Sex differences in morbidity: a case of discrimination in general practice

Weaving Together the Ancient and the Contemporary: Intersections of the Bhagavad Gita with Modern Psychology

The Bhagavad Gita is a well-known and deeply respected ancient text from the Indian subcontinent. It is widely regarded as a storehouse of spiritual knowledge. This article explores the different ways in which psychologists have approached the study of the Gita and the extent to which it has been acknowledged as providing concepts that can contribute to the creation of mental well-being in modern times. It is important to understand the status accorded to the Gita within psychology and the contributions it can make to the growth of the psychological sciences. Psychology as we know it today developed largely within the academic institutions of Europe and North America and began its steep rise to recognition and fame largely in the first half of the 20th century. Western 'scientific' theories, concepts, and writings were carried to and widely disseminated in countries with diverse cultures. In this process indigenous, cultural and philosophical forms of knowledge that could have been incorporated into the evolving discipline were largely ignored or marginalized. The time has come to begin an exploration of such resources to assess how they can contribute to enhancing psychology's acceptance in different parts of the world. Given psychology's wide base of applications, it would be beneficial to explore its links with the message of the Bhagavad Gita. This study presents an analysis of 24 articles on the Bhagavad Gita that are of psychological significance and have been published in the last 10 years (2012-2022). Three themes addressing the ways in which this text has been approached by contemporary psychologists were elicited: (1) comparisons with modern psychotherapy, (2) preludes to modern psychological concepts and (3) potential for building well-being and resilience. In addition to this analysis, the article explores a powerful message contained in the Gita around seeking support for mental health issues, a message that has not been widely recognized to date.

Community prevalence and dyad disease pattern of multimorbidity in China and India: a systematic review

BACKGROUND

Driven by the increasing life expectancy, China and India, the two most populous countries in the world are experiencing a rising burden of multimorbidity. This study aims to explore community prevalence and dyad patterns of multimorbidity in China and India.

METHODS

We conducted a systematic review of five English and Chinese electronic databases. Studies involving adults 18 years or older at a community level, which reported multimorbidity prevalence and/or patterns were included. A modified Newcastle-Ottawa Scale was used for quality assessment. Despite large heterogeneity among reported studies, a systematic synthesis of the results was conducted to report the findings.

RESULTS

From 13 996 studies retrieved, 59 studies met the inclusion criteria (46 in China, 9 in India and 4 in both). The median prevalence of multimorbidity was 30.7% (IQR 17.1, 49.4), ranging from 1.5% to 90.5%. There was a large difference in multimorbidity prevalence between China and India, with median prevalence being 36.1% (IQR 19.6, 48.8) and 28.3% (IQR 8.9, 56.8), respectively. Among 27 studies that reported age-specific prevalence, 19 studies found multimorbidity prevalence increased with age, while 8 studies observed a paradoxical reduction in the oldest age group. Of the 34 studies that reported sex-specific prevalence, 86% (n=32) observed a higher prevalence in females. The most common multimorbidity patterns from 14 studies included hypertensive diseases combined with diabetes mellitus, arthropathies, heart diseases and metabolic disorders. All included studies were rated as fair or poor quality.

CONCLUSION

Multimorbidity is highly prevalent in China and India with hypertensive diseases and other comorbidities being the most observed patterns. The overall quality of the studies was low and there was a lack of representative samples in most studies. Large epidemiology studies, using a common definition of multimorbidity and national representative samples, with sex disaggregation are needed in both countries.

PROSPERO REGISTRATION NUMBER

CRD42020176774.

Beta-Blockers for Exams Identify Students at High Risk of Psychiatric Morbidity

OBJECTIVES

Beta-blockers relieve the autonomic symptoms of exam-related anxiety and may be beneficial in exam-related and performance anxiety, but knowledge on related psychiatric outcomes is unknown. We hypothesized that beta-blocker therapy for exam-related anxiety identifies young students at risk of later psychiatric events.

METHODS

Using Danish nationwide administrative registries, we studied healthy students aged 14-30 years (1996-2012) with a first-time claimed prescription for a beta-blocker during the exam period (May-June); students who were prescribed a beta-blocker for medical reasons were excluded. We matched these students on age, sex, and time of year to healthy and study active controls with no use of beta-blockers. Risk of incident use of antidepressants, incident use of other psychotropic medications, and suicide attempts was examined by cumulative incidence curves for unadjusted associations and multivariable cause-specific Cox proportional hazard analyses for adjusted hazard ratios (HRs).

