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PubMed2004

Lessons from epidemiologic studies in clinical trials of traumatic brain injury.

Lessions from epidemiological studies. The Clinical Trial Group for Neurosurgery of the University of California San Diego (UCSD) is involved in epidemiological studies and trials of new pharmacological agents in traumatic brain injury. A great number (> 10,000) of patients has been prospectively analyzed forming an integrated database for further purposes. The development of these databases is based on earlier work by the European Neurosurgeons Jennett and Braakmann and the US-Traumatic Coma Data Bank Study. These studies allowed for the development of sophisticated data collection instruments which were used in the international Tirilizad Trials which enrolled over 1,100 patients. A major observation from that trial was that pretreatment hypotension or hypoxia could be unbalanced even in a large two arm blinded study. Another issue of the tirilazad trial was the influence of gender affecting not only outcome but also drug metabolism. Similar experiences were gathered with the phase-III trial on the competitive NMDA-receptor antagonist selfotel, which interferes with the excitotoxic amino acid glutamate as mediator of secondary brain damage, as ischemia-induced neuronal degeneration. Unfortunately, the trial, already underway, had to be prematurely aborted, since concurrent stroke studies with enrollment of nonintubated patients on low-dose selfotel revealed an increased number of deaths and other adverse events. A retrospective analysis did not confirm that Selfotel was associated with an increased mortality in TBI, but there was also no evidence that the drug was efficacious. A problem here was that a major portion of patients did not have intracranial mass lesions (contusion, subdural haematoma) on CT, questioning whether these had a treatment responsive brain injury. Both studies on tirilazad or selfotel underscore the significance of well designed and conducted phase-I and -II trials to characterize the pharmacokinetics of the agent, to confirm availability of drug in the brain, and to identify a sufficient number of patients with lesions responding to the drug. A major issue is the blood-brain barrier permeability of the agent under study. Further, the phenomenon of secondary deterioration - neurological worsening - turned out as a powerful predictor of poor outcome. The findings and conclusions of both clinical trials (tirilazad, selfotel) were utilized for a subsequent patient study on CP101-606 in consultation with the Pfizer company, the US Brain Injury Consortium, and the San Diego Clinical Trial Group. The patient population was a priori selected towards responsiveness of the brain lesions to the treatment. The major conclusions are: I Development of therapeutic regimens targeted towards the mechanisms of brain injury. II Availability of adequate preclinical data. III Directing treatment towards an appropriate patient population. IV Central gathering and interpretation of the neuroradiological findings. V Monitoring of trial center performance. VI Stratification and pre-trial prognostic analysis for identification of subgroups.

Brain Injuries↗
PubMed1995

Gender and the organization of sexual behavior.

Gender socialization seems important in every culture although the precise nature of gender categories and the specifics of gender roles differ across societies. Gender socialization produces in most people a compulsion to behave according to appropriate rules and expectations, and a grave anxiety about not being considered by others, or by themselves, truly male or female. Sexual performance is tightly tied to appropriate gender role behavior, and the need to conform to conventional scripts probably inhibits most people from expressing individual desires and interests. The gratification obtained from gender affirmation, however, may compensate for any lost erotic or intimate rewards. Our society is in the throes of major changes in gender roles, and many of the frequent public debates about sexual issues (e.g., impact of pornography, prevalence of sexual abuse and harassment, advisability of public sex education, propriety of homosexuals in the military) reflect insecurities about the effect of these new roles on sexual behavior. Present knowledge suggests that any change in gender roles is bound to have a major effect on sexual behavior, both within the life of an individual and within a society. Insecurities and adjustment difficulties are likely to remain normative, and to be part of the problems brought to every mental health clinician.

Adolescent↗
PubMed2004

Special considerations in treating bipolar disorder in women.

There are obvious gaps in research surrounding issues specific to women who suffer from bipolar disorder, including gender differences and their implications for management, the impact of the reproductive cycle, and evidence based treatment guidelines for pregnancy and the postpartum period. Gender differences have not been reported for the prevalence of bipolar disorder; however, women are more likely to experience rapid cycling, mixed mania, and antidepressant-induced manias. This may affect response to treatment, which has been found, in some cases, to differ in men and women. In addition, side effects in response to treatments may well differ in men and women, especially with regard to lithium and valproate prescription. The course of bipolar disorder in women may be influenced by the menstrual cycle, pregnancy, the postpartum period, and menopause, although many issues require further clarification. Treatment of bipolar disorder during pregnancy and the postmenopausal period requires careful consideration, as does treatment during the childbearing years, as some mood stabilizers influence the metabolism of oral contraceptives. This review article has attempted to evaluate existing literature regarding women with bipolar disorder in a comprehensive and critical way, and to consolidate into a single source the gender-specific aspects of the disorder that may have treatment implications for women.

