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PubMed1997

Women physicians in Quebec.

This article presents the results of a qualitative study on women physicians in Quebec which aimed to go beyond a mere statistical description of the tendencies observed in their practices. It proposes an interpretation of their discourses on their practice and its context bringing to light the interdependence of individual strategies and structural constraints. We met 30 women physicians and eight men physicians asking them to talk freely about their personal and professional experience. The data reveal how the individual characteristics and interests of women physicians prevail in their decisions at key moments in their lives which have repercussions on the shaping of their practice. These moments include admission into the faculty of medicine, training, professional orientation and the choice of a specialized field, organization of professional practice and personal life. The medical practice of women is constructed through these choices and the gender variable plays a more or less significant role at each stage of this construction. Their distinctive choices reflect how gender relations are reproduced in the private sphere and the interactions between their private and professional lives. According to our participants, a difference lies in the place occupied by their profession in women and men physicians' lives. The private life of women physicians appears to be closely linked to their decisions regarding the organization of their professional life and as a result to the health services they provide, suggesting they have their own way of "being a physician". The individual nature of the strategies they adopt can have, at a collective level, consequences on the planning and the distribution of medical resources in the publicly managed health care system in Quebec while raising the global issue of gendered division of labor.

Adaptation, Psychological↗
PubMed1999

A survey of rehabilitative services and people coping with physical disabilities in Uganda, East Africa.

The impact of physical disability in the developing world is a tremendous health issue. The developing world presents many challenges in the lives of these people, many who cope without rehabilitative care. To determine how disabled people manage in this setting, 49 mobility-impaired Ugandans were interviewed. Functional capacity was assessed by determining the severity of lower extremity impairment and identifying the use of assistive devices and personal assistance needed in activities of daily living. Males appeared to have greater access to rehabilitative equipment, namely wheelchairs, and to personal assistance. The use of assistive devices was indicative of greater mobility, which subsequently provided greater opportunities, such as formal education or employment. Subjects with severe impairments without access to rehabilitative equipment were dependent upon crawling for mobility and begged for economic survival. Although there were a mix of responses towards perceived attitudes towards disabled subjects, more reported being viewed in a positive than in a negative light. Findings suggest that gender-related issues may limit access to rehabilitative equipment, due to limited financial resources of women living in the developing world. Uganda utilizes a viable political organization of people with disabilities to raise awareness and to empower its citizens coping with disability.

Adaptation, Psychological↗
PubMed2003

[Transexual gender identity disorders: diagnostic and legal issues].

The current classification systems (ICD-10, DSM-IV), epidemiology, symptoms and diagnostic features of gender identity disorders are discussed. In the best interest of the patients, and in view of the legal situation, treatment has to follow set "standards of care". The necessity of a psychotherapeutically guided real life test, lasting at least 1 year before somatic treatment can begin, is again pointed out.

Adolescent↗
PubMed2001

Culture and urban mental health.

The previous panoramic view provides sufficient evidence that cultural understanding of urban realities and expressions of their impact on mental health are necessary for a successful approach to mental health in cities. The issues go beyond understanding how urban realties and cultural issues differ in New York from Jakarta; every city has a variety of unwritten cultural norms that permeate every aspect of its mental health. Unless these norms are understood within the dynamic structure of city living, any attempt to intervene on mental health programs will be doomed to failure. Understanding the cultural blueprint of a city, however, is only the first step, as we need to shed our cultural assumptions while we consider contextual socioeconomic and political factors for each city. Finally we need to adapt our western view of cultural values and how citizens function or do not function within the urban environments. Because each city in is its own culturally specific entity, the three steps outlined previously can help create an accurate portrait of what is needed to implement culturally sensitive changes. A paradigm shift, laid on a bicurcated foundation, on the one hand a locally attuned awareness of urban cultural dimensions and on the other educational programs based on extensive knowledge of worldwide problems such as stigma, gender-specific issues, disability, and the plight of vulnerable populations can potentially have far reaching implications on mental health policy changes addressing the cultural needs of cities. Urban mental health is poised to be one of the central issues for the next few decades, because of the size of the world urban population and because of the protean nature of its problems. Cultural factors interplay with urban dynamics in a unique, at times creative, other times destructive, fashion. Under conditions of socioeconomic disadvantage vulnerable individuals who lack adaptive mechanisms may become mentally ill or experience an exacerbation of their mental illness. Understanding how cultural dynamics articulate with adaptation to urban life may greatly enhance our ability to properly assess and treat mental disorders in cities. In the assessment and treatment of patients living in urban areas contextual cultural factors rather than being merely complementary assume a preeminent if not crucial role.

Cross-Cultural Comparison↗
PubMed1996

Epilepsy in women.

Physicians should be aware of certain gender-related issues in the treatment of women with epilepsy. Although in the past reproduction was discouraged in women with epilepsy, more than 90% of the pregnancies in such patients currently have an uneventful outcome with appropriate management. Oral contraceptive agents are not contraindicated in women with epilepsy; however, the contraceptive failure rate increases fourfold if patients are being treated concurrently with enzyme-inducing antiepileptic drugs. In pregnant patients, free drug levels of carbamazepine, phenobarbital, phenytoin, and valproate may change because of alterations in protein binding, clearance, and possible absorption. The dosage should be adjusted if the patient's seizures are increasing. Women with epilepsy may have disease-related or treatment-related menstrual dysfunction, complications of pregnancy (slightly increased risk of toxemia and fetal loss), endocrine dysfunction, appearance changes (a general coarsening of facial features with long-term administration of antiepileptic agents), and psychosocial maladjustment. Some effects are drug specific. Although control of seizures remains the primary goal of treating women with epilepsy, the widening choice of antiepileptic drugs may facilitate optimal management of secondary and gender-specific complications.

