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PubMed2005

Unpacking the concept of patient satisfaction: a feminist analysis.

AIM: The aim of this paper is to present a feminist critique of the concept of patient satisfaction. BACKGROUND: Fiscal restraint, health care restructuring, shifting demographics, biomedical technological advances, and a significant shortage of health care professionals are stretching health care systems across North America to the breaking point. A simultaneous focus on consumerism and health service accountability is placing additional pressure on the system. The concept of patient satisfaction, with roots in the consumer movement of the 1960s, has both practical and political relevance in the current health care system and is commonly used to guide research related to consumer experiences of health care. Because the quality of health care encounters may lead to treatment-seeking delays, patient satisfaction research may be an effective vehicle for addressing this public health issue. However, there is wide agreement that patient satisfaction is an under-theorized concept. Using current conceptualizations of patient satisfaction, we end up all too often producing a checklist approach to 'achieving' patient satisfaction, rather than developing an understanding of the larger issues underlying individual experiences of health care. We focus on the symptoms rather than the problems. DISCUSSION: Without further theoretical refinement, the results of research into patient satisfaction are of limited use. To push forward theoretical development we might apply a variety of theoretical lenses to the analysis of both the concept and the results of patient satisfaction research. Feminism, in particular, offers a perspective that may provoke further refinement of patient satisfaction as a concept. CONCLUSIONS: Without a deeper understanding of the values and beliefs (or the worldview) that informs our approaches to researching patient satisfaction, researchers will be reacting to the most obvious indicators and failing to address the underlying issues related to individual experiences of health care.

Appointments and Schedules↗

PubMed1997

Postmodern feminist emancipatory research: is it an oxymoron?

Many nurse-researchers who use feminist methods believe that postmodernism undermines the scientific and emancipatory aspirations of our discipline and they are therefore wary of postmodern theories. One of the main threats of postmodernism is the critique of humanism because humanism forms the ethical foundation for both nursing and feminism. These critiques expose the dark underside of humanistic ideals and show how, paradoxically, humanism has functioned to oppress people. The arguments presented here help emancipatory researchers to defend their practices, both in relation to research participants and in the ways in which the subjects is theorized. The conclusion is that postmodernism can be compatible with politically motivated, humanistically-based inquiry.

Ethics, Nursing↗

PubMed2006

History for a practice profession.

This essay explores the meaning of history for a practice profession. It argues that our clinical backgrounds suggest particular kinds of historical questions that colleagues with different backgrounds would not think to ask. This essay poses three possible questions as examples. What if we place the day after day work of caring for the sick - that which is nursing - at the center of an institution's history? What if we were to embrace a sense of nurses and nursing work as truly diverse and different? What if we were to analytically engage the reluctance of the large number of nurses to formally embrace feminism? This essay acknowledges that these are not the only possible questions and, in the end, they most likely will not even be the important ones. But this essay does argue that we, who are both clinicians and historians, need to more seriously consider the implications of our questions for disciplinary practice and research. It argues, in the end, that the meaning of history to a practice profession lies in our questions: questions that are different than those raised by other methods, and questions that may escape notice in the press of daily practice and research.

Attitude of Health Personnel↗

PubMed1984

Estrogen-producing adrenocortical carcinoma. A light and electron microscopic study.

A case of adrenocortical carcinoma with feminization seen in a man aged 35, is reported. The levels of estron (E1) and estradiol (E2) in the venous blood draining the tumor were high, and it was confirmed by in vitro assay of tumor cells taken from the primary tumor of the left adrenal gland that the tumor produced estrone. The light microscopic examination demonstrated that the primary tumor was composed of mixture of large cells with pleomorphic nuclei and vacuolated cytoplasm and uniform cells with ovoid nuclei and eosinophilic cytoplasm. The electron microscopic examination on the latter cells revealed numerous large and irregularly shaped mitochondria with mostly tubular or lamellar and occasionally vesicular cristae and electron-dense matrix, well-developed smooth-surfaced endoplasmic reticulum in the cytoplasm. However, lipid droplets and lysosomes or lipofuscin granules were scanty. From these findings, it is suggested that cells of the present tumor have characteristics of those in the zona reticularis of the adrenal cortex as well as in the fetal cortex, and the functional property of this tumor is well correlated with its morphological features.

Adrenal Cortex Neoplasms↗

PubMed2004

Feminist discourse on sex screening and selective abortion of female foetuses.

