Browsing by Subject "sex"

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  • Jalonen, Emmi (Helsingin yliopisto, 2019)
    Tyypin 1 diabetesta esiintyy Suomessa eniten maailmassa. Tärkeimmät estettävissä olevat lisäsairastavuutta aiheuttavat tekijät ovat sairauden mikro- ja makrovaskulaariset komplikaatiot. The Finnish Diabetic Nephropathy Study eli FinnDiane -seurantatutkimus selvittää näiden lisäsairauksien syntymekanismeja, erityisesti munuaissairauden (nefropatia) osalta, joka tunnetaan merkittävänä kuolleisuuden riskitekijänä. Diabeettinen nefropatia lisää huomattavasti sydän- ja verisuonisairastavuutta, mikä on diabetesta sairastavien potilaiden johtava kuolinsyy. Pulssipaine on systolisen ja diastolisen verenpaineen erotus. Se on noninvasiivinen tapa mitata valtimoiden jäykkyyttä, ja esimerkiksi valtimoiden keskiverenpaineeseen verrattuna huomioi paremmin sekä systolisen että diastolisen verenpaineen vaihtelun. Aiemmassa tutkimuksessamme on osoitettu diabetesta sairastavien kiihtyneestä valtimoiden jäykistymisestä johtuva varhaisempi pulssipaineen nousu jo nuoremmalla iällä. Tässä tutkimuksessa halusimme selvittää, ennustaako kohonnut pulssipaine kuolleisuutta tyypin 1 diabetesta sairastavilla henkilöillä. Tutkimusaineisto koostui 4439 FinnDiane-tutkimukseen osallistuneesta aikuispotilaasta, joilla diabetes oli todettu alle 40-vuotiaana ja joiden insuliinihoito oli aloitettu vuoden sisään diagnoosista. Tiedot kerättiin kyselylomakkeella, jota täydennettiin vastaanotolla. Tiedot kuolemasta saatiin Tilastokeskuksen kuolinrekisteristä. Tietoa kerättiin vuosien 1994-2014 välisenä aikana. Seuranta-ajan mediaani oli 14 vuotta. 713 kuoli seuranta-aikana. Jaoimme potilaat pulssipaineen suhteen neljänneksiin, joita vertailimme Coxin regressio –menetelmää käyttäen. Kolmen matalimman neljänneksen välillä ei saatu merkittävää eroa kuolleisuudessa, mutta korkeimman pulssipaineen neljänneksessä kuolleisuus oli 1,4-kertainen edellisiin verrattuna. Lisäksi analysoimme aineistoa pulssipaineen mediaanin suhteen kahtia jaettuna. Korkeampi pulssipaine liittyi yhdenmukaisesti suurempaan kuolleisuuteen. Muita pulssipaineeseen liittyvän kuolleisuuden riskitekijöitä olivat nefropatia, miessukupuoli ja huono glukoositasapaino.
  • Hämäläinen, Riina (Helsingin yliopisto, 2020)
    The sex/gender model used in biological archaeologies to investigate human remains and past lives is one that relies on the epistemological and ontological separation of sex and gender. Despite this separation the model ends up treating these concepts synonymously due to the taken-for-granted binary nature of sex which in a deterministic manner eventuates into an equally binary gender. This thesis develops a theoretical framework for an archaeological concept of gender that operates without the division, binarism and determinism implicit in the sex/gender model. Pursuing answers to the questions whether it is possible to approach both sex and gender in archaeology in a nonbinary way, and if so, what is an archaeologically feasible alternative, it seeks to devise a method to approach sex and gender in mortuary archaeology beyond the deterministic binary. This thesis is firmly theory-oriented and the writings of various authors within the discipline of archaeology, feminism and queer studies comprise the necessary material. The theories pertaining to the field of feminism are intersectionality and queer theory, which eschew normativity and essentialism and call for gender diversity. Respective to archaeology, the theories influencing this thesis derive from new materialisms to whom the rejection of divisions and dichotomies is characteristic. In this regard, of particular note are the writings of new materialist and feminist theorist Karen Barad. Applying her theories concerning the relational, entangled and mutually constitutive nature of matter and meaning to the topic of sex and gender is central in devising a nonbinary new materialist perspective to be used for the purpose of a more open and inclusive mortuary archaeology. This thesis reveals that the dualistic division between nature and culture has resulted in a separate conceptual development and different strategies of engagement concerning sex and gender. The reason why sex is seen as a biological fact and gender as a cultural meaning proves false when both are affected equally by nature and culture, with the body serving as a nexus-point in which these two forces converge. Applying Barad’s insight reveals that binary sex is not an inherent quality of the body, but one that is produced through a scientific biomedical apparatus. Sex and gender exist in a state of inseparability when undetermined, but when subjected to a determination process, they become mutually exclusive phenomena, thereby disrupting sex-to-gender determinism. In their separate state, both are constitutive of matter and meaning, which is why gender made determined through intersectionality can be used to study gendered understandings through the materiality of the body, exempt from binary views. Analysing a topical bioarchaeological publication concerning a female Viking warrior through the approach that does not depend