Enhancing gender equality for women using person-centred care and cultural curiosity

Socially constructed gender norms influence people's access to, and experience of, healthcare. Gender norms can negatively affect the health of women, men and people with other gender identities, such as transgender or non-binary individuals. Person-centred care and shared decision-making, which are widely recognised as essential aspects of healthcare, could be effective approaches for enhancing gender equality in healthcare for women. However, many women appear to receive suboptimal person-centred care. Additionally, there is a lack of representation of diverse gender identities in research, as well as a lack of awareness of diverse gender identities among nurses and other healthcare professionals. To enhance gender equality in healthcare for women, nurses and nursing students should be encouraged to reflect on their unconscious biases and adopt a stance of cultural curiosity, while organisations need to improve preregistration and post-registration training on equality and diversity.

Transgender and nonbinary young adults' depression and suicidality is associated with sibling and parental acceptance-rejection

INTRODUCTION

Transgender and nonbinary young adults (TNB YA) report high rates of depression and more suicidality than their cisgender counterparts. Parental rejection is a known predictor of worse mental health among TNB YA; however, less is known about TNB YA experiences of sibling acceptance-rejection. The purpose of this study was to determine how TNB YA perception of sibling and parental acceptance-rejection are related to TNB YA depression and suicidality.

DESIGN

Cross-sectional.

METHODS

TNB YA (ages 18-25) who had disclosed their gender identity to an adult sibling were recruited to take part in an online study and completed measures of sibling and parent acceptance-rejection, depression, as well as lifetime and past year suicidality. Stepwise regressions were conducted to evaluate associations between acceptance-rejection and TNB YA depression and suicidality.

RESULTS

The sample consisted of 286 TNB YA (Mage  = 21.5, SD = 2.2) who were predominantly White (80.6%) and assigned female sex at birth (92.7%). Each family member's acceptance-rejection was associated with increased TNB YA depression scores when considered independently and combined. Independently, high rejection from each family member was associated with greater odds of reporting most suicidality outcomes. When all family members were considered together, only high rejection from a male parent was associated with four times greater odds of reporting lifetime suicidality. High rejection from both parents was associated with greater odds of reporting past year suicide attempt (OR: 3.26 female parent; 2.75 male parent).

CONCLUSION

Rejection from family members is associated with worse depression and suicidality, and rejection from male parents may be particularly damaging. Sibling acceptance uniquely contributes to TNB YA's depression symptoms alone and in the context of parental support.

Investigating inequalities in men's health: a literature review

As part of a project to review the delivery of healthcare services in Torbay and South Devon, England, the author undertook a literature review focusing on the specialty of men's health. Men have a shorter life expectancy than women and this discrepancy is particularly pronounced in areas of social deprivation such as those found in the coastal and rural communities of the author's locality. The concept of men's health is complex, and this literature review identified five main themes that can have a significant influence on the delivery of healthcare services for men: masculinity, ethnicity, mental health, relevance of place, and access to services. In this article, the author discusses these themes and considers approaches that could be used to improve the provision of men's healthcare.

Supporting transgender patients with their personal hygiene

Attending to one's personal hygiene is a private and ritualistic act that is linked to self-expression and is important for one's well-being and self-esteem. Providing effective support with personal hygiene to patients can demonstrate thoughtfulness and sensitivity to their individual needs. Nurses in all fields of nursing may encounter patients who identify as transgender, but many nurses have expressed concerns about their lack of knowledge and confidence in that area of care. This article discusses the use of gender-affirming language and the factors to consider when supporting transgender patients with their personal hygiene as part of personalised, equitable and inclusive nursing care.

Supporting gender-diverse young people: the role of the nurse

Gender-diverse individuals will need to access healthcare services for various reasons, with most of this care provided outside of specialist gender services. Nurses have an important role in advocating for the specific needs of gender-diverse individuals and providing person-centred care. Therefore, they have a responsibility to ensure their knowledge of appropriate terminology and gender-affirming interventions is up to date. This article provides information about gender diversity to enhance nurses' understanding of this area to enable them to care for gender-diverse people effectively and sensitively. While the focus of this article is on gender-diverse young people, the same principles can be applied across all age groups.

Adjustment challenges and coping strategies of Arab female international university students

Background

Over the past decade, Türkiye has experienced an increasing influx of international students, particularly from various Arab countries. The significant number of Arab international university students has prompted researchers to pay more attention to the experiences of this population in the country. This study examined the adjustment problems experienced by Arab female international university students in Türkiye.

Method

The research has a mixed methods design and includes both quantitative and qualitative studies. In the quantitative study, the International Students Adjustment Scale (ISAS) was used with 373 participants to examine the challenges in which dimensions of adjustment (academic, sociocultural, or personal) were more challenging for the study group. In the qualitative study, semi-structured interviews were conducted with 19 Arab female international university students to gain a deeper understanding of their experiences in the domain that is found the issues are more profound.

Results

Data from the quantitative study revealed that these students experienced similar challenges in each dimension of adjustment; however, problems in the sociocultural domain were much more profound. In line with the quantitative study, the interview questions of the qualitative study were prepared to explore the sociocultural domain and included the pre-arrival expectations, the post-arrival adjustment challenges, and the coping strategies of the study group. The Results of the qualitative study showed that although their prearrival expectations were almost met, they encountered various problems, ranging from cultural differences in daily activities to discrimination. It was also found that many of them were reluctant to ask for help, and to cope with adjustment problems, they usually used maladaptive or dysfunctional coping strategies such as avoidance and isolation.

