Women General Practitioners Research Articles

Family Planning and Preconception Care Service Management: The Key Role of Bulgarian GPs.

Assisting women in attaining their reproductive goals is crucial for improving the well-being of families and children. As the first point of contact for healthcare, general practitioners (GPs) are ideal for family planning (FP) and preconception care (PCC). However, primary care interventions' efficacy is unclear. The aim of this study was to examine GPs' knowledge, attitudes, and perspectives on FP and PCC service management. Most GPs were aware of FP and PCC services and held a firm conviction that they should be primarily accountable together with obstetrician-gynaecologists. However, it is worth noting that less than 50% of respondents reported receiving thorough and comprehensive knowledge of their respective specialities. Those with general medicine qualifications demonstrated a high level of commitment to providing such services. The women's GPs and those with training in general medicine prescribed birth control pills and emergency contraception three times more frequently than the other doctors who suggested condoms or traditional methods or referred patients to another specialist (p < 0.05). In conclusion, PCC is of the utmost importance, and its effective implementation demands the collaboration of policymakers, healthcare providers, and individuals. GPs are essential in managing FP and PCC. They must incorporate more in-depth PCC into their clinical practice.

Management of hypertension in pregnancy.

SUMMARYHypertensive disorders of pregnancy are common and can result in maternal and fetal morbidity and mortality. Women may have chronic hypertension, or develop hypertension during pregnancy.Management involves close maternal and fetal surveillance. If an antihypertensive drug is needed, prescribe one that is safe in pregnancy.Pre-eclampsia is a hypertensive disorder of pregnancy. Women at high risk of pre-eclampsia should start aspirin 150 mg daily at 12–16 weeks gestation and continue until 36 weeks gestation, to reduce the risk of preterm delivery.There are long-term cardiovascular and mortality risks associated with pregnancies complicated by gestational hypertension and pre-eclampsia. Ongoing cardiovascular and metabolic risk surveillance should be undertaken by the woman’s general practitioner.

Gladys Mary Wauchope (1889-1966): Brighton physician and second female medical student at the London Hospital Medical College.

Gladys Mary Wauchope was a pioneering woman physician and general practitioner in London and Brighton. Descended from an ancient Scottish family, she was the second female medical student at the London Hospital Medical College after Elizabeth Garrett Anderson, enrolling during the brief period from 1918 to 1928 in which women were permitted to study medicine in mainstream London medical schools due to shortages of doctors caused by the First World War. Unperturbed by opposition to her gender from male colleagues, she was initially house physician on the firm of Sir Robert Hutchison at 'the London', and went on to hold an array of posts in large London hospitals at a time when finding such work was challenging for women doctors. She settled in Hove as a general practitioner in 1924, later becoming a consultant physician at several major Brighton hospitals. Made only the eighth female fellow of the Royal College of Physicians, she also set up the first diabetic clinic in Sussex and Kent. Gladys authored several books, including her autobiography 'The Story of a Woman Physician', which documents life through two world wars and the introduction of the National Health Service, whilst keenly observing the changing landscape of medicine and its place in society.

Subclinical hypothyroidism during pregnancy: the Melbourne public hospitals consensus.

