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PubMed2005

A longitudinal study of the effects of dual-earner couples' utilization of family-friendly workplace supports on work and family outcomes.

Little research exists on the effects of the utilization of workplace supports on work-family conflict and job satisfaction. With family systems theory as a framework, 2 waves of national survey data were collected from 234 couples (N = 468) caring for children and for aging parents. Data were analyzed with structural equation modeling techniques. Longitudinal results indicate that individuals' use of workplace supports was related to work-family conflict in the direction opposite to expectations and was related to job satisfaction in the direction consistent with expectations. Differential effects for wives versus husbands were found. In addition, couples' use of workplace supports was only minimally related to wives' outcomes. Results are discussed in terms of gender differences, family systems theory, and methodological and measurement issues related to the longitudinal study of utilization of workplace supports.

Adolescent↗
PubMed1997

A 'bonding between strangers': a palliative model of clinical supervision.

This paper examines the role of clinical supervision in relation to the work of palliative care nurses. Through a single 'paradigm' case study illustration the author explores a phenomenologically guided palliative method of supervision. It is suggested that such means of supervised clinical practice forge a bond between patients, families, nurse and colleagues. The discussion explores ethical issues related to supervisory relationships including language, power and gender. The paper concludes with the central recommendation that, aside from methodological considerations, constructing a safe working environment for clinical supervision is important.

Anger↗
PubMedDate not supplied

Living with HIV infection: perceptions of patients with access to care at a non-governmental organization in Chennai, India.

Through interviews, we examined explanatory frameworks of living with HIV infection among 50 HIV-positive individuals (23 women, 27 men) receiving care at a non-governmental organization in Chennai, India. Results were analysed according to three sets of issues, all of which were found to differ by gender: causal beliefs about HIV, impact of HIV, and care/treatment of HIV. HIV-positive participants attributed their infection to biological, moral and social causes, and the physical, financial and relationship dimensions of their lives were impacted upon by the infection. Furthermore, HIV-related stigma evoked fears about isolation and discrimination. Regarding care/treatment, men were most usually first initiated into the healthcare system while women often entered as a consequence of their partner's condition. Non-adherence to medication was reported by 32% of the participants due to financial constraints or side-effects. Although all participants were hopeful about a cure for HIV, women were less positive than men about treatment. Results highlight the importance of a gender-sensitive approach to HIV care, nuanced to accommodate an individual's gender, marital status and social background.

Adult↗
PubMed2003

Impact of trends in primary, secondary, and postsecondary education on applications to medical school. II: considerations of race, ethnicity, and income.

The availability of sufficient numbers of qualified medical school applicants has been a periodic source of concern. Over the past few years, this concern has emerged again, as fewer men have applied to medical school and as the number of minority applicants has stagnated. This time, however, the cause for concern is greater, because these declining numbers coincide with a growing need for physicians and the possibility that medical school capacity will have to be expanded to avert future physician shortages. Against this background, applications by members of racial and ethnic minorities, who represent an increasing fraction of the college age population, become particularly important. The author reports the trends in education, over several decades, by members of the principal racial-ethnic groups-whites, blacks, Hispanics, and Asians-traces their participation from kindergarten through college, and projects the likelihood of their applying to medical school over the next two decades. (A companion article in this issue reports a parallel study from the standpoint of gender.) One prominent observation is the firm link between academic achievement in the earliest grades and success thereafter. A second is the profound influence of parents' education, income, and expectations at each step along the way. Inadequacies in either sphere erode the potential for children to reach college and to do so in ways that predict interest in and capacity for medical school. Yet, even when that potential emerges, inadequate finances deflect qualified high school and college students from the paths that lead to medical education. These factors weigh most heavily on black and Hispanic children, particularly boys, but are prevalent among whites, as well. Without aggressive education in the earliest years and without adequate financial support in the later years, it is not clear that there will be a sufficiently large pool of qualified applicants for the number of medical school seats that must exist in the future.

Adult↗
PubMed2001

The ethical dimensions of cultural competence in border health care settings.

Through thematic stories of patient and provider interactions on the U.S.-Mexico border, this article challenges the commonly understood definition of culture. It explores areas of concern related to cultural competency and medical ethics. Stories outline issues related to communication and comprehension, use of interpreters, gender and sexual orientation, traditional health care practices, socioeconomic status, age, health care settings, and involvement of community representatives. Policy recommendations address language, continuity of care, and health care professions education.