Discussion

The findings of the quantitative study are in line with the previous studies that the overall adjustment of international students is influenced by different domains that are broadly academic, sociocultural, and personal. Among them, the sociocultural domain is found as the one in the study population that encounters more challenges. The results of the qualitative study support the findings of previous studies related to prearrival expectancies, provide more understanding of adjustment challenges and bring more information about adopted coping strategies.

Body Positivity or Humorous Parody? The Impact of Instagram Imagery on Body Image Concerns

Research has shown that Instagram imagery can affect women's body image. However, it remains unclear how Instagram images are perceived, and which type of images can have a positive impact on body image. In this study (N = 170), we examined whether exposure to body positive and humorous parody (vs. body ideal) imagery would be perceived as critiques of thin body ideals, would elicit photo-based activity in the form of "likes", and would positively affect women's body image. Results showed that both body positivity and humorous parody images elicited more "likes" and were perceived as critiquing thin body standards more than body ideal images. Moreover, women's body satisfaction and positive mood were higher after exposure to body positivity and humorous parody compared to exposure to body ideal images. Women exposed to humorous parody also reported a lower drive for thinness. These findings demonstrate that both body positivity and humorous parody can be considered critiques that improve body image.

Germline Gene Editing: The Gender Issues

Human germline gene editing constitutes an extremely promising technology; at the same time, however, it raises remarkable ethical, legal, and social issues. Although many of these issues have been largely explored by the academic literature, there are gender issues embedded in the process that have not received the attention they deserve. This paper examines ways in which this new tool necessarily affects males and females differently-both in rewards and perils. The authors conclude that there is an urgent need to include these gender issues in the current debate, before giving a green light to this new technology.

Meeting the health and social care needs of LGBT+ people

Rapid sociocultural shifts in understanding and acceptance of variations in sexual orientation and gender identity have occurred in recent decades, and UK health and social care providers have a legal obligation to address inclusion, discrimination and equality in policies and services. Despite this, lesbian, gay, bisexual and transgender + (LGBT+) people continue to report inadequate health outcomes and suboptimal experiences of care. This article considers the health ecology in relation to those who identify as LGBT+ and outlines the concept of intersectionality. The author discusses some of the issues experienced by LGBT+ people in relation to various physical and mental health conditions and services. The article aims to encourage nurses to consider what steps they can take to improve care for this group.

Catalyzing action on HIV/SRH integration: lessons from Kenya, Malawi, and Zimbabwe to spur investment

The HIV pandemic has long revealed the inequities and fault lines in societies, one of the most tenacious being the pandemic's disproportionate impact on adolescent girls and young women. In east and southern Africa, renewed global action is needed to invigorate an effective yet undervalued approach to expanding HIV prevention and improving women's health: integration of quality HIV and sexual and reproductive health (SRH) services. The urgency of advancing effective integration of these services has never been clearer or more pressing. In this piece, national health officials from Kenya, Malawi, and Zimbabwe and global health professionals have joined together in a call to catalyze actions by development partners in support of national strategies to integrate HIV and SRH information and services. This agenda is especially vital now because these adolescent girls and young women are falling through the cracks due to the cascading effects of COVID-19 and disruptions in both SRH and HIV services. In addition, the scale-up of pre-exposure prophylaxis (PrEP) has been anemic for this population. Examining the opportunities and challenges of HIV/SRH integration implemented recently in three countries - Kenya, Malawi, and Zimbabwe - provides lessons to spur integration and investments there and in other nations in the region, aimed at improving health outcomes for adolescent girls and young women and curbing the global HIV epidemic. While gaps remain between strong national integration policies and program implementation, the experiences of these countries show opportunities for expanded, quality integration. This commentary draws on a longer comparative analysis of findings from rapid landscaping analyses in Kenya, Malawi, and Zimbabwe, which highlighted cross-country trends and context-specific realities around HIV/SRH integration.

Reflecting on 'insider' and 'outsider' positionality when undertaking culturally sensitive research with young Pakistani men: insights from a female researcher

BACKGROUND

Conducting culturally sensitive research into male experiences can be challenging for female researchers. Despite this, there are very few published reflective accounts of how they have overcome these difficulties.

AIM

To illustrate a female researcher's challenges in conducting research into young men's experiences of puberty in Pakistan and highlight the strategies used to overcome these.

DISCUSSION

An important challenge for the researcher was creating an environment in which participants felt able to share their experiences. This was overcome by the incorporation of the experiences of public involvement contributors in the development of the project, offering a choice of interview format to participants and other solutions driven by the 'insider' position of the researcher. The researcher's 'outsider' role as a mature and pregnant woman appeared to create a 'safe' environment, allowing the young men to openly share their personal experiences.

CONCLUSION

Female researchers can successfully conduct culturally sensitive research with young men in patriarchal societies such as Pakistan. The key is to be aware of potential cultural issues and to use any insider/outsider positionality to the greatest effect.

IMPLICATIONS FOR PRACTICE

In addition to adapting procedures, such as gaining trust, building rapport and assuring a non-judgemental and comfortable environment, the 'outsider' position of the female researcher should be given due consideration when undertaking culturally sensitive research with men.

