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PubMed2004

Contrasting negative-feedback control of endogenously driven and exercise-stimulated pulsatile growth hormone secretion in women and men.

GH represses its own secretion via rapid and reversible feedback exerted at key hypothalamic loci. The primary mechanisms include stimulation of somatostatin release and inhibition of GHRH outflow. Autoinhibition is prominent in the adult male rat but diminutive in the female animal. The sex contrast reflects important differences in central neuropeptide signaling in this species. No comparable insights into gender-specific control of GH autofeedback are available in the human. To examine this issue, we quantitated acute recombinant human (rh)GH-induced inhibition of baseline (resting) and aerobic exercise-stimulated GH secretion in healthy young men (n = 8) and early follicular-phase women (n = 6). Each subject underwent four fasting, morning inpatient infusion studies in a prospectively randomized, placebo-controlled, double-blind, within-subject cross-over design. The feedback paradigm comprised 6-min bolus iv infusion of saline or rhGH (10 microg/kg) followed in 120 min by rest or submaximal aerobic (individually calibrated) bicycle ergometry for 30 min. Concomitantly, blood was sampled every 10 min for 6 h, and sera were submitted to immunochemiluminometric GH assay (sensitivity 0.005 microg/liter). Biexponential deconvolution analysis was applied to estimate stimulated GH secretory-burst mass (microg/liter per 90 min after onset of exercise or rest). Women and men had statistically comparable serum estradiol but unequal testosterone concentrations. Repeated-measures ANOVA documented a significant three-way interaction among gender, stimulus type (rest or exercise), and feedback status (saline or rhGH injection) in determining GH secretory-burst mass (P = 0.008). There were prominent two-factor interactions among gender and exercise (P < 0.001); gender and rhGH-induced negative feedback (P = 0.002); and exercise and rhGH feedback (P = 0.006). Gender comparisons disclosed that women, compared with men, maintain 20-fold higher GH secretory-burst mass at rest (P < 0.001); 40-fold less stimulation of pulsatile GH release by exercise than rest (P < 0.001); and 20-fold greater inhibition of GH secretory-burst mass by rhGH than saline at rest (P < 0.05). Observed feedback contrasts by sex were specific, inasmuch as gender did not affect absolute estimates of exercise-stimulated GH secretion (microg/liter/90 min); nadir GH concentrations (microg/liter) enforced by rhGH infusion; and the time latency (min) to manifest maximal inhibition after rhGH injection. In summary, the present clinical investigation unmasks: 1) markedly greater fractional feedback inhibition of pulsatile GH secretion by rhGH in young women than men; and 2) partial resistance of the aerobic-exercise stimulus to GH autofeedback in both women and men. We postulate that sex-steroid-specific control of somatostatin and GHRH outflow may mediate the former gender contrasts, whereas unknown (gender-independent) factors may determine the capability of exercise to significantly antagonize GH autoinhibition.

Adult↗
PubMed2001

Anterior cruciate ligament injuries.

Increasingly, epidemiological data has shown differences in the total number of injuries and in the incidence of serious knee injuries among males and females in jumping and pivoting activities. Particularly, strong epidemiological data support increased incidence of non-contact anterior cruciate ligament injuries in females. Despite more than a decade of vigorous debate and intense study on this topic, research has yet to clearly link gender as an individual risk factor for this injury. Risk factors can be divided into intrinsic or extrinsic factors; for this review they are divided into anatomic, hormonal, and neuromuscular categories. The most intriguing of these deals with neuromuscular control of the limb. In particular, neuromuscular issues involving hip and trunk position and its muscular control have been increasingly implicated in this injury etiology. Gender differences have been found in motion patterns, positions, and muscular forces generated with various lower extremity coordinated activities. Thus, many clinicians currently advocate a strengthening program that emphasizes proximal hip control mediated through gluteus and proximal hamstring activation in a close chain fashion. This, combined with skill training in landing and pivoting maneuvers, is thought to help prevent injury. We must encourage continued, structured, and focused research in this area. However, until specific predictive and protective factors are identified, training and prevention programs should continue to be implemented, assessed, and improved.

