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PubMed2003

Understanding the consequences of access barriers to health care: experiences of adults with disabilities.

PURPOSE: The study explores: (1) the scope and nature of the consequences that adults with disabilities perceive as the result of inappropriate access to health care services; (2) the variability of these consequences by demographic attributes such as disability type, gender, and health insurance type; and (3) the inter-relatedness and multidimensionality of these consequences. METHODS: Qualitative, semi-structured, in-depth interviews were administered over the telephone to 30 participants with spinal cord injury, cerebral palsy, or multiple sclerosis as part of a nation-wide study on access and utilisation in the USA. Interviews were transcribed and coded for analysis using the qualitative analysis program, NVivo. RESULTS: Consequences were grouped into one of five categories: social, psychological, physical, economic and independence issues. Responses differed slightly with regard to disability type, gender and health insurance type. There was substantial overlap among consequence categories. For most respondents, negative consequences were not limited to just one area--frequently, one consequence triggered others. CONCLUSIONS: Health insurers and providers need a better understanding of the multiple consequences of access barriers. Based on this knowledge, detrimental and costly effects of inappropriate service delivery could be more effectively prevented. Implications for health care services and policy are discussed.

Adult↗
PubMed2003

Project assist: a modified therapeutic community for homeless women living with HIV/AIDS and chemical dependency.

This article described a substance abuse treatment program for homeless women who abuse substances and are living with HIV/AIDS. A therapeutic community model was modified to meet the unique needs of this population. However, in light of criticism that the traditional TC model fails to attend to women's issues (Brown et al., 1996), the program uses a gender-specific treatment approach. In addition, the treatment program incorporates a variety of HIV support and education services, and provides enhanced health services to address the multiple medical needs of this population. To date, limited treatment options have been available to address the unique issues of women who are homeless, chemically dependent, and HIV-positive. To our knowledge, this is the first description of such a program to appear in the professional literature.

Comorbidity↗
PubMed1994

Breastfeeding and feminism.

Breastfeeding empowers women and contributes to gender equality; therefore, it is an important feminist, human rights, and women's issue. Although seldom addressed as a feminist issue, breastfeeding is paradigmatically one because it requires rethinking basic issues such as the sexual division of labor, the fit between women's productive and reproductive lives, and the role of physiological processes in defining gender ideology. The conceptual problems which emerge in the fit between breastfeeding promotion and feminist theory include the place of motherhood; technology versus liberation; fear of biological determinism; breasts and sexuality; locating guilt; personal choice; romanticizing breastfeeding; and conceptualizing women's work. Feminist theorists who take up breastfeeding as an issue and medical researchers who address questions raised by feminist theory have the occasion to produce a non-dualistic feminist problematic that would draw together a wide range of theories and practices that go beyond breastfeeding and mothering. The failure to develop this analysis could have serious consequences.

Breast Feeding↗
PubMed1989

Synthetic and natural speech preferences of male and female listeners in four age groups.

The purpose of this investigation was to examine the preferences of listeners of both sexes in four age groups with regard to natural and computer-generated synthetic speech in six different contexts. The subjects (listeners) for this study included 5 males and 5 females in each of four age groups (6-8 year olds, 10-12 year olds, adolescents, and adults). The listeners rated their preferences for 11 different voices (four natural and seven synthetic) on a 5-point Likert scale. Their preferences were rated for six communication contexts dependent on the potential user of the voice (adult male, adult female, child male, child female, computer, and self). The data were analyzed separately for each of the six communication contexts. In general, female listeners across the age range indicated that only natural female voices (adult or child) were acceptable alternatives to their own speech, thus rejecting the natural male voices as well as the synthetic voices. Male listeners appeared to be somewhat more flexible in terms of gender-appropriateness for themselves and other adult men, but selected female-sounding voices for women and female children. Children preferred to have computers produce synthesized speech, while adults preferred computers with more natural-sounding voices. The results of this investigation raise a number of issues related to the combined effects of age and gender-appropriateness of natural and synthetic speech. These are discussed in terms of their implications for the future development of synthetic speech technology used in communication devices.

Adolescent↗
PubMed2000

Hospital pharmacy automation: collective mobility or collective control?

This study examines the relationship between new technology and pharmacy's changing role in the division of labour in health care. Does automation advance pharmacy's collective mobility project and transition to its new role as a clinical rather than a merely technical profession? Alternatively, does it threaten pharmacy's cultural authority and control of medication dispensing? Does technology serve as an artifact demarcating occupational and gender boundaries in the drug distribution labour process? These issues were examined through qualitative case studies conducted at three hospital pharmacies located in mid-sized Canadian health care facilities. All three institutions had implemented automated drug distribution technology in the expectation that it would allow more pharmacist's time to be shifted from dispensing-related to clinical activities. It was found that pharmacists had attempted to maintain control of their labour process and had resisted peripheralization from drug dispensing. Technological processes did serve as artifacts reinforcing occupational demarcations as well as professional solidarity vis a vis hospital administrators although its impact on gender boundaries was less evident.