on the sex binary reveals that a scientific biomedical apparatus is subject to criticism on multiple fronts. Though the case study should be credited with rejecting gender role stereotypes, it demonstrates determinism and binarism as well as homogeneity and universalism in terms of categories. Failing to imagine possibilities beyond a fixed binary also results in the exclusion of alternate ways of knowing and being. The open-ended approach proposed in this thesis not only seeks to grant these possibilities opportunities to exist, but counsels cognisance towards the exclusions apparatuses enact. Embracing speculation, it also holds ambiguity and vagueness to be meaningful qualities pertaining to gendered archaeology. Regarding the mortuary setting, binary sex determinations need not be abandoned, but they should be used alongside this nonbinary approach.
  • Åhlgren, Johanna; Voikar, Vootele (2019)
    Individually ventilated caging (IVC) systems for rodents are increasingly common in laboratory animal facilities. However, the impact of such substantial change in housing conditions on animal physiology and behavior is still debated. Most importantly, there arise the questions regarding reproducibility and comparison of previous or new phenotypes between the IVC and open cages. The present study was set up for detailed and systematic comparison of behavioral phenotypes in male and female mice of three widely used inbred strains (C57BL/6JRccHsd, DBA/2JRccHsd, 129S2/SvHSd) after being kept in two housing environments (IVC and open cages) for 6?weeks (since 4?weeks of age) before behavioral testing. The tests addressed exploratory, anxiety-like and stress-related behavior (light-dark box, open field, forced swim test, stress-induced hyperthermia), social approach and species-specific behavior (nest building, marble burying). In all tests, large and expected strain differences were found. Somewhat surprisingly, the most striking effect of environment was found for basal body temperature and weight loss after one night of single housing in respective cages. In addition, the performance in light-dark box and open field was affected by environment. Several parameters in different tests showed significant interaction between housing and genetic background. In summary, the IVC housing did not invalidate the well-known differences between the mouse strains which have been established by previous studies. However, within the strains the results can be influenced by sex and housing system depending on the behavioral tasks applied. The bottom-line is that the environmental conditions should be described explicitly in all publications.
  • Sibakov, Tuomas (Helsingin yliopisto, 2020)
    In this work I examine how imōto-moe, a recent trend in Japanese animation and manga in which incestual connotations and relationships between brothers and sisters is shown, contributes to the sexualization of girls in the Japanese society. This is done by analysing four different series from 2010s, in which incest is a major theme. The analysis is done using visual analysis.The study concludes that although the series can show sexualization of drawn underage girls, reading the works as if they would posit either real or fictional little sisters as sexual targets. Instead, the analysis suggests that following the narrative, the works should be read as fictional underage girls expressing a pure feelings and sexuality, unspoiled by adult corruption.To understand moe, it is necessary to understand the history of Japanese animation. Much of the genres, themes and styles in manga and anime are due to Tezuka Osamu, the “god of manga” and “god of animation”. From the 1950s, Tezuka was influenced by Disney and other western animators at the time. His stories and themes had intellectual and philosophical depth that the western counterparts did not have. The works also touched themes that the western animation steered away from, including sexuality, which was not compartmentalized in a similar fashion in Japan as it was in the Western world. His works not only created new genres by themselves, but the constant combination by future generations created thethematic complexity that can be seen in manga and anime today.Tezuka also had a role in underage girl sexualization: his girl characters were an inspiration for the sexuality of little girls, both real and fictional, in the 70s. The western works of Vladimir Nabokov’s Lolita and Lewis Carroll’s Alice’s Adventures in Wonderland drew attention to the cuteness of little girls. In combination, sexualized versions of Tezuka’s characters were drawn, at first as a parody. In the 80s there was a boom of drawn girls in sexually compromised situations, or loliconart. Duringthe 80s, the focus shifted away from connotations to real girl imagery and drawn rape imagery towards less violent forms.In 1989, a dubious connection was drawn between otaku, fans of popular culture, including loliconimagery, and a serial killer of small children. The moral panic that followed slowed the spread of loliconin the 90s.Meanwhilein the 90s, an idea of moebegan to form: if fictional little girls are not corrupted by adult sexuality, the girls cause feelings of affection in the viewer. The viewers are affected by moe via isolated, but recognizable tropes, such as cat ears and tail, a speech habit, or twin tails. A part of this research is to examine how well imōto-fits under the loliconcriteria, and undermoe: the characters are sexualized: they are showing having sexual thoughts and expressing sexual activity. After the examination, I conclude that, at least in the works examined, imōto-moe fits under the latter category: the male partners are passive and follow the girl’s lead, the ages are very close, and many of the series emphasize the virtual aspect: to enjoy little sisters, they have to be two-dimensional, outside the laws of reality.
