The purpose of this research is to determine if loss aversion is replicable as an overt behavioral response to potential gains and losses in complex, recurring, uncertain, and risky choice with real gains and losses of money and food. Cognitive methods used to determine the effect of loss have primarily measured verbal response to hypothetical choice scenarios in which participants cognitively predict their behavior in a series of bets or situations involving imagined monetary gains and losses. Less has been done using behavioral methods that measure overt behavioral response to gains and losses of actual commodities. The present study uses the experimental analysis of behavior to measure the asymmetrical effect of loss in multiple choice domains. A series of four experiments investigated four factors likely to affect the expression and degree of loss aversion: (a) learning and experience with consequences of choice; (b) real gains and losses instead of hypothetical quantities or imagined commodities; (c) gains and losses of a non-quantitative, primary reinforcer (food); and (d) the menstrual cycle. Participants played one of two computer games in which they earned or lost coins or food tokens exchanged for real food. Participants (N = 27, 15 women) played several 18-minute sessions in gains-only conditions and 16 sessions in 36-minute gains+punishment conditions. Recurring, complex, uncertain, and risky choice was simulated in the games by using 6-ply interdependent concurrent variable interval schedules of reinforcement (gains) and punishment (losses). Choice behavior with real gains and losses of money and food was modeled using the generalized matching law, allowing for the quantification of the effects of potential loss, relative to gains, as a change in bias and sensitivity. Loss aversion was operationalized as gain-loss asymmetry ratios derived from bias estimates produced in unpunished and punished choice conditions. Gain-loss asymmetry was replicated in both women and men in complex, recurring, uncertain, and risky choice with potential gains and losses of real money and food. Average gain-loss asymmetry ratios were 3 to 6 times greater in choice with money and 4 to 16 times greater in choice with food than those reported in the cognitive and behavioral literature. Although individual differences in response to loss were striking, the asymmetrically larger behavioral effects of loss, relative to gains, were nearly ubiquitous. Marked disruption in sensitivity to reinforcement was observed in punished choice for most participants, but for 33% of participants in choice with money and 42% in choice with food, sensitivity to reinforcers increased. No evidence was found for behavioral choice varying with the menstrual cycle.

Ziel dieser vorliegenden, vergleichenden Literaturarbeit ist es, den heutigen Wissensstand in Bezug auf den Kohlenhydratstoffwechsel einer Frau darzustellen. Hierbei werden die physiologischen Veränderungen des Metabolismus zu verschiedenen Zeitpunkten im Leben einer Frau, begonnen mit der Kindheit und Pubertät, über Menstruation und Schwangerschaft bis hin zur Menopause, betrachtet und es werden die Ursachen und möglichen Mechanismen aufgezeigt, die zu Abweichungen der Insulinresistenz und der Insulinsekretion und damit möglicherweise zu einer Glukoseintoleranz bzw. einem Typ-2 Diabetes mellitus führen können. Der Kohlenhydratstoffwechsel wird nicht nur bezüglich der physiologischen, sondern auch in bezug auf die iatrogen verursachten Veränderungen, d.h. unter oraler hormonaler Kontrazeption, unter Hormonersatztherapie im Klimakterium, sowie hinsichtlich bestimmter Pathologien, wie dem zur Infertilität führenden polyzystischem Ovarsyndrom oder dem Gestationsdiabetes, untersucht. Ergebnis: Es scheint eine starke Verknüpfung zwischen dem weiblichen Reproduktionssystem und dem Kohlenhydratstoffwechsel zu geben, deren Interaktion von den unterschiedlichsten Faktoren beeinflusst wird. Der Frauenarzt sollte sich bei der Verschreibung hormoneller Kontrazeptiva, der Hormonersatztherapie und im Besonderen bei der Therapie des polyzystischen Ovarsyndroms sowie bei der Untersuchung seiner Patientinnen bewusst sein, dass verschiedene Lebensphasen, wie Pubertät, Schwangerschaft und Klimakterium und die damit verknüpften Veränderungen des Reproduktionssystems und der Sexualhormone auch deutliche metabolische Veränderungen nach sich ziehen können. Besonders eine erhöhte Insulinresistenz, die mit einer gesteigerten Insulinsekretion einhergeht, muss bedacht werden. Nicht nur das Syndrom X, eine Zusammenfassung von metabolischen Abnormitäten (Dyslipidämie, Insulinresistenz, Adipositas, Hypertonie), die mit einem deutlich erhöhten Risiko kardiovaskulärer Krankheiten und besonders der Atherosklerose einhergehen, sondern die daraus folgende steigende Prävalenz von Typ-2 Diabetes mellitus und das stark vermehrte Auftreten von Adipositas verlangen nach einer fachübergreifenden Zusammenarbeit zwischen Frauenärzten und Internisten. / The aim of this comparative review is to reveal the current standard of knowledge concerning carbohydrate metabolism in women. The study demonstrates the physiological changes in metabolism at various stages in a female life, from childhood and puberty, through menstruation and pregnancy and ending with the menopause, whilst also evaluating different causes and possible mechanisms that lead to aberrance in insulin resistance and insulin secretion and thereby potentially to glucose intolerance and/or type 2 Diabetes mellitus. In addition to presenting physiological alterations in glucose metabolism, this work also analyses changes generated by iatrogenic treatment such as oral contraceptives and hormone replacement therapy, as well as those caused by different pathologies like polycystic ovary syndrome or gestational diabetes. The results indicate a strong correlation between the female reproduction system and the carbohydrate metabolism. The interaction is influenced by the many very different factors. Before prescribing oral contraceptives, hormone replacement therapy in climacteric (especially during the treatment of infertility in PCOS), or examining patients, the gynaecologist needs to be aware of the fact that different phases in life along with sex steroids and connected changes in the reproductive system, might lead to severe metabolic diversifications. Special attention should be paid to an increased insulin resistance, associated with an augmentation in insulin secretion. Not only the metabolic syndrome, the simultaneous appearance of metabolic abnormalities (dyslipidaemia, insulin resistance, adiposity, hypertonia), which holds a higher risk of cardiovascular diseases, especially arteriosclerosis, but also the consequential increased prevalence of type 2 diabetes mellitus and the highly increased prevalence of adiposity, demand for a multidisciplinary collaboration between gynaecologists and internists.