RESULTS

We identified 12,147 healthy students with exam-related beta-blocker use and 12,147 matched healthy students with no current or prior use of beta-blockers (median age, 19 years; 80.3% women). Among all healthy students, 0.14% had a first-time prescription for a beta-blocker during the exam period with the highest proportion among students aged 19 years (0.39%). Eighty-one percent of the students filled only that single prescription for a beta-blocker during follow-up. During follow-up, 2225 (18.3%) beta-blocker users and 1400 (11.5%) nonbeta-blocker users were prescribed an antidepressant (p < 0.0001); 1225 (10.1%) beta-blocker users and 658 (5.4%) nonbeta-blocker users were prescribed a psychotropic drug (p < 0.0001); and 16 (0.13%) beta-blocker users and 6 (0.05%) nonbeta-blocker users attempted suicide (p = 0.03). Exam-related beta-blocker use was associated with an increased risk of antidepressant use (adjusted HRs, 1.68 [95% confidence intervals (CIs), 1.57-1.79], p < 0.0001), other psychotropic medication use (HR, 1.93 [95% CI, 1.76-2.12] p < 0.0001), and suicide attempts (HR, 2.67 [95% CI, 1.04-6.82] p = 0.04).

CONCLUSION

In healthy students, use of beta-blockers during the exam period was associated with an increased risk of psychiatric outcomes and might identify psychologically vulnerable students who need special attention.

Resource allocation and the burden of co-morbidities among patients diagnosed with chronic obstructive pulmonary disease: an observational cohort study from Danish general practice

Background

Chronic obstructive pulmonary disease is a leading cause of mortality, and associated with increased healthcare utilization and healthcare expenditure. In several countries, morbidity-based systems have changed the way resources are allocated in general practice. In primary care, fee-for-services tariffs are often based on political negotiation rather than costing systems. The potential for comprehensive measures of patient morbidity to explain variation in negotiated expenditures for patients with chronic obstructive pulmonary disease has not previously been examined. The aim of this study is to analyze fee-for-service expenditure of patients diagnosed with chronic obstructive pulmonary disease visiting Danish general practice clinics and further to assess what proportion of fee-for-service expenditure variation was explained by patient morbidity and general practice clinic characteristics, respectively.

Methods

We used patient morbidity characteristics such as diagnostic markers and multi-morbidity adjustment based on adjusted clinical groups (ACGs) and fee-for-service expenditure for a sample of primary care patients for the year 2010. Our sample included 3,973 patients in 59 general practices. We used a multi-level approach.

Results

The average annual fee-for-service expenditure of caring for patients diagnosed with chronic obstructive pulmonary disease in general practice was about EUR 400 per patient. Variation in the expenditures was driven by multimorbidity characteristics up to 28 % where as characteristics such as age and gender only explained 5 %. Expenditures increased progressively with the degree of multimorbidity. In addition, expenditures were higher for patients who had diagnostic markers based on ICPC-2 (body systems and/or components such as infections and symptoms). Nevertheless, 9.8–15.4 % of the variation in expenditure was related to the clinic in which the patient was cared for.

Conclusion

Patient morbidity and general practice clinic characteristics are significant patient-related fee-for-service expenditure drivers in chronic obstructive pulmonary disease care.

Association between fee-for-service expenditures and morbidity burden in primary care

BACKGROUND

In primary care, fee-for-services (FFS) tariffs are often based on political negotiation rather than costing systems. The potential for comprehensive measures of patient morbidity to explain variation in negotiated FFS expenditures has not previously been examined.

OBJECTIVES

To examine the relative explanatory power of morbidity measures and related general practice (GP) clinic characteristics in explaining variation in politically negotiated FFS expenditures.

METHODS

We applied a multilevel approach to consider factors that explain FFS expenditures among patients and GP clinics. We used patient morbidity characteristics such as diagnostic markers, multimorbidity casemix adjustment based on resource utilisation bands (RUB) and related GP clinic characteristics for the year 2010. Our sample included 139,527 patients visiting GP clinics.

RESULTS

Out of the individual expenditures, 31.6% were explained by age, gender and RUB, and around 18% were explained by RUB. Expenditures increased progressively with the degree of resource use (RUB0-RUB5). Adding more patient-specific morbidity measures increased the explanatory power to 44%; 3.8-9.4% of the variation in expenditures was related to the GP clinic in which the patient was treated.

CONCLUSIONS

Morbidity measures were significant patient-related FFS expenditure drivers. The association between FFS expenditure and morbidity burden appears to be at the same level as similar studies in the hospital sector, where fees are based on average costing. However, our results indicate that there may be room for improvement of the association between politically negotiated FFS expenditures and morbidity in primary care.