Anterior Cruciate Ligament Injuries↗
PubMed2001

Historical assessment of nutrition studies using only African-American study subjects: gender, socioeconomic status, and geographic location.

While the African-American community has disproportionate rates of morbidity and mortality from chronic diet-related diseases, few studies have examined demographically the spectrum of these outcomes in the population. The purpose of this study is to determine the extent to which published scientific literature has examined African-American samples with sufficient specificity to identify nutrition problems in subsets of the population. Age, gender, socioeconomic status, geographic location, and sample size are used to examine study questions. In addition, the United States Department of Agriculture (USDA) Continuing Survey of Food Intakes for Individuals (CSFII) 1994-1996 is used to illustrate how evaluating nutrient variables by demographic indicators provides insights into the heterogeneity of nutrient intake patterns among African Americans. Relative to the adequacy of scientific investigation into these issues, a review of twenty-nine studies conducted from 1970 to the present demonstrates bias in gender, income, and sample size for African-Americans-only dietary research samples. Relative to identifying dietary patterns that do not meet US dietary guidelines, pervasive patterns that persist across income groups were found, indicating the need for nutrition education programs at all levels. Although there are science based diet information available, it does not seem to have reached the African-American community in numbers sufficient to be reflected in dietary changes as reported by surveys. This research demonstrates the need for detailed studies highlighting these issues, as well as the production of culturally appropriate nutrition education materials and methods that will be effective in reaching this population.

Black or African American↗
PubMed1996

The new genetics and women.

The U.S. Human Genome Project (HGP) is a federally funded effort to produce a detailed genetic and physical map of all human chromosomes. Because of their central role in reproduction and caregiving, women are likely to be affected differently, and more significantly, by the information the HGP generates. It is important to identify inequities that may emerge from gender differences and to consider ways in which they may be avoided, reduced, or overcome. Although this type of analysis is one of the goals of the Ethical, Legal, and Social Issues Program of the National Center for Human Genome Research, few studies have focused explicitly on the impact of the HGP on women. This article describes the potential impact of the "new genetics" on women. Identification of gender differences as they affect both research and clinical practice and the psychosocial, legal, and ethical implications of the HGP should evoke and inform public discussion and policies that may be generated by these issues.

Caregivers↗
PubMed1993

A study of attitudes to gender and nursing stereotypes in newly recruited student nurses.

This article presents the findings of a study which investigated the attitudes of 100 newly recruited student nurses towards gender and nursing stereotypes. The students were in their second day of the Common Foundation Programme at North Staffordshire College of Nursing and Midwifery. The data were collected using a researcher developed instrument which utilised a Likert scale for measurement of attitudes in relationship to statements pertaining to gender and nursing stereotypes. The findings reveal overall high mean scores and an implied propensity towards beliefs in gender and nursing stereotypes. Analysis related to demographic variables of gender, age and sex gives a number of significant results. The highest proportion of significant results were related to gender differences in the sample. The data provide a basis for evaluation of teaching and learning related to students in the sample course of studies. The findings also have more general implications for curricular issues and the development of teaching strategies.

Adolescent↗
PubMed1999

Drug abuse treatment outcome study of adolescents: a comparison of client characteristics and pretreatment behaviors in three treatment modalities.

