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PubMedDate not supplied

Teaching women's issues in psychiatric residency: residents' attitudes.

There is increasing interest in psychiatry in women's and gender issues. This article evaluates psychiatric residents' interest in women's issues during training. The authors surveyed residents at four psychiatric residency programs to evaluate their opinions on the teaching of women's issues. Residents rated this topic an important one, but felt training could be improved. The authors review one program's curriculum and suggest ways in which women's mental health issues might be incorporated into residency training.

Attitude of Health Personnel↗
PubMed2005

Impact of environment upon gender identity and sexual orientation: a lesson for parents of children with intersex or gender confusion.

Two histories of physically normal men with persistent gender issues highlight the major impact played by parental input on the sexual and gender development of children. Both men had been subjected to firm, harsh behavior modification by their parents, particularly their mothers, during childhood in response to effeminate behavior. While both men continue to manifest major gender/sexual issues as adults, their outcomes have been dramatically different. The first man takes female hormones and denies any satisfaction from his sexuality. This individual remains convinced that he has female internal sexual organs and monthly internal menstrual bleeding. Although he has a career, he has become alienated from his family and is a social cripple. The second man has a successful career, lives a heterosexual life with his children and wife of 20 years and is involved in his community. He is visually attracted to men and remains obsessed with male pornography. This individual credits his mother with directing him toward a successful heterosexual life, which he feels has prevented the emotional burden of an active homosexual life. These two cases illustrate the tremendous influence played by environment and parental input on the sexual perspectives of developing children.

Adaptation, Psychological↗
PubMed1990

Erotized transference reconsidered: expanding the countertransference dimension.

A reconsideration of the erotized transference from a contemporary perspective has been presented utilizing detailed case material provided by Stoller. The main thesis is that this type of transference, traditionally conceived as a product of a particular kind of patient often felt to be borderline, is better understood as arising in a specific intersubjective context involving both participants in the psychoanalytic situation. The focus is on the intricate interaction of analyst and patient, recognizing that either may serve as a selfobject for the other. This view assumes a more expanded countertransference role than recognized in the earlier literature. The psychoanalytic situation can be erotized by either or both participants. A corollary thesis is that the details of a patient's fantasy should also be viewed as codetermined and that imbedded within it might be the patient's subjective experience of the psychoanalytic interaction. Alluded to peripherally is that the erotized transference in the interaction between male analyst and female patient is, in part, a manifestation of traditional roles assumed in situations involving a male authority figure in close engagement with a female who perceives herself as relatively powerless. This issue has recently received considerable attention from writers who have addressed themselves to the important gender issues in psychoanalysis.

Adult↗
PubMed1997

Gender and schizophrenia.

Schizophrenia is a chronic psychotic illness that characteristically manifests itself from the early adult years throughout the entirety of life. Its symptoms are well known, its phenomenology has been exhaustively studied, and palliative treatments exist, although they rarely produce complete response. The pathophysiology and the etiology of the illness remain unknown. Clues to the basic understanding of schizophrenia are rare, but they do appear. Gender differences in schizophrenia have always been implicated in the challenge to clearly understand the disorder. Male and female schizophrenics display identical symptomatic features during acute illness, seemingly minimizing the relevance of gender issues. Within the last decade, however, more careful screening has revealed significant gender differences in schizophrenia: in age at onset, premorbid personality, subtype of schizophrenia, psychosocial function, and treatment response. Attention to these differences could be important to answer theoretical and therapeutic questions regarding the disorder.

Adaptation, Psychological↗
PubMed2006

Manifestations of affective disturbance in sub-Saharan Africa: key themes.