Anticonvulsants↗
PubMed2006

Medical students' perceptions in relation to ethnicity and gender: a qualitative study.

BACKGROUND: The British medical student population has undergone rapid diversification over the last decades. This study focuses on medical students' views about their experiences in relation to ethnicity and gender during their undergraduate training within the context of the hidden curriculum in one British medical school as part of a wider qualitative research project into undergraduate medical education. METHOD: We interviewed 36 undergraduate medical students in one British Medical School, across all five years of training using a semi-structured interview schedule. We selected them by random and quota sampling, stratified by sex and ethnicity and used the whole medical school population as a sampling frame. Data analyses involved the identification of common themes, reported by means of illustrative quotations and simple counts. RESULTS: The students provided information about variations patterned by gender in their motivation and influences when deciding to study medicine. Issues in relation to ethnicity were: gaining independence from parents, perceived limitations to career prospects, incompatibility of some religious beliefs with some medical practices and acquired open-mindedness towards students and patients from different ethnic backgrounds. Despite claiming no experiences of gender difference during medical training, female and male students expressed gender stereotypes, e.g. that women bring particularly caring and sympathetic attitudes to medicine, or that surgery requires the physical strength and competitiveness stereotypically associated with men that are likely to support the continuation of gender differentiation in medical careers. CONCLUSION: The key themes identified in this paper in relation to ethnicity and to gender have important implications for medical educators and for those concerned with professional development. The results suggest a need to open up aspects of these relatively covert elements of student culture to scrutiny and debate and to take an explicitly wider view of the influence of what has sometimes been called the hidden curriculum upon the training of medical professionals and the practice of medicine.

Adult↗
PubMed2004

Managerial implications of medical sales representative perceptions of job duties, job qualifications, and other performance-related issues.

This study examined the perceptions of medical sales representatives of job related duties, job qualifications needed, and motivating factors and tested for differences based on gender, age, years of experience and education using prior research as a base. This study also explored issues that may arise between sales people and physicians. The authors surveyed 132 medical sales representatives from pharmaceutical firms located in Ankara, Turkey. The authors' findings highlight the need in Turkey for developing in-service training programs for medical sales representatives, especially in the areas related to technical aspects of the product, effective marketing and personal selling strategies, and consumer relations. Training in these areas will help salespeople to better manage the problems typically encountered in physician-sales representative relations. While the study was conducted in Turkey, the results are similar to findings in prior research conducted in other countries and therefore may be of interest to all sales managers.

Administrative Personnel↗
PubMed2003

Sexual health experiences of adolescents in three Ghanaian towns.

CONTEXT: Ghanaian youth are greatly affected by widespread social change, and their reproductive health needs may differ by social group, age and gender. METHODS: In-person interviews on sexual health issues were conducted with 704 never-married youth aged 12-24 in three Ghanaian towns. The sample included youth who were in school, in apprenticeship programs or in neither school nor apprenticeship programs (unaffiliated). RESULTS: More than half of the respondents had ever had sexual intercourse (52%), with the adjusted odds for females being 1.6 times those for males and the odds for unaffiliated and apprenticed youth being 2.5-3.2 times those for in-school youth. The odds of having had sex in the previous month were elevated for females (2.0) and apprentices (2.7). Both sexes tended to accept violence towards women, with unaffiliated youth showing the highest level of acceptance and in-school youth the lowest. Nearly all respondents (99%) knew of condoms, but fewer than half (48%) could identify any of four elements of correct use; females and sexually inexperienced youth were the least informed. Two-thirds of respondents considered it unacceptable for males to carry condoms, and three-quarters considered it unacceptable for females. Twenty-five percent of males and 8% of females reported having had a sexually transmitted infection. One-third of sexually experienced females reported having ever been pregnant; of those, 70% reported having had or having attempted to have an abortion. CONCLUSIONS: Adolescent reproductive health programs should be targeted to the needs of specific groups.

Adolescent↗
PubMedDate not supplied

[Body, strength, and labor: reflexions in the light of gender relations].

