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This final chapter investigates what Pepys’s famously frank and comprehensive diary does not say – and how readers have dealt, or failed to deal, with those omissions. The focus is on a selection of the people mentioned in Pepys’s papers whose lives are barely mentioned in official documents or who went otherwise unrecorded: his wife Elizabeth, women and girls in whom he had a sexual interest, and certain of the Black people who worked for him or lived near him. Pepys’s diary and his other surviving records contain valuable information on their lives – information which shows Pepys to have been a sexual predator and an enslaver. For a range of reasons, these are aspects of his life missing from his popular reputation. Getting the most from the diary, and using it to explore the lives of others, requires understanding and countering influential traditions about Pepys and how his diary should be read.
This chapter looks at the evidence of Pepys’s diary manuscript and at the implications of Pepys’s decision to write in shorthand. These are dimensions usually missing from discussion of this key source, for the nature of Pepys’s shorthand is generally not well understood by commentators. Pepys used Thomas Shelton’s shorthand system, known as ‘tachygraphy’. The chapter begins by explaining how this system worked and how it shaped Pepys’s prose style. With illustrations from Pepys’s manuscript, it uses his description of the Great Fire and Charles II’s coronation to show how his pages differ from what is in print. It then explores the escalating methods of disguise that he developed for sexual passages and the implications of this. Finally, it considers what his manuscript tells us about his intentions in writing, especially about his sense of who might read his diary.
A poet celebrated for his syncretism, Shelley’s sense of fluidity arguably extends to his understanding of sex and sexuality, as he wrote during a time of peak flexibility and transition in thinking about gender-sex. Reading Erasmus Darwin’s descriptions of variously sexed plants, Ovid’s tales of shapeshifting, and William Lawrence’s intertwinement of sexed and racialised bodies, Shelley, the great poet of relation, comes to see the body as materially shifting, porous, and relational. Reading passages from A Discourse on the Manners of the Ancient Greeks Relative to the Subject of Love alongside the figure of nonbinary, intersex creation in ‘The Witch of Atlas’, Asia’s transformation into the posthuman ‘lamp of light’, and the nonhuman ‘shape all light’ in ‘The Triumph of Life’, this essay suggests Shelley began to understand polymorphous sexuality connected to sexed bodies of shapeshifting, mutable morphology.
This paper highlights systemic research and clinical deficiencies in addressing eating disorders among males and men, focusing on societal stigma, gender-biased diagnostics and barriers to care. It advocates for comprehensive reforms, including addressing systemic underfunding, closing research gaps, improving clinician training and tailored interventions to reduce disparities and improve outcomes.
Cognitive impairment is a common feature of multiple sclerosis (MS), and its severity may be influenced by several factors, such as biological sex and levels of cognitive reserve (CR). The relationship between sex, CR, and cognition has not yet been fully investigated. Therefore, the present study aimed to explore sex differences in CR building and the effect of sex and CR on cognitive performance in MS.
Method:
233 participants underwent the Brief Repeatable Battery of Neuropsychological Tests (BRB-N), the Stroop test, and the Cognitive Reserve Scale. The t-test was performed to compare sociodemographic variables, Italian adaptation of the Cognitive Reserve Scale, and cognitive test scores between sexes. To evaluate the effect of CR and sex and their interaction on cognitive performance several models of multivariate analyses of covariance were performed (dependent variables: all subtests of Brief Repeatable Battery of Neuropsychological Tests and Stroop scores; independent variables: sex and CR). Covariates included age, Expanded Disability Status Scale, and BDI-II scores.
Results:
Women showed higher levels of CR, particularly in daily activities (t = −5.848, p<.001), hobbies (t = −2.591, p = .010), and social life (t = −2.362, p = .011). Sex differences were noted in verbal memory and fluency (with women outperforming men) and processing speed (with men performing better than women). Multivariate analyses revealed a nonsignificant interaction between CR and sex on cognition (Λ=.950, F(10,260)=.813, p = .617, ηp2 = .050).