BACKGROUND: Affective disorder, once seen as rare in sub-Saharan Africa, is now viewed as more common. There are however challenges in assessing rates of depression, exploring manifestations of depression, and understanding risk factors for depression, especially those related to gender. AIM: To identify key themes and new directions for research on affective disorder in sub-Saharan Africa, with particular reference to gender issues. METHODS: Interpretive review of selected literature, and theoretical analysis. RESULTS: There are gender differences in manifestations and rates of depression in sub-Saharan Africa, and there are forms of presentation (largely somatic, based on interpersonal relationships, or spiritual in nature) which may obscure the detection of depression. Studies are consistent however that when depressive symptoms are sought and are present, these are reasonably easy to elicit. LIMITATIONS: This was not a systematic review, and the substantial grey literature from sub-Saharan Africa was not reviewed. For many countries, there are no data available. CONCLUSIONS: Affective disorder, when properly sought for through both qualitative and quantitative methods, has been found to be common in sub-Saharan Africa. There is a paucity of research on interventions with affective disorder in this region.

Adult↗
PubMed1999

The glass ceiling in academe: health administration is no exception.

This paper reviews gender issues in academe and presents findings of a limited survey of ACEHSA-accredited health administration graduate programs. The survey shows gender ratios adverse to women at the full, associate, and assistant professor levels. Men to women ratio among faculty was 1.98, among full-time faculty it was 2.24, and among tenured/tenure-track faculty it was 2.69, despite an excess of female students over male students in graduate programs, and despite equal proportions of women and men faculty holding doctoral degrees. Distribution by rank showed 48.5 percent full professors, 27.8 percent associate professors, and, 20.1 percent assistant professors among men, vs. 27.4 percent, 41.1 percent, and 31.5 percent respectively among women. In other academic fields similar gender ratios prevail, and many researchers have documented evidence of continuing gender inequities in tenure, promotion and salary, given comparable performance, despite the enactment of Title IX in 1972. Gender disparities are rooted in a complex web of gender-specific constraints interwoven with secular human capital and structural variables, and confounded by sexist discriminatory factors. In light of these issues, recommendations are made toward creating an equitable academic climate without compromising the ideal of meritocracy, through gender-sensitive initiatives and vigilance mechanisms to bring policies to fruition.

Data Collection↗
PubMed2002

Placing gender at the centre of health programming: challenges and limitations.

In this paper we argue that a gender analysis is fundamental to health and health planning. We begin with a definition of gender and related concepts including equity and equality. We discuss why gender is key to understanding all dimensions of health including health care, health seeking behaviour and health status, and how a gender analysis can contribute to improved health policies and programming. Despite the many reasons for incorporating gender issues in health policies and programmes many obstacles remain, including the lack of attention to gender in the training of health professionals and the lack of awareness and sensitivity to gender concerns and disparities in the biomedical community. We argue that the key to placing gender values firmly in place in Health for All renewal is a change in philosophy at all levels of the health sector and suggest ways in which such a change can be implemented in the areas of policy, research, training and practical programmes and interventions.

Culture↗
PubMed1999

The pattern of sexual politics: feminism, homosexuality and pedophilia.

Until recently sex and gender issues were thought to be biological or natural rather than political. The feminist movement largely changed perceptions of gender, and the gay and lesbian movements significantly altered conceptions of sex, so that what were once seen as permanent moral standards are now viewed as historical and political constructions. As views of these groups have moved towards social constructionism, perceptions of child sexuality have become more absolutist. Current attitudes towards child sexuality and representations of it resemble historical attitudes towards women and homosexuals. This article argues that there is a two-phase pattern of sexual politics. The first is a battle to prevent the battle, to keep the issue from being seen as political and negotiable. Psychological and moral categories are used to justify ridicule and preclude any discussions of the issue, and standard Constitutional guarantees are seen as irrelevant. The second phase more closely resembles traditional politics as different groups argue over rights and privileges. Feminist and gay/lesbian politics have recently entered the second phase, while pedophilia is in the first.

Adolescent↗
PubMed2001

An international imperative for gender-sensitive theories in women's health.

PURPOSE: To propose gender-sensitive theories as a future direction for theoretical development of women's health. Few theories pertain to women's health and illness experiences, with gender issues embedded in social, cultural, and historical contexts. ORGANIZING CONSTRUCT: Significance, definition, and philosophical bases of gender-sensitive theories. FINDINGS: Six major components should be incorporated in the development of gender-sensitive theories: (a) gender as a major feature, (b) women's own words and experiences, (c) nature of women's experiences, (d) theorists' perspectives, (e) contexts, and (f) guidelines for actions. CONCLUSIONS: We believe that the development of gender-sensitive theories in nursing could enable researchers to transcend androcentric and ethnocentric views on women's health, decrease gender inequity in health care, enhance women's well being, and ultimately contribute to knowledge development in nursing.

