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PubMed2006

Gender differences in depression and response to psychotropic medication.

BACKGROUND: In the United States, depression is approximately twice as common among women as among men, across all age groups. OBJECTIVE: This review examines gender differences in the epidemiology and clinical presentation of depression, and explores whether women respond differently than men to antidepressant medications. METHODS: This is a selective review focusing on current issues in the management of depression, with particular attention to gender differences in the epidemiology, diagnosis, and treatment of the disease. RESULTS: Women are more likely than men to have atypical symptoms of depression (eg, hypersomnia, hyperphagia), to have comorbid anxiety disorders, and to attempt suicide. Women are also more likely to have seasonal affective disorder. Mood and anxiety symptoms that seem to be related to the menstrual cycle do not often represent genuine premenstrual dysphoria, but when premenstrual dysphoric disorder does occur, its impact on quality of life is similar to that of major depressive disorder. There is ongoing controversy about whether men and women respond equally well to antidepressant medications, and preliminary evidence suggests that selective serotonin reuptake inhibitors (SSRIs) are more effective in the presence of estrogen. Depression affects about 10% of pregnant women. Antidepressant medication should be considered during pregnancy if depression is moderate or severe, or if withdrawal of maintenance medication is likely to result in recurrent depression. The potential benefits of using antidepressant medications in a pregnant or breastfeeding woman should be balanced against the potential risks to the newborn. Because of the risk of neonatal withdrawal syndrome, SSRIs should be used at the lowest effective dose during the third trimester of pregnancy and should be tapered before delivery. CONCLUSIONS: Continuing research is needed to determine how gender influences the risk, clinical presentation, and response to treatment of depression. Exploration of sex differences in animals and humans should aid in efforts to treat depression as an organic disorder rather than a psychological maladaptation.

Antipsychotic Agents↗

PubMedDate not supplied

Split gender identity: problem or solution? Proposed parameters for addressing the gender dysphoric patient.

Working with the gender dysphoric patient is complex because of the various clinical issues that arise. One issue that has not been addressed in the psychiatric literature is whether to address the patient with the biologically congruent pronoun or name or with the patient's preferred-gender pronoun or cross-gender name. This article presents clinical examples that allow a template to be developed for pronoun use in working with such patients. Whether the clinician uses biologically congruent names and pronouns may depend upon the patient's progress in adopting the cross gender role as well whether family or friends either know or accept such changes. In certain situations, such as meetings with family members, the therapist may address the patient with gender congruent names; whereas on other occasions use cross-gender pronouns or names.

Adult↗

PubMed1995

Lower extremity fractures in motor vehicle collisions: the role of driver gender and height.

In a previous study it was noted that there was a higher incidence of lower-extremity fractures among women drivers. Analyses were based on a linkage between trauma registry and police crash report data. The present study addresses the issue of whether the differences noted are attributed to driver gender or are merely a reflection of differences in driver height. An inverse association was noted between driver height and the incidence of lower-extremity fractures. Those shorter than average (5'7") for this population had a 64% increase in lower-extremity fracture, which can be mainly attributed to ankle/tarsal injuries. Thus, the incidence of these injuries appears to be a function of driver height, with an increase among shorter drivers, most of whom are women.

Accidents, Traffic↗

PubMed2003

Ethical issues in new uses of preimplantation genetic diagnosis: should parents be allowed to use preimplantation genetic diagnosis to choose the sexual orientation of their children?

Extending the application of preimplantation genetic diagnosis (PGD) to screen embryos for non-medical traits such as gender, height and intelligence, raises serious moral, legal, and social issues. In this paper I consider the possibility of using PGD to select the sexual orientation of offspring. After considering five potential objections, I conclude that parents should be permitted to use PGD to choose the sexual orientation of their children.

Female↗

PubMedDate not supplied

STD prevention and the challenge of gender and cultural diversity: knowledge, attitudes, and risk behaviors among black and Hispanic inner-city STD clinic patients.