Interest in potential adverse outcomes associated with maternal subclinical hypothyroidism (normal free T4, elevated thyroid-stimulating hormone (TSH)) has increased significantly over recent years. In turn, the frequency of maternal thyroid function testing has risen, despite universal thyroid function screening not being recommended, leading to a marked increase in referrals to obstetric endocrinology clinics. In 2017 the American Thyroid Association revised their diagnostic and management guidelines. Although welcome, these new guidelines contain recommendations that may cause confusion in clinical practice. To ensure uniform practice in the diagnosis and management of subclinical hypothyroidism in pregnancy across all Melbourne public hospitals. Endocrinology and obstetric representatives from all Melbourne public hospital networks reviewed the 2017 American Thyroid Association guidelines and other relevant literature to develop a consensus for diagnosing and treating subclinical hypothyroidism during pregnancy in Melbourne. The consensus guidelines were then referred to the Endocrine Society of Australia for comment and endorsement. Consensus was achieved and the guidelines were endorsed by the Council of the Endocrine Society of Australia. Trimester and assay-specific TSH reference intervals derived from healthy local populations should be used, where available. When unavailable, a TSH cut-off of 4 mU/L (replacing the previously recommended 2.5 mU/L) should be used to initiate treatment, irrespective of thyroid auto-antibody status. The recommended starting dose of levothyroxine is 50 μg daily, with a therapeutic TSH target of 0.1-2.5 mU/L. Levothyroxine should generally be ceased after delivery, with some exceptions. Hospitals will ensure smooth transfer of care back to the woman's general practitioner with clear documentation of pregnancy thyroid management and a recommended plan for follow-up. Fewer women will be classified as having subclinical hypothyroidism during pregnancy, which is likely to lead to reductions in emotional stress, hospital visits, repeated blood tests and financial costs. Uniform clinical practice will occur across Melbourne.

Semi-Individualized Homeopathy Add-On Versus Usual Care Only for Premenstrual Disorders: A Randomized, Controlled Feasibility Study.

Premenstrual syndrome and premenstrual dysphoric disorder (PMS/PMDD) bother a substantial number of women. Homeopathy seems a promising treatment, but it needs investigation using reliable study designs. The feasibility of organizing an international randomized pragmatic trial on a homeopathic add-on treatment (usual care [UC] + HT) compared with UC alone was evaluated. A multicenter, randomized, controlled pragmatic trial with parallel groups. The study was organized in general and private homeopathic practices in the Netherlands and Sweden and in an outpatient university clinic in Germany. Women diagnosed as having PMS/PMDD, based on prospective daily rating by the daily record of severity of problems (DRSP) during a period of 2 months, were included and randomized. Women were to receive UC + HT or UC for 4 months. Homeopathic medicine selection was according to a previously tested prognostic questionnaire and electronic algorithm. Usual care was as provided by the women's general practitioner according to their preferences. Before and after treatment, the women completed diaries (DRSP), the measure yourself concerns and well-being, and other questionnaires. Intention-to-treat (ITT) and per protocol (PP) analyses were performed. In Germany, the study could not proceed because of legal limitations. In Sweden, recruitment proved extremely difficult. In the Netherlands and Sweden, 60 women were randomized (UC + HT: 28; UC: 32), data of 47/46 women were analyzed (ITT/PP). After 4 months, relative mean change of DRSP scores in the UC + HT group was significantly better than in the UC group (p = 0.03). With respect to recruitment and different legal status, it does not seem feasible to perform a larger, international, pragmatic randomized trial on (semi-)individualized homeopathy for PMS/PMDD. Since the added value of HT compared with UC was demonstrated by significant differences in symptom score changes, further studies are warranted.

Are associations reported in cohort studies as robust as they appear?