Intimate Partner Violence Predicts Posttraumatic Stress Disorder Severity Independent of Early Life and Deployment-Related Trauma in Deployed Men and Women Veterans

Intimate partner violence (IPV) refers to emotional, physical, and/or sexual abuse perpetrated by a current or former partner. IPV affects both genders, though little is known about its effects on men as victims. The aims of this study were to determine if IPV is a factor contributing to posttraumatic stress disorder (PTSD) severity independently of deployment-related trauma, and to determine if there are gender differences in these associations. Participants were 46 female and 471 male post-9/11 veterans. Four sequential regressions were employed to examine the independent contribution of IPV among multiple trauma types on PTSD severity in men and women at two epochs, post-deployment (participants were anchored to deployment-related PTSD symptoms) and current (within the past month). Models were significant for both epochs in men (ps < .001) but not in women (ps > .230). In men, IPV independently predicted PTSD severity in both epochs (β > .093). However, in women, early life trauma (β = .284), but not IPV was a significant and independent predictor for current PTSD. Thus, there are distinct gender differences in how trauma type contributes to PTSD symptom severity. Although the statistical models were not significant in women, we observed similar patterns of results as in men and, in some cases, the β was actually higher in women than in men, suggesting a lack of power in our analyses. More research is clearly needed to follow-up these results; however, our findings indicate that IPV is a contributing factor to PTSD severity in veterans.

Gender diversity in nursing: time to think again

Despite recent discussions and campaigns to widen nursing's appeal to people of diverse gender identities, it continues to be perceived as a largely female profession. In the context of an ageing workforce, and alongside recruitment and retention challenges, efforts should be directed at developing a more inclusive profession rather than focusing on why people other than women do not become nurses. To attract more men, transgender people and those who identify as nonbinary, as well as women, the approach to nursing recruitment needs to change. The profession must develop a more inclusive culture and examine and promote the advantages that gender diversity can bring to nursing. This article explores the lack of gender diversity in contemporary nursing, briefly examines the history of gender in nursing, and considers how the profession might evolve into a more gender-diverse and inclusive workforce.

What Can We Learn from Sex Differences in MS?

Multiple sclerosis (MS) is the major acquired central nervous system disease of young adults. It is a female predominant disease. Multiple aspects of MS are influenced by sex-based differences. This has become an important area of research and study. It teaches us how the impact of sex on a disease can lead to new insights, guidelines, management, and treatments.

Parental Burnout and the COVID-19 Pandemic: How Portuguese Parents Experienced Lockdown Measures

OBJECTIVE

This work aimed to analyze parental burnout (PB) and establish a comparison between the times before (Wave 1) and during (Wave 2) the COVID-19 pandemic.

BACKGROUND

The COVID-19 pandemic brought additional stress to families. The pandemic could be particularly difficult for parents experiencing parental burnout, a condition that involves four dimensions: an overwhelming sense of exhaustion, emotional distancing from the child, saturation or a loss of fulfillment with the parental role, and a sharp contrast between how parents used to be and how they see themselves now.

METHOD

A quasi-longitudinal research design was adopted, comparing two cross-sectional studies among Portuguese parents (N = 995), with an interval of 2 years between each wave of data collection. Participants were surveyed voluntarily through an online questionnaire located on the institutional web platform of the universities involved in the study. Multivariate analysis of covariance was used to take into account the associations among variables, alongside controlling the possible confounding effects.

RESULTS

Parents have overall higher parental burnout scores in Wave 2 than Wave 1, with increased exhaustion, emotional distancing, and contrast, but decreased saturation. Although parental burnout levels remain higher for mothers across the two Waves, the growth is greater for fathers than for mothers.

CONCLUSION

Reconciling childcare with paid work is a stressful and new experience for many fathers. However, results suggest that even amid a crisis, some parents had the opportunity to deeply bond with their children.

IMPLICATIONS

We expect this work to encourage stakeholders to consider proper intervention strategies to address potential parental burnout. Also, initiatives that strengthen gender equity within parenting context are needed.

Impact of gender on in-hospital mortality and 90-day readmissions in patients undergoing transcatheter edge-to-edge mitral valve repair: Analysis from the National Readmission Database

BACKGROUND

Patients undergoing transcatheter edge-to-edge mitral valve repair (TEER) carry a high risk of rehospitalization due to disease, procedure, patient, hospital, and system related factors.

AIMS

We aimed to explore the impact of gender on in-hospital mortality and 90-day readmissions in patients undergoing TEER.

METHODS

We utilized the National Readmission Database from 2012 to 2018 to identify individuals who underwent TEER for mitral regurgitation. Gender-based differences in in-hospital mortality and 90-day readmissions were explored using multivariable logistic regression models.

RESULTS

Between 2012 and 2018, an estimated 21,415 TEER procedural hospitalizations were identified, of which 9893 (46.2%) were in women and 11,522 (53.8%) were in men. Compared with men, women were older, from a lower socioeconomic status but had a lower co-morbidity burden. In-hospital mortality rate during the index hospitalization was similar in women and men (2.1% vs. 2.1%, p = 0.908). Ninety-day all-cause and heart failure readmission rates were significantly higher in women compared to men (30.2% vs. 25.4%; p < 0.001 and 28.1% vs. 23.9%; p = 0.020 respectively). In a multivariable analysis, women had 36% greater odds of 90-day readmission compared to men (adjusted odds ratio [aOR] 1.36, 95% CI: 1.22-1.52; p < 0.001). Trend analysis revealed no significant improvement in rates of 90-day readmission during the observation period for men or women (p = 0.245, p = 0.429, respectively).

CONCLUSIONS

Following TEER, there has been no significant improvement in 90-day readmission rates between 2012 and 2018. Female gender is associated with higher 90-day all-cause and heart failure readmission rates.