BACKGROUND AND OBJECTIVES: This study describes gender and cultural differences in sex-related risk behaviors, knowledge, and attitudes among black and Hispanic men and women seeking services at an STD clinic in the South Bronx. STUDY DESIGN: Survey instruments were administered to 3,348 men and women selected as a proportionate random sample of clinic patients registered from January through December 1992. RESULTS: There were significant differences in risk behaviors, knowledge about AIDS and STDs, and attitudes related to condom use among men and women who sought services at this large inner-city clinic. Across groups, the majority of subjects had a history of prior STDs and previously had been treated at a STD clinic. Overall levels of knowledge were high, with the exception of specific issues related to condom use and STD symptoms. Gender and cultural differences were most apparent in sex practices, experience with condoms, and attitudes concerning the use of condoms in relationships. CONCLUSIONS: These data indicate the need to design clinic prevention programs that reflect the diversity of gender and culturally based attitudes, knowledge, and behaviors within inner-city populations. Minority men and women who seek services at STD clinics are known to be at high risk of HIV infection and other sexually transmitted diseases. Yet providing all members of this patient population with the same prevention messages is not sufficient; differences in sex practices, educational needs, and concerns about adopting safer sex behaviors must be taken into account. This study underscores how important it is for clinics to develop the multiple interventions necessary to provide patients with the specific information and skills they need--beyond admonishments to avoid risky sex and use condoms--and for clinic staff to be trained in providing education that is gender and culturally appropriate.

Adult↗

PubMed2001

Gender differences in response to auditory-verbal intervention in children who are deaf or hard of hearing.

Recent research has questioned the role of gender in language development and in special education outcomes, yet neither issue has been addressed in literature on students who are deaf or hard of hearing. To determine if language and placement outcomes differ by gender, the present study considered the behavior of children who attended a clinical program subscribing to an auditory-verbal philosophy. Parents of 28 boys and 42 girls with hearing losses evaluated their children using the Parent Rating Scale of the Leiter International Performance Scale--Revised (Roid & Miller, 1997) and the Parental View of Therapy Scale (developed for the present study). Also, clinical file data were surveyed. The boys were found to be more likely than the girls to be rated by their parents as having basic features of temperament nonconducive to traditional clinical language intervention. The girls' language and placement outcomes surpassed the boys', although both groups' outcomes were positive. A possible limitation of the study was that the population was atypical of students with hearing losses in general.

Child↗

PubMed2001

A multicenter evaluation of whether gender dimorphism affects survival after trauma.

BACKGROUND: The frequency of women who have sustained severe injuries has increased over the past 30 years. The purpose of this study was to evaluate whether severely injured women have a survival advantage over men. To address this issue, we undertook a multicenter evaluation of the effects of gender dimorphism on survival in trauma patients. METHODS: Patient information was collected from the databases of three level I trauma centers. We included all consecutive patients who were admitted to these centers over a 4-year period. We evaluated the effects of age, gender, mechanism of injury, pattern of injury, Abbreviated Injury Score (AIS), and Injury Severity Score (ISS) on survival. RESULTS: A total of 20,261 patients were admitted to the three trauma centers. Women who were younger than 50 years of age (mortality rate 5%) experienced a survival advantage over men (mortality rate 7%) of equal age (odds ratio 1.27, P <0.002). This advantage was most notably found in the more severely injured (ISS >25) group (mortality rate 28% in women versus 33% in men). This difference was not attributable to mechanism of injury, severity of injury, or pattern of injury. CONCLUSIONS: Severely injured women younger than 50 years of age have a survival advantage when compared with men of equal age and injury severity. Young men have a 27% greater chance of dying than women after trauma. We conclude that gender dimorphism affects the survival of patients after trauma.

Female↗

PubMed1995

Adolescents calling a peer-listening phone service: variations in calls by gender, age, and season of the year.