  • Saarenmaa, Elina (Helsingfors universitet, 2013)
    Aims The aim for this cross-cultural study was to increase understanding of today's modern relationships by researching the nature of the friends with benefits relationships (FWBRs). The FWBRs are an example of a current type of phenomenon in interpersonal relationships and a new area of investigation in the field of Interpersonal Communication Studies. The FWBR is identified as a friendship where the participants also have sex. The phenomenon was defined and explained through both Finnish and American informants' real life experiences. The research followed the hermeneutic phenomenological tradition with the goal of creating meaning and probing particular features of this kind of relationship. Previous academic research on FWBRs has only concentrated on studying American undergraduate college-students and has mostly been done with quantitative surveys. Unlike the existing academic literature, this study aimed to explore older adults outside of the college surroundings by conducting research with qualitative methods. Methods Half-structured theme interviews were used as a method to gain a deeper understanding of the informants' thoughts, attitudes and experiences. Altogether, 21 interviews were collected for this study. 10 interviews were done in Helsinki, Finland and 11 were done in San Francisco, USA. The participants were heterosexual men and women, aged 24-54. The data was analyzed holistically using the hermeneutical phenomenological approach, combined with qualitative content analysis. Results and Conclusions The FWBR was researched as a complex and ill-defined phenomenon. Certain recurring communication patterns and relationship features were observed to be particular to FWBRs. The biggest differences were observed between different age groups, rather than between the different cultures or genders. The informants agreed that the phenomenon is becoming more acknowledged and popular, and that it should be discussed more openly. FWBRs were seen mainly as experimental relationships that are part of being youth. However, they were observed also as meaningful relationships among older adults. The informants' experiences with FWBRs were mainly positive. However, the participants did not desire to have casual sex. Rather, they were looking for a deeper connection and the possibility for a romantic relationship.
  • Tuominen, Lauri; Miettunen, Jouko; Cannon, Dara M.; Drevets, Wayne C.; Frokjaer, Vibe G.; Hirvonen, Jussi; Ichise, Masanori; Jensen, Peter S.; Keltikangas-Järvinen, Liisa; Klaver, Jacqueline M.; Knudsen, Gitte M.; Takano, Akihiro; Suhara, Tetsuya; Hietala, Jarmo (2017)
    Background: Neuroticism is a major risk factor for affective disorders. This personality trait has been hypothesized to associate with synaptic availability of the serotonin transporter, which critically controls serotonergic tone in the brain. However, earlier studies linking neuroticism and serotonin transporter have failed to produce converging findings. Because sex affects both the serotonergic system and the risk that neuroticism poses to the individual, sex may modify the association between neuroticism and serotonin transporter, but this question has not been investigated by previous studies. Methods: Here, we combined data from 4 different positron emission tomography imaging centers to address whether neuroticism is related to serotonin transporter binding in vivo. The data set included serotonin transporter binding potential values from the thalamus and striatum and personality scores from 91 healthy males and 56 healthy females. We specifically tested if the association between neuroticism and serotonin transporter is different in females and males. Results: We found that neuroticism and thalamic serotonin transporter binding potentials were associated in both males and females, but with opposite directionality. Higher neuroticism associated with higher serotonin transporter binding potential in males (standardized beta 0.292, P = .008), whereas in females, higher neuroticism associated with lower serotonin transporter binding potential (standardized beta -0.288, P = .014). Conclusions: The finding is in agreement with recent studies showing that the serotonergic system is involved in affective disorders differently in males and females and suggests that contribution of thalamic serotonin transporter to the risk of affective disorders depends on sex.