Resources allocation and health care needs in diabetes care in Danish GP clinics

BACKGROUND

In several countries, morbidity burdens have prompted authorities to change the system for allocating resources among patients from a demographic-based to a morbidity-based casemix system. In Danish general practice clinics, there is no morbidity-based casemix adjustment system.

AIM

The aim of this paper was to assess what proportions of the variation in fee-for-service (FFS) expenditures are explained by type 2 diabetes mellitus (T2DM) patients' co-morbidity burden and illness characteristics.

METHODS AND DATA

We use patient morbidity characteristics such as diagnostic markers and co-morbidity casemix adjustments based on resource utilisation bands and FFS expenditures for a sample of 6706 T2DM patients in 59 general practices for the year 2010. We applied a fixed-effect approach.

RESULTS

Average annual FFS expenditures were approximately 398 euro per T2DM patient. Expenditures increased progressively with the patients' degree of co-morbidity and were higher for patients who suffered from diagnostic markers. A total of 17-25% of the expenditure variation was explained by age, gender and patients' morbidity patterns.

CONCLUSION

T2DM patient morbidity characteristics are significant patient related FFS expenditure drivers in diabetes care. To address the specific health care needs of T2DM patients in GP clinics, our study indicates that it may be advisable to introduce a morbidity based casemix adjustment system.

Understanding preventive behaviors among mid-Western African-American men: a pilot qualitative study of prostate screening

BACKGROUND: African-American men bear a disproportionate burden for disease compared to other ethnic and racial groups. Due to gender differences in socialization and lifestyle practices, men are more likely to adopt attitudes and beliefs that undermine their health and well-being, including beliefs related to masculinity. The purpose of this study was to explore and understand the contextual factors in the attitudes and beliefs of African-American men's view of health in general, and as related to prostate cancer in particular. METHODS: Qualitative data from 15 African-American men were collected from two focus groups and analyzed for common themes using a qualitative descriptive design. RESULTS: Three themes emerged that focused on the beliefs and attitudes regarding general health and prostate cancer screening: (i) traditional beliefs about masculinity; (ii) psychosocial impact from family medical history; and (iii) sexual mores regarding digital rectal exams. CONCLUSIONS: The socialization of African-American men and masculinity ideologies may be significant factors in the focus group member's decisions to seek preventive health behavior changes. Further research is needed to examine the determinants of African-American men's health seeking behavior, in particular on the influence of masculine beliefs.

Do women consult more than men? A review of gender and consultation for back pain and headache

OBJECTIVES

Because women consult their general practitioners more frequently on average than men, it is commonly assumed that they consult more for all symptoms and conditions. This assumption is reinforced by qualitative studies reporting a widespread reluctance to consult by men. However, few studies directly compare consultation in men and women experiencing similar symptoms or conditions.

METHODS

A systematic review of the evidence on gender and consultation for two common symptoms, back pain and headache. Extensive electronic searches identified 15 papers reporting the relationship between gender and help-seeking for back pain and 11 papers for headache. Two independent reviewers assessed articles for inclusion and extracted data from eligible studies.

RESULTS

Few studies compared consultation patterns for these symptoms among men and women known to have experienced the symptom. The quality of the studies was variable. Overall, evidence for greater consultation by women with back pain was weak and inconsistent. Among those with back pain, the odds ratios for women seeking help, compared with men, ranged from 0.6 (95% confidence intervals 0.3, 1.2, adjusted only for age) to 2.17 (95% confidence intervals 1.35, 3.57, unadjusted), although none of the reported odds ratio, below 1.00 was statistically significant. The evidence for women being more likely to consult for headache was a little stronger. Five studies showed a statistically elevated odds ratio, and none suggested that men with headache symptoms were more likely to consult than women with headache symptoms. Limitations to the studies are discussed.

CONCLUSION

Given the strength of assumptions that women consult more readily for common symptoms, the evidence for greater consultation amongst women for two common symptoms, headache and back pain, was surprisingly weak and inconsistent, especially with respect to back pain.

The influence of patient and doctor gender on diagnosing coronary heart disease

Using novel methods, this paper explores sources of uncertainty and gender bias in primary care doctors' diagnostic decision-making about coronary heart disease (CHD). Claims about gendered consultation styles and quality of care are re-examined, along with the adequacy of CHD models for women. Randomly selected doctors in the UK and the US (n=112, 56 per country, stratified by gender) were shown standardised videotaped vignettes of actors portraying patients with CHD. Patients' age, gender, ethnicity and social class were varied systematically. During interviews, doctors gave free-recall accounts of their decision-making, which were analysed to determine patient and doctor gender effects. We found differences in male and female doctors' responses to different types of patient information. Female doctors recall more patient cues overall, particularly about history presentation, and particularly amongst women. Male doctors appear less affected by patient gender but both male and especially female doctors take more account of male patients' age, and consider more age-related disease possibilities for men than women. Findings highlight the need for better integration of knowledge about female presentations within accepted CHD risk models, and do not support the contention that women receive better-quality care from female doctors.

