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PubMed2003

Experienced therapists' opinions on central issues in psychodynamic psychotherapy of patients with personality disorders.

Individual psychodynamic psychotherapy is a recommended, but controversial, treatment for patients with personality disorders (PDs). The aim of this study was to examine the relationship between demographic and professional characteristics of experienced psychotherapists and their attitudes and opinions towards aspects of this kind of psychotherapy. A questionnaire covering these issues of psychodynamic psychotherapy with patients belonging to all three DSM-IV clusters of PD was developed. A sample of 324 Norwegian psychiatrists and clinical psychologist with considerable experience in individual dynamic psychotherapy of patients with PDs filled in valid questionnaires. The therapists' age, gender, profession, postgraduate courses and degree of experience were examined as to their opinions on the following issues: alliances, aims, contraindications, needs to terminate, suicides, use of drugs, length of treatment, need for supervision and complaints to colleagues about patients' behaviour in such therapy with PD patients. Independent sample t-tests of the mean z-transformed group scores were the main statistical method applied. Therapist experience made the most significant differences as to treatment issues, while some differences also were found for age, gender and profession. The influence of postgraduate courses was negligible. Our study might have a selection bias towards therapist with strong psychodynamic orientation and particular interest in the psychotherapy of patients with PDs.

Adult↗
PubMed2006

Ethics of justice and ethics of care. Values and attitudes among midwifery students on adolescent sexuality and abortion in Vietnam and their implications for midwifery education: a survey by questionnaire and interview.

UNLABELLED: Adolescent's sexuality and related reproductive health and rights problems are sensitive issues in Vietnam. Globalisation has had an impact on the lifestyles of young people, and rising numbers of abortion and STI/HIV risks among youth are posing major health concerns in the country. These problems need to be addressed. Midwives belong to a key category of health personnel in Vietnam, whose task it is to promote adolescents' sexual and reproductive health and prevent reproductive ill health. It is important to understand future midwives' perceptions and attitudes in order to improve their education and training programmes. AIM: The aim of this study was to investigate Vietnamese midwifery students' values and attitudes towards adolescent sexuality, abortion and contraception and their views on professional preparation. METHODS: A quantitative survey including 235 midwifery students from four different secondary medical colleges in northern Vietnam was carried out in 2003. A qualitative study addressing similar questions was performed and 18 midwifery students were individually interviewed. FINDINGS: Findings revealed a general disapproval of adolescent pre-marital sexual relations and abortion-'an ethics of justice'-but also an empathic attitude and willingness to support young women, who bear the consequences of unwanted pregnancies and social condemnation-'an ethics of care'. Gender-based imbalance in sexual relationships, limited knowledge about reproductive health issues among youth, and negative societal attitudes were concerns expressed by the students. The students saw their future tasks mainly related to childbearing and less to other reproductive health issues, such as abortion and prevention of STI/HIV. CONCLUSION: Midwifery education in Vietnam should encourage value-reflective thinking around gender inequality and ethical dilemmas, in order to prepare midwives to address adolescents' reproductive health needs.

Abortion, Legal↗
PubMed1998

Management issues for women with epilepsy: a review of the literature.

OBJECTIVE: A review of literature referable to management issues for women with epilepsy (WWE) was undertaken for the development of a practice parameter. BACKGROUND: Epilepsy is a common neurologic condition with gender-related management implications. Although reviews of this topic often focus on pregnancy-related issues for WWE, specific health concerns for WWE are present throughout all phases of reproductive life. METHODS: An OVID MEDLINE literature search was conducted for 1965 to 1997 using the following key words/phrases and cross referencing: epilepsy/ seizures and pregnancy, anticonvulsants, antiepileptic drugs (AEDs), teratogenesis, oral contraceptives, birth defects, folate/folic acid, vitamin K, metabolic bone disease, and breast-feeding. RESULTS: Pregnancy outcome literature for WWE spans several decades. Methodology varies and interpretation is complicated by modern management strategies. Contributions of socioeconomic factors, AEDs, maternal epilepsy, and seizures during pregnancy to adverse pregnancy outcomes have not been clearly delineated. There is a biologic basis for recommendations concerning contraception, folate supplementation, vitamin K use in pregnancy, breast-feeding, metabolic bone disease, catamenial epilepsy, and reproductive endocrine disorders, but no outcome studies afford a strong evidence base for practice recommendation. CONCLUSIONS: WWE face health issues for which there is no available outcome literature to guide decision making. The urgent need for studies in many of these areas is highlighted by expanded treatment options with new AEDs and epilepsy surgery.

