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Gehrels AM, Wagner AD, Besselink MG, Verhoeven RHA, van Eijck CHJ, van Laarhoven HWM, Wilmink JW, van der Geest LG. Gender differences in tumor characteristics, treatment allocation and survival in stage I-III pancreatic cancer: a nationwide study. Eur J Cancer 2024; 206:114117. [PMID: 38781719 DOI: 10.1016/j.ejca.2024.114117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/25/2024] [Accepted: 05/04/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION Sex and gender are modulators of health and disease and may have impact on treatment allocation and survival in patients with cancer. In this study, we analyzed the impact of sex and gender on treatment allocation and overall survival in patients with stage I-III pancreatic cancer. METHODS Patients with stage I-III pancreatic cancer diagnosed between 2015 and 2020 were selected from the nationwide Netherlands Cancer Registry. Associations between sex and gender and the probability of receiving surgical and/or systemic treatment were examined with multivariable logistic regression analyses. Overall survival was assessed with log rank test and multivariable Cox proportional hazard analysis. RESULTS Among 6855 patients, 51.2 % were female. Multivariable logistic regression analyses with adjustment for known confounders (age, performance status, comorbidities, tumor location, tumor stage and previous malignancies) showed that females less often received systemic chemotherapy compared to males (OR 0.799, 95 %CI 0.703-0.909, p < .001). No difference was found in the probability for undergoing surgical resection. Furthermore, females had worse overall survival compared to males (median OS 8.5 and 9.2 months respectively, 95 %CI 8.669-9.731). CONCLUSION This nationwide study found that female patients with stage I-III pancreatic cancer significantly less often received systemic treatment and had worse overall survival as compared to males. Disparities in pancreatic cancer care can be decreased by recognizing and resolving potential obstacles or biases in treatment decision-making.
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Affiliation(s)
- A M Gehrels
- Amsterdam UMC, location University of Amsterdam, Department of Medical Oncology, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands.
| | - A D Wagner
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - M G Besselink
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands; Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
| | - R H A Verhoeven
- Amsterdam UMC, location University of Amsterdam, Department of Medical Oncology, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands; Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, Netherlands
| | - C H J van Eijck
- Department of Surgery, Erasmus MC Cancer Institute, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - H W M van Laarhoven
- Amsterdam UMC, location University of Amsterdam, Department of Medical Oncology, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - J W Wilmink
- Amsterdam UMC, location University of Amsterdam, Department of Medical Oncology, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - L G van der Geest
- Amsterdam UMC, location University of Amsterdam, Department of Medical Oncology, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands; Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, Netherlands.
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Gibson LP, Ferrer RA, Meghani SH, Acevedo AM. Potential role of cannabis in ameliorating observed racialized disparities in cancer pain management. J Natl Cancer Inst 2024; 116:1019-1025. [PMID: 38471103 PMCID: PMC11223862 DOI: 10.1093/jnci/djae058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/26/2024] [Accepted: 03/04/2024] [Indexed: 03/14/2024] Open
Abstract
Cancer-related pain affects a large proportion of all patients with cancer yet remains inadequately managed, particularly among patients from certain racialized backgrounds. Recently, there has been increased research and clinical interest in the use of medical cannabis for cancer pain management, including its potential to ameliorate race-based disparities in cancer pain control. Although medical cannabis is not currently a US Food and Drug Administration-approved treatment option for cancer-related pain, many oncologists discuss and recommend its use with their patients, underscoring the need for researchers and clinicians to proactively identify barriers to cannabis for cancer pain management that may disproportionately affect patients from certain racial groups. In this commentary, we highlight challenges that patients from racialized backgrounds may face when incorporating cannabis into their palliative care regimens and discuss opportunities for researchers and clinicians to address these challenges should medical cannabis become a recommended treatment option for cancer pain management. In particular, we identify challenges at the structural (eg, lack of insurance coverage), clinician (eg, racialized stereotypes regarding addiction and pain), and individual (eg, internalized stigma) levels and emphasize the importance of multilevel approaches in combating these challenges as the evidence base regarding medical cannabis and its potential harms and therapeutic benefits continues to accumulate.
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Affiliation(s)
- Laurel P Gibson
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | - Rebecca A Ferrer
- Basic Biobehavioral and Psychological Sciences Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Salimah H Meghani
- Department of Biobehavioral Health Sciences, NewCourtland Center for Transitions and Health, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Amanda M Acevedo
- Basic Biobehavioral and Psychological Sciences Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
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3
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Adu P, Jurcik T, Demah E, Korang PT, Grigoryev D. Mental health literacy for social phobia in Ghana: Investigation of gender stereotypes and previous experience for recognition rates and prejudice. Int J Soc Psychiatry 2024; 70:271-281. [PMID: 37968913 PMCID: PMC10913351 DOI: 10.1177/00207640231206055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
BACKGROUND Mental health literacy (MHL) research has been of substantial interest internationally. Nevertheless, the interplay between beliefs, attitudes, previous experience with mental disorders, and knowledge of Ghanaians on specific mental disorders remains to be understood. The present study explored the interconnectedness between gender stereotypes, prejudice, previous experience with social phobia, and MHL among the general population in Ghana. METHOD Six hundred and one Ghanaians were recruited for an online experimental study design using a survey approach for data gathering. Respondents were randomly assigned to one of the two conditions (i.e., male and female vignettes) depicting symptoms of social phobia for a hypothetical person. Participants further completed self-reported measures including gender stereotypes (based on Ambivalent Sexism Inventory) and prejudice. RESULTS Results revealed a 15.5% recognition rate for social phobia. Recognition rates of social phobia did not differ by the experimental condition or by the gender of participants. However, personal experience of social phobia was positively related to an increased likelihood of correctly labeling social phobia among men in the female vignette condition, whereas correct recognition of social phobia was negatively related to prejudice among women in the male vignette condition. In the male vignette condition, men with more hostile sexism attitudes toward men exhibited more prejudice toward their hypothetical male counterpart. In contrast, women with hostile sexism attitudes toward men exhibited less prejudice, but greater benevolent sexism attitudes toward men was associated with more prejudice toward the hypothetical male in the vignette. CONCLUSION Findings from the current study emphasize the role of the cultural milieu in shaping effective mental health interventions. The results also have implications for promoting MHL to reduce prejudice in Ghana and other developing countries in the region.
