Chloe E. Bird

Gender matters: an integrated model for understanding men's and women's health

Health research has failed to adequately explore the combination of social and biological sources of differences in mens and womens health. Consequently, scientific explanations often proceed from reductionist assumptions that differences are either purely biological or purely social. Such assumptions and the models that are built on them have consequences for research, health care and policy. Although biological factors such as genetics, prenatal hormone exposure and natural hormonal exposure as adults may contribute to differences in mens and womens health, a wide range of social processes can create, maintain or exacerbate underlying biological health differences. Researchers, clinicians and policy makers would understand and address both sex-specific and non-sex-specific health problems differently if the social as well as biological sources of differences in mens and womens health were better understood.

Preferential Use of Sonographically Guided Biopsy to Minimize Patient Discomfort and Procedure Time in a Percutaneous Image-Guided Breast Biopsy Program

Objective. To determine whether preferential use of sonographic guidance for percutaneous biopsy of breast masses results in a subset of patients with a shorter procedure time and less discomfort compared with patients undergoing stereotactic biopsy. Methods. A prospective observational study was performed on 193 women undergoing percutaneous image‐guided breast biopsy between 1997 and 1999. Data were collected on room time, physician time, and patient comfort levels for 122 stereotactic and 71 sonographically guided biopsies. Differences between stereotactic and sonographically guided biopsy for all lesions and for masses were analyzed for statistical significance. Results. Mean room times were 62.2 minutes for stereotactic biopsy and 39.4 minutes for sonographically guided biopsy (P < .0001). Mean physician times were 23.0 minutes for stereotactic biopsy and 15.8 minutes for sonographically guided biopsy (P < .0001). When we limited our analyses to women undergoing biopsy for masses, the difference in physician time largely disappeared, but the difference in room time remained (P < .0001). Women undergoing stereotactic biopsy were more likely to report discomfort due to body positioning than were women undergoing sonographically guided biopsy (P < .001). These differences existed whether we included all lesions or restricted our analyses to masses. Conclusions. Preferential use of sonographically guided breast biopsy for masses results in shorter procedure times and less patient discomfort compared with prone stereotactic biopsy.

Mammography-related anxiety: effect of preprocedural patient education.

OBJECTIVESnTo determine the effect of preprocedural education on mammography-related anxiety.nnnMATERIALS AND METHODSnA total of 613 women undergoing mammography were surveyed regarding anxiety about the procedure and expected results. Half the study population watched an educational videotape and half watched an entertaining movie in the waiting room.nnnRESULTSnAnxiety levels about results were significantly higher than anxiety levels about the procedure (P <.001). There was no difference in procedural or cancer anxiety levels among women shown the educational tape and those shown the entertaining movie.nnnCONCLUSIONnThe fear of discovering breast cancer generates most of mammography-related anxiety. Preprocedural education did not affect procedural or cancer-related anxiety.

Priorities and Expectations

In this chapter, we examine how work and family life are related to mens and womens health. Many of the differences in mens and womens lives that we have considered in earlier chapters have their roots in their family roles and in their jobs. Family and work are the two arenas where the constraints on choice are most readily apparent and frequently experienced, because they involve a myriad of routine decisions that occur on a daily basis. Consequently, in these arenas it is clear that individuals are making choices actively or at least by default. Moreover, both work and family roles are associated with some activities, as well as stresses, that tend to occur along gender lines. For example, occupations, careers, and family life each carry with them expectations derived from mens and womens social roles. Thus, as one of the mothers Judith Warner interviewed for her recent book on motherhood aptly noted, “These are choices that dont feel like choices at all. They are the harsh realities of family life in a culture that has no structures in place to allow women – and men – to balance work and child rearing” (Warner, 2005). Many of these choices are forced by time or financial constraints, which as this mothers comment illustrates can often leave individuals with a sense that they had little if any freedom to choose among the competing priorities, tasks, and goals.