Adolescents have specific concerns although these may not be readily apparent to health care providers. Described here are gender, age, and seasonal variations of concerns of adolescents calling a peer-listening phone service which has been in operation in Northwest Ohio since May 1987. The data reported are from calls received between May 1, 1987 and December 31, 1992. Demographic data as well as issues discussed are recorded for each call. There were significant gender (p < or = .001), age (p < or = .01), and seasonal (p < or = .05) variations when compared to the calls in total. Knowing which issues are important for adolescents may help us better elicit problems and give anticipatory guidance when seeing adolescents. Further studies will need to be done in order to determine how needs related to these issues can be best addressed.

Adolescent↗

PubMed1999

Confidentiality through a feminist lens. Reaction piece.

An ethical foundation for confidentiality is found in the AAOHN Code, grounded in a respect for autonomy. Confidentiality is a phenomenon involving a trust relationship between at least two people. An undesirable outcome could result if the confidential information or observation is revealed. Although confidentiality has an impact regardless of the individual's gender, women can be at higher risk for compromises to confidentiality. The implications for women include but are not limited to the inherent inequality in client/professional relationships, paternalistic practices in health care delivery, and the importance of autonomy as an ethical principle. The nurse's sensitivity to the possible vulnerability of women, the recognition of the importance of trust and communication in professional relationships, and an effort to ask the gender question contribute to an ethical practice in occupational health care related to the issue of confidentiality.

Confidentiality↗

PubMed1996

Gender bias and the JAMA study: are medical illustration and the A.M.I. politically correct?

The May/June 1996 Association of Medical Illustration News issued an alert to its membership. An article by Kristin Mount raised the spectre of gender bias against women in medical illustration (Mount 1996). She cited the findings of a 1994 research project in the Journal of the American Medical Association. Researchers found female images significantly underrepresented in various medical texts, possibly to the detriment of women. The present article gauges the seriousness of the problem and suggests ways of dealing with it.

American Medical Association↗

PubMed1996

[Self concept and need for social approval in bulimia patients].

The present work concerns the relation between the need for social approval (assessed as social desirability) and bulimia with respect to gender-differences. Since bulimia is mainly a female issue, a relationship was predicted between the development of bulimia and the internalization of a socially desired feminine sex-stereotype with respect to the self-concept. The need for approval was assessed for male subjects, female subjects not suffering from eating-disorders, and female bulimic subjects. The results show that bulimic women have significant higher self-ratings concerning the need for approval. Without neglecting multicausal explications, the results suggest that social desirability as an expression of social approval should receive more attention as a facilitating factor in the development of bulimia.

Adult↗

PubMed1992

Children's gender-typed perceptions of physical activity: consequences and implications.

This paper provides an expanded discussion of issues raised in our 1990 experimental study, with particular focus upon the differential cognitive, affective, and psychomotor consequences to girls and boys of gender-typed, sex-segregated play. Evidence is provided that, as agents of socialization, teachers and schools can enlist practices and provide structure to foster cross-sex interaction and behavior. Nonstereotypical play is advocated so that each sex can enjoy the benefits typically accruing only to the opposite; correspondingly, and in light of a society not yet gender-aschematic, psychological androgyny is invoked as the developmental ideal.

Child↗

PubMed1998

Ensuring the success of women in academic orthopaedics.

In spring of 1995, the Academic Orthopaedic Society convened a panel of 21 female academic orthopaedists and 24 senior members of the society to discuss the challenges facing female orthopaedic residents and women in academic orthopaedics. Participants began by reviewing results of a 200 item mail survey of fulltime and parttime female academic orthopaedic surgeons. The survey had been conducted in early 1995. Using the Delphi technique, the panelists identified challenges facing women and ranked them in priority order. Although the challenges identified by survey respondents and panelists were similar, the priority assigned to them varied. Panel and survey findings pointed to a need for action in six areas: increasing mentoring; overcoming gender bias; reducing women's social and professional isolation; increasing attention to promotion and salary equity; providing greater accommodation for family responsibilities; and expanding recruitment efforts. This paper suggests actions that department chairpersons and the Academic Orthopaedic Society may take to attract more women to academic orthopaedics. Because many of the issues emerging from the survey and panel were not gender specific, implementation of the recommendations may benefit male and female orthopaedic residents and academic surgeons in general.

