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Jufresa-Blanch E, Carrilero N, García-Altés A. The influence of general practitioner and patient sex on the treatment of major depression. Front Pharmacol 2023; 14:1274774. [PMID: 38027028 PMCID: PMC10665506 DOI: 10.3389/fphar.2023.1274774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction: Biological and sociocultural factors may lead to a significant gender bias in the treatment of major depression and thus contribute to accentuating gender inequalities. However, the influence of the general practitioner's (GP's) sex on the prescription of antidepressants has not been adequately assessed in previous work and remains unclear. This retrospective cohort study aims to determine the influence of GP and patient sex on the treatment of major depression. Methods: The study population comprised 87,629 patients (33.56% male patients and 66.44% female patients) aged over 15 years newly diagnosed with major depression recorded between 2017 and 2019 in Catalonia, Spain. Logistic regression models were used to evaluate the effect of GP sex on the therapeutic strategy (i.e., whether antidepressants were prescribed at the first diagnostic visit). Cox proportional hazards models and survival analyses were conducted to compare, according to GP and patient sex, the probability that a patient would be prescribed an antidepressant at any time during the study period. Finally, a multiple linear regression analysis was performed to assess the pharmacological intensity of the treatment [monthly fluoxetine-equivalent defined daily dose (DDD)]. Results: Female patients were more likely to be prescribed an antidepressant at the time of diagnosis, both by male [OR = 1.11, 95% CI = (1.05, 1.17), p < 0.001] and female GPs [OR = 1.13, 95% CI = (1.09, 1.17), p < 0.001]. Similarly, female patients were 8% and 9% more likely than male patients to be prescribed an antidepressant from male [HR = 1.08, 95% CI = (1.05, 1.11), p < 0.001] and female GPs [HR = 1.09, 95% CI = (0.92, 1.07), p < 0.001], respectively, during the study period. Female GPs prescribed less antidepressants than male GPs: an average of 0.39 less monthly fluoxetine-equivalent DDD [β = -0.39, 95% CI = (0.10, -3.92), p < 0.001]. Discussion: Few differences are observed between male and female GPs regarding the therapeutic strategy and its intensity for the treatment of major depression. However, both male and female GPs are influenced by biases and stereotypes that entail differential antidepressant-prescribing behaviors in accordance with the sex of the patient and their characteristics.
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Affiliation(s)
- Elisabeth Jufresa-Blanch
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Spain
| | - Neus Carrilero
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Spain
- Department of Experimental and Health Sciences (DCEXS), Universitat Pompeu Fabra, Barcelona, Spain
- Institut de Recerca de l’Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Anna García-Altés
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Institut d’Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
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2
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Takeda T, Yoshimi K, Inoue F, Odai T, Shirato N, Watanabe Z, Otsubo T, Terauchi M. Gender Differences in Premenstrual Syndrome and Premenstrual Dysphoric Disorder Diagnosis and Treatment among Japanese Obstetricians and Gynecologists: A Cross-Sectional Study. TOHOKU J EXP MED 2023; 261:95-101. [PMID: 37612076 DOI: 10.1620/tjem.2023.j059] [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] [Indexed: 08/25/2023]
Abstract
Premenstrual symptoms are characterized by unpleasant psychophysical symptoms that appear during the luteal phase before menstruation and interfere with a woman's quality of life. Premenstrual syndrome (PMS) is a pathological condition with premenstrual symptoms, of which premenstrual dysphoric disorder (PMDD) is a particularly severe psychological symptom. This study aimed to examine the gender differences in the diagnosis and treatment of PMS and PMDD among obstetricians and gynecologists (OB/GYNs) in Japan. Data were obtained from the survey conducted by the Japanese Society of Obstetrics and Gynecology. We used data from 1,257 of the 1,265 OB/GYNs who are engaged in PMS/PMDD practice and reported their gender. Multivariate regression analysis adjusted for propensity scores was performed. Female OB/GYNs were more frequently engaged in treating patients with PMS/PMDD than males [odds ratio (OR) 1.74; 95% confidence interval (CI) 1.36-2.21]. With regard to the diagnostic methods, more female OB/GYNs selected the two-cycle symptom diary than males (OR 2.88; 95% CI 1.80-4.60). Regarding treatment, fewer female OB/GYNs selected selective serotonin reuptake inhibitors as their first-line drug (OR 0.39; 95% CI 0.17-0.89). Gender differences were found in the selection of PMS/PMDD diagnosis and treatment methods among Japanese OB/GYNs.