Women Garment Workers Face Huge Inequities in Global Supply Chain Factories Made Worse by COVID-19

Women make up the large majority of workers in global supply chains, especially factories in the apparel supply chain. These workers face significant inequalities in wages, workplace hazards, and a special burden of gender-based violence and harassment. These "normal" conditions have been compounded by the impact of the COVID-19 pandemic, which has exacerbated long-standing structural inequities. Decades of well-financed "corporate social responsibility" programs have failed because they do not address the underlying causes of illegal and abusive working conditions. New initiatives in the past half-decade offer promise in putting the needs and rights of workers front and center. Occupational health and safety professionals can assist in the global effort to improve working and social conditions, and respect for the rights and dignity of women workers, through advocacy and action on the job, in their professional associations, and in society at large.

How does hormone transition in transgender women change body composition, muscle strength and haemoglobin? Systematic review with a focus on the implications for sport participation

Objectives

We systemically reviewed the literature to assess how long-term testosterone suppressing gender-affirming hormone therapy influenced lean body mass (LBM), muscular area, muscular strength and haemoglobin (Hgb)/haematocrit (HCT).

Design

Systematic review.

Data sources

Four databases (BioMed Central, PubMed, Scopus and Web of Science) were searched in April 2020 for papers from 1999 to 2020.

Eligibility criteria for selecting studies

Eligible studies were those that measured at least one of the variables of interest, included transwomen and were written in English.

Results

Twenty-four studies were identified and reviewed. Transwomen experienced significant decreases in all parameters measured, with different time courses noted. After 4 months of hormone therapy, transwomen have Hgb/HCT levels equivalent to those of cisgender women. After 12 months of hormone therapy, significant decreases in measures of strength, LBM and muscle area are observed. The effects of longer duration therapy (36 months) in eliciting further decrements in these measures are unclear due to paucity of data. Notwithstanding, values for strength, LBM and muscle area in transwomen remain above those of cisgender women, even after 36 months of hormone therapy.

Conclusion

In transwomen, hormone therapy rapidly reduces Hgb to levels seen in cisgender women. In contrast, hormone therapy decreases strength, LBM and muscle area, yet values remain above that observed in cisgender women, even after 36 months. These findings suggest that strength may be well preserved in transwomen during the first 3 years of hormone therapy.

Advocating for LGBTQ+ older adults: a review of the role of executive nurses

Over the past four decades, the number of people aged over 60 years has increased worldwide, and within this population there has been a proportional increase in people with diverse sexual orientations and gender identities. Executive nurses have an important leadership role in challenging heterocisnormative care practices in healthcare environments that affect the well-being of older adults who are lesbian, gay, bisexual, transgender, queer or questioning and others (LGBTQ+). This article reports on the findings of a secondary analysis of data extracted from an earlier scoping review to provide recommendations for executive nurses on how to advocate for LGBTQ+ older adults and create safe and inclusive healthcare environments for them.

Understanding equality and diversity in nursing practice

Equality and diversity are terms that are used frequently in nursing, healthcare and workplace settings. Nurses' professional standards of practice and behaviour are underpinned by values of equality and diversity. This means that nurses must treat people as individuals, avoid making assumptions about them, recognise diversity and individual choice, and respect and uphold their dignity and human rights. This article explores what equality and diversity mean in nursing practice, the legal framework that underpins these terms, and the inequalities and discrimination that patients and staff may experience in health and social care settings. It discusses the role of organisational culture in supporting nurses to uphold the values of equality and diversity and encourages nurses to reflect on this topic to enhance their practice.

Gender differences in the manifestation of burden among family caregivers of people with mental disorders

This is a cross-sectional study conducted with 537 family caregivers of people with mental disorders. The objective was to quantify the degree of burden experienced by men and women, and identify the most affected dimensions of their lives and the factors associated with burden manifestation by gender. The Zarit Burden Interview (ZBI) scale was used to assess burden. Mean burden was 22.8 points (SD = 6.3) for men and 27.8 points (SD = 17.8) for women. The most affected dimensions among the two groups were the same; however, among the 22 items on the scale, 11 presented significantly higher means among women. The factors associated with the manifestation of burden in both groups were as follows: low income; use of psychotropic drugs; greater degree of dependence of the service user; not receiving family support; and dissatisfaction with family relationships. For men, manifestation of burden was also associated with age. For women, there were further associations of the outcome with the presence of health problems, not having someone to share care with, and caring for the assisted person for >10 years. Our findings suggest that the degree of burden of family members caring for those with mental disorders is associated with gender, and this should be considered by services responsible for planning care shared by professionals and relatives. Guidelines for Strengthening the Reporting of Observational Studies in Epidemiology (STROBE Statement) were adhered to in this study.

"You'll See": Younger Women Interviewing Older Women in Qualitative Research

Understanding the co-construction of the interview process between older adult research participants and relatively younger interviewers requires a nuanced analysis of positioning, reflexivity, and power within interviewing dynamics, accounting for differences in historical context and lived experience. Guided by a feminist life span approach, this study examined interviewing dynamics between a younger woman interviewer and older women research participants, ages 57-93 (mean = 65.3), in two qualitative studies completed five years apart. Four themes emerged: 1) contrasting experiences drew explicit attention to discrepancies in historical context, age, and life experience between participants and the interviewer. Similarities often arose in the theme of 2) invoking expertise in which participants oriented to or invoked their own expertise in their life story and experiences and the interviewer's expertise in research, sexuality studies, and social services. Participants enacted 3) demonstrating care, by prioritizing the researcher's goals, offering advice, and expressing hopes for younger generations. Finally, 4) the participants and researcher used distinctive conversational strategies when addressing challenging or sensitive topics. This paper contributes a needed analysis of age-related dynamics in qualitative research as well as indicating potential strategies to inform reflexive cross-generational conversations in gerontological research and practice more broadly.