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Affiliation(s)
- Peter Adu
- School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
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4
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Saldaña-Téllez M, Meneses-Navarro S, Cano-Garduño L, Unger-Saldaña K. Barriers and facilitators for breast cancer early diagnosis in an indigenous community in Mexico: voices of otomí women. BMC Womens Health 2024; 24:33. [PMID: 38218790 PMCID: PMC10787990 DOI: 10.1186/s12905-023-02875-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 12/29/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Literature on barriers and facilitators for early detection of Breast Cancer (BC) among indigenous women is very scarce. This study aimed to identify barriers and facilitators for BC early diagnosis as perceived by women of the otomí ethnic group in Mexico. METHODS We performed an exploratory qualitative study. Data was collected in 2021 through three focus group interviews with 19 otomí women. The interview transcripts were analyzed using the constant comparison method and guided by a conceptual framework that integrates the Social Ecological Model (SEM), the Health Belief Model and the Institute of Medicine's Healthcare Quality Framework. RESULTS Barriers and facilitators were identified at several levels of the SEM. Among the main barriers reported by the study participants were: beliefs about illness, cancer stigma, cultural gender norms, access barriers to medical care, and mistreatment and discrimination by health care personnel. Our participants perceived as facilitators: information provided by doctors, social support, perceived severity of the disease and perceived benefits of seeking care for breast symptoms. CONCLUSIONS Healthcare policies need to be responsive to the particular barriers faced by indigenous women in order to improve their participation in early detection and early help-seeking of care for breast symptoms. Measures to prevent and eradicate all forms of discrimination in healthcare are required to improve the quality of healthcare provided and the trust of the indigenous population in healthcare practitioners.
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Affiliation(s)
| | - Sergio Meneses-Navarro
- CONAHCYT (National Council of Science and Technology)-Center for Research in Health Systems, National Institute of Public Health, Mexico City, Mexico
| | - Leonor Cano-Garduño
- CEDIPIEM (Center for the Development of the Indigenous People of the State of Mexico), Mexico City, Mexico
| | - Karla Unger-Saldaña
- CONAHCYT (National Council of Science, Humanities and Technology), National Cancer Institute, Mexico City, Mexico.
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5
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Del Toro-Rodríguez A, Prados G, Cambil Martín J, Mendoza-Vinces Á, Fernández-Puerta L. [Association between ageism and sexism in university students]. Rev Esp Geriatr Gerontol 2024; 59:101432. [PMID: 37925782 DOI: 10.1016/j.regg.2023.101432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/24/2023] [Accepted: 10/04/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND AND AIMS Ageism is the negative perception towards others based on age. The aim of this research was to analyze the levels of ageism and its association with sexism and other factors in university students. MATERIALS AND METHODS Cross-sectional study among the students of the University of Granada. The data was collected through an online survey. Information on sociodemographic and academic variables was collected together with the Negative Stereotypes Questionnaire towards Old Age (CENVE), the Ambivalent Sexism Scale (ASI), the Brief Version of the Big Five Personality Inventory (BFPTSQ), the Anxiety Scale for Aging (AE) and the Contact with the Elderly Scale (CPM). Ageism levels were determined and associations with other variables were analyzed. A logistic regression model explored ageism' associated factors. RESULTS Two hundred and sixty-three students participated. Most had low or very low levels of ageism (83.3%). The most ageist students showed higher hostile sexism (OR=1.07; p<.01) and higher aging anxiety (OR=1.10; p<.05) than students with high scores in ageism. Graduate students showed protector OR for ageism when compared to postgraduate students (OR=.31; p<.05). CONCLUSIONS Higher hostile sexism and aging anxiety are associated with higher ageism in students from the University of Granada. Universities must include in their study plans knowledge about this problem and develop programs aimed at avoiding discrimination in the elderly.
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Affiliation(s)
- Ainhoa Del Toro-Rodríguez
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Granada, Granada, España
| | - Germán Prados
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Granada, Granada, España.
| | - Jacobo Cambil Martín
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Granada, Granada, España
| | - Ángela Mendoza-Vinces
- Departamento de Enfermería, Facultad de Ciencias Médicas, Carrera de Enfermería, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador
| | - Laura Fernández-Puerta
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Granada, Granada, España
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Ginsburg O, Vanderpuye V, Beddoe AM, Bhoo-Pathy N, Bray F, Caduff C, Florez N, Fadhil I, Hammad N, Heidari S, Kataria I, Kumar S, Liebermann E, Moodley J, Mutebi M, Mukherji D, Nugent R, So WKW, Soto-Perez-de-Celis E, Unger-Saldaña K, Allman G, Bhimani J, Bourlon MT, Eala MAB, Hovmand PS, Kong YC, Menon S, Taylor CD, Soerjomataram I. Women, power, and cancer: a Lancet Commission. Lancet 2023; 402:2113-2166. [PMID: 37774725 DOI: 10.1016/s0140-6736(23)01701-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 06/27/2023] [Accepted: 08/11/2023] [Indexed: 10/01/2023]
Affiliation(s)
- Ophira Ginsburg
- Centre for Global Health, US National Cancer Institute, Rockville, MD, USA.