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Affiliation(s)
- Takashi Takeda
- Division of Women's Health, Research Institute of Traditional Asian Medicine, Kindai University
| | - Kana Yoshimi
- Division of Women's Health, Research Institute of Traditional Asian Medicine, Kindai University
| | - Fumi Inoue
- Division of Women's Health, Research Institute of Traditional Asian Medicine, Kindai University
| | - Tamami Odai
- Department of Women's Health, Tokyo Medical and Dental University
| | - Nahoko Shirato
- Department of Obstetrics and Gynecology, Showa University School of Medicine
| | - Zen Watanabe
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine
| | - Tempei Otsubo
- Department of Psychosomatic and Psychiatric Medicine, Tokyo Women's Medical University Adachi Medical Center
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Bertha N, Visser T, Haines N. New Patient Referral Patterns May Reflect Gender Biases in Orthopedics. Cureus 2023; 15:e40935. [PMID: 37496543 PMCID: PMC10368298 DOI: 10.7759/cureus.40935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 07/28/2023] Open
Abstract
Background Orthopedic surgery traditionally has been a male-dominant specialty with the lowest percentage of female residents and female faculty of all medical specialties. Prior studies demonstrate gender biases from both referring providers and patients. This study investigates surgeon, referring provider, and patient demographic differences in new patient orthopedic referrals. Methodology A retrospective chart review was performed to analyze the demographics of new patients referred to male and female orthopedic surgeons within adult reconstruction and shoulder/elbow specialties at a single academic institution. Patients and referring provider demographics were compared for male and female orthopedic surgeons. Statistical analysis utilized Student's t-test and chi-square analyses for quantitative and qualitative data, respectively. Results In total, 2,642 new patients were analyzed, with 2,084 patients being referred from a provider, and 306 patients requesting specific providers. When compared to male surgeons, female surgeons had fewer referrals from male providers (45.3% vs. 50.3%, p = 0.03) and no difference from female providers (30.6% vs, 29.9%, p = 0.72). The female adult reconstruction surgeon had fewer internal referrals compared to a male surgeon of similar experience and time at the institution (8.4% vs. 12.8%, p = 0.03). Female patients requested male surgeons more frequently than female surgeons (76.7% vs. 23.3%, p = 0.02). Conclusions New patient demographics differed between male and female orthopedic surgeons at a single academic institution with more male referring providers referring to male surgeons. Female patients requesting male orthopedic providers may reflect patient and specialty-driven biases. There remains a need for additional female representation in orthopedic surgery, and new patient referral patterns may be a marker to assess and monitor gender biases.
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Affiliation(s)
- Nicholas Bertha
- Department of Orthopaedics, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Timothy Visser
- Department of Orthopaedics, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Nikkole Haines
- Department of Orthopaedics, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
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4
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Hundt MA, Tien C, Kahn JA. Addressing sex-based disparities in liver transplantation. Curr Opin Organ Transplant 2023; 28:110-116. [PMID: 36437701 DOI: 10.1097/mot.0000000000001040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW Disparities in access to liver transplantation by sex have been well described, disadvantaging women. Understanding the multifactorial causes of these disparities as well as the variety of proposed solutions is critical to improving access to this life-saving intervention for women. This review aims to summarize the current body of evidence on observed sex disparities in liver transplantation and highlight actionable, evidence-based mechanisms by which these disparities can be addressed. RECENT FINDINGS Strategies for addressing sex disparities in liver transplantation include increasing organ utilization, changing allocation policy, and leveraging public policies to reduce the incidence of end-stage liver disease. Several other promising interventions are currently being explored. SUMMARY In the United States, women face additional barriers to liver transplantation on the basis of sex. Immediate action is necessary to systematically address these inequities.
