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PubMed2005

Women are not the same as men: specific clinical issues for female patients with bipolar disorder.

Women are not the same as men. While this observation can be considered to subjectively manifest in many different ways, objectively a greater tendency for bipolar II disorder, depressive symptoms, a rapid cycling course, and the consequences of being of child-rearing age can all represent additional challenges for female patients. Despite much recent interest in improving the management of patients with bipolar disorder, relatively little guidance exists relating to female-biased gender-specific issues. This review article will explore how female gender can influence bipolar disorder and its treatment and will focus on epidemiologic differences, the relevance to clinical presentation of events unique to women (particularly contraception, pregnancy, and lactation), and the importance of considering gender when making decisions about the pharmacological management of mood. All female patients should receive counseling regarding family planning and sexually transmitted diseases, as well as the risks of and treatment options during pregnancy and postpartum. Wherever possible, treatment choices should be made in a partnership between patient and clinician.

Anticonvulsants↗
PubMed1992

Gender in bioethics: theory and practice -- an introduction.

Does the care perspective make a difference? Can it reach as far as we would like? It is the goal of this special issue on Gender in Bioethics: Theory and Practice to begin to address some of these important questions. In the first article, Virginia Sharpe provides a comprehensive and thoughtful analysis of how the orientations of justice and care are played out in medical ethical theory. In the second article, James Nelson argues that the more traditional approach in Bioethics to maternal-fetal conflicts is not useful, and that a care perspective is more appropriate. Thoughtful commentary on Nelson's article is provided by Rosemarie Tong. For readers new to the justice-care debate in moral theory, the following articles will provide an informative introduction. For those who are more familiar, it is hoped that you will be challenged by the extension of the debate to the practical issue of maternal-fetal conflicts.

Bioethics↗
PubMed2006

Gender-specific determinants of goiter.

Despite the strong implications of differences between females and males in the risk of goiter, gender-specific issues have not been extensively addressed in investigations of goiter prevalence. The objective of our analysis was to investigate the gender-specific determinants of goiter. Between April 2001 and April 2002. A total of 853 healthy employees from 4 institutions in the western part of Germany between 18 and 68 yr of age were examined by ultrasound of the neck to determine the thyroid volume. Information on sex, age, daily use of iodized salt, the history of goiter in the first-degree relatives, type and amount of smoking, oral contraceptives, and number of pregnancies were assessed by standardized questionnaires. Gender-specific predictors of goiter prevalence were assessed by multivariate logistic regression. The overall prevalence of goiter among study subjects was 204/853 (23.9%). Goiter was present in 80 out of 370 females (21.6%) vs 124/483 (25.7%) in males. In general, smoking (p < 0.0001), increasing age (p < 0.0001), and lack of daily intake of iodized salt (p = 0.004) were associated with goiter prevalence, but not sex (p = 0.39) and family history of goiter (p = 0.16). In 370 females, parity (p = 0.004) and lack of daily intake of iodized salt (p = 0.01) were the major determinants for goiter, whereas age (p = 0.18), oral contraceptives (p = 0.82), family history of goiter (p = 0.33), and smoking (p = 0.09) did not affect goiter prevalence. In 483 males, smoking (p < 0.0001) and age (p < 0.001) affected goiter prevalence, but not family history of goiter (p = 0.39), and the iodine status failed just to reach the significant level (p = 0.08) in this analysis. Gender-specific determinants of goiter are parity and iodine status in females and smoking and increasing age in males.

Adolescent↗
PubMed1999

Introduction of the pill and its impact.

Introduction of the birth control pill in the United States in 1960 marked the end of a relatively short period of time (< 10 years) to intentionally produce an oral contraceptive, and the beginning of a relatively long period of controversy surrounding the use of the pill. Availability of the pill had an impact on various aspects of social life, including women's health, fertility trends, laws and policies, religion, interpersonal relationships and family roles, feminist issues, and gender relations, as well as sexual practices among both adults and adolescents. The pill proved to be highly effective from the outset. Although safety issues developed with the earlier formulations, continued evolution of pill hormones and doses has resulted in a greatly improved and safe oral contraceptive. A broad range of noncontraceptive health benefits also is associated with the pill. These health effects are significant, as they include protection against potentially fatal diseases, including ovarian and endometrial cancers, as well as against other conditions that are associated with substantial morbidity and potential hospitalization and associated costs. The popularity of the pill has remained high, with rates of use in the past 30 years in the United States ranging from one-quarter to almost one-third of women using contraception. Almost 40 years after its introduction, the pill's contraceptive efficacy is proven, its improved safety has been established, and the focus has shifted from supposed health risks to documented and real health benefits.

