Comparison of female and male graduates of southern Appalachian family practice residencies

PURPOSE: One aim of Southern Appalachian family practice residencies is to produce graduates for surrounding physician-needy areas. Some evidence suggests that women are less likely to go to rural areas and that they practice differently than men. This study investigated the practice patterns and location of Appalachian family practice residency female and male graduates. METHODS: Surveys were sent to graduates of seven family practice residencies from 1984 to 1994 in the Southern Appalachian area to determine practice patterns, locations, and reasons for choosing practices. RESULTS: Women were more likely than men to be single and not to have children. More women worked part-time. Women's and men's practice patterns and characteristics were similar except that women were more likely to provide prenatal care and do vaginal deliveries. Women in similar percentages practiced in small towns, and a greater percentage of women practiced in rural areas with populations of less than 2,500. CONCLUSIONS: Female family practice residency graduates from Appalachian residencies are fulfilling the purposes of their residencies as well as male graduates, although more of them are working part-time.     

Leisure-time physical activity and marital status in relation to depression between men and women: A prospective study.

Background: Previous studies have identified the preventive effect of leisure-time physical activity (LTPA) on depression. Women and men have different emotional vulnerabilities. The impact of LTPA on depression varies by gender. Little is known about the impact of LTPA on depression for people with different marital status. Objectives: The objective of this study was to assess the long-term effects of LTPA, changes in LTPA, and marital status on the risk of developing depression for general Canadians. Methods: Data from the biennial National Population Health Survey (NPHS) cycles conducted between 1994/95 and 2004/05 were analyzed in 2008. After excluding individuals with preexisting depression at baseline, respondents were classified as physically active or inactive and then followed up in subsequent cycles of the NPHS to look at risk of developing depression. Individuals who changed their activity level were also examined. Subgroup analyses by different marital status were performed to identify high-risk populations. Results: In 1994/1995, 17,276 participants were included in the NPHS longitudinal panel. Respondents who were inactive were more likely to be older, female, obese, widowed/separated/divorced, not working, low income, and lacking social support. After controlling for potential confounding factors, it was found that LTPA reduced the risk of developing depression for women. The modest risk reduction observed for men was not statistically significant. Women who were active at baseline and two years of follow-up were significantly less likely to report depression at four years of follow-up compared to women who were inactive at baseline and at two years of follow-up. A 51% greater probability of developing depression was observed after two years for women who changed their LTPA from active to inactive compared to women who remained active. No significant results were found for men. Divorced/separated/widowed women who stopped LTPA had 4.2 times the risk of developing depression after two years compared to those who remained active. The risk of developing depression after stopping activity did not vary according to marital status among men. Conclusions: LTPA has preventive effects on depression for women. Reduction in LTPA level is associated with subsequent depression for women. Divorced/separated/widowed women are at particularly high risk of developing depression if LTPA is stopped. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

A model for predicting depression in victims of rape

This article proposes a model for understanding the factors contributing to long-standing depression in women who have been raped. A path analysis of data obtained from 71 women who had been raped revealed that women with generalized beliefs that they could not control events in their lives were more likely to attribute responsibility for their rape to permanent intrapsychic factors and were more likely to be depressed. Women who perceived that they had higher levels of internal control tended to have higher levels of education, were more likely to be employed, and were less likely to be depressed more than one year after having been raped. Childhood sexual abuse was not associated with internal control or attributions of causality or depression in this analysis. Implications for the determination of prognosis and treatment recommendations in civil litigation assessments are discussed.     

Molecular identification and analysis of a novel human corticotropin-releasing factor (CRF) receptor: the CRF2gamma receptor

Previous work has established that women with good marriages are less at risk of depression of clinical severity following a crisis than women in poor quality relationships. Evidence for such protectiveness is less clear for men. The paper examines the relationship between marital quality, onset of depression, and gender following a severely threatening life event. The results show that good quality of marriage related to lower rates of depression for both men and women, although the overall rate for women was higher. For women with a good marital relationship, but for whom support from partner was not forthcoming at the time of the crisis (i.e. the person was "let down"), risk was increased, confirming a result from a study in Islington. The current study shows that the same set of findings holds for men. Gender differences did emerge when the subjective need for support within the marital relationship is taken into account, with women expressing greater need. However, such a desire for support was not necessarily translated into support-seeking behaviour as in a poor relationship turning to a partner was frequently inopportune. Women were also more likely to seek support outside the marriage; as in the earlier Islington research this was related to a lower risk of depression for those in a poor relationship. An unexpected finding was that men who received support outside marriage had an increased risk of depression.     