Medication use and gender in Massachusetts: results of a household survey

In this study, we investigate the extent to which women and men differ in patterns of medication use, based on quantitative and qualitative data from a household survey in Western Massachusetts. Using a broad definition of medications, 96% of the sample reported taking one or more medications in the month preceding the survey (86% if vitamins, supplements, and alternative medications are excluded). Twenty-one percent of respondents reported taking five or more medications, and women were significantly more likely to report taking five or more medications in the month preceding the survey. For both sexes, analgesics and vitamins were the most commonly used medications, but women were more likely to report having taken hormones, supplements, and antihistamines. The likelihood of medicating reported health conditions did not differ by sex, but the frequency of reporting health conditions was higher among women, and the difference was significant for body aches and psychosomatic conditions. Analyses of qualitative data indicate that female networks of relatives and friends are an important source of advice on medications for both men and women. Responses to open-ended questions suggest that women's discourse about the effect of medications differs from men's in terms of the range and detail of descriptions of symptoms and side effects.

Sex differences in consequences of musculoskeletal pain

STUDY DESIGN

Cross-sectional population-based study.

OBJECTIVE

To study sex differences in consequences of musculoskeletal pain (MP): limited functioning, work leave or disability, and healthcare use.

SUMMARY OF BACKGROUND DATA

MP is a major public health problem in developed countries due to high prevalence rates and considerable consequences. There are indications that consequences of MP differ for men and women.

METHODS

Data of a Dutch population-based study were used, limited to persons 25 to 64 years of age (n = 2517). Data were collected by a postal questionnaire.

RESULTS

Women with any MP report more healthcare use for MP, i.e., contact with a medical caregiver and use of medicines than men, while men report more work disability (ever in life) due to low back pain only, irrespective of work status. None of the sex differences can be explained by age, household composition, educational level, smoking status, overweight, physical activity, and pain catastrophizing. Older age was related to more limited functioning due to MP (women), work disability due to MP (men), and healthcare use due to MP (men and women). A one-person household was associated with work disability (women) and use of medicines (men). Low educational level was associated with limited functioning (men), work leave (men), contact with a medical caregiver (men), and work disability (men and women). Smoking was associated with limited functioning (men), work leave (women), and healthcare use (women). Physical inactivity was associated with limited functioning due to MP in women. Pain catastrophizing was associated with limited functioning, work leave, and healthcare use (men and women) and work disability (men).

CONCLUSIONS

Consequences of MP show a slightly different pattern for men and women. Women with any MPreport more healthcare use for MP, while men report more work disability due to low back pain only. These sex differences can not be explained by general risk factors, but associations between these factors and consequences of MP show some sex differences.

Sex differences in hospital readmission among colorectal cancer patients

BACKGROUND

While several studies have analysed sex and socioeconomic differences in cancer incidence and mortality, sex differences in oncological health care have been seldom considered.

OBJECTIVE

To investigate sex based inequalities in hospital readmission among patients diagnosed with colorectal cancer.

DESIGN

Prospective cohort study.

SETTING

Hospital Universitary in L'Hospitalet (Barcelona, Spain).

PARTICIPANTS

Four hundred and three patients diagnosed with colorectal between January 1996 and December 1998 were actively followed up until 2002. Main outcome measurements and

METHODS

Hospital readmission times related to colorectal cancer after surgical procedure. Cox proportional model with random effect (frailty) was used to estimate hazard rate ratios and 95% confidence intervals of readmission time for covariates analysed.

RESULTS

Crude hazard rate ratio of hospital readmission in men was 1.61 (95% CI 1.21 to 2.15). When other significant determinants of readmission were controlled for (including Dukes's stage, mortality, and Charlson's index) a significant risk of readmission was still present for men (hazard rate ratio: 1.52, 95% CI 1.17 to 1.96).

CONCLUSIONS

In the case of colorectal cancer, women are less likely than men to be readmitted to the hospital, even after controlling for tumour characteristics, mortality, and comorbidity. New studies should investigate the role of other non-clinical variable such as differences in help seeking behaviours or structural or personal sex bias in the attention given to patients.