Anticonvulsants↗
PubMed2005

A framework for examining the sustained acceptability of microbicides.

The concept of acceptability involves a complex set of individual, couple and socio-cultural factors. Within a specific focus on microbicides, this article sets forth the relevant behavioral issues demanding attention as scientists and product developers strive to identify microbicides that will be used in a sustained, long-term fashion to prevent HIV/AIDS. The paper re-conceptualizes long-term acceptability within the ARRM framework, reviews the basic issues and research related to microbicide acceptability, discusses couple relationships (especially the nature of intimate relationships), and identifies related gender and power factors. The importance of the cultural context within various international settings pervades all of these issues. Finally, a set of challenges is discussed for those contemplating such research.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Sex, gender, and irritable bowel syndrome: making the connections.

BACKGROUND: Irritable bowel syndrome (IBS) is a widespread chronic health condition experienced more often by women than by men. The extent to which women outnumber men varies, however, with a narrower sex ratio found in population surveys and the widest in gastroenterology clinics. This suggests that explanations of women's excess risk of this condition likely involve both sex, or biological, differences between men and women as well as gender, or social, differences. OBJECTIVE: This article reviews research on sex and gender factors in IBS and, in particular, the ways in which these factors affect the risk of IBS, either independently or in synergy. METHODS: A multidisciplinary literature review of English-language IBS research published between 1966 and 2002 was conducted using a number of electronic databases (ASSIA, MEDLINE, PsycLIT, and SSCI/Web of Knowledge), augmented by manual search of issues not yet entered onto the databases. The key terms sex, gender, women, men, and irritable bowel disease were used to identify articles with potential relevance; titles and abstracts were reviewed and downloaded to a bibliographic referencing system. This approach yielded approximately 450 articles of interest in the subject area. RESULTS: The literature review highlighted a range of sex- and gender-linked factors in IBS, including hormonal factors, genetic differences, psychosocial factors related to stress, mental well-being, gender roles, and the experience of sexual abuse. In addition, the literature suggests that gender-related factors overlap each other in explanations of IBS among women, and the interactions between these factors and sex-linked biology are not yet fully understood. CONCLUSION: A complex model is needed-reflecting sex- and gender-linked factors and their interactions-to fully understand how these factors affect variations in risk and outcome between men and women with IBS.

Child↗
PubMed2003

African widows: anthropological and historical perspectives.

Variety characterizes widows' experiences around the world and in Africa south of the Sahara. This article explores the socioeconomic and cultural contexts of African widowhood, using anthropological studies in a number of African societies, including the author's research among Abaluyia of western Kenya. Some features of African widowhood are characteristic of African women's lives regardless of their marital status: their embeddedness in kinship systems and dependence on those systems for claims to productive resources, their economic self-reliance (which does not mean prosperity), strongly gendered divisions of labor, and the pervasiveness of patriarchal gender relations. Other features are specific to widowhood, including remarriage, issues of personal autonomy, and loss of status, access to productive resources and social support. Colonial and postcolonial historical transformations, including Africa's current dire economic situation and the AIDS epidemic, are considered in relation to widows' lives. An interesting question (given the theme of this edited volume) is whether a husband' s death puts African widows "on their own again," and whether, given African systems of kinship and marriage, most African women (and indeed men, too) can ever be said to be "on their own."

Africa↗
PubMed2005

Nicotine dependence, depression, and gender: characterizing phenotypes based on withdrawal discomfort, response to smoking, and ability to abstain.

