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PubMed1997

Gender and age differences in attitudes to dental pain and dental control.

In the literature, it is usual to find women and younger subjects reporting higher levels of dental anxiety than men and older subjects. Fear of pain was found to be the most important predictor of dental anxiety and issues of control were also related to such anxiety. Therefore, it was predicted that gender and age differences would be reflected in attitudes to pain and control. Subjects were randomly selected from the voters' list in metropolitan Toronto and mailed a questionnaire with a request for cooperation in a study of their thoughts, feelings, and behaviour regarding dental treatment. The questionnaire included demographic data, measures of dental anxiety and painful experiences as well as the Pain Anxiety Symptoms Scale and the Iowa Dental Control Index. The results supported the main predictions. In addition, attitudes to pain and control were found to be complex phenomena with characteristic gender differences.

Adolescent↗
PubMed1987

The growth and composition of the U.S. labor force.

In sharp contrast with the experiences of all other industrialized nations, the size of the labor force of the United States is growing rapidly while, simultaneously, its age, gender, and ethnic composition are changing markedly. Consequently, human resource issues present an unprecedented challenge in the nation's quest to achieve a fully employed and equitable society. New public policies that focus on labor market adjustment policies will be required if these developments are to be a boon rather than a bane to the emerging postindustrial economy.

Adult↗
PubMedDate not supplied

Developmental immunotoxicology: emerging issues.

While the history of immunotoxicology research involving experimental animals of immature ages dates back over several decades, there exist remarkably little data, to date, directly comparing the impact of developmental status on immunotoxicological risk. Given the size of the nonadult human population and the potential for differential vulnerability among the various ages, this represents a serious gap of knowledge in efforts to minimize environmentally linked health risks. This article frames the issues surrounding developmental immunotoxicological evaluations. In particular, the issues introduced include those of potential animal models, strain/genotype selection, gender, age of exposure, and age of assessment. Recent research results involving early exposure to lead (Pb) and other chemicals are discussed to highlight the nature of the decisions that are available and the potential cost-benefit associated with various approaches to evaluation.

Adolescent↗
PubMed2005

Difficulties, disagreements, and disappointments in late-life marriages.

Although research has examined marital satisfaction in later life, little is known about the specific relationship challenges that older couples experience. Thus, the objective of the study was to explore the challenges older couples face. Data came from the USC Longitudinal Study of Generations. Qualitative analysis was conducted on 105 older couples, with an average age of 69, who responded in 1997 to an open-ended question about difficulties, disagreements, and disappointments in their marriage. Ten themes emerged from the data. In order of frequency, they were leisure activities, intimacy, finances, no problems, personality, intergenerational relations, household concerns, personal habits, health issues, and work/retirement. Comparisons in responses were made for age, gender, marital quality, length of marriage, and health. In addition, the dyadic data were examined for patterns within the relationship.

Aged↗
PubMed2003

Son preference, sex selection, and the "new" new reproductive technologies.

Throughout recorded history, humans have tried to influence the sex of their offspring, through pregnancy injunctions, infanticide, and infant/child neglect. Reproductive technologies developed in the late 20th century allow determination of the sex of the offspring during pregnancy, making "sex selection" through abortion possible. Especially in parts of East and South Asia, sex selection against female fetuses has had dramatic consequences for male/female sex ratios. However, "newer" new reproductive technologies, such as prenatal genetic diagnosis and DNA-weighted semen selection, can now be applied for sex selection; eventually, the latter technology may become easily accessible as a noninvasive method. The prospects of these new technologies for sex selection must be considered in the light of cultural values surrounding son preference / daughter discrimination in many parts of the world, most notably Asia, as well as preferences for a "gender-balanced" family in much of the West. The ethical issues surrounding these technologies, such as the right to life and the equal treatment of female children, are potentially profound, but legislating the appropriate use of these "newest" new reproductive technologies will be difficult.

Asia↗
PubMed2003

Women with HIV/AIDS: treating the fastest-growing population.