The present paper intends to contribute on a reflection and discussion of some issues related to female's body and the strength present in laborwork, understood as the moment in which through the support of another person, a woman "gives birth". It also discusses the perspective of male dominance having as reference the symbolic violence from Bordieu, proposing that the humanizing of labor demands a thorough discussion on gender dominance.

Female↗
PubMed1982

Gender roles in the relationships of lesbians and gay men.

Recent research on gay male and lesbian couples suggests that traditional gender-role-playing sometimes occurs in their relationships, though it is less common than in the relationships of heterosexuals. This paper briefly explores three issues raised by these findings. First, we consider reasons why partners of the same gender might engage in gender-role-playing. Second we discuss the processes that might be involved in allocating masculine and feminine roles to partners in a couple. Finally, we consider the finding that traditional gender roles are associated with diminished satisfaction and suggest possible reasons why this might be so.

Adult↗
PubMed2006

Community perceptions and experiences of domestic violence and induced abortion in Wakiso district, Uganda.

In this qualitative research, the author explored (in general) whether domestic violence and induced abortion feature in men's and women's sexual and reproductive health experiences. In particular, he explored whether and how gender roles influence reproductive decision-making behavior regarding contraception, unwanted pregnancy, and induced abortion. The study area was Wakiso district in central Uganda, which surrounds the capital city, Kampala. The author collected data using in-depth interviews and focus group discussions and analyzed them using grounded theory. Effects of unplanned pregnancy were perceived to be gender specific. Unintended pregnancy and induced abortion as a health issue did not concern men. Rather, what concerned them was spouses' contraception, which they often strongly opposed. Consequently, covert contraceptive use was common. The author describes a relation between domestic violence, nonuse of contraception, unintended pregnancy, and induced abortion.

Abortion, Induced↗
PubMedDate not supplied

Gender-specific response to depression treatment.

Gender-specific responses to pharmacotherapy or psychotherapy for depression are virtually unknown. Early studies rarely examined treatment response by gender, and the small number of males studied has led to inaccurate comparisons between male and female response. This article addresses conceptual issues and reviews what little can be ascertained from earlier studies of the relationship between gender and treatment outcome. It also presents data from a series of studies conducted over the last 15 years at the University of Pittsburgh School of Medicine.

Adult↗
PubMed2000

Services provided during methadone treatment. A gender comparison.

Greater improvement in posttreatment outcomes has been shown in programs that tailor frequency and type of services to unique client needs. Using a sample of 635 clients (199 females and 436 males) admitted to three community-based methadone treatment programs, this study examined gender differences in services needed and provided during the first 3 months of treatment. Results revealed that compared to males, women entered treatment with more psychological symptoms and AIDS/HIV-risky behaviors; they also presented with less criminal activity, less alcohol use, and higher motivation. Counselors addressed psychological and crisis issues more frequently with women, and counseling strategies were more often directed toward developing problem-solving and communication skills. Counselors also made more medical referrals and reported having better rapport with females. Attention to employment issues and HIV/AIDS sexual-risk behaviors did not differ by gender, even though women had more needs in these areas.

Adult↗
PubMed1993

Gender differences in economic well-being among the elderly of Java.

With populations aging rapidly in many developing nations, issues of economic dependency among the elderly are of increasing importance. Using data from a 1986 survey of the elderly on Java, Indonesia, I describe gender differences in economic well-being and identify characteristics associated with economic disadvantage. At both the individual and the household level, older women have fewer resources than older men. Even within categories of support (work income and remittances), women have lower levels of well-being. Gender differences in household-level economic well-being are due primarily to differences in household structure and in levels of skills. Gender differences in individual receipts (from all sources) are more complicated, but can be understood more clearly with reference to gender differences in skills levels (literacy, language, job skills), current work status and authority, and domestic authority.

Aged↗
PubMed1999

Reply to the Commentaries on the Math-Fact Retrieval Hypothesis.

Geary and Wigfield and Brynes (this issue) point out a number of limitations of the math-fact retrieval hypothesis that we agree with. For instance, we acknowledge that whereas the correlational evidence we offer in our article (this issue) provides suggestive evidence for a link between math-fact retrieval and gender differences in math test performance, that evidence is not compelling. We also acknowledge that even if it is the case that math-fact retrieval is one of the cognitive mechanisms responsible for the gender differences in math performance, there are still many aspects of gender differences in math performance that need to be understood. We also point out a number of areas where we disagree. Most prominently, we do not believe that the spatial cognition hypothesis or affective/motivational hypotheses account for two significant literatures-gender differences in test performance and gender differences in grade performance. We discuss the basis for our beliefs and close with a discussion of the need for intervention research that will resolve some of the issues discussed in the series of articles in this issue. At the end of the article we also present a very speculative hypothesis that would knit together all of the positions presented in the articles in this issue of CEP. Copyright 1999 Academic Press.