Female↗
PubMed2003

Gendered nursing education and practice in Iran.

Through qualitative ethnographic methods, the researcher gendered nursing education and practice among human nursing students and faculty. Interaction with nursing students and faculty occurred in a familiar turf using the native language in interviews and on field observations. Settings included classrooms, skills laboratory, faculty offices, clinical areas, and informants' homes. Formal and informal interviews, observations, and printed materials provided useful data to reach consistent common patterns. Thematic analysis and triangulation of data identified gender variations in care and compassion, spirituality, economic motives, and practice preference. Integrated experiences of pre-Islamic period were used to describe the current developments of gendered nursing education and practice in the Islamic Republic of Iran. Study of gendered nursing education and practice brings attention to the cultural significance of gender issues. This body of knowledge will benefit American nurses and educators by increasing their cultural understanding of gender.

Adult↗
PubMed2004

Gender stratification in management. The World Health Organization 2000.

The World Health Organization (WHO) is a global organization that nowadays has integrated gender issues into its policy, programmes and budget. How then is the state of affairs in the area of gender equity at the ultimate governing bodies of the modern WHO? This study aims to assess the representation of women and men and their promotion within the supreme decision-making bodies of the WHO during the year 2000. Information sources used are the official and confirmed protocols of the 53rd World Health Assembly (WHA) in 2000 and of the two Executive Board (EB) meetings of the corresponding year. A descriptive quantitative content analysis approach is used exclusively. The present study demonstrates strikingly skewed gender distribution, with men substantially at an advantage numerically in the prominent positions at the WHA 2000. Additionally, men also hold an advantage in terms of being promoted to leading positions within the bodies examined, notably all upgraded chairs of the EB during 2000. However, the formerly male-dominated supervisory positions of the WHO are, these days, challenged by women having been elected at the very top of the WHO. The present study stresses the need to elaborate a qualitative research design to advance the understanding of the social construction of gender in supreme governing positions of the modern WHO.

Administrative Personnel↗
PubMed2005

Biomedical research on health and performance of military women: accomplishments of the Defense Women's Health Research Program (DWHRP).

In 1994, Congress provided dollar 40 M for biomedical research on issues of importance for military women. This supported 104 intramural and 30 extramural studies and launched an era of research to narrow the knowledge gap on protection and enhancement of health and performance of military women. Projects addressed issues specific to female physiology (e.g., gynecological health in the field, maternal malaria), problems with higher prevalence for women (e.g., marginal iron deficiency, stress fracture), and issues of drug and materiel safety that had only been extrapolated from studies of men (e.g., chemical agent prophylaxis, fatigue countermeasures). Several important assumptions about female physiology and occupational risks were found to be astoundingly wrong. Hormonal changes through the menstrual cycle were less important to acute health risks and performance than predicted, exercise did not increase risk for amenorrhea and consequent bone mineral loss, and women tolerated G-forces and could be as safe as men in the cockpit if their equipment was designed for normal size and strength ranges. Data on personal readiness issues, such as body fat, physical fitness, nutrition, and postpartum return to duty, allowed reconsideration of standards that were gender appropriate and not simply disconnected adjustments to existing male standards. Other discoveries directly benefited men as well as women, including development of medical surveillance databases, identification of task strength demands jeopardizing safety and performance, and greater understanding of the effects of psychosocial stress on health and performance. This surge of research has translated into advances for the welfare of service women and the readiness of the entire force; relevant gender issues are now routine considerations for researchers and equipment developers, and some key remaining research gaps of special importance to military women continue to be investigated.

Attitude to Health↗
PubMed2005

Engendering the bureaucracy? Challenges and opportunities for mainstreaming gender in Ministries of Health under sector-wide approaches.