Automation↗
PubMed2003

Distributed cortical networks for syntax processing: Broca's area as the common denominator.

Different types of syntactic information (word category, grammatical gender) are processed at different times during word recognition. However, it is an open issue which brain systems support these processes. In the present event-related fMRI study, subjects performed either a syntactic gender decision task on German nouns (GEN), a word category decision task (WC, nouns vs. prepositions), or a physical baseline task (BASE). Reaction times in WC were faster than in GEN, supporting earlier electrophysiological results. Relative to BASE, both syntactic tasks activated the inferior tip of BA 44. In addition, BA 45 showed activation in GEN, whereas BA 47 was activated in WC. The imaging data indicate that the inferior portion of BA 44 together with type-specific prefrontal areas supports both initial word category related and later syntactic processes.

Adult↗
PubMedDate not supplied

How pervasive are sex differentials in childhood nutritional levels in south Asia?

This paper considers the assumption that there are widespread sex differentials in the household allocation of food in South Asia. From primary field data and a critical review of the existing literature, it concludes that we have no reason to believe that girls in this region invariably get an unfair deal in the matter of nutrition, even in those areas where sex differentials in child mortality are the most acute. Too much of the research to support such a contention starts with the biased view that gender differences in nutritional status must exist. It is pointed out in this paper that a new look at this issue is essential if we are to use scarce resources most effectively to fight gender inequalities. By identifying more precisely the areas in which women are worst discriminated against, action to affect these areas can be focused much better than by spreading efforts into programs where the need is at best marginal.

Breast Feeding↗
PubMed1999

US Food and Drug Administration office of women's health: update.

The Food and Drug Administration's commitment to women's health issues began a new chapter with the establishment of the Office of Women's Health in 1994. This office has worked on the regulation of various products, on FDA policy relating to the inclusion of women of childbearing potential in early-phase drug trials, and on gender analysis of drugs. This commitment to women's health issues had its beginnings in the early 1980s. Actions taken by the agency since then include focusing on approving new drugs for diseases that specifically afflict women, taking steps to increase data on how drugs affect women, strengthening labeling information to give women a more accurate understanding of how certain drugs will affect them, and conducting public education campaigns. The Office of Women's Health will continue the agency's wide-ranging efforts from drug development and approval, to labeling, to policy formulation, to public education.

Female↗
PubMed1994

Developing an ethics curriculum for a family practice residency.

PURPOSE: To develop a curriculum in ethics in family practice by studying which ethical issues physicians believe to be important based on frequency of encounter, difficulty in managing the problem, and helpfulness of discussion; to examine whether there are any important differences between faculty and residents and between genders; and to determine the preferred format(s) for teaching these issues. METHOD: Between November 1991 and June 1992 a total of 475 questionnaires were mailed to all the family practice residents (first- and second-year), graduates in their first two years of practice, and the physician faculty of the Department of Family Medicine at the McGill University Faculty of Medicine. Overall, 319 usable questionnaires were returned, for a final response rate of 67%. The questionnaire asked respondents to evaluate 14 ethical dilemmas in order to determine the importance of teaching specific ethical issues as well as to determine the preferred format for teaching. Chi-square tests, analyses of variance, and Student's t-tests were used to test the significance of differences in responses. RESULTS: No consistent pattern of interrelationship was found among frequency of encounter and difficulty and helpfulness of discussion for most items. Overall, there was little difference in how faculty and residents, men and women, perceived the importance of these ethical issues. Women reported encountering ethical issues less frequently than men [F (14,285) = 1.82, p < .04], while at the same time finding them somewhat more difficult and more deserving of discussion. Small-group, case-oriented discussion appears to have been the favored teaching format regardless of the ethical dilemma. CONCLUSION: It is difficult to narrow down the content to be included in a curriculum in ethics in family practice. Frequency of encounter, difficulty in management, and helpfulness of discussion can all be argued to be important factors for consideration; they should all be considered separately or in combination for each teaching situation if time restrictions force a choice between topics.

Adult↗
PubMedDate not supplied

Medical school, psychosocial attitudes, and gender.

A scale measuring empathy and a scale measuring attitudes toward social issues and human relations in health care were administered to medical students when they were applicants to medical school and again midway through their third year. Students in their third year exhibited less positive and/or more negative attitudes compared to their scores as applicants. The changes were largest in areas relating to social issues, such as government involvement in health care, and least in areas relating to human relations, such as the role of social factors as determinants of a patient's health or illness. There were few differences between women and men on these scales. These data suggest that attitudes toward the interpersonal aspect of patient care may be less severely affected by the medical school experience than previously expected, and that the medical school experience does not affect women's attitudes differently than it does men's.

Attitude↗
PubMedDate not supplied

[Mary Shelley's Frankenstein and Bram Stoker's Dracula: gender and science in literature].