OBJECTIVES: The present study presents background and pretreatment characteristics of adolescent substance abuse treatment clients, and it provides a mechanism for describing perhaps the largest research sample of adolescents who were in drug treatment in this decade. METHODS: The sample was 3382 subjects who presented for treatment from 1993 to 1995 in 37 programs in Pittsburgh. Pennsylvania: Miami, Florida; Minneapolis, Minnesota; Chicago, Illinois; Portland, Maine; and New York City, New York. Informed permission for the youth to participate was obtained from the subject's custodial parent/guardian, and both the youth and the youth's parents or guardians provided informed assent if they agreed to participate as subjects. Adolescents then were interviewed privately and confidentially by a trained professional interviewer who was independent of the treatment programs. The interviews queried subjects about their background, including education and employment; physical and mental health; use of tobacco, alcohol, and other drugs; sexual experiences; legal problems: religious beliefs; and treatment experience. RESULTS: The long-term residential treatment modality was the least gender balanced of the modalities and had the most African-American and Hispanic clients. This modality was distinguished by the proportion of clients who were referred to treatment by the juvenile or criminal justice system. Compared with other clients in other modalities, short-term inpatient clients were more likely to be female and white. Inpatient clients also reported more indicators of psychiatric impairment. Outpatient clients were slightly younger than clients in the other modalities, and more of them were attending school at the time of admission to treatment. Outpatient clients had the least criminally involved lifestyles, their rates of (regular daily or weekly) drug use were also the lowest of the three modalities for all drugs assessed, and they had the least drug treatment experience. CONCLUSIONS: These results merit several recommendations. One is the need for more community-based adolescent substance abuse treatment programs. An additional recommendation is for more substance abuse treatment programs in facilities that serve incarcerated youth. Finally, and perhaps most critically, it is recommended that programs be designed to address such specialized issues as comorbid substance abuse and psychiatric problems, family dysfunction, physical and sexual abuse, gender and ethnic differences, and academic performance.

Adolescent↗
PubMed1997

Culture, universals, and the personal.

This chapter summarizes a part of the case that can be made that the individual construction of a personal domain of choice and privacy generalizes across cultures and is not restricted to persons who live within Western or so-called modern societies. The research findings reported here are consistent with the view that persons seek to establish such areas of control in order to maintain a differentiated personal identity and a sense of personal agency. Children, adolescents, and adults from the United States and traditional cultures have been found to identify a class of behaviors and issues as being outside the legitimate sphere of social or moral regulation. Mothers from Western and traditional cultural settings recognize and foster their children's claims to areas of personal choice and privacy. Across cultures, as children mature and move toward adulthood, they lay claim to a broader range of issues and actions as personal matters. Research on adolescent-parent conflict with U.S. and Chinese samples has indicated that these shifts associated with adolescent claims to freedom are the source of most family conflicts. Anthropological accounts of adolescent-parent conflicts in 160 cultures have provided evidence that such conflicts are widespread (Schlegel and Barry, 1991). Finally, we are beginning to obtain evidence that parental overcontrol of personal issues is associated with symptoms of psychological problems in their adolescent children. These research findings are consistent with the proposal (Nucci, 1996) that establishment of a personal domain is an intrinsic feature of normal human development, resulting from the inevitable attempt by individuals to account for and differentiate between their own motives, values, and experiences and those of others. The evidence also points to the fact that such personal issues are coexistent with concerns for interpersonal harmony and social integration. Thus, it is not surprising that the work summarized here also suggests considerable social-class and cultural variation in how the personal is expressed. Such variation is consistent with the assumption that the personal is constructed out of social interactions (Nucci, 1996) that entail reciprocal interchange between individual and societal structures (Turiel, 1996). In Spiro's analysis (1984), the results of such reciprocal structural interaction cannot be accounted for by reducing the analysis of psychological structures in terms of cultural structures and vice versa. Thus, any accurate interpretation of the impact of culture on psychological development must be constrained by features that are peculiar to psychological systems. Extending this to the cross-cultural study of the personal domain, a case can be made for the need to explore such issues at the level of the individual, rather than at the level of the cultural shared-symbol system. On the other hand, this nonreductionist approach and the available evidence rule out the reification of the personal as a culturally empty set of psychological issues. As illustrated in studies of the distribution of rights in relation to gender and social hierarchy among Druze Arabs (Wainryb and Turiel, 1994), the interplay between the personal and the cultural system of roles and obligations provides a rich and contradictory portrait that can be understood only by shifting perspective from the social to the individual and back again without favor.