Some data suggest that babies born to women in Australian public hospitals, largely cared for by midwives either alone or jointly with the woman's general practitioner, tend to die more often than those born in private hospitals where intrapartum care is provided by obstetricians. To test this finding with refined statistical methods, a study by Adams et al. (BJOG 2018;125:149–58) contrasts perinatal mortality rates among women that delivered in public versus private obstetrician-led hospitals in Brisbane, Australia. Their study included 69 037 public and 62 399 private hospital births. The authors applied a propensity score (PS) matched method to minimise bias due to measured confounders, and reported that the risk of perinatal mortality was substantially higher among births in public than in private hospitals. This increased risk, although attenuated, was still evident following adjustments for major congenital anomalies, birth method, and gestational age. Propensity score methodology enables an observational study to be converted to a ‘pseudo-randomised’ trial that is free of measured confounding (Rosenbaum & Rubin. Biometrika 1983;70:41–55; Austin. Multivariate Behavior Res 2011;46: 399–424). However, PS analysis does not account for unmeasured confounding, an important source of bias in observational epidemiology that results from variables that may be associated with both the exposure and the outcome, but which were not measured in the study. In randomised trials, when treatment allocation is done properly (i.e. via randomisation), the treatment groups are virtually balanced with respect to both measured and unmeasured confounders. In comparison, PS analysis guarantees the former, but not the latter, and unmeasured confounding still remains a serious concern. An elegant and simple-to-use method to assess the extent to which unmeasured confounding may play a role in the association between hospital type and risk of perinatal mortality, is the ‘E-value’ (VanderWeele & Ding. Ann Intern Med 2017;167:268–74). This measure provides an estimate of how large an unmeasured confounder (of both the exposure-unmeasured confounder, and the unmeasured confounder-outcome scenarios of the exposure-outcome association) must be to render the observed odds ratio (OR) a null estimate, as well as on the lower limit of 95% confidence interval (CI) estimate to include the null value of the observed OR. In the study by Adams et al., the observed OR for the association between deliveries in public hospitals (versus those in private hospitals) and perinatal mortality was 1.53 (95% CI 1.29–1.80). The corresponding E-values for the OR and the lower limit of the 95% CI were 2.43 and 1.90, respectively (see VanderWeele & Ding. Ann Intern Med 2017;167:268–74 for details). This suggests that in order for the observed OR to be reduced to null, and for the lower 95% CI estimate to cross null, the corresponding ORs for unmeasured confounding must be at least 2.43 and 1.90, respectively. Given the magnitude of these ORs, the association of increased perinatal mortality in Australian public hospitals for deliveries cared for by midwives either alone or jointly with the woman's general practitioner by Adams and colleagues is less likely to be the result of unmeasured confounding. None declared. Completed disclosure of interests form available to view online as supporting information. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

A better model of care after surgery for early endometrial cancer - Comprehensive needs assessment and clinical handover to a woman's general practitioner.

Endometrial cancer is the most common invasive gynaecological cancer in Australia. Despite the fact that review after treatment of early endometrial cancer has not been shown to detect recurrent disease, practice at several hospitals brings women back for specialist hospital review for 5years after definitive cancer surgery. Implement an improved model of follow-up care following hospital treatment for early endometrial cancer. Quantitative and qualitative. Seventy-three of the eligible 81 women undertook the model of care. All general practitioners (GPs) agreed to follow-up care. Thirty-one women (42%) and 37 GPs (51%) returned surveys. All women found the nurse consultation very useful or useful with 77% reporting making lifestyle changes and 87% found the GP consultation very useful or useful with 72% reporting making lifestyle changes. Eighty-nine percent of GPs found the care plan useful, 94% set up patient recall systems, 79% used the care plan to develop their own care plan, 100% felt confident in providing follow-up care with 91% reporting the care plan and hospital processes improved their confidence. Comparison with the pre-cohort women showed: higher rates of communication at various care points to GPs (from P<0.001); more referrals (P<0.001); and a projected decrease of nine hospital doctor appointments per patient. With an increasing number of people surviving cancer, in order to address holistic health needs and maintain tertiary service capacity, general practice will be required to provide more follow-up care. Our model demonstrates an acceptable and quality mechanism for this to occur.

Pilates program design and health benefits for pregnant women: A practitioners' survey