  • DIABIMMUNE Study Grp; Korhonen, Laura; Oikarinen, Sami; Lehtonen, Jussi; Mustonen, Neea; Tyni, Iiris; Niemelä, Onni; Honkanen, Hanna; Huhtala, Heini; Ilonen, Jorma; Hämäläinen, Anu-Maaria; Peet, Aleksandr; Tillmann, Vallo; Siljander, Heli; Knip, Mikael; Lönnrot, Maria; Hyöty, Heikki; Härkönen, Taina; Ryhänen, Samppa; Koski, Katriina; Kiviniemi, Minna; Ahlfors, Helena; Kallionpää, Henna; Laajala, Essi; Lahesmaa, Riitta; Lähdesmäki, Harri; Moulder, Robert; Nieminen, Janne; Ruohtula, Terhi; Vaarala, Outi; Alahuhta, Kirsi; Virtanen, Suvi M.; Kondrashova, Anita (2019)
    Previous data about the role of viruses in the development of allergic immunoglobulin E (IgE) sensitization are contradictory. The aim of this study was to determine the possible associations between exposure to different viruses (rhinovirus, enterovirus, norovirus, and parechovirus) during the first year of life and IgE sensitization. Viruses were analyzed from stool samples collected monthly from infants participating in a prospective birth cohort study. From that study, 244 IgE sensitized case children and 244 nonsensitized control children were identified based on their allergen-specific IgE antibody levels at the age of 6, 18, and 36 months. Stool samples (n = 4576) from the case and control children were screened for the presence of rhinovirus, enterovirus, norovirus, and parechovirus RNA by reverse transcription quantitative polymerase chain reaction. The study showed that rhinovirus was the most prevalent virus detected, present in 921 (20%) samples. None of the viruses were associated with IgE sensitization in the full cohort but after stratifying by sex, the number of rhinovirus positive samples was inversely associated with IgE sensitization in boys (odds ratio [OR]: 0.81; 95% confidence interval [CI]: 0.69-0.94; P = 0.006). There was also a temporal relation between rhinoviruses and IgE sensitization, as rhinovirus exposure during the first 6 months of life was associated with a reduced risk of subsequent IgE sensitization in boys (OR: 0.76; 95% CI: 0.6-0.94; P = 0.016). In conclusion, early exposure to rhinoviruses was inversely associated with IgE sensitization but this protective association was restricted to boys.
  • Kim, Chee Hae; Koo, Bon-Kwon; Dehbi, Hakim-Moulay; Lee, Joo Myung; Doh, Joon-Hyung; Nam, Chang-Wook; Shin, Eun-Seok; Cook, Christopher M.; Al-Lamee, Rasha; Petraco, Ricardo; Sen, Sayan; Malik, Iqbal S.; Nijjer, Sukhjinder S.; Mejia-Renteria, Hernan; Alegria-Barrero, Eduardo; Alghamdi, Ali; Altman, John; Baptista, Sergio B.; Bhindi, Ravinay; Bojara, Waldemar; Brugaletta, Salvatore; Silva, Pedro Canas; Di Mario, Carlo; Erglis, Andrejs; Gerber, Robert T.; Going, Olaf; Haerle, Tobias; Hellig, Farrel; Indolfi, Ciro; Janssens, Luc; Jeremias, Allen; Kharbanda, Rajesh K.; Khashaba, Ahmed; Kikuta, Yuetsu; Krackhardt, Florian; Laine, Mika; Lehman, Sam J.; Matsuo, Hitoshi; Meuwissen, Martijin; Niccoli, Giampaolo; Piek, Jan J.; Ribichini, Flavo; Samady, Habib; Sapontis, James; Seto, Arnold H.; Sezer, Murat; Sharp, Andrew S. P.; Singh, Jasvindar; Takashima, Hiroaki; Talwar, Suneel; Tanaka, Nobuhiro; Tang, Kare; Van Belle, Eric; van Royen, Niels; Vinhas, Hugo; Vrints, Christiaan J.; Walters, Darren; Yokoi, Hiroyoshi; Samuels, Bruce; Buller, Christopher; Patel, Manesh R.; Serruys, Patrick W.; Escaned, Javier; Davies, Justin E. (2019)