Suicide following an inpatient hospitalization for a suicide attempt: a Canadian follow-up study

This study contributes a Canadian perspective to a growing body of international studies examining suicide among cohorts of suicide attempters, and a much more limited literature on the epidemiology of suicide in Canada. We evaluated the 13-year mortality experience of a regional cohort of 876 first-ever inpatient hospital admissions for a suicide attempt admitted between 1979 and 1981. Compared to the general population, study subjects were 4 times more likely to die of any cause, but 25 times more likely to commit suicide and 15 times more likely to die of accidental or adverse causes. Ten years after then first hospitalization for attempted suicide, 5.9% of study subjects had committed suicide. Baseline age appeared to be a risk factor for women, but not for men. Women under 60 years had the best 10-year survival (3.6% had committed suicide) and women over 60 years had the poorest (17.5%). A total of 8.7% of men under 60 years and 10% of those over 60 years committed suicide within 10 years. The remainder of the analysis focused on those under 60 years of age at the time of their index inpatient hospitalization. Three factors were prognostic for suicide: being male, which had a relative risk (RR) of 5.0, living in a lower income area (RR = 3.2), and having used a violent method during the index attempt (RR = 2.5). The periods of greatest risk for suicide were within the 1st and 4th years following first-ever inpatient hospitalization, with the 4th year representing the time of highest risk. The identification of time periods subsequent to first-ever hospitalization when patients are at greatest risk of suicide can be used to guide the timing and duration of clinical interventions and aftercare to ensure that patients are appropriately supported during periods of highest risk.     

Suicide of a patient: gender differences in bereavement reactions of therapists

Emotional reactions of therapists who experienced the death by suicide of one or more of their patients were investigated. Data were collected by a questionnaire containing both objective and open-ended items from 27 men and 36 women, psychiatrists and psychologists, working in psychiatric hospitals in Slovenia. The most frequently reported reactions by the therapists were of increased caution in the treatment of their patients and an increase in conferring with colleagues, partners, and supervisors. About two thirds reported experiencing strong guilt feelings along with other commonly reported survivor feelings of grief, depression, and loss. Gender differences were apparent (women more often felt shame and guilt, sought consolation, or doubted their professional knowledge). No significant differences appeared between disciplines and years of work experience. Agreement was general that support was important both professionally and personally. Suggestions are offered to help the therapist work through the trauma of a patient's suicide.     

Gender differences in emotional risk for self- and other-directed violence among externalizing adults.

Objective: Women and men generally differ in how frequently they engage in other- and self-directed physical violence and may show distinct emotional risk factors for engagement in these high-impact behaviors. To inform this area, we investigated gender differences in the relationship of emotional tendencies (i.e., anger, hostility, and anhedonic depression) that may represent risk for other-directed violence (i.e., physical fighting, attacking others unprovoked) and self-directed violence (i.e., self-injury, suicide attempts). Method: The ethnically diverse sample consisted of 372 adults (252 men and 120 women age 18–55) with a history of criminal convictions. Facets of emotional risk assessed with the Aggression Questionnaire (Buss & Warren, 2000) and Mood and Anxiety Symptom Questionnaire (Watson et al., 1995) were entered simultaneously as explanatory variables in regression analyses to investigate their unique contributions to other- and self-directed physical violence in men and women. Results: Analyses revealed that anhedonic depressive tendencies negatively predicted other-directed violence and positively predicted self-directed violence in men and women, consistent with a model of depression in which aggression is turned inward (Henriksson et al., 1993). Gender differences, however, emerged for the differential contributions of anger and hostility to other- and self-directed violence. Trait anger (i.e., difficulty controlling one's temper) was associated with other-directed violence selectively in men, whereas trait hostility (i.e., suspiciousness and alienation) was associated with self- and other-directed violence among women. Conclusions: The divergent findings for trait anger and hostility underscore the need to examine gender-specific risk factors for physical violence to avoid excluding potentially useful clinical features of these mental health outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Relational Perspective on Women and Power.