BackgroundLittle is known about recommendations for safe and appropriate instruction of Pilates exercises to women during pregnancy. The aim of this study was to examine Pilates practitioners’ perspectives regarding Pilates program design for pregnant women. We also sought to elucidate their views on the potential benefits, restrictions and contraindications on Pilates in pregnancy. MethodsA cross-sectional survey was performed. Pilates practitioners were invited to participate via email. Participants were surveyed about their experience and views on: screening processes in alignment with The American College of Obstetricians and Gynecologists (ACOG) (2002) guidelines; (ii) optimal exercise program features and (iii) physical and mental health benefits of Pilates for pregnant women. ResultsThe survey was completed by 192 Pilates practitioners from a range of settings. Practitioners reported conducting formal screening (84%) for safety in pregnant women prior to commencing Pilates classes. Most did not routinely seek medical approval from the woman's general practitioner. Divergent views emerged regarding the safety and benefits of Pilates exercises in the supine position. Mixed opinions were also generated regarding the effects of spinal flexion exercises, single-leg stance exercises and breathing manoeuvres. There was little agreement on the optimal frequency or dosage of exercises. Views regarding absolute contraindications to exercise differed from The American College of Obstetricians and Gynecologists (ACOG) (2002) guidelines which cautioned about the dangers of persistent bleeding, premature labour, pre-eclampsia, placental praevia and incompetent cervix. The most frequent reported physical and psychological benefit of Pilates was improving pelvic floor strength (12%) and improved social wellbeing (23%). ConclusionsThe study highlighted wide variations in practice for Pilates exercises with pregnant woman as well as low adherence to clinical practice guidelines. Further evidence is required to advise on appropriate screening and individualized Pilates programming, particularly for women with medical conditions during pregnancy.

Using Web-Based Questionnaires and Obstetric Records to Assess General Health Characteristics Among Pregnant Women: A Validation Study.

BackgroundSelf-reported medical history information is included in many studies. However, data on the validity of Web-based questionnaires assessing medical history are scarce. If proven to be valid, Web-based questionnaires may provide researchers with an efficient means to collect data on this parameter in large populations.ObjectiveThe aim of this study was to assess the validity of a Web-based questionnaire on chronic medical conditions, allergies, and blood pressure readings against obstetric records and data from general practitioners.MethodsSelf-reported questionnaire data were compared with obstetric records for 519 pregnant women participating in the Dutch PRegnancy and Infant DEvelopment (PRIDE) Study from July 2011 through November 2012. These women completed Web-based questionnaires around their first prenatal care visit and in gestational weeks 17 and 34. We calculated kappa statistics (κ) and the observed proportions of positive and negative agreement between the baseline questionnaire and obstetric records for chronic conditions and allergies. In case of inconsistencies between these 2 data sources, medical records from the woman’s general practitioner were consulted as the reference standard. For systolic and diastolic blood pressure, intraclass correlation coefficients (ICCs) were calculated for multiple data points.ResultsAgreement between the baseline questionnaire and the obstetric record was substantial (κ=.61) for any chronic condition and moderate for any allergy (κ=.51). For specific conditions, we found high observed proportions of negative agreement (range 0.88-1.00) and on average moderate observed proportions of positive agreement with a wide range (range 0.19-0.90). Using the reference standard, the sensitivity of the Web-based questionnaire for chronic conditions and allergies was comparable to or even better than the sensitivity of the obstetric records, in particular for migraine (0.90 vs 0.40, P=.02), asthma (0.86 vs 0.61, P=.04), inhalation allergies (0.92 vs 0.74, P=.003), hay fever (0.90 vs 0.64, P=.001), and allergies to animals (0.89 vs 0.53, P=.01). However, some overreporting of allergies was observed in the questionnaire and for some nonsomatic conditions sensitivity of both measurement instruments was low. The ICCs for blood pressure readings ranged between 0.72 and 0.92 with very small mean differences between the 2 methods of data collection.ConclusionsWeb-based questionnaires can be used to validly collect data on many chronic disorders, allergies, and blood pressure readings among pregnant women.

Under-representation of women on governing bodies: women general practitioners on Clinical Commissioning Groups in England.

Recently formed Clinical Commissioning Groups in the English National Health Service have important responsibility for commissioning local health and care services. Women are under-represented on the governing bodies of these significant primary care based organizations despite the fact that they constitute almost half of the general practitioner workforce in England. This essay examines some of the reasons for this under-representation including the predominance of women in the salaried and part-time sector of general practice and gendered management styles within the National Health Service. It is argued that the under-representation of women on Clinical Commissioning Group governing bodies matters in terms of social justice, representation of the broader community and role models.