    OBJECTIVES This study sought to evaluate sex differences in procedural characteristics and clinical outcomes of instantaneous wave-free ratio (iFR)- and fractional flow reserve (FFR)-guided revascularization strategies. BACKGROUND An iFR-guided strategy has shown a lower revascularization rate than an FFR-guided strategy, without differences in clinical outcomes. METHODS This is a post hoc analysis of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate stenosis to guide Revascularization) study, in which 601 women and 1,891 men were randomized to iFR- or FFR-guided strategy. The primary endpoint was 1-year major adverse cardiac events (MACE), a composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization. RESULTS Among the entire population, women had a lower number of functionally significant lesions per patient (0.31 +/- 0.51 vs. 0.43 +/- 0.59; p <0.001) and less frequently underwent revascularization than men (42.1% vs. 53.1%; p <0.001). There was no difference in mean iFR value according to sex (0.91 +/- 0.09 vs. 0.91 +/- 0.10; p = 0.442). However, the mean FFR value was lower in men than in women (0.83 +/- 0.09 vs. 0.85 +/- 0.10; p = 0.001). In men, an FFR-guided strategy was associated with a higher rate of revascularization than an iFR-guided strategy (57.1% vs. 49.3%; p = 0.001), but this difference was not observed in women (41.4% vs. 42.6%; p = 0.757). There was no difference in MACE rates between iFR- and FFR-guided strategies in both women (5.4% vs. 5.6%, adjusted hazard ratio: 1.10; 95% confidence interval: 0.50 to 2.43; p = 0.805) and men (6.6% vs. 7.0%, adjusted hazard ratio: 0.98; 95% confidence interval: 0.66 to 1.46; p = 0.919). CONCLUSIONS An FFR-guided strategy was associated with a higher rate of revascularization than iFR-guided strategy in men, but not in women. However, iFR- and FFR-guided strategies showed comparable clinical outcomes, regardless of sex. (C) 2019 by the American College of Cardiology Foundation.
  • Kuusimäki, Tomi; Kurki, Samu; Sipilä, Jussi O. T.; Salminen-Mankonen, Heli; Carpen, Olli; Kaasinen, Valtteri (2020)
    Background Advances in the treatment of Parkinson's disease (PD) and changes in general life expectancy may have improved survival in patients with PD. Objective The objective of this study was to investigate recent trends in PD mortality. Methods In total, 1521 patients with PD in local and national registries were followed for 11 years (2006-2016) from diagnosis until exit date or death, and the causes of death were recorded. Results The survival of men with PD improved during the follow-up period, but no change was observed in women (2-year postdiagnosis survival in men, 79.0%-86.3%, P = 0.03; 2-year postdiagnosis survival in women, 82.8%-87.5%, P = 0.42). Pneumonia was the most common immediate cause of death. Discussion The survival of men with PD has improved in Finland without a similar change in women. Because changes in treatment likely affect both sexes similarly, the results may reflect the decreasing sex gap in life expectancy. This phenomenon will likely increase the already high male-to-female prevalence ratio of PD.