Journal Article↗
PubMed2003

Acculturation strategies and ethnic identity as predictors of behavior problems in arctic minority adolescents.

OBJECTIVE: To explore the effect of acculturation attitudes and ethnic and national identity on behavior problems in arctic minority adolescents in northern Norway. METHOD: The Youth Self-Report, the Multigroup Ethnic Identity Measure, and acculturation strategies were completed by 581 indigenous Sami and 291 Kven high school students in 1994-1995, at age 15-18 years. Response rate was 85%. Behavior problems were in addition to ethnic/national identity and acculturation attitudes studied in relation to ethnicity, gender, age, socioeconomic status, parentage, ethnic language, and ethnic context. RESULTS: Although there were no ethnic group differences in behavior problems, the impact of ethnocultural predictors differed between ethnocultural and indigenous adolescents. Acculturation attitudes were most significant for indigenous adolescents' mental health, and identity issues showed the strongest impact on ethnocultural peers. The study revealed significant gender differences regarding the influence of ethnocultural factors, and contextual variation among Sami adolescents with the strongest impact in contexts with low density of Sami people. CONCLUSIONS: The significant ethnic group variations emphasize the importance of conducting both between- and within-group analysis on the impact of ethnocultural issues on behavior problems in minority adolescents.

Acculturation↗
PubMed2002

Social status of the rural girl child in Tamil Nadu.

OBJECTIVE: The social status of the girl child in school age was assessed in a village in Tamil Nadu applying both qualitative and quantitative methods. METHODS: The home milieu was taken as the social context for the study purpose since home is the first societal unit a child comes into contact with. The various issues considered to study the social status were (1) Gender preference in having children (2) Nutrition and health care given to them (3) Importance given to their education (4) Activity pattern in daily life (5) Attitude of the community towards (a) girl child after menarche and (b) marriage. RESULT: In the study village, although there was desire to have sons, a girl child is not ignored. The value of having a girl in the family was appreciated. There was no gender discrimination in giving nutrition and health care. However the workload in girls was found to be marginally higher than in boys. The educational status of girls was lower than that of boys in terms of school enrollment and attendance. But menarche, was not an important cause of the lower educational status of girls. In the sociocultural context of the study village the priority in a girl's life during school going age was marriage. Soon after attaining puberty in a girl's life during school going age was marriage, not education and this perhaps reveals the lesser importance given to a girl's education by the community. CONCLUSION: The need of the hour is to improve her educational status by changing the attitude of the community so that a girl child's priority in her school age is not marriage but education.

Child↗
PubMed1991

Sources and consequences of satisfaction and dissatisfaction in nursing: findings from a national sample.

The implications for the current nursing shortage of the job satisfaction and dissatisfaction described by 252 members of the American Nursing Association are discussed. Comparison of sources of dissatisfaction by the frequency with which they were mentioned, the strength of emotion with which they were expressed and their potential to provoke defection from nursing, indicate inadequate working conditions and counter-productive attitudes within employing organizations to be the most serious sources of dissatisfaction. Dissatisfaction with remuneration and benefits rank second to structural problems, by each measure. The relative importance of problems with gender and family roles, colleagues, education, and professional associations, and of respect, recognition, and autonomy issues are also discussed.

Adult↗
PubMed1999

Dr. Angry and Mr. Smile: when categorization flexibly modifies the perception of faces in rapid visual presentations.

Are categorization and visual processing independent, with categorization operating late, on an already perceived input, or are they intertwined, with the act of categorization flexibly changing (i.e. cognitively penetrating) the early perception of the stimulus? We examined this issue in three experiments by applying different categorization tasks (gender, expressive or not, which expression and identity) to identical face stimuli. Stimuli were hybrids: they combined a man or a woman with a particular expression at a coarse spatial scale with a face of the opposite gender with a different expression at the fine spatial scale. Results suggested that the categorization task changes the spatial scales preferentially used and perceived for rapid recognition. A perceptual set effect is shown whereby the scale preference of an important categorization (e.g. identity) transfers to resolve other face categorizations (e.g. expressive or not, which expression). Together, the results suggest that categorization can be closely bound to perception.