Intimate partner violence and ways of coping with stress: cross-sectional survey of female patients in Russian general practice.

Despite World Health Organization guidelines on health service responses to intimate partner violence (IPV) against women general practitioners (GPs) often overlook the problem. Training on IPV addresses GPs' barriers to asking women patients about abuse and responding appropriately. One of the barriers is stereotype of women as passive victims. Little is known about coping behaviour of women patients with a history of IPV. The objectives are (i) to compare problem- and emotion-focused coping used by patients who have experienced IPV with those who have not; (ii) to examine whether greater coping resources (health, education, employment and income) would be associated with more problem-focused coping. The Russian Ways of Coping Questionnaire was administered to every fifth woman who participated in a cross-sectional survey on IPV prevalence in 24 St Petersburg general practices. Linear regression was used (n = 159) to test associations between life-time IPV, coping resources and ways of coping. Mean problem-focused coping scores were 0.2-4.7 units higher in those patients who have experienced IPV compared with those who have not [95% confidence interval (CI): -4.2, 11.9; P = 0.16-0.92], while mean emotion-focused coping scores were 2.5-4.2 units higher (95% CI: -3.0, 11.0; P = 0.12-0.57). After adjustment for coping resources there was no evidence for an association between IPV and problem-focused coping. Patients who have experienced IPV use as much problem-focused and emotion-focused coping, as those patients who have not experienced IPV. These findings should be incorporated into training on IPV to address GPs' stereotypes towards patients who have experienced IPV.

Thirty-year persistence of obesity after presentation to a pediatric obesity clinic

Background: Few large, long-term studies are available on the relationship between childhood and adult obesity.Aim: The present study examined the 30-year association between childhood and adult obesity in a large sample of girls with essential and uncomplicated obesity.Subjects and methods: 318 girls who had visited our Pediatric Obesity Clinic between January 1972 and December 1974 were re-contacted between January 2002 and December 2005. All had undergone an assessment of weight, height and pubertal status at the baseline visit. Anthropometry was performed again on those who agreed to take part in the follow-up visit. The women's general practitioners were also asked to compile a health questionnaire. Hypertension, hypercholesterolemia, hypertriglyceridemia and diabetes were defined according to current guidelines. Rates are expressed as number of cases per 1000 person-years (PY). Multivariable Poisson regression was used to identify predictors of persistent obesity.Results: 224 (70%) of the 318 girls took part to the 30-year follow-up study. They had the same baseline anthropometry of those not available at follow-up. Sixteen per cent of them were still obese at the 30-year follow-up, giving a persistence rate of obesity of 5.2 × 1000 PY. Tanner stages ≥1 [rate = ratios (RR) from 4.73 to 7.74 for different stages, p ≤ 0.021] and Z-score of BMI (RR = 2.72 for one SDS, p = 0.019) were independent predictors of obesity persistence. Having a university degree vs. an elementary degree was instead protective (RR = 0.32, p = 0.009). The most prevalent complication was hypertriglyceridemia (8.8 × 1000 PY), followed by hypercholesterolemia (rate = 8.4 × 1000 PY), hypertension (rate = 5.2 × 1000 PY) and diabetes mellitus (rate = 1.0 × 1000 PY).Conclusion: The study reinforces the notion that obesity should be prevented at an early age and shows that adolescents with severe obesity and low educational degree are at greater risk of becoming obese adults.