Contraception↗
PubMed1996

Case study: cross-gender preoccupations with two male children with autism.

Persons with autism frequently exhibit circumscribed interests and unusual preoccupations. In this case study, two young males with autism are presented who have preoccupations with feminine gender-stereotyped activities and objects. These types of preoccupations in children with autism have not been reported in the literature, but may be more prevalent than realized due to parental underreporting given the negative stigma associated with feminine interests in young boys. The development of gender identity in young children with autism has rarely been addressed in the literature. It seems unlikely that these two cases can be categorized as gender identity disorders. Understanding these preoccupations in the context of autism rather than focusing on the gender identity issues has important implications for treatment. These cases point to the need for further study of the complex interplay of environmental and neurobiologic factors affecting gender identity roles and preoccupations in autism.

Autistic Disorder↗
PubMed2001

Major depression: does a gender-based down-rating of suicide risk challenge its diagnostic validity?

OBJECTIVE: This paper will summarize the authors' research that disproved the accepted lifetime suicide risk in major depression. It will then explore the pivotal issue of gender in understanding suicide risk in depression and raise questions as to whether this is adequately reflected in the current diagnostic construct of this condition. METHOD: The methods of two recent papers published by the authors are briefly recounted. In the first of these papers, an age-specific algorithm was developed to reflect the necessary mathematical relationship between the prevalence of major depression, total population suicide rates and suicide risk in depression. It allowed for deaths in each age group from other causes, corrected for official underreporting, and was calculated on the entire population of the USA. In the second paper this methodology was further refined and applied to gender and age data. RESULTS: The suicide risk in major depression as it is currently defined diagnostically is of the order of 3.4% rather than the previously accepted figure of 15%. However, a single figure is misleading as it averages two highly disparate figures of almost 7% for men and only 1% for women. In youths (< age 25) the male: female ratio is even higher (10:1). CONCLUSIONS: Among sufferers of major depression, men and those who have been hospitalized have a much greater risk of suicide. These findings are sensitive to diagnostic inclusivity (the algorithm's denominator) which raises the question as to whether women with a depressive illness are more likely to be correctly identified than male sufferers? An argument is made for a gender-based nosological revision of the diagnostic criteria. In the interim, given the treatable morbidity of depression and the availability of safe, well-tolerated antidepressants, there is a prima facie case for lowering our threshold of treatment in men and youths presenting with a history of anger dyscontrol, or substance abuse, who have decompensated from previous levels of functioning and who show features of either typical or atypical depression.

Adolescent↗
PubMed2006

There are differences in cerebral activation between females in distinct menstrual phases during viewing of erotic stimuli: A fMRI study.

There is evidence that men experience more sexual arousal than women but also that women in mid-luteal phase experience more sexual arousal than women outside this phase. Recently, a few functional brain imaging studies have tackled the issue of gender differences as pertaining to reactions to erotica. The question of whether or not gender differences in reactions to erotica are maintained with women in different phases has not yet been answered from a functional brain imaging perspective. In order to examine this issue, functional MRI was performed in 22 male and 22 female volunteers. Subjects viewed erotic film excerpts alternating with emotionally neutral excerpts in a standard block-design paradigm. Arousal to erotic stimuli was evaluated using standard rating scales after scanning. Two-sample t-test with uncorrected P < 0.001 values for a priori determined region of interests involved in processing of erotic stimuli and with corrected P < 0.05 revealed gender differences: Comparing women in mid-luteal phase and during their menses, superior activation was revealed for women in mid-luteal phase in the anterior cingulate, left insula, and orbitofrontal cortex. A superior activation for men was found in the left thalamus, the bilateral amygdala, the anterior cingulate, the bilateral orbitofrontal, bilateral parahippocampal, and insular regions, which were maintained at a corrected P in the amygdala, the insula, and thalamus. There were no areas of significant superior activation for women neither in mid-luteal phase nor during their menses. Our results indicate that there are differences between women in the two cycle times in cerebral activity during viewing of erotic stimuli. Furthermore, gender differences with women in mid-luteal phases are similar to those in females outside the mid-luteal phase.

Adolescent↗
PubMed1995

AIDS prevention for African-American and Latina women: building culturally and gender-appropriate intervention.

African-American and Latino women are at high risk of HIV infection through heterosexual transmission, reflected in the significant increases in reported AIDS cases of women thus infected. Few AIDS-prevention programs have addressed this risk for women by directly, separately and, in appropriate ways, focusing on specific women's issues of gender roles, sexuality, and differential power relationships with men, in the context of racial and class relations, as these affect HIV transmission. This article discusses the contributions of a community-based AIDS-prevention program to the development of culturally and gender-appropriate intervention for African-American and Latina women at high risk. Further such programs are needed which build on the use of ethnic cultural concepts, racial and other social relations, and acknowledge issues specific to minority women in order to prevent their infection with HIV.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Meeting explores gender differences in viral load.