| | | | | | | | - Freddie Bray
- International Agency for Research on Cancer, Lyon, France
| | - Carlo Caduff
- Department of Global Health and Social Medicine, King's College London, London, UK
| | - Narjust Florez
- Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | - Nazik Hammad
- Department of Medicine, Division of Hematology-Oncology, St. Michael's Hospital, University of Toronto, Canada; Department of Oncology, Queens University, Kingston, Canada
| | - Shirin Heidari
- GENDRO, Geneva, Switzerland; Gender Centre, Geneva Graduate Institute, Geneva, Switzerland
| | - Ishu Kataria
- Center for Global Noncommunicable Diseases, RTI International, New Delhi, India
| | - Somesh Kumar
- Jhpiego India, Johns Hopkins University Affiliate, Baltimore, MD, USA
| | - Erica Liebermann
- University of Rhode Island College of Nursing, Providence, RI, USA
| | - Jennifer Moodley
- Cancer Research Initiative, Faculty of Health Sciences, School of Public Health and Family Medicine, and SAMRC Gynaecology Cancer Research Centre, University of Cape Town, Cape Town, South Africa
| | - Miriam Mutebi
- Department of Surgery, Aga Khan University, Nairobi, Kenya
| | - Deborah Mukherji
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon; Clemenceau Medical Center Dubai, Dubai, United Arab Emirates
| | - Rachel Nugent
- Center for Global Noncommunicable Diseases, RTI International, Durham, NC, USA; Department of Global Health, University of Washington, Seattle, WA, USA
| | - Winnie K W So
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong Special Administrative Region, China
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, National Institute of Medical Science and Nutrition Salvador Zubiran, Mexico City, Mexico
| | | | - Gavin Allman
- Center for Global Noncommunicable Diseases, RTI International, Durham, NC, USA
| | - Jenna Bhimani
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - María T Bourlon
- Department of Hemato-Oncology, National Institute of Medical Science and Nutrition Salvador Zubiran, Mexico City, Mexico
| | - Michelle A B Eala
- College of Medicine, University of the Philippines, Manila, Philippines; Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Yek-Ching Kong
- Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Sonia Menon
- Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
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Hutchens J, Frawley J, Sullivan EA. Is self-advocacy universally achievable for patients? The experiences of Australian women with cardiac disease in pregnancy and postpartum. Int J Qual Stud Health Well-being 2023; 18:2182953. [PMID: 36821349 PMCID: PMC9970247 DOI: 10.1080/17482631.2023.2182953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
PURPOSE Patient self-advocacy is valued and promoted; however, it may not be readily accessible to all. This analysis examines the experiences of women in Australia who had cardiac disease in pregnancy or the first year postpartum through the lenses of self-advocacy and gender, specifically seeking to elaborate on the contexts, impacts, barriers, and women's responses to the barriers to self-advocacy. METHOD A qualitative study design was used. Twenty-five women participated in semi-structured in-depth interviews. Data were analysed using thematic analysis. RESULTS Analysis of findings generated the following themes: 1) Silent dream scream, 2) Easier said than done, 3) Crazy-making, and 4) Concentric circles of advocacy. Regardless of women's personal attributes, knowledge and experience, self-advocating for their health was complex and difficult and had negative cardiac and psychological outcomes. CONCLUSION While the women encountered significant barriers to self-advocating, they were resilient and ultimately developed strategies to be heard and to advocate on their own behalf and that of other women. Findings can be used to identify ways to support women to self-advocate and to provide adequately resourced and culturally safe environments to enable healthcare professionals to provide person-centred care.
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Affiliation(s)
- Jane Hutchens
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, Australia,CONTACT Jane Hutchens School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Jane Frawley
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, Australia
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Barreto M. Statutory mental health services in the UK do not meet the needs of people from ethnic minority groups. Evid Based Nurs 2023; 26:157. [PMID: 37258088 DOI: 10.1136/ebnurs-2023-103697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 06/02/2023]
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9
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Janssen NP, Oude Voshaar RC, Wassink-Vossen S, Hendriks GJ. Functional improvement by behavioural activation for depressed older adults. Eur Psychiatry 2023; 66:e62. [PMID: 37496446 PMCID: PMC10594265 DOI: 10.1192/j.eurpsy.2023.2433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Recovery in mental health care comprises more than symptomatic improvement, but preliminary evidence suggests that only collaborative care may improve functioning of depressed older adults. This study therefore evaluates the effectiveness of behavioural activation (BA) on functional limitations in depressed older adults in primary care. METHODS This study uses data from a multicentre cluster randomised controlled trial in which 59 primary care centres (PCCs) were randomised to BA and treatment as usual (TAU), and 161 consenting older (≥65 years) adults with clinically relevant symptoms of depression participated. Interventions were an eight-week individual BA programme by a mental health nurse (MHN) and unrestricted TAU. The outcome was self-reported functional limitations (WHODAS 2.0) at post-treatment (9 weeks) and at 12-month follow-up. RESULTS At the end of treatment, the BA participants reported significantly fewer functional limitations than TAU participants (WHODAS 2.0 difference -3.62, p = 0.01, between-group effect size = 0.39; 95% CI = 0.09-0.69). This medium effect size decreases during follow-up resulting in a small and non-significant effect at the 12-month follow-up (WHODAS 2.0 difference = -2.22, p = 0.14, between-group effect size = 0.24; 95% CI = -0.08-0.56). MoCA score moderated these results, indicating that the between-group differences were merely driven by those with no cognitive impairment. CONCLUSIONS Compared to TAU, BA leads to a faster improvement of functional limitations in depressed older adults with no signs of cognitive decline. Replication of these findings in confirmatory research is needed.