Women's perceptions and beliefs about the use of complementary and alternative medicines during menopause

Studies of menopausal women are providing increasing evidence of the reasons for complementary and alternative medications (CAM) use during menopause, the types of CAM used and the prevalence of use; however, further insight into the experiences of women using CAM during menopause is required. The aim of this study was to put CAM use during menopause into context by identifying and describing the factors that influence menopausal women in their decision to use CAM. Menopausal women participated in focus groups and telephone interviews and the following information were collected: symptoms experienced during menopause; therapies (other than hormones) used to cope with menopause, and the perceived benefits of these therapies, and how the women found out about these therapies. The data collected were analysed using thematic analysis. Fifteen women participated in the study; 13 in the focus groups and two in telephone interviews. The women reported using a diverse range of therapies, supplements and activities. Empowerment was a central theme throughout the study. The level of support from the women's general practitioners was reported to be a major influence in their decision to take CAM. The availability of information about CAM and individual determinants, such as symptoms and perceptions of menopause, were also identified as significant influences. The women in this study expressed a desire to have control over their symptoms and the way in which their menopause was treated. This study has highlighted a need for more information and education about menopause and, in particular, the range, safety and efficacy of CAM use during menopause. The study also shows there is a need for strong participatory relationships between women and their health professionals.

The feminization of the medical work force, implications for Scottish primary care: a survey of Scottish general practitioners

BackgroundThe number of women working in general practice internationally has been steadily rising. In Scotland there have been concerns that such a change may lead to increased part-time working and subsequently to a fall in available general practice manpower despite an apparently rising overall number of general practitioners. However, there is very little information on the actual hours worked by men and women general practitioners or on the types of work they are undertaking.MethodsAnonymous workload questionnaires of all Scottish general practitioner principals and non-principalsResultsResponse rates for general practice principals and non-principals were 67.2% and 65.2% respectively. Male principals spent on average 18% more time on general medical services (GMS) and 50% more time on non-GMS activities (such as teaching, specialist sessions, administration and research) than women (both p <0.01). This difference was similar for non-principals. In no age group did the hours worked by women doctors approach that of male doctors.ConclusionWomen doctors in primary care in Scotland work fewer hours in all age groups than their male counterparts. The rapidly increasing proportion of women in general practice may lead to an increasing shortfall of medical availability in the future if current work patterns are maintained. Further longitudinal research is required to establish this and man-power planning is required now to address this. More worryingly auxiliary activities such as teaching and administrative duties are not being taken up by women. This may have serious implications for the future development of the specialty in Scotland.

Pharmacist-Provided Quantitative Heel Ultrasound Screening for Rural Women at Risk of Osteoporosis

Osteoporosis is underdiagnosed, and rural communities often have limited technical resources for the assessment of osteoporosis. To evaluate the impact of a pharmacist, trained in the use of a portable heel ultrasound device, in screening elderly rural women for risk of osteoporosis and determine whether those found to be at risk seek further help and treatment from their general practitioner (GP) following screening. Following promotion of the service, 345 women were recruited from 6 rural community pharmacies in Tasmania, Australia, and underwent quantitative heel ultrasound screening. Women were comprehensively educated on risk factors for osteoporosis and completed a calcium intake questionnaire. Results were forwarded to each woman's GP, and the participants were followed up 3 months later to assess outcomes from the screening procedure. Approximately 20% of women were shown to be at high risk for osteoporosis; 201 (58%) of these were referred to their GP for further assessment. Sixty-eight percent of women who were screened discussed their results with their GP, and 11% underwent further investigation. Over one-third of women screened began medication (30% calcium, 6% bisphosphonate, 6% vitamin D) for osteoporosis. Pharmacist-provided screening for osteoporosis in rural areas is a potentially useful method to identify women at risk for fracture and a convenient time point for discussion of preventive therapy.

Sequential magnetic resonance imaging follow-up of multiple sclerosis before the clinical phase

There is much evidence of the importance of the preclinical phase of multiple sclerosis (MS). However, apart from a recent report of the incidental discovery of a case of primary progressive MS, there are no data on the sequential magnetic resonance imaging (MRI) follow-up of patients before the clinical phase. We report the incidental discovery of white matter changes on MRI and their follow-up in a patient three years before the first neurological event (optic neuritis). A 34-year-old woman presented with headaches and depression after her young daughter had been involved in a car accident and spent two weeks in intensive care. The woman's general practitioner performed a brain MRI, which revealed multiple T2-weighted hypersignals suggesting MS. During the next three years, clinical examination remained normal but we observed new T2 lesions and/or new enhanced T1 lesions after gadolinium infusion on the four successive MRIs. Thirty-seven months after the first MRI, the patient developed a right optic neuritis. The diagnosis of MS was made according to space and time dissemination on MRI criteria. We proposed a treatment with Interferon Beta 1a (Avonex).