Conclusions:
CR and sex seemed to affect cognitive performance independently in pwMS. This highlights the importance of considering both factors in cognitive assessment, and that both sexes may benefit from specific psychoeducational training aimed at increasing CR levels.
Anxiety disorders are among the most common mental disorders worldwide, and most previous studies have focused solely on alcohol drinking or tobacco smoking as risk factors for anxiety.
Aim
This study investigated the associations of alcohol drinking and tobacco smoking with anxiety.
Method
The data of 30 836 individuals in the Taiwan Biobank were retrieved and analysed in our study. To investigate the associations of tobacco and alcohol use with anxiety, we analysed Patient Health Questionnaire 4 (specifically scores for the first two questions assessing generalised anxiety disorder) results of the included participants and data on their tobacco and alcohol use, and other covariates.
Results
Participants who used only tobacco and those using both tobacco and alcohol were more likely to experience anxiety than were those who did not use tobacco or alcohol. Among men, the use of alcohol and/or tobacco was associated with a significantly higher risk of anxiety. Among women, the use of both alcohol and tobacco was associated with a significantly higher risk of anxiety. Older age was associated with a lower risk of anxiety.
Conclusions
Tobacco and alcohol use significantly influence the risk of anxiety, particularly in men, and older age also influences this risk. The associations of anxiety with tobacco and alcohol use in women may change because of the increasing prevalence of their use among women in Taiwan in recent years.
Sex and gender have a significant relationship to health and health outcomes for women, men, and sexually and gender-diverse people. Sex relates to biological attributes, whether born female or male, while gender identity relates to how someone feels and experiences their gender, which may or may not be different to their physiology or sex at birth. Biological characteristics expose women and men to different health risks and health conditions. Gender also exposes people to different health risks, and gender inequity impacts on their potential to achieve health and well-being.
Women’s authorship position in science, technology, engineering, mathematics and medicine research reflects career progression, especially the transition from first to last (usually senior) author. Employment of women in mental health sciences has increased, and so should have had an impact on the change to senior author position.
Aims
To identify if first or last women’s authorship has changed, and mental health has better representation.
Method
We investigated women’s authorship position in a systematic review and meta-analyses, following PRISMA guidelines and using random-effects regression analyses.
Results
We identified 149 studies with sampling periods from 1975 to 2020 (excluding potential COVID-19 pandemic effects) that showed a large variation of women authors, and found an average proportion for first (26.2%) and last (16.1%) author position. In mental health (psychology and psychiatry), there was a higher representation, with 40% first author and 36.7% last author position, whereas medicine was 25.9% and 19.5%, respectively. The rate of change for psychology and psychiatry women authors was also higher every 10 years: 8.56% (95% CI 6.44–10.69%) for first and 6.86% (95% CI 4.57–9.15%) for last author, and rate was 2.35% higher for first author and 2.65% higher for last author than in medicine. Different methods of classifying gender and identification method did not affect our results.
Conclusions
Although mental health topics seem to fare better, our comprehensive review highlighted that the proportions of women first compared with last authors shows the same leaky pipeline as in other analyses, so we cannot be complacent about gender equality and career progression.
We recall the life and work of Timothy J. Crow, whose contributions provided great insights into the pathophysiology of schizophrenia and continue to shape many questions in the field. We compile his key works relating to psychotic disorders, focusing on the trajectory of his theoretical stance. Our account is interlaced with our own interpretation of the evidence that influenced Crow’s arguments over the years as well as his scientific method. Crow has had a significant impact on the neuroscience of schizophrenia. Many of his observations are still valid and several questions he raised remain unanswered to date.
Impairment in both psychosocial functioning and neurocognition (NC) performance is present in bipolar disorder (BD) yet the role of sex differences in these deficits remains unclear. The present systematic review and meta-analysis examined whether males and females with BD demonstrate differences in psychosocial functioning and NC performance.
Methods
The Cochrane Library, EMBASE, PsycINFO, PubMed, Scopus, and Web of Science databases were systematically searched from inception until November 20, 2023.