Communication↗
PubMed1997

Cognitive impairment in the euthymic phase of chronic unipolar depression.

Cognitive functioning in the nonsymptomatic phase and the long-term cognitive outcome of patients with mood disorders are both heuristic and important clinical issues in the study of mood disorders. Literature findings are inconsistent because of design confounds. We tried to address these issues while controlling for several confounds including age, education, gender differences in neurobehavioral functioning, and diagnosis. Nonsymptomatic patients with a history of chronic unipolar depression and bipolar affective disorder and healthy male individuals were administered neuropsychological tests to assess attention, visual-motor tracking, executive abilities, and immediate verbal memory. Subjects had comparable depression scores at the time of testing. Disease duration was 7.5 years (SD 5.1) for unipolar and 11 years (SD 7.3) for bipolar patients. Unipolar patients were more impaired than healthy normal comparison subjects on measures of visual-motor sequencing (Trail Making Test A, p < .05), executive function (Trail Making Test B, Stroop Test Color/Word Trial, p < .05), and immediate memory and attention (CERAD 1st trial, WAIS Digit Symbol subtest, p < .05). Differences between bipolar patients and normal comparison subjects did not reach significance in any of the selected measures. Male patients with a history of chronic unipolar disorder are at risk for cognitive impairment in the nonsymptomatic phase of their disease. Cognitive disturbance is the type seen with prefrontal dysfunction and may be assessed with standard neuropsychological assessments.

Bipolar Disorder↗
PubMed1994

Gender differences and perceptions about childbearing among infertile couples.

OBJECTIVE: To explore gender differences and responses of infertile couples to childbearing issues. DESIGN: Data analysis from the first wave of a larger three-wave prospective panel study. Face-to-face interviews with both husbands and wives were conducted. SETTING: Husbands and wives were interviewed separately in their homes. One was generally interviewed immediately after the other. PARTICIPANTS: One hundred sixty-one infertile couples in southeastern Michigan were interviewed in 1988. MEASURES: Variables of interest included the self-recognized source of the fertility problem, the importance of children to individuals, stress associated with infertility treatment, the number of tests and treatments received, the acceptability of indicated treatments, the length of time couples expected it would take to have a child, and the ideal and expected number of children. RESULTS: Women experienced significantly more stress from tests and treatment, placed greater importance on having children, were more accepting of indicated treatments, and wanted more children than men did. CONCLUSIONS: Implications for nurses working with infertile couples are discussed, including provision of emotional support, evaluation of perceptions of success, assessment of couples' expectations, and inclusion of husbands in decision making.

Adult↗
PubMed2002

"Languaging" factors affecting clients' acceptance of forgiveness intervention in marital therapy.

Forgiveness is a significant intervention for healing interpersonal injury. Yet therapists do not often use forgiveness intervention. Employing a semantic perspective and a survey design (n = 307), this study investigated whether the language used to rationalize forgiveness intervention (set at five levels: personal growth, relationship reconciliation, spiritual issue, others' growth, and pardoning/condoning) may affect its acceptability. Gender, problem type, and choice were also included in the analyses. Overall, forgiveness was found to be an acceptable intervention. A pardoning/condoning rationale led to significantly lower acceptability ratings. Other results are discussed. We conclude that therapists should be less apprehensive about using forgiveness, but need to inform themselves better concerning its purpose, process, and articulation.

Adult↗
PubMed2007

Stigma, sexually transmitted infections and attendance at the GUM Clinic: an exploratory study with implications for the theory of planned behaviour.

A gap in the literature regarding understanding of people's health care seeking behaviours in relation to sexually transmitted infections is identified. Employing both deductive and inductive methods, 10 patients (five female, five male) were interviewed to explore the psychosocial, motivational and attitudinal factors associated with attendance at a Genito-Urinary Medicine (GUM) clinic in a close-knit community in the north of England. Seven stigma-related themes were identified as salient issues surrounding perceptions of sexual health screening and included: (1)prejudice surrounding STIs; (2)fear of exposure; (3)isolation; (4)reluctance to attend; (5)contamination; (6)relationship issues; and (7)perceived invulnerability. Within these themes distinct gender differences were identified. Implications for the theory of planned behaviour (TPB) are discussed against the factors identified.

Adolescent↗
PubMedDate not supplied

Occupational epidemiology in agriculture: a case study in the southern African context.