Professional and domestic work arrangements of women general practitioners in France

Parallel to the increase in the number of women taking up medical careers, the reform of the 3rd cycle of medical studies in France has brought about some changes in professional norms. The traditional model of general practitioner (GP) practice usually refers to a totally dedicated male doctor, with the domestic support of a female carer. For many women doctors this model of reference clashes head on with the traditional division of the roles between women and men. The current forms of the “social contract between the sexes” are questioned and women GPs introduce specific (time) strategies for managing medical practice and family life.

The balancing act: key issues in the lives of women general practitioners in Australia.

To identify key issues affecting women general practitioners in their professional and non-professional lives. A qualitative study using the Delphi technique, with three rounds of data provision circulated to each participant. Coding was used to ensure anonymity. The participants were a purposive sample of 40 women GPs drawn from all Australian States and Territories. The study was conducted between October 1996 and January 1997. Key issues affecting the professional and non-professional lives of women GPs. Some of the key professional issues for women GPs were job satisfaction, balancing work and personal life, autonomy, availability of flexible and part-time work and training, affordability of professional expenses, fair remuneration, and having a voice in decision-making. Key non-professional issues included self-care; time for relationships with a partner, children, family and friends; and time management to allow pursuit of non-medical interests. The conflicting demands made on women GPs diminish their job satisfaction and lead to stress and imbalance in their lives. Recommendations to ameliorate the problems for women GPs include appropriate training, policy formation, financial and other support, and a change in cultural expectations of women GPs by the community, the profession and governments.

Attitudes to menopause and hormone replacement therapy among Asian and Caucasian women general practitioners

Objective: To look for any differences in attitudes to menopause and hormone replacement therapy (HRT) between Asian and Caucasian women standardised for educational background, socio-economic status and access to medical information. Method: Self administered postal questionnaire sent to 144 women doctors (general practitioners) in defined geographical areas. Results: The overall response rate was 61%. Both Asian and Caucasian women responded in a similar manner for most aspects. A high proportion of these women doctors (over 75%) would seek HRT at the climacteric. More Asian respondents reported a fear of breast cancer ( P=0.001), and that a woman feels less of a woman after the menopause ( P=0.02). More Caucasian respondents felt positively about the potential for HRT to enhance enjoyment of life ( P=0.01). Conclusions: The lack of major differences between the ethnic groups in our sample suggests that variations reported elsewhere may be due to lack of knowledge and/or differences in socio-economic status.

Ser médico o médica marca diferencias en la práctica asistencial

To identify the differences between the clinical practice (conduct) of male and female doctors and its determining factors; and to find the variability in the various conducts studied which is explained by a set of variables, gender among them. Cross-sectional, multi-centre descriptive study. Andalusian health centres with populations of over 100000 inhabitants. Selection of 159 primary care doctors with postgraduate training by means of simple randomised sampling. 56% were men, 44% women, with power of comparisons at 68%. Self-administered questionnaire to measure the dependent variable, overall conduct (clinical practice) and 11 dimensions of this conduct. Independent variables were: determinants of conduct identified by the theory of reasoned action (attitudes and subjective norm) and by the theory of social learning (self-efficacy and control locus), gender and other social and demographic variables and work conditions variables. Multiple linear regression models were constructed to explain each conduct analysed. Being a female doctor affects positively overall conduct and conduct in information, psycho-social guidance, prevention of obesity, active recruitment for family planning and collaboration with nurses. In Andalusia women general practitioners have a more marked orientation towards the psycho-social sides of care than their male colleagues. They give more information to their patients and more frequently perform preventive activities linked to their gender. They also rely on the work of their nurses more than male doctors.