Throughout the ages, literary works have expressed fears and expectations generated by scientific discoveries and have portrayed images and myths about science itself. Several parameters can contribute to these representations of science, including the culture and social class to which the authors of these works belong. We also cannot deny the influence of gender, as due to the fact that the male sphere of action dominates science, male or female authoring can determine a peculiar characterization of the scientific world. In the present work, through a comparative analysis of two important literary works from the 19th century, Frankenstein, by Mary Shelley, and Dracula, by Bram Stoker, the issues concerning the view of science and their relation to gender are highlighted. While Shelley, as a woman, apart from the scientific world, reveals in Frankenstein all her distrust about it, Stoker, the model of a Victorian man, expresses in Dracula his total trust in science.

History, 19th Century↗
PubMed2002

Determinants of women's choice of obstetrician/gynecologist.

INTRODUCTION: There has been a reported increase in women's desires to have female medical providers. It is unclear if this finding extends to obstetrician/gynecologists or how important gender is relative to other factors in choosing a provider. This study seeks to address these issues. METHODS AND MATERIALS: In community locations in Brooklyn, New York, 537 women completed a questionnaire regarding demographics, gender of their current provider, and whether they considered age, gender, experience, location, or cost to be the most important factor in choosing an obstetrician/gynecologist. They rated their current experience and the importance of gender using a 10-point Likert scale. RESULTS: Overall, 61% of participants preferred a female provider. The proportion did not vary with gender of the interviewer or participants' age. A female provider was preferred by 56% of Protestants, 58% of Catholics, and 58% of Jews and by 74% of Hindus and 89% of Muslims (p = 0.02). Regardless of whether a woman preferred a male or a female provider, 38% of participants felt strongly (7-10 on Likert scale) that gender was important. There was no difference in satisfaction with current provider between women who preferred a male or female provider. Gender was as important in choosing an obstetrician as experience or cost. Almost as many women with a female provider indicated a preference for a male (46%) as women with a male provider who preferred a female provider (54%). CONCLUSIONS: A slight majority of these women, particularly those who are Hindu or Moslem or currently use a female, prefer female providers. Only a minority of these women feel strongly about their preference, and women with male providers are as satisfied as are women with female providers. Gender of provider was about as important as a physician's experience in choice of clinician.

Adult↗
PubMed2005

Rethinking gender differences in health: why we need to integrate social and biological perspectives.

The complexity of gender differences in health (i.e., men's lower life expectancy and women's greater morbidity) extends beyond notions of either social or biological disadvantage. Gaps remain in understanding the antecedents of such differences and the issues this paradox raises regarding the connections between social and biological processes. Our goals in this analytic essay are to make the case that gender differences in health matter and that understanding these differences requires an explanation of why rational people are not effective in making health a priority in their everyday lives. We describe some salient gender health differences in cardiovascular disease, immune function and disorders, and depression and indicate why neither social nor biological perspectives alone are sufficient to account for them. We consider the limitations of current models of socioeconomic and racial/ethnic health disparities to explain the puzzling gender differences in health. Finally, we discuss constrained choice, a key issue that is missing in the current understanding of these gender differences, and call on the social science community to work with biomedical researchers on the interdisciplinary work required to address the paradoxical differences in men's and women's health.

Cardiovascular Diseases↗
PubMed2004

Biographical sketches of elderly African-American women in later life.

The research concerning the African-American elderly is limited, since this group is made up of less than eight percent of the entire U.S. population. Due to discriminatory practices in the U.S., based on race and gender, the African-American elderly woman has some unique issues facing her in old age. This paper will present three qualitative interviews of African-American women from age 65 to 100. These biographical sketches will report how these women dealt with family traditions, lifestyle changes, and growing old in their lives. Their perceptions of personal joys and frustrations, plus attitudes about how race, not gender, was a significant factor in their lives, will be reported. Education and religion were life-long strengths in their lifestyle.

Black or African American↗
PubMed1996

Lack of gender differences in neuroleptic response in patients with schizophrenia.

OBJECTIVE: The authors sought to determine if there were gender differences in neuroleptic response in male and female patients with schizophrenia who were matched for clinical and demographic variables and participated in a double-blind trial of traditional antipsychotic drugs. METHODS: 24 males (m) and 20 females (f) with schizophrenia or schizoaffective disorder who did not differ in clinical characteristics (age of onset, course of illness, prior hospitalizations, premorbid functioning) participated in an extended drug-free period followed by a neuroleptic trial under double-blind, placebo-controlled conditions. RESULTS: Males and females showed significant improvement in total, positive and negative BPRS symptoms during neuroleptic treatment. However, there were no significant differences in treatment response between sexes. No sex differences were found in baseline drug-free symptomatology, neuroleptic dose or dosage by weight. CONCLUSIONS: There were no significant sex differences in neuroleptic treatment response in male and female patients well-matched for clinical, treatment and demographic characteristics. Methodological issues which distinguish this study from prior studies reporting gender differences in neuroleptic response are examined.

Adult↗