The management of sexually transmitted infections by Australian general practitioners

OBJECTIVES

To ascertain how frequently general practitioners (GPs) in Australia encounter sexually transmitted infections (STIs), how STIs are managed in general practice, and the characteristics of GPs who manage STIs.

METHODS

Data were derived from the Bettering the Evaluation and Care of Health (BEACH) database. BEACH is a cross sectional survey of national GP activity. Approximately 1000 GPs per year each record details of 100 consecutive patient encounters. Details from April 1998 to March 2001 about frequency and pattern of STIs managed and the characteristics of GP managing them were analysed using SAS.

RESULTS

3030 GPs provided data on 303000 encounters. Only 521 problems managed were STIs. Viral STIs were most frequently managed including genital herpes (0.08 per 100 encounters), genital warts (0.07 per 100 encounters). Gonorrhoea, syphilis, chlamydia, and trichomoniasis were rarely managed. Medication was prescribed at a rate of 56.1 per 100 STI contacts (95% CI 50.4 to 61.7). Antivirals were the most common followed by topical chemotherapeutics. GPs managing STIs were significantly younger and more likely to be female, urban, have fewer years in practice, work fewer sessions a week, work in a larger practice, have graduated in Australia, and hold the FRACGP (all p<0.005) than those who did not.

CONCLUSION

Management of diagnosed STIs forms only a small part of a GP's workload in Australia. Genital herpes and warts are the most commonly managed conditions. GPs managing STIs are different from those who do not. Strategies to improve diagnosis, management, and screening should be evaluated.

Social network and role demands in women's Type 2 diabetes: a model

Type 2 diabetes is a common chronic disease in middle-aged and older women. The social network, although an important source of support, can place conflicting demands on women who cope with a chronic disorder. Because this paradoxical situation can be a burden for many women a model was constructed to systematically investigate social network demands in women's Type 2 diabetes. In developing the model, network theory provided the framework and an extensive literature review determined which network components should be included. Material from our individual and focus group interviews was used to clarify the model. Traditional gender roles in the home, obligation profiles at the workplace, cultural expectations on women's bodies, and prejudice about the psychological etiology of women's diseases in health care, could all contribute to women's experiencing role conflict in their daily diabetes management. To systematically investigate potential deterrents to women's self-care, questions that address the different components of women's social networks are proposed.

Hypertensive patients and their general practitioners

This study examined the relative contribution of hypertensive patients and their physicians in selecting total annual physician visit frequencies and made regional comparisons between two Canadian cities. We found that the frequency of physician visits was primarily influenced by physician referrals and physician practice patterns, which accounted for about 80 percent of the total explainable variance in physician visits. The relative contribution of other available patient and physician characteristics in determining visit frequency was rather small.

Regional equity in childhood health--register-based follow-up of the Finnish 1987 birth cohort

Our objective was to investigate regional health differences among Finnish children using a population-based longitudinal register data. All live births born in 1987 were included in the study (N=59,546) and followed-up until the age of seven years. Statistically significant regional variation was found for all health indicators but diabetes. Background variables, such as maternal age and social class, explained only the difference in mortality. Various indicators gave different geographical patterns. Regional equity in childhood health has not been achieved in Finland. Existing health registers were feasible in studying regional variation in health, but a set of comprehensive morbidity indicators - preferably derived from different data sources - should be developed to monitor equity in health.

Social and gender variation in the prevalence, presentation and general practitioner provisional diagnosis of chest pain

OBJECTIVES

To describe the prevalence of Rose angina and non-exertional chest pain in men and women in socioeconomically contrasting areas; to describe the proportions of men and women who present with the symptom of chest pain and who receive a provisional general practitioner diagnosis of coronary heart disease; to assess the effects of gender and deprivation.

DESIGN

Two random general population samples in socially contrasting areas were surveyed using the Rose angina questionnaire: the case notes of people identified with chest pain were reviewed.

SETTING

Glasgow conurbation.

PARTICIPANTS

1107 men and women, aged 45-64, with chest pain.

OUTCOME MEASURES

Prevalence of Rose angina and non-exertional chest pain; the proportions who had presented with chest pain and received a general practitioner's provisional diagnosis of coronary heart disease.

RESULTS

There was no difference between social groups in the prevalence of all chest pain but a greater proportion of those in deprived groups had Rose angina and a greater proportion of these had the more severe grade. The proportion of people who had presented with chest pain was higher among socioeconomically deprived groups but there was no difference in the proportions receiving a general practitioner provisional diagnosis of coronary heart disease. Men were more likely to present with chest pain than women and were more likely to receive a provisional general practitioner diagnosis of coronary heart disease.

