Mechanisms accounting for gendered differences in mental health status among young Canadians: A novel quantitative analysis.

Adolescent girls consistently report worse mental health than boys. This study used reports from a 2018 national health promotion survey (n = 11,373) to quantitatively explore why such gender-based differences exist among young Canadians. Using mediation analyses and contemporary social theory, we explored mechanisms that may explain differences in mental health between adolescents who identify as boys versus girls. The potential mediators tested were social supports within family and friends, engagement in addictive social media use, and overt risk-taking. Analyses were performed with the full sample and in specific high-risk groups, such as adolescents who report lower family affluence. Higher levels of addictive social media use and lower perceived levels of family support among girls mediated a significant proportion of the difference between boys and girls for each of the three mental health outcomes (depressive symptoms, frequent health complaints, and diagnosis of mental illness). Observed mediation effects were similar in high-risk subgroups; however, among those with low affluence, effects of family support were somewhat more pronounced. Study findings point to deeper, root causes of gender-based mental health inequalities that emerge during childhood. Interventions designed to reduce girls' addictive social media use or increase their perceived family support, to be more in line with their male peers, could help to reduce differences in mental health between boys and girls. Contemporary focus on social media use and social supports among girls, especially those with low affluence, warrant study as the basis for public health and clinical interventions.

A novel application of a data mining technique to study intersections in the social determinants of mental health among young Canadians.

OBJECTIVES: Adolescent mental health is an emergent clinical and public health priority in Canada. Gender-based differences in mental health are well established. The objective of this study was to evaluate a new data mining technique to identify social locations of young Canadians where differences in mental health between adolescent males and females were most pronounced. METHODS: We examined reports from 21,221 young Canadians aged 11-15 years (10,349 males, 10,872 females) who had responded to a 2018 national health and health behaviours survey. Using recursive partitioning for subgroup identification (SIDES), we identified social locations that were associated with the strongest differences between males and females for three reported mental health outcomes: positive psychosomatic health, symptoms of depression, and having a diagnosed mental illness. RESULTS: The SIDES algorithm identified both established and new intersections of social factors that were associated with gender-based differences in mental health experiences, most favouring males. DISCUSSION: This analysis represents a novel proof-of-concept to demonstrate the utility of a subgroup identification algorithm to reveal important differences in mental health experiences between adolescent males and females. The algorithm detected new social locations (i.e., where gender intersected with other characteristics) associated with poor mental health outcomes. These findings set the stage for further intersectional research, involving both quantitative and qualitative analyses, to explore how axes of discrimination may intersect to shape potential gender-based health inequalities that emerge during childhood.

Systematic review of methods used to study the intersecting impact of sex and social locations on health outcomes.

PURPOSE: Independent health impacts of sex or social circumstances are well-studied, particularly among older adults. Less theorized or examined is how combinations or intersections of these underpin differential health effects. Nevertheless, and often without naming it as such, an intersectional framework aligns with studies of social determinants of health, life-course epidemiology and eco-epidemiology. In this systematic review we examined and aimed to identify research methods used to operationalize, whether intentionally or inadvertently, interconnected effects of sex and social locations on health outcomes for 45+ year olds. METHODS: Using broad search terms, numerous databases, and following Prisma guidelines, 732 of 9214 papers initially identified, met inclusion criteria for full review. RESULTS: Of the 501 papers included after full review, methods used in considering intersections of sex and social circumstances/location(s) included regression (112 of 365 papers), growth curves (7 of 22), multilevel (15 of 25), decomposition (6 of 9), mediation (10 of 17), structural equation modelling (23 of 25), and other (2 of 3). Most (n = 157) approximated intersectional analyses by including interaction terms or sex-stratifying results. DISCUSSION: Few authors used the inherent strength of some study methods to examine intersecting traits. As even fewer began with an intersectionality framework their subsequent failure to deliver cannot be faulted, despite many studies including data and methodologies that would support intersectional analyses. There appeared to be a gap, not in analytic potential but rather in theorizing that differential distributions of social locations describe heterogeneity within the categories 'men' and 'women' that can underlie differential, gendered effects on older adults' health. While SEM, mediation and decomposition analyses emerged as particularly robust methods, the unexpected outcome was finding how few researchers consider intersectionality as a potential predictor of health.