Adolescent↗
PubMed2005

Are they being used safely? A retrospective cross-sectional tertiary health care survey of selective serotonin reuptake inhibitors prescribing practice in Singapore.

OBJECTIVES: To determine the prescribing pattern of the SSRIs and to evaluate the safety of current utilization of SSRIs associated with concomitant psychotropic medications in Singapore. METHODS: The average prescribed daily dose (PDD) for each SSRI was calculated and compared with the defined daily dose (DDD). Pearson's chi2 test, one-way analysis of covariance (ANCOVA) and multinomial logistic regression were performed to examine the impacts of variables such as age, gender, patient type and concomitant psychotropic medications on the utilization of SSRIs. Safety issues were discussed by examining the potential metabolic drug interactions between the SSRIs and concomitant psychotropic medications. RESULTS: The most frequently prescribed SSRI was fluoxetine and the PDDs were slightly more than the DDDs for all these SSRIs except fluvoxamine. The SSRIs were mainly prescribed to the patients who were younger, female and outpatients. Psychotropics were more likely concomitantly used with fluvoxamine, sertraline and paroxetine, relative to fluoxetine. CONCLUSION: The prescribing pattern of SSRIs in a tertiary health center in Singapore is generally consistent with the accepted practices, although some safety concerns in terms of metabolic drug interactions were raised. This study provides useful baseline information for further in-depth studies for SSRIs usage both locally and for international comparison.

Adolescent↗
PubMed1993

Stress, anxiety and depression: women's accounts of their health problems.

In a study of a stratified random sample of 356 Canadian women, stress, anxiety and depression were among the most frequently reported health problems. The first part of this paper outlines the different social characteristics of those who reported stress, anxiety and depression. Women experienced mental health problems differently depending on their socio-economic status, ethnicity, family structure, the quality of family relationships and the nature of their participation in the labour market. It is argued that we need a more detailed analysis of these aspects of women's estate if we are to understand the social production of mental health and variations between women. Subsequent sections of the paper discuss women's own understanding of the sources of their mental health problems. While they spoke of the particularities of their own lives, these were often located in the context of broader social influences. They emphasized the social aetiology of mental health, noting the importance of gender roles and images of women. They described the heavy workload of women, issues of identity and their social legacies. In conclusion, it is noted that women appear to normalize the mental health problems they report. This may, in part, reflect the lack of social reinforcement and validation of their experiences.

Adult↗
PubMed2001

Exploring women's needs in an Amazon region of Ecuador.

This study broadly explored women's perceptions of their most pressing problems and needs in the mostly rural Amazonian province of Orellana in Ecuador in mid-2000. In-depth interviews with community women and health and social service providers used two rapid structured, qualitative methods--free-listing and pile-sorting--to explore the 'insider's' perspective, with the participation of local organisations, and generated discussion on the emerging issues, giving an opportunity for action aimed at improving women's situation. Unequal gender relations, subordination of women, economic problems, men drinking too much and domestic violence were identified as the most pressing concerns. Several reproductive and sexual health problems were also identified and information about others elicited. This paper describes the methodology used in the research, reports on the 20 most cited problems and looks more closely at the findings in relation to violence against women, lack of access to contraception and ambiguities arising from the need to resort to clandestine abortion. Despite the existence of innovative national policies related to domestic violence and reproductive health, there is a scarcity of resources and poor infrastructure in Orellana. Patronising attitudes on the part of health service staff also greatly limit women's access to reproductive and sexual health services.

Abortion, Induced↗
PubMedDate not supplied

Imagining HIV/AIDS: morality and perceptions of personal risk in Nigeria.