On January 29, 2000, Project Inform co-sponsored a meeting with the National Institute of Health's Office of AIDS Research and the National Institute of Child Health and Human Development on the issue of gender differences in HIV levels. The meeting convened HIV researchers, physicians and women living with HIV to review the research to date, identify potential gaps and develop a research agenda.

CD4 Lymphocyte Count↗
PubMed1997

Pseudoissues in practice evaluation: impediments to responsible practice.

This article reviews often-cited barriers to the implementation of practice evaluation activities and suggests that they are pseudoissues. Five pseudoissues in evaluation are reviewed: (1) time constraints, (2) single-system design issues, (3) gender and ethnic bias, (4) complexity of practice, and (5) incompatibility between the science of evaluation and the art of helping. These pseudoissues result from two misconceptions: First, these issues are sometimes viewed as affecting only the evaluation component of practice, but they pervade all of practice. Second, the confusion about the purpose of single-system designs leads to unwarranted concerns about design and methodology. The article argues that the incorporation of evaluation activities in practice helps practitioners become more aware of and sensitive to legitimate barriers to effective practice and paves the way for overcoming these barriers.

Adolescent↗
PubMed1983

Psychiatric training in gender specific psychology and goals for women in therapy.

A questionnaire addressing itself to the necessity of psychiatric training in gender specific issues and therapists' attitudes towards women in treatment was answered by almost half the total number of residents in psychiatric programs across Canada in the spring of 1980. Although the majority felt that training in gender specific psychology was a necessity, our survey indicated only a small proportion of Canadian programs (2 out of the 16 psychiatric schools) have incorporated this into their present curricula. An overview of the survey showed residents to agree with the following attitudes regarding women in therapy: 1) women's conflicts should be considered in the framework of their developmental life cycle and reproductive issues; 2) women do not present the same conflicts, goals and values as men; 3) therapy should help women to become more autonomous and assertive in the home and at work; and 4) women's primary goal should not necessarily be seen as that of caregivers and homemakers. Further, the residents expressed the beliefs that sex role ideology could interfere with therapy and that the "traditional hierarchy of power" should not be replicated between therapist and patient.

Adult↗
PubMed1998

Competency to stand trial adjudication: a comparison of female and male defendants.

Competency to stand trial adjudication is a decision point in the criminal justice system at which gender bias may result in different outcomes for female defendants as compared with males. However, this is an unexplored research area that lacks well-designed studies. The goals of this investigation, which used the largest known sample of U.S. female competency to stand trial defendants studied thus far, are to further understand this group of offenders and to address the gender bias issue as observed in a major southwestern urban court system. Multivariate logistic regression analyses on selected data for 157 female defendants and 187 of their male counterparts examined (1) variations within gender categories and (2) differences between men and women. The results of the within models showed some similarities, but also clear differences, in the determinants of court dispositions. The analyses failed to show an overall pattern of association between gender and competency adjudication. The influence of gender showed considerable variability across psychotic symptoms involving hallucinations and/or delusions: women with psychotic symptomatology were at high risk of being adjudicated incompetent. This study demonstrates how reliable data on female competency to stand trial defendants can assist the interface of the mental health and criminal justice systems in their adherence to the legal standard of competency. It also highlights the following research needs: (1) increased sample sizes of female evaluees; and (2) richer data sets with more and better information on how gender influences specific psychotic symptomatology, type of crime, and legally functional abilities.

Adult↗
PubMed2006

Unique donor-suitability issues.

On occasion, there arise questions or situations involving blood-donor eligibility determination, which are not adequately addressed by the existing regulations and standards. In such instances, even the most experienced blood collector may be uncertain regarding the best course of action and unable to find adequate guidance in the standard blood banking references, regulations and literature. In order to examine this area in greater depth, the American Association of Blood Banks (AABB) sponsored a short topic session on 'Unique Donor Suitability Issues' at their 2004 annual meeting. The invited speakers were four seasoned physician medical directors, with a combined experience of over 40 years in blood collection at both regional and national levels. They were tasked with identifying and researching problematic areas in donor-suitability determination, and suggesting an overall approach to dealing with such issues. They determined that three of the most problematic areas of eligibility evaluation included donors with: (1) disabilities, (2) disorders of haemostasis, and (3) trans-sexual, homosexual and other unusual gender-related issues. Each of these topics was presented in a 10-min lecture, followed by an open format consisting of audience participation and panel discussion by the speakers. The session was additionally enhanced by a representative of the United States Food and Drug Administration (FDA) who participated as a member of the audience. This review presents the contents of the short topic session in an expanded form.