Although a preference for sons is reportedly a universal phenomenon, in some Asian societies daughters are considered financial and cultural liabilities. Increasing availability of ultrasonography and amniocentesis has led to widespread gender screening and selective abortion of normal female foetuses in many countries, including India. Feminists have taken widely divergent positions on the morality of this practice. Feminists from India have strongly opposed it, considering it as a further disenfranchisement of females in their patriarchal society, and have agitated successfully for legislative prohibitions. Libertarian feminists on the other hand, primarily from the United States, have argued that any prohibition of the use of this technology is a curtailment of a woman's reproductive choices and a violation of her right to make autonomous decisions regarding procreation. Using India as an illustrative case, this paper argues that in the context of what prevails in some societies, an ethical argument that hinges on the principle of autonomy as understood in the West can be problematic. Furthermore, a liberal theoretical assumption that it is always better to have more rather than fewer choices may not hold up well against the realities of life for such women. Although feminists have little disagreement concerning substantive matters, it is in the area of strategy that differences of opinion have arisen, their moral reasoning and responses shaped by the culture, ethnicity, class and race to which they belong. A view that a single 'orthodox' feminism of any variety can embody the aspiration of all women reverts to the problematic issues in the evolution of the rationalistic, individualistic, 'male' ethics against which women have consistently raised objections.

Abortion, Induced↗

PubMed2002

Marriage in the 20th century: A feminist perspective.

A defining feature of the 20th century in Western civilization was a profound change in the roles women play in both private and public life. The field of couple therapy was influenced by that change and, to a limited extent, participated in it. I will argue that the field has avoided fully embracing the principles of feminism that generated the social changes in gender and marital roles, settling instead for a more token acknowledgment that gender means something, without wanting to specify what that something is. In responding to the other articles in this issue, I make the case that the connection between gender and power in marriage needs to be more fully integrated, in the theory, research, and treatment of couples.

Couples Therapy↗

PubMedDate not supplied

The growing commercial value of the male body: a longitudinal survey of advertising in women's magazines.

BACKGROUND: With the advances of feminism, men have gradually relinquished their once-exclusive 'masculine' roles as fighters and breadwinners. In response to this change, the male body may have gained in relative importance as one of the few surviving marks of masculinity. We hypothesized that these trends might be quantified by using a commercial measure such as advertising. METHODS: We examined the proportion of exposed male and female bodies portrayed in advertisements between 1958 and 1998 in two leading American women's magazines. RESULTS: In both magazines, the proportion of undressed women in the advertisements has changed little over the last 40 years, whereas the proportion of undressed men has increased dramatically, especially since the early 1980s. CONCLUSIONS: Trends in commercial advertising offer tentative support for the hypothesis that the male body is increasing in importance as a mark of masculinity--at least as judged from the actions of advertisers seeking to influence women's attitudes.

Adult↗

PubMed2003

[Gender stereotypes in gynecology and obstetrics: obstacles for young male physicians?].

Up to the mid 1990s, a 'feminization' of medicine took place that was especially pronounced in the field of gynecology. The present paper looks into the reasons for this change based on the literature and results from a study conducted by the author. In 2001, two thirds of the new qualifications in gynecology/obstetrics were awarded to women. The feminist movement has led to the emancipation of women and the assertion that women should be treated by female doctors only. Parallel to this development, gender roles also underwent a change: nowadays, the ideal woman or man is 'androgynous'. Young physicians are both highly instrumental and highly expressive. The increasing similarities between the sexes exert an influence on lifestyle and biographical planning. An increasing number of young physicians no longer prioritize their profession. Male physicians with high expressiveness are often family oriented and consciously refrain from choosing to specialize in gynecology/obstetrics because of the long hours and heavy workload. On the other hand, quite a few women physicians are more instrumental and prioritize their professional commitment. If more male physicians are not attracted into gynecology/obstetrics over the next few years, a process of 'horizontal segregation' could occur, with women physicians accomplishing the patient-focused work while their male colleagues take over the surgery and scientific part of the specialty. It is the very differences between the sexes, however, and the exchange between them, which allow a medical discipline to thrive.

Adult↗

PubMed1991

Androgen receptor and the testes influence hypertension in a hybrid rat model.

The objective of this study was to determine if males with a deficient androgen receptor would develop hypertension when crossed with a hypertensive parent. Female King-Holtzman rats (n = 15), heterozygous for the testicular feminization (Tfm) gene, were crossed with male spontaneously hypertensive rats (SHR), and blood pressure was measured weekly from 5-14 weeks in the F1 hybrid males. Approximately 50% of the F1 hybrid males were Tfm males and androgen receptor-deficient, and 50% were normal. Blood pressure in the parent King-Holtzman males, Tfms, and female rats was also followed for the same time period. The F1 normal male hybrids had a significantly higher (p less than 0.05) systolic blood pressure than the Tfm hybrid males after 12 weeks (195 +/- 8 versus 170 +/- 8 mm Hg, respectively). Blood pressure in the male and Tfm Holtzman rats was 120 +/- 5 mm Hg and 110 +/- 6 mm Hg, respectively. Castration lowered blood pressure by 38 mm Hg in the hybrid males and 27 mm Hg in the Tfm hybrids. Female F1 hybrids also showed a pressure rise above that of female Holtzman controls (155 +/- 6 mm Hg versus 110 +/- 6 mm Hg, p less than 0.01) but lower than the F1 males and Tfm hybrids. Ovariectomized females with testosterone implants did not show an elevation in blood pressure. Plasma electrolytes, norepinephrine, and cholesterol were not significantly different between normal and Tfm hybrid males. The results suggest that the presence of an androgen receptor and a testis-derived factor mediate the blood pressure rise in the hybrid males.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed2003

