other

As of 2019 how many women and how many countries practiced FGC

Despite being internationally recognized as a human rights violation, FGC has been performed on at least 200 million girls and women in 31 countries across 3 continents - >50% occurring in Egypt, Ethiopia and Indonesia

What is Type II excision

Removal of the clitoris and partial or total excision of the labia minora

What is Type III infibulation

Excision of all the external genitalia & stitching/narrowing of the vaginal opening

What is type IV - Other harmful procedures

Pricking, Piercing, Incising, Scraping, Cauterization

Reasons for FGC

Tradition, social norm, rites of passage, religion, marriageability, economics, gender roles and chastty

Short term health consequences of FGC

Severe pain, excessive bleeding, fever & sepsis, problems passing urine, psychological consequences, death

long-term health consequence of FGC

Complications in pregnancy, labour and delivery; painful periods and retained menstrual blood; problems having sex; recurrent urinary tract infections; vulval scaring; PTSD/anxiety

What is the current legislation on FGC in Australia

Illegal in every Australian state, person cutting and taking them can be imprisoned
In 2021, an Elder in the community and new mum have been charged in WA for
planning to carry out FGM/C for her 2 week infant, reported by GP