CONCLUSIONS

No evidence was found of social differences in patient presentation or general practitioner diagnosis that might explain reported variations in uptake of cardiology services. In contrast, gender variation may originate in part from differences in patient presentation and general practitioner diagnosis. Further investigation of socioeconomic variations in uptake of cardiology services should focus later in the care pathway, on general practitioner referral patterns and clinical decisions taken in secondary care.

Gender differences in processing information for making self-assessments of health

OBJECTIVE

This study proposes that women's greater inclusiveness of various sources of information when making self-assessed health (SAH) judgments accounts for the finding that SAH is a weaker predictor of mortality in women than in men.

METHODS

Data from a sample of 830 elderly residents of a retirement community and a 5-year mortality follow-up study were used to examine the bases for women's and men's reports of negative affect (NA) and judgments of SAH. The degree to which each health-related measure accounts for the SAH-mortality association in each gender group was examined.

RESULTS

The findings support two possible explanations for the lower accuracy of SAH as a predictor of mortality among women: 1) In both men and women, NA is associated with poorer SAH, but in men, NA is more closely linked to serious disease in conjunction with other negative life events, whereas in women, NA reflects a wider range of factors not specific to serious disease. 2) Men's SAH judgments reflect mainly serious, life-threatening disease (eg, heart disease), whereas women's SAH judgments reflect both life-threatening and non-life-threatening disease (eg, joint diseases).

CONCLUSIONS

Women's SAH judgments and NAs are based on a wider range of health-related and non-health-related factors than are men's. This difference can explain gender differences in the accuracy of SAH judgments and may be related to other documented differences in women's physical and mental health and illness behavior. The findings emphasize the need to study the bases of NA and other self-evaluations separately for women and men.

Gender inequalities in health and health care services use in Catalonia (Spain)

BACKGROUND AND OBJECTIVES

While socio-economically derived differences in health and health services use have long been a subject of study, differences based on gender, considered as the explicative variable, have scarcely been quantified from population-based data. The aim of this investigation was to analyse inequalities in health and health care services utilisation between men and women in Catalonia (Spain).

DESIGN, SETTING, PARTICIPANTS, AND MEASURES

Data from the Catalan Health Interview Survey, a cross sectional survey conducted in 1994, were used. A total of 6604 women and 5641 men aged 15 years or over were included for analysis. Health related variables studied were self perceived health, restriction of activity (past two weeks), and presence of chronic conditions; health services use variables analysed were having visited a health professional (past two weeks), an optometrist (12 months), or a dentist (12 months); and hospitalisation (past 12 months). Age standardised proportions were computed according to gender, and prevalence odds ratios (OR) were derived from logistic regression equations.

MAIN RESULTS

Women more frequently rated their health as fair or poor than men (29.8% v 21.4%; OR = 1.22; 95% CI: 1.10, 1.34). More women than men reported having restricted activity days (OR = 1.86; 95% CI: 1.59, 2.18) and chronic conditions (OR = 1.74; 95% CI: 1.60, 1.89). The proportion of women visiting a health professional was slightly greater than that for men (OR = 1.20; 95% CI: 1.09, 1.31), as was the proportion of women visiting an optometrist (OR = 1.21; 95% CI: 1.11, 1.33), and a dentist (OR = 1.43; 95% CI: 1.31, 1.55). The proportion of hospitalisation was lower in women (6.6%) than in men (7.7%; OR = 0.73; 95% CI: 0.63, 0.85). When health services use was analysed according to self perceived health, women declaring good health reported a greater probability of consulting a health professional (OR = 1.35; 95% CI: 1.20, 1.52). There were no differences in respect to hospitalisation, visits to the optometrist and to the dentist.

CONCLUSIONS

These results indicate a pattern close to the inverse care law, as women, who express a lower level of health and thus would need more health care, are not, however, using health services more frequently than men.

Are women more ready to consult than men? Gender differences in family practitioner consultation for common chronic conditions

BACKGROUND

When consultations for all reasons are combined, women are seen to consult their general practitioners more than men through most of adult life. It is, therefore, often assumed that women are more likely to consult for every condition.

OBJECTIVES

To examine whether women report being more likely to consult a general practitioner than men when taking account of the underlying condition and various aspects of the experience of the condition consulted for.

METHODS

Home-based nurse-interviews with 852 people in early middle age (39 years) and 858 in late middle age (58 years) sampled from the general population in the West of Scotland. Detailed information about current chronic conditions included general practitioner consultation and reported experience of pain frequency, pain severity, limitation to normal activities and restricted activity in the previous four weeks.