Untold Stories: Male Child Sexual Abusers' Accounts of Telling and Not Telling about Sexual Abuse Experienced in Childhood

With evidence suggesting that females are more likely to be victims of child sexual abuse (CSA), much of the literature - including that on disclosure - focuses on females. Thus, male victims remain "under-studied". Given this, the aim here is to contribute to the scant knowledge base on the sexual abuse of males and disclosure by focusing on males whose voices are even more rarely heard than those in the general male population: those who have perpetrated CSA. The men whose stories are told here had been convicted of, and imprisoned for, CSA in the United Kingdom (UK). They were part of a sample of 101 incarcerated males, 40 of whom reported at interview that they had been sexually abused in childhood. Eighteen of those 40 men are focused on here as they provided some detail as to whether they had disclosed that abuse in childhood or adulthood, the responses they had received, and also why they had not disclosed. Their narratives shed some much-needed light on the nature of sexual abuse experienced by males, its onset and duration, sexual re-victimization, relationships with perpetrators, the diverse nature of disclosure, the extent to which victims disclose and when, the responses received, and why they do not tell. Little is known of these aspects of male CSA. The implications of the findings are considered together with future research directions.

Demographic, Behavioral, and Social Characteristics Associated With Smoking and Vaping Among Men Who Have Sex With Men in San Francisco

Tobacco use is the leading lifestyle-related cause of death in the United States. We analyzed correlates of smoking and vaping tobacco in the National HIV Behavioral Surveillance (NHBS) among men who have sex with men (MSM) in San Francisco in 2014 (n = 410) using multivariable logistic regression models. We found that more than two in five MSM (41%) smoked or vaped. Smoking was greater for men of color (46% vs. 35%; p = .02); those with annual income below $50,000 (47% vs. 34%; p = .01); those without a college education (51% vs. 30%; p < .01); and the uninsured (55% vs. 38%; p = .04). In multivariable analyses, greater odds of smoking were observed among men living with HIV (adjusted odds ratio [aOR] = 1.7; 95% CI [1.00, 2.8]); men who reported cocaine use (aOR = 3.1; 95% CI [1.9, 5.0]), and men who reported greater number of alcohol drinks on a drinking day (aOR = 1.2; 95% CI [1.05, 1.29]). Lower odds of smoking were observed for men who completed college (aOR = 0.57; 95% CI [0.36, 0.88]). Greater odds of vaping were observed among men who reported meth use (aOR = 3.01; 95% CI [1.65, 5.50]). Lower odds of vaping were observed among men who completed college (aOR = 0.55; 95% CI [0.32, 0.98]). In conclusion, the prevalence of smoking and vaping among MSM is extremely high, particularly HIV-positive MSM. MSM who smoked and vaped were more likely to be racial and ethnic minorities, have lower socioeconomic status, and report more substance and alcohol use. These findings highlight the need to develop strategies effectively addressing the high rates of cigarette smoking and vaping among MSM, particularly among minority MSM and MSM living with HIV.

Sex hormone exposure and reproductive factors in pulmonary arterial hypertension: a case-control study

Pulmonary arterial hypertension (PAH) is a sexually dimorphic disease that for unknown reasons affects women more than men. The role of estrogens, both endogenous and exogenous, and reproductive factors in this female susceptibility is still poorly understood. It has been strongly suggested that sex hormones may influence the development and progression of the disease. We sought to determine whether sex hormone exposures and reproductive factors associate with PAH patients compared to control subjects, using a questionnaire and interview to obtain information regarding these potential risk factors. We conducted a single-center unmatched case-control study. Six hundred and thirty-four women and men with PAH, as well as 27 subjects with BMPR2 mutations but no PAH and 132 healthy population controls were enrolled from the Vanderbilt Pulmonary Hypertension Research Cohort and researchmatch.org. Questionnaires and nurse-led interviews were conducted to obtain information regarding sex hormone exposures and reproductive factors. Additional history was obtained on enrolled patients including disease severity variables and comorbidities. Responses to the questionnaires were analyzed to describe these exposures in this population as well as assess the association between disease severity variables and sex hormone exposures. Reproductive and endogenous factors that determine lifelong estrogen exposure were similar between PAH cases and controls. Patients with associated PAH were significantly more likely to be postmenopausal compared to controls. There were similar rates of "ever-use" and duration of use of oral contraceptive pills and hormone replacement therapy in patients when compared to controls. Disease severity variables were not significantly affected by any exposure after adjusting for PAH sub-group. In contrast to our hypothesis, that a greater exposure to exogenous sources of female sex hormones associates with PAH case status, we found similar rates of endogenous and exogenous sex hormone exposure between PAH patients and unmatched controls.

Adolescent Bystanders Witnessing Cyber Violence Against Women and Girls: What They Observe and How They Respond

The widespread use of social networks has turned cyber violence into a serious problem. We performed a survey with 1,468 adolescents aged 13-17 years and found that almost one in four frequently observed different forms of cyber violence against women and girls. More than a third of the adolescents who witnessed the violence did nothing, and while girls gave more active responses to help the victim, both girls and boys normalized and even justified this behavior. Our findings also underline how little is known about institutional resources for victims. We also discuss the implications for awareness and prevention.