Adolescent↗
PubMedDate not supplied

[Inhibition and resource capacity during normal aging: a confrontation of the dorsal-ventral and frontal models in a modified version of negative priming].

BACKGROUND: Over the past decades, cognitive psychology contribution to our understanding of aging relies on two major perspectives, focusing on the selective impact of age on either cognitive multiple-systems or global factors of cognition: slowing, working memory and inhibition. In the latter, reduction in inhibitory control during aging (in its access, deletion or restraint functions) is associated with poorer performance on a variety of tasks referring to memory, comprehension or language [Hasher, Zacks and May (16)]. The attractiveness of inhibition as an explanatory factor results in part in the absence of negative priming during aging. Negative priming refers to the slow down of latencies when individuals have to respond to recently ignored informations, compared to unrelated informations. The dissociation, between a preserved location negative priming and an absence of identity negative priming during aging, supports the dorsal-ventral model of inhibition which suggests that spatial and identity inhibition are supported by different and independent visual pathways. An alternative model, directly at odds, is that inhibitory mechanisms are supported by the frontal lobe. In this perspective, inhibition is not a central process responsible for the control of working memory contents, but an automatic and local mechanism whose triggering depends on controlled attention. Therefore, working memory drives efficient inhibition by sustaining task instructions and appropriate responses throughout task execution. This hypothesis is consistent with Houghton and Tipper's (17) architecture of selective attention. According to the authors, the presence or absence of automatic inhibition is very closely linked to a Match/Mismatch field whose function is to compare the present stimulus to an internal self-generated internal template. When an information fails to match the subject's current goals, the match/mismatch field causes an automatic inhibitory imbalance which reduces the to-be-ignored properties' responsiveness. In contrast, information matching subjects' goal is enhanced through an automatic excitatory imbalance. The accurate functioning of the Match/Mismatch field requires efficient executive functioning responsible for the uphold of goals and correct responses. In the case of negative priming, manipulating the efficiency of working memory is of interest as it should affect the triggering of slowing, ie, an indirect inhibitory deficit, when the task is resource demanding [Conwayet al. (6)]. Moreover, if inhibition, as reflected by negative priming, is mediated by individual resource capacity, then NP should disappear during aging only when individuals are engaged in a resource-demanding task. OBJECTIVES: To address this issue, we examine whether cognitive control load in a gender decision task contributed to the presence or absence of NP during aging. According to the dorsal-ventral model, task complexity should not have any impact on performance, since gender decision task relies on a conceptual analysis of information. In turn, the frontal model predicts that age differences in performance profile will only differ when individual resource capacity is overloaded. DESIGN OF THE STUDY: Sixty-four participants (32 young and 32 older adults) performed a gender categorisation task through two experiments. Trials involved two stimuli presented successively at the same location. A word served as a prime and a word as a target. Both prime and target could be male or female. When prime and target matched on gender, we talked about VALID pairs (or compatible). When prime and target mismatched on the manipulated features, we talked about INVALID pairs (or incompatible). Participants' task was to identify the gender of the target. They were explicitly instructed not to respond to primes but to read them silently. Our interest was in response latencies for valid versus invalid pairs. We manipulated task complexity by the absence (experiment 1) or presence (experiment 2) of a distractor during probe trials. RESULTS: For younger adults, primes presented before targets gave rise to behavioural costs when pairs were mapped to the same response compared to pairs that were mapped to opposite ones. This slowing, called Negative Compatibility Effect (NCE), was independent of the presence or absence of a distractor. NCE was reliable for the elderly patients only under condition of no interfering information during the probe trial: pattern of performance of older participants was identical to that of young adults (experiment 1). This effect disappeared as task complexity increased (experiment 2). DISCUSSION: This result suggests that NCE triggering is dependant on the amount of cognitive control engaged by the task, and therefore that the ability to inhibit irrelevant information is secondary to a general capacity of the working memory. CONCLUSION: The implications of our data are consistent with the level of processing account, as well as the recent neuroimaging contributions which suggest, for example, the involvement of the dorso-lateral prefrontal cortex (sensitive to aging) when task demands are high, and a ventro-lateral prefrontal implication when demands are low [see Eenshuistra et al. for a review (10)].

Adult↗