Sex/gender bias in the management of chest pain in ambulatory care.

Cardiovascular diseases (CVD) are the main cause of death worldwide and despite a higher prevalence in men, mortality from CVD is higher among women. Few studies have assessed sex differences in chest pain management in ambulatory care. The objective of this post hoc analysis of data from a prospective cohort study was to assess sex differences in the management of chest pain in ambulatory care. We used data from the Thoracic Pain in Community cohort study that was realized in 58 primary care practices and one university ambulatory clinic in Switzerland. In total, 672 consecutive patients aged over 16 years attending a primary care practice or ambulatory care clinic with a complaint of chest pain were included between February and June 2001. Their mean age was 55.2 years and 52.5% were women. The main outcome was the proportion of patients referred to a cardiologist at 12 months follow-up. A panel of primary care physicians assessed the final diagnosis retained for chest pain at 12 months. The prevalence of chest pain of cardiovascular origin (n = 108, 16.1%) was similar for men and women (17.5% vs 14.8%, respectively, p = 0.4). Men with chest pain were 2.5 times more likely to be referred to a cardiologist than women (16.6% vs 7.4%, odds ratio: 2.49, 95% confidence interval: 1.52-4.09). After adjustment for the patients' age and cardiovascular disease risk factors, the estimates did not significantly change (odds ratio: 2.30, 95% confidence interval: 1.30-3.78). Although the same proportion of women and men present with a chest pain of cardiovascular origin in ambulatory care, there is a strong sex bias in their management. These data suggest that effort must be made to assure equity between men and women in medical care

Hommes et femmes: sommes-nous tous égaux face à la douleur [Are there differences between men and women with pain?].

An increasing number of articles are published on the differences about pain in men and women. These differences seem to be due to the sex, the biological dimension of the person, and to the gender, which is the role given to that person in a given social and culture environment. The pain prevalence is higher in women, its threshold and tolerance are lower. The pain interpretation, its perception and the coping is also different in men and women. Finally doctors translate and treat pain differently. This article proposes some explanations on these differences which should help us to treat this frequent and noxious symptom for the quality of life in a better way

[Urinary incontinence: neither men nor women should be forgotten]

Item does not contain fulltextThe prevalence of urinary incontinence is higher in women, but up to 40% of elderly men suffer from it. It is very important for care givers to search actively for this problem, because only half of the patients, mostly men, will seek help specifically for this symptom. The patients, who do not ask for help, mostly women, think that urinary incontinence is a normal problem while getting old and think that there is no specific treatment for it. Urinary incontinence has an important impact on physical and mental health and has a high economic cost. Men with urinary incontinence are less well taken in charge than women up to the use of absorbent pads, which they partly fix up themselves

Finding the right interactional temperature: do colder patients need more warmth in physician communication style?

Being aware of which communication style should be adopted when facing more difficult patients is important for physicians; it can help prevent patient reactions of dissatisfaction, mistrust, or non-adherence that can be detrimental to the process of care. Past research suggests that less agreeable patients are especially critical towards, and reactive to, their physician's communication style, compared to more agreeable patients. On the basis of the literature, we hypothesized that less agreeable patients would react more negatively than agreeable patients to lower levels of affiliativeness (i.e., warmth, friendliness) in the physicians, in terms of satisfaction with the physician, trust in the physician, and determination to adhere to the treatment. Thirty-six general practitioners (20 men/16 women) working in their own practice in Switzerland were filmed while interacting with 69 patients (36 men/33 women) of different ages (M = 50.7; SD = 18.19; range: 18-84) and presenting different medical problems (e.g., back pain, asthma, hypertension, diabetes). After the medical interview, patients filled in questionnaires measuring their satisfaction with the physician, their trust in the physician, their determination to adhere to the treatment, and their trait of agreeableness. Physician affiliativeness was coded on the basis of the video recordings. Physician gender and dominance, patient gender and age, as well as the gravity of the patient's medical condition were introduced as control variables in the analysis. Results confirmed our hypothesis for satisfaction and trust, but not for adherence; less agreeable patients reacted more negatively (in terms of satisfaction and trust) than agreeable patients to lower levels of affiliativeness in their physicians. This study suggests that physicians should be especially attentive to stay warm and friendly with people low in agreeableness because those patients' satisfaction and trust might be more easily lowered by a cold or distant physician communication style

Hypertension: la définition actuelle est-elle adaptée la femme?