This article focuses on the fact that women and men have equal but different needs for power. Integrating a psychoanalytic relational approach with feminist theory and social psychology, the author explains gender differences and societal influences on the pursuit of power. Social psychology research indicates that women are more likely to pursue power in ways that help others, whereas men are more likely to pursue their own individual ambitions. However, both genders become more nurturing in their expressions of power as they age. The presence of siblings in early life and having children as adults are more likely to produce an individual who demonstrates prosocial power. Young women today appear to be less conflicted about pursuing power in the world than the previous generation, but they are still ambivalent when it comes to making their way in the world. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Onychomycosis. Baseline results of an observational study

The investigators present an analysis of baseline quality-of-life and patient-management approaches from an observational study of 150 patients being treated by podiatric physicians and dermatologists for onychomycosis. The majority (73%) made the initial office visit specifically because of their onychomycosis. Both men and women indicated that they had substantial physical discomfort as well as concerns related to appearance. Women reported significantly more problems than did men as a result of their onychomycosis. Physicians reported that 54% of patients suffered from toenail discomfort, 36% had pain while walking, 40% reported that their condition limited wearing of shoes, and 67% were embarrassed by the condition. The results of this study suggest that the treatment approach of podiatric physicians is more likely to address the palliative concerns of patients with onychomycosis, while the approach of dermatologists is more likely to attempt a definitive cure.     

Gender-sensitive recommendations for assessment and treatment of depression in men.

Psychologists increasingly recognize depression as a serious, albeit often undiagnosed, condition in men. In fact, undiagnosed and untreated depression in men may be one reason why many more men than women commit suicide. However, because of cultural conditioning that discourages expression of depressed mood in men, assessment as well as treatment of depression in men are sometimes difficult. Use of gender-sensitive assessment strategies and interventions will assure that more men will be identified and treated for depression. This article integrates scientific findings related to depression in men with specific gender-sensitive assessment and psychotherapeutic intervention strategies designed to enhance psychologists' skills in working with this significant problem in men. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Domestic violence: a hidden problem for general practice

Domestic violence is a common problem that may affect more than a quarter of women. It is a complex area in which to undertake research. Studies often focus on selected populations and exhibit a diversity of design, making comparison difficult. This review focuses on physical violence by men against women partners or ex-partners, and exemplifies important issues for general practitioners. Domestic violence frequently goes undetected. This may be the result of doctor's fears of exploring an area perceived as time-consuming, where knowledge is lacking and where they feel powerless to 'fix' the situation. Women may not reveal that they are experiencing violence, sometimes because doctors are unsympathetic or hostile. Nevertheless, women wish to be asked routinely about physical abuse and want to receive immediate advice and information about their options if necessary. Women experience a range of health and social problems in association with domestic violence, including depression, anxiety, substance abuse and pregnancy complications. However, none of these features is specific enough to be useful as an indicator of violence. Therefore, doctors should routinely ask all women direct questions about abuse. This recommendation can be incorporated into guidelines, which should be implemented widely in the UK, to improve the care of women experiencing domestic violence. In parallel with this, the educational needs of general practitioners should be addressed. Further research is needed to establish the prevalence of domestic violence in women presenting to general practice and to investigate how the problem is currently being addressed. If progress is to be made in tackling domestic violence, action within primary care is just one part of this: a fundamental change in the attitudes of men towards women is required.     

Gender differences in partner violence in a birth cohort of 21-year-olds: Bridging the gap between clinical and epidemiological approaches.

This study describes partner violence in a representative sample of young adults. Physical violence perpetration was reported by 37.2% of women and 21.8% of men. Correlates of involvement in severe physical violence differed by gender. Severe physical violence was more strongly associated with unemployment, low educational attainment, few social support resources, polydrug use, antisocial personality disorder symptoms, depression symptoms, and violence toward strangers for men than for women. Women who were victims of severe physical violence were more likely than men who were victims to experience symptoms of anxiety. The findings converge with community studies showing that more women than men are physically violent toward a partner and with clinical studies highlighting violence perpetrated against women by men with deviant characteristics. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A longitudinal study of the careers of a cohort of assistant professors in psychology.

