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PubMed1995

Diagnostic testing strategies for coronary artery disease: special issues related to gender.

Early reports of the prevalence, diagnosis, and outcomes of coronary artery disease (CAD) in women have led to the acceptance of several myths concerning noninvasive diagnostic studies in women. Many of the myths can be explained by age-related differences in prevalence, methodological errors that exclude women from enrollment, worse clinical baseline risk profiles, comorbid diseases at the time of interventions, and smaller coronary vessels. Awareness of these age-related prevalence factors in women and the potential for delaying the onset of CAD by estrogen treatment in postmenopausal women must be considered in assessing the accuracy of diagnostic studies. The critical role of noninvasive testing in women is to diagnose CAD accurately in a population with a lower prevalence of disease prior to the development of more severe clinical manifestations when therapeutic interventions have a high risk and a poor outcome. Exercise radionuclide ventriculography has lower specificity in women, which may be due to gender differences in the response to exercise. Radionuclide perfusion imaging for the detection of CAD is accurate, there is extensive published literature, and it is used widely. High-dose dipyridamole in combination with echocardiography is not widespread in the United States; most pharmacologic echocardiographic studies are performed using dobutamine, and there are no reports on gender differences using dobutamine echocardiography.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1996

Are there gender differences or issues related to angiographic imaging of the coronary arteries?

The use of coronary angiography and coronary interventions in women with suspected coronary artery disease has recently come under close scrutiny. Clear differences in the utilization of these procedures, including coronary artery bypass graft (CABG) surgery have led to concerns that a bias may exist against the use of these procedures in women. Alternative explanations of these perceived practice differences have focused on their propriety based on patients' ages, underlying disease severity, expected prevalence of coronary disease and comorbid conditions rather than physician bias. The possibility that these procedures are over utilized in men has also been suggested. Pertinent to this debate are historical observational data suggesting that women may be at higher risk of major complications of coronary interventions and CABG surgery. Because coronary artery disease is the most frequent cause of death among women in the United States, there is some sociopolitical urgency in addressing these important concerns. This article reviews the use and findings of diagnostic coronary angiography in women with suspected coronary artery disease. Specific risks to women who have coronary angiography performed are also discussed. Finally, the outcome of percutaneous coronary revascularization procedures in women compared to men is discussed.

Aged↗
PubMedDate not supplied

Self-reported comfort in athletic training of gender-specific and non-gender-specific injuries and issues.

CONTEXT: To assist athletes in maintaining optimal health, athletic trainers must work with athletes of both sexes. OBJECTIVE: To examine athletic trainers' comfort levels in providing care for gender-specific and non-gender-specific injuries and issues. DESIGN: We mailed 235 Gender Comfort in Athletic Training Questionnaires to program directors, who were asked to distribute and collect them. SETTING: We randomly selected 21 athletic training education program directors and invited them by e-mail to participate in the study. Fourteen program directors representing the 10 National Athletic Trainers' Association districts agreed to participate. PATIENTS OR OTHER PARTICIPANTS: A total of 192 participants returned completed questionnaires, for a response rate of 82% (103 women, 89 men; 101 senior athletic training students, 91 certified athletic trainers). MAIN OUTCOME MEASURE(S): The questionnaire consisted of 17 injuries and issues common to both female and male athlete scenarios. Three gender-specific items were added to each scenario. Responses were scored on a 5-point scale anchored by 1 (very uncomfortable) and 5 (very comfortable). Participants were asked to indicate the reason for any degree of discomfort. Internal consistency, determined by the Cronbach alpha, was .92 for the female athlete scenario and .93 for the male athlete scenario. RESULTS: We found significant differences between women and men certified athletic trainers for the female and male athlete scenarios. Overall, women were more comfortable caring for female injuries and issues, whereas men were more comfortable caring for male injuries and issues. Certified athletic trainers reported more comfort overall than athletic training students. The most common underlying reason reported for discomfort in caring for female and male injuries and issues was experience level. CONCLUSIONS: Athletic training education programs should provide early and more deliberate experiences with injuries and issues of a more intimate nature, including those that are gender specific and non-gender specific. These experiences may increase athletic trainers' level of comfort in providing care to athletes of the opposite sex.

Journal Article↗
PubMed2001

Early childhood traumatic development and its impact on gender identity.

The author clarifies issues of gender identity typical to contemporary Western societies. Nowadays, we tend to emphasize self-autonomy as the main target of the individual's development. In adolescence this may cause many questions as to the adolescent's conception of his or her gender and sexual identity. These questions are the outcome of early development, and thus early traumas may impact the entire gender development. In this context, trauma includes not only major violations such as sexual abuse, terror attacks, and so forth, but also comprises events heretofore considered minor.