A comparison between the direct anterior and posterior approaches for total hip arthroplasty: the role of an 'Enhanced Recovery' pathway.

AIMS: We assessed the difference in hospital based and early clinical outcomes between the direct anterior approach and the posterior approach in patients who undergo total hip arthroplasty (THA). PATIENTS AND METHODS: The outcome was assessed in 448 (203 males, 245 females) consecutive patients undergoing unilateral primary THA after the implementation of an 'Enhanced Recovery' pathway. In all, 265 patients (mean age: 71 years (49 to 89); 117 males and 148 females) had surgery using the direct anterior approach (DAA) and 183 patients (mean age: 70 years (26 to 100); 86 males and 97 females) using a posterior approach. The groups were compared for age, gender, American Society of Anesthesiologists grade, body mass index, the side of the operation, pre-operative Oxford Hip Score (OHS) and attendance at 'Joint school'. Mean follow-up was 18.1 months (one to 50). RESULTS: There was no significant difference in mean length of stay (p = 0.07), pain scores on the day of surgery, the first, second and third post-operative days (p = 0.36, 0.23, 0.25 and 0.59, respectively), the day of mobilisation (p = 0.12), the mean OHS at six and 24 months (p = 0.08, and 0.29, respectively), the incidence of infection (p = 1.0), dislocation (p = 1.0), re-operation (p = 0.21) or 28 days' re-admission (p = 0.06). Significantly more patients in the DAA group achieved a planned discharge target of three days post-operatively (68% vs 56%, p = 0.007). The rate of periprosthetic femoral fractures was significantly higher in the DAA group (p = 0.04). CONCLUSION: We conclude that there is no difference in clinical outcomes between the DAA and the posterior approach in patients undergoing THA when an 'Enhanced Recovery' pathway is used. However, a significantly higher rate of periprosthetic femoral fractures remains a concern with the DAA, even in experienced hands. TAKE HOME MESSAGE: Our results show that the DAA for THA is not superior to posterior approach when 'Enhanced Recovery' pathway is used. Cite this article: Bone Joint J 2016;98-B:754-60.

Correlates of partner and family violence among older Canadians: a life-course approach.

INTRODUCTION: Knowledge about individual and interpersonal correlates of violence in Canadian seniors is limited. This study identifies correlates of current and past violence by intimate partner and family member(s) in community-dwelling Canadian seniors, while accounting for childhood adverse circumstances. METHODS: We performed logistic regression analysis of baseline data from a longitudinal study of community-dwelling individuals aged 65 to 74 years and living in Kingston (Ontario) and Saint-Hyacinthe (Quebec). Domestic violence was assessed using the Hurt- Insult-Threaten-Scream (HITS) screening tool. Odds ratios (ORs) are reported with 95% confidence intervals (CIs). RESULTS: Current violence of a psychological nature was reported by 18% of the sample. Women were at greater risk of current and lifetime violence perpetrated by a family member (current violence: adjusted OR = 1.83; 95% CI: 1.02-3.30) as well as experiencing violence from their intimate partner in their lifetime than were men (adjusted OR = 2.48; 95% CI: 1.40-4.37). Risk factors have accumulated over the life course that were found to be consistently associated with both current and lifetime violence included having witnessed violence at home in childhood (lifetime violence by family member: adjusted OR = 9.46; 95% CI: 5.11-17.52), as well as poor quality of relationships with intimate partners, family and friends. CONCLUSION: Our research documents the ongoing impact of early adversity on subsequent partner and family violence in Canada. Findings identify some preventable factors associated with current psychological violence and past violence among community dwelling Canadian seniors.