Results
Twenty studies published between 2005 and 2023 with a total sample size of 2286 patients with BD were included. A random effects meta-analysis revealed a statistically significant result with a small effect (SMD = 0.313) for sex differences in verbal learning and memory as well as visual learning and memory (SMD = 0.263). Females outperformed males in both domains. No significant sex differences were observed for any other NC outcome or psychosocial functioning. High heterogeneity and differences in assessment scales used should be considered when interpreting these findings, given their potential impact on results.
Conclusions
Future research should adopt a more homogenous, standardized approach using longitudinal designs to gain a clearer insight into sex differences in this population. This approach so may increase the use of preventative therapeutic options to address the difficult clinical challenge of reaching cognitive and functional recovery.
The bridal chamber has a rich history in ancient and medieval marriage practices. For some Byzantine communities, rites for inaugurating a couple’s sexual life in the bridal chamber were the most important ceremonies of the wedding process. This chapter traces the history of bridal chamber rituals and the church’s involvement in them through liturgical blessings performed by priests at the bed of consummation.
In Islam, sexual relations are permissible within marriage between a man and a woman. Islam encourages fertility between legally married couples; therefore, the treatment of infertility is permissible. Contraception use for family planning is permissible, but the use of contraception for permanently limiting the number of children is debated. The use of a third party in reproduction is not accepted in Islam. It is advisable that Muslim men or women seek medical care for sexual and reproductive issues from Muslim health care providers of their respective sex.
Published guidelines for conducting clinical trials for migraine therapeutics recommend recruiting participants based on disease epidemiology and including sex/gender-based subpopulation analyses. These recommendations aim to improve the quality and generalizability of migraine clinical trials. The aim of this study was to summarize participant demographics in migraine clinical trials for FDA-approved calcitonin gene-related peptide (CGRP)-targeting drugs (receptor antagonists [gepants], CGRP peptide or receptor monoclonal antibodies [mAbs]) and assess the use of sex/gender-based subpopulation analyses in these studies.
Methods:
We conducted a review of industry-sponsored migraine clinical trials for FDA-approved CGRP-targeting medications. Demographic data (sex and/or gender) from phase II or III trials were abstracted, and the use of sex/gender-based analyses was recorded.
Results:
Fourteen trials of gepants were included in this analysis. Participants who were identified as females or women were more likely to participate in these trials (87.0 ± 2.2%). Twenty-four trials of CGRP mAbs were reviewed. These studies also reported that participants were predominantly identified as female or women (84.9 ± 2.3%). None of the clinical trials reviewed reported sex/gender-based analyses of their results.
Conclusions:
This study suggests that men are underrepresented in migraine CGRP clinical trials. Greater attention to sex and gender is needed in migraine clinical trial design so that they better align with current recommendations made by headache societies and regulatory agencies.
Chapter 2 discusses prostitution in Chinese history and provides the context surrounding prostitution in contemporary China. Sex work has presented the state with regulatory challenges throughout most of Chinese history. In Imperial China (361 BC–1912 CE), prostitution policy varied based on the status of the men and women involved. In Republican China (1912–1949), the regulation of sex work was formulated primarily at the local level. Some local governments sought to abolish it, but they were more likely to license and tax it, or to establish state-run brothels. When the Chinese Communist Party (CCP) came to power in 1949, it moved swiftly to prohibit prostitution nationwide, and in the first few decades of the People’s Republic of China (PRC), prostitution was less prevalent and more hidden. Yet the scarcity of prostitution during the Mao era is best viewed as a brief historical anomaly. Sex work reemerged in the early 1980s, in the wake of Deng Xiaoping’s policy of reform and opening, and it has been integral to many of the country’s major political, economic, and social developments since 1979.
Increased rehabilitation intensity, the number of minutes of therapy per day, is associated with improved outcomes. However, it is unclear whether males and females receive the same inpatient stroke rehabilitation intensity. A sub-analysis of a retrospective population-based cohort study of adults (5877 females, 6893 males) with stroke discharged to inpatient rehabilitation between 2017 and 2021 was conducted. The mean rehabilitation intensity was 75.86 min/day for males and 73.33 min/day for females (p < .0001). Males <80 years of age were more likely to receive higher rehabilitation intensity than females. Future research should explore what factors account for this sex difference.