Adolescent↗
PubMed2001

Animal models of anxiety and depression: how are females different?

The present study examines gender-related issues in the development of animal models of depression and anxiety disorders. Three main issues are discussed: (1) gender differences in the prevalence, etiology, and responses to treatments of neuropsychiatric disorders. An extensive literature reports that mood disorders are more frequent in women compared with men but the great majority of basic research has focused on male rodents as animal models; (2) sex-differences in behavior reflect both organizational and activational effects of steroid hormones, and should be considered in the conceptual frame of the evolutionary theory of sexual selection; (3) animal models of anxiety and depression. Social stress appears to be a good model to induce anxiety-like and depression-like responses, but a large discrepancy in the possibility of inducing social stress in the two genders exists. Reliable models of social stress in females are needed. The effects of social context, as a possible source of stress, on exploration and anxiety in male and female mice were investigated by taking into account the natural history and social behavior of this species. Mice housed individually for 7 days or with siblings were tested in a free-exploratory paradigm of anxiety (where test animals have a choice to stay in their home cage or to explore an open field). Individually housed females showed lower propensity for exploration and a higher level of anxiety compared with group-housed females. Individually housed males tended to show an opposite profile. Animal models may contribute to elucidating some aspect of neuropsychiatric disorders, but they require consideration of the natural life of the animal species studied and of their social behavior in an evolutionary perspective.

Animals↗
PubMed2005

Attitudes towards patient gender among psychiatric hospital staff: results of a case study with focus groups.

There is an increasing awareness of gender-related issues in psychiatry. However, empirical findings on attitudes of psychiatric staff towards patient gender are limited. Gender-related issues are particularly relevant in the debate about mixed versus segregated sex wards, yet while the appropriateness of mixed-sex wards is questioned in Great Britain this is not the case in Germany. To investigate attitudes of psychiatric staff towards both patient gender and mixed versus segregated sex wards, we conducted a case study using focus groups with members of professional teams. We evaluated the transition process from two single-sex wards to two mixed-sex wards in a 330-bed psychiatric hospital in a rural area in south Germany. Staff described female patients as more externally oriented, motivating of others, demanding, and even sexually aggressive. Male patients, on the other hand, were described as more quiet, modest, or lazy. Furthermore, participants described the mixing process as a positive development whereas they did not see a need for gender-separated wards in order to protect vulnerable female patients. Some gender descriptions by professionals are "reversed" in comparison with gender stereotypes supposed to be present in wider society. The perception of crossed gender norms may affect staff attitudes towards the vulnerability of female patients in psychiatric settings and the provision of single-sex wards in in-patient psychiatric care. Practical implications are discussed against the background of a high rate of female patients with sexual abuse histories.

Attitude of Health Personnel↗
PubMed2004

Gender identity development and issues.

This article focuses on the psychosexual development of children and adolescents who have sex-typed behavioral patterns that correspond to the diagnosis of Gender Identity Disorder, as defined in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders. The author provides an update on phenomenology and diagnosis, associated behavior problems, developmental course, biologic and psychosocial influences, and treatment and ethical issues.

Adolescent↗
PubMed2001

Caring for women with inflammatory bowel disease.

Crohn's disease and ulcerative colitis are chronic inflammatory conditions involving the gastrointestinal tract. Although many aspects of the management of these diseases are identical for all patients, some issues that are specific to women are not necessarily part of routine care. Gender-specific issues such as menses, fertility, pregnancy, and menopause are often overlooked and mismanaged. Women and men also have different psychological concerns arising from the disease. Health care providers, regardless of their primary focus, should be aware of these differences and should be familiar with certain general information on gender-specific issues, reviewed in this article.

Body Image↗
PubMed2005

Gender and psychopathy: an overview of important issues and introduction to the special issue.

One of the most important concepts to ever emerge in forensic psychology and law is psychopathy. It would be difficult to exaggerate the profound effect the construct has had on research and practice in correctional psychology, psychiatry, and criminology. Much less pronounced has been an interest in understanding the potential relevance and practical implications that this personality disorder might have for providing insights into antisocial behaviors and crimes committed by girls and women. In this paper we provide an overview of some of the pressing issues confronting clinicians and researchers and provide an introduction to this special issue dedicated to gender and psychopathy.

Aggression↗
PubMed1995

Risky heterosexual practices amongst women over 30: gender, power and long term relationships.