The increasing ascendancy of 'gender mainstreaming' as the central approach to improving gender equity has largely determined strategies to integrate a gender focus in sector-wide approaches (SWAps). This paper explores the impetus for and process of gender mainstreaming in SWAps in the Ministries of Health in Uganda, Ghana, Malawi and Mozambique, and outlines some achievements and challenges. The shifting and contested relationships between the Ministry of Health, donors and other government ministries (such as Ministries of Finance and Ministries of Women's Affairs/Gender) are important in shaping the opportunities and constraints faced in gender mainstreaming. The refocusing of resource allocation to different sectors has led to changes in the balance of power between the various actors at the national level, with diverse implications for promoting gender equity in health. Some of the achievements to date and ongoing challenges are explored through concrete examples from different countries. These include: the development of structures for mainstreaming, including the dilemmas of the 'focal points' approach and the role of national gender mainstreaming machinery; the need for training and building capacity to identify and address gender issues, which involves engaging with new languages and concepts, and developing new skills; building alliances, consensus and momentum; integrating gender concerns into policy and planning documents; and promoting gender equity in human resources in the health sector. Cross-cutting themes underlying these challenges are the need for gender-specific information and ways to finance mainstreaming strategies. Implications are drawn for ways forward, without losing sight of the challenge of translating discourses of gender mainstreaming, and its central ideal of social transformation, into pragmatic strategies in the bureaucratic environment.

Africa↗
PubMed2005

Integrating gender into a basic medical curriculum.

INTRODUCTION: In 1998, gaps were found to exist in the basic medical curriculum of the Radboud University Nijmegen Medical Centre regarding health-related gender differences in terms of biological, psychological and social factors. After screening the curriculum for language, content and context, adjustments aimed at incorporating gender issues were proposed. The aim of this study was to evaluate those adjustments, as well as to investigate whether gender had been successfully incorporated into the basic medical curriculum, and to identify the factors that played a role in this. METHODS: The education material of 9 curricular blocks was re-evaluated and interviews were held with block co-ordinators. RESULTS: Since the beginning of the project, gender has increasingly been brought to the attention of the students. Various factors have played a role: concrete and directly executable content-oriented proposals for adjustment; adequate translation of gender differences into actual patient care; motivated block co-ordinators; the presence of a 'trigger person' in the faculty; incorporation into the existing education programme; the involvement of block co-ordinators in decision making, and the provision of practical support. DISCUSSION: Integrating gender into the basic medical curriculum has been largely successful. Block co-ordinators' personal recognition of the importance of gender in patient care greatly facilitated implementation. The evaluation stimulated the forming of new ideas. It is recommended that these factors and those mentioned above should be taken into consideration when integrating gender into other faculties.

Curriculum↗
PubMed2005

Junior physicians' workplace experiences in clinical fields in German-speaking Switzerland.

BACKGROUND AND OBJECTIVES: To date, there have been several prospective cohort studies investigating the workplace experiences of junior physicians, but with limited focus on gender issues. The objective of the present study is to explore the workplace experiences of first-year residents according to gender, type of training hospital, and clinical field. METHODS: Data reported are from the second assessment of the longitudinal Swiss physicians' career development study, begun in 2001. In 2003, 497 residents (54.7% females, 45.3% males) assessed their workplace conditions, social support at work, and effort-reward imbalance. RESULTS: There are few, but relevant, gender related differences in workplace experiences, with female physicians experiencing less mentoring and higher over-commitment, yet more positive social relationships at work. In a multivariate model, significant differences in some workplace variables with regard to type of training hospital and/or clinical field are found: workplace conditions are rated worse in type "A" hospitals (university and cantonal hospitals) than in type "B"/"C"/"D" hospitals (regional hospitals and highly specialised units), and in surgical fields than in internal medicine. In "A" hospitals mentoring is assessed as better, but positive social relationships as worse. Both scales are rated worse in surgical fields than in internal medicine. The effort-reward imbalance (ERI) is rated significantly higher (unfavourable) in "A" hospitals than in "B"/"C"/"D" hospitals, regardless of gender and clinical field. Significantly more subjects with an ERI quotient above 1 (which is unfavourable) work in "A" hospitals, and in surgical fields regardless of hospital type. Of the total sample, 81 subjects (16.3%), 41 males and 40 females, show an ERI quotient above 1. The greater the workload, the worse the rating of workplace conditions, effort-reward imbalance, and over-commitment. CONCLUSION: Institutional determinants are crucial factors for the workplace experiences and first career steps of junior physicians. Medical educators, especially those in "A" hospitals, should become more involved in structured residency programs and be aware of potential gender inequalities in the career support of female physicians.