Smoking is often viewed as a comprehensive phenotype rather than a complex set of traits involving intermediate phenotypes. To explore this issue in a laboratory setting, we tested 69 smokers stratified on depression, nicotine dependence, and gender. On the third day of an initial withdrawal period, we tested for differences among participants in uncued and cued craving and withdrawal; on the fourth day, we exposed them to a controlled dose of smoke and assessed them for physiological and hedonic effects and reduction of craving and withdrawal. Following resumption of smoking for at least a week, we then tested participants on their ability to abstain for an 11-day interval. During the withdrawal test, high-depressed smokers and men exhibited elevated craving and withdrawal scores overall, whereas no differences emerged for dependence. Cue exposure produced significant increases in craving but not withdrawal. During the smoke-exposure test, men were significantly more likely than women, and high-depressed smokers more likely than low-depressed smokers, to show evidence of experiencing pleasurable "buzzes." High-dependent smokers showed significant increases in diastolic blood pressure, possibly suggestive of greater sensitivity to nicotine. During the quit test, high-dependent smokers had more difficulty abstaining than low-dependent smokers, and women more than men; no differences emerged based on depression. Independently of group membership, inability to abstain was predicted by increased anxiety, depression, and difficulty concentrating in response to cue exposure. These findings provide support for the existence of phenotypes that can be distinguished by withdrawal symptomatology (primarily driven by depression) and ability to remain abstinent (primarily driven by dependence).

Adult↗
PubMed2000

The relationship of hardiness, sense of coherence, sports participation, and gender to perceived stress and psychological symptoms among college students.

BACKGROUND: This study addresses the issue of why under conditions of stress some people stay physically and psychologically healthy while others become ill. Being able to deal with stress, to cope with the pressures of daily life, and yet stay healthy, is seen as a function of such factors as physical health, psychological health, constitutional predisposition, social support, exercise habits, and personality. METHODS: This study examined the moderating effects of the personality constructs of hardiness and sense of coherence, sports participation (college varsity athletes and college nonathletes), and gender on the relationship between perceived stress and psychological symptoms. College varsity athletes (n = 135) and college nonathletes (n = 135), all undergraduates at New York University, completed four questionnaires: Hardiness Scale, Sense of Coherence Scale, Daily Hassles Scale, and Profile of Mood States. Participants also completed a background questionnaire providing basic demographic data. Psychological symptoms and perceived stress were the criterion variables: hardiness, sense of coherence, sports participation, and gender were the predictor variables. Correlational analyses were applied to the resulting data and used to answer and to test the research hypotheses. RESULTS: There was a significant positive correlation between perceived stress and psychological symptoms among college varsity athletes and college nonathletes. There was a significant positive correlation between the personality scales of Hardiness and Sense of Coherence for both college varsity athletes and college nonathletes. When controlling for gender, college varsity athletes scored significantly higher on hardiness, scored slightly higher on sense of coherence, and reported significantly less perceived stress and significantly fewer psychological symptoms than the college nonathletes. Comparing by gender, no statistically significant mean differences were found on the four main variables. A significant negative correlation was observed between personality hardiness and perceived stress and psychological symptoms for the total sample. However, the college nonathletes subsample showed no significant effect between hardiness and perceived stress. CONCLUSIONS: Finally, there was a significant negative correlation between sense of coherence and perceived stress and psychological symptoms for both the college varsity athletes and college nonathletes.

Adolescent↗
PubMed2000

[Adolescent sexuality: epidemiology, clinical approach and preventive measures].

The interest in sexuality of adolescents in medical practice is often mainly focussed on the onset of sexual intercourse and on the emergence of contraceptive needs, though the beginning of adolescence takes place much earlier with the first signs of puberty followed by the menarche. At the issue of this profound metamorphosis the adolescent needs to adapt herself to a modified, sexual body. Adolescence is also a time of identity development and of changes in relationships, which are influenced by gender role in family and perception related to gender during childhood. This article shows epidemiological data to consider and the main issues of gynaecologic consultation with the adolescent. The different stages of development depend on biological and environmental factors which either favour resilience or weaken the individual due to a lack of affection or to abusive relationships. Medical consultation for a gynaecological problem, questions on puberty and development or on contraception give medical professionals and especially gynaecologists a chance to address sexual issues naturally, to anticipate questions as well as contraceptive needs. The consultation with the adolescent includes also the screening for behaviour related to a lack of information or a personal or relational difficulty.

Adolescent↗
PubMed2001

Towards gender balance: but will women physicians have an impact on medicine?