Career Choice↗

PubMed1983

Human figure drawings of gender-problem children: a comparison to sibling, psychiatric, and normal controls.

The Draw-a-Person test was used to evaluate a number of questions regarding children referred for potential problems in their gender-identity development (N = 36). Sibling (N = 31), psychiatric (N = 23), and normal (N = 30) children served as comparison groups. The major results included the following: (1) The gender-referred children were more likely to draw an opposite-sex person when requested to "draw a person" than were the other three groups; (2) the gender-referred children who drew an opposite-sex person were more likely to play with opposite-sex toys and dress-up apparel on a free-play task than were the gender-referred children who drew a same-sex person; (3) the gender-referred children drew taller opposite-sex persons than same-sex persons; (4) using Koppitz's (1968) criteria, the normal children had a smaller proportion of emotional disturbance indicators in their same-sex drawings than did the other three groups. These findings were discussed with regard to psychometric and interpretive issues in the assessment of children with atypical gender-role behavior.

Art↗

PubMed2004

Gender Differences in Smoking and Self Reported Indicators of Health.

HEALTH ISSUE: Smoking among Canadian women is a serious public health issue. Using the 1998-99 National Population Health Survey, this study examined underlying factors contributing to differences in prevalence of smoking among subgroups of women and men, and its effects on self-reported indicators of health. KEY FINDINGS: In Canada, 26.4% of women and 29.2% of men were classified as current smokers. Higher levels of education and income were associated with decreased odds of current smoking. Adjusting for all other factors, being an ethnic minority decreased the odds of current smoking for both men and women (OR:0.35, 99%CI:0.23-0.54; OR:0.13, 99%CI: 0.09-0.20 respectively). Single mothers had the highest odds of smoking (OR: 2.12, 99%CI: 1.28-3.51) when compared to married mothers with children under 25 years of age. Current women smokers and current and former men smokers were less likely to report very good or excellent health compared with never smokers (OR: 0.83, 99%CI: 0.70-0.98; OR: 0.49, 99%CI: 0.41-0.60; OR: 0.75, 99%CI: 0.63-0.90 respectively). Women who were current smokers had increased odds of needing health care and not receiving it (OR: 1.50, 99%CI: 1.10-2.05). DATA GAPS AND RECOMMENDATIONS: Key issues for Canadian women include an increased prevalence of smoking among young girls and the strong association between smoking and social and economic disadvantage. Tobacco control policies and programs must target high-risk groups more effectively. Of particular importance is the development of programs and policies that do not serve to reinforce existing inequities, but rather, contribute to their amelioration.

Journal Article↗

PubMed2004

Angel, handmaiden, battleaxe or whore? A study which examines changes in newly recruited student nurses' attitudes to gender and nursing stereotypes.

This article presents the findings of a comparative study, which investigated the attitudes of two groups of newly recruited student nurses to gender and nursing stereotypes. The 1992 sample (n=100) was a group of student nurses who were in their second day of studies of a Project 2000 type curriculum. The 2002 sample (n=96) were in their second month of studies of a "Fitness for Practice" curriculum [Fitness for Practice (the 'Peach Report'), UKCC, London, 1999]. Data were collected using a questionnaire, which utilised a Likert scale for measurement of attitudes to statements pertaining to gender and nursing stereotypes. The findings reveal significant differences between the characteristics of the two groups of students. For example, the 2002 group were generally older and had more healthcare experience. However, male representation in the sample groups was similar. The overall high scores and implied propensity towards beliefs in gender and nursing stereotypes in the 1992 study was found not to be the case for the 2002 sample. This is particularly true of most statements related to gender stereotypes, nursing as 'feminine', male nurse stereotyping and issues related to nurses' uniform. However, there is less evidence of changes in attitudes towards female nursing stereotypes with indecision being a general feature of both the 1992 and 2002 responses.