Reviews the literature on female psychologists in academe and presents results from a 7-yr longitudinal study of a cohort of 171 male and 174 female assistant professors in psychology. The literature review indicates that women psychologists are less likely to be promoted or receive tenure than men, publish less than men, are less likely to have a PhD, and are less likely to have been an administrator than are men. Women are also limited by constraints of childrearing and mobility necessitated by their husband's career. However, new evidence from the cohort study provides little support for some common assumptions about the career progress of men and women. Instead, results indicate few differences between the career paths of male and female psychologists. (35 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of gender, menstrual phase and practice on the perceived location of the midsagittal plane

Women show menstrual phase-related cognitive changes that suggest altered hemispheric activation for a particular task, such that they demonstrate the greatest lateral performance differences on prototypical left hemisphere tasks during the luteal phase and on prototypical right hemisphere tasks during menstruation. Additionally, menstrual phase may alter total cerebral responsiveness, such that response times and performance accuracy for many tasks are best during the luteal phase and most impaired during the menstrual phase. We evaluated the effect of menstrual phase on spatial bisection (a perceptuospatial task) to help further understand hormonally-mediated changes in interhemispheric dynamics. Healthy young adult women and men blindly pointed to their midsagittal plane with either hand. Women were repeatedly tested according to menstrual phase, and men were tested at similar intervals. The mean pointing error in the luteal phase differed significantly from that of all other phases and did not differ significantly from those of men, who pointed significantly to the left across test sessions. These findings suggest that, in space bisection tasks, women are more likely to have asymmetric hemispheric activation during the luteal phase than during the menstrual phase. Thus, space bisection did not resemble other prototypical right hemisphere behaviors. The luteal phase may have nonspecifically activated both hemispheres on this task instead of suppressing right hemisphere function, and a slight functional asymmetry favoring the right hemisphere may have been promoted. In addition, intermanual pointing discrepancies in both subject groups decreased over repeated sessions. This suggests that, while practice alters an internal kinesthetic reference, it does not influence an imaginal extrapersonal spatial reference.     

Gender differences in risk behaviors among HIV+ persons with an IDU history. The link between partner characteristics and women's higher drug-sex risks. The Manif 2000 Study Group

BACKGROUND AND OBJECTIVES: Risk-taking behaviors differ among women and men injection drug users (IDU). GOAL: To specify the nature of sexual and drug risk-taking among women IDU and ex-IDU and how it relates to partner characteristics. DESIGN: A cross-sectional analysis of 324 HIV+ subjects enrolled into a prospective cohort study in Marseille, France. RESULTS: Women, as compared with men, were considerably more likely to report nonuse of condoms with a main partner (31% versus 12%). They were more likely to shoot with a partner at last injection (39% versus 12%), but far less likely to sterilize used needles (4% versus 16%). Two thirds of both men and women reported consistent condom use with a seronegative partner, but only 47% of men and 23% of women reported the same with a seropositive partner. Among the women only, needle and syringe sharing was associated with consistent use of a condom. CONCLUSIONS: Women reported behaviors which protect their partners from STD infection more frequently than behaviors which protect themselves. Greater attention must be paid to sexual risk-taking among HIV+ women.     

Suicides after pregnancy in Finland, 1987-94: register linkage study

OBJECTIVE: To determine rates of suicide associated with pregnancy by the type of pregnancy. DESIGN: Register linkage study. Information on suicides in women of reproductive age was linked with the Finnish birth, abortion, and hospital discharge registers to find out how many women who committed suicide had had a completed pregnancy during her last year of life. SETTING: Nationwide data from Finland. SUBJECTS: Women who committed suicide in 1987-94. RESULTS: There were 73 suicides associated with pregnancy, representing 5.4% of all suicides in women in this age group. The mean annual suicide rate was 11.3 per 100,000. The suicide rate associated with birth was significantly lower (5.9) and the rates associated with miscarriage (18.1) and induced abortion (34.7) were significantly higher than in the population. The risk associated with birth was higher among teenagers and that associated with abortion was increased in all age groups. Women who had committed a suicide tended to come from lower social classes and were more likely to be unmarried than other women who had had a completed pregnancy. CONCLUSIONS: The increased risk of suicide after an induced abortion indicates either common risk factors for both or harmful effects of induced abortion on mental health.     

