- Email: [email protected]
Do Male Nurses Suffer More? Focusing Masculinity, Femininity, Sense of Coherence and Work Strain
WCMH Abstracts 77
79
DO MALE NURSES SUFFER MORE? FOCUSING MASCULINITY, FEMININITY, SENSE OF COHERENCE AND WORK STRAIN
DO SYMPTOM SPECIFIC TESTOSTERONE THRESHOLDS EXIST IN HEALTHY MEN?
O. Kada 1,∗ , E. Brunner 1 , M. Maier 2
Jakob E. Lackner 1,∗ , Georg Schatzl 1 , Gerhard Lunglmayr 2 , Ernst Rücklinger 3 , Christian Kratzik 1
1 Carinthia University of Applied Sciences, School of Health and Care, Feldkirchen, Austria, 2 AlpsAdriatic University of Klagenfurt, Department of Psychology, Klagenfurt, Austria E-mail address: [email protected] (O. Kada).
Nursing is a profession associated with a lot of psychological and physical strains (Jenull & Brunner, 2008; Jenull, Brunner & Mayr, 2008). Men who enter this femaledominated profession face a variety of difficulties, especially stigmatization in the society and in the workplace (Bartjes & Hammer, 2006; Kada & Brunner, in press; Twomey & Meadus, 2008). They struggle with clichés, e.g. the cliché of being ùnmanly’ or homosexual (Evans & Frank, 2003; Kada & Brunner, in press). Empirical findings on the role of masculinity and femininity in male nurses and the association of these personality traits with work stress are inconsistent (e.g. Kirchmeyer & Bullin, 1997; Steenbarger & Greenberg, 1992). The concepts of sex role orientation and stress are linked by coping (Brooks, Morgan & Scherer, 1990). The present mixed methods study (Onwuegbuzie & Collins, 2007) investigated stigmatization in male nurses working in the care for the elderly (qualitative interviews, N = 13) as well as work stress (KFZA, Prümper, Hartmannsgruber & Frese, 1995), sex role orientation/sex role ideals (BSRI, Bem, 1974; Schneider-Düker & Kohler, 1988) and sense of coherence (SOC-L9; Singer & Brähler, 2007) in male and female nurses (quantitative survey, N = 115). The qualitative data was analyzed using qualitative content analysis (Elo & Kyngäs, 2008). Analyzing the quantitative data ANOVAs were calculated. Males frequently reported negative reactions from family and friends when they decided to become a nurse. Clichés are manifold, e.g. working in a job for women or having to clean excrement. Male and female nurses do not differ significantly in their sex role orientation with both being rather masculine (Kada & Brunner, in press). No differences between men and women were found regarding work content, stressors, resources at the workplace, and organizational climate. The sense of coherence had the most profound effect on the outcomes; gender role ideals turned out to be more important than gender role orientation (Grimmell & Stern, 1992). Nurses compared to assistant nurses reported more stressors; organizational climate was negatively associated with age. The results are discussed in the context of the theory of psychological androgyny (Bem, 1974, 1977) as well as the process of professionalization initiated in 1997 by the Austrian Healthcare and Nursing Act (Schwamberger, 2006).