RESULTS

Women were no more likely than men to consult a general practitioner in the previous year when experiencing the five most common groups of conditions; in addition, women were no more likely than men to consult at a given level of severity for a given condition type, except in the case of one aspect of reported experience of mental health problems.

CONCLUSIONS

The results argue against the most widely accepted explanation for gender differences in consulting, namely, that women are simply more likely to consult a general practitioner than men irrespective of underlying morbidity. Reasons for the higher rates of women consulting observed in general practice-based studies are discussed in relation to these data.

Gender difference in persistent at-risk sexual behavior after a diagnosed sexually transmitted disease. ACSF-Investigators

BACKGROUND AND OBJECTIVES

There are few data on sexual behavior after an episode of sexually transmitted disease (STD).

GOALS

To examine association between a history of STD and subsequent at-risk sexual behavior in the general population.

STUDY DESIGN

In the French National Survey of Sexual Behavior, current sexual behavior was compared between heterosexuals who reported an STD in the 4 years prior to the last year and those who reported no STD (n = 2517).

RESULTS

Reporting of STD was associated with a high rate of past multiple partnership among both sexes, but was associated with current at-risk behavior in men only. Men with a previous history of STD were 2.8 times (95% confidence interval [CI]: 1.4-5.6) more likely to report high-risk unprotected sex as a current behavior. No such association was observed in women (adjusted odds ratio [OR]: 1.0; 95% CI: 0.5-2.0). Conversely, in women, a previous episode of STD was significantly associated with reporting of behavior changes (adjusted OR: 3.4; 95% CI: 1.6-7.1).

CONCLUSION

A self-reported history of STD is a marker of current high-risk sexual behavior among heterosexual men that could be used to target prevention programs. In contrast, it may be associated in women with subsequent adoption of STD and HIV risk reduction strategies.

Gender differences in consulting a general practitioner for common symptoms of minor illness

The aim of this paper is to examine whether, in response to the same symptoms of minor illness, women reported a greater propensity to consult a general practitioner than men. Respondents taking part in the West of Scotland Twenty-07 Study (853 aged 39 and 858 aged 58) were presented with a check-list of 33 symptoms during the course of a home interview conducted by nurses. They were asked whether they had experienced any of these symptoms in the last month, and if they had, whether they consulted a general practitioner about it. A summary indicator for reporting, or consulting for, at least one symptom was constructed, and statistical associations between gender, reporting and consulting for symptoms were examined using chi-square tests with Yates' correction. Women were more likely to have consulted a general practitioner for at least one of the 33 symptoms of minor illness reported in the previous month (34% of women, 27% of men aged 39, chi2 = 3.97, p < 0.05; 49% of women, 43% of men aged 58, chi2 = 3.21, (NS)). Women were significantly more likely to have consulted for five individual symptoms in the younger cohort, and for three symptoms in the older cohort, whilst men were significantly more likely to have consulted for only one symptom, in the younger cohort. However, when only those who had reported a symptom in the last month were included in analysis there were no gender differences in consulting for any of the 33 symptoms in the older cohort, and for just 3 symptoms in the younger cohort. These data do not support the most widely suggested explanation for gender differences in consulting, that once symptoms are perceived, women have a higher propensity to consult a general practitioner with the symptom than men.

Sex differences in prescribed medications: another case of discrimination in general practice

Biological, social and behavioural factors influence doctors to prescribe different types of medications to male and female patients. Secondary analysis of data from the Australian Morbidity and Treatment Survey 1990-1991 was conducted using multiple logistic regression to discriminate male and female patient encounters in general practice. The approach used considered possible confounding influences of GP and patient characteristics. The results showed that females were significantly more likely than males to receive prescriptions for: antibiotics; hormones; drugs affecting the central nervous, cardiovascular and urogenital systems; drugs for allergy and immune disorders; ear and nose topical preparations, and skin preparations, even after taking into account morbidity differences. If males and females were treated according to their presenting problems, differences in morbidity patterns would account for the management differences. However, the present investigation would suggest that GP and patient behaviours are also important factors that lead to differences in the prescriptions received by male and female patients in general practice.