AIDS is essentially the same disease in men and women, but a combination of social, psychological, and physiologic factors appear to define HIV disease and AIDS in women and suggest that different approaches may be needed for female patients. The likelihood that a woman will receive, adhere to, and respond to antiretroviral therapy differs from that among men. Specific psychosocial issues serve as barriers to treatment and adherence in women. Gender differences in CD4+ counts and viral load may warrant revisions of standard treatment guidelines, which were originally developed for men. Physicians need to understand gender differences in the course of AIDS, treatment responses, and the efficacy of newer antiretroviral drugs. Earlier diagnosis of HIV infection and AIDS in women may hinge on recognition of gender-specific AIDS-defining illnesses. Development of once-daily, tolerable, safer pharmacologic agents with distinct resistance profiles might improve adherence and efficacy of treatment in both men and women.

AIDS Serodiagnosis↗
PubMed2005

Prevalence and correlates of misconduct among ethnically diverse adolescents of Native Hawaiian/ part-Hawaiian and non-Hawaiian ancestry.

BACKGROUND: Research on the prevalence and correlates of adolescent misconduct, arrests, and juvenile delinquency has been greatly neglected for the ethnically diverse adolescent groups in Hawai'i (i.e. Asian Americans, Pacific Islanders). AIMS: The aims of the present study are three-fold: (1) to determine whether there are differential rates of adolescent misconduct based on ethnicity, gender, and socioeconomic (SES) factors; (2) on an exploratory basis, to ascertain the demographic, social-cultural, psychological-psychiatric, and school-related correlates of misconduct, with some focus on cultural identification; and (3) to derive a parsimonious model of the correlates for an ethnically diverse group of adolescents by disentangling cultural identification from other variables including ethnicity. METHODS: Data were analyzed from the Native Hawaiian Mental Health Research Development Program, consisting of 2,732 Asian/Pacific Islander youths. Misconduct was operationally defined as 'was arrested or got in serious trouble with the law' within the past six months via adolescent self-report. Of added importance were the inclusion of a valid measure of Hawaiian cultural identification and actual school data. RESULTS: Significantly higher rates were obtained for Native Hawaiians, males, and adolescents whose main wage earners' educational attainment was at the high school level or less. Absences may be a more important marker for females than males in the prediction of arrests and serious trouble with the law. The most parsimonious model of self-reported arrests/serious trouble with the law consisted of four variables in the following order of importance: substance use, actual grade-point average, aggressive symptoms, and gender. CONCLUSION: This is one of the first major studies to examine the prevalence and risk-protective factors of misconduct for adolescents of Asian/Pacific Islander ancestry, and the first to include a valid measure of cultural identification and actual school data. The findings indicated that gender-specific prevention and intervention programs are needed. However, the issues are also complex whereby the use of substances, school performance, and aggression must be taken into account in deriving successful programs. The lack of sustained association between culturally based factors (e.g., ethnicity, Hawaiian cultural identification) and misconduct in the final parsimonious model suggested that the culturally based variables are not direct causes of misconduct, but rather correlates of misconduct that are over-shadowed by more substantive factors, such as substance use and academic performance, the latter being variables that must be addressed for youths across the United States. The present results reaffirmed the common correlates of misconduct across different ethnic groups. Further research is needed in the causal relationships among these important associations with misconduct.

Adaptation, Psychological↗
PubMedDate not supplied

Canada's International Development Research Centre's eco-health projects with Latin Americans: origins, development and challenges.

BACKGROUND: Since its founding in 1970, Canada's International Development Research Centre (IDRC) has supported research by concerned Latin American researchers on environments and human health relationships. Framing of such relationships has changed through different periods. METHODS: Participant observation, bibliographic searches, document review, and interviews with key IDRC staff. FINDINGS: From the early years of multiple different projects, IDRC developed more focussed interest in tropical diseases, pesticides, agriculture and human health in the 1980s. The United Nations Conference on Sustainable Development in the early 1990s gave impetus to examination of links between ecosystems and human health or "EcoHealth". Projects in Latin America built on earlier work but extended it in methods (transdisciplinarity, community participation, gendered approach) and scope (broader land use and development paradigm issues tackled). A key IDRC-funded activity in Latin America was "EcoSalud", an Ecuadorian effort, which has worked with farming communities, agricultural researchers, health practitioners and local politicians to advance integrated pest management, better recognize and treat poisonings and improve pesticide-related policies. ONGOING CHALLENGES INCLUDE: mobilizing sufficient resources for the primary prevention focus of EcoHealth activities when primary care infrastructure remains stretched, promoting micro-level change in diverse communities and ecosystems, and addressing power structures at the global level that profoundly affect environmental change.