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Affiliation(s)
- Noortje P. Janssen
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- Department of Primary and Community Care, Research Institute of Health Sciences, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
- Institute for Integrated Mental Health Care Pro Persona, Nijmegen, The Netherlands
| | - Richard C. Oude Voshaar
- Department of Psychiatry, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Sanne Wassink-Vossen
- Department of Old Age Psychiatry, GGNet Mental Health, Warnsveld, The Netherlands
| | - Gert-Jan Hendriks
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- Institute for Integrated Mental Health Care Pro Persona, Nijmegen, The Netherlands
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10
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Kalff MC, Dijksterhuis WPM, Wagner AD, Oertelt-Prigione S, Verhoeven RHA, Lemmens VEPP, van Laarhoven HWM, Gisbertz SS, van Berge Henegouwen MI. Sex differences in treatment allocation and survival of potentially curable gastroesophageal cancer: A population-based study. Eur J Cancer 2023; 187:114-123. [PMID: 37146505 DOI: 10.1016/j.ejca.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 03/31/2023] [Accepted: 04/04/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Although curative treatment options are identical for male and female gastroesophageal cancer patients, access to care and survival may vary. This study aimed to compare treatment allocation and survival between male and female patients with potentially curable gastroesophageal cancer. METHODS Nationwide cohort study including all patients with potentially curable gastroesophageal squamous cell or adenocarcinoma diagnosed between 2006 and 2018 registered in the Netherlands Cancer Registry. The main outcome, treatment allocation, was compared between male and female patients with oesophageal adenocarcinoma (EAC), oesophageal squamous cell carcinoma (ESCC), and gastric adenocarcinoma (GAC). Additionally, 5-year relative survival with relative excess risk (RER), that is, adjusted for the normal life expectancy, was compared. RESULTS Among 27,496 patients (68.8% men), most were allocated to curative treatment (62.8%), although rates dropped to 45.6%>70 years. Curative treatment rates were comparable among younger male and female patients (≤70 years) with gastroesophageal adenocarcinoma, while older females with EAC were less frequently allocated to curative treatment than males (OR = 0.85, 95% confidence interval [CI] 0.73-0.99). For those allocated to curative treatment, relative survival was superior for female patients with EAC (RER = 0.88, 95% CI 0.80-0.96) and ESCC (RER = 0.82, 95% CI 0.75-0.91), and comparable for males and females with GAC (RER = 1.02, 95% CI 0.94-1.11). CONCLUSIONS While curative treatment rates were comparable between younger male and female patients with gastroesophageal adenocarcinoma, treatment disparities were present between older patients. When treated, the survival of females with EAC and ESCC was superior to males. The treatment and survival gaps between male and female patients with gastroesophageal cancer warrant further exploration and could potentially improve treatment strategies and survival.
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Affiliation(s)
- Marianne C Kalff
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; Cancer Center Amsterdam, de Boelelaan 1118, 1081 HV Amsterdam, The Netherlands.
| | - Willemieke P M Dijksterhuis
- Cancer Center Amsterdam, de Boelelaan 1118, 1081 HV Amsterdam, The Netherlands; Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT Utrecht, The Netherlands
| | - Anna D Wagner
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Sabine Oertelt-Prigione
- Department of Primary and Community Care, Radboud Institute of Health Sciences (RIHS), Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands; Sex, and Gender-Sensitive Medicine, Medical Faculty OWL, University of Bielefeld, Universitätsstraße 25, 33615 Bielefeld, Germany
| | - Rob H A Verhoeven
- Cancer Center Amsterdam, de Boelelaan 1118, 1081 HV Amsterdam, The Netherlands; Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT Utrecht, The Netherlands
| | - Valery E P P Lemmens
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT Utrecht, The Netherlands; Department of Public Health, Erasmus MC, Erasmus University, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Hanneke W M van Laarhoven
- Cancer Center Amsterdam, de Boelelaan 1118, 1081 HV Amsterdam, The Netherlands; Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Suzanne S Gisbertz
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; Cancer Center Amsterdam, de Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | - Mark I van Berge Henegouwen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; Cancer Center Amsterdam, de Boelelaan 1118, 1081 HV Amsterdam, The Netherlands.
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Spiropoulos A, Deleemans J, Beattie S, Carlson LE. Mothers with Cancer: An Intersectional Mixed-Methods Study Investigating Role Demands and Perceived Coping Abilities. Cancers (Basel) 2023; 15:cancers15061915. [PMID: 36980801 PMCID: PMC10047435 DOI: 10.3390/cancers15061915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/10/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
Mothers with cancer report guilt associated with failing to successfully balance their parental roles and cancer. This study utilized a cross-sectional mixed-methods design and intersectional framework to investigate the multiple roles that mothers with cancer assume and their perceived coping ability. Participants included mothers diagnosed with any type or stage of cancer, in treatment or ≤3 years post-treatment, and experiencing cancer-related disability with a dependent child (<18 years, living at home). Participants completed a questionnaire battery, semi-structured interview, and optional focus group. Descriptive statistics, correlations, and thematic inductive analyses are reported. The participants' (N = 18) mean age was 45 years (SD = 5.50), and 67% were in active treatment. Their role participation (M = 42.74, ±6.21), role satisfaction (M = 43.32, ±5.61), and self-efficacy (M = 43.34, ±5.62) were lower than the general population score of 50. Greater role participation and higher role satisfaction were positively correlated (r = 0.74, p ≤ 0.001). A qualitative analysis revealed that the mothers retained most roles, and that their quality of life depended on their capacity to balance those roles through emotion-focused and problem-focused coping. We developed the intersectional Role Coping as a Mother with Cancer (RCMC) model, which has potential research and clinical utility.