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Affiliation(s)
- Melanie A Hundt
- Division of Gastrointestinal and Liver Diseases
- Department of Medicine, University of Southern California, Los Angeles, California, USA
| | - Christine Tien
- Department of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jeffrey A Kahn
- Division of Gastrointestinal and Liver Diseases
- Department of Medicine, University of Southern California, Los Angeles, California, USA
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Ghazaryan N, Autry AM. Gender Bias in the Emergency Department. Emerg Med J 2023; 40:240-241. [PMID: 36868810 DOI: 10.1136/emermed-2023-213177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 03/05/2023]
Affiliation(s)
- Nelly Ghazaryan
- Department of Obstetrics and Gynecology, UCSF Fresno, Fresno, California, USA
| | - Amy Meg Autry
- Department of Obstetrics and Gynecology, UCSF Fresno, Fresno, California, USA
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Lakbar I, Einav S, Lalevée N, Martin-Loeches I, Pastene B, Leone M. Interactions between Gender and Sepsis—Implications for the Future. Microorganisms 2023; 11:microorganisms11030746. [PMID: 36985319 PMCID: PMC10058943 DOI: 10.3390/microorganisms11030746] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/09/2023] [Accepted: 03/11/2023] [Indexed: 03/15/2023] Open
Abstract
Sex and gender dimorphisms are found in a large variety of diseases, including sepsis and septic shock which are more prevalent in men than in women. Animal models show that the host response to pathogens differs in females and males. This difference is partially explained by sex polarization of the intracellular pathways responding to pathogen–cell receptor interactions. Sex hormones seem to be responsible for this polarization, although other factors, such as chromosomal effects, have yet to be investigated. In brief, females are less susceptible to sepsis and seem to recover more effectively than males. Clinical observations produce more nuanced findings, but men consistently have a higher incidence of sepsis, and some reports also claim higher mortality rates. However, variables other than hormonal differences complicate the interaction between sex and sepsis, including comorbidities as well as social and cultural differences between men and women. Conflicting data have also been reported regarding sepsis-attributable mortality rates among pregnant women, compared with non-pregnant females. We believe that unraveling sex differences in the host response to sepsis and its treatment could be the first step in personalized, phenotype-based management of patients with sepsis and septic shock.
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Affiliation(s)
- Ines Lakbar
- Department of Anesthesiology and Intensive Care Unit, Assistance Publique Hôpitaux Universitaires de Marseille, Aix-Marseille University, Hospital Nord, 13015 Marseille, France
- CEReSS, Health Service Research and Quality of Life Centre, School of Medicine-La Timone Medical, Aix-Marseille University, 13015 Marseille, France
| | - Sharon Einav
- Intensive Care Unit, Shaare Zedek Medical Center, Jerusalem 23456, Israel
- Faculty of Medicine, Hebrew University, Jerusalem 23456, Israel
| | - Nathalie Lalevée
- INSERM, INRAE, Centre for Nutrition and Cardiovascular Disease (C2VN), Aix-Marseille University, 13005 Marseille, France
| | - Ignacio Martin-Loeches
- Intensive Care Unit, Trinity Centre for Health Science HRB-Wellcome Trust, St James’s Hospital, D08 NHY1 Dublin, Ireland
| | - Bruno Pastene
- Department of Anesthesiology and Intensive Care Unit, Assistance Publique Hôpitaux Universitaires de Marseille, Aix-Marseille University, Hospital Nord, 13015 Marseille, France
- INSERM, INRAE, Centre for Nutrition and Cardiovascular Disease (C2VN), Aix-Marseille University, 13005 Marseille, France
| | - Marc Leone
- Department of Anesthesiology and Intensive Care Unit, Assistance Publique Hôpitaux Universitaires de Marseille, Aix-Marseille University, Hospital Nord, 13015 Marseille, France
- INSERM, INRAE, Centre for Nutrition and Cardiovascular Disease (C2VN), Aix-Marseille University, 13005 Marseille, France
- Correspondence:
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Al Khatib O, Taha H, Al Omari L, Al-Sabbagh MQ, Al-Ani A, Massad F, Berggren V. Workplace Violence against Health Care Providers in Emergency Departments of Public Hospitals in Jordan: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3675. [PMID: 36834370 PMCID: PMC9964576 DOI: 10.3390/ijerph20043675] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/15/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
Workplace violence (WPV) against healthcare providers is a serious problem that carries health, safety, and legal consequences. Healthcare providers working in emergency departments (ED) are more susceptible to WPV compared to other healthcare settings. This study aimed to assess the prevalence of physical and verbal violence against ED physicians and nurses in public hospitals in Amman, Jordan, and to explore the relationship between WPV and the socio-demographic characteristics of the participants. A quantitative descriptive cross-sectional study design was used to assess physical and verbal violence against ED physicians and nurses. A self-administered questionnaire was completed by 67 physicians and 96 nurses from three public hospitals in Amman. In the past year, 33% and 53% of the participants experienced physical and verbal violence, respectively. Compared to their female counterparts, males were more frequently physically (43.7% vs. 2.3%, p-value < 0.001) and verbally (61.3% vs. 29.5%, p-value < 0.001) abused. The main perpetrators of physical and verbal violence were the patients' relatives. Out of 53 physical and 86 verbal abuse incidents, only 15 cases (10.8%) were followed up with legal persecution. In conclusion, there is a widespread occurrence of physical and verbal violence against ED physicians and nurses in the public sector hospitals in Jordan. A collaborative effort by all stakeholders should be instituted to ensure the safety of the physicians and nurses and to improve the quality of the healthcare provided.
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Affiliation(s)
- Osama Al Khatib
- Department of Family and Community Medicine, Faculty of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Hana Taha
- Department of Pharmacology, Public Health and Clinical Skills, Faculty of Medicine, The Hashemite University, P.O. Box 330127, Zarqa 13133, Jordan
- Department of Neuroscience, Caring Science and Society, Karolinska Institutet, 141 52 Huddinge, Sweden
| | - Lujain Al Omari
- Department of Family and Community Medicine, Faculty of Medicine, The University of Jordan, Amman 11942, Jordan
| | | | - Abdallah Al-Ani
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman 11941, Jordan
| | - Faysal Massad
- Department of Family and Community Medicine, Faculty of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Vanja Berggren
- Department of Neuroscience, Caring Science and Society, Karolinska Institutet, 141 52 Huddinge, Sweden
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Couture A, Birstler J. The Gender of the Sender: Assessing Gender Biases of Greetings in Patient Portal Messages. J Womens Health (Larchmt) 2023; 32:171-177. [PMID: 36459624 PMCID: PMC10081704 DOI: 10.1089/jwh.2022.0333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purpose: The purpose of the study was to determine if the use of professional titles in patient electronic health record (EHR) messages varied by gender of the physician receiving the message and gender of the patient sending the message. Methods: We conducted a retrospective observational study evaluating 285,744 messages for a patient's greeting to their physician. Logistic regression mixed effects models were fit to estimate the relationship between title use and gender. Results: Female physicians received 189,442 (66%), and female patients sent 183,579 (64%) messages. Female physicians received an average of 1754 messages each (sd = 1615, median [IQR] = 1624 [255-3040]), which was significantly more than the average 1235 messages for males (sd = 1527, median [IQR] = 385 [103-1857], Mann-Whitney-Wilcoxon p-value = 0.006). Female patients were more likely to send messages using professional titles (OR = 1.37, CI = 1.28-1.47, p < 0.001). Female physicians were no more likely than male physicians to receive professional titles (OR = 1.06, CI = 0.89-1.27, p = 0.500). Conclusions: Female physicians received significantly more EHR messages than men, and female patients were more likely to use a professional title when addressing their physician, regardless of gender. Across all patients, physician gender did not influence the rate of professional title used.