Perceived work conditions and work-related symptoms among employed Finns

The aim of the study was to determine the number and nature of perceived harmful work conditions and perceived work-related symptoms among employed Finns by sex and socioeconomic group. The associations between perceived harmful work conditions and perceived symptoms were also investigated. Knowledge of perceived work-related ill health can serve as a basis for health promotion at work. In a computer-assisted telephone interview of 2744 salaried employees and wage-earners, the respondents were asked about perceived harmful work conditions as well as perceived health complaints, and their relatedness to work. At least one harmful factor at work was reported by 94% of the respondents, and half of them reported more than three such factors. The most commonly occurring harmful factors were increased work pace, mental demand, repetitive movements, and noise. Of the symptoms perceived as work-related, musculoskeletal symptoms were the most common. They were reported by 44% of the respondents, followed by mental symptoms (26%), psychosomatic symptoms (19%), and respiratory or sensory symptoms (15%). Both the reporting of perceived harmful work factors and perceived work-related symptoms varied by socioeconomic group and sex. Perceived work-related musculoskeletal symptoms were associated with perceived ergonomic harmful work factors among both the men and the women, with physical or chemical work factors among the men, and with psychosocial or work organizational factors among the women. Perceived work-related respiratory symptoms were associated with perceived harmful physical or chemical work factors among both the men and the women, and both groups also reported mental and psychosomatic symptoms in relation to harmful psychosocial or organizational work factors. Among the women psychosomatic symptoms and harmful ergonomic work factors were also related. Perceived harmful factors at work and work-related symptoms are common among the work force. Even though the degree of work-related ill health was related to socioeconomic group, the reporting of particular symptoms indicated the probability of a particular work factor being considered harmful independently of socioeconomic group, although there was some relationship to sex. The implications for occupational health services are evident; employees' work-related symptoms can serve as an indicator of (preventable) perceived problems at work.

Gender differences in medical treatment: the case of physician-prescribed activity restrictions

A growing scientific literature highlights concern about the influence of social bias in medical care. Differential treatment of male and female patients has been among the documented concerns. Yet, little is known about the extent to which differential treatment of male and female patients reflects the influence of social bias or of more acceptable factors, such as different patient preferences or different anticipated outcomes of care. This paper attempts to ascertain the underlying basis for an observed differential in physicians' tendency to advice activity restrictions for male and female patients. We explore the extent to which the gender-based treatment differential is attributable to: (1) patients' health profile, (2) patients' role responsibilities, (3) patients' illness behaviors, and (4) physician characteristics. These four categories of variables correspond to four prominent social science hypotheses concerning gender differences in health and health care utilization (i.e, biological basis hypothesis, fixed role hypothesis, socialization hypothesis, physician bias hypothesis). Data are drawn from the Medical Outcomes Study (MOS), a longitudinal observational study of 1546 patients of 349 physicians practicing in three U.S. cities. Multivariate logistic regression is used to evaluate the likelihood of physician-prescribed activity restrictions for male and female patients, and to explore the absolute and relative influence of patient and physician factors on the observed treatment differential. Results reveal that the odds of prescribed activity restrictions are 3.6 times higher for female patients than for males with equivalent characteristics. The observed differential is not explained by differences in male and female patients' health or role responsibilities. Gender differences in illness behavior and physician gender biases both appear to contribute to the observed differential. Female patients exhibit more illness behavior than males, and these behaviors increase physicians' tendency to prescribe activity restrictions. After accounting for illness behavior differences and all other factors, the odds of prescribed activity restrictions among female patients of male physicians is four times that of equivalent male patients of those physicians. Medical practice, education, and research must strive to identify and remove the likely unconscious role of social bias in medical decision making.

Work-related interventions during office visits to occupational health physicians

BACKGROUND

Systematically applied work-related interventions during visits to occupational health (OH) physicians support the preventive and health promotive goals of OH. The proportion of the visits including a work-related intervention was analyzed according to patient, health problem, and physician determinants in a sample of visits to OH physicians in Finland.

METHODS

A cross-sectional study was carried out among 55 Occupational Health Services (OHS) units. Office encounters with 4,404 male and 5,373 female employed patients ages 18-64 years, recorded by 114 OHS physicians, were analyzed.

RESULTS

Altogether 856 (8.8%) encounters included a work-related intervention. The work-related interventions were distributed across all the main disease categories, the majority of which were musculoskeletal diseases. Of the patient determinants, occupational group (the residual group of non-white-collar or non-blue-collar workers) associated positively with a work-related intervention, while age or gender did not. The physician's female gender and experience associated positively with work-related interventions. Work-related interventions took place more often in integrated and joint model OHS than in municipal health care centers and private medical centers.

CONCLUSIONS

Work-related interventions are used by OH physicians for diverse health problems. More research is needed to better understand the reasons for the observed differences in work-related interventions. Also, research is needed to evaluate the efficiency of such interventions.