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Affiliation(s)
- Athina Spiropoulos
- Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Julie Deleemans
- Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Sara Beattie
- Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Tom Baker Cancer Centre, Alberta Health Services, Calgary, AB T2N 4N2, Canada
| | - Linda E Carlson
- Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
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Conroy LM, Ghafir D, Narayan M, McSpedden H, Neher S, Hashmi SS, Lunstroth R. A Student-Designed Multimodal Sex- and Gender-Based Women's Health Elective Program: Advocacy Curriculum for Medical Students. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2023; 10:23821205231221370. [PMID: 38152833 PMCID: PMC10752131 DOI: 10.1177/23821205231221370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 11/29/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVES The objective of this article is to describe the design and implementation of a multimodal, student-driven, sex- and gender-based women's health (SGBWH) elective with a curricular focus on patient and legislative advocacy. In this single arm, pre/post design, interventional study, we detail and evaluate the use of social media, newsletters, and round-table discussions in conjunction with a traditional lecture-based educational format to engage medical students in a virtual learning environment. METHODS We developed a 22-week SGBWH curriculum for pre-clinical and clinical medical students, which included a series of lectures on multi-specialty and gender-inclusive topics related to SGBWH, small group discussions with community leaders and legislators involved in women's health advocacy, and other self-directed resources such as social media, a website, and digital newsletters. Students were surveyed before and after completing the curriculum to assess for increases in self-reported confidence in advocating for their female and gender minority patients. RESULTS AND CONCLUSION One hundred and one students completed the anonymous pre- and post-elective surveys. There was statistically significant improvement in 8 of the 12 self-reported confidence measures. Eight (8%) participants identified their sex as male. Fifty-five (55%) participants stated future interest in primary care specialties (Internal Medicine, Family Medicine, Obstetrics and Gynecology, and Pediatrics). Our curriculum improved medical students' self-reported confidence in advocating for their female and gender minority patients when controlling for sex and specialty interest of participants. The success of our multimodal approach demonstrates the value in incorporating resources such as social media as tools for education and advocacy in the evolving landscape of medical education.
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Affiliation(s)
| | - Danna Ghafir
- McGovern Medical School at UTHealth, Houston, TX, USA
| | | | | | - Samuel Neher
- McGovern Medical School at UTHealth, Houston, TX, USA
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Sánchez De Miguel M, Orkaizagirre-Gomara A, Izagirre-Otaegi A, Ortiz de Elguea-Díaz FJ, Badiola-Etxaburu I, Gómez-Gastiasoro A. Development, Application and Evaluation of an Active Learning Methodology for Health Science Students, Oriented towards Equity and Cultural Diversity in the Treatment and Care of Geriatric Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14573. [PMID: 36361451 PMCID: PMC9656949 DOI: 10.3390/ijerph192114573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 10/31/2022] [Accepted: 11/03/2022] [Indexed: 06/16/2023]
Abstract
The increased aging of populations and rises in immigration have prompted the design of new methodologies and instruments for fostering the invisible care of geriatric patients among health science students in accordance with the 2030 Agenda and the SDGs. A total of 656 psychology, nursing and dentistry students participated in this study, which had a pretest-posttest design and was implemented over the course of three academic years. The intervention groups received training using an active learning methodology based on a case study involving a geriatric patient; specifically, a Maghrebi woman. The control groups were not exposed to the case study. The CCI-U questionnaire was designed ad hoc to evaluate the acquisition of invisible competences for caring for geriatric patients in accordance with their age, sex, emotional situation and ethnic origin. The questionnaire had a reliability of α = 0.63 to 0.72 and its factor solution was found to have a good fit. Students in the intervention groups scored higher than those in the control groups, with the difference being statistically significant for ethnic origin in all three undergraduate courses and all three academic years. The proper application of this active learning methodology fosters the invisible care of geriatric patients among students in accordance with the 2030 Agenda.
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Affiliation(s)
- Manuel Sánchez De Miguel
- Department of Basic Psychological Processes, Faculty of Psychology, University of the Basque Country, 20018 Donostia-San Sebastian, Spain
- Biodonostia Health Research Institute, 20014 Donostia-San Sebastian, Spain
| | - Aintzane Orkaizagirre-Gomara
- Department of Clinical Nursing-II, Faculty of Medicine and Nursing, University of the Basque Country, 20018 Donostia-San Sebastian, Spain
| | - Andrea Izagirre-Otaegi
- Department of Clinical Nursing-II, Faculty of Medicine and Nursing, University of the Basque Country, 20018 Donostia-San Sebastian, Spain
| | | | - Iker Badiola-Etxaburu
- Department of Cellular Biology and Histology (Dentistry), Faculty of Medicine and Nursing, University of the Basque Country, 48940 Leioa-Bilbao, Spain
| | - Ainara Gómez-Gastiasoro
- Department of Basic Psychological Processes, Faculty of Psychology, University of the Basque Country, 20018 Donostia-San Sebastian, Spain
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Persson T, Löve J, Tengelin E, Hensing G. Notions About Men and Masculinities Among Health Care Professionals Working With Men's Sexual Health: A Focus Group Study. Am J Mens Health 2022; 16:15579883221101274. [PMID: 35726805 PMCID: PMC9218462 DOI: 10.1177/15579883221101274] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Health care professionals’ (HCPs) notions about gender may influence the provision and quality of care. If care-seeking men are met by HCPs holding idealized and stereotypical notions of masculinity, this could reinforce barriers to adequate care. This study explored notions about men and masculinities among HCPs working with men’s sexual health in Sweden. Focus group interviews with 35 HCPs from primary health and sexual health clinics were analyzed using qualitative content analysis. The analysis resulted in three descriptive themes: (a) Contradictory masculinity—elusive but clear. Notions of masculinity as a phenomenon or concept were elusive, but masculine and un-masculine traits, behaviors, and qualities were clear. (b) Sexual health care is a social place where men and masculinities can be challenging. Male patients were associated with unwanted sexual tensions. Masculinity could challenge professionality. Seeking sexual health care was perceived as doing un-masculinity. (c) Regarding masculinity as irrelevant—a difficult ambition to achieve. Participants strived for gender-neutrality by regarding patients as humans, individuals, or patients rather than as men and masculine. The analysis also identified a theme of meaning: Notions of masculinity are situated relationally. HCPs situate masculinity in real and hypothetical relationships. Romantic and sexual preferences were used to define preferred masculinity. This study identified themes that showed how HCPs balanced professional and private notions of men and masculinity in their patient encounters. Increased gender awareness and training are needed to professionalize the management of gendered notions in encounters with men who seek care for sexual health problems.