The increasing numbers of women in medicine in western societies has raised the issue about their impact on medical practice. As a way of addressing the issue, this paper explores women's position in medicine in the Nordic countries, where the medical profession will soon be gender-balanced. Support for both a ghettoization and a vanguard argument for women physicians can be documented. The final section offers three sociological perspectives--the socialization theory, the neo-Weberian, and the social constructionist--as theoretical explanations for the gender segregation of medicine and as diagnostic paradigms and potential heuristic devices to aid women's empowerment as medical providers.

Empathy↗
PubMed1997

Women and schizophrenia: a review.

OBJECTIVE: This is a selective review article which aims to explore current areas of research involving women with schizophrenia and to identify areas requiring future research. METHOD: Research studies conducted both nationally and internationally are reviewed with an emphasis on a gender-based approach. RESULTS: The review is divided into three sections. First there is an introduction including a brief consideration of the possible reasons for the noted lack of studies focussing on women with schizophrenia and a summary of the epidemiological evidence that has prompted interest in gender-based schizophrenia research. Second, there is a review of some studies that utilise gender as a paradigm to understand the pathophysiology of schizophrenia, and third, a discussion of the role of gender in management approaches is presented. CONCLUSIONS: The main conclusion is that women have not been well represented in schizophrenia research. Female-specific management issues and a better understanding of the impact of schizophrenia on women require more gender-based research.

Brain↗
PubMed2005

Body image concerns of gay men: the roles of minority stress and conformity to masculine norms.

The authors hypothesized that gay men's experiences of minority stress and their conformity to masculine norms would be associated with increased body image dissatisfaction and masculine body ideal distress. For this cross-sectional study, 357 gay males completed a Web-based survey, and 2 multiple regression analyses indicated that minority stress factors (i.e., internalized homophobia, expected stigma for being gay, and experiences of physical attack) were associated with body image dissatisfaction and masculine body ideal distress, accounting for 5% and 13% of the variance, respectively. Gay men's conformity to masculine norms was not associated with body image dissatisfaction but did uniquely explain an additional 3% of variance in masculine body ideal distress scores. The utility of the minority stress model, how traditional masculinity may contribute to gender-related presenting concerns, suggestions for developing and evaluating remedial and preventive interventions, limitations, and future research issues are discussed.

Adolescent↗
PubMed1983

Sex differences in coping and perceptions of life events.

These data illustrate some important methodological considerations about the study of life events and the study of developmental data. As the data on the distribution of life events indicate, when individuals retell their life stories, events are rarely discrete. Psychologically, an event expands to include those predictors that later became apparent and the time taken to put the event into perspective. This calls into question the interpretation given to many life event questionnaires that seek to consider an event within a narrow time framework. Positive and negative events appear to have differential consequences. Our exploration of coping with positive events was an interesting one. Most of our respondents did not perceive that they had a coping task to accomplish when the event was perceived as a positive one. Many of the events reported by our respondents were events in the lives of others. Although this was more often the case for women than for men, interpersonal events and events in which the major impact fell on a family member were quite common in later life. In attempting to understand the impact of sociohistorical events as a context for development, it has often been assumed that overall negative events such as wars and economic depressions will have predominantly negative impacts. Our data suggest that sociohistorical events form the context for events in the family life cycle that happen independently of what is happening in the larger society. Events related to family formation happened against different backgrounds of sociohistorical events. These data also suggest that we look for cohort effects in nonlinear ways that would reflect generational communality of an event. This study also has limits. Our sample was small, and as the respondents had maximum freedom to pick the events to be discussed, we only know that we had a sample of three positive and three negative event contexts. We did not ask individuals 500 many positive and negative events they had during their lives and how the events mentioned fit into that ranking. The interviews were rich in the individuals' perceptions of the important aspects of their lives and indicated a realistic group of persons who had managed to cope reasonably well with the events in their lives. The cohorts in the study are of the age that traditional gender differences are founded on. Looking at the content of the issues to be coped with and the requirements of the situation suggest that life experience is what is predictive of coping skills.(ABSTRACT TRUNCATED AT 400 WORDS)

Adaptation, Psychological↗
PubMed1994

Psychology, psychologists, and psychiatric epidemiology.

