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Emerging issues in gender and ethnic differences in substance abuse and treatment.

The emerging understanding of gender differences among ethnic minorities in the rates, etiology, course, and treatment of substance abuse and common comorbid mental health disorders has significant scientific and practical implications. Growing recognition of these differences and their implications for treatment and policy decisions has highlighted research gaps and the need for more thoughtful application of the knowledge gained from existing research findings. In this brief review, we outline some of the unique aspects of substance abuse and comorbid mental health problems for women, as well as for women of various ethnic/cultural groups, including specific barriers to obtaining and remaining in treatment. Research challenges to improving limited knowledge about the rates, course, and treatment of substance abuse disorders among ethnic minority women are highlighted.

Acculturation↗

The gender-related issues in malignant melanoma.

The problem of malignant melanoma is important in the United States, in the world as a whole, and particularly in Hawaii with its high levels of ultraviolet radiation. It is estimated that 32,000 Americans will develop melanoma and 6,800 will die of this tumor in 1993. Melanoma is now the seventh most frequent cancer in the United States. It is more common than ovarian, cervical, CNS cancer and leukemia. Both incidence and mortality from melanoma are rapidly increasing. The incidence of melanoma has consistently increased 6% a year and the death rate has increased 2% a year since 1950. At current rates, one in 400 will die of this tumor. Should this rate of increase continue, by the year 2000, it is estimated that one in 75 Americans will develop melanoma during a lifetime. The highest melanoma incidence in the U.S. is found in Hawaii. Melanoma is increasing faster than any other cancer in the United States and all over the world.

Adult↗

Attitudes towards and perceptions about contraceptive use among married refugee women of Somali descent living in Finland.

OBJECTIVES: To assess attitudes towards and perceptions about contraceptive use among married refugee women of Somali descent living in Finland. METHOD: A sample of 100 married refugee women of Somali descent (18-50 years of age) were invited to participate in a study on contraceptive use in Finland (30 women refused). Qualitative and quantitative methods were used to collect the data. Questionnaire of the first data set was written in the Somali language. Interviews were conducted in the Somali language. RESULTS: The attitudes and opinions of these women towards contraceptive use (73% did not use contraceptives, 27% did use them) were connected with religious beliefs and issues involving marital relations. Religious or gender issues did not seem to influence those who used contraception. CONCLUSIONS: The findings indicated that the majority of the married refugee women of Somali descent living in Finland did not use contraception. The process of starting the use of contraception was possible because of an access to good reproductive health care and family planning services, changes in life situations, and adaptations to Finnish social and cultural norms.

Adolescent↗

Gender-related influences in nursing education.

Issues around gender identity, self-concept, professional education, and women's learning preferences shape the socialization of nurses and nursing education. How gender issues influence learners and nursing education in relation to nursing education for registered nurses are explored and recommendations are made for nursing educators in two broad categories: self-awareness and helping learners learn. The exploration leads to three conclusions: first, it is timely for nurses to continue such explorations for their own practice, and to share how to help other nurses cope with visible and invisible gender-related issues; second, nurses can share strategies to address the influence of gender issues in nursing education, and, third, the nursing profession benefits from drawing on available resources to discuss gender issues. Although reflections on these issues have been shaped by working with registered nurse learners, they are equally relevant to basic nursing students and practicing nurses.

Canada↗

Empowering women: participatory approaches in women's health and development projects.

The authors describe the experience of NGOs (nongovernmental organizations) and community-based organizations in implementing projects aimed at improving women's health. The study included 16 projects, reflecting Australian NGO experiences in Africa, China, Southeast Asia, the Pacific, and South America. They illustrate the value of participatory approaches in determining needs and priorities, and the value of the continued involvement of women in implementation, monitoring, and evaluation. Approaches that succeeded in increasing women's access to and use of health services addressed gender issues, set realistic and achievable objectives, and recognized and enhanced the roles and status of women.

Australia↗

How men and women view the world: a sexual perspective.

This papers presents a number of views on men and women and how they react to one another. Very little attention is given to discussing gender issues within nurse education, despite the fact that understanding gender perspectives would have a great impact on nursing care. As the majority of nurses are women and offer a different perspective on life from men, the authors find this issue needs to be addressed at pre- and post-registration levels.

Attitude↗

Bioethics for clinicians: 26. Assisted reproductive technologies.

Assisted reproductive technologies (ARTs) can be very helpful for certain patients, but ethical concerns have been raised about the inherent nature of specific techniques and the contexts in which many techniques are used. Physicians play important roles in supporting those who wish to become parents and in educating patients about impediments to fertilization and way to promote conception. We discuss various ethical issues surrounding ARTs, including family relationships, informed choice, gender issues, embryo status and the commercialization of reproduction, as well as legal and policy issues. We examine the empirical evidence of the effectiveness of ARTs and suggest ways to approach ARTs in practice.

Bioethics↗

The ultimate challenge of cloacal exstrophy.