This chapter introduces the main topic of this book, inducing intimacy, and explains that the focus is deceptively induced sex and intimate relationships (i.e., sex and sexual and/or romantic relationships). It then sets out the book’s core aims, that is, to examine how the law has responded to inducing intimacy as a form of wrongdoing and source of harms and what can this tell us about the justifiability and desirability of using law to respond to these practices in the present age. The chapter also outlines the scope of the book and the sources used before introducing the theoretical framework that informs the analysis in the remaining chapters, which is based on the cultural significance of sex and marriage, including their significance for self-construction. The chapter closes by outlining the main arguments of the book, including the potential for its historical analysis to inform contemporary debates about whether and how to respond to inducing intimacy via law today.
This chapter explores the civil wrong of seduction to establish its nature and parameters and draw out its associations with deception. It argues that, as the earliest legal response to deceptive sex, seduction is in some senses the civil law analogue of later criminal laws. The chapter then shows how the action of seduction was rooted in the idea that deception was wrongful because it was one way of leading a woman off the ‘right’ path and that the harms it caused reflected the gendered significance of marriage and other ‘moral’ forms of intimacy. Furthermore, it highlights how these features of the action provided a framework within which the range of qualifying deceptions was limited and the temporal dimensions of the wrong were set. Finally, the chapter offers some reflections on how the distinctions between private and public introduced in Chapter 1 bore on the decision to keep seduction a civil wrong before foregrounding how these observations, and those made throughout the rest of the chapter, are pertinent to contemporary discussions about criminalising deceptive sex.
Understanding sex differences among persons with moderate-to-severe traumatic brain injury (TBI) is critical to addressing the unique needs of both males and females from acute care through to rehabilitation. Epidemiological studies suggest that 7 of every 10 persons with moderate-to-severe TBI are male, with females representing about 30%–33%.
Objective:
To examine the proportion of female and male individuals included in randomized controlled trials (RCTs) of interventions for moderate-to-severe TBI.
Methods:
A systematic review was conducted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines up to and including December 2022 using MEDLINE, PubMed, Scopus, CINAHL, EMBASE and PsycINFO databases. Studies were included if they met the following criteria: (1) human participants with a mean age ≥18 years, (2) ≥50% of the sample had moderate-to-severe TBI and (3) the study design was a RCT. Data extracted included author, year, country, sample size, number of female/male participants and time post-injury.
Results:
595 RCTs met the criteria for inclusion, published between 1978 and 2022, totaling 86,662 participants. The average proportion of female participants was 23.14%, and the percentage increased a small but significant amount over time. There was a significantly lower percentage of female participants in RCTs initiated in the acute phase (≤ 1 month) when compared with RCTs conducted in the chronic phase (≥ 6 months) post-injury (p < 0.001).
Conclusions:
Female participants are underrepresented in RCTs of moderate-to-severe TBI. Addressing this underrepresentation is critical to establish effective treatments for all persons with TBI.
This chapter analyses crimes involving procuring sex, including procuring sex by deception. It argues that to appreciate the nature of these offences, and their place within this book, it is necessary both to understand how the verb ‘to procure’ was interpreted, including when and why it required deception, and to pay attention to the acts whose procurement was proscribed by law. The chapter provides elucidation on both fronts, showing how the procuring offences were geared towards prohibiting ‘illicit’ (i.e., immoral) sexual activities and therefore criminalised the use of deception to lure others into committing such acts. In demonstrating this point, the chapter argues that a culturally sensitive vision of what makes intimacy valuable shaped and constrained the use of the procuring offences. Finally, the chapter argues that the demise of the procuring offences set the stage for the expansion of the crime of rape by deception and that examining how the procuring offences worked yields important lessons for those attempting to engage critically with this development.