1
Department of Urology, Medical University of Vienna, 2 Department of Urology, Landesklinikum Mistelbach, Statistical analysis and Methodological Consulting KEG, Vienna E-mail address: [email protected] (J.E. Lackner). 3
Late onset hypogonadism is diagnosed as combination between symptoms and laboratory proved testosterone deficiency. Some authors suggested that testosterone threshold exist at which specific clinical symptoms occur (Zitzman et al, J Clin Endo Metab 91: 4335-4343, 2006). The objective was to prove such a hypothesis. Material and Method: 675 healthy blue collar workers were invited for an evaluation of their health status. A urological examination was done, as well as blood samples for serum testosterone were taken. All men answered the International Index of Erectile Function-5, the Aging Males symptoms scale and the Becks Depression Inventory. Clinical symptoms were statistically correlated to testosterone levels and compared to the testosterone levels of men who did not show these clinical symptoms. Results: Significant correlations between testosterone and clinical symptoms were already found at testosterone levels of 14.4 nmol/ml (lack of concentration) to 13.5 nmol/l (psychic symptoms) and no statistically significant correlations were found at similar testosterone levels;14.8 nmol/l (severe ED) to 13.7nmol/l (depression), in comparing men with symptoms to men without symptoms. Age was found as a major confounder. Taking age into account, then significant correlations were seen for psychic symptoms, sweating and weakness and testosterone. Whereas symptoms like loss of libido was correlated to age (OR 1.087 CI 1.049-1.136, p = 0.001) and not to testosterone. Men with erectile dysfunction had testosterone levels between 14.8 nmol/l to 14.65 nmo/l, however erectile dysfunction was significant correlated to age and not to testosterone. Conclusion: Clinical symptoms may occur already at normal testosterone levels. Age is a major confounder between clinical symptoms and testosterone levels, so that some symptoms are primarily related to age and not to serum testosterone levels. doi:10.1016/j.jomh.2009.08.077
doi:10.1016/j.jomh.2009.08.075
80 78 SOCIOLOGICAL ISSUES AND MEN’S HEALTH: PERCEIVED GENDER ROLES AND HOW THEY AFFECT MEN’S HEALTH BEHAVIOUR P. Flandorfer 1,∗ , K. Fliegenschnee 2 1 Vienna Institute of Demography, Vienna, Austria, 2 Austrian Academy of Sciences, Vienna, Austria E-mail address: [email protected] (P. Flandorfer).
Background: It is well known that women in developed countries have a higher life expectancy than men. However, since the 1980s, the gender gap in mortality has narrowed. Our focus is on behavioural factors and the analysis of sociological issues relating to men’s health. Methods: The theoretical ideas are developed inductively on the basis of qualitative expert interviews with physicians, researchers specialising on gender medicine in Vienna and carers for elderly people. Their work makes all of them experts on gender-related health issues. Our analysis is based on the Grounded Theory methodology. Results: Our findings show that not all physicians are aware of gender-specific health behaviour and health issues. In our theoretical model, ‘perceived gender roles/gender identity’ is the most important main category. It comprises attributes, habits and generation change. Our results indicate that men’s social roles render them less healthy. Visiting the doctor may be interpreted as weakness. Men cannot overcome their inhibitions in the same way women do. They are exposed to more hierarchical stress at the work place. Social norms are responsible for gender-specific socialisation, which, in turn, gives rise to differences in the health behaviours and lifestyles of women and men. The category ‘generation change’ describes how these behaviour patterns slowly change. Nowadays, the media provide more health-related information which raises the health awareness of younger men. Conclusion: Our overall findings show that behavioural factors play an important role in explaining the narrowing of the gender gap in mortality. Although traditional gender roles still prevail, they start to weaken, because men have become more health conscious and care more about their body. A special characteristic of our study is the use of qualitative methods to gain a deeper understanding of the changes in men’s health behaviour. In conjunction with quantitative and interdisciplinary research about this phenomenon, our findings can contribute to insights on the sociological micro level. doi:10.1016/j.jomh.2009.08.076
TESTIM REGISTRY IN THE UNITED STATES (TRIUS): DEMOGRAPHIC AND CLINICAL PARAMETERS AT ENROLLMENT M.M. Miner 1,∗ , M. Khera 2 , R.K. Bhattacharya 3 , G. Blick 4 , H. Kushner 5 , D. Nguyen 6 1 Miriam Hospital Men’s Health Center, Warren Alpert School of Medicine, Brown University, Providence, RI, USA, 2 Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA, 3 University of Kansas Medical Center, Kansas City, KS, USA, 4 Circle Medical LLC, Norwalk, CT, USA, 5 BioMedical Computer Research Institute, Inc., Philadelphia, PA, USA, 6 Auxilium Pharmaceuticals, Malvern, PA, USA E-mail address: Martin [email protected] (M.M. Miner).