Child Sexual Abuse and Situational Context: Children's Experiences in Post-Conflict Northern Uganda

Although substantial literature exists on child sexual abuse (CSA), little is known about abuses children encounter in northern Uganda, a post-conflict area. Media reports have indicated a high incidence for CSA. The study, firstly, explored boys' and girls' experiences of sexual abuse by adults in this post-conflict region and secondly, interventions directed at improving the current situation of children at risk of child abuse and the survivors were investigated as well. The study was guided by radical feminism and nested ecological framework theories. Semi-structured interviews were conducted involving 43 sexually abused children. Narrative responses were audio recorded and transcribed. Content qualitative analysis was used to understand sexual offenses from children's perspectives. Participants mentioned the following as the most perilous situations; laxity in parental roles, cultural norms, and practices, patriarchal attitudes, child sexual desires and attitudes, family breakdown and alcoholism. The study found many reported cases of CSA in the region. The results imply the exigent need of separate units specifically for reporting and handling child sexual offenses, need for personnel training on gender issues and filing system in child protection agencies and family programs for both fathers and mothers on child protection strategies for prevention and mitigation of CSA.

The Role of Vulnerable and Grandiose Narcissism in Psychological Perpetrated Abuse Within Couple Relationships: The Mediating Role of Romantic Jealousy

The aim of this study was to analyze the direct and indirect relationships between the two phenotypes of narcissism, vulnerable and grandiose, and the tendency to perpetrate psychological abuse, exploring the mediating role of romantic jealousy. Our sample included 473 participants (213 males), aged 18-30 years (M = 22.74; SD = 2.81), involved in a stable romantic relationship. A structural equation modeling was conducted to test our model and a multigroup analysis was performed to test gender differences. Results show that the two forms of narcissism are both linked to psychological perpetrated abuse, but in different ways. Vulnerable narcissism was linked to psychological abuse only indirectly, through the role of romantic jealousy. On the contrary, grandiose narcissism was positively and directly associated with psychological abuse within the romantic relationship. Moreover, the model was invariant across genders. Limitations, strengths, and theoretical and clinical implications are discussed.

The Big Five Personality Traits as Predictors of Loneliness among Older Men in Israel

Loneliness may have complex implications for the mental and physical health of older people. It could have unique expressions among older men due to the social construction of gender, which raises an expectation that men should be strong, assertive, and capable of independently coping with their difficulties. As a result, older men suffering from loneliness may avoid talking about it and seeking help for this matter. The Big Five personality traits were found to be associated with many life domains, including loneliness, yet this issue has received limited research attention with regard to older adults in general and older men in particular. Therefore, the current study explores the contribution of the Big Five personality traits to understanding loneliness among older men in Israel, while controlling for several demographic factors. The data were collected through structured questionnaires administered to a sample of 392 older men. The results indicate that agreeableness, emotional stability, and openness to experiences were negatively associated with older men's loneliness. In addition, no association was found between extraversion and conscientiousness and respondents' loneliness, and no significant association was found between age and loneliness, and being employed and being in a relationship were associated with lower levels of loneliness. The conclusion is that it is important that professionals working with older men utilize the Big Five personality traits to understand loneliness and offer them interventions for reducing their loneliness. Furthermore, it is essential to promote social awareness of the importance of intimate relationships, as well as of employment, in the old age.

Exploring Gender and Racial/Ethnic Differences in the Effects of Child Sexual Abuse

Child sexual abuse (CSA) has been linked to a number of adverse effects including hypersexuality (HYP), substance use (SUB), suicidality (SUI), and depression (DEP). Despite a plethora of research on CSA, little is known about how it affects adolescents and the cultural factors that influence their coping styles. This study was founded on social-cultural coping theory and the model of traumagenic dynamics of sexual abuse, suggesting that CSA consequences lead to maladaptive coping mechanisms influenced by sociocultural factors. Using archival data, loglinear analysis was conducted to examine gender differences within racial/ethnic groups in HYP, SUI, DEP, and SUB among adolescent survivors of CSA in a National sample of 13,583 male and female high school students. The purpose of the study was to identify differences in the effects of CSA as manifested by variations of maladaptive coping across racial/ethnic groups and gender. Boys were significantly more likely to use substances, while girls were more likely to experience depressive symptoms and suicidality. Notably, this study did not reveal any significant racial/ethnic differences in adolescent coping. These findings can inform treatment planning and interventions for adolescents who may present with DEP, SUI, SUB, or risky sexual behaviors, but may have underlying trauma from CSA. This study contributes to the knowledge base about the processes that take place within adolescent CSA survivors, shedding light on cultural nuances among adolescent coping and informing culturally competent practice.

Adolescent Girls' Experiences With Sexual Pressure, Coercion, and Victimization: #MeToo

BACKGROUND

The #MeToo social media campaign in the United States has highlighted what is a pervasive problem in many cultures-the sexual intimidation and victimization of women by men, especially those in roles of authority.

METHODS

In a study of 735 girls, ages 15-19 years, enrolled in a sexual risk reduction randomized controlled trial, we captured baseline data using audio-computer assisted self-interviews to increase validity and reliability of responses to questions regarding such behaviors.

RESULTS

Despite their age, one-half of these girls reported being coerced into sex acts (excluding intercourse) with 1 in 5 reporting such victimization by a man who used his position of authority. Alarmingly, 12-28% of girls reported being forced into penetrative sex acts against their will. Far too many girls reported they had had multiple episodes of such violence.