Anticonvulsants↗
PubMed1999

The kappa opioid nalbuphine produces gender- and dose-dependent analgesia and antianalgesia in patients with postoperative pain.

Nalbuphine, pentazocine, and butorphanol, mixed agonist/antagonist opioids that induce analgesia by acting predominantly at kappa opioid receptors, have recently been shown in single-dose studies to have greater analgesic efficacy in women than in men. In the current experiments, the first placebo controlled dose response study of opioid analgesic efficacy that examines for gender differences, nalbuphine (5, 10, or 20 mg) and placebo were evaluated in 62 men and 69 women for the treatment of moderate to severe postoperative pain following extraction of impacted wisdom teeth. In a randomized, open injection, double blind experimental design, pain intensity was recorded on a 10 cm visual analog scale (VAS) immediately prior to drug administration (baseline) and at 20 min intervals thereafter. Although responses to placebo were similar in men and women, for all doses of nalbuphine women exhibited significantly greater analgesic response than men, compatible with our previous results. Unexpectedly, men receiving the 5 mg dose of nalbuphine experienced significantly greater pain than those receiving placebo; only the 20 mg dose of nalbuphine in men produced significant analgesia compared to placebo. While a similar antianalgesic effect was not observed in women, only the 10 mg dose of nalbuphine produced significant analgesia compared to placebo. These results suggest that the optimal analgesic dose of nalbuphine for women is lower than the highest dose that can be safely administered. In contrast, the antianalgesic effect of nalbuphine suggests avoidance of its routine use for postoperative analgesia in men until further studies clarify this issue. Because gender differences in other mixed kappa agonists/antagonists (i.e. pentazocine and butorphanol) have previously been shown, these results may generally apply to this class of opioid analgesics.

Adult↗
PubMed2004

Reproductive health awareness of school-going, unmarried, rural adolescents.

OBJECTIVE: In 1996, India included Adolescent Health in Reproductive and Child Heatlh Programme. This Task-Force Study was planned to test the awareness level of adolescents regarding various reproductive health issues and to identify lacunae in knowledge, particularly in legal minimum age of marriage, number of children, male preference, contraceptive practices, about STIs /AIDS etc. METHODS: It was a multicentre study, done in rural co-education/higher secondary schools of 22 districts located in 14 states through Human Reproductive Research Centre (HRRC's) of the Indian Council of Medical Research (ICMR). A sample of 8453 school going adolescents (aged 10-19 years) was surveyed by means of open ended, self-administered questionnaires maintaining confidentiality. RESULTS: Mean age of adolescents was 14.3 +/- 3.4 years. Awareness of legal minimum age of marriage was present in more than half of adolescents. Attitude towards marriage beyond 21 years in boys and 18 years in girls was favorable. Mean number of children desired was 2.2 +/- 1.4. However, number of children desired by boys (2.2+/-1.6) was significantly more (p< 0.000) than those desired by girls (2.0+/-1.1). More boys (23.7%) than girls (9.4%) wanted three or more children with male preference. Only 19.8% of adolescents were aware of at least one method of contraception. Only two-fifth (39.5%) were aware of AIDS and less than one-fifth (18%) were aware of STDs and most of them thought it is same as AIDS. Awareness of at least one method of immunization was present in three-fifth (60.1%) of students. It was least for DPT (13.5%) and most (55%) were aware of polio only. Awareness of all Reproductive Health matters was more in boys than girls and more in late teens (15-19) than earlier teens (10-14). CONCLUSION: The study showed tremendous lacunae in awareness of all Reproductive Health (RH) matters. There is a need for evolving information, education, and communication strategies to focus on raising awareness on RH and gender related issues. A sociocultural research is needed to find the right kind of sexual health services for young girls and boys.

Adolescent↗
PubMed2005

The pervasive triad of food security, gender inequity and women's health: exploratory research from sub-Saharan Africa.

OBJECTIVES: This study was designed to explore the interactions between food securing activities, health and gender equity from the perspective of rural east African women. The specific objectives were to document the critical interaction among these three issues-food security, gender inequity, women's health within the context of sub-Saharan Africa; to describe the nature of this triad from the perspective of women farmers in Africa; and to propose a framework for linking available interventions to the vicious nature of this triad. SETTING: In-depth interviews and focus group discussions were conducted with rural women farmers in Kwale District, Kenya and Bagamoyo District, Tanzania. METHODS: A total of 12 in-depth interviews and 4 focus group discussions have been included in this analysis. Transcribed text from interviews and focus group discussions were coded and thematic conceptual matrices were developed to compare dimensions of common themes across interviews and settings. A thematic analysis was then performed and a framework developed to understand the nature of the triad and explore the potential for interventions within the interactions. FINDINGS: The vicious cycle of increasing work, lack of time, and lack of independent decision making for women who are responsible for food production and health of their families, has health and social consequences. Food securing activities have negative health consequences for women, which are further augmented by issues of gender inequity. CONCLUSION: The African development community must respond by thinking of creative solutions and appropriate interventions for the empowerment of women farmers in the region to ensure their health.

Agriculture↗
PubMed1996

Comorbidity in hyperactive children: issues related to selection bias, gender, severity, and internalizing symptoms.

Parental behavior ratings of hyperactive boys and girls aged 6-11 years seen for evaluation in a general outpatient child psychiatry clinic and in a specialty "attention deficit disorder" (ADD) program were analyzed. The pattern of comorbidity in the two groups showed no significant differences. Most of the associated internalizing and externalizing behavioral scales in hyperactive boys and in hyperactive girls were elevated and in clinical ranges except for the "somatic complaints" scale. Comorbidity in both hyperactive boys and girls was related to the severity of the hyperactivity itself.

Attention Deficit Disorder with Hyperactivity↗