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Affiliation(s)
- Tommy Persson
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Knowledge Center for Sexual Health, Gothenburg, Sweden
| | - Jesper Löve
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ellinor Tengelin
- Department for Health Sciences, University West, Trollhättan, Sweden
| | - Gunnel Hensing
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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“Broken”—How Identities as Women, Mothers and Partners Are Intertwined with the Experience of Living with and Seeking Treatment for Pelvic Organ Prolapse. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095179. [PMID: 35564573 PMCID: PMC9100064 DOI: 10.3390/ijerph19095179] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/12/2022] [Accepted: 04/15/2022] [Indexed: 02/01/2023]
Abstract
Pelvic Organ Prolapse (POP) occurs when one or more pelvic organs descend into or through the vaginal opening, significantly impacting physical and mental health. POP affects the female reproductive tract and, overwhelmingly, people who identify as women. However, little research has examined the impact of gendered expectations on women’s treatment-seeking for POP and their decision-making around surgery for POP. To address this gap, we conducted semi-structured interviews with 26 women seeking surgery for POP in Alberta, Canada. Data were analyzed from a gender-based lens, using the Framework Method. Participants reported the need to balance their identities as women, partners, and mothers in their pursuit of treatment and faced many barriers to treatment related to their gendered responsibilities. Findings highlight the gendered experiences of prolapse in the context of healthcare needs and can inform policies and practices which promote more equitable access to prolapse treatment.
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Leitch S, Zeng J, Smith A, Stokes T. Medication risk management and health equity in New Zealand general practice: a retrospective cross-sectional study. Int J Equity Health 2021; 20:119. [PMID: 33975606 PMCID: PMC8111894 DOI: 10.1186/s12939-021-01461-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite an overt commitment to equity, health inequities are evident throughout Aotearoa New Zealand. A general practice electronic alert system was developed to notify clinicians about their patient's risk of harm due to their pre-existing medical conditions or current medication. We aimed to determine whether there were any disparities in clinician action taken on the alert based on patient ethnicity or other demographic factors. METHODS Sixty-six New Zealand general practices from throughout New Zealand participated. Data were available for 1611 alerts detected for 1582 patients between 1 and 2018 and 1 July 2019. The primary outcome was whether action was taken following an alert or not. Logistic regression was used to assess if patients of one ethnicity group were more or less likely to have action taken. Potential confounders considered in the analyses include patient age, gender, ethnicity, socio-economic deprivation, number of long term diagnoses and number of long term medications. RESULTS No evidence of a difference was found in the odds of having action taken amongst ethnicity groups, however the estimated odds for Māori and Pasifika patients were lower compared to the European group (Māori OR 0.88, 95 %CI 0.63-1.22; Pasifika OR 0.88, 95 %CI 0.52-1.49). Females had significantly lower odds of having action taken compared to males (OR 0.76, 95 %CI 0.59-0.96). CONCLUSIONS This analysis of data arising from a general practice electronic alert system in New Zealand found clinicians typically took action on those alerts. However, clinicians appear to take less action for women and Māori and Pasifika patients. Use of a targeted alert system has the potential to mitigate risk from medication-related harm. Recognising clinician biases may improve the equitability of health care provision.
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Affiliation(s)
- Sharon Leitch
- Department of General Practice and Rural Health, Otago Medical School - Dunedin Campus, University of Otago, Dunedin, New Zealand.