The disparity between people's knowledge about HIV/AIDS and the extent to which they take measures to protect themselves is one of the most vexing issues for public health workers and social science analysts. This paper aims to explain some of this discrepancy, using survey and ethnographic data collected among young rural-urban migrants in Aba and Kano, two cities in Nigeria. The paper argues that many young Nigerian migrants do not perceive significant personal risk because they construct the risk of AIDS in ethical and moral terms, projecting immorality and danger onto imaginary others. To understand the way young Nigerians interpret risk, the paper focuses on four related issues: (1) the organization and meaning of sexual relationships; (2) the intersection of gender and ideas about reproduction; (3) the perception of AIDS as a disease without hope; and (4) the importance of religion in young people's framing of moralities and ethical choices about sexuality and HIV/AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Gender differences in practice style: a Dutch study of general practitioners.

The differences between female and male general practitioners (GPs) were studied regarding three different factors: 1) Do female GPs see more female patients than their male colleagues in the same practice?; 2) Are female GPs confronted with different types of health problems from their male colleagues?; and 3) Do female GPs provide different services to their patients? Data from the Dutch National Study on Morbidity and Interventions in General Practice were used. All practices in this study with both female (n = 23) and male (n = 27) GPs were selected. This resulted in detailed data on 47,254 consultations, 62% of which were with female patients. The three research questions all received an affirmative response: 1) female patients tend to choose female general practitioners; 2) female GPs see different health problems from their male colleagues, and that is only partly because the patient so chooses; and 3) besides the expected differences in female-specific problems, there is a clear GP-gender effect in the presence of 'social' and 'metabolic' problems in the female GP's consultations. Some differences in the provision of services between male and female GPs occurred, with female GPs spending more time on their patients and having a stronger tendency to provide continuity of care. In addition to a gender effect (both physician and patient) a part-time effect in most issues studied was observed.

Adolescent↗
PubMed1999

Sex in the New World: an empowerment model for HIV prevention in Latina immigrant women.

In 1996, nearly 60% of U.S. AIDS cases among Latinas were attributed to unprotected sex with men. Economic disadvantage, language barriers, and strong cultural gender norms regarding sex exacerbate the risk for HIV infection among Latina immigrant women. Through a collaboration among scientists and providers, this study was designed to evaluate the impact of a multifaceted empowerment program for Latina immigrant women on HIV risk behaviors. Women (N = 74) were followed for the first 6 months of their participation and attended up to nine distinct types of activities (e.g., information meetings, friendship circles, and workshops). Although the program was not developed to specifically target HIV risk behaviors, women showed significant increases in sexual communication comfort, were less likely to maintain traditional sexual gender norms, and reported changes in decision-making power. Targeting broader sociocultural issues may increase the necessary skills for Latina women to prevent HIV infection from their sexual partners. Successful collaborations between scientists and providers are critical in developing effective, community-relevant interventions.

Adult↗
PubMed2001

Transcutaneous flow related variables measured in vivo: the effects of gender.

BACKGROUND: The identification of potential sources of error is a crucial step for any new assessment technique. This is the case for transcutaneous variables, such as flow and arterial gases, which have been applied as functional indicators of various aspects of human health. Regarding gender, a particular subject-related determinant, it is often claimed that women present higher transcutaneous oxygen pressure (tcpO2) values than men. However, the statistical significance of this finding is still uncertain. METHODS: The haemodynamical-vascular response to a local reactive hyperaemia procedure (the tourniquet cuff manoeuvre) was studied in two previously selected group of volunteers (n = 16; 8 women and 8 men). The effect of gender was assessed under standardised experimental conditions, using the transcutaneous flow-related variables tcpO2-tcpCO2 and Laser-doppler Flowmetry (LDF). RESULTS: Regarding tcpO2, statistically significant differences between genders were not found, although higher values were consistently found for the gases in the female group. Regarding LDF, high statistically significant differences (p < 0.005) were found, with the men's group presenting the highest values and variability. Other derived parameters used to characterise the vascular response following the cuff-deflation (t-peak) were similar in both groups. CONCLUSIONS: The relative influence of gender was not clearly demonstrated using these experimental conditions. However the gender-related LDF differences suggest that further investigation should be done on this issue. Perhaps in the presence of certain pathological disparities involving peripheral vascular regulation, other relationships may be found between these variables.