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Affiliation(s)
- Allison Couture
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Jen Birstler
- Department of Biostatistics and Medical Information, University of Wisconsin Madison, Madison, Wisconsin, USA
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Yu SF, Hsu CM, Wang HT, Cheng TT, Chen JF, Lin CL, Yu HT. Establishing the Competency Development and Talent Cultivation Strategies for Physician-Patient Shared Decision-Making Competency Based on the IAA-NRM Approach. Healthcare (Basel) 2022; 10:healthcare10101844. [PMID: 36292290 PMCID: PMC9601707 DOI: 10.3390/healthcare10101844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 09/13/2022] [Accepted: 09/17/2022] [Indexed: 11/21/2022] Open
Abstract
Shared decision making (SDM) is a collaborative process involving patients and their healthcare workers negotiating to reach a shared decision about medical care. However, various physician stakeholders (attending physicians, medical residents, and doctors in post-graduate years) may have different viewpoints on SDM processes. The purpose of this study is to explore the core competence of physicians in performing SDM tasks and to investigate the significant competency development aspects/criteria by applying the literature research and expert interviews. We adopt the IAA (importance awareness analysis) technique for different stakeholders to evaluate the status of competency development aspects/criteria and to determine the NRM (network relation map) based on the DEMATEL (decision-making trial and evaluation laboratory) technique. The study combines the IAA and NRM methods and suggests using the IAA-NRM approach to evaluate the adoption strategies and common suitable paths for different levels of physicians. Our findings reveal that SDM perception and practice is the primary influencer of SDM competence development for all stakeholders. The current model can help hospital administrators and directors of medical education understand the diverse stakeholders’ perspectives on the core competence of SDM tasks and determine common development plans. It provides strategic directions for SDM competency development and talent cultivation programs.
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Affiliation(s)
- Shan-Fu Yu
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 833, Taiwan
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Chiayi Chang Gung Memorial Hospital, Puzi City 613, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Tayouan City 333, Taiwan
- Graduate Institute of Adult Education, National Kaohsiung Normal University, Kaohsiung City 802, Taiwan
| | - Chih-Ming Hsu
- Medical Education Department, Chiayi Chang Gung Memorial Hospital, Puzi City 613, Taiwan
- Department of Business Administration, National Chung Cheng University, Minxiong Township, Chiayi 621, Taiwan
| | - Hui-Ting Wang
- Graduate Institute of Adult Education, National Kaohsiung Normal University, Kaohsiung City 802, Taiwan
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 833, Taiwan
| | - Tien-Tsai Cheng
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 833, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Tayouan City 333, Taiwan
| | - Jia-Feng Chen
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 833, Taiwan
| | - Chia-Li Lin
- Department of International Business, Ming Chuan University, Taipei City 111, Taiwan
- Correspondence: (C.-L.L.); (H.-T.Y.)
| | - Hsing-Tse Yu
- Department of Obstetrics and Gynecology, Taipei Chang Gung Memorial Hospital, Taipei City 105, Taiwan
- Correspondence: (C.-L.L.); (H.-T.Y.)
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10
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The Influence of Gender Bias: Is Pain Management in the Field Affected by Health Care Provider's Gender? Prehosp Disaster Med 2022; 37:638-644. [PMID: 35924723 DOI: 10.1017/s1049023x2200111x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Appropriate pain management indicates the quality of casualty care in trauma. Gender bias in pain management focused so far on the patient. Studies regarding provider gender are scarce and have conflicting results, especially in the military and prehospital settings. STUDY OBJECTIVE The purpose of this study is to investigate the effect of health care providers' gender on pain management approaches among prehospital trauma casualties treated by the Israel Defense Forces (IDF) medical teams. METHODS This retrospective cohort study included all trauma casualties treated by IDF senior providers from 2015-2020. Casualties with a pain score of zero, age under 18 years, or treated with endotracheal intubation were excluded. Groups were divided according to the senior provider's gender: only females, males, or both female and male. A multivariate analysis was performed to assess the odds ratio of receiving an analgesic, depending on the presence of a female senior provider, adjusting for potential confounders. A subgroup analysis was performed for "delta-pain," defined as the difference in pain score during treatment. RESULTS A total of 976 casualties were included, of whom 835 (85.6%) were male. Mean pain scores (SD) for the female only, male only, and both genders providers were 6.4 (SD = 2.9), 6.4 (SD = 3.0), and 6.9 (SD = 2.8), respectively (P = .257). There was no significant difference between females, males, or both female and male groups in analgesic treatment, overall and per specific agent. This remained true also in the multivariate model. Delta-pain difference between groups was also not significant. Less than two-thirds of casualties in this study were treated for pain among all study groups. CONCLUSION This study found no association between IDF Medical Corps providers' gender and pain management in prehospital trauma patients. Further studies regarding disparities in acute pain treatment are advised.