Blood Banks↗
PubMed2002

Gender selection: cultural and religious perspectives.

OBJECTIVE: To review the current developments in the field of preconceptual sex selection and to discuss the cultural and religious perspectives as that accompany the scientific progress. DESIGN: A survey of the major publications in Judaism, Christianity and Islam regarding the issue of gender selection. Examination of current methods of preconceptual gender selection revealed that in vivo methods such as timing of intercourse, the use of ovulation induction medications, and artificial insemination do not appear to affect the sex ratio to a clinically significant degree. In vitro separation of X- and Y-bearing spermatozoa by gradient techniques have been reported to alter significantly the sex ratio at birth. However, these trials were not controlled, and molecular biological techniques could not validate that these methods indeed change the Y- to X bearing spermatozoa ratio sufficiently for clinical use. Nevertheless recent scientific advances have made highly reliable preconceptual sex selection possible by using preimplantation diagnosis (PGD) or sperm separation by flow cytometry combined with AIH or IVF. At present, these methods have been used to avoid sex-linked disorders. Both involve the invasive procedure of IVF and thus are held by most as inappropriate for nonmedical indications. However, improvement in flow cytometry output of sexed spermatozoa might provide in the near future sufficient sorted gametes for artificial insemination. It may be that in the near future, an improvement in flow cytometry output of sexed spermatozoa will provide sufficient sorted gametes for artificial insemination. In such a case, the medical community will be forced to take a stand, whether this reliable noninvasive method of sexing will be allowed for social purposes and even if the practice of PGD should be allowed for nonmedical indications. CONCLUSION: The requirement for a man to procreate by having a minimum of two children-a boy and a girl-is obligatory according to Jewish law. According to both schools, Beit Shamai and Beit Hillel, in order to fulfill the obligation of procreation at least one son is required. Therefore the application of sex preselection for nonmedical indications may by of practical importance using the method of sperm separation or sex selection of pre-embryo by PGD. According to Christian view, especially the one of the Catholic Church, gender preselection even for medical indications is forbidden. Islamic legal viewpoint is that fetal sex selection is lawful when it is practiced on an individual basis, to fulfill the wish of a married couple to have a boy or a girl through available medical means.

Christianity↗
PubMed2000

Sexual harassment during medical training: the perceptions of medical students at a university medical school in Australia.

CONTEXT: A survey of medical students' experiences of sexual harassment during medical training. OBJECTIVE: To assess the prevalence and nature of workplace sexual harassment as perceived by undergraduate medical students in order to address their learning needs concerning setting and maintaining sexual boundaries. DESIGN: A questionnaire involving both quantitative and qualitative descriptions. SETTING: A university medical school in Australia. PARTICIPANTS: The medical student population. MAIN OUTCOME MEASURES: Estimated prevalence of sexual harassment according to gender and year of training; frequency of sexual harassment reported by category of behaviour, year of training and gender; type of sexual harassment and alleged harasser reported by gender; frequency of sexual harassment reported by category of behaviour and alleged harasser. RESULTS: Female students encountered an unacceptable amount of sexual harassment in medical training from fellow students, patients, faculty and doctors they worked with, which was perceived as affecting learning opportunities. CONCLUSION: Genderized sexual harassment exists in medical training. While both male and female students report episodes perceived as sexual harassment a difference in interpretation results in greater vulnerability for female students. Medical educators need to address issues of gender, sexual harassment, and the setting and maintaining of sexual boundaries in order to avoid a hostile learning environment.

Australia↗
PubMed1995

Secrets and reasons for secrecy among school-aged children: developmental trends and gender differences.

The substance and dynamics of secrets were elicited and analyzed for 180 children at three grade levels, to examine developmental trends and gender differences. The recorded frequencies were subjected to loglinear analyses. The results, which revealed a grade effect regarding topics of secrets, indicated a developmental shift in topics with age from secrets pertaining to possessions to secrets pertaining to interpersonal relations, heterosexual involvement, and moral transgressions. A grade effect also emerged regarding reasons for secrecy; a shift was indicated from need for exclusiveness typical of younger children to socially embedded reasons for secrecy characteristic of older children. A gender main effect regarding topics of secrets indicated that boys more often than girls bear secrets pertaining to possessions and moral transgressions, whereas girls tend more often than boys to bear secrets pertaining to family issues. No gender effect was evident, however, in regard to reasons for secrecy. The developmental trends in both aspects of secrecy investigated may be conceived in the framework of a dual shift from separateness to relatedness and from true latency to late latency.

Adolescent↗