The control of blood pressure in men and women differs due to different physiological pathways. Moreover, conditions increasing the risk of hypertension, such as pre-eclampsia, exposure to oral contraceptives are specific to women. Men have a higher blood pressure than women from pubertal growth to advanced age. However, the definition of hypertension (blood pressure--140/90 mmHg) is the same for adult men and women. The management of hypertension should be based not only on the level of blood pressure, but also on the global cardiovascular risk. Sex is included in the global evaluation of the cardiovascular risk

Douteurs thoraciques en médecine ambulatoire. Sans oublier les patients qui n'ont "rien au coeur" [Thoracic pain in primary care. Don't forget the patients without heart disease].

Thoracic pain in primary care. Don't forget the patients without heart disease Thoracic pain is a frequent medical complaint. Diagnostic and therapeutic guidelines have been developed and evaluated mostly in emergency and hospital settings. The primary care practitioner, as the emergency room doctor, has to identify quickly any severe condition needing urgent and highly specialized treatment. But in primary care, the process is not finished then! A patient with no vital and urgent problem still needs a diagnosis, information and adequate treatment. This review goes over the presentation of thoracic pain, the differential diagnoses and the challenge of treating such patients in ambulatory care

Genre et disparités: l'exemple du tabagisme [Gender and disparities: the example of tobacco smoking].

La prévalence mondiale du tabagisme est environ cinq fois plus importante chez les hommes que chez les femmes, toutefois cet écart tend à s'égaliser. En ce qui concerne les conséquences sur la santé du tabagisme, les femmes semblent plus susceptibles que les hommes. Elles sont notamment plus à risque de présenter certains cancers pulmonaires ou de décéder de maladies cardiovasculaires. Si les hommes sont moins enclins à demander de l'aide pour arrêter de fumer, les femmes quant à elles ont moins de succès dans leurs tentatives d'arrêt et les traitements semblent moins efficaces chez ces dernières. Des interventions d'aide à l'arrêt et des mesures de prévention du tabagisme adaptées aux spécificités de genre ont le potentiel d'améliorer la prise en charge des fumeurs et de diminuer les disparités de genre en santé. Smoking prevalence is globally five times higher among men compared to women but this gap tends to decrease. Regarding health consequences of smoking, women tend to be more vulnerable than men. They are namely more at risk to present certain lung cancers and die of cardiovascular disease. While men are less prone to seek help for smoking cessation, women are less successful in their quit attempts and smoking cessation treatments are less effective among them. Interventions for smoking cessation and preventive measures tailored to gender specificities have the potential to improve management of smokers and decrease gender disparities in healthcare

Hypertension: la définition actuelle est-elle adaptée la femme [Hypertension: is the actual definition adapted to women?].

The control of blood pressure in men and women differs due to different physiological pathways. Moreover, conditions increasing the risk of hypertension, such as pre-eclampsia, exposure to oral contraceptives are specific to women. Men have a higher blood pressure than women from pubertal growth to advanced age. However, the definition of hypertension (blood pressure--140/90 mmHg) is the same for adult men and women. The management of hypertension should be based not only on the level of blood pressure, but also on the global cardiovascular risk. Sex is included in the global evaluation of the cardiovascular risk

Y a-t-il un avenir pour les femmes et le temps partiel en medecine de premier recours? [Is there a future for women and part-time doctors in primary care?]

We tried to understand the extent and the consequences of the feminization of medicine and of the upcoming of part-time jobs in primary care. In 2003, 52% of medical graduates are women, with an increase of 80% of women studying medicine and a decrease of 30% of men, since 1980. The women practice rather in group practices, in the cities and part-time. Working part-time increases satisfaction of the patients, the doctors with a part-time job and their colleagues. We urge the politicians and the medical societies to create a flexible training and adjusted possibilities to practice, so that we won't loose many motivated and proficient doctors especially as the attraction of primary care decreases