Analyzing women's roles through graphic representation of narratives.

A 1992 triangulated international nursing study of women's health was reported. The researchers used the perspectives of feminism and symbolic interactionism, specifically role theory. A narrative analysis was done to clarify the concept of role integration. The narrative analysis was reported in 1992, but graphic/visual techniques used in the team dialogue process of narrative analysis were not reported due to space limitations. These techniques have not been reported elsewhere and thus remain innovative. Specific steps in the method are outlined here in detail as an audit trail. The process would be useful to other qualitative researchers as an exemplar of one novel way that verbal data can be abstracted visually/graphically. Suggestions are included for aspects of narrative, in addition to roles, that could be depicted graphically in qualitative research.

Adaptation, Psychological↗

PubMed1998

Health care, ethics and nursing in Bangladesh: a personal perspective.

Health care in Bangladesh is in a sad condition, with not enough doctors and nurses available to serve its people, but, even with this limited number of health care professionals, better care would be possible if greed for money and unaccountability to the people were controlled by the Government. Conditions for members of the nursing profession are not acceptable for those who are dedicated to serving the sick. Acknowledgement of nursing's professional dignity is almost completely absent. In addition, the salary earned is not enough to make a living. There are in existence professional associations who are struggling for the rights of the nursing community, although few concrete results have yet been seen. This article is written from the perspective of the author's position as a member of the Board and Treasurer of the International Association of Bioethics, and her interest in feminism and bioethics, which justifies her link with oppressed nurses (because most are women) and unethical practices in the nursing profession in Bangladesh.

Bangladesh↗

PubMed1989

Female gene expression in the seminal vesicle of mice after prenatal exposure to diethylstilbestrol.

Previous studies from our laboratory on the feminization of the male mouse reproductive tract after prenatal exposure to diethylstilbestrol (DES) showed that the mRNA for the major estrogen-inducible uterine secretory protein, lactoferrin (LF), was constitutively expressed in the seminal vesicle of male mice exposed prenatally to DES, but not in the seminal vesicle of control mice. After castration, treatment with 17 beta-estradiol (20 micrograms/kg.day) for 3 days induced the LF mRNA in the seminal vesicle of both control and prenatally DES-exposed mice; however, the levels in DES-treated tissues were approximately 6-fold higher than those in control tissue. This report describes the presence of LF in seminal vesicle tissues and secretions of prenatally DES-exposed mice, as determined by immunohistochemistry and Western blot analysis. Further, these data are correlated with immunolocalization of the estrogen receptor in the seminal vesicle tissue. We conclude that the seminal vesicle of prenatally DES-exposed male mice has acquired two key characteristics of female tissues, namely LF production/regulation and estrogen receptor localization/distribution similar to that in uterine tissues.

Animals↗

PubMed1991

Sexual dimorphism of pancreatic beta-cell degeneration in transgenic mice expressing an insulin-ras hybrid gene.

The human H-ras oncogene induces cell degeneration and diabetes when expressed in pancreatic beta-cells in transgenic mice. The disease develops predominantly in male mice between 5-8 months of age. Most transgenic female mice do not manifest this phenotype, even at much greater ages. However, ovariectomy induces female beta-cell degeneration similar to that in the males. In contrast, castration or the presence of the testicular feminization mutation do not alter the course of the disease in males. Treatment of males and ovariectomized females with estrogen prevents the development of diabetes. These results suggest that testicular androgens and a functional testosterone receptor are not required for the increased susceptibility of male beta-cells to the effects of the Ras oncoprotein, and that the relative resistance of female beta-cells is mediated by estrogen. In addition, a genetic component of female beta-cell resistance to Ras is revealed by crossing the transgenic mice with C3HeB/FeJ mice, which results in a pronounced increase in the incidence of female diabetes.

Animals↗

PubMed2000

Growth hormone therapy of Turner syndrome: the impact of age of estrogen replacement on final height. Genentech, Inc., Collaborative Study Group.