Background: Hypogonadism affects almost 40% of men aged ≥45 years in the U S and is accompanied by sexual dysfunction, depression, and loss of muscle and bone mass as well as a propensity for comorbidities that negatively impact quality of life. Testosterone replacement therapy (TRT) has been shown to alleviate the effects of hypogonadism in men. TRiUS is the first prospective observational cohort registry of hypogonadal men on TRT. Subjects on TRT with once daily Testim 1% topical testosterone gel drawn from a variety of diverse clinical settings including endocrinology, urology, and primary care practices were enrolled to study the effectiveness of TRT in a non-trial setting. We report here the registry protocol and select baseline demographic and clinical data. Methods: Hypogonadal men entered the registry at initiation of TRT with Testim after informed consent to document baseline assessment and periodic evaluations through Month 12. Prospective data collected included demographics, anthropometrics, clinical and laboratory parameters, and questionnaires for sexual function (Brief Male Sexual Function Inventory) and mood (PHQ-9 for depression). Compliance was assessed using patient diary cards. Results: At the time of these analyses, 849 hypogonadal men were enrolled at 72 sites. Hypogonadism was either self-reported based on prior diagnosis by a physician and history of TRT or confirmed by clinical/laboratory evaluation prior to initiation of TRT with Testim. The men were primarily Caucasian (82.3%); 43.4% of men were college educated with a mean age of 52.14 ± 12.3 yrs (R, 21-85). Mean baseline BMI was 31.4 ± 6.9; 52% had BMI > 30 kg/m2 . The mean duration of hypogonadism was 15.8 ± 29.9 months (R, 0-252) and mean total T level at baseline was 279.35 ± 142.73. Hypogonadism was designated by the physician as primary in 63%, secondary in 35%, and mixed in 2% of subjects. Most enrollees were naïve to TRT (76%); prior TRT was reported in 203 men (23.9%) of whom 59% (120/203) had used 2 or more testosterone formulations. Concomitant medications included PDE5 inhibitors (21%, 180), antidepressants (16%, 136), and opioids (11%, 90). Comorbidities associated with hypogonadism were metabolic syndrome (57%), hypertension (58%), dislipidemia (20%), CAD (18%), diabetes (12%), HIV (10%), depression (8%), and sleep apnea (3.5%). Conclusions: TRiUS will provide ‘‘real world’’ longitudinal data on TRT with Testim from diverse clinical settings and help elucidate the benefits of TRT with multiple validated measures. doi:10.1016/j.jomh.2009.08.078
jmh
Vol. 6, No. 3, pp. 229–275, September 2009
247
79
DO MALE NURSES SUFFER MORE? FOCUSING MASCULINITY, FEMININITY, SENSE OF COHERENCE AND WORK STRAIN
DO SYMPTOM SPECIFIC TESTOSTERONE THRESHOLDS EXIST IN HEALTHY MEN?
O. Kada 1,∗ , E. Brunner 1 , M. Maier 2
Jakob E. Lackner 1,∗ , Georg Schatzl 1 , Gerhard Lunglmayr 2 , Ernst Rücklinger 3 , Christian Kratzik 1
1 Carinthia University of Applied Sciences, School of Health and Care, Feldkirchen, Austria, 2 AlpsAdriatic University of Klagenfurt, Department of Psychology, Klagenfurt, Austria E-mail address: [email protected] (O. Kada).
Nursing is a profession associated with a lot of psychological and physical strains (Jenull & Brunner, 2008; Jenull, Brunner & Mayr, 2008). Men who enter this femaledominated profession face a variety of difficulties, especially stigmatization in the society and in the workplace (Bartjes & Hammer, 2006; Kada & Brunner, in press; Twomey & Meadus, 2008). They struggle with clichés, e.g. the cliché of being ùnmanly’ or homosexual (Evans & Frank, 2003; Kada & Brunner, in press). Empirical findings on the role of masculinity and femininity in male nurses and the association of these personality traits with work stress are inconsistent (e.g. Kirchmeyer & Bullin, 1997; Steenbarger & Greenberg, 1992). The concepts of sex role orientation and stress are linked by coping (Brooks, Morgan & Scherer, 1990). The present mixed methods study (Onwuegbuzie & Collins, 2007) investigated stigmatization in male nurses working in the care for the elderly (qualitative interviews, N = 13) as well as work stress (KFZA, Prümper, Hartmannsgruber & Frese, 1995), sex role orientation/sex role ideals (BSRI, Bem, 1974; Schneider-Düker & Kohler, 1988) and sense of coherence (SOC-L9; Singer & Brähler, 2007) in male and female nurses (quantitative survey, N = 115). The qualitative data was analyzed using qualitative content analysis (Elo & Kyngäs, 2008). Analyzing the quantitative data ANOVAs were calculated. Males frequently reported negative reactions from family and friends when they decided to become a nurse. Clichés are manifold, e.g. working in a job for women or having to clean excrement. Male and female nurses do not differ significantly in their sex role orientation with both being rather masculine (Kada & Brunner, in press). No differences between men and women were found regarding work content, stressors, resources at the workplace, and organizational climate. The sense of coherence had the most profound effect on the outcomes; gender role ideals turned out to be more important than gender role orientation (Grimmell & Stern, 1992). Nurses compared to assistant nurses reported more stressors; organizational climate was negatively associated with age. The results are discussed in the context of the theory of psychological androgyny (Bem, 1974, 1977) as well as the process of professionalization initiated in 1997 by the Austrian Healthcare and Nursing Act (Schwamberger, 2006).