The purpose of this paper is to inquire into what interests psychologists might have in epidemiological approaches to the study of psychopathology, what psychologists have contributed in the past, and what they might be expected to contribute in the future. This inquiry starts with a consideration of epidemiological findings and issues that should command the interests of psychologists: differences between treated rates and untreated rates of psychiatric disorders, relations of psychiatric disorders to gender and socioeconomic status, and problems of case identification and diagnosis. My own experience with these issues and problems is discussed. An argument is made that there are important needs for the expertise of psychologists in psychiatric epidemiology and compelling reasons for them to enter the field in greater numbers than they have in the past.

Cross-Cultural Comparison↗
PubMed2001

Preconception gender selection.

Safe and effective methods of preconception gender selection through flow cytometric separation of X- and Y-bearing sperm could greatly increase the use of gender selection by couples contemplating reproduction. Such a development raises ethical, legal, and social issues about the impact of such practices on offspring, on sex ratio imbalances, and on sexism and the status of women. This paper analyzes the competing interests in preconception gender selection, and concludes that its use to increase gender variety in a family, and possible for selecting the gender of firstborn, might in many instances be ethically acceptable.

Ethical Analysis↗
PubMedDate not supplied

Patient care in multidisciplinary cancer clinics: does attention to psychosocial needs predict patient satisfaction?

Satisfaction with treatment is an important early indicator of medical outcome for cancer patients. This study examined patient satisfaction with treatment-planning and follow-up appointments among 58 recently diagnosed ENT and GI cancer patients seen at a multidisciplinary cancer clinic. Patients reported which medical specialties they saw, whether adjuvant treatment was planned, and whether they had a chance to discuss their feelings about the diagnosis. Patients also rated the attention paid by staff to several psychosocial issues considered relevant to cancer. These included how the patient was coping, support services available, and the issue of common emotional reactions to cancer. Patients then rated their overall satisfaction with their clinic visits. Overall satisfaction was predicted by younger age, female gender, and greater attention to how patients were coping with their illness. Having a chance to discuss one's feelings about the diagnosis, and staff attention to other psychosocial issues, also predicted patient satisfaction. The relationship of these psychosocial issues to patient satisfaction did not vary by gender. Results suggest that patient satisfaction may be enhanced when hospital staff attend to and provide for the psychosocial needs engendered by a diagnosis of cancer.

Adaptation, Psychological↗
PubMed1993

An examination of personal/situational variables, stress appraisal, and burnout in collegiate teacher-coaches.

Following Smith's (1986) cognitive-affective model of stress and burnout in athletics, this investigation examined (a) the relationship of personal/situational variables (social support, gender, and years of experience) to stress appraisal and (b) the relationship of stress appraisal (perceived stress, coaching issues, and role conflict) to burnout. Male (n = 99) and female (n = 115) teacher-head basketball coaches from NCAA Division III and NAIA colleges completed established measures of burnout, perceived stress, teacher-coach role conflict, and social support and a measure of coaching issues developed for this study. Multivariate analyses supported the hypothesized relationships. Specifically, greater satisfaction with social support, less experience, and gender (females higher) were related to stress appraisal, and all stress appraisal variables were positively related to burnout. Contrary to previous studies, these teacher-coaches reported moderate to high levels of burnout.

Burnout, Professional↗
PubMed2003

Claimsmakers in the child sexual abuse "wars": who are they and what do they want?

The research findings described in this article are based on in-depth interviews with 40 people who helped bring concerns about child sexual abuse to audiences in the Western world. The results of this study suggest that significant differences of opinion and perspective exist both within and between the two widely recognized camps of opinion that have developed around this issue. From respondents' descriptions of their own and others' viewpoints, a continuum model of eight positions on issues related to child sexual abuse was developed and is described in this article. Using a social constructionist framework, the author suggests that debates about child sexual abuse, although framed primarily as empirical issues, may reflect moral and political, as well as scientific, disagreements. Debates about issues related to child sexual abuse take place in larger social and political contexts that include concerns about the family, gender relations, sexuality and sexual behavior, the "science wars," and the role of government. Conflicting claims about practice issues related to child sexual abuse require that social work practitioners be taught to critically examine how the moral and political beliefs of researchers might influence the kinds of questions they ask and how they interpret and frame their research findings.

Attitude to Health↗