Statistics suggest that older and younger people are about equally at risk for HIV infection, yet existing research on heterosexuality and safer sexual practices has tended to focus on people under the age of 25. The present qualitative study investigates risk behaviours and the practice of safer sex in older populations. Group discussions comprising women over the age of 30 (n = 23) targeted two issues: the gendered power dimension of heterosexuality and safer sex in long term relationships. Cohort issues were also discussed. The discussion groups revealed that the imbalance of power between men and women which has been shown by previous research to constrain younger women's choices with regard to safer sex, continues to affect older women's decisions. Many of the group participants still found it difficult to assert themselves in sexual relationships and even those who were able to challenge overt pressures to engage in unsafe sex were still susceptible to internalized social pressures. In addition, it seems that risks for older age groups are increased by difficulties in continuing to use condoms in long term relationships where monogamy cannot be taken for granted. It was also apparent that there are difficulties in changing sexual behaviours which were established before HIV became an issue.

Adult↗
PubMed1988

Royal Decree No. 727/1988 on the restructuring of ministerial departments, 11 July 1988.

This Decree restructures the Central Administration of Spain to include the Ministry of Social Affairs. Among the functions of the Ministry are the following: 1) the preparation and execution of the Government's policy for the promotion and encouragement of conditions that make possible the social equality of both sexes, and the participation of women in political, cultural, economic, and social life; and 2) the legal protection of minors and, in a general fashion, the analysis, formulation, and coordination of programs of action relating to the prevention of juvenile delinquency; the promotion of institutions for adoption and foster care; and the evaluation and inspection of organizations of family integration. Royal Decree No. 791/1988 of the Ministry of Social Affairs of 20 July 1988 sets forth the organic structure of the Ministry of Social Affairs. Among the departments of the Ministry is the General Directorate for the Protection of Minors, whose general objective is the analysis, formulation, coordination, and supervision of programs of action relating to the legal and social protection of minors and the prevention of the marginalization of infants and youth. Attached to the Ministry as an autonomous organization is the Women's Institute.

Adolescent↗
PubMed2001

[Sex-typical aspects of the physician-patient relationship of elderly patients in general practice].

So far the issue of gender combination in the patient-doctor relationship has not been investigated in depth. In a cross sectional study 84 general practitioners of the Canton of Zurich were asked to give information on health problems and expectations of their patients over 55 years. Data regarding fears and expectations on the part of the physicians pertaining to their own age were assessed. Results show that cardio-circular, muscular-skeletal, fibre-tissue, urological, nutritional and metabolic system diseases as well as psychological and behavioural problems were most commonly diagnosed in older patients in general practice. Patients often had expectations not or difficult to fulfill by their physicians. Gender stereotypes appeared in the descriptions of typical older male or female patient. Female doctors characterise their patients similarly to their male colleagues. Regarding their own aging both genders reported fears of dependency. Female doctors primarily hoped for wisdom, whereas, their male colleagues wished for themselves health and more time for their own interests. Results indicate that the issue of gender combination and the competence in dealing with psychosocial problems of older patients should be given special consideration in graduate programs and continuous training of doctors.

Activities of Daily Living↗
PubMed2003

Trauma and women.

Trauma is extremely prevalent in the lives of women, and the emotional, physical, social, and financial costs are often enduring and pervasive. Given its prevalence, all mental health professionals should receive training in the impact of trauma and learn the principles of its treatment. Although a considerable amount is known about the impact of trauma, much less is known about how to help survivors fully recover, especially women suffering from chronic, complex PTSD. Treatments must-be sensitive to issues of gender. Much research is needed, especially controlled, prospective studies to illuminate normal and pathological responses to trauma. Also needed are large epidemiological studies that compare the genders across trauma types and assess contextual issues of the trauma. We need to learn much more about the individual, family, and community resources that impart resilience, as well as impede recovery. Given the prevalence of violence, it will be impossible to resolve its impact on an individual basis. Interventions also need to be directed at system-level factors that foster violence.

Anxiety Disorders↗
PubMed2000

The influence of the gender of patient and analyst in the psychoanalytic relationship.

An overview of current explorations of the influence of gender on the psychoanalytic situation is presented. The topic does not lend itself to simple generalizations because the accumulated experience of several generations of psychoanalysts is now merging with newer views of psychoanalytic technique, while at the same time psychoanalytic theory is being influenced by changing ideological crosscurrents and by new knowledge regarding the similarities and differences in the development of both genders. Major issues still open are the relationship between gender and sexuality and between erotic desire and love; the challenges of the boundary of the psychoanalytic relationship as a facilitating and containing frame for the exploration of oedipal conflicts; and the related temptations, prohibitions, and derivatives of the erotic tension in the transference-countertransference.

Culture↗