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Campbell Oparaji D, Hutchinson-Colas J. Women in medicine: It is not only necessary but also essential for the next generation. Case Rep Womens Health 2022; 35:e00427. [PMID: 35942073 PMCID: PMC9356347 DOI: 10.1016/j.crwh.2022.e00427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 11/26/2022] Open
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12
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Hardy V, Yue A, Archer S, Merriel SWD, Thompson M, Emery J, Usher-Smith J, Walter FM. Role of primary care physician factors on diagnostic testing and referral decisions for symptoms of possible cancer: a systematic review. BMJ Open 2022; 12:e053732. [PMID: 35074817 PMCID: PMC8788239 DOI: 10.1136/bmjopen-2021-053732] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 12/23/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Missed opportunities for diagnosing cancer cause patients harm and have been attributed to suboptimal use of tests and referral pathways in primary care. Primary care physician (PCP) factors have been suggested to affect decisions to investigate cancer, but their influence is poorly understood. OBJECTIVE To synthesise evidence evaluating the influence of PCP factors on decisions to investigate symptoms of possible cancer. METHODS We searched MEDLINE, Embase, Scopus, CINAHL and PsycINFO between January 1990 and March 2021 for relevant citations. Studies examining the effect or perceptions and experiences of PCP factors on use of tests and referrals for symptomatic patients with any cancer were included. PCP factors comprised personal characteristics and attributes of physicians in clinical practice. DATA EXTRACTION AND SYNTHESIS Critical appraisal and data extraction were undertaken independently by two authors. Due to study heterogeneity, data could not be statistically pooled. We, therefore, performed a narrative synthesis. RESULTS 29 studies were included. Most studies were conducted in European countries. A total of 11 PCP factors were identified comprising modifiable and non-modifiable factors. Clinical judgement of symptoms as suspicious or 'alarm' prompted more investigations than non-alarm symptoms. 'Gut feeling' predicted a subsequent cancer diagnosis and was perceived to facilitate decisions to investigate non-specific symptoms as PCP experience increased. Female PCPs investigated cancer more than male PCPs. The effect of PCP age and years of experience on testing and referral decisions was inconclusive. CONCLUSIONS PCP interpretation of symptoms as higher risk facilitated testing and referral decisions for possible cancer. However, in the absence of 'alarm' symptoms or 'gut feeling', PCPs may not investigate cancer. PCPs require strategies for identifying patients with non-alarm and non-specific symptoms who need testing or referral. PROSPERO REGISTRATION NUMBER CRD420191560515.