TITRE: Corrélats de la violence entre conjoints et en milieu familial chez les Canadiens âgés : une approche fondée sur les parcours de vie. INTRODUCTION: La connaissance des corre´lats personnels et interpersonnels de la violence chez les aiˆne´s canadiens est limite´e. Cette e´tude e´tablit les corre´lats de la violence actuelle et passe´e inflige´e par un conjoint ou un membre de la famille chez les aiˆne´s canadiens re´sidant dans la collectivite´, en tenant compte des conditions de´favorables dans l'enfance. MÉTHODOLOGIE: Nous avons proce´de´ a` une analyse de re´gression logistique des donne´es de base d'une e´tude longitudinale sur des personnes de 65 a` 74 ans re´sidant dans la collectivite´ a` Kingston (Ontario) et a` Saint-Hyacinthe (Que´bec). La violence familiale a e´te´ mesure´e avec l'outil d'e´valuation du risque Frapper-Insulter-Menacer-Crier (FIMC) (Hurt-Insult-Threaten-Scream, HITS). Les rapports de cotes (RC) ont e´te´ e´tablis avec un intervalle de confiance (IC) a` 95 %. RÉSULTATS: Dix-huit pour cent des sujets de l'e´chantillon ont de´clare´ subir de la violence de nature psychologique. Les femmes pre´sentaient un risque plus e´leve´ que les hommes de subir ou d'avoir subi de la violence de la part d'un membre de leur famille (violence actuelle : RC ajuste´ » 1,83; IC a` 95 % : 1,02 a` 3,30) et de la part d'un conjoint au cours de leur vie (RC ajuste´ » 2,48; IC a` 95 % : 1,40 a` 4,37). Les facteurs de risque accumule´s au cours de la vie associe´s syste´matiquement a` la violence actuelle et passe´e sont d'avoir e´te´ te´moin de violence domestique dans l'enfance (violence au cours de la vie inflige´e par un membre de la famille : RC ajuste´ » 9,46; IC a` 95 % : 5,11 a` 17,52) ainsi que des relations de mauvaise qualite´ avec le conjoint, la famille et les amis. CONCLUSION : Notre recherche documente les conse´quences a` long terme de conditions de´favorables dans l'enfance sur la violence conjugale et familiale au Canada. Nos re´sultats isolent certains facteurs e´vitables associe´s a` la violence psychologique actuelle et passe´e chez les personnes aˆge´es re´sidant dans la collectivite´ au Canada.

Measuring the health effects of gender.

The health effects of gender are mediated via group-level constraints of sex roles and norms, discrimination and marginalisation of individuals, and internalisation of the stresses of role discordance. Although gender is frequently a lens through which data are interpreted there are few composite measures that insert gender as an independent variable into research design. Instead, sex disaggregation of data is often conflated with gender, identifying statistically significant but sometimes clinically insignificant sex differences. To directly assess the impact of gender on wellbeing requires development of group and individual-level derived variables. At the ecological level such a summative variable could be composed of a selection of group-level measures of equality between sexes. This gender index could be used in ecological and individual-level studies of health outcomes. A quantitative indicator of gender role acceptance and of the personal effects of gender inequities could insert the often hidden variable of gender into individual-level clinical research.

Medical faculty's views and experiences of parental leave: a collaborative study by the Gender Issues Committee, Council of Ontario Faculties of Medicine.

OBJECTIVES: To examine medical faculty's actual and ideal parental leave arrangements with the aim of informing policy decisions. Leave lengths, effect on career, financial arrangements, and availability of temporary replacements were explored. METHODS: All medical faculty (6387) in Ontario, Canada were surveyed by mail and asked about parental leave experiences since 1990. Responses of men and women were compared as were those of leave takers and the entire group. RESULTS: Thirty-two percent (n = 996) of the 3107 respondents were women and 68% (n = 2067) were men. Ninety-eight percent (n = 317) of new mothers had taken maternity leave, while only 21% (n = 159) of new fathers had. Both paid and unpaid leave was generally shorter than that allowed by law or identified as ideal. Parental leave had a somewhat negative effect on the careers of all faculty. Women were more worried than men about the effect of their absence on colleagues' work and more generous with ideal leave length and funding. Temporary replacement of leave takers was central to an effective leave policy. CONCLUSIONS: Institutional and academic culture may cause new parents to take suboptimal leave despite legislation allowing more. A change in the work environment is required for medicine to offer its teachers what it teaches--that infants benefit from nurturing, nursing, and stability early in life.

Do students' attitudes toward women change during medical school?