PURPOSE: Our review addresses the various system abnormalities associated with cloacal exstrophy and revisits the question of gender assignment. Gender assignment decisions and psychological aspects of gender issues have become the "ultimate challenge." Exploration of gender identity, gender role behavior and sexual orientation has just begun. MATERIALS AND METHODS: A comprehensive literature review was performed with all world literature regarding the current management of cloacal exstrophy. Research focused on management principles, outcomes and documentation of concurrent anomalies. We also describe original research evaluating gender identity in our own series of patients raised as girls to illustrate the challenge of treatment and augment the available literature, which is scant. RESULTS: Abnormalities of the vertebral column ranged from hemivertebra to myelomeningocele. With magnetic resonance imaging, the incidence of spinal dysraphism approached 100% and cord tethering was also more frequently recognized. For children with the short bowel syndrome, advances in antibiotic usage, and parenteral and enteral nutrition have increased the survival rate and reduced morbidity. A neurological component has been recognized for bladder function, bladder neck continence, lower extremity function and erectile capacity. Mitrofanoff-type reconstruction with bladder neck closure and continent catheterizable stoma dramatically increased continence. Diminutive or absent penis has been documented in 30% of males, and no documentation of paternity exists. The majority of females have bicornuate uterus. However, ovaries and tubes were generally normal. No reports of proven fertility exist. CONCLUSIONS: The strategy and timing of surgery relating to gender assignment remain controversial. A desperate need exists for research focusing on gender development and quality of life. Until that time, a cautious watchful approach may be most appropriate as our patients with cloacal exstrophy mature into adulthood.

Abnormalities, Multiple↗

Gender awareness among physicians--the effect of specialty and gender. A study of teachers at a Swedish medical school.

BACKGROUND: An important goal for medical education today is professional development including gender equality and awareness of gender issues. Are medical teachers prepared for this task? We investigated gender awareness among physician teachers, expressed as their attitudes towards the role of gender in professional relationships, and how it varied with physician gender and specialty. We discuss how this might be related to the gender climate and sex segregation in different specialties. METHOD: Questionnaires were sent to all 468 specialists in the clinical departments and in family medicine, who were engaged in educating medical students at a Swedish university. They were asked to rate, on visual analogue scales, the importance of physician and patient gender in consultation, of preceptor and student gender in clinical tutoring and of physician gender in other professional encounters. Differences between family physicians, surgical, and non-surgical hospital doctors, and between women and men were estimated by chi-2 tests and multivariate logistic regression analyses. RESULTS: The response rate was 65 %. There were differences between specialty groups in all investigated areas mainly due to disparities among men. The odds for a male family physician to assess gender important were three times higher, and for a male non-surgical doctor two times higher when compared to a male surgical doctor. Female teachers assessed gender important to a higher degree than men. Among women there were no significant differences between specialty groups. CONCLUSIONS: There was an interaction between physician teachers' gender and specialty as to whether they identified gender as important in professional relationships. Male physicians, especially from the surgical group, assessed gender important to a significantly lower degree than female physicians. Physicians' degree of gender awareness may, as one of many factors, affect working climate and the distribution of women and men in different specialties. Therefore, to improve working climate and reduce segregation we suggest efforts to increase gender awareness among physicians, for example educational programs where continuous reflections about gender attitudes are encouraged.

Education, Medical↗

Women in addictions treatment: comparing VA and community samples.

Despite increasing awareness of gender issues in substance use treatment, women with substance use disorders (SUD) and gender-specific treatment remain understudied. This study examines differences, including identification of comorbid issues and patients' perceived treatment needs, between women in different SUD treatment settings: an intensive VA outpatient program (VA; N = 76) and a private residential/outpatient program (Residence XII; N = 308). In both settings the Addiction Severity Index (ASI) was administered at intake; ASI data were collected from retrospective chart review. Results support previous findings that women entering SUD treatment endorse high rates of psychiatric and medical comorbidity, and past abuse. Women in VA SUD treatment experienced more impairment on indices of medical, psychiatric, and employment issues whereas the private agency sample had higher alcohol and family/social composite scores. The differences between and similarities among the two treatment groups have implications for design of women-specific SUD treatment programs.

Adult↗

[Women and sex-specific health research in the German Society for Social Medicine and Prevention].

Since the 1970s women's health research has put gender-specific topics on the agenda of health research and practice. Based on a social science approach, it focuses on social conditions of the maintenance of women's health and of their needs in prevention, health promotion, medical treatment, and rehabilitation. Besides an analysis of woman-specific topics (such as sexual violence or drug abuse) women's health research addresses questions of gender bias in health research. In Germany, guidelines are lacking that ensure appropriate attention to gender issues for health research. The section "Woman-specific and gender-specific health research" of the German Society for Social Medicine and Prevention (DGSMP) intends to intensify the discussion on the gaps in health research and prevention and on the development of guidelines to detect gender bias. The main goal is to implement the concept of gender mainstreaming in public health.

Female↗