Adult↗
PubMed2003

Gender in medicine - an issue for women only? A survey of physician teachers' gender attitudes.

BACKGROUND: During the last decades research has disclosed gender differences and gender bias in different fields of academic and clinical medicine. Consequently, a gender perspective has been asked for in medical curricula and medical education. However, in reports about implementation attempts, difficulties and reluctance have been described. Since teachers are key persons when introducing new issues we surveyed physician teachers' attitudes towards the importance of gender in professional relations. We also analyzed if gender of the physician is related to these attitudes. METHOD: Questionnaires were sent to all 468 senior physicians (29 % women), at the clinical departments and in family medicine, engaged in educating medical students at a Swedish university. They were asked to rate, on five visual analogue scales, the importance of physician and patient gender in consultation, of physician and student gender in clinical tutoring, and of physician gender in other professional encounters. Differences between women and men were estimated by chi-2 tests and multivariate logistic regression analyses. RESULTS: The response rate was 65 %. The physicians rated gender more important in consultation than in clinical tutoring. There were significant differences between women and men in all investigated areas also when adjusting for speciality, age, academic degree and years in the profession. A higher proportion of women than men assessed gender as important in professional relationships. Those who assessed very low were all men while both men and women were represented among those with high ratings. CONCLUSIONS: To implement a gender perspective in medical education it is necessary that both male and female teachers participate and embrace gender aspects as important. To facilitate implementation and to convince those who are indifferent, this study indicates that special efforts are needed to motivate men. We suggest that men with an interest in gender issues should be involved in this work. Further research is needed to find out how such male-oriented endeavours should be outlined.

Journal Article↗
PubMed2004

Empowerment and advocacy: reflections on action research with Bangladeshi and Pakistani families who have children with severe disabilities.

The concepts of empowerment and advocacy, and how they impinge on power relationships for service providers working with black and Asian communities, are explored through the findings of a 20-month project carried out between 2000 and 2001 with 19 Pakistani and Bangladeshi families who have children with severe disabilities in Birmingham. This action research project evaluated an advocacy project designed to improve the quality of life for Pakistani and Bangladeshi families with at least one child with severe disabilities. The objectives included improving access to resources, services, information and support in ways which were non-stigmatising, and which were sensitive to the particular needs of the children and their carers. The present paper discusses four main themes: (1) advocacy and empowerment in practice; (2) issues of the efficacy of advocacy and of consultation within advocacy; (3) individual empowerment versus the families' needs; and (4) cultural and gender issues which emerged from the analysis of the study. The authors identify features of empowerment which must be addressed in advocacy services which are sensitive to ethnic differences. These issues must be addressed if services are to reap their potential to make a positive impact on the lives of the most vulnerable and powerless members of the community.

Adult↗
PubMed2001

Implications of gender differences on coronary artery disease risk reduction in women.

Differences in the clinical presentation and resultant treatment of coronary artery disease (CAD) for men and women have sensitized advanced practice nurses to the importance of addressing gender issues when caring for women with CAD. Certain patient characteristics and clinical conditions may place women at higher risk of CAD development or progression. These factors include depression, African American status, menopausal status, age, type 2 diabetes, and thyroid function. In addition, female gender may adversely influence the relative benefits of cholesterol lowering in elderly women with borderline high serum cholesterol levels and response to interventions for modification of sedentary behavior and for smoking cessation. This article addresses emerging knowledge regarding gender differences in CAD risk factors and responsiveness to risk reduction interventions, issues regarding patient management, the implications of emerging knowledge on early detection of CAD risk factors more prevalent in women, and the development of targeted intervention approaches.

Acute Disease↗