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Affiliation(s)
- Victoria Hardy
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Adelaide Yue
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Stephanie Archer
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - Matthew Thompson
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Jon Emery
- Centre for Cancer Research and Department of General Practice, University of Melbourne VCCC, Parkville, Victoria, Australia
| | - Juliet Usher-Smith
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Fiona M Walter
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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13
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Campesi I, Montella A, Seghieri G, Franconi F. The Person's Care Requires a Sex and Gender Approach. J Clin Med 2021; 10:4770. [PMID: 34682891 PMCID: PMC8541070 DOI: 10.3390/jcm10204770] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/14/2021] [Accepted: 10/14/2021] [Indexed: 12/15/2022] Open
Abstract
There is an urgent need to optimize pharmacology therapy with a consideration of high interindividual variability and economic costs. A sex-gender approach (which considers men, women, and people of diverse gender identities) and the assessment of differences in sex and gender promote global health, avoiding systematic errors that generate results with low validity. Care for people should consider the single individual and his or her past and present life experiences, as well as his or her relationship with care providers. Therefore, intersectoral and interdisciplinary studies are urgently required. It is desirable to create teams made up of men and women to meet the needs of both. Finally, it is also necessary to build an alliance among regulatory and ethic authorities, statistics, informatics, the healthcare system and providers, researchers, the pharmaceutical and diagnostic industries, decision makers, and patients to overcome the gender gap in medicine and to take real care of a person in an appropriate manner.
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Affiliation(s)
- Ilaria Campesi
- Laboratory of Sex-Gender Medicine, National Institute of Biostructures and Biosystems, 07100 Sassari, Italy;
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy;
| | - Andrea Montella
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy;
| | - Giuseppe Seghieri
- Department of Epidemiology, Regional Health Agency of Tuscany, 50124 Florence, Italy;
| | - Flavia Franconi
- Laboratory of Sex-Gender Medicine, National Institute of Biostructures and Biosystems, 07100 Sassari, Italy;
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Stock S, Altin S, Nawabi F, Civello D, Shukri A, Redaèlli M, Alayli A. A cross-sectional analysis of health literacy: patient- versus family doctor-reported and associations with self-efficacy and chronic disease. BMC FAMILY PRACTICE 2021; 22:187. [PMID: 34525978 PMCID: PMC8442421 DOI: 10.1186/s12875-021-01527-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 08/19/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Adequate health literacy (HL) levels contribute to good health outcomes and successful disease self-management in patients with chronic disease. Hence, it is essential that family doctors recognize patients with inadequate HL in need of additional support. This study had two aims: (1) to assess and compare patient self-reported versus family doctor-rated HL estimates, and (2) to explore associations between patient-reported HL, self-efficacy and chronic diseases. METHODS Participants in this cross-sectional survey were recruited through general practices in North Rhine-Westphalia, Germany. Patient self-reported HL was measured using the European Health Literacy Survey-16. Family doctor-rated HL was measured with an adapted version of this instrument. Using crosstabulations patient-reported and family doctor-rated HL estimates were compared for 346 patient-family doctor pairs. Associations between HL, self-efficacy and chronic disease were investigated using regression analyses. RESULTS Patient-reported and family doctor-rated HL estimates were concordant in 38% of all cases. On average family doctors rated their patients' HL lower than patients rated their own HL. The lower average family doctor ratings were more pronounced when patients were older, male and had more than one chronic disease. Female family doctors rated HL of male patients lower than their male colleagues. Patient reported HL had a significant positive association with self-efficacy. Mediation analysis provided support that self-efficacy acts as mediator between HL and the number of chronic diseases. CONCLUSIONS Our study findings indicate a significant discrepancy between patients' self-reported HL and externally rated HL by family doctors. A more systematic utilization of HL screeners might help reduce this discrepancy. At the same time, consideration should be given to enhancing communication training for family doctors and addressing critical HL skills in patient education.
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Affiliation(s)
- Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Gleueler Str. 176-178, 50924, Cologne, Germany
| | | | - Farah Nawabi
- Institute for Health Economics and Clinical Epidemiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Gleueler Str. 176-178, 50924, Cologne, Germany
| | - Daniele Civello
- Institute for Health Economics and Clinical Epidemiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Gleueler Str. 176-178, 50924, Cologne, Germany
| | - Arim Shukri
- Institute for Health Economics and Clinical Epidemiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Gleueler Str. 176-178, 50924, Cologne, Germany
| | - Marcus Redaèlli
- Institute for Health Economics and Clinical Epidemiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Gleueler Str. 176-178, 50924, Cologne, Germany
| | - Adrienne Alayli
- Institute for Health Economics and Clinical Epidemiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Gleueler Str. 176-178, 50924, Cologne, Germany.
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