Agriculture↗
PubMed1988

Quantitative EEG: I. Techniques and problems of frequency analysis and topographic mapping.

Quantitative EEG techniques include frequency analysis (spectral analysis), significance probability mapping, and other analytic techniques. Each can be done on spontaneous EEG in various states or in conjunction with sensory stimulation. Several types of displays are available, including topographic mapping of scalp electrical activity. Assessment of normality in these records must take into account age, gender, state of alertness, medications, and other factors. Substantial statistical issues are critical in these assessments and must be thoroughly understood by all users. Other problems can easily mislead the interpretations of these tests, sometimes in subtle ways. References are often active. Traditional EEG artifacts can appear in surprising ways, and new artifacts can be caused by computer processing and display format. Important technical choices must be made in recording quantitative EEG, and the correct choices are not clearly known. These choices include references, number of channels, epoch length, number of epochs acquired, and artifact rejection criteria. This review summarizes a variety of the techniques commonly used. Advantages of particular methods are contrasted. Problems with these techniques are discussed at length, with emphasis on the difficulties and choices facing users of typical commercial quantitative EEG machines. As quantitative EEG techniques come into some clinical use, issues of nomenclature, technique, normality, and problems will become widely understood. For now, clinicians should respect the problems inherent in these techniques. Quantitative EEG tests should only be interpreted along with the traditional paper EEG tracing that represents the raw data on which the quantitative analysis was performed. A thorough familiarity with traditional EEG is a prerequisite to understanding the meaning of the quantitative EEG results.

Arousal↗
PubMed1987

The future of obstetrics and gynecology. Council on Long Range Planning and Development with the cooperation of the American College of Obstetricians and Gynecologists.

The American Medical Association Council on Long Range Planning and Development has identified trends in the environment of medicine that are likely to affect the future of obstetrics and gynecology practice. The professional liability crisis is among the most potent factors affecting the types and numbers of services that obstetricians and gynecologists will provide in the future. The setting for obstetrics and gynecology practice is likely to be affected by advances in technology and trends in delivery and reimbursement systems. Two factors with potential to affect the organization of practice are the high numbers of women entering the specialty and increasing practice expenses, largely associated with liability costs. Other factors affecting future patterns of delivery include the anticipated aging of the female population and the changing social and economic roles of women. In particular, the feminist movement has focused more attention on women's health care and is expected to have a continuing impact on the delivery of obstetric and gynecologic care. The Council concludes that the most salient issues for the specialty in the future will be the following: (1) the direction of the professional liability crisis, (2) medical practice competition, (3) the feminization of poverty, (4) ethical issues arising from technological and social imperatives, (5) the changing gender profile of the specialty, and (6) the impact of the feminist movement on women's health care.

Ethics, Medical↗
PubMedDate not supplied

When female medical students are the majority: do numbers really make a difference?

According to Kanter's theory of group dynamics, when women constitute half or more of the population in a given setting, their interactions with their male peers are more balanced and they are in a better position to influence their colleagues' professional attitudes and behavior. The influence is only significant, however, if other structural factors favor attitude and behavioral changes. Using data obtained from a mail survey of 1,247 students (82.4% response rate) conducted at three levels of medical training in three medical schools where female students were in the majority, we compared male and female students on their professional attitudes. At entrance to medical school, women were more interested in the humanistic, psychosocial, and multidisciplinary components of the physician's role than their male colleagues. At the intermediate level, however, women's interest in humanistic and psychosocial issues was less pronounced and at the graduate level this gender difference was no larger present. These results are discussed in terms of their implications for medical training.

Attitude↗
PubMed1995

Physical activity, body weight, and adiposity: an epidemiologic perspective.