Adaptation, Physiological↗
PubMed2006

[Between denial and helplessness: health care providers facing domestic violence in Mexico].

OBJECTIVE: To increase the knowledge of health care providers' understanding of and practices on domestic violence, in order to improve care. MATERIALS AND METHODS: This study was conducted between May and November 2003, In Quintana Roo, Coahuila, and Mexico City, three Mexican states with a high prevalence of domestic violence. Sixty in-depth interviews with health care providers in public health institutions and key informants of health service provision were completed. RESULTS: Health care providers were categorized based on the extent to which they reproduced four"discourses about violence". These discourses influence their daily practice and are related to the informants' gender values and social positions. Most informants expressed their willingness to address the issue of domestic violence. CONCLUSIONS. Attention to and care for domestic violence is insufficient in health services; this may be due more closely related to a predominant discourse tolerating domestic violence among decision-makers, than to the attitudes of health care providers; the latter demonstrated greater awareness of women's rights.

Denial, Psychological↗
PubMed1997

Working conditions in home care: negotiating race and class boundaries in gendered work.

Home care work in metropolitan areas is a source of employment for immigrant women of color. Service work of this type intertwines domestic and caring labor in ways that reinforce the historically gendered and racialized nature of the work. Such macro level economic and political issues are played out at the micro level of daily service provided within elderly clients' homes. A study of these processes in home care work was carried out in urban southern Ontario in two nonprofit home care agencies. In-depth interviews and focus groups held with visible minority home care workers suggested that workers deal daily with racist attitudes and behaviors from clients and their families; agencies recognize these oppressive processes but usually handle them on a case-by-case basis through supervisors; and home care workers handle racism on the job as they do in their off-work hours-by avoidance, situating incidents within an analysis of the circumstances of elderly clients, setting boundaries on discussions, and occasionally, confrontation.

Adult↗
PubMed2002

Complicating childhood: gender, ethnicity, and "disadvantage" within the New Zealand children's health camps movement.

By the mid-20th century New Zealand's children's health camps movement had gained the status of a national icon, highlighting children's health and well-being in a campaign unrivalled, before the 1960s, by any equivalent peace-time cause. The movement's long existence within a relatively small nation state with an increasingly vocal indigenous population makes it an ideal base from which to study challenges to the undifferentiated category of "the child." The success of the movement was based upon a highly unitary conception of childhood and an uncomplicated view of child health. The paper shows how at certain moments in the movement's development a blanket categorization of childhood was challenged, first by gender and later, and more substantially, by the ethnicity of health camp recruits. "Disadvantage" was a constant subtext, but its link with socio-economic status was downplayed in official discourses. Gender was highlighted in the 1920s and 1930s when girls' health needs were informed by (White) racial anxieties. Thereafter the physical and mental health needs of boys underwrote health camp recruitment and programs, even if this was not formally acknowledged. From the late 1980s, however, gender was subordinated to ethnicity. A growing focus on the Treaty of Waitangi issues and relationships of Maori to social services saw Maori children become visible in New Zealand's health camps as never before. With an acknowledgement of difference came competition for funds and an undermining of the national consensus about child health.

Child↗
PubMed1997

Feminism: a path to clinical knowledge development.

Nurses are under increasing pressure to defend the efficacy, value and cost benefits of professional nursing care. Now more than ever, there is a need for nurses to undertake quality clinical research, through which practice may be shaped and guided. Feminist theory can provide a lens through which nurses may explore clinical issues. It also provides a framework by which socially constructed differences, such as gender and culture, may be incorporated into the design of clinical research projects. Because feminism is an openly political and transformative process, feminist concepts are suitable for use where the aim of the research is to catalyse practice change. This paper explores the use of feminism as a theoretical framework for nursing research.

Clinical Competence↗