1
Department of Urology, Medical University of Vienna, 2 Department of Urology, Landesklinikum Mistelbach, Statistical analysis and Methodological Consulting KEG, Vienna E-mail address: [email protected] (J.E. Lackner). 3
Late onset hypogonadism is diagnosed as combination between symptoms and laboratory proved testosterone deficiency. Some authors suggested that testosterone threshold exist at which specific clinical symptoms occur (Zitzman et al, J Clin Endo Metab 91: 4335-4343, 2006). The objective was to prove such a hypothesis. Material and Method: 675 healthy blue collar workers were invited for an evaluation of their health status. A urological examination was done, as well as blood samples for serum testosterone were taken. All men answered the International Index of Erectile Function-5, the Aging Males symptoms scale and the Becks Depression Inventory. Clinical symptoms were statistically correlated to testosterone levels and compared to the testosterone levels of men who did not show these clinical symptoms. Results: Significant correlations between testosterone and clinical symptoms were already found at testosterone levels of 14.4 nmol/ml (lack of concentration) to 13.5 nmol/l (psychic symptoms) and no statistically significant correlations were found at similar testosterone levels;14.8 nmol/l (severe ED) to 13.7nmol/l (depression), in comparing men with symptoms to men without symptoms. Age was found as a major confounder. Taking age into account, then significant correlations were seen for psychic symptoms, sweating and weakness and testosterone. Whereas symptoms like loss of libido was correlated to age (OR 1.087 CI 1.049-1.136, p = 0.001) and not to testosterone. Men with erectile dysfunction had testosterone levels between 14.8 nmol/l to 14.65 nmo/l, however erectile dysfunction was significant correlated to age and not to testosterone. Conclusion: Clinical symptoms may occur already at normal testosterone levels. Age is a major confounder between clinical symptoms and testosterone levels, so that some symptoms are primarily related to age and not to serum testosterone levels. doi:10.1016/j.jomh.2009.08.077
doi:10.1016/j.jomh.2009.08.075
80 78 SOCIOLOGICAL ISSUES AND MEN’S HEALTH: PERCEIVED GENDER ROLES AND HOW THEY AFFECT MEN’S HEALTH BEHAVIOUR P. Flandorfer 1,∗ , K. Fliegenschnee 2 1 Vienna Institute of Demography, Vienna, Austria, 2 Austrian Academy of Sciences, Vienna, Austria E-mail address: [email protected] (P. Flandorfer).