Overweight is a common problem in the United States, especially among minority women and persons of lower socioeconomic status and lower educational attainment. Moreover, the prevalence of reported inactivity may be highest in these same population subgroups. Both overweight and sedentary behavior are important risk factors for chronic disease morbidity and mortality; however, there is encouraging evidence that moderate to higher levels of physical activity may provide protection from certain chronic diseases, even among persons with established risk factors. Several methodological issues preclude the ability to determine accurately the impact of physical activity on body weight and adiposity. These issues include (a) a low prevalence of higher-intensity physical activity in the general population, (b) measurement error with regard to self-reported activity, especially that of lower-intensity, (c) inappropriate time frame of the physical activity assessment, (d) effect modification by age and gender, and (e) failure to adjust for important statistical confounders. Despite these methodological issues, the inverse association between physical activity and weight has been reported in several cross-sectional epidemiologic studies, which consistently report lower body weight, or more favorable distribution of body fat, with higher categorical levels of self-reported physical activity. Directionality of the physical activity and weight relation cannot be determined from these studies, however, and the few longitudinal epidemiologic studies that have assessed the influence of physical activity on the risk of weight gain report inconclusive results. This is possibly because a one-time assessment of physical activity if not adequate in describing the contribution of habitual physical activity on long-term weight maintenance. Therefore, longitudinal population-based studies with multiple assessments of physical activity over long follow-up periods are necessary to determine this relationship. In any case, the evidence suggests that persons concerned with overweight, or especially the prevention of overweight and obesity, should increase their physical activity. Sociodemographic characteristics such as age, gender, educational level, and weight are associated with physical activity patterns and choices. Therefore, these characteristics should be considered by professionals when implementing physical activity interventions for weight control. Walking is accessible to all segments of the U.S. population. Because walking is convenient, low cost, and safe, and can result in weight loss if done regularly for durations of at least 20-30 min, its relative merits should be stressed in weight reduction and maintenance programs. Furthermore, to reduce the morbidity and mortality associated with overweight, obesity, and sedentary behavior, priority for intervention programs should be directed at persons in the most vulnerable sectors of the population.

Adipose Tissue↗
PubMedDate not supplied

The voice of the patient: a national, representative study of satisfaction with family physicians.

OBSERVATION: Among quality-of-care data types, patient satisfaction with care is a direct expression of patients and is related to important outcomes. To what degree are patients of family physicians satisfied with their care? What do their responses indicate about opportunities for quality improvement? Until now, national, representative data pertaining to patient satisfaction with family physicians' care have not been available. This article provides such data. SUBJECTS AND METHODS: A national sample, representative of the age-sex distribution of US ambulatory care visits, was drawn from a large database of surveys from patients of family physicians. Survey responses were analysed for levels of satisfaction with the salient aspects of care. RESULTS AND CONCLUSIONS: Data indicated general satisfaction with care provided by family physicians. Physicians themselves obtained the highest ratings, followed by nurses. Patients were less satisfied with access to care issues; items pertaining to waiting for the physician were rated the least satisfactory of all. Patient gender affected ratings of several survey items; women were more satisfied with physician-related items than were men; men were more satisfied with process-related issues than were women. If family physicians want more satisfied patients, they should show more respect for patients' time.

Adolescent↗
PubMed2006

Medical student attitudes towards HIV.

The aim of the study was to determine medical student attitudes towards HIV-related issues, to examine if the following student factors can affect attitudes: gender, perception of HIV infectivity, exposure to an HIV+ individual, career intent and attending a clinical attachment. A self-administered questionnaire was given to students at the beginning and end of a clinical attachment. Of the 240 questionnaires handed out at the beginning of the attachment, 183 (76%) were completed. Students generally expressed positive attitudes towards people with HIV. Female students and individuals who had considered working in a related specialty or had met an HIV+ person expressed more patient-centred attitudes in some of their responses. Following the course, 72 questionnaires were returned. Responses to several of the attitudinal statements had changed significantly. Medical students generally have enlightened attitudes towards HIV-related issues, which may be affected by student factors and attending a clinical attachment.

Adult↗
PubMed2001

Rural career choice issues as reported by first year medical students and rural general practitioners.

Governments have recently instituted several programmes designed to attract medical students to rural practice. Questions may be raised as to whether interventions based around issues identified as important to practising rural general practitioners (GPs) are equally applicable to undergraduate medical students. The results of two studies on the importance of personal and practice issues as ascribed by Australian rural GPs and Victorian medical students are analysed. The effect of the students' gender, place of origin and intended location of practice is assessed. Findings suggest that practising GPs may have resolved many of the student issues and may be well placed to advise students on perceived hurdles to rural practice. Furthermore, students may be seeking a practice style similar to that sought by female GPs. The present paper concludes that while there are similarities between the groups, the differences identified support caution when basing student programmes on research performed on rural GPs.