Some challenges facing occupational epidemiology in developing countries are outlined in this case study of agriculture drawing on Southern African research. These include the characterization of exposures in resource- and data-poor environments typical of developing countries, the assessment of outcomes where cross-cultural and socio-environmental confounders may be substantial obstacles, and the impact of environmental exposures on workplace health. Traditional assignment of low priority to the chronic effects of low-dose exposures relative to acute morbidity in developing countries must be critically examined, as must the gender bias of much occupational epidemiology in agriculture. Advocacy issues involving child labor and the ethics of research among vulnerable groups deserve rigorous attention. It is argued that, if occupational epidemiology is to have meaningful impact on the health of the most marginalized groups of workers in developing countries, it must redefine itself in terms of a public health approach. The boundaries of epidemiologic inquiry need to be broad, and amenable to interfacing with policy research, using qualitative methods and participatory approaches. More so than in order industrial settings, epidemiologists must move from research to practice, seeking to take action where interventions are needed, and to evaluate such actions.

Adolescent↗
PubMed2001

Filipino domestic workers in Hong Kong: health related behaviors, health locus of control and social support.

A total of 290 female Filipino domestic helpers residing in Hong Kong completed a concurrent cross sectional survey designed to provide an initial report of basic data which measured mental health symptoms, health-related behaviors, health locus of control and social support. The four top ranking symptoms of mental distress reported included waking in the early hours, loneliness, worry and taking a long time to get to sleep. In general, the level of health related behaviors was high, with a satisfactory diet and low rates of alcohol, nicotine and coffee consumption. However, few women surveyed had previously had a Pap smear. There were also low scores for other preventive health practices. Reinforcement for health behaviors was seen as either a matter of chance or being influenced by powerful others for two thirds of the women. The conclusion highlights the intersection between gender, immigration and social class by drawing attention to issues of acceptance and accessibility of healthcare services for immigrant within host countries. In addition, cultural directions for immigrant health education are outlined.

Adolescent↗
PubMed1996

Out of the closet and into the marketplace: meeting basic needs in the gay community.

This study suggests that an emerging, popular market profile legitimizing gays as a lucrative niche may need qualification. Those targeting the gay community encounter subtlety and contradiction that traces to a history of exclusion and discrimination. Using data from a major Seattle (WA) survey, the study examines barriers to securing goods and services. While basic demographics such as gender have a strong influence on perceived barriers, other issues such as a need to conceal one's orientation, abuse encountered, and means to complain are examined. In short, to those seeking characteristics of a potentially powerful market segment, this study seeks to identify and discuss market areas most likely to drive gays and lesbians back into the closet.

Female↗
PubMed1998

Quality of life following a change in therapy for diabetes mellitus.

OBJECTIVE: The study objective was to evaluate and compare quality-of-life (QOL) parameters between patients with type 2 (non-insulin-dependent) diabetes mellitus who changed therapy from an oral hypoglycaemic agent (OHA) to insulin and those who remained on an OHA. DESIGN: The World Health Organization Quality of Life Questionnaire (WHOQOL) was used to assess quality of life among 2 groups of patients with type 2 diabetes mellitus at baseline and after a 2-month follow-up period. SETTING: The study was conducted in the outpatient department of the Vuk Vrhovac Clinic, a referral centre for registration, treatment and follow-up of patients with diabetes mellitus in Zagreb, Croatia. PARTICIPANTS AND INTERVENTIONS: 32 consecutively recruited patients with type 2 diabetes mellitus who were switched from an OHA to insulin therapy (group 1) were compared with 28 patients who remained on OHA (group 2) with respect to QOL issues. The patient groups were comparable in terms of gender, age, duration of disease, education and family status. However, patients in group 1 had glycosylated haemoglobin (HbA1c) values greater than 9.5% on average during a period of approximately 6 months, which was the criterion used for switching to insulin therapy. MAIN OUTCOME MEASURES AND RESULTS: At baseline, various QOL ratings were higher among patients in group 2 than group 1, indicating better quality of life with respect to overall quality of life (t = -2.31, p = 0.03), physical health (t = -2.36, p = 0.02), psychological state (t = -2.01, p = 0.05) and level of independence (t = -2.75, p = 0.001), while no differences were found between groups with respect to the social domain, personal beliefs and environmental QOL aspects. After the follow-up period, the groups were comparable in all QOL aspects other than overall quality of life (t = -2.18, p = 0.03) and level of independence (t = -3.49, p = 0.001), both of which remained higher for patients in group 2. No changes in QOL parameters were detected within group 2 from baseline to the end of the 2-month follow-up period, whereas patients in group 1 showed significant improvement in psychological QOL determinants (t = -2.14, p = 0.04). CONCLUSION: Results of the study indicate that introducing insulin therapy in patients with type 2 diabetes mellitus and sustained elevated HbA1c levels might positively affect their quality of life.