| | - Jiaxu Zeng
- Department of Preventive and Social Medicine, Otago Medical School - Dunedin Campus, University of Otago, Dunedin, New Zealand
| | - Alesha Smith
- School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Tim Stokes
- Department of General Practice and Rural Health, Otago Medical School - Dunedin Campus, University of Otago, Dunedin, New Zealand
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Alcalde-Rubio L, Hernández-Aguado I, Parker LA, Bueno-Vergara E, Chilet-Rosell E. Gender disparities in clinical practice: are there any solutions? Scoping review of interventions to overcome or reduce gender bias in clinical practice. Int J Equity Health 2020; 19:166. [PMID: 32962719 PMCID: PMC7510055 DOI: 10.1186/s12939-020-01283-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 09/15/2020] [Indexed: 12/11/2022] Open
Affiliation(s)
- Lorena Alcalde-Rubio
- Department of Public Health, History of Science and Gynaecology, School of Medicine, University Miguel Hernández, Crta Nacional, N-332, s/n, 03550, Sant Joan d'Alacant, Spain
| | - Ildefonso Hernández-Aguado
- Department of Public Health, History of Science and Gynaecology, School of Medicine, University Miguel Hernández, Crta Nacional, N-332, s/n, 03550, Sant Joan d'Alacant, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Lucy Anne Parker
- Department of Public Health, History of Science and Gynaecology, School of Medicine, University Miguel Hernández, Crta Nacional, N-332, s/n, 03550, Sant Joan d'Alacant, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Eduardo Bueno-Vergara
- Department of Public Health, History of Science and Gynaecology, School of Medicine, University Miguel Hernández, Crta Nacional, N-332, s/n, 03550, Sant Joan d'Alacant, Spain
| | - Elisa Chilet-Rosell
- Department of Public Health, History of Science and Gynaecology, School of Medicine, University Miguel Hernández, Crta Nacional, N-332, s/n, 03550, Sant Joan d'Alacant, Spain. .,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
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Role of gender in perspectives of discrimination, stigma, and attitudes relative to cervical cancer in rural Sénégal. PLoS One 2020; 15:e0232291. [PMID: 32343755 PMCID: PMC7188246 DOI: 10.1371/journal.pone.0232291] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 04/11/2020] [Indexed: 12/24/2022] Open
Abstract
Cervical cancer is the leading cause of female cancer deaths in Sénégal which is ranked 17th in incidence globally, however, the screening rate there is very low. Nuanced gendered perceptions and health behaviors of both women and men play a significant role in women's health. Our study analyzed gender differences on perceptions of gender roles, discrimination, cancer attitudes, cancer stigma, and influences in healthcare decision making within our study population to inform ongoing cervical cancer prevention work in the rural region of Kédougou, Sénégal. We conducted a cross-sectional survey of 158 participants, 101 women and 57 men (ages 30-59) across nine non-probability-sampled communities from October 2018 through February 2019. Bivariate analysis was conducted to assess gender differences across all variables. We also conducted analyses to determine whether there were significant differences in beliefs and attitudes, by screening behavior and by education. We found significant gender differences regarding the perception of a woman's role (P < 0.001) and a man's role (P = 0.007) as well as in the everyday discrimination questions of "decreased respect by spouse" (P < 0.001). Regarding cancer stigma, among women, 18.00% disagreed and 10.00% strongly disagreed while among men, 3.6% disagreed and 1.8% strongly disagreed that "If I had cancer, I would want my family to know that I have it." When making decisions about one's healthcare, women are more likely than men to trust social contacts such as their spouse (46.5% vs 5.3%, p < 0.001) while men are more likely than women to trust health service personnel such as a nurse (50.9% vs 18.8%, p < 0.001). Furthermore, men and women were both more likely to state that men have the final decision regarding the healthcare decisions of women (p < 0.001). Our data reveal structural disadvantages for women within our study population as well as gender differences in the adapted everyday discrimination scale and cancer stigma scale. Higher rates of both personal and perceived cancer stigma among women has profound implications for how population and community level communication strategies for cancer prevention and control should be designed. Efforts to advance the goal of the elimination of cervical cancer should, in the short-term, seek to gain a more profound understanding of the ways that gender, language, and other social determinants impact negative social influences and other barriers addressable through interventions. Social and behavior change communication may be one approach that can focus both on education while seeking to leverage the social influences that exist in achieving immediate and long-term goals.
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Heise L, Greene ME, Opper N, Stavropoulou M, Harper C, Nascimento M, Zewdie D. Gender inequality and restrictive gender norms: framing the challenges to health. Lancet 2019; 393:2440-2454. [PMID: 31155275 DOI: 10.1016/s0140-6736(19)30652-x] [Citation(s) in RCA: 434] [Impact Index Per Article: 86.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/01/2019] [Accepted: 03/06/2019] [Indexed: 02/07/2023]
Abstract
Gender is not accurately captured by the traditional male and female dichotomy of sex. Instead, it is a complex social system that structures the life experience of all human beings. This paper, the first in a Series of five papers, investigates the relationships between gender inequality, restrictive gender norms, and health and wellbeing. Building upon past work, we offer a consolidated conceptual framework that shows how individuals born biologically male or female develop into gendered beings, and how sexism and patriarchy intersect with other forms of discrimination, such as racism, classism, and homophobia, to structure pathways to poor health. We discuss the ample evidence showing the far-reaching consequences of these pathways, including how gender inequality and restrictive gender norms impact health through differential exposures, health-related behaviours and access to care, as well as how gender-biased health research and health-care systems reinforce and reproduce gender inequalities, with serious implications for health. The cumulative consequences of structured disadvantage, mediated through discriminatory laws, policies, and institutions, as well as diet, stress, substance use, and environmental toxins, have triggered important discussions about the role of social injustice in the creation and maintenance of health inequities, especially along racial and socioeconomic lines. This Series paper raises the parallel question of whether discrimination based on gender likewise becomes embodied, with negative consequences for health. For decades, advocates have worked to eliminate gender discrimination in global health, with only modest success. A new plan and new political commitment are needed if these global health aspirations and the wider Sustainable Development Goals of the UN are to be achieved.
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Affiliation(s)
- Lori Heise
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins School of Nursing, Baltimore, MD, USA.