Adult↗
PubMed1997

Maximizing the health of women with epilepsy: science and ethics in new drug development.

Issues of unique concern to women with epilepsy largely arise from gender-based physiological differences. Female sex steroid hormones may alter the expression of epilepsy and the efficacy of antiepileptic drugs (AEDs). Seizures and AEDs in turn affect the hypothalamic-pituitary axis and can adversely impact reproductive function and bone health. Maternal seizures and exposure to AEDs may compromise fetal development. At this time, women with epilepsy and their medical caretakers do not have access to all the information necessary to formulate a treatment plan that will have the least impact on reproductive and general health. In part, this is because reproductive aged women are excluded from the earliest phases of drug testing and pregnant and lactating women are excluded from all aspects of new drug development. Therefore, as new AEDs enter the marketplace, women with epilepsy must decide whether a new AED is appropriate for therapy based on very limited information. Postmarketing surveillance of gender-specific adverse effects, as with all adverse effects, depends on voluntary reporting. Only a small percentage of significant adverse events are believed to be captured by the present system. Consumers, ethicists, and some physician groups are now arguing that women should be included in all aspects of the development of drugs they will ultimately use-even pregnant and lactating women. Some of the issues of concern for women with epilepsy regarding epilepsy treatment, reproductive function and general health will be reviewed, followed by a discussion of the drug development process and how it does, and could better, address the concerns of women.

Adult↗
PubMed2003

Gender differences in diagnostic procedures.

This review examines the contribution of the literature to the controversial issue of diagnostic procedures in women affected by coronary artery disease (CAD), on which a large number of papers have been published. It has been reported that cerebro- and cardiovascular diseases represent the first cause of death in the New as well as in the Old World, Italy included. Some studies are conditioned by bias; one of these is the Framingham study, in which angina was reported and defined only clinically and for a relatively young age range, as a benign condition in women. Angiographic studies, such as the CASS, considered a super elected group of women referred to the hemodynamic laboratory for chest pain, which in the female gender often has atypical characteristics. In our opinion, it is mandatory to take into account: 1) what chest pain really means in women; 2) the fact that there are gender differences: women have a different biological and hormonal status, lifestyle, and perception of the disease; 3) that there is a different approach of the physicians to a woman with possible or suspected CAD. We suggest, therefore, a more peculiar and individualized diagnostic approach to women suspected as having CAD. This approach should also take the pre-test probability of disease into consideration. The first investigational step we recommend is the exercise ECG test; should this be unfeasible or not interpretable, an imaging and/or pharmacological stress test is advisable. In case of positive first test results, coronary angiography should be performed.

Aged↗
PubMed2003

Teaching social and cultural awareness to medical students: "it's all very nice to talk about it in theory, but ultimately it makes no difference".

PURPOSE: To investigate the effect of exposure to a new course addressing social and cultural issues in medicine on third-year medical students' awareness and understanding of how these issues affect their lives as students, the lives of patients, the work of physicians, and patient-physician interaction. The course, Physicians, Patients & Society (PPS) was introduced at the time the school was moving to a PBL curriculum. METHOD: In the late 1990s, a questionnaire was administered to third-year medical students at one Canadian medical school, prior to the curriculum change (Time 1). In-depth interviews were held with 25 of these students. A few years later, the same methods were repeated (Time 2) with a third-year class that had experienced the PPS course. RESULTS: The response rate for Time 1 was 59% (n = 72), for Time 2, 51% (n = 61). Students in Time 2 did not demonstrate increased awareness of social and cultural issues. Most failed to recognize, or even denied, the effects of race, class, gender, culture, and sexual orientation. Those who acknowledged the effect of social differences tended to deny social inequality, or at best recognized disadvantages experienced by Others, but not the accompanying privileges enjoyed by their own social group. CONCLUSIONS: In general, students concluded that learning about social and cultural issues made little or no difference when they did their clinical rotations. For a medical school to produce physicians who are sensitive to and competent working with diverse communities requires a balance between attention to "difference," attention to self, and attention to power relations.

Adult↗