Adult↗
PubMed2006

Regular prescriptions for benzodiazepines: a cross-sectional study of outpatients at a university hospital.

OBJECTIVE: To investigate 1) the patterns of regular prescriptions for benzodiazepines among department clinics in a university teaching hospital, 2) the effects of patient's characteristics on regular benzodiazepine prescriptions, and 3) the patterns of benzodiazepine prescriptions among department clinics from the perspective of pharmacological half-life. PATIENTS: Patients were 22,099 outpatients (51% female; mean age: 56 years) who were prescribed any drug three or more times. METHODS: Cross-sectional study of patient-based data (July 2002 to August 2003) from the database of a computer ordering system at a university hospital. The patterns of regular prescriptions for benzodiazepines were compared among the clinical departments (i.e., Internal Medicine, Psychiatry, and Others). A logistic regression model was used to assess the effects of patient gender and age, and the clinic visited on the issuing of regular prescriptions for benzodiazepines. RESULTS: Regular benzodiazepine users were 3,204 (14.5%). Benzodiazepines were more likely to be prescribed for women (61.3%) than for men and were prescribed most often by psychiatrists (31.7%), followed by internists (20.1%). Multivairate logistic regression model showed that being female and elderly, and being prescribed by a psychiatrist were significantly associated with regular benzodiazepine prescriptions. With regard to the pharmacological half-life, internists were more likely to prescribe short half-life benzodiazepines than were psychiatrists (p < 0.001). CONCLUSION: A large number of outpatients at a Japanese university hospital appeared to be maintained on a regular supply of benzodiazepine drugs. Educational programs are needed to promote the rational prescribing of benzodiazepines.

Age Distribution↗
PubMed1997

Cardiac transplantation in women.

This article reviews key physiologic and psychosocial issues that affect female heart transplant recipients. Pretransplant concerns ranging from possible gender bias to preformed antibodies are addressed. Posttransplant survival rates by gender and by pretransplant diagnosis are discussed as well as the incidence of major complications. Side effects of immunosuppression therapy that may be of particular concern to women are presented. A number of pregnancy-related issues are summarized, including ethical concerns, contraception methods; pregnancy guidelines; the effects of normal physiologic changes; and peripartum, intrapartum, and postpartum management. Key areas for future research are presented.

Female↗
PubMed1996

Age and gender differences in perceived accident likelihood and driver competences.

Road traffic accident involvement rates show clear age and gender differences which may in part be accounted for by differences in risk perception and perceptions of driving competence. The present study extends and replicates that of Matthews and Moran (1986). Young (18-30 years) and older (45-60 years) male and female drivers responded to a questionnaire on perceived accident risk and driving competence (judgment and skill) with respect to themselves and four target groups, and also rated a series of videotaped driving sequences with respect to likelihood of accident occurrence and perceived driving competence. Results showed that effects of rater characteristics were generally confined to the questionnaire. Younger males were perceived as most likely to experience an accident and were judged to be lower than other groups in driving competence. Younger groups showed little bias against older groups and vice versa, but gender-related bias was apparent. The findings of Matthews and Moran were generally confirmed. The results are discussed with reference to four main issues: (1) demographic bias effects--which are generally weak; (2) stereotyping on the basis of gender and/or age of driver; (3) group-specific bias; (4) self-appraisal bias.

Accidents, Traffic↗
PubMed1983

Issues in diagnosis and treatment of transsexualism.

Transsexualism involves incongruity between anatomy and gender identity in biological normal persons. The literature in this area indicates controversy in diagnosis and treatment. Current guidelines for assessment and treatment selection are critically reviewed. Outcome data suggest that sex reassignment surgery is variably effective and potentially deleterious. Child and adult interventions may be more viable than previously assumed. Recommendations for research include systematic follow-up, longitudinal studies of gender-deviant children, and studies of psychopathology. Until rigorous outcome data are available, return to a conservative position on sex reassignment, using highly exclusive diagnostic guidelines and restrictive selection criteria, is advocated.

Adolescent↗