Sex differences in unipolar depression: Evidence and theory.

A large body of evidence indicates that women are more likely than men to show unipolar depression. Five classes of explanations for these sex differences are examined and the evidence for each class is reviewed. Not one of these explanations adequately accounts for the magnitude of the sex differences in depression. Finally, a response set explanation for the sex differences in depression is proposed. According to this explanation, men are more likely to engage in distracting behaviors that dampen their mood when depressed, but women are more likely to amplify their moods by ruminating about their depressed states and the possible causes of these states. Regardless of the initial source of a depressive episode (i.e., biological or psychological) men's more active responses to their negative moods may be more adaptive on average than women's less active, more ruminative responses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender differences in homeless persons with schizophrenia and substance abuse

The purpose of this study was to test the generalizability of previous research on gender differences between men and women with co-occurring schizophrenia and substance abuse. One hundred eight patients with schizophrenia or schizo-affective disorder involved in a study of treatment for homeless persons were interviewed for information regarding substance use, social functioning and support, comorbid disorders, victimization, medical illness, and legal troubles. We found that women had more children and were more socially connected than men. Women also had higher rates of sexual and physical victimization, comorbid anxiety and depression, and medical illness than men. We conclude that homeless women with dual disorders, like women with substance use disorders in the general population, have distinct characteristics, vulnerabilities, and treatment needs compared with men. In addition to comprehensive treatment of psychiatric and substance use disorders, gender-specific services should be developed, including prevention and treatment of victimization and related problems as well as help with accessing medical services.     

Responses to depression and their effects on the duration of depressive episodes.

Proposes that the ways people respond to their own symptoms of depression influence the duration of these symptoms. People who engage in ruminative responses to depression, focusing on their symptoms and the possible causes and consequences of their symptoms, will show longer depression than people who take action to distract themselves from their symptoms. Ruminative responses prolong depression because they allow the depressed mood to negatively bias thinking and interfere with instrumental behavior and problem-solving. Laboratory and field studies directly testing this theory have supported its predictions. The author discusses how response styles can explain the greater likelihood of depression in women than men, then integrates this response styles theory with studies of coping with discrete events. The response style theory is compared to other theories of the duration of depression. Finally, suggestions are made that may help a depressed person to stop engaging in ruminative responses and on how response style for depression may develop. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Quantitative analysis of microvascular changes in diffuse astrocytic neoplasms with increasing grade of malignancy

BACKGROUND: Despite concerns about its prevalence and ramifications, harassment has not been well quantified among physicians. Previous published studies have been small, have surveyed only 1 site or a convenience sample, and have suffered from selection bias. METHODS: Our database is the Women Physicians' Health Study, a large (4501 respondents; response rate, 59%), nationally distributed questionnaire study. We analyzed responses concerning gender-based and sexual harassment. RESULTS: Overall, 47.7% of women physicians reported ever experiencing gender-based harassment, and 36.9% reported sexual harassment. Harassment was more common while in medical school (31% of gender-based and 20% for sexual harassment) or during internship, residency, or fellowship (29% for gender-based and 19% for sexual harassment) than in practice (25% for gender-based and 11% for sexual harassment). Respondents more likely to report gender-based harassment were physicians who were now divorced or separated and those specializing in historically male specialties, whereas those of Asian and other (nonwhite, nonblack, non-Asian, non-Hispanic) ethnicity, those living in the East, and those self-characterized as politically very conservative were less likely to report gender-based harassment. Being younger, born in the United States, or divorced or separated were correlated with reporting ever experiencing sexual harassment; those who were Asian or who were currently working in group or government settings were less likely to report it. Those who felt in control of their work environments, were satisfied with their careers, and would choose again to become physicians reported lower prevalences of ever experiencing harassment. Those with histories of depression or suicide attempts were more likely to report ever having been harassed. CONCLUSIONS: Women physicians commonly perceive that they have been harassed. Experiences of and sensitivity to harassment differ among individuals, and there may be substantial professional and personal consequences of harassment. Since reported rates of sexual harassment are higher among younger physicians, the situation may not be improving.