Female↗

PubMed1994

The social impact of aging populations: some major issues.

Demographic trends regarding the issue of aging underscore the fact that both current situations and future trends directly concerns all of us. Aging is the reality for the future world. The pace at which demographic transition develops varies among countries and regions of the world, but most of the developed and developing countries will be challenged by increasing numbers of dependent individuals. This is particularly critical in the less-developed countries where older populations will increase substantially faster. It is expected that by the year 2000, Latin America and the Caribbean will have 41 million elderly, 7.2% of the total population. By 2025 this percentage will increase to 10.8%. The stunning growth of the elderly demands special attention of policy and decision-makers. The total dependency ratio will decrease in the Americas between 1980 and 2025 due to a marked decrease in the fertility rate, whereas old age dependency ratios will show a marked increase in all countries except Haiti and Surinam. Most of the elderly populations, predominantly women, are living in urban centers. This fact is one of the most important characteristic of the socioeconomic picture in Latin American and Caribbean countries: urbanization with poverty. Women are bearing mainly the burden. It is obvious that, from a cultural perspective, the social impact of aging populations is a complex issue. The wide range of possible future programs will be the result of differences and similarities in social values, relationships, and dynamics within each society. It is important to recognize that since modern industrialized societies live in a culture emphasizing competition for economic wealth, that values economic over social productivity, and where inequities based on class, gender, and race are accepted, that these are the issues influencing the parameters of aging populations. Social policy development for the elderly needs to be critically examined in order for society to adapt to aging as well as for older populations to adapt to a charging society. The major political challenge is the need for redistributive policies. Developing countries must add new priorities to their scarce resources, for social programs for elderly, while still having to deal with the problems of their younger populations. Women issues are extremely important in considering social policies for elderly population. Feminization of poverty and ill-health during old age is a result of exacerbated risks for women across the life course. Appropriate care and support for this vulnerable group is a priority.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗

PubMed2004

Factors influencing residents' decisions to pursue a career in hand surgery: a national survey.

PURPOSE: The number of programs offering hand surgery fellowships has remained approximately the same over a 6-year period while the number of fellows within these programs has decreased by 46%. This study aimed to identify factors that persuaded or dissuaded orthopedic and plastic surgery residents in choosing hand surgery as a career. METHODS: We conducted a national survey of final-year orthopedic (n = 600) and plastic surgery (n = 177) residents. We developed an internet questionnaire based on literature review and focus group discussions. A Web site link was sent via e-mail to program directors of accredited orthopedic and plastic surgery programs for distribution of this anonymous survey to the residents. Factor analysis combined items into an "intellectual issues" category and a "lifestyle issues" category. Logistic regression was used to evaluate factors that predict an outcome of entering a hand surgery fellowship. RESULTS: We achieved a 30% response rate. Respondents and nonrespondents were not significantly different in terms of gender and race. After controlling for age, gender, marital status, and specialty, residents who enjoyed the intellectual issues of the hand surgery field were more likely to pursue a hand surgery fellowship (odds ratio = 10.1; 95% confidence interval = 3.3-30.8). Although a positive attitude toward lifestyle issues of the hand surgery field tended to be associated with pursuit of a hand surgery fellowship, the relationship was much weaker (odds ratio = 2.5; 95% confidence interval = 0.8-7.3). CONCLUSIONS: Lifestyle issues associated with a career in hand surgery such as low reimbursement and long hours were not the most important factors to residents when considering a career in the field. Residents pursued hand surgery primarily because of factors such as interest in and exposure to this field. To prevent a potential shortfall of hand surgeons, both orthopedic and plastic surgery programs must strengthen residents' exposure to hand surgery education in their training.

Adult↗