BACKGROUND: Medical school has historically reinforced traditional views of women. This cohort study follows implementation of a revitalized curriculum and examines students' attitudes toward women on entry into an Ontario medical school, and 3 years later. METHODS: Of the 75 students entering first year at Queen's University medical school 70 completed the initial survey in September 1994 and 54 were resurveyed in May 1997. First-year students at 2 other Ontario medical schools were also surveyed in 1994, and these 166 respondents formed a comparison group. Changes in responses to statements about sex-role stereotypes, willingness to control decision-making of female patients, and conceptualization of women as "other" or "abnormal" because they are women were examined. Responses from the comparison group were used to indicate whether the Queen's group was representative. RESULTS: Attitudinal differences between the primary group and the comparison group were not significant. After 3 years of medical education students were somewhat less accepting of sex-role stereotypes and less controlling in the doctor-patient encounter. They continued, however, to equate adults with men and to see women as "not adult" or "other." Female students began and remained somewhat more open-minded in all areas studied. INTERPRETATION: A predicted trend toward conservatism was not seen as students became older, more aware and closer to completion of medical training, although they continued to equate adults with male and to see women as "other." Findings may validate new curricular approaches and increased attention to gender issues in the academic environment.

A qualitative study of sexual harassment of female doctors by patients.

This paper reports the qualitative data from a study of sexual harassment of female family physicians by patients. In addition to the everyday harassment that any woman might encounter in a work setting, the physicians in this study also reported types of harassment which are unique to the practice of medicine. These include opportunistic harassment such as exposure of the genitals, inappropriately touching the physician when the examination requires close contact, excessive discussion of sexual matters for apparent erotic gratification, and acting out behaviours from non-competent patients. Other reported behaviours were not, strictly speaking, sexual harassment but were troublesome nonetheless, including spontaneous erections during physical examinations, physically intimidating behaviour, and ambiguous behaviours which were sexual in nature, but difficult to interpret. The findings are discussed in the context of theory pertaining to contrapower harassment. It is concluded that for some patients the gender of the physician takes precedence over her occupational status and, this combined with the unique characteristics of the doctor/patient relationship, can make the practice of family medicine more conductive to sexual harassment than other professions.

Gender sensitivity in medical curricula.

Both sex--the biologic aspects of being female or male--and gender--the cultural roles and meanings ascribed to each sex--are determinants of health. Medical education, research and practice have all suffered from a lack of attention to gender and a limited awareness of the effects of the sex-role stereotypes prevalent in our society. The Women's Health Interschool Curriculum Committee of Ontario has developed criteria for assessing the gender sensitivity of medical curricula. In this article, the effects of medicine's historical blindness to gender are explored, as are practical approaches to creating curricula whose content, language and process are gender-sensitive. Specific areas addressed include ensuring that women and men are equally represented, when appropriate, that men are not portrayed as the prototype of normal (and women as deviant), that language is inclusive and that women's health and illness are not limited to reproductive function. By eliminating or at least addressing the subtle and often unintentional gender stereotyping in lecture material, illustrations and problems used in problem-based learning, medical educators can undertake a much-needed transformation of curriculum.

Sexual harassment of female doctors by patients.

BACKGROUND: Sexual harassment within the doctor-patient relationship is typically discussed in terms of male doctors harassing female patients. We investigated the sexual harassment of female doctors by patients. METHODS: Surveys were mailed to a random sample of 599 of the 1064 licensed female family physicians in Ontario, Canada. Respondents were asked about their experiences of sexual harassment by either male or female patients and about the nature and frequency of harassing behavior. Suggestions for prevention were requested. RESULTS: Seventy percent (422) of the questionnaires were completed and returned. More than 75 percent of the respondents reported some sexual harassment by patient at some time during their careers. Physicians had been harassed most often in their own offices and by their own patients. However, in settings such as emergency rooms and clinics, unknown patients presented a proportionately higher risk. The physicians' perceptions of the seriousness of the problem varied with the frequency and severity of the incidents. CONCLUSIONS: Sexual harassment of female doctors appears to occur frequently, and it is therefore an important topic to address in medical school and professional development.