  • Korpijaakko, Cedric; Wasenius, Niko; Teramo, Kari; Klemetti, Miira; Kautiainen, Hannu; Eriksson, Johan; Laine, Merja (Helsingin yliopisto, 2020)
    Aims The aim of this study was to evaluate whether maternal type 1 diabetes influences skin autofluorescence (SAF), used as a marker of accumulated advanced glycation end products (AGEs), in young adult offspring. Methods This cross-sectional case-control study included 78 offspring of women with type 1 diabetes (cases) and 85 control participants (controls). Cases were born between 1st January 1996 and 31st December 2000, at the Department of Obstetrics and Gynecology, Helsinki University Hospital, and controls were born during the same period in the Hospital District of Helsinki and Uusimaa, Finland. All study participants, aged 18 to 23 years, were invited to participate in a clinical assessment including laboratory tests and questionnaires. SAF was assessed from all participants using the AGE reader. Results The mean SAF value did not differ between the cases (1.61 [0.37]) arbitrary units [AU]) and the controls (1.64 [0.41] AU) (p=0.69). After adjusting for HbA1c, body fat percentage, smoking, and season the mean SAF value did not differ between the cases and the controls (p=0.49) but differed between men and women (p=0.008), without any interaction observed (p=0.78). Conclusions No differences in SAF values were observed between the young adult offspring of women with type 1 diabetes and offspring born to mothers without diabetes. Surprisingly, young adult women showed higher SAF values than men in both case and control groups.
  • Fawcett, Katherine A.; Obeidat, Ma'en; Melbourne, Carl; Shrine, Nick; Guyatt, Anna L.; John, Catherine; Luan, Jian'an; Richmond, Anne; Moksnes, Marta R.; Granell, Raquel; Weiss, Stefan; Imboden, Medea; May-Wilson, Sebastian; Hysi, Pirro; Boutin, Thibaud S.; Portas, Laura; Flexeder, Claudia; Harris, Sarah E.; Wang, Carol A.; Lyytikäinen, Leo Pekka; Palviainen, Teemu; Foong, Rachel E.; Keidel, Dirk; Minelli, Cosetta; Langenberg, Claudia; Bossé, Yohan; Berge, Maarten Van den; Sin, Don D.; Hao, Ke; Campbell, Archie; Porteous, David; Padmanabhan, Sandosh; Smith, Blair H.; Evans, David M.; Ring, Sue; Langhammer, Arnulf; Hveem, Kristian; Willer, Cristen; Ewert, Ralf; Stubbe, Beate; Pirastu, Nicola; Klaric, Lucija; Joshi, Peter K.; Patasova, Karina; Massimo, Mangino; Polasek, Ozren; Starr, John M.; Karrasch, Stefan; Strauch, Konstantin; Meitinger, Thomas; Rudan, Igor; Rantanen, Taina; Pietiläinen, Kirsi; Kähönen, Mika; Raitakari, Olli T.; Hall, Graham L.; Sly, Peter D.; Pennell, Craig E.; Kaprio, Jaakko; Lehtimäki, Terho; Vitart, Veronique; Deary, Ian J.; Jarvis, Debbie; Wilson, James F.; Spector, Tim; Probst-Hensch, Nicole; Wareham, Nicholas J.; Völzke, Henry; Henderson, John; Strachan, David P.; Brumpton, Ben M.; Hayward, Caroline; Hall, Ian P.; Tobin, Martin D.; Wain, Louise V. (2021)
    Background: Lung function is highly heritable and differs between the sexes throughout life. However, little is known about sexdifferential genetic effects on lung function. We aimed to conduct the first genome-wide genotype-by-sex interaction study on lung function to identify genetic effects that differ between males and females. Methods: We tested for interactions between 7,745,864 variants and sex on spirometry-based measures of lung function in UK Biobank (N=303,612), and sought replication in 75,696 independent individuals from the SpiroMeta consortium. Results: Five independent single-nucleotide polymorphisms (SNPs) showed genome-wide significant (P<5x10-8) interactions with sex on lung function, and 21 showed suggestive interactions (P<1x10-6). The strongest signal, from rs7697189 (chr4:145436894) on forced expiratory volume in 1 second (FEV1) (P=3.15x10-15), was replicated (P=0.016) in SpiroMeta. The C allele increased FEV1 more in males (untransformed FEV1 β=0.028 [SE 0.0022] litres) than females (β=0.009 [SE 0.0014] litres), and this effect was not accounted for by differential effects on height, smoking or pubertal age. rs7697189 resides upstream of the hedgehog-interacting protein (HHIP) gene and was previously associated with lung function and HHIP lung expression. We found HHIP expression was significantly different between the sexes (P=6.90x10-6), but we could not detect sex differential effects of rs7697189 on expression. Conclusions: We identified a novel genotype-by-sex interaction at a putative enhancer region upstream of the HHIP gene. Establishing the mechanism by which HHIP SNPs have different effects on lung function in males and females will be important for our understanding of lung health and diseases in both sexes.