Clinical trials of recombinant human GH therapy in Turner syndrome that began more than a decade ago show that GH accelerates the linear growth rate. Several studies indicate that final height is also improved, although the magnitude of the increase has been debated. The age at which feminization is induced could be an important factor in determining the patient's ultimate growth response. To test this, 60 patients from a large (n = 117), previously unreported, clinical trial of GH treatment were randomly assigned to begin conjugated estrogens at either 12 or 15 yr of age. The 60 patients were all less than 11 yr of age at entry (mean, 9.5 yr) and received 0.375 mg/kg x week of GH for nearly 6 yr on a daily or three times weekly regimen. Height gain was calculated by comparing the study patients' final or near final heights to their pretreatment projected heights as well as to those of a separate set of age-matched, historical control patients. Patients in whom estrogen treatment was delayed until age 15 yr gained an average of 8.4 +/- 4.3 cm over their projected height, whereas those starting estrogen at 12 yr gained only 5.1 +/- 3.6 cm, on the average (P < 0.01). Analysis of the interval data showed that growth was stimulated for approximately 2 yr after estrogen initiation, but then declined in association with bone age advancement. Patients who were older than 11 yr at entry (n = 57) all initiated estrogen 1 yr after beginning GH and showed a mean gain in adult height of 4.7 cm, similar to those given estrogen at age 12 yr. Multivariate analysis revealed that the number of years of GH therapy before estrogen treatment was a strong factor in predicting height gained, indicating that the timing of estrogen introduction is an important determinant of final height in this cohort of GH-treated patients with Turner syndrome matched for baseline age and other characteristics.

Adolescent↗

PubMed2002

Steroid deficiency syndromes in mice with targeted disruption of Cyp11a1.

Steroid deficiencies are diseases affecting salt levels, sugar levels, and sexual differentiation. To study steroid deficiency in more detail, we used a gene-targeting technique to insert a neo gene into the first exon to disrupt Cyp11a1, the first gene in steroid biosynthetic pathways. Cyp11a1 null mice do not synthesize steroids. They die shortly after birth, but can be rescued by steroid injection. Due to the lack of feedback inhibition by glucocorticoid, their circulating ACTH levels are exceedingly high; this results in ectopic Cyp21 gene expression in the testis. Male Cyp11a1 null mice are feminized with female external genitalia and underdeveloped male accessory sex organs. Their testis, epididymis, and vas deferens are present, but undersized. In addition, their adrenals and gonads accumulate excessive amounts of lipid. The lack of steroid production, abnormal gene expression, and aberrant reproductive organ development resemble various steroid deficiency syndromes, making these mice good models for studies of steroid function and regulation.

Adrenal Glands↗

PubMed2006

The women's health movement: making policy, 1970-1995.

With the advent of second-wave feminism during the 1970s, a significant body of literature emerged describing sexist practices in women's health care. Gender-bias and gender disparities found in women's health care became concerns that garnered considerable attention in the United States because of the increased health risks posed for women. This article describes key historical challenges and accomplishments made in U.S. women's health care policy during the quarter century spanning 1970-1995 that influence contemporary health care social work practice and social work education.

Female↗

PubMed2004

Gender-biased diagnosing of women's medical complaints:contributions of feminist thought, 1970-1995.

With the advent of second-wave feminism during the 1970s, a significant body of literature emerged describing sexist practices in women's health care. Gender-biased diagnosing-the notion that somatic complaints by female medical patients are more likely to be labeled by physicians as psychosomatic-became a concern that garnered considerable attention in Europe and the United States because of the increased health risks it posed for women. This article examines the impact of feminist knowledge on this topic during the quarter century spanning 1970-1995. Analysis of the literature reveals feminist perspectives played a critical role in uncovering and problematizing gender bias in women's health care.

Europe↗

PubMed2006

Gender please, without the gender police: rethinking pain in archetypal narratives of butch, transgender, and FTM masculinity.

Why is it that many of the often-cited narratives about butch, FTM, and/or transgender masculinity happen to be fictions that highlight suffering as a de facto rite of passage for the butch, FTM, or transgendered protagonist? This essay attempts to answer that question, first by outlining the "coherentist assumptions" of lesbian feminism and the forms of gender-policing that cast butch, FTM, and transgendered subjectivities as "false consciousness." It then analyzes the practice of anchoring butch, FTM, and/or transgender identity claims in pain-filled narratives such as "The Well of Loneliness," "Stone Butch Blues," and "Boys Don't Cry." While these narratives do important cultural work-exposing the violence heaped upon butches, FTMs, and transgendered guys-it may be time to imagine alternative narratives that are less invested in suffering as a barometer of masculine authenticity.

Female↗