| | | | - Neisha Opper
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - Maria Stavropoulou
- Programme on Gender Equality and Social Inclusion, Overseas Development Institute, London, UK
| | - Caroline Harper
- Programme on Gender Equality and Social Inclusion, Overseas Development Institute, London, UK
| | - Marcos Nascimento
- Programa de Posgraduação em Saúde da Criança e da Mulher, Instituto Fernandes Figueira-Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Debrework Zewdie
- School of Public Health and Health Policy, City University of New York, New York, NY, USA
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Lešnik A, Tomažič J. Starizem v zdravstvenih ustanovah. OBZORNIK ZDRAVSTVENE NEGE 2017. [DOI: 10.14528/snr.2017.51.4.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Uvod: Starizem izhaja iz predsodkov in stereotipov o lastnostih, ki jih na podlagi kronološke starosti pripisujemo starostnikom. Namen raziskave je bil ugotoviti, ali starostniki v kliničnem okolju doživljajo starizem in v kolikšni meri jih le-ta prizadene. Metode: Opisna kvantitativna raziskava je bila izvedena v zdravstveni ustanovi na priložnostnem vzorcu 132 starostnikov, starih od 65 do 90 let. Uporabljen je bil na podlagi pregleda literature zasnovan vprašalnik z 11 vprašanji zaprtega tipa. Prisotnost starizma in stopnja prizadetosti je bila merjena s tristopenjsko številsko lestvico. Za opis vzorca in sistematičen prikaz odgovorov na raziskovalna vprašanja je bila uporabljena deskriptivna univariatna in bivariatna (hi-kvadrat test za neodvisne vzorce) analiza. Rezultati: Skupno je bilo zaznanih 319 diskriminatornih dogodkov. Od 132 anketiranih je najmanj en diskriminatorni dogodek doživelo 91 (69,0 %) starostnikov. Med slednjimi se je 40 (44,0 %) starostnikov počutilo vsaj enkrat prizadeto in 23 (25,2 %) vsaj enkrat zelo prizadeto. Pri zaznavanju prizadetosti statistično pomembne razlike med skupinami glede na spol (χ2 = 13,554, p = 0,825), izobrazbo (χ2 = 20,807, p = 0,409) in starost (χ2 =19,328, p = 0,501) nismo ugotovili. Diskusija in zaključek: Raziskava potrdi prisotnost starizma v kliničnem okolju. Ker ima starizem negativen vpliv na odnos do starostnika in kakovost njegove oskrbe, je profesionalno komunikacijo s starostniki treba uvesti v izobraževanje vseh profilov zdravstvenih delavcev.
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Koning C, Young LE, Butcher D. Prevalence of acute and prodromal myocardial infarctions symptoms in adult women with confirmed diagnoses: a systematic review protocol. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2016; 14:61-68. [PMID: 27532650 DOI: 10.11124/jbisrir-2016-002569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
REVIEW QUESTION/OBJECTIVE The purpose of this review is to systematically review literature to determine the period of prevalence of prodromal and acute symptoms experienced by adult women diagnosed with an acute myocardial infarction (AMI).More specifically, the objective of this descriptive review is to assess the prevalence and describe the distribution of prodromal and acute symptoms experienced by adult women during an AMI event, evident in documented literature between 1994 and the present date.The specific question for this review is: how common and how are prodromal and acute symptoms of an AMI distributed in adult women diagnosed with an AMI? CENTER CONDUCTING THE REVIEW University of Victoria and the Queen's Joanna Briggs Collaboration for Patient Safety: a Collaborating Centre of the Joanna Briggs Institute.
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Affiliation(s)
- Clare Koning
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
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Pilgrim T, Heg D, Tal K, Erne P, Radovanovic D, Windecker S, Jüni P. Age- and Gender-related Disparities in Primary Percutaneous Coronary Interventions for Acute ST-segment elevation Myocardial Infarction. PLoS One 2015; 10:e0137047. [PMID: 26352574 PMCID: PMC4564139 DOI: 10.1371/journal.pone.0137047] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 07/20/2015] [Indexed: 01/12/2023] Open
Abstract
Background Previous analyses reported age- and gender-related differences in the provision of cardiac care. The objective of the study was to compare circadian disparities in the delivery of primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) according to the patient’s age and gender. Methods We investigated patients included into the Acute Myocardial Infarction in Switzerland (AMIS) registry presenting to one of 11 centers in Switzerland providing primary PCI around the clock, and stratified patients according to gender and age. Findings A total of 4723 patients presented with AMI between 2005 and 2010; 1319 (28%) were women and 2172 (54%) were ≥65 years of age. More than 90% of patients <65 years of age underwent primary PCI without differences between gender. Elderly patients and particularly women were at increased risk of being withheld primary PCI (males adj. HR 4.91, 95% CI 3.93–6.13; females adj. HR 9.31, 95% CI 7.37–11.75) as compared to males <65 years of age. An increased risk of a delay in door-to-balloon time >90 minutes was found in elderly males (adj HR 1.66 (95% CI 1.40–1.95), p<0.001) and females (adj HR 1.57 (95% CI 1.27–1.93), p<0.001), as well as in females <65 years (adj HR 1.47 (95% CI 1.13–1.91), p = 0.004) as compared to males <65 years of age, with significant differences in circadian patterns during on- and off-duty hours. Conclusions In a cohort of patients with AMI in Switzerland, we observed discrimination of elderly patients and females in the circadian provision of primary PCI.
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Affiliation(s)
- Thomas Pilgrim
- Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland
| | - Dik Heg
- Institute of Social and Preventive Medicine (ISPM) and Clinical Trials Unit, Department of Clinical Research, University of Bern, Bern, Switzerland, Switzerland
| | - Kali Tal
- Institute of Social and Preventive Medicine (ISPM) and Clinical Trials Unit, Department of Clinical Research, University of Bern, Bern, Switzerland, Switzerland
| | - Paul Erne
- Division of Cardiology, St. Anna Hospital, Lucerne, Switzerland
| | - Dragana Radovanovic
- AMIS Plus Data Center, Institute for Social and Preventive Medicine, University of Zurich, Zurich, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland
| | - Peter Jüni
- Institute Primary Care and Clinical Epidemiology, University of Bern, Bern, Switzerland
- * E-mail:
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Hirsh AT, Hollingshead NA, Matthias MS, Bair MJ, Kroenke K. The Influence of Patient Sex, Provider Sex, and Sexist Attitudes on Pain Treatment Decisions. THE JOURNAL OF PAIN 2014; 15:551-9. [DOI: 10.1016/j.jpain.2014.02.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 01/20/2014] [Accepted: 02/11/2014] [Indexed: 10/25/2022]
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Austin EL. Sexual Orientation Disclosure to Health Care Providers Among Urban and Non-Urban Southern Lesbians. Women Health 2013; 53:41-55. [DOI: 10.1080/03630242.2012.743497] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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