LINKING EVIDENCE TO ACTION

It is clear that this study captures a common, but minimally documented, threat faced by adolescent girls ranging from men pressuring them to engage in sex activities through the use of victimization, intimidation, or provision of substances to underage girls to gain compliance. Using such evidence to enhance and tailor sexual risk reduction, health, safety, and communication interventions for both males and females is essential. Identifying triggers to at-risk situations, providing skill building in communication, negotiation and refusal skills, as well as clearly discussing consent issues among both genders are important components in evidence-based interventions if we are to impact positively the next generation to curtail sexual pressure, coercion, and violence.

From Freud to Feminism: Gendered Constructions of Blame Across Theories of Child Sexual Abuse

Most theories of child sexual abuse are, to some degree, gendered, with nonoffending mothers bearing the burden of blame, ideologically and legally, for the transgressions of predominantly male offenders. This article explores the social construction of blame for child sexual abuse via critical analyses of evolving theoretical perspectives on maternal culpability for the inception and maintenance of abuse dynamics. Drawing on selected conceptual and research knowledge that supports and refutes anecdotal claims, this synthesis of the literature culminates in the proposal of an evidence-informed, feminist-grounded, multitheoretical child sexual abuse framework that disrupts dominant mother-blaming discourse and guides socially just and ethically responsive policy, practice, and research.

"Just don't be creepy": A phenomenological study of the experiences of men in massage therapy

Background Societal expectations around traditional binary gender roles result in some professions being considered "men's work" or "women's work". Massage therapy (MT) is one such profession that, despite being predominantly female, is joined by an increasing number of men with a desire to help others. Methods This descriptive phenomenological study asked male massage therapists in Ontario, Canada, about their experience of gender in their professional lives. Fourteen men shared their experiences of practice, which included discriminatory hiring and patient preferences for female practitioners. These issues resulted in difficulty establishing a clinical practice. To create a successful practice, men described the need for professionalism, clear communication, and a comfortable treatment environment. Results and conclusions Researchers should explore the impact of discrimination on men in MT, patient preferences based on the therapist's gender, and the role of education in perpetuating societal heterosexual norms. Finally, as with any shift in culture, all levels of organization must take action to remove discrimination and bias within the profession of MT.

The Stability of Retrospective Child Sexual Abuse Reports and its Association With Problem Avoidance

Due to reliability problems, use of retrospective measurement to assess child sexual abuse has long concerned researchers. Possible psychosocial causes of these reliability issues-including problem avoidance-have not been thoroughly studied. We tested the reliability of retrospective child sexual abuse measurement in a nationally representative sample of 12,438 adults over two periods (2001-2002, 2007-2008), assessed sex differences in reliability, and examined whether reliability depends on problem avoidance tendencies. Nearly three-fourths of child sexual abuse cases in the former wave were not again reported, and two-thirds of child sexual abuse cases in the latter wave were not previously reported. Females were more likely to report CSA later if reported previously (OR = 5.11). Participants who reported child sexual abuse in the former wave but not the latter were more avoidant than consistent reporters (3.13 versus 2.77). Our findings suggest that females may report child sexual abuse more consistently. Furthermore, inconsistent reporting may indicate problem avoidance. Suggestions for researchers and practitioners are discussed.

Comparing Female- and Male-Perpetrated Child Sexual Abuse: A Mixed-Methods Analysis

This mixed-methods study compares experiences of female- and male-perpetrated child sexual abuse using self-report data from a correctional subsample of 26 women and 25 men currently incarcerated for a sex crime against a child. First, we use bivariate and logistic regression analyses to determine whether there are differences in offender, victim, and offense characteristics between women and men who commit child sexual abuse. Second, we examine participants' open-ended responses eliciting details about their offenses. Quantitative results reveal some differences between women and men in victim characteristics, presence of a co-offender, and adulthood experiences with violence but no differences between women and men in experiences of childhood adversity, including prior child sexual abuse victimization. Qualitative results, however, suggest marked differences in the way women and men characterize their offenses. Overall, findings indicate that women and men report unique experiences with child sexual abuse perpetration and therefore would benefit from gender-specific treatment.

Bulimia Nervosa: A Comprehensive Analysis of Treatment, Policy, and Social Work Ethics

Bulimia nervosa is an often debilitating eating disorder with a biopsychosocial set of risk factors. Those presenting are at an increased mortality rate and often have physical health complications as well as harmful cognitions related to self-esteem and overall self-concept. This article examines treatment, policy, and social work ethics as they relate to bulimia nervosa. A comprehensive cognitive-behavioral approach including psychoeducation, self-monitoring, exposure therapy, interpersonal therapy, body image therapy, energy balance training, and relapse prevention is recommended as evidence-based practice for treating bulimia nervosa. Authors identify health care policy and analyze it as a common barrier to treatment access. They also review ethical principles of competency and social justice as they relate to social work practitioners working with those diagnosed with bulimia nervosa.

Gender Differences in the Path From Sexual Victimization to HIV Risk Behavior Among Homeless Youth

Experiencing sexual victimization prior to becoming homeless is common among homeless youth and is associated with increased HIV risk behavior. This study examined mediating variables that underlie this association, adding to the understanding of gender differences in these paths. Participants were homeless youth in Los Angeles recruited through service access centers who completed a computerized self-administered interview in English or Spanish using an iPad. Findings indicate a high presence of sexual victimization across both genders. Female participants experienced posttraumatic stress disorder and subsequent engagement with exchange sex, whereas male participants were primarily involved in substance use risk pathways. Results indicate paths in the association between sexual victimization and HIV risk behavior differ between male and female homeless youth. Gender-specific, mental-health-informed interventions targeting sexual risk reduction are warranted.