Background: It is well known that women in developed countries have a higher life expectancy than men. However, since the 1980s, the gender gap in mortality has narrowed. Our focus is on behavioural factors and the analysis of sociological issues relating to men’s health. Methods: The theoretical ideas are developed inductively on the basis of qualitative expert interviews with physicians, researchers specialising on gender medicine in Vienna and carers for elderly people. Their work makes all of them experts on gender-related health issues. Our analysis is based on the Grounded Theory methodology. Results: Our findings show that not all physicians are aware of gender-specific health behaviour and health issues. In our theoretical model, ‘perceived gender roles/gender identity’ is the most important main category. It comprises attributes, habits and generation change. Our results indicate that men’s social roles render them less healthy. Visiting the doctor may be interpreted as weakness. Men cannot overcome their inhibitions in the same way women do. They are exposed to more hierarchical stress at the work place. Social norms are responsible for gender-specific socialisation, which, in turn, gives rise to differences in the health behaviours and lifestyles of women and men. The category ‘generation change’ describes how these behaviour patterns slowly change. Nowadays, the media provide more health-related information which raises the health awareness of younger men. Conclusion: Our overall findings show that behavioural factors play an important role in explaining the narrowing of the gender gap in mortality. Although traditional gender roles still prevail, they start to weaken, because men have become more health conscious and care more about their body. A special characteristic of our study is the use of qualitative methods to gain a deeper understanding of the changes in men’s health behaviour. In conjunction with quantitative and interdisciplinary research about this phenomenon, our findings can contribute to insights on the sociological micro level. doi:10.1016/j.jomh.2009.08.076
TESTIM REGISTRY IN THE UNITED STATES (TRIUS): DEMOGRAPHIC AND CLINICAL PARAMETERS AT ENROLLMENT M.M. Miner 1,∗ , M. Khera 2 , R.K. Bhattacharya 3 , G. Blick 4 , H. Kushner 5 , D. Nguyen 6 1 Miriam Hospital Men’s Health Center, Warren Alpert School of Medicine, Brown University, Providence, RI, USA, 2 Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA, 3 University of Kansas Medical Center, Kansas City, KS, USA, 4 Circle Medical LLC, Norwalk, CT, USA, 5 BioMedical Computer Research Institute, Inc., Philadelphia, PA, USA, 6 Auxilium Pharmaceuticals, Malvern, PA, USA E-mail address: Martin [email protected] (M.M. Miner).
Background: Hypogonadism affects almost 40% of men aged ≥45 years in the U S and is accompanied by sexual dysfunction, depression, and loss of muscle and bone mass as well as a propensity for comorbidities that negatively impact quality of life. Testosterone replacement therapy (TRT) has been shown to alleviate the effects of hypogonadism in men. TRiUS is the first prospective observational cohort registry of hypogonadal men on TRT. Subjects on TRT with once daily Testim 1% topical testosterone gel drawn from a variety of diverse clinical settings including endocrinology, urology, and primary care practices were enrolled to study the effectiveness of TRT in a non-trial setting. We report here the registry protocol and select baseline demographic and clinical data. Methods: Hypogonadal men entered the registry at initiation of TRT with Testim after informed consent to document baseline assessment and periodic evaluations through Month 12. Prospective data collected included demographics, anthropometrics, clinical and laboratory parameters, and questionnaires for sexual function (Brief Male Sexual Function Inventory) and mood (PHQ-9 for depression). Compliance was assessed using patient diary cards. Results: At the time of these analyses, 849 hypogonadal men were enrolled at 72 sites. Hypogonadism was either self-reported based on prior diagnosis by a physician and history of TRT or confirmed by clinical/laboratory evaluation prior to initiation of TRT with Testim. The men were primarily Caucasian (82.3%); 43.4% of men were college educated with a mean age of 52.14 ± 12.3 yrs (R, 21-85). Mean baseline BMI was 31.4 ± 6.9; 52% had BMI > 30 kg/m2 . The mean duration of hypogonadism was 15.8 ± 29.9 months (R, 0-252) and mean total T level at baseline was 279.35 ± 142.73. Hypogonadism was designated by the physician as primary in 63%, secondary in 35%, and mixed in 2% of subjects. Most enrollees were naïve to TRT (76%); prior TRT was reported in 203 men (23.9%) of whom 59% (120/203) had used 2 or more testosterone formulations. Concomitant medications included PDE5 inhibitors (21%, 180), antidepressants (16%, 136), and opioids (11%, 90). Comorbidities associated with hypogonadism were metabolic syndrome (57%), hypertension (58%), dislipidemia (20%), CAD (18%), diabetes (12%), HIV (10%), depression (8%), and sleep apnea (3.5%). Conclusions: TRiUS will provide ‘‘real world’’ longitudinal data on TRT with Testim from diverse clinical settings and help elucidate the benefits of TRT with multiple validated measures. doi:10.1016/j.jomh.2009.08.078
jmh
Vol. 6, No. 3, pp. 229–275, September 2009
247