Persistent Complications of Child Sexual Abuse: Sexually Compulsive Behaviors, Attachment, and Emotions

Child sexual abuse has the potential to cause distress for the victim across the lifespan. Romantic relationships may be particularly difficult for victims of child sexual abuse. This retrospective study examined differences in adult romantic attachment, sexually compulsive behaviors, and emotion regulation by history of child sexual abuse in a large, nonclinical sample. Those with a history of child sexual abuse reported more attachment anxiety in romantic relationships and engaged in more sexually compulsive behaviors. Overall, males displayed more sexually compulsive behaviors than females regardless of history of sexual abuse. Males with a history of sexual abuse displayed the greatest number of sexually compulsive behaviors. Surprisingly, no differences were observed in emotion regulation or attachment avoidant behaviors by history of child sexual abuse. Future research should seek to replicate current findings and examine emotion regulation difficulties experienced as a result of trauma.

Response to Ross's Comment to Miccio-Fonseca and DeFeo

Response to Ross on his comments regarding my purported misunderstanding of Ross's article and the DSM-V (Ross, 2015). Although Ross claims he offered no personal opinions of any kind in his commentary, undeniably there were two separate and independent comments in (Miccio-Fonseca (2015) and DeFeo (2015) addressing similar issues. Is this coincidental? This author maintains the stance expressed in the cited commentary.

With a Little Help From My Family: A Mixed-Method Study on the Outcomes of Family Support and Workload

Our aim was to investigate some predictors and outcomes of family-to-work enrichment (FWE) via a mixed-method approach. We sampled 447 married employees of an Italian factory. Survey results from Study 1 showed that emotional support from family positively predicted FWE, while this latter mediated the associations between the former on one side, and work engagement and life satisfaction on the other. Moreover, extra-household support directly associated positively with life satisfaction. Evidence from 20 anthropological in-depth interviews (Study 2) returned a more complex picture, highlighting the gendered role of partners inside couples, the importance of kinship support, the sense and the value of filiation and parenthood in their connection with job roles, the complex and continuous interplay between family and life domains. In combination, results from both studies stressed the importance of family support; additionally, evidences from Study 2 suggested that FWE could be better understood taking into account crossover dynamics and the compresence of work-to-family enrichment and conflict. In sum, these studies contributed to shed light on FWE dynamics, an under-researched topic in Italy, whose knowledge could be of great empirical and practical value.

Effects of Duration on Perceptions of Teacher Sexual Misconduct

This study explored how respondent gender, gender dyad (male teacher-female student versus female teacher-male student) and duration/frequency (weekly sexual contact over 4 months versus a single incident) affected perceptions of teacher-adolescent student sexual involvement. Respondents were 224 undergraduates (104 men, 120 women) recruited from a psychology research pool. Most (87%) were 18-21 years old, and 59% were Caucasian. Each respondent read one of four scenarios (varied by gender dyad and duration/frequency) depicting a teacher-adolescent student sexual interaction and then completed a series of questions about his or her perceptions. Results indicated that men perceived these experiences less negatively than did women, and the female teacher-male student dyad was viewed less negatively than the male teacher-female student dyad. Relatively few significant interactions emerged, and the only main effect for duration/frequency was for commitment. Results are discussed in terms of the need for more research and education.

Gender vulnerabilities, spousal abuse and the incidence of HIV in Lesotho:a case for an integrative rights-based approach

The article posits that imbalances in gender relations are influencing two distinctive yet connected crises for women in Lesotho: the HIV epidemic and spousal abuse. The overarching premise is that as spousal abuse is increasingly recognised and as HIV infections spread, responses to the phenomenon do not reflect the related risks and consequences in married women's lives. This article underscores the nexus of connections between HIV and spousal abuse in Lesotho, identifying potential areas for pragmatic state-led responses. Applying a rights-based approach, it assesses women's vulnerability to each problem at the individual, societal and programmatic levels, noting that there are both direct and underlying factors heightening risks for women. The article asks, what is the value added by a rights-based approach to the subject under discourse? And, how can a rights-based approach be translated into practical tools for planning, monitoring and evaluating projects and programmes aimed at tackling the multifaceted risks and challenges of HIV and spousal abuse confronting women in Lesotho? In response to these questions, the author identifies three trajectories of opportunities for an integrated, comprehensive response. The unmistakable anchor of the article's propositions is the rights-based approach. Although the discussion focuses on Lesotho, the implications for the broader African region cannot be overemphasised in light of commonly shared experiences pertaining to the severe difficulties posed by spousal abuse and HIV.

AIDS fatigue and university students' talk about HIV risk

Drawing on a qualitative study that included 20 focus group discussions with male and female students at an urban-based university in South Africa, this article reports on perceptions, attitudes and reported behaviour with respect to HIV and AIDS and safer sex in the campus setting, with an aim to better understand how young people are responding to the challenges of HIV and AIDS in contemporary South Africa. The findings demonstrate the gap between reported HIV-prevention knowledge and safer-sex practices among a group of young and educated South Africans. Although the participants reported that students were knowledgeable about HIV and had easy access to condoms on campus, a range of factors mediated their capacity to apply this knowledge to safer-sex practices. Besides the usual set of complex social-cultural dynamics, including normative gender roles and power inequalities between men and women, socioeconomic challenges, and differences in age and status between sexual partners, the findings reveal substantial denial, stigma and HIV/AIDS 'fatigue.' The findings point to the importance of seeking creative ways to impart HIV-prevention and safer-sex messages that are not explicitly referent to HIV but link rather with broader issues concerning relationships, lifestyle